Purpose

Osteoarthritis of the trapezio-metacarpal joint (TMJ or basal thumb joint) is a common condition causing significant disability. A range of non-operative and operative management options can be used for its treatment. One of the most common conservative treatments is a steroid injection into the joint. To confirm correct placement of the steroid it is preferable to use X-ray image intensification. Few previous studies have audited effectiveness, particularly with the use of radiological guidance.

Orthopaedic cobalt chromium particles and ions can induce indirect DNA damage and chromosome aberrations in human cells on the other side of a cellular barrier in tissue culture. This occurs by intercellular signalling across the barrier. We now show that the threshold for this effect depends on the metal form and the particle composition.

Ionic cobalt and chromium induced single strand breaks at concentrations equivalent to those found in the blood of patients with well functioning metal on metal hip prostheses. However, they only caused double strand breaks if the chromium was present as chromium (VI), and did not induce chromosome aberrations. Nanoparticles of cobalt chromium alloy caused DNA double strand breaks and chromosome aberrations, of which the majority were tetraploidy. Ceramic nanoparticles induced only single strand breaks and/or alkaline labile sites when indirectly exposed to human fibroblasts.

The assessment of reproductive risk from maternal exposure to biomaterials, especially those liberated by orthopaedic implants, is not yet possible with epidemiology. Whilst the barrier model used here differs from the in vivo situation in several respects, it may be useful as a framework to evaluate biomaterial induced damage across physiological barriers.

Background: Growing demands upon orthopaedic services in the United Kingdom have resulted in increasing waiting times for orthopaedic consultations. The increasing pressure of new government targets has led to role delegation within the NHS. Magnetic Resonance Imaging (MRI) is a limited resource that requires judicious and validated use. We evaluated the use of MRI in the assessment of patients presenting with back pain to a service managed by an Physiotherapy Extended Scope Practitioner (ESP) working in a secondary care referral centre, against the standard as practiced by orthopaedic surgeons in a separate secondary care referral centre without a dedicated operative spinal service.

Methodology: A retrospective review of 130 lumbar MRI scans requested by an ESP service was compared with a retrospective review of 145 lumbar MRI scans requested by orthopaedic surgeons. In both cases cross-site tertiary referral was required if surgery was to be considered. Presenting symptoms and signs, abnormalities detected on the MRI scans and subsequent management were recorded with rate of listing for operative management used as a measure of appropriate MRI usage. Simple descriptive analysis was undertaken.

Results: 82% and 91% respectively of orthopaedic and ESP referrals for MRI had either neurological signs or symptoms. However, a higher rate of neurological signs was reported by ESP 70% versus 42%).

Despite reported differences in patient presentation the abnormal scan rate was comparable (ESP 91%, orthopaedics 92%).

The tertiary referral rate was also comparable (ESP 47%, orthopaedics 37%).

Of the patients referred to the tertiary referral centres the percentage listed for operative intervention was 68% and 72% respectively for ESP and orthopaedic surgeons. In terms of the number of patients investigated by MRI scan 32% and 26% of patients from the ESP and Orthopaedic centres respectively were listed for surgery.

Discussion: This study shows that physiotherapy ESP use of MRI in the investigation of patients presenting with back pain is comparable to orthopaedic surgeons in a centre without a dedicated spinal service. With adequate training and knowledge of red/ yellow flag signs applicable to assessment of spinal problems we support the role of physiotherapy ESPs in the assessment of patients with spine related problems.