Range Of Motion Impairments Research Articles

Lumbar Spine and Neural Tissue Mobilizations Improve Outcomes in Runners Presenting With Foot/Ankle Pathology: A Case Series.

Foot/ankle pain is common among runners. Inadequate management of runners with foot/ankle pain can lead to lost training time, competition removal, and other activity limitations. Neurodynamics, which refers to the integrated biomechanical, physiological, and structural function of the nervous system during movement, can be overlooked in patients with foot/ankle pain. Although a link between the cervical spine, neurodynamics, and upper quarter pain has been studied, less is known about the relationship between the lumbar spine and lower quarter. This case series describes the successful management of 3 runners with foot/ankle pain. Three female runners (ages 23, 24, and 45y) presented to physical therapy with foot/ankle pain and difficulty running. Each patient had positive examination findings with local foot/ankle testing. A comprehensive lumbar spine examination demonstrated impairments in range of motion and joint mobility that were hypothesized to be contributing. Positive lower quarter neurodynamic tests were also found. All patients were treated with nonthrust lumbar spine mobilization and lower quarter neural tissue mobilization. Changes in the Patient-Specific Functional Scale, Numerical Pain Rating Scale, Lower Extremity Functional Scale, and Global Rating of Change occurred after intervention targeting the lumbar spine and lower-extremity neurodynamics in all patients. This case series demonstrates the importance of including a thorough lumbar spine examination and neurodynamic testing to identify appropriate interventions while managing patients with foot/ankle pain, even when patients have signs indicative of local ankle/foot pathology. These examination procedures should be performed particularly when a patient is not responding to management targeting local foot/ankle structures.

Long-term outcomes after capitate fractures: a median 16-year follow-up.

The long-term effects of a capitate fracture are unknown. The aim of this study was to assess both clinical and radiological long-term outcomes after a capitate fracture. From a cohort of 526 consecutive patients with post traumatic radial sided wrist pain, 23 were identified diagnosed with a capitate fracture. 16 of these (11 males and 5 females) with a median age at injury of 17.5 years (range 11-27 years) were eligible for a follow-up after a median of 16 years (range 8 to 17 years). In this study patients were examined using conventional radiographs, computed tomography (CT) and magnetic resonance imaging (MRI) at the time of injury and with CT at the follow-up. At follow-up radiological signs of osteoarthritis were graded in four stages and clinical outcome was evaluated by measuring range of wrist motion and grip and pinch strength. The subjective outcome was assessed using DASH and PRWE questionnaires. Five patients had isolated capitate fractures and 11 had concomitant fractures, 10 of which had a simultaneous scaphoid fracture. 14 patients had been treated non-surgically in a cast and two patients were treated surgically. None of the fractures were visible on conventional radiographs at the time of injury. At follow-up all fractures had healed without signs of avascular necrosis. In one patient, CT examination revealed osteoarthritis between the capitate and lunate. This did not cause clinical symptoms. Functional impairments and pain scores were low: median DASH score 0, median PRWE 3 and median VAS pain score 0. We found no impairment in range of motion or grip and pinch strength. At a median of 16-year follow-up, patients with a capitate fracture report normal self-assessed hand function as well as good wrist motion and strength. The risk of development of posttraumatic arthritis in the joints around the capitate is low.

Russian versions of FADI and FAAM for preoperative and postoperative assessment of the foot function

