Association between movement speed and instability catch kinematics and the differences between individuals with and without chronic low back pain.

Studies reported the existence of instability catch (IC) during trunk flexion in patients with chronic low back pain (CLBP). However, different movement speeds can cause different neuromuscular demands resulting in altered kinematic patterns. In addition, kinematic characterization corresponding to clinical observation of IC is still limited. Therefore, this study aimed to determine (1) the association between movement speed and kinematic parameters representing IC during trunk flexion and (2) the differences in kinematic parameters between individuals with and without CLBP. Fifteen no low back pain (NoLBP) and 15 CLBP individuals were recruited. Inertial measurement units (IMU) were attached to T3, L1, and S2 spinous processes. Participants performed active trunk flexion while IMU data were simultaneously collected. Total trunk, lumbar, and pelvic mean angular velocity (T_MV, L_MV, and P_MV), as well as number of zero-crossings, peak-to-peak, and area of sudden deceleration and acceleration (Num, P2P, and Area), were derived. Pearson's correlation tests were used to determine the association between T_MV and L_MV, P_MV, Num, P2P, and Area. An ANCOVA was performed to determine the difference in kinematic parameters between groups using movement speed as a covariate. Significant associations (P < 0.05) were found between movement speed and other kinematic parameters, except for Area. Results showed that L_MV significantly differed from the P_MV (P = 0.002) in the CLBP group, while a significant between-group difference (P = 0.037) was found in the P_MV. Additionally, significant between-group differences (P < 0.05) in P2P and Area were observed. The associations between movement speed and kinematic parameters suggest that movement speed changes can alter kinematic patterns. Therefore, clinicians may challenge lumbopelvic neuromuscular control by modifying movement speed to elicit greater change in kinematic patterns. In addition, the NoLBP group used shared lumbar and pelvic contributions, while the CLBP group used less pelvic contribution. Finally, P2P and Area appeared to offer the greatest sensitivity to differentiate between the groups. Overall, these findings may enhance the understanding of the mechanism underlying IC in CLBP.

Effectiveness of physiological flexion swaddling and oromotor interventions in improving preterm infants' oral feeding ability in the NICU: a randomized controlled trial.

OBJECTIVE: This study aimed to prove the effectiveness of physiological flexion swaddling and oromotor interventions in terms of the duration needed to achieve the oral feeding ability of preterm infants in the NICU. METHODS: A randomized clinical trial in five Neonatal intensive care units (NICU) was performed involving 70 preterm infants born at 28-34 weeks gestational age. Participants were allocated to 1) the experimental group (n = 39) received physiological flexion swaddling and oromotor interventions, and 2) the control group (n = 31) received conventional swaddling and oromotor interventions. Mann-Whitney U analysis was used to determine the effectiveness of each group according to the duration needed to achieve oral feeding ability, while Kaplan-Meier survival analysis was applied to compare the duration of both groups. RESULTS: The experimental group had a significantly shorter duration in achieving oral feeding ability [4 (1-15) vs. 7 (2-22) days; p = 0.02]. The Kaplan-Meier survival curve analysis showed that infants in the experimental group achieved full oral feeding ability earlier than those in the control group (15 vs. 22 days). CONCLUSIONS: Physiological flexion swaddling and oromotor interventions have been proven to be effective in shortening the number of days needed to achieve the oral feeding ability of preterm infants in the NICU.

Dorsal blocking orthoses for proximal interphalangeal joint volar plate injuries: A retrospective cohort study investigating the impact of joint angle on patient outcomes.

