Forearm Position Research Articles

FOREARM POSITION MATTERS DURING ECCENTRIC SHOULDER EXERCISES: AN EMG RECRUITMENT STUDY WITH IMPLICATIONS FOR REHABILITATION.

Eccentric exercise has demonstrated great utility in the rehabilitation of various shoulder pathologies. Research on the electromyographic (EMG) activity of the shoulder musculature during these activities is limited, however. Furthermore, no studies have observed how forearm positioning during exercise affects EMG output. The purpose was to examine the degree of specific muscle recruitment among commonly used eccentric exercises in rehabilitation of the upper extremity and shoulder. Secondarily, the authors hypothesized that different hand/forearm positions would alter EMG activity within the targeted musculature during a given exercise. Prospective cross-sectional observation of EMG analysis. This study analyzed surface EMG data obtained from 10 healthy individuals during five eccentric exercises of the dominant extremity, performed in a randomized order: side-lying eccentric horizontal abduction (SL ER), half-kneeling weighted ball decelerations (BALL DC), seated eccentric external rotation in scaption (STD ER), standing eccentric external rotation at 0deg (STND ER), supine eccentric external rotation at 90deg (SUP ER). Each exercise was performed with two to three forearm position variants commonly used in clinical environments: neutral, pronation, and/or supination. EMG data were collected from the upper trapezius, infraspinatus, teres minor, latissimus dorsi, and anterior/middle/posterior deltoid. Data were analyzed for each individual exercise and within each muscle using a mixed-model ANOVA repeated across forearm position. Significant interactions were followed by a Bonferroni post-hoc test for pairwise comparisons. Effect size was calculated for all significant pairwise comparisons using a Cohen's d statistic. Significant differences in EMG activity for the selected musculature exist between forearm positions for four of the five exercises and Cohen's d effect sizes 0.178 - 1.159. Specific eccentric shoulder exercises activate muscles of the shoulder complex differently based on forearm positioning. Level 2.

The Sensor-Based Physical Analogue Scale as a Novel Approach for Assessing Frequent and Fleeting Events: Proof of Concept.

New technologies (e.g., smartphones) have made it easier to conduct Experience Sampling Method (ESM) studies and thereby collect longitudinal data in situ. However, limiting interruption burden (i.e., the strain of being pulled out of everyday life) remains a challenge, especially when assessments are frequent and/or must be made immediately after an event, such as when capturing the severity of clinical symptoms in everyday life. Here, we describe a wrist-worn microcomputer programmed with a Physical Analogue Scale (PAS) as a novel approach to ESM in everyday life. The PAS uses the position of a participant's forearm between flat and fully upright as a response scale like a Visual Analogue Scale (VAS) uses continuous ratings on a horizontal line. We present data from two pilot studies (4-week field study and lab study) and data from a 2-week ESM study on social media ostracism (i.e., when one's social media message is ignored; N = 53 participants and 2,272 event- and time-based assessments) to demonstrate the feasibility of this novel approach for event- and time-based assessments, and highlight advantages of our approach. PAS angles were accurate and reliable, and VAS and PAS values were highly correlated. Furthermore, we replicated past research on cyber ostracism, by finding that being ignored resulted in significantly stronger feelings of being offended, which was more pronounced when ignored by a group compared to a single person. Furthermore, participants did not find it overly difficult to complete the assessments using the wearable and the PAS. We suggest that the PAS is a valid measurement procedure in order to assess fleeting and/or frequent micro-situations in everyday life. The source code and administration application are freely available.

Comparison of visibility of ulnar sided triangular fibrocartilage complex (TFCC) ligaments between isotropic three-dimensional and two-dimensional high-resolution FSE MR images

