What is manipulation? A new definition.

BACKGROUND: Definitions are important in healthcare. Unfortunately, problems can be found withall existing definitions of manipulation. METHODS: This paper derives a set of eligibility criteria from prior definitions of manipulation to inform what should (and should not) be incorporated within a valid definition. These criteria were then used to select components from currently available empirical data to create a new definition. RESULTS: The resulting definition of manipulation is: "Separation (gapping) of opposing articular surfaces of a synovial joint, caused by a force applied perpendicularly to those articular surfaces, that results in cavitation within the synovial fluid of that joint." The corresponding definition for the mechanical response of a manipulation is: "Separation (gapping) of opposing articular surfaces of a synovial joint that results in cavitation within the synovial fluid of that joint." In turn, the action of a manipulation can be defined as: "A force applied perpendicularly to the articular surfaces." CONCLUSIONS: We believe these definitions to be valid (derived from and consistent with all available empirical data), complete (containing all necessary components), minimally sufficient (minimal redundancy, and sufficient to distinguish manipulation from other physical interventions), and robust (able to withstand important limitations embodied within sensible eligibility criteria). It is hoped that the simplicity and clarity of these definitions, and the transparency of their formation, will encourage their wide adoption in clinical, research, educational and professional settings.

SE-TCN network for continuous estimation of upper limb joint angles.

The maturity of human-computer interaction technology has made it possible to use surface electromyographic signals (sEMG) to control exoskeleton robots and intelligent prostheses. However, the available upper limb rehabilitation robots controlled by sEMG have the shortcoming of inflexible joints. This paper proposes a method based on a temporal convolutional network (TCN) to predict upper limb joint angles by sEMG. The raw TCN depth was expanded to extract the temporal features and save the original information. The timing sequence characteristics of the muscle blocks that dominate the upper limb movement are not apparent, leading to low accuracy of the joint angle estimation. Therefore, this study squeeze-and-excitation networks (SE-Net) to improve the network model of the TCN. Finally, seven movements of the human upper limb were selected for ten human subjects, recording elbow angle (EA), shoulder vertical angle (SVA), and shoulder horizontal angle (SHA) values during their movements. The designed experiment compared the proposed SE-TCN model with the backpropagation (BP) and long short-term memory (LSTM) networks. The proposed SE-TCN systematically outperformed the BP network and LSTM model by the mean RMSE values: by 25.0 and 36.8% for EA, by 38.6 and 43.6% for SHA, and by 45.6 and 49.5% for SVA, respectively. Consequently, its R2 values exceeded those of BP and LSTM by 13.6 and 39.20% for EA, 19.01 and 31.72% for SHA, and 29.22 and 31.89% for SVA, respectively. This indicates that the proposed SE-TCN model has good accuracy and can be used to estimate the angles of upper limb rehabilitation robots in the future.

Pro-stride and extracorporeal shockwave therapy as treatment of lateral collateral desmopathy of the proximal interphalangeal joint in a Dutch Warmblood gelding.

A 6-year-old chestnut Dutch Warmblood gelding was presented for right front lameness 1 mo after being cast in a stall at a 1.20-meter jumping event. Lameness work-up revealed mild lameness on the right and left front legs, with diffuse swelling over the right front pastern. Ultrasonic evaluation yielded suspicion of collateral desmopathy of the proximal interphalangeal joint that was subsequently confirmed via MRI. Two weeks after initial evaluation, the proximal and distal interphalangeal joints were injected with Pro-Stride Autologous Protein Solution, immediately followed by Extracorporeal Shockwave Therapy of the lateral and medial collateral ligaments. Follow-up at 2 and 3 mo after treatment revealed reduced joint effusion of the proximal and distal interphalangeal joints, as well as improved fiber organization of the associated collateral ligaments. This should inform practitioners that multimodal therapeutic treatments including biologics and stimulation of healing through sound waves can aid in ligamentous injuries in sport horses.