BACKGROUND: Injuries to the proximal interphalangeal joint (PIPJ) of the fingers are commonly treated in hand therapy departments. Conservative management for PIPJ volar plate injuries typically involves a dorsal blocking orthosis and flexion exercises. Historically hand therapists have placed the PIPJ in varying degrees of flexion but the optimal angle is unknown. PURPOSE: To compare the outcomes of two treatment groups who received dorsal blocking orthoses: Those who the orthosis was positioned in neutral compared to those in 25-30° of flexion. STUDY DESIGN: Retrospective cohort study. METHOD: Patients treated by the hand therapy service at a major metropolitan hospital network in Melbourne, Australia, for conservative management of a PIPJ volar plate injury over a three-year period were included in our study. Data regarding patient demographics, digits affected and injury type were collected. Outcomes included presence of a fixed flexion deformity (FFD), amount of hand therapy received and total active flexion at the PIPJ. RESULTS: One hundred and eleven participants were included in our study. The mean age was 26 and 59 (53%) were males. Seventy two (64%) participants received a dorsal blocking orthosis positioned in neutral and 39 (35%) were positioned in 25-30° flexion at the PIPJ. Participants whose orthosis was positioned at 25-30° had an average of 24 more minutes in hand therapy (which equates to approximately one appointment) compared to those whose PIPJ was positioned in neutral (p=0.006, d=0.5). Eight percent less participants developed a FFD (p = 0.24) and 13% more participants achieved full flexion (p = 0.06) in the group who received a dorsal blocking orthosis in neutral, however these results were not statistically significant. CONCLUSION: PIPJ volar plate injures treated in an orthosis positioned in neutral required fewer hand therapy appointments. There was no statistically significant difference between groups regarding development of a FFD or full flexion.

Relationship Between the Results of the Landing Error Scoring System and Trunk Muscle Thickness.

Background: A landing error scoring system (LESS) is widely used to evaluate landing maneuvers. Poor landing maneuvers, such as lateral bending of the trunk, are thought to be associated with a risk of lower-extremity injury. However, no studies have examined the association between landing and trunk muscle function, which is associated with a high risk of lower-extremity injury. Hypothesis/Purpose: This study examined whether an association exists between landing movements and a high risk of lower-extremity injury and trunk muscle function. It was hypothesized that athletes with poor activation of deep trunk muscle (transversus abdominis and internal oblique) would have lower LESS scores. Study Design: Cross-sectional study. Methods: The trunk muscle thickness at rest and during the plank was measured using ultrasonography. The percent of change in muscle thickness (during plank/at rest) was calculated. The LESS was measured using the Physimax. Based on the LESS scores, patients were divided into high- (LESS > 6) and low-risk (5 > LESS) groups for lower extremity injury. The relationship between the high-risk group and trunk muscle thickness was examined using a stepwise regression analysis. Results: The high-risk group had significantly lower muscle thicknesses of the transversus abdominis (p=0.02) and transversus abdominis plus internal oblique abdominis (p=0.03) muscles during the plank. Additionally, the high-risk group showed significantly lower percent of change in muscle thickness of the internal oblique (p=0.02) and transversus abdominis plus internal oblique (p=0.01) muscles. Only the percentage of change in the thickness of the internal oblique and transverse abdominal muscles was extracted from the regression as a factor. Conclusion: The findings indicated that athletes with landing movements and a high risk of injury, as determined based on the LESS results, had low trunk muscle function, and a relationship was observed between the change in thickness of transversus abdominis and internal oblique abdominis muscles. Level of Evidence: 3B.

Malignant Hip Flexion Failure Syndrome: An Oncologic Disease Compared to Malignant Psoas Syndrome.

Malignant psoas syndrome (MPS) causes painful hip immobilization when a malignant tumor reaches the psoas muscle. However, there exists a different condition in which a malignant tumor invades the psoas muscle, leading to hip flexion failure without painful hip immobilization. This study aimed to define malignant hip flexion failure syndrome (MHFFS) as tumors located in the upper lumbar region or at the lesser trochanter of the femur, near the origin or termination of the psoas muscle, and to compare its prevalence, characteristics, and outcomes with those of classical MPS. We analyzed 291 patients who received palliative radiotherapy (RT) in the lumbar, pelvic, and lower leg regions from 2013 to 2023. The prevalence of MPS and MHFFS, pathological features, distinctive clinical presentations, treatment modalities, and treatment outcomes have been summarized. We also defined the 'Clinical sign reported by Ishikawa and Teramura (IT sign)' to describe the characteristic action of lifting the affected lower leg with both hands in MHFFS cases and assessed its clinical significance. Among the 291 patients, 6 (2.1%) had MHFFS and 11 (3.8%) had MPS. MHFFS resulted from metastatic tumors in the 11th and 12th thoracic vertebrae, as well as the 1st and 2nd lumbar vertebrae or the lesser trochanter of the femur, and it was characterized by hip and groin pain along with hip flexion dysfunction. All cases showed a positive IT sign. The response to RT varied, with symptomatic improvement observed in 50% of the patients. MPS is characterized by tumor invasion of the psoas muscle, causing severe lumbosacral nerve pain. Strong opioids were used for pain management in all patients, and epidural anesthesia was required in some patients. The median survival time of patients with MPS and MHFFS was 13.2 months. MPS required opioids more potently than MHFFS, but MHFFS responded relatively well to early RT.

