Trunk Angle Research Articles

Neonatal Noninvasive Ventilation Nasal Mask Interface Pressure and the Inter-Individual Variation of Mask Placement.

The 2014 American Academy of Pediatrics recommendation for CPAP as an alternative to mechanical ventilation for treatment of neonatal respiratory distress prompted a rapid shift to noninvasive ventilation (NIV). Since most patients receive nasal bubble CPAP (a form of NIV), a concomitant increase in nasal pressure injuries followed. This prospective observational study aims to develop strategies to reduce nasal mask pressure injury in neonates by 1.) quantifying CPAP mask-interface pressure and 2.) assessing placement variability. A 1F MEMS Connect pressure sensor (Millar®) was modified for contact pressure measurements with silicone embedding and calibrated. The CPAP generator and interface components were sized for a 24-week neonatal simulator. Thirteen neonatal ICU staff placed the simulator on CPAP at 6 cmH2O and 8 L/min of flow with no humidification. Pressure was measured at three locations (the forehead, nasal bridge, and philtrum) in triplicate (three measurements per site). Descriptive statistics, a location-specific, one-way analysis of variance (ANOVA) with a Tukey post hoc test, and a two-sample paired t-test of the means of the first and last triplicate were performed (Minitab, LLC). Pressure ranged from 12.3 to 377.3 mmHg. The mean (SD) interface pressure at the philtrum was significantly higher than both the nasal bridge and the forehead (philtrum: 173.9 (101.3), nasal bridge: 67.79 (28.9), and forehead 79.02 (36.87), p ˂ 0.001). CPAP fixation varied, including bonnet placement, trunk angle, mask compression, use of hook and loop extenders, and level of vigorous bubble feedback achieved. This study developed a modified pressure sensor for quantifying the pressure exerted by a nasal mask on facial skin. Maximum pressures were higher than those previously reported. Inter-individual differences were present in both quantitative and qualitative measures of pressure. Reduction of NIV-associated pressure injuries may be achieved through NIV fixation technique training and improved nasal mask stability and size increments.

Effects of Technique Asymmetry on 500 m Speed Skating Performance.

This study aimed to determine the effects of technique asymmetry on 500 m straight-track speed skating performance. We analyzed 20 elite skaters, measuring their joint angles, center of mass shift, and times and speeds during the gliding and push-off phases. The technique asymmetry index (ASI) was calculated for each parameter, and paired t-tests were used to compare bilateral asymmetry. Spearman correlation coefficients assessed the relationship between the ASI and both the average straight track speed and overall performance. Significant bilateral asymmetries in the knee, push-off, trunk, and hip angles were found in both male and female participants (p < 0.05). The male participants demonstrated a higher right push-off speed (p = 0.029) and a longer left gliding time (p = 0.048). Significant asymmetry was also observed in the lateral shift of the center of mass during each phase of the straight-track skating gait cycle (p < 0.001). No significant correlation was found between the ASIs and the overall performance (p ≥ 0.067). These findings indicate that while elite speed skaters demonstrated significant bilateral technique asymmetry in straight track skating, these asymmetries did not significantly impact their overall performance.

Changes in rotator movement during early gait acquisition in after total hip arthroplasty

BackgroundIn walking in healthy adults, rotation of the hip joint affects stride length and shifts the center of gravity, but these are not seen in hip osteoarthritis which affects gait. In gait of total hip arthroplasty, there are few reports on changes in the horizontal plane. This study clarified the preoperative and early postoperative gait characteristics of patients undergoing total hip arthroplasty. MethodsThe analysis included 12 females who underwent initial total hip arthroplasty using a posterolateral approach. Gait was measured pre and postoperatively using a three-dimensional motion analysis device. Statistics were compared pre and postoperative range of motion, muscle strength, walking speed, stride length, gravity movement distance, trunk angle, hip joint angle, and joint moment. FindingsThe maximum hip abduction moment and trunk flexion angle to the surgical side were lower than in healthy subjects. The angle of internal rotation during the stance phase was significantly higher in the postoperative period. The distance of the center of gravity shift in the left and right directions was significantly decreased postoperatively. InterpretationGait disturbance was seen preoperatively and remained after surgery. Walking after total hip arthroplasty provides the hip joint rotates inward which is closer to normal walking. However, no change was observed in the external rotation moment of the hip joint during walking. We suspect that the invasiveness of the posterolateral approach of total hip arthroplasty affects the muscles for external rotation of the hip joint. This can also cause in gait disturbances.

