Elbow Research Articles

An Automatic Method for Elbow Joint Recognition, Segmentation and Reconstruction.

Elbow computerized tomography (CT) scans have been widely applied for describing elbow morphology. To enhance the objectivity and efficiency of clinical diagnosis, an automatic method to recognize, segment, and reconstruct elbow joint bones is proposed in this study. The method involves three steps: initially, the humerus, ulna, and radius are automatically recognized based on the anatomical features of the elbow joint, and the prompt boxes are generated. Subsequently, elbow MedSAM is obtained through transfer learning, which accurately segments the CT images by integrating the prompt boxes. After that, hole-filling and object reclassification steps are executed to refine the mask. Finally, three-dimensional (3D) reconstruction is conducted seamlessly using the marching cube algorithm. To validate the reliability and accuracy of the method, the images were compared to the masks labeled by senior surgeons. Quantitative evaluation of segmentation results revealed median intersection over union (IoU) values of 0.963, 0.959, and 0.950 for the humerus, ulna, and radius, respectively. Additionally, the reconstructed surface errors were measured at 1.127, 1.523, and 2.062 mm, respectively. Consequently, the automatic elbow reconstruction method demonstrates promising capabilities in clinical diagnosis, preoperative planning, and intraoperative navigation for elbow joint diseases.

Effect of Forearm Supination and Pronation on Median & Ulnar Nerve Conduction Velocity Among Throwers, Archers, and Non-Athletes

ABSTRACT The distinct and specialized movements performed in different sports disciplines may significantly influence nerve performance, potentially affecting nerve responses and the overall function within the respective athletic activities. The purpose of this study is to find the effect of forearm supination and pronation across the elbow joint on ulnar and median nerve conduction velocity (NCV) in throwers, archers, and non-athletes. A total of 34 participants both male and females were recruited with a body mass index (BMI) between 18.5 and 24.9 kg/m2. Nerve conduction study (NeuroStim NS2 EMG/NCV/EP System) was used for measuring ulnar and median NCV across the elbow joint at different angles with the forearm in supination and pronation. Repeated measure analysis of variance (RMANOVA) revealed that there are statistically significant differences in mean values of forearm positions, angles, nerves and groups (p < .05). This study illuminates distinctive NCV variations across diverse athletic groups during forearm supination and pronation movements. Pronation consistently exhibited faster ulnar NCV compared to the median nerve across throwers, archers, and non-athletes, while in supination specific joint positions revealed notable differences within sports groups and nerve function.

The Future of Total Elbow Arthroplasty: A Statistical Forecast Model for Germany.

This study provides a statistical forecast for the development of total elbow arthroplasties (TEAs) in Germany until 2045. The authors used an autoregressive integrated moving average (ARIMA), Error-Trend-Seasonality (ETS), and Poisson model to forecast trends in total elbow arthroplasty based on demographic information and official procedure statistics. They predict a significant increase in total elbow joint replacements, with a higher prevalence among women than men. Comprehensive national data provided by the Federal Statistical Office of Germany (Statistisches Bundesamt) were used to quantify TEA's total number and incidence rates. Poisson regression, exponential smoothing with Error-Trend-Seasonality, and autoregressive integrated moving average models (ARIMA) were used to predict developments in the total number of surgeries until 2045. Overall, the number of TEAs is projected to increase continuously from 2021 to 2045. This will result in a total number of 982 (TEAs) in 2045 of mostly elderly patients above 80 years. Notably, female patients will receive TEAs 7.5 times more often than men. This is likely influenced by demographic and societal factors such as an ageing population, changes in healthcare access and utilization, and advancements in medical technology. Our projection emphasises the necessity for continuous improvements in surgical training, implant development, and rehabilitation protocols.

Rehabilitation and quality of life of patients after arthroplasty for malignant bone tumors of the upper limb

