Journal of Physiology & Pathology in Korean Medicine (동의생리병리학회지)

The Physiological Society of Korean Medicine and The Society of Pathology in Korean Medicine (대한동의생리학회·한의병리학회)
권호 표지

Ultrasonographic Findings of Both Knee in Hemiplegic Ambulators with Recent Stroke

초기 편마비 보행 환자에서 양측 무릎의 초음파 검사 소견

  • Park, Soon-Ah (Department of Nuclear medicine, Wonkwang University College of Medicine and Hospital) ;
  • Yang, Chung-Yong (Departments of Physical Medicine and Rehabilitation, Wonkwang University College of Medicine & Institute of Wonkwang Medical Science & Regional Cardiocerebrovascular Center) ;
  • Kim, Ji-Hee (Departments of Physical Medicine and Rehabilitation, Wonkwang University College of Medicine & Institute of Wonkwang Medical Science & Regional Cardiocerebrovascular Center) ;
  • Lee, Kang-Keun (Departments of Physical Medicine and Rehabilitation, Wonkwang University College of Medicine & Institute of Wonkwang Medical Science & Regional Cardiocerebrovascular Center) ;
  • Shin, Byung-Cheul (School of Korean Medicine, Pusan National University) ;
  • Lee, In (School of Korean Medicine, Pusan National University)
  • 박순아 (원광대학교 의과대학 핵의학교실) ;
  • 양충용 (원광대학교 의과대학 재활의학교실 & 원광의과학연구소 & 권역심뇌혈관질환센터) ;
  • 김지희 (원광대학교 의과대학 재활의학교실 & 원광의과학연구소 & 권역심뇌혈관질환센터) ;
  • 이강근 (원광대학교 의과대학 재활의학교실 & 원광의과학연구소 & 권역심뇌혈관질환센터) ;
  • 신병철 (부산대학교 한의학전문대학원 한의학과) ;
  • 이인 (부산대학교 한의학전문대학원 한의학과)
  • Received : 2012.05.25
  • Accepted : 2012.08.01
  • Published : 2012.08.25
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Abstract

To evaluate of the ultrasonographic changes in hemiplegic and unaffected knee joints of hemiplegic ambulators with recent onset stroke. Twenty patients (40 knees) with prevalence duration of 14-39 weeks (mean 24.70 weeks) after a stroke insult were included. All participants were walking independently without leg dragging, had no previous knee injury. There were significant differences in intercondylar cartilage thickness and pes anserinous tendinopathy (PAT) between hemiplegic and unaffected knees (p<0.05). There were no differences in cartilage thickness of medial condyle and lateral condyle, patellar tendinitis/bursitis, suprapatellar effusion, synovitis, joint space narrowing, and Baker's cyst of ultrasonographic findings and x-ray findings in hemiplegic knee compared to the control except PAT (p<0.05). In hemiplegic knee, medial or lateral condylar cartilage thickness was significantly correlated with body weight, intercondylar cartilage thickness, and PAT (p<0.05). PAT was significantly correlated with Brunnnstrom stage and condylar cartilage thickness (p<0.05). Knee pain was significantly correlated with lateral condylar cartilage thickness (p<0.1). The hemiplegic knee had more ultrasonographic abnormalities including PAT and more cartilage thickness preservation in patient with recent onset stroke. Intraarticular sonographic findings including cartilage thickness was significantly correlated with extraarticular findings including PAT and a symptom of knee pain.

