Short-term effects of a new resistance exercise approach on physical function during chemotherapy after radical breast cancer surgery: a randomized controlled trial.

BACKGROUND: Approximately 30% of post-operative breast cancer patients develop shoulder joint movement disorders affecting routine upper limb movement. This study discusses the impact of a neuromuscular joint facilitation (NJF) method on the physical function of breast cancer patients experiencing shoulder dysfunction during chemotherapy after radical surgery. METHODS: This study included 162 female patients who have unilateral breast cancer in a cancer hospital in China. They developed shoulder joint mobility disorders during chemotherapy within 1-3 months postoperatively. These patients were divided into three groups: NJF, conventional rehabilitation (conventional group), and control groups. The clinical examination included the maximum passive and active range of motion (ROM) of the shoulder (flexion, extension, abduction, adduction, and external and internal rotation). Other evaluations included a pain score using a visual analog scale (VAS), grip strength, and supraspinatus muscle thickness. All tests were evaluated pre-and post-intervention. RESULTS: The NJF group showed a significant increase in all shoulder ROM angles post-intervention. In the conventional group, all other ROM values increased significantly, except passive external rotation ROM. In the control group, all other ROM values increased significantly, except passive and active external rotation ROM. All three groups had decreased VAS scores, increased grip strength, and supraspinatus muscle thickness post-intervention during active abduction. In the control group, the supraspinatus contraction rate decreased significantly at 60° and 90° abduction post-intervention compared to that at pre-intervention. CONCLUSION: This study revealed that NJF during chemotherapy had positive clinical intervention effects, improving shoulder joint mobility disorders, pain, grip strength, and external rotation following radical breast cancer surgery. CLINICAL TRIAL REGISTRATION: Chinese Clinical Trial Registry; https://www.chictr.org.cn/ (ChiCTR2300073170), registered (03/07/2023).

The Delphi of ORACLE: An Expert Consensus Survey for the Development of the Observational Risk Assessment of Contractures (Longitudinal Evaluation).

OBJECTIVE: Despite rising prevalence rates, no standard tool is available to identify individuals at risk of developing contractures. This study aimed to gain expert consensus on items for the development of the Observational Risk Assessment Tool for Contractures: Longitudinal Evaluation (ORACLE) for care home residents. DESIGN: A two-round, online modified Delphi study. PARTICIPANTS: Panellists were qualified healthcare professionals with a background in physiotherapy, occupational therapy, nursing, and rehabilitation medicine. MAIN OUTCOME MEASURES: In the first round, the experts were asked to rate the predesigned list of items on a Likert scale while in the second round, consensus was sought in the areas of disagreement identified in the previous round. RESULTS: The two rounds of the Delphi survey included 30 and 25 panellists, respectively. The average clinical and academic experience of the panellists was 22.2 years and 10.5 years, respectively. The panel demonstrated a high level of consensus regarding the clinical factors (10 out of 15 items); preventive care approaches (9 out of 10 items), and contextual factors (12 out of 13 items) ranging from 70% to 100%. CONCLUSION: This Delphi study determined expert consensus on items to be included in a contracture risk assessment tool (ORACLE). The items were related to factors associated with joint contractures, appropriate preventive care interventions, and potentially relevant contextual factors associated with care home settings. The promise of a risk assessment tool that includes these items has the capacity to reduce the risk of contracture development or progression and to trigger timely and appropriate referrals to help prevent further loss of function and independence.

A new role for joint mobility in reconstructing vertebrate locomotor evolution.

Reconstructions of movement in extinct animals are critical to our understanding of major transformations in vertebrate locomotor evolution. Estimates of joint range of motion (ROM) have long been used to exclude anatomically impossible joint poses from hypothesized gait cycles. Here we demonstrate how comparative ROM data can be harnessed in a different way to better constrain locomotor reconstructions. As a case study, we measured nearly 600,000 poses from the hindlimb joints of the Helmeted Guineafowl and American alligator, which represent an extant phylogenetic bracket for the archosaurian ancestor and its pseudosuchian (crocodilian line) and ornithodiran (bird line) descendants. We then used joint mobility mapping to search for a consistent relationship between full potential joint mobility and the subset of joint poses used during locomotion. We found that walking and running poses are predictably located within full mobility, revealing additional constraints for reconstructions of extinct archosaurs. The inferential framework that we develop here can be expanded to identify ROM-based constraints for other animals and, in turn, will help to unravel the history of vertebrate locomotor evolution.

