Normal Active Range Of Motion Research Articles

Normal active range of motion of lower extremity joints of the healthy young adults in Cairo, Egypt

BackgroundRange of motion (ROM) can be considered as one of the most commonly measured variables in musculoskeletal health care. When interpreting ROM, a common method is to compare obtained ROM values to normative data. So the current study aimed to establish (1) normative active ROM (AROM) values for lower extremity joints in young Egyptian adults, (2) compare the AROM between dominant and non-dominant lower extremity joints, and (3) compare between the values of AROM of lower extremity joints in both genders.ResultsPaired t-test demonstrated that there was statistical but not a clinical difference between the dominant and non-dominant ROM values of the lower extremity joints. Unpaired t-test revealed that there was statistical but not a clinical difference between male and female ROM values of lower extremity joints.ConclusionsThis study summarized normative data of Egyptian young adults; there were statistical but not a clinical difference between dominant and none dominant lower extremity joints in AROM and between males and females.

L’échec de la réparation de la coiffe augmente le risque de développer une arthrose gléno-humérale secondaire : suivi à long terme après réparation ouverte des lésions sévères du tendon du sous-scapulaire

BackgroundThe subscapularis musculotendinous unit provides a stabilizing effect on the glenohumeral joint and thus, enables normal active range of motion. As pathologies of the subscapularis tendon (SSC) are diagnosed with increased regularity, treatment strategies and their long-term consequences are of relevant interest. Therefore, the primary objective of this retrospective case series was to evaluate clinical and radiological long-term results after open repair of large SSC tears. HypothesisRepair failure negatively influences clinical outcomes and the progression of secondary glenohumeral osteoarthritis (OA). MethodsBetween 1998 and 2007, 24 patients with traumatic large (Lafosse III and IV) SSC tears were treated with an open transosseous repair technique. Of those, 20 patients (83%) with a mean age of 55±8 years (range, from 31 to 68 years) at the time of surgery were subjected to a long-term follow-up after a mean of 14±3 years (range, from 10 to 18 years). The Subjective Shoulder Value (SSV), the Constant Score (CS), the University of California at Los Angeles (UCLA) Shoulder Score, and the American Society for Shoulder and Elbow Surgeons (ASES) Score were obtained. Magnetic resonance imaging (MRI) was performed to evaluate tendon integrity. The progression of secondary glenohumeral OA from pre- to postoperative was analyzed using the collective instability arthropathy (CIA) score. ResultsOne patient (5%) had to undergo revision surgery due to a symptomatic re-tear of the SSC tendon. Besides that, the mean SSV of the affected shoulder was 83%±12, the CS 78±10, the UCLA 32±2, and the ASES 89±14 points, respectively. MRI revealed a re-tear of the SSC tendon in 4 patients (29%). On the affected shoulder, glenohumeral OA progressed significantly from pre- (CIA, 0.3±0.5) to postoperative (CIA, 1.7±0.9; p=0.003) and was significantly associated with repair failure (p=0.040). ConclusionOpen repair of large SSC tears yielded good clinical long-term results. Nevertheless, repair failure was common and, in the further course, negatively affected clinical outcomes and the progression of secondary glenohumeral OA. Level of evidenceIV; retrospective case series.

Repair failure increases the risk of developing secondary glenohumeral osteoarthritis: A long-term follow-up after open repair of large subscapularis tendon tears

