Relocation Test Research Articles

Glenohumeral joint kinematics during apprehension-relocation test in patients with anterior shoulder instability and glenoid bone loss.

This study aimed to quantify the shoulder kinematics during an apprehension-relocation test in patients with anterior shoulder instability (ASI) and glenoid bone loss using the radiostereometric analysis (RSA) method. Kinematics were compared with the patient's contralateral healthy shoulder. A total of 20 patients with ASI and > 10% glenoid bone loss and a healthy contralateral shoulder were included. RSA imaging of the patient's shoulders was performed during a repeated apprehension-relocation test. Bone volume models were generated from CT scans, marked with anatomical coordinate systems, and aligned with the digitally reconstructed bone projections on the RSA images. The glenohumeral joint (GHJ) kinematics were evaluated in the anteroposterior and superoinferior direction of: the humeral head centre location relative to the glenoid centre; and the humeral head contact point location on the glenoid. During the apprehension test, the centre of the humeral head was 1.0 mm (95% CI 0.0 to 2.0) more inferior on the glenoid for the ASI shoulder compared with the healthy shoulder. Furthermore, the contact point of the ASI shoulder was 1.4 mm (95% CI 0.3 to 2.5) more anterior and 2.0 mm (95% CI 0.8 to 3.1) more inferior on the glenoid compared with the healthy shoulder. The contact point of the ASI shoulder was 1.2 mm (95% CI 0.2 to 2.6) more anterior during the apprehension test compared to the relocation test. The humeral head centre was located more inferior, and the GHJ contact point was located both more anterior and inferior during the apprehension test for the ASI shoulders than the healthy shoulders. Furthermore, the contact point displacement between the apprehension and relocation test revealed increased joint laxity for the ASI shoulder than the healthy shoulders. These results contribute to existing knowledge that ASI shoulders with glenoid bone loss may also suffer from inferior shoulder instability.

Biometric Image-Analysis Techniques for Monitoring Chronic Neck Pain

The term “mechanical neck pain” is a generic term used to define neck pain in people with neck injuries, neck dysfunction, or shoulder and neck pain. Several factors must be considered during the physical-therapy evaluation of cervical disorders, including changes in the visual systems and postural and proprioceptive balance. Currently, the Cervicocephalic Relocation Test (CRT) is used by physiotherapists to detect changes in cervical proprioception. This procedure requires precise equipment, customized installation in a dedicated area and, above all, a significant amount of time post-treatment for the doctor to make the diagnosis. An innovative system composed of Google’s MediaPipe library combined with a personal laptop and camera is proposed and evaluated. The system architecture was developed, and a user interface was designed with the goal of allowing the system to be used more easily, more quickly, and more effectively by the healthcare practitioner. The tool is presented in this paper and tested in a use case, and the results are presented. The final user report, containing the visualization of the results of the CRT, which are ready for analysis by the physical therapist, can be exported from the developed tool.

A novel multiagent system for cervical motor control evaluation and individualized therapy: integrating gamification and portable solutions

The study focused on designing a portable, objective device for assessing and addressing Cervical Motor Control (CMC) impairments. This device is based on a proposed architecture that employs advanced technology to evaluate and enhance patients’ CMC. During a pilot study with 10 participants, the device’s feasibility and usability were verified, including an initial assessment using the Head Relocation Test and a 12-session intervention over 4 weeks. The architecture of the proposed system is responsible for gathering pertinent data concerning patients’ cervical motor control. It employs advanced algorithms to process this data and objectively assess CMC function. Furthermore, the system tailors the therapy to each patient’s individual needs. Preliminary results indicate that the device and the proposed architecture positively impact assessment test performance accuracy. While additional validation tests are required to confirm their effectiveness, this device emerges as a promising and valuable alternative for assessing and treating patients with CMC impairments. Its focus on advanced technology and personalized adaptation aligns with previous research in telerehabilitation and classroom physical activity promotion.

