Total Range Of Motion Research Articles

Patellar taping alters knee kinematics during step descent in individuals with a meniscal injury: An exploratory study

BackgroundMeniscus lesions are common musculoskeletal knee injuries which often lead to pain, limitation and compensations during functional tasks, such as descending stairs. This study investigated the effect of patellar taping with tension and without tension on three-dimensional (3D) kinematics of the knee during a slow step descent task in patients with meniscal lesions. MethodsTen patients diagnosed with a meniscal lesion, confirmed by magnetic resonance imaging, underwent five, step descent movements at slow speed under three different conditions: 1) no taping; 2) tension-free taping; and 3) patellar taping with medial tension. 3D kinematic data were recorded from the injured knee using an eight-camera infrared Vicon motion analysis system. Maximum and minimum angle values and total range of motion (maximum/minimum value) in three movement planes during single-limb stance were compared using a repeated measure ANOVA. FindingsResults showed a significant increase in the maximum and minimum angle value in the sagittal plane (mean differences=2.4° and 4.2°, respectively) and a decrease in the transverse plane (−6.3° and −2.2°, respectively) for the patellar taping condition compared to the no taping condition. A decreased rotational angle range when comparing the patellar taping to the no taping (−4.1°) and tension-free taping (−3.1°) conditions was also observed. These changes remained significant when pain was considered as a covariate in the analysis. The tension applied to the patellar tape played a role in controlling the sagittal and transverse plane step-down movement among patients in our study. InterpretationThese results support the use of patellar taping with a medially oriented tension to help to reduce the transversal plane movement of the knee in this population and they bring new light to the taping effect.

Investigating the contribution of the upper and lower lumbar spine, relative to hip motion, in everyday tasks

BackgroundIt is commonplace for clinicians to measure range of motion (ROM) in the assessment of the lumbar spine. Traditional single ‘joint’ models afford measuring only a limited number of regions along the spine and may, therefore, over-simplify the description of movement. It remains to be determined if additional, useful information can be gleaned by considering the traditional ‘lumbar region’ as two regions. ObjectiveThe aim of this study was to determine whether modelling the lumbar spine as two separate regions (i.e. upper and lower), yields a different understanding of spinal movement relative to hip motion, than a traditional single-joint model. This study is unique in adopting this approach to evaluate a range of everyday tasks. MethodLumbar spine motion was measured both by being considered as a whole region (S1 to T12), and where the lumbar spine was modelled as two regions (the upper (L3-T12) and lower (S1-L3)). ResultsA significant difference was evident between the relative contribution from the lower and upper spine across all movements, with the lower lumbar spine consistently contributing on average 63% of the total ROM. A significant difference was also evident between the whole lumbar spine-hip ratio, and the lower lumbar spine-hip ratio, for the movement of lifting only. The lower lumbar spine achieved greater velocity for all tasks, when compared to the upper lumbar spine. ConclusionThis study has consistently demonstrated differences in the contribution of the upper and lower spinal regions across a range of everyday tasks; hence, it would appear that greater focus should be given to performing more detailed assessments to fully appreciate spinal movement.

Comparison of the outcomes of cannulated screws vs. modified tension band wiring fixation techniques in the management of mildly displaced patellar fractures

