Abduction Range Research Articles

Effects of two different mobilization techniques on pain, range of motion and functional disability in patients with adhesive capsulitis: a comparative study.

[Purpose] This study aimed to compare the effects of two different mobilization techniques in the management of patients with adhesive capsulitis. [Subjects and Methods] Thirty non-diabetic men and women with adhesive capsulitis were randomly allocated to the reverse distraction group (n=15) or Kaltenborn group (n=15). The reverse distraction technique and Kaltenborn’s caudal and posterior glides (grades III and IV) were applied 10–15 times along with conventional physical therapy for 18 treatment sessions in 6 weeks. Pain was measured with a visual analog scale, abduction and external rotation range of motion with goniometry, hand behind back reach with inch tape, and functional disability with the Flexilevel scale of shoulder function before and after the treatment. [Results] Although all the variables improved significantly in both groups after 18 intervention sessions, reverse distraction was significantly better than Kaltenborn’s caudal and posterior glides in decreasing pain and improving abduction range of motion and functional scores. [Conclusion] This study supports the clinical use of reverse distraction as an alternative to conventional mobilization techniques to decrease pain and improve range of motion and functional scores in patients with adhesive capsulitis.

副神経を温存した頸部郭清術後の頭頸部がん患者の手術後早期における肩関節外転可動域の影響因子

副神経を温存した頸部郭清術後の頭頸部がん患者の手術後早期における肩関節外転可動域の影響因子

Acute effect of scapular proprioceptive neuromuscular facilitation (PNF) techniques and classic exercises in adhesive capsulitis: a randomized controlled trial.

[Purpose] The aim of our study was to compare the initial effects of scapular proprioceptive neuromuscular facilitation techniques and classic exercise interventions with physiotherapy modalities on pain, scapular dyskinesis, range of motion, and function in adhesive capsulitis. [Subjects and Methods] Fifty-three subjects were allocated to 3 groups: scapular proprioceptive neuromuscular facilitation exercies and physiotherapy modalities, classic exercise and physiotherapy modalities, and only physiotherapy modalities. The intervention was applied in a single session. The Visual Analog Scale, Lateral Scapular Slide Test, range of motion and Simple Shoulder Test were evaluated before and just after the one-hour intervention in the same session (all in one session). [Results] All of the groups showed significant differences in shoulder flexion and abduction range of motion and Simple Shoulder Test scores. There were statistically significant differences in Visual Analog Scale scores in the proprioceptive neuromuscular facilitation and control groups, and no treatment method had significant effect on the Lateral Scapular Slide Test results. There were no statistically significant differences between the groups before and after the intervention. [Conclusion] Proprioceptive neuromuscular facilitation, classic exercise, and physiotherapy modalities had immediate effects on adhesive capsulitis in our study. However, there was no additional benefit of exercises in one session over physiotherapy modalities. Also, an effective treatment regimen for shoulder rehabilitation of adhesive capsulitis patients should include scapular exercises.

Luxação do quadril na paralisia cerebral: a evolução do lado contralateral após cirurgia reconstrutiva

ObjectiveTo evaluate the progression of the contralateral hip after unilateral reconstruction of hip dislocation in patients classified as GMFCS IV–V; and to identify potential prognostic factors for their evolution. MethodsThis was a retrospective study on 17 patients with spastic cerebral palsy, who were classified on the GMFCS scale (Gross Motor Functional Classification System) as degrees IV and V, and who underwent unilateral reconstruction surgery to treat hip dislocation (adductor release, femoral varus osteotomy and acetabuloplasty). The minimum postoperative follow‐up was 30 months. The clinical parameters evaluated were sex, age at time of surgery, length of follow‐up after surgery and range of abduction. The treatment parameters were use/nonuse of femoral shortening, application of botulinum toxin and any previous muscle releases. The radiographic parameters were Reimer's extrusion index (REI), acetabular angle (AA) and the continuity of Shenton's line. ResultsAmong the 17 patients evaluated, eight presented dislocation (group I) and nine did not (group II). Group I comprised three males and five females; group II comprised one male and eight females. The mean age at the time of surgery among the group I patients was 62 months and the mean follow‐up was 62 months. In group II, these were 98 and 83 months, respectively. There was a trend in which patients of greater age did not evolve with contralateral dislocation. Among the nine patients with the combination of REI<30% and AA<25°, only one presented dislocation during the follow‐up. Contralateral subluxation occurred within the first two years after the surgery. ConclusionHips presenting REI<30° and AA<25° do not tend to evolve to subluxation and can be kept under observation. Preoperative clinical and radiographic measurements alone are not useful for indicating the natural evolution of non‐ operated hips. The critical period for subluxation is the first two years after surgery.

