Degrees Range Of Motion Research Articles

Clinical Outcomes of Arthroscopic Adhesiolysis: A Case Series of 40 Patients With Postoperative Knee Stiffness.

Introduction Restricted range of motion over the knee joint is a known complication following the surgical procedure. Aggressive rehabilitation protocols can initially manage knee stiffness due to arthrofibrosis. If conservative management fails, surgical (open or arthroscopic) release is the preferred modality of management. We present a series of 40 patients with postoperativeknee stiffness who were treated with arthroscopic adhesiolysis. Material and methods This is a retrospective study conducted at Phoenix Orthopedic Superspeciality Hospital, Nagpur, India, from 2017 to 2021. Our study included 40 patients with postoperative knee joint stiffness, of whom 27 were males and 13 were females. The study considered the duration of stiffness, which ranged from six months to five years. All patients underwent arthroscopic knee release. A rigorously supervised physical therapy program followed this procedure. Patients were examined at three months, six months, and one year to assess improvement in knee range of movement. Results Out of 40 patients, six were classified as Shelbourne type 4, and the remaining were Shelbourne type 3. Twenty-three of 40 patients developed arthrofibrosis following intra-articular or peri-articular fracture fixation surgery; 11 patients were operated on arthroscopically for anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) reconstruction. Three patients developed stiffness following total knee replacement, one following patellectomy, and three following infection after fracture fixation. The mean pre-op knee range of motion (ROM) was 48.875 degrees. Following arthroscopic release, the mean improvement in ROM was 60 degrees intra-operatively. The average postoperative range was 108.25 degrees. Conclusion Arthroscopic adhesiolysis and quadriceps release are reliable methods for dealing with postoperative knee stiffness. It prevents wound complications and increases the chances of surgical site infection due to smaller incisions. Postoperatively, we achieved an average increase of 60 degrees in ROM over the knee joint.

Teardrop Alignment Changes After Volar Locking Plate Fixation of Distal Radius Fractures With Volar Ulnar Fragments.

We assessed factors associated with change in radiographic teardrop angle following volar locking plate (VLP) fixation of volarly displaced intra-articular distal radius fractures with volar ulnar fragments (VUF) within the ICUC database. The primary outcome was change in radiographic alignment on follow-up imaging, defined as a change in teardrop angle from intra-operative fluoroscopy greater than 5°. Patients with distal radius fractures treated with a VLP within the ICUC database, an international collaborative and publicly available dataset, were identified. The primary outcome was volar rim loss of reduction on follow-up imaging, defined as a change in radiographic alignment from intra-operative fluoroscopy, teardrop angle less than 50°, or loss of normal radiocarpal alignment. Secondary outcomes were final range of motion (ROM) of the affected extremity. Radiographic Soong classification was used to grade plate position. Descriptive statistics were used to assess variables' distributions. A Random Forest supervised machine learning algorithm was used to classify variable importance for predicting the primary outcome. Traditional descriptive statistics were used to compare patient, fracture, and treatment characteristics with volar rim loss of reduction. Volar rim loss of reduction and final ROM in degrees and as compared with contralateral unaffected limb were also assessed. Fifty patients with volarly displaced, intra-articular distal radius fractures treated with a VLP were identified. Six patients were observed to have a volar rim loss of reduction, but none required reoperation. Volar ulnar fragment size, Soong grade 0, and postfixation axial plate position in relation to the sigmoid notch were significantly associated (P < .05) with volar rim loss of reduction. All cases of volar rim loss of reduction occurred when VUF was 10.8 mm or less. The size of the VUF was the most important variable for predicting volar rim loss of reduction followed by postfixation plate position in an axial position to the sigmoid notch and the number of volar fragments in the Random Forest machine learning algorithm. There were no significant differences in ROM between patients with volar ulnar escape and those without.

Prevalence and Demographic Distribution of Hypermobility in a Random Group of School-Aged Children in Nigeria.