Evaluation of a passive back-support exoskeleton during in-bed patient handling tasks

This study evaluated the effects of a back-support exoskeleton on the trunk and hip joint angles, lower back muscle activity and heart rate during four patient handling tasks: assisting a patient from sitting to lying, laterally repositioning the patient and turning the patient in two directions. Eight participants performed these tasks with and without the exoskeleton. Results demonstrated a significant reduction in the lower back muscle activity, but less pronounced effects for other tasks involving minimal trunk flexion. Hip flexion angles were reduced for all tasks when the exoskeleton was worn. The amount of reduction in the muscle activity and changes in the trunk and hip angles varied by task. The exoskeleton did not affect the heart rate across all tasks. The exoskeleton appeared to be more effective in tasks requiring substantial trunk flexion, indicating its potential benefits for reducing lower back muscle strain during such activities.

Trunk kinematics and limb movement of horses walking backwards and forwards in hand and lifting a single limb

Equine physiotherapy commonly includes basic exercises such as walking backward (BW) and voluntary lifting of single limbs (SLL), but trunk movements during these have not been studied. In order to compare the trunk kinematics during BW and SLL with forward walking (FW), nine horses were measured in FW, BW and during SLL triggered by tactile cue. Kinematics were obtained from skin markers captured by ten high-speed video cameras. Trunk angles were calculated in sagittal and horizontal planes from withers, dorsal to spinous processes of the 16th thoracic vertebra (T16), 2nd and 4th sacral vertebrae (S2, S4), WT16S2 and T16S2S4 respectively. From the hooves, maximum hoof height during swing phase and horizontal distance between hoof and median body plane during swing and stance phases were determined.Dorsoventral range of motion (ROM) and maximum flexion of WT16S2 was significantly larger in BW than in FW, while laterolateral ROM was significantly smaller during hindlimb swing phase in BW and SLL than in FW. In contrast, dorsoventral ROM of T16S2S4 was significantly smaller during stance and swing phases of hindlimbs in BW compared to FW, and throughout the movement. During forelimb swing phase, T16S2S4 ROM was significantly larger in BW than SLL. Hindhoof height in SLL was significantly higher than in FW. Distance between median body plane and hooves was significantly larger in BW than in FW, and significantly larger in BW than in SLL for hindlimb swing phase. In BW, increased lumbosacral stabilisation and the larger area of support created by fore- and hindlimbs may represent a strategy to enhance body stabilisation, as BW entails some insecurity.

Factors leading to falls in transfemoral prosthesis users: a case series of prosthesis-side stumble recovery responses

BackgroundFalls due to stumbling are prevalent for transfemoral prosthesis users and may lead to increased injury risk. This preliminary case series analyzes the transfemoral prosthesis user stumble recovery response to highlight key deficits in current commercially-available prostheses and proposes potential interventions to improve recovery outcomes.MethodsSix transfemoral prosthesis users were perturbed on their prosthetic limb at least three times while walking on a treadmill using obstacle perturbations in early, mid and late swing. Kinematic data were collected to characterize the response, while fall rate and key kinematic recovery metrics were used to assess the quality of recovery and highlight functional deficits in current commercially-available prostheses.ResultsAcross all participants, 13 (54%) of the 24 trials resulted in a fall (defined as > 50% body-weight support) with all but one participant (83%) falling at least once and two participants (33%) falling every time. In contrast, in a previous study of seven young, unimpaired, non-prosthesis users using the same experimental apparatus, no falls occurred across 190 trials. For the transfemoral prosthesis users, early swing had the highest rate of falling at 64%, followed by mid-swing at 57%, and then late swing at 33%. The trend in falls was mirrored by the kinematic recovery metrics (peak trunk angle, peak trunk angular velocity, forward reach of the perturbed limb, and knee angle at ground contact). In early swing all four metrics were deficient compared to non-prosthesis user controls. In mid swing, all but trunk angular velocity were deficient. In late swing only forward reach was deficient.ConclusionBased on the stumble recovery responses, four potential deficiencies were identified in the response of the knee prostheses: (1) insufficient resistance to stance knee flexion upon ground contact; (2) insufficient swing extension after a perturbation; (3) difficulty initiating swing flexion following a perturbation; and (4) excessive impedance against swing flexion in early swing preventing the potential utilization of the elevating strategy. Each of these issues can potentially be addressed by mechanical or mechatronic changes to prosthetic design to improve quality of recovery and reduce the likelihood a fall.

