An interexaminer agreement and reliability study on cadavers with musculoskeletal ultrasound of the shoulder performed by physiotherapists and radiologists compared with dissection.

STUDY DESIGN: A cross-sectional inter-examiner agreement and reliability study on fresh frozen cadaver shoulders. BACKGROUND: Musculoskeletal ultrasound (MSU) is frequently used by physical therapists and radiologists to improve specific diagnosis in rotator cuff related pathology. The evaluation of the rotator cable seems to be important as stabilizing structure when cuff tears occur. OBJECTIVES: To evaluate the inter-examiner agreement and reliability of MSU of the shoulder to detect rotator cuff-pathology and the involvement of the rotator cable in comparison to "dissection". METHODS: Physical therapists, a radiologist and an orthopedic surgeon (dissection) investigated 40 fresh frozen cadaver shoulders in order to detect shoulder pathology including rotator cable involvement. Examiners were blinded to each other's findings. RESULTS: We found a strong and significant agreement between the raters: PTs, the radiologist and the dissector in this cadaver study for all rotator cuff, the long head of the biceps pathologies and in detecting abnormalities of the rotator cable. The kappa value was substantial to (almost) perfect agreement for all diagnostic outcome categories. CONCLUSIONS: This study shows that among a limited group of physical therapists, one radiologist and a dissector a strong level of agreement with kappa values from substantial to (almost) perfect in finding subacromial pathology.

Manual Lymphatic Drainage Increases the Number of Opened Lymphatic Pathways in Patients with Lower Limb Lymphedemas: A Sequential Research on 80 Patients.

The purpose of this study was to lymphoscintigraphically assess the effect of skin mobilization, nonspecific massage, and manual lymphatic drainage (MLD) on the root of the lower limb in patients with lower limb lymphedema. Lower limb root lymphoscintigraphical exams of 80 patients with lower limb lymphedema were analyzed. All patients underwent our stand 3 phase protocol and then were subjected to the 4th phase which included 3 subphases. Images were taken directly after the injection (subphase 1), after pinching and stretching the injection site (subphase 2), after nonspecific massage was applied to the injected site (subphase 3) and after manual lymphatic drainage of the injected site (subphase 4). The number of opened lymphatic pathways was analyzed and compared after and between each subphase (SP). SP 1 displayed open lymphatic pathways in 22 of the 80 cases (27.5%). SP 2 displayed newly opened lymphatic pathways in 48 of the 80 cases (60.0%). SP 3 displayed newly opened lymphatic pathways in 57 of the 80 cases (71.3%). Only 9 of these 57 cases did not show improvement following the next SP. SP 4 displayed newly opened lymphatic pathways in 60 of the 80 cases (75.1%). MLD improved the visualization of the lymphatic pathways in 48 cases (60%) compared to phase 3. MLD was the only technique to allow visualization of the lymphatic drainage at the level of the root of the edematous limb in 6 cases (7.5%). Physical therapy leads to a greater number of lymphatic collaterals opening in a region where no other complex decongestive therapy technique can be applied.

Pronator quadratus repair after volar plate fixation in distal radial fractures: evaluation of the clinical and functional outcome and of the protective role on the flexor tendons-a randomized controlled study.

The objective was to evaluate pronator quadratus (PQ) repair following volar plating of distal radial fractures on clinical and functional outcome, as well as flexor tendon friction, during the first 12 months in ideally positioned plates (Soong 0). Confounding factors like variation in plate positioning, anatomical consolidation of the fracture and associated lesions were excluded. Eighty patients were included with distal radius fractures treated by volar locking plate in Soong grade 0 position, who were randomized to group PQ repair and group no repair. Sixty-five patients completed the 1-year follow-up: group PQ repair (n = 35) and group no repair (n = 30). Primary outcomes included range of motion, grip strength, pain level and QuickDASH. Secondary outcomes included distance between flexor pollicis longus (FPL) and volar rim and the largest distance between FPL and plate (soft tissue thickness occupied by PQ), assessed by ultrasonography. Mobility, grip strength and QuickDASH revealed no significant differences, except extension was significantly higher only in first 3 months and radial deviation was significantly higher only at 6 weeks after PQ repair. Pain level was significantly lower after PQ repair only in the first 3 months. Distance between FPL and volar rim and the largest distance between FPL and plate were significantly higher after PQ repair. No friction contact between FPL and volar rim was measured in both groups at all measurement moments. Consequently, protective flexor tendon effect of PQ repair could consequently not be concluded. In conclusion, clinical and functional short term benefits, except improved wrist extension and reduced pain in the first 3 months, were not proven in this study. In Soong grade 0, PQ repair is probably not necessary to prevent flexor tendon pathology. In Soong grade 1 or 2, this is still to be investigated. LEVEL OF EVIDENCE: 2.