BackgroundK wire fixation with tension band wiring has conventionally been used for the open reduction and internal fixation of the patella. However, it suffers from distinct disadvantages such as implant irritation, need for open reduction, incidence of palpable implants, and need for subsequent implant removal. A smaller incision with percutaneous fixation may be an alternative to this established conventional technique. Thus, the purpose of this trial was to compare the treatment outcomes of patients with mildly displaced patellar fractures treated with closed reduction and percutaneous cannulated screw fixation (CRCF) as compared to open reduction and tension band wiring fixation (ORTF). Specifically, we aimed to determine whether cannulated screw fixation was associated with improved clinical outcomes at 12 months as measured using the Lysholm score, pain scores, degree of flexion, range of motion, time to radiographic union, radiographic outcomes, and complication rates.MethodsSixty-three patients with transverse patellar fractures displaced less than 8 mm were included in this prospective, randomized, controlled trial, with 52 patients in the final data analysis. Thirty-two patients were operatively treated by CRCF with either two or three cannulated screws. Thirty-one patients were operatively treated by conventional ORTF using the modified tension band technique. At postoperative intervals of 3, 6, and 12 months, knee function was evaluated using the Lysholm score, pain was assessed using the visual analog scale (VAS) score, and active knee extensions and flexion were measured in degrees by goniometry.ResultsThe CRCF group had average Lysholm scores of 84.4 ± 5.8, 86.7 ± 6.4, and 93.2 ± 5.3 after 3, 6, and 12 months, respectively, which were significantly greater than those of the ORTF group (79.0 ± 5.3, p = 0.001; 81.5 ± 4.6, p = 0.002; and 89.8 ± 6.2, p = 0.039, respectively). Lower pain and squatting scores were the main reasons for the poorer Lysholm scores in the ORTF group. The VAS scores showed that the CRCF group had lower pain scores and better flexion and total range of motion (ROM) compared with the ORTF group after 3 and 6 months, although both groups had similar outcomes after 12 months. The mean fracture healing time of 2.65 months was similar in the CRCF groups (2.77 months; p = 0.440). Complication rates were 3/26 (11.5 %) in the CRCF group and 14/26 (53.4 %) in the ORTF group. Two patients in the CRCF group and eight patients in the ORTF group experienced skin irritation. In addition, two (7.7 %) patients in the CRCF group and 11 (42.3 %) patients in the ORTF group required implant removal because of symptoms due to the presence of the implants.ConclusionSurgical treatment of mild displaced (less than 8 mm) transverse patellar fractures by the CRCF technique provides satisfactory clinical results and excellent knee function, with little pain and a low incidence of complications at early follow-up (up to 6 months). These results suggest that the CRCF technique may be a superior alternative to conventional ORTF. Registration Trial (Chinese Clinical Trial Register): Current Controlled Trials ChiCTR-PRCH-14005017, registration dates 2014-06-14.

Unilateral laminoplasty with lateral mass screw fixation for less invasive decompression of the cervical spine: a biomechanical investigation.

To compare the stabilization behavior of additional unilateral mass screw fixation with current standard procedures in patients with cervical spondylotic myelopathy (CSM) in a biomechanical study. Ten human C2-C7 cervical specimens were tested under various segment conditions: native (NAT), laminoplasty (LP), laminoplasty with unilateral (LPU) or bilateral (LPB) stabilization, laminectomy with bilateral stabilization (LCB), and laminectomy. The instrumented level was from C3 to C6. For each segment condition, in vitro flexibility tests were performed using a spinal simulator and an applied load of ±2.5 Nm. The three-dimensional kinematics of the entire cervical segment in three main loading directions [flexion-extension (FE), lateral bending (LB), and axial rotation (AR)] was measured with an ultrasonic motion analysis system. Analysis of variance followed by a post hoc test was used to determine differences under the specific segment conditions to assess the parameters range of motion (ROM) and neutral zone (NZ). For FE, the total ROM of laminoplasty (-6.3% difference to NAT) and laminectomy (+6.4%) remained at the level of native (p > 0.56), whereas the instrumentations LPU (-37.1%), LPB (-44%), and LCB (-43.2%) lead to significant reductions (p < 0.01) without significant differences in LPU to LPB and LCB (p > 0.38). The same results were found with LB. For AR, the stabilization of all instrumentations was less pronounced, but had the same tendency seen for FE and AR. The results for the NZ showed equivalent values as that for ROM. The degree of stabilization was as expected for LC and LCB; namely, no stabilization for LC and maximal stabilization for LCB. LPU exhibited almost the same degree of stabilization as LCB. LPU could be a new treatment option for less invasive decompression for multilevel CSM.