Arthroplasty is the most widely used surgical technique for bone tumors of the upper limbs. However, it should be noted that the functional outcomes after endoprosthetic reconstruction for malignant bone tumors of the upper limb does not always satisfy patients and often lead to impaired working capacity of patients, and their disability. The need to improve functional outcomes determines the practical and socio-economic significance of the research. The purpose of the study was to evaluate the impact of a complex of rehabilitation measures on the quality of life of patients after surgery with endoprosthetic reconstruction for malignant bone tumors of the upper limb. Material and Methods. The treatment and rehabilitation outcomes in 146 patients were analyzed. There were 88 (60 %) men and 58 (40 %) women with an average age of 47 years (range, 19–75 years). The tumor was localized in the proximal humerus in 98 (67 %) patients, in the diaphysis in 18 (12 %), in bones that make up the elbow joint in 16 (11 %) and in the distal radius in 14 (9.6 %) patients. Results. Our rehabilitation technique improved functional outcomes after endoprosthetic reconstruction for all tumor localizations. The musculoskeletal Tumor Society (MSTS) score was improved by 10 % (75 vs 65 %) for arthroplasty of the shoulder joint, for the wrist joint by 8 (80 vs 72 %). The rehabilitation technique allowed significant improvement of MSTS score for arthroplasty of the humeral diaphysis and bones making up the elbow joint (from 76 to 95 % and from 68 to 82 %, respectively). Conclusion. Rehabilitation measures play an important role in optimizing quality of life of patients after surgical treatment of bone tumors of the upper limb with arthroplasty, helping to improve functional outcomes.

Predicting Forces in the Components of the Human Upper Limb through Multibody Dynamics and Optimization Techniques

Abstract An accurate model of the human upper limb is crucial for various applications, including prosthetic development, optimizing ergonomics, and rehabilitation. The novelty of this research is to obtain a model that predicts the forces of muscles, ligaments, and joint reactions under any loading conditions, thereby enabling the prediction of musculoskeletal forces during different daily activities. For this, a multibody three-dimensional dynamic model of the human upper limb is presented to study the upper limb musculoskeletal system. The model comprises 35 muscle elements, 11 ligaments, and 7 joints. Thirty equations of motion with 73 unknowns were obtained using Newton’s second law of motion. The Ariel Performance Analysis System (APAS) was utilized to record and analyze the motion of 16 bony landmarks using 8 digital video cameras with a sampling rate of 100 frames per second. The genetic algorithm (GA) and particle swarm optimization (PSO) are used to solve the redundant force problem of the model. The GA and PSO are implemented with two distinct objective functions; the first is the sum of the squared muscles’ stresses. The second one is the sum of the muscles’ energy consumption. The model was validated through EMG recordings of eight superficial muscles and with the available data in the literature. The results show that the inclusion of the ligaments at the GH and elbow joints in addition to the trapezoid and conoid ligaments in the model led to a more precise prediction of the muscles’ force. The PSO shows more accuracy and smoothness of the predicted muscles’ force, despite the GA taking more running time and requiring significant memory resources. The model also revealed that there is no great difference in the predicted muscles’ force when using any of the two cost functions.

Enhanced nerve function recovery in radial nerve palsy patients with humerus shaft fracture: a randomized study of low-frequency pulse electrical stimulation combined with exercise therapy.

To evaluate the effect of low-frequency pulse electrical stimulation plus exercise therapy on nerve function recovery in patients with radial nerve palsy after humerus shaft fracture. A total of 110 patients with humerus shaft fracture and radial nerve injury admitted to our hospital from January 2017 to December 2021 were recruited. They were randomized to receive either conventional exercise therapy (control group) or conventional exercise therapy plus low-frequency pulse electrical stimulation (study group) according to the random number table method, with 55 cases in each. Clinical efficacy, muscle strength recovery, nerve conduction velocity (MCV), amplitude, wrist joint, and elbow joint activities of patients were analyzed and compared. Patients with low frequency stimulation (LFS) showed significantly higher treatment effectiveness (89.09%) than those with exercise therapy only (69.09%). The incorporation of LFS with exercise therapy provided more enhancement in the muscle strength of wrist extensor and total finger extensor in patients when compared with a mere exercise intervention, suggesting better muscle function recovery of patients produced by LFS. Moreover, a significant increase in MCV and its amplitude was observed in all included patients, among which those receiving LFS showed a greater escalation of MCV and its amplitude. Following a treatment duration of 6 months, more patients in the LFS cohort were reported to achieve a wrist extension and elbow extension with an angle over 45° than the controls. There was no notable variance in adverse responses noted between the two patient groups. In patients afflicted with humerus shaft fracture and radial nerve injury, the amalgamation of exercise therapy with low-frequency pulse electrical stimulation can significantly improve clinical efficacy, promote nerve function, and muscle strength recovery, and features a high safety profile. The combination of exercise therapy and low-frequency pulsed electrical stimulation can notably improve the promotion of neurologic function and muscle strength recovery in patients with humerus shaft fractures and radial nerve injuries with a high degree of safety.Clinical trial registration:https://www.researchregistry.com, identifier researchregistry9461.

