Elbow Extension Research Articles

Mechanical Design and Development of a 2 Degrees of Freedom Prosthetic Arm

To improve the availability of affordable prostheses in developing regions, there is a need to introduce and produce a readily available and efficient device using locally sourced materials and accessible electronics. This paper presents the mechanical design of a prosthetic human arm with 2 DOFs at the elbow and 1 DOF at the wrist. The objective of this design is to have an anthropomorphic, functional, and low-cost prosthesis. A set of dynamic simulations were performed using SOLID WORKS and MATLAB SIMULINK to determine the feasibility of the mechanism as well as the torque required to perform the activities. The proposed fabricated model was subjected to real-time tests to determine its performance. The results obtained from this study are compared to results from other prosthetic arms including the Utah Arm by motion control Inc, Boston Elbow, and the CINVESTAV-IPN. The prototype weighing 800g is capable of active elbow flexion and extension and wrist Prono-supination this confirmed and supported the fact that the proposed fabricated model is a useful step to achieving affordable prostheses with this approach. These results are in line with the World Health Organization’s standard for prosthetics and orthotics and they showed that the design could be a good solution due to the physical characteristics and the kinematic of the system.

MEFFNet: Forecasting Myoelectric Indices of Muscle Fatigue in Healthy and Post-Stroke During Voluntary and FES-Induced Dynamic Contractions.

Myoelectric indices forecasting is important for muscle fatigue monitoring in wearable technologies, adaptive control of assistive devices like exoskeletons and prostheses, functional electrical stimulation (FES)-based Neuroprostheses, and more. Non-stationary temporal development of these indices in dynamic contractions makes forecasting difficult. This study aims at incorporating transfer learning into a deep learning model, Myoelectric Fatigue Forecasting Network (MEFFNet), to forecast myoelectric indices of fatigue (both time and frequency domain) obtained during voluntary and FES-induced dynamic contractions in healthy and post-stroke subjects respectively. Different state-of-the-art deep learning models along with the novel MEFFNet architecture were tested on myoelectric indices of fatigue obtained during [Formula: see text] voluntary elbow flexion and extension with four different weights (1 kg, 2 kg, 3 kg, and 4 kg) in sixteen healthy subjects, and [Formula: see text] FES-induced elbow flexion in sixteen healthy and seventeen post-stroke subjects under three different stimulation patterns (customized rectangular, trapezoidal, and muscle synergy-based). A version of MEFFNet, named as pretrained MEFFNet, was trained on a dataset of sixty thousand synthetic time series to transfer its learning on real time series of myoelectric indices of fatigue. The pretrained MEFFNet could forecast up to 22.62 seconds, 60 timesteps, in future with a mean absolute percentage error of 15.99 ± 6.48% in voluntary and 11.93 ± 4.77% in FES-induced contractions, outperforming the MEFFNet and other models under consideration. The results suggest combining the proposed model with wearable technology, prosthetics, robotics, stimulation devices, etc. to improve performance. Transfer learning in time series forecasting has potential to improve wearable sensor predictions.

Effects of aerobic exercise during recovery from eccentric contraction on muscular performance, oxidative stress and inflammation

This study investigated the effects of aerobic exercise during recovery from eccentric contraction (EC) on muscular performance, oxidative stress, and inflammation. Nineteen male subjects between 18 and 29 years were divided into unexercised (control, n = 9) and exercised (n = 10) groups. Initially, the subjects performed EC as 3 sets until exhaustion with elbow flexion and extension on the Scott bench at 80% in 1RM, followed by four aerobic exercise sessions. The results obtained indicated (p > 0.05) that aerobic physical exercise during the recovery period does not improve muscle performance (isometric strength and muscular fatigue), oxidative stress parameters (lipid peroxidation, protein oxidation and antioxidant enzyme activity), and inflammatory cytokines (IL-1β, TNF-α, IL-10). In conclusion, the aerobic exercise during the recovery period does not alter the parameters of performance, oxidative stress and inflammation induced by the EC.

