Active Range Of Motion Research Articles

The association of limited or painful spinal range of motion with lumbar disc degeneration: the back complaints in older adults (BACE) study.

We currently lack clear definitions for structural and symptomatic spinal osteoarthritis (OA). To define spinal OA and create diagnostic criteria for this condition, it is necessary to determine the relationship between clinical signs and symptoms of back pain and radiographic features of OA. Notably, recent studies suggest a defining sign of spinal OA could be a limited or painful spinal range of motion (ROM). Therefore, our objective was to assess the association between restricted or painful active spinal ROM, and multilevel structural features of lumbar disc degeneration (LDD) (i.e., disc space narrowing, osteophytes) on radiographs. We used the baseline data from the'Back Complaints in Older Adults' (BACE) study. The association between a limited or painful active spinal ROM, and multilevel disc space narrowing or osteophytes was assessed using multivariable logistic regression adjusted for age, mean pain intensity in the previous week, sex, BMI, and the Fear Avoidance Belief Questionnaire score. Primary analyses were performed on imputed datasets. We included 675 patients with a mean age of 66.52years (SD 7.69). Limited latero-flexion (fingertip that at best reached halfway up the upper leg) was associated with increased odds of having multilevel osteophytes (OR 1.85; 95% CI: 1.13 to 3.01). However, a limited or painful ROM in other directions (i.e., rotation, ante-flexion) was not associated with multilevel osteophytes, and a limited or painful active ROM in any direction was found to have no association with multilevel disc space narrowing. Our study indicates that a restricted ROM in latero-flexion could potentially be a defining sign in future definitions of symptomatic spinal OA. However, since our results partially differ from previous studies, further research is needed to explore the association between active ROM and LDD.

G.T.A.R.A. (Grip/Grasp Training with Active Range of Motion Activities Using Guitar): A Randomized Controlled Trial Using Guitar Lessons for Restoring Hand Function among Patients with Unilateral Hand Impairment

Objective. To determine the effects of guitar lessons (intervention group) in comparison to conventional occupational therapy (OT) sessions (control group) on hand function of chronic stroke patients with unilateral hand impairment. Methods. This randomized controlled trial enrolled 34 chronic stroke patients with unilateral hand impairment. Participants were grouped randomly into intervention (guitar lessons) and control (conventional occupational therapy) groups. Each group participant underwent a total of eight consecutive therapy sessions, twice weekly for an hour each session, at the designated treatment rooms in the Department of Rehabilitation Medicine of the Philippine General Hospital. Pre- and post-treatment evaluations were done to assess range of motion, grip and pinch strength, and hand functions. Satisfaction surveys were answered at the end of the 8-therapy session. Results. Improvements in hand function were assessed through measurement of range of motion (ROM), grip and pinch strength, and with the use of Beery-Buktenica Developmental Test of Visual-Motor Integration, Jebsen-Taylor Hand Function test, and Purdue Pegboard Test of Manual Dexterity. In this study, the comparison of actual change of passive range of motion (ROM) of the impaired hand from pre- to post-treatment between control and intervention groups showed no statistically significant difference. No statistically significant difference between groups were also observed for the active ROM of the impaired hand. Comparison of function of the impaired hand pre- and posttreatment between control and intervention groups showed no statistically significant difference except for an observed greater improvement with the control group in motor coordination (median [IQR] 0 [-1 to 0] vs 1 [1 to 5], p = 0.004), tip (median [IQR] 0.33 [0 to 0.75] vs 1 [0.58 to 1.5], p = 0.006), and 3-jaw (median [IQR] 0.5 [0 to 0.92] vs 1.08 [0.41 to 2], p = 0.043) pinch strength. In evaluating the satisfaction of participants in both groups, higher mean scores were observed in the control group. No statistically significant difference in most of the questions in the satisfaction survey in both groups. All participants in both groups displayed 100% compliance in attending onsite treatments. Despite not showing statistically significant difference between groups (p = 0.721), an 11.8% tendency for better compliance is found in the intervention group. Conclusion. The specific guitar lesson created and performed in this study as used by 17 participants of the intervention group have brought about improvement in hand function that is comparable with those who underwent traditional occupational therapy. This may be most helpful in areas with limited access to rehabilitation facilities and occupational therapy services. This may also be used as a continuing activity of chronic stroke patients at home to help improve hand function.