Long-Term Effect of Intra-Articular Adipose-Derived Stromal Vascular Fraction and Platelet-Rich Plasma in Dogs with Elbow Joint Disease-A Pilot Study.

(1) Background: The aim of the current pilot study was to describe the long-term effects of a single intra-articular injection of autologous stromal vascular fraction (SVF) with platelet-rich plasma (PRP) in dogs with confirmed elbow OA, using orthopedic lameness scoring and kinetic and kinematic gait analysis. For comparison of normal long-term variation of gait over time, a group of healthy control dogs (CDs) was also evaluated. (2) Methods: A prospective longitudinal clinical pilot study investigating 19 client-owned dogs with elbow OA (OADs) treated with SVF and PRP and eight CDs not receiving treatment. The OAD and CD groups were evaluated before and after 6 and at least 12 months following treatment with SVF and PRP (OAD group) and twice with a six-month interval (CD group), respectively, through orthopedic examinations, goniometry, and kinetic and kinematic analyses (seven variables). (3) Results: The OAD had an increase in fore-hind peak force symmetry ≥12 months after treatment (p < 0.05), but no other objective variables changed over time. Orthopedic consensus scores had improved at ≥six months follow-up evaluation (p < 0.05). None of the investigated gait variables had changed at ≥six months follow-up evaluation in the CD group. (4) Conclusions: The current study could not confirm a significant benefit from SVF and PRP treatment in OADs, but future studies should be conducted in order to fully evaluate the potential of the treatment. The improvement seen in fore-hindlimb symmetry may represent an improvement in gait or an incidental finding.

Machine Learning Approaches for Stroke Risk Prediction: Findings from the Suita Study.

Stroke constitutes a significant public health concern due to its impact on mortality and morbidity. This study investigates the utility of machine learning algorithms in predicting stroke and identifying key risk factors using data from the Suita study, comprising 7389 participants and 53 variables. Initially, unsupervised k-prototype clustering categorized participants into risk clusters, while five supervised models including Logistic Regression (LR), Random Forest (RF), Support Vector Machine (SVM), Extreme Gradient Boosting (XGBoost), and Light Gradient Boosted Machine (LightGBM) were employed to predict stroke outcomes. Stroke incidence disparities among identified risk clusters using the unsupervised k-prototype clustering method are substantial, according to the findings. Supervised learning, particularly RF, was a preferable option because of the higher levels of performance metrics. The Shapley Additive Explanations (SHAP) method identified age, systolic blood pressure, hypertension, estimated glomerular filtration rate, metabolic syndrome, and blood glucose level as key predictors of stroke, aligning with findings from the unsupervised clustering approach in high-risk groups. Additionally, previously unidentified risk factors such as elbow joint thickness, fructosamine, hemoglobin, and calcium level demonstrate potential for stroke prediction. In conclusion, machine learning facilitated accurate stroke risk predictions and highlighted potential biomarkers, offering a data-driven framework for risk assessment and biomarker discovery.

Assessing the need for improving tactics of surgical treatment in patients with elbow joint contractures (retrospective clinical study)

Objective: based on the analysis of the results of surgical treatment of patients with elbow contractures caused by ossification, assess the need to improve the planning and tactics of surgical interventions. Material and methods. According to the data of the primary medical documentation and a questionnaire, a retrospective analysis of the invasiveness of surgical intervention and the results of surgical treatment was performed, 406 patients of this category in the National Medical Research Center of Traumatology and Orthopedics n. a. R. R. Vreden in 2011-2021. Results. The development of late postoperative complications was characteristic of the overwhelming (about 80%) number of patients surveyed. The dominant (54.9%) complications were post-rehabilitation long-term pain and lack of movement in the operated joint. About 35% of patients rated the functional state of the operated elbow joint as satisfactory and poor. Approximately 30% of patients rated their general condition and quality of life below the average normal values. Conclusion. The existing technique of preoperative examination, planning and performing surgery for elbow contractures caused by ossification needs to be improved, since in about a third of patients it does not allow achieving stable results and does not provide a full volume of painless movements in the elbow joint in the medium and long-term observation periods.

