Potential Clinical Impact of Compounded Versus Noncompounded Intrathecal Baclofen Moberg-Wolff et al
Intrathecal baclofen (ITB) is available in both commercially and locally compounded forms. Moberg-Wolff notes that there are concerns about the safety and consistency of the latter and investigated the differences between the ITB preparations of 1 commercial and 6 pharmacy sources. Twenty-nine samples were analyzed. Concentrations ranged from 2000 to 6000mcg/ml. Over 40% of the compounded samples differed by more than 5% from their labeling and 1 in 5 varied by more than the 10% limit permitted by the FDA. Precipitation was noted in a number of the compounded preparations and only samples that did not deviate significantly from their labeling were supplied by the commercial source. The author concludes that ITB concentrations can vary between sources and that these variations could potentially become a safety concern particularly for patients unusually sensitive to slight dose fluctuations.
Association of Dynamic Joint Power With Functional Limitations in Older Adults With Symptomatic Knee Osteoarthritis Segal et al
Segal and colleagues studied the movement strategies associated with symptomatic knee osteoarthritis in a cross-sectional study of 60 community dwelling people. Subjects were required to have pain "on most days of the month" and a Kellgren-Lawrence grade of 2 or higher. Joint movement and power analysis were determined with 3-dimensional computerized motion analysis. The investigators found that subjects with higher levels of mobility tended to rely more on an ankle rather than a hip strategy during gait. They also noted that higher knee extensor and flexor strength may contribute to an ankle strategy in higher functioning men, while hip abductor weakness may bias women with lower-mobility function to minimize loading across the knee via use of a hip strategy. The investigators conclude that these findings may serve as foci for the design of more targeted rehabilitation gait interventions.
Novel Applications of Ultrasound Technology to Visualize and Characterize Myofascial Trigger Points and Surrounding Soft Tissue Sikdar et al
Recent papers in the Archives by groups led by Chen (2007:88:1658-61), Shah (2008;89:16-23) and Chou (2009:90:905-12) have begun to provide a more quantitative understanding of the physical, biochemical, and electrodiagnostic characteristics of the taut bands and trigger points of myofascial pain. Sikdar and colleagues expand on this work in exploratory investigation of the feasibility of using ultrasound to image these features. The investigators found that trigger points could be localized as elliptically shaped hypoechoic areas with sizes of about .16cm2. It was also noted that active and latent points did not appear to differ in size but that those identified as active were associated with a more highly resistive vascular bed. The authors conclude that these findings suggest that ultrasound imaging techniques can be used to visualize and assist in the characterization of myofasical pain.
Patient Education for the Treatment of Ulnar Neuropathy at the Elbow Nakamichi et al
Nakamichi and colleagues note that while surgery is frequently performed for patients with ulnar, neuropathy, there are indications that education may be more beneficial than previously thought. The authors investigated this premise in 77 adults (a total of 80 nerves) with ulnar neuropathy at the elbow. All subjects were given an educational program that reviewed the pathophysiology of the condition and instructed them in work place and movement modifications to minimize ulnar nerve trauma, traction and pressure. The investigators found that two thirds of the nerves studied exhibited an excellent or good outcome and that none worsened over the study's 3-month course and follow-up. Elbow osteoarthritis was associated with a worse outcome while age, sex, side, duration and severity, diabetes, dislocation, and smoking were not. The authors conclude that education is an effective approach to the treatment of many people with ulnar neuropathy but is likely most beneficial in those with less severe elbow osteoarthritis.
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