We studied degenerative changes in the cervical intervertebral discs of 497 asymptomatic subjects by MRI and evaluated disc degeneration by loss of signal intensity, posterior and anterior disc protrusion, narrowing of the disc space and foraminal stenosis. In each subject, five disc levels from C2–C3 to C6–C7 were evaluated. The frequency of all degenerative findings increased linearly with age. Disc degeneration was the most common observation, being present in 17% of discs of men and 12% of those of women in their twenties, and 86% and 89% of discs of both men and women over 60 years of age. We found significant differences in frequency between genders for posterior disc protrusion and foraminal stenosis. The former, with demonstrable compression of the spinal cord, was observed in 7.6% of subjects, mostly over 50 years of age. Our results should be taken into account when interpreting the MRI findings in patients with symptomatic disorders of the cervical spine

In many papers, the diagnosis of pincer-type femoroacetabular impingement (FAI) is attributed to the presence of coxa profunda. However, little is known about the prevalence of coxa profunda in the general population and its clinical relevance.

In order to ascertain its prevalence in asymptomatic subjects and whether it is a reliable indicator of pincer-type FAI, we undertook a cross-sectional study between July and December 2013. A total of 226 subjects (452 hips) were initially screened. According to strict inclusion criteria, 129 asymptomatic patients (257 hips) were included in the study. The coxa profunda sign, the crossover sign, the acetabular index (AI) and lateral centre–edge (LCE) angle were measured on the radiographs. The median age of the patients was 36.5 years (28 to 50) and 138 (53.7%) were women.

Coxa profunda was present in 199 hips (77.4%). There was a significantly increased prevalence of coxa profunda in women (p < 0.05) and a significant association between coxa profunda and female gender (p < 0.001) (92% vs 60.5%). The crossover sign was seen in 36 hips (14%), an LCE > 40° in 28 hips (10.9%) and an AI < 0º in 79 hips (30.7%). A total of 221 normal hips (79.2%) (normal considering the crossover) had coxa profunda, a total of 229 normal hips (75.5%) (normal considering the LCE) had coxa profunda and a total of 178 normal hips (75.3%) (normal considering AI) had coxa profunda.

When the presence of all radiological signs in the same subject was considered, pincer-type FAI was found in only two hips (one subject). We therefore consider that the coxa profunda sign should not be used as a radiological indicator of pincer-type FAI. We consider profunda to be a benign alteration in the morphology of the hip with low prevalence and a lack of association with other radiological markers of FAI. We suggest that the diagnosis of pincer-type FAI should be based on objective measures, in association with clinical findings.

Cite this article: Bone Joint J 2015; 97-B:478–83.

We retrospectively examined the long-term outcome of 96 asymptomatic hips in 96 patients with a mean age of 49.3 years (16 to 65) who had radiological evidence of femoroacetabular impingement. When surveillance commenced there were 17, 34, and 45 hips with cam, pincer, and mixed impingement, respectively. Overall, 79 hips (82.3%) remained free of osteoarthritis for a mean of 18.5 years (10 to 40). In contrast, 17 hips (17.7%) developed osteoarthritis at a mean of 12 years (2 to 28). No statistically significant difference was found in the rates of development of osteoarthritis among the three groups (p = 0.43). Regression analysis showed that only the presence of idiopathic osteoarthritis of the contralateral diseased hip was predictive of development of osteoarthritis on the asymptomatic side (p = 0.039).

We conclude that a substantial proportion of hips with femoroacetabular impingement may not develop osteoarthritis in the long-term. Accordingly, in the absence of symptoms, prophylactic surgical treatment is not warranted.