Definition of anatomical zero positions for assessing shoulder pose with 3D motion capture during bilateral abduction of the arms.

BackgroundSurgical interventions at the shoulder may alter function of the shoulder complex. Clinically, the outcome can be assessed by universal goniometry. Marker-based motion capture may not resemble these results due to differing angle definitions.MethodsThe clinical inspection of bilateral arm abduction for assessing shoulder dysfunction is performed with a marker based 3D optical measurement method. An anatomical zero position of shoulder pose is proposed to determine absolute angles according to the Neutral-0-Method as used in orthopedic context. Static shoulder positions are documented simultaneously by 3D marker tracking and universal goniometry in 8 young and healthy volunteers. Repetitive bilateral arm abduction movements of at least 150° range of motion are monitored. Similarly a subject with gleno-humeral osteoarthritis is monitored for demonstrating the feasibility of the method and to illustrate possible shoulder dysfunction effects.ResultsWith mean differences of less than 2°, the proposed anatomical zero position results in good agreement between shoulder elevation/depression angles determined by 3D marker tracking and by universal goniometry in static positions. Lesser agreement is found for shoulder pro-/retraction with systematic deviations of up to 6°. In the bilateral arm abduction movements the volunteers perform a common and specific pattern in clavicula-thoracic and gleno-humeral motion with maximum shoulder angles of 32° elevation, 5° depression and 45° protraction, respectively, whereas retraction is hardly reached. Further, they all show relevant out of (frontal) plane motion with anteversion angles of 30° in overhead position (maximum abduction). With increasing arm anteversion the shoulder is increasingly retroverted, with a maximum of 20° retroversion. The subject with gleno-humeral osteoarthritis shows overall less shoulder abduction range of motion but with increased out-of-plane movement during abduction.ConclusionsThe proposed anatomical zero definition for shoulder pose fills the missing link for determining absolute joint angles for shoulder elevation/depression and pro-/retraction. For elevation-/depression the accuracy suits clinical expectations very well with mean differences less than 2° and limits of agreement of 8.6° whereas for pro-/retraction the accuracy in individual cases may be inferior with limits of agreement of up to 24.6°. This has critically to be kept in mind when applying this concept to shoulder intervention studies.

Teaching of Independent Exercises for Prehabilitation in Breast Cancer.

We attempted to determine the feasibility of studying prehabilitation exercises to improve shoulder pain and abduction range of motion (ROM) after breast cancer surgery. We evaluated methods of exercise teaching and assessed effect on postsurgical seroma formation. This was a feasibility study with two non-blinded groups of subjects randomized by timing of appointment. This single-site study was performed at an academic tertiary medical center. Sixty cancer patients were randomly assigned to either group 1, in-person teaching arm, n = 36, or group 2, video-only teaching arm, n = 24. Forty-five patients completed the study. Shoulder exercises were assigned to both groups 1month prior to surgery during evaluation. Group 1 received in-person instruction on exercises, plus an information sheet with exercises and a link to an online video. Group 2 received only the information sheet with exercises and a link to the online video. The primary outcomes considered are as follows: exercise compliance, shoulder pain (via visual analog scale), shoulder abduction ROM (via goniometer), and presence or absence of seroma. Seventy-six percent of study patients chose to exercise. There was no difference in exercise compliance between in-person teaching versus video teaching (75%, 24/32 vs. 77%, 10/13, OR = 1.03). Sixty-six of patients (20/30) lost greater than 10° shoulder abduction ROM at 1month post surgery. Twenty-nine of patients (9/31) had worse shoulder pain than baseline at 1month post surgery (24%, 6/25 exercisers, and 50%, 3/6 non-exercisers). Fifteen percent of patients (4/27) had worse shoulder pain than baseline at 3months post surgery (8%, 2/23 exercisers, and 100%, 2/2 non-exercisers). Prehabilitation exercise program inferred no additional risk of seroma formation (Exercisers 21%, 7/33 vs. non-exercisers 22%, 2/9, OR = 0.94). Our subjects were able to perform three exercises independently in the preoperative period. A high-quality randomized controlled trial is necessary to assess the appropriate timing and efficacy of this intervention.

