Journal of Musculoskeletal Research

Purpose: To compare the patients operated on for lumbar disc hernia with two different methods in view of pain, disability, physical performance, physical activity and aerobic capacity. Methods: Forty-one patients were included in the study (group I, nucleoplasty – n = 14), (group II, lumbar discectomy – n = 27). Visual Analog Scale (VAS) was performed for pain; Oswestry Disability Index for lumbar disability level; total rolling time, lie/sit, sit and stand, 50 foot walking and five-minute walk tests for physical performance measurements; the Compendium of Physical Activities (CPA) scale for activity level measurement, and VO₂ max measurements for aerobic capacity. Results: In the second month's controls, changes of pain and disability levels were insignificant in both groups, even though pain in nucleoplasty group and disability in discectomy group were found to be better. In performance measurements, group II showed better results in the second postoperative month, whereas group I had better results in the sixth postoperative month. The levels of physical activity in group I, and of aerobic capacity in group II increased significantly. Conclusion: Different physiotherapy approaches are necessary to obtain good results in terms of pain intensity, disability, physical performance, physical activity and aerobic capacity, since these parameters are found to be worse during the sixth month postoperative in patients who had undergone lumbar discectomy.

Because of few anatomic reports investigating the mechanism of lateral epicondylitis (tennis elbow), we performed cadaveric and clinical studies to investigate the involvement of neurovascular bundles passing through the common extensor origin. We dissected and observed under a light microscope tissue samples of neurovascular bundles passing through the common extensor tendon from 40 upper left and right limbs from cadavers. Tissue samples were prepared by hematoxylin & eosin and Weil's myelin staining. We also investigated the records of 20 patients who had been treated for lateral epicondylitis between 1991 and 2004. From cadavers, we found 60 bundles in the common extensor tendon, each 0.5 to 1.0 mm in diameter, with more bundles in the right than left limbs. Twenty-four of these bundles passed over the vertex of the lateral epicondyle of the humerus, and most of the bundles contained only one artery each. The bundles mostly originated from the radial recurrent artery, passing through the aponeurosis of the extensor corpi radialis brevis, but in some cases originated from the radial collateral artery, passing through the aponeurosis of the triceps brachii muscle. The bundles had a membranous covering when passing through the aponeurosis and produced a hiatus. Histological analysis of resected common extensor tendon tissue, 1 cm in diameter, of patients showed hyaline degeneration and fibrosis formation infiltration. Neurovascular bundles passed through the common extensor tendon in nine cases; six cases showed pulsing bleeding. After a mean follow-up of two years (6–48 months), 16 cases showed excellent results, two showed good results and two showed reliefs. Lateral epicondylitis could be caused by damage to neurovascular bundles when they pass through the common extensor origin; one cause of pain is the neurovascular bundle being compressed when passing through the common extensor tendon, secondary to the pathologic degeneration of the origin of the common extensor tendon.

The study's aim was to determine the initial effects of a dynamic seating system as a therapeutic intervention in children with cerebral palsy. A two-factor, repeated-measures design was used. Twelve children with neuromuscular dysfunction (mean age 6.0, SD 2.7 years) were included in the study, randomly assigned to an experimental or a control group. At study initiation the experimental group received a wheelchair with dynamic seating components that allows limited range of motion in the hip and knee, and the control group received a static setting wheelchair. Participants were evaluated for range of motion, muscle spasticity (Modified Ashworth Scale), motor function (Gross Motor Function Measure), and level of disability (Pediatric Evaluation of Disability Inventory) at study initiation, 3-months, and 6-months post intervention. Both groups improved in motor function over time, particularly in the categories of Sitting and Crawl/Kneel. Measures of disability improved in both groups for the categories of self-care, mobility, and social function. A larger, more homogeneous sample would likely show significant group differences in measures of muscle spasticity, gross motor function and disability.

Less attention is paid to joint reactions when optimization tasks are solved aiming to predict individual muscle forces driving a biomechanical model. The reactions are important, however, for joint stability and for prevention from injuries, especially for fast motions and submaximal loading. The purpose of the paper is to investigate the influence of the joint reaction as a criterion in an objective function and to study the possibilities for prediction of antagonistic co-contraction. Planar elbow flexions in the sagittal plane with duration from 0.4 to 2 s are simulated, and muscle forces and elbow joint reaction are calculated solving numerically optimization tasks formulated for models with one (elbow moment equation only) and two (elbow and shoulder moment equations) degrees of freedom (DOF). The objective function is a weighted sum of muscle forces and joint reaction raised to different powers. The following conclusions can be made: (1) if the joint reaction is included in the objective function, antagonistic co-contraction can be predicted even for 1 DOF model; in some situations the use of such objective function can destroy the synergistic muscles' action; (2) the prediction of antagonistic muscles' co-contraction for 2 DOF model depends on the way the biarticular muscles are modeled, and this is valid for both dynamic and quasistatic conditions; if there are no biarticular muscles, antagonistic co-contraction cannot be predicted in one joint using popular objective functions, like minimum of sum of muscle forces or muscle stresses raised to a power.

Background: This pilot study aimed to assess quantitative differences between normal and steppage gait by analyzing force plate data. Materials and Methods: We studied 25 subjects with drop foot, who were treated in the orthopedic center for drop foot brace. Twenty healthy students were included as a control group. There were no differences in the age, weight, height, and body mass index between the patients and the controls (p > 0.05). They walked at self-selected speed with a mean of 10 trials (+2) to collect their ground reaction forces data by force plate. Results: There were no significant differences between the groups in antero-posterior component of ground reaction force (p > 0.05). There was significant relationship between the time parameters in vertical and medio-lateral components of ground reaction forces (p < 0.05). We have found that the medio-lateral impulse in the patients group is negative (p < 0.05), which means instability in patients' gait. Conclusion: The result of this research reveals that the analysis of ground reaction force quantitatively describes steppage gait. The average stance time among patients is longer than control group. Further work with a larger database of subjects is required to confirm our findings.

Background and aims: To study possible interrelations of clinical and functional parameters with ultrasonographic findings of shoulders of hemiplegic stroke patients. This would assist in determining the need for a possible ultrasound evaluation of hemiplegic shoulders. Methods: Prospective case series were studied in the Department of Geriatric Medicine and Rehabilitation, at a university-affiliated referral hospital. We studied a total of 26 consecutive stroke patients with hemiplegic shoulders undergoing a standard rehabilitation course. Hemiplegic shoulders were studied by ultrasound and scored for the number of pathological (positive) findings. Shoulder scores were correlated with various clinical and functional parameters (Ashworth score, Fugl-Meyer score, Functional Independence Measure) as non-dependent variables. Results: No correlation was found between any of the parameters we have studied and the ultrasonographic score, except for shoulder pain (p = 0.012). A regression analysis documented painful shoulder (p = 0.002) and spasticity (p = 0.039) as significantly associated with higher ultrasonographic scores. Conclusions: Ultrasound investigation of hemiplegic upper extremities does not interrelate with any of the parameters associated with rehabilitation outcome and should be reserved for those suffering painful and spastic hemiplegic shoulders.