Protocol for strength testing and rehabilitation of the upper extremity.

The development of the upper body table (UBXT) provided trunk and pelvis stabilization, necessary for accurate testing of the strength (and power) of the upper extremity with the Cybex II(R) lsokinetic Dynamometer; however, a standard protocol for set-up and testing did not immediately exist in 1979. During treatment of patients with upper extremity problems, Sportclinic, Providence Medical Center, Seattle, Washington, developed a complete protocol for rehabilitation and testing with the Cybex II and the UBXT, using fast speeds, a 90-foot-pound torque scale, and special adaptations of equipment and procedure. The objectives of the protocol were to increase accuracy in testing and decrease the chance of injury to the patient J Orthop Sports Phys Ther 1983;4(4):229-235.

The relationship of upper extremity strength to throwing speed.

Cybex II Isokinetic Dynamometer (Lumex Corp. Ronkonkoma, NY) tests for the upper extremity strength of eight professional baseball players, together with radar gun measurements of their individual throwing speeds, were subjected to statistical analysis. Results of simple and multiple regression analysis showed a relationship between the strength of the elbow extension and wrist extension movements and throwing speed.

Gait analysis. Alterations in support phase forces using supportive devices.

This study documents changes in momentary distribution of forces under the foot, comparing barefoot gait to that with heel cups, medial arch supports, and low-dye taping. Cholesterol crystal force plate analysis and a computerized Kistler force platform were used in the study. Low-dye taping or a heel cup significantly diminished the duration of forces under the midfoot, medializing the instant center of forces. A medial arch support shifted the instant center of forces laterally, though it did not diminish the duration of forces under the arch. The relationship between these alterations of force distribution and the treatment of common runner's ailments such as plantar fasciitis, posterior tibial tendinitis, metatarsalgia, and shin splints is much clearer in the light of these results.

Transcutaneous oxygen tension measurement in peripheral vascular disease.

To date, results of laboratory and clinical investigations suggest that transcutaneous pO2 measurements hold considerable promise as a technique for evaluating the adequacy of cutaneous circulation. The advantages of this technique are that it is simple to use, noninvasive and does not require the use of radioactive isotopes. Since the available data are, as yet, insufficient to confirm the reliability of this technique, a prospective study of segmental transcutaneous pO2 values in patients with peripheral vascular disease is being continued. These values are then being correlated with the subsequent clinical course.

Waterskiing Injuries.

Although 14 million people water-ski, injury data are sparse and there is disagreement about safety. More detailed and accurate studies are needed so that preventive steps can be taken.

Prevention of thromboembolic disease by external pneumatic compression in patients undergoing total hip arthroplasty.

A prospective study was undertaken in order to test the efficacy of intermittent calf compression for prevention of thromboembolism in patients undergoing total hip arthroplasty. The patients were studied pre- and postoperatively by routine Doppler ultrasound examinations in addition to clinical assessment. Statistically significant evidence substantiates the view that intermittent calf compression decreased the incidence of thr thromboembolic problem.

Instability of the subtalar joint. Diagnosis by stress tomography in three cases.

Lateral instability in the subtalar joint was documented by a method of stress tomography in three patients. The subtalar inversion angle averaged 38 degrees +/- S.D. 6 degrees in asymptomatic feet and 57 degrees +/- S.D. 5 degrees in those with unstable subtalar joints . Review of the literature suggests that as many as 10 per cent of patients having the Watson-Jones procedure for abnormal talar tilt also have instability in the subtalar joint. It is felt that the subtalar joint should be evaluated in patients seen with the clinical symptom of lateral instability.

Controlled environment treatment for limb surgery and trauma (a preliminary report).

This paper demonstrates a new approach to postsurgical and post-traumatic wound management in the lower limbs. Our own results of 20 below-knee amputations are documented. A less detailed report is then given of experience with an additional 20 amputees: this second group includes experience not only here at Seattle but at five other centers in the United States. The same method for wound management and for control of edema was employed in all cases. The method, Controlled Environment Treatment (CET), uses filtered air as a dressing medium, with a control console to maintain the pressure, constant or varying, according to a preset program. Temperature and humidity are also controllable, as is gas composition. The limb, together with its controlled environment, is contained with a pliable, transparent, treatment bag, which permits inspection and palpation of the wound site without disturbing the bacteriologically sterile air within the chamber. A special seal reduces air leakage yet avoids constriction of the limb. This CET system was originally developed by the Department of Health and Social Security, Biomechanical Research and Development Unit, Roehampton, England. Subsequent developments are also noted of an improved Mark II CET Unit and of simpler, related, management systems for conditions not requiring sterile environments.

The radiology of the subtalar joint with special reference to talo-calcaneal coalition.

Congenital talo-calcaneal coalition is one of the conditions responsible for spastic flat foot. The common site is across the middle talo-calcaneal joint, and although routine radiographic views of the foot do not show the coalition, important secondary signs may be present. The findings in 17 cases are reviewed, the following secondary signs being recognised: 1. A talar beak. 2. Narrowing of the posterior talo-calcaneal joint space. 3. Rounding of the lateral process of the talus. 4. Failure of visualisation of the middle subtalar joint in the lateral view, and 5. Asymmetry of the anterior subtalar joints in the lateral oblique vies. The differential diagnosis of these signs is discussed and the normal anatomy of the subtalar joints is illustrated. Some diagnostic pitfalls are described.