Search

Background: Carpal tunnel syndrome is the commonest upper limb peripheral neuropathy. Diffusion tensor imaging evaluates the tissue microarchitecture and measures the movement of water protons. It is non-time-consuming, not invasive and not operator dependent. The aim of our study was to evaluate whether diffusion tensor imaging can diagnose carpal tunnel syndrome and whether DTI parameters can correlate with severity of carpal tunnel syndrome. Results: Seventy-two wrists were assessed, 36 diagnosed with carpal tunnel syndrome and 36 age and sex matched controls. FA & ADC were measured at four locations (distal radioulnar joint, proximal, middle and distal carpal tunnel), and the mean for the whole median nerve was calculated. FA & ADC showed statistically significant difference between cases and control at each of the measured four locations and the mean of the whole median nerve. FA & ADC at the hook of hamate (distal CT) showed the most significant difference between cases and control. For FA, the cut-off point at the hook of hamate was 0.5 (sensitivity 94.4%, specificity of 88.9%, positive predictive value 89.5% and negative predictive value 94.1%) and the cut-off point for the mean of the whole nerve was 0.545 (sensitivity 97.22%, specificity 77.78%, positive predictive value 81.4% and negative predictive value 96.6%). For ADC, the cut-off point at the hook of hamate was 1.44 (sensitivity 97.22%, specificity 86.11%, positive predictive value 87.5% and negative predictive value 96.9%) and the cut-off point for the mean of the whole nerve was 1.415 (sensitivity 86.11%, specificity, 83.33%, positive predictive value 83.8% and negative predictive value 85.7%). Conclusion: Diffusion tensor imaging can diagnose carpal tunnel syndrome with accuracy compared to the gold standard nerve conduction studies. Both FA and ADC showed statistically significant differences between cases & controls with FA measurements found to be more significant. [ABSTRACT FROM AUTHOR]

Background: Musculoskeletal cone-beam computed tomography (CBCT) is an imaging technique for wrist assessment. In this study, we compared image quality and patient satisfaction between CBCT and multidetector computed tomography (MDCT) in traumatic wrist patients in a dose-matched setting. Methods: We prospectively enrolled traumatic patients who were scheduled for CT of the wrist. Patients were randomly assigned to CBCT or MDCT. Radiation dose was kept identical between both modalities. Subsequently, patients were asked to complete a questionnaire regarding the examination. Measurements of contrast-to-noise ratio (CNR) were performed. Three blinded readers independently rated image quality on Likert scales. Results: A total of 125 patients (mean age 35 years [standard deviation 16]; 91 men) were included. A total of 108 patients returned the questionnaire. With equivalent dose, CNRs were higher in CBCT compared to MDCT (p < 0.001) and the median ratings of image quality were better for CBCT compared to MDCT (p ≤ 0.04). Patients only rated positioning in CBCT as more comfortable than in MDCT (p < 0.001), while there were no further differences regarding satisfaction with both modalities. Conclusions: At equivalent dose settings to MDCT, CBCT showed a high image quality for the depiction of bony structures, soft tissue and artifacts in wrist examinations of trauma patients. Overall, patients were equally satisfied with both methods. Altogether, CBCT might be a promising alternative for wrist imaging. However, further studies with more different devices are needed. [ABSTRACT FROM AUTHOR]

Background: The primary causes of short stature (SS) are idiopathic short stature (ISS) and growth hormone deficiency (GHD). The diagnosis of GHD relies on growth hormone stimulation tests (GHSTs), while the diagnosis of ISS is achieved through exclusion. Objectives: Growth hormone (GH) and insulin-like growth factor-I are the best therapeutic drugs for treating GHD, but their suitability for ISS remains controversial. Therefore, distinguishing between these two causes of SS is crucial. Currently, the diagnosis of GHD depends on GHSTs, whereas the diagnosis of ISS is achieved through exclusion, which is an invasive process. Thus, developing a noninvasive and convenient method to differentiate between GHD and ISS would be of great importance. Patients and Methods: We enrolled patients aged 3 -14 years who presented with SS and underwent GHSTs and pituitary gland (PG) magnetic resonance imaging (MRI) at our hospital from January 2020 to October 2022 for a cross-sectional study. A total of 205 patients were included, comprising 83 with ISS and 122 with GHD. The GHD patients were further divided into two groups based on the peak GH level in GHSTs. All patients underwent routine physical examinations, GHSTs, PG MRI, and X-rays of the left wrist. Two authors independently recorded the PG features (height, length, width, volume, pituitary stalk diameter, pituitary stalk length, and morphology). The PG morphology was categorized into three types: Convex, flat, and concave. Bone age was estimated from X-rays of the left wrist, which were reviewed by an experienced radiologist. Comparisons between the two groups were conducted using two independent samples t-tests or chi-square (χ²) tests. Results: There were no differences between the two groups regarding baseline clinical characteristics, except for the GH peak in GHSTs (P < 0.05). Pituitary stalk diameter, PG height, PG volume, and the dorsum sellae were significantly lower, while the tuberculum sellae was higher in the GHD group compared to the ISS group (all P < 0.05). The proportion of concave PG was higher, and the proportion of flat PG was lower in the GHD group (all P < 0.05). In subgroup analysis, PG height and PG volume were significantly lower in the absolute GHD (AGHD) group compared to the partial GHD (PGHD) group (all P < 0.05). Correlation analysis showed that PG height (r = 0.635, P < 0.01) and PG volume (r = 0.786, P < 0.01) were positively correlated with the GH peak level. Further analysis also demonstrated the differential diagnostic accuracy of PG height and PG volume, with high sensitivity (PG height: 66.3%; PG volume: 843%) and specificity (PG height: 85.2%; PG volume: 77.9%). Conclusion: pituitary gland height, PG volume, and the concave type of PG morphology may be very helpful in the differential diagnosis of GHD and ISS. [ABSTRACT FROM AUTHOR]

