Limb Elevation Research Articles

Edema India: Executive Summary of Screening, Diagnosis, and Management of Edema.

The management of edema requires a systematic approach to screening, diagnosis, and treatment, with an essential initial assessment to differentiate between generalized and localized edema. The Association of Physicians of India (API) aimed to develop the first Indian Edema Consensus (Edema India), offering tailored recommendations for screening, diagnosing, and managing edema based on the insights from the expert panel. The panel suggested when evaluating edema symptoms, important factors to consider include the patient's current illness, medical history, risk factors, family history, and medications. Key diagnostic investigations for edema include complete blood count, cardiovascular imaging and markers, deep vein thrombosis (DVT) assessment, along with renal, hepatic, and thyroid function tests. Edema management involves a combination of pharmacologic and nonpharmacologic interventions, including limb elevation, physiotherapy, compression therapy, fluid removal, diuretics (loop diuretics: first-line therapy), and a sodium-restricted diet. The panel believed that educating patients could foster a preventive mindset, helping to prevent the worsening of edema.

Acyclovir extravasation in a newborn: a case report

ObjectiveExtravasation of infused drugs is not a rare problem in medical practice. Acyclovir is a vesicant and an antiviral medication commonly used for young children. In the present study, we presented a neonate with soft tissue damage due to acyclovir extravasation.Case reportA female newborn (Iranian, Asian) with gestational age 37+2 weeks and breech presentation was born by Cesarean delivery from a mother with a recent history of Herpes simplex virus (HSV) infection (Yas Women’s Hospital, Tehran, Iran). Intravenous administration of acyclovir was initiated through a peripheral catheter inserted on the dorsal side of the left hand. A few minutes after the second dose, the patient showed a diffused firm swelling, local discoloration, and induration in the dorsum of the hand. The peripheral catheter was removed immediately. Hyaluronidase was injected subcutaneously in five different regions around the catheterization site. Intermittent limb elevation and cold compression (for 10 minutes) were applied. Serial follow-ups and examinations were performed hourly to check limb inflammation, ischemia, and compartment syndrome. The limb swelling and discoloration significantly improved 4 hours after the second dose of hyaluronidase.ConclusionEarly diagnosis of acyclovir extravasation and immediate management could prevent severe complications in neonates. Further studies are needed to suggest a standard approach and treatment protocol for acyclovir extravasation.

Diagnosis of filariasis: A case report of a reemerging neglected tropical disease

Filariasis is a neglected tropical disease (NTD) of humans caused by the helminthic filarial species Wuchereria (W.) bancrofti, Brugia (B.) timori, and B. malayi. Diverse species of mosquitoes transmit the microfilariae of these worms to cause filaria infection, with the disease presenting classical clinical manifestations such as lymphedema, adenolymphangitis, and hydrocele, which result in permanent disfigurement and psychosocial and economic stigmatization. These sequelae necessitate the need for proper identification and characterization of the etiological agent for therapy and prevention. In this study, we report a case of unilateral lymphedema in a 28-year-old gateman/farmer from the Sabon Gari Local Government Area of Kaduna State, Northern Nigeria. Microscopy of the patient’s blood sample demonstrated the presence of microfilariae, leading to PCR characterization to be W. bancrofti. Upon diagnosis, the patient was treated with tablets of doxycycline 200 mg daily and albendazole 200 mg bid for six weeks, followed by a single dose of ivermectin 150 mg/kg (15 mg) at the 4th week of initiating treatment. This treatment regimen was complemented by a combination of bed rest, use of compression bandage, and limb elevation at night, resulting in remarkable improvement of the patient’s health after six weeks. In conclusion, lymphatic filariasis diagnosis was microscopically confirmed by the demonstration of microfilaria in the blood film obtained at night, leading to molecular characterization by PCR to be W. bancrofti. This is a workup for treating filarial infections in patients with unilateral leg swelling and a history of living in or traveling to endemic areas. This should also be a wake-up call to policymakers and practitioners regarding the possible recrudescence of filariasis in Nigeria.

