Use Of Crutches Research Articles

Device for training the extensor muscles in the upper extremity of bedridden patients preparatory to use of crutches

Device for training the extensor muscles in the upper extremity of bedridden patients preparatory to use of crutches

Management of Antenatal Pelvic Girdle Pain Study (MAPS): A Double Blinded, Randomised Trial Evaluating the Effectiveness of Two Pelvic Orthoses

Pelvic girdle pain (PGP) occurs in 70% of pregnant women; of whom 25% have severe pain and 8% severe disability requiring the use of crutches, wheelchair or confinement to bed [1]. Patients with pregnancy related PGP have been shown to have increased pelvic joint motion compared with healthy pregnant controls, probably due to a combination of hormonal and biomechanical factors, leading to an increase in pelvic joint laxity, changes in lumbopelvic posture and increase in shearing forces through pelvic joints, thus leading to pain [2,3]. PGP is difficult to manage; activities such as turning in bed, prolonged walking, or carrying items may cause pain; impacting negatively on quality of life [4]. In economic terms societal costs are significant, mainly as a consequence of work absenteeism; with 20% of people requiring an average of 7-11 weeks sick leave [5-8]. There are high direct health costs as well as increased health risks as women with PGP have a higher request for induction of labour and elective caesarean section to achieve symptomatic relief [3,5,7].

Relationship between cortical or subcortical lesions and long-term functional capacity in stroke patients

Strokes occur in the cortical or subcortical regions of the brain, compromise cortical functions and sensory-motor performance, and have a negative impact on long-term functional capacity. The aim of this study was to evaluate the relationship between strokes in the cortical or subcortical regions and autonomy, functional independence, and use of locomotor aids. We evaluated 62 patients with ischemic strokes confirmed by CT-scan. The cortical and subcortical regions were defined by an experienced neuroradiologist. Patients were divided into two groups: those with cortical strokes (group 1: n = 47) and those with subcortical strokes (group 2: n = 15). Patients were then assessed for autonomy and independence 90 days after stroke using the Barthel Index and modified Rankin Scale. Locomotor aid included the use of wheelchairs, crutches, and walking sticks for community outings. The associations of cortical or subcortical strokes with autonomy, independence, and use of locomotor aids were analyzed by simple logistic regression corrected for confounding variables (age, severity of stroke and treatment received) and were considered significant when P < 0.05. Lower autonomy was observed in group 1 than in group 2. Specifically, 6.4% of patients in group 1 scored higher than 95 on the Barthel Index, compared to 46.7% in group 2 ( P = 0.04). A significant difference in the use of locomotor aids was observed between the groups (wheelchair: 29.8% of group 1 vs. 6.7% of group 2, P = 0.03; walking sticks or crutches: 44, 7% of group 1 vs. 33.3% of group 2, P = 0.03; Table 1). Patients with ischemic strokes in cortical regions demonstrate less autonomy and have a greater chance of using locomotor aids than patients with strokes in subcortical regions do.

Effects of post-fracture non-weight-bearing immobilization on muscle atrophy, intramuscular and intermuscular adipose tissues in the thigh and calf.

Disuse and/or a non-weight-bearing condition changes muscle composition, with decreased skeletal muscle tissue and increased fat within (intramuscular adipose tissue, IntraMAT) and between (intermuscular adipose tissue, InterMAT) given muscles. Excessive adipose tissue contributes to dysfunctional and metabolically impaired muscle. How these adipose tissues change during orthopedic treatment (e.g., cast immobilization, daily use of crutches) is not well documented. This study aimed to quantify changes in IntraMAT, InterMAT, and thigh and calf muscle tissue during orthopedic treatment. We studied 8 patients with fifth metatarsal bone or fibular fractures. The ankle joint involved underwent plaster casting for approximately 4weeks, with crutches used during that time. Axial T1-weighted MRI at the mid-thigh and a 30% proximal site at the calf were obtained to measure IntraMAT and InterMAT cross-sectional areas (CSAs) and skeletal muscle tissue CSA before treatment and 4weeks afterward. Thigh and calf muscle tissue CSAs were significantly decreased from before to after treatment: thigh, 85.8 ± 7.6 to 77.1 ± 7.3cm2; calf, 53.3 ± 5.5 to 48.9 ± 5.0cm2 (p < 0.05). None of the IntraMAT or InterMAT changes was statistically significant. There was a relation between the percentage change of thigh IntraMAT CSA and muscle tissue CSA (rs = -0.86, p < 0.01). The 4weeks of treatment primarily induced skeletal muscle atrophy with less of an effect on IntraMAT or InterMAT. There is a risk of increasing IntraMAT relatively by decreasing skeletal muscle tissue size during orthopedic treatment.

