Flexion Range Research Articles

Comparison of mid-term effectiveness between diabetic secondary stiff shoulder and primary frozen shoulder after arthroscopic shoulder capsular release combined with acromiohumeral distance restoration

To compare the mid-term effectiveness of arthroscopic shoulder capsular release combined with acromiohumeral distance (AHD) restoration in the treatment of diabetic secondary stiff shoulder and primary frozen shoulder. A retrospective analysis was conducted on clinical data of 22 patients with diabetic secondary stiff shoulder (group A) and 33 patients with primary frozen shoulder (group B), who underwent arthroscopic 270° capsular release combined with AHD restoration treatment. There was no significant difference between the two groups in gender, age, affected side, disease duration, and preoperative AHD, shoulder flexion range of motion, abduction range of motion, American Shoulder and Elbow Surgeons (ASES) score, visual analogue scale (VAS) score, and Constant score ( P>0.05). Only the difference in the internal rotation cone rank and external rotation range of motion between the two groups showed significant differences ( P<0.05). The improvement in shoulder pain and function was evaluated by using VAS score, ASES score, and Constant score before operation and at last follow-up. Active flexion, abduction, external rotation range of motion, and internal rotation cone rank were recorded and compared. AHD was measured on X-ray films. All patients were followed up 24-92 months (median, 57 months). There was no significant difference in follow-up time between group A and group B ( P>0.05). No fractures or glenoid labrum tears occurred during operation, all incisions healed by first intention, and no complication such as wound infection or nerve injury was observed during the follow-up. At last follow-up, there were significant improvements in active flexion, abduction, external rotation range of motion, internal rotation cone rank, AHD, VAS score, ASES score, and Constant score when compared with preoperative ones in both groups ( P<0.05). Except for the difference in change in external rotation range of motion, which had significant difference between the two groups ( P<0.05), there was no significant difference in other indicators between the two groups ( P>0.05). Arthroscopic capsular release combined with AHD restoration can achieve good mid-term effectiveness in the treatment of diabetic secondary stiff shoulder and primary frozen shoulder. However, the improvement in external rotation range of motion is more significant in the patients with diabetic secondary stiff shoulder.

Biomechanical Comparison of Corticopedicular Spine Fixation versus Pedicle Screw Fixation in a Lumbar Degenerative Spondylolisthesis Finite Element Analysis Model

To compare the stability of a corticopedicular posterior fixation (CPPF) device with traditional pedicle screws for decompression and fusion in adult degenerative lumbar spondylolisthesis. Finite element analysis (FEA) was used in a validated model of grade 1 L4-L5 spondylolisthesis to compare segmental stability after laminectomy alone, laminectomy with pedicle screw fixation, or laminectomy with CPPF device fixation. A 500-N follower load was applied to the model and different functional movements were simulated by applying a 7.5-Nm force in different directions. Outcomes included degrees of motion, tensile forces experienced in the CPPF device, and stresses in surrounding cortical bone. At maximum loading, laminectomy alone demonstrated a 1° increase in flexion range of motion, from 6.35° to 7.39°. Laminectomy with pedicle screw fixation and CPPF device fixation both reduced spinal segmental motion to ≤1° at maximum loading in all ranges of motion, including flexion (0.94° and 1.09°), extension (-0.85° and -1.08°), lateral bending (-0.56° and -0.96°), and torsion (0.63° and 0.91°), respectively. There was no significant difference in segmental stability between pedicle screw fixation and CPPF device fixation during maximum loading, with a difference of ≤0.4° in any range of motion. Tensile forces in the CPPF device remained ≤51% the ultimate load to failure (487 N) and stress in surrounding cortical bone remained ≤84% the ultimate stress of cortical bone (125.4 MPa) during maximum loading. CPFF fixation demonstrated similar segmental stability to traditional pedicle screw fixation whereas tensile forces and stress in surrounding cortical bone remained below the load to failure.

