Weeks Of Immobilization Research Articles

Changes in Hind Paw Epidermal Thickness, Peripheral Nerve Distribution and Mechanical Sensitivity After Immobilization in Rats

This study was designed to investigate histological changes in skin tissue accompanying immobilization-induced hypersensitivity. Changes in mechanical sensitivity, epidermal thickness, and peripheral nerve profiles in the upper dermis were examined in glabrous skin of rat hind paw after 1, 2, and 4 weeks of ankle joint immobilization by plaster casts. Induction of mechanical hypersensitivity was confirmed after 2 and 4 weeks of joint immobilization. Epidermal thinning and increase in peripheral nerve profiles were observed in skin tissues in immobilized rats. The time course of epidermal thinning and increase in peripheral nerve profiles were similar closely to that of hypersensitivity, with significant differences between the immobilized and control rats after 2 weeks of immobilization, which became even more remarkable at 4 weeks of immobilization. These findings suggest that joint immobilization by cast induces epidermal thinning and increases peripheral nerve profiles in the upper dermis and that these changes might be partly responsible for immobilization-induced hypersensitivity.

Suture-Button Suspensionplasty for the Treatment of Thumb Carpometacarpal Joint Arthritis

Despite the numerous techniques available to treat thumb carpometacarpal arthritis, studies show no long-term differences in outcomes among these techniques. However, simple trapeziectomy has been gaining popularity because of its low propensity for complications and relatively short intraoperative procedural time. Current approaches to trapeziectomy use Kirschner wire fixation to prevent subsidence. Unfortunately, this fixation method requires at least 4 weeks of immobilization of the thumb. We describe a novel technique involving suture-button (SB) suspensionplasty (Mini TightRope, Arthrex, Naples, FL) that allows for earlier mobilization of the thumb and faster overall recovery. This method uses a SB device that suspends the thumb ray after arthroscopic hemitrapeziectomy or full trapeziectomy. Preliminary results are promising, but further studies must be conducted to confirm the safety and efficacy of this SB suspensionplasty technique.

Deficits 10-Years after Achilles Tendon Repair

The purpose of this study was to determine the long-term impact of surgical repair and subsequent 6-week immobilization of an Achilles tendon rupture on muscle strength, muscle strength endurance and muscle activity. 63 patients participated in this study on average 10.8 ± 3.4 years after surgically repaired Achilles tendon rupture and short-term immobilization. Clinical function was assessed and muscle strength, strength endurance and muscle activity were measured using a dynamometer and electromyography. Ankle ROM, heel height during heel-raise tests and calf circumference were smaller on the injured than on the contralateral side. Ankle torques during the concentric dorsiflexion tasks at 60 °/sec and 180 °/sec and ankle torques during the eccentric plantarflexion task and during the concentric plantarflexion task at 60 °/sec for the injured leg were significantly lower than those for the contralateral leg. The total work during a plantarflexion exercise at 180 °/sec was 14.9% lower in the injured compared to the contralateral leg (p < 0.001). Muscle activity for the gastrocnemius muscle during dorsiflexion tasks was significantly higher in the injured than in the contralateral limb. Limited ankle joint ROM and increased muscle activity in the injured leg suggest compensatory mechanisms to account for differences in muscle morphology and physiology caused by the injury.

Effects of joint contracture on the contralateral unoperated limb in a rabbit knee contracture model: A biomechanical and genetic study

