Early Active Mobilization after Tendon Transfers Using Mesh Reinforced Suture Techniques

1995 ◽  
Vol 20 (3) ◽  
pp. 291-300 ◽  
Author(s):  
K. L. SILFVERSKIÖLD ◽  
E. J. MAY
Keyword(s):  
Range Of Motion ◽  
Suture Techniques ◽  
Wrist Extension ◽  
Tendon Transfers ◽  
Opposite Hand ◽  
Active Flexion ◽  
Active Range Of Motion ◽  
Active Mobilization ◽  
The Mean ◽  
Flexion And Extension

23 tendon transfers in the hand and forearm were performed using a polyester mesh sleeve to reinforce conventional suture techniques. All transfers were mobilized with active flexion and extension within 3 days of operation. Excluding one rupture (due to extreme unintentional loading) and depending on the type of transfer used, a mean of between 69% and 78% of the final active range of motion was obtained 1 month post-operatively. With the exception of transfers for wrist extension, the mean final active range of motion amounted to between 91% and 100% of the available passive range of motion and between 75% and 100% of the corresponding “normal” active range of motion in the opposite hand. The mean final active range of motion after reconstructions for wrist extension amounted to 85% of the passive range of motion and to at least 80% of the maximum range of motion potentially available with the transfers used. The results indicate that early active mobilization after tendon transfers may offer significant advantages in terms of quicker and simpler rehabilitation as well as improved results.

scholarly journals Early Clinical Results of Arthroscopically Assisted Drilling via the Radius in a Distal-to-Proximal Direction for Osteochondritis Dissecans of the Elbow

2019 ◽  
Vol 7 (9) ◽  
pp. 232596711986893
Author(s):  
Yuji Arai ◽  
Kunio Hara ◽  
Hiroaki Inoue ◽  
Ginjiro Minami ◽  
Yoshikazu Kida ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Osteochondritis Dissecans ◽  
Japanese Orthopaedic Association ◽  
Case Series ◽  
Return To Sport ◽  
Functional Scores ◽  
Arthroscopically Assisted ◽  
The Mean ◽  
Flexion And Extension

Background: We have previously reported the technique of arthroscopically assisted drilling of osteochondritis dissecans (OCD) lesions of the elbow via the radius in a distal-to-proximal direction. With this technique, the entire OCD lesion can be drilled vertically under arthroscopic guidance with pronation and supination of the forearm and flexion and extension of the elbow joint. Purpose: To retrospectively evaluate return to sport, range of motion, and the Japanese Orthopaedic Association–Japan Elbow Society Elbow Function Score (JOA-JES score) after treatment of an elbow OCD lesion by drilling through the radius. Study Design: Case series; Level of evidence, 4. Methods: From November 2003 to January 2006, a total of 7 male adolescent baseball players with OCD lesions of the elbow were treated through use of arthroscopically assisted drilling via the radius. The stage of the OCD lesion was evaluated based on preoperative plain radiographs. Patients were observed for a minimum of 36 months, and clinical analysis included time for return to sport, elbow range of motion, and the JOA-JES score before intervention and at final follow-up. Results: We evaluated all 7 patients at a mean follow-up time of 36.1 months (range, 24-68 months). The stage of the OCD lesion on plain radiography was “translucent” in 1 patient, “sclerotic” in 5 patients, and “loosening” in 1 patient. The mean range of motion before surgery was 131.2° and –4.7° in flexion and extension, respectively, and this improved to 138.6° and 1.1° at final follow-up. The improvement in extension was statistically significant ( P = .04). The mean JOA-JES score of 83.0 before surgery significantly improved to 94.0 at final follow-up ( P < .001). One patient required excision of a free body at 51 months postoperatively, but all patients returned to sports early and without pain at an average of 4.6 months postoperatively. No feature of osteoarthrosis was noted on radiography on the final examination in any patient. Conclusion: The findings of this study demonstrate that arthroscopically assisted drilling of an elbow OCD lesion through the radial head allows for early return to sporting activities as well as improved motion and functional scores.

scholarly journals Impact of dynamic alignment, motion, and center of rotation on myelopathy grade and regional disability in cervical spondylotic myelopathy

