Range Of Motion In Patients Research Articles

A single session of visual feedback improves range of motion in patients with chronic idiopathic neck pain: A randomized and controlled study.

Chronic pain is associated with cortical reorganization, and interventions targeting cortical remapping, such as visual feedback of the painful body segment, seem promising. The primary aim of the present study was to evaluate the impact of visual feedback of the neck, using mirrors on pain intensity. Secondary aims were to evaluate the impact of visual feedback on neck range of motion and unadjusted cognitive processes. Pain intensity, range of motion, fear of movement, catastrophizing and anxiety were assessed before and after 10 repetitions of each of the neck movements, with (experimental group; n=21) and without (control group; n=21) visual feedback of the neck. A significant increase in the range of motion of all neck movements (p<0.05) was found in the experimental group when compared with the control group. Increases in range of motion varied between 2.5° and 3.4°. No significant effects were found for the remaining variables (p>0.05). The study findings suggest that performing a series of 10 active movements of the neck while observing the reflection of the neck in a mirror might help to improve neck range of motion. Furthermore, our results support further studies investigating the effect of longer interventions using visual feedback of the neck, either alone or combined with other interventions.

肩関節機能障害者におけるApley Scratch Testと自動的可動域の関連

肩関節機能障害者におけるApley Scratch Testと自動的可動域の関連

Effects of Arthroscopic Coracohumeral Ligament Release on Range of Motion for Patients with Frozen Shoulder.

Background:A thickened coracohumeral ligament is a highly specific manifestation of, and primary restraint against external rotation in frozen shoulders.Objective:The purpose of this study was to evaluate the effects of complete arthroscopic coracohumeral ligament release on range of motion in frozen shoulder.Methods:Fifty-two consecutive shoulders in 52 patients were treated between April 2015 and June 2016. To evaluate solely glenohumeral range of motion, the scapula was fixed by an examiner with one hand (without palpating scapular motion), and range of motion was measured using a goniometer. For the first step, arthroscopic pancapsular release was performed in a beach-chair position with (Group 1) or without (Group 2) complete coracohumeral ligament release. For the final step, the remaining coracohumeral ligaments in Group 2 were released and the ranges of motion were compared to those in Group 1.Results:The average age of the patients was significantly higher in Group 1, but there were no significant differences between the two groups with respect to sex, affected side, preoperative range of motion, or American Shoulder and Elbow Society Score. Abduction, external rotation at adduction, and external and internal rotations at 90° of flexion in Group 1 were significantly greater than those in Group 2. After the additional release of the remaining coracohumeral ligaments in Group 2, all ranges of motion were significantly recovered and there was no significant difference between the groups.Conclusion:Complete coracohumeral ligament release is a recommended intraoperative procedure for regaining full range of motion in frozen shoulders.

Effect of pulsed electromagnetic field on nonspecific low back pain patients: a randomized controlled trial

BackgroundFurther research on pulsed electromagnetic field (PEMF) effects on the different conditions of low back pain was warranted due to lack of studies in this area. ObjectivesTo investigate the effects of pulsed electromagnetic field therapy with 50Hz frequency, with low intensity of 20Gauss compared to conventional non-invasive treatment modalities in patients with chronic non-specific low back pain. MethodsDesign – A prospective, randomized, patient-blinded, controlled trial. Setting – The study was conducted at Outpatient Physiotherapy Clinic in Cairo, Egypt. The study was conducted between May 2015 and September 2016. Participants – Fifty participants with non-specific low back pain enrolled into experimental and control groups. Interventions – The experimental group received the Conventional physical therapy Protocol as well as magnetic field, while the control group received the same Conventional physical therapy and sham electromagnetic field. Both groups received 12 sessions over 4 weeks’ period. Outcome measures – Primary outcome measures was pain intensity while the secondary outcome measures were disability and lumbar range of motion – ROM. There were no adverse events occurred during the study. ResultsFifty participants with non-specific low back pain (control group n=25; experimental group n=25) were randomized. There were significant between-group differences in pain scores (mean difference – MD 1.52; 95%CI −0.34 to 3.35), function disability (MD 8.14; 95%CI 6.5 to 9.96), Range of Motion (ROM) of lumbar flexion (MD −1.27; 95%CI −1.09 to −1.45), ROM of lumbar extension (MD −1.1; 95%CI −0.97 to −1.23), ROM of lumbar right side bending (MD 8.2; 95%CI 6.56 to 9.84) and ROM of lumbar left side bending (MD 10.4; 95%CI 8.81 to 11.99) in favour of the experimental group. ConclusionAdding pulsed electromagnetic field to Conventional physical therapy Protocol yields superior clinical improvement in pain, functional disability, and lumbar ROM in patients with non-specific low back pain than Conventional physical therapy alone.

