Vid rehabilitering är det viktigt att veta om och när muskler vid det skadade området återfår sin styrka. Gällande axelskador finns det idag ingen etablerad metod för mätning av muskelstyrka. I de metoder som testats är vissa attribut inte önskvärda och därför vill man på Karolinska universitetssjukhuset, Huddinge ta fram en ny, förbättrad metod. I metoden ska man kunna mäta en patients muskelstyrka och se skillnaden mellan mätningar över en tidsperiod. Av intresse är den maximala muskelstyrkan samt muskelstyrkan vid 45° abduktion och flexion. Projektet går ut på att ta fram en prototyp som kan användas enligt metoden och se om prototypen är lämplig. En testgrupp bestående av både friska och axelskadade personer genomförde tester för prototypens noggrannhet hos vinkelmätning, prototypens användbarhet samt lämplig vinkel för maximal muskelkraft i axeln. Resultatet visade att prototypens noggrannhet var inom det godkända intervallet för metoden. Användbarheten var också godkänd då alla testpersoner kunde använda prototypen inom de begränsningar vi satte. Vi såg ingen övergripande trend där maximal muskelkraft i axeln erhölls vid 45° även om det stämde för vissa individer. För vidare arbete och ökad validitet krävs fler studier med större testgrupper. / During rehabilitation, it is important to know if and when the muscles in the injured area have regained their strength. Regarding shoulder injuries, there is currently no established method of measuring muscle strength. In the methods tested, certain attributes are undesirable. Therefore, Karolinska Universitetssjukhuset, Huddinge is looking into developing a new, improved method. In this method, one should be able to measure a patient's muscle strength and study the difference in measurements over time. The maximum muscle strength and the muscle strength at 45 ° of abduction and flexion is of interest. The project is to produce a prototype that can be used according to the new method and see if the prototype is appropriate. A test group consisting of both healthy and shoulder injured patients performed tests regarding the prototype accuracy of angular measurement, prototype usability and appropriate angle for maximum muscle strength in the shoulder. The result showed that the prototype accuracy was within the approved range of the method. Usability was also approved as all test subjects could use the prototype within the limits we set. We did not see an overall trend in which maximum muscle force in the shoulder were obtained at 45 °. For further work and increased validity, further studies with larger test groups is required / Nej

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Metal-on-metal hip resurfacing arthroplasty (MoMHRA) is an alternative treatment option to total hip arthroplasty (THA), especially in the young and active. Despite the early successful results, reports of adverse soft-tissue reactions around the MoMHRA have caused increased concern. These reactions have been termed pseudotumours and have been shown to be associated with increased wear. However, their incidence and aetiology is not known. The broad aims of this thesis were to 1) determine the clinical impact of pseudotumour; and 2) identify ways of reducing the risk of pseudotumour. The clinical impact was determined by examining the incidence and prevalence of pseudotumours needing revision and the subsequent outcome following revision. At the Nuffield Orthopaedic Centre, the 10-year survival of the BHR, commonest MoMHRA used, was 87.1% (95%CI: 83.0% to 91.2%) and the 10-year incidence of revisions due to pseudotumour was 7.5% (95%CI: 4.3% to 10.7%). In a prevalence study of two tertiary referral centres, pseudotumour was identified as the most common revision indication. An outcome based, case-control study characterised outcome following revision due to pseudotumour as inferior to that following revision for any other failure mode, and inferior to the outcome of matched primary THAs. The inferior outcome was associated with the extensive tissue damage at revision. Risk factors contributing to development of pseudotumour were found to be both patient and surgeon related. Patient factors significantly increasing risk included female gender and small component size. Case control studies demonstrated two surgical factors that were associated with significantly increased risk; cup malorientation and a reduction in head neck ratio (HNR) at operation particularly in females. Furthermore, evidence based recommendations were provided on optimum cup orientation and screening practice. Surgeons should aim for a radiographic cup inclination/anteversion zone of 45°/20° ± 10°. Patients with mal-positioned cups, those with high HNR prior to surgery, and those that had significant HNR reduction with the MoMHRA should be considered at increased risk of developing a pseudotumour. An ex vivo study demonstrated that the majority of pseudotumours occur due to high prosthesis wear, and result from an exaggerated innate response with an accompanying variable immune response. However a small but significant number of pseudotumours (20%) were observed with low wear and a prominent immune response. Furthermore, the cups oriented within the optimum zone were associated with less wear. Hence, subsequent in vivo research focused on providing evidence-based guidance on how to achieve the target cup orientation and factors to consider in minimising the scatter in cup orientation observed following hip arthroplasty. This great scatter was mostly due to two factors: 1) the variability between surgeons at orientating a component at implantation and 2) the difference in the pelvic position between implantation and radiographic assessment. The angular offset was 5° for inclination and 8° for anteversion because of the different definitions at impaction and X-Ray. Surgeons should need to be aware of these factors. Greater amount of pelvic movement occurs during MoMHRA, in comparison to THA. To achieve the target MoMHRA cup orientation surgeons should implant the cup with an intra-operative inclination/anteversion of 40°/30°. It is concluded that pseudotumour following MoMHRA has a significant clinical impact. In order to minimise it, surgeons should appropriately select patients and optimise surgical technique to achieve optimum cup orientation and try to avoid reducing the native head neck ratio. Appreciation of risk factors for pseudotumour development (female gender, small size component, cup orientation, HNR reduction), would aid detection prior to extensive soft-tissue damage and improve inferior outcome associated with revision.

