The Acute Effect of Percussive Massage Intervention with and without Heat Application on Plantar Flexor Muscles' Passive and Active Properties.

Recently, percussive massage (PM) intervention using a handheld percussive massage device, namely a massage gun, has been used as an easy way to perform vibration functions. Additionally, a product has been developed that allows PM intervention and heat application to be performed simultaneously. Thus, this study aimed to compare the acute effects of PM intervention with and without heat application on dorsiflexion (DF) range of motion (ROM), passive stiffness, and muscle strength in the gastrocnemius muscle. Fifteen healthy young men (20.9 ± 0.2 years) participated in this study. We measured the DF ROM, passive torque at DF ROM (an indicator of stretch tolerance), passive stiffness, and maximum voluntary isometric contraction (MVIC) torque of the plantar flexor muscles before and immediately after 120 seconds PM intervention with and without heat application. The results showed that PM intervention with and without heat application significantly increased DF ROM and passive torque at DF ROM and decreased passive stiffness, not MVIC torque. These results suggest that PM intervention increased ROM and decreased passive stiffness regardless of the presence or absence of the heat application.

Effect of the post-learning period on the accuracy and self-efficacy of measuring the joint range of motion.

[Purpose] To verify the effects of the differences in the post-learning period on the accuracy and self-efficacy of measuring the range of passive flexion of the knee and elbow of students. [Participants and Methods] Thirty-six physical therapy students were classified into three groups (short-term, medium-term, and long-term) based on the interval since learning to measure the range of motion. Participants were asked to self-evaluate their efficacy in appropriately measuring the range of motion for knee and elbow flexion using a 10-point Likert scale. Subsequently, the flexion range of the left knee and elbow was measured using a universal goniometer and compared to the measurements obtained using an electronic accelerometer. [Results] Absolute errors in measuring knee flexion were significantly smaller in the medium- and long-term groups than in the short-term group. No other significant main effects or correlations were observed. [Conclusion] Although the accuracy of measuring the range of motion by students improved while they were in school, it did not improve sufficiently based on the joint being assessed. Furthermore, the post-learning period did not affect a student's self-efficacy for measuring the range of motion and did not reflect its accuracy.

Effects of elevation on shoulder joint motion: comparison of dynamic and static conditions.

BACKGROUND: Although visual examination and palpation are used to assess shoulder motion in clinical practice, there is no consensus on shoulder motion under dynamic and static conditions. This study aimed to compare shoulder joint motion under dynamic and static conditions. METHODS: The dominant arm of 14 healthy adult males was investigated. Electromagnetic sensors attached to the scapular, thorax, and humerus were used to measure three-dimensional shoulder joint motion under dynamic and static elevation conditions and compare scapular upward rotation and glenohumeral joint elevation in different elevation planes and angles. RESULTS: At 120° of elevation in the scapular and coronal planes, the scapular upward rotation angle was higher in the static condition and the glenohumeral joint elevation angle was higher in the dynamic condition (P<0.05). In scapular plane and coronal plane elevation 90°- 120°, the angular change in scapular upward rotation was higher in the static condition and the angular change in scapulohumeral joint elevation was higher in the dynamic condition (P<0.05). No differences were found in shoulder joint motion in the sagittal plane elevation between the dynamic and static conditions. No interaction effects were found between elevation condition and elevation angle in all elevation planes. CONCLUSIONS: Differences in shoulder joint motion should be noted when assessing shoulder joint motion in different dynamic and static conditions. Level of evidence: Level III, diagnostic cross-sectional study.

Mechanisms of Neuropathic Pain and Pain-Relieving Effects of Exercise Therapy in a Rat Neuropathic Pain Model.