Muscle endurance, strength, and active range of motion in patients with different subphenotypes in systemic sclerosis: a cross-sectional cohort study

Objective: Proximal muscle weakness is common in patients with systemic sclerosis (SSc). Dynamic muscle endurance, muscle strength in the lower extremities, and active range of motion (AROM) in the upper extremities are less studied. We investigated functional muscle endurance, strength, and AROM, and explored differences depending on skin and/or lung involvement in SSc patients.Method: The study divided 205 patients with limited/diffuse cutaneous systemic sclerosis (lcSSc/dcSSc) into no–mild and moderate–end-stage lung involvement, the latter based on the Medsger disease severity score. Dynamic muscle endurance in shoulder and hip flexion was assessed by the Functional Index-2, lower extremity muscle strength by the Timed-Stands Test (TST), and shoulder–arm AROM by the Functional Shoulder Assessment (FSA).Results: Shoulder and hip flexion muscle endurance were reduced in relation to reference values median (IQR) [53% (27–100%) and 40% (23–90%), respectively, p < 0.001]. Patients with moderate–end-stage lung involvement had less endurance in shoulder [39% (21–71%) and hip flexion 35% (20–70%)] than patients with no-mild lung involvement [57% (33–99%) and 48% (28–100%), p < 0.05]. All patients, regardless of subtype/grouping, needed longer to complete the TST [21 s (17–27 s)] compared to reference values [17 s (15–18 s), p < 0.001], and patients with moderate-end-stage lung involvement had worse TST score than patients with no-mild lung involvement, [25 s (18–30 s) vs 19 s (16–25 s), p < 0.001]. The FSA sum scores were lower compared with reference values (p < 0.01). DcSSc patients had a lower FSA-sum score [53 (48–57)] than lcSSc patients [57 (52–60), p < 0.01].Conclusion: SSc patients have markedly reduced muscle endurance in the upper and lower extremities, reduced muscle strength in the lower extremities, and impaired AROM in the shoulders and arms. Patients with moderate–end-stage lung involvement had more impaired muscle endurance and strength but no differences were found between lcSSc and dcSSc patients. Not only muscle strength, but also dynamic muscle endurance should be measured in SSc patients.

Low-level laser therapy and dry needling for myofascial pain syndrome of the upper trapezius muscle: An interventional study

Myofascial pain syndrome is a frequently encountered musculoskeletal problem characterized by a hypersensitive trigger point. It presents with pain, increased pain threshold, and limited range of motion (ROM). This study compared the effectiveness of low-level laser therapy and dry needling to treat patients with myofascial pain syndrome. Men and women from 20 to 55 years of age with myofascial pain syndrome of the upper trapezius muscle and meeting the study criteria were randomly assigned to 4 weeks of low-level laser therapy three times weekly and dry needling once weekly. Responses were measured with a visual analog scale (VAS), pain threshold meter, and ROM of the cervical spine. Thirty-one patients completed the study, 15 received laser therapy, and 16 received dry needling. The median pretreatment VAS score was 6 in both groups. After 4 weeks of therapy, the severity of pain decreased in both groups. The decrease in VAS score was greater with low-level laser therapy than with dry needling, but the difference was not significant. Post treatment differences in pain threshold and cervical ROM were also not significant. Low-level laser treatment and dry needling were equally effective in reducing pain and increasing the pain threshold and cervical ROM in patients with myofascial pain syndrome of the upper trapezius muscle. Changes in VAS scores, pain tolerance values, and ROM were larger with low-level laser therapy than with dry needling.

