This study evaluated changes in manual wheelchair skills after reconstructive hand and arm surgery in 16 people with tetraplegia. Key findings:
- 68% of participants improved their wheelchair maneuvering abilities after surgery on average 12 months later.
- Improvements were seen in tests of static pushing, sprinting 25 meters, navigating a figure-8 course, and lifting buttocks from the chair.
- Some participants were able to perform tests post-surgery that were impossible before, such as navigating obstacles or pushing uphill.
- Gains varied by the type of reconstruction and level of spinal cord injury, with most improvement seen in grip reconstruction patients.
This study investigated the clinical outcomes and biomechanics of bi-unicondylar arthroplasty (Bi-UKA) compared to total knee arthroplasty (TKA) and healthy controls through three approaches:
1) Gait analysis found that Bi-UKA patients walked faster and with longer strides than TKA patients, exhibiting closer to normal gait patterns.
2) Patient-reported outcomes showed higher Oxford Knee Scores and quality of life scores for Bi-UKA patients compared to TKA patients.
3) A cadaveric study found that Bi-UKA preserved extensor efficiency of the knee better than TKA, particularly during gait.
The document compares two surgical techniques - the Arciero and LaPrade reconstructions - for repairing injuries to the posterolateral corner (PLC) of the knee. A biomechanical study on cadaver knees found that both techniques successfully restored stability to the PLC and neither technique performed significantly better. Additionally, subsequent damage to the tibiofibular ligament or anterior cruciate ligament did not cause a significant difference in stability between the two reconstruction methods. The study concludes that surgeons can choose either technique without concern for differences in surgical outcomes.
1. The study examined the effect of meniscus removal on anterior cruciate ligament (ACL)-deficient knee laxity using a navigation system.
2. It found that patients who underwent partial or total removal of the medial meniscus had significantly greater anterior tibial translation during Lachman and drawer tests, compared to patients with an isolated ACL injury.
3. Under pivot shift testing, all groups showed similar results except for anterior displacement, which was significantly greater in patients who underwent a meniscectomy.
Dr. Calvin Johnson is an orthopedic surgeon who specializes in knee and shoulder surgery as well as sports medicine. He completed his medical school, residency, and fellowships at the University of Oklahoma. The document discusses the anterolateral ligament of the knee and provides evidence for reconstructing the ALL in certain cases, such as primary ACL reconstruction with selected indications, a high-grade pivot shift, high-risk athletes, or hyperlaxity. It explains how injury to the ALL can cause the pivot shift to worsen over time after an untreated ACL tear and discusses the nature of a Segond fracture.
Design criteria for a Total Knee prosthesis for the Indian populationL Prakash
Life expectancy is increasing, Patients are becoming more obese, increasing the demands on the implants, Replacements done 20 years or earlier are all coming back for revision and We have too many choices for implants and thus often make wrong choices. Indian knees are anatomically different from Caucasean counterparts. As squatters, our hips are often spared the ordeal of primary OA, which we well compensate by the high incidence of OA knees. The demands and expectations of our patients differ considerably from their western counterparts
This paper is an attempt to address these problems
The document discusses the anterolateral ligament (ALL) of the knee and its role in rotational stability. While ACL reconstruction can restore anterior-posterior stability, it does not fully restore rotational control. The ALL is found in 97% of knees and acts as an internal rotatory stabilizer. Injury to the ALL can explain residual pivot shift seen after ACL reconstruction and why the pivot shift gets worse over time in ACL-deficient knees. Modified Lemaire's procedure, which adds an extra-articular tendon graft to ACL reconstruction, may help reduce rotational instability and graft failures by restoring the ALL.
This study investigated the clinical outcomes and biomechanics of bi-unicondylar arthroplasty (Bi-UKA) compared to total knee arthroplasty (TKA) and healthy controls through three approaches:
1) Gait analysis found that Bi-UKA patients walked faster and with longer strides than TKA patients, exhibiting closer to normal gait patterns.
2) Patient-reported outcomes showed higher Oxford Knee Scores and quality of life scores for Bi-UKA patients compared to TKA patients.
3) A cadaveric study found that Bi-UKA preserved extensor efficiency of the knee better than TKA, particularly during gait.
The document compares two surgical techniques - the Arciero and LaPrade reconstructions - for repairing injuries to the posterolateral corner (PLC) of the knee. A biomechanical study on cadaver knees found that both techniques successfully restored stability to the PLC and neither technique performed significantly better. Additionally, subsequent damage to the tibiofibular ligament or anterior cruciate ligament did not cause a significant difference in stability between the two reconstruction methods. The study concludes that surgeons can choose either technique without concern for differences in surgical outcomes.
1. The study examined the effect of meniscus removal on anterior cruciate ligament (ACL)-deficient knee laxity using a navigation system.
2. It found that patients who underwent partial or total removal of the medial meniscus had significantly greater anterior tibial translation during Lachman and drawer tests, compared to patients with an isolated ACL injury.
3. Under pivot shift testing, all groups showed similar results except for anterior displacement, which was significantly greater in patients who underwent a meniscectomy.
Dr. Calvin Johnson is an orthopedic surgeon who specializes in knee and shoulder surgery as well as sports medicine. He completed his medical school, residency, and fellowships at the University of Oklahoma. The document discusses the anterolateral ligament of the knee and provides evidence for reconstructing the ALL in certain cases, such as primary ACL reconstruction with selected indications, a high-grade pivot shift, high-risk athletes, or hyperlaxity. It explains how injury to the ALL can cause the pivot shift to worsen over time after an untreated ACL tear and discusses the nature of a Segond fracture.
Design criteria for a Total Knee prosthesis for the Indian populationL Prakash
Life expectancy is increasing, Patients are becoming more obese, increasing the demands on the implants, Replacements done 20 years or earlier are all coming back for revision and We have too many choices for implants and thus often make wrong choices. Indian knees are anatomically different from Caucasean counterparts. As squatters, our hips are often spared the ordeal of primary OA, which we well compensate by the high incidence of OA knees. The demands and expectations of our patients differ considerably from their western counterparts
This paper is an attempt to address these problems
The document discusses the anterolateral ligament (ALL) of the knee and its role in rotational stability. While ACL reconstruction can restore anterior-posterior stability, it does not fully restore rotational control. The ALL is found in 97% of knees and acts as an internal rotatory stabilizer. Injury to the ALL can explain residual pivot shift seen after ACL reconstruction and why the pivot shift gets worse over time in ACL-deficient knees. Modified Lemaire's procedure, which adds an extra-articular tendon graft to ACL reconstruction, may help reduce rotational instability and graft failures by restoring the ALL.
Presentation on the Anterolateral Ligament (ALL) with information on diagnosis with ultrasound and treatment using an ultrasound guided, percutaneous, reconstruction and an internal brace
Short Term Analysis of Clinical, Functional Radiological Outcome of Total Kne...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
The document discusses the use of surgical landmarks in revision total knee arthroplasty (TKA). It outlines several important landmarks including the femoral epicondyles, fibular head, tibial tubercle, inferior pole of patella, and adductor tubercle. The adductor tubercle distance to femoral width ratio of 0.52 is identified as the most accurate and reliable landmark for determining joint line position. The landmarks can be used for preoperative planning, proper surgical exposure, component removal, establishing a stable tibial platform, and re-establishing the correct joint line position during revision TKA.
1) The study compared the biomechanical rigidity of cadaveric cervical spines instrumented with posterior instrumentation alone versus combined posterior and anterior instrumentation following C4-C6 laminectomy.
2) Laminectomy alone did not significantly increase motion compared to the intact spine. Both posterior instrumentation and combined posterior-anterior instrumentation reduced motion compared to laminectomy.
3) Posterior instrumentation alone provided equivalent rigidity to the spine as combined posterior-anterior instrumentation, with no significant differences in motion between the two instrumentation techniques.