Importance of hip capsular repair in total hip arthroplasty (THA) via the posterior lateral approach: a five year retrospective cohort study.

PURPOSE: This study aims to assess the impact of repairing the hip joint capsule during posterior-lateral approach total hip arthroplasty (THA) on postoperative hip joint function and late dislocation incidence. METHODS: A retrospective cohort study included 413 patients, divided into experimental (hip joint capsule repair, n = 204) and control (hip joint capsule excision, n = 209) groups. Patients were followed for five years, evaluating postoperative hip range of motion (ROM), dislocation rate, VAS and HHS scores, inflammatory and coagulation markers, hospitalization, blood loss, and body composition. Statistical analysis included the Student's t-test, Chi-square test, and logistic regression for dislocation risk factors. RESULTS: Joint capsule repair improved postoperative hip flexion and extension within six months and at two years postoperatively, internal and external rotation within three months, and abduction and adduction throughout the entire follow-up period (P < 0.05). Capsular repair also reduced early and late dislocation rates (P < 0.05). Significant differences in HHS and VAS scores, inflammatory and coagulation indicators, hospitalization, blood loss, and body composition were noted (P < 0.05). Multivariate logistic regression indicated hip joint repair, rheumatoid arthritis, epilepsy, and sarcopenia as dislocation risk factors (P < 0.05). CONCLUSIONS: Capsular repair during posterior-lateral THA improves postoperative hip function and mobility while reducing dislocation rates, blood loss, pain, inflammation, and economic burden. Patients with rheumatoid arthritis, epilepsy, or sarcopenia require individualized planning and enhanced postoperative care to minimize complications.

In vivo and ex vivo range of motion in the fire salamander Salamandra salamandra.

Joint range of motion (RoM) analyses are fundamental to our understanding of how an animal moves throughout its ecosystem. Recent technological advances allow for more detailed quantification of this RoM (e.g. including interaction of degrees of freedom) both in ex vivo joints and in vivo experiments. Both types of data have been used to draw comparisons with fossils to reconstruct locomotion. Salamanders are often used as analogues for early tetrapod locomotion; testing such hypotheses requires an in-depth analysis of salamander joint RoM. Here, we provide a detailed dataset of the ex vivo ligamentous rotational joint RoM in the hindlimb of the fire salamander Salamandra salamandra, using a new method for collecting and visualising joint RoM. We also characterise in vivo joint RoM used during walking, via scientific rotoscoping and compare the in vivo and ex vivo data. In summary, we provide (1) a new method for joint RoM data experiments and (2) a detailed analysis of both in vivo and ex vivo data of salamander hindlimbs, which can be used for comparative studies.

Spherical frame projections for visualising joint range of motion, and a complementary method to capture mobility data.

Quantifying joint range of motion (RoM), the reachable poses at a joint, has many applications in research and clinical care. Joint RoM measurements can be used to investigate the link between form and function in extant and extinct animals, to diagnose musculoskeletal disorders and injuries or monitor rehabilitation progress. However, it is difficult to visually demonstrate how the rotations of the joint axes interact to produce joint positions. Here, we introduce the spherical frame projection (SFP), which is a novel 3D visualisation technique, paired with a complementary data collection approach. SFP visualisations are intuitive to interpret in relation to the joint anatomy because they 'trace' the motion of the coordinate system of the distal bone at a joint relative to the proximal bone. Furthermore, SFP visualisations incorporate the interactions of degrees of freedom, which is imperative to capture the full joint RoM. For the collection of such joint RoM data, we designed a rig using conventional motion capture systems, including live audio-visual feedback on torques and sampled poses. Thus, we propose that our visualisation and data collection approach can be adapted for wide use in the study of joint function.

