Limited Active Range Of Motion Research Articles

Recovery of Shoulder, Elbow, and Forearm Movement After Nerve Reconstruction for Neonatal Brachial Plexus Palsy.

There is a relative dearth of published data with respect to recovery of upper extremity movement after nerve reconstruction for neonatal brachial plexus palsy (NBPP). This study aimed to demonstrate long-term recovery of active range of motion (AROM) at the shoulder, elbow, and forearm after nerve reconstruction for NBPP and to compare that with patients managed nonoperatively. We interrogated a prospectively collected database of all patients evaluated for NBPP at a single institution from 2005 to 2020. AROM measurements for shoulder, elbow, and forearm movements were collected at every visit up to 5 years of follow-up and normalized between 0 and 1. We used generalized estimated equations to predict AROM for each movement within local age windows over 5 years and compared the operative and nonoperative cohorts at each age interval. In total, >13 000 collected datapoints representing 425 conservatively and 99 operatively managed children were included for analysis. At 5 years, absolute recovery of AROM after nerve reconstruction was ∼50% for shoulder abduction and forward flexion, ∼65% for shoulder external rotation, and ∼75% for elbow flexion and forearm supination, with ∼20% loss of elbow extension AROM. Despite more limited AROM on presentation for the operative cohort, at 5 years, there was no significant difference between the groups in AROM for shoulder external rotation, elbow extension, or forearm supination, and, in Narakas grade 1-2 injury, shoulder abduction and forward flexion. We demonstrate recovery of upper extremity AROM after nerve surgery for NBPP. Despite more severe presenting injury, operative patients had similar recovery of AROM when compared with nonoperative patients for shoulder external rotation, elbow extension, forearm supination, and, for Narakas grade 1-2 injury, shoulder abduction and forward flexion.

A novel technique for subscapularis repair in total shoulder arthroplasty

Anatomic total shoulder arthroplasty, when used for treatment of primary glenohumeral arthritis, is historically very successful. We propose a novel technique for subscapularis repair during closure of a deltopectoral approach to the shoulder with subscapularis peel. Our technique allows for early motion following surgery and also provides for improved subscapularis repair integrity and resilience during postoperative rehabilitation. Postoperatively, we allow passive and active assisted range of motion at week 1, limited active range of motion at week 2, and unrestricted external rotation range of motion beginning at week 6. The use of our technique has led to improved patient outcomes with regard to range of motion postoperatively following anatomic total shoulder arthroplasty and we recommend its adoption into practice.

Heterogeneity among patients with subacromial pain – variabilities within clinical presentation and its impact on daily life

ObjectiveThe primary aim was to describe the variability within clinical presentation of patients with subacromial pain in primary care, secondly to investigate associations between clinical presentation and self-reported pain intensity, shoulder function, level of anxiety and depression, and health-related quality of life. Design and settingA cross-sectional study based on data from two clinical studies in primary care, one randomized controlled trial and one implementation study. Three components: active range of motion (AROM), rotator cuff function and scapular kinematics were analyzed to describe variability within clinical presentation and patient-reported measurements were used to investigate the impact on daily life. ParticipantsPatients aged 30-67 years, describing pain for more than two weeks, with positive signs for a minimum of three out of the following five clinical tests: impingement sign according to Neer, impingement test according to Hawkins-Kennedy, Pattes maneuver, Jobe’s test, and painful arc. ResultsAmong the 164 patients included, 24% displayed dysfunction in one, 50% two and 24% in all three components. Limited AROM was seen in 46%, rotator cuff dysfunction in 91% and scapular dyskinesia in 57% of the patients. ConclusionsThese results reveal a heterogeneity among primary care patients with subacromial pain confirming a large variability regarding the components AROM, rotator cuff function and scapular kinematics. All three components appear unique (not significantly correlated) where a rotator cuff dysfunction is very frequent while limited AROM and scapular dyskinesia are more inconsistent. There are significant, but rather weak, associations between clinical presentation and impact on daily life.

