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Purpose The present study analyses the kinematics of patients with neck problems and healthy controls by estimation of Finite Helical Axis behaviour. A cross sectional study design was used to investigate whether FHA behaviour differs due to neck problems. Methods: 584 subjects were recruited from private and ambulatory institutional physiotherapy practices. Among these 171 patients with neck related problems were selected based on referral diagnosis by primary care general practitioners. Cervical kinematics were compared based on minimal convex hull, path length and mean angle of the Finite Helical Axis distribution as well as on the helical angle. Three active planar motions were registered: flexion–extension, axial rotation and lateral bending. Results: Patients demonstrated a significantly reduced and less variable behaviour of the Finite Helical Axis during active flexion–extension and axial rotation motions as compared to healthy individuals and lateral bending. Conclusion: Patients with neck related problems demonstrate a more restricted motion behaviour with less variability in Finite Helical Axis distribution and orientation during active planar motions. At present it is not clear whether these kinematic differences are the result or the cause of dysfunction. Graphic abstract: These slides can be retrieved under Electronic Supplementary Material. [Figure not available: see fulltext.]

The objective of the current study was to explore the potential of dynamic computed tomography to detect kinematic changes, induced by sequential sectioning of the lateral collateral ligaments of the ankle, during full motion sequence of the talocrural joint. A custom-made device was used to induce cyclic controlled ankle inversion movement in one fresh frozen cadaver leg. A 256-slice CT scanner was used to investigate four different scenarios. Scenario 1 with all ligaments intact was first investigated followed by sequential section of the anterior talo-fibular ligament (Scenario 2), the calcaneo-fibular ligament (Scenario 3) and posterior talo-fibular ligament (Scenario 4). Off-line image processing based on semi-automatic segmentation and bone rigid registration was performed. Motion parameters such as translation, rotational angles and orientation and position of the axis of rotation were calculated. Differences between scenarios were calculated. Progressive increase of cranio-caudal displacement up to 3.9 mm and flexion up to 10° compared to Scenario 1 were reported. Progressive changes in orientation (up to 20.6°) and position (up to 4.1 mm) of the axis of rotation were also shown. Estimated effective dose of 0.005 mSv (1.9 mGy CTDIvol) was reported. This study demonstrated that kinematic changes due to the absence of ligament integrity can be detected with 4DCT with minimal radiation exposure. Identifying abnormal kinematic patterns could have future application in helping clinicians to choose patients’ optimal treatment. Therefore, further studies with bigger in vitro sample sizes and consequent investigations in vivo are recommended to confirm the current findings.

Evaluating musculoskeletal conditions of the lower limb and understanding the pathophysiology of complex bone kinematics is challenging. Static images do not take into account the dynamic component of relative bone motion and muscle activation. Fluoroscopy and dynamic MRI have important limitations. Dynamic CT (4D-CT) is an emerging alternative that combines high spatial and temporal resolution, with an increased availability in clinical practice. 4D-CT allows simultaneous visualization of bone morphology and joint kinematics. This unique combination makes it an ideal tool to evaluate functional disorders of the musculoskeletal system. In the lower limb, 4D-CT has been used to diagnose femoroacetabular impingement, patellofemoral, ankle and subtalar joint instability, or reduced range of motion. 4D-CT has also been used to demonstrate the effect of surgery, mainly on patellar instability. 4D-CT will need further research and validation before it can be widely used in clinical practice. We believe, however, itis here to stay, and will become a reference in the diagnosis of lower limb conditions and the evaluation of treatment options. Cite this article: Bone Joint J 2021;103-B(5):822-827.

Two simulation experiments are presented to gauge the accuracy of a new inverse kinematics method based on Bayesian inference (BIK; Pataky et al., 2019 , J Biomech) in more realistic models than were considered previously. The first application concerns planar kinematics in the presence of soft-tissue artefacts and the second application concerns rigid body kinematics in 3D with finite helical axes (FHA). The percentage of simulations in which BIK was more accurate than least-squares based methods was only high in cases of relatively large noise magnitudes (noise SD > 5 mm) or when the rotation magnitude was very small ( ⩽ 5 deg) in the 3D FHA model. Correlated parameters are the likely culprit of the low performance of BIK. Also computation time is a major deficit of the BIK approach ( ± 20 s for the movement between two time frames). These results indicate that more research will be necessary to improve the accuracy of BIK for complex biomechanical models at realistic noise levels and to reduce computation time.

