Narrow Results

To evaluate the efficacy of Chinese medicine (CM) acupuncture for chronic neck pain (CNP), a single blind, controlled, crossover, clinical trial was undertaken. Twenty-nine volunteers with CNP were randomly recruited into two groups. Both groups received two phases of treatment with a washout period between the two phases. Group A (14 volunteers) received CM acupuncture in the first phase and sham acupuncture in the second, while Group B (15 volunteers) received sham in the first and real in the second. CM acupuncture was individualized and consisted of nine sessions on both local and distal points. Manual twisting of the needle was applied on all points plus strong electrical stimulation of distal points in CM acupuncture. Sham acupoints (lateral to the real) and sham (weak) electrical stimulation was used in the control group. Comparison of subjective and objective measures between the two groups was made at different periods, including baseline, after each phase of treatment, after washout, and after the 16th week follow-up. The subjective measures included pain intensity, duration per day, analgesic medication count, visual analogue scales (VAS) and neck disability index (NDI). The objective measures consisted of neck range of motion (ROM) and pain threshold (PT). Both the real and sham treatments significantly reduced subjective pain, without significant differences between groups for most subjective measures. Objective measures showed no significant change for either group before and after each period or by inter-groups analysis. A minimum 16-week effect of both real and sham acupuncture was found for subjective measures in the follow-up periods. Further study is recommended with an increased sample size, a longer washout period, and a longer baseline period.

Our previous study has demonstrated that 6 weeks of Tai Chi exercise significantly improves knee pain and stiffness in elderly with knee osteoarthritis. This study also examine the effects of Tai Chi exercise on gait kinematics, physical function, pain, and pain self-efficacy in elderly with knee osteoarthritis. In this prospective, pretest-posttest clinical trial, 40 men and women (64.4 ± 8.3 years) diagnosed with knee osteoarthritis participated in 6 weeks of instructed Tai Chi training, 1 hour/session, 2 sessions/week. The following measures were taken at baseline and the conclusion of the intervention: (a) gait kinematics including stride length, stride frequency, and gait speed quantified using video analysis, (b) physical function, (c) knee pain, and (d) pain self-efficacy. Data were analyzed using repeated MANCOVA, MANOVA, ANOVA and Wilcoxon tests. After 6 weeks of Tai Chi exercise, stride length (p = 0.023; 1.17 ± 0.17 vs. 1.20 ± 0.14 m), stride frequency (p = 0.014; 0.91 ± 0.08 vs. 0.93 ± 0.08 strides/s), and consequently gait speed (p < 0.025; 1.06 ± 0.19 vs. 1.12 ± 0.15 m/s) increased in the participants. Physical function was significantly improved (p < 0.001) and knee pain was significantly decreased (p = 0.002), while no change was observed in pain self-efficacy. In conclusion, these findings support that Tai Chi is beneficial for gait kinematics in elderly with knee osteoarthritis, and a longer term application is needed to substantiate the effect of Tai Chi as an alternative exercise in management of knee osteoarthritis.

Background: In order to introduce new pharmacological agents with the intent to inhibit the adhesion formation, it is important to test such products on laboratory animals under a protocol that can evaluate the quantitative and qualitative aspects of healing of the tendons. Most experimental models focus on the tensile strength and histological analysis of the tendons, failing to sufficiently quantify the degree of the adhesion formation.

Methods: The experiment included six male New Zealand rabbits that underwent surgery of their right forepaws. The deep flexor tendon of the middle finger was transected and repaired and after six weeks the rabbits were killed. In order to assess the extent of adhesions, the functional stiffness of the tendons and the range of motion of the specimens’ fingers was studied using a tensile testing machine. The setup used allowed the simultaneous recording of the specimens’ motion and the pulling force values.

Results: The mean values of the left and right forepaws were expressed in the same chart showing a clear difference between the operated and non operated forepaws.

Conclusions: Using a relatively simple set up in the laboratory we had the chance to focus on a more elaborate analysis of the data with the help of low cost and accessible software.

