Search

Objective Measuring muscle quantity and quality is very important because the loss of muscle quantity and quality is associated with several adverse effects specifically in older people. Ultrasound is a method widely used to measure muscle quantity and quality. One problem with ultrasound is its limited field of view, which makes it impossible to measure the muscle quantity and quality of certain muscles. In this study, we aimed to evaluate the intra- and inter-rater reliability of extended-field-of-view (EFOV) ultrasound for the measurement of muscle quantity and quality in nine muscles of the limbs and trunk. Methods Two examiners took two ultrasound EFOV images with a linear probe from each of the muscle sites. The intraclass correlation coefficient (ICC) was used, and the standard error of measurement and coefficient of variation were calculated. Results Intra-rater reliability was good to excellent (ICC = 0.2–1.00) for all muscle measurements. The inter-rater reliability for most of the muscle measurements was good to excellent (ICC = 0.82–0.98). Inter-rater reliability was moderate (0.58–0.72) for some muscle quantity measurements of the tibialis anterior, gastrocnemius, rectus femoris, biceps femoris and triceps brachii muscles. Conclusion Muscle quantity and quality can be measured reliably using EFOV US.

The foramen ovale (FO) of the sphenoid bone is clinically important for the interventional treatment of trigeminal neuralgia. Percutaneous procedures applied to treat the chronic pain condition typically involve the cannulation of this oval-like foramen located at the base of the skull. Anatomic variations of the FO have been reported to contribute to difficulties in the cannulation of this structure. Computed tomography (CT) can help the surgeon improve the accuracy and safety of the intervention. However, even with navigation technology, unsuccessful cannulation of the FO has been reported. The aim of this observational anatomic study was to define morphometric and morphologic data of the FO and to investigate for potential differences between measurements taken on dried human crania and digitized measurements of the FO measured on CT images. One hundred eighteen FOs were evaluated. Twenty FOs underwent CT scanning. The mean length of the foramen was 7.41±1.3 mm on the left side and 7.57±1.07 mm on the right. The mean width of the foramen was 4.63±0.86 mm on the left side and 4.33±0.99 on the right. The mean area on the left side was 27.11±7.58 and 25.73±6.64 mm 2 on the right. No significant left-right differences were found for any of these dimensions. The most important conclusion that we can draw is that the measurements can indeed be performed on CT images to obtain an accurate picture of the morphology. Considering the surgical importance of the FO and taking into consideration the limitations this study added to scientific knowledge, this study was constructive as far as neurosurgeons and anatomists are concerned.

OBJECTIVES: To quantitatively evaluate the impact of a cardiac acquisition CT mode on motion artifacts in comparison to a conventional cine mode for dynamic musculoskeletal (MSK) imaging. METHODS: A rotating PMMA phantom with air-filled holes drilled at varying distances from the disk center corresponding to linear hole speeds of 0.75 cm/s, 2.0 cm/s, and 3.6 cm/s was designed. Dynamic scans were obtained in cardiac and cine modes while the phantom was rotating at 48°/s in the CT scanner. An automated workflow to compute the Jaccard distance (JD) was established to quantify degree of motion artifacts in the reconstructed phantom images. JD values between the cardiac and cine scan modes were compared using a paired sample t-test. In addition, three healthy volunteers were scanned with both modes during a cyclic flexion-extension motion of the knee and analysed using the proposed metric. RESULTS: For all hole sizes and speeds, the cardiac scan mode had significantly lower (p-value

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, it is 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.

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.]

Dynamic computer tomography (CT) is an emerging modality to analyze in-vivo joint kinematics at the bone level, but it requires manual bone segmentation and, in some instances, landmark identification. The objective of this study is to present an automated workflow for the assessment of three-dimensional in vivo joint kinematics from dynamic musculoskeletal CT images. The proposed method relies on a multi-atlas, multi-label segmentation and landmark propagation framework to extract bony structures and detect anatomical landmarks on the CT dataset. The segmented structures serve as regions of interest for the subsequent motion estimation across the dynamic sequence. The landmarks are propagated across the dynamic sequence for the construction of bone embedded reference frames from which kinematic parameters are estimated. We applied our workflow on dynamic CT images obtained from 15 healthy subjects on two different joints: thumb base (n = 5) and knee (n = 10). The proposed method resulted in segmentation accuracies of 0.90 ± 0.01 for the thumb dataset and 0.94 ± 0.02 for the knee as measured by the Dice score coefficient. In terms of motion estimation, mean differences in cardan angles between the automated algorithm and manual segmentation, and landmark identification performed by an expert were below 1°. Intraclass correlation (ICC) between cardan angles from the algorithm and results from expert manual landmarks ranged from 0.72 to 0.99 for all joints across all axes. The proposed automated method resulted in reproducible and reliable measurements, enabling the assessment of joint kinematics using 4DCT in clinical routine.

