Pronation Range Of Motion Research Articles

Investigating the Combined Effects of Fascial Distortion Model Manual Therapy and Balance-Strength Training in Individuals with Chronic Ankle Instability.

The Fascial Distortion Model (FDM) is a relatively new manual therapy approach in the field of musculoskeletal physical therapy, and its potential effectiveness in treating chronic ankle instability (CAI) remains unexplored. A randomized controlled trial with 23 participants was conducted. Patients were randomly assigned to either the FDM + balance-strength training (BST) group (n = 8), receiving extra FDM sessions weekly in addition to two sessions of BST, or the BST group (n = 7). Healthy controls (n = 8) did not receive any treatment and participated only in pre- and post-test measurements. Objective measurements including Y-Balance Test Lower Quarter (YBT-LQ), Flamingo Balance Test (FBT), Weight-Bearing Lunge Test (WBLT), ankle joint range of motion (ROM), and Cumberland Ankle Instability Tool (CAIT) were recorded at baseline and the end of the intervention. The results demonstrated significant differences between the FDM + BST and BST groups for supination ROM (p = 0.008) and similarly for WBLT (p = 0.041), FBT (p = 0.40), YBT-LQ (p = 0.023), and CAIT score (p = 0.008). Moreover, while both groups demonstrated significant improvement at the post-test compared with their pre-test for plantarflexion and pronation ROM, WBLT, and CAIT score, the FDM + BST group demonstrated significant improvements in supination ROM, FBT, and YBT-LQ. Our study suggests that the addition of FDM concepts to a BST may lead to enhanced improvements in ankle ROM, static and dynamic balance, and self-reported outcomes in individuals with CAI compared to BST.

An unusual pediatric monteggia equivalent lesion: a rare case report

Abstract: Monteggia lesion is a rare fracture in which ulna shaft fracture and radial head dislocation occur together. Monteggia equivalent is the lesion associated with ulna shaft fracture and radius head and/or neck fracture. We offer a case of Monteggia equivalent in a 9-years-old boy. In the surgery of the patient, anatomical plating was performed for ulna shaft fracture and intramedullary nail was applied for radius neck fracture. When we look at the literature, such case reports are very rare.
 Conclusion: In the 1-year follow-up of the patient, there was no loss in flexion, extension, supination and pronation range of motion.

The signed helical angle: A technique for characterizing midfoot motion during gait

Quantifying motion in the midfoot during gait and other movements is important for a variety of applications, but challenging due to the complexity of the multiple small articulations involved. The most common motion capture based techniques are limited in their ability to characterize the non-planar nature of the midfoot joint axes. In this study we developed a novel Signed Helical Angle (SHA) to quantify midfoot angular displacement. Motion capture data from 40 healthy subjects walking at a controlled speed were used to calculate finite helical axes and angles from a two-segment foot model. Axes were classified as either pronation or supination based on their orientation, and given a sign, thus either adding to or subtracting from the angular displacement. Analysis focused on insights from axis orientation and comparisons to other techniques. Results showed that when transitions were excluded, pronation and supination axes were fairly well clustered in the transverse plane. The resulting SHA midfoot angle waveform was comparable to sagittal plane Euler and helical component waveforms, but with 39% (approximately 3°) greater range of motion in pronation and 25% (approximately 4°) greater in supination, due to the direct measurement of the motion path and the influence of the other planes. The proposed SHA method may provide an intuitive and useful method to analyze midfoot motion for a variety of applications, particularly when interventions cause subtle changes that may be diluted in planar analyses.

Coronoid Fragment Size in Monteggia Fractures Predicts Ultimate Function.

We sought to determine what effect the size of a displaced coronoid fracture fragment in Monteggia injuries has on clinical outcome. Sixty-seven patients presented to an academic medical center for operative fixation of a Monteggia fracture. Radiographs were assessed for length and height of the displaced coronoid fragment using measuring tools in our center's imaging archive system. Data were analyzed using binary logistic or linear regression, as appropriate, controlling for sex, age, and Charlson Comorbidity Index. Outcome measurements included radiographic healing, range of motion, postoperative complications, and reoperation. The cohort had a mean follow-up of 16.7 months. Mean coronoid fragment area was 362.4±155.9 mm2. Elbow range of motion decreased by 3.8° of elbow flexion (P<.001), 3.3° of elbow extension (P<.001), and 3.8° of forearm supination (P=.007) for every 1-cm2 increase in coronoid fragment area. Complications (P=.012) and reoperation (P=.036) were associated with increasing coronoid fragment area. Nonunion rate, nerve injury, and pronation range of motion were not correlated to increasing coronoid fracture fragment area (P=.777, P=.123, and P=.351, respectively). As displaced coronoid fragment size increases in Monteggia fracture patterns, elbow range of motion decreases linearly. Coronoid displacement was also associated with increased rates of postoperative complication and need for reoperation. [Orthopedics. 2024;47(1):15-21.].

