Improvement In Range Of Motion Research Articles

Evaluation of the efficacy of a novel lumbar exoskeleton with multiple interventions for patients with lumbar disc herniation: a multicenter randomized controlled trial of non-inferiority

BackgroundLumbar disc herniation (LDH) occurs when the nucleus pulposus or annulus fibrosus protrudes into the intervertebral space, potentially compressing nerve roots and causing symptoms such as sciatica, restricted mobility, and lower extremity weakness. The development of portable lumbar exoskeleton devices offers a new approach, combining traction, range of motion (ROM) exercises, and resistance training in a single system, potentially reducing treatment complexity and enhancing LDH patient outcomes.ObjectiveThis study aims to evaluate the efficacy and safety of a novel lumbar exoskeleton device compared to traditional traction methods combined with rehabilitation therapy for patients with LDH.MethodsA multicenter, non-inferiority randomized controlled trial was conducted with 118 participants diagnosed with LDH. Participants were randomly assigned to the Exoskeleton Group or the Traction Group. The Exoskeleton Group used the novel device for traction, ROM, and resistance training, while the Traction Group underwent traditional traction and rehabilitation therapy. Outcomes included efficacy rate after 10 treatments, Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), and lumbar ROM—were assessed at 3, 6, and 10 treatments.ResultsA total of 118 eligible participants were recruited. After 10 treatments, both groups showed significant improvements in VAS scores, ODI, and lumbar ROM compared to baseline (P < 0.001). However, there was no significant difference in the overall efficacy rate between the two groups (P = 0.748).ConclusionThe novel lumbar exoskeleton device demonstrates comparable efficacy and safety to traditional traction therapy combined with rehabilitation, offering a promising alternative for the conservative treatment of LDH.

Three-Plane Calcaneal Osteotomy With Joint Preservation vs Subtalar Arthrodesis to Treat Painful Calcaneal Fracture Malunions.

Calcaneal fracture malunion (CFM) commonly occurs with multiple pathologic changes and progressive pain and difficulty walking. The purpose of this study was to propose a modified 3-plane joint-preserving osteotomy for the treatment of CFM with subtalar joint incongruence, and to compare its efficacy to subtalar arthrodesis. A retrospective comparative analysis of the data of 56 patients with CFM admitted from January 2017 to December 2022 was performed. Twenty-six patients were in the osteotomy group and 30 in the arthrodesis group. Computed tomographic (CT) scans were used for measurement of the intraarticular steps. Radiologic parameters, visual analog scale (VAS) score for pain, 12-Item Short Form Health Survey (SF-12) mental component summary (MCS) and physical component summary (PCS) scores were compared between the 2 groups of patients to assess the outcome preoperatively and at last follow-up, which averaged 22.6 ± 3.6 months and 27.6 ± 3.6 months for the osteotomy and arthrodesis groups, respectively. Improvements in pain, function, and overall quality of life were obtained in both groups compared with the preoperative values at last follow-up. The VAS and SF-12 scores were similar between the groups at the last follow-up. In the osteotomy group, the average CT scan-measured intraarticular step-offs were significantly reduced from 3.7 ± 1.2 mm to 0.9 ± 0.3 mm. The osteotomy group showed improvement in pronation and supination range of motion (ROM) of the feet (P < .01). The correction of the ankle height and Meary angle were slightly better in the osteotomy group. In this short-term follow-up study, good results were achieved in both joint-preserving osteotomy and subtalar arthrodesis groups for the treatment of CFM with subtalar joint incongruence. The osteotomy group preserved the subtalar joint and achieved improvements in pronation and supination ROM.

The effects of TECAR therapy on pain, range of motion, strength and subscale of HAGOS questionnaire in athletes with chronic adductor related groin pain: a randomized controlled trial

