A muscle-preserving, spinous process-splitting approach for ossification of the ligamentum flavum in the thoracic spine in professional athletes: a report of three cases

A muscle-preserving, spinous process-splitting approach may be a less invasive approach to conventional laminectomy in patients with thoracic ossification of the ligamentum flavum. Few reports have discussed the usefulness of this procedure for thoracic lesions in professional athletes who need highly active thoracic spinal function after surgery. The treatment of thoracic ossification of the ligamentum flavum using a spinous process-splitting approach in 3 professional athletes is presented. In all three cases the patients could return to play within 3 months after surgery without complications, and in two of the cases, there was no spinal deformity or local recurrence of ossification of the ligamentum flavum at the final follow-up at least 8 years after surgery. The spinous process-splitting approach could be a safe procedure for multi-level and all other forms of ossification of the ligamentum flavum and is less invasive to the paraspinal muscles, relieves back symptoms, and restores function for athletes

Potential influencing factor on health‐related quality of life in Japanese with knee osteoarthritis: the Locomotive syndrome and Health outcome in Aizu cohort Study (LOHAS)

Abstract Purpose Several studies have investigated the factors that influence health‐related quality of life in patients with knee osteoarthritis (KOA). This study aimed to identify and investigate the degree of involvement of potential factors influencing health‐related quality of life (HRQOL) in an aged population with or without KOA. Methods This multi‐centered study included 651 participants who underwent health checkups in rural areas of Japan in 2010. The association between three component summary score of short‐form 12 (physical component summary; PCS, mental component summary; MCS, and role‐social component summary; RCS) and covariates were investigated using multiple linear regression model and calculated the scaled estimated regression coefficient. Results Decreasing mobility, severity of knee pain, high pain‐related self‐efficacy (PSE), older age, high functional self‐efficacy (FSE), and female gender had significant effect on PCS (p < 0.05). However, radiographic KOA had no influence on PCS. Presence of depression and body mass index had a significant influence on the MCS (p < 0.05). Decreasing mobility, presence of depression, PSE and older age had significant influence on the RCS (p < 0.05). Conclusion Our study results showed that physical, mental, and role/social QOL were affected by different influencing factors. Physical QOL was strongly influenced by subjective pain, physical performance, and self‐efficacy, whereas radiographic KOA had no such effect. Depressive mood is associated with both mental and role/social QOL. The role/social QOL was predominantly affected by physical function and pain‐related self‐efficacy. Taking measure to improving functional ability and mental status might be the key factor to improve HRQOL in patient with KOA. Level of evidence Level 3: Epidemiologic cross‐sectional study (prognostic study

Chronic hyperglycemia increases the risk of lateral epicondylitis: the Locomotive Syndrome and Health Outcome in Aizu Cohort Study (LOHAS)

Background: Although humeral epicondylitis is a common health problem, there have been no reports that describe its prevalence in Japanese general population, and relatively little is known about its etiology and associated risk factors. Questions/purposes: This study aimed to clarify the prevalence of humeral epicondilitis in Japanese general population, and investigate the associated risk factors using the data from a cross-sectional study of the Locomotive Syndrome and Health Outcome in Aizu Cohort Study (LOHAS). Methods: A total of 1, 777 participants who participated in health checkups conducted at rural area in Japan in 2010 were enrolled. The prevalence of lateral and medial epicondylitis was investigated. Logistic regression models were performed to examine the relationship between lateral epicondylitis and correlated factors such as occupational status, smoking and alcohol preferences, and medical characteristics. Results: The overall prevalence of lateral and medial epicondylitis was 2.5 % and 0.3 %, respectively. A shortened version of the disabilities of the arm, shoulder and hand (The QuickDASH) score was significantly higher in subjects with lateral epicondylitis than in those without (15.0 ± 12.7 vs 8.5 ± 11.1). Subjects with definite chronic hyperglycemia (HbA1c ≥ 6.5) showed a 3.37-times higher risk of lateral epicondylitis than those with favorable glycemic control (HbA1c < 5.5) (95 % confidence interval (CI) 1.16–8.56). Age and sex, as well as occupational status, smoking and alcohol preference, and other metabolic factors were not significantly related to higher risk of lateral epicondylitis. Conclusions: Lateral epicondylitis influences activities of daily living. Chronic hyperglycemia might be one of the risk factor for lateral epicondylitis. Clinical relevance: Chronic hyperglycemia is significantly associated with lateral epicondylitis

Low testosterone levels, depressive symptoms, and falls in older men: a cross-sectional study.

