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Prosthetic and orthotic devices
Published in Alex Mihailidis, Roger Smith, Rehabilitation Engineering, 2023
Joel Kempfer, Renee Lewis, Goeran Fiedler, Barbara Silver-Thorn
Although individual procedures differ, amputation surgery typically incorporates myoplasty or myodesis. Myoplasty, which entails connecting the severed opposing muscles over the distal bone, aims to provide distal soft tissue padding to enhance comfort in the prosthetic socket and secure the muscles at functional lengths such that they can generate force. In contrast, myodesis attaches the severed muscles directly to the bone with the goal of improving the effectiveness of muscle work and control of limb motion. The surgical procedure is more time intensive and thus more taxing for the patient than myoplasty, making it contra-indicated for many elderly or frail amputation candidates. Common post-surgical problems include phantom limb pain and the formation of bone spurs and neuromas. Phantom limb pain typically diminishes with wound healing and compression therapy but can develop into a chronic issue for a considerable portion of patients. Bone spurs result from the calcification of cut bone ends attempting to attach to other bone. Neuromas, small nerve end bundles at the severed nerve site, are perceived as “electric shock” when palpated. If severe, bone spurs and neuromas may necessitate revision surgery.
Articular Cartilage Pathology and Therapies
Published in Kyriacos A. Athanasiou, Eric M. Darling, Grayson D. DuRaine, Jerry C. Hu, A. Hari Reddi, Articular Cartilage, 2017
Kyriacos A. Athanasiou, Eric M. Darling, Grayson D. DuRaine, Jerry C. Hu, A. Hari Reddi
Along with thickening, new bone formation is observed. Osteophytes form as bony outgrowths, usually located along the periphery of degenerating cartilage. While osteophyte formation is used as a clinically relevant finding of osteoarthritis, its initiation process and the cellular source are still debated in the literature. Osteophytes are strongly associated with malalignment (Nagaosa et al. 2002; Felson et al. 2005; van der Esch et al. 2005), an identified cause for cartilage lesions that can lead to further degeneration. Although multiple causes can induce osteophyte formation, including osteoarthritis, osteomyelitis (infection of the bone), and diabetic neuropathy (nerve damage due to diabetes), the mechanism of formation is still undetermined. An improper healing response and changes in the balance of catabolic and anabolic factors have been proposed as likely candidates (Felson and Neogi 2004). The source of cells that initiate osteophyte formation is still undetermined, although they are thought to potentially originate from the peripheral cartilage (Peng et al. 2000). These bone spurs often result in reduced mobility, pain, and, in the spine, numbness due to nerve impingement. The remodeling and formation of osteophytes alter the contours of the joint. Symptomatic osteophytes may require surgical removal. Further studies on osteophyte initiation and growth are needed to develop new therapeutic approaches.
Spine
Published in David A Lisle, Imaging for Students, 2012
Osteoarthritis (degenerative arthropathy) is a major cause of neck pain, with increasing incidence in old age. The primary phenomenon in osteoarthritis of the spine is degeneration of the intervertebral disc. Intervertebral disc degeneration in the cervical spine is most common at C5/6 and C6/7. Degenerate discs may herniate into the spinal canal or intervertebral foramina, with direct compression of the spinal cord or nerve roots. More commonly, disc degeneration leads to abnormal stresses on the vertebral bodies and on the facet and uncovertebral joints. These abnormal stresses lead to formation of bone spurs or osteophytes. Osteophytes may project into the spinal canal causing compression of the cervical cord, or into the intervertebral foramina causing nerve root compression. Cervical cord compression presents clinically with neck pain associated with a stiff gait and brisk lower limb reflexes (myelopathy).
Effect of unifocal versus multifocal lenses on cervical spine posture in patients with presbyopia
Published in International Journal of Occupational Safety and Ergonomics, 2019
Rami L. Abbas, Mohamad T. Houri, Mohammad M. Rayyan, Hamada Ahmad Hamada, Ibtissam M. Saab
When using multifocal lenses the head is positioned upward and the neck is extended with the chin tilted upward. This creates excessive compression on the posterior cervical facet joints, especially in the middle region of the cervical spine, leading to degenerative arthritis with associated bone spurs. In addition, this posture increases lower cervical compression forces that can lead to a disc herniation or rupture [19].