Introduction: Low grip work and high feelings of self-perceived fatigue could be an early characteristic of decline in reserve capacity, which comes to full expression as physical frailty in a later stage. When grip work and self-perceived fatigue can be identified as characteristics differentiating between robustness and pre-frailty it might allow to identify pre-frailty earlier. Therefore, this study aimed to investigate whether the combination of grip work and self-perceived fatigue is related to pre-frailty in well-functioning older adults aged 80 and over. Methods: Four-hundred and five community-dwelling older adults aged 80 and over (214 robust and 191 pre-frail) were assessed for muscle endurance (grip Work corrected for body weight (GW_bw)), self-perceived fatigue (MFI-20) and frailty state (Fried Frailty Index, FFI). A Capacity to Perceived Vitality ratio (CPV) was calculated by dividing GW_bw by the MFI-20 scores. ANCOVA analysis (corrected for age and gender) was used to compare robust and pre-frail older adults, and binary logistic regressions were applied to analyze the relationship between CPV and pre-frailty status. Results: Pre-frail older adults who scored negative on the exhaustion item of the FFI still showed significantly lower GW (p < 0.001), CPV ratios (p < 0.001) and higher self-perceived fatigue (p < 0.05) compared to the robust ones. The likelihood for pre-frailty related significantly to higher age, being men and lower CPV ratios. In women, every unit increase in CPV ratio decreased the likelihood for pre-frailty by 78% (OR 0.22; 95% CI: 0.11–0.44), for men this effect was less strong (34%, OR 0.66; 95% CI: 0.47–0.93). Conclusions: Pre-frail community-dwelling persons aged 80 years and over without clinical signs of exhaustion on the FFI still experience significantly higher fatigue levels (lower Grip Work, higher self-perceived fatigue and lower CPV levels) compared to robust ones. CPV ratio could therefore be a good tool to identify subclinical fatigue in the context of physical (pre-)frailty.

BACKGROUND: Repetitive piano play may overload neck and shoulder muscles and tendons, leading to playing-related musculoskeletal disorders (PRMDs). METHODS: In this pilot study (EMG data of the extensor carpi radialis have been published separately), surface electromyography (sEMG) activity of the upper trapezius (UT) 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 etudes. 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, and the frequency component using median frequency based on the frequency band powers. Statistical analysis encompassed repeated measures ANOVAs for the amplitude and frequency components of the sEMG signal (set at 5%). The students also rated the intensity of rehearsals using a visual analog scale (VAS). RESULTS: The median values for the %MVC presented a global mean for the left trapezius of 5.86 (CI90% 4.71, 6.97) and 5.83 for the right trapezius (CI90% 4.64, 7.05). The rehearsals at moderate intensity increased the amplitude of %MVC of the upper trapezius by around 50% and decreased the median frequency. CONCLUSIONS: Playing faster presented higher magnitudes of activity of the upper trapezius. The decrease in the median frequency in response to long rehearsals may be a sign of muscle fatigue. Med Probl Perform Art. 2022;37(1):1-12.

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, it is here to stay, and will become a reference in the diagnosis of lower limb conditions and the evaluation of treatment options. Cite this article

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.

Summary Background To date, the accuracy of bio-impedance (BIA) to assess body composition & sarcopenia in persons aged 80 and over remains unclear. Objective We aimed to evaluate the agreement between dual energy X-ray absorptiometry (DXA) and BIA equations to determine lean mass, as well as their suitability to identify sarcopenia. Design 174 community dwelling well-functioning persons (83 women, 91 men) aged 80 and over were included. Appendicular lean mass (ALM) was predicted using BIA-based equations available in literature, and compared to DXA outcomes. Through cross-validation and stepwise multiple linear regression, a new ALM-formula was generated suitable for this population. Results Literature-based BIA equations systematically overestimated ALM. The new prediction formula that we propose for the 80+ is: ALM = 0,827+(0,19*Impedance Index)+(2,101*Sex)+(0,079*Weight); R2 = 0,888; SEE = 1,450 kg. Sarcopenia classification based on our new BIA equation for ALM showed better agreement with DXA (k ≥ 0,454) compared to literature-based BIA equations (k Conclusions Despite the high correlation between both methods, literature-based BIA equations consistently overestimate ALM compared to DXA in persons aged 80 and over. We proposed a new equation for ALM, reaching higher agreement with DXA and thus improving the accuracy of BIA for this specific age group.

