Range Of Motion Deficits Research Articles

Motor impairments and activity limitations in children with spastic cerebral palsy: A Dutch population-based study

To determine the prevalence of motor impairments and activity limitations and their inter-relationships in Dutch children with spastic cerebral palsy. In a population-based survey 119 children, age range 6-19 years, with spastic cerebral palsy were examined. Anthropometry, muscle tone, abnormal posture, joint range of motion, major orthopaedic impairments and gross motor functioning and manual ability were assessed or classified, in addition to limitations in mobility and self-care activities. Spearman's correlation coefficients, bivariate post hoc analyses and univariate and multivariate logistic regression analyses were used. Children with spastic cerebral palsy had a lower body height and weight compared with typically developing peers. Forty percent had no range of motion deficits. Hip dislocations were rarely encountered. Motor impairments were associated with gross motor functioning and manual ability levels. Close to sixty-five percent walked independently. Children with diplegia and tetraplegia differed in activity limitations. Motor impairments and limitations in mobility and self-care activities were only modestly related in multivariate analyses. Distribution of cerebral palsy-related characteristics is consistent with that found in representative studies of other countries. The distinction between diplegia and tetraplegia is relevant from an activity point of view. The child's activity limitations are not a mirror of the motor impairments, which suggests multifactorial influences. An activity-oriented rehabilitation approach goes beyond treating specific impairments.

Moje-Prothese im proximalen Interphalangealgelenk

The purpose of this study was to find out if the Moje implant made of ceramic material can fulfil the clinical expectations that are expected in a replacement of the proximal interphalangeal finger joint (PIP joint). The performance was compared to the results achieved with hands that did not undergo surgery. From January 2001 to March 2005 15 patients suffering from primary arthrosis received a total of 21 Moje implants as PIP joint replacements. Computer-assisted data were collected including postoperative range of movement (in both hands), strength, pain reduction, patient satisfaction and number of complications. The average range of motion in PIP joints replaced by the Moje implant was 18.5 degrees (minimum 7 degrees lack of extension to 69 degrees flexion) which correlates to 26% of the ROM of the other hand side). The proportion of pinch strength "thumb opposition to index finger" of the hand that underwent surgery compared to the other side was 56%. Power achieved with the Jamar dynamometer was 94.2% of that, of the non-operated hand. 80% of the patients stated an improvement of their pain situation (more than 2 points on a VAS of 1-5). Most patients were well satisfied with the outcome of the surgery. There was a need for 13 re-operations in 9 fingers. The main problems were loosening of the proximal implant, with subluxation and fractures of the cortical bone. The Moje ceramic implant does not fulfil the published ideal attributes for a PIP joint replacement as shown in the clinical results. Even a modification of the prosthesis design in 2004 has not diminished the deficits in range of motion and stability. The implant in its present design shows neither the required performance, nor the ideal attributes needed for an adequate PIP joint replacement.

Femoral Remodeling May Influence Patient Outcomes in Slipped Capital Femoral Epiphysis

Clinical studies of patients treated for slipped capital femoral epiphysis have found limited functional impairment and femoral neck deformity causing eventual coxarthrosis. Since patient-focused assessments minimize bias and reflect health-related quality of life status, we coupled their use to a clinical examination to obtain a more patient-centered picture of slipped capital femoral epiphyseal outcomes. The impact of residual deformity on outcomes also was examined. Of 78 patients treated for slipped capital femoral epiphyses between 1972 and 1998, 29 (38 hips) were evaluated at a mean followup of 7.6 years (range, 1.4-26 years). The average patient age was 21.8 years (range, 14.6-39 years), 55% were female, and the average body mass index was 28.7 (range, 16.1-50.2). Most slips were stable (92%, 35 of 38) and mild or moderate in severity (98%, 36 of 37). Followup examinations revealed slight deficits in range of motion, strength, and limb length. Radiographs showed slight improvements in head-shaft angle and reduced but persistent femoral neck deformity. Osteoarthritic changes were absent or negligible in 84% (32 of 38) of the hips. The average Iowa hip score was 90.5 (range, 51-100). Patient outcome scores for the AAOS Hip/Knee Questionnaire fell slightly below 50th percentile norms. Neither slip stability, severity, nor body mass index impacted outcome. Femoral neck deformity correlated with function, pain, and Boyer grade. Overall, patients had minor functional deficits and pain that may have been related to femoral neck deformity, but longer followup is warranted.

