Wrist Extensor Strength Research Articles

Focused shock wave and ultrasound therapies in the treatment of lateral epicondylitis - a randomized control trial

Persistent symptoms of lateral epicondylitis prompt patients to seek effective conservative treatment. The study aimed to determine the effects of focused shock wave (FSWT) and ultrasound therapies for lateral epicondylitis. Sixty patients with tennis elbow were randomly divided into three equal groups: A, B, and C. Group A received a total of 3 FSWT sessions, with 7 days between treatments; Group B received ultrasound therapy in 10 sessions over 2 weeks, while patients in Group C were treated with placebo ultrasound. All patients were also given deep friction massage. Before the start of therapy, and at 1, 3, 6, and 12 weeks after its completion, pain intensity and function of the affected upper limb were assessed in all patients. Wrist extensor and flexor strength and grip strength were measured in the affected and unaffected limb. Significant reductions in pain and significant improvements in the function of the affected limb compared to baseline values were observed in all study groups at 6 and 12 weeks after the completion of therapy. Analysis of percentage changes in these variables showed significant differences between Groups A and B in favor of Group A. The strength of wrist extensors and grip strength of the affected limb at 6 and 12 weeks after treatment completion was significantly higher in Groups A and B compared to pre-therapy values. However, there were no statistically significant differences between the groups regarding percentage changes in muscle strength in the affected limb. Pain reduction and function improvement in patients with lateral epicondylitis were significantly greater after FSWT (0.2 mJ/mm2 / 4 Hz / 2000 shocks) than after sonotherapy (3 MHz / 0.5 W/cm2 / 20%). Increases in wrist extensor strength and grip strength of the affected limb were comparable after both therapies. Given the greater therapeutic effect in the subjective evaluation, we recommend a combination therapy of FSWT with deep friction massage.Trial registration The trial was prospectively registered in the ISRCTN registry (no. ISRCTN11907358 registration date 30.07.2020).

Comparison of wrist range of motion and muscle strength in assembly workers with and without lateral epicondylitis.

Lateral epicondylitis (LE), also called tennis elbow, is a common musculoskeletal disorder that causes pain in the elbow area and is highly prevalent in assembly workers who repeatedly move their wrists. The purpose of this study was to compare the wrist ROM and muscle strength of assembly workers with and without LE. Forty-five male assembly line workers (23 with LE) participated in the study. Participants had their wrist range of motion (flexion, extension, ulnar deviation, and radial deviation) and strength (wrist flexors, extensors, and hand grip) measured using Smart KEMA sensors. Workers with LE showed significantly reduced wrist extension and radial deviation ROM compared to workers without LE, with no significant differences in wrist flexion and ulnar deviation ROM between groups. Workers with LE had significantly lower wrist extensor strength compared to workers without LE, and there was no significant difference in wrist flexor and grip strength between the two groups. For workers with LE, the difference in wrist ROM and muscle strength will be useful for planning intervention and evaluating treatment outcomes for assembly workers with LE.

Radial or Focal Extracorporeal Shock Wave Therapy in Lateral Elbow Tendinopathy: A Real-Life Retrospective Study.

Lateral elbow tendinopathy (LET) is characterized by pain, poor muscle strength of the wrist ex-tensors, and disability. Among the conservative rehabilitative approaches, focal as well as radial extracorporeal shock wave therapy (ESWT), are considered effective in LET management. The objective of this study was to compare the safety and effectiveness of focal (fESWT) and radial (rESWT) in terms of LET symptoms and the strength of wrist extensors, taking into account potential gender differences. This is a retrospective longitudinal cohort study of patients with LET treated with ESWT that had received a clinical and functional evaluation, including visuo-analogic scale (VAS), muscle strength using an electronic dynamometer during Cozen's test, and the patient-rated tennis elbow evaluation (PRTEE) questionnaire. Follow-ups were carried out weekly in four visits after enrollment, and at 8 and 12 weeks. During the follow-ups, the VAS score decreased in both treatments, even if patients receiving fESWT reported early pain relief compared to those treated with rESWT (time for treatment p-value < 0.001). Additionally, peak muscle strength increased independently of the device used, and again more rapidly in the fESWT group (time for treatment p-value < 0.001). In the stratified analysis for sex and for the type of ESWT, rESWT appears to be less effective in female participants in terms of mean muscle strength and PRTEE scores, without differences according to the type of device used. The rESWT group reported a higher rate of minor adverse events (i.e., discomfort, p = 0.03) compared to fESWT. Our data suggest that both fESWT and rESWT might be effective in improving LET symptoms, even if the higher rate of painful procedures were reported in patients treated with rESWT.

