¿Efectividad de la técnica de liberación miofacial en el aumento del rango articular en restricción glenohumeral? Una comparación con la kinesioterapia tradicional / Effectiveness of the myofascial release technique in increasing joint range in glenohumeral restriction? A comparison with traditional kinesiotherapy

OBJETIVO: comparar la kinesioterapia tradicional con la técnica miofacial en pacientes con restricción articular interna glenohumeral. MÉTODO: estudio comparativo de 8 pacientes en un grupo de intervención (GI) y kinésico (GC), durante 8 semanas. Se comparó el pre y post test del ROM interno glenohumeral en ambos grupos mediante t de student. RESULTADOS: el grupo de la técnica miofascial demostró una amento significativo de ROM interno glenohumeral de 15,2º (p < 0,001), mientras que el grupo control no fue significativo (p > 0,05) sólo de de 6,4º. CONCLUSIONES:Un tratamiento de terapia con la Técnicas Liberación Miofascial en pacientes con déficit rotacional interno de hombro es más eficaz para aumentar el rango de movimiento articular de rotación interna glenohumeral que una técnica tradicional y conservadora.

OBJETIVE: to compare traditional kinesiotherapy with myofacial technique in patients with glenohumeral internal joint restriction. METHODS: comparative study of 8 patients in an intervention (IG) and kinesiotherapy (CG) group for 8 weeks. The pre- and post-test of glenohumeral internal ROM in both groups was compared using Student's t-test. RESULTS: the myofascial technique group showed a significant increase in glenohumeral internal ROM of 15.2º (p < 0.001), while the control group was not significant (p > 0.05) only 6.4º. CONCLUSIONS: A therapy treatment with Myofascial Release Techniques in patients with shoulder internal rotational deficit is more effective in increasing glenohumeral internal rotational joint range of motion than a traditional, conservative technique.

Arthroscopic tibiotalocalcaneal arthrodesis. Technique, indications and results / Panartrodesis artroscópica de tobillo. Indicaciones, técnica y resultados

Background: Arthroscopic tibiotalocalcaneal arthrodesis with a retrograde nail is performed as a minimally invasive technique in patients without improvement in conservative treatment of osteoarthritis. Complications and hospital stay after surgery are less using this technique when they are compared with open ones. Materials and methods: We review retrospectively from 2016 to 2019 seven patients subjected to a posterior arthroscopic tibiotalocalcaneal arthrodesis with a retrograde intramedullary nail. AOFAS scale was used to assess functional results and we collected other data as complications, time required for bony union, time of nonweight-bearing and scale of satisfaction. We also made a description of the technique we performed. Results: The mean hospital stay was 3.43±0.53 days, patients have well functional results and complications were very low. It was noticed tibiotalar bony union in about 86% of patients 10 weeks after surgery and subtalar bony union in about 71% 20 weeks after surgery. Nonweight-bearing was made using a cast for 4 weeks and later, it was changed for Walker allowing patients partial weight-bearing until 10 weeks after surgery. One patient had wound complications and he needed later surgery and another presented tibiotalar pseudoarthrosis, although without symptoms. Conclusion: Posterior arthroscopic tibiotalocalcaneal arthrodesis offers very good results with a high rate of bony union, few complications, and minimal nonweight-bearing time. This technique could be used in patients without major deformities, especially in those at high risk of complications from the surgical wound.(AU)

Antecedentes: La artrodesis tibiotalocalcánea artroscópica con clavo retrógrado es una técnica mínimamente invasiva que se realiza en pacientes con artrosis que no mejoran con tratamiento conservador. La ventaja de esta técnica es su menor estancia hospitalaria y su menor tasa de complicaciones respecto a técnicas abiertas. Materiales y métodos: Se realiza un estudio retrospectivo descriptivo de los 7 pacientes intervenidos entre 2016-2019 de artrodesis tibiotalocalcánea artroscópica por vía posterior con clavo retrógrado en nuestro hospital. En él se analizan los datos de funcionalidad con la escala AOFAS, grado de satisfacción, tiempo de consolidación, de descarga y complicaciones. Además, se realiza una descripción de la técnica quirúrgica empleada. Resultados: Se observó una estancia hospitalaria de 3,43±0,53 días de media, buena funcionalidad y baja tasa de complicaciones. Obtuvimos consolidación tibiotalar en el 86% de los casos en aproximadamente 10 semanas y una consolidación subtalar en el 71% en 20 semanas. El tiempo de descarga fue de 4 semanas con férula y posteriormente carga parcial con Walker hasta la décima semana postoperatoria. Uno de los casos tuvo que ser reintervenido por complicaciones en la herida quirúrgica y otro presentó seudoartrosis tibiotalar, aunque sin repercusión clínica. Conclusión: La panartrodesis artroscópica por vía posterior ofrece muy buenos resultados, con elevada tasa de consolidación ósea, pocas complicaciones y tiempo de descarga mínimo. Esta técnica podría ser utilizada en pacientes sin grandes deformidades, sobre todo en aquellos con alto riesgo de complicaciones de la herida quirúrgica, al constatarse un descenso de las mismas.(AU)

