Investigation of multidirectional hip range of motion and hip motion asymmetry in individuals with idiopathic scoliosis with different curve patterns

BackgroundWhile some studies of the asymmetry of lower limbs in individuals with idiopathic scoliosis exist, there is a need for multidirectional studies conducted on hip joint range of motion and its relationship to curve patterns in idiopathic scoliosis.ObjectivesThis study analyzes the hip joint range of multidirectional motions, hip motion asymmetry and investigates them according to curve patterns in individuals with idiopathic scoliosis.MethodsThe sample included 108 females with idiopathic scoliosis. Participants were divided into three groups: double curves, single thoracic curve and single lumbar curve. The range of hip flexion and extension, abduction and adduction, and internal and external rotations were assessed actively and passively with a universal goniometer. The range of motion, left–right asymmetry and the mid-points of the ranges of motion were analyzed.ResultsThe passive range of the right hip abduction was higher in the thoracic curve group vs. the lumbar curve group. Active and passive ranges of hip extension were higher in the left hip vs. right hip. Active left–right asymmetry was higher than passive left–right asymmetry.ConclusionIndividuals with idiopathic scoliosis had different hip abduction motions according to curve pattern that originated from single curves. Left–right hip asymmetry was seen for the hip extension motion. Higher left–right asymmetry for active motion than passive motion in hip abduction may indicate a problem in motion perception in individuals with idiopathic scoliosis.     

系统康复治疗对下肢制动后膝关节活动范围的影响

对院内康复治疗和院外锻炼对股骨干骨折术后病人及不同康复时机对下肢骨折术后病人膝关节活动范围的影响进行临床观察，结果表明：康复治疗组术后１２个月时患肢膝关节活动范围为１２９．２９°±２５．８６°，对照组为６２．１２°±４８．３９°，两组差异非常显著（Ｐ＜０．０１）；在本组病例中下肢骨折术后１２个月时膝关节活动范围的改善与术后开始康复治疗间隔时间呈显著负相关（ｒ＝－０．７３，Ｐ＜０．０１）。说明下肢骨折术后康复治疗在改善制动后膝关节功能方面明显优于自行锻炼，康复治疗得越早，效果越明显。     

Reliability and smallest real difference of the ankle lunge test post ankle fracture

This study aimed to determine the reliability and the smallest real difference of the Ankle Lunge test in an ankle fracture patient population.In the post immobilisation stage of ankle fracture, ankle dorsiflexion is an important measure of progress and outcome. The Ankle Lunge test measures weight bearing dorsiflexion, resulting in negative scores (knee to wall distance) and positive scores (toe to wall distance), for which the latter has proven reliability in normal subjects only.A consecutive sample of ankle fracture patients with permission to commence weight bearing, were recruited to the study. Three measurements of the Ankle Lunge Test were performed each by two raters, one senior and one junior physiotherapist. These occurred prior to therapy sessions in the second week after plaster removal. A standardised testing station was utilised and allowed for both knee to wall distance and toe to wall distance measurement.Data was collected from 10 individuals with ankle fracture, with an average age of 36 years (SD 14.8). Seventy seven percent of observations were negative. Intra and inter-rater reliability yielded intra class correlations at or above 0.97, p < .001. There was a significant systematic bias towards improved scores during repeated measurement for one rater (p = .01). The smallest real difference was calculated as 13.8 mm.The Ankle Lunge test is a practical and reliable tool for measuring weightbearing dorsiflexion post ankle fracture.     

The effects of Mobilization with Movement on dorsiflexion range of motion,dynamic balance,and self-reported function in individuals with chronic ankle instability

Previous studies have examined the effectiveness of a manual therapy intervention known as Mobilization with Movement (MWM) to increase dorsiflexion range of motion (ROM) in individuals with chronic ankle instability (CAI). While a single talocrural MWM treatment has increased dorsiflexion ROM in these individuals, examining the effects of multiple treatments on dorsiflexion ROM, dynamic balance, and self-reported function would enhance the clinical application of this intervention. This study sought to determine if three treatment sessions of talocrural MWM would improve dorsiflexion ROM, Star Excursion Balance Test (SEBT) reach distances, and self-reported function using the Foot and Ankle Ability Measure (FAAM) in individuals with CAI. Eleven participants with CAI (5 Males, 6 Females, age: 21.5 ± 2.2 years, weight: 83.9 ± 15.6 kg, height: 177.7 ± 10.9 cm, Cumberland Ankle Instability Tool: 17.5 ± 4.2) volunteered in this repeated-measures study. Subjects received three MWM treatments over one week. Weight-bearing dorsiflexion ROM (cm), normalized SEBT reach distances (%), and self-reported function (%) were assessed one week before the intervention (baseline), prior to the first MWM treatment (pre-intervention), and 24–48 h following the final treatment (post-intervention). No significant changes were identified in dorsiflexion ROM, SEBT reach distances, or the FAAM-Activities of Daily Living scale (p > 0.05). Significant changes were identified on the FAAM-Sport (p = 0.01). FAAM-Sport scores were significantly greater post-intervention (86.82 ± 9.18%) compared to baseline (77.27 ± 11.09%; p = 0.01) and pre-intervention (79.82 ± 13.45%; p = 0.04). These results indicate the MWM intervention did not improve dorsiflexion ROM, dynamic balance, or patient-centered measures of activities of daily living. However, MWM did improve patient-centered measures of sport-related activities in individuals with CAI.     