Glenoid rim morphology in young athletes with unstable painful shoulders: primarily painful vs. frankly unstable

To investigate the characteristics of glenoid rim morphology in young athletes (<40 yr) with unstable painful shoulder. This was a retrospective case series. The inclusion criteria were as follows: (1) shoulder pain during sports activity, (2) traumatic onset, (3) no complaint of shoulder instability, and (4) soft tissue or bony lesions confirmed on imaging examinations (computed tomography and magnetic resonance imaging). The above-mentioned painful cohort was then compared (in a 2:1 ratio) to a match-paired control group of patients with similar demographics but with frank anterior glenohumeral instability as defined by imaging and physical findings. The pain (not apprehension) was reproduced during the anterior apprehension test in supine position and relieved by relocation test in all patients. Glenoid rim morphology, bone union in shoulders with a fragment-type glenoid, glenoid defect size, bone fragment size, medial displacement of bone fragments (MDBF), and medial distance of erosion (MDE) were compared between painful shoulders and unstable shoulders. There were 79 painful shoulders and 165 unstable shoulders. The glenoid rim morphology was normal in 33 shoulders, erosion-type in 15 shoulders, and fragment-type in 31 shoulders among painful shoulders, whereas the respective shoulders were 19, 33, and 113 among unstable shoulders (P<.001). Bone union was complete in 15 shoulders, partial in 14 shoulders, and nonunion in 2 shoulders among painful shoulders, whereas the respective shoulders were 43, 31, and 39 among unstable shoulders (P=.001). The mean glenoid defect size was 6.0±7.2% and 12.7±7.4%, respectively (P<.001), and the mean bone fragment size was 5.8±6.4% and 5.4±4.6%, respectively, (P=.591). The mean MDBF was 1.4±1.5 mm and 3.0±2.2 mm, respectively (P<.001), and the mean MDE was 2.3±1.2 mm and 5.2±2.4 mm, respectively (P<.001). In shoulders with a smaller glenoid defect (<13.5%), the prevalence of shoulders with MDBF (<2 mm) and shoulders with MDE (<2 mm) was more frequent in painful shoulders. On the other hand, in shoulders with a larger glenoid defect (≥13.5%), erosion-type glenoid, nonunion in fragment-type glenoid and bone fragment smaller than 7.5% was not recognized in painful shoulders. Shoulders with MDBF (<2 mm) were significantly more frequent in painful shoulders (P=.009). In painful shoulders normal or erosion-type glenoid was predominant, and glenoid defect size was significantly smaller than unstable shoulders. On the other hand, a large bone fragment (≥7.5%) remained and united completely or partially in all shoulders with a larger glenoid defect (≥13.5%). Bone union was obtained within 2 mm from the articular surface in most of them.

Do We Need A Bone Block Procedure in Recurrent Anterior Shoulder Instability?: A Case Report

Background: Recurrent Anterior Shoulder Instability (RASI) is usually preceded by trauma. The incidence recurrence rate is high in trauma Induced RASI, especially in younger patients. The right diagnosis and management must be ruled out immediately for a better outcome. Case Report: The 28-year-old man complained of right shoulder instability for the past eight years, which worsened in the last year. The patient had a history of trauma. Anterior apprehension and relocation test for the right shoulder showed a positive result. Radiologic imaging showed bony bankart loss (27%) and an on-track hillsach lesion of the humeral head. The Instability Severity Index Score (ISIS) is 7 points. Based on these results, an open surgery bone block-Latarjet procedure was done. The surgery was successfully performed, and there was no sign of recurrent instability and pain after one year.Discussion: The number of recurrent shoulder dislocations is over 75%. Bone loss found in the patient will increase the chance of RASI. No block procedure effectively prevented future recurrence from the bone stop effect, which increases the glenoid cavity, stretching effect, and tensioning effect that prevents excessive humeral translation.Conclusion: In the case of RASI, treatment decisions need to be based on the patient's exact condition. Bone block-Latarjet procedure is indicated in patients with bony bankart loss &gt;25%, on track hillsach lesion, and &gt;6 ISIS. In this research, the patient showed improved functional and clinical outcomes after eight years of chronic shoulder instability.

Arthroscopic findings of the glenohumeral joint in symptomatic anterior instabilities: comparison between overhead throwing disorders and traumatic shoulder dislocation.