Panartrodesis artroscópica de tobillo. Indicaciones, técnica y resultados / Arthroscopic tibiotalocalcaneal arthrodesis. Technique, indications and results

Antecedentes: La artrodesis tibiotalocalcánea artroscópica con clavo retrógrado es una técnica mínimamente invasiva que se realiza en pacientes con artrosis que no mejoran con tratamiento conservador. La ventaja de esta técnica es su menor estancia hospitalaria y su menor tasa de complicaciones respecto a técnicas abiertas. Materiales y métodos: Se realiza un estudio retrospectivo descriptivo de los 7 pacientes intervenidos entre 2016-2019 de artrodesis tibiotalocalcánea artroscópica por vía posterior con clavo retrógrado en nuestro hospital. En él se analizan los datos de funcionalidad con la escala AOFAS, grado de satisfacción, tiempo de consolidación, de descarga y complicaciones. Además, se realiza una descripción de la técnica quirúrgica empleada. Resultados: Se observó una estancia hospitalaria de 3,43±0,53 días de media, buena funcionalidad y baja tasa de complicaciones. Obtuvimos consolidación tibiotalar en el 86% de los casos en aproximadamente 10 semanas y una consolidación subtalar en el 71% en 20 semanas. El tiempo de descarga fue de 4 semanas con férula y posteriormente carga parcial con Walker hasta la décima semana postoperatoria. Uno de los casos tuvo que ser reintervenido por complicaciones en la herida quirúrgica y otro presentó seudoartrosis tibiotalar, aunque sin repercusión clínica. Conclusión: La panartrodesis artroscópica por vía posterior ofrece muy buenos resultados, con elevada tasa de consolidación ósea, pocas complicaciones y tiempo de descarga mínimo. Esta técnica podría ser utilizada en pacientes sin grandes deformidades, sobre todo en aquellos con alto riesgo de complicaciones de la herida quirúrgica, al constatarse un descenso de las mismas.(AU)

Background: Arthroscopic tibiotalocalcaneal arthrodesis with a retrograde nail is performed as a minimally invasive technique in patients without improvement in conservative treatment of osteoarthritis. Complications and hospital stay after surgery are less using this technique when they are compared with open ones. Materials and methods: We review retrospectively from 2016 to 2019 seven patients subjected to a posterior arthroscopic tibiotalocalcaneal arthrodesis with a retrograde intramedullary nail. AOFAS scale was used to assess functional results and we collected other data as complications, time required for bony union, time of nonweight-bearing and scale of satisfaction. We also made a description of the technique we performed. Results: The mean hospital stay was 3.43±0.53 days, patients have well functional results and complications were very low. It was noticed tibiotalar bony union in about 86% of patients 10 weeks after surgery and subtalar bony union in about 71% 20 weeks after surgery. Nonweight-bearing was made using a cast for 4 weeks and later, it was changed for Walker allowing patients partial weight-bearing until 10 weeks after surgery. One patient had wound complications and he needed later surgery and another presented tibiotalar pseudoarthrosis, although without symptoms. Conclusion: Posterior arthroscopic tibiotalocalcaneal arthrodesis offers very good results with a high rate of bony union, few complications, and minimal nonweight-bearing time. This technique could be used in patients without major deformities, especially in those at high risk of complications from the surgical wound.(AU)

Evaluación de resultados del tratamiento aplicado a adultos mayores con entidades del SOMA en Sala de Rehabilitación Integral / Evaluation of the results of the treatment applied to older adults with OMAS entities in the Comprehensive Rehabilitation Room

