Possible Duration of WISH-type Hip Brace Use: Prognostic Value of Timed Up and Go Test.

Objectives: The WISH-type S-form hip brace (WISH brace) has significantly improved hip function and functional mobility in patients with hip osteoarthritis (OA). However, most patients later undergo surgery. The main purpose of this study was to evaluate how long the orthosis can be effectively used by patients with hip OA, and to reveal the associated prognostic factors. Methods: This prospective study examined the survival curve of the equipment by using surgery as an endpoint and investigated how the duration of use affects patients. Harris Hip Score, muscle strength, and the Timed Up and Go test (TUG) were evaluated as prognostic factors. Results: By drawing the survival curves of 26 patients, approximately one third were expected to be still using the brace after 7 years. A rapid decrease in use was observed at around 1 year. A significant difference between patients with and without bracing at 1 year was found for the TUG result with the unaffected leg inside (ULI) at the start of bracing. A cut-off value of 9.5 s for the TUG with ULI significantly differentiated patients with and without bracing at 1 year, suggesting a possible predictor of brace survivorship in the early phase. Conclusions: The TUG with ULI with a cut-off value of 9.5 s, or at most 10 s, may be a possible predictor of persistence of brace use in the early phase.

Delayed detection of passive motion in shoulders with a rotator cuff tear.

The aim of this study was to test whether or not the threshold to the detection of passive motion (TTDPM) and passive joint position sense on the affected shoulder of patients with rotator cuff tear (RCT) was impaired compared to those on the unaffected side and to investigate the relationship between the tear size and changes in the TTDPM and passive joint position sense induced by RCT. This study included 21 patients with unilateral RCT before arthroscopic rotator cuff repair. To investigate proprioception in this study, we measured the TTDPM and passive joint position sense in abduction and external rotation using an isokinetic dynamometer. The tear size was evaluated intraoperatively under direct arthroscopic visualization. The TTDPM in abduction and external rotation was significantly longer on the affected side than on the unaffected side. However, the angular absolute error in passive joint position sense in abduction and external rotation was not significantly different between the limbs. A comparison according to the tear size impaired proprioception of the TTDPM in the larger tear group showed significantly longer values than in the smaller group. There was impaired proprioception of TTDPM in patients with RCT, and the impaired proprioception was related to tear severity. Impaired proprioception of TTDPM may inhibit consistent muscle recruitment to achieve precise control. Our results suggest that clinicians should consider proprioceptive exercises for impaired proprioception in their treatment for conservative or postoperative patients.

Inpatient knee pain after hip fracture surgery affects gait speed in older adults: A retrospective chart-referenced study.

AIM: Post-hip fracture knee pain (PHFKP) develops in 28-37.4% of patients with hip fracture and contributes to prolonged hospitalization. Although reduced balance and gait speed contribute to falls, the effects of PHFKP remain unclear. This study aimed to clarify whether PHFKP is a factor in balance and gait speed. METHODS: We retrospectively reviewed the medical records of patients after hip fracture. Development of PHFKP, basic information, and physical function were examined. Berg balance scale (BBS) and maximum walking speed (MWS) were collected at discharge. These parameters were compared with the presence or absence of PHFKP. In addition, multiple analyses were conducted with BBS and MWS as dependent variables and PHFKP as one of the independent variables. RESULTS: Of the 146 patients enrolled, 43 (29.5%) developed PHFKP, and 37.2% of patients with PHFKP showed residual symptoms at discharge. Intensity of PHFKP was mostly mild to moderate. The PHFKP group showed an extended length of stay (+13.3 days) and a tendency toward more discharges to facilities compared with the control group. Knee extension range of motion limitation, knee extensor strength, and BBS did not differ between groups, while MWS was significantly lower in the PHFKP group (0.85 ± 0.32 m/s vs. 1.07 ± 0.39 m/s). Multiple analyses showed that development of PHFKP was not associated with BBS, but was associated with decreased MWS (standardized beta = -0.202, P = 0.005). CONCLUSIONS: PHFKP was identified as an independent factor in gait speed decline. PHFKP patients should be monitored for reduced gait speed during rehabilitation. Geriatr Gerontol Int 2021; 21: 830-835.

Femoral morphology is associated with development of knee pain after hip fracture injury among older adults: A nine-year retrospective study.