Treatment of proximal humeral fractures by reverse shoulder arthroplasty: Mid-term evaluation of functional results and Notching

ObjectiveAn analysis was made on relationship between Notching and functional and radiographic parameters after treatment of acute proximal humeral fractures with reverse total shoulder arthroplasty. MethodsA retrospective evaluation was performed on 37 patients with acute proximal humeral fracture treated by reversed shoulder arthroplasty. The mean follow-up was 24 months.Range of motion, intraoperative and postoperative complications were recorded. Nerot's classification was used to evaluate Notching. Patient satisfaction was evaluated with the Constant Score (CS).Statistical analysis was performed to evaluate the relationship between Notching and glenosphere position, or functional outcomes. ResultsMean range of elevation, abduction, external and internal rotation were 106.22°, 104.46°, 46.08° and 40.27°, respectively. Mean CS was 63. Notching was present at 12 months in 29% of patients. Statistical analysis showed significance differences between age and CS, age and notching development, and tilt with notching. No statistical significance differences were found between elevation, abduction, internal and external rotation and CS either with scapular or glenosphere-neck angle. ConclusionReverse shoulder arthroplasty is a valuable option for acute humeral fractures in patients with osteoporosis and cuff-tear arthropathy. It leads to early pain relief and shoulder motion. Nevertheless, it is not exempt from complications, and long-term studies are needed to determine the importance of notching.

MULLIGAN MOBILIZATION IS MORE EFFECTIVE IN TREATING DIABETIC FROZEN SHOULDER THAN THE MAITLAND TECHNIQUE

Background:&nbsp;Patients with frozen shoulder suffer from significant pain and progressive limitation of shoulder active and passive movements. Such clinical problems are primarily treated conservatively. Physical therapy is an integral part in treatment of frozen shoulder. Rehabilitation may include various manual mobilization techniques in order to relieve pain and restore mobility and function. Therefore, this study aimed at comparing the effects of two different mobilization techniques (Mulligan Mobilization with Movement and Maitland end range mobilization) on improving shoulder pain, function and mobility in patients with diabetic frozen shoulder.Methods:&nbsp;Thirty patients were randomly and equally distributed into two groups: (1) Mulligan group receiving mobilization with movement, and (2) Maitland group receiving end range oscillatory mobilization. Treatment was given 3 times per week, for 6 consecutive weeks. Patients were evaluated before and after treatment with regards to shoulder pain severity and functional disability using the Shoulder Pain and Disability Index as well as for shoulder flexion, abduction, external and internal rotation range of motion using a digital level inclinometer.Results:&nbsp;Patients in the two groups showed significant improvement in all the measured variables over the treatment period (p&lt;0.01), however, patients who received the Mulligan technique showed greater improvement (p&lt;0.05). Between group comparisons showed that patients in the Mulligan group significantly improved than those in the Maitland on all measured variables (p&lt;0.05), except for the internal rotation range of motion (p&gt;0.05).Conclusion:&nbsp;Mulligan and Maitland end range mobilization are effective in decreasing shoulder pain and dysfunction as well as in increasing shoulder mobility in all directions. However, the Mulligan mobilization is more effective when treating patients with diabetic frozen shoulder.

Morphological and Functional Hip Long-Term Results after Exstrophy Repair.