ACTIVE THERAPEUTIC MOVEMENT IMPROVES PAIN-FREE RANGE OF MOTION IN A 53 YEAR OLD WOMAN WITH REFRACTORY BILATERAL FROZEN SHOULDER

Event Abstract Back to Event ACTIVE THERAPEUTIC MOVEMENT IMPROVES PAIN-FREE RANGE OF MOTION IN A 53 YEAR OLD WOMAN WITH REFRACTORY BILATERAL FROZEN SHOULDER David J. Clark1* 1 Carrick Institute, United States Background: A 53 year old woman presented with 18 month history of bilateral frozen shoulder refractory to previous treatment of steroid shots and physical therapy. In addition to a history of chronic migraines, she also complained of frequent headaches that originated from both her cervical spine and muscles including the trapezius and levator scapulae. Four years prior she was diagnosed with Hashimoto’s. She was taking daily Topamax®, Voltaren®, tizanidine, trazadone, synthroid, Wellbutrin®, estradiol and Dexilant®. On an as-needed basis, she was taking meperidine and cyclobenzaprine. Methods: Neurological and physical examination revealed limited active range of motion in lateral abduction, external rotation, extension and flexion of both glenohumeral joints. She displayed head forward posture and rounded shoulders. Form closure passive retraction of her shoulders allowed her to elevate both shoulders significantly higher in abduction and with less pain. She was treated twelve times over three months using the ATM2 (Backproject, Sunnyvale, California) utilizing passive positioning of shoulder retraction and isometric contractions of the pectoralis minor and deltoid. Each treatment session lasted approximately 10 minutes. Results: Over the course of the treatments the patient demonstrated improved active range of motion in shoulder abduction. At the twelfth treatment she had normal pain-free active range of motion in abduction and flexion of the glenohumeral joints. The patient reported almost 100% subjective improvement in her bilateral shoulder pain and significant improvement in the frequency and intensity of her headaches. Her sleep quality had significantly improved. She had stopped using the Voltaren®, mepiridine and cyclobenzaprine. Conclusion: The author recommends further investigation into the use of Active Therapeutic Movement in the treatment of refractory frozen shoulder. Keywords: Frozen shoulder (adhesive capsulitis), Hashimoto's autoimmune thyroiditis, Isometric exercise, Posture abnormalities, active therapeutic movement Conference: International Symposium on Clinical Neuroscience, Orlando, United States, 24 May - 26 May, 2019. Presentation Type: Poster Presentation Topic: Clinical Neuroscience Citation: Clark DJ (2019). ACTIVE THERAPEUTIC MOVEMENT IMPROVES PAIN-FREE RANGE OF MOTION IN A 53 YEAR OLD WOMAN WITH REFRACTORY BILATERAL FROZEN SHOULDER. Front. Neurol. Conference Abstract: International Symposium on Clinical Neuroscience. doi: 10.3389/conf.fneur.2019.62.00036 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 02 Apr 2019; Published Online: 27 Sep 2019. * Correspondence: Mx. David J Clark, Carrick Institute, Cape Canaveral, Florida, 32920, United States, mail@doctordavidclark.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers David J Clark Google David J Clark Google Scholar David J Clark PubMed David J Clark Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Spinal Accessory Nerve Injury Induced by Manipulation Therapy: A Case Report.

Spinal accessory nerve (SAN) injury mostly occurs during surgical procedures. SAN injury caused by manipulation therapy has been rarely reported. We present a rare case of SAN injury associated with manipulation therapy showing scapular winging and droopy shoulder. A 42-year-old woman visited our outpatient clinic complaining of pain and limited active range of motion (ROM) in right shoulder and scapular winging after manipulation therapy. Needle electromyography and nerve conduction study suggested SAN injury. Physical therapy (PT) three times a week for 2 weeks were prescribed. After a total of 6 sessions of PT and modality, the patient reported that the pain was gradually relieved during shoulder flexion and abduction with improved active ROM of shoulder. Over the course of 2 months follow-up, the patient reported almost recovered shoulder ROM and strength as before. She did not complain of shoulder pain any more.