While several studies have cited a potential association between testosterone deficiency and risk of falls among community-dwelling older men, evidence for such an association is conflicting. Depressive symptoms, which occasionally accompany testosterone deficiency but which are often neglected as associated symptoms, may actually provoke falls independent of or jointly with testosterone deficiency. We examined the association between testosterone levels, depressive symptoms, and falls, and assessed the joint effect of testosterone levels and depressive symptoms on falls among older men.Data for this cross-sectional study were obtained from 869 men aged over 60 years who participated in health check-ups conducted in 2010 from 2 Japanese municipalities. Salivary testosterone (sT) levels were measured using an enzyme-linked immunosorbent assay, and depressive symptoms were assessed via the short form of the Center for Epidemiologic Studies Depression Scale. Self-reported "any fall" over the 1-month period. Among the total of 482 participants analyzed (median age, 70 years), 10.8% reported any fall. On comparison between 90th percentile sT levels and lower levels, our logistic regression model with restricted cubic splines showed that lower sT levels were associated with an increased likelihood of suffering any fall after adjustment for sociodemographic characteristics, comorbidities, and mobility function. For example, 5th percentile sT was associated with any fall [adjusted odds ratio (OR), 4.23; 95% confidence interval (CI), 1.66–10.8]. Depressive symptoms were also strongly associated with any fall [adjusted OR, 3.49 (95% CI, 1.52–8.04)]. We noted no apparent interaction of sT and depressive symptoms with falls (P = .079), suggesting that the joint effect of testosterone deficiency and depressive symptoms on falls was multiplicative. Indeed, compared with a combination of 90th percentile sT values and no depressive symptoms, adjusted OR for any fall in a combination involving 5th percentile sT and depressive symptoms was 14.8-fold (95% CI, 3.76–58.0). Our findings indicated that both relatively low testosterone levels and presence of depressive symptoms were independently associated with falls among older men. Causality of these associations should be confirmed in future prospective studies

Overactive bladder symptom severity is associated with falls in community-dwelling adults: LOHAS study.

[Objectives] To examine the association between overactive bladder (OAB) symptom severity and falls and the contribution of OAB symptoms to falls in a community-dwelling population. [Design] Cross-sectional study. [Setting] 2 Japanese municipalities. [Participants] A total of 2505 residents aged over 40 years, who participated in health check-ups conducted in 2010. OAB symptom assessed via overactive bladder symptom score (OABSS) was divided into six categories based on distribution and Japanese clinical guidelines. Mobility problems and depressive symptoms were assessed via the Timed Up and Go test and the short form of the Center for Epidemiologic Studies Depression Scale, respectively. [Primary outcome measures] Self-reported any fall and frequent fall (≥2) over the 1-month period. Independent contributions to any fall and frequent falls were assessed via logistic regression to generate population-attributable fractions (PAFs), assuming separate causal relationships between OAB symptoms, mobility problems and depressive symptoms and any or frequent falls. [Results] Among the total 1350 participants (mean age: 68.3 years) analysed, any fall and frequent falls were reported by 12.7% and 4.4%, respectively. Compared with no OABSS score, moderate-to-severe OAB and mild OAB were associated with any fall (adjusted ORs 2.37 (95% CI 1.12 to 4.98) and 2.51 (95% CI 1.14 to 5.52), respectively). Moderate-to-severe OAB was also strongly associated with frequent falls (adjusted OR 6.90 (95% CI 1.50 to 31.6)). Adjusted PAFs of OAB symptoms were 40.7% (95% CI 0.7% to 64.6%) for any fall and 67.7% (95% CI −23.1% to 91.5%) for frequent falls. Further, these point estimates were similar to or larger than those of mobility problems and depressive symptoms. [Conclusions] An association does indeed exist between OAB symptom severity and falls, and OAB symptoms might be important contributors to falls among community-dwelling adults. Further longitudinal studies are warranted to examine whether or not OAB symptoms predict risk of future falls and fall-related injuries

Age-Related Differences in the Limited Range of Motion of the Lower Extremity and Their Relation to Low Back Pain in Young Baseball Players: A Cross-Sectional Study of 1215 Players