ObjectivesAssessment of the ulnar attachment of the triangular fibrocartilage complex (TFCC) in a neutral forearm position remains challenging. Our study aims to evaluate the visibility of ulnar sided TFCC on 3 T MRI and compare isotropic 3D FSE sequences utilizing multiplanar reformation (MPR) with standard high-resolution 2D FSE sequences. MethodsNinety-nine MRI wrist studies in patients with wrist pain were retrospectively analyzed. Patients were scanned with a neutral forearm position and reviewed with isotropic 3D coronal FSE proton density-weighted images (PDWI) and 2D coronal FSE PDWI. MPR was used for 3D assessment. Visibility of the dorsal radioulnar ligament (DRUL), triangular ligament (TL), and volar radioulnar ligament (VRUL) was assessed by three raters utilizing a five-point grading scale.Grades were compared between 2D and 3D sequences. Intrarater and interrater reliability for the delineation of anatomic structures was measured by Spearman's rank correlation coefficient, Cohen’s kappa, and percentage of exact agreement/agreement within a range of ±1 score point. ResultsVisibility grades in 3D were statistically significantly higher than those in 2D in all ligaments by all raters (p < 0.01). In Spearman's rank correlation coefficient and Cohen’s kappa analysis, interrater correlations and agreements are variable but tended to be higher on 3D than on 2D. Both 2D and 3D sequences showed high intrarater exact agreement in all ligaments (80–91 % on 2D and 88–95 % on 3D). All exact interrater agreements on 3D were acceptable for TL (83–93 %) and acceptable to close to acceptable for VRUL (72–96 %). ConclusionThe utilization of isotopic 3D imaging combined with MPR function significantly improves visibility of ulnar attachment of the TFCC.

Isolate and irreducible radial head dislocation in children: a rare case of capsular interposition

BackgroundRadial head dislocation with no associated lesions, is a relatively uncommon injury in children.In this case report, it is reported a case of anteromedial locked radial head dislocation in children, and we discuss its clinical presentation and pathogenetic mechanism of injury.Case presentationAn 8-year-old girl fell off on her right forearm with her right elbow extended in hyperpronation. An isolated radio-capitellar dislocation was identified with no other fractures or neurovascular injuries associated. Elbow presented an extension-flexion arc limited (0°- 90°), and the prono-supination during general anesthesia shows “a sling effect” from maximal pronation (+ 55°) and supination (+ 90°) to neutral position of forearm. The radial head dislocation was impossible to reduce and an open reduction was performed using lateral Kocher approach. The radial head was found “button-holed” through the anterior capsule. The lateral soft tissues were severely disrupted and the annular ligament was not identifiable. Only by cutting the lateral bundle of the capsule was possible to reduce the joint.At 50 moths follow-up, patient presented a complete Range of motion (ROM), complete functionality and no discomfort or instability even during sport activities.Discussion and conclusionIt is important to understand the pathogenic mechanisms of locked radial head dislocation in children. Some mechanism described are the distal biceps tendon or the brachialis tendon interposition. However even the anterior capsule can hinder reduction. A characteristic “sling-effect” of the forearm could be pathognomonic for capsular button-holing. Surgical release of the capsular bundle sometimes is the only way to reduce the dislocation and obtain a good outcome.

Evaluasi Aktivitas Manual Material Handling dan Penerapan K3 Bagian Palletizing Kemasan Jerigen di PT. XYZ

&lt;span lang="EN"&gt;Production results that are handled manually are lifting the burden of jerry cans weighing 24 kg from the conveyor to the pallet. This removal process is risky for musculoceletal and can cause lower back pain. The appointment process takes place in the packing line section D. The purpose of this study is to determine the level of risk, find out the form of conveyor in accordance with working conditions and provide recommendations for corrective actions to be taken when the operator's work attitude has the risk of injury. The assessment of work posture is based on the assessment of RULA for each part (upper arm, forearm, wrist, wrist rotation, back, neck, and leg position) which are then categorized based on the results of the grand score on the action level indicating that the posture is required repair or not. The results of this study found that 3 workers for the grand score of work posture an average of 7 which indicates the need for action now. This is influenced by heavy loads with manual lifting&lt;/span&gt;.