The purpose of this study was to determine the prevalence of hypermobility in randomly selected healthy children, without previous trauma or disease process affecting the joints and whether other demographic variables (age, sex, BMI) had an impact on Beighton scores and range of motion (RoM) in children between 6 and 10 years of age. 286 children were included; 27.3% of them had a Beighton score ≥7/9 and 72% would be classified hypermobile if we had used a Beighton cut-off score ≥4/9. Prevalence declined with increasing age. Girls were more often hypermobile (34%) than boys (20%) and this was mainly caused by increased RoM in the knees. Positive scores of finger items of the Beighton were more common than on the other items, leading to a high prevalence of peripheral hypermobility. Localized hypermobility was only found in the fifth MCP joint. A total of 15% of the children with normal mobility reached 20 excess degrees RoM of the left and right fifth MCP. Pain was present in 12 of the 239 children but was not linked to the level of mobility. Hypermobility is the rule in this pain-free population of children with GJH.

Fixation of intra-articular calcaneal fractures: A comparative study of the postoperative outcome between HA/PPLA screws and locking plates

BackgroundForged unsintered hydroxyapatite and poly l-lactic acid (F-u-HA/PLLA) screw is bioactivite, bioabsorbable, and radiopaque with high mechanical strength. Its efficacy has been previously demonstrated in the treatment of lateral humeral condylar, lateral tibial condylar, ankle, and patellar fractures. However, studies on its efficacy in treatment of calcaneal fractures is lacking. This study aimed to compare the postoperative results of F-u-HA/PLLA screw fixation and locking plate fixation for intra-articular calcaneal fractures. MethodsFrom January 2013 to December 2019, 47 closed intra-articular fractures treated with either F-u-HA/PLLA screws (group S, 18 feet in 17 patients) or locking plates (group P, 29 feet in 28 patients) in a single trauma center were retrospectively reviewed. The sinus tarsi approach was used in both groups. The time to bone union, step-off, varus deformity, Bohler's angle, and width and height of the calcaneus were assessed after surgery. Ankle joint range of motion (ROM) and postoperative complications were also assessed. ResultsAll fractures were successfully treated. The Kaplan-Meier curves of the two groups showed similar trends. The log-rank test showed no significant difference in the time to bone union between the two groups (p = 0.48). In the Cox proportional hazards model adjusted for preoperative width and Bohler's angle, the hazard ratio for bone union was not statistically significant (HR: 1.13, 95%CI: 0.50–2.56, p = 0.78). Other variables included step-off (group S: 2.0 vs group P: 2.2 mm, p = 0.84), varus deformity (2.0° vs. 3.0°, p = 0.7), Gissane's angle (103.5° vs 104.0°, p = 0.84), width (38.0 vs 34.8 mm, p = 0.12), height (42.1 vs 44.0 mm, p = 0.07), and ankle ROM degrees (dorsal flexion, 20.0° vs. 20.0°, p = 0.13; plantar flexion 40.0° vs 40.0°, p = 0.56), which were not significantly different between groups P and S. The Bohler's angle was smaller in group S than in group P (20.5° vs 27.0°, p < 0.01). No skin necrosis or infection was observed in either group. ConclusionPostoperative results of F-u-HA/PLLA screw fixation using the sinus tarsi approach for intra-articular calcaneal fractures were as good as those of locking plate fixation.

Clinical efficacy and time-effect relationship of dynamic qi acupuncture for acute lumbar sprain

To observe the clinical efficacy of dynamic qi acupuncture for acute lumbar sprain, and to explore the differences of different needle retention time on the improvement of pain, lumbar mobility and lumbar dysfunction. A total of 160 patients with acute lumbar sprain were randomly divided into an observation group A (40 cases, 4 cases dropped off), an observation group B (40 cases, 2 cases dropped off), an observation group C (40 cases, 4 cases dropped off) and a medication group (40 cases, 6 cases dropped off). The patients in the observation group A, the observation group B and the observation group C were treated with acupuncture at "lumbago point" and Sanjian (LI 3) on the left side, and during the needles were kept for 10, 20 and 30 min respectively, the patients were required to take tolerable lumbar active activities, once a day; the patients in the medication group were treated with celecoxib capsules, 0.2 g each time, twice a day. All the patients were treated for 5 d. Before and after treatment, the scores of numerical rating scale-11 (NRS-11), lumbar range of motion (ROM) and modified Oswestry disability index (ODI) were observed, and the clinical efficacy of each group was evaluated. After treatment, the scores of NRS-11, ROM and ODI in each group were decreased compared before treatment (P<0.01). The decreased degree of NRS-11, ROM and ODI in each observation group was greater than that in the medication group (P<0.05), and the decreased degree of ROM and ODI in the observation group B and the observation group C was greater than that in the observation group A (P<0.05). The total effective rates were 94.4% (34/36) in the observation group A, 94.7% (36/38) in the observation group B and 97.2% (35/36) in the observation group C, respectively, which were higher than 79.4% (27/34) in the medication group (P<0.05). Dynamic qi acupuncture with needle retention for 10, 20 and 30 min all could effectively improve the pain, lumbar mobility and lumbar dysfunction in patients with acute lumbar sprain. If the lumbar dysfunction is severe, needle retention for 20 min or more is recommended.

