ABSTRACT
The aim of the present study is to examine the applicability of the isokinetic DEC parameter for identifying submaximal effort in workers with potential weakness of the shoulder external rotators. A previous study indicated that the DEC was a powerful identifier of submaximal effort of shoulder external rotation in normal volunteers. Its applicability in shoulder injury patients is of specific interest. Thus, a retrospective study of 74 (33 female and 41 male) patients who claimed compensation for work-related shoulder injury was designed. 52 patients had their injured side DEC values within the normal range and were thus labeled as maximal performers. Ten patients had higher than cutoff DEC values, indicating submaximal effort whereas 12 patients had exceedingly low DEC values. Gender comparison showed a significantly different proportion of maximal performers. Strength deficits registered in patients demonstrating maximal performance correlated with the final outcome. The findings support the application of the DEC for determination of the extent of weakness of shoulder external rotators in male patients. In terms of shoulder external rotators status in male worker injury, the results support the application of isokinetic tests both in the clinical and medicolegal sense. However, the gender discrepancy warrants further research.
Subject(s)
Muscle Contraction , Muscle Strength , Muscle, Skeletal/physiopathology , Occupational Injuries/physiopathology , Physical Endurance , Range of Motion, Articular , Shoulder Joint/physiopathology , Adolescent , Adult , Disability Evaluation , Female , Humans , Male , Middle Aged , Occupational Injuries/diagnosis , Reproducibility of Results , Sensitivity and Specificity , Young AdultABSTRACT
The purpose of the present case report is to show the potential for use of 3D gait analysis as an assessment method of feigned muscle weakness. We describe a patient complaining of right leg pain and weakness. Physical examination showed severe quadriceps muscle weakness in a highly abnormal gait pattern context. Conventional diagnostic workup did not show any relevant findings. Three-dimensional (3D) gait analysis was performed with a 3D motion capture system. Joint angles, internal moments and powers were computed from the motion data. Lower leg muscle surface-electromyography was also performed. During the late stance phase, flexor moment and negative power peaks (indicating eccentric knee extensor activity) were generated in the knee, together with relevant Rectus femoris activity. All findings were highly inconsistent with true quadriceps weakness and gave objective ground to suspect insincerity of patient complaints. 3D gait analysis might be a valuable clinical assessment tool in suspected feigned lower limb muscle weakness.
Subject(s)
Gait/physiology , Health Services Misuse , Imaging, Three-Dimensional/methods , Muscle Weakness/diagnosis , Workers' Compensation , Adult , Disability Evaluation , Humans , Knee Joint/physiopathology , Lower Extremity , Male , Video RecordingABSTRACT
A 50-yr-old man arrived at our department for a rehabilitation prescription after a right knee medial collateral ligament sprain. Magnetic resonance imaging showed medial collateral ligament partial rupture and medial femoral condyle increased signal intensity indicating bone edema. After treatment, the patient still complained of weight-bearing knee medial compartment pain. A lateral wedged insole was prescribed to decrease medial compartment compression forces. Initial response to insole use was good, but soon after, the patient complained of severe worsening knee pain. On examination, the lateral joint line and condyle palpation were tender. Insole use discontinuation was recommended, and another magnetic resonance imaging scan was performed. It showed an high T2-weighted signal intensity, representing bone marrow edema comprising a volume of 5 x 5 x 4.5 cm of lateral femoral condyle. Discontinuation of orthosis use relieved the pain, and the edema disappeared. To our knowledge, lateral femoral condyle painful bone marrow edema after lateral wedged insole use has not been previously described. The findings of this case report indicate that lateral wedged insole prescription should be carefully evaluated.
Subject(s)
Arthralgia/etiology , Arthralgia/therapy , Edema/etiology , Knee Joint , Orthotic Devices/adverse effects , Bone Marrow/pathology , Edema/physiopathology , Humans , Magnetic Resonance Imaging , Male , Medial Collateral Ligament, Knee/injuries , Middle Aged , Range of Motion, Articular , Sprains and Strains/complicationsABSTRACT
Work related upper extremity disorders are associated with cumulative trauma resulting from the continuous use of forearm muscles rather than from a specific incident. The aim of this work is to compare wrist extensor muscles activation between patients with lateral epicondylitis and healthy subjects. Differences can be used in the design of rehabilitation or injury prevention programs according to biomechanical deficits. Surface EMG signals from three forearm extensor muscles (Carpi Radialis-ECR, Digitorum Communis-EDC and Carpi Ulnaris-ECU) were recorded by linear electrode arrays in wrist extension as well as during selective contractions. Average Rectified Values (ARV) were calculated in order to identify the contribution of each muscle to different tasks. On the other hand, Muscle Fiber Conduction Velocity, Mean and Median Frequencies and also ARV were studied to obtain fatigue indexes related to metabolic changes in the muscles during a high force sustained contraction. Results showed muscular imbalance with lower ECR activity compensated by higher ECU activation, and higher fatigue indexes in patients with lateral epicondylitis.
