Méthodes d'exploration de la force musculaire: Une analyse critique

Return to play decision after shoulder dislocation in upper limb athletes: Critical analysis between the habits of medical professionals and the literature

BACKGROUND

The return to field is a critical moment for an athlete who has dislocated his shoulder as there is a significant risk of recurrence. The decision to return to field made by the doctor will therefore be crucial for the smooth continuation of the athlete's career.

HYPOTHESIS

This objective is to compare the criteria most used by specialists in clearing an overhead athlete to return to competition after a first episode of antero-internal dislocation of the glenohumeral joint with or without surgery and those mentioned in the literature.

PATIENTS AND METHODS

The target population consisted of French-speaking physicians in orthopedic surgery, physical medicine and rehabilitation or sports medicine. This study was conducted by the means of a questionnaire. The questionnaire was validated by three experts in sports medicine and published on an online survey website.

RESULTS

Sixty-three medical specialists responded to the questionnaire. On average, they use more than nine criteria to decide if an athlete is fit to return to competition. Over the 12 criteria proposed, four are used by more than 90% of respondents: laxity/instability, pain, range of motion and patient's subjective feeling. The methods used to evaluate certain criteria such as pain, joint range or muscular strength are often subjective and very often not validated by the literature.

CONCLUSION

Doctors use a set of criteria to allow an overhead athlete to return to competition. This study highlights that the techniques employed to evaluate these criteria are not always thoroughly validated by literature reviews.

LEVEL OF EVIDENCE

III; observational study.

Development and Performance Evaluation of a Smart Upper-Limb Rehabilitation Exercise Device

User-friendly rehabilitation medical devices can enhance health and the quality of life through the convergence of information communication and medical technology. Muscle contraction enables bodily movement, and the assessment of muscle strength is crucial. Muscle contraction includes isometric, isotonic, and isokinetic types. Many individuals with physical disabilities rely on wheelchairs due to lower-limb paralysis. There is a substantial correlation between the level of upper-limb functional recovery and the quality of daily life. This study aimed to design and evaluate a device that utilizes various muscle contractions to enhance the effectiveness of upper-limb rehabilitation exercises. The results from the isometric performance assessment showed percentage error rates of >30% for 5-30 kg. Correction equations were employed, and the isometric performance assessment resulted in error rates below 2.1% for 5-30 kg. Isokinetic performance assessment using video analysis evaluated a consistent wire speed from 10 cm/s to 70 cm/s with an average error rate of 0.91% across all speeds. This study demonstrates the ability to accurately measure various muscle contractions and showcases the potential for real-time feedback. This highlights how such a device could be helpful for target groups, including older adults and individuals with disabilities, during upper-limb rehabilitation exercises.

Morbidity of long head of the triceps motor branch neurotization to the axillary nerve: Retrospective subjective and objective assessment of triceps brachii strength after transfer

INTRODUCTION

Morbidity is considered to be negligible in Leechavengvongs transfer (LT) of the long head of the triceps onto the axillary nerve, but the assessment methods used may lack reproducibility. We assessed triceps strength after LT objectively by the isokinetic technique, addressing the following questions: Is strength lowered after LT compared to the healthy limb? And 2) is there a good correlation between isokinetic dynamometry and subjective assessment?

HYPOTHESIS

Isokinetic measurement shows a decrease in triceps strength at peak torque after LT compared to the healthy limb, and this morbidity is underestimated on subjective assessment.

MATERIAL AND METHODS

This single-center retrospective study included patients undergoing LT for axillary nerve trunk palsy between 2008 and 2020, with M5 triceps preoperatively on the British Medical Research Council (BMRC) scale. Twenty patients, with a mean age of 25±9years (range, 15-48years) were assessed at a mean 58±47months (range, 6-174months). Elbow extension strength was assessed on a standardized questionnaire, BMRC isometric test and isokinetic test on an angular course of 90° at 60°/sec and 180°/sec concentrically and 30°/sec excentrically.

RESULTS

Strength at 60°/sec and 180°/sec concentrically and 30°/sec excentrically was significantly lower than in the healthy limb: respectively, -17Nm, -15Nm, and -16Nm, (p<0.001) for a mean -23%. Loss of strength was mainly severe on isokinetic testing and mild on isometric testing. Seven patients reported contracture (35%), 12 fatigue (60%), and 3 weakness (15%). Satisfaction with extension strength was excellent or good for respectively 12 (60%) and 8 patients (40%). Triceps strength was graded BMRC M4 in 9 triceps (11%) and M5 in 11 (55%).

DISCUSSION

After LT, isokinetic measurement found generally severe loss of triceps strength, but without subjective impact on everyday life.

LEVEL OF EVIDENCE

IV; retrospective study.