Multimodal ultrasound evaluation of asymptomatic ulnar nerve dislocation at the cubital tunnel.

Ultrasonography has received broad acceptance as an effective peripheral nervous imaging examination. Shear wave elastography (SWE) can quantitatively assess the stiffness of nerves; however, little research has been conducted on elastography for ulnar nerve dislocation. The purpose of this study was thus to investigate the characteristics of multimodal ultrasound, including high-resolution ultrasonography and SWE, for asymptomatic ulnar nerve dislocation at cubital tunnel. In this prospective cross-sectional study, 41 participants were recruited in Shandong Provincial Hospital Affiliated to Shandong First Medical University in July 2022. The inclusion criteria for participants were being in good health and being 18-60 years of age. Meanwhile, the exclusion criterion was a history of upper limb pain or fractures, peripheral neuropathy, or systemic or immunological diseases. Finally, 38 participants were enrolled. Two ultrasound doctors measured the maximum diameter, the maximum cross-sectional area (CSA), and the shear modulus of the ulnar nerve at the cubital tunnel independently. Another two ultrasound doctors determined whether dislocation was present during dynamic elbow flexion and extension and divided the elbows into a dislocation group and a control group. The descriptive statistics and independent sample t-test were used for data analysis, and intragroup correlation coefficient (ICC) was used to determine the consistency of evaluation between observers. Ulnar nerve dislocation was observed in 15.8% (12/76) of the ulnar nerves. There was no significant difference in the maximum diameter between the dislocation group (0.194±0.022 cm) and the control group (0.181±0.023 cm) (t=1.888; P=0.063). The CSA and SWE of the ulnar nerve were 0.064±0.009 cm2 and 43.629±6.737 kPa in the dislocation group, respectively, and were 0.050±0.008 cm2 and 31.293±7.858 kPa in the control group, respectively. There were significant differences between the two groups in terms of CSA (P<0.001) and SWE (P<0.001). The ICCs of the maximum diameter, CSA, and SWE values between observers were 0.970, 0.900, and 0.915, respectively. Multimodal ultrasound consisting of high-resolution ultrasonography combined with elastography can comprehensively and quantitatively evaluate the morphological changes and mechanical properties of the dislocated ulnar nerve and monitor disease progress.

Single Bone Intramedullary Fixation of the Radius in Pediatric Both Bone Forearm Fractures Using Straight Stainless Steel Kirschner Wire: A Cross-sectional Study on Radiological and Clinical Feature.

We aimed to report radiological and clinical features of single bone intramedullary fixation of the radius in pediatric both bone forearm fractures using straight stainless steel Kirschner (K) wire. Fifty-eight children (42 boys and 16 girls) referred to our hospital with both bone diaphyseal forearm fractures were operated on by using the single bone rigid K-wire intramedullary fixation and mini-open technique. The mean follow-up time was 8.9 months (6-12). The mean age of the patients was 7.4 years (4-12). More than 2/3 of the fractures were in the right hand. Around 63% of the fractures were in the middle third, 28% in the distal third, and 9% in the proximal third. Moreover, 12% were open type I Gustilo-Anderson fractures. The mean time from injury to surgery was two days (1-4), and the mean length of hospital stay was 2.8 days (2-5). The mean duration of surgery was 24.7 minutes (18-38), and the mean follow-up time was 8.9 months (6-12). All fractures united within 4-16 weeks (mean: 7.62). The cast and implant were removed simultaneously as the radiographic fracture union. There was no serious complication. Superficial infection of the pin track and loosening of the pin occurred in three cases (5%), all controlled by antibiotics and timely removal of the pins. Mild restriction of elbow extension (less than 20 degrees) was observed in three cases, which returned to normal at the last follow-up. Limitation of dorsiflexion of the wrist by more than 20° occurred in two patients (35° and 45°), which reverted to 25° and 25°, respectively, at the last follow-up. In both bone forearm fractures in children, open reduction and internal fixation of only the radius with a stainless steel straight Kirschner wire could be a promising method with good results. This retrograde technique of intramedullary fixation is a simple and cost-effective method with minimal complications and acceptable outcomes in children aged 4-12 years.

