Shoulder Elevation Research Articles

Using inertial measurement units to quantify shoulder elevation after reverse total shoulder arthroplasty: a pilot study comparing goniometric measures captured clinically to inertial measures captured ‘in-the-wild’

BackgroundReverse total shoulder arthroplasty (rTSA) is utilized for a variety of indications, but most commonly for patients with rotator cuff arthropathy. This procedure reduces pain, improves satisfaction, and increases clinically measured range of motion (ROM). However, traditional clinical ROM measurements captured via goniometer may not accurately represent ‘real-world’ utilization of ROM. In contrast, inertial measurement units (IMUs) are useful for establishing ROM outside the clinical setting. We sought to measure ‘real-world’ ROM after rTSA using IMUs. MethodsA previously validated IMU-based method for continuously capturing shoulder elevation was used to assess 10 individuals receiving rTSA (1M, 82 ± 5 years) and compared to a previously captured 10 healthy individuals (4M, 69 ± 20 years) without shoulder dysfunction. Control subject data were previously collected over 1 week of continuous use. Patients undergoing rTSA donned sensors for 1 week pre-rTSA, 6 weeks at 3 months post-rTSA following clearance to perform active-independent ROM, and 1 week at 1 year and 2 years post-rTSA. Shoulder elevation was computed continuously each day. Daily continuous elevation was broken into 5° angle ‘bins’ (eg, 0-5°, 5-10°, etc.) and converted to percentage of the total day. IMU-based outcome measures were ROM binned percent (as described previously) and maximum/average elevation each week. Clinical goniometric ROM and patient-reported outcome measures were also captured. ResultsNo differences existed between patient and healthy control demographics. While patients showed improvement in American Shoulder and Elbow Surgeon (ASES) score, pain score, and goniometric ROM, IMU-based average and maximum elevation were equal between control subjects and patients both pre- and post-rTSA. The percent of time spent above 90° was equal between cohorts pre-rTSA, rose significantly at 3 months post-rTSA, and returned to preoperative levels thereafter. DiscussionAlthough pain, satisfaction, and ROM measured clinically may improve following rTSA, real-world utilization of improved ROM was not seen herein. Improvements during the acute rehabilitation phase may be transient, indicating longer or more specific rehabilitation protocols are necessary to see chronic improvements in post-rTSA movement patterns.

Anatomy and clinical application of suprascapular nerve to accessory nerve transfer.

BACKGROUNDLoss of motor function in the trapezius muscle is one complication of radical neck dissection after cutting the accessory nerve (AN) during surgery. Nerve repair is an effective method to restore trapezius muscle function, and includes neurolysis, direct suture, and nerve grafting. The suprascapular nerve (SCN) and AN are next to each other in position. The function of the AN and SCN in shoulder elevation and abduction movement is synergistic. SCN might be considered by surgeons for AN reanimation.AIMTo obtain anatomical and clinical data for partial suprascapular nerve-to-AN transfer.METHODSTen sides of cadavers perfused with formalin were obtained from the Department of Human Anatomy, Histology and Embryology, Peking University Health Science Center. The SCN (n = 10) and AN (n = 10) were carefully dissected in the posterior triangle of the neck, and the trapezius muscle was dissected to fully display the accessory nerve. The length of the SCN from the origin of the brachial plexus (a point) to the scapular notch (b point) and the distance of the SCN from the origin point (a point) to the point (c point) where the AN entered the border of the trapezius muscle were measured. The length and branches of the AN in the trapezius muscle were measured. A female patient aged 55 years underwent surgery for partial SCN to AN transfer at Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology. The patient suffered from recurrent upper gingival cancer. Radical neck dissection was performed on the right side, and the right AN was removed at the intersection between the nerve and the posterior border of the SCM muscle. One-third of the diameter of the SCN was cut off, and combined epineurial and perineurial sutures were applied between the distal end of the cut-off fascicles of the SCN and the proximal end of the AN without tension. Both subjective and objective evaluations were performed before, three months after, and nine months after surgery. For the subjective evaluation, the questionnaire included the Neck Dissection Impairment Index (NDII) and the Constant Shoulder Scale. Electromyography was used for the objective examination. Data were analyzed using t tests with SPSS 19.0 software to determine the relationship between the length of the SCN and the linear distance. A P value of < 0.05 was considered as statistically significant.RESULTSThe whole length of the AN in the trapezius muscle was 16.89 cm. The average numbers of branches distributed in the descending, horizontal and ascending portions were 3.8, 2.6 and 2.2, respectively. The diameter of the AN was 1.94 mm at the anterior border of the trapezius. The length of the suprascapular nerve from the origin of the brachial plexus to the scapular notch was longer than the distance of the suprascapular nerve from the origin point to the point where the accessory nerve entered the upper edge of the trapezius muscle. The amplitude of trapezius muscle electromyography indicated that both the horizontal and ascending portions of the trapezius muscle on the right side had better function than the left side nine months after surgery. The results showed that the right-sided supraspinatus and infraspinatus muscles did not lose more function than the left side.CONCLUSIONBased on anatomical data and clinical application, partial suprascapular nerve-to-AN transfer could be achieved and may improve innervation of the affected trapezius muscle after radical neck dissection.