Перелом шийки променевої кістки в дітей: клініка, діагностика, методи лікування

Radial neck fractures are most common in children aged 8 to 11 years, accounting for 5% to 10% of all fractures of the bones that make up the elbow joint and up to 1% of all fractures in the pediatric population. Most often, the injury occurs as a result of a fall on an outstretched arm in the position of extension in the elbow joint. indirect injury from the fall with emphasis on the arm straightened at the elbow joint with the forearm deflected outward, and less often due to the direct effect of a damaging effect. The most typical damage in the area of the proximal radius in children is transverse fractures of the neck, in which the plane of the fracture passes through its metaphysis. The aim is to compare the experience of treating fractures of the radial neck, to analyze the possibilities of postoperative complications based on the literature and our own observations. In children with radial neck fractures, depending on the type of displacement of bone fragments and their angulation, there are different options for repositioning, which, accordingly, provide different treatment efficiency. Treatment of radial neck fractures in the pediatric population, necessarily taking into account the type of fragment displacement, should involve starting with low-traumatic and minimally invasive closed methods, and only in cases of their failure and/or impossibility (inappropriateness) it is possible to determine the choice of indications for open surgical intervention. The results which we obtained from the application of the open reposition technique for radial neck fractures according to the Metaizo method with fixation of fragments with elastic intramedullary rods in childhood clinically, radiologically and functionally coincide with the existing modern data of literary sources. Based on this, we believe that this technique is a good option for surgical treatment of pathology, simple and reliable, with minimal possibilities of postoperative complications, even with the most significant values of angulation of bone fragments. The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. The informed consent of the patients was obtained for the research. No conflict of interests was declared by the authors.

Photogrammetric analysis of limb joint angles in cows with normal gait before and after hoof trimming

The aim of this study was to evaluate the effect of hoof trimming on overall limb movements by comparing the changes in 8 limb joint angles before and after one week of hoof trimming. Seventeen Holstein-Friesian dairy cows that were able to move freely and had no history of hoof diseases were included in the study. The cows were walked on a rubber mat with a high friction coefficient (HFM) and a low friction coefficient by the spraying of sodium polyacrylate (LFM). A high-speed camera was set to 200 fps on the image analysis software, and the images of the cows that were given 15 reflective markers on their right side were captured while walking on the test mat. The tests were conducted before and after one week of hoof trimming, and the cows were trimmed by the functional hoof trimming method. With image analysis software, video clips of walking cows were confirmed visually and tracked during one gait cycle by each reflective marker attached to the hoof of the forelimb and hindlimb, after which the stance phase and swing phase were identified. The durations of the stance phase and swing phase of the forelimb and hindlimb, respectively, and the maximum, minimum, and range of motion (ROM) values of the 8 joint angles, shoulder joint, elbow joint, carpus joint, forelimb fetlock joint, hip joint, stifle joint, hock joint and hindlimb fetlock joint during one gait cycle were included in the analysis. The maximum and minimum angles of the hip and stifle joints were narrower after hoof trimming than before, although the ROM did not change and was clearer for HFM than for LFM. It was thought that the flexion of the proximal hindlimb would progress smoothly during walking after trimming.

Preparation of CNT/CNF/PDMS/TPU Nanofiber-Based Conductive Films Based on Centrifugal Spinning Method for Strain Sensors.

Flexible conductive films are a key component of strain sensors, and their performance directly affects the overall quality of the sensor. However, existing flexible conductive films struggle to maintain high conductivity while simultaneously ensuring excellent flexibility, hydrophobicity, and corrosion resistance, thereby limiting their use in harsh environments. In this paper, a novel method is proposed to fabricate flexible conductive films via centrifugal spinning to generate thermoplastic polyurethane (TPU) nanofiber substrates by employing carbon nanotubes (CNTs) and carbon nanofibers (CNFs) as conductive fillers. These fillers are anchored to the nanofibers through ultrasonic dispersion and impregnation techniques and subsequently modified with polydimethylsiloxane (PDMS). This study focuses on the effect of different ratios of CNTs to CNFs on the film properties. Research demonstrated that at a 1:1 ratio of CNTs to CNFs, with TPU at a 20% concentration and PDMS solution at 2 wt%, the conductive films crafted from these blended fillers exhibited outstanding performance, characterized by electrical conductivity (31.4 S/m), elongation at break (217.5%), and tensile cycling stability (800 cycles at 20% strain). Furthermore, the nanofiber-based conductive films were tested by attaching them to various human body parts. The tests demonstrated that these films effectively respond to motion changes at the wrist, elbow joints, and chest cavity, underscoring their potential as core components in strain sensors.

