Dissertations / Theses on the topic 'JOINT DISEASES; DIAGNOSIS'

Lateral hip pain (LHP), characterised by non-specific symptoms in the region of the greater trochanter, is a condition frequently encountered by physiotherapists and other health professionals. However, the pathogenesis of LHP is not well understood. Although pathology of the gluteal tendons and their associated bursae have long been implicated in the cause of this problem, trochanteric bursitis has emerged as the primary clinical diagnosis. In order to determine a differential diagnosis, clinicians are reliant on information collated from the patient history and physical examination, yet the validity of many of the tests used to diagnose LHP has not been established. Abnormalities of the gluteal bursae may give rise to LHP and therefore to ensure precision of clinical assessment and treatment techniques, knowledge of bursal morphology is essential. However, a review of the literature revealed that there are no complete morphological accounts of all the bursae in this area. Therefore, the main purposes of this study were (a) to determine the morphology of the bursae associated with the greater trochanter and (b) to examine the physiotherapy and radiological diagnoses of LHP, and the validity of selected tests used in the diagnosis of LHP. In the anatomical study, the bursae deep to each of the layered gluteal tendons were examined in 21 embalmed human hips (9 male, 12 female; mean age 79 years, SD 9.4 years) using macro-dissection and histological techniques. Morphological associations, size, positions and histological characteristics of the bursae were recorded. A total of 121 bursae were identified in ten different locations, with an average of six bursae per hip. Variation was evident, but it was typical that at least two bursae were found deep to gluteus maximus (GMax) and the fascia lata, and gluteus medius (GMed). In approximately two-thirds of specimens a single bursa was situated deep to the tendon of gluteus minimus (GMin). All of these bursae demonstrated a synovial lining, which was predominantly areolar in type. This study revealed that numerous bursae are intimately associated with the greater trochanter, and provides new morphological detail which is of significance when considering clinical and biomechanical models of LHP. A clinical study was undertaken whereby 40 consecutive patients (37 female, 3 male; mean age 54.4 years, SD 9.5 years) with unilateral LHP were recruited prospectively. Each eligible participant underwent a standardised physiotherapy assessment followed by a magnetic resonance (MR) imaging study of the pelvis and both hips. The MR images were analysed in random order by three radiologists blinded to clinical findings and symptomatic side, and the intra-and inter-observer reliability for image analysis was examined using the kappa statistic. To determine the validity of selected clinical tests as evaluated against MR imaging, sensitivity, specificity, and positive and negative likelihood ratios (LRs) were calculated, and the chi-squared test was used to determine association. As demonstrated by MR imaging, GMed tendon pathology, bursitis, osteoarthritis (OA) and gluteal muscle atrophy are all associated with the report of LHP. Interestingly, these various pathologies were identified in asymptomatic as well as symptomatic limbs. However, while bursitis was equally prevalent in symptomatic and asymptomatic hips, GMed tendon pathology and OA were observed more frequently on the symptomatic side. Furthermore, muscle atrophy which predominantly affected GMin, was specific to symptomatic hips. Large variation was evident in the strength of agreement between radiologists and there was little agreement between physiotherapy and radiological diagnoses of pathology. Physiotherapists frequently diagnosed trochanteric bursitis as a cause of LHP and while palpation was identified as the most provocative test for reproducing patients complaint of LHP, it was not shown to be a valid technique. Instead, the outcomes pertaining to the validity of the clinical tests indicate that attention should be focused towards the assessment and treatment of gluteal tendon pathology. The two tests that appeared to be most useful for diagnosing gluteal tendon pathology were pain reproduction with passive hip abduction and resisted testing of GMed and GMin. While these findings demonstrate that various pathologies are associated with the report of LHP, they also highlight some problems associated with the use of MR imaging as a reference standard. Before further clinical validation studies of LHP are undertaken in larger populations, it is recommended that verification of MR imaging outcomes are performed against surgical and histological findings.

