Flexion Force Research Articles

Leveraging Multivariable Linear Regression Analysis to Identify Patients with Anterior Cruciate Ligament Deficiency Using a Composite Index of the Knee Flexion and Muscle Force

Patients with anterior cruciate ligament (ACL) deficiency (ACLD) tend to have altered lower extremity kinematics and dynamics. Clinical diagnosis of ACLD requires more objective and convenient evaluation criteria. Twenty-five patients with ACLD before ACL reconstruction and nine healthy volunteers were recruited. Five experimental jogging data sets of each participant were collected and calculated using a musculoskeletal model. The resulting knee flexion and muscle force data were analyzed using a t-test for characteristic points, which were the time points in the gait cycle when the most significant difference between the two groups was observed. The data of the characteristic points were processed with principal component analysis to generate a composite index for multivariable linear regression. The accuracy rate of the regression model in diagnosing patients with ACLD was 81.4%. This study demonstrates that the multivariable linear regression model and composite index can be used to diagnose patients with ACLD. The composite index and characteristic points can be clinically objective and can be used to extract effective information quickly and conveniently.

Aging-induced alterations in EEG spectral power associated with graded force motor tasks.

It has been demonstrated that in young and healthy individuals, there is a strong association between the amplitude of EEG-derived motor activity-related cortical potential or EEG spectral power (ESP) and voluntary muscle force. This association suggests that the motor-related ESP may serve as an index of central nervous system function in controlling voluntary muscle activation Therefore, it may potentially be used as an objective marker to track changes in functional neuroplasticity due to neurological disorders, aging, and following rehabilitation therapies. To this end, the relationship between the band-specific ESP-combined spectral power of EEG oscillatory and aperiodic (noise) components-and voluntary elbow flexion (EF) force has been analyzed in elder and young individuals. 20 young (22.6 ± 0.87year) and 28 elderly (74.79 ± 1.37year) participants performed EF contractions at 20%, 50%, and 80% of maximum voluntary contraction (MVC) while high-density EEG signals were recorded. Both the absolute and relative ESPs were computed for the EEG frequency bands of interest. The MVC force generated by the elderly was foreseeably lower than that of the young participants. Compared to young, the elderly cohort's (1) total ESP was significantly lower for the high (80% MVC) force task; (2) relative ESP in beta band was significantly elevated for the low and moderate (20% MVC and 50% MVC) force tasks; (3) absolute ESP failed to have a positive trend with force for EEG frequency bands of interest; and (4) beta-band relative ESP did not exhibit a significant decrease with increasing force levels. As opposed to young subjects, the beta-band relative ESP in elderly did not significantly decrease with increasing EF force values. This observation suggests the use of beta-band relative ESP as a potential biomarker for age-related motor control degeneration.

Mitochondria transplant therapy improves regeneration and restoration of injured skeletal muscle.

Injection of exogenous mitochondria has been shown to improve the ischaemia-damaged myocardium, but the effect of mitochondrial transplant therapy (MTT) to restore skeletal muscle mass and function has not been tested following neuromuscular injury. Therefore, we tested the hypothesis that MTT would improve the restoration of muscle function after injury. BaCl2 was injected into the gastrocnemius muscle of one limb of 8-12-week-old C57BL/6 mice to induce damage without injury to the resident stem cells. The contralateral gastrocnemius muscle was injected with phosphate-buffered saline (PBS) and served as the non-injured intra-animal control. Mitochondria were isolated from donor mice. Donor mitochondria were suspended in PBS or PBS without mitochondria (sham treatment) and injected into the tail vein of BaCl2 injured mice 24h after the initial injury. Muscle repair was examined 7, 14 and 21days after injury. MTT did not increase systemic inflammation in mice. Muscle mass 7days following injury was 21.9±2.1% and 17.4±1.9% lower (P<0.05) in injured as compared with non-injured intra-animal control muscles in phosphate-buffered saline (PBS)- and MTT-treated animals, respectively. Maximal plantar flexor muscle force was significantly lower in injured as compared with uninjured muscles of PBS-treated (-43.4±4.2%, P<0.05) and MTT-treated mice (-47.7±7.3%, P<0.05), but the reduction in force was not different between the experimental groups. The percentage of collagen and other non-contractile tissue in histological muscle cross sections, was significantly greater in injured muscles of PBS-treated mice (33.2±0.2%) compared with MTT-treated mice (26.5±0.2%) 7days after injury. Muscle wet weight and maximal muscle force from injured MTT-treated mice had recovered to control levels by 14days after the injury. However, muscle mass and force had not improved in PBS-treated animals by 14days after injury. The non-contractile composition of the gastrocnemius muscle tissue cross sections was not different between control, repaired PBS-treated and repaired MTT-treated mice 14days after injury. By 21days following injury, PBS-treated mice had fully restored gastrocnemius muscle mass of the injured muscle to that of the uninjured muscle, although maximal plantar flexion force was still 19.4±3.7% (P<0.05) lower in injured/repaired gastrocnemius as compared with uninjured intra-animal control muscles. Our results suggest that systemic mitochondria delivery can enhance the rate of muscle regeneration and restoration of muscle function following injury.