The objective of this study was to build and validate the FE models of thoracolumbar junctional T11-T12 and T12-L1 functional spinal units (FSUs) and compare the biomechanical responses of the two FSUs under physiological loading modes: flexion, extension, lateral bending and axial rotation.

Anatomically accurate FE models of thoracolumbar T11-T12 and T12-L1 FSUs were developed and validated against published experimental results in terms of load displacement responses and range of motion (ROM) under flexion and extension pure moments of 7.5 Nm, left and right lateral bending pure moments of 7.5 Nm and left and right axial torque of 7.5 Nm. The overall responses predicted by the T11-T12 and T12-L1 FE models showed differences in stiffness under different load configurations. Amongst all loading configurations, the motions at T11-T12 and T12-L1 were the stiffest under axial torque. The lateral bending motions of T11-T12 and T12-L1 were relatively flexible. Under sagittal moments, the motion in extension was greater than in flexion at level T11-T12, while the rotation in flexion was greater than in extension at level T12-L1.

Hip simulators are regularly used by researchers to assess total hip arthroplasty (THA) implants, range of motion, stability, and alignment of acetabular cup and stem. Previous papers have described three types of simulators: three-dimensional protractors, biaxial rocking motion (BRM) protractors, and single-axis prosthetic range-of-motion (PROM) devices. We have developed a new hip simulator in which the ROM device is completely automated in three independent axes (elevation, internal/external rotation, and plane of elevation). Coupled with the simulator, we used a FaroArm Gold Series coordinate measuring machine (CMM) to accurately align the implant components. The results show that the methodology and alignment setup are accurate and repeatable. With this simulator and digitizer, we are able to study the characteristics of numerous THA implants at various orientations of the pelvis, acetabular cup, stem, and femur.

Background Data: Cervical active range of motion (cervical AROM) is often assessed in clinical practice to quantify musculoskeletal impairments of the neck and evaluate efficacy of interventions. Such assessment requires instruments with proven reliability and validity. Purpose: To investigate and compare the intra-rater reliabilities and concurrent validity of the universal goniometer and tape measure in measuring cervical AROM. Methods: Cervical AROM in 100 consecutively sampled apparently healthy individuals was measured with both universal goniometer and tape measure and repeated after five days. Data were summarized using descriptive statistics, standard error of measurement, Pearson product moment correlation and intraclass correlation coefficient (ICC) at 0.05 level of significance. Results: Intra-rater reliability of the tape measure (r = 0.28–0.62; ICC = 0.44–0.75) and universal goniometer (r = 0.21–0.67; ICC = 0.34–0.79) were within the acceptable range except for right lateral flexion for goniometer and left lateral flexion for tape measure. Standard errors of measurement were 0.14–0.20 and 0.76–1.27 for tape measure and goniometer, respectively. Concurrent validity coefficients of the two instruments for all cervical AROM (r = 0.23–0.40) except left lateral flexion and right rotation were within the acceptable range. There was no gender difference in cervical AROM using the goniometer but male participants had significantly more range in flexion and right lateral flexion using the tape measure. Conclusions: Tape measure and goniometer have similar intra-rater reliability and significant but weak concurrent validity in assessing cervical AROM except left lateral flexion and right rotation.

Purpose: The purpose of the study was to find the effects of early rehabilitation on high flex cruciate retaining total knee replacement (TKR) on pain and function. Methods: We designed a prospective pre-post trial and evaluated 34 participants who underwent unilateral TKR following end stage knee osteoarthritis. Outcome measure of numeric pain rating scale (NPRS), knee ROM, quadriceps strength and functional measure of timed up and go test (TUG) and six-minute walk test (SMWT) was assessed before and three months post surgery by a blinded observer. Results: The knee flexion ROM showed significant improvement of 25.1^∘±11.2^∘ at 3-months. The NPRS, TUG and SMWT showed significant change of 6.47±0.92, 21.7±2.6, 157.7±31 from baseline to 1.3±0.8, 17.5±1.6, 263±37.9 at 3 months respectively following TKR (p = 0.001). Conclusion: Early rehabilitation showed improvement in knee ROM, pain reduction, and accelerated recovery in performing TUG and SMWT.