Metabolic Syndrome and Its Components in Young Adults Conceived by ICSI.

BACKGROUND: Intracytoplasmic sperm injection (ICSI) conception presents the early embryo with a radically different environment, which may lead to permanent alterations to key cardiometabolic processes. Blood pressure, indicators of insulin resistance, and lipid profiles have previously been studied in offspring born after in vitro fertilisation (IVF) and ICSI, with conflicting findings. Also, results in young adults born after ICSI are lacking. AIM: We investigated if young adult men and women conceived by ICSI more frequently have metabolic syndrome and its individual features in comparison to spontaneously conceived controls. DESIGN: Cardiometabolic and anthropometric parameters from 126 longitudinally followed young adults conceived by ICSI were compared to those of 133 controls. RESULTS: At age 18 years, only 1 of the participants displayed the metabolic syndrome (1 control woman). Mean concentrations of total cholesterol, triglycerides, insulin, HOMA-IR, and blood pressure were comparable between the ICSI conceived and control participants. A higher proportion (19.6%) of men conceived by ICSI had low (<40 mg/dl) HDL cholesterol compared to controls (5.6%). CONCLUSIONS: While men conceived by ICSI, but not women, had lower mean HDL cholesterol concentrations in comparison to controls, other markers of the metabolic syndrome were not affected by the mode of conception.

Ultrasonographic evaluation of the distance between the flexor pollicis longus tendon and volar prominence of the plate as a function of volar plate positioning and pronator quadratus repair - A cadaver study.

Flexor tendon injury after volar plating of distal radius fractures is due to friction against the plate. To assess this risk, the distance between the flexor pollicis longus (FPL) and the volar prominence of the plate was measured with ultrasonography under various conditions: a standard plate fixed proximal or distal to the watershed line and a low-profile volar rim plate, with and without transection of the pronator quadratus (PQ). Distance from the FPL to the volar prominence of the plate decreased significantly when the PQ was cut and when a standard plate was placed distal to the watershed line, with the tendon often bulging over the plate. No statistical difference was measured between a volar rim plate and a standard plate distal to the watershed line. Our results confirm the importance of positioning the volar plate proximal to the watershed line and of repairing the PQ.

Body fat content, fat distribution and adipocytokine production and their correlation with fertility markers in young adult men and women conceived by intracytoplasmic sperm injection (ICSI).

OBJECTIVE: Differences in body fat content during childhood and adolescence have been described in offspring conceived by in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI). However, data on body fat and its distribution as well as on adipocytokine production in young adults conceived by ICSI are nonexistent. We investigated if young adult men and women conceived by ICSI have a normal body fat patterning and adipocytokine production. DESIGN: Cohort study. PATIENTS: One hundred twenty-seven young adults conceived by ICSI and 138 peers born after spontaneous conception. MEASUREMENTS: Anthropometric parameters (skinfold thickness, hip and waist circumferences), dual X-ray absorptiometry (whole body and regional) measurements and adipocytokine levels (leptin and adiponectin) were analysed in relation to fertility markers (serum anti-Mullerian hormone (AMH) and inhibin B). RESULTS: While at age 18 years, a normal body fat distribution and normal leptin and adiponectin production was found in both male and female ICSI offspring, young men conceived by ICSI had a higher peripheral fat deposition in comparison with spontaneously conceived peers. No correlation between AMH and inhibin B with leptin or adiponectin was observed. CONCLUSION: While men conceived by ICSI, but not women, had a higher peripheral fat deposition, body fat distribution as well as mean levels of adipocytokines were not affected by the mode of conception.

Radiography of the distal extremity of the manus in the donkey foal: Normal images and quantitative characterization from birth to 2 years of age: A pilot study.