Preoperative Less Right Shoulder Elevation Had a Higher Risk of Postoperative Shoulder Imbalance When Main Thoracic Curve Shows Higher Correction Regardless of the Upper Instrumented Vertebra Level for Patients with Adolescent Idiopathic Scoliosis Lenke Type 1.

This is a retrospective study. This study aimed to investigate the incidence of and risk factors for postoperative shoulder imbalance (PSI) in patients with Lenke type 1. PSI is a complication resulting in poor self-image and satisfaction in adolescent idiopathic scoliosis (AIS) patients. We examined the data of AIS patients with Lenke type 1 curves who underwent posterior fusion surgery in a retrospective manner. PSI was defined as a 2-year postoperative absolute radiographic shoulder height (RSH) of ≥2 cm. Patients were divided into two groups based on the presence of PSI and the level of their upper instrumented vertebra (UIV) (UIV at T2 or T3 [U-UIV] or UIV below T3 [L-UIV]). The radiographic parameters and clinical outcomes were compared, and the cutoff values of risk factors were identified by multivariate analysis. Of 104 patients, 21 (20.2%) had left shoulder elevation PSI. The PSI group had a significantly greater preoperative RSH (-5.1 mm vs. -14.3 mm) and main thoracic (MT) curve correction rate (77.3% vs. 69.1%) than the non-PSI group. The PSI incidence did not differ between the U-UIV and L-UIV groups. Multivariate analysis identified preoperative RSH and the MT curve correction rate as independent risk factors for PSI. The receiver operating characteristic curve analysis identified the preoperative RSH cutoff value as -6.5 mm and MT curve correction rate cutoff value as 76.9%. Even in AIS patients with Lenke type 1 curves, the incidence of PSI was relatively high (20.2%). Patients with preoperative lower right shoulder elevation (i.e., RSH >-6.5 mm) had a higher risk of PSI regardless of UIV level when the MT curve showed a higher correction rate (i.e., correction rate >76.9%).

Reliability of a human pose tracking algorithm for measuring upper limb joints: comparison with photography-based goniometry

BackgroundRange of motion (ROM) measurements are essential for diagnosing and evaluating upper extremity conditions. Clinical goniometry is the most commonly used methods but it is time-consuming and skill-demanding. Recent advances in human tracking algorithm suggest potential for automatic angle measuring from RGB images. It provides an attractive alternative for at-distance measuring. However, the reliability of this method has not been fully established. The purpose of this study is to evaluate if the results of algorithm are as reliable as human raters in upper limb movements.MethodsThirty healthy young adults (20 males, 10 females) participated in this study. Participants were asked to performed a 6-motion task including movement of shoulder, elbow and wrist. Images of movements were captured by commercial digital cameras. Each movement was measured by a pose tracking algorithm (OpenPose) and compared with the surgeon-measurement results. The mean differences between the two measurements were compared. Pearson correlation coefficients were used to determine the relationship. Reliability was investigated by the intra-class correlation coefficients.ResultsComparing this algorithm-based method with manual measurement, the mean differences were less than 3 degrees in 5 motions (shoulder abduction: 0.51; shoulder elevation: 2.87; elbow flexion:0.38; elbow extension:0.65; wrist extension: 0.78) except wrist flexion. All the intra-class correlation coefficients were larger than 0.60. The Pearson coefficients also showed high correlations between the two measurements (p < 0.001).ConclusionsOur results indicated that pose estimation is a reliable method to measure the shoulder and elbow angles, supporting RGB images for measuring joint ROM. Our results presented the possibility that patients can assess their ROM by photos taken by a digital camera.Trial registrationThis study was registered in the Clinical Trials Center of The First Affiliated Hospital, Sun Yat-sen University (2021–387).

