Publicly Available Anatomic Total Shoulder Arthroplasty Rehabilitation Protocols Show High Variability and Frequent Divergence from the 2020 ASSET Recommendations.

Background: In 2020, the American Society of Shoulder and Elbow Therapists (ASSET) published an evidence-based consensus statement outlining postoperative rehabilitation guidelines following anatomic total shoulder arthroplasty (TSA). Purpose: The purpose of this study was to (1) quantify the variability in online anatomic TSA rehabilitation protocols, and (2) assess their congruence with the ASSET consensus guidelines. Methods: This study was a cross-sectional investigation of publicly available, online rehabilitation protocols for anatomic TSA. A web-based search was conducted in April 2022 of publicly available rehabilitation protocols for TSA. Each collected protocol was independently reviewed by two authors to identify recommendations regarding immobilization, initiation, and progression of passive (PROM) and active range of motion (AROM), as well as the initiation and progression of strengthening and post-operative exercises and activities. The time to initiation of various components of rehabilitation was recorded as the time at which the activity or motion threshold was permitted by the protocol. Comparisons between ASSET start dates and mean start dates from included protocols were performed. Results: Of the 191 academic institutions included, 46 (24.08%) had publicly available protocols online, and a total of 91 unique protocols were included in the final analysis. There were large variations seen among included protocols for the duration and type of immobilization post-operatively, as well as for the initiation of early stretching, PROM, AROM, resistance exercises, and return to sport. Of the 37 recommendations reported by both the ASSET and included protocols, 31 (83.78%) were found to be significantly different between groups (p\<0.05). Conclusion: Considerable variability was found among online post-operative protocols for TSA with substantial deviation from the ASSET guidelines. These findings highlight the lack of standardization in rehabilitation protocols following anatomic TSA. Level of Evidence: 3b.

Effect of Kinesio taping on edema and wrist functions in patients with distal radius fracture followed conservatively with a cast: A randomized controlled single-blinded study.

BACKGROUND: Data in the literature on the results of Kinesio taping (KT) application after cast removal in patients with distal radius fracture (DRF) are quite limited. PURPOSE: It was aimed to evaluate the effectiveness of KT applied immediately after cast removal in addition to the exercise program on edema, functionality, range of motion, and muscle strength in patients with conservatively followed DRF. STUDY DESIGN: Randomized controlled single-blinded clinical study. METHODS: This study was conducted with 64 patients with a diagnosis of DRF. The patients were randomized as Kinesio taping group (KTG) and control group. Both groups received a conventional home exercise program. KT was applied to patients in KTG for 10 days. Circumference and volume measurements were taken at baseline and day 10. Arm, Shoulder, and Hand Questionnaire for Disability, Visual Analog Scale, grip strength, and wrist joint range of motion measurements were taken at baseline, day 5, and day 10. RESULTS: The circumference difference between the affected extremity and the healthy extremity was statistically greater in the control group on the fifth day at the wrist level (<0.001) and 6 cm proximal to the wrist (p = 0.001). The circumference difference between the affected extremity and the healthy extremity was statistically greater in the control group on the 10th day at the wrist level (p < 0.05) and 6 cm proximal to the wrist (p = 0.01). Wrist extension angle (<0.001), wrist flexion angle (p = 0.001), and supination angle (p = 0.001) were higher in KTG on the 10th day. On the 10th day, the grip strength (p < 0.05) was higher in the KTG, while the Visual Analog Scale value (p < 0.01), Arm, Shoulder, and Hand Questionnaire for Disability score (p < 0.01), and the percentage of strength loss in the healthy arm (p < 0.01) were lower in the KTG. CONCLUSIONS: In patients with DRF who were treated conservatively with a cast, the inclusion of Kinesio taping (KT) in the rehabilitation program was found to be effective in reducing edema and pain, as well as improving functionality, strength, and range of motion.

Spinal loads during dynamic full flexion and return to standing posture in different age and sex groups: A musculoskeletal model study.

