Rotation Range Research Articles

Clinical outcomes of olecranon sled fixation in patients with Mayo type II olecranon fractures

BackgroundTension band wiring and plate fixation are common internal fixation methods used for olecranon fractures, but complications and reoperations are common. The purpose of this study is to investigate the clinical outcomes of displaced olecranon fractures treated with olecranon sled internal fixation. MethodsThe data of 39 patients with olecranon fractures treated with olecranon sled in the Department of Traumatology of Beijing Jishuitan Hospital between May 2018 and April 2020 were retrospectively analyzed. There were 17 males and 22 females; the mean age was 44.0 ± 15.8 (range, 18–68 years). Preoperative olecranon fractures were classified according to the Mayo classification: 24 cases were type IIA and 15 cases were type IIB. Elbow range of motion (extension and flexion) and forearm rotation (protonation and supination) were observed at the last follow-up. The Mayo elbow performance score (MEPS), Disabilities of the arm, shoulder and hand (DASH) and visual analogue scale (VAS) scores were used to evaluate elbow function and pain, and complications were also recorded. ResultsThirty-nine patients were followed up for 33.6 ± 8.3 months (range, 25–51 months) after the operation. At the last follow-up, the mean flexion-extension arc was 137° ± 15° (range, 60°–160°), and the mean pronation-supination arc was 178° ± 4° (range, 160°–180°). The mean MEPS was 94.9 ± 9.9 (range, 50.0–100.0). The mean DASH score was 5.4 ± 4.3 (range, 0–18.3). The mean VAS score was 0.4 ± 0.8 (range, 0–3). Seven patients developed olecranon skin irritation, and 3 of them had the internal fixation device removed. Two patients developed heterotopic ossification, of whom 1 patient suffered elbow stiffness. ConclusionOlecranon sled internal fixation has good clinical outcomes in the treatment of Mayo type II olecranon fractures with a low rate of reoperations.

Combined Effects of Glenohumeral Mobilization, Stretching, and Thoracic Manipulation on Shoulder Internal Rotation Range of Motion.

Interventions including posterior glenohumeral mobilizations (PGM), sleeper stretches, and thoracic manipulation are commonly used to address posterior shoulder tightness. The purpose of this study was to assess the effects of adding thoracic manipulation to PGM and sleeper stretches on passive range of motion (PROM), joint mobility, and infraspinatus electromyographic (EMG) activity in shoulders with decreased internal rotation (IR) PROM. Randomized Sequential Intervention Laboratory Study. Forty individuals with clinically significant IR loss attended two study sessions. Participants were randomized to receive five 30 seconds bouts of either grade III PGM or sleeper stretching. Following a seven-day washout period, all participants attended a second session and received a prescriptive supine HVLA manipulation targeting the T3-4 segment, followed by the previously randomized intervention. Outcome measures included internal rotation PROM, horizontal adduction PROM, posterior glenohumeral joint translation assessed via ultrasound imaging, and EMG activity of the infraspinatus during a PGM. All outcome measures were assessed pre- and immediately post-intervention and compared statistically. There were significant within-group, but not between-group, differences for IR and horizontal adduction PROM following a single session of PGM or sleeper stretch. When combined with thoracic manipulation, significantly smaller within session changes of IR PROM were observed for both PGM (mean difference 4.4, p=0.017) and sleeper stretches (mean difference 6.4, p=0.0005). There were no significant between group differences for horizontal adduction PROM, humeral head translation, or EMG activity across all time points. Both GH posterior mobilizations and sleeper stretches improved IR and horizontal adduction PROM in a single session. The addition of thoracic manipulation prior to local shoulder interventions resulted in smaller gains of both IR and horizontal adduction ROM. Level 2.