In most animal models, unoperated contralateral limbs are used as controls. However, in some experimental circumstances, the contralateral limb may represent a skewed control. The main purpose of this study was to determine if the unoperated contralateral limb could be used as a control, or if a different unoperated animal's limb should be used instead. Seventeen rabbits were divided into two groups. Group 1 rabbits (n = 12) underwent surgery on their right limbs to induce a contracture. Group 2 rabbits (n = 5) underwent no surgery. The left non-operated limbs of rabbits in group 1 were biomechanically and genetically compared to the limbs of unoperated rabbits in group 2 with the use of a validated joint measuring device and custom microarray, respectively. After 8 weeks of immobilization, there was a statistically greater flexion contracture in the unoperated contralateral limbs compared to the limbs of animals that received no surgery(8.4 ± 8.9° vs. 0 ± 0°; p-value = 0.03). When animals were remobilized for an additional 16 weeks, the significance between groups was lost (11.9 ± 21.4° vs. 8.9 ± 9.5°; p = 0.38). Similarly, there was a statistically significant increase in nine genes at 8 weeks (p < 0.001). However, at 24 weeks, only the PMCA 1 gene was statically increased (p < 0.001). In our rabbit model, the non-operated limb develops a small flexion contracture at 8 weeks. After 16 weeks of remobilization, there is no biomechanical or genetic difference between contralateral non-operated limbs and limbs of animals not undergoing any surgical intervention. Given the biomechanical and genetic findings, the contralateral non-operated limb can be used as a valid control.

Fracture of the Sesamoid Bone of the Index Finger: A Case Report.

The average adult hand has five sesamoid bones: two at the metacarpophalangeal (MCP) joint of the thumb, one at the interphalangeal joint of the thumb, one at the radial side of the MCP joint of the index finger, and one at the ulnar side of the MCP joint of the little finger. To the best of our knowledge, fracture of the sesamoid bone of the thumb was first reported by Skillern in 19151. In the ninety-six years that have followed, we believe only twenty-one published reports of an additional thirty-six cases of fracture of the thumb sesamoid bones have been reported in the English-language literature2–15. This rare fracture is typically the result of a hyperextension injury to the MCP joint of the thumb and is most often managed conservatively with a short period of immobilization. Full recovery without residual pain is expected2,13,14. Even less common are fractures of other sesamoid bones of the hand. Wood16 described two cases of fracture of the sesamoid bone of the little finger in the only report of which we are aware. To the best of our knowledge, fracture of the sesamoid bone of the index finger has been reported only once17. This injury occurred because of a fall onto an outstretched hand and a resultant hyperextension force to the MCP joint of the index finger. The fracture was treated with six weeks of immobilization, and there was full recovery17. We present a case of fracture of the sesamoid bone of the index finger that resulted from a direct blow to the palm and ultimately required …

Nanostructural Changes of Intervertebral Disc After Diode Laser Ablation

Immobilization can lead to intervertebral disc degeneration. The biomechanical characteristics of such discs have not so far been investigated at the micro- or nanoscale, the level at which cells sense and respond to the surrounding environment. This study aimed to characterize changes in the elastic modulus of the collagen fibrils in the nucleus pulposus at the nanoscale and correlate this with micro-biomechanical properties of the nucleus pulposus after immobilization, in addition to observation of tissue histology and its gene expressions. An immobilization system was used on the rat tail with an external fixation device. The elastic modulus was measured using both nano and micro probes for atomic force microscopy after 4 and 8 weeks of immobilization. Histology of the tissue was observed following hematoxylin and eosin staining. Gene expression in the annulus fibrosus tissue was quantified using real-time reverse transcription-polymerase chain reaction. The elastic modulus of the collagen fibrils in the nucleus pulposus at the nanoscale increased from 74.07 ± 17.06 MPa in the control to 90.06 ± 25.51 MPa after 8 weeks (P = 0.007), and from 33.51 ± 9.33 kPa to 43.18 ± 12.08 kPa at the microscale (P = 0.002). After immobilization for 8 weeks, a greater number of cells were observed by histology to be aggregated within the nucleus pulposus. Collagen II (P = 0.007) and aggrecan (P = 0.003) gene expression were downregulated whereas collagen I (P = 0.002), MMP-3 (P < 0.001), MMP-13 (P < 0.001) and ADAMTs-4 (P < 0.001) were upregulated. Immobilization not only influenced individual collagen fibrils at the nanoscale, but also altered the micro-biomechanics and cell response in the nucleus pulposus. These results suggest that significant changes occur in intervertebral discs at both scales after immobilization, a situation about which clinicians should be aware when immobilization has to be used clinically.