Purpose: Pain disrupts the daily and social lives of patients with neuropathic pain. Effective treatment of neuropathic pain is difficult. Pharmacological treatments for neuropathic pain are limited, and 40-60% of patients do not achieve even partial relief of their pain. This study created a chronic constriction injury (CCI) model in rats to examine the effects of regular exercise on neuropathic pain relief, elucidate the mechanism, and determine the effects of neuropathic pain in the hippocampus. Methods: CCI model rats were randomly divided into exercise (Ex) and no exercise (No-Ex) groups. Normal rats (Normal group) were used as controls. The Ex group exercised on a treadmill at 20 m/min for 30 min, 5 days per week for 5 weeks post-CCI. The 50% pain response threshold was assessed by mechanical stimulation. Using immunohistochemistry, we examined activation of glial cells (microglia and astrocytes) by CCR2 and TRAF6 expression in the spinal cord dorsal horn and DCX and PROX1 expression in the hippocampal dentate gyrus. Results: The 50% pain response threshold was significantly lower in the Ex than in the No-Ex group at 5 weeks post-CCI, indicating pain relief. In the spinal cord dorsal horn, IBA1, CCR2, and TRAF6 expression was markedly lower in the Ex group than in the No-Ex group at 3 weeks post-CCI. IBA1, GFAP, CCR2, and TRAF6 expression was markedly lower in the Ex group than in the No-Ex group at 5 weeks post-CCI. In the hippocampus, DCX, but not PROX1, expression was significantly higher in the Ex group than in the No-Ex group at 3 weeks post-CCI. At 5 weeks post-CCI, both DCX and PROX1 expression was markedly increased in the Ex group compared to the No-Ex group. Conclusion: Our findings suggest that regular exercise can improve the neuropathic pain-induced neurogenic dysfunction in the hippocampal dentate gyrus.

Clinical outcome in patients with hand lesions associated with complex regional pain syndrome after arthroscopic rotator cuff repair.

BACKGROUND: Complex regional pain syndrome (CRPS)-related hand lesions are one of the complications following arthroscopic rotator cuff repair (ARCR). This study aimed to investigate the clinical outcomes of patients with CRPS-related hand lesions following ARCR. METHODS: Altogether, 103 patients with ARCR were included in this study (mean age, 63.6±8.2 years; 66 males and 37 females; follow-up period, preoperative to 12 months postoperative). Clinical assessment included the Japanese Orthopaedic Association (JOA) score, University of California, Los Angeles (UCLA) score, Constant score, 36-item short form health survey (SF-36) score, and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score from preoperative to 12 months postoperatively. The patients were either assigned to the CRPS group or non-CRPS group depending on CRPS diagnosis until the final follow-up, and clinical outcomes were then compared between the groups. RESULTS: Of 103 patients, 20 (19.4%) had CRPS-related hand lesions that developed entirely within 2 months postoperatively. Both groups showed significant improvement in JOA, UCLA, and Constant scores preoperatively to 12 months postoperatively (P<0.001). Comparisons between the two groups were not significantly different, except for SF-36 "general health perception" (P<0.05) at 12 months postoperatively. At final follow-up, three patients had residual CRPS-related hand lesions with limited range of motion and finger edema. CONCLUSIONS: CRPS-related hand lesions developed in 19.4% of patients following ARCR. Shoulder or upper-limb function improved in most cases at 12 months, with satisfactory SF-36 patient-based evaluation results. Patients with residual CRPS-related hand lesions at the last follow-up require long-term follow-up.

Combination of risk factors affecting retear after arthroscopic rotator cuff repair: a decision tree analysis.

