Reduced Range Of Motion Research Articles

Optimal Treatment of C3 Lamina in Cervical Laminoplasty

Results of C4-C6 laminoplasty with C3 laminectomy and C3-C6 laminoplasty were compared retrospectively. To clarify the difference between C3 laminectomy and C3 laminoplasty in cervical laminoplasty. Intraoperative damage to the semispinalis cervicis has been shown to lead to postoperative axial symptoms and reduced range of motion (ROM). To prevent this event, C3 laminectomy in cervical laminoplasty is considered superior to C3 laminoplasty. A total of 36 patients were included in this study: 20 patients (GroupA) of C3 laminectomy, C4-C6 laminoplasty compared with 16 patients (GroupB) of C3-C6 laminoplasty. We collected patient's background data, operative time, Japanese Orthopaedic Association (JOA) score, VAS score, and radiologic findings such as C2-C7 Cobb angle, ROM, C2 inter-spinous angle, and use of postoperative PRN medication were compared. There was no statistically significant difference in the C2-C7 Cobb angles between the 2 groups before and after surgery (P= 0.315). In ROM, there was a 17.7% decrease from 31.5 preoperatively to 25.9 postoperatively in Group A, and a 6.1% decrease from 29.3 preoperatively to 27.5 postoperatively in Group B. There was no statistically significant difference in ROM (P= 0.683). Postoperative neck pain (VAS) was significantly lower in Group A than in Group B both at 1week (P= 0.015) and 1month (P= 0.035) after surgery. The C2 inter-spinous angle was statistically significantly smaller in Group A than in Group B (P= 0.004). Clinical outcomes and surgical outcomes did not differ significantly between groups. If the C2 interspinous angle is wide and intraoperative semispinalis capitis damage can be minimized, it is worth trying C3 laminoplasty, but if the C2 inter-spinous angle is narrow, C3 laminectomy is recommended from the beginning.

Comparison between the effect of immersive virtual reality training versus conventional rehabilitation on limb loading and functional outcomes in patients after anterior cruciate ligament reconstruction: A prospective randomized controlled trial

PurposeAnterior cruciate ligament injury (ACL) commonly occurs during sporting events. It causes pain, instability and reduction in range of movement of the knee which results in altered balance, reduced strength as well as loading to the involved knee. The challenge to get the patient back to competitive sports level much depends on the rehabilitation process. Post ACLR rehabilitation is challenging due to the long rehabilitation time as well as boring repetitive exercises. The aim of this study is to compare between the effectiveness of using immersive virtual reality (PlayStation VR) in addition to the conventional rehabilitation as an aid in rehabilitation of patients after ACLR in terms of objective functional assessment and pain and subjective knee function scoring. MethodsThis randomised controlled trial was undertaken in a tertiary hospital in Malaysia from July 2019 until July 2020. Thirty patients were randomised into a group undergoing purely conventional rehabilitation (Group 1) and a group undergoing both conventional rehabilitation and immersive virtual reality assisted rehabilitation (Group 2). The immersive virtual reality assisted rehabilitation was started at 3 months post operatively for 3 months duration. Limb loading, balance, range of motion, functional hop tests of the knee, pain and subjective scoring of the knee with the International Knee Documentation Committee (IKDC) Scores were measured preoperatively and at 6 months. ResultsThere were significant differences in terms of improvement of pain scores (p = 0.012) as well as IKDC Scores (p = 0.024) in Group 2 as compared to Group 1. However, there were no significant differences with regards to limb loading, balance, range of motion and functional hop tests of the knee (p > 0.05). No adverse events were observed during the study period. ConclusionImmersive virtual reality can be used as an adjunct in rehabilitation of patients after ACL reconstruction in terms of improving their pain as well as their subjective knee evaluation. Large randomised control trial is recommended to further investigate the efficacy.

