Maximum Range Of Motion Research Articles

Clinical Outcome and Quality of Life after Modular Reverse Total Shoulder Arthroplasty in Comparison with Joint-Preserving Locking Plate Osteosynthesis in Aged Patients: A Retrospective Comparison Study.

Proximal humeral fractures (PHFs) show a high incidence in aged patients. While nondisplaced fractures achieve good results by conservative treatment, surgical procedures are discussed controversially. Next to open reduction and internal fixation (ORIF), the primary use of reverse shoulder arthroplasty (RSA) has become increasingly important. The aim of this study was to investigate the clinical function, activities of daily living (ADL), as well as pain assessment in patients with PHFs, treated by ORIF or RSA. A retrospective comparison study was assessed. From November 2011 to March 2016, 34 patients (17 matched pairs) that had undergone either ORIF or RSA of the proximal humerus, were included in this study. Pain was measured by numeric rating scale (NRS). ADL were obtained by Katz-Index and SF-12. Moreover, shoulder function was assessed using the Oxford Shoulder Score (OSS). The maximum range of motion (ROM) was also recorded. From November 2011 to March 2016, 34 patients (17 matched pairs) that had undergone either ORIF (Figure or RSA of the proximal humerus) were included in this study. For statistical analyses, Student's t-test, Wilcoxon test, and Chi-Quadrat test were used. Statistical significance was indicated with p < 0.05. Totally 34 patients with an average age of 76.6 years were included. Surgical treatment was performed on average 5.2 days after diagnosis, differing significantly between the two groups (RSA/ORIF: 6.9/3.5 days) The operation time of RSA (97 min) was significantly longer than for ORIF (78 min). Pain assessment, as well as the Katz-Index and the SF-12, showed no significant differences. Moreover, clinical shoulder function showed no significant discrepancies between the two surgical techniques. Aged patients with PHFs treated with RSA display similar results regarding clinical function, ADL as well as pain perception compared with ORIF. However, revision surgery rate was lower in patients who underwent RSA. Thus, the surgical treatment of PHFs by RSA represents an excellent alternative, especially with regard to an aging patient population.

Influence of preoperative rotational shoulder stiffness on rate of motion restoration after anatomic and reverse total shoulder arthroplasty for glenohumeral osteoarthritis with an intact rotator cuff

BackgroundA subset of patients undergoing anatomic and reverse total shoulder arthroplasty (aTSA and rTSA) lag behind their peers in regaining overhead range of motion (ROM) after surgery. The primary purpose of this study was to compare the rate of recovery of ROM after aTSA and rTSA performed in stiff (preoperative passive external rotation [ER] ≤0 °) versus non-stiff (preoperative passive ER >0°) shoulders with RCI-GHOA. HypothesisWe hypothesized that preoperatively stiff shoulders (preoperative passive ER ≤0 °) would have slower recovery in ROM postoperatively with lower postoperative motion compared to non-stiff shoulders. Methods and materialsA retrospective review of a multi-institution shoulder arthroplasty database was performed between 2001 and 2021. We identified 1,164 aTSAs and 539 rTSAs performed for RCI-GHOA with a minimum of 2-year clinical follow-up along with follow-up between 3–6 months and a third visit at any other time point. Primarily, the rate of recovery in ROM and time to maximum ROM was evaluated. Secondarily, we assessed six outcome scores and the influence of subscapularis repair during rTSA. Recovery in each outcome was modeled using continuous two-phase segmented linear regression models with random effects. Rate of recovery was defined as the slope of the first segment. Patients were considered to have recovered after surgery at the timepoint corresponding to the inflection point between piecewise segments. ResultsOf the 1,164 aTSAs and 539 rTSAs included, 172 aTSAs (15%) and 80 rTSAs (15%) were stiff preoperatively, respectively. Compared to preoperatively stiff aTSAs, non-stiff aTSAs regained ER, abduction, internal rotation (IR), and forward elevation (FE) faster over a shorter duration. Similarly, non-stiff rTSAs regained ER, abduction, and FE faster and over a shorter duration compared to stiff rTSAs, but regained IR more slowly over a longer duration. Stiff rTSAs performed with subscapularis repair did not have any appreciable gain in ER after the immediate postoperative period. Although non-stiff and stiff rTSAs performed without subscapularis repair regained ER at a similar rate (4.4 vs. 4.2 °/month), stiff rTSAs continued to regain ER 1.9-times longer (11.9 vs. 6.4 months). When the subscapularis was repaired, non-stiff rTSAs regained abduction and IR faster over a short duration compared to stiff rTSAs. ConclusionsPreoperative stiffness is associated with slower recovery of active ROM over a longer duration in patients undergoing shoulder arthroplasty for RCI-GHOA. Level of evidenceIII; Retrospective Cohort Comparison; Treatment Study.

