Neuromuscular Deficits Research Articles

Effects of Ground Slopes on Erector Spinae Muscle Activities and Characteristics of Golf Swing.

(1) Background: 'Slope' refers to the position faced by golfers on the course. Research on the recruitment strategies of thoracolumbar erector spinae during golf swings on different slopes may help us to understand some underlying mechanisms of lower back pain. (2) Purpose: The purpose of the present study is to assess electromyography (EMG) patterns of the erector spinae muscles (ES) and the kinematics of the trunk and swing parameters while performing golf swings on three different ground slopes: (1) no slope where the ball is level with the feet (BLF), (2) a slope where the ball is above the feet (BAF), and (3) a slope where the ball is below the feet (BBF). Furthermore, the present study evaluates the effect of slope on the kinematics of the trunk, the X-factor angle, and the hitting parameters. (3) Methods: Eight right-handed recreational male golfers completed five swings using a seven-iron for each ground slope. Surface electromyograms from the left and right sides of the ES thoracolumbar region (T8 and L3 on the spinous process side) were evaluated. Each golf swing was divided into five phases. Kinematics of the shoulder, trunk, and spine were evaluated, and the ball speed, swing speed, carry, smash factor, launch angle, and apex were measured using Caddie SC300. (3) Results: The muscle activity of the BAF and BBF slopes was significantly lower than that of the BLF slope during the early follow-through phase of the thoracic ES on the lead side (i.e., left side) and during the acceleration and early follow-through phases of the lumbar ES on the lead side. The lead and trail side (i.e., right side) lumbar ES were more active during acceleration than the thoracic ES. Additionally, the trends of the lead and trail sides of the thoracolumbar regions on the three slopes were found to be the same across the five phases. Trunk angle and X-factor angles had no significant differences in address, top of backswing, or ball impact. The maximum separation angles of the X-factor appeared in the early phase of the downswing for all the three slopes. Regarding smash factor and launch angle, there were no significant differences between the three slopes. The ball speed, swing speed, carry, and apex were higher on BLF than on BAF and BBF slopes. (4) Conclusion: The findings suggest that amateur golfers face different slopes with altered muscle recruitment strategies. Specifically, during the acceleration phase of the golf swing, the BAF and the BBF slopes, compared with the BLF slope, significantly underactivated the lead side thoracolumbar erector spinae muscles, thereby increasing the risk of back injury. Changes in muscle activity during critical periods may affect neuromuscular deficits in high-handicap players and may have implications for the understanding and development of golf-related lower back pain. In addition, the X-factor angle was not affected by the slope, however, it can be found that the hitting parameters on the BLF slope are more dominant than on the other slopes.

Neuromuscular characteristics of agonists and antagonists during maximal eccentric knee flexion in soccer players with a history of hamstring muscle injuries.

Muscle strain injuries (MSIs) in the hamstrings are among the most prevalent injuries in elite soccer. We aimed to examine the relation between biomechanical maladaptation in eccentric strength and neuromuscular factors separated by their time and frequency domains. 20 elite soccer players with a previous history of unilateral MSI in the M. biceps femoris (BF) long head and 20 without MSI participated. Knee flexion torques, rate of torque development (RTD) and electromyographic signals (EMG) of the BF, the M. semitendinosus (SMT) and knee extensors were obtained during unilateral maximal eccentric knee flexions performed at slow (30°/s) and fast (120°/s) angular speeds. Root mean squares and mean power frequency (MF) was calculated. In the group with a history of MSI, reduced maximal eccentric flexion torque (slow eccentrics -8±11, p<0.05; fast eccentrics -18±13 N*m, p<0.05) and RTD (-33±28 N*m/s, p<0.05; -95±47 N*m/s, p<0.05) concomitantly occurred with diminished agonistic myoelectrical activities (-4±5% of MVC, p<0.05; -10±7% of MVC, p<0.05) and MFs (-24±13 Hz, p<0.05; -24±18 Hz, p<0.05) in the BF. Simultaneously, antagonistic myoelectric activity was elevated (+4±3% of MVC, p<0.05; +3±3% of MVC, p<0.05) in MSI affected legs as compared to unaffected legs for both eccentric contractions. Deficits in myoelectrical activity (r2 = 0.715, p<0.05; r2 = 0.601, p<0.05) and MF (r2 = 0.484, p<0.05; r2 = 0.622, p<0.05) correlated with deficits in maximal torque in the affected leg in the MSI group. Analysis of SMT demonstrated no significant differences. Positive relationships between neuromuscular deficits and the reduced eccentric strength profile underpin neuronal inhibition after MSI. This persistent involvement of dysfunctional synergist and antagonist neural hamstring function in strength weakness is of clinical relevance in sports medicine for prevention and rehabilitation.