Immediate Effects of Mirror Therapy in Patients With Shoulder Pain and Decreased Range of Motion

ObjectiveTo determine the effects of a brief single component of the graded motor imagery (GMI) sequence (mirror therapy) on active range of motion (AROM), pain, fear avoidance, and pain catastrophization in patients with shoulder pain. DesignSingle-blind case series. SettingThree outpatient physical therapy clinics. ParticipantsPatients with shoulder pain and limited AROM (N=69). InterventionPatients moved their unaffected shoulder through comfortable AROM in front of a mirror so that it appeared that they were moving their affected shoulder. Main Outcome MeasuresWe measured pain, pain catastrophization, fear avoidance, and AROM in 69 consecutive patients with shoulder pain and limited AROM before and immediately after mirror therapy. ResultsThere were significant differences in self-reported pain (P=.014), pain catastrophization (P<.001), and the Tampa Scale of Kinesiophobia (P=.012) immediately after mirror therapy; however, the means did not meet or exceed the minimal detectable change (MDC) for each outcome measure. There was a significant increase (mean, 14.5°) in affected shoulder flexion AROM immediately postmirror therapy (P<.001), which exceeded the MDC of 8°. ConclusionsA brief mirror therapy intervention can result in statistically significant improvements in pain, pain catastrophization, fear avoidance, and shoulder flexion AROM in patients presenting with shoulder pain with limited AROM. The immediate changes may allow a quicker transition to multimodal treatment, including manual therapy and exercise in these patients. Further studies, including randomized controlled trials, are needed to investigate these findings and determine longer-term effects.

Residual Grip and Pinch Strength Deficits After Completion of Hand Rehabilitation

Introduction: Grip and pinch strength are commonly used to document progress in the hand rehabilitation process and in return to work clinics. Grip strength measurement is widely studied; however, pinch strength measurements are not well documented. The majority of the studies on grip and pinch strength were conducted on healthy participants, and there is a dearth of studies on people with hand injuries. Patients who undergo hand rehabilitation have various diagnoses, and the type of diagnosis may affect the residual hand force deficits. Objectives: To examine whether there are residual hand force deficits after the completion of the rehabilitation process by comparing grip and pinch strength between the injured and uninjured hand, to explore whether the type of diagnosis affected these deficits, and to investigate whether there are gender, age, and dominancy differences in these deficits. Materials and Methods: Data were collected retrospectively from 234 participants (174 males and 60 females) with hand injury who were referred to the hand clinic for functional evaluation after completion of the rehabilitation process using the EVAL computerized system. Mean number of years after injury was 3.05 (standard deviation [SD], 2.78). Mean age was 39.2 (SD, 14.7) years. Outcome measures include the average grip strength (in kilograms) of 8 trials measured at the second handle position during the rapid exchange grip force test, and the average of 3 trials of lateral pinch, tripod pinch, and tip pinch (in kilograms). Both injured and uninjured hands were evaluated. The deficits in hand force were calculated using the formula: (Injured hand / Uninjured hand) × 100. The participants were divided into 5 groups according to the type of injury as follows: elbow and shoulder fractures, musculoskeletal disorders in the upper extremity, finger injury (limited active range of motion in the fingers due to fractures of the phalanges or tendon injury), wrist fractures, and nerve injuries (postrelease or repair surgery). The data were analyzed using the general linear model for repeated measures (SPSS). Results: There were significant differences in hand force between the injured and uninjured hands after completion of hand rehabilitation for all injury groups ( P &lt; .05). There were no significant differences in grip and pinch force deficit whether the dominant or nondominant hand was injured. Grip strength deficits ranged from 20% to 30%, whereas pinch strength deficits ranged from 40% to 50%. There were no significant differences in both grip and pinch strength between the 5 injury groups or between men and women. Conclusion: The significant differences in grip and pinch strength between the injured and uninjured hands indicated that there were residual deficits in hand force after completion of the rehabilitation process. Yet, mean grip strength in the injured hand was greater than 9 kg and mean pinch strength was greater than 2 kg, indicating that despite those deficits, hand force in these participants was considered functional. Furthermore, hand force deficits after completion of the rehabilitation process were not affected by gender or by the location and type of injury.