During forward flexion, spine motion varies due to age and sex differences. Previous studies showed that lumbar/pelvis range of flexion (RoF) and lumbo-pelvic ratio (L/P) are age/sex dependent. How variation of these parameters affects lumbar loading in a normal population requires further assessment. We aimed to estimate lumbar loads during dynamic flexion-return cycle and the differences in peak loads (compression) and corresponding trunk inclinations due to variation in lumbar/pelvis RoF and L/P. Based on in vivo L/P (0.11-3.44), temporal phases of flexion (early, middle, and later), the lumbar (45-55°) and hip (60-79°) RoF; full flexion-return cycles of six seconds were reconstructed for three age groups (20-35, 36-50 and 50+ yrs.) in both sexes. Six inverse dynamic analyses were performed with a 50th percentile model, and differences in peak loads and corresponding trunk inclinations were calculated. Peak loads at L4-L5 were 179 N higher in younger males versus females, but 228 N and 210 N lower in middle-aged and older males, respectively, compared to females. Females exhibited higher trunk inclinations (6°-20°) than males across all age groups. Age related differences in L4-L5 peak loads and corresponding trunk inclinations were found up to 415 N and 19° in males and 152 N and 13° in females. With aging, peak loads were reduced in males but were found non-monotonic in females, whereas trunk inclinations at peak loads were reduced in both sexes from young to middle/old age groups. In conclusion, lumbar loading and corresponding trunk inclinations varied notably due to age/sex differences. Such data may help distinguishing normal or pathological condition of the lumbar spine.

The preservation of cervical flexibility helps maintain cervical sagittal alignment after laminoplasty.

BACKGROUND CONTEXT: Cervical spine range of motion (ROM) is a critical factor in changes in cervical sagittal alignment (CSA) and clinical outcomes after cervical laminoplasty (LMP). However, the impact of postoperative cervical ROM on CSA after cervical LMP is still unclear. PURPOSE: Evaluating the imaging and symptomatic data from patients with cervical spondylotic myelopathy (CSM) to identify the influence of postoperative cervical ROM on post-LMP CSA and surgical outcomes. STUDY DESIGN: Retrospective study. PATIENT SAMPLE: Eighty-six patients undergoing LMP due to multilevel CSM OUTCOME MEASURES: Radiographic parameters were measured before surgery and at follow-up: cervical lordosis (CL), T1 slope (T1S), cervical sagittal vertical axis (cSVA), CL in flexion (Flex CL), CL in extension (Ext CL), total cervical spine range of motion (ROM), cervical spine range of flexion (Flex ROM), and cervical spine range of extension (Ext ROM). Japanese Orthopedic Association (JOA) and visual analog score (VAS) were used to assessed clinical outcomes. Other parameters included age, gender, body mass index (BMI), follow-up time, number of surgical segments, proximal level, distalis level, and collar wear time. METHODS: We divided patients according to the changes in CSA (loss of cervical lordosis (LCL)>10°, or ≤10°; an increase in cervical sagittal vertical axis (I-cSVA) >10mm, or ≤10mm). A receiver-operating characteristic curve (ROC) analysis was constructed to identify the optimal cut-off value to discriminate the patients with and without postoperative deterioration of CSA. RESULTS: The postoperative total and Flex ROM were significantly lower in the LCL>10° and I-cSVA>10mm groups. Multivariate logistic regression analysis showed that low post-Flex ROM was significant risk factor for postoperative deterioration of CSA. ROC showed that the cut-off value for postoperative Flex ROM was 15.60°. Improvements in JOA recovery rate and neck pain were more significant in the flexibility group (post-Flex ROM ≥15.6°) after surgery. Patients in the stiffness group (post-Flex ROM <15.6°) wore a collar longer. CONCLUSIONS: The preservation of cervical flexibility can maintain CSA after cervical LMP. Postoperative cervical stiffness is related to poor surgical outcomes because significant cervical kyphotic change and sagittal imbalance are likely to occur after surgery. Prolonged wearing of cervical collar is correlated with cervical stiffness following cervical LMP.

Restoration of internal rotation after reverse shoulder arthroplasty may vary depending on etiology in patients younger than 60 ​years of age: a multicenter retrospective study.