Minimally Invasive Fixation with Dorsal Suspension Button and Volar Plate in Distal Radius Fractures with Dorsal Die Punch Fragments: A Preliminary Study.

Objective The objective of the study is to analyze the clinical and radiological results obtained using a minimally invasive fixation technique with a volar locking plate and a suspension system with a dorsal button in distal articular radius fractures with dorsal comminution. Materials and Methods Six patients with distal radius fractures, between 19 and 68 years of age, were included in the study. Mean follow-up was of 15 weeks. Range of motion (ROM) in flexion, extension, radial deviation, ulnar deviation, pronation, supination, the strength in kilograms, and values on the Visual Analog Scale (VAS), Disabilities of Arm, Shoulder and Hand (DASH), and Mayo Wrist Score (MWS) scales were evaluated at 4, 8, and 12 weeks postoperative. Correction of anteroposterior diameter of the radius and concordance between postoperative anteroposterior diameter and the contralateral wrist diameter were evaluated radiologically. Results The following mean values were obtained at 12 weeks postoperative: ROM in flexion: 40.5°, ROM in extension: 49.5°, ROM in radial deviation: 24.5°, ROM in ulnar deviation: 15°, ROM in pronation: 87°, ROM in supination: 89°, strength: 37.5 kg, pain in VAS scale: 2 points, DASH: 54.5 points, and MWS: 67.5 points. At 12 weeks postoperative, the mean correction of anteroposterior diameter was 0.49 mm. The anteroposterior diameter and that of the contralateral wrist were strongly correlated. Conclusion Fixation with the volar locking plate and dorsal suspension button could be considered an alternative to dorsal plate fixation for treatment of distal radius fractures with comminution or associated dorsal die punch fragments.

Double-Incision Technique for the Treatment of Distal Biceps Tendon Rupture.

A longitudinal antecubital incision of 3 to 4 cm allows dissection to identify and isolate the lateral antebrachial cutaneous nerve (LABCN). Supination of the forearm protects the posterior interosseus nerve, which often cannot be visualized. The distal portion of the distal biceps should be carefully identified and exposed. A high-resistance nonresorbable suture is sewn with use of a Krackow technique to whipstitch the distal 4 cm of the tendon. Alternatively, 2 sutures (4 strands) can be utilized. A curved forceps is placed in the interosseous space to identify the location for the second 4-cm incision, on the dorsal proximal forearm over the tip of the forceps with the forearm pronated. The radial tuberosity is exposed by bluntly separating the common extensor tendons, followed by transection of the supinator fibers. Two drill holes are made 5 mm apart from one another for suture passage. The tendon is passed across a loop of wire, from the anterior to the posterior incision. With the elbow at 90° of flexion and full pronation, the tendon is docked into the trough and the sutures are tied. Alternatively, the surgical repair of the distal biceps tendon rupture can be performed through a single anterior approach4. The exposure starts with a curved longitudinal antecubital incision, exploiting the interval between the brachioradialis and pronator teres with radial (lateral) retraction of the brachioradialis and medial retraction of the pronator teres. A single anterior incision allows repair through the use of various types of fixation devices, such as suture anchors, cortical buttons, and interference screws, but seems to carry an increased risk of neurological complications, especially in terms of paresthesias in the distribution of the LABCN. Nonoperative treatment might be acceptable for elderly patients with poor functional demands. The double-incision technique with bone-tunnel fixation provides good fixation strength with an expected low rate of neurological complications1. This approach offers a useful treatment option for young and active patients with physically demanding lifestyles. The double-incision technique is an effective and safe procedure to restore elbow functionality in patients with distal biceps tendon rupture. A meta-analysis1,4-16 revealed no significant differences in postoperative functional scores following procedures performed via the single-incision compared with double-incision approach. Although the differences were smaller than the minimal clinically important difference17, the single-incision technique yielded significantly greater flexion (mean ± standard deviation, 136° ± 13°) and pronation range of motion (79° ± 10°) compared with the double-incision technique (133° ± 13° and 75° ± 14°, respectively) at 2 years postoperatively. No differences in extension and supination were observed. Rates of heterotopic ossification ranged from 0.5% to 11% for the single-incision approach and from 1% to 21.4% for the double-incision approach, with significant differences favoring the single-incision technique, although in the majority of cases the heterotopic ossification was an incidental finding. Neurological complications were found in 24.5% and 13.4% cases for the single- and double-incision techniques, respectively, with a significant difference favoring the double-incision technique. When damage to specific nerves was evaluated, the double-incision technique was associated with significantly less risk of LABCN damage. One or 2 high-resistance nonresorbable sutures are sewn with use of a Krackow technique to whipstitch the distal 4 cm of the biceps tendon.A curved forceps is placed in the interosseous space to identify the location for the second incision, on the dorsal proximal forearm over the tip of the forceps.Pronation of the forearm protects the posterior interosseus nerve, which often cannot be visualized during volar dissection and bone fixation.Positioning the tendon more posteriorly on the radial tuberosity allows for optimal biomechanical function. ROM = range of motionCR = conventional radiologyMRI = magnetic resonance imagingUS = ultrasoundLABC = lateral antebrachial cutaneousPIN = posterior interosseous nerveHO = heterotopic ossificationCI = confidence intervalSI = single incisionDI = double incision.

