Need for including Hand Eye Coordination and Hand Function Training in the Management of Adhesive Capsulitis – A non-randomized control trial

Objectives: The objective of the study was to identify the effect of Maitland mobilization with hand-eye coordination and hand function exercises in the prognosis of adhesive capsulitis. Methods: This non-randomized control trial was done with 40 patients with adhesive capsulitis referred to the OPD at UCA College of Physiotherapy, Chennai. The study was performed for 8 months duration from August 2018 to March 2019. After providing a sufficient explanation of the procedure, the patients were divided into Group-A and Group-B. Group-A were allocated to Maitland group (n=20) (MG) and Group-B, were assigned to the Maitland, Hand-eye coordination and Hand Function exercises group (n=20) (MHG), respectively. We measured Quality of life using SF36 to know whether these patients had poor QOL compared to normative. Each patient underwent testing before the experiment to evaluate the range of motion of the shoulder (Abduction and External rotation) measured using a 180º goniometer, Functional Disability assessed using SPADI index. Statistical analysis was applied using SPSS version 20.0. Before the study, data normality was tested. A parametric test was used to compare pre-and post-intervention data in each Group-And also compare the MG vs. MHG. An α < 0.05 is the level of significance in all analyses. Results: A total of 40 subjects accounted for the study results. Their quality of life was significantly lower from the normative values. Both groups were homogenous at baseline with no significant difference between the ROM and SPADI scores. Both groups showed a significant improvement in ER, abduction ROM and SPADI scores, however the between group posttest analysis revealed that the Group-B subjects progressed significantly better. Conclusions: The study concluded that the Maitland mobilization and hand-eye coordination and hand function exercises are an effective tool in improving shoulder abduction, external rotation and shoulder functions. doi: https://doi.org/10.12669/pjms.38.3.5153 How to cite this:Senthil Kumar B, Subbaiah S, Ramachandran A. Need for including Hand Eye Coordination and Hand Function Training in the Management of Adhesive Capsulitis – A non-randomized control trial. Pak J Med Sci. 2022;38(3):---------. doi: https://doi.org/10.12669/pjms.38.3.5153 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Validation of a Human Pose Tracking Algorithm for Measuring Upper Limb Joints: Comparison With Photography-based Goniometry

Background: Range of motion (ROM) measurements are essential for diagnosing and evaluating upper extremity conditions. Clinical goniometry is the most commonly used methods but it is time-consuming and skill-demanding. Recent advances in human tracking algorithm suggest potential for automatic angle measuring from RGB images. It provides an attractive alternative for at-distance measuring. However, the reliability of this method has not been fully established. The purpose of this study is to evaluate if the results of algorithm are as reliable as human raters in upper limb movements.Methods: Thirty healthy young adults (20 males, 10 females) participated in this study. Participants were asked to performed a 6-motion task including movement of shoulder, elbow and wrist. Images of movements were capture by commercial digital camera. Each movement was measured by a pose tracking algorithm and compared with the surgeon-measurement results. The mean differences between the two measurements were compared. Pearson correlation coefficients were used to determine the relationship. Reliability was investigated by the intra-class correlation coefficients.Results: Comparing this algorithm-based method with manual measurement, the mean differences were less than 3 degrees in 5 motions (shoulder abduction: 0.51; shoulder elevation: 2.87; elbow flexion:0.38; elbow extension:0.65; wrist extension: 0.78) except wrist flexion. All the intra-class correlation coefficients were larger than 0.60. The Pearson coefficients also showed high correlations between the two measurements (p<0.001). Conclusions: Our results indicated that pose estimation is a reliable method to measure the shoulder and elbow angles, supporting RGB images for measuring joint ROM. Our results proved the possibility that patients can assess their ROM by photos taken by a digital camera.Trial registration: This study was registered in the Clinical Trials Center of The First Affiliated Hospital, Sun Yat-sen University (2021-387).

Comprehensive Multi-cohort Transcriptional Meta-analysis of Muscle Diseases Identifies a Signature of Disease Severity

Muscle diseases share common pathological features suggesting common underlying mechanisms. We hypothesized there is a common set of genes dysregulated across muscle diseases compared to healthy muscle and that these genes correlate with severity of muscle disease. We performed meta-analysis of transcriptional profiles of muscle biopsies from human muscle diseases and healthy controls. Studies obtained from public microarray repositories fulfilling quality criteria were divided into six categories: i) Immobility, ii) inflammatory myopathies, iii) ICU acquired weakness (ICUAW), iv) congenital muscle diseases, v) chronic systemic diseases, vi) motor neuron disease. Patient cohorts were separated in discovery and validation cohorts retaining roughly equal proportions of samples for the disease categories. To remove bias towards a specific muscle disease category we repeated the meta-analysis five times by removing data sets corresponding to one muscle disease class at a time in a “leave-one-disease-out” analysis. We used 636 muscle tissue samples from 30 independent cohorts to identify a 52 gene signature (36 up-regulated and 16 down-regulated genes). We validated the discriminatory power of this signature in 657 muscle biopsies from 12 additional patient cohorts encompassing five categories of muscle diseases with an area under the receiver operating characteristic curve of 0.91, 83% sensitivity, and 85.3% specificity. The expression score of the gene signature inversely correlated with quadriceps muscle mass (r =-0.50, p-value = 0.011) in ICUAW and shoulder abduction strength (r=-0.77, p-value = 0.014) in amyotrophic lateral sclerosis (ALS). The signature also positively correlated with histologic assessment of muscle atrophy in ALS (r=0.88, p-value=1.62x10−3) and fibrosis in muscular dystrophy (Jonckheere trend test p-value = 4.45 x 10−9). Our results identify a conserved transcriptional signature associated with clinical and histologic muscle disease severity. Several genes in this conserved signature have not been previously associated with muscle disease severity.

