Motion Of Shoulder Joint Research Articles

Relationship between rotator cuff posterior delamination and subscapularis tear: a large cross-sectional analysis

Rotator cuff posterior delamination and subscapularis tear are commonly observed in rotator cuff injuries. However, there are very few studies on the relationship between posterior delamination and subscapularis tendon tear. This study aimed to investigate the relationship between posterior delamination and subscapularis tendon tear. The study was conducted from March 2018 to June 2021 with 553 patients who underwent rotator cuff repairs at two institutions. The age and gender, size of rotator cuff tear, duration of symptoms, range of motion of shoulder joint, visual analog scale score, Korean Shoulder Scale score, gap and width of rotator cuff tear, and fatty degeneration of the supraspinatus and infraspinatus muscles were compared to confirm the differences between a delaminated and nondelaminated rotator cuff tear. Moreover, the proportions of the subscapular tendon rupture and subscapularis tendon rupture according to the size of the rotator cuff tear were analyzed in both the delaminated and nondelaminated rotator cuff tear groups. Compared to the nondelaminated rotator cuff tear group, the age of the delaminated rotator cuff tear group was significantly higher, and as the size of the rotator cuff tear increased, the proportion of delaminated tear increased (P<.001). Furthermore, the duration of symptoms was longer, visual analog scale score was higher, Korean Shoulder Scale score was lower, gap and width of rotator cuff as well as fatty degeneration of the supraspinatus and infraspinatus were more severe in the group with posterior delamination than that without. In the nondelaminated rotator cuff tear group, 212 subjects (84.46%) had no subscapularis tear, and 39 subjects (15.54%) had subscapularis tear. In the delaminated rotator cuff tear group, 103 subjects (34.11%) had no subscapular tendon tear while 199 subjects (65.89%) had a subscapular tendon tear (P<.001). Furthermore, as the size of the rotator cuff tear increased, the rate of subscapular tendon tear increased in both the delaminated and nondelaminated rotator cuff tear groups. The results suggest that there is a high probability of concomitant rupture of the subscapularis tendon in the patient group with posterior delamination tear. Therefore, it should be noted that if a posterior delamination is confirmed during surgery, it is necessary to carefully check for rupture of the scapular tendon.

Titanium elastic nail treatment for a humeral shaft fracture of an adolescent arm wrestler: A case report and literature review

Arm wrestling is a sport where two people take opposing positions at a table and put their elbows on the table with their palms together, the aim being to make the opponent’s hand touch the table. Arm wrestling, which seems harmless, may become a show of strength for adolescents and young adults. Muscle and tendon injuries and bone fractures may occur due to arm wrestling. Fractures of the humeral shaft and distal third region can also occur due to arm wrestling. Here, we present the contribution of closed reduction and titanium intramedullary nail treatment to early return to school for a 14-year-old male patient with an AO 12.A1 fracture of the humeral shaft that occurred during arm wrestling. Our treatment reduced the duration of immobilization, provided complete union at the fracture site along with full range of motion of shoulder and elbow joints at 3 months after the injury.

Effect of Mirror Therapy on Upper Extremity Function in a Patient with Humeral Fracture: A Case Study

Mirror therapy is the intervention aimed to improve functional aspects by creating a reflective illusion and mirror neuron system. Although there are many researches stating its effectiveness in neurological and orthopedic injuries, it has not been used widely in clinical settings for upper-limb fracture cases. A 69-year-old female sustained a right humeral shaft fracture and underwent open reduction internal fixation. Following the surgery, the patient was referred to the physiotherapy (PT) department for wrist drops, pain, and stiffness in the shoulder joint. The patient received conventional PT (electrical stimulation and exercises) for the first 3 weeks. Later, mirror therapy was introduced for wrist and shoulder movements. She was evaluated for pain, range of motion of shoulder and wrist joints, and functional ability at baseline, at 3 weeks, and at 6 weeks. There was an improvement in all outcome measures predominantly within 3rd week–6th week. Mirror therapy showed positive effects on upper-limb functions when combined with conventional therapy.

A novel passive shoulder exoskeleton for assisting overhead work.

