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Takuma Yuri,1,2 Nariyuki Mura,1,3,4 Kyosuke Hoshikawa,4 Hugo Giambini,2 Hiromi Fujii,1 Yoshiro Kiyoshige1,4 1Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, Yamagata, Japan; 2Department of Biomedical Engineering, The University of Texas at San Antonio, San Antonio, TX, USA; 3Department of Orthopaedic Surgery, Yoshioka Hospital, Tendo, Japan; 4Department of Physical Therapy, Yamagata Prefectural University of Health Sciences, Yamagata, JapanCorrespondence: Takuma YuriGraduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, 260 Kamiyanagi, Yamagata, 990-2212, JapanTel +81-23-686-6741Email d2167013@yachts.ac.jpPurpose: Ultrasound elastography has been used to evaluate the skeletal muscle stiffness as a biomarker for sarcopenia assessment. However, there is no consensus with respect to the size and location of the region of interest in assessing such fat infiltrated muscle. The objective of this study was to determine which cross-sectional area should be measured in torn disuse muscle with fat infiltration to accurately measure muscle activity using real-time tissue elastography (RTE).Methods: Twenty-seven patients, whose rotator cuff muscle with torn tendon was successfully repaired, were followed by programmed rehabilitation. RTE measurements of the supraspinatus muscle were obtained during muscle contraction before and one-year after surgery so that the activity value was defined as the difference between elastography measurements at rest and elastography measurements during contraction. Given that the patients with successfully repaired and completed rehabilitation showed an increased activity value, the sensitivity for three regions of interest; posterior portion of the anterior-middle subregion (AM-p), anterior region (AR), and whole cross-sectional area of the supraspinatus (whole) were compared with the number of patients showing an increase in activity values as sensitivity analysis.Results: The sensitivity showing an increase in activity values was 74.1% for the AM-p area, 70.4% for the AR area, and 81.5% for the whole area. Intraclass correlation coefficient1,3 was 0.87– 0.97 for the AM-p area, 0.88– 0.98 for the AR area and 0.92– 0.99 for the whole area.Conclusion: The whole cross-sectional area is suitable to measure muscle activity in muscle with fat infiltration. The results in this study will provide some beneficial information when ultrasound elastography is used for the assessment of sarcopenia muscle with fat infiltration.Keywords: ultrasound elastography, region of interest, sarcopenia, fat infiltration, supraspinatus muscle

We investigated the relationship between throwing-related elbow pain and subjective assessment of disability of throwing performance in 53 adolescent baseball players. The relationship of elbow pain to various issues including disability related to throwing performance and the condition of the elbow during the baseball season were semi-quantitatively assessed by each subject. Compared to the 34 players without elbow pain, the 19 players with significant elbow pain also had severe disability related to throwing performance and worsening elbow condition. These results suggest a correlation between elbow pain and disability related to throwing performance. [ABSTRACT FROM AUTHOR]

Objective : The aim of this study was to investigate elbow injuries in high school baseball players. Methods : Seventy-one high school baseball players, aged from 15 to 17 years (mean :16 years), underwent a medical examination after the fall baseball season had ended. Questionnaire and physical examination were performed. Ultrasonography was used to assess the medial elbow laxity. Medial elbow instability was defined as an increase of 2.2mm or more in the medial joint space or lateral shift of the proximal ulna on the throwing side, compared to the non-throwing side. Diagnosis of medial collateral ligament injury (MCL injury) was based on elbow pain, positive milking test, and positive ultrasonographic medial elbow instability. Diagnosis of ulnar neuritis was based on positive findings of either muscle weakness or sensory changes in the ulnar nerve among subjects having difficulty in throwing due to elbow pain or numbness of little and ring fingers. Results : During a prior season, 32 subjects (25%) had experienced elbow pain, 3 (4%) had experienced numbness of little and ring fingers, and 26 (37%) had difficulty in throwing due to elbow pain. At the medical examination, 8 subjects (11%) had elbow pain, no player had numbness, and 8(11%)had difficulty in throwing due to elbow pain. Seventeen subjects (24%) were positive for the milking test. Twelve subjects (17%) had ultrasonographic medial elbow instability. MCL injury was diagnosed in 3 subjects (4%). Ulnar neuritis was diagnosed in 6 subjects (8%). Discussion : Elbow pain and difficulty in throwing at the medical examination was correlated with the milking test. These suggest that the milking test is useful for the screening of elbow pain and difficulty in throwing. [ABSTRACT FROM AUTHOR]