Background Understanding the 3D-kinematics of the upper cervical spine during manual mobilization is essential for clinical examination and therapy. Some information about rotational motion is available in literature but translational components are often ignored, complicating the understanding of the complex inter-segmental motions. Objectives This study aims to describe the amount, trajectories and reproducibility of atlanto-occipital facet joints’ displacement during a flexion-extension mobilization and of the atlanto-axial facet joints during an axial rotation mobilization. Design Original research using quantitative data. Methods 20 fresh frozen human cervical specimens were examined with a Zebris® CMS20 ultrasound-based motion tracking system. Two physiotherapists performed regionalmobilizations in flexion-extension and axial rotation. The amount of displacement and the trajectories were calculated along the XYZ axes. Difference between measurements was evaluated with the Friedman two-way ANOVA test. Intra- and inter-rater reliability were estimated through ICC scores. Results 3D-displacement (2.6–23.4 mm) was larger at C1–C2 during axial rotation, Atlanto-occipital flexion displayed the greatest variability in the C0 trajectory. During a right rotation, the left C1 facet moved mainly forward, and the right C1 facet moved backward. During a left rotation, the left C1 facet moved backward, while the right C1 facet moved forward. Intra-tester and Inter-tester ICCs varied between 0.5 and 0.90 (p Conclusions During passive spinal motion, there is an important variability in magnitude and trajectory of joints’ displacement. Nevertheless, different clinicians may be able to achieve the same position at the end of the mobilization.

Background: A cross-sectional observational study of three-dimensional cervical kinematics in 35 non-specific neck pain patients and 100 asymptomatic controls. To compare qualitative and quantitative aspects of cervical kinematics between healthy subjects and subjects with non-specific neck pain and to determine the effect of age on cervical kinematics in healthy subjects. Methods: Three-dimensional kinematics of active lateral bending and flexion-extension of 35 patients and 100 controls were registered by means of an electromagnetic tracking system. The means of several kinematic parameters were compared using t-tests. In addition, we assessed the age-dependency of the three-dimensional kinematic parameters by stratifying the 100 control subjects in 6 age categories. Findings: Comparison of the patient group with the control group reveals no statistically significant differences in qualitative and quantitative parameters. Analysis of the effect of age showed that the range of motion decreases significantly (p < 0.01) with increasing age. In lateral bending, the ratio between axial rotation and lateral bending increases significantly (p < 0.01) among older subjects. Differences in acceleration, jerk and polynomial fit are seen between the age categories, but are not significant. Interpretation: This study demonstrates no significant differences in kinematic parameters between healthy subjects and subjects with non-specific neck pain. Healthy subjects in higher age categories demonstrate higher ratios of coupled movements and lower ranges of motion. Future research should focus on classifying patients with non-specific neck pain in order to gain a better insight on possible subgroup specific differences in kinematics. More studies on this subject are warranted. Level of evidence: 4.

Purpose To identify the different fatigue items in existing frailty scales. Methods PubMed, Web of Knowledge and PsycINFO were systematically screened for frailty scales. 133 articles were included, describing 158 frailty scales. Fatigue items were extracted and categorized in 4 fatigue constructs: “mood state related tiredness”, “general feeling of tiredness”, “activity based feeling of tiredness” and “resistance to physical tiredness”. Results 120 fatigue items were identified, of which 100 belonged to the construct “general feeling of tiredness” and only 9 to the construct “resistance to physical tiredness”. 49,4% of the frailty scales included at least 1 fatigue item, representing 15 ± 9,3% of all items in these scales. Fatigue items have a significantly higher weight in single domain (dominantly physical frailty scales) versus multi domain frailty scales (21 ± 3.2 versus 10.6 ± 9.8%, p= Conclusion Fatigue is prominently represented in frailty scales, covering a great diversity in fatigue constructs and underlying pathophysiological mechanisms by which fatigue relates to frailty. Although fatigue items were more prevalent and had a higher weight in physical frailty scales, the operationalization of fatigue leaned more towards psychological constructs. This review can be used as a reference for choosing a suitable frailty scale depending on the type of fatigue of interest.

Objectives: The aim of this study was to validate an ultrasound protocol for evaluating the anterolateral ligament of the knee. Methods: A Thiel technique cadaveric specimen was used to validate an optimal scanning position and develop an ultrasound protocol to evaluate the anterolateral ligament. Three musculoskeletal sonographers acquired short- and long-axis images of the anterolateral ligament in 36 knees from 18 healthy volunteers. Anterolateral ligament length, thickness, width, and distance between anterolateral ligament insertion and lateral tibia plateau were measured. Intraclass Correlation Coefficient (ICC) was calculated. Results: The inter-rater reliability for anterolateral ligament thickness was poor, ICC = 0.35 (95% CI: –0.06–0.63). The inter-rater reliability for anterolateral ligament length and width was good, ICC = 0.80 (95% CI 0.64–0.89), ICC = 0.88 (95% CI 0.79–0.94), respectively; and the inter-rater reliability for the distance between insertion and lateral tibia plateau was excellent, ICC = 0.96 (95% CI 0.93–0.98). Conclusions: Ultrasonography is a reliable method for evaluating the anterolateral ligament. There is an excellent reliability for the distal part of the anterolateral ligament. As injuries usually occur in this part of the ligament, this protocol may be used to evaluate the anterolateral ligament in patients with suspected anterior cruciate ligament tears in clinical practice.

