Pulsed Shortwave Diathermy and Joint Mobilizations for Achieving Normal Elbow Range of Motion After Injury or Surgery With Implanted Metal: A Case Series

Context: Regaining full, active range of motion (ROM) after trauma to the elbow is difficult. Objective: To report the cases of 6 patients who lacked full ROM in the elbow because of trauma. The treatment regimen was thermal pulsed shortwave diathermy and joint mobilizations. Design: Case series. Setting: University therapeutic modalities laboratory. Patients or Other Participants: Six patients (5 women [83%], 1 man [17%]) lacked a mean active ROM of 24.5° of extension approximately 4.8 years after trauma or surgery. Intervention(s): Treatment consisted of 20 minutes of pulsed shortwave diathermy at 800 pulses per second for 400 microseconds (40–48 W average power, 150 W peak power) applied to the cubital fossa, immediately followed by 7 to 8 minutes of joint mobilizations. After posttreatment ROM was recorded, ice was applied to the area for about 30 minutes. Main Outcomes Measure(s): Changes in extension active ROM were assessed before and after each treatment. Once the patient achieved full, active ROM or failed to improve on 2 consecutive visits, he or she was discharged from the study. Results: By the fifth treatment, 4 participants (67%) achieved normal extension active ROM, and 2 of the 4 (50%) exceeded the norm. Five participants (83%) returned to normal activities and full use of their elbows. One month later, the 5 participants had maintained, on average, (mean ± SD) 92% ± 6% of their final measurements. Conclusions: A combination of thermal pulsed shortwave diathermy and joint mobilizations was effective in restoring active ROM of elbow extension in 5 of the 6 patients (83%) who lacked full ROM after injury or surgery.

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Lateral open wedge calcaneus osteotomy with bony allograft augmentation in adult acquired flatfoot deformity. Clinical and radiological results

European Journal of Orthopaedic Surgery & Traumatology ◽

10.1007/s00590-021-02888-3 ◽

2021 ◽

Author(s):

Gabriele Colo’ ◽

Mattia Alessio Mazzola ◽

Giulio Pilone ◽

Giacomo Dagnino ◽

Lamberto Felli

Keyword(s):

Range Of Motion ◽

Case Series ◽

Deformity Correction ◽

Tibialis Posterior ◽

Open Wedge ◽

Foot And Ankle ◽

Retrospective Case ◽

Level Of Evidence ◽

Adult Acquired Flatfoot Deformity

Abstract The aim of this study is to evaluate the results of patients underwent lateral open wedge calcaneus osteotomy with bony allograft augmentation combined with tibialis posterior and tibialis anterior tenodesis. Twenty-two patients underwent adult-acquired flatfoot deformity were retrospectively evaluated with a minimum 2-year follow-up. Radiographic preoperative and final comparison of tibio-calcaneal angle, talo–first metatarsal and calcaneal pitch angles have been performed. The Visual Analog Scale, American Orthopedic Foot and Ankle Score, the Foot and Ankle Disability Index and the Foot and Ankle Ability Measure were used for subjective and functional assessment. The instrumental range of motion has been also assessed at latest follow-up evaluation and compared with preoperative value. There was a significant improvement of final mean values of clinical scores (p < 0.001). Nineteen out of 22 (86.4%) patients resulted very satisfied or satisfied for the clinical result. There was a significant improvement of the radiographic parameters (p < 0.001). There were no differences between preoperative and final values of range of motion. One failure occurred 7 years after surgery. Adult-acquired flatfoot deformity correction demonstrated good mid-term results and low recurrence and complications rate. Level of evidence Level 4, retrospective case series.

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Evaluating the Outcomes of Rotator Cuff Repairs With Polytetrafluoroethylene Patches for Massive and Irreparable Rotator Cuff Tears With a Minimum 2-Year Follow-up

The American Journal of Sports Medicine ◽

10.1177/0363546518801014 ◽

2018 ◽

Vol 46 (13) ◽

pp. 3155-3164 ◽

Cited By ~ 9

Author(s):

Vasanth Seker ◽

Lisa Hackett ◽

Patrick H. Lam ◽

George A.C. Murrell

Keyword(s):

