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 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Wrist stiffness is a complication of wrist trauma or surgery. Rehabilitation is the treatment of choice to improve the wrist range of motion. Since 1988 we used the arthroscopic wrist arthrolysis. Criteria for patient inclusion in our preop and postop study were wrist stiffness with or without pain, unsuccessful results from rehabilitation after 3 to 6 months. From 1988 to 2003, 47 cases (45 patients: 35 males and 10 females), with a mean age of 36 years were operated on. All the radiocarpal, midcarpal and DRUJ portals were used in relationship with the site of rigidity. At a mean follow up of 58 months (range from 3 to 176 months) no complications were documented. Pain was almost absent in all the cases, mean flexion-extension ROM increased from 92 degrees preop to 106 degrees postop, mean pronation/supination increased from 145 degrees preop to 155 degrees postop, and mean grip strength increased from 25 to 31 kg postop. The average modified Mayo Wrist Score improved from 39 to 87, and the postop DASH Questionnaire obtained an average of 21 points.
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PMID:[Arthroscopic wrist arthrolysis]. 1736 95

Lateral unicompartmental knee arthroplasty (UKA) is a valid alternative treatment in the event of arthritis confined to the lateral compartment. This paper examines its indications, technique and short to medium-term results. A total of 159 Miller-Galante cemented UKA prostheses (Zimmer, Warsaw, Indiana) were implanted consecutively (131 medial and 28 lateral) by the same surgeon. This study investigates 28 lateral UKAs in 27 patients. Twenty-five implants in 24 patients (including a subject operated bilaterally) were followed up for 12-60 months. Three patients were discarded on account of to short a follow-up period. The Hospital for Special Surgery (HSS) knee score was used to compare the pre- and post-operative results of the lateral UKA patients. The HSS score improved from a pre-op mean of 59.92 (range 48-68) to 88.04 (range 71-95) at the last follow-up. There was a positive increase in the pain, function and ROM components of the score. The lateral UKA prosthesis can be regarded as a sound alternative to total knee replacement. Correct patient selection on the basis of optimum surgical indications, however, is essential.
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PMID:Lateral unicompartimental knee arthroplasty: indications, technique and short-medium term results. 1749 27

The integration of palliative care in critical care settings is essential to improve care of the dying, and critical care nurses are leaders in these efforts. However, lack of education in providing end-of-life (EOL) care is an obstacle to nurses and other healthcare professionals as they strive to deliver palliative care. Education regarding pain and symptom management, communication strategies, care at the end of life, ethics, and other aspects of palliative care are urgently needed. Efforts to increase EOL care education in most undergraduate and graduate nursing curricula are beginning; yet, most critical care nurses have not received formal training in palliative care. Moreover, educational resources such as critical care nursing textbooks often contain inadequate information on palliative care. The ELNEC-Critical Care program provides a comprehensive curriculum that concentrates on the requirements of those nurses who are working in areas of critical care. Extensive support materials include CD-ROM, binder, Web sites, newsletters, textbooks, and other supplemental items. The ultimate goal is to improve EOL care for patients in all critical care settings and enhance the experience of family members witnessing the dying process of their loved ones.
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PMID:End-of-life Nursing Education Consortium (ELNEC) Training Program: improving palliative care in critical care. 1757 3

The flexion-rotation test (FRT) is commonly used when assessing cervicogenic headache. Additionally, active range of motion (AROM) is frequently used to evaluate impairment in neck pain. No studies have investigated the interaction of the FRT and AROM with age, gender, pain and lifestyle factors. The purpose of this study was to determine the influence of these factors on the FRT and cervical AROM. A group of 66 participants (aged 20-78) were studied, 28 experienced sub-clinical neck pain (recurrent neck pain or discomfort which has not received treatment from a healthcare professional) while 38 did not. Age, gender, lifestyle factors and sub-clinical neck pain were assessed using a questionnaire. Measurement of AROM was performed by two examiners blind to the results of the questionnaire. Multiple linear regression analysis found that 59% of the variance in the FRT was explained by the presence of sub-clinical pain and cervical lateral flexion measures. Secondly, 58-72% of the variance in active cervical ROM measures was influenced by factors including the FRT, gender and movements of the neck in other planes. This study found that lifestyle factors do not influence the cervical FRT and AROM.
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PMID:The influence of age, gender, lifestyle factors and sub-clinical neck pain on the cervical flexion-rotation test and cervical range of motion. 1794 29