Assessing the Validity and Reliability of A Low-Cost Microcontroller-Based Load Cell Amplifier for Measuring Lower Limb and Upper Limb Muscular Force

Lower and upper limb maximum muscular force development is an important indicator of physical capacity. Manual muscle testing, load cell coupled with a signal conditioner, and handheld dynamometry are three widely used techniques for measuring isometric muscle strength. Recently, there is a proliferation of low-cost tools that have potential to be used to measure muscle strength. This study examined both the criterion validity, inter-day reliability and intra-day reliability of a microcontroller-based load cell amplifier for quantifying muscle strength. To do so, a low-cost microcontroller-based load cell amplifier for measuring lower and upper limb maximal voluntary isometric muscular force was compared to a commercial grade signal conditioner and to a handheld dynamometer. The results showed that the microcontroller-based load cell amplifier correlated nearly perfectly (Pearson's R-values between 0.947 to 0.992) with the commercial signal conditioner and the handheld dynamometer, and showed good to excellent association when calculating ICC scores, with values of 0.9582 [95% C.I.: 0.9297-0.9752] for inter-day reliability and of 0.9269 [95% C.I.: 0.8909-0.9533] for session one, intra-day reliability. Such results may have implications for how the evaluation of muscle strength measurement is conducted in the future, particularly for offering a commercial-like grade quality, low cost, portable and flexible option.

Objective evaluation of elbow flexion strength and fatigability after nerve transfer in adult traumatic upper brachial plexus injuries

Nerve transfers Oberlin-type are currently used in upper brachial plexus lesions to recover elbow flexion. Is the regained active motion sufficient to resume heavy manual activities? Five adult patients (mean age 37 years) operated of a nerve transfer to recover elbow flexion (transfer of a motor fascicle of the ulnar nerve to the motor branch of the biceps; in three patients, additional transfer from the median to the motor nerve of the brachialis) were clinically and isokinetically evaluated, after a mean follow-up of 47 months. The median Constant-Murley score was 22/100, the DASH 56/100 and the MEPI 60/100. For isokinetic tests the most significant finding was a severe deficit of elbow strength, of about 80%. No patient was able to maintain an isometric contraction during sufficient time to evaluate fatigability. This preliminary study suggests that major functional impairments persist despite early recovery of elbow flexion. These results should be confirmed in a study on a larger group of patients.

Isokinetic muscle strengthening after acquired cerebral damage: a literature review

OBJECTIVE

Isokinetic strengthening is a rehabilitation technique rarely used in stroke patients. However, the potential benefits of force and endurance training in this population are strongly suspected.

METHOD

This literature review synthesizes the results of clinical trials on this topic. The research was conducted on PubMed, using "Stroke", "rehabilitation", "isokinetic", "upper limb" and "training" as keywords.

RESULTS

Seventeen studies focusing on the use of isokinetics in assessment or rehabilitation (six studies) following stroke were reviewed. For the lower limb, muscle strength and walking ability improved after isokinetic rehabilitation programs. For the upper limb, the only two studies found in the literature suggest improvement in the strength of the trained muscles, of grip force, of the Fugl-Meyer motor score and of global functional capacities. This review does not reveal any consensus on the protocols to be implemented: type of muscle contraction, velocities….

CONCLUSION

While isokinetic strengthening has not proven its efficiency in rehabilitation of the upper limb following stroke, its interest with regard to rehabilitation of the lower limbs has been recognized. Randomized controlled trials in this field are necessary to confirm its efficiency, especially concerning upper arm rehabilitation.

Test de repositionnement céphalique : étude de la stabilité de performance

OBJECTIVE

The purpose of the present experiment was to determine the reliability of the cervicocephalic relocation test (CRT).

METHODOLOGY

Thirteen young healthy adults were recruited to undergo a CRT test-retest. The test-retest reliability was determined by repeatedly measuring CR to a neutral position after active movement, with trials approximately 1 hour apart. Each CRT involved 20 CRs to a natural head position, 10 repositioning after right head rotation, and 10 repositioning after left head rotation (with the order of rotation sides randomized). The performance score for each subject for each CRT was the mean of the errors made during the 20 relocations (in degrees).

STUDY RESULTS

The mean rate of error of the first and second trials was 3.2+/-1.1 degrees and 2.9+/-0.9 degrees, respectively. The intra class correlation coefficient was 0.81, and the standard error of measurement 0.90 degrees.

CONCLUSION

CRT testing supports evidence of reliable cervicocephalic performance stability in healthy young adults. CRT shows promise as a relevant tool of assessment in head and neck proprioception.

Évaluation isocinétique de la force musculaire de patients atteints de polyradiculonévrite aiguë

OBJECTIVE

To evaluate the feasibility and the interest of isokinetic measures tests in subjects with inflammatory demyelinating polyradiculoneuropathy or Guillain-Barré syndromes (GBS).

METHODS

Nine patients with GBS are tested at the beginning and after 6 months of recovery stage. They benefit from (1) isokinetic assessment of muscular strength of knee, elbow, ankle: flexion/extension and shoulder abduction/adduction ranging 30 per s at 180 per s angular velocity; (2) isometric assessment of the same muscular groups; (3) manual muscle testing; (4) functional independence measure.

RESULTS

Isokinetic tests were tolerated at 60 and 120 per s. Fatigability appears since the third second of isometric test. The relationships between isokinetic, manual tests and isometric tests are variables (0.29 < r < 0.97). The evaluation after 6 months of recovery showed a good sensibility of isokinetic test.

CONCLUSION

The continuation of this motor isokinetic evaluation, in a large population, will permit to establish longitudinal and evolutive profile of each patient and will facilitate to chose the rehabilitation program.