Effects of Electromyography Bridge on Upper Limb Motor Functions in Stroke Participants: An Exploratory Randomized Controlled Trial.

The electromyography bridge (EMGB) plays an important role in promoting the recovery of wrist joint function in stroke patients. We investigated the effects of the EMGB on promoting the recovery of upper limb function in hemiplegia. Twenty-four stroke patients with wrist dorsal extension dysfunction were recruited. Participants were randomized to undergo EMGB treatment or neuromuscular electrical stimulation (NMES). Treatments to wrist extensors were conducted for 25 min, twice a day, 5 days per week, for 1 month. Outcome measures: active range of motion (AROM) of wrist dorsal extension; Fugl-Meyer assessment for upper extremity (FMA-UE); Barthel index (BI); and muscle strength of wrist extensors. After interventions, patients in the NMES group had significantly greater improvement in the AROM of wrist dorsal extension at the 4th week and 1st month follow-up (p < 0.05). However, patients in the EMGB group had a statistically significant increase in AROM only at the follow-up assessment. No significant differences were observed in the AROM between the EMGB group and the NMES group (p > 0.05). For secondary outcomes in the EMGB group, compared to baseline measurements, FMA-UE, BI, extensor carpi radialis and extensor carpi ulnaris muscle strength were significantly different as early as the 4th week (p < 0.05). The muscle strength of the extensor digitorum communis muscle showed significant differences at the follow-up (p < 0.05). There were no statistically significant differences between patients in the two groups in any of the parameters evaluated (p > 0.05). The combination of EMGB or NMES with conventional treatment had similar effects on the improvement of the hemiplegic upper limb as assessed by wrist dorsal extension, FMA-UE, and activities of daily living. The improvement in both groups was maintained until 1 month after the intervention.

Effectiveness of Lateral Elbow Tendinopathy Treatment Depends on the Content of Biologically Active Compounds in Autologous Platelet-Rich Plasma.

Autologous platelet-rich plasma (PRP) injection is an alternative treatment option for patients with lateral elbow tendinopathy. The treatment is supposed to accelerate tissue regeneration by providing high concentrations of growth factors derived from platelets. The aim of the study was to assess the relationship between the content of biologically active compounds in PRP and the clinical effect of the treatment. Thirty patients with lateral elbow tendinopathy treated with a single PRP injection, were evaluated. The pain intensity (measured by a visual analogue scale (VAS)), the pressure pain threshold (PPT), the grip strength and strength of the main arm and forearm muscle groups, and the functional outcome (measured by the Disability of Arm, Shoulder and Hand (DASH) and Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaires), were assessed before PRP injection and at one- and three-months follow-up. Flow cytometry measurements of the growth factors and inflammatory cytokines in PRP were performed, and the results were used to establish the relationship between those molecules and the clinical outcome. After three months from the intervention, the minimal clinically important difference in pain reduction and functional improvement was observed in 67% and 83% of patients, respectively. Positive correlations were found between the extent of pain reduction after three months and concentrations in the PRP of platelets, epidermal growth factor (EGF), vascular endothelial growth factor, and platelet-derived growth factors. The concentration of EGF in the PRP significantly correlated with an improvement in grip strength, strength of wrist extensors, and the size of functional improvement measured by the PRTEE. The local injection of PRP is a safe and effective treatment option for lateral elbow tendinopathy, and the clinical outcome is correlated with concentrations of its biologically active compounds.

Correlation of Anthropometry of Hand with Wrist Extensor Strength in Normal Asymptomatic Individuals

Introduction: Measurement of hand grip strength is the basic criteria for the evaluation of hand structure and function. The human hand serves various dynamic purposes in day to day activities of an individual. Infact, the entire upper limb is functional because of the hand. This study was carried out to find out if there is any relation between the anthropometric measurements of the hand and the wrist extensor strength of Indian adults.&#x0D; Methodology: A data was collected of 75 individuals with no pathological abnormalities from Acharya Vinoba Bhave Rural Hospital, Sawangi Meghe, Wardha. The consent of all the individuals was taken and they were informed about the procedure. The individuals were evaluated for wrist extensor strength by using a hand-held dynamometer. Also, the hand measurements such as hand length and width using a measuring tape.&#x0D; Results: The average wrist extensor strength of the right hand of the individuals was found to be more than that of the left hand. The length of both the hands was almost equal while the width of the left hand was greater than the right hand.&#x0D; Conclusion: There is a slight positive Correlation between the average wrist extensor strength and the length and width of the hand which can play a vital role in the rehabilitation process.