Assessment of Femoral Tunnel Placement in ACL ReconstructionJeremy Burnham
This study reviews the literature on tunnel placement in anterior cruciate ligament reconstruction, and assess the ability of experienced physicians and surgeons to evaluate the tunnel position using x-rays.
MRI Study of Anterolateral Ligament and Its Association with Knee Injury-Dr. ...TheRightDoctors
This study used 161 knee MRI scans to examine the anterolateral ligament (ALL) and its association with knee injuries. The ALL was clearly visible on all scans using specific imaging sequences. 21% of scans showed a torn ALL. Of those with a torn ACL, 40% also had a torn ALL, suggesting the two ligaments may work together to stabilize the knee. While the ALL's role requires more research, this study demonstrated the ALL can be identified on MRI and may be involved in controlling internal knee rotation and the pivot shift mechanism.
Comparison of 3 d shoulder complex kinematic part 1Satoshi Kajiyama
This study compared shoulder complex kinematics between individuals with and without shoulder pain. Transcortical bone pins were inserted into the clavicle, scapula, and humerus of 12 asymptomatic and 10 symptomatic individuals. Angular positions of the sternoclavicular, acromioclavicular, and scapulothoracic joints were measured during shoulder motions. Differences were found between groups for sternoclavicular and scapulothoracic joint positions, with symptomatic individuals demonstrating less sternoclavicular posterior rotation and scapulothoracic upward rotation. However, the magnitude of differences was small and clinical implications are not fully understood.
The six minute walk test for patients with lumbar spinal stenosisYoshiyuki Imoo
This study evaluated the validity of the 6-minute walk test (6MWT) for patients with lumbar spinal stenosis (LSS) by examining its correlation with a self-report questionnaire called the Zurich Claudication Questionnaire (ZCQ). Patients underwent the 6MWT and completed the ZCQ before and after LSS surgery. There were significant improvements in ZCQ scores and 6MWT parameters after surgery. The 6MWT parameters showed weak correlations with ZCQ subscales both before and after surgery, indicating the 6MWT has some criterion validity for evaluating walking ability in LSS patients, though it may measure different aspects than the ZCQ physical function scale.
This study evaluated replacing the lateral scapula (LS) projection with a modified trauma axial (MTA) projection in the routine radiographic examination of acute shoulder injuries. A retrospective analysis of 244 shoulder examinations found that an anteroposterior (AP) view paired with an MTA projection identified 33 more traumatic abnormalities than an AP view paired with an LS projection. The MTA projection more clearly showed injuries like Hill-Sachs lesions, glenoid fractures, and fractures of the greater tuberosity. Additionally, the MTA projection had a lower estimated radiation dose than the LS projection. Therefore, the study recommends that the routine acute shoulder examination should include only AP and MTA projections.
This document summarizes a study that aims to evaluate knee stability following injury and reconstruction of the anterolateral ligament (ALL). It introduces the pivot shift test, a common method used to examine ACL stability by inducing internal rotation and a valgus force on the extended knee. The study seeks to determine the importance of the deep fibers of the iliotibial band as they relate to combined anterior tibial translation and internal rotation during a pivot shift test. It also aims to clarify the roles of the deep iliotibial band fibers and ALL in relation to the ACL and their overall contribution to knee stability. The study method involves using metal clamps and instrumentation to reproduce the strain of a pivot shift test on
The document discusses the advantages and disadvantages of posterior stabilized (PS) and posterior cruciate retaining (PCR) total knee arthroplasty designs. PS designs offer better range of motion and are easier for deformity cases but require tight gaps and alignment. They may have increased wear from the spine/cam articulation. PCR designs have less exaggerated knee motions and translation but less range of motion. Mobile bearing designs and patient factors should be considered when choosing between PS and PCR.
Biomechanical Properties of the AnteroLateral Ligament (ALL) of the Knee comp...KHALIFA ELMAJRI
This document discusses a study comparing the biomechanical properties of the anterolateral ligament (ALL) and iliotibial tract (ITT) of the knee. Testing of ALL and ITT specimens harvested from cadavers found that the ITT is about 10 times more resistant and slightly more viscous than the ALL under 5% strain. The ITT is also about 6 times more resistant to large deformations and fails at lower strains and higher stresses compared to the ALL. The study helps address gaps in understanding the mechanical properties of these ligaments, but comparisons are limited by controversies around anatomical definitions and the effects of preservation methods.
Background:
The anterolateral ligament (ALL) is a true well-defined ligament in the knee first described in 1879 by Segond. After the work of Claes et al., several studies were conducted about biomechanics and its role in stability of the knee. The anatomical existence of the ALL has been studied by and various radiographic diagnostic modalities and in cadavers. It originates from lateral femoral epicondyle and is inserted between Gerdy’s tubercle and the fibular head. There has been controversy about the existence of ALL in pediatric patients. The aim of this work was to confirm the presence of ALL in pediatric patients by using MRI.
Materials and Methods:
We reviewed the knee MRI scans of 100 pediatric patients (ages between one and 12 yr) who had no knee injury or congenital deformity and had been evaluated by an expert radiologist.
Results:
The ALL was detected in 90% of the pediatric patients with the use of MRI.
Conclusions:
The main finding of this study was that ALL can be seen in pediatric patients using MRI. Despite numerous studies, additional research is needed to further define the role of the ALL in knee function.
Level of Evidence:
Level IV.
Isokitenic 2015: Clinical Practice Guidelines for Muscle Injury FC Barcelona...MuscleTech Network
Presentation at: 'Football Medicine Strategies for Player Care', XXIV International Conference on Sports Rehabilitation and Traumatology, 11th- 12th April, 2015- London
Scapular positioning and motor control in children and adults a laboratory st...lichugojavier
1) The study compared clinical measures of scapular positioning and motor control between adults (n=46) and children (n=59).
2) It found that children had significantly greater scapular upward rotation but smaller forward shoulder posture than adults when controlling for height.
3) The study also found no significant differences between children and adults in visual observation of scapular tilting or winging, or on the Kinetic Medial Rotation Test, a measure of scapular motor control. The results provide reference values for interpreting clinical tests of the scapula in adults and children.
This document provides information on acromioclavicular (AC) joint injuries. It discusses the anatomy and biomechanics of the AC joint. It also outlines the epidemiology, mechanisms of injury, clinical evaluation, classification systems and treatment options for different grades of AC joint separation. For acute injuries under 4 weeks, treatment options discussed include conservative management or surgical stabilization techniques like hook plates, tightropes or ligament reconstruction. For chronic injuries, options include AC joint excision or reconstruction of the coracoclavicular ligaments.
663229 - Reliability of Power Output in Single Leg Counter Movement Jump in E...Sergio Gaggioni
This document summarizes a study that assessed the reliability of using single leg countermovement jumps (CMJs) to measure power output in elite rugby players. Twenty professional rugby players performed 3 maximal single leg CMJs with each leg. Power output was measured using a force platform. Results showed excellent reliability for power output measurements between jumps, with intraclass correlation coefficients of 0.963-0.974 for left and right legs. Power output was similarly reliable when comparing forwards and backs, suggesting single leg CMJs could reliably measure limb asymmetries and be used to assess an athlete's readiness to return to play following injury. However, further research is needed to address limitations like jumping form.
This document summarizes a study on AC joint separations and associated intra-articular shoulder pathology. The study reviewed 18 patients with AC separations requiring repair and found that 61% had some form of intra-articular pathology like SLAP tears, partial RCT tears, or full RCT tears. The conclusion is that AC separations have a high rate of concurrent intra-articular injuries, so MRI or arthroscopy before AC joint repair is recommended to identify any additional pathology.
This 3-day workshop provides sessions on spinal cord injury (SCI) physiotherapy management for physiotherapists. The first day covers topics relevant to the entire multidisciplinary SCI team. The second and third days focus on physiotherapy, with over 20 sessions led by international experts on topics like upper extremity training, respiratory management, and outcome measures. Sessions cater for novice therapists new to SCI as well as experienced therapists. The workshop costs $25 and takes place in Delhi, India, during the ISCoS conference in November 2010.
