Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 592
Filtrar
1.
Mil Med ; 189(Supplement_3): 585-591, 2024 Aug 19.
Artículo en Inglés | MEDLINE | ID: mdl-39160856

RESUMEN

INTRODUCTION: Recovering from neuromuscular injuries or conditions can be a challenging journey that involves complex surgeries and extensive physical rehabilitation. During this process, individuals often rely on orthotic devices to support and enable movement of the affected limb. However, users have criticized current commercially available powered orthotic devices for their bulky and heavy design. To address these limitations, we developed a novel powered myoelectric elbow orthosis. MATERIALS AND METHODS: The orthosis incorporates 3 mechanisms: a solenoid brake, a Bowden cable-powered constant torque elbow mechanism, and an extension limiter. The device controller and battery are in a backpack to reduce the weight on the affected arm. We performed extensive calculations and testing to ensure that the orthosis could withstand at least 15 Nm of elbow torque. We developed a custom software effectively control the orthosis, enhancing its usability and functionality. A certified orthotist fitted a subject who had undergone a gracilis free functioning muscle transfer surgery with the device. We studied the subject under Mayo clinic IRB no. 20-006849 and obtained objective measurements to assess the orthosis's impact on upper extremity functionality during daily activities. RESULTS: The results are promising since the orthosis significantly improved elbow flexion range of motion by 40° and reduced compensatory movements at the shoulder (humerothoracic joint) by 50°. Additionally, the subject was able to perform tasks which were not possible before, such as carrying a basket with weights, highlighting the enhanced functionality provided by the orthosis. CONCLUSION: In brief, by addressing the limitations of existing devices, this novel powered myoelectric elbow orthosis offers individuals with neuromuscular injuries/conditions improved quality of life. Further research will expand the patient population and control mechanisms.


Asunto(s)
Diseño de Equipo , Aparatos Ortopédicos , Humanos , Aparatos Ortopédicos/normas , Diseño de Equipo/normas , Enfermedades Neuromusculares/fisiopatología , Enfermedades Neuromusculares/rehabilitación , Articulación del Codo/fisiopatología , Articulación del Codo/fisiología , Codo/fisiopatología
2.
Exp Physiol ; 109(9): 1557-1571, 2024 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-38935545

RESUMEN

Muscle disuse induces a decline in muscle strength that exceeds the rate and magnitude of muscle atrophy, suggesting that factors beyond the muscle contribute to strength loss. The purpose of this study was to characterize changes in the brain and neuromuscular system in addition to muscle size following upper limb immobilization in young females. Using a within-participant, unilateral design, 12 females (age: 20.6 ± 2.1 years) underwent 14 days of upper arm immobilization using an elbow brace and sling. Bilateral measures of muscle strength (isometric and isokinetic dynamometry), muscle size (magnetic resonance imaging), voluntary muscle activation capacity, corticospinal excitability, cortical thickness and resting-state functional connectivity were collected before and after immobilization. Immobilization induced a significant decline in isometric elbow flexion (-21.3 ± 19.2%, interaction: P = 0.0440) and extension (-19.9 ± 15.7%, interaction: P = 0.0317) strength in the immobilized arm only. There was no significant effect of immobilization on elbow flexor cross-sectional area (CSA) (-1.2 ± 2.4%, interaction: P = 0.466), whereas elbow extensor CSA decreased (-2.9 ± 2.9%, interaction: P = 0.0177) in the immobilized arm. Immobilization did not differentially alter voluntary activation capacity, corticospinal excitability, or cortical thickness (P > 0.05); however, there were significant changes in the functional connectivity of brain regions related to movement planning and error detection (P < 0.05). This study reveals that elbow flexor strength loss can occur in the absence of significant elbow flexor muscle atrophy, and that the brain represents a site of functional adaptation in response to upper limb immobilization in young females.


Asunto(s)
Encéfalo , Codo , Inmovilización , Fuerza Muscular , Músculo Esquelético , Atrofia Muscular , Humanos , Femenino , Adulto Joven , Fuerza Muscular/fisiología , Codo/fisiopatología , Músculo Esquelético/fisiopatología , Inmovilización/efectos adversos , Atrofia Muscular/fisiopatología , Encéfalo/fisiopatología , Encéfalo/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Contracción Isométrica/fisiología , Adulto , Extremidad Superior/fisiopatología , Adolescente
3.
J Neurophysiol ; 132(1): 78-86, 2024 07 01.
Artículo en Inglés | MEDLINE | ID: mdl-38691520