ДИАГНОСТИКА И ЛЕЧЕНИЕ СВЕЖИХ РАЗРЫВОВ ДИСТАЛЬ-НОГО СУХОЖИЛИЯ ДВУГЛАВОЙ МЫШЦЫ ПЛЕЧА

Distal biceps ruptures occur mostly in 40–60 y. o. men during rapid elbow flexion against significant external force. Clinical examination remains the mainstay of the diagnostics of the distal biceps tendon rupture (“Popeye” deformity, ecchymosis, and hook-test), ultra-sound and MR investigations may be used in doubtful cases. Non-operative treatment leads to the decrease of flexion and external rota-tion forces, thus surgical treatment is preferable in most cases. The choice of surgical approach depends on the fixation method. Transos-seous fixation with bone tunnels and two-incision technique is valid and pro-vides low level of re-ruptures with more anatomic restoration of the insertion point, but is associated with higher rate of heterotopic ossification. Newer methods of fixation (buttons, anchors, interferential screws) may allow the sin-gle approach, but not always provide anatomic reinsertion and may lead to higher rate of complications at the site of surgical approach in the elbow crease. Functional post-operative care in majority of cases leads to the restoration of range of movements at 6 weeks, and muscle forces at 12 weeks. This usually allows full restoration of the physical activity at 3 to 6 months after the sur-gery.

Strength Assessment After Reverse Shoulder Arthroplasty

The main objective was to evaluate the anterior flexion force (AFF) and the lateral abduction force (LAF) of patients who underwent reverse shoulder arthroplasty (RSA) and to compare the measured force with that in a similar-age control group. The secondary objective was to identify prognostic factors for muscle strength recovery. Forty-two shoulders that underwent primary RSA between September 2009 and April 2020 met the inclusion criteria and were called the arthroplasty group (AG). The control group (CG) consisted of 36 patients. The mean AFF and the mean LAF were evaluated with a digital isokinetic traction dynamometer. The average AFF found in the AG was 15 N, while in the CG, the average AFF was 21 N (P < .001). The average LAF in the AG was 14 N (standard deviation [SD] 8 N), while in the CG the average LAF was of 19 N (SD 6 N) (P = .002). All prognostic factors studied in the AG showed no statistical significance: dominance (AFF 0.697/LAF 0.883), previous rotator cuff repair surgery (AFF 0.786/LAF 0.821), Hamada radiological classification (AFF 0.343/LAF 0.857), magnetic resonance imaging (MRI) pre-operative evaluation of the quality of the teres minor (AFF 0.131/LAF 0.229), suture of the subscapularis at the end of the arthroplasty procedure (AFF 0.961/LAF 0.325) and postoperative complications (AFF 0.600/LAF 0.960). The mean AFF was 15 N, and the mean LAF was 14 N. The comparison of AFF and LAF with a CG showed a 25% reduction in muscle strength. It was not possible to demonstrate prognostic factors for muscle strength recovery after RSA.

Evaluation of Various Fixation Methods in Acute Scapholunate Dissociation, A Finite Element Study.

This study aimed to compare the outcomes of fixing scapholunate with pins and screws in parallel, convergent, and divergent orientations. In this computer simulation study, the CT scan images of a healthy subject were used to construct a 3D model of the wrist joint using MIMICS software. The imposed force to scaphoid and 3D model lunate bones, as well as the scapholunate angle and distance, were compared in different surgical techniques using parallel, divergent, and convergent pins and screws. In the absence of external force, the imposed stress applied to the scaphoid and lunate bones in cases of parallel pins and screws were 7.5MPa, 5.08MPa (pins), 1.134MPa, and 1.151MPa (screws), and 10.90MPa, 10.90MPa (pins), 9.7MPa, and 34.1MPa (screws) for 50N flexion force. The imposed stress in this approach is significantly lower compared to other interventions. Better outcomes were seen regarding scapholunate angle and scapholunate distance in using parallel pins or screws as well. In conclusion, implementing parallel pins and screws for scapholunate fixation had better results in terms of achieving carpal stability in scapholunate dissociation. However, fixation with pins and screws showed a statistically significant difference. Furthermore, a wide range of motion exercises with no additional forces can be used in the rehabilitation of patients undergoing this surgery.