Lower limbs kinematic analysis during a jump landing task in soccer players with unilateral anterior cruciate ligament reconstruction

BackgroundFatigue leads to an acute decline in muscle strength, altered patterns of lower extremity muscle activation, changes in hip and knee kinematics. In terms of the effects of fatigue on knee joint kinematics during plyometric training, there is still a lack of knowledge regarding kinematic differences between athletes who passed the ACL reconstructions rehabilitation period and healthy athletes. Therefore, this study aimed to compare lower limb joint kinematic parameters between reconstructed cruciate ligament and healthy control soccer players during jump landing in a fatigued setting.MethodsLower limb kinematic parameters were recorded in 20 professional soccer players (age, 24.95 ± 2.92 years; body mass, 77.20 ± 12.88 kg; height, 1.77 ± 3.19 m) during jump landing task before and after the fatigue protocol. The control group consisted of healthy subjects and the experimental group consisted of subjects with ACL reconstruction by thigh transplantation. Kinematic data was recorded with 4 cameras to measure lower limb angles at first foot contact and maximum range of motion.ResultsThe results showed that before fatigue, there was only a significant difference between the two groups in the maximum range of motion of the non-involved hip joint (P = 0.022) and angle of the involved hip at first contact (P = 0.049). In other data on joint range of motion or initial contact angle, no significant difference was observed between the two groups (P > 0.05). After fatigue protocol, there was a significant difference in initial foot contact in non-involved (P = 0.030), and involved (P = 0.020) hip joint angles between the two groups. However, no significant difference in initial contact angle or range of motion of other joints was observed between the groups.ConclusionsThis study shows that plyometric fatigue does not contribute to numerous changes in contact angles and range of motion in lower extremity joints in healthy soccer players and those with a history of cruciate ligament repairs.

Improvement of ankle foot orthotics fabrication using 3D printing method

Orthotics are the body support devices used for correction, immobilization, fixation, and prevention of paralysis. The greatest number of orthotics utilized by people suffering from plantarflexion and dorsiflexion disability, especially in Indonesia, is ankle foot orthotic (AFO). However, the duration associated with fabricating AFO through conventional methods is considered time-consuming. This paper aims to fabricate ankle foot orthotics (AFO) using innovative combinations of 3D scanning and 3D printing. The method begins with 3D scanning of the patient’s lower limb using photogrammetry (3DF Zephyr). The design is generated and adjusted, afterwards, the orthotic prototype is produced by fused deposition modeling (FDM) 3D printing using polypropylene (PP) material. This choice is attributed to the material's advantages, such as being lightweight, rigid, durable, and cost-effective. The 3D mesh model scanned using 3DF Zephyr shows good quality and more precise results. In addition, the prototype produced using 3D printing was tested by walking based on normal gait analysis’s angle of foot and calf measurement, which shows a maximum range of motion (ROM) of 16.1˚. The proposed methods of fabricating orthotic prototypes can successfully reduce the processing time by approximately 70% compared to the conventional method.

Sensory-motor training with virtual reality as a complementary intervention to manual therapy for persistent non-specific neck pain: a randomized controlled trial.