RESUMEN Introducción: el paciente anciano está expuesto a múltiples problemáticas con el envejecimiento que van a condicionar en gran manera su independencia y que de forma obligatoria hay que conocer y tratar de solucionar. Objetivo: evaluar el resultado del tratamiento aplicado a adultos mayores con entidades del sistema osteomioarticular en sala de rehabilitación integral. Materiales y Métodos: se realizó un estudio observacional, descriptivo, de tipo longitudinal de los todos los pacientes de 60 y más años, que acudieron al Centro de rehabilitación integral, quedando la muestra constituida por 920 pacientes tratados en el período comprendido entre enero y diciembre de 2007 con enfermedades del Soma. Resultados: predominó el sexo femenino (59 %) en el grupo de edades de 60 a 69 años (48%). Las afecciones ortopédicas fueron las más frecuentes con el 64 % y dentro de estas, la periartritis escapulo humeral. La electroterapia fue el tratamiento más utilizado (38,4%) de los casos. Dentro de los síntomas que presentaron estos pacientes el que más frecuente se encontró fue el de alteraciones en las funciones tanto al inicio y como posterior al tratamiento aplicado. El 93% de los pacientes resultaron rehabilitados, siendo el 86 % los evaluados de excelente al final de tratamiento aplicado. Conclusiones: los resultados en la atención al adulto mayor fueron excelentes en la gran mayoría de los casos con la aplicación del tratamiento rehabilitador (AU).

SUMMARY Introduction: the elder patient is exposed to multiple problems with ageing that will greatly condition their independence and that we will necessarily have to know and try to solve, using all the available resources within our reach. Objective: to assess the result of the treatment applied to older adults with entities of the osteomyoarticular system in the comprehensive rehabilitation room. Materials and methods: an observational, descriptive, longitudinal study of all the patients aged 60 years and over who attended the Comprehensive Rehabilitation Center was carried out, intentionally the sample stayed formed by 920 patients treated in the period between January and December 2007 with diseases of the OMAS. Results: female sex predominated (59%) in the age group of 60 to 69 years (48%). Orthopedic conditions were the most frequent with 64% and within these, scapular-humeral periarthritis. Electrotherapy was the most used treatment (38.4% of the cases). Among the symptoms that these patients presented, the most frequently found was alterations in functions both at the beginning and after the treatment applied. 93 % of the patients were rehabilitated, resulting outstanding 86 % of the assessed patients at the end pf the treatment. Conclusions: the results of elder people care was outstanding in most of the cases with the rehabilitative treatment application (AU).

Development of a patient-oriented outcome measure for patients with hand and elbow disorder: HandQ.

PURPOSE: The Disabilities of the Arm, Shoulder, and Hand (DASH) is the most widely used patient-oriented outcome measure for the upper extremities in the world, and high reliability and validity of it has already been confirmed. However, there are several problems with using the DASH, some of which are culturally related. We aimed to (1) develop a patient-oriented disease-specific outcome measure for patients with disorders of the hand and elbow, which we call the HandQ and (2) examine the practical applicability, reliability, and validity of the HandQ for any patient with disorders of the hand and elbow. METHODS: A total of 216 patients were surveyed with the HandQ, as well as the Hand20 and the DASH to assess psychometric characteristics. RESULTS: There were no considerable floor and ceiling effects regarding the total HandQ score. Test-retest reliability and internal consistency determined using the intraclass correlation coefficient (0.942) and Cronbach's α test (0.961) were excellent. The HandQ was well correlated with the Hand20 and the DASH scores. Scree plot showed unidimensionality of the HandQ, and the graphical model showed the questionnaire items of the HandQ had reasonable correlation among each item. CONCLUSIONS: The HandQ has a sufficient reliability and internal consistency, and an excellent validity, and was shown to be able to be practically applicable in all patients with hand and elbow disorders.

Randomized trial for the treatment of post-traumatic elbow stiffness: surgical release vs. rehabilitation.