A longitudinal MRI study of muscle atrophy during lower leg immobilization following ankle fracture

To investigate MRI biomarkers of muscle atrophy during cast immobilization of the lower leg. Eighteen patients (8 male, 10 female), who had one lower leg immobilized in a cast, underwent 3.0 Tesla (T) MR imaging 5, 8, 15, 29, and 43 days after casting. Measurements were made on both lower legs of total muscle volume. Cross-sectional area (CSA), fractional water content, and T(2) were measured in tibialis anterior (TA), gastrocnemius medialis (GM) and lateralis (GL) and soleus (SOL). Fiber pennation angle was measured in GM. Total muscle volume decreased by 17% (P < 0.001) over the 6 weeks of immobilization. The greatest loss in CSA (mean[SD]) was seen in GM (-23.3(8.7)%), followed by SOL (-19.0(9.8)%), GL (-17.1(6.5)%), and TA (-10.7(5.9)%). Significant reductions of CSA were also detectable in the contra-lateral leg. T(2) increased in all muscles: TA 27.0(2.5) ms to 29.6(2.8) ms (P < 0.001), GM 34.6(2.9) ms to 39.8(5.4) ms (P < 0.001) and SOL 34.4 (2.9) ms to 44.9(5.9) ms (P < 0.001). Small reductions were found in fractional water content. Pennation angle decreased in the cast leg (P < 0.001). Quantitative MR imaging can detect and monitor progressive biochemical and biophysical changes in muscle during immobilization.

Old men still have the skeletal muscle contractile function to get up and go even after they have had their leg in a cast

Old men still have the skeletal muscle contractile function to get up and go even after they have had their leg in a cast

Daily muscle vibration amelioration of neural impairments of the soleus muscle during 2 weeks of immobilization

V-wave, F wave and H-reflex responses of soleus were used to determine neural adaptations to 2-week immobilization and whether muscle vibration intervention during immobilization would attenuate the negative adaptations induced by immobilization. Thirty subjects were divided into the ankle immobilization group and the immobilization with muscle vibration group. Mechanical vibrations with constant low amplitude (0.3 mm) were applied (12 × 4 min daily) with a constant frequency of 100 Hz on the soleus muscle of the subjects in vibration group during the ankle immobilization period. Soleus maximal M-wave (Mmax) and H-reflex (Hmax) were evoked at rest. F-wave was recorded by supramaximal stimulation delivered at rest and V-wave during maximum voluntary contraction (MVC). The EMG during MVC was represented by its root-mean-square (RMS) value. Each subject was examined before and after 2 weeks of immobilization. Results showed that following 2 weeks of immobilization, Mmax, Hmax and F wave all did not change with immobilization in either group ( P > 0.05). After 2 weeks of immobilization, significant reductions in V/Mmax (of 30.78%) ( P < 0.01) and EMG RMS (24.82%) ( P < 0.001) were found in the immobilization group. However, no significant changes occurred in the immobilization with muscle vibration group. Such findings suggested that 2 weeks of immobilization resulted in neural impairments as evidenced by the reduction in EMG and V wave, and that such decrease was prevented by the intervention of muscle vibration during the immobilization period.

Does scaphoid bone bruising lead to occult fracture? A prospective study of 50 patients

Introduction Bone bruising of the scaphoid is a term reported when magnetic resonance imaging (MRI) is carried out for scaphoid injury. The aim of our study was twofold: to see if bone bruising alone without fracture of the scaphoid bone seen on initial MRI, in a clinically symptomatic (tender) patient at 10–14 days, progressed to fracture, and to define how this entity of bone bruising should be managed. Methods This was a prospective study looking at 170 patients with scaphoid injuries, of which 50 had bone bruising without fracture. These were followed up for at least 8 weeks to ascertain whether or not they had developed a fracture. They were assessed for continuity or resolution of their symptoms by way of clinical examination and/or a further MRI and X-ray (scaphoid views). Results Of the 170 scaphoid injuries identified, there were 120 scaphoid fractures seen on scaphoid view radiographs. The remaining 50 were clinically symptomatic and had MRI scaphoid imaging, which demonstrated various grades of bone bruising. All were treated in a scaphoid plaster, and re-examined at 8 weeks. There were four patients who remained symptomatic, for whom MRI scans were performed, which revealed all four with resolving scaphoid bone bruising, and one with a scaphoid fracture ( p value = 0.0386). Incidentally, 2 further weeks of immobilisation resolved the symptoms of those four patients. The one patient with a fracture was offered further treatment for the risk of progressing to a nonunion. Conclusion Bone bruising detected on MRI without fracture is an important entity, and can lead to occult fracture (2%). It can take anywhere up to 8 weeks to declare. Treatment for bone bruising should be with a scaphoid cast and follow-up X-ray.