The Importance of Early Intervention for Penile Fracture in Forced Flexion - Report of Two Cases at Madinat Zayed Hospital

Background: A penile fracture is a urological emergency that happens when an erect penis sustains a violent trauma, resulting in a tear in the tunica albuginea of one or both corpora cavernosa.&#x0D; Case report: Case 1: A 33-year-old male patient who experienced pain, swelling, and forceful flexion of the penis. The patient reported hearing a cracking sound during masturbation. This case was identified on the basis of clinical presentation and the findings of a physical examination. The emergency surgical repair was performed with an evacuation of the hematoma.&#x0D; Case 2: A 32-year-old male patient who presented to the emergency department 20 hours after the injury with associated complaints of pain and swelling in the penis and scrotum This case was identified on the basis of clinical presentation and the findings of a physical examination. The emergency surgical repair was performed with an evacuation of the hematoma. Tunical defect closure was performed with an interrupted 3.0 vicryl suture. Additionally, the patient developed phimosis and a circumcision was performed to remove the tight fibrotic segment of the foreskin hemostasis and closed by 3.0 rapid sutures.&#x0D; Conclusion: A pre-operative urethrography or flexible cystoscopy should be considered when urethral injury is suspected. Prompt surgical intervention usually leads to satisfactory cosmetic and functional results. Early-stage intervention is required to retain penile function.

Providing specialized care to patients with a rupture of the distal tendon of the biceps brachii: diagnosis and treatment algorithm

Biceps brachii distal tendon injury is rare, 2.55–5.35 per 100,000. This nosological form did not have a gender modality and was previously found mainly in middle-aged men (46.3 y.o.). By 2022, this injury “rejuvenated” and began to occur more often, covering the categories of juniors and young athletes, whose professional activities have expanded significantly with the advent of new power disciplines, contact sports and popularization of bodybuilding. The authors note the negative impact of smoking and the use of anabolic steroids, statins and obesity on the incidence of these lesions. The maximum supination force in this type of injury is reduced by an average of 40 %, and the maximum flexion force is reduced by an average of 20 %. Considering the significance of functional disorders not only of the elbow joint, but also of motor patterns of the entire upper limb girdle for professional athletes, sports-organized people and people involved in the physical aspects of labor, surgical treatment is recommended. Nonsurgical treatment can be aimed at suppressing edema and inflammation, limiting early movements in the elbow joint and increasing secondary muscle tension, and it is suitable for patients with low functional demand, poor compliance and high risks of both surgical treatment and anesthesia care. That is, the choice of treatment tactics is still based, in addition to anatomical changes and on the “subjective” patient data, his/her needs for physical activity and requires an algorithmic approach in order to avoid both known complications and confidently predict a positive result during the prehospital period. Based on ten years of clinical and practical experience adjusted by widely available scientific periodicals, we have developed a scheme that is understandable to every specialist in the field of traumatology, orthopedics or sports medicine, and is applicable regardless of the medical institution level. For the first time, this scheme was published in this work.

Pes anserine detachment in posteromedial approach to the tibial plateau fracture provides better intraoperative exposure without compromising the flexor muscle strength.

During the posteromedial approach to the tibial plateau fracture (TPF), pes anserine is generally retracted. However, pes anserine detachment could provide a better fracture site exposure. Even so, the general conception is that the latter could negatively affect flexor muscle strength. We aimed to evaluate the effect of pes anserine detachment on the flexion force and functional outcomes of TPF with posteromedial involvement. In this retrospective-prospective cohort study, 22 TPF patients with Schatzker type IV who were managed with posteromedial approach and pes anserine detachment were included. The knee flexion force was measured 12months after the surgery at several angles of flexion (30°, 60°, and 90°) and rotations (internal and external). The International Knee Documentation Committee (IKDC) and the Knee Injury and Osteoarthritis Outcome Score (KOOS) were used to assess knee function. A visual analog scale (VAS) was used to measure knee pain. The mean strength of the knee flexor muscle was not statistically different between the involved and non-involved sides at 30°, 60°, and 90° knee flexion, and also at the internal and external rotation. The mean IKDC score of the patients was 81.6 ± 7.8. The mean KOOS score of the patients was 82.2 ± 9.1. The mean VAS for pain was 2.4 ± 1.8. The mean knee range of motion was 124 ± 10.5°. Pes anserine release and re-attachment in the posteromedial approach to the TPF has no detrimental effect on the flexion muscle strength and knee function. Therapeutic Level IV.