Test-retest reliability of isometric and isokinetic wrist strength

BackgroundThe isokinetic dynamometer has been considered the gold-standard measurement of muscle performance. However, the reliability for the isometric and isokinetic wrist flexor and extensor strength using the Biodex isokinetic dynamometer has not been reported to date. This study evaluated test-retest reliability of isometric and isokinetic wrist strength using the Biodex System 3 isokinetic dynamometer. MethodsThis is a test-retest reliability study. Peak concentric and isometric torque was determined of the dominant limb wrist flexor and extensor of healthy individuals using the Biodex Multi-Joint System 3 dynamometer. The participants were evaluated by the same examiner in two different sessions separated by an interval of two to seven days. Reliability was investigated using the intraclass correlation coefficient (ICC2,1), standard error of measurement (SEM) and minimum detectable difference (MDD). ResultsTwenty healthy subjects participated in the study. The ICCs for concentric and isometric torque of the wrist flexor and extensor ranged from 0.79 to 0.91, revealing excellent intra-examiner test-retest reliability; SEM ranging from 0.4 to 1.5; and MDD ranged from 1.12 Nm to 4.17 Nm. ConclusionsExcellent intra-examiner test-retest reliability was found regarding peak concentric toque of the wrist flexor and extensor at an angular velocity of 45°/s as well as isometric torque of the wrist flexor and extensor in healthy individuals measured using the Biodex System 3 isokinetic dynamometer.

Voluntary and magnetically evoked muscle contraction protocol in males with Duchenne muscular dystrophy: Safety, feasibility, reliability, and validity.

Clinical trials addressing treatments for Duchenne muscular dystrophy (DMD) require reliable and valid measurement of muscle contractile function across all disease severity levels. In this work we aimed to evaluate a protocol combining voluntary and evoked contractions to measure strength and excitability of wrist extensor muscles for safety, feasibility, reliability, and discriminant validity between males with DMD and controls. Wrist extensor muscle strength and excitability were assessed in males with DMD (N=10; mean ± standard deviation: 15.4 ± 5.9 years of age), using the Brooke Upper Extremity Rating Scale (scored 1-6), and age-matched healthy male controls (N=15; 15.5 ± 5.0 years of age). Torque and electromyographic (EMG) measurements were analyzed under maximum voluntary and stimulated conditions at two visits. A protocol of multiple maximal voluntary contractions (MVCs) and evoked twitch contractions was feasible and safe, with 96% of the participants completing the protocol and having a less than 7% strength decrement on either measure for both DMD patients and controls (P ≥ .074). Reliability was excellent for voluntary and evoked measurements of torque and EMG (intraclass correlation coefficient [ICC]over 0.90 and over 0.85 within and between visits, respectively). Torque, EMG, and timing of twitch-onset measurements discriminated between DMD and controls (P < .001). Twitch contraction time did not differ significantly between groups (P=.10). Findings from this study show that the protocol is a safe, feasible, reliable, and a valid method to measure strength and excitability of wrist extensors in males with DMD.

Upper limbs cycle ergometer increases muscle strength, trunk control and independence of acute stroke subjects: A randomized clinical trial.

Studies demonstrate the benefits of upper limbs cycle ergometer (ULCE) in subacute and chronic stroke subjects, but the literature still needs to explore the acute phase of the disease. Verify the effects of ULCE on muscular strength, trunk control and independence of post-stroke subjects in hospital acute phase. In this randomized clinical trial participants were allocated into two groups. The control group (CG) performed two daily sessions of conventional physiotherapy, while the intervention group (IG) had one daily session of conventional physiotherapy and one of ULCE. The interventions were carried out for 20 minutes for five days. Both groups were assessed before and after the treatment for upper limbs strength by manual dynamometer, trunk control by Trunk Impairment Scale and level of independence by the Modified Rankin Scale. Twenty subjects with mean ages of 63.5±4.5 were enrolled. There was a significant intra-group difference of palmar grip, shoulder abductors, elbow flexor and wrist extensor strength, trunk control and functional independence only in IG. Inter-group difference for all variables showed superiority in IG. ULCE is an effective device for increasing muscle strength, trunk control and consequently improving the independence of post-stroke subjects in the acute hospital phase.