Persistent non-specific neck pain (NP) is a widespread condition described as a complex biopsychosocial disorder, characterized by physical and psychological symptoms. Virtual reality (VR) shows promise in NP treatment, potentially reducing pain, kinesiophobia, and improving range of motion (ROM) and motor control. The primary aim of the study was to assess the effectiveness of VR sensorimotor training, combined with manual therapy, in reducing the level of disability in persistent non-specific NP individuals. The secondary aim was to determine if this VR-enhanced approach also contributes to improvement in overall function, pain perception and kinesiophobia. Monocentric, single-blind, randomized controlled trial. We conducted this trial at San Raffaele Scientific Institute, Department of Rehabilitation and Functional Recovery, Milan, Italy. Forty NP participants were enrolled in the study and randomly allocated into two groups. The study involved a 6-week rehabilitation program, comprising 12 sessions of 45 minutes each, twice weekly. Both intervention groups underwent manual therapy as a consistent component of their treatment. The Experimental Group (VRT) was additionally engaged in sensorimotor rehabilitation exercises using Virtual Reality, whereas the Control Group (CT) performed the same exercises without VR. We assessed subjects at baseline (T0) and after six weeks of rehabilitation (T1). The primary outcome was the disability (Neck Disability Index) while the secondary outcomes were: pain perception (Numeric Rating Scale, NP and Disability Scale, Central Sensitization Inventory) function (Cervical Kinematics) and kinesiophobia (Tampa Scale of Kinesiophobia). Both groups demonstrated significant reduction in level of disability, pain perception, and kinesiophobia. Significant advancements in kinematics were observed: VRT group showed enhanced ROM during craniocervical rotation (P=0.039), lateral bending (P=0.001), flexion-extension (P=0.009), and mean velocity across movements (P<0.001), whereas CT group improved in maximal ROM during lateral bending rotation (P=0.001). Between-group analysis, after Bonferroni's correction for multiple comparisons, revealed that VRT group had significantly better outcomes in ROM during rotation (P=0.040), ratio of the primary over the secondary movement while performing rotation (P=0.021), and mean velocity during lateral bending (P=0.031). Sensorimotor training, combined with manual therapy, could enhance kinematic outcomes for NP patients, supporting the potential of VR in rehabilitation. This study highlighted that both groups demonstrated significant reduction in level of disability, pain perception, and kinesiophobia after sensorimotor training combined with manual therapy. It is important to underscore that in terms of reducing the level of neck disability, both interventions proved to be equally effective. This parity in efficacy is a critical finding, reaffirming the robustness of our therapeutic approaches for this specific outcome.

Biomechanical Effect of Different Posterior Fixation Techniques on Stability and Adjacent Segment Degeneration in Treating Thoracolumbar Burst Fracture With Osteoporosis: A Finite Element Analysis.

Finite element analysis. To investigate the biomechanical effect of four posterior fixation techniques on stability and adjacent segment degeneration in treating thoracolumbar burst fractures with osteoporosis. In terms of stability and adjacent segment degeneration, there remains no consensus or guidelines on the optimal technique for the treatment of thoracolumbar burst fractures in patients with osteoporosis. Images of CT scans were imported into MIMICS and further processed by Geomagic to build three-dimensional models of the T10-L5 region. A v-shaped osteotomy was performed on the L1 vertebral body to simulate a burst fracture in the setting of osteoporosis. Subsequently, four fixation techniques were designed using SolidWorks software. Range of motion (ROM) of the global spine, ROM distribution, ROM of adjacent segment, Von Mises stress on adjacent intervertebral disks, and facet joints were analyzed. Among the four groups, the cortical bone screw fixation (CBT) showed the highest global ROM at 1.86°, while long-segmented pedicle screw fixation (LSPS) had the lowest global ROM at 1.25°. The LSPS had the smallest percentage of ROM of fractured vertebral body to fixed segment at 75.04%, suggesting the highest stability after fixation. The maximum ROM of the adjacent segment was observed in the CBT at 1.32°, while the LSPS exhibited the smallest at 0.89°. However, the LSPS group experienced larger maximum stress on the adjacent intervertebral disks (9.60MPa) and facet joints (3.36MPa), indicating an increasing risk of adjacent segment disease. LSPS provided the greatest stability, while CBT provided the smallest amount of stability. However, the elevated stress on adjacent intervertebral disks and facet joints after LSPS fixation increased the possibility of adjacent segment degeneration. Cement-augmented pedicle screw fixation (CAPS) and combined cortical bone screw and pedicle screw fixation (CBT-PS) demonstrated significant biomechanical advantages in providing moderate fixation strength while reducing stress on the intervertebral disks and facet joints.

Assessment of occupational health hazards among printing press workers

Background Workers in printing press are frequently exposed to various occupational health hazards, including physical, chemical, mechanical (ergonomic), biological, and psychological hazards while doing their jobs. Chemical and mechanical hazards pose a significant threat to the health and safety of printing press workers (PPWs). A hazardous working condition not only brings numerous health risks to the workers’ health but also minimizes the enterprise’s productivity. Recognizing these hazards and their consequences is the first step toward creating a safer and healthier work environment for this dedicated workforce. Aim To assess occupational health hazards (OHHs) as reported by PPW. Design A descriptive study design was utilized. Sample A purposive sample of 299 was approached for the current study. Tools Printing Press Workers Structured Questionnaire. Results Workers at the printing press were exposed to different types of OHHs, 44.6% of PPWs were exposed to chemical hazards, 46.3% were exposed to mechanical hazards, 58.5% were exposed to accidents in the workplace, and 39.5% had work accidents due to machines. Regarding causes of chemical hazards, 61.5, 55.2, 89.0, and 57.2% of PPWs were always exposed in the workplace to dust, organic solvents, ink, and lead, respectively. As for the causes of mechanical hazards, 61.9% of the study sample always have work that requires carrying heavy objects, 63.9% have a job that always requires a fixed work situation, and 61.9% have work that requires vigorous effort or maximum range of motion. Additionally, 68.9% of the study sample always have work that requires pushing or pulling, and 68.9% always have jobs that require similar repetitive movements. There were highly statistically significant positive correlations between the work stage and chemical and mechanical hazards (P=0.00). Conclusion PPWs faced various OHHs and health problems due to their work and environment. Over one-third were exposed to mild chemical hazards, almost half were exposed to moderate chemical hazards and less than one-fifth were exposed to high chemical hazards. Regarding mechanical hazards, over one-third of PPWs were exposed to mild mechanical hazards, another one-third were exposed to moderate mechanical hazards, and almost one-third were exposed to high mechanical hazards. Recommendations Conduct training programs on safety and health measures to increase knowledge and awareness of printing workers to minimize OHHs. Also, ensure effective usage of personal protective equipment (PPE).