Does femoroacetabular impingement syndrome affect range of motion? A systematic review with meta-analysis.

It is unclear whether femoroacetabular impingement syndrome (FAIS) affect hip range of motion (ROM). We performed a systematic review with meta-analysis searching six electronic databases from inception to March 21, 2022. We included studies assessing hip ROM in FAIS, FAI morphology without symptoms (FAIm), and healthy controls. Mean differences between groups were measured in ROM degrees with 95% confidence interval (CI). A total of 17 studies (1702 hips) were included. Comparison of FAIS patients versus healthy controls showed that hip ROM was clinically and statistically reduced in FAIS for internal rotation (90° hip flexion, -8.01°, 95% CI: -11.21, -4.90; 0° hip flexion -6.38°, 95% CI: -9.79, -2.97); adduction (90° hip flexion, -4.74°, 95% CI: -8.13, -1.34); flexion (-5.41°, 95% CI: -7.05, -3.49), abduction (0° hip flexion, -5.76°, 95% CI: -8.38, -3.23), and external rotation (90° hip flexion, -3.5°, 95% CI: -5.32, -1.67) ranging from low to high certainty of evidence. Comparison of FAIm versus healthy controls showed no statistically significant differences in any direction of movement, albeit with uncertainty of evidence. The certainty of evidence was unclear, particularly for asymptomatic FAIm. Hip ROM may be reduced in all directions except extension in FAIS compared to controls. Hip ROM may not be restricted in asymptomatic FAIm. Further studies are needed to resolve the uncertainty of evidence about ROM restrictions in asymptomatic FAIm compared to healthy controls.

Does Cage Position Affect the Risk of Cage Subsidence After Oblique Lumbar Interbody Fusion in the Osteoporotic Lumbar Spine: A Finite Element Analysis

This study aimed to evaluate the biomechanical effects of different cage positions with stand-alone (SA) methods and bilateral pedicle screw fixation (BPSF) in the osteoporotic lumbar spine after oblique lumbar interbody fusion (OLIF). A finite element model of an intact L3-L5 lumbar spine was constructed. After validation, an osteoporosis model (OP) was constructed by assigning osteoporotic material properties. SA models (SA1, SA2, SA3) and BPSF models (BPSF1, BPSF2, BPSF3) in which a cage was placed in the anterior, middle, and posterior third of the L5 superior endplate (SEP) were constructed at the L4-L5 segment of the OP. The L4-L5 range of motion (ROM), the stress of the L5 SEP, the stress of the cage, and the stress of fixation were compared among the different models. According to the degree of ROM of L4-L5, the stress of the L5 SEP and the stress of the cage for most physiological motions, the SA and BPSF models were ranked as follows: SA2 < SA1 < SA3, BPSF2 < BPSF1 < BPSF3. In BPSF2, the stress of fixation was minimal in most motions. At the same cage position, the ROM of L4-L5, the stress of the L5 SEP, and the stress of the cage in the BPSF models were significantly reduced compared with those in SA models; compared with SA2, BPSF2 had a maximum reduction of 83.24%, 70.71%, and 73.52% in these parameters, respectively. Placing the cage in the middle third of the L5 SEP for OLIF could reduce the maximum stresses of the L5 SEP, the cage, and the fixation, which may reduce the risk of postoperative cage subsidence, endplate collapse, and fixation fracture in the osteoporotic lumbar spine. Compared with SA OLIF, BPSF could provide sufficient stability for the surgical segment and may reduce the incidence of the aforementioned complications.

Outcome of free gracilis muscle transfer for the restoration of elbow flexion in traumatic brachial plexus palsy.