Comparison of Myoelectric Activity Between Standing and Lying Plate Press Exercises in Recreationally-Trained Participants

The plate press is a multi-joint exercise that involves the elbow and shoulder joints and can be performed in two different body positions (lying and standing). The purpose of this study was to evaluate the myoelectric activity between two different plate press exercises (lying and standing) in recreationally-trained men. Fifteen resistance-trained men (26.7 ± 3.2 years, 83.1 ± 6.8 kg, 176.0 ± 6.4 cm) performed one set of 10 repetitions with a standard weight of 10kg for the standing and lying plate press exercises at 60 beats per minute. Surface electromyography was used to measure the myoelectric activity (integrated electromyography, iEMG) of the pectoralis major (PM), anterior deltoid (AD), triceps brachii (TB), and biceps brachii (BB). Two-way ANOVA (2 x 4) with repeated-measures was used to test differences between exercises and muscle groups (PM, AD, TB, and BB) for the iEMG values. There were significant differences between exercises for AD (Standing &gt; Lying: 41.7\%, p=0.05), TB (Lying &gt; Standing: 51.4\%, p=0.047), and BB (Standing &gt; Lying: 54.6\%, p=0.001). In the comparison between muscle groups, TB presented the lowest myoelectric activation for the standing plate press exercise (57.6\%, p&lt;0.05) and BB presented the lowest myoelectric activation for the lying plate press exercise (48.1\%, p&lt;0.05). In conclusion, the lying plate press exercise showed a greater myoelectric activation of the TB and the standing plate press exercise showed greater myoelectric activation of the AD and BB. PM showed high myoelectric activation in both exercises but with no difference between exercises.

Ilizarov technique for treating elbow stiffness caused by myositis ossificans: A case report

BACKGROUND Myositis ossificans (MO) is a rare disease involving the formation of bone outside the musculoskeletal system. While surgical intervention is the main treatment approach, preventing recurrence and standardized rehabilitation are also crucial. Here, we present a surgical strategy to prevent the recurrence of MO. CASE SUMMARY A 28-year-old female patient was admitted for the first time for a comminuted fracture of the left olecranon. However, incorrect postoperative rehabilitation resulted in the development of elbow joint stiffness with ectopic ossification, causing a loss of normal range of motion. The patient was diagnosed with MO based on physical examination, X-ray findings, and clinical presentation. We devised a surgical strategy to remove MO, followed by fixation with an Ilizarov frame, and implemented a scientifically reasonable rehabilitation plan. The surgery lasted for 3 h with an estimated blood loss of 45 mL. A drainage tube was placed after surgery, and fluid was aspirated through ultrasound-guided puncture. The patient experienced a significant reduction in joint stiffness after surgery. In the final follow-up at 9 mouths, there was evident improvement in the range of motion of the elbow joint, and no other symptoms were reported. CONCLUSION The Ilizarov frame is an advantageous surgical technique for facilitating rehabilitation after MO removal. It offers benefits such as passive recovery, individualized treatment, and prompt recovery.

Efficacy of low molecular weight hyaluronic acid (500–730 kDa) in post-traumatic pathology of periarticular soft tissues at different sites: data from an open-label pilot clinical study