The term shoulder instability refers to a variety of mechanisms and clinical presentations. One of the common pathologies of throwing disorders is internal impingement with anterior instability. Most throwing athletes with symptomatic internal impingement with anterior instability exhibit positive apprehension and relocation test results, whereas those with recurrent anterior shoulder instability display positive apprehension test results. While the glenoid labrum-inferior glenohumeral ligament complex is a significant critical stabilizer for the prevention of anterior shoulder dislocation, the characteristics of the essential lesion in internal impingement with anterior instability have not been determined yet. This study aimed to compare the intra-articular lesion of athletes with internal impingement related to the overhead throwing motion in athletes with a traumatic shoulder dislocation. Sixty-one athletes (all men; mean age, 25.2±12.6yr) who underwent an arthroscopic procedure were divided into 2 groups: 25 in the throwing group and 36 in the dislocation group. All shoulders had subtle glenohumeral instability defined by a positive anterior apprehension test and a relocation test. Those with voluntary and multidirectional instability and large glenoid bone loss (more than 25%) were excluded from the current study. All shoulders were evaluated for the following evidence: rotator cuff injury, superior labrum tear anterior and posterior lesions, labral pathologies including Bankart lesions, osteochondral lesions to the humeral head, biceps tendon fraying or rupture, and inferior glenohumeral ligament and middle glenohumeral ligament (MGHL) conditions. Arthroscopic findings of the throwing group showed more supraspinatus injuries (92% and 25%, P<.001), type II superior labrum tear anterior and posterior lesions (60% and 3%, P<.001), posterosuperior labral lesions (92% and 39%, P<.001), and hypoplastic MGHLs (56% and 6%, P<.001) and lesser Bankart lesions (8% and 92%, P<.05) than those of the dislocation group. These results indicate that the characteristic lesions of internal impingement with anterior instability in throwing athletes include partial thickness rotator cuff tears, superior labrum tear anterior and posterior lesions, posterosuperior labral tears, and hypoplastic MGHLs. As expected, the physiopathology of internal impingement with anterior instability in throwing athletes may be related to the dysfunction of the anterosuperior glenohumeral capsular ligament, including the MGHL, rather than the inferior glenohumeral ligament as in traumatic anterior shoulder dislocations. These findings would be useful for defining treatment strategies for internal impingement with anterior instability in overhead throwing athletes.

Cervical joint positioning error and its association with cervical spine mechanics among undergraduate students.

A cross sectional analytical study was conducted from September 26 to December 28 2018 at Shifa Tameer-e-Millat University Islamabad with 111 undergraduate students aged 17-26 years as participants. The aim of the study was to establish the normative values of cervical joint positioning error (CJPE) and its association with cervical spine mechanics. Neck discomfort was measured using the neck portion of the "student specific Cornell Musculoskeletal Discomfort Questionnaire" (ssCMDQ) and CJPE was measured via cervico-cephalic relocation test using a goniometer. Non-parametric tests of significance were used because the data was not normally distributed in terms of normality testing. Normative values of CJPE were noted to be highest in flexion (9o±9o), rotation towards left (9o±6o) and right (8o±7o), extension (6o±8o), and lastly lateral flexion towards left (5o±7o) and right (5o±5o). Higher CJPE in all movements was observed among females; however, no significant statistical differences were observed (p>0.05). In terms of correlation, important trends included significantly positive correlation of neck discomfort with CJPE in extension, and of CJPE in lateral flexion towards the left with CJPE in lateral flexion towards the right and flexion (p<0.05).

The multi-grip and standard myoelectric hand prosthesis compared: does the multi-grip hand live up to its promise?

BackgroundMulti-grip myoelectric hand prostheses (MHPs), with five movable and jointed fingers, have been developed to increase functionality. However, literature comparing MHPs with standard myoelectric hand prostheses (SHPs) is limited and inconclusive. To establish whether MHPs increase functionality, we compared MHPs with SHPs on all categories of the International Classification of Functioning, Disability, and Health-model (ICF-model).MethodsMHP users (N = 14, 64.3% male, mean age = 48.6 years) performed physical measurements (i.e., Refined Clothespin Relocation Test (RCRT), Tray-test, Box and Blocks Test, Southampton Hand Assessment Procedure) with their MHP and an SHP to compare the joint angle coordination and functionality related to the ICF-categories ‘Body Function’ and ‘Activities’ (within-group comparisons). SHP users (N = 19, 68.4% male, mean age = 58.1 years) and MHP users completed questionnaires/scales (i.e., Orthotics and Prosthetics Users’ Survey—The Upper Extremity Functional Status Survey /OPUS–UEFS, Trinity Amputation and Prosthesis Experience Scales for upper extremity/TAPES-Upper, Research and Development-36/RAND-36, EQ-5D-5L, visual analogue scale/VAS, the Dutch version of the Quebec User Evaluation of Satisfaction with assistive technology/D-Quest, patient-reported outcome measure to assess the preferred usage features of upper limb prostheses/PUF-ULP) to compare user experiences and quality of life in the ICF-categories ‘Activities’, ‘Participation’, and ‘Environmental Factors’ (between-group comparisons).Results‘Body Function’ and ‘Activities’: nearly all users of MHPs had similar joint angle coordination patterns with an MHP as when they used an SHP. The RCRT in the upward direction was performed slower in the MHP condition compared to the SHP condition. No other differences in functionality were found. ‘Participation’: MHP users had a lower EQ-5D-5L utility score; experienced more pain or limitations due to pain (i.e., measured with the RAND-36). ‘Environmental Factors’: MHPs scored better than SHPs on the VAS-item holding/shaking hands. The SHP scored better than the MHP on five VAS-items (i.e., noise, grip force, vulnerability, putting clothes on, physical effort to control) and the PUF-ULP.ConclusionMHPs did not show relevant differences in outcomes compared to SHPs on any of the ICF-categories. This underlines the importance of carefully considering whether the MHP is the most suitable option for an individual taking into account the additional costs of MHPs.

