Normal Range Of Motion Research Articles

Normal range of motion at the hip show different pressure behavior in the lateral and acetabular compartments: a cadaveric investigation

PurposeThe techniques used previously to assess intracapsular pressures did not allow the assessment of pressure variations in both compartments throughout the entire range of motion without puncturing the capsular tissue. Our hypothesis was that the intra-capsular pressure would be different in the lateral and acetabular compartment depending on the movement assessed.MethodsEight hip joints from four cadaveric specimens (78.5 ± 7.9 years) were assessed using intra-osseous tunnels reaching the lateral and acetabular compartments. Using injector adaptors, 2.7 ml of liquid were inserted in both compartments to simulate synovial liquid. Optic pressure transducers were used to measure pressure variations. We manually performed hip adduction, abduction, extension, flexion and internal rotation at 90° of flexion.ResultsHip extension and internal rotation show the highest intra-capsular pressures in the lateral compartment with increases of 20.56 ± 19.29 and 19.27 ± 18.96 mmHg, respectively. Hip abduction and hip internal rotation showed depressurisations of − 16.86 ± 18.01 and − 31.88 ± 30.71 mmHg in the acetabular compartment, respectively. The pressures measured in the lateral compartment and in the acetabular compartment were significantly (P < 0.05) different for the hip abduction, 90° of flexion and internal rotation. Pressure variations showed that maximum intracapsular fluid pressures in the lateral compartment occur at maximum range of motion for all movements.ConclusionAs an increase in pressure may produce hip pain, clinician should assess pain at maximum range of motion in the lateral compartment. The pressure measured in the acetabular compartment vary depending on the hip position. The movements assessed are used in clinical practice to evaluate hip integrity and might bring pain. The pressure variations throughout the entire range of motion are a relevant information during hip clinical assessment and might help clinicians to better understand the manifestations of pain.

Normal Range of Movement During Rotation Stress Testing for the Alar Ligaments: An Observational Study

ObjectiveThe purpose of this study was to determine the normal range of rotation occurring during rotation stress testing for alar ligament integrity and to ascertain whether rotation range on testing is affected by an individual's age. MethodIn this observational study, 88 people aged 18 to 86 years old with no current neck problems or known risk factors for craniocervical instability underwent rotation stress testing for the alar ligaments. The test was performed in each direction in neutral, flexion, and extension, with the participant both sitting and supine. Rotation range was recorded using an electromagnetic movement tracking system. Range was assessed overall and then compared by 10-year age groups using analysis of variance. Reliability of measurements was assessed by intraclass correlation coefficient(2,1) and standard error of measurement. ResultsMean angles of upper cervical rotation ranged between 10.91° (standard deviation 3.38°) to 16.12° (standard deviation 5.13°). Overall measured rotation ranged from 1.37° to 33.22°. Participants in older age groups generally displayed reduced rotation; however, the reduction was less than 4°. Reliability of rotation measurements was good to excellent, with the intraclass correlation coefficient ranging from 0.80 to 0.99. ConclusionsNormal range of rotation measured during stress testing for the alar ligament varied widely but did not exceed 33o. All values measured in this study fell below recommendations for ligament integrity. Age-related change was not clinically significant in the interpretation of this test in this asymptomatic population.

Joint Hypermobility and Clinical Correlates in a Group of Patients With Eating Disorders.

Background: The ability to move joints beyond the normal range of motion is called Joint Hypermobility (JHM). JHM has been associated with a plethora of physical problems and is a frequent sign of hereditary disorders of connective tissue. Neuropsychiatric conditions such as eating disorders (ED) have also been related to JHM. However, little is known about the clinical profile of people with ED and JHM. The aim of this study was to explore JHM in patients with ED and to compare the clinical characteristics of hypermobile ED patients with non-hypermobile ED patients.Method: Fifty-three outpatients diagnosed with ED were assessed using the Beighton score for JHM, the Eating Disorders Inventory 2, the Eating Disorder Examination, and the Detail and Flexibility Questionnaire. Information relating to patients' psychiatric and somatic comorbidities/symptoms was also collected.Results: Using the traditional Beighton score's cutoff of ≥4, 41.5% of the sample presented with JHM. Our results indicate that compared with non-hypermobile ED patients, those with JHM are significantly younger, suffer at a greater extent from joint pain and easy bruising, have a shorter duration of the ED, and have lower scores for cognitive rigidity. In addition, for those with anorexia nervosa, the restricting subtype represents a significantly lower proportion of hypermobile ED patients compared to non-hypermobile ED patients. Multivariate analyses showed that cognitive rigidity, age, and duration of the ED could predict the JHM status in this sample.Conclusion: These results suggest that JHM is frequent in patients with ED and is accompanied by signs of tissue fragility. Patients with ED and JHM seem to present a specific profile characterized by less cognitive rigidity and restricting behavior in the case of anorexia nervosa. Further research is needed in order to confirm these results.

