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Posterior tibialis tendon dysfunction (PTTD) is a debilitating condition that leads to biomechanical changes, for which foot orthoses are often prescribed to attenuate. There is a need to improve the ability to predict these biomechanical alterations, determine the biomechanical effectiveness of foot orthoses, and anticipate their effects on individuals with PTTD during gait. Is the supination resistance test (SRT) reliable, and capable of predicting foot and ankle biomechanics, as well as the biomechanical effects of foot orthoses in individuals with PTTD during gait? Twenty-one individuals with PTTD participated with supination resistance measured over two sessions. Midfoot and ankle angles, and moments, were analyzed during gait. SRT test-retest reliability was evaluated, and the biomechanical effects of foot orthoses were assessed using statistical parametric mapping. SRT correlations with foot and ankle biomechanics and foot orthoses effects were examined. The SRT demonstrated excellent intrarater reliability. Positive correlations were noted between the SRT and midfoot sagittal and frontal angles, while a negative correlation was observed with ankle sagittal and frontal angles. In the foot orthoses condition, midfoot dorsiflexion, external rotation, ankle eversion angles, and inversion moments were reduced. A negative correlation was identified between SRT and foot orthoses effects on the ankle frontal angle. The SRT is useful for predicting foot and ankle biomechanics, as well as the effects of foot orthoses on ankle frontal angles during gait in individuals with PTTD. These findings emphasize the clinical and research relevance of assessing supination resistance in PTTD management. • The supination resistance test has excellent intrarater reliability. • The supination resistance test is correlated with midfoot and ankle biomechanics. • Foot orthoses reduce midfoot dorsiflexion and ankle eversion angles/moments. • The supination resistance test is negatively correlated with ankle frontal angle. [ABSTRACT FROM AUTHOR]

Objective: To detail the neurovascular crossing patterns between the leash of Henry (LoH) and the deep branch of the radial nerve (DBRN) in supination and pronation of the forearm, using imaging methods with anatomic correlation. Materials and methods: This cross-sectional study was performed ex vivo with HRUS and MRI with anatomic correlation on 6 samples and in vivo with HRUS with Doppler on 55 participants scanned bilaterally. The in vivo participants were enrolled over a 6-month period. The crossing patterns between the LoH and DBRN were assessed ex vivo and in vivo. Additional morphological features of the DBRN, LoH, and fat plane were assessed in vivo only. Biometric features of the participants were recorded. Statistical analyses were performed using Shapiro–Wilk, parametric and non-parametric tests. Results: The most common neurovascular crossing pattern was the ascending branch of the radial recurrent artery (RRAab) crossing below (ex vivo: 83.3%, in vivo: 85.3%) and the muscular branch crossing above (ex vivo: 100%, in vivo: 63.2% %) the DBRN. Both the deep and superficial surfaces of the DBRN exhibited an intimate relationship with the vessels of the LoH. A positive correlation between vessel diameter and anthropometric factors was observed. In addition, the muscular branch exhibited a significantly smaller diameter than the RRAab. Conclusion: Our study detailed the relationship between the LoH and the DBRN and highlighted the high incidence of vessel crossing above the DBRN at the level of the muscular branch. Knowledge of neurovascular crossings is crucial for understanding neurovascular entrapment syndromes and planning interventional procedures to reduce vascular complications. [ABSTRACT FROM AUTHOR]

Forearm rotation is essential for daily activities and functional dexterity, involving both pronation and supination. Forearm rotation limitations can result from various pathologies, often linked to trauma, structural changes in radio-ulnar joints, and interosseous membrane alterations. Soft tissue contracture, such as post-burn scarring or specific neurological conditions, can also restrict forearm rotation. We present two cases of painless restricted passive and active supination, devoid of bony, neurovascular, soft tissue, or congenital abnormalities. We describe a surgical technique to improve forearm rotation in these patients. [ABSTRACT FROM AUTHOR]

The forearm muscles coordinately control wrist motion, and their activity is affected by forearm rotation. Although forearm rotation has been implicated in the development of lateral and medial epicondylitis, its biomechanical background remains unknown. Therefore, the present study investigated the activity of wrist muscles in various forearm positions. Surface electromyography of the extensor carpi radialis brevis, extensor carpi ulnaris, flexor carpi radialis, and flexor carpi ulnaris was performed on 40 healthy upper limbs. We initially measured muscle strength and electromyographic activity (integrated electromyographic value per second) at maximum voluntary output towards wrist extension and flexion in a neutral position. We then assessed electromyographic activity under constant wrist torque (75% of maximum strength in the neutral position) in pronation, the neutral position, and supination. The percentage of maximum electromyographic activity was evaluated for each position. In wrist extension, the extensor carpi radialis brevis was activated during forearm pronation, while extensor carpi ulnaris activity did not change in any forearm position. In wrist flexion, the flexor carpi radialis was activated during forearm supination, while flexor carpi ulnaris activity was significantly lower with forearm pronation than in the neutral position. Since muscle activation increases traction force at the tendon origin, forearm positions that increase muscle activity may be a biomechanical risk factor for the development of tendinopathy. The present results are consistent with epidemiological and pathological findings on lateral and medial epicondylitis. These results provide insights into wrist biomechanics and the pathophysiology of lateral and medial epicondylitis. [ABSTRACT FROM AUTHOR]

This study aimed to determine whether hallux pronation influences the proximal to distal phalangeal articular angle (PDPAA) and evaluate its relationship with postoperative recurrence. We included 94 hallux valgus (HV) patients who underwent distal chevron metatarsal osteotomy (DCMO) alone (DCMO-only group, n = 15) and DCMO with Akin osteotomy (DCMO + Akin group, n = 79). Preoperative additional toe radiographs were taken under supination stress to position the pronated toe as a true anteroposterior orientation. The mean follow-up period was 12.9 months. The PDPAA on weightbearing radiograph did not significantly differ from the PDPAA corrected by supination stress (5.0 ± 7.0 vs. 4.7 ± 6.4 degrees, p = 0.820). The DCMO-only group showed a higher recurrence rate than the DCMO + Akin group (33.3 vs. 7.6%, p = 0.014). In the DCMO-only group, those with recurrence had significantly higher preoperative PDPAA values than those without recurrence (7.6 ± 5.9 vs. -0.2 ± 3.0 degrees; respectively, p = 0.013). In conclusion, the PDPAA was not significantly influenced by the hallux pronation in patients with HV. For HV patients with a large preoperative PDPAA, additional Akin osteotomy should be considered to prevent recurrence. [ABSTRACT FROM AUTHOR]

Abstract Background Limitations in forearm rotation resulting from distal radius fracture are often neglected in clinical practice. We aimed to explore possible influencing factors of forearm rotation limitation following conservative treatment of these fractures. Methods A series of patients with distal radius fractures who underwent conservative treatment in the Third Hospital of Hebei Medical University were retrospectively enrolled. Basic patient information and data on post-reduction imaging parameters and specific treatment strategies were collected. Ranges of forearm pronation and supination motion were recorded at 6-month and 12-month follow-ups. Univariate and multivariate logistic regression analyses were used to identify factors associated with forearm rotation limitation. Results A total of 118 enrolled patients, 49 patients (41.5%) had limited forearm rotation function at the 6-month follow-up. Analysis of the fracture and cast fixation characteristics revealed that involvement of the sigmoid notch (odds ratio [OR], 7.010; 95% confidence interval [CI], 1.572–31.249), immobilization > 6 weeks (OR, 2.524; 95% CI, 1.044–6.099), and pronation fixation (OR, 1.797; 95% CI, 1.082–2.985) were associated with limited forearm rotation. Among patients with sigmoid notch fractures, there were no significant differences in forearm pronation or supination motion between the 6-month and 12-month follow-ups. At the 12-month follow-up, there was less supination function in patients with > 6 weeks of immobilization than in those with 6 weeks, and pronation fixation were influencing factors of post-fracture limitation in forearm rotation. The effects of these factors on pronation and supination were not completely consistent and exhibited varying duration.