Operative Versus Nonoperative Management for Distal Biceps Brachii Tendon Lesions: A Systematic Review and Meta-analysis.

Background:Both nonoperative and operative treatments have been proposed to manage distal biceps brachii tendon avulsions. However, the advantages and disadvantages of these approaches have not been properly quantified.Purpose:To summarize the current literature on both nonoperative and operative approaches for distal biceps brachii tendon ruptures and to quantify results and limitations. The advantages and disadvantages of the different surgical strategies were investigated as well.Study Design:Systematic review; Level of evidence, 4.Methods:A systematic literature search was performed in March 2020 using PubMed Central, Web of Science, Cochrane Library, MEDLINE, Iscrctn.com, clinicaltrials.gov, greylit.org, opengrey.eu, and Scopus literature databases. All human studies evaluating the clinical outcome of nonoperative treatment as well as different surgical techniques were included. The influence of the treatment approach was assessed in terms of the Disabilities of the Arm, Shoulder and Hand (DASH) score and the Mayo Elbow Performance Index; extension, flexion, supination, and pronation range of motion (ROM); and flexion and supination strength ratio between the injured and uninjured arms. Risk of bias and quality of evidence were assessed using the Cochrane guidelines.Results:Of 1275 studies, 53 studies (N = 1380 patients) matched the inclusion criteria. The results of the meta-analysis comparing operative versus nonoperative approaches for distal biceps tendon avulsion showed significant differences in favor of surgery in terms of DASH score (P = .02), Mayo Elbow Performance Index (P < .001), flexion strength (94.7% vs 83.0%, respectively; P < .001), and supination strength (89.2% vs 62.6%, respectively; P < .001). The surgical approach presented 10% heterotopic ossifications, 10% transient sensory nerve injuries, 1.6% transient motor nerve injuries, and a 0.1% rate of persistent motorial disorders. Comparison of the different surgical techniques showed similar results for the fixation methods, whereas the single-incision technique led to a better pronation ROM versus the double-incision approach (81.5° vs 76.1°, respectively; P = .01).Conclusion:The results of this meta-analysis showed the superiority of surgical management over the nonoperative approach for distal biceps tendon detachment, with superior flexion and supination strength and better patient-reported outcomes. The single-incision surgical approach demonstrated a slightly better pronation ROM compared with the double-incision approach, whereas all fixation methods led to similar outcomes.

Measurement Properties of Outcome Measures Used to Assess Physical Impairments in Patients After Distal Radius Fracture: A Systematic Review.

Individuals with distal radius fractures (DRF) may experience difficulty with gripping an object, painful wrist movements, sensorimotor difficulties, and swelling around the wrist and hand. A comprehensive review of the existing evidence concerning the measurement properties of common physical impairment measures can provide a valuable resource to guide hand therapy practice while managing DRF. The primary objective was to locate and assess the quality of literature on the measurement properties for the measures of physical impairment used in individuals with DRF. Two reviewers searched PubMed, CINAHL, and EMBASE. A combination of DRF, measurement properties, and physical impairments were used as keywords, and articles were independently assessed using the Consensus-Based Standards for the Selection of Health Measurement Instruments critical appraisal tool. Primary studies were included if they examined at least 1 of the following: reliability, validity, responsiveness, or indices of true and meaningful changes for measures of physical impairment in the DRF sample. A total of 19 articles were included in this review. The quality of the studies ranged from 46% to 92%. This review suggests that measures such as assessment of grip strength and supination and pronation range of motion (ROM), using various goniometric devices, showed good intrarater and interrater reliability, construct validity, and responsiveness in individuals with DRF. Acceptable reliability and responsiveness were reported in grip and wrist ROM assessments for measuring changes in wrist and hand function after DRF; however, wrist ROM assessed using traditional goniometric techniques were less reliable in individuals with DRF. This study provides insight into which objective tools might be better suited for measuring outcomes related to DRF.