Stiffness and Rotator Cuff Tears: Incidence, Arthroscopic Findings, and Treatment Results

Although stiffness of the shoulder has been evaluated after rotator cuff repair, it has not been studied in patients with cuff tears that occurred before repair. The primary purpose of this study was to determine whether preoperative stiffness persists after cuff repair. We also evaluated the incidence and possible causes of stiffness in patients who underwent arthroscopic rotator cuff repair. This was a retrospective evaluation of 72 arthroscopic patients who underwent rotator cuff repair. Preoperative range-of-motion (ROM) deficits in abduction, forward flexion, external rotation, and internal rotation were recorded and were added together to determine the total ROM deficit (TROMD). Patients were then divided into 3 groups on the basis of TROMD. Group 1 comprised 42 patients with 0 degrees to 20 degrees TROMD. Group 2 consisted of 24 patients with 25 degrees to 70 degrees TROMD, and group 3 included 6 patients with a TROMD greater than 70 degrees. Preoperative medical history, intraoperative condition of the capsule and bursa, and cuff tear size were recorded. Capsular and bursal abnormalities were more common in stiffer patients, but arthroscopic evidence of adhesive capsulitis was found only in group 3 (3 of 6 patients). Postoperatively, average TROMD deficit decreased from 10 degrees to 4 degrees in group 1, from 36 degrees to 12 degrees in group 2, and from 89 degrees to 31 degrees in group 3. No reoperations or postoperative manipulations were reported in group 1 or 2. In group 3, 3 patients (the only 3 with adhesive capsulitis) showed no or minimal improvement in postoperative ROM. These 3 patients required a secondary arthroscopic capsular release. After all 3 repairs had completely healed, the TROMD averaged 35 degrees in this subgroup. Preoperative stiffness is common in patients who undergo rotator cuff repair. Mild and moderate stiffness generally resolve after surgery followed by routine therapy. Patients with a TROMD of 70 degrees or more may have adhesive capsulitis as well as a cuff tear and may not do well with cuff repair alone. Level IV, case series.

Descriptive Report of Shoulder Range of Motion and Rotational Strength 6 and 12 Weeks Following Rotator Cuff Repair Using a Mini-Open Deltoid Splitting Technique

Retrospective chart review. To measure short-term postsurgery glenohumeral internal rotation and external rotation strength, shoulder range of motion (ROM), and subjective self-report ratings following mini-open rotator cuff repair of full-thickness rotator cuff tears. Physical therapists provide rehabilitation for patients following mini-open rotator cuff repair. Long-term outcome studies have reported a high percentage of good and excellent results following surgery; however, little has been published regarding the immediate short-term results of this procedure, during which the patient is under the direct care of the physical therapist. Charts from 11 female and 26 male patients, with a mean +/- SD age of 57.3 +/- 9.9 years, were reviewed following rotator cuff repair, using an arthroscopically assisted mini-open deltoid-splitting approach. All patients underwent postsurgery rehabilitation by the same therapist using a standard protocol. Retrospective chart review was used to obtain descriptive profiles of shoulder joint ROM at 6 and 12 weeks postsurgery and isokinetically assessed shoulder strength at 12 weeks postsurgery. For the postsurgical shoulder, ROM deficits ranging between 5 degrees to 7 degrees were measured for shoulder abduction and external rotation and internal rotation at 90 degrees of abduction. The postsurgical extremity had greater flexion ROM (9 degrees ) compared to the contralateral side. Isokinetic external rotation strength deficits of 5% to 7% were present at 12 weeks postsurgery, with 2% to 11% greater internal rotation shoulder strength on the operative extremity, when compared to the other side. Patients completed the self-report section of the modified American Shoulder Elbow Surgeons (ASES) Rating Scale at 12 weeks postsurgery and scored a mean of 38.7/45.0 points. The application of early ROM and progressive strengthening following mini-open rotator cuff repair allows for the successful return of ROM and strength 12 weeks postsurgery. The results of this study provide objective data for both shoulder ROM and strength at time points during which patients are traditionally receiving physical therapy following surgery.

