Does running lead to knee osteoarthritis?

This question is a common one that is aked of many rheumatologists, orthopedists, and family practice docs.  The answer changes every week.  This latest study contradicts a study presented by radiologists at their national meeting earlier this year.

So anyway, here it is…

Running may not increase risk of developing osteoarthritis later in life.

Time (12/25, Narayan) reported, “The common wisdom is that regular running or vigorous sport-playing during youth subjects the joints to so much wear and tear that it increases a person’s risk of developing osteoarthritis later in life.” Now, however, “an emerging body of research” indicates there is “no connection between running and arthritis,” and that “regular, vigorous exercise…may even help protect people from joint problems later on.” For example, a 2008 study following 1,000 active runners and non-runners “for 21 years” found that “the runners’ knees were no more or less healthy than the non-runners’ knees,” no matter “how much the runners ran,” and a 2007 study of 1,279 seniors found that “the most active people had the same risk of arthritis as the least active.”

So, if you’re as confused as I am, so be it!

An article in the January 2010 issue of Woman’s Day magazine described carpal tunnel syndrome- the diagnosis and treatment.  Near the end was a sentence that said that surgery should be considered a treatment of last resort.  I agree 100% with that assertion, but the author  neglected to mention many options.

My colleagues and I presented a paper at the American College of Rheumatology meeting in November 2009 describing a minimally invasive procedure using a small needle and ultrasound guidance.

This technique has prevented the need for surgery in many patients.  While not 100% effective for everybody, it sure beats the knife. Here it is…

Ultrasound-Guided Percutaneous Injection, Hydrodissection, and Fenestration for Carpal Tunnel Syndrome

Tuesday, October 20, 2009

Hall D (Pennsylvania Convention Center)

Daniel G. Malone, University of Wisconsin, Madison, WI, Thomas B. Clark, MSKUS, Vista, CA and Nathan Wei, Arthritis & Osteo Ctr of MD, Frederick, MD

Purpose: Carpal tunnel syndrome, caused by compression of the median nerve deep to the flexor retinaculum, is the most common entrapment neuropathy.  Most patients are initially treated with conservative measures such as splinting.   When conservative measures fail, interventional techniques are considered the next step.  Many studies have appeared comparing open surgical flexor retinaculum release to blind injections of corticosteroids into the carpal tunnel, but neither technique has proven superior to the other.  Advantages of injection are: lower level of invasiveness, faster recovery, and ease of the technique.  Occasional failures and complications occur with all techniques.
Method: We have been using an ultrasound-guided procedure of percutaneous hydrodissection of the median nerve away from the deep surface of the flexor retinaculum, followed by fenestration of the flexor retinaculum along a path parallel to the long axis of the arm, starting from the level of the distal palmar crease and progressing proximally to the level of the radio-lunate joint, the intent being to lower the pressure exerted by the flexor retinaculum on the nerve (panel 1).  We have treated a series of 39 wrists in 29 patients with electrically-proven carpal tunnel syndrome, using this technique of hydrodissection and fenestration, performed using standard injection equipment and a GE LogiQ e ultrasound system with a 12 MHz linear array probe.  All patients had typical carpal tunnel syndrome symptoms and presented to us for interventional treatment, conservative measures having failed.  No patient had had previous surgery, and 2 had had blind carpal tunnel steroid injections, without hydrodissection or fenestration.  Outcomes were defined as:
Excellent-all symptoms resolved,
Fair-some residual symptoms, or return of symptoms, but improved compared to prior to procedure,
Failure-required open surgical release.
Follow-up periods after procedure ranged from 5-64 weeks, averaging 38 weeks (as of late June 09).  Patients were contacted by telephone, or seen in follow-up in clinic, to determine outcomes.
Excellent—31 wrists
Fair—5 wrists
Failure—3 wrists

No complications were encountered.
Ultrasound-guided hydrodissection and fenestration is a viable, easy, relatively non-invasive therapy for carpal tunnel syndrome that can result in prolonged symptom relief, and may be a way to postpone, or even obviate the need for, open release.

Keywords: carpal tunnel syndrome and ultrasound

Disclosure: D. G. Malone, General Electric, 5 ; T. B. Clark, General Electric, 5 ; N. Wei, None.

Plantar fasciitis is an extremely common problem, particularly in the summer when people walk around in flip flps all the time.  But I still see alot of it now in people where it is a chronic condition.

And chronic conditions call for the heavy artillery.

I can’t stand it when I hear about a patient getting a cortisone shot for this condition.  It just shouldn’t be done.

Let me tell you what should and can be done…

A tibial nerve block using ultrasound guidance anesthetizes the bottom of the heel.  Then using ultrasound guidance I can poke small holes in the plantar fascia and get rid of any spurs that are there at the same time.  Then I inject PRP (platelet-rich plasma), a derivative of a patient’s own blood.  The PRP is loaded with growth and healing factors which help the plantar fascia to regenerate new tissue. And- gets rid of the pain!

Just did this procedure last week in a patient.  He’s doing great!

Every once in awhile, there’s a study that warms your heart.  Here’s one that stimulates the appetite.

An oral supplement of collagen from chicken breast cartilage may ease the symptoms of rheumatoid arthritis, but not quite as effectively as conventional treatment, according to results of a randomized trial.

Chicken type II collagen supplementation for patients with rheumatoid arthritis (RA) reduced pain, stiffness, and tender and swollen joint counts significantly compared with baseline in a recent report in the journal, Arthritis Research & Therapy.  According to lead author, Wei Wei, MD, PhD, (no relation to me… as far as I know) of Anhui Medical University in Hefei, China, and his colleagues.

The supplement was not as effective as methotrexate, using  American College of Rheumatology (ACR) measurement criteria.

However, since it has few, if any, side effects, chicken collagen could represent “a promising alternative therapeutic strategy that may be used as a nutritional supplement against RA,” they concluded in their report.

At present, conventional RA  treatments aim at suppressing the immune response since RA is an autoimmune process.

But “the supplements may work by inducing oral tolerance, modulating the immune response to type II collagen, which is a major protein in joint cartilage and a potential antigen in the autoimmune process,” the researchers explained.

After 24 weeks of treatment, the chicken collagen supplement had significantly improved the following outcomes compared with baseline:

Methotrexate improved all these indicators to a significantly greater degree than the chicken collagen supplement for pain, Health Assessment Questionnaire score, and patient assessment.

And, chicken collagen was significantly less effective than methotrexate at reducing RA disease activity measured on the 28-joint disease activity score (DAS28, P=0.019).

Adverse event rates, as predicted were significantly lower with the collagen supplements compared with methotrexate.

I like chicken… fried chicken, roasted chicken, broiled chicken, grilled chicken, chicken soup, chicken gravy, chicken croquettes, chicken stew, chicken pot pie…

Mark Victor Hansen and Jack Canfield were right… chicken soup is good for the soul… and also for your joints, I guess.

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