A new iPhone application for the measurement of active craniocervical range of motion in patients with nonspecific neck pain: A reliability and validity study

Measurement of cervical spine range of motion (ROM) is often considered to be an essential component of cervical spine physiotherapy assessment. This study aimed to investigate the reliability and validity of an iPhone application (app) (Goniometer Pro) for measuring active craniocervical ROM (ACCROM) in patients with nonspecific neck pain. A cross-sectional study was conducted at the musculoskeletal biomechanics laboratory located at Iran University of Medical Sciences. Forty nonspecific neck pain patients participated in this study. The outcome measure was the ACCROM, including flexion, extension, lateral flexion, and rotation. Following the recruitment process, ACCROM was measured using a universal goniometer (UG) and iPhone 7 app. Two blinded examiners each used the UG and iPhone to measure ACCROM in the following sequences: flexion, extension, lateral flexion, and rotation. The second (2 hours later) and third (48 hours later) sessions were carried out in the same manner as the first session. Intraclass correlation coefficient (ICC) models were used to determine the intra-rater and inter-rater reliability. The Pearson correlation coefficients were used to establish concurrent validity of the iPhone app. Minimum detectable change at the 95% confidence level (MDC95) was also computed. Good intra-rater and inter-rater reliability was demonstrated for the goniometer with ICC values of ≥ 0.66 and ≥ 0.70 and the iPhone app with ICC values of ≥ 0.62 and ≥ 0.65, respectively. The MDC95 ranged from 2.21° to 12.50° for the intra-rater analysis and from 3.40° to 12.61° for the inter-rater analysis. The concurrent validity between the two instruments was high, with r values of ≥ 0.63. The magnitude of the differences between the UG and iPhone app values (effect sizes) was small, with Cohen d values of ≤ 0.17. The iPhone app possesses good reliability and high validity. It seems that this app can be used for measuring ACCROM.

Quantitative Evaluation of Lower Extremity Joint Contractures in Spinal Muscular Atrophy: Implications for Motor Function.

To quantitatively describe passive lower extremity range of motion in participants with spinal muscular atrophy (SMA) types 2 and 3, and to establish preliminary thresholds to identify individuals at risk for performing poorly on disease-specific motor function outcome measures. Eighty participants with SMA types 2 and 3, enrolled in an international multicenter natural history study, were evaluated with lower extremity range of motion testing and the Hammersmith Functional Motor Scale-Expanded. A hip extension joint angle of -7.5° or less for SMA type 2 and 0° or less for SMA type 3 identified diminished motor ability with good sensitivity. For knee extension, a joint angle of -9.0° or less for SMA type 2 or 0° or less for SMA type 3 was similarly sensitive. Minimal hip and knee joint contractures were associated with diminished motor ability. Clinical trial designs should consider the effect of contractures on motor function.

Effectiveness of high strength suture fixation in treatment of patellar transverse fracture

To explore the effectiveness of high strength suture fixation in treatment of patellar transverse fracture. Between June 2014 and June 2016, 38 patients with the patellar transverse fracture were treated with high strength suture internal fixation. There were 24 males and 14 females with the age of 26 to 64 years (mean, 45 years). There were 6 cases of accident injury and 32 cases of crashing injury. The time interval between injury and surgery was 2-8 days (mean, 5 days). The preoperative visual analogue scale (VAS) score, Lysholm score, and range of motion (ROM) of patients were 84.3±8.4, 44.5±7.2, and (62±12)°, respectively. All patients' incisions healed by first intention after operation. There was no neurovascular injury, deep venous thrombosis of lower limbs, or local foreign matter irritation reaction. The X-ray films showed that the reduction of patella and the location of internal fixator were good at 2 days after operation. All the 38 patients were followed up 12-18 months (mean, 16 months). All fractures healed and the healing time was 2-4 months (mean, 3 months). At last follow-up, according to the Böstman criteria, 36 patients were rated as excellent and 2 as good, with an excellent and good rate of 100%. The VAS score, Lysholm score, and ROM of patients were 10.2±6.6, 93.1±6.4, and (124±14)°, respectively, showing significant differences when compared with preoperative ones ( t=42.759, P=0.000; t=31.099, P=0.000; t=20.727, P=0.000). Application of high strength suture fixation in the treatment of patellar transverse fracture has advantages of simple to operate, effective fixation, and less complication. It can avoid reoperation of removing the internal fixators. The satisfied ROM and function of the knee joint can be obtained after operation.