Multidetector computed tomography of temporomandibular joint: A road less travelled

This article reviews the imaging anatomy of temporomandibular joint(TMJ), describes the technique of multi-detector computed tomography(MDCT) of the TMJ, and describes in detail various osseous pathologic afflictions affecting the joint. Traumatic injuries affecting the mandibular condyle are most common, followed by joint ankylosis as a sequel to arthritis. The congenital anomalies are less frequent, hemifacial microsomia being the most commonly encountered anomaly involving the TMJ. Neoplastic afflictions of TMJ are distinctly uncommon, osteochondroma being one of the most common lesions. MDCT enables comprehensive evaluation of osseous afflictions of TMJ, and is a valuable tool for surgical planning. Sagittal, coronal and 3D reformatted images well depict osseous TMJ lesions, and their relationship to adjacent structures.     

简化太极拳运动中踝关节活动度的变化

目的研究简化太极拳运动时踝关节角度的变化。方法对 3 0例健康成年男性被试用关节测角器测量运动时踝关节角度。结果右踝关节活动以背屈为主 ,左踝处于“动态中间 0°位”。结论简化太极拳运动可在踝关节功能范围内锻炼背屈和跖屈肌群 ,特别是小腿三头肌的力量。     

不同年龄与不同位置下进行远端指间关节活动度的测量研究

摘要 目的：使用通用量角器测量远端指间关节活动度,探讨不同年龄和不同姿势对测量结果的影响。 方法：选取40名健康志愿者（20名年轻人和20名老年人）,对其在四个姿势下（即姿势1近端指间关节屈曲并主动屈曲远端指间关节、姿势2近端指间关节屈曲并被动屈曲远端指间关节,姿势3近端指间关节伸直并主动屈曲远端指间关节,姿势4近端指间关节伸直并被动屈曲远端指间关节）分别进行远端指间关节活动度的测量。 结果：在同一年龄组,近端指间关节屈曲和伸直位可对远端指间关节的活动度产生明显的影响。即使保持近端指间关节在同一姿势,远端指间关节主动活动度和被动活动度值间差异具有显著性。另外,近端指间关节伸直位时远端指间关节主动屈曲的活动度明显小于近端指间关节屈曲位时远端指间关节被动屈曲的活动度。在同一姿势下,年轻人与老年人的远端指间关节活动度也存在显著性差异。 结论：不同年龄和不同姿势可明显影响远端指间关节活动度的测量结果。     

早期康复介入对膝部骨折术后关节活动范围的影响

目的:比较膝部骨折术后不同时期介入康复治疗对关节活动范围(ROM)的影响。方法:根据康复介入的时间将53例膝部骨折术后患者分成第1期康复组(27例)和第2期康复组(26例),分别测量两组进入第2期康复时的膝关节ROM,第2期康复1个月后膝关节ROM及随诊1年后的膝关节活动障碍例数。结果:两组进入第2期康复时及第2期康复1个月后膝关节ROM差异均有非常显著性意义(P<0.001);两组随诊1年后的膝关节活动障碍例数差异有显著性意义(P<0.05)。结论:早期介入康复对改善膝部骨折术后ROM具有重要作用。     

Effect of heat in increasing the range of knee motion after the development of a joint contracture: an experiment with an animal model