Background: Limitations in forearm rotation resulting from distal radius fracture are often neglected in clinical practice. We aimed to explore possible influencing factors of forearm rotation limitation following conservative treatment of these fractures. Methods: A series of patients with distal radius fractures who underwent conservative treatment in the Third Hospital of Hebei Medical University were retrospectively enrolled. Basic patient information and data on post-reduction imaging parameters and specific treatment strategies were collected. Ranges of forearm pronation and supination motion were recorded at 6-month and 12-month follow-ups. Univariate and multivariate logistic regression analyses were used to identify factors associated with forearm rotation limitation. Results: A total of 118 enrolled patients, 49 patients (41.5%) had limited forearm rotation function at the 6-month follow-up. Analysis of the fracture and cast fixation characteristics revealed that involvement of the sigmoid notch (odds ratio [OR], 7.010; 95% confidence interval [CI], 1.572–31.249), immobilization > 6 weeks (OR, 2.524; 95% CI, 1.044–6.099), and pronation fixation (OR, 1.797; 95% CI, 1.082–2.985) were associated with limited forearm rotation. Among patients with sigmoid notch fractures, there were no significant differences in forearm pronation or supination motion between the 6-month and 12-month follow-ups. At the 12-month follow-up, there was less supination function in patients with > 6 weeks of immobilization than in those with < 6 weeks of immobilization (P = 0.012), with no significant difference in pronation function (P = 0.131). At the 6-month follow-up, the degree of forearm supination was significantly lower in the fixed pronation position than in the neutral (P = 0.001) or supination (P < 0.001) positions, with no significant differences in the degree of forearm pronation among the three groups (P = 0.166). At the 12-month follow-up, no significant differences in pronation (P = 0.257) or supination (P = 0.164) were found among the three groups. Conclusions: Sigmoid notch involvement, immobilization > 6 weeks, and pronation fixation were influencing factors of post-fracture limitation in forearm rotation. The effects of these factors on pronation and supination were not completely consistent and exhibited varying duration. [ABSTRACT FROM AUTHOR]

This work presents the design of a new game controller device and the development of two exergames (Peter Jumper and Andromeda) for upper limb rehabilitation. The eJamar controller is a novel electromechanical device designed to measure wrist and hand movements, such as pronation/supination, flexion/extension, and ulnar/radial deviation, enabling users to perform control actions in the exergames. One of eJamar's most significant features is its ability to measure hand grip strength, a function not available in commercial gaming controllers. The exergame Peter Jumper involves a character jumping over obstacles in various environments, promoting hand grip exercises. The exergame Andromeda involves shooting enemy ships, promoting coordination between hand movements and grip strength, making it suitable for different rehabilitation techniques. A testing protocol was applied with eight healthy participants (5F and 3M), who completed a survey evaluating gameplay, usability, and satisfaction of the system. The results demonstrated that the developed exergames are intuitive and easy to play, with participants reporting that a therapist's presence is not required for gameplay. Hence, it suggests that the developed system can improve the rehabilitation process, promoting wrist–arm movements and grasping actions. [ABSTRACT FROM AUTHOR]

Seventy‐eight parameters are theoretically needed to describe the relative position and orientation of all the 14 bones in the foot and ankle with respect to a reference bone (foot posture). However, articular contacts and soft tissues introduce kinematic coupling, reducing the number of the foot degrees‐of‐freedom (DOF). This study aims at providing quantification and definition of these couplings. The foot posture was measured in vitro through a series of computed tomography scans, spanning the whole range of foot dorsi/plantar flexion and pronation/supination, also considering the effect of weightbearing. The envelope of foot postures was investigated by means of principal component analysis. The foot and ankle motion were well described with four principal sets of kinematic couplings, that is, synergies. One synergy covers the independent motion of the ankle, while three synergies describe the foot motion. The first foot synergy shows all the bones rotating approximatively about a common axis, mapping the foot abduction/adduction about the Chopart joint. The second foot synergy results in a spherical motion, whose center is located between lateral cuneiform and navicular bone, mapping the foot pronation/supination. The third foot synergy maps the opening of the foot arches during the load acceptance. The foot and ankle complex can thus be described as a four DOF system, whose motion is the result of the linear combination of four synergies. Significance: Synergies reveal the contribution of each bone to the three‐dimensional foot posture, providing a compact representation of the motion of the foot and ankle complex, improving the comprehension of its physiology. [ABSTRACT FROM AUTHOR]

Background: Assessment of walking with shoes is important for understanding different types of walking in various environments. Methods: In this study, a shoe-type sensor was used to demonstrate the shoe–floor angle in fifteen participants who walked on a treadmill under varying gait speed and sole adjustments, lifting one side of the sole. The shoe–floor angle in the sagittal; the angle of toe-up (θTup) and toe-down (θTdown) and frontal planes; and the angle of pronation (θPro) and supination (θSup) were calculated, and angles at the initial contact and maximum angles were extracted. Results: The results showed that most angles significantly increased with an increase in the gait speed (θTup and θTdown; p < 0.01 both, θPro and θSup; p < 0.02 and 0.04). Conversely, only the supination angle at the initial contact changed significantly, owing to the tilt of the sole (p < 0.01). Conclusion: Shoe movements were more strongly affected by gait speed than by sole adjustment. [ABSTRACT FROM AUTHOR]

Posterior interosseous nerve lesion is a rare mononeuropathy of the upper limb. Atraumatic posterior interosseous nerve lesions are commonly caused by lipomas of the forearm, manifesting as slow-progressing wrist and finger drop. In this review and case report study, we present a systematic review of the literature for patients presenting with posterior interosseous palsy due to lipomas and a rare case of patient with acute posterior interosseous nerve lesion caused by a lipoma. Our primary interest was in the timing of clinical presentation. For the review process, we followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. After reviewing the literature, we identified thirty patients with posterior interosseous nerve lesions caused by lipomas. In 28 patients, the symptoms presented progressively, ranging from 1 month to a maximum of 240 months. We found only one case of a patient with acute presentation and another patient with acute worsening of chronic weakness due to trauma. Atraumatic posterior interosseous nerve lesions are frequently secondary to forearm lipomas. In the majority of cases, the symptoms will develope progressively. However, in this study, we also report a rare case of a patient presenting with acute posterior interosseous nerve lesion due to a lipoma. [ABSTRACT FROM AUTHOR]

We investigated the efficacy of the supination-external rotation ('Sup-ER') orthosis, designed as a non-operative treatment to maintain normal anatomical growth of the shoulder, on the progression of glenohumeral dysplasia in patients with brachial plexus birth injuries. The Sup-ER orthosis was fabricated for 20 infants diagnosed with glenohumeral dysplasia after brachial plexus birth injuries and its success in correcting glenohumeral dysplasia was confirmed by objective calculations of the alpha angle on serial ultrasound findings and improvement in Active Movement Scale scores. Of the 20 patients, 14 had successful resolution of glenohumeral dysplasia, confirmed by shoulder abduction, shoulder flexion, external rotation and supination, Active Movement Scale scores and improving alpha angle measurements. Failure to rectify glenohumeral dysplasia, evidenced by worsening ultrasound findings and Active Movement Scale scores, necessitated a change to operative management in six patients. Level of evidence: IV [ABSTRACT FROM AUTHOR]