Shoulder exoskeletons (SEs) can assist the shoulder joint of workers during overhead work and are usually passive for good portability. However, current passive SEs face the challenge that their torque generators are often attached to the human arm, which adds a significant amount of weight to the user's arms, resulting in additional energy consumption of the user. In this paper, we present a novel passive SE whose torque generator is attached to the user's back and assists the shoulder joint through Bowden cables. Our approach greatly reduces the weight on the user's arms and can accommodate complex shoulder joint movements with simple and lightweight mechanical structure based on Bowden cables. In addition, to match the nonlinear torque requirements of the shoulder joint, a unique spring-cam mechanism is proposed as the torque generator. To verify the effectiveness of the device, we conducted a usability test based on muscle activations of 10 healthy subjects. When assisting overhead work, the SE significantly reduced the mean and maximum electromyography signals of the shoulder-related muscles by up to 25%. The proposed SE contributes to further research on passive SE design to improve usability, especially in terms of reducing weight on human arms.

Anatomical study and clinical application of thoracoacromial artery perforator flap

Objective:To study the anatomical characteristics of thoracoacromial artery perforator flap（TAAP）, and to explore the advantages and disadvantages of TAAP in head and neck reconstruction. Methods: Four fresh cadavers （8 hemichests） were collected for anatomical observation, the blood supply of chest skin was observed through autopsy, the presence, number, location, caliber, and landmark on the chest surface of all thoracoacromial artery perforators per hemichest were recorded, including the distance of each from the midpoint of the clavicle. The diameters of the thoracoacromial artery and perforating vessels were measured with vernier calipers （accuracy 0.05 mm）, the pedicle length and thickness were measured with a cm scale （accuracy: 1 mm） after the flap was obtained, and the retained photos were recorded. Results:No perforating branch （12.5%） was found on one side of the 8 hemichests, two perforating branches （12.5%） were found on one hemichest, and one perforating branches （75.0%） were found on the rest of the hemichests. The perforating point was about between the clavicular head of pectoralis major （clavicular part） and the sternocostal head （sternocostal part）. The vessels at the beginning of perforation were generally bulky, with an average diameter of 2.25 mm, however, the vessel diameter was significantly reduced after the perforation of the flap. The pedicle length of thoracoacromial artery perforator flap ranged from 5.43 cm to 9.03 cm, with an average length of 7.14 cm. The pedicle length from the exit point of perforator muscle gap to the flap was 2.32-4.63 cm, with an average length of 3.28 cm. The distance between the exit point of perforator muscle space and the lower edge of the midpoint of the clavicle was 3.31-4.52 cm, with an average distance of 3.77 cm. Conclusion:The thoracoacromial artery perforator flap has some advantages such as similar color as head, neck and maxillofacial region, stable blood supply, relatively consistent vascular pedicle length and caliber size, relatively larger flap, less damage to pectoralis major muscle, and protection of chest shape, thoracic movement and shoulder joint movement function. Although the clinical application of this flap is limited by the uncertainty of perforating vessels, postoperative asymmetry of the nipple and residual chest scar, it still has a broad application prospect in head and neck reconstruction.

Polymyalgia rheumatica presenting as sternoclavicular arthritis: a case report

BackgroundPolymyalgia rheumatica and giant cell arteritis are systemic inflammatory conditions of the elderly. Polymyalgia rheumatica classically presents as a bilateral proximal muscle pain and stiffness syndrome. Biceps tenosynovitis is the commonest pathology in polymyalgia rheumatica. However according to literature, erosive sternoclavicular arthritis is a rare association of polymyalgia rheumatica. Giant cell arteritis is an inflammatory granulomatous arteritis predominantly involving large cerebral arteries. Thus, its classic clinical presentation includes severe headache with scalp tenderness, jaw claudication, and sudden painless loss of vision. Urological manifestations (prostatic vasculitis and epididymo-orchitis) were seldom reported in giant cell arteritis.Case presentationA 53-year-old Sinhalese man presented with progressive right-sided shoulder joint pain and neck pain associated with constitutional symptoms and episodic generalized headache. Examination revealed restricted movements of the right shoulder joint with nontender pulsatile bilateral temporal arteries. Blood testing showed elevated erythrocyte sedimentation rate and C-reactive protein. Color Doppler ultrasound of the superficial temporal artery revealed “halo sign.” The temporal artery showed infiltration of mononuclear cells in the arterial media and adventitia. Computed tomography revealed right sternoclavicular arthritis with incidental finding of ureteric stricture. The patient was treated with high-dose oral prednisolone, and good clinical and biochemical response was observed during follow-up.ConclusionPolymyalgia rheumatica–giant cell arteritis may rarely present as erosive sternoclavicular arthritis as the initial manifestation, mimicking many rheumatological conditions. Urological involvement such as ureteric strictures may be rare associations of primary systemic vasculitis. A high degree of suspicion combined with targeted investigations would allow early identification the polymyalgia rheumatica–giant cell arteritis syndrome in the presence of atypical manifestations, leading to improved patient outcomes.

