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Weber M, Rahn J, Hackl M, Leschinger T, Dresing K, Müller LP, Wegmann K, Harbrecht A. Postoperative swelling after elbow surgery: influence of a negative pressure application in comparison to manual lymphatic drainage-a randomized controlled trial. Arch Orthop Trauma Surg 2023; 143:6243-6249. [PMID: 37421514 PMCID: PMC10491702 DOI: 10.1007/s00402-023-04954-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 06/18/2023] [Indexed: 07/10/2023]
Abstract
PURPOSE Postoperative soft tissue swelling is a significant factor influencing outcomes after elbow surgery. It can crucially affect important parameters such as postoperative mobilization, pain, and subsequently the range of motion (ROM) of the affected limb. Furthermore, lymphedema is considered a significant risk factor for numerous postoperative complications. Manual lymphatic drainage is nowadays part of the standardized post-treatment concept, basing on the concept of activating the lymphatic tissue to absorb stagnated fluid from the tissue into the lymphatic system. This prospective study aims to investigate the influence of technical device-assisted negative pressure therapy (NP) on early functional outcomes after elbow surgery. NP was therefore compared to manual lymphatic drainage (MLD). Is a technical device-based NP suitable for treatment of lymphedema after elbow surgery? METHODS A total of 50 consecutive patients undergoing elbow surgery were enrolled. The patients were randomized into 2 groups. 25 participants per group were either treated by conventional MLD or NP. The primary outcome parameter was defined as the circumference of the affected limb in cm postoperative up to seven days postoperatively. The secondary outcome parameter was a subjective perception of pain (measured via visual analogue scale, VAS). All parameters were measured on each day of postoperative inpatient care. RESULTS AND CONCLUSION NP showed an overall equivalent influence compared to MLD in reducing upper limb swelling after surgery. Moreover, the application of NP showed a significant decrease in overall pain perception compared to manual lymphatic drainage on days 2, 4 and 5 after surgery (p < 0.05). CONCLUSION Our findings show that NP could be a useful supplementary device in clinical routine treating postoperative swelling after elbow surgery. Its application is easy, effective and comfortable for the patient. Especially due to the shortage of healthcare workers and physical therapists, there is a need for supportive measures which NP could be.
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Affiliation(s)
- Maximilian Weber
- Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Jürgen Rahn
- Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Michael Hackl
- Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Tim Leschinger
- Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Klaus Dresing
- Department of Trauma, Plastic and Reconstructive Surgery, Georg-August-University Göttingen, Robert-Koch-Strasse 40, 37075, Göttingen, Germany
| | - Lars P Müller
- Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Kilian Wegmann
- Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Andreas Harbrecht
- Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
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Vincent JI, MacDermid JC, King GJW, Grewal R. The Patient-Rated Elbow Evaluation and the American Shoulder and Elbow Surgeons-Elbow form capture aspects of functioning that are important to patients with elbow injuries. J Hand Ther 2021; 34:415-422. [PMID: 32327289 DOI: 10.1016/j.jht.2020.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 01/20/2020] [Accepted: 02/04/2020] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN This is a cross-sectional study. INTRODUCTION The Patient-Rated Elbow Evaluation (PREE) and the self-report section of the American Shoulder Elbow Surgeons-elbow form (pASES-e) are two important elbow-specific self-report measures used in routine clinical practice. PURPOSE OF THE STUDY To use the International Classification of Functioning Disability and Health (ICF) to link aspects of functioning that are reported using the Patient-Specific Functional Scale by a cohort of patients with elbow disorders and compare it to the content of the PREE and the pASES-e. METHODS One hundred patients with a variety of elbow disorders (mean age and SD 53.88 (14.51); M: F 48: 52) were recruited from the Roth-McFarlane Hand and Upper Limb Centre. They self-reported important aspects of functioning using the Patient-Specific Functional Scale. These concerns were linked to the ICF using formal linking procedures. These ICF categories were compared to the categories related to the PREE and the pASES-e. Linking was carried out by two independent raters, and agreement was calculated using percentage agreement. RESULTS A total of 423 self-reported functional activities were linked to 25 second-level ICF categories from the activity and participation domain. Commonly reported activities were D640 doing housework (52%); D540 dressing (47%); and D475 driving (35%). PREE had better coverage of the patient concerns (71%) than pASES-e (50%). D475-driving (35%) and D440-fine hand use (24%) were the 2 major categories that were not captured by the questionnaires. Agreement between the raters was 90.5%. DISCUSSION This study established that the PREE and the pASES-e were able to capture aspects of functioning important to patients and that align with the ICF, with this happening to a greater extent on the PREE than the pASES-e. Because all patients reported concerns from the activity and participation section ('d' categories) of the ICF, this validated that these PROMs measure this conceptual domain. CONCLUSION The PREE provided more comprehensive coverage of patients' functional concerns than the pASES-e.