The Effect of an Exercise Program on the Biomechanics of the Shoulder Girdle in Overhead Shooting in High-level Handball Players

Handball athletes are subjected to high loads, especially during the process of throwing or shooting overhead. These athletes often complain of pain and report unexplained loss of throwing velocity and throwing control. Shoulder dyskinesia and overuse syndrome have been identified as risk factors among elite handball athletes. Understanding the dynamics and kinematics of the throwing phase is vital for the exercise professional. This study evaluates the effect of an interventional exercise program on shoulder girdle biomechanics and overhead shooting. The sample consisted of 20 high level handball athletes from Greece. The athletes were divided into two groups: 10 in the study group, who were given the exercise program, and 10 in the control group, who only engaged in in-team handball training. Before and after the program, the following measurements were performed: a) angular measurements of abduction, adduction, flexion and extension of the shoulder; b) isokinetic evaluation of abduction flexion and adduction extension of the shoulder joint, at three angular velocities (60°/sec, 180°/sec and 300°/sec). Inferential statistics showed that there was a statistically significant difference in angular measurements with a reduction in range of motion for 10 of the study group. In the isokinetic assessment there was a statistically significant difference, in the 180°/sec velocities in flexion and extension, and in the deficit of flexion of both shoulders. In conclusion, the interventional exercise program had, to some extent, a beneficial effect on muscle strengthening of the shoulder girdle. The results of this study may suggest training guidelines, provide important information to exercise professionals, and provide feedback to handball athletes.

A Marker Free Visual-based Home Rehabilitation Framework

Adhesive capsulitis or more commonly known as frozen shoulder, is a familiar occurrence for adults aged above 40 caused by the inflammation of the connective tissues surrounding the shoulder joint. There are different severity of adhesive capsulitis but patients afflicted with frozen shoulder typically will experience stiffness, severe pain, and reduced range of motion (ROM) for the shoulder. No matter the course of treatment being non-steroidal anti-inflammatory drugs (NSAIDs) or steroid injections, which can help reduce the inflammation and reduce pain, in order to restore ROM for the afflicted shoulder joint, rehabilitation exercises need to be performed. Even without the current climate where medical workers are severely overworked, physical therapists are in short order especially for developing countries like Malaysia. A remedy for this situation would be to deploy home rehabilitation instead. This would be a way for patients to get proper rehabilitation exercises in between visits to the clinic to meet the physical therapist. This can also reduce the frequency of in-clinic visits while still allowing the patient to progress in the rehabilitation of their afflicted shoulder joint. Though home rehabilitation seems like a clear solution, it does come with its own set of challenges. How open will the patients themselves be to utilizing a home rehabilitation system? In light of that, this paper proposes a home rehabilitation framework focusing on a marker free visual-based implementation using the Microsoft Kinect camera. The framework will measure the impact of variables such as capability, motivation and opportunity on the adoption rate of the home rehabilitation. Cronbach’s Alpha tests were conducted to ascertain the reliability of the variables used in the framework.

The efficacy in shoulder range of motion of a snapping manual maneuver added to a standardized exercise protocol in axillary web syndrome: a randomized controlled trial

Purpose Axillary Web Syndrome (AWS) is a common sequela after surgical axillary lymph node dissection (ALND) often manifesting with reduced range of motion (ROM) of the limb, which requires rehabilitation. Notwithstanding, a standardized rehabilitation protocol is currently lacking in clinical practice. Our primary objective was therefore to evaluate the effectiveness of the use of a snapping manual maneuver (SMM, used in our clinical practice) to increase ROM during abduction (ABD) when compared with a standardized stretching exercise (SSE) protocol. A three-year follow-up of the enrolled patients was also carried out to determine the incidence of Breast Cancer-Related Lymphedema (BCRL). Materials and methods Between July 2013 and January 2019, we conducted a single-blinded randomized clinical trial. A total of 60 patients, who underwent ALND in our hospital, came to our clinic under medical advice or on voluntary access and reported AWS symptoms. The patients were randomly assigned into two equally divided groups. The treatment of group one consists in the execution of a supervised SSEs protocol, while group two additionally received a manual snapping maneuver. Patients of both groups received two treatment sessions within two weeks. At the end of the session, they were asked to continue the exercises autonomously on a daily basis, three times per day, for one month. Results There were no statically significant differences in ROM at our one-month follow-up and the incidence of BCRL was equally distributed after three years. Conclusions The use of the manual snapping maneuver in addition to stretching once per week for two weeks does not appear to improve the outcome of the patients in comparison with stretching alone and does not appear to be related to lymphedema in our 3 years follow-up.

