Validating Surface Topography for the Measurement of the Thoracic Kyphosis Angle in Patients With Scoliosis: A Prospective Study of Accuracy

ObjectiveThe purpose of this study was to test the validity and determine the accuracy of surface topography in relation to photogrammetry for measuring the thoracic kyphosis angle in patients with scoliosis.MethodsThis was a prospective, cross-sectional study of diagnostic accuracy that followed the guidelines recommended by the Standards for Reporting Diagnostic Accuracy. We consecutively included 51 participants aged 7 to 18 years. Exclusion criteria were surgical treatment of the spine, neurological disease, lower limb discrepancy greater than 1.5 cm, and body mass index above 29 kg/m². Each participant was evaluated using both a surface topography scan and photogrammetry in random order. The measurement obtained through photogrammetry was used as a reference in this study. For statistical purposes, Pearson's correlation test, Bland-Altman graphical analysis, and the receiver operating characteristic curve (P < .05) were performed.ResultsThe correlation between the measurements was strong and significant (r = 0.76, P < .001) with an average difference of 0.4° in the Bland-Altman analysis. The receiver operating characteristic curve area was excellent for hypokyphosis (93.4%) and good for hyperkyphosis (86.4%), both being significant (P < .005).ConclusionThe agreement and strong correlation between the 2 methods indicate the validity of surface topography to measure the thoracic kyphosis angle. The surface topography provides accurate measures for the thoracic kyphosis angle with cutoff points for hypo- (33.3°) and hyperkyphosis (40.8°) for individuals with scoliosis.     

Novel Screening Tool for Adolescent Idiopathic Scoliosis: A Reliability Study

ObjectiveThe aim of this study was to assess the agreement between a web-based scoliosis screening tool and a standard screening procedure.MethodsSixty participants were selected (median age, 12 years; 75% were women) and separated into 2 groups: those with unknown spinal curvature status and those with confirmed scoliosis. Each participant was assessed by 2 blinded assessors, with one measuring the angle of trunk rotation using a scoliometer and the second using a web-based screening application. The app provided a relative risk score for having scoliosis based on a weighted algorithm. Those with an angle of trunk rotation ≥7° or risk score >2 were deemed as being at risk for having scoliosis.ResultsThere was fair agreement (kappa = 0.34; 95% confidence interval [CI], 0.14-0.55; P < .001) between the app and the scoliometer among the unconfirmed cases. The McNemar test indicated a difference in the proportion of positive tests (P = .001), whereby the screening app produced a significantly higher number of positive tests (15/53 = 28.3%) compared to the standard screening procedure (4/53 = 7.5%) for unconfirmed cases. Among the confirmed cases, the app correctly identified 5 out of 7 (sensitivity: 71%; 95% CI, 29%-96%) participants, whereas the scoliometer correctly identified 6 out of 7 (sensitivity: 86%; 95% CI, 42%-100%) participants.ConclusionThese findings indicate fair agreement between the app and the scoliometer, though it was not possible to precisely estimate the sensitivity of the app in this study.     

Clinical and radiological assessment of vertebral rotation in idiopathic scoliosis

Background. Idiopathic scoliosis is a three-dimensional deformity of the spine and the trunk. The principle clinical method of estimation of the rotational deformity in the transversal plane of the body is the measurement of the angle of trunk rotation with a scoliometer. The aim of the study was to investigate the relationship between the angle of trunk rotation and the two radiological parameters: the Perdriolle angle of axial rotation and the Cobb angle of spinal curvature. Material and Methods. 50 children with single or double scoliosis (total of 65 curves) were examined clinically and radiologically. For each patient the angle of trunk rotation was measured with the Bunnell scoliometer, the Cobb angle and the Perdriolle angle were calculated at the a-p standing radiograph. Results. Strong positive linear correlation was found among the three parameters in thoracic curves. The correlation was less important in lumbar curves. Thoracic curves revealed superior values of the angle of trunk rotation and inferior values of the angle of Perdriolle than the lumbar curves matched for Cobb angle. Conclusions. Clinical measurement of the angle of trunk rotation with the use of a scoliometer can predict the value of the angle of the curve in thoracic scoliosis. This might replace a certain amount of radiological examination and reduce the patients' irradiation.     