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Affiliation(s)
- Joshua I Vincent
- School of Physical Therapy, Western University, London, ON, Canada; Roth-McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada.
| | - Joy C MacDermid
- School of Physical Therapy, Western University, London, ON, Canada; Roth-McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada; Department of Surgery, University of Western Ontario, London, ON, Canada
| | - Graham J W King
- Roth-McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada; Department of Surgery, Western University, London, ON, Canada
| | - Ruby Grewal
- Roth-McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada; Department of Surgery, Western University, London, ON, Canada
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Abstract
A sound knowledge of the elbow anatomy and biomechanics is critical to understanding the pathology of various elbow disorders and instigating appropriate management. The elbow joint is a trochoginglymoid joint: that is, it has flexion-extension [ginglymoid] motion at the ulnohumeral and radiocapitellar articulations and pronation and supination [trochoid] motion at the proximal radioulnar joint. Stability of the elbow joint is achieved through static and dynamic components. The aim of this article is to concisely describe the anatomy and biomechanics of the elbow joint relevant to the practice of trauma and orthopaedic surgeons.
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Giannicola G, Sessa P, Calella P, Gumina S, Cinotti G. Chronic complex persistent elbow instability: a consecutive and prospective case series and review of recent literature. J Shoulder Elbow Surg 2020; 29:e103-e117. [PMID: 32197771 DOI: 10.1016/j.jse.2019.11.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 11/10/2019] [Accepted: 11/16/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Chronic complex persistent elbow instability (CCPEI) is a condition that even expert elbow surgeons find challenging to treat. The results of the few studies that have dealt with the treatment of this condition are conflicting. We describe the surgical results of a consecutive prospective series of patients with CCPEI and provide a review of the recent literature. METHODS We assessed 21 patients with previous failed surgical or conservative treatment, with a terrible-triad injury in 13, Monteggia-like lesion in 6, humeral shear fracture-dislocation in 1, and radial head fracture-dislocation in 1. Overall, 21 open débridement procedures, 15 ulnar nerve transpositions, 6 ulnar in situ neurolysis procedures, 7 total elbow arthroplasties, 8 radial head arthroplasties, 1 radial head resection with humeroradial anconeus interpositional arthroplasty, 4 coronoid graft reconstructions, 14 ligament retensioning procedures, 3 ulnar nonunion treatments, and 2 ulnar osteotomies were performed. Two dynamic external fixators were applied. The Mayo Elbow Performance Score, quick Disabilities of the Arm, Shoulder and Hand score, and modified American Shoulder and Elbow Surgeons score were used preoperatively and postoperatively. RESULTS The mean follow-up period was 29.4 months. A significant improvement was found between preoperative and postoperative clinical scores and range-of-motion values. The reintervention and major complication rates were 19% and 23%, respectively. Arthritic evolution was observed in 71% of the cases. CONCLUSIONS CCPEI is a challenging condition with an uncertain prognosis. The variability in patients' pathoanatomic conditions requires customized surgical treatment aimed at elbow stabilizer reconstruction when the ulnohumeral joint is preserved or aimed at joint replacement in case of severe articular degeneration. The time interval between the initial trauma and index surgical procedure significantly affects the feasibility of reconstructive procedures.