BACKGROUND: Repetitive actions while playing piano may overload forearm muscles and tendons, leading to playing-related musculoskeletal disorders (PRMDs), including lateral epicondylitis. METHODS: In this pilot study, surface electromyography (sEMG) activity of the extensor carpi radialis (ECR) was captured in 10 conservatory piano students while playing a fast and a slow music score selected from the individual’s repertoire, each 3 minutes long. Measurements were made at baseline and again after 2 hrs and 4 hrs of rehearsal time of the piano études. The amplitude of the sEMG signal was processed by a smoothing algorithm, and the frequency component with a non-orthogonal wavelets procedure. Amplitude of the sEMG was expressed in percent of maximal voluntary contraction (%MVC) at baseline. Statistical analysis encompassed 2-way repeated measures ANOVAs for the amplitude and frequency components of the sEMG signal (a set at 5%). The students also rated the intensity of rehearsals using a VAS. RESULTS: The ECR presented with a mean amplitude of 23%MVC for the slow scores, which increased significantly to 36%MVC for the fast scores. The sEMG signal presented a significant though small decrease of 1.9%MVC in amplitude between baseline and 4 hrs of rehearsal time and no shift in frequency, which may indicate that the rehearsals were held at a physiological steady-state and suggesting optimization or complementary muscle loading. CONCLUSIONS: These data accentuated that the loading of the ECR (as reflected in the amplitude component) was higher than that seen for computer keyboard workers. The augmented loading of the ECR and reduced blood flow to forearm muscles may be a factor in the development of PRMDs in pianists.

Gait disorders represent a therapeutic challenge in Parkinson’s disease (PD). This study investigated the efficacy of 4-week action observation training (AOT) on disease severity, freezing of gait and motor abilities in PD, and evaluated treatment-related brain functional changes. 25 PD patients with freezing of gait were randomized into two groups: AOT (action observation combined with practicing the observed actions) and “Landscape” (same physical training combined with landscape-videos observation). At baseline and 4-week, patients underwent clinical evaluation and fMRI. Clinical assessment was repeated at 8-week. At 4-week, both groups showed reduced freezing of gait severity, improved walking speed and quality of life. Moreover, AOT was associated with reduced motor disability and improved balance. AOT group showed a sustained positive effect on motor disability, walking speed, balance and quality of life at 8-week, with a trend toward a persisting reduced freezing of gait severity. At 4-week vs. baseline, AOT group showed increased recruitment of fronto-parietal areas during fMRI tasks, while the Landscape group showed a reduced fMRI activity of the left postcentral and inferior parietal gyri and right rolandic operculum and supramarginal gyrus. In AOT group, functional brain changes were associated with clinical improvements at 4-week and predicted clinical evolution at 8-week. AOT has a more lasting effect in improving motor function, gait and quality of life in PD patients relative to physical therapy alone. AOT-related performance gains are associated with an increased recruitment of motor regions and fronto-parietal mirror neuron and attentional control areas.

Objectives: Biomechanical mechanisms underlying passive joint techniques commonly used in musculoskeletal medicine such as mobilisation and manipulation are largely unknown. We aimed to visualise and measure in vivo time-dependent changes in the volume or distribution of synovial fluid after passive joint movements. Methods: Experiments were conducted in three healthy subjects using magnetic resonance imaging (MRI) and ultrasonography (US) for visualising and measuring synovial fluid volume and distribution in joints of the upper cervical spine, the knee joints, and the metacarpophalangeal joints of the second and third fingers up to 60 minutes before and after passive motion assessment, mobilisation, and/or high-velocity, low-amplitude thrust manipulation. Results: MRI could not detect any fluid in the articular space of the lateral atlanto-axial joints. Using US, the antero-posterior diameter of the suprapatellar recess was decreased from 11.0 to 9.0 millimetres in one subject 30 minutes after mobilisation of the knee. US imaging of the palmar recesses of the metacarpophalangeal joints was found insufficiently reproducible. Conclusions: In our experiments, current techniques for MRI and US were not appropriate for visualisation and measurement of in vivo time-dependent changes, if any, in the volume or distribution of synovial fluid after passive joint movements. As a limitation, we did not estimate any measurement error of US. New, innovative research is needed to generate evidence on the biomechanical effects of passive joint techniques commonly used in musculoskeletal medicine.

The Palmaris longus muscle can be absent unilateral or bilateral in about 22.4% of human beings. The aim of this study is to investigate whether the presence of the Palmaris longus muscle is associated with an advantage to handgrip in elite tennis players compared to recreational athletes. Sixty people participated in this study, thirty elite tennis players and thirty recreational athletes. The presence of the Palmaris longus muscle was first assessed using different tests. Grip strength and fatigue resistance were measured by an electronic hand dynamometer. Proprioception was registered by the Flock of Birds electromagnetic tracking system. Three tests were set up for measuring proprioception: joint position sense, kinesthesia, and joint motion sense. Several hand movements were conducted with the aim to correctly reposition the joint angle. Results demonstrate a higher presence of the Palmaris longus muscle in elite tennis players, but this was not significant. Maximal grip strength was correlated with gender and only on the dominant side, it was also correlated with age. Fatigue resistance showed only on the non-dominant side, a significant difference in elite and recreational athletes. In proprioception there was no correlation with elite and recreational athletes or the presence of the Palmaris longus muscle.