The surgical treatment of complex proximal humerus fractures is still a great challenge. Not all fracture types can be successfully reconstructed. Indications for a primary joint replacement arise from critical fracture patterns and defined predictors of ischemia in the elderly (age >60 years). If good functional results are to be achieved a soft-tissue-preserving surgical technique, secure tuberosity attachment and accurate soft tissue balancing of the rotator cuff, correct restoration of height, retrotorsion and offset, and appropriate physiotherapy afterwards are essential. In multicentre studies in patients who had undergone primary hemoarthroplasty average Constant-Murlay Scores of 56.0-73.5 point were recorded. At follow-up, 79% of the patients reported only mild pain or none at all, and the ROM was acceptable (41.9% anteversion >90 degrees , 34.7% abduction >90 degrees ). Generally, subjective evaluations were much better than the objective results.The incidence of complications after humeral head replacement is still relatively high, whereas the 10-year survival rate of shoulder hemiarthroplasties has been found in a recent study to be 100%.
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PMID:[Primary hemiarthroplasty in proximal humerus fractures]. 1796 Mar 62

Background. Subacromial impingement syndrome is a frequently seen disorder of the shoulder, however it is also often misdiagnosed. The aim of the study was the assessment of the clinical value of the arthroscopic subacromial decompression. <br /> Material and methods. From January 1999 to December 2002 sixty five patients were included to our study. The main complaints of patients was severe, long-lasting and progressing pain of the shoulder. Sixty one patients had failed conservative treatment (physical therapy, NSAID's, multiple steriod injections). Average duration of pain before surgery was 20 months, ranged from 1 to 50 months. On examination, restricted range of abduction and narrowing of subacromial space to 5 mm (3-8 mm) on plain AP X-ray view were found. The patients were followed up after six and twelve months after surgery.<br /> Results. Finally, we noted full range of movement and absence of pain in neutral shoulder position in 38 patients. Four patients presented persistent pain while moving their shoulders, but no resting pain. In two cases pain relief was achieved but shoulder joint ROM restriction by 20 degrees abduction and 10 degrees external rotation. <br /> Conclusions. Based on performed study we conclude that treatment emploing arthroscopic subacromial decompression is a valuable method, allowing to achieve very good outcomes and to introduce early rehabilitation.
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PMID:Arthroscopic treatment of subacromial impingement syndrom. 1803 45

Traditional rehabilitation for shoulder dislocation has a success rate of only 20%. The body blade has been hypothesized to strengthen the muscles stabilizing the shoulder girdle by training the contractile tissues directly and also indirectly affecting the joint and surrounding noncontractile tissues when responding to rapid positional changes and mechanical energy. Shoulder dislocation negatively affects both the active (musculature) and passive (joint and ligaments) stabilizers of the glenohumeral joint. Therefore, the purpose of this case report was to evaluate the efficacy of therapeutic exercise using the body blade in the conservative management of an individual with glenohumeral instability. The patient, an 18-year-old male, dislocated his left shoulder after a wave crashed on top of him. Intervention included therapeutic exercise using the body blade. Measures were taken at examination, re-evaluation (6th visit), and discharge (11th visit). According to the 11-point numeric pain rating scale, worst pain was reduced from 4 to 0. Glenohumeral ROM measures at discharge were all within normal range except external rotation (deficit of 10 degrees), compared to the initial ROM deficits of 10-35% of noninvolved values. Post intervention strength, as assessed by handheld dynamometry, revealed deficits only in scapular retraction compared to the uninvolved side (21% compared to an initial deficit of 39%). Other muscle groups showing deficits from 20% to 40% at initial examination exceeded the comparative strength of the other limb at discharge. The SPADI and WOSI scores were reduced from 13 to 0 and 482 to 46, from initial examination to discharge, respectively. Furthermore 6 months post episode of care the patient reported no recurrent dislocation of the involved shoulder. The success rate of an exercise program with individuals who have dislocated their glenohumeral joint is poor. After 11 visits of physical therapy using the body blade the patient improved in ROM, strength, and function.
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PMID:Rehabilitation of a glenohumeral instability utilizing the body blade. 1807 7