Schoolchildren’s Musculoskeletal Pain and Backpack Weight Impact on Posture: A Short-Term Study

ABSTRACT Background: Research indicates heavy backpacks can cause students to adjust their posture, potentially harming their spine and shoulders. This study focuses on musculoskeletal pain in schoolchildren in Bangalore, attributed to backpack weight, and examines postural impacts in both urban and rural settings. Methodology: With consent, 500 students from various schools underwent physical measurements, including backpack weight, and provided data through questionnaires. Postural angles were assessed without backpacks to determine the impact of weight. Findings: On average, students carried backpacks weighing 6.53 kg, about 13.53% of their body weight. Pain was reported by 50.9% of boys and 63.9% of girls, with a higher incidence among girls from private schools (88.2%) compared to boys from government schools (51.6%). Conclusion: A significant link was found between heavier backpacks and decreased craniovertebral angle, head on neck (HON), and head and neck on trunk (HNOT) angles, aligning with increased pain prevalence. This underscores the health risks of heavy school backpacks and the need for weight management.

Ergonomics of Various Modalities for Ear Surgery.

Evaluate ergonomic differences of various modalities for performing middle ear surgery. Observational study. Two academic tertiary care centers. Attending physicians and residents performing middle ear surgery were photographed intraoperatively. Intraoperative photographs were analyzed using the validated Rapid Upper Limb Assessment (RULA) tool to measure musculoskeletal disease (MSD) risk. Descriptive statistics and significance testing were used to characterize and compare ergonomic differences between surgical modalities. Multivariable ordinal regression was performed to assess factors associated with increased MSD risk, as determined by the final RULA score. Most of our 110 intraoperative photos featured attendings (82.7%) performing combined middle ear surgery and mastoidectomy (60.0%). Body angles and the final RULA score varied significantly among modalities. On subset analysis, microscopic surgery exhibited significantly worse wrist, trunk, and neck angles compared to endoscopic and exoscopic surgery. Exoscopic surgery had significantly lower final RULA scores than both endoscopic and microscopic surgery, indicating significantly lower MSD risk. Microscopic and endoscopic surgery final scores did not vary significantly. In a multivariable ordinal regression of factors associated with increased RULA score, exoscopic surgery had statistically significantly less ergonomic risk relative to microscopic surgery (odds ratio = 0.12, 95% confidence interval = [0.03-0.43]). Exoscopic, endoscopic, and microscopic surgery all featured low ergonomic risk, although exoscopic middle ear surgery demonstrated the lowest risk profile among studied surgical modalities. This demonstrates the importance of using each modality in combination with other ergonomic interventions to provide meaningful musculoskeletal benefits.

Correlation between clinical and epidemiological characteristics of adolescents with idiopathic scoliosis and their quality of life