Radioulnar joint reconstruction: a novel surgical technique and biomechanical assessment for chronic instability

PurposeThis study aims to describe and biomechanically evaluate a novel technique using a strip of the flexor carpi ulnaris tendon for distal radioulnar joint reconstruction.MethodsSurgical technique was thoroughly detailed, and a cadaveric biomechanical test was conducted to evaluate sagittal plane stability. Pronosupination range of motion was measured before and after the procedure. Dorsal and volar translation resistances were checked in three situations: with the uninjured triangular fibrocartilage complex, after its complete resection and after the surgical procedure.ResultsFor distal radioulnar joint translation, higher values were found both in dorsal and volar translation in situations with an injured triangular fibrocartilage complex, with means equal to 25.4 mm (SD: 9.4 mm) and 26.1 mm (SD: 8.0 mm), respectively. For intact triangular fibrocartilage complex, both dorsal and volar translations averages were 3.4 mm (SD: 0.9 mm) and 4.5 mm (SD: 1.8 mm), respectively. Finally, when evaluating dorsal and volar translations after surgical reconstruction, means were 6.3 mm (SD: 1.3 mm) and 6.8 mm (SD: 0.9 mm), respectively. Regarding supination and pronation range of motion, which ranged from 57.9 to 63.4o, there were no differences in mean and median measures, when the cadavers with intact and reconstructed triangular fibrocartilage complex were compared (p > 0.05).ConclusionPromising mechanical evaluations encourage us to hypothesize that the technique effectively reconstructs the dorsal and volar radioulnar ligaments, preserving pronosupination and maintaining the physiological characteristics of the wrist joint. Clinical comparative studies are still necessary to fully validate this procedure.Level of evidenceTherapeutic - Level V.

Short Term Clinical Outcomes Following Arthroscopic Suprapectoral Onlay Biceps Tenodesis with a Single Suture Anchor

Objectives:The long head of the biceps tendon is a well-recognized potential source of anterior shoulder pain. Arthroscopic biceps tenodesis has emerged as a popular surgical option, however, limited studies exist evaluating postoperative outcomes after an arthroscopic approach. The purpose of this study was to assess short term clinical and functional outcomes after arthroscopic suprapectoral onlay biceps tenodesis with a single suture anchor.Methods:A prospective case series of 50 patients undergoing arthroscopic suprapectoral biceps tenodesis by a single surgeon. Patients were evaluated preoperatively and postoperatively at six months with the American Shoulder and Elbow Surgeons (ASES) questionnaire, Visual Analog Scale (VAS), Single Assessment Numeric Evaluation (SANE), Veteran Rand 12-Item Health Survey (VR-12), and 12-Item Short Form Survey (SF-12). Strength, range of motion (ROM), biceps apex distance, provocative tests and return to work (RTW) were assessed postoperatively.Results:26 males and 24 females were evaluated. Average ± SD age at surgery was 50.14 ± 10.94 years, and average follow up was 6.48 ± 1.28 months. Biceps apex distance, active/passive elbow flexion, extension, supination, or pronation ROM did not differ (p>0.192 for all) between affected and unaffected sides. Elbow flexion strength significantly increased postoperatively (p=0.004). Significant improvements were noted (p ≤ 0.001 for all) in ASES, VAS pain, SANE, Constant-Murley, and VR/SF-12 Physical Component scores. Four procedures were revisions (8.0%), which were significantly correlated with postoperative bicipital groove pain (p = 0.034), positive Yergason’s test (p = 0.047), and takingpostoperative opioids (p = 0.037). These revision cases and patients with increased BMI were significantly less likely to achieve MCID for VR/SF-12 Physical Component scores (p < 0.05). No patients required subsequent surgery involving the biceps. Out of 45 employed patients, 32 (71.11%) returned to work at an average of 4.68 ± 2.95 months. Light duty had a statistically greater return to work rate compared to heavy duty (p = 0.027). Popeye deformity was seen in 5 (10%) patients, which had significantly increased biceps apex distances (p = 0.029). However, no significant differences were noted in these patients (p > 0.05 for all) for patient-reported outcomes, range or motion, or strength. Only one reported awareness of cosmetic deformity.Conclusion:Shoulder strength, ROM, and multiple outcome measures improved significantly post-operatively with use of arthroscopic biceps tenodesis using a single anchor technique. Although 10% of patients developed cosmetic deformity, this did not significantly affect postoperative outcomes. Revision patients should be counseled preoperatively regarding the increased likelihood of postoperative pain and appropriate opioid medication use.Table 1.Logistic Regression of Variable Associated with Postoperative OutcomesUnivariate Regression (p-value)Multivariate Regression(p-value)Odds Ratio (95% CI)Abnormal Cosmesis – Subjective Gender0.1010.2481.116 (0.926 -1.346) Current Smoker0.0780.1821.166 (0.930 -1.461)Postoperative Pain - Bicipital Groove BMI0.0510.0611.021 (-0.001-0.043) Revision 0.038 0.034 1.691 (1.041-2.747) Postitive O’Brien’s Test BMI0.0530.0871.021 (0.997 -1.045) WC0.1330.5641.091 (0.811 -1.469) Hypercholesterolemia0.0650.0771.450 (0.959-2.191)Positive Yeargason’s Test Current Smoker0.0730.2791.148 (0.894 -1.473) Revision 0.144 0.047 1.447 (1.006-2.083) RC Debridement0.0980.1240.822 (0.640 -1.055) Labral Repair0.1800.5502.04 (0.985-4.261)Pain Medications BMI0.0410.0741.038 (0.996 -1.091) Revision0.1930.6671.132 (0.643 -1.994) Preop Pain - Bicipital Groove0.1150.2131.297 (0.861 -1.953)Opioid Pain Medications Gender0.0540.0731.185 (0.985 -1.426) WC0.1340.3411.102 (0.902 -1.347) HTN0.1300.0530.805 (0.646 -1.003) Revision 0.031 0.037 1.433 (1.022-2.009) Return to Work RCR w/ SAD0.1360.2720.852 (0.640 -1.134) SAD0.1990.4260.818 (0.501 -1.339)Return to Work Same or Higher Intensity Past Smoker0.0820.1640.805 (0.594 -1.093) Psych0.1670.6540.802 (0.305-2.105) Revision0.0450.0940.643 (0.383 -1.079) SAD0.0450.4161.34 (0.660-2.727)Values in bold denote statistical significance (p < 0.05)

