Flexion Values Research Articles

Effectiveness of Contrast Bath and Nerve Gliding Exercises in Carpal Tunnel Syndrome Among Software Workers

Carpal Tunnel Syndrome (CTS) is a complex symptom resulting from compression of the median nerve at the carpal tunnel. Locations of monitors, keyboard (or) mouse are associated with musculoskeletal problems. Among musculoskeletal problems, Carpal tunnel syndrome (CTS) is commonly reported in computer professionals. The purpose of this study was to examine the effectiveness of contrast bath and nerve gliding exercises for carpal tunnel syndrome in software workers. 30 subjects (20 males and 10 females) were participating in this study based on inclusion and exclusion criteria. They were assigned into groups Group A and B with 15 subjects each. Group A (Experimental group) received Contrast bath and Nerve Gliding Exercises, while Group B (Control group) received conventional exercises for the wrist. The outcome measures used were NPRS and ROM. Statistical analysis was done using paired-t test. On comparing the pre-test and post-tests within Group A & Group B on the Numerical Pain Rating Scale (NPRS), wrist flexion and extension Range of Motion (ROM) show a significant difference in mean values at P ≤ 0.001. There was a significant difference in the mean values of NPRS (6.33 to 3.40), wrist flexion (54.00 to 72.66), and wrist extension (55.66 to 72.80) in subjects from Group A who underwent contrast bath and nerve gliding exercises, compared to the significant difference in the mean values of NPRS (6.26 to 4.46), wrist flexion (53.66 to 63.00), and wrist extension (56.00 to 61.66) in subjects from Group B, which served as the control group.

Effect of radiofrequency ablation of genicular nerves on the isokinetic muscle strength of knee joint in patients with osteoarthritis knee: A randomized double-blind sham controlled clinical trial.

This randomised controlled trial evaluated the effect of radiofrequency ablation (RFA) of genicular nerve on muscle strength in osteoarthritis knee patients with chronic pain. Fifty-four patients with chronic knee osteoarthritis, experiencing significant pain (VNRS > 50) and moderate to severe disease (KL grade ≥ 2) were enrolled. Group 1 received RFA of genicular nerves of the affected knee while Group 2 received a sham procedure. The primary outcome was change in knee muscle strength evaluated using isokinetic peak torque(IPT) using IsoforceTM isokinetic dynamometer at 3 months. Secondary outcomes included changes in pain scores, function, perceived effect of the treatment and compliance to physiotherapy. At 3 months, significant difference was observed between IPT of flexor muscle at 60 and 180 degrees between the treatment and the Sham control (p-value = 0.01). No significant difference was observed in the extensor muscle strength. Within-group analysis revealed a significant increase in the IPT values for both extension and flexion at 60 and 180 degrees/sec evident across various time intervals. Group1 consistently reported lower VNRS scores at all time points. WOMAC scores of both groups were significantly different at all timepoints, with higher scores indicating reduced functionality in Group2. The GPE and compliance to physiotherapy were higher in Group1 patients at all times of follow up albeit decreasing trend in later periods. Application of RFA to genicular nerves in chronic OA knee patients resulted in better pain relief, improved functionality and increased muscle strength at extension and flexion at 3 months follow-up.

Role of the Flexion Relaxation Phenomenon in the Analysis of Low Back Pain Risk in the Powerlifter: A Proof-of-Principle Study.

Unlike the most common training approaches for bodybuilding, powerlifting programs are generally based on maximum and submaximal loads, putting enormous stresses on the lumbar spine. The flexion relaxation phenomenon evaluation is a clinical tool used for low back pain (LBP) assessment. This study aimed to evaluate the role of the flexion relaxation phenomenon in the analysis of LBP in the powerlifters. Healthy professional powerlifters participated in the study. In fact, we divided the participants into a LBP-low-risk group and a LBP-high-risk group, based on a prior history of LBP. Outcome measures included flexion relaxation ratio (FRR) and trough surface electromyography collected during trunk maximum voluntary flexion; furthermore, during a bench press lifting, we measured the height of the arched back(ARCH), using a camera and the Kinovea video editing software, to consider a potential correlation with the risk of LBP. We included a group of 18 male (aged 24-39y) powerlifters of 93kg category. We measured a nonsignificant mean difference of ARCH between low-risk LBP group and high-risk LBP subjects. Curiously, maximum voluntary flexions were both above the threshold of 3.2μV; therefore, with an absence of appropriate myoelectric silence, on the contrary, the FRR ratios were higher than 9.5, considering the presence of the phenomenon, exclusively for the low-risk group. The lumbar arched back measurement data did not report any association with the LBP risk, regarding the maximum voluntary flexion value, and even more than the FRR there is a relationship with the presence or the absence of LBP risk. FRR could be considered as a useful parameter for studying the risk of LBP in powerlifting. The FRR index not only refers to the possible myoelectric silence of the lumbar muscles in trunk maximum forward flexion but also takes into account the energy value delivered by the lumbar muscles during the flexion. Furthermore, we can indicate that the size of the powerlifter ARCH may not be a determining factor in the occurrence of LBP.