RESUMEN

Stroke-caused synergies may result from the preferential use of the reticulospinal tract (RST) due to damage to the corticospinal tract. The RST branches multiple motoneuron pools across the arm together resulting in gross motor control or abnormal synergies, and accordingly, the controllability of individual muscles decreases. However, it is not clear whether muscles involuntarily activated by abnormal synergy vary depending on the muscles voluntarily activated when motor commands descend through the RST. Studies showed that abnormal synergies may originate from the merging and reweighting of synergies in individuals without neurological deficits. This leads to a hypothesis that those abnormal synergies are still selectively excited depending on the context. In this study, we test this hypothesis, leveraging the Fugl-Meyer assessment that could characterize the neuroanatomical architecture in individuals with a wide range of impairments. We examine the ability to perform an out-of-synergy movement with the flexion synergy caused by either shoulder or elbow loading. The results reveal that about 14% [8/57, 95% confidence interval (5.0%, 23.1%)] of the participants with severe impairment (total Fugl-Meyer score <29) in the chronic phase (6 months after stroke) are able to keep the elbow extended during shoulder loading and keep the shoulder at neutral during elbow loading. Those participants underwent a different course of neural reorganization, which enhanced abnormal synergies in comparison with individuals with mild impairment (P < 0.05). These results provide evidence that separate routes and synergy modules to motoneuron pools across the arm might exist even if the motor command is mediated possibly via the RST.NEW & NOTEWORTHY We demonstrate that abnormal synergies are still selectively excited depending on the context.


Asunto(s)
Músculo Esquelético , Tractos Piramidales , Accidente Cerebrovascular , Humanos , Masculino , Femenino , Persona de Mediana Edad , Accidente Cerebrovascular/fisiopatología , Músculo Esquelético/fisiología , Músculo Esquelético/fisiopatología , Tractos Piramidales/fisiopatología , Tractos Piramidales/fisiología , Anciano , Adulto , Codo/fisiología , Codo/fisiopatología , Hombro/fisiología , Hombro/fisiopatología
4.
Brain Res ; 1836: 148911, 2024 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-38604558

RESUMEN

Cervical spinal cord injury (SCI) causes dramatic sensorimotor deficits that restrict both activity and participation. Restoring activity and participation requires extensive upper limb rehabilitation focusing elbow and wrist movements, which can include motor imagery. Yet, it remains unclear whether MI ability is impaired or spared after SCI. We investigated implicit and explicit MI ability in individuals with C6 or C7 SCI (SCIC6 and SCIC7 groups), as well as in age- and gender-matched controls without SCI. Inspired by previous studies, implicit MI evaluations involved hand laterality judgments, hand orientation judgments (HOJT) and hand-object interaction judgments. Explicit MI evaluations involved mental chronometry assessments of physically possible or impossible movements due to the paralysis of upper limb muscles in both groups of participants with SCI. HOJT was the paradigm in which implicit MI ability profiles differed the most between groups, particularly in the SCIC6 group who had impaired elbow movements in the horizontal plane. MI ability profiles were similar between groups for explicit MI evaluations, but reflected task familiarity with higher durations in the case of unfamiliar movements in controls or attempt to perform movements which were no longer possible in persons with SCI. Present results, obtained from a homogeneous population of individuals with SCI, suggest that people with long-term SCI rely on embodied cognitive motor strategies, similar to controls. Differences found in behavioral response pattern during implicit MI mirrored the actual motor deficit, particularly during tasks that involved internal representations of affected body parts.


Asunto(s)
Codo , Imaginación , Movimiento , Traumatismos de la Médula Espinal , Humanos , Masculino , Femenino , Adulto , Traumatismos de la Médula Espinal/fisiopatología , Traumatismos de la Médula Espinal/psicología , Traumatismos de la Médula Espinal/rehabilitación , Persona de Mediana Edad , Imaginación/fisiología , Codo/fisiopatología , Movimiento/fisiología , Desempeño Psicomotor/fisiología , Lateralidad Funcional/fisiología , Juicio/fisiología , Mano/fisiopatología , Mano/fisiología
5.
Clin Neurophysiol ; 161: 180-187, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38520798

RESUMEN

OBJECTIVE: To measure neuromagnetic fields of ulnar neuropathy patients at the elbow after electrical stimulation and evaluate ulnar nerve function at the elbow with high spatial resolution. METHODS: A superconducting quantum interference device magnetometer system recorded neuromagnetic fields of the ulnar nerve at the elbow after electrical stimulation at the wrist in 16 limbs of 16 healthy volunteers and 21 limbs of 20 patients with ulnar neuropathy at the elbow. After artifact removal, neuromagnetic field signals were processed into current distributions, which were superimposed onto X-ray images for visualization. RESULTS: Based on the results in healthy volunteers, conduction velocity of 30 m/s or 50% attenuation in current amplitude was set as the reference value for conduction disturbance. Of the 21 patient limbs, 15 were measurable and lesion sites were detected, whereas 6 limbs were unmeasurable due to weak neuromagnetic field signals. Seven limbs were deemed normal by nerve conduction study, but 5 showed conduction disturbances on magnetoneurography. CONCLUSIONS: Measuring the magnetic field after nerve stimulation enabled visualization of neurophysiological activity in patients with ulnar neuropathy at the elbow and evaluation of conduction disturbances. SIGNIFICANCE: Magnetoneurography may be useful for assessing lesion sites in patients with ulnar neuropathy at the elbow.


