Degrees Of Internal Rotation Research Articles

The effect of femoral strapping on hip internal rotation and pain response in females with patellofemoral pain

BackgroundHip internal rotation has been reported to affect patellofemoral joint mechanics and contribute to patellofemoral pain (PFP). The SERF (Stability through External Rotation of the Femur) strap was designed to provide hip stability by pulling the thigh into external rotation during weight-bearing activities. Research questionWhat are the effects of the SERF strap on hip internal rotation and pain response in females with PFP who present with hip internal rotation during weight-bearing activities? MethodsNineteen females between the ages of 18 and 45 with a diagnosis of PFP participated. Lower extremity kinematics were obtained during three tasks (drop-jump, unilateral step-down, over-ground running) under strap and no-strap conditions. A 10-cm visual analog scale (VAS) was used to assess pain response during each task and strap condition. Participants who exhibited at least 5 degrees of hip internal rotation during at least one of the 3 tasks were included in the final analysis. Peak hip internal rotation and mean VAS score were compared separately between strap conditions across tasks using 2 ×3 (strap condition x task) repeated-measures ANOVAs. ResultsEighteen of the 19 females with PFP met the criteria for the presence of hip internal rotation. There was a significant reduction in peak hip internal rotation across tasks when wearing the SERF strap (mean ± sd = 7.4 ± 2.3, p<0.001). Additionally, the change in mean VAS pain score was significantly lower across tasks when wearing the SERF strap (1.0 ± 1.0, p=0.03). SignificanceThe SERF strap was effective in reducing hip internal rotation and PFP during dynamic weight-bearing activities in symptomatic females. The SERF strap may be a useful treatment adjunct for persons with PFP who present with poor transverse plane control of the hip.

Two-dimensional-lattice-confined single-molecule-like aggregates.

Intermolecular distance largely determines the optoelectronic properties of organic matter. Conventional organic luminescent molecules are commonly used either as aggregates or as single molecules that are diluted in a foreigner matrix. They have garnered great research interest in recent decades for a variety of applications, including light-emitting diodes1,2, lasers3-5 andquantum technologies6,7, among others8-10. However, there is still a knowledge gap on how these molecules behave between the aggregation and dilution states. Here we report an unprecedented phase of molecular aggregate that forms in a two-dimensional hybrid perovskite superlattice with a near-equilibrium distance, which we refer to as a single-molecule-like aggregate (SMA). By implementing two-dimensional superlattices, the organic emitters are held in proximity, but, surprisingly, remain electronically isolated, thereby resulting in a near-unity photoluminescence quantum yield, akin to that of single molecules. Moreover, the emitters within the perovskite superlattices demonstrate strong alignment and dense packing resembling aggregates, allowing for the observation of robust directional emission, substantially enhanced radiative recombination and efficient lasing. Molecular dynamics simulations together with single-crystal structure analysis emphasize the critical role of the internal rotational and vibrational degrees of freedom of the molecules in the two-dimensional lattice for creating the exclusive SMA phase. This two-dimensional superlattice unifies the paradoxical properties of single molecules and aggregates, thus offering exciting possibilities for advanced spectroscopic and photonic applications.

Open wedge high tibial osteotomy alters patellofemoral joint kinematics: A multibody simulation study.

