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We report on our first experience with ultrasonography in soft tissue lesions. The normal and pathological anatomy of the shoulder joint, knee joint, achilles tendon and muscle is demonstrated. The technical equipment of real-time sonography is demonstrated.
Rodent models are being extensively used to investigate the effects of traumatic injury and develop and assess the mechanisms of repair and regeneration. We present quantitative assessment of two-dimensional (2D) kinematics of overground walking and for the first time three-dimensional (3D) joint angle kinematics of all four limbs during treadmill walking in intact adult female Long-Evans rats. Gait cycle with subphases and intralimb and interlimb cyclograms are presented. Phase relationships between joint angles on a cycle-by-cycle basis and interlimb footfalls are assessed using a simple technique. Electromyogram (EMG) data from major flexor and extensor muscles for each of the hindlimb joints and elbow extensor muscles of the forelimbs synchronized to the 3D kinematics are also obtained. Overground walking kinematics, provides information on base of support, stride length, and hindfoot rotation. Treadmill walking kinematics indicate primarily monophasic angle trajectories for the hip and shoulder joints, weak double peak patterns for the knee and elbow joints, and a prominent double peak pattern for the ankle joints. Maximum flexion of the knee during swing precedes that of the ankle, which precedes that of the hip. A mild exercise regimen over 8 weeks does not alter the kinematics. EMG activity indicates specific relationships of the neural activity to joint angle kinematics. We find that the ankle flexors as well as the hip and elbow extensors maintain constant burst duration with changing cycle duration. Data and techniques described here are likely to be useful for quantitative assessment of altered gait and neural control mechanisms after neurotrauma.
Numerical analysis of (99)Tcm polyphosphate distribution in 1 348 selected, non-pathologic joint pairs revealed a significantly higher right-sided accumulation in 37 per cent, a left-sided dominance in 21 per cent and no significant side difference in the remaining 42 per cent. The most common level of asymmetry was the shoulder joint.
Two kinds of friction tests were conducted to investigate the lubricating effect of the injection of amphiphilies on the osteoarthritic joint. The effects of the addition of L alpha-dipalmitoyl phosphatidyl-choline (L alpha-DPPC) riposomes and gamma-globulin in a saline solution of sodium hyaluronate (HA) were evaluated through pendulum friction tests. The frictional characteristics of pig shoulder joints were confirmed to depend on the viscosity of the lubricants only in the physiologically low load condition and in the condition immediately after loading. Detergent (polyoxyethylene p-t-octylphenyl ether) was successfully used to remove adsorbed films from the articular surfaces. The friction coefficient of natural synovial joints was significantly increased in a mode of mixed lubrication with the HA solution of 0.2 g/dl by the treatment of the surface with the detergent. The addition of L alpha-DPPC riposomes or gamma-globulin significantly improved the boundary lubricating ability of the articular surfaces treated with the detergent, depending on the quantity of those additives. It appears that the L alpha-DPPC riposomes and gamma-globulin can form protective films on the articular surfaces like a biomembrane. Moreover, the reciprocating frictional behaviour in sliding pairs of pig articular cartilages and glass plates was studied in order to elucidate the tribological role of those constituents in the boundary lubricating film on the articular surface. Pig synovial fluid and water solutions of HA were used as lubricants. The synovial fluid had superior lubricating ability compared to the HA solution of equivalent viscosity under a physiologically high load condition. This fact seems to be responsible for the boundary lubricating ability of constituents other than hyaluronic acid. Langmuir-Blodgett (LB) films of L alpha-DPPC on the glass plate were kept at a low and stable friction coefficient, depending on the number of film layers. In conditions of mixed films with L alpha-DPPC and gamma-globulin, the frictional behaviour was improved by increasing the quantity of gamma-globulin. A model is proposed in which the effective adsorbed films are composed of proteins, phospholipids and other conjugated constituents on the articular surfaces to be accurate in describing the boundary lubricating mechanism. The mechanism is controlled by hydrophobic groups in those amphiphilies.
AIM: To evaluate brachial biceps tendon lesions in four young female tennis players who complained about anterior shoulder pain on their dominant side. METHODS: Medical and sport's activity history, palpation of the painful zone, Ghilchrist (palm-up) test, and brachial biceps contraction against resistance were performed. RESULTS: The two girls who suffered from mild tenderness in the bicipital groove and over the anterior aspect of the upper arm and the shoulder joint, had tendinitis of the long biceps head. The two girls who suffered from severe tenderness just under the groove, had a partial tear in the long head of the biceps. Ghilchrist test was positive in all girls. CONCLUSION: Tennis players can have shoulder pain without clear history of trauma. Pain occurred probably as a result of technical errors or use of inadequate equipment.