Trunk kinematic analysis of ascent and descent stairs in college students with idiopathic scoliosis: a case-control study

BACKGROUND CONTEXTTraditional 3D motion analysis typically considers the spine as a rigid entity. Nevertheless, previous single-joint models have proven inadequate in evaluating the movement across different spinal segments in patients with idiopathic scoliosis (IS). Scoliosis significantly impairs movement functions, especially during activities such as ascending and descending stairs. There is a lack of research on the patterns of stair movement specifically for patients with IS. PURPOSEThis study aims to investigate trunk kinematics in college students with IS during stair ascent and descent tasks. A total of 56 participants, 28 with IS and 28 with healthy controls, were recruited for this case-control study. The trunk movements were analyzed using a motion analysis system that incorporated a multisegment spine model. Understanding the multi-segment spine kinematics during stair tasks can contribute to the development of effective rehabilitation programs for individuals with IS. STUDY DESIGNCase-control study. SAMPLE SIZETwenty-eight IS and 28 controls. OUTCOME MEASURESCobb angle, spinal curvature, spinal active range of motion (ROM), Kinematics. METHODSThe Qualisys system (Gothenburg, Sweden) was utilized in this study with a sampling frequency of 150 Hz. It recorded the kinematics in the thoracic, lumbar, thoracic cage, and pelvis while ascending and descending stairs for both the 28 IS individuals and the 28 control participants. Additionally, clinical parameters such as the Cobb angle, curvature of the spine, spinal range of motion (ROM), and other relevant factors were concurrently assessed among the subjects. Project supported by the National Natural Science Foundation of China (Grant No. 82205306). The authors declare no conflict of interest in preparing this article. RESULTSThe findings of this study revealed that IS individuals exhibited reduced kyphotic curvature in the sagittal plane (p<.05) when compared to the control group. In contrast, these IS patients displayed greater coronal curvature (Cobb angle) in the frontal plane and a more substantial difference in thoracic side bending range of motion in comparison to the control group (p.05). Moreover, during the ascending stair activity, IS patients showed reduced thoracic cage flexion-extension range of motion (p<.05), while displaying increased lumbar rotation range of motion and anterior-posterior pelvic tilt range of motion (p<.05) in contrast to the control group. Notably, the kinematic analysis during the descent of stairs indicated that IS patients exhibited a larger range of motion in thoracic flexion-extension, thoracic side bending, thoracic cage side bending, thoracic rotation, and thoracic cage rotation when compared to the control group (p<.05). CONCLUSIONSThe results showed significant differences in trunk kinematics between the two groups during both stair ascent and descent tasks. The utilization of the "multisegment spine model" facilitates the acquisition of motion information across multiple segments of the spine in patients diagnosed with IS, effectively enhancing the assessment outcomes derived from imaging information. The three-dimensional structural deformity in the trunk affects both static and dynamic activity patterns. In different activity states, IS patients demonstrate stiff movements in certain segments while experiencing compensatory instability in others. In the future, clinical rehabilitation programs for IS should prioritize stair-related activity training.

Arthroscopic margin convergence of large-sized rotator cuff tears does not lead to better clinical outcome compared with conventional repair

BackgroundThe margin convergence (MC) technique is used to repair longitudinal-type tears as direct repair of the apex of the longitudinal-type tear from medial to lateral is challenging. Few studies have compared the postoperative clinical outcomes and retear rates of arthroscopic rotator cuff repair (ARCR) using the MC technique with those of conventional ARCR without using the MC technique. Therefore, this study aimed to investigate the efficacy of MC on the clinical outcome and retear rates of patients with large-sized rotator cuff tears (RCTs). It was hypothesized that ARCR using the MC technique would yield clinical outcome and retear rates similar to those of ARCR without using the MC technique. MethodsThe medical records of consecutive patients who underwent ARCR for large-sized RCTs were retrospectively evaluated. Forty-four and 35 shoulders were repaired using MC (MC group) and not using MC (non-MC group), respectively. The range of motion and the Japanese Orthopaedic Association (JOA) score were assessed preoperatively and after a minimum follow-up period of 12 months postoperatively. Magnetic resonance imaging was performed at least 3 months postoperatively to determine whether the tendons had healed. ResultsThe average postoperative follow-up duration was 26.6 months and 24.3 months in the MC and non-MC groups, respectively. The mean range of motion and JOA score improved significantly in both groups postoperatively; however, the postoperative range of external rotation and the total JOA score was significantly lower in the MC group. The overall retear rate did not differ significantly between the MC (13/44, 29.5 %) and non-MC (7/35, 20.0%) groups, respectively (P=0.332). No significant differences were observed between the cases with retears in the two groups in terms of the postoperative range of motion and the total JOA score. In contrast, the postoperative range of external rotation and the total JOA score of the patients with healed tendons in the MC group were significantly poorer than those of the patients with healed tendons in the non-MC group. ConclusionsARCR using MC of large-sized longitudinal-type tears does not lead to better postoperative range of external rotation and clinical outcome compared with those of conventional repair.

