Ultrasound-guided corticosteroid injection in the coracohumeral ligament in patients with Adhesive Capsulitis of the shoulder: A double-blinded, sham-controlled randomized study.

BACKGROUND: Contracture and thickening of the coracohumeral ligament (CHL) occur in patients with adhesive capsulitis. This adversely affects the movement and function of the shoulder joint. There is limited evidence that explores the effectiveness of an isolated steroid injection into CHL in combination with physical therapy. This prospective randomized control trial aimed to evaluate the clinical effects of ultrasound-guided corticosteroid injection compared to a sham injection into the CHL in subjects with adhesive capsulitis. METHODS: Forty patients (23 males, 52.2 ± 8 years of age) with unilateral adhesive capsulitis (with 5.4 ± 2 months mean duration of symptoms) were randomly assigned to either the experimental or control group. Both groups received ultrasound-guided injections into the CHL. The experimental group (n=20) received corticosteroids and the control group (n=20) received a sham lidocaine injection. All subjects underwent supervised conventional physical therapy three times a week for 3 months. Subjects were evaluated for improvements in pain, range of motion, and disability at 6 and 12 weeks as compared to pre-injection baseline measurements. Data were compared statistically across groups and times at p<0.05. The CHL thickness was compared at baseline across sides using paired t-tests. RESULTS: The experimental group showed statistically greater improvements in pain, functional scores, flexion, abduction, internal and external rotation range of motion at 12 weeks compared to the control group. Pain reduction was observed in both groups at 6 and 12 weeks, but the experimental group exhibited significantly greater reductions. The CHL was significantly thicker on the affected side as compared to the unaffected side (p<0.001). DISCUSSION AND CONCLUSION: This study partially supported the hypothesis. Notably, significant improvements in pain, range of motion, and functional scores were observed at 12 weeks in the experimental group. The greater improvements in pain and external rotation may have resulted in lower disability scores in the experimental group. The results emphasize the importance of targeted intervention into the CHL.

A Sonomyography-Based Muscle Computer Interface for Individuals With Spinal Cord Injury.

Impairment of hand functions in individuals with spinal cord injury (SCI) severely disrupts activities of daily living. Recent advances have enabled rehabilitation assisted by robotic devices to augment the residual function of the muscles. Traditionally, electromyography-based muscle activity sensing interfaces have been utilized to sense volitional motor intent to drive robotic assistive devices. However, the dexterity and fidelity of control that can be achieved with electromyography-based control have been limited due to inherent limitations in signal quality. We have developed and tested a muscle-computer interface (MCI) utilizing sonomyography to provide control of a virtual cursor for individuals with motor-incomplete spinal cord injury. We demonstrate that individuals with SCI successfully gained control of a virtual cursor by utilizing contractions of muscles of the wrist joint. The sonomyography-based interface enabled control of the cursor at multiple graded levels demonstrating the ability to achieve accurate and stable endpoint control. Our sonomyography-based muscle-computer interface can enable dexterous control of upper-extremity assistive devices for individuals with motor-incomplete SCI.

Radiographic Analysis of the Sagittal Alignment of Spine and Pelvis in Asymptomatic Indian Population.

STUDY DESIGN: This is a descriptive observational study. PURPOSE: The objective of this study is to analyze and document the sagittal alignment of the spine and pelvis in normal Indian adult volunteers and compare these parameters with the study population of other races and ethnicities. OVERVIEW OF LITERATURE: Given the importance of the spinopelvic parameters, there is a need to describe the parameters differentially in relation to the ethnicity of the studied individual. Very few reports have defined the normal physiological value. Ethnic differences are a significant factor not only when describing the anthropometric data but also when applying the findings to a different ethnic group. We have compared these values with other races and ethnicities so that we can know whether the principles of spinal fixation can be applied globally. METHODS: In total, 100 participants were studied by using their anteroposterior and lateral radiographic images of whole of pelvic and spinal area. Additionally, various spinal and pelvic parameters were also measured. Subsequently, the outcomes were analyzed with respect to age, sex, and body mass index (BMI). The correlation between different parameters and differences in these parameters between Indians and other races/ethnicities along with population groups were also analyzed. RESULTS: There was a significant increase in thoracic kyphosis (TK) from T1-T12 and T4-T12 with increasing age. Lumbar lordosis (LL), sacral translation (sagittal vertical axis), and pelvic tilt were significantly higher among females. Additionally, sacral slope (SS), pelvic incidence, C7 sagittal offset, and T9 sagittal offset were also higher in females. TK (T4-T12 and T1-T12), LL, SS, and pelvic incidence showed a significant correlation with BMI. As compared to European population, TK, segmental LL, and sacral translation were found to be significantly lesser in Indian population. CONCLUSIONS: There is a statistically significant difference between Indians and other races/ethnicities and population groups with respect to TK, LL, and sacral translation. The values obtained can be considered as the physiological normal values for Indian population. Importantly, these values can serve as the reference values for future studies.

Computed Tomography-Based Feasibility Study of C1 Posterior Arch Crisscrossing Screw Fixation.

STUDY DESIGN: Retrospective radiographic analysis. PURPOSE: Posterior fixation of C1 using screws is the most popular technique among the various methods for C1 stabilization, but it places the surrounding neurovascular structures at risk. Approximately 20% of the population has an anomalous groove for the vertebral artery; therefore, salvage methods are necessary. Therefore, we analyzed the feasibility of a newer C1 posterior arch crisscrossing screw fixation technique and studied its feasibility in the Indian population on the basis of the anatomy of the C1 posterior arch. OVERVIEW OF LITERATURE: Multiple techniques have been described for C1-C2 fixation, such as wiring techniques, interlaminar clamps, transarticular screws, screw-plate/screw-rod system fixation, and hook-screw system fixation techniques, to provide rigid C1-C2 stability. However, although C1 fixation has evolved with time, it is not complication-free. METHODS: A 100 computed tomography (CT) scans of cervical spines with 1 mm slice thickness in the axial and sagittal sections obtained were randomly selected for the evaluation. Atlantoaxial anomalies due to trauma, deformities, infections, and tumors were excluded. All the images were measured for height of the posterior tubercle, width of the posterior arch, and length of the screw, and the screw projection angle was calculated. Demographic data were collected for all the subjects. RESULTS: Out of the 88 CT scans analyzed, the mean height of the posterior tubercle was 7.4 mm, wherein 84.09% exceeded 7 mm, and the width of the posterior tubercle was 5.4 mm, wherein 88.6% (n=78) had posterior arch width >3.5 mm. A total of 13.6% (n=12) vertebrae were not suitable for screw placement, whereas 75% (n=66) vertebrae could accommodate 3.5×15 mm or longer screws. The screw projection angles ranged from 11.2° to 35° on the right and from 15.6° to 38.2° on the left. CONCLUSIONS: C1 posterior arch screw fixation is a feasible and safe method because it poses little risk of injury to the surrounding neurovascular structures.