Introduction:Bracing and physiotherapy in Adolescent idiopathic scoliosis, are closely linked to heightened levels of psychological distress.Objective:The objective of this study is to investigate the relationship between the clinical and epidemiological characteristics of AIS patients and their quality of life.Subjects and Methods: This study encompassed 60 patients aged 13.85 ± 1.87 years,exhibiting mild to severe AIS. All subjects adhered to a Schroth exercise program for a minimum of three months, with 26 of them additionally undergoing conservative treatment with braces. Each participant completed the ISYQOL questionnaire and an individual form detailing clinical and epidemiological characteristics. Results:A notable correlation was observed concerning the use of braces.Patients utilizing a brace demonstrated higher ISYQOL scores,indicating a lower HRQoL,compared to those exclusively following Schroth exercise programs. HRQoL exhibited positive correlations with the age at diagnosis,height,age at menstruation onset, and duration of Schroth exercise treatment. HRQoL displayed negative correlations with age,weight,duration of brace treatment, maximum angle trunk rotation , and maximum Cobb angle. The study indicated that lumbar curves were associated with a higher QoL.Conclusions:The use of a brace was found to have a negative impact on HRQoL.

Relationship between Soccer Shooting Speed and Trunk Angles in the Frontal Plane during One-Leg Drop Landing and Standing Hip Abduction Tasks

Relationship between Soccer Shooting Speed and Trunk Angles in the Frontal Plane during One-Leg Drop Landing and Standing Hip Abduction Tasks

The applicability of markerless motion capture for clinical gait analysis in children with cerebral palsy

The aim of this comparative, cross-sectional study was to determine whether markerless motion capture can track deviating gait patterns in children with cerebral palsy (CP) to a similar extent as marker-based motion capturing. Clinical gait analysis (CGA) was performed for 30 children with spastic CP and 15 typically developing (TD) children. Marker data were processed with the Human Body Model and video files with Theia3D markerless software, to calculate joint angles for both systems. Statistical parametric mapping paired t-tests were used to compare the trunk, pelvis, hip, knee and ankle joint angles, for both TD and CP, as well as for the deviation from the norm in the CP group. Individual differences were quantified using mean absolute differences. Markerless motion capture was able to track frontal plane angles and sagittal plane knee and ankle angles well, but individual deviations in pelvic tilt and transverse hip rotation as present in CP were not captured by the system. Markerless motion capture is a promising new method for CGA in children with CP, but requires improvement to better capture several clinically relevant deviations especially in pelvic tilt and transverse hip rotation.

Relationship among the COM Motion, the Lower Extremity and the Trunk during the Squat.

Squatting is a common motion in activities of daily living and is frequently used in training programs. Squatting requires a shift of the body in both vertical and anterior-posterior directions. Postural control during squatting is considered a mixed strategy; however, details and roles of the trunk and lower limb joints are unclear. The purpose of this study was to investigate the relationship among the kinematics of the lower limb, the trunk and the center of mass (COM) descent during squatting. Twenty-six healthy young adults performed repeated parallel squats. Lower limb joint and trunk angles and the COM were analyzed using a 3D motion analysis system. We evaluated the relationship between the kinematics and the squat depth by performing correlation analysis and multiple linear regression analysis. The ankle was the first to reach its maximum angle, and the remaining joints reached their maximum angles at the maximum squat depth. The knee joint motion and the squat depth were significantly correlated and there was a correlation between the hip and the ankle joint motion and the anteroposterior displacement of the COM during squatting. Multivariate linear regression analysis indicated that squat depth was predicted by both the knee and ankle motion and that anteroposterior displacement of the COM was predicted by the hip, ankle, and knee joint motion. The knees contributed to the vertical COM motion during squatting, while the hips contributed to the COM motion in the anteroposterior direction. On the other hand, the ankles contributed to COM motions in both the vertical and anteroposterior directions during squatting.

Effects of postural control by personal mobility on human joint movements-prototype of a new alert system for personal mobility devices

Purpose: This study aimed to develop a prototype Personal Mobility (PM) system with human-robot synchronous motion measurement and sensory feedback as an attention reminder to ensure the safe performance of sustained, step-by-step rehabilitation tailored to the daily living conditions of elderly individuals. Methods: Five healthy adults were fitted with a simulation tool to experience the elderly, and inertial measurement unit sensors were placed on the subjects and the PM device to measure joint movements during two postural movements (sitting to supine and supine to standing). In addition, vibration stimulation and voice guidance were implemented as alerts at a certain set threshold of the joint motion angle. We analyzed the deviation of each joint motion between the subject and the PM device regarding the angle measurements of the trunk, hip, knee, and ankle joints. Results: Trunk angle misalignment was high in the sitting-to-supine position. Hip angle misalignment was greater in the supine to standing position. As an alert system, vibration and voice guidance could be presented to the subject with a 0.3-second delay after the set threshold was reached. Conclusion: The misalignment between a human and a motorized wheelchair in contact with the human is more than several tens of degrees when expressed as the angle change value of the joint motion. We believe that a system that can constantly sense and alert the user regarding whether the user and the PM device are in sync is necessary for PM devices being used in rehabilitation or as daily life support.

