Improvement In Range Of Motion Research Articles

Effect of dorsal capsular imbrication on intraoperative DRUJ instability following arthroscopic TFCC repair surgery

BackgroundTo assess the clinical outcomes and identify the ideal indication for implementing dorsal distal radioulnar joint (DRUJ) capsular imbrication after triangular fibrocartilage complex (TFCC) repair in cases of DRUJ instability.MethodsWe conducted a retrospective study on patients who underwent arthroscopic TFCC repair between 2016 and 2021. Inclusion criteria comprised a symptomatic ulna fovea sign for over 6 months and dorsal DRUJ subluxation on magnetic resonance imaging. A total of 225 patients were divided into two groups: Group 1 (135 cases) with a negative ballottement test after “Cross-form TFCC repair” (CR) and Group 2 (90 cases) with a positive ballottement test after “Cross-form TFCC repair” and augmented DRUJ stability through dorsal DRUJ capsular imbrication (CR + DCI). Pain visual analog scale score (VAS), grip strength, modified Mayo Wrist Score (MMWS), wrist range of motion (ROM), and patient-reported outcomes (PROMs) were assessed for a minimum of 3 years postoperatively.ResultsBoth groups showed significant improvements in pain VAS score, grip strength, wrist ROM, MMWS, and PROMs between the preoperative and postoperative periods (all P < 0.05). Recurrent DRUJ instability occurred in 3.7% and 1.1% of patients in the “CR” and “CR + DCI” groups, respectively, with a significant difference. Despite the “CR + DCI” group initially exhibiting inferior ROM compared with the “CR” group, subsequently, no significant difference was noted between them.ConclusionsDorsal DRUJ capsular imbrication effectively reduces postoperative DRUJ instability rates, enhances grip strength, and maintains wrist ROM in patients with a positive intra-operative ballottement test after arthroscopic TFCC repair.

Meta-analysis of the effect of curcumin supplementation on skeletal muscle damage status.

Meta-analysis was conducted to examine the effect of supplemental curcumin intake on skeletal muscle injury status and to propose an optimal intervention program. In accordance with the procedures specified in the PRISMA statement for systematic reviews and meta-analyses of randomized controlled trials, the Review Manager 5.3 was used to analyze the results of creatine kinase (CK), muscle soreness, interleukin-6 (IL-6), and range of motion (ROM) as outcome indicators in the 349 subjects included in the 14 articles. The effect size of curcumin supplementation on muscle soreness, mean difference (MD) = -0.61; the relationship between curcumin supplementation and muscle soreness for time of measurement (I2 = 83.6%)、the relationship between curcumin supplementation and muscle soreness for period of intervention (I2 = 26.2%)、the relationship between whether one had been trained (I2 = 0%) and supplementation dose (I2 = 0%) were not heterogeneous for the relationship between curcumin supplementation and muscle soreness; The effect size on CK, MD = -137.32; the relationship between curcumin supplementation and CK (I2 = 79.7%)、intervention period (I2 = 91.9%)、whether or not trained (I2 = 90.7%)、and no heterogeneity in the relationship between curcumin supplementation and CK for the time of measurement (I2 = 0%); The effect size MD = 4.10 for the effect on ROM; The effect size for IL-6 was MD = -0.33. This meta-analysis highlights that curcumin supplementation significantly mitigates skeletal muscle damage, with notable improvements in CK levels, muscle soreness, IL-6 levels, and ROM. The results highlight the importance of curcumin dosage and timing, revealing that prolonged supplementation yields the best results, especially for untrained individuals or those less exposed to muscle-damaging exercise. For muscle soreness and ROM enhancement, a pre-emptive, low-dose regimen is beneficial, while immediate post-exercise supplementation is most effective at reducing CK and IL-6 levels.

One-day surgery is safe and effective in unicompartmental knee arthroplasty: A prospective comparative study at 1 year of follow-up.

