Participants with restricted dominant shoulder internal rotation range of motion demonstrate no side-to-side difference in humeral head translation; and no difference before and after joint mobilization: a pilot study.

[Purpose] To compare humeral head translation (HHT) during shoulder elevation between dominant and non-dominant shoulders in participants with limited dominant shoulder internal rotation range of motion (ROM). To determine if joint mobilization alters HHT, and if relationships exist between the bicipital forearm angle and HHT. [Participants and Methods] Fifteen (9 female) participants (age 25.7 ± 6.8 years) with a minimum 15-degree dominant shoulder internal rotation ROM deficit compared to the opposite shoulder participated. All participants underwent bicipital forearm angle (BFA) measurements and ultrasound imaging to measure acromiohumeral and posterior glenohumeral distances in 3 positions: Resting, 90 degrees of shoulder flexion, and 60 degrees of shoulder abduction with full external rotation. Ultrasound images were used to calculate HHT. Participants' dominant shoulders underwent posterior glide mobilization, followed immediately by repeated ultrasound images and ROM measures. [Results] There was no dominant to non-dominant shoulder, or before and after mobilization HHT differences. No correlations existed between bicipital forearm angles and HHT or ROM gains after mobilization. [Conclusion] Participants with internal rotation ROM loss demonstrated symmetrical HHT. Joint mobilization increased ROM, but HHT was unchanged. No relationships existed between BFA and HHT.

Differentiation of strains in the lateral and medial bands of the iliofemoral ligament: A segmental approach.

Iliofemoral ligament strains have been assessed in a circumscribed portion, limiting the information regarding the strains in the proximal, mid and distal portions. The purpose of this study is to describe the longitudinal and transversal strain within the proximal, mid and distal portions of the lateral and medial bands of the iliofemoral ligament. Ten fresh cadaveric specimens were assessed. The iliofemoral ligaments were divided into medial and lateral bands. Hemispherical beads (2.6 mm) were placed on the lateral and medial borders of each band. Four positions were assessed: abduction, extension, internal and external rotations combined with extension. The hemispherical beads were scanned at the end range of motion using a laser scanner. The three-dimensional position of each bead was used to estimate longitudinal and transversal strains. A three-factor ANOVA was used to compare movements, borders, and portions within each ligament for longitudinal strains. A one-way ANOVA was used to compare transversal strains between portions. This technique showed mean reliability (ICC: 2, 1) of 0.90 ± 0.06. The external rotation showed the highest strains in both ligaments (p < 0.05). Abduction showed a significant difference between the lateral and medial borders in both bands (p = 0.001). Eight movement-border combinations showed a significant difference between proximal, medial, and lateral portions (p < 0.005). According to our results, there is a clear effect of portions (proximal, mid and distal) within the ligament and movements. Abduction shows the lowest strains longitudinally but the largest strains transversally. Although we do not know the impact of this phenomenon, future studies should assess the strains following hip arthroscopies. The latter might improve the impact of this procedure on hip biomechanics. Lastly, the iliofemoral ligament should be assessed using a segmental approach rather than as a complete unit.

Effect of lacertus fibrosus release on perineural pressure of the median nerve at the elbow: a cadaveric study.

PURPOSE: The lacertus fibrosus (or bicipital aponeurosis) is a potential site of proximal median neuropathy at the elbow. Lacertus syndrome with motor and/or sensory symptoms has been addressed with a minimally invasive surgical lacertus release. This study evaluates if a lacertus release alters the maximal perineural pressure (Pmax) of the median nerve at the level of the lacertus fibrosus during elbow flexion. METHODS: Seven upper limbs from four fresh cadavers were included. Perineural pressure of the median nerve at the level of the lacertus fibrosus was measured continuously during automated elbow flexions by the biceps brachii muscle. RESULTS: The mean Pmax before the lacertus release was significantly different than the mean Pmax after the lacertus release (669.15 mmHg vs 77.01 mmHg, p = 0.0180). The mean Pmax after the lacertus release decreased with an average 81.41%. CONCLUSION: A simple surgical release of the lacertus fibrosus significantly decreases the maximal perineural pressure of the median nerve at the level of the lacertus fibrosus during elbow flexion.

The trapeziometacarpal screw home torque mechanism as a clinical indicator of the posterior joint ligament complex integrity: A cadaveric investigation.