Trunk Position Sense in Older Tai Chi Sword Practitioners

To examine whether older Tai Chi sword practitioners had developed better trunk position sense than healthy control subjects, 16 female Tai Chi sword practitioners from a local community Tai Chi Club in Hong Kong were compared with 11 female healthy control subjects. Active trunk repositioning was used to test trunk proprioceptive acuity. Tai Chi sword practitioners made significantly smaller absolute angle errors than control subjects in trunk rotation to the left (2.2° ± 0.9° vs. 4.4° ± 2.7°; p = 0.006) and to the right (2.1° ± 0.9° vs. 4.2° ± 2.9° of control; p = 0.01), but there were negligible improvements in trunk forward flexion (3.9° ± 3.0° and 4.8° ± 3.0°, respectively; p = 0.46). These results demonstrate that Tai Chi sword practitioners had developed better position sense in trunk rotation but not in trunk flexion than healthy older subjects.     

Comparison of hip rotation range of motion in judo athletes with and without history of low back pain

This study compared hip rotation range of motion in judo athletes with and without a history of low back pain. Forty-two athletes (22 males) were divided into two groups: 21 with history of low back pain (HLBP) and 21 without history of low back pain (Control). Internal and external hip rotation range of motion in active and passive movement were measured using computed photogrammetry. The HLBP group exhibited a significant reduction in active internal rotation (27.5 ± 6.5° vs 38.2 ± 6.5°), active total rotation (80.1 ± 9.5° vs 87.4 ± 7.9°) of the non-dominant limb (P < 0.01) and active total rotation (82.6 ± 7.6° vs 87.6 ± 9.8°; P = 0.04) in comparison with the control group. In passive rotation, the HLBP group showed a significant reduction in internal rotation of the dominant (41.9 ± 6.1° vs 46.1 ± 8.4°; P = 0.04) and non-dominant limb (37.1 ± 8.4° vs 47.3 ± 7.6°; P < 0.001), total rotation of the non-dominant limb (96.7 ± 10.2° vs 105.1 ± 11°; P = 0.005) and total rotation (98.5 ± 9.2° vs 105 ± 11.2°; P = 0.02). Within the HLBP group, a significant reduction in both active and passive internal rotation (P < 0.001) and active and passive total rotation (P < 0.01) of the non-dominant limb was detected. The same was not found in the control group. The results demonstrate that judo athletes with a history of low back pain exhibit deficits in hip rotation and greater asymmetry between limbs.     

Using Ultrasound to Screen for Scoliosis to Reduce Unnecessary Radiographic Radiation: A Prospective Diagnostic Accuracy Study on 442 Schoolchildren

Scoliosis screening is important for timely initiation of brace treatment to mitigate curve progression in skeletally immature children and adolescents. School scoliosis screening programs in Hong Kong follow the protocol of referring children screened positive with a scoliometer and Moiré topography for confirmatory standard radiography. Despite being highly sensitive (88%) in detecting those who require specialist referral, the screening program was found to have a false-positive rate >50%, which could lead to unnecessary X-ray radiation. Radiation-free ultrasound has been reported to be valid and reliable for quantitative assessment of curve severity in scoliosis patients. The aim of this prospective diagnostic accuracy study was to determine the accuracy of ultrasound in determining the threshold of referral that requires X-ray for children screened positive with the scoliometer and Moiré topography. Our study recruited 442 schoolchildren with a mean Cobb angle of 14.0 ± 6.6°. The sensitivity and specificity of ultrasound in predicting the correct referral status, confirmed by X-ray, were 92.3% and 51.6%, with positive and negative predictive values of 29.0% and 96.9%, respectively. Receiver operating characteristic curve analysis revealed area under the curve values of 0.735 for ultrasound alone and 0.832 for ultrasound in combination with measurement of angle of trunk rotation. The finding supports the accuracy of using ultrasound to determine referral status, which could result in a >50% reduction of unnecessary radiation for children undergoing scoliosis screening.     