The contact area of the radiocapitellar joint under pronation and supination with axial load using a 3-dimensional computed tomography: an in vivo study

To evaluate the contact area of the radiocapitellar joint with forearm pronation and supination under axial loading. Six healthy volunteers (2 males and 4 females, mean age: 44.6 years) were included in the study. A computed tomography scan of the extended elbow joints was obtained at 4 positions of forearm: full pronation with or without loadand full supination with or without load. Mimics, 3-matic Medical, Geomagic, and Photoshop were used to reconstruct 3-dimensional models. The contact area of the radiocapitellar joint was measured. Shifting of the center of the contact area of the radiocapitellar joint was measured. The axial load added 8.6% and 10.5% contact area to pronation and supination without load, respectively. From pronation without load, the center of contact area significantly shifted 2.4 ± 1.1 mm anteromedially to supination without load and shifted by 1.0 ± 0.5 mm to the center of the radial head compared with the pronation with load. The center of the contact area significantly shifted 2.4 ± 1.5 mm anteromedially from the pronation to the supination under loading. The contact area of the tuberosity anterior in the radial head significantly increased by 14% (without load) and 8% (with load) from pronation to supination. Axial loading increases the contact area of the radiocapitellar joint. The center of the contact area of the radiocapitellar joint changed according to loading and shifted to the anterior tuberosity of the radial head from forearm pronation to supination.

Motion of the distal radioulnar joint in extension and flexion of the wrist using axial CT imaging of healthy volunteers

BackgroundThe midcarpal joint and the radiocarpal joint contribute to the extension and flexion of the wrist. Little is known about the contribution of the distal radioulnar joint (DRUJ) to the extension and flexion of the wrist. This study evaluated the ulnar motion in extension and flexion of the wrist using computed tomography (CT) imaging. MethodsA total of 30 wrists of healthy volunteers were enrolled. CT images of the axial sections of the DRUJ were obtained with 3 different positions of the wrist: 0° of extension (straight position), maximum active extension, and maximum active flexion. Each wrist motion was performed with 3 different forearm positions: neutral, pronation, and supination. Ulnar position at the DRUJ level was measured and ulnar position with the wrist in straight position was defined as baseline. The ulnar position was recorded as positive value when the position of the ulnar head was volar side and negative value when the position of the ulnar head was dorsal side. The difference from baseline in a position of maximum extension and flexion was evaluated. ResultsIn forearm neutral position and pronation, a value of ulnar position in maximum wrist flexion is significantly negative compared to that in the wrist straight position: the ulnar head moved dorsally from the wrist straight position to wrist flexion. In forearm supination, a value of ulnar position in maximum wrist extension is significantly positive compared to that in the wrist straight position: the ulnar head moved to the volar side from the wrist straight position to wrist extension. ConclusionsThe ulnar head moves during extension and flexion of the wrist. The direction of the ulnar motion was different according to the wrist and forearm position.

Upper Arm Arteriovenous Grafts are Superior over Forearm Arteriovenous Grafts in Upper Extremity Dialysis Access

In this study, we compared the outcomes of forearm arteriovenous grafts (AVGs) and upper arm AVGs in a large, prospectively collected data set, which represents real-world experience with upper extremity prosthetic dialysis access, to determine if there are clinically significant differences in the upper arm and forearm positions. We identified 2,063 patients who received upper extremity AVGs within the Vascular Quality Initiative data set (2010-2018). Axillary to axillary upper arm AVGs were excluded (n=394) from the analysis. The main outcome measures were primary and secondary patency rates at 12months. Other outcomes were 6-month wound infection, steal syndrome, and arm swelling. The log-rank test was used to evaluate patency loss using a Kaplan-Meier analysis. Cox proportional hazards models were used to examine adjusted association between locations (forearm and upper arm) and outcomes. There were 1,160 forearm AVGs and 509 upper arm brachial artery AVGs in the study cohort. Patients with forearm AVGs were more likely to have a body mass index>30 (45% vs. 38%, P=0.013), no history of previous access (73% vs. 63%, P<0.001), and underwent local-regional anesthesia (56% vs. 43%, P<0.001). The 12-month primary patency (51.5% vs. 62.9%, P<0.001) and secondary patency (76.4% vs. 89.1%, P<0.001) were significantly lower for forearm AVGs. Wound infection, steal syndrome, and arm swelling were similar between forearm AVGs and upper arm AVGs at the 6-month follow-up. In multivariable analysis, the primary patency loss (adjusted hazard ratio (aHR) 1.66, 95% confidence interval (CI) 1.33-2.01, P<0.001) and 12-month secondary patency loss (aHR 2.71, 95% CI 1.84-3.98, P<0.001) were significantly higher for forearm AVGs at 12months. From this observational study of the Vascular Quality Initiative data set, the primary and secondary patency rates were superior for upper arm brachial artery AVGs compared with forearm AVGs.