Effect Of Use Of Flexible Transfemoral Prosthesis On Level Of Independence In Performing Daily Activities Of Transfemoral Amputee

Background: Transfemoral amputees experience many difficulties in carrying out daily activities. One of the devices that can be used in above-knee amputation patients is transfemoral prosthesis. The use of transfemoral prostheses in post-amputation patients can help with activities, one of which is independence in self-care, mobility, and locomotion.&#x0D; Methods: The study was conducted at PT Kuspito Orthotic Prosthetics and the time of the study was carried out in 2021. The population of this study was users of flexible prostheses at PT Kuspito Ortotik Prosthetic. The samples of this study were flexible prostheses users at PT. Kuspito prosthetic orthotic that meets the criteria as many as 30 users. The sampling technique was purposive sampling, inclusion criteria: subjects aged 17-35 years, subjects in good health, subjects using a flexible unilateral prosthesis, at least using an artificial leg for 1 month, having a strength value of 4, having normal Range Of Motion. Exclusion criteria: the subject had advanced disease, bilateral prosthesis user. The measuring instrument used was the Functional Independence Measure (FIM) questionnaire that is valid and reliable. &#x0D; Results: The value of Sig. is 0.000, there is a significant difference in the level of independence between the results of the pre-test and post-test. there is a significant difference in the results that using a flexible prosthesis can increase the level of independence in above-knee amputees in carrying out daily activities. &#x0D; Conclusion: The functional independence of above-knee amputation patients is strongly influenced by the use of a flexible prosthesis. It is recommended that above-knee amputation patients can use a flexible prosthesis to increase the level of independence.

A Clinico–radiological Correlation of Patients with Lumbar Spinal Instability

Background: A larger than normal range of motion in the spinal segment defines lumbar segmental instability, which is a sort of aberrant motion to physiologic stressors. Clinical complaints and signs such as low back ache or radiculopathy, as well as Kotilainen and Valtonen's three criteria for instability (painful catch, instability catch, and apprehension) will be correlated with an MRI investigation to determine lumbar spinal instability. Disc degeneration and facet degeneration along with soft tissues supporting spinal motion segment are important provocative factors for lumbar spine instability. The existence of lumbar instability must be identified since it can alter the treatment approach and patient prognosis.&#x0D; Objective: To evaluate clinical signs and symptoms in patients with Lumbar spinal instability, as well as to investigate radiological signs using X-rays and an MRI scan.&#x0D; Methods and Materials: In this study in which patients with history suggestive of Lumbar spinal instability will be evaluated clinically and radiologically. Patients of age group of 25-75 years will be included in this study. Clinical tests, static and dynamic Xrays and MRI scan will be studied.&#x0D; Expected Outcomes: By this study we can expect clinico–radiological co relation in patient with low back ache in lumbar spinal instability. Outcome data will be assessed on Clinico-radiological Criteria of Lumbar Instability and clinic-radiological correlation will be done.

