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External Rotation (external + rotation)
Selected AbstractsNeurological recovery in obstetric brachial plexus injuries: an historical cohort studyDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 2 2004Agnes F Hoeksma MD An historical cohort study was conducted to investigate the rate and extent of neurological recovery in obstetric brachial plexus injury (OBPI) and to identify possible prognostic factors in a cohort of children with OBPI from birth to 7 years. All children (n=56; 31 females, 25 males) with OBPI were evaluated at fixed time intervals by one examiner. They underwent a final neurological examination at a mean age of 3 years 10 months (range 1 to 7 years). Neurological outcome was not as favourable as is often reported: complete neurological recovery occurred in 37 out of 56 children (66%). In half of these there was delayed recovery, in which case complete neurological recovery was assessed from 1.5 to 16 months of age (median age 6.5 months, SD 4.2 months). External rotation and supination were the last to recover and recovered the least. Although biceps function at three months was considered to be the best indicator for operative treatment, external rotation and supination were found to be better in predicting eventual complete recovery. Initial symptoms directly post partum were not found to be prognostic. Functional outcome was mainly reported to be good. [source] Long-term follow-up of children with obstetric brachial plexus palsy I: functional aspectsDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 3 2007Christina Strömbeck MD The aims of this study were to describe the development of sequelae in obstetric brachial plexus palsy (OBPP) and to identify possible differences in functional outcome from 5 years of age to follow-up, 2 to 15 years later. A cohort of 70 participants (35 males, 35 females; age range 7-20y, mean 13y 6mo [SD 4y 3mo], median 13y) with OBPP of varying degrees of severity were monitored. Differences in status between 5 years of age and follow-up were studied. Active joint motion in the shoulder and hand function, especially grip strength, generally remained unchanged or improved, whereas a slight but significant deterioration occurred in elbow function. Shoulder surgery resulted in considerable improvement of shoulder function. Participants with nerve reconstruction had a similar profile of change as the non-operated group. It was concluded that ongoing follow-up of children with OBPP, beyond the preschool years, is required due to decreases in elbow function, a commonly occurring restriction in external rotation of the shoulder, together with individual variations in long-term outcomes. In a related article (part II: neurophysiological aspects) long-term neurophysiological and sensory aspects of OBPP are reported. [source] Neurological recovery in obstetric brachial plexus injuries: an historical cohort studyDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 2 2004Agnes F Hoeksma MD An historical cohort study was conducted to investigate the rate and extent of neurological recovery in obstetric brachial plexus injury (OBPI) and to identify possible prognostic factors in a cohort of children with OBPI from birth to 7 years. All children (n=56; 31 females, 25 males) with OBPI were evaluated at fixed time intervals by one examiner. They underwent a final neurological examination at a mean age of 3 years 10 months (range 1 to 7 years). Neurological outcome was not as favourable as is often reported: complete neurological recovery occurred in 37 out of 56 children (66%). In half of these there was delayed recovery, in which case complete neurological recovery was assessed from 1.5 to 16 months of age (median age 6.5 months, SD 4.2 months). External rotation and supination were the last to recover and recovered the least. Although biceps function at three months was considered to be the best indicator for operative treatment, external rotation and supination were found to be better in predicting eventual complete recovery. Initial symptoms directly post partum were not found to be prognostic. Functional outcome was mainly reported to be good. [source] Knee kinematics in medial osteoarthritis during in vivo weight-bearing activitiesJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 12 2009Satoshi Hamai Abstract Dynamic knee kinematics were analyzed for medial osteoarthritic (OA) knees in three activities, including two types of maximum knee flexion. Continuous x-ray images of kneeling, squatting, and stair climbing motions were taken using a large flat panel detector. CT-derived bone models were used for the model registration-based 3D kinematic measurements. Three-dimensional joint kinematics and contact locations were determined using two methods: bone-fixed coordinate systems and by interrogation of CT-based bone model surfaces. The femur exhibited gradual external rotation with knee flexion for kneeling and squatting activities, and gradual internal rotation with knee extension for stair