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Affiliation(s)
- Giuseppe Giannicola
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, "Sapienza" University of Rome-Policlinico Umberto I, Rome, Italy
| | - Pasquale Sessa
- Department of Orthopedics and Traumatology, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy.
| | - Piergiorgio Calella
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, "Sapienza" University of Rome-Policlinico Umberto I, Rome, Italy
| | - Stefano Gumina
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, "Sapienza" University of Rome, Polo Pontino, Latina, Italy
| | - Gianluca Cinotti
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, "Sapienza" University of Rome-Policlinico Umberto I, Rome, Italy
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Zhou Y, Cai JY, Chen S, Liu S, Wang W, Fan CY. Application of distal radius-positioned hinged external fixator in complete open release for severe elbow stiffness. J Shoulder Elbow Surg 2017; 26:e44-e51. [PMID: 28104095 DOI: 10.1016/j.jse.2016.09.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 08/31/2016] [Accepted: 09/07/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Radical release for severe stiff elbows may lead to instability. Hinged external fixation is used to treat unstable elbows. We hypothesized that extensive open release combined with a distal radius-positioned hinged external fixator would have good performance and low complications rate in treating severe elbow stiffness. Thus, the efficacy and security of this technique were assessed in this study. METHODS We retrospectively reviewed 38 post-traumatic elbows with severe stiffness that underwent arthrolysis between February 2011 and February 2014. All patients were assessed as having elbow instability after complete arthrolysis. Ligament repair was combined with implantation of a hinged external fixator (fixed to the humerus and distal radius) to maintain elbow stability. Flexion arc, forearm rotation, Mayo Elbow Performance Score, elbow stability, and radiographs were evaluated preoperatively and postoperatively, and complications were documented. RESULTS Mean follow-up was 31 months. Significant improvement was noted in flexion-extension arc (from 27° to 126°), forearm rotation (from 148° to 153°), and mean Mayo Elbow Performance Score (from 68 points to 96 points). Mean pronation arc decreased from 66° preoperatively to 6° at 1.5 months of follow-up and showed a transient reduction during first 6 months postoperatively. Pin-related infection occurred in 2 patients, which was cured with conservative treatment. Two patients had moderate instability after removal of the fixator and regained stability at the 12-month follow-up. At the last follow-up, complications included ulnar nerve paralysis in 3, recurrence of heterotopic ossification in 1, and moderate pain in 1. CONCLUSIONS Complete open release combined with a distal radius-positioned hinged external fixator is an effective treatment for severe stiff elbows. This technique had a low complication rate.
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Affiliation(s)
- Yi Zhou
- Department of Orthopaedics, Shanghai Jiao Tong University, Affiliated Sixth People's Hospital, Shanghai, China; Department of Orthopaedics, Capital Medical University, Affiliated Beijing ChaoYang Hospital, Beijing, China
| | - Jiang-Yu Cai
- Department of Orthopaedics, Shanghai Jiao Tong University, Affiliated Sixth People's Hospital, Shanghai, China; Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Shuai Chen
- Department of Orthopaedics, Shanghai Jiao Tong University, Affiliated Sixth People's Hospital, Shanghai, China
| | - Shen Liu
- Department of Orthopaedics, Shanghai Jiao Tong University, Affiliated Sixth People's Hospital, Shanghai, China
| | - Wei Wang
- Department of Orthopaedics, Shanghai Jiao Tong University, Affiliated Sixth People's Hospital, Shanghai, China
| | - Cun-Yi Fan
- Department of Orthopaedics, Shanghai Jiao Tong University, Affiliated Sixth People's Hospital, Shanghai, China.