Bony encasement of the ulnar nerve secondary to heterotopic ossification of the elbow: an evaluation of long-term outcomes

BackgroundUlnar neuropathy at the elbow caused by heterotopic ossification (HO) is a rare condition. This retrospective study aims to report on 32 consecutive cases of ulnar nerve encasement caused by elbow HO and evaluate long-term outcomes of operative management and a standardized postoperative rehabilitation regimen. MethodsA retrospective case series was conducted on 32 elbows (27 patients) that underwent operative management of bony ulnar nerve encasement. All procedures were performed in the inpatient setting at an Academic Level 1 Trauma Center from September 1999 to July 2021 by one of three fellowship-trained shoulder and elbow. Postoperatively, all patients received formal physical therapy, heterotopic ossification prophylaxis (30 received indomethacin, 2 received radiation), and a structured continuous passive motion machine regimen. Patient demographics, age, gender, type of injury, history of tobacco use, and medical comorbidities were obtained to include in the analysis. Long-term follow-up examinations were performed to evaluate elbow flexion-extension arc of motion, Mayo Elbow Performance Scores (MEPS), and visual analog scale (VAS) pain scores. ResultsThirty-two elbows with complete bony ulnar nerve encasement secondary to HO were identified (14 from burns, 15 from trauma, 3 closed head injuries). Following surgery, the mean flexion-extension arc of motion improved significantly, increasing from 21° to 100° at long-term follow-up (average 8.7 years, range 2-17 years), with statistically significant improvements in preoperative versus long-term postoperative elbow extension (p < 0.001), flexion (p < 0.001), and total arc of motion (p < 0.001). There was a statistically significant improvement in pre- vs. post-procedure ulnar nerve function, as demonstrated by a decrease in average McGowan grade (1.2 to 0.7; p = 0.002). Additionally, 63% of patients with preoperative ulnar neuropathy symptoms (20/32) had either complete resolution or subjective improvement after surgery. The mean time from injury to surgery was 518 days (range 65-943 days). Age, gender, time to surgery, and medical co-morbidities were not associated with outcomes. The complication rate was 9% (3/32). Patients had an average flexion-extension arc of motion of 97 degrees and average MEPS of 80 (“good”) at long-term follow-up. ConclusionsThe combination of operative management, postoperative heterotopic ossification prophylaxis, and a regimented rehabilitation program has proven to be a durable solution for treating and ensuring good long-term functional outcomes for patients with elbow HO and bony ulnar nerve encasement. This treatment approach leads to superior range of motion, improved or resolved ulnar neuropathy, and good to excellent long-term functional outcomes.

Anconeus Muscle Transfer to Correct or Prevent Wrist Radial Deviation in Radial and Posterior Interosseous Nerve Injuries

Wrist radial deviation is a possible complication of tendon transfer for restoration of wrist extension in cases of radial nerve paralysis. In posterior interosseous nerve (PIN) injury, this is because of the imbalance caused by the intact extensor carpi radialis longus and paralysis of the extensor carpi ulnaris (ECU). This deformity may also occur following transfer of the pronator teres (PT) to the extensor carpi radialis brevis (ECRB) for radial nerve palsy. To address wrist radial deviation, we propose transferring the anconeus muscle, extended by the intermuscular septum between the ECU and the flexor carpi ulnaris (FCU), to the ECU tendon. Through an incision over the ulna, the intermuscular septum between the ECU and FCU is harvested at the level of the periosteum and left attached to the anconeus proximally. The anconeus muscle is then released from the ulna, and the intramuscular septum extension is sutured to the ECU tendon under maximal tension. Anconeus muscle transfer was performed on two patients to correct chronic wrist radial deviation following PT to ECRB tendon transfer for radial nerve injury, as well as on two patients with PIN paralysis. In four patients, transfer was performed in addition to standard tendon transfers for radial nerve paralysis to prevent radial wrist deviation deformity. Wrist radial deviation was corrected or prevented in all but one patient at an average follow-up of 10 months. Patients with PIN lesions and those who had anconeus transfer concomitantly with radial nerve tendon transfers were capable of active ulnar deviation. No patient experienced elbow extension weakness, pain, or instability. Anconeus muscle transfer extended by intermuscular septum presents a viable alternative for addressing radial deviation of the wrist in cases of PIN nerve lesions or following PT to ECRB tendon transfer in radial nerve paralysis. Therapeutic V.