The effectiveness of non-surgical interventions in athletes with groin pain: a systematic review and meta-analysis

BackgroundGroin pain is a common pathology among athletes, presenting pain and a reduced range of motion (ROM) as clinical characteristics. Passive physical therapy (PPT) and exercise therapy (ET) interventions are chosen firstly before surgery. The aim of this systematic review and meta-analysis was: (i) to qualitative review the effects of each non-surgical intervention; (ii) to quantitative compare the effects of PPTs plus ET intervention to ET in isolation in pain intensity, and hip ROM in athletes with groin pain.MethodsA systematic review and meta-analysis was conducted. Pubmed, PEDro, Web of science, Scopus and Cochrane library were searched. Randomized controlled trials comparing PPT plus ET to ET interventions were included. The methodological quality and risk of bias of the included studies, were assessed with the PEDro scale and the Cochrane risk-of-bias tool. To assess the certainty of evidence the GRADEpro GDT was used. Meta-analyses were conducted using RevMan 5.4 using mean difference analysis to assess the variables pain intensity and hip ROM.ResultsA total of 175 studies was identified from the consulted databases. Five studies were included for systematic- review, from which three studies were meta-analyzed. The methodological quality of the included studies ranged from poor to high. ET compared to PPT plus ET provided statistically significant improvements in pain intensity in the short-term (MD = 2.45; 95% CI 1.11, 3.79; I2 :65%). No statistically significant differences between interventions were obtained for hip ROM in the short-term.ConclusionsThe qualitative review showed that PPTs plus ET and ET seem to have positive effects on pain intensity and hip ROM. The quantitative analysis found very low certainty of evidence proposing a positive effect in pain intensity for ET interventions based on hip muscles stretching, compared to PPT combined with ET, in the short-term.

Biomechanical study of two-level oblique lumbar interbody fusion with different types of lateral instrumentation: a finite element analysis.

The aim of this study was to verify the biomechanical properties of a newly designed angulated lateral plate (mini-LP) suited for two-level oblique lumbar interbody fusion (OLIF). The mini-LP is placed through the lateral ante-psoas surgical corridor, which reduces the operative time and complications associated with prolonged anesthesia and placement in the prone position. A three-dimensional nonlinear finite element (FE) model of an intact L1-L5 lumbar spine was constructed and validated. The intact model was modified to generate a two-level OLIF surgery model augmented with three types of lateral fixation (stand-alone, SA; lateral rod screw, LRS; miniature lateral plate, mini-LP); the operative segments were L2-L3 and L3-L4. By applying a 500 N follower load and 7.5 Nm directional moment (flexion-extension, lateral bending, and axial rotation), all models were used to simulate human spine movement. Then, we extracted the range of motion (ROM), peak contact force of the bony endplate (PCFBE), peak equivalent stress of the cage (PESC), peak equivalent stress of fixation (PESF), and stress contour plots. When compared with the intact model, the SA model achieved the least reduction in ROM to surgical segments in all motions. The ROM of the mini-LP model was slightly smaller than that of the LRS model. There were no significant differences in surgical segments (L1-L2, L4-L5) between all surgical models and the intact model. The PCFBE and PESC of the LRS and the mini-LP fixation models were lower than those of the SA model. However, the differences in PCFBE or PESC between the LRS- and mini-LP-based models were not significant. The fixation stress of the LRS- and mini-LP-based models was significantly lower than the yield strength under all loading conditions. In addition, the variances in the PESF in the LRS- and mini-LP-based models were not obvious. Our biomechanical FE analysis indicated that LRS or mini-LP fixation can both provide adequate biomechanical stability for two-level OLIF through a single incision. The newly designed mini-LP model seemed to be superior in installation convenience, and equally good outcomes were achieved with both LRS and mini-LP for two-level OLIF.

Spinolaminar locking plates improve fixation strength compared to pedicle screws: a biomechanical analysis.