Rotator Cuff ◽

Range Of Motion ◽

External Rotation ◽

Case Series ◽

Shoulder Function ◽

Rotator Cuff Tears ◽

Level Of Evidence ◽

Irreparable Tear ◽

Pain At Rest

Background: Massive and irreparable rotator cuff tears are difficult to manage surgically. One technique is to use a synthetic polytetrafluoroethylene (PTFE) patch to bridge the tear. However, there is little information regarding the outcomes of this procedure. Purpose: To determine the ≥2-year outcomes of patients for whom synthetic patches were used as tendon substitutes to bridge irreparable rotator cuff defects. Study Design: Case series; Level of evidence, 4. Methods: This retrospective cohort study used prospectively collected data. Patients included those with a synthetic patch inserted as an interposition graft for large and/or irreparable rotator cuff tears with a minimum 2-year follow-up. Standardized assessment of shoulder pain, function, range of motion, and strength was performed preoperatively, at 6 and 12 weeks, and at 6 months and ≥2 years. Radiograph and ultrasound were performed preoperatively, at 6 months, and ≥2 years. Results: At a mean of 36 months, 58 of 68 eligible patients were followed up, and 53 of 58 (90%) patches remained in situ. Three patches failed at the patch-tendon interface, while 1 patient (2 shoulders/patches) went on to have reverse total shoulder replacements. Patient-ranked shoulder stiffness ( P < .001), frequency of pain with activity and sleep ( P < .0001), level of pain at rest and overhead ( P < .0001), and overall shoulder function improved from bad to very good ( P < .0001) by 6 months. Supraspinatus (mean ± SEM: 29 ± 16 N to 42 ± 13 N) and external rotation (39 ± 13 N to 59 ± 15 N) strength were the most notable increases at the ≥2-year follow-up ( P < .0001). Passive range of motion also improved by 49% to 67%; forward flexion, from 131° to 171°; abduction, from 117° to 161°; external rotation, from 38° to 55°; and internal rotation, from L3 to T10 ( P < .0001) preoperatively to ≥2 years. The most improvement in passive range of motion occurred between 12 months and ≥2 years. The mean (SD) Constant-Murley score was 90 (12), while the American Shoulder and Elbow Surgeons score was 95 (8). Conclusion: At 36 months postoperatively, patients who had synthetic patches used as tendon substitutes to bridge irreparable rotator cuff defects reported less pain and greater overall shoulder function as compared with preoperative assessments. They demonstrated improved range of passive motion and improved strength. The data support the hypothesis that the technique of using a synthetic PTFE patch to bridge a large and/or irreparable tear has good construct integrity and improves patient and clinical outcomes.

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Functional outcome of diaphyseal fractures of forearm in adolescents treated with TENS

International Journal of Scientific Reports ◽

10.18203/issn.2454-2156.intjscirep20190642 ◽

2019 ◽

Vol 5 (3) ◽

pp. 69

Author(s):

Divyanshu Goyal ◽

S. L. Sharma ◽

Laxmikant Meena ◽

Ravindra Lamoria ◽

Mahesh Bansal

Keyword(s):

Range Of Motion ◽

Functional Outcome ◽

Case Series ◽

Age Group ◽

Forearm Fractures ◽

Retrospective Case ◽

Superficial Infection ◽

Fractures In Children ◽

Case Series Study ◽

Diaphyseal Fractures

Background: A retrospective case series study was done on forearm diaphyseal fracture in adolescents treated with TENS (titanium elastic nailing system). Purpose of the study was analysis of functional outcome of TENS in forearm diaphyseal fractures in children between 12-18 year age group.Methods: We retrospectively evaluated 30 patients operated by same senior surgeon during the period from March 2014 to February 2015 with closed diaphyseal forearm fractures in age group 12–18 years treated with TENS in whom closed reduction could not be achieved. Nail diameter taken as 33-40% of narrowest diameter of diaphysys were introduced proximally in ulna and distally in radius under image intensifier in closed manner. Postoperatively, patients encouraged for active shoulder, elbow and finger movements and suture removal done after 2 weeks. Patients were followed up for minimum period of one year. Results: In terms of union and range of motion using Anderson et al criteria 24 patients had excellent results, 4 patients had satisfactory results and one patient had poor result having non-union of ulna. Two patients had superficial infection at the nail entry site which eventually resolved. One patient lost for follow up.Conclusions: We conclude that TENS in both bone forearm fractures in adolescent age group in terms of union and range of motion is a minimally invasive and effective method of fixation.

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Arthroscopic treatment of anteromedial ankle impingement

Journal of the Foot & Ankle ◽

10.30795/jfootankle.2020.v14.1200 ◽

2020 ◽

Vol 14 (3) ◽

pp. 260-263

Author(s):

Guillermo Arrondo ◽

Daniel Gómez ◽

Germán Joannas ◽

Xavier Martín-Oliva ◽

Matías Iglesias ◽

...