[Self-assessment of daily activities using the Duruöz Hand Index-Validation of the German translation]. / Selbstbeurteilung von Alltagsaktivitäten mittels Duruöz-Hand-Index ­ Validierung der deutschen Übersetzung.

BACKGROUND: Independence in activities of daily living depends to a large extent on the upper extremities; however, the instruments widely used in geriatrics to assess self-care abilities do not allow a focus on this body region. In order to map the fluctuating course of hand function-dependent daily living skills with a self-assessment instrument, rheumatologists have developed the Duruöz Hand Index (DHI). OBJECTIVE: The German translation authorized by Duruöz was tested for its applicability in the assessment of geriatric outpatient and day hospital patients and test quality criteria were determined. MATERIAL AND METHODS: Study participants completed the DHI three times. A postgraduate student blinded to the results performed an anamnesis and examination. The geriatric team made an inter-professional assessment of hand function-related daily living skills twice with at least 2­week intervals. RESULTS: Data collection was performed from 16 November 2016 to 27 April 2017 on 101 geriatric day hospital or outpatient patients. Retest reliability was high (0.937), as was internal consistency (Cronbach's α 0.949). Difficulty with activities of daily living correlated more closely with joint mobility (Keitel Index) and fine motor skills (20 cents test) than with hand strength. CONCLUSION: The DHI provides a survey of difficulties with activities of daily living that is focused on the upper extremities. Because about one in three patients required assistance (answering follow-up questions, reading aloud) despite the exclusion of patients with more severely impaired cognition and vision, the examiner should remain present.

[Positioning the hand to act-Validation of the 8-point reaching range test]. / Die Hand positionieren, um zu agieren ­ Validierung des 8-Punkte-Greifraum-Tests.

BACKGROUND: The standardized geriatric assessment of the upper extremities is often limited to measurement of hand strength. The only other instrument mentioned in the S1 guidelines on level 2 geriatric assessment is the 20 cents test (20-C-T); however, in addition to strength and fine motor skills, successful hand placement is a prerequisite for self-care. OBJECTIVE: The 8­point reaching range test (8P-GRT) was developed for standardized separate testing of sides in a seated person concerning hand positioning relevant to daily living. The purpose of the study was to determine quality criteria of the 8P-GRT in geriatric hospital patients. MATERIAL AND METHODS: Between 31 July 2019 and 23 September 2019, a total of 82 inpatients were examined at the Hospital Red Cross Lübeck Geriatrics Center using the 8P-GRT, shoulder pain and disability index (SPADI), a questionnaire on self-care activities corresponding to the hand positions of the 8P-GRT, hand strength measurement and the 20-C­T. RESULTS: The interrater reliability was 0.99 and the retest reliability was 0.95 for the right side and 0.90 for the left side. On the individual level a ceiling effect (both sides score 8) occurred in 4.1% (n = 3) but no floor effect was observed. The internal consistency (Cronbach's alpha) of the two-factorial test according to factor analysis was 0.78 (right) and 0.76 (left). Each of the other tests correlated more closely with the 8P-GRT on the right side, whereby the correlation was highest with the abovenamed questionnaire (-0.72), followed by the SPADI (-0.60). CONCLUSION: A standardized survey of hand strength, fine motor skills and active positioning of the hand (e.g., 8P-GRT) synthesizes the main aspects of upper extremity functioning into an overall picture.

Paleobiological reconstructions of articular function require all six degrees of freedom.