BackgroundThe subscapularis musculotendinous unit provides a stabilizing effect on the glenohumeral joint and thus, enables normal active range of motion. As pathologies of the subscapularis tendon (SSC) are diagnosed with increased regularity, treatment strategies and their long-term consequences are of relevant interest. Therefore, the primary objective of this retrospective case series was to evaluate clinical and radiological long-term results after open repair of large SSC tears. HypothesisRepair failure negatively influences clinical outcomes and the progression of secondary glenohumeral osteoarthritis (OA). MethodsBetween 1998 and 2007, 24 patients with traumatic large (Lafosse III and IV) SSC tears were treated with an open transosseous repair technique. Of those, 20 patients (83%) with a mean age of 55±8 years (range, from 31 to 68 years) at the time of surgery were subjected to a long-term follow-up after a mean of 14±3 years (range, from 10 to 18 years). The Subjective Shoulder Value (SSV), the Constant Score (CS), the University of California at Los Angeles (UCLA) Shoulder Score, and the American Society for Shoulder and Elbow Surgeons (ASES) Score were obtained. Magnetic resonance imaging (MRI) was performed to evaluate tendon integrity. The progression of secondary glenohumeral OA from pre- to postoperative was analyzed using the collective instability arthropathy (CIA) score. ResultsOne patient (5%) had to undergo revision surgery due to a symptomatic re-tear of the SSC tendon. Besides that, the mean SSV of the affected shoulder was 83%±12, the CS 78±10, the UCLA 32±2, and the ASES 89±14 points, respectively. MRI revealed a re-tear of the SSC tendon in 4 patients (29%). On the affected shoulder, glenohumeral OA progressed significantly from pre- (CIA, 0.3±0.5) to postoperative (CIA, 1.7±0.9; p=0.003) and was significantly associated with repair failure (p=0.040). ConclusionOpen repair of large SSC tears yielded good clinical long-term results. Nevertheless, repair failure was common and, in the further course, negatively affected clinical outcomes and the progression of secondary glenohumeral OA. Level of EvidenceIV; retrospective case series.

The Holevich modification of the first dorsal metacarpal artery flap in coverage of thumb skin losses

<p class="abstract"><strong>Background:</strong> Reconstruction of complex soft tissue defects of the thumb is a challenging problem. It is very important to reconstruct these defects using sensate flaps as the thumb pulp needs to be sensate for implementing the various functions of the thumb. The aim of this study is to report our experience on the safety and functional outcome of the innervated first dorsal metacarpal artery flap (FDMA) for soft tissue defects of thumb.</p><p class="abstract"><strong>Methods:</strong> During 18 month period, nine patients with a mean age of 29 years, male:female ratio of 8:1 underwent coverage of soft tissue defects of the thumb, of various volar and dorsal defects, using an innervated first dorsal metacarpal artery flap. Indications were postburn deformities and acute trauma. None of the patients had any neurorraphy. Outcome of the Holevich modification of FDMA flap was assessed with regards to survival and function, reachability for different locations of the thumb, recovery of sensation in terms of two-point discrimination (2PD), donor morbidity with regards to deformity and range of motion were analysed.<strong></strong></p><p class="abstract"><strong>Results:</strong> The mean size of the defect was 6.7 cm<sup>2</sup>. Average hospital stay was 5 days. Average time of sensory recovery was 6 months. The mean 2PD was 4 mm (range 2-6 mm). All patients had a normal active range of motion in the donor finger. One of nine patients had distal flap marginal necrosis of 3-4 mm; it healed with debridement and regular dressings over 12 days.</p><p class="abstract"><strong>Conclusions:</strong> The Holevich modification ensures the safety of the innervated FDMA flap in thumb defect coverage with good recovery of sensation.</p>

Forearm Pain- Diving

HISTORY: A 22 year old International and NCAA Division I female diver developed medial forearm pain during the Spring of 2017 experienced only during the pike position of her dive. The pain initially was during the activity only but progressed to pain after the activity had ended. PHYSICAL EXAM: The examination of the athlete was done in the athletic training room by a physical therapist. Subjectively, questions about female athlete triad indicated inconsistent menstrual cycle. However, she did consume adequate calories including foods with calcium and protein. Further questioning about hormone levels and nutrition indicated she had been found to have low levels of vitamin D in previous blood tests as well as very low estrogen. The athlete reported having to take estrogen supplements in the past. The physical exam revealed normal active range of motion bilaterally, normal sensation, reflexes, and strength. Vascular system was noted to be intact. Upper limb nerve tension was tested, resulting in negative findings. Pin point pain with palpation along the ulna in two places, one approximately middle of the ulna and the other approximately 2 inches from the proximal radioulnar joint, reproduced her pain. Applied manual force at each end of the ulna over a fulcrum also reproduced her pain suggesting an osseous pathology so imaging was suggested by the physical therapist and ordered by the orthopedic surgical fellow. DIFFERENTIAL DIAGNOSIS: Ulnar Stress Reaction 1. Periostitis 2. Bone Contusion TESTS AND RESULTS: Plain Radiographs demonstrate bowing of the ulna WORKING DIAGNOSIS: The final diagnosis was bowing of the ulna with a stress reaction. TREATMENT AND OUTCOMES: 1. Increase core strength in pike position in create a “tighter” pike throughout the pike position during dive. 2. Scapulothoracic strengthening to offload the forearm during the dive. 3. Diving Technique 4. Vitamin D supplements and nutrition counseling.