Context: Shoulder Impingement Syndrome (SIS) is a common clinical condition in general practice and overhead athletes. Alterations in the scapular position can lead to shoulder impingement syndrome. The effect of exercises on shoulder impingement syndrome is studied but the effect of Kinesiotape is not well explored.

Methods: A total of 42 participants were included in the study. The subjects were assessed for SPADI, pain, proprioception, lateral scapula slide test, and pectoral minor length test at the baseline and the subjects were randomly divided into two groups. The intervention group ($n$ = 18) received scapular taping and scapular exercises and the control group ($n$ = 17) received scapular exercises only. Post-outcome measures were taken at 4 weeks and 12 weeks during the intervention. Repeated measures ANOVA was used for the outcome measures and Bonferroni’s test was used to determine the pairwise comparisons at different measurement levels amongst experimental and control groups.

Results: The study consisted of 17 males and 18 females. There was statistical significance in both groups ($p$ < 0.01) over the 4th and 12th weeks. Pain ($p$ < 0.01) and proprioception ($p$ = 0.017) was also statistically significant between both the groups at 4 weeks.

Conclusion: This study concludes that scapular taping can be used as an adjunct with scapular involvement.

Various designs of cervical total disc replacement (CTDR) have been introduced and employed in an attempt to avoid disadvantages of the fusion surgery. The purposes of this study were to evaluate the effects of the range of motion (ROM), the instantaneous center of rotation (ICR) and the facet joint force (FJF) with different constrained types of CTDR devices. A three-dimensional finite element (FE) model of intact cervical spine (C3-7) was made from CT scans of a normal person and validated. Postoperative FE models simulating CTDR implantation at the C5-6 disc space were made for CTDR-I (constrained design) and CTDR-II (nonconstrained design), respectively. Hybrid protocol (intact: 1 Nm) with a compressive follower load of 73.6 N was applied at the superior endplate of the C3 vertebral body. The inferior endplate of C7 vertebral body was constrained in all directions. At the index level, CTDR-I showed a higher increase in segmental motion and FJF than CTDR-II in extension, lateral bending and axial rotation. The CTDR-II with an elastomer-type core reproduced a near physiological ICR of the intact model in extension and axial rotation. Abnormal kinetic and kinematic changes related to the CTDR may induce surgical level problems and cause long-term failure of spinal surgery.

This study aimed to investigate three-dimensional (3D) kinematic characteristics of elbow and wrist motions, the relationship between them, and the anthropometric factors affecting them. Using motion capture system, this study measured and calculated the 3D angles of elbow flexion/extension, elbow pronation/supination, wrist flexion/extension, and wrist adduction/abduction of 40 healthy young adults. The study measured nine anthropometric variables and used unpaired $t$-tests to assess gender difference. Also, bivariate correlation tests and step-wise multiple regression analyses were performed between joint ranges and anthropometric variables, as well as different joint motions. Results showed two opposite patterns occurred during elbow flexion/extension. The study found a correlation between the range of elbow flexion/extension and the range of elbow pronation/supination that occurred during elbow flexion/extension. Additionally, the study tested joint correlations between the four joint motions. Finally, the study established bivariate and multiple regression relationships between range of elbow motions and anthropometric factors. This research presented an unrecognized pattern of 3D elbow flexion/extension, and associations between various anthropometric factors and different joint motions. These findings can contribute to the design of orthosis of upper extremities and the rehabilitation of joint mobility.

