Ken R. Mautner
Column-editor : Tracy Ray
Emily R. Hunt, Shelby E. Baez, Anne D. Olson, Timothy A. Butterfield and Esther Dupont-Versteegden
immediately after the insult modulates the potentially damaging inflammatory processes. 30 , 31 Increases in peak torque seen after massage suggest that it also can accelerate muscle recovery and hasten the return of normal function. 23 Moreover, massage also induces an upregulation of protein synthesis and
Zachary Y. Kerr, Andrew E. Lincoln, Shane V. Caswell, David A. Klossner, Nina Walker and Thomas P. Dompier
(21.4%, n = 104), sprains (18.1%, n = 88), and inflammatory conditions (15.8%, n = 77) were the highest. Concussions comprised the highest proportion of head/face injuries in competition (82.1%, n = 32) and practice (54.5%, n = 30). The remaining competition head/face injuries were mostly contusions
Kevin M. Cross
Dimethyl sulfoxide (DMSO) was introduced to the medical community in the mid-1960s as a powerful anti-inflammatory agent. Clinical studies and subjective claims abounded about its healing effects on a variety of musculoskeletal injuries. Unfortunately, soon after the incorporation of DMSO into rehabilitation routines, the American Medical Association (AMA) denounced many of the studies of DMSO as being unscientific in nature, and the possibility of toxic effects on the optical lens was noted in an experiment using primates as subjects. As a result, the use of DMSOin the medical community was halted. The exact mechanisms by which DMSO affects the healing process are unknown; however, several studies from the 1980s noted specific effects during various phases of the inflammatory process, such as monocyte and fibroblast activity. Presently, DMSO is considered an investigational drag and has not been approved by the Food and Drag Administration for use with musculoskeletal disorders.
Jeffrey B. Driban, Easwaran Balasubramanian, Mamta Amin, Michael R. Sitler, Marvin C. Ziskin and Mary F. Barbe
Joint trauma is a risk factor for osteoarthritis (OA), which is becoming an increasingly important orthopedic concern for athletes and nonathletes alike. For advances in OA prevention, diagnosis, and treatment to occur, a greater understanding of the biochemical environment of the affected joint is needed.
To demonstrate the potential of a biochemical technique to enhance our understanding of and diagnostic capabilities for osteoarthritis.
Outpatient orthopedic practice.
8 subjects: 4 OA-knee participants (65 ± 6 y of age) and 4 normal-knee participants (54 ± 10 y) with no history of knee OA based on bilateral standing radiographs.
The independent variable was group (OA knee, normal knee).
Main Outcome Measures:
16 knee synovial-protein concentrations categorized as follows: 4 as pro-inflammatory, or catabolic, cytokines; 5 as anti-inflammatory, or protective, cytokines; 3 as catabolic enzymes; 2 as tissue inhibitors of metalloproteinases [TIMPs]; and 2 as adipokines.
Two anti-inflammatory cytokines (interleukin [IL]-13 and osteoprotegerin) and a pro-inflammatory cytokine (IL-1β) were significantly lower in the OA knees. Two catabolic enzymes (matrix metalloproteinase [MMP]-2 and MMP-3) were significantly elevated in OA knees. TIMP-2, an inhibitor of MMPs, was significantly elevated in OA knees.
Six of the 16 synovial-fluid proteins were significantly different between OA knees and normal knees in this study. Future research using a similar multiplex ELISA approach or other proteomic techniques may enable researchers and clinicians to develop more accurate biochemical profiles of synovial fluid to help diagnose OA, identify subsets of OA or individual characteristics, guide clinical decisions, and identify patients at risk for OA after knee injury.
David J. Pezzullo
Plantar fasciitis is one of the most common foot injuries athletes sustain. The painful heel is the result of overloading and inflammation of the plantar fascia at its insertion into the medial process of the tuberosity of the calcaneus. Many different treatment approaches have been used to address this overuse problem. Treatment for plantar fasciitis has included decreased weight bearing, nonsteroidal anti-inflammatory drugs (NSAIDs), orthotics, arch taping, weight loss, steroid injections, ultrasound, ice, physical therapy, and surgical release. Clinically the use of night splints has been found to be very successful in the treatment of plantar fasciitis, as described in this case study.
Christopher D. Brown, Christine A. lauber and Thomas Cappaert
Iontophoresis is a method of local transfer of ionized medicated and nonmedicated substances through the skin and into the target tissues using magnetic polarization. The anti-inflammatory properties exhibited by dexamethasone sodium phosphate (DEX) combined with iontophoresis make it a potentially desirable treatment for clinicians wishing to administer a noninvasive localized drug concentration without having a large systemic concentration of that drug. Since concurrent treatments are commonly used in clinical practice, many of the published studies that included the use of DEX also used concurrent treatments. However, this may make it difficult for clinicians to determine the individual effectiveness of DEX iontophoresis in treating musculoskeletal conditions.
Focused Clinical Question:
Does DEX iontophoresis, alone, decrease pain and improve function in patients with musculoskeletal conditions when compared with placebo or control?
Lori A. Bolgla, Douglas R. Keskula and Jewell B. Duncan
Researchers have suggested that quadriceps inhibition resulting from a simulated knee effusion would lead to decreased lower extremity performance.
To investigate the relationship between a simulated knee effusion and lower extremity performance.
9 college students.
Subjects performed 3 functional-performance tests before and after a simulated knee effusion. Measurement was the average distance hopped for a single hop and crossover hop for distance and time for completion on a timed hop test.
An analysis of variance revealed significant change in average test scores after injection only for the timed hop in subjects receiving a 60-ml injection.
Nonsignificant differences might have resulted from compensation from other muscle groups, fluid movement within the knee joint, and absence of an inflammatory process. Further research on the relationship between simulated knee effusion and lower extremity performance is needed.
Sheri A. Hale
To review the etiology of patellar tendinopathy as it relates to clinical management of chronic patellar-tendon disease in athletes.
Information was gathered from a MEDLINE search of literature in English using the key words patellar tendinitis, patellar tendonitis, patellar tendinosis, patellar tendinopathy, and jumper’s knee.
All relevant peer-reviewed literature in English was reviewed.
The etiology of patellar tendinopathy is multifactorial, incorporating both intrinsic and extrinsic factors. Age, muscle flexibility, training program, and knee-joint dynamics have all been associated with patellar tendinopathy. The roles of gender, body morphology, and patellar mobility in patellar tendinopathy are unclear.
The pathoetiology of patellar tendinopathy is a complex process that results from both an inflammatory response and degenerative changes. There is a tremendous need for research to improve our understanding of the pathoetiology of patellar tendinopathy and its clinical management.