Comparative study of postural control in 20-40 years olds and karate athletes using a neuromuscular training device

Postural control helps maintain upright posture and contributes to balance regulation. Increasing neuromuscular deficits in older subjects lead to a deterioration in postural control, which can be improved through neuromuscular training. Assuming that neuromuscular deficits occur at an early age, the postural abilities of 20 to 40 year olds were investigated. In addition, the influence of competitive sports on postural control was examined by including karate squad athletes. For an age comparison, 123 age-homogeneous healthy people between 20 and 40 years were examined. 24 karate squad athletes were compared with the 20 -25 year old healthy subjects. A neuromuscular training device, the Human Body Equilibrium 360, was used to collect data. In the age comparison, there were no significant differences for all seven measurements. The study group was too young to detect deficits. However, some general findings could be published. In the two-legged stance, a significant increase in the fluctuations of the body centre of gravity after eye closure could be seen in all groups. The influence of footedness and handedness could be seen in the one-legged stance and the strength test. Gender-specific differences could be observed. The examination of karate squad athletes showed various training-specific adaptations. For example, karate athletes were better able to compensate for the loss of visual information. Karate athletes also showed a significantly wider gait pattern and a larger stability area. Athletes were able to shift their body centre of gravity further without getting out of balance. The Huber 360 is only conditionally suitable as a rehabilitation and training device, due to the low discriminatory power of the tests in its entire range of applications, as significant differences between the groups are difficult to detect. Individual training specific adaptations through performance-oriented karate training are recognisable and underline the influence of training on postural control. In summary, the use of the Huber 360 to assess postural abilities in age comparisons and to distinguish training specific adaptations requires a differentiated and more selective use of the individual tests. Further studies with older patients with different diseases are planned.

Multidisciplinary amyloidosis care in the era of personalized medicine.

Amyloidosis refers to a group of conditions where abnormal protein-or amyloid-deposits in tissues or organs, often leading to organ malfunction. Amyloidosis affects nearly any organ system, but especially the heart, kidneys, liver, peripheral nervous system, and gastrointestinal tract. Neuromuscular deficits comprise some of its ubiquitous manifestations. Amyloidosis can be quite challenging to diagnose given its clinical heterogeneity and multi-system nature. Early diagnosis with accurate genetic and serologic subtyping is key for effective management and prevention of organ decline. In this review, we highlight the value of a multidisciplinary comprehensive amyloidosis clinic. While such a model exists at numerous clinical and research centers across the globe, the lack of more widespread adoption of such a model remains a major hindrance to the timely diagnosis of amyloidosis. Such a multidisciplinary care model allows for the timely and effective diagnosis of amyloidosis, be it acquired amyloid light amyloidosis (AL), hereditary transthyretin amyloidosis (hATTR), or wild type amyloidosis (TTR-wt), especially in the current era of personalized genomic medicine. A multidisciplinary clinic optimizes the delivery of singular or combinatorial drug therapies, depending on amyloid type, fibril deposition location, and disease progression. Such an arrangement also helps advance research in the field. We present our experience at The Ohio State University, as one example out of many, to highlight the centrality of a multi-disciplinary clinic in amyloidosis care.