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.

Background Manual treatments targeting different regions (shoulder, cervical spine, thoracic spine, ribs) have been studied to deal with patients complaining of shoulder pain. Thoracic manual treatments seem able to produce beneficial effects on this group of patients. However, it is not clear whether the patient improvement is a consequence of thoracic manual therapy or a placebo effect. Objectives To compare the efficacy of thoracic manual therapy and placebo thoracic manual treatment for patients with shoulder dysfunction. Methods Electronic databases (MEDLINE, CENTRAL, PEDro, CINAHL, WoS, EMBASE, ERIC) were searched through November 2016. Randomized Controlled Trials assessing pain, mobility and function were selected. The Cochrane bias estimation tool was applied. Outcome results were either extracted or computed from raw data. Meta-analysis was performed for outcomes with low heterogeneity. Results Four studies were included in the review. The methodology of the included studies was generally good except for one study that was rated as high risk of bias. Meta-analysis showed no significant effect for “pain at present” (SMD -0.02; 95% CI: −0.35, 0.32) and “pain during movement” (SMD -0.12; 95% CI: −0.45, 0.21). Conclusion There is very low to low quality of evidence that a single session of thoracic manual therapy is not more effective than a single session of placebo thoracic manual therapy in patients with shoulder dysfunction at immediate post-treatment.

Background: Manual treatments targeting different regions (shoulder, cervical spine, thoracic spine, ribs) have been studied to deal with patients complaining of shoulder pain. Thoracic manual treatments seem able to produce beneficial effects on this group of patients. However, it is not clear whether the patient improvement is a consequence of thoracic manual therapy or a placebo effect. Objectives: To compare the efficacy of thoracic manual therapy and placebo thoracic manual treatment for patients with shoulder dysfunction. Methods: Electronic databases (MEDLINE, CENTRAL, PEDro, CINAHL, WoS, EMBASE, ERIC) were searched through November 2016. Randomized Controlled Trials assessing pain, mobility and function were selected. The Cochrane bias estimation tool was applied. Outcome results were either extracted or computed from raw data. Meta-analysis was performed for outcomes with low heterogeneity. Results: Four studies were included in the review. The methodology of the included studies was generally good except for one study that was rated as high risk of bias. Meta-analysis showed no significant effect for "pain at present" (SMD -0.02; 95% CI: -0.35, 0.32) and "pain during movement" (SMD -0.12; 95% CI: -0.45, 0.21). Conclusion: There is very low to low quality of evidence that a single session of thoracic manual therapy is not more effective than a single session of placebo thoracic manual therapy in patients with shoulder dysfunction at immediate post-treatment.

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.

Resume Introduction Une recherche sur Pubmed montre que la composition corporelle humaine (CC) est souvent utilisee dans les publications en sciences du sport. La CC est une branche de la biologie humaine, sujette a des interpretations diverses par ses utilisateurs. Mesurer quantitativement la CC humaine est important pour gerer les performances et l’entrainement mais une mauvaise interpretation des termes et des techniques joue un role clef dans de nombreuses erreurs frequentes. Synthese des faits Le propos de cette etude est de passer en revue un nombre d’erreurs particulieres que l’on observe dans le domaine de la CC en sciences du sport et en medecine du sport en particulier. On a montre que l’erreur principale venait de la transposition des donnees de la CC morphologique vers des interpretations chimiques de la CC. Deux des principales methodes d’estimation de la CC dans cette revue (l’IMC et l’hydrodensitometrie) ont ete utilises pendant des decennies, la troisieme methode (DEXA) est plus recente. Une analyse approfondie avec des donnees in vivo et in vitro a indique que l’hydrodensitometrie reste une methode de critere quelque peu faillible, en particulier chez les sujets dont la densite de la masse libre de graisse est differente de la valeur supposee de 1,10 g/mL. L’application de l’IMC dans le domaine de l’adiposite reste douteuse car elle donne, malgre sa bonne relation avec l’obesite en general, une approximation tres relative de la distribution tissulaire. Enfin la DEXA donne de bonnes estimations mais manque de precision clinique dans les donnees de la CC.

