Knee and Elbow Range of Motion in Healthy Older Individuals

Normative values for range of motion in older individuals, essential in evaluation and treatment planning, are few. In this study, effect of age, sex, sidedness, type of motion, and general activity level on range of motion was examined, with a clinical goniometer, in knee and elbow joints of 60 healthy subjects. Subjects, 10 per group, were divided into 3 age groups, 55 to 64,65 to 74, and 75 to 84 years, for each sex. Data for right and left sides were combined since a significant difference was demonstrated only for elbow flexion in females. A significant decrease in female knee joint range of motion with age was observed but was not considered clinically relevant. Only small differences between the sexes, and no relationship between activity levels and range of motion were observed. Arnerican Academy of Orthopaedic Surgeons' values for the knee joint may not be appropriate for older individuals because their estimates differ by more than the known measurement error from these data and other published studies of this age group.     

全膝关节置换术之后的快速康复方案

在美国,每年大约有50万例全膝关节置换术(TKA),这项回顾性、观察性、队列研究比较了TKA术后快速和标准的康复方案。所有患者均在2012年1月至2017年7月期间接受了初次TKA。2012年1月至2013年12月期间接受治疗的患者接受了三天住院治疗,并在术后第一周内开始标准康复方案(SRP)。从2013年开始,患者在术前7天对隐神经髌下支和股前皮神经进行低温神经松解术等疼痛处理,术后当天出院回家,并在术后当天开始快速康复方案(RRP)。在基线及手术后52周随访时中测量患者的关节活动范围。     

Increasing Knee Range of Motion Using a Unique Sustained Method

In order for functional and sport specific activities to occur, knee flexion and extension range of motion (ROM) is necessary. Loss of full ROM at the knee joint can be detrimental to the function of the lower extremity and treatment is needed to regain full function of ROM. Research supports the use of the sustained force to increase knee ROM. This article presents a unique method of attaining sustained force. The technique is cost effective, involves equipment already available in most physical therapy clinics, conserves time, and provides consistent force overtime without causing the therapist fatigue.

Discussion

Despite the fact clinical research has been performed, a poor appreciation exists for the appropriate clinical use of sports massage.

Conclusion

Additional studies examining the physiological and psychological effects of sports massage are necessary in order to assist the sports physical therapist in developing and implementing clinically significant evidence based programs or treatments.     

早期持续被动运动对膝骨折术后关节活动范围的影响

目的 :探讨早期持续被动运动 (continuouspassivemotion ,CPM)训练对膝骨折术后关节活动范围的影响。方法 :4 7例膝关节骨折患者分为G0、G1、G2和G3组 ,在完成常规物理治疗后 ,G1、G2和G3组分别在术后第 1、2和 3周时开始CPM训练 ,共 4周。结果 :治疗第 6周时测量 4组患膝关节活动范围 ,平均值分别为 (6 4± 5 )°、(89± 7)°、(78± 4 )°、(71± 3)°。组间比较差异有显著性。结论 :膝关节骨折术后早期CPM训练能更快促进膝功能康复。     

持续被动运动在膝关节置换术后早期康复治疗中的作用

目的评价持续被动运动(CPM)在膝关节置换术后早期康复治疗中对疼痛和膝关节主动屈伸活动度的作用。方法 20例(40膝)女性重度骨性关节炎患者行双膝关节同时置换术。分为实验组和对照组,每组10例20膝。实验组术后每天2次行CPM和主动康复治疗,对照组每天2次主动康复治疗。术前、术后2周和3个月应用疼痛视觉模拟评分(VAS)和角度测量仪评估两组患者的疼痛和膝关节主动屈伸活动度。结果术后2周和3个月,两组患者的疼痛评分和膝关节活动度均无显著性差异(P>0.05)。与术前相比,疼痛评分和膝关节主动屈伸活动度在术后3个月均有明显改善(P<0.01)。结论进行主动康复治疗后,CPM的辅助应用对膝关节置换术后3个月内疼痛和关节活动度的改善无明显促进作用。     

Continuous Passive Motion Following Primary Total Knee Arthroplasty:short- and Long-term Effects on Range of Motion

Abstract

Study design: a systematic review of randomised controlled trials.