More than 32.8% of the over-60s suffer from shoulder osteoarthritis. For advanced osteoarthritis, arthroplasty is the treatment of choice. Current systems have moved on from the first shoulder prosthesis implanted by Neer in 1974, thanks to the use of adaptable modular systems. The aim of this study was to investigate the effectiveness of anatomical shoulder replacements in 30 cases of primary glenohumeral osteoarthritis through clinical and radiographic follow-up for a mean of 5 years. All implants were total cemented prostheses. Preoperative investigations included a clinical examination, conventional X-rays and CT. The Constant-Murley scale was used to evaluate the results; the mean score increased from 21.4 preoperative to 69.8 postoperative (p<0.05). In patients aged under 50, the increase in the mean postoperative Constant Score and ROM was greater than for the sample as a whole. The following complications were encountered: 2 postoperative radial nerve paralyses, resolving in 3 months, 2 cases of glenoid loosening, 1 periprosthetic fracture and 3 cases of pain and stiffness. The results led us to conclude that anatomical prostheses are effective in the treatment of severe primary glenohumeral arthropathy.
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PMID:Efficacy of anatomical prostheses in primary glenohumeral osteoarthritis. 1832 Mar 84

Latissimus dorsi transfer is indicated for isolated posterior superior defects of the rotator cuff. Additional lesions limit the success of the outcome, but they are relatively frequent in revision surgery. We analyzed their influence on the postoperative function in 52 patients with an irreparable tear of the rotator cuff (35 primary operations, 17 revision surgeries). We observed a continuous improvement in the Constant score from 36 to 69 points, also in ROM, strength, relief of pain and of different subjective parameters for the entire group in consecutive examinations at 11.1, 35.7 and 50.2 months. We found increased osteoarthritis (from 1.0 to 1.5 mm), as well as a decrease in the acromiohumeral distance (from 5.6 to 4.7 mm). In contrast, we detected a slight decrease in the values in the revision group and in the presence of an additional subscapularis lesion.
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PMID:Latissimus dorsi transfer for irreparable rotator cuff tears: a longitudinal study. 1843 May 94

The purpose of this pilot study was to examine the immediate effects of a manual therapy technique called Inhibitive Distraction (ID) on active range of motion (AROM) for cervical flexion in patients with neck pain with or without concomitant headache. A secondary objective of this study was to see whether patient subgroups could be identified who might benefit more from ID by studying variables such as age, pain intensity, presence of headache, or pre-intervention AROM. We also looked at patients' ability to identify pre- to post-intervention changes in their ability to actively move through a range of motion. Forty subjects (mean age 34.7 years; range 16-48 years) referred to a physical therapy clinic due to discomfort in the neck region were randomly assigned to an experimental and a control group. We used the CROM goniometer to measure pre- and post-intervention cervical flexion AROM in the sagittal plane within a single treatment session. The between-group difference in AROM increase was not statistically significant at P<0.05 with a mean post-intervention increase in ROM of 2.4 degrees (SD 6.2 degrees ) for the experimental group and 1.2 degrees (SD 5.8 degrees ) for the placebo group. We were also unable to identify potential subgroups more likely to respond to ID, although a trend emerged for greater improvement in chronic patients with headaches, lower pain levels, and less pre-intervention AROM. In the experimental group and in both groups combined, subjects noting increased AROM indeed had a significantly greater increase in AROM than those subjects not noting improvement. In conclusion, this study did not confirm immediate effects of ID on cervical flexion AROM but did provide indications for potential subgroups likely to benefit from this technique. Recommendations are provided with regard to future research and clinical use of the technique studied.
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PMID:Immediate effects of inhibitive distraction on active range of cervical flexion in patients with neck pain: a pilot study. 1906 48


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