Comparative bone microstructure of two non-mammaliaform cynodonts from the Late Triassic (Carnian) Chañares formation of Northwestern Argentina

ABSTRACT The aim of the present contribution is to examine the bone histology of two non-mammaliaform cynodonts recovered from the Late Triassic (Carnian) Chañares Formation, at Los Chañares locality, La Rioja province, Northwestern Argentina. The taxa analysed here are the Traversodontidae Massetognathus pascuali and the Probainognathidae Probainognathus jenseni, both forms known from multiple skeletons. Our osteohistological results reveal an uninterrupted growth pattern and high intraspecific histovariability in Massetognathus. On the other hand, Probainognathus presents cyclical growth, a cortex dominated by parallel-fibred bone tissue and scarce vascularisation. In spite of being derived non-mammaliaform eucynodonts, Massetognathus and Probainognathus show high growth plasticity, a feature usually regarded as plesiomorphic for cynodonts. Both taxa show a thick cortex in the long bones, a feature that could be linked to counteract the strong flexion forces during digging.

Efficacy of Tenodermodesis Method in Chronic Mallet Finger Surgery

Objective: To report the efficacy of tenodermodesis surgery on a chronic mallet finger injury.&#x0D; Background: Mallet finger is an injury commonly emerging due to a partial or complete rupture of the extensor tendon's terminal insertion distal to the distal interphalangeal (DIP) joint. Commonly caused by a forced flexion of the DIP joint. &#x0D; Material-Method: A total of 15 patients data was investigated retrospectively. All the patients whose conservative treatment failed and underwent a mallet finger surgery with the tenodermodesis method were included. The technic was slightly modified: Sutures were applied, so they traverse the skin and tendon together after suturing the tendon and capsule.&#x0D; Results: The patients were followed up for up to 24 months. All patients had improvements in DIP joint motion. Nine patients reached a full extension of the DIP joint. According to Crawford's criteria, all the patients have no pain and had an excellent and good score after the procedure. No postop complication was reported. &#x0D; Conclusion: Tenodermodesis method a curative surgery technic with a high success outcome rate for chronic tendinous mallet finger deformity.

Electrophysiological and functional signs of Guillain–Barré syndrome predicted by a multiscale neuromuscular computational model

Objective. The diagnosis of nerve disorders in humans has relied heavily on the measurement of electrical signals from nerves or muscles in response to electrical stimuli applied at appropriate locations on the body surface. The present study investigated the demyelinating subtype of Guillain–Barré syndrome using multiscale computational model simulations to verify how demyelination of peripheral axons may affect plantar flexion torque as well as the ongoing electromyogram (EMG) during voluntary isometric or isotonic contractions. Approach. Changes in axonal conduction velocities, mimicking those found in patients with the disease at different stages, were imposed on a multiscale computational neuromusculoskeletal model to simulate subjects performing unipodal plantar flexion force and position tasks. Main results. The simulated results indicated changes in the torque signal during the early phase of the disease while performing isotonic tasks, as well as in torque variability after partial conduction block while performing both isometric and isotonic tasks. Our results also indicated changes in the root mean square values and in the power spectrum of the soleus EMG signal as well as changes in the synchronization index computed from the firing times of the active motor units. All these quantitative changes in functional indicators suggest that the adoption of such additional measurements, such as torques and ongoing EMG, could be used with advantage in the diagnosis and be relevant in providing extra information for the neurologist about the level of the disease. Significance. Our findings enrich the knowledge of the possible ways demyelination affects force generation and position control during plantarflexion. Moreover, this work extends computational neuroscience to computational neurology and shows the potential of biologically compatible neuromuscular computational models in providing relevant quantitative signs that may be useful for diagnosis in the clinic, complementing the tools traditionally used in neurological electrodiagnosis.