Strengthening exercises during treatment of patients with unstable lumbar fractures produce a kyphotic or lordotic sagittal movement in the lumbar spine. These movements have been measured roentgenologically. Forward flexion exercises in the shoulder joints to 45 degrees produced a kyphotic movement, while forward flexion to 110 degrees and abduction exercises to 90 degrees produced a lordotic movement. Flexion of hips and knees to 45 degrees produced a kyphotic movement adding to the movements caused by the shoulder exercises. Increasing the load on the upper extremities produced an increase of all movements.
STUDY DESIGN: Prospective cohort study. OBJECTIVES: To study upper extremity musculoskeletal pain during and after rehabilitation in wheelchair-using subjects with a spinal cord injury (SCI) and its relation with lesion characteristics, muscle strength and functional outcome. SETTING: Eight rehabilitation centers with an SCI unit in the Netherlands. METHODS: Using a questionnaire, number, frequency and seriousness of musculoskeletal pain complaints of the upper extremity were measured. A pain score for the wrist, elbow and shoulder joints was calculated by multiplying the seriousness by the frequency of pain complaints. An overall score was obtained by adding the scores of the three joints of both upper extremities. Muscle strength was determined by manual muscle testing. The motor score of the functional independence measure provided a functional outcome. All outcomes were obtained at four test occasions during and 1 year after rehabilitation. RESULTS: Upper extremity pain and shoulder pain decreased over time (30%) during the latter part of in-patient rehabilitation (P<0.001). Subjects with tetraplegia (TP) showed more musculoskeletal pain than subjects with paraplegia (PP) (P<0.001). Upper extremity pain and shoulder pain were significantly inversely related to functional outcome (P<0.001). Muscle strength was significantly inversely related to shoulder pain (P<0.001). Musculoskeletal pain at the beginning of rehabilitation and BMI were strong predictors for pain 1 year after in-patient rehabilitation (P<0.001). CONCLUSIONS: Subjects with TP are at a higher risk for upper extremity musculoskeletal pain and for shoulder pain than subjects with PP. Higher muscle strength and higher functional outcome are related to fewer upper extremity complaints.
PURPOSE: To broaden our understanding of muscle function during the tennis volley under different ball placement and speed conditions by examining the activity of selected superficial muscles of the stroking arm and shoulder (flexor carpi radialis, extensor carpi radialis, triceps brachii, deltoids, and pectoralis major) and muscles related to postural support (left and right external oblique, lumbar erector spinae, and gastrocnemius) during the volley. METHODS: Seven skilled tennis players were asked to perform volley strokes under 18 experimental conditions, including variations in lateral contact location (forehand and backhand), ball contact height (high, middle, and low), and ball speed (fast, medium, and slow). A ball machine was modified so that the subjects could not predict the ball trajectory before it was released from the machine. Muscle activity was determined using surface electromyographic (EMG) techniques, and the critical instants of a volley were determined using two force platforms and two high-speed (120 Hz) video cameras. Average EMG values for different phases of the volley, defined by the critical instants, were computed. RESULTS AND CONCLUSIONS: In general, muscle activity increased with increasing ball speed. The extensor carpi radialis was more active than the flexor carpi radialis during both forehand and backhand volleys, suggesting the importance of wrist extension/abduction and grip strength. The increase in EMG levels in the forearm muscles shortly before the ball impact indicated that the subjects did not tighten their grip and wrist until moments before ball impact. Both antero-middle and postero-middle deltoids were active in most stroke phases. However, the roles of the deltoid muscles during a volley cannot be determined without knowing the actions of the other shoulder joint muscles.
We have used a three-dimensional X-ray cinematographic approach to investigate the kinematics of the forelimb during target reaching and food taking in five cats. Measurements of the trajectory of the limb during the reaching movement showed that the movement paths of the metacarpophalangeal joint (MCP) and the wrist were sigmoidal with a long nearly linear segment. The elbow followed a bent movement path with maximal inflection in the middle. The path of the humerus had an ascending parabola-like characteristic. The velocity profiles of the MCP and wrist were nearly bell-shaped and skewed to the left, whereas the profiles of the elbow joint were more or less double peaked with the second peak occurring 60-40 ms before object contact. Several different velocity peaks reflecting specific aspects of the task existed when the bell-shaped velocity profiles were divided in their vectorial components. Angular motion of the elbow consisted of a flexion-extension sequence during the reach and a flexion during the subsequent retraction. After an initial flexion during lift-off the wrist was extended. It kept this extended position during orienting towards the food container. During the retraction phase it was further extended. The angle between the wrist axis and the parasagittal plane changed during the movement. It first increased, then decreased during the last 100 ms before the object was reached. During the retraction it increased again to support the object weight against gravity. The position of the wrist was established by radio-ulnar supination and movements of the whole arm around the shoulder joint. We hypothesize that the position of the wrist axis is the controlled variable during protraction and retraction, regardless of whether it is achieved by radio-ulnar supination or by movements around the shoulder.