Unassisted quiet standing and walking after crutch usage in patients with total hip replacements: Does crutch length matter?

BackgroundCrutch use is prescribed early in the rehabilitation process following total hip replacement (THR) surgery to improve safety and promote return to active living. Research questionPurpose of this study was to understand mid-term effects of crutch length setup on quiet standing and walking two months post-op when crutch use was no longer required. MethodsThirty patients were evaluated 2 months post-surgery when they had been walking without crutch for a month. The patients had previously been assigned randomly to elbow flexed (EF) or elbow extended (EE) crutch set-ups and evaluated 3 days post-surgery. Quiet standing stability was assessed with participants standing in a comfortable position with each foot on separated force platforms, facing forward for 10 s. In addition, participants walked on the laboratory path, instrumented with motion tracking system and force platforms.For the quiet standing trial, centre of pressure measure, acromial height and lower limbs load bearing symmetry were evaluated. For the walking trial, spatiotemporal and ground reaction force (GRF) parameters were evaluated together with side symmetry indices. ResultsResults showed no significant differences in any standing trial variables between groups. For walking, GRF parameters and symmetry indices were similar for both groups. However, increased base of support width, reduced self-selected walking speed and stride length were found for the EF group. SignificanceThis study showed that crutch set-up influenced gait after patients started to walk unassisted. Patients that previously used crutch adjusted according to the EE setup, demonstrated a more efficient gait with higher self-selected speed and longer and narrower stride. Clinicians may use these results for a proper crutch height adjustment, which improves walking and, in turn, functional recovery in post THR patients.

Estimation of Ground Reaction Forces Using Low-Cost Instrumented Forearm Crutches

Instrumented crutches are useful for many rehabilitation tasks, including monitoring the correctness of crutch use, analyzing gait properties for patients with lower-limb impairments, as well as providing sensory data for controlling lower-body robotic orthoses. In this paper, we describe the design and analysis of an instrumented crutch system equipped with low-cost accelerometer and pressure sensors to estimate all components of the ground reaction force(GRF), providing a well-defined and physically meaningful sensory output for practical applications. We propose an angle-dependent quadratic model to map pressure and inclination data to force components, which we identify using least-squares methods. Through systematic characterization experiments, we first show that our model can predict GRF vectors with less than 7% rms errors in all axes for fixed crutch angles used for training. Subsequently, we generalize the model to crutch angles other than those used for training, showing that rms estimation errors remain below 7% for all axes. Finally, we assess measurement accuracy and performance under dynamic loading conditions with time-varying crutch angles, showing that errors still remain below 8% under realistic conditions.

Supine Percutaneous Nephrolithotripsy in Double-S Position.

Background At present, the percutaneous nephrolithotripsy (PCNL) is performed both in supine and in prone position. The aim of this paper is to describe an innovative position during PCNL. Methods We describe a supine position. The patient's legs are slightly abducted at the hips. The thorax is laterally tilted (inclination 30°–35°) and kept in the right position by one or two gel pads placed between the scapula and the vertebrae. External genitalia can be accessed at any time, so that it is always possible to use flexible instruments in the upper urinary tract. We used this position for a period of 12 months to treat with PCNL 45 patients with renal lithiasis. Results All the procedures were successfully completed without complications, using the position we are describing. The following are some of its benefits: an easier positioning of the patient; a better exposure of the flank for an easier access to the posterior renal calyces of the kidney; a lower risk of pressure injuries compared to positions foreseeing the use of knee crutches; the possibility of combined procedures (ECIRS) through the use of flexible instruments; and a good fluoroscopic visualization of the kidney not overlapped by the vertebrae. Conclusions This position is effective, safe, easy, and quick to prepare and allows for combined anterograde/retrograde operations.