BACKGROUND: Reverse shoulder arthroplasty (RSA) offers promising functional outcomes for young patients, yet challenges persist in restoring internal rotation (IR). This study aimed to assess the restoration of IR after RSA in patients younger than 60 years of age and analyze the factors affecting IR recovery. METHODS: A retrospective multicenter study was conducted, examining the functional outcome of patients who underwent RSA, with a minimum follow-up period of 2 years. Two subgroups of patients who underwent primary RSA were analyzed separately with respect to active internal rotation with the elbow at the side (AIR1): "difficult AIR1" and "easy AIR1." RESULTS: The study included 136 patients (overall series) with a mean age of 51.6 years. The overall series showed statistically significant improvement in active range of motion (RoM), pain, and Constant scores, especially with active IR (p â€‹< â€‹0.01). According to etiology, statistically significant improvement (p â€‹< â€‹0.05) in active IR was observed for fracture sequelae, primary osteoarthritis, and rheumatoid arthritis, whereas no statistically significant improvement in IR was observed for tumor, revision, and cuff-tear arthropathy (p â€‹> â€‹0.05). In subgroup analysis, patients with easy AIR1 displayed a statistically significant lower body mass index and better Constant score mobility, as well as improved motion in forward elevation and active IR (p â€‹< â€‹0.05). No statistically significant associations were found between improved IR and prosthetic design or subscapularis repair. Scapular notch, lysis of the graft, and teres minor atrophy were significantly associated with better active IR (p â€‹< â€‹0.05). CONCLUSION: RSA improves active RoM, pain, and functional outcomes in patients aged under 60. However, the degree of improvement in IR may vary depending on several factors and the underlying etiologies. These insights are crucial for patient selection and counseling, guiding RSA optimization efforts. LEVEL OF EVIDENCE: IV.

Comparison of resistance training vs static stretching on flexibility and maximal strength in healthy physically active adults, a randomized controlled trial.

BACKGROUND: The aim of the present study was to compare the effects of resistance training through full range of motion and static stretching (SS) of the hip and lower back extensors on flexibility and strength in healthy, physically active, adults. METHODS: Eighteen participants (age: 24.2 ± 3.0 years, body mass: 71.3 ± 8.9 kg, height: 172.8 ± 7.5 cm) were randomly assigned to either a Resistance Training (RT) (n = 6), SS (n = 6), or control (CON) group (n = 6). The sit & reach (S&R) flexibility test and maximum isometric straight legged deadlift (ISLDL) at 95% and 50% range of motion (ROM) were tested pre- and post-intervention with significance set at p < 0.05. Both groups conducted four to eight sets per session. Within each set, the RT group performed eight repetitions each lasting four seconds, while the SS group stretched continuously for 32 s. The rest periods between each set were 60-90 s. Consequently training volume and rest times were matched between the groups. RESULTS: The RT and SS groups achieved significant, large magnitude improvements in the S&R test compared to the CON group (p < 0.01 g = 2.53 and p = 0.01, g = 2.44), but no differences were observed between the RT and SS groups (p = 1.00). Furthermore, the RT group demonstrated a larger improvement in 50% and 95% ROM ISLDL compared to SS (p < 0.01, g = 2.69-3.36) and CON (p < 0.01, g = 2.44-2.57). CONCLUSION: Resistance training through a full ROM was equally effective as SS for improving S&R flexibility, but improved hip- and lower back extensor strength more than SS and the CON. The authors recommend using large ROM resistance training to improve hip and lower back extensor flexibility and muscle strength. TRIAL REGISTRATION: ISRCTN88839251, registered 24. April 2024, Retrospectively registered.

Outcomes of Mulligan Concept Applications in Obese Individuals with Chronic Mechanical Low Back Pain: A Randomized Controlled Trial.

BACKGROUND: Various treatment modalities have been employed for mechanical low back pain (MLBP), but evidence of their efficacy varies greatly. Objective: This randomized controlled trial aimed to assess the outcomes of Mulligan concept applications, including sustained natural apophyseal glides (SNAGS) and natural apophyseal glides (NAGS), in obese patients with MLBP. METHODS: The study, conducted between January 2021 and June 2022 at a tertiary hospital, involved randomizing patients into two groups. Both groups underwent six sessions of stretching and strengthening exercises every other day. The Mulligan group received additional intervention with SNAG and NAGS techniques. Measurements were made regarding the Visual Analog Scale (VAS) score, Oswestry Disability Index (ODI) score and range of motion (ROM) for the patients' MLBP level. RESULTS: Post-interventions, both groups exhibited positive changes in flexion ROM, extension ROM, right and left rotation ROM, right and left lateral flexion ROM, VAS score, and ODI score compared to pre-intervention (p < 0.001 for both groups and variables). The Mulligan group showed a higher increase in ROM and a more significant decrease in VAS and ODI scores. Conclusions: Mulligan mobilization techniques prove significantly beneficial for enhancing ROM in all directions, reducing pain levels, and alleviating disability in obese individuals with MLBP.