Immediate effects of thoracic spine self-mobilization in patients with mechanical neck pain: A randomized controlled trial

ObjectivesTo investigate the immediate effects of thoracic spine self-mobilization in patients with mechanical neck pain. Study designRandomized, controlled trial. BackgroundThoracic spine self-mobilization is performed after thoracic spine thrust manipulation to augment and maintain its effects. To the best of our knowledge, no study has investigated the effects of thoracic spine self-mobilization alone in individuals with mechanical neck pain. The purpose of this randomized, controlled trial was to evaluate the immediate effects of thoracic spine self-mobilization alone without any other intervention on disability, pain, and cervical range of motion in patients with mechanical neck pain. MethodsFifty-two patients (39 females and 13 males) with mechanical neck pain were randomly allocated to either a thoracic spine self-mobilization group that was performing a thoracic spine active flexion and extension activity using two tennis balls fixed by athletic tape or a placebo thoracic spine self-mobilization group. Outcome measures were collected at pre-intervention and immediately after intervention, including the Neck Disability Index, visual analogue scale, and active cervical range of motion (ROM). The immediate effect of the intervention was analyzed using two-way repeated measures analysis of variance (ANOVA). If interactions were found, a simple main effect test was performed to compare the pre-post intra-group results. ResultsThe results of two-way repeated measures ANOVA indicated that the main effect of time was significant (p < 0.05) for all measurement outcomes. The main effect of group was not significant for all measurement outcomes (p > 0.05). The group × time interactions for cervical flexion active ROM (p = 0.005) and cervical extension active ROM (p = 0.036) were significant. The tests of simple main effect in cervical flexion active ROM (p < 0.0001) and cervical extension active ROM (p < 0.0001) showed a significant difference before and after intervention in the thoracic spine self-mobilization group. ConclusionPatients with mechanical neck pain who carried out thoracic spine self-mobilization showed increases in active cervical flexion and extension ROM.

Effectiveness of mobilization with movement (Mulligan concept techniques) on low back pain: a systematic review

Objective: To evaluate evidence on the effectiveness of Mulligan techniques on low back pain. Data sources: PubMed/Medline, Scopus, Ovid, CINAHL, Embase, PEDro, Google Scholar, and Cochrane Library were searched from inception to 31 March 2018 for randomized clinical trials reporting outcomes of pain or disability in adult patients (⩾18 years) with low back pain. Review methods: Two authors screened the results and extracted data for use in this review. The risk of bias was evaluated using the Cochrane criteria. Basic information and treatment protocols were also extracted. In addition, the level of evidence of each study and strength of conclusion for pain and disability were determined. Results: A total of 20 studies with 693 patients were included. Nine trials focused on sustained natural apophyseal glide, three on spinal mobilization with limb movement and seven on bent leg raise. The results showed that Mulligan techniques can decrease pain and disability and increase range of motion in patients with low back pain; however, the strength of conclusion for pain and disability was moderate. Furthermore, inconclusive results were observed for the effectiveness of Mulligan techniques on movement speed. In this review, eight studies were categorized as low risk of bias, while 12 studies had high risk of bias. Level of evidence analysis revealed that 17 studies were classified as level of evidence B, while three studies were classified as level of evidence A2. Conclusion: Current evidence is insufficient in supporting the benefits of Mulligan techniques on pain, disability, and range of motion in low back pain patients.