Influence of distal radius fractures involving the intermediate column on forearm rotation

BackgroundThe objective of the study was to compare the radiologic and clinical outcome of patients with distal radius fractures involving the intermediate column and distal radial metaphyseal fractures treated conservatively.MethodsTwo cohorts of 52 matched patients with distal radius fractures treated conservatively, one with a fracture involving the intermediate column and the other with no intermediate column fracture, were retrospectively analyzed by examining the data. Patients were matched for age, sex, fracture side, and AO fracture type. The two groups were analyzed for differences in wrist motion; grip strength; Gartland and Werley score; Disabilities of the Arm, Shoulder and Hand (DASH) score; and visual analogue scale (VAS) score at 12 months. The differences in continuous variables were compared using the paired t test. Linear regression analyses or Pearson correlation analyses were used to evaluate the associations of radiological parameters with clinical outcomes.ResultsThe analysis showed significant differences in the range of motion (ROM) for pronation (p = 0.000) and supination (p = 0.008) in the paired groups. There was a significant difference in DASH scores (p = 0.024) in the paired groups. Using Pearson correlation analysis, negative correlations (r = − 0.360, p = 0.000) were observed between articular step-off and ROM for pronation. Linear regression analyses also indicated that ROM for pronation had negative relationships (β = − 6.327, p = 0.001) with articular step-off.ConclusionsDistal radius fractures involving the intermediate column had an adverse effect on forearm rotation after distal radius fractures treated conservatively.

In Vivo Three-Dimensional Analysis of Malunited Forearm Diaphyseal Fractures with Forearm Rotational Restriction.