Comparative Effects of Spinal Anesthesia and Combined Spinal with Peripheral Nerve Blocks on Postoperative Outcomes in Anterior Cruciate Ligament Repair

Objectives: This study aimed to compare the effectiveness of spinal anesthesia (SA) alone versus combined spinal anesthesia with adductor canal block (ACB) and sciatic nerve block (SNB) (SA + ACB + SNB) in patients undergoing arthroscopic anterior cruciate ligament (ACL) reconstruction. We hypothesized that SA + ACB + SNB would provide better analgesia, greater patient satisfaction, and shorter postanesthesia recovery times than SA alone. Methods: A prospective randomized controlled trial was conducted with 60 patients aged 15–49 years scheduled for elective arthroscopic ACL reconstruction. Participants were randomly assigned to receive either SA or SA + ACB + SNB. Postoperative pain was assessed using the Visual Analog Scale (VAS) at 4, 12, and 24 h post-operation. General health was evaluated using the 12-item Short Form Survey (SF-12) at 1 month postoperatively. Range of motion and analgesic consumption were also recorded. Results: The median VAS score at 4 h post-operation was significantly lower in the SA + ACB + SNB group compared to the SA group (0 [IQR: 0–1] vs. 2 [IQR: 1–3], p = 0.0137). No significant differences in VAS scores were found at 12 h (p = 0.9282) and 24 h (p = 0.5809). PCS-12 and MCS-12 scores did not differ significantly between groups. The SA group had a lower postoperative range of motion (ROM) compared to the SA + ACB + SNB group, with a mean active ROM of 40.67 degrees (±23.52) versus 72.17 degrees (±24.69), respectively (p < 0.0001). Analgesic consumption was similar, with 53.33% of participants in each group using postoperative analgesics (p = 1.0). The mean surgery duration was 74.6 min. The gender distribution was 83% male and 17% female, with an average age of 27.7 years. Conclusions: Adding ACB and SNB to spinal anesthesia improved immediate postoperative pain relief and preserved range of motion in patients undergoing ACL reconstruction, suggesting potential clinical benefits in pain management and functional recovery.

Abstract 4121816: Viral Venture: A Case of Myocarditis and IgA Vasculitis from Adenovirus Infection

Case Description: A 19-year-old man presented to the emergency department for 3 days of shortness of breath, progressive bilateral lower extremity rash, generalized fatigue, and diffuse joint following an earlier visit to urgent care for pharyngitis symptoms. Physical exam was notable for tachycardia, pain with active wrist and ankle range of motion, pharyngeal erythema, cervical adenopathy, and confluent erythematous palpable purpura and petechiae noted on bilateral lower extremities with scattered lesions on his thighs, arms, and back. Laboratory workup notable for markedly elevated high-sensitivity troponin to 3398 ng/L, and elevated CRP. Further workup was notable for normal urinalysis, negative streptococcus antigen, negative ANCA antibodies, ANA, Hepatitis B and C, and cryoglobulins. Imaging and cardiac workup were notable for normal left ventricular function and cardiac MRI notable for late gadolinium enhancement in the anteroapical mid-myocardial region suggestive of myocarditis. Skin biopsy ultimately revealed immunodeposition of IgA on superficial capillaries compatible with a diagnosis of IgA vasculitis. The patient was started on steroids for IgA vasculitis with rapid improvement in his symptoms and he was discharged home in good condition. Discussion: Recognizing the severe complications of viral infection can lead to prompt treatment and prevention of progression to severe end organ damage. Our case highlights rarely reported cardiac involvement of IgA vasculitis secondary to adenovirus infection based on laboratory and imaging diagnosis with cardiac MRI. To date, only 16 cases of cardiac involvement in IgA vasculitis have been reported. This case adds to the limited body of published cases describing this presentation of IgA vasculitis and is also consistent with the results of prior cases suggesting that an immunosuppressive regimen including glucocorticoids may help to prevent disease progression and induce remission in cases with cardiac involvement without the need for endomyocardial biopsy.

Effect of traditional Chinese Yijinjing exercise on hand dysfunction in rheumatoid arthritis patients: a randomized controlled trial

IntroductionRheumatoid arthritis (RA) patients often experience significant hand dysfunction. Yijinjing, a traditional Chinese exercise, has been recognized for its benefits to mind–body health. This study aimed to evaluate the efficacy and safety of Yijinjing in improving hand dysfunction among individuals with RA.MethodsThis research was conducted as a single-center, outcome-blinded, randomized controlled trial. A total of 66 eligible RA participants were randomly assigned in a 1:1 ratio to either the Yijinjing exercise group (YJJG) with sessions conducted three times per week over a 12-week period or the control group (CG), which maintained ordinary activities. Various outcomes were assessed, including the Michigan Hand Outcomes Questionnaire (MHQ), handgrip strength, active range of motion (AROM), RA disease activity, the Health Assessment Questionnaire Disability Index (HAQ-DI), levels of anxiety and depression, and wrist ultrasound, all of which were collected at baseline and the week 12.ResultsAt the end of the 12 weeks, the YJJG demonstrated significant improvements in MHQ scores compared to the CG (p < 0.05), alongside enhancements in handgrip strength and AROM, specifically in wrist extension, radial deviation, and metacarpophalangeal flexion (p < 0.05). Wrist ultrasound scores did not exhibit a significant increase in the YJJG, meaning no inflammation aggravation (p > 0.05). Additionally, morning stiffness duration, Disease Activity Score 28-ESR (DAS28-ESR), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) levels showed significant improvement in the YJJG (p < 0.05). Both groups reported enhancements in quality of life, as well as reductions in anxiety and depression scores, with the YJJG displaying greater improvements overall (p < 0.05). Importantly, no adverse events or significant abnormalities in vital signs were observed in either group.ConclusionYijinjing exercise may effectively enhance hand function, handgrip strength, and flexibility in RA patients with low disease activity. Furthermore, it appears to improve quality of life and reduce anxiety and depression without exacerbating joint inflammation.Clinical trial registrationhttps://clinicaltrials.gov/study/NCT05527158, Identifier NCT05527158.