Clinical Relevance Commentary in Response to: Coaching of patients with and isolated minimally displaced fracture of the radial head immediately increases range of motion

Even a minor injury occurring at the elbow can result in limitations in elbow active range of motion (AROM). 18 Sardelli M. Tashjian R.S. MacWilliams B.A. Functional elbow range of motion for contemporary task. J Bone Joint Surg Am. 2011; 93: 471-477 Crossref PubMed Scopus (150) Google Scholar , 21 Morrey B.F. An K.N. Functional evaluation of the elbow. in: Morrey B.F. The Elbow and Its Disorders. 3rd ed. WB Saunders, Philadelphia, PA2000: 74-83 Google Scholar It is widely accepted that patient participation in a home program has been an integral component of therapy to facilitate improvements in motion, function, and reduction of pain. My clinical experience is consistent with the finding that patients with Broberg-Morrey–modified Mason type 1 or 2 fracture 1 Broberg M.A. Morrey B.F. Results of treatment of fracture-dislocations of the elbow. Clin Orthop Relat Res. 1987; 216: 109-119 PubMed Google Scholar of the radial head or the neck often may have reports of pain, stiffness, swelling, limited AROM, and limitations in function immediately after the period of initial nonoperative treatment of rest. I concur that patients typically show some improvement in AROM on the same day when the protection of a sling/splint is discontinued, are instructed in safe parameters of exercise, and have the opportunity to demonstrate correct exercise and activity performance.

Performance of the 4-way range of motion test for radiographic injuries after blunt elbow trauma

ObjectivesAcute elbow injuries are common in the acute care setting. A previous study observed that limited active range of motion (ROM) was highly sensitive for radiographic injuries after blunt trauma. Our aim was to validate these findings in patients ≥5 years old with an acute (<24 hours) nonpenetrating elbow injury. MethodsThis prospective study included a convenience sample of patients undergoing plain radiographs of an injured elbow in 3 emergency departments. Before imaging, treating clinicians completed a standardized data collection sheet including mechanism of injury and 4-way ROM findings (full extension, flexion to 90°, full pronation and supination). Radiographic interpretation by a staff radiologist was used to ascertain the presence of fracture or joint effusion. ResultsThe median age of the 251 patients was 24 years. Ninety-two patients (36.7%) had active 4-way ROM, and 159 patients (63.3%) demonstrated limited ROM. Negative radiographs were present in 152 patients (60.6%), whereas 99 patients (39.4%) had abnormal radiographs: 75 with explicit fractures and 24 with only joint effusions. The 4-way ROM elbow test had a sensitivity of 0.99 (95% confidence interval [CI], 0.94-1.00), specificity of 0.60 (95% CI, 0.52-0.68), positive predictive value of 0.62 (95% CI, 0.54-0.69), and negative predictive value of 0.99 (95% CI, 0.94-1.00). ConclusionsActive 4-way ROM test is 99% sensitive for all radiographic injures following blunt elbow trauma and 100% sensitive for injuries requiring surgical intervention. Caution should be used in relying on this test in the pediatric population until it is validated in a larger cohort.

Efficacy of Kinesiology Taping for Recovery from Occupational Wrist Disorders Experienced by a Physical Therapist

[Purpose] The aim of this paper was to report the efficacy of kinesiology taping for recovery from wrist pain and limited range of motion (ROM) in a physical therapist with repetitive strain injuries. [Subjects] A 32 year-old male physical therapist developed recurring severe pain in the dominant wrist and limited active ROM with extremely painful supination. [Methods] The kinesiology tape was applied to the lumbricals, musculi interossei dorsales, palmares, the wrist extensor and flexor muscles, and the wrist joint for 3 weeks for an average of 10 h/day. [Results] After application of the kinesiology tape, the Numeric Pain Rating Scale and Patient-rated Wrist Evaluation scores decreased, and the Patient-Specific Functional Scale score increased in comparison with the initial score. [Conclusion] Repeated kinesiology taping of the wrist muscles and joint could be an effective method for recovery from occupational wrist disorders experienced by physical therapists.