Pedicle screw loosening is a significant complication of posterior spinal fixation, particularly among osteoporotic patients and in deformity constructs. In orthopedic trauma surgery, locking plates and screws have revolutionized the fixation of osteoporotic fractures. We have combined the traumatology principle of fixed-angle locking plate fixation with the spine principles of segmental instrumentation. A novel spinolaminar locking plate was designed based on morphometric studies of human thoracolumbar vertebrae. The plates were fixed to cadaveric human lumbar spines and connected to form 1-level L1-L2 or L4-L5 constructs and compared to similar pedicle screw constructs. Pure moment testing was performed to assess range of motion before and after 30,000 cycles of cyclic fatigue. Post-fatigue fixture pullout strength was assessed by applying a continuous axial tensile force oriented to the principal axis of the pedicle until pullout was observed. Spinolaminar plate fixation resulted in superior pullout strength compared to pedicle screws (1,065 ± 400N vs. 714 ± 284N, p = 0.028). Spinolaminar plates performed equivalently to pedicle screws in range of motion reduction during flexion/extension and axial rotation. Pedicle screws outperformed the spinolaminar plates in lateral bending. Finally, no spinolaminar constructs failed during cyclic fatigue testing, whereas one pedicle screw construct did. The spinolaminar locking plate maintained adequate fixation post-fatigue, particularly in flexion/extension and axial rotation compared to pedicle screws. Moreover, spinolaminar plates were superior to pedicle screw fixation with respect to cyclic fatiguing and pullout strength. The spinolaminar plates offer a viable option for posterior lumbar instrumentation in the adult spine.

Risk factors for seroma formation after axillary lymph node dissection with special focus on the impact of early shoulder exercise

Background Shoulder and arm dysfunction such as reduced range of motion (ROM) and seroma formation, are common complications following axillary lymph node dissection (ALND). There are conflicting results on the effect of early postoperative exercise on the risk of seroma. This study aims to present incidence of symptomatic seroma formation in a large, population-based cohort, and assesses whether early shoulder mobilization, and other common patient and treatment-related factors are predictors of seroma. Methods This observational cohort study at the Surgical clinic at Lund University Hospital in Sweden, included 217 consecutive patients who underwent ALND due to breast cancer, cutaneous malignant melanoma (CMM), or carcinoma of unknown primary. A shoulder exercise program was introduced on the first postoperative day and data were collected at routine follow-up 4–6 weeks postsurgery. Main outcome was the strength of the associations between postsurgery exercise and seroma incidence based on logistic regression analyses, supported by data on seroma volume and number of aspirations. Results Two hundred patients completed the study. The overall seroma incidence was 67.5% and the odds of seroma were lower for patients practicing ROM exercise two times/day versus 0–1 time/day (OR 0.42, 95% CI 0.18–0.96, p = .038). ROM exercise greater than two times/day did not increase the volume, neither did the arm cycling exercise. ALND combined with mastectomy and CMM surgery were associated with larger seroma volumes (1116 ± 1068ml, p = .006) and (1318 ± 920 ml, p < .001), respectively, compared to the breast conserving surgery (537 ± 478ml) while neoadjuvant chemotherapy showed no influence. The effect of age, patients ≥60 years compared to younger, or BMI ≥ 30.0 were weaker (p = .08). Conclusions Extensive surgical treatments for breast cancer and malignant melanoma produces more seroma, and higher age and obesity may also influence the risk. ROM exercises twice daily predict a lower incidence of seroma following ALND, and more frequent shoulder exercise do not increase the volumes.

Biomechanical analysis of Instrumented decompression and Interbody fusion procedures in Lumbar spine: a finite element analysis study.