IntroductionGroin pain is a common issue among athletes. Adductor-related pain is known as the most common cause of groin pain. Although, non-operative treatments have limited efficacy, Capacitive and Resistive Energy Transfer (TECAR), can be used in the treatment of musculoskeletal conditions. The objective of the present study is to explore the effect of TECAR therapy on pain, range of motion (ROM), strength, and subscales of the "Copenhagen Thigh and Groin Assessment Scale"(HAGOS) questionnaire in athletes suffering from adductor-related groin pain (ARGP).MethodsThis study was a two arm parallel groups randomized sham-controlled superiority trial. A total of 22 male professional athletes (mean age 21.36 years) were randomly assigned to either the real TECAR therapy (n = 11) or sham TECAR therapy (n = 11) group, using block-balanced randomization. Both groups received stretching exercises. Intervention group received 10 sessions of TECAR therapy while, the control group received sham TECAR therapy. Primary outcome was pain that was measured by Visual Analogue Scale (VAS). Secondary outcomes included ROM, strength, and HAGOS questionnaire subscales. All outcomes were assessed at baseline, after 5 sessions, after 10 sessions, and one month after treatment. Analysis of Variance (ANOVA) and Analysis of Covariance were used to compare between-group mean differences. P-value was set at 0.05. Effect size Cohen’s d was also reported. This study took place from September 2022 to August 2023 at the Rehabilitation Clinic at Iran University of Medical Sciences.ResultsA total of 22 male athletes were included (11 in each group), with a mean age of 21.09 years in the TECAR group and 21.63 years in the sham group. TECAR therapy was associated with significant reductions in pain intensity across all evaluation sessions. Specifically, after 5 sessions, there was a large effect size for pain reduction (p = 0.01, Cohen’s d = -1.09 [95% CI: -0.195 to -1.987]); after 10 sessions, the effect was even larger (p = 0.001, Cohen’s d = -2.153 [95% CI: -1.103 to -3.203]); and at the 1-month follow-up, the pain reduction persisted (p = 0.001, Cohen’s d = -1.96 [95% CI: -0.944 to -2.978]). In terms of secondary outcomes, there was a significant improvement in hip adduction ROM at the 1-month follow-up (p = 0.03, Cohen’s d = 0.908 [95% CI: 0.03 to 1.78]). However, no statistically significant differences were found for other secondary outcomes, with effect sizes ranging from no effect to intermediate.ConclusionThe results of this study suggest that TECAR therapy may reduce pain and improve hip adduction range of motion in athletes with adductor-related groin pain.Trial registrationThis trial was registered at the (https://www.irct.ir), (IRCT20220622055250N1) on 18/09/2022.

Treatment of irreducible second metatarsophalangeal joint dislocation by double percutaneous osteotomy: Haspell and distal metatarsal mini-invasive osteotomy.

Subluxation or dislocation of the second metatarsophalangeal joint may be commonly associated with crossover toe, metatarsalgia, and painful calluses. This retrospective study aims to evaluate the clinical and functional results in patients with irreducible second metatarsophalangeal joint dislocation treated by double percutaneous osteotomy in one step: Haspell's osteotomy and Distal Metatarsal Mini-Invasive Osteotomy. A total of 39 patients were included in this study. 31 patients had a simultaneous procedure on the first ray for hallux valgus correction. The American Orthopaedic Foot and Ankle Society score (AOFAS), the degree of joint range of motion (ROM) and hyperkeratosis of the second ray were assessed as outcomes at the baseline (T0), at 6 months (T1), and at 1 year (T2) from surgery. The mean pre-operative AOFAS score was 62.76 ± 5.5, at 6 months after surgery it increased to a value of 78.81 ± 8.15 and at one year to a value of 88.78± 6.51. No differences in term of ROM were found between pre and postoperative values at 6 months. A significant improvement in ROM at 12 months was found. Hyperkeratosis, assessed with a nominal scale classification, decreased statistically significantly and, one year after surgery, in 88.88 % of cases they completely resolved. The double percutaneous osteotomy brings advantages in terms of pain reduction. In conclusion, DMMO associated with Haspell's osteotomy is a safe and effective and reproducible technique in the resolution of metatarsalgia in patient with irreducible instability of the second metatarsophalangeal joint. LEVEL OF CLINICAL EVIDENCE: 4.

Evaluating Outcomes of Step-Cut Osteotomy for Pediatric Cubitus Deformities.

Supracondylar fractures in children often result in malunion and subsequent cubitus varus or valgus deformity. While often considered cosmetic, these deformities can lead to pain, functional impairment, and other complications. Corrective osteotomy is a common treatment option, with step-cut osteotomy being a preferred method due to its effectiveness and relative simplicity. This study aims to evaluate the outcomes of step-cut osteotomy in correcting post-traumatic cubitus deformities. A prospective cohort study was conducted on patients presenting with post-traumatic cubitus varus or valgus deformity. Pre-operative evaluation included clinical and radiological assessment of the deformity. Step-cut osteotomy was performed, followed by rigid fixation with a recon plate. Post-operative outcomes were assessed in terms of deformity correction, range of motion (ROM), and complications. The study included 10 patients (8 male, 2 female) with a mean age of 9.6 years. The mean pre-operative carrying angle was 25.25° varus, corrected to 3.37° valgus postoperatively. Significant improvement in ROM and humerus-elbow-wrist angle was observed. While the lateral prominence index decreased, it was not statistically significant. Excellent or good results were achieved in 80% of patients. One patient experienced transient radial nerve palsy. Step-cut osteotomy effectively corrected cubitus deformities with minimal complications. While it primarily addresses coronal plane deformity, satisfactory outcomes were achieved without correction of rotational deformity. Rigid fixation with a recon plate provided stability and allowed for early mobilization. The study's limitations include a small sample size and the inability to conduct adequate follow-up due to the COVID-19 pandemic. Step-cut osteotomy is a reliable and effective treatment option for post-traumatic cubitus varus and valgus deformities in children. It demonstrates good to excellent outcomes in terms of deformity correction, ROM, and functional improvement, with a low complication rate. Further studies with larger sample sizes and longer follow-up periods are warranted to strengthen these findings.