Effects of Nordic Walking on Functional Capacity of Women Cohort with Breast Cancer.

Background: Breast cancer is one of the most common tumours and one of the leading causes of death among women in all parts of the world. The aim of this study is to investigate the influence of Nordic walking on the functional capacity of women who have undergone surgery for breast cancer. Methods: The study involved a cohort of women who exercised through Nordic walking for 10 weeks (from March to May 2022). The subjects trained with a licenced instructor (INWA method), with two training sessions per week of 70-80 min each. We collected information on pain, arm mobility, hand grip strength, shoulder joint range of motion bilaterally, circumference of both arms, body mass index, physical activity, aerobic capacity, and endurance. Results: There were 14 women, median age 63. BMI was significantly lower (28.9/28.1; p = 0.013) after training and a difference in shoulder range of motion was better (anteflexion right (142.5/170, p = 0.002), retroflexion right (40/60, p = 0.005), abduction right (135/180, p = 0.005), abduction left (135/180, p = 0.005)). There was no difference in right hand strength, while there was a significant difference in left hand strength (19/20, p = 0.007). A correlation was found between BMI and the six-minute walk test (r = -0.70; p = 0.005). Conclusions: Considering the multidimensionality of the disease itself and the results of this study, we believe that Nordic walking is a favourable and good choice of physical activity for breast cancer patients.

Resistance Training Causes the Stretch-Induced Force Deficit-A Randomized Cross-Over Study.

PURPOSE: Stretch-induced force deficit suggests an acute stretch-specific strength capacity loss, which is commonly attributed to EMG reductions. Since those deficits could also be attributed to general fatigue induced by overloading the muscle, this study aimed to compare stretching with an exhausting calf raise programme to compare strength and stretching responses. METHOD: This study included 16 participants with different, high-duration calf muscle stretching effects (10, 20, 30 min of stretching) with resistance training (RT) (3 × 12 repetitions) performed until muscle failure, by using a cross-over study design with pre-post comparisons. Strength was tested via isometric plantar flexor diagnostics, while flexibility was assessed using the knee-to-wall test (KtW) and an isolated goniometer test. RESULTS: Using a three-way ANOVA, RT strength decreases were greater compared to 10 and 20 min of stretching (p = 0.01-0.02), but similar to those of 30 min of stretching. ROM in the KtW showed no specific stretch-induced increases, while only the stretching conditions enhanced isolated tested ROM (p < 0.001-0.008). No RT-related isolated ROM increases were observed. CONCLUSIONS: The results showed both interventions had similar effects on strength and ROM in the calf muscles. More holistic explanatory approaches such as fatigue and warm-up are discussed in the manuscript and call for further research.

Effect of 6-Week Instrument-Assisted Soft Tissue Mobilization on Joint Flexibility and Musculotendinous Properties.

Instrument-assisted soft tissue mobilization (IASTM) stimulates soft subcutaneous tissues by applying pressure to the skin with a specialized bar or spurtle-like instrument. No studies have verified whether several weeks of continuous IASTM alone can alter joint flexibility and musculotendinous properties in healthy participants. We examined the effect of a 6-week IASTM program on joint flexibility and the musculotendinous properties of the lower limbs. Fourteen healthy men (aged 19-35 years) who participated in a 6-week IASTM program (3 days weekly) for the soft tissue of the posterior aspect of one lower leg were included. The other leg served as the control. Before and after the intervention, we measured the maximal ankle joint dorsiflexion angle (dorsiflexion range of motion: DFROM) and maximal passive torque (MPT), a measure of stretch tolerance. We measured muscle and tendon stiffness using shear wave elastography on the gastrocnemius and Achilles tendon. IASTM significantly increased the DFROM and MPT (p < 0.05 for both). However, no significant changes were observed in muscle and tendon stiffness. None of the parameters changed significantly in the control group. The 6-week IASTM program increased stretch tolerance and joint flexibility but did not change muscle and tendon stiffness.