Reduced flexion rotation test in women with chronic and episodic migraine

ObjectiveTo compare flexion rotation test and global active cervical mobility in women with chronic migraine, episodic migraine, and headache-free controls. The influence of neck pain-related disability on the flexion rotation test was also analyzed.MethodsWomen with chronic migraine (n = 25), episodic migraine (n = 30), and those who were headache-free (n = 30) were evaluated. Upper cervical mobility was measured using the flexion rotation test and global active mobility was assessed using the cervical range of motion device. Neck pain related-disability was assessed using the Neck Disability Index. Statistical analyses were performed using a MANOVA test, prevalence ratios, and linear regression.ResultsChronic (right, MD: ?15°; 95%CI: ?21° to ?11°; left, MD: ?13°; 95%CI: ?20° to ?12°) and episodic (right, MD: ?8°; 95%CI: ?13° to ?4°; left, MD: ?8°; 95%CI: ?12° to ?5°) migraine groups achieved lower flexion rotation test mobility bilaterally than headache-free women. Only chronic migraine was associated with a lower global cervical range of motion compared to that of headache-free women during flexion, (MD: ?8°; 95%CI: ?15° to ?1°), extension (MD: ?13°; 95%CI: ?20° to ?4°), right lateral flexion (MD: ?4°; 95%CI: ?9° to ?0.2°), left lateral flexion (MD: ?6°; 95%CI: ?10° to ?2°), right rotation (MD: ?9°; 95%CI: ?15° to ?4°), and left rotation (MD: ?8°; 95%CI: ?13° to ?2°). Migraine was associated with a 2.85-fold increase in the risk of a positive flexion rotation test. Flexion Rotation Test was influenced by disability-related neck pain (R² = 19.1; p = 0.001).ConclusionWomen with migraine have a lower upper cervical range of motion than headache-free women. Women with chronic migraine demonstrated reduced global cervical range of motion when compared to headache-free women. Migraine was associated with in increased likelihood of a positive Flexion Rotation Test. Reduction in mobility was influenced by migraine frequency and disability-related neck pain.     

The effects of spinal posture and pelvic fixation on trunk rotation range of motion

Background

Axial rotation of the trunk is important to many vocational tasks and activities of daily living, and may be associated with back injuries. The influence of spinal postures on trunk rotation appears conflicting. This study investigated the influence of forward trunk inclination, spinal posture and pelvic fixation on maximum trunk rotation.

Methods

Twenty male participants were assessed using an optoelectronic motion-analysis system to track trunk movement during maximal trunk rotations in different spinal positions within the sagittal plane. A repeated-measures multivariate analysis of variance investigated the effects of forward trunk inclination, spinal posture and pelvic fixation on trunk and pelvic rotation. Test–retest reliability was determined using interclass correlation coefficients and standard error of measurement.

Findings

Forward trunk inclination at 45° yielded a 19% (6.2°; P < 0.001) increase in trunk rotation and a 40% (25.5°; P < 0.001) decrease in pelvic rotation when compared to standing. When flexing and extending the spine at a forward trunk inclination of 45° there was a 5% (1.9°; P < 0.01) and a 4% (1.6°; P < 0.05) decrease in trunk rotation. Fixing the pelvis increased the trunk rotation by up to 9% (3.3°; P < 0.001).

Interpretation

Inclining the trunk forward and maintaining a neutral spine maximised trunk rotation range of motion (RoM). This has implications for educational programmes intended to maximise sporting performance. Within the clinical setting, unrestricted observation of trunk rotations is considered more appropriate as it may benefit the clinician in determining possible detrimental relative flexibilities that may exist within the body.     