Presentation on the Anterolateral Ligament (ALL) with information on diagnosis with ultrasound and treatment using an ultrasound guided, percutaneous, reconstruction and an internal brace
Short Term Analysis of Clinical, Functional Radiological Outcome of Total Kne...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
The document discusses the use of surgical landmarks in revision total knee arthroplasty (TKA). It outlines several important landmarks including the femoral epicondyles, fibular head, tibial tubercle, inferior pole of patella, and adductor tubercle. The adductor tubercle distance to femoral width ratio of 0.52 is identified as the most accurate and reliable landmark for determining joint line position. The landmarks can be used for preoperative planning, proper surgical exposure, component removal, establishing a stable tibial platform, and re-establishing the correct joint line position during revision TKA.
1) The study compared the biomechanical rigidity of cadaveric cervical spines instrumented with posterior instrumentation alone versus combined posterior and anterior instrumentation following C4-C6 laminectomy.
2) Laminectomy alone did not significantly increase motion compared to the intact spine. Both posterior instrumentation and combined posterior-anterior instrumentation reduced motion compared to laminectomy.
3) Posterior instrumentation alone provided equivalent rigidity to the spine as combined posterior-anterior instrumentation, with no significant differences in motion between the two instrumentation techniques.
Assessment of Femoral Tunnel Placement in ACL ReconstructionJeremy Burnham
This study reviews the literature on tunnel placement in anterior cruciate ligament reconstruction, and assess the ability of experienced physicians and surgeons to evaluate the tunnel position using x-rays.
MRI Study of Anterolateral Ligament and Its Association with Knee Injury-Dr. ...TheRightDoctors
This study used 161 knee MRI scans to examine the anterolateral ligament (ALL) and its association with knee injuries. The ALL was clearly visible on all scans using specific imaging sequences. 21% of scans showed a torn ALL. Of those with a torn ACL, 40% also had a torn ALL, suggesting the two ligaments may work together to stabilize the knee. While the ALL's role requires more research, this study demonstrated the ALL can be identified on MRI and may be involved in controlling internal knee rotation and the pivot shift mechanism.
Comparison of 3 d shoulder complex kinematic part 1Satoshi Kajiyama
This study compared shoulder complex kinematics between individuals with and without shoulder pain. Transcortical bone pins were inserted into the clavicle, scapula, and humerus of 12 asymptomatic and 10 symptomatic individuals. Angular positions of the sternoclavicular, acromioclavicular, and scapulothoracic joints were measured during shoulder motions. Differences were found between groups for sternoclavicular and scapulothoracic joint positions, with symptomatic individuals demonstrating less sternoclavicular posterior rotation and scapulothoracic upward rotation. However, the magnitude of differences was small and clinical implications are not fully understood.
The six minute walk test for patients with lumbar spinal stenosisYoshiyuki Imoo
This study evaluated the validity of the 6-minute walk test (6MWT) for patients with lumbar spinal stenosis (LSS) by examining its correlation with a self-report questionnaire called the Zurich Claudication Questionnaire (ZCQ). Patients underwent the 6MWT and completed the ZCQ before and after LSS surgery. There were significant improvements in ZCQ scores and 6MWT parameters after surgery. The 6MWT parameters showed weak correlations with ZCQ subscales both before and after surgery, indicating the 6MWT has some criterion validity for evaluating walking ability in LSS patients, though it may measure different aspects than the ZCQ physical function scale.
This study evaluated replacing the lateral scapula (LS) projection with a modified trauma axial (MTA) projection in the routine radiographic examination of acute shoulder injuries. A retrospective analysis of 244 shoulder examinations found that an anteroposterior (AP) view paired with an MTA projection identified 33 more traumatic abnormalities than an AP view paired with an LS projection. The MTA projection more clearly showed injuries like Hill-Sachs lesions, glenoid fractures, and fractures of the greater tuberosity. Additionally, the MTA projection had a lower estimated radiation dose than the LS projection. Therefore, the study recommends that the routine acute shoulder examination should include only AP and MTA projections.
This document summarizes a study that aims to evaluate knee stability following injury and reconstruction of the anterolateral ligament (ALL). It introduces the pivot shift test, a common method used to examine ACL stability by inducing internal rotation and a valgus force on the extended knee. The study seeks to determine the importance of the deep fibers of the iliotibial band as they relate to combined anterior tibial translation and internal rotation during a pivot shift test. It also aims to clarify the roles of the deep iliotibial band fibers and ALL in relation to the ACL and their overall contribution to knee stability. The study method involves using metal clamps and instrumentation to reproduce the strain of a pivot shift test on
The document discusses the advantages and disadvantages of posterior stabilized (PS) and posterior cruciate retaining (PCR) total knee arthroplasty designs. PS designs offer better range of motion and are easier for deformity cases but require tight gaps and alignment. They may have increased wear from the spine/cam articulation. PCR designs have less exaggerated knee motions and translation but less range of motion. Mobile bearing designs and patient factors should be considered when choosing between PS and PCR.
Biomechanical Properties of the AnteroLateral Ligament (ALL) of the Knee comp...KHALIFA ELMAJRI
This document discusses a study comparing the biomechanical properties of the anterolateral ligament (ALL) and iliotibial tract (ITT) of the knee. Testing of ALL and ITT specimens harvested from cadavers found that the ITT is about 10 times more resistant and slightly more viscous than the ALL under 5% strain. The ITT is also about 6 times more resistant to large deformations and fails at lower strains and higher stresses compared to the ALL. The study helps address gaps in understanding the mechanical properties of these ligaments, but comparisons are limited by controversies around anatomical definitions and the effects of preservation methods.
Background:
The anterolateral ligament (ALL) is a true well-defined ligament in the knee first described in 1879 by Segond. After the work of Claes et al., several studies were conducted about biomechanics and its role in stability of the knee. The anatomical existence of the ALL has been studied by and various radiographic diagnostic modalities and in cadavers. It originates from lateral femoral epicondyle and is inserted between Gerdy’s tubercle and the fibular head. There has been controversy about the existence of ALL in pediatric patients. The aim of this work was to confirm the presence of ALL in pediatric patients by using MRI.
Materials and Methods:
We reviewed the knee MRI scans of 100 pediatric patients (ages between one and 12 yr) who had no knee injury or congenital deformity and had been evaluated by an expert radiologist.
Results:
The ALL was detected in 90% of the pediatric patients with the use of MRI.
Conclusions:
The main finding of this study was that ALL can be seen in pediatric patients using MRI. Despite numerous studies, additional research is needed to further define the role of the ALL in knee function.
Level of Evidence:
Level IV.
Isokitenic 2015: Clinical Practice Guidelines for Muscle Injury FC Barcelona...MuscleTech Network
Presentation at: 'Football Medicine Strategies for Player Care', XXIV International Conference on Sports Rehabilitation and Traumatology, 11th- 12th April, 2015- London
Scapular positioning and motor control in children and adults a laboratory st...lichugojavier
1) The study compared clinical measures of scapular positioning and motor control between adults (n=46) and children (n=59).
2) It found that children had significantly greater scapular upward rotation but smaller forward shoulder posture than adults when controlling for height.
3) The study also found no significant differences between children and adults in visual observation of scapular tilting or winging, or on the Kinetic Medial Rotation Test, a measure of scapular motor control. The results provide reference values for interpreting clinical tests of the scapula in adults and children.
This document provides information on acromioclavicular (AC) joint injuries. It discusses the anatomy and biomechanics of the AC joint. It also outlines the epidemiology, mechanisms of injury, clinical evaluation, classification systems and treatment options for different grades of AC joint separation. For acute injuries under 4 weeks, treatment options discussed include conservative management or surgical stabilization techniques like hook plates, tightropes or ligament reconstruction. For chronic injuries, options include AC joint excision or reconstruction of the coracoclavicular ligaments.