Non-surgical vs. surgical treatment of distal radius fractures: a meta-analysis of randomized controlled trials

PurposeTo compare the clinical outcomes between nonsurgical and surgical treatment of distal radius fracture.MethodsWe performed a systematic literature search by using multiple databases, including Medline, PubMed, and Cochrane. All databases were searched from the earliest records through February 2023. The study compared nonsurgical versus surgical treatment of distal radius fractures and included only randomized controlled trials (RCTS).ResultsThere were seventeen randomized controlled trials retrieved. A total of 1730 patients were included: 862 in the nonsurgical group and 868 in the surgical group. The results showed a significant reduction in DASH score with surgical treatment (WMD 3.98, 95% CI (2.00, 5.95), P < 0.001). And in grip strength (%), the results showed a significant improvement in surgical treatment compared with non-surgical treatment (WMD − 6.60, 95% CI (-11.61, -1.60), P = 0.01). There was significant difference in radial inclination, radial length, volar title, range of wrist pronation, range of wrist supination. However, no difference in radial deviation, ulnar deviation, ulnar variance, range of wrist extension and range of wrist flexion was observed.ConclusionsThe results of this meta-analysis suggest that some patients with surgical treatment of distal radius fractures not only improved the grip strength (%), decreased the DASH score, but also improved the range of wrist pronation and the range of wrist supination compared with nonsurgical treatment. Based on the present meta-analysis, we suggest that some patients with surgical treatment might be more effective in patients with distal radius fracture.

Continued stepped care model improves early-stage self-report quality of life and knee function after total knee arthroplasty.

The Stepped Care Model (SCM) is an evidence-based treatment approach that tailors treatment intensity based on patients' health status, aiming to achieve the most positive treatment outcomes with the least intensive and cost-effective interventions. Currently, the effectiveness of the Stepped Care Model in postoperative rehabilitation for TKA (Total Knee Arthroplasty) patients has not been reported. The present study aimed to investigate whether the stepped care model could improve early-stage self-report quality of life and knee function after total knee arthroplasty via a prospective randomized controlled design. It was a mono-center, parallel-group, open-label, prospective randomized controlled study. Patients who aging from 60-75 years old as well as underwent unilateral primary total knee arthroplasty due to end-stage knee osteoarthritis between 2020.06 to 2022.02 were enrolled. Participants were randomized and arranged into two groups in a 1:1 allocation. The control group was given traditional rehabilitation guidance, while the stepped care model group was given continued stepped care. Hospital for special surgery knee score, daily living ability (ADL), knee flexion range, and adverse events at 1, 3, and 6 months after total knee arthroplasty were recorded. 88 patients proceeded to the final analysis. There was no significant difference of age, gender, length of stay, BMI, and educational level between the two groups at the baseline. After specific stepped care model interventions, patients showed significant improvements in HHS in 1 month (85.00 (82.25, 86.00) vs. 80.00 (75.00, 83.00), p< 0.001), 3 months (88.00 (86.00, 92.00) vs. 83.00 (76.75, 85.00), p< 0.001), and 6 months (93.00 (90.25, 98.00) vs. 88.00 (84.25, 91.75), p< 0.001) when compared with the control group. Similar results were also found in both daily living ability and knee flexion angle measurements. No adverse event was observed during the follow-up. The present study found that the stepped care model intervention significantly improved early-stage knee function and self-reported life quality after total knee arthroplasty due to knee osteoarthritis. Female patients and those less than 70 years old benefit more from the stepped care model intervention after total knee arthroplasty.

Radiocapitellar joint plasty for missed monteggia fracture with radial head deformity in children: a retrospective study.

The retrospective study reviewed the clinical and radiological outcomes of patients treated with radiocapitellar joint plasty. 10 children with missed Monteggia fracture (MMF) were reviewed. The average time from injury to operation was 20 months. The average age of children who underwent the operation was 10.5 years. 6 flat and 4 domed radial heads were included. 7 type I and 3 type III MMF were identified based on the Bado classification. All children with MMF were treated by open radial head reduction with radiocapitellar joint plasty and ulnar osteotomy (UO). The average union time was 4.9 ± 2.6 months. The average osteotomy angle to reduce the radial head was 15.7 ± 3.5°, and the average lengthening of the ulna was 8.2 ± 3.2 mm. The average preoperative flexion range of motion was 110.5 ± 9.1°, and the postoperative flexion range of motion was 138.8 ± 15.1° (p < 0.05). The average preoperative extension range of motion was 10.1 ± 3.2°, and the postoperative extension range of motion was 5.5 ± 3.3° (p < 0.05). The average preoperative pronation range of motion was 78.8 ± 8.7°, while the postoperative pronation range of motion was 81.1 ± 5.6° (p > 0.05). The average preoperative supination range of motion was 68.3 ± 9.7°, and the postoperative supination range of motion was 80.1 ± 7.8° (p < 0.05). The preoperative Kim score was 66.5 ± 10.9°, and the postoperative Kim score was 88.1 ± 12.6 (p < 0.05). The radial head was completely reduced in 9 patients, and subluxation in 1 patient. Osteoarthritis of the radiocapitellar joint was observed in 2 patients. Radiocapitellar joint plasty is effective surgical intervention for MMF with radial head deformity. It yields favorable functional outcomes while ensuring continued radial head reduction.