Deficits in Upper-Limb Task Performance in Children With Hemiplegic Cerebral Palsy as Defined by 3-Dimensional Kinematics

Mackey AH, Walt SE, Stott NS. Deficits in upper-limb task performance in children with hemiplegic cerebral palsy as defined by 3-dimensional kinematics. Objective To define upper-limb movement deficits in children with hemiplegia using 3-dimensional (3-D) kinematic analysis of functional tasks. Design Cohort study. Setting University gait laboratory. Participants Ten children with hemiplegic cerebral palsy (mean age, 13.3y; range, 10–17y) and 10 control children (mean age, 9.8y; range, 6–12y). Interventions Not applicable. Main Outcome Measure 3-D upper-limb movement analysis. Results 3-D kinematics detected clinically significant between-group differences. Children with hemiplegia were significantly slower than control children in time taken to complete tasks ( P<.05) and achieved slower movement velocities ( P<.05). Group differences in range of motion (ROM) occurred in all 3 tasks examined (hand to mouth, hand to head, reach). Children with hemiplegia had significantly less supination ( P<.03) and shoulder flexion ( P<.03) and increased compensatory trunk flexion ( P<.01) compared with control data (hand-to-mouth task). The reach task highlighted restriction of elbow extension in children with hemiplegia (minimum elbow extension: hemiplegia, 24±18°; control, 3±7°). Completing tasks bilaterally did not alter performance of the tasks in children with hemiplegia. Conclusions 3-D kinematics detected deficits in timing, ROM, and proximal compensatory strategies during upper-limb functional task performance in children with hemiplegia.

The Effect of Rotator Cuff Tear Size on Shoulder Strength and Range of Motion

Prospective cohort study. To determine the effect of rotator cuff tear size on shoulder strength and range of motion. Patients with rotator cuff pathology typically present with weakness and motion loss in various motions. The extent to which the presence of a rotator cuff tear and the size of the tear affect strength and range of motion is not well understood. Sixty-one patients scheduled for surgery, with a diagnosis of a rotator cuff tear and/or subacromial impingement, underwent examination for shoulder pain, function, range of motion, and strength. The extent of rotator cuff pathology was documented during subsequent surgery (presence of tear, tear size, tear thickness). There were 10 massive tears, 15 large tears, 13 medium tears, 12 small tears, and 11 rotator cuffs without a tear. Patients had marked weakness in abduction strength at 90 degrees and 10 degrees of abduction, in external rotation strength at 90 degrees, and in the "full can test" (all, P<.0001). Marked range of motion losses in shoulder flexion and external rotation at 0 degrees and 90 degrees abduction (all, P<.001) were also observed. Abduction strength deficit at 10 degrees was affected by rotator cuff tear size (P<.0001). Twenty of 25 patients with large or massive tears had deficits greater than 50%, compared with only 1 of 11 patients with no tear, 2 of 12 patients with a small tear, and 5 of 13 patients with a medium tear (P<.0001). Other strength and range of motion deficits or indices of pain and function were unaffected by tear size. Weakness of greater than 50% relative to the contralateral side in shoulder abduction at 10 degrees of abduction was indicative of a large or massive rotator cuff tear.