Investigation of intersegmental coordination patterns in human walking

BackgroundIntersegmental coordination between thigh, shank, and foot plays a crucial role in human gait, facilitating stable and efficient human walking. Limb elevation angles during the gait cycle form a planar manifold describes the by the planar covariation law, a recognized fundamental aspect of human locomotion. Research questionHow does the walking speed, age, BMI, and height, affect the size and orientation of the intersegmental coordination manifold and covariation plane? MethodsThis study introduces novel metrics for quantifying intersegmental coordination, including the mean radius of the manifold, rotation of the manifold about the origin, and the orientation of the plane with respect to the coordinate planes. A statistical investigation is conducted on a publicly available human walking dataset for subjects aged 19–67 years, walking at speeds between 0.18 and 2.3 m s−1 to determine correlations of the proposed quantities. We used two sample t-test and ANOVA to find statistical significance of changes in the metrics with respect to gender and walking speed, respectively. Regression analysis was used to establish relationships between the introduced metrics and walking speed. ResultsHigh correlations are observed between walking speed and the computed metrics, highlighting the sensitivity of these metrics to gait characteristics. Conversely, negligible correlations are found for demographic parameters like age, body mass index (BMI), and height. Male and female groups exhibit no practically significant differences in any of the considered metrics. Additionally, metrics tend to increase in magnitude as walking speed increases. SignificanceThis study contributes numerical metrics to characterize ISC of lower limbs with respect to walking speed along with regression models to estimate these metrics and related kinematic quantities. These findings hold significance for enhancing clinical gait analysis, generating optimal walking trajectories for assistive devices, prosthetics, or rehabilitation, aiming to replicate natural gaits and improve the functionality of biomechanical devices.

Randomised controlled trial of tourniquet associated pain generated in lower limb after exsanguination by Esmarch bandage versus limb elevation

BackgroundTourniquets are common adjuncts in the operating theatre but can be associated with post-operative pain. This study was designed to compare what effect pre-tourniquet Esmarch bandage exsanguination has on pain, compared to pre-tourniquet exsanguination by elevation alone.Methods52 volunteers (104 lower limbs) were included in this study with each volunteer acting as their own matched control. The primary outcome was patient reported pain, measured in both legs simultaneously using area under curve. Secondary outcomes were pain score during inflation and deflation, cumulative pain score, duration of recovery and blood pressure during testing.ResultsPain after Esmarch was superior to elevation as measured by area under pain curve (68.9 SD 26.1 vs 77.2 SD 27.3, p = 0.0010), independent of leg dominance. Cumulative pain scores demonstrated the same superiority after inflation (50.7 SD 17.1 vs 52.9 SD 17.0, p = 0.026) but not after deflation (p = 0.59). Blood pressure was not significantly different. Time to full recovery of the lower limb was the same for both groups—7.6 min (SD 2.1 min, p = 0.80).ConclusionPrevious studies describe a positive effect on pain when Esmarch bandage was used prior to tourniquet inflation for upper limb. Our findings suggest the same benefit from Esmarch when it was used on lower limbs—particularly during inflation of tourniquet. In addition to pain profiles, surgeon preference and patient factors need to be considered when deciding between elevation and Esmarch bandage.

Ultrasound-guided pericapsular nerve block compared with IV opioids in hip injuries: A randomised controlled trial