Background: Knee arthroplasties are a common surgical procedure for patients suffering from knee osteoarthritis. Continuous passive motion (CPM) is frequently used to increase range of motion (ROM) in the knee and promote rapid postoperative recovery of patients undergoing total knee arthroplasty (TKA). Many clinical trials have tried to assess its efficacy, but results have been contradictory.

Objectives: To review the efficacy in terms of ROM of CPM in the postoperative management of patients undergoing TKA.

Methods: Medline, Embase, Cinahl and Cochrane databases and bibliographic indexes and relevant citations were searched. All relevant studies were assessed for methodological quality using a validated scoring instrument.

Data collection and analysis: Two reviewers independently extracted data and assessed trial quality. Results of a meta-analysis of ROM data were divided into short-term effects (i.e. 7-14 days after surgery) and long-term effects (i.e. 6-12 months after surgery). Where possible, data from individual trials were combined in a meta-analysis. Data were analysed using weighted mean differences (WMD with 95% confidence intervals [CI]) between treatment and control groups in the short and long term, weight being the inverse of variance.

Main results: Fifteen studies investigating the effect of continuous passive motion in the management of TKA patients were included in the review. Study quality ranged from poor (2 points on a 10-point scale) to good (8 points). The evidence on the efficacy of CPM after TKA is conflicting. Positive short-term effects of adding CPM to standardised physical therapy (PT) have been reported on flexion ROM. Five studies were included in a pooled analysis, for a total of 317 patients (pooled effect size WMD 8.27; 95% CI -1.60, 18.15)

Conclusions: There is evidence of a moderate positive, short-term effect of adding CPM to standardised PT after total knee arthroplasty. There is no relevant long-term effect of CPM use.     

关节镜下半月板成形术对膝关节半月板损伤患者血清疼痛因子、一氧化氮、透明质酸及关节活动度的影响

目的 探讨关节镜下半月板成形术(AMP)对膝关节半月板损伤患者血清疼痛因子、一氧化氮(NO)、透明质酸(HA)及关节活动度的影响.方法 选取2019年5月—2020年12月收治的90例膝关节半月板损伤为研究对象,根据治疗方法不同分为对照组和治疗组,每组45例.对照组接受保守治疗,治疗组行AMP治疗.比较两组的临床疗效,...     

Effect of Different Neurodynamic Mobilization Techniques on Knee Extension Range of Motion in the Slump Position

Abstract

Mobilization of the nervous system has emerged as a significant adjunct to the treatment of musculoskeletal injuries. Clinical studies have shown that neurogenic symptoms can be resolved by treatment techniques directed at restoring normal neural biomechanics and physiology. Two alternate mobilization techniques have been proposed: the slider and tensioner techniques. A search of the literature revealed no peer-reviewed studies comparing the effects of these two treatment techniques, although a number of studies have investigated these techniques in isolation and found them to have positive effects on range of motion and other outcome measures. The aim of this study was to investigate the effects of these two techniques on knee range of motion of normal subjects (30 females [mean age 21.4+/?1.2 years, range 19-24]) in the slump position. Knee flexion angle of the right leg was measured using a universal 360° goniometer while in a fully slumped position, prior to and after the application of the respective mobilization technique. The tensioner technique brought about a significant decrease in knee flexion angle (P=0.003) with a mean percentage change of 14.7+/?11.8%(3.4+/?2.5°). The slider technique brought about a significant decrease in knee flexion angle (P<0.001) with a mean percentage change of 19.9+/?15%(4.3+/?2.6°). There was a non-significant between-group difference for the effect of the two techniques on range of motion (P=0.075). The findings of this study indicate that in normal female subjects, both the tensioner and slider techniques have a positive and significant effect on improving knee extension range of motion in the slump position. This could decrease the sensitivity of the sciatic nerve and the neuromeningeal structures to mechanical load. The clinical significance of changes of this magnitude on neural tissue and of these techniques in a symptomatic population requires further investigation.     