Keyword(s):

Soft Tissue ◽

Range Of Motion ◽

Case Series ◽

Functional Results ◽

Level Of Evidence ◽

Bony Impingement ◽

Soft Tissue Impingement ◽

Arthroscopic Removal ◽

Physical Impact

Objective: Impingement syndromes are recognized as an important cause of chronic ankle pain, which results from the entrapment of an inflamed soft-tissue component between the osteophytes. The predominant site of occurrence is the anterolateral aspect of the ankle for soft-tissue impingement, and anteromedial aspect for bony impingement. Symptoms related to the physical impact of bone or soft-tissue pain often result in limited ankle range of motion. Methods: We conducted a retrospective study of 34 patients (34 ankles) with anteromedial bony impingement. All patients underwent arthroscopy, with a mean follow-up of 34 months. Results: All osteophytes were removed, and the ankle range of motion improved. The AOFAS score improved from 73 preoperatively to 95 postoperatively. Conclusion: The arthroscopic removal of the anteromedial osteophytes of the ankle had excellent functional results. It is an effective procedure that allows rapid patient recovery. Level of Evidence IV; Therapeutic Studies; Case Series.

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Radiological Classification and Clinical Results of Arthroscopic and Open Surgical Release for Elbow Osteoarthritis: A Two-Center Comparative Case Series

10.21203/rs.3.rs-257594/v1 ◽

2021 ◽

Author(s):

Masahiro Tatebe ◽

Akimasa Morita ◽

Toshikazu Kurahashi ◽

Hitoshi Hirata

Keyword(s):

Range Of Motion ◽

Open Surgery ◽

Arthroscopic Surgery ◽

Intraclass Correlation ◽

Case Series ◽

Clinical Results ◽

Ectopic Ossification ◽

Surgery Group ◽

Elbow Osteoarthritis ◽

Group A

Abstract Background This study aimed to compare the image classification and clinical results in cases of debridement arthroplasty for elbow osteoarthritis and to compare between open and arthroscopic surgery performed at two independent facilities. Methods Of the 51 patients who underwent surgery for elbow osteoarthritis performed by two doctors, 36 patients whom we were able to observe for more than 6 months were included. One doctor performed open surgery at one hospital, while another doctor performed arthroscopic surgery at the other hospital. There were 15 cases of open surgery (group O) and 21 cases of arthroscopic surgery (group A). All patients were examined for the range of motion, Hand20 score, and pain. The degree of osteoarthritis was examined using the Broberg and Morrey classification and Hastings and Rettig classification. The intra- and interobserver degree of agreement of the two classifications were analyzed using intraclass correlation coefficients.ResultsThe range of motion improved in both groups. There were no significant differences between the two groups with respect to incidence of ulnar symptoms, operation time, postoperative Hand20 score, postoperative pain, and degree of radiological osteoarthritis. The intra- and interobserver degree of agreement for radiological classifications were moderate to substantial and moderate, respectively. There was no correlation between the clinical results and radiological classifications. One patient in group A showed ectopic ossification but no serious complications or adverse events, such as nerve damage, were observed in either group. ConclusionsAt the time of the final follow-up, nearly the same results were observed in both groups. No relationship was found between symptoms and radiological osteoarthritis classification scores. Level of EvidenceTreatment study Level III

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Septic arthritis of the knee following anterior cruciate ligament reconstruction

Orthopedic Reviews ◽

10.4081/or.2009.e3 ◽

2009 ◽

Vol 1 (1) ◽

pp. 3 ◽

Cited By ~ 9

Author(s):

Matjaz Sajovic ◽

Gorazd Lesnicar ◽

Mojca Z. Dernovsek

Keyword(s):