Dissertação de Mestrado Integrado em Medicina Veterinária
A doença articular degenerativa (DAD) apresenta uma etiologia multifatorial, envolvendo fatores genéticos, biomecânicos e bioquímicos, caracterizando-se pela existência de degeneração da cartilagem articular com produção de novo tecido ósseo. A sua prevalência na população felina parece aumentar com a idade, sendo o seu diagnóstico feito com base na associação de sinais clínicos e alterações ao exame radiográfico. O presente estudo teve por base uma amostra de 100 pacientes felinos (N=100) com exame radiográfico e anamnese disponíveis. Os objetivos principais foram calcular a prevalência de DAD na presente amostra e avaliar a frequência e a gravidade das lesões no esqueleto axial e apendicular. Para isto, os exames radiográficos dos 100 animais foram avaliados por dois observadores quanto à existência de sinais radiográficos compatíveis com DAD e respetivo grau de gravidade. Na população avaliada, a prevalência de sinais radiográficos compatíveis com DAD foi de 38%. Os esqueletos apendicular e axial apresentaram alterações em 24% e 25% dos animais, respetivamente. Existiam lesões simultaneamente na coluna e nas articulações apendiculares em 11% dos animais avaliados. A articulação do esqueleto apendicular mais frequentemente afetada foi a articulação úmero-rádio-ulnar, e a que apresentou lesões de maior gravidade foi a articulação femoro-tíbio-patelar. No esqueleto axial, o segmento da coluna com maior frequência de alterações compatíveis com DAD foi a região torácica. Já a região lombar apresentou scores de gravidade mais elevados quando comparado com os restantes segmentos. Não foi encontrada uma associação estatisticamente significativa entre a presença de sinais radiográficos e o sexo ou a idade. No entanto, foi encontrada uma relação estatisticamente significativa entre a raça do animal e a presença de DAD (p<0,05). A prevalência encontrada (38%) é largamente superior ao número de animais da amostra em que se suspeitava da existência de doença articular (3%). Além de frequente, a DAD é sub-diagnosticada na prática clínica, sendo responsável por provocar dor crónica nos pacientes felinos passando muitas vezes desapercebida quando a avaliação se baseia na anamnese e nos sinais clínicos. Sendo assim, o exame radiográfico e sua correta apreciação reveste-se de extrema importância de modo a identificar e possibilitar o tratamento desta doença.
ABSTRACT - Prevalence of radiographic changes associated with degenerative joint disease in the domestic cat – retrospective study of 100 cases - Degenerative joint disease (DJD) has a multifactorial etiology that involves genetics, biomechanics and biochemistry factors and it is characterized by the degeneration of the cartilage with production of new bone tissue. Its prevalence in the feline population increases with age and its diagnosis takes in consideration the clinical signs as well the radiographic chances. The present study used a sample of 100 feline patients (N=100) with radiographic exams and anamnesis available. The main objective was to calculate DJD prevalence in the sample as well as determine the frequency and severity of these lesions in the axial and appendicular skeleton. To accomplish this, radiographic exams from 100 patients were observed and evaluated by two different observers, who assessed them for the presence of radiographic signs compatible with DJD and respective degree of severity. In the evaluated population, the prevalence of radiographic signs compatible with DJD was 38%. The appendicular and axial skeleton had shown changes in 24% and 25% of the animals, respectively. There were lesions in both spine and appendicular joints in 11% of the population. The most frequently affected joint of the appendicular skeleton was the elbow, and the one that presented with the most severe lesions was the knee. In what concerns to the axial skeleton, the segment of the spine with the highest frequency of compatible with DJD was the thoracic region. The lumbar region presented higher severity scores when compared to the other segments. No statistically significant association was found between the presence of radiographic signs and sex or age. However, a statistically significant relationship was found between the patient’s breed and the presence of DJD (p<0,05. The prevalence of DJD determined (38%) is significantly higher than the number of patients in which it was suspected (3%). DJD is not only frequent and responsible for causing chronic pain in feline patients, but also under-diagnosed in the clinical practice, going unnoticed when the evaluation is based on anamnesis and clinical signs. Therefore, the radiographic examination and its correct evaluation is of extreme importance to identify and make the treatment of this disease possible.
info:eu-repo/semantics/publishedVersion