Reduced trunk movement control during motor dual-tasking in older adults

Older adults have a decreased trunk movement control which is linked to their higher fall risk. While motor/cognitive dual-tasking deteriorates balance and walking in older adults, there is limited understanding on how trunk kinematics and kinetics are affected by dual-tasking in scenarios where falls can occur. Therefore, the purpose of the study was to determine the impacts of a challenging motor dual-task, specifically obstacle avoidance during walking, on trunk and lower-body kinematics and kinetics of older adults compared to young adults. The study captured three-dimensional kinematic and kinetic data from 12 young adults and 10 older adults as they walked on a treadmill and stepped over an obstacle with both legs. The study analyzed trunk, hip, knee, and ankle angles and torques. Trunk torque was further broken down to trunk muscle torque, gravitational torque, and inertia torque. A linear mixed effects model was used to investigate the difference in each variable between the two groups. Older adults exhibited significantly increased trunk flexion angle and trunk extension muscle torque compared to young adults, with the trunk being the only segment/joint showing differences in both kinematics and kinetics. Trunk torque breakdown analysis revealed that larger trunk flexion led to a larger gravitational torque, which contributed to an increased compensatory trunk muscle torque. Moreover, older adults' less controlled trunk flexion during weight shifting from trail leg to the lead leg, necessitated a compensatory trunk deceleration during trail leg obstacle avoidance which was achieved by generating additional increase in trunk muscle torque. The study demonstrated that motor dual-tasking has the most negative effects on trunk control in older adults compared to young adults. This exposes older adults to a higher fall risk. Therefore, future work should focus on supporting trunk control during daily multi-tasking conditions where falls can occur.

Either Autonomy Support or Enhanced Expectancies Delivered Via Virtual-Reality Benefits Frontal-Plane Single-Leg Squatting Kinematics.

Our purpose in this study was to determine the effects of a virtual reality intervention delivering specific motivational motor learning manipulations of either autonomy support (AS) or enhanced expectancies (EE) on frontal plane single-leg squatting kinematics. We allocated 45 participants (21 male, 24 female) demonstrating knee, hip, and trunk frontal plane mechanics associated with elevated anterior cruciate ligament injury risk to one of three groups (control, AS, or EE). Participants mimicked an avatar performing five sets of eight repetitions of exemplary single-leg squats. AS participants were given the added option of choosing the color of their avatar. EE participants received real-time biofeedback in the form of green highlights on the avatar that remained on as long as the participant maintained pre-determined 'safe' frontal plane mechanics. We measured peak frontal plane knee, hip, and trunk angles before (baseline) and immediately following (post) the intervention. The control group demonstrated greater increases in knee abduction angle (Δ = +2.3°) than did the AS (Δ = +0.1°) and EE groups (Δ = -0.4°) (p = .003; η2p = .28). All groups demonstrated increased peak hip adduction (p = .01, ηp2 = .18) (control Δ = +1.5°; AS Δ = +3.2°; EE Δ = +0.7°). Hip adduction worsened in all groups. AS and EE motivation strategies appeared to mitigate maladaptive frontal plane knee mechanics.