Angle Specific Analysis of Side-to-Side Asymmetry in the Shoulder Rotators

Abstract: Although side-to-side asymmetry of the shoulder rotators calculated by independent peak torque (IPT) has been used for interpretation of injury risks in athletes, it may not measure strength through the entire range of motion (ROM) tested. The aim of this study was to compare side-to-side asymmetry of the shoulder rotators between independent peak torque (IPT) and ten-degree angle specific torque (AST). Twenty healthy adult males (24.65 ± 2.4 years) performed concentric and eccentric internal rotation (IR) and external rotation (ER) of the preferred and non-preferr ed arms on an isokinetic dynamometer at 60°/s through 150° of total ROM. The total ROM was divided into 14 ten-degree angles of the physiological ROM from −90° of ER to 60° of IR. Concentric and eccentric IR IPT (10.5% ± 8.7% and 12.1% ± 7.2%) and ER IPT (13.6% ± 9.8% and 8.7% ± 5.6%) were significantly less than AST at several angles ( p < 0.05). IPT might lead to erroneous interpretations of side-to-side asymmetry in the shoulder rotators and does not represent the entire ROM tested. This information could be us ed to prescribe strength exercises to enhance overhead performance and reduce risk of shoulder injuries.

Glenohumeral range of motion (ROM) and isometric strength of professional team handball athletes, part III: changes over the playing season.

The aim of our study was to investigate the relation of workload on range of motion and isometric strength of team handball athletes' shoulders over a competitive season. 31 Professional male handball athletes underwent clinical shoulder examinations. Athletes were examined subsequently during the complete playing season (week 0, 6, 22 and 40) to determine bilateral isometric shoulder rotational strength and active range of motion (ROM). In addition, relative (intraclass correlation coefficients (ICC) and absolute (standard error of measurement) reliability were calculated. Intraobserver reliability was excellent (ICC 0.76-0.98) for isometric strength and flexibility measurements. Internal rotation (IR) and total arc ROM in the throwing shoulder (TS) decreased significantly (p < 0.05) in both sequences (week 22 to week 40, week 0 to week 40). External rotation (ER) ROM and isometric strength in IR and ER did not change significantly. Glenohumeral internal rotation deficit (GIRD) and external rotation gain (ERG) of the TS decreased significantly between week 22 and week 40, but both did not change overall (week 0 to week 40). There was significant influence on IR ROM (week 22 to week 40) and strength in ER (week 0 to week 40) in the non-throwing shoulder. Several characteristics of handball players' shoulders changed significantly from the beginning to the end of a season. More specifically, the repetitive forces accumulated during the competitive season resulted in altered GIRD, ERG and isometric strength of the dominant glenohumeral joint.

Are the standard parameters of cervical spine alignment and range of motion related to age, sex, and cervical disc degeneration?

The aims of this study were 1) to establish the standard parameters of alignment and total and segmental range of motion (ROM) of the cervical spine in the asymptomatic population, and 2) to identify factors that influence cervical ROM and alignment. The authors measured 636 standard cervical lateral, flexion, and extension plain radiographs of 212 asymptomatic volunteers. The relationship between cervical alignment and total ROM was assessed with simple linear regression. Multivariate linear regression was used to determine the effect of the influential factors on cervical alignment and total and segmental ROM. The mean value for C2-7 cervical alignment was 21.40° ± 12.15°, and the mean value for total ROM was 63.59° ± 15.37°. Sex was a significant factor in cervical alignment, total ROM, and segmental ROM for C2-3 and C5-6 (p < 0.05). Age had a significant negative association with both the total ROM and all of the segmental ROM measurements (p < 0.05). Cervical disc degeneration at the level of interest had a significant negative association with C4-5, C5-6, and C6-7 ROM (p < 0.05). Cervical alignment in female subjects was 2.47° lower than that in male subjects. Total ROM was 3.86° greater in female than in male subjects and decreased 6.46° for each decade of aging. Segmental ROM decreased 1.28° for each decade of aging and 2.26° for each category increase in disc degeneration at the level of interest.

Reliability of two goniometric methods for measuring active subtalar range of motion.