Interbody fusions have become increasingly popular to achieve good fusion rates. Also, unilateral instrumentation is favored to minimize soft tissue injury with limited hardware. Limited finite element studies are available in the literature to validate these clinical implications. A three-dimensional, non-linear ligamentous attachment finite element model of L3-L4 was created and validated. The intact L3-L4 model was modified to simulate procedures like laminectomy with bilateral pedicle screw Instrumentation, transforaminal, and posterior lumbar interbody fusion (TLIF and PLIF, respectively) with unilateral and bilateral pedicle screw instrumentation. Compared to instrumented laminectomy, interbody procedures showed a considerable reduction in range of motion (RoM) in extension and torsion (6% and 12% difference, respectively). Both TLIF and PLIF showed comparable RoM in all movements with < 5% difference in reduction of RoM between them. Bilateral instrumentation showed a more significant decrease in RoM (> 5% difference) in the entire range of motion except in torsion when compared to unilateral instrumentation. The maximum difference in reduction in RoM was noted in lateral bending (24% and 26% for PLIF and TLIF, respectively), while the least difference in Left torsion (0.6% and 3.6% for PLIF and TLIF, respectively) in comparing bilateral with unilateral instrumentation. Interbody fusion procedures were found to be biomechanically more stable in extension and torsion than the instrumented laminectomy. Single-level TLIF and PLIF achieved a similar reduction in RoM with a < 5% difference. Bilateral screw fixation proved biomechanically superior to unilateral fixation in the entire range of motion except in torsion.

Effect of Hamstring Tightness and Fatigue on Dynamic Stability and Agility in Physically Active Young Men.

Hamstring extensibility has been defined as a factor to diminished dynamic stability and therefore increased risk of injury. The purpose of this study was to analyse the effects of hamstring tightness and fatigue on dynamic stability and agility. Nineteen participants were divided between the normal extensibility group (NEG) (n = 9, 82.2° ± 12.4°) and hamstrings tightness group (HTG) (n = 10, 64° ± 4.9°) using the passive straight leg raise test. To analyse dynamic stability and agility, they performed the modified Star Excursion Balance Test (mSEBT) and Dynamic Postural Stability Index (DPSI), and hexagon agility test, respectively, before and after a fatigue protocol. A two-way repeated measures ANOVA was used to determine differences among conditions: NEG vs. HTG, and rested vs. fatigued. HTG showed a significantly lower reach in the anterior direction in the mSEBT in pre- and post-fatigue than NEG. Participants in the NEG showed poor stability after landing in the mediolateral direction on DPSI post-fatigue. No significant changes were found in agility related with the group nor fatigue state. Participants with hamstring extensibility reduction has no differences in dynamic stability after landing nor agility after fatigue test, but significantly affects reaching distances during one-leg balance. As a conclusion, a reduction in range of motion in HTG was observed, but no other effects were observed on performance and dynamic stability after a local fatigue protocol depending on hamstring extensibility.

HOW DO ANTERIOR CRUCIATE LIGAMENT INJURY AND RECONSTRUCTION AFFECT FUNCTIONAL KNEE EXTENSION? A SYSTEMATIC REVIEW AND META-ANALYSIS

Anterior cruciate ligament (ACL) ruptures are debilitating injuries, often managed via ACL reconstruction (ACLR). Reduced range of motion (ROM), particularly loss of extension (LOE), is the most significant contributor to post-operative patient dissatisfaction. LOE may preclude return to sport, increase re-rupture rates and precipitate osteoarthritis.Passive LOE rates following ACLR have been reported at 15%. However, LOE incidence during active tasks are poorly characterised. Our review sought to determine knee extension angles for active tasks following an ACL injury or ACLR. We hypothesised greater incidences of active LOE following ACL injury or ACLR, compared to uninjured contralateral limbs or controls.We systematically searched MEDLINE, Embase, Cochrane Library, Scopus, SPORTDiscus, and relevant trials databases for English articles. Included were cohort, cross-sectional, case-controlled or randomised controlled trials analysing adults with ACL injury treated surgically or otherwise, with at least 12-weeks follow-up and reporting either active knee extension angle, active LOE angles or incidence of active knee LOE during functional tasks. The protocol was registered on PROSPERO (CRD42018092295). Subsequent meta-analysis was performed.After screening, 71 eligible articles were included. Studies were heterogenous in design and quality. Included tasks were overground walking (n=44), running (n=3), hopping/jumping/cutting (n=11) single-leg landing (n=7), and stair climbing (n=6). LOE incidence varied depending on functional activities (33.95-92.74%). LOE incidence did not vary depending on ACL status (67.26% vs. 65.90% vs. 62.57% for ACL intact, ACLD and ACLR, respectively).We observed no difference in active LOE incidence according to ACL status. Importantly, the observed incidence for active LOE was reliably higher than previously reported rates for passive measures.Given the discrepancy between active and passive LOE incidence, clinicians may advisably prioritise active ROM during ACL rehabilitation.