Introduction Self-administered questionnaire recommended by international orthopaedic community is a practical instrument for use in pathological conditions related to the foot and ankle.The objective was to validate the Russian-language versions of the FADI and FAAM questionnaires to be filled out by orthopaedic patients with forefoot disorders before and after surgical treatment.Material and methods The study included 100 adult patients with forefoot disorders to be surgically treated. The average age of the patients was 52 ± 12.1 years with 97 % being females and 26 % being athletes. The patients completed the FADI and FAAM questionnaires preoperatively and at 2 months after surgery and they were requested to fill out the SF-36 questionnaire and the LEFS scale preoperatively.Results The Cronbach's α value was 0.91 for activities of daily living and 0.94 for sports measured with both questionnaires. The reproducibility of the questionnaires was demonstrated by high ICC values (≥ 0.992) and no changes (ES < 0.01) in stable patients. Satisfactory construct validity was confirmed by significant correlations in activities of daily living and sports activities; criterion validity was confirmed by the dorsiflexion angle in the MCP1 and the daily (p < 0.001) and sports activities (p < 0.05). Convergent validity of the FADI and FAAM was identified with correlations measured with SF-36 and LEFS. Patients with moderate/severe impairment in range of motion had worse functional status scored with the FADI and FAAM as compared with those who had no/mild impairment. A significant improvement was seen postoperatively in non-athletes (p < 0.001). Sports activity significantly improved postoperatively in athletes (p < 0.05).Discussion A limitation of the study includes the sample consisting mostly of patients with one type of orthopaedic pathology (valgus foot). Another limitation is that the majority of patients were females, and the patients were treated in the same health care facility. We can conclude that in the future it would be advisable to test the Russian versions of the FADI and FAAM questionnaires in patients with other foot pathologies and to conduct multicenter studies using these questionnaires.Conclusion The FADI and FAAM scores measured in the Russian population showed greater sensitivity to changes in the foot/ankle joint in individuals who had indications for surgical treatment for a foot condition.

Impact of Spencer Technique on Pain, Range of Motion, and Functional Disability in Patients With Frozen Shoulder: A Pilot Study.

Background and objective The shoulder is the most flexible ball- and socket-type joint in the human body. The pathological condition that can commonly affect this joint is the frozen shoulder. This condition is marked by pain and stiffness in the area surrounding the shoulder complex. This leads to difficulty in doing the daily activities of living. Exercise and physical therapy are mostly recommended to decrease pain and improve and maintain the range of motion (ROM). Mainly traditional techniques such as Mulligans, Maitland, and Kaltenborn are used, along with electrotherapy and exercises, for the treatment of this condition. The effect of the Spencer technique is seen in baseball players' shoulder function. Thus, the purpose of this study is to determine how the Spencer approach affects patients with frozen shoulders in terms of pain, ROM, and functional impairment. Methodology This study included 20 patients aged between 40 and 60 years with stage 2 and 3 diagnosed frozen shoulder. This is a single-group pilot study that received the Spencer technique along with a moist heat pack and Codman's exercises on the affected shoulder for three weeks. Outcome measures used for assessment before and after treatment were the visual analogscale (VAS), shoulder ROM, and shoulder pain and disability index (SPADI). After the second, third, and sixth months, a follow-up was conducted.Two patients were lost to follow-up; consequently, statistical analysis was performed on the data from 18 patients. Results The current study's results suggested that there was an improvement in the mean values of VAS, ROM, and SPADI at post-three weeks, anda sustained effect was observed at the second, third, and sixth months. A statistically significant difference (P< 0.05) was found. Conclusions The study's conclusions demonstrated improved pain, ROM, and SPADI scores post-intervention. Treatment effects persisted, as seen by follow-up at the two, three, and six-month marks. As a result, the Spencer technique utilized in this pilot study on frozen shoulder patients proved effective. Also, the outcome effects were sustained, which suggests its utility in frozen shoulder rehabilitation.

Evaluating Functional Performance Tests in those with Non-arthritic Intra-articular Hip Pain: An International Consensus Statement.