The influence of range of motion on the functional and structural capacity of the triceps brachii—an experimental study with electromyography

&lt;p&gt;Range of motion in exercises is one of the foundations for greater activation of a muscle group. The objective of this investigation was to compare the structural and functional capacity of the triceps brachii between three groups with different angles (90°, 110°, and 130°) in a unilateral elbow extension exercise. The sample consisted of 25 subjects with a mean age of 24.12 ± 3.83 years, mean height of 1.78 ± 0.10 m and mean body weight of 78.01 ± 15.70 kg. The following variables were collected pre- and post-intervention: triceps brachii circumference, one repetition maximum, and electromyography during dynamic exercise. Over eight weeks, subjects performed this exercise, performing 3 sets of 12 repetitions for each arm, with days of rest in between. The results showed that the 110° angle provided greater muscle activation compared to the other angles. There was no difference between the triceps brachii circumference and the root mean square (RMS) between the groups. It was concluded that, although the 110° angle showed a tendency for greater muscle activation, the RMS and arm perimeter data did not show significant differences between all the angles evaluated (90°, 110°, 130°).&lt;/p&gt;

Early detection and rehabilitation in Erb-Duchenne paralysis before age 1 year: A Case Report From Lusaka Zambia

Erb-Duchenne paralysis is a neurological condition characterized by paralysis of the arm which occurs due to injury of the upper trunk of C5-C6 of the brachial plexus and can lead to disturbances in movement and sensation. Erb-Duchenne paralysis commonly presents with a “Waiter’s Tip” deformity characterized by elbow extension, medial rotation of the arm, forearm pronation, and wrist flexion. Management of Erb-Duchenne paralysis may involve strengthening exercises, range of motion exercises, manual therapy, and neuromuscular electrical stimulation. However, in most cases, the diagnosis of Erb-Duchenne paralysis is not detected early enough for rehabilitation outcomes to be maximized. We herein report a case of a 6-months old child who had Erb-Duchenne paralysis in the left upper limb. The aim of this case report is to highlight the importance of early detection and rehabilitation of Erb-Duchenne paralysis. Furthermore, the report also discusses the physiotherapy techniques that can be used to optimize outcomes.

Muscle Strength Enhancement and Metabolic Acceleration of College Students in Traditional Archery Programs Based on Functional Training

Abstract At the present stage, the evaluation of human motor function is mainly semi-quantitative, which only evaluates the overall motor function from the degree of joint mobility and muscle status, but the size of muscle strength cannot be obtained by direct measurement. In this paper, we take the muscle activation degree and joint angle of college students in traditional archery programs based on “functional training” as the experimental objects and establish a muscle strength prediction model based on a generalized dynamic fuzzy neural network (GD-FNN). By analyzing the relationship between the surface electromyographic signals and muscle strength under elbow flexion and extension, we selected suitable parameters as the sample data of the fuzzy neural network and proposed a learning algorithm based on the variable sliding window of the GD-FNN. The predicted muscle force was compared with the desired muscle force of the main flexion and extension muscles through the subjects’ elbow flexion exercise and extension exercise. The normalized root-mean-square error between the predicted and actual muscle strength of the algorithm in this paper is less than 0.2. Compared with the maximal strength test, the peak extensor moments (right) and peak extensor moments (left) of the college athletes before and after the functional training, the mean values increased by 30.6 N.m and 42.39 N.m, respectively. Compared with the metabolism of the students during the ordinary training of 2.74 met based on the “functional training” of traditional archery increased, students’ metabolism to 5.03 met. It shows that functional training is favorable to the muscle strength of traditional archery college students and has a positive effect on the metabolic capacity of the body.

