Full Active Range Of Motion Research Articles

Shoulder Range of Motion Measurement Using Inertial Measurement Unit-Concurrent Validity and Reliability.

This study aimed to evaluate the reliability of the RSQ Motion sensor and its validity against the Propriometer and electronic goniometer in measuring the active range of motion (ROM) of the shoulder. The study included 15 volunteers (mean age 24.73 ± 3.31) without any clinical symptoms with no history of trauma, disease, or surgery to the upper limb. Four movements were tested: flexion, abduction, external and internal rotation. Validation was assessed in the full range of active shoulder motion. Reliability was revised in full active ROM, a fixed angle of 90 degrees for flexion and abduction, and 45 degrees for internal and external rotation. Each participant was assessed three times: on the first day by both testers and on the second day only by one of the testers. Goniometer and RSQ Motion sensors showed moderate to excellent correlation for all tested movements (ICC 0.61-0.97, LOA < 23 degrees). Analysis of inter-rater reliability showed good to excellent agreement between both testers (ICC 0.74-0.97, LOA 13-35 degrees). Analysis of intra-rater reliability showed moderate to a good agreement (ICC 0.7-0.88, LOA 22-37 degrees). The shoulder internal and external rotation measurement with RSQ Motion sensors is valid and reliable. There is a high level of inter-rater and intra-rater reliability for the RSQ Motion sensors and Propriometer.

Accuracy of a Smartphone Software Application Compared With a Handheld Goniometer for Measuring Shoulder Range of Motion in Asymptomatic Adults.

Typically, shoulder range of motion (ROM) measurements are performed in a clinic setting, where physicians, physical therapists (PTs), and occupational therapists make use of a goniometer. To determine the accuracy of a smartphone-based ROM software application (app) in assessing active shoulder ROM and compare the measurements with traditional goniometry as measured by a PT. Cohort study (diagnosis); Level of evidence, 2. This prospective, nonblinded study was conducted at a single institution with adult asymptomatic participants with full active ROM of both shoulders. Participants were enrolled between June 1 and 15, 2021. Each participant self-assessed their active shoulder ROM using the PeerWell smartphone app. A single PT concurrently measured each participant's active shoulder ROM using a handheld universal goniometer. Bilateral shoulder ROM (forward flexion, abduction [AB], external rotation, internal rotation [IR], and extension) was measured 2 times for each participant. Interrater reliability between the smartphone app and PT measurements as well as intrarater reliability for each method of measurement were assessed using the intraclass correlation coefficient (ICC), and limits of agreement were analyzed for the difference in measurement methods. Data were analyzed for 60 shoulders (30 right, 30 left) from 30 participants (mean age, 31.4 ± 11.7 years; 73% female). The interrater reliability between the 2 methods was excellent for all movements (ICCs, 0.90-0.96). For all movements except shoulder AB, the mean difference in the measurements between the 2 methods was <1.3°; the mean difference in AB ROM was 2.08°. For all movements except IR, both PTs and the app showed excellent intrarater reliability (ICCs >0.90); for IR, good intrarater reliability (ICC ≥0.75) was observed. The PeerWell smartphone app provided measurements comparable with manual measurements taken by a PT using a goniometer. These data provide evidence that the smartphone app is a reliable and valid tool for measuring shoulder ROM and show promise for measuring and monitoring patient ROM remotely.

Lack of Consensus in Rehabilitation Protocols After Posterior Shoulder Stabilization.