Objectives The aim of this study was to evaluate the functional outcomes of patients with free gracilis muscle transfer (FGMT) for the restoration of elbow flexion. Patients and methods Between January 2012 and January 2019, a total of 16 patients (13 males, 3 females; mean age: 27.3±11.7 years; range: 18 to 53 years) who underwent FGMF to achieve elbow flexion after traumatic brachial plexus palsy (TBPP) were retrospectively analyzed. Data including demographic and clinical characteristics of the patients, etiology, affected side, injury level, accompanying injuries, time between injury and surgery, follow-up time, complications, whether nerve reconstruction and artery repair were performed previously, and details of the procedure were recorded. The outcome measures were elbow range of motion in degrees, muscle strength, and Disabilities of the Arm, Shoulder and Hand (DASH) and Short Form-36 (SF-36) scores.Results The mean follow-up was 30±11.5 (range, 24 to 42) months. Two patients had C5-C8 injuries, two patients had C6-T1 injuries, and all other patients had injuries to the C5-T1 roots. Muscle strength was M3/M4 in 11 (68.8%) patients, M2 in two (12.5%) patients, and M0 in one (6.2%) patient. The median active range of motion of the elbow joint in patients with successful results (M3 and above) was measured as 75 (range, 30 to 100) degrees. A statistically significant improvement was observed in the pre- and postoperative DASH scores and in some SF-36 subscale scores of patients with successful results.Conclusion Free gracilis muscle flap is a reliable option in the restoration of elbow flexion in patients with TBPP. Although there is an improvement in functional results, disability, and quality of life, there may be no change in patients’ mental status and pain.

Multi-segmental lumbar spinal stenosis treated with Dynesys stabilization versus lumbar fusion in elderly patients: a retrospective study with a minimum of 5 years’ follow-up

Middle- and long-term outcomes of multi-segmental lumbar spinal stenosis treated with Dynesys stabilization (DS) have rarely been reported. Older age and multi-segmental degeneration may be positive factors in achieving satisfactory outcomes following DS. The present study aimed to compare the middle- and long-term outcomes of DS with lumbar fusion for treatment of multi-segmental lumbar spinal stenosis (ms-LSS) in elderly patients. This study retrospectively analyzed patients with ms-LSS treated by DS or lumbar fusion from January 2011 to April 2013. Twenty-two patients were included in the Dynesys group, and 44 patients treated by lumbar fusion and rigid fixation were included in the fusion group. Clinical outcomes were assessed by VAS and ODI. Radiological outcomes were measured by range of motion (ROM) of stabilized segments and the proximal adjacent segment, intervertebral disc height (DH) and L1-S1 lumbar lordosis angle (LL). Modified Pfirrmann grade score was used to access disc degeneration. The mean follow-up time of the Dynesys group and fusion group was 68.50 ± 6.40 and 70.14 ± 7.26months, respectively. Baseline data were similar between the two groups. There were no significant differences between the two groups in terms of improvement of clinical outcomes (VAS and ODI). DS preserved a certain degree of ROM (3.74 ± 2.00) of surgical segments. ROM of proximal adjacent segment underwent an increase in both groups at the final follow-up. The DH of the surgical segments and proximal adjacent segment in both groups was significantly lower than that before surgery (P = 0.000). LL of both groups improved (P = 0.000), and there was no significant difference between the two groups. The modified Pfirrmann score of proximal adjacent segment of both groups increased at the final follow-up. The fusion group underwent a more significant increase (P = 0.000), whereas the inter-group difference showed no significance (P = 0.090). DS is a safe and effective surgical treatment of multi-segmental lumbar spinal stenosis in the elderly population. DS preserves a certain degree of mobility of surgical segments.

Measurement of knee joint range of motion with a digital goniometer: A reliability study.

