Three-dimensional scanner with a modified evaluation method for measuring hand edema subtitle: an idea for accurate evaluation and preliminary fundamental and clinical validation.

Acute hand edema often results in loss of fine hand motor activities, especially without appropriate care. There is still no reliable and easy to use method to measure hand edema. In this study, we tested a handheld three-dimensional (3D) scanner on plastic male and female hand models using a whole hand measuring method (WM) and a modified method (MM) which excluded fingers. We evaluated the intra-rater reliability and inter-rater reliability and compared the measured volumes to computed tomography (CT) findings. Statistical analysis showed that the 3D scan method was valid and reliable for both WM and MM methods. In WM, intra-rater and inter-rater reliability were 0.97 and 0.84, with 95% confidence interval (CI) of 0.87-1.00 and 0.61-0.94, respectively. In MM, intra-rater and inter-rater reliability were 0.96 and 0.83, with 95% CI of 0.84-1.00 and 0.61-0.94, respectively. In comparison to the CT, the differences between 3D scan and CT in the male model volumes were 30.35 ± 2.70 cm3 (mean ± standard deviation) for WM and 11.60 ± 2.07 cm3 for MM. In the female model, the differences were 18.92 ± 2.66 cm3 and 11.18 ± 2.35 cm3, respectively. In both models, MM was significantly more accurate than WM (p < 0.001). When used in a clinical case, the scanner recorded changes in actual volume through the course of treatment. This cost-effective handheld 3D camera can be a reliable tool for evaluating hand edema even in cases of acute injury.

Preoperative and postoperative shoulder position sense in patients who underwent arthroscopic Bankart repair for traumatic shoulder joint instability.

BACKGROUND: Proprioceptive feedback is a reflex dislocation prevention mechanism that contributes to shoulder joint stability. In patients with Bankart lesions, the anteroinferior glenohumeral ligament complex is damaged and reduces the likelihood of tensile stress. As a result, proprioceptive feedback does not work, which leads to instability. Surgical reconstruction is indicated to restore proprioception, but the details of recovery after arthroscopic surgery are unknown. The purpose of this study is to investigate whether arthroscopic Bankart repair can improve the position sense of the shoulder. METHODS: We used the isokinetic dynamometer Biodex System 3 (Biodex, Shirley, NY, USA) to investigate preoperative and postoperative joint position sense in 140 shoulders (137 men, 3 women) undergoing arthroscopic Bankart repair for traumatic shoulder joint instability. The control subjects comprised 40 shoulders of healthy volunteers (all men). Active position sense was measured by setting the shoulder external rotation to 75° based on 90° abduction and neutral internal/external rotation position. Reproductive angle inaccuracy (RAI) was measured thrice, and the mean value was calculated. The RAI was measured preoperatively, 6 months and 1 year postoperatively, and at the final observation (range, 16-96 months; mean, 31.5 months). RESULTS: Mean RAI was significantly higher (6.4°) preoperatively in the traumatic shoulder instability group than in the control group (5.0°). Mean postoperative RAI changed to 5.0, 4.9, and 4.7° at 6 months, 1 year, and final observation, respectively (mean, 31.5 months). RAI recovered to the same level as the control group at 6 months after the surgery and was maintained the same level until final observation. CONCLUSION: Position sense was significantly worse in patients with traumatic shoulder joint instability than in healthy volunteers, and a significant improvement in position sense was observed after reconstruction of the anteroinferior glenohumeral ligament complex by arthroscopic Bankart repair. Therefore, arthroscopic Bankart repair is a favorable procedure that can improve the position sense of the shoulder in patients with traumatic shoulder instability.

Comparison of reliability, validity and responsiveness of the Japanese Orthopaedic Association Shoulder 36 Ver. 1.3 among different diagnoses of shoulder lesions.