Bilateral upper extremity trunk model for cross-country sit-skiing double poling propulsion: model development and validation.

The subacromial impingement syndrome is a high-incidence injury for cross-country sit-skiing skier, which is often accompanied by muscle imbalance. However, at present, no musculoskeletal model has been identified for this sport. Thus, this research aimed to establish a bilateral upper extremity trunk (BUET) musculoskeletal model suitable for cross-country sit-skiing based on OpenSim software and verify the function of the model. By splicing three existing OpenSim models, an upper limb model with 17 segments, 35 degrees of freedom, and 472 musculotendon actuators was established. The clavicle and scapula were modeled as individual bodies and then connected to the torso through a three-degrees-of-freedom rotational joint and to the clavicle through a weld joint, respectively. The five lumbar vertebrae were established separately and coupled into a three-degree-of-freedom joint. Kinematics, kinetic, and EMG signal data of five 15-s maximal effort interval tests were obtained by using seven cameras, ergometers, and surface EMG synchronous collection. Based on the resulting rotator cuff muscle geometry of the model, simulated muscle activation patterns were comparable to experimental data, and muscle-driven ability was proven. The model will be available online ( https://simtk.org/projects/bit ) for researchers to study the muscle activation of shoulder joint movement.

Comparison of clinical efficacy of simple double-row suture bridge technique and double-row suture bridge technique combined with type Ⅱ "Chinese way" in the treatment of huge rotator cuff injury

Objective: To compare the postoperative efficacy of simple double-row suture bridge technique and double-row suture bridge technique combined with type Ⅱ "Chinese way" in treating huge massive rotator cuff injury. Methods: The clinical data of 74 patients with unilateral massive rotator cuff injury admitted to Department of Orthopedic, Beijing Chaoyang Hospital, Capital Medical University, from January 2019 to September 2021 were retrospectively analyzed. There were 39 males and 35 females, aged (60.2±7.8) years (range: 42 to 77 years). During operation, 44 patients were treated with single double-row suture bridge technique (the simple group), and 30 patients were treated with double-row suture bridge technique combined with type Ⅱ "Chinese way" treatment (the combined group). In the simple group, only internal and external row anchors were used to fix the fractured rotator cuff, while in the combined group, the biceps long head tendon was first transposed to the footprint area and fixed with an internal row anchor tail thread, and then the remaining rotator cuff fracture was repaired with double-row suture bridge technique. The operation conditions were recorded. The range of motion of shoulder joint, visual analogue scale (VAS), American Society for Shoulder and Elbow Surgeons (ASES) score, University of California, Los Angeles (UCLA) score, Constant-Murley shoulder joint score before operation, 6 months after operation and at the last follow-up were compared between the two groups. Postoperative complications and imaging results were recorded. The difference values of each observation index before and after operation were calculated. The repeated measures analysis of variance was used for repeated measurement data, and LSD multiple comparison method was used for the data at different time points in the two groups. Results: All the patients successfully completed the operation, and no serious complications occurred during or after operation. The patients were followed up for (14.6±5.4) months (range: 6 to 24 months). In all patients, the shoulder range of motion, VAS, ASES score, UCLA score and Constant-Murley shoulder score at 6 months after operation and at the last follow-up were significantly improved compared with those before operation (all P<0.01), and the results at the last follow-up were also better than those at 6 months after operation (all P<0.01). The results of the combined group at 6 months after operation and at the last follow-up (all P<0.01) were better than those of the single group. At 6 months after operation and at the last follow-up, the anteroposternal X-ray showed no significant progress in the degeneration of shoulder joint. Of the 27 patients who completed MRI during follow-up, 14 patients re-injured of reconstructed rotator cuff tissue (type Ⅳ and type Ⅴ) was found in 14 cases, the incidence was 22.7% (10/44) in the simple group and 13.3%(4/30) in the combined group. There was no significant difference between the two groups(χ2=1.026, P=0.311). Conclusion: Compared with the simple double-row suture bridge technique, the method of double-row suture bridge technique combined with type Ⅱ "Chinese way" for repairing massive rotator cuff injury has better effect on improving the short-term pain symptoms, joint range of motion, restoring joint function, and has lower incidence of complications.