Altered neuromuscular control in the vastus medialis following anterior cruciate ligament injury: A recurrence quantification analysis of electromyogram recruitment

BackgroundNeuromuscular deficits exist following anterior cruciate ligament (ACL) injury. To observe these deficits, we examined nonlinear characteristics of vastus medialis electromyography (EMG) signals during submaximal isometric knee extensor contractions. Our purpose was to examine if determinism and entropy in EMG signals reflected neuromuscular control deficits in individuals with ACL-deficient limbs. Methods24 participants (12 male, 12 female, mean age = 18.8 ± 3.1 years) with unilaterally injured ACLs and 25 age-similar healthy controls (11 male, 14 female, mean age = 18.8 ± 3.1 years) volunteered. Isometric knee extensions were tested at 10%, 25%, 35%, and 50% maximum voluntary contractions. Surface electrodes adhered over the vastus medialis captured EMG signals. EMG data were processed with recurrence quantification analyses. Specifically, determinism (an index of system predictability) and entropy (an index of system disorder) were calculated from recurrence plots. FindingsDeterminism and entropy in EMG signals were lower in the injured than uninjured limb, and lower than that from healthy controls (P < .05). InterpretationVastus medialis EMG signals from the injured limb were less predictable and less complex than those from healthy limbs. The findings reflect impaired neuromuscular control in the injured limb's quadriceps and are consistent with a ‘loss of complexity’ hypothesis in physiologic signals emanating from pathologic states. Determinism and entropy in EMG signals may represent biomarkers of one's neuromuscular control system.

C9orf72 functions in the nucleus to regulate DNA damage repair.

The hexanucleotide GGGGCC repeat expansion in the intronic region of C9orf72 is the most common cause of Amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD). The repeat expansion-generated toxic RNAs and dipeptide repeats (DPRs) including poly-GR, have been extensively studied in neurodegeneration. Moreover, haploinsufficiency has been implicated as a disease mechanism but how C9orf72 deficiency contributes to neurodegeneration remains unclear. Here, we show that C9orf72 deficiency exacerbates poly-GR-induced neurodegeneration by attenuating non-homologous end joining (NHEJ) repair. We demonstrate that C9orf72 localizes to the nucleus and is rapidly recruited to sites of DNA damage. C9orf72 deficiency resulted in impaired NHEJ repair through attenuated DNA-PK complex assembly and DNA damage response (DDR) signaling. In mouse models, we found that C9orf72 deficiency exacerbated poly-GR-induced neuronal loss, glial activation, and neuromuscular deficits. Furthermore, DNA damage accumulated in C9orf72-deficient neurons that expressed poly-GR, resulting in excessive activation of PARP-1. PARP-1 inhibition rescued neuronal death in cultured neurons treated with poly-GR peptides. Together, our results support a pathological mechanism where C9orf72 haploinsufficiency synergizes with poly-GR-induced DNA double-strand breaks to exacerbate the accumulation of DNA damage and PARP-1 overactivation in C9orf72 ALS/FTD patients.

Motor unit dysregulation following 15days of unilateral lower limb immobilisation.

Disuse atrophy, caused by situations of unloading such as limb immobilisation, causes a rapid yet diverging reduction in skeletal muscle function when compared to muscle mass. While mechanistic insight into the loss of mass is well studied, deterioration of muscle function with a focus towards the neural input to muscle remains underexplored. This study aimed to determine the role of motor unit adaptation in disuse-induced neuromuscular deficits. Ten young, healthy male volunteers underwent 15days of unilateral lower limb immobilisation with intramuscular electromyography (iEMG) bilaterally recorded from the vastus lateralis (VL) during knee extensor contractions normalised to maximal voluntary contraction (MVC), pre and post disuse. Muscle cross-sectional area was determined by ultrasound. Individual MUs were sampled and analysed for changes in motor unit (MU) discharge and MU potential (MUP) characteristics. VL CSA was reduced by approximately 15% which was exceeded by a two-fold decrease of 31% in muscle strength in the immobilised limb, with no change in either parameter in the non-immobilised limb. Parameters of MUP size were reduced by 11% to 24% with immobilisation, while neuromuscular junction (NMJ) transmission instability remained unchanged, and MU firing rate decreased by 8% to 11% at several contraction levels. All adaptations were observed in the immobilised limb only. These findings highlight impaired neural input following immobilisation reflected by suppressed MU firing rate which may underpin the disproportionate reductions of strength relative to muscle size. KEY POINTS: Muscle mass and function decline rapidly in situations of disuse such as bed rest and limb immobilisation. The reduction in muscle function commonly exceeds that of muscle mass, which may be associated with the dysregulation of neural input to muscle. We have used intramuscular electromyography to sample individual motor unit and near fibre potentials from the vastus lateralisfollowing 15days of unilateral limb immobilisation. Following disuse, the disproportionate loss of muscle strength when compared to size coincided with suppressed motor unit firing rate. These motor unit adaptations were observed at multiple contraction levels and in the immobilised limb only. Our findings demonstrate neural dysregulation as a key component of functional loss following muscle disuse in humans.