The purpose of the study was to measure anthropometry, range of motion, and muscle strength of Koreans with paraplegia, using wheelchairs. The total number of people with disabilities in Korea was 2,618,918, of which 1,223,135 (46.7%) people were with physical disabilities in 2019. For the research, people with paraplegia living in Chungcheongnam-do, Korea were recommended through the disability-related organizations. Totally 77 Koreans with paraplegia participated, out of which 57 participants were men and 20 participants were women in the age group of 30–69 years. There were 82 measurement items categorized into 39 static measurement items, 31 range of motion items, and 12 muscle strength of hand/finger items. The results were presented and analyzed with values in the 5, 25, 50, 75, and 95 percentiles by each item and gender. In the category of basic anthropometric measurements, the horizontal size items of the participants with paraplegia were reported to be larger than those of people without disabilities due to the development of the upper body resulting from wheelchair propulsion movements with some exceptions related to their overall body physiques. In sitting posture, there would be various factors affecting the anterior and lateral maximum/minimum reach measurements such as differences in neurological symptoms according to the spinal cord injury level and daily movement level. The data showed a meaningful difference between men and women in height and flexibility in sitting posture. An independent sample $t$-test was also performed between male and female groups. There were differences in the anthropometric values, range of motion, pinch force, and grip force between men and women with paraplegia. The measurement results of anthropometry of hand/foot and muscle strength of hands and fingers of Koreans with paraplegia would be used for designing products for their hands and feet such as hair dryers and tumblers. The results of range of motion measurements would be used as important data for the design and development of wheelchairs for people with spinal cord injury. The measurement results of Koreans with paraplegia would be used as basic data for designing and developing assistive technology and universal products for wheelchair users who work and perform daily activities. The anthropometric measurements of individuals with other subclassifications of disabilities will be necessary in the future study for more detailed implication and application in this field.

The purpose of this study is to derive and analyze the static, dynamic, and muscle strength measurement items of amputees in Korea for the design of large-scale agricultural work equipment considering their altered physical characteristics and functions. A total of 46 amputees participated in the study, with 34 males and 12 females in the age ranging between 30 and 60 years. Thirty items were derived for the measurement items considering the designing of the large-scale agricultural work equipment. The measurement results were presented as 5%tiles, 50%tiles, and 95%tiles values by item and gender, and t-test verification was performed on gender basis. There was a statistically significant difference between the men and women in most of the measurement items. Our results indicate that the male data should be used for the spatial design of equipment with static measurement items and the design of the controllers with dynamic measurement items, whereas the female data should be applied in the designing of parts that require muscle strength, such as accelerators. The results of this study can provide a basic data for developing the design of large-scale agricultural work equipment and machines that are usable and convenient for amputees in Korea, and in exploring the anthropometric measurements of the subtypes of people with physical disabilities.

Background: Elbow is a very functional joint. Elbow stiffness is a significant cause of disability hampering the function of the upper extremity as a whole. Muscle Energy Techniques (METs) are relatively pain-free techniques used in clinical practice for restricted range of motion (ROM).

Objective: To study the effects of MET on pain, ROM and function given early in the rehabilitation in post-surgical elbow stiffness.

Methods: An RCT was conducted on 30 patients post elbow fracture fixation. Group 1 was given MET immediately post removal of immobilization while Group 2 received MET 1 week later along with the rehabilitation protocol. Pain (Visual Analogue Scale), ROM (goniometry) and function (Disability of Arm, Shoulder and Hand questionnaire) were assessed pre and post 3 weeks.

Results: Group 1 showed greater improvement than Group 2, mean flexion and extension change between groups being $11.7\pm 2.8$, 95%CI(5.9,17.4) and $8.5\pm 2.0$, 95%CI(4.4,12.7), respectively. VAS and DASH scores improved better in Group 1, mean change being $1.2\pm 0.2$, 95%CI(0.6,1.8) and $18.2\pm 2.2$, 95%CI(13.5,22.8) for VAS and DASH scores, respectively.

Conclusion: MET can be used as an adjunct to the rehabilitation protocol to treat elbow stiffness and can be given safely in the early stages of post elbow fracture rehabilitation managed surgically with open reduction and rigid internal fixation.

Background: Although the effect of active warm-up (WU) on acute flexibility enhancement is well documented, the test-induced WU effect in muscle length test has not been widely studied.

Objective: This study aimed to verify the test-induced WU effect on hamstring flexibility tests.

Methods: The active knee extension (AKE) was performed using the right leg, whereas the straight leg raise (SLR) was performed using the left leg. Ten trials of AKE or SLR were performed: two as the pre-intervention trials (Pre); six as the WU intervention; and another two trials as the post-intervention (Post). During WU, subjects in the WO-Hold group performed six trials of the AKE or SLR without hold, and those in the W-Hold group performed six trials of the AKE or SLR with a 5s hold.