Radio-ulnar synostosis is a rare complication which develops following forearm trauma, the main manifestation being stiffness and leading to the loss of pronation and supination. For the patient, it is a very frustrating experience due to the impairment of the normal function of the forearm, whereas for the surgeon the treatment is difficult as, unfortunately, there is no consensus regarding the best way to approach it. Many surgical techniques and other kinds of adjuvant therapies have been developed in an effort to solve this disability. This paper presents an overview of the principal factors which contribute to the development of synostosis and the best therapeutic approach methods found in the literature. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Sichuan University (Medical Science Edition) is the property of Editorial Board of Journal of Sichuan University (Medical Sciences) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Distal radioulnar joint (DRUJ) instability is a common post-traumatic complication, often leading to chronic pain and dysfunction. Current reconstructive techniques, such as the single suture button construct, offer suboptimal stabilization in certain motions. This study aimed to evaluate whether a double suture button construct provides greater stability than the single construct in a cadaver model of DRUJ instability. We hypothesized that the double suture button construct would more effectively minimize dorsal translation of the radius relative to the ulna. Methods: We used nine freshly frozen human cadaver upper extremities, destabilized the DRUJ, and then reconstructed the joint using three different suture button constructs: single transverse, double (transverse + oblique), and single oblique. The specimens were secured in a custom-designed testing apparatus to measure dorsal translation of the radius. The study proceeded in five stages: stable DRUJ, unstable DRUJ, and reconstruction using a single transverse, double (transverse + oblique), and single oblique suture button construct. Dorsal translation was measured at neutral, 45° pronation, and 45° supination. Statistical comparisons of mean values were conducted for each stage. Results: Reconstruction with the transverse, transverse plus oblique, and oblique suture button constructs resulted in statistically significant reductions in dorsal translation compared to the unstable DRUJ (p < 0.001 for all). The double-suture button construct significantly minimized dorsal translation in all positions, restoring stability comparable to a stable DRUJ: neutral (p = 1.000), pronation (p = 0.963), and supination (p = 1.000). In contrast, single constructs failed to fully restore stability in pronation and supination. Conclusion: The double suture button construct provides significantly greater stabilization of the DRUJ compared to the single construct. These findings suggest that the double construct could be a more effective option for treating DRUJ instability, particularly in restoring normal joint function during various motions. Further research is warranted to confirm these results in clinical settings. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to evaluate the functional outcome and quality of life in distal biceps tendon repair with single incision technique and anchor fixation method. Methods: A retrospective cohort study was made of patients with complete distal biceps tendon rupture. The chosen repair method was single incision technique with anchor fixation. The outcome was assessed with functional testing of the elbow with strength and ROM. Additionally Mayo elbow performance index, Oxford elbow score, Disability arm hand shoulder questionnaire and patient rated elbow evaluation scores were used to evaluate quality of life. Results: Of the 28 patients, the average strength in flexion and supination was decreased with 91% and 89% of the strength compared to the non-injured arm. ROM was preserved in flexion, extension, supination and pronation. The mean scores for quality of life evaluation were MEPS = 96 ± 7.8, OES = 46.8 ± 1.9, DASH = 1.0 ± 1.9 and PREE = 2.0 ± 3.6. LABCN injury was the most common temporary complication with 30% followed by pain with 23%. Two patients were identified with HO and 1 patient was identified with median nerve injury. There were no cases of radioulnar synostosis and PIN injury. Conclusion: Overall strength in flexion and supination were slightly decreased with preserved ROM. Patients reported nearly perfect quality of life as demonstrated with the scores. The complications rate was high with mainly minor complications. Distal biceps tendon repair with single incision technique and anchor fixation overall leads to a very satisfying outcome. [ABSTRACT FROM AUTHOR]

Background: An obstetric brachial plexus injury (OBPI) occurs when the brachial plexus is subjected to severe traction during the labor and delivery procedure. These individuals may see considerable improvements in shoulder function and glenohumeral congruity after undergoing the triangle tilt operation. This research aimed to assess the clinical, functional as well as radiological outcomes of managing obstetric brachial plexus injury using triangle tilt surgery. Methods:Eighteen patients who were treated for obstetric brachial plexus injury using triangle tilt surgery technique in this prospective clinical study with follow up period of at least 2 years clinically and radiological by x-ray and CT of shoulder joints. Postoperative evaluation was performed according to Mallet Score. Results: Posterior supination significantly increased after intervention from 14.16±2.25 to 25.50±2.72 (p<0.001). The measurements of the glenoid version showed significant improvement which was about 29.55±3.27 and improved to be about 22.66±2.95 (p<0.001). There was significant improvement in the abduction angle while preoperative was 78.05±10.72 and became post operative 149±9.85 (p<0.001). There was significant improvement in SHEAR deformity grades while preoperative was grade 3 and grade 4 and became post operative grade 2 (p<0.001). Glenoid version significantly improved from preoperative compared to post operative (p<0.001). Abduction angle significantly increased from pre to post as 78.05±10.72 to 149±9.85 (p<0.001). Nonunion of the clavicular osteotomy happened in 3 cases only and was managed by wire fixation. Conclusions: This study underscores that triangle tilt surgy could be a safe as well as effective method for management of secondary deformities of obstetric brachial plexuses injury in children in different ages. [ABSTRACT FROM AUTHOR]

Background: The one-bone forearm procedure has been considered as a potential treatment for severe forearm deformities. However, its primary limitation lies in the elevated risks of nonunion and infection. In order to enhance union rates, a technical modification was introduced, aiming not only to establish end-to-end radio-ulnar fixation but also to incorporate an additional overlay and fixation between the proximal and distal radius osteotomy stumps. This technique, initially applied in a heterogeneous patient population including individuals with neurological, tumoral, and congenital conditions, yielded promising results, achieving a consolidation rate of 100% and enabling supination corrections of up to 120°. Methods: In this study, we present a retrospective cohort of 28 patients, with an average age of 9 years, all afflicted by forearm supination contracture exceeding 90° secondary to neonatal brachial plexus injury. These patients underwent treatment with the modified technique. Results: The mean correction achieved in forearm rotation was 116°, and the average follow-up period extended to 43 months. Remarkably, all patients exhibited bone union within an average period of 6.6 weeks, without any complications. Conclusion: Our findings underscore the efficacy of this modified technique, which enables substantial rotational corrections, boasts a high union rate, and maintains a low incidence of complications. This approach is particularly valuable for young patients suffering from neonatal brachial plexus injury with severe fixed supination deformities. Case series, Level of evidence: IV [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: Congruency of the proximal radioulnar joint (PRUJ) is important in the rotation of the forearm while any compromise would significantly impair the elbow function. The purpose of this study is to determine the morphological features of the radial head and investigate its role in the congruency of the PRUJ during forearm rotation. The hypothesis is that the PRUJ is more congruent in the maximal pronation and supination positions than in the neutral position. Methods: Thirty sets of computed tomography images of the elbow were acquired, and a three‐dimensional model of the proximal radius and ulna was generated. The radius of curvature of the radial head and the radial head at the maximal pronation, neutral positions and maximal supination were calculated and compared with a one‐way analysis of variance. Results: The point on the radial head contacting the middle point of radial head at the maximal pronation and supination was located at the ends of the semi‐major axis of the ellipse, while it was located at one end of the semi‐minor axis at neutral position. The radii of curvature of the pronation, neutral and supination points of the radial head were 14.72 ± 1.51, 9.74 ± 1.49 and 14.58 ± 1.70 mm, respectively. The value of the neutral point was significantly smaller than that of the pronation and supination points. Conclusions: This study quantitatively evaluated the morphology of the radial head and suggested that the best congruency of the PRUJ was achieved at maximal pronation and supination, while the neutral position was associated with the least congruency. Level of Evidence: Basic Science Study. [ABSTRACT FROM AUTHOR]