Robot-assisted training with functional electrical stimulation enhances lower extremity function after spinal cord injury.

Functional electrical stimulation (FES) synchronized with robot-assisted lower extremity training is used in spinal cord injury (SCI) rehabilitation to promote residual function. Data of SCI inpatients who trained lower limb mobilization on a stationary robotic system were retrospectively analyzed. The primary outcome was the improvement of muscle strength from the first through to the last training session during FES-induced as well as voluntarily induced flexion and extension. The secondary outcome was the sum score of voluntary muscle function in the lower limbs before and after the training period. Data from 72 patients with SCI (AIS A-D) were analyzed. For extension, FES-assisted strength increased (p < 0.001) from 25.2 to 44.0N, voluntary force (p < 0.001) from 24.4 to 39.9N. For flexion, FES-assisted flexion (p < 0.006) increased from 14.1 to 19.0N, voluntary flexion (p < 0.005) from 12.6 to 17.1N. There was a significant correlation between the increase in FES-assisted force and voluntary flexion (r=0.730, p=0.001) as well as between the increase in FES-assisted force and voluntary extension (r=0.881, p < 0.001). The sum score in muscle test increased from 15 to 24 points. Robot-assisted training with FES seems to support the regeneration of residual functions after SCI. This is evidenced by an improvement in motor function and strength in the lower limbs.

Wide-Pulse High-Frequency Neuromuscular Electrical Stimulation Evokes Greater Relative Force in Women Than in Men: A Pilot Study.

This study aimed to examine the potential sex differences in wide-pulse high-frequency neuromuscular electrical stimulation (WPHF NMES)-evoked force. Twenty-two subjects (10 women) completed this study. Prior to the stimulation, the visual analogue scale (VAS) for discomfort and the rating of perceived exertion (RPE) were measured, followed by the isometric strength of the dominant elbow flexor muscles. The subjects then completed ten, 10-s on 10-s off WPHF NMES (pulse width: 1 ms, frequency: 100 Hz) at maximum tolerable intensities. The subjects’ RPE was recorded after each set, and the VAS was measured following the last stimulation. The stimulation induced significant increase in discomfort for both sexes, with women having greater discomfort than men (men: 22.4 ± 14.9 mm, women: 39.7 ± 12.7 mm). The stimulation amplitude was significantly greater in men than in women (men: 16.2 ± 6.3 mA, women: 12.0 ± 4.5 mA). For the evoked force, only the relative NMES-evoked force was found greater in women than in men (men: 8.96 ± 6.51%, women: 17.08 ± 12.61%). In conclusion, even at the maximum tolerable intensity, WPHF NMES evoked larger relative elbow flexion force in women than in men, with women experiencing greater discomfort.

Novel Procedure for Determining the Finger Force in Flexion Depending on the Finger Position

Abstract Introduction: The design and development of a novel dynamic hand orthosis that allows individual and progressive adaptation to the patient’s condition require knowledge about the maximum voluntary contraction forces of the fingers. The following work presents a test setup and procedure for determination of isometric finger contraction forces during flexion depending on various finger positions and finger tasks. Methods: The test setup places hand and fingers in certain positions (position 0: grasping of a plate; position 1-3: circular grasping of cylinders of three different diameters). The force measurement is carried out using pressure sensing: A capacitive force sensor is placed on each fingertip. To perform various finger tasks, the subjects are asked for isometric contraction of defined finger groups and single fingers against the boundary system. For proof of the concept, measurements are performed with six subjects and compared with reference values from the literature. Results: The separated finger force of each finger can be captured during the finger tasks in varying positions. Furthermore, the total finger force of all active fingers can be determined. It is shown that the total finger force during contraction of all fingers (IMRLtask; 78.4N ± 25.8N, d2) is higher than during contraction of the index finger (25.8N ± 3.4N, d2). Furthermore, the single finger force of the index finger is higher than the index finger activity in IMRL-task. The results also show a tendency for the finger contraction force to increase with increasing flexion. Further investigations may require improvements to the method. In this proof of concept, this potential is revealed and discussed. However, the functionality of the test setup and procedure can be demonstrated.