The aim of this study was to clarify the mechanisms of rotational restriction in malunited forearm diaphyseal fractures. We retrospectively analyzed the cases of 18 patients with malunited forearm diaphyseal fractures and rotational restriction. All patients underwent bilateral computed tomography (CT) of the forearm in maximum supination, pronation, and neutral positions. From these images, we created 3-dimensional (3-D) bone surface models. We quantified the 3-D deformities, identified instances of osseous impingement between the radius and the ulna during forearm rotation, calculated the path length of the central band (CB) of the interosseous membrane, and measured forearm range of motion. Sixteen patients had extension deformity of the radius (the RE group) and 2 had flexion deformity (the RF group). In the RE group, extension deformity of the radius and valgus deformity of the ulna had significant negative correlation with pronation range of motion (R = -0.50, p = 0.046) and supination range of motion (R = -0.63, p = 0.027), respectively. Osseous impingement was mainly observed during pronation (15 of 16 patients). The CB path with the largest changes in length originated from the distal CB attachment area of the radius and ran toward the proximal area of the ulna (the transverse CB). The transverse CB significantly increased in length in supination compared with that in pronation (p < 0.001). Therefore, tightness of the transverse CB appeared to cause supination restriction in the RE group. In the RF group, osseous impingement caused supination restriction. The greatest increases in the transverse CB length were observed in pronation in the RF group, which appeared to cause pronation restriction. In the RE group, pronation restriction was associated with osseous impingement that was due to extension deformity of the radius, and supination restriction was associated with CB tightness that was due to valgus deformity of the ulna. In the RF group, our results suggested that pronation restriction was caused by CB tightness and that supination restriction was caused by osseous impingement. Three-dimensional corrective osteotomy for extension deformity of the radius in malunited forearm diaphyseal fractures would improve rotational restriction by relieving osseous impingement during pronation and CB tightness during supination.

Pronation-Supination Motion Is Altered in a Rat Model of Post-Traumatic Elbow Contracture.

The elbow joint is highly susceptible to joint contracture, and treating elbow contracture is a challenging clinical problem. Previously, we established an animal model to study elbow contracture that exhibited features similar to the human condition including persistent decreased range of motion (ROM) in flexion-extension and increased capsule thickness/adhesions. The objective of this study was to mechanically quantify pronation-supination in different injury models to determine if significant differences compared to control or contralateral persist long-term in our animal elbow contracture model. After surgically inducing soft tissue damage in the elbow, Injury I (anterior capsulotomy) and Injury II (anterior capsulotomy with lateral collateral ligament transection), limbs were immobilized for 6 weeks (immobilization (IM)). Animals were evaluated after the IM period or following an additional 6 weeks of free mobilization (FM). Total ROM for pronation-supination was significantly decreased compared to the uninjured contralateral limb for both IM and FM, although not different from control limbs. Specifically, for both IM and FM, total ROM for Injury I and Injury II was significantly decreased by ∼20% compared to contralateral. Correlations of measurements from flexion-extension and pronation-supination divulged that FM did not affect these motions in the same way, demonstrating that joint motions need to be studied/treated separately. Overall, injured limbs exhibited persistent motion loss in pronation-supination when comparing side-to-side differences, similar to human post-traumatic joint contracture. Future work will use this animal model to study how elbow periarticular soft tissues contribute to contracture.

Recovery of Wrist Function after Volar Locking Plate Fixation for Distal Radius Fractures

The purpose of our present study was to examine the recovery of the postoperative wrist function, and to compare the range of motion among each direction ofthe wrist joint during the same time periods after surgery for distal radius fractures. Twenty patients treated with a volar locking plate were evaluated. The active range of motion and grip strength were assessed at four weeks, six weeks, three months, six months and one year after surgery. The ratio of the range of motion in pronation and supination recovered significantly earlier than for any other directions within six months after surgery (p = 0.0205), however, the ratio of the range of motion among the six directions was not significantly different at one year after surgery (p = 0.0823). The recovery of the range of motion in flexion was 96.8% compared with the contralateral wrist at one year after surgery, and it was not significantly lower than that in extension, radial deviation or ulnar deviation (97.8%, 93.5%, 94.4%, respectively). The grip strength of dominant hand recovered from 50% after four weeks to 66% after six weeks, 83% after three months, 91% after six months and 106% at the examination performed after one year compared with the uninjured non-dominant hand. The grip strength of non-dominant hand recovered from 52% after four weeks to 59% after six weeks, 79% after three months, 84% after six months and 94% at the examination performed after one year compared with the uninjured dominant hand. The mean DASH score was 5.3. The range of motion in flexion can achieve similar improvement to that in the other directions by obtaining the appropriate postoperative parameters. The optimal postoperative radiographic parameters were thus identified to be essential for successfully obtaining a recovery of the wrist function for unstable distal radius fractures.