This study describes a radiographic survey of the anatomical development of the distal extremity of the manus in the donkey from 0 to 2 years of age. The right distal limb of 10 donkey foals, born in the spring of 2012, underwent radiographs every month for the first 6 months of age and every 3 months during the following 18 months. Latero-medial radiographs with and without barium marker at the coronary band and dorso-palmar radiographs with both front feet in weight bearing were obtained. The distal physis of the third metacarpal bone and the proximal physis of the proximal phalanx (phalanx proximalis) were closed at the mean age of 18.6 months. The distal physis of the proximal phalanx appeared as a clear radiolucent line at 2 weeks of age and was still subtly visible in some donkeys at 24 months. The proximal physis of the middle phalanx (phalanx media) was closed at the mean age of 16.7 months. The distal physis of this phalanx was visible at birth, but closed at 4 days. The distal phalanx (phalanx distalis) was triangular at birth. At the age of 20-21 months, the palmar processes (processus palmares) were both developed. The navicular bone (os sesamoideum distalis) was developed at the mean age of 9 months. The proximal sesamoid bones (ossa sesamoidea proximalia) were seen in continuously development during the 24 months. It seems that the physes in the distal extremity of the manus in the donkey close at an older age than the physes in the horse.

A red orange extract modulates the vascular response to a recreational dive: a pilot study on the effect of anthocyanins on the physiological consequences of scuba diving.

Nutritional antioxidants have been proposed as an expedient strategy to counter the potentially deleterious effects of scuba diving on endothelial function, flow-mediated dilation (FMD) and heart function. Sixteen volunteers performing a single standard dive (20 min at 33 m) according to US Navy diving procedures were randomly assigned to two groups: one was administered with two doses of 200 mg of an anthocyanins (AC)-rich extract from red oranges, 12 and 4 h before diving. Anthocyanins supplementation significantly modulated the effects of diving on haematocrit, body water distribution and FMD. AC administration significantly reduces the potentially harmful endothelial effects of a recreational single dive. The lack of any significant effect on the most common markers of plasma antioxidant capacity suggests that the mechanism underlying this protective activity is independent of the putative antioxidant effect of AC and possibly involves cellular signalling modulation of the response to high oxygen.

The effect of a passive stretch training protocol on performance during a drop jump in humans.

AIM: Our study's aim is to show how a five-week stretch training protocol, based on passive stretching, can change muscle performance during a drop jump (stretch shortening cycle). METHODS: This study observes in 8 healthy subjects (four males and four females), the effect of a 5-week passive stretch training protocol on the stretch shortening cycle (SSC) during the performance of a drop jump, and identify the architectural changes in the muscle. Subjects underwent measurements of their drop jump performance 3 times before, and 3 times after, the stretch training protocol. For the muscle tendon unit (MTU), changes were measured using the Hawkins and Hull's model. In order to calculate the length changes in the MTU, we measured the ankle and knee angles. For changes in the fascicle, the pennation angle and the thickness of the gastrocnemius medialis (GM) muscle were measured. RESULTS: After the 5-week stretch training protocol, a significant increase in flexibility was observed in the fascicle during the first phase of the jump (a shortening of 10% after training vs. 20% before). No significant change was observed in the tendon, while the MTU showed a highly significant improvement (P<0.01) in muscle compliance during the landing phase. The average performance during the drop jump also showed a highly significant change (P<0.01). CONCLUSION: The results show a higher degree of flexibility in the MTU, enabled the latter to store more energy which was then converted to kinetic energy during the push-off phase of the drop jump.

Direct relationship of body mass index and waist circumference with body tissue distribution in elderly persons.

