In osteoporosis treatment, current interventions, including pharmaceutical treatments and exercise protocols, suffer from challenges of guaranteed efficacy for patients and poor patient compliance. Moreover, bone loss continues to be a complicating factor for conditions such as spinal cord injury, prescribed bed-rest, and space flight. A low-cost treatment modality could improve patient compliance.
Abstract. Source of Study: London, United Kingdom. This intervention study was conducted to assess two developing protocols for quadriceps and hamstring rehabilitation: Blood Flow Restriction (BFR) and Neuromuscular Electrical Stimulation Training (NMES). BFR involves the application of an external compression cuff to the proximal thigh. In NMES training a portable
Complete or nearly complete disruption of the attachment of the gluteus is seen in 10–20% of cases at the time of THA. Special attention is needed to identify the lesion at the time of surgery because the avulsion often is visible only after a thickened hypertrophic trochanteric bursa is removed. From 1/1/09 to 12/31/13, 525 primary hip replacements were performed by a single surgeon. After all total hip components were implanted, the greater trochanteric bursa was removed, and the gluteus medius and minimus attachments to the greater trochanter were visualised and palpated. Ninety-five hips (95 patients) were found to have damage to the muscle attachments to bone. Fifty-four hips had mild damage consisting of splits in the tendon, but no frank avulsion of abductor tendon from their bone attachments. None of these cases had severe atrophy of the abductor muscles, but all had partial fatty infiltration. All hips with this mild lesion had repair of the tendons with #5 Ticron sutures to repair the tendon bundles together, and drill holes through bone to anchor the repair to the greater trochanter. Forty-one hips had severe damage with complete or nearly complete avulsion of the gluteus medius and minimus muscles from their attachments to the greater trochanter. Thirty-five of these hips had partial fatty infiltration of the abductor muscles, but all responded to
Conservative management of osteoarthritis is boring, boring, boring! After all, we are surgeons. We operate, we cut! We all know that to retain respectability we have to go through the motions of ‘conservative management’, just so that we don't appear too anxious to apply a ‘real’ solution to the problem. However, the statistics are overwhelming. An estimated 43 million Americans have ‘arthritis’, but only 400,000 are coming forward each year for TKR. That means that in one way or another 42,600,000 are being treated conservatively. Most of those are self treating by self medication, use of external support, but mostly by decreasing their activities to a level where they can tolerate symptoms. They come to us when these measures stop working. We know what to do. 1. Weight loss – patients don't do it, 2. Physical therapy – very limited effectiveness 3. NSAIDS – patients have already tried OTC NSAIDS and have heard scary stories about therapeutic NSAIDS, 4. Hyaluronans – expensive, labour intensive, modest effectiveness, 5. Glucosamine/Chondroitin – might work, won't hurt, mixed evidence, 6. SAM-e, MSM – limited evidence – who knows?. What's on the horizon? Could OA of the knee go the way of RA, i.e. dramatically disappear from the population seeking TKR? It could happen.
Compartment syndrome (CS) is a unique form of skeletal muscle ischaemia. N-acetyl cysteine (NAC) is an anti-oxidant in clinical use, with beneficial microcirculatory effects. Sprague-Dawley rats (n=6/group) were randomised into Control, CS and CS pre-treated with NAC (0.5g/kg i.p. 1 hr prior to induction) groups. In a post-treatment group NAC was administered upon muscle decompression. Cremasteric muscle was placed in a pressure chamber in which pressure was maintained at diastolic minus 10 mm Hg for 3 hours inducing CS, muscle was then returned to the abdominal cavity. At 24 hours and 7 days post-CS contractile function was assessed by