Measuring subtalar joint (STJ) motion is accompanied by complications due to the oblique STJ axis which results in triplanar pronation and supination. We developed a pronator and supinator testing apparatus whose axis was aligned with Inman's STJ axis. The purpose of this study was to assess day-to-day reliability of active STJ range of motion (ROM) measurements and to compare the results with those of a rearfoot goniometer. Active pronation, supination and total STJ ROM measurements were administered to 12 men (mean age: 23.8 years) and 12 women (mean age: 22.3 years) at two separate test sessions. Intraclass correlations (ICC), limits of agreement (LoA) and minimum detectable change (MDC) were calculated. Except for pronation ROM in men, the STJ goniometer revealed substantial (ICC > 0.8) reliability in all conditions. Relative MDCs and LoAs were below 15% and 10%, respectively. Significantly higher total ROM (P< 0.05) was found for women compared to men when using the STJ goniometer. The rearfoot goniometer showed high reliability (ICCs > 0.7) but underestimated STJ ROM in average of 37%. Both goniometric methods showed high day-to-day reliability. However, when using the rearfoot goniometer, researchers have to consider whether the level of underestimation of STJ motion is acceptable in the context of the planned investigation.

Differential segmental motion contribution of single- and two-level anterior cervical discectomy and fusion.

To determine and compare the biomechanical effects of single- and two-level anterior cervical decompression and fusion (ACDF) on the re-distribution of the segmental contribution to total cervical range of motion (ROM) in a prospective longitudinal design. Fifty-one patients undergoing either a single- or two-level ACDF due to cervical disc disease were recruited. Functional radiographs were taken preoperatively and then at 3, 6 and 12-month follow-ups. Global ROM of C2-C7, ROM of the treated functional spinal unit (FSU) and the superior and inferior segmental ROMs were then measured. The relative contribution from the FSU and each of the adjacent segments to total cervical ROM were compared pre- and post-operatively within and between the two groups at each of the time points. Single-level ACDF patients demonstrated a significantly greater total cervical ROM at 6 and 12months compared with the two-level ACDF group (p=0.021 and 0.045, respectively). A significantly greater contribution from the FSU to the total ROM was found at 3months in the two-level ACDF group (p=0.016), but the greater contribution shifted to the superior adjacent segment at 6 and 12months (p=0.025 and 0.046). The two-level ACDF group did not demonstrate a significant difference at 3months (p=0.087), but a significant increase in contribution was found at 6 and 12months (p<0.01). Single-level ACDF maintains and restores a more physiological re-distribution of segmental contribution of ROM compared with two-level ACDF, which required longer time to achieve stable FSU immobilization and coupled with significantly increased superior segment contribution.

Relationship between functional performance and falls in female patients with end stage hip osteoarthritis

s / Osteoarthritis and Cartilage 23 (2015) A82eA416 A349 568 RELATIONSHIP BETWEEN FUNCTIONAL PERFORMANCE AND FALLS IN FEMALE PATIENTS WITH END STAGE HIP OSTEOARTHRITIS F. Pozzi y, S. Abujaber z, S. Fenstermacher y, J. Zeni, Jr. y. yUniv. of Delaware, Newark, DE, USA; z The Univ. of Jordan, Amman, Jordan Purpose: To compare functional performance between women with end stage hip osteoarthritis (OA) who sustained a fall within the previous 6 months and women who did not. In addition, the relationship between functional performance and fall status (yes/no) will be explored. Methods: Thirty-one female individuals (age 65±8 years of age, 30.8±7.8Kg/m2 BMI) who were scheduled to undergo total hip arthroplasty were enrolled in this study. Patients underwent a functional evaluation with a physical therapist approximately 2 weeks before the surgery. Self-reported function was assessed using the Hip Harris Score (HHS) and the Hip Outcome Score (HOS). Total hip range of motion (ROM) was calculated as part of the HHS. Pain in the lower extremity joints and low back was measured using an analog scale (0, no pain; 10, worst pain imaginable). Isometric hip abductor strength was measured using a hand held dynamometer and knee extensor strength was measured using an electromechanical dynamometer. Both strength measures were normalized according to body weight. Functional performance was assessed with the Timed Up-and-Go (TUG), Stair climbing (SCT), and Six Minute Walk (6MW) tests. Fall status was assessed by asking patients whether they sustained a fall in the previous 6 months. The group was then divided into fall and no-fall groups based on the response to the fall question. An independent sample ttest was used to compare data between groups. Point-biserial correlation coefficient was then calculated to explore the relationship between functional variables and fall status. The quartile distribution of the performance on the functional tests (TUG, SCT, and 6MW) was built with the data from all subjects. The percentile value of the performance of the subjects in the fall group was then calculated. Results: Seven out of 31 patients (22.5%) reported sustaining at least one fall within 6 months from the evaluation session. Patients that fell were significantly older (þ8 years, p 1⁄4 0.01) and had significantly less total hip ROM (-21 , p 1⁄4 0.03) and quadriceps strength on both surgical and non-surgical side (-0.82 and -0.97 Nm/Kg, respectively, p 1⁄4 0.04). Additionally, patients in the fall group took longer time to complete the TUG (þ6.73s, p < 0.01) and SCT (þ18.76s, p < 0.01), and walk shorter distance in the 6MW test (-134.8m, p < 0.01, table 1). The correlation analysis revealed that older age and worse performance during functional tests were strongly related falls (Table 1). The percentile distribution of the performance during functional tests for subjects in the fall group revealed that most of the patients performed below the 25th percentile for each functional measures, although two subjects in the fall group were in the top quartile for TUG and SCT (Figure 1). Table 1 Demographic characteristics, range of motion, pain, strenght, performance tests, and sel