Thérapie avec Pro-Stride et ondes de choc extracorporelles comme traitement de la desmopathie collatérale latérale de l'articulation interphalangienne proximale chez un hongre Warmblood hollandais. Un hongre Warmblood hollandais alezan de 6 ans a été présenté pour boiterie avant droite 1 mois après s'être blessé lors d'une compétition de sauts à 1,20 mètre. Le bilan de boiterie a révélé une légère boiterie sur les pattes avant droite et gauche, avec une enflure diffuse sur le paturon avant droit. L'examen échographique a révélé une suspicion de desmopathie collatérale de l'articulation interphalangienne proximale qui a ensuite été confirmée par imagerie par résonnance magnétique. Deux semaines après l'évaluation initiale, les articulations interphalangiennes proximales et distales ont reçu une injection de solution de protéines autologues Pro-Stride, immédiatement suivie d'une thérapie par ondes de choc extracorporelles des ligaments collatéraux latéral et médial. Le suivi à 2 et 3 mois après le traitement a révélé un épanchement articulaire réduit des articulations interphalangiennes proximales et distales, ainsi qu'une meilleure organisation des fibres des ligaments collatéraux associés.Ceci devrait informer les praticiens que les traitements thérapeutiques multimodaux, y compris les produits biologiques et la stimulation de la guérison par des ondes sonores, peuvent aider dans les blessures ligamentaires chez les chevaux de sport.(Traduit par Dr Serge Messier).

Healthy and Osteoarthritis-Affected Joints Facing the Cellular Crosstalk.

Osteoarthritis (OA) is a chronic, progressive, severely debilitating, and multifactorial joint disease that is recognized as the most common type of arthritis. During the last decade, it shows an incremental global rise in prevalence and incidence. The interaction between etiologic factors that mediate joint degradation has been explored in numerous studies. However, the underlying processes that induce OA remain obscure, largely due to the variety and complexity of these mechanisms. During synovial joint dysfunction, the osteochondral unit undergoes cellular phenotypic and functional alterations. At the cellular level, the synovial membrane is influenced by cartilage and subchondral bone cleavage fragments and extracellular matrix (ECM) degradation products from apoptotic and necrotic cells. These "foreign bodies" serve as danger-associated molecular patterns (DAMPs) that trigger innate immunity, eliciting and sustaining low-grade inflammation in the synovium. In this review, we explore the cellular and molecular communication networks established between the major joint compartments-the synovial membrane, cartilage, and subchondral bone of normal and OA-affected joints.

Axial involvement in enthesitis-related arthritis: results from a single-center cohort.

BACKGROUND: Axial involvement in children with enthesitis-related arthritis (ERA) has characteristics that differ from those of peripheral involvement. This study characterized their clinical characteristics and treatment. METHODS: Patients with ERA at the Children's Hospital of Nanjing Medical University between January 2018 and December 2020 were included. The ERA cohort was divided into two based on the presence or absence of axial joint involvement. Demographic characteristics, clinical features, and treatments were described and compared. RESULTS: In total, 105 children with ERA were enrolled (axial ERA, n = 57; peripheral ERA, n = 48). The age at disease onset of the axial group tended to be higher (11.93 ± 1.72 vs. 11.09 ± 1.91 years) and the diagnosis delay was bigger in patients with axial ERA (10.26 ± 11.66 months vs. 5.13 ± 7.92 months). The inflammatory marker levels were significantly higher in patients with axial. There were no differences in HLA-B27 positivity between the groups (34 [59.65%] vs. 28 [58.33%], P > 0.05). Hip involvement was more frequent in the axial group (52.63% vs 27.08%; X2 = 7.033). A total of 38 (66.67%) and 10 (20.83%) patients with axial and peripheral ERA, respectively, were treated with biological disease-modifying anti-rheumatic drugs (DMARDs) at diagnosis. The administration of biologics increased gradually in the axial ERA group, peaking at 18 months and decreasing thereafter, whereas that in the peripheral ERA group peaked at 6 months and began to decline thereafter. CONCLUSIONS: Axial ERA is a persistent active disease and requires a more aggressive treatment. Classification and early recognition of axial involvement may help with timely diagnosis and appropriate management.

Noninfectious tissue interactions at periprosthetic interfaces.

The success of hip arthroplasty is based on modern materials in addition to the continuous development of surgical techniques and clinical experience gained over six decades. The biocompatible implant materials used in hip arthroplasty can be textured or coated with biomimetic surfaces to ensure durable component ingrowth and moderate host response. Material integrity plays a critical role in the durability of the stable interface between implant components and periprosthetic tissues. Inflammation at the interfaces due to the release of degradation products from the implant materials is one of the causes of hip arthroplasty failure. This review summarizes the implant materials currently used in hip arthroplasty, their preclinical testing and the postoperative neogenesis of periprosthetic tissues, and the interactions of periprosthetic bone and the implant materials at the periprosthetic interfaces.