Evaluation of Apparatus and Protocols to Measure Human Passive Neck Stiffness and Range of Motion

Understanding of human neck stiffness and range of motion (ROM) with minimal neck muscle activation (“passive”) is important for clinical and bioengineering applications. The aim of this study was to develop, implement, and evaluate the reliability of methods for assessing passive-lying stiffness and ROM, in six head-neck rotation directions. Six participants completed two assessment sessions. To perform passive-lying tests, the participant’s head and torso were strapped to a bending (flexion, extension, lateral bending) or a rotation (axial rotation) apparatus, and clinical bed, respectively. The head and neck were manually rotated by the researcher to the participant’s maximum ROM, to assess passive-lying stiffness. Participant-initiated (“active”) head ROM was also assessed in the apparatus, and seated. Various measures of apparatus functionality were assessed. ROM was similar for all assessment configurations in each motion direction except flexion. In each direction, passive stiffness generally increased throughout neck rotation. Within-session reliability for stiffness (ICC > 0.656) and ROM (ICC > 0.872) was acceptable, but between-session reliability was low for some motion directions, probably due to intrinsic participant factors, participant-apparatus interaction, and the relatively low participant number. Moment-angle corridors from both assessment sessions were similar, suggesting that with greater sample size, these methods may be suitable for estimating population-level corridors.

Joint position sense error in the hip and knee without reference to the joint angle

BACKGROUND: Joint position reproduction measures the angle acuity of reference angle reproduction using an indicator angle. However, reference angles are often not available. OBJECTIVE: This study aimed to examine joint position sense at three different targeted joint angles, which were estimated from the maximum range of motion (maxROM) without a reference angle at each targeted joint angle. METHODS: The maxROM was measured in straight leg raise (SLR) and active knee extension (AKE) positions. In both positions, a targeted joint angle at 75% of the maxROM was assessed first, followed by that at 50% and 25% of the maxROM. A one-sample t-test was used to analyze differences between the targeted and reproduced angles in both positions. RESULTS: All reproduced angles significantly differed from the targeted angle in both SLR and AKE positions except for the reproduced angle measured at 75% maxROM. Overall, position errors in the AKE position were higher than those in the SLR position. CONCLUSIONS: Estimating the angle based on the maxROM without a matched reference angle may lead to significant discrepancies in comparison with the targeted joint angle. In clinical settings, if accurate reproduction of motions is required to improve proprioception, providing a reference angle might be helpful.

Does having an external focus in immersive virtual reality increase range of motion in people with neck pain?

BackgroundWhen instructing exercises to improve Range of Motion (ROM), clinicians often create an internal focus of attention, while motor performance may improve more when using an external focus. Objectives: Using Virtual Reality (VR), we investigated the effect of tasks with an internal and external focus on maximal ROM in people with neck pain and explored whether this effect was associated with fear of movement. MethodIn this cross-over experimental design study, the cervical ROM of 54 participants was measured while performing a target-seeking exercise in a VR-environment (external focus task) and during three maximal rotation and flexion-extension movements with the VR-headset on, without signal (internal focus task). The main statistical analysis included two dependent T-tests. Pearson correlation coefficients were calculated to investigate whether the differences in ROM in both conditions were correlated to fear of movement. ResultsMaximal neck rotation was larger in the external focus condition than in the internal focus condition (mean difference: 26.4°, 95% CI [20.6, 32.3]; p < 0.001, d = 1.24). However, there was a difference favouring the internal focus condition for flexion-extension (mean difference: 8.2°, 95% CI [-14.9, −1.5]; p = 0.018, d = 0.33). The variability in ROM was not explained by variability in fear of movement (for all correlations p ≥ 0.197). ConclusionAn external focus resulted in a larger range of rotation, but our flexion-extension findings suggest that the task has to be specific to elicit such an effect. Further research, using a task that sufficiently elicits movement in all directions, is needed to determine the value of an external focus during exercise.