2015 ◽  
Vol 23 (6) ◽  
pp. 690-700 ◽  
Author(s):  
Shian Liu ◽  
Renaud Lafage ◽  
Justin S. Smith ◽  
Themistocles S. Protopsaltis ◽  
Virginie C. Lafage ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Motion Analysis ◽  
Cervical Spondylotic Myelopathy ◽  
Dynamic Motion ◽  
Sf 36 ◽  
Flexion Extension ◽  
Focal Parameters ◽  
The Mean ◽  
Neck Disability ◽  
Flexion And Extension

OBJECT Cervical stenosis is a defining feature of cervical spondylotic myelopathy (CSM). Matsunaga et al. proposed that elements of stenosis are both static and dynamic, where the dynamic elements magnify the canal deformation of the static state. For the current study, the authors hypothesized that dynamic changes may be associated with myelopathy severity and neck disability. This goal of this study was to present novel methods of dynamic motion analysis in CSM. METHODS A post hoc analysis was performed of a prospective, multicenter database of patients with CSM from the AOSpine North American study. One hundred ten patients (34%) met inclusion criteria, which were symptomatic CSM, age over 18 years, baseline flexion/extension radiographs, and health-related quality of life (HRQOL) questionnaires (modified Japanese Orthopaedic Association [mJOA] score, Neck Disability Index [NDI], the 36-Item Short Form Health Survey Physical Component Score [SF-36 PCS], and Nurick grade). The mean age was 56.9 ± 12 years, and 42% of patients were women (n = 46). Correlations with HRQOL measures were analyzed for regional (cervical lordosis and cervical sagittal vertical axis) and focal parameters (kyphosis and spondylolisthesis between adjacent vertebrae) in flexion and extension. Baseline dynamic parameters (flexion/extension cone relative to a fixed C-7, center of rotation [COR], and range of motion arc relative to the COR) were also analyzed for correlations with HRQOL measures. RESULTS At baseline, the mean HRQOL measures demonstrated disability and the mean radiographic parameters demonstrated sagittal malalignment. Among regional parameters, there was a significant correlation between decreased neck flexion (increased C2–7 angle in flexion) and worse Nurick grade (R = 0.189, p = 0.048), with no significant correlations in extension. Focal parameters, including increased C-7 sagittal translation overT-1 (slip), were significantly correlated with greater myelopathy severity (mJOA score, Flexion R = −0.377, p = 0.003; mJOA score, Extension R = −0.261, p = 0.027). Sagittal slip at C-2 and C-4 also correlated with worse HRQOL measures. Reduced flexion/extension motion cones, a more posterior COR, and smaller range of motion correlated with worse general health SF-36 PCS and Nurick grade. CONCLUSIONS Dynamic motion analysis may play an important role in understanding CSM. Focal parameters demonstrated a significant correlation with worse HRQOL measures, especially increased C-7 sagittal slip in flexion and extension. Novel methods of motion analysis demonstrating reduced motion cones correlated with worse myelopathy grades. More posterior COR and smaller range of motion were both correlated with worse general health scores (SF-36 PCS and Nurick grade). To our knowledge, this is the first study to demonstrate correlation of dynamic motion and listhesis with disability and myelopathy in CSM.

Pronator Teres Branch Transfer to the Anterior Interosseous Nerve for Treating C8T1 Brachial Plexus Avulsion

Neurosurgery ◽  
2014 ◽  
Vol 75 (4) ◽  
pp. 375-379 ◽  
Author(s):  
Jianyun Yang ◽  
Xiaotian Jia ◽  
Cong Yu ◽  
YuDong Gu
Keyword(s):  
Range Of Motion ◽  
Lateral Condyle ◽  
Main Trunk ◽  
Medial Condyle ◽  
Pronator Teres ◽  
Finger Flexion ◽  
Active Range Of Motion ◽  
Anterior Interosseous Nerve ◽  
The Mean ◽  
Finger Flexor Muscles