Objectives: The frequently used prediction equations of body mass do not seem appropriate for elderly individuals. Here, we establish the relationship between femoral dimensions and known body mass in elderly individuals in order to develop prediction formulas and identify the factors affecting their accuracy. Materials and Methods: The body mass linear least-squares regression is based on 17 femoral dimensions, including femoral volume, and 66 individuals. Body proportion and composition effects on accuracy are analyzed by means of the body mass index (BMI) and on a subset sample (n525), by means of the masses of adipose, bone and muscle tissues. Results: Most variables significantly reflect body mass. Among them, six dimensions (e.g., biepicon- dylar breadth, femoral volume, and head femoral diameter) present percent standard errors of estimate ranging from 9.5 to 11% (r50.72–0.81) in normal BMI samples. Correlations are clearly lower in samples with normal and abnormal BMI [r50.38–0.58; % of standard error of estimate (SEE)517.3–19.6%] and not significantly correlated in females (femoral volume) who present high proportions of abnormal BMI and adipose tissue. In the subset, femoral volume is well correlated with bone mass (r50.88; %SEE57.9%) and lean body mass (r50.67; %SEE517.2%). Discussion: Our body mass estimation equations for elderly individuals are relevant since relatively low correlations are recurrent in studies using younger individuals of known body mass. However, age, sex, lifestyle, and skeleton considerations of studied populations can provide information about the relevance of the body mass estimation, which is dependent on the BMI classification and the proportion of adipose tissue. Our general considerations can be used for studies of younger individuals.

BACKGROUND: There is a lack of valid, reliable, and feasible instruments for measuring planar active cervical range of motion (aCROM) and associated 3D coupling motions in patients with neck pain. Smartphones have advanced sensors and appear to be suitable for these measurements.OBJECTIVES: To estimate the concurrent validity and interrater reliability of a new iPhone application for assessing planar aCROM and associated 3D coupling motions in patients with neck pain, using an electromagnetic tracking device as a reference test.DESIGN: Cross-sectional study.METHODS: Two samples of neck pain patients were recruited; 30 patients for the validity study and 26 patients for the reliability study. Validity was estimated using intraclass correlation coefficients (ICCs), and by calculating 95% limits of agreement (LoA). To estimate interrater reliability, ICCs were calculated. Cervical 3D coupling motions were analyzed by calculating the cross-correlation coefficients and ratio between the main motions and coupled motions for both instruments.RESULTS: ICCs for concurrent validity and interrater reliability ranged from 0.90 to 0.99. The width of the 95% LoA ranged from about 5° for right lateral bending to 11° for total rotation. No significant differences were found between both devices for associated coupling motion analysis.CONCLUSIONS: The iPhone application appears to be a useful discriminative tool for the measurement of planar aCROM and associated coupling motions in patients with neck pain. It fulfills the need for a valid, reliable, and feasible instrument in clinical practice and research. Therapists and researchers should consider measurement error when interpreting scores.

Objective To perform an MR imaging-anatomical correlation to elucidate the anatomy of muscles, tendons, and ligaments about the hallux as seen on MR imaging. Materials and methods Four fresh and 4 embalmed cadaver specimens were used for this study. The embalmed specimens and one fresh specimen were dissected by three investigators. The fresh specimens were preserved deep frozen. They were thawed and imaged with a 3 T MR system. Proton density weighted images were obtained. The specimens were refrozen and sectioned with a band saw into 3 mm thick slices. Results Musculotendinous structures were equally well seen in the fresh and embalmed specimens. The capsular ligaments could best be studied in the fresh specimens. Proximal to the sesamoids the following muscle and tendon anatomy was delineated: the abductor hallucis tendon inserted on the medial sesamoid bone together with the medial belly of the flexor digitorum brevis; the adductor hallucis (transverse and oblique heads) inserted on the lateral sesamoid together with the lateral head of the flexor hallucis brevis. At the level of the sesamoid bones and distally, the ligaments making up the plantar plate were delineated, including the presesamoid band, the flexor hallucis longus pulley, the sesamometatarsal ligaments, the sesamophalangeal ligaments, and the capsular ligaments. Conclusion MRI allows for accurate assessment of the complex anatomy of the hallux. At the level proximal to the sesamoids the muscle and tendon insertions are well demonstrated. At the level of the sesamoids and distally, the ligaments making up ‘the plantar plate’ are well demonstrated.

Purpose: Investigate the potential of 4D-CT to detect kinematic changes induced by sequential lateral ankle ligament section. Methods and Materials: The tibia of two fresh frozen specimens were fixed on a custom-made device and the ankle joint was moved at a pace of 25 cycles/minute. The Anterior Talo-Fibular Ligament, the Calcaneo-Fibular Ligament and the Posterior Talo-Fibular Ligament were cut sequentially. Dynamic-CT scan image datasets of the intact ankle and after each ligament cut were acquired with a 256-slice GE Revolution CT-Scanner (80kV,25mA,tube rotation time 0.28s,z-axis coverage 120mm,scanning-time 3.92s). Rigid registrations of single bones (tibia,talus and calcaneus) were performed and transformation matrixes were derived. Using the global reference frame of the CT (x,y,z), the talo-crural (motion of talus relative to the tibia) and sub-talar (motion of calcaneus relative to the talus) joint kinematics were described as displacement of the centroid of the talus and calcaneus respectively. Radiation dose was also recorded. Results: The difference between the displacement of the intact ankle and the cut scenarios was up to 2.90mm, 1.19mm, 1.37mm (sub-talar joint) and up to 2.63mm, 2.58mm, 5.46mm (talo-crural joint) for the x,y,z axes respectively. Comparing the intact and injured ankle, deflections in the centroid displacements curves occurred at different time points. Each acquisition required a radiation dose (CTDIvol) of 1.9mGy. Conclusion: The present study showed that low dose 4D-CT may allow to detect motion changes of the talo-crural and sub-talar joint induced by lateral ankle ligament lesions. This highlights the potential of 4D-CT to investigate dynamic functional joint laxity.