OBJECTIVES: To explore the relationship of BMI and WC with muscle/adipose tissue mass ratios and with trunk adipose tissue distribution, based on an anatomical 5-compartment model, by dissection of cadavers of elderly persons. DESIGN: Cross-sectional explorative study. SETTING: Brussels Cadaver Analysis Study. PARTICIPANTS: Cadavers of twenty-nine white Caucasian elderly persons (17 females and 12 males, aged 78.1±6.9 years). MEASUREMENTS: Whole body and trunk composition were determined at the anatomical tissue-system level by direct dissection. RESULTS: BMI and WC were significantly and positively related to absolute tissue masses in both sexes. Muscle tissue mass, adipose tissue mass and trunk internal adipose tissue mass correlated better with BMI (r-values between 0.68 and 0.89) than with WC (r-values between 0.49 and 0.71). BMI was significantly and inversely related with various muscle/adipose tissue ratios in both sexes (r-values between -0.54 and -0.68). WC correlated with muscle/adipose tissue ratios in females only (r-values between -0.55 and -0.64). BMI was also significantly related to trunk adipose tissue distribution in elderly females, but not in males. When comparing individual tissue proportions within and between adjacent BMI-classifications or WC categories, body composition varied considerably. CONCLUSION: Our results show that BMI and WC are significantly related with adipose tissue mass and with several ratios of muscle to adipose tissue in elderly subjects. However, cautious clinical interpretation is warranted since important differences in tissue mass proportions were found in subjects with similar BMI and/or WC values.

Are there hemodynamic implications related to an axillary arch?

The axillary arch (AA) has been thoroughly studied and described as a supernumerary muscle, present unilaterally or bilaterally. This study aims to provide an in vivo demonstration of the influence of an AA on vascular, biometrical, and hemodynamic parameters. Two-hundred thirty-nine subjects with a mean age of 21.3 ± 2.7 years participated in this study. After visual screening by two independent experts, 20 subjects (8.4%) presented with an AA unilaterally (n = 12) or bilaterally (n = 8). An echo-Doppler examination of the vena and arteria axillaris was performed to measure blood flow, velocity of circulating elements, and blood vessel diameter in different positions of the arm (abduction: 45°, 90°, 90° combined with exorotation 'ER', 120°). The arteria axillaris parameters, measured in the test (n = 9; six women, three men) and control group (n = 11; six women, five men), were equivalent for all tested positions. The axillary vein parameters, compared to variations within the groups, revealed no significant differences. However, when comparing variation between groups, significant differences were found for (i) diameter in 90° abduction + ER and 120° abduction; (ii) velocity in 90° and 120° abduction. Blood flow demonstrated no significant difference between groups in any of the positions. The results of this study indicate that there is no functional vascular implication of the AA in the test samples. This study also questions the interpretation of some hypotheses regarding the AA and entrapment syndromes.

Quality control of 157 whole body adiposity prediction formulae in age and activity matched men.

AIM AND METHODS: The physiological and clinical importance of body composition is part of public health, nutrition and Sports medicine. The most popular field method for estimating total body adiposity remains anthropometry separately or in formulae. The aim of this study was to verify the suitability of an absolute maximum out of more than 600 existing anthropometry equations estimating % adipose tissue (AT) in a cross validation with dual energy X-ray absorptiometry (DXA), bioelectrical impedance analysis (BIA) and hydrodensitometry (HD) on 74 British male subjects (mean age 34.4±14.1) with different lifestyles corresponding to a maximum of populations the original formula was developed for. RESULTS: Pearson correlation coefficients, paired sample t-test and Bland and Altman plots where used for analyses. From the tested formulae, 19 correlated well (r≥0.70) and showed no significant difference (p>0.05) with BIA, 15 with DXA and only 12 with HD. The results show a better match of the predicted % AT by anthropometric equations with BIA then with DXA or HD. CONCLUSION: All results and conditions considered, this study suggest not to use HD nor anthropometric formulae to assess % AT in men for an individual estimation.

Morphology and kinematics of the atlanto-axial joints and their interaction during manual cervical rotation mobilization.

BACKGROUND DATA: At present little data are available on the relationship between spinal anatomy and kinematics. No studies have verified the relationship between atlanto-axial kinematics during manual mobilization and the spatial features of the atlanto-axial ligaments and the lateral joints. MATERIALS AND METHODS: Twenty un-embalmed cervical spine specimens (9 male and 11 female; 80 ± 11 years) were studied. Atlanto-axial kinematics were registered during manual axial rotation mobilization using an ultrasound-based motion tracking system. Anatomical landmarks were digitized and spatial features of the lateral atlanto-axial joint surfaces and alar ligaments were extracted. The relationship between the anatomical features and the spinal kinematics was analyzed using statistical regression analysis. RESULTS: Only the range of motion of the coupled flexion-extension motion component, the ratio and the time shift between main axial rotation and coupled lateral bending motion components could be predicted for about 52%, 49% and 73%, respectively, by a selected set of anatomical features. CONCLUSION: Supposed relationships between anatomical features and joint kinematics are only partially confirmed. The results indicate that the kinematics of the atlanto-axial joint during manual regional axial mobilization are not completely predetermined by the specimens' specific anatomy.