Measuring Upper Limb Kinematics of Forehand and Backhand Topspin Drives with IMU Sensors in Wheelchair and Able-Bodied Table Tennis Players

To better understand the biomechanics of para-table tennis players, this study compared the shoulder, elbow, and wrist joint kinematics among able-bodied (AB) and wheelchair players in different classifications. Nineteen participants (AB, n = 9; classification 1 (C1), n = 3; C2, n = 3; C3, n = 4) executed 10 forehand and backhand topspin drives. Shoulder abduction/adduction, elbow flexion/extension, wrist extension/flexion, respective range of motion (ROM), and joint patterns were obtained using inertial measurement unit (IMU) sensors. The results showed clear differences in upper limb kinematics between the able-bodied and wheelchair players, especially in the elbow and wrist. For the para-players, noticeable variations in techniques were also observed among the different disability classes. In conclusion, wheelchair players likely adopted distinct movement strategies compared to AB to compensate for their physical impairments and functional limitations. Hence, traditional table tennis programs targeting skills and techniques for able-bodied players are unsuitable for para-players. Future work can investigate how best to customize training programs and to optimize movement strategies for para-players with varied types and degrees of impairment.

Use of a Portable Inertial Measurement Unit as an Evaluation Method for Supraspinatus Muscle: Proposed Normative Values

Treatment protocols do not specify an appropriate weight for rehabilitating the shoulder joint. The purpose of this study was to establish normative values for the shoulder abduction range of motion and recommended weights to be used in the rehabilitation process after injury to the supraspinatus muscle. Fifty-eight volunteers were assessed using the DyCare system. A test was conducted by lifting the arm to a 90° angle and having the participants lift different weights. The range of motion was similar for both sexes, suggesting that sex had no influence on this variable. Regarding the use of weights, men did not show as much stability in their movement execution, with a high dispersion seen in values between zero and three kilograms of weight, reaching a maximum weight of six kilograms. However, women showed good joint stability from the beginning of the test, with values that remained constant as weight increased up to a maximum of five kilograms. In conclusion, no major differences were observed in supraspinatus muscle injury recovery according to sex. However, differences were observed in the amount of weight that was necessary and appropriate to allow the participants to recover their muscular strength and avoid relapses.

Machine Learning and Statistical Prediction of Pitching Arm Kinetics

Background: Over the past decade, research has attempted to elucidate the cause of throwing-related injuries in the baseball athlete. However, when considering the entire kinetic chain, full body mechanics, and pitching cycle sequencing, there are hundreds of variables that could influence throwing arm health, and there is a lack of quality investigations evaluating the relationship and influence of multiple variables on arm stress. Purpose: To identify which variables have the most influence on elbow valgus torque and shoulder distraction force using a statistical model and a machine learning approach. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A retrospective review was performed on baseball pitchers who underwent biomechanical evaluation at the university biomechanics laboratory. Regression models and 4 machine learning models were created for both elbow valgus torque and shoulder distraction force. All models utilized the same predictor variables, which included pitch velocity and 17 pitching mechanics. Results: The analysis included a total of 168 high school and collegiate pitchers with a mean age of 16.7 years (SD, 3.2 years) and BMI of 24.4 (SD, 1.2). For both elbow valgus torque and shoulder distraction force, the gradient boosting machine models demonstrated the smallest root mean square errors and the most precise calibrations compared with all other models. The gradient boosting model for elbow valgus torque reported the highest influence for pitch velocity (relative influence, 28.4), with 5 mechanical variables also having significant influence. The gradient boosting model for shoulder distraction force reported the highest influence for pitch velocity (relative influence, 20.4), with 6 mechanical variables also having significant influence. Conclusion: The gradient boosting machine learning model demonstrated the best overall predictive performance for both elbow valgus torque and shoulder distraction force. Pitch velocity was the most influential variable in both models. However, both models also revealed that pitching mechanics, including maximum humeral rotation velocity, shoulder abduction at foot strike, and maximum shoulder external rotation, significantly influenced both elbow and shoulder stress. Clinical Relevance: The results of this study can be used to inform players, coaches, and clinicians on specific mechanical variables that may be optimized to mitigate elbow or shoulder stress that could lead to throwing-related injury.