Hamstring Injury Rehabilitation and Prevention in the Female Athlete.

Hamstring injuries (HSIs) are common in female athletes and are associated with a lengthy recovery period and a high rate of reinjury. Currently, the majority of existing literature investigating HSI rehabilitation has been conducted using male participants. However, female athletes display intrinsic anatomical and biomechanical differences compared to males that influences the way this population experiences HSIs and HSI rehabilitation. HSI rehabilitation and injury prevention guidelines for female athletes must take these differences into account. Female athletes display anatomical differences such as increased anterior pelvic tilting, gluteus maximus weakness, an increased pelvic width-to-femoral length ratio, and an increased degree of femoral anteversion, all of which can predispose females to HSIs. Maneuvers designed to strengthen the gluteal musculature and transverse abdominis can overcome these risk factors. Females show increased joint laxity and a greater range of motion of hip flexion and internal rotation compared to males. Females have lower passive hamstring stiffness than males, therefore hamstring flexibility exercises may not be as necessary during rehabilitation for females as in the male athlete population. Female athletes may instead benefit from trunk stabilization exercises and agility training due to neuromuscular control deficits that arise from the maturation and growth of the female pelvis. Existing literature on hamstring injury prevention shows consistent use of the Nordic Hamstring Exercise and balance exercises may reduce the risk of sustaining an HSI in both males and females, though more studies are needed to ascertain the optimal regimen for injury prevention in the female athlete population specifically. The goal of this clinical commentary is to discuss sex-specific anatomic and biomechanical differences of the lumbar, pelvic, and hip regions with the aim of providing guidelines for rehabilitation and injury prevention of HSIs in female athletes.Level of Evidence5

Muscle activation timing and knee biomechanics during single leg hop in subjects with and without anterior cruciate ligament reconstruction: a case study

The Single Leg Hop test (SLHT) is commonly performed to determine readiness to return to sport (RTS) after anterior cruciate ligament (ACL) injury and reconstruction [1]. Usually, the between-limb symmetry of hop distance is considered as a criterion to clear the athletes to RTS. However, athletes may pass this criterion despite ongoing biomechanical and neuromuscular deficits. Several works developed an instrumented approach of the SLHT to assess biomechanical parameters associated to ACL injury risk [1]. Although it is known that muscle pre-activation timing during landing can be altered in patients with ACL reconstruction (ACLR) [2], thus exposing them to a reinjury risk, very few studies have related biomechanical parameters with electromyographic (EMG) signals of the involved muscles. The aim of this preliminary study is to assess muscle pre-activation timing prior to SLHT landing in both ACLR and HC athletes and to associate this information with ACL injury-related kinematic and kinetic parameters. Two male soccer athletes (Tegner Activity Score ≥ 6) participated in the study, one healthy (HC) and one with ACLR (12 months before the test; injured limb: left). They performed three SLHT landing on a force plate (AMTI, USA, 1000 Hz) after standardized warm-up. The 3D trajectories of 52 markers were measured by an optoelectronic system (Vicon, 200 Hz) [3]. Eight wireless bipolar EMG electrodes (MiniWave, Cometa, Italy) were placed on Vastus Medialis (VM), Vastus Laterialis (VL), Semitendinous (ST) and Biceps femoris (BF) on both limbs according to the SENIAM guidelines [4]. All instruments were electronically synchronized. Foot-force plate contact was identified by setting a threshold of 20 N on the vertical GRF (vGRF) [5]. EMG onset prior to landing was identified according to [2]. A set of ACL injury risk-related parameters were then extracted: peak vGRF (vGRF peak ), peak knee flexion and abduction moment (KMflex peak KMabd peak ), and knee flexion at initial contact (KflexIC). Also, for each SLHT, the hop distance was assessed (SLH dist ). The Limb Symmetry Index (LSI) was then calculated for each parameter. For each athlete and each limb, the SLH with the greater hopping distance was considered for further data processing. Muscle pre-activation timing was shorter in ACLR subject than HC in all muscles (Table 1). ACLR subject also showed higher values in peak knee moments, especially in the injured limb, as well as greater asymmetry for most of the investigated parameters, especially knee angles and moments. In the ACLR subject, the lower muscle pre-activation timing prior to landing may lead to an uncoordinated movement and to a deficit in muscle force generation to stabilize the joint, thus increasing knee injury risk [2]. This timing was even shorter in the injured limb. From a biomechanical point of view, a greater asymmetry was found in the ACLR subject with respect to the HC in both kinematic and kinetic parameters. On the contrary, hop distance LSI did not show any clear difference between the two participants. These results corroborate the hypothesis that evaluating only hop distance is reductive.