BACKGROUND: Several risk factors for postoperative retear after arthroscopic rotator cuff repair (ARCR) have been cited in a large number of reports; various combinations of these seem to be present in the clinical setting. PURPOSE: Using a combination model for decision tree analysis, we aimed to investigate the combination of risk factors that affect postoperative retear the most. METHODS: A total of 286 patients who underwent magnetic resonance (MR) imaging at 6 months after surgery were included in this study. Based on the structural integrity of the MR images taken 6 months after surgery, the patients were divided into a healed group (intact tendon, 254 patients) and a retear group (ruptured tendon, 32 patients). Using univariate and decision tree analyses, we selected a combination of 11 risk factors that drastically affected postoperative retear. RESULTS: The mean age was 64.9 ± 7.1 years, and the mean symptom duration was 9.7 ± 11.6 months. The tear was small/medium in 177 patients and large/massive in 109 patients. The technique for surgical repair was single row in 42 patients, double row in 60 patients, and suture bridging in 216 patients. On univariate analysis, both groups had significant differences in the anteroposterior (AP) tear size (P < .0001), mediolateral tear size (P < .0001), hyperlipidemia (P = .0178), global fatty degeneration index (P < .0001), supraspinatus fatty degeneration stage (P < .0001), and critical shoulder angle (CSA) (P = .0015). All of these 5 risk factors, except for mediolateral tear size, were selected as candidates for the decision tree analysis. Eight combination patterns were determined to have prediction probabilities that ranged from 4.3% to 86.1%. In particular, the combination of an AP tear size of ≥40 mm, hyperlipidemia, and a CSA of ≥37° affected retear after ARCR the most. CONCLUSIONS: Decision tree analysis lead to the extraction of different retear factor combinations, which were divided into 5 retear groups. The worst combination was of AP tear size ≥40 mm, hyperlipidemia, and CSA ≥37°, and the prediction probability of this combination was 86.2%. Therefore, our data may offer a new index for the prediction of retear after ARCR.

Clinical results of conservative management in patients with full-thickness rotator cuff tear: a meta-analysis.

BACKGROUND: Several systematic reviews have reported on the conservative treatment of full-thickness rotator cuff tears; however, clinical results of this treatment still remain determined. METHODS: PubMed, Cochrane Library, PEDro, and CINAHL databases were systematically searched for randomized clinical trials and observational studies. Two independent researchers reviewed a total of 2,981 articles, 28 of which met the criteria for inclusion in the study. Clinical outcome measures included Constant score, visual analog scale score for pain, range of motion, and short-form 36 questionnaires. The meta-analysis used a linear mixed model weighted with the variance of the estimate. RESULTS: The meta-analysis showed a significant improvement after surgery. Pain score is 26.2 mm (1 month) to 26.4 mm (3 months), and 24.8 mm (12 months) (P<0.05); active abduction: 153.2º (2 months), 159.0º (6 months), 168.1º (12 months) (P<0.05); Constant score: 67.8 points (2 months) to 77.2 points (12 months) (P<0.05); short-form 36 questionnaires "vitality" section: 57.0 points (6 months) to 70.0 points (12 months) (P<0.05). CONCLUSIONS: Our data confirmed the effectiveness of conservative treatment in patients with full-thickness rotator cuff tears 12 months post-intervention. The results suggest that conservative treatment for patients with full-thickness rotator cuff tears should be the first line of treatment before considering surgery.

Usefulness of Shoulder36 in rotator cuff tears: Comparison with Simple Shoulder Test.

BACKGROUND: In patients with rotator cuff tears, Shoulder36 (Sh36) was compared to the Simple Shoulder Test (SST) to determine a broader use of Sh36 worldwide. METHODS: Sh36, SST, "Constant score," and the Japanese Orthopaedic Association score (JOA) were used to evaluate 230 patients (male, 116; female, 114) during the first visit, analyzed by staff blinded to the study. Pearson's correlation coefficient was used for the statistical analysis. RESULTS: The correlation coefficient between the Constant score and each domain in Sh36 was as follows: r = 0.68 (vs. pain, p < 0.01); r = 0.69 (vs. range of motion, p < 0.01); r = 0.74 (vs. muscle strength, p < 0.01); r = 0.62 (vs. general health, p < 0.01); r = 0.66 (vs. ability of daily living, p < 0.01); and r = 0.65 (vs. ability for sports, p < 0.01). The correlation coefficient between the JOA and each domain in Sh36 was as follows: r = 0.76 (vs. pain, p < 0.01); r = 0.73 (vs. range of motion, p < 0.01); r = 0.78 (vs. muscle strength, p < 0.01); r = 0.68 (vs. general health, p < 0.01); r = 0.71 (vs. ability of daily living, p < 0.01); and r = 0.70 (vs. ability for sports, p < 0.01). The correlation coefficient between the SST and each domain in Sh36 was as follows: r = 0.73 (vs. pain, p < 0.01); r = 0.70 (vs. range of motion, p < 0.01); r = 0.75 (vs. muscle strength, p < 0.01); r = 0.67 (vs. general health, p < 0.01); r = 0.69 (vs. ability of daily living, p < 0.01); and r = 0.64 (vs. ability for sports, p < 0.01). CONCLUSION: A strong association exists between the SST and each domain in the Sh36, in patients with rotator cuff tears ( r = 0.64-0.73), suggesting the usefulness of Sh36 for patient-based scoring.