Results: A significant difference was noted between Pre-AKE and Post-AKE, and between Pre-SLR and Post-SLR, respectively, in both the groups. The effect of WU is clear when performing consecutive AKE or SLR without any additional hold.

Conclusion: Practitioners should be cautious in interpreting the testing result to avoid overestimation of the treatment effect since the test itself may induce substantial WU effect to the target tissues.

Background: Zancolli theorized that the first metacarpal bone axially rotates on the semispheroidal part of the trapezium, which is controlled by ligaments. This study used three-dimensional computed tomography (3D-CT) to describe the motion of the first metacarpal bone on the trapezium.

Methods: 3D-CT images were taken of the left hand of 30 healthy volunteers (mean age $\text{40}\text{.0 ± 5}\text{.4}$ years, 15 men and 15 women). They were divided into five groups: radial abduction, retroposition, adduction, palmar abduction, and opposition. The range of motion of radial abduction and palmar abduction of the trapeziometacarpal joint was measured from the first metacarpal bone to the second metacarpal bone. The range of motion of pronation was measured following Cheema's method. The main contacts of the joint surface of trapezium and the first metacarpal bone were determined on the 3D-CT images.

Results: Pronation of the trapeziometacarpal joint was $\text{42 ± 9°}$ in radial abduction, $\text{61 ± 6°}$ in retroposition, $\text{68 ± 6°}$ in adduction, $\text{91 ± 6°}$ in palmar abduction, and $\text{99 ± 3°}$ in opposition. Radial abduction was $\text{40 ± 7°}$ in radial abduction, $\text{17 ± 10°}$ in retroposition, $\text{15 ± 7°}$ in adduction, $\text{13 ± 6°}$ in palmar abduction, and $\text{-4 ± 3°}$ in opposition. Palmar abduction was $\text{-8 ± 8°}$ in radial abduction, $\text{0 ± 3°}$ in retroposition, $\text{14 ± 6°}$ in adduction, $\text{40 ± 7°}$ in palmar abduction, and $\text{37 ± 5°}$ in opposition. The contact surfaces of the trapezium and the first metacarpal bone were dorsal and ulnar in radial abduction, radial and ulnar in retroposition, and volar-ulnar and volarradial in opposition, respectively, while they were both central in adduction and both radial in palmar abduction.

Conclusions: The range of motion of the trapeziometacarpal joint was 44° for radial abduction/adduction, 48° for palmar abduction/adduction, and 57° for pronation/supination. The varying contact surfaces of the trapezium and the first metacarpal bone enabled a wide range of motion.

Background: The purpose of our present study was to examine the recovery of the postoperative wrist function, and to compare the range of motion among each direction ofthe wrist joint during the same time periods after surgery for distal radius fractures.

Methods: Twenty patients treated with a volar locking plate were evaluated. The active range of motion and grip strength were assessed at four weeks, six weeks, three months, six months and one year after surgery.

Results: The ratio of the range of motion in pronation and supination recovered significantly earlier than for any other directions within six months after surgery (p = 0.0205), however, the ratio of the range of motion among the six directions was not significantly different at one year after surgery (p = 0.0823). The recovery of the range of motion in flexion was 96.8% compared with the contralateral wrist at one year after surgery, and it was not significantly lower than that in extension, radial deviation or ulnar deviation (97.8%, 93.5%, 94.4%, respectively). The grip strength of dominant hand recovered from 50% after four weeks to 66% after six weeks, 83% after three months, 91% after six months and 106% at the examination performed after one year compared with the uninjured non-dominant hand. The grip strength of non-dominant hand recovered from 52% after four weeks to 59% after six weeks, 79% after three months, 84% after six months and 94% at the examination performed after one year compared with the uninjured dominant hand. The mean DASH score was 5.3.

Conclusions: The range of motion in flexion can achieve similar improvement to that in the other directions by obtaining the appropriate postoperative parameters. The optimal postoperative radiographic parameters were thus identified to be essential for successfully obtaining a recovery of the wrist function for unstable distal radius fractures.