Objective: The wrist is the second most commonly involved location for GCTB, while distal ulna is a relatively rare location and limited evidence exists on which surgical approaches and reconstruction techniques are optimal. We carried out a multicenter retrospective study to evaluate the recurrence rate of distal ulna GCTB and the long-term functional outcomes of different surgery options. Methods: All 28 patients received surgical treatment for distal ulna GCTB in one of three tertiary bone tumor centers between May 2007 and January 2021 with a minimum two-year follow-up. Surgical options included intralesional curettage or en bloc resection (one of 3 types). Functional outcomes were assessed by the MSTS score, the QuickDASH instrument, MWS, and MHQ according to the latest treatment. Results: Overall recurrence rate was 14.2%. The curettage group (N = 7) had a significantly higher recurrence rate compared to en bloc resection (N = 21) (42.9% vs 4.8%) (mean follow-up: 88.8 mo). Seven patients received the Darrach procedure, 5 received the original Sauvé–Kapandji procedure, and 9 received the modified Sauvé–Kapandji procedure with extensor carpi ulnaris (ECU) tenodesis. Of the 4 patients having a recurrence, 1 received the Darrach EBR, 2 received the modified Sauvé–Kapandji procedure, and 1 received resection for soft tissue recurrence. Only MWS and esthetics in the MHQ scores were different (curettage, Darrach, Sauvé–Kapandji, and Sauvé–Kapandji with ECU tenodesis [MWS: 96.5 ± 1.3 vs 91.5 ± 4.7 vs 90.8 ± 2.8 vs 91.5 ± 3.6; esthetics in MHQ: 98.5 ± 3.1 vs 89.9 ± 4.7 vs 93.8 ± 4.4 vs 92.6 ± 3.8], respectively). Conclusions: En bloc resection for distal ulna GCTB had a significantly lower recurrence rate compared with curettage and achieved favorable functional outcome scores. Given the higher recurrence rate after curettage, patients should be well informed of the potential benefits and risks of selecting the distal radioulnar joint-preserving procedure. Moreover, reconstructions after tumor resection of the ulna head do not appear to be necessary. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study was to investigate the potential of arthroscopic scapholunate ligament repair and dorsal capsulodesis with suture anchor as a treatment option for patients experiencing symptomatic acute and subacute (< 3 months) scapholunate instability. Methods: From Jan. 2017 to Jan 2020, 19 wrists with acute or subacute tears of the SL ligament with symptomatic instability were treated with arthroscopic SL repair and dorsal capsulodesis with a suture anchor. The average time from injury to operation was 8.8 weeks (range, 4–11 weeks) and the regular follow-up mean duration at our clinic was 26.5 months (range, 24–32 months). The pain score according to the visual analog scale, wrist range of motion, grip strength, radiographic outcomes and functional outcomes according to the Modified Mayo Wrist Score (MMWS) were evaluated preoperatively and postoperatively during the follow-up period. Results: All 19 patients had rupture and dissociation of the SL ligament in the radiocarpal joint. The total arc of wrist motion in the flexion–extension plane loss averaged 5.1° (P >.01).The Wilcoxon signed-rank test was used to compare the results: grip force improved significantly with 14.7% improvement of that on the normal side (P <.01); the postoperative MMWS was significantly better than the preoperative scores (P <.01). Of 19 patients of the series, 18 patients (94.7%) achieved good or excellent results according to the MMWS and 16 patients (84.2%) resumed their previous activities. Only one patient (5.3%) had residual laxity of the scapholunate ligament joint at 15 months of follow-up. Conclusions: At a minimum of two years of follow-up, patients with acute or subacute symptomatic dissociation of scapholunate ligament instability who underwent arthroscopic scapholunate ligament repair and dorsal capsulodesis with suture anchor treatment had satisfactory results. Level of Evidence: Level IV, case series. [ABSTRACT FROM AUTHOR]