Study objectivesThe study aimed to compare the analgesic effect of USG-guided PENG (Peri capsular nerve group) block with Intravenous Nalbuphine hydrochloride (IVN) in patients with hip fracture coming to the emergency department (ED). The purpose was also to monitor the adverse effects and rescue analgesic requirements in both treatment modalities. MethodsThe study was an open-label randomised controlled trial (RCT) comparing PENG block versus IVN in treating patients with femoral head and neck fractures, as well as pubic rami fracture of the hip (HF). The participants in the PENG group received a USG-guided PENG block by injection of 25 ml of 0.25% bupivacaine, whereas the IVN group received 0.15 mg/kg of nalbuphine. An emergency physician with expertise in ultrasound-guided nerve blocks performed the PENG blocks. The primary outcome was to measure the improvement of the NRS (Numerical rating scale) score at 30 min in both static position (Patient-chosen position for the best comfort) and dynamic position (15-degree passive affected lower limb elevation). Secondary outcomes were to measure static and dynamic NRS pain scores at 2 h, 4 h, and 6 h after intervention in both groups. The requirement for rescue analgesia, adverse events and any block-related complications were also recorded. ResultsA total of 60 patients with HF were included in the final analysis. The static and dynamic NRS score was significantly lower in the PENG group compared to the IVN group at 30 min, 2 h, 4 h, and 6 h post-intervention. In the PENG group, the static NRS score was improved by 5.73 ± 1.17, while In the IVN group, the static NRS score was just improved by 2.13 ± 0.97 at 30 min. In the same duration, the Dynamic NRS score in the PENG group was improved by 6.13 ± 1.38, while In the IVN group, it improved just by 2.43 ± 1.28. Rescue analgesia was required in 50.0% of patients in the IVN group but none in the PENG group. Further, no block-related complications or adverse events were observed in the patients of the PENG group. ConclusionThe study provides evidence that the ultrasound-guided PENG block has a better analgesic effect and has fewer adverse events than IV opioids in patients with HF.

Periarticular Infiltration Compared to Single Femoral Nerve Block in Total Knee Arthroplasty: A Prospective Randomized Study.

Objective To compare patients undergoing total knee arthroplasty (TKA) under spinal anesthesia and single femoral nerve block (FNB) with subjects undergoing TKA under spinal anesthesia and periarticular infiltration (PAI). Materials and Methods A total of 100 patients undergoing primary TKA were randomized into two groups. Group 1 included patients undergoing surgery under FNB associated with spinal anesthesia, while group 2 included patients undergoing TKA under IPA and spinal anesthesia. The assessment of these subjects in the early postoperative period included pain, active flexion, active extension, elevation of the extended limb, and morphine use. Results There was no significant difference in the types of analgesia concerning pain, the elevation of the extended limb, and morphine use. Active flexion and extension were better in the PAI group ( p = 0.04 and p = 0.02 respectively). Conclusion We conclude that the techniques are similar regarding pain control, limb elevation, and morphine use. The use of IPA provided better active flexion and extension during the hospital stay compared to single FNB in patients undergoing TKA.

Frostbite in the Pediatric Population: A Comprehensive Review and a Prospective Canadian Survey.

Frostbite in the pediatric population, where skeletal maturity has not been achieved, can have important repercussions on subsequent growth. Yet, the optimal management of frostbite injuries in children remains vague. This review aims to summarize the current evidence for frostbite management in children and understand Canadian practice trends on this topic. A review using Medline, Scopus, Web of Science, and gray literature was performed to identify relevant literature on the clinical manifestations, diagnostic methods, and treatment options in pediatric frostbite. An online survey was sent to plastic surgeons through the Canadian Society of Plastic Surgeons (CSPS) mailing list to further identify national practices and trends for pediatric frostbite management. A total of 109 articles were reviewed. No article provided a specific algorithm for pediatric frostbite, with existing recommendations suggesting the use of adult guidelines for treating children. Our survey yielded 9 responses and highlighted the rarity of pediatric frostbite cases, with no responder treating more than 10 cases per year. Most (55.6%) do not use a pediatric-specific treatment algorithm, whereas 30% apply adult guidelines. A conservative approach focusing on rewarming (55.6%), limb elevation (50%), and tetanus status verification (66.7%) was predominant. Imaging and surgical interventions seem to be reserved for severe cases. The current literature for pediatric frostbite management lacks specificity. Canadian practices vary, with a trend toward a conservative approach. The limited evidence and rarity of experience highlight the need for further research, ideally in a collaborative multicentric manner, to create a consensus for pediatric frostbite care.