663229 - Reliability of Power Output in Single Leg Counter Movement Jump in E...Sergio Gaggioni
This document summarizes a study that assessed the reliability of using single leg countermovement jumps (CMJs) to measure power output in elite rugby players. Twenty professional rugby players performed 3 maximal single leg CMJs with each leg. Power output was measured using a force platform. Results showed excellent reliability for power output measurements between jumps, with intraclass correlation coefficients of 0.963-0.974 for left and right legs. Power output was similarly reliable when comparing forwards and backs, suggesting single leg CMJs could reliably measure limb asymmetries and be used to assess an athlete's readiness to return to play following injury. However, further research is needed to address limitations like jumping form.
This document summarizes a study on AC joint separations and associated intra-articular shoulder pathology. The study reviewed 18 patients with AC separations requiring repair and found that 61% had some form of intra-articular pathology like SLAP tears, partial RCT tears, or full RCT tears. The conclusion is that AC separations have a high rate of concurrent intra-articular injuries, so MRI or arthroscopy before AC joint repair is recommended to identify any additional pathology.
This 3-day workshop provides sessions on spinal cord injury (SCI) physiotherapy management for physiotherapists. The first day covers topics relevant to the entire multidisciplinary SCI team. The second and third days focus on physiotherapy, with over 20 sessions led by international experts on topics like upper extremity training, respiratory management, and outcome measures. Sessions cater for novice therapists new to SCI as well as experienced therapists. The workshop costs $25 and takes place in Delhi, India, during the ISCoS conference in November 2010.
This document announces a 2012 cadaver course on tendon transfers in reconstructive tetraplegia hand surgery held in Nottwil, Switzerland from April 9-12. The preliminary program outlines the daily schedule which includes lectures and hands-on sessions on topics like anatomy, suture techniques, and reconstruction of the elbow, thumb, fingers, and intrinsics. Participants will learn techniques at a medical training facility and hear about spasticity, rehabilitation, and clinical cases. The goal is to teach reconstructive surgery techniques to improve hand function for people with tetraplegia.
Jan Fridén and Simeon Grossmann are surgeons who specialize in restoring hand function to people with tetraplegia through delicate surgery. They connect muscles and tendons in the arm and hand in new configurations to allow paralyzed fingers and thumbs to move again. Over 210 consultations and 30 surgeries have been performed. The surgery aims to regain abilities like grasping objects and hand shaking to improve independence. Extensive rehabilitation is needed after surgery. The doctors work to expand international collaboration and training on this specialized technique.
This article discusses the pioneering contributions of Erik Moberg to the field of hand surgery. Moberg graduated from medical school in 1932 and began focusing on hand injuries in 1944 after being inspired by Dr. Bunnell's principles. He established the first hand surgery ward in Scandinavia in 1949. Moberg was passionate about teaching and wrote the influential book "Emergency Surgery of the Hand". He helped form the Nordic Hand Club in 1951, now called the Scandinavian Society for Surgery of the Hand. Moberg trained many surgeons in hand surgery and continued working to rehabilitate patients with tetraplegia later in his career. He is recognized for his focus on the importance of sensation in reconstructive hand
Dr. Ivan Justan from the Czech Republic was awarded the first FESSH fellowship in reconstructive hand surgery for tetraplegia patients. The 3-month fellowship took place from March to May 2009 at the Department of Hand Surgery at Sahlgrenska University Hospital in Gothenburg, Sweden. During this time, Dr. Justan received training on the history, diagnostics, classification systems, surgical techniques, rehabilitation programs, and research related to performing reconstructive hand surgery on tetraplegia patients.
This document lists various muscles in the arm and shoulder, their abbreviations, main actions, innervating nerves, and spinal root levels. It includes muscles that perform actions like external/internal rotation, abduction/adduction, flexion/extension of the arm, elbow, wrist and fingers. For each muscle the table provides concise information about its function and spinal nerve innervation.
ΣΥΝΔΕΣΜΟΠΛΑΣΤΙΚΗ ΠΡΟΣΘΙΟΥ ΧΙΑΣΤΟΥ ΣΥΝΔΕΣΜΟΥ ΜΕ ΜΟΝΗ ΔΕΣΜΗ ΣΕ ΑΝΑΤΟΜΙΚΗ ΘΕΣΗ. ...STAVROS ALEVROGIANNIS
(Παρουσίαση σε Διεθνές Συνέδριο Εταιρείας Αρθροσκόπησης & Χειρουργικής Γόνατος της Πολωνίας, POZNAN 2011).
FREE HAND NOVEL ANATOMIC SINGLE BAND TECHNIQUE FOR ACLR
(X/O BUTTON,CONMED,LINVATEC,USA).PRELIMINARY RESULTS.
(POZNAN 2011)
Results of Mini-Open Latarjet Procedure in Failed in Arthroscopic Bankart Rep...TheRightDoctors
The document summarizes a study on the mini-open Latarjet procedure for patients with failed arthroscopic Bankart repair for recurrent shoulder instability. 24 patients underwent the mini-open Latarjet procedure and were followed for a minimum of 2 years. Results found satisfactory range of motion, functional outcomes, and low recurrence rates. Complications were minor. The study concludes the mini-open Latarjet is an effective option for challenging cases of recurrent instability after failed soft tissue repair due to significant bone loss.
IRJET- Design and Fabrication of Wheelchair for Paraplegia PatientsIRJET Journal
This document describes the design and fabrication of a wheelchair for paraplegic patients. The wheelchair was designed to address several issues faced by paraplegic individuals, including difficulty transferring from the wheelchair unassisted, inability to stand independently, and hand burns from manual wheelchair propulsion. The designed wheelchair features include:
1. A divided wheel that can be locked or unlocked to facilitate independent transfers.
2. A freewheel mechanism and levers to allow for faster self-propulsion without hand burns.
3. A standing mechanism using a gas spring, brakes, and adjustable seat that enables independent standing without electronics.
The goal of the design is to give paraplegic individuals greater independence through a low
Management of OA knee by osteotomies around the knee.docxSanthosh Raj
1. Dr. Santhosh Raj BK is conducting a study to evaluate the functional outcomes and cartilage regeneration for patients with medial compartment osteoarthritis of the knee joint following osteotomies.
2. The study will assess patients' functionality before and after distal femoral osteotomy or high tibial osteotomy using various scales. MRI and arthroscopy will also be used to examine cartilage status and regeneration.
3. During surgery, patients will receive platelet-rich plasma injections into damaged cartilage areas in addition to osteotomies and other procedures like ACL reconstruction or meniscal repair. Post-operative rehabilitation protocols will be followed.
The Principe of high tibial osteotomy is to reduce the stresses of the internal compartment of the knee by valgizing the tibia.The
total knee arthroplasty on this tibia with a “malunion” presents technical difficulties related to the initial approach, the presence of osteosynthesis material, the presence of malunion and the change of bone density. The objectives of this study are to determine the clinical and radiographic results of patients undergoing Total Knee Arthroplasty (TKA) after High Tibial Osteotomy (HTO). This is a retrospective descriptive study including patients undergoing Total Knee Arthroplasty (TKA) after an High Tibial Osteotomy (HTO) at the Hospital of Mont de Marsan (France) from 2008 to 2017 with a minimum follow-up of 12 months. Thirty knees (27 patients) were recruited. The sex ratio was 1.72. The average age was 70.33 years (54years-88years). The average time between High Tibial Osteotomy (HTO) and Total Knee Arthroplasty (TKA) was 10.83 years (1 year-26 years). The medial opening was 63.33% and lateral closure for the rest. Clinical improvement was observed, with an average gain of 24.97 points for pain, 1 point for stability, 1 point for knee mobility and 5 points for walking distance. The clinical result was perfect in 13.33%, excellent in 42% and medium in 36.67% of cases. The alignment was obtained in 76.67% of cases (p = 0.0039). The posterior tibial slope, epiphyseal varus, patellar height were corrected in 80% of cases respectivly (p = 0.000011, p = 0.44, p = 0.15). Residual pain was observed in 26.66%, joint stiff ness in 16.66%, skin healing disorder in
16% and infection in 6.66% of cases. Total knee arthroplasty made it possible to recover the failure of an high tibial osteotomy.