Growth and maturation are central concerns in the organization of training and competitions in youth sports. This study examined maturity-associated variation in body size and adiposity among adolescent girls participating in competitive age group youth soccer. The sample included 441 players 10.08-16.73 years of age. Stature and body mass were measured and body composition was predicted. The Fels method was used to estimate skeletal age. Skeletally maturity status (late, average or early maturing) was based on the difference between chronological and skeletal age for each player. Mean stature approximated the 50th percentiles of the general population in all competitive age groups, while mean weight fluctuated between 50th and 75th percentiles. Age- and maturity-specific means for estimated fat mass ranged between 18.0% and 28.2%. The number of players classified as skeletally mature increased with competitive age groups (under-13: 0%; under-15: 8%; under-17: 49%). In general, early maturing girls tended to be heavier than their age group peers and especially when compared to late maturing players. [ABSTRACT FROM AUTHOR]

Bone age assessment (BAA) based on X-ray imaging of the left hand and wrist can accurately reflect the degree of the body's physiological development and physical condition. However, the traditional manual evaluation method relies too much on inefficient specialist labor. In this paper, to propose automatic BAA, we introduce a hierarchical convolutional neural network to detect the regions of interest (ROI) and classify the bone grade. Firstly, we establish a dataset of children's BAA containing 2518 left hand X-rays. Then, we use the fine-grained classification to obtain the grade of the region of interest via object detection. Specifically, fine-grained classifiers are based on context-aware attention pooling (CAP). Finally, we perform the model assessment of bone age using the third version of the Tanner–Whitehouse (TW3) methodology. The end-to-end BAA system provides bone age values, the detection results of 13 ROIs, and the bone maturity of the ROIs, which are convenient for doctors to obtain information for operation. Experimental results on the public dataset and clinical dataset show that the performance of the proposed method is competitive. The accuracy of bone grading is 86.93%, and the mean absolute error (MAE) of bone age is 7.68 months on the clinical dataset. On public dataset, the MAE is 6.53 months. The proposed method achieves good performance in bone age assessment and is superior to existing fine-grained image classification methods. [ABSTRACT FROM AUTHOR]

Background: Anatomical parameters of the wrist bones obtained with radiographic images are important for diagnosis and treatment because the ankle pathologies are associated with certain anatomical patterns. The purpose of the present study was to surgically examine the morphometric measurements obtained from wrist radiographs of adult individuals and to develop regression equations for the estimation of bilateral wrist sizes from the obtained measurements. Materials and Methods: The study had a retrospective design and was performed on 200 radiological images (100 right, 100 left) of healthy adult individuals aged 18-65 (50 male, 50 female) applying to the Department of Radiology in the Department of Medicine at the University of Cukurova from 2012 to 2022. The IBM SPSS 21.0 program was used for statistical analyzes, and statistical significance was assumed to be p<0.05. Results: The radiographic measurements were classified according to the right and left hands, and when the bilateral (right and left sides) differences were examined, no statistically significant differences were detected between the right and left hands in all of the angle and length measurements obtained from the wrist images (p>0.05). In addition, the correlation between the angle and length measurements obtained from the wrist radiological images was examined and the statistically significant correlation coefficients between the measurement values we obtained ranged from 0.139 to 0.917. Especially, a very strong positive correlation was found between RA and SFA (r=0.917, p<0.001) measurements. Conclusions: In line with our results, we think that the regression equations developed can be used successfully in terms of using contralateral wrist radiographs as a template in reconstructive surgery of the wrist, since there is no statistically significant difference in right and left (bilateral) wrist measurements and there is sufficient symmetry. [ABSTRACT FROM AUTHOR]

Objective To investigate whether high-resolution peripheral quantitative CT (HR-pQCT) of two metacarpophalangeal (MCP) joints can more accurately classify patients as having erosive RA compared with conventional radiography (CR) of 44 joints in the hands, wrists and feet. Methods In this single-centre cross-sectional study, patients with established RA (disease duration ≥5 years) were investigated by HR-pQCT and CR. The second and third MCP joints of the dominant hand were assessed for erosions by HR-pQCT. CR of the hands, wrists and feet were scored according to the Sharp–van der Heijde (SHS) method. Results In total, 353 patients were included; 66 (18.7%) patients were classified as having non-erosive RA, and 287 (81.3%) had erosive RA by CR. The sensitivity and specificity (95% CI) of HR-pQCT for classifying patients as having erosive RA when standard CR of hands, wrists and feet was used as the reference was 89% (84, 92%) and 30% (20, 43%), respectively. Using HR-pQCT as the reference, the sensitivity and specificity of CR for classifying patients having erosive RA were 85% (80, 89%) and 38% (25, 52%), respectively. McNemar's χ2 test showed no significant difference between the sensitivities of patients classified as having erosive RA by HR-pQCT or by CR (2.14, P  = 0.177). Conclusion The diagnostic accuracy of HR-pQCT scanning of only two MCP joints and CR of 44 joints suggests the two modalities were comparable for classifying patients with established RA as having erosive disease. Clinical trial registration ClinicalTrials.gov (NCT03429426). [ABSTRACT FROM AUTHOR]