Paleobiologists typically exclude impossible joint poses from reconstructions of extinct animals by estimating the rotational range of motion (ROM) of fossil joints. However, this ubiquitous practice carries the assumption that osteological estimates of ROM consistently overestimate true joint mobility. Because studies founded on ROM-based exclusion have contributed substantially to our understanding of functional and locomotor evolution, it is critical that this assumption be tested. Here, we evaluate whether ROM-based exclusion is, as currently implemented, a reliable strategy. We measured the true mobilities of five intact cadaveric joints using marker-based X-ray Reconstruction of Moving Morphology and compared them to virtual osteological estimates of ROM made allowing (a) only all three rotational, (b) all three rotational and one translational, and (c) all three rotational and all three translational degrees of freedom. We found that allowing combinations of motions in all six degrees of freedom is necessary to ensure that true mobility is always successfully captured. In other words, failing to include joint translations in ROM analyses results in the erroneous exclusion of many joint poses that are possible in life. We therefore suggest that the functional and evolutionary conclusions of existing paleobiological reconstructions may be weakened or even overturned when all six degrees of freedom are considered. We offer an expanded methodological framework for virtual ROM estimation including joint translations and outline recommendations for future ROM-based exclusion studies.

Low elbow mobility indicates unique forelimb posture and function in a giant extinct marsupial.

Joint mobility is a key factor in determining the functional capacity of tetrapod limbs, and is important in palaeobiological reconstructions of extinct animals. Recent advances have been made in quantifying osteological joint mobility using virtual computational methods; however, these approaches generally focus on the proximal limb joints and have seldom been applied to fossil mammals. Palorchestes azael is an enigmatic, extinct ~1000 kg marsupial with no close living relatives, whose functional ecology within Australian Pleistocene environments is poorly understood. Most intriguing is its flattened elbow morphology, which has long been assumed to indicate very low mobility at this important joint. Here, we tested elbow mobility via virtual range of motion (ROM) mapping and helical axis analysis, to quantitatively explore the limits of Palorchestes' elbow movement and compare this with their living and extinct relatives, as well as extant mammals that may represent functional analogues. We find that Palorchestes had the lowest elbow mobility among mammals sampled, even when afforded joint translations in addition to rotational degrees of freedom. This indicates that Palorchestes was limited to crouched forelimb postures, something highly unusual for mammals of this size. Coupled flexion and abduction created a skewed primary axis of movement at the elbow, suggesting an abducted forelimb posture and humeral rotation gait that is not found among marsupials and unlike that seen in any large mammals alive today. This work introduces new quantitative methods and demonstrates the utility of comparative ROM mapping approaches, highlighting that Palorchestes' forelimb function was unlike its contemporaneous relatives and appears to lack clear functional analogues among living mammals.

In vivo human gracilis whole-muscle passive stress-sarcomere strain relationship.

We measured the passive mechanical properties of intact, living human gracilis muscles (n=11 individuals, 10 male and 1 female, age: 33±12 years, mass: 89±23 kg, height: 177±8 cm). Measurements were performed in patients undergoing surgery for free-functioning myocutaneous tissue transfer of the gracilis muscle to restore elbow flexion after brachial plexus injury. Whole-muscle force of the gracilis tendon was measured in four joint configurations (JC1-JC4) with a buckle force transducer placed at the distal tendon. Sarcomere length was also measured by biopsy from the proximal gracilis muscle. After the muscle was removed, a three-dimensional volumetric reconstruction of the muscle was created via photogrammetry. Muscle length from JC1 to JC4 increased by 3.3±1.0, 7.7±1.2, 10.5±1.3 and 13.4±1.2 cm, respectively, corresponding to 15%, 34%, 46% and 59% muscle fiber strain, respectively. Muscle volume and an average optimal fiber length of 23.1±0.7 cm yielded an average muscle physiological cross-sectional area of 6.8±0.7 cm2 which is approximately 3 times that measured previously from cadaveric specimens. Absolute passive tension increased from 0.90±0.21 N in JC1 to 16.50±2.64 N in JC4. As expected, sarcomere length also increased from 3.24±0.08 µm at JC1 to 3.63±0.07 µm at JC4, which are on the descending limb of the human sarcomere length-tension curve. Peak passive muscle stress was 27.8±5.5 kPa in JC4 and muscle modulus ranged from 44.8 MPa in JC1 to 125.7 MPa in JC4. Comparison with other mammalian species indicates that human muscle passive mechanical properties are more similar to rodent muscle than to rabbit muscle. These data provide direct measurements of whole-human muscle passive mechanical properties that can be used in modeling studies and for understanding comparative passive mechanical properties among mammalian muscles.