Objective: The purpose of the present study was to measure changes in blood flow velocity and volume flow rate (VFR) in the contralateral vertebral artery (VA) during end-range rotation and pre-manipulative hold at C1-C2 and to compare these measurements between participants with and without C1-C2 range of motion (ROM) restriction. Methods: This research was approached as an exploratory study and designed as a parallel noninterventional controlled trial with intentionally equal allocation, for studying diagnostic tests. Fifteen women and 13 men (mean age 44) were recruited (volunteer sample) in physiotherapy clinics. No participant had any current neurologic or vertebrobasilar insufficiency symptoms. The measurements of 13 participants with a limited ROM C1-C2 and 15 with no limitation were compared. Blood flow velocity and VFR in the contralateral VA were measured using color duplex Doppler imaging in 3 neck positions: neutral, maximal rotation, and pre-manipulative hold of C1-C2. Results: Pre-manipulative hold significantly (P

OBJECTIVE: To evaluate the involvement of the iliotibial band (ITB), the anterolateral ligament (ALL), and the anterior arm of the biceps femoris in MRI-diagnosed Segond fracture and to evaluate other associated findings of Segond fracture. MATERIALS AND METHODS: We retrospectively reviewed the MRI of 13 cases of Segond fracture. The studies included proton density-weighted, T2-weighted, and proton density-weighted with fat saturation images in the three planes. We studied 2 cadaveric specimens with emphasis on the ALL. One cadaveric specimen was dissected while the other was sectioned in the sagittal plane. RESULTS: The mean age of the patients was 36 years (range, 17-52). There were 7 men and 6 women. The mean size of the Segond bone fragment was 8?×?10?×?2 mm. The distance from the tibia varied from 2 to 6 mm. Associated findings included anterior cruciate ligament (ACL) tear (n?=?13), medial collateral ligament (MCL) tear (n?=?8), meniscocapsular tear of the posterior horn of the medial meniscus(n?=?5), and posterolateral corner involvement (n?=?4). Bone marrow edema involved the mid-lateral femoral condyle and the posterior tibial plateau on both the medial and the lateral side. Edema at the Segond area was seen, but was limited. Fibular head edema was also seen. The ITB (11 out of 13) and ALL (10 out of 13) inserted on the Segond bone fragment. The anterior arm of the biceps tendon did not insert on the Segond fracture. CONCLUSION: Associated findings of Segond fracture include ACL tear, MCL tear, medial meniscus tear, and posterolateral corner injury. Both the ITB and the ALL may be involved in the Segond avulsion. The anterior arm of the biceps femoris tendon is not involved.

Action observation and execution activate regions that are part of the motor and mirror neuron systems (MNS). Using functional magnetic resonance (fMRI), we defined the presence and extent of MNS activation during three different motor tasks with the dominant, right-upper limb in healthy individuals. The influence of the modality of task administration (execution, observation, observation and execution) was also investigated. fMRI scans during the execution (E) of a motor task, the observation (O) of a video showing the same task performed by another person and the simultaneous observation and execution (OE) of the task were obtained from three groups of healthy subjects (15 subjects per group) randomized to perform: a simple motor (SM) task, a complex motor (CM) task and a finalistic motor (FM) task. Manual dexterity was assessed using the 9-hole peg test and maximum finger tapping frequency. MNS activation was higher during FM than SM or CM tasks, independently from the modality of administration (E, O, or OE). Inferior frontal gyrus recruitment was more significant during SM than CM tasks in the E and O conditions. Compared to SM and FM, CM task resulted in increased recruitment of brain regions involved in complex motor task performance. Compared to O and E, OE resulted in the recruitment of additional, specific, brain areas in the cerebellum, temporal and parietal lobes. The modality of administration and the type of task modulated MNS recruitment during motor acts. This might have practical implications for the set-up of individualized motor rehabilitation strategies.

Introduction. Knowledge about facet morphology has already been discussed extensively in literature but is limited regarding asymmetry and its relation to facet degeneration. Method. Facet dimensions, surface area, curvature, and degeneration of the superior facets were measured in 85 dried human vertebrae from the anatomical collection of the Vrije Universiteit Brussel. The vertebrae were analysed using the Microscribe G2X digitizer (Immersion Co., San Jose, CA) and a grading system for the evaluation of cervical facet degeneration. Coordinates were processed mathematically to evaluate articular tropism. The statistical analysis includes the paired t-test and the Pearson correlation. Results. On average, no systematic differences between the left and right facets were found concerning morphology and degeneration. However, there were significant differences regardless of the side-occurrence. There was a significant correlation between the dimensions of the total facet surface and the degree of degeneration but not for the recognizable joint surface. Conclusions. Facet tropism of the upper joint facets occurred often in the cervical spine but without side preference. A bigger difference in degeneration asymmetry was associated with a bigger difference in facet joint dimension asymmetry.