Three-Dimensional Spinal Position With and Without Manual Distraction Load Increases Spinal Height

ObjectiveThe purpose of this study was to investigate if spinal height increases using 3-dimensional (3-D) spinal position with and without manual distraction load and to assess the correlation between spine height changes and degrees of trunk rotation.MethodsFifty-six participants were randomly placed in one of two groups: (1) 3-D spinal position with manual distraction load, and (2) without manual distraction load. Spinal height was measured before and after the interventions using a stadiometer. For the statistical analysis, we used a 2 (Loading status: pre- versus post-intervention height) X 2 (3-D spinal position: with versus without manual distraction load) repeated measures Analysis of Variance (ANOVA) was used to identify significant interaction and main effects. Paired t-tests were used to calculate differences in spinal height changes between the two interventions. Pearson correlation coefficient was used to measure correlations between changes in spinal heights and degrees of trunk rotation.ResultsMean spinal height increase with 3-D spinal position with and without manual distraction load was 6.30 mm (±6.22) and 5.69 mm (±4.13), respectively. No significant interaction effect was present between loading status and 3-D spinal position but a significant main effect in loading status was. Paired t-tests revealed significant differences in spinal heights between pre-and post-3-D spinal position with and without manual distraction load. No significant correlation was measured between trunk rotation and spinal height changes.Conclusion3-D spinal position with or without distraction load increased spinal height. This suggests that 3-D spinal positioning without manual distraction could be used in home settings to help maintain intervertebral disc (IVD) health.     

Inertial measurement unit compared to an optical motion capturing system in post-stroke individuals with foot-drop syndrome

BackgroundFunctional electrical stimulation (FES) can be used for compensation of foot-drop for post-stroke individuals by pre-programmed fixed stimulation; however, this stimulation seems no more effective than mechanical ankle foot orthoses.ObjectiveWe evaluated the metrological quality of inertial sensors for movement reconstruction as compared with the gold-standard motion capturing system, to couple FES with inertial sensors to improve dorsiflexion on the paretic side, by using an adaptive stimulation taking into account individuals’ performance post-stroke.MethodsAdults with ischemic or hemorrhagic stroke presenting foot-drop and able to walk 10 m, were included from May 2016 to June 2017. Those with passive ankle dorsiflexion < 0° with the knee stretched were excluded. Synchronous gait was analyzed with the VICON© system as the gold standard and inertial measurement units (IMUs) worn by participants. The main outcome was the dorsiflexion angle at the heel strike and mid-swing phase obtained from IMUs and the VICON system. Secondary outcomes were: stride length, walking speed, maximal ankle dorsiflexion velocity and fatigue detection.ResultsWe included 26 participants [18 males; mean age 58 (range 45–84) years]. During heel strike, the dorsiflexion angle measurements demonstrated a root mean square error (RMSE) of 5.5°; a mean average error (MAE) of 3.9°; Bland-Altman bias of  − 0.1° with limits of agreement  − 10.9° to + 10.7° and good intra-class correlation coefficient (ICC) at 0.87 between the 2 techniques. During the mid-swing phase, the RMSE was 5.6; MAE 3.7°; Bland-Altman bias  − 0.9° with limits of agreement  − 11.7° to + 9.8° and ICC 0.88. Good agreement was demonstrated for secondary outcomes and fatigue detection.ConclusionsIMU-based reconstruction algorithms were effective in measuring ankle dorsiflexion with small biases and good ICCs in adults with ischemic or hemorrhagic stroke presenting foot-drop. The precision obtained is sufficient to observe the fatigue influence on the dorsiflexion and therefore to use IMUs to adapt FES.     