To compare the outcomes and complications of two perioperative protocols for the management of patients who underwent medial unicompartmental knee arthroplasty (UKA): 24 h (1-day surgery [OS]) versus 72 h (enhanced recovery after surgery [ERAS]) of the length of hospital stay (LOS). In our hypothesis, the reduction of the LOS from 3 to 1 day did not influence the outcomes and complications. A total of 42 patients (21 in each group) with isolated anteromedial knee osteoarthritis and meeting specific criteria were prospectively included in the study. Clinical outcomes included Knee Society Score (KSS) and Forgotten joint score while pain evaluation was performed using a Visual Analogue Scale (VAS). Functional outcomes were assessed measuring the knee range of motion (ROM) while radiographic outcomes were evaluated measuring the amelioration of the varus deformity through the hip-knee-ankle angle (HKA). Clinical and functional outcomes did not significantly differ between the two groups. Complications occurred in 9.5% of OS and 4.7% of ERAS group patients. Significant improvements in knee ROM, VAS pain, KSS and HKA angle were observed postsurgery, with no significant differences between groups except in KSS expectations and function trends. The OS protocol is safe and effective and LOS, in a well-defined fast-track protocol, did not significantly impact clinical and functional outcomes. OS may lead to reduced hospitalisation costs and potential reductions in complications associated with prolonged stays, benefiting both patients and healthcare facilities. However, further research with larger sample sizes and longer follow-up periods is needed to confirm these findings. Early mobilisation and rehabilitation protocols are key components of successful patient recovery following UKA procedures. Level II.

A Clinical Evaluation of Platelet-Rich Plasma Therapy in Treatment of Frozen Shoulder

Background: Frozen shoulder is a common reason for shoulder pain and impairment. Several treatments are used to relieve pain and enhance range of motion (ROM) in patients. Recent study has focused on the injection of platelet-rich plasma (PRP). Aim of the Study: The goal of this study is to find out the impact and possible outcome of PRP treatment in frozen shoulder management. Methods: This study was conducted in TMSS Medical College and Rafatullah Community Hospital, Bogura, Bangladesh, from January 2019 to December 2019. In the study, 65 patients in stages I or II with frozen shoulder were treated with PRP. All acquired data was entered into a Microsoft Excel work sheet and evaluated with descriptive statistics in SPSS 11.5. Results: The majority of the participants (84.62%) were female, with 15.38% being male. The average age of the participants was 57.45 years. The investigation comprised participants who received PRP injections for frozen shoulder (62.4% right limb, 37.6% left limb). Before therapy, the average flexion was around 61°, abduction was 70°, and external rotation was 21°. Furthermore, the baseline scores for VAS, DASH, and the SF-12 Health Survey questionnaire were 9.41, 64.86, and 24 correspondingly. All patients demonstrated significant improvement in shoulder ROM, discomfort, and function (p &lt; 0.001). Conclusion: This case series study found a significant improvement in pain and disability outcomes for individuals after PRP injection. These findings support PRP as a safe therapy protocol that reduces pain and improves upper limb function. It can also increase shoulder range of motion.

A Clinical Evaluation of Platelet-Rich Plasma Therapy in Treatment of Frozen Shoulder

Background: Frozen shoulder is a common reason for shoulder pain and impairment. Several treatments are used to relieve pain and enhance range of motion (ROM) in patients. Recent study has focused on the injection of platelet-rich plasma (PRP). Aim of the Study: The goal of this study is to find out the impact and possible outcome of PRP treatment in frozen shoulder management. Methods: This study was conducted in TMSS Medical College and Rafatullah Community Hospital, Bogura, Bangladesh, from January 2019 to December 2019. In the study, 65 patients in stages I or II with frozen shoulder were treated with PRP. All acquired data was entered into a Microsoft Excel work sheet and evaluated with descriptive statistics in SPSS 11.5. Results: The majority of the participants (84.62%) were female, with 15.38% being male. The average age of the participants was 57.45 years. The investigation comprised participants who received PRP injections for frozen shoulder (62.4% right limb, 37.6% left limb). Before therapy, the average flexion was around 61°, abduction was 70°, and external rotation was 21°. Furthermore, the baseline scores for VAS, DASH, and the SF-12 Health Survey questionnaire were 9.41, 64.86, and 24 correspondingly. All patients demonstrated significant improvement in shoulder ROM, discomfort, and function (p &lt; 0.001). Conclusion: This case series study found a significant improvement in pain and disability outcomes for individuals after PRP injection. These findings support PRP as a safe therapy protocol that reduces pain and improves upper limb function. It can also increase shoulder range of motion.