36. Assessment of static spine stability and relative implications of trunk muscles, thoracolumbar fascia and intra-abdominal pressure

<h3>BACKGROUND CONTEXT</h3> The spine is an inherently unstable structure due to the numerous degrees of freedom it possesses. Yet, its static spinal stability is believed to be maintained by the actions of muscle activations combined with their intramuscular pressure (IMP), intra-abdominal pressure (IAP) generated by the abdominal muscles, and the passive engagement of the thoracolumbar fascia (TLF). Nonetheless, previous studies provide little information about the relative contribution of these tissues. <h3>PURPOSE</h3> The purpose of this research was to leverage a novel, validated and fully representative finite elements (FE) model of the spine to explore the relative actions of spinal muscles, TLF, IMP and IAP, as well as their collective efforts to achieve equilibrium static spinal stability. <h3>STUDY DESIGN/SETTING</h3> A novel, validated and comprehensive FE spine model was previously developed by the authors, which was applied to the current study. The model put forth includes accurate continuum models of all thoracic and lumbar vertebral bodies (VBs), intervertebral discs (IVDs), major spine muscles inclusive of their IMP (modelled as fluid-structure continuum), TLF tissue and a model of the IAP (modeled strategy like IMP). <h3>METHODS</h3> Equilibrium static stability was assessed as the ability of select tissues to restore the spine's initial position after an external perturbation is applied. For this reason, a previously validated spinal perturbation of 350N flexion force was applied at the first thoracic vertebra. Case studies including each tissue on its own, as well as combinations, were investigated. For each scenario, in-planar lumbar VBs final displacements, after tissue activations and applying the perturbation, were recorded in efforts of quantifying equilibrium static stability. Muscle activation was based on validated EMG muscle forces while IAP was introduced as an increasing pressure of 67 mmHg (9 kPa) maximum value in an abdominal cavity. <h3>RESULTS</h3> With the upright spine position being the initial stable position, the application of the 350N perturbation on the model inclusive of only the VBs and IVDs was identified as the most unstable position. Thereafter, activating the IAP, muscles, and TLF contributed individually to 24%, 53.8%, and 77% equilibrium static stabilities, respectively. Furthermore, combined tissues stability results fell between 60% and 93%, with 93% being the result of all tissues activated together to their maximum physiological capability. Another worthwhile finding was the approximately 46% drop in IMP developed by spinal muscles on the passive engagement of the TLF, suggesting its role in stabilizing and preventing excessive muscles pressurization. <h3>CONCLUSIONS</h3> This research concluded that the included muscles, combined with their IMP, IAP and TLF, are major spine stabilizers, contributing to 93% of the spine's equilibrium static stability, as defined in this paper. The TLF in particular, one of the strongest passive tissues in the back, showed to be capable of storing excessive loads, potentially as a protective measure. This was supported by the observed resultant forces at the TLF-VBs connection points, which summed up to around 244N acting opposite to applied perturbation. Lastly, results of this study may assist to better understand the notion of equilibrium static spinal stability as literature and previous studies are still pressing for more representative spine models able to assess other modes of stability. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Satisfaction and Functional Outcome of Surgical Treatment in Patients with Brachial Plexus Injury: A Decade of Retrospective Comparative Study.

Brachial plexus injury (BPI) is a severe peripheral nerve injury resulting in physical disability. Few studies have investigated the postoperative functional status. We aimed to evaluate the satisfaction with surgical treatment in patients with BPI referred to the Panzdah-e Khordad Hospital, Tehran, Iran from 2011 to 2021. In this descriptive-analytical retrospective comparative study, physical examination, along with BrAT, and DASH questionnaires were used to evaluate the patients' status. Then the collected data on the patients' functional status and movements were collected. To compare the mean of quantitative variables before and after the surgery, the dependent t-student was used. Generally, the patients stated that they still had considerable difficulty doing most of the items of the questionnaires. Nevertheless, there was a significant difference between the following variables before and after surgery; shoulder abduction goniometry (0-150) and force (M0:M5), shoulder external rotation goniometry (0-90) and force (M0:M5)), shoulder forward flexion goniometry (0-180) and force (M0:M5)), elbow flexion goniometry (0- 150), elbow extension force (M0:M5), and wrist and finger muscle force (M0:M5) (P<0.001). Posterior approach in BPI surgery was associated with good outcomes in terms of shoulder external rotation and abduction. However, patients still suffered from difficulties in daily activities.