climbing. From 100° to 120° flexion, contact locations showed a medial pivot pattern similar to normal knees. However, knees with medial OA displayed a femoral internal rotation bias and less posterior translation when compared with normal knees. A classic screw-home movement was not observed in OA knees near extension. Decreased variability with both activities and methods of calculation were demonstrated for all three activities. In conclusion, the weight-bearing kinematics of patients with medial OA differs from normal knees. Pathological changes of the articulating surfaces and the ligaments correspond to observed abnormalities in knee kinematics. © 2009 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 27:1555,1561, 2009 [source] Sex differences in coupled knee motions during the transition from non-weight bearing to weight bearingJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 6 2009Sandra J. Shultz Abstract Knee ligament injuries frequently happen when the joint transitions from non-weight bearing (NWB) to weight bearing (WB). To gain insight into the mechanism that produces these injuries, physically active females (N,=,41) and males (N,=,39) underwent measurement of coupled tibiofemoral joint displacements [anterior tibial translation (ATT) and varus,valgus and internal,external rotations] and neuromuscular responses as the knee transitioned from NWB to WB in response to a 40% body weight load applied under the control of gravity. The transition from NWB to WB produced no difference in ATT between males and females; however, significant sex-based differences were noted for both transverse and frontal plane knee motions. With the knee NWB, females were in a greater absolute valgus compared to males (6.6 vs. 5.0°), and moved through greater varus motion than males during the transition from NW to WB (2.3 vs. 1.4°), resulting in similar valgus alignment for both sexes at peak WB (4.3 vs. 3.6°). In the transverse plane, the knees of females were positioned in more external rotation compared to males when NWB (1.4 vs. ,0.3°), then females externally rotated their knees while males internally rotated their knees during the transition from NWB to WB. This resulted in a 3.4° difference in transverse plane knee position at peak WB (2.3 vs. ,1.1°). Our findings suggest that the coupled knee motions produced during the transition from NWB to WB are sex dependent, and may provide insight into the knee motion patterns that place females at increased risk of knee ligament injury. © 2008 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 27: 717,723, 2009 [source] Dynamic activity dependence of in vivo normal knee kinematicsJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 4 2008Taka-aki Moro-oka Abstract Dynamic knee kinematics were analyzed for normal knees in three activities, including two different types of maximum knee flexion. Continuous X-ray images of kneel, squat, and stair climb motions were taken using a large flat panel detector. CT-derived bone models were used for model registration-based 3D kinematic measurement. Three-dimensional joint kinematics and contact locations were determined using three methods: bone-fixed coordinate systems, interrogation of CT-based bone model surfaces, and interrogation of MR-based articular cartilage model surfaces. The femur exhibited gradual external rotation throughout the flexion range. Tibiofemoral contact exhibited external rotation, with contact locations translating posterior while maintaining 15° to 20° external rotation from 20° to 80° of flexion. From 80° to maximum flexion, contact locations showed a medial pivot pattern. Kinematics based on bone-fixed coordinate systems differed from kinematics based on interrogation of CT and MR surfaces. Knee kinematics varied significantly by activity, especially in deep flexion. No posterior subluxation occurred for either femoral condyle in maximum knee flexion. Normal knees accommodate a range of motions during various activities while maintaining geometric joint congruency. © Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 26:428,434, 2008 [source] Kinematic analysis of kneeling in cruciate-retaining and posterior-stabilized total knee arthroplastiesJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 4 2008Satoshi Hamai Abstract Kneeling is an important function of the knee for many activities of daily living. In this study, we evaluated the in vivo kinematics of kneeling after total knee arthroplasty (TKA) using radiographic based image-matching techniques. Kneeling from 90 to 120° of knee flexion produced a posterior femoral rollback after both cruciate-retaining and posterior-stabilized TKA. It could be assumed that the posterior cruciate ligament and the post-cam mechanism were functioning. The posterior-stabilized TKA design had contact regions located far posterior on the tibial insert in comparison to the cruciate-retaining TKA. Specifically, the lateral femoral condyle in posterior-stabilized TKA translated to the posterior edge of the tibial surface, although there