Biomechanical Modeling: How Much Punching Operators’ Moment of Force in Punching Process

One of the causes of injuri is operator work and machine that is not ergonomic. On SISCO, usage the length of the handle of the punching tool which is made of iron becomes one of problems in the punching process. The manual punching process requires great energy and strength. This causes operators complaints during the production process include hand and arm muscular pains. One of the ways to minimize pains, injuries, and accidents is using biomechanical approach. The method used in the biomechanical approach is using biomechanical modeling Single-segment Static Model. In the study obtained, the calculations of moment of force at the initial position of palm, forearm and upper arm generated values of 14.7175 Nm, 29.5236616 Nm and 32.1110157 Nm, while moment of force at the final position of palm, forearm and upper arm generated values of 34.2256666 Nm and 37.396405 Nm. The calculations of moment of force at the initial and final positions indicate that the distance of arm influence the moment of force; the longer the arm length, the bigger the moment of force produced.

Medical Staff’s Posture on Airflow Distribution and Particle Concentration in an Operating Room

During a surgical procedure, each of the medical staffs would have different postures. Supporting medical staff such as anaesthesiologist would stand in upright condition with straighten-forearm, while medical staff that is performing surgical procedures is in bent-forearm posture. The positioning of forearm might interrupt the air supplies from the ceiling-mounted diffuser, that serves to remove the airborne particles from the surgical zone. Consequently, the movement of particles in the surgical zone is affected, and the tendency of particles to fall onto the patient’s wound is increased. This situation could elevate the chances of a patient contracting surgical site infections and could increase the risk of death. The present study aims to examine the effects of medical staff’s forearm posture on the number of particles falling onto the patient. A simplified computational fluid dynamics (CFD) model of the operating room was developed and validated based on the published data. An RNG k-ε turbulence model based on the Reynolds-Averaged Navier-Stokes (RANS) equations was used to simulate the airflow, while a discrete phase model was used to simulate the movement of the airborne particles. Results show that bent-forearm of medical staff obstructed the downward airflow to remove the particles released by the medical staff. Approximately 37 particles/m3 accumulated in the chest region of the medical staff. A high particle accumulation is also observed at the gap between the staff’s legs due to the stagnant airflow.

Characterizing forearm muscle activity in young adults during dynamic wrist flexion–extension movement using a wrist robot

Current research suggests that the wrist extensor muscles function as the primary stabilizers of the wrist-joint complex. However, most investigations have utilized isometric study designs, with little consideration for wrist dynamics or changes in posture. The purpose of the present study was to assess forearm muscle activity during the execution of dynamic wrist flexion/extension in multiple forearm orientations (pronation/supination). In 12 young adult males, surface electromyography (EMG) was recorded from eight muscles of the dominant arm: flexor carpi radialis (FCR), flexor carpi ulnaris (FCU), flexor digitorum superficialis (FDS), extensor carpi radialis (ECR), extensor carpi ulnaris (ECU), extensor digitorum (ED), biceps brachii (BB) and triceps brachii (TB). While grasping a handle, participants performed dynamic wrist flexion/extension using a three-degrees-of-freedom wrist manipulandum. The robotic device applied torque to the handle, in either a flexion or extension direction, and in one of three forearm postures (30° supinated/neutral/30° pronated). Results indicated that forearm posture had minimal influence on forearm muscle activity, but significantly altered the activity of the biceps and triceps brachii. Movement phase (concentric-eccentric) dictated muscle activity in every muscle. Interestingly, muscle activity in the eccentric phase was equal between the two applied handle torques, regardless of whether the muscle acted as the agonist or antagonist. Co-contraction ratios were higher in the flexion conditions (flexion: 2.28 ± 2.04, extension: 0.32 ± 0.27), suggesting significantly greater wrist extensor activity–likely a contribution to wrist joint stability. This highlights the vulnerability of the wrist extensor muscles to overuse injuries in settings requiring prolonged use of dynamic wrist exertions.

