In vivo Kinematic Characteristics of the Elbow during Active Flexion-Extension Motion Using Dual Fluoroscopic Imaging System / 医用生物力学

Objective To investigate the translation and rotation of healthy elbow joints during active flexion and extension, so as to provide references for the treatment of elbow instability and injuries. Methods Ten healthy subjects with no history of upper extremity trauma were recruited. Dual fluoroscopic imaging system (DFIS) was applied to quantify six-degree-of-freedom (6-DOF) kinematics of humeroulnar and humeroradial joint from full extension to maximum flexion in supination position. Correlation analysis was used to evaluate the relationship between the 6-DOF kinematics of the elbow joint. Results Valgus angle of humeroulnar joint gradually decreased from 15.2°±3.1° to 5.3°±2.3° with the flexion increasing. Valgus angle of humeroradical joint gradually decreased from 19.7°±4.2° to 8.2°±2.4° from full extension to maximum flexion. The valgus angle of humeroulnar and humeroradial joint was linearly related to the flexion angle during flexion and extension. The internal rotation of humeroulnar joint was quadratic nonlinearly related to the flexion angle during motion. The maximum internal rotation of the ulnar was 4.0°±4.9° at 110° flexion, and the maximum external rotation was 5.1°±4.2°. The internal rotation of humeroulnar joint gradually increased from 3.2°±16.0° to 27.2°±18.0°. Conclusions During normal flexion and extension of the elbow, the valgus angle of humeroulnar joint decreased linearly, while the internal and external rotation angle showed a nonlinear change, which first rotated internally and then rotated externally. The valgus angle of humeroradial joint decreased linearly and the internal rotation angle increased linearly. Therefore, humeroulnar joint is not a hinge joint during elbow flexion and extension. There is a kinematic difference between humeroulnar joint and humeroracial joint. For clinical treatment of complex elbow injuries, elbow instability and elbow replacement, different motion characteristics in joints should be considered to improve the outcome after surgery.

New opinion on the mechanism of Dazhu (BL 11) for gonalgia with flexion-extension dysfunction / 中国针灸

The effect of Dazhu (BL 11) for gonalgia with flexion-extension dysfunction is remarkable, and its mechanism of action is interpreted as the influential point of bone treating bone diseases. However, through the exploration of a variety of literature, the relevant classical research, the views of senior experts, and combined with the author's experience, we put forward some new ideas and views for reference. Through in-depth analysis about pathogenesis of gonalgia with flexion-extension dysfunction and the functional attributes of Dazhu (BL 11), combining meridian tendons differentiation and myofascial meridians, we consider that Dazhu (BL 11), with its unique "location" advantage, plays the role of regulating multiple viscera, meridians, meridian tendons and myofascial meridians, which is the mechanism for gonalgia with flexion-extension dysfunction.

Cambios metafisiarios de los miembros inferiores originados por osteocondromatosis múltiple hereditaria / Mataphyseal changes of the lower limb caused by multiple hereditary osteochondromatosis

Se realizó un estudio de población, de tipo prospectivo, descriptivo y observacional en pacientes que acudieron a la Unidad de Tumores Óseos y Partes Blandas (UTOPB) del Hospital Universitario “Dr. Manuel Núñez Tovar” entre enero de 2008 y julio de 2010, con el diagnóstico de Osteocondromatosis Múltiple Hereditaria (OMH) que afectaba las articulaciones de las extremidades inferiores; se estudiaron 26 pacientes, equivalentes a 52 extremidades inferiores, con predominio del sexo masculino 1,2:1, las edades de los pacientes comprendían entre los 6 y 15 años, con mayor registro de casos a los 12 años (19,2%). Se cuantificó el número de osteocondromas periarticulares en las articulaciones de cadera, rodilla y tobillo, observando un predominio en la rodilla (48,7%) a expensas de la metáfisis distal del fémur. Se clasificó la afectación funcional de las articulaciones en tres grados (leve, moderada y severa), tomando como referencia el movimiento de flexoextensión, siendo el tobillo la articulación que presento el mayor grado de limitación y la cadera la menos afectada a la presencia de osteocondromas