How well can we detect cervical driven sensorimotor dysfunction in concussion patients? An observational study comparing patients with idiopathic neck pain, whiplash associated disorders and concussion

BackgroundPatients with mild traumatic brain injury (mTBI) suffer from sensorimotor impairments. Evidence is emerging that cervical spine plays an important role in mTBI, but it is not known how cervicocephalic kinaesthetic sensibility measured during dynamic unpredictable head movements and measures of position sense, cervical induced postural balance and eye movement control differ between mTBI, whiplash associated disorders (WAD) patients, idiopathic neck pain patients and healthy controls. Research questionAre cervical sensorimotor deficits present in mTBI patients and do they differ from sensorimotor deficits found in traumatic and nontraumatic neck pain patients and whether they differ from healthy controls. MethodsTwenty idiopathic neck pain patients, 18 WAD, 17 mTBI and 20 healthy controls were enroled in the study. Frequency and velocity of centre of pressure movements were measured during parallel stance in the neutral and neck torsion positions, gain and smooth pursuit neck torsion difference of eye movements during smooth pursuit neck torsion test (SPNTT) and cervicocephalic kinaesthesia using Butterfly and head-to-neutral relocation test. ResultsStatistically significant differences in postural balance, both tests of cervicocephalic kinaesthesia and SPNTT were observed between healthy controls and all patient groups. No differences were observed between patient groups for SPNTT, Butterfly and head-to-neutral relocation test, but differences were present in postural balance between mTBI and both groups of patients with neck pain disorders. Differences were found in the ML direction for mTBI, but not differences were found for AP direction. SignificanceResults of our study show that mTBI present with similar impairment in cervical driven sensorimotor deficits as patients with neck pain disorders, but they differ from healthy individuals. Clinical practice would benefit from identifying cervical spine related sensorimotor impairments in patients with mTBI. This could enable to design more targeted prevention and rehabilitation programs to minimise cervical spine related disorders in concussion patients.

Training prosthesis users to switch between modes of a multi-articulating prosthetic hand

Purpose Producing triggers to switch between modes of myoelectric prosthetic hands has proven to be difficult. We evaluated whether digital training methods were feasible in individuals with an upper limb defect (ULD), whether myosignals in these individuals differ from those of non-impaired individuals and whether acquired skills transfer to prosthesis use. Materials and methods Two groups participated in a 9-day pre-test–post-test design study with seven 45-minute training sessions. One group trained using a serious game, the other with their myosignals digitally displayed. Both groups also trained using a prosthesis. The pre- and post-tests consisted of an adapted Clothespin Relocation Test and the spherical subset of the Southampton Hand Assessment Procedure. After the post-test, the System Usability Scale (SUS) was administered. Clinically relevant performance measures and myosignal features were analysed. Results Four individuals with a ULD participated. SUS-scores deemed both training methods feasible. Three participants produced only a few correct triggers. Myosignals features indicated larger variability for individuals with a ULD compared to non-impaired individuals (previously published data [1]). Three participants indicated transfer of skill. Conclusions Even though both training methods were deemed feasible and most participants showed transfer, seven training sessions were insufficient to learn reliable switching behaviour. Trial registration: The study was approved by the medical ethics committee of the University Medical Center Groningen (METc 2018.268). Implications for rehabilitation Switching between pre-programmed modes of a myoelectric prosthetic hand can be learned, however it does require training. Serious games can be considered useful training tools for trigger production in early phases of myoelectric prosthesis control training. In order to evoke transfer of skill from training to daily life both task-specificity and focus of attention during training should be taken into account.

Relationship between Cervicocephalic Kinesthetic Sensibility Measured during Dynamic Unpredictable Head Movements and Eye Movement Control or Postural Balance in Neck Pain Patients.