Three-Dimensional Automated Assessment of the Distal Radioulnar Joint Morphology According to Sigmoid Notch Surface Orientation

To develop reproducible 3-dimensional measurements for quantification of the distal radioulnar joint (DRUJ) morphology. We hypothesized that automated 3-dimensional measurement of the ulnar variance (UV) and the sigmoid notch (SN) angle would be comparable to those of the reference standard while overcoming some drawbacks of conventional 2-dimensional measurements. Radiological data of healthy forearm bones (radiographs and computed tomography) of 53 adult subjects were included in the study. Automated measurements were developed for assessment of the SN morphology based on 3-dimensional landmarks, incorporating subject-specific estimation of cartilage surface orientation. A common anatomical reference was defined among the different imaging modalities and a comparison of the SN angle and UV measurements was performed in radiographs, computed tomography scans, and 3-dimensional models. Finally, the 3-dimensional UV measurements were evaluated in an experimental setup using 3-dimensional printed bone models. The automated 3-dimensional measurements of SN subtypes showed a notably larger notch radius (18.9 mm) for negative SN angles compared with positive SN angles in subjects (16.9 mm). Similar UV measurements were obtained in healthy DRUJ morphologies, with a high correlation between radiographs and 3-dimensional measurements for the SN angle (0.77) and UV (0.85). In the experimental setup with pathological radial inclinations, UV was on average 1.13 mm larger in the radiographs compared with the 3-dimensional measurements, and 1.30 mm larger in the cases with pathological palmar tilts. Furthermore, UV radiograph measurements on the modified palmar tilt deviated from the 3-dimensional measurements. The developed 3-dimensional automated measurements were able to quantify morphological differences among sigmoid notch subtypes and were comparable to those of the reference standard. The developed methods do not depend on the forearm position or orientation of the distal radius and can be used for 3-dimensional quantification of DRUJ pathologies in 3-dimensional surgical planning.

Characterizing forearm muscle activity in university-aged males during dynamic radial-ulnar deviation of the wrist using a wrist robot

Functioning as wrist stabilizers, the wrist extensor muscles exhibit higher levels of muscle activity than the flexors in most distal upper-limb tasks. However, this finding has been derived mostly from isometric or wrist flexion-extension protocols, with little consideration for wrist dynamics or radial-ulnar wrist deviations. The purpose of this study was to assess forearm muscle activity during the execution of dynamic wrist radial-ulnar deviation in various forearm orientations (pronation/supination). In 12 healthy university-aged males, surface electromyography (EMG) was recorded from eight muscles of the dominant arm: flexor carpi radialis (FCR), flexor carpi ulnaris (FCU), flexor digitorum superficialis (FDS), extensor carpi radialis (ECR), extensor carpi ulnaris (ECU), extensor digitorum (ED), biceps brachii (BB) and triceps brachii (TB). While grasping a handle, participants performed dynamic radial-ulnar deviation using a three-degrees-of-freedom wrist manipulandum. The robotic device applied torque to the handle, in either a radial or ulnar direction, and in one of three forearm postures (30° supinated/neutral/30° pronated). Results indicated that forearm posture influenced the muscles acting upon the hand (FDS/ED), whereas movement phase (concentric-eccentric) and torque direction influenced nearly every muscle. The ECR demonstrated the greatest task-dependency of all forearm muscles, which is possibly reflective of forearm muscle lines of action. Co-contraction ratios were much higher in radial trials than ulnar (Radial: 1.20 ± 0.78, Ulnar: 0.28 ± 0.18, P < 0.05), suggesting greater FCU and ECU contribution to wrist joint stability in radial-ulnar movement. These findings highlight a greater complexity of wrist extensor function than has previously been reported in isometric work.

RADIOGRAPHIC ANATOMY OF THE FORELIMB IN THE NORTHERN TAMANDUA (TAMANDUA MEXICANA).