Influence of Lead Knee Extension on Ball Velocity and Elbow Varus Torque in Professional and High School Baseball Pitchers.

Background: When the lead leg of a pitcher contacts the ground, the knee braces and then rapidly extends, initiating energy transfer to begin pelvis and trunk rotation. Purpose: To investigate the relationship of lead knee extension during the pitching delivery with peak lead knee extension velocity, ball velocity, and elbow varus torque in high school and professional pitchers. Study Design: Descriptive laboratory study. Methods: Data from 50 professional (PRO) and 50 high school (HS) pitcher groups were retrospectively analyzed. Pitchers threw 8 to 12 fastballs under 3-dimensional motion analysis (480 Hz). The groups were divided according to high or low lead knee extension: PRO-high (n = 18), PRO-low (n = 16), HS-high (n = 16), and HS-low (n = 17). Lead knee flexion, lead knee extension velocity, ball velocity, and elbow varus torque were analyzed between groups. Regression analyses were performed to quantify associations between lead knee extension and ball velocity and elbow varus torque for all pitchers. Results: At foot contact, all pitchers landed with similar knee flexion. PRO-high and HS-high pitchers had significantly greater lead knee extension through remaining pitching time points compared with the PRO-low and HS-low pitchers. PRO-high pitchers had faster ball velocity than PRO-low pitchers (39.8 ± 1.1 vs 39.3 ± 1.3 m/s, respectively), and HS-high pitchers had faster ball velocity than HS-low pitchers (34.1 ± 2.6 vs 31.2 ± 1.8 m/s, respectively) (P < .05). PRO-high pitchers had decreased elbow varus torque compared with PRO-low pitchers (85.3 ± 10.7 vs 95.4 ± 13.3 N·m, respectively); conversely, HS-high pitchers had greater elbow varus torque than HS-low pitchers (64.2 ± 14.7 vs 56.3 ± 12.2 N·m, respectively). For every 1° increase in lead knee extension, ball velocity increased by 0.47 m/s (P < .001) and elbow varus torque increased by 0.27 N·m (P = .025). Conclusion: Proper lead knee extension allowed efficient energy transfer through the kinetic chain to produce optimal ball velocity and minimize elbow varus torque in professional pitchers. Conversely, while proper lead knee extension improved ball velocity among high school pitchers, this did not minimize elbow varus torque. Clinical Relevance: Professional pitchers can extend their lead knee with minimal impact at the elbow. In high school pitchers, cognizance of proper full-body pitching mechanics remains a priority over increased velocity.

Exercise-induced changes in intramuscular total creatine concentration measured with 1H magnetic resonance spectroscopy: A pilot study.

Total amount of creatine (Cr) and phosphocreatine, or total creatine (tCr), may have a significant impact on the performance of skeletal muscles. In sports such as bodybuilding, it is popular to take Cr supplements to maintain tCr level. However, no study has explored the quantitative relationship between exercise intensity and the induced change in muscle's tCr. In this well-controlled study, straight-leg plantar flexion with specific load and duration was performed by 10 healthy subjects inside an MRI scanner, immediately followed by 1H MR spectroscopy (MRS) for measuring tCr concentration in gastrocnemius. For repeatability assessment, the experiment was repeated for each subject on two different days. Across all the subjects, baseline tCr was 46.6 ± 2.4 mM, ranging from 40.6 to 50.1 mM; with exercise, tCr significantly decreased by 10.9% ± 1.0% with 6-lb load and 21.0% ± 1.3% with 12-lb load (p < 0.0001). Between two different days, baseline tCr, percentage decrease induced by exercise with a 6-lb and 12-lb load differed by 2.2% ± 2.3%, 11.7% ± 6.0% and 4.9% ± 3.2%, respectively. In conclusion, the proposed protocol of controlled exercise stimulation and MRS acquisition can reproducibly monitor tCr level and its exercise-induced change in skeletal muscles. The measured tCr level is sensitive to exercise intensity, so can be used to quantitatively assess muscle performance or fatigue.