Physiotherapy treatment for reverse total shoulder arthroplasty: Results of a patient-centred rehabilitation guideline using functional and patient-reported outcome measures.

Rehabilitation after primary reverse total shoulder arthroplasty (RTSA) is accepted to be an essential component to successful outcome achievement, but successful rehabilitation approaches have yet to be well described in the literature. This retrospective review documents the outcomes of a cohort of 29 patients undergoing RTSA surgery with rehabilitation following the Upper Limb Treatment and Rehabilitation Advice (ULTRA) guideline (Appendix 1). The Oxford Shoulder Score, Quick Disabilities of the Arm, Shoulder and Hand score, range of movement (degrees of flexion, abduction and external rotation) and numerical rating score for pain were prospectively collected pre-operatively and at one- and two-years post-operatively. Scores were then evaluated to establish whether or not there were any significant changes over time. Statistically significant improvements were seen in all outcome domains from pre-operative to one-year post-operative. All improvements met the threshold for achieving substantial clinical benefit as well as exceeding the minimum clinically important difference, and all improvements were maintained at the two-year post-operative time point. The present study showed that following the ULTRA guideline after elective RTSA can give statistically significant improvements in range of movement, pain score and patient-reported outcome at one-year post-operatively, which can be maintained up to two-years post-operatively.

Central Tendon Tenotomy for Management of Extrinsic Extensor Tightness of the Hand: Surgical Technique and Case Reports.

We present a 67-year-old woman with long finger extrinsic extensor tightness and a 56-year-old man with limited index finger flexion due to extrinsic extensor tightness secondary to tendon transfers for radial nerve palsy. Both patients underwent prior surgical procedures that led to limited range of motion (ROM). Subsequently, they elected for central tendon tenotomy (CTT), which demonstrated postoperative ROM improvement and satisfactory patient outcomes. Surgical management of extrinsic extensor tendon tightness of the hand is generally addressed by performing tenolysis to improve tendon excursion. We present a novel and simple technique of CTT with pertinent anatomy, descriptive cases, and a cadaveric video.

COMPARATION OF KINESITHERAPY AND POWERPLATE IN PATIENTS WITH CERVICOARTHROSIS

Osteoarthritis is a chronic disease of the musculoskeletal system, in which degeneration of the affected tissues is observed. Modern living conditions and immobility create favorable conditions for the spread of the disease. The cervical region of the spine is subjected to significant dynamic and static loads, which often leads to pain and limited mobility. Diagnosing cervical arthrosis at an early stage opens up opportunities for effective and timely complex treatment. Such treatment includes not only medicinal approaches, but also various physical therapies, balneotherapy, as well as massage and kinesitherapy. Improving and maintaining the functional status of patients with cervical arthrosis is essential for their quality of life. This disease is characterized by destruction of articular cartilage, in which the formation of new tissue at the edges of bones and tendons is observed. It has a progressive course and affects a significant part of the population. These changes are part of the aging process of the body and the musculoskeletal system. The patented technology of Power Plate is designed to trigger the body’s innate reflexive reaction to precise vibrations, stimulating muscles in a consistent and regulated fashion, thereby expediting the benefits of training. Power Plate’s efficacy has been substantiated through numerous medical and scientific investigations, alongside practical application in clinical recovery and wellness establishments, sports enhancement hubs, and widespread adoption by a multitude of professional and collegiate sports organizations in the United States, as well as numerous others globally. Vibration is defined as an oscillatory motion involving mechanical forces. Its intensity is influenced by biomechanical parameters such as amplitude, frequency, and the scale of the oscillations. Specifically, amplitude refers to the peak-to-peak displacement measured in millimeters, frequency relates to the rate at which oscillation cycles repeat and is measured in Hertz (Hz), and acceleration reflects the scale of the vibrations. This study aims to compare the efficacy of two therapeutic interventions, kinesitherapy (analytical exercises) and power plate, in enhancing muscle strength and improving cervical range of motion. Eighteen patients were divided into experimental (n=10) and control (n=8) groups. The control group received physical medicine and kinesitherapy, while the experimental group underwent physical medicine and power plate therapy, both for 21 days. Clinical assessments were conducted pre- and post-therapy. Results indicated symptom improvement in both groups, with better outcomes observed in the control group. Furthermore, the control group exhibited more significant improvements in range of motion compared to the experimental group. Kinesitherapy demonstrated greater efficacy than power plate therapy, likely due to its targeted muscle exercises and isotonic/ isometric contraction combination, as opposed to the rapid and numerous contractions induced by the power plate. These findings highlight the importance of tailored therapeutic approaches in enhancing muscle strength and cervical spine mobility.