BACKGROUND: To date, no clinical test provides specific objective information on the integrity of key ligamentous support of the trapeziometacarpal (TMC) joint. PURPOSE: To examine the potential of the TMC joint screw home torque mechanism (SHTM) in estimating the integrity of the posterior ligament complex in older adult population. STUDY DESIGN: Cross-sectional laboratory-based study. METHODS: Twenty cadaver hands presenting with various degrees of TMC joint degradation ranging from none to severe osteoarthritis (OA) were radiographed in multiple positions to establish their degeneration status, joint mobility, and amount of dorsal subluxation at rest and with the application of the SHTM. Comparisons and correlations between degeneration status, joint mobility, subluxation reduction and ligament status obtained from dissection were calculated. RESULTS: No significant statistical correlation was demonstrated with the subluxation reduction ratio of the SHTM and the combined ligament complex value however, a moderate negative correlation was found with dorsal central ligament injury at 21 Nm (τb = -0.46, p < 0.05) and 34 Nm (τb = -0.45, p < 0.05). A statistically significant reduction of radial subluxation of the TMC joint was observed between the subluxation at rest (M = 5.2, SD = 1.9) and subluxation with SHTM of 21 Nm (M = 4.4, SD = 2.4), t (19) = 3.2, p = 0.01, 95% CI [0.3, 1.4] and subluxation with SHTM of 34 Nm (M = 4.3, SD = 2.6), t (19) = 2.6, p = 0.02, 95% CI [0.2, 1.5]. CONCLUSION: Our results did not support the SHTM as indicator of the TMC posterior ligament complex integrity however, it demonstrated 100% stabilization effect with non-arthritic TMC population.

Variability of Intradiscal Pressure During Cervical Spine Posterior-Anterior Mobilization: A Cadaveric Investigation.

OBJECTIVES: The purpose of this study was to investigate in cadaveric specimens the reliability of measuring cervical intradiscal pressure (CIDP) and if posterior-anterior (PA) mobilizations targeting the cervical spine were associated with CIDP changes. METHODS: Cervical PA mobilizations were performed on the spinous processes of 7 (3 men, 4 women) cadaveric specimens using a servo-controlled linear actuator to provide 25N and 45N forces. CIDP measurements were performed at C4-5, C5-6, C6-7, and C7-T1 intervertebral discs (IVDs) using a fiberoptic catheter system that recorded CIDP for each IVD cervical segment. To assess CIDP measurement reliability, the intraclass correlation coefficient (ICC [3,k]) was calculated. Repeated measures Friedman analysis of variance assessed effect of cervical mobilizations on CIDP for before, during, and immediately after mobilization at 25N and 45N forces for each cervical IVD segment. RESULTS: All CIDP measurements demonstrated excellent reliability (ICC >0.98). During the 25N mobilizations, the median CIDP varied from -0.12 to 0.91 (interquartile range, 5.22-5.36), while for 45N mobilizations the median ranged from -0.94 to 1.21 (interquartile range, -7.74 to 43.49). These changes were not statistically significant (P > .40) during 25N and 45N PA mobilizations, with the exception of C5-6 CIDP at 25N and 45N (P = .05 and .018, respectively). CONCLUSION: There was high CIDP variability between cadavers during and after mobilization. Mobilizations of 1 cervical vertebra resulted in both CIDP increase or decrease at adjacent and remote cervical IVD segments that were not consistent. Cervical PA mobilizations produced variable CIDP changes at adjacent and remote cervical segments in cadavers.

Application of Ultrasound in Spine Kinematic Determination: A Systemic Review.

Spine kinematic determination is required to diagnose or rehabilitate back pain due to spinal instability. Ultrasound imaging, as a less harmful and cost-effective method, has been recently applied to kinematic analysis. This study reviews all available published articles to see how much progress has been made in spine kinematic measurement by ultrasound. In this regard, we searched PubMed, Scopus, and Google Scholar among all available studies until 2021, using keywords such as ultrasound, spine, kinematics, rotation, twist, flexion, and bending. Finally, after identifying and scanning 183 articles, only nine articles were included, which analyzed spine kinematics by ultrasound. Among these nine articles, three reported axial displacements, three reported flexion/extension, and three reported axial rotation. Although ultrasound is a suitable alternative to other kinematic measurement methods, very little research and progress have been made in this area. Today, this method is still not used practically for spine kinematic measurement because the bone scans via ultrasound imaging are challenging to understand, and no three-dimensional kinematic measurement technique has been reported. However, recent advances in converting ultrasound images into three-dimensional images can pave the way for further improvements.