Acute and Long-Term Effects of Stretching with Whole-Body Vibration on Young's Modulus of the Soleus Muscle Measured Using Shear Wave Elastography.

The effect of whole-body vibration (WBV) stretching on soleus (SOL) muscle stiffness remains unclear. Therefore, we aimed to investigate the acute and long-term effects of stretching with WBV on SOL muscle stiffness. This study employed a repeated-measures experimental design evaluating 20 healthy young males. SOL muscle stretching with WBV was performed for 5 min per day (1 min per set, five sets) over 4 weeks, for 4 days a week. Participants stretched the SOL muscle with ankle dorsiflexion in a loaded flexed knee position on a WBV device. Data were obtained to examine acute effects before stretching, immediately after stretching, and at 5, 10, 15, and 20 min. Moreover, data were obtained to examine the long-term effects before stretching, immediately after the completion of the 4-week stretching program, and at 2 and 4 weeks later. SOL muscle stiffness was measured using Young's modulus with shear wave elastography. The acute effect of SOL muscle stretching with WBV persisted for up to 20 min. Additionally, the long-term effect of stretching was better maintained than the acute effect, which was effective for up to 4 weeks (p < 0.001). Clinically, continuous stretching with WBV may be used to improve SOL muscle stiffness in rehabilitation programs.

Postoperative rehabilitation and quality of life evaluation for transoral endoscopic thyroidectomy vestibular approach.

There are no targeted rehabilitation training modalities and assessment tools for patients after transoral endoscopic thyroidectomy vestibular approach (TOETVA). Herein, we develop a new assessment questionnaire and rehabilitation training modality and evaluate its safety and effectiveness. The THYCA-QoL-TOETVA questionnaire was compiled, and reliability and validity analyses were performed. Patients were divided into the new rehabilitation training group (N) or the conventional rehabilitation training group (C), and 1:1 propensity score matching (PSM) was performed after administering questionnaires to patients in both groups. Cervical range of motion (CROM) data were also measured and collected for statistical analysis. The questionnaire used in this study showed good expert authority, coordination, internal consistency, and questionnaire reliability. A total of 476 patients were included after PSM, and the questionnaire results showed that recovery and quality of life were better in the N group than in the C group (124.55 ± 8.171 vs. 122.94 ± 8.366, p = 0.026). Analysis of cervical spine mobility showed that rehabilitation was better in the N group compared to the C group at postoperative one month (flexion: 1.762°, extension: 4.720°, left lateral bending: 3.912°, right lateral bending: 4.061°, left axial rotation: 5.180°, right axial rotation: 5.199°, p value all of these < 0.001), and at postoperative three months (flexion: 2.866°, extension: 2.904°, left lateral bending: 3.927°, right lateral bending: 3.330°, left axial rotation: 4.395°, right axial rotation: 3.992°, p value all of these < 0.001). The THYCA-QoL-TOETVA provides an appropriate and effective tool for measuring the postoperative quality of life of TOETVA patients. This new rehabilitation training can effectively alleviate the problem of limited neck movement and improve the quality of life of patients after TOETVA surgery.Trial registration: ChiCTR2300069097.

Effect of duration of preoperative pain on outcomes of total temporomandibular joint replacement.

The purpose of the study was to determine whether the duration of preoperative pain affects outcomes of temporomandibular joint replacement (TMJR). Twenty-seven patients who underwent primary TMJR between 1 July 2020 and 31 October 2022 were retrospectively assessed for duration of preoperative pain, level of preoperative and postoperative pain on a visual analogue scale (VAS; 0, none; 10, severe), preoperative and postoperative range of motion (ROM), and net change in quality of life (much better, better, same, worse, much worse), reporting the longest available follow up for each patient. Surgical success was defined as postoperative pain of ≤4 and postoperative ROM of ≥30 mm, or net change (Δ) in ROM of ≥10 mm. Regression analyses evaluated associations between independent variables and postoperative pain and ROM. At a mean follow-up of 17.8 (SD: 6.8, range 3-32) months , pain (5.1, SD: 2.2, p < 0.001) and ROM (9.3 mm, SD: 8.0, p<0.001) significantly improved. Quality of life was much better in 16 patients, better in eight, the same in one, and worse in two. Longer duration of preoperative pain tended to be negatively associated with postoperative ROM (ß = -0.27; 95% CI -0.6 to 0.0; p = 0.078) but was not associated with severity of postoperative pain. Surgical success was achieved in 23/27 patients. The successful group tended to have lower pain on VAS preoperatively (5.9, SD: 1.9) vs 7.5, SD: 1.3) and postoperatively (0.4, SD: 0.8 vs 4.8, SD: 2.6), and greater improvement in quality of life (much better: 14/23 vs 2/4). In conclusion, longer duration of preoperative pain tended to be associated with worse postoperative ROM following TMJR. Higher preoperative pain may be a predictor for unsuccessful surgery.