BACKGROUND: Shoulder 36 (Sh-36) is an original quality of life measure for shoulder lesions with high reliability and validity; however, in some cases, especially in those with a Bankart lesion, we observed no improvement in Sh-36 during the postoperative follow-up. Sh-36 may be less effective for a certain shoulder lesion. This study aimed to compare the reliability, validity, and responsiveness of Sh-36 among different representative diagnoses of shoulder lesions. METHODS: Sh-36 and the Disability of the Arm, Shoulder and Hand (DASH) were measured in 192 patients with a Bankart lesion (Bankart group), rotator cuff tear (Cuff group), and SLAP lesion (SLAP group) who underwent arthroscopic surgery. Both measures were evaluated before surgery, and at 3, 6, 9, 12, 18, and 24 months postoperatively, and reliability, validity, and responsiveness of Sh-36 and the DASH were compared among the three groups. RESULTS: Significant postoperative improvement was observed in the three groups (p < 0.0001) within 9 months. No marked improvement was observed after 9 months in the Bankart and SLAP groups due to the ceiling effect; however, most domains of Sh-36 increased continuously in the Cuff group during the whole follow-up period. Reliability and construct validity were sufficient in all the groups. The longitudinal validity was sufficient in most domains for the three groups; however, the standardized response mean in the Bankart group was lower than that in other two groups, indicating low responsiveness in this group because of the ceiling effect. CONCLUSIONS: Sh-36 was a valid and reliable instrument in patients who have undergone arthroscopic shoulder surgery, especially for patient with a rotator cuff tear with high responsiveness. However, Sh-36 had lower standard response mean representing lower responsiveness in the Bankart group due to the ceiling effect and may not be ideal for longitudinal follow-up in patients with a Bankart lesion.

Recovery of Shoulder Rotational Muscle Strength After Arthroscopic Bankart Repair.

BACKGROUND: Shoulder rotational muscles act as dynamic stabilizers of the glenohumeral joint, and the recovery of muscle strength plays an important role in stabilizing the joint during postoperative rehabilitation. However, temporal changes in muscle strength after arthroscopic Bankart repair have not been clarified. PURPOSE: To better understand the temporal recovery of shoulder rotational muscle strength after arthroscopic Bankart repair. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Isokinetic concentric shoulder rotational muscle strength was evaluated in 50 patients who were diagnosed with recurrent dislocations of the glenohumeral joint and treated with arthroscopic Bankart repair. RESULTS: The mean peak torque/weight and total work were reduced significantly at 1.5 months after surgery (P < .0001) and returned to preoperative levels by 6 months for external rotation and 4.5 months for internal rotation. The contralateral peak torque ratios reached preoperative levels by 6 months after surgery. The ipsilateral peak torque ratios were reduced between 1.5 and 3 months after surgery and returned to preoperative levels at 6 months for external rotation and 4.5 months for internal rotation. CONCLUSION: Isokinetic shoulder rotational muscle strength after arthroscopic Bankart repair recovered to preoperative levels by 6 months for external rotation and 4.5 months for internal rotation.

Ultraviolet light-irradiated photocrosslinkable chitosan hydrogel to prevent bone formation in both rat skull and fibula bone defects.

In the field of orthopaedic surgery, an orthopaedic surgeon sometimes requires to suppress excessive bone formation, such as ectopic bone formation, ossifying myositis and radio-ulnar synostosis, etc. Ultraviolet (UV) light irradiation of a photocrosslinkable chitosan (Az-CH-LA) generates an insoluble hydrogel within 30 s. The purpose of this study was to evaluate the ability of the photocrosslinked chitosan hydrogel (PCH) to inhibit bone formation in an experimental model of bone defect. Rat calvarium and fibula were surgically injured and PCH was implanted into the resultant bone defects. The PCH implants significantly prevented bone formation in the bone defects during the 4 and 8 week observation periods. In the PCH-treated defects, fibrous tissues infiltrated by inflammatory cells were formed by day 7, completely filling the bone defects. In addition to these findings, expression of osteocalcin and runt-related gene 2 (RUNX2) mRNA, both markers of bone formation, was lower in the PCH-treated defects than in the controls. In contrast, collagen type 1α2 and α-smooth muscle actin (α-SMA) mRNA levels were significantly higher in the PCH-treated defects after 1 week. PCH stimulated the formation of fibrous tissue in bone defects while inhibiting bone formation. Thus, PCH might be a promising new therapeutic biomaterial for the prevention of bone formation in orthopaedic surgery.