Abstract BACKGROUND: The treatment of C8T1 avulsion is challenging for neurosurgeons. Various methods for the restoration of finger flexion are used. However, most of these methods have different disadvantages and cannot restore the full active range of motion of the fingers. OBJECTIVE: To determine the feasibility of the pronator teres branch transfer to the anterior interosseous nerve with anatomic study and to use this method in 1 case. METHODS: The upper limbs of 15 fresh cadavers were dissected to identify the main trunk of the median nerve, the pronator teres branch, and the anterior interosseous nerve. The mean number and length of the pronator teres branches were recorded. The anterior interosseous nerve was dissected atraumatically to the most proximal level where the fibers of the anterior interosseous nerve did not mingle with the fibers of the main trunk of the median, which was defined as the atraumatic level of the anterior interosseous nerve. A line joining the most protruding point of the medial condyle and lateral condyle of the humerus was used as a measurement landmark. Pronator teres branch transfer to the anterior interosseous nerve was performed in 1 patient with C8T1 avulsion. RESULTS: The mean number of the pronator teres branches was 2.37 ± 0.49. The mean length of the pronator teres branches was 9.64 ± 0.71 mm. The mean distance between the point where the pronator teres branches originated and the landmark line was 3.87 ± 0.34 mm. The mean distance between the atraumatic level of the anterior interosseous nerve and the landmark line was −5.46 ± 0.73 mm. Transfer of the pronator teres was used to innervate the anterior interosseous nerve in 1 patient with C8T1 avulsion. When assessed 14 months after the operation, a full active range of motion of the fingers had been restored, and the patient's finger flexor muscles had regained grade 4 power. CONCLUSION: The pronator teres can be transferred to the anterior interosseous nerve directly at the elbow level. This operation was performed successfully in 1 patient, who exhibited finger flexion recovery.

Treatment of unstable proximal interphalangeal joint fractures with hemi-hamate osteochondral autografts

2016 ◽  
Vol 42 (2) ◽  
pp. 188-193 ◽  
Author(s):  
M. Burnier ◽  
T. Awada ◽  
F. Marin Braun ◽  
P. Rostoucher ◽  
M. Ninou ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Articular Surface ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Pinch Strength ◽  
Middle Phalanx ◽  
Level Of Evidence ◽  
Active Flexion ◽  
The Mean

The primary aim of this study was to assess the clinical and radiological results after hemi-hamate resurfacing arthroplasty in patients with acute or chronic unstable fractures of the base of the middle phalanx and to describe technical features that can facilitate the surgical procedure. Hemi-hamate arthroplasties were done in 19 patients (mean age 39 years) with an isolated fracture at the base of the middle phalanx that involved more than 40% of the articular surface. We assessed ten chronic cases (treated >6 weeks after fracture) and nine acute ones (<6 weeks) at a mean of 24 months. Pain scores, QuickDASH scores, grip strengths, range of motion and radiological findings were recorded at follow-up. At follow-up, the mean active flexion at the proximal interphalangeal joint was to 83° with a mean fixed flexion of 17° (active range of motion 66°). The mean active distal interphalangeal motion was 41°. The mean visual analogue scale score was 1.1. The mean QuickDASH score was 11. The mean pinch strength was 82% of the opposite side. Radiographs revealed one partial graft lysis. Level of evidence: IV

Biceps-to-Triceps Transfer in Tetraplegia

1999 ◽  
Vol 24 (2) ◽  
pp. 235-237 ◽  
Author(s):  
M. REVOL ◽  
E. BRIAND ◽  
J. M. SERVANT
Keyword(s):  
Range Of Motion ◽  
Nerve Injury ◽  
Radial Nerve ◽  
Elbow Flexion ◽  
Active Range Of Motion ◽  
The Mean ◽  
Radial Nerve Injury

Eight tetraplegic patients (13 elbows) were treated by biceps-to-triceps transfer. To avoid the risk of radial nerve injury, we chose a medial routing of the biceps. The mean follow-up after surgery was 17.8 months (range, 4–47 months). No complications were encountered. Active extension of the elbow was achieved in each case. The mean postoperative active range of motion of the elbow was 6° extension and 137° flexion. After the biceps-to-triceps transfer mean extension torque of the elbow was 3.7 Nm and mean flexion torque was 10 Nm. In eight elbows in which it was measured, there was a 47% reduction in elbow flexion power. Nevertheless no patient complained about that reduction, and all of them were satisfied.

scholarly journals Ultrasound and Joint Mobilizations for Achieving Normal Wrist Range of Motion After Injury or Surgery: A Case Series