Keywords

References

  1. Kuan, T.S., Tsou, J.Y., Su, F.C. Hemiplegic gait of stroke patients: the effect of using a cane. Arch Phys Med Rehabil 80: 777-784, 1999. https://doi.org/10.1016/S0003-9993(99)90227-7
  2. Chen, C.L., Chen, H.C., Tang, S.F., Wu, C.Y., Cheng, P.T., Hong, W.H. Gait performance with compensatory adaptations in stroke patients with different degrees of motor recovery. Am J Phys Med Rehabil 82: 925-935, 2003. https://doi.org/10.1097/01.PHM.0000098040.13355.B5
  3. Richards, J.D., Pramanik, A., Sykes, L., Pomeroy, V.M. A comparison of knee kinematic characteristics of stroke patients and age-matched healthy volunteers. Clin Rehabil 17: 565-571, 2003. https://doi.org/10.1191/0269215503cr651oa
  4. Segal, R., Avrahami, E., Lebdinski, E., Habut, B., Leibovitz, A., Gil, I., Yaron, M., Caspi, D. The impact of hemiparalysis on the expression of osteoarthritis. Arthritis Rheum 41: 2249-2256, 1998. https://doi.org/10.1002/1529-0131(199812)41:12<2249::AID-ART21>3.0.CO;2-O
  5. Kellgren, J.H., Lawrence, J.S. Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16: 494-502, 1957. https://doi.org/10.1136/ard.16.4.494
  6. Abraham, A.M., Goff, I., Pearce, M.S., Francis, R.M., Birrell, F. Reliability and validity of ultrasound imaging of features of knee osteoarthritis in the community. BMC Musculoskelet Disord 12: 70, 2011. https://doi.org/10.1186/1471-2474-12-70
  7. Lee, C.L., Chen, T.W., Weng, M.C., Wang, Y.L., Cheng, H.S., Huang, M.H. Ultrasonographic findings in hemiplegic shoulders of stroke patients. Kaohsiung J Med Sci 18: 70-76, 2002.
  8. Iagnocco, A. Imaging the joint in osteoarthritis: a place for ultrasound? Best Pract Res Clin Rheumatol 24: 27-38, 2010.
  9. Grobbelaar, N., Bouffard, J.A. Sonography of the knee, a pictorial review. Semin Ultrasound CT MR 21: 231-274, 2000. https://doi.org/10.1016/S0887-2171(00)90045-3
  10. Friedman, L., Finlay, K., Jurriaans, E. Ultrasound of the knee. Skeletal Radiol 30: 361-377, 2001. https://doi.org/10.1007/s002560100380
  11. Yang, C.P., Lee, C.L., Chen, T.W., Lee, S., Weng, M.C., Huang, M.H. Ultrasonographic findings in hemiplegic knees of stroke patients. Kaohsiung J Med Sci 21: 70-77, 2005. https://doi.org/10.1016/S1607-551X(09)70280-3
  12. Kaufman, K.R., Hughes, C., Morrey, B.F., Morrey, M., An, K.N. Gait characteristics of patients with knee osteoarthritis. J Biomech 34: 907-915, 2001. https://doi.org/10.1016/S0021-9290(01)00036-7
  13. Aisen, A.M., McCune, W.J., MacGuire, A., Carson, P.L., Silver, T.M., Jafri, S.Z., Martel, W. Sonographic evaluation of the cartilage of the knee. Radiology 153: 781-784, 1984.
  14. de Miguel Mendieta, E., Cobo Ibanez, T., Uson Jaeger, J., Bonilla Hernan, G., Martin Mola, E. Clinical and ultrasonographic findings related to knee pain in osteoarthritis. Osteoarthritis Cartilage 14: 540-544, 2006. https://doi.org/10.1016/j.joca.2005.12.012
  15. Baker, N.D. Evaluation of popliteal cysts. Rheum Dis Clin North Am 17: 803-804, 1991.
  16. Acebes, J.C., Sanchez-Pernaute, O., Diaz-Oca, A., Herrero-Beaumont, G. Ultrasonographic assessment of Baker's cysts after intra-articular corticosteroid injection in knee osteoarthritis. J Clin Ultrasound 34: 113-117, 2006. https://doi.org/10.1002/jcu.20210
  17. Fornage, B.D., Rifkin, M.D. Ultrasound examination of tendons. Radiol Clin North Am 26: 87-107, 1988.
  18. Unlu, Z., Ozmen, B., Tarhan, S., Boyvoda, S., Goktan, C. Ultrasonographic evaluation of pes anserinus tendino-bursitis in patients with type 2 diabetes mellitus. J Rheumatol 30: 352-354, 2003.
  19. Uson, J., Aguado, P., Bernad, M., Mayordomo, L., Naredo, E., Balsa, A., Martin-Mola, E. Pes anserinus tendino-bursitis: what are we talking about? Scand J Rheumatol 29: 184-186, 2000. https://doi.org/10.1080/030097400750002076
  20. Tyyni, A., Karlsson J. Biological treatment of joint cartilage damage. Scand J Med Sci Sports 10: 249-265, 2000. https://doi.org/10.1034/j.1600-0838.2000.010005249.x
  21. Iagnocco, A., Coari, G., Zoppini, A. Sonographic evaluation of femoral condylar cartilage in osteoarthritis and rheumatoid arthritis. Scand J Rheumatol 21: 201-203, 1992. https://doi.org/10.3109/03009749209099222
  22. Smith, M.D., Triantafillou, S., Parker, A., Youssef, P.P., Coleman, M. Synovial membrane inflammation and cytokine production in patients with early osteoarthritis. J Rheumatol 24: 365-371, 1997.
  23. Park, K.T., Kim, H.J., Kang, Y.J., Park, H.K., Choi, N.H. The ultrasonographic findings related to pain and functional status in patients with knee osteoarthritis J Korean Acad Rehab Med 32: 668-681, 2008.
  24. Hogue, R.E., McCandless, S. Genu recurvatum: auditory biofeedback treatment for adult patients with stroke or head injuries. Arch Phys Med Rehabil 64:,368-370, 1983.
  25. Roth, E.J., Merbitz, C., Mroczek, K., Dugan, S.A., Suh, W.W. Hemiplegic gait. Relationships between walking speed and other temporal parameters. Am J Phys Med Rehabil 76: 128-133, 1997. https://doi.org/10.1097/00002060-199703000-00008
  26. Monteforte, P., Sessarego, P., Rovetta, G. Sonographic assessment of soft tissue alterations in osteoarthritis of the knee. G Ital Med Lav Ergon 30: 75-77, 2008.
  27. Yoon, H.S., Kim, S.E., Suh, Y.R., Seo, Y.I., Kim, H.A. Correlation between ultrasonographic findings and the response to corticosteroid injection in pes anserinus tendinobursitis syndrome in knee osteoarthritis patients. J Korean Med Sci 20: 109-112, 2005. https://doi.org/10.3346/jkms.2005.20.1.109
  28. Biundo, J.J. Regional rheumatic pain syndromes. In Primer on the rheumatic diseases, 11th ed. Schumacher H.R., Ed. Arthritis Foundation, Atlanta, p 144, 1997.
  29. Kang, I., Han, S.W. Anserine bursitis in patients with osteoarthritis of the knee. South Med J 93: 207-209, 2000.
  30. Blazina, M.E., Kerlan, R.K., Jobe, F.W., Carter, V.S., Carlson, G.J. Jumper's knee. Orthop Clin North Am 4: 665-678, 1973.
  31. Warden, S.J., Brukner, P. Patellar tendinopathy. Clin Sports Med 22: 743-759, 2003. https://doi.org/10.1016/S0278-5919(03)00068-1
  32. Kornaat, P.R., Bloem, J.L., Ceulemans, R.Y., Riyazi, N., Rosendaal, F.R., Nelissen, R.G., Carter, W.O., Hellio, Le Graverand, M.P., Kloppenburg, M. Osteoarthritis of the knee: association between clinical features and MR imaging findings. Radiology 239: 811-817, 2006. https://doi.org/10.1148/radiol.2393050253