Evaluation and treatment of stiffness in patients with rotator cuff tears (SS-02)

The independent problems of shoulder stiffness and rotator cuff tearing have been extensively studied. In this study, a subgroup of patients who have both problems simultaneously is evaluated. This was a prospective evaluation of 72 consecutive arthroscopic rotator cuff repair patients. Preoperative range of motion (ROM) deficits in abduction, forward flexion, external rotation (ER) and internal rotation (IR) were recorded. These measurements were then added together to calculate the total ROM deficit (TROMD). The patients were then divided into three groups depending on their TROMD. In group 1 there were 42 patients with a 0° to 20° TROMD. In group 2 there were 24 patients with a 25° to 70° TROMD. In group 3 there were 6 patients with greater than a 75° TROMD. Patients in group 3 initially had standard frozen shoulder treatment consisting of intra-articular cortisone injections and physical therapy. The relative sizes of the RCT in each group were compared using a “cuff tear index” (CTI) which is the A/P dimension times the M/L dimension of the tear. The CTI in group 1 was 3.7, in group 2 it was 7.7 and in group 3 it was 12. In group 1, 33% of the patients had hypertension or heart disease, 42% in group 2 and 50% in group 3. In group 1, 5% of the patients had diabetes, 8% in group 2 and 50% in group 3. Preoperative Modified UCLA scores were the highest in group 1 (total score 25) and lowest in group 3 (total score 17). Bursal inflammation was seen in 76% of group 1 patients, 83% of group 2 patients and 100% of group 3 patients. Capsular abnormalities were common in all of the groups but a thick and contracted capsule was found only in group 3 patients (3 out of 6 patients). Acromioplasty and an arthroscopic RCR was performed in all cases. There were no manipulations under anesthesia, nor any capsular releases except to improve cuff mobility. One year postoperatively, TROMD in group 1 was reduced to an average of 4°, in group 2 to 12°, and in group 3 to 31°. However, three patients in this group required a second arthroscopy with a capsular release in order to achieve their final level of improvement. The release was performed at an average of 5 months postoperative after poor return of ROM. All had intact repairs and did well after capsular release. All 3 patients had thick, contracted capsules at the time of the initial RCR and at the time of capsular release. Based on this study, patients with TROMD up to 75° will do well with rotator cuff repair and postoperative rehabilitation. Even patients with greater than 75° TROMD will do well if they do not have true capsulitis. Stiff RCT patients who have capsulitis will not do well. We are currently performing a simultaneous RCR and complete capsular release on these patients with very good early clinical results.

Komplikationen und Probleme der VKB-Ersatzplastikoperation mit Patellarsehnendrittel in arthroskopischer Press-Fit-Technik - Analyse von 1043 Fällen

Material: Von 1/1998 bis 5/2000 wurden 1043 (100 %) Ersatzplastikoperationen prospektiv mit der Fragestellung nach Komplikationen bzw. Problemen erfasst. Das Durchschnittsalter betrug 32 Jahre (von 14 bis 62 Jahre), 371 waren weiblich, 672 männlich.

Outcomes following quadriceps tendon ruptures

Complete rupture of the quadriceps femoris tendon is a well-described injury. There is a scarcity of literature relating to the outcome of patients with this injury after surgery. We undertook a retrospective analysis of patients who had surgical repair of their ruptured quadriceps tendon at our institution over a seven year period-totalling 27 patients. Males were more commonly affected with a M:F ratio of 8:1. The peak incidence was in the sixth decade of life. The non-dominant limb was twice as likely to be affected. Assessment consisted of completion of a functional knee questionnaire, clinical examination and isokinetic testing on a Biodex dynanometer. Symptomatic outcome following surgical repair was excellent with a mean symptom score generated of 22.7 out of a maximum of 25. 18/19 patients returned to their premorbid level of activity on average 18.1 weeks following injury. There was no difference in quadriceps girth comparing affected and unaffected limbs. Less than 5° deficit in range of motion existed between affected and unaffected limbs. Approximately two-thirds of patients were the same or better when comparing peak torque/body weight, average power, maximum average peak torque and total work/body weight in affected and unaffected limbs.