Modeling and Causality Analysis of Human Sensorimotor Control System Based on NVAR Method

Article Modeling and Causality Analysis of Human Sensorimotor Control System Based on NVAR Method Jiyu Tan 1,2, Yurong Li 1,2,*, Qiurong Xie 3, and Xiaoling Wang 3 1 College of Electrical Engineering and Automation, Fuzhou University, Fuzhou 350108, China 2 Fujian Key Lab of Medical Instrument and Pharmaceutical Technology, Fuzhou University, Fuzhou 350116, China 3 College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China * Correspondence: liyurong@fzu.edu.cn Received: 2 September 2023 Accepted: 19 October 2023 Published: 21 December 2023 Abstract: Neuromuscular disorders (such as stroke and spinal cord injuries) can lead to nerve damage that profoundly affects a patient's ability to control limb movements. Analyzing and modeling the human sensorimotor control system can establish a neurophysiological foundation for both fundamental research and clinical rehabilitation assessment. Electroencephalogram (EEG) signals provide insights into how the cerebral cortex regulates limb movements, while electromyogram (EMG) signals reveal how muscles respond to motor commands. Utilizing these signals, cortical-muscular models can be developed to facilitate the quantification and assessment of the human sensorimotor control system. This study proposes a method based on the nonlinear vector autoregression model and coiflets wavelet packet decomposition to perform multivariate time-frequency Granger causality analysis. The objective of this analysis is to compute the cortical-muscular causality matrix during elbow extension in stroke patients and construct a cortical-muscular causal network. The result reveals a frequency-dependent directed information flow pattern in the cortical-muscle causality matrix during elbow extension. Specifically, the GC values of EEG→EMG (down) and EMG→EEG (up) in the alpha and beta bands are significantly higher than those in the gamma band. The cortical-muscular causal network of stroke patients does not have small-world properties. The result indicates that the proposed method is able to characterize functional connections of brain myoelectric synchronization in different frequency bands within the time-frequency domain. It also uncovers the causal association that inherently exists in the human sensorimotor control system, providing a theoretical basis for further evaluation and quantification of the human sensorimotor control system.

Impact of Timing of Primary Nerve Surgery on Shoulder, Forearm, and Elbow Recovery in Neonatal Brachial Plexus Palsy

BACKGROUND AND OBJECTIVES: Neonatal brachial plexus palsy (NBPP) almost universally affects movement at the shoulder, elbow, and forearm. Timing of nerve reconstruction surgery to optimize long-term outcomes remains unknown. This study aimed to determine if timing of nerve reconstruction affects long-term recovery of an active range of motion (AROM) at the shoulder, elbow, and forearm in NBPP. METHODS: We interrogated a prospectively collected database of all patients with NBPP who underwent primary nerve surgery at a single tertiary referral center between 2005 and 2020. The cohort was divided into those who underwent surgery at ≤6 or &gt;6 months old and ≤9 or &gt;9 months old. AROM for shoulder abduction, forward flexion, and external rotation, elbow flexion and extension, and forearm supination were collected at each visit. RESULTS: Ninety-nine children were included in the analysis; 28 underwent surgery at ≤6 months old, 71 at &gt;6 months, 74 at ≤9 months, and 25 at &gt;9 months. There was no difference in AROM at 5 years for any of the movements between the ≤6- and &gt;6-month groups. The ≤9-month group had significantly better shoulder forward flexion and elbow extension AROM than the &gt;9-month group at a 5-year follow-up and better forearm supination at up to a 15-year follow-up. Patients who presented earlier were more likely to have earlier operations. CONCLUSION: Surgery before 9 months may improve long-term upper extremity recovery in NBPP. Early referral should be encouraged to optimize timing of operative intervention.