Posterior shoulder instability is being identified and treated more frequently by orthopaedic providers. After posterior shoulder stabilization, long-term outcomes in function and mobility are largely dependent on the postoperative rehabilitation period. Thus, it is important to assess the consistency between protocols at different institutions. The purpose of this study was to investigate the variability among rehabilitation protocols published by academic orthopaedic programs and their affiliates. It was hypothesized that there would be little consistency in the duration of immobilization, timing of functional milestones, and start dates of various exercises. Cross-sectional study. Rehabilitation protocols after posterior shoulder stabilization that were published online from Accreditation Council for Graduate Medical Education (ACGME)-accredited orthopaedic surgery programs and their affiliates were evaluated for recommendations on immobilization, exercises, activities, range of motion (ROM), and return-to-sport goals. Of the 204 ACGME-accredited orthopaedic surgery programs, 22 programs and 17 program affiliates had publicly available rehabilitation protocols that were included for review. There were 37 programs (94.9%) that recommended the use of sling immobilization for a mean of 4.7 ± 1.8 weeks postoperatively. Active ROM of the elbow, wrist, and hand was the most common early ROM exercise to be recommended (36 programs; 92.3%). The goal of 90° passive external rotation demonstrated the widest range of recommended start dates (0-12 weeks postoperatively). Late ROM exercises and start dates varied between protocols, with the largest standard deviation found in achieving full active ROM (13.5 ± 3.6 weeks). Resistance exercises showed a wide range of recommended start dates. Bench presses and push-ups began, on average, at 13.1 ± 3.4 and 15.3 ± 3.2 weeks, respectively. Return to sport was recommended at 21.7 ± 3.6 weeks. There was a high level of variability in postoperative rehabilitation protocols after posterior shoulder stabilization among orthopaedic programs and their affiliates, suggesting that a standard protocol for rehabilitation has yet to be established.

Isolated fracture of the lesser tuberosity of the humerus – a rare injury that requires surgical treatment

Introduction. An isolated fracture of the small tuberosity is a very rare injury that can often be overlooked. That injury is significant due to the function of the subscapularis muscle, which loses its attachment by separating the small tuberosity. Case report. A 45-year-old male, former athlete, suffered a left shoulder injury while falling downhill. Although the clinical picture was not convincing, a computed tomography scan showed a fracture. Open repositioning and osteosynthesis were performed. After rehabilitation, the patient regained a full active range of motion in the shoulder joint three months after the operation. We present the mechanism of injury, clinical picture, necessary diagnostics, and technique of surgical treatment of isolated fracture lesser tuberosity of the humerus. The results of other authors whose series are also quite small were analyzed. Conclusion. It was concluded that an isolated fracture of the small tuberosity requires surgical treatment to preserve a good range of motion in the shoulder joint.

Titanium elastic nail for infected humerus fracture with wrist drop: a rare case report

&lt;p class="abstract"&gt;Humerus mid-shaft fractures are typically managed with ORIF and plate fixation but a rare attempt for CRIF with titanium elastic nail (TENS) nail done even with infection &lt;em&gt;in situ&lt;/em&gt;. A 28 year old male, a daily wage worker presented to us with mid-shaft humerus fracture with wrist drop after an incident of fall while carrying heavy load on his head. On X-ray evidence of osteolysis at the fracture site was found and following bone biopsy infected foci was discovered. Later, managed with CRIF with TENS nail and antibiotics. CRIF for infected long bone fracture is rare, but a bold attempt was made for internal fixation which yielded good results and post-operative 3 months showed great results with full active range of motion without any infective foci and with recovery of wirst range of motion.&lt;/p&gt;

Isolated Spinal Accessory Nerve Palsy from Volleyball Injury.

Spinal accessory nerve (SAN) palsy is typically a result of posterior triangle surgery and can present with partial or complete paralysis of the trapezius muscle and severe shoulder dysfunction. We share an atypical case of a patient who presented with SAN palsy following an injury sustained playing competitive volleyball. A 19-year-old right hand dominant competitive volleyball player presented with right shoulder weakness, dyskinesia, and pain. She injured the right shoulder during a volleyball game 2 years prior when diving routinely for a ball. On physical examination she had weakness of shoulder shrug and a pronounced shift of the scapula when abducting or forward flexing her shoulder greater than 90 degrees. Manual stabilization of the scapula eliminated this shift, so we performed scapulopexy to stabilize the inferior angle of the scapula. At 6 months postoperative, she had full active range of motion of the shoulder. SAN palsy can occur following what would seem to be a routine volleyball maneuver. This could be due to a combination of muscle hypertrophy from intensive volleyball training and stretch sustained while diving for a ball. Despite delayed presentation and complete atrophy of the trapezius, a satisfactory outcome was achieved with scapulopexy.