Foot posture index and hip joint rotation mobility in handball and soccer players

Purpose: To assess the foot posture and hip joint mobility of elite handball and soccer players and to investigate possible correlations between these measurements. Methods: We compared the differences in means of Foot Posture Index (FPI), passive hip internal (IR), and external (ER) rotation range of motion (ROM) between three groups of male subjects (17 handball players, 17 soccer players, and 16 non-athletes). The Kruskal-Walli’s test and post-hoc pairwise comparison with the Mann-Whitney U test were used to determine the differences between the group means, and associations between variables were analyzed with Spearman’s correlation coefficient. Results: No significant differences in the mean FPI were found between the soccer players (1.3 ± 2.9), handball players (0.7 ± 2.1), and the control group (1.7 ± 2.5) (p &gt; 0.05). Similarly, no significant difference was found between the groups in the hip ER ROM. In contrast, a significantly lower (p &lt; 0.05) hip IR ROM was observed in the soccer players (30.6° ± 5.3°) compared to the handball players (41.0° ± 8.1°) and the control group (41.1° ± 6.4°). A weak positive correlation was only observed between the FPI and hip IR ROM in the soccer players (ρ: 0.36, p = 0.035). Conclusions: Handball and soccer players show a tendency toward less pronated feet compared to non-athletes, but the differences are not significant and the mean FPI values are still within the range of normal foot posture. The range of hip IR seems to be reduced in soccer players and weakly, but significantly and positively associated with the FPI value, which needs to be further investigated in future studies.

What is the influence of biomechanical variables on the Y balance test performance in recreational runners?

BackgroundAsymmetries and poor Y balance test (YBT) performance are associated with an increased risk of injuries in athletes. The aim of this study was to investigate the association between YBT performance with biomechanical variables in runners. MethodsThe runners underwent the YBT, followed by the assessment of center of pressure, plank position, muscle strength (MS) of hip flexors, extensors, abductors, and external rotators, knee extensors, ankle dorsiflexion range of motion (ROM), Q angle, forefoot alignment, and passive hip internal rotation. Associations between variables were examined using multiple linear regression models with the Bayesian Information Criterion. Results122 cases were analyzed. The R2 values were 0.38; 0.05; 0.06; and 0.15 for the anterior, posteromedial, posterolateral and composite directions models, respectively. The anterior reach in the YBT was associated with ankle dorsiflexion ROM [Sβ 95%IC: 0.43 (0.32–0.55)], passive hip internal rotation [Sβ 95%IC: 0.35 (0.24–0.47)], MS of the hip extensors [Sβ 95%IC: 0.19 (0.07–0.31)] and forefoot alignment [Sβ 95%IC: 0.14 (-0.25-0.02)]. The posteromedial and posterolateral reach were associated with MS of the hip flexors [Sβ 95%IC: 0.23 (0.09–0.37) and 0.24 (0.11–0.38)], respectively. The composite score was associated with MS of the hip flexors [Sβ 95%IC: 0.31 (0.18–0.45)], ankle dorsiflexion ROM [Sβ 95%IC: 0.24 (0.10–0.37)] and Q angle [Sβ 95%IC: 0.18 (0.04–0.31)]. ConclusionYBT performance in different directions demonstrated specific associations with key biomechanical factors.