Local injection therapy (LIT) with hyaluronic acid (HA) medications is one of the most promising methods for the treatment of periarticular soft tissue pathology (PASTP) caused by injury or overuse. Objective: to evaluate the efficacy and safety of LIT with HA medication with a molecular weight of 500–730 kDa in patients with various post-traumatic PASTP. Material and methods. The study included 30 patients with rotator cuff syndrome (RCS), lateral epicondylitis (LE) and plantar fasciitis (PF) after trauma. Inclusion criteria were the presence of moderate/severe pain (≥40 mm on a visual analogue scale (VAS)) over a 3-month period and the absence of effect of LIT with glucocorticoids. All patients were administered HA peritendinously three times (7 days apart) under ultrasound guidance. Treatment results were evaluated after 1 and 3 months based on the dynamics of pain intensity (VAS) and functional indicators using the ASES (American Shoulder and Elbow Surgical Evaluation), MES (Mayo Elbow Score) and FFI (Foot Functional Index) questionnaires. Results and discussion. In the general group, there was a statistically significant decrease in pain intensity after 1 and 3 months from a mean of 57.6 ± 14.7 to 37.0 ± 14.8 and 35.0 ± 14.3 mm according to VAS respectively (p &lt; 0.05). In the patient groups with different PASTP, the average assessment of pain intensity and functional impairment at baseline and after 1 and 3 months was: for RCS (n = 11) 59.0 ± 15.1, 39.0 ± 15.7, 36.3 ± 16.2 mm according to VAS and 49.1 ± 14.3, 60.1 ± 13.7, 61.7 ± 3.8 according to ASES, respectively; with LE (n = 10) 54.0 ± 13.4, 35.0 ± 9.7, 34.0 ± 11.7 mm according to VAS and 71.5 ± 11.1, 78.3 ± 9.0, 81.5 ± 8.3 according to MES; with PF (n = 9) 61.0 ± 16.5, 36.6 ± 19.3, 34.4 ± 15.8 mm according to VAS and 47.2 ± 22.8, 39.6 ± 39.7, 39.0 ± 29.9 according to FFI. None of the patients experienced any adverse events during treatment. Conclusion. HA medication with a molecular weight of 500–730 kDa showed good efficacy and safety in LIT of PASTP of the shoulder, elbow joint and foot. Further studies are needed to evaluate the possibility of a broad use of the drug for the treatment of PASTP in real clinical practice.

A multichannel investigation of proprioceptive accuracy

Proprioceptive accuracy (PAc), i.e., the acuity of perception of the state of different parts of the motor system, shows substantial intraindividual differences, and is often considered a general ability. However, it is questionable whether there is an association between accuracies measured with different tests at different body sites. PAc with respect to both knee and elbow joints (joint position reproduction) and the flexors of the upper arms (weight discrimination) was measured in 87 young healthy individuals with regular physical activity across multiple indices. Expected and perceived performance was also assessed for each behavioral task. Frequentist and Bayesian analysis largely supported the idea that PAc with respect to various parts of the motor system are unrelated. No dominant-subdominant differences for actual performance were found; however, PAc for the dominant and subdominant limb were associated in many cases. Finally, perceived performance was related to expected but not to actual performance for all three proprioceptive modalities. In conclusion, actual accuracy of perception of the actual state of a part (i.e., joint, muscle) of the motor system cannot be generalized to other parts. Perceived accuracy, dominantly shaped by expectations, is independent from actual accuracy.

Lateral elbow magnetic resonance imaging findings in patients without pain complaints

Magnetic resonance imaging (MRI) can help evaluate lateral epicondylitis; however, abnormal findings on MRI are not always consistent with the symptoms. The occurrence of such abnormal MRI findings at the lateral side of the elbow in patients without pain remains unclear. Therefore, the purpose of this study was to investigate the MRI findings of the lateral elbow joint in patients with no complaints of pain in the elbow joint. We retrospectively identified 152 patients who had undergone MRI of the area including the elbow from July 2015 to January 2022. We excluded patients with pain in the elbow area and those with diagnosis of diseases that could affect MRI findings at the lateral elbow. The presence of lateral collateral ligament complex (LCLC) and common extensor tendon (CET) lesions on MRI was assessed by two reviewers. In total, 22 patients (12 men and 10 women) were included in the analysis. The mean age of the patients was 54 years. Five patients, all ≥65 years old, had abnormal findings related to the LCLC or CET on MRI. Abnormal LCLC and CET findings on MRI can be encountered in older patients even in the absence of elbow pain.

Musculoskeletal injuries in bodybuilders: A brief review with an emphasis on injury mechanisms