We conducted a prospective, descriptive and observational population-based study, in patients attending the Unit of Bone and Soft Tissue Tumors (UTOPB) at the Hospital "Dr. Manuel Núñez Tovar" between January 2008 and July 2010, with the diagnosis of Multiple Hereditary Osteochondromatosis (MHO), which affected the joints of the lower extremities, were studied 26 patients, equivalent to 52 lower extremities; with a male predominance 1,2:1, the age of the patients ranged between 6 and 15 years, with highest number of cases at 12 years (19.2%). We quantified the number of periarticular osteochondromas at the hip, knee and ankle, having predominance in the knee (48.7%) at the expense of the distal femur metaphysis. We scored the functional range of the joints in three grades (mild, moderate and severe), with reference to the movement of flexion-extension, the ankle joint had the highest degree of limitation and, the hip was less affected to the presence of osteochondromas

Effect of Angles of Head Flexion/Extension on Static Sitting Balance in Normal Youth / 中国康复理论与实践

@#Objective To investigate the effect of different head flexion/extension angles on static sitting balance in normal youth. Methods34 selected healthy college students were measured with the track length of the centre of gravity under eyes closed, head in a neutral position,flexed in 15°, 30°, 45°, and extended in 15°, 30° (30 s each position). Results the average length from small to big were: head flexedin 30°, neutral position, flexed in 15°, flexed in 45°, extended in 15°, extended in 30°. There was no significant difference among the averagelength when head flexed in 30°, in neutral position and flexed in 15° (P>0.05). Conclusion The static sitting balance is the most whenhead put in neutral position to flexed in 30°, and worst in extended in 30° in healthy youth.

Desorden temporomandibular asociada a la injuria en flexión extensión de la cervical: presentación de un caso / Temporomandibular disorder related to injury in the cervical flexion extension: case report

El presente artículo tuvo como objetivo presentar un caso clínico de una paciente que buscó la clínica del SERVICIO ATM quejándose de graves chasquidos durante la masticación y dolor en los músculos masticatorios, que han comenzado poco después de sufrir un accidente de autobús. El diagnóstico fue sugestivo de desorden temporomandibulares asociado con injuria en flexión-extensión del cuello. Este tipo de lesión es secundaria a una fuerza súbita, lo que conduce a un mecanismo de aceleración-deceleración de energía transferida al cuello, que puede causar daños a los tejidos blandos y una variedad de manifestaciones clínicas. A menudo se produce después de los accidentes de tráfico y es responsable de la aparición de muchos casos de desorden temporomandibular. Los principales síntomas son graves chasquidos, sensibilidad dolorosa a la palpación de los músculos de la masticación, en la articulación temporomandibular durante la apertura de la boca, en el cuello y las estructuras adyacentes, además de dolor de cabeza. El tratamiento propuesto se instituyó el uso de férula oclusal, 24 horas al día, reduciendo el tiempo de uso de acuerdo a la regresión de los síntomas. Después de 5 meses de tratamiento, hubo regresión total del dolor y parcial del chasquido

The aim of this article is to report clinical case of a pacient that described severe "clicking sound" during the chewing and pain in the masticatory muscles, which began immediately after a motor vehicle accident. The suggestive diagnosis was temporomandibular joint disorder associated to a whiplash injury. It has been described as an acceleration-deceleration mechanism of energy transfer to the neck, which can lead to soft tissue injuries and a variety of clinical manifestations. These injuries usually occur after motor vehicle accidents and it's responsible for the occurrence of many cases of temporomandibular joint disorder. The main signs and symptoms are severe "clicking sound", pain in the masticatory muscles, temporomandibular joint pain during wide mouth opening, pain in the neck and adjacent structures and headache. The proposed treatment consisted of the use of oclusal splint, 24 hours per day. The decreasing of use was indicated accordingly to the decreasing of the symptoms. After five months, the pain was extinguished and clicking sound was partially decreased