Medial knee stability at flexion increases tibial internal rotation and knee flexion angle after posterior-stabilized total knee arthroplasty

BackgroundSoft-tissue balance is an important element for the success of total knee arthroplasty; however, the influence of intraoperative soft-tissue balance on knee kinematics in posterior-stabilized-total knee arthroplasty remains unknown. We investigated whether intraoperative soft-tissue balance could influence knee kinematics and flexion angle after posterior-stabilized-total knee arthroplasty.MethodsThis study included 30 patients with knee osteoarthritis and varus alignment who underwent posterior-stabilized total knee arthroplasty; intraoperative soft-tissue balance parameters, such as varus ligament balance and joint component gap, were assessed by an offset-type tensor at knee flexion angles of 0°, 10°, 30°, 60°, 90°, 120°, and 135°. Medial and lateral compartment gaps were calculated. The amount of tibial internal rotation was determined between 60° and 135° flexion by the navigation system. Simple linear regression analysis was used to analyze the effects of intraoperative soft-tissue balance on tibial internal rotation. Linear regression analysis was used to assess correlation between tibial internal rotation and postoperative knee flexion angle.FindingsMedial compartment gaps at 60° (r = −0.57, P < 0.05) and 90° (r = −0.60, P < 0.05) of flexion were significantly negatively correlated with tibial internal rotation. Moreover, tibial internal rotation showed a significant correlation with the 2-year postoperative knee flexion angle (r = 0.50, P < 0.05) and improvement in knee flexion angle (r = 0.61, P < 0.05).InterpretationThus, smaller medial compartment gaps at 60° and 90° of flexion play an important role in achieving medial pivot motion with tibial internal rotation; moreover, tibial internal rotation provides a better flexion angle after posterior-stabilized total knee arthroplasty.     

Sex affects gait adaptations after exercise in individuals with anterior cruciate ligament reconstruction

BackgroundOsteoarthritis after anterior cruciate ligament reconstruction has been linked with changes in gait. Individuals with reconstruction demonstrate gait changes after exercise, however there is no information on altered gait after exercise based on sex. The purpose of this study was to examine the association of sex on changes in running gait after exercise in individuals with reconstruction compared to healthy.MethodsForty females (22 reconstructed) and 22 men (11 reconstructed) ran before and after exercise. Triplanar lower extremity kinematics and kinetics were measured on the involved limb. Data were reduced to 0–100% of gait. Change scores were calculated for each 1% with 90% confidence intervals. Mean differences were calculated for all significant differences.FindingsAfter exercise, females with reconstruction increased knee valgus (1.81°), knee external rotation (2.02°), lateral trunk flexion (1.24°) and trunk rotation (2.15°) compared to healthy females. Females with reconstruction increased knee extension moment (0.07 Nm/kg), knee abduction moment (0.08 Nm/kg), hip extension moment (0.14 Nm/kg) and hip internal rotation moment (0.04 Nm/kg) compared to healthy females. After exercise, males with reconstruction decreased knee varus (−4.83°), hip adduction (−1.99°), and hip internal rotation (−4.44°), however increased lateral trunk flexion (1.94°) compared to healthy males. Males with reconstruction increased knee extension moment (0.07 Nm/kg), knee adduction moment (0.31 Nm/kg), knee internal rotation moment (0.13 Nm/kg), hip flexion moment (0.17 Nm/kg), and hip external rotation moment (0.05 Nm/kg) compared to healthy males.InterpretationMales with reconstruction increased hip loading while women with reconstruction increased trunk motion post-exercise. Sex should be considered when evaluating response to exercise after reconstruction.     

Effect of Short-Term 3-Dimensional Schroth Exercises In Adolescent Idiopathic Scoliosis: An Observational Study

ObjectiveThe purpose of this study was to examine how a short-term Schroth exercise camp affects pain intensity, angle of trunk rotation (ATR), postural recovery, trunk muscle endurance, flexibility, dynamic balance, body image, perception of cosmetic deformity, and health-related quality of life in individuals with adolescent idiopathic scoliosis (AIS).MethodsA single-group pretest–posttest design was conducted. Forty-five individuals between the ages of 10 and 18 years who were diagnosed with AIS were included in the study. ATR with scoliometer, postural symmetry changes with Anterior Trunk Symmetry Index and Posterior Trunk Symmetry Index, trunk muscle endurance with straight plank and side plank durations, dynamic balance with Y Balance Test, cosmetic deformity perceptions with the Walter Reed Visual Assessment Scale, and health-related quality of life with the Scoliosis Research Society 22-item questionnaire. The participants engaged in a short-term Schroth exercise camp involving 4.5 hours of corrective exercises per day for 7 days. Above mentioned assessments were done on the first and last day of the exercise camp.ResultsAfter the Schroth exercise camp, participants showed decreased ATR, improved postural symmetry ratio, and greater trunk muscle endurance and dynamic balance scores. There were also improvements in cosmetic deformity perception and health-related quality of life (P < .05).ConclusionThis preliminary study suggests that a short-term Schroth exercise camp could have a beneficial effect for adolescents with AIS. Although the results of this study should be considered preliminary, the initial findings seem to be promising and repeatable.     