Measurements of joint range of motion (ROM) are part of a physical therapist's daily work. Activities of daily living and exercises can be complicated to perform when ROM is limited, and depending on the demands in daily living, the knee joint requires different ROM. In sports, a few degrees in ROM may make the difference between getting injured or not. The goals for physical therapists are to help the patients to regain full ROM, mobility, strength, and function after sustaining an injury. To measure joints with the manual universal goniometer is considered time-consuming and difficult with respect to repeated measurements. Recently, a new digital instrument for measuring ROM was developed-EasyAngle. A first objective of the study was to investigate the reliability of EA for measuring knee joint angles, considering intrarater and interrater reliability. A second objective was to investigate if there were any differences in the intrarater reliability between a novice and an experienced assessor. Passive knee angles were measured in fixed positions for 40 knee joints (20 subjects). Two registered physical therapists, one novice and one experienced, conducted the measurements. Both registered physical therapists were blinded to the measurements throughout the study. The results showed very good intrarater (intraclass correlation coefficient [ICC] 0,997-0,998, standard error of mean 1.15-1.48, smallest detectable difference [SDD] 3.19-4.09, limits of agreement -3.36-3.04, -4.66-4.09) and interrater reliability (ICC 0.994, standard error of mean 2.11, SDD 5.85, limits of agreement -4.75-6.95) for measurements of knee joint ROM. No statistical difference between a novice and an experienced assessor was detected (p=0.86). The results of the present study showed very good ICC values for both intrarater and interrater reliability measuring knee joint ROM with EasyAngle. Relatively high SDD values were seen for both assessors and may indicate a problem monitoring small differences between measurements. Further studies are recommended to increase the generalizability of the results.

Thursday, September 27, 2018 3:35 PM–5:05 PM Section on Motion Technology Abstract Presentations: 140. Impact of range of motion on progression of adjacent segment disease: disc versus disc

BACKGROUND CONTEXT Previously, long term outcomes investigating range of motion (ROM) preservation over time between an investigational arm mobile core device (MCD) and control arm controlled core device (CCD) have been reported. No studies have looked at the relationship of ROM to the progression of adjacent segment disease (ASD) between disc prostheses. PURPOSE The primary purpose of this study was to compare changes in ROM between two lumbar TDRs. Secondarily the relationship between incremental degrees of motion maintained to progression of ASD was investigated. STUDY DESIGN/SETTING This is a post hoc analysis of data collected from a large, prospective, multicenter clinical trial. PATIENT SAMPLE As part of the clinical trial, 175 patients received either the investigational MCD or the CCD control device. All patients were treated for symptomatic disc degeneration unresponsive to minimum 6 months nonoperative care. OUTCOME MEASURES The primary outcome measure was ROM and the progression of ASD. METHODS ROM was evaluated through radiographs at the index level at baseline (preoperative) and at 5-years postoperative. At 5-years, a change in adjacent ASD was defined as >1 grade increase. RESULTS Results: At baseline both MCD and CCD patients had similar index level ROM of 6.6° and 6.2°, respectively (p=.6). At 5-years postoperative patients with a CCD had an average ROM of 4.2° which represented a statistically significant reduction from baseline (p=.02). Patients with a MCD had an average ROM of 6.1° at 5-years which was similar to the baseline ROM (p=.4). In a comparison between groups, patients with a CCD had 31% less ROM at 5-years postoperative than patients with a MCD (p=.02). In this same patient group the protective effect of ROM on progression of ASD was measured. For every degree of ROM preserved, the likelihood of the progression of ASD at the superior level declined consistently. Patients receiving an MCD were less likely to have progression of ASD at 5-years than patients who received a CCD (8.8% vs. 19%, p=.05). CONCLUSIONS These data show that there may be a relationship between the maintenance of motion over time and the progression of ASD. While additional analysis is warranted, a novel new MCD may be better at maintaining ROM and thus better at delaying ASD than the earlier generation CCD. FDA DEVICE/DRUG STATUS aclivL, ProDisc-L and Charite are approved for this indication.

Outcome assessment for Brachial Plexus birth injury. Results from the iPluto world-wide consensus survey.

ABSTRACTThere is no consensus regarding strategies to optimally treat children with a brachial plexus birth injury (BPBI). Comparison of outcome data presented by different centers is impossible due to the use of (1) many different outcome measures to evaluate results; (2) different follow‐up periods after interventions; and (3) different patient ages at the time of assessment. The goal of iPluto (international PLexus oUtcome sTudy grOup) was to define a standardized dataset which should be minimally collected to evaluate upper limb function in children with BPBI. This dataset must enable comparison of the treatment results of different centers if prospectively used. Three rounds of internet surveys were used to reach consensus on the dataset. A Delphi‐derived technique was applied using a nine point Likert scale. Consensus was defined as having attained a rating of 7/8/9 by > = 75% of the participants. A total of 59 participants from five continents participated in the Second and Third Rounds of the survey. Consensus was reached regarding four elements: (1) evaluation should take place at the age of 1/3/5/7 years; range of motion in degrees should be measured for (2) passive joint movement; (3) active range of motion; and (4) the Mallet score should be determined. Consensus on how to asses and report outcome for BPBI was only reached on motor items from the “Body Function and Structure” domain. Consensus regarding additional ICF domains to obtain a more elaborate set of outcome items, should be addressed in future research. © 2018 The Authors. Journal of Orthopaedic Research® Published by Wiley Periodicals, Inc. on behalf of the Orthopaedic Research Society. J Orthop Res 36:2533–2541, 2018.