2010 ◽  
Vol 45 (5) ◽  
pp. 486-491 ◽  
Author(s):  
David O. Draper
Keyword(s):  
Range Of Motion ◽  
Full Range ◽  
Case Series ◽  
Average Intensity ◽  
Normal Extension ◽  
Therapeutic Modalities ◽  
Active Range Of Motion ◽  
Before And After ◽  
The University ◽  
Flexion And Extension

Abstract Context: Regaining full, active range of motion (AROM) after trauma to the wrist is difficult. Objective: To report the cases of 6 patients who lacked full range of motion (ROM) in the wrist due to trauma. The treatment regimen was thermal 3-MHz ultrasound and joint mobilizations. Design: Case series. Setting: University therapeutic modalities laboratory. Patients or Other Participants: Six patients (2 women, 4 men) from the university population lacked a mean AROM of 21.7° of flexion and 26.8° of extension approximately 2.1 years after trauma or surgery. Main Outcome Measure(s): I assessed changes in flexion and extension AROM before and after each treatment. Treatment consisted of 6 minutes of 3-MHz continuous ultrasound at an average intensity of 1.4 W/cm2 on the dorsal and volar aspects of the wrist, immediately followed by approximately 10 minutes of joint mobilizations. After posttreatment ROM was recorded, ice was applied to the area for about 20 minutes. Once the patient achieved full AROM or did not improve on 2 consecutive visits, he or she was discharged from the study. Results: By the sixth treatment, 5 participants achieved normal flexion AROM, and 3 exceeded the norm. All 6 achieved normal extension AROM, and 4 exceeded the norm. All returned to normal activities and normal use of their hands. One month later, they had, on average, maintained 93% of their final measurements. Conclusions: A combination of thermal ultrasound and joint mobilizations was effective in restoring AROM to wrists lacking ROM after injury or surgery.

scholarly journals Bilateral Upper Limb Training With Functional Electric Stimulation in Patients With Chronic Stroke

2008 ◽  
Vol 23 (4) ◽  
pp. 357-365 ◽  
Author(s):  
Marko Ka-leung Chan ◽  
Raymond Kai-yu Tong ◽  
Kenneth Yiu-kwan Chung
Keyword(s):  
Occupational Therapy ◽  
Range Of Motion ◽  
Upper Limb ◽  
Electric Stimulation ◽  
Control Group ◽  
Wrist Extension ◽  
Upper Limb Rehabilitation ◽  
Upper Limb Function ◽  
Active Range Of Motion ◽  
Limb Rehabilitation

Background. The recovery rate of upper limb function after stroke is poor when compared with independent walking. Therefore, effective methods are warranted for upper limb rehabilitation. Objective. The aim of this study was to investigate the effectiveness of functional electric stimulation (FES) with bilateral activities training on upper limb function. Methods. This study was a double-blinded randomized controlled trial. Twenty patients were recruited 6 months after the onset of stroke and completed 15 training sessions. Participants were randomly assigned to the FES group or to the control group. Each session consisted of stretching activities (10 minutes), FES with bilateral tasks (20 minutes), and occupational therapy treatment (60 minutes). The participants used a self-trigger mechanism, with an accelerometer as a motion detector, for generating an electric stimulation pattern that was synchronized with the bilateral upper limb activities during the training. The participants in the control group received the same duration of stretching and occupational therapy training except that they just received placebo stimulation with the bilateral tasks. The outcome measures included Functional Test for the Hemiplegic Upper Extremity (FTHUE), Fugl—Meyer Assessment (FMA), grip power, forward reaching distance, active range of motion of wrist extension, Functional Independence Measure, and Modified Ashworth Scale. Results. At baseline comparison, there was no significant difference in both groups. After 15 training sessions, the FES group had significant improvement in FMA ( P = .039), FTHUE ( P = .001), and active range of motion of wrist extension ( P = .020) when compared with the control group. Conclusions. Bilateral upper limb training with FES could be an effective method for upper limb rehabilitation of stroke patients after 15 training sessions.