Complication after the reconstruction of the old patellar tendon rupture

Introduction. Chronic patellar tendon rupture (PTR) occurs rarely; its frequency and prevalence are unknown. There are very little data on the late patellar tendon reconstruction in rheumatoid arthritis and its complications. Case report. We presented a surgical repair of a PTR with early postoperative rupture of the contralateral patellar tendon for a 21-year-old woman with a past medical history of juvenile rheumatoid arthritis (treated with corticosteroids) who sustained initial injury 11 months prior to the presentation. The contralateral side was used for autograft harvesting. We used bone-tendon-bone (BTB) autograft and allografts followed by double-wire loop reinforcement and immediate postoperative mobilization. The patient was followed for 2 years, and the function of both knees was re-stored completely, with a full active range of motion. In this case, reconstruction of an 11-month-old chronic PTR (with complete resorption of the tendon and completely separated infrapatellar pads, complicated by the contralateral PTR) with BTB autograft and allografts and double wire loop reinforcement gave an excellent functional result. Two years after the surgical treatment, the extensor function of both knees was completely restored with a full range of movements. The patient reported satisfying outcomes and was able to return to all pre-injury activities without the assistance of orthopedic devices. Conclusion. This case report highlights the importance of the early diagnosis and describes operative techniques used in chronic PTR repair and treatments of the early postoperative complications such as rupture of the contralateral tendon.

Persistent Calf Pain In Cyclist

HISTORY: A 57-year-old cyclist male with history of uncontrolled hypertension and hyperlipidemia presented with a 5-year history of progressive calf pain and numbness. He referred symptoms started after a trauma with the bicycle pedal and initially symptoms were precipitated after 2 km of cycling long distances. Nowadays, claudication appears after walking <100 meters distance and even with activities of daily living. PHYSICAL EXAMINATION: examination revealed paresthesia, discoloration and pallor of the right leg, with popliteal and dorsalis pedis pulses reduced with the knee in neutral position and hypertrophy of the calf muscles. There was full active range of motion of his right leg, with no pain. He had no neurological symptoms or signs. Claudication appeared 10 minutes of treadmill walking al 3 km/h. DIFFERENTIAL DIAGNOSIS: 1. Exertional compartment syndrome.2. Popliteal artery entrapment syndrome.3. Tibial stress fracture. TEST AND RESULTS: -Doppler ultrasonography: compromise of popliteal artery with significant occlusion. FINAL WORKING DIAGNOSIS: Peripheral arterial occlusive disease TREATMENT AND OUTCOMES: 1. Endovascular therapy with a stent colocation. 2. Physical therapy with active range of motion of the lower limb, strengthening and flexibility exercises. 3. Control of lipide profile and control of hypertension.4. Return to sports 6 weeks post-op.

Knee Injury - Motorcycling

HISTORY: A 29-year-old male presented to our sports medicine clinic with right knee pain. Three months ago, he had an accident during motorcycle racing in which he fell off the bike. He sustained multiple lacerations including a large laceration on the right knee that was managed nonoperatively. He developed pain and numbness over the anterolateral aspect of the right knee interfering with mobility. He also reported mild right knee weakness and frequent knee buckling. PHYSICAL EXAMINATION: Examination revealed healed laceration with significant scar tissue growth over the anterolateral aspect of the distal third of right thigh. There was moderate tenderness to palpation along borders of the scar, quadriceps tendon, and lateral femoral condyle. Neurologic exam was intact with normal sensation, reflexes, and strength of bilateral lower extremities. There was full active range of motion of right knee but with discomfort at end range of flexion. There was midline tracking of patella throughout range of motion. DIFFERENTIAL DIAGNOSIS: 1. Hypertrophic/Keloid scar pain 2. Arthrofibrosis 3. Chronic patellar dislocation 4. Quadriceps and patellar tendinosis 5. Lateral femoral condyle contusion 6. Patella alta TEST AND RESULTS: Right knee anterior-posterior, lateral and patella radiographs: —there is no evidence of displaced fracture or dislocation.—the patellofemoral alignment is maintained. Right knee magnetic resonance imaging: —patterns of contusion and stress response involving the anterior and lateral aspects of the lateral femoral condyle and inferior pole of the patella, findings suspect for patellar dislocation with subsequent reduction.—medial and lateral collateral ligament scarring. Medial and lateral retinacular sprains.—patella alta with limited arthrosis.—quadriceps and patellar tendinosis. FINAL WORKING DIAGNOSIS: Hypertrophic/Keloid scar pain TREATMENT AND OUTCOMES: 1. Home exercises with quadriceps strengthening for 12-15 weeks, no improvement in pain or function. 2. Two courses of physical therapy with quadriceps and vastus medialis oblique strengthening, range of motion exercises, improvement in range of motion but limited improvement in pain. 3. Ultrasound-guided intralesional corticosteroid injection to the right knee, notable reduction in pain.