Humerus Shaft Fractures Managed by Locking Compression Plate

Background: The incidence of nonunion of humerus has been as high as 15% of all humeral fractures. Majority of humeral shaft fractures were treated by conservative treatment using splints, hanging arm cast, braces compromising anatomical reduction in view of wide range of movement of shoulder and elbow joint. Methods: The prospective study was conducted at Dept. of Ortho-Surgery, Sheikh Sayera Khatun Medical College &amp; Hospital, Gopalgonj, Bangladesh from January 2021 to June 2022. Total 20 patients with fracture shaft humerus, who were treated with locking compression plate from the period were study. All patients are admitted and subjected to clinical &amp; radiological examination, necessary lab investigations are carried out for proposed surgery. Regular follow up will be carried out by clinical examination and with X-rays at interval of 6 weeks, 3 months than 6 months and study will be conducted on a minimum of 20 patients. Results: Total 20 patients with fracture shaft humerus, who were treated with locking compression plate from the period of study. The age group of the patients in our study ranged from 15 years to 65 years. Most of the patients belong to 21- 40 years. 65% with male predominance (70%), with type A3 as the commonest fracture (50%) involving the mid shaft (70%) of humerus, underwent open reduction and internal fixation using locking compression plate. Conclusion: The age of the patient ranged from 15 years to 65. Majority of the patients were males. (M: F = 14: 6). In our series, left humerus was involved in 50% cases, while right was involved in the other 50% of cases.

The Influence of Anticipation of Movement Starting Time on Feedforward Activation of Trunk Muscles during Rapid Shoulder Joint Movements.

This study aimed to clarify the differences in the onset of trunk muscle activity with and without anticipation of the movement starting time during rapid shoulder movements. Ten healthy men in a relaxed upright position performed rapid 135° flexion, 135° abduction, and 45° extension of the shoulder on the dominant hand side with and without anticipation of the movement starting time. They moved their shoulder joints following a 3-s countdown and a light stimulus in the anticipation and non-anticipation conditions, respectively. Electromyography of the anterior and posterior quadratus lumborum, transversus abdominis, internal oblique, external oblique, rectus abdominis, lumbar multifidus, lumbar erector spinae on the non-dominant hand side, and the middle deltoid on the dominant hand side were measured. The onset of activity of each trunk muscle relative to the onset of the middle deltoid was calculated. Two-way analysis of variance (eight trunk muscles × two anticipation conditions) was used to compare the onset of electromyographic activity of the trunk muscles in each direction of the shoulder movement. There were significant interactions between the muscles and anticipation conditions during shoulder abduction and extension. The onset of activity in the anterior and posterior quadratus lumborum, transversus abdominis, and internal oblique occurred earlier with anticipation of the movement starting time than without anticipation during shoulder abduction and extension. The anticipation of movement starting time may contribute to a reliable center of mass control within the support base and improve lumbar spine stability by hastening the onset of activity of the deep trunk muscles.