Immobilization in External Rotation After Primary Shoulder Dislocation Did Not Reduce the Risk of Recurrence

The treatment of primary traumatic anterior shoulder dislocation varies widely from no immobilization, to two or three weeks of immobilization in internal rotation with the arm in a sling, to treatment with a brace in external rotation. The aim of the present clinical trial was to compare immobilization in internal and external rotation after anterior shoulder dislocation. One hundred and eighty-eight patients with a primary anterior traumatic dislocation of the shoulder were randomly assigned to treatment with immobilization in either internal rotation (ninety-five patients) or external rotation (ninety-three patients) for three weeks. The primary outcome measure was a recurrent dislocation within twenty-four months of follow-up. The follow-up rate after a minimum period of two years was 97.9% (ninety-three of ninety-five) in the internal rotation group and 97.8% (ninety-one of ninety-three) in the external rotation group. The compliance rate with the immobilization was 47.4% (forty-five of ninety-five) in the internal rotation group and 67.7% (sixty-three of ninety-three) in the external rotation group. The intention-to-treat analyses showed that the recurrence rate was 24.7% (twenty-three of ninety-three) in the internal rotation group and 30.8% (twenty-eight of ninety-one) in the external rotation group (p = 0.36). Immobilization in external rotation does not reduce the rate of recurrence for patients with first-time traumatic anterior shoulder dislocation.

Commentary on an article by Sigurd Liavaag, MD, et al.: “Immobilization in External Rotation After Primary Shoulder Dislocation Did Not Reduce the Risk of Recurrence. A Randomized Controlled Trial”

Sigurd Liavaag and coauthors are to be commended for their manuscript, “Immobilization in External Rotation After Primary Shoulder Dislocation Did Not Reduce the Risk of Recurrence. A Randomized Controlled Trial.” This multicenter trial in Norway demonstrated no apparent clinical benefit of three weeks of immobilization in external rotation following primary anterior shoulder dislocation in 188 subjects. The authors of this clinical trial focused on a clinically relevant age group (range, sixteen to forty years), executed an effective stratified block randomization, monitored treatment compliance, and reported excellent follow-up (98% at two years). The findings of Liavaag et al. mirror those of Finestone et al.1, who also reported no apparent benefit of immobilization in external rotation. The patients in the study by Finestone et al. were all male, were younger (mean …

Proximal Humerus Fractures in the Elderly Can Be Reliably Fixed With a “Hybrid” Locked-plating Technique

Controversy exists regarding the best treatment of proximal humerus fractures in the elderly. Recent studies of open reduction and internal fixation have demonstrated high complication rates. We asked whether (1) open reduction and internal fixation could be performed with low rates of immediate and delayed complications, (2) reduction of these fractures could be maintained over time by evaluating long-term radiographs and visual analog pain scores, and (3) 6-week immobilization would lead to disabling stiffness by evaluating postoperative motion and functional scores. We retrospectively reviewed all 35 patients older than 75years with displaced proximal humerus fractures treated using a "hybrid" technique between 2002 and 2008. All patients were immobilized for 6weeks after surgery. Thirteen of the 35 patients either died or developed severe dementia during followup. The analysis included 22 patients followed a minimum of 1year (mean, 3years; range, 1-6.7years). There were no early or late reoperations in this series. An acceptable reduction was achieved in 89% of the shoulders and maintained over time. All fractures healed. Osteonecrosis was noted on radiographs in 11% of the shoulders. Six weeks of immobilization did not lead to disabling stiffness. At most recent followup, mean active elevation was 141°, mean active internal rotation L1, mean active external rotation 36°, and mean American Society of Shoulder and Elbow Surgeons score 68. Utilizing this approach, open reduction and internal fixation followed by 6-week immobilization results in a low rate of reoperation and good functional outcomes for elderly patients with proximal humerus fractures. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Two weeks of muscle immobilization impairs functional sympatholysis during exercise and improves the vasodilator potency of ATP despite reducing P2Y receptor content