Background: Foot morphology in children is a crucial factor influencing multiple aspects of their physical development. Between the ages of 5 and 10 years, the critical period of child development is when the movement and stability patterns are consolidated that can affect their long-term physical performance and quality of life. The aim of this study is to analyze how the type of foot influences different physical characteristics, laxity, strength, motor tests, and baropodometric variables in children aged 5 to 10 years. Methods: A cross-sectional study involving 196 children was conducted. Different physical characteristics, laxity, strength, motor tests, and baropodometric variables of the sample were analyzed for age and Foot Posture Index (FPI). Results: Differences in all variables were examined by age and FPI. Statistical analysis showed a moderate to high correlation (r > 0.6, p < 0.01) between FPI and the relaxed calcaneal stance position (RCSP) test. Some significant differences were also found in variables related to foot pronation and supination. These results provide valuable information for understanding differences in motor and functional development during childhood and pre-adolescence. Conclusions: The findings highlight the variability in physical and functional development between age and foot type groups, highlighting the importance of considering these differences in the assessment and management of foot-related conditions and biomechanics in childhood. Foot type significantly influences children's growth and development. [ABSTRACT FROM AUTHOR]

The effects of foot orthoses on lower limb biomechanics during walking have been studied extensively. However, the lack of knowledge regarding the effects of various foot orthoses models for the same population complicates model selection in clinical practice and research. Additionally, there is a critical need to enhance our ability to predict the outcomes of foot orthoses using clinical tests, such as the supination resistance test. What are the effects of two commonly prescribed types of FO (thin-flexible and medially wedged) on lower limb biomechanics during gait? Is there a correlation on these effects with the results of the supination resistance test? Twenty-three participants with flat feet were enrolled in this cross-sectional descriptive study. Participants underwent walking trials under three conditions: shod, thin-flexible FOs and medially wedged FOs. Midfoot, ankle, knee and hip angles, moments were calculated. Repeated measure ANOVAs were employed for within-group comparison across conditions. Correlations between the effects of FOs on foot and ankle angles/moments and supination resistance were determined using regression analyses using a statistical parametric mapping approach. Thin-flexible and medially wedged FOs reduced midfoot dorsiflexion angles and ankle inversion moments. Medially wedged FOs also decreased midfoot and ankle abduction angles, midfoot plantarflexion moments compared to thin-flexible FOs and shoes. Moderate to good correlations between the supination resistance test and the medially wedged FOs were observed for the frontal and transverse ankle angles and moments. Medially wedged FOs are more effective in modifying lower limb biomechanics during walking compared to thin-flexible FOs. Greater supination resistance was associated with more pronounced effects for medially wedged FOs on foot and ankle biomechanics. These findings hold promise for refining orthotic prescription strategies, potentially offering advantages to individuals with musculoskeletal disorders. • Medially wedged foot orthoses generated the greater biomechanical effects. • Foot orthoses primarily impacted the distal segments of the lower limb. • Moderate correlations were observed between SRT and the biomechanical effects. • The supination resistance test will help in the foot orthoses selection process. [ABSTRACT FROM AUTHOR]

OBJECTIVE Evaluate whether total elbow replacement (TER) through a lateral approach is accurate and stable. ANIMALS 12 skeletally mature large-breed dog cadavers were used. METHODS Limb alignment, elbow joint motion, and collateral ligament laxity were evaluated preoperatively. The order of surgery (left or right) and the approach (lateral or medial) were randomly selected for TER in each dog. The other approach was used in the contralateral elbow. Intraoperative technical difficulties, duration of surgery, and anatomic complications were recorded. Limb alignment, elbow joint motion, collateral ligament laxity, and prosthetic component alignment were evaluated after surgery. Data were collected from June 11 to 15, 2023. RESULTS The duration of surgery using a lateral or medial approach did not differ (P = .499). Anatomic complications were not observed. The lateral approach resulted in 8° more elbow extension (P = .003), 1.58° less lateral collateral ligament constraint (P = .033), 2.80° less medial collateral ligament constraint (P = .002), 4.38° less frontal plane constraint (P = .004), 8° greater humeral component inclination (P = .033), and 5.6° greater radioulnar component varus (P = .001) than the medial approach. Varus of the radius, mechanical axis deviation, limb supination, elbow flexion, mediolateral humeral component and craniocaudal radioulnar component orientation did not differ among joints operated using a lateral or medial approach. In normal cadaveric elbows, a lateral approach for TER appears feasible, producing equivalent limb alignment, joint laxity, and joint motion to normal elbows and to TER placed using a medial approach. CLINICAL RELEVANCE In dogs, TER can be performed using a lateral surgical approach. [ABSTRACT FROM AUTHOR]

The distinct and specialized movements performed in different sports disciplines may significantly influence nerve performance, potentially affecting nerve responses and the overall function within the respective athletic activities. The purpose of this study is to find the effect of forearm supination and pronation across the elbow joint on ulnar and median nerve conduction velocity (NCV) in throwers, archers, and non-athletes. A total of 34 participants both male and females were recruited with a body mass index (BMI) between 18.5 and 24.9 kg/m2. Nerve conduction study (NeuroStim NS2 EMG/NCV/EP System) was used for measuring ulnar and median NCV across the elbow joint at different angles with the forearm in supination and pronation. Repeated measure analysis of variance (RMANOVA) revealed that there are statistically significant differences in mean values of forearm positions, angles, nerves and groups (p <.05). This study illuminates distinctive NCV variations across diverse athletic groups during forearm supination and pronation movements. Pronation consistently exhibited faster ulnar NCV compared to the median nerve across throwers, archers, and non-athletes, while in supination specific joint positions revealed notable differences within sports groups and nerve function. [ABSTRACT FROM AUTHOR]

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Background: Ankle sprains are one of the most common injuries in sports, particularly in activities that involve frequent and highintensity lower limb movements, such as roller skating. This study aims to assess the prevalence of ankle sprains among nationallevel roller skating athletes in Karad, with a focus on identifying contributing factors, injury patterns, and preventive measures. Roller skating requires extensive use of ankle mobility and stability, which increases the risk of strain and injury, particularly among athletes pushing physical limits for competitive performance. Materials and Methods: A validated questionnaire was prepared on google form and national level skating players filled this questionnaire. Prior to conducting the survey, the ethical committee approval was made. Players select according to inclusion and exclusion criteria. 72 players are participating in this study and result was obtained. Result: prevalence of ankle sprain in national level roller skating players in male population is 70.9% and in female population is 29.1%. and 94.9% players noticed swelling, bruising over ankle after ankle sprain. 24.9% skating players aware about physiotherapy can help in managing ankle sprain and avoid further complications. But 75.9% players don't know that physiotherapist can cure ankle sprain and 87.2% players experience ankle sprain more than one time. Conclusion: The high physical demands and rapid foot movements required in roller skating, the findings reveal a significant prevalence of ankle sprains among athletes, which may stem from factors such as repetitive motion, inadequate warm-up, poor technique, or uneven surfaces. [ABSTRACT FROM AUTHOR]

Background: Although many studies have focused on the degenerative changes of the ulnohumeral and radiohumeral joints in osteoarthritis (OA) of the elbow, the proximal radioulnar joint (PRUJ), which facilitates the pronation and supination motions of the forearm, has not been comprehensively evaluated. Purpose: To assess the prevalence of PRUJ OA in patients diagnosed with OA of the elbow using computed tomography (CT) images and to establish an association between the CT findings and clinical manifestations. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Between 2010 and 2022, a total of 85 consecutive patients who were scheduled to undergo osteocapsular arthroplasty for OA of the elbow and had undergone preoperative CT imaging were included in the study. As a control group, 85 patients who underwent CT scans of the elbow for reasons other than OA of the elbow were selected and matched to patients in the OA group. CT findings of OA in the PRUJ, including osteophytes, joint space narrowing, subchondral cysts, and loose bodies, were evaluated. Inter- and intraobserver agreement analyses for CT findings were performed. The relationship between the CT findings of OA in the PRUJ and OA of the elbow classification systems (Broberg-Morrey, Hasting-Rettig, and Kwak) as well as clinical manifestations (range of motion [ROM], Mayo Elbow Performance Score, and visual analog scale for pain) were evaluated. Results: Patients in the OA group showed osteophytes in the radial notch (81.2%), osteophytes in the radial head (45.9%), joint space narrowing (54.1%), loose bodies (25.9%), and subchondral cysts (23.5%) involving the PRUJ. Both the interobserver (κ = 0.866) and intraobserver agreements (κ = 0.933) for CT findings of PRUJ OA were almost perfect. The CT findings of PRUJ OA were associated with the severity of OA of the elbow in Cochran-Armitage Trend analysis (with Brogberg-Morray, r = -2.624, P =.011; with Hasting-Rettig, r = -3.421, P =.002; with Kwak, r = -2.266, P =.032). The presence of radial notch osteophytes restricted ROM in the flexion-extension arc and pronation-supination arc (P =.009 and P <.001, respectively). Conclusion: PRUJ OA could be identified using CT imaging and showed radial notch osteophytes, joint space narrowing, loose bodies within the joint space, and subchondral cysts. PRUJ OA was related to overall OA of the elbow and may contribute to reduced ROM in the elbow joint. Therefore, preoperative evaluation of PRUJ OA can aid in the surgical planning of osteocapsular arthroplasty for OA of the elbow. [ABSTRACT FROM AUTHOR]