Foot kinematics and leg muscle activation patterns are altered in those with limited ankle dorsiflexion range of motion during incline walking

BackgroundLarger ankle dorsiflexion (DF) is required when walking on inclined surfaces. Individuals with limited DF range of motion (ROM) may experience greater tissue stress on sloped surfaces and walk in altered gait patterns compared to the those with normal DF ROM. Research questionWould the individuals with limited DF ROM walk with distinctive ankle DF patterns compared to those with normal DF ROM on the inclined surfaces? MethodsTen Limited DF ROM (passive ROM=35.3 ± 2.7°) and nine Normal DF ROM (passive ROM=46.4 ± 4.2°) participants walked on a treadmill at five slope angles (0°, 5°, 10°, 15°, 20°) for 2 min at a self-selected speed. The peak DF angles and the peak myoelectric activity levels of the tibialis anterior (TA) and soleus (SOL) muscles were quantified during the swing and stance phases of each walking trial, and they were compared between the two groups. ResultsParticipants with limited DF ROM walked with smaller peak DF (3.1° at 0° slope ~ 8.4° at 20° slope) and greater peak TA activity in swing than those of the Normal ROM participants (3.4° ~ 12.2°), with significant differences at 20° slope. The peak DF angle in stance (Limited: 9.6° ~ 19.0°; Normal: 10.1° ~ 21.0°) did not differ between the two groups at all slopes, but the peak activity of the SOL muscle was significantly greater for the Limited group at slopes of 10° and higher. SignificanceStudy results indicate that incline walking could be more challenging to the individuals with limited DF ROM as they need to approach and push-off the sloped surfaces with more efforts of the dorsiflexor and the plantar flexor muscles, respectively. Prolonged walking on inclined surfaces may produce faster development of muscle fatigue or tissue damage than those with normal DF ROM.

Lateral Patellofemoral Ligament Reconstruction With a Hamstring Allograft

Background: Medial patellar instability is rare but may occur after lateral retinacular release. The lateral patellofemoral ligament is a significant stabilizer for medial and lateral patellar displacement, and soft tissue–based reconstruction may restore its stabilizing effect. Indications: Lateral patellofemoral ligament reconstruction (LPFLR) is indicated for patellar instability failing exhaustive nonoperative measures. Technique Description: Diagnostic arthroscopy for medial patellofemoral ligament (MPFL) status, patellar tracking, chondral status, and postoperative changes of lateral retinacular release is conducted. A 5-cm incision is made between the midpoint of the patella and the lateral epicondyle, or a single midline incision can be used if performing a concomitant MPFL reconstruction. Dissection is carried down to the lateral retinaculum and capsule, and two 1-cm incisions are made at the distal and proximal patella through the patellar and quadriceps tendon, respectively. The lateral epicondyle is then directly palpated, and two 1-cm incisions are made directly anterior and posterior to the epicondyle into the iliotibial band in full extension. A hamstring allograft is then shuttled in a V-shaped configuration from the quadriceps tendon through the iliotibial band and finally to the patellar tendon. Excess graft is trimmed and doubled over proximally and distally to replicate the normal (or contralateral) 0° to 15° of patellar eversion. Trial resting length and tension is set with temporary sutures through the proximal and distal doubled graft in full extension. The knee is taken through full range of motion to ensure there is no graft tightening in flexion or loosening in full extension. Eversion and patellar translation are then examined. Heavy nonabsorbable sutures are used to set length of the doubled allograft proximally and distally. Results: Case series of LPFLR have demonstrated significant improvements in patients’ pain, Lysholm score and Knee Injury and Osteoarthritis Outcome Score, and kinesiophobia with no instability events and normal range of motion at short-term follow-up. Discussion/Conclusion: Medial patellar instability can occur following lateral retinacular release and patients experiencing instability despite nonoperative treatment are likely to benefit from a soft tissue–based LPFLR. Although other nongraft-based techniques may confer similar outcomes, the authors find it more reliable to perform a lateral reconstruction as described.

The role of the metabolic status of lymphocytes in the pathogenesis of rheumatoid arthritis