Hazards of hydrodensitometry.

The limitations of the two-component model of body composition have been investigated extensively in the past resulting in a clear message of violation of basic assumptions underlying its use. This strong message may or may not be appropriate, since hydrodensitometry is still used, in particular in sports sciences. The combination of novel information with previously described indicators should allow to confirm or reject the pretended violation of basic assumptions underlying the use of hydrodensitometry. Water content of adipose tissue (AT) and of AT free mass as opposed to fat and fat free mass, and bone density of separate bones was obtained from the Brussels Cadaver Analysis Study collection. Analysis of different studies indicated anomalies up to -12% fat but also suggests that the borderline between chemical and morphological interpretations becomes vague and the ad hoc terminology does not reflect reality. Predicted % body fat using different methods on the same individual ranges between 9.6% up to 21% of AT. Total body water of separate tissues suggests intra-and intervariability within tissues. Whole skeleton density and the separate bone density cannot support the two-component constancy (1.164 g/mL to 1.570 g/mL).

Body mass index as a measure of bone mass.

AIM: BMI is an indicator of body composition (BC) and adiposity in particular. This status is the result of good correlations with indirect (e.g. predictive) two- and three-component models predicting body fat. Aim of the study is to measure the direct relation of BMI with total and segmental BC, e.g. of skin, muscle, bone, viscera and adipose tissue. METHODS: BC constituents of 29 white elderly persons (17 females and 12 males, aged 78.1+/-6.9 years) were determined by direct dissection. Correlations and stepwise linear regression analysis with BMI (dependent variable) and all BC constituents (independent variables) were calculated. RESULTS: All tissues dissected indicated a too high unexplained variance except for bone that accounted for 84% of BMI variance in females and 61% in males (P<0.001). No other constituents improved the prediction. CONCLUSION: The BMI cannot be an appropriate adiposity index. The high proportion of unexplained variance between BMI and direct BC constituents limit its use as a whole body and as a segmental BC index. The BMI could be an index for Bone Mass instead.

Reproducibility of kinematic motion coupling parameters during manual upper cervical axial rotation mobilization: a 3-dimensional in vitro study of the atlanto-axial joint.

INTRODUCTION: The reproducibility of the 3-dimensional (3D) kinematic aspects of motion coupling patterns of segmental manual mobilizing techniques is not yet known. This study analyzes the segmental 3D aspects of manual mobilization of the atlanto-axial joint in vitro. METHODS AND MATERIALS: Twenty fresh human cervical specimens were studied in a test-retest situation with two examiners. The specimens were manually mobilized using three different techniques: a regional mobilization technique, a segmental mobilization technique on the atlas with manual fixation of the axis and a segmental mobilization applying a locking technique. Segmental kinematics were registered with a Zebris CMS20 ultrasound-based tracking system. The 3D aspects of motion coupling between main axial rotation and coupled lateral bending were analyzed by six parameters: the range of motion the three motion components, the cross-correlation, the ratio and the shift. RESULTS: The results indicate stronger intra- than inter-examiner reproducibility. The range of motion of the axial rotation component shows a substantial level of intra- and inter-examiner reproducibility (ICC's 0.67-0.76). The parameters describing the coupling patterns show only moderate to substantial intra-examiner reproducibility for the more experienced of the two examiners (ICC's 0.55-0.68). All other correlations were not significant and no differences could be observed between regional versus segmental techniques. CONCLUSION: Reproducibility of segmental 3D-aspects of manual mobilization of the atlanto-axial joint in an in vitro situation can differ between examiners. The results of the present study may indicate a possible tendency to higher reproducibility if mobilizations are performed by an examiner with high expertise and experience in applying the specific techniques. Continued investigation including more examiners with different levels of experience and different techniques is necessary to confirm these observations.

The role of the axillary arch (of Langer) in the management and the kinesiology of the overhead shoulder mobility.