was no finding of subluxation. After posterior-stabilized TKA, the contact position of the post-cam translated to the posterior medial corner of the post with external rotation of the femoral component. Because edge loading can induce accelerated polyethylene wear, the configuration of the post-cam mechanism should be designed to provide a larger contact area when the femoral component rotates. © 2007 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 26:435,442, 2008 [source] Measurement of varus,valgus and internal,external rotational knee laxities in vivo,Part II: relationship with anterior,posterior and general joint laxity in males and femalesJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 8 2007Sandra J. Shultz Abstract We examined sex differences in general joint laxity (GJL), and anterior,posterior displacement (ANT,POST), varus,valgus rotation (VR,VL), and internal,external rotation (INT,EXT) knee laxities, and determined whether greater ANT and GJL predicted greater VR,VL and INT,EXT. Twenty subjects were measured for GJL, and scored on a scale of 0,9. ANT and POST were measured using a standard knee arthrometer at 133 N. VR,VL and INT,EXT were measured using a custom joint laxity testing device, defined as the angular displacements (deg) of the tibia relative to the femur produced by 0,10 Nm of varus,valgus torques, and 0,5 Nm of internal,external torques, respectively. INT,EXT were measured during both non-weight-bearing (NWB) and weight-bearing (WB,=,40% body weight) conditions while VR,VL were measured NWB. All laxity measures were greater for females compared to males except for POST. ANT and GJL positively predicted 62.5% of the variance in VR,VL and 41.8% of the variance in WB INT,EXT. ANT was the sole predictor of INT,EXT in NWB, explaining 42.3% of the variance. These findings suggest that subjects who score higher on clinical measures of GJL and ANT are also likely to have greater VR,VL and INT,EXT knee laxities. © 2007 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 25:989,996, 2007 [source] The role of M. popliteus in unpredictable and in self-initiated balance provocationsJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 3 2006Ann-Katrin Stensdotter Abstract The purpose of this study was to determine whether m. popliteus (POP) activity would contribute to the control of knee joint position in unpredictable and in self-initiated provocations of standing balance. Ten healthy women (age 25.2,±,4.5 years, means and SD) without known knee pathology were tested for postural reactions (1) to unpredictable support surface translations in anterior and posterior directions, and (2) in self-initiated balance provocations in a reaction time (RT) forward reach-and-grip task. Electromyographic activity was recorded from POP and other leg muscles plus the deltoid muscle. Three-dimensional kinematics were captured for the knee joint and the body centre of mass was calculated. POP was active first of all the muscles recorded, regardless of translation direction, and knee joint movements elicited were either knee extension or external rotation of the tibia. In the RT task, the POP was active after initiation of reaching movement, and there was little consistency in the kinematic response. POP activity was not direction specific in response to support surface translation, but appeared triggered from reactive knee joint movement. The response to the support-surface translation suggests that POP served to control knee joint position rather than posture. In the RT task, we could not deduce whether POP activity was attributed to knee joint control or to postural control. © 2006 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 24:524,530, 2006 [source] A biomechanical study on flexible intramedullary nails used to treat pediatric femoral fracturesJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 6 2005Jason K. Green Abstract Flexible intramedullary nails have been indicated to treat femoral fractures in pediatric patients. The purpose of this study was to examine the stability of simulated transverse fractures after retrograde intramedullary flexible nail fixation. Various nail diameter combinations were tested using composite femurs in bending, torsion, and a combined axial/bending test where a vertical compressive force was applied to the femoral head. The cross-sectional percent area fill of the nails within the femurs was also determined. In 4 point bending, the greatest repair stiffness was 12% of the intact stiffness. In torsion, the greatest stiffness was 1% of the intact stiffness for either internal or external rotation. The greatest repair stiffness was 80% of the intact stiffness for a compressive load applied to the femoral head. Nail combinations with single nail diameters greater than 40% of the mid-shaft canal width, as measured from an AP radiograph, prevented the fracture from being reduced and left a posterior gap. Flexible intramedullary nails may be of value in the treatment of pediatric femoral fractures, but care must be taken to insert