Asunto(s)
Codo , Conducción Nerviosa , Nervio Cubital , Neuropatías Cubitales , Humanos , Masculino , Femenino , Persona de Mediana Edad , Adulto , Neuropatías Cubitales/fisiopatología , Neuropatías Cubitales/diagnóstico , Neuropatías Cubitales/diagnóstico por imagen , Conducción Nerviosa/fisiología , Codo/fisiopatología , Codo/inervación , Codo/diagnóstico por imagen , Anciano , Nervio Cubital/fisiopatología , Nervio Cubital/diagnóstico por imagen , Estimulación Eléctrica/métodos , Campos Magnéticos
6.
J Back Musculoskelet Rehabil ; 37(4): 871-881, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38250756

RESUMEN

BACKGROUND: The shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) and Patient Rated Wrist/Hand Evaluation (PRWHE) are commonly used questionnaires to assess patient-reported hand function. Information about the measurement properties of the Dutch versions is scarce. OBJECTIVE: To gain insight into the measurement properties of the Dutch language versions of the QuickDASH and the PRWHE in patients with (non)specific complaints of the hand, wrist, forearm and elbow. METHODS: Internal consistency, construct validity, test-retest reliability, responsiveness, and floor and ceiling effects were assessed according to COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) recommendations. RESULTS: Questionnaires were filled out by 132 patients. Internal consistency of QuickDASH (Cronbach's α= 0.92) and PRWHE (Cronbach's α= 0.97) was high. Predefined hypotheses for construct validity were not confirmed for 75% for both QuickDASH and PRWHE (accordance with 62% of predefined hypotheses for both questionnaires). Test-retest reliability of QuickDASH (ICC = 0.90) and PRWHE (ICC = 0.87) was good. Both QuickDASH (AUC = 0.84) and PRWHE (AUC = 0.80) showed good responsiveness. No floor or ceiling effects were present. CONCLUSIONS: Measurement properties of the Dutch language versions of the QuickDASH and the PRWHE, applied to patients with (non)specific complaints of the hand, wrist, forearm and elbow, were very similar. Test-retest reliability and responsiveness were good for both QuickDASH and PRWHE. Construct validity could not be demonstrated sufficiently.


Asunto(s)
Evaluación de la Discapacidad , Humanos , Masculino , Femenino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Países Bajos , Adulto , Encuestas y Cuestionarios/normas , Mano/fisiopatología , Anciano , Codo/fisiopatología , Antebrazo/fisiopatología , Muñeca/fisiopatología
7.
F1000Res ; 12: 498, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-39108346

RESUMEN

Background: Overhead athletes frequently perform rapid and powerful throwing overhead strokes in positions at the extreme range of motion, increasing the risk of upper limb injury. The Kerlan-Jobe Orthopedic Clinic (KJOC) Shoulder and Elbow Score has shown to be a valid and reliable questionnaire that can be used for the assessment of the functional status of the upper limb of patients involved in highly demanding overhead sports. The KJOC has been translated into several other languages however, a Greek version of the KJOC is not available yet. Methods: The KJOC will be cross-culturally adapted into Greek following international guidelines. At least 100 overhead athletes with or without shoulder or elbow complaints will be recruited and asked to fill in the Greek version of the KJOC twice and the Disabilities of Arm, Shoulder and Hand Questionnaire (DASH) once. The internal consistency and the test-retest reliability will be examined using Cronbach's alpha and the intraclass correlation coefficient (ICC), respectively. The standard error of measurement (SEM) and the minimum detectable change (MDC) will be calculated and possible ground or ceiling effects will be also examined. Convergent validity will be evaluated with the Greek DASH using Pearson's correlation. Results: The results of this study will be presented in an article to be published later. Conclusions: This report describes the process of translation and cross cultural adaptation of the Greek version of the KJOC. We believe a study protocol will assist researchers in the field to improve the reporting of similar studies and as a result improve the quality of their studies.


Asunto(s)
Atletas , Humanos , Grecia , Encuestas y Cuestionarios , Comparación Transcultural , Reproducibilidad de los Resultados , Codo/fisiopatología , Hombro/fisiopatología , Traducciones , Masculino
8.
J Fam Pract ; 70(6): 303, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-34431778

RESUMEN

THE COMPARISON: A Elbow and forearm with erythematous, well-demarcated, pink plaques with mild micaceous scale in a 42-year-old White woman. B Elbow and forearm with violaceous, well-demarcated plaques with micaceous scale and hyperpigmented patches around the active plaques in a 58-year-old Black man.