MR imaging biomarkers for evaluation of adhesive capsulitis of the shoulder. Additive value of anterior capsule abnormality as a reliable criterion for diagnosis of adhesive capsulitis: a cross sectional analytic study

BackgroundAdhesive capsulitis of the shoulder is a pain syndrome of progressive nature, associated with reduced active and passive range of motion of the gleno-humeral joint. Previous studies suggested an underlying synovial inflammatory process, followed by capsular hypertrophy and reactive fibrosis. The aim of our study was to investigate the influence of anterior shoulder joint capsule abnormal thickening and abnormal signal intensity on MRI, as important imaging biomarkers, for the diagnosis of as adhesive capsulitis.ResultsThis cross sectional analytic study involved 28 patients with adhesive capsulitis ((17 males, 11 females, age range:23–65 years, mean age: 45.61 years ± 11.95) and 28 controls (14 males, 14 females; age range, 39 to 61 years; mean age 52.82 years ± 6.45;). The patients and the controls were reviewed by two radiologists with experience of more than 10 years, blinded to each other's results. Adhesive capsulitis was diagnosed based on clinical criteria of significant restricted passive motion of shoulder joint. The thickness and abnormal signal intensity of anterior glenohumeral joint capsule were evaluated at its thickest portion, positioned underneath the subscapularis muscle. Additionally, the formerly known MR characteristics of adhesive capsulitis, involving the thickness of humeral and glenoid portions of axillary recess, maximal thickness of axillary capsule, and thickness of coracohumeral ligament, were assessed. The estimation of abnormal hyperintensity of humeral and glenoid capsule in axillary recess, subcoracoid fat triangle obliteration and abnormal hyperintensity were also included in our study. All magnetic resonance imaging (MRI) quantitative values showed significant difference between adhesive capsulitis group and control group. Regarding qualitative values, only abnormal high signal intensity of the anterior portion of joint capsule, of the axillary portion of joint capsule and of glenoid portion of axillary capsule showed statisticaly significant difference between cases and controls. In receiver operating characteristic (ROC) curve study, the anterior capsule thickness revealed a high diagnostic value with an area under the curve (AUC) of 1.0. An anterior capsule thickness cut off value of at 2.45 mm showed a very high diagnostic performance, revealing a sensitivity of and specificity of 100%.ConclusionsThe anterior glenohumeral joint capsule abnormal thickening, and abnormal hyperintensity have a high diagnostic performance, in addition to the previously known abnormal MRI findings, in the evaluation of adhesive capsulitis.

Kinesio Taping combined with electroacupuncture for the treatment of Bigliani typeⅠsubacromial impingement syndrome

To investigate the clinical effect of Kinesio Taping combined with electroacupuncture in the treatment of Bigliani typeⅠsubacromial impingement syndrome. From January 2019 to June 2021, 82 cases with Bigliani typeⅠsubacromial impingement syndrome were selected and divided into treatment group and control group. Treatment group included 41 cases, 23 males and 18 females, aged from 20 to 52 years old, with an average of (39.31±5.80)years old. There were 12 cases on left shoulder and 29 cases on right shoulder. The course of disease was from 3.2 to 35.4 months. The treatment group was treated with Kinesio Taping and electroacupuncture. In control group, there were 41 cases, including 22 males and 19 females, aged from 19 to 53 years old with an average of (40.67±6.13) years old, 30 cases on right shoulder, 11 cases on left shoulder. The courses of disease was from 3.0 to 36.0 months. The control group was treated with simple shoulder electroacupuncture. Patients in both groups were treated with electroacupuncture 3 times a week for 3 weeks. After each electroacupuncture treatment in the treatment group, the Kinesio Taping was applied immediately and kept for 2 days. Before treatment, immediately after treatment, and after 1, 3, 8 weeks, the shoulder joint Constant-Murley score, pain visual analogue scale (VAS), and shoulder joint range of motion were used to evaluate the treatment effect. After 1 week of treatment, there was 1 patient in treatment group refused treatment due to hypersensitivity to Kinesio Taping, 1 patient in control group was allergic to the metal needle and refused treatment. And the other 80 patients completed all treatment. Immediately after treatment, and 1, 3, and 8 weeks after treatment, VAS of treatment group were (2.06±1.03), (2.74±1.66), (3.28±1.04), and (3.90±0.12) points, respectively. The Constant-Murley scores of shoulder joint were(86.41±3.52), (82.44±3.14), (80.46±2.54), (76.97±2.01) points. VAS of control group were(3.35±0.41), (3.08±0.92), (3.77±0.67), (3.96±1.04) points, and the Constant-Murley scores of the shoulder joint were(75.82±2.73), (74.72±1.53), (73.66±1.53), (70.68±1.95) points respectively. Immediately after treatment, VAS, Constant-Murley score, and shoulder range of motion between two groups were better than those of before treatment (P<0.05), and the difference was statistically significant between two groups after treatment (P<0.05). One week after treatment, VAS, Constant-Murley score, and shoulder joint range of motion between two groups were better than those of before treatment (P<0.05), but there was no significant difference in VAS between two groups (P>0.05). There were significant differences in the Constant-Murley score and shoulder range of motion between two groups (P<0.05). At 3 and 8 weeks after treatment, VAS, Constant-Murley score, and the range of motion of shoulder joints between two groups were better than those of before treatment (P<0.05), but there was no significant difference between two groups(P>0.05). The treatment for bigliani typeⅠsubacromial impingement syndrome with Kinesio Taping combined with electroacupuncture can reduce pain, effectively improve the function of shoulder joint. In addition, with Kinesio Taping protection when motion, the patients sports ability can be improved obviously, with good immediate effect, and no trauma. If the patients are willing to accept it, it would be an immediate and effective treatment.