To investigate the relationship between handgrip strength (HGs) features, evaluated with an innovative cylindrical-shaped grip device, and demographic, anthropometric and clinical variables, in patients with rheumatoid arthritis (RA). Consecutive RA patients were prospectively enrolled for this cross-sectional study. For each patient were collected demographic, anthropometric, clinical data related to disease activity. HGs was assessed in terms of area under the force–time curve (AUC-FeT), peak grip force and time to reach the curve plateau. The correlations between the variables were studied with the Spearman's rho correlation coefficient. The receiver operating characteristic (ROC) curve analysis was used to test the discriminant accuracy of HGs features in identifying patients in moderate/high disease activity. A multivariate analysis was performed to estimate the contribution of covariates on the AUC-FeT. A significant correlation was found among AUC-FeT, age, Simplified Disease Activity Index (SDAI), Ultrasound-Clinical Arthritis Activity (US-CLARA) (all at p < 0.0001), and body mass index (BMI) (p = 0.0001). Any correlation was found between HGs and radiographic damage. The discriminatory power of AUC-FeT was good [area under-ROC curve = 0.810 (95% CI 0.746–0.864)]. Variables significantly associated with AUC-FeT in multivariate analysis were age (p = 0.0006), BMI (p = 0.012), gender (p = 0.004), SDAI (p = 0.047) and US-CLARA (p = 0.023). HGs is negatively influenced by demographic (gender and age), anthropometric (BMI), and disease activity variables (SDAI and US-CLARA). These findings highlight the role of HGs in RA patients' functional impairment and disability. [ABSTRACT FROM AUTHOR]

Background: Anterior cruciate ligament (ACL) injuries demand individualized treatments based on an accurate estimation of the child's skeletal age. Wrist radiographs, which have traditionally been used to determine skeletal age, have a number of limitations, including cost, radiation exposure, and inconvenience. Purpose: To evaluate the reliability and validity of a radiographic staging system using tibial apophyseal landmarks as hypothetical proxies for skeletal age to use in the preoperative management of pediatric ACL tears. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: The study included children younger than 16 years of age who underwent ACL reconstruction between July 2008 and July 2018 and received both skeletal age radiography and knee radiography within 3 months of each other. Skeletal age was calculated from hand and wrist radiographs using the Greulich and Pyle atlas. Tibial apophyseal staging was categorized into 4 stages: cartilaginous stage (stage 1), apophyseal stage (stage 2), epiphyseal stage (stage 3), and bony/fused stage (stage 4). Data were collected by 2 independent assessors. The analysis was repeated 1 month later with the same assessors. We calculated descriptive statistics, measures of agreement, and the correlation between skeletal age and apophyseal stage. Results: The mean chronological age of the 287 patients included in the analysis was 12.9 ± 1.9 years; 164 (57%) of the patients were male. The overall Spearman r between skeletal age and tibial apophyseal staging was 0.69 (0.77 in males; 0.60 in females). The interrater reliability for the tibial apophyseal staging was substantial (Cohen κ = 0.66), and the intrarater reliability was excellent (Cohen κ = 0.82). The interrater reliability for skeletal age was excellent (intraclass correlation coefficient [ICC] = 0.93), as was the intrarater reliability (ICC = 0.97). Conclusion: The observed correlation between skeletal age and tibial apophyseal staging as well as observed intra- and interrater reliabilities demonstrated that tibial apophyseal landmarks on knee radiographs may be used to estimate skeletal age. This study supports the validity of knee radiographs in determining skeletal age and provides early evidence in certain clinical presentations to simplify the diagnostic workup and operative management of pediatric knee injuries, including ACL tears. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Medical Imaging & Radiation Sciences is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This study determined dietary intake and energy balance of elite premenarcheal rhythmic gymnasts during their preseason training. Forty rhythmic gymnasts and 40 sedentary age-matched females (10-12 yrs) participated in the study. Anthropometric profile and skeletal ages were determined. Dietary intake and physical activity were assessed to estimate daily energy intake, daily energy expenditure, and resting metabolic rate. Groups demonstrated comparable height, bone age, pubertal development, resting metabolic rate. Gymnasts had lower body mass, BMI, body fat than age-matched controls. Although groups demonstrated comparable daily energy intake, gymnasts exhibited a higher daily energy expenditure resulting in a daily energy deficit. Gymnasts also had higher carbohydrate intake but lower fat and calcium intake. Both groups were below the recommended dietary allowances for fiber, water, calcium, phosphorus and vitamin intake. Gymnasts may need to raise their daily energy intake to avoid the energy deficit during periods of intense training. [ABSTRACT FROM AUTHOR]