Sulcus-deepening trochleoplasty grants satisfactory results with minimal patellofemoral arthritis at 23-30 years of follow-up.

The purpose of this study was to evaluate the radiographic and clinical outcomes of sulcus-deepening trochleoplasty at a minimum follow-up of 23 years. The authors evaluated a retrospective series of 10 patients (11 knees) who underwent trochleoplasty between 1993 and 2000. All patients were assessed at a minimum follow-up of 23 years by an independent clinician who noted any patellar redislocations and collected the International Knee Documentation Committee (IKDC), Kujala scores and range of motion. Radiographic examination was performed to assess patellofemoral arthritis using the Iwano classification. A total of 11 knees, from five women and five men aged 25.6 ± 6.9 years (range, 15-47 years) underwent trochleoplasty during the inclusion period. All 11 knees underwent adjuvant procedures during trochleoplasty (100%): 10 had tibial tuberosity osteotomy (TTO) and vastus medialis plasty and 1 had only vastus medialis plasty (had prior TTO). At a follow-up of 24.4 ± 2.1 years (range, 23-30 years), two patients were lost to follow-up (18%). The Iwano classification was Grade 1 in three patients (33%), Grade 2 in four patients (44%) and Grade 4 in two patients (22%). The flexion range was 130 ± 8.7° and satisfaction was 9.2 ± 0.7, Kujala was 76.9 ± 8.5 and IKDC was 65.5 ± 13.8. At 23-30 years following sulcus-deepening trochleoplasty in this small series of 10 patients (11 knees), patients had satisfactory clinical scores, only 1 patient reported an episode of traumatic patellar dislocation, and two knees had patellofemoral arthritis of Iwano Grade >2 (22%). Level IV.

Modern multiligament knee injury surgical reconstruction techniques can achieve excellent knee function and patient satisfaction, with low complication rates.

To report on the recovery of strength and functional capacity symmetry following multiligament knee surgical reconstruction (MLKR), as well as the capacity of athletes to return to sport. This prospective cohort study recruited 47 patients undergoing MLKR between February 2018 and July 2021. Forty patients had full outcome assessment postoperatively at 6, 12 and 24 months and were included in the analysis, 75% were knee dislocation one injuries and 60% were injured playing sport. Patient-reported outcome measures (PROMs) assessed included the International Knee Documentation Committee score, the Knee Outcome Survey, the Lysholm Knee Score and the Tegner Activity Scale (TAS). Patient satisfaction was also assessed. Objective assessment included assessment of active knee flexion and extension range of motion (ROM), the single (single horizontal hop for distance [SHD]) and triple (triple horizontal hop for distance [THD]) hop tests for distance and peak isokinetic knee flexor/extensor torque. All PROMs significantly improved (p < 0.001) from presurgery to 24 months postsurgery. At 24 months, 70% of patients were satisfied with their sports participation. Active knee flexion (p < 0.0001) and extension (p < 0.0001) ROM significantly improved over time, as did the limb symmetry indices (LSIs) for the SHD (p < 0.0001), THD (p < 0.0001), peak knee extensor (p < 0.0001) and flexor (p = 0.012) torque. While LSIs for the SHD, THD and knee flexor strength tended to plateau by 12 months, knee extensor strength continued to improve from 12 to 24 months. The majority of patients undergoing modern MLKR surgical techniques and rehabilitation can achieve excellent knee function, with low complication rates. Level IV.

Predicting functional movement capacity in adults: the effect of range of motion and isometric strength

The aim of the study was to determine the role of isometric strength and range of motion in predicting Functional Movement Screen (FMS) scores of adults. A total of 120 participants (age = 34.62 ± 11.82 years; height = 170.56 ± 9.63 cm; weight = 73.62 ± 15.39 kg) volunteered to participate in the study. Anthropometric measurements were performed, including height, body weight, muscle mass, and body fat. Following this, the ranges of motion of the shoulder, hip, knee, and ankle joints were measured sequentially. Isometric strength and FMS tests were then performed. Hip extension isometric strength explained 23% of the variation in FMStotal. The common effect of knee flexion, shoulder flexion, and dorsiflexion joint range of motion explained 34% of the change in FMStotal (F (3−116) = 20.375, p < 0.001). A significant relationship (R = 0.658, R2 = 0.413) was found between hip extension isometric strength, knee flexion, shoulder flexion, and dorsiflexion range of motion and FMStotal (F (4−115) = 21.952, p < 0.001). The common effect of all these variables explains 43% of the change in FMStotal. The results indicate that the FMS test scores, which are utilized to evaluate the risk of injury in sedentary adults, can be significantly predicted by the effect of hip extension isometric strength and parameters related to knee flexion, shoulder flexion, and dorsiflexion joint range of motion. At this time, it is advised that range of motion and isometric strength be taken into account when determining a person’s functional movement capacity.