BACKGROUND: Indications for the treatment of osteochondritis dissecans of the humeral capitellum have remained unclear. The aims of this study were to analyze the outcomes and to determine the most useful classification for the choice of treatment. METHODS: The cases of 106 patients with osteochondritis dissecans of the capitellum were studied retrospectively. At the time of the initial presentation, the mean age of the patients was 15.3 years. The capitellar growth plate was open in eighteen patients and closed in eighty-eight. Thirty-six patients were treated nonoperatively. Fifty-five patients underwent fragment removal alone, twelve underwent fragment fixation with a bone graft, and three underwent reconstruction of the articular surface with use of osteochondral plug grafts from the lateral femoral condyle. The mean follow-up period was 7.2 years. The outcomes in terms of pain in the elbow, return to sports, and radiographic findings were analyzed and compared. RESULTS: An osteochondritis dissecans lesion with an open capitellar physis and a good range of elbow motion resulted in a good outcome. Continued elbow stress resulted in the worst outcome in terms of pain and radiographic findings. In patients with a closed capitellar physis, surgery provided significantly better results than elbow rest (p < 0.01). Fragment fixation or reconstruction provided significantly better results than fragment removal alone (p < 0.05). The results of removal alone were dependent on the size of the defect in the capitellum. The outcome in terms of pain was closely associated with sports activity and radiographic findings. CONCLUSIONS: We believe that osteochondritis dissecans of the capitellum can be classified as stable or unstable. Stable lesions that healed completely with elbow rest had all of the following findings at the time of the initial presentation: an open capitellar growth plate, localized flattening or radiolucency of the subchondral bone, and good elbow motion. Unstable lesions, for which surgery provided significantly better results, had one of the following findings: a capitellum with a closed growth plate, fragmentation, or restriction of elbow motion of >or=20 degrees . For large unstable lesions, fragment fixation or reconstruction of the articular surface leads to better results than simple excision. [ABSTRACT FROM AUTHOR]

We examined the relation among ankle instability and stress radiography, generalized joint laxity and muscle strength of the ankle in female soccer players. The stress radiography was taken using Telos SE. The muscle strength of the ankle was measured by a handheld dynamometer (Micro Fet). Eleven players (78.6%) and 19 feet (67.9%) had ankle sprain in the past. There was no significant difference in the talar tilt angle, anterior drawer distance and anterior drawer ratio between the injured ankle and the uninjured ankle. The generalized joint laxity test was performed in the wrist, elbow, shoulder, hip, knee, ankle and spine. According to the Tokyo university method, the laxity score was 3.1 points in the group with injured ankles and 1.9 points in that with the uninjured ankles. There was significant difference between the two groups. The strength of plantar flexion in the injured ankles was significantly less than that in the uninjured ankles. The strength of the injured ankle was weaker than that in the uninjured ankle. Conclusively, if the player has generalized joint laxity, there is the possibility of ankle sprain occurring. Strengthening of the ankle muscles is requested to prevent the occurrence of ankle sprains in female soccer players. [ABSTRACT FROM AUTHOR]

Background: Indications for the treatment of osteochondritis dissecans of the humeral capitellum have remained unclear. The aims of this study were to analyze the outcomes and to determine the most useful classification for the choice of treatment.Methods: The cases of 106 patients with osteochondritis dissecans of the capitellum were studied retrospectively. At the time of the initial presentation, the mean age of the patients was 15.3 years. The capitellar growth plate was open in eighteen patients and closed in eighty-eight. Thirty-six patients were treated nonoperatively. Fifty-five patients underwent fragment removal alone, twelve underwent fragment fixation with a bone graft, and three underwent reconstruction of the articular surface with use of osteochondral plug grafts from the lateral femoral condyle. The mean follow-up period was 7.2 years. The outcomes in terms of pain in the elbow, return to sports, and radiographic findings were analyzed and compared.Results: An osteochondritis dissecans lesion with an open capitellar physis and a good range of elbow motion resulted in a good outcome. Continued elbow stress resulted in the worst outcome in terms of pain and radiographic findings. In patients with a closed capitellar physis, surgery provided significantly better results than elbow rest (p < 0.01). Fragment fixation or reconstruction provided significantly better results than fragment removal alone (p < 0.05). The results of removal alone were dependent on the size of the defect in the capitellum. The outcome in terms of pain was closely associated with sports activity and radiographic findings.Conclusions: We believe that osteochondritis dissecans of the capitellum can be classified as stable or unstable. Stable lesions that healed completely with elbow rest had all of the following findings at the time of the initial presentation: an open capitellar growth plate, localized flattening or radiolucency of the subchondral bone, and good elbow motion. Unstable lesions, for which surgery provided significantly better results, had one of the following findings: a capitellum with a closed growth plate, fragmentation, or restriction of elbow motion of > or =20 degrees . For large unstable lesions, fragment fixation or reconstruction of the articular surface leads to better results than simple excision.Level Of Evidence: Prognostic Level II. [ABSTRACT FROM AUTHOR]