X-Ray Quiz: A Woman with Traumatic Wrist Pain

A 30-year-old woman presented to the our emergency department (ED) with a complaint of wrist pain after a fall onto her right outstretched hand. Initial evaluations revealed a swollen wrist, generalised carpal tenderness, and limited active range of motion of the wrist. Standard posteroanterior (PA) and lateral X-rays of the wrist were performed.

Management of Failed Arthroscopic Rotator Cuff Repair

Most patients experience pain relief and functional improvement following arthroscopic rotator cuff repair, but some continue to experience symptoms postoperatively. Patients with so-called failed rotator cuff syndrome, that is, with continued pain, weakness, and limited active range of motion following arthroscopic rotator cuff repair, present a diagnostic and therapeutic challenge. A thorough patient history, physical examination, and imaging studies (eg, plain radiography, MRI, magnetic resonance arthrography, ultrasonography) are required for diagnosis. Management is determined based on patient age, functional demands, rotator cuff competence, and the presence or absence of glenohumeral arthritis. Treatment options include revision repair, nonanatomic repair with or without biologic or synthetic augmentation, tendon transfer, and arthroplasty.

Management of Failed Arthroscopic Rotator Cuff Repair

Most patients experience pain relief and functional improvement following arthroscopic rotator cuff repair, but some continue to experience symptoms postoperatively. Patients with so-called failed rotator cuff syndrome, that is, with continued pain, weakness, and limited active range of motion following arthroscopic rotator cuff repair, present a diagnostic and therapeutic challenge. A thorough patient history, physical examination, and imaging studies (eg, plain radiography, MRI, magnetic resonance arthrography, ultrasonography) are required for diagnosis. Management is determined based on patient age, functional demands, rotator cuff competence, and the presence or absence of glenohumeral arthritis. Treatment options include revision repair, nonanatomic repair with or without biologic or synthetic augmentation, tendon transfer, and arthroplasty.

The Utilization of Nintendo® Wii™ During Burn Rehabilitation

The purpose of this study was to demonstrate feasibility and measure outcomes on pain, anxiety, active range of motion (AROM), function, enjoyment, and presence with the adjunctive use of Nintendo® Wii™ (Nintendo of America Inc., Redmond, WA) during acute burn rehabilitation. Participants were alternated and stratified based on the location of burn into Wii or control treatment groups. Joints of interest with limited AROM were the shoulder, elbow, wrist, hip, knee, and ankle. All participants received three consecutive sessions of passive range of motion and predetermined joint-specific exercises. This was followed by either designated Wii games or therapist-chosen interventions (control). The outcomes were compared between groups using t-tests (P < .05) and Cohen's d statistic. Data from 23 participants aged 20 to 78 years were analyzed. The difference in mean slopes suggested that the Wii group experienced less pain (x = -0.97, P = .07) than the control group over time. Overall, trends with anxiety (x = -0.1l, P = .77), AROM (x = 0.55, P = .81), function (x = -0.38, P = .43), and enjoyment (x = 0.09, P = .73) seemed to favor the Wii group. Presence minimally changed between successive treatment sessions for those in the Wii group. Although statistical significance was not reached in any category, feasibility was supported and the overall pattern for outcomes was positive for the Wii group, the most favorable being for pain reduction. Future research with larger sample sizes is warranted to explore best practice with video game technology throughout the continuum of burn rehabilitation with appropriate prescriptions.