Perbedaan Pengaruh Penggunaan Transtibial Prosthesis Dan Axial Crutch Terhadap Keseimbangan Pasien Post Amputasi Transtibial

Abstract: Transtibial Prosthesis, Walking Balance, Axilla Crutch, Post Transtibial Amputation. This study aims to determine the effect of the use of transtibial prosthesis and axial crutch on the balance of transtibial post amputation patient. This research is hoped to be beneficial to the benefit of people who have transtibial amputation in order to obtain the appropriate balance. This research method is Quantitative research, pre experiment, using research design one groups pre and post test design, where in this research there is only one group of subjects that will be measured equilibrium using prosthesis and axial crutch. Research conducted at PT. Kuspito Ortotik Prostetik. In this research, there are two variables, namely (1) dependent variable, balance, (2) independent variables are use of transtibial prosthesis and axial crutch. Data collection is done in two stages, first and second phase. In the first stage, the researcher records the client identity that has been defined as the research subject (sample), including name, gender, age, address, and examination to establish the type of patient who meets the inclusion criteria. Afterwards, measurements were made on patients using transtibial prostheses and recording the results of the treatment group in terms of their equilibrium values. In the second stage of data collection, measurements were taken in patients using axial crutch and recording the results of the treatment group in terms of their equilibrium value. The instruments used are TUG Test equipment (armrest and armrest seats, stopwatch, wall, stationery). Data were analyzed with SPSS for Win13.00 for Windows software. Test the normality of data using Shapiro-Wilk normality test. The results showed that there was a difference of effect of axial crutch with prosthesis on post amputation patient equilibrium (0,017 &lt;0,05), it is also known that average equilibrium in group of axial crutch (18,46) while mean balance in group Prosthesis (20,84). Crutches are walking sticks, usually used in pairs that are created to regulate the balance at the time of going and sustaining the user's body. Axilla crutches are not designed to rest during support of the body. To minimize the inconvenience of using axilla crutches, a prosthesis is created which, when an amputation patient has been determined to use a prosthesis, determines the purpose of prosthetic fitting, whether functional, cosmetic or both.

FUNCTIONAL OUTCOMES OF HIP ARTHROSCOPY IN AN ACTIVE DUTY MILITARY POPULATION UTILIZING A CRITERION-BASED EARLY WEIGHT BEARING PROGRESSION

Hip arthroscopy allows surgeons to address intra-articular pathology of the hip while avoiding more invasive open surgical dislocation. However the post-operative rehabilitation protocols have varied greatly in the literature, with many having prolonged periods of limited motion and weight bearing. The purpose of this study was to describe a criterion-based early weight bearing protocol following hip arthroscopy and investigate functional outcomes in the subjects who were active duty military. Active duty personnel undergoing hip arthroscopy for symptomatic femoroacetabular impingement were prospectively assessed in a controlled environment for the ability to incorporate early postoperative weight-bearing with the following criteria: no increased pain complaint with weight bearing and normalized gait pattern. Modified Harris Hip (HHS) and Hip Outcome score (HOS) were performed preoperatively and at six months post-op. Participants were progressed with a standard hip arthroscopy protocol. Hip flexion was limited to not exceed 90 degrees for the first three weeks post-op, with progression back to running beginning at three months. Final discharge was dependent upon the ability to run two miles at military specified pace and do a single leg broad jump within six inches of the contralateral leg without an increase in pain. Eleven participants met inclusion criteria over the study period. Crutch use was discontinued at an average of five days following surgery based on established weight bearing criteria. Only one participant required continued crutch use at 15 days. Participants' functional outcome was improved postoperatively, as demonstrated by significant increases in HOS and HHS. At the six month follow up, eight of 11 participants were able to take and complete a full Army Physical Fitness Test. Following completion of the early weight bearing rehabilitation protocol, 81% of participants were able to progress to full weight bearing by four days post-operative, with normalized pain-free gait patterns. Active duty personnel utilizing an early weight bearing protocol following hip arthroscopy demonstrated significant functional improvement at six months. Level 4, Case-series.