Investigation of The Correlation Between Pain, Proprioception and Range of Motion in Patients With Temporomandibular Joint Dysfunction

Purpose: The aim of study was to investigate the relationship between pain, proprioception and range of motion in patients with temporomandibular joint dysfunction (TMD). Material and Methods: The study was completed with 45 participants diagnosed with TMD and 45 healthy controls. Visual analog scale and graded chronic pain scale were used to assess pain intensity, dolorimeter was used for pain pressure threshold (PPT) assessment. Evaluation of cervical proprioception by cervical joint position error test (JPET), cervical joint range of motion assessment by digital goniometer, mouth opening measurements were made with a ruler. Results: In the study, pain intensity was high and PPT was low in the TMD group. In the JPET, the right-left rotation and left lateral flexion values in the TMD group had higher mean values than the control group (p=0.028, p=0.003, p=0.004, respectively). There was a significant difference between the groups in digital goniometer measurement in right-left rotation, right-left lateral flexion movements(p=0.008, p=0.001, p=0.041, p=0.005, respectively). The TMD group had a lower mean than the control group in painless, maximum assisted and unassisted mouth opening measurements(p=0.001, p=0.001, p=0.001, respectively). Conclusion: TMD patients presented a lower PPT, less accurate head repositioning, and some impairment in cervical range of motion.

Ankle movement alterations during gait in children with acute lymphoblastic leukemia with suspected peripheral mononeuropathy. A cross-sectional study

BackgroundPeripheral neuropathy due to chemotherapeutic drugs causes alterations in ankle movement during gait. This study aimed to describe the spatiotemporal parameters and ankle kinematics during gait in schoolchildren with acute lymphoblastic leukemia with clinically suspected peripheral neuropathy. MethodsIn children with acute lymphoblastic leukemia in the maintenance phase, we calculated spatiotemporal and kinematic parameters of the ankle during gait using Kinovea® software. Furthermore, we identified alterations in the parameters obtained considering the values of the normality data from a stereophotogrammetry system as the reference values. Finally, we represented the kinematic parameters of the ankles calculated with Kinovea® compared to the normality values of the stereophotogrammetry. FindingsWe evaluated 25 schoolchildren; 13 were male (52.0%) with a median age of 88.0months and a median of 60.0 weeks in the maintenance phase, and 54.8% were classified as standard risk. Spatiotemporal parameters: cadence (steps/min), bilateral step length (m), and average gait speed (m/s) in ALL children were significantly lower than reference values (p < 0.001). Except for right mid-stance and bilateral foot strike, initial swing showed that both ankles maintained plantar flexion values during gait, significantly lower in ALL patients (p < 0.05). InterpretationWe identified spatiotemporal and kinematics alterations in schoolchildren with acute lymphoblastic leukemia during all phases of the gait suggestive of alteration in ankle muscles during movement, probably due to peripheral neuropathy; nevertheless, our results should be taken with caution until the accuracy and reliability of Kinovea® software as a diagnostic test compared to the stereophotogrammetric system in children with ALL and healthy peers is proven.

The biomechanical effect of lumbopelvic distance reduction on reconstruction after total sacrectomy: a comparative finite element analysis of four techniques