Outcome after Implantation of the Aptis Total Distal Radioulnar Joint Replacement Prosthesis

To date, the Aptis distal radioulnar joint (DRUJ) prosthesis by Scheker is the only total, bipolar prosthesis available. In the literature, only few data exist concerning the prosthesis and its surgical technique. Aim of the present study was the evaluation of the medium-term clinical and radiological outcome following implantation of the Aptis DRUJ prosthesis. 5 patients (4 women and 1 man) with mean age of 40.2 (30-65) years underwent secondary implantation of the Aptisprosthesis between February 2006 and May 2013. The average date of the follow-up was after 36 (24-48) months. Besides the complications, the wrist range of motion (ROM) and the strength in grip were measured. The quality of pain was determined using a visual analogue pain scale from 0-10. In follow-up X-ray controls, bone resorption and bony abnormalities were evaluated. The DASH score as well as the postoperative subjective satisfaction of the patients were recorded. No patient required removal of the prosthesis. Only 1 patient underwent secondary surgery in which debridement of the screw tip over the radius was required. The postoperative range of motion in pronation and supination was measured with 78 (70-90)° and 82 (70-90)°. The average grip strength amounted to 29 (24-32) kg. This represented 85 (76-100)% of the value of the contralateral side. Postoperative pain symptoms on the visual analogue pain scale were measured with 0 points at rest and with 1.2 (0-2) points under strain. Radiological evaluation showed bone resorption at the radial peg in 2 patients, but without evidence of implant loosening. The DASH score was recorded with 37 (13-75) points. All patients were satisfied or very satisfied after the surgical treatment. The Aptis prosthesis is a safe and efficient treatment option for previously failed surgery of the DRUJ.

Reliability of two goniometric methods for measuring active subtalar range of motion.

Measuring subtalar joint (STJ) motion is accompanied by complications due to the oblique STJ axis which results in triplanar pronation and supination. We developed a pronator and supinator testing apparatus whose axis was aligned with Inman's STJ axis. The purpose of this study was to assess day-to-day reliability of active STJ range of motion (ROM) measurements and to compare the results with those of a rearfoot goniometer. Active pronation, supination and total STJ ROM measurements were administered to 12 men (mean age: 23.8 years) and 12 women (mean age: 22.3 years) at two separate test sessions. Intraclass correlations (ICC), limits of agreement (LoA) and minimum detectable change (MDC) were calculated. Except for pronation ROM in men, the STJ goniometer revealed substantial (ICC > 0.8) reliability in all conditions. Relative MDCs and LoAs were below 15% and 10%, respectively. Significantly higher total ROM (P< 0.05) was found for women compared to men when using the STJ goniometer. The rearfoot goniometer showed high reliability (ICCs > 0.7) but underestimated STJ ROM in average of 37%. Both goniometric methods showed high day-to-day reliability. However, when using the rearfoot goniometer, researchers have to consider whether the level of underestimation of STJ motion is acceptable in the context of the planned investigation.

Angle-torque relationship of the subtalar pronators and supinators in younger and elderly males and females.

BackgroundThe angle-dependent torque capacity of the subtalar pronators and supinators is important to maintain dynamic ankle stabilisation. Based on the peak torques during maximum voluntary isometric pronation and supination across the subtalar range of motion, the strength curves of younger and elderly males and females were investigated.MethodsMaximum voluntary isometric subtalar pronator and supinator strength tests were administered to 30 younger and 30 elderly volunteers (each 15 male and 15 female subjects). Total active subtalar range of motion and peak pronator and supinator torques were measured in five anatomical subtalar joint angles using a custom-built apparatus with two force transducers. Furthermore, relative torques (normalised to the individual peak torque) and pronator-to-supinator strength-ratios were also calculated.ResultsPronator-to-supinator strength ratio, and peak pronator and supinator torques are affected by age and by joint angle x age interactions. All supinator strength curves show a steadily descending characteristic from the pronated to the supinated positions. The pronator strength curve had an inverted U-shaped characteristic, except for younger women of whom 47 % exert highest peak values in the end-range pronation angle. Both relative pronator and supinator strength are dependent on sex (P < 0.05). Relative pronator strength is also affected by joint angle x sex (P < 0.0001) and joint angle x sex x age (P < 0.05) interactions. Beside age effects on all range of motion parameters, pronation range of motion is influenced by a sex x age interaction (P < 0.05).ConclusionsAge- and sex-related differences in both subtalar strength profile and range of motion have to be considered when testing strength across subtalar range of motion. Younger females have higher pronator strength capacity in the most pronated joint angle, which may be due in part to their greater subtalar joint range of motion compared to the other groups. In the most supinated position both pronator and supinator strength capacity is reduced in younger females compared to younger males.Electronic supplementary materialThe online version of this article (doi:10.1186/s13047-015-0125-2) contains supplementary material, which is available to authorized users.