Numerical Simulation of Rock Breaking by Diamond Particles Under Ultra Deep Drilling Conditions

In the quest to access deeper fossil energy reserves, the past three decades have witnessed a concerted effort by scientists to develop and refine technologies capable of efficient drilling in environments characterized by high temperatures and pressures. Despite these advancements, our comprehension of the physical phenomena at play remains incomplete. A fundamental challenge pertains to the interaction between the rock and the drilling bit during drilling operations. This study delves into the influence of drilling bit pressure and rotation speed on the rock-breaking efficacy of impregnated diamonds under geostress conditions of 240 MPa and temperatures of 200℃.It juxtaposes these findings with those from rock-bit interaction experiments executed on a physical simulator, which was designed in accordance with similarity principles, in a controlled laboratory setting. Our findings indicate that for ultra-deep formations, a high Weight on Bit (WOB) coupled with a lower rotation speed results in enhanced rock cutting efficiency and a reduced rate of bit wear. Consequently, we recommend optimal drilling parameters of 8.0 to 8.5 kN for WOB and a rotational speed range of 180 to 240 rad/min. Furthermore, the study underscores the profound impact of horizontal differential stress on the rate of penetration (ROP). The insights gleaned from these tests are instrumental in refining the design of rock-breaking tools and optimizing drilling parameters, thereby augmenting the efficiency of rock breaking in challenging drilling environments.

Boron nitride nanosheets from high shear exfoliation for high-performance thermal conductivity films

Boron nitride nanosheets (BNNSs) with intrinsically ultra-high thermal conductivity have attracted more and more attention and various methods have been proposed to prepare BNNSs-based thermally conductive adhesives. In this work, a liquid phase shear exfoliation process was proposed to prepare BNNSs. BNNSs can be directly prepared by exfoliating h-BN particles dispersed in isopropanol at a controlled rotational speed range of 16,000–22,000 rpm and the maximum yield of BNNSs is up to 32.1%. After the BNNSs were modified with polydopamine (M-BNNSs), the dispersion performance of BNNSs in water was significantly improved. BNNSs were incorporated into a cellulose nanofiber-based adhesive, and the highly thermally conductive films were prepared by a flow-delay process. A tested in-plane thermal conductivity of up to 23.23 W·m−1·K−1 and excellent mechanical properties are demonstrated and thermal infrared images provide a more visual representation of the high thermal conductivity and heat dissipation properties of the film, indicating the promising application of the film in the field of thermal conductivity.

Noninvasive and Reliable Quantification of Anteromedial Rotatory Knee Laxity: A Pilot Study on Healthy Individuals

Background: Anteromedial rotatory instability (AMRI) of the knee is a complex and severe condition caused by injury to the anterior cruciate ligament and/or the medial collateral ligament. Clinical studies dealing with AMRI are rare, and objective measurements are nonexistent. Purpose/Hypothesis: The objectives of this study were, first, to quantify anteromedial rotatory knee laxity in healthy individuals using a noninvasive image analysis software and, second, to assess intra- and interrater reliability and equivalence in measuring anteromedial knee translation (AMT). It was hypothesized that AMT could be reliably quantified using a noninvasive image analysis software. Study design: Cohort study; Level of evidence, 3. Methods: This prospective proof-of-concept study included healthy individuals aged 16 to 40 years with no history of knee injury or surgery. Three adhesive surface markers were placed on predefined landmarks on the medial side of the knee. Three independent investigators examined anteromedial rotatory knee laxity with an anterior drawer test in different tibial rotations (neutral tibial rotation, 15° of external tibial rotation, and 15° of internal tibial rotation). The entire examination of each knee was recorded, and AMT including the side-to-side difference (SSD) was assessed using a freely available and validated image analysis software (PIVOT iPad application). Group comparisons were performed using a 1-way analysis of variance with Bonferroni-adjusted post hoc analysis. Intraclass correlation coefficients (ICCs) were calculated to assess inter- and intrarater reliability of AMT measurements. Equivalence of measurements was evaluated using the 2 one-sided t-test procedure. Results: Anteromedial rotatory knee laxity was assessed in 30 knees of 15 participants (53% male) with a mean age of 26.2 ± 3.5 years. In all 3 raters, the highest AMT was observed in neutral tibial rotation (range of means, 2.2-3.0 mm), followed by external tibial rotation (range of means, 2.0-2.4 mm) and internal tibial rotation (range of means, 1.8-2.2 mm; P < .05). Intrarater reliability of AMT (ICC, 0.88-0.96) and SSD (ICC, 0.61-0.96) measurements was good to excellent and moderate to excellent, respectively. However, interrater reliability was poor to moderate for AMT (ICC, 0.44-0.73) and SSD (ICC, 0.12-0.69) measurements. Statistically significant equivalence of AMT and SSD measurements was observed between and within raters for almost all testing conditions. Conclusion: Anteromedial rotatory knee laxity could be quantified using a noninvasive image analysis software, with the highest AMT observed during neutral tibial rotation in uninjured individuals. Reliability and equivalence of measurements were good to excellent within raters and moderate between raters.