nails that are correctly sized for the canal and to protect the healing fracture from high torsional and bending loads. © 2005 Orthopaedic Research Society. Published by Elsevier Ltd. All rights reserved. [source] Effects of rotation on measurement of lower limb alignment for knee osteotomyJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 6 2004Hideo Kawakami Abstract The purposes of this study were to clarify the effects of rotation on two-dimensional measurement of lower limb alignment for knee osteotomy using a three-dimensional method and to determine whether this 3-D simulation method could help with planning of knee osteotomy. We developed computer software to calculate femorotibial angle (FTA) and hip,knee,ankle angle (HKA) and simulate knee osteotomy from a CT-based 3-D bone model of the lower limb. Lower limb rotation on anteroposterior long-standing radiographs was measured by superimposing the 3-D bone models. Changes in alignment with limb rotation were calculated using the software. FTA after virtual closed-wedged osteotomy was measured for a hypothetical case of a rotation error of the osteotomy plane in reattaching the proximal cutting surface to the distal cutting surface. For 31 varus knees in 20 patients with medial compartment arthritis, the mean rotation angle, relative to the epicondylar axis, with variable limb position was 7.4 ± 3.9° of internal rotation (mean ± SD), ranging from 8° of external rotation to 14° of internal rotation; the mean changes in FTA and HKA were 3.5 ± 2.2° (range, 0.4,8.6) and 1.6 ± 1.3° (range, 0.2,4.9), respectively. The FTA "flexion angle" (lateral view alignment from neutral AP) and the absolute HKA "flexion angle" correlated with the change in FTA and HKA with limb rotation, respectively (FTA, R = 0.999; HKA, R = 0.993). The mean change in FTA after virtual closed-wedged osteotomy was 3.2° for internal and external 10° rotation errors in reattaching the osteotomy plane. Rotation may affect measurement of lower limb alignment for knee osteotomy, and 3-D methods are preferable for surgical planning. © 2004 Orthopaedic Research Society. Published by Elsevier Ltd. All rights reserved. [source] Kinematics of the knee at high flexion angles: An in vitro investigationJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 1 2004Guoan Li Abstract Restoration of knee function after total knee, meniscus, or cruciate ligament surgery requires an understanding of knee behavior throughout the entire range of knee motion. However, little data are available regarding knee kinematics and kinetics at flexion angles greater than 120° (high flexion). In this study, 13° cadaveric human knee specimens were tested using an in vitro robotic experimental setup. Tibial anteroposterior translation and internal,external rotation were measured along the passive path and under simulated muscle loading from full extension to 150° of flexion. Anterior tibial translation was observed in the unloaded passive path throughout, with a peak of 31.2 ± 13.2 mm at 150°. Internal tibial rotation increased with flexion to 150° on the passive path to a maximum of 11.1 ± 6.7°. The simulated muscle loads affected tibial translation and rotation between full extension and 120° of knee flexion. Interestingly, at high flexion, the application of muscle loads had little effect on tibial translation and rotation when compared to values at 120°. The kinematic behavior of the knee at 150° was markedly different from that measured at other flexion angles. Muscle loads appear to play a minimal role in influencing tibial translation and rotation at maximal flexion. The results imply that the knee is highly constrained at high flexion, which could be due in part to compression of the posterior soft tissues (posterior capsule, menisci, muscle, fat, and skin) between the tibia and the femur. © 2003 Orthopaedic Research Society. Published by Elsevier Ltd. All rights reserved. [source] Vascular endothelial growth factor 121 and 165 in the subacromial bursa are involved in shoulder joint contracture in type II diabetics with rotator cuff diseaseJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 6 2003Akiyoshi Handa Vascular endothelial growth factor (VEGF) is a glycoprotein that plays an important role in neovascularization and increases vascular permeability. We reported that VEGF is involved in motion pain of patients with rotator cuff disease by causing synovial proliferation in the subacromial bursa (SAB). The present study investigates whether VEGF is also involved in the development of shoulder contracture in diabetics with rotator cuff disease. We examined 67 patients with rotator cuff disease, including 36 with complete cuff tears, 20 with incomplete tears, and 11 without apparent tears (subacromial bursitis). The patients were into groups according to the presence or absence of diabetes (14 type II diabetics and 53 non-diabetics). Specimens of the synovium of the SAB were obtained from all patients during surgery. Expression of the VEGF gene in the synovium of the subacromial bursa was