BACKGROUND CONTEXTFollowing total sacrectomy, lumbopelvic reconstruction is essential to restore continuity between the lumbar spine and pelvis. However, to achieve long-term clinical stability, bony fusion between the lumbar spine and the pelvic ring is crucial. Reduction of the lumbopelvic distance can promote successful bony fusion. Although many lumbopelvic reconstruction techniques (LPRTs) have been previously analyzed, the biomechanical effect of lumbopelvic distance reduction (LPDR) has not been investigated yet. PURPOSETo evaluate and compare the biomechanical characteristics of four different LPRTs while considering the effect of LPDR. STUDY DESIGN/SETTINGA comparative finite element (FE) study. METHODSThe FE models following total sacrectomy were developed to analyze four different LPRTs, with and without LPDR. The closed-loop reconstruction (CLR), the sacral-rod reconstruction (SRR), the four-rod reconstruction (FRR), and the improved compound reconstruction (ICR) techniques were analyzed in flexion, extension, lateral bending, and axial rotation. Lumbopelvic stability was assessed through the shift-down displacement and the relative sagittal rotation of L5, while implant safety was evaluated based on the stress state at the bone-implant interface and within the rods. RESULTSRegardless of LPDR, both the shift-down displacement and relative sagittal rotation of L5 consistently ranked the LPRTs as ICR<SRR<FRR<CLR, with ICR being the stiffest for both parameters. LPDR decreased the shift-down displacement values by 25% in CLR, by 61% in SRR, by 15% in FRR, and by 46% in ICR, as well as reduced the relative sagittal rotation values by 21% in CLR, by 73% in SRR, by 11% in FRR, and by 53% in ICR. Considering the stress at the bone-implant interface, without LPDR, the ICR yielded the smallest stress values for flexion, lateral bending, and axial rotation with 131.4 MPa, 68.2 MPa, and 70.3 MPa, respectively, and the second smallest in extension with 36.1 MPa. Due to LPDR, these stress values were reduced by 31% in flexion, by 17% in extension, by 29% in lateral bending, and by 29% in axial rotation. Within the rods, without LPDR, the ICR yielded the smallest stress values for flexion, extension, lateral bending, and axial rotation with 346.5 MPa, 108.0 MPa, 186.2 MPa, and 199.7 MPa, respectively. With LPDR, these stress values were reduced by 16% in flexion, by 9% in extension, by 11% in lateral bending, and by 12% in axial rotation. CONCLUSIONSLPDR significantly improved both lumbopelvic stability and implant safety in all reconstruction techniques after total sacrectomy. LPDR reduced the shift-down displacement of L5, the relative sagittal rotation of L5, and the stress values at the bone-implant interface. Furthermore, in the ICR and SRR techniques, LPDR decreased the peak stress values within the rods. All four investigated LPRTs demonstrated suitability for lumbopelvic reconstruction, with the ICR technique exhibiting the highest lumbopelvic stiffness. CLINICAL SIGNIFICANCELPDR creates a biomechanically advantageous environment following total sacrectomy; therefore, it has the potential to impact the design of custom-made 3D-printed or traditional LPRTs. However, to confirm the findings of the current FE study, long-term clinical trials are recommended.

The effect of instrument-assisted soft tissue mobilization in lumbar disc herniation: A randomized controlled trial

AimTo investigate the effect of instrument-assisted soft tissue mobilization technique on pain, joint range of motion, functionality and quality of life in patients with lumbar disc herniation. MethodsThis is a double blinded, randomized controlled trial. A total of 60 patients were randomly allocated to either an experimental group [n = 30, age = 46.33 ± 12.96 years] or a control group [n = 30, age = 57.03 ± 9.64 years]. The experimental group received instrument-assisted soft tissue mobilization [3 consecutive days a week for 4 weeks] in addition to conventional physiotherapy [five days a week for 4 weeks]. The control group only received the conventional physiotherapy [five days a week for 4 weeks]. Pain intensity, range of motion of the lumbar spine (flexion, extension, lateral flexion), functional disability related to low back pain and quality of life were assessed at the beginning and end of the study. ResultsThe experimental group showed statistically significant improvements in the range of motion in lumbar area (flexion, extension and lateral flexion values) compared to that shown in the control group (p < 0.05). The mean differences in Oswestry disability index were significantly better in experimental group than in the control group (p < 0.05). There were no significant differences between the two groups in terms of pain and quality of life (p > 0.05). ConclusionsInstrument-assisted soft tissue mobilization, in addition to conservative treatment, can improve range of motion in lumbar area and reduce functional disability in patients with Lumbar Region Disc Herniations.