Orientador: Manoel Barros Bértolo
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: Objetivo: Avaliar sinovite pelo ultrassom (US) articular em pacientes com artrite reumatóide (AR) inicial e correlacionar com os dados clínicos, radiográficos e laboratoriais. Pacientes e Métodos: Este estudo avaliou 832 articulações de 32 pacientes (24 mulheres e 8 homens) com AR inicial selecionados no período de 2008 a 2010 do ambulatório de artrite da Universidade Estadual de Campinas, caracterizado por 20 (62.5%) caucasóides e 12 (37.5%) não caucasóides; um tempo médio de doença de 13 meses, com média de idade de 42 anos. Nesta amostra foram detectadas, pelas escalas semiquantitativas cinza (SG) e pelo power Doppler (PD), 173 articulações com sinovite de grau 0 a 3. Foi usado um ultrassom GE LOGIQ XP-linear de alta frequência (8-10 MHz). Todas as mãos foram radiografadas e analisadas pelo score de Larsen com variação de grau entre 0 a V. Resultados: Este estudo evidenciou correlações significativas e positivas entre os dados ultrassonográficos, clínicos e laboratoriais: SGUS e PDUS do punho D e PCR (r=0.41 a 0.42), SGUS do 3ªMTF D, 4ªMTF D com o HAQ - DI (r=0.37 a 0.38), SGUS do 4ªMTF E e o PCR (r=0.42), SGUS do 2ªMTF D e o FR (r=0.40), SGUS-Score 7mod com o DAS28 (PCR) (r=0.38) e o PDUS-Score 7mod com o PCR (r=0.39). Houve correlações significativas negativas com o SGUS 2ªMTCF D com a dose e o tempo de uso MTX (r=-0.36 a -0.37). O PCR nesta amostra pode ser considerado um indicador de atividade inflamatória quando existe sinovite detectada pelo US. Conclusão: A utilização do US mostrou ser uma importante ferramenta na avaliação de AR inicial e dá um suporte mais seguro no diagnóstico para iniciativas terapêuticas mais precisas e seletivas
Abstract: This study evaluated 832 joints of 32 patients (24 women and 8 men) with early RA enrolled for the period 2008 to 2010 of the arthritis clinic of the Universidade Estadual de Campinas (UNICAMP), characterized by 20 (62.5%) Caucasians, 12 (37.5%) non-Caucasians, an average disease was 13 months, with a mean age of 42 years. This sample was detected by semi-quantitative gray scale (GS) and power Doppler (PD) 173 joints with synovitis of degree 0 to 3. It was used a GE LOGIQ XP-linear ultrasound and high frequency (8-10 MHz) transducer. All hands were X-rayed and analyzed by the Larsen score, with grades ranging from 0 to V. This study showed positive and significant correlation between sonographic, clinical and laboratory data: GSUS/PDUS of right wrist and CRP (r = 0.41 to 0.42), GSUS of the right 3ºMTP, GSUS of the right 4ºMTP and HAQ - DI (r = 0.37 to 0.38), GSUS of the left 4ºMTP and CRP (r = 0.42), GSUS of the right 2ºMTP and FR (r = 0.40), GSUS 7mod-score with the DAS28 (CRP) (r = 0.38) and PDUS 7mod-Score to CRP (r = 0.39). There was a significant negative correlation with the right 2ºMCP with dose and duration of MTX use (r = -0.36 to -0.37). The CRP in this sample can be considered an indicator of inflammatory activity, when analyzed separately or with all the joints committed. Using the US was an important tool in the evaluation of RA and gives a more secure support for initiatives in the diagnosis and treatment more precise and selective
Doutorado
Clinica Medica
Doutor em Clínica Médica