Objective: To find out the diagnostic role of kisspeptin and neurokinin B in idiopathic central precocious puberty (ICPP) and premature thelarche (PT). Methods: The girls who presented with early breast development before the age of 8 years were evaluated. Patients with intracranial pathologies were excluded. Basal and stimulated follicle-stimulating hormone/luteinizing hormone (LH) levels and basal neurokinin B/kisspeptin levels were measured. Patients who had peak value of LH >5 mIU/mL and a bone age (BA)/chronological age (CA) ratio >1.1 were diagnosed as central precocious puberty (CPP), while cases who did not meet these criteria were diagnosed as PT. Healthy agematched prepubertal girls were included as the control group. Results: The study group contained 25 girls with ICPP (7±0.8 years), 35 girls with PT (6.8±0.7 years), and 30 controls (6.7±0.7 years). Basal serum kisspeptin and neurokinin B levels were 2.36±0.47 ng/mL and 2.61±0.32 ng/mL, respectively in the ICPP group, 2.23±0.43 ng/mL and 2.24±0.23 ng/mL, respectively in the PT group, and 1.92±0.33 ng/mL and 2.03±0.24 ng/mL, respectively in the controls. Both kisspeptin and neurokinin B levels were higher in the ICPP and PT groups compared to controls (p<0.05). Moreover, basal neurokinin B level was different between ICPP and PT groups (p<0.01). A serum neurokinin B level of 2.42 ng/mL provided the most appropriate level to differentiate ICPP from PT, with a sensitivity of 84% and specificity of 77.1%. Conclusion: Differentiation of CPP from PT is sometime difficult, and there is a need for a simple method for the differential diagnosis. Our results suggest that basal serum neurokinin B level can be used as an adjunctive parameter to differentiate ICCP from PT. [ABSTRACT FROM AUTHOR]

Objective. To compare structural damage assessed by conventional radiography and tendon damage assessed by musculoskeletal US (MSUS) at wrist and ankle in RA patients. Methods. We evaluated 72 consecutive patients [56 (77.8%) females] with RA. The MSUS evaluation consisted in a B-mode examination of bilateral extensor carpi ulnaris and tibialis posterior tendons. Tendon damage was defined and scored according to OMERACT. A total score for the tendon damage score (TDS) was calculated by summing the grades for each tendon. For the radiographic evaluations we used the van der Heijde score; a total radiographic score (RTS) was calculated by summing a bone erosion score (ERS) and a joint space narrowing score (JSNS). Results. We evaluated 288 tendons. The mean (S.D.) of TDS was 2.3 (1.8). Fifty-four (75%) patients presented tendon damage of at least one tendon. From all evaluated tendons, 134 (46.5%) had no tendon damage, 146 (50.7%) had grade 1 and 8 (2.8%) had grade 2 tendon damage. The mean (S.D.) for RTS was 91.4 (97), for ERS was 47.3 (61.9) and for JSNS was 44.1 (37.2). We found a significant correlation between disease duration and both TDS and RTS (r = 0.413 and r = 0.560, respectively; P< 0.0001). We found a good significant correlation between TDS and all variables of radiographic structural damage (RTS, r=0.65; ERS, r= 0.637; JSNS, r=0.618; P< 0.001). Conclusion. The MSUS assessment of only four tendons can be an additional feasible method to assess structural damage in RA patients. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effects of treatment with gonadotropin-releasing hormone analog (GnRHa) on final height in girls who experienced moderately early puberty with symptoms beginning at 7-8.5 years of age. Methods: Female cases diagnosed with moderately early puberty which had started between ages 7 to 8.5 years were included in the study. In the treatment groups, all cases with a bone age ≤10.5 years constituted group 1 (n=18) and those with a bone age >10.5 years constituted group 2 (n=23). The 8 patients for which treatment approval could not be obtained constituted group 3. The 49 cases in all three groups were observed until they reached their final height. Results: Target height, target height standard deviation score (SDS), final height, and final height SDS values were similar in all 3 groups. Final height showed a significant positive correlation with target height (p=0.000, r=0.54) and height at diagnosis (p=0.003, r=0.467) in all groups. Linear regression analysis revealed that a 1 cm longer height at diagnosis increased the final height 0.213 fold, and a 1 cm longer target height at diagnosis increased the final height 0.459 fold. Conclusion: We found that GnRHa did not make a positive contribution to final height in cases of moderately early puberty. [ABSTRACT FROM AUTHOR]

