Limited Passive Range Of Motion Research Articles

Musculoskeletal ultrasound of the shoulder in patients with adhesive capsulitis.

Adhesive capsulitis is a common pathological condition of the shoulder that affects the general population. The aim of the present study was to explore shoulder ultrasonographic findings in patients with adhesive capsulitis. A cross-sectional descriptive study was conducted on 96 patients with adhesive capsulitis. Abnormal shoulder ultrasonographic findings were found in all participants. The top three abnormal ultrasonographic imaging features were biceps tendon effusion (71.8%), positive dynamic supraspinatus impingement (56.2%) and subdeltoid-subacromial bursitis (47.9%). By assessing the relationship between limited functional shoulder range of motion (ROM) and abnormal shoulder ultrasonographic findings, limited passive ROM (PROM) with shoulder flexion of ≤120 degrees was found to be significantly associated with positive dynamic supraspinatus impingement. Similarly, limited PROM in shoulder abduction of ≤130 degrees was found to be significantly associated with subdeltoid and subacromial bursitis, as well as positive dynamic supraspinatus impingement. In addition, limited PROM with shoulder internal rotation of ≤60 degrees was significantly associated with positive dynamic supraspinatus impingement. Varying abnormal shoulder ultrasonographic findings were obtained in patients with adhesive capsulitis. Therefore, it should be cautioned that relying solely on physical examination may not accurately indicate true shoulder pathology and it is suggested that the final diagnosis should be based on a combination of the patients' clinical and overall ultrasonographic findings.

Prevalence, risk factor and outcome in middle-aged and elderly population affected by hemiplegic shoulder pain: An observational study.

Hemiplegic shoulder pain is the most common complication after stroke. It usually occurs during the critical period of stroke recovery and hinders the rehabilitation of upper extremity motor function. However, there are few studies on the risk factors, the development and prognosis of shoulder pain after stroke. This study aimed to observe the prevalence of post-stroke shoulder pain in the middle-aged and elderly population, find out the risk factors for post-stroke shoulder pain, and explore its effect on stroke outcome. Eligible patients with hemiplegic shoulder pain in the rehabilitation unit were recruited and followed up at 2 and 4 months. The basic clinical information including age, gender, hypertension and atrial fibrillation history, stroke types, stroke location was recorded. Range of motion for shoulder, glenohumeral subluxation, muscle tension, activity of daily living of upper limb were measured. Data from blood test and shoulder ultrasonography were collected. 480 stroke patients were screened within 1 year, and 239 patients were included in the statistical analysis. The prevalence of hemiplegic shoulder pain was 55.6% (133/239) at admission, 59.4% (142/239) after 2 months, and 55.1% (130/236) after 4 months. We found that shoulder pain was more likely to occur in women, patients with large-area stroke, increased tension of biceps brachii or triceps brachii, subluxation and limited passive range of motion of the shoulder. And the ability of daily living of patients with shoulder pain was significantly lower than that of patients without shoulder pain. Shoulder ultrasonography showed that the most common lesion in patients with shoulder pain was supraspinatus tendon thickening, and the thickness of supraspinatus tendon in the hemiplegic side of patients with shoulder pain was significantly higher than that of unaffected side. In addition, the hospitalization rate of patients with shoulder pain after 2 months and 4 months was significantly higher than that without shoulder pain. Hemiplegic shoulder pain has a high prevalence and can last for several months. Multiple risk factors are involved. Moreover, hemiplegic shoulder pain affects the readmission rate of patients. Therefore, we should pay more attention to this problem in our clinical work. The application of various means to relieve shoulder pain will be conducive to the recovery of upper limb motor function and shorten the in-hospital rehabilitation time.

Prognostic factors for outcomes of surgical mobilisation in patients with posttraumatic limited range of motion of the proximal interphalangeal joint: a multivariate analysis

This study aimed to identify the prognostic factors for outcomes of surgical mobilisation in patients with posttraumatic limited range of motion (ROM) of the proximal interphalangeal (PIP) joint and determine which procedure actually improves the PIP joint ROM. A total of 71 fingers (57 patients: 49 men, 8 women; mean age, 41 years) with posttraumatic limited passive ROM of the PIP joint (<60°) who underwent surgical mobilisation were reviewed. Possible prognostic factors, including age, injury type, injured finger, injury in the adjacent finger, and procedure types, were assessed. We defined the PIP joint ROM improvement as the primary outcome in the linear regression analysis. To evaluate surgical efficacy, we classified the surgical treatment options into four categories (volar release, dorsal release, volar and dorsal release, and joint distraction with an external fixator) and compared their outcomes. The mean postoperative improvement in the PIP joint ROM was 12°. In the linear regression analysis, advanced age (estimate, −0.41; 95% confidence interval [CI], −0.76 to −0.06), open injury (estimate, −13.54; 95% CI −27.02 to −0.06), and skin defects (estimate, −23.22; 95% CI −34.83 to −11.61) were associated with worse outcomes; however, the volar approach was associated with favourable outcomes. Surgical mobilisation is strongly recommended when limited ROM of the PIP joint is caused by flexion site contracture. To improve the final outcome of fingers with complex injuries, a tailored treatment strategy is required to avoid dorsal release.