Prior Shoulder Arthroscopy is Associated with Inferior Clinical Outcomes Following Primary Reverse Shoulder Arthroplasty for Rotator Cuff Tear Arthropathy

Background Various patient-related and condition-related factors can influence the clinical benefits of reverse shoulder arthroplasty (RSA). With the emergence of new potential joint-preserving arthroscopic interventions, understanding the impact of shoulder arthroscopy prior to RSA is increasingly relevant. Therefore, the purpose of this study was to understand the impact of previous ipsilateral shoulder arthroscopy on outcomes and shoulder function following RSA for rotator cuff tear arthropathy. Methods Patients who underwent RSA for rotator cuff tear arthropathy from June 2016 to September 2020 by a single surgeon were retrospectively reviewed from a prospectively collected clinical database. Patients were separated into two groups: 1) patients who underwent RSA following prior ipsilateral shoulder arthroscopy (RSAPA) and 2) patients who underwent RSA without previous shoulder surgery (RSA). Patient-reported outcomes (PROs), including SST, ASES, UCLA score, SAS score, and active shoulder range of motion were measured preoperatively and at a minimum 2 years postoperative. Results A total of 103 patients (n=38 RSAPA and n=65 control RSA) were analyzed. The mean duration of follow-up for patients with prior ipsilateral shoulder arthroscopy was significantly shorter compared to the control patients (RSAPA=33 months and RSA=50 months, p < 0.0001). All PROs improved postoperatively (p < 0.001). Improvements in PROs for RSAPA were diminished relative to RSA control group patients, including SST (RSAPA=5.4 vs RSA=7.6, p = 0.005), ASES (RSAPA=40.8 vs RSA=54.7, p = 0.021), and UCLA (RSAPA=16 vs RSA=20.7, p = 0.009) scores. Improvements in forward flexion (RSAPA=69° vs RSA=95°, p = 0.0003) and abduction (RSAPA= 67° vs RSA=83°, p = 0.003) were decreased in the RSAPA group compared to the control group (RSA). One patient (1.5%) with prior shoulder arthroscopy required revision due to recurrent instability, whereas no patients in the control group required revision surgery (p=0.25). Conclusion Patients with rotator cuff tear arthropathy who underwent RSA following prior shoulder arthroscopy demonstrated significant improvements in function and patient-reported outcomes, but these outcomes are diminished compared to those patients with no history of surgery.

Obstetric Brachial Plexus Palsy and Functional Implications: Which Joint in the Upper Extremity Is More Closely Associated?

Background and Objectives: The objective of this study is to examine the correlation between the active range of motion (ROM) of the affected upper extremity and functional capacity in children with Obstetric Brachial Plexus Palsy (OBPP) who have undergone the modified Hoffer tendon transfer technique. Materials and Methods: The study cohort comprised 52 children with OBPP, aged 4–14 years, who had undergone a shoulder tendon transfer. The ROM was quantified using a goniometer, while functionality was evaluated through the administration of the Brachial Plexus Outcome Measure (BPOM). Results: The study identified significant correlations between the shoulder ROM and the Brachial Plexus Outcome Measure (BPOM). Specifically, shoulder flexion (p = 0.017; r = 0.351) was positively associated with shoulder functionality, while shoulder internal rotation (p = 0.001; r = 0.481) was linked to appearance scores. A significant negative relationship was observed between elbow extension (p < 0.001; r = −0.512) and elbow and forearm activities. Conclusions: The study highlights the necessity of assessing both joint range of motion and body perception for effective treatment and follow-up, to improve the functionality and quality of life for children with OBPP.

Re-tear following rotator cuff repair: Do functional outcomes predict success?