The Effects of Upper Extremity Isokinetic Strengthening in Post-Stroke Hemiplegia: A Randomized Controlled Trial

ObjectiveThe aim of this study was to evaluate the efficacy of isokinetic strengthening in paretic upper extremity among patients with post-stroke hemiplegia. MethodsHemiplegic patients with at least 6 months post-stroke and those with arm and hand Brunnstrom motor recovery stage ≥ 3 were included to the study. Patients were randomized into two groups. Isokinetic training group received 4 weeks (3 days/week) of isokinetic strengthening, while the control group was tailored strengthening exercises with exercise bands. Outcome measures were the isokinetic peak torque of wrist flexor and extensors, Fugl-Meyer Assessment of upper extremity, Stroke Impact Scale (SIS), Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, hand grip strength, peak isometric strength of wrist flexor and extensors. Outcome measures were evaluated before treatment, after treatment (at the end of week 4) and 4 weeks after the end of treatment (at the end of week 8). The trial was registered at ClinicalTtrials.gov (ID: NCT03834311). ResultsAfter 4 weeks, changes in extensor peak torque at 60°/sn (p=0.007) and extensor peak isometric muscle strength (p=0.007) were higher in the isokinetic group (n=12) than those in the control group (n=12). At the end of week 8, only DASH score revealed a significantly higher improvement in the isokinetic group than that in the control group (p=0.014). ConclusionsIsokinetic strengthening may provide motor and functional improvement in paretic upper extremity among patients with post-stroke hemiplegia.

Effect of Deep Friction Massage with Taping Technique on Strength, Pain, Function and Wrist Extensor Muscle Activity in Patient with Tennis Elbow

Background Lateral epicondylitis, generally referred to as tennis elbow, is a common condition of the forearm. Treatment typically includes specialized manual therapy, including deep friction massage (DFM), taping, and Mill’s manipulation. Purpose The aim of this study was to evaluate changes in pain, function, strength, and muscle activity following taping with DFM. Study design Randomized controlled trial Methods We recruited 30 patients with tennis elbow and equally divided into two groups using randomization (Taping group versus taping and DFM group). Pre- and post-intervention measures included a visual analog scale (VAS) pain scores, the Patient-rated Tennis Elbow Evaluation (PRTEE) questionnaire, pain-free grip strength (PFGS), wrist extensor strength (WES), and wrist extensor electromyography (EMG). DFM and diamond taping were applied as the study intervention. The differences between pre- and post-intervention outcome measures were analyzed using two-way repeated-measures analysis of variance. Results A significant time-by-group interaction was observed for the VAS, PRTEE scores, PFGS, WES, and EMG. A post hoc paired <italic>t</italic>-test showed that pain, function, and strength improved significantly post-intervention in the group treated with taping and DFM. The VAS and PRTEE scores significantly decreased, and PFGS, WES, and EMG significantly increased in both groups post-intervention. Conclusions Our findings demonstrated that taping with DFM can be an effective strategy for decreasing pain, improving function, and increasing strength and muscle activation in patients with lateral epicondylitis.

Effects of Photobiomodulation Therapy and Restriction of Wrist Extensor Blood Flow on Grip: Randomized Clinical Trial.

Objective: To evaluate the influence of two different photobiomodulation therapy (PBMT) protocols (red 660 nm vs. infrared 830 nm) combined with a blood flow restriction (BFR) training protocol in wrist extensor muscles on handgrip, wrist extension force, and electromyographic behavior [root mean square (RMS)]. Background: PBMT has been widely used to increase muscle performance and recovery in recent clinical trials. However, there is no evidence whether PBMT (red and/or infrared) can promote better results when combined with BFR, a known method to induce better strength gains. Methods: This study was a randomized controlled trial including 58 volunteers allocated into four groups: (1) control (conventional strengthening), (2) BFR (strengthening with BFR), (3) 660 nm (BFR strengthening with 660 nm PBMT-35 mW; 0.05 cm2; 2.10 J, total energy 18.9 J), and (4) 830 nm (BFR strengthening with 830 nm PBMT-32 mW; 0.101 cm2; 1.92 J, total energy 17.2 J). Data were analyzed by using a mixed-effects model, with a 5% significance index. Results: A statistically significant increase was obtained for handgrip strength for the 660 nm group [27.36 ± 2.61 kilogram force (kgF)] compared with the 830 nm group (23.04 ± 3.06 kgF) (p = 0.010) and for wrist extensor strength in the 660 nm (7.77 ± 0.58 kgF) and BFR (7.54 ± 0.92 kgF) groups compared with the control group (5.33 ± 0.61 kgF) (p = 0.001 and p = 0.004, respectively). The RMS value for the 660 nm group was significantly higher than control (p < 0.0001), BFR (p < 0.0001), and the 830 nm group (p = 0.0009). Conclusions: The association of PBMT (660 nm) and BFR was effective for increasing handgrip strength of the wrist extensors, associated with an increase in RMS.