Range of Motion in Older Women

This study had three purposes: to compare the active neck and upper extremity range of motion (ROM) in healthy older women with expected estimates; to consider if right and left side measures were similar; and to determine the degree of ROM loss with advancing age. Sixty-one older women, living independently in the community, were measured at the neck, shoulder, elbow, forearm, and wrist on the right and left sides using a standard protocol. ROM was less than expected by 14_ to 30_ for neck lateral flexion (26.00_ ?8.72_ on right; 26.41_ ?7.67_ on left), shoulder abduction (154.62_D 21.37_ on right; 150.25_ ?21.65_ on left), shoulder flexion (158.23_ ?19.55_ on right; 159.20_ ?8.73_ on left), shoulder internal rotation (52.92_ ?8.99_ on right; 53.74_ ?9.94_ on left), and shoulder external rotation (76.05_ ?16.31_ on right; 72.44_ ?15.37 on left). Some differences were noted between right and left side ROM. Linear regression for age and range suggested that range decreased with age by an average of approximately 1_ per year in right shoulder abduction, right shoulder flexion, and right and left shoulder external rotation.     

Effect of Anterior Tibiofemoral Glides on Knee Extension during Gait in Patients with Decreased Range of Motion after Anterior Cruciate Ligament Reconstruction

Purpose: The purpose of this preliminary investigation was to evaluate the effect of anterior tibiofemoral glides on maximal knee extension and selected spatiotemporal characteristics during gait in patients with knee extension deficits after anterior cruciate ligament (ACL) reconstruction.Methods: Twelve patients with knee-extension deficits after recent ACL reconstructions underwent quantitative gait analyses immediately before and after 10 minutes of repeated anterior tibiofemoral glides on the operative limb, and again after a 10-minute seated rest period.Results: Maximum knee extension during stance phase of the operative limb significantly increased immediately after the treatment (mean increase: 2.0°±4.1°, 95% CI: 0.6°-3.3°). Maximum knee extension decreased after the 10-minute rest period (mean decrease: 0.9°±1.8°, 95% CI: -0.1°-1.8°), although the decrease was not statistically significant. Small increases in operative limb step length, stride length, and gait speed were observed after the rest period compared to baseline values only.Conclusions: A single session of anterior tibiofemoral glides increases maximal knee extension during the stance phase of gait in patients with knee-extension deficits. Increases in knee extension are small and short-lived, however, suggesting that continued activity is required to maintain the observed improvements.     

Joint Range of Motion in Flaccid Hemiplegia

The effect of muscle tone on passive range of motion (PROM) in affected joints and comparison joints on the unaffected side was investigated in 15 patients with flaccid paralysis hemiplegia. PROM was measured in the shoulder and hip in flexion, extension, abduction, adduction and internal and external rotation using the plastic universal goniometer. PROM in the elbow and knee was assessed in flexion and extension. Wrist PROM was measured in flexion, extension and radial and ulnar deviation. Additionally, ankle dorsiflexion, plantarflexion, eversion and inversion PROM were assessed. Decreased muscle tone significantly affected shoulder (p = 0.006), wrist (p = 0.032) and hip (p = 0.003) PROM. Significant differences between the affected and unaffected sides were found in shoulder PROM in extension (p = 0.014), adduction (p = 0.001) and internal (p = 0.034) and external rotation (p = 0.007). Wrist PROM was significantly different in flexion (p = 0.048) and extension (p = 0.001), and hip PROM was significantly different in abduction (p = 0.029), adduction (p = 0.012) and external rotation (p = 0.001). Surprisingly, although muscle tone had no influence on ankle PROM, there was a significant difference in ankle plantarflexion PROM (p = 0.013). In conclusion, in flaccid hemiplegia, decreased muscle tone affects the PROM in the shoulder, wrist and hip. Differences in PROM between the unaffected and affected side are evident in shoulder extension, adduction and internal and external rotation, wrist flexion and extension, hip abduction, adduction and external rotation, and ankle plantarflexion.     

持续被动运动联合等速闭链训练对膝关节前交叉韧带重建术患者疼痛、关节活动度及运动功能的影响

目的 评价持续被动运动联合等速闭链训练对膝关节前交叉韧带(ACL)重建术患者疼痛、膝关节活动度和运动功能的影响.方法 选择2020年6月—2021年1月行膝关节ACL重建术115例为观察对象,根据康复训练方法不同分为对照组57例和观察组58例.对照组采用常规康复训练,观察组在对照组基础上采用持续被动运动联合等速闭链训练...     