The thoracic limb anatomy of anteaters in the family Myrmecophagidae is specialized for accessing termite and ant nests and for defense purposes. In the case of the northern tamandua (Tamandua mexicana), the forelimbs are also adapted for arboreal and terrestrial locomotion. Unfortunately, this species faces many conservation threats, such as habitat loss and traffic accidents, and injured individuals are frequently taken to wildlife rehabilitation centers. However, lack of knowledge of the radiographic osteoanatomy of this species may prevent appropriate management of injuries and thereby reduce the chances of successful release and survival. In order to fill this knowledge gap, this article describes for the first time the radiographic anatomy of the thoracic limb of the northern tamandua using four standard views and one additional view. The additional orthogonal view helps visualize structures, such as the hamatus process and the sesamoid bone, that are otherwise difficult to visualize due to the natural forearm position of anteaters. Additionally, some fractures and physeal growth plates were identified in one juvenile individual. Further radiographic investigations should be conducted on anteaters to provide more tools for diagnosis, treatment, and rehabilitation of these animals.

Correlation Between Forearm Positions Across Elbow Joint and Ulnar Nerve Conduction Velocity Among Mobile Hand-Held Users

Abstract: Background: Extensive use of mobile hand-held devices with prolonged forearm pronation and elbow flexion could result in pain and weakness with decreased nerve conduction velocities (NCV) of peripheral nerves. Purpose: To identify the ulnar nerve conduction velocity at different forearm positions across elbow joint in mobile-hand held devices users. Design of the study: One shot case study Subjects: Fifty healthy subjects from both genders, Their age ranged from 20 to 40 years old. All subjects had body mass index BMI between 18.5 and 24.9 Kg/m2. Method: Electromyography (EMG) was used for measuring ulnar NCV across elbow joint at different angles (0, 45, and 90,120) degrees of elbow flexion with different forearm positions (supination and pronation). Result: Multivariate Analysis of Variance (MANOVA) revealed that there was a statistical significant difference in mean values of ulnar nerve conduction velocities at different angles of elbow flexion with forearm supination and pronation (P=0.001). There was a statistical significant difference in mean values of ulnar nerve conduction velocities between forearm pronation and supination at the different angles of elbow flexion (P=0.001). Conclusion: forearm supination with full extension elbow position showed the most significant increase in ulnar nerve conduction velocity than other positions. As well as the best position for elbow joint during using mobile hand held devices is 0°-45° elbow flexion with elbow supinated.

Diurnal Profiles of Physical Activity and Postures Derived From Wrist-Worn Accelerometry in UK Adults

Background: Wrist-worn accelerometry is the commonest objective method for measuring physical activity in large-scale epidemiological studies. Research-grade devices capture raw triaxial acceleration which, in addition to quantifying movement, facilitates assessment of orientation relative to gravity. No population-based study has yet described the interrelationship and variation of these features by time and personal characteristics. Methods: 2,043 United Kingdom adults (35–65 years) wore an accelerometer on the non-dominant wrist and a chest-mounted combined heart-rate-and-movement sensor for 7 days free-living. From raw (60 Hz) wrist acceleration, we derived movement (non-gravity acceleration) and pitch and roll (forearm) angles relative to gravity. We inferred physical activity energy expenditure (PAEE) from combined sensing and sedentary time from approximate horizontal arm angle coupled with low movement. Results: Movement differences by time-of-day and day-of-week were associated with forearm angles; more movement in downward forearm positions. Mean (SD) movement was similar between sexes ∼31 (42) mg, despite higher PAEE in men. Women spent longer with the forearm pitched &gt;0°, above horizontal (53% vs 36%), and less time at &lt;0° (37% vs 53%). Diurnal pitch was 2.5–5° above and 0–7.5°below horizontal during night and daytime, respectively; corresponding roll angles were ∼0° (hand flat) and ∼20° (thumb-up). Differences were more pronounced in younger participants. All diurnal profiles indicated later wake-times on weekends. Daytime pitch was closer to horizontal on weekdays; roll was similar. Sedentary time was higher (17 vs 15 hours/day) in obese vs normal-weight individuals. Conclusions: More movement occurred in forearm positions below horizontal, commensurate with activities including walking. Findings suggest time-specific population differences in behaviors by age, sex, and BMI.

