UHCW publication: Effect of a lateral glide mobilisation with movement of the hip on vibration threshold in healthy volunteers

Effect of a lateral glide mobilisation with movement of the hip on vibration threshold in healthy volunteers.
Smith, Darren A; Saranga, Jacob; Pritchard, Andrew; Kommatas, Nikolaos A; Punnoose, Shinu Kovelal; et al.
Journal of bodywork and movement therapies Vol. 22, Iss. 1, (January 2018): 13-17.


Abstract

Background
Mulligan's mobilisation-with-movement (MWM) techniques are proposed to achieve their clinical benefit via neurophysiological mechanisms. However, previous research has focussed on responses in the sympathetic nervous system only, and is not conclusive. An alternative measure of neurophysiological response to MWM is required to support or refute this mechanism of action. Recently, vibration threshold (VT) has been used to quantify changes in the sensory nervous system in patients experiencing musculoskeletal pain.

Objective
To investigate the effect of a lateral glide MWM of the hip joint on vibration threshold compared to a placebo and control condition in asymptomatic volunteers.

Methods
Fifteen asymptomatic volunteers participated in this single-blinded, randomised, within-subject, placebo, control design. Participants received each of three interventions in a randomised order; a lateral glide MWM of the hip joint into flexion, a placebo MWM, and a control intervention. Vibration threshold (VT) measures were taken at baseline and immediately after each intervention. Mean change in VT from baseline was calculated for each intervention and then analysed for between group differences using a one-way analysis of variance (ANOVA).

Results
A one-way ANOVA revealed no statistically significant differences between the three experimental conditions (P = 0.812).

Conclusion
This small study found that a lateral glide MWM of the hip did not significantly change vibration threshold compared to a placebo and control intervention in an asymptomatic population. This study provides a method of using vibration threshold to investigate the potential neurophysiological effects of a manual therapy intervention that should be repeated in a larger, symptomatic population.

NICE draft guideline on rheumatoid arthritis - consultation open

NICE draft guidelines on rheumatoid arthritis in adults are open for consultation until 1st March 2018.


The proposals include giving adults with rheumatoid arthritis access to specialist physiotherapy to help manage their condition and improve their fitness, flexibility and strength.


See the draft guidelines and register to contribute to the consultation process at https://www.nice.org.uk/guidance/indevelopment/gid-ng10014/consultation/html-content-2

RCOT announces revised guidelines for occupational therapy and total hip replacement

The Royal College of Occupational Therapists (RCOT) is delighted to announce the publication of the second edition of the practice guidelines for working with people undergoing total hip replacement. Endorsed by the British Hip Society, the new guidelines recognise in particular the changes in length of recommended stay for patients as well as the fact that this surgery is increasingly being performed on younger patients.
https://www.rcot.co.uk/practice-resources/rcot-practice-guidelines/hip

Effect of a lateral glide mobilisation with movement of the hip on vibration threshold in healthy volunteers

J Bodyw Mov Ther. 2018 Jan;22(1):13-17. doi: 10.1016/j.jbmt.2016.10.001. Epub 2016 Oct 21.

OBJECTIVE: To investigate the effect of a lateral glide MWM of the hip joint on vibration threshold compared to a placebo and control condition in asymptomatic volunteers.
METHODS:

CONCLUSION: This small study found that a lateral glide MWM of the hip did not significantly change vibration threshold compared to a placebo and control intervention in an asymptomatic population. This study provides a method of using vibration threshold to investigate the potential neurophysiological effects of a manual therapy intervention that should be repeated in a larger, symptomatic population.

UHCW Research: A Pritchard

Infographic: Meniscal transplantation is beneficial at one year

Bone Joint J. 2018 Jan;100-B(1):64-65. doi: 10.1302/0301-620X.100B1.BJJ-2017-1478.
UHCW Research: Smith NA, Wright, D, Spalding, T, Hutchinson, C and Thompson, P

A pilot randomized trial of meniscal allograft transplantation versus personalized physiotherapy for patients with a symptomatic meniscal deficient knee compartment

Bone Joint J. 2018 Jan;100-B(1):56-63. doi: 10.1302/0301-620X.100B1.BJJ-2017-0918.R1.

Meniscal allograft transplantation is undertaken to improve pain and function in patients with a symptomatic meniscal deficient knee compartment. While case series have shown improvements in patient reported outcome measures (PROMs), its efficacy has not been rigorously evaluated. This study aimed to compare PROMs in patients having meniscal transplantation with those having personalized physiotherapy at 12 months.