Development of a more biofidelic musculoskeletal model with humeral head translation and glenohumeral ligaments

Computational musculoskeletal modeling is useful for understanding upper extremity biomechanics, especially when in vivo tests are unfeasible. A musculoskeletal model of the upper limb with increased biofidelity was developed by including humeral head translation (HHT) and ligaments. The model was validated and ligament contribution and effect of shoulder (thoracohumeral) elevation on HHT was evaluated. Humerus translated superiorly with increased elevation, with translations closely matching (avg. difference 2.83 mm) previous in vitro studies. HHT and ligament inclusion in the model will improve biomechanical predictions of upper extremity movements and study of conditions, like subacromial impingement, rotator cuff tear, or shoulder instability.

Lower Trapezius Myocutaneous Propeller Flap Based on Dorsal Scapular Artery.

The pedicled lower trapezius myocutaneous flap is generally transferred to the recipient site through a subcutaneous tunnel, and a portion of the flap buried in the tunnel needs to be de-epithelialized. Thus, considerable amount of normal skin is sacrificed, and the redundant tissue buried in the tunnel can cause bulging deformity. We believe that transferring the lower trapezius myocutaneous flap in a propeller fashion can avoid the aforementioned issues. A retrospective review was performed on all lower trapezius myocutaneous propeller flap reconstructions by a single surgeon from July 2013 to March 2021. Data on patient demographics, diagnosis, features of the defect, characteristics of the flap, and the outcome were collected and analyzed. Thirty-three lower trapezius myocutaneous propeller flaps were used to reconstruct soft tissue defects in the head, neck, and back. The etiologies were malignancy, trauma, postburn scar contracture, and congenital melanocytic nevus. The mean skin paddle dimensions were 29.0 cm in length (range, 13-45 cm) and 10.9 cm in width (range, 6-15 cm). The donor sites were closed primarily in 30 patients, closed using a skin graft in 1 patient, and covered with the second flap in 2 patients. Venous congestion occurred in the distal portion of 4 flaps and partial necrosis in the distal 6 cm of 1 flap. The average follow-up time was 17.5 months (range, 1-56 months). The normal contour of the back was preserved without bulging deformity. No patient developed a winged scapula or a decrease in shoulder elevation. The lower trapezius myocutaneous propeller flap may be an option for reconstruction of soft tissue defects of the head, neck, and back with less waste of normal tissue and bulging deformity.

Differences in Coracohumeral Distance Between the Symptomatic and the Asymptomatic Shoulder in Patients With Unilateral Shoulder Pain and in Healthy Participants: A Cross-Sectional Study

ObjectivesThe aim of this study was to analyze whether differences in the coracohumeral distance (CHD) exist between the symptomatic and the asymptomatic shoulder in patients with subacromial pain syndrome and compare with the shoulder of control participants. MethodsThis was a cross-sectional, observational study. A sample comprising 62 participants with subacromial pain syndrome was recruited from 3 different primary care centers. The CHD was determined from standardized ultrasonography measures performed on both shoulders at 0° and 60° of shoulder abduction, whereas the dominant arm was measured for the control participants. ResultsStatistically significant differences in CHD at 0° and 60° were found between the symptomatic and control shoulders (P = .011/P = .002) and between the contralateral asymptomatic shoulder and controls (P = .026/P = .007). ConclusionWe found differences in CHD at 0° and 60° of shoulder elevation between both the affected and the nonaffected shoulders when compared with healthy shoulders. These results suggest that CHD may be a contributing factor in chronic shoulder pain.

Three-Dimensional Quantitative Evaluation of the Scapular Skin Marker Movements in the Upright Posture.

Motion capture systems using skin markers are widely used to evaluate scapular kinematics. However, soft-tissue artifact (STA) is a major limitation, and there is insufficient knowledge of the marker movements from the original locations. This study explores a scapular STA, including marker movements with shoulder elevation using upright computed tomography (CT). Ten healthy males (twenty shoulders in total) had markers attached to scapular bony landmarks and underwent upright CT in the reference and elevated positions. Marker movements were calculated and compared between markers. The bone-based and marker-based scapulothoracic rotation angles were also compared in both positions. The median marker movement distances were 30.4 mm for the acromial angle, 53.1 mm for the root of the scapular spine, and 70.0 mm for the inferior angle. Marker movements were significantly smaller on the superolateral aspect of the scapula, and superior movement was largest in the directional movement. Scapulothoracic rotation angles were significantly smaller in the marker-based rotation angles than in the bone-based rotation angles of the elevated position. We noted that the markers especially did not track the inferior movement of the scapular motion with shoulder elevation, resulting in an underestimation of the marker-based rotation angles.