Factors Affecting Return to Work in Patients Undergoing Arthroscopic Rotator Cuff Repair.

OBJECTIVE: Although clinical outcomes after arthroscopic rotator cuff repair are generally favorable, postoperative return to work is also an important issue. This study aimed to assess clinical outcomes and clarify the factors affecting return to work in patients who had undergone arthroscopic rotator cuff repair. METHODS: In total, 63 patients who had undergone arthroscopic rotator cuff repair were included in this study. Clinical assessment was performed using Japanese Orthopaedic Association (JOA) scores, along with measurements of pain, range of motion, muscle strength, cuff integrity, and fatty infiltration. Depending on their return-to-work status at the final follow-up, subjects were assigned to either the complete return group (the patient returned to work) or the incomplete return group (the patient had quit or had changed their occupation at final follow-up). Various clinical parameters affecting the return to work outcome were examined through univariate and multivariate analyses. RESULTS: Of the 63 subjects, 42 belonged to the complete return group and 21 belonged to the incomplete return group. Therefore, the working capability recovery rate following arthroscopic rotator cuff repair was 66.7%. Both groups showed significant improvement from their preoperative status, but there were statistically significant differences in JOA scores between the groups at 9 and 12 months postoperatively (P <0.01). Multivariate stepwise logistic regression analysis showed that heavy work and female sex were significantly adversely associated with return to work (P <0.05). CONCLUSION: The working capability recovery rate following arthroscopic rotator cuff repair was 66.7%, and the preoperative factors affecting recovery of working capability were heavy work and female sex.

Hand lesion after arthroscopic rotator cuff repair: Association with complex regional pain syndrome.

BACKGROUND: It is known that complex regional pain syndrome (CRPS) occurs after arthroscopic rotator cuff repair (ARCR); however, few studies have investigated this complication. Therefore, the purpose of the present study was to evaluate CRPS after ARCR. METHODS: A total of 182 patients who underwent ARCR were enrolled in this study. The average age of patients was 62.8 ± 10.0 years, with an average follow-up period of 21.5 ± 38.1 months. CRPS criteria outlined by the Ministry of Health, Labor, and Welfare study team for CRPS in Japan (MHLWJ) and International Association for the Study of Pain (IASP 2005) were utilized for diagnosis. There are two rating systems for the "clinical purpose" and "research purpose" in both criteria, respectively. Clinical outcomes, including Japanese Orthopedic Association (JOA) and University of California, Los Angeles scores, were evaluated using univariate and multivariate analysis. RESULTS: CRPS exclusively occurred in the hand of the operated limb, developing within 3 months of surgery. Two or more of the following symptoms were noted in patients with the hand lesion associated with CRPS: edema (93.4%), restricted range of motion (83.4%), hyperalgesia (30.1%), paridrosis (20.4%), and atrophic change (12.2%). Under these conditions, the incidences of CRPS were 24.2% (44/182) when evaluated by the MHLWJ rating system for the "clinical purpose;" 11% (22/182) by the MHLWJ rating system for the "research purpose;" 6% (11/182) by the IASP 2005 for the "clinical purpose;" and 0.5% (1/182) by the IASP 2005 for the "research purpose." Results of multivariate analysis demonstrated that "Function" in the JOA score was a risk factor for the development of CRPS after ARCR, when evaluated by a system for the "clinical purpose" of the MHLWJ. CONCLUSION: Following ARCR, CRPS-induced hand lesions occur more frequently than is generally believed, thereby suggesting that its impact on surgical outcomes should be clarified in the future.

Influence of Brassiere Wearing on Shoulder Kinematics.