Mast cell tumour‐associated osteolysis in a Shiba dog

AbstractA 13‐year‐old, female Shiba dog presented with elevation of the right pelvic limb and swelling of the thigh. The right pelvic limb was severely swollen, and subcutaneous haemorrhaging was observed. Radiographs showed bone resorption in the stifle joint region. Fine‐needle aspiration cytology of the stifle was consistent with a mast cell tumour. Computed tomography was performed, and the affected limb was amputated. The histo‐pathological diagnosis was mast cell tumour, and the femur and tibia were found externally lysed with an internal invasion of tumour cells. The safety margins were secured, but the tumour had infiltrated the lymph nodes. Hence, the patient was treated with chemotherapy. There was no tumour recurrence or metastasis for 201 days after surgery, but the patient died. To our knowledge, no case of osteolysis due to mast cell tumour has been reported, making this a very rare case.

A case of unusual hemorrhage as a complication of dengue fever in a tertiary hospital in Dhaka

Common bleeding complications of dengue hemorrhagic fever are epistaxis, gum bleeding, gastrointestinal bleeding, menorrhagia, hematuria.1 Major hemorrhage like intracranial hemorrhage have been documented but rare. We present here a case of a 24 year old man with complaints of high grade intermittent fever for 5 days, upper abdominal discomfort for 3 days and swelling of right upper limb for same duration. Laboratory investigations revealed a positive dengue serology, thrombocytopenia and elevated transaminases. USG of the hand revealed a hematoma involving the right upper arm. The patient was managed conservatively with elevation and immobilization of the upper limb and recovered gradually. J MEDICINE 2024; 25: 100-101

Prospective Study of the Incidence of Asymptomatic Deep-vein Thrombosis in Postoperative Patients: A Single-center Study

Abstract Introduction: Postoperative DVT remains one of the formidable challenges for the surgeon. It is associated with a significant risk of associated morbidity and mortality. Diagnosis of DVT is usually established by the combination of symptoms and imaging, which is most commonly performed noninvasively by color Doppler. However, in multiple instances, the patient may remain asymptomatic, and hence, the diagnosis may be missed. Aim and Methodology: This study was performed at tertiary care to study the incidence of asymptomatic DVT in postoperative patients across various specialties. All postoperative patients were subjected to color Doppler on the 1st, 7th, and 30th postoperative days. Results: Out of 300 patients who were part of the study over 1 year, 31 patients developed DVT, of which eight were symptomatic. They all were managed as per any other patient of DVT by anticoagulants, class II stockings, and limb elevation. We had no mortality. Conclusion: DVT may develop in postoperative cases. It may be fatal if not recognized and treated in time. Timely diagnosis and adequate management remain key in avoiding morbidity and mortality. Data related to postoperative patients developing asymptomatic DVT are limited. There seems to be ambiguity in its etiology, prognosis, management protocol, and follow-up.

Analysis of the risk factors of shoulder pseudoparalysis in patients with full­thickness rotator cuff tears

Background. Rotator cuff tears occur in approximately one in five people in the general population. The unpredictability of the dynamics of tears gives rise to studies of the patterns of their progression. It is known that massive rotator cuff tears form over a long period of time, as a result of which normal biomechanics are disrupted and cuff tear arthropathy develops. The loss of active elevation of the upper limb, developing due to a violation of the normal biomechanics of the shoulder joint, is called “shoulder pseudoparalysis”. There are a small number of studies devoted to risk factors for the occurrence of this condition, and they are completely absent in the domestic literature. These facts dictate the need to conduct research aimed at identifying risk factors for the development of shoulder pseudoparalysis, especially in our country. The aim isto evaluate, using our own clinical material, risk factors for the development of functional disorders in the shoulder joint in the form of shoulder pseudoparalysis in patients with full-thickness rotator cuff tears. Material and methods. A retrospective study was conducted of 254 patients who underwent surgery for full-thickness rotator cuff tears between January 2018 and August 2021. The analysis was based on data from medical histories, clinical, functional and instrumental studies. Results. 34.3% of patients had functional impairment in the form of shoulder pseudoparalysis; risk factors were: massive damage to the rotator cuff (p<0.001), irreparable ruptures (p<0.001), involvement of the subscapularis tendon (p<0.001), involvement of attachment points of “rotator cable” (p<0.001). More severe injuries to the subscapularis tendon aggravate the manifestations of shoulder pseudoparalysis (p<0.001). Involvement of a greater number of attachment points of the “rotator cable” aggravates the manifestations of shoulder pseudoparalysis (p<0.001) Conclusion. The data obtained demonstrate that massive irreparable tears of the rotator cuff of the shoulder joint with severe damage to the subscapularis tendon are the most dangerous from the point of view of disruption of normal biomechanics and, as a consequence, the development of shoulder pseudoparalysis