Pseudarthrosis at L5-S1 after Posterolateral Lumbar Fusion

STUDY DESIGN: This is a retrospective study. OBJECTIVES: We wanted to investigate the rate of pseudarthrosis at L5-S1 after posterolateral fusion only for degenerative lumbar spinal disease, and to determine the radiological findings that help diagnose pseudarthrosis. SUMMARY OF THE LITERATURE REVIEW: The pseudarthrosis rate at L5-S1 is much higher than that at the other lumbar segments. However, there have been few studies for the rate and risk factors of pseudarthrosis at L5-S1. MATERIALS AND METHODS: A total of 88 patients who underwent pedicle screw instrumentation and posterolateral lumbar fusion were evaluated with a minimum of 1-year follow up. Bony union was evaluated by the bony fusion mass, the angulation on the flexion-extension radiographs and the radiolucent zone around the pedicle screws. The patients' age, bony mineral density, the number of fused segments and lumbar lordosis were evaluated for their association with pseudarthrosis at L5-S1. RESULTS: Pseudarthrosis developed in 22 patients at L5-S1 and in 8 patients at other levels. The change of angulation on the flexion-extension radiographs at the last follow-up was 5.2degrees in the pseudarthrosis group and 1.7degrees in the fusion group (P=0.3). A radiolucent zone of the sacral screws was noted in 10 patients; in 7 of the 22 patients in the pseudarthrosis group and in 3 of the 66 patients in the fusion group. The average age, the mean number of levels fused and the bone mineral density were similar in both groups. Lumbar lordosis was not associated with the development of pseudarthrosis at L5-S1. CONCLUSION: The pseudarthrosis rate was significantly higher at L5-S1 than that at the other lumbar segments following instrumented posterolateral fusion. Pseudarthrosis was closely related to hypermobile angulation (> or =5degrees) on the flexion-extension radiographs and a radiolucent zone around the sacral screws.

fMRI study of brain of stroke patients during knee extension-flexion of the affected side / 中华物理医学与康复杂志

Objective To investigate the underlying mechanism of motor recovery of the hemiplegic lower extremity in stroke patients. Methods The brain activation pattern during sequential extension-flexion of the affect-ed knee of 7 stroke patients and 8 healthy subjects was observed by blood-oxygen- level-dependent fMRI (BOLD-fM-RI) and analyzed by microsoft SPM5. Results When executing unilateral knee flexion-extension, contralateral paracentral lobe and contralateral supplementary motor area and right temporal gyms and inferior parietal lobes of both sides were significantly activated in all the healthy subjects, while the ipsilateral parietal lobe BA7 and BA5 were sig-nificantly activated in 6 of the 7 stroke patients. Conclusions Sequential extension-flexion of the affected knee of stroke patients was probably dependent on the activation of BA7 and BA5 in the intact side. Compensatory activation of the intact hemisphere might be one of the main mechanisms for the paretic lower extremity motor recovery in stroke patients.

The Relationship between Flexion-Extension Gap and Clinical Results in Total Knee Arthroplasty

PURPOSE: To evaluate the relationship between flexion-extension gap discrepancy and clinical results in total knee arthroplasty (TKA). MATERIALS AND METHODS: We evaluated the clinical results of 38 knees, which were performed TKA between March 2003 and June 2003, and followed up for at least 2 years. We divided all cases by the difference of medial and lateral joint gap in flexion and extension. Group A was no flexion-extension gap difference(17 cases) and group B was different gap(21 cases). We evaluated Knee Score, Function Score, range of motion and radiologic results RESULTS: The difference of group B was less than 2mm. In Knee Score and function score, Group A improved from preoperative 50.1 and 45.0 to the last follow up to 95.6 and 95.9, and those of Group B improved from 48.2 and 45.2 to 96.9 and 91.4. There was no statistical difference between two groups(p>0.05). Flexion angle of Group A increased from preoperative 108.2 degree to the last follow up 115.3 degree. That of Group B increased from preoperative 101.9 degree to the last follow up 113.6degree. But, there was no statistical difference between two groups(p>0.05). 2 cases of recurrent hemarthrosis were in Group B. CONCLUSION: We got good clinical results by flexion-extension gap difference within 2 mm. But long term followed up was needed.

Contributions of the Radiocarpal and Midcarpal Jointin Flexion-extension Motion of Wrist / 대한정형외과학회잡지

PURPOSE: Flexion and extension of the wrist occurs at the radiocarpal and midcarpal joints. This study examined the angular contribution of the radiocarpal and midcarpal joints to the total arc of motion. MATERIALS AND METHODS: Five healthy adults were selected and ten wrists were tested. Lateral X-rays were taken with the wrist in the neutral position, 30 degrees flexion, 60 degrees flexion, 90 degrees flexion, 30 degrees extension, 60 degrees extension, and 90 degrees extension. The radiocarpal and midcarpal angle were measured. The angular contribution of the radiocarpal and midcarpal angle was calculated at each phase of motion; neutral to 30 degrees, 30 degrees to 60 degrees, 60 degrees to 90 degrees. RESULTS: During wrist flexion, the angular contribution of the midcarpal joint was 65%, 72%, 71% at each phase of motion, respectively. During wrist extension, the angular contribution of midcarpal joint was 37%, 53%, 78% at each phase of motion, respectively. Therefore, during wrist extension, the main contributor of motion is changed from the radiocarpal joint in the early phase to the midcarpal joint in the late phase. CONCLUSION: It is suggested that the proximal carpal low is not moved passively by just the link system but the motion is guided by the peculiar shape of midcarpal articulation and ligaments complex at each phase. The link system is believed to act in the early phase of flexion and in late phase of extension.