BACKGROUND: There are no previous randomized trials comparing surgical to conservative treatment for post-traumatic elbow stiffness. The aim of our study was to compare elbow range of motion (ROM) and clinical outcomes among patients undergoing surgical treatment or a standardized rehabilitation for post-traumatic elbow stiffness. METHODS: Randomized clinical trial of patients with post-traumatic elbow stiffness for more than 6 months who failed conventional physical therapy for 4 months. Patients were randomized into 2 treatment groups. The conservative group underwent the rehabilitation protocol associated with the use of orthoses (static progressive for extension and dynamic for flexion) and continuous passive motion. The surgical group underwent surgical release by a posterior approach without triceps detachment, followed by a rehabilitation protocol similar to the conservative group. The primary outcome of the study was flexion-extension ROM at 6 months of follow-up. Secondary outcomes included the visual analog scale for pain, the Mayo Elbow Performance Score, the Disabilities of the Arm, Shoulder, and Hand score, absolute and relative increase in flexion-extension ROM, and complication rates. RESULTS: Thirty patients were analyzed in the study, 15 in each group. The mean elbow flexion-extension ROM at the end of 6 months of follow-up was 108° in the surgical group and 88° in the conservative group (P = .002). The mean absolute and the relative increase of elbow flexion-extension at 6 months were, respectively, 17° and 27% in the conservative group and 41° and 59% in the surgical group (P < .001). CONCLUSION: Surgical elbow release associated with the rehabilitation protocol resulted in a greater flexion-extension ROM, as well as a greater absolute and relative increase compared with rehabilitation alone at 6 months of follow-up. The groups did not differ regarding clinical scores and complication rates.

A Blended Physiotherapy Intervention for Persons With Hemophilic Arthropathy: Development Study.

BACKGROUND: Joint bleeds are the hallmark of hemophilia, leading to a painful arthritic condition called as hemophilic arthropathy (HA). Exercise programs are frequently used to improve the physical functioning in persons with HA. As hemophilia is a rare disease, there are not many physiotherapists who are experienced in the field of hemophilia, and regular physiotherapy sessions with an experienced physiotherapist in the field of hemophilia are not feasible for persons with HA. Blended care is an innovative intervention that can support persons with HA at home to perform the advised physical activities and exercises and provide self-management information. OBJECTIVE: The aim of this study was to develop a blended physiotherapy intervention for persons with HA. METHODS: The blended physiotherapy intervention, namely, e-Exercise HA was developed by cocreation with physiotherapists, persons with HA, software developers, and researchers. The content of e-Exercise HA was compiled using the first 3 steps of the Center for eHealth Research roadmap model (ie, contextual inquiry, value specification, and design), including people with experience in the development of previous blended physiotherapy interventions, a literature search, and focus groups. RESULTS: A 12-week blended intervention was developed, integrating face-to-face physiotherapy sessions with a web-based app. The intervention consists of information modules for persons with HA and information modules for physiotherapists, a graded activity program using a self-chosen activity, and personalized video-supported exercises. The information modules consist of text blocks, videos, and reflective questions. The patients can receive pop-ups as reminders and give feedback on the performance of the prescribed activities. CONCLUSIONS: In this study, we developed a blended physiotherapy intervention for persons with HA, which consists of information modules, a graded activity program, and personalized video-supported exercises.

Physiotherapy interventions for pain management in haemophilia: A systematic review.

PURPOSE: Approximately 35%-50% of people with haemophilia (PWH) report living with chronic musculoskeletal pain. Although exercise based rehabilitation is effective for pain in other arthritises, there are no published guidelines for management of chronic pain in PWH. This review aims to evaluate and appraise the current evidence of effectiveness of physiotherapy interventions on (a) pain intensity, (b) quality of life (QoL) and (c) function in PWH. METHODS: A systematic review of five databases AMED and CINAHL, EMBASE and MEDLINE and PEDro, as well as trial registries, grey literature and hand searching key journals was completed. Included studies were critically appraised and evaluated for risk of bias. The GRADE approach was used to rate the quality of the evidence. RESULTS: Nine trials consisting of 235 participants met the inclusion criteria. All studies had an overall risk of bias with low methodological quality. Meta-analysis was not possible due to heterogeneity across trials. Studies comparing a range of physiotherapy interventions against no intervention showed no clear beneficial effect on pain intensity or QoL. Only one study, investigating hydrotherapy or land-based exercise against control, showed positive effect for pain intensity, but rated very low on GRADE assessment. Studies comparing one physiotherapy intervention against another showed no clear benefit on pain intensity, QoL or function. LASER with exercise and hydrotherapy were shown to have some positive effects on pain intensity, but no clear benefit on function. CONCLUSIONS: At present, there is limited evidence for the use of physiotherapy interventions in addressing the issue of pain in PWH. Better designed trials with higher quality and explicit methodology along with user involvement are needed to assess the efficacy of any proposed intervention.