Intra- and Inter-rater Reliability of the Lumbar-Locked Thoracic Rotation Test in Patients With Neck Pain.

Neck pain is a common musculoskeletal disorder. Therefore, establishing effective physical therapy for neck pain is one of the most important issues. In addition, in physical therapy for neck pain, it is important to evaluate the thoracic spine, which is an adjacent region of the neck. The lumbar-locked rotation test is designed to evaluate the rotational range of the thoracic spine. However, the reliability of the test when performed on patients with neck pain has not been confirmed. We aimed to determine the intra- and inter-rater reliability of the lumbar-locked rotation test in patients with neck pain. In this study involving 43 patients, two separate examiners measured thoracic spine rotation. Both examiners conducted three measurements for each side, before and after a five-minute interval. Reliability was assessed using various intra-class correlation coefficient (ICC) models. The intra-rater reliability showed ICC values of 0.99 for both examiners. The inter-rater reliability showed ICC values of 0.98 for both right and left thoracic rotations. The findings strongly suggest that the lumbar-locked rotation test has high within-session intra- and inter-rater reliability for patients with neck pain. This test can be considered a reliable method of measuring the thoracic spine rotational range of motion in patients with neck pain in clinical practice.

Does having an external focus in immersive virtual reality increase range of motion in people with neck pain?

BackgroundWhen instructing exercises to improve Range of Motion (ROM), clinicians often create an internal focus of attention, while motor performance may improve more when using an external focus. Objectives: Using Virtual Reality (VR), we investigated the effect of tasks with an internal and external focus on maximal ROM in people with neck pain and explored whether this effect was associated with fear of movement. MethodIn this cross-over experimental design study, the cervical ROM of 54 participants was measured while performing a target-seeking exercise in a VR-environment (external focus task) and during three maximal rotation and flexion-extension movements with the VR-headset on, without signal (internal focus task). The main statistical analysis included two dependent T-tests. Pearson correlation coefficients were calculated to investigate whether the differences in ROM in both conditions were correlated to fear of movement. ResultsMaximal neck rotation was larger in the external focus condition than in the internal focus condition (mean difference: 26.4°, 95% CI [20.6, 32.3]; p < 0.001, d = 1.24). However, there was a difference favouring the internal focus condition for flexion-extension (mean difference: 8.2°, 95% CI [-14.9, −1.5]; p = 0.018, d = 0.33). The variability in ROM was not explained by variability in fear of movement (for all correlations p ≥ 0.197). ConclusionAn external focus resulted in a larger range of rotation, but our flexion-extension findings suggest that the task has to be specific to elicit such an effect. Further research, using a task that sufficiently elicits movement in all directions, is needed to determine the value of an external focus during exercise.