The purpose of this study was to investigate the influence of thoracic high-velocity low-amplitude thrust (HVLAT) manipulation on quantitative and qualitative 3-dimensional cervical spine kinematic patterns in a subgroup of patients with acute neck pain.Thirty patients with acute neck pain, aged 20 to 59, received a thoracic HVLAT manipulation. Three-dimensional kinematics of the cervical spine were registered pretreatment and posttreatment using an electromagnetic tracking system. Quantitative and qualitative parameters were calculated for axial rotation, lateral bending, and flexion-extension movement. Subjective pain ratings were measured with the visual analogue scale and the Neck Disability Index and were collected pretreatment and posttreatment.After treatment, the range of motion of the main motion improved significantly for axial rotation (P = .034), lateral bending (P.001), and flexion-extension (P = .031). Although for axial rotation as the main motion, the smoothness of the flexion-extension movement improved significantly after treatment (P = .036), the reverse was true for flexion-extension as the main motion. Visual analogue scale scores exhibited a statistically (P.001) and clinically significant reduction of pain sensation. The mean change in Neck Disability Index scores only exhibited a statistically significant improvement 1 week after treatment.Thoracic HVLAT manipulation led to positive changes in quantitative and qualitative aspects of 3-dimensional cervical spine kinematics. Because of the 1-intervention group design, external factors influencing the healing process could not be eliminated.

Study Design. A cross-sectional observational study of three-dimensional (3D) cervical kinematics in 41 chronic neck pain (CNPs) patients and 156 asymptomatic controls. Objective. The objective was to investigate 3D cervical kinematics by analyzing and comparing quantitative and qualitative parameters in healthy subjects and CNPs. Furthermore, subgroups were formed to explore the influence of pain-location on cervical kinematics. The possible correlation of kinematic parameters with the degree of functional disability was examined as well. Summary of Background Data. In patients with chronic neck pain, a clear pathological cause is frequently not identifiable. Therefore, the need to assess neck pain with a broader view than structure or anatomical-based divergences is desirable. Methods. Movements of the cervical spine were registered using an electromagnetic tracking system. Quantitative and qualitative kinematics were analyzed for active axial rotation, lateral bending, and flexion-extension motion components. Results. During lateral bending, the range of the main motion demonstrated significant higher values (P = 0.001) in the controls (mean: 68.67 degrees +/- 15.17 degrees) than patients (mean: 59.28 degrees +/- 15.41 degrees). Significant differences were demonstrated between subgroups for several kinematic parameters (P

Objectives: To quantify differences in active cervical range of motion (aCROM) between patients with neck pain and those without neck pain, in patients with whiplash-associated disorders (WADs) and nontraumatic neck pain, and in patients with acute complaints versus those with chronic complaints. Data Sources: Seven bibliographic databases were searched from inception to April 2015. In addition, a manual search was performed. Study Selection: Full articles on a numerical comparison of aCROM in patients with neck pain and asymptomatic control persons of similar ages were included. Two reviewers independently selected studies and assessed risk of bias. Data Extraction: Two reviewers extracted the data. Pooled mean differences of aCROM were calculated using a random-effects model. Data Synthesis: The search yielded 6261 hits; 27 articles (2366 participants, 13 low risk of bias) met the inclusion criteria. The neck pain group showed less aCROM in all movement directions compared with persons without neck pain. Mean differences ranged from -7.04 (95% CI, 9.70 degrees to 4.38 degrees) for right lateral bending (11 studies) to -89.59 degrees (95% CI, 131.67 degrees to 47.51 degrees) for total aCROM (4 studies). Patients with WADs had less aCROM than patients with nontraumatic neck pain. No conclusive differences in aCROM were found between patients with acute and patients with chronic complaints. Conclusions: Patients with neck pain have a significantly decreased aCROM compared with persons without neck pain, and patients with WADs have less aCROM than those with nontraumatic neck pain. (C) 2016 by the American Congress of Rehabilitation Medicine

The upper cervical complex is a distinctive spinal area with a great need for mobility as well as stability. The specific anatomical morphology of the atlanto-occipital and of the atlanto-axial joints seems to support these complex functional demands. The present study reports on some systematic and non-systematic observations of specific morphological variations and variants of the upper cervical joint anatomy. They are reported with respect to morphological features of the transverse atlantal and alar ligaments, morphological features of the lateral atlanto-axial and atlanto-occipital joints, additional joint configurations of the atlanto-occipital junction, muscular attachments to the joint capsule of the lateral atlanto occipital joint, and the Processus styloideus in its relationship with movements of the upper cervical joints. The observations mainly confirm general anatomical descriptions from textbooks, although some confront with these basic anatomical configurations mainly due to large morphological variation. Additionally, specific anatomical variants may raise questions on the generally accepted functional anatomical features. Some of these specific morphological configurations may have major implications for the kinematics of the occipito-atlanto-axial complex. This paper intends to reflect on the functional impact of the observed upper cervical morphological variability.