INTRODUCTION: A recent area of interest has become adipose tissue of the bone marrow. Unlike fat found elsewhere in the body, it is able to respond to its microenvironment by expanding, contracting, and even releasing hormones of its own. The marrow adipose tissue (MAT) increases with age and even within anorexic patients. Changes in MAT may be directly linked to bone tissue, since both adipocytes and osteoblasts share a common progenitor cell population. This is supported by recent results showing that the constitutive deletion of the MRTF-A (Myocardin related transcription factor A) gene not only led to leaner mice leaner but also had a bone phenotype. The bones were shorter and had decreased bone mass; the female mice were more susceptible to osteopenia. It is unclear as to how this bone phenotype will respond to fracture repair, a coordinated process that is dependent upon differentiation toward the osteoblast lineage. Therefore, both male and female MRTF-A knockout (KO) and wild type (WT) mice were examined in a fracture study. METHODS: Male and female mice (KO and WT) aged 8-16 weeks were fractured using a closed, stabilized fracture model. Tissues were harvested as post-operative day 14, 21, and 37. Radiographic films and histological assessment were completed at each time point to visualize the progression of fracture repair. Gene expression studies using RT-qPCR were all done at time points 14 and 37. Results were compared between genotype and sex. RESULTS: Fracture calluses between WT and KO male and female mice appeared nearly identical via X-ray, suggesting that MRTF-A did not affect fracture repair. Only at the later time points did the histology show females had increased MAT regardless of genotype. Immunofluorescence with perilipin further confirmed this. Adipogenic, chondrogenic, and osteogenic markers also yielded differences in relative mRNA expression between the sexes. CONCLUSIONS: The MRTF-A KO mice did not show delayed or altered fracture repair compared to the WT mice. However, the data suggest difference in MAT deposition between male and female mice. Further work is necessary to fully understand this sex difference.

Articular cartilage accrual occurs predominantly during childhood and adolescence, with the magnitude, direction, and pattern of internal joint loads directing the cartilage growth. If any of these factors of the joint loading are abnormal, it can predispose these children to degenerative knee joint disease as an adult. To provide an estimate of the internal joint loads, a paediatric-focused, static optimization-based lower limb model was developed, compared to recorded sEMG, and analyzed for sensitivity to changes in ground reaction force and muscle attachment site. The model was found to provide consistent predictions of joint contact force predictions ranging from 0.01 to 0.35xBW with standard error of 8% to 17%, with the exception of left knee medial-lateral shear at 108%. Muscle force predictions related well to sEMG, with the standard error ranging from 14% to 36%, except for gastrocnemius lateral at 104%. The model was sensitive to variations in the ground reaction force vector, with a maximum deviation of 0.11 xBW determined as a result of a ±5% variation in GRF. The model was found to be sensitive to clinically relevant deviations in muscle attachment site. Maximum knee anterior shear was significantly changed (p < 0.05) with a 1cm posterior quadriceps insertion deviation, maximum lateral shear with a posterior semimembranosus deviation, and maximum medial shear with a posterior or medial quadriceps deviation. No deviations caused statistically significant changes in compression. Statistically significant change in joint contact force could not be predicted based on changes in muscle moment arm, but could be indirectly predicted by the predicted muscle forces. The model’s uniform convergence and sensitivity to variations in input indicate that the model is sufficiently reliable and robust. This sensitivity suggests that the model is capable of adapting to altered loading conditions and musculoskeletal geometry, either due to deformity or corrective procedure. The model was therefore deemed to be a strong platform for developing clinically specific models for analyzing internal knee loads in a diverse paediatric population. / Thesis (Master, Rehabilitation Science) -- Queen's University, 2012-09-26 10:37:20.752

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Anaplastic large-cell lymphoma (ALCL) is a CD30 + lymphoproliferative disorder that may manifest with skin involvement.1 We present a rare case of Agent Orange-induced ALCL with cutaneous involvement of the hand, surgical excision, and follow-up treatment.