The median sacral artery in rectal blood supply: A cadaveric study.

INTRODUCTION: Insufficient blood supply to the posterior rectal remnant after proctectomy is a possible mechanism for anastomotic leakage. The median sacral artery (MSA) is not generally considered to participate in the rectal blood supply, although some case studies have reported the rectum being supplied by it. The aim of this study is to elucidate the anatomy of the MSA in relation to the posterior rectal wall. METHODS: Nineteen embalmed cadavers (12 males, seven females; mean age: 76 ± 9 years) were injected with a colored radio-opaque mixture in the aortic bifurcation, radiographed and subsequently dissected along the sacrum. The relationship between the MSA and the rectum was observed and the diameter of the MSA was measured 2 cm below the aortic bifurcation. RESULTS: MSAs were identified in 16 (84.2%) of the 19 cadavers. Nine MSAs (47.4%) reached the rectal wall and penetrated it. MSAs that reached the posterior rectum took two different routes in the presacral space. Dissection and radiography showed four penetrating MSAs (21.1%) ending in a branching pattern and five (26.3%) as a tapering vessel. Seven MSAs (36.8%) did not reach the rectal wall. The mean MSA diameter was 1.98 ± 0.12 mm. CONCLUSIONS: Almost half the MSAs reached and penetrated the posterior rectal wall, suggesting possible participation in the rectal blood supply. A large portion of the MSAs that penetrate the rectal wall run outside surgical margins and could continue to provide blood supply to the rectal remnant, potentially preventing anastomotic leakage.

Influence of Standardized Procedures on the Reliability of Hip Clinical Assessment.

OBJECTIVE: This study evaluated a standardized and personalized approach to verify the effects of conditions on intrarater and interrater reliability, standard error of measurement, and minimal detectable difference for provocative tests and range-of-motion (ROM) tests used in hip pain assessment: flexion-adduction-internal rotation (FADIR), flexion-abduction-external rotation-extension (FABER), and hip internal rotation with 90° of hip flexion (hip IR). METHODS: Nineteen participants (mean [± SD] age = 24 ± 2 years; 10 women and 9 men) without lower limb or back pain were recruited. Three raters evaluated each participant during 2 testing sessions, 1 day apart. Raters performed the 3 tests in 4 conditions: classic (C), controlled pressure duration (CPD), subject-specific position (SSP), and mixed (M = CPD + SSP). RESULTS: For intrarater reliability, the CPD condition showed the highest intraclass correlation coefficients (ICCs; mean and 95% confidence interval [CI]) for hip IRROM (0.83; 95% CI, 0.53-0.94) and FADIRROM (0.75; 95% CI, 0.60-0.89). The SSP condition showed the highest ICCs for FABERheight (0.71; 95% CI, 0.42-0.87) and FABERROM (0.62; 95% CI, 0.27-0.83). Concerning interrater reliability, the classic condition presented the highest ICCs for FABER variables (height: 0.54; 95% CI, 0.28-0.76; ROM: 0.58; 95% CI, 0.32-0.79) and hip IR ROM (0.72; 95% CI, 0.51-0.87). The CPD condition showed the highest ICC for FADIRROM (0.57; 95% CI, 0.32-0.78). CONCLUSION: In the conditions of this study, CPD showed the highest ICCs for hip IRROM and FADIRROM, and SSP showed the highest ICCs for FABERheight and FABERROM.

Accuracy of Ultrasound-Guided Pudendal Nerve Block in the Ischial Spine and Alcock's Canal Levels: A Cadaveric Study.