A comparative study of the efficacy of radial and focused shock wave therapy for tennis elbow depending on symptom duration.

IntroductionIn physical therapy, the duration and severity of pain complaints determine the choice of an appropriate physical agent and parameters needed. The aim of this study was to compare the therapeutic efficacy of focused and radial shock waves for tennis elbow with respect to the dysfunction period.Material and methodsThe patients with acute (n = 27) and chronic (n = 31) tennis elbow were randomly assigned to a treatment arm: focused shock wave therapy (3 sessions, 2000 shocks, 4 Hz, 0.2 mJ/mm²) or radial shock wave therapy (3 sessions, 2000 shocks, 8 Hz, 2.5 bar). In order to objectivize therapy effects, the severity of pain complaints (Visual Analog Scale), strength of wrist flexors and extensors and grip strength were assessed. We performed pre-intervention measurements and short-term follow-up at 1, 6 and 12 weeks of therapy completion.ResultsAt 6 and 12 weeks of therapy completion, all groups exhibited significantly reduced pain complaints (p < 0.05). The most noticeable changes in grip strength, wrist extensors and flexors strength were observed in the affected extremities of all experimental groups while changes within the unaffected extremities were slight. Grip strength as well as the strength of flexor and extensor muscles of the affected limb were significantly greater at 12 weeks of therapy completion compared to pre-intervention values (p < 0.05). At the same time point, percent changes of all study parameters were comparable for all groups (p > 0.05).ConclusionsFocused and radial shock wave therapy tend to show a significant and comparable short-term therapeutic effect for acute and chronic tennis elbow.

The effects of kinesiotaping on wrist extensor strength using an isokinetic device in patients with chronic lateral epicondylitis: A randomized-controlled trial

This study aims to evaluate short-term effects of kinesiotaping (KT) on pain, arm function, grip strength, and wrist extensor strength in patients with chronic lateral epicondylitis (LE). A total of 48 patients (32 females, 16 males years; mean age 47.6 years; range 27 to 67 years) with chronic LE were randomly assigned to either KT group (n=27) or sham group (n=21). Pain intensity with visual analog sclae (VAS), arm pain and function with Patient-Rated Tennis Elbow Evaluation Questionnaire (PRTEE), grip strength with hand dynamometer, and wrist extensor strength by an isokinetic device were evaluated before and at the end of the treatment. The KT stayed on for five days and the procedure was repeated for three times. Although pain and functional levels of patients with chronic LE were significantly improved both with KT (pain, p=0.001; function, p=0.001) and sham groups (pain, p=0.001; function, p=0.001), no significant difference was observed between the groups. Both KT and sham taping provided similar improvement in pain relief through arm functions in patients with chronic LE.

The effect of rehabilitation interventions on physical function and immobility-related complications in severe stroke: a systematic review

ObjectiveTo evaluate the effectiveness of rehabilitation interventions on physical function and immobility-related complications in severe stroke.DesignSystematic review of electronic databases (Medline, Excerpta Medica database, Cumulative Index to Nursing and Allied...

Strength training and aerobic exercise training for muscle disease.