Asunto(s)
Codo/fisiopatología , Antebrazo/fisiopatología , Psoriasis/diagnóstico , Psoriasis/fisiopatología , Pigmentación de la Piel , Adulto , Negro o Afroamericano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Psoriasis/epidemiología , Estados Unidos/epidemiología , Población Blanca
9.
Clin Neurophysiol ; 132(9): 2274-2281, 2021 09.
Artículo en Inglés | MEDLINE | ID: mdl-34229959

RESUMEN

The addition of ultrasound (US) to electrodiagnostic (EDX) tests can significantly enhance the accuracy of testing for ulnar neuropathy at the elbow (UNE). We aimed to obtain expert consensus to guide clinicians on the combined use of EDX and US in UNE investigation. Consensus was achieved using the Delphi method. Two consecutive anonymised questionnaires were submitted to 15 experts, who were asked to choose their level of agreement with each statement. Consensus was pre-defined as ≥ 80% rating agreement. The experts concluded that all investigations of UNE should include both nerve conduction studies and US. There was consensus that US should include cross-sectional area measurement and assessment of nerve mobility at the elbow, and that the entire ulnar nerve should be imaged. This study defined expert opinion on the 'core' techniques that should be used routinely in the UNE investigation using EDX and US. Areas with lack of consensus highlighted some controversial issues in the current use of these diagnostic modalities and the need for future research. This document is an initial step to guide clinicians on the combined investigation of UNE using EDX and US, to be regularly updated as new research emerges.


Asunto(s)
Conferencias de Consenso como Asunto , Electrodiagnóstico/métodos , Neuropatías Cubitales/diagnóstico , Ultrasonografía/métodos , Codo/diagnóstico por imagen , Codo/fisiopatología , Electrodiagnóstico/normas , Humanos , Guías de Práctica Clínica como Asunto , Neuropatías Cubitales/diagnóstico por imagen , Neuropatías Cubitales/fisiopatología , Ultrasonografía/normas
10.
J Orthop Surg Res ; 16(1): 394, 2021 Jun 19.
Artículo en Inglés | MEDLINE | ID: mdl-34147121

RESUMEN

OBJECTIVE: The aim of this study is to analyze the efficacy of open reduction and Herbert screw fixation for coronal fractures of the capitellum via the anterior approach in adolescents. METHODS: We retrospectively analyzed the clinical and imaging data of 15 adolescents with capitellar fractures who were admitted to our hospital from May 2014 to May 2019. The fracture was reduced through the cubital crease incision via the anterior approach and was internally fixated with Herbert screws. A follow-up was conducted after the operation to examine fracture healing and elbow function. The postoperative functional recovery of patients was evaluated with the Mayo Elbow Performance index (MEPI) and the Broberg-Morrey rating system. RESULTS: Patients underwent surgery 3.7 days after injury on average. Intraoperative fracture reduction was satisfactory. No vascular injury or nerve injury occurred. Bony union occurred in an average of 6 weeks after the operation. All adolescents completed a 12- to 36-month follow-up. At the last follow-up, the Mayo Elbow Performance index was considered excellent in 12 patients and good in three patients. The Broberg-Morrey score was considered excellent in 12 patients, good in two patients, and fair in one patient. CONCLUSION: Open reduction with Herbert screw fixation via the anterior approach is a feasible surgical method for the treatment of coronal fractures of the capitellum in adolescents. LEVELS OF EVIDENCE: Therapeutic, retrospective study-Level IV.


Asunto(s)
Huesos del Brazo/lesiones , Tornillos Óseos , Fijación Interna de Fracturas/métodos , Fracturas del Húmero/cirugía , Reducción Abierta/métodos , Adolescente , Huesos del Brazo/fisiopatología , Niño , Codo/fisiopatología , Estudios de Factibilidad , Femenino , Fijación Interna de Fracturas/instrumentación , Curación de Fractura , Humanos , Fracturas del Húmero/fisiopatología , Masculino , Reducción Abierta/instrumentación , Recuperación de la Función , Estudios Retrospectivos , Resultado del Tratamiento
11.
PLoS One ; 16(6): e0252667, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34111160