Objective: to study in dynamics metabolic changes in lymphocytes on the model of adjuvant-induced rheumatoid arthritis (RA) in warm-blooded animals.Material and methods. The RA model was elicited by administering Freund's complete adjuvant (AF) to male Wistar rats. Lymphocyte metabolism was corrected with a mixture of citric and succinic acids, which was injected for 4 weeks (at doses of 17 and 88 mg/kg body weight) from the first day of model formation. Animals of the control group were injected subcutaneously with isotonic sodium chloride solution. The total number of leukocytes, the size of lymphocytes and the activity of lactate dehydrogenase (LDH) and succinate dehydrogenase (SDH) in these cells were determined. Changes in the musculoskeletal system were assessed radiographically and actometrically in the «open field» model.Results and discussion. In the first 2 weeks of the experiment in the model group, an increase in the level of leukocytes by 65% compared to the control (p=0.002) was noted, an increase in the activity of lymphocytes SDH by 51% and a decrease in the total («horizontal») mobility of animals by 30% were also revealed. Subsequently, the level of leukocytes decreased by 25%, the activity of LDH and SDH – by 38%, the radius of lymphocytes – by 14% (p&lt;0.01). The action of carboxylic acids was dose-dependent: at the maximum dose, no statistically significant differences in the total number of leukocytes, LDH and SDH activity in lymphocytes, as well as their sizes were found between the group with adjuvant- induced RA and the control group.Conclusion. In animals with adjuvant-induced RA, correction of the metabolic status of lymphocytes with a mixture of citric and succinic acids, which are key substrates of the Krebs cycle, led to a decrease in structural damage of musculoskeletal system and, as a consequence, to the maintenance of normal range of motion.

Expenditure of early initiation of neuromuscle electrical stimulation after orthopedic surgeries on the hip and knee joints (literature review)

Every year the number of cases of anterior cruciate ligament reconstruction, total hip and knee arthroplasty increases. This leads to the improvement of rehabilitation protocols for patients after surgery to quickly restore normal range of motion and return to normal life. Objective. Provide physical therapists with an evidence-based resource that can guide clinical decision making, thereby enabling clinicians to make effective use of electrical stimulation to improve muscle function in patients after orthopedic operations and increase awareness of the range of applications for neuromuscular electrical stimulation (NMES). Metods. Electronic databases PMC, PUBMED and SCOPUS were used to search the relevant literature, which was published in the period from the creation of databases to December 2020. Additional articles were identified by analyzing bibliographies in systematic reviews. We have reviewed the full text of selected articles to confirm that all included studies meet the stated objectives of the review. Results. In patients after orthopedic surgery on the hip and knee joints, the inclusion of NMES in standard physical therapy significantly increases the strength of the quadriceps muscle compared to conventional physical therapy. Early activation can be helpful to avoid suppression of quadriceps function and atrophy, provide the patient with the most effective course of rehabilitation, and return to active life after anterior cruciate ligament reconstruction or knee arthroplasty. It is also advisable to use NMES as an alternative mechanical prevention of deep vein thrombosis and edema in the early period after hip arthroplasty. In the presented studies, patients tolerated NMES well even when it initiated on 1–2 postoperative days. However, no standardized NMES protocols reported in the literature, so the choice of stimulation parameters is at the discretion of the physician and usually depends on the individual tolerability of the patients.

Clinical manifestations and treatment of ulnar club hand

The medical records of 13 cases (16 limbs) diagnosed with ulnar club hand in Beijing Jishuitan Hospital between 1966 and 2016 were reviewed. The radiological characteristics of upper limb bones, the shape and function of shoulder, elbow, forearm, wrist, and hand were recorded. The surgical options include radial wedge osteotomy, ulnar anlage excision, release of syndactyly or narrowed first web, and release of camptodactyly were performed to correct deformities. The subjective evaluation of patients or their families was recorded. Thirteen patients with 16 affected limbs were identified with ulnar club hand. There were 7 males and 6 females with an average age of 12.4 years (range:1-29 years). Among them, 3 cases were bilateral, and 10 cases were unilateral. Six patients had right-side involvement and 4 patients had left-side involvement. Based on Bayne's classification, there were 4 type Ⅰ, 7 type Ⅱ, 4 type Ⅲ, and 1 type Ⅳ. The affected extremity was shorter than the normal limb. In patients with type Ⅰ deformity, the elbows were stable with normal range of motion, the wrists were stable with almost normal range of motion, and the hands were normal. In patients with type Ⅱ deformity, the stability of elbow was variable, and hand deformities were common. In patients with type Ⅲ deformity, the elbows were unstable, and hand deformities were common. The elbow of the patient with type Ⅳ deformity showed radiohumeral synostosis without hand deformity. Surgical treatment was performed on 9 limbs. Mean follow-up was 22.3 months(range: 8-48 months), the subjective evaluation of patients or their families was satisfactory or relatively satisfactory. The surgical treatments of ulnar club hand usually focus on correction of hand and forearm deformities. The surgical result is good.