Robotic and sensor technology for frozen shoulder Rehabilitation

A common clinical shoulder problem is frozen shoulder. The degree of shoulder joint movement must be measured as part of the rehabilitation procedure. These assessments can be used to assess the severity of a patient's disease, set rehabilitation goals, and determine the appropriate level of activity difficulty, as well as comprehend the rehabilitation's impacts. In the healthcare industry, robots are rapidly being used; as they are in many other industries, Specifically for hospital logistics support, surgery, and rehabilitation. Because rehabilitation affects millions of individuals all around the world, there has been steady growth in the rehabilitation robotics sector over the last decade, with the advent of new technology aimed at overcoming the different challenges that this industry faces. A model is proposed in this study for identifying movements produced during frozen shoulder rehabilitation activities. The model is made up of wearable wireless sensor network (WSN) inertial sensor nodes that were built particularly for this investigation and enable for the identification of inertial sensor nodes of physiological movements anywhere. We describe current robotic systems for shoulder rehabilitation in this work, with an emphasis on indicators and further emerging technologies that, when used with robots, can enhance the advantages of rehabilitation for regaining shoulder function.

ADDED EFFECT OF PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION TECHNIQUE WITH MAITLAND MOBILISATION TECHNIQUE IN PERIARTHRITIS OF SHOULDER

Background: Periarthritis of shoulder is a chronic inammatory disorder of shoulder and surrounding soft tissues, characterized by insidious and progressive pain &amp; restriction of both active and passive glenohumeral joint motion in all planes. To assess the effect of Proprioceptive Neuromuscular Facilitati Objective: on &amp; Maitland Mobilisation in Periarthritis of shoulder. To compare the added effect of PNF with Maitland Mobilisation in Periarthritis of shoulder. 30 Patients diagnosed with stage I &amp; II Method: periarthritis of shoulder were included in the study. Group A which is control group received IFT for 10 minutes, hot pack, Maitland grade 3&amp; 4 end range mobilization for shoulder to improve external rotation, abduction, and exion. Group B which is experimental group received same conventional treatment as group A along with PNF technique for 3 weeks. At the end of 3rd week, posttest evaluation comprising of active ROM measurements, strength by taking MMT, &amp; SPADI was taken for both the groups. It was found that ther Results: e was signicant increase in ROM and decrease in SPADI score within both the groups i. e. control and experimental. Study proved Conclusion: that PNF combined with conventional treatment helps to improve range of motion and function of shoulder joint in stage I &amp; II of periarthritis of shoulder. So the technique can be incorporated with the conventional protocol for the management of above condition.