Arm levitation in multiple system atrophy

AbstractA 53‐year‐old woman presented with repetitive involuntary elevation of the left upper limb beyond her shoulder joint. Initially, the symptom was suspected to be due to a functional neurological disorder. Based on the clinical and radiological findings, however, we diagnosed arm levitation associated with multiple system atrophy. The mechanism of her arm levitation was suggested to be a disturbance of the right frontal cortex with resultant impairment of the inhibitory mechanisms of the primary motor cortex.

Proprioceptive Acuity Assessment in Multiple Directions Across Multiple Joints in the Upper Limb.

Proprioception is essential for precise movement as it helps the body transmit important data about its surroundings to the central nervous system for maintaining body posture and position. This study aimed to investigate the effect of direction and joint angle on upper limb proprioception. Thirty individuals (all males) completed a position reproduction activity in 13 directions and three joint angles. It was discovered that upper limb proprioception is dependent on joint angle, direction, and range of motion. The position reproduction error was found to be dependent on the direction, which had a significantly lower accuracy in the direction with a larger range of motion. In addition, upper limb repositioning errors increased at greater limb elevation angles. Our findings also showed that the joint angle did not significantly affect the absolute error of elbow flexion. With an increase in the elbow flexion, the increase of the gravitational moment of the upper arm and hand coupled with the increase of the muscle arm of the biceps brachii possibly causes slight changes in muscle length perceived by spindles or muscular force perceived by Golgi tendon organs.

Ultrasound-guided pericapsular nerve group (PENG) block versus femoral nerve block for positioning during spinal anaesthesia in proximal femur fractures: A randomised comparative study.

Femoral nerve block is a widely used analgesia technique for positioning before spinal anaesthesia for proximal femur fracture surgeries. Pericapsular nerve group (PENG) block is a newer technique with motor-sparing characteristics. We compared the analgesic efficacy of these blocks for patient positioning for spinal anaesthesia. In this study, 60 patients were randomised to either the PENG group (n = 30) or the femoral group (n = 30). After performing the block, the pain was assessed every 10 min using a visual analogue scale (VAS) score for 30 min. The primary objective was the median [interquartile range (IQR)] reduction in pain (dynamic VAS with 15-degree passive limb elevation) at 30 min. Secondary objectives were ease of spinal position score (EOSP), angle obtained during positioning, duration of postoperative analgesia and quadriceps weakness. The demographics were comparable in both groups. After 30 min, the median (IQR) VAS was 6 (5-7) in the PENG group and 5 (5-6) in the femoral group (P = 0.004). Secondary outcomes such as EOSP score and angle obtained by patients were comparable. In the postoperative period, patients had significantly lower pain in the PENG group compared to the femoral group. The duration of analgesia was prolonged with PENG block. Quadriceps weakness was significantly low with PENG block (P < 0.001). PENG block provides better analgesia than a femoral block before spinal anaesthesia for proximal femur fracture surgery. The postoperative duration of analgesia was also longer.