In this article we reviewed the literature on injuries and their mechanisms in bodybuilders. Bodybuilding is a weightlifting sport where the main goal is to increase muscle mass while maitaining body symmetry. From a biomechanical point of view, it is important to analyse technical performance of exercises to improve sports technique. Compound exercises based on the development of muscle hypertrophy must be included. The training is different before and during season, in pre-season it is based on reduction of body fat to a low level and a high volume of aerobic exercise. Adequate nutrition, use of supplements and banned substances are widespread in the sport. In that case athletes should be very careful for banned substances in accordance with WADA Code. The most commonly performed exercises where injuries happen are the squat, deadlift and benchpress. The majority of injuries (60 %) are acute, with 93 % shoulder joint injuries, 85 % lower back injuries and 80 % knee injuries. The incidence of injuries is low compared to other sports, between 0.24/1000 hours of training or 0.12 injuries per lifter per year. The most common type of injury is muscle strain, followed by tendinitis and cartilage wear. So it is therefore important to identify risk factors to allow the development of appropriate prevention programs. Muscle ruptures are common with high eccentric loads, with pectoralis major tendon being the most vulnerable to be injured. Than followed by a rupture of biceps femoris during the deadlift exercise, during sudden flexion of the hip joint while the knee is extended. Eccentric contraction and rupture also occurs in the quadriceps muscle, which lifters try to avoid by performing low-bar squat. Uncontrolled abdominal pressure during high-weight exercises causes discus hernias, which lifter can prevent by breathing correctly and using strong muscle stabilizers. The most well-known injury of all is elbow burzitis or »Bodybuilders elbow« due to repetitive flexion and extension movements of elbow joint. To prevent this injuries we have to include preventive measures such as medical check-ups, education of athletes, ensuring safety in competitions, appropriate training and load distribution, treating the body as a whole and regular equipment check-ups.

Safety and effectiveness of thermal radiofrequency applied to the musculocutaneous nerve for patients with spasticity.

Evaluate safety and effectiveness of thermal radiofrequency in the musculocutaneous nerve in patients with focal elbow flexor spasticity. Ambispective observational follow-up study. Patients with focal spasticity secondary to central nervous system injury with elbow flexor pattern who received thermal radiofrequency treatment in the musculocutaneous nerve between 2021 and 2023 were included. 12 patients. Ultrasound-guided thermal radiofrequency was applied to the musculocutaneous nerve at 80°C for 90 s. Effectiveness was assessed prior to thermal radiofrequency and at 6 months using scales to measure pain (VAS), spasticity (MAS), disability (DAS), quality of life (SQol-6D), patient-perceived and physician-perceived satisfaction (PIG-C, PGA), and goal attainment (GAS). Elbow joint range of motion was evaluated via goniometry. Safety was evaluated by assessing side effects. Patients had statistically significant improvements in spasticity (p = 0.003), severe elbow flexion (p = 0.02), pain (p = 0.046), functioning (p < 0.05), and spasticity-related quality of life (p < 0.05 in three sections). Furthermore, treatment goals were attained. Patient- and physician-perceived clinical improvement was achieved. Regarding side effects, two patients had dysesthesia that was self-limiting, with maximum duration of 1 month. Thermal radiofrequency in the musculocutaneous nerve can be a safe, effective treatment for patients with severe spasticity with an elbow flexor pattern.

The validation of inertial measurement units in upper limb movement during wheelchair activity

Introduction: 3D motion capture is accepted to be the gold standard approach to all data collection for the production of accurate data, however, in recent literature the ecological validity of 3D systems has come into question. This has brought about the use of Inertial measurement units (IMU’s) and the investigation into their accuracy in enabling accurate real life scenario data collection. The depth of research on IMU’s in wheelchair data collection is limited, and at current there is limited attempts at a validation in comparison to an established data collection software. This research aims to validate basic upper body motions seen within wheelchair propulsion in an attempt to identify the current limitations of IMU’s. Methods: numerous IMU placements and calibration stances were investigated for the collection of elbow flexion and shoulder flexion. IMU’s for elbow flexion were placed at the wrist and central on the forearm. For shoulder flexion the IMU was placed 1 cm above the elbow joint. During the calibration phase, standing anatomical position with thumbs forwards, palms outwards, bent elbow and straight arms outwards at 90° for elbow and shoulder flexion, respectively. For both shoulder and elbow flexion, the participant started at a neutral position and moved through to 90° of flexion and returned to starting position. Quintic was used as the validated software. Results: the wrist placed IMU determined elbow flexion more accurately than the forearm placed IMU. Range of motion for both shoulder and elbow flexion were well calculated within several degrees when using the anatomical thumbs forwards calibration pose; with 99.97 and 89.69°, respectively compared to 88.48 and 97.32°. However, the degree of elbow flexion was overestimated with a difference of 27.78°, with the IMU being 91.11° and quintic being 63.33°. Similar results were also seen for the prediction of elbow flexion during the starting phase with a difference of 26.58°. Discussion: with range of motion accurately calculated in comparison to quintic, and shoulder flexion maximum and minimum values also being similar when segment angle was calculated. Then the differences are likely due to error in the calculation of joint angle using a calculation of global coordinate system from the IMU coordinate system during data processing. Therefore, future research should target alternate approaches to data processing in order to reduce the errors seen.