P349 Assessment of prevalence and risk factors for carpal tunnel syndrome in polio survivors

Objective Carpal tunnel syndrome (CTS) is a commonly reported nerve entrapment syndrome in patients with chronic physical disabilities. It causes disability independent of underlying disease. In this study, we aimed to identify prevalence and risk factors for CTS in polio survivors. Methods Based on clinical and electrophysiological findings, 46 patients with prior paralytic poliomyelitis were selected from patients referred to clinical neurophysiology laboratory. The CTS was classified according to the severity of nerve conduction (NC) changes. Demographic factors, medical history, crutch or cane use, post-polio syndrome,body mass index (BMI), wrist index and Barthel index were compared between the polio survivors with CTS (CTS group) and without CTS (non-CTS group). A logistic regression analysis was conducted to evaluate odds ratio of different risk factors. Results Prevalence of CTS confirmed by NC studies in polio survivors was 43.4% (20 patient). Eighteen (45%), 12 (30%) and 2 (%5) hands had mild, moderate and severe CTS, respectively. The age, BMI and wrist index were higher in the CTS group than in the non-CTS group (p Discussion Our study confirms a high occurrence of CTS in polio survivors. Conclusions Body mass index may be associated with prevalent CTS in polio survivors. Significance Prevention of weight gain in polio survivors may reduce the risk of CTS.

Crutches.

On Being a Doctor1 August 2017CrutchesRaphael Karkowsky, MDRaphael Karkowsky, MDFrom Penn Delancey Internal Medicine, Philadelphia, Pennsylvania.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M17-1147 Audio Reading - “Crutches” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "Crutches," by R. Karkowsky. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail I follow him from behind. He walks unsteadily and, even with the use of crutches, his legs, largely paralyzed from polio as a child, are not strong enough to keep his feet from dragging across the floor. I breathe a sigh of relief when he makes it to the exam room without falling.Today's visit is unscheduled. “Mr. Devon is worried about his blood pressure,” my receptionist told me. We have a significant history together, so despite being short on time, I agreed to see him.We first met nearly 2 years ago. At that first office visit, he shook ... Author, Article, and Disclosure InformationAffiliations: From Penn Delancey Internal Medicine, Philadelphia, Pennsylvania.Corresponding Author: Raphael Karkowsky, MD, Penn Delancey Internal Medicine, 800 Walnut Street, 17th Floor, Philadelphia, PA 19107; e-mail, Raphael.[email protected]upenn.edu. PreviousarticleNextarticle Advertisement Audio Reading - “Crutches” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "Crutches," by R. Karkowsky. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ FiguresReferencesRelatedDetails Metrics 1 August 2017Volume 167, Issue 3Page: 212KeywordsAlcoholsBlood pressureEmotionsMalnutritionMemoryPoliomyelitisSaltsShouldersTouchWheelchairs ePublished: 1 August 2017 Issue Published: 1 August 2017 Copyright & PermissionsCopyright © 2017 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

Bio-inspired control of joint torque and knee stiffness in a robotic lower limb exoskeleton using a central pattern generator.