Clinical results after very early, early and late arthroscopic arthrolysis of the knee

PurposeImpaired patient outcome can be directly related to a loss of motion of the knee following surgical procedures. If conservative therapy fails, arthroscopic arthrolysis is an effective procedure to improve range of motion (ROM). The purpose of this study was to evaluate the outcome of patients undergoing very early (< 3 months), early (3 to 6 months), and late (> 6 months) arthroscopic arthrolysis of the knee.MethodsWith a follow-up on average at 35.1 ± 15.2 (mean ± SD, 24 to 87) months, 123 patients with post-operative motion loss (> 10° extension deficit/ < 90° of flexion) were included between 2013 and 2018 in the retrospective study, while eight patients were lost to follow-up. A total of 115 patients were examined with a minimum follow-up of two years. Twenty percent (n = 23) of patients of this study population had a post-operative motion loss after distal femoral fracture, 10.4% (n = 12) after tibial head fracture, 57.4% (n = 66) after anterior/posterior cruciate ligament (ACL/PCL) reconstruction, 8.7% (n = 10) after infection of the knee, and 3.4% (n = 4) after patella fracture. Thirty-seven patients received very early (< 3 months, mean 1.8 months) arthroscopic arthrolysis, and 37 had early (3 to 6 months, mean 4.3 months) and 41 late (> 6 months, mean 9.8 months) arthroscopic arthrolysis after primary surgery.ResultsThe average ROM increased from 73.9° before to 131.4° after arthroscopic arthrolysis (p < 0.001). In the group of very early (< 3 months) arthroscopic arthrolysis 76% (n = 28) of the patients had a normal ROM (extension/flexion 0/140°), in the group of early (3–6 months) arthrolysis 68% (n = 25) of the patients and in the group of late arthrolysis 41.5% (n = 17) of the patients showed a normal ROM after surgery (p = 0.005). The total ROM after arthrolysis was also significantly increased in the group of very early and early arthrolysis (136.5° and 135.3° vs. 123.7°, p < 0.001). A post-operative flexion deficit occurred significantly less in the group of very early and early arthroscopic arthrolysis compared to the late arthroscopic arthrolysis (3.9° and 4.2° vs. 16.6°, p < 0.001). Patients treated with very early (< 3 months) and early (3 to 6 months) showed a significantly increased post-operative Tegner score of 4.8 ± 1 and 4.7 ± 1.1 compared to 3.8 ± 1.1 in the group of late arthroscopic arthrolysis (> 6 months, p < 0.001).ConclusionsAn arthroscopic arthrolysis is highly effective and leads to good to excellent mid-term results. An early arthroscopic arthrolysis within 6 months after primary surgery leads to significantly improved ROM and functional scores compared to the late arthrolysis (> 6 months).

Clinical effect of fractional carbon dioxide laser in the treatment of contracture scars