Motor alterations along the kinetic chain in amateur volleyball and handball athletes with shoulder pain: An observational comparative study

Overhead sports overload the shoulder complex due to movement repetition and the great amount of force created during the athletic motion, which may cause adaptations in the shoulder and lead to shoulder pain. However, overhead movements include the kinetic chain, and alterations in some of the structures throughout the kinetic chain may increase stress on the shoulder complex and be associated with shoulder pain. PurposeTo compare kinetic chain components in overhead athletes with and without shoulder pain. MethodsForty-one volleyball and handball athletes (21 with and 20 without shoulder pain) were included and assessed for hip internal (IR) and external rotation (ER) range of motion (ROM), hip and trunk isometric strength, trunk endurance and neuromuscular control of the lower and upper limbs (Y balance test). ResultsAthletes with shoulder pain showed smaller IR ROM in both hips, lower endurance time for trunk extensors and flexors, decreased reach distance in the anterior and posteromedial direction, as well as a smaller composite score in the Y balance test (p < 0.05). ConclusionVolleyball and handball athletes with shoulder pain showed changes in ROM throughout the kinetic chain in addition to lower core endurance, and decreased neuromuscular control of lower limbs.

Safety and effectiveness of the three-dimensional-printed guide plate-assisted rotation axis positioning of a hinged external fixator for the elbow.

We aimed to evaluate the safety and effectiveness of three-dimensional (3D)-printed guide plates for assisting in the positioning of the rotation axis of an elbow-hinged external fixator. Terrible triad (TT) patients, who were screened using the predefined inclusion and exclusion criteria, underwent installation of a hinged external fixator on the basis of internal fixation; 3D-printed guide plates, generated from the patient's imaging data, assisted in positioning the rotation axis. All patients received the same peri-operative management and were followed up at six, 12, 24, and 48 weeks postoperatively. The duration of positioning pin placement, the number of fluoroscopies, pin placement success rate, types and incidence of post-operative complications, and the Mayo elbow performance score (MEPS) of the diseased elbow and range of motion (ROM) of both elbows were assessed. In 25 patients who completed the follow-up, the average time required for positioning pin placement was 329.32 ± 42.38 s (263-443 s), the average number of fluoroscopies was 2.32 ± 0.48 times (2-3 times), and the pin placement success rate was 100%. At the last follow-up, the mean MEPS of the diseased elbow was 97.50 ± 6.92 (75-100), with an excellent and good rate of 100%, and all patients demonstrated stable concentric reduction. The average range of flexion and extension was 135.08° ± 17.10° (77-146°), while the average range of rotation was 169.21° ± 18.14° (108-180°). No significant difference was observed in the average ROM between the both elbows (P > 0.05). Eight (32%) patients developed post-operative complications, including elbow stiffness due to heterotopic ossification in three (12%) patients, all of whom did not require secondary intervention. Utilizing 3D-printed guide plates for positioning the rotation axis of an elbow-hinged external fixator significantly reduced intra-operative positioning pin placement time and the number of fluoroscopies with excellent positioning results. Satisfactory results were also obtained in terms of post-operative complications, elbow ROM, and functional scores.

Reproduction of forearm rotation dynamic using intensity-based biplane 2D–3D registration matching method

This study aimed to reproduce and analyse the in vivo dynamic rotational motion of the forearm and to clarify forearm motion involvement and the anatomical function of the interosseous membrane (IOM). The dynamic forearm rotational motion of the radius and ulna was analysed in vivo using a novel image-matching method based on fluoroscopic and computed tomography images for intensity-based biplane two-dimensional–three-dimensional registration. Twenty upper limbs from 10 healthy volunteers were included in this study. The mean range of forearm rotation was 150 ± 26° for dominant hands and 151 ± 18° for non-dominant hands, with no significant difference observed between the two. The radius was most proximal to the maximum pronation relative to the ulna, moved distally toward 60% of the rotation range from maximum pronation, and again proximally toward supination. The mean axial translation of the radius relative to the ulna during forearm rotation was 1.8 ± 0.8 and 1.8 ± 0.9 mm for dominant and non-dominant hands, respectively. The lengths of the IOM components, excluding the central band (CB), changed rotation. The transverse CB length was maximal at approximately 50% of the rotation range from maximum pronation. Summarily, this study describes a detailed method for evaluating in vivo dynamic forearm motion and provides valuable insights into forearm kinematics and IOM function.