Exercise efficacy in management of Cervical Spondylotic Myelopathy – A case report

Cervical Spondylotic Myelopathy is an ageing, degenerative spinal condition and a common cause of myelopathy in adults, with the average age of presentation being 56 years. This case report was on a 63-year man who was apparently healthy until he was presented with grade v on Nurick Classification System for Myelopathy. Lhermitte Sign was present. The clinical presentations were motor deficit in the upper limbs (ULs), lower limbs (LLs) and hands; intermittent bouts of spasms in lower limbs; painfully reduced range of motion (ROM) in the shoulder, cervical and lumbosacral joints; impaired activity of daily living (ADL) including ambulation, and reduced sleeping hours. The treatment plan aimed to relieve pain at the affected joints; improve ROM in joints of ULs and LLs; strengthen weak muscles (ULs and LLs); improve trunk control; improve patella mobility and release of tight muscle/structures(hamstrings). The adopted Exercise protocols, which were done between 11 am-1 pm at thrice weekly appointments for four months, were Mobilization &amp; Strengthening Exercises (all limbs); Back Flexibility Exercises; Quadriceps Strengthening Exercises both LLs and Neuromotor Exercises. The patient became stable on a tripod stand in the fourth month and was discharged on a home programme at the end of the fourth month. The observed improvement in the clinical condition of this Cervical Spondylotic Myelopathy patient lays credence to the efficacy of the use of exercise interventions in this condition.

Evaluation of the Efficacy of a Lift-Assist Device Regarding Caregiver Posture and Muscle Load for Transferring Tasks.

The aim of this study was to confirm the effect of a lift-assist device when performing a patient-lifting task. Ten working caregivers participated in this experiment, and lifting patients from bed to wheelchair (B2C) and wheelchair to bed (C2B) was performed for manual care (MC) and lift-assist device (robot) care (RC). EMG sensors and IMU motion sensors were attached as indicators of the assistive device's effectiveness. EMG was attached to the right side of eight muscles (UT, MD, TB, BB, ES, RF, VA, and TA), and flexion/extension angles of the neck, shoulder, back, and knee were collected using motion sensors. As a result of the analysis, both B2C and C2B showed higher muscle activities in MC than RC. When using a lift-assist device to lift patients, the RC method showed reductions in muscle activities compared to MC. As a result of the work-posture analysis, both the task type and the task phase exhibited pronounced reductions in shoulder, back, and knee ROM (range of motion) compared to those of MC. Therefore, based on the findings of this study, a lift-assist device is recommended for reducing the physical workloads of caregivers while performing patient-lifting tasks.

The Assessment of Ankle Range-of-Motion and Its Relationship with Overall Muscle Strength in a Cross-Section of Soccer Players.

Soccer (football) practice can induce a limitation of ankle range of motion (ROM) that is a possible risk factor for injury and other negative consequences over time. The main objective of this research was to investigate the effects of soccer practice on ankle ROM throughout the entire period of a sports career of soccer players (SP). Furthermore, the relationship between ankle ROM and muscle strength in SP of different ages was studied. A total of 204 SP (range 6.7−45.1 years) and 87 controls (range: 7.5−45.2 years) matched for age, body mass index (BMI), and gender, were assessed. Ankle ROM in both plantar flexion (APF) and dorsiflexion (ADF) in addition to handgrip strength (HGS) were evaluated using an inclinometer and the Jamar hydraulic hand dynamometer, respectively. The comparison between SP and control groups showed a significant reduction in ankle ROM of both APF (26.3 ± 7.2° vs. 32.6 ± 7.4°; d = −0.90; p < 0.001) and ADF (95.5 ± 15.6° vs. 105.5 ± 15.8°; d = −0.66; p < 0.001). In SP, the results of the ANOVAs test indicate that age had a significant effect on ADF (F = 4.352, p = 0.038, partial eta-squared (ηp2) = 0.015) but not on APF (F = 0.430, p = 0.746, ηp2 = 0.001). Moreover, considering only the SP, a weak inverse correlation between ADF and HGS group ADF was found (rs = −0.27; p < 0.001). Factors such as the non-linear trend of growth in young SP could hinder the definition of the relationship between ankle ROM, age, and muscle strength. However, the appropriate consideration of age and muscle strength could facilitate the management of ankle ROM in PF of different ages.