Posterior-inferior capsular shift for the treatment of recurrent, voluntary posterior subluxation of the shoulder.

The treatment of recurrent posterior instability of the shoulder, especially when it is associated with voluntary subluxation, remains controversial, and operative correction generally is not advised. The results of operative correction of recurrent posterior subluxation in a consecutive series of twenty-six shoulders in twenty-four patients were reviewed. Eighteen shoulders were on the dominant side. The average age of the patients was twenty-four years (range, fifteen to thirty-three years). All of the patients had involuntary as well as voluntary posterior instability, but none had a psychiatric disorder. Only five patients had sustained a definite injury that had initiated the instability. Seven shoulders had had previous operations. A program of nonoperative treatment for a duration of at least three months had failed to control the symptoms in all patients. The twenty-six shoulders were treated with a posterior-inferior capsular shift procedure, which included repair of a so-called posterior Bankart lesion in seven shoulders. In addition, one of the shoulders had a posterior bone block and three shoulders (in two patients) had an osteotomy of the posterior part of the glenoid because of excessive glenoid retroversion. The outcome was assessed by means of a personal interview and a clinical examination, which included calculations of a score according to the system of Constant and Murley and the performance of the Simple Shoulder Test, and by means of a radiographic examination, with standardized radiographs and computerized tomography scanning. At an average of 7.6 years (range, 1.8 to 14.6 years) after the operation, the patients estimated that the function of the shoulder was an average of 86 percent of that of a normal shoulder. The average relative score according to the system of Constant and Murley was 91 percent. The subjective result was excellent for sixteen shoulders, good for eight, and fair for two. More than half of all of the patients were able to perform all activities of the Simple Shoulder Test, but eight patients (eight shoulders; 31 percent) still had discomfort at night. Five patients (21 percent) changed their profession because of the shoulder. All but one shoulder had a nearly normal active range of motion. The instability recurred in six (23 percent) of the twenty-six shoulders; three recurrences were in shoulders that had had a primary operation, and three were in shoulders that had had an operation on the posterior aspect of the shoulder before the index procedure. The instability did not recur in four shoulders that had had previous operations on the anterior aspect of the shoulder. The subjective shoulder value, which was the patient's estimation of the value of the affected shoulder as a percentage of that of an entirely normal shoulder, was significantly higher for the stable shoulders (91 percent) than for the unstable shoulders (72 percent) (p<0.05). The relative score according to the system of Constant and Murley was also higher for the stable shoulders (93 percent) than for the unstable shoulders (87 percent), but the difference was not found to be significant, with the numbers available. The joints were found to be well centered radiographically, and only six shoulders showed minimum signs of osteoarthritis. Computerized tomography scanning revealed an average glenoid retroversion of 3.2 degrees (range, 17 degrees of retroversion to 22 degrees of anteversion). When only the shoulders that had not had a posterior bone block or an osteotomy of the posterior aspect of the glenoid were considered, the average glenoid retroversion of those that had recurrent instability was 12.5 degrees, whereas it was only 6.2 degrees for those that remained stable (p<0.05). Overall, operative correction of voluntary posterior instability of the shoulder yielded very satisfactory intermediate-term clinical results. (ABSTRACT TRUNCATED)

Long-term follow-up of free vascularized joint transfers to the hand in children

Toe-to-hand vascularized joint transfers in four children were reviewed 6 to 8 years after operation (average, 6.6 years). Two children had vascularized metatarsophalangeal (MTP) joints. Both children have near normal active range of motion. The transferred epiphyses have provided a major contribution to digital growth. The other two children had second toe proximal interphalangeal (PIP) joints transferred to damaged hand joints. Active PIP joint extension has been disappointing, and the overall growth contribution of the transferred epiphysis has been small. We conclude that MTP to metacarpophalangeal vascularized joint transfer can provide painless, functional, stable motion, with near normal growth potential, and the usefulness of toe PIP to hand PIP joint transfer is limited by the inability to achieve good active extension and limited growth potential.