Nerve Transfers for Restoration of Elbow Flexion in Patients With Acute Flaccid Myelitis

The purpose of this study was to evaluate short- to midterm outcomes of patients with acute flaccid myelitis who underwent nerve transfers for restoration of elbow flexion. Patients with a minimum of 10 months of follow up after undergoing nerve transfers to restore elbow flexion were clinically assessed using the Active Movement Scale (AMS). They were evaluated for any postoperative complications, particularly weakness in the distribution of the donor nerve(s). Fifteen of 25 consecutive patients who were treated using this surgical technique were included in the final analysis. All patients exhibited poor elbow flexion preoperatively (AMS 0 to 3). At a mean follow up of 17.3 months, 80% (15/25) of patients achieved excellent elbow flexion (AMS 6 or 7); 9 of these 15 had full active range of motion. Two patients achieved good elbow flexion (AMS 5) with antigravity movement to less than 50% of the passive range of motion. No cases of superficial or deep infection were reported, and all patients maintained identical motor function, relative to preoperative status, of the muscles innervated by the donor nerves. Nerve transfer surgery has shown promising short- to midterm results for recovery of nerve and muscle function, particularly for the restoration of elbow flexion. We recommend this treatment option for patients not demonstrating clinical improvement after 6 to 9 months of incomplete recovery. Therapeutic IV.

A Paradigm Shift in Managing Acute and Chronic Boutonniere Deformity: Anatomic Rationale and Early Clinical Results for the Relative Motion Concept Permitting Immediate Active Motion and Hand Use.

We have utilized relative motion splinting for early motion following acute repair of boutonniere injuries, and we have developed nonoperative orthosis-based therapy for the treatment of chronic injuries. We offer our early clinical experience using relative motion flexion splinting for boutonniere deformities and explain the anatomic rationale that permits immediate active motion and hand use following acute injury or repair. For chronic boutonniere deformity, we offer a nonsurgical management method with low morbidity as a safe alternative to surgery. Our understanding of the extrinsic-intrinsic anatomic interrelationship in boutonniere deformity offers rationale for relative motion flexion splinting, which is confirmed by cadaver study. Our early clinical results in 5 closed and 3 open acute and 15 chronic cases have encouraged recommending this management technique. For repaired open and closed acutely injured digits, we utilize relative motion flexion orthoses that place the injured digits in 15° to 20° greater metacarpophalangeal flexion than its neighboring digits and otherwise permit full active range of motion and functional hand use maintaining the 15° to 20° greater metacarpophalangeal flexion for 6 weeks. In fixed chronic boutonniere cases, serial casting is utilized to obtain as much proximal interphalangeal extension as possible (at least -20°), and then relative motion flexion splinting and hand use is instituted for 12 weeks. Our acute cases obtained as good as, or better range of motion than, conventional management techniques, with early full flexion and maintenance of extension without any recurrences. The most significant difference is morbidity, with ability to preserve hand function during healing and the absence of further therapy after 6 weeks of splinting. Patients with chronic boutonniere deformity presented from 8 weeks to 3 years following injury (averaging 31 weeks) and were 15 to 99 years of age (averaging 42 years). All were serially casted to less than -20° (averaging -4°) and maintained that level of extension after 3 months of relative motion flexion splinting. All achieved flexion to their palm, and all met the Steichen-Strickland chronic boutonniere classification of "excellent." There were no recurrent progressive boutonniere deformities in either acute or chronic cases and no instances of reflex sympathetic dystrophy/chronic regional pain syndrome (RSD/CRPS). Relative motion flexion splinting affords early active motion and hand use with excellent range of motion achieved following acute open boutonniere repair or closed boutonniere rupture with less morbidity than conventional management. Chronic boutonniere deformity will respond to relative motion flexion splinting if serial casting can place the proximal interphalangeal joint in less than -20° extension, and the patient actively uses the hand in a relative motion flexion orthosis for 3 months, recovering flexion. No further therapy was needed in our cases. We believe this management technique should be attempted for chronic boutonniere deformity as a preferable alternative to surgery, which remains an option if needed.