Effects of performing dual tasks on postural sway and postural control complexity in people with haemophilic arthropathy.

INTRODUCTION: People with haemophilic arthropathy (PWHA) have impairments in postural control. However, little is known about the effects of demanding conditions, including the unipedal stance and dual tasks, on postural control in PWHA. AIM: Determine the effects of performing dual tasks while in the one-leg stance on postural sway and postural control complexity in PWHA vs. healthy active (HAG) and non-active (HNAG) groups of individuals. METHODS: Fifteen PWHA and 34 healthy subjects (18 active and 16 non-active) were recruited. Vertical (V), mediolateral (ML) and anteroposterior (AP) centre of mass signals were acquired using a 3-axis accelerometer placed at the L3/L4 vertebrae of subjects as they performed the one-leg stance under single and dual-task conditions. Sway balance and the complexity of postural control were studied via root mean square (RMS) acceleration and sample entropy, respectively. Increased complexity of postural sway was attributed to increased automatism of postural control. RESULTS: RMS values for PWHA were higher than HAG under both conditions for the V and ML axes, and higher than HNAG under the dual-task condition for the ML axis. Sample entropy was lower in PWHA than healthy individuals under the dual-task condition for V and ML axes, and the single-task condition for the ML axis (P < .05). CONCLUSION: PWHA had poorer postural sway and decreased postural control complexity when performing a one-leg stance than healthy people, especially when the dual-task condition was applied. These results may help to design new approaches to assess and improve postural control in PWHA.

Do Individual Differences in Physical Therapists' Skills Affect Postoperative Results of Total Knee Arthroplasty?

We investigated variations in postoperative outcomes of total knee arthroplasty which were dependent on the physical therapist (PT) who performed rehabilitation while keeping other parameters as uniform as possible. Seventy-nine among 690 knees were selected based on strict inclusion and exclusion criteria. Patients were randomly assigned to five PTs, who had from 2 to 21 years of experience. Range of motion (ROM) on postoperative days (PODs) 1, 3, 7, and 14 and at postoperative months 3, 6, and 12, results of timed up and go (TUG) test on POD 14, time to walking with a single cane, and time to climbing stairs, were evaluated. There were significant differences until POD 3, and no significant differences afterward in flexion. There was a significant difference on POD 1 only in extension. The TUG test showed no significant difference, but there were significant differences at the time of walking with a single cane and climbing stairs. The time taken to achieve rehabilitation, which was determined subjectively by each PT, differed among therapists, but differences in ROM were present in early period. Therefore, ROM after surgery is not affected by differences between PTs.

Synthesis of silver @hydroxyapatite nanoparticles based biocomposite and their assessment for viability of Osseointegration for rabbit knee joint anterior cruciate ligament rehabilitation.

In this examination, chitosan-silk fibroin/polyethylene terephthalate (CTS-SF/PET), chitosan-silk fibroin/polyethylene terephthalate/hydroxyapatite (CTS-SF/PET/HAP) and chitosan-silk fibroin/polyethylene terephthalate/Silver @hydroxyapatite (CTS-SF/PET/Ag@HAP) scaffolds were prepared by utilizing the plasma splashing procedure. Field emission scanning electron microscopy (FESEM) results demonstrated that the outside of the PET covered with HAP nanoparticles. The cell viability results demonstrated that the number of Mesenchymal stem cells (MSCs) primarily spread out on CTS-SF/PET/Ag@HAP. RT-PCR results demonstrated that there was an upregulated mRNA articulation of osseous development-related properties in the CTS-SF/PET/Ag@HAP composite. The in vivo rabbit animal assessment scores of the CTS-SF/PET/Ag@HAP composite were significantly better than those of the CTS-SF/PET at 1 to 3 months. Both in-vivo and in-vitro results exhibited in this investigation recommend that the cytocompatibility and osseointegration of CTS-SF/PET/Ag@HAP tendon were fundamentally improved by expanding the multiplication of cells and up-regulating the outflow of tendon development-related properties. In conclusion, the CTS-SF/PET/Ag@HAP tendon is a promising candidate for Anterior Cruciate Ligament (ACL) replacement in the future.

Acromegalic Arthropathy.