Reliability of In Vivo Creatine-Weighted Chemical Exchange Saturation Transfer (CrCEST) MRI in Calf Skeletal Muscle of Healthy Volunteers at 3 T.

BACKGROUND: Skeletal muscle mitochondrial oxidative phosphorylation (mtOXPHOS) is important for ATP generation and its dysfunction leads to exercise intolerance. Phosphorus magnetic resonance spectroscopy (31P-MRS) is a useful, noninvasive technique for mtOXPHOS assessment but has limitations. Creatine-weighted chemical exchange saturation transfer (CrCEST) MRI is a potential alternative to assess muscle bioenergetics. PURPOSE: To evaluate the interscan repeatability, intra- and interobserver reproducibility of CrCEST during mild plantar flexion exercise. STUDY TYPE: Retrospective. SUBJECTS: Twenty healthy volunteers (age 37.6 ± 12.4 years, 11 females). FIELD STRENGTH/SEQUENCE: 3 T/CEST imaging using gradient echo readout. ASSESSMENT: τCrCEST (postexercise Cr recovery time) was assessed in two scans for each participant, following mild plantar flexion exercises targeting the medial gastrocnemius (MG), lateral gastrocnemius (LG), and soleus (Sol) muscles. Three observers measured τCrCEST for interobserver reproducibility. Three readings by one observer were used to measure intraobserver reproducibility. Two scans were used for within-participant interscan repeatability. STATISTICAL TESTS: Paired t tests, intraclass correlation coefficient (ICC), and Pearson correlation were conducted. Bland-Altman plots were used to analyze the interobserver variability. A P-value of 0.05 was considered statistically significant. RESULTS: There was excellent intra- (ICC ∈ 0.94 - 0.98 $$ \in \left[0.94-0.98\right] $$ ) and interobserver (ICC ∈ 0.9 - 0.98 $$ \in \left[0.9-0.98\right] $$ ) reproducibility, with moderate interscan repeatability for τCrCEST in LG and MG (ICC ∈ 0.54 - 0.74 $$ \in \left[0.54-0.74\right] $$ ) and poor-to-moderate interscan repeatability in Sol (ICC ∈ 0.24 - 0.53 $$ \in \left[0.24-0.53\right] $$ ). Excellent interobserver reproducibility was confirmed by Bland-Altman plots (fixed bias P-value ∈ 0.08 - 0.87 $$ \in \left[0.08-0.87\right] $$ ). DATA CONCLUSION: CrCEST MRI shows promise in assessing muscle bioenergetics by evaluating τCrCEST during mild plantar flexion exercise with reasonable reliability, particularly in LG and MG. LEVEL OF EVIDENCE: 4 TECHNICAL EFFICACY: Stage 1.

[Anterior open wedge osteotomy of the distal femur]. / Anteriore Open-Wedge-Osteotomie am distalen Femur.

OBJECTIVE: To treat instability caused by a genu recurvatum using ventral open wedge osteotomy of the distal femur. INDICATIONS: Knee instability caused by Genu recurvatum with femoral extension deformity. CONTRAINDICATIONS: Inadequate blood flow to the lower extremity, soft tissue issues, obesity, osteoporosis. SURGICAL TECHNIQUE: Through a primary medial approach to the distal femur, a ventral open wedge osteotomy is performed using chisel bunch formation and arthrodesis spreader. For symmetrical expansion, another lateral approach at the distal femur and insertion of another arthrodesis spreader is performed. Osteosynthesis was performed with an angle stable plate from the medial side and with additional stabilization using a 4-hole angle stable plate from the lateral side. The osteotomy gap was filled with a bone graft wedge. POSTOPERATIVE MANAGEMENT: Partial weight-bearing of 20 kg was allowed for 6 weeks with passive exercise and lymphatic drainage. A hard frame orthosis for immobilization at 0-10-90° was fitted for 6 weeks. Radiographic controls were performed at 6 weeks, 3 months, and 1 year. After the last radiographic control, hardware was removed. RESULTS: There are no reports in the current literature regarding the effect of a change in the sagittal plane at the distal femur on alignment, stability, and biomechanics of the knee. This case report shows that genu recurvatum with physiological posterior tibial slope can be successfully treated with anterior femoral flexion osteotomy. Hyperextension was completely eliminated at the follow-up examination after hardware removal after 12 months.