Reliability of mandibular range of motion measurements in healthy children.

BACKGROUND: Mandibular range of motion (MROM) variables are widely used to evaluate oral function. OBJECTIVE: The aim of this study was to establish the reliability of MROM variables in healthy children. METHODS: In this cross-sectional study, healthy children were examined 2 weeks apart. The following MROM variables were established: active maximum interincisal opening (AMIO), passive maximum interincisal opening (PMIO), protrusion and left and right laterotrusion. The reliability of the MROM measurements was determined by analysing the intra-class correlation coefficient (ICC), standard error of measurement (SEM), smallest detectable change (SDC) and limits of agreement (LoA). RESULTS: A total of 167 healthy children were examined. The ICC indicated good reliability for AMIO (0.885); excellent reliability for PMIO (0.925); and moderate reliability for protrusion (0.578), laterotrusion left (0.601) and laterotrusion right (0.634). The SDC was 0.9 mm for AMIO, 0.4 mm for PMIO, 2.2 mm for protrusion, 1.6 mm for laterotrusion left and 1.4 mm for laterotrusion right. The LoA was -5.67 to 5.82 for AMIO, -3.90 to 3.57 for PMIO, -3.89 to 3.55 for protrusion, -2.99 to 2.77 for laterotrusion left, and - 2.71 to 2.77 for laterotrusion right. CONCLUSIONS: AMIO and PMIO measurements are both highly reliable in healthy children. The low SDC indicate that AMIO and PMIO are promising longitudinal measurements. Protrusion and laterotrusion measurements had moderate reliability. These results support our clinical recommendation to measure AMIO rather than PMIO, as PMIO is more difficult and more time-consuming to perform than AMIO.

The Influence of Physical Exercises on the Flexibility of Older Individuals with Knee Osteoarthritis: A Systematic Review.

Background: Flexibility is a component of functional capacity and is relevant in maintaining the musculature and structures adjacent to the joints. Then, the improvement of the flexibility must be a critical goal in the rehabilitation programs. By improving flexibility in knee osteoarthritis (KOA) individuals, the pain is relieved, the risk of injury is reduced, and the need for surgical interventions is delayed. We aimed to summarize the available literature on the influence of different physical exercise modalities on flexibility in older KOA individuals. Methods: This study followed the PRISMA statement and registered in PROSPERO (CRD42020195786). Seven databases (MEDLINE/PubMed; PEDro; CINAHL; Scopus; Web of Science; Embase; and SPORTDiscus) were screened for papers published prior to Sep 6, 2022. The PEDro scale, Cochrane collaborations, and ROBINS-I tools were used to evaluate the methodological quality and risk of bias. Results: Ten studies (including 438 participants diagnosed with KOA) fulfilled the eligibility criteria, and nine concluded that flexibility was improved after a physical exercise program. Conclusion: Despite the modality, physical exercise improves flexibility in older KOA individuals, improving the functional capacity. Health professionals engaged in KOA rehabilitation should use physical exercise as a strategy to improve the flexibility of this population.

The Relationship between Heart Rate Variability, Pain Intensity, Pain Catastrophizing, Disability, Quality of Life and Range of Cervical Motion in Patients with Chronic Non-Specific Neck Pain: A Cross-Sectional Study.