We conducted a prospective follow-up MRI study of originally asymptomatic healthy subjects to clarify the development of Modic changes in the cervical spine over a ten-year period and to identify related factors. Previously, 497 asymptomatic healthy volunteers with no history of cervical trauma or surgery underwent MRI. Of these, 223 underwent a second MRI at a mean follow-up of 11.6 years (10 to 12.7). These 223 subjects comprised 133 men and 100 women with a mean age at second MRI of 50.5 years (23 to 83). Modic changes were classified as not present and types 1 to 3. Changes in Modic types over time and relationships between Modic changes and progression of degeneration of the disc or clinical symptoms were evaluated. A total of 31 subjects (13.9%) showed Modic changes at follow-up: type 1 in nine, type 2 in 18, type 3 in two, and types 1 and 2 in two. Modic changes at follow-up were significantly associated with numbness or pain in the arm, but not with neck pain or shoulder stiffness. Age (≥ 40 years), gender (male), and pre-existing disc degeneration were significantly associated with newly developed Modic changes. In the cervical spine over a ten-year period, type 2 Modic changes developed most frequently. Newly developed Modic changes were significantly associated with age, gender, and pre-existing disc degeneration

Increased incidence of obesity and longer life expectancies will place increased demands on load bearing joints. In the present work, a method of pre-clinical evaluation to assess the condition of the joint and potentially inform on cases of joint deterioration, is described. Acoustic emission (AE) is a non-destructive test methodology that has been used extensively in engineering for condition monitoring of machinery and structures. It is a passive technique that uses piezoelectric sensors to detect energy released from internal structural defects as they deform and grow. The technique has been used with some success in the past to identify characteristic signals generated from the knee joint during activities such as standing and sitting, in candidate arthroplasty patients (1,2). In this study, 40 asymptomatic subjects had AE data generated from their knee joints analysed. Subject characteristics such as age, gender, and lifestyle were disclosed and evaluated against the AE data. Each subject was invited to take a seated position and a piezoelectric AE sensor (Pancom P15, 150kHz resonance, 19mm diameter) was attached to the subject's knee using a wax couplant and tape as close to the articulating surface and on a bony prominence to avoid signal attenuation in the soft tissue. Subjects were invited to sit and stand 3 times. AE data were collected and processed using an AMSY5 AE processor (Vallen, Germany). Tests were repeated on a separate occasion and selected subjects were invited to participate on a third occasion. The AE data of particular interest were the peak amplitudes and the frequency power spectrum of the waveform. Post-test inspection of subject characteristics allowed them to be separated into three broad categories: no previous history (group A), some instances of pain in the knee (group B), and those who have had previous minor surgery on the knee (group C). The corresponding AE results were grouped separately. It was found that groups A and B demonstrated similar signal amplitude characteristics while group C produced much higher, significantly different (p<0.05) amplitudes and amplitude distributions. Typical results are shown in figure 1. At present, broad trends could be identified and relationships emerged between the data and subject history (prior surgery, typical daily activity). Further work will continue with asymptomatic subjects and the work will be extended to pre-operative patients to identify whether certain trends are amplified in this population

Aims. This study sought to establish the prevalence of the cross over sign (COS) and posterior wall sign (PWS) in relation to the anterior pelvic plane (APP) in an asymptomatic population through reliable and accurate 3D-CT based assessment. Materials and Methods. Data from pelvic CT scans of 100 asymptomatic subjects (200 hips) undertaken for conditions unrelated to disorders of the hip were available for analysis in this study. A previously established 3D analysis method was applied to assess the prevalence of the COS and PWS in relation to the APP. Results. Of the 200 included hips, 24% (48) presented a positive COS and 5.5% (11) presented a positive PWS. A combination of COS and PWS was observed in 1% (two) of all hips (1%). . Conclusion. The high incidence of acetabular retroversion, determined by the COS, shows that this anatomic configuration may not differ in frequency between asymptomatic individuals and patients with symptomatic femoroacetabular impingement (FAI). Patients presenting with hip pain and evidence of FAI should be subjected to strict diagnostic scrutiny and evaluated in the sum of their clinical and radiological presentation. In our cohort of asymptomatic adults, the COS showed a higher incidence than the PWS or a combined COS/PWS. Cite this article: Bone Joint J 2017;99-B:1584–9