Spinal loads during dynamic full flexion and return to standing posture in different age and sex groups: A musculoskeletal model study

During forward flexion, spine motion varies due to age and sex differences. Previous studies showed that lumbar/pelvis range of flexion (RoF) and lumbo-pelvic ratio (L/P) are age/sex dependent. How variation of these parameters affects lumbar loading in a normal population requires further assessment. We aimed to estimate lumbar loads during dynamic flexion-return cycle and the differences in peak loads (compression) and corresponding trunk inclinations due to variation in lumbar/pelvis RoF and L/P.Based on in vivo L/P (0.11–3.44), temporal phases of flexion (early, middle, and later), the lumbar (45-55°) and hip (60-79°) RoF; full flexion-return cycles of six seconds were reconstructed for three age groups (20–35, 36–50 and 50+ yrs.) in both sexes. Six inverse dynamic analyses were performed with a 50th percentile model, and differences in peak loads and corresponding trunk inclinations were calculated.Peak loads at L4-L5 were 179 N higher in younger males versus females, but 228 N and 210 N lower in middle-aged and older males, respectively, compared to females. Females exhibited higher trunk inclinations (6°-20°) than males across all age groups. Age related differences in L4-L5 peak loads and corresponding trunk inclinations were found up to 415 N and 19° in males and 152 N and 13° in females. With aging, peak loads were reduced in males but were found non-monotonic in females, whereas trunk inclinations at peak loads were reduced in both sexes from young to middle/old age groups.In conclusion, lumbar loading and corresponding trunk inclinations varied notably due to age/sex differences. Such data may help distinguishing normal or pathological condition of the lumbar spine.

Better clinical outcomes and return to sport rates with additional medial meniscus root tear repair in high tibial osteotomy for medial compartmental knee osteoarthritis.

This retrospective study aimed to investigate whether the repair of medial meniscus posterior root tears (MMPRTs) is effective for improving clinical outcomes and return to sports rates in young patients (50 years old or younger) with medial compartment knee osteoarthritis (KOA) and MMPRTs. Between 2016 and 2019, 153 patients with KOA and MMPRTs who underwent open-wedge high tibial osteotomy (OWHTO) were retrospectively included. The patients were divided into OWHTO combined with MMPRT repair (n = 73) and isolated OWHTO (n = 80) groups. Lysholm scores, Hospital for Special Surgery (HHS) scores, Tegner scores, flexion contracture, range of knee flexion, return to sports rates and postoperative complications were compared. Radiological outcomes, including hip-knee-ankle angle (HKA), medial proximal tibial angle (MPTA), joint line convergence angle (JLCA) and Kellgren-Lawrence (K-L) grade, were compared between the two groups. After a mean follow-up of 30.1 ± 3.0 months, the OWHTO + Repair group observed better clinical outcomes compared with the OWHTO group (Lysholm score: 86.7 ± 7.4 vs. 81.6 ± 6.9, p = 0.023. HHS score: 85.4 ± 8.20 vs. 80.5 ± 7.1, p = 0.039). The OWHTO + Repair group had higher Tegner scores and return to sports rates than the OWHTO group (Tegner score: 6 vs. 5, p = 0.020; return to sports rates: 38% vs. 15%, p = 0.001). No fracture or major complications occurred. Radiological outcomes showed no significant differences between the two groups (HKA: 181.1 ± 2.7 vs. 180.1 ± 1.5 n.s; MPTA: 90.1 ± 1.8 vs. 89.2 ± 1.4, n.s; JLCA:1.9 ± 0.7 vs. 2.1 ± 0.7, n.s). Additional MMPRT repair during OWHTO was associated with better clinical outcomes and higher rates of return to sports in young patients with medial compartment KOA and MMPRTs. Level III.

Short-term effect of acupuncture dry needle in treatment of chronic mechanical low back pain: a randomized controlled clinical trial.