IJRET : International Journal of Research in Engineering and Technology is an international peer reviewed, online journal published by eSAT Publishing House for the enhancement of research in various disciplines of Engineering and Technology. The aim and scope of the journal is to provide an academic medium and an important reference for the advancement and dissemination of research results that support high-level learning, teaching and research in the fields of Engineering and Technology. We bring together Scientists, Academician, Field Engineers, Scholars and Students of related fields of Engineering and Technology.
IJRET : International Journal of Research in Engineering and Technology is an international peer reviewed, online journal published by eSAT Publishing House for the enhancement of research in various disciplines of Engineering and Technology. The aim and scope of the journal is to provide an academic medium and an important reference for the advancement and dissemination of research results that support high-level learning, teaching and research in the fields of Engineering and Technology. We bring together Scientists, Academician, Field Engineers, Scholars and Students of related fields of Engineering and Technology.
The document discusses the management of severe congenital hip dysplasia (CHD) with total hip arthroplasty (THA) plus a shortening osteotomy performed at the same time. It notes that this technique allows for faster bone healing, precise control of femoral derotation, and retention of thigh muscles. The results of 376 Crowe IV hips treated with THA and subtrochanteric shortening osteotomy over 25 years are presented, with a complication rate of around 22-18% reported.
Clavicle fractures are common injuries that can often be treated non-operatively. However, there are some cases where operative fixation is recommended, such as when there is significant shortening or angulation of the bone fragments. While non-operative treatment can have good outcomes, it carries a risk of nonunion or residual pain. Operative fixation aims to restore normal anatomy, but also risks complications from the hardware. There is variability in healing outcomes both between patients and between operative and non-operative treatment methods, and more research is still needed to determine the best approach in different situations.
This study examines 10 cases of acromioclavicular (AC) joint injuries in military personnel treated either conservatively or surgically. For conservatively treated grade I-II injuries, full function was regained within 6 months, while grade III-V injuries took 6-12 months. Surgically treated grade III injuries took 6 months to regain function and grade IV-V took 12-15 months. Functional outcomes were assessed at 3, 6, and 12 months, with UCLA shoulder scores improving significantly over time for both groups. The study concludes that precontoured clavicular hook plates provide good fixation for type III dislocations without additional ligament repair.
This document discusses testing methods for total ankle and shoulder replacement implants. It notes that while testing methods are standardized for knee and hip implants, extremity implants like ankle and shoulder prosthetics have not been as extensively tested. The document outlines current testing procedures for these implants, which typically use modified knee or hip simulators. It discusses adapting simulators to test total ankle replacements, including setting up fixtures and inputting motion profiles. Testing procedures for total shoulder replacements are also described, such as using a hip simulator with custom fixtures to simulate shoulder motion. The document stresses the need for more research on in vivo joint motions and forces to further improve testing methods for these implants.
1) Multiple infection prevention measures were used in 54 patients undergoing ACL reconstruction surgery, including preoperative skin washing and bathing, intraoperative use of sterile drapes and instruments soaked in vancomycin solution, and postoperative rehabilitation.
2) No postoperative infections occurred in any patients over 6-18 months of follow-up. Knee function scores improved significantly from pre-operation levels.
3) The study suggests that using multiple prevention measures can successfully prevent infections after ACL reconstruction surgery and allow for good postoperative recovery of knee function.
Development and validation of eevc wg17 lower legform fe model for pedestrian...eSAT Journals
Abstract Vehicle-pedestrian collisions had claimed the lives of many in the world roads yearly. Among the types of injury that may occur in a vehicle-pedestrian collision, lower extremity injuries have the highest account. These alarming statistic has encouraged joining effort from researchers, car manufacturers and the government to find solutions in reducing the risk of vulnerable road users. The car bumper structure design plays a crucial role in cushioning the impact on the pedestrian leg during a collision. The European Enhanced Vehicle-Safety Committee (EEVC) has developed test methods to evaluate severity of the lower leg injury, upper leg injury and head impact injury in a vehicle-pedestrian simulated collision. Since lower extremity injury are most common, undivided attention should be paid on the lower legform to bumper test. The maximum bending angle, maximum shearing displacement and maximum tibia acceleration are among the three injury criterion determined for lower legform to bumper test. Before the lower legform to bumper test can be perform the lower legform has to be certified statically and dynamically. The advancement of computerization had supported the usage of Finite Element Method(FEM) in simulating real life scenarios for analysis. Irregular geometries are now discretized and solved numerically. Finite Element Analysis(FEA) has proven to reduce time and cost significantly therefore the author took advantaged of this tool and simulated a lower legform to bumper collision. This paper presents in detail the static and dynamic certification of the Finite Element (FE) legform model using the HyperWorks software. The static results for both bending and shearing has to be within the EEVC/WG17 limits and the internal energy at 15º shall be 100±7J. The maximum bending angle shall not be less than 6.2º and not more than 8.2º, the maximum shearing displacement shall not be less than 3.5mm and not more than 6mm, and the maximum upper tibia acceleration shall not be less than 120g and not more than 250g in the dynamic certification test. Index Terms: Pedestrian Safety, Legform Impactor, EEVC WG17, Finite Element Analysis
The document describes an arthroscopic technique for surgically treating symptomatic complete or high grade acromioclavicular joint disruptions using a semitendinosis graft and titanium flip button. Concerns over other techniques led to modifications of this technique to address biomechanical limitations and applicability to broader patient populations. The technique involves creating tunnels in the clavicle and coracoid to pass the graft and button, reconstructing the coracoclavicular ligament while avoiding hardware at the clavicle. Reported benefits include reduced morbidity, improved cosmesis, and ability to address concurrent shoulder pathology compared to open techniques.
This document provides information about hip and knee replacement services at Humanitas Research Hospital in Italy. It discusses the history and founding of hip replacement research and education centers in Pietra Ligure and Rozzano led by Prof. Lorenzo Spotorno and Prof. Guido Grappiolo. It highlights the hospital's high volume of joint replacements per year, focus on research and education, and use of innovative techniques like fast track recovery programs and mini-invasive surgeries. Early results with a new uncemented short stem hip implant called GTS are also summarized, showing outcomes comparable to previous implants.
A STUDY ON THE MOTION CHANGE UNDER LOADED CONDITION INDUCED BY VIBRATION STIM...csandit
To assist not only motor function but also perception ability of elderly and/or handicapped
persons, the power-assist robots which have perception-assist function have been developed.
These robots can automatically modify the user’s motion when the robot detects inappropriate
user’s motion or a possibility of accident such as collision between the user and obstacles. For
this motion modification in perception-assist, some actuators of power-assist robot are used. On
the other hand, since some elderly persons, handicapped persons or some workers need not use
power-assist function but perception-assist function only, another new concept perception-assist
method was investigated in our previous study. In this perception-assist method, only vibrators
are used for generating motion change with kinesthetic illusion to assist perception-ability only.
In this study, since the perception-assist is often used during tasks under a loaded condition, the
features of motion change under the loaded condition are investigated.
This document describes the design and mechanics of an active prosthetic knee (APK). It provides details on the motivation, objectives, and design features of the APK. The key points are:
1) The APK aims to provide a cost-effective active prosthetic knee joint with a simple modular design to enable easy maintenance and robust performance.
2) The mechanical design of the APK utilizes aluminum for its lightweight components. It incorporates a ball screw drive mechanism powered by a motor to provide active motion at the knee joint.