Introduction. Most of studies on Total Hip Arthroplasty (THA) are focused on acetabular cup orientation. Even though the literature suggests that femoral anteversion and combined anteversion have a clinical impact on THA stability, there are not many reports on these parameters. Combined anteversion can be considered morphologically as the addition of anatomical acetabular and femoral anteversions (Anatomical Combined Anatomical Anteversion ACA). It is also possible to evaluate the Combined Functional Anteversion (CFA) generated by the relative functional position of femoral and acetabular implants while standing. This preliminary study is focused on the comparison of the anatomical and functional data in asymptomatic THA patients. Material and methods. 50 asymptomatic unilateral THA patients (21 short stems and 29 standard stems) have been enrolled. All patients underwent an EOS low dose evaluation in standing position. SterEOS software was used for the 3D measurements of cup and femur orientation. Cup anatomical anteversion (CAA) was computed as the cup anteversion in axial plane perpendicular to the Anterior Pelvic Plane. Femoral anatomical anteversion (FAA) was computed as the angle between the femoral neck axis and the posterior femoral condyles in a plane perpendicular to femoral mechanical axis. Functional anteversions for the cup (CFA) and femur (FFA) were measured in the horizontal axial patient plane in standing position. Both anatomical and functional cumulative anteversions were calculated as a sum. All 3D measures were evaluated and compared for the repeatability and reproducibility. Statistical analysis used Mann-Whitney U-test considering the non-normal distribution of data and the short number of patients (<30 for each group). Results. Functional cumulative anteversion was significantly higher than anatomical cumulative anteversion for all groups (p<0.05). No significant difference could be noted between the cases according to the use of short or standard stems. Conclusion. This study shows the difference of functional implant orientation as compared to the anatomical measurements. This preliminary study has limitations. First the limited sample of patients. Then this series only includes asymptomatic subjects. Nevertheless, this work focused on the feasibility of the measurements shows the potential interest of a functional analysis of cumulated anteversion. Standing position influences the relative position of THA implants according to the frontal and sagittal orientation of the pelvis. The relevance of these functional measurements in instability cases must be demonstrated, especially in patients with anterior subluxation in standing position which is potentially associated with pelvic adaptative extension. Further studies are needed for the feasibility of measurements on EOS images in sitting position and their analysis in case of instability. For any figures or tables, please contact authors directly

Aims: We studied the prevalence of calciþc tendinopathy in asymptomatic subjects and the relationship between calciþc deposits and the anatomopathological characteristic of coracoacromial arch. Methods: 222 right-handed volunteers underwent x-ray examination of the right shoulder. We measured the acromiohumeral distance (AHD) and evaluated the acromion shape and the degenerative changes of the GH and AC joints. We measured the size of the deposits and classiþed the calciþcations based on their location, shape and neatness. The subjects with deposits were clinically evaluated and underwent a second x-ray study after 14 months. Results: 11 subjects (5%) had calciþcation. The latter was in the substance of supraspinatus in 5(mean age 45 yrs) and at cuff insertion in 6 (66 yrs). The deposits measured 0.7±0.3cm (avg). There were 3 linear and 2 beanlike intratendinous calciþcations and 5 linear and 1 beanlike deposits at tendon insertion. Calciþcations had well-deþned margins. AHD, acromion shape, arthritic of the GH or AC joint were unrelated to the presence of calciþcations. No subject showed evidence of cuff tear. Intratendinous deposit decreased in size in 2 cases and disappeared in 1. Conclusions: 5% of asymptomatic subjects have calciþcations. Calciþcations are always small and well-deþned. Morphology and changes of the cora-coacromial arch or the GH or AC joint donñt inßuence the deposition of calcium. Our study suggests that calciþcations may decrease in size or disappear without completion of Uhthoffñs cycle

