Septic arthritis of a lumbar facet joint caused by Staphylococcus aureus.

STUDY DESIGN: Case report of a 35-year-old woman with septic arthritis of a lumbar facet joint. OBJECTIVES: To report a rare case of severe low back pain and the specific differential diagnostic problems. SUMMARY OF BACKGROUND DATA: Differential diagnosis between spondylodiscitis and facet joint septic arthritis on a clinical basis is very difficult. The lesions of the joint appear on a plain film only approximately 1.5 months after onset of the symptoms. Although the radionuclide bone scan is sensitive and shows a more laterally and vertically localized uptake than in spondylodiscitis, this technique is not very specific. Computed tomography scan and magnetic resonance imaging are the most reliable investigations even at the very early stages of the disease. Confirmation of the diagnosis has to be obtained by blood cultures or, in exceptional cases, by direct puncture of the joint. Appropriate antibiotic treatment is in most cases sufficient to heal this lesion. METHODS: The etiology, clinical presentation, technical examinations, and treatment are reviewed. RESULTS: Computed tomography scan and magnetic resonance imaging complemented by positive blood cultures led to the very early diagnosis of septic arthritis of the lumbar facet joint in this relatively young patient. CONCLUSIONS: With our case report we confirm the very small number of data reported in the literature, indicating that infections of the facet joint can be detected at a very early stage using magnetic resonance imaging and computed tomography scan.

Wheelchair propulsion efficiency: movement pattern adaptations to speed changes.

Low mechanical efficiency values in wheelchair propulsion are usually explained on the basis of the supply of force and power generated during the push phase. The purpose of this study is to analyze the movement and muscular activity pattern in handrim wheelchair propulsion, focusing on both the push and recovery phases. Data on cardiorespiratory and propulsion technique parameters were obtained from 40 wheelchair basketball players with extensive experience in wheelchair propulsion in six situations: two exercise levels (60% and 80% of individual VO2peak), and three velocities (1.11, 1.67, and 2.22 m.s-1) with constant power output on a treadmill. A two-factor analysis of variance with repeated measurements was applied with "exercise level" and "speed" as the main factors. A significant effect on gross mechanical efficiency was found when the velocity was increased from 1.67 to 2.22 m.s-1. Decreased mechanical efficiency could be explained by a significant change in the acceleration of the wheelchair-user system during recovery, caused by arm and trunk movements, inducing inertial forces to act on the wheelchair. Consequently, mechanical work increased significantly during the recovery phase. These findings indicate that studies on mechanical efficiency in wheelchair propulsion should not only be focussed on power supply during the push phase, but also on the movement pattern during recovery.

Wheelchair propulsion: functional ability dependent factors in wheelchair basketball players.

The aim of this study was to examine the user-related parameters, 1) force generation 2) maximal aerobic power and 3) propulsion technique, in respect to functional ability level [ISMWSF] wheelchair basketball classification: groups 1, 2 and 3) of 40 elite wheelchair basketball players. Isometric (position on the handrims = -30, 0 degrees, +30 degrees and +60 degrees) and dynamic force application (velocities = 0.56, 0.83 and 1.11 m.s-1) on the handrims (test 1) was measured by means of a computerised wheelchair simulator, with the subjects sitting in a standardised position. Each subject performed a maximal exercise test (test 2) on a motor driven treadmill at 1.67 m.s-1 and four subsequent submaximal tests (test 3) at two exercise levels (60 and 80% of individual VO2) and two velocities (1.11 and 2.22 m.s-1) with constant power output. In tests 2 and 3, cardiorespiratory and kinematic data were recorded simultaneously. Although no significant differences between functional ability groups were found in relation to force application on the handrims, three different force application strategies were observed (test 1). Maximal aerobic capacity and power output (test 2) differed significantly (p < 0.05) between groups 1 and 2 and between groups 1 and 3. No differences in mechanical efficiency were observed between the three functional ability groups, irrespective of changes in wheelchair velocity and external load (test 3). Propulsion technique was not proven to be functional ability dependent although remarkable differences in movement pattern were observed, especially during the recovery phase.

The accident-prone and overuse-prone profiles of the young athlete.

A 1 year prospective study was done to develop an accident-prone and overuse-prone profile of young athletes. A group of 185 freshman physical education students (118 males; 67 females of the same age (18.3 +/- 0.5 years) trained under the same conditions and were exposed to similar extrinsic risk factors. Using a descriptive statistical technique, an analysis of correspondence, the complex interrelation between the criterium variables (acute injuries and overuse injuries) and the predictor variables (intrinsic risk factors; physical characteristics--anthropometric data, physical fitness parameters, flexibility aspects and malalignment of the lower extremities; and psychological factors--16 personality traits) was estimated for males and females separately. Although dynamic strength seems to be an important risk factor in acute injuries, sports accidents must be seen in relation to psychological factors. However, the overuse-prone profile is mainly based on physical traits: a combination of muscle weakness, ligamentous laxity, and muscle tightness predisposes to stress injuries. In addition, these overuse effects are intensified by large body weight and length, a high explosive strength, and malalignment of the lower limbs. Nevertheless, it has to be kept in mind that psychosomatic factors play a role in how one experiences these overuse phenomena.