Recovery of knee function in the isolated MCL and combined ACL-MCL deficient knee.

The MCL is the prime medial stabiliser of the knee and is a commonly injured structure which leads to valgus instability of the knee. We aim to analyse differences in recovery of knee motion and muscle function over one year follow up in the isolated MCL and combined ACL-MCL injured knee. We hypothesized that combined ACL-MCL injuries lead to greater knee motion and muscle function deficits at 1 year. Isolated MCL (Group I) or combined ACL-MCL injuries (Group II) from 2006-2010 were included. Those with a previous MCL injury, injury to contralateral limb or presenting 2 weeks post-injury were excluded. At certain outpatient follow up intervals, we recorded pre-determined parameters of knee function. Follow-up was at weeks 2, 6, 12, 26, 52. The cohort included 82 patients (54 males:28 females) with a mean age of 32 (range 16-56). Group II showed a deficit in Total Range of Movement (TROM) and flexion at 6 month follow up (p<0.05). Group II showed an extension deficit at week 2 (p<0.05). The Peak Torque Deficit (PTD) and Average Power Deficit (APD) improved for quadriceps and hamstrings across all follow up intervals (p>0.05). There is a TROM and flexion deficit at 6 months in group II, resolving by 1 year. There was no difference in PTD or APD in either group.

Reprint of: Range of motion and isometric strength on shoulder joints of team handball athletes during the playing season, part II: changes after midseason

Summary Objective Our objective was to investigate the influence of workload and consecutive changes on active range of motion and isometric strength of team handball athletes' throwing shoulders (TSs) because the available data are insufficient. Methods In a longitudinal investigation, 31 professional male handball athletes underwent a clinical shoulder examination. Athletes were examined at the beginning (week 0), at the end (week 6) of the preseasonal training, and at the end of the half-season (week 22) on both shoulders to determine isometric rotational strength (hand held dynamometer) and active range of motion (goniometer). Results This analysis demonstrates the results subsequently from week 6 to week 22 and from week 0 to week 22. The glenohumeral internal rotation (IR) deficit (GIRD), external rotation (ER) gain, and ER at the TS increased significantly ( P 2 >0.10, d >0.30) in the first sequence (week 6 to week 22) but not significantly from week 0 to week 22. The total range of motion remained stable, and IR changed but not significantly. There was no influence on IR, ER, and total range of motion at the non-TS. The isometric strength of the TS and non-TS IR did not change. The isometric strength in ER significantly increased bilaterally during the investigation period. Conclusions Our data verify changes and influences, such as an increasing GIRD, at the overhead TS joint in accordance with the workload during team handball season. ER gain did improve after the halfseason period but did not fully compensate the GIRD at the TS. Level of evidence Basic Science, Kinesiology.