Objectives: Little is currently known on how human ocular volume (OV) relates to body size or composition across adult men and women. This gap was filled in an exploratory study on the path to developing anthropological and physiological models by measuring OV in young healthy adults and related brain, head, and body mass along with major body components. Methods: Thirty-six men and 44 women, ages 20-35 yrs, were evaluated with magnetic resonance imaging and dual-energy X-ray absorptiometry that provided estimates of OV, brain, head, fat, lean soft tissue (LST), and bone mineral mass. Associations between OV and other components were evaluated first followed by development of allometric models relating OV and other components to body size as defined by stature. Results: Mean OV was non-significantly larger in men (X ± SD; 6.35 ± 0.69 cm3) than in women (6.26 ± 0.53 cm3; P=NS), although OV in women was significantly larger relative to brain and head mass than in men (both p

Background Very little is known about the kinematics of the upper cervical spine in particular during Manual Therapy techniques. In fact no data about displacement of the atlanto-axial joint during High-Velocity Low-Amplitude (HVLA) thrust are available. Knowing the precise kinematics of these vertebrae might allow a better comprehension of such important technique and possible vital structures involvement. Methods A Zebris CMS20 ultrasound-based motion tracking system was adopted. Twenty fresh human cervical specimens were used in this study. Facet joint displacements of C1 relative to C2 were analysed during three consecutive HVLA thrusts into rotation. Displacement during the thrust and the maximum displacement reached with the manoeuvre were analysed. Results Descriptive statistics showed a mean Norm displacement during the thrust of 0.5 mm (SD ± 0.5). The maximum displacement, representing the overall facet movement from neutral to end-range position, indicated a Norm value of 6.0 mm (SD ± 3.4). Heterogeneous displacement directions were found during the thrust. Intra and inter-rater reliability reached an insufficient reproducibility level. Considering the amount of displacement induced, no statistical significant differences between the registrations were shown. Conclusion Displacement during the execution of HVLA thrust is unintentional, unpredictable and not reproducible. On the other hand and in accordance with other studies, the displacement induced with the present technique seems not to be able to endanger vital structure on the Spinal Cord and the Vertebral Artery. This study also adds to a better comprehension of the kinematic of the atlanto-axial segment during the performance of HVLA manipulation.

Objective Wrist problems are common in grip sports. To better understand the entrapment symptomatology of the different neurovascular passages of the wrist, an anatomical revision seems necessary because confusion and error has increased lately. This study will focus on the ulnar canal. Comparison of the original description of the canal with definitions emanating from scientific papers, anatomical handbooks and Internet websites reveal various differences, which may create clinical confusion. Design With the original paper of Guyon as a reference, comparison was made (i) with 37 cadavers (74 wrists); (ii) with an Internet search and; (iii) with a bibliographic survey. The dissections allowed for the verification of Guyon's description and were used to illustrate the findings. Results Dissection of 74 wrists confirmed Guyon's original description. Out of the 2559 Internet hits, papers in English, French, German and Dutch were considered, only. The Internet websites and the published material presented an erroneous images and/or explanations. Conclusion Dissection and bibliometry suggest that the canal has received multiple denominations including a confusion with the “canalis pisohamatum”. This confusion is situated on Internet sites, in scientific/clinical papers and in “classical anatomy literature”. A better understanding of this region will undoubtedly enhance our knowledge of entrapment pathologies.

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Background and Purpose. To evaluate the added value of MRI with respect to peripheral quantitative computed tomography (pQCT) and dual energy X-ray absorptiometry (DXA) for predicting femoral strength.Material and Methods. Bone mineral density (BMD) of eighteen femur specimens was assessed with pQCT, DXA, and MRI (using ultrashort echo times (UTE) and the MicroView software). Subsequently biomechanical testing was performed to assess failure load. Simple and multiple linear regression were used with failure load as the dependent variable.Results. Simple linear regression allowed a prediction of failure load with either pQCT, DXA, or MRI in anr2range of 0.41–0.48. Multiple linear regression with pQCT, DXA, and MRI yielded the best prediction (r2=0.68).Conclusions. The accuracy of MRI, using UTE and MicroView software, to predict femoral strength compares well with that of pQCT or DXA. Furthermore, the inclusion of MRI in a multiple-regression model yields the best prediction.