Changes in lower limb alignment after open-wedge high tibial osteotomy (owHTO) influence joint kinematics. The aim of this study was to investigate the morphological and kinematic changes of the knee joint, in particular the patellofemoral joint, using a multibody simulation model. OwHTO with an open tibial wedge of 6-12 mm (1 mm intervals) was virtually performed on each of 13 three-dimensional (3D) computer-aideddesign models (CAD models) derived from computer tomography scans of full-leg cadaver specimens. For each owHTO, an individual biomechanical simulation model was built and knee flexion from 5° to 100° was simulated using a multibody simulation model of the native knee. Morphologic and alignment parameters as well as tibiofemoral and patellofemoral kinematic parameters were evaluated. Almost linear changes in tibial tuberosity trochlea groove(TT-TG) (0.42 mm/1 mm wedge height) were observed which led to pathological values (TT-TG > 20 mm) in 3 out of 13 knees. Furthermore, a 6 mm increase in osteotomy wedge height increased lateral patellofemoral rotation by 0.8° (range: 0.39° to 1.11°) and led to a lateral patellar translation of 0.8 mm (range: 0.37-3.11 mm) on average. Additionally, valgisation led to a medial translation of the tibia and a decrease in the degree of tibial internal rotation during knee flexion of approximately 0.3°/1 mm increase in osteotomy wedge height. The increase in TT-TG and the biomechanical effects observed influence patellofemoral tracking, which may increase retropatellar pressure and are potential risk factors for the development of anterior knee pain.

Retrospective analysis of the subscapularis-sparing approach for reverse total shoulder arthroplasty.

The influence of the subscapularis tendon on reverse total shoulder arthroplasty (RTSA) has been discussed controversially. The aim of the study was to investigate the subscapularis-sparing approach for RTSA and the effect of the intact subscapularis tendon. This retrospective comparative study included 93 patients. Among these, 55 underwent the deltopectoral subscapularis-sparing approach, and in 38 cases, the standard deltopectoral approach with subscapularis tenotomy was applied. At the final follow-up, representative shoulder scores were measured, radiographs were taken in two planes, and shoulder sonography was performed. The subscapularis-sparing group showed a significantly higher Constant score (71.8 vs. 65.9 points) and adapted Constant score if the subscapularis tendon was shown to be intact in the postoperative sonography (85.2% vs. 78.6%) (p = 0.005; p = 0.041). Furthermore, these patients had improved abduction (128.2 vs. 116.8, p = 0.009) and external rotation (34.6 vs. 27.1, p = 0.047). However, no significant differences were found for the degree of internal rotation and internal rotation strength. No dislocation or infection was observed. The degree of scapular notching was not significantly different between the two groups (p = 0.082). However, independently from the integrity of the subscapularis the subscapularis-sparing approach showed no difference in clinical and radiographic outcome (Constant score scapularis-sparing 70.0 points vs. tenotomy 66.8 points; p = 0.27). The subscapularis-sparing approach RTSA showed improved clinical outcome, abduction, and external rotation, if the subscapularis was shown to be intact at time of follow-up. Both groups showed no difference in internal rotation.

Virtual range of motion is a safe and acceptable alternative to intra-operative manual range of motion testing in direct anterior robotic total hip arthroplasty

IntroductionIn robotic total hip arthroplasty (THA), virtual range of motion (VROM) modeling allows the surgeon to account for spinopelvic motion and create an impingement-free range of motion that is patient-specific. The primary purpose of this study was to evaluate the risk of dislocation in patients undergoing direct anterior THA using VROM rather than manual ROM trialing. MethodsProspectively collected data was reviewed retrospectively of all consecutive anterior THAs performed by a single fellowship-trained surgeon. No patients were excluded from the study. VROM identified bone and implant impingement, which was recorded in degrees of hip external rotation(ER) at 0° of hip extension (standing), and in degrees of hip internal rotation(IR) at 90° of hip flexion (sitting). No patients had manual ROM trialing performed. Dislocation events were recorded during the first 3 months of follow-up. 362 patients, with a mean age of 67 and mean BMI of 28.8, were included. ResultsThis cohort, including 154 patients (42.5%) with abnormal spinopelvic motion, demonstrated zero dislocations using VROM. The average ER impingement occurred at 60.9° ER (range 20-90°), and 50.8° IR (range 25-90°). Patients with ER impingement <55° had significantly less acetabular anteversion (16.4° ±3.3°, p < 0.001). Compared to the entire cohort, anteversion of the acetabulum was also decreased in the stuck-sitting subgroup (17.4° ±3.3°, p < 0.001) and increased in the stuck standing subgroup (20.5° ±3.6°, p < 0.001). ER impingement was a stronger predictor of acetabular anteversion than spinopelvic motion category (r = 0.458). Patients with ER impingement <45° (6.4%) or IR impingement <35° (6.6%) were “early impingers”. ConclusionIn this cohort of anterior THA patients with a high proportion of abnormal spinopelvic motion, a technique utilizing only VROM produced no dislocations. An impingement-free zone of 45° ER standing and 35° IR sitting is recommended.