Comparison of anterior knee laxity, stiffness, genu recurvatum, and general joint laxity in the late follicular phase and the ovulatory phase of the menstrual cycle.

BACKGROUND: One risk factor for anterior cruciate ligament (ACL) injury may be fluctuations in female hormones. This study examined variability in joint laxity, as a risk factor for ACL injury, during the menstrual cycle. METHODS: Subjects were 15 female university students with regular menstrual cycles. We measured estradiol (E2) concentration, anterior knee laxity (AKL), stiffness, genu recurvatum (GR), and general joint laxity (GJL) during the late follicular and ovulatory phases. AKL was measured as anterior tibial displacement of the femur after application of 44-, 89-, and 133-N loads on the tibia. Stiffness was calculated as Δforce/Δdisplacement at loads of 44-89 N and between 89 and 133 N. GR was measured prone, with the base of the patella distal to the edge of the bed. The University of Tokyo joint laxity test was used to evaluate GJL. RESULTS: E2 concentration was significantly higher in the ovulatory phase than in the late follicular phase (p = 0.018), AKL and stiffness did not differ significantly between phases, and GR and GJL were significantly higher in the ovulatory phase than in the late follicular phase (p = 0.011, 0.031). CONCLUSION: These findings suggest that E2 concentrations may affect GR and GJL during the menstrual cycle.

Lower Limb Movement Pattern Differences Between Males and Females in Squatting and Kneeling.

Movement pattern differences may contribute to differential injury or disease prevalence between individuals. The purpose of this study was to identify lower limb movement patterns in high knee flexion, a risk factor for knee osteoarthritis, and to investigate kinematic differences between males and females, as females typically develop knee osteoarthritis more commonly and severely than males. Lower extremity kinematic data were recorded from 110 participants completing 4 variations of squatting and kneeling. Principal component analysis was used to identify principal movements associated with the largest variability in the sample. Across the tasks, similar principal movements emerged at maximal flexion and during transitions. At maximal flexion, females achieved greater knee flexion, facilitated by a wider base of support, which may alter posterior and lateral tibiofemoral stress. Principal movements also detected differences in movement temporality between males and females. When these temporal differences occur due to alterations in movement velocity and/or acceleration, they may elicit changes in muscle activation and knee joint stress. Movement variability identified in the current study provides a framework for potential modifiable factors in high knee flexion, such as foot position, and suggests that kinematic differences between the sexes may contribute to differences in knee osteoarthritis progression.

Assessing the Effects of Kata and Kumite Techniques on Physical Performance in Elite Karatekas.

This study aimed at assessing physical performance of elite karatekas and non-karatekas. More specifically, effects of kumite and kata technique on joint mobility, body stability, and jumping ability were assessed by enrolling twenty-four karatekas and by comparing the results with 18 non-karatekas healthy subjects. Sensor system was composed by a single inertial sensor and optical bars. Karatekas are generally characterized by better motor performance with respect nonkaratekas, considering all the examined factors, i.e., mobility, stability, and jumping. In addition, the two techniques lead to a differentiation in joint mobility; in particular, kumite athletes are characterized by a greater shoulder extension and, in general, by a greater value of preferred velocity to perform joint movements. Conversely, kata athletes are characterized by a greater mobility of the ankle joint. By focusing on jumping skills, kata technique leads to an increase of the concentric phase when performing squat jump. Finally, kata athletes showed better stability inclosed eyes condition. The outcomes reported here can be useful for optimizing coaching programs for both beginners and karatekas based on the specific selected technique.

In vivo kinematics of fixed-bearing total ankle arthroplasty.