Effectiveness of dynamic cupping therapy versus IASTM with eccentric training for shin splint syndrome among football players

Background. Shin splints result from repetitive stress on the shin bone, causing strain in the muscles and connective tissues of the lower leg. Among athletes, females (55.3%) experience shin splints more frequently than males (44.7%). Dynamic cupping combines negative pressure, massage movements, and joint motions, while instrument-assisted soft tissue mobilization (IASTM) involves repeated strokes to stimulate muscles, tendons, and fascia. Eccentric exercises enhance muscle activation through lengthening. Purpose. This study aimed to compare the effectiveness of dynamic cupping therapy with eccentric exercise and IASTM with eccentric exercise in managing shin splints among football players. Method. Forty football players were divided into two groups: Group A (dynamic cupping + eccentric exercise) and Group B (IASTM + eccentric exercise). Pain (VAS), medial tibial stress syndrome (MTSS) questionnaire, and range of motion (ROM) were assessed weekly to evaluate outcomes. Results. Dynamic cupping therapy with eccentric training showed significant improvements in pain reduction and ROM compared to IASTM with eccentric training. Conclusion. Dynamic cupping therapy combined with eccentric exercise was more effective than IASTM with eccentric exercise in treating shin splints in football players.

Randomized controlled trial of analgesic effect and movement improvement between Meridian Balancing Acupuncture Method and standard Local Acupuncture in the treatment of Cervical Type Cervical Spondylosis

Objective: To compare the therapeutic efficacy of analgesic effects and motility improvement between Meridian Balancing Acupuncture Methods (MBAM) and Local Acupuncture in the treatment of Cervical Type Cervical Spondylosis. Methods: Sixty patients with Cervical Type Cervical Spondylosis were randomly divided into MBAM group and Local Acupuncture group. In MBAM intervention, up to 10 sensitive/reactive distal points on the limbs were selected and manipulated, while patients rotated their necks. In Local Acupuncture intervention 10 sensitive acupoints were selected and manipulated on the neck, upper back, and shoulders. Both groups underwent 30-minute treatments, three times during one week. Visual Analog Scale (VAS) pain levels and Cervical Spine Range of Motion (ROM) in three directions were assessed before and after each treatment, and at follow-up. Results: · VAS Scores were significantly reduced within both groups (P&lt;0.05), however after 2nd and 3rd treatments, MBAM VAS scores were significantly lower (P&lt;0.05). MBAM VAS scores differences were, in general, all significantly higher than Local Acupuncture (P&lt;0.05). · In general within MBAM group, ROM in all three directions significantly increased (P&lt;0.05). Within Local Acupuncture group, ROM improvements were more limited. After the 3rd treatment, MBAM demonstrated significantly higher Rotation ROM (P&lt;0.05). Overall, ROM differences in all three directions were significantly higher in MBAM than in Local Acupuncture (P&lt;0.05). · Total effective rate was 100% in both groups. However, significant effective rate was statistically higher in MBAM (93.33%) compared to Local Acupuncture (73.33%) (P&lt;0.05). Conclusion: Both treatments can effectively relieve pain and improve limited motion in Cervical Type Cervical Spondylosis patients. Although Local Acupuncture showed no immediate improvement in several single treatments. MBAM outperformed Local Acupuncture in immediate and short-term analgesic effects, although both treatments were comparable at follow-up. Overall, MBAM demonstrated superiority in improving cervical motility, with immediate, short term and follow-up better outcomes. After the treatment course, MBAM demonstrated superior curative effect compared Local Acupuncture

EFFECT OF STATIC STRETCHING AND MYOFASCIAL RELEASE THERAPY ON MUSCLE SPASTICITY AND RANGE OF MOTION IN CHILDREN WITH CEREBRAL PALSY: RANDOMISED CLINICAL TRIAL