Measurements of Lumbar Segmental Range of Motion with 3-dimensional Motion Analysis in Healthy Adults

OBJECTIVE: To measure the lumbar segmental range of motion (ROM) with 3-dimensional motion analysis system and compare the results with radiologic ROM measurements. METHOD: Ten healthy adult volunteers were included. We attached surface markers at the corresponding skin surface of each lumbar vertebral bodies and measured lumbar segmental ROM in flexion-extension, right bending, left bending, axial rotation with 3-D motion analysis. We compared some of the results with radiologic segmental ROM measurements. RESULTS: In 3-D motion analysis, segmental ROM of flexion and extension, right bending, left bending, right rotation, left rotation were, respectively: 10.1degrees, 45degrees, 3.5degrees, 1.7degrees and 1.9degrees(L1-L2); 17.9degrees, 6.2degrees, 5.1degrees, 1.4degrees and 1.1degrees (L2-L3); 15.0degrees, 7.2degrees, 4.9degrees, 2.1degrees and 1.1degrees (L3-L4); 14.9degrees, 5.8degrees, 4.6degrees, 1.7degree and 1.6degree (L4-L5); 10.6degrees, 4.9degrees, 3.8degree, 2.6degree and 0.8degree (L5-S1). There was no statistically significant difference in segmental ROM between 3-D motion analysis measurements and radiologic measurements except L5-S1 right bending, L2-L3 and L5-S1 left bending. No statistical significant difference in lumbar flexion and bending ROM was found between two methods. CONCLUSION: 3-D motion analysis is a useful method when measuring the lumbar segmental range of motion and it has an advantage to analyze segmental lumbar motion with three directions simultaneously.

Radiologic Result of Displacement according to Position and Measurement Methods in Spondylolisthesis / 대한척추외과학회지

STUDY DESIGN: Prospective analysis was based on radiographic appearance in 80 cases of spondylolisthesis taken in positional change. PURPOSE: The aim of the study was to investigate the flexion-extension lateral radiographs about the difference between decubitus and upright position and the measurement method of displacement in spondylolisthesis. SUMMARY OF LITERATURE REVIEW: Although the flexion-extension lateral radiographs of spine were known the most preferable diagnostic method for spine instability, there are some debates about the difference of displacement according to the patient position and measurement methods. MATERIALS AND METHODS: The radiographs of 80 patients with spondylolisthesis were taken in the decubitus and upright position. Extent of the displacement were measured by Taillard, DuPuis, modified Qunnell & Stockdale method and Ferguson angle, slip angle, lordosis angle and vertebral centroid measurement of lumbar lordosis(CLL) were measured, according to position. RESULTS: Significant difference between the positions was shown on the CLL and lordosis angle. Differences between positions analyzed from Taillard, DuPuis, modified Qunnell & Stockdale method, Ferguson angle and slip angle had no statistical significance. Differences between positions analyzed from the pathologic movement of translation(>4 mm) had a clinically significance in the upright position rather than the decubitus. CONCLUSION: The lateral flexion-extension radiographs on upright position rather than decubitus position are considered as the more useful diagnostic method.

Changes of Posterior Bulging of the Lumbar Intervertebral Discs with Flexion and Extension in Central Disc Bulges and Disc Degeneration

OBJECTIVE: To determine the changes of posterior bulging of the lumbar intervertebral discs with flexion and extension movement of the spine in patients with central disc bulges or disc degeneration. METHOD: Twenty patients with low back pain were studied. Nine patients had central type disc bulging and eleven patients had disc degeneration only. The spines were scanned in neutral, flexion, and extension positions in a vertically open 0.5T MR scanner. Degree of posterior bulging of the lumbar intervertebral disc of the pathological level was measured. RESULTS: In the patients with disc bulge, posterior bulging of the disc decreased in all of the patients by 0.8 0.6 mm with flexion of the spine and increased in 77.8% of the patients by 1.0 0.8 mm with extension of the spine. In the patients with disc degeneration, posterior bulging decreased with flexion in 36.7% of the patients. With extension, posterior bulging increased in 55.6% of the patients. CONCLUSION: This study found that patients with low back pain and central disc bulges have consistent and marked discrepancies in posterior bulging with flexion-extension in comparison with our previous study with asymptomatic patients with normal MRIs.

