In The News: January 2011
Surface Electromyography Speeds Recovery Following Knee Surgery
Fear of pain and re-injury can often inhibit recovery following knee surgery. This often results in avoidance of physical activity and the development of deconditioning syndrome—decreased muscle strength, limited range of motion, even weakness in the cardiovascular system. One remedy, according to a study in the November 2010 issue of Biofeedback, is surface electromyography (SEMG)—a noninvasive procedure in which the electrical activity of muscle groups is detected and analyzed during contraction and relaxation. SEMG assessment takes place several weeks after physical therapy has begun. The patient performs prescribed exercises, then muscle inhibition is determined by SEMG, which may indicate that the knee is capable of stronger contraction or may not have reached its full range of motion. Since a patient may be unconsciously protecting the knee by not performing the full range of exercises prescribed in post-op physical therapy, the procedure can be used to show that the knee is capable of more exercise. Researchers found SEMG helped patients overcome muscle inhibition, resulting in increased strength, improved range of movement, and a return to more normal knee functioning.
Vitamin D Deficiency Widespread in Joint-Surgery Patients
Nearly 50 percent of patients undergoing orthopaedic surgery have vitamin D deficiency, a condition that can impede post-op recovery. Bone remodeling or bone tissue formation, a part of the healing process, occurs about two to four weeks after surgery, the critical stage when the body needs vitamin D. Researchers at Hospital for Special Surgery in New York City, conducting a review of 723 patients who were scheduled for orthopaedic surgery in 2007, found vitamin D deficiency rampant. "The take-home message," said the study’s authors, "is that low vitamin D is imminently correctable. We recommend that people undergoing a procedure that involves bone or muscle correct their vitamin D intake [700-1,000 IU per day is recommended for older adults] if they want a faster, better result." The study appeared in the October 2010 issue of The Journal of Bone and Joint Surgery.
Older Women With Normal T-Scores May Not Need Frequent Screening
Since 2002, the U.S. Preventive Services Task force has recommended that women age 65 and older be screened for osteoporosis every two years. That recommendation has now come in for questioning by researchers at Chapel Hill (N.C.) School of Medicine. Claiming that the two-year screening interval is based on limited scientific evidence, their study suggests that women age 67 and older with normal bone mineral density (BMD) scores may not need screening again for 10 years. Said the study’s author, Margaret Gourlay, MD, "If a woman’s bone density at age 67 is good, she doesn’t need to be re-screened in two years, because we’re not likely to see much change." After analyzing data from 5,035 women age 67 and older, Dr. Gourlay and her team concluded that baseline BMD is the most important factor to consider in determining how often a patient should be screened. They suggested that older women with a T-score of -2.0 and below will transition to osteoporosis more rapidly, while women with T-scores higher than -2.0 may not need screening again for up to 10 years.
New RA Drug Shows Early Promise
A new medication has been developed for rheumatoid arthritis (RA) patients who aren’t helped by standard RA therapy. Called fostamatinib, the medication, currently under development, is part of a new class of drugs known as spleen tyrosine kinase inhibitors, which work to block pathways that are responsible for joint inflammation. The drug is taken orally rather than by injection. Researchers at Harvard Medical School studied 457 patients who were taking methotrexate but still had active RA. Those who took fostamatinib along with methotrexate were twice as likely as those taking methotrexate and a placebo to experience significant improvement in their disease after six months. Researchers said although the drug is promising because it is taken orally and works very fast, more studies will be needed to prove fostamatinib’s long-term safety and effectiveness.