Quantifying Contracture Severity at Hospital Discharge in Adults: A Burn Model System National Database Study.

Contracture is a common complication of burn injury and can cause significant barriers to functional recovery and rehabilitation. There are limited studies of quantitative range of motion after burn injury. The purpose of this study is to examine quantitative contracture outcomes by anatomical location, burn size, and length of stay in adults. Data were obtained from the Burn Model System National Database from 1994 to 2003. All adult patients with a joint contracture at acute discharge were included and 16 joint motions were examined. Contractures were reported as both mean absolute loss of normal range of motion in degrees and percent loss of normal range of motion. Analysis of variance was used to assess for a linear trend for contracture severity by burn size and length of stay. Data from 659 patients yielded 6,228 instances of contracture. Mean absolute loss of normal range of motion ranged from 20° to 65° representing an 18 to 45% loss of normal movement across the studied joint motions. In the majority of joint motions, contracture severity significantly increased with larger burn size and longer length of stay; however, wrist and many lower extremity joint movements did not demonstrate this trend. The data illustrate the quantitative assessment of range of motion deficits in adults with burn injury at discharge and the relation to burn size and length of stay.

Periarticular injection and continuous femoral nerve block versus continuous femoral nerve block alone on postoperative opioid consumption and pain control following total knee arthroplasty: Randomized controlled trial

Continuous femoral nerve block (CFNB) has been used to prevent the breakthrough pain after total knee arthroplasty (TKA). Multimodal drug injection (PMDI) has also been shown to decrease opioid consumption and pain. We investigated whether the use of PMDI further improves analgesic and rehabilitation outcomes when used in conjunction with CFNB. This is a prospective randomized controlled study of 44 patients undergoing primary TKA. The treatment group (n=23) received a PMDI of combined ropivacaine, epinephrine, ketorolac and morphine, and the controlled group (n=21) received saline at wound closure. Total opioid consumption, pain scores, knee range of motion (ROM) outcomes, length of stay, and patient satisfaction were measured and compared. The total consumption of morphine is similar between the two groups (52.6±40.6 vs. 41.5±32.9, p=0.325). The mean morphine consumption of the treatment group was significantly lower than the control at 4h after surgery (4.2±5.5 vs. 11.3±8.1, p=0.002) but comparable on POD1, POD2, and POD3. The mean pain scores were significantly higher in the treatment group than the control group at POD2 (at rest: 47.3±29.1 vs. 23.8±20.6, p=0.004; after PT: 57.7±25.4 vs. 35.2±26.8, p=0.007) and POD3 (at rest: 30.9±30.3 vs. 14.8±20.9, p=0.045; after PT: 50.2±30.6 vs. 29.0±32.1, p=0.035), and not significantly different at 4h after surgery or at POD1. Mean maximal knee flexion ROM in degrees during active and active assisted mobilization showed no significant difference between the control and the treatment groups on POD2 and POD3. The mean length of stay of the treatment group is significantly longer than the control group (5.1±2.1 vs. 3.8±1.6, p=0.032). At discharge, no significant difference exists between the two groups for mean patient satisfaction. The addition of PMDI led to a decrease in opioid consumption in the immediate postoperative period but with no significant difference in the total consumption within the first three days postoperatively. This finding provides an opportunity for appropriate preoperative treatment and education for both patients and caregivers.