OBJECTIVE: Gender differences in scapular kinematics during arm elevation have been reported. Because women wear brassieres (bras) daily, their scapular motion may be restricted by the garment; however, the influence of bra wearing on this motion has not been reported. Therefore, using a three-dimensional electromagnetic tracking device, we investigated the influence of bra wearing on shoulder kinematics during arm elevation. METHODS: The subjects were 19 healthy women, and the shoulder on the dominant side was evaluated. Subjects performed scapular plane arm elevation while wearing or not wearing bras. Kinematic data were recorded using an electromagnetic tracking device. The glenohumeral elevation angle, scapular upward and internal rotation angles, and the posterior tilt angle were determined from the recorded data. The angles were calculated at 20°-120° arm elevation, and the data were compared between the two conditions. RESULTS: The scapular upward and internal rotation angles and the posterior tilt angle were significantly smaller with the subjects wearing bras than not wearing bras. In contrast, the glenohumeral elevation angle was significantly greater when bras were warn. CONCLUSIONS: Bra wearing may influence shoulder kinematics. Consequently, great care should be taken to account for this factor during the evaluation of kinematics in female subjects.

Cut-off values of the Japanese Orthopaedic Association score corresponding to Constant scores for evaluating outcomes in rotator cuff tear.

PURPOSE: To clarify the cut-off value of the Japanese Orthopaedic Association (JOA) score corresponding to rotator cuff tear outcome as evaluated by the Constant score. METHODS: The subjects were 230 patients with rotator cuff tear. The Constant and JOA scores on the first examination in our hospital were evaluated. After investigation of the correlation between the Constant and JOA scores, the cut-off JOA score was calculated, corresponding to excellent, good and fair outcomes as evaluated by the Constant score. RESULTS: The Constant and JOA scores on the first examination were 49.64 ± 12.84 and 72.52 ± 12.84, respectively, with a strong correlation ( r = 0.87, p < 0.01). Receiver operating characteristic analysis revealed that the cut-off JOA score was 87.0 for excellent outcome (area under the curve, AUC: 0.93; sensitivity: 100%; specificity: 88.6%; p < 0.01), 84.0 for good outcome (AUC: 0.94; sensitivity: 100%; specificity: 83.4%; p < 0.01) and 78.0 for fair outcome (AUC: 0.88; sensitivity: 100%; specificity: 71.3%; p < 0.01). CONCLUSIONS: In patients with rotator cuff tear, good outcome as judged by a Constant score of ≥80 corresponds to a JOA score cut-off of 84.0. Judgement of the treatment outcomes and evaluation of the surgical method may be more accurate when using clear cut-off values for the scoring system employed, such as those determined in our study.

Cutoff value of Japanese Orthopaedic Association shoulder score in patients with rotator cuff repair: Based on the University of California at Los Angeles shoulder score.

BACKGROUND: The Japanese Orthopaedic Association shoulder score cutoff values were calculated in patients with rotator cuff repair using the University of California at Los Angeles shoulder score. METHODS: Overall, 175 patients with rotator cuff repair were subjects in this study. The University of California at Los Angeles and Japanese Orthopaedic Association shoulder scores were evaluated before surgery and at 3, 6, 9, and 12 months after surgery. The cutoff value of the Japanese Orthopaedic Association shoulder score was determined using the 4-stage criteria of the University of California at Los Angeles shoulder score and a University of California at Los Angeles shoulder score of 28 points, which is the boundary between an excellent/good group and a fair/poor group. RESULTS: Both the JOA shoulder and UCLA shoulder scores showed significant improvement at 6, 9, and 12 months from the preoperative scores (p < 0.0001). There was a strong correlation between the total values of the two scores (r = 0.85, p < 0.0001). The cutoff value of the Japanese Orthopaedic Association shoulder score based on the highest accuracy from receiver operating characteristic curve analysis was 83 points. CONCLUSION: A Japanese Orthopaedic Association shoulder score cutoff value of 83 was equivalent to a University of California at Los Angeles shoulder score cutoff value of 28 for distinguishing between excellent/good and fair/poor outcomes after rotator cuff repair.