Physeal sparing distal radio-ulnar joint ligament reconstruction in children.

Distal radio-ulnar joint (DRUJ) injuries are under-reported in the paediatric population. No single study has discussed methods of DRUJ reconstruction in immature patients with chronic instability. We present a physeal sparing ligamentoplasty for chronic DRUJ instability and describe the outcomes in two patients. Two consecutive children with chronic DRUJ instability were treated using physeal sparing ligamentoplasy. After the failure of triangular fibrocartilage complex repair, reconstruction was done using palmaris longus tendon graft that was tunnelled through the distal radius epiphysis and wrapped subperiosteally around the ulnar neck. Graft was tied in a neutral forearm position. DRUJ stability was achieved in both patients. Grip strength averaged 90% of the healthy side. Prono-supination range of motion (ROM) averaged 88 and 86%, respectively, of the healthy side, without intraoperative nor postoperative complications. Our novel technique was effective in the regain of DRUJ stability with minor effect on the prono-supination ROM. Further studies are planned to experiment the biomechanical effectiveness of our technique. Level of evidence: Therapeutic IV.

Potential Risk of Developing Peripheral Neuropathy in Heavy Motor Vehicle Driving: A Cross-sectional Study

Introduction: There is a growing concern regarding increasing road traffic accidents due to overburdened drivers, which also affect their general health. Drivers maintain the extreme position of arm, forearm, and legs which during distant journeys may put increased constraint on nerves passing in forearm and legs in addition to the vibrations transmission i.e., Hand Arm Vibration Syndrome (HAVS) and Foot Transmitted Vibration (FTV). Aim: To find out if chronic repeated movements at wrist and foot along with vibration transmitted from steering wheel and pedals influence the nerve conduction parameters and to find out which nerves are more prone to neurological conduction defects. Materials and Methods: A cross-sectional study was conducted over a period of two years in Neurophysiology Lab, Department of Physiology, JN Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India. Mean peak sensory and motor latency, mean motor and sensory Nerve Conduction Velocity (NCV), Sensory Nerve Action Potential (SNAP) and Compound Muscle Action Potential (CMAP) of median, ulnar and common peroneal nerve in Professional Heavy Vehicle Drivers (PHVD) was compared with non-drivers using Medicaid System’s (Electromyography) EMG/ (Nerve Conduction Velocity) NCV equipment with Neuroperfect Software. Student’s unpaired t-test was used to assess the significance of difference in nerve conduction study findings. Results: Heavy vehicle drivers showed slow Sensory Nerve Conduction Velocity (SNCV) (drivers: 51.40±3.30, non-drivers: 53.66±3.60 in right hand p-value 0.0001) and (drivers: 52.51±3.78, non-drivers: 53.87±3.61 in left hand p-value=0.0145) and increase in sensory latency (drivers: 3.71±0.72, non-drivers: 2.89±0.56 in right hand p-value&lt;0.0001 and drivers: 3.4±0.81 non-drivers: 2.76±0.70 in left hand p-value &lt;0.0001) of median nerve. Ulnar nerve sensory latency was prolonged (drivers: 2.98±0.52, non-drivers: 2.76±0.42 in right hand p-value 0.0021 and drivers: 2.97±0.42, non-drivers: 2.80±0.65 in left hand p-value 0.0386) and sural nerve sensory latency was prolonged (drivers: 3.05±0.55, non-drivers: 2.78±0.54 in right leg p-value=0.0011 and drivers: 2.92±0.45, non-drivers: 2.69±0.40 in left leg p-value 0.0004).There was no significant difference in Motor Nerve Conduction Velocity (MNCV), motor latency, SNAP and CMAP of median, ulnar and common peroneal nerve among heavy vehicle drivers in comparison to non-drivers. Conclusion: We conclude that pressure and vibrations transmitted at hand and foot along with repeated movements at forearm wrist and pedals leads to more neurological conduction defects in median nerve than in ulnar and sural nerve. Flexibility in delivery time, incorporating judicious breaks in duty, better ergonomics design may help in improving work conditions of drivers.

The effects of forearm position and contraction intensity on cortical and spinal excitability during a submaximal force steadiness task of the elbow flexors.