EEG sensor driven assistive device for elbow and finger rehabilitation using deep learning

In today's world, a large number of people suffer from motor impairment-related challenges. Rehabilitation is the main method used to overcome these difficulties. The goal of the paper is to develop a deep learning-based electroencephalogram (EEG) sensor-controlled assistive device for the rehabilitation of elbow and finger movements. We have introduced an innovative finger and elbow movement rehabilitation method using an EEG sensor. The EEG sensor's recorded EEG signals, attention values, and meditation values have been used for this purpose. This rehabilitation technique helps a person perform basic finger movement rehabilitation motions, such as finger extension and flexion. Also, basic elbow movement rehabilitation exercises, i.e., elbow extension and elbow flexion, can be performed by using this rehabilitation technique. In this research, an EEG sensor records the prefrontal lobe’s EEG signals, attention value, and meditation value of a person while the person performs motor imagery. A deep learning-based CNN-TLSTM (Convolution Neural Network-tanh Long Short-Term Memory) model with attention mechanism has been designed for decoding the EEG sensor recorded data. The trained deep learning model decides the course of action of the rehabilitation device. The designed model achieves an accuracy of 99.6%. A working prototype model of the rehabilitation device has been developed, and the overall success rate of the model is found to be 98.66%. The novelty of the paper lies in i) designing an attention-based CNN-TLSTM model for motor imagery classification and ii) developing a low-cost EEG sensor-driven rehabilitation device for finger and elbow movement rehabilitation.

Reliability and validity of modified upper limb neurodynamic tests in patients with cervical radiculopathy.

Neurodynamic Tests (NDTs) are used to assess neural mechanosensitivity in various conditions such as neural sliding, tension or inflammatory dysfunction. But in some upper quadrant dysfunctions, standard testing procedure of NDT cannot be assessed or tolerated by patient. The purpose of the study was to determine the validity, intra-rater and inter-rater reliability of modified NDTs via median and ulnar nerve in patients with cervical radiculopathy. Thirty-three patients (18 men and 15 women, mean age ± SD ) with cervical radiculopathy having positive response to standard NDTs were included in the study. Modified neurodynamic tests for median & ulnar nerve were performed with modification in the sequencing of standard neurodynamic test at lower degrees of glenohumeral abduction and external rotation. Outcome measures used were angle of elbow extension for median nerve and angle elbow flexion for ulnar nerve at the point of pain onset indicated by "OP" (Onset of Pain). Reliability of OP was evaluated using measurement of Intra-class Correlation Coefficient (ICC), Standard Error of Measurement (SEM) and Minimal Detectable Change (MDC) values. Results indicated high ICC values and low SEM values for OP during modified median and modified ulnar NDTs (M-MNT1 and M-UNT) on symptomatic side of patients with cervical radiculopathy. Spearman correlation analysis for validity of test score showed strong correlation () with standard NDT. There was strong correlation between Modified NDTs and standard tests depicting good validity and substantial reliability of OP during M-MNT1 and M-UNT for positive NDT response in patients with cervical radiculopathy.

Neural mechanosensitivity findings in patients with adhesive capsulitis

BACKGOURND: The pathophysiology of adhesive capsulitis may be associated with increased neural mechanosensitivity in upper limb neurodynamic test. OBJECTIVE: To investigate the findings of neurodynamic assessment in patients with more than four month history of adhesive capsulitis. METHODS: Thirty-five patients with more than four month history of adhesive capsulitis were participated in this study. A physiotherapist performed the Upper Limb Neurodynamic test 1 procedure on the participant’s upper limb. Elbow extension range of motion at the end of the Upper Limb Neurodynamic test 1 was compared with the participant’s elbow extension at the end of Upper Limb Neurodynamic test 1 performed on the opposite upper limb and to elbow extension on the symptomatic side performed with the arm by the side. RESULTS: The intensity of pain in Upper Limb Neurodynamic test 1 increased with lateral flexion of the neck to the unaffected side and eased with lateral flexion to the affected side in all participants. A marked restriction of the elbow passive extension range of motion in Upper Limb Neurodynamic test 1 on the affected side (–54.6±17.8°) compared to the unaffected side was found (–7.3±10.7°) (p &lt; 0.001). CONCLUSIONS: Restriction of elbow passive extension range of motion at the end of the Upper Limb Neurodynamic 1 test reproduced patients’ familiar adhesive capsulitis associated pain and the pain changed with structural differentiation using cervical lateral flexion. Neurodynamic assessment may need to be considered to assess neural mechanosensitivity in patients with adhesive capsulitis.