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

Resume Objectifs Il ne fait pas de doute que les circonferences, mesurees a differents endroits des segments corporels, ont de nombreuses applications. Les etudes utilisant les circonferences ont souvent des applications cliniques mais sont basees sur une supposee. De facon generale, la litterature nous offre peu ou aucune justification pour le choix d’une circonference particuliere pour une application particuliere. Le but de ce travail est d’etablir une relation entre chaque circonference et (i) les masses tissulaires du segment et (ii) avec les masses tissulaires du corps entier afin d’etablir un rapport de fiabilite de chaque circonference. Materiel et methodes Apres un protocole anthropometrique, les cadavres bien conserves de 23 sujets caucasiens minces (9 hommes âges de 74,8 ± 5,7 ans et 14 femmes âgees de 79,2 ± 7,3 ans) ont ete disseques selon le modele a 5 composants et les resultats ont ete exprimes au niveau du systeme tissulaire, a savoir peau, muscle, tissu adipeux, visceres et os. Resultats La relation va de r = 0,80 a r = 0,99 (p Conclusion Cette etude suggere la reappreciation de la circonference de la taille. Cette mesure n’est pas fiable pour les individus minces mais pourrait l’etre pour les obeses. Il semble que la combinaison du tour de poitrine et de celui des hanches pourrait avoir une application plus generale en sante publique. Au total, ces donnees confirment la signification attribuable d’une serie de circonferences alors que d’autres semblent douteuses ou sont rejetees.

Quantitative assessment of force in masticatory muscles is not a routine clinical test, probably due to the lack of an “easy-to-use” device. Aim of this study is (1) to present a low cost bite force instrument located in a custom-made housing, designed to guarantee a comfortable and effective bite action, (2) to evaluate its mechanical characteristics, in order to implement it in clinical settings and in experimental setups. Linearity, repeatability and adaptation over time were assessed on a set of four different sensors in bare and housed condition. Application of the housing to the transducer may appreciably alter the transducer's response. Calibration of the housed transducer is thus necessary in order to correctly record real bite force. This solution may represent a low cost and reliable option for biting force measurement and objective assessment of individual force control in the scientific and clinical setting.

Resume Objectifs Evaluer l’importance du placement des electrodes dans les strategies d’enregistrement. Actualites Les strategies methodologiques d’enregistrement different selon qu’on utilise la telemetrie ou un systeme filaire, un placement des electrodes approprie et une normalisation du signal en accord avec le mouvement etudie. Les analyses comparatives suggerent qu’il existe des differences de qualite du signal entre les methodes (jusqu’a 30 %) et entre l’acquisition dans l’air et dans l’eau (jusqu’a –25 %). Les causes en sont : le choix du muscle ; le placement des electrodes et l’incoherence qu’il y a a utiliser une normalisation statique pour un mouvement dynamique, donnant des intensites allant jusqu’a 111 % (tir a l’arc) et meme 283 % (slalom geant) par rapport a la reference statique de 100 %. La relation entre l’electromyographie (EMG) integre (intensite) et la force musculaire est tres variable et depend entre autres de l’angle articulaire et de la fatigue. Trente pour cent de ces relations sont non lineaires. Le placement des electrodes selon une reference anthropometrique neglige la deformation du muscle en activite ; la variabilite de l’epaisseur de la peau comme celle du pannicule sous-cutane ont un impact sur le signal EMG. Conclusion L’enregistrement de l’EMG du mouvement doit s’adapter a chaque situation ce qui differe de l’EMG clinique. Dans ce travail, nous montrons comment le choix des electrodes, les methodes d’enregistrement, les positions articulaires, les techniques de normalisation et la variabilite de la composition corporelle peuvent conduire a des resultats pretant a confusion.

Eur J Clin Invest 2012; 42 (9): 961–966 Abstract Background The contours of a human body are determined by the volumes of the underlying tissues [adipose tissue (AT), muscle, bone and viscera]. Conceptually, they are assumed to be used as a concentric set of cylinders. Determination of these clinically applied circumferences in terms of relative tissue proportions has led to conflicting results. As it remains unclear what a circumference really measures or represents and how it relates to body composition (BC), the aim of this study was to determine the content of the circumferences and whether these perimeters can be used to assess segmental or whole body tissue components. Design Subsequent to an anthropometric protocol, the five white Caucasian cadavers were fractionated into slices of 3 cm and segmental and whole BC was determined at the anatomical tissue-system level by direct dissection. Results Only two circumferences correlated significantly with their dominating component [upper arm circumference (r = 0·98; P