Peripheral Application of Repetitive Pulse Magnetic Stimulation on Joint Contracture for Mobility Restoration:Controlled Randomized Study

Background:&nbsp;Joint contracture is a limitation in the passive or active range of motion (ROM) of a joint, where in addition to the mobility limiting factor the pain is also present. Repetitive pulsed Magnetic Stimulation (rPMS) appears to be an effective, non-invasive and safety solution for treating this condition. Therefore aim of this study was to evaluate the effect of rPMS in treating joint contracture.Methods:&nbsp;30 subjects with joint contracture in the knee were enrolled in this study and divided respectively into Treatment and Control group. The treatment group were delivered with rPMS therapy. The control group was delivered with conventional physiotherapy method (ultrasound). The primary outcome measurements were: 1. Mobility evaluation by goniometry (ROM in degrees while performing flexion) and Patient Functional Assessment Questionnaire (PFAQ) for ability to perform Activities of Daily Living (ADL) and 2. Pain evaluation by 10-point Visual Analog Scale (VAS) for pain perception. Absence of adverse events was set as a secondary measure.Results:&nbsp;The results of the study show statistical difference (p&lt;0.05) between the levels of improvement of all studied parameters while comparing between both groups. The results suggest greater immobility restoration and pain relieving effect of the rPMS in comparison to conventional physiotherapy method.Conclusion:&nbsp;rPMS an effective and safe non-invasive method for mobility restoration and pain relief in case of joint contractures. This study suggests the method as beneficial and quality of life ameliorating among patients suffering from immobilized joints accompanied by pain.

Functioning free muscle transfer for the restoration of elbow flexion in brachial plexus injury patients

BackgroundRestoration of elbow function in traumatic brachial plexus injury patients remains the priority in the reconstruction of the involved extremity. In cases of complete nerve root injuries and in delayed cases, the only option for elbow reconstruction is the functional free muscle transfer. The purpose of this paper was to present the clinical outcomes and complications of functioning free muscle transfers using the gracilis muscle for the restoration of elbow flexion in brachial plexus injury patients in a tertiary institution from January 1, 2005 to January 31, 2014. Patient and methodsA retrospective review of all patients who had functioning free muscle transfers for elbow flexion was done with a minimum of 12 months follow-up. Outcome measures were elbow flexion in terms of range of motion in degrees, muscle strength of the transferred muscle, VAS (visual analogue scale) for pain, postoperative DASH scores and complications of the procedure. ResultsThere were 39 males and three females. The average age at the time of surgery was 28.6 (SD, 8.5) years. The average delay to surgery was 16 months (range, 3–120 months). The flap success rate for viability was achieved in 38 of 42 patients. The average follow-up for the 38 patients was 30 months (range, 12–103 months, SD 19 months). Success rate of at least M3/5 muscle strength was achieved in 37 of 42 patients with an average range of elbow flexion of 107° (SD, 20.4°). The average post-operative VAS for pain was 3.6 (SD, 3.0). The average post-operative DASH score was 43.09 (SD, 14.9). There were a total of 10 minor complications and five major complications. ConclusionFunctioning free muscle transfer using the gracilis muscle was a reliable procedure in the restoration of elbow flexion in patients with incomplete brachial plexus injury treated beyond 6 months from the time of injury and in patients with complete injuries.

Increased Range of Motion Is Important for Functional Outcome and Satisfaction After Total Knee Arthroplasty in Asian Patients

BackgroundAlthough range of motion (ROM) is considered as an important factor for good outcome after total knee arthroplasty (TKA), the association of the degree of ROM with functional outcome and patient satisfaction is debated. We, therefore, investigated whether increased ROM would affect functional outcome and patient satisfaction after TKA in Asian patients. MethodsWe reviewed 630 patients who underwent primary TKA with minimum 2-year follow-up. Clinical outcomes were evaluated by Knee Society (KS) score, Western Ontario and McMaster Universities osteoarthritis index, and high-flexion knee score. Patient satisfaction was evaluated using a validated questionnaire. The association of ROM and change in ROM (cROM) with clinical outcomes and satisfaction were analyzed using partial correlation analysis and multiple median regression analysis. ResultsAll functional scores showed significant correlation with postoperative ROM (r = 0.129, P = .001 in Knee Society score; r = −0.101, P = .012 in Western Ontario and McMaster Universities osteoarthritis index; r = 0.183, P < .001 in high-flexion knee score). cROM correlated with satisfaction (r = 0.192, P = .005). Postoperative ROM and cROM were revealed as predisposing factors affecting function outcome using multivariable regression analysis. cROM was found as a predisposing factor affecting satisfaction. ConclusionsBased on the results of this study, ROM positively associated with functional outcome and cROM positively associated with patient satisfaction after TKA. These findings suggest that increased ROM after TKA is an important factor for functional outcome and satisfaction in Asian patients.