Non-arthritic intra-articular hip pain, caused by various pathologies, leads to impairments in range of motion, strength, balance, and neuromuscular control. Although functional performance tests offer valuable insights in evaluating these patients, no clear consensus exists regarding the optimal tests for this patient population. This study aimed to establish expert consensus on the application and selection of functional performance tests in individuals presenting with non-arthritic intra-articular hip pain. A modified Delphi technique was used with fourteen physical therapy experts, all members of the International Society for Hip Arthroscopy (ISHA). The panelists participated in three rounds of questions and related discussions to reach full consensus on the application and selection of functional performance tests. The panel agreed that functional performance tests should be utilized at initial evaluation, re-evaluations, and discharge, as well as criterion for assessing readiness for returning to sports. Tests should be as part of a multimodal assessment of neuromuscular control, strength, range of motion, and balance, applied in a graded fashion depending on the patient's characteristics. Clinicians should select functional performance tests with objective scoring criteria and prioritize the use of tests with supporting psychometric evidence. A list of recommended functional performance tests with varying intensity levels is provided. Low-intensity functional performance tests encompass controlled speed in a single plane with no impact. Medium-intensity functional performance tests involve controlled speed in multiple planes with low impact. High-intensity functional performance tests include higher speeds in multiple planes with higher impact and agility requirements. Sport-specific movement tests should mimic the patient's particular activity or sport. This international consensus statement provides recommendations for clinicians regarding selection and utilization of functional performance tests for those with non-arthritic intra-articular hip pain. These recommendations will encourage greater consistency and standardization among clinicians during a physical therapy assessment.

Clinically Relevant Subgroups Among Athletes Who Have Ruptured Their Anterior Cruciate Ligaments: A Delaware-Oslo Cohort Study.

To identify subgroups of individuals with anterior cruciate ligament (ACL) injuries based on patient characteristics, self-reported outcomes, and functional performance at baseline, and to associate subgroups with long-term outcomes after ACL rupture. A total of 293 participants (45.7% male, mean ± SD age 26.2 ± 9.4 years, days from injury 58 ± 35) were enrolled after effusion, pain, and range of motion impairments were resolved and quadriceps strength was at least 70% of the uninvolved limb. Mixture modeling was used to uncover latent subgroups without a prior group classification using probabilistic assignment. Variables include demographics, functional testing, and self-reported outcome measures. Radiographic evidence of osteoarthritis (OA; i.e., Kellgren/Lawrence grade of ≥1) in the involved knee at 5 years after injury was the primary outcome of interest. Chi-square tests assessed differences in the presence of radiographic OA in the involved knee between subgroups at 5 years after ACL rupture. Secondary outcomes of interest included radiographic OA in the uninvolved knee, return to preinjury sport by 2 years, operative status, and clinical OA (classified using Luyten et al criteria) at 5 years. Four distinct subgroups exist after ACL rupture (younger good self-report, younger poor self-report, older poor self-report, older good self-report) with 30%, 31%, 47%, and 53%, respectively, having involved knee OA. The percentage of radiographic OA was not significantly different between the groups (P=0.059). The prevalence of OA in all subgroups is highly concerning. These results suggest there are unique subgroupings of individuals that may guide treatment after ACL rupture and reconstruction by providing support for developing a patient-centered approach.

Baseline Range of Motion, Strength, Motor Function, and Participation in Youth with Hutchinson-Gilford Progeria Syndrome

Aims Limited information is available on impairments, activity limitations and participation restrictions in youth with Hutchinson-Gilford progeria syndrome (HGPS), a rare genetic premature aging disease. The purposes were to: (1) describe range of motion (ROM), grip, pinch and quadriceps strength, functional balance, walking endurance, and gross motor limitations and participation restrictions; (2) evaluate the association between ROM impairments and age; and (3) evaluate the association between the Gross Motor Function Measure-88 (GMFM) scores and lower extremity (LE) ROM, quadriceps strength, and age. Methods Upper and LE ROM, grip, pinch and quadriceps strength, Timed Up and Go (TUG), Six Minute Walk Test, GMFM-88, and Canadian Occupational Performance Measure data were recorded for 38 participants with HGPS. Results All youth exhibited ROM impairments and most displayed decreased grip and pinch strength, walking endurance, and gross motor skills when compared to same-aged peers. However, the majority had good functional balance with TUG scores in the normal range. Participation restrictions included difficulty keeping up with peers when walking and difficulty completing activities of daily living. Some ROM measurements were negatively associated with age indicating that older participants had more extensive ROM limitation than younger participants. Conclusions Physical and occupational therapists can use this information when evaluating youth with HGPS, designing a plan of care, and providing treatment interventions.