Differential leg and trunk operation during skipping without and with hurdles in bipedal Japanese macaque.

When locomoting bipedally at higher speeds, macaques preferred unilateral skipping (galloping). The same skipping pattern was maintained while hurdling across two low obstacles at the distance of a stride within our experimental track. The present study investigated leg and trunk joint rotations and leg joint moments, with the aim of clarifying the differential leg and trunk operation during skipping in bipedal macaques. Especially at the hip, the range of joint rotation and extension at lift off was larger in the leading than in the trailing leg. The flexing knee absorbed energy and the extending ankle generated work during each step. The trunk showed only minor deviations from symmetry. Hurdling amplified the differences and notably resulted in a quasi-elastic use of the leading knee and in an asymmetric operation of the trunk.

Effects of exercise combined with cervicothoracic spine self-mobilization on chronic non-specific neck pain

To investigate the short-term effects and differences between exercise alone and exercise combined with self-mobilization training on chronic non-specific neck pain (CNSNP). Thirty subjects who met the criteria were recruited and randomly assigned to the exercise training group, the exercise combined with cervical self-mobilization training group (ECCM), and the exercise combined with cervicothoracic self-mobilization training group (ECCTM). The exercise training group received 6 weeks of deep neck flexor under biofeedback and scapular stability training, and the other two groups received 6 weeks of cervical self-mobilization and cervicothoracic self-mobilization, respectively, in addition to exercise training. Neck pain, cervical range of motion (ROM), neck disability, strength and endurance of deep neck flexor and quality of life were assessed before and after 6 weeks of training. The study results showed that all the three training programs for 6 weeks increased the strength and endurance of deep neck flexor, increased cervical ROM, reduced pain, and improved neck function (P < 0.05). The exercise combined with self-mobilization two groups compared with only the exercise training group had better improvement in ROM of extension, lateral flexion, rotation and quality of life (P < 0.05). Compared with exercise alone and exercise combined with cervical self-mobilization training, the exercise combined with cervicothoracic self-mobilization training was the best in improving ROM of right lateral flexion (exercise training group vs ECCTM: P < 0.01, d = 1.61, ECCM vs ECCTM: P < 0.05, d = 1.14) and pain (exercise training group vs ECCTM: P < 0.05, d = 1.34, ECCM vs ECCTM: P < 0.05, d = 1.23). Deep flexor muscle and shoulder stability training can improve the endurance and strength of the deep flexor muscles of the neck and coordinate the movement patterns of the shoulder and neck. Self-mobilization techniques can promote improvements in cervical lateral flexion and rotation range of motion, alleviate neck disability and further improve quality of life. A combination of exercise and cervicothoracic self-mobilization training appears beneficial for the management of neck pain.

Medial meniscus extrusion during gait is associated with decrease in knee rotation in early-stage knee osteoarthritis

BackgroundIn patients with medial knee osteoarthritis (OA), medial meniscus extrusion during gait is aggravated by mechanical stress, such as knee adduction moment (KAM). Conversely, the decrease in the range of knee rotation during stance phase is also one of the important issues in early knee OA, whereas the correlation between medial meniscus extrusion and knee rotation during gait are unclear. Research questionTo investigate the correlation between increase in medial meniscus extrusion and range of knee rotation during gait in patients with early- and late-stage of knee OA. MethodsForty patients with medial knee OA were enrolled and divided into early- and late-OA group by Kellgren-Lawrence grading scale. During gait tasks, the extent of medial meniscus extrusion was measured using ultrasonography and kinetic/kinematic data were measured using three-dimensional motion analysis system. The correlation between medial meniscus extrusion and the range of knee rotation or KAM were evaluated in the overall, early-, and late- OA groups. ResultsA significant negative correlation was observed between an increase in medial meniscus extrusion and range of knee rotation angle in early-OA group only. However, an increase in medial meniscus extrusion significantly correlated with the second KAM peak in the overall and early-OA groups. SignificanceThe decrease in range of knee rotation during stance phase may be associated with the increase in medial meniscus extrusion during gait in patients with early knee OA.