Rehabilitation exercise program after surgical treatment of quadriceps tendon rupture: A case report

ObjectivesThis case report describes in detail the rehabilitation exercise program, provide post-operative therapeutic objectives/recommendations and to facilitate the return to a possible schedule of ADL and participation in sports after the surgical treatment of quadriceps tendon rupture. Also, the exact surgical technique is described. DesignA single case report. ParticipantThe patient was an active 53-year-old man who sustained this injury as a result of a sudden misstep with his left foot into a hole, while he was trekking across muddy countryside. Clinical examination of the knee revealed skin ecchymosis, swelling and tenderness over the distal thigh. Plain radiographs showed patella baja, and the scheduled magnetic resonance imaging (MRI) showed interrupted continuity of the quadriceps tendon and the patella. A diagnosis of quadriceps tendon rupture was made and the patient was scheduled to undergo surgical intervention the following day. Rehabilitation exercise programA well-structured rehabilitation exercise program was followed in order to ensure rapid recovery and good functional outcomes. His postoperative course progressed normally, demonstrating a return to the normal activities of daily living at 6 weeks, full active range of motion at 16 weeks, and return to sports recreational activities at 5 months. ConclusionsAn early surgical treatment and subsequently a well-structured rehabilitation exercise program have contributed to maximize the functional outcomes of the patient and provide a rapid and safe return to the activities of daily living (7th week) with participation in non-contact sports after the 18th week.

Heel Injury-Figure Skate

HISTORY: A nine year old female figure skater presented with 6 weeks of atraumatic right foot pain. She recently started training double jumps prior to the onset of pain. Pain was located on the plantar side of the right midfoot and she initially noticed it following practices. Weight bearing increased her pain and eventually it hurt during practice as well as after practice . No changes in training time or frequency. She has been figure skating for two years. No history of previous foot injuries or bone stress injuries. No family history of osteoporosis. Her past medical history is significant for chronic Lyme’s disease. PHYSICAL EXAM: Ht 4' 6" (1.372 m) | Wt 69 lb (31.3 kg) | BMI 16.64 kg/m2 (56 percentile), Healthy and NAD. Accompanied by her mother. Examination: Inspection: Neutral foot type. Normal alignment of lower extremities. There was no redness, swelling, or skin changes. Palpation: moderate tenderness on the right plantar mid foot. Range of motion: there was full active range of motion of the ankle, without significant pain. Strength: Muscle strength (ankle plantarflexion, dorsiflexion, inversion, eversion) full. Special tests: Fracture test (tap, percussion, bump) negative, squeeze test negative, anterior drawer test negative, Talar tilt test negative, Stress test negative, Thompson test negative. DIFFERENTIAL DIAGNOSIS: 1.Navicular bone stress injury 2.Tarsal coalition 3.Anterior tibialis tendinopathy 4.Posterior tibialis tendinopathy 5.Bone tumor 6.Nerve entrapment 7.Heel pad syndrome 8.Sever disease TEST AND RESULTS: 1.Ankle X-ray- No obvious fracture or callus 2.MRI Ankle- bone marrow edema in the neck of the calcaneus 3.DXA- Normal bone density FINAL DIAGNOSIS: Calcaneus bone stress injury TREATMENT AND OUTCOMES: 1.Decreased activity level 2.Non-weight bearing on crutches for 2 weeks 3.Walking boot for 3 weeks with partial weight bearing on crutches 4.PT 1-2x/ week for 2-3 weeks 5.Vitamin D 2000 IU everyday 6.Partial weight bearing to full weight bearing as tolerated 7.Gradual return to sports after 12 weeks of injury, when she did not have pain with ambulation, and repeat MRI showed no evidence of residual bone marrow edema.