Rotator cuff related shoulder pain: An update of potential pathoaetiological factors

Rotator cuff related shoulder pain (RCRSP) was a term proposed to replace scientifically outdated and potentially flawed diagnoses such as subacromial impingement syndrome, as well as uncertain pathoanatomical diagnoses such as rotator cuff tendinitis/tendinosis, and partial thickness and full thickness rotator cuff tears. RCRSP refers to the muscles, tendons, and surrounding structures, such as bursa, bone, ligament, capsule, nerve, and vascular tissue related to the entirety of the rotator cuff of the shoulder. It also recognises the complexity of evolving pain science. The term RCRSP acknowledges that the basis for presenting symptoms is mostly indeterminable and is used when a collection of clinical symptoms is present. RCRSP is probably the most common musculoskeletal shoulder condition and manifests as shoulder pain and weakness, most commonly during shoulder elevation and external rotation. Another important feature suggestive of RCRSP is a history of increased physiological load preceding the onset of symptoms, or a decreased ability to deal with physiological load due to lifestyle factors such as poor sleep, stress, reduced physical activity, uptake in or increased smoking, and poor nutrition. The aim of this narrative review is to discuss possible intrinsic (internal), extrinsic (external), and combined (intrinsic and extrinsic) mechanisms that may contribute to RCRSP. Our synthesis does not find definitive evidence for an extrinsic or combined extrinsic and intrinsic mechanism(s) that results in or is associated with RCRSP. We acknowledge that the narrative nature of this scholarly paper may have influenced our conclusions.

A comparison of compensatory movements between body-powered and myoelectric prosthesis users during activities of daily living

BackgroundPeople with upper limb absence use compensatory movements to accommodate lack of motion in the prosthetic hand. The purpose of this study was to determine if the type of prosthesis used (i.e. body-powered or myoelectric) affects compensatory movements during activities of daily living. MethodsTwelve transradial body-powered and/or myoelectric prosthesis users performed up to six unimanual and bimanual activities of daily living. Trunk range of motion and peak upper limb angles for each task were compared between prostheses. FindingsCompensatory movement generally did not differ based on prosthesis type. However, body-powered users had increased trunk lateral lean compared to myoelectric users during a deodorant application task (P = 0.025). Body-powered users also had increased trunk axial rotation (P = 0.048) and decreased shoulder elevation (P = 0.046) when transferring a box between shelves. Compensatory movements were not systematically correlated with duration of prosthesis ownership, socket comfort, or terminal device type. InterpretationA prosthesis user's compensatory movements may depend on other factors beyond whether the prosthesis terminal device is actuated through body-powered or myoelectric mechanisms. Further exploration of the factors that influence joint kinematics in prosthesis users may inform future prosthesis prescription practices and help patients become successful users.

Design and Preliminary Evaluation of a Wearable Passive Cam-Based Shoulder Exoskeleton

Mechanically passive exoskeletons may be a practical and affordable solution to meet a growing clinical need for continuous, home-based movement assistance. We designed, fabricated, and preliminarily evaluated the performance of a wearable, passive, cam-driven shoulder exoskeleton (WPCSE) prototype. The novel feature of the WPCSE is a modular spring-cam-wheel module, which generates an assistive force that can be customized to compensate for any proportion of the shoulder elevation moment due to gravity. We performed a benchtop experiment to validate the mechanical output of the WPCSE against our theoretical model. We also conducted a pilot biomechanics study (eight able-bodied subjects) to quantify the effect of a WPCSE prototype on muscle activity and shoulder kinematics during three shoulder movements. The shoulder elevation moment produced by the spring-cam-wheel module alone closely matched the desired theoretical moment. However, when measured from the full WPCSE prototype, the moment was lower (up to 30%) during positive shoulder elevation and higher (up to 120%) during negative shoulder elevation compared to the theoretical moment, due primarily to friction. Even so, a WPCSE prototype, compensating for about 25% of the shoulder elevation moment due to gravity, showed a trend of reducing root-mean-square electromyogram magnitudes of several muscles crossing the shoulder during shoulder elevation and horizontal adduction/abduction movements. Our results also showed that the WPCSE did not constrain or impede shoulder movements during the tested movements. The results provide proof-of-concept evidence that our WPCSE can potentially assist shoulder movements against gravity.