The effect of arthroscopic coracoplasty on subscapularis strength in cases of subcoracoid impingement in the absence of subscapularis tear.

Subcoracoid impingement leads to anterior shoulder pain, and arthroscopic subcoracoid decompression (coracoplasty) is the preferred treatment in recalcitrant cases. The purpose of the present study was to evaluate the effect of coracoplasty on the severity of anterior shoulder pain and the strength of the subscapularis muscle and to correlate it with the preoperative and postoperative coracohumeral distance (CHD) (t:transverse, s:sagittal). Sixteen patients without any subscapularis tendon tears who underwent arthroscopic subcoracoid decompression and rotator cuff repair with 2 years follow-up were included. Preoperative and postoperative 2-year assessments of function and pain were performed using the modified Kennedy-Hawkins test, power grading of various subscapularis muscle tests, and ASES scores. Preoperative and postoperative coracohumeral distance (tCHD, sCHD) and coracoid overlap (CO) were measured using MRIs before and after surgery. The Mean Hawkins pain score and coracoid overlap were decreased. The strength scores for subscapularis strength testing, ASES score, maximum degree of internal rotation, and coracohumeral distance increased (P < .05). Changes in belly press strength were negatively correlated with postoperative tCHD (r = -0.6, P = .04) and postoperative sCHD (r = -0.7, P = .008). A significant increase in the internal rotation range of the shoulder, subscapularis strength, and relief of anterior shoulder pain was observed. However, this increase was inversely proportional to the postoperative CHD, indicating the mechanical effect of the coracoid on subscapularis strength.

Effects of Adding Extracorporeal Shockwave Therapy (ESWT) to Platelet-Rich Plasma (PRP) among Patients with Rotator Cuff Partial Tear: A Prospective Randomized Comparative Study.

A rotator cuff tear is a prevalent ailment affecting the shoulder joint. The clinical efficacy of combined therapy remains uncertain for partial rotator cuff tears. In this study, we integrated extracorporeal shockwave therapy (ESWT) with platelet-rich plasma (PRP) injection, juxtaposed with PRP in isolation. Both cohorts exhibited significant improvements in visual analogue scale (VAS), Constant-Murley score (CMS), degrees of forward flexion, abduction, internal rotation, and external rotation, and the sum of range of motion (SROM) over the six-month assessment period. The application of ESWT in conjunction with PRP exhibited notable additional enhancements in both forward flexion (p = 0.033) and abduction (p = 0.015) after one month. Furthermore, a substantial augmentation in the range of shoulder motion (SROM) (p < 0.001) was observed after six months. We employed isobaric tag for relative and absolute quantitation (iTRAQ) to analyze the differential plasma protein expression in serum samples procured from the two groups after one month. The concentrations of S100A8 (p = 0.042) and S100A9 (p = 0.034), known to modulate local inflammation, were both lower in the ESWT + PRP cohort. These findings not only underscore the advantages of combined therapy but also illuminate the associated molecular changes.

Unveiling Syndesmotic Malreduction: A Proof-of-Concept towards Portable Ultrasound Detection.