Acoustic analysis of spatiotemporal variability in children with childhood apraxia of speech

Childhood apraxia of speech (CAS) is a pediatric neurological motor speech disorder characterized by impaired speech execution in the absence of neuromuscular deficits. Children with CAS show distinct speech features, including sequencing, coarticulation, and prosodic deficits, compared to children with other speech disorders. The core deficit in CAS is at the level of planning and programming the precise spatiotemporal parameters of movement sequences necessary to produce natural-sounding speech. This study will investigate spatiotemporal variability in children with CAS compared to children with typical development (TD) using the acoustic spatiotemporal index (aSTI). The aSTI measures spatiotemporal variability in the amplitude envelope of speech sounds across multiple repetitions of an utterance; higher aSTI values reflect higher movement variability. In the current project, children with CAS and TD were recruited nationally to participate in an online study investigating language and motor skills. Children produced 10 repetitions of “Buy Bobby a puppy” and “Mom pets the puppy”; we analyzed these two sentences using the aSTI. Data from 20 children (CAS = 10; TD = 10), ranging in age from 7- to 12-years-old, will be presented. We predict that children with CAS will show higher aSTI values compared to children with TD.

Angle-specific analysis of knee strength deficits after ACL reconstruction with patellar and hamstring tendon autografts.

After anterior cruciate ligament reconstruction (ACLR), there are differences in the neuromuscular deficits observed in patients with bone-patellar tendon-bone (BPTB) and with hamstring tendon (HT) autografts. The differences in knee extensor and flexor strength are commonly reported, but analyses have largely focused on peak torque metrics despite the requirement to generate torque through range when returning to sport. The aim of this study was to investigate the angle-specific strength and strength asymmetry differences between BPTB and HT around the time of return to play after ACLR. A total of 357 male field sport athletes with either a BPTB (n=297) or an HT (n=60) autograft underwent concentric knee flexor and extensor isokinetic strength testing 9months post-ACLR. Angle-specific torques were compared between grafts and limbs using 1D Statistical Parametric Mapping and discrete-point variables. Inter-limb extensor torque asymmetry was greater in BTPB than HT at knee angles of >30° (p=0.001, peak d=5.53), with flexor torque asymmetry lower in BPTB than HT at flexion angles of >25° (p=0.001, peak d=2.68). Angle of maximum asymmetry and angle of operated limb peak torque differed in knee extension for BPTB (p < 0.001, d=0.32) but not HT, whereas knee flexion angle of maximum asymmetry and operated limb peak torque differed in both BTPB (p < 0.001, d=0.75) and HT (p < 0.001, d=0.43). Graft type affected extensor torque at knee angles of 67°-85° and flexor torque at knee angles of 27°-85°. Angle-specific strength analysis may inform the rehabilitation process and improve rehabilitation and return-to-play decision making strategies in comparison with the use of peak torque values alone.

Forskolin, an Adenylcyclase/cAMP/CREB Signaling Activator Restoring Myelin-Associated Oligodendrocyte Destruction in Experimental Ethidium Bromide Model of Multiple Sclerosis.