KNEE extension lag

In a study involving 34 patients, researchers looked at how knee extension lag correlated with other measures of injured and healthy limbs. The average flexion force was found to be greater than the average extension force in the injured extremity, and there was no difference between the means of flexion and extension force. This study also found that the extension lag was unrelated to squatting depth, extension force, flexion force, circumference at the joint line, circumference 5 and 15 centimeters cephalad to the patella pole, and active or passive knee flexion. When compared to a control group of patients with healthy rotational movements, these medians showed significant variation. Comparisons between patient groups suggest a connection between quadriceps weakness and knee extension lag, but no other factors have been found to correlate with this finding. Researchers recommend recruiting participants with extension lags greater than 30 in order to increase the likelihood of discovering such links.

General, spinal or regional anaesthesia does not affect strength performance 6 months after ACL reconstruction

PurposeThe recovery of strength is a key element in successfully returning to sports after ACL reconstruction. The type of anaesthesia has been suspected an influential factor in the post-operative recovery of muscle function.MethodsIn this retrospective analysis, n = 442 consecutive patients undergoing primary isolated ACL reconstruction using a hamstring autograft were analysed by pre- and post-operative isokinetic tests in a single orthopaedic centre. These were subdivided into four cohorts: (1) general anaesthesia (n = 47), (2) general anaesthesia with prolonged (48 h) on-demand femoral nerve block (n = 37), (3) spinal anaesthesia (n = 169) and (4) spinal anaesthesia with prolonged (48 h) on-demand femoral nerve block (n = 185). Primary outcome was the change from pre- to post-operative isokinetic strength during knee extension and flexion.ResultsUsing one-way ANOVA, there was no significant influence of the type of anaesthesia. The main effect of anaesthesia on change in extension forces was not significant, and effect sizes were very small (n.s.). Similarly, the main effect of anaesthesia on change in flexion forces was statistically not significant (n.s.).ConclusionsThe findings of this study support the interpretation that the type of anaesthesia has no significant effect on the ability to recover thigh muscle strength 6 months after isolated hamstring ACL reconstruction. With regard to the recovery of athletic performance and return-to-sports testing criteria, there is no reason to avoid regional anaesthesia.Level of evidenceIII.

The Efficacy of Lumbar Support on Pain, Disability, and Motor Control in Women With Postpartum Pelvic Girdle Pain: Protocol for a Randomized Controlled Trial.

BackgroundPregnancy-related posterior pelvic girdle pain (PPGP) is one of the most important clinical manifestations of postpartum back pain. Those affected often complain of discomfort during daily activities. It is hypothesized that altered motor control is associated with perceived pain. Pelvic support can regulate possible underlying altered motor control mechanisms and decrease pain. However, the influence of a lumbosacral orthosis, which is broader support that allows for a wider contact area and more skin sensory stimulation to restore proper motor function, has not yet been investigated in women with postpartum PPGP.ObjectiveThis study investigates the efficacy of broader lumbar support and narrower pelvic support on pain, proprioception, disability, and muscle strength in women with pregnancy-related PPGP.MethodsThis study will be a single-center, 3-armed, participant-blinded, randomized controlled trial. In total, 84 women diagnosed with pregnancy-related PPGP will be recruited and randomly assigned into 3 groups. Intervention groups A and B will receive pelvic and lumbar supports, respectively. Group C (control) will receive only a patient education leaflet containing advice on strengthening exercises, comfortable positions, and other practical information. The study outcomes are pain, effort score during the active straight leg raising test, maximum isometric hip flexion force, maximum isometric hip external rotation force, maximum isometric trunk rotation force, and joint position reproduction of hip abduction. The study outcomes will be measured at 4 time points: baseline (T1), immediately after the intervention (T2), 4 weeks following interventions began (at this time, the intervention period is completed) (T3), and 1 week after discontinuing the interventions (T4) to evaluate the possible lasting effects of wearing supports. Multivariate analysis of variance will be used to test between- and within-group differences.ResultsRecruitment for this study will be started in summer 2022 and is expected to be completed by the end of fall 2022.ConclusionsThis study will examine the efficacy of broader lumbar support as an early rehabilitative treatment for women receiving postpartum posterior pelvic pain support compared to those receiving a narrower pelvic support. We expect the broader lumbar support to impact pain management and disability better than the current narrower pelvic belt. Long-term follow-up studies will help determine whether such lumbosacral orthosis reduces pain and improves daily activities in women with pregnancy-related PPGP.Trial RegistrationIranian Registry of Clinical Trials IRCT20150210021034N11; https://www.irct.ir/trial/54808International Registered Report Identifier (IRRID)PRR1-10.2196/40553