Gymnasts' Ability to Modulate Sensorimotor Rhythms During Kinesthetic Motor Imagery of Sports Non-specific Movements Superior to Non-gymnasts

Previous psychological studies using questionnaires have consistently reported that athletes have superior motor imagery ability, both for sports-specific and for sports-non-specific movements. However, regarding motor imagery of sports-non-specific movements, no physiological studies have demonstrated differences in neural activity between athletes and non-athletes. The purpose of this study was to examine the differences in sensorimotor rhythms during kinesthetic motor imagery (KMI) of sports-non-specific movements between gymnasts and non-gymnasts. We selected gymnasts as an example population because they are likely to have particularly superior motor imagery ability due to frequent usage of motor imagery, including KMI as part of daily practice. Healthy young participants (16 gymnasts and 16 non-gymnasts) performed repeated motor execution and KMI of sports-non-specific movements (wrist dorsiflexion and shoulder abduction of the dominant hand). Scalp electroencephalogram (EEG) was recorded over the contralateral sensorimotor cortex. During motor execution and KMI, sensorimotor EEG power is known to decrease in the α- (8–15 Hz) and β-bands (16–35 Hz), referred to as event-related desynchronization (ERD). We calculated the maximal peak of ERD both in the α- (αERDmax) and β-bands (βERDmax) as a measure of changes in corticospinal excitability. αERDmax was significantly greater in gymnasts, who subjectively evaluated their KMI as being more vivid in the psychological questionnaire. On the other hand, βERDmax was greater in gymnasts only for shoulder abduction KMI. These findings suggest gymnasts' signature of flexibly modulating sensorimotor rhythms with no movements, which may be the basis of their superior ability of KMI for sports-non-specific movements.

Analysis of Compliance with Time under Tension and Force during Strengthening Exercises with Elastic Bands

Quantifying training variables of a physical exercise modality is essential for an appropriate dosage. In training with elastic bands, time under tension (TUT) and force represent the duration and intensity of this force-training modality. The aims of this study were to evaluate the degree of compliance to TUT prescription for three different scenarios of two exercises and the comparison of the force values obtained versus the estimate values. A total of 29 healthy volunteers were evaluated in a clinical environment under controlled conditions in 3 different scenarios (different velocities or ROMs) of both shoulder abduction and knee extension in 2 sets of 10 repetitions per scenario within a single session. Concentric and isometric phases showed a higher degree of compliance for their TUTs than the eccentric phase TUTs for all scenarios of both exercises, whereas the degree of compliance was higher for the total TUT than for the phases’ TUTs. Additionally, the eccentric phase showed a general tendency to develop for longer time periods than prescribed, whilst the fast scenario showed a higher degree of compliance for isometric phase TUTs and total TUTs than the extant two scenarios in both exercises. On the other hand, the force of the elastic bands tends to be overestimated according to the estimates of the manufacturers. These findings, both those related to the degree of compliance with TUTs and the force analysis, can be used by physiotherapists and other exercise professionals as a reference to achieve a good dosage of routine exercises with elastic bands.

Prevalence and Morphology of the Coracoclavicular Joint: An Osteological Study of 2,724 Subjects Using Univariable and Multivariable Logistic Regression Analyses

Background: The coracoclavicular joint (CCJ) is an anomalous articulation between the surfaces of the inferior clavicle and superior coracoid and its etiology is controversial. Reportedly, symptomatic patients demonstrate significant functional limitations including shoulder abduction loss and potential for brachial plexus compression and impingement.Purpose: To determine the prevalence of CCJ across age, gender and ethnicity, and to identify clinically useful morphological characteristics.Methods: 2,724 subjects with intact clavicles and scapulae from the Hamann-Todd Osteological Collection were evaluated for the presence of CCJ. Logistic regression was used to determine the effect of age, height, gender, and race on prevalence of CCJ. 354 clavicles with CCJ were measured for size and location of the CCJ facet.Results: CCJ was observed in 9% of subjects. CCJ was more prevalent in African-Americans (12%) than Caucasian-Americans (6%) (p &lt; 0.001) and more prevalent in females (11%) than males (8%) (p = 0.055). Facet location along clavicle length was consistent (average 25%, range 15–35%). But, facet location along clavicle width varied (average 60%, range 10–90%), with males having a more posterior location. For every 10-year increase in age, facet elevation (p = 0.001) and surface area (p &lt; 0.001) increased.Conclusions: CCJ prevalence was 9% in our large osseous population, found more commonly in African-Americans and females. Facet location is predictable with respect to clavicle length, but less so along clavicle width. The clavicular facet may develop at some point in life and continue to grow in size after its appearance.Clinical Relevance: Presence of a CCJ represents a potential overlooked source of anterior shoulder pain and supracoracoid impingement. Epidemiologic and morphological characteristics presented in our study can aid in the identification, clinical understanding, and surgical excision of a symptomatic CCJ. Level of Evidence: Level IV.