In today's industrialized world, between sixty and ninety percent of the working-age population experiences low back discomfort. Chronic mechanical low back pain (CMLBP), the most common ailment among working-age people in contemporary industrial society, causes a major economic burden due to the widespread use of medical services and the absence of work. For those suffering from persistent mechanical low back pain, this experiment aimed to assess the efficacy of using acupuncture dry needles in the short term. Our research included 30 individuals with nonspecific low back pain; their ages varied from 20 to 45. The participants were divided into two parallel groups using a random process: 15 individuals in group A had acupuncture treatment with a dry needle placed to specified locations on their backs, whereas 15 individuals in group B participated in muscle strengthening and stretching exercises. Both before and after therapy, researchers examined the lumbar range of motion (ROM) in four directions: flexion, extension, bilateral side bending, as well as pain intensity and functional impairment. We examined the data for normality and covariance homogeneity using the Shapiro-Wilk and Box's tests, respectively. The variables of interest that were investigated were compared across various test groups and measurement periods using a 2x2 mixed design-multivariate analysis of variance (MANOVA). We used a significance threshold of 0.05. When comparing the two groups after treatment, it was found that the flexion and extension range of motion increased significantly (p<0.05), while the pain intensity, bending to the right and left, and functional impairment decreased significantly (p<0.05). The results of multiple pairwise comparisons showed a noteworthy difference in pain severity, functional debility, and back ROM between the two groups before and after treatment (p<0.05), with group A showing an advantage over group B after treatment. Based on the study results, dry needle acupuncture may be a beneficial modality in treating chronic mechanical low back pain by relieving pain intensity, improving functional debility, and improving ROM.

Monodigital Double Cross-Finger Flaps-A Novel Approach for Coverage of Large Volar Defects.

A single cross-finger flap can only address digital defects of a limited size, and larger defects often require distant flaps such as abdominal or groin flaps that are cumbersome to perform and sometimes bulky. Two cross-finger flaps harvested from the same donor digit could offer a simple and effective solution for many such defects. In this study, we describe the technique of monodigital double cross-finger flaps and its clinical applicability, with evaluation of donor and recipient site morbidity. A total of 10 subjects with large volar defects were included in the study. The demographic data, etiology, defect size, flap donor, and recipient sites were tabulated prior to surgery. Each subject was assessed for postoperative complications at the donor and recipient site and followed up for 6-12 months to document any flap or donor site morbidities. The subjects included 9 males and 1 female subjects, with an average age of 35.6 years (21-67 years). Most patients had posttraumatic defects, with 3 cases of full thickness burns and one with postsurgical tissue necrosis. All defects were volar, with 4 on the little finger, 3, 2, and 1 in the ring, index and middle fingers, respectively. No major postoperative complications were noted in any case. All flaps survived well with good contour, and donor fingers achieved near-normal range of flexion with only minimal restriction (10-15°) at the distal interphalangeal joint that did not result in any overall functional disability. Monodigital double cross-finger flap technique offers a simple and effective solution for reconstruction of large digital defects that are not amenable for closure by a classical cross-finger flap, and is a good alternative for other procedures, providing supple soft tissue coverage and no significant morbidity at the donor digit provided that there is preservation of a small skin bridge across the proximal interphalangeal joint.

Comparative Analysis of Outcomes of Lateral Versus Medial Approach in the Total Knee Arthroplasty for Valgus Deformity: A Systematic Review and Meta-analysis.

Valgus knee deformity poses great challenges in total knee arthroplasty (TKA) and requires precision in balancing of soft tissue and implant component positioning. The surgical approach used for TKA has a determinantal impact on intraoperative soft tissue balancing, postoperative knee function, and complications. We executed a systematic review and meta-analysis of current literature, which included a maximum number of studies with quantitative analysis of all possible outcomes to substantiate the current evidence of the advantage of lateral versus medial approach in TKA for valgus knee deformity. We performed a meticulous primary electronic search across PubMed, Emabse, Scopus, and Cochrane Library databases, and looked for the comparative studies that evaluated the medial versus lateral approach in TKA for valgus knees. Statistical analyses were executed with RevMan-5.4.1. On the evaluation of four randomized controlled trials (RCTs), two prospective and five retrospective comparative studies, our analysis revealed a better functional outcome in terms of Knee Society Score [MD 2.24, 95% CI 0.42, 4.05; p = 0.02] with the medial approach. However, comparable results were observed for two approaches with regard to Knee Society Function [MD 0.69, 95% CI -1.77, 3.15; p = 0.58], knee flexion range of motion (ROM) [MD 3.30, 95% CI -1.34, 7.95; p = 0.16], overall complications [OR 0.60, 95% CI 0.27,1.34; p = 0.22], wound-related complications, infection, nerve injury, periprosthetic fracture, post-operative valgus, blood loss, duration of surgery, postoperative pain, and patellar tilt for TKA in valgus knee. Evidence from the currently available published data suggests that the lateral approach, compared to the medial approach in TKA for the valgus knee, does not show clear superiority.