INTRODUCTION: We aimed to clarify differences in femoral morphology associated with post-hip fracture knee pain (PHFKP). METHODS: Medical records and radiographic examinations were retrospectively reviewed to determine the relationship between PHFKP development and femoral morphology. Leg length discrepancy (LLD) and neck-shaft angle discrepancy (NSAD) were measured from hip radiographs. RESULTS: 202 were enrolled, of whom 64 (31.7%) developed PHFKP. The PHFKP group showed more varus NSA. Intertrochanteric femoral fractures (γ-nail or CHS) displayed a more varus NSA. CONCLUSIONS: Femoral morphology (varus NSA) may be involved in the development of PHFKP.

Biomechanical analysis of the pitching characteristics of adult amateur baseball pitchers throwing standard and lightweight balls.

[Purpose] The purpose of this study was to determine the relationship between pitching weight and pitching mechanics, including ball reaction force (BRF) and temporal parameters, for the prevention of throwing injury in adult amateur pitchers. [Participants and Methods] Twenty adult male amateur pitchers (mean age, height, and body mass: 26 ± 3.4 years, 1.7 ± 0.03 m, and 71.6 ± 9.5 kg, respectively) randomly pitched light (110 g) and heavy (145 g) baseballs at maximum velocity. Kinematic, kinetic, and temporal parameters were compared between the light and heavy balls. [Results] Pitching heavy balls significantly increased the BRF to 9.2 N and maximum trunk rotation angular velocity to 26.2°/sec, and decreased the ball speed to 1.4 m/sec and upper limb joint torque efficiency and shoulder internal rotation angular velocity at the moment of ball release at 250.8°/sec. Furthermore, the peak temporal kinetic parameters until ball release appeared early in the throwing of the heavy ball. [Conclusion] Adult amateur pitchers who pitched heavy balls had greater BRF; had decreased upper limb joint torque efficiency, ball speed, and arm angular velocity; and reached maximum kinetics early. Adult amateur pitchers may be at risk of throwing injuries due to throwing of heavy balls.

Muscle activity of the vastus medialis obliquus during squat motion after static stretching of the tensor fasciae latae.

[Purpose] The purpose of this study was to investigate the changes of muscle activity during squat motion after stretching the tensor fasciae latae muscle. [Participants and Methods] The participants comprised 19 healthy males. The test muscles were the vastus medialis obliquus and vastus lateralis. The participants performed the squat motion before and after stretching the tensor fasciae latae. We measured the muscle activities and the onset timing of the vastus medialis obliquus relative to that of the vastus lateralis during squat motions. [Results] The onset timing of the vastus medialis obliquus relative to that of the vastus lateralis was decreased, and the vastus medialis obliquus activity and vastus medialis obliquus/vastus lateralis activity ratio were increased after stretching the tensor fasciae latae. [Conclusion] This study revealed that stretching of the tensor fasciae latae increases the relative vastus medialis obliquus muscle activity.

Comparison of effects of joint flexibility on the lumbo-pelvic rhythm in healthy university students while bending the trunk forward.

[Purpose] To clarify the influence of flexibilities of the hip and lumbar spine joints on bending the trunk forward. [Participants and Methods] We assessed the joint flexibility of 47 healthy university students using the Beighton hypermobility score and assigned them to the group of normal or poor flexibility. We performed electromyography to acquire kinematic data and analyzed the three-dimensional motion while the students bent their trunks forward. Further, we compared the groups based on angular displacements of the hip joint and lumbar spine in each phase of the movement. Offset of the erector spinae and hip extensor muscle activity was calculated as a percentage (%) of the maximum range of motion. [Results] The lumbo-pelvic rhythm differed between participants with and without poor flexibility of the hip joint in the second half of the forward bending task. Participants with poor flexibility of the hip joint showed activation of the erector spinae and biceps femoris for a longer period compared to those with normal flexibility. Notably, flexion-relaxation responses were not found in the biceps femoris of 30% of the participants. [Conclusion] Poor hip joint flexibility may cause low back pain. Measuring the lumbo-pelvic rhythm might help identify individuals at a high risk of low back pain while they are still healthy.

Relationship between asymmetric trunk flexion movement and elector spinae muscle activity.

[Purpose] To clarify the relationship between asymmetric trunk flexion movement and erector spinae (ES) muscle activity using a three-dimensional motion analysis system and surface electromyography. [Subjects and Methods] The subjects comprised 14 healthy individuals. Angles of trunk flexion, rotation, and side bending were measured using a three-dimensional motion analysis system attached to the trunk and pelvic segment. Activities of the ES muscle on both sides at the L1 and L4 levels were measured using surface electromyography. [Results] In healthy individuals, the ES was more markedly activated in the trunk extension phase than in the trunk flexion phase. There was no significant difference in terms of the extent of trunk rotation and trunk side bending during these tasks. [Conclusion] This study did not clarify the relationship between asymmetric movement during trunk flexion and ES activity.