Icariin-conditioned serum combined with chitosan attenuates cartilage injury in rabbit knees with osteochondral defect.

BACKGROUND: Knee osteoarthritis (KOA) is one of the most common degenerative diseases. Its development is closely related to cartilage injury and subchondral bone remodeling homeostasis. In the present study, we combined icariin-conditioned serum (ICS) with thiolated chitosan (CSSH), a material widely used in tissue engineering for cartilage repair, to demonstrate its effect on the repair of cartilage damage and abnormal subchondral remodeling. METHODS: New Zealand rabbits were undergoing surgery for cartilage defect, and joint cavity injection was performed in each group with 0.5 mL normal saline (NS), ICS, CSSH and ICS-CSSH in the right joint every week for five times. Positioning performance was observed using VICON motion capture system. Glycosaminoglycans (GAG) secretion of articular fluid was assessed. Osteoarthritis Research Society International (OARSI) score and immunohistochemical (IHC) analysis including H&E, Safranin O and collagen II staining were employed to evaluate the morphologic repair of cartilage and subchondral bone. mRNA expression of COL2A1, MMP13 and ADAMTS5 was detected in chondrocytes from injury area. RESULTS: ICS combined with CSSH attenuated cartilage injury and abnormal subchondral remodeling in rabbits with KOA. ICS and CSSH groups showed slight improvement in positioning performance, while ICS-CSSH group exhibited better positioning performance. ICS-CSSH group showed increased GAG secretion of articular fluid and expression of COL2A1 in articular chondrocytes. Furthermore, both macroscopic observation and IHC analysis showed femoral condyle in ICS-CSSH rabbits were repaired with more native cartilage and subchondral bone regeneration. CONCLUSIONS: ICS combined with CSSH could promote the repair of osteochondral defect and stabilize subchondral bone remodeling in rabbit knees.

Remodeling articular immune homeostasis with an efferocytosis-informed nanoimitator mitigates rheumatoid arthritis in mice.

Massive intra-articular infiltration of proinflammatory macrophages is a prominent feature of rheumatoid arthritis (RA) lesions, which are thought to underlie articular immune dysfunction, severe synovitis and ultimately joint erosion. Here we report an efferocytosis-informed nanoimitator (EINI) for in situ targeted reprogramming of synovial inflammatory macrophages (SIMs) that thwarts their autoimmune attack and reestablishes articular immune homeostasis, which mitigates RA. The EINI consists of a drug-based core with an oxidative stress-responsive phosphatidylserine (PtdSer) corona and a shell composed of a P-selectin-blocking motif, low molecular weight heparin (LMWH). When systemically administered, the LMWH on the EINI first binds to P-selectin overexpressed on the endothelium in subsynovial capillaries, which functions as an antagonist, disrupting neutrophil synovial trafficking. Due to the strong dysregulation of the synovial microvasculature, the EINI is subsequently enriched in the joint synovium where the shell is disassembled upon the reactive oxygen species stimulation, and PtdSer corona is then exposed. In an efferocytosis-like manner, the PtdSer-coroneted core is in turn phagocytosed by SIMs, which synergistically terminate SIM-initiated pathological cascades and serially reestablish intra-articular immune homeostasis, conferring a chondroprotective effect. These findings demonstrate that SIMs can be precisely remodeled via the efferocytosis-mimetic strategy, which holds potential for RA treatment.

Elbow-joint morphology in the North American 'cheetah-like' cat Miracinonyx trumani.