Computational study of extrinsic factors affecting ACL strain during single-leg jump landing

BackgroundNon-contact anterior cruciate ligament (ACL) injuries are a major concern in sport-related activities due to dynamic knee movements. There is a paucity of finite element (FE) studies that have accurately replicated the knee geometry, kinematics, and muscle forces during dynamic activities. The objective of this study was to develop and validate a knee FE model and use it to quantify the relationships between sagittal plane knee kinematics, kinetics and the resulting ACL strain.Methods3D images of a cadaver knee specimen were segmented (bones, cartilage, and meniscus) and meshed to develop the FE model. Knee ligament insertion sites were defined in the FE model via experimental digitization of the specimen’s ligaments. The response of the model was validated against multiple physiological knee movements using published experimental data. Single-leg jump landing motions were then simulated on the validated model with muscle forces and kinematic inputs derived from motion capture and rigid body modelling of ten participants.ResultsThe maximum ACL strain measured with the model during jump landing was 3.5 ± 2.2%, comparable to published experimental results. Bivariate analysis showed no significant correlation between body weight, ground reaction force and sagittal plane parameters (such as joint flexion angles, joint moments, muscle forces, and joint velocity) and ACL strain. Multivariate regression analysis showed increasing trunk, hip and ankle flexion angles decreases ACL strain (R2 = 90.04%, p < 0.05).ConclusionsSoft landing decreases ACL strain and the relationship could be presented through an empirical equation. The model and the empirical relation developed in this study could be used to better predict ACL injury risk and prevention strategies during dynamic activities.

Exploring celiac trunk parameters in median arcuate ligament syndrome: A CT study.

To assess anatomical variations in the celiac trunk (Ct) in patients with Median Arcuate Ligament Syndrome (MALS) using computed tomography (CT). The primary objectives were to investigate the celiac trunk angle (CtA), origin level, length (CtL), and their relationships with the superior mesenteric artery (SMA) in MALS patients. Additionally, the study intended to evaluate gender differences in these parameters and explore correlations between variables. Retrospectively, reports of abdominal CT scans taken between January 2018, and Sepmtember 2021, in the hospital image archive were screened vey two observers independently for MALS diagnosis. Parameters such as CtA, CtL, Ct-SMA distance, SMA angle (SMAA), and median arcuate ligament thickness (MALT) were measured. Statistical analyses were conducted using SPSS software. Among the 81 patients (25 females, 56 males), significant differences were observed in MALT between genders (p = 0.001). CtA showed a negative correlation with CtL and Ct-SMA (p < 0.001), and a positive correlation was found between CtL and Ct-SMA (p = 0.002). CtL was measured as 25mm for the all group. Origin levels of Ct and SMA were evaluated in comparison to vertebral levels. Ct-SMA distance was relatively shorter (9.19mm) compared to the literature. SMAA findings were consistent with normal population values. This study provided valuable insights into the anatomical parameters of the Ct ans SMA in MALS patients. Despite some differences compared to normal population parameters, no evidence supported the hypothesis of a superiorly placed Ct contributing to MALS.

Biomechanical Comparison of Pediatric Female Ballet Dancers With and Without Pain

BACKGROUND: Across all genres of dance, studies have reported musculoskeletal injury in 20-84% of dancers with 95% reporting a history of musculoskeletal pain. Compared to other dance styles, ballet dancers specifically are most affected by musculoskeletal injuries. The purpose of this study is to compare movement patterns and muscle activity in pediatric female pre-professional dancers with and without self- reported pain, using the Patient-Reported Outcomes Measurement Information System pediatric numeric rating scale. We hypothesize dancers reporting pain will exhibit compensatory strategies, such as asymmetrical movement patterns and muscle activity, across a series of ballet movements. METHODS: A total of 55 female ballet dancers who train en pointe were seen for testing (age 14.4±1.9 years), with 34 dancers (62%) self-reported pain in the 7 days preceding testing. Biomechanical testing, performed in pointe shoes, included performance of static (5 classical ballet positions) and dynamic ballet movements (développé, arabesqué and grand jeté) while instrumented with surface electromyography (EMG) to capture muscle activity and inertial measurement (IMU) dual sensors on the trunk and lower extremities to capture movement patterns. The experimental setup allowed for measurement of trunk and lower extremity muscle activity, as well as trunk, hip, knee, and ankle joint angles in the sagittal, coronal, and transverse planes. Student’s t-test was used to compare the pain and no pain groups across all variables with statistical significance set to α=0.05. RESULTS: Movement patterns and EMG differences were seen between groups. During first and third positions, the right (non-barre sided) leg demonstrated less external knee rotation in the pain group (p≤0.05). In fifth position, the left (barre-sided) leg exhibited increased ankle flexion (p=0.048), reduced hip abduction (p=0.027), and reduced knee adduction (p=0.026) in the pain group. The pain group exhibited decreased trunk flexion/extension range-of-motion during the grand jeté (p=0.004), and increased trunk rotation range-of-motion when performing the arabesqué en pointe (p=0.034). Rectus femoris activation was reduced for the pain group on the left leg in fifth position (p&lt;0.03). The up leg in the pain group during the développé (flat) showed increased hamstring activation (p=0.04). CONCLUSION: Ballet dancers with pain exhibited differences in movement patterns while performing certain ballet movements, notably during fifth position, grand jeté, and arabesqué (en pointe). Additionally, dancers with pain exhibited reduced rectus femoris activation in fifth position and increased hamstring activation on the working leg during the développé (flat). Future work should investigate how movement patterns and muscle activation in ballet dancers vary by location and severity of reported pain.