Physical therapy in addition to occlusal splint in myogenic temporomandibular disorders: A randomised controlled trial.

Myogenic temporomandibular disorders (M-TMD) commonly involve occlusal splint (OS) therapy and musculoskeletal physiotherapy (MPT). To compare the effects of combining OS with MPT and education (EG) against OS and education (CG), in chronic M-TMD patients. In this double-blind randomised controlled trial, 62 participants were assigned to either EG or CG. The primary outcomes, pain levels at rest (VAS rest), maximum oral opening (VAS open) and during chewing (VAS chew), were measured by Visual Analogue Scale (VAS) in cm. The secondary outcome was the range of motion (ROM) for maximum oral opening. Both interventions lasted 3 months, with outcomes assessed at baseline (T0), post-treatment (T1) and 3 months post-treatment (T2). Intention-to-treat analysis revealed significant improvements favouring EG (VAS rest = -1.50 cm [CI95%: -2.67, -0.32], p = .04; VAS open = -2.00 cm [CI95%: -3.23, -0.75], p < .01; VAS chew = -1.71 cm [CI95%: -2.90, -0.52], p = .01; ROM = 4.61 [CI95%: 0.93, 8.30], p = .04). Additionally, VAS measures were influenced by follow-up times (VAS rest = -0.73 cm [CI95%: -1.30, -0.17], p = 0.03; VAS open = -0.97 cm [CI95%: -1.57, -0.37], p < .01; VAS chew = -1.15 cm [CI95%: -1.73, -0.58], p < .01). At T1, EG demonstrated higher number of responders compared to CG for VAS open (χ2(1) = 4.39, p = .04) and VAS chew (χ2(1) = 11.58, p < .01). Adding MPT to education and OS yields better outcomes in terms of pain reduction and ROM improvement, in chronic M-TMD. NCT03726060.

Efficacy of neuromuscular electrical stimulation and interrupted serial casting in children with spastic diplegia

ObjectivesThis research was aimed at comparing the effects of neuromuscular electrical stimulation (NMES) combined with interrupted serial casting (SC) versus SC alone on various aspects of lower limb function in children with diplegic cerebral palsy. SC is a clinical technique used to increase passive range of motion (ROM), decrease hypertonicity, and improve walking in children with cerebral palsy (CP). MethodsThis randomized comparative trial involved 33 children with diplegic CP, who were randomly assigned to group A or group B at recruitment. Group A received SC along with a customized physical therapy program, whereas group B received the same interventions as group A along with NMES applied through cast windows during casting. Evaluations were based on ROM, the Modified Tardieu Scale, handheld dynamometer measurements, and the Observational Gait Scale. Assessments were conducted before and after 8 weeks of intervention. ResultsBoth groups exhibited significant improvements in dorsiflexion ROM, popliteal angle, gastrocnemius dynamic spasticity, and hamstring dynamic spasticity after the intervention (P = 0.0001 for all). However, significant differences (P < 0.05) in dorsiflexor strength, knee extensor strength, and observational gait scale score were observed between groups after the intervention, favoring group B. ConclusionsThe use of NMES during SC may help overcome the substantial decrease in strength resulting from casting, thus achieving less reduction of tone, improving ROM without significantly decreasing strength, and attaining greater improvements in gait function.