Nos eqüinos, as articulações sinoviais são submetidas a graus variáveis de estresse físico, de acordo com o tipo de movimento executado. Com o trabalho ou treinamento intenso, o aumento da carga imposta aos seus tecidos pode provocar sinovite mecanicamente induzida, com produção e liberação de citocinas, e conseqüentemente estimulação de metaloproteinases e de outros componentes inflamatórios. Estes eventos podem acarretar em desequilíbrio entre os processos de síntese e degradação de proteoglicanos e glicosaminoglicanos da matriz cartilagínea, levando a osteoartrite. Perante a magnitude de ocorrência de osteoartrite em eqüinos atletas, teve-se como objetivo caracterizar a população de cavalos, com diagnóstico firmado de osteoartrite, atendida junto ao Serviço de Clínica Médica de Eqüinos do Hospital Veterinário (HOVET) da Faculdade de Medicina Veterinária e Zootecnia da Universidade de São Paulo (FMVZ/USP), em um período de 10 anos. O levantamento da casuística foi executado através da análise de fichas de registro dos casos antigos. A amostragem foi composta envolvendo a totalidade de casos de eqüídeos, com diagnóstico firmado da doença articular, arrolando-se e analisando-se dados referentes a: espécie, idade, sexo, peso, raça, atividade esportiva, início e evolução da doença, tipo de manifestação clínica, e exames radiográficos. Foram analisados 152 prontuários de eqüídeos acometidos por osteoartrite. Observou-se que a maioria tratava-se de animais da espécie eqüina, com idade média de 8 anos, macho ou fêmea, das raças Quarto de Milha, Mangalarga Paulista e sem raça definida, pesando em torno de 420kg, praticantes de romaria ou provas de Quarto de Milha.O tempo médio entre o início da sintomatologia de osteoartrite e o atendimento hospitalar foi de 7,7 meses.A análise estatística não mostrou relação entre presença de claudicação, dor palpável, sensibilidade em casco, sensibilidade muscular, teste de flexão positiva e atividade exercida (p>0,05). Porém, mostrou correlação entre a presença de edema/calor e atividade exercida (p<0,05). Também não mostrou relação entre dor palpável, edema/calor, sensibilidade de casco, sensibilidade muscular, e claudicação (p>0,05). Mediante os resultados obtidos pela avaliação radiográfica dos pacientes acometidos por osteoartrite, notou-se que não houve relação direta entre o menor e maior escore em relação à presença ou não de claudicação. Concluiu-se que o perfil do paciente, acometido por osteoartrite, mais freqüentemente atendido pelo Serviço de Clínica Médica de Eqüinos ? HOVET ? USP trata-se da espécie eqüina, da raça Quarto de Milha, 8 anos de idade, 420 kg, praticante de provas de Quarto de Milha.
The equine sinovial joints are submitted do different degrees of physical stress, depending on the movement performed. With work and hard training, the increase on the loads applied to its tissues maycause mechanically induced synovitis, with production and release of cytokines, and consequently metalloproteinases stimulation and other inflammatory components. These events may lead to anunbalance between the synthesis and degradation processes, of proteoglycan and glicosaminoglycan of the cartilaginous matrix, leading to the osteoarthritis. Regarding the magnitude of the osteoarthritis incidence on athletic horses, our goal is to characterize the horse population with confirmed osteoarthritis diagnoses examined by the Equine Internal Medicine Service at the Veterinary Hospital at the College of Veterinary Medicine and Animal Science of University of São Paulo, in a 10 year period. The retrospective study was performed through the analysis of documented cases. The sampling included the totality of equide cases with confirmed joint disease diagnosis and analyzed considering: age, sex, breed, sportive activity, beginning and evolution of the disease, clinical signs observed and radiographic exam. One hundred and fifty two (152) equides hospital forms with confirmed osteoarthritis were analyzed .It was found that most cases were equines, with an average age of 8 years, either male or female, with the predominance of Quarter Horses, Mangalarga Paulista and Mixed Breds, weighing around 420Kg, used for long distance rides or western activities. The average time between the beginning of the osteoarthritis clinical signs and the referring to the hospital was 7,7 months. The statistical analysis did not show relation between lameness, palpable pain, hoof sensitivity, muscular pain, positive flexion test and use (p>0,05). Although, its howed a relation between edema /heat and use (p<0,05). No relation was found between palpable pain, edema/heat, hoof and muscular pain and lameness (p<0,05). The results found in the radiographic evaluation of the animals with osteoarthritis showed no direct relation between the radiographic score and lameness. The animals with osteoarthritis more frequently sent to the Equine Internal Medicine Service -HOVET-USP, is equine , Quarter Horse, 8 years old, 420Kg, used in western competitions.

La drépanocytose est la maladie moléculaire et héréditaire (transmission mendélienne récessive et autosomique) la plus répandue au monde. Elle est un problème de santé publique par sa gravité et ses implications socio-économiques dans de nombreux pays. Seuls les sujets homozygotes (SS) ou hétérozygotes composites (SC) sont malades, les hétérozygotes (AS) ne sont que des transmetteurs du gène S. Elle est la première cause d’OstéoNécrose de la Tête Fémorale (ONTF), douloureuse évoluant vers l’arthrose, en l’absence de traitement chez un patient jeune.

