Role of Radiographs and Ultrasound in Diagnosing Calcific Tendinitis and Periarthritis in the Wrist and Hand with Ultrasound-Guided Barbotage as Management Tool

Aim To demonstrate the role of radiographs and ultrasound (USG) in the diagnosis of calcific tendinitis and periarthritis in the wrist and hand and the efficacy of USG-guided barbotage for its management. Materials and Methods A retrospective chart review was performed in six patients who presented with acute-onset pain in the wrist and hand varying from 3 days to 2 weeks. Four patients had tenderness over pisiform and two patients had pain along the lateral aspect of the wrist and thumb. Radiographs and USG revealed calcific focus corresponding to the site of pain. USG-guided calcific barbotage and injection was performed for the same and pain relief was assessed immediately and through telephonic follow-up at 6 months using subjective satisfaction score. Data were analyzed using Microsoft Excel 2013. Results Four patients with tenderness over pisiform had flexor carpi ulnaris calcific tendinitis and two patients with pain along the lateral aspect of the wrist and thumb had first metacarpophalangeal calcific periarthritis and abductor pollicis brevis calcific tendinitis on radiographs as well as USG. In post-USG-guided calcific barbotage and injection, all patients had significant immediate and 6 months delayed relief in symptoms with excellent satisfaction scores. Conclusion Acute calcific tendinitis/periarthritis is a benign and self-limiting inflammatory condition. Radiographs are extremely helpful in identifying calcific focus. Ultrasonography in experienced hands is the best modality to identify, confirm the symptomatic calcific focus, and perform USG-guided intervention. USG-guided calcific barbotage is the simplest, quickest, and effective way to treat this condition and avoid compromised functional capacity.

Changes in muscle–tendon unit length–force characteristics following experimentally induced photothrombotic stroke cannot be explained by changes in muscle belly structure

Purpose The aim of this study was to assess the effects of experimentally induced photothrombotic stroke on structural and mechanical properties of rat m. flexor carpi ulnaris. Methods Two groups of Young-adult male Sprague–Dawley rats were measured: stroke (n = 9) and control (n = 7). Photothrombotic stroke was induced in the forelimb region of the primary sensorimotor cortex. Four weeks later, muscle–tendon unit and muscle belly length–force characteristics of the m. flexor carpi ulnaris, mechanical interaction with the neighbouring m. palmaris longus, the number of sarcomeres in series within muscle fibres, and the physiological cross-sectional area were measured. Results Stroke resulted in higher force and stiffness of the m. flexor carpi ulnaris at optimum muscle–tendon unit length, but only for the passive conditions. Stroke did not alter the length–force characteristics of m. flexor carpi ulnaris muscle belly, morphological characteristics, and the extent of mechanical interaction with m. palmaris longus muscle. Conclusion The higher passive force and passive stiffness at the muscle–tendon unit level in the absence of changes in structural and mechanical characteristics of the muscle belly indicates that the experimentally induced stroke resulted in an increased stiffness of the tendon.

Electromyography-based Fatigue Assessment During Endurance Testing by Different Vibration Training Protocols

Objectives: This study presents a method of assessing muscle fatigue during endurance testing at 50% maximal voluntary contraction (MVC) using electromyography (EMG) information as indirect indices of fatigability in the forearm muscles, namely, flexor digitorum superficialis (FDS); flexor carpi ulnaris (FCU); extensor carpi ulnaris (ECU) and extensor carpi radialis brevis (ECRB)." This study presents a method of assessing muscle fatigue during endurance testing at 50% maximal voluntary contraction (MVC) using electromyography (EMG) information as indirect indices of fatigability in the forearm muscles, namely, flexor digitorum superficialis (FDS); flexor carpi ulnaris (FCU); extensor carpi ulnaris (ECU) and extensor carpi radialis brevis (ECRB). Methods: A randomized comparative experimental design was used during endurance test with 8 VT protocols; based on different combinations of vibration frequency (35 & 45 Hz), amplitude (3±0.5g & 9±0.5g), and exposure duration (30 & 60 seconds), i.e., were given to the study participants for 4 days. A random sampling of participants was conducted from two groups (n=56/group), as follows: individuals with a Sedentary Lifestyle (SL) and a group of Construction Workers (CW). Results: Multivariate Analysis of Variance (MANOVA) results indicated a significant increase in EMG rms, median frequency, waveform length, mean absolute value (P<0.001), and the variance of EMG signal (P<0.05) (except in ECU for the SL group and ECRB for the CW group on the variance of EMG signal) after VT in all muscles of both research groups. Therefore, an increase in the EMG parameter value after a grip endurance task revealing an elevation in EMG signal amplitude is indicative of muscle fiber fatigue. Furthermore, the strongest correlation was found between grip endurance and WL (r=0.471, P<0.001), and EMG rms (r=0.401, P<0.001) of the ECU muscle in the SL group only. Discussion: The patterns of EMG signal represented the amplitude and spectral parameters of the signal, enabling real-time fatigue analysis. Additionally, surface EMG information is useful for indirectly evaluating performance fatigue during the endurance test.