BACKGROUND: Blockade of the pudendal nerve (PN) using ultrasound (US) guidance has been described at the levels of the ischial spine and Alcock's canal. However, no study has been conducted to compare anatomical accuracy between different approaches in targeting the PN. OBJECTIVE: To investigate the accuracy of US-guided injection of the PN at the ischial spine and Alcock's canal levels. This study also compared the accuracy of the infiltrations by three sonographers with different levels of experience. SUBJECTS: Eight Thiel-embalmed cadavers (16 hemipelvises). METHODS: Three physiatrists trained in musculoskeletal US imaging with 12 years, five years, and one year of experience performed the injections. Each injected a 0.1-mL bolus of colored dye in both hemipelvises of each cadaver at the ischial spine and Alcock's canal levels under US guidance. Each cadaver received three injections per hemipelvis. The accuracy of the injection was determined following hemipelvis dissection by an anatomist. RESULTS: The injections were accurate 33 times out of the total 42 attempts, resulting in 78% accuracy. Sixteen out of 21 injections at the ischial spine level were on target (76% accuracy), while the approach at Alcock's canal level yielded 17 successful injections (81% accuracy). The difference between the approaches was not statistically significant. There was also no significant difference in accuracy between the operators. CONCLUSIONS: US-guided injection of the PN can be performed accurately at both the ischial spine and Alcock's canal levels. The difference between the approaches was not statistically significant.

Accuracy of unguided and ultrasound guided Coracohumeral ligament infiltrations - a feasibility cadaveric case series.

BACKGROUND: Coracohumeral ligament (CHL) thickening, contracture, and fibroplasia have been identified in glenohumeral idiopathic adhesive capsulitis (GHIAC). The CHL is the main structure responsible for the range of motion limitations. Favorable outcomes have been reported with CHL surgical release. Intra-articular glenohumeral joint corticosteroid infiltrations are utilized to disrupt the inflammatory process and reduce pain in GHIAC. The aim of this study was to investigate whether the CHL could be accurately targeted with a periligamentous infiltration. METHODS: A convenience sample of 12 unembalmed cadaver shoulders (mean age: 74.5 years, range 66-87 years) without evidence of previous injury or surgery were utilized in this exploratory double factor feasibility cadaveric (unguided and ultrasound (US) guided) case series. Two clinicians trained in musculoskeletal infiltration techniques carried out the infiltrations on each shoulder with colored latex. One clinician infiltrated without guidance, the other with US-guidance. The injecting clinicians were blinded to the others infiltration procedure and the order was randomized. An anatomist blinded to the infiltration order performed a shoulder dissection and recorded the infiltrate location. Percentage calculation for accuracy of infiltration and a chi-square evaluation of the difference between unguided and US-guided infiltrations was applied. RESULTS: An accuracy of 75% was achieved for unguided infiltration and 80% for US-guided infiltration techniques. Chi-squared indicated there was no significant difference (p = 0.82) between the unguided and US-guided techniques. CONCLUSION: US-guided and unguided infiltrations achieved good accuracy targeting the CHL, suggesting infiltrations can specifically and accurately target the CHL. In vivo investigation using such infiltration techniques are warranted.

Quantification and Reliability of Hip Internal Rotation and the FADIR Test in Supine Position Using a Smartphone Application in an Asymptomatic Population.

OBJECTIVE: The purpose of this study was to quantify and report the intrarater and interrater reliability of hip internal rotation (IR) range of motion supine with the hip and knee at 90° of flexion and for the flexion-adduction-internal rotation (FADIR) test. Hip internal rotation measured in a lying supine position with the hip and knee at 90° of flexion revealed information on hip impairments. To date no simple quantification approach has been presented in this position; therefore, the FADIR test has not been quantified yet. METHODS: Twenty participants (mean ± standard deviation [SD] age, 24.0 ± 2.1 years; 10 women and 10 men) without lower-limb or back pain were recruited. Three raters evaluated each participant during 2 testing sessions, 1 day apart. A built-in smartphone compass application was used to obtain the hip IR range of motion in both procedures. RESULTS: Mean (± SD) supine IR was 51.7° (± 9.7°) and 62.6° (± 11.4°) for men and women, respectively. Concerning the FADIR test, mean values were 41.8° (± 9.64°) and 50.1° (± 8.0°) for men and women, respectively. The mean intrarater and interrater reliability coefficients were 0.80 and 0.72 for hip IR and 0.75 and 0.40 for the FADIR test. The standard error of the mean ranged from 4.8° to 8.3° (minimal detectable difference [MDD], 13.3° to 22.9°) for hip IR and from 4.6° to 10.3° (MDD, 12.8° to 28.6°) for the FADIR test. CONCLUSION: Overall, the smartphone compass application is adequate to quantify hip IR in a lying supine position. However, the poor to moderate interrater reliability in the FADIR test and the size of the MDD values suggest that the FADIR test should be standardized.

Three-Dimensional Spinal Position With and Without Manual Distraction Load Increases Spinal Height.