To evaluate the utility and diagnostic performance of portable handheld ultrasound for evaluating fibular rotation at the distal tibiofibular articulation after syndesmotic disruption. Four above-the-knee cadaveric specimens were included. Syndesmotic disruption was precipitated by transecting the Anterior Inferior Tibiofibular Ligament, Interosseous Ligament, and Posterior Inferior Tibiofibular Ligament. Thereafter, a proximal fibular osteotomy was performed, and three conditions were modeled at the distal syndesmosis: 1) reduced, 2) 5 degree internal rotation malreduction, and 3) 5 degree external rotation malreduction. Two blinded observers performed separate ultrasonographic examinations for each condition at the level of both the anterior and posterior distal tibiofibular articular surfaces. Syndesmotic gap penetrance, defined as the ability of the P-US to generate signal between the distal fibula and tibia at the level of the incisura, was graded positive if the sonographic waves penetrated between the distal tibiofibular joint and negative if no penetrating waves were detected. The accuracy measures of the anterior and posterior gap penetrance were evaluated individually. Our preliminary results showed that posterior gap penetrance showed good performance when detecting either internal or external rotational malreduction of the fibula with very good specificity (87.5%) and PPV (90.0%). On the other hand, the anterior gap penetrance showed limited performance when detecting either form of rotational malreduction. We introduced a novel sign, the "gap penetrance sign", best measured from the posterior ankle, which can accurately detect syndesmotic malreduction using P-US in a manner that does not require specific quantitative measurements and is readily accessible to early P-US users.

A computational toolbox for the assembly yield of complex and heterogeneous structures

The self-assembly of complex structures from a set of non-identical building blocks is a hallmark of soft matter and biological systems, including protein complexes, colloidal clusters, and DNA-based assemblies. Predicting the dependence of the equilibrium assembly yield on the concentrations and interaction energies of building blocks is highly challenging, owing to the difficulty of computing the entropic contributions to the free energy of the many structures that compete with the ground state configuration. While these calculations yield well known results for spherically symmetric building blocks, they do not hold when the building blocks have internal rotational degrees of freedom. Here we present an approach for solving this problem that works with arbitrary building blocks, including proteins with known structure and complex colloidal building blocks. Our algorithm combines classical statistical mechanics with recently developed computational tools for automatic differentiation. Automatic differentiation allows efficient evaluation of equilibrium averages over configurations that would otherwise be intractable. We demonstrate the validity of our framework by comparison to molecular dynamics simulations of simple examples, and apply it to calculate the yield curves for known protein complexes and for the assembly of colloidal shells.

Weight-Bearing Computed Tomography Evaluation of Acute SER4a Ankle Fractures

Category: Ankle; Trauma Introduction/Purpose: Recent studies have reported cadaveric and early clinical data regarding Weber B supination-external- rotation (SER)4a ankle fractures. SER4a ankle fractures have discordance of the medial clear space (MCS) between weight-bearing (WB) and gravity stress (GS) radiographs, showing instability on the GS view which normalizes with WB. Unfortunately, evaluation of the medial clear space only provides a two-dimensional evaluation of a three-dimensional structure. Prior cadaveric research has shown significant decreases in the tibiotalar joint contact area with only 1 mm of displacement of the talus. The purpose of this study is to utilize weight-bearing computed tomography (WBCT) to evaluate differences in the tibiotalar joint contact area and rotational alignment in patients with acute SER4a ankle fractures compared to their contralateral uninjured ankle. Methods: Adult patients presenting within ten days of injury with an isolated Weber B fibula fracture and a normal MCS ( &lt; 5 mm) on injury radiographs were evaluated with weight-bearing and gravity stress radiographs. Patients determined to have isolated Weber B SER4a ankle fractures (GS positive but WB negative radiographs) and no history of injury to the contralateral ankle were included. The ability to place equal weight on both extremities was confirmed by standing on side-by-side scales. WBCT scans were obtained of both the healthy and injured ankles. The images were evaluated using Disior Bonelogic (Paragon28, Helsinki, Finland) software to calculate the tibiotalar joint contact area, axial tibiotalar rotation, and talocrural angle. An a priori power analysis was performed with six patients needed. Results: Five out of ten patients have been enrolled in the study to date (3 females, 2 males, average age 52.4). Preliminary data show an average 4.3% (standard deviation (SD) 4.9) increase in tibiotalar joint contact area between the injured and uninjured extremity. The average difference in axial tibiotalar angle is 3.6 (SD 6.9) degrees of internal rotation of the injured ankle. The talocrural in the injured and uninjured extremity have an average difference of 0.062 (SD 1.8) degrees. Conclusion: This study provides the first in vivo evaluation of the joint contact area changes seen in SER4 ankle fractures. Although limited in sample size, the results demonstrate that SER4a ankle fractures do not have decreased tibiotalar joint contact area relative to the healthy, uninjured side. The trend towards increased surface area in the injured ankles is hypothesized to be a result of the increased reliance on joint congruency with injury to the fibula and deltoid.