Objective: To explore the clinical effect of the fractional carbon dioxide laser in the treatment of contracture scars. Methods: A retrospective before-after self-control study was conducted. From December 2016 to April 2021, 16 patients (7 males and 9 females, aged 3-49 years) with contracture scars causing impaired function of the adjacent joint were admitted to Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. Eighteen joint scars of 16 patients were treated with fractional carbon dioxide laser every 2-3 months until the joint retained its normal range of motion or the effect plateaued. The treatment times of each patient were recorded. Before the first treatment and 6 months after the last treatment, the ranges of motion of the affected joint were measured in each patient, and the difference was calculated, meanwhile, the Vancouver Scar Scale (VSS) was used to evaluate the scar of each patient. In the treatment of 1 joint scar in each of 6 patients (totally 6 times of treatments), the ranges of motion of the affected joint before the current treatment, immediately after the treatment, and at the first follow-up after the treatment were documented, and the differences between the ranges before and immediately after the treatment as well as between the ranges before and at the first follow-up after the treatment were calculated. Adverse effects after the treatment in the treatment area were documented. At the last follow-up, a self-made questionnaire was used to collect the implementation status of the physical therapy and other scar management modalities during the treatment interval and follow-up period. Data were statistically analyzed with Wilcoxon rank sum test. Results: Eighteen joint scars in 16 patients received 2 (1, 3) times of fractional carbon dioxide laser treatment. The range of motion of the affected joint of 16 patients 6 months after the last treatment was 56.5 (39.0, 128.8)°, notably higher than 38.4 (22.9, 116.3)° before the first treatment (Z=-3.724, P<0.01), showing a remarkable improvement by 17.4 (8.0, 24.1)°. The vascular distribution, softness, and thickness scores, and total score in VSS scoring of scars of 16 patients 6 months after the last treatment were significantly lower than those before the first treatment (Z=-2.989, -3.762, -2.814, -3.739, P<0.01), with the most obvious improvement in softness. In 6 times of treatments, the range of motion of the affected joint immediately after treatment and at the first follow-up of (2.5±0.6) months after treatment were 156.2 (148.0, 164.2)° and 160.2 (156.7, 166.4)°, both notably higher than 151.4 (145.7, 155.3)° before treatment (Z=-2.201, -2.201, P<0.05), showing a remarkable improvement by 9.1 (4.4, 13.0)° and 13.1 (8.0, 15.7)°, respectively. No adverse effects such as blisters, infection, or hypertrophic scar formation were observed in the treatment area of 16 patients after treatment. Most patients adopted physical therapy, compression, silicone gel or sheets, and braces during the treatment interval and follow-up period. Conclusions: The fractional carbon dioxide laser can soften the scar and increase the range of motion of the affected joint, which is suitable for the clinical treatment of mild contracture scars.

Finite element analysis of hip implant with varying in taper neck lengths under static loading conditions

Background and objectiveTotal hip arthroplasty is known as one of the best advancements in orthopedics in the 20th century. Due to age or trauma hip joint has to replace by an artificial implant. After the hip arthroplasty, the patients can return to normal day-to-day activities with a normal range of motion. There are several types and designs are currently available. These designs usually depend upon the anatomy of the patients. There is a need for revision surgery due to dislocation and aseptic loosening in these joints over time in actively younger patients. Minor changes in the design stage can certainly improve the life expectancy of the implant and will also further reduce the revision rate. MethodsIn this current work, finite element analysis is carried out by varying the neck length with a change in femoral head size for a circular-shaped stem. The effects of using a shorter neck are analyzed. A total of nine combinations are considered for analysis. Modeling is carried out in CATIA V-6 and analysis is performed in ANSYS R-19. A femoral head of 36, 40, and 44 mm and taper neck length of 18, 16, and 14 mm is considered. CoPE is considered as the material combination for all the models. ResultsIt was observed that the von Mises stresses in the complete implant tend to decrease with an increase in the femoral head size. Maximum 5% variation in stress values when 36 mm femoral head is compared with 44 mm. The stresses in the taper neck region tend to decrease with a decrease in the neck length. Minimum von Mises stress of 161.83 MPa was found for the complete implant and in the head-neck region, a minimum von Mises stress found 91.9 MPa. ConclusionsPerformance evaluation of hip implant under static loading conditions gives a clear idea about the behavior of implant. It was found that a decrease in the von Mises stresses with a decrease in the taper length. However, these variations won't affect much in the performance of the hip implant. Also, a reduction in taper length can significantly increase the dislocation in the implant. So it is advised to consider the optimal taper length with an increase in the femoral head size.

Prospective study of management of fracture midshaft clavicle with titanium elastic nailing system (Tens)

Background: Midclavicular fracture are most common type of clavicular fracture and there are recent trend to Fixtion of this factures. this is prospective study to evaluate the result of tens in midclavicular fractures. Material and Methods: Study of 33 (23 male & 10 female) consecutive patient of midclavicular fracture treated by tens and follow up done for radiological and functional evaluation at 4, 8,12, 16 weeks. Result: The average follow up of 13 weeks and union achieved in all 33 cases. length of incision, hospital stay, blood loss, operation time were less significant. there medial Protusion of nail in 4 patient that requires medial trimming of nail, one case of open reduction was got infected treated by early implant removal. no other significant complication were observed. Conclusion: In our hand tens provide good restoration of Clavivular length and allow early mobilization of extremity to got normal range of movements also good cosmetic appearance.

