Journal of Musculoskeletal Research

Background: Rheumatoid arthritis (RA) is a chronic inflammatory disease that leads to bone loss due to an imbalance of the bone turnover process that could be evaluated using bone turnover markers. Inflammation in RA is mainly mediated by Tumor necrosis factor-$\alpha$ (TNF-$\alpha$) that will increase osteoclastogenesis. In recent studies, Dickkopf-1 (DKK-1) is a key regulatory pathway for bone formation that affects osteoblastogenesis. Objective: This study aims to examine the imbalance of the bone turnover process in RA patients. Methods: This was a cross-sectional study with 38 subjects of premenopausal women with RA. Serum levels of TNF-$\alpha$, DKK-1, and bone turnover markers (CTx and P1NP) were investigated. Result: The median duration of RA in this study was 5 years with 60.5% of subjects in remission or with low disease activity. The median value of TNF-$\alpha$ was 10.6 pg/mL, the mean value of DKK-1 was 4027pg/mL, the mean value of CTx was 2.74ng/mL, and the mean value of P1NP was 34pg/mL. This study revealed a weak positive correlation between TNF-$\alpha$ and P1NP ($r=0.36$; $p=0.03$). Conclusion: This study found a low level of TNF-$\alpha$, a high level of DKK-1, a high level of CTx and a low level of P1NP that indicates an imbalance of bone turnover process in RA patients that is in favor of bone resorption.

The role of antioxidant supplementation on muscle recovery after disuse is unknown. The aim was to investigate the effect of Vitamin C and E supplementation on muscle recovery after hindlimb suspension. Twenty-two Wistar rats were allocated into 4 groups: exercise with supplementation (VIT, $n=5$); exercise with placebo (PLA, $n=5$); hindlimb suspension (SUSP, $n=6$), and control (CON, $n=6$). All groups, except for CON, were submitted to a hindlimb suspension protocol for 10 days. Then, VIT and PLA underwent 10 days of a rehabilitation protocol consisting of exercise on a treadmill. VIT received vitamin C (250 mg/kg/day) and E (360 mg/kg) during rehabilitation. Samples of soleus and tibialis anterior were prepared for cross-sectional area (CSA) and biochemical analysis. Both VIT (1265.6m$\mu$², 95% CI: 1234.6–1290.3) and PLA (1280.9m$\mu$², 95% CI: 1296.4–1354.9) presented higher CSA of the soleus in relation to CON (816.66m$\mu$², 95% CI: 866.3–904.0, $P$ $<$ 0.05) with no difference between them. Both VIT (1276.9m$\mu$², 95% CI: 1378.7–1484.6) and PLA (1573.3m$\mu$², 95% CI: 1553.9–1651.5) presented higher tibialis anterior CSA in relation to CON (1041.56m$\mu$², 95% CI: 1119.1–1185.2, $P$ $<$ 0.05). In this muscle, CSA of PLA was higher than VIT ($P$ $<$ 0.05). Vitamin’s supplementation attenuated tibialis anterior hypertrophy following the rehabilitation protocol.

The same surgeon used microendoscopic decompression (MED) for all 70 patients with degenerative lumbar spondylolisthesis (DS). During the same period, fusion was not performed. Clinical outcomes were evaluated by the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and visual analogue scale (VAS). Standing maximal flexion-extension lateral radiographs were obtained before and after MED to measure the intervertebral angles and percentages of slipping. The mean duration of follow-up was 47.5 months. The effectiveness rate of low back pain (LBP) was the highest among all five functional scores of the JOABPEQ. LBP, pain and numbness in the buttocks and lower limb as measured by the VAS were significantly improved on follow-up evaluation. Improvements in LBP were significantly correlated with improvements in all other functional scores of the JOABPEQ and with improvements in pain and numbness in the buttocks and lower limb scores of the VAS. However, neither spondylolisthesis nor motion on flexion/ extension (MFE) before and after MED influenced the improvement in LBP and the LBP after MED. The presence of LBP before MED did not lead to poor outcomes. Residual LBP was not related to residual spondylolisthesis or MFE or the development of increased spondylolisthesis postoperatively; however, residual LBP was significantly related to other residual disturbances.