Ankle sprains are the most frequently occurring musculoskeletal injuries among recreational athletes. Ankle support through bandages following the initial orthotic treatment might be beneficial for rehabilitation purposes. However, the literature is sparse regarding the use of an ankle support directly after the acute phase of an ankle sprain. Therefore, this study investigates the hypothesis that wearing an ankle bandage immediately after an acute ankle sprain improves motor performance, stability and reduces pain. In total, 70 subjects with acute unilateral supination trauma were tested. Subjects were tested five weeks post-injury to assess immediate effects of the ankle bandage. On the testing day, subjects completed rating questionnaires and underwent comprehensive biomechanical assessments. Biomechanical investigations included fine coordination and proprioception tests, single leg stances, the Y-Balance test, and gait analysis. All biomechanical investigations were conducted for the subject's injured leg with and without a bandage (MalleoTrain® Bauerfeind AG, Zeulenroda-Triebes, Germany) and the healthy leg. Results indicated moderate to strong improvements in ankle stability and pain relief while wearing the bandage. Wearing the bandage significantly normalized single leg stance performance (p < 0.001), stance phase duration (p < 0.001), and vertical ground reaction forces during walking (p < 0.05). However, the bandage did not have a clear effect on fine coordination and proprioception. The findings of our study suggest that ankle bandages may play a crucial role in early-stage rehabilitation by enhancing motor performance and reducing pain. [ABSTRACT FROM AUTHOR]

Background: Perilunate dislocations and perilunate fracture dislocations (PLD/PLFDs) are rare injuries of the wrist, with surgical management leading to acceptable functional results. Purpose: The purpose of this study was to assess the functional outcomes of the patients of our department who were treated with surgical management of PLDs/PLFDs through dorsal approach, as well as to report any complications on their follow-up. Patients and methods: In this retrospective study, 52 patients with PLD/PLFD, fulfilling the inclusion and exclusion criteria of the study, underwent surgical management of their injury. All patients were followed up at 6 weeks, 12 weeks, 6 months, 1 year postoperatively with radiographic imaging as well as functional scores measured with the modified mayo wrist score and the QuickDASH questionnaire. Results: The mean postoperative modified Mayo score was 76.8 ± 8.8 and the mean QuickDASH score was 1.52 ± 2.18. Of the 52 cases, 20% had excellent results, 42% had good results, 29% had fair results and 9% had poor results as per the modified Mayo wrist score. No patient signed any symptoms of median nerve neuropathy. Conclusion: In conclusion, open reduction and internal fixation through dorsal approach is a reliable technique to manage perilunate injuries in spite of radiological evidence of wrist arthritis, as it also provides consistently good results in terms of functional outcomes. Level of evidence IV: Retrospective case series study. [ABSTRACT FROM AUTHOR]

Data in the literature on the results of Kinesio taping (KT) application after cast removal in patients with distal radius fracture (DRF) are quite limited. It was aimed to evaluate the effectiveness of KT applied immediately after cast removal in addition to the exercise program on edema, functionality, range of motion, and muscle strength in patients with conservatively followed DRF. Randomized controlled single-blinded clinical study. This study was conducted with 64 patients with a diagnosis of DRF. The patients were randomized as Kinesio taping group (KTG) and control group. Both groups received a conventional home exercise program. KT was applied to patients in KTG for 10 days. Circumference and volume measurements were taken at baseline and day 10. Arm, Shoulder, and Hand Questionnaire for Disability, Visual Analog Scale, grip strength, and wrist joint range of motion measurements were taken at baseline, day 5, and day 10. The circumference difference between the affected extremity and the healthy extremity was statistically greater in the control group on the fifth day at the wrist level (<0.001) and 6 cm proximal to the wrist (p = 0.001). The circumference difference between the affected extremity and the healthy extremity was statistically greater in the control group on the 10th day at the wrist level (p < 0.05) and 6 cm proximal to the wrist (p = 0.01). Wrist extension angle (<0.001), wrist flexion angle (p = 0.001), and supination angle (p = 0.001) were higher in KTG on the 10th day. On the 10th day, the grip strength (p < 0.05) was higher in the KTG, while the Visual Analog Scale value (p < 0.01), Arm, Shoulder, and Hand Questionnaire for Disability score (p < 0.01), and the percentage of strength loss in the healthy arm (p < 0.01) were lower in the KTG. In patients with DRF who were treated conservatively with a cast, the inclusion of Kinesio taping (KT) in the rehabilitation program was found to be effective in reducing edema and pain, as well as improving functionality, strength, and range of motion. • Kinesio tape application is effective on edema in the postoperative subacute period. • Kinesio tape KT application is effective in pain control, improvement of function and muscle strength. • Kinesio tape KT application is effective in wrist flexion, extension and supination range of motion. [ABSTRACT FROM AUTHOR]

Background: The outcomes of first metatarsal (M1) distal osteotomies in hallux valgus (HV) can be improved, especially for intermetatarsal angle (IMA) correction, which is mainly based on lateral displacement of the M1 head (i.e., translation) through the osteotomy. Conversely, there is a spontaneous reduction in the IMA in first metatarsophalangeal joint (MTP1) arthrodesis. But we do not know whether this can be applied to distal osteotomies. We propose a distal osteotomy, called 3D chevron, which combines supination and varization of the M1 head. This might realign soft tissues around the MTP1, potentially leading to a spontaneous reduction in the IMA by an analogous mechanism to MTP1 fusion. Therefore, our study aimed to assess whether spontaneous reductions in IMAs exist in distal M1 osteotomies in the absence of lateral translations of M1 heads. Methods: A prospective continuous series of 25 3D chevrons was performed. Two groups were formed during surgery. Patients requiring no M1 head lateral displacement were included in the "successful correction without translation" group, and patients requiring M1 head lateral displacement were included in the "failed correction without translation" group. Radiographic analysis was performed preoperatively and at 1 year postoperatively. Results: Twenty-two women and three men, with a mean age of 44.8 ± 14.2 years and a mean body mass index of 22.6 ± 4.1 kg/m2, underwent follow-up at one year after surgery. The "successful correction without translation" group was composed of HV with milder deformities (13/25 HVs, median preoperative IMA = 13 (IQR 2)) compared to the "failed correction without translation" group (median IMA = 16 (IQR 2.25) p < 0.001). Spontaneous reductions in IMAs were observed in the "successful correction without translation" group, with a median decrease in the IMA of 6 degrees (CI95%[5.5; 8.0]; p < 0.001) between preoperative and 1-year radiographs. Conclusion: Distal osteotomies allow for spontaneous reduction in the IMA in HV. First metatarsal head translation through an osteotomy should not be considered as the only procedure to correct IMAs in distal osteotomies. [ABSTRACT FROM AUTHOR]