Arthroscopic Capsular Release Versus Manipulation under Anesthesia for Refractory Frozen Shoulder: A Systematic Review with Meta-Analysis.

Frozen shoulder (FS) is a painful and debilitating condition affecting the shoulder joint. When patients fail to improve after conservative treatments, operative treatments including arthroscopic capsular release (ACR) and manipulation under anesthesia (MUA) are recommended. However, the comparison between these two interventions remains controversial. This study aimed to compare the efficacy and safety of ACR and MUA for refractory FS. A systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines. PubMed, EMBASE, Cochrane Library, and Web of Science were searched for eligible studies until December 10, 2023. Meta-analyses were conducted using Manager V.5.3.3. Pooled effect sizes were expressed as the weighted mean difference (WMD) or odds ratio (OR) with 95% confidence intervals (CIs). A total of eight comparative studies with 768 patients were included. Compared with MUA, ACR had statistically better Δ VAS (WMD, -0.44; 95% CI, -0.71 to -0.18; I2 = 6%; p = 0.001) at over 12-month follow-up, which did not reach the minimal clinically important difference (MCID). Other outcomes regarding pain relief, function, and range of motion (ROM) improvements were not statistically different between the two groups at different follow-up timepoints. Compared with the MUA group, the ACR group had a significantly higher rate of severe complications (OR, 4.14; 95% CI, 1.01 to 16.94; I2 = 0%; p = 0.05), but comparable rates of mild complications and additional intervention. In treating refractory FS, ACR demonstrated comparable pain relief, functional and ROM improvements, rates of mild complications and additional intervention but a higher risk of severe complications to MUA during short-term follow-up periods. Notably, ACR exhibited statistically superior improvement in the long-term pain relief compared to the MUA group, although it did not reach the MCID.

Analysis of clinical effect of arthroscopic release at different time in treating knee adhesion after arthroscopic surgery

Objective: To explore the efficacy of arthroscopic release in treating postoperative knee adhesion and investigate the influence of release timing on the treatment outcomes. Methods: A total of 50 patients who accepted arthroscopic release in Peking University Third Hospital from February 2017 to December 2021 were included in the retrospective cohort. The study cohort comprised 28 men and 22 women, with a mean age of (30.8±11.9) years. All the primary surgeries were manipulated under arthroscopes. A comparison was made between pre-and postoperative range of motion (ROM), visual analog scale (VAS), International Knee Documentation Committee (IKDC) scores, and Tegner activity scale scores for the patients. According to the interval between the appearance of adhesion and arthroscopic release, the patients were divided into four groups:<3 months group (n=12), 3-6 months group (n=16),>6-12 months group (n=14), and>12 months group (n=8). Inter-group comparisons on postoperative ROM, IKDC scores, and Tegner activity scale scores and improvement values of each outcome were conducted. Results: All the patients were followed up for (36.4±19.7) months. Patients gained significant improvement in flexion, extension, IKDC scores, and Tegner scores (125.0°±20.0° vs 75.7°±27.5°, 2.3°±4.8° vs 7.4°±7.3°, 69.8±17.7 vs 51.4±12.8, 4.1±2.1 vs 2.2±1.1) (all P<0.05), while the VAS scores did not show significant improvement. There were no significant differences among different groups in postoperative extension, IKDC scores or Tegner scores, nor in their improvements. However, patients in the ≤6 months group could gain better postoperative flexion and improvement in flexion than those in the >6 months group (129.9°±20.0° vs 118.8°±17.4°, 58.6°±32.8° vs 37.3°±23.1°) (P<0.05). Conclusions: Arthroscopic release presents a great effect in treating knee adhesion after arthroscopic operation. Once the symptoms of adhesion appear and physical rehabilitation fails to improve the ROM, one should accept early surgical intervention (less than 6 months) for a better outcome.

Effect of pulsed radiofrequency to the suprascapular nerve (SSN) in treating frozen shoulder pain: A randomised controlled trial.