Photo Bio-stimulation on Acupuncture Points: Impact on Selected Measures in Children with Spastic Cerebral Palsy

This study aims to investigate the effect of adding photo bio-stimulation to standard physical therapy on spasticity, ankle active range of motion (ROM), gross motor function, plantar surface area (PSA), hind foot peak pressure, and quality of life (QoL) in children with spastic cerebral palsy (CP). Fifty-one children with spastic CP were randomly assigned to the laser therapy group (LG) and received regular physical therapy plus laser acupuncture over three acupuncture points (GB34, LR3, LIV3), and the control group received regular physical therapy three times per week for 4 weeks. Muscle tone using the modified Ashworth scale, ankle active ROM using goniometry, PSA and the peak pressure on the hind foot (PPHF) by E-Med system, motor function by Gross Motor Function Measure (88 items), and pediatric QoL questionnaire were assessed before and after intervention and after 3 months. Posttreatment values of ankle plantar flexion (AP), ankle dorsiflexion (AD), and PPHF demonstrated statistically significant differences and medium to high effect size in favor of LG ( P = 0.005 and d = 0.73, P = 0.02 and d = 0.57, P = 0.01 and d = 0.61, respectively). At the 3-month follow-up analysis, the same outcomes (AD, AP, and PPHF) demonstrated statistically significant differences and medium to high effect size ( P = 0.000 and d =1.46, P = 0.02 and d = 0.86, P = 0.01 and d = 0.75, respectively) in favor of the LG. Adding laser acupuncture on GB34, LR3, and LIV3 to standard physical therapy can reduce spasticity, and improve ankle ROM, gross motor function, PSA, hind foot peak pressure, and QoL for children with spastic CP.

Isokinetic profiles of hamstring and quadriceps muscles in the police special force operators

Knee injuries are of concern to police. The aims of this study were to determine initial reference values for isokinetic knee extension and flexion in police special force operators to explore the conventional hamstring contraction (Hcon) quadriceps contraction (Qcon) ratio, and to determine the limb symmetry index of the quadriceps and hamstring muscles. Absolute and relative isokinetic torque of quadriceps and hamstrings were assessed in 10 police special force operators using an isokinetic dynamometer Con-Trex. Subjects performed maximal knee extension and flexion at a contraction velocity of 60°/s at 90° of knee flexion. Means, standard deviations, 95% confidence interval values, and effect sizes were calculated. A paired samples t-test was used to test the between-leg differences in absolute and relative torques of quadriceps and hamstring muscles and to test the between-leg difference in Hcon/Qcon ratios as well as strength asymmetries of quadriceps and hamstrings. Descriptive statistics revealed torque values similar to athletes, and paired sample t-tests showed no significant between-leg differences in torque values at a group level. Small effect sizes were observed between legs in both the absolute and relative peak torque of the hamstring muscles. While, on a group level, no Hcon/Qcon ratio disparity between legs or asymmetries were observed, individual results indicated a trend towards greater dispersion for the dominant leg and some individual results indicated an increased asymmetry in isometric strength of hamstrings. The study provides normative data for this unique police population and highlights the need for relative strength work in this population.

Investigation of Acute Effects of Thoracic Manipulation on Trunk Flexion and Balance in Athletes

The aim of this study is to examine the acute effects of thoracic manipulation on trunk flexion and balance characteristics in athletes. 60 male team athletes with a mean age of 22.60±0.32 years participated in the study voluntarily. Trunk flexion values and balance levels of all participants were determined before manipulation. After the measurements, the participants were randomly divided into two groups as the thoracic manipulation group (TMG) and the placebo manipulation group (PMG). Then, as a single session, thoracic manipulation was applied to the TMG group and placebo thoracic manipulation was applied to the PMG group. The trunk flexions and balance levels of each participant were remeasured after the application, and the differences before and after the application were examined. Since the data analyzed via SPSS 25.0 package program showed normal distribution, paired-t test was used to evaluate the pre-application and post-application results. The results were analyzed at the p&amp;lt;0.05 significance level. In the results of the study, it was determined that there was a significant improvement in the standard deviation of forward and backward sway (FBSD), medial-lateral sway (MLSD) and used perimeter (P) parameters in post-application static balance. A significant improvement in the mean balance error monitoring (ATE) parameter in the post-application dynamic balance was also determined. An increase in trunk flexion values was observed in the TMG group after the application. As a result, it is concluded that high-velocity, low-amplitude (HVLA) thoracic manipulation application provides instant positive contributions to trunk mobility and balance feature in athletes.