Limited Flexion of the Middle Finger Due to a Degenerative Partial Flexor Tendon Rupture Mimicking a Soft Tissue Tumor.

Atraumatic subcutaneous rupture of the finger flexor tendon of the hand and forearm is rare. Most sites of closed and subcutaneous ruptures of the finger flexor tendon are the tendon-bone insertion and musculotendinous junction, and an intratendinous lesion is unusual. We report the case of a 76-year-old female who presented to our department with a one-month history of a soft tissue mass and limited flexion of the left middle finger without trauma. Preoperative magnetic resonance imaging revealed a soft tissue mass that caused limited finger flexion. Intraoperative findings showed an intratendinous rupture of the flexor digitorum profundus tendon at the middle phalanx; the lesion was resected to obtain smooth grinding of the tendon. One year postoperatively, the soft tissue mass and limited flexion of the finger resolved without recurrence.

High-resolution oblique coronal MRI at optimal flexed-knee angle: a novel imaging method for enhanced anterior cruciate ligament tear diagnosis.

BACKGROUND: The accuracy of traditional knee MR imaging in diagnosing anterior cruciate ligament tears, especially partial tears, is relatively low, which may lead to misdiagnosis and missed diagnosis. This study aimed to assess the diagnostic performance of a novel imaging method, high-resolution oblique coronal MRI at an optimal flexed-knee Angle, for ACL tears. METHODS: 50 healthy volunteers were scanned with a scan-assisted device for the optimal flexion angle of ACL. For 92 knee trauma patients selected strictly according to inclusion and exclusion criteria, conventional extended-knee scans (control group) and high-resolution oblique coronal scans based on the optimal flexed-knee angle (experimental group) were conducted. Two observers rated ACL visibility blindly on a 5-point scale. Arthroscopy-defined outcomes determined diagnostic metrics for each method and sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated. RESULTS: The average optimal flexion angle for healthy volunteers was approximately 30° (30.3° ± 5.0°). Imaging demonstrated complete visualization of the ACL in 96.7% of images in the experimental group versus 12.0% in the control group. The diagnostic indicators of the experimental group surpassed those of the control group: sensitivity (94.9% vs. 76.3%), specificity (97.0% vs. 81.8%), positive predictive value (98.2% vs. 88.2%), negative predictive value(91.4% vs. 65.9%), and accuracy (95.7% vs. 78.3%). ROC analysis indicated superior diagnostic performance in the experimental group, with an AUC of 0.945 compared with 0.776 for the control group (p < 0.0001). CONCLUSIONS: High-resolution oblique coronal imaging at the optimal 30° flexed-knee angle improved ACL visualization and diagnostic performance compared with conventional techniques.

Does preoperative forward elevation weakness affect clinical outcomes in anatomic or reverse total shoulder arthroplasty patients with glenohumeral osteoarthritis and intact rotator cuff?

Background: This study sought to determine if preoperative forward elevation (FE) weakness affects outcomes of anatomic (aTSA) and reverse total shoulder arthroplasty (rTSA) for patients with rotator cuff-intact glenohumeral osteoarthritis (RCI-GHOA). Methods: A retrospective review of a single institution's prospectively collected shoulder arthroplasty database was performed between 2007 and 2020, including 333 aTSAs and 155 rTSAs for primary RCI-GHOA with a minimum 2-year follow-up. Defining preoperative weakness as FE strength ≤4.9 pounds, three cohorts were matched 1:1:1 by age, sex, and follow-up: weak (n=82) to normal aTSAs, weak (n=44) to normal rTSAs, and weak aTSAs (n=61) to weak rTSAs. Compared outcomes included range of motion, outcome scores, and complication and revision rates at latest follow-up. Results: Weak aTSAs and weak rTSAs achieved similar postoperative outcome measures to normal aTSAs and normal rTSAs, respectively (P>0.05). Compared to weak rTSAs, weak aTSAs achieved superior postoperative passive (P=0.006) and active external rotation (ER) (P=0.014) but less favorable postoperative Shoulder Pain and Disability Index (P=0.032), American Shoulder and Elbow Surgeons (P=0.024), and University of California, Los Angeles scores (P=0.008). Weak aTSAs achieved the minimal clinically important difference (MCID) and substantial clinical benefit at a lower rate for abduction (P=0.045 and P=0.003) and FE (P=0.011 and P=0.001). Weak aTSAs had a higher revision rate (P=0.025) but a similar complication rate (P=0.291) compared to weak rTSAs. Conclusions: Patients with RCI-GHOA and preoperative FE weakness obtain postoperative outcomes similar to patients with normal preoperative strength after either aTSA or rTSA. Preoperatively, weak aTSAs achieved greater ER but lower rates of clinically relevant improvement in overhead motion compared to weak rTSAs. Level of evidence: III.