Tibial Malrotation after Intramedullary Locked Tibia Nailing and its Computed Tomography-Based Assessment

Objectives To assess the incidence and degree of malrotation of tibia after fixation with intramedullary nail for tibial shaft fractures and its measurement by computed tomography (CT). The study also aims to assess the value of CT-based torsion angle in such cases. Material and Methods In this prospective study, fifty patients with closed/open fracture of tibia shaft (proximal 1/3, middle 1/3 or distal 1/3) with or without fracture of fibula were chosen and operated with closed/open reduction internal fixation with reamed intramedullary locked nail. Torsion angle calculated by post-operative CT and revision done for selected cases when tibial malrotation was more than 10 degrees than the control (normal side). Results The range of malreduction was from 43 degrees of external rotation to 12 degrees internal rotation. 15 of the 50 (30%) tibia operated showed malrotation and 5 (10%) were above 20 degrees. The repetition of torsion angle showed a variation of 3.2 to 4.3 degrees. Some injury patterns showed more malrotation than the others. Conclusion Assessment of tibial malrotation following intramedullary nailing has shown higher incidence of malalignment than previously reported in the literature. CT-based torsion angle calculation can be used as a reliable indicator of malrotation.

Shoulder Range of Motion Measurement Using Inertial Measurement Unit-Concurrent Validity and Reliability.

This study aimed to evaluate the reliability of the RSQ Motion sensor and its validity against the Propriometer and electronic goniometer in measuring the active range of motion (ROM) of the shoulder. The study included 15 volunteers (mean age 24.73 ± 3.31) without any clinical symptoms with no history of trauma, disease, or surgery to the upper limb. Four movements were tested: flexion, abduction, external and internal rotation. Validation was assessed in the full range of active shoulder motion. Reliability was revised in full active ROM, a fixed angle of 90 degrees for flexion and abduction, and 45 degrees for internal and external rotation. Each participant was assessed three times: on the first day by both testers and on the second day only by one of the testers. Goniometer and RSQ Motion sensors showed moderate to excellent correlation for all tested movements (ICC 0.61-0.97, LOA < 23 degrees). Analysis of inter-rater reliability showed good to excellent agreement between both testers (ICC 0.74-0.97, LOA 13-35 degrees). Analysis of intra-rater reliability showed moderate to a good agreement (ICC 0.7-0.88, LOA 22-37 degrees). The shoulder internal and external rotation measurement with RSQ Motion sensors is valid and reliable. There is a high level of inter-rater and intra-rater reliability for the RSQ Motion sensors and Propriometer.