Platelet-Rich Plasma Treatment With Physical Therapy in Chronic Partial Supraspinatus Tears.

Background:Despite the insufficient evidence, due to potential contribution to the improvement, platelet-rich plasma (PRP) is emerging as a promising method.Objectives:The aim of this study was to assess the effectiveness of PRP injection in partial supraspinatus tears by comparing with physical therapy (PT).Patients and Methods:Seventy patients with chronic partial supraspinatus tears in magnetic resonance imaging were randomized into two groups; PRP (n = 35) and PT (n = 35). Before the treatment, at the end of the treatment and at the 12th month after the end of the treatment, range of motion (ROM), visual analog scale (VAS) for pain, Disabilities of Arm, Shoulder and Hand questionnaire (DASH), Neer’s, Hawkins’ and drop arm tests and Beck Depression Inventory were investigated.Results:Statistical analysis was made for 62 subjects (PRP group, n = 30; PT group, n = 32). There were no differences between the groups according to demographic data. At the 12th month after the end of the treatment, significant improvement in ROM was detected in both groups, pain was reduced significantly in both groups and improvement of the DASH score was observed in both groups. At all the evaluation steps, increases in ROM degrees were significantly higher in the PT group than the PRP group. For VAS in activity and in rest, after the treatment, improvement was higher in the PT group than the PRP group. However, improvement of the DASH score of the PRP group was significantly better than the PT group.Conclusions:When we compared with PT, PRP seemed to be a well-tolerated application which showed promising results in patients with chronic partial supraspinatus tears.

Two-Stage Primary Total Knee Arthroplasty with Well-Designed Antibiotic-Laden Cement Spacer Block for Infected Osteoarthritic Knees: The First Case Series from China.

We aimed to assess the efficacy of applying a two-stage primary total knee arthroplasty (TKA) with an antibiotic-laden cement spacer block to treat infected osteoarthritic knees. This retrospective study included 17 cases of severely infected osteoarthritic knees treated with two-stage primary TKA. Open debridement and irrigation with insertion of a well-designed antibiotic cement spacer was performed as the first stage. Systemic antibiotics were used in the interval period. Two-stage TKAs were performed after elimination of infection. The pre- and post-operative Hospital for Special Surgery Knee (HSS) score as well as range of motion (ROM) were assessed. Elimination of infection was achieved in 16 patients. C-reactive protein returned to normal levels in an average of 3.4 wks (range, 1-7 wks), whereas erythrocyte sedimentation rate (ESR) recovered in an average of 11.4 wks (range, 6-19 wks). The average interval between the two-stage operations was 16.8 wks (range, 10-27 wks). Compared with the pre-operative level, the mean HSS score had a substantial increase after the first-stage and second-stage surgery (p<0.05). The post-operative maximum extension degree was smaller and the maximum flexion and ROM degree were larger than the pre-operative degree (all p<0.05). There were no recurrent infections and no patients lost to follow-up. One patient chose to receive arthrodesis because of uncontrolled infection after numerous operations and treatments. Two-stage TKA with open debridement, irrigation, and insertion of a well-designed antibiotic-laden cement spacer at the first stage could provide effective pain relief and function restoration as well as infection control in the interval. This treatment protocol provided an encouraging final clinical outcome, which could be a reliable alternative for patients with infected osteoarthritic knees.

Effects on single segmental lumbar stability after graded facetectomy and laminectomy: a finite element study

To explore the effects on degenerative single segmental lumbar spinal stability after posterior graded laminectomy and facetectomy by a finite element method. A finite element model of L3-S1 segments with a single segmental degeneration at L4-5 level was established. Different models of L4-L5 segmental instability after posterior graded laminectomy and facetectomy were established. And interior 1/3, 1/2, 2/3 of laminar and bilateral facet joints were resected. Physical loads were applied to the models and the changes of range of motion (ROM) at L4-5 level in different models were recorded during flexion, extension, lateral bending and rotation. As compared to preoperative model, after resecting 1/3 bilateral facet joints at L4-5 level, L4-5 segmental ROM increased 18% during flexion, 27% during extension and 45% during torsion. And the increased degree of ROM became more obvious along with a greater resection range of bilateral facet joints. No significant difference existed in L4-5 segmental ROM during lateral bending in all models. Facet joints play vital roles in lumbar segmental stability. And segmental instability may occur when 1/3 bilateral facet joints are resected.