Anterior Cruciate Ligament ◽

Anterior Cruciate Ligament Reconstruction ◽

Septic Arthritis ◽

Range Of Motion ◽

Ligament Reconstruction ◽

Cruciate Ligament ◽

Case Series ◽

Activity Level ◽

Cruciate Ligament Reconstruction ◽

Anterior Cruciate

Septic arthritis of the knee is a rare complication after arthroscopic anterior cruciate ligament reconstruction, and the most appropriate treatment is unclear. All case series reported so far have been retrospective, and case numbers of septic arthritis have ranged from 4 to 11. From a consecutive case series of 1,283 patients who underwent arthroscopic anterior cruciate ligament reconstruction between January 1997 and May 2008, we report on 3 patients (0.23%) with post-operative septic arthritis. All patients had acute infection (≤ 2 weeks), bacterial cultures showed Staphylococcus species in 2 patients, while the bacterial culture was negative in the third. All of them underwent immediate arthroscopic debridement and lavage with continuous irrigation, as well as antibiotic treatment. The results were evaluated with physical and radiographic examination, functional testing, KT-2000, Lysholm and Tegner scales. The infection was successfully eradicated without further surgical treatment and the ligament graft was retained in all patients. Follow-up, at an average of 33 months, revealed that the patients had full symmetric knee range of motion and no effusion. The average Lysholm score was 91 points. In the patient with a lower subjective score, radiographs demonstrated patellofemoral joint-space narrowing, which is most probably in correlation with his anterior knee pain problems and lower activity level. The 134 N KT-2000 arthrometer side-to-side differences averaged 13 mm. Their performance in the single-legged hop test gave excellent results. The goals of treatment for septic arthritis after anterior cruciate ligament reconstruction are, primarily, to protect the articular cartilage and, secondly, to protect the graft. Through early diagnosis and prompt treatment, the infection can be successfully eradicated, with stability of the knee and full range of motion achieved.

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Operative Outcomes of Grade 3 Turf Toe Injuries in Competitive Football Players

Foot & Ankle International ◽

10.1177/1071100718775967 ◽

2018 ◽

Vol 39 (9) ◽

pp. 1076-1081 ◽

Cited By ~ 5

Author(s):

Kenneth Smith ◽

Norman Waldrop

Keyword(s):

Range Of Motion ◽

Operative Procedure ◽

Case Series ◽

Operative Management ◽

Return To Play ◽

First Metatarsophalangeal Joint ◽

Operative Outcomes ◽

Turf Toe ◽

Grade 3

Background: Turf toe is a term used to describe a hyperextension injury to the first metatarsophalangeal joint. Although the vast majority of turf toe injuries can be treated successfully without operative intervention, there are instances where surgery is required to allow the athlete to return to play. Although there is a plethora of literature on turf toe injuries and nonoperative management, there are currently few reports on operative outcomes in athletes. Methods: We obtained all cases of turf toe repair according to the ICD-10 procedural code. The inclusion criteria included: age greater than 16, turf toe injury requiring operative management and at least a varsity level high school football player. The charts were reviewed for age, BMI, level of competition, injury mechanism, football position, setting of injury and playing surface. In addition, we recorded the specifics of the operative procedure, a listing of all injured structures, the implants used and the great toe range of motion at final follow-up visit. The AOFAS Hallux score and VAS was used postoperatively as our outcome measures. Our patient population included 15 patients. The average follow-up time was 27.5 months. Results: The average patient was 19.3 years old with a body mass index of 32.3. The average playing time missed was 16.5 weeks. The average dorsiflexion range of motion at the final follow-up was 42.3 degrees. At final follow-up, the average AOFAS Hallux score was 91.3. The average VAS pain score was 0.7 at rest and 0.8 with physical activity. Conclusion: Complete turf toe injuries are often debilitating and may require operative management to restore a pain-free, stable, and functional forefoot. This study represents the largest cohort of operatively treated grade 3 turf toe injuries in the literature and demonstrates that good clinical outcomes were achieved with operative repair. Level of Evidence: Level IV, case series

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Surface Replacement Proximal Interphalangeal Joint Arthroplasty: A Case Series

Hand ◽

10.1177/1558944718760035 ◽

2018 ◽

Vol 14 (5) ◽

pp. 669-674

Author(s):

Pieter W. Jordaan ◽

Duncan McGuire ◽

Michael W. Solomons

Keyword(s):

Patient Satisfaction ◽

Range Of Motion ◽

Retrospective Review ◽

Case Series ◽

Proximal Interphalangeal Joint ◽

Joint Arthroplasty ◽

Interphalangeal Joint ◽

Surface Replacement ◽

Significant Difference

Background: In 2012, our unit published our experience with a pyrocarbon proximal interphalangeal joint (PIPJ) implant. Due to high subsidence rates, a decision was made to change to a cemented surface replacement proximal interphalangeal joint (SR-PIPJ) implant. The purpose of this study was to assess whether the change to a cemented implant would improve the subsidence rates. Methods: Retrospective review of all patients who had a cemented SR-PIPJ arthroplasty performed from 2011 to 2013 with at least 12 months follow-up. Results: A total of 43 joints were included with an average follow-up of 26.5 months. There was a significant ( P = .02) improvement in arc of motion with an average satisfaction score of 3.3 (satisfied patient). Subsidence was noted in 26% of joints with a significant difference in range of motion ( P = .003) and patient satisfaction ( P = .001) between the group with and without subsidence. Conclusions: The change to a cemented implant resulted in satisfied patients with an improvement in range of motion. The rate of subsidence improved but remains unacceptably high.

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