The Effects of Scapular Stabilization Exercise on the Muscular Functions and Pain Release of Shoulder Joints in Youth Baseball Players

We investigated the effect of scapular stabilization exercise on shoulder joints mobilization and pain release in youth baseball players. Total 15 youth baseball players were voluntarily participated, and randomly divided into one of two experimental groups: either stabilization exercise group (EXE, n=7) or control group (NonE, n=8). Stabilization exercises (i.e., punching, scapular retraction, scapular fold, shrug, pull over, seated press, scaption with retraction, body blade, rotator cuff) were administered to EXE (8 weeks, 3 timesᆞwk, 60-100 min·session). Muscular power using Biodex system 3, full range of motion (ROM) with a goniometer, and the degree of pain with the Visual Analogue Scale was assessed at both baseline and the time point of completion of 8 weeks training program. Twoway ANOVA (group vs. time) was adopted to observe any interactive effects between factors. The statistical significance level was set at α=.05. There was an improvement in muscular power at both slow (i.e., 60/sec) and medium (i.e., 180/sec) speed setting in isokinetic instrument during internal and external rotation on dominant shoulder, and internal rotation only (not with external rotation) on non-dominant shoulder. There was no change in ROM in NonE, but total ROM was significantly expanded in EXE, revealing only degree of internal rotation increased. VAS significantly decreased in EXE. In conclusion, scapular stabilization exercise exerted positive effect on muscular power output, full range of motion and pain release on shoulder joint in youth baseball players. This indicates that scapular stabilization exercise possibly exert meaningful effect in injury prevention and sport performance.

Management of distal humerus fracture is not always a surgeon's nightmare!

Aim: To evaluate the functional outcome of distal humerus intercondylar fracture treated by open reduction and internal fixation. Methods: The prospective study of 42 patients with intercondylar humerus fracture treated at Sri Ramachandra Medical Centre between March 2010 and March 2014. The inclusion criteria were age above 19 years, Type C fractures of the distal humerus and closed fracture's. The exclusion criteria were extraarticular fractures of the distal humerus, unicondylar with intercondylar extension and open fractures. The rating system of the Mayo elbow functional scoring system was used. The patients were followed for a minimum of 1-year. Results: In 42 patients, 26 were males and 16 were females. In our series, we had 81% excellent/good results, 19% fair/poor result. We had complications in 7 patients. Two patients had early Kirschner-wire back out. One patient had an infection, and 4 patients had ulnar nerve neuritis. Conclusion: Meticulous surgical technique, stable internal skeletal fixation, and early controlled postoperative mobilization are critical factors for a successful outcome. Trans-olecranon approach with the patient in lateral position offers excellent exposure of the articular surface. Arc of motion was more important than the total range of motion. The clinical evaluation did not always correlate with the follow-up radiograph.

Effect of Manual Force on Lumbar Side Bending Range of Motion

Objective: We evaluated the immediate changes in intervertebral motion after application of lumbar manual force. Methods: Fifteen male volunteers (aged 26–43 years) with no history of significant low back pain were recruited to participate as a study group (manual traction). Control group (without manual traction) consisted of fifteen male volunteers who are matched with age (age 21-45 years). Consenting volunteers were referred for three radiographs (neutral position, right side bending position prior to manual force and right side bending position after manual force). The L3/4 segment was chosen for manual force, which was performed by a single examiner. Frontal angular rotation of each lumbar spine segment and total lumbar spinal motion were measured radio graphically before and after manual force by a single investigator (radiologist). Within-group differences were assessed with the paired t test. Results: Analysis of the pre-and post-manual force radiographs showed a significant average increase at the L3/4 segment from 4.9° to 6.4° and an improvement in the total range of motion from 17.8° to 19.5° in the study group. No significant increase was found at the L1/2, L2/3, or L4/5 segments in the study group. In the control group, there were no significant changes in all measurements. Conclusion: These results suggest that manual force targeting the L3/4 segment results in an immediate increase in the angular motion of the L3/4 segment and improvement in total motion of the lumbar spine.