An innovative equivalent kinematic model of the human upper limb to improve the trajectory planning of exoskeleton rehabilitation robots

Abstract. Upper limb exoskeleton rehabilitation robots have been attracting significant attention by researchers due to their adaptive training, highly repetitive motion, and ability to enhance the self-care capabilities of patients with disabilities. It is a key problem that the existing upper limb exoskeletons cannot stay in line with the corresponding human arm during exercise. The aim is to evaluate whether the existing upper limb exoskeleton movement is in line with the human movement and to provide a design basis for the future exoskeleton. This paper proposes a new equivalent kinematic model for human upper limb, including the shoulder joint, elbow joint, and wrist joint, according to the human anatomical structure and sports biomechanical characteristics. And this paper analyzes the motion space according to the normal range of motion of joints for building the workspace of the proposed model. Then, the trajectory planning for an upper limb exoskeleton is evaluated and improved based on the proposed model. The evaluation results show that there were obvious differences between the exoskeleton prototype and human arm. The deviation between the human body and the exoskeleton of the improved trajectory is decreased to 41.64 %. In conclusion, the new equivalent kinematics model for the human upper limb proposed in this paper can effectively evaluate the existing upper limb exoskeleton and provide suggestions for structural improvements in line with human motion.

Interosseous-lumbrical adhesions – a rare condition? A series of five cases

Adhesions between the interosseous and lumbrical muscles involving the deep transverse metacarpal ligament (dTML) can be a cause of chronic pain and reduced range of motion. New reports on this condition are rare. We identified five patients experiencing pain, swelling and decreased range of motion in the metacarpophalangeal (MCP) joints during manual load. The condition was caused by a direct trauma. After not responding to conservative treatment, patients underwent surgery. Time between trauma and surgery was on average 16 months and the mean postoperative follow-up was 8 months. The lumbrical–interosseus junction was exposed by volar or dorsal incision, adhesions were widely released and the distal third of the dTML was resected. This resulted in normal passive excursion of the muscles and the tendon junction. At the mean follow-up time 8.2 months (3–18) after surgery, all patients were pain-free and had gained near normal range of motion in the MCP joints. Interosseous-lumbrical adhesions may be more common than reflected by the literature. Hand surgeons should keep this condition in mind in cases with chronic inter-metacarpal pain after trauma or infection. Surgical exploration is relatively straight forward and tends to lead to gratifying results. Level of Evidence: IV (therapeutic)

The development of burn scar contractures and impact on joint function, disability and quality of life in low- and middle-income countries: A prospective cohort study with one-year follow-up

ObjectiveThe aim of this study was to assess the development of burn scar contractures and their impact on joint function, disability and quality of life in a low-income country. MethodsPatients with severe burns were eligible. Passive range of motion (ROM) was assessed using lateral goniometry. To assess the development of contractures, the measured ROM was compared to the normal ROM. To determine joint function, the normal ROM was compared to the functional ROM. In addition, disability and quality of life (QoL) were assessed. Assessments were from admission up to 12 months after injury. ResultsThirty-six patients were enrolled, with a total of 124 affected joints. The follow-up rate was 83%. Limited ROM compared to normal ROM values was observed in 26/104 joints (25%) at 12 months. Limited functional ROM was observed in 55/115 joints (48%) at discharge and decreased to 22/98 joints (22%) at 12 months. Patients who had a contracture at 12 months reported more disability and lower QoL, compared to patients without a contracture (median disability 0.28 versus 0.17 (p = 0.01); QoL median 0.60 versus 0.76 (p = 0.001)). Significant predictors of developing joint contractures were patient delay and the percentage of TBSA deep burns. ConclusionThe prevalence of burn scar contractures was high in a low-income country. The joints with burn scar contracture were frequently limited in function. Patients who developed a contracture reported significantly more disability and lower QoL. To limit the development of burn scar contractures, timely access to safe burn care should be improved in low-income countries.