Correlation of upper limb joint load withsimultaneous throwing mechanics including acceleration parameters in amateur baseball pitchers.

[Purpose] The purpose of this study was to provide information regarding the knowledge of mechanical principles related to the load applied to the shoulder and elbow during the pitching motion. [Subjects and Methods] The three-dimensional kinematics of body segments were measured in 19 amateur baseball players with a VICON motion capture system. The correlation between maximum shoulder internal torque, maximum elbow varus torque, and simultaneous kinematic parameters including joint angular acceleration and ball acceleration was investigated. [Results] Peak shoulder internal rotation torque and elbow varus torque averaged 31 Nm and 26 Nm, respectively. Ball acceleration had the strongest influence on shoulder internal rotational torque (standardized partial regression coefficient 0.69). During previous maximum external rotation (pre-MER), the main cause parameter of elbow varus torque was shoulder horizontal adduction velocity (r=0.672). On the other hand, after MER (post-MER), the main cause was ball acceleration (r=0.745). [Conclusion] Results of our study suggest that one of the main mechanical principles of joint load during the baseball pitching motion may be the 'inertia' yielded on the segment distal to the certain joint.

Professional identity acquisition process model in interprofessional education using structural equation modelling: 10-year initiative survey.

The mandatory interprofessional education (IPE) programme at Gunma University, Japan, was initiated in 1999. A questionnaire of 10 items to assess the students' understanding of the IPE training programme has been distributed since then, and the factor analysis of the responses revealed that it was categorised into four subscales, i.e. "professional identity", "structure and function of training facilities", "teamwork and collaboration", and "role and responsibilities", and suggested that these may take into account the development of IPE programme with clinical training. The purpose of this study was to examine the professional identity acquisition process (PIAP) model in IPE using structural equation modelling (SEM). Overall, 1,581 respondents of a possible 1,809 students from the departments of nursing, laboratory sciences, physical therapy, and occupational therapy completed the questionnaire. The SEM technique was utilised to construct a PIAP model on the relationships among four factors. The original PIAP model showed that "professional identity" was predicted by two factors, namely "role and responsibilities" and "teamwork and collaboration". These two factors were predicted by the factor "structure and function of training facilities". The same structure was observed in nursing and physical therapy students' PIAP models, but it was not completely the same in laboratory sciences and occupational therapy students' PIAP models. A parallel but not isolated curriculum on expertise unique to the profession, which may help to understand their professional identity in combination with learning the collaboration, may be necessary.

Trunk kinematics and muscle activities during arm elevation.

BACKGROUND: While trunk movement accompanies arm elevation, trunk muscle activities during arm elevation at different speeds are unclear. The purpose of this study was to examine the trunk muscle activities at various speeds of arm elevation and then to evaluate their roles in trunk kinematics. METHODS: Twenty-two healthy subjects participated. The participants performed right shoulder flexion at three different speeds. Surface electromyography was used to measure the activities of bilateral external oblique muscles (EO), internal oblique muscles (IO), rectus abdominis muscles (RA) and lumber erector spinae muscles (ES). A three-dimensional motion analyzer was used to measure arm and trunk movements. RESULTS: In natural and slow movements, the muscle activities of left ES, right EO and left IO were significantly augmented compared with those of the contralateral muscles, in the relatively late phase. In fast movement, the muscle activities of both ES were significantly augmented during the early phase compared with later in the action. The muscle activities of the left ES and the right EO were significantly augmented compared with those of the contralateral muscles. There was a consistent pattern of trunk extension, lateral flexion and rotation during arm elevation, irrespective of the speed. CONCLUSIONS: Bilateral ES activity may be required for back-extension torques, especially for the early phase of rapid elevating motion. The anterior muscles' activity may contribute to the production of anterior force against the backward movement of the center of mass of the upper limb in the late phase. Trunk rotation, controlled by the trunk muscles in harmony, may assist the scapular movement to align the scapular plane in the arm elevating plane.

Effect of the WISH-type hip brace on functional mobility in patients with osteoarthritis of the hip: evaluation using the Timed Up & Go Test.