During exercise, contracting muscle can override sympathetic vasoconstrictor activity (functional sympatolysis). ATP has been proposed to play a role in skeletal muscle blood flow regulation by inducing local vasodilation via P2 receptors and overriding sympathetic vasoconstrictor activity. However, little is known about the role of muscle training status on functional sympatholysis and ATP induced vasodilation. Eight healthy male subjects were studied before and after 5 weeks of one-legged knee-extensor training (3–4 times/week) and 2 weeks of immobilization of the other leg (full leg cast). Leg hemodynamics were measured at rest, during exercise (24±1 W) and during arterial ATP infusion with and without co-infusion of tyramine. Muscle biopsies were obtained from the vastus lateralis muscle. Exercise increased leg blood flow (LBF) to 2.61±0.13, 2.62±0.13 and 2.93±0.23 L/min in the control, trained and immobilized leg, respectively. Tyramine blunted the LBF response during exercise with the control and immobilized leg (P<0.05), whereas it was unchanged in the trained leg. During arterial ATP infusion, the LBF response was higher after immobilization (P<0.05), whereas it did not change after training. When tyramine was co-infused with ATP, LBF was reduced in the immobilized leg (P<0.05), whereas it remained similar in the control and trained leg. Immobilization lowered the P2Y2 receptor content (P<0.05), whereas exercise training tended to increase P2Y2 content. No change in P2X1 receptors was observed. These results indicate that physical inactivity inhibits functional sympatholysis during exercise and that immobilization increases the vasodilatory response to ATP, despite lowering P2Y2 receptor content. Supported by the Lundbeck Foundation

Early mobilization after uncomplicated medial subtalar dislocation provides successful functional results

BackgroundSubtalar dislocation is a rare injury, with the medial type occurring in the majority of cases. The period of postreduction immobilization is a matter of controversy. Most studies set the period of immobilization between 4 and 8 weeks. The hypothesis in this study is that a period of 2–3 weeks of immobilization in a cast, followed by early mobilization, could provide better functional results than longer periods of immobilization.Materials and methodsDuring a period of 4 years, eight patients (six men, two women) with mean age of 37.2 years and uncomplicated medial subtalar dislocation were treated in our institution. Immediate reduction under sedation and cast immobilization was provided in all cases. Our rehabilitation protocol consisted of two completed weeks of immobilization and thereafter ankle range-of-motion exercises and partial weight-bearing mobilization. Patients were followed up for a mean period of 3 years. Clinical results were evaluated using the AOFAS Ankle–Hindfoot scale.ResultsAll patients achieved almost normal ankle range of motion and good clinical outcome (mean AOFAS score 92.25). No radiographic evidence of arthritis or avascular necrosis of the talus was detected. Two patients complained of mild pain of the hindfoot. All patients returned to daily routine activities in about 2 months from injury.ConclusionsImmediate reduction and early mobilization could be key factors for uneventful recovery of uncomplicated medial subtalar dislocation. Multicenter clinical trials are needed for further validation of our initial results.Level of evidenceIII, prospective clinical series study.

Locking plates for fixation of extra-articular fractures of the first metacarpal base: A series of 15 cases