Mesotherapy improves range of motion in patients with rotator cuff tendinitis

There is published evidence on the effect of mesotherapy for inflammatory shoulder diseases. Objective: Evaluate the gain in range of motion (ROM) in patients with rotator cuff tendinopathy treated with mesotherapy. A retrospective series of cases conducted from medical records. Location: an outpatient rehabilitation and orthopedic service. 145 patients with clinical diagnosis of rotator cuff tendinopathy, with limited active range of motion. Method: The study subjects were treated with mesotherapy between 1995 and 2008, the blends were selected according to the patient’s profile and tolerance. The effect on the ROM was qualified as “not improved” or “improved”. The improvement in symptomatology was correlated to age, duration of symptoms, and drugs used in the mesotherapy. The concomitant application of physical therapy was also correlated with the result. The adverse effects were evaluated systematically. Results: 117 patients (80.7%) presented objective improvement of ROM or of pain. The result was not influenced by age, duration of symptoms, or by the concomitant application of physical therapy. Only smaller adverse effects were observed. Conclusion: This study suggests that mesotherapy can be efficient in the treatment of rotator cuff tendinopathy, for the improvement of pain, ROM, or global functioning of the upper limb. The clinical impact of this study is that mesotherapy can be associated with the standard physical therapy treatment to improve ROM and pain in rotator cuff tendinopathy.

A Rare Isolated Trapezoid Fracture

A 45-year-old woman presented to the emergency department with left wrist pain following a fall. Physical exam was remarkable for soft tissue swelling of the palmar and dorsal hand, point tenderness at the base of the second metacarpal, and limited active range of motion. Three-view wrist radiographs showed significant soft tissue swelling without evidence of fracture or dislocation. Computed tomography obtained due to concern for an occult fracture revealed a comminuted fracture of the trapezoid bone involving the articular surface with an anteriorly displaced bone fragment (Figures 1 and ​and2).2). The patient was placed in a sugar-tong splint and given orthopedic follow up. Figure 1 Coronal view computed tomography of wrist demonstrating trapezoid fracture. Figure 2 Axial view computed tomography of wrist demonstrating comminuted trapezoid fracture. Fractures of the trapezoid bone are rare, accounting for 0.4% of carpal fractures.1 This is primarily due to its protected position in the wrist, nestled within strong intercarpal ligaments between the surrounding carpal bones and the base of the second metacarpal. Its position and integrity contribute vitally to the carpal arch, but make detection of injury elusive.1,2 Fractures are rarely isolated, often involving fractures of the second metacarpal base.2 Patients may have second metacarpal base tenderness, “snuffbox” tenderness,3 or pain with axial loading of the second digit4 after trauma involving an axial or bending force along the second metacarpal. The overlapping bones and intimate articulations of the wrist make plain radiographs difficult to interpret.1,5 In 2 separate reports reviewing 17 trapezoid fractures, only 1 fracture was diagnosed by plain radiographs; all others required advanced imaging.6,7 In 1 study, 30% of wrist fractures missed by plain radiograph were diagnosed by computed tomography.5 Treatment approaches have varied from cast immobilization to open reduction and internal fixation, depending on degree of displacement and integrity of the carpal arch.1,6 Unrecognized trapezoid fractures may lead to functional compromise. Delayed union and nonunion resulting in diminished grasp power2 and pain are reported.2,4,8 In a patient with the appropriate mechanism, persistent pain, or second metacarpal base injuries, it falls on the emergency physician to suspect and diagnose this fracture.2,8

Mesotherapy improves range of motion in patients with rotator cuff tendinitis

Há evidências publicadas sobre o efeito da mesoterapia para as doenças inflamatórias do ombro. Objetivo: Avaliar o ganho de amplitude de movimento (ADM) em pacientes com tendinopatia do manguito rotador tratados com mesoterapia. Uma série retrospectiva de casos conduzida a partir de prontuários médicos. Um serviço ambulatorial de reabilitação e ortopedia. População: 145 pacientes com diagnóstico clínico de tendinopatia do manguito rotador, com limitação da amplitude de movimento ativa. Método: Os sujeitos do estudo foram tratados com mesoterapia entre 1995 e 2008, as mesclas foram selecionadas de acordo com o perfil do paciente e sua tolerância. O efeito sobre a ADM foi qualificado como “sem melhora” ou “com melhora”. A melhora da sintomatologia foi correlacionada com a idade, duração dos sintomas e drogas usadas na mesoterapia. A realização concomitante de fisioterapia também foi correlacionada com o desfecho. Os efeitos adversos foram avaliados sistematicamente. Resultados: 117 pacientes (80,7%) apresentaram melhor objetiva da ADM ou a dor. O resultado não foi influenciado pela idade, duração dos sintomas ou pela realização concomitante de fisioterapia. Apenas efeitos adversos menores foram observados. Conclusão: Este estudo sugere que a mesoterapia pode ser eficaz no tratamento da tendinopatia do manguito rotador, seja pela melhora da dor, ADM ou função global do membro superior. O impacto clínico deste estudo é que a mesoterapia pode ser associada ao tratamento fisioterapêutico padrão para melhorar ADM e dor na tendinopatia do manguito rotador.