A 30-year-old woman was referred to physical therapy for bilateral shoulder and thoracic spine pain concurrent with loss of range of motion. Notable medical history included surgical removal of a pituitary adenoma that had resulted in excessive growth hormone secretion, developing into acromegaly with hallmark physical features. Following examination, radiographs were requested to evaluate the extent of arthropathies associated with acromegaly. Radiographs revealed advanced arthropathies of the bilateral acromioclavicular and glenohumeral joints, along with loss of disc height and anterolisthesis throughout the thoracic spine. J Orthop Sports Phys Ther 2019;49(11):864. doi:10.2519/jospt.2019.8302.

Standard and water rehabilitation: An analysis of over 14 years' experience in patients with haemophilia or other clotting factor disorders after orthopaedic surgery.

INTRODUCTION: In people with haemophilia (PWH) with severe arthropathy, total joint replacement (TJR) can be undertaken if conservative management fails. Post-operative rehabilitation treatment is an important part of the comprehensive management of patients undergoing TJR. AIM: To compare post-operative standard rehabilitation (SR) and SR plus water rehabilitation (WR) in PWH undergoing TJR. METHODS: PWH who were admitted to our centre between June 2003 and December 2016 for rehabilitation after TJR were included in the study. Rehabilitation included SR (ie, manual and mechanical mobilization, scar tissue massage, light muscle strengthening exercises and walking training with and without crutches) with or without WR. WR exercises with floats of different size and volume were performed when possible. Range of motion (ROM), muscle strength, pain level, perceived health status and length of hospital stay were analysed retrospectively. RESULTS: A total of 184 patients (233 rehabilitation programmes were enrolled in the study, corresponding to 160 after total knee replacement [TKR], 37 after total ankle replacement [TAR] and 36 after total hip replacement [THR]). Fifty-eight (25%) patients were treated with WR in addition to SR (32 for TKR, 19 for TAR and 7 for THR) with an average of 5.7 hours of WR. Muscle strength, pain and perceived health status improved significantly after rehabilitation. CONCLUSION: This non-randomized study seems to indicate that WR plus SR improves muscle strength, pain and perceived health status more than SR alone in PWH undergoing TJR. It would be necessary, however, to carry out randomized comparative studies to confirm these provisional conclusions.

Effect of breast reconstruction modality on the development of postmastectomy shoulder morbidity.

BACKGROUND: The aim of this study was to evaluate the impact of breast reconstruction modality on the incidence of shoulder morbidity. METHODS: Breast cancer patients who underwent immediate reconstructions using three modalities, namely, tissue expander-implant, latissimus dorsi (LD) pedicled flap, and deep inferior epigastric artery perforator (DIEP) flap, from 2008 to 2013 were examined. The cumulative incidence of shoulder morbidity was compared among the reconstruction modalities, and risk factor analysis was performed using multivariable analysis. RESULTS: A total of 430 reconstructions (223 expander-implant, 44 LD flap, and 163 DIEP flap) in 420 patients were analyzed in this study. Shoulder morbidity developed in 95 patients (22.1%) and was most common in the LD group (43.2%) followed by the expander-implant (23.8%) and the DIEP (14.1%) groups over a mean follow-up of 52 (range: 24-120) months. The multivariable analysis showed that the expander-implant (odds ratio (OR) 2.15, p = 0.010) and the LD flap (OR 6.27, p < 0001) were significant risk factors for shoulder morbidity, compared to the DIEP flap. Old age (p = 0.041), presence of tumor-positive lymph nodes (p = 0.014), and receiving neoadjuvant chemotherapy (p = 0.002) were independent risk factors for the development of shoulder morbidity. Early rehabilitation within 2 postoperative-months reduced the risk of sustained shoulder morbidity. CONCLUSION: The choice of reconstruction modality might affect the development of postmastectomy shoulder morbidity. Understanding the risk factors for shoulder morbidity would help to improve the informed consent process and assist surgeons in the early diagnosis and initiation of rehabilitation therapy to prevent chronic shoulder dysfunction after breast reconstruction.

Elbow arthroscopy in children and adolescents: analysis of outcome and complications.