Shoulder Pain in a Weightlifter

HISTORY: A 20-year-old male weightlifter presented as a new patient to a sports medicine clinic with left shoulder pain. Pain began five months prior while the patient was performing overhead presses with a 205 lb barbell. While pushing up into his 5th repetition, he felt a “shift” in his left shoulder. He did not have a significant amount of pain at the time. In the following weeks, he began to have more pain in the left shoulder and decreased his weight during overhead presses and chest presses due to pain and weakness. He tried taking two weeks off from lifting, but when he resumed he was unable to complete any overhead or chest work due to pain. The pain is focal over the anterior-lateral shoulder with no radiation. No numbness or tingling. He is unsure if his weakness is due to pain or a separate issue. PHYSICAL EXAMINATION: There was no bony abnormality or muscle atrophy. Patient had full active range of motion of the left shoulder in forward flexion and abduction, with mild pain at end range. Passively, he had 85 degrees of external rotation and 85 degrees of internal rotation with arm abducted to 90 degrees. There was tenderness to palpation along the distal clavicle and acromion, as well as over the supraspinatus, infraspinatus, teres minor/major, biceps, and anterior deltoid. Jobe’s test positive for pain and weakness. Positive cross-arm test. Negative Hawkin’s, Neer’s, O’brien’s, Speed’s, and Yergason’s. Pain with resisted external rotation and shoulder abduction. Strength was 5/5 at bilateral deltoid, biceps, triceps, wrist extensors, finger flexors, and finger abductors, but 4/5 during resisted left glenohumeral external rotation due to pain. DIFFERENTIAL DIAGNOSIS: 1) Glenohumeral subluxation 2) Rotator cuff tear 3) Labral tear 4) AJ joint sprain/separation 5) Clavicle fracture TESTS AND RESULTS: 1) XR Chest from ER visit for unrelated incident: Visualized left clavicle normal, shoulder not visualized. 2) MRI left shoulder without contrast: Nondisplaced fracture of the distal clavicle with associated bony edema of the clavicle and acromion at the AC joint with mild surrounding soft tissue edema. Low grade tendinosis of the infraspinatus and supraspinatus with suspicion for a tiny undersurface tear without retraction. 3) XR Clavicle: Clavicle is intact and negative for fracture. FINAL/WORKING DIAGNOSIS: Nondisplaced fracture of distal clavicle TREATMENT AND OUTCOMES: 1.Given no signs of fracture healing after 5 months, ordered laboratory work which revealed Vitamin D deficiency. Patient started on Vitamin D 1200mg and Calcium 800mg daily. 2. Activity modified to abstain from weight bearing exercises through the left upper extremity until next follow up visit.

After Lightening Strikes: A Case Of Anoxic Encephalopathy In A 30 Year Old Soccer Player

HISTORY: A 30 year old male with a past medical history of hypothyroidism was out playing soccer when he was struck by lightening. After the lightening strike, the patient experienced cardiac arrest, and CPR was performed. Spontaneous circulation was achieved after a 17 minutes of CPR, and the patient was admitted to a burn unit for partial thickness burns of his left anterior chest, abdomen, and right medial lower calf. During the patient’s stay on the burn unit, he was noted to have severe cognitive deficits secondary to an anoxic brain injury sustained during his cardiac arrest, and also had a PEG tube placed after developing aspiration pneumonia. Following the burn unit, the patient was transferred to an acute rehab facility to address the severe cognitive deficits he had developed. Upon arrival at the acute rehabilitation facility, the patient was a Rancho Los Amigos level three. PHYSICAL EXAM: The patient was lying comfortably in bed. He was able to mimic behavior, but was unable to follow commands consistently. On ocular exam, the patient had a left pupil that was fixed and dilated, and sub-conjunctival hemorrhages. Abdominal exam was significant for an in-place PEG tube. Integumentary was significant for partial thickness wounds on his anterior chest and right lower extremity. The patient demonstrated full active range of motion of his upper and lower extremities. DIFFERENTIAL DIAGNOSIS: Anoxic encephalopathy Encephalopathy secondary to electrocution Toxic metabolic encephalopathy TESTS AND RESULTS: -Labs on admission were significant for the following: White blood cell count of 5.0; hemoglobin of 10.3; blood urea nitrogen of 55; AST of 42 and ALT of 70. -CT head on admission showed no evidence of intracranial hemorrhage, lobar infarct, hydrocephalus, or midline shift. FINAL DIAGNOSIS: Anoxic encephalopathy secondary to lightening strike TREATMENT AND OUTCOMES: The patient was started on amantadine to stimulate increased attention and wakefulness, and seroquel and trazadone to help address the patients nocturnal agitation and promote sleep. At the end of his 5 week stay on the acute rehabilitation unit, the patient had advanced to a Ranchos Los Amigos level eight. He was fully oriented to his environment, tolerating an oral diet, engaging in appropriate conversation, and ambulating with a walker.