Determining a relative total lumbar range of motion to alleviate adjacent segment degeneration after transforaminal lumbar interbody fusion: a finite element analysis

BackgroundA reduction in total lumbar range of motion (ROM) after lumbar fusion may offset the increase in intradiscal pressure (IDP) and facet joint force (FJF) caused by the abnormally increased ROM at adjacent segments. This study aimed to determine a relative total lumbar ROM rather than an ideal adjacent segment ROM to guide postoperative waist activities and further delay adjacent segment degeneration (ASD).MethodsAn intact L1-S1 finite element model was constructed and validated. Based on this, a surgical model was created to allow the simulation of L4/5 transforaminal lumbar interbody fusion (TLIF). Under the maximum total L1-S1 ROM, the ROM, IDP, and FJF of each adjacent segment between the intact and TLIF models were compared to explore the biomechanical influence of lumbar fusion on adjacent segments. Subsequently, the functional relationship between total L1-S1 ROM and IDP or total L1-S1 ROM and FJF was fitted in the TLIF model to calculate the relative total L1-S1 ROMs without an increase in IDP and FJF.ResultsCompared with those of the intact model, the ROM, IDP, and FJF of the adjacent segments in the TLIF model increased by 12.6-28.9%, 0.1-6.8%, and 0-134.2%, respectively. As the total L1-S1 ROM increased, the IDP and FJF of each adjacent segment increased by varying degrees. The relative total L1-S1 ROMs in the TLIF model were 11.03°, 12.50°, 12.14°, and 9.82° in flexion, extension, lateral bending, and axial rotation, respectively.ConclusionsThe relative total L1-S1 ROMs after TLIF were determined, which decreased by 19.6-29.3% compared to the preoperative ones. Guiding the patients to perform postoperative waist activities within these specific ROMs, an increase in the IDP and FJF of adjacent segments may be effectively offset, thereby alleviating ASD.

Biomechanical Analysis Reveals Shoulder Instability With Bipolar Bone Loss Is Best Treated With Dynamic Anterior Stabilization for On-Track Lesions and With Remplissage for Off-Track Lesions

To compare the biomechanical effects of augmenting Bankart repair (BR) with either remplissage or dynamic anterior stabilization (DAS) in the treatment of anterior shoulder instability with on-track or off-track bipolar bone loss. Eight fresh-frozen cadaveric shoulders were tested at 60° of glenohumeral abduction in the intact, injury, and repair conditions. Injury conditions included 15% glenoid bone loss with an on-track or off-track Hill-Sachs lesion as previously recommended. Repair conditions included isolated BR, BR with remplissage, and BR with DAS (long head of biceps transfer). The glenohumeral stability was assessed by measuring the anterior translation under 0, 10, 20, 30, 40, 50 N load and maximum load without causing instability at mid-range (60°) and end-range (90°) external rotation (ER). Maximum range of motion (ROM) was measured by applying a 2.2-N·m torque in passive ER and internal rotation. Isolated BR failed to restore native glenohumeral stability in both on-track and off-track bipolar bone loss models. Both remplissage and DAS significantly decreased the anterior instability in the bipolar bone loss models, showing better restoration than the isolated BR. In the on-track lesions, DAS successfully restored native glenohumeral stability and mobility, whereas remplissage significantly decreased anterior translation without load (-2.12 ± 1.07 mm at 90° ER, P= .003; -1.98 ± 1.23 mm at 60° ER, P= .015). In the off-track lesions, remplissage restored native glenohumeral stability but led to significant ROM limitation (-8.6° ± 2.3° for internal rotation, P < .001; -13.9° ± 6.2° for ER, P= .003), whereas DAS failed to restore native stability at 90° ER regarding the increased anterior translation under 50 N (4.10 ± 1.53 mm, P < .001) and decreased maximum load (-13.8 ± 9.2 N, P= .021). At time-zero, both remplissage and DAS significantly reduced residual anterior instability compared with isolated BR in the bipolar bone loss models and restored the native glenohumeral stability under most translational loads. However, remplissage could decrease the anterior translation without load for on-track lesions and may restrict ROM for off-track lesions, whereas DAS failed to restore native stability under high translational loads for off-track lesions. DAS could be recommended to treat on-track bipolar bone loss with less biomechanical adverse effects, whereas remplissage might be the preferred procedure to address off-track bipolar bone loss for better stability.