Extra-articular fractures of the first metacarpal base may lead to retraction of the first web and weakness of the pinch. Conventional surgery (K-wire or non-locking plates) needs six weeks of immobilization. Our goal was to achieve the reduction of such fractures using locking mini-plates to allow early mobilization. Our series included 15 patients, with an average age of 35 years, operated on for an extra-articular fracture of the first metacarpal base. All patients underwent surgery with variable angle locking mini-plates. In 10 patients, we used a double-row plate and for the other five patients T-shaped plates. Fractures were immobilized for two weeks. Outcome evaluation consisted in the assessment of subjective criteria (pain, quick-DASH), objective criteria (Kapandji score, Jamar ®, pinch ®), screening for complications, time off work and radiological consolidation. Follow-up time was 10 months. Pain averaged 2.2/10 and quick-DASH 17.4. Kapandji score was 90%, grip strength 95.5% and pinch strength 88.6% of the contralateral hand. Three secondary displacements occurred with T-plates. Mean time off work was seven weeks. Radiological consolidation was detected at four to six weeks. Our results seem to indicate that locking T-plates do not provide sufficient strength to allow early mobilization. The direct cost of locking plates is high but this must be weighed against the reduced indirect costs when calculating the cost effectiveness of this type of management. Double-row locking plates offer a valuable therapeutic alternative since they allow stable fixation and early mobilization of the thumb, which may outweigh their high cost.

Early Active Short Arc Motion Following Central Slip Repair

Open repairs of the central slip have traditionally been treated with 4 to 6 weeks of immobilization, followed by therapy to restore motion. Although rehabilitative efforts were usually directed at avoiding extension lag, loss of flexion was also commonly encountered. Early active short arc motion produces improved range of motion with shorter treatment time compared with static immobilization of the repaired central slip. The technique is straightforward but its success depends on attention to the details of splinting and exercise, and the patient's active cooperation and compliance.

Intra-abdominal Migration of a Lag Screw in Gamma Nailing: Report of a Case

An 83-year-old female patient was referred to the emergency room with progressive pain on mobilization. Three weeks before presentation, she had been treated with a gamma nail for an unstable right intertrochanteric fracture. Pelvic x-ray showed an intra-abdominally migrated lag screw. No evidence of intra-abdominal lesions was visible on computed tomographic scan. The lag screw as well as the intramedullary nail was extracted and in a second operation, a total hip arthroplasty was implanted. Unfortunately, the total hip implant dislocated and needed reduction. The three consecutive operations seriously weakened the soft tissue envelope. A plaster cast and brace, immobilizing the right hip and pelvis, were provided to prevent recurrences of dislocation. After 6 weeks of immobilization, the patient did well. No late complication occurred. A review of the literature with an emphasis on pathophysiology of intra-abdominal or retroperitoneal migration of lag screws in gamma nailing is presented.

The Rate of Triangular Fibrocartilage Injuries Requiring Surgical Intervention

Triangular fibrocartilage complex injuries are one of the most common causes of ulnar-sided wrist pain. Although pain and discomfort may improve with simple immobilization for a short period of time, a significant number of patients eventually require surgical intervention. The purpose of this study was to investigate the incidence of surgical intervention on patients with a clinical diagnosis of a triangular fibrocartilage complex injury. A retrospective chart review was performed to identify patients with ulnar-sided wrist pain identified with the appropriate ICD-9 code from September 2005 to September 2007. All patients were evaluated and treated by a board-certified, fellowship-trained hand surgeon. Any patients with associated pathology were excluded from the study. All patients were initially treated with a minimum of 4 weeks of either a volar wrist splint worn all the time or a short-arm cast. Magnetic resonance images were obtained on patients without symptomatic relief, and in these cases, surgical arthroscopy was performed. Of the 84 patients identified, 36 patients required surgical intervention. All 36 patients had evidence of triangular fibrocartilage complex injury during arthroscopy. All patients had symptomatic improvement postoperatively. The use of short-arm cast versus a splint did not affect the rate of surgical intervention (P=.38). Among the patients with clinical diagnosis of triangular fibrocartilage complex injury, the rate of surgical intervention required after a minimum 4 weeks of immobilization was 43%. The use of a short-arm cast or volar wrist splint did not affect the rate of surgical intervention.

Flexion-type fractures of the proximal tibial physis: a report of five cases and review of the literature

This study describes five patients who had sustained a rare flexion-type fracture separation of the proximal tibial epiphysis and reviews the previous reports of this injury in the literature. The average age of our patients at injury was 15 years. All were male. The left side was involved in four patients; the right in one patient. Four of the injuries occurred during sports activities. All five of these fractures healed in satisfactory alignment after 6 weeks of immobilization without complication. We conclude that these injuries can be safely managed by closed reduction and cast immobilization in a position of full knee extension.