Background: Cerebral palsy (CP) encompasses a group of permanent movement and posture disorders caused by early brain damage. It is commonly associated with muscle spasticity, impaired range of motion (ROM), and reduced mobility. While various pharmacological and non-pharmacological treatments exist, the evidence regarding the effectiveness of myofascial release (MFR) alone or in combination with static stretching (SS) in reducing muscle spasticity and improving ROM in children with CP remains limited. Objective: This study aimed to evaluate the combined effects of static stretching and myofascial release therapy on reducing muscle spasticity and improving the range of motion in children with cerebral palsy. Methods: This randomized clinical trial included 30 children with CP, divided equally into three groups: the static stretching group (SS), the myofascial release group (MFR), and the combined therapy group. The SS group underwent 20 repetitions of 30-second stretches, while the MFR group received 7 minutes of foam rolling therapy, both performed 5 days per week for 24 weeks. The combined therapy group received 12 repetitions of 30-second stretches and 5 minutes of MFR at a cadence of three to four rolls per minute, 5 days per week for 24 weeks. Outcomes included ankle dorsiflexion ROM, assessed with a goniometer, and spasticity, evaluated with the Modified Ashworth Scale, measured at baseline and after 24 weeks. Results: The combined therapy group achieved significant improvements in ankle dorsiflexion ROM (83%) and a 61% reduction in spasticity compared to the SS group (ROM: 61%; spasticity: 35%) and the MFR group (ROM: 75%; spasticity: 37%) (p&lt;0.05). The MFR group demonstrated superior outcomes over static stretching in isolation. Conclusion: The combination of static stretching and myofascial release therapy is an effective treatment approach for reducing muscle spasticity and improving the range of motion in children with cerebral palsy.

The Clinical Application of Gel-Based Composite Scaffolds in Rotator Cuff Repair.

Rotator cuff tears are a common injury that can be treated with or without surgical intervention. Gel-based scaffolds have gained significant attention in the field of tissue engineering, particularly for applications like rotator cuff repair. Scaffolds can be biological, synthetic, or a mixture of both materials. Collagen, a primary constituent of the extracellular matrix (ECM) in musculoskeletal tissues, is one of the most widely used materials for gel-based scaffolds in rotator cuff repair, but other ECM-based and synthetic-based composite scaffolds have also been utilized. These composite scaffolds can be engineered to mimic the biomechanical and biological properties of natural tissues, supporting the healing process and promoting regeneration. Various clinical studies examined the effectiveness of these composite scaffolds with collagen, ECM and synthetic polymers and provided outstanding results with remarkable improvements in range of motion (ROM), strength, and pain. This review explores the material composition, manufacturing process and material properties of gel-based composite scaffolds as well as their clinical outcomes for the treatment of rotator cuff injuries.

Treatment of long finger metacarpophalangeal arthritis using HAPY® pyrocarbon interposition implants: a study of 34 cases.

Destruction of the metacarpophalangeal joint can result in disabling pain and stiffness. Several therapeutic options are available, including pyrocarbon interposition implants. The primary endpoint of this study was assessment of clinical and radiographic outcomes in 34 patients treated with HAPY® pyrocarbon interposition implants (Tornier, Grenoble, France) with a minimum follow-up of 3 years. The secondary endpoint was to assess complications and the need for revision surgery. Thirty-four patients (61 implants) who underwent metacarpophalangeal arthroplasty with the HAPY® implant were reviewed with a minimum follow-up of 3 years. The etiology was inflammatory (rheumatoid arthritis) in 18 cases (37 implants), primary osteoarthritis in 16 (21 implants), and post-traumatic in 3 (3 implants). Preoperative data comprised age, gender, operated finger, etiology (inflammatory, primary or post-traumatic), digital chain mobility, pain assessment on visual analog scale, grip strength on a standardized handheld dynamometer, and functional scores including QuickDASH and the Patient-Rated Wrist/Hand Evaluation. Immediate postoperative radiographs (anteroposterior, lateral and oblique views) centered on the metacarpophalangeal joint were compared with those at last follow-up. Metacarpal and phalangeal implant subsidence were assessed. At a mean follow-up of 71.5 months, pain score was reduced by a mean 5.4 points: 6.4/10 versus 1/10 (p < 0.001). The mean active range of motion in flexion-extension showed a significant improvement of 27°: 42.9 ° versus 70 ° (p < 0.001). The QuickDASH and Patient-Rated Wrist/Hand Evaluation functional scores significantly improved by a mean 26.7 points (50.6 ± 20.1 versus 23.9 ± 25 (p < 0.001)) and 32.8 points (53.58 ± 21.6 versus 20.77 ± 22.1 (p < 0.001)), respectively. Comparison between pre- and post-operative grip strength did not show a significant difference. 94% of patients reported being satisfied with the procedure, while 6% were dissatisfied or very dissatisfied. One of the dissatisfied patients developed type 1 complex regional pain syndrome, while the other had persistent pain and stiffness. Mean implant subsidence in the metacarpal was 0.48 mm ± 4.2 mm, and in the first phalanx 3.6 mm ± 9.6 mm. One patient (2.9%) experienced implant dislocation in the immediate postoperative period. No further implant dislocations were observed during follow-up. The HAPY® interpositional implant provided good clinical and radiographic outcomes for the management of long finger arthritis, offering functional results and improvement in range of motion, comparable to other series. The HAPY® interpositional implant has the advantage of being non-constrained and maximizing bone stock.