The purpose of the present cross-sectional study was to examine the relationship between heart rate variability (HRV) and the range of cervical motion, disability, pain intensity, pain catastrophizing, and quality of life in patients with chronic, non-specific neck pain. Thirty-five patients, aged 20-48 years, with chronic non-specific neck pain, completed validated questionnaires regarding neck pain intensity, pain-associated disability, catastrophic thoughts, and quality of life. The range of cervical motion was assessed using a digital goniometer. HRV indices were recorded in three positions (supine, sitting, and standing) through a smartphone application. Several significant correlations were observed between HRV indices and neck pain disability, the helplessness factor of catastrophizing, neck rotation, and quality of life. These correlations were only observed in the standing position. Pain catastrophizing was positively correlated with disability and pain intensity during active neck movement (Pearson r = 0.544, p < 0.01; Pearson r = 0.605, p < 0.01, respectively). Quality of life was negatively correlated with pain intensity during active movement (Pearson r = -0.347, p < 0.05). HRV indices were correlated with the psychological and physical domains of neck pain. These cardiac indices have been related to neck pain variables in some previous studies. Further research is needed to confirm this relationship in different daily conditions.

Evaluating the effects of two different kinesiology taping techniques on shoulder range of motion and proprioception in patients with hypermobile Ehlers-Danlos syndrome: a randomized controlled trial.

Background: Ehlers-Danlos syndrome (EDS) is a common group of inherited connective tissue disorders with a prevalence as high as 0.75%-2% of the population. Physical manifestations include pain and decreased proprioception, especially in more mobile joints, such as the shoulder. The kinesiology tape (K-Tape) is often used to treat patients with shoulder dysfunction. The effectiveness of the K-Tape is uncertain, and there is a lack of studies specifically studying the K-Tape in an EDS population. Purpose: The purpose of this study was to compare the short-term effects of two different K-Tape procedures on shoulder active joint reposition (AJR) and active range of motion (AROM) in patients with hypermobile EDS (hEDS) and shoulder pain. Methods: All participants were recruited from the EDS support groups and presented with shoulder pain. Baseline demographic information was obtained for each participant, after which AROM and AJR were assessed. The participants were randomized to receive one of two K-Tape procedures. Testing was repeated immediately post-taping and 48 h post-taping. Results: Significant improvements in shoulder external (F = 10.917, p < 0.001) and internal (F = 11.736, p < 0.001) rotations were seen from baseline to immediately post-taping and baseline to 48 h post-taping in the experimental K-Tape group. There were no significant differences in the shoulder rotation in the control K-Tape group and no significant differences in either group for shoulder flexion or AJR at any time point (p > 0.05). Conclusion: K-Tape may offer short-term improvements in shoulder rotation AROM in patients with hEDS and shoulder pain.

Functional Internal Rotation is Associated with Subscapularis Tendon Healing and Increased Scapular Tilt after Grammont style BIO RSA with 155° humeral implant.

BACKGROUND: While forward flexion consistently improves after reverse shoulder arthroplasty (RSA), restoration of internal rotation behind the back (IR1) is much less predictable. This study aims to evaluate the role of the subscapularis tendon in restoration of IR and identify other factors that may influence IR such as anterior scapular tilt and postoperative passive internal rotation at 90° of abduction (IR2). The hypothesis was that IR1 is positively associated with both subscapularis healing, postoperative passive IR2, and anterior scapular tilt. METHODS: A retrospective review was performed on a consecutive series of Grammont style BIO (bony increased offset) RSAs performed by a single surgeon between January 2014 and December 2015. Inclusion criteria were: (1) primary RSA for rotator cuff arthropathy, massive irreparable rotator cuff tear, or primary osteoarthritis with B2 glenoid morphology, (2) minimum of two years clinical follow-up, and (3) complete intraoperative repair of a repairable subscapularis tendon. The primary outcomes were postoperative return of IR1 compared to postoperative IR2, healing rate of subscapularis tendon, and scapular tilt. RESULTS: The cohort included 77 patients, aged 72.6±7.0 years at index surgery and comprising 32 men (42%) and 45 women (58%). At a mean follow-up of 3.3±1.0 years, ultrasound evaluation revealed a successful repair of the subscapularis in 41 patients (53%). Healed subscapularis repair was significantly associated with greater IR1 (85% vs. 53%, p=0.031). A multivariate logistic regression revealed functional postoperative IR1 was independently associated with subscapularis healing (OR, 4.3; 95%CI [1.1-20.2]; p=0.046) as well as greater anterior tilt (OR, 1.2; 95%CI [1.1-1.5]; p=0.008) and postoperative IR2 (OR, 1.09; 95%CI [1.05-1.14]; p<0.001) but lower postoperative passive abduction (OR, 0.96; 95%CI [0.92-1.00], p=0.045). The area under receiver operating characteristic curve obtained with the Youden index was 0.88 with a sensitivity of 81.8% and specificity of 90.6%. CONCLUSIONS: This study revealed that in a Grammont-type RSA, postoperative IR1 recovery is first associated with subscapularis tendon healing, followed by IR2 and finally the ability to tilt the scapula anteriorly. Better understanding of these factors preoperatively may provide greater insight on expected return of functional internal after RSA.