RESUMEN

PURPOSE: For displaced distal radius fracture, this trial aimed to compare an above-elbow (AE) and below-elbow (BE) cast at the end of a 24-week follow-up using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire as a primary outcome. METHODS: This is a clinical trial with parallel groups (1:1) and a blinded evaluator. There are two non-surgical interventions: AE and BE. A total of 128 adult patients with acute (up to 7 days) displaced distal radius fracture of type A2-3, C1-3 by the AO classification were included. The follow-up was 24 weeks. The primary outcome was the DASH questionnaire at 24 weeks. Secondary outcomes were the maintenance of reduction by the evaluation of radiographic parameters, pain measured by VAS, PRWE, objective functional evaluation and rate of adverse effects. RESULTS: The difference between the two groups in the DASH score at 24 weeks was not significant, with the mean (95% CI) DASH score being AE: 9.44 (2.70 to 16.17) vs. BE: 9.88 (3.19 to 16.57) (p = 0.895). The above-elbow group had a significantly greater worsening of the mean DASH score from baseline to 2 weeks (p < 0.001). No statistically significant differences were found between the 2 groups in any of the other follow-up assessments. Objective functional evaluation, PRWE, radiographical measures and rates of reduction loss were similar between groups. Above-elbow casting resulted in more adverse effects (mostly shoulder pain; 19 events vs. 9 events); RR = 0.39 (0.19-0.94); p = 0.033 at the end of six-month follow-up. CONCLUSIONS: This study did not demonstrate a difference between above-elbow and below-elbow cast in terms of DASH outcome at 6 months in non-surgical treatment of deviated distal radius fractures. However, below-elbow casting is less debilitating during the treatment period, has comparable performance in maintaining the reduction, and is related to fewer minor adverse effects than above-elbow casting.


Asunto(s)
Tratamiento Conservador , Codo/patología , Fracturas del Radio/terapia , Codo/fisiopatología , Femenino , Fracturas Mal Unidas/fisiopatología , Fuerza de la Mano , Humanos , Masculino , Dolor/etiología , Medición de Resultados Informados por el Paciente , Fracturas del Radio/diagnóstico por imagen , Fracturas del Radio/fisiopatología , Rango del Movimiento Articular , Escala Visual Analógica
12.
Clin Neurophysiol ; 132(6): 1226-1233, 2021 06.
Artículo en Inglés | MEDLINE | ID: mdl-33867256

RESUMEN

OBJECTIVE: To determine inter-rater reliability, minimal detectable change and responsiveness of Tonic Stretch Reflex Threshold (TSRT) as a quantitative measure of elbow flexor spasticity. METHODS: Elbow flexor spasticity was assessed in 55 patients with sub-acute stroke by determining TSRT, the angle of spasticity onset at rest (velocity = 0°/s). Elbow flexor muscles were stretched 20 times at different velocities. Dynamic stretch-reflex thresholds, the elbow angles corresponding to the onset of elbow flexor EMG at each velocity, were used for TSRT calculation. Spasticity was also measured with the Modified Ashworth Scale (MAS). In a sub-group of 44 subjects, TSRT and MAS were measured before and after two weeks of an upper-limb intervention. RESULTS: The intraclass correlation coefficient was 0.65 and the 95% minimal detectable change was 32.4°. In the treated sub-group, TSRT, but not MAS significantly changed. TSRT effect size and standardized response mean were 0.40 and 0.35, respectively. Detection of clinically meaningful improvements in upper-limb motor impairment by TSRT change scores ranged from poor to excellent. CONCLUSIONS: Evaluation of stroke-related elbow flexor spasticity by TSRT has good inter-rater reliability. Test responsiveness is low, but better than that of the MAS. SIGNIFICANCE: TSRT may be used to complement current scales of spasticity quantification.


Asunto(s)
Codo/fisiopatología , Espasticidad Muscular/diagnóstico , Reflejo de Estiramiento/fisiología , Accidente Cerebrovascular/complicaciones , Adulto , Anciano , Electromiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Espasticidad Muscular/etiología , Espasticidad Muscular/fisiopatología , Músculo Esquelético/fisiopatología , Reproducibilidad de los Resultados , Accidente Cerebrovascular/fisiopatología
13.
Sci Rep ; 11(1): 5500, 2021 03 09.
Artículo en Inglés | MEDLINE | ID: mdl-33750882

RESUMEN

The relationship between ankle joint function and throwing-related injuries has not been demonstrated. We hypothesized that limited ankle joint range of motion (ROM) was related to risk factors for shoulder and elbow injuries in young baseball players. This 12-month prospective cohort study evaluated the age, height, weight, playing position, shoulder, elbow, and ankle function of 228 enrolled baseball players. Shoulder and elbow injuries were tracked during the season. Univariate and multivariate analyses were performed to identify risk factors for shoulder and elbow injuries among participants divided into non-injured and injured groups. Univariate analysis showed that age, height, weight, ROM of elbow flexion in the dominant arm, muscle strength ratio of shoulder abduction, and the likelihood of being a pitcher or a catcher were significantly greater in the injured group than in the non-injured group. ROM of shoulder abduction-external/internal rotation, shoulder total arc on the dominant arm, ankle joint dorsiflexion, and plantar flexion on the back (non-lead) and front (lead) legs were significantly less in the injured group than in the non-injured group. In conclusion, ROM dorsiflexion deficits in the back leg, shoulder abduction-external rotation in the dominant arm, ROM increase in elbow flexion on the dominant side, older age, and being a pitcher were significant independent risk factors for injury.