Limb position affects intraoperative assessment of condylar width

PurposeWe sought to define how changes in position and rotation of fluoroscopic imaging may affect the assessment of condylar widening intraoperatively.MethodsThirty-three patients with tibial plateau fractures were prospectively identified and included in this study. Fluoroscopic images of the uninjured tibial plateau were obtained in (1) full extension and (2) slight flexion on foam ramp. Beginning with a plateau view, additional views of the tibial plateau were then obtained by rotating the fluoroscope around the knee in 5 degree increments up to 15 degrees in both internal and external rotation. Measurements of distal femoral condylar width (DFW), distal femoral articular width (FAW), proximal tibial articular width (TAW) and lateral plateau width (LPW) were performed.ResultsLPW was decreased in flexion compared to extension at all degrees of rotation (p = 0.04–0.00001). There was a trend toward increasing LPW with increasing degrees of internal rotation which reached significance at 15˚ of internal rotation when the knee was flexed. On ANOVA, there was a significant difference of LPW with increasing degree of internal rotation when the knee was in flexion (p = 0.008), but not in extension. There were no differences in DFW, FAW, TAW and DFW/TAW at any point though LPW was decreased in flexion at all degrees of rotation. The FAW/TAW ratio was increased in flexion at all degrees of rotation.DiscussionThe knee in flexion will underestimate the measurement of condylar width compared to the knee in full extension, by ~ 2 mm. Rotation of the knee, in comparison, did not have a significant effect on condylar width assessment.Level of evidenceDiagnostic II.

Femoral and acetabular features explain acetabular contact pressure sensitivity to hip internal rotation in persons with cam morphology: A finite element analysis

BackgroundFemoroacetabular impingement is characterized by premature contact between the proximal femur and acetabulum. The loss of femoral head-neck concavity associated with cam morphology leads to mechanical impingement during hip flexion and internal rotation. Other femoral and acetabular features have been linked with mechanical impingement but have not been comprehensively investigated. This study sought to determine which bony features are most influential in contributing to mechanical impingement in persons with a cam morphology. MethodsTwenty individuals (10 female, 10 male) with a cam morphology participated. Finite element analyses incorporating subject-specific bony geometry derived from computed tomography scans were used to determine which femoral (alpha angle and femoral neck-shaft angle) and acetabular (anteversion angle, inclination angle, depth, and lateral center-edge angle) features accentuate acetabular contact pressure with increasing degrees of hip internal rotation with the hip flexed to 90°. To determine the best predictors of acetabular contact pressure sensitivity to internal rotation, all morphological variables were included in a stepwise regression with the final model subjected to a bootstrapping procedure. FindingsThe stepwise regression revealed that femoral neck-shaft angle, acetabular anteversion angle, acetabular inclination angle, and acetabular depth were the best combination of variables to predict contact pressure sensitivity to internal rotation, explaining 55% of the variance. Results of the bootstrap analysis revealed that a median value of 65% [37%, 89%] variance in sensitivity could be explained by these morphological variables. InterpretationMechanical impingement and the concomitant acetabular contact pressure are modulated by multiple femoral and acetabular features in persons with a cam morphology.

Reduced kinetic model of polyatomic gases

Kinetic models of polyatomic gas typically account for the internal degrees of freedom at the level of the two-particle distribution function. However, close to the hydrodynamic limit, the internal (rotational) degrees of freedom tend to be well represented just by rotational kinetic energy density. We account for the rotational energy by augmenting the ellipsoidal statistical Bhatnagar–Gross–Krook (ES–BGK) model, an extension of the BGK model, at the level of the single-particle distribution function with an advection–diffusion–relaxation equation for the rotational energy. This reduced model respects the$H$theorem and recovers the compressible hydrodynamics for polyatomic gases as its macroscopic limit. As required for a polyatomic gas model, this extension of the ES–BGK model not only has the correct specific heat ratio but also allows for three independent tunable transport coefficients: thermal conductivity, shear viscosity and bulk viscosity. We illustrate the effectiveness of the model via a lattice Boltzmann method implementation.

Dynamic Analysis of the Coracohumeral Ligament Using Ultra-Sonography in Shoulder Contracture.