关节镜半月板成形术联合玻璃酸钠注射对半月板损伤患者疗效、疼痛程度及膝关节活动度的影响

[目的]探究关节镜半月板成形术联合玻璃酸钠注射对半月板损伤患者疗效、疼痛程度及膝关节活动度的影响.[方法]选取2017年5月至2020年6月西安医学院第二附属医院收治的94例半月板损伤患者,采用随机数字表法分为观察组(给予关节镜半月板成形术联合玻璃酸钠注射治疗,成形术后立即予以2.5 m L透明质酸钠关节腔内注射,每周...     

Incidence of Deep Venous Thrombosis Associated with Femoral Venous Catheterization

Objective : To determine in adult medical patients the incidence of deep venous thrombosis (DVT) resulting from femora] venous catheterization (FVC).
Methods : A prospective, observational study was performed at a 420-bed community teaching hospital. Hep-arin-coated 7-Fr 20-cm femoral venous catheters were inserted unilaterally into a femoral vein. Each contra-lateral leg served as a control site. Age, gender, number of FVC days. DVT risk factors, administration of DVT prophylaxis, and DVT formation and site were tabulated for each patient. Venous duplex sonography was performed bilaterally on each patient within 7 days of femoral venous catheter removal.
Results : Catheters were placed in 29 men and 13 women. Femoral DVT was identified by venous duplex sonography in 11 (26.2%) of the FVC legs and none (0%) in the control legs. Posterior tibial and popliteal DVT was identified in both the FVC and control legs of 1 patient. DVT formation at the site of FVC insertion was highly significant (p = 0.005). There were no statistically significant associations with age (p = 0.42), gender (p = 0.73), number of DVT risk factors (p = 0.17), number of FVC days (p = 0.89), or DVT prophylaxis (p — 099).
Conclusion : Placement of femoral catheters for central venous access is associated with a significant incidence of femoral DVT as detected by venous duplex sonography criteria at the site of femoral venous catheter placement. Physicians must be aware of this risk when choosing this vascular access route for adult medical patients. Further studies to assess the relative risk for DVT and its clinical sequelae when using the femoral vs other central venous catheter routes are indicated.     

Reliability and Measurement error of Active Knee extension Range of Motion in a Modified slump Test Position: A Pilot study

Abstract

The slump test is a tool to assess the mechanosensitivity of the neuromeningeal structures within the vertebral canal. While some studies have investigated the reliability of aspects of this test within the same day, few have assessed the reliability across days. Therefore, the purpose of this pilot study was to investigate reliability when measuring active knee extension range of motion (AROM) in a modified slump test position within trials on a single day and across days. Ten male and ten female asymptomatic subjects, ages 20–49 (mean age 30.1, SD 6.4) participated in the study. Knee extension AROM in a modified slump position with the cervical spine in a flexed position and then in an extended position was measured via three trials on two separate days. Across three trials, knee extension AROM increased significantly with a mean magnitude of 2° within days for both cervical spine positions (P>0.05). The findings showed that there was no statistically significant difference in knee extension AROM measurements across days (P>0.05). The intraclass correlation coefficients for the mean of the three trials across days were 0.96 (lower limit 95% CI: 0.90) with the cervical spine flexed and 0.93 (lower limit 95% CI: 0.83) with cervical extension. Measurement error was calculated by way of the typical error and 95% limits of agreement, and visually represented in Bland and Altman plots. The typical error for the cervical flexed and extended positions averaged across trials was 2.6° and 3.3°, respectively. The limits of agreement were narrow, and the Bland and Altman plots also showed minimal bias in the joint angles across days with a random distribution of errors across the range of measured angles. This study demonstrated that knee extension AROM could be reliably measured across days in subjects without pathology and that the measurement error was acceptable. Implications of variability over multiple trials are discussed. The modified set-up for the test using the Kincom dynamometer and elevated thigh position may be useful to clinical researchers in determining the mechanosensitivity of the nervous system.