Comparative study of open elbow arthrolysis with and without hinge external fixation for the treatment of post-traumatic elbow stiffness

BackgroundThe present study aimed to compare the functional outcomes of hinged external fixators and non-external fixation in open elbow arthrolysis (OEA) for post-traumatic elbow stiffness (PTES) and to evaluate their applicability and limitations in patients with posttraumatic elbow stiffness.MethodsThe clinical data of patients with PTES treated with OEA at our hospital between March 2015 and June 2022 were retrospectively analyzed. The assessed variables were the operation time, intraoperative blood loss volume, duration of hospitalization, and treatment costs. The elbow range of motion (ROM), Mayo Elbow Performance Score (MEPS), shortened disabilities of the arm, shoulder and hand questionnaire (Q-DASH) score, Oxford Elbow score (OES), Broberg and Morrey score (BMS), visual analog scale (VAS) for pain, and complications such as pin tract infection and heterotopic ossification were compared between patients with and without hinge external fixation. We also compared the baseline characteristics and functional outcomes of patients with and without hinge external fixation.ResultsA total of 156 patients (48 patients with hinged external fixators and 108 patients without external fixators) diagnosed with PTES were included in this study. The mean follow-up was 15.8 ± 3.6 months. Compared with patients without external fixators, those with external fixators showed significantly greater improvements in elbow flexion and extension ROM (59.6° ± 26.1° vs. 46.2° ± 26.2°, p = 0.004) but had a significantly longer duration of hospitalization (p < 0.001), significantly longer operation time (p < 0.001), significantly higher treatment costs (p < 0.001), and significantly greater intraoperative blood loss volume (p < 0.001). There were no significant differences between the two groups in terms of improvement in elbow rotation ROM, MEPS score, VAS score for pain, OES score, Q-DASH score, BMS score, or incidence of complications.ConclusionThe use of a hinged external fixator in open arthrolysis for posttraumatic elbow stiffness may result in short-term improvements in flexion-extension range of motion but is accompanied by increased blood loss, longer operative time, extended hospitalization, and higher costs. Further studies are needed to confirm these findings.Clinical trial numberNot applicable.

Hydrodilatation: a comparison between diabetics and non-diabetics with adhesive capsulitis.

The primary aim of this retrospective study is to compare the short and medium-term outcomes for shoulder hydrodilatation for treatment of shoulder AC between diabetic and non-diabetic patients, to evaluate if there were better outcomes amongst non-diabetic patients. Patients with clinical or radiological diagnosis of AC and who underwent fluoroscopic guided shoulder hydrodilatation in our local institution from January 2021 to June 2022 were included in this study. Clinical outcomes were measured with visual analog scale (VAS) for pain and passive range of motion consisting of forward flexion (FF) and external rotation (ER) at pre-hydrodilatation, one month and six months post hydrodilatation. A total of 163 shoulders were included, corresponding to 156 patients consisting of 47 diabetics, 109 non-diabetics and seven bilateral shoulders (3 diabetics and 4 non-diabetics). At the time of presentation, there was no significant difference in VAS, FF or ER between diabetics and non-diabetics. From pre-hydrodilatation to 1-month post-hydrodilatation and one month to six months post-hydrodilatation, there was significant improvement in VAS, FF and ER for both groups. Comparing diabetics vs. non-diabetics, the non-diabetic group had significantly better FF (p < 0.01) at one month post hydrodilatation. At 6 months post-hydrodilatation, non-diabetic group also had significantly better outcomes including VAS score (p = 0.02), FF (p < 0.01) and ER (p = 0.02). Hydrodilatation is an effective treatment option in the short and medium term in both diabetics and non-diabetics with adhesive capsulitis, with good relief of pain and improvement in shoulder range of motion. Diabetic patients have significantly less improvement in range of motion and pain compared to non-diabetics at six months post hydrodilatation.