The North American cheetah-like cat Miracinonyx trumani is an extinct species that roamed the Pleistocene prairies 13 000 years ago. Although M. trumani is more closely related to the cougar (Puma concolor) than to the living cheetah (Acinonyx jubatus), it is believed that both A. jubatus and M. trumani possess a highly specialized skeleton for fast-running, including limbs adapted for speed at the expense of restricting the ability of prey grappling. However, forelimb dexterity of M. trumani has not been yet investigated. Here, we quantify the 3D-shape of the humerus distal epiphysis as a proxy for elbow-joint morphology in a sample of living cats to determine whether the extinct M. trumani was specialized to kill open-country prey using predatory behaviour based on fast running across the prairies and steppe terrains of the North American Pleistocene. We show that M. trumani had an elbow morphology intermediate to that of P. concolor and A. jubatus, suggesting that M. trumani had a less specialized pursuit predatory behaviour than A. jubatus. We propose that M. trumani probably deployed a unique predatory behaviour without modern analogues. Our results bring into question the degree of ecomorphological convergence between M. trumani and its Old World vicar A. jubatus.

Joint mobility as a bridge between form and function.

Joints enable nearly all vertebrate animal motion, from feeding to locomotion. However, despite well over a century of arthrological research, we still understand very little about how the structure of joints relates to the kinematics they exhibit in life. This Commentary discusses the value of joint mobility as a lens through which to study articular form and function. By independently exploring form-mobility and mobility-function relationships and integrating the insights gained, we can develop a deep understanding of the strength and causality of articular form-function relationships. In turn, we will better illuminate the basics of 'how joints work' and be well positioned to tackle comparative investigations of the diverse repertoire of vertebrate animal motion.

Bilateral non-traumatic elbow luxation in a Yorkshire terrier puppy.

A 10-week-old Yorkshire terrier had lameness of the right forelimb with complete lateral radioulnar luxation at the humerus, consistent with Type III congenital elbow luxation; this is rarely treated in the presence of multiple skeletal deformities. Lateral subluxation of the radial head at the left elbow was diagnosed as Type I congenital elbow luxation. Procurvatum, distal valgus, and external torsion were present in both antebrachiae. Surgical stabilization of the right elbow was performed with temporary transarticular pins in the humeroulnar and radioulnar joints. A custom-made orthosis was applied to support the surgical reduction for 20 wk. Recurrent luxation was not observed. After complete right-sided function was established, the left forelimb showed noticeable instability in the antebrachium, and the puppy frequently fell while running. The lateral collateral ligament of the left elbow was augmented using screws and synthetic ligaments 22 wk after the right-side surgery. Congruity of the left elbow joint improved, and the puppy could bear full weight on the left forelimb, although slight deficits in movement and falling were observed. We demonstrate the effectiveness of combining a temporary transarticular pin and custom-made orthosis while treating Type III congenital elbow luxation and the inadequacy of collateral ligament augmentation alone for treating Type I congenital elbow luxation with antebrachium deformities. Key clinical message: Herein, we observed that a combination of a temporary transarticular pin and a custom-made orthosis was effective for the treatment of Type III congenital elbow luxations.

Luxation bilatérale non traumatique du coude chez un chiot Yorkshire terrier. Un Yorkshire terrier de 10 semaines présentait une boiterie du membre antérieur droit avec une luxation radio-ulnaire latérale complète au niveau de l'humérus, compatible avec une luxation congénitale du coude de type III; ceci est rarement traité en présence de multiples déformations squelettiques. La subluxation latérale de la tête radiale au niveau du coude gauche a été diagnostiquée comme une luxation congénitale du coude de type I. Procurvatum, valgus distal et torsion externe étaient présents dans les deux sections antébrachiales. La stabilisation chirurgicale du coude droit a été réalisée avec des broches trans-articulaires temporaires dans les articulations huméro-ulnaire et radio-ulnaire. Une orthèse sur mesure a été appliquée pour soutenir la réduction chirurgicale pendant 20 semaines. Aucune luxation récurrente n'a été observée. Une fois la fonction complète du côté droit établie, le membre antérieur gauche a montré une instabilité notable de la section antébrachiale et le chiot tombait fréquemment en courant. Le ligament collatéral latéral du coude gauche a été augmenté à l'aide de vis et de ligaments synthétiques 22 semaines après la chirurgie du côté droit. La congruence de l'articulation du coude gauche s'est améliorée et le chiot pouvait supporter tout son poids sur le membre antérieur gauche, bien que de légers déficits de mouvement et des chutes aient été observés. Nous démontrons l'efficacité de la combinaison d'une broche trans-articulaire temporaire et d'une orthèse sur mesure dans le traitement de la luxation congénitale du coude de type III et l'insuffisance de l'augmentation du ligament collatéral seule pour traiter la luxation congénitale du coude de type I avec des déformations de la section antébrachiale.Message clinique clé:Ici, nous avons observé qu'une combinaison d'une broche trans-articulaire temporaire et d'une orthèse sur mesure était efficace pour le traitement des luxations congénitales du coude de type III.(Traduit par Dr Serge Messier).