Validity and reliability of wheelchair sitting posture measures using Coach’s Eye in abled subjects

People in wheelchairs spend a long time in the sitting position and often incur alignment problems resulting in neck and back pain. This study: (1) assessed the validity/reliability of Coach’s Eye (CE) smart device application, (2) examined the effect of seat to back support angle adjustments on head, neck, and shoulder posture in the sitting position, and (3) compared changes in cervical rotation at each back support angle. Abled subjects sat in a wheelchair with back support angles positioned at 90°, 100°, and 110°. CE, as well as ImageJ software, was used to analyze three angles: sagittal head angle (SHA), cervical angle (CVA), and shoulder angle (SA). There were highly significant differences for CVA and SA (p < 0.001) among the three seat to back support angles. Validity of CE was examined by correlating CE with ImageJ scores. CE had high validity for all angles (r = 0.99, 0.98, 0.99 respectively, p < 0.001). Inter-rater reliability for SHA, CVA, and SA was high (intraclass correlation coefficient [ICC] ranged from 0.95 to 0.99). Head (CVA) and shoulder (SA) alignment was closest to neutral posture with back support angles set at 110° and 90°, respectively.     

Intrarater and Interrater Reliability of Angular Measures Using TEMPLO Two-dimensional Motion Analysis Software

ObjectiveThe purpose of this study was to assess the intrarater and interrater reliability of marking 2 angles with the TEMPLO software and to provide relevant information for clinical practice.MethodsA prospective test–retest study has been conducted. Four raters took measures on 2 days, with 2 weeks in between. Craniovertebral angle and trunk forward lean were drawn on 22 video frames using TEMPLO. Reliability was examined using intraclass correlation coefficients including standard errors of measurement and minimal detectable change values as measures of precision expressed in the unit of the test (°).ResultsIntraclass correlation coefficients for intrarater and interrater reliability ranged from 0.98 to 1.00. Standard errors of measurement and minimal detectable change values ranged from 0.4° to 0.8° and 0.8° to 2.3°, respectively.ConclusionThese results indicate excellent reliability for craniovertebral angle and trunk forward lean assessed with TEMPLO software. Changes exceeding 2.3° may be expected to fall outside the test’s variability.     

Subacromial Motion Metrics in Painful Shoulder Impingement: A Dynamic Quantitative Ultrasonography Analysis

ObjectivesTo explore the subacromial motion metrics in patients with and without subacromial impingement syndrome (SIS) and to investigate whether the abnormality was associated with rotator cuff pathologies.DesignThis cross-sectional observational study used dynamic quantitative ultrasonography imaging for shoulder joint assessment.SettingOutpatient rehabilitation clinic.ParticipantsIndividuals with SIS on at least 1 shoulder (n=32) and asymptomatic controls (n=32) (N=64).InterventionsNot applicable.Main Outcome MeasuresFrame-by-frame, the humeral greater tuberosity against the lateral edge of the acromion was traced to obtain the minimal vertical acromiohumeral distance (AHD). The rotation angle and radius of the humerus were computed using the least-squares curve fitting method.ResultsApproximately two-thirds of the shoulders with SIS did not have any sonographically identifiable rotator cuff pathologies. There was a consistent trend of nonsignificantly increased humeral rotation angles in painful shoulders. The generalized estimating equation demonstrated that the decreased minimal vertical AHD was associated with painful subacromial impingement (β coefficient: ?0.123cm, 95% confidence interval [CI], ?0.199 to ?0.047). The area under the curve for the minimal vertical AHD to discriminate painful or impinged shoulders ranged from 0.624-0.676. The increased rotation angle (β coefficient: 10.516°; 95% CI, 3.103-17.929) and decreased rotation radius (β coefficient: ?2.903cm; 95% CI, ?5.693 to ?0.111) were shown to be significantly related to the presence of supraspinatus tendinopathy.ConclusionsShoulders with SIS were characterized by a decreased minimal vertical AHD during dynamic examination. Abnormal subacromial metrics can develop in patients with mild (or no) rotator cuff pathologies. More prospective cohort studies are warranted to investigate the changes in subacromial motion metrics in populations at risk for painful or impinged shoulders.     