Evaluation of the Effectiveness of the Virtual Reality Technologies Comprehensive Rehabilitation Program Application: a Prospective Cohort Study of 59 Patients with Rotator Cuff Injury

AIM. To evaluate the effectiveness of the comprehensive rehabilitation program for patients with rotator cuff injury using virtual reality technology. MATERIAL AND METHODS. The study examined 59 patients, 29 (49.2%) male and 30 (50.8%) female, the average weight was 79 [70.00;87.50] kg, the average height was 1.72 [1.63;1.78] m, the average age was 48 [32.00;54.00] years, randomly divided into two groups. The control group consisted of 30 patients, including 16 men and 14 women, the average age was 47.00 [27.00;54.00] years, the average height and weight were 1.71 [1.63;1.78] m and 77.50 [70.50;88.25] kg, respectively. Patients of the control group received a standard rehabilitation methodology. The study group consisted of 29 people, 13 men and 16 women, mean age 48 [39.50;56.50] years, mean height 1.72 [1.62;1.78] m, mean weight 81.00 [70.00;86.00] kg, who received classes with the inclusion of virtual reality technologies against the background of the standard method. RESULTS AND DISCUSSION. The study showed a positive dynamics of pain syndrome, an improvement of the functional state of the shoulder joint according to the results of the DASH questionnaire, an increase in the volume of the shoulder joint motions. The average indicators of dynamic strength and muscular endurance and performance in the “inward/outward rotation” test increased by 58% and 68.5%. In the “ adduction/abduction” tests, the strength indicators of patients with rotator cuff tears increased by 67.5%, and muscle endurance and performance by an average of 82.3%. According to the results of isokinetic testing, the growth of strength values in the “extension / flexion” test was 64.5%, and muscle endurance and performance were 79%. CONCLUSION. The inclusion of virtual reality technologies at the stage of medical rehabilitation of patients with rotator cuff injuries can significantly reduce shoulder pain, improve upper extremity functioning, increase joint range of motion, and significantly improve strength, muscular endurance and performance.

The Effects of Pedestrian Environment on Ambulation with a Walking Frame in Elderly Individuals: A Survey and Experimental Study.

Understanding the effects of sloped roads in the pedestrian environment on the body during ambulation with a walking frame can help design friendlier living environments for elderly individuals. A survey of the characteristics of walking frames used in different pedestrian environments was investigated in five communities, and a controlled study of the effects of a sloped road on a subject with different walking frames was carried out as foundational research in the laboratory. A synchronous acquisition system consisting of a wireless motion capture module and a physiological information recording module was applied to collect data on the motion of the shoulder joint and skin conductance response (SCR) of fingers in one participant. Force data were collected from sensors placed on the four legs of the walking frame. The experimental data obtained during different tasks were quantitatively analyzed. Compared to flat ground, the shoulder joint rotated in the opposite direction in horizontal and internal/external planes when using a wheeled walking frame on an uphill road, and the supportive force decreased on both uphill and downhill roads. The range of motion of the shoulder joint reduced and the direction of the shoulder joint motion changed when using a footed walking frame on both uphill and downhill roads. Additionally, the peak value of the supportive force on the uphill road appeared in the first 50% of the gait cycle, which was earlier than in the other cases. In addition, walking on the uphill road with a walking frame had a maximum SCR value, which means a greater impact of psychological arousal. Biomechanics of the shoulder joint and psychological arousal are closely related to the ease of walking on a sloped road with a walking frame. These findings are beneficial for designing more appropriate environments for elderly individuals who walk with aids.

Management of frozen shoulder by leech therapy and adjuvant phytotherapy

BACKGROUND: Frozen shoulder is also known as adhesive capsulitis. It is one of the common musculoskeletal disorders. Its common symptoms such as pain and restricted movement of the shoulder joint. Conventional management of frozen shoulder include oral analgesics, range of motion exercises, intra- capsular corticosteroids injection, local application of analgesic oils and ointments but no such effective results have been found yet. As per Ayurveda perspective the condition can be correlated with Avabahuka. Further, Jalaukavacharana (~leech therapy) is one of the ancient para-surgical procedure described in Ayurveda for treatment of variety of such inflammatory condition along with other para surgical procedure and internal herbal drugs. METHODOLOGY: A 52 -year female patient having chief complaints of pain with restricted movement of left shoulder joint, pain in cervical region radiating towards left shoulder joint and mild tingling sensation on lower back region, was clinically diagnosed as case of frozen shoulder. This patient was treated with specific regimen such as Jalaukavacharana (~leech therapy) locallyalong with Ashwagandhaghanvati and Panchatikta ghrita guggulu internally. The parameters observed for prognosis were pain, stiffness, range of movements. Therapeutic evaluation of treatment was done based on improvement in the symptoms.