Systema?c reviews have consistently concluded that the inter-examiner reliability of passive assessment of mo?on in joints of the spine, the pelvis, and the extremi?es is unacceptably low.1-8 In addi?on, the methodological quality of the studies included in these reviews was generally poor. Reliability, as a component of reproducibility, reflects the extent to which repeated measurements provide similar results in stable study subjects.9 Therefore, reviewers have aCempted to assess the risk of bias in studies of inter-examiner reliability of passive joint mo?on assessment by determining whether the characteris?c under study, i.e., the joint’s mobility, remained stable during the research. Instability of a joint’s mobility can occur as a result of natural varia?on over ?me or as an effect of the assessment procedure itself poten?ally resul?ng in underes?mated outcomes of reliability. However, empirical evidence for this type of bias is lacking making reviewers’ judgments difficult. Mechanical effects of passive joint interven?ons such as s?ffness changes could be expected to occur rela?vely immediately.10 However, biomechanical mechanisms of manual therapy have only scarcely been inves?gated and the current evidence for the explana?on of effects from passive movementbased interven?ons seems to be in favour of neurophysiological mechanisms.11,12 We hypothesised that poten?al changes in biomechanical proper?es of joints aQer passive movements are due to immediate changes in intra-ar?cular joint pressure and, consequently, in volume or distribu?on of synovial fluid. We used ultrasonography (US) and magne?c resonance imaging (MRI) for visualising and measuring in vivo ?me-dependent changes in synovial fluid volume in joints of the upper cervical spine, the knee joints, and the metacarpophalangeal joints of three healthy human subjects aQer passive joint mo?on assessment, mobilisa?on, and thrust manipula?on. This presenta?on shows the results of these preliminary basic science experiments. Addi?onally, the limita?ons of the study as well as future direc?ves are discussed. The presenta?on concludes by discussing with the audience whether synovia can be a determinant of the poten?al biomechanical effects of manual therapy.

Background Limited radiologic literature is available to calculate the change in CTDIvol by changing the NI as used on the equipment of General Electric (GE, Milwaukee, USA). The guideline from GE provide an increase in noise of 5% and a decrease in mA of 10% per dose step. However, the appropriate NI is not easy to find whenever a substantial change in CTDIvol is desired. Evaluation We scanned 12 cadavers (GE CT750HD Discovery, autokV, dose modulation, slice thickness 0.625 mm, filtered back projection) with decreasing dose till 10% of the initial CTDIvol by adjusting the NI. This resulted in 12 datasets for CT thorax (CTT) and CT abdomen (CTA). The NI (x-axis) and the predicted CTDIvol (y-axis) were described in a graph. The relation between the NI and the CTDIvol is proportional to x^(-2.014 ± 0.039) for CTT and x^(-2.004 ± 0.002) for CTA (R^ = 0.999 ± 0.001, for both). The predicted CTDIvol displayed on the console was compared to the obtained CTDIvol in the dose report in 20 patients (CTT and CTA) in clinical practice. For our equipment, the obtained CTDIvol seemed 0.99 ± 0.01 % of the estimated CTDIvol. Discussion Noise, and by extension the NI, is not the only important parameter in the judgment of image quality. For instance, obese and some older patients have increased intrinsic contrast due to the augmented fat content. A radiologist or dedicated technician might find it appropriate to allow more noise in these patients images. Indeed, they develop an attitude for the right dose for the right indication by experience. The inverse quadratic function provides us with the opportunity to calculate the NI belonging to a certain CTDIvol, from which we know by experience that it results in diagnostic image quality for that patient. CONCLUSION The guideline from GE (see background) is usefull for subtile adjustments of protocols. Whenever a more substantial change in CTDIvol is desired, the relation (CTDIvol/NI^²)_1 = (CTDIvol/NI^²)_2 is recommended to calculate the associated NI more quickly.

Introduction The study of neck kinematics during high-velocity, low-amplitude manipulations of the atlanto-axial segment is essential to understanding cervical motion mechanisms and their impact and possible risk for soft-tissue injuries during treatment of spine disorders. Methods Twenty fresh-frozen specimens were tested during manual application of an axial rotation technique. Findings The kinematics indicate the thrust induced motion components of approximately 1° at the treated segment around all three axes of the local embedded reference frame. Moreover, an equal amount of axial rotation motion took place at the adjacent atlanto-occipital joint. Interpretation Overall atlanto-axial motion remained below the level of slow regional mobilization of the cervical spine. These findings can be correlated to literature data concerning the limited increase in vertebral artery strain during high-velocity, low-amplitude manipulation.

Although the occurrence of muscle spindles (MS) is quite high in most skeletal muscles of humans, few MS, or even absence, have been reported in digastric and mylohyoideus muscles. Even if this condition is generally accepted and quoted in many papers and books, observational studies are scarce and based on histological sections of a low number of specimens. The aim of the present study is to confirm previous data, assessing MS number in a sample of digastric and mylohyoideus muscles. We investigated 11 digastric and 6 mylohyoideus muscles from 13 donors. Muscle samples were embedded in paraffin wax, cross-sectioned in a rostrocaudal direction, and stained using haematoxylin-eosin. A mean of 5.1 ± 1.1 (range 3–7) MS was found in digastric muscles and mean of 0.5 ± 0.8 (range 0–2) in mylohyoideus muscles. A significant difference (P<0.001) was found with the control sample, confirming the correctness of the histological procedure. Our results support general belief that the absolute number of spindles is sparse in digastric and mylohyoideus muscles. External forces, such as food resistance during chewing or gravity, do not counteract jaw-opening muscles. It is conceivable that this condition gives them a limited proprioceptive importance and a reduced need for having specific receptors as MS.