Trunk,pelvic and hip kinematics during the Stork test in pregnant women with pelvic girdle pain,asymptomatic pregnant and non-pregnant women

BackgroundPelvic girdle pain is prevalent during pregnancy, and women affected report weight-bearing activities to be their main disability. The Stork test is a commonly used single-leg-stance test. As clinicians report specific movement patterns in those with pelvic girdle pain, we aimed to investigate the influence of both pregnancy and pelvic girdle pain on performance of the Stork test.MethodsIn this cross-sectional study, 25 pregnant women with pelvic girdle pain, 23 asymptomatic pregnant and 24 asymptomatic non-pregnant women underwent three-dimensional kinematic analysis of the Stork test. Linear mixed models were used to investigate between-group differences in trunk, pelvic and hip kinematics during neutral stance, weight shift, leg lift and single leg stance.FindingsFew and small significant between-group differences were found. Pregnant women with pelvic girdle pain had significantly less hip adduction during single leg stance compared to asymptomatic pregnant women (estimated marginal means (95% confidence intervals) -1.1° (−2.4°, 0.3°) and 1.0° (−0.4°, 2.4°), respectively; P = 0.03). Asymptomatic pregnant women had significantly less hip internal rotation compared to non-pregnant women 4.1° (1.6°, 6.7°) and 7.9° (5.4°, 10.4°), respectively (P = 0.04) and greater peak hip flexion angle of the lifted leg in single leg stance 80.4° (77.0°, 83.9°) and 74.1° (70.8°, 77.5°), respectively (P = 0.01). Variation in key kinematic variables was large across participants in all three groups.InterpretationOur findings indicate that trunk, pelvic and hip movements during the Stork test are not specific to pregnancy and/or pelvic girdle pain in the 2nd trimester. Instead, movement strategies appear unique to each individual.     

Effects of dry needling of the obliquus capitis inferior on sensorimotor control and cervical mobility in people with neck pain: A double-blind,randomized sham-controlled trial

BackgroundImpairments of sensorimotor control relating to head and eye movement control and postural stability are often present in people with neck pain. The upper cervical spine and particularly the obliquus capitis inferior (OCI) play an important proprioceptive role; and its impairment may alter cervical sensorimotor control. Dry needling (DN) is a valid technique to target the OCI.ObjectivesTo investigate if a single DN session of the OCI muscle improves head and eye movement control-related outcomes, postural stability, and cervical mobility in people with neck pain.MethodsForty people with neck pain were randomly assigned to receive a single session of DN or sham needling of the OCI. Cervical joint position error (JPE), cervical movement sense, standing balance and oculomotor control were examined at baseline, immediately post-intervention, and at one-week follow-up. Active cervical rotation range of motion and the flexion rotation test were used to examine the global and upper cervical rotation mobility, respectively.ResultsLinear mixed-models revealed that the DN group showed a decrease of JPE immediately post-intervention compared to the sham group (mean difference [MD]= -0.93°; 95% confidence interval [CI]: -1.85, -0.02) which was maintained at one-week follow-up (MD= -1.64°; 95%CI: -2.85, -0.43). No effects on standing balance or cervical movement sense were observed in both groups. Upper cervical mobility showed an increase immediately after DN compared to the sham group (MD= 5.14°; 95%CI: 0.77, 9.75) which remained stable at one-week follow-up (MD= 6.98°; 95%CI: 1.31, 12.40). Both group showed an immediate increase in global cervical mobility (MD= -0.14°; 95%CI: -5.29, 4.89).ConclusionThe results from the current study suggest that a single session of DN of the OCI reduces JPE deficits and increases upper cervical mobility in patients with neck pain. Future trials should examine if the addition of this technique to sensorimotor control training add further benefits in the management of neck pain.     