Abstract Purpose Congruency of the proximal radioulnar joint (PRUJ) is important in the rotation of the forearm while any compromise would significantly impair the elbow function. The purpose of this study is to determine the morphological features of the radial head and investigate its role in the congruency of the PRUJ during forearm rotation. The hypothesis is that the PRUJ is more congruent in the maximal pronation and supination positions than in the neutral position. Methods Thirty sets of computed tomography images of the elbow were acquired, and a three‐dimensional model of the proximal radius and ulna was generated. The radius of curvature of the radial head and the radial head at the maximal pronation, neutral positions and maximal supination were calculated and compared with a one‐way analysis of variance. Results The point on the radial head contacting the middle point of radial head at the maximal pronation and supination was located at the ends of the semi‐major axis of the ellipse, while it was located at one end of the semi‐minor axis at neutral position. The radii of curvature of the pronation, neutral and supination points of the radial head were 14.72 ± 1.51, 9.74 ± 1.49 and 14.58 ± 1.70 mm, respectively. The value of the neutral point was significantly smaller than that of the pronation and supination points. Conclusions This study quantitatively evaluated the morphology of the radial head and suggested that the best congruency of the PRUJ was achieved at maximal pronation and supination, while the neutral position was associated with the least congruency. Level of Evidence Basic Science Study.

The objectives of this study were to (1) investigate the effect of the timing of the upper body joint motions in baseball batting on the bat-head speed and (2) develop and evaluate a simulation model inputting the individual hand forces on the bat. Twenty-three male collegiate baseball players performed tee batting set at waist height. A 10-segment angle-driven simulation model consisting of a bat and upper body was driven using the coordinate data of the standard motion. Performance optimization was conducted by changing the timing of the joint angle time histories of the upper body to increase the maximum bat-head speed. The optimization simultaneously estimated the individual hand forces by polynomial approximation dependent on the total bat forces to assess joint torques of the upper body. The bat-head speed increased to 39.2 m/s from 35.6 m/s, and the optimized timings were characterized by the earlier timing of the barrel-side elbow supination, wrist radial flexion, torso right lateral flexion, and the later timing of the barrel-side shoulder abduction. It is concluded that the skillful coordination of the individual joint movements for the upper body can produce a higher bat-head speed through effective sequencing of proximal to distal movements. [ABSTRACT FROM AUTHOR]

BACKGROUND: Kinesio taping is often used for the treatment of various sports injuries. The methods of foot and ankle sports taping are complex and diverse. Among them, Fascia taping is applicable to a wider range of people and can be used for different foot posture types, but it still lacks of practical verification, and its specific biomechanical role is not clear. OBJECTIVE: To observe the changes in plantar pressure characteristics of subjects with different foot positions during walking and jogging after Fascia taping. METHODS: Thirty-seven young healthy subjects were recruited from the Yantai campus of Binzhou Medical University to conduct the test. They were scored according to the foot posture index-six items version, and were divided into the supination foot group, the neutral foot group, and the pronation foot group. The static foot morphological indexes (including navicular drop, arch height index, arch height flexibility-longitudinal arch, and arch height flexibility-transverse arch) and the pressure-time integral of each foot zone during walking and jogging were collected and calculated respectively before and after Kinesio taping. The specific biomechanical mechanism of Fascia taping was analyzed. RESULTS AND CONCLUSION: (1) General data: There was no statistical difference among the three groups of subjects in general data, such as gender, height, and body mass index (P > 0.05). Before taping, there was a significant difference in the foot morphological indexes and the areas of the outer front foot, midfoot, and hindfoot between different foot posture groups (P < 0.01). (2) Static foot morphological indexes: After taping, there was no statistically significant difference between the groups in navicular drop, arch height flexibility-longitudinal arch, and arch height flexibility-transverse arch (P > 0.05), while there was still a significant difference between the groups in the arch height index (P < 0.05). In the supination foot group, the arch height index increased slightly, but there was no significant difference before and after taping (P > 0.05). In the pronation foot group, the navicular drop and arch height flexibility-longitudinal arch was significantly reduced, and the arch height index was increased. There was a significant difference before and after taping (P < 0.05). (3) The index of plantar pressure during walking: After taping, there was no significant difference between the three groups in the area of lateral forefoot and medial midfoot (P > 0.05). In the pronation foot group, the lateral load of the forefoot increased after taping (P < 0.05). In the supination position group, the load of the lateral forefoot and midfoot regions increased significantly (P < 0.05), while the difference in the rear foot region was not significant (P > 0.05). (4) The index of plantar pressure during jogging: After taping, there was no statistically significant difference between groups in the lateral forefoot (P > 0.05). In the pronation foot group, the load of the medial forefoot increased significantly (P < 0.05). In the supination position group, the load of the lateral forefoot, the middle foot and the rear foot region increased significantly (P < 0.05). (5) The results showed that the Fascia taping was suitable for different foot postures. It could not only correct the static foot structure of subjects with different foot postures, but also regulate the abnormal plantar pressure distribution during the dynamic activities of walking and jogging, and the load of the midfoot, forefoot, and hindfoot in the supination and pronation posture tended to normal foot posture load level. [ABSTRACT FROM AUTHOR]

Objective. Clinical practice guidelines recommend the radial nerve mechanosensitivity evaluation in patients with lateral epicondylalgia. Despite different positions and sequences having been described, no research analyzed how each variation triggers symptoms associated with lateral epicondylalgia. The aim of this study was to explore the effects of different positions and sequences in the upper limb neural tension test 2b (ULNT2b) in symptom responses in patients with lateral epicondylalgia. Methods. In this observational study, 66 patients underwent 4 test conditions: standard ULNT2b, ULNT2b proximal to distal, ULNT2B with resisted supination, and resisted supination isolated. Paresthesia sensations, symptom reproduction, pain intensity (measured using a visual analog scale), and distribution of painful symptoms data were collected. Results. Significant differences in paresthesia sensations were observed between groups, with significant differences between the standard ULNT2B and other ULNT variations or resisted supination maneuvers. Symptom reproduction also differed significantly across groups, with significant differences between the standard ULNT2B and other ULNT or resisted supination tests. The positive/negative test and percentage of distribution of painful symptoms scores varied significantly across 4 conditions in both lateral and frontal views. Although pain intensity scores during tests were comparable among the tests, distribution of painful symptoms differed significantly. Conclusion. Variations in the ULNT2b test can affect symptom responses in patients with lateral epicondylalgia. The standard ULNT2b test appears more effective at reproducing symptoms, intensity of paresthesia, and distribution of painful symptoms compared to other ULNT variations and the resisted supination test. Impact. ULNT2b sequences have been shown to elicit varying responses concerning paresthesia, replication of familiar symptoms, positive/negative test results, and distribution of painful symptoms. Clinicians should consider specific test variations during the patients' radial nerve mechanosensitivity assessment to identify aggravating factors reproducing recognizable symptoms. A control group of asymptomatic participants and the role of presence of other comorbidities, psychological factors, or the duration of symptoms were not considered in this study and might play an important role influencing the results of the tests. [ABSTRACT FROM AUTHOR]