Elbow flexor force steadiness is less with the forearm pronated (PRO) compared with neutral (NEU) or supinated (SUP) and may relate to neural excitability. Although not tested in a force steadiness paradigm, lower spinal and cortical excitability was observed separately for biceps brachii in PRO, possibly dependent on contractile status at the time of assessment. This study aimed to investigate position-dependent changes in force steadiness as well as spinal and cortical excitability at a variety of contraction intensities. Thirteen males (26 ± 7 yr; means ± SD) performed three blocks (PRO, NEU, and SUP) of 24 brief (~6 s) isometric elbow flexor contractions (5, 10, 25 or 50% of maximal force). During each contraction, transcranial magnetic stimulation or transmastoid stimulation was delivered to elicit a motor-evoked potential (MEP) or cervicomedullary motor-evoked potential (CMEP), respectively. Force steadiness was lower in PRO compared with NEU and SUP (P ≤ 0.001), with no difference between NEU and SUP. Similarly, spinal excitability (CMEP/maximal M wave) was lower in PRO than NEU (25 and 50% maximal force; P ≤ 0.010) and SUP (all force levels; P ≤ 0.004), with no difference between NEU and SUP. Cortical excitability (MEP/CMEP) did not change with forearm position (P = 0.055); however, a priori post hoc testing for position showed excitability was 39.8 ± 38.3% lower for PRO than NEU at 25% maximal force (P = 0.006). The data suggest that contraction intensity influences the effect of forearm position on neural excitability and that reduced spinal and, to a lesser extent, cortical excitability could contribute to lower force steadiness in PRO compared with NEU and SUP.NEW & NOTEWORTHY To address conflicting reports about the effect of forearm position on spinal and cortical excitability of the elbow flexors, we examine the influence of contraction intensity. For the first time, excitability data are considered in a force steadiness context. Motoneuronal excitability is lowest in pronation and this disparity increases with contraction intensity. Cortical excitability exhibits a similar pattern from 5 to 25% of maximal force. Lower corticospinal excitability likely contributes to relatively poor force steadiness in pronation.

Lambeau circonférentiel en rotation pour la stabilisation longitudinale du radius

Surgical management of radial longitudinal deficiency (RLD) aimed to correct the wrist radial deviation by centralizing the carpus upon the ulnar distal end, conjointly with soft tissue structures balancing around the wrist, whilst preserving the distal ulnar physis growth potential. Although, several skin incisions were used for centralization procedure, but few of them dealt with the issue of substantial skin tension radially with available redundant skin ulnarly, and the difficulty for full access of the radio-volar aspect for fully release the tethering structures. Nineteen wrists in 13 patients with RLD of Bayne and Klug type IV, were operated on by centralization using circumferential rotational flap between 2008 and 2017. The average age at the time of centralization was 18.5 months. Follow-up evaluation was done at 3 months intervals, average follow-up was 42 months. Patients were evaluated at postoperative follow-up according to the clinical appearance of scar, wrist stability, and radiological parameters on preoperative and postoperative radiographs. Encouraging primary wound healing, and on the latest follow-up; a smooth satisfactory wrist contour was restored, significant improvement of the hand forearm angle (HFA) and hand forearm position (HFP) compared with the preoperative measures, and a significant ulna growth continued postoperatively signifying no distal ulnar physis injury occurred. Parents were satisfied with the resulted esthetics and function of the hand, which would be attributed to the improved stability of the carpo-ulnar pseudo-articulation. This flap allowed excellent access to the radio-volar aspect of the wrist, and facilitates rotation of the ulnar redundant skin in a radio-volar direction, whilst rotating the distal hand and carpus into ulnar-sided direction, provided additional skin to the radial aspect. It was safely used for centralization procedure in this study preserving the growth potential of the distal ulna without memorable complications attributed to the flap, leaving a smooth satisfactory contoured wrist. A circumferential rotational flap was safely used for centralization procedure in this study, provided additional skin on the radial aspect and take up the slack on the ulnar aspect and gave excellent access to the wrist and surrounding soft tissue structures without recorded complications attributed to the flap.