The purpose of this study was to characterise the neuromuscular patterns associated with different severities of knee osteoarthritis (OA). Forty-five patients with moderate OA, thirty-seven with severe OA and thirty-eight asymptomatic controls underwent a complete gait analysis with only the electromyographic (EMG) findings presented in this abstract. Severity levels were established through the Kellgren-Lawrence radiographic grading system, functional ability, and those classified with severe OA were tested within one-week of total knee replacement surgery. All OA patients had medial joint involvement. Subjects walked along a five-meter walkway a total of five times at a self- selected walking speed. Muscle activation patterns of the vastus medialis and lateralis, medial and lateral hamstring and medial and lateral gastrocnemius were recorded and normalised to maximum voluntary isometric contractions. All EMG waveforms were analyzed for group differences using PCA [1] followed by an ANOVA (group by muscle) for the PCA scores for each muscle group. These scores reflect both magnitude and shape changes. The control group was significantly younger (53.3 ±9.5 yrs) and lighter (77.5 ±14.5 Kg) than the patient groups (Moderate =59.8 ±8.0 years and 94.2 ±19.2 Kg and Severe = 63.1 ±7.9 yrs and 95.8 ±14.6Kg). The severe OA group walked significantly slower (0.9 ±0.2 m/s) than the asymptomatic (1.3 ±0.1) m/s) and the moderate OA (1.2 ±0.2 m/s) groups. The PCA analysis of the EMG waveforms revealed statistically significant differences (P< 0.05) in patterns among the three groups and between muscles within the three muscle groups tested. The neuromuscular differences found among groups during gait demonstrate that the role of the musculature surrounding the knee is altered slightly in those with moderate OA and altered drastically in those with end-stage OA compared to asymptomatic subjects, reflecting a progression. The differences are consistent with the severe group adopting a co-activation strategy of agonist and antagonists, more lateral activation and a reduction in plantar flexion during push off. These are consistent with strategies to increase dynamic stability and reduce medial joint loading. The moderate OA group illustrates a trend toward adopting this pattern but with only very subtle differences from asymptomatic subjects as has been previously reported. These neuromuscular alterations have implications with respect to muscle function and may assist in defining severity

Background: Intervertebral motion is often assumed to be altered with back pain, however, the patterns are inaccessible to measurement in live subjects. A method for digitally tracking and analysing fluoroscopic images of the vertebrae of subjects who are undergoing standardised passive motion has recently been brought into clinical use for the assessment of surgical fusions. We have studied the differences between the behaviour of spinal linkages in subjects who are asymptomatic, and those who have had fusion operations. This paper describes the reliability, ranges and qualitative features of intervertebral motion patterns in 27 asymptomatic subjects and 3 fusion patients. Methods and results: Thirty asymptomatic male volunteer subjects aged 19–40, underwent 2 –20 second sessions of fluoroscopic screening during 80 degrees of lumbar spine bending within 20 minutes of each other. Intervertebral sidebending motion from L2–5 was measured in 27 subjects whose images were judged suitable for tracking. Approximately 120 digitised images throughout each motion sequence were analysed 5 times by 2 blinded observers for intervertebral range and each result averaged. The intra-subject biological error (RMS), for range of intervertebral motion was 2.75° for Observer1 and 2.91° for Observer 2. The interobserver error for tracking the same screenings was 1.86° (RMS). At almost all levels, these motion patterns were remarkably regular. Four male patients aged 33, 44, 45 and 52 years, who had undergone different spinal stabilisation procedures consisting of flexible stabilisation (DNESYS), posterior instrumented fusion, and anterior interbody fusion with facet fixation were investigated. Images were acquired and analysed in the same way except that a larger number of images (500 per screening) was utilised in each case. Four operated levels and 2 adjacent levels were analysed. All motion patterns were easily distinguishable from those of the normal subjects. The PLIF and DYNESYS stabilisations demonstrated no motion at the instrumented levels. The anterior inter-body fusion-transfacet fixation patient was shown to have developed a pseudarthrosis. Conclusions: Detailed lumbar intervertebral bending patterns in asymptomatic subjects were distinguishable from the fused and adjacent-to fused segments in operated patients. Results suggest that there is sufficient reliability in the method to evaluate lumbar intersegmental ranges and motion patterns for fusion assessment