Neurofibromatosis type 1 comorbid with attention deficit and hyperactivity disorder. Case report

IntroductionA 9-year-old girl under pediatric follow-up since the age of 4 years after diagnosis of neurofibromatosis type 1ObjectivesTo present a case of neurofibromatosis and ADHD comorbidity to raise awareness of the importance of screening for neurodevelopmental disorders.MethodsCase report and literature reviewResultsThe patient had an adequate control and follow-up of the disorder with periodic check-ups and magnetic resonance imaging during her follow-up. She was referred due to symptoms of inattention with failure to perform exams and impulsivity in interpersonal relationships, affecting her social functioning. In addition, the patient presented simple motor tics of eye contraction and shoulder elevation. The patient was diagnosed with attention deficit hyperactivity disorder together with tic disorder. She was treated with stimulant medication with worsening of tics and marked hyporexia. Therefore, medication with guanfacine was started up to 4 mg per day, adjusted by weight. With this dose there was a control of the tics, with improvement of the symptoms of inattention and impulsivity. In different spheres an improvement in their functionality was observed, with improvement in mood, self-esteem and academic performance.ConclusionsNeurofibromatosis type 1 is a rare monogenic disorder with a varied presentation (ophthalmologic, dermatologic and predisposition to tumor development). Patientshave been shown to present with symptoms of inattention and executive function impairment, along with other neurodevelopmental disorders such as autism spectrum disorders, learning disabilities or intellectual disability. The literature shows that up to 60% of them has ADHD criteria.DisclosureNo significant relationships.

Moment arms of the deltoid, infraspinatus and teres minor muscles for movements with high range of motion: A cadaveric study

BackgroundMoment arms are an indicator of the role of the muscles in joint actuation. An excursion method is often used to calculate them, even though it provides 1D results. As shoulder movement occurs in three dimensions (combination of flexion, abduction and axial rotation), moment arms should be given in 3D. Our objective was to assess the 3D moment arms of the rotator cuff (infraspinatus and teres minor) and deltoid muscles for movements with high arm elevation. MethodsThe 3D moment arms (components in plane of elevation, elevation and axial rotation) were assessed using a geometric method, enabling to calculate the moment arms in 3D, on five fresh post-mortem human shoulders. Movement with high range of motion were performed (including overhead movement). The humerus was elevated until it reaches its maximal posture in different elevation plane (flexion, scaption, abduction and elevation in a plane 30° posterior to frontal plane). FindingsWe found that the anterior deltoid was a depressor and contributes to move the elevation plane anteriorly. The median deltoid was a great elevator and the posterior deltoid mostly acted in moving the elevation plane posteriorly. The infraspinatus and teres minor were the greatest external rotator of the shoulder. The position of the glenohumeral joint induces changes in the muscular moment arms. The maximal shoulder elevation was 144° (performed in the scapular plane). InterpretationThe knowledge of 3D moment arms for different arm elevations might help surgeons in planning tendon reconstructive surgery and help validate musculoskeletal models.

Point Prevalence of the Biomechanical Dimension of Dysfunctional Breathing Patterns Among Competitive Athletes.