BACKGROUND: A good recovery of the physiological mobility of the ankle is an indication of patients' satisfaction after total ankle arthroplasty, which does not generally match that of other consolidated procedures such as hip and knee replacement. The aim of this study was to investigate the kinematics of the Zimmer Total Metal Total Ankle (ZTMTA) during the different exercises. METHODS: Fifteen patients with ZTMTA were enrolled in this study. The patients performed non-weightbearing flexion-extension, stair climbing and descending, and fluoroscopic images were taken to capture the ankle movements. A combined images/three-dimensional models method was used to perform a kinematic analysis. RESULTS: Plantar-dorsiflexion resulted the main plane of movement, with the largest range of motion (ROM) of 23.3 ± 9.0° during flexion-extension. Inversion-eversion and adduction-abduction resulted lower than 10° in any trials. CONCLUSIONS: In the investigated population, the ZTMTA allowed a good recovery of the mobility, with ROMs comparable to the healthy subjects.

Awareness of limited joint mobility in type 2 diabetes in general practice in the Netherlands: an online questionnaire survey.

BACKGROUND: Next to the well-known micro- and macrovascular complications, type 2 diabetes mellitus (T2DM) is associated with musculoskeletal disorders of the upper extremities referred to as limited joint mobility (LJM), e.g. carpal tunnel syndrome (CTS) and adhesive capsulitis. Unrecognized and untreated LJM can lead to poor quality of life and non-compliance to diabetes treatment which aggravates LJM. Despite its reported higher prevalence in international prevalence studies, examination of the upper extremities is still no part of the regular diabetes mellitus (DM) check-ups. The primary aim of this study was therefore to evaluate the awareness of Dutch GPs and nurse practitioners concerning LJM. Secondary aims were to evaluate the current management of a patient with LJM, and to assess opinions regarding the question of who should screen for LJM if this is done in the near future. METHODS: An online survey was conducted among 390 general practitioners (GPs) and 245 nurse practitioners (NPs) of three diabetes care groups in The Netherlands to assess their awareness of the association between DM and LJM. RESULTS: Most GPs are not aware that LJM is a DM complication, with an unawareness for specific upper extremity disorders ranging from 59 to 73%. Of the NPs, 76% is not aware either. Only 41% of GPs would advise the most optimal treatment for diabetes patient with CTS. Finally, only 25% of the GPs believe that screening for LJM should be performed during the regular diabetes check-up compared to 63% of the NPs. CONCLUSION: The majority of GPs and NPs are not aware of LJM as a T2DM complication. In contrast to NPs, most GPs do not believe that screening for LJM should be performed during the regular diabetes check-up.

Correlation between three-dimensional medial longitudinal arch joint complex mobility and medial arch angle in stage II posterior tibial tendon dysfunction.

BACKGROUND: The purpose of this study was to evaluate correlation between three-dimensional medial longitudinal arch joint complex mobility and medial arch angle in stage II posterior tibial tendon dysfunction flatfoot under loading. METHODS: CT scans of 15 healthy feet and 15 feet with stage II posterior tibial tendon dysfunction flatfoot were taken both in non- and simulated weight-bearing condition. The CT images of the hindfoot and medial longitudinal arch bones were reconstructed into three-dimensional models with Mimics and Geomagic reverse engineering software. The three-dimensional complex mobility of each joint in the medial longitudinal arch and their correlation with the medial arch angle change were calculated. RESULTS: From non- to simulated weight-bearing condition, the medial arch angle change and the medial longitudinal arch joints mobility were significant larger in stage II posterior tibial tendon dysfunction flatfoot (p<0.05). The eversion of the talocalcaneal joint, the proximal translation of the calcaneus relative to the talus, the dorsiflexion of the talonavicular joint, the dorsiflexion and abduction of the medial cuneonavicular joint, and the lateral translation of the medial cuneiform relative to the navicular, and the dorsiflexion of the first tarsometatarsal joint were all significantly correlated to the medial arch angle change in stage II posterior tibial tendon dysfunction flatfoot (all r>0.5, p<0.05). CONCLUSIONS: There is increased mobility in the medial longitudinal arch joints in stage II posterior tibial tendon dysfunction flatfoot and the medial arch angle change under loading causes displacement not only at hindfoot joints but also involve midfoot and forefoot joint.

Range of motion of the ankle joint in male Japanese patients undergoing hemodialysis: influence of diabetes and hemodialysis.