Quadrupedal locomotion of squirrel monkeys on small-diameter support was analyzed kinematically and kinetically to specify the timing between limb movements and substrate reaction forces. Limb kinematics was studied cineradiographically, and substrate reaction forces were synchronously recorded. Squirrel monkeys resemble most other quadrupedal primates in that they utilize a diagonal sequence/diagonal couplets gait when walking on small branches. This gait pattern and the ratio between limb length and trunk length influence limb kinematics. Proximal pivots of forelimbs and hindlimbs are on the same horizontal plane, thus giving both limbs the same functional length. However, the hindlimbs are anatomically longer than the forelimbs. Therefore, hindlimb joints must be more strongly flexed during the step cycle compared to the forelimb joints. Because the timing of ipsilateral limb movements prevents an increasing amount of forelimb retraction, the forelimb must be more protracted during the initial stance phase. At this posture, gravity acts with long moment arms at proximal forelimb joints. Squirrel monkeys support most of their weight on their hindlimbs. The timing of limb movements and substrate reaction forces shows that the shift of support to the hindlimbs is mainly done to reduce the compressive load on the forelimb. The hypothesis of the posterior weight shift as a dynamic strategy to reduce load on forelimbs, proposed by Reynolds ([1985]) Am. J. Phys. Anthropol. 67:335-349; [1985] Am. J. Phys. Anthropol. 67:351-362), is supported by the high correlation of ratios between forelimb and hindlimb peak vertical forces and the range of motion of shoulder joint and scapula in primates.
A 62-year-old woman developed eosinophilic cellulitis of her right arm, accompanied by systemic signs (fever, leucocytosis) and massive restriction of the motility of her right shoulder joint. Sonography and computed tomography revealed massive cutaneous and subcutaneous oedema, and accumulations of fluid around the deep muscular fasciae, interstices and (less severe) within the joint. High-dose systemic corticosteroid treatment led to rapid clearing of the skin lesions, and joint motility was restored several weeks later. This is the first case of eosinophilic cellulitis in which involvement of deep structures adjacent to joints has been demonstrated by modern imaging techniques.
A case report of a rare, traumatic dislocation of the shoulder joint in a newborn infant, unassociated with fracture or neurologic cause, is presented, along with the unfortunate result obtained.
There has been carried out an analysis of treatment of 134 patients with habitual shoulder-slips according to 4 known methods and I proposed by the authors. There has been detected a number of typical defects, made by doctors in the process of treatment during acute period. The essence of the proposed method consists in strengthening by lavsan bandage "North-CITO" of the anterior part of the shoulder joint that allows to begin early restorative treatment.
The radiation exposure during biomechanical investigation of the shoulder joint done with a digital radiography system (Polytron 1000 VR - Siemens) was measured experimentally. Total radiation dose and surface dose were determined by phantom measurements. The radiation exposure per image is about 1/6 to 1/7 of that of a conventional study. The digital radiography system used is thus suitable for kinesiologic studies of large joints in healthy volunteers.
Various methods of radiological investigation of recurrent dislocation or subluxation of the shoulder are described and their merits compared. Magnetic resonance imaging is expensive and its role not yet well established in the evaluation of shoulder instability. Double contrast arthrography still provides an adequate examination of the shoulder joint. If the glenoid labrum needs to be better defined, this procedure should be followed by computerised tomography.
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STUDY DESIGN: Cross-over study. OBJECTIVE: To determine the effect of strenuous wheelchair exercise on oxygen uptake (VO2 ), muscle activity and propulsion cycle timing (including the push time and recovery time during one full arm cycle). SETTING: Laboratory of Sport Sciences at the University of France-Comte in France. METHODS: Two exercise bouts of 6-min duration were performed at a constant workload: (1) non-fatigable exercise (moderate workload) and (2) fatigable exercise (heavy workload). Measurement of VO2, surface electromyographic activity (EMG) from shoulder muscles, and temporal parameters of wheelchair ergometer propulsion were collected from eight able-bodied men (26+/-4 years). RESULTS: A progressive increase in VO2 associated with EMG alterations (P<0.05), and a decrease of the cycle and recovery time (P<0.05) during the heavy exercise. Whereas the push time remained constant, an increased muscle activation time (P<0.05) was found during heavy exercise. CONCLUSION: Observations during wheelchair ergometry indicate the development of fatigue and inefficient muscle coordination, which may contribute to deleterious stress distributions at the shoulder joint, increasing susceptibility to injury.