OBJECTIVE: To compare the effects of 2 different heat modalities, infrared and ultrasonic therapy, on a knee flexion contracture. DESIGN: In vivo, experimental, controlled study involving a rat knee joint contracture model that was immobilized using a ligature in flexion for 40 days. SETTING: Collegiate research laboratory. ANIMALS: Ninety-three adult male Wistar rats. INTERVENTIONS: After remobilization, rats were assigned to 3 treatment groups: stretching only (S), stretching with infrared therapy (S+IR), and stretching with ultrasonic therapy (S+US). Six treatment sessions were given in 2 weeks. MAIN OUTCOME MEASURES: The angle of maximum knee extension, wet-weight of triceps surae muscles, phase lag, and dynamic stiffness as mechanical responses were measured, and histologic study was conducted. RESULTS: Compared with the S group, both the S+IR and S+US groups exhibited a significant increase in range of motion (ROM) (P=.021, P=.008, respectively) and a tendency to decrease the phase lag, but there was no significant difference between the 2 heat-combined groups. There were no differences in the weights of the triceps surae muscles and in dynamic stiffness among the groups. CONCLUSIONS: Six treatment sessions of stretching with infrared or ultrasound were more effective than stretching without heat at increasing the ROM and decreasing the phase lag of a moderately severe joint contracture. The clinical implementation of heat is advocated to regain a normal ROM and mechanical property when experiencing a joint contracture.     

Acute neck pain: cervical spine range of motion and position sense prior to and after joint mobilization

Despite the relatively high prevalence of cervical spine pain, the efficacy of treatment procedures is limited. In the current study, range of motion and proprioception was assessed prior to and after specific cervical spine mobilisation techniques. A 44-year-old male office worker presented with a history of cervical pain of 1 day duration. He had woken with pain, stiffness and a loss of range of motion. Examination findings indicated pain to be at C5–6 on the left side. Measurement of maximal three-dimensional cervical motion was undertaken using a Zebris system. A position matching task tested the individual's ability to actively reposition their head and neck. The treatment undertaken involved grade III down-slope mobilisations on the left side at C5–6 and C6–7 in supine lying. This technique was then progressed by placing the subject in an upright sitting position, and sustained natural apophyseal glides were performed at C6.Immediately following the treatment, the patient reported a considerable decrease in pain, less difficulty in movement and reduced stiffness. Motion analyses showed the most marked percentage improvements in range of motion after treatment were in flexion (55%), extension (35%), left rotation (56%), and left lateral flexion (22%). Ipsilateral lateral flexion with axial rotation was also notably improved following treatment. No change in proprioceptive ability was found following the treatment. The findings showed that the application of standardised specific mobilisation techniques led to substantial improvements in the range of motion and the restitution of normal coupled motion.     

持续被动运动在改善截瘫患者踝关节屈伸功能和减轻骨质疏松的效果观察

目的观察持续被动运动(continuous passive motion,CPM)在改善截瘫患者踝关节屈伸功能和减轻骨质疏松的效果。方法将60例截瘫患者随机分为CPM组32例和对照组28例,CPM组应用CPM,对照组应用人工手法被动运动。比较治疗前后两组患者踝关节被动屈伸活动范围和骨密度的差异。结果治疗后CPM组患者踝关节活动度和骨密度优于对照组(均P<0.01)。结论 CPM可改善截瘫患者踝关节屈伸功能,减轻骨质疏松的发生。     

Effects of ankle joint mobilizations in adults poststroke: a pilot study

Kluding PM, Santos M. Effects of ankle joint mobilizations in adults poststroke: a pilot study.

Objective

To compare the effect of 2 interventions on ankle mobility, ankle kinematics, and weight-bearing symmetry during functional activities in subjects with hemiparesis after a stroke.

Design

Randomized trial.

Setting

Academic medical center.

Participants

A convenience sample of 16 subjects with hemiparesis after stroke (mean age, 55.2y; mean time since stroke, 21.4mo).

Intervention

Subjects received 8 sessions over 4 weeks of either functional task practice combined with ankle joint mobilizations, or functional task practice only.

Main Outcome Measures

Changes in ankle range of motion (ROM) (not blinded), ankle kinematics during sit-to-stand (STS) and gait, and lower-extremity weight-bearing symmetry during STS and static standing.

Results

The combined intervention group gained 5.7°±3.1° in passive ankle ROM compared with 0.2°±2.6° in the functional practice only group (95% confidence interval [CI], 2.5-8.6; P<.01). No significant changes in ankle kinematics or weight bearing during static standing were noted in either group. The functional practice group decreased differences in weight bearing during STS by 9.5%±6.47%, whereas the combined intervention group increased this difference by 3.37%±5.29% (95% CI, 3.26-19.46; P=.01).

Conclusions

The increase in ankle motion did not improve joint kinematics and may have prevented improvement in weight-bearing symmetry.     