Treatment for frozen shoulder (FS) focuses on pain control and restoring movement and strength through physical therapy. We aimed to evaluate the efficacy of pulsed radiofrequency (PRF) lesioning of the suprascapular nerve for the treatment of FS pain. Forty patients with FS were enrolled and randomly assigned into the intervention group (n = 20) that received PRF and a control group (n = 20) which received medical treatment (NSAIDs). Patients were followed-up for a total of three months. The primary outcome was the pain intensity, measured by the Numeric Pain Rating Scale (NRS). The secondary outcomes included shoulder range of motion (ROM) evaluation measured by simple shoulder test (SST); Likert-type-based patient satisfaction scale; and any adverse events (AEs) throughout the treatment period. All results were measured at baseline, at the end of one week, four weeks and 12 weeks after treatment. At 12 weeks post-procedure, the intervention group significantly improved their pain (NRS dropped to 2.80 ± 0.5) and there was significant improvement in range of motion (SST from 6.55% ± 2.0% to 76.50% ± 6.5) compared to control group. PRF lesioning of the SSN is a fast and effective modality in treating frozen shoulder pain and improving ROM for three months.

Early outcomes of the Oxford unicompartmental knee arthroplasty: 140 cases from a single institute in Taiwan.

The clinical and radiologic outcomes of the Oxford unicompartmental knee arthroplasty utilizing Microplasty® instrumentation have not been extensively investigated in Taiwanese patients. Despite the efficacy of this treatment for unicompartmental knee diseases, its specific impact on this population remains unknown. We retrospectively analyzed prospectively collected data of patients who underwent OUKA with MP between 2018 and 2021, including demographic information, component position, preoperative and postoperative knee range of motion (ROM), numeric rating scale (NRS), and 2011 Knee Society Score-functional activity score (2011 KSS-FAS). We compared preoperative and postoperative data and analyzed the correlation between clinical and radiographic outcomes. Among 140 patients with an average age of 66.8 years, predominantly female, the majority exhibited components that fell within the radiographically acceptable tolerance ranges. The mean 2.5-year follow-up revealed significant improvements in knee ROM from 102.6° ± 12.9° to 127.3° ± 9.8° ( p < 0.05), pain reduction from 7.7 ± 0.8 to 0.4 ± 0.7 ( p < 0.001), and KSS-FAS from 30.7 ± 10.5 to 94.3 ± 5.2 ( p < 0.001). Notably, a tibial component medial overhang within tolerance predicted shorter hospital stays, and a higher preoperative KSS correlated with lower postoperative NRS. No independent variables were identified as predictors of a higher postoperative KSS. Our study on OUKA with MP in Taiwanese patients reveals promising early clinical and radiographic outcomes. Tibial component medial overhang <3 mm is associated with shorter hospital stays, and a higher preoperative KSS predicts lower NRS at 1 year postoperatively.

Total Shoulder Arthroplasty for Glenohumeral Arthritis Associated with Posterior Glenoid Bone Loss: Midterm Results of an All-Polyethylene, Posteriorly Augmented, Stepped Glenoid Component

BackgroundThe purpose of this study is to report the minimum 5-year clinical and radiographic outcomes of patients undergoing anatomic total shoulder arthroplasty (aTSA) with a posteriorly augmented glenoid component. MethodsThirty-five shoulders with minimum 5-year follow-up underwent aTSA using a posteriorly augmented glenoid component for the treatment of glenohumeral osteoarthritis with posterior glenoid bone loss. Clinical outcomes included range of motion (ROM), Visual Analog Scale (VAS) for pain, and patient reported outcomes scores (PROS). Radiographs (XR) and computed tomography (CT) scans were obtained to assess glenoid morphology, retroversion, central peg osseous integration (CPOI) via Wirth score, Lazarus scores, and Yian scores. Postoperative outcomes were measured at minimum 2- and 5-year follow-up. Kaplan-Meier survival analysis was calculated. ResultsTwo patients experienced prosthetic instability requiring revision, leaving 33 shoulders with an average follow-up of 6.6 years. Average preoperative glenoid retroversion was 21.6˚. A significant improvement in pain, ROM, and PROS was noted at minimum 2-year and 5-year follow-up. Additionally, VAS pain, American Shoulder and Elbow Surgeons (ASES), and Quick Disabilities of the Arm, Shoulder, and Hand (DASH) scores improved between minimum 2-year and 5-year follow-up. The average Lazarus and Yian scores at final follow-up were 0.73 and 2.6, respectively. There was an increase in Lazarus score and decrease in Wirth score between 2- and 5-year follow-up. A significant correlation was identified between VAS pain scores and both Lazarus and Wirth scores. Survivorship free from revision was 92% at 8.8 years postoperatively. ConclusionsMidterm results of aTSA with a posteriorly augmented, stepped glenoid component demonstrate sustained improvements in clinical outcomes with low rates of radiographic loosening. Continued improvement in pain and function, as well as a minor progression of radiographic osteolysis, may be expected between 2- and 5-year follow-up. Additionally, the severity of radiographic loosening correlates with subjective pain levels.