Multiple sclerosis (MS) is a chronic neurodegenerative disease marked by oligodendrocyte loss, which results in central neuronal demyelination. AC/cAMP/CREB signaling dysregulation is involved in the progression of MS, including mitochondrial dysfunctions, reduction in nerve growth factors, neuronal inflammation, apoptosis, and white matter degeneration. Our previous research has shown that Forskolin (FSK), a naturally occurring direct adenylyl cyclase (AC)/cAMP/CREB activator, has neuroprotective potential to alleviate pathogenic factors linked with numerous neurological abnormalities. The current study intends to explore the neuroprotective potential of FSK at doses of 40 mg/kg and 60 mg/kg alone, as well as in combination with conventional medicines, such as Fingolimod (FNG), Donepezil (DON), Memantine (MEM), and Simvastatin (SIM) in EB-induced demyelinated experimental MS rats. Adult Wistar rats were divided into nine groups, and EB was infused stereotaxically in the rat brain’s intracerebropeduncle (ICP) area. Chronic gliotoxin EB treatment results in demyelination as well as motor and cognitive dysfunctions. FSK, combined with standard medications, improves behavioral dysfunctions, such as neuromuscular and motor deficits and memory and cognitive abnormalities. Following pharmacological treatments improved remyelination by enhancing myelin basic protein and increasing AC, cAMP, and CREB levels in brain homogenates. Furthermore, FSK therapy restored brain mitochondrial-ETC complex enzymes and neurotransmitter levels while decreasing inflammatory cytokines and oxidative stress markers. The Luxol fast blue (LFB) stain results further indicate FSK’s neuroprotective potential in preventing oligodendrocyte death. Therefore, the results of these studies contribute to a better understanding of the possible role that natural phytochemicals FSK could have in preventing motor neuron diseases, such as multiple sclerosis.

Lower-Limb Muscle Activity During Aquatic Treadmill Running in Individuals With Anterior Cruciate Ligament Reconstruction

While anterior cruciate ligament (ACL) tears are commonly managed with ACL reconstruction (ACL-R), 35% of ACL-R individuals fail to return to the preinjury elite sport level. Persistent neuromuscular deficits in the hamstrings and quadriceps have been observed. It has been proposed that aquatic therapy can be used to optimize neuromuscular control after ACL-R. (1)To compare muscle activity in ACL-R individuals during aquatic treadmill (ATM) running at different water depths and (2)to compare muscle activity during ATM running between ACL-R and healthy individuals. A total of 38 participants, including 18 ACL-R individuals (mean postoperative time [SD] = 25.8 [25.0] mo) and 20 healthy individuals were recruited. Muscle activity of biceps femoris (BF), rectus femoris (RF), tibialis anterior, and medial gastrocnemius during land treadmill and ATM running at mid-shin, mid-thigh, and waist levels were recorded using surface electromyography (sEMG). The sEMG signals of the selected muscles were normalized and expressed in % Maximal Voluntary Contraction (%MVC). Muscle activity of the ACL-R, ACL-contralateral, and healthy control limbs at different water depths was compared. Among the 3 groups, the ACL-R group demonstrated the most prominent percentage increase of 101.97% (P = .001) at mid-shin level, 139.66% (P = .001) at mid-thigh level, and 141.97% (P < .001) at waist level, respectively, in %MVC when compared to land. In the ACL-R group, muscle activity of BF in the stance phase (BFSt) was significantly higher than the control group on land at all water depths. Muscle activity of RF in the swing phase (RFSw) in the ACL-R group significantly increased in all water depths immersion when compared to land, respectively. This study showed an increasing trend in muscle activity of BFSt and RFSw in ACL-R individuals during ATM running at increased water depths. ATM running could be implemented as neuromuscular training in rehabilitation after ACL-R.

The relationship between the Functional Movement Screen and the Y Balance Test in youth footballers.