Magnetic resonance imaging with computed tomography of a renal leiomyoma

Renal leiomyoma are rare, benign tumors of the kidney. There is little information about the imaging of these tumors with modern modalities. We present a case of computed tomographic (CT) and magnetic resonance (MR) imaging of a large renal leiomyoma.     

Intra- and inter-rater reliability of a modified measure of hand behind back range of motion

The aim of this reliability study was to identify the clinimetric properties, specifically intra- and inter-rater reliability, for measuring the functionally and clinically important hand behind back (combined shoulder internal rotation/adduction and elbow flexion) range of motion using a modified technique. Sixty asymptomatic participants (20 male, 40 female) aged 45.4 ± 11.7 years (mean ± SD). Hand behind back was measured as the distance from the mid-line between the posterior superior iliac spines (PSIS) to the tip of the thumb and recorded in centimetres above the PSIS (a positive measure) or below the PSIS (a negative measure). The intra- and inter-rater reliability for the measurement were excellent, with ICC (2,1) of 0.95 for intra-rater and ICC (2,2) of 0.96 for inter-rater reliability. The standard error of the measurement (SEM) and smallest real difference (SRD) values showed acceptable levels of measurement error, SEM 4.3 mm and SRD 12.8 mm for intra-rater reliability and SEM 2.6 mm and SRD 7.7 mm for inter-rater reliability. The assessment of hand-behind-back motion from a point equidistant between the PSISs to the tip of the thumb is more reliable than traditional methods and a useful clinical tool.     

Clinical reliability and usability of smartphone goniometers for hip range of motion measurement

[Purpose] This study aimed to utilize the objective measurements and a survey questionnaire for assessing the intra- and inter-rater reliability, measurement time, and usability of a smartphone application type of goniometer to measure the hip joint angles. [Participants and Methods] Three examiners (physiotherapists) measured the hip joint range of motion using universal and smartphone goniometers on 30 daycare center rehabilitation patients. Reliability was calculated using the intra-class correlation coefficient. The examiners completed a questionnaire survey for assessing the usability of the goniometers. [Results] The intra-rater reliability was high, but the inter-rater reliability was low. Measurement times using the two instruments showed no difference. The usability questionnaire findings suggested that the smartphone goniometer was easier to use than the universal goniometer. [Conclusion] Reliability within the raters was high, but reliability among the raters was low. However, both goniometric devices provided a satisfactory range of motion measurement data when a single evaluator used the same device for all measurements.     

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.     

Sex differences in the pattern of innominate motion during passive hip abduction and external rotation

The objective of the study was to evaluate sex differences in the pattern of innominate motion about the sacroiliac joint (SIJ) during hip movement. Although the magnitude of intrinsic SIJ motion is influenced by joint congruence and ligament elasticity sex differences in pelvic joint kinematics are under-investigated. Forty healthy and active males and females between the ages of 18 and 35 were recruited. 3D motion of the innominate bones and femur were recorded with a magnetic tracking device as the hips were loaded in standardised increments of 10° in 3 positions – external rotation (ER), abduction (AB), and combined external rotation and abduction (AB + ER). While females had greater overall innominate motion, two distinct sex dominant patterns emerged. Patterns of innominate motion also differed when load was applied to the dominant rather than non-dominant limb. As the main motion within the pelvis is intrinsic, the results of the present study point to a differing viscoelastic response and different movement strategies to passive load between the sexes. In addition, careful attention to limb dominance should be considered when testing SIJ motion.     

Assessing the knee flexion range of motion after total knee arthroplasty: Technology versus senses

IntroductionFollowing total knee arthroplasty surgery, attention should be paid to post-operative knee range of motion to achieve daily activities. Goniometer assessment is widely used to assess the range of motion in the post-operative period. This study aimed to determine the inter-rater ability of a smartphone application and visual estimation of the knee joint after total knee arthroplasty among different professions that commonly work together and compare whether any method is superior to another.MethodRange of motion measurements was performed by four clinicians as two physiotherapists and two orthopedic fellows. They utilized the Goniometer Reports application for smartphones, universal goniometer, and visual estimation to measure angles of knees which was operated. A two-way mixed model of intra-class correlation coefficient (ICC) with a 95% confidence level was used to assess inter-rater reliability.ResultsThirteen patients (11 female) and 20 knees (10 right) were assessed. The ICCs were found excellent both for between methods and between raters.ConclusionOur results show that technology seems a more accurate way to determine the knee range of motion after knee arthroplasty compared to senses. However, in lack of technological resources or time, or to avoid possible infection, visual estimation also could provide useful information.