Robotic lower limb exoskeletons are becoming increasingly popular in therapy and recreational use. However, most exoskeletons are still rather limited in their locomotion speed and the activities of daily live they can perform. Furthermore, they typically do not allow for a dynamic adaptation to the environment, as they are often controlled with predefined reference trajectories. Inspired by human leg stiffness modulation during walking, variable stiffness actuators increase flexibility without the need for more complex controllers. Actuation with adaptable stiffness is inspired by the human leg stiffness modulation during walking. However, this actuation principle also introduces the stiffness setpoint as an additional degree of freedom that needs to be coordinated with the joint trajectories. As a potential solution to this issue a bio-inspired controller based on a central pattern generator (CPG) is presented in this work. It generates coordinated joint torques and knee stiffness modulations to produce flexible and dynamic gait patterns for an exoskeleton with variable knee stiffness actuation. The CPG controller is evaluated and optimized in simulation using a model of the exoskeleton. The CPG controller produced stable and smooth gait for walking speeds from 0.4 m/s up to 1.57 m/s with a torso stabilizing force that simulated the use of crutches, which are commonly needed by exoskeleton users. Through the CPG, the knee stiffness intrinsically adapted to the frequency and phase of the gait, when the speed was changed. Additionally, it adjusted to changes in the environment in the form of uneven terrain by reacting to ground contact forces. This could allow future exoskeletons to be more adaptive to various environments, thus making ambulation more robust.

Prospective clinical evaluation of a novel anatomic cuff for forearm crutches in patients with osteoarthritis

BackgroundThe use of forearm crutches has been associated with pain and neuropraxia along the ulnar bone. Whilst anatomic grips have improved comfort of crutch walking, to date anatomic forearm cuffs have not been clinically evaluated. The aim of this clinical pilot study was to determine if the use of forearm crutches with anatomic cuffs reduces pain and increases comfort and function in long-term users of forearm crutches during a 4-week period.MethodProspective study in ten patients suffering from end-stage osteoarthritis of the lower extremity. All participants were long-term users of conventional forearm crutches. Participants used forearm crutches with an anatomically shaped cuff for 4-weeks. General health was assessed using the SF-36, and the crutches were evaluated using a newly developed questionnaire focusing on symptoms along the forearm.ResultsPain and paresthesia along the forearms decreased by 3.3 points (95% confidence interval difference (CI): [−5.0; −1.6], p = .004) and 3.5 points (95%CI: [−5.1; −1.9], p = .002), respectively, after using the crutches with the new anatomic cuff for 4 weeks. Comfort and sense of security of crutch use increased by 3.0 points (95%CI: [1.3; 4.7], p = .007) and 2.4 points (95%CI: [0.7; 4.1], p = .024). Cross-correlation analysis revealed correlations among items in the same item category and no correlations between items of different item categories of the new questionnaires.ConclusionAn anatomically shaped cuff increases comfort of forearm crutches. Further research should confirm long-term clinical improvement.Trial registrationThis study was registered retrospectively in ISRCTN (TRN: ISRCTN 11135150) on 14/02/2017.

The impact of non weight bearing: A prospective cohort study

BackgroundPatients with lower limb injuries are commonly advised to non weight bear (NWB) on their injured limb as part of treatment. Occasionally, patients complain that offloading one limb, associated with the use of crutches or other mobility aids, may lead to pain on one of the other supporting limbs. This has led to compensation claims (1) but has never been the subject of formal research. MethodsA prospective cohort trial was undertaken to address this question. Patients were recruited from two Metropolitan Hospital Orthopaedic Fracture Clinics and Orthopaedic Wards. A survey was administered at two time points; the first at the point of definitive orthopaedic treatment and commencement of the NWB phase. The second after the NWB phase was completed. The surveys included a pain Visual Analogue Scale (VAS), Short Form (SF)12, a pain body chart and a health questionnaire. ResultsA total of 55 patients were enrolled in the study. Seven patients developed new joint pain after a period NWB. These patients scored significantly lower on the follow up SF12 when compared to those who did not develop new pain (p=0.045). Follow up phone calls at least 6 months following completion of the second survey revealed that all initial and new pain areas in these participants had resolved. The main limitation of this study was the limited numbers. ConclusionThis study supports the idea that crutches, prescribed in the short term to allow a limb to be NWB, achieve this aim with minimal impact. Their use may be associated with new other joint pain however it can be anticipated this will resolve after cessation of crutch use.