This study aimed to determine the correlation between the volumetric parameters derived from the images of the second, third, and fourth cervical vertebrae by using cone beam computed tomography with skeletal maturation stages and to propose a new formula for predicting skeletal maturation by using regression analysis. We obtained the estimation of skeletal maturation levels from hand-wrist radiographs and volume parameters derived from the second, third, and fourth cervical vertebrae bodies from 102 Japanese patients (54 women and 48 men, 5–18 years of age). We performed Pearson’s correlation coefficient analysis and simple regression analysis. All volume parameters derived from the second, third, and fourth cervical vertebrae exhibited statistically significant correlations (P<0.05). The simple regression model with the greatest R-square indicated the fourth-cervical-vertebra volume as an independent variable with a variance inflation factor less than ten. The explanation power was 81.76%. Volumetric parameters of cervical vertebrae using cone beam computed tomography are useful in regression models. The derived regression model has the potential for clinical application as it enables a simple and quantitative analysis to evaluate skeletal maturation level. [ABSTRACT FROM AUTHOR]

Relationships between skeletal maturation and fundamental motor skills and gross motor coordination were evaluated in 429 children (213 boys and 216 girls) 7–10 years. Skeletal age was assessed (Tanner-Whitehouse 2 method), and stature, body mass, motor coordination (Körperkoordinations Test für Kinder, KTK) and fundamental motor skills (Test of Gross Motor Development, TGMD-2) were measured. Relationships among chronological age, skeletal age (expressed as the standardised residual of skeletal age on chronological age) and body size and fundamental motor skills and motor coordination were analysed with hierarchical multiple regression. Standardised residual of skeletal age on chronological age interacting with stature and body mass explained a maximum of 7.0% of the variance in fundamental motor skills and motor coordination over that attributed to body size per se. Standardised residual of skeletal age on chronological age alone accounted for a maximum of 9.0% of variance in fundamental motor skills, and motor coordination over that attributed to body size per se and interactions between standardised residual of skeletal age on chronological age and body size. In conclusion, skeletal age alone or interacting with body size has a negligible influence on fundamental motor skills and motor coordination in children 7–10 years. [ABSTRACT FROM AUTHOR]

Background: Electrophysiologic (EDX) study is the most valuable method in grading the severity of carpal tunnel syndrome (CTS), but it is invasive and painful. We evaluated the efficacy of ultrasound for this purpose. Materials and Methods: Eighty-one wrists of 52 consecutive patients with clinical evidences of CTS, confirmed and graded by EDX as mild, moderate, and severe, were examined by ultrasonography. Cross-sectional area (CSA) of the median nerve was measured at the distal wrist (CSA-D), and proximal forearm (CSA-P), and wrist-to-forearm ratio (WFR) was calculated for each hand. Results: The mean CSA-D was 0.12 cm2 ± 0.03, 0.15 cm2 ± 0.03 and 0.19 cm2 ± 0.06 and the mean WFR was 2.77 ± 1.14, 3.07 ± 1.07 and 4.07 ± 1.61 in mild, moderate and severe groups respectively. WFR showed significant differences between the severe and none severe CTS groups (P < 0.001), but there was no significant difference between mild and moderate CTS groups (P < 0.381). CSA-D showed a significant difference between all groups (P < 0.0001). In the Receiver Operating Characteristic curve analysis, the optimal cut-off value of the CSA-D and WFR for detecting severe CTS were 0.15 (area under the curve 0.784, 95% confidence interval (CI): 0.662-0.898, P < 0.001, sensitivity of 68.2% and specificity of 70.9%) and 3 (area under the curve 0.714, 95% CI: 0.585-0.84, P = 0.001, sensitivity of 68.2% and specificity of 64.8%) respectively. All values were superior in CSA-D. Conclusion: Ultrasonography, can be complementary but not conclusive to the classification of CTS severities. CSA-D and WFR both increased in proportion to CTS severity, but neither parameter exhibited excellent performance in grading the severities. [ABSTRACT FROM AUTHOR]

Talent identification and development in soccer is often biased by maturation-related differences of young athletes. However, there is no information available about success rates for youth maturing at different tempos to achieve success in elite adult soccer. The purposes of this study were to determine the prevalence of different maturational groups among boys playing soccer, and to track them for competence in adult performance. A prospective cohort study design was used to follow 55, 14-year-old boys playing in Serbian youth soccer Division I over eight years. At the age of 14, biological age using skeletal age rates was determined, and participants were categorized as early maturers (EaM), normal maturers (NoM), and late maturers (LaM). Game competence for adult soccer at age 22 was described as elite if an individual played for clubs competing in top-five international soccer leagues (La Liga, Premier League, Bundesliga, Serie A, and Ligue 1), and/or has become a member of an adult National team. Among boys in our study group, 43.8% were categorized as EaM, 35.4% as NoM, and 20.8% as LaM (P = 0.11). A significant difference in biological age was found among maturational groups at age 14, with EaM > NoM > LaM (P > 0.0001). When assessed for adult soccer competence, 33.3% of participants (16 out of 48 players) succeed in achieving elite level. Elite soccer competence acquired 60.1% players from the group of LaM, 38.1% from NoM, and 11.8% from EaM (P > 0.0001). Our comparative analysis suggests that soccer excludes early maturing boys and favors late maturing boys as level of performance increases. [ABSTRACT FROM AUTHOR]