Shimozawa, Y, Kurihara, T, Kusagawa, Y, Hori, M, Numasawa, S, Sugiyama, T, Tanaka, T, Suga, T, Terada, RS, Isaka, T, and Terada, M. Point prevalence of the biomechanical dimension of dysfunctional breathing patterns among competitive athletes. J Strength Cond Res 37(2): 270-276, 2023-There is growing evidence of associations between altered biomechanical breathing patterns and numerous musculoskeletal and psychological conditions. The prevalence of dysfunctional and diaphragmatic breathing patterns is unknown among athletic populations. The purpose of this study was to examine the prevalence of dysfunctional and diaphragmatic breathing patterns among athletic populations with a clinical measure to assess the biomechanical dimension of breathing patterns. Using a cross-sectional design, 1,933 athletes across multiple sports and ages were screened from 2017 to 2020. Breathing patterns were assessed using the Hi-Lo test in the standing position. Scores of the Hi-Lo test were determined based on the presence or absence of abdominal excursion, anterior-posterior chest expansion, superior rib cage migration, and shoulder elevation. The Hi-Lo test scores were used to categorize observational breathing mechanics as dysfunctional and diaphragmatic breathing patterns. The prevalence of athletes with dysfunctional breathing patterns was 90.6% (1,751 of 1,933). Athletes with diaphragmatic breathing patterns accounted for 9.4% of all athletes in our sample (182 of 1,933). There were no differences in the proportion of breathing patterns between male and female athletes ( p = 0.424). Breathing patterns observations were associated with sport-setting categories ( p = 0.002). The highest percentages of dysfunctional breathers were in middle school student athletes (93.7%), followed by elementary school student athletes (91.2%), high school student athletes (90.6%), professional/semiprofessional athletes (87.5%), and collegiate athletes (84.8%). The current study observed that dysfunctional breathing patterns (90.6%) in the biomechanical dimension were more prevalent than diaphragmatic breathing pattern (9.4%) among competitive athletes. These results suggest that clinicians may need to consider screening breathing patterns and implementing intervention programs aimed to improve the efficiency of biomechanical dimensions of breathing patterns in athletic populations. This study may help raise awareness of impacts of dysfunctional breathing patterns on athletes' health and performance.

Evaluation of clinical and radiographic outcomes after total shoulder arthroplasty with inset Trabecular Metal-backed glenoid.

Trabecular Metal (TM)-backed glenoid implants were introduced for their theoretical ability to increase osseointegration while minimizing wear and the risk of loosening in total shoulder arthroplasty (TSA). Initial follow-up studies of TM-backed glenoids demonstrated high rates of metallic debris formation around the implant site, raising concerns about longevity. More recent data suggest that metallic debris formation may be less prevalent than previously reported and that the implants may have positive long-term outcomes regardless of debris. The goal of our study was to assess the clinical and radiographic outcomes at mid-term follow-up of TSA using a TM-backed glenoid implant placed with full backside support using an inset technique. We hypothesized that our clinical and radiographic outcomes would be good using this technique. We retrospectively reviewed the charts of 39 patients who underwent 41 TSA procedures with a Zimmer Biomet TM-backed glenoid component performed by a single surgeon between January 2010 and March 2016. After exclusions for death unrelated to surgery and loss to follow-up, 35 patients (37 shoulders) with minimum 2-year clinical follow-up were included in the study. The glenoids were all placed in an inset fashion with full backside support. Clinical, patient-reported, and radiographic outcomes were analyzed. The average follow-up period was 7.2 years (range, 2-11 years). At final follow-up, average shoulder elevation was 153° ± 22° and average external rotation was 53° ± 12°. The average American Shoulder and Elbow Surgeons score was 86.8 ± 19.0, and the average visual analog scale score was 1.3 ± 2.4. Metallic debris was found in 9 shoulders (27%), and radiolucency was observed around the glenoid components in 13 shoulders (39%) on the final postoperative radiographs. Metallic debris and radiolucency findings were low in severity, with average grades of 0.32 (standard deviation, 0.54) and 0.39 (standard deviation, 0.50), respectively. There were no reoperations. This study of 37 shoulders undergoing TSA with a TM-backed glenoid demonstrated 100% implant survivorship at an average follow-up of 7 years. Clinical outcomes were excellent despite the occurrence of some metallic debris formation. The findings suggest that a TM-backed glenoid component implanted in an inset fashion to achieve full backside support can provide good clinical and patient-reported outcomes in TSA patients at mid-term follow-up and suggest that continued consideration of the role of TM-backed glenoids and the optimal technique for implantation may be warranted.

Patients without re-dislocation in the short term after arthroscopic knotless Bankart repair for anterior shoulder instability may show residual apprehension and recurrence in the long term after 5 years.