Comparison of Ischemic Compression Combined With Muscle Energy Technique Versus Ischemic Compression Alone on Myofascial Trigger Points of Upper Trapezius in Breast Cancer Survivors

Background: A hyperirritable region, typically located within a taut band of skeletal muscle, is known as a myofascial trigger point. It can cause discomfort upon compression, as well as the typical referred pain, motor dysfunction, and autonomic abnormalities. TrPs may be associated with breast cancer. Symptoms of upper body dysfunction and pain are typical among breast cancer survivors. Noninvasive techniques including massage, spray and stretch, physical therapy, and transcutaneous electrical stimulation can all help reduce trigger points. Ischemic compression and Muscle energy technique (MET) is an intriguing non-invasive treatment that has showed more effect on myofascial trigger points Objectives: Aims and objective of this study was to compare the effect of ischemic compression combined with muscle energy technique and ischemic compression alone on myofascial trigger points in breast cancer survivors. To see improvement in range of cervical flexion, cervical extension and cervical lateral flexion. Method: This was Quasi-experimental study in which convenient sampling was done from breast cancer patient from breast cancer ward of PINUM and Allied hospital Faisalabad for 6 months after meeting inclusion and exclusion criteria. 20 individuals with Myofascial Trigger points were assigned into two groups: Group 1 and Group 2. Group 1 received ischemic compression combined with Muscle Energy Technique for 3 weeks and Group 2 received ischemic compression alone for 3 weeks. Evaluation of pain, range of cervical flexion, cervical extension and cervical lateral flexion was done by Numeric Pain Rating Scale, Goniometer and Neck Pain Disability Index respectively. Results: wilcoxon and Mann whitney tests were applied and results showed p value &lt;0.01. Conclusion: According to data analysis and after applying Mann-whitney test we found that ischemic compression combined with muscle energy technique has more effect on myofascial trigger points in improving pain and range of motion than ischemic compression alone. Keywords: Breast cancer, Goniometer, Ischemic compression, Myofascial Trigger Points, ,Muscle Energy Technique, ROM

Shoulder mobility and strength impairments in patients with rotator cuff related shoulder pain: a systematic review and meta analysis.

The methods previously proposed in the literature to assess patients with rotator cuff related shoulder pain, based on special orthopedic tests to precisely identify the structure causing the shoulder symptoms have been recently challenged. This opens the possibility of a different way of physical examination. To analyze the differences in shoulder range of motion, strength and thoracic kyphosis between rotator cuff related shoulder pain patients and an asymptomatic group. The protocol of the present research was registered in the International Prospective Register of Systematic Review (PROSPERO) (registration number CRD42021258924). Database search of observational studies was conducted in MEDLINE, EMBASE, WOS and CINHAL until July 2023, which assessed shoulder or neck neuro-musculoskeletal non-invasive physical examination compared to an asymptomatic group. Two investigators assessed eligibility and study quality. The Newcastle Ottawa Scale was used to evaluate the methodology quality. Eight studies (N=604) were selected for the quantitative analysis. Meta-analysis showed statistical differences with large effect for shoulder flexion (I2 = 91.7%, p<0.01, HG = -1.30), external rotation (I2 = 83.2%, p<0.01, HG = -1.16) and internal rotation range of motion (I2 = 0%, p<0.01, HG = -1.32). Regarding to shoulder strength; only internal rotation strength showed statistical differences with small effect (I2 = 42.8%, p<0.05, HG = -0.3). There is moderate to strong evidence that patients with rotator cuff related shoulder pain present less shoulder flexion, internal and external rotation range of motion and less internal rotation strength than asymptomatic individuals.