The coracohumeral ligament (CHL) is related to the range of motion of the shoulder joint. The evaluation of the CHL using ultrasonography (US) has been reported on the elastic modulus and thickness of the CHL, but no dynamic evaluation method has been established. We aimed to quantify the movement of the CHL by applying Particle Image Velocimetry (PIV), a technique used in the field of fluid engineering, to cases of shoulder contracture using the US. The subjects were eight patients, with 16 shoulders. The coracoid process was identified from the body surface, and a long-axis US image of the CHL parallel to the subscapularis tendon was drawn. The shoulder joint was moved from 0 degrees of internal/external rotation to 60 degrees of internal rotation at a rhythm of one reciprocation every 2 s. The velocity of the CHL movement was quantified by the PIV method. The mean magnitude velocity of CHL was significantly faster on the healthy side. The maximum magnitude velocity was significantly faster on the healthy side. The results suggest that the PIV method is helpful as a dynamic evaluation method, and in patients with shoulder contracture, the CHL velocity was significantly decreased.

Clinical significance of the elbow forward translation motion in patients with rotator cuff tears

Range of motion (ROM) limitations can result in restricted activities of daily living (ADL) due to shoulder dysfunction, suggesting that evaluation of complex shoulder movements is necessary in clinical practice. Here, we present a new physical examination, the elbow forward translation motion (T-motion) test for measuring the position of the elbow when both dorsal hands are placed on the iliac crest in a sitting position and the elbow is moving forward. We examined the relationships between T-motion and shoulder function to identify the significance of this test in clinical practice. Preoperative patients with rotator cuff tears (RCTs) were eligible for this cross-sectional study. Active ROM and Japanese Orthopaedic Association (JOA) scores were measured as shoulder function. The degree of internal rotation was based on the Constant-Murley Score. We defined a positive T-motion test result as an elbow positioned posterior to the body on the sagittal plane. Group comparisons and logistic regression analyses were conducted to investigate the relationships between the availability of T-motion and shoulder function. Sixty-six patients with RCTs participated in this cross-sectional study. The values of the JOA total score (P<.001), subscale of function and ADL (P<.001), active range of forward flexion (P=.006), abduction (P<.001), and external rotation (P<.001) were lower in the positive group than in the negative group. In addition, a significant correlation was found between the availability of T-motion and internal rotation by the chi-square test (P<.001). Logistic regression analyses showed that internal rotation (odds ratio 2.69; 95% confidence interval 1.47-4.93; P<.01) and external rotation (odds ratio 1.07; 95% confidence interval 1.00-1.14; P=.04) were related to the availability of T-motion after adjustments for covariates, and the cutoff points were 4 points for internal rotation (area under the curve 0.833, sensitivity 53.3%, specificity 86.1%, P<.001) and 35° for external rotation (area under the curve 0.788, sensitivity 60.0%, specificity 88.9%, P<.001). The positive T-motion group exhibited low shoulder function, including a less active ROM and JOA shoulder score. T-motion, which is a quick and simple movement, may be a new indicator for a complex shoulder motion and contribute to evaluating the decreased ADL and limited shoulder motion in patients with RCTs.

Iliotibial band tightness and internal rotation of the tibia in the stance phase of running associated with patella instability.

Management of patellar instability is still a clinical challenge, especially in pediatric and adolescent athletes. The purpose of the study was to check the association between the positive apprehension test (which is a sign of patellar instability) and positive Ober's test [which is a sign of a tight iliotibial band (ITB)] and the lower degree of internal rotation of the tibia in young athletes determined by inertial sensors. The participants of this observational case-control study were 56 young athletes aged 10-15. The moving patellar apprehension test for lateral patellar instability and Ober's test for assessing the flexibility of the ITB were performed on all participants. There were 32 sides with positive apprehension tests (cases) and 80 with negative apprehension tests (controls). The degree of internal rotation of the tibia was determined with an inertial sensor. Internal rotation of the tibia in the stance phase of running was lower in the case group than in the control group. Logistic regression analysis showed that the degree of internal rotation of the tibia in the stance phase of running was a good predictor of patellar instability. Our study illustrates that wearable devices can be valuable in determining possible initial patellar instability. Using inertial sensors, a strong association between patellar instability, ITB tightness, and lower internal rotation of the tibia in the stance phase of running was determined. The significance of this study might be the possibility of preventing damage or dislocations of the patella by improving the elasticity of the ITB, which is particularly relevant since patellar instability is common among adolescents.