Blood Flow Restriction Training as an Adjunct to Conventional Care in a Patient With Adhesive Capsulitis and Rotator Cuff Tendinopathy: A Case Report

Background The use of blood flow restriction training (BFRT) to treat patients with lower extremity conditions has been found to be relatively safe, but there is minimal evidence and no reports on BFRT in patients with shoulder dysfunction. Case Presentation This case report describes the safe application of BFRT as part of a conventional multimodal course of care for a 40-year-old man with shoulder pain. The patient's pathoanatomic diagnosis was left shoulder adhesive capsulitis, rotator cuff tendinopathy, and a superior labral anterior-to-posterior tear. He presented with substantial impairments in range of motion, strength, and function. Clinical guidelines for dosing BFRT are unclear, and we describe the successful use of rating-of-perceived-exertion criteria for guiding exercise intensity. Outcome and Follow-Up The patient had a positive outcome in 7 visits over 13 weeks, with normalization of shoulder range of motion and function, and 60% to 85% strength gains, without adverse effects from BFRT. Discussion This case highlights the feasibility and application of BFRT in combination with traditional rehabilitation strategies in a patient with multiple shoulder pathologies. JOSPT Cases 2021;1(4):289–293. doi:10.2519/josptcases.2021.10625

Common musculoskeletal impairments in postpartum runners: an international Delphi study

BackgroundPostpartum runners report musculoskeletal pain with running. Because of inadequate research, little is known about the origin and pain-related classification. Through expert consensus, this study is the first attempt to understand the musculoskeletal impairments that these runners present with. The objective of this survey was to gather expert consensus on characteristics of reported impairments in postpartum runners that have musculoskeletal pain.MethodsA web-based Delphi survey was conducted and was composed of five categories: strength, range of motion, alignment and flexibility impairments, as well as risk factors for pain in postpartum runners.ResultsA total of 117 experts were invited. Forty-five experts completed round I and forty-one completed rounds II and III. The strength impairments that reached consensus were abdominal, hip and pelvic floor muscle weakness. The range of motion impairments that reached consensus were hip extension restriction, anterior pelvic tilt and general hypermobility. The alignment impairments that reached consensus were a Trendelenburg sign, dynamic knee valgus, lumbar lordosis, over-pronation and thoracic kyphosis. The flexibility impairments that reached consensus were abdominal wall laxity, and tightness in hip flexors, lumbar extensors, iliotibial band and hamstrings. The risk factors for pain in postpartum runners were muscular imbalance, poor lumbopelvic control, too much too soon, life stressors, pain during pregnancy and pelvic floor trauma.ConclusionThis study presents a framework for clinicians to understand pain in postpartum runners and that can be investigated in future cohort studies.Level of evidence5

Are jaw range of motion, muscle function and proprioception impaired in adults with persistent temporomandibular disorders? A systematic review and meta-analysis.

The nature of certain musculoskeletal impairments associated with temporomandibular disorders (TMD) is unclear. Understanding impairments within TMD subgroups is important to guide management. Characterise local musculoskeletal impairments in adults with persistent TMD. PubMed, EMBASE, CINAHL, Scopus, Web of Science and Cochrane databases were searched from inception to 12 January 2020. Bibliographies were searched for additional articles, including grey literature. Case-control and interventional studies reporting temporomandibular range of motion (ROM), muscle function (MF) or proprioception in TMD and control groups were included. Risk of bias was assessed using SIGN checklist for case-control studies. Results were pooled using random-effects model. Confidence in cumulative evidence was determined using American Academy of Neurology guidelines. Sixty-six studies were included, most rated moderate risk of bias. Twelve primary outcomes were assessed, with partial scope for meta-analysis. Significant reductions were found for active maximal mouth opening (P<.00001, MD=-4.65mm), protrusion (P<.0001, MD=-0.76mm) and maximum bite force (P<.00001) in TMD versus controls. Subgroup analysis scope was limited. Reduced AMMO was found in myogenic TMD subgroups versus controls (P=.001, MD= -3.28mm). Few studies measured proprioception, with high methodological variability. Confidence in cumulative evidence ranged from high to very low. ROM and bite force impairments accompany TMD. Insufficient data were available to investigate impairments within TMD subgroups. Several musculoskeletal impairments have been identified, which may guide clinical management of TMD. Lack of subgroup data, and data for proprioception and MF, highlights future direction for research. CRD42020150734.