Delayed Single Kirschner Wire Compression Technique for Mallet Fracture

2005 ◽  
Vol 30 (2) ◽  
pp. 180-184 ◽  
Author(s):  
D. FRITZ ◽  
M. LUTZ ◽  
R. ARORA ◽  
M. GABL ◽  
M. WAMBACHER ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Articular Surface ◽  
Kirschner Wire ◽  
Compression Technique ◽  
Active Range Of Motion ◽  
Mallet Fracture ◽  
Strenuous Work ◽  
Distal Interphalangeal ◽  
The Mean

Twenty-four mallet fractures which involved at least one third % of the articular surface of the distal interphalangeal joint were treated by open reduction and internal fixation using a single double-ended Kirschner wire at a mean of 9 days after injury (range 4–15). At a mean follow-up of 43 (range 12–18) months the active range of motion, pain and the Warren and Norris criteria were evaluated. The mean active range of motion was from −2° extension (range 0–10°) to 72° flexion (range 50–90°). Nineteen patients were pain free and five suffered from mild pain during strenuous work. The Warren and Norris results were successful in 22 and improved in two cases. Radiographs showed, that all the fractures united in a near-anatomic position but with joint narrowing in six digits.

Paediatric toe-to-hand transfer: an assessment of outcomes from a single unit

2015 ◽  
Vol 41 (3) ◽  
pp. 281-294 ◽  
Author(s):  
D. Nikkhah ◽  
N. Martin ◽  
M. Pickford
Keyword(s):  
Range Of Motion ◽  
Hand Function ◽  
Donor Site ◽  
Level Of Evidence ◽  
Reliable Technique ◽  
Special Review ◽  
Active Range Of Motion ◽  
The Mean ◽  
Toe Transfer ◽  
Second Toe

Toe-to-hand transfer is an acceptable treatment option for children born with absent digits. Toe transfer can provide functionally useful digits and may enhance patient wellbeing. A total of 19 children had 31 free second-toe-to-hand microsurgical transfers between 1998 and 2012. The mean age of these children at the time of the first operation was 45 months. All transferred toes survived. The donor site was satisfactory in all 19 patients. Twelve children (19 toes) attended a special review clinic; all children could grasp large objects (Duplo bricks) after toe transfer. The total passive range of motion was greater than total active range of motion by an average of 54 degrees. Static 2-point discrimination was generally excellent (mean = 5 mm). Eleven out of 12 children strongly agreed that their toe transfer had improved hand function. Microsurgical toe-to-hand transfer is a safe and reliable technique that can provide useful function for children with congenital differences. Our series compares favourably with the published literature. Level of evidence: IV

Reliability of Intraoperative Knee Range of Motion Measurements by Goniometer Compared with Robot-Assisted Arthroplasty

2018 ◽  
Vol 32 (03) ◽  
pp. 233-238 ◽  
Author(s):  
Hyuck Kwon ◽  
Ick-Hwan Yang ◽  
Woo-Suk Lee ◽  
Alvin Yu ◽  
Sang Oh ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Intraclass Correlation ◽  
Robotic System ◽  
Mean Values ◽  
Before And After ◽  
Passive Flexion ◽  
The Mean ◽  
Motion Measurements ◽  
Flexion And Extension ◽  
Good Agreement

AbstractAccurate measurement of knee range of motion (ROM) is critical to predict the outcomes of knee surgery and prognosis. We investigated the reliability of knee ROM measurements by goniometer compared with robotic system. Fifty-three patients with medial osteoarthritis who were planning to undergo unicompartmental knee arthroplasty (UKA) with robotic UKA were prospectively enrolled. During the operation, knee ROM measurement was performed in both flexion and extension before and after insertion of the implant using both a goniometer and robotic system. The intraclass correlation coefficient (ICC) of extension measured by the goniometer and robotic system showed good agreement; however, the ICC of flexion did not show good agreement. During passive flexion, the mean values measured before insertion of the implant were significantly lower by goniometer (134.6 ± 6.43) than by robot (145.4 ± 6.80; p = 0.017); likewise, the mean values after insertion of the implant were significantly lower by goniometer (138.6 ± 6.07) than by robotic system (147.0 ± 6.60; p = 0.045). A goniometer can underestimate knee ROM measurements compared with robotic system, especially in flexion. Orthopaedic surgeons should be cautious when measuring the flexion angle with a goniometer.

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