Comparison of Intervertebral ROM in Multi-Level Cadaveric Lumbar Spines Using Distinct Pure Moment Loading Approaches.

Pure-moment loading is the test method of choice for spinal implant evaluation. However, the apparatuses and boundary conditions employed by laboratories in performing spine flexibility testing vary. The purpose of this study was to quantify the differences, if they exist, in intervertebral range of motion (ROM) resulting from different pure-moment loading apparatuses used in two laboratories. Twenty-four (laboratory A) and forty-two (laboratory B) intact L1-S1 specimens were loaded using pure moments (±7.5 Nm) in flexion-extension (FE), lateral bending (LB) and axial torsion (AT). At laboratory A, pure moments were applied using a system of cables, pulleys and suspended weights in 1.5 Nm increments. At laboratory B, specimens were loaded in a pneumatic biaxial test frame mounted with counteracting stepper-motor-driven biaxial gimbals. ROM was obtained in both labs using identical optoelectronic systems and compared. In FE, total L1-L5 ROM was similar, on average, between the two laboratories (lab A: 37.4° ± 9.1°; lab B: 35.0° ± 8.9°, p=0.289). Larger apparent differences, on average, were noted between labs in AT (lab A: 19.4° ± 7.3°; lab B: 15.7° ± 7.1°, p=0.074), and this finding was significant for combined right and left LB (lab A: 45.5° ± 11.4°; lab B: 35.3° ± 8.5°, p < 0.001). To our knowledge, this is the first study comparing ROM of multi-segment lumbar spines between laboratories utilizing different apparatuses. The results of this study show that intervertebral ROM in multi-segment lumbar spine constructs are markedly similar in FE loading. Differences in boundary conditions are likely the source of small and sometimes statistically significant differences between the two techniques in LB and AT ROM. The relative merits of each testing strategy with regard to the physiologic conditions that are to be simulated should be considered in the design of a study including LB and AT modes of loading. An understanding of these differences also serves as important information when comparing study results across different laboratories.

A biomechanical investigation of dual growing rods used for fusionless scoliosis correction

BackgroundThe use of dual growing rods is a fusionless surgical approach to the treatment of early onset scoliosis which aims to harness potential growth and correct spinal deformity. The purpose of this study was to compare the in-vitro biomechanical response of two different dual rod designs under axial rotation loading. MethodsSix porcine spines were dissected into seven level thoracolumbar multi-segment units. Each specimen was mounted and tested in a biaxial Instron machine, undergoing nondestructive left and right axial rotation to peak moments of 4Nm at a constant rotation rate of 8deg. s−1. A motion tracking system (Optotrak) measured 3D displacements of individual vertebrae. Each spine was tested in an un-instrumented state first and then with appropriately sized semi-constrained and ‘rigid’ growing rods in alternating sequence. The range of motion, neutral zone size and stiffness were calculated from the moment–rotation curves and intervertebral range of motion was calculated from Optotrak data. FindingsIrrespective of test sequence, rigid rods showed a significant reduction of total rotation across all instrumented levels (with increased stiffness) whilst semi-constrained rods exhibited similar rotational behavior to the un-instrumented spines (P<0.05). An 11.1% and 8.0% increase in stiffness for left and right axial rotation respectively and 14.9% reduction in total range of motion were recorded with dual rigid rods compared with semi-constrained rods. InterpretationBased on these findings, the Semi-constrained growing rods were shown to not increase axial rotation stiffness compared with un-instrumented spines. This is thought to provide a more physiological environment for the growing spine compared to dual rigid rod constructs.