La Guadeloupe compte 450.000 habitants, dont 12% sont porteurs de l’hémoglobine S. Le nombre des drépanocytaires est estimé à 1.200 dont les 3/4 sont suivis au Centre Caribéen de la Drépanocytose (CCD), créé en 1990. Le centre assure la prise en charge médicale des enfants dès leur naissance et des adultes malades. Nos activités au CHU de Pointe-à-Pitre, au CCD et à l’Unité INSERM-UMR S458 depuis juillet 1992 nous ont permis d’étudier:

- le diagnostic de l’ONTF;

- l’évaluation de l’hyperpression osseuse dans l’ONTF et l’évaluation du traitement par forage simple;

- l’étude de l’impact de la prise en charge orthopédique précoce sur la survenue et l’évolution de l’ONTF.

Notre étude concerne les patients drépanocytaires adultes homozygotes (SS) et double hétérozygotes (SC):

- une série rétrospective de 1993-1994 [E-1994] portant sur 115 patients (58 SS, 57 SC) identifiés en 1984,

sans suivi médical ni orthopédique;

- une série prospective de 1995 à 2008 [E-2008] portant sur 215 patients (94 SS, 121 SC) avec prise en

charge médicale et orthopédique.

L’IRM est l’examen de référence pour le diagnostic de l’ONTF comme dans la nécrose idiopathique. En absence d’imagerie moderne, la radiographie traditionnelle réalisée de façon complète (profil et, surtout, faux profil), permet le diagnostic avant toute déformation. Seules les lésions cliniquement symptomatiques et évolutives (examen clinique itératif, contrôle radiologique, tomographie, TDM ou IRM) ont une indication opératoire.

L’hyperpression intra osseuse, dans l’ONTF drépanocytaire, est significativement liée à la douleur (que les patients soient homozygotes ou hétérozygotes). Sa diminution a un effet antalgique objectif, observée après forage. Elle permet de confirmer le diagnostic d’ostéonécrose au stade précoce, dans les régions où l’IRM est inexistante.

Un forage réalisé aux stades précoces de l’ONTF permet un arrêt rapide de l’évolution des lésions vers une arthrose, avec une efficacité certaine pour les stades I et II. Il garde une efficacité limitée pour le stade III. En plus de l’indolence apportée par la décompression, le bénéfice du forage se manifeste par l’allongement du délai avant arthroplastie (de 7,4 ± 2,7 ans). La technique est réalisable dans les régions sous équipées, où la drépanocytose est fréquente.

La description histologique aux différents stades radiologiques de l’ONTF montre toujours des lésions de nécrose médullaire et osseuse. A l’inverse des lésions idiopathiques, les lésions drépanocytaires sont caractérisées par la présence d’une inflammation, en dehors de tout processus infectieux.

Dans la littérature, la fréquente de l’ONTF drépanocytaire chez l’adulte est voisine de 40%, proche de celle observée dans [E-1994], notre population non suivie (36,5%). En comparant les études [E-1994] et [E-2008], la fréquence de l’ONTF passe de 36,5% à 14,4%. L’officialisation en 1992 d’une prise en charge médicale et d’un suivi orthopédique régulier au CCD et au CHU de Pointe-à-Pitre, a permis la réduction de la fréquence de l’ONTF et d’autres morbidités.

Le rappel sur la drépanocytose révèle la complexité de la maladie, la variabilité de son expression clinique et de ses complications. L’amélioration de vie des patients nécessite une prévention primaire, secondaire et tertiaire, en l’absence d’un traitement spécifique de la maladie.

La prise en charge médicale, complétée par une prévention et un traitement précoce (orthopédique ou chirurgical) telle que réalisés au CCD en Guadeloupe, a permis une réduction significative de la survenue de la nécrose de hanche et de ses complications. Pour une prévention tertiaire des complications ostéo-articulaires, nous suggérons:

- une prise en charge médicale régulière des enfants et des adultes afin de réduire les crises vaso-occlusives;

- une éducation des patients à la recherche de signes d’appel de l'ONTF et, aussi, d’autres articulations;

- un examen clinique ostéo-articulaire lors des bilans annuels et après toute crise vaso-occlusive;

- une attention particulière à l’adolescence (passage enfant-adulte), après une grossesse;

- une prise en charge précoce, orthopédique ou chirurgicale conservatrice (forage ou ostéotomie) face à une

nécrose, afin de réduire les complications invalidantes de l’ONTF.