Mini-Open Distal Biceps Tendon Repair Using All-Suture Anchors

Distal biceps tendon ruptures are uncommon injuries that can cause impairment in range of motion and function. While distal bicep tendon repair to the radial tuberosity has been demonstrated to restore function and strength, there is a lack of consensus on the optimal technique. The purpose of this Technical Note and video is to provide our preferred method of repair using an open, onlay-tissue fixation with all-suture anchors (FiberTak; Arthrex) and anatomic positioning of the biceps tendon on the radial tuberosity.

Measures of impairment applicable to the classification of Paralympic athletes competing in wheelchair sports: A systematic review of validity, reliability and associations with performance

ABSTRACT A fundamental aspect of classification systems in Paralympic sport is having valid and reliable measures of impairment. However, minimal consensus exists for assessing impaired strength, coordination and range of motion. This review aimed to systematically identify measures of upper body strength, coordination and range of motion impairments that meet the requirements for use in evidence-based classification systems in wheelchair sports. Three electronic databases were searched from 2003 until 31 August 2019 for studies that assessed upper body function of participants and used a measurement tool that assessed strength, coordination or range of motion. The body of evidence for each identified measure was appraised using the Grading of Recommendations Assessment, Development and Evaluation framework. Twenty-three studies were included: ten measured strength and coordination, and six measured range of motion. There was “moderate” confidence in using isometric strength for assessing strength impairment. Tapping tasks for the assessment of coordination impairment received a “low” confidence rating. All other identified measures of coordination and range of motion impairment received a “very low” confidence rating. Several potential measures were identified for assessing upper body strength, coordination and range of motion impairments. Further research is warranted to investigate their use for classification in Paralympic wheelchair sports.

The clinical decision making process in the use of mobilisation with movement – A Delphi survey

BackgroundMobilisation with movement (MWM) is a method of treating musculoskeletal disorders. Although widely used clinically and with increasing research investigation, little is known about the decision making process for its utilization. ObjectivesTo understand the factors experts believe important for utilization of MWM when assessing a patient, predicting responses to its delivery, responsive body areas, and expected outcomes to MWM. DesignA web-based Delphi study of experts in the use of MWM. MethodsRound one contained five open-ended questions regarding assessment strategies, prediction of successful and unsuccessful outcomes, body areas most responsive, and common outcome measures observed. Rounds 2 and 3 were quantitative and aimed at establishing consensus. ResultsThirty seven experts participated in the study and took part in round 1, thirty two in round 2, and twenty eight in round 3. The exclusion of red flags and impairment in range of motion (ROM), obtained the highest level of consensus for the item assessment strategies. Patient's presenting with a variety of issues on movement, in addition to mild to moderate levels of severity and immediately responsive to a trial MWM, were believed to respond favourably to MWM. Patients with predominant inflammatory pain, with high levels of psychosocial factors, increased central sensitization and not improving after a trial of MWM, were recognized as non-responders. Improvement of different aspects of movement (e.g. ROM, less fear) are the most common outcomes observed. ConclusionsThis study provides factors believed to be important in the decision making process when using MWM clinically.