REHABILITATION PROGRAM DURATION AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: A COMPARATIVE STUDY BETWEEN PROFESSIONAL AND RECREATIONAL ATHLETES

Introduction: Anterior cruciate ligament injury is an injury that occurs in both sexes and in the population of all ages. The anterior cruciate ligament (ACL) is a very strong internal ligament of the knee, whose injuries occur frequently in athletes (professional and recreational) and after which the recovery is very long and complicated. The aim of this study is to determine the effectiveness of a standardized rehabilitation program after anterior cruciate ligament reconstruction based on the time required for rehabilitation in athletes and recreational athletes. Methods: Research is designed as prospective study. The research was conducted in Polyclinic FM Sarajevo over a period of 10 months, starting in June 2018 and ending in March 2019. The collection of data required for the study was carried out using a form prepared for the analysis of patients included in the study. Results: Thirty-six people participated in the study, divided into two groups. In the first group, 52.8% belonged to recreational athletes, while in the second group, 47.2% belonged to athletes. At the end of the study, the flexion value in both studied groups was 120º. At the end of the study, the percentage of subjects with correct extension of the injured limb was 94.7% of recreational athletes and 64.7% of athletes. Of the total number of respondents included in this study, 33% were soccer players, 14% were basketball players, and 53% were recreational athletes. Conclusion: Based on the research results, it was confirmed that early rehabilitation after the established rehabilitation treatment program is shorter in recreational athletes than in professional athletes.

Exercise-Induced Transient Oxidative Stress Is Mitigated in Down Syndrome: Insights About Redox Balance and Muscle Strength.

Reis, AL, Deus, LA, Neves, RVP, Corrêa, HL Reis, TL, Aguiar, LS Honorato, FS, Barbosa, JMS, Araújo, TB, Palmeira, TRC, Simões, HG, Prestes, J, Sousa, CV, Ide, BN, and Rosa, TdS. Exercise-induced transient oxidative stress is mitigated in Down syndrome: insights about redox balance and muscle strength. J Strength Cond Res 38(3): e125-e34, 2024-This study aimed to evaluate the acute effects of a session of resistance exercise (RE) performed with elastic tubes on the redox balance and inflammatory profile in individuals with Down syndrome (DS). Subjects ( n = 23) were allocated into 2 groups: individuals with DS (DS; n = 11) and individuals without DS (WDS; n = 12), who performed an acute RE session. Diagnostic assessment included medical history, anthropometric measures (body height, body mass, body mass index, and body composition assessment), biological collections, muscle strength assessments (handgrip and maximal voluntary isometric contraction tests), and exercises. The redox balance and inflammatory profile were assessed in urine and saliva samples before and after an acute RE session. There were no differences between WDS and DS groups for body composition ( p > 0.05). The DS group presented higher values pre and post an acute RE session with elastic tubes for oxidative and proinflammatory markers compared with WDS ( p < 0.05). Uric acid values increased from pre-acute RE session to post-acute RE session for WDS ( p < 0.0001). No differences were identified within groups for the delta analysis ( p > 0.05). Inverse correlations were found between total force and F2-isoprostane, 8OHdG, uric acid, allantoin, IL-6, TNF-α, and the TNF-α:IL-10 ratio. A positive correlation was found between IL-10 and total force. The DS group presented increased peak force in the knee extension and elbow flexion exercises (∼25 and 12%, respectively) but decreases in handgrip strength of ∼7%. The WDS group showed higher peak force values for knee extension, elbow flexion, and handgrip (∼16, 10, and 14%, respectively). The DS group had lower transient elevation of oxidative stress after an acute RE session compared with WDS. Oxidative stress and inflammation responses of DS to an acute RE session with elastic tubes may be insufficient to induce health adaptations for the same relative load compared with WDS.

Arthroereisis with a Talar Screw in Symptomatic Flexible Flatfoot in Children

Background: Pes planovalgus, or flexible flatfoot, deformity is a common problem in pediatric orthopedic patients. There is no consensus on using the technique of arthroereisis in the treatment of symptomatic pes planovalgus. The aim of our study was to prospectively assess the functional outcomes following symptomatic pes planovalgus treatment with the use of the Spherus talar screw. Methods: Twenty-seven patients (11 females, 16 males), at a mean age of 10.5 years (7–14 years) were included in the prospective study. We assessed the level of physical activity (including sports) based on the University of California, Los Angeles (UCLA) activity scale, a 10-point level-of-activity VAS scale, and the Grimby physical activity scale. Pain was assessed based on a VAS pain scale; foot function was assessed with the revised Foot Function Index (FFI-R); and ankle joint mobility was measured. Results: The mean follow-up period was 18 months (14–26 months). There was a significant improvement in VAS-measured physical activity scores from 5.47 to 7 at follow-up, p = 0.048. There was a significant improvement in UCLA activity scale scores from 4.78 to 6.05 at follow-up, p = 0.045. Pain levels decreased from a mean VAS score of 4.73 prior to surgery to a mean score of 2.73 at follow-up, p = 0.047. The functional FFI-R scores showed a significant improvement from 140 points prior to surgery to 97.75 points at follow-up, p = 0.017. Comparison of the preoperative and follow-up values of the range of plantar flexion, adduction, and abduction in the operated limb also showed no significant changes in those individual parameters. The mean values of dorsiflexion, plantar flexion, adduction, and abduction at the ankle joint at follow-up, compared individually between the operated and non-operated foot showed no statistically significant differences. Conclusions: The use of a talar screw in the treatment of symptomatic pes planovalgus helps reduce pain and improve functional outcomes after treatment. Foot function assessments showed diminished pain, improved levels of physical and sport activity, and no effect on the range of motion after surgery in comparison with preoperative data. Arthroereisis with a talar screw is a valid surgical technique for the treatment of symptomatic pes planovalgus.