세라밴드 운동이 고령여성의 신체조성, 관절가동범위(ROM) 및 하지 균형에 미치는 영향

In this study, the body composition and range of motion of shoulder, knee, and ankle joints and lower limbs balance were measured by performing thera-band exercise for 12 weeks targeting female elderly people. As a result of analyzing the effect by measuring and heel pressure ratio, the following conclusions were obtained.BR First, in the change of body composition, BMI increased significantly(p.05) in the control group. Second, in the change of shoulder joint, the thera-band exercise group significantly increased in flexion (p.001) and abduction(p.05), and in the knee joint, the thera-band exercise group significantly increased in flexion(p.01). The ankle joint significantly(p.05) increased in plantar flexion in the thera-band exercise group. Third, in the change of lower limbs balance, the sera band exercise group significantly increased the right foot average pressure(p.05) and the right forefoot pressure ratio(p.05), and the control group had the left forefoot pressure ratio(p.01) and the left There was a significant decrease in the heel pressure ratio(p.05).BR Summarizing the above conclusions, it is believed that 12 weeks of thera-band exercise for the elderly women will be helpful for healthy old life as it is an effective exercise for positive changes in body composition, increase and maintenance of joint range of motion, and improvement of left-right balance ability.

EVALUATION OF ARTHROSCOPIC BUTTON AND FIBER TAPE FIXATION IN ACROMIO-CLAVICULAR JOINT INJURIES

BACKGROUND: Acromio-clavicular injuries (ACI) account for 9% of all shoulder injuries. The injuries are divided into VI types according to Rockwood classification. Surgery is indicated in Type IV to VI and often in Type III injuries. The optimal surgery for these injuries is debatable, though arthroscopic fixation is increasingly being preferred due to small incisions, early rehabilitation and reduced hardware. Dog-bone button (arthroscopic button) is a broad anatomically contoured button and when used with Fiber-tape offers an excellent option to reconstruct the Acromio-Clavicular joint (ACJ). Our study is to evaluate the results of this fixation by using the Constant Score. Thirty (30) adultMETHODS: patients with Type III-V ACI were operated arthroscopically with Dog-Bone Button and Fiber-tape fixation. The patients were followed up for a period of 6 months. Constant score, range of motion of shoulder joint and Coraco-clavicular distance were taken pre-operatively and 6 months after the surgery. Twenty-two patients had RW III injury, sixRESULTS: patients had RW IV and two patients had RW V injury. The mean pre-operative Constant Score was 58.53 (±7.38) and the mean post-operative Constant Score at 6 months was 89.83 (± 9.16). The difference between constant score was statistically significant (p&lt;0.001). Mean preoperative CC distance was 20.27+ 2.3mm to 10.28 mm + 3.12mm at 6 months follow up. Similarly, the difference between pre-operative and post-operative range of motion in flexion and abduction was significant on paired data analysis (p&lt;0.001). One patient had subluxation of AC joint after surgery and had to be re- operated with a threaded K-wire. Arthroscopic Dog-bone button fixation provides good functionalCONCLUSIONS: and radiological outcome and is a viable method to reconstruct acute acromio-clavicular joint injuries.

A Case Series on Morphological Variations of Biceps Brachii in Adult Human Cadavers and its Clinical Implications

Biceps brachii, a powerful forearm supinator, is a muscle in which many anatomical variations have been reported. Biceps brachii anomalies may play an important role in neurovascular compression syndromes in the arm and also affect shoulder joint movements. Three significant morphological variations in Biceps brachii were noted during routine dissection of upper limbs used for undergraduate teaching purposes. An extra articular origin of tendon of long head of Biceps brachii which was passing through the subpectoral tunnel formed by Pectoralis major was observed in one right upper limb. Nonfusion of two bellies of Biceps brachii with an accessory bicipital tendon was observed in one right upper limb. Presence of one supernumerary head of Biceps Brachii with a communicating branch between Median and Musculocutaneous nerves was observed in one right upper limb. Knowledge of these variations is essential for Surgeons and Orthopaedicians during surgery involving shoulder, arm and elbow regions. Key words: Biceps brachii, Supernumerary heads, Extra articular.