Background: Function-related tests for shoulder disorders are probably related to pain and demographic data which need to be investigated. This paper aimed to study the associations among function-related tests, pain, and demographic data in individuals with shoulder disorders. Methods: The demographic data, pain by numerical rating scale (NRS), and function-related tests which are hand behind neck (HBN) and hand behind back (HBB) tests were collected. The associations were analyzed using the Spearman correlation coefficient and point-biserial correlation. Results: Five hundred sixty-six individuals with shoulder disorders participated. High significant association was reported between HBN and HBB ($r_s=0.780$, $p<0.001$). Also, NRS ($r_s=$ –0.196, $r_s=$ –0.237), age ($r_s=$ –0.258, $r_s=$ –0.241), number of underlying diseases ($r_s=$ –0.161, $r_s=$ –0.171), and diabetes mellitus (DM) ($r_{pb}=$ –0.124, $r_{pb}=$ –0.143) had significant correlations with HBN and HBB tests. Conclusion: The association among HBN, HBB, NRS, age, number of underlying diseases, and DM reflected the importance of pain management and the considerations of the patient’s background involving age and underlying diseases.

Background: Acupuncture treatment has become increasingly popular in the Western due to its therapeutic effects and low cost. However, some studies suggest that both real and sham acupuncture have effects.

Objectives: Our study aimed to evaluate the effect of real and placebo acupuncture in cutaneous and deep sensitivity threshold.

Methods: Three different types of placebo acupunctures were compared with real acupuncture, four groups at the St25 point (abdominal) and four at the Bl52 point (lumbar region), totaling eight groups. 185 subjects were recruited and randomized, ratings of cutaneous sensitivity threshold (von Frey filaments) and pressure pain threshold (algometer) occurred before and after the application.

Results: The cutaneous sensitivity threshold showed no significant difference in the intragroup analysis and also compared between groups. The pressure pain threshold showed a significant decrease in values in the Real group Bl52 (p = 0.044) and insertion and removal Bl52 (p = 0.037) for intra-group analysis and comparison between groups, there was a significant reduction in Real groups St25 and insertion and withdrawal in Bl52 point compared to Park Sham Bl52 and Real Bl52, respectively (p < 0.05).

Conclusion: Cutaneous sensitivity threshold did not change after applying acupuncture or placebo, but these techniques influence the pressure pain threshold.

Purpose: To investigate morphological changes in the infrapatellar fat pad (IPFP) during active knee extension using ultrasonography.

Methods: IPFP deformity from 30^∘ knee flexion to full extension was recorded using ultrasonography. IPFP thickness and patellar tendon-tibial angle were evaluated on 26 healthy knees in the first session and nine knees in the second session. Intra-rater and inter-rate reliability were evaluated using coefficient of variation (CV) and intraclass correlation coefficient (ICC) of types (1, 3) and (2, 3), respectively. Absolute reliability was assessed using the standard error of measurement (SEM). Changes in the patellar tendon-tibial angle and IPFP thickness were analyzed using paired $t$-test.

Results: At each knee angle, ICC (1, 3) was $>0.90$ for the patellar tendon-tibial angle and IPFP thickness (CV $<8\%$). Compared to 30^∘ knee flexion, the patellar tendon-tibial angle increased significantly from 33.3^∘ to 38.9^∘ ($p<0.01$). The IPFP thickness significantly increased from 4.4mm to 5.3mm with active knee extension ($p<0.01$), without overlap of the 95% CI of SEM. For inter-rater reliability, ICC (2, 3) was $>0.7$ for each variable (CV $<11\%$).

Conclusions: Increased IPFP thickness during active knee extension indicates IPFP deformity in the anterior interval. Ultrasonography may help evaluate morphological changes and estimate IPFP scarring.