Forearm and elbow secondary surgical procedures in neonatal brachial plexus palsy: a systematic scoping review

IntroductionNeonatal Brachial plexus palsy (NBPP) is an injury during delivery that can lead to loss of motor function and limited range of motion in patients due to damage of nerves in the brachial plexus. This scoping review aims to explore types of procedures performed and assess outcomes of forearm and elbow secondary surgery in pediatric patients. MethodsSearches of PubMed, Cochrane, CINAHL, Web of Sciences and Scopus were completed to obtain studies describing surgical treatment of elbow and forearm in pediatric patients with NBPP. 865 abstracts and titles were screened by two independent reviewers resulting in 295 full text papers; after applying of inclusion and exclusion criteria 18 articles were included. The level of evidence of this study is level IV. Results10 main procedures were performed to regain function of the forearm and elbow in neonatal brachial plexus birth palsy patients. Procedures had different aims, with supination contracture (6) and elbow flexion restoration (5) being the most prevalent. The variance between pre-and postoperative soft tissue and bony procedures outcomes decreased and showed improvement with respect to the aim of each procedure category. For soft tissue procedures, a statistically significant increase was found between pre- and postoperative values for active elbow flexion, passive supination, and active supination. For bony procedures, there was a statistically significant decrease between pre- and postoperative values of passive and active supination. ConclusionsOverall, all procedures completed in the assessed articles of this study were successful in their aim. Bony procedures, specifically osteotomies, were found to have a wider range of results, whereas soft tissue procedures were found to be more consistent and reproducible with respect to their outcomes. Bony and soft tissue procedures were found vary in their aims and outcomes. This study indicates the need for further research to augment knowledge about indications and long-term benefits to each procedure.

Shoulder pain management strategies and early functional outcome after arthroscopic rotator cuff tear repair. A randomized controlled study

BackgroundThe management of acute postoperative pain after rotator cuff surgery can be challenging. To our knowledge, there are no data available in the literature correlating satisfactory pain control with improvement in terms of function. The purposes of the present study were to evaluate: 1) pain pattern after arthroscopic rotator cuff repair in patients operated with two different techniques (transosseous vs transosseous equivalent); 2) safety/efficacy of three different pharmacological pain control strategies; 3) possible relationship between a correct shoulder pain management protocol in the early post-operative period and patients’ functional improvement. Methods114 patients underwent rotator cuff tear repair, either with a Transosseus or a Transosseus equivalent technique. 62 (54%) were male and 52 (46%) were female. The average age was 59 ± 9 years. They were randomly assigned into three different pain management protocols: Paracetamol as needed (max 3 tablets/day) for 1 week (Protocol A), Paracetamol + Codein 1 tablet three times per day for 7 days (Protocol B), or Paracetamol + Ibuprofen 1 tablet two times per day for 7 days (Protocol C). Immediate passive mobilization of the operated shoulder was allowed. VAS and Passive Flexion values were recorded at 7 (T1), 15 (T2) and 30 (T3) days post-surgery. DASH values were recorded at 90 days post-surgery. All patients were asked to register any kind of signs/symptoms that may appear during drug assumption according to each pain management protocols. ResultsAll the pain management protocols administered were well tolerated by all the study population, and no adverse signs/symptoms were highlighted during drug assumption.Pain pattern: in both surgical techniques, patients within Protocol A were associated with worst results in terms of mean VAS at each time point examined when compared to Protocol B and C (p < 0,05). In patients within Protocol A, no statistically significant differences were found at each point time examined comparing the two surgical techniques, with the exception of T2, where the TO was associated with an higher VAS value than TOE (p < 0.05). No differences were highlighted in Protocol B and C when comparing the values between two surgical techniques.ROM: in both surgical techniques, patients within Protocol A were associated with worst results in terms of mean PROM at each time point examined when compared to Protocol B and C (p < 0,05). In the TO group, patients within Protocol B had better PROM values at T1 (p < 0,05) and T2 (p < 0,05) compared to Protocol C, but no differences were highlighted at T3. In the TOE group, no statistically significant differences were found between patients within Protocol B and C at each time point examined.DASH: In the TO group, no statistically significant differences were found regarding the DASH values comparing Protocol B vs Protocol C, but they were highlighted comparing the values between Protocol A and Protocol B (p < 0,05), and between Protocol A and Protocol C (p < 0,05). Similar results were recorded in the TOE group. ConclusionPost-operative pain is influenced by the surgical technique used being transosseous more painful in the first 15 days after surgery. Oral anti-inflammatory drugs are a feasible strategy to appropriately control post-operative pain. An association between Paracetamol and either Codein or Ibuprofen can lead to better outcomes in terms of VAS reduction and early recovery of passive ROM.