931 Minimising Surgical Inpatient Bed Use and Maximising Patient Flow in Plastic Surgery: Proposal for Combined Acute Trauma Clinic with Attached Local Anaesthetic Theatre and Ambulatory Care with IV Therapy Service

Abstract Background The majority of hand trauma referrals to plastic surgery consist of minor injuries that ideally require initial washout and exploration under local anaesthetic, during which repair of most damaged structures can also be undertaken. Meanwhile, a significant proportion of acute admissions to plastic surgery are for infected wounds requiring washout, intravenous antibiotics, limb elevation, and daily wound review to ensure resolution. These occupy surgical beds of often-limited capacity, and confine otherwise generally mobile, independent patients. Literature Trauma clinics are well-established, often being utilised as see-and-treat services (Rea-et-al 2004), reducing the wait for a potentially unpredictable main trauma theatre, with proven cost benefit (Cullen-et-al 2021). This is further aided by patient counselling regarding waiting times for surgery (Khan &amp; Iqbal 2021), and the model has been augmented to incorporate virtual reviews (Westley-et-al 2020). Infected wounds amenable to local anaesthetic or wide-awake-local-anaesthetic-no-tourniquet (Lalonde 2015) could similarly be managed in this environment, but may necessitate admission for intravenous antibiotics, nevertheless. However, soft-tissue infections are increasingly being managed in outpatient settings through using single/twice-daily dosed antibiotics with daily review (Ektare et al 2015). Proposal An ideal configuration would therefore consist of a trauma clinic space with assessment bays, local anaesthetic minor theatre, and IV infusion chair(s), staffed by a receptionist, an assessing doctor/nurse practitioner, an operating surgeon with scrub nurse/trained healthcare assistant, and an IV-trained nurse. Conclusions We believe that this cost-effective setup would ensure patients receive timely adequate care for acute limb trauma and infections while reducing inpatient presence and improving efficiency.

Faster Return to Daily Activities and Better Pain Control: A Prospective Study of Enhanced Recovery After Surgery Protocol in Breast Augmentation.

Enhanced recovery after surgery (ERAS) has been proven to decrease the amount of opioid use and reduce postoperative pain for a variety of surgeries, including breast reconstruction. However, data on ERAS in breast augmentation is lacking. This study aims to investigate the effectiveness and safety of ERAS for breast augmentation. A standardized ERAS protocol was established with full consideration of all aspects of perioperative care. Patients undergoing implant-based breast augmentation were prospectively recruited between December 2020 and January 2023, and assigned to either the ERAS or non-ERAS group randomly. The primary outcome was the activity of daily living after surgery. The secondary was postoperative pain and other outcomes included time to freely elevation, vomiting frequency, the use of analgesics, and complications. A total of 122 patients were included, with 70 in the ERAS group and 52 in the non-ERAS group. Compared to non-ERAS patients, ERAS patients had a shorter time to freely elevation of upper limbs (2.3d vs. 5.5d, P<0.001). For ERAS patients, the pain scores were significantly lower on postoperative days 1 to 3, the activity of daily living index was significantly higher on postoperative days 1 to 3 and the opioids consumption was decreased (7.1mg vs. 46.2mg, P=0.018). No difference was observed in complication and hospital costs between the two groups. The ERAS protocol significantly reduced postoperative pain and the use of opioids and promoted a return to daily activities without increasing complications in breast augmentation. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Physiotherapy in a patient with diastasis of the rectus abdominis muscle after childbirth.

Examination for the presence of diastasis of the rectus abdominis muscle and examination of the entire posture is very important in postpartum women. Currently, examination by 2D ultrasound, caliper and palpation is used. It is examined at rest and during stress tests. Case study of a patient with diastasis of the direct abdominal muscle after a first spontaneous uncomplicated delivery at the age of 32 years. Examination to confirm diastasis of the rectus abdominis muscle - the width of linea alba was measured with a 2D linear probe by ultrasound 4.5 cm above the umbilicus, in the region of the umbilicus and 4.5 cm below the umbilicus. Lying on the back at rest, and with elevation of the lower limbs. The degree of severity was classified into four grades. A standard physiotherapy postural examination was performed. A part of the intervention was individual exercise with activation of the m. transversus abdominis to reduce diastasis of the direct abdominal muscles. The exercise program included postural adjustment, modification of breathing stereotype and quality, and activation of pelvic floor muscles. Exercises to reduce pain in the ligamentous apparatus and training in correct ergonomics were also performed. The dosage of exercise was 15 min per day in the 1st week of treatment, 2-4 week of treatment 20 min per day, 5-12 week of treatment 30 min per day, 5 days per week, for 12 weeks. The effect of exercise with activation of m. transversus abdominis on the reduction of diastasis of the direct abdominal muscle in the postpartum patient was objectively proven by the above mentioned objectification methods.