UHCW Research: Smith NA, Wright, D, Spalding, T and Thompson, P

Rotational glenohumeral adaptations are associated with shoulder pathology in professional male handball players

Knee Surgery, Sports Traumatology, Arthroscopy, Jan2018; 26(1): 67-75

Glenohumeral range of motion adaptations may affect throwing athletes and contribute to shoulder injury. The purpose of this study was to evaluate shoulder rotation deficits among elite professional handball players and its correlation to the presence of shoulder pain and morphological changes

UHCW Research: Lior Laver

Children best placed to explain facts of surgery to patients, say experts

Medical Devices & Surgical Technology Week; Atlanta [Atlanta]31 Dec 2017: 90.
Research shows that patients who are given clear information about their test, operation or care are less anxious and more satisfied with their care.

Patient information leaflets are a popular way to support verbal discussion with a health professional, particularly where consent is needed. However, the average reading age in the UK is 9 years, and some studies indicate that the average readability (a measure of how easy a piece of text is to read) needed for patient information leaflets is beyond 9 years.

So Dr Catrin Wigley at University Hospitals Coventry and Warwickshire NHS Trust and colleagues assessed the average readability of six NHS patient information leaflets for hip replacement surgery (total hip arthroplasty) and found an average readability score of 17 - well above a reading age of 9 years.

They then recruited 57 school children aged 8-10 at a local primary school to help revise the content.

A prospective, observational cohort study of patients presenting to an emergency department with acute shoulder trauma: the Manchester emergency shoulder (MESH) project

BMC Emergency Medicine 201717:40 https://doi.org/10.1186/s12873-017-0149-y

Fracture and dislocation of the shoulder are usually identifiable through the use of plain radiographs in an emergency department. However, other significant soft tissue injuries can be missed at initial presentation. This study used contrast enhanced magnetic resonance arthrography (MRA) to determine the pattern of underlying soft tissue injuries in patients with traumatic shoulder injury, loss of active range of motion, and normal plain radiography.

UHCW Research: Charles E. Hutchinson

The Assessment and Management of Simple Elbow Dislocations

The Open Orthopaedic Journal,  Volume 11, 2017

The majority of simple elbow dislocations can be successfully managed non-operatively with good reliable outcomes. Careful follow up is essential, however, to identify patients that may occasionally develop persistent instability or stiffness and require intervention.

UHCW Research: Andrew J. Grazette and Alex Aquillina

Current Concepts in Elbow Trauma

Editorial in The Open Orthopaedics Journal vol 11, 2017

Elbow injuries are relatively common and have a significant socioeconomic impact, accounting for 10% of all injuries to the upper limb with almost one third of these being dislocations and approximately 10% being fractures.  Furthermore, the elbow is the second most commonly dislocated joint in adults and the most commonly dislocated joint in the paediatric population with 40% of these injuries being associated with sport.  Injuries patterns can range from simple low-energy dislocations up to high-energy complex fractures and fracture-dislocations.

UHCW Research: Chetan S. Modi

Clinical Anatomy and Assessment of the Elbow

The Open Orthopaedics Journal, 2017, 11, (Suppl-8, M2) 1347-1352

The elbow is a complex synovial hinge joint comprising of three articulations. Satisfactory function and stability are provided by bony and soft tissue stabilising structures. Injuries around the elbow joint are common.
Knowledge of the intricate anatomy around the elbow joint is essential to successfully assessing and managing elbow injuries and restoring good function.

UHCW Research: Alexander L Aquilina  and Andrew J Grazette

Tonogenchoncel-L (Invossa) Gene Therapy for Regeneration of Cartilage in Patients with Degenerative Arthritis or Osteoarthritis of the Knee

Tonogenchoncel-L is a type of treatment which involves taking cells which make up the cartilage and altering them genetically to help stimulate the growth of the cartilage. These modified cells are injected directly into the knee joint with the intention of helping the lost cartilage regrow. If tonogenchoncel-L was licenced in the UK it could provide a unique treatment for people with knee osteoarthritis which has the potential to help cartilage regrow and improve symptoms.