Asunto(s)
Tobillo/fisiopatología , Traumatismos en Atletas/fisiopatología , Béisbol , Lesiones de Codo , Codo , Fuerza Muscular , Lesiones del Hombro/fisiopatología , Niño , Codo/fisiopatología , Femenino , Humanos , Masculino , Factores de Riesgo
14.
Muscle Nerve ; 63(5): 690-696, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33543772

RESUMEN

INTRODUCTION: Neuromuscular ultrasonography (NMUS) is a valuable adjunct to electrodiagnostic testing for the diagnosis of entrapment neuropathy. The aim of this study was to determine whether diagnostic accuracy of NMUS could be enhanced in patients with unilateral ulnar mononeuropathy at the elbow (UNE) by utilizing side-to-side ulnar nerve cross-sectional area (CSA) ratios. METHODS: Retrospective case-control analysis of unilateral UNE cases identified cutoff values for elbow segment ulnar nerve maximum CSA (MCSA) of the symptomatic/asymptomatic limb (M ratio), as well as side-to-side ratios comparing MCSA with ipsilateral CSA at the Guyon canal (E/G), middle forearm (E/F), and middle humerus (E/H). Diagnostic accuracy values were calculated. RESULTS: The optimal M-ratio cut-off was 1.22 (sensitivity, 92.9%; specificity, 97.8%; accuracy, 95.4%). Optimal cutoffs for inter-E/G, -E/F, and -E/H ratios were 1.07 (sensitivity, 98%; specificity, 78%; accuracy, 87.7%), 1.11 (sensitivity, 95%; specificity, 80%; accuracy, 87.2%), and 1.18 (sensitivity, 95%; specificity, 93%; accuracy, 94%), respectively. DISCUSSION: The M ratio and inter-E/H ratio exhibited high diagnostic accuracy for unilateral UNE. Prospective studies are needed to compare the accuracy of the new measures with a single MCSA measurement.


Asunto(s)
Codo/diagnóstico por imagen , Nervio Cubital/diagnóstico por imagen , Neuropatías Cubitales/diagnóstico , Ultrasonografía/métodos , Adulto , Anciano , Estudios de Casos y Controles , Codo/fisiopatología , Electrodiagnóstico/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Conducción Nerviosa/fisiología , Estudios Retrospectivos , Sensibilidad y Especificidad , Nervio Cubital/fisiopatología , Neuropatías Cubitales/diagnóstico por imagen , Neuropatías Cubitales/fisiopatología
15.
Knee Surg Sports Traumatol Arthrosc ; 29(6): 2000-2005, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32870386

RESUMEN

PURPOSE: Controversy exists with regards to the etiology and treatment of lateral epicondylitis and the role of the lateral capsule in this pathology. The aim of this study was to compare arthroscopic lateral capsule resection with or without extensor carpi radialis brevis (ECRB) tendon debridement for treatment of lateral epicondylitis. METHODS: This is a retrospective study of 38 patients who underwent arthroscopic surgery for LE with two different techniques: Eighteen patients were treated with arthroscopic lateral capsular resection (LCR) + ECRB debridement and 20 patients were treated with arthroscopic LCR alone, without ECRB debridement. Both groups were assessed with Quick Disabilities of the Arm, Shoulder and Hand (QDASH) score for function and Visual Analog Scale (VAS) score for pain. RESULTS: Quick DASH scores were 12 [Formula: see text] 5 and 13 [Formula: see text] 4 at Groups 1 and 2, respectively, without any statistically significant difference. VAS pain scores were 15 [Formula: see text] 2 for both groups. VAS function scores were 85 [Formula: see text] 22 and 86 [Formula: see text] 18 at Groups 1 and 2 respectively. Sick leave periods in terms of weeks were 7 [Formula: see text] 5 and 7 [Formula: see text] 4 at Groups 1 and 2, respectively. There was no statistically significant difference in outcome of the two groups compared in terms of VAS pain, function scores, failure (re-operation) rates and sick leave period at the end of final follow-up. CONCLUSION: Both arthroscopic LCR alone and Arthroscopic LCR with ECRB debridement for the management of refractory LE provide significant improvement in pain and function. Isolated Arthroscopic LCR could be a sufficient surgical treatment for refractory LE. Thus, ECRB debridement or release may not be necessary in every case. LEVEL OF EVIDENCE: IV.