A longitudinal study for incidence of low back pain and radiological changes of lumbar spine in asymptomatic Japanese military young adults.

INTRODUCTION: The relation between radiological abnormalities on lumbar spine and low back pain (LBP) has been debated, presumably because of potential biases related to heterogeneity in selection of the subjects, radiological abnormalities at entry, or its cross-sectional observation in nature. Therefore, the aim of this study of a selected population of asymptomatic Japanese Self Defense Forces (JSDF) young adults male with normal lumbar radiographs was to investigate the incidence of newly developed lumbar degenerative changes at middle age and to study their association to LBP. SUBJECTS AND METHODS: In 1990, 84 JSDF male military servicemen aged 18 years, without a history of LBP and radiological abnormal findings, were enrolled. After 20 years, 84 subjects were underwent repeated X-ray and completed questionnaires on current LBP and lifestyle factors. RESULTS: The prevalence of LBP was demonstrated 59 %, with 85 % of them showing mild pain. Analysis of lumbar radiographs revealed that 48 % had normal findings and 52 % had degenerative changes. The association between LBP and life style factors was not demonstrated. Lumbar spine in subjects with LBP was more degenerated than in those without. Although disc space narrowing and LBP did not achieve a statistical significance, a significant correlation existed between vertebral osteophyte and LBP in univariate and multivariate analysis (OR 3.0; 95 % CI 1.227-7.333). DISCUSSION AND CONCLUSIONS: This longitudinal study demonstrated the significant association between vertebral osteophyte and incidence of mild LBP in initially asymptomatic and radiologically normal subjects. These data provide the additional information concerning the pathology of LBP, but further study is needed to clarify the clinical relevance.

Axonal outgrowth is associated with increased ERK 1/2 activation but decreased caspase 3 linked cell death in Schwann cells after immediate nerve repair in rats.

BACKGROUND: Extracellular-signal regulated kinase (ERK1/2) is activated by nerve damage and its activation precedes survival and proliferation of Schwann cells. In contrast, activation of caspase 3, a cysteine protease, is considered as a marker for apoptosis in Schwann cells. In the present study, axonal outgrowth, activation of ERK1/2 by phosphorylation (p-ERK 1/2 ) and immunoreactivity of cleaved caspase 3 were examined after immediate, delayed, or no repair of transected rat sciatic nerves. RESULTS: Axonal outgrowth, detected by neurofilament staining, was longer after immediate repair than after either the delayed or no repair conditions. Immediate repair also showed a higher expression of p-ERK 1/2 and a lower number of cleaved caspase 3 stained Schwann cells than after delayed nerve repair. If the transected nerve was not repaired a lower level of p-ERK 1/2 was found than in either the immediate or delayed repair conditions. Axonal outgrowth correlated to p-ERK 1/2, but not clearly with cleaved caspase 3. Contact with regenerating axons affected Schwann cells with respect to p-ERK 1/2 and cleaved caspase 3 after immediate nerve repair only. CONCLUSION: The decreased regenerative capacity that has historically been observed after delayed nerve repair may be related to impaired activation of Schwann cells and increased Schwann cell death. Outgrowing axons influence ERK 1/2 activation and apoptosis of Schwann cells.

Photocrosslinkable chitosan hydrogel can prevent bone formation in both rat skull and fibula bone defects.

UV light irradiation to a photocrosslinkable chitosan (Az-CH-LA) resulted in an insoluble and flexible hydrogel within 30 s. The purpose of this study was to evaluate the ability of the photocrosslinkable chitosan to inhibit bone formation in the bone defects. A 5-mm-diameter defect was made in the rat calvarium, and then photocrosslinkable chitosan was implanted and irradiated with UV for 30 s. Furthermore, a 2-mm defect was made in the fibula of a rat hind leg, and then photocrosslinkable chitosan was implanted and irradiated with UV. Bone formations in the rat skull and fibula defects with photocrosslinkable chitosan hydrogel were significantly prevented for 8 weeks. Thus, the chitosan hydrogel has an inhibitory effect on bone formation.