The purpose of this study is to compare functional outcomes between patients who were found to have a retear on ultrasound versus those with an intact repair following arthroscopic rotator cuff repair. Retrospective cohort study comparing functional outcomes of 84 patients who underwent arthroscopic rotator cuff repair and were found to have a retear versus those who did not experience a retear. Functional outcomes included American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test, strength and active range of motion (AROM) assessed preoperatively and postoperatively at 3 and 6 months. Patients without a retear by 6 months demonstrated greater improvements in internal rotation at 3 months (2.3° of mean change, p = 0.0356), as well as greater improvements in external rotation range of motion (8.8° of mean change, p = 0.0210) between 3 and 6 months as compared to those patients who did experience a retear. Both groups showed decreased pain scores and increased ASES scores at all points postoperatively. Our study found statistically significant improvements in internal rotation at 3 months, and external rotation between 3 and 6 months in the non-retear group. No differences in functional outcomes existed between at final follow-up.

Buddy taping after reduction of displaced extra-articular phalangeal finger fractures in children: a randomized controlled trial.

In this randomized controlled trial, we assessed the non-inferiority of buddy taping to splinting after reduction of displaced extra-articular proximal and middle phalangeal finger fractures in children. The primary outcome was the rate of secondary fracture displacements; the secondary outcomes were patient comfort, analgesic efficacy and total range of active motion 6 months after injury. Eighty-one patients participated: 43 with taping and 38 with splinting. Secondary displacement occurred in eight patients: five in the splinting group and three in the taping group. Risk difference was below the predefined non-inferiority of 10%. Patient comfort was significantly higher in the taping group, with no group differences for other parameters. Our previous study recommended taping for undisplaced finger fractures in children. With the current data, we recommend taping these finger fractures irrespective of displacement or need for reduction. We are encouraged to propose taping as an alternative to splinting for increased patient comfort, lower cost, and shorter application time.Level of evidence: I.

Healed Subscapularis and Its Clinical Implications for Internal Rotation in Humeral Lateralized Reverse Shoulder Arthroplasty

The efficacy of subscapularis (SSC) repair in reverse shoulder arthroplasty (RSA) remains controversial. Few studies have evaluated the postoperative integrity and effect on clinical outcomes of repaired SSC; however, conflicting results regarding whether the healing of the repaired SSC influences outcomes have also been reported. Therefore, this study aimed to address the controversy by evaluating clinical outcomes in SSC repair compared to non-repair after humeral lateralized RSA, and to evaluate the significance of the integrity of the repaired SSC. This study included patients who underwent humeral lateralized RSA between 2015 and 2019 and categorized them into two groups: repaired (n=66) and non-repaired (n=36) SSCs. The clinical outcomes, such as the visual analog scale score, constant score, American Shoulder and Elbow Surgeons (ASES) score, active range of motion (aROM), activities of daily living scores consisting of active internal rotation and forward flexion (ADL score), and rotational strength, were compared. Ultrasonography was used to assess the integrity of the repaired SSC following the modified Sugaya classification and to evaluate the acromial fracture. Subgroup analysis was performed on patients with healed SSC versus non-healed SSC, versus non-repaired SSC. Overall, 102 patients were included, with a mean age of 73 ± 5 years. Both groups exhibited substantial postoperative improvements in clinical scores, active ROM, and rotational strength without significant differences. At the 2-year follow-up, 52% of patients showed healed tendons, while 44% exhibited retears in the repaired SSC group. Significant clinical improvements were noted in both groups, regardless of the SSC integrity. However, the healed SSC group exhibited significantly improved outcomes in ADL score, IR aROM, and IR strength compared to the non-healed SSC group (p=0.002, p=0.011, p<0.001). Meanwhile, compared to the non-repaired SSC group, the healed SSC group also showed significant improvements in IR aROM and IR strength (p=0.016, p=0.002), but the difference in ADL score was not statistically significant (p=0.133). Furthermore, while the SSC repair group showed a marginally higher rate of acromial fractures (9% vs. 6%, p=0.709) as evaluated through both radiography and ultrasonography, the overall rates of complications remained statistically comparable across the groups (13% vs. 11%, p=0.854). Healed SSC groups showed significantly better IR aROM, and IR strength than both non-healed and non-repaired SSC groups, highlighting SSC healing's crucial role in enhancing IR functional outcomes even with humeral lateralized RSA; hence, SSC repair should be advocated whenever possible during RSA, though further research is needed to improve its low healing rate.