Arm-cycling is a versatile exercise modality with applications in both athletic enhancement and rehabilitation, yet the influence of forearm orientation remains understudied. Thus, this study aimed to investigate the impact of forearm position on upper-body arm-cycling Wingate tests. Fourteen adult males (27.3 ± 5.8 years) underwent bilateral assessments of handgrip strength in standing and seated positions, followed by pronated and supinated forward arm-cycling Wingate tests. Electromyography (EMG) was recorded from five upper-extremity muscles, including anterior deltoid, triceps brachii lateral head, biceps brachii, latissimus dorsi, and brachioradialis. Simultaneously, bilateral normal and propulsion forces were measured at the pedal-crank interface. Rate of perceived exertion (RPE), power output, and fatigue index were recorded post-test. The results showed that a pronated forearm position provided significantly (p < 0.05) higher normal and propulsion forces and triceps brachii muscle activation patterns during arm-cycling. No significant difference in RPE was observed between forearm positions (p = 0.17). A positive correlation was found between seated handgrip strength and peak power output during the Wingate test while pronated (dominant: p = 0.01, r = 0.55; non-dominant: p = 0.03, r = 0.49) and supinated (dominant: p = 0.03, r = 0.51; don-dominant: p = 0.04, r = 0.47). Fatigue changed the force and EMG profile during the Wingate test. In conclusion, this study enhances our understanding of forearm position's impact on upper-body Wingate tests. These findings have implications for optimizing training and performance strategies in individuals using arm-cycling for athletic enhancement and rehabilitation. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to compare the effects of four different immobilization methods [single sugar tong splint (SSTS), double sugar tong splint (DSTS), short arm cast (SAC), and long arm cast (LAC)] commonly used for restricting forearm rotation in the upper extremity. Methods: Forty healthy volunteers were included in the study. Dominant extremities were used for measurements. Basal pronation and supination of the forearm were measured with a custom-made goniometer, and the total rotation arc was calculated without any immobilization. Next, the measurements were repeated with the SAC, LAC, SSTS and DSTS. Each measurement was compared to the baseline value, and the percentage of rotation restriction was calculated. Results: The most superior restriction rates were observed for the LAC (p = 0.00). No statistically significant difference was detected between the SSTS and DSTS in terms of the restriction of supination, pronation or the rotation arc (p values, 1.00, 0.18, and 0.50, respectively). Statistically significant differences were not detected between the SAC and the SSTS in any of the three parameters (p values, 0.25; 1.00; 1.00, respectively). When the SAC and DSTS were compared, while there was no significant difference between the two methods in pronation (p = 0.50), a statistically significant difference was detected in supination (p = 0.01) and in the total rotation arc (p = 0.03). Conclusion: The LAC provides superior results in restricting forearm rotation. The SAC and SSTS had similar effects on forearm rotation. The DSTS, which contains, in addition to the SSTS, a sugar tong portion above the elbow, does not provide additional rotational stability. [ABSTRACT FROM AUTHOR]

The purpose of this study is to find out functional outcome after open reduction and internal fixation in intraarticular distal humerus fracture. The method used is the case report method. The purpose of this method is to present in-depth information about a particular case, including symptoms, diagnosis, treatment, and results. A 51-years-old male patient presented to the emergency department after injuring his right elbow following motorcycle accident. He had suffered pain, swelling and bruise on his right elbow without neurovascular injury or external wound. Anteroposterior and lateral x rays and 3D CT scan of the right elbow joint showed simple articular and comminuted metaphyseal classified as type 13-C2. The normal range of flexion-extension of the elbow is 0°–145°. The functional range of motion required for daily activities is 30°–130° of flexion-extension and 50° of supination to 50° of pronation. Distal humerus fracture management requires a carefully planned approach. Surgical management by internal fixation is the treatment of choice for these fractures considered for a satisfactory function. [ABSTRACT FROM AUTHOR]

A 15-year-old girl with humeroradial synostosis since birth underwent a resection arthroplasty. A trapezoidal resection osteotomy of approximately 2 cm was performed at the anterior part of the bone flexure. This resulted at 18 months in an elbow arc of motion of 60°–110° and forearm pronation/supination of 40° and 60° without postoperative complications and improved disabilities of the arm, shoulder and hand and Hand 20 scores. Radiographic analysis revealed a humeroradial joint with a maintained pseudarthrosis and hinged motion at the humeroulnar joint. When performed by an experienced surgeon, resection arthroplasty corrects humeroradial synostosis, resulting in improvement in range of motion and quality of life. Level of Evidence: Level V (Therapeutic) [ABSTRACT FROM AUTHOR]

Purpose: To determine outcomes following surgical management of terrible triad injuries in patients treated with and without a hinged elbow orthosis (HEO) in the post-operative setting. Methods: This study was a retrospective review of 41 patients who underwent surgical treatment of terrible triad injuries including radial head fracture, coronoid fracture, and ulnohumeral dislocation between 2008 and 2023 with at least 10-week follow-up. Results: Nineteen patients were treated post-operatively without HEO, and 22 patients were treated with HEO. There were no differences in range of motion (ROM) between patients treated with and without HEO in final flexion–extension arc (118.4° no HEO, 114.6° HEO, p = 0.59) or pronation–supination arc (147.8° no HEO, 141.4° HEO, p = 0.27). Five patients treated without HEO and one patient treated with HEO returned to the operating room for stiffness (26%, 5%, p = 0.08). QuickDASH scores were similar between groups (p = 0.69). Conclusions: This study found no difference in post-operative ROM, complications, or QuickDASH scores in patients treated post-operatively with or without HEO. Based on these results, we cannot determine whether the use of HEO adds additional stability to the elbow while initiating ROM exercises post-operatively. [ABSTRACT FROM AUTHOR]

Surgical experience is often reflected by efficient, fluid, and well-calculated movements. For a new trainee, learning these characteristics is possible only by observation as there is no quantification system to define these factors. We analyzed surgeons' hand movements with different experience levels to characterize their movements according to experience. Hand motions were recorded by an inertial measurement unit (IMU) mounted on the hands of the surgeons during a simulated surgical procedure. IMU data provided acceleration and Eulerian angles: yaw, roll, and pitch corresponding to hand motions as radial/ulnar deviation, pronation/supination, and extension/flexion, respectively. These variables were graphically depicted and compared between three surgeons. Participants were assigned to three groups based on years of surgical experience: group 1: >15 y; group 2: 3-10 y; and group 3: 0-1 y. Visualization of the roll motion, being the main motion during suturing, showed the clear difference in fluidity and regularity of the movements between the groups, showing minimal wasted movements for group 1. The angle of the roll motion, measured at the minimum, midpoint, and maximum points was significantly different between the groups. As expected, the experienced group completed the procedure first; however, the acceleration was not different between the groups. Surgeons' hand movements can be easily characterized and quantified by an IMU device for automatic assessment of surgical skills. These characteristics graphically visualize a surgeon's regularity, fluidity, economy, and efficiency. The characteristics of an experienced surgeon can serve as a training model and as a reference tool for trainees. [ABSTRACT FROM AUTHOR]

Introduction: Distal radioulnar joint (DRUJ) instabilities are challenging and their optimal treatment is controversial. In special cases or when reconstruction of the stabilizing triangular fibrocartilage complex (TFCC) fails, K-wire transfixation can be performed. However, no consensus has been reached regarding the rotational position of the forearm in which this should be done. Therefore, it was investigated whether anatomical reduction would best be achieved by transfixation in neutral position or supination of the forearm. Materials and methods: Twelve cadaveric upper limbs were examined before dissection of the DRUJ stabilizing ligaments and after closed transfixation in both positions by C-arm cone-beam CT. Whether this was first done in neutral position or in supination was randomized. The change in the radioulnar ratio (RR) in percentage points (%points) was analyzed using Student's t-test. RR was used since it is a common and sensitive method to evaluate DRUJ reduction, expressing the ulnar head's position in the sigmoid notch as a length ratio. Results: The analysis showed an increased change in RR in neutral position with 5.4 ± 9.7%points compared to fixation in supination with 0.2 ± 16.1%points, yet this was not statistically significant (p = 0.404). Conclusions: Neither position leads to a superior reduction in general. However, the result was slightly closer to the anatomical position in supination. Thus, transfixation of the DRUJ should be performed in the position in which reduction could best be achieved and based on these data, that tends to be in supination. Further studies are necessary to validate these findings and to identify influential factors. [ABSTRACT FROM AUTHOR]