Radiographic Index Analysis of the Cervical Spine Curvature and the Range of Flexion-extension / 中国医师杂志

Objective To provide a new method for measuring cervical spine curvature and the range of flexion-extension and to analyse the radiographic features of the cervical degeneration.Methods The study included 78 patients with cervical spondylosis,90 patients with neck symptoms and 86 normal volunteers.The three groups were compared with each other by the indexes of the cervical spine curvature and the range of flexion-extension.Results There was significantly difference among three groups in the cervical vertebrae lordosis at neutral position.The range of flexion-extension of cervical spondylosis in the patients was smaller than that of the normal volunteers.Conclusions The index method can accurately depict the cervical spine curvature and the range of flexion-extension.There is definitive order in symptom appearance,alterations of physiologic curvature and flexion-extension in the cervical degeneration.

Displacement of the Endotracheal Tube is not Related to Its Fixation or Unflxation When the Neck is Extended or Flexed / 대한마취과학회지

BACKGROUND: Endobroncheal intubation or extubation may occur accidentally when the patient's neck is flexed or extended even in the appropriate endotracheal intubation. The purpose of this study is to examine the effect of fixation or unfixation of the endotracheal tube at the teeth level on the displacement of its distal end when the patient's neck is extended or flexed. METHODS: This study was conducted in 37 patients who underwent endotracheal general anesthesia. The patients with the evidence of pathology in head, neck and chest were excluded from the study. Individual patient's displacement in endotracheal tube tip compared unfixed cases with fixed cases when the change of neck position. The moved distance was measured by fiberoptic bronchoscope. The data were statistically analyzed by Student's paired t-test. RESULTS: The endotracheal tube moved away from the carina when the patient's neck was extended, while it moved toward the carina when flexed in all cases. When the patient's neck was extended the average distance displaced 1.2 0.7 cm in fixed cases and 1.1 0.9 cm in unfixed cases. when the neck was flexed, they were 1.2 0.5 cm and 1.0 0.8 cm respectively. There were not statistically significant between the fixed and the unfixed cases. CONCLUSIONS: It is concluded that the displacement of the endotracheal tube is not related to its fixation or unfixation at the teeth level and therefore, unfixation does not provide any benefits in terms of the displacement of the distal end of the tube in adult trachea.

Geometric Analysis of Dural Compression in Non-traumatic Spinal Instability

We studied the extent of dural sac compression and the contributory factors involved during lumbar flexionextension motion in non-traumatic spinal instability patients. In a total of 79 patients, spinal instability at L4-L5 or L5-S1 had been clinically and radiologically diagnosed. Their lateral flexion-extension lumbar myelograms were reviewed and we selected 48 cases which had adequate lumbar mobility, and clear and unequivocal measuring points. Those patients were divived into four groups of 12, as follows: Group I: transient low back pain without radiologic abnormalities(Control); Group II: spinal instability without displacement(SIWD) had been clinically and radiologically diagnosed; Group III: symptomatic degenerative spondylolisthesis(DSL); Group IV: symptomatic isthmic spondylolisthesis(ISL). Using the OPTIMAS 5.2 image analyzing program, we measured dural AP distance(DD) at intervertebral disc level and dural area(DA) at each functional motion segment, as seen on flexion-extension lumbar myelograms. The results were as follows: (1) In the control group and SIWD group, the degree of dural sac compression was not significantly different. (2) In the DSL group, DD and DA at the L4-L5 level were markedly lower than in the control group(p<0.05). In the ISL group, DD was significantly higher(p<0.05), but DA was slightly lower than in the control group. In addition, DD and DA in the ISL group were significantly higher than in the DSL group. (3) At the L5-S1 level, these changes were variable and there were no significant trends. In conclusion, we discovered that in determining the extent of dural sac compression in spondylolisthesis, measuring both dural distance and dural area is more valuable than measuring either of these alone. This is because in this condition, anterior displacement of the vertebral body or posterior displacement of the mobile lamina plays an important role. We also found that the different mechanisms of dural sac compression seen in the DSL and ISL group, as well as the variable changes seen at the L5-S1 level, are due to anatomical characteristics.