Short-Term Clinical Results of Middle Trapezius Tendon Transfer with Achilles Tendon Allograft for Irreparable Supraspinatus Tears

BackgroundAmong emerging options, Middle Trapezius Tendon (MTT) transfer has shown promise, particularly in isolated supraspinatus irreparable rotator cuff tears (ISIRCTs) and nonarthritic shoulders unsuitable for reverse total shoulder arthroplasty. This study aims to assess clinical and radiological results of MTT transfer utilizing an Achilles tendon allograft for ISIRCTs. MethodsWe retrospectively reviewed patients who received MTT transfer using Achilles tendon allograft for ISIRCTs between May 2020 and August 2021. Clinical assessments using pain VAS, Constant, ASES, UCLA, and SANE score were assessed pre- and postoperatively. Active Range of Motion (aROM) were obtained, and radiologic assessments included AHD, Hamada grade, and MTT integrity. Results18 patients were involved with mean age of 63.8 ± 7.1, followed for an average of 25.4 ± 4.4 months. Significant improvements were observed in pain relief (VAS:4.7±1.5 to 1.6±0.9, P<.001), shoulder function (Constant: 53.1±11.1 to 70.0±15.1, ASES: 57.7±13.5 to 78.2±17.0, UCLA: 13.6±4.5 to 22.0±6.4; all P<.001), and patient satisfaction (SANE: 51.3±14.1 to 73.7±15.0, P<.001). Active range of motion significantly improved in Forward elevation (FE) and abduction (ABD). Radiologic assessments showed no significant change in AHD and Hamada grade, with p-values of 0.503 and 0.260, respectively. ConclusionMTT transfer using Achilles tendon allograft showed improvement in pain relief, clinical scores, and active FE and ABD in patients with ISIRCTs. However, the validation of its effectiveness necessitates multicenter and long-term studies.

Clinical, Functional and Radiographic Outcomes of Inverted-Bearing Reverse Shoulder Arthroplasty at Minimum Two Year Follow-up

BackgroundInverted-Bearing Reverse Shoulder Arthroplasty (IB-RSA) is an alternative reverse bearing construct characterized by an ultra-high molecular weight polyethylene glenosphere combined with a CoCr metallic humeral liner. This concept was designed both to minimize bearing wear as well as reduce the potential for scapular notching seen with more traditional-bearing RSA systems. This study reports on clinical outcomes, functional scores, pain scores, and radiographic incidence of scapular notching in a series of IB-RSA at a minimum of two-year follow-up. MethodsA retrospective study was conducted on patients who underwent an IB-RSA between 2016 and 2019, with a minimum follow-up period of two years. Patients were evaluated clinically for DASH score (DS), American Shoulder and Elbow Surgeons score (ASES), EQ-5D Health Questionnaire (EQ-5D), Global Rating of Change score (GRC), Single Assessment Numeric Evaluation score (SANE) and range of motion (ROM). Presence and grade of radiographic scapular notching was assessed using the classification of Sirveaux at 6,12, 24 months and at the last x-ray available. Results61 consecutive patients were assessed at a mean postoperative follow-up of 37 months (range, 24-72 months). IB-RSA exhibited high overall outcome scores including DASH (38.3 +/-5), ASES (83 +/- 6), GRC (4 +/-0.6), and SANE (83 +/-11). ROM was assessed in 41 patients with 135 +- 21 of elevation, 23 +- 12 of external rotation and 5 +- 2 for internal rotation. Scapular notching was radiographically present in 23 (38%) patients (twenty grade 1, three grade 2) in the final follow-up, with all cases showing evidence of mechanical notching while no grade 3 or 4 cases were observed. The scapular notching didn’t progress in most of the patients after the first year (P>0.05). The presence of scapular notching did not influence on clinical outcome scores as DASH, ASES, EQ-5D, GRC, SANE (P>0.05) or active range of motion (P>0.05). ConclusionIB-RSA demonstrates high patient-reported and functional outcome scores at a minimum of two years follow-up. We report only low-grade scapular notching with little progression after the first year. There was no correlation between scapular notching and clinical outcomes.

Rehabilitation after reverse total shoulder arthroplasty: a survey of members of the American Shoulder and Elbow Surgeons

Surgeons disagree about whether patients should undertake home physical therapy (HPT) or formal physical therapy (FPT) after undergoing reverse total shoulder arthroplasty (RTSA). Recent studies suggest that HPT is as effective as FPT, but surgeons who perform RTSA may believe that FPT continues to have a role. Our primary purpose was to describe the opinions and self-reported practices of surgeons who perform RTSA regarding prescribing physical therapy (PT) after surgery. We also sought to identify factors associated with prescription of FPT. A survey was distributed electronically from May to September 2023 to the 1076 members of the American Shoulder and Elbow Surgeons who were practicing in the United States at that time. Of these surgeons, 237 (22%) responded to the survey. Anonymous responses were collected via Qualtrics, including demographic data and information about the RTSA implant systems used. Descriptive statistics were used to analyze surgeon characteristics, implant types, and rehabilitation practices. Multivariate logistic regression was used to identify surgeon, procedure, and implant characteristics associated with the likelihood of FPT prescription. Because some respondents reported using multiple RTSA implant types and some did not answer implant-specific questions, a total of 225 RTSA implant types were included. Forty-six percent of respondents reported that they recommended FPT for every patient; 64% said they typically prescribe FPT. A smaller proportion of respondents who had completed a hand and upper-extremity fellowship said that they prescribed FPT compared with those who had not completed such a fellowship. However, PT prescription was not associated with any other studied characteristics, such as number of years in practice or whether the surgeon tended to repair the subscapularis. On average, respondents estimated that 92% of their patients received either FPT or HPT. Respondents also reported varying timeframes for starting PT activities after surgery. For example, 50% of respondents reported recommending passive shoulder range of motion below the shoulder level within the first postoperative week, whereas 73% recommended waiting 2-6 weeks for active shoulder range of motion below shoulder level. Most surveyed surgeons prescribe FPT and/or HPT after primary RTSA, with a slight preference for FPT. Surgical factors did not influence rehabilitation preferences. Further randomized studies to investigate the impact of PT on clinical outcomes of RTSA are needed.