Impairment Tutorial: The Combined Values Chart

Abstract Impairment values are more often combined than added, and the Combined Values Chart in the AMA Guides to the Evaluation of Permanent Impairment can be used to calculate the combined value of two numbers. The values are derived from the formula A + B(1 – A) = the combined value of A and B, where A and B are the decimal equivalents of the impairment ratings. This mathematically prevents an estimate of impairment greater than 100%. With smaller numbers, the combined value may equal the arithmetic sum of the 2 numbers. Impairments of different organ systems are converted to whole person impairment ratings before combining. In most lower extremity impairment cases only one evaluation method is used, but certain circumstances justify combining impairments. Examples in the lower extremity include diagnosis-based estimates with short leg, degenerative joint disease (in the case of fractures in and about joints), and neurologic loss. Combining vs adding can be confusing, but one can nearly always combine, with the following exceptions for the musculoskeletal system: range of motion (ROM) deficits within an upper extremity; ROM deficits of the thumb; total hand impairment; rating hip or knee replacement results; and ROM deficits of the spine at a specific level.

Residual impairment after lower extremity fracture.

In a prospective follow-up study of 158 consecutive patients 18 to 64 years old with unilateral lower extremity fracture, our aim was to disclose the impairment and disability 6 months after the injury. The patients were interviewed within 1 week after the trauma, and all patients returned to the hospital for an interview and a clinical assessment 6 months later. The disability was measured by administering the Sickness Impact Profile (SIP) to all patients by an interview process. SIP scores were calculated for pretraumatic and posttraumatic states. The pretraumatic SIP scores described the functional status before the injury. Additionally, three major aspects of impairments were measured 6 months after the fractures: range of motion, muscle strength, and pain. Most patients had a significantly higher SIP score 6 months after the fracture(s) than pretraumatically. The mean overall SIP score was 2.7 pretraumatically and 8.7 6 months posttraumatically. Major deficits in range of motion was observed, especially in the ankle joint. Additionally, loss of muscle strength was observed in the thigh and calf muscles in one fourth of the patients. Only low levels of residual pain were reported after 6 months.

Reliability and responsiveness of disablement measures following acute ankle sprains among athletes.

The minimum amount of change which represents clinical improvement following ankle sprains is unknown. This study considers the usefulness of physiological and behavioral measures commonly employed for this purpose in sports rehabilitation settings. Thirteen collegiate athletes of both genders were measured at approximately 3 and 10 days post-grade I or II ankle sprain. Volumetric displacement and sagittal plane ankle range of motion measures were used as impairment indicators. Motor ability scores (activity count) and a perceived athletic ability measure (visual analog scale) were used to indicate functional limitations. Volumetric displacement and both functional limitation measures demonstrated responsiveness to change between two occasions of measurement separated by 1 week. Observed changes in range of motion deficits could not be distinguished from measurement error. The results of this study suggest that behavioral measures of motor activity and perceived athletic ability may be at least as useful as physical measures of organic dysfunction for assessing clinical improvement following acute ankle sprains among athletes.

The use of Manipulation in Sports Medicine Practice

The most common injuries to athletes cause acute or chronic alterations of the musculoskeletal system. These changes often are accompanied by pain, deficits in range of motion, and impaired athletic performance. The use of appropriate manipulation techniques after specific musculoskeletal diagnosis may decrease pain and improve the athlete’s functional deficits, speeding return to play.

Shoulder range of motion in elite tennis players. Effect of age and years of tournament play.

We studied glenohumeral rotational range of motion in 39 members of the United States Tennis Association National Tennis Team and touring professional program. We took goniometric measurements of internal and external rotation of dominant and nondominant shoulders at the glenohumeral joint with the humerus at 90 degrees of abduction. We categorized the tennis players by age and by years of tournament play. Results were analyzed by total rotation, internal rotation, external rotation, and dominant-to-nondominant shoulder differences. In our results, dominant internal rotation of the shoulder declined and the difference between dominant and nondominant internal rotation increased with both age and years of tournament play. Men and women tennis players showed the same degree of deficits in range of motion. Significant analysis of variance statistics were calculated for dominant internal rotation with years of total play, dominant total rotation with years of total play, and nondominant total rotation with age. Moderate negative correlations were found between dominant internal rotation and years of total play and dominant total rotation and years of total play. These results indicate a loss of internal rotation that seems progressive with longer periods of play. This loss of internal rotation of the shoulder is an absolute loss of motion because total rotation also decreases. Early detection and a corrective training program should be considered because adaptations may result in deleterious biomechanics affecting both performance and risk of injury.