Abstract Background Age-related differences in the limited range of motion of the lower extremities and their relationship with low back pain in juvenile athletes have not been well assessed. This study investigated the relationship between low back pain and limited range of motion of the hip and knee in young baseball players during the baseball season. Results Participants comprised 1215 baseball players (216 pitchers, 999 fielders) aged 6–16 years who underwent medical checkups (self-completed questionnaire and physical examination). Of the 1215 players, 255 (21.0%) experienced seasonal low back pain requiring rest during the previous year. The prevalence of low back pain and a positive Thomas test, straight-leg-raising test, and heel-to-buttock test increased with age. Univariate analysis revealed that a positive heel-to-buttock test in both the throwing and non-throwing arm sides in the 11–12 age group and a positive Thomas test in the throwing arm side in the 13–14 age group were associated with seasonal low back pain (P = 0.0051, P = 0.021, and P = 0.048, respectively). Multivariate analysis, adjusted for factors associated with low back pain, showed significant associations between the positive heel-to-buttock test (odds ratio 1.75, 95% confidence interval 1.11–2.79; P = 0.016) and low back pain in players aged 11–14 years. Conclusions A positive heel-to-buttock test is potentially associated with low back pain among juvenile baseball players. Particular attention should be paid to the limited range of motion of the knee joint and tightness of the quadriceps femoris muscle among baseball players with low back pain aged 11–14 years

Postoperative outcomes of arthroscopic subacromial decompression for rotator cuff tear with shoulder stiffness

Some patients with rotator cuff tear have shoulder stiffness preoperatively. Concomitant preoperative shoulder stiffness may affect postoperative outcomes of arthroscopic subacromial decompression (ASD) for rotator cuff tear. The purpose of this study was to compare postoperative outcomes for ASD between rotator cuff tear patients with and without preoperative shoulder stiffness and to analyze the serial change in functional scores, range of motion (ROM), and pain intensity of the 2 groups after operation. 60 shoulders of 58 patients who underwent ASD for rotator cuff tear were studied. Arthroscopic release was performed for the stiffness group. The results were assessed before surgery and 1, 3, 6, 12 and 24 months after surgery, and the results in the stiffness group and non-stiffness group were compared. No differences in serial changes for postoperative outcomes of ASD were seen in terms of the Japanese Orthopaedic Association shoulder scoring system (JOA scores) and the visual analog scale (VAS scores) for pain at night and pain during motion between the stiffness group and non-stiffness group. However, compared to the non-stiffness group, forward flexion and abduction angles were significantly smaller for the stiffness group at 1 and 3 months after surgery. External rotation and internal rotation angles were significantly smaller at 1 month after surgery for the stiffness group than for the non-stiffness group. Preoperative shoulder stiffness does not affect improvement of postoperative JOA scores and VAS scores of ASD. When measured 6 months after surgery, ROM in the stiffness group and the non-stiffness group was similar

Ultrasonographic assessment of the flexor pronator muscles as a dynamic stabilizer of the elbow against valgus force

Flexor pronator muscles (FPMs) play a key role in stabilizing the elbow joint against valgus forces. However, no studies have investigated the in vivo kinematics of FPMs against these forces on the elbow. This study aimed to clarify the in vivo contribution of each FPM as a dynamic stabilizer in a clinical situation.Twelve healthy volunteers participated in this study. Verbal informed consent was obtained from all subjects. The elbow was flexed to 90 degrees, and the forearm was placed in the neutral position. Manual valgus stress was applied to the elbow joint until maximal shoulder external rotation was achieved. The width of the ulnohumeral joint space and the ulnar shift of the sublime tubercle were measured before and after isometric contraction of FPMs using ultrasonography.The horizontal distances were decreased 1.1±0.6 mm after forearm pronation, 0.6±0.5 mm after wrist palmar flexion, 0.1±0.4 mm after wrist ulnar flexion, and 0.2±0.5 mm after finger flexion. Significant changes were observed during forearm pronation, wrist palmar flexion, and finger flexion but not during wrist ulnar flexion (p<0.05). The sublime tubercle was significantly shifted 0.5±0.1 mm medially after forearm pronation, 0.2±0.1 mm medially after wrist palmar flexion, and 0.1±0.1 mm laterally after wrist ulnar flexion and finger flexion (p<0.05). The FPMs, especially the pronator teres and the flexor carpi radialis, function as dynamic stabilizers against elbow valgus stress. The results of this study may be useful in developing injury prevention and rehabilitation strategies for throwing injuries of the elbow