Combined effect of change in humeral neck-shaft angle and retroversion on shoulder range of motion in reverse total shoulder arthroplasty — A simulation study

BackgroundWe studied combined effect of change in humeral neck shaft angle and retroversion on shoulder ROM in reverse total shoulder arthroplasty using 3-dimensional simulations.MethodsUsing a 3D model construct based on the CT scans of 3 males and a 3-dimensional analysis program, a humeral component of reverse total shoulder arthroplasty was implanted in 0°, 10°, 20°, 30°,40° retroversion and 135°, 145°, and 155° neck shaft angle. Total horizontal range of motion (sum of horizontal adduction and abduction) at 30° and 60° scaption, adduction in the scapular plane and IR behind the back were measured for various combinations of neck shaft angle and retroversion.FindingsChange in retroversion didn't show any effect on total horizontal range of motion. Total horizontal range of motion at both 30° and 60° scaption, showed maximum values at 135° neck shaft angle and minimum values at 155° neck shaft angle. With any combination of retroversion angles, adduction deficit was maximum at 155° neck shaft angle and no adduction deficit at 135° neck shaft angle. Every 10° decrease in neck shaft angle resulted in an average 10.4° increase in adduction. For every 10° increase in retroversion, there was loss of internal rotation behind the back up to at least one vertebral level.Interpretation135° neck shaft angle resulted in maximum total horizontal range of motion both at 30° and 60° scaption regardless of retroversion angles. 135° neck shaft angle also reduced the chances of scapular impingement. Decrease in retroversion angle resulted in more amount of internal rotation behind the back.     

Shoulder Kinematics of Axillary Web Syndrome in Women Treated for Breast Cancer

ObjectiveTo better understand how the shoulder moves in breast cancer survivors with axillary web syndrome (AWS), we compared 3-dimensional (3D) shoulder kinematics during shoulder elevation among breast cancer survivors with and without AWS 5 years postoperatively. Although research consistently shows decreased shoulder range of motion with AWS, we do not understand the underlying biomechanics.DesignNested case control study.SettingUniversity Academic Breast Center.ParticipantsTwenty-five women who had surgery 5 years previously for unilateral breast cancer with the removal of at least 1 lymph node participated in this study (N=25). Twelve participants had AWS; 13 women did not have AWS.InterventionsNot applicable.Main Outcome MeasuresThree-dimensional shoulder kinematic data during shoulder forward flexion, scapular plane abduction, and coronal plane abduction were collected using 3D electromagnetic motion tracking. Kinematic data were extracted at 30°, 60°, 90°, and 120° of arm elevation for scapular upward rotation, internal rotation, and posterior tilt as well as for glenohumeral external rotation.ResultsWomen with AWS demonstrated 15.2° less scapular upward rotation at 120° humerothoracic elevation (95% confidence interval [-25.2, -5.2], P=.005), regardless of plane. No significant between-group differences were found for any other angle of scapular upward rotation, nor for scapular internal rotation, scapular posterior tilt, or glenohumeral axial rotation at any angle.ConclusionsFive years after surgery for breast cancer, women diagnosed with AWS have altered scapulohumeral kinematics that may place them at an increased risk of shoulder pain based on existing kinematic literature in healthy cohorts. This information can help guide rehabilitation programs for breast cancer survivors to facilitate pain-free upper extremity function after treatment.