Introduction Abnormalities of the bony pelvis in exstrophy-epispadias complex (EEC) and their possible relation to hip disease are well described. However, there is a lack of information about long-term orthopedic consequences and hip function in patients with EEC. Therefore, we investigated clinical and radiological results in an EEC patient cohort after long-term follow-up. Patients and Methods We conducted a cross-sectional study using standardized radiography, clinical investigation, and the Harris hip score. Seventeen postpuberty consecutive unselected EEC patients (3 female, 14 male; mean age 18.2 years) that presented to our clinic due to urological procedures or routine check-up from 2010 to 2011 were included. All had undergone symphysis approximation with a traction bandage without osteotomy in early childhood. Radiological analysis was conducted offline by two independent investigators. Results Radiological analysis showed a mean pubic diastasis of 5.1 cm (range 2.8-8.5 cm). Borderline hip dysplasia was present in four patients, one of them having had co-occurring developmental hip dysplasia in previous history. No severe dysplasia, subluxation, or luxation of the hip was found; however, one patient showed early hip arthrosis. Clinical examination revealed no relevant restriction of range of motion, although rotation and abduction were slightly altered in five patients. None of the EEC patients complained about pain or restriction in sports or daily activities. Harris hip score was perfect for all but one study participants. Conclusion Despite EEC-specific hip morphology, long-term hip function is not impaired in patients after symphyseal approximation without osteotomy in the newborn period. The symphysis diastasis after this procedure is comparable to available postosteotomy data. The large majority of EEC patients did not show dysplastic or degenerative hip disease. Functional hip score results confirmed reasonable age-related hip function in nearly all examined patients. However, postnatal ultrasound hip screening is recommended to prevent and adequately treat potential co-occurring developmental hip dysplasia.

Measurement of active shoulder motion using the Kinect, a commercially available infrared position detection system

The shoulder's ability to participate in sports and activities of daily living depends on its active range of motion. Clinical goniometry is of limited utility in rigorously assessing limitation of motion and the effectiveness of treatment. We sought to determine (1) whether a validated position-sensing tool, the Kinect, can enable the objective clinical measurement of shoulder motion and (2) the degree to which active range of motion correlates with patient self-assessed shoulder function. In 10 control subjects, we compared Kinect motion measurements to measurements made on standardized anteroposterior and lateral photographs taken concurrently. In 51 patients, we correlated active motion with the ability to perform the functions of the Simple Shoulder Test (SST). In controls, Kinect measurements strongly agreed with photographic measurements. In patients, the total SST score was strongly correlated with the range of active abduction. The ability to perform each of the individual SST functions was strongly correlated with active motion. The active motion in well-functioning patient shoulders averaged 155° ± 22° abduction, 159° ± 14° flexion, 76° ± 18° external rotation in abduction, -59° ± 25° internal rotation in abduction, and -3.3 ± 3.7 inches of cross-body adduction, values similar to the control shoulders. Use of the Kinect system was practical in clinical examination rooms, requiring <5 minutes to document the 5 motions in both shoulders. The Kinect provides a clinically practical method for objectively measuring active shoulder motion. Active motion was an important determinant of patient-assessed shoulder function.

Determinants of Hip Displacement in Children With Cerebral Palsy.

Coxa valga and femoral anteversion often are seen in patients with spastic hip displacement and osteotomy is recommended. However, the relationship between femoral deformities and hip displacement has not been clearly defined and other factors, such as joint motion and posture, should be considered before recommending treatment. For children with cerebral palsy with Gross Motor Function Classification System Level IV or V, we questioned (1) whether hip abduction range correlates with hip displacement, (2) what the relationships are between proximal femoral deformities and hip displacement, and (3) whether the patient with a windblown posture has greater degrees of femoral anteversion? We retrospectively studied 31 consecutive children with cerebral palsy with Level IV or V gross motor function who underwent three-dimensional CT for preoperative assessment of hip displacement between January 2010 and December 2013. Among the children, 23 had a windblown posture and eight had symmetric hip motion. Femoral anteversion and true neck-shaft angle were measured from the three-dimensional CT images. Migration percentage was the dependent variable we chose to study in relation to femoral anteversion, neck-shaft angle, maximal hip abduction, and hip flexion contracture, using correlations and multiple linear regressions. Using ANOVA and Scheffé's post hoc tests, we analyzed and compared the data of 23 abducted hips and 23 adducted hips in the 23 children with windblown posture and in 16 displaced hips in the eight children with symmetric hip abduction. Greater migration percentage was associated with less hip abduction range (r = -0.86; p < 0.001). Femoral anteversion had a weak correlation (r = 0.28; p < 0.05) to migration percentage, and the association became insignificant after considering hip abduction motion. Adducted windblown hips had greater femoral anteversion than the symmetric displaced hips and abducted windblown hips (46° vs 36° and 38°, respectively; p < 0.05). Our study results did not support a relationship between femoral deformities and hip displacement after considering gross motor function and hip abduction motion. Greater femoral anteversion was noted in the adducted hips of patients with windblown posture, and derotation osteotomy is especially recommended. Level III, diagnostic study.