Comparative study between bi-columnar plating as opposed to double tension band osteosynthesis in inter-condylar distal humerus fractures in adults

Introduction: Distal humerus fractures with inter-condylar extension are unusual in Orthopaedic practice. The treatment for the same has been defined inside the literature and consists of parallel and orthogonal fixation with the aid of using plates. The study aimed to observe the effectiveness of “double tension band wiring” method for the remedy of distal humerus fractures with inter-condylar extension and compare the effects with studies related to its treatment with locking plates. Materials and methods: 50 patients, all presenting with closed fractures of the distal humerus, out of them 20 have been dealt with double tension band wiring procedure and 30 were treated with locked plates fixation method. Results: Out of 50 cases treated with these 2 methods of internal fixation, rigid fixation and union was achieved in each and every patient. The mean duration of use of tourniquet during surgery was 65 minutes with minimum of 54 minutes and maximum of 110 minutes. Complete radiological union of the fracture was seen at a mean duration of 11 weeks after the surgery (9-15 weeks). Average range of motion was 103 degrees with maximum range of motion of 110 degrees (20-130 degrees) and minimum of 65 degrees (25-90 degrees). Good results were obtained in both the groups in our study. Conclusion: Both the approaches of treatment gave good results. Union became accomplished in almost all instances. However, implant related difficulty become more with locked plates. Double tension band is a reliable, easier, inexpensive and safe technique of fixation of inter-condylar fractures of distal humerus in adults.

APPLICATION OF EXTERNAL TORQUE ENHANCES THE DETECTION OF SUBTLE SYNDESMOTIC ANKLE INSTABILITY IN A WEIGHTBEARING CT

One-fourth of all ankle trauma involve injury to the syndesmotic ankle complex, which may lead to syndesmotic instability and/or posttraumatic ankle osteoarthritis in the long term if left untreated. The diagnosis of these injuries still poses a deceitful challenge, as MRI scans lack physiologic weightbearing and plain weightbearing radiographs are subject to beam rotation and lack 3D information. Weightbearing cone-beam CT (WBCT) overcomes these challenges by imaging both ankles during bipedal stance, but ongoingdebate remains whether these should be taken under weightbearing conditions and/or during application of external rotation stress. The aim of this study is study therefore to compare both conditions in the assessment of syndesmotic ankle injuries using WBCT imaging combined with 3D measurement techniques.In this retrospective study, 21 patients with an acute ankle injury were analyzed using a WBCT. Patients with confirmed syndesmotic ligament injury on MRI were included, while fracture associated syndesmotic injuries were excluded. WBCT imaging was performed in weightbearing and combined weightbearing-external rotation. In the latter, the patient was asked to internally rotate the shin until pain (VAS&gt;8/10) or a maximal range of motion was encountered. 3D models were developed from the CT slices, whereafter. The following 3D measurements were calculated using a custom-made Matlab® script; Anterior tibiofibular distance (AFTD), Alpha angle, posterior Tibiofibular distance (PFTD) and Talar rotation (TR) in comparison to the contralateral non-injured ankle.The difference in neutral-stressed Alpha angle and AFTD were significant between patients with a syndesmotic ankle lesion and contralateral control (P=0.046 and P=0.039, respectively). There was no significant difference in neutral-stressed PFTD and TR angle.Combined weightbearing-external rotation during CT scanning revealed an increased AFTD in patients with syndesmotic ligament injuries. Based on this study, application of external rotation during WBCT scans could enhance the diagnostic accuracy of subtle syndesmotic instability.

Joint position sense error in the hip and knee without reference to the joint angle.

Joint position reproduction measures the angle acuity of reference angle reproduction using an indicator angle. However, reference angles are often not available. This study aimed to examine joint position sense at three different targeted joint angles, which were estimated from the maximum range of motion (maxROM) without a reference angle at each targeted joint angle. The maxROM was measured in straight leg raise (SLR) and active knee extension (AKE) positions. In both positions, a targeted joint angle at 75% of the maxROM was assessed first, followed by that at 50% and 25% of the maxROM. A one-sample t-test was used to analyze differences between the targeted and reproduced angles in both positions. All reproduced angles significantly differed from the targeted angle in both SLR and AKE positions except for the reproduced angle measured at 75% maxROM. Overall, position errors in the AKE position were higher than those in the SLR position. Estimating the angle based on the maxROM without a matched reference angle may lead to significant discrepancies in comparison with the targeted joint angle. In clinical settings, if accurate reproduction of motions is required to improve proprioception, providing a reference angle might be helpful.