The use of ultrasound for monitoring reduction and ulnar nerve subluxation in pediatric humeral supracondylar fractures

BackgroundTraditional treatment for displaced humeral supracondylar fractures (SCFs) in children involves closed reduction (CR) under fluoroscopic guidance, percutaneous pinning, and immobilization with a long-arm cast. This study aims to explore the viability of using radiation-free ultrasound (US) for guiding CR and tracking ulnar nerve dynamics during medial pinning, contrasting the US method with the conventional cross pinning technique. Materials and methodsWe assessed 70 children with acute displaced SCFs. The US group (n = 30) underwent US-guided reduction, whereas the traditional group (n = 40) underwent fluoroscopy-guided reduction. Both groups received percutaneous cross pinning and subsequent cast immobilization. Postoperative outcomes were compared between the two methods after a 6-month follow-up. In the US group, ultrasonography assessed fracture displacement distances before and after CR. The angle at which the ulnar nerve relocated to the cubital tunnel during elbow extension was documented using real-time US monitoring during medial pinning. ResultsThe US group demonstrated improved reduction accuracy, increased range of motion, superior restoration of both Baumann and Humeroulnar angles, and a decreased incidence of malunions compared to the traditional group (all p < 0.05). The ultrasonographic measurement of fracture displacement was comparable with that of fluoroscopy (intraclass correlation coefficient > 0.90). In the US group, no ulnar nerve injury was noted, compared to 2.5 % in the traditional group, and real-time US observations revealed ulnar nerve hypermobility, with 53.3 % of patients exhibiting anterior ulnar nerve subluxation at 120° elbow flexion, 40 % at 90°, 16.7 % at 60°, and none at 30° flexion. ConclusionUltrasound is as reliable as fluoroscopy for evaluating fracture reductions. The use of intra-operative ultrasound significantly improves reduction accuracy and radiographic outcomes while reducing the risk of ulnar nerve injury.

Effectiveness of Deep Cervical Fascial Manipulation® and Sequential Yoga Poses on Pain and Function in Individuals with Mechanical Neck Pain: A Randomised Controlled Trial.

This study aimed to investigate the effect of fascial manipulation (FM) of the deep cervical fascia (DCF) and sequential yoga poses (SYP) on pain and function in individuals with mechanical neck pain (MNP). Following the predefined criteria, ninety-nine individuals with MNP were recruited, randomised, and assigned to either the intervention group (IG) (n = 51) or the control group (CG) (n = 48). Individuals in the IG received FM (4 sessions in 4 weeks) and the home-based SYP (4 weeks). The CG participants received their usual care (cervical mobilisation and thoracic manipulation (4 sessions in 4 weeks) along with unsupervised therapeutic exercises (4 weeks). The participants underwent baseline and weekly follow-up measurements of pain using a numerical pain rating scale (NPRS) and elbow extension range of motion (EEROM) during the upper limb neurodynamic test 1 (ULNT1). The baseline and the fourth session follow-up measurements of the patient-specific functional scale (PSFS) and fear-avoidance behavior Questionnaire (FABQ) were also taken. A repeated-measures ANOVA was performed. There were statistically significant differences between the IG and CG on the NPRS third and fourth sessions, with mean differences (MD) of -1.009 (p < 0.05) and -1.701 (p < 0.001), respectively. Regarding EEROM, there was a 20.120° difference (p < 0.001) in the fourth session between the groups. The MD in FABQ was -5.036 (p < 0.001), but there were no significant differences in PSFS between the groups during the follow-up. FM and SYP can aid in reducing pain and fear-avoidance behaviour and improve the function and extensibility of the upper quarter region.