From NIHR Innovation Observatory

Upadacitinib for Adults with Moderate to Severe Active Rheumatoid Arthritis After Conventional Synthetic Disease-Modifying Anti-Rheumatic Drugs (DMARDs) or Biologic DMARDs Failure

There is currently no cure for rheumatoid arthritis and treatment aims to improve quality of life and to prevent or reduce joint damage. The most common treatment options are steroids to reduce inflammation, medications to reduce pain and swelling, and medications that slow the progression of joint damage from RA. Upadacitinib is currently being developed to be taken orally as a treatment option for those who have active moderate to severe RA who do not respond to certain treatment options. This drug works by stopping the inflammation caused by a specific type of protein and if licensed, it may be an option that can be used earlier in the treatment pathway.

From NIHR Innovation Observatory

Common Paediatric Elbow Injuries

The Open Orthopaedics Journal, 11(Sup 8, M6) p1380-1393. DOI: 10.2174/1874325001711011380

Paediatric elbow injuries account for a large proportion of childrens’ fractures. Knowledge of common injuries is essential to understanding their assessment and correct management. Understanding of the ossification centres around the paediatric elbow is essential to correctly assessing and managing the common injuries that we have discussed in the review. Outcomes after these injuries are usually favourable with restoration of normal anatomy.

UHCW Research: Christopher E. Hill, Stephen Cooke

Total distal radioulnar joint replacement for symptomatic joint instability or arthritis [IPG595]

New: Interventional procedures guidance from NICE:

Evidence-based recommendations on total distal radioulnar joint replacement for symptomatic joint instability or arthritis in adults. This involves removing the wrist end of the ulna (one of the forearm bones) and replacing it with a metal prosthesis that also attaches to the wrist end of the radius (the other forearm bone).

1.1 Current evidence on the safety and efficacy of total distal radioulnar joint replacement for symptomatic joint instability or arthritis is limited in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent and audit or research.

1.2 Clinicians wishing to do total distal radioulnar joint replacement for symptomatic joint instability or arthritis should:

Greater pre-operative anxiety, pain and poorer function predict a worse outcome of a total knee arthroplasty

Knee Surg Sports Traumatol Arthrosc (2017) 25: 3403. https://doi.org/10.1007/s00167-016-4314-8

Around 10–30 % of patients are dissatisfied with the results of their total knee arthroplasty (TKA). This review aimed to identify and evaluate the predictors of outcome measured by the three domains of health-related quality of life (pain, stiffness and function). The focus was on pre-operative psychological factors as related to other patient-related variables.

UHCW Research: Daniel Wilson-Nunn

Autologous chondrocyte implantation for treating symptomatic articular cartilage defects of the knee

New Technology Appraisal Guidance from NICE

Autologous chondrocyte implantation (ACI) is recommended as an option for treating symptomatic articular cartilage defects of the knee, only if:

• the person has not had previous surgery to repair articular cartilage defects 
• there is minimal osteoarthritic damage to the knee (as assessed by clinicians experienced in investigating knee cartilage damage using a validated measure for knee osteoarthritis) 
• the defect is over 2 cm2 and 
• the procedure is done at a tertiary referral centre.

NJR 14th Annual Report: significant increase in joint replacement procedures with “very impressive” outcomes

The orthopaedic joint replacement register for England, Wales, Northern Ireland and the Isle of Man has published a new report which highlights a record number of procedures being performed.

More joint replacements than ever before were carried out in the financial year 2016/17, with just fewer than 243,000 cases submitted to the National Joint Registry (NJR). This sees a significant increase of more than 20,000 joint replacement operations recorded in the registry on the previous period.

Adult native knee extensor mechanism ruptures

Injury. 2016 Oct;47(10):2065-2070. doi: 10.1016/j.injury.2016.06.032. Epub 2016 Jun 27.

Extensor mechanism rupture is a serious event requiring prompt diagnosis and treatment. Patella fractures are reportedly six times more frequent than soft tissue injuries such as quadriceps or patella tendon ruptures. Classically quadriceps and patella tendon ruptures are seen more in males, with those over 40 predominantly suffering from quadriceps tendon ruptures, often associated with an underlying condition, whereas patella tendon ruptures are mostly associated with sport injuries and are commonly seen in the under 40s. Almost all types of extensor mechanism ruptures benefit from early management which typically involves surgery. Diagnosis can be deemed easy to make by demonstrating inability to actively extend the knee, this however can be easily overlooked and missed in a busy emergency department leading to a late diagnosis and necessitating more complex surgery. Earlier surgical intervention and rehabilitation tend to produce improved outcomes.

UHCW Research: Pengas I. P. and Spalding, T.