OBJECTIVE: The purpose of this study was to investigate if spinal height increases using 3-dimensional (3-D) spinal position with and without manual distraction load and to assess the correlation between spine height changes and degrees of trunk rotation. METHODS: Fifty-six participants were randomly placed in one of two groups: (1) 3-D spinal position with manual distraction load, and (2) without manual distraction load. Spinal height was measured before and after the interventions using a stadiometer. For the statistical analysis, we used a 2 (Loading status: pre- versus post-intervention height) X 2 (3-D spinal position: with versus without manual distraction load) repeated measures Analysis of Variance (ANOVA) was used to identify significant interaction and main effects. Paired t-tests were used to calculate differences in spinal height changes between the two interventions. Pearson correlation coefficient was used to measure correlations between changes in spinal heights and degrees of trunk rotation. RESULTS: Mean spinal height increase with 3-D spinal position with and without manual distraction load was 6.30 mm (±6.22) and 5.69 mm (±4.13), respectively. No significant interaction effect was present between loading status and 3-D spinal position but a significant main effect in loading status was. Paired t-tests revealed significant differences in spinal heights between pre-and post-3-D spinal position with and without manual distraction load. No significant correlation was measured between trunk rotation and spinal height changes. CONCLUSION: 3-D spinal position with or without distraction load increased spinal height. This suggests that 3-D spinal positioning without manual distraction could be used in home settings to help maintain intervertebral disc (IVD) health.

3D augmented reality mirror visual feedback therapy applied to the treatment of persistent, unilateral upper extremity neuropathic pain: a preliminary study.

Objective: We assessed whether or not pain relief could be achieved with a new system that combines 3D augmented reality system (3DARS) and the principles of mirror visual feedback. Methods: Twenty-two patients between 18 and 75 years of age who suffered of chronic neuropathic pain. Each patient performed five 3DARS sessions treatment of 20 mins spread over a period of one week. The following pain parameters were assessed: (1) visual analogic scale after each treatment session (2) McGill pain scale and DN4 questionnaire were completed before the first session and 24 h after the last session. Results: The mean improvement of VAS per session was 29% (p < 0.001). There was an immediate session effect demonstrating a systematic improvement in pain between the beginning and the end of each session. We noted that this pain reduction was partially preserved until the next session. If we compare the pain level at baseline and 24 h after the last session, there was a significant decrease (p < 0.001) of pain of 37%. There was a significant decrease (p < 0.001) on the McGill Pain Questionnaire and DN4 questionnaire (p < 0.01). Conclusion: Our results indicate that 3DARS induced a significant pain decrease for patients who presented chronic neuropathic pain in a unilateral upper extremity. While further research is necessary before definitive conclusions can be drawn, clinicians could implement the approach as a preparatory adjunct for providing temporary pain relief aimed at enhancing chronic pain patients' tolerance of manual therapy and exercise intervention. Level of Evidence: 4.

Assessment of Lumbar Spine Height Following Sustained Lumbar Extension Posture: Comparison Between Musculoskeletal Ultrasonography and Stadiometry.

OBJECTIVES: The purpose of this study was to correlate sitting height measured by stadiometry with lumbar spine height (LSH) modifications measured by musculoskeletal ultrasonography (MSU). METHODS: Eighteen healthy young adults were recruited for this study (mean age: 21.5 ± 1.5 years). All subjects were tested in the following sequence: (1) lying supine for 10 minutes, (2) sitting under loaded (9.5 kg) and unloaded conditions for 5 minutes each, (3) lying supine for 15 minutes with passive lumbar extension, and (4) sitting unloaded for 5 minutes. Both stadiometry and MSU measurements were taken after each step of the testing sequence. RESULTS: Following the loaded sitting step, sitting height (measured by stadiometry) decreased by 3.4 ± 1.6 mm, whereas following sustained lumbar extension, sitting height increased by 5.4 ± 3.5 mm (P < .05). Following loaded sitting and sustained lumbar extension, LSH decreased by 3.8 ± 1.7 mm and increased by 6.2 ± 4.1 mm, respectively (P < .05). On the basis of the mean differences (between the different steps of the testing sequence), the mean correlation coefficient and the mean coefficient of determination between stadiometry and MSU measurements were calculated at 0.93 ± 0.07 and 0.88 ± 0.13, respectively, and no statistical differences were observed (P > .05). CONCLUSIONS: In vivo measurements of sitting height changes, measured using stadiometry, were strongly correlated with LSH changes, measured using ultrasonography.