BACKGROUND: Chondral or osteochondral lesions, post-traumatic contracture and loose bodies of the elbow are often associated with chronic pain, stiffness, repetitive swelling and joint blockages. Therefore, arthroscopy of the elbow is often used in the elderly for the treatment of osteochondral defects or arthrolysis. There are only a few reports and studies about arthroscopic therapy of the elbow in children and adolescents. This study assesses the clinical outcome of arthroscopic therapy in this age group. METHODS: In a retrospective study, children and adolescents who underwent an elbow arthroscopy in the period from 2010 to 2014 were included. The children were evaluated using the validated outcome measures Mayo Elbow Performance Score (MEPS), range of motion, pain on visual analog scale (VAS), Oxford Elbow Score (OES), quick dash and postoperative satisfaction. Furthermore, all complications were analyzed. RESULTS: In total, 27 patients were included. The mean (range) age was 14 (11-17) years, with a follow-up of 45 months. Fourteen (52%) were female and thirteen children (48%) were male. Twenty children had an arthroscopy due to osteochondritis dissecans and seven children for post-traumatic pain and stiffness. The mean (standard deviation) MEPS improved from 65 (15) to 96 (8; p = .005). The OES and quick dash were 93 and 5.4. The mean extension improved from - 15° (± 13.8) to 3° (± 10.2; p < .001). The mean flexion improved from 131° (± 13.4) to 137° (± 9.5; p = .003). Average pain on VAS was postoperative .2 (± .5), and 81.5% of all children had excellent or good results. There were no complications such as damage of nerves or blood vessels observed. CONCLUSION: Elbow arthroscopy is an appropriate and safe treatment option in children and adolescents with good and excellent postoperative results.

The effectiveness of conservative and surgical treatment for shoulder stiffness: a systematic review of current literature.

Introduction: Currently, no therapeutic intervention is universally accepted, and the most effective management for restoring motion and diminishing pain in patients with shoulder stiffness has yet to be defined. This systematic review analyses outcomes of conservative and surgical interventions to treat shoulder stiffness. Source of data: A systematic review of literature according to the PRISMA guidelines was performed. A comprehensive search of PubMed, Medline, CINAHL, Cochrane, Embase, Ovid and Google Scholar databases using various combinations of the keywords 'shoulder', 'shoulder stiffness', 'stiff shoulder', 'conservative', since inception of databases to June 2018 was performed. Areas of agreement: Shoulder stiffness could be treated with conservative means including nonsteroidal anti-inflammatory medications, corticosteroid injections, or transcutaneous electrical nerve stimulation, manipulation under anaesthesia, and arthroscopic capsular release. Areas of controversy: No therapeutic intervention is universally accepted, and the most effective management to restore motion and diminish pain in patients with shoulder stiffness has yet to be defined. Growing points: The rate of failure after treatment for stiff shoulder is higher in the surgical group than in the conservative group. Areas timely for developing research: There is insufficient evidence to establish whether surgical or conservative management is the best choice to manage shoulder stiffness. Prospective, randomized studies are needed to establish whether surgical or conservative management produce a clinically relevant difference in functional outcome.

Range of Motion Improvement Following Surgical Management of Knee Arthrofibrosis in Children and Adolescents.

BACKGROUND: Arthrofibrosis of the knee is well-described in adults as a potentially debilitating postoperative complication following anterior cruciate ligament reconstruction, total knee arthroplasty, or fracture fixation. Knee arthrofibrosis in children and adolescents, however, has received little attention. The primary purpose of this study was to report improvements in range of motion (ROM) following lysis of adhesions and manipulation under anesthesia (LOA/MUA) in children and adolescents with knee arthrofibrosis, and, secondarily, to evaluate for any effect of preoperative dynamic splinting on ROM outcomes. METHODS: Ninety patients aged 18 years and below (mean, 14.4±3.5) and 31% male who underwent LOA/MUA at an urban tertiary care hospital following prior knee surgery were evaluated. Demographic, clinical, ROM, and revision data were compiled. Primary outcome was absolute ROM. Secondarily, ROM was analyzed as a categorical variable with "Full ROM" defined to be -5 to 130 degrees or better, "functional" ROM was defined as unable to obtain -5 to 130 degrees but not requiring revision, and "failure" defined as resulting in revision arthrofibrosis surgery. t tests and χ analyses were used to compare ROM and count variables between dynamic splinting subgroups. RESULTS: Mean time from index surgery to LOA/MUA was 6.0±4.4 months, and follow-up was 42±56 months. Index procedures included anterior cruciate ligament reconstruction (N=33), tibial spine arthroscopic reduction and internal fixation (N=18), fracture fixation (N=17), soft tissue repair (N=17), and multiligament reconstruction (N=5). In total, 68 subjects (76%) had any flexion loss, 57 subjects (63%) had any extension loss, and 40 subjects (44%) had both flexion and extension loss.Fifty-six subjects (62%) had full ROM at final follow-up, 25 subjects (28%) had functional ROM, and 9 subjects (10%) required revision. No demographic, clinical, or surgical variable was predictive of treatment failure. Patients who underwent dynamic splinting preoperatively (N=46; 51%) had greater preoperative flexion (99±16 vs.77±34 degrees; P=0.001), but no difference in flexion at final follow-up (121±20 vs.128±11 degrees; P=0.08). Failure was not associated with time from index procedure to LOA/MUA, and the proportion who regained full ROM postoperatively was equivalent between those who had dynamic splinting and those who did not (65% vs. 59%; P=0.70). CONCLUSIONS: LOA/MUA for children with arthrofibrotic knees results in significant improvements in ROM with 90% revision-free success. Preoperative dynamic or static progressive splinting improves preoperative flexion but does not affect postoperative range of motion or failure rate. LEVEL OF EVIDENCE: Level II.