Sickle-cell anemia is the most widespread hereditary (autosomal recessive Mendelian transmission) molecular pathology in the world. It is a public health issue in many countries, due to its severity and socio-economic impact. Only homozygous (SS) and double heterozygous (SC) subjects are affected, heterozygous (AS) subjects merely transmitting the gene S. Sickle-cell anemia is the most frequent cause of osteonecrosis of the femoral head (ONFH), a painful condition which evolves towards osteoarthritis if not treated at an early age.

Guadeloupe has a population of 450,000, 12% of whom are carriers of hemoglobin S. There are estimated to be 1,200 sickle-cell anemia sufferers, three-quarters of whom are followed in the Caribbean Sickle-Cell Center (Centre Caribéen de la Drépanocytose: CCD), which was set up in 1990. The Center provides medical care for adult patients and for children as of birth. Work has been ongoing since July 1992, in the Pointe-à-Pitre University Hospital, the CCD and the INSERM-UMR S458 research unit, focusing on:

- diagnosis of ONFH;

- bone hyperpressure measurement in ONFH and assessment of simple drilling treatment;

- the impact of early orthopedic treatment on the onset and evolution of ONFH.

The present study involved homozygous (SS) and double heterozygous (SC) adult sickle-cell anemia patients:

- a retrospective series, from 1993 to 1994 [S-1994], including 115 patients (58 SS, 57 SC) identified in 1984,

who had no medical or orthopedic care;

- a prospective series, from 1995 to 2008 [S-2008], including 215 patients (94 SS, 121 SC), with medical and orthopedic care.

MRI is the diagnostic gold-standard in ONFH, as in idiopathic necrosis. Where such modern imaging is not available, complete standard X-ray (lateral and especially false lateral) enables diagnosis to be made before deformity sets in. Surgery is indicated only for clinically symptomatic evolutive lesions on iterative clinical check-up, X-ray control, tomography, CT or MRI.

Intraosseous hyperpressure in sickle-cell ONFH shows a significant correlation with pain, in both homozygous and heterozygous patients. Pressure reduction is objectively pain-relieving, as seen after drilling, and can confirm diagnosis of ONFH at an early stage, in places where MRI is not available.

Drilling performed in the early stages of ONFH quickly arrests evolution towards osteoarthritis, with proven efficacy in grades I and II, and a certain degree of effectiveness in grade III. Over and above the pain-relief provided by decompression, drilling also enables hip replacement to be postponed, by 7.4±2.7 years. Moreover, the technique is feasible in those under-equipped regions in which sickle-cell disease is widespread.

Histologic description of radiologic ONFH stages consistently finds medullary and bone necrosis. In contrast to idiopathic lesions, sickle-cell related lesions show inflammation without any associated infection.

In the literature, the frequency of adult sickle-cell ONFH is reported to be nearly 40%, close to the 36.5% found in the S-1994 study of a non-treated population. In the S-2008 study of a population with medical and orthopedic care, ONFH frequency fell to 14.4%. The official provision of medical care and regular orthopedic follow-up in the CCD and Pointe-à-Pitre Hospital has reduced the frequency of ONFH and other morbidities.

A review of sickle-cell disease reveals its complexity: the variability of its clinical expression and associated complications. Improving patients’ quality of life requires primary, secondary and tertiary prevention, in the absence of specific treatment.

Medical care, supplemented by early prevention and treatment (orthopedic or surgical), as practiced in the Guadeloupe CCD, has significantly reduced the rates of ONFH and associated complications. We recommend the following CCD protocol for tertiary prevention of osteoarticular complications:

- regular medical care for children and adults, to reduce the incidence of vaso-occlusive crises;

- patient education in alarm signs of osteonecrosis of the femoral head and of other joints;

- systematic osteoarticular assessment at yearly check-up and after all vaso-occlusive crises;

- special focus on adolescence (child-to-adult transition) and following pregnancy;

- early care, both orthopedic and by conservative surgery (drilling or osteotomy), in case of necrosis, to reduce the rate of disabling complications of ONFH
Doctorat en Sciences médicales
info:eu-repo/semantics/nonPublished