BackgroundThe Functional Movement Screen (FMS) and the Y Balance Test (Y-BT) are screening tools to detect movement deficits and to identify footballers at high risk of injury. If these tools are able to identify athletes with high risk of injury, they should measure the same construct and also be highly correlated.ObjectivesThe aim of the study was to determine the relationship between the FMS and Y-BT in youth footballers. The present study also aimed to assess the degree of association between the FMS and Y-BT considering high-injury-risk (FMS <= 14 points and Y-BT <= 89.6%) and low-injury-risk groups (FMS > 14 points and Y-BT > 89.6%).MethodA sample of 226 healthy athletes (mean age: 14.0 ± 2.3 years) was selected from a football club. The FMS and Y-BT data were collected from all participants. The Y-BT raw data were normalised to the relative length of the lower limbs. Spearman’s correlation was used in the analysis.ResultsFor the whole group, there was a moderate correlation (R = 0.41; p < 0.001) between the composite FMS score and composite Y-BT score. The strength of relationships varied from weak to moderate between the FMS subtests and most Y-BT results for each direction. In the high-injury-risk group, there was no correlation (R = 0.11; p = 0.61) between the composite FMS score and composite Y-BT score. For the low-injury-risk group, there was a weak significant correlation (R = 0.27; p < 0.007) between the composite FMS score and composite Y-BT score. Additionally, 56 and 53 athletes were classified to the high-injury-risk group based on the FMS and Y-BT, respectively. Only 23 athletes were classified to the high-risk group by both tests.ConclusionsYouth footballers showed only weak to moderate correlations between the FMS and the Y-BT. Footballers classified in the high-injury-risk group based on the FMS and Y-BT presented a different relationship between the FMS and Y-BT tasks compared to the low-injury-risk group. The results confirmed that the FMS and Y-BT should not be used interchangeably as they assess different movement deficits in the group of youth football players. The study results may partially suggest that using one of these screening tools cannot successfully predict injury risk in adolescent football players. This justifies the need to use these tests simultaneously to identify possible neuromuscular control deficits in youth footballers.

Bone-Patellar Tendon-Bone Autograft Harvest Prolongs Extensor Latency during Gait 2 yr after ACLR.

Bone-patellar tendon-bone (BPTB) graft harvest for anterior cruciate ligament reconstruction alters patellar tendon properties, which inflict poor quadriceps neuromuscular function. BPTB autografts are associated with higher rates of posttraumatic osteoarthritis, which in turn is associated with pathological gait. The purpose of this study was to investigate the latency between the time of peak quadriceps activity and the peak knee flexion moment during gait, between those with BPTB grafts ( n = 23) and other graft types (hamstring autograft or allografts, n = 54), 5 ± 2 months and 2 yr (25 ± 3 months) after anterior cruciate ligament reconstruction. We hypothesized that longer latencies would be observed in the BPTB graft group in the involved limb. We expected latencies to shorten over time. Knee moments and quadriceps EMG were collected during gait, and vastus medialis, vastus lateralis, rectus femoris (RF), and quadriceps latencies were calculated. Linear mixed-effects models were used to compare latencies between graft types and over the two time points. The main effects of graft type were observed for vastus medialis ( P = 0.005) and quadriceps ( P = 0.033) latencies with the BPTB graft group demonstrating longer latencies. No main effects of graft type were observed for vastus lateralis ( P = 0.051) and RF ( P = 0.080) latencies. Main effects of time were observed for RF latency ( P = 0.022). Our hypothesis that the BPTB graft group would demonstrate longer extensor latency was supported. Contrary to our second hypothesis, however, latency only improved in RF and regardless of graft type, indicating that neuromuscular deficits associated with BPTB grafts may persist 2 yr after surgery. Persistent deficits may be mediated by changes in the patellar tendon's mechanical properties. Graft-specific rehabilitation may be warranted to address the long-term neuromechanical deficits that are present after BPTB graft harvest.

Arthrogenic Muscle Inhibition Following Anterior Cruciate Ligament Injury.

Arthrogenic muscle inhibition (AMI) is a common impairment in individuals who sustain an anterior cruciate ligament (ACL) injury. The AMI causes decreased muscle activation, which impairs muscle strength, leading to aberrant movement biomechanics. The AMI is often resistant to traditional rehabilitation techniques, which leads to persistent neuromuscular deficits following ACL reconstruction. To better treat AMI following ACL injury and ACL reconstruction, it is important to understand the specific neural pathways involved in AMI pathogenesis, as well as the changes in muscle function that may impact movement biomechanics and long-term structural alterations to joint tissue. Overall, AMI is a critical factor that limits optimal rehabilitation outcomes following ACL injury and ACL reconstruction. This review discusses the current understanding of the: (1)neural pathways involved in the AMI pathogenesis following ACL injury; (2)consequence of AMI on muscle function, joint biomechanics, and patient function; and (3)development of posttraumatic osteoarthritis. Finally, the authors review the evidence for interventions specifically used to target AMI following ACL injury.