Hydrogen-absorbing alloy-based metal-hydride actuation for application in rehabilitative systems.

BACKGROUND: A lightweight rehabilitation assisting system is required to help the aged and disabled with daily life activities, thereby improving the quality of their lives. OBJECTIVE: This paper discusses the development of a metal-hydride (MH) actuator, with excellent heat transfer performance, for application in a rehabilitative system incorporating an MH module. METHODS: The operating mechanism of MH actuators requires that the mechanical power of the pneumatic actuator only be generated via heat transfer through a Peltier element and the absorption/desorption of a hydrogen-contained MH module. To achieve this aim, a 3D model was first designed for two MH modules, and a thermal analysis was carried out according to the type of contact with the Peltier elements to fabricate an MH module with improved heat transfer performance. LabVIEW (National Instruments) was used for automatic temperature control of the Peltier element in the MH actuator driving experiment. Zr0.9TI0.1Cr0.6Fe1.4, which yields a pressure-composition-temperature (PCT) curve of appropriate pressure and temperature ranges for a rehabilitative system, was selected as the hydrogen-absorbing alloy. RESULTS: In addition, the temperature conditions of the MH actuator driving experiment were restricted by two temperature control ranges (30-40∘C/30-50∘C) of the Peltier element. Within these Peltier element temperature ranges of 30-40∘C and 30-50∘C, results showed that the MH actuator was driven in the ranges of 2-3 atm and 2.5-3.5 atm, respectively. CONCLUSIONS: These findings indicate that the MH actuator proposed in this paper can be utilized to drive a rehabilitative system for elbow and knee joint exoskeletons.

Effectiveness of prowling with proprioceptive training on knee hyperextension among stroke subjects using videographic observation- a randomised controlled trial.

INTRODUCTION: Knee hyperextension is seen in 40-68% of ambulating hemiparetics. If left untreated it may lead to laxity of posterior structures of knee resulting in early degeneration of knee leading to pain, reduced independence in activities of daily living (ADL), deformities and instability. In this study we hypothesize walking with bent knee attitude (prowling) along with proprioceptive training may help to reduce knee hyperextension during the stance phase of gait cycle. OBJECTIVE: To test the efficacy of prowling along with proprioceptive training on knee hyperextension range, dorsiflexion range and spatio temporal parameters of gait using Wisconsin gait scale (WGS) as compared to routine physiotherapy. METHOD: 32 subjects were randomized into 2 groups- experimental and control groups. Both the groups were given routine physiotherapy. Experimental group received an additional treatment consisting of prowling along with proprioceptive training. Knee hyperextension and ankle dorsiflexion ranges were videotaped and analysed using Kinovea software, and for spatio-temporal gait parameters WGS was used. RESULTS: In our study, the experimental group showed significant improvement over the control group with regards to knee hyperextension, dorsiflexion range and WGS score. Pre post intervention analysis, within the group, for time taken to cover the distance revealed significant improvement, however between group analysis did not reveal any significant difference. CONCLUSION: Prowling along with proprioceptive training is effective in reducing knee hyperextension, increasing dorsiflexion range and improving spatio-temporal gait parameters.