Cervical afferent input is believed to affect postural balance and oculomotor control in neck pain patients, but its relationship to cervicocephalic kinesthesia, describing movement sense, has not yet been studied. The aim of this study was to analyze the relationship of two aspects of cervicocephalic kinesthesia to postural balance and oculomotor control in neck torsion positions. Forty-three idiopathic neck pain patients referred from orthopedic outpatient clinics and forty-two asymptomatic controls were enrolled in the study. A force plate was used to measure center-of-pressure movements during parallel stances under neutral and neck torsion maneuvers. Video-oculography was used to assess eye movements during smooth pursuit neck torsion test (SPNTT), while kinesthetic awareness was measured using the Butterfly test and head-to-neutral relocation test. Multiple regression was used to describe relationships between tests. Body sway in the anterior–posterior direction was related to Butterfly parameters but less to the head-to-neutral test. A medium relationship between Butterfly parameters and gain during SPNTT, with less SPNT-difference, was observed, but not for the head-to-neutral test. It can be concluded that specific aspect of neck kinesthetic functions (i.e., movement sense) importantly contributes towards oculomotor and balance control, which is more evident under neck torsion positions in neck pain patients, but is less pronounced in asymptomatic individuals.

Prone Apprehension Relocation Test significantly correlates with radiological instability scores of the hip.

ABSTRACTRecently, there was a debate about whether borderline dysplastic hips should be treated surgically with hip arthroscopy or periacetabular osteotomy (PAO). Current studies recommend a classification into stable and unstable hips. Therefore, radiological scores have been described in recent years. Likewise, a new clinical stability test with the Prone Apprehension Relocation Test (PART) has been described. However, there has been no correlation between the modern radiological scores and the PART. We prospectively studied a consecutive group of patients who presented to our clinic. The PART and radiological scores were assessed in these patients. We divided the patients into a PART-positive and a PART-negative group and analyzed the associated clinical and radiological findings. Out of 126 patients (126 hips) included, 36 hips (29%) were evaluated as PART positive. There were significantly more females in the PART positive group (P = 0.005). Comparing the PART groups, significant differences (P < 0.0001) were found for the lateral center edge angle (LCEA), Femoro-Epiphyseal Acetabular Roof (FEAR) index, Gothic arch angle (GAA), anterior wall index (AWI), the occurrence of the upsloping lateral sourcil (ULS) and signs of acetabular retroversion. The correlation analysis showed an association between LCEA, FEAR index, GAA, AWI, ULS and the PART. A chi-square automatic interaction detection algorithm revealed that the strongest predictor of positive PART was the GAA. In conclusion, a high correlation between the PART and known radiological instability parameters was found. Consequently, a combination of clinical instability testing and radiological instability parameters should be applied to detect unstable hips.

Bony Apprehension Test for Identifying Bone Loss in Patients With Traumatic Anterior Shoulder Instability: A Validation Study

Background: The presence of bone loss has important implications for the surgical treatment of patients with recurrent shoulder instability. The bony apprehension test (BAT) is a physical examination maneuver that was designed to improve specificity from the anterior apprehension test (AAT) in detecting critical bone loss. Purpose: The purpose of this study was to compare the BAT with the AAT and relocation test based on their abilities to predict critical bone loss. Several well–described criteria were utilized to capture critical (≥25%) and subcritical (≥13.5%) glenoid defects, as well as Hill-Sachs defects (≥19%). The ability of the BAT to predict bipolar bone loss was also assessed, as indicated by engaging Hill-Sachs defects and off–track lesions. Study Design: Cohort study (diagnosis); Level of evidence, 1. Methods: The study cohort included patients ≥18 years of age who were scheduled to undergo arthroscopic stabilization for traumatic anterior shoulder instability. Notable exclusion criteria included multidirectional shoulder instability, connective tissue disorders, and workers’ compensation or litigation cases. Patients underwent physical examination immediately before surgery by the treating surgeon (ie, before the induction of anesthesia). Critical glenoid and humeral bone defects were measured on preoperative computed tomography scans. Hill-Sachs engagement and on- or off–track determination of bone loss were assessed arthroscopically and via computed tomography, respectively. Results: A total of 52 patients were included in the study. In cases of subcritical glenoid bone loss (≥13.5%) and critical Hill-Sachs defects (≥19%), the BAT had good and fair specificity (82% and 72%, respectively) but poor sensitivity (40% and 39%). The BAT also had poor sensitivity (0%), specificity (67%), and positive predictive value (0%) for higher percentages of glenoid bone loss (≥25%). When engaging Hill-Sachs lesions were assessed, the BAT had excellent specificity (94%) and positive predictive value (94%) but poor sensitivity (43%) and negative predictive value (44%). Furthermore, the BAT performed poorly at predicting off–track humeral lesions. The AAT demonstrated 100% sensitivity and 0% specificity in detecting all measures of bone loss. Conclusion: The BAT performed poorly at identifying subcritical and critical bone loss and was not found to have any clinical value. Future work is needed to identify a physical examination test that could complement advanced imaging for preoperative assessment of critical bone loss.