Behavioral and cortical dynamics underlying superior accuracy in short-distance passes

Improved pass accuracy is a prominent determinant of success in football. It demands an effective interaction of complex behavioral and cortical dynamics. Exploring differences in the ability to sustain an accurate pass behavior in a stable setting and the associated cortical dynamics at different expertise levels may provide an insight into skilled strategies contributing to superior accuracy in football. The aim of this study is to compare trial-to-trial variability of pass biomechanics and the corresponding cortical dynamics during short-distance passes between novices and experienced football players. Thirty participants (15 novices, 15 football players) performed 90 short-distance passes. The intertrial variability of pass biomechanics (foot acceleration, range of hip flexion, knee flexion and foot rotation) was assessed by means of multiscale entropy. The task-related cortical dynamics were analyzed via source-derived event-related spectral perturbations. Experienced players demonstrated higher accuracy and overall lower entropy values across multiple time scales which was significant for hip flexion. The electroencephalography data revealed group differences in parieto-occipital alpha desynchronization and frontal theta synchronization in successive phases of passes. The current findings suggest that experienced football players may show a skilled ability to recruit and retain pass biomechanics promoting higher accuracy, whereas novices may show an explorative behavior with higher spatial variability. This difference may be associated with distinctive visuospatial and attentional strategies acquired with expertise in football. Our study provides an insight into expertise-specific behavioral and cortical dynamics of superior accuracy in football and a basis for its prospective investigation in enriched contexts.

Comparison of Treatment Outcomes of Different Immobilized Finger Positions After Repair of Flexor Tendon Rupture in Zones I and II: A Nonrandomized Controlled Trial With Historical Control Group.

Introduction The position of finger immobilization after flexor tendon rupture repair is changed to the extended position to prevent flexion contracture of the interphalangeal (IP) joint. However, in Strickland's assessment, We believe that a reduction in TAF (total active flexion) affects the outcome and that extension fixation is not necessarily the primary focus.For example, there are management methods that swap the fixed position between day and night. It is assumed that some effect is sought by placing the fingers in the flexed position. That is, the method of fixation is currently selected at individual facilities through twists and turns; however,the indications and criteria for selecting finger fixation positions are ambiguous, and they are apparently subject to the experience of therapists. This study aimed to characterize follow-up outcomes of flexion and extension fixation after zones I and II flexor tendon rupture repair. Methods This nonrandomized controlled trial with historical controls included 25 patients with flexor tendon ruptures of 30 fingers. The flexion fixation group consisted of 12 patients (n=16 fingers) and the extension fixation group consisted of 13 patients (n=14 fingers). The group with flexion fixation comprised patients who slept with their injured fingers in the flexed position (intervention group). The group with extension was retrospectively selected between April 2017 and March 2019, who slept with their injured finger in the extended position (historical control group). Strickland assessments of the range of motion (ROM) of each joint at the conclusion of hand therapy, the ratio of total active motion of the repaired, to the healthy finger (%TAF), and IP joint extension limitation angles were compared using Mann-Whitney U tests. Ratios of excellent and good ratings based on the Strickland assessment were compared using Fisher exact tests. Result The results of the Strickland assessment showed excellent or goodoutcomes for 22(73%) of 30 fingers, which was in line with our previous findings. Strickland ratings of excellent were achieved in seven (44%) of 16 fingers and four (28%) of 14 fingers in the groups with flexion and extension fixation, respectively. The outcomes for two (22%) of 16 fingers and seven (78%) of 14 fingers in the groups with flexion and extension fixation were, respectively, rated asgood. The proportion of patients rated as excellent was significantly higher in the group with flexionthan extension fixation (p=0.040). The %TAF and the active flexion angle of the distal interphalangeal (DIP) joint were higher in the group with flexionthan extension fixation (p=0008 and p=0.025, respectively). Furthermore, the total angle of the IP joint limit of extension did not significantly differ between the groups. Conclusion Flexion fixation after flexor tendon rupture achieved an excellent Strickland rating and was more effective than extension fixation, especially in terms of the active flexion ROM of the DIP joint. Flexion fixation might be an alternative to extension fixation because the range of flexion should be greater and might provide a range of finger extension motion equivalent to that of extension fixation.

The preservation of cervical flexibility helps maintain cervical sagittal alignment after laminoplasty