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Abstract
High-resolution ultrasonography can help clinicians visualize key anatomic structures of the elbow and guide periarticular and intra-articular injections. Historically, most procedures done around the elbow have been done using landmark guidance, and few studies have reported the accuracy of ultrasonography-guided injections in the elbow region. This article reviews common musculoskeletal disorders about the elbow that can be evaluated with ultrasonography, reviews the literature on ultrasonography-guided injections of the elbow region, and describes the senior author's preferred approach for the most commonly performed elbow region injections.
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Affiliation(s)
- Walter I Sussman
- Department of Physical Medicine and Rehabilitation, Emory University, 1441 Clifton Road, NE Atlanta, GA 30322, USA; Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
| | - Christopher J Williams
- Department of Physical Medicine and Rehabilitation, Emory University, 1441 Clifton Road, NE Atlanta, GA 30322, USA
| | - Ken Mautner
- Department of Physical Medicine and Rehabilitation, Emory University, 1441 Clifton Road, NE Atlanta, GA 30322, USA; Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA.
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Schnetzke M, Schüler S, Keil H, Aytac S, Studier-Fischer S, Grützner PA, Guehring T. Development and validation of a novel questionnaire for self-determination of the range of motion of wrist and elbow. BMC Musculoskelet Disord 2016; 17:312. [PMID: 27457712 PMCID: PMC4960848 DOI: 10.1186/s12891-016-1171-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 07/08/2016] [Indexed: 11/30/2022] Open
Abstract
Background The aim of this study was to develop and validate a novel self-administered questionnaire for assessing the patient’s own range of motion (ROM) of the wrist and the elbow. Methods In a prospective clinical study from January 2015 to June 2015, 101 consecutive patients were evaluated with a novel, self-administered, diagram-based, wrist motion assessment score (W-MAS) and elbow motion assessment score (E-MAS). The questionnaire was statistically evaluated for test-retest reliability, patient-physician agreement, comparison with healthy population, and influence of covariates (age, gender, affected side and involvement in workers’ compensation cases). Results Assessment of patient-physician agreement demonstrated almost perfect agreement (k > 0.80) with regard to six out of eight items. There was substantial agreement with regard to two items: elbow extension (k = 0.76) and pronation (k = 0.75). The assessment of the test-retest reliability revealed at least substantial agreement (k = 0.70). The questionnaire revealed a high discriminative power when comparing the healthy population with the study group (p = 0.007 or lower for every item). Age, gender, affected side and involvement in workers’ compensation cases did not in general significantly influence the patient-physician agreement for the questionnaire. Conclusion The W-MAS and E-MAS are valid and reliable self-administered questionnaires that provide a high level of patient-physician agreement for the assessments of wrist and elbow ROM. Level of evidence: Diagnostic study, Level II Electronic supplementary material The online version of this article (doi:10.1186/s12891-016-1171-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marc Schnetzke
- Department for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwigshafen am Rhein, Germany
| | - Svenja Schüler
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Holger Keil
- Department for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwigshafen am Rhein, Germany
| | - Sara Aytac
- Department for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwigshafen am Rhein, Germany
| | - Stefan Studier-Fischer
- Department for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwigshafen am Rhein, Germany
| | - Paul-Alfred Grützner
- Department for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwigshafen am Rhein, Germany
| | - Thorsten Guehring
- Department for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwigshafen am Rhein, Germany. .,Department for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at the University of Heidelberg, Ludwig Guttmann Strasse 13, 67071, Ludwigshafen am Rhein, Germany.