T1 Measuring Burn Scar Contracture: Challenging the Standard

Standard goniometry is the most commonly used method of assessing range of motion (ROM) in patients with burn scar contracture. However, standard goniometry disregards the cutaneous biomechanical influence between adjacent joint positions and skin (or scar) pliability to accommodate motion. Given that natural skin is a single, continuous piece of tissue enveloping the entire body without joints, the appropriateness of standard goniometry to quantify motion when burn scars or other integumentary impairments are the source of limitation, is called into question. We conducted a prospective, multi-center, comparative study investigating the difference between two goniometric protocols for measuring ROM outcome in burn survivors: 1) standard goniometry - based on arthrokinematics and 2) revised goniometry - based on principles of cutaneokinematics and functional positions. Maximal active ROM was measured for 11 motions, three times in each position in random order. Data were summarized using means and standard deviations and analyzed using a mixed model ANOVA with each subject representing a random effect in the model. Pearson’s Correlations were performed between the severity of limitation and the percentage of scar involvement. Data were collected for 174 joints from 66 subjects at seven different burn centers, resulting in a total of 1044 goniometric measurements for comparison. ROM findings using the revised goniometric protocol demonstrated significantly more limitation in motion 38.8 %±15.2% than the standard goniometric protocol 32.1% ±13.4% (p<.0001). Individual analyses of the motions likewise, showed significantly more limitation with the revised methods compared to the standard methods for 9/11 motions. Pearson’s correlation showed a significant positive correlation between the percentage of area affected by scarring and ROM outcome with revised goniometry (R2=.05, p=.0008) and the Δ between the revised and standard protocols (R2=.04, p=.0025) but no correlation was found with standard goniometry (R2=.015, p=.065). These findings support the notion that standard goniometry underestimates the ROM impairment for individuals whose motion is limited by burn scars. Due to the high frequency of movement related problems that burn survivors experience, ROM is a foundational outcome measure. It is used as a marker of recovery, influences function, affects quality of life and contributes to the decision of resource allocation during recovery. Therefore, having measurement methods that consider the unique characteristics of skin impairment is an important priority for both clinical reporting and future research in burn care. Clinical change in fundamental methods of measuring ROM after burn injury.

A randomized controlled study of whether setting specific goals improves the effectiveness of therapy in people with Parkinson’s disease

Objective: To evaluate the effects of an intervention based on a specific set of goals on goal attainment, manual dexterity, hand grip strength and finger prehension force compared to a standardized approach in patients with Parkinson’s disease. Design: Randomized controlled trial. Setting: Home-based. Participants: Fifty patients with a clinical diagnosis of Parkinson’s disease acknowledging impaired manual ability were randomized into two groups. Interventions: Patients in the experimental group (n = 25) were included in an intervention focused on task components that involved goals proposed by participants. Patients in the control group (n = 25) received a standard intervention focused on impairments in range of motion, grasp and manipulation. Home condition and duration (four weeks, twice a week) were similar in both groups. Main outcome measures: The primary outcome measure was goal achievement assessed with the Goal Attainment Scaling. Secondary outcomes were manual dexterity evaluated with the Purdue Pegboard Test and hand grip strength and finger prehension force assessed using a dynamometer. Results: After four weeks, significant between-group improvement in goal attainment was observed in the experimental group (change 17.36 ± 7.48 vs. 4.03 ± 6.43, P < 0.001). Compared to the control group, the experimental group also showed a significant improvement (P < 0.05) in manual dexterity (postintervention values in the most affected arm 10.55 ± 1.95 vs. 7.33 ± 3.63 pins, P < 0.001) and finger prehension force (postintervention values in the most affected arm 8.03 ± 1.93 vs. 6.31 ± 1.85 kg, P = 0.010). Conclusions: Targeting therapy toward specific goals leads to greater changes in arm function than a standardized approach in people with Parkinson’s disease.