Changes in Neck and Shoulder Muscles Fatigue Threshold When Using a Passive Head/Neck Supporting Exoskeleton During Repetitive Overhead Tasks.

This study aimed to investigate the effects of a head/neck supporting exoskeleton (HNSE) on the electromyographic fatigue threshold (EMGFT) of the neck and shoulder muscles during a simulated overhead work task. Overhead work is a well-known risk factor for neck and shoulder musculoskeletal disorders due to the excessive strain imposed on the muscles and joints in these regions. Fourteen healthy males performed a repetitive overhead nut fastening/unfastening task to exhaustion while wearing and not wearing the HNSE at two neck extension angles (40% and 80% of neck maximum range of motion). Electromyographic signals were continuously recorded from the right and left sternocleidomastoid (SCMR, SCML), splenius capitis (SCR, SCL), upper trapezius (UTR, UTL), and anterior deltoid (ADR, ADL) muscles. The normalized electromyographic amplitude (nEMG) data was time normalized, and a bisegmental linear regression was applied to determine the muscle fatigue break point. The results showed a significant increase in fatigue threshold time in the SCMR (p < .001), SCML (p = .002), and UTR (p = .037) muscles when the HNSE was used. However, the EMGFT times for the right and left deltoid and left trapezius muscles showed a nonsignificant reduction due to the head/neck support exoskeleton use. In addition, the neck extension angle did not reveal a significant effect on muscles' EMGFT time. Overall, the findings confirmed a significant delay in fatigue onset in sternocleidomastoid muscles, as measured by the electromyographic fatigue threshold. This finding suggests that the HNSE can be an effective ergonomic intervention for reducing the risk of musculoskeletal disorders in overhead workers. However, further studies are needed to investigate the effect of the HNSE at other neck extension angles and more realistic tasks to ensure the generalizability of our results. The present findings emphasize the application of the fatigue onset time to evaluate the effectiveness of ergonomic interventions, including exoskeletons, which can subsequently be utilized to alleviate postural demands and reduce the risk of musculoskeletal disorders.

Numerical study on thermal-hydraulic characteristics of lead-bismuth loop system under moving conditions

The investigation of flow and heat transfer of lead-bismuth eutectic (LBE) under moving conditions is vital to the design optimization of LBE loop system in offshore engineering. In this paper, we have developed a method for simulating moving conditions using sliding mesh. Moreover, we have conducted experiments to validate the numerical model, and the comparison results demonstrate a good agreement between them. The calculation results demonstrate that the period of the flow rate fluctuation is consistent with the motion period, and the amplitude of the fluctuation will increase with the increase of the maximum range of motion and the decrease of the motion period. In addition, the influence of rolling on system parameters is more severe than that of heaving. These results obtained in this study have important engineering application value for the design of LBE loop system under moving conditions.

Assessing changes in range of motion in adolescent patients undergoing myoActivation® for chronic pain related to myofascial dysfunction: a feasibility study

IntroductionmyoActivation® assessment utilizes systemized movement tests to assess for pain and limitations in motion secondary to myofascial dysfunction. myoActivation needling therapy resolves the myofascial components of pain and is associated with immediately observed changes in pain, flexibility, and range of motion. The principal aim of this feasibility study was to objectively characterize the kinematic metrics of upper and lower body motion before and after myoActivation movement tests and therapy.MethodsFive consecutive eligible adolescent participants considered appropriate for myoActivation were consented to receive their myoActivation intervention in a motion laboratory. Clinical motion analysis was used to measure the changes in maximum range of motion (maxROM) and maximum angular speed to maximum ROM (speedROM) of movement tests predicted to change. Metrics were analyzed to assess changes over specified time intervals - i) baseline to after initial myoActivation session, and ii) baseline to after complete myoActivation course. Each participant served as their own control.ResultsWe demonstrated objective evidence of improved maxROM and/or speedROM in 63% of the movement tests predicted to change after just one session of myoActivation and in 77% of movement tests predicted to change over the complete course of treatment. The myoActivation clinician observed positive change in 11/19 of movement tests across all patients, that were predicted to change after the initial myoActivation session; 81% of these positive changes were confirmed by the kinematic data.DiscussionClinical motion analysis provides objective support to clinicians evaluating, treating, and teaching myofascial release. A larger, prospective clinical trial is warranted to explore the impact of myoActivation on movement. Refinement of observation techniques and outcome measures established in this feasibility study will strengthen future clinical motion analysis of the myoActivation process.