Adhesive capsulitis after COVID-19 vaccine injection: a peculiar case treated with combined bursa distention and glenohumeral capsular hydrodilatation

Frozen shoulder is a common and self-limiting condition affecting the soft tissues of the shoulders, characterized by severe pain, impaired range of motion (ROM) and limitation of daily activities. Its prevalence is 5% and it occurs most commonly in the fifth and sixth decades of life; women are more affected [DePalma in Clin Orthop Relat Res 466:552–560, 2008]. It can be idiopathic or associated with other conditions such as metabolic disorders, diabetes, thyroid diseases, prolonged immobilization, trauma [DePalma in Clin Orthop Relat Res 466:552–560, 2008], or complications after vaccine administration known as SIRVA (Shoulder injury related to vaccine administration). SIRVA is not caused by the vaccine itself but by inappropriate vaccination techniques [Martín Arias et al. in Vaccine 35:4870–4876, 2017]. The natural history of the frozen shoulder is a progression through three stages based on clinical and arthroscopic presentations: freezing, frozen and thawing [DePalma in Clin Orthop Relat Res 466:552–560, 2008; Do et al. in Orthop J Sport Med 9:232596712110036, 2021]. The onset is characterized by disabling pain, that worsens at night; it is induced by inflammation and hypervascularity and lasts from 10 to 36 weeks [Do et al. in Orthop J Sport Med 9:232596712110036, 2021]. The second stage is predominated by stiffness and severe reduction of ROM. This phase typically lasts from 9 to 12 months [Do et al. in Orthop J Sport Med 9:232596712110036, 2021]. Eventually, a recovery phase occurs, with a gradual recovery of the ROM that can last between 12 and 42 months. Ultrasound is an emerging diagnostic tool that contributes to differential diagnosis and treatment [Zappia et al. in Insights Imaging 7:365–371, 2016; Ricci et al. in J Ultrasound Med 39:633–635, 2020]: signs of adhesive capsulitis consist of thickening of the inferior recess of the glenohumeral joint capsule, thickening of the coracohumeral ligament and soft tissue structures in the rotator cuff interval, with hypervascularity. An unspecific sign is increased fluid in the tendon sheath of the long head of the biceps [Martín Arias et al. in Vaccine 35:4870–4876, 2017; Tandon et al. in J Ultrasound 20:227–236, 2017].

The Impact of COVID-19 Pandemic and Social Distancing on Motor Function and Growth of Children with Congenital Zika Syndrome: A Prospective Cohort Study

ABSTRACT This article describes the impact of social distancing during the COVID-19 pandemic on the motor function and growth of children with congenital Zika syndrome (CZS). Children’s motor function, weight, height and joint range of movement (ROM) were evaluated before the onset of the pandemic and soon after their return to face-to-face activities at a rehabilitation center. Fifty-two children (Mean 46.07 months, SD 3.76 months) were assessed. Results showed a reduction in proportion of children with adequate body mass index (p = .04), an increase in proportion with adequate height (p < 0.001), deterioration in gross motor function in children with severe motor impairment (p < .01), and a reduction in the maximum ROM for shoulder (p < .01) and wrist flexion (p = .046), elbow (p = .01), knee (p = .03) and ankle extension (p < .01), and an increase in hip flexion (p = .04). The social distancing period appears to have contributed to important losses in motor function and joint mobility of children with CZS; however, this period of time appeared to have less impact on their growth.

Effect of Myofascial Release (MFR) on Tendo Achilles (TA) Flexibility in Nurses: A Review.