Comparison of high, medium and low mobilization forces for increasing range of motion in patients with hip osteoarthritis: A randomized controlled trial

BackgroundManual therapy has been shown to increase range of motion (ROM) in hip osteoarthritis (OA). However, the optimal intensity of force during joint mobilization is not known. ObjectiveTo compare the effectiveness of high, medium and low mobilization forces for increasing range of motion (ROM) in patients with hip OA and to analyze the effect size of the mobilization. DesignRandomized controlled trial. MethodsSixty patients with unilateral hip OA were randomized to three groups: low, medium or high force mobilization group. Participants received three treatment sessions of long-axis distraction mobilization (LADM) in open packed position and distraction forces were measured at each treatment. Primary outcomes: passive hip ROM assessed before and after each session. Secondary outcomes: pain recorded with Western Ontario and McMaster Universities (WOMAC) pain subscale before and after the three treatment sessions. ResultsHip ROM increased significantly (p < 0.05) in the high-force mobilization group (flexion: 10.6°, extension: 8.0°, abduction:6.4°, adduction: 3.3°, external rotation: 5.6°, internal rotation: 7.6°). These improvements in hip ROM were statistically significant (p < 0.05) compared to the low-force group. There were no significant changes in the low-force and medium-force groups for hip ROM. No significant differences in hip pain were found between treatment groups. ConclusionA high force LADM in open packed position significantly increased hip ROM in all planes of motion compared to a medium or low force mobilization in patients with hip OA. A specific intensity of force mobilization appears to be necessary for increasing ROM in hip OA.

Long-term efficacy of cervical artificial disc replacement for cervical degenerative diseases

Objective: To evaluate the long-term efficacy of cervical artificial disc replacement for patients with cervical disc herniation and degenerative cervical canal stenosis. Methods: Total of sixty-eight patients underwent single-level Bryan artificial disc replacement in Beijing Jishuitan Hospital from December 2003 to December 2007 with a minimum 10-year follow-up were retrospectively analyzed. There were 43 males and 25 females with a mean age of (46±8) years. According to preoperative CT and MRI, the patients were divided into two groups: 27 patients in cervical disc herniation group and 41 patients in degenerative cervical canal stenosis group. The evaluation indexes before surgery and at last follow-up were compared between two groups. The clinical indexes included Japanese Orthopaedic Association (JOA) score, neck disability index (NDI) and Odom's grade; and the radiological indexes included the global and segmental range of motion (ROM), Cobb's angle at operated level. The continuous variable data were analyzed by independent sample t test. Results: In cervical disc herniation group, the improvement rate of JOA score was 83%±22%, NDI% decreased by 14%±9%, and Odom's grade was excellent in 17 patients, good in 10 patients. In degenerative cervical canal stenosis group, the improvement rate of JOA was 68%±34%, NDI% decreased by 11%±7%, and Odom's grade was excellent in 19 patients, good in 18 patients, fair in 4 patients. The segmental ROM was 10°±4° and 7°±6° in cervical disc herniation and degenerative cervical canal stenosis group at last follow-up (t=2.284, P=0.026). The global ROM was 50°±9° and 44°±14° in cervical disc herniation and degenerative cervical canal stenosis group at last follow-up (t=2.112, P=0.038). Conclusions: Cervical artificial disc replacement has a favorable long-term efficacy in treating cervical degenerative diseases. The postoperative global and segmental ROM in patients with cervical disc herniation are better than those in patients with degenerative cervical canal stenosis.