Objective: To analyze the variability and longitudinal stress-related changes in ulnar variance (UV) in a group of immature artistic gymnasts. The relationship between UV and a group of biological and training variables was also investigated. Design: Prospective cohort study. Setting: Portuguese Federation of Gymnastics. Participants: Twenty-five Portuguese skeletally immature gymnasts competing nationally. Assessment of Risk Factors: Skeletal age (Tanner-Whitehouse 3 method), stature, body mass and body mass index (BMI) (Seca stadiometer), fat-free mass and percentage of body fat mass (Tanita BC 418), handgrip strength (Takei dynamometer), and training data (interview). Main Outcome Measures: To determine UV stress-related changes over time, left UV was obtained using Hafner procedure. Ulnar variance values and biological characteristics were tested twice (at baseline and after 18 months of training). Results: Analysis of covariance analysis presented a significant interaction between age and time effect in UV at baseline. Each category of UV reacted differently to the interaction between age and training time. Significant relationships between UV and biological and training variables (chronological and skeletal age, body mass, BMI, handgrip strength, hour per week, and years of training) were evident in at least one of the moments of data collection. Conclusions: The gymnasts showed significant longitudinal UV changes toward less negative UV over the training period. Nevertheless, we could not find a significant correlation between UV and the majority of the researched variables. Thus, although UV has been broadly studied, this phenomenon is complex because it depends on different intrinsic and extrinsic factors that are difficult to control, making necessary additional research on this topic. Clinical Relevance: The gymnast’s wrist has been associated with a high incidence of painful symptomatology and injuries, leading to the formulation of several hypotheses related to the UV ethiology. Knowledge about the possible intrinsic or extrinsic factors related to UV changes and/or different UV categories (negative, neutral, and positive), as well as their consequent specific injuries in gymnasts’ wrists may contribute to a primary prevention or reduction in the occurrence, recurrence and severity of pain, functional disability, or injuries in radius-ulnocarpal joint, thereby improving gymnasts’ performance. [ABSTRACT FROM AUTHOR]

Objective. The aim of this study was to examine the influence of different MRI unit field strengths, coil types and image resolutions on the OMERACT RA MRI scoring system (RAMRIS) of bone marrow oedema (BME) and image quality.Methods. Forty-one patients and 12 healthy controls participated in this cross-sectional study. Coronal short tau inversion recovery (STIR) and T1-weighted sequences were obtained at 0.23, 0.6, 1.5 and 3T using flex coils (Flex). Additional STIR sequences were obtained with phased array extremity coils (Extr) (at 0.6 and 1.5T) and higher resolution (at 1.5T). In otal, 338 STIR image sets were anonymized and scored according to RAMRIS and parameters of image quality were measured.Results. The BME sum scores were similar overall when comparing the different MRI units, coil types and voxel sizes, yet significantly higher at the higher resolution of 1.5T Extr compared with 0.23T Flex (P = 0.004), 0.6T Flex (P = 0.03), 1.5T Flex (P = 0.05) and 3T Flex (P = 0.001). Mean differences were relatively minor (0–3.5). Intrareader reliability of BME scores was high [intraclass correlation coefficient ≥ 0.90 for all except 0.23T (0.81) and percentage exact agreement 81–88%]. The smallest detectable difference was better at 0.6, 1.5 and 3T (9–29% of maximum value) than at 0.23T (40%). Image quality was lowest at 0.23T.Conclusion. No major, consistent differences were found between BME scores using STIR sequences obtained at different field strengths, coil types and image resolutions, suggesting that these are equally suited for assessment of BME in RA. However, parameters of image quality and intrareader reliability (favouring 0.6, 1.5 and 3T) should be considered when selecting the MRI acquisition strategy. [ABSTRACT FROM PUBLISHER]

Acupuncture and electroacupuncture treatments of symptomatic carpal tunnel syndrome (CTS) may improve symptoms and aid nerve repair as well as improve sensory and motor functions. However, limited evidence is available regarding the effects of these treatments based on comprehensive evaluation methods. This research completed the treatment and evaluation of 26 patients with confirmed CTS. Participants were divided into two treatment groups based on a modified neurophysiological grading scale. Of the total number of participants, 15 received acupuncture and 11 received electroacupuncture on both upper limbs. Acupoints were PC-7 (Daling) and PC-6 (Neiguan) along the pericardial meridian compatible with the median nerve tract. The treatment program consisted of 24 sessions of 15 min duration over 6 weeks. After electroacupuncture treatments, symptom severity was evaluated using the short clinical questionnaire by Lo and Chiang, which indicated improvements in the respective symptom severity score. After the acupuncture treatment, grip strength in the major symptomatic side in CTS patients could be significantly increased. Electrophysiology evaluation likewise indicated a significant increase in the distal median motor amplitude of the palm-wrist segment. In addition, Tinel's sign significantly decreased in the major symptomatic side. Our findings indicated that electroacupuncture could improve symptomatology, while acupuncture could exert positive therapeutic effects for CTS patients, as evidenced by improved symptomatology, grip strength, electrophysiological function, and physical provocation sign. [ABSTRACT FROM AUTHOR]