Hemi-hamate autograft for reconstruction of the middle phalanx base

Objective To discuss the techniques and treatment outcomes of hemi-hamate autograft for reconstruction of the middle phalanx base.Methods Twelve cases of intra-articular comminuted fractures of middle phalanx base in 12 fingers were treated with transfer of hamate articular surface.Mini screws and external fixator were used to fix the pieces.Restricted functional exercise was carried out in the first 2 postoperative weeks.The external fixator was removed 4 to 6 weeks postoperatively dependent on fracture healing.Active joint movement was gradually increased.Results The patients were follow-up for 6 to 18 months.All the middle phalanx base fractures healed.Joint deformities were corrected.Proximal interphalangeal joint movement was satisfactory.The total range of motion of the finger was 180 °to 260 °.Based on the total active motion evaluation,the results were rated as excellent in 6 fingers,good in 3 fingers,fair in 2 fingers and poor in 1 finger.The excellent and good rate was 75％.Conclusion Hemi-hamate articular surface transfer is a good surgical procedure for treating intra-articular comminuted fractures of middle phalanx base.Early restricted functional exercise is beneficial to the recovery of joint function. Key words: Hamate; Phalanx; Fractures, bone; Fracture fixation

Finger Movement Function After Ultrasound-Guided Percutaneous Pulley Release for Trigger Finger: Effects of Postoperative Rehabilitation

ObjectiveTo develop and test a postoperative rehabilitation protocol for use by individuals with trigger finger undergoing ultrasound-guided percutaneous pulley release. DesignNonrandomized controlled trial. SettingHospital and local community. ParticipantsIndividuals suffering from trigger finger with joint contracture (N=21) were recruited and grouped into an intervention group (n=9) or a control group (n=12). InterventionsAll the participants underwent the same surgical procedure performed by the same surgeon. A 4-week postoperative rehabilitation program was designed based on the wound healing process. The intervention group received postoperative rehabilitation after the surgery, whereas the control group received no treatment after the surgery. Main Outcome MeasuresThe finger movement functions were quantitatively evaluated before and 1 month after the surgery using a 3-dimensional motion capture system. The fingertip workspace and joint range of motion (ROM) were evaluated while the participant was performing a sequential 5-posture movement, including finger extension, intrinsic plus, straight fist, full fist, and hook fist. ResultsThe intervention group demonstrated significantly more improvements than the control group in the fingertip workspace (49% vs 17%), ROM of the distal interphalangeal (DIP) joint (16% vs 4%), ROM of the proximal interphalangeal (PIP) joint (21% vs 5%), and total active ROM (17% vs 5%). ConclusionsThis pilot study evaluated a postoperative rehabilitation protocol for trigger finger and demonstrated its effects on various finger functions. Participants who underwent the rehabilitation program had significantly more improvements in the fingertip workspace, ROM of the DIP and PIP joints, and total active ROM.

Flexibility of thoracic spines under simultaneous multi-planar loading.

The corrective potential of two posterior-only destabilization procedures for scoliosis deformity was quantified under single and multi-planar loading using cadaveric spines. Ten full-length human cadaveric thoracic spines were mounted in an 8-df servohydraulic load frame. Cyclic, pure moments were applied in: (1) flexion-extension, (2) lateral bending, (3) axial rotation, (4) flexion-extension with axial rotation, and (5) lateral bending with axial rotation at 0.5°/s, to ±4 Nm. Each specimen was tested intact, and again after nine en bloc bilateral total facetectomies, and one, two, three, and four levels of Ponte osteotomies. Motion was measured throughout loading using optical motion tracking. Under single-plane loading, facetectomies and Ponte osteotomies increased thoracic spine flexibility in all three planes. Compared to total facetectomies, higher per-level increases were seen following Ponte osteotomies, with increases in total range of motion (total ROM) of up to 2.7° in flexion-extension, 1.4° in lateral bending, and 3.1° in axial rotation following each osteotomy. Compared to the facetectomies, four supplemental osteotomies increased total ROM by 23% in flexion (p<0.01) and 8% in axial rotation (p<0.01). Increases in lateral bending were smaller. Under multi-planar loading, each Ponte osteotomy provided simultaneous increases of up to 1.4°, 1.6°, and 2.2° in flexion-extension, lateral bending, and axial rotation. Ponte osteotomies provided higher per-level increases in ROM under single-plane loading than total facetectomies alone. Further, Ponte osteotomies provided simultaneous increase in all three planes under multi-planar loading. These results indicated that, to predict the correction potential of a surgical release, multi-planar testing may be necessary.