evaluated by using the reverse transcriptase polymerase chain reaction. The VEGF protein was localized by immunohistochemistry, and the number of vessels was evaluated based on CD34 immunoreactivity. The results showed that VEGF mRNA was expressed in significantly more diabetics (100%, 14/14) than in non-diabetics (70%, 37/53) (P = 0.0159, Fisher's test). Investigation of VEGF isoform expression revealed VEGF121 in all 14 diabetics and in 37 of the 53 non-diabetics, VEGF 165 in 12 of the 14 diabetics and in 21 of the 53 non-diabetics, and VEGF 189 in 1 of the 14 diabetics and in 2 of the 53 non-diabetics. No VEGF206 was expressed in either group. VEGF protein was localized in both vascular endothelial cells and synovial lining cells. The mean number of VEGF-positive vessels and the vessel area were also significantly greater in the diabetics (p < 0.015, Mann-Whitney U test). Synovial proliferation and shoulder joint contracture were more common in the diabetics (P = 0.0329 and P = 0.073, respectively; Fisher's test). The mean preoperative range of shoulder motion significantly differed in terms of elevation between two groups: 103.8° in diabetics and 124.9° in no diabetics (p = 0.0039 Mann,Whitney U test). In contrast, external rotation did not significantly differ: 44° in diabetics and 49° in non-diabetics (p ° 0.4957, Mann,Whitney U test). These results suggest that VEGF121 and VEGF165 expression in the SAB is responsible for the development of shoulder joint contracture, especially in elevation, among type II diabetic patients with rotator cuff disease. © 2003 Orthopaedic Research Society. Published by Elsevier Science Ltd. All rights reserved. [source] Total obstetric brachial plexus palsy: Results and strategy of microsurgical reconstructionMICROSURGERY, Issue 3 2010Tarek A. El-gammal M.D. From 2000 to 2006, 35 infants with total obstetric brachial plexus palsy underwent brachial plexus exploration and reconstruction. The mean age at surgery was 10.8 months (range 3,60 months), and the median age was 8 months. All infants were followed for at least 2.5 years (range 2.5,7.3 years) with an average follow-up of 4.2 years. Assessment was performed using the Toronto Active Movement scale. Surgical procedures included neurolysis, neuroma excision and interposition nerve grafting and neurotization, using spinal accessory nerve, intercostals and contralateral C7 root. Satisfactory recovery was obtained in 37.1% of cases for shoulder abduction; 54.3% for shoulder external rotation; 75.1% for elbow flexion; 77.1% for elbow extension; 61.1% for finger flexion, 31.4% for wrist extension and 45.8% for fingers extension. Using the Raimondi score, 18 cases (53%) achieved a score of three or more (functional hand). The mean Raimondi score significantly improved postoperatively as compared to the preoperative mean: 2.73 versus 1, and showed negative significant correlation with age at surgery. In total, obstetrical brachial plexus palsy, early intervention is recommended. Intercostal neurotization is preferred for restoration of elbow flexion. Tendon transfer may be required to improve external rotation in selected cases. Apparently, intact C8 and T1 roots should be left alone if the patient has partial hand recovery, no Horner syndrome, and was operated early (3- or 4-months old). Apparently, intact nonfunctioning lower roots with no response to electrical stimulation, especially in the presence of Horner syndrome, should be neurotized with the best available intraplexal donor. © 2010 Wiley-Liss, Inc. Microsurgery, 2010. [source] Prospective blinded comparison of surface versus wire electromyographic analysis of muscle recruitment in shoulder instabilityPHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 1 2009Anju Jaggi Abstract Background.,This pilot study assesses level of agreement between surface and fine-wire electromyography (EMG), in order to establish if surface is as reliable as fine wire in the diagnosis and treatment of abnormal muscle patterning in the shoulder.,Method.,Eighteen participants (11 female) with unstable shoulders were recruited after written consent and ethical approval. Anthropometric information and mean skinfold size for triceps, subscapular, biceps and suprailiac sites were obtained. Triple-stud self-adhesive surface electrodes ('Triode'; Thermo Scientific, Physio Med Services, Glossop, Derbyshire, England) were placed over pectoralis major (PM), latissimus dorsi (LD), anterior deltoid (AD) and infraspinatus (IS) at standardized locations. Participants performed five identical uniplanar standard movements (flexion, abduction, external rotation, extension and cross-body adduction). After a 20-minute rest period, a dual-needle technique for fine-wire insertion was performed and the standard movements were repeated. An experienced examiner in each technique reported if muscle activation patterns differed from agreed normal during any movement and were blinded to the other test results. Sensitivity, specificity and Kappa values for level of agreement between methods were calculated