Influence of preoperative rotational shoulder stiffness on rate of motion restoration after anatomic and reverse total shoulder arthroplasty for glenohumeral osteoarthritis with an intact rotator cuff

BackgroundA subset of patients undergoing anatomic and reverse total shoulder arthroplasty (aTSA and rTSA) lag behind their peers in regaining overhead range of motion (ROM) after surgery. The primary purpose of this study was to compare the rate of recovery of ROM after aTSA and rTSA performed in stiff (preoperative passive external rotation [ER] ≤0 °) versus non-stiff (preoperative passive ER >0°) shoulders with RCI-GHOA. HypothesisWe hypothesized that preoperatively stiff shoulders (preoperative passive ER ≤0 °) would have slower recovery in ROM postoperatively with lower postoperative motion compared to non-stiff shoulders. Methods and materialsA retrospective review of a multi-institution shoulder arthroplasty database was performed between 2001 and 2021. We identified 1,164 aTSAs and 539 rTSAs performed for RCI-GHOA with a minimum of 2-year clinical follow-up along with follow-up between 3–6 months and a third visit at any other time point. Primarily, the rate of recovery in ROM and time to maximum ROM was evaluated. Secondarily, we assessed six outcome scores and the influence of subscapularis repair during rTSA. Recovery in each outcome was modeled using continuous two-phase segmented linear regression models with random effects. Rate of recovery was defined as the slope of the first segment. Patients were considered to have recovered after surgery at the timepoint corresponding to the inflection point between piecewise segments. ResultsOf the 1,164 aTSAs and 539 rTSAs included, 172 aTSAs (15%) and 80 rTSAs (15%) were stiff preoperatively, respectively. Compared to preoperatively stiff aTSAs, non-stiff aTSAs regained ER, abduction, internal rotation (IR), and forward elevation (FE) faster over a shorter duration. Similarly, non-stiff rTSAs regained ER, abduction, and FE faster and over a shorter duration compared to stiff rTSAs, but regained IR more slowly over a longer duration. Stiff rTSAs performed with subscapularis repair did not have any appreciable gain in ER after the immediate postoperative period. Although non-stiff and stiff rTSAs performed without subscapularis repair regained ER at a similar rate (4.4 vs. 4.2 °/month), stiff rTSAs continued to regain ER 1.9-times longer (11.9 vs. 6.4 months). When the subscapularis was repaired, non-stiff rTSAs regained abduction and IR faster over a short duration compared to stiff rTSAs. ConclusionsPreoperative stiffness is associated with slower recovery of active ROM over a longer duration in patients undergoing shoulder arthroplasty for RCI-GHOA. Level of evidenceIII; Retrospective Cohort Comparison; Treatment Study.

Experience of using the passive exoskeleton EXAR-34 in complex rehabilitation of a patient with post-traumatic plexopathy due to gunshot cervicothoracic wound (clinical observation)

The use of passive exoskeletons is a promising direction in the treatment of patients with severe combat injuries to the shoulder girdle, leading to disability in 30 % of cases. Aim: To demonstrate the capabilities of the passive exoskeleton EXAR-34 in the rehabilitation and habilitation of a victim with damage to the branches of the brachial nerve plexus. Materials and methods: An analysis of medical documentation, physical examination, morphometry, and goniometry were carried out. Clinical observation and discussion: A patient with post-traumatic left-sided plexopathy due to a gunshot perforating shrapnel cervicothoracic wound with gunshot fractures of the transverse processes of C6, C7, Th3 vertebrae, I–III ribs on the left after reconstructive intervention on elements of the brachial nerve plexus, when previously carried out rehabilitation measures were ineffective, during the first fitting of the EXAR-34 device, the range of active movements in the joints of the injured limb increased to 37,1–60,7 %, and routine motor skills were restored. Conclusion:The experience of using the EXAR-34 device demonstrates high promise in complex rehabilitation and habilitation of patients after reconstructive interventions on the brachial plexus for combat wounds.