Force capacity of trunk muscle extension and flexion in healthy inactive, endurance and strength-trained subjects—a pilot study

Recreational sports are becoming increasingly important in overcoming the drawbacks of our modern sedentary lifestyle. We wanted to know whether ambitious strength or endurance training has a systematic effect on the maximum strength capacity of the trunk muscles compared to no sport at all. We investigated two groups of physically active men who practised either endurance (ET; cycling and triathlon, n = 13) or strength training (ST; power lifting, n = 13), and a group of healthy physically inactive men (control [C], n = 12). Training intensity was at competition level in both active groups. All participants performed isometric maximum voluntary contractions in flexion and extension direction. Independent of force direction maximum torque levels were highest for the ST group (p < 0.001 vs. ET and C), but after normalizing to the subject’s upper body weight these differences decreased, together with a drop in significance levels (extension: p < 0.01 vs. C; flexion: p < 0.05 vs. ET; p < 0.01 vs. C). With respect to the ratio between extension and flexion maximum forces due to the small group size no systematic differences could be detected between the groups, but effect sizes imply relevant effects (ET vs. ST: d = 0.588, ST vs C: d = −0.811). The results of this pilot study indicate that ST show higher functional force capacity values for flexion compared to the other groups. For extension, ST and ET did not differ. These results imply relevant differences for the extension to flexion force ratio.

Are 4D Motion Sensors Valid and Reliable for Studying Baseball Pitching?

Background: Baseball pitching injuries are on the rise. Inertial measurement units (IMUs) provide immediate feedback to players and coaches, allowing for collection outside of the traditional laboratory setting with real-world application. The 4D Motion system provides kinematics throughout the pitching motion and may be beneficial for individualized programs in the throwing athlete. A systematic analysis of these sensors has not been completed. Purpose: To evaluate the validity of the 4D Motion IMU system for analyzing the baseball pitching motion compared with marker-based motion capture, and evaluate the internal reliability and consistency of the device. Study Design: Controlled laboratory study. Methods: Ten high school pitchers participated in this study (10 male; 9 right-hand dominant; mean age, 16.6 ± 1.3 years; mean body mass index, 24.1 ± 3.9). Participants were simultaneously outfitted with six 4D Motion IMU sensors and retroreflective markers. The pitchers threw fastballs at maximum effort off a mound at the standard height and distance. A comparison was made between the IMUs and corresponding motion capture values for shoulder external rotation, elbow flexion, chest extension, pelvis and chest rotation velocity, and rotation acceleration. Results: Significant differences were found for 5 of 7 metrics analyzed. The IMU overreported most metrics, except for elbow flexion and pelvis rotation angular acceleration, where both positive and negative errors were observed. The root mean square error and percentage errors indicated smaller discrepancies for chest extension (4°± 5°) and pelvis (38 ± 19 deg/s) and chest (96 ± 42 deg/s) rotation velocity, with elbow flexion having the largest variance (21°± 9°). Conclusion: The values of the 4D Motion IMU system should not be considered equivalent when compared with marker-based motion capture studies. The system lacked internal consistency and reliability, with angular velocities being the most consistent. Caution should be used when using the metrics provided by an IMU-based system for individualized monitoring. Clinical Relevance: If found valid and reliable, IMUs could be used for longitudinal workload monitoring, individualized throwing and rehabilitation programs, and ultimately injury prevention. This study demonstrates that the data obtained from a 4D Motion system using Gen 3 sensors are not equivalent to the data obtained from a marker-based motion capture system.