EFFECTIVENESS OF SLEEPER’S STRETCHING ON RANGE OF MOTION IN OVERHEAD ATHLETES WITH GLENOHUMERAL INTERNAL ROTATION DEFICIT

Background -This study aimed to evaluate the effectiveness of sleeper’ stretching exercise on range of motion and proprioception in overhead athletes with glenohumeral internal rotation deficit. Study design-Pre and Post, intervention, using a within subjects and between subjects comparison of a convenience sample. Methods-Glen humeral internal rotation, external rotation and total rotational motion of the dominant and non-dominant shoulders of overhead athletes were measured using a universal goniometer. Determinations were made as to the degree of Glenohumeral Internal Rotation Deficit (GIRD) in the dominant shoulder. A daily (5 days per week), 4-week posterior capsule stretching program was administered. Post-stretching internal rotation, external rotation and total rotational motion measures were again obtained. Results- The result showed significant improvement in IR in both groups i.e. dominant and non-dominant arm, from the descriptive data analysis it has been seen that the effect of sleeper’s stretch was more in group 1 (dominant arm) than the group 2 (non-dominant arm) with a P value of F (1) =144.94, p&lt;0.05 and F (1) =20.196, p&lt;0.05 respectively. No statistically significant improvement in range of motion was found for external rotation, non-dominant arm external rotation, and non-dominant arm total motion. Conclusions-Main findings of this study demonstrated that the sleeper’s stretching protocol was significantly effective for increasing internal rotation and total rotational motion of dominant arm and.

Therapeutic Arthroscopy for Noninfectious Stiffness and Anterior Shoulder Pain After Reverse Shoulder Arthroplasty Leads to Clinical Improvement in Most Patients with a Low Complication Rate.

Reverse shoulder arthroplasty (RSA) exhibits favorable outcomes in managing rotator cuff arthropathy, primary glenohumeral arthritis, and complex proximal humeral fractures. Despite its success and reliability, certain patients experience persistent pain and stiffness. The clinical utility of therapeutic arthroscopy in RSA patients remains an area for investigation. The purpose of this study was to report clinical outcomes, including patient-reported outcomes (PROs), range of motion (ROM), and satisfaction, in patients who underwent therapeutic arthroscopy for noninfectious stiffness and subcoracoid impingement following RSA. The hypothesis was that patients would experience clinical improvement and satisfaction, with earlier intervention being superior to later intervention. Multicenter retrospective review on patients who underwent therapeutic arthroscopy for noninfectious stiffness and anterior shoulder pain following RSA with minimum 1-year follow-up. PROs and ROM were collected pre- and postoperatively. Subjective improvement in ROM and pain, complications, satisfaction, and return to activities were recorded. Data was stratified into two cohorts based on timing of RSA to arthroscopy (1 year or less was considered early intervention and > 1 year late intervention) and variables were analyzed for each cohort. A total of 19 patients met the study criteria (13 patients in early intervention cohort, 6 in late intervention cohort). The average time from the index surgery to arthroscopy was 7.7 ± 2.1 months in the early intervention cohort and 28.3 ± 10.3 months in the late intervention cohort (p=0.004). The overall cohort improved significantly regarding pain (VAS: Δ-1.1, p=0.003), ROM (FF: Δ21°, p=0.002; ER: Δ14°, p=0.010; IR: Δ1 spinal level, p=0.023) and PROs (ASES: Δ18.2, p=0.001; SSV: Δ16.3, p=0.009). The early intervention cohort demonstrated significant improvement in VAS (Δ-1.1, p=0.029), ASES (Δ16.2, p=0.013), SSV (Δ18.5, p=0.008), FF (Δ23º, p=0.016), and ER (Δ15°, p=0.028). The late intervention cohort had significant improvement in VAS (Δ-1.3, p=0.048) and FF (Δ17°, p=0.017). Seventy-four percent of patients in the overall cohort reported decreased pain, 79% improvement in ROM, 68% returned to activities, and 74% were satisfied. There were no complications. Therapeutic arthroscopy for noninfectious stiffness and anterior shoulder pain following RSA improves clinical outcomes in most patients with a low complication risk. Although postoperative outcomes were comparable between groups, functional improvement was more likely in patients who underwent intervention earlier.