BACKGROUND: Grip strength is widely accepted as an indicator of maximum hand strength and contraction of active muscles of the hand and forearm. OBJECTIVE: The aim of this study was to assess the effects of forearm posture (pronation, supination and neutral) and anthropometric variation on MVC grip strength and grip endurance time in young university adults. METHODS: Fifty healthy, right-handed men volunteered to participate in this study. The experiment was characterized by measuring MVC grip strength and endurance time of 50% MVC randomly in three different postures (supine, pronation and neutral). Performance was assessed in terms of dependent variables: MVC grip strength and grip endurance time. RESULTS: MANCOVA results showed no significant effect of posture on MVC grip strength (p = 0:333) and grip endurance time (p = 0:772). There was a significant effect of age (p = 0.044), height (p = 0.012) and forearm length (p = 0.039) on the grip endurance time in supine position. However, palm circumference had a significant effect on MVC grip strength (p = 0.036) in pronation posture only. The pronation forearm posture produces 7.4% more grip strength than a supine posture. In addition, the grip endurance time was improved in the supine position, compared to the neutral and pronation forearm posture. CONCLUSIONS: This study showed that the MVC grip strength is affected by the weight and palm circumference. In addition, palm circumference was the most influential factor affecting grip strength. Thus, anthropometric and posture-specific grip strength data are essential for clinical and industrial applications. The results can be used to prepare guidelines for rehabilitation, health care, sport and medicine.

Objective: To investigate the effects of six-week cervical traction and infrared therapy on neck pain intensity (PI) and neck disability index (NDI) among individuals with cervical spondylosis.

Methods: This study was a non-randomized cross-over cohort design. A total of 40 participants (men=20, and women=20) who were purposively selected, received a six-week infrared therapy, observed a one-week washout period, and then six-week concurrent infrared therapy and cervical traction. The PI and NDI were measured at baseline, after infrared therapy, the washout period, and infrared plus cervical traction. Data were analyzed using repeated-measures analysis of variance (RM ANOVA), Friedman’s ANOVA, independent samples t-test, and Kendall’s tau correlation test.

Result: The mean age of the participants was 40±8.60 years. Infrared therapy plus cervical traction significantly reduced PI: $\chi$²(3)=102.06, $p<0.001$, and NDI: F (1, 39) = 222.56, $p<0.001$, relative to infrared therapy alone. Specifically, the minimum clinically important difference (MCID) for PI was 2.2, while infrared alone reduced the PI by 1.0 (Z = 4.633, $p<0.001$), infrared therapy plus cervical traction reduced PI by 6.0 (Z = 7.405, $p<0.001$). The MCID for NDI was 8.50, while infrared alone reduced the NDI by 1.05 (t = 30.087, $p<0.001$), infrared therapy plus cervical traction reduced NDI by 15.83 ($t=14.644$, $p<0.001$).

Conclusion: Concurrent infrared and cervical traction significantly reduced PI and NDI among patients with cervical spondylosis more than lone infrared therapy.

Background and Purpose: Osteoarthritis patients often suffer from anxiety which can affect the disease prognosis. This study is aimed at assessing the various psychological dimensions in different joint arthritic subjects of the rural population and finding the most common joint arthritis that can lead to anxiety in the rural population. Materials & methods: A total of 252 subjects satisfied the inclusion criteria and were recruited for the study after written informed consent and were asked to fill in the GPS online through Google forms. The “feelings” subscale assesses the patient’s psychological stress due to pain and disease. The psychological dimensions of sub-section feelings of GPS were analyzed by one-way ANOVA to assess whether there is a difference on average in the scores among the three groups at a p < 0.05 significant level. Tukey HSD was used for post hoc pairwise comparisons. Results: One-way ANOVA results showed that there was no statistically significant difference between the groups for fear, level of anxiety, depression, stress, and fatigue. Tukey HSD post hoc comparison revealed that the results were statistically significant for fear (Q = 3.35, p = 0.04) and fatigue levels (Q = 3.69, p = 0.02). The Tukey HSD post hoc comparison for levels of anxiety, depression, and stress was not statistically significant. Conclusion: From this study, we conclude that anxiety, fatigue, and fear are highly prevalent in hip osteoarthritis. Anxiety is associated with all joint osteoarthritis and can result in poor quality of living. We recommend physicians to emphasize psychological dimensions and address them at an early stage in order to achieve a better prognosis in degenerative joint diseases.