Asunto(s)
Artroscopía/métodos , Codo de Tenista/cirugía , Adulto , Desbridamiento , Codo/fisiopatología , Codo/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Estudios Retrospectivos , Codo de Tenista/fisiopatología , Resultado del Tratamiento
16.
Am J Sports Med ; 49(1): 162-171, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33196301

RESUMEN

BACKGROUND: Although a variety of pathologic conditions associated with osteochondritis dissecans (OCD) have been reported, the pathological progression has remained unclear. HYPOTHESIS: Separation of the immature epiphyseal cartilage is an early event in OCD, and osteonecrosis in the articular fragment is a late event. STUDY DESIGN: Case Series; Level of evidence, 4. METHODS: The participants were 26 boys (mean age, 13.8 years; mean skeletal age score for the elbow, 24.6 points) with capitellar OCD who underwent osteochondral autograft transplantation. A total of 28 cylindrical osteochondral plugs, including the articular fragment, an intermediate layer, and proximal epiphyseal bone, were harvested from the central area of the capitellum and were examined histologically. The articular fragments of OCD were independently assessed by 5 observers and divided into 4 pathological variations: IA, nearly normal-cartilaginous; IB, deteriorated-cartilaginous; IIA, cartilage-ossifying; and IIB, cartilage-osteonecrotic. The reliability of assessment and the correlation of the pathological variations with the clinical data were examined. RESULTS: The reliability of the assessment among 5 observers was almost perfect (Cohen kappa value = 0.91). OCD variations of IA, IB, IIA, and IIB were evident in 5, 10, 5, and 6 patients, respectively. OCD-I (cartilaginous) and OCD-II (osteochondral) corresponded significantly to radiographic stage I (radiolucency or slight calcification with open physis) and stage II (delayed ossification or bony fragment), respectively (Cohen kappa value = 0.79; percentage agreement = 81%). The pathological OCD variations were significantly correlated with the clinical data, including the period from symptom onset to surgery, patient age, and the skeletal age score (P < .01, in each). CONCLUSION: The present study has revealed that the pathological variations correspond to the progression of OCD, thus proving our hypothesis. OCD-IA was shown to be an early lesion caused by separation of the immature epiphyseal cartilage. OCD-IB appeared to result from ossification arrest over a prolonged period from the onset of OCD-IA, whereas OCD-IIA showed delayed ossification in the epiphyseal cartilage where vascularization from the surrounding bone had been established. Osteonecrosis in OCD-IIB was shown to be a late pathological event caused by disruption of the vascular supply to OCD-IIA.


Asunto(s)
Articulación del Codo/patología , Codo/fisiopatología , Placa de Crecimiento/patología , Osteocondritis Disecante/cirugía , Adolescente , Béisbol , Articulación del Codo/diagnóstico por imagen , Articulación del Codo/cirugía , Humanos , Masculino , Osteocondritis Disecante/diagnóstico por imagen , Osteocondritis Disecante/patología , Reproducibilidad de los Resultados , Resultado del Tratamiento
17.
Clin Biomech (Bristol, Avon) ; 81: 105245, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33302117

RESUMEN

BACKGROUND: Cerebral palsy affects 1 per 1.000 children, and in 83% of the cases upper extremity is involved. Dynamic elbow flexion deformity is a movement disorder observed in individuals with hemiparesis secondary to cerebral palsy. We sought to determine whether children with hemiplegic cerebral palsy exhibit dynamic elbow flexion deformity during daily activities and its influence to reaching function. METHODS: Sixteen children with upper limb hemiparesis and cerebral palsy (age 11y 7mo (SD 3y 2mo); 11 boys, 5 girls; Gross Motor Function Classification System level I or II) were included in this observational descriptive study. Manual Ability Classification System, Children's Hand-use Experience Questionnaire and Shriners Hospital for Children Upper Extremity Evaluation were used to evaluate affected upper extremity function. Spasticity was assessed with Modified Ashworth scale. Involuntary elbow flexion was recorded in eight daily activities. Elbow motion during reach function was measured. FINDINGS: Fifteen out of 16 individuals showed dynamic elbow flexion deformity. There was a significative increase of involved median elbow flexion in all the activities studied, except for "high speed stairs climbing" evaluation. Children's Hand-use Experience Questionnaire showed that children were independent in most of the daily activities (21 out of 29). Correlation between dynamic elbow flexion deformity and Shriners Hospital for Children Upper Extremity Evaluation was observed only in sitting-standing activity (Spearman's ρ 0.549, P = 0.028). INTERPRETATION: Dynamic elbow flexion deformity is very common in hemiplegic cerebral palsy and occurs proportionally to the degree of the effort demanded by the activities. Despite of presenting this movement disorder, it does not affect in children participation in daily activities.