BACKGROUND: The WISH-type S-form brace, is considered to improve hip function and gait in patients presenting with painful hip osteoarthritis (OA). OBJECTIVES: To evaluate the effects of the brace on functional mobility. STUDY DESIGN: Cross sectional survey. METHODS: The Timed Up & Go Test (TUG) was performed with right and left turns separately in each subject. RESULTS: In the patients with the bilateral hip brace, the average time to complete the TUG (8.3 ± 1.7 seconds) was significantly shorter than in those without the brace (9.4 ± 2.9 seconds). On the other hand, for the patients with unilateral hip OA, the improvement of TUG with the hip brace was significant in turning the unbraced leg inside (7.4 ± 1.1 vs. 7.6 ± 1.2 seconds), while not turning the braced leg inside (7.5 ± 1.1 vs. 7.6 ± 1.2 seconds). Furthermore, significant improvement of TUG was found at three-month follow-up and maintained until the 12-month follow-up assessment. This improvement was independent of the application of the brace at the assessment. CONCLUSIONS: The direct effect of the hip brace may be related to the hip function in the turning phase of TUG. In addition, mechanical improvements due to daily exercise may provide an indirect, but essential, effect of the brace on TUG performance.

Biomechanical analysis of gait in patients with painful osteoarthritis of the hip treated with WISH-type hip brace.

BACKGROUND: A hip brace, the WISH-type S-form brace, improved hip function scores markedly in patients with painful hip osteoarthritis (OA). To evaluate the biomechanical effects of the brace, gait analysis using a force plate was performed. METHODS: For the gait of seven patients with this hip brace, characteristic parameters calculated from three-dimensional (i.e., vertical, forward, and medial) components of the floor reaction force were analyzed using a flat force plate. RESULTS: Gait analyses revealed several tendencies: a shorter time for one step, a stronger step, and a shift of the center of gravity of the body to the contralateral side. In particular, stronger vertical reaction force at the first peak in the early stance and earlier switch from backward to forward reaction force vectors were observed as effects of the hip brace, with statistically significant difference. CONCLUSIONS: These biomechanical assessments suggest that abnormal gait in hip OA may be closer to normal gait in patients using this brace, although the deceleration and weighing-off effects, which are indicators useful for observing gait recovery, did not reach significance.

Extended application of WISH type S-form hip brace for patients with bilateral painful hip osteoarthritis: report of two cases.

Dynamic lateral instability of the femoral head develops in patients with osteoarthritis (OA) of the hip. Recently we have developed a hip brace, called the WISH-type hip brace, and showed successful response of the patients quantitatively. However, a negligible effect was observed in patients with bilateral involvement. Here, we extended the application of the WISH-type hip brace for two patients with bilateral OA joints. The resultant WISH-type hip brace with two S-form portions for bilateral thighs provided good recovery in hip function. Interestingly Timed Up & Go (TUG) test performed for one patient revealed a positive effect of the brace on the functional mobility. To the best of our knowledge, this is the first report elucidating the therapeutic effect of brace therapy with bilateral hip stabilization from hip functional and functional mobility points of view. Application of the present brace should be taken into account for patients with painful bilateral hip OA before easy application of invasive surgery such as total hip arthroplasty.

Prognostic significance of 18F-FDG uptake in primary osteosarcoma after but not before chemotherapy: a possible association with autocrine motility factor/phosphoglucose isomerase expression.

Response to neoadjuvant chemotherapy is a significant prognostic factor for osteosarcoma (OS). 18-F-fluorodeoxy-D: -glucose (FDG) positron emission tomography (PET) is a noninvasive imaging modality that correlates with histological grading in musculoskeletal sarcomas. To determine the prognostic value of FDG PET in patients receiving chemotherapy, 13 patients were evaluated by FDG-PET, and followed for more than 4 years. FDG PET standardized uptake values before (SUV1) and after (SUV2) chemotherapy were analyzed and correlated with the expression of metastasis-related glycolytic enzyme, autocrine motility factor (AMF)/phosphoglucose isomerase (PGI) by immunohistochemical examination in surgically excised tumors. Although mean SUV1 for OS patients with metastatic lesions were similar to those in the completely disease-free (CDF) group (6.5 vs. 6.6, respectively, P = 0.975), mean SUV2 for OS with metastatic lesions were significantly higher than those in the CDF group (5.1 vs. 2.5, respectively, P = 0.0445). Interestingly, immunohistochemical analysis using anti-AMF/PGI antibody revealed that SUV2 correlated significantly with the AMF/PGI staining titers (P = 0.0303), while no correlation between SUV1 and the AMF/PGI staining titers existed (P = 0.964). The present study suggests that FDG PET after chemotherapy may provide information for AMF/PGI-related metastatic potentiality of residual tumors located out side of the area surgically resected afterward, and then lead to a useful prediction of the patients' prognosis.