Head repositioning accuracy in patients with neck pain and asymptomatic subjects: concurrent validity, influence of motion speed, motion direction and target distance.

BACKGROUND: Cervicocephalic kinesthetic deficiencies have been demonstrated in patients with chronic neck pain (NP). On the other hand, authors emphasized the use of different motion speeds for assessing functional impairment of the cervical spine. PURPOSE: The objectives of this study were (1) to investigate the head repositioning accuracy in NP patients and control subjects and (2) to assess the influence of target distance, motion speed, motion direction and pain. MATERIALS AND METHODS: Seventy-one subjects (36 healthy subjects and 35 NP patients; age 30-55 years) performed the head repositioning test (HRT) at two different speeds for horizontal and vertical movements and at two different distances. For each condition, six consecutive trials were sampled. RESULTS: The study showed the validity and reproducibility of the HRT, confirming a dysfunctional threshold of 4.5°. Normative values of head repositioning error up to 3.6° and 7.1° were identified for healthy and NP subjects, respectively. A distance of 180 cm from the target and a natural motion speed increased HRT accuracy. Repositioning after extension movement showed a significantly larger error in both groups. Intensity, duration of pain as well as pain level did not significantly alter head repositioning error. CONCLUSIONS: The assessment of proprioceptive performance in healthy and NP subjects allowed the validation of the HRT. The HRT is a simple, not expensive and fast test, easily implementable in daily practice to assess and monitor treatment and evolution of proprioceptive cervical deficits.

Head-trunk kinematics during high-velocity-low-amplitude manipulation of the cervical spine in asymptomatic subjects: helical axis computation and anatomic motion modeling.

OBJECTIVE: This study aimed to analyze the in vivo 3-dimensional kinematics of the head during cervical manipulation including helical axis (HA) computation and anatomic motion representation. METHODS: Twelve asymptomatic volunteers were included in this study. An osteopathic practitioner performed 1 to 3 manipulations (high-velocity and low-amplitude [HVLA] multiple component technique) of the cervical spine (between C2 and C5) with the patient in the sitting position. During manipulation, head motion was collected using an optoelectronic system and expressed relative to the thorax. Motion data were processed to analyze primary and coupled motions and HA parameters. Anatomic motion representation including HA was obtained. RESULTS: During manipulation, average maximal range of motion was 39° (SD, 6°), 21° (SD, 7°), and 8° (SD, 5°) for lateral bending (LB), axial rotation (AR), and flexion extension, respectively. For the impulse period, magnitude averaged of 8° (SD, 2°), 5° (SD, 2°), and 3° (SD, 2°), for LB, AR, and flexion extension, respectively. Mean impulse velocity was 139°/s (SD, 39°/s). Concerning AR/LB ratios, an average of 0.6 (SD, 0.3) was observed for global motion, premanipulation positioning, and impulse. Mean HA was mostly located ipsilateral to the impulse side and displayed an oblique orientation. CONCLUSION: This study demonstrated limited range of AR during cervical spine manipulation and provided new perspectives for the development of visualization tools, which might be helpful for practitioners and for the analysis of cervical manipulation using HA computation and anatomic representation of motion.

Effects of lower limb neurodynamic mobilization on intraneural fluid dispersion of the fourth lumbar nerve root: an unembalmed cadaveric investigation.

OBJECTIVES: Manual and physical therapists incorporate neurodynamic mobilisation (NDM) to improve function and decrease pain. Little is known about the mechanisms by which these interventions affect neural tissue. The objective of this research was to assess the effects of repetitive straight leg raise (SLR) NDM on the fluid dynamics within the fourth lumbar nerve root in unembalmed cadavers. METHODS: A biomimetic solution (Toluidine Blue Stock 1% and Plasma) was injected intraneurally, deep to the epineurium, into the L4 nerve roots of seven unembalmed cadavers. The initial dye spread was allowed to stabilise and measured with a digital calliper. Once the initial longitudinal dye spread stabilised, an intervention strategy (repetitive SLR) was applied incorporating NDMs (stretch/relax cycles) at a rate of 30 repetitions per minute for 5 minutes. Post-intervention calliper measurements of the longitudinal dye spread were measured. RESULTS: The mean experimental posttest longitudinal dye spread measurement (1.1 ± 0.9 mm) was significantly greater (P = 0.02) than the initial stabilised pretest longitudinal dye spread measurement. Increases ranged from 0.0 to 2.6 mm and represented an average of 7.9% and up to an 18.1% increase in longitudinal dye spread. DISCUSSION: Passive NDM in the form of repetitive SLR induced a significant increase in longitudinal fluid dispersion in the L4 nerve root of human cadaveric specimen. Lower limb NDM may be beneficial in promoting nerve function by limiting or altering intraneural fluid accumulation within the nerve root, thus preventing the adverse effects of intraneural oedema.