Background Strength training or aerobic exercise programmes might optimise muscle and cardiorespiratory function and prevent additional disuse atrophy and deconditioning in people with a muscle disease. This is an update of a review first published in 2004. Objectives To examine the safety and efficacy of strength training and aerobic exercise training in people with a muscle disease. Search methods We searched the Cochrane Neuromuscular Disease Group Specialized Register (July 2012), CENTRAL (2012 Issue 3 of 4), MEDLINE (January 1946 to July 2012), EMBASE (January 1974 to July 2012), EMBASE Classic (1947 to 1973) and CINAHL (January 1982 to July 2012). Selection criteria Randomised or quasi-randomised controlled trials comparing strength training or aerobic exercise programmes, or both, to no training, and lasting at least six weeks, in people with a well-described diagnosis of a muscle disease. We did not use the reporting of specific outcomes as a study selection criterion. Data collection and analysis Two authors independently assessed trial quality and extracted the data obtained from the full text-articles and from the original investigators. We collected adverse event data from included studies. Main results We included five trials (170 participants). The first trial compared the effect of strength training versus no training in 36 people with myotonic dystrophy. The second trial compared aerobic exercise training versus no training in 14 people with polymyositis and dermatomyositis. The third trial compared strength training versus no training in a factorial trial that also compared albuterol with placebo, in 65 people with facioscapulohumeral muscular dystrophy (FSHD). The fourth trial compared combined strength training and aerobic exercise versus no training in 18 people with mitochondrial myopathy. The fifth trial compared combined strength training and aerobic exercise versus no training in 35 people with myotonic dystrophy type 1. In both myotonic dystrophy trials and the dermatomyositis and polymyositis trial there were no significant differences between training and non-training groups for primary and secondary outcome measures. The risk of bias of the strength training trial in myotonic dystrophy and the aerobic exercise trial in polymyositis and dermatomyositis was judged as uncertain, and for the combined strength training and aerobic exercise trial, the risk of bias was judged as adequate. In the FSHD trial, for which the risk of bias was judged as adequate, a +1.17 kg difference (95% confidence interval (CI) 0.18 to 2.16) in dynamic strength of elbow flexors in favour of the training group reached statistical significance. In the mitochondrial myopathy trial, there were no significant differences in dynamic strength measures between training and non-training groups. Exercise duration and distance cycled in a submaximal endurance test increased significantly in the training group compared to the control group. The differences in mean time and mean distance cycled till exhaustion between groups were 23.70 min (95% CI 2.63 to 44.77) and 9.70 km (95% CI 1.51 to 17.89), respectively. The risk of bias was judged as uncertain. In all trials, no adverse events were reported. Authors' conclusions Moderate-intensity strength training in myotonic dystrophy and FSHD and aerobic exercise training in dermatomyositis and polymyositis and myotonic dystrophy type I appear to do no harm, but there is insufficient evidence to conclude that they offer benefit. In mitochondrial myopathy, aerobic exercise combined with strength training appears to be safe and may be effective in increasing submaximal endurance capacity. Limitations in the design of studies in other muscle diseases prevent more general conclusions in these disorders.

The effect of muscle fatigue on wrist joint position sense in healthy adults

Study designPretest and posttest experimental study. IntroductionThe effect of muscle fatigue on wrist joint position sense (JPS) has yet to be determined. Purpose of the StudyThe primary aim was to determine whether muscle fatigue affects wrist JPS in healthy adults. The secondary aims were to compare the effect of muscle fatigue on younger and older adults JPS and determine the association between JPS rate of change and total muscle fatigue (TMF) rates postexercise. MethodsForty male and female healthy adults were assigned into younger (18-40 years) and older (41-65 years) groups. Preexercise and postexercise testing consisted of active wrist JPS, handgrip, and wrist extensor strength assessments. Muscle fatigue was induced via a calibrated gripper and wrist extension dumbbell exercises. Dependent variables were the JPS rate of change (ie, preexercise and postexercise), TMF rate (ie, grip and wrist extension average strength decline), and Borg Rating of Perceived Exertion scale scores. ResultsPostexercise wrist JPS test scores were significantly higher than preexercise. Exercises induced statistically significant TMF rates and Borg Rating of Perceived Exertion scores among all participants. No statistically significant age-group differences on JPS rate of change, and TMF rate was found. A statistically significant mild correlation (r = 0.425) existed between JPS rate of change and TMF rates. DiscussionPostexercise fatigue significantly impairs wrist JPS in both younger and older adults. On average, an 18% muscle strength decline led to 215% wrist JPS deficit. ConclusionsSignificant wrist proprioception deficits persist for ≤5 min following exertional exercises, regardless of age level.