The Impact of Virtual Reality as a Rehabilitation Method Using TRAVEE System on Functional Outcomes and Disability in Stroke Patients: A Pilot Study

Background: Stroke is the third leading cause of disability. Virtual reality (VR) has shown promising results in post-stroke rehabilitation. The VR TRAVEE system was designed for the neuromotor rehabilitation of the upper limb after a stroke and offers the ability to track limb movements by providing auditory feedback and visual augmentation. The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), aligned with the International Classification of Functioning, Disability, and Health (ICF) principles, is a valid tool for measuring disability regardless of its cause. This study aimed to investigate the feasibility of the VR TRAVEE system in upper limb rehabilitation for stroke patients. Methods: A total of 14 stroke patients with residual hemiparesis were enrolled in the study. They underwent a 10-day program combining conventional therapy (CnvT) with VR rehabilitation. At baseline (T0), the upper limb was assessed using the Modified Ashworth Scale (MAS), active range of motion (AROM), and the Numeric Rating Scale (NRS) for pain. These assessments were repeated after the 10-day rehabilitation program (T1). Additionally, disability was measured using WHODAS 2.0 at T0 and again 30 days after completing the program. Results: Significant improvements were observed in AROM and MAS scores for the shoulder, elbow, wrist, and metacarpophalangeal joints, as well as in the reduction in shoulder pain (p ˂ 0.001). WHODAS scores decreased across all six domains, with a statistically significant improvement in the Cognition domain (p = 0.011). Conclusions: Combining CnvT with VR as a rehabilitation approach enhances motor function in the upper limb. This method has the potential to reduce disability scores and promote neuroplasticity.

The acute cross-education effect of foam rolling on the thigh muscles in patients after total knee arthroplasty

IntroductionIn the early postoperative period after total knee arthroplasty (TKA), joint range of motion (ROM) limitation and increased stiffness due to pain are commonly observed. Previous studies have reported that a single bout of foam rolling (FR) can acutely increase ROM and pain threshold on the contralateral (non-intervention) side in healthy participants. In this study, we aimed to expand this knowledge for TKA rehabilitation and investigated the acute effects of FR intervention on the non-operative side on ROM, stiffness, and pain of the operative side in postoperative patients within the first week after TKA.Materials and methodsThe study employed a randomized crossover design: 20 patients (mean age 75.0 ± 7.8 years) in the first postoperative week after TKA were divided alternately into Roll_Break and Break_Roll groups in the order of prescription. In the Roll_Break group, after the initial evaluation, a 180-s (60-s × three sets) FR intervention using a roller massager by a physiotherapist for the knee extensors was performed on the contralateral side (non-operative side), followed by the measurement. Afterwards, after 180-s of supine at rest, the measurement was performed again (i.e., control phase). In the Break_Roll group, after the initial evaluation, each patient was placed in a seated resting position for 180-s, and then another measurement was performed (i.e., control phase). After this, the FR intervention was performed for 180-s, and then the measurement was performed again. The intensity of the FR intervention was set to the maximum intensity that did not cause pain. We measured pain using the visual analogue scale at rest and during the knee joint ROM measurements, knee joint active movement ROM, knee joint passive ROM, and stiffness during the knee joint active movement.ResultsAll outcome variables showed significant improvements after the FR intervention (intervention phase) when compared pre- to post-intervention, and significantly favourable effects were found compared to the control condition.ConclusionThe results showed significant improvements in ROM, pain, and stiffness of the operative side after the FR intervention on the non-operative side. For future therapy approaches for TKA patients, FR treatment of the non-operative side should be employed in the first weeks after surgery.

Comparative Study on Postoperative Immobilization in Reverse Total Shoulder Arthroplasty: 4 Weeks vs. 6 Weeks of Immobilization Yields Similar Clinical and Functional Outcomes.

Background/Objectives: To investigate clinical and functional outcomes of patients undergoing reverse total shoulder arthroplasty (RTSA) using a rehabilitation protocol of either 4 or 6 weeks of immobilization. Methods: This comparative study analyzed a consecutive patient cohort that underwent RTSA in a single institute from January 2021-February 2023. Patients were assigned to groups according to the duration of postoperative immobilization and were followed up for a minimum of one year. Patient demographics, range of motion (ROM), functional outcomes using the Simple Shoulder Test (SST) and the American Shoulder and Elbow Score (ASES) as well as postoperative complications were recorded. The minimum clinically important difference (MCID) was used to assess whether the differences between the groups in SST, ASES, SWB, and VAS were clinically relevant. Results: Sixty patients met the inclusion criteria (35 patients in the 6-week immobilization group (6 WG) and 25 patients in the 4-week immobilization group (4 WG)) and were available for the total follow-up period. Similar baseline demographics were observed between the groups. Active ROM significantly improved for both groups, with abduction and forward flexion improving the most. In terms of functional outcomes, significant improvement (p < 0.001) was demonstrated for both groups (ASES, SST, VAS, and SWB). However, patients in the 4 WG reached significantly better results in VAS and SWB at 6 weeks and 3 months, as well as in ASES 3 months postoperatively, whereas both groups leveled off at the end of the follow-up period after 1 year. Taking into account the MCID, these differences for ASES at 3 months, as well as VAS and SWB at 6 weeks and 3 months postoperatively, were significant. Surprisingly, there were no differences between the groups over the entire follow-up period in terms of the SST. Conclusions: The author's findings suggest faster clinical recovery at 6 weeks and 3 months in patients undergoing postoperative immobilization of 4 weeks compared to 6 weeks following RTSA. However, clinical and functional outcomes were equal for 4 WG and 6 WG at one year follow up.