Primary surgical repair of acute Achilles tendon rupture: comparative results of three surgical techniques

To determine which of the three surgical techniques for acute unilateral complete rupture of Achilles tendons in use at the University Clinical Centre Maribor gives the best short-term functional results. In the retrospective analysis of the results of 3surgical techniques, 262 patients of which 244 (93.1%) were men (mean age 41.6 ± 10.0 years, range 21.5-83.0 years) operated on during the period from 2000 to 2008 were included. Group A (open technique with fascial augmentation) included 42 (16%) patients, group B (original modification of percutaneous suturing according to Čretnik and Kosanović) included 159 (60.7%) patients, and group C (original percutaneous fixation with two embracing and crossed loops according to Kruščić) included 61 (23.3%) patients. The rehabilitation protocol for groupC included use of individually manufactured closed ankle functional orthosis, which replaced the plaster cast after 2weeks of immobilization and permits early ankle range-of-motion exercising and full weight bearing. The functional outcome and incidence of postsurgical complications were analysed from medical records covering the period of 6months. Patients from groupC achieved the best functional results in the shortest time. The duration of immobilization (5.3 ± 0.1 weeks) and use of crutches (5.3 ± 0.5 weeks) were the shortest. The ability to rise up on toes on the affected leg, to walk on toes and heels, and duration of restriction of physical activities including sports were shorter than in the other two groups (p < 0.001 for all variables). Two reruptures were experienced in groupB, one in groupC, and none in groupA. Good functional results and a relatively small number of postsurgical complications advocate the use of percutaneous suturing techniques. The best and fastest functional recovery was attained in the group treated with the original technique of percutaneous fixation with two embracing and crossed thread loops according to Kruščić.

Clinical study of peripheral arterial occlusive disease of lower extremities

Background:Diagnosing PAD is important in order to implement appropriate therapies for preventing cardiovascular morbidity and mortality, improving functional impairment, and preventing further functional decline. The objective was to study the pattern of clinical presentation and etiology of peripheral arterial occlusive disease.Methods: This was a cross sectional observational study of 50 cases diagnosed with peripheral arterial disease of the lower extremities. History was taken as soon as the patient was admitted. A thorough clinical examination was carried out personally to find out and establish clinically first, the presence of vascular obstruction. Detailed vascular system examination was done as per the proforma provided.Results:TAO and atherosclerosis are the etiologies for ischemia in these cases, with atherosclerosis being more common of the two. All the cases of PAD presented with ischemic claudication and rest pain as common symptoms, while gangrene (80% of cases) and ischemic ulcer (20% of cases) were the other predominant symptoms. Doppler findings correlated with the disease presentation, TAO having a more infra-popliteal obstruction and atherosclerosis showing more proximal obstruction. All the cases were managed with some form of surgery and majority of them had limb loss. The level of amputation was below knee in 42% and above knee in 58% cases. Improvement of rest pain noted in 62.5% of cases, healing of ulcer in 50% of cases and improvement in claudication pain in 37.5% of patients who underwent lumbar sympathectomy.Conclusions:Post operatively most of the patients recovered uneventfully and some patients required secondary suturing of the surgical site. Three patients required a revision amputation at a higher level. At first month follow-up, many patients were ambulatory with the use of crutches.

Ambulation Aid for Nonweightbearing Foot and Ankle Injuries&lt;subtitle&gt;Suggestion from the Field&lt;/subtitle&gt;

Patients with injuries that preclude one leg from bearing weight frequently must use crutches. The difficulties of crutch ambulation are apparent to anyone who has used crutches for more than a few hours. Crutch ambulation is cumbersome and tiring. Using crutches strains the patient's body, often causing muscle aches and stiffness. Also, the activities of patients on crutches are limited. Their ambulation is compromised, and they have difficulty carrying things and working with their hands because their hands are not free. The purpose of this article is to describe a brace that allows patients with distal lower limb injuries to walk without the conventional use of crutches. The brace holds the knee in 90 degrees of flexion, places the patient's weight primarily on the knee and distal portion of the shank, and transmits his weight through a pedestal to the floor (Fig. 1).…

