正常老年人关节活动范围的研究

目的确定各年龄组正常老年人的主要关节活动范围(ROM)的正常值,各组内ROM的性别间差异,ROM随增龄而下降的情况,及这种下降是否影响日常生活活动(ADL).方法50～89岁4个年龄组共200人,男女各100人,测量肩、肘、前臂、腕、髋、膝、踝等关节的共24个ROM.计算各组ROM的95%正常值范围,按双侧估计95%正常值,-x±1.96s;对组内性别间ROM差异按α=0.05进行成组设计的两样本均数比较的t检验;对老年前期组与老年组ROM差异按α=0.05进行两大样本均数比较的u检验.结果50～59岁、60～69岁、70～79岁、80～89岁4组ROM的正常值均随年龄的增加而进行性下降趋势;组内ROM的性别间差异多无显著性意义.结论老年人各组ROM均随年龄的增加有不同程度的下降,但明显大于基本ADL所需的数值.     

Performance requirements of tests performed nearer the patient

Commercial test systems which can be used outside the laboratory are proliferating, but there are doubts about the quality of results obtained when they are used by unskilled staff. Although rapid but approximate results can be invaluable in some clinical situations, they can be disastrous in others, particularly when the results conflict with those obtained by conventional laboratory techniques. The clinician needs to define his requirements for the quality of such tests, and the manufacturer encouraged to produce equipment which gives accurate results, independent of the skill of the operator. The laboratory scientist has an important role in the development and effective application of tests performed nearer the patient.     

Percutaneous insertion of Hickman catheters while the patient is in bed: a simplification of the technique

Central-venous long-term catheters are an important tool for patients undergoing anticancer chemotherapy. To circumvent dependence on the surgical department and their waiting lists, catheters were placed while the patient was in bed in the ward of a general oncology unit. A total of 84 single-lumen Hickman catheters were inserted with aseptic technique, percutaneously in this setting. The complication rate after the insertion was low, with only 1 case of pneumothorax (1.2%) and 7.1% of patients suffering arterial puncture. The placement of Hickman catheters while the patients is in bed is a safe procedure that can save hospitalization costs and permits the insertion at the optimum time in the care of the patient.     

Range of motion of the scoliotic spine in adults]

OBJECTIVE: To describe the movement of the trunk in adults with untreated adolescent idiopathic scoliosis (AIS) and to evaluate their relationship with the age of the patients, the location and angle of the curve, and the number of involved intervertebral segments. MATERIALS AND METHODS: Two hundred adult subjects with untreated AIS, without associated signs, were analyzed with rachimetry. The flexion, extension, bending, and rotation of the trunk were determined for each patient. The results were compared with a different sample: healthy subjects without spinal disease/other groups with more severe scoliosis (treated). RESULTS: In the absence of discopathy, regardless of the angle, location of the curve, or age of the patient, adults with untreated AIS demonstrated a 24% increase in truncal flexion, and a 30% decrease in hip flexion. The other movements studied with rachimetry were comparable to normal subjects. Lesions of the intervertebral segments increased in number and severity with age. These lesions progressively limited the mobility of the spine, initially in extension; and then in bending and flexion. CONCLUSIONS: The measurement of the mobility of the spine and the pelvis is part of the systematic examination of patients with adult scoliosis. This information can be used to improve the patients' health and spinal function; independent of their age and degree of spinal deformity.     

Patterns of motion loss in subjects with idiopathic loss of shoulder range of motion

BACKGROUND: Subjects with idiopathic loss of shoulder motion have difficulty sleeping, performing overhead activities, and completing activities of daily living. Treatment has been variable in approach and success. Cyriax's proposed shoulder capsular pattern was external rotation most limited followed by abduction followed by internal rotation. This investigation was performed to determine if a consistent pattern of motion loss was present in subjects with idiopathic loss of shoulder motion. METHODS: Repeated measurement of 25 (22 female) subjects' bilateral shoulder patterns of motion were compared. The three-dimensional position of the scapula and humerus throughout active shoulder abduction, external rotation, flexion, internal rotation, and scapular plane abduction was evaluated with an electromagnetic motion capture system. Patterns of motion loss were determined for both shoulders. The proportions of peak shoulder motion to mean maximum non-involved shoulders abduction, external, and internal rotation were utilized to determine the pattern of motion loss. FINDINGS: There was a significant difference in motion loss patterns between the involved and non-involved shoulders with the arm at the side. The internal rotation less than abduction less than external rotation pattern was demonstrated in 14 of 25 (56%) involved shoulders. No pattern was present in 14 of 21 (67%) non-involved shoulders. With the arm abducted, internal rotation was the most limited motion in 23 of 25 (92%) involved shoulders. INTERPRETATION: The results did not support Cyriax's proposed glenohumeral capsular pattern. Defining the pattern of motion loss in subjects with idiopathic loss of shoulder motion may assist in diagnosis and treatment.     

