Diagnostic and therapeutic value of ultrasonography in the detection of paralabral ganglion cysts with a curved array transducer: A case report

BACKGROUND: Paralabral cysts are a rare cause of shoulder pain. Linear ultrasound transducers are often used for musculoskeletal evaluation and intervention. However, the use of linear transducer is limited when the target structure is located deep and blocked by bony barriers, as is the case of paralabral ganglion cysts. OBJECTIVE: This case report aims to describe a beneficial role of using a convex transducer on the evaluation and ultrasonography-guided intervention of paralabral cysts below the acromion. CASE DESCRIPTION: Two patients visiting the outpatient clinic of Physical Medicine and Rehabilitation complained of severe pain during shoulder movement. Ultrasound scans with linear transducer detected rotator cuff lesions. Shoulder MRIs performed because of persistent pain despite ultrasound-guided bursa injection at the subacromial-subdeltoid bursa using a linear array transducer, confirmed paralabral cysts. Although a linear array transducer could not visualize the lesion but could only perform suprascapular nerve block and intra-articular injection, the use of a convex array transducer improved the visualization of the cystic lesion which we treated using ultrasound-guided aspiration and intra-cystic injection. Visual analog scale and Shoulder Pain and Disability Index were checked to assess the treatment effect of each intervention. The intra-cystic injection with aspiration and intra-articular injection showed minimal to moderate improvement of pain score. CONCLUSION: In pain related to shoulder movement, especially pain that continues despite appropriate treatment for rotator cuff lesions, ultrasound diagnosis of paralabral ganglion cysts using convex transducers will improve the diagnostic value and accuracy of intervention.

The Biomechanics of Shoulder Movement with Implications for Shoulder Injury in Table Tennis: A Minireview

A high proportion of shoulder injuries in table tennis players are common, which is both a diagnostic and therapeutic challenge. An understanding of the interaction between biomechanical function of the shoulder and mechanisms of shoulder injuries in table tennis players is necessary to prevent injury and to conduct clinical treatment of the shoulder as soon as possible. The purpose of this minireview was to select the available evidence on the biomechanical characteristics of shoulder movement and potential relationships with various shoulder injuries that are common in table tennis players. Five studies revealed interesting biomechanical characteristics of shoulder movement patterns in table tennis players: large internal rotation torque, an increased torsion-rotation movement, and a greater angular velocity of internal rotation were found. Two studies were noted that were related to specific shoulder injury: glenohumeral internal rotation deficit (GIRD) and impingement syndrome. Unfortunately, it is difficult to draw conclusions on the mechanisms of shoulder injury in table tennis players due to the little evidence available that has investigated shoulder injury mechanisms based on biomechanical characteristics. Future studies should focus on the potential relationship between the biomechanical characteristics of the shoulder and injury prevalence to provide valuable reference data for clinical treatment.

CASE SERIES: INSTANT EFFECT OF MARMA THERAPY IN THE PAIN MANAGEMENT WSR: TO SHOULDER PAIN

Science of Marma known as Marma Vigyanam is a dynamic part, specially described in Sushrut samhita and other Ayurvedic classics. According to Sushrut Mamsa, Sira, Snayu, Asthi, and Sandhi, these five elements collectively present at Marma point. This is the peculiarity of Marma.1 Marmas are the vital points on the body having importance regarding surgical procedure and traumatic effect. It is also known as Ayurvedic Accupressure. In this paper, three similar cases of pain and stiffness in shoulder joints are presented, who has attended OPD of District Hospital Shivaji Nagar, Bhopal. In during the clinical examination partially restriction of shoulder movement is also recorded. The case was initially treated with Marma therapy mainly the stimulation of bilateral Bahu Marma along withAmsa Marma for instant pain management. After the treatment of about ten minutes the patient got relief in pain and stiffness and felt lightness in surrounding area of painful place. Amsa Marma manipulation can be used to give instant relief from Shoulder pain effectively.

Wireless Gesture Control Wheelchair

Wheelchairs have been used by patients who suffer from various physical disabilities to help them with locomotion and cater their day to day needs with ease. But there are some cases where the movement of a wheelchair is dependent on another individual as is the case with patients who lack the required arm strength and movement to properly push the wheels forward such as quadriplegics, paraplegics, stroke patients, elders etc. Joystick oriented wheelchairs, thought to be a solution to those kinds of patients, can pose different problems as it requires basic shoulder movement. It is not always possible for the aforementioned types of patients. In addition, our solution doesn't have the positional constraints that a joystick wheelchair might have as it is wireless and can be worn on either hand which allows the patient to sit in their preferred position for minimum discomfort. This project is an attempt to help the disabled move around independently. Thus, in this research work, we present a prototype of a wireless gesture-based wheelchair which can be controlled via hand gestures. The framework consists of a transmitter and a receiver that communicate with each other wirelessly. For wireless transmission, 433Mhz RF Transmitter and Receiver Unit has been used as it transmits data through an antenna at the speed of 1Kbps - 10Kbps and the range can be adjusted as required. The transmitter unit consists of an Arduino LilyPad microcontroller and an accelerometer that has been attached to a hand glove. The accelerometer sensor has been used to register the position of the hand while creating a gesture. This glove is supposed to be worn by the patient allowing them to move their hand conveniently, sending signals to the receiver unit connected to the wheelchair leading to the movement of the wheels in the desired direction. The receiver unit consist of motor drivers that convert the voltage as needed by the wheels. This paper presents an alternative to the commercial wheelchairs as it is cost effective, easy to control and efficient. The working and assembly of the system has been explained in the paper.

Estimation of Continuous Joint Angles of Upper Limb Based on sEMG by Using GA-Elman Neural Network

The estimation of continuous and simultaneous multijoint angle based on surface electromyography (sEMG) signal is of considerable significance in rehabilitation practice. However, there are few studies on the continuous joint angle of multiple joints at present. In this paper, the wavelet packet energy entropy (WPEE) of the special subspace was investigated as a feature of the sEMG signal. An Elman neural network optimized by genetic algorithm (GA) was established to estimate the joint angle of shoulder and elbow. First, the accuracy of the method is verified by estimating the angle of the shoulder joint. Then, this method was used to simultaneously and continuously estimate the shoulder and elbow joint angle. Six subjects flexed and extended the upper limbs according to the intended movements of the experiment. The results show that this method can obtain a decent performance with a RMSE of 3.4717 and R2 of 0.8283 in shoulder movement and with a RMSE of 4.1582 and R2 of 0.8114 in continuous synchronous movement of the shoulder and elbow.