Clinical features of people with hip-related pain, but no clinical signs of femoroacetabular impingement syndrome

ObjectivesIdentifying impairments in hip range of motion (ROM) and muscle strength in people with hip-related pain, without signs of femoro-acetabular impingement syndrome (FAIS). Study aims: to determine if hip strength and ROM i) differs between the symptomatic and less-symptomatic hip of people with hip-related pain; and between people with hip-related pain and healthy controls; and ii) are associated with hip-related Quality of Life and pain. DesignCross-sectional study. SettingUniversity laboratory. ParticipantsThirty participants with hip-related pain who were awaiting hip arthroscopy (22 women; age = 37 ± 10yrs), 32 healthy controls (19 women; age = 30 ± 10yrs). Main outcome measuresHip ROM, muscle strength, pain intensity and the Hip disability and Osteoarthritis Outcome Score (HOOS) were assessed. ResultsLess hip flexion ROM (p = 0.004), and extension (p = 0.004), abduction (p = 0.001) and internal rotation (IR) (p = 0.048) strength were measured on the symptomatic compared to non-symptomatic side. Hip-related pain participants had lower hip abduction strength (p = 0.045), and less flexion (p < 0.001), IR (p = 0.027) and external rotation (ER) (p = 0.019) ROM compared to controls. Less ER ROM (p = 0.03–0.04), and greater abduction (p = 0.03–0.04) and adduction strength (p = 0.02) were associated with better patient reported outcome measures. ConclusionsSpecific impairments in hip ROM and strength were identified in people with hip-related pain but no FAIS.

Two-Year Follow-Up of Impaired Range of Motion in Chronic Fatigue Syndrome

To measure changes in range of motion (ROM) over time in a cohort of 55 adolescents and young adults with chronic fatigue syndrome and to determine whether changes in ROM correlated with changes in health-related quality of life. Participants underwent a standardized examination of 11 areas of limb and spine ROM at baseline and at 3- to 6-month intervals for 2 years, resulting in a ROM score that ranged from 0 (normal throughout) to 11 (abnormal ROM in all areas tested). We measured the time until the ROM score was ≤2 (the score in healthy age-matched controls). Change in ROM was measured by subtracting the 24-month from the baseline ROM score and by summing the degrees of change in the 10 tests with continuous outcomes. Health-related quality of life was measured using the Pediatric Quality of Life Inventory 4.0 (PedsQL). The mean age at enrollment was 16.5 years (range 10-23). Two-year follow-up was available for 53 (96%). The proportion with a ROM score of >2 fell gradually over 2 years, from 78% at entry to 20% at 24 months (P < .001). ROM scores improved from a median of 5 at entry to 2 at 24 months (P < .001). The change in the summed degrees of improvement in ROM correlated positively with improvement in the PedsQL physical function subscale (r = 0.30; P < .03). In association with multimodal therapy, young people with chronic fatigue syndrome experienced progressively less impairment in ROM over 2 years, correlating with improvements in the physical function subscale of the PedsQL.

Intra-articular findings in shoulder joints affected by calcific tendinitis

Additional pathologies accompanying calcific tendinitis of the rotator cuff still remain unknown. The hypothesis of this study was that there are various additional pathologies accompanying calcific tendinitis, which might need further treatment. This study aimed to document intra-articular pathologies and investigate whether the location and spread of calcific tendinitis are associated with intra-articular pathologies and impairment in range of motion. Arthroscopy was performed on 53 patients for chronic calcific tendinitis. Documentation included demographic baseline variables, intraoperative findings of all structures in the glenohumeral joint, range of motion, joint laxity under general anesthesia, and basic details of intraoperative procedures. In all, 189 additional pathologies were found, 77 during intra-articular arthroscopy. Of all extra- and intra-articular pathologies, 74 and 70%, respectively, required surgical treatment. A mean of 3.6 additional pathologic findings per patient were observed; 19% of all patients had multiple (i. e., ≥2) calcific spots. The main additional pathologies were bursitis (87%), type II–III acromion (Bigliani classification, 70%), and synovitis (47%). No statistical significance was found for any associations tested between the localization of the deposit and the documented pathologies. Patients with symptomatic, chronic calcific tendinitis of the shoulder may suffer from multiple and therapeutically relevant disorders of the glenohumeral joint requiring surgical care. The frequency of findings underlines the importance of a diagnostic and therapeutic arthroscopy of the shoulder in order to ensure that surgeons properly address intra-articular pathologies.