3) The APK design is intended to fit a broad range of users through an anthropometric approach and aims to minimize energy depletion during movement.
Study of functional outcome following arthroscopic anatomical ACL reconstruct...Dr.Avinash Rao Gundavarapu
This document summarizes a study examining the functional outcomes of 40 patients who underwent arthroscopic anatomical ACL reconstruction using autologous hamstring grafts. The study found significant improvements in stability scores (measured by IKDC, Lachman, anterior drawer, and pivot shift tests) at 6-month follow-up compared to pre-operation scores. Complications were minor, with 7.5% having superficial infections and 7.5% difficulty regaining full range of motion. The study concludes that anatomical ACL reconstruction is an excellent technique for restoring stability, especially in active patients.
Open Anterior Capsular Reconstruction of the Shoulder for Chronic Instability...Peter Millett MD
Stability of the shoulder comes from a complex interaction of various factors. Dynamic and static components are provided by soft tissue and bony structures creating joint stability. Recurrent anterior glenohumeral instability can be a difficult problem because there is a wide variety of possible pathologies. For more shoulder surgery and shoulder instability studies, visit Dr. Millett, Orthopedic Surgeon, Vail Colorado http://drmillett.com/shoulder-studies
IRJET- A Study to Compare Immediate Effect of Static Stretching and Cyclic St...IRJET Journal
This study compared the immediate effects of static stretching and cyclic stretching on hamstring tightness. 30 sedentary subjects were randomly assigned to either a static stretching or cyclic stretching group. Both groups performed their assigned stretching intervention and hamstring tightness was measured before and after using the 90-90 straight leg raise test. Both static and cyclic stretching significantly improved hamstring flexibility immediately after stretching. However, when comparing the two groups, there was no significant difference in the improvement of hamstring flexibility between static and cyclic stretching. Therefore, the study concluded that a single bout of either static or cyclic stretching can acutely improve hamstring flexibility to a similar degree in sedentary individuals.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
2. Wheelchair control after reconstructive upper limb surgery 715
Table I. Demographics
International Triceps grade
Age at surgery Age at injury Classification 0–5
Sex Years Years Type of injury Right/left Level of injury ASIA Right/left
F 34 30 Sport OCu/O C5–C6 A 0/0
M 19 17 Sport O/O C5–C6 A 0
M 50 22 Abuse OCu/OCu C6–C7 A 5
M 62 60 Bicycle OCu/OCu C5–C6 B 2
M 28 25 Diving O/OCu C5–C6 A 2
M 32 20 Diving OCu/OCu C6–C7 B 5
M 31 21 Car O/O C5–C6 A 0/0
M 29 18 Diving OCu/OCu C5 A 0
M 22 20 Diving OCu/OCu C7 A 5
M 32 26 Diving OCu/OCu C6–C7 A 0/4
M 28 28 Sport OCu/OCu C6–C7 A 4
M 30 15 Bicycle OCu/OCu C5–C6 A 1
M 55 51 Sport O/O C6–C7 A 4
M 31 23 Bicycle OCu/OCu C5–C6 A 0
M 21 18 Diving OCu/OCu C5–C6 A 0
F 39 37 Car OCu/OCu C7 A 5
Mean 33.9 26.9
ASIA: American Spinal Injury Association; O: ocular (visual feedback); Cu: cutaneous sensory feedback.
was mobilized and the interval between middle and posterior deltoid Patients who underwent reconstruction of active finger flexion and/or
identified. A tibialis anterior tendon graft was removed from the lower thumb flexion (13) started postoperative training of the reconstructed
leg and the distal deltoid tendon was attached to the tendon graft with functions the day after surgery. The goal of this training was to initi-
an overlap of 5 cm and sutured together (Fig. 1A). The distal tendon ate early motor relearning via unloaded activation of the muscles
graft insertion was sutured to the flat triceps tendon. The muscle-tendon in their new positions. This part of the training required extensive
unit passive tension was set to a moderate level when the arm was assistance and guidance by an experienced physiotherapist during 4
positioned along the body and the elbow extended. After skin closure training sessions per day for 4 weeks. For the first month the hand
and wound draping, a circumferential plaster cast was applied, with was immobilized with splints between the training sessions. The
the elbow flexed 10–15º from full extension. patients were allowed to manoeuvre their manual wheelchair indoors
with the splints attached to the hand. The patients were released from
Reconstruction of grip. This reconstruction typically included muscle- hospital 3 days after surgery. After one month the patients returned
tendon transfers of brachioradialis (Fig 1B) to flexor pollicis longus for 5 days of activity and functional training of the hand and they
(FPL) and extensor carpi radialis longus to flexor digitorum profundus, were allowed to start using their hand in daily activities under guid-
together with split FPL to extensor pollicis longus tenodesis, fusion of ance and surveillance. After 3 months they were allowed to start with
the basis of the thumb or transfer of extensor digiti minimi to abductor strengthening exercises. Follow-ups were performed 2, 3, 6 and 12
pollicis brevis (Fig 1C), as well as reconstruction of interossei (Fig. months postoperatively.
1D) (for details see 13).
Measuring procedures
Potential risks
All individuals were examined by the reconstructive hand surgery team,
Potential risks during and after reconstructive upper limb surgery in which included surgeon, physiotherapists and occupational therapists
tetraplegia do not differ from soft tissue extremity surgery in other before surgery and during the postoperative follow-ups.
patient groups. In other words, bleeding and infections may occur
in rare cases. Two more likely complications are adhesions in the
Functional tests of wheelchair control
tendon-to-tendon attachment regions that may occur because of in-
appropriate or insufficient postoperative training, and pressure sores The functional test for manual wheelchair control included 8 different
due to non-optimal fitting of the splints. Awareness of these potential tasks (Test 1–8):
complications is necessary among all personnel treating and training • Test 1. A 25-m wheelchair sprint.
the patients after surgery. • Test 2. Manoeuvre the wheelchair around a figure-of-eight (6 m).
• Test 3. Propel a wheelchair up a 3 m 1:12 gradient.
Postoperative rehabilitation • Test 4. Manoeuvre the wheelchair over a 2.5 cm high and 2.5 cm
wide rim.
Those patients who underwent a transfer of posterior deltoid to triceps,
• Test 5. Manoeuvre the wheelchair over a 5 cm high and 5 cm wide
were supplied with a powered wheelchair, which had a special armrest
rim.
attached, for the first 3 months. The arm was immobilized in a cast for
• Test 6. A static forward push of the wheelchair.
one month and thereafter an adjustable angle orthosis was applied for
• Test 7. A 3-s buttock lift from the wheelchair.
gradually increasing the flexion of the elbow. These precautions were
• Test 8. The position of the hand on the rim during wheelchair pro-
made to prevent tendon elongation (12). The patients were released
pulsion.
from hospital 3 days after surgery. One month later they returned for
5 days to try out the adjustable orthosis and to start to activate their All tests were performed twice and the best result was recorded. Tests
reconstructed elbow extension function and to gradually increase 1–5 were measured using a timekeeper in seconds and with a standing
elbow flexion. After 3 months the patients were allowed to begin to start. Test 6 was measured with a scale attached to the wheelchair via
propel their manual wheelchairs and after 4 months they were allowed an inelastic webbing strap and then attached to a stationary fixture.