Rheumatoid Arthritis (RA) is a disease in which the body has "turned on itself", with its immune system attacking mobility. In RA, an immune mechanism attacks and destroys the joints and limits mobility, in some circumstances to the point of needing replacement of joints. The aim of this research is the development of a less costly, widely accessible, passive sensing technology that provides a quantitative assessment of RA and that monitors the therapeutic effectiveness on joint-debilitating diseases. The proposed solution relies on a quantitative evaluation of human gestures. Such a quantitative assessment supports the comparison between the motion capabilities of a patient and that of a healthy person, using a kinematic model of the human skeleton. Criteria for the classification of severity were established, and tables were generated to classify the levels of severity as a function of the measurements extracted from processed videos of a subject performing predefined movements. This research project, while contributing a new tool to the process of classification of RA level of severity, opens the way for using widely accessible digital imaging for diagnosing and monitoring the evolution of the illness. Replacing MRI or HRUS with a cheaper and more accessible technology would have a major impact on health care services. From the clinical point of view, the proposed techniques based on digital images processing combined with a monitoring approach based on infrared images that was previously developed may provide a utility of care for patients with RA, as well as an alternative and automated approach for early detection of RA and active inflammation at a critical time.

Kan, Wai Chi.
Thesis (M.Phil.)--Chinese University of Hong Kong, 2010.
Includes bibliographical references (p. 111-116).
Abstract --- p.i
Acknowledgement --- p.iii
List of Publications --- p.vi
List of Figures --- p.xi
List of Tables --- p.xii
Chapter 1 --- Introduction --- p.1
Chapter 1.1 --- Terahertz Radiation --- p.1
Chapter 1.2 --- Biomedical Applications of Terahertz Imaging --- p.3
Chapter 1.3 --- THz Spectroscopy --- p.4
Chapter 1.4 --- Osteoarthritis --- p.4
Chapter 1.5 --- Aim and motivation --- p.5
Chapter 1.6 --- Overview of thesis --- p.5
Chapter 2 --- Theory --- p.7
Chapter 2.1 --- Propagation of electromagnetic field through dielectric media --- p.7
Chapter 2.2 --- Deconvolution --- p.10
Chapter 2.3 --- Baseline offset --- p.12
Chapter 2.4 --- Frequency-dependent Refractive Index and Absorption Coefficient --- p.15
Chapter 2.4.1 --- Reflection Geometry --- p.15
Chapter 2.4.2 --- Transmission Geometry --- p.17
Chapter 2.5 --- Conversion of Optical Delay into Depth --- p.22
Chapter 2.6 --- Finite Difference Time Domain Method --- p.23
Chapter 2.7 --- Summary --- p.25
Chapter 3 --- Terahertz Systems --- p.26
Chapter 3.1 --- Terahertz Pulsed Generation --- p.26
Chapter 3.2 --- Terahertz Pulsed Detection --- p.28
Chapter 3.3 --- Terahertz Pulsed Imaging (TPI) System --- p.29
Chapter 3.4 --- Reflection System --- p.29
Chapter 3.4.1 --- Flatbed System --- p.29
Chapter 3.4.2 --- Probe --- p.32
Chapter 3.5 --- Transmission System --- p.36
Chapter 3.5.1 --- Antenna --- p.39
Chapter 3.6 --- Data Acquisition --- p.40
Chapter 3.6.1 --- Flatbed System --- p.40
Chapter 3.6.2 --- Probe --- p.42
Chapter 3.7 --- Baseline Validation --- p.46
Chapter 4 --- Osteoarthritis --- p.48
Chapter 4.1 --- Introduction --- p.48
Chapter 4.2 --- Cartilage Composition and Structure --- p.49
Chapter 4.3 --- 〇A symptoms --- p.51
Chapter 4.4 --- Other Imaging Techniques --- p.52
Chapter 4.5 --- Sample Preparation and Histology --- p.54
Chapter 5 --- THz Pulsed Imaging of OA --- p.58
Chapter 5.1 --- Results --- p.58
Chapter 5.1.1 --- Optical Delays --- p.59
Chapter 5.1.2 --- Estimation of surface refractive index --- p.69
Chapter 5.1.3 --- Conversion of Optical Delay into Cartilage Thickness --- p.72
Chapter 5.1.4 --- Correlation with Histology --- p.74
Chapter 5.1.5 --- Errors and Problems --- p.80
Chapter 5.2 --- FDTD of cartilage layers --- p.85
Chapter 5.3 --- Conclusion --- p.87
Chapter 6 --- Sliced Cartilage Sample and Bone Measurement --- p.88
Chapter 6.1 --- Sliced Cartilage Samples --- p.88
Chapter 6.1.1 --- Multi-reflections of sliced cartilage samples --- p.89
Chapter 6.1.2 --- The influence of pressure on cartilage thickness --- p.91
Chapter 6.1.3 --- Estimation of surface refractive index of sliced cartilage samples --- p.93
Chapter 6.1.4 --- Comparison between sliced cartilage and knee joint measurements --- p.95
Chapter 6.2 --- Bone --- p.97
Chapter 7 --- Transmission System Result --- p.99
Chapter 7.1 --- Data Validation --- p.99
Chapter 7.1.1 --- Water spectrum --- p.99
Chapter 7.1.2 --- Quartz measurement --- p.100
Chapter 7.2 --- Liquid cell --- p.100
Chapter 7.3 --- Cartilage Transmission Result --- p.103
Chapter 7.4 --- Difficulties and problems --- p.105
Chapter 7.5 --- Conclusions --- p.106
Chapter 8 --- Conclusions and future work --- p.107
Chapter 8.1 --- Summary --- p.107
Chapter 8.2 --- Discussion --- p.107
Chapter 8.3 --- Suggestions for further study --- p.109
Bibliography --- p.111