Outcome of humeral shaft fractures treated by functional cast brace.

Background:Functional brace application for isolated humeral shaft fracture persistently yields good results. Nonunion though uncommon involves usually the proximal third shaft fractures. Instead of polyethylene bivalve functional brace four plaster sleeves wrapped and molded with little more proximal extension expected to prevent nonunion of proximal third fractures. Periodic compressibility of the cast is likely to yield a better result. This can be applied on the 1st day of the presentation as an outpatient basis. Comprehensive objective scoring system befitting for fracture humeral shaft is a need.Materials and Methods:Sixty six (male = 40, female = 26) unilateral humeral shaft fractures of mean age 34.4 years (range 11–75 years) involving 38 left and 28 right hands were included in this study during April 2008 to December 2012. Fractures involved proximal (n = 18), mid (n = 35) and distal (n = 13) of humerus. Transverse, oblique, comminuted and spiral orientations in 18, 35 and 13 patients respectively. One had segmental fracture and three had a pathological fracture with cystic bone lesion. Mechanisms of injuries as identified in this study were road traffic accidents 57.6% (n = 38), fall 37.9% (n = 25). 12.1% (n = 8) had radial nerve palsy 7.6% (n = 5) had Type I open fracture. Four plaster strips of 12 layers and 5–7.5 cm broad depending on the girth of arm were prepared. Arm was then wrapped with single layer compressed cotton. Lateral and medial strips were applied and then after molding anterior and posterior strips were applied in such a way that permits full elbow range of motion and partial abduction of the shoulder. Care was taken to prevent adherence of one strip with other except in the proximal end. Limb was then put in loose collar and cuff sling intermittently allowing active motion of the elbow ROM and pendular movement of the shoulder. Weekly tightening of the cast by fresh layers of bandage over the existing cast brace continued.Results:The results were assessed using 100 point scoring system where union allotted 30 points and 60 points allotted for angulations (10), elbow motion (10), shoulder abduction (10), shortening (5), rotation (5), absence of infection (10), absence of nerve palsy during treatment (10). Remaining 10 points were allotted for five items with two points each. They were the absence of skin sore, absence of vascular problem, absence of reflex sympathetic dystrophy (RSD), recovery of paralyzed nerve during injury and recovery of paralyzed nerve during treatment. Results were considered excellent with 90 and above, good with 80–89, fair with 70–79 and poor below 70 point. Results at 6 months were excellent in 43.94% (n = 29), good in 42.42% (n = 28), fair in 9.1% (n = 6), poor in 4.55% (n = 3). Union took place in 98.48% (n = 65) with an average of 10.3 weeks (range 6–16 weeks). 87.5% (n = 7) paralyzed radial nerve recovered. All wounds healed. Four patients had transient skin problem. One patient with mid shaft fracture had nonunion due to the muscle interposition.Conclusion:Modified functional cast brace is one of the options in treatment for humeral shaft fractures as it can be applied on the 1st day of the presentation in most of the situations. Simple objective scoring system was useful particularly in uneducated patients.

Evaluación de resultados funcionales y Notching tras el tratamiento de fracturas de húmero mediante artroplastia total invertida a medio plazo

ObjectiveAn analysis was made on relationship between Notching and functional and radiographic parameters after treatment of acute proximal humeral fractures with reverse total shoulder arthroplasty. MethodsA retrospective evaluation was performed on 37 patients with acute proximal humeral fracture treated by reversed shoulder arthroplasty. The mean follow-up was 24 months.Range of motion, intraoperative and postoperative complications were recorded. Nerot's classification was used to evaluate Notching. Patient satisfaction was evaluated with the Constant Score (CS).Statistical analysis was performed to evaluate the relationship between Notching and glenosphere position, or functional outcomes. ResultsMean range of elevation, abduction, external and internal rotation were 106.22°, 104.46°, 46.08° and 40.27°, respectively. Mean CS was 63. Notching was present at 12 months in 29% of patients. Statistical analysis showed significance differences between age and CS, age and notching development, and tilt with notching. No statistical significance differences were found between elevation, abduction, internal and external rotation and CS either with scapular or glenosphere-neck angle. ConclusionReverse shoulder arthroplasty is a valuable option for acute humeral fractures in patients with osteoporosis and cuff-tear arthropathy. It leads to early pain relief and shoulder motion. Nevertheless, it is not exempt from complications, and long-term studies are needed to determine the importance of notching.