A case of bilateral revision total knee arthroplasty using distal femoral allograft\u2013prosthesis composite and femoral head allografting at the tibial site with a varus-valgus constrained prosthesis: ten-year follow up

BackgroundWe report the successful use of allograft–prosthesis composite (APC) and structural femoral head allografting in the bilateral reconstruction of large femoral and tibial uncontained defects during revision total knee arthroplasty (RTKA).Case presentationA 67-year-old female with degenerative arthritis underwent bilateral total knee arthroplasty (TKA) using the Press Fit Condylar (PFC) modular knee system at our clinic in March, 1996. At 8 years postoperatively, the patient presented with painful, bilateral varus knees, with swelling, limited passive range of motion (ROM), and severe instability. We treated to reconstruct both knee using a femoral head allograft at the tibial site, a structural distal femoral allograft at the femoral site, and a varus-valgus constrained (VVC) prosthesis with cement. At the 10-year follow up, we found no infection, graft failure, loosening of implants, in spite of using massive bilateral structural femoral head allografts in RTKA.ConclusionThe use of APC enabled a stable and durable reconstruction in this uncommon presentation with large femoral bone deficiencies encountered during a RTKA.

The influence of splinting on healing tissues

In addition to immobilizing injured soft tissue to allow healing, splints are used to positively influence collagen remodeling through the application of low-load forces to healing or contracted soft tissue, permitting soft tissue growth and concomitant increased function. When correction of limited passive range of motion due to soft tissue contracture is needed, splinting is an absolute requisite. No other currently available modality is able to hold a constant low-load tension for a prolonged time sufficient to cause tissue growth.

Traumatic tears of the subscapularis tendon. Clinical diagnosis, magnetic resonance imaging findings, and operative treatment.

The study population consisted of 14 shoulders in 13 consecutive patients with surgically confirmed isolated subscapularis tendon tears. In all but three patients, the mechanism of injury was traumatic hyperextension or external rotation of the abducted arm. All patients reported pain and weakness in the affected shoulder. Physical findings revealed limited passive range of motion at maximal internal and external rotation due to pain, weakness of internal rotation of the shoulder, and tenderness in the region of the intertubercular groove. However, these findings did not conclusively point to the subscapularis tendon as the site of injury. Preoperative interpretation of magnetic resonance imaging studies was used to diagnose tears of the subscapularis tendon in 14 shoulders and biceps tendon subluxation or dislocation in 6 shoulders. On arthroscopic examination, one patient was found to have a partial-thickness tear that was treated with arthroscopic debridement. Six shoulders had full-thickness tears of the subscapularis tendon, and seven shoulders had full-thickness tears associated with concomitant biceps tendon pathologic conditions, including subluxation, dislocation, or rupture. The full-thickness subscapularis tendon tears were repaired via an open anterior approach to the shoulder through the deltopectoral groove. Associated biceps tendon injuries were treated with tenodesis of the tendon to the intertubercular groove. Our early followup results have shown that, with proper diagnoses and surgical treatments, patients have greatly decreased pain and marked improvement in shoulder function.

SHOULDER LIMITATION IN JUVENILE RHEUMATOID ARTHRITIS

One hundred consecutive children with juvenile rheumatoid arthritis (JRA) were evaluated for shoulder dysfunction. Shoulder arthritis was virtually absent in all 45 children with pauciarticular onset JRA. Twenty of 40 children (50%) with polyarticular JRA and 12 of 15 (80%) with systemic onset JRA had shoulder involvement characterized by pain or restricted passive range of motion (PROM). Ninety-five percent of those with shoulder arthritis had bilateral involvement. Children with systemic onset were likely to have shoulder disease within 2.5 years of onset and to have more severely limited PROM. Children with polyarticular onset developed shoulder arthritis any time during the course of their disease. With either type of onset, internal rotation was the most commonly and severely limited motion, followed by abduction. Clinicians treating children with JRA should carefully monitor pain and examine both rotational and planar components of shoulder motion.

Shoulder limitation in juvenile rheumatoid arthritis.

One hundred consecutive children with juvenile rheumatoid arthritis (JRA) were evaluated for shoulder dysfunction. Shoulder arthritis was virtually absent in all 45 children with pauciarticular onset JRA. Twenty of 40 children (50%) with polyarticular JRA and 12 of 15 (80%) with systemic onset JRA had shoulder involvement characterized by pain or restricted passive range of motion (PROM). Ninety-five percent of those with shoulder arthritis had bilateral involvement. Children with systemic onset were likely to have shoulder disease within 2.5 years of onset and to have more severely limited PROM. Children with polyarticular onset developed shoulder arthritis any time during the course of their disease. With either type of onset, internal rotation was the most commonly and severely limited motion, followed by abduction. Clinicians treating children with JRA should carefully monitor pain and examine both rotational and planar components of shoulder motion.