Home-based guidance training system with interactive visual feedback using kinect on stroke survivors with moderate to severe motor impairment

The home-based training approach benefits stroke survivors by providing them with an increased amount of training time and greater feasibility in terms of their training schedule, particularly for those with severe motor impairment. Computer-guided training systems provide visual feedback with correct movement patterns during home-based training. This study aimed to investigate the improvement in motor performance among stroke survivors with moderate to severe motor impairment after 800 min of training using a home-based guidance training system with interactive visual feedback. Twelve patients with moderate to severe stroke underwent home-based training, totaling 800 min (20–40 min per session, with a frequency of 3 sessions per week). The home-based guidance training system uses Kinect to reconstruct the 3D human body skeletal model and provides real-time motor feedback during training. The training exercises consisted of six core exercises and eleven optional exercises, including joint exercises, balance control, and coordination. Pre-training and post-training assessments were conducted using the Fugl-Meyer Assessment-Upper Limb (FMA-UE), Fugl-Meyer Assessment-Lower Limb (FMA-LE), Functional Ambulation Categories (FAC), Berg Balance Scale (BBS), Barthel Index (BI), Modified Ashworth Scale (MAS), as well as kinematic data of joint angles and center of mass (COM). The results indicated that motor training led to the attainment of the upper limit of functional range of motion (FROM) in hip abduction, shoulder flexion, and shoulder abduction. However, there was no improvement in the active range of motion (AROM) in the upper extremity (U/E) and lower extremity (L/E) joints, reaching the level of the older healthy population. Significant improvements were observed in both left/right and superior/inferior displacements, as well as body sway in the mediolateral axis of the COM, after 800 min of training. In conclusion, the home-based guidance system using Kinect aids in improving joint kinematics performance at the level of FROM and balance control, accompanied by increased mediolateral body sway of the COM for stroke survivors with moderate to severe stroke. Additionally, spasticity was reduced in both the upper and lower extremities after 800 min of home-based training.

Effect of lower-limb isokinetic muscle strengthening on knee function and joint contact force in knee osteoarthritis patients awaiting total knee arthroplasty: study protocol for a randomized controlled trial.

Knee osteoarthritis (OA) is a common and serious joint disease and patients mainly suffer from knee pain and dysfunction, significantly impacting their quality of life and daily activities. Non-pharmacological treatments and total knee arthroplasty (TKA) are the two major treatments for knee OA. TKA is the primary treatment for severe knee OA patients, however, the postoperative rehabilitation results are not entirely satisfactory. To enhance postoperative rehabilitation outcomes, preoperative lower-limb muscle strengthening has aroused attention and demonstrated significant results on functional recovery after TKA. Specifically, isokinetic muscle strengthening (IMS) has been highly anticipated as an efficient training method. Nevertheless, its effects in perioperative and long-term periods of TKA require further investigation. This study aims to evaluate the impact of preoperative lower-limb IMS during the 4weeks before TKA on the perioperative and postoperative outcomes, with particular attention on knee function, pain, and inflammatory response. In this study, 104 patients awaiting TKA will be randomized to 2 groups: the IMS and health education groups. All patients will be evaluated at baseline, post-intervention, discharge day, and postoperative day 14, with follow-up assessments at 6weeks, 3, 6, and 12months after discharge. The primary outcome will be the Knee Injury and Osteoarthritis Outcome Score 3months after TKA and the medial-to-lateral knee contact force ratio. The secondary outcomes will be changes in lower-limb muscle strength, knee pain, inflammation response, active range of motion, performance-based function (5-times Sit-to-Stand Test, Time Up-and-Go Test, 3m walking speed), Berg Balance Scale, and surgical need. Lower-limb IMS can improve muscle strength, pain, and function for early knee OA patients. However, the effects of different doses of IMS on perioperative and postoperative knee pain, inflammation response, and function after TKA are inconclusive. This study will provide high-quality evidence to assess the efficacy of IMS in end-stage patients who will undergo TKA. Understanding IMS in end-stage knee OA patients will help guide future surgical management for this population. Trial Registration Chinese Clinical Trial Registry ChiCTR2400088136.