Accuracy of Fluoroscopic Guided Acetabular Component Positioning During Direct Anterior Total Hip Arthroplasty

Acetabular component malposition contributes to increased complications and early revision. Supine positioning during direct anterior approach (DAA) THA facilitates the use of fluoroscopy to improve component positioning. This study evaluated the accuracy of acetabular component orientation using intraoperative fluoroscopy in DAA THA. A total of 780 surgeries by two surgeons were retrospectively reviewed over a 3-year period. Ranges for abduction (30°–50°) and version (5°–250) were employed. Overall, 92% fell within the targeted abduction range, 93% fell within the targeted anteversion range, and 88% met both criteria. The accuracy of component positioning for combined abduction and anteversion improved yearly (79.2%, 2011; 90.9%, 2012; and 95.6%, 2013). Fluoroscopy in DAA THA is a useful tool to improve acetabular component orientation, though a learning curve exists with its interpretation.

An on-ice measurement approach to analyse the biomechanics of ice hockey skating.

Skating is a fundamental movement in ice hockey; however little research has been conducted within the field of hockey skating biomechanics due to the difficulties of on-ice data collection. In this study a novel on-ice measurement approach was tested for reliability, and subsequently implemented to investigate the forward skating technique, as well as technique differences across skill levels. Nine high caliber (High) and nine low caliber (Low) hockey players performed 30m forward skating trials. A 3D accelerometer was mounted to the right skate for the purpose of stride detection, with the 2nd and 6th strides defined as acceleration and steady-state, respectively. The activity of five lower extremity muscles was recorded using surface electromyography. Biaxial electro-goniometers were used to quantify hip and knee angles, and in-skate plantar force was measured using instrumented insoles. Reliability was assessed with the coefficient of multiple correlation, which demonstrated moderate (r>0.65) to excellent (r>0.95) scores across selected measured variables. Greater plantar-flexor muscle activity and hip extension were evident during acceleration strides, while steady state strides exhibited greater knee extensor activity and hip abduction range of motion (p<0.05). High caliber exhibited greater hip range of motion and forefoot force application (p<0.05). The successful implementation of this on-ice mobile measurement approach offers potential for athlete monitoring, biofeedback and training advice.

Movement, Function, Pain, and Postoperative Edema in Axillary Web Syndrome

Axillary web syndrome (AWS) is a condition that may develop following breast cancer surgery and that presents as a palpable axillary cord of tissue. The purposes of this study were: (1) to determine the clinical characteristics of AWS related to movement, function, pain, and postoperative edema and (2) to define the incidence of and risk factors for AWS within the first 3 months following breast cancer surgery. This was a prospective cohort study with a repeated-measures design. Women who underwent breast cancer surgery with sentinel node biopsy or axillary lymph node dissection (N=36) were assessed for AWS, shoulder range of motion, function, pain, and postoperative edema (using girth measurements, bioimpedance, and tissue dielectric constant) at 2, 4, and 12 weeks. Demographic characteristics were used for risk analysis. Seventeen women (47.2%) developed AWS, and AWS persisted in 10 participants (27.8%) at 12 weeks. Abduction range of motion was significantly lower in the AWS group compared with the non-AWS group at 2 and 4 weeks. There were no differences between groups in measurements of function, pain, or edema at any time point. Trunk edema measured by dielectric constant was present in both groups, with an incidence of 55%. Multivariate analysis determined lower body mass index as being significantly associated with AWS (odds ratio=0.86; 95% confidence interval=0.74, 1.00). Limitations included a short follow-up time and a small sample size. Axillary web syndrome is prevalent following breast/axilla surgery for early-stage breast cancer and may persist beyond 12 weeks. The early consequences include movement restriction, but the long-term effects of persistent AWS cords are yet unknown. Low body mass index is considered a risk factor for AWS.