The impact of massage therapy on upper extremity function in children with cerebral palsy

Abstract Introduction. Cerebral palsy is a neurological condition that reduces motor function, leading to difficulties with upper extremity movements. Massage therapy, known for reducing muscle tension and promoting relaxation has gained attention as a rehabilitation method. However, limited research focuses on its effectiveness in children with cerebral palsy. Aim. This study evaluates the impact of massage therapy on upper extremity function in children with cerebral palsy, focusing on the relationship between therapy frequency, duration and functional outcomes. Methodology. A quantitative, cross-sectional design was applied, collecting data from 28 children aged 3 to 18 years through structured questionnaires. The outcomes measured included improvements in range of motion, spasticity reduction, pain relief and quality of life. Data were analyzed using ANOVA and Kruskal-Wallis H tests to assess the significance of therapy characteristics. Results. Children receiving therapy 2–3 times per week for more than 12 months showed significant improvements in range of motion (F(2,14) = 4.91, p = 0.024), spasticity reduction (F(3,16) = 3.44, p = 0.042) and pain relief (F(2,14) = 7.41, p = 0.006). Increased therapy frequency was also associated with better performance in daily tasks and improved quality of life (H(2) = 8.15, p = 0.017). Conclusion. Massage therapy is an effective intervention for improving upper extremity function and quality of life in children with cerebral palsy. Future research with randomized trials is recommended to validate these findings and explore long-term benefits.

One-day surgery is safe and effective in unicompartmental knee arthroplasty: A prospective comparative study at 1 year of follow-up.

To compare the outcomes and complications of two perioperative protocols for the management of patients who underwent medial unicompartmental knee arthroplasty (UKA): 24 h (1-day surgery [OS]) versus 72 h (enhanced recovery after surgery [ERAS]) of the length of hospital stay (LOS). In our hypothesis, the reduction of the LOS from 3 to 1 day did not influence the outcomes and complications. A total of 42 patients (21 in each group) with isolated anteromedial knee osteoarthritis and meeting specific criteria were prospectively included in the study. Clinical outcomes included Knee Society Score (KSS) and Forgotten joint score while pain evaluation was performed using a Visual Analogue Scale (VAS). Functional outcomes were assessed measuring the knee range of motion (ROM) while radiographic outcomes were evaluated measuring the amelioration of the varus deformity through the hip-knee-ankle angle (HKA). Clinical and functional outcomes did not significantly differ between the two groups. Complications occurred in 9.5% of OS and 4.7% of ERAS group patients. Significant improvements in knee ROM, VAS pain, KSS and HKA angle were observed postsurgery, with no significant differences between groups except in KSS expectations and function trends. The OS protocol is safe and effective and LOS, in a well-defined fast-track protocol, did not significantly impact clinical and functional outcomes. OS may lead to reduced hospitalisation costs and potential reductions in complications associated with prolonged stays, benefiting both patients and healthcare facilities. However, further research with larger sample sizes and longer follow-up periods is needed to confirm these findings. Early mobilisation and rehabilitation protocols are key components of successful patient recovery following UKA procedures. Level II.

Comparison Between Robotic Finger Therapy Exercise and Conventional Exercise on the Range of Motion of the Metacarpophalangeal Joints: Study of Post-stroke Patients at Diponegoro National Hospital

BACKGROUND : Metacarpophalangeal (MCP) joints range of motion (RoM) exercise can be done using either conventional exercise or robotic finger therapy. This study aimed to compare MCP joints RoM improvement between conventional exercise and robotic finger therapy exercise in post-stroke patients. METHOD : This study was a randomized controlled trial pre and post test controlled group design. The data were taken from individuals aged 45-65 years with a history of stroke undergoing medical rehabilitation at the Diponegoro National Hospital before and after intervention (robotic finger therapy exercise vs conventional exercise) for 6 weeks. MCP joints RoM was measured using goniometer before and after the intervention. Datas were analysed using SPSS ver 20.0. Normality of data distribution would be assessed using the Shapiro-Wilk test. Differences in the RoM of MCP joints before and after treatment in each group were tested using paired t-test. Group differences were tested using unpaired t-test. RESULT : There was significant RoM improvement in each MCP joint in each group before and after the treatment (p&lt;0.05). There was no significant difference in RoM improvement between groups (p&gt;0.05). CONCLUSION : Both robotic and conventional therapy significantly improve MCP joints RoM in post-stroke patients. There was no significant difference in MCP joints RoM improvements between robotic finger therapy and conventional exercise.