Trunk stabilization, body balance, body perception, and quality of life in professional physically disabled and able-bodied archers

Archery is defined as a static sport that requires postural control, upper body strength and balance ability to achieve high scores. The aim of this study was to compare the trunk stabilization, body perception, and quality of life of professional physically disabled and able-bodied archers. Twenty professional archers aged between 18 and 55 years were included in the study. The individuals were divided into two groups as physically disabled archers (n = 10) and able-bodied archers (n = 10). All athletes were evaluated with anthropometric measurements of upper extremity, normal range of motion (ROM) of shoulder, manual muscle strength of upper extremity, and endurance of trunk flexion and extension for trunk stabilization, with modified functional reach, lateral reach and bilateral reach tests for body balance, with Body Perception Scale (BPS) for body perception, and with Short Form 36 (SF-36) for quality of life. Statistically significant differences were found in all reach tests, physical role difficulties and physical function sub-scores of SF-36, and left horizontal adduction and right internal rotation ROM in favor of the able-bodied group. There was a statistically significant difference in arm circumference measurements in favor of the disabled group. No significant difference was there between the groups in endurance of trunk flexion and extension, and BPS. In conclusion, it has been observed that the able-bodied archers have better body balance and quality of life than disabled archers and there is no difference between disabled and able-bodied athletes in terms of trunk stabilization and body perception.

Biodegradable magnesium screws in elbow fracture fixation: Clinical case series

Biodegradable magnesium-based implants are innovative alternatives that potentially eliminate the need for implant removal. Recent studies have demonstrated the osteogenic properties and bacterial inhibition potentials of magnesium screws. We reported a clinical series of three elbow fracture cases, where magnesium screws were used in the treatment of one radial head and two capitellum fractures. Postoperative clinical courses were uneventful, and fracture healing occurred within 3 months. In all cases, radiolucencies were observed around implants especially in the screw head region at 2 months post-operation, but disappeared with consolidation at 1 year post-operation. All patients achieved near normal range of motion, minimal symptoms and good functional outcomes. No complication such as failure of fixation, loss of reduction, malunion or infection was seen. No implant revision or removal was necessary. Magnesium bioabsorbable screws are shown to be a viable option for these fractures.

A Single Retrograde Intramedullary Nail Technique for Treatment of Displaced Proximal Humeral Fractures in Children: Case Series and Review of the Literature.

Background:Displaced proximal humeral fractures in older children with low remodeling potential need to be reduced and fixed. There are many options for stabilization, including external fixation, rigid internal fixation with screws and plates, percutaneous pinning, and flexible intramedullary nailing. The use of 2 flexible retrograde nails, originated at the University of Nancy, France, became the most popular technique in Europe. The aim of this study was to describe and assess a modified, single retrograde nail technique to treat fractures of the proximal part of the humerus.Methods:We performed a retrospective monocentric study. From June 2016 to May 2019, a modified retrograde nail technique with 1 prebent nail was used for the management of 21 consecutive children with a closed displaced proximal humeral fracture. Demographic and surgical data were collected. The surgical technique is similar to the classic elastic stable intramedullary nailing, but only 1 nail is used. The average surgical time and perioperative complications were used as criteria for the feasibility of this technique. Radiographs were obtained preoperatively; at 1, 4, and 6 weeks postoperatively; and after implant removal at an average of 4.2 months postoperatively. The clinical outcomes were assessed on the basis of the shoulder range of motion documented in the medical records and by using the French edition of the QuickDASH (shortened version of the Disabilities of the Arm, Shoulder and Hand [DASH] questionnaire) evaluation scale at the time of implant removal.Results:Nineteen patients with a mean age of 12.6 years and a mean follow-up of 6 months were included in the study. The mean surgical time was 49 minutes. The single intramedullary nail technique provided a satisfactory reduction of all fractures. No perioperative complication occurred. In 1 case, partial loss of reduction was observed on the first-week control radiograph. All patients had a healed fracture, no deficits, excellent results according to the QuickDASH score, a normal range of motion, and excellent strength of the shoulder joint at the time of implant removal (at a mean of 4.2 months).Conclusions:The current study confirms the feasibility and efficacy of the single retrograde intramedullary nail technique to treat displaced proximal humeral fractures in children.Level of Evidence:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.