Purpose: Currently, there is limited research on the effectiveness of rehabilitative exercises for neck pain patients generally, and chronic neck pain patients in particular. Interestingly, recent evidence suggests that dysfunction of cervicocephalic kinaesthesia, as measured by head repositioning accuracy (HRA), is present in many chronic patients, and that active eye-head-neck co-ordination exercises may be useful in terms of patients’ rehabilitation. The purpose of this study was twofold: i) to determine if there was a difference in HRA in chronic neck pain subjects versus controls; ii) to assess the effect of a rehabilitative exercise programme on chronic neck pain subjects’ HRA and reported levels of pain. Method: A prospective, intervention study on a convenience sample of chronic neck pain subjects (> 3 months duration) versus age- and gender-matched, asymptomatic control subjects was conducted. Exclusion criteria included any form of active treatment (> 1 per month) for musculoskeletal complaints, including medication, as well as any arthritic, orthopaedic, or neurological disorder. Both symptomatic and asymptomatic subjects were assigned, via stratified, random allocation, to either a rehabilitative exercise or non-exercise group. This gave rise to 4 groups. Symptomatic and asymptomatic exercise subjects were given a training session as well as written and verbal instructions on how to perform the eye-head-neck co-ordination exercises. Subjects were asked to perform the exercises twice daily over a 4-week period, and to keep a diary of exercise compliance and any associated symptomatology. Outcomes included HRA for all active cervical range-of-motion, measured by a helmet-mounted laser pointer on a paper target, and pain intensity as measured by a 100 mm visual analogue scale (VAS). Outcomes were measured in all subjects at baseline, end of week 2, and end of week 4. Results: 63 subjects were recruited, of which 56 completed the 4-week study. 28 chronic neck pain subjects (14 males and 14 females; mean age 22.6 years, range 19–30 years), and 28 asymptomatic controls (14 males and 14 females; mean age 23.9 years, range 19–31 years) were assigned via stratified random allocation, to an exercise or non-exercise group. Each of the 4 groups contained 14 subjects. Active HRA was found to be significantly reduced in neck pain subjects compared to control subjects (ANOVA, p< 0.001). Whiplash patients (N=17) in particular, were significantly less precise (ANOVA, p< 0.001). A significant reduction in reported pain was experienced by the symptomatic exercise versus symptomatic non-exercise group (ANOVA, p< 0.001). At 4-weeks, the symptomatic exercise group demonstrated significantly improved HRA in all active movements compared to the other groups (ANOVA, p< 0.001). Conclusions: This study provides evidence that simple, eye-head-neck co-ordination exercises may be helpful in reducing functional impairment in terms of cervicocephalic kinaesthesia as well as reported levels of pain in chronic neck pain subjects

Introduction. The usefulness of markers of non-specific low back pain (NSLBP), including MRI derived measurements of cross-sectional area (CSA) and functional CSA (FCSA, fat free muscle area) of the lumbar musculature, is in doubt. To our knowledge, such markers remain unexplored in Lumbar Disc Degeneration (LDD), which is significantly associated with NSLBP, Modic change and symptom recurrence. This exploratory 3.0-T MRI study addresses this shortfall by comparing asymmetry and composition in asymptomatic older adults with and without Modic change. Methods. A sample of 21 healthy, asymptomatic subjects participated (mean age 56.9 years). T2-weighted axial lumbar images were obtained (L3/L4 to L5/S1), with slices oriented through the centre of each disc. Scans were examined by a Consultant MRI specialist and divided into 2 groups dependent on Modic presence (M) or absence (NM). Bilateral measurements of the CSA and FCSA of the erector spinae, multifidus, psoas major and quadratus lumborum were made using Image-J software. Muscle composition was determined using the equation [(FCSA/CSA)*100] and asymmetry using the equation [(Largest FCSA-smallest FCSA)/largest FCSA*100]. Data were analysed using Mann-Whitney U tests (p value set at). Intrarater reliability was examined using Intraclass Correlations (ICCs). Results. ICCs ranged between 0.74 and 0.96 for all area measurements, indicating excellent reliability. There was no significant difference in TCSA and FCSA asymmetry (P=0.1–1.0) and muscle composition (P=0.1–1.0) between M and NM groups. Conclusion. Modic change in the absence of pain does not appear to influence cross-sectional asymmetry or composition of the lumbar musculature. CSA remains a controversial marker. No conflicts of interest. Funding: This work is funded by an Allied Health Professional Doctoral Fellowship awarded to Janet Deane by Arthritis Research U.K