Back morphology and walking patterns mean 13.8 years after surgery for lumbar disk herniation in adolescents.

In many pain conditions, there is lingering pain despite healed tissue damage. Our previous study shows that individuals who underwent surgery for lumbar disk herniation (LDH) during adolescence have worse health, more pain, and increased disk degeneration mean 13 years after surgery compared with controls. It is unclear if walking patterns segregate surgically treated LDH adolescents and controls at mean 13-year follow-up. Here, we analyzed the relationship between gait, back morphology and other health outcomes in a cohort of individuals treated surgically because of lumbar disk herniation compared with controls. We analyzed gait during a walking paradigm, back morphology at the site of surgery, and standardized health outcomes, among individuals who received surgery for LDH as adolescents, "cases" (n = 23), compared with "controls" (n = 23). There were gait differences in head (P = 0.021) and trunk angle (P = 0.021) between cases and controls in a direction where cases exhibited a posture associated with sickness. The gait variance was explained by subjective pain and exercise habits rather than objective disk degeneration. Over a decade after surgery for LDH during adolescence, health among cases is worse compared with controls. The head and trunk angles differ between cases and controls, indicating that the residual pain lingers and may cause changes in movement patterns long after a painful episode in early life. Gait may be a useful target for understanding maintenance of pain and disability among individuals treated surgically for LDH during adolescence.

A radio-anatomical study of median arcuate ligament syndrome: unveiling the morphology and morphometry of median arcuate ligament, celiac trunk, and superior mesenteric artery.

In the context of medical literature, a significant lacuna exists in understanding median arcuate ligament syndrome (MALS). While clinical aspects are well documented, literature lacks a robust exploration of the anatomical relationship between the celiac trunk and the median arcuate ligament (MAL). Morphometric parameters, including the vertebral level of MAL origin, MAL thickness, celiac trunk (CeT) origin level, diameter, and distances between CeT/Superior Mesenteric Artery (SMA) and the MAL center were observed on 250 CT angiograms. Cadavers (n = 11) were dissected to examine the same parameters and histo-morphological examination of MAL tissue was done. Radiological findings established average MAL thickness of 7.79 ± 2.58mm. The celiac trunk typically originated at T12. The average distance between the celiac trunk and the MAL center was 1.32 ± 2.04mm. The angle of the celiac trunk to the abdominal aorta was primarily obtuse. The average celiac trunk diameter was 5.53 ± 1.33mm. Histological examinations revealed a diverse MAL composition, indicating variable mechanical properties. This study provides comprehensive morphometric data on the anatomical relationship between the MAL and the celiac trunk. In contrast to available literature which says the average MAL thickness of > 4mm is an indicator of increased thickness, we observed much higher average thickness in the studied population. The findings contribute to a better understanding of normal anatomical variations which can serve as reference values for accurate radiological diagnosis of MALS. The histological examination revealed the heterogeneous nature of the MAL tissue composition, suggesting variable mechanical properties and functions in different regions.