Shoulder linked arthroplasty in patients with obstetric brachial plexus palsy can improve quality of life and function at short-term follow-up

Patients with obstetric brachial plexus palsy (OBPP) are prone to develop degenerative shoulder disease at a younger age than the general population. To date, no reports have been published on the complexities or outcome of shoulder arthroplasty (SA) in this unique patient group. We reviewed of 9 SAs in 9 patients (3 men and 6 women) with OBPP with mean follow-up 5.1years (range, 2.6-7.6 years). Patients were a mean age of 29years (range, 16-56 years). Patients had undergone a mean of 3 previous operations (range, 2-6). All patients underwent linked constrained SA. The mean Oxford Shoulder Score increased from 8 (range, 3-10) preoperatively to 21 (range, 12-32) at the final follow-up (P<.001) predominantly due to pain relief. Mean range of active forward elevation and abduction improved from 35° and 39° to 46° and 45°, respectively. Patients improved significantly in 2 of 8 Short-Form 36-Item health-related quality of life domains, bodily pain (P =.013) and mental health (P=.035), and the overall physical component summary score (P=.006). Range of motion had mild improvements. Three required reoperation (33%), comprising 1 excision of heterotopic ossification, 1 trimming of a prominent screw, and 1 deltoid rupture repair. SA is effective at relieving pain and health-related quality of life for young patients with OBPP; however, compared with the general population, the complication rate is high and functional gains are small.

Effect of progressive resistive exercises on shoulder abduction range of motion in post operative oral cancer patients undergoing radiation therapy

Effect of progressive resistive exercises on shoulder abduction range of motion in post operative oral cancer patients undergoing radiation therapy

A Peculiar Case of Elbow Pain

HISTORY: 12 year old male baseball player presented with insidious onset of right shoulder and medial elbow pain over the previous year. First noticed the pain when he was throwing baseballs. He was a right-handed thrower and the pain began in his shoulder then progressed to the elbow. Initial presentation to the orthopedic clinic was after 2 months of complete rest where he attempted to return to baseball but could not throw due to pain. PHYSICAL EXAMINATION: A focused right upper extremity exam revealed full range of motion of the elbow. There was tenderness to palpation over the medial epicondyle and the ulnar collateral ligament. There was medial elbow pain with valgus stress and with Milking maneuver. There was no worsening of symptoms with resisted flexion of the wrist and no tenderness to palpation of the flexor/pronator tendons. Right shoulder with patient supine and abducted to 90 degrees revealed external rotation to 90 degrees on the right. There was also tenderness to palpation along the anterior and lateral humerus and decreased forward flexion and abduction range of motion as compared to the left upper extremity. DIFFERENTIAL DIAGNOSIS: Little leaguer’s shoulder, Little leaguer’s elbow, stress fracture, medial epicondylitis TESTS AND RESULTS: X-rays of the right shoulder showed widening of the humeral physis. X-rays of the right elbow showed widening of the medial epicondylar physis INITIAL WORKING DIAGNOSIS: Little leaguer’s elbow, little leaguer’s shoulder TREATMENT AND OUTCOMES: The athlete was held out of activities for 4 weeks. At follow up visit shoulder pain had completely resolved. The elbow was still giving him a lot of pain and for this reason a MRI arthrogram was done which showed avascular necrosis of the trochlea. CT scan of the elbow was ordered for evaluation of the AVN which confirmed the disease of the trochlea and medial epicondyle apophysitis. Subsequent follow ups showed continued improvement in his pain and he was allowed to slowly progress back to activity. Full clearance was given 8 months after initial presentation. FINAL WORKING DIAGNOSIS: Avascular necrosis of the trochlea, little leaguer’s elbow

English

The objective of this paper was to compare the range of motion in Border Collies to that of Labrador Retrievers. Humeral circumference, thigh circumference and differences between sex and age were also compared. Twenty three (23) healthy Border Collies and 18 healthy Labrador Retrievers were used. A single investigator measured range of motion of the carpus, elbow, shoulder, hip, stifle and tarsus as well as humeral and thigh circumference under field conditions in 23 Border Collies and 18 Labrador Retrievers. Border Collies had a significantly greater range of motion (P&lt;O.001) in all joints than Labrador Retrievers. Sex was a significant predictor of range of motion (P=0.010), but age was not (P=0.400). Range of motion significantly varied by joint (P&lt;0.001) and the effect was different within Border Collies versus Labrador Retrievers (P=0.008). Range of motion did not vary between left and right sides (P=0.365). Considerations of range of motion were made in deciding pathology and progress based on type and breed of dog (sporting, herding, protection). Comparisons were made based on breed and from left side to right side. &nbsp; Key words: Range of motion, goniometry, flexion, extension, and abduction.