Introduction: Contrary to the prevailing conviction that lumbar segments affected by lytic spondylolisthesis are unstable, multiple studies have failed to find evidence of increased or abnormal motion at these segments. Affected segments do not exhibit excessive anterior translation: the so-called slip. Previous studies, however, did not use techniques that might reveal abnormalities in the quality of motion, as opposed to its magnitude. Methods: To determine if features of instability could be detected in the radiographs of patients with spondylolisthesis, a retrospective, cohort study was conducted of the kinematics of the lumbar spine of patients with spondylolisthesis compared with asymptomatic normal subjects. The flexion-extension radiographs of 15 patients with spondylolytic spondylolisthesis were analysed to determine the location of their instantaneous centres of rotation, and their magnitudes of translation and sagittal rotation. Normative data were obtained by applying the same techniques to the radiographs of 20 asymptomatic subjects. Results: All but one of the 15 patients exhibited at least one segment with abnormal motion. Only one patient had excessive translation at the lytic segment. Four had minor abnormalities affecting either the lytic segment or ones above. Nine patients exhibited major abnormalities. Seven had paradoxical motion at the lytic segment, in which the centre of rotation was located above L5, instead of below, and in which L5 translated backwards, instead of forwards, during flexion. Two patients exhibited axial dropping of L4, instead of horizontal translation, during extension. Discussion: Not all patients with spondylolisthesis show features of instability. However, a proportion of patients exhibit highly abnormal movements that are consistent with instability. The abnormalities involve movements within normal range but in abnormal directions. Visual inspection of radiographs will not reveal these abnormalities but they can be detected by plotting the instantaneous axes of rotation

INTRODUCTION: Contrary to the prevailing conviction that lumbar segments affected by lytic spondylolisthesis are unstable, multiple studies have failed to find evidence of increased or abnormal motion at these segments. Affected segments do not exhibit excessive anterior translation: the so-called slip. Previous studies, however, did not use techniques that might reveal abnormalities in the quality of motion, as opposed to its magnitude. METHODS: To determine if features of instability could be detected in the radiographs of patients with spondylolisthesis, a retrospective, cohort study was conducted of the kinematics of the lumbar spine of patients with spondylolisthesis compared with asymptomatic normal subjects. The flexion-extension radiographs of 15 patients with spondylolytic spondylolisthesis were analysed to determine the location of their instantaneous centres of rotation, and their magnitudes of translation and sagittal rotation. Normative data were obtained by applying the same techniques to the radiographs of 20 asymptomatic subjects. RESULTS: All but one of the 15 patients exhibited at least one segment with abnormal motion. Only one patient had excessive translation at the lytic segment. Four had minor abnormalities affecting either the lytic segment or ones above. Nine patients exhibited major abnormalities. Seven had paradoxical motion at the lytic segment, in which the centre of rotation was located above L5, instead of below, and in which L5 translated backwards, instead of forwards, during flexion. Two patients exhibited axial dropping of L4, instead of horizontal translation, during extension. DISCUSSION: Not all patients with spondylolisthesis show features of instability. However, a proportion of patients exhibit highly abnormal movements that are consistent with instability. The abnormalities involve movements within normal range but in abnormal directions. Visual inspection of radiographs will not reveal these abnormalities but they can be detected by plotting the instantaneous axes of rotation

The oblique sagittal diameter of the lumbar spinal canal was measured by diagnostic ultrasound in seventy-three patients with symptomatic disc lesions, and compared with measurements from 200 asymptomatic subjects. Results suggest that the available space in the spinal canal is highly significant in the symptomatology of disc lesions, and in the patient's response to treatment