Effects of vibration therapy on muscle soreness and athletic performance in wheelchair basketball players

IntroductionVibration therapy (VT) has been widely used to increase performance and rehabilitate injuries in athletes. Delayed onset muscle soreness (DOMS), caused by excessive overload after training and competitions, leads to loss of performance. ObjectiveThe aim of this study was to investigate the effects of wearable local VT on muscle soreness and athletic performance in wheelchair basketball (WCB) players. MethodA non-randomized crossover design was used in this study in which thirteen elite WCB athletes (31.84 ± 12.59 years) participated. A two-week washout period was applied between the measurements of the control and the vibration groups. Muscle soreness, range of motion (ROM), joint position sense, 20-m sprint speed, and shooting percentage were evaluated for all participants pre-exercise, 30 min and 24 h post-exercise for both arms. After eccentric exercise, immediately local wearable VT was applied to both triceps brachii muscles for 10 min in the vibration group. ResultsCompared to baseline, there was a significant increase in muscle soreness and a significant decrease in joint position sense, ROM, sprint speed and shooting percentage in both groups 24 h post-exercise (p < 0.05). No significant differences were observed between the groups for muscle soreness and 20-m sprint speed (p > 0.05). However, there were significant improvements in elbow ROM, elbow joint position sense, and shooting percentage in the VT group (p < 0.05). ConclusionThe local VT may help improve the elbow ROM, elbow joint position sense, and shooting performance but can't contribute to reducing muscle soreness and sprint performance in recovery from exercise.

ACE Inhibitor Use Does Not Significantly Affect Occurrence of Manipulation Under Anesthesia Following Total Knee Arthroplasty

Introduction Common medications may attenuate fibroblast proliferation and scar tissue formation. This study aims to evaluate the association between angiotensin converting enzyme inhibitor (ACEI) use and post-operative stiffness assessed by rate of manipulation under anesthesia (MUA) and change in range of motion (ROM) following total knee arthroplasty (TKA). Methods Patients undergoing primary TKA January 2014 - September 2019 were identified. Demographic information, use of ACEI medications, occurrence of MUA in the 6 months following surgery, and ROM was determined by chart review. MUA was indicated upon failure to achieve 90° ROM at 1-month follow-up. Demographics were analyzed using Student’s t-test and Chi-Squared tests. SPSS (version 24, IBM) multivariate regression calculated odds ratios for MUA controlling for age, BMI, American Society of Anesthesiologist’s class, and gender. Results 1590 primary TKA’s were identified. 274 patients (17.3%) were taking ACEI medications. 46 patients required MUA (2.9%). Five patients (1.8%) taking an ACEI required MUA, versus 41 of the 1316 control patients (3.1%). No significant difference in MUA rates between the ACEI and control cohorts (odds ratio 0.670, 95% CI: 0.259 – 1.735, p=0.410) was identified. Change in ROM was not significantly different between cohorts at 1 and 3 month intervals. At 1-year, improvement in ROM was significantly less in patients taking ACEIs (+6.54° vs. +9.90°, p=0.035) and significantly fewer ACEI cohort patients achieved 118° flexion (56.9% vs. 68.4%, p=0.013). Conclusions This study supplies evidence that ACEIs do not reduce post-operative stiffness following TKA. Additionally, patients taking ACEI medications have significantly less improvement in ROM 1 year post-operatively.