Awake Early Manual Reduction Is Highly Effective for Subaxial Cervical Spine Dislocation.

Introduction: Guidelines published in 2013 recommend early closed reduction for cervical spine dislocation. There are two types of closed reduction: manual reduction and traction. Manual reduction can be performed early. In addition, it can correct rotation and requires a short time for complete reduction. We perform manual reduction for cervical spine dislocation. This study aimed to evaluate early manual reduction's success rate and safety for cervical dislocation. We also examined the relationship between time to reduction and improvement in paralysis. Methods: This retrospective cohort study included 361 patients with cervical spine injuries treated at our hospital between July 2010 and December 2021. We assigned patients to the early group if the time from injury to reduction was ≤6 hours and to the late group if >6 hours. We performed awake manual reduction on the patients. Furthermore, we compared reduction's success rate and safety, including neurological outcomes. Results: Overall, 46 patients were included in the study: 31 and 15 in the early and late groups, respectively. The success rate of reduction was 93%, and no neurological complications from reduction were observed. The neurological outcomes and reduction success rates were significantly superior in the early group than in the late group. Conclusions: Neurological outcomes were significantly superior when reduction was performed within 6 hours than after 6 hours. Manual reduction can be performed early, safely, and easily. It is effective for cervical spine dislocation requiring early reduction for an excellent neurologic prognosis.

Effects of Different Test Positions on Quantitative Muscle Strength of Wrist and Finger Flexor Muscle Groups and Its Standardization.

OBJECTIVES: To explore the effects of different test positions on quantitative muscle strength of wrist and finger flexor muscle groups and to establish a standardized muscle strength test protocol for each muscle group. METHODS: Forty healthy subjects (12 males and 28 females) were recruited. A portable digital quantitative muscle strength tester, Micro FET2TM, was used to measure the flexor muscle strength of each finger and the wrist joint at the 30° extension, 0° neutral, and 30° flexion, respectively. Palmar abduction strength of the thumb was measured at 30° and 60°, respectively. Ten subjects were randomly selected from the 40 subjects, and the quantitative muscle strength of each muscle group was tested again by the same operator after an interval of 10 to 15 days. RESULTS: Except for the fact that in males, there was no significant difference in flexor muscle strength of thumb and wrist joint between 30° of wrist extension and neutral 0° position, the muscle strength of the other fingers flexion and wrist palmar flexor showed the following characteristics：30° of wrist extension > neutral 0° position > 30° of flexion, and the PAST was 30°>60°; The flexor muscle strength of all the subjects was thumb > index finger > middle finger > ring finger > little finger; All muscle strength values of male were greater than those of female, and the difference was statistically significant (P<0.05); There was no significant difference between the left and right side muscle strength values of all subjects (P>0.05). The reliability of muscle strength values measured at different times in 10 subjects was good. CONCLUSIONS: The quantitative muscle strength of each muscle group of the hand and wrist is affected by the test position, and a standardized and uniformed test position should be adopted in the actual identification. Micro FET2TM has good reliability for hand and wrist quantitative muscle strength testing. The 30° extension of the wrist can be used as the best standardized test position for the flexion muscle strength of each finger and wrist joint. The 30° position can be used as the best standardized test position for PAST.

Non-absorbable Suture-Loaded Anchors for Finger Pulley Reconstruction.