Cross-sectional studies of the lumbar spinal canal were performed by computerised tomography in asymptomatic subjects and in patients with myelographic and clinical findings suggestive of lumbar stenosis. In most cases stenosis was found to be developmental or combined in nature. Computerised tomography is a useful adjunct to myelography in the evaluation of lumbar stenosis as it enables an accurate assessment to be made of the type, degree and extent of narrowing of the vertebral canal

Aim. The aim of this study is to identify the incidence of the presence of an Inverted Radial Reflex (IRR) in asymptomatic subjects with Adolescent Idiopathic Scoliosis and determine its significance. Methods. Our study group consists of Adolescent Idiopathic Scoliosis patients who presented consecutively in our institution from June to September 2010. They were either seen in outpatient clinics or as elective admissions prior to operative correction of their spinal deformity. The presence of an idiopathic scoliosis deformity and the absence of any abnormal neurological symptoms were our inclusion criteria. They were examined by two clinicians for the presence of IRR using a tendon hammer. As part of their management all such patients routinely undergo an MRI scan in our Trust to investigate for the presence of intraspinal pathology. When the IRR was present we looked at their MRI scans to identify any relevant abnormalities. Results: We identified 100 subjects. There were 72 females and 28 males with an average age of 15 years. The IRR was present in 12 cases and in 6 of them the sign was present bilaterally. There were no further associated signs or symptoms. All cases had recently undergone MRI of their whole spine and their investigations did not demonstrate any abnormalities in the lower cervical spine. Conclusion. We have found an incidence of 12% for the presence of IRR in our study group. In all cases there were no abnormal cord signal changes in MRI scans and we can therefore conclude that in asymptomatic Adolescent Idiopathic Scoliosis patients the presence of IRR is of no clinical significance

Tapping the radial side of the wrist normally elicits a reflex contraction producing elbow flexion, wrist extension and wrist radial deviation. An abnormal response, consisting of finger flexion when performing this manoeuvre is known as the inverted radial (supinator) reflex (IRR). The significance of this reflex in asymptomatic subjects is unknown. To document the frequency of the IRR in an asymptomatic population and to identify any presymptomatic pathology in those subjects. The study group consisted of patients and staff at the senior author's institution. Patients were taken from clinics where the complaints were of lower limb symptoms. Subjects were excluded if they had any history of neck pain or stiffness or if they had any subjectively abnormal sensation. The radial reflex was elicited with a tendon hammer. Those subjects with an IRR were asked to attend for a MRI scan of the cervical spine to investigate for any abnormality. 47 subjects were studied. There were 8 subjects who displayed an IRR. In 4 subjects the IRR was unilateral and in 4 bilateral. Seven subjects consented to further investigation by MRI. The average age of these patients was 36 years. The MRI scans revealed normal appearances in 6 cases. There was no cord signal abnormality in any case. The IRR occurred with a frequency of 17% in the study group. There was no significant cervical pathology identified in these subjects. In young asymptomatic patients, the presence of an inverted radial reflex is of no diagnostic relevance

To study the association between hip and ankle biomechanics during gait and moderate knee osteoarthritis (OA). Gait analysis was performed on a group of forty-four patients clinically diagnosed with moderate knee OA, and on a group of sixty asymptomatic subjects. Three-dimensional net joint angles and net joint reaction moments at the hip, knee and ankle joints were calculated. Peak values were extracted from the gait waveform patterns and compared between the two subject groups with Student’s t-tests. The peak hip extension moment, the peak hip adduction moment, the peak hip internal and external rotation moments, and the peak ankle dorsiflexion and plantarflexion moments were all reduced in the knee osteoarthritis population compared to the asymptomatic population. Differences in knee joint loading patterns with moderate knee osteoarthritis have been previously reported, but these data suggest that changes in the mechanical environment of all lower extremity joints are associated with early stages of knee osteoarthritis. Other studies have associated reduced peak hip adduction moments with reduced likelihood of OA progression. These data provide a rationale for hip abductor muscle strengthening as a means to lower knee joint loading

Aims

The objective of this study was to present the outcomes of rotational acetabular osteotomy (RAO) over a 30-year period for osteoarthritis (OA) secondary to dysplasia of the hip in pre- or early-stage OA.