A comparison of quantitative parameters of axial posture and spinal mobility between motor subtypes of Parkinson's disease.

Background and purpose:

Parkinson’s disease (PD) is a heterogeneous neurodegenerative disorder characterized by contradictory clinical outcomes among its several subtypes. The disease can manifest with a tremor-dominant (TD) or a non-tremor-dominant (NTD) phenotype. Although the TD subtype may show a better prognosis, there is limited information on the phenotypic differences regarding the level of axial symptoms. For this reason, in this study it was aimed to make a quantitative comparison of axial posture and spinal mobility between PD with TD and NTD. 

This case-control study was conducted on 94 patients with diagnosed PD. A group diagnosis approach was used in the study, such that the diagnosis of each patient was confirmed, and they were assig-ned to TD and NTD groups by a neurologist expert on movement disorders. Of the patients with PD, 61 were in the TD group, and 33 were in the NTD group. Spinal mouse was used to measure spinal posture and spinal mobility in both sagittal and frontal planes. 

Two groups of 61 patients (25 male + 36 female) with TD-PD (mean age: 64.49±10.37 years) and 33 patients (20 male +13 female) with NTD-PD (mean age: 63.45±9.11 years) were enrolled in the study. There were no significant differences bet­ween the patients with TD and NTD in terms of sagittal and frontal postures (p>0.05). In addition to this, anterior trunk tilt was found to significantly increase as the disease stage advanced in both groups. While the greatest anterior trunk tilt change in the TD-PD group was observed in the 3rd stage, NTD-PD group was in the 2.5th stage. Aside from this, the out­comes of the spinal mobility measurements in the frontal and sagittal planes were similar between the groups (p>0.05).

It is widely acknowledged that many clinical aspects of the TD and NTD forms of PD differ; however, in our study, it was observed that there may be no difference in the axial symptoms of the patients with PD in terms of classification according to tremor dominance.

Percutaneous distal chevron osteotomy is associated with lower immediate postoperative pain and a greater range of motion than the open technique: A prospective randomized study.

PURPOSE: The results of past studies comparing percutaneous techniques with traditional open techniques for hallux valgus are controversial. Therefore, this study aimed to compare the radiologic and clinical outcomes of percutaneous and open distal chevron osteotomies. METHODS: Seventy-one patients with mild to severe hallux valgus deformity were randomized to undergo percutaneous distal chevron osteotomy (percutaneous group, n = 36) or open distal chevron osteotomy (open group, n = 35) between October 2019 and September 2020. Radiological and clinical outcomes were assessed preoperatively and postoperatively. Outcome measures included the foot and ankle outcome score, foot functional index, visual analogue scale (VAS) scores for pain, range of motion (ROM) of the first metatarsophalangeal (MTP) joint, hallux valgus angle, intermetatarsal angle, and first metatarsal shortening. Additionally, the first metatarsal declination angle was measured to evaluate sagittal malunion. RESULTS: The mean first metatarsal declination angle decreased significantly at 12 months postoperatively in both groups (p = 0.021 and p < 0.001 in the percutaneous and open groups, respectively), and the decrement was significantly greater in the open group (p = 0.033). The mean VAS score for pain on postoperative day one was 4.2 ± 1.9 and 5.3 ± 1.7 in the percutaneous and open groups, respectively (p = 0.019). The mean ROM of the first MTP joint did not change significantly after surgery, from 72.5 ± 7.5 preoperatively to 71.0 ± 9.5 at 12 months postoperatively in the percutaneous group (p = 0.215); however, it decreased significantly from 70.6 ± 7.3 preoperatively to 63.4 ± 10.4 at 12 months postoperatively in the open group (p < 0.001). There were no significant differences between the groups regarding other clinical outcomes. CONCLUSION: The percutaneous group showed a lower immediate pain level at postoperative day 1 and better ROM of the first MTP joint at 12 months postoperatively.