Increased muscle stiffness can result in a reduced range of motion (ROM) and impaired function. An increased ankle injury risk has been associated with reduced ankle dorsiflexion ROM. Although self-myofascial release (SMFR) is commonly used in clinical and sporting settings, little is known about its impact on gastrocnemius and Achilles tendon (AT) stiffness. As a result, we investigated how SMFR using a foam roller (FR) affects gastrocnemius-AT complex stiffness and ankle dorsiflexion ROM. According to these results, self-myofascial relaxation of the gastrocnemius and an improvement in ankle dorsiflexion ROM can be accomplished by rolling an FR along the calf. Myofascial release (MFR) is a type of manual therapy that involves stretching the myofascial complex with a light load and for a long duration in order to restore optimal length, relieve pain, and improve function.Viscoelastic deformation is the rapid increase in muscle length following stretching.

Effects of rod diameter on kinematics of posterior cervical spine instrumented constructs: an ex vivo study.

Posterior cervical spine fixation is a robust strategy for stabilizing the spine for a wide range of spinal disorders. With the evolution of spinal implant technology, posterior fixation with lateral mass screws in the subaxial spine is now common. Despite interest in variable rod diameters to meet a wide range of clinical needs such as trauma, revision, and deformity surgery, indications for use of posterior cervical spine fixation are not clear. This laboratory investigation evaluates the mechanical stability and kinematic properties of lateral mass fixation with various commercially available rod diameters. The authors conducted an ex vivo experiment using 13 fresh-frozen human cervical spine specimens, instrumented from C3 to C6 with lateral mass screws, to evaluate the effects of titanium rod diameter on kinematic stability. Each intact spine was tested using a kinematic profiling machine with an optoelectrical camera and infrared sensors applying 1.5-Nm bending moments to the cranial vertebra (C2) simulating flexion-extension, lateral bending, and axial rotation anatomical motions. A compressive follower preload of 150 N was applied in flexion-extension prior to application of a bending moment. Instrumented spines were then tested with rod diameters of 3.5, 4.0, and 4.5 mm. The kinematic data between intact and surgical cases were studied using a nonparametric Wilcoxon signed-rank test. A multivariable, multilevel linear regression model was built to identify the relationship between segmental motion and rod diameter. Instrumentation resulted in significant reduction in range of motion in all three rod constructs versus intact specimens in flexion-extension, lateral bending, and axial rotation (p < 0.05). The maximum reductions in segmental ROM versus intact spines in 3.5-, 4.0-, and 4.5-mm rod constructs were 61%, 71%, and 81% in flexion-extension; 70%, 76%, and 81% in lateral bending; and 50%, 60%, and 75% in axial rotation, respectively. Segmental motion at the adjacent segments (C2-3 and C6-7) increased significantly (p < 0.05) with increasing rod diameter. The 4.5-mm rod construct had the greatest increase in motion compared to the intact spine. With increasing rod diameters from 3.5 to 4.0 mm, flexion-extension, lateral bending, and axial rotation across C3-6 were significantly reduced (p < 0.05). Similar trends were observed with a statistically significant reduction in motion in all anatomical planes when the rod diameter was increased to 4.5 mm. Although the increase in rod diameter resulted in a more rigid construct, it also created an increase (p < 0.05) in the kinematics of the adjacent segments (C2-3 and C6-7). Whether this increase translates into adverse long-term clinical effects in vivo requires further investigation and clinical assessment.

A case of wrist ganglion treated with individualized homoeopathic medicine: A case report

Ganglion are benign cystic swelling of unknown aetiology that most commonly encountered in the wrist especially dorsal aspect. Women are more frequently affected especially between age of 20-50 years. Although these are asymptomatic but may present with symptoms include wrist pain especially with movement or when a mass is felt, a reduction in range of motion, and a decrease of grip strength. Clinical presentation is usually sufficient for its diagnosis.A case of 25-year-old female suffering from wrist ganglion for few months, has been presented here. After a thorough clinical evaluation, Ruta Graveolens 200 was prescribed followed by placebo for period of four months. This case report demonstrates improvement of cystic swelling (without recurrence) as well as other presenting complaints of the patient with individualised homoeopathic treatment.