Interrater Reliability of the Prone Apprehension Relocation Test.

Background:The Prone Apprehension Relocation Test (PART) augments existing radiographic measures and clinical provocative maneuvers in diagnosing hip instability. One measure of the potential clinical utility of the PART depends on the reproducibility of test results by evaluating providers including physicians, licensed athletic trainers, and physical therapists.Purpose:To determine the interrater reliability of the PART among health care providers.Study Design:Cohort study (diagnosis); Level of evidence, 3.Methods:We retrospectively identified patients in our institution’s hip preservation registry who presented between September 2017 and June 2019 for evaluation of hip pain. Patients included in the study had the PART performed by a single physician as well as 1 of 12 physician extenders (a licensed athletic trainer or a physical therapist). The providers were blinded to the findings of the other examining professional. Interrater reliability was assessed using the Cohen κ (≥0.75 was considered excellent; between 0.75 and 0.40, moderate; and ≤0.40, poor).Results:A total of 96 patients (190 hips) were included in this study (61 women and 35 men, average age 32 ± 12.1 years). A total of 23 hips had a positive PART from both examiners. Interrater reliability was excellent between health care professionals for the PART when evaluating the right hip (κ = 0.80), left hip (κ = 0.82), and when combining the results for left and right (κ = 0.81). A subanalysis of patients with a positive PART from both raters demonstrated that 19 of the 23 hips had a lateral center-edge angle >25°.Conclusion:Our study demonstrated excellent interrater reliability of the PART, supporting its use in the physical evaluation of painful hips.

Preference or flexibility? Spatial navigation by Syrian hamsters (Mesocricetus auratus) in a multiple-cue environment.

We investigated if and how Syrian hamsters (Mesocricetus auratus) show flexibility in their use of multiple sources of information in a spatial learning task. In Experiment 1, hamsters were trained to exit an arena through one of three doors. The goal, marked by a beacon, was fixed during the training phase. When the beacon was placed nearer to another door, the hamsters predominantly chose the original door rather than those with the relocated beacon (Tests A and C). The removal of the beacon had little effect on their performance (Test B). In Experiment 2, when we changed the shape of the apparatus to make the positional information of the goals other than the beacon invalid, a few individual subjects used the beacon (Test B'). However, after experiencing the invalidity of such positional information, the original door was less frequently chosen in a rerun of the beacon relocation test (Test C). Finally, in Experiment 3, we confirmed that hamsters could easily learn to use the beacon when it was the sole cue for navigation. These results suggest that, despite hamsters' limited tendency to use a beacon for navigation, they can flexibly use multiple strategies depending on their experience or environmental context. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

INTER-RATER RELIABILITY OF THE PRONE APPREHENSION RELOCATION TEST (PART)

Background:Hip dysplasia and related instability can cause pain, limit hip function, and ultimately result in osteoarthritis. The Prone Apprehension Relocation Test (PART) augments existing radiographic markers and clinical provocative maneuvers in diagnosing hip dysplasia. Reproducibility of the PART between examiners has not been previously studied.Hypothesis/Purpose:One measure of the potential clinical utility of the PART depends on the reproducibility of test results by evaluating providers including physicians, licensed athletic trainers, and physical therapists. The purpose of this study is to determine the inter-rater reliability of the PART between health care professionals.Methods:We retrospectively identified patients in our institution’s hip preservation registry who presented between September 2017 and June 2019 for evaluation of hip pain. Patients included in the study had the PART performed by two health care professionals who were blinded to the other’s results. Inter-rater reliability was assessed using the Cohen 𝜅, with a value of 𝜅 ≥ 0.75 considered excellent inter-rater reliability, between 0.75 and 0.40 moderate, and ≤ 0.40 poor.Results:96 patients (190 hips) were included, with 63 females and 35 males, average age 32 ± 12.1 years. 23 hips had a positive PART from both examiners. Inter-rater reliability was excellent between health care professionals for the PART when evaluating the right hip (𝜅 = 0.80), left hip (𝜅 = 0.82), and when combining the results for left and right (𝜅 = 0.81). A sub-analysis of patients who had a positive PART from both raters demonstrated that 19 of the 23 hips had a lateral center edge angle > 25°.Conclusion:Our study demonstrates that the PART is a reliable physical exam maneuver in the evaluation of hip pain.