Runners With Anterior Knee Pain Use a Greater Percentage of Their Available Pronation Range of Motion

"Excessive" pronation is often implicated as a risk factor for anterior knee pain (AKP). The amount deemed excessive is typically calculated using the means and standard deviations reported in the literature. However, when using this method, few studies find an association between pronation and AKP. An alternative method of defining excessive pronation is to use the joints' available range of motion (ROM). The purposes of this study were to (1) evaluate pronation in the context of the joints' ROM and (2) compare this method to traditional pronation variables in healthy and injured runners. Thirty-six runners (19 healthy, 17 AKP) had their passive pronation ROM measured using a custom-built device and a motion capture system. Dynamic pronation angles during running were captured and compared with the available ROM. In addition, traditional pronation variables were evaluated. No significant differences in traditional pronation variables were noted between healthy and injured runners. In contrast, injured runners used significantly more of their available ROM, maintaining a 4.21° eversion buffer, whereas healthy runners maintained a 7.25° buffer (P = .03, ES = 0.77). Defining excessive pronation in the context of the joints' available ROM may be a better method of defining excessive pronation and distinguishing those at risk for injury.

Axial rotation of the first metatarsal head in a normal population and hallux valgus patients

Does metatarsal pronation exist and, if so, what is its impact? Hallux valgus is a deformity associating angulation and a rotational component. The present study sought to investigate the nature and origin of the coronal plane displacement. A prospective single-center radiological and anatomic study was conducted on 100 feet operated on for hallux valgus. Baseline X-ray determined the preoperative position of the 1st metatarsal head in the coronal plane. The range of motion (ROM) of the cuneometatarsal joint in pronation-supination was measured peroperatively. An anatomic study investigated possible diaphyseal torsion. Mean radiologic pronation in hallux valgus was 12.7° (range, 0°-40°). Cuneometatarsal rotational ROM was determined by adding peroperative ROM in pronation (mean, 9.3°; range, 0°-30°) and in supination (mean, 8.7°; range, 0°-20°). Intermetatarsal divergence showed no correlation with radiologic pronation or ROM in pronation. Radiologic pronation showed no correlation with peroperative ROM in pronation. Pronation of the metatarsal head was never observed without associated sesamoid pronation; the latter, however, was in some cases observed without the former. Twenty randomly selected metatarsal cadaver specimens from the anatomy laboratory of the University of Nice (France) showed diaphyseal torsion in 80% of cases, with the metatarsal head in neutral position or in supination with respect to the base. In hallux valgus, 1st ray pronation appears to be systematic, in contrast to the typical supination found in the general population. Metatarsal rotation is always associated with sesamoid rotation, whereas the converse is not the case: displacement of the sesamoids appears to displace the metatarsal head via the metatarsosesamoid ligaments. This "drive-belt" effect, however, varies in its mechanical properties and the transmission is imperfect and likely subject to progressive ligament stretching, so that head rotation does not exactly follow and may even become independent of the sesamoid displacement. Radiologic and clinical rotation thus do not match any longer. The anatomic study showed that, while diaphyseal torsion cannot be ruled out, the metatarsal pronation mainly derives from cuneometatarsal joint rotational instability, the evolution of which does not parallel lateral instability, no correlation being found between degree of varus and rotational instability. The present study found metatarsal pronation to be associated with hallux valgus, making a preoperative AP view useful; the underlying mechanism was generally cuneometatarsal instability. Although difficult to specify exactly without correlation between radiological and clinical data, any such pronation raises the question of whether replacing the metatarsal head on its sesamoid supports is sufficient to achieve stability in all planes, or whether on the contrary derotation should be associated to metatarsal valgization osteotomy to restore horizontal support. Level IV.

Simultaneous powering of forearm pronation and key pinch in tetraplegia using a single muscle-tendon unit

This study clinically assessed the concept that both thumb flexion and forearm pronation can be restored by brachioradialis (BR)-to-flexor pollicis longus (FPL) tendon transfer if the BR is passed dorsal to the radius. Six patients [two women and four men, mean age 32.3 years (SD 4.9, range 23-56)] underwent BR-to-FPL transfer dorsal to the radius and through the interosseous membrane (IOM). Lateral key pinch strength and pronation range of motion (ROM) were measured 1 year after surgery. A group of six patients [two women and four men, mean age 31.2 years (SD 5.0, range 19-52)] who underwent traditional palmar BR-to-FPL was included for comparison. Postoperative active pronation was significantly greater in the dorsal transfer group compared to the palmar group [149 (SD 6) and 75 (SD 3), respectively] and pinch strength was similar in the two groups [1.28 (SD 0.16) kg and 1.20 (SD0.21) kg, respectively]. We conclude that it is feasible to reconstruct lateral key pinch and forearm pronation simultaneously using only the BR motor.