Two hundred thirty elite high school athletes in karate, kendo, judo, wrestling, hockey, canoeing, trucking, water polo, and speed skating in Yamagata Prefecture were examined medically, especially from orthopedic perspectives, including muscle flexibility and injuries or disorders to the neck, trunk, and extremities. Among the athletes examined, 133 (58%) athletes were suffering from an average of 1.5 injuries or disorders. Athletes who were treated by medical clinics during the examination or for whom reexamination at a medical clinic was considered necessary were 7 (14%) in 2003, 11 (12%) in 2004, and 21 (24%) in 2005. Injuries or disorders to the lower back, knees, and ankles showed a higher prevalence among these parts of the body. Athletes with lower muscle flexibility showed a significant higher prevalence of low back problems than those with normal or higher muscle flexibility (p=0.006). For elite high school athletes, muscle flexibility should be maintained or improved. Support should also be given to athletes with injuries and disorders so that they may maintain their performance and not suffer from other disorders. [ABSTRACT FROM AUTHOR]

Background: Care procedures for preterm infants can induce stress that may disrupt homeostasis, possibly altering cerebral perfusion or oxygenation. We evaluated the physiological and cerebral oxygenation changes during the routine care of very preterm infants., Methods: We analyzed the changes in heart and respiratory rates and in systemic and regional cerebral oxygen saturation of 27 very preterm infants, defining three care periods of 5 min each: 30 min before care, 30 min during care, and 30 min after care. Mean maximum and minimum values for each parameter during the defined care periods were compared by analysis of variance (ANOVA) for repeated measures., Results: The mean heart rate was significantly higher during (160 ± 8 bpm) than before and after care (151 ± 21 and 151 ± 6 bpm, respectively). The mean respiratory rate decreased during care and increased afterward: 44 ± 2.2, 40.6 ± 3.2, and 46.7 ± 3.4 cycles/min, respectively (p < 0.05). The mean regional cerebral oxygen and systemic saturation did not vary significantly. Mean minimum and maximum values for each parameter varied during and after care as compared with before care (all p < 0.01). The mean minimum cerebral and systemic saturation was lower after care than before care: 59 ± 8 % versus 63 ± 8 % and 83 ± 3 % versus 90 ± 7 %, respectively (p < 0.05)., Conclusions: During routine care procedures for very preterm infants, the change in physiological parameters suggested an autonomic stress reaction. Cerebral desaturation may occur during and after the care of such infants and call for specific attention to better support the physiological and cerebral well-being of these infants during standard care procedures., Competing Interests: Declaration of competing interest None., (Copyright © 2024. Published by Elsevier Masson SAS.)

Background: Superior translation of the humeral head is often identified in large and massive rotator cuff (RC) tears. However, the ability of the remaining RC muscles to compensate for the forces causing such superior translation in RC tears remains unclear. The purpose of this study was to investigate the impact of compensatory forces exerted by the remaining RC muscles on humeral head translation using a progressive RC tear model., Methods: Eight fresh-frozen cadaveric shoulders (mean donor age, 57 years) were tested using a custom shoulder testing system. In addition to an intact RC model, 3 RC tear models were created: a supraspinatus tear (Tear I); combined supraspinatus and infraspinatus tears (Tear II); and combined tears of the supraspinatus, infraspinatus, and superior one-third of the subscapularis (Tear III). Compensatory conditions were simulated by increasing the loading of the remaining RC muscles in each RC tear model. Humeral head translation was measured at different abduction and neutral rotation angles in each condition with normal and high deltoid muscle loading., Results: Significant superior translation of the humeral head was observed in Tears II and III (but not Tear I), compared with the intact state, under high loading of the deltoid during abduction and during rotation. In Tear II, compensatory conditions involving increased loading of the teres minor and subscapularis muscles effectively reduced superior translation, so that no significant differences were observed compared with the intact state, even under high deltoid muscle loading. However, in Tear III, significant superior translation was still observed, regardless of the compensatory conditions., Conclusions: ompensation by the remaining RC muscles, particularly the teres minor and subscapularis, effectively reduced superior translation of the humeral head in the posterosuperior RC tear model, whereas this compensatory strategy was insufficient if tears also involved the superior one-third of the subscapularis., Clinical Relevance: Patients with posterosuperior RC tears may find conservative treatment focusing on strengthening the remaining RC muscles, especially the subscapularis and teres minor, to be beneficial. Conversely, patients with repairable massive RC tears also involving the subscapularis tendon may benefit from surgical interventions aimed at primarily repairing the subscapularis tendon to restore the transverse force couple. Massive tears deemed not to be repairable should be evaluated for arthroplasty or other procedures., Competing Interests: Disclosure: This study was in part supported by the University of Texas at San Antonio and the San Antonio Medical Foundation. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/I254)., (Copyright © 2024 by The Journal of Bone and Joint Surgery, Incorporated.)