The relationship between various anatomical landmarks used for localizing the first rib during surface palpation.

OBJECTIVES: To assess the relationship between anatomical landmarks used to locate the first rib during surface palpation. One currently cited technique suggests locating the width of the transverse processes (TPs) of the first cervical vertebrae (C1) to determine the estimated width of the first thoracic vertebrae (T1) TP, allowing for subsequent palpation of the first rib laterally to the transverse process of T1. Based on anatomical structural relationships, the authors propose an additional method of locating the first rib, lateral to T1 TP, by palpating through the trapezius muscle at the width of the mastoid process (MP). METHODS: Overlying tissue of the bilateral MP, C1 TPs, and T1 TPs of 28 cadavers were removed. Measurements of the left to right spans at the following structures were collected using a digital caliper: mastoid process, C1 TP, and T1 TP. Measurements were used to determine the agreement between each anatomical structural span. RESULTS: The mean absolute difference (standard deviation, SD) between C1 TP span versus T1 TP span was 3.9 (±2.58) mm with an intraclass correlation coefficient (ICC) of 0.88 (95% CI = 2.9-4.9). The mean absolute difference between MP span and T1 TP span was 35.4 (±6.46) mm with an ICC of 0.71 (95% CI = 33.0-37.8). DISCUSSION: This study confirms the anatomical accuracy and feasibility of using the C1 TP span to determine the general width of the T1 TP span while palpating for the first rib just lateral to the T1 TP. Additionally, this study demonstrates that the more easily palpated mastoid process serves as an effective landmark to identify a width sufficiently lateral to the T1 TP, appropriate for first rib palpation through the trapezius muscle.

Assessing adverse events associated with chiropractic care in preschool pediatric population: a feasibility study.

BACKGROUND: Manual therapies are commonly used by healthcare professionals when caring for children. However, few prospective studies have evaluated their adverse events (AEs). This study aims to assess the feasibility of a pragmatic prospective study aiming to report the immediate and delayed (48-hours post-treatment) AEs associated with manual therapies in children aged 5 or younger. Preliminary data on AEs frequency are also reported. METHODS: Between July 2021 and March 2022, chiropractors were recruited through purposive sampling and via a dedicated Facebook group for Quebec chiropractors interested in pediatrics. Legal guardians of patients aged 5 or younger were invited to fill out an online information and consent form. AEs were collected using the SafetyNET reporting system, which had been previously translated by the research team. Immediate AEs were collected through a questionnaire filled out by the legal guardian immediately after the treatment, while delayed AEs were collected through a questionnaire sent by email to the legal guardian 48 h after the treatment. Feasibility was assessed qualitatively through feedback from chiropractors and quantitatively through recruitment data. RESULTS: Overall, a total of 28 chiropractors expressed interest following the Facebook publication, and 5 participated. An additional two chiropractors were enrolled through purposive sampling. In total, 80 legal guardians consented to their child's participation, and data from 73 children were included for the analysis of AEs. At least one AE was reported in 30% of children (22/73), and AEs were mainly observed immediately following the treatment (16/22). The most common AEs were irritability/crying (11 children) or fatigue/tiredness (11 children). Feasibility analysis demonstrated that regular communication between the research team and clinicians, as well as targeting clinicians who showed great interest in pediatrics, were key factors for successful research. CONCLUSION: Results suggest that it is feasible to conduct a prospective pragmatic study evaluating AEs associated with manual therapies in private practices. Direct communication with the clinicians, a strategic clinicians' recruitment plan, and the resulting administrative burden should be considered in future studies. A larger study is required to confirm the frequency of AEs reported in the current study. TRIAL REGISTRATION: ClinicalTrials.gov., NCT05409859, Registered on June 3 2022. https://clinicaltrials.gov/study/NCT05409859 .