Movement-synchronized cerebellum rhythm coordinates multi-joint movements in young and elderly adults.

Rhythmic limb multi-joint movement like locomotion is controlled by intralimb coordination. Intralimb coordination changes entail immediate alterations in movement patterns and be related with cerebellum function. Synchronized cerebellum activity has known to modulate the frequency of walking, but not known the effect of only intralimb coordination. The purpose of this study was to reveal the effect of synchronized and unsynchronized cerebellum activity on the coordination of multi-joint movements of the unilateral leg in young and elderly people. To achieve our purpose, we applied synchronized and unsynchronized cerebellum transcranial alternating current stimulation during cyclic unilateral multi-joint movement by visual tracking task. The results showed that the reduction in comprehensive synchrony between targets and movements through trials had no significant differences under all stimulus conditions in young and elderly people. However, the reduction in variation of synchronization through trials was significantly smaller under the synchronized transcranial alternating current stimulation condition in both young and elderly groups. Variation of synchronization was remarkably reduced under the synchronized transcranial alternating current stimulation condition for the elderly group. This study showed that movement-synchronized cerebellum activity contributes to reducing fluctuations in movement synchrony by coordinating unilateral multi-joint movements. Moreover, this reduction was remarkable in the elderly group.

Vascular impulse technology versus elevation for reducing the swelling of upper and lower extremity joint fractures.

Soft-tissue conditioning due to posttraumatic oedema after complicated joint fractures is a central therapeutic aspect both pre- and postoperatively. On average, 6-10 days pass until the patient is suitable for surgery. This study compares the decongestant effect of vascular impulse technology (VIT) with that of conventional elevation. In this monocentric RCT, 68 patients with joint fractures of the upper (n = 36) and lower (n = 32) extremity were included and randomized after consent in a 1:1 ratio. Variables were evaluated for all fractures together and additionally subdivided into upper or lower extremity for better clinical comparability. Primary endpoint was the time in days from hospital admission to operability. Secondary endpoints were total length of stay, oedema reduction, pain intensity, complications, and revisions. The time from admission until operability was reduced by 1.4 (95% CI - 0.4; 3.1) days in the mITT analysis (p = 0.120) and was statistically significant with 1.7 (95% CI 0.1; 3.3) days in the as-treated sensitivity analysis (pAT = 0.038). Significantly less pain and a faster oedema reduction were found in the intervention group. Due to rare occurrences, nothing can be concluded regarding complications and revisions. Administration of VIT therapy did not lead to a significant reduction in time until operability in the whole population but was superior to elevation for soft-tissue conditioning and pain reduction. However, there was a significant reduction by 2.5 days (95% CI 0.7; 4.3) in the subgroup of lower extremity fractures. VIT therapy therefore seems to be a helpful tool in the treatment of posttraumatic oedema after complex joint fractures of the lower and upper extremity, especially in tibial head and lower leg fractures.

Application of a Joint Coordinate System Kinematic Model to the Canine Thoracic Limb.

OBJECTIVE: The aim of this study was to apply a three-dimensional kinematic model to the canine thoracic limb using a joint coordinate system. ANIMALS: Six clinically normal adult mixed-breed dogs. PROCEDURES: Dogs had 19 retroreflective markers affixed to the skin of the right forelimb. Twelve infrared cameras were arranged in a circle around the testing space, recording the locations of the markers as dogs walked and trotted through the testing space. Five trials were used of both walks and trots at velocities 0.9 to 1.2 m/s and 1.7 to 2.1 m/s respectively. Raw marker location data were used to generate a joint coordinate system, and a six degrees of freedom model of the canine forelimb was created. Three-dimensional kinematic angles were collected for the shoulder, elbow and carpal joints. RESULTS: Sagittal, transverse and frontal plane kinematics joint angles were generated by use of a joint coordinate system. Range of motion was calculated for each joint in all three planes. CONCLUSION AND CLINICAL RELEVANCE: This minimally invasive joint coordinate system model can be used in both clinical and research settings to determine changes in range of motion of the shoulder, elbow or carpus in the canine forelimb in three dimensions.