Comparative Analysis of Eccentric Glenosphere in Reverse Total Shoulder Arthroplasty: A Computer Simulation Study.

The aim was to evaluate the effects of different glenosphere eccentricities on impingement, range of motion (ROM), and muscle length during standard activities in reverse total shoulder arthroplasty (RSA). In this study, we utilized computational modeling techniques to create native shoulder and shoulder models undergoing RSA and simulate shoulder movements in all abduction-adduction, flexion-extension, and rotation. We tested a total of 36 different glenosphere configurations, which included three different inferior tilts (0°, +10°, +20°) and two different lateral offsets (0 mm and +4 mm), as well as six different glenosphere eccentricities (concentricity, inferior, posterior, anterior, anteroinferior, and posteroinferior). We evaluated the maximum impingement-free ROM, impingement sites, and muscle lengths. All glenosphere configurations exceeded 50% of native shoulder ROM in three planes and total global ROM. In abduction-adduction, there was no significant difference among the different glenosphere eccentricities (p > 0.05). In flexion-extension, the posteroinferior eccentricity had the maximum ROM among the different eccentricities, but no significant difference among the different glenosphere eccentricities (p > 0.05). In rotation, there was a significant difference overall, and anteroinferior eccentricity had a significant advantage over concentricity (p < 0.05). In total global ROM, anteroinferior eccentricity had a significant advantage over concentricity when lateral offset was 0 mm (p < 0.05). In all models of glenosphere eccentricities, only the elongation of the infraspinatus muscle was statistically significant (p < 0.05). Glenosphere eccentricity significantly influenced rotation, total global ROM, and the length of the subscapularis muscle. Among them, anteroinferior offset achieved the maximum ROM in abduction-adduction, rotation, and total global activities. Both anteroinferior and inferior glenoid eccentricity showed significant advantages over the concentricity in rotation and total global ROM. Basic Science Study; Computer Modeling.

Application of External Torque Enhances the Detection of Subtle Syndesmotic Ankle Instability in a Weightbearing CT

Category: Sports; Trauma Introduction/Purpose: Syndesmotic ankle injuries are present in one-fourth of all ankle trauma and may lead to syndesmotic instability or posttraumatic ankle osteoarthirtis on the long term. At present, they continue to impose a diagnostic dilemma our clinical practice. While magnetic resonance imaging lacks application of load to the ankle joint, plain weightbearing radiographs are skewed by superposition of the osseous structures. The recent advent of weightbearing cone-beam CT (WBCT) overcomes these drawbacks by imaging both ankles during bipedal stance. However, it remains debated whether syndesmotic ankle injuries should be imaged under weightbearing conditions and/or during application of external rotation. Therefore, we aimed to implement both weightbearing and external rotation in the assessment of syndesmotic ankle injuries using WBCT imaging combined with 3D measurement techniques. Methods: In this retrospective study, patients with an acute syndesmotic ankle injury were analyzed using a WBCT (N= 21; Age= 31.64±14.07 years old). Inclusion criteria were an MRI confirmed syndesmotic ligament injury imaged by a WBCT of the ankle during weightbearing and combined weightbearing-external rotation. Exclusion criteria consisted of fracture associated syndesmotic injuries. For the external rotation protocol, the patient was asked to internally rotate the shin while ensuring that the foot remained firmly plantigrade until pain (Visual Analogue Scale &gt; 8/10) or a maximal range of motion was reached. 3D models were generated from the CT slices. Tibiofibular displacement and Talar Rotation were quantified by automated 3D measurements using a custom-made Matlab® script; Anterior Tibiofibular distance (ATFD), Alpha angle, posterior Tibiofibular distance (PTFD) and Talar rotation (TR) angle in comparison to the contralateral non-injured ankle. Results: The difference in neutral-stressed Alpha angle and ATFD showed a significant difference between patients with a syndesmotic ankle lesion and contralateral control (P = 0.046 and P = 0.039, respectively). The difference in neutral-stressed PTFD and TR angle did not show a significant difference between patients with a syndesmotic ankle lesion and healthy ankles (P = 0.492; P = 0.152, respectively). Conclusion: Application of combined weightbearing-external rotation reveals an increased ATFD in patients with syndesmotic ligament injuries (Figure 1). This study provides the first insights based on 3D measurements to support the potential relevance of applying external rotation during WBCT imaging. In clinical practice, this could enhance the current diagnostic accuracy of subtle syndesmotic instability in a non-invasive manner. However, future studies are required to determine cut-off values that may indicate the amount of displacement that might lead to chronic instability and require a certain type of treatment strategy.