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The Supine Position Technique Method Is Better Than the Conventional Method for Manual Reduction of Acute Nontraumatic Temporomandibular Joint Dislocation. J Craniofac Surg 2016; 27:919-22. [DOI: 10.1097/scs.0000000000002645] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Wang W, Liu S, Jiang SC, Ruan HJ, He N, Fan CY. Limited Medial and Lateral Approaches to Treat Stiff Elbows. Orthopedics 2015; 38:e477-84. [PMID: 26091220 DOI: 10.3928/01477447-20150603-55] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Accepted: 07/28/2014] [Indexed: 02/03/2023]
Abstract
Open arthrolysis is an effective way to treat elbow stiffness. However, previous approaches led to significant surgical trauma. The goal of the current study was to evaluate the outcome of open arthrolysis with limited medial and lateral approaches combined with hinged external fixation to treat elbow stiffness. A total of 18 patients (18 elbows) with elbow stiffness were retrospectively reviewed. The same inclusion and exclusion criteria were used for all patients. Preoperatively, the mean flexion arc was 43°±28° and the mean Mayo Elbow Performance Score was 62 points. Limited medial and lateral approaches were used to provide safe and complete arthrolysis. The other protocols included ulnar nerve transposition, medial epicondyle osteotomy, radial head resection, ligament repair, and hinged external fixation. Patients were encouraged to begin early rehabilitation 24 hours after surgery. At a mean follow-up of 20 months, the flexion arc improved to 130°±11° and the mean Mayo Elbow Performance Score was 97 points (15 excellent, 3 good). One patient had elbow instability, but function met the requirements of his daily life. Transient ulnar nerve palsy without infection occurred in 4 patients. With limited medial and lateral approaches, elbow stiffness can be treated effectively with open arthrolysis. This method is trauma controlled. Furthermore, a hinged external fixator can provide sufficient and safe rehabilitation. The use of open arthrolysis with limited medial and lateral approaches combined with hinged external fixation is an effective and safe method to treat elbow stiffness.
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Pipicelli JG, Chinchalkar SJ, Grewal R, Athwal GS. Rehabilitation considerations in the management of terrible triad injury to the elbow. Tech Hand Up Extrem Surg 2011; 15:198-208. [PMID: 22105630 DOI: 10.1097/bth.0b013e31822911fd] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
An elbow dislocation associated with a radial head and coronoid fractures is termed a terrible triad. This injury almost always renders the elbow unstable requiring surgical intervention. The primary goal of surgery is to stabilize the elbow to permit early motion to prevent stiffness. Recent literature has improved our understanding of elbow anatomy and biomechanics as well as the pathoanatomy of this injury. This article reviews key concepts that will allow the surgeon and therapist to apply an systematic rehabilitation approach when managing such injuries.
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Affiliation(s)
- Joey G Pipicelli
- Division of Hand Therapy, Hand and Upper Limb Centre, St. Joseph's Health Care, 268 Grosvenor Street, London, Ontario, Canada.
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de Araújo RC, Junior FL, Rocha DN, Sono TS, Pinotti M. Effects of intensive arm training with an electromechanical orthosis in chronic stroke patients: a preliminary study. Arch Phys Med Rehabil 2011; 92:1746-53. [PMID: 21959035 DOI: 10.1016/j.apmr.2011.05.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Revised: 03/25/2011] [Accepted: 05/24/2011] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate the use of an electromechanical device, comprising an exoskeleton, a static orthosis, and a glove, for functional rehabilitation of the elbow and hand in patients with hemiparesis, and to compare it with physical therapy rehabilitation. DESIGN Pretest-posttest design. SETTING Rehabilitation laboratory. PARTICIPANTS Volunteer sample of persons (N=12) with persistent hemiparesis from a single, unilateral stroke within the past 3 to 36 months. INTERVENTIONS The volunteers were randomly divided into 2 groups. One group was treated with a conventional program of physiotherapy, and another group participated in a training program in which an electromechanical orthosis was used. All volunteers received 24 sessions, held 3 times a week for 8 weeks. MAIN OUTCOME MEASURES Modified Ashworth Scale (MAS), Fugl-Meyer Assessment (FMA), and electromyogram (EMG) amplitude. RESULTS No statistical difference was found in the initial and final values of the MAS. Both groups showed a significant increase for the total scores of the FMA. However, only the group treated with the orthosis showed an increase in FMA scores related to the wrist and hand joint. The EMG analysis showed increased EMG amplitudes for all muscles in the group treated with the orthosis, whereas the group treated with physiotherapy showed gains in electromyographic activity only in the extensor digitorum communis. Intergroup comparison showed that the initial FMA scores of the wrist/hand were higher in the group treated with physiotherapy. However, after training, the scores in the group that used the orthosis were equivalent to those of the physiotherapy group. CONCLUSIONS The results suggest that this device can be an auxiliary tool to help the conventional rehabilitation program of motor function of the affected upper extremity.