Comparison of the kinematics and kinetics of shoulder exercises performed with constant and elastic resistance

Background

Internal and external rotation exercises of the shoulder are frequently performed to avoid injury and pain. Knowledge about the motion and loadings of the upper extremities during these exercises is crucial for the development of optimal training recommendations. However, a comparison of the angles and corresponding moments in the upper extremities that are achieved during internal and external rotation exercises for the shoulder by using different resistance types has not yet been performed. Therefore, the aim of the study was to examine upper extremity kinetics and kinematics in 3D of the internal and external rotation exercises.

Methods

The kinematics and kinetics of 12 participants while they performed 10 different exercises with a constant and with an elastic external load corresponding to 2% body mass was assessed. The motion of the upper extremities was recorded three-dimensionally with a motion capture system, using a newly developed marker set and joint coordinate systems with 28 markers. The applied external load was measured with a load cell placed in series with the external resistance, and moments were calculated using an inverse dynamics approach.

Results

The range of motion and the joint loading was highly dependent on the exercises. The range of motion in the glenohumeral joint did not differ significantly between the two resistance types, whereas internal/external rotation moments were significantly higher with constant resistance than those with elastic resistance.

Conclusions

Larger or lower moments can, therefore, be achieved through selection of the appropriate resistance type, while the range of motion can be altered through the selection of exercise type. Therefore, the loading motion patterns identified in this study can help to choose suitable shoulder exercises dependent on the training objective.

     

Evaluation of the patient with neck versus shoulder pain

Neck and shoulder pain are common complaints among the general population, being the second and third most common musculoskeletal complaints, respectively, after back pain in the primary care setting. Differentiating between neck and shoulder pain can be challenging, as both share symptoms and physical examination findings. The differential diagnoses of neck and shoulder pain are extensive. Providers are encouraged to develop a systematic, comprehensive, and reproducible approach, including thorough history taking and physical examination along with focused diagnostic testing.     

Thermographic evaluation of the painful shoulder in the hemiplegic patient

In this study, we investigated the applicability of thermography as a technique for evaluating the painful postcerebrovascular accident (CVA) shoulder in hemiplegic patients. A thermographic series was taken of the upper extremities and upper trunk of 27 female subjects. The four groups we evaluated were nonhemiplegic subjects (n = 9), post-CVA subjects with recovered function (n = 6), hemiplegic subjects with upper extremity motor impairment (n = 6), and hemiplegic subjects with both motor impairment and ipsilateral shoulder pain (n = 6). The data revealed a normal thermographic series in 8 of the 9 nonhemiplegic subjects, but only in 1 of the 18 post-CVA subjects. The majority of the abnormal thermographic series of post-CVA subjects showed a 1 degree to 5 degree C coolness on the involved side. No consistent thermographic patterns emerged that could be related to the severity or location of pain. Further studies are needed to evaluate the efficacy of thermography as a means of determining the relationship between ipsilateral post-CVA coolness and hemiplegic shoulder pain.     

Interobserver reproducibility of the visual estimation of range of motion of the shoulder

OBJECTIVES: To assess interobserver reproducibility (agreement and reliability) of visually estimated shoulder range of motion (ROM) and to study the influence of clinical characteristics on the reproducibility. DESIGN: Test-retest analyses. SETTING: Various health care settings in the Netherlands. PARTICIPANTS: Consecutive patients with shoulder complaints (N = 201) referred by 20 general practitioners, 2 orthopedic physicians, and 20 rheumatologists. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Independent visual estimation by 2 physiotherapists of the ROM. Agreement was calculated as the mean difference in visual estimation between examiners +/-1.96 x standard deviations of this mean difference. The intraclass correlation coefficient (ICC) was calculated as a measure of reliability, based on a 2-way random effects analysis of variance. RESULTS: The lowest level of agreement was for visual estimation of active and passive elevation (limits of agreement, -43.4 to 39.8 and -46.7 to 41.5, respectively, for the difference between the affected and contralateral sides), for which the level of agreement was most clearly associated with pain severity and disability. The ability to differentiate between subjects was acceptable for all movements for the difference between the affected and contralateral sides (ICCs, > .70) except for horizontal adduction (ICC = .49). CONCLUSIONS: Interobserver agreement was low for the assessment of active and passive elevation, especially for patients with a high pain severity and disability. Except for horizontal adduction, visual estimation seems suitable for distinguishing differences between affected and contralateral ROM between subjects.     