Background: The volar locking plate is frequently used in the fixation of unstable distal radius fractures, but despite this there is a paucity of mid to long term outcome studies. The purpose of this study was to investigate the mid-term functional outcomes of elderly patients treated with a volar locking plate for unstable distal radius fractures.

Methods: Thirty-two patients with a mean age of 74.1 (range, 65–85) years were followed for a mean of 39.1 (range, 30–81) months. Patients with follow-up periods of < 24 months were excluded from this study to investigate the mid-term clinical outcomes. The Mayo wrist score (MWS), grip strength and wrist range of motion were retrospectively reviewed at 12 months, 24 months and the latest follow-up (mean 39.1 months). Osteoarthritis status according to the system of Knirk and Jupiter was assessed at 24 months.

Results: Significant improvements in MWS and grip strength were observed between 12 and 24 months but not between 24 months and the final follow-up. There was no significant difference in wrist range of motion between 12 and 24 months. The MWS of 14 patients with radiographic signs of osteoarthritis was not significantly different from that of 18 patients without radiographic signs of osteoarthritis.

Conclusions: Elderly patients treated with the volar locking plate showed improved MWS and grip strength postoperatively after 12 months. Improvement in grip strength was slower than range of motion.

Background: The standard cross-finger flap (CFF) and laterally based thenar flap (LTF) are the time-tested modalities of fingertip reconstruction. We were unable to find any studies that have compared these two flaps for fingertip reconstruction. The aim of this study is compare the outcomes of these two flaps at 11 months after fingertip reconstruction.

Methods: This is a prospective study of 40 patients with fingertip amputation who underwent reconstruction with either a standard CFF or an LTF. Data with regards to the patient, the injury, treatment and complications were recorded. Patients were followed up weekly for the first 6 weeks and at 3, 6, 9 and 12 months thereafter. Outcome measures assessed at final follow-up included passive range of motion, two-point discrimination, cold intolerance, patient aesthetic satisfaction with the flap, assessment of donor scar and psychosocial benefit.

Results: Fingertip reconstruction was done with 23 CFFs and 17 thenar flaps. Partial necrosis was noted in three thenar flaps. The mean follow-up period was 11 months. The sensory recovery and aesthetic satisfaction with the flap were greater in thenar flap group. There were no differences between the two flaps in the other outcome measures.

Conclusions: Sensory recovery and aesthetic outcomes were better in thenar flaps compared to a CFF. However, thenar flap were associated with a greater incidence of partial flap loss.

Level of Evidence: Level III (Therapeutic)

Introduction: The primary goal of total knee arthroplasty (TKA) is to resolve knee destruction and associated problems at the end stages of diseases such as osteoarthritis and rheumatoid arthritis. High satisfactory rate has been reported in terms of pain relief and correction of deformity. However, the method for objective assessment of the outcome, such as range of motion (ROM) and quantitative evaluation of the clinical outcome of TKA, is to be confirmed. The purpose of this study was mandatory to investigate the ROM objectively and the newly designed prostheses.

Materials and methods: The study was done in randomly selected patients who received dynamic measurement of knee function. Twenty-six patients participated in the study. They were divided into two groups (13 patients in A and 13 patients in B group), according to the knee prostheses they had received. Basic knee functions were evaluated in various dynamic activities, including nonweight bearing status of knee flexion, level walking, kneeling, and squatting, using computerized gait analysis techniques (Vicon 512 system). Passive knee ROM and static alignment were measured using traditional goniometer. HSS scores, physical, and neural examination were recorded.

Results: After comparing patients in almost similar criteria, results have shown that there was no significant difference between two types of knee prostheses in randomly selective patients.

Conclusion: Newly designed prostheses for achieving higher flexion angle cannot guarantee to provide better knee flexion for every patient. A patient, who can achieve higher knee flexion in pre-operative status, will have high flexion results in post-operative result. In other words, poor knee flexion function in pre-operation will lead to poor knee flexion function in post-operation status. Minor prosthesis design has little to do with the surgical outcome of knee flexion.