Symptoms and Functional Measures in Individuals Performing Various Exercise Intensities: A Pilot Study

PurposeTo assess the functional limitations in activities of daily living (ADL) and level of delayed onset of muscle soreness (DOMS) in individuals after completing various intensities of exercises with and without prior yoga stretching poses.MethodsTwelve research participants (untrained active healthy men and women) aged between 18 and 30 years were recruited from students of University of New England and randomly assigned into 2 groups (six participants each). Four muscle groups (elbow flexors, elbow extensors, knee flexors and knee extensors) were selected (one muscle group per limb) from each participant and maximal voluntary isometric contraction (MVIC) in all four selected muscles were calculated using a hand‐held Dynamometer.Participants performed eccentric exercises protocol (5 × 10 repetitions with rest time) with full active range of motion using (Ultimately Fit Adjustable Ankle Weights) their 15% of MVIC on day 1 of first week, 25% of MVIC on day 1 of third week, and 35% of MVIC on day 1 of fifth week in all four limbs (right and left upper elbows and right and left knees). Participants did not perform any exercise protocol during the week 2 and 4. In weeks 1, 3, and 5, after the eccentric exercise protocol (day 1), from day 2 to 6 the subjective (health activities of daily living (ADL) difficulty scale, visual analogue scale (VAS)) and objective assessments (pain pressure threshold (PPT), arm and thigh circumference, and active range of motion (AROM)) were carried out. Group 1 (6 participants) performed only exercise protocol whereas group 2 (6 participants) performed prior yoga stretching poses for upper and lower limbs along with above mentioned exercise protocol.ResultsGroup 2 participants has minimal pain and health activities of daily living (ADL) difficulty when compared to group 1 participants. Group 1 participants performed exercise protocol at week 5 with 35% MVIC had moderate pain (pain scale ranged 3–6 out of 10) in the elbow extensors and ADL difficulty (difficulty level scale ranged 3–6 out of 10) in pull a heavy object, carry an object with my arm above shoulder, washing opposite armpit and back, reach high shelf, ascending stairs, bend to pick up form the floor when compared to group 2 participants. There was no significant difference in the AROM and, arm and thigh circumference between both groups during entire exercise protocol.ConclusionUpper limb (extensors) muscles are more prone for DOMS when compared to lower limb muscles. Yoga stretching poses prior to eccentric exercise protocol may have effect in reducing DOMS.Support or Funding InformationFunded by Biology Department, College of Arts and Sciences, University of New England, METhis abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Incidence of tenolysis and features of adhesions in the digital flexor tendons after multi-strand repair and early active motion.

We report seven patients requiring tenolysis after primary or delayed primary flexor tendon repair and early active mobilization out of 148 fingers of 132 consecutive patients with Zone 1 or 2 injuries from 1993 to 2017. Three fingers had Zone 2A, two Zone 2B, and two Zone 2C injuries. Two fingers underwent tenolysis at Week 4 or 6 after repair because of suspected repair rupture. The other five fingers had tenolysis 12 weeks after repair. Adhesions were moderately dense between the flexor digitorum superficialis and profundus tendons or with the pulleys. According to the Strickland and Tang criteria, the outcomes were excellent in one finger, good in four, fair in one, and poor in one. Fingers requiring tenolysis after early active motion were 5% of the 148 fingers so treated. Indications for tenolysis were to achieve a full range of active motion in the patients rated good or improvement of range of active motion of the patients rated poor or fair. Not all of our patients with poor or fair outcomes wanted to have tenolysis. Level of evidence: IV.