to start with strengthening exercises. Follow-ups were performed 3, 6 The greatest static forward push was recorded in kilograms. Test 7 was
and 12 months postoperatively. measured with a scale placed in the wheelchair and the percentage of
J Rehabil Med 43
3. 716 A.-S. Lamberg and J. Fridén
Fig. 1. Surgical procedures commonly used in reconstructive hand surgery in tetraplegia. (A) After attaching the tibialis anterior tendon graft to the
posterior deltoid, it is tunnelled subcutaneously and inserted into the original triceps tendon proximal to the elbow joint. A meticulous suture technique is
applied to secure the mechanical integrity of the attachment site. The figure shows the TA tendon graft sutured to the triceps tendon with a 5 cm overlap
while the elbow joint is kept in full extension. *Triceps tendon, **TA tendon graft. (B) The brachioradialis (BR) muscle is a major donor for replacing,
for example, wrist extension and thumb flexion. BR requires extensive mobilization to guarantee maximal excursion during activation. A ruler is used
during procedure to measure muscle amplitude. (C) In many C6 injuries, some little finger extension is retained. This remaining function can be utilized
by transferring extensor digiti minimi (EDM) muscle as a donor to abductor pollicis brevis (APB) and thus providing palmar abduction of the thumb to
increase the opening of hand. The figure shows the EDM tendon brought subcutaneously to insert into the distal tendon of APB. (D) Reconstruction of
interossei function is crucial for positioning of the fingers relative to the thumb (key pinch) and also for securing proximal interphalangeal (PIP) joint
extension to enable improved opening of the hand. The figure shows tendon grafts brought through the lumbrical canal, thus mimicking the original
intrinsic function of metacarpophalangeal joint flexion and PIP extension.
seated body weight lifted from the wheelchair was recorded. In test 8, II). Those individuals who did not succeed with the test pre-
the hand strike position on the wheel was videotaped. The arc between operatively were excluded from the statistical analysis. Out of
the position of the hand at initial strike of the push and the position at
the 23 individuals tested, 7 succeeded in propelling over a 5 cm
which the hand left the rim was measured in degrees.
The ability to manoeuvre the wheelchair was tested in 16 individu- rim before the operation (1 elbow and 6 grip reconstructions),
als before surgery and 12 months after reconstructive hand and arm although 3 more succeeded after reconstruction (1 elbow and
surgery. The patients underwent 23 reconstructive operations, 10 elbow 2 grip reconstructions). Thirteen individuals succeeded in ma-
extensor reconstructions and 13 grip reconstructions (Table I). noeuvring uphill before the operation (4 elbow reconstructions
and 9 grip reconstructions) and 2 more succeeded in the test after
Statistical analysis
surgery (1 grip reconstruction and 1 elbow reconstruction).
Statistical analyses were performed using Excel and SPSS (SPSS Inc.,
Chicago, IL, USA). To analyse the results after each procedure, a paired
Individual improvements after completed reconstructive
t-test was performed to compare preoperative results and the 12-months
post-operative checkpoint. A p-value of 0.05 was considered significant.
surgery
Wilcoxon’s signed-rank test was used to compare each individual’s Overall, major improvements were recorded for most of the
preoperative results with data one year after completed reconstruction, tests one year after completed surgery for each patient (n = 16).
as paired variables. Individuals who did not succeed with the test pr-
Eighty-nine percent of the 16 participants improved in static
eoperatively were excluded from the statistical analysis.
push, 81% in 25-m sprint, 69% in figure-of-eight, and 57% in
buttock lift. Sixty-nine percent of the individuals improved
RESULTS in manoeuvring uphill, 2 persons succeeded after reconstruc-
tion and 3 persons remained unable to manoeuvre uphill after
Changes in performance after reconstructive surgery surgery. Forty-four percent of the participants improved in
Twenty-three reconstructive surgeries were performed. After manoeuvring over a 5 cm rim. Paired comparisons of “sprint”,
12 months, performance in the 25 m sprint, figure-of-eight, “figure-of-eight”,”uphill”,”2.5 cm rim” and “static push”
uphill, 2.5 cm rim and static push improved significantly (Table demonstrated significant improvements (Fig. 2).
J Rehabil Med 43
4. Wheelchair control after reconstructive upper limb surgery 717
Table II. Results of functional test for manual wheelchair after reconstructive surgery
Paired sample t-test
Succeeded with (95% CI)
Total number the test Significance
Test of tests n Measurements Mean Min–max Upper Lower 2-tailed
25-m sprint
Preoperative 23 23 Seconds 19.739 10–38
12 months 23 23 Seconds 18.152 9–30 0.46 2.72 0.007
Figure-of-eight
Preoperative 23 23 Seconds 19.065 10–35
12 months 23 23 Seconds 16.761 9–29 1.17 3.44 0.0004
Uphill
Preoperative 23 13 Seconds 4.9762 3–17
12 months 23 13 Seconds 4.1429 2–13 0.03 1.64 0.043
2.5 cm rim
Preoperative 23 18 Seconds 1.8261 1–11
12 months 23 18 Seconds 1.0435 0.5–3 0.05 1.51 0.036
5 cm rim
Preoperative 23 7 Seconds 1.1842 1–7
12 months 23 7 Seconds 0.8158 0.5–6 –0.14 0.88 0.149
Static push
Preoperative 23 23 Kilogram 15.826 3–37
12 months 23 23 Kilogram 19.174 4–45 –5.1 –1.59 0.0007
Buttock lift, 3 s
Preoperative 20 20 % of weight 42.55 3–100
12 months 20 20 % of weight 46.55 9–100 –8.91 0.81 0.097
Hand strike
Preoperative 17 17 Degrees 100.53 75–125
12 months 17 17 Degrees 102.82 82–122 –8.29 3.71 0.43
Paired t-test between preoperative results and 12 months postoperatively. Individuals who did not succeed with the test preoperatively were excluded
from the statistical analysis.
CI: confidence interval.
Comparing individuals with different levels of injury the elbow and hand. The group without triceps function was
Level of injury and triceps function differed between the generally slower than those with preserved triceps for all speed
individuals who only underwent grip reconstruction (n = 8) tests and was weaker in static push forward (Table III). Only
compared with those who only had elbow reconstruction or one person in the group with triceps function less than grade
a combination of elbow and grip reconstructions (n = 8). The one succeeded to manoeuvre over the 5 cm rim before operation
greatest difference between the groups was observed in the but two more succeeded after completed surgeries.
buttock lift. The individuals without preserved triceps func- Missing values were due to persons who did not bring their
tion significantly improved (p = 0.02) after reconstruction of manual wheelchair or could not attend for follow-up, medical
problems or technical issues. Five persons were excluded from
the statistical analysis because they did not succeed with the
test preoperatively, but succeeded postoperatively; 2 persons
manoeuvring uphill and 3 persons over a 5 cm rim (Table II).
Complications
There were no serious adverse events in this group of
patients. However, one patient had a skin ulcer caused by elbow
plaster after triceps reconstruction and another patient had a
haematoma in the palmar aspect of the forearm. Extra padding
under the plaster combined with oral penicillin treatment,
and compression over the haematoma, respectively, promptly
treated both complications.
DISCUSSION
Fig. 2. Percentage of individuals who improved after completed
reconstructive surgery. Statistical analyses of the individual improvements This study demonstrated that significant and clinically relevant
are based on paired variables. *p < 0.05, **p < 0.01, ***p < 0.001. improvements in wheelchair manoeuvrability skills could be
J Rehabil Med 43
5. 718 A.-S. Lamberg and J. Fridén
Table III. Comparison of the results from wheelchair manoeuvring tests between individuals with different levels of injury. Group A and B represent
individuals with triceps grade < 1 (n = 8) and grade > 1 (n = 8), respectively
Group A Group B
Pre Post Pre Post
Wheelchair manoeuvring test n Mean Mean p-value n Mean Mean p-value
25 m sprint, s 8 22.3 19.4 0.027 8 14.9 12.5 0.017
Figure-of-eight, s 8 21.4 16.8 0.028 8 12.8 11.6 0.056
Uphill, s 4 8.8 7.5 0.102 7 8.6 6.6 0.023
2.5 cm rim, s 6 3.3 1.7 0.180 8 1.6 1.1 0.046
5 cm rim, s 1 3 2 – 6 3.5 2.2 0.109
Static push, kg 8 12.3 16.5 0.018 8 24.1 29 0.017
Buttock lift, % 7 15.4 26.9 0.018 7 80.4 80 0.674
Hand strike, degrees 6 97.8 101.2 0.917 5 106.6 99.4 0.345
Wilcoxon’s signed-rank test was used to compare preoperative and postoperative results. Individuals who did not succeed with the test preoperatively
were excluded from statistical analysis.