The influence of abductor lever-arm changes after shoulder arthroplasty

Clinically, pain relief is usually satisfactory after shoulder arthroplasty, but the range of motion can be limited. The changes of the lever-arms of deltoid and supraspinatus muscles are considered to be important factors influencing postoperative active motion. After excluding patients with muscle weakness resulting from a neurologic condition, patients with chronic rotator-cuff tears, patients who did not follow rehabilitation guidelines, and patients with bilateral arthroplasties, 22 arthroplasty cases remained and were evaluated. Compared with the unaffected side, four radiologic parameters were assessed: (A) offset of humeral head, (B) lateralization of humeral head, (C) acromiohumeral interval, and (D) superoinferior migration of humeral head. The differences were measured and statistically analyzed. In summary: (1) The active and passive range of motion of abduction in scapular plane were 89.5° ± 26.1° and 109.7° ± 25.0°. (2) Parameters A, B, and C statistically changed (p < 0.05). (3) B value of the operated side was reduced below zero in six (27.3%). (4) There was a tendency to create medial shifting and inferior subluxation with the arthroplasty. This had a moderate adverse correlation to the active range of motion (correlation coefficient 0.498). (5) Before normalization for bone size, only C as a single parameter had moderate correlation with motion; after normalization, this decreased. (6) If combined parameters were assessed, A + C had a moderate correlation (correlation coefficient 0.435) with motion. (7) If an accurate anatomic relationship cannot be completely restored, A seemed more significant than any other parameters (p = 0.002); namely, shoulders with a smaller offset had a more limited active range of motion in abduction.

The 11th Nerve Syndrome: Accessory Nerve Palsy or Adhesive Capsulitis?

Carolynn Patten, MD, Seattle, Wash, presented a study examining the role of adhesive capsulitis of the glenohumeral joint in the 11th nerve syndrome, which is frequently suffered by patients who have undergone a neck dissection. Forty-four patients were evaluated prospectively; 31 were found to have the classic symptoms of shoulder droop, pain, and limited active range of motion in lateral abduction of the arm. Of this group of patients, 71% to 83% were found to have physical abnormalities related to pathologic changes of the glenohumeral joint (adhesive capsulitis) rather than neuromuscular deinnervation from injury to the spinal accessory nerve. Recovery from symptoms of adhesive capsulitis were also found to be more prolonged. The observations from this work are quite important. It confirms the belief that the 11th nerve syndrome is more than a neuromuscular problem, implying the importance of physiotherapy and other measures to treat the glenohumeral joint component of

Isokinetic strength testing in monitoring progress in a multidisciplinary work reentry program: A case study

The purpose of this paper is to present a case study of a patient with a history of low back pain and the use of isokinetic testing in tracking that patient through a work-reentry program. A 44-year-old male with a diagnosis of low back pain underwent a functional capacity evaluation and began a work-reentry program. Initial isokinetic testing revealed low torque outputs in both the trunk and knee flexion and extension tests as well as limited active range of motion. Coefficient of variation appeared to be relatively high and the patient seemed guarded in his movements during the testing. Psychological testing revealed a high fear of reinjury which may have influenced the initial test. Subsequent isokinetic testing performed on the tenth and twenty-fourth days of program and at 1 month post-program exhibited greater than expected increases in torque output. This could be due in part to a reduction in the fear of reinjury, a learning effect with repeated exposure to testing, and the patient's increased confidence in the use of unguarded movements. His trunk range of motion remained essentially the same throughout the serial testing. Pain in the back and left leg was slightly diminished despite an increase in strength and function.