AIM: Based on cadaveric, neurosurgical and medico-diagnostic evidence the axillary arch of Langer (AA) is assumed to create symptoms similar to those of entrapment or obstruction type syndromes, e.g. Thoracic Outlet Syndrome. Although the incidence of a AA varies between studies and races, there are many assumptions that its frequency and its axillary location influences the motor control of the shoulder girdle. In addition to the existing anatomical evidence and based on functional reasoning it can be predicted that the AA influences the shoulder girdle kinesiology in vivo also. However no study is known that verifies these functional assumptions in vivo. METHODS: In order to complete our knowledge of the AA we evaluated strength, endurance, motor control, precision and proprioception in vivo, e.g. hand held dynamometry, abduction and adduction shoulder strength and endurance, functional exercise assessment, throwing impact force on a (precision) target and shoulder joint position sense were measured in two groups of athletes and physical education students, one with an AA (N.=22) and a control group without AA (N.=22). RESULTS: The results indicate a significant (p<0.05) influence of the presence of an AA on strength, endurance and motor control increase in women associated with an increase of paraesthetics. For all these parameters no significant difference occurred in men. The throwing and proprioceptive joint position sense data however indicate a clear (P<0.05) increase of impact forces suggesting a possible shoulder stabilisation and an improvement of proprioception both in men and most in women. CONCLUSION: These finding have both a functional and clinical relevance and do not fully confirm the anatomical predictions from the cadaveric evidence nor support the (surgical) diagnoses of excision of the AA of Langer in throwing in athletes.

Morphological and constitutional comparison of age-matched in-vivo and post-mortem populations.

Cadaver studies are often used as a reference in clinical studies and in-vivo Body Composition (BC). However, there is a paucity of comparative information between in-vivo and post-mortem populations. Forty living volunteers for the study (18 males and 22 females, age range 55-92 years) were age-matched with a sample of 26 well-preserved cadavers (13 males and 13 females). Twenty eight anthropometric variables were chosen, i.e. nine circumferences, eight breadths, four lengths, five skinfolds, weight and height. These were measured both in vivo and post-mortem. All measures were taken according to Martin and Saller (1957), Clauser et al. (1969) and Clarys et al. (1984). Normality verification, Variant Analysis (one way Anova) and Mollison transformations were used for the comparative treatment. Data from this study confirm that the in-vivo and post mortem macro morphology are in agreement. The best similarities were found between the female groups. This study confirms that cadaver research is reliable for the validation of in-vivo techniques and as a reference standard in the absence of other direct validation measures.

Cadaver studies and their impact on the understanding of human adiposity.

The skinfold thickness is a much-used measurement for monitoring adiposity in a wide range of medical, health, occupational and sport science disciplines. Misconceptions abound, however, in its use, particularly that of purportedly predicting body 'fat' as opposed to 'adipose tissue'. To obtain data to investigate body composition and the extent to which anthropometry can be justifiably used to predict whole-body adiposity, an extensive dissection study was undertaken on 34 cadavers. In addition, to pre-empt questions on the applicability of cadaver data to living subjects, 40 elderly in vivo subjects of the same age range were compared with the cadaver population. No significant macro-morphological differences were found between males or females in the morbid and in vivo groups. Significant findings affect our previous understanding of the predictability of whole-body 'fat'. Skinfold compressibility was by no means constant; skin thickness varied with location in both sexes, females having thinner skin than males; there were significant sex differences in adipose tissue patterning. An identical thickness of adipose tissue did not necessarily contain the same concentrations of fat. Despite this variability, a relationship was demonstrated between aggregate skinfold measures and subcutaneous adipose tissue mass (as opposed to subcutaneous fat), this relationship being more evident in men. A strong relationship was found between subcutaneous adiposity and whole-body adiposity, and between direct skinfold depth measures and whole-body adiposity. The amount of visceral adipose tissue was the same in men and women, but in the men this represented a greater proportion of their total body adiposity. Further, the use of waist-to-hip girth ratio (WHR) was identified as an important predictor of health risk. These findings demonstrate that it is not sustainable to introduce a non-quantifiable error by transforming anthropometric values (skinfolds) into predictions of percentage body fat. If subcutaneous adiposity can be predicted, then an excellent indication of overall adiposity could be obtained. Currently, skinfold measurement can yield a reasonable indication of comparative subcutaneous adiposity (better in men than in women). In neither gender is this prediction completely reliable due to both inter- and intra-individual differences in the skinfold measurement procedure.