Anterior tibial artery pseudoaneurysm as a rare technical complication after corrective fibular osteotomy: a case report

IntroductionPartial fibular osteotomy has been recognized as a surgical alternative to treat medial compartment osteoarthritis of the knee. Related peroneal neuropathies are of concern among the relatively few complications after this procedure. In our clinical practice, the osteotomy level has therefore been modified to avoid the above defects. However, a rare case of vascular injury was encountered. Herein we describe an accidental anterior tibial artery pseudoaneurysm as a rare technical complication after this corrective osteotomy.Case presentationA 55-year-old male visited our emergency room, presenting a painful swelling over his right anterolateral shin along with surrounding ecchymosis. Thirteen days ago, he just underwent a corrective fibular osteotomy over his right painful varus knee at our institute, and was discharged after an uneventful postoperative stay. Urgent angiography revealed an out-pouching vascular lesion, pseudoaneurysm, involving his right anterior tibial artery. Prompt endovascular repair with stent insertion and balloon compression successfully stopped the persistent extravasation from the injured artery. Follow-up angiography as well as outpatient review confirmed the regression of this lesion and associated symptoms without sequelae.ConclusionAlthough corrective fibular osteotomy is a simple surgical procedure, it is not free of complications. The suggested osteotomized level in the pertinent literature predisposes patients to certain neuromuscular deficits, which could be avoided by the modified level of osteotomy. However, our case highlights surgeons’ familiarity with certain risky neurovascular structures around the osteotomy site and corresponding technical considerations. A recent surgical history along with alarming symptoms/signs should arouse clinical suspicion, aid in timely identification and make appropriate interventions for potential vascular complications.

Study of suprascapular notch converted into a foramen in adult human scapulae in Karnataka region

Scapula is a triangular bone present in the back, which articulates with the humerus and clavicle forming the shoulder girdle. In the superior border of the scapula there is a notch called the suprascapular notch, through which the suprascapular nerve pass. The suprascapular nerve can be compressed by the ossified part of the transverse scapular ligament a cause for neuropathies.The present study was done on adult scapulae in department of Anatomy SUIMS &amp; R.C. Shimoga, where the transverse scapular ligament [TSL] was ossified in 10 scapulae out of 127 adult dry scapulae [7.87%] studied of unknown sex. It was also noted that 6 out of 10 scapulae belonged to the right side &amp; 4 to left side showing a slight preponderance to the right side. Incidence of the complete suprascapular foramen varies from one geographical region to other region, work nature of indivisuals and is variable with the samples collected by different workers for the study.The compresssion of the suprascapular nerve is an acquired neuropathy leading to neuromuscular deficits and decrease in the range of motion of the shoulder. Suprascapular nerve blocks are given in this region. The knowledge of this type of nerve compression is helpful for evaluation of patients with neurovascular deficits to orthopedicians, radiologists, anaesthetists and surgeons in their clinical practice.

Fibular regeneration following fibulectomy in children- evaluation minimum two years after fibular harvest

Background the literature on fibular regeneration once procuring non-vascularized fibular grafts in child continuous to be scanty. The non-vascularized fibular graft has distinction of fibular regeneration occurring at the donor area.Material and methods retrospectively analyzed the fibular regeneration at the donor leg following harvest of non-vascularized fibular graft. These patients had minimum 2 years follow up. The radiological regeneration was made in percentage by calculating the area of both operated and normal limb.Results A total of 30 patients were evaluated. The average patient age was 9.56 years. No pain or neuromuscular deficit in the operated limb. The mean follows up of 39.4 months. The continuity of the fibula in the longitudinal was restored in 27 cases.

Cortical Changes as a Result of Sports Injuries: A Short Commentary

Currently, the treatment for the central nervous system (CNS) and neurocognitive fluctuations as a result of sports injuries is considered a relatively uncovered area under the sports neuroscience paradigm. For example, the compensatory neural changes (e.g., brain cortical changes) and the cognitive load can create a feedforward loop that affects recovery and relapse after a musculoskeletal injury. Although several methodologies have been promoted (e.g., brain mapping systems, inhibitory control, and cognitive flexibility), neuromuscular deficits are frequently non-assessed and non-intervened during rehabilitation practices. Here we present an up-to-date description of the most relevant CNS changes after injury, the concept of somatotopic maps, and their relationship with motor control, intracortical inhibition, and cortical facilitation processes. Neuroplasticity strategies beyond the traditional structural-based approaches on the injured tissue are also covered; however, further research is needed to establish evidence-based recommendations for sports professionals.