The variable roles of the upper and lower subscapularis during shoulder motion

Background

The varied roles of the subscapularis muscle as an internal rotator of the humerus, a shoulder abductor, a humeral head depressor and an anterior stabiliser may be a result of differing innervation and lines of torque between its superior and inferior components. The aims of the study were to investigate the differences in the level of muscle activation between the upper and lower subscapularis during abduction, flexion, internal and external rotation movements, and temporal characteristics during abduction and flexion.

Methods

Intramuscular electrodes recorded electromyographic muscle activity from the upper and lower subscapularis muscles of the dominant throwing arm of twenty-four normal subjects. Participants completed ten repetitions of four shoulder movements — abduction, flexion, internal rotation and external rotation. Muscle activity was expressed as a percentage of maximum voluntary isometric contraction.

Findings

The lower subscapularis was found to activate at a higher level than the subscapularis during abduction, flexion and external rotation movements and this was significant during concentric and eccentric phases of abduction and flexion (< 0.001). During internal rotation, upper subscapularis muscle activity mirrored that of lower subscapularis, with a mean difference of 1.14%. Neither upper nor lower subscapularis had onset data commencing prior to the abduction movement; however upper subscapularis activated significantly later than lower subscapularis (P = 0.018).

Interpretation

The lower subscapularis has significantly higher muscle activity during shoulder elevation and this might reflect its greater role as a humeral head depressor and anterior stabiliser.     

Electromyographic study relating to shoulder motion: control of shoulder joint by functional electrical stimulation.

The purpose of this study is to create the standard stimulation patterns of shoulder motion from electromyographic (EMG) data in 13 healthy human volunteers in order to control the movement of the paralyzed shoulder in quadriplegic and hemiplegic patients by functional electrical stimulation (FES). Simultaneous EMG measurement was made at 24 points of 17 major muscles relating to shoulder motion. Since the number of the output channels in the portable FES apparatus is limited, 12 major muscles were selected from statistically processing these EMG data and stimulation patterns were created based on the EMG data of these muscles. Thus three standard stimulation patterns were created to move the shoulder, i.e., (i) 90 degrees flexion to 90 degrees horizontal abduction, (ii) 90 degrees flexion to 20 degrees horizontal adduction, and (iii) 90 degrees abduction to 90 degrees horizontal adduction. With the created stimulation patterns, the restoration of the shoulder motion in plegic patients was successful and it will be reported in the next paper.     

Arc of motion and socket depth in reverse shoulder implants

Background

Reverse shoulder arthroplasty relies on its congruent ball/socket joint to restore shoulder function. For a simple ball/socket joint, as shown in total hip arthroplasty, range of motion decreases with the increase of articular constraint. We challenge here that this intuitive concept might not be held in reverse shoulder arthroplasty because of the effect of multiple concurrent factors.

Methods

Abduction impingement-free arc of motion in reverse shoulder arthroplasty was examined with a virtual computer model. Six articular constraints, defined by normalized socket depths, were simulated. Four concurrent factors: glenosphere diameter, lateral offset of glenosphere from the glenoid surface, humeral neck-shaft angles, and locations of the glenosphere on the glenoid surface, were also studied, which composed a total of 81 combinations and 486 individual conditions.

Findings

Three distinct classes of arc of motion relative to the articular constraint were revealed: I – arc of motion decreased with increased constraint (57%), II – arc of motion with a complex relationship to constraint (37%), and III – arc of motion increased with increased constraint (6%).

Interpretation

Classes II and III were counter-intuitive which could be caused by impingement on the acromion associated primarily with superior positioning. Surgeons may need to be aware of it when the glenoid component has to be placed superiorly. The detailed motion/constraint relationship will further help engineers improve the design in reverse shoulder arthroplasty.