The aim of this study was to report the long-term results, residual instability, and recurrence rate of arthroscopic Bankart repair surgery without a re-dislocation event in the first 5 years. We performed a retrospective analysis of Bankart repairs performed in a single center, by a single surgeon, with a minimum of 5 years' follow-up. Patients without a re-dislocation in the first 5 years of surgery were included. Patients who underwent open repair, those who underwent revision surgery, and those with critical glenoid bone loss were excluded. A total of 68 shoulders in 66 patients (51 male and 15 female patients) were included. Patients were analyzed in 2 domains: (1) failures defined as re-dislocation and (2) failures defined as apprehension and re-dislocation combined (residual instability). Clinical outcomes were assessed using shoulder range of motion, the American Shoulder and Elbow Surgeons score, and the Western Ontario Shoulder Instability Index (WOSI) score. Pain, residual apprehension, re-dislocations, and additional surgical procedures were recorded. The mean age of patients was 31.16 (range, 16-60 years), and the mean follow-up duration was 8.42 ± 2.1 years. The median number of dislocations was 3 (range, 1-20), and the median time from first dislocation to surgery was 16 months (interquartile range, 3-100.5 months). Five patients reported re-dislocations (7.4%) with a mean period of 6.54 ± 2.5 years (range, 5-10.8 years). Seven patients without re-dislocations and 2 patients with re-dislocations reported residual apprehension. Mean shoulder elevation and mean external rotation were 161.3° ± 12.4° and 39.2° ± 11°, respectively. The mean visual analog scale, American Shoulder and Elbow Surgeons, and WOSI scores were 0.5 ± 1.4, 91 ± 11.9, and 88 ± 12.1, respectively. Age was similar in patients with stable shoulders and those with shoulders with re-dislocation or residual instability. The WOSI score was lower in patients with re-dislocation and residual instability (P = .030 and P = .049, respectively). Arthroscopic Bankart repair is a successful surgical option for anterior shoulder instability. The 7.4% re-dislocation rate after 5 years indicates there may be a deterioration of capsulolabral repair in certain patients. The long-term failure pattern may be underestimated in short- to mid-term projections.

The use of a three-dimensional dynamic arm support prevents the development of muscle fatigue during repetitive manual tasks in healthy individuals.

Work-related upper extremity disorders are costly to society due to resulting medical costs, presenteeism and absenteeism. Although their aetiology is likely multifactorial, physical workplace factors are known to play an important role in their development. Promising options for preventing work-related upper extremity disorders include assistive technologies such as dynamic arm supports designed to follow the movement of the arm while compensating for its weight. The objective of this study was to assess the effects of a dynamic arm support on perceived exertion, muscle activity and movement patterns of the upper limb during repetitive manual tasks in healthy individuals. Thirty healthy right-handed individuals were allocated either a static or a dynamic task to perform with and without a dynamic arm support. During the task, surface electromyographic activity (anterior and middle deltoid, upper trapezius) and upper limb kinematics (elbow, shoulder, sternoclavicular) were measured using surface EMG and inertial sensors. Results showed that the dynamic arm support significantly reduced perceived exertion during the tasks and limited the development of muscular fatigue of the anterior and middle deltoid as demonstrated by EMG signal mean epoch amplitudes and median frequency of the EMG power spectrum. The dynamic arm support also prevented a decrease in shoulder elevation and an increase in total shoulder joint excursion during static and dynamic task, respectively. These results denote the potential benefits of dynamic arm supports in work environments. Further studies should focus on their efficacy, acceptability and implementability in work settings.

785 Assessing The Kinematics Of Virtual Reality Gaming As Physical Therapy In Burn Patients

IntroductionVirtual reality (VR) gaming offers an immersive experience that can enrich physical therapy for the burn patient by introducing variability, enjoyment, and reward during functional motions of the upper extremities. In this study, we aim to support a proof-of-concept for VR gaming in upper extremity burn rehabilitation by characterizing shoulder and elbow kinematics during VR gaming in a healthy volunteer.MethodsA healthy volunteer without burn injuries played two games, a virtual rhythmic baton and virtual boxing game, on a commercially available VR gaming platform. Kinematics during play were assessed using two external cameras placed orthogonally, to the player’s front and left, so that 3-dimensional motion of the player’s left arm could be captured. Video of each gaming session was processed using an open-source perceptual computing software that dynamically tracks the user’s upper extremity during play. Kinematics at the left shoulder and elbow were characterized with respect to range of motion (ROM) and time spent in composite positions.ResultsDuring the rhythmic baton game, the player achieved 157 degrees of elbow flexion ROM and 90 degrees shoulder elevation ROM. During the boxing game, the player achieved 156 degrees of elbow flexion ROM and 123 degrees shoulder elevation ROM. The baton game was associated with more time spent in the “rest” position (elbow extended with shoulder adducted, 60% of the game) while boxing was associated with more time in the “Guard” position (elbow flexed with shoulder elevated, 79% of the game) (Figure 1). Both games demonstrated simultaneous movement at both the shoulder and elbow during play.ConclusionsThe two VR games investigated in this kinematic assessment challenged players to achieve a wide range of motion at the upper extremity with functional, multi-joint movements. These findings support a potential role for commercial VR gaming in burn rehabilitation and future research in burn patients is required to demonstrate its therapeutic value.