Spine and lower extremity kinematics during gait in patients with cervical spondylotic myelopathy

Background ContextCervical spondylotic myelopathy (CSM) typically manifests with a slow, progressive stepwise decline in neurologic function, including hand clumsiness and balance difficulties. Gait disturbances are frequently seen in patients with CSM, with more advanced cases exhibiting a stiff, spastic gait. PurposeTo evaluate the spatiotemporal parameters and spine and lower extremity kinematics during the gait cycle of adult patients with CSM before surgical intervention. Study DesignProspective cohort study. Patient SampleTwenty-eight subjects with symptomatic CSM who have been scheduled for surgery and 30 healthy controls (HC). Outcome MeasuresSpine and lower extremity kinematics and spatiotemporal parameters. MethodsClinical gait analysis was performed for patients with CSM and HC. The data were analyzed with a one-way analysis of variance. ResultsPatients with CSM have significantly more anterior pelvis tilt (CSM: 13.97°, HC: 5.56°), larger lumbar lordosis (CSM: 8.59°, HC: 2.7°), smaller cervical lordosis (CSM: 6.02°, HC: 11.35°), and less head flexion (CSM: 0.69°, HC: 8.66°) at the beginning of the gait cycle. There was a decrease in knee range of motion in patients with CSM compared with controls (CSM: 36.31°, HC: 50.17°). Furthermore, patients with CSM presented with slower walking speed (CSM: 0.81 m/s, HC: 1.05 m/s), decreased cadence (CSM: 95.57 step/m, HC: 107.64 step/m), increased double support time (CSM: 0.40 s, HC: 0.28 s) and stride time (CSM:1.28 s, HC: 1.13 s), shorter stride length (CSM: 1.04 m, HC: 1.18 m) and step length (CSM:0.51 m, HC: 0.58 m), and wider width (CSM: 0.14 m, HC:0.11 m). ConclusionsOur study shows that patients with CSM enter the gait cycle with a larger anterior pelvic tilt and lumbar lordosis as well as less cervical lordosis and head flexion. As a consequence of these abnormal spinal parameters at the onset of the gait cycle, lower extremity biomechanics are also altered. Our study is the first to demonstrate the relationship between aberrant spinal alignment and lower extremity function. Identification of this interrelationship as well as the specific gait and biomechanical disturbances seen in myelopathic patients can both inform our understanding of the disease and tailor rehabilitation protocols.

Delay of total hip arthroplasty to advanced stage worsens post-operative hip motion in patients with femoral head osteonecrosis.

Osteonecrosis of the femoral head (ONFH) is commonly detected in young patients and most surgeons tend to delay total hip arthroplasty (THA) until the end stage of the disease. We hypothesised that post-operative range of motion (ROM) of the hip as well as baseline ROM at the time of surgery decreases with the disease progression. The purpose of this study was to determine whether patients, who were operated at an advanced stage, have pre- and post-operative hip ROM similar to ROM of patients, who were operated at earlier stages. Eight hundred and fifty patients (850 hips) treated with THA for ONFH were classified according to pre-operative stages of Association Research Circulation Osseous (ARCO). Fifty-six patients were operated at stage 2, 458 at stage 3, and 336 at stage 4. Pre-operative and oneyear post-operative ROM was compared among the stages. Pre-operative sum of hip ROM decreased with the progression of ARCO stage (P < 0.001) and correlated with the post-operative sum of hip ROM (correlation coefficient 0.661). Although hip ROM improved after THA in all stages, post-operative ROM in patients with lower pre-operative ROM did not improve to the same level as in those with a higher pre-operative ROM (P < 0.001). The progression of ONFH negatively affected post-operative hip ROM as well as baseline hip ROM at the time of THA. Surgeons should consider a delay of THA negatively affects the hip ROM after the arthroplasty, when they determine the treatment modality for ONFH patients.

Correlation analysis between pre-anesthesia/post-anesthesia range of motion and knee flexion function after total knee arthroplasty

Objective To evaluate the relationship between pre-anesthesia/post-anesthesia range of motion (ROM) and knee flexion function after total knee arthroplasty (TKA). Methods 108 patients with osteoarthritis of knee joint replacement performed by the same surgeon of primary TKA screening from 2016 January to 2017 January in our hospital were enrolled in the study. Correlation analysis were conducted between pre-anesthesia/post-anesthesia ROM and knee flexion function of 1, 6, 12 months after total knee arthroplasty. Results The Correlation coefficient of the Pre-anesthesia ROM and postoperative ROM are 0.392, 0.665, 0.708 at 1, 6 and 12 months, while the Correlation coefficient of the Pre-anesthesia ROM and Post-anesthesia ROM of postoperative are 0.495, 0.759, 0.793 (P<0.001), indicating that the correlation difference between pre-anesthesia/post-anesthesia ROM and knee flexion function of 1, 6, 12 months after total knee arthroplasty is statistically significant (P<0.05). Conclusions Post-anesthesia range of motion is a better determinant of postoperative range of motion in patients. This should be taken into consideration by surgeons during preoperative planning and in managing patients'expectations. Key words: Knee joint/SU; Arthroplasty, replacement, knee; Range of motion, articular