A 59-year-old woman, who previously underwent surgery on her left long finger A1 pulley and left small finger distal interphalangeal joint for triggering and mallet deformity at another medical facility in March 2021, sought evaluation at an Orthopedics Hand clinic. She presented with limited finger movement, a flexion contracture, and difficulty extending her left long finger. Examination revealed an A2 pulley injury with extensive scar tissue. Subsequently, she underwent surgery to remove the scar tissue and reconstruct the A2 pulley using suture tape anchors. This case highlights the negative outcome following A1 pulley release due to an unintended A2 injury, resulting in significant scarring and an intrinsic plus digit posture. Additionally, it underscores the potential effectiveness of using non-absorbable synthetic sutures to minimize scarring and promote an early range of motion in cases where healing leads to excessive scarring around the flexor tendon sheath.

Critical Examination of Methods to Determine Tibiofemoral Kinematics and Tibial Contact Kinematics Based on Analysis of Fluoroscopic Images.

Goals of knee replacement surgery are to restore function and maximize implant longevity. To determine how well these goals are satisfied, tibial femoral kinematics and tibial contact kinematics are of interest. Tibiofemoral kinematics, which characterize function, is movement between the tibia and femur whereas tibial contact kinematics, which is relevant to implant wear, is movement of the location of contact by the femoral implant on the tibial articular surface. The purposes of this review article are to describe and critique relevant methods to guide correct implementation. For tibiofemoral kinematics, methods are categorized as those which determine (1) relative planar motions and (2) relative three-dimensional (3D) motions. Planar motions are determined by first finding anterior-posterior (A-P) positions of each femoral condyle relative to the tibia and tracking these positions during flexion. Of the lowest point (LP) and flexion facet center (FFC) methods, which are common, the lowest point method is preferred and the reasoning is explained. 3D motions are determined using the joint coordinate system (JCS) of Grood and Suntay. Previous applications of this JCS have resulted in motions which are largely in error due to "kinematic crosstalk." Requirements for minimizing kinematic crosstalk are outlined followed by an example, which demonstrates the method for identifying a JCS that minimizes kinematic crosstalk. Although kinematic crosstalk can be minimized, the need for a JCS to determine 3D motions is questionable based on anatomical constraints, which limit varus-valgus rotation and compression-distraction translation. Methods for analyzing tibial contact kinematics are summarized and validation of methods discussed.

[Incorrectly healed supracondylar humerus fracture : That will grow out later on?!] / Fehlverheilte suprakondyläre Humerusfraktur : Das wächst sich schon noch aus?!

The supracondylar humerus fracture is the most frequent fracture of the elbow region during the growth period. The peak age is around 5 years. Extension fractures predominate. The clinical diagnostics are supplemented by X­ray images in two projections. Growth-associated spontaneous corrections of posttraumatic deformities rarely occur. The goal of treatment is therefore the active transformation of every displaced fracture into a nondisplaced stably fixed fracture.If this is not successful, the consequences of healing in a malalignment can be, e.g., restriction of elbow flexion due to remaining antecurvation or cubitus varus. Combinations are often present. The causes include technical problems with reduction and retention but also misjudgement of the X­ray findings, ignorance of the growth prognosis or inadequate verification of whether the treatment goal has been achieved.Unsatisfactory treatment results should be corrected as early as possible. This can be done primarily before bony healing is completed or secondarily as a corrective osteotomy at any later point in time. The earlier the correction of the malalignment is performed, the greater the chances of a complete restoration to the original condition. Depending on the type and extent of the deformity various techniques for corrective osteotomy are suggested in the literature.

Spinal manipulation and mobilization forces delivered treating sciatica: a case report.