Background: Bending the trunk forward and backward while standing are common daily activities and can have various patterns. However, any dysfunction in these movements can considerably affect daily living activities. Consequently, a comprehensive evaluation of spinal motion during these activities and precise identification of any movement abnormalities are important to facilitate an effective rehabilitation. In recent years, with the development of measurement technology, the evaluation of movement patterns using an inertial motion capture system (motion sensor) has become easy. However, the accuracy of estimated angular information obtained via motion sensor measurements can be affected by angular velocity. This study aimed to compare the validity of estimated angular information obtained by assessing standing trunk forward and backward bending at different movement speeds using a motion sensor with a three-dimensional motion analysis system., Methods: The current study included 12 healthy older men. A three-dimensional motion analysis system and a motion sensor were used for measurement. The participants performed standing trunk forward and backward bending at comfortable and maximum speeds, and five sensors were attached to their spine. Statistical analysis was performed using the paired t-test, intraclass correlation coefficient, mean absolute error, and multiple correlation coefficient., Results: Results showed that the estimated angular information obtained using each motion sensor was not affected by angular velocity and had a high validity., Conclusions: Therefore, the angular velocity in this study can be applied clinically for an objective evaluation in rehabilitation., (© 2024. The Author(s).)

Background: Arthroscopic rotator cuff repair (ARCR) is a minimally invasive surgical technique. However, it is challenging to control postoperative pain. This study aimed to investigate the difference between a single-shot interscalene block and a combined continuous block for ARCR., Methods: Ninety-four patients who underwent ARCR were included in this study. In the preceding period, 43 patients received a single-shot interscalene block and continuous postoperative intravenous opioid infusion (Single group). In the posterior period, 51 patients received a single-shot interscalene block preoperatively and a continuous block postoperatively (Continuous group). Their mean age at surgery was 64.9 years (range, 43-83 years). The mean follow-up period was 25.4 months (range, 24-54 months). The numerical rating scale (NRS) of pain was evaluated immediately after the surgery, at rest, and at night for 1-4 days after the surgery. One day postoperatively, the amount of food taken was assessed from 0 % (no food intake) to 100 % (all food taken). The University of California at Los Angeles (UCLA) shoulder score, range of motion (ROM), and isometric shoulder strength were evaluated., Results: NRS at rest in the Continuous group on the day of surgery was 3.7 ± 2.5. This was significantly lower than in the Single group (5.2 ± 1.8) ( P  = 0.002). NRS at rest in the Continuous group on the second day after surgery was 3.0 ± 2.1, significantly lower than in the Single group (3.9 ± 1.8) ( P  = 0.04). The amount of food taken in the morning in the Continuous group was 61 % ± 37 %, which was significantly greater than in the Single group (35 % ± 41 %) ( P  = 0.004). The ROM of extension at 6 months postoperatively in the Continuous group was 47 ± 7°, which was significantly greater than in the Single group (43 ± 6°) ( P = 0.02). The postoperative strength of the external rotator at 6 months in the Continuous group was 95 ± 33 N, significantly greater than in the Single group (78 ± 28 N) ( P  = 0.01). There was no significant difference in UCLA score at any time., Conclusion: The continuous interscalene block with ultrasound guidance in ARCR effectively relieved pain. The recovery of ROM for extension and the strength of the external rotator was better in the Continuous group., Competing Interests: The authors declare that there is no conflict of interest., (© 2024 Asia Pacific Knee, Arthroscopy and Sports Medicine Society. Published by Elsevier (Singapore) Pte Ltd.)