Long-Term Outcomes After Distal Scaphoid Fractures: A 10-Year Follow-Up

The aim of this study was to evaluate the functional, clinical, and radiological outcome 10 years after distal scaphoid fractures. From a prospective epidemiological study on posttraumatic radial-sided wrist pain, we evaluated 41 cases of distal scaphoid fractures. All cases had been treated nonsurgically in a thumb spica cast. Patients were examined using radiographs, magnetic resonance imaging andcomputed tomography at the time of injury and with computed tomography after a median of 10 years (range, 8-11 years). Fractures were classified according to a modified Prosser classification system. The primary outcome was assessment of self-reported function using Disabilities of the Arm, Shoulder, and Hand (DASH) and Patient-Reported Wrist Evaluation (PRWE). Secondary outcomes were clinical status (range of motion and grip and pinch strength) and to evaluate fracture healing and arthritis in the scaphotrapezium-trapezoid (STT)joint. Functional impairment and pain scores at follow-up were low: median DASH score 2, median PRWE 0, and median visual analog scale (VAS) pain score 0. We found no impairment in range of motion or strength. We found 26 type I fractures, 12 type IIA, 1 type IIC, and 2 type IV. There was 1 asymptomatic nonunion in a type I fracture. Computed tomography revealed arthritis in the STT joint in 7 out of 41 wrists, none of which caused clinical symptoms. From an 8- to 11-year perspective, patients with distal scaphoid fractures report normal self-assessed hand function as well as good wrist motion and strength. The risk for development of posttraumatic STT arthritis was low. Prognostic II.

Glenohumeral and scapulothoracic strength impairments exists in patients with subacromial impingement, but these are not reflected in the shoulder pain and disability index

BackgroundPain and loss of function are cardinal symptoms associated with Subacromial impingement syndrome (SIS), while the presence and magnitude of deficits in strength and range of motion (ROM) are largely undescribed in non-athletic patients with SIS. Moreover, the relevance of impairments in strength and ROM to patient-reported shoulder function is not well described, even though testing of strength is recommended in clinical guidelines.The purpose of this study was, first, to investigate impairments in glenohumeral and scapulothoracic strength and in abduction and internal rotation ROM in patients with SIS. Secondly, to investigate the influence of these impairments on patient-reported shoulder function.MethodsCross-sectional study based on a consecutive cohort of 157 patients referred to specialist examination and diagnosed with shoulder impingement (SIS) using predefined validated diagnostic criteria. Prior to specialist examination, questionnaires regarding shoulder function (Shoulder Pain And Disability Index, SPADI) demographics and kinesiophobia (TSK-11) were collected, and shoulder strength and ROM was measured by trained testers, with the patient reporting pain levels during testing and for the last week. Impairments in strength (abduction, external-rotation, (protraction and horizontal-extension) and ROM (abduction and internal rotation) were investigated in patients with unilateral shoulder pain, using one-sample t-tests. SPADI total score (SPADI) and SPADI function score (SPADI-F), were chosen as dependent variables in multiple regressions to investigate the influence of impairments on patient-reported shoulder function. Independent variables of interest were; strength in abduction and external rotation, abduction ROM, pain-during-tests, pain-last-week and kinesiophobia.ResultsSignificant impairments were found for all impairment tests, but most pronounced for glenohumeral strength and abduction ROM (29–33% deficits), and less for scapulothoracic strength and internal rotation ROM (8–18% deficits). Pain variables influenced SPADI and SPADI-F score to a high degree (R2 = 23.4–31.6%, p < 0.001), while strength and ROM did not.ConclusionSubstantial strength and ROM impairments were found in patients with SIS. Only pain significantly influenced patient-reported function, while impairments did not. As SPADI score does not reflect the substantial strength and ROM impairments in external rotation and abduction observed in patients with SIS, supplemental assessment of these impairments seems important.