Does Tranexamic Acid Improve Early Postoperative Shoulder Motion After Total Shoulder Arthroplasty?

Although the hematologic benefits of tranexamic acid (TXA) have been thoroughly evaluated, an additional value demonstrated in knee arthroplasty and rotator cuff repair is improved early postoperative range of motion (ROM). This study aims to evaluate whether TXA given during total shoulder arthroplasty (TSA) confers improved early postoperative ROM or pain. We did retrospective review of 653 TSAs (223 anatomic TSA [aTSA] and 430 reverse TSA [rTSA]) performed in 596 patients at a single institution from 2007 to 2022. Intraoperative TXA use was implemented on a case-by-case basis starting in 2014 then became standard practice in 2016. Pre- to postoperative improvement in ROM was evaluated at 6 weeks, 3 months, 6 months, 1 year, and 2-years of follow-up. Mixed-effects models were used to evaluate whether administration of TXA intraoperatively improved ROM or pain at each follow-up time point. TXA was administered to 26% (n = 58) of aTSAs and 43% (n = 179) of rTSAs. Patients with a history of hypertension received TXA at a higher rate for both aTSA (P = 0.009) and rTSA (P = 0.005). Intraoperative TXA was not associated with improved ROM or pain for aTSA or rTSA at any time point investigated. Average estimated intraoperative blood loss was markedly less in the TXA group for both aTSA [250 to 300 mL] (P < 0.001) and rTSA [200 to 300 mL] (P < 0.001) when compared with the non-TXA groups [300 to 400 mL for both]. Intraoperative TXA does not improve ROM or pain after TSA. However, intraoperative blood loss was reduced, further supporting the routine use of TXA to reduce hematologic complications and improve intraoperative visibility.

Effects of Vibration Therapy on Muscle Strength, Shoulder Range of Motion, and Muscle Biomechanical Properties in Patients with Breast Cancer Undergoing Radiotherapy: A Randomized Controlled Trial.

To investigate the effects of vibration therapy to home-based exercises on shoulder muscle strength, range of motion (ROM), pain-related disability, and muscles viscoelastic properties of shoulder and neck in patients with breast cancer undergoing radiotherapy. In this randomized controlled superiority trial was conducted with 38 participants who underwent breast cancer surgery. All patients were randomized into two groups: control group (CG) and vibration group (VG). Both groups performed home-based exercises for 5 days a week for 6 weeks. VG recived additional vibration therapy for 2 days a week for 6 weeks. Shoulder ROM, muscle strength, pain, disability, grip stength, and viscoelastic properties of the pectoralis major, upper trapezius, and sternocleidomastoid were compared pre- and post-intervention. VG demonstrated better improvement in shoulder ROM, muscle strength and pain-related disability (p < 0.05), except for internal rotation ROM. Only tone of pectoralis major was significantly higher in VG according to group x time interaction (p < 0.05), no differences were detected in terms of muscle viscoelastic properties in the CG patients (p > 0.05). Vibration therapy provided superior improvements in muscle strength, ROM, and pain-related disability compared to home-based exercises alone in patients with breast cancer undergoing radiotherapy in the early postoperative phase.

The Impact of Disc Height on Outcomes Following Cervical Disc Replacement: A Systematic Review.

Systematic review. Describe the impact of disc height on outcomes following cervical disc replacement (CDR). Implant sizing and positioning may impact outcomes following CDR. A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using the EMBASE and PubMed databases. The goal of this review was to assess the impact of postoperative "disc height" on clinical and radiologic outcomes following CDR. A total of 12 studies were included in the systematic review. In the literature. "disc height" was assessed using multiple different measures: postoperative disc height (DH; n=4), disc height change (DHC; n=4), degree of disc distraction (DDD; n=2), prosthesis height (PH; n=2), functional spinal unit height (FSUH; n=2), and facet distraction (FD; n=1). DH and DHC were the most common measures studied. DHC was associated with statistically and clinically significant differences in several patient-reported outcomes measures (PROMs). However, DH was not associated with any statistically or clinically significant differences in PROMs. With respect to cervical range of motion (ROM), DHC appeared to demonstrate statistically and clinically relevant differences in some of the studies included in this review, while DH was associated with statistically, but not clinically, significant differences. The majority of studies identified DHC <2mm as an important cutoff to optimize outcomes. "Disc height," especially as measured by DHC, may be an important intraoperative consideration when selecting implant size during CDR. Maintaining DHC <2mm may optimize PROMs and ROM. Improving technique and implant sizing may aid in translating ex vivo advantages in implant mobility to in vivo improvements in ROM and PROMs.