Postural balance and oculomotor control are influenced by neck kinaesthetic functions in elite ice hockey players

BackgroundResearch indicates that neck kinaesthetic awareness plays an important role in oculomotor and balance control, however the relationship has not been studied in athletes. As performance in ice hockey demands visual perception acuity during skating, while constantly shifting between unilateral and bilateral stances in sports specific posture more in-depth relationship should be studied. Research questionWhat is the relationship between neck kinaesthetic awareness, postural balance and eye movement control in professional ice hockey players and non-trained individuals? MethodsIn this observational study, centre-of-pressure was measured using force plate in twenty-eight hockey players and thirty non-trained participants during different stances in eyes-opened and eyes-closed conditions. Butterfly test and Head-to-Neutral Relocation test were performed to assess neck kinaesthesia. Horizontal smooth pursuit eye movements were measured using video-oculography. Linear regression was used to determine the relationship between neck kinaesthesia, body sway and oculomotor control. ResultsTime-on-target in Butterfly test was able to predict low to medium proportions of variance in amplitude and velocity parameters for single leg stances in hockey players (R2 = .220–.698). Head-to-Neutral Relocation test was able to predict low to medium proportion of variance in average eye movement velocity during first 100 milliseconds of smooth pursuit initiation for both groups (R2 = .262–.541). SignificanceFindings from our study suggest that cervical spine afferent input plays an important role in maintaining unilateral postural balance in hockey players, with less evidence presented in controls. Sports specific posture or upper body loading could lead to adaptations in neck proprioception, not frequently considered when searching for balance related injury risk factors or performance deficits. Our study suggests, that in addition to balance control, neck kinaesthesia can also affect oculomotor performance which was present in both groups. This is especially evident when initiating changes in eye movement direction.

Impact of Body Mass Index on the Accuracy of Physical Examination and MRI of the Shoulder.

Background:The physical examination of overweight patients can require specific adaptations. Orthopaedic literature on the impact of body mass index (BMI) on the physical examination of the shoulder is virtually nonexistent.Purpose:To assess whether BMI affects the sensitivity and specificity of common shoulder tests, using arthroscopy as a gold standard. We also examined the effects of BMI on the sensitivity and specificity of magnetic resonance imaging (MRI) of the shoulder for reference.Study Design:Cohort study (diagnosis); Level of evidence, 2.Methods:We analyzed the data of 116 consecutive patients who underwent shoulder arthroscopy for the treatment of rotator cuff tears, Bankart lesions, and superior labral anterior-posterior (SLAP) lesions. Preoperative BMI, physical examination of the shoulder findings, and MRI findings were extracted. Contingency tables and receiver operating characteristic curves were used to evaluate the sensitivity and specificity of provocative tests of the shoulder and MRI as well as their relationship to BMI.Results:The sensitivity and specificity of the Jobe supraspinatus test were 77.8% and 72.7% in patients with BMI ≤25, 82.6% and 70.6% in those with 25 < BMI ≤ 30, and 81.3% and 55.6% in those with BMI >30, respectively (P < .001). The apprehension and relocation tests demonstrated higher sensitivity and specificity for the overweight patients (25 < BMI ≤ 30) compared with the other BMI groups, with a sensitivity and specificity of 83.3% and 100% for the apprehension test and a sensitivity and specificity of 75% and 100% for the relocation test, respectively. The O’Brien, Speed, and Ebinger tests for SLAP tears had low accuracy and did not yield statistically significant results. MRI interpretation was found to be influenced by BMI in obese patients, especially when SLAP lesions were assessed.Conclusion:Counterintuitively, tests for shoulder instability had greater specificity in overweight patients and should be encouraged, particularly in obese patients, in whom the specificity of shoulder MRI for the detection of a Bankart lesion is lower. The Jobe test was more sensitive but less specific in overweight patients. These findings may assist care providers in improving the interpretation of the shoulder examination of overweight patients and consequently lead to better treatment-related decisions.