[Purpose] The purpose of this study was to analyze ankle range of motion in patients undergoing hemodialysis and those with diabetes. [Participants and Methods] Eight male kidney disease patients without diabetes undergoing hemodialysis and 10 male kidney disease patients with diabetes undergoing hemodialysis were enrolled in this study. For comparison, 27 patients with diabetes not undergoing hemodialysis and 10 healthy participants were included. All participants were divided into 4 groups: patients without diabetes undergoing hemodialysis, patients with diabetes undergoing hemodialysis, patients with diabetes not undergoing hemodialysis, and control group. The measured parameter was the passive range of motion of the ankle joint. [Results] Patients with diabetes not undergoing hemodialysis demonstrated the greatest joint restriction, followed by patients with diabetes undergoing hemodialysis. The main effect of diabetes was observed in ankle range of motion, rather than hemodialysis. There was a significant difference between both the diabetes undergoing hemodialysis and the diabetes not undergoing hemodialysis groups and the other groups. [Conclusion] Limited joint mobility of the ankle in patients undergoing hemodialysis may be affected by diabetes rather than hemodialysis.

ROM mapping of ligamentous constraints on avian hip mobility: implications for extinct ornithodirans.

Studies of soft tissue effects on joint mobility in extant animals can help to constrain hypotheses about joint mobility in extinct animals. However, joint mobility must be considered in three dimensions simultaneously, and applications of mobility data to extinct taxa require both a phylogenetically informed reconstruction of articular morphology and justifications for why specific structures' effects on mobility are inferred to be similar. We manipulated cadaveric hip joints of common quail and recorded biplanar fluoroscopic videos to measure a 'ligamentous' range of motion (ROM), which was then compared to an 'osteological' ROM on a ROM map. Nearly 95% of the joint poses predicted to be possible at the hip based on osteological manipulation were rendered impossible by ligamentous constraints. Because the hip joint capsule reliably includes a ventral ligamentous thickening in extant diapsids, the hip abduction of extinct ornithodirans with an offset femoral head and thin articular cartilage was probably similarly constrained by ligaments as that of birds. Consequently, in the absence of extraordinary evidence to the contrary, our analysis casts doubt on the 'batlike' hip pose traditionally inferred for pterosaurs and basal maniraptorans, and underscores that reconstructions of joint mobility based on manipulations of bones alone can be misleading.

Type 1 diabetes, sport practiced, and ankle joint mobility in young patients: What is the relationship?

BACKGROUND/OBJECTIVE: It is known that patients with diabetes can develop limited joint mobility (LJM) and that this can depend on the metabolic control maintained and the duration of the disease. The aims of this study were to verify the presence of ankle joint mobility (AJM) deficits in both plantar and dorsiflexion in young type 1 diabetic patients (T1D) considering also the possible role of sport practiced as a further factor, able to modify AJM. METHODS: AJM was evaluated by an inclinometer in 82 T1D patients (M/F: 48/34), mean age 12.9 ± 2.6 years, body mass index (BMI) 19.7 ± 3.6 kg/m2 , duration of diabetes 5.6 ± 3.3 years, mean HbA1c 7.5 ± 1.0% and in 226 healthy controls (M/F: 146/80), age-, gender-, and BMI-matched practicing different sports (soccer, volleyball, basketball, and dance). RESULTS: The patients' ankle range of motion was significantly lower than that in controls (132.7 ± 22.3° vs 126.1 ± 17.9°; P < .017). In particular, ankle plantar flexion was significantly lower in the patients group (31.6° ± 7.9° vs 28.5° ± 6.6°; P < .002). Soccer players showed lower AJM in both groups: patients (120.1 ± 15.9° vs 127.3 ± 18.1) and controls (119.4 ± 21.1° vs 142.0 ± 18.1; P < .0001) than subjects practicing other sports or who were sedentary. In both groups, patients and controls, age, sex, duration of disease, hemoglobin 1Ac, and BMI have not been shown to be correlated to the mobility assessed. CONCLUSIONS: The results of this study, in addition to confirming the negative effect of diabetes on AJM of young T1D patients, suggest that during these evaluations the sport-related effect should be considered because it can induce significant changes of AJM.