Comparing the Results of Latissimus Dorsi Versus Teres Major Transfer in Children With Obstetric Brachial Plexus Injury and Residual Shoulder Sequelae.

Obstetric brachial plexus injury (OBPI) remains a fairly common problem in newborns despite the improved obstetric care. Children who do not show complete recovery often present with residual shoulder deformity of limited external rotation and abduction. Secondary interventions in the form of tendon transfer and soft tissue release are aimed at correcting the implicated muscular imbalance to restore shoulder function. The aim of this work was to compare the results of latissimus dorsi versus teres major tendon transfer in patients with OBPI with limited shoulder external rotation. This study included 40 patients admitted to El Hadara University Hospital with OBPI and limited shoulder abduction and external rotation aged between 1.5 and 4 years. Half of the patients had a latissimus dorsi transfer, and the other half, a teres major one. Children with limited preoperative passive external rotation in both groups required a subscapularis slide. Patients were evaluated preoperatively, at 6 months, and 12 months postoperatively using the Gilbert scale. Teres major tendon transfer showed better results in restoring limited shoulder abduction and external rotation than latissimus dorsi transfer. Limited shoulder internal rotation was the main complication occurring postoperatively. Loss of the last degree of internal rotation occurred in most patients who had subscapularis slide. Most patients regained functional midline abilities with physiotherapy and required no further interventions. Isolated teres major transfer has shown better results in improving the range of external rotation and abduction compared with isolated latissimus dorsi tendon transfer. Age of the patients did not affect the overall final improvement in shoulder range of motion. Limited internal rotation is the main complication postoperatively, which was prevalent in patients who required a subscapularis slide but was not statistically significant.

Comparison of Chiropractic Manipulation Therapy and Functional Movement-Based Myofascial Release in Shoulder Range of Motion of Collegiate Athletes: A Pilot Study

Background: Shoulder pain is the third most common presentation of musculoskeletal pain in the clinic with a lifetime prevalence of up to 70%. In athletes, shoulder dysfunction is often due to the extreme forces experienced by the joint during sport participation. Studies have shown that a deficit of 5 degrees in total arc of motion, 20 degrees in internal rotation, and 15 degrees in horizontal adduction can increase an athlete’s chances of injury by a factor of four.&#x0D; Methods: Student athletes with shoulder pain and decreased range of motion (ROM) in their dominant arm were separated into cohorts and received twelve therapy sessions. One cohort received chiropractic manipulation (CM) and the other received functional movement-based myofascial release (FMMR) with CM. ROM of the shoulder was measured during the first, sixth, and last sessions using goniometry and video capture. Cohorts were compared using statistical analyses on data collected.&#x0D; Results: A total of four participants have completed at least the first six sessions of participation in study. Initial results show there is no statistical difference in improvement in shoulder ROM between cohorts. Student T-tests comparing cohorts’ improvements in six of the seven specific ROM tests resulted in no statistical significance (p-values ≤ 0.05). The two participants that completed all twelve intended therapy sessions showed evidence of positive trajectory for increased ROM and qualitatively expressed improvement in shoulder motion.&#x0D; Conclusion: This study shows that there was no statistically significant difference in treating athletes with CM versus FMMR combined with CM. This can mainly be attributed to the study’s current size (n=4). Even with the small participant size, and lack of statistical significance several trends of the individual range of motion measurements provide questions that would benefit from the continuation of the study towards the full cohort participation.