Objective. To investigate the relationship between synovial vascularity and joint damage progression in each finger joint of patients with RA under low disease activity during treatment with biologic agents.Methods. We studied 310 MCP and 310 PIP joints of 31 patients with active RA who were administered adalimumab (ADA) or tocilizumab (TCZ). Patients were examined with clinical and laboratory assessments. Power Doppler sonography was performed at baseline and at weeks 8, 20 and 40. Synovial vascularity was evaluated according to quantitative measurement. Hand and foot radiography was performed at baseline and at week 50.Results. Composite scores of the DAS with 28 joints and the Simplified Disease Activity Index (SDAI) were significantly decreased from baseline to week 8, being sustained at a low level by biologic agents during the observational period. MCP and PIP joints with positive synovial vascularity after week 8 showed more subsequent joint damage progression than joints without synovial vascularity throughout the follow-up. The changes in radiographic progression in these joints were independent of the sum of synovial vascularity from baseline to week 40 or the occasional occurrence of positive synovial vascularity.Conclusion. Smouldering inflammation reflected by positive synovial vascularity under low disease activity was linked to joint damage. The damage progressed irrespective of the severity of positive synovial vascularity. Even with a favourable overall therapeutic response, monitoring of synovial vascularity has the potential to provide useful joint information to tailor treatment strategies.Trial registration. University Hospital Medical Information Network Clinical Trials Registry; http://www.umin.ac.jp/ctr/; UMIN000004476. [ABSTRACT FROM AUTHOR]

Background. Distal radius fractures are the most common fracture of the upper extremity and cause variable disability. This study examined the role of social support in patient-reported pain and disability at one year following distal radius fracture. Methods.The Medical Outcomes Study Social Support Survey was administered to a prospective cohort of 291 subjects with distal radius fractures at their baseline visit. Pearson correlations and stepwise linear regression models (F-to-remove 0.10) were used to identify whether social support contributes to wrist fracture outcomes.The primary outcome of pain and disability at one year was measured using the Patient RatedWrist Evaluation. Results.Most injuries were low energy (67.5%) and were treated nonoperatively (71.9%). Pearson correlation analysis revealed that higher reported social support correlated with improved Patient RatedWrist Evaluation scores at 1 year, r(n = 181) = -0.22, P < 0.05. Of the subscales within the Social Support Survey, emotional/informational support explained a significant proportion of the variance in 1-year Patient Rated Wrist Evaluation scores, R2 = 4.7%, F (1, 181) = 9.98, P < 0.05. Conclusion. Lower emotional/informational social support at the time of distal radius fracture contributes a small but significant percentage to patient-reported pain and disability outcomes. [ABSTRACT FROM AUTHOR]

The article discusses research investigating whether preadolescent boys exhibit plyometric trainability. They recruited 45 children of approximately 11 years who were randomly assigned to either a group that participated only in regular soccer practice or a group that participated in soccer practice and plyometric training (PT), which is a method for improving muscle ability to generate explosive power. Results showed that prepubertal boys exhibited plyometric trainability.

Inactivating mutations in phosphate-regulating endopeptidase (PHEX) cause X-linked hypophosphatemic rickets (XLHR) characterized by phosphaturia, hypophosphatemia, bony deformities, and growth retardation. We assessed the efficacy of combined calcitriol and orally administered phosphate (Pi) therapy on longitudinal growth in relation to age at treatment onset in a retrospective, single-center review of children with XLHR and documented PHEX mutations. Growth was compared in those who started treatment before (G1; N = 10; six boys) and after (G2; N = 13; five boys) 1 year old. Median height standard deviation score (HSDS) at treatment onset was normal in G1: 0.1 [interquartile range (IR) −1.3 to 0.4) and significantly ( p = 0.004) lower in G2 (IR −2.1 (−2.8 to −1.4). Treatment duration was similar [G1 8.5 (4.0-15.2) vs G2 11.9 (6.2-14.3) years; p = 0.56], as were prescribed phosphate and calcitriol doses. Recent HSDS was significantly ( p = 0.009) better in G1 [−0.7 (−1.5 to 0.3)] vs G2 [−2.0 (−2.3 to −1.0)]. No effects of gender or genotype on growth could be identified. Children with PHEX-associated XLHR benefit from early treatment and can achieve normal growth. Minimal catchup growth was seen in those who started treatment later. Our findings emphasize the importance of early diagnosis to allow treatment before growth has been compromised. [ABSTRACT FROM AUTHOR]