BACKGROUND CONTEXTCervical spine range of motion (ROM) is a critical factor in changes in cervical sagittal alignment (CSA) and clinical outcomes after cervical laminoplasty (LMP). However, the impact of postoperative cervical ROM on CSA after cervical LMP is still unclear. PURPOSEEvaluating the imaging and symptomatic data from patients with cervical spondylotic myelopathy (CSM) to identify the influence of postoperative cervical ROM on post-LMP CSA and surgical outcomes. STUDY DESIGNRetrospective study. PATIENT SAMPLEEighty-six patients undergoing LMP due to multilevel CSM OUTCOME MEASURESRadiographic parameters were measured before surgery and at follow-up: cervical lordosis (CL), T1 slope (T1S), cervical sagittal vertical axis (cSVA), CL in flexion (Flex CL), CL in extension (Ext CL), total cervical spine range of motion (ROM), cervical spine range of flexion (Flex ROM), and cervical spine range of extension (Ext ROM). Japanese Orthopedic Association (JOA) and visual analog score (VAS) were used to assessed clinical outcomes. Other parameters included age, gender, body mass index (BMI), follow-up time, number of surgical segments, proximal level, distalis level, and collar wear time. METHODSWe divided patients according to the changes in CSA (loss of cervical lordosis (LCL)>10°, or ≤10°; an increase in cervical sagittal vertical axis (I-cSVA) >10mm, or ≤10mm). A receiver-operating characteristic curve (ROC) analysis was constructed to identify the optimal cut-off value to discriminate the patients with and without postoperative deterioration of CSA. RESULTSThe postoperative total and Flex ROM were significantly lower in the LCL>10° and I-cSVA>10mm groups. Multivariate logistic regression analysis showed that low post-Flex ROM was significant risk factor for postoperative deterioration of CSA. ROC showed that the cut-off value for postoperative Flex ROM was 15.60°. Improvements in JOA recovery rate and neck pain were more significant in the flexibility group (post-Flex ROM ≥15.6°) after surgery. Patients in the stiffness group (post-Flex ROM <15.6°) wore a collar longer. CONCLUSIONSThe preservation of cervical flexibility can maintain CSA after cervical LMP. Postoperative cervical stiffness is related to poor surgical outcomes because significant cervical kyphotic change and sagittal imbalance are likely to occur after surgery. Prolonged wearing of cervical collar is correlated with cervical stiffness following cervical LMP.

Defining pseudoparalysis and pseudoparesis: a consensus study

The purpose of this study was to establish consensus statements via a modified Delphi process on the definition of shoulder pseudoparalysis and pseudoparesis. A consensus process on the definition of a diagnosis of pseudoparalysis utilizing a modified Delphi technique was conducted, and 26 shoulder/sports surgeons from 11 countries, selected based on their level of expertise in the field, participated in these consensus statements. Consensus was defined as achieving 80%-89% agreement, whereas strong consensus was defined as 90%-99% agreement, and unanimous consensus was indicated by 100% agreement with a proposed statement. Three statements regarding the diagnosis of pseudoparalysis reached strong (>89%) consensus: passive range of motion should be unaffected, the passive range of abduction should not be considered, and diagnosis should be excluded if lidocaine injection produces a substantial improvement in range of motion. Additionally, consensus (>79%) was reached that the active range of external rotation should not be considered for diagnosis, pain as a cause of restricted motion must be excluded, and that distinctions between restricted active flexion and external rotation should be made by range of motion rather than tear characteristics. No consensus could be reached on statements regarding the size, number of tendons or chronicity of cuff tears. Nor was there agreement on the active range of flexion permitted or on the difference between pseudoparalysis and pseudoparesis. A modified Delphi process was utilized to establish consensus on the definition of shoulder pseudoparalysis and pseudoparesis. Unfortunately, almost half of the statements did not reach consensus, and agreement could not be reached across all domains for a unifying definition for the diagnosis of pseudoparalysis in the setting of rotator cuff tears. Furthermore, it was not agreed how or whether pseudoparalysis should be differentiated from pseudoparesis. Based on the lack of a consensus for these terms, studies should report explicitly how these terms are defined when they are used.

Return to running criteria after anterior cruciate ligament reconstruction: an online survey of 1404 Italian physiotherapists.

The aim of this study is to study the clinical decision-making practice of Italian physiotherapists in return to running (RTR) after anterior cruciate ligament (ACL) reconstruction, and the differences in decision-making in relation to physiotherapist's characteristics. An online survey was developed, 1404 physiotherapists were contacted by email, via chartered association, or via social media. Most respondents (83%) indicated that the RTR decision should be made by a multidisciplinary team with RTR clearance around 3-4 months after surgery (47%). The most important criteria guiding the RTR decision were knee flexion range of motion (ROM) >130° (50%), complete extension ROM (95%), no pain (45%) and no effusion (68%). A Limb Symmetry Index (LSI) >70% for quadriceps (49%), hamstring (48%) and LSI >90% for posterolateral hip (45%) and triceps surae strength (42%) should be achieved for RTR. Approximately half of the participants (49%) do not consider ACL laxity tests to be used for RTR decisions. Response differences were found between sample subgroups. More experienced physiotherapists and those with post graduate training had lower thresholds to clear RTR. Experienced physiotherapists who treated a higher number of patients after ACL reconstruction, who had certified specialist training and a specific interest towards ACL rehabilitation, generally reported clinical practice modalities more in line with current evidence.