Sport-Specific Habitual Adaptations in Neck Kinesthetic Functions Are Related to Balance Controlling Mechanisms

Whilst the importance of trunk, lower and upper extremities for the efficiency of maintaining body sway is well documented, the effects of cervical spine function have been seldom investigated. Afferent information from high density proprioceptors located in the cervical spine can alter postural balance, however the effects of sport’s specific habitual adaptation on balance performance have not yet been investigated. Twenty-seven taekwondo fighters and thirty controls performed unilateral balance tasks while facing forward and during neck torsion balance test while standing on the force plate. Neck kinesthesia was measured with the Head-to-Neutral Relocation test and the Butterfly test with motion-inertial unit. Differences between balance tasks were analyzed using two-way ANOVA. Additionally, correlations between body sway parameters and neck kinesthesia were studied using Pearson correlation coefficient. No differences were found between forward facing and neck torsion balance tasks in taekwondo fighters. However, correlations were found between balance on the non-preferred leg and neck kinesthesia. On the contrary, healthy individuals presented with statistically significant differences between both balance tasks and correlations between balance and neck kinesthesia. Taekwondo fighters seem to present with habitual adaptations in balance control, that differ from non-trained individuals.

Targeted Muscle Reinnervation for the Prevention and Treatment of Postamputation Pain and Improvement of Prosthetic Function: A Systematic Review

PURPOSE: Targeted muscle reinnervation (TMR) is a surgical technique where transected nerves in amputated limbs are redirected to new motor targets.1 TMR was originally developed to enhance prosthetic control following amputation but has recently also become popular for managing postamputation pain.2 Standardized outcome measures and time points to evaluate pain and prosthetic function in these patients have not yet been established. We aim to identify and recommend assessment tools used to assess pain and prosthetic function following TMR, as well as to summarize early results. METHODS: A comprehensive search of literature was conducted using 5 bibliographic databases. Two independent reviewers screened abstracts and full-text articles to select studies describing postamputation pain and/or prosthetic function outcomes of TMR. Methodological quality was appraised using the Newcastle-Ottawa Scale (NOS) and Cochrane Risk of Bias tool (RoB). Studies with duplicate patient populations were identified. Data were extracted including timing of TMR with respect to amputation, location of amputation, and measured pain and/or prosthetic function outcomes. Differences between reviewers were resolved through consensus. RESULTS: A total of 476 articles were identified, of which 62 were selected for full-text screening and 16 studies were included. Studies from 8 institutions were represented, including 4 cohort studies and 1 randomized controlled trial.3 Overall, 253 unique patients underwent TMR. One hundred (39.53%) patients were male and 40 (15.81%) were female. Ten studies assessed pain outcomes and 7 described prosthetic function outcomes. Three assessment tools were used to analyze pain: Patient-Reported Outcomes Measurement Information System (PROMIS) in 3 studies, Numerical Rating Scale (n = 2), and Visual Analogue Scale (n = 3). Studies showed decreased prevalence of neuroma pain and phantom limb pain (PLP) following primary TMR compared to amputation only. Prevalence of pain following secondary TMR also decreased postoperatively, although intensity of PLP transiently increased. Primary TMR lead to a greater decrease in PROMIS pain scores compared to amputation only, although there was no significant difference in pain scores following secondary TMR compared to standard neuroma excision treatment. Nine assessment tools were used to evaluate prosthetic function, including box-and-block test (n = 5), clothespin relocation test (n = 4), and amputee mobility predictor (n = 3). Of the 5 studies using box-and-block test, 4 demonstrated improved prosthetic function following TMR. CONCLUSIONS: Early reports of TMR for the prevention and treatment of postamputation pain are convincing, although the variation in prosthetic training time and scarcity of comparative studies makes it difficult to determine comparative effectiveness for prosthetic function. We recommend that future prospective studies evaluating pain and prosthetic function deploy common assessment tools, such as PROMIS and box-and-block test, at consistent time points. REFERENCES: 1. Cheesborough JE, Smith LH, Kuiken TA, et al. Targeted muscle reinnervation and advanced prosthetic arms. Semin Plast Surg. 2015;29:62–72. 2. Souza JM, Cheesborough JE, Ko JH, et al. Targeted muscle reinnervation: a novel approach to postamputation neuroma pain. Clin Orthop Relat Res. 2014;472:2984–2990. 3. Dumanian GA, Potter BK, Mioton LM, et al. Targeted muscle reinnervation treats neuroma and phantom pain in major limb amputees: a randomized clinical trial. Ann Surg. 2019;270:238–246.