Kinematic changes in gait in boys with Duchenne Muscular Dystrophy: Utility of the Gait Deviation Index, the Gait Profile Score and the Gait Variable Scores.

BACKGROUND: Duchenne Muscular Dystrophy (DMD) is an X-linked muscle disorder caused by a mutation or deletion in the dystrophin gene. In boys with DMD, muscle weakness progresses in a proximal to distal pattern, leading to gait abnormalities at all joints, in all planes of motion. Longitudinal studies are imperative to quantify changes in gait function due to DMD and are of particular importance when examining the efficacy of treatment interventions. RESEARCH QUESTION: The purpose of this study was to examine the sensitivity of the Gait Deviation Index (GDI) and Movement Analysis Profile (Gait Profile Score (GPS) and Gait Variable Score (GVS)) to quantify the longitudinal ambulatory decline in boys with DMD. A secondary aim was to quantify the effect of corticosteroid (CS) treatment. METHODS: The gait patterns of 75 boys were assessed longitudinally, 11 were steroid naïve (SN), and 64 received CS treatment. Joint kinematics were collected using either a VICON 612 or a Motion Analysis Corporation 3-D system. Representative trials were used to compute the GDI, GPS and the nine GVS for each boy for each visit. RESULTS: At baseline, GVS for the boys with DMD revealed abnormalities in all lower extremity joints and in all planes of movement compared to TD peers. GDI and GPS indices verified that the overall quality of gait in boys with DMD decreases at a significant rate with age. Boys who were steroid naïve changed at a rate 3 times greater than boys on CS in coronal plane hip motion. SIGNIFICANCE: The gait indices of GDI and GPS are able to identify changes in the quality of gait patterns in boys with DMD. Although boys on steroids had greater gait deviations than boys who were SN at baseline, the rate of decline in gait quality was slower in boys on CS.

A comparative study of bone union and nonunion during distraction osteogenesis.

BACKGROUND: The clinical characteristics of bone nonunion during distraction osteogenesis (DO) were rarely discussed. This study was employed to specify the difference between bone union and nonunion during DO. METHODS: The patients with bone lengthening were recruited in our study. The bone union cases indicated the ones that remove the external fixator successfully, whereas the bone nonunion represented the bridging callus did not appear even after 9 months (an absence of bridging callus for at least three out of four cortices on plain radiographs) that needs autogenous bone transplantation. The differences in the pixel value ratio (PVR) growth of regenerated callus, lengthening index (LI), healing index (HI), external fixation index (EFI) and blood biochemical indexes between bone union and nonunion were analyzed. RESULTS: A total of 8 bone nonunion and 27 bone union subjects were included in this study. The PVR growth in bone nonunion was significantly lower than that in bone union (0.19 ± 0.06 vs. 0.32 ± 0.16, P = 0.048). Interestingly, the HI and EFI in bone nonunion was significantly higher than that in bone union (62.0 ± 31.4 vs. 37.0 ± 27.4, P = 0.036; 75.0 ± 30.9 vs. 49.9 ± 16.1, P = 0.006). However, no significant difference with regard to LI was identified (0.76 ± 0.52 vs. 0.77 ± 0.32, P = 0.976). Moreover, the circulating level of urea and lymphocyte count in bone union was significantly lower than that in bone nonunion (4.31 ± 1.05 vs. 5.17 ± 1.06, P = 0.049; 2.08 ± 0.67 vs. 2.73 ± 0.54, P = 0.018). On the contrary, the circulating level of magnesium in bone union was significantly higher than that in bone nonunion (0.87 ± 0.07 vs. 0.80 ± 0.07, P = 0.014). CONCLUSION: Compared to the bone union, the PVR growth was significantly lower, whereas the HI and EFI was significantly higher in the bone nonunion. Moreover, the circulating level of urea, magnesium and lymphocyte count was also different between these two. Therefore, the PVR, HI and EFI seems to be reliable and sensitive indicators to reflect the bone nonunion during DO, which might be considered in bone lengthening. Further prospective studies are still needed to elaborate the concerned issues.