Efficacy of serial casting protocols in idiopathic toe-walking.

Idiopathic toe-walking (ITW) is a diagnosis of exclusion. A relationship between ITW and decreased range of motion (ROM) is postulated. Treatments focus on increasing ankle dorsiflexion including serial casting. There is no consensus for duration of serial casting. This study aimed to determine ROM changes with cast change intervals of one vs. two weeks, and the rate of ITW recurrence. This was a retrospective study of 86 patients, ages 0-9 years with ITW undergoing weekly casting (N = 29) and two-week casting (N = 57) at a children's hospital from 2014-2020. ROM at baseline, two weeks, four weeks, and final cast removal were collected. Statistical analyses included chi-squared tests, two-sample t-tests, and linear mixed regression. Outcome distributions were assessed for normality. P-values < 0.05 were considered statistically significant. After adjusting for baseline ROM, the mean change in ROM from baseline to two weeks was 10.6∘ vs 7.5∘ in the one-week vs. two-week casting interval, respectively (p < 0.001). The baseline to final measurement was 13.4∘ vs 9.8∘ in the one-week vs. two-week casting interval, respectively (p < 0.001). The rate of recurrence of ITW was similar between the two groups. This study suggests greater improvement in ROM in the one-week vs. two-week casting interval group.

Robotic exoskeletons and total knee arthroplasty: The future of knee rehabilitation and replacement - A meta-analysis.

Exoskeletons can play a crucial role in post-TKA rehabilitation by accelerating recovery, improving mobility, and reducing further injury risk. This meta-analysis evaluated the effectiveness of exoskeletons in post-total knee replacement (TKR) rehabilitation. Comprehensive searches were conducted on PubMed, OVID Medline, Cochrane Collaboration Library, and Embase (period: database inception to March 2023). Randomized controlled trials enrolling patients who underwent TKR and studies examining the effect of robot-assisted rehabilitation on physical function and pain outcomes were eligible for inclusion. Eight studies (302 patients) were thus included. Exoskeletons significantly improved active range of motion (ROM) (SMD: 10.98, 95% confidence interval (CI): 7.81-14.16, P < .001), passive ROM (SMD: 4.11, 95% CI: 1.02-7.20, P = .009), Hospital for Special Surgery scores (SMD: 7.78, 95% CI: 5.87-9.68, P < .00001), and hospital stay length (SMD: -3.19, 95% CI: -4 to -2.38, P < .00001) compared with conventional rehabilitation. Active and passive ROM improvements suggest that exoskeletons aid knee function restoration and mobility post-TKR, whereas Hospital for Special Surgery score improvements support exoskeleton use in TKR rehabilitation. A shorter hospital stay was an important finding which could potentially reduce healthcare costs and improve outcomes. Despite the inclusion of a limited number of studies, our findings suggest that exoskeletons can enhance post-TKR rehabilitation outcomes and improve quality of life. Robot-assisted rehabilitation may be effective following TKR. Further research should confirm these findings.

Dry needling combined with exercise therapy: Effects on wrist flexors spasticity in post-stroke patients - A randomized controlled trial.

The positive contribution of dry needling (DN) in conjunction with exercise therapy for patients with stroke and spasticity remains uncertain. To examine the effects of DN combined with exercise therapy on wrist flexor spasticity and motor function in patients with stroke. Twenty-four participants with stroke were randomly assigned to either the DN and exercise therapy group or the DN alone group. Assessments were conducted at baseline, after the 4th treatment session, and 3 weeks post-treatment. A significant Group×Time interaction was observed for wrist active range of motion (ROM) (P = 0.046), favoring the DN with exercise therapy group (∼10° at baseline, ∼15° immediately after the 4th session, and 15.4° at follow-up). The improvements in spasticity, passive ROM, and H-reflex latency were sustained during follow-up. However, there were no significant between-group differences in any outcome at any measurement time point. The combined DN and exercise therapy did not exhibit superiority over DN alone concerning spasticity severity and motor function. However, it demonstrated additional advantages, particularly in improving motor neuron excitability and wrist passive extension.