Introduction: Accurately measuring the forces applied during spinal manipulation and its biomechanical effects on the spine are critically important in current research. This single case report discusses the potential benefit of accurately monitoring manipulative forces in treating low back pain with sciatica. The type of force-based spinal manipulation used to manage this case was Cox Technic flexion distraction decompression (CTFDD) spinal manipulation care, along with other ancillary modalities. Methods: The treatment plan, in this case, was primarily force-based CTFDD, equal-force bi-directional traction (EqFT), pre-modulated electrical muscle stimulation (EMS), infrared light therapy (ILT), and a home stretching and strengthening program. Clinical findings: Initially, the case study patient presented with complaints of left lumbar spine pain, which radiated into the left buttock, down the left leg, accompanied by an inability to dorsiflex the left foot. The patient was concerned with this condition as the left leg pain and left lower extremity motor deficit were having a profound effect on the patient's ability to perform activities of daily living and work. The patient was recommended to undergo spinal decompression surgery, which the patient did not want, and elected to exhaust all alternative, non-surgical treatments first. Diagnosis intervention and outcomes: A diagnosis of sciatica with a sequestered disk fragment and left lower extremity motor deficit was rendered through objective physical examination results and a review of a lumbar MRI study. Past interventions included prescription medications, physical rehabilitation, chiropractic, pain management, and neurosurgical consultation. All past interventions prior to initiating CTFDD care provided minimal subjective and/or objective clinical improvement. This patient had a positive clinical outcome from a force-based CTFDD treatment plan along with other modalities consisting of pre-modulated EMS, ILT, and a home stretching and strengthening program. Conclusion: Force-based CTFDD spinal manipulation, along with other modalities consisting of pre-modulated EMS, ILT, and a home stretching and strengthening program, has been found to be an alternative, non-surgical treatment for discogenic sciatica. Continued research is needed on force-based CTFDD spinal manipulation to further evaluate the neurological and biomechanical effects of the forces and motion applied to the spine and determine health benefits for the treatment of low back pain.

Radical Posterior Release for Severe Flexion Contracture of Knee Following Total Knee Arthroplasty: A Case Report.

Introduction: Fixed flexion deformity (FFD) following total knee arthroplasty occurs in approximately 4% of patients undergoing primary total knee arthroplasty. Treatment modalities for significant disabling FFD post-arthroplasty encompass manipulation under anesthesia, osteophyte resection, soft tissue release, peroneal nerve decompression, and revision knee replacement. Case Report: A 43-year-old lady, a known case of rheumatoid arthritis and psoriasis, presented with fixed flexion contracture of the left knee following total knee arthroplasty. The range of motion (ROM) at the left knee was 60°-110°. With the help of the plastic surgery team, the patient underwent an extensive posterior soft tissue release. Intra-operatively, the ROM achieved was 5°-110°. After 3 weeks, the patient was mobilized with full weight bearing with a knee brace. But unfortunately, there was a gradual recurrence of deformity at 3-month follow-up in spite of adequate and aggressive rehabilitation. Conclusion: Patients with FFD for more than 2 years following a total knee arthroplasty may not benefit from extensive radical posterior soft tissue release. Revision knee replacement may be the better option.

Electrophysiological Activity of Multifunctional and Behaviorally Specialized Spinal Neurons Involved in Swimming, Scratching, and Flexion Reflex in Turtles.

The adult turtle spinal cord can generate multiple kinds of limb movements, including swimming, three forms of scratching, and limb withdrawal (flexion reflex), even without brain input and sensory feedback. There are many multifunctional spinal neurons, activated during multiple motor patterns, and some behaviorally specialized neurons, activated during only one. How do multifunctional and behaviorally specialized neurons each contribute to motor output? We analyzed in vivo intracellular recordings of multifunctional and specialized neurons. Neurons tended to spike in the same phase of the hip-flexor (HF) activity cycle during swimming and scratching, though one preferred opposite phases. During both swimming and scratching, a larger fraction of multifunctional neurons than specialized neurons were highly rhythmic. One group of multifunctional neurons was active during the HF-on phase and another during the HF-off phase. Thus, HF-extensor alternation may be generated by a subset of multifunctional spinal neurons during both swimming and scratching. Scratch-specialized neurons and flexion reflex-selective neurons may instead trigger their respective motor patterns, by biasing activity of multifunctional neurons. In phase-averaged membrane potentials of multifunctional neurons, trough phases were more highly correlated between swimming and scratching than peak phases, suggesting that rhythmic inhibition plays a greater role than rhythmic excitation. We also provide the first intracellular recording of a turtle swim-specialized neuron: tonically excited during swimming but inactive during scratching and flexion reflex. It displayed an excitatory postsynaptic potential following each swim-evoking electrical stimulus and thus may be an intermediary between reticulospinal axons and the swimming CPG they activate.