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Affiliation(s)
- Rodrigo C de Araújo
- Department of Mechanical Engineering, Universidade Federal de Minas Gerais-UFMG, Belo Horizonte, Brazil.
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de Haan J, Schep NWL, Eygendaal D, Kleinrensink GJ, Tuinebreijer WE, den Hartog D. Stability of the elbow joint: relevant anatomy and clinical implications of in vitro biomechanical studies. Open Orthop J 2011; 5:168-76. [PMID: 21633722 PMCID: PMC3104563 DOI: 10.2174/1874325001105010168] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2011] [Revised: 03/26/2011] [Accepted: 04/01/2011] [Indexed: 11/27/2022] Open
Abstract
The aim of this literature review is to describe the clinical anatomy of the elbow joint based on information from in vitro biomechanical studies. The clinical consequences of this literature review are described and recommendations are given for the treatment of elbow joint dislocation. The PubMed and EMBASE electronic databases and the Cochrane Central Register of Controlled Trials were searched. Studies were eligible for inclusion if they included observations of the anatomy and biomechanics of the elbow joint in human anatomic specimens. Numerous studies of the kinematics, kinesiology and anatomy of the elbow joint in human anatomic specimens yielded important and interesting implications for trauma and orthopaedic surgeons.
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Affiliation(s)
- J de Haan
- Department of Surgery-Traumatology, Westfriesgasthuis, P.O. Box 600, 1620 AR Hoorn, The Netherlands
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Hyun YS, Shin SI, Kang JW, Ahn JH. New V-shaped Technique in SLAP Repair (Comparison of Cinical Results Between New V-shaped Repair and Conventional Rapair Technique in Arthroscopic Type II SLAP Surgery). Clin Shoulder Elb 2010. [DOI: 10.5397/cise.2010.13.1.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Cho CH, Song KS, Kim SK. Antegrade Interlocking Intramedullary Nailing in Humeral Shaft Fractures. Clin Shoulder Elb 2010. [DOI: 10.5397/cise.2010.13.1.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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Moon JG. Biomechanics of the Elbow. Clin Shoulder Elb 2010. [DOI: 10.5397/cise.2010.13.1.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Desroches G, Dumas R, Pradon D, Vaslin P, Lepoutre FX, Chèze L. Upper limb joint dynamics during manual wheelchair propulsion. Clin Biomech (Bristol, Avon) 2010; 25:299-306. [PMID: 20106573 DOI: 10.1016/j.clinbiomech.2009.12.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Revised: 12/18/2009] [Accepted: 12/22/2009] [Indexed: 02/07/2023]
Abstract
BACKGROUND Inverse dynamic methods have been widely used to estimate joint loads during manual wheelchair propulsion. However, the interpretation of 3D net joint moments and powers is not always straightforward. It has been suggested to use joint coordinate systems (expression of joint moment on anatomical axes) and the 3D angle between joint moment and angular velocity vectors (propulsion, resistance or stabilization joint configuration) for a better understanding of joint dynamics. METHODS Nine spinal cord injured subjects equipped with reflective markers propelled in a wheelchair with an instrumented wheel. Inverse dynamic results were interpreted using joint coordinate systems, 3D joint power and the 3D angle between the joint moment and joint angular velocity vectors at the three upper limb joints. The 3D angle was used to determine if the joints were predominantly driven (angle close to 0 or 180 degrees) or stabilized (angle close to 90 degrees ). FINDINGS The wrist and elbow joints are mainly in a stabilization configuration (angle close to 90 degrees ) with a combination of extension and ulnar deviation moments and an adduction moment respectively. The shoulder is in a propulsion configuration, but close to stabilization (angle hardly below 60 degrees ) with a combination of flexion and internal rotation moments. INTERPRETATION Stabilization configuration at the joints could partly explain the low mechanical efficiency of manual wheelchair propulsion and could give insight about injury risk at the wrist, elbow and shoulder joints.