Evaluating flexibility and predicting curve correction using fulcrum-bending radiographs in Lenke type 2 adolescent idiopathic scoliosis

BackgroundFulcrum-bending (FB) correction is considered to provide the best estimation of main thoracic (MT) curve flexibility and postoperative correction in surgical treatment for adolescent idiopathic scoliosis (AIS). However, few studies evaluated the usefulness of FB radiographs for proximal thoracic (PT) curve. We aimed to perform flexibility assessments using both active side-bending (SB) and FB radiographs and evaluate surgical outcomes after posterior spinal fusion (PSF) for Lenke type 2 AIS. MethodsThis study included 38 consecutive patients with Lenke type 2 AIS who underwent PSF using a pedicle screw construct with a minimum 2-year follow-up. Radiographic parameters, including correction rate, SB and FB flexibility, and FB correction index (FBCI: [correction rate/FB flexibility] × 100), were evaluated preoperatively, immediately after surgery, and at the 2-year follow-up. The clinical outcomes were preoperatively evaluated using the Scoliosis Research Outcomes Instrument-22 and at the follow-up. ResultsAll scoliosis curves significantly improved and shoulder balance shifted toward left shoulder elevation (all comparisons, p < 0.0001). There were significant differences between the SB and FB corrections in the PT and MT curves (p < 0.0001). The magnitudes of the discrepancies between the SB and FB corrections in the PT and MT curves were 11.2° ± 5.2° and 11.6° ± 7.2°, respectively. FB correction did not differ from postoperative Cobb angles correction immediately after surgery or at the 2-year follow-up; the mean FBCIs in the PT and MT curves were 98.8% and 105.5%, respectively. The self-image domain SRS-22 scores had significantly increased at the 2-year follow-up (p < 0.0001). ConclusionsThere were significant differences between the SB and FB corrections, and FB correction tended to approximate the postoperative curve correction (FBCI = 100%) for PT and MT curves in patients with Lenke type 2 AIS. FB flexibility is more reliable than SB flexibility in evaluating actual curve flexibility even for the PT curve.

355 Use of Novel Telemedicine Software to Automate Cranial Nerve and Neuro-Ophthalmic Remote Testing

INTRODUCTION: Despite the rapid surge in telemedicine use due to the COVID-19 pandemic, there is still a paucity of telemedicine tools for the remote assessment of patients with neurological diagnoses. Current telemedicine platforms lack the capabilities to perform thorough cranial nerve and neuro-ophthalmic testing. To address this need, we developed a novel software that patients can use to undergo cranial nerve and neuro-ophthalmic testing remotely via their own personal computer. METHODS: We conducted a pilot study of patients above 18 years old diagnosed with a brain tumor who receive their care at our institution. Ten patients were enrolled to undergo a comprehensive cranial nerve and neuro-ophthalmic testing using our proprietary telemedicine software. We assessed visual acuity, visual fields, extraocular movements, facial sensitivity, facial symmetry, hearing, uvula/palatal movement, shoulder elevation, tongue deviation, and speech. Their performance on the telemedicine software to physical examination by their treating physician. All patients were given a patient satisfaction survey upon completion of the telemedicine visit. RESULTS: Ten patients have been enrolled so far with a mean age of 47±14.3 years old (4 males, 6 females). Diagnoses included brain metastases, pituitary adenoma, craniopharyngioma and meningiomas. Visual acuity, facial sensitivity, facial symmetry, shoulder elevation, tongue deviation were consistent with physical examination findings in all six patients. Extraocular movements were consistent in 80% of patients. Assessment of the uvula was the most challenging, comparable to physical examination in only 20% of patients. Visual fields were equivalent in 80% of patients and superior than confrontation testing in 10% of patients. CONCLUSION: While this is a very early experience with a new telemedicine software, we demonstrate the feasibility of performing comprehensive cranial nerve and neuro-ophthalmic testing. We provide a detailed account of the challenges encountered, the patient experience and satisfaction results.