Rehabilitation post-distraction osteogenesis for brachymetacarpia: a case report.

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Efficacy of Thoracolumbar Bracing in Spinal Immobilization: Precise Assessment of Gross, Intersegmental, and Segmental Spinal Motion Restriction by a 3D Kinematic System

Various diseases of the spine are treated by immobilization via orthoses, although detailed evidence on the efficiency of orthotic bracing remains elusive. The present study sought to investigate the impact of 3 different orthoses on spinal immobilization using 3-dimensional (3D) kinematic measurements. Twelve healthy volunteers performed different motion tasks, including trunk flexion/extension and bilateral trunk bending. Movements were performed under 4 different conditions: 1) without orthosis, 2) while wearing a 3-point hyperextension brace (HB), 3) while wearing a custom-made semirigid orthosis (SO), and 4) while wearing a custom-made rigid orthosis (RO). Spinal motion was analyzed using a 3D optical motion capture system assessing regional, intersegmental, and segmental range of motion (ROM). Assessment of spinal motion was successfully accomplished in all subjects. Overall, orthoses significantly reduced spinal motion compared with no bracing. RO caused the greatest restriction of regional, intersegmental, and segmental spinal motion among all orthoses. For flexion/extension, the mean percentage decreases between T3 and L5 in full active ROM with HB, SO, and RO compared with no orthosis were 38%/30%, 48%/47%, and 51%/55%, respectively (P ≤ 0.05). Lateral bending was impaired by 28%, 44%, and 70%, respectively (P ≤ 0.05). Assessment of lateral bending revealed greater immobilization by SO and RO compared with HB (P ≤ 0.05). The present 3D kinematic system allows for precise assessment of spinal motion. Custom-made orthoses cause superior restriction on gross spinal motion compared "off-the-shelf" orthoses. If orthotic bracing is indicated, design, comfort, and patient compliance need to be carefully considered to guarantee successful therapy.

Physical Therapy Protocols for Arthroscopic Bankart Repair

Background:Outcomes after arthroscopic Bankart repair can be highly dependent on compliance and participation in physical therapy. Additionally, there are many variations in physician-recommended physical therapy protocols.Hypothesis:The rehabilitation protocols of academic orthopaedic surgery departments vary widely despite the presence of consensus protocols.Study Design:Descriptive epidemiology study.Level of Evidence:Level 3.Methods:Web-based arthroscopic Bankart rehabilitation protocols available online from Accreditation Council for Graduate Medical Education (ACGME)–accredited orthopaedic surgery programs were included for review. Individual protocols were reviewed to evaluate for the presence or absence of recommended therapies, goals for completion of ranges of motion, functional milestones, exercise start times, and recommended time to return to sport.Results:Thirty protocols from 27 (16.4%) total institutions were identified out of 164 eligible for review. Overall, 9 (30%) protocols recommended an initial period of strict immobilization. Variability existed between the recommended time periods for sling immobilization (mean, 4.8 ± 1.8 weeks). The types of exercises and their start dates were also inconsistent. Goals to full passive range of motion (mean, 9.2 ± 2.8 weeks) and full active range of motion (mean, 12.2 ± 2.8 weeks) were consistent with other published protocols; however, wide ranges existed within the reviewed protocols as a whole. Only 10 protocols (33.3%) included a timeline for return to sport, and only 3 (10%) gave an estimate for return to game competition. Variation also existed when compared with the American Society of Shoulder and Elbow Therapists’ (ASSET) consensus protocol.Conclusion:Rehabilitation protocols after arthroscopic Bankart repair were found to be highly variable. They also varied with regard to published consensus protocols. This discrepancy may lead to confusion among therapists and patients.Clinical Relevance:This study highlights the importance of attending surgeons being very clear and specific with regard to their physical therapy instructions to patients and therapists.