Asunto(s)
Parálisis Cerebral/complicaciones , Parálisis Cerebral/fisiopatología , Codo/fisiopatología , Hemiplejía/complicaciones , Actividades Cotidianas , Adolescente , Niño , Preescolar , Contractura/complicaciones , Codo/patología , Femenino , Humanos , Masculino , Espasticidad Muscular/complicaciones , Rango del Movimiento Articular
18.
Pediatr Phys Ther ; 33(1): E23-E27, 2021 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-33273257

RESUMEN

PURPOSE: The objective of this analysis is to present the benefits and functional outcomes when using a custom dynamic elbow brace as an adjunct to therapeutic interventions for a child with neonatal brachial plexus palsy. SUMMARY OF KEY POINTS: Impairments associated with neonatal brachial plexus palsy can cause lifelong limitations of mobility, dexterity, and functional use of the involved upper extremity. The functional design of the custom dynamic elbow brace provided therapeutic versatility including immobilization, active-assisted controlled movement, and resistance exercise. These features facilitated efficient and functional muscle activation patterns, negating compensatory or substitute movements. CONCLUSIONS AND RECOMMENDATIONS FOR CLINICAL PRACTICE: The brace provided opportunities for focused muscle activation and subsequent improvements in strength, development of motor control, and functional mobility. Using a custom dynamic elbow brace was an effective therapeutic tool, used in conjunction with a comprehensive treatment program, and contributed to a successful outcome.


Asunto(s)
Tirantes , Codo/fisiopatología , Parálisis Neonatal del Plexo Braquial/rehabilitación , Femenino , Humanos , Lactante
19.
Chin J Traumatol ; 24(2): 120-124, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33358331

RESUMEN

Total elbow arthroplasty as a treatment option for open elbow fracture is relatively rare described. We reported a 39 years old polytrauma patient with complex open elbow fracture (Gustilo-Anderson type IIIB). The patient presented with large soft tissues defect on dorsal part of the left elbow, ulnar palsy due to the irreparable loss of the ulnar nerve, distal triceps loss due to the complete loss of the olecranon, loss of both humeral condyles with collateral ligaments and complex elbow instability. Only few similar cases have been published. Reconstructive surgery included repetitive radical debridement, irrigation, vacuum assisted closure system therapy, external fixation, coverage of the soft tissue defect with fascia-cutaneous flap from the forearm. Four months after the injury, total elbow arthroplasty with autologous bone graft (from the proximal radius) inserted in the ulnar component, was performed. At 3 years postoperatively, the patient is able to perform an active flexion from 0° to 110° with full prono-supination. Only passive extension is allowed. The ulnar neuropathy is persistent. Patient has no signs of infection or loosening of the prosthesis.


Asunto(s)
Artroplastia de Reemplazo de Codo/métodos , Artroplastia/métodos , Lesiones de Codo , Fracturas Óseas/cirugía , Fracturas Abiertas/cirugía , Traumatismo Múltiple/cirugía , Adulto , Trasplante Óseo/métodos , Codo/fisiopatología , Articulación del Codo/fisiopatología , Fracturas Óseas/clasificación , Fracturas Óseas/fisiopatología , Humanos , Masculino , Radio (Anatomía)/trasplante , Rango del Movimiento Articular , Traumatismos de los Tejidos Blandos/cirugía , Colgajos Quirúrgicos , Trasplante Autólogo , Resultado del Tratamiento , Nervio Cubital/lesiones , Neuropatías Cubitales/etiología
20.
Artículo en Inglés | MEDLINE | ID: mdl-33352652

RESUMEN

BACKGROUND: This case report describes whether a female civil servant who developed bilateral ulnar neuropathy can be classified as having an occupational disease. METHODS: The Dutch six-step protocol for the assessment and prevention of occupational diseases is used. RESULTS: Based on the six-step protocol, we propose that pressure on the ulnar nerve in the elbow region precipitated the neuropathy for this employee while working prolonged periods in elbow flexion with a laptop. CONCLUSION: Despite the low incidence laptop use might be a risk factor for the occurrence of ulnar neuropathy due to prolonged pressure on the elbow. Employers and workers need to be educated about this disabling occupational injury due to laptop use and about protective work practices such as support for the upper arm and elbow. This seems especially relevant given the trend of more flexible workspaces inside and outside offices, and given the seemingly safe appearance of laptop use.


Asunto(s)
Articulación del Codo/fisiopatología , Codo/fisiopatología , Teletrabajo , Nervio Cubital/lesiones , Neuropatías Cubitales/diagnóstico , Femenino , Humanos , Traumatismos Ocupacionales , Neuropatías Cubitales/etiología
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA