No description available.

The overall aim of the project was to further the research into the objective measurement of the symptoms of arthritic disease. There were three major parts to this study. The first part was to design a measurement system capable of making large scale, objective measurements of the stiffness of the human metacarpophalangeal joint. The second part was to design a new device to measure the grip strength of the human hand objectively. The last part was to use these two measurement systems to conduct research into the clinical manifestations of arthritic disease and study the effects of some therapeutic agents. A new, microcomputer controlled arthrograph system was developed to measure the stiffness of the metacarpophalangeal joint of the index finger. The system proved to be reliable, easy to use and sufficiently accurate to quantify changes in joint stiffness. A new design of grip machine was produced which enabled the forces developed during a power grip to be analysed. Measurement was made of the force contributions of individual digits and the maximum total gripping force. The machine was portable and extremely easy to use. A study of the circadian variation of joint stiffness and grip strength, over a full twenty four hour period, was carried out. Measurements were made every two hour in both healthy and arthritic subjects. A circadian variation of stiffness was observed in the joints of arthritic subjects. Joint stiffness was elevated in the early morning and for some subjects the degree of change was profound. No significant circadian variation was observed in the joint stiffness of healthy subjects. A circadian variation of grip strength was observed in arthritic subjects. Grip strength reached a minimum value between 2.00 and 4.00 a.m. in the majority of subjects. No consistent relationship was found between changes in joint stiffness and changes in grip strength. The effect of several forms of physiotherapy on the joint stiffness of arthritic subjects was studied in both the short and long term. The subjects were measured before, and then immediately after, treatment each time they visited a physiotherapy hand clinic. Only the results of those patients who attended the clinic for a minimum of five weeks were used in any subsequent analysis. Four different treatments were studied: hot wax and ultrasound, hot wax alone, ultrasound alone and exercise. The combination of hot wax baths and ultrasonic therapy effected temporary reductions in all joint stiffness parameters. The reductions in energy dissipation and torque range were highly significant ( p < 0.05 and p < 0.001 respectively ). No significant reductions were found for hot wax, ultrasound alone or exercise. In the long term, no significant change in joint stiffness was found for any of the treatments considered.

No description available.

Thesis (MSc)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: Reverse total shoulder arthroplasty is used as the treatment for arthritic rotator cuff deficient shoulders. Some of the most common complications of a reverse shoulder arthroplasty are scapular notching, glenoid dissociations, glenohumeral dislocation, loosening or dissociation of the humeral component and nerve injury. Clinical outcomes are dependent on the preoperative diagnosis, the function of the deltoid and remaining rotator cuff muscles, biomechanical design of the prosthesis, and the orientation and placement of the reverse shoulder component. This study aims to optimize the patient-specific placement of a reverse shoulder component. A simulation software package was developed that can be used to determine the optimal placement of the reverse shoulder prosthesis for a specific patient. This is achieved by maximizing the humerothoracic range of motion and minimizing the adduction deficit. The motion of the simulation model is driven by shoulder complex motion equations adjusted for each patient. This data was obtained from literature with the motion of the arm fixed to the coronal, scapular and sagittal elevation planes. The influence of the various components of the Tornier Aequalis® - Reversed II system, together with changing the glenoid component inclination and humeral component retroversion, was investigated. This allowed the simulation software to be verified and validated, as well as applying the insight and knowledge gained to a case study. Further simulations evaluated a design change of the humeral component neck-shaft angle from the standard 155 ° to 145 ° or 165 °. The reverse shoulder simulation software provides accurate patient-specific Three Dimensional (3D) pre-operative planning and shoulder complex motion simulation. / AFRIKAANSE OPSOMMING: Omgekeerde volledige skouerartoplastie word as behandeling van ontsteking in gewrigsomhulsel-aangetaste skouers gebruik. Onder die algemeenste komplikasies van 'n omgekeerde skouergewrig-operasie is kepe in die skouerblad (skapulier), lostrekkings of onthegting van die gewrigskom (glenoïede), ontwrigting van die boarm/skouergewrig, die loskom of onthegting van die boarmbeen en beskadiging van senuwees. Mediese resultate is afhanklik van diagnose voor die operasie, die werking van die driehoekspier (deltoïede) en oorblywende draaispiere, die biomeganiese ontwerp van die prostese en die oriëntasie en plasing van die omgekeerde skouerkomponent. Hierdie studie is gemik op die beste pasiënt-spesifieke plasing van die omgekeerde skouerkomponent. Die simulasie-sagtewarepakket wat ontwikkel is, kan gebruik word om die optimale plasing van die omgekeerde skouerprostese in die geval van 'n spesifieke pasiënt te bepaal. Dit word gedoen deur die bewegingsvermoë van die bo-armbeen te maksimaliseer en die gebrekkige werking van die trekspiere te minimaliseer. Die werking van die simulasiemodel word gedryf deur die beweging van skouerkomponente te vergelyk, aangepas vir elke pasiënt. Hierdie data is verkry uit literatuur en die koppeling van die arm se beweging aan die belangrikste, skouerblad- en sagittale elevasievlakke. Die invloed van die onderskeie komponente van die Tornier Aequalis® - Reversed II-stelsel is saam met die verandering van die gewrigskom-komponent se helling en bo-armkomponent se terugstoting ondersoek. Sodoende kon die simulasie-sagteware nagegaan, bevestig en geldig verklaar word; en die insig en kennis wat verkry is op 'n gevallestudie toegepas word. Met verdere simulasies is 'n ontwerpwysiging ge- ëvalueer waar die skouerkomponent se beenpyphoek vanaf die standaard van 155° na 145° of 165° verander is. Die omgekeerde skouersimulasiesagteware maak akkurate pasiëntspesifieke driedimensionele (3D) beplanning voor 'n operasie en simulasie van die bewegings skouerdele moontlik.

名古屋大学博士学位論文 学位の種類 : 博士(医学)(論文) 学位授与年月日:平成8年3月8日 辻井洋一郎氏の博士論文として提出された

国立情報学研究所で電子化したコンテンツを使用している。

Résumé : Contrairement à ce que l'on pourrait croire, les douleurs chroniques ne constituent pas uniquement des symptômes, mais bien une pathologie à part entière. La pharmacopée actuelle ne permettant pas de les soulager efficacement, il y a maintenant un besoin de les considérer dans leur spécificité lors de la recherche de nouvelles thérapies. Dans cette optique, nous avons étudié le rôle des chimiokines et de leurs récepteurs dans le contrôle de la douleur. Connu pour leur rôle dans la réponse immunitaire, nous avons en particulier investigué le rôle du couple ligand-récepteur CCL2-CCR2 dans la régulation des douleurs d’origine arthritique. Nous avons d'abord évalué l'effet analgésique de notre molécule antagoniste du récepteur CCR2, l'INCB3344, dans un modèle de douleur inflammatoire où elle renverse d'environ 50% les douleurs provoquées et les douleurs spontanées lorsqu'administrée par voie spinale. Nous avons également pu observer que bloquer l'activation de CCR2 au niveau de la moelle épinière limite non seulement la neuroinflammation spinale, mais permet également de réduire la sévérité de l'atteinte inflammatoire périphérique en limitant le transport rétrograde de la substance P. Nous avons ensuite appliqué nos observations sur un modèle de douleur arthritique plus près de la réalité clinique des patients souffrant d'arthrite rhumatoïde. Nous y avons reproduit la majorité de nos effets analgésiques suite à une administration spinale. Le traitement est cependant demeuré sans effet sur l'œdème périphérique. Parallèlement à cela, l'administration périphérique du composé, sur une base de deux bolus par jour ou en libération continue par des mini-pompes osmotiques, n'a eu que de très faibles effets analgésiques, mais s'est révélé avoir un impact marquant sur l'œdème périphérique et le gain de poids des animaux. Finalement, c'est en combinant l'INCB3344 avec de l'ibuprofène qu'il a été possible d'avoir un impact positif sur le plus grand nombre de paramètres associés à la douleur chronique. Ces résultats suggèrent donc qu'un antagoniste du récepteur CCR2 possède un potentiel analgésique intéressant, d'autant plus lorsqu'il s'agit de douleur d'origine inflammatoire puisqu'il permet d'agir à la fois sur l'hypersensibilité nociceptive et sur la source même de la douleur inflammatoire. Ce potentiel devient d'autant plus intéressant que de le combiner à un anti-inflammatoire non-stéroïdien (l'ibuprofène) améliore l'efficacité des deux composés. // Abstract : Contrary to popular beliefs, chronic pain is not only a set of symptoms, but a bona fide pathology that the drugs currently available are not sufficient to efficiently relieve. There is thus a need to modify our approach to discover new analgesic agents, taking into consideration the specific physiopathology of chronic pain. With this in mind, we investigated the role of chemokines and their receptors in the modulation of pain. Also known for their participation in the immune response, we focused on the CCL2-CCR2 ability to regulate arthritic pain. We first evaluated the analgesic properties of INCB3344, a specific antagonist of the CCR2 receptor, in a model of inflammatory pain. It reverses both provoked and spontaneous pain by 50% when administered i.t. We also observed that spinally blocking CCR2 limited the expression of proinflammatory mediators. It also reduced peripheral inflammation by preventing peripheral transport of SP. We then translated our findings in a model of arthritic pain, closer to the clinical reality of patients with rheumatoid arthritis. Spinal administration of INCB3344 had similar analgesic actions, but did not altered peripheral inflammation. On the other hand, peripheral administration of INCB3344, either by subcutaneous injection or by continuous release assured by an osmotic pump, had almost no analgesic effects, but significantly reduced peripheral inflammation and reduced the weight loss. By combining INCB3344 with a daily administration of ibuprofen, we were however able to reduce both pain hypersensitivity and the severity of the peripheral inflammation. Taken together, these results suggest that CCR2 antagonism has promising analgesic properties; especially for inflammatory or arthritic pain as it can acts both on the sensibilized nociceptive network and on the peripheral source of the inflammatory pain. This become even more interesting as its mechanism is at least not completely redundant with those of classic non-steroidal anti-inflammatory drugs, which allow the combination of both class of molecule to yield even larger effect.