Corkscrew axillary artery with giant saccular aneurysm formation

Axillary artery aneurysms are rare, with limited cases reported.1Rose J.F. Lucas L.C. Bui T.D. Mills Sr., J.L. Endovascular treatment of ruptured axillary and large internal mammary artery aneurysms in a patient with Marfan syndrome.J Vasc Surg. 2011; 53: 478-482Abstract Full Text Full Text PDF PubMed Scopus (34) Google Scholar, 2Lind R.C. de Vries M. Rolink R. Oskam J. Pierie M.E. Surgical management of an isolated symptomatic true axillary artery aneurysm.Vasc Med. 2013; 18: 145-146Crossref PubMed Scopus (4) Google Scholar Coiling of the axillary arteries with formations of aneurysms are extremely uncommon.3Ortiz-Pomales Y. Smith J. Weiss J. Casey K. Tortuous axillary artery aneurysm causing median nerve compression.Ann Vasc Surg. 2014; 28: 122.e1-122.e3Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar Symptoms can include acute vascular insufficiency and neurologic deficits. Treatment should address the coiling vessels and the aneurysms. An 86-year-old woman complaining of increasing right shoulder pain and swelling was transferred to our hospital’s Department of Vascular Surgery. She had been diagnosed with advanced liver cancer, with multiple systemic metastases, and had been hospitalized 7 days earlier in the oncology department for support therapy. The physical examination revealed a pulsatile mass on her right upper extremity. She had no history of trauma or connective tissue disorders and denied long-term use of crutches. A contrast-enhanced computed tomography angiogram showed a corkscrew axillary artery with giant saccular aneurysm formation, reaching 35 mm by 62 mm in size (A and B). Considering its corkscrew course, an endovascular intervention using stent grafts was not suitable. Resection of the coiled part of the axillary artery and an end-to-end anastomosis were planed. However, the patient’s general condition was not ideal either, with liver function grade classified as Child C, which placed her at extremely high-risk for an open operation. The patient died of hepatic failure 10 days later during the hospitalization.

The impact of walking devices on kinematics in patients with spastic bilateral cerebral palsy

Increased anterior pelvic and trunk tilt is a common finding in patients with bilateral cerebral palsy especially during walking with assistive devices. As previous studies demonstrate various gait alterations when using assistive devices, the assessment of surgical interventions may be biased when the patients become independent of (or dependent on) assistive devices after therapy. Furthermore, some of these patients in fact are able to walk without devices even though in daily life they prefer to use them. Consequently, for such patients the classification into GMFCS level II or III may be ambiguous. The specific aim of this study was therefore to assess the influence of the use of forearm crutches and posterior walker during walking and to set this influence in relation to outcome effects of surgical intervention studies.26 ambulatory patients with spastic bilateral CP (GMFCS II–III) were included who underwent 3D gait analysis. All patients used forearm crutches or posterior walkers in everyday life even though they were able to walk without assistive devices for short distances.Independent of the type of assistive devices, the patients walk on average with more anterior trunk tilt and pelvic tilt (7°±6° and 3°±2°) and with a maximum ankle dorsiflexion decreased by 2° (±3°) when walking with assistive devices, enhancing the mal-positioning present without device. Oppositely, the knees on average are more extended by 6° (±4°) when using the assistive devices.These effects have to be taken into account when assessing gait patterns or when monitoring the outcome after intervention as assistive devices may partially hide or exaggerate therapeutic effects.

Analysis of terrain effects on the interfacial force distribution at the hand and forearm during crutch gait

ABSTRACTForces transferred to the upper body during crutch use can lead to both short-term and long-term injuries, including joint pain, crutch palsy, and over-use injuries. While this force transmission has been studied in controlled laboratory settings, it is unclear how these forces are affected by irregular terrains commonly encountered during community ambulation. The purpose of this study was to determine the effects of walking speed and uneven terrain on the load magnitude, distribution, and rate of loading at the human-crutch contact surfaces. Our results show that the rates of loading were significantly increased with higher walking speeds and while negotiating certain irregular terrains, despite there being no apparent effect on the peak force transmission, suggesting load rate may be a more appropriate metric for assessing terrain effects on crutch gait. Furthermore, irrespective of the type of terrain and walking condition, the largest compressive forces were found to reside in the carpal-tunnel region of the hand, and may therefore be a primary contributor to carpal-tunnel injury.