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Ohshiro S, Hidaka E, Miyamoto S, Aoki M, Yamashita T, Tatsumi H. Influence of elbow flexion angle on mobilization of the proximal radio-ulnar joint: a motion analysis using cadaver specimens. ACTA ACUST UNITED AC 2008; 14:278-82. [PMID: 18455468 DOI: 10.1016/j.math.2008.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2007] [Revised: 02/20/2008] [Accepted: 02/28/2008] [Indexed: 10/22/2022]
Abstract
The purpose of this study was to determine the most effective elbow joint flexion angle for mobilization of the proximal radio-ulnar joint. Five fresh-frozen cadaveric elbows were used to measure displacement of the radial head in the antero-medial and postero-lateral directions by traction force of 2kgf and 4kgf, respectively. Simulation of the gliding of the proximal radio-ulnar joint was performed at four elbow flexion angles (0 degrees , 30 degrees , 60 degrees , 90 degrees). Data obtained from those flexion angles were compared using one-way repeated measures analysis of variance. Radial head displacement at 60 degrees and 90 degrees during antero-medial gliding were significantly greater than those at 0 degrees and 30 degrees (p<0.05) There were no significant differences in radial head displacement among four elbow flexion angles during postero-lateral gliding at 2kgf and 4kgf. Our findings suggest that proximal radio-ulnar joint mobilization in the antero-medial direction can be performed effectively at 60 degrees and 90 degrees elbow flexion.
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Affiliation(s)
- Sadanori Ohshiro
- Graduate School of Health Sciences, Sapporo Medical University, School of Health Sciences, Chuo-ku, Sapporo, Japan
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Cutti AG, Giovanardi A, Rocchi L, Davalli A, Sacchetti R. Ambulatory measurement of shoulder and elbow kinematics through inertial and magnetic sensors. Med Biol Eng Comput 2007; 46:169-78. [PMID: 18087742 DOI: 10.1007/s11517-007-0296-5] [Citation(s) in RCA: 213] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2007] [Accepted: 11/24/2007] [Indexed: 01/19/2023]
Abstract
Inertial and magnetic measurement systems (IMMSs) are a new generation of motion analysis systems which may diffuse the measurement of upper-limb kinematics to ambulatory settings. Based on the MT9B IMMS (Xsens Technologies, NL), we therefore developed a protocol that measures the scapulothoracic, humerothoracic and elbow 3D kinematics. To preliminarily evaluate the protocol, a 23-year-old subject performed six tasks involving shoulder and elbow single-joint-angle movements. Criteria for protocol validity were limited cross-talk with the other joint-angles during each task; scapulohumeral-rhythm close to literature results; and constant carrying-angle. To assess the accuracy of the MT9B when measuring the upper-limb kinematics through the protocol, we compared the MT9B estimations during the six tasks, plus other four, with the estimations of an optoelectronic system (the gold standard), in terms of RMS error, correlation coefficient (r), and the amplitude ratio (m). Results indicate that the criteria for protocol validity were met for all tasks. For the joint angles mainly involved in each movement, the MT9B estimations presented RMS errors <3.6 degrees , r > 0.99 and 0.9 < m < 1.09. It appears therefore that (1) the protocol in combination with the MT9B is valid for, and (2) the MT9B in combination with the protocol is accurate when, measuring shoulder and elbow kinematics, during the tasks tested, in ambulatory settings.
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