Musculoskeletal Modeling of the Compensatory Role of the Shoulder Muscles in Ensuring the Stability of the Shoulder Joint in the Conditions of Partial Traumatic Tear of the Supraspinatus Muscle Caused by Calcific Tendinitis

Relevance. The presence of calcium deposits in the rotator cuff tendons usually leads to a restriction of the biomechanics of the shoulder joint and, in particular, to a failure of the scapulohumeral rhythm. The question of the compensatory participation of the muscles of the shoulder girdle in ensuring the stability of the shoulder joint in conditions of partial-thickness damage to the tendon of the supraspinatus muscle caused by calcific tendinitis remains interesting and understudied.&#x0D; Objective: to carry out skeletal and muscular modeling with the study of the compensatory participation of the rotator cuff muscles in ensuring the stability of the shoulder joint during the elementary movement of elevation of the upper limb in conditions of partial-thickness damage to the supraspinatus tendon caused by the presence of calcification in it.&#x0D; Materials and Methods. For the analysis we used simulation modeling in the software package AnyBody Modeling System™ (AnyBody Technology A / S, Denmark) for Windows. The calculation was carried out using the software component Mannequin, selected from the AnyBody Managed Model Repository™ model collection. The parameters of joint forces acting in the direction of three axes – X, Y, Z – were calculated, where the X axis corresponded to the anterior-posterior force direction (antero-posterior force), the Y axis – to the inferior-superior force direction, the Z axis – compression-distraction force direction (medio-lateral force) on the shoulder joint. The object of the study was muscle activity (Activity) and muscle strength (Fm) of m. deltiodus clavicular, m. deltiodus scapularis, m. infrapsinatus, m. subscapularis, m. teres major, and m. teres minor while simulating a decrease in the strength of m. supraspinatus by 50% caused by the presence of calcification in the thickness of its tendon.&#x0D; Results. With complex movement of the upper limb, associated with the elevation of the upper limb, in conditions of partial-thickness tear to the m. supraspinatus, with a decrease in its strength by 50%, there is a compensatory increase in the strength of the muscles of the shoulder joint – the posterior portion of the m. deltoidus scapularis, m. infraspinatus and m. subscapularis, to ensure the stability of the shoulder joint. Taking into account minor changes in joint reactions along three axes, with a decrease in the strength of m. supraspinatus caused by the presence of calcification in its thickness, the compensatory mechanism of including additional muscle activity and muscle efforts of other muscles of the shoulder girdle provides the necessary stability of the shoulder joint in these conditions.&#x0D; Conclusions. The study confirms the possibility of successful application of programs of conservative treatment of calcifications of the m. supraspinatus tendon, aimed at developing the compensatory capabilities of the muscles of the shoulder girdle.

Characterization of prosthetic knees through a low-dimensional description of gait kinematics

The characterization of both limbs’ behaviour in prosthetic gait is of key importance for improving the prosthetic components and increasing the biomechanical capability of trans-femoral amputees. When characterizing human gait, modular motor control theories have been proven to be powerful in providing a compact description of the gait patterns. In this paper, the planar covariation law of lower limb elevation angles is proposed as a compact, modular description of prosthetic gait; this model is exploited for a comparison between trans-femoral amputees walking with different prosthetic knees and control subjects walking at different speeds. Results show how the planar covariation law is maintained in prostheses users, with a similar spatial organization and few temporal differences. Most of the differences among the different prosthetic knees are found in the kinematic coordination patterns of the sound side. Moreover, different geometrical parameters have been calculated over the common projected plane, and their correlation with classical gait spatiotemporal and stability parameters has been investigated. The results from this latter analysis have highlighted a correlation with several parameters of gait, suggesting that this compact description of kinematics unravels a significant biomechanical meaning. These results can be exploited to guide the control mechanisms of prosthetic devices based purely on the measurement of relevant kinematic quantities.