The Honest Palm Sign: Detecting Incomplete Effort on Physical Examination

We investigated a simple, novel diagnostic test for detecting incomplete effort during the motor portion of the neurological examination. The results from the honest palm sign (HPS) were evaluated for 162 consecutive neuro-oncology patients who had undergone upper extremity strength testing. Deltoid, bicep, and wrist extensor strength was assessed in all patients. During the examination, patients were repeatedly encouraged to "try as hard as possible" and to "resist with all your strength." The absence of nail prints on the palms constituted a positive HPS test result (i.e., indicative of incomplete effort). The presence of nail prints constituted a negative HPS test result (i.e., indicative of full effort). A total of 162 patients were tested. Their mean age was 55.5 ± 14.9 years, the median Karnofsky performance scale score was 80 (range, 60-100), and 63 patients (39%) were men. Of the 162 patients, 102 (63%) had malignant gliomas, 28 (17%) had brain metastases, 21 (13%) had other primary brain tumors, and 11 (6.8%) had primary central nervous system lymphomas. Of the 162 patients, 48 (30%) had positive HPS test results. The test sensitivity (84.6%), specificity (75.2%), positive likelihood ratio (3.41), and negative likelihood ratio (0.205) were good. After excluding 33 patients with characteristics that rendered them unsuitable for testing, the results from the remaining 129 patients were analyzed. The sensitivity was unchanged (84.6%), but the specificity (96.6%), positive likelihood ratio (24.5), and negative likelihood ratio (0.16) improved dramatically. The HPS test is a simple, sensitive, and very specific test for detecting incomplete effort during the motor portion of neurological evaluations.

Can Whole-Body Vibration Exercises in Different Positions Change Muscular Activity of Upper Limbs? A Randomized Trial.

The aim of this study was to investigate the acute effects of whole-body vibration exercises (WBVE) in different positions on muscular activity of flexor digitorum superficialis (FD), wrist extensor (ED), and handgrip strength (HG) of healthy men. Fifteen participants have performed 5 test sets each one consisting of HG strength measurement and 1-minute WBVE intervention (frequency: 50 Hz, amplitude: 1.53 mm, synchronous tri-planar oscillating/vibratory platform), that could be control (no exposition to vibration), squat (30 seconds of rest and 30 seconds of WBVE in squat position), or push-up (30 seconds of rest, and 30 seconds of WBVE in push-up position). After testing, participants had 2 minutes of rest and then were encouraged to keep themselves on a pull-up bar for 30 seconds. During all procedures, muscular activity of FD and ED was measured by surface electromyography (EMG). Statistical analysis has revealed that the EMG measured in the FD during the static pull-up bar exercise after SQUAT condition was significantly higher (P = .004) than the CONTROL and PUSH-UP conditions. Whole-body vibration exercises in squat position increase acutely muscle activation of the FD during isometric exercises of longer duration, while muscle activation of ED and HG strength are not affected by WBVE.

Safety and efficacy of polydeoxyribonucleotide injections versus prolotherapy for patients with elbow epicondylitis in a randomized double-blind active-controlled trial

Our aim was to evaluate the efficacy of polydeoxynucleotide (PDRN) injections compared to standardized prolotherapy for patients with lateral epicondylitis (LE). In this randomized, double-blind, active-controlled trial, eligible patients with LE received intra-tendinous injections (1 mL of PDRN or hypertonic dextrose [15%]) under ultrasound (US) guidance at weeks 0, 2 and 4. Primary outcome was Visual Analogue Scale (VAS) for elbow pain. Secondary outcomes were pain-free grip strength (PFGS), pressure-pain threshold (PPT), isokinetic wrist extensor strength (IWES), patient-rated tennis elbow evaluation (PRTEE), EQ-5D-5L and US characteristics of the LE. All outcomes and adverse events were assessed at weeks 0, 6 and 12. The final analysis included 38 patients (PDRN injection, n = 19; prolotherapy, n = 19) (Fig. 1) (Table 1). Significant improvements from baseline to 12 weeks were observed in VAS for elbow pain in both groups (53.6 ± 19.1 mm, P < 0.001 in PDRN; 50.6 ± 16.8 mm, P < 0.001 in prolotherapy) (Fig. 2). While the between-group difference in VAS was not significant ( P = 0.605). Significant pre-versus-post improvements were observed within each group for the secondary outcomes other than US characteristics ( P < 0.001, P = 0.001, and 0.003, respectively). Of these outcomes, PFGS, PPT, and IWES exhibited increase of up to 90% (ratio = affected side/unaffected side × 100) in both groups. However, all secondary outcomes showed non-significant between-group differences. There were no serious adverse events that resulted in drop-outs. PDRN injections and prolotherapy used as standardized interventions can be safe and effective treatments improving for LE-related pain and function.