Effect of a modified S-form hip brace, WISH type, for patients with painful osteoarthritis of the hip: a role in daily walking as a hip muscle exercise.

A hip brace designated as WISH-type of S-form hip brace was applied for 14 patients with painful hip osteoarthritis (OA), who were required to walk as an exercise at least a half hour every day. Patients were independently evaluated and serially scored using the Harris and Japanese Orthopaedic Surgery (JOA) scores. Pain relief on gait was obtained immediately and dramatically in all patients, providing high compliance. Approximately three fourths of patients acquired independence from analgesics. Both Harris and JOA scoring systems indicated significant improvement of hip function. Only two cases showed poor responses, and common factors in these cases included bilateral involvement and unsuccessfulness of daily walking exercise. The present WISH-type hip brace may be one of the most valuable treatments in the management of the hip OA. Requirements of muscle exercise around the hip girdle involving daily walking should be emphasized for maintenance of the brace effects.

Pre- and postoperative evaluation of the metabolic activity in muscles associated with ruptured rotator cuffs by F-FDG PET imaging.

We examined uptake of 2-[(18)F]-fluoro-2-deoxy-D-glucose (FDG) using positron emission tomography (PET) into the bilateral shoulder muscles of four patients before and after unilateral rotator cuff repair. The relative ratio of the subtracted standardized uptake value on the supraspinatus with a torn supraspinatus tendon to that of the subscapularis on the ipsilateral side was significantly lower than that on the normal side (0.69 +/- 0.05 versus 1.06 +/- 0.36). The relative ratio of the infraspinatus on the rupture side was also significantly lower than that on the normal side (0.91 +/- 0.09 versus 1.41 +/- 0.35). However, by 6 months postoperative, the reduced glucose metabolism in these muscles had recovered to the same levels as those on the normal side. As indicated by FDG PET, muscle metabolism in rotator cuff tears was reduced, subsequently recovering to the level of the normal side after operative repair.

Evaluation of muscle metabolic activity in the lower limb of a transfemoral amputee using a prosthesis by using (18)F-FDG PET imaging--an application of PET imaging to rehabilitation.

This study used FDG PET to evaluate the lower limb muscles metabolic activities of transfemoral amputees during walking with prostheses. As a preliminary study, FDG PET was applied for two normal adult volunteers to evaluate muscle activity in the lower extremities after gait exercise. This same method was applied for two amputee volunteers with prostheses. We found that FDG accumulated more in both gluteus medius muscles after gait exercise compared to other muscles in normal adult volunteers. In the skilled amputee volunteer, FDG uptake increased in the adductor and gluteus medius in the amputated side, while in the unskilled the adductor, gluteus maximus, and gluteus medius showed increased FDG uptake only in the normal side. This result suggests that basic metabolic changes such as an increase in oxidative metabolism and less reliance on glycolytic activity would occur as a result of skeletal muscle training in amputees.

Use of 2-[18F]-fluoro-2-deoxy-d-glucose positron emission tomography (FDG PET) imaging for the evaluation of muscle metabolic activity in ruptured rotator cuffs: Identification of shoulder muscles by fusion imaging studies involving both FDG PET and magnetic resonance imaging.

The uptake of 2-[(18)F]-fluoro-2-deoxy-d-glucose (FDG) into shoulder muscles was studied in 11 patients with rotator cuff tears. FDG was injected under resting conditions, and cuff muscle exercises were performed followed by evaluation of the standardized uptake value (SUV) in shoulder muscles bilaterally. Analysis was performed with a subtracted SUV, obtained by subtracting the SUV of the muscle at rest from that after exercise. Fusion imaging studies involving FDG positron emission tomography (PET) and magnetic resonance imaging would provide a novel strategy with the potential of improving on the limited resolution of PET images. In this study this relatively new strategy revealed a similar decrease in the supraspinatus SUV in cases involving both complete and partial tears. The SUV in the infraspinatus and subscapularis also decreased, regardless of whether these muscles were intact or ruptured; the SUV in the deltoid remained basically unchanged. With the use of this exercise protocol, FDG PET might prove useful for objective evaluation of rotator cuff muscle activity.