Shoulder function in patients with unoperated anterior shoulder instability

A functional analysis, including Rowe score and measurements of isokinetic peak torque and range of motion of the shoulder, and a subjective assessment were performed in 26 consecutive patients (23 males and 3 females) with unoperated anterior shoulder instability. Patients experienced the initial dislocation at an average age of 23 +/- 8 years and 58% occurred during sports activity. No patient had gone through any controlled rehabilitation program. In this study, an average of 7 years (range, 1 to 28) had passed since the initial dislocation. Fifty-nine percent of the patients complained of markedly reduced ability to perform in sports because of instability, impaired strength, decreased range of motion, and pain induced by activity. The majority (65%) of the patients reported instability only during physical activity. The average Rowe score was 68 +/- 14 on a scale of 100. In comparison with the healthy side, the injured shoulder had a significantly lower isokinetic peak torque during abduction and internal rotation, as well as a reduced range of motion in extension, abduction, and external rotation, but not in flexion. The severity of impairment (Rowe score, deficit in range of motion, and peak torque) was not related to the number of dislocations sustained or to the duration of instability.

Relationship between active range of motion deficits and muscle strength and tone at the elbow in patients with hemiparesis

The purpose of this study was to describe the relationship between deficits in active range of motion (ROM) at the elbow and both agonist muscle strength and antagonist muscle tone in patients with stroke. Twenty-three patients with non-flaccid hemiparesis participated. Active elbow flexion and extension ROM were measured gravity eliminated bilaterally and ROM deficits were calculated for the paretic side. Isometric elbow flexion and extension strength were measured on the paretic side using a hand-held dynamometer. Elbow flexor and extensor muscle tone were graded manually using the Modified Ashworth Scale. The Spearman correlations between active elbow flexion ROM deficits and elbow flexion force, and between active elbow extension ROM deficits and elbow extension force were -.929 and -.772 respectively. The correlations between the elbow flexion ROM deficits and elbow extensor muscle tone, and between the elbow extension ROM deficits and elbow flexor muscle tone were .287 and .480 respectively. Regression analysis revealed a curvilinear relationship between active elbow flexion ROM deficits and elbow flexion force (R =.881), and a linear relationship between active elbow extension ROM deficits and elbow extension force (R = .771). In patients like those tested, agonist muscle force (strength) may be more important than passive antagonist restraint (tone) as a determinant of ROM deficits. Because a limited amount of muscle force is required for full active ROM, increases in muscle strength beyond some threshold will not be accompanied by further improvements in active ROM.

Functional biomechanical deficits in running athletes with plantar fasciitis

Plantar fasciitis is a relatively common injury that occurs in running athletes. The disease entity is a good example of an overloaded process of the plantar fascia at its calcaneal insertion. This study was designed to examine the strength and flexibility findings in the muscles that are put on tensile load during running, and which are responsible for controlling the forces on the foot during stance and pushoff, thus modifying the overload. Three groups of athletes underwent physical examination, including checking ankle range of motion in plantar flexion and dorsiflexion. Cybex peak torque measurements were taken at 60 and 180 deg/sec. The groups were a control group of 45 athletes with no symptoms, a group that included 43 affected feet with symptomatic plantar fasciitis, and a group that included the 43 unaffected contralateral feet. Analysis of data showed dynamic range of motion deficits in 38 of 43 affected feet, static range of motion deficits in 37 of 43 affected feet, deficits in peak torque at 60 deg/sec in 41 of 43 affected feet, and deficits in peak torque at 180 deg/sec in 37 of 43 affected feet. Statistical comparison of range of motion showed that the group with symptomatic plantar fasciitis was significantly restricted compared to both control and unaffected contralateral feet groups. Statistical comparison of peak torque showed that the symptomatic plantar fasciitis group was significantly lower than both other groups at both velocities. This study documents strength and flexibility deficits in the supporting musculature of the posterior calf and foot that are affected by plantar fasciitis.(ABSTRACT TRUNCATED AT 250 WORDS)