detected after hand or arm reconstruction surgery. Donnelly et propulsion velocity and strength to push forward were detected
al. (14) identified functional mobility, including wheelchair use between those with preserved triceps and those with lack of
and transfers, as 1 of the top 3 problems listed by individuals triceps function; the former group being both stronger and
with spinal cord injury. After hand and grip reconstruction the faster preoperatively. However, both groups increased in their
individuals are able to grip the rim and they can use the elbow ability to manoeuvre the manual wheelchair postoperatively.
extension when pushing forwards or regaining balance and this Further studies are needed to investigate how reconstructive
affects the patterns and abilities to manoeuvre the wheelchair. hand surgery specifically affects the shoulder and arm during
Interestingly, some individuals succeeded in performing the 5 cm different phases of wheelchair propulsion.
lip test and manoeuvring uphill after surgery, but not preopera- The skill of lifting the buttocks improved significantly in
tively. The ability to use the new functions after tendon transfer is patients who underwent elbow reconstruction. The ability to
affected by several factors, such as muscle re-education, muscle unload the buttocks while seated in the manual wheelchair is
strengthening, technique and motivation, and the improvements important to prevent pressure sores. Studies have shown that
in using the arm/hand are likely to be due to a combination of a forward-leaning position and leaning side to side are more
these factors. Although patients included in this study did not effective than pressure relief lift (20–21). With regained triceps
have any specific manoeuvring skill training, their skills did function, persons with high level of injury can easily perform
improve. Specific wheelchair manoeuvring skill training may side-to-side leaning with better pressure relief and they can
therefore advance the outcome even more. push themselves from a forward-leaning position up to sitting
Several studies have pointed out that physical activity is position. These are important factors in preventing pressure
one factor that affects physical health of the SCI population sores, even if they cannot perform a total pressure relief lift.
(15–17). Better manoeuvring skills, improvements and, in The ability to lift the buttocks is also important during trans-
some cases, regained ability in manoeuvring over a rim or up fers, although other factors, such as balance, technique etc.,
a slope, increase the independency level, which may have a play an important role.
positive effect on physical activity level. Improvements after surgery are the results of the combined
Lack of grip function and loss of triceps function have been effects of surgical reconstruction and rigorous post-surgery
pointed out as factors that can affect the propulsion ability of training (22). Prior to surgery, the patient is carefully informed
the manual wheelchair. Individuals with tetraplegia have lower about the need to adhere to the ambitious rehabilitation pro-
propulsion velocity than those with paraplegia and those with gramme. Therapists give details of the exercises and activi-
C6 injury propel slower than those with C7 injury (10, 18, ties to perform, as well as restrictions to consider while the
19). The ability to push with greater strength and propel faster healing and relearning processes proceed. The improvements
significantly increases after reconstruction, although the angle after surgery are also dependent on the level of injury and
between grip and release does not change. This indicates that the type of surgery. Those with a lower level of injury and
the ability to develop force during wheelchair propulsion in- preserved triceps function have significant improvements in
creases after reconstruction. Increased ability to develop force more advanced skills, such as driving up a slope, where the
may have a positive effect on propulsion, as the ability to travel grip function is important. Persons with a higher level of in-
a longer distance per cycle increases. Subjects with tetraplegia jury that lacks triceps function, on the other hand, improve in
devote more time to each metre travelled, and therefore subject skills that require improvements in the whole upper extremity.
their shoulders to a longer period of force (10). By increasing Both groups, however, improved significantly in forward push
propulsion velocity and with a stronger forward push after strength and speed. To test improvements after surgery and
reconstructive surgery the duration of force to the shoulder to set up reasonable goals it is important to take the type of
during propulsion may decrease. This may have a positive ef- surgery and the level of injury into account. Elbow extension
fect on preventing shoulder pain. Preoperative differences in reconstruction per se can provide important improvements
J Rehabil Med 43
6. Wheelchair control after reconstructive upper limb surgery 719
for those individuals who lack triceps function, and further 6. Vastamaki M. Short-term versus long-term comparative results
improvements can be made with a grip reconstruction. after reconstructive upper-limb surgery in tetraplegic patients. J
Hand Surg 2006; 31: 1490–1494.
The advancement of surgical techniques, together with pro-
7. Meiners T, Abel R, Lindel K, Mesecke U. Improvements in activi-
gressively increasing complexity of the rehabilitation protocols ties of daily living following functional hand surgery for treatment
in this field, make the necessity of a highly specialized team of lesions to the cervical spinal cord: self-assessment by patients.
even more evident than before. The best way of building up Spinal Cord 2002; 40: 574–580.
and maintaining a high standard of service is to secure a high 8. Wuolle KS, Bryden AM, Peckham PH, Murray PK, Keith M.
Satisfaction with upper-extremity surgery in individuals with
level of education of all personnel involved, provide functional tetraplegia. Arch Phys Med Rehabil 2003; 84: 1145–1149.
infrastructure, carry out a sufficient number of surgeries per 9. Wangdell J, Fridén J. Satisfaction and performance in patient
year, provide access to rehabilitation facilities, carry out con- selected goals after grip reconstruction in tetraplegia. J Hand Surg
tinuous outcome measurements and enable development. This 2010; 35E: 563–568.
is usually possible in only a very few centres. 10. Kulig K, Newsam CJ, Mulroy SJ, Rao S, Gronley JK, Bontrager
El, et al. The effect of level of spinal cord injury on shoulder joint
In conclusion, the results of this study demonstrate that kinetics during manual wheelchair propulsion. Clin Biomech
the improvement in manoeuvring skills after reconstructive (Bristol, Avon) 2001; 16: 744–751.
hand and arm surgery in individuals with tetraplegia implies 11. Rothwell AG, Fridén J, Hall J, Björklund A-S. Wheelchair function
increased mobility. Hand and arm function are highly priori- following upper limb surgery – a proposal for international tetraple-
gic research project. 7th International Conference on Tetraplegia.
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Bolonga, Italy: University of Modena, Modena, July 2001.
is a crucial factor in living a more active life. Future studies 12. Fridén J, Ejeskar A, Dahlgren A, Lieber RL. Protection of the
are needed to demonstrate not only the long-term effects of deltoid to triceps tendon transfer repair sites. J Hand Surg 2000;
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incorporation of new skills in order to increase other aspects 13. Hentz VR, Leclercq C. Surgical rehabilitation of the upper limb
in tetraplegia. London: WB Saunders; 2002.
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ACKNOWLEDGEMENTS Cord 2004; 42: 302–307.
15. Myers J, Lee M, Kiratli J. Cardiovascular disease in spinal cord
The Swedish Research Council Grant 11200, University of Gothenburg, injury: an overview of prevalence, risk, evaluation, and manage-
Sahlgrenska University Hospital, and Promobilia Foundation provided ment. Am J Phys Med Rehabil 2007; 86: 142–152.
funding for this project. The authors are indebted to Alastair Rothwell 16. Janssen TW, van Oers CA, van Kamp GJ, TenVoorde BJ, van der
and Jennifer Dunn for planning the details of the study and for valuable Woude LH, Hollander AP. Coronary heart disease risk indicators,
suggestions during the course of the study. The authors are also indebted aerobic power, and physical activity in men with spinal cord in-
to Maria Knall for skilful technical assistance. juries. Arch Phys Med Rehabil 1997; 78: 697–705.
17. de Groot S, Dallmeijer AJ, Post MW, Angenot EL, van der Woude
LH. The longitudinal relationship between lipid profile and physi-
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