for each muscle according to the method of Altman (1991).,Results.,Fifteen participants were successfully tested. Sensitivity, specificity and Kappa values between techniques for each muscle were PM (57%, 50%, 0.07), LD (38%, 85%, 0.22), AD (0%, 76%, ,0.19) and IS (85%, 75%, 0.6). Only IS demonstrated high sensitivity and specificity and a moderate level of agreement between the two techniques. There was no correlation between skinfold size and agreement levels.,Conclusion.,The use of surface EMG may help to classify types of shoulder instability and recognize abnormal muscle patterns. It may allow physiotherapists to direct specific rehabilitation strategies, avoiding strengthening of inappropriate muscles. It has a reasonable degree of confidence to evaluate IS but may have poor sensitivity in detecting abnormal patterns in PM, LD and AD. Further work is required to see if investigator interpretation may have been a factor for the poor level of agreement. Copyright © 2008 John Wiley & Sons, Ltd. [source] Motor performance in very preterm infants before and after implementation of the newborn individualized developmental care and assessment programme in a neonatal intensive care unitACTA PAEDIATRICA, Issue 6 2009Anna Ullenhag Abstract Aim: To compare motor performance in supine position at the age of 4-months corrected age (CA) in very preterm (VPT) infants cared for in a neonatal intensive care unit (NICU) before and after the implementation of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP). Methods: Assessments of motor performance in supine position according to level of motor development and quality of motor performance were made, using the Structured Observation of Motor Performance in Infants (SOMP-I). Subjects: VPT infants cared for in a NICU at a Swedish university hospital before, Group A (n = 68), and after, Group B (n = 58), the implementation of developmentally supportive care based on NIDCAP. Results: The infants who were treated after the introduction of NIDCAP showed higher level of motor development in the arms/hands and trunk. No significant group differences were noted in total deviation score for the respective limbs, but lower frequency of lateral flexion in head movements, extension,external rotation,abduction, extension,internal rotation,adduction and varus and valgus position in the feet was found in the NIDCAP group, compared with those treated before the introduction. Conclusion: The infants who were treated after NIDCAP care had been implemented showed a higher level of motor development in arms/hand and trunk and fewer deviations in head, legs and feet at 4-months CA than infants treated before NIDCAP implementation. The observed changes may be due to NIDCAP and/or improved perinatal and neonatal care during the studied time period. [source] Clinical significance of suprascapular nerve mobilizationCLINICAL ANATOMY, Issue 8 2005Kale D. Bodily Abstract The anatomy of the suprascapular nerve is important to surgeons when focal nerve lesions necessitate surgical repair. Recent experience with a patient who had a complete suprascapular nerve lesion in the retroclavicular region (combined with axillary and musculocutaneous nerve lesions) is presented to illustrate that successful direct nerve repair is possible despite resection of a neuroma. Specifically, we found that neurolysis and mobilization of the suprascapular nerve and release of the superior transverse scapular ligament provided the necessary nerve length to achieve direct nerve repair after the neuroma was removed. A combined supraclavicular and infraclavicular approach to the suprascapular nerve provided excellent visualization, especially in the retroclavicular region. Postoperatively, the patient recovered complete shoulder abduction and external rotation with the direct repair, an outcome uncommonly achieved with interpositional grafting. Based on our operative experience, we set out to quantify the length that the suprascapular nerve could be mobilized with neurolysis. Mobilization of the nerve and release of the superior transverse scapular ligament generated an average of 1.6 cm and 0.7 cm of extra nerve length respectively, totaling 2.3 cm of additional usable nerve length overall. The ability to expose the suprascapular nerve in the retroclavicular/infraclavicular region and to mobilize the suprascapular nerve for possible direct repair has not been previously emphasized and is clinically important. This surgical approach and technique permits direct nerve repair after resection of a focal neuroma in the retroclavicular or infraclavicular region, thus avoiding interpositional grafting, and improving outcomes. Clin. Anat. 18:573,579, 2005. © 2005 Wiley-Liss, Inc. [source] Sex differences in coupled knee motions during the transition from non-weight bearing to weight bearingJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 6 2009Sandra J. Shultz Abstract Knee ligament injuries frequently happen when the joint transitions from non-weight bearing (NWB) to weight bearing (WB). To gain insight