Polydeoxyribonucleotide injection in the patients with partial-thickness tear of supraspinatus tendon: a prospective and pilot study using ultrasound

ABSTRACTObjective: Polydeoxyribonucleotide as adenosine receptor (A2A) agonist has been used in plastic surgery and dermatology related to its regenerative property. The aim of this pilot study is to evaluate the safety and efficacy of polydeoxynucleotide injection in patients with rotator cuff tears by a variety of outcomes including pain, disability, physical performance test, and ultrasonography (US).Methods: Seventeen patients (9 men, 8 women, age: 57.9 ± 9.1) with partial-thickness tear of supraspinatus tendon were evaluated in a prospective, open-label, and pre-and-post study. Seventeen patients underwent 3 times intra-lesional polydeoxynucleotide injection under ultrasound (US) guidance on weeks 0, 2 and 4. The safety and efficacy were assessed on weeks 0, 6 and 12. Main outcome measures included shoulder pain on Visual Analogue Scale (VAS) and DASH (disabilities of arm, hand, shoulder) score, range of motion in shoulder, shoulder strength and tear volume (cm3) by US. Adverse events were monitored. (CRIS: https://www.cris.nih.go.kr, KCT0000767).Results: Active shoulder pain on VAS reduced from 5.53 to 3.53 (P = 0.016), and acting pain, one of DASH questionnaires, reduced from 3.35 to 2.00 (P < 0.001). However, resting shoulder pain on VAS and total DASH scores were not significantly different. Forward flexion and internal rotation in range of motion improved significantly (from 169.41 to 178.13 degrees [P = 0.004] and from 83.53 to 88.75 degrees [P = 0.014], respectively). The volume of torn lesion decreased during the study period, however it was not significant. There were no significant adverse events leading to hospitalization.Conclusions: Minimally invasive procedure through polydeoxynucleotide injection into torn area of supraspinatus tendon on US could be candidate for the safe and effective treatment on shoulder pain and limited range of motion in patients with rotator cuff tear.

Effects of Different Stretching Times on Range of Motion in Patients with Hamstring Tightness: A Randomised Control Trial

Hamstring tightness is commonest cause of altered biomechanics of ankle, knee, hip and spine. Long persistent tightness results in pain, decreased range of motion and others pathologies in knee joint. Stretching techniques are used to treat muscle tightness. In clinical settings, different stretch holding timesare used to treat hamstring tightness. The purpose of the study was to determine effects of different static stretch holding-times on hamstring muscles flexibility and their impacts on improving range of motion (ROM) of knee extension in adults. This experimental work was conducted on students of University of Lahorefrom December 2013 to March 2014. The study comprised of 60 subjects with asymptomatic tightness of hamstrings muscles and subjects were aged between 18-26 years (irrespective of their gender). Range of motion at knee joint was measured by universal goniometer before the commencement of stretching technique. Static stretching was applied to group A, B and C with 30, 60 and 90 seconds holds, respectively. Stretches were exerted at frequency of three sessions per week and three repetitions per session. Reevaluation of ROM was performed after 4 and 6 weeks. The mean values of ROM of knee extension showed gainin range after applying static stretching at 30s, 60s and 90s holding times. By applying repeated measure analysis of variance (ANOVA), the p-values were found to be statistically significant (p&lt;0.001) for static stretching techniques with 30s, 60s, 90s holding times, respectively. Based on these finding, it is plausible toconclude that application of static stretching at holding times of 30, 60 and 90 seconds can significantly improve the ROM of knee extension. Stretching techniques with different holding times were equally effective in improving knee extension and gaining hamstring flexibility in adults.