Factors Influencing Knee Flexion Range of Movement after Primary Total Knee Arthroplasty : Study of a Consecutive Series over Ten Years

Introduction: Knee flexion after total arthroplasty is not always satisfactory. Our hypothesis: many factors can influence it. Some of these factors have been studied, but with controversial results.&#x0D; Methodology: It was a monocentric prospective and comparative study. All primary total knee replacement were included. For each factor, we compared a group of patients with above mean flexion to those with smaller flexion, using comparison of means, regression analysis and the chi square test.&#x0D; Results: We had 110 arthroplasties from 88 patients. Three preoperative factors affected the outcome: pre-operative knee flexion &lt; 110°, flexum deformity &gt; 5° and a body mass index above 30kg/m2. The respective Pearson coefficient value for these three factors were +0.50, +0.05, and -0.13.The chi square values were respectively 12.019 (p&lt;0.001) and 6.091 (p&lt;0.02) for the first two ones. Mean postoperative flexion values were significantly low for the patients with high body mass index (p&lt;0.03) and for those with knee flexion &lt; 110° (p&lt;0,001).&#x0D; Conclusion: Such studies should be carried out in other settings to prepare later meta-analysis. The effect of early physiotherapy in knee arthritis treatment in preventing knee stiffness at the time of total knee replacement should be evaluated.

What Does Provide Better Effects on Balance, Strength, and Lower Extremity Muscle Function in Professional Male Soccer Players with Chronic Ankle Instability? Hopping or a Balance Plus Strength Intervention? A Randomized Control Study.

Chronic ankle instability (CAI) has a higher frequency in soccer due to the rapid changes in body movement. Thus, this study compared the effects of eight weeks of a hopping protocol and a combined protocol of balance plus strength in a within-between group analysis. Thirty-six male professional soccer players participated in this study and were randomly allocated in three groups: control group (CG, n = 12), hopping group (HG, n = 12), and balance plus strength group (BSG, n = 12). Strength, static and dynamic balance, and function were assessed at baseline and eight weeks post intervention. First, Foot and Ankle Ability Measure (FAAM) and FAAM sport scales were applied. Then, a dynamometer was used to measure strength of the muscles around the hip, knee, and ankle joints. The Bass stick measured static balance and the Y balance test measured dynamic balance. Additionally, functional tests were carried out by Triple Hop, the Figure 8 hop, and vertical jump. A repeated measures ANOVA [(3 groups) × 2 moments] was used to compare the within and between group differences. In general, all tests improved after eight weeks of training with both protocols. Specifically, the BSG improved with large ES for all tests, while the HG improved all test with small to large effect sizes (ES). Furthermore, HG showed higher values for vertical jump (p < 0.01, ES = 1.88) and FAAMSPORT (p < 0.05, ES = 0.15) than BSG. BSG showed higher values for hip abduction (p < 0.05, ES = 2.77), hip adduction (p < 0.05, ES = 0.87), and ankle inversion (p < 0.001, ES = 1.50) strength tests, while HG showed higher values for knee flexion [ES = 0.86, (0.02, 1.69)] and ankle plantarflexion [ES = 0.52, (−0.29, 1.33)]. Balance plus strength protocol showed more positive effects than the hopping protocol alone for soccer players with CAI.

Extension contracture stiff knee in haemophilia: Surgical timing and procedure for total knee arthroplasty.

Total knee arthroplasty (TKA) for a stiff knee of patients with haemophilia (PWH) represents a challenge for orthopaedic surgeons for the difficulties of exposing the knee and high complication rate compared to a flexible knee. To optimize the surgical exposure in primary TKA for PWH and to propose a threshold angle of extension contracture in treating haemophilic knee joints, retrospectively. Sixty-seven primary TKAs for PWH (mean age, 48 years) were performed, and incisional approaches to joint were standard (58 cases) and V-Y quadricepsplasty (V-Y) (9 cases). The decision of surgical approach was decided intraoperatively by two surgeons. Pre- and post-knee angles were evaluated in each group. Variables in the V-Y group were evaluated using univariate logistic regression analysis and receiver operating characteristic curve analysis. Univariate logistic regression analysis demonstrated that the preoperative range of motion (ROM) and flexion were significantly associated with V-Y. Threshold values of preoperative flexion and ROM resulting in V-Y using receiver operating characteristic analysis were 45° and 35°, respectively. Primary TKA for PWH using a standard approach may be performed before the stage preoperative flexion <45° and ROM <35°.