Background: Inertial measurement unit (IMU)-based motion sensors are affordable, and their use is appropriate for rehabilitation. However, regarding the accuracy of estimated angle information obtained from this sensor, it is reported that it is likely affected by velocity., Objective: The present study investigated the reliability and validity of the angle information obtained using IMU-based sensors compared with a three-dimensional (3D) motion analyzer., Methods: The Euler angle obtained using the 3D motion analyzer and the angle obtained using the IMU-based sensor (IMU angle) were compared. Reliability was assessed by comparing the Bland-Altman analysis, intra-class correlation coefficient (ICC) (1,1), and cross-correlation function. The root mean square (RMS) error, ICC (2,1), and cross-correlation function were used to compare data on the Euler and IMU angles to evaluate the validity., Results: Regarding reliability, the Bland-Atman analysis indicated no fixed or proportional bias in the angle measurements. The measurement errors ranged from 0.2° to 3.2°. In the validity, the RMS error ranged from 0.3° to 2.2°. The ICCs (2,1) were 0.9. The cross-correlation functions were >0.9, which indicated a high degree of agreement., Conclusion: The IMU-based sensor had a high reliability and validity. The IMU angle may be used in rehabilitation.

Background: A torn rotator cuff muscle deteriorates over time leading with an increase in muscle atrophy and fatty infiltration. There are several clinical assessments for evaluating the atrophy of the torn supraspinatus muscle. However, it is unclear which approach can more accurately estimate the activity of the torn supraspinatus muscle. The purpose of this study was to determine which magnetic resonance imaging-based muscle atrophy imaging assessment currently implemented in the clinical setting accurately estimates the activity of the torn supraspinatus muscle., Methods: Forty patients who were diagnosed with a rotator cuff tear and were candidates for repairs were selected for this study. Cross-sectional area, occupation ratio, and tangent sign were analyzed on T1-weighted oblique sagittal plane magnetic resonance images in which the scapular spine leads to the Y-section. Muscle belly ratio of the supraspinatus muscle was analyzed by calculating the ratio of the width of the muscle belly to the distance from the greater tubercle to the proximal end of the muscle on T1-weighted coronal plane magnetic resonance imaging images. Fatty infiltration was evaluated using the Goutallier classification system. Tear size was obtained intraoperatively by measuring the width and length of the tear and classified based on the Cofield's classification. To assess activity of the torn supraspinatus muscle, participants were first instructed to sit on a chair with the affected arm resting on a table and the shoulder abducted to 60° in the scapular plane with neutral rotation. Elasticity of the supraspinatus muscle belly was then obtained at rest and during isometric contraction using with real-time tissue elastography. Muscle activity, a surrogate for contractility, was defined as the difference between the elasticities measured at rest and during isometric contraction. A stepwise multiple regression analysis was used to investigate independent factors, such as sex, tear width, cross-sectional area, occupation ratio, tangent sign, and muscle belly ratio, related to muscle activity., Results: Stepwise multiple regression analysis ( R 2  = 0.522, P  < .001) revealed that supraspinatus muscle activity was significantly correlated with muscle belly ratio ( β  = 0.306, P  = .044) and Goutallier stage ( β  = -0.490, P  = .002)., Conclusion: Estimations of muscle belly ratio are most suitable for assessing the activity of a torn supraspinatus muscle compared to other clinical measurements., (© 2023 The Authors.)

Background: This study aimed to investigate the prognosticator of the contralateral rotator cuff in patients who underwent arthroscopic rotator cuff repair (ARCR) for symptomatic rotator cuff tear (RCT)., Methods: A total of 104 patients with a mean age of 64.7 years (range, 40-83 years) underwent ARCR and were checked for the presence of a contralateral RCT using preoperative ultrasonography. Preoperative demographic data, including patients' occupations and sports activities, were also evaluated., Results: The mean follow-up period for the operated shoulder was 25.0 months (range, 12-72 months). An RCT of the contralateral shoulder was observed in 40 of the 104 (38.5%) patients. Contralateral shoulder pain was observed in 16 (40%) and 15 (23.1%) patients in the RCT group preoperatively and the non-tear group, respectively. Of the 31 patients with shoulder pain, a poor prognosis was seen in 17 (54.8%). Statistical significance was observed between the active and sedentary groups in the RCT group, with eight patients (30.8%) in the active group and none in the sedentary group having a poor prognosis ( P  = .02). In contrast, in the non-tear group, a poor prognosis was observed in four patients (10.5%) in the active group, which was not significantly different compared to the five patients (19.2%) in the sedentary group ( P  = .33)., Conclusions: For patients in the active group, RCTs are a risk factor for poor prognosis in the contralateral shoulder of ARCR., (© 2023 The Authors.)