Posterior-stabilized inserts are preferable to cruciate-substituting ultracongruent inserts due to more favourable kinematics and stability.

It is unknown whether the conforming superiority of ultracongruent (UC) inserts over posterior stabilized (PS) inserts, due to an increased anterior lip for prevention of anterior displacement of the condyles during knee flexion, leads to better knee scores or greater knee stability in arthroplasty patients. This meta-analysis compared clinical outcomes, intraoperative kinematics, sagittal stability, and range of motion (ROM) between groups with either UC or PS inserts in primary total knee arthroplasty (TKA). Studies that recorded clinical outcomes, intraoperative kinematics, sagittal stability, and ROM in patients who underwent primary TKA with UC or PS inserts were included in the meta-analysis. Subgroup analyses based on differences in flexion angles were performed for intraoperative kinematics. Thirteen studies met the criteria for inclusion in the meta-analysis. The UC and PS insert groups reported similar pain scores (95% CI - 0.15 to 0.16; n.s.) and function scores (95% CI - 0.30 to 0.14; n.s.). In contrast, femoral rotation during flexion (95% CI - 0.06 to 6.35; p = 0.05), posterior femoral translation during flexion (95% CI - 2.74 to - 0.15; p = 0.03), tibial sagittal laxity at 90° (95% CI 2.91 to 7.72; p < 0.0001), and ROM (95% CI - 4.84 to - 1.53; p = 0.0002) differed significantly between the groups. Subgroup analyses revealed that the pooled data for femoral rotation were significantly different between groups: 60°, 4.09 (p < 0.00001); 90°, 7.94 (p < 0.00001); and 120°, 8.16 (p < 0.00001). Furthermore, pooled data for posterior femoral translation were significantly different between groups: 90°, - 3.70 (p < 0.00001); and 120°, - 3.96 (p < 0.00001). There were no significant differences in clinical outcomes between the groups with UC and PS inserts. However, the UC insert group showed significantly greater external femoral rotation, less posterior femoral translation, greater tibial laxity in the sagittal plane, and less ROM than the PS insert group. Based on the results of the current meta-analysis, in substituting the PCL, PS inserts are preferable to UC inserts due to more favourable kinematics and stability, even though both inserts have equivalent clinical outcomes. Therapeutic study, Level II.

Manual therapy in the treatment of patients with hemophilia B and inhibitor

BackgroundThe main clinical manifestations of hemophilia are muscle and joint bleeding. Recurrent bleeding leads to a degenerative process known as hemophilic arthropathy. The development of inhibitors (antibodies against FVIII/FIX concentrates) is the main complication in the treatment of hemophilia. The objective was to assess the safety and efficacy of manual therapy treatment in a patient with hemophilia and inhibitor.Case presentationA 26-year-old patient with hemophilia B and inhibitor received physiotherapy treatment based on manual therapy for 3 months, with a frequency of 2 sessions per week. The joint status was evaluated using the Hemophilia Joint Health Score; pain was assessed with the Visual Analog Scale; and the range of movement was evaluated using a universal goniometer. The patient developed no joint bleeding in the knees or ankles as a result of the physiotherapy treatment. Following treatment, improvements were noted in the range of movement of knees and ankles, the perception of pain in both knees, and ankle functionality.ConclusionsUntil now, manual therapy using joint traction was contraindicated in patients with hemophilia and inhibitor, as it was feared to cause possible joint bleeding. This is the first case study to address the safety and efficacy of manual therapy in a patient with hemophilia and an inhibitor. The results of this study may help to establish which manual therapy treatments are indicated in patients with hemophilic arthropathy and inhibitors. Thus, a physiotherapy program based on manual therapy may be safe in patients with hemophilia and inhibitor and such therapy may improve joint condition, pain, and joint range of motion in patients with hemophilia and inhibitor. Randomized clinical trials are needed to confirm the results of this case study.