Introduction: Innovative instruments have been designed to assess forearm rotation, an anatomically challenging motion to measure. This study assessed the concurrent validity, interrater reliability and responsiveness of a novel goniometer watch (GoWatch) to measure pure forearm rotation. The modified finger goniometer (MFG) was the criterion reference. Methods: Forty participants with restricted forearm rotation were recruited. Two raters measured supination and pronation using the GoWatch and MFG before and after a hand therapy session. Repeated-measures ANOVA assessed for systematic bias with an apriori residual error of 5° deemed as acceptable. Secondary analysis used intraclass coefficients (ICCs) to categorise interrater reliability. Responsiveness of the GoWatch was calculated using Cohen's d Results: The GoWatch demonstrated acceptable agreement with the MFG with a mean difference for supination 1.19° and pronation 0.20°. Interrater reliability was also within acceptable limits with a mean difference GoWatch supination 4.43° and pronation 2.23°. Interrater reliability for GoWatch supination and pronation were categorized as excellent (ICC = 0.94) and good (ICC = 0.85) respectively. Systematic bias was observed in the instrument by rater interaction with rater two consistently underestimating GoWatch measures (p <.05). GoWatch supination showed small to medium responsiveness (Rater 1: d = 0.14; Rater 2: d = 0.29) and pronation very small to medium responsiveness (Rater 1: d = 0.29; Rater 2: d = 0.05). Conclusion: The GoWatch is a viable and user-friendly alternative to measure forearm rotation with demonstrable validity, interrater reliability and responsiveness. Further research is required to ensure systematic bias is not endemic when used across multiple raters. [ABSTRACT FROM AUTHOR]

Background: The Latarjet procedure is an effective shoulder stabilizing surgery, however, the procedure results in an alteration of anatomy that may result in shoulder and elbow weakness. Thus, the purpose of this study was to assess post-operative shoulder and elbow strength after the Latarjet procedure. We hypothesized that shoulder and elbow strength are not affected after the procedure. Methods: The study group consisted of patients that had undergone the arthroscopic Latarjet procedure. An isokinetic dynamometer was used to evaluate the strength of bilateral shoulder internal rotation, elbow flexion, forearm supination using peak torque (N/m), as well as grip strength (kilograms). Shoulder range of motion and the potential effects of hand dominance were further analysed. Results: Nineteen patients with a mean age of 29 years and an average follow up of 47 months were included. Shoulder internal rotation strength, elbow flexion and forearm supination strength and grip strength were not significantly different when compared to the non-operative side (p > 0.13). The range of shoulder external rotation was significantly reduced (p < 0.001) on the Latarjet side. Conclusion: The results from this study demonstrate no statistically significant differences in the strength of shoulder internal rotation, elbow flexion, forearm supination or grip strength despite the surgical alterations to the subscapularis and conjoint tendon. [ABSTRACT FROM AUTHOR]

BACKGROUND: In children with cerebral palsy (CP), fine motor skills limit forearm supination and active extension of the elbow, wrist, or fingers. Therapeutic interventions focusing on improving the ranges at these joints while facilitating active movements are the key to augmenting fine motor skills. OBJECTIVE: This pilot study examines if children with CP (with UE involvement) exposed to the Novel Hand Rehabilitation (NHR) Board will demonstrate 1) changes in spasticity and passive ROM of forearm and wrist/finger muscles, and 2) improvement in fine motor abilities. METHODS: The forearm and wrist/fingers of children with spastic CP (N = 15; M = 7, F = 8) aged 49–72 months (65.33±6.355 months) were positioned on the NHR board till their tolerance limit or a minimum duration of 30 minutes. The outcome measures, i.e., spasticity (Modified Ashworth Scale), passive range of motion (PROM) of wrist and fingers, and fine motor skills (PDMS-2 - Fine motor scale), were recorded. RESULTS: The spasticity of forearm pronators (0.001) and wrist flexors (0.008) reduced significantly, but not in wrist extensors. Post-intervention improvements in wrist extension (p = 0.005) and ulnar deviation ROM (p = 0.007) were significant. In thumb, changes were non-significant for the CMC flexion, but extension (0.003) and abduction (0.001) as well as MCP extension (0.004) were significant. The post-intervention MCP extension ROM for the 2nd (0.001), 3rd (0.007), and 4th fingers (0.014) were also substantial, but not for PIP and DIP joints. The post-intervention percentage change in the Grasping and Visual-motor integration subtests of PDMS-2 was 11.03% (p = 0.002) and 5.09% (p = 0.001) respectively. CONCLUSION: The immediate effects on fine motor skills in children with CP after the NHR board application were positive and encouraging. Hence, the NHR board can be recommended as an intervention to improve the fine motor abilities of children with CP. [ABSTRACT FROM AUTHOR]

The research aims to increase the efficiency of the training process for young tennis players old based on lateral epicondylitis secondary prevention methods. Tennis players with apparent residual effects of lateral epicondylitis were selected for the study and divided into experimental (18 boys and 14 girls) and control groups (18 boys and 13 girls). The experimental group was trained according to the developed technique, and the control group as per standard one. The results of goniometry in the experimental group showed the normalization of the motion amplitude in extension and supination. The motor density of the training session applying the complex technique for the secondary prevention of lateral epicondylitis in the experimental group increased on average from 66.6% to 82.2% in boys and from 65.7% to 80.0% in girls. [ABSTRACT FROM AUTHOR]

Background: Lateral epicondylitis is considered to be the most prevalent overuse injury which affects 1% to 3% of the total population among all age groups and genders. The tendon of extensor carpi radialis brevis gets affected and can be strengthened by resistance exercises. It also affects plumbers, carpenters, housewives etc. The daily activities are interrupted which increases pain in lateral epicondylitis can be treated conservatively and surgically. Purpose: To compare the effectiveness of concentric vs Eccentric training programs for lateral epicondylitis by reducing pain. Materials and Methods: 68 subjects were selected from Active physio care physiotherapy clinic based on the inclusion and exclusion criteria. The detailed procedure for performing the study was explained to the subjects, and the informed consent form was collected from them before starting the study. The pre and post test values were measured using the numerical pain rating scale (NPRS) and pain rated tennis elbow evaluation (PRTEE). The subjects selected based on the inclusion and exclusion criteria were divided into two groups: concentric group and Eccentric group (n = 34). Study period: November 2022 to April 2023. Results: Statistical analysis of numerical pain rating scale and pain rated tennis elbow evaluation post test result revealed that both groups show similar effect but Eccentric exercise Group (Group B) exceeds Concentric Exercise group (Group A) with p VALUE of p<0.0001. Conclusion: When comparing the concentric group to the Eccentric group, the Eccentric group indicates significant effects in improving the strength of the elbow, improving the functional activity and strength of the forearm [ABSTRACT FROM AUTHOR]

Background: Flat foot is a condition in which the Medial longitudinal arch (MLA) has a more flattened curve when foot makes full contact with the ground. In medical terms, flat foot is associated with the pronated foot. For people ages 20 to 60, flat foot prevalence is 13.6%. People who have weak posterior tibial tendons are more likely to have flat feet and Flat foot is one of the contributing factors to development of anterior knee pain. Purpose: To compare the effectiveness of Tibialis posterior strengthening exercise and Quadriceps strengthening exercise among people with anterior knee pain. Materials and Method: The experimental study included 170 volunteers, both male and female, aged 20-60 years, who were drawn from Martin Physiotherapy Clinic by convenience sample method. informed consent was obtained before beginning the study. The participants were divided into two groups, the Tibialis posterior (n=85) group received Tibialis posterior strengthening exercise, whereas the Quadriceps (n=85) group received Quadriceps strengthening exercise. The intervention was administered five times over the course of six weeks. Study Period: March 2023 to July 2023. Results: The collected data was statistically analysed using paired and unpaired t-test, showed significant improvement in Tibialis posterior group than quadriceps group with p<0.0001. Conclusion: The study concludes that Tibialis posterior strengthening was more effective in reducing pain and improving functional status among peoples with anterior knee pain. [ABSTRACT FROM AUTHOR]

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