Takehiko Yamaji

Use of 2-[18F]-fluoro-2-deoxy-d-glucose positron emission tomography (FDG PET) imaging for the evaluation of muscle metabolic activity in ruptured rotator cuffs: Identification of shoulder muscles by fusion imaging studies involving both FDG PET and magnetic resonance imaging.

The uptake of 2-[(18)F]-fluoro-2-deoxy-d-glucose (FDG) into shoulder muscles was studied in 11 patients with rotator cuff tears. FDG was injected under resting conditions, and cuff muscle exercises were performed followed by evaluation of the standardized uptake value (SUV) in shoulder muscles bilaterally. Analysis was performed with a subtracted SUV, obtained by subtracting the SUV of the muscle at rest from that after exercise. Fusion imaging studies involving FDG positron emission tomography (PET) and magnetic resonance imaging would provide a novel strategy with the potential of improving on the limited resolution of PET images. In this study this relatively new strategy revealed a similar decrease in the supraspinatus SUV in cases involving both complete and partial tears. The SUV in the infraspinatus and subscapularis also decreased, regardless of whether these muscles were intact or ruptured; the SUV in the deltoid remained basically unchanged. With the use of this exercise protocol, FDG PET might prove useful for objective evaluation of rotator cuff muscle activity.

Effect of the WISH-type hip brace on functional mobility in patients with osteoarthritis of the hip: evaluation using the Timed Up & Go Test

Background: The WISH-type S-form brace, is considered to improve hip function and gait in patients presenting with painful hip osteoarthritis (OA). Objectives: To evaluate the effects of the brace on functional mobility. Study Design: Cross sectional survey. Methods: The Timed Up & Go Test (TUG) was performed with right and left turns separately in each subject. Results: In the patients with the bilateral hip brace, the average time to complete the TUG (8.3 ± 1.7 seconds) was significantly shorter than in those without the brace (9.4 ± 2.9 seconds). On the other hand, for the patients with unilateral hip OA, the improvement of TUG with the hip brace was significant in turning the unbraced leg inside (7.4 ± 1.1 vs. 7.6 ± 1.2 seconds), while not turning the braced leg inside (7.5 ± 1.1 vs. 7.6 ± 1.2 seconds). Furthermore, significant improvement of TUG was found at three-month follow-up and maintained until the 12-month follow-up assessment. This improvement was independent of the application of the brace at the assessment. Conclusions: The direct effect of the hip brace may be related to the hip function in the turning phase of TUG. In addition, mechanical improvements due to daily exercise may provide an indirect, but essential, effect of the brace on TUG performance. Clinical relevance From a functional mobility viewpoint, the present WISH-type hip brace may contribute to risk reduction of future falls in hip OA patients.

Effect of a modified S-form hip brace, WISH type, for patients with painful osteoarthritis of the hip: a role in daily walking as a hip muscle exercise

A hip brace designated as WISH-type of S-form hip brace was applied for 14 patients with painful hip osteoarthritis (OA), who were required to walk as an exercise at least a half hour every day. Patients were independently evaluated and serially scored using the Harris and Japanese Orthopaedic Surgery (JOA) scores. Pain relief on gait was obtained immediately and dramatically in all patients, providing high compliance. Approximately three fourths of patients acquired independence from analgesics. Both Harris and JOA scoring systems indicated significant improvement of hip function. Only two cases showed poor responses, and common factors in these cases included bilateral involvement and unsuccessfulness of daily walking exercise. The present WISH-type hip brace may be one of the most valuable treatments in the management of the hip OA. Requirements of muscle exercise around the hip girdle involving daily walking should be emphasized for maintenance of the brace effects.

Biomechanical analysis of gait in patients with painful osteoarthritis of the hip treated with WISH-type hip brace

BackgroundA hip brace, the WISH-type S-form brace, improved hip function scores markedly in patients with painful hip osteoarthritis (OA). To evaluate the biomechanical effects of the brace, gait analysis using a force plate was performed.MethodsFor the gait of seven patients with this hip brace, characteristic parameters calculated from three-dimensional (i.e., vertical, forward, and medial) components of the floor reaction force were analyzed using a flat force plate.ResultsGait analyses revealed several tendencies: a shorter time for one step, a stronger step, and a shift of the center of gravity of the body to the contralateral side. In particular, stronger vertical reaction force at the first peak in the early stance and earlier switch from backward to forward reaction force vectors were observed as effects of the hip brace, with statistically significant difference.ConclusionsThese biomechanical assessments suggest that abnormal gait in hip OA may be closer to normal gait in patients using this brace, although the deceleration and weighing-off effects, which are indicators useful for observing gait recovery, did not reach significance.

Extended Application of WISH type S-form hip Brace for Patients with Bilateral Painful Hip Osteoarthritis: Report of Two Cases

Dynamic lateral instability of the femoral head develops in patients with osteoarthritis (OA) of the hip. Recently we have developed a hip brace, called the WISH-type hip brace, and showed successful response of the patients quantitatively. However, a negligible effect was observed in patients with bilateral involvement. Here, we extended the application of the WISH-type hip brace for two patients with bilateral OA joints. The resultant WISH-type hip brace with two S-form portions for bilateral thighs provided good recovery in hip function. Interestingly Timed Up & Go (TUG) test performed for one patient revealed a positive effect of the brace on the functional mobility. To the best of our knowledge, this is the first report elucidating the therapeutic effect of brace therapy with bilateral hip stabilization from hip functional and functional mobility points of view. Application of the present brace should be taken into account for patients with painful bilateral hip OA before easy application of invasive surgery such as total hip arthroplasty.