Kickstand Technique for Treatment of Valgus-Impacted Proximal Humerus Fractures

Purpose: Describe a new technique using a minimally invasive surgical intervention for the treatment of valgus-impacted proximal humerus fractures. The Kickstand technique is a novel approach that offers reliable fixation and union without the need for additional hardware. Materials and Methods: A retrospective case series of 3 patients with valgus-impacted proximal humerus fractures was treated with this Kickstand technique using an intramedullary fibular allograft. Postoperative x-rays and outcomes are presented. Results: The Kickstand technique was used to address valgus-impacted fractures in 3 patients. Postoperative range of motion and shoulder outcome scores were reported at 2 years for patients A and B, and at 1 year for patient C (Active range of motion external rotation: 28 degrees; Active range of motion elevation: 140 degrees; Simple Shoulder Test-12: 11; American Shoulder and Elbow Standardized Shoulder Assessment: 78). Postoperative Grashey and lateral x-rays for each patient show union of the valgus-impacted humerus. Conclusions: The Kickstand technique using intramedullary fibular allograft is an alternative fixation technique for displaced valgus proximal humerus fracture. It has the advantage of avoiding additional metallic hardware and allowing early motion but requires the use of intramedullary fibular allograft which can interfere with future use of stemmed humeral prosthesis.

Long-Travel 3-PRR Parallel Platform Based on Biomimetic Variable-Diameter Helical Flexible Hinges.

Technological advancements across various sectors are driving a growing demand for large-scale three-degree-of-freedom micro-nano positioning platforms, with substantial pressure to reduce footprints while enhancing motion range and accuracy. This study proposes a three-prismatic-revolute-revolute (3-PRR) parallel mechanism based on biomimetic variable-diameter helical flexible hinges. The resulting platform achieves high-precision planar motion along the X- and Y-axes, a centimeter-level translation range, and a rotational range of 35° around the Z-axis by integrating six variable-diameter flexible helical hinges that serve as rotational joints when actuated by three miniature linear servo drives. The drives are directly connected to the moving platform, thereby enhancing the compactness of the system. A kinematic model of the motion platform was established, and the accuracy and effectiveness of the forward and inverse kinematic solutions were validated using finite element analysis. Finally, a prototype of the 3-PRR parallel platform was fabricated, and its kinematic performance was experimentally verified visually for improved endpoint displacement detection. The assessment results revealed a maximum displacement error of 9.5% and confirmed that, judging by its favorable workspace-to-footprint ratio, the final system is significantly more compact than those reported in the literature.

Acceptable range of forearm deformity derived from relation to three-dimensional analysis and clinical impairments.

This study aimed to investigate deformity patterns that cause clinical impairments and determine the acceptable range of deformity in the treatment of forearm diaphyseal fractures. A three-dimensional (3D) deformity analysis based on computed bone models was performed on 39 patients with malunited diaphyseal both-bone forearm fractures to investigate the 3D deformity patterns of the radius and ulna at the fracture location and the relationship between 3D deformity and clinical impairments. Clinical impairments were evaluated using forearm motion deficit. Cutoff values of forearm deformities were calculated by performing receiver operating characteristic analysis using the deformity angle and the limited forearm rotation range of motion (less than 50° of pronation or supination) resulting in activities of daily living (ADL) impairment as variables. The extension, varus, and pronation deformities most commonly occurred in the radius, whereas the extension deformity was commonly observed in the ulna. A positive correlation was observed between pronation deficit and extension deformity of the radius (R = 0.41) and between supination deficit and pronation deformity of the ulna (R = 0.44). In contrast, a negative correlation was observed between pronation deficit and pronation deformity of the radius (R = -0.44) and between pronation deficit and pronation deformity of the ulna (R = -0.51). To minimize ADL impairment, radial extension deformity should be <18.4°, radial rotation deformity <12.8°, and ulnar rotation deformity <16.6°. The deformities in the sagittal and axial planes of the radius and in the axial plane of the ulna were responsible for the limited forearm rotation.