Thesis (M.Tech.:Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2006 18, xvii, 157, 14 leaves, Annexures A-K
The aim of this study was to assess the inter-examiner reliability of motion palpation of the patella, in both pathological (osteoarthritis) as well as functional (patellofemoral pain syndrome) conditions, in order to assess the validity of this assessment tool, which is commonly used as a method in identifying restricted patella motion.

M.Tech.
It has been well documented in literature that at least 80% of the general population will suffer from lower back pain or dysfunction at one stage in their lives. Recent literature suggests Sacroiliac joint dysfunction to be a common cause of lower back pain. Clinical interest in the dysfunction and the consequences of this joint being a major cause of lower back pain is growing, as more biomechanical clinicians are finding Sacroiliac joint disorders to be a common occurrence in clinical practice (Pool-Goudzwaard, Vleeming, Stoekart, Snijders and Mens, 1998). Sacroiliac syndrome is characterised by loss of joint play or altered mobility in the Sacroiliac joint‟s range of motion, and is usually associated with altered structural relationships in the region of the Sacroiliac joint (Grieve, 2001). This loss of normal movement is often adjusted by Chiropractors to regain normal mobility, however the correct diagnosis of the loss of mobility is required to induce the correct treatment. Motion palpation has been scrutinised by many researchers who widely questioned its inter-tester reliability. As yet there has been no consensus as to a „gold standard‟ for motion palpation of the Sacroiliac joint. This study aims to reconfirm the inter-examiner reliability of two such motion palpation tests, i.e. Gillet‟s motion palpation and the Standing Flexion test. One hundred participants underwent a double blind experimental study where the results from eight different examiners were recorded to obtain the reliability of the tests. Four examiners tested the participants using Gillet‟s motion palpation and four examiners used the Standing Flexion test. The results were recorded as either right, left or no restriction. The results were then compared and correlated. There was no statistically significant reliability found in either of the two tests. The mean reliability for the Standing Flexion test was found to be 59.31% while the Gillet‟s Motion Palpation produced a mean reliability of 56.38%. These two values are considerably lower than the expected 80% indicating low reliability between the two tests.

博士
中原大學
電子工程研究所
93
Inner structure image can be retrieved by computerized Tomography (CT). The existed feature analysis techniques process object’s image on 2D CT slices to segmentation the object’s inner features and/or structure features. Furthermore, the techniques also be used in industrial or medical application, by enhacing image features to produce better 3D reconstruction results. These studies do not figure out 3D object features to employ them. Isosurface reconstruction for volumes cannot provide clear 3D object feature because it uses linear interpolation. In this thesis, a set of 2D CT image feature recognition techniques are developed and applied in diagnoses and surgical planning of musculoskeletal system. Our techniques transform feature objects to simple B-spline radical curve and calculate feature properties such as the centers and radii of objects to obtain 3D object angles, distances, ratios and deviations. These properties are more meaningful than 2D information in topology view and provide better clinical information for bones and joints. Clinicians can use the deviations to normal value to automate diagnoses and surgical planning to reduce the operation time and improve accuracy Key words：Image analysis, feature recognition, bone and joint surgery and management, 3D image reconstruction and surgical simulation