Effect of Physiotherapy Management of the Post-Traumatic Stiff Elbow: A Case Report

23 years old female who is a student by occupation had a history of a direct fall on her right elbow and injury takes place on her left elbow. After the injury, an orthopedic surgeon and the patient wastreated conservatively. The patient came to the physiotherapy department with a chief complaint of left elbow pain with difficulty in moving the left elbow. On examination, restriction in elbow flexion and extension assortment of motion and tightness of left biceps brachii were seen. The intervention was carried out for 6 sessions per week for 6 weeks. The patient was treated with electrotherapy and exercise therapy. After 6 weeks of intervention pain was reduced (VAS score from 7 to 3), elbow extension range of motion was improved and OES was 20 to 39. This case report results suggest that physiotherapy treatment is important in reducing pain and increasing range of motion and functional ability.

Genotype-phenotype spectrum and prognosis of early-onset Marfan syndrome

BackgroundMarfan syndrome is a genetic connective tissue disorder affecting skeletal, ocular, and cardiovascular organ systems. Previous research found that pathogenic variants clustered in exons 24–32 of fibrillin-1 (FBN1) gene result in more severe clinical phenotypes. Furthermore, genotype-phenotype correlation studies suggested that more severe cardiovascular phenotypes were related to variants held responsible for haploinsufficiency. Our objective was to analyze the differences in clinical manifestations and genotypes of individuals with early-onset Marfan syndrome and to assess their impact on management strategies.MethodsWe analyzed clinical and genetic data of a new patient with early-onset Marfan syndrome together with 51 previously reported ones in the PubMed database between 1991 and 2022.ResultsAnalysis showed 94% (49/52) of pathogenic variants clustered in exons 24–32 of the FBN1. The most common skeletal features were arachnodactyly (98%), reduced elbow extension (48%), pectus deformity (40%), and scoliosis (39%). Haploinsufficiency variants were reported as having poor outcome in 87.5% of the cases. Among patients carrying variants that substitute a cysteine for another amino acid and those that do not change cysteine content, cardiac intervention was found to be associated with a better outcome (p = 0.035 vs. p = 0.002). Variants that create an extra cysteine residue were found to be associated with a higher risk of ectopia lentis. Additionally, children up to 36-months-old were more often reported as still alive at the time of publication compared to newborns (p < 0.01).ConclusionsOur findings have implications for prognosis, because different genotype groups and their resulting phenotype may require personalized care and management.

Ergonomic learning curves on gynecological laparoendoscopic single-site (LESS) surgery

BackgroundFew previous studies have introduced general techniques to overcome the “chopstick effect” in laparoendoscopic single-site surgery (LESS). We aim to investigate and highlight the key ergonomic methodologies for gynaecologic LESS based on the surgeon’s hands-on performance.MethodsThe first author surgeon A reviewed and analyzed the LESS procedures performed by herself and how she taught surgeon B from January 2021 to April 2022. The procedures were classified based on technical difficulty and learning periods, and the hands-on technical skills of LESS module were evaluated.ResultsSurgeon A conducted 580 LESS procedures, which were divided into the novice (n = 48) and intermediate (n = 33) periods, and the remaining cases were included in the routine period. We formed a special ergonomic LESS operating methodology: Maintain good LESS laparoscopic spatial sensation, keep hand-eye coordination, well cooperation between the main surgeon and the assistant; Experienced multiport laparoscopy surgery (MPS) skills, improve basic LESS technique: grasp, lift, transfer, place, blunt separating, coagulation and cutting. Coordination location, orientation, movements, and flexion or extension of shoulders, arms, elbow, wrist and finger joints; Maintain strength, tension and ambidexterity postures with joint and muscular efforts to control instruments. Surgeon B learned the above experiences by performing 39 LESS procedures under the guidance of surgeon A.ConclusionThis educational research sheds light on the common challenges faced in LESS and presents the importance of ergonomic hands-on performance skills in improving surgical outcomes, which could serve as a guide for future training and education in LESS.