into the mechanism that produces these injuries, physically active females (N,=,41) and males (N,=,39) underwent measurement of coupled tibiofemoral joint displacements [anterior tibial translation (ATT) and varus,valgus and internal,external rotations] and neuromuscular responses as the knee transitioned from NWB to WB in response to a 40% body weight load applied under the control of gravity. The transition from NWB to WB produced no difference in ATT between males and females; however, significant sex-based differences were noted for both transverse and frontal plane knee motions. With the knee NWB, females were in a greater absolute valgus compared to males (6.6 vs. 5.0°), and moved through greater varus motion than males during the transition from NW to WB (2.3 vs. 1.4°), resulting in similar valgus alignment for both sexes at peak WB (4.3 vs. 3.6°). In the transverse plane, the knees of females were positioned in more external rotation compared to males when NWB (1.4 vs. ,0.3°), then females externally rotated their knees while males internally rotated their knees during the transition from NWB to WB. This resulted in a 3.4° difference in transverse plane knee position at peak WB (2.3 vs. ,1.1°). Our findings suggest that the coupled knee motions produced during the transition from NWB to WB are sex dependent, and may provide insight into the knee motion patterns that place females at increased risk of knee ligament injury. © 2008 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 27: 717,723, 2009 [source] Three-dimensional knee joint kinematics during golf swing and stationary cycling after total knee arthroplastyJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 12 2008Satoshi Hamai Abstract The expectation of returning to sports activities after total knee arthroplasty (TKA) has become more important to patients than ever. To our knowledge, no studies have been published evaluating the three-dimensional knee joint kinematics during sports activity after TKA. Continuous X-ray images of the golf swing and stationary cycling were taken using a large flat panel detector for four and eight post-arthroplasty knees, respectively. The implant flexion and axial rotation angles were determined using a radiographic-based, image-matching technique. Both the golf swing from the set-up position to the top of the backswing, and the stationary cycling from the top position of the crank to the bottom position of the crank, produced progressive axial rotational motions (p,=,0.73). However, the golf swing from the top of the backswing to the end of the follow-through produced significantly larger magnitudes of rotational motions in comparison to stationary cycling (p,<,0.01). Excessive internal,external rotations generated from the top of the backswing to the end of the follow-through could contribute to accelerated polyethylene wear. However, gradual rotational movements were consistently demonstrated during the stationary cycling. Therefore, stationary cycling is recommended rather than playing golf for patients following a TKA who wish to remain physically active. © 2008 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res [source] Verification of skin-based markers for 3-dimensional kinematic analysis of the equine tarsal jointEQUINE VETERINARY JOURNAL, Issue 8 2004S. KHUMSAP Summary Reasons for performing study: Kinematic studies are usually based on tracking markers attached to the skin. However, complex joints, such as the tarsal joint, function in 3-dimensions (3D), and have therefore necessitated application of the invasive bone pin technique, limiting kinematic studies to the research laboratory. This study investigates the feasibility of using skin-based markers for 3D analysis of tarsal joint motion. Hypothesis: Three-dimensional motions of the tarsal joint can be measured with an acceptable degree of accuracy using skin markers. Methods: Retroreflective markers were attached over the tibial and metatarsal segments. Markers were tracked automatically at trot. Three-dimensional skin correction algorithms were used for correction of skin displacement, and 3D motions derived from the corrected (CSD) and uncorrected (USD) skin displacement were compared with data from a previous study in which those motions were described using bone-fixed markers (BFM) by correlation, root mean square errors (RMS) and shape agreement (SA) of the curves. Results: The RMS of BFM and CSD were smaller than those of BFM and USD for all motions. The correlation coefficients of BFM and CSD were higher than those of BFM and USD. SA was good or fair for all motions except internal/external rotation and medial/lateral translation. Conclusions and potential relevance: With appropriate correction for skin movement relative to skeletal landmarks, skin markers can identify tarsal 3D motions for flexion/extension, abduction/adduction, cranial/caudal translation, and proximal/distal translation, allowing analysis and comparison of information between horses during swing and stance phases. [source] | |||||||||||||