Search Results (185)

Control of elbow exoskeletons using muscular signals, although promising for the rehabilitation of millions of patients, has not yet been widely commercialized due to challenges in real-time intention estimation and management of dynamic uncertainties. From a practical perspective, millions of patients with stroke, spinal cord injury, or neuromuscular disorders annually require active rehabilitation, and elbow exoskeletons with precise and safe motion intention tracking capabilities can restore functional independence, reduce muscle atrophy, and lower treatment costs. In this research, an intelligent control framework was developed for an elbow joint exoskeleton, designed with the aim of precise and safe real-time tracking of the user’s motion intention. The proposed framework consists of two main stages: (a) real-time estimation of desired joint angle (as a proxy for movement intention) from High-Density Surface Electromyography (HD-sEMG) signals using an LSTM network and (b) implementation and comparison of three PID, impedance, and sliding mode controllers. A public EMG dataset including signals from 12 healthy individuals in four isometric tasks (flexion, extension, pronation, supination) and three effort levels (10, 30, 50 percent MVC) is utilized. After comprehensive preprocessing (Butterworth filter, 50 Hz notch, removal of faulty channels) and extraction of 13 time-domain features with 99 percent overlapping windows, the LSTM network with optimal architecture (128 units, Dropout, batch normalization) is trained. The model attained an RMSE of 0.630 Nm, R² of 0.965, and a Pearson correlation of 0.985 for the full dataset, indicating a 47% improvement in R² relative to traditional statistical approaches, where EMG is converted to desired angle via joint stiffness. An assessment of 12 motion–effort combinations reveals that the sliding mode controller consistently surpassed the alternatives, achieving the minimal tracking errors (average RMSE = 0.21 Nm, R² ≈ 0.96) and showing superior resilience across all tasks and effort levels. The impedance controller demonstrates superior performance in flexion/extension (average RMSE ≈ 0.22 Nm, R² > 0.94) but experiences moderate deterioration in pronation/supination under increased loads, while the classical PID controller shows significant errors (RMSE reaching 17.24 Nm, negative R² in multiple scenarios) and so it is inappropriate for direct myoelectric control. The proposed LSTM–sliding mode hybrid architecture shows exceptional accuracy, robustness, and transparency in real-time intention monitoring, demonstrating promising performance in offline simulation, with potential for real-time clinical applications pending hardware validation for advanced upper-limb exoskeletons in neurorehabilitation and assistive applications. Full article

Background/Objectives: Combat trauma involving large joints is associated with a high risk of thromboinflammatory complications. Early identification of laboratory markers for hypercoagulability is essential to optimise perioperative management. This study aimed to evaluate the dynamics of inflammation and haemostasis indicators in patients with combat-related joint trauma and to identify the most informative markers for preoperative risk assessment. Methods: A total of 29 patients with combat injuries to the hip, knee, elbow, or ankle joints were examined. Blood samples were taken 1–3 days prior to surgery and again on the first postoperative day. Parameters of coagulation (e.g., PT, INR, fibrinogen, D-dimer, soluble fibrin complexes, antithrombin III), fibrinolysis, and inflammation (e.g., CRP, haptoglobin, sialic acid, ESR, LSI, LII) were analysed and compared to those of 30 healthy controls. Statistical analysis included Student’s t-test and Pearson’s correlation. Results: At baseline, patients demonstrated significant increases in inflammatory markers (CRP 64.2 ± 7.3 mg/L, ↑738.9%; haptoglobin 3.25 ± 0.4 g/L, ↑164.3%; ESR 46.8 ± 5.2 mm/h, ↑313.8%) and procoagulant activity (D-dimer 1.42 ± 0.18 µg/mL, ↑136.6%; fibrinogen 6.12 ± 0.51 g/L, ↑102.4%; soluble fibrin complexes 38.7 ± 4.9 mg/L, ↑597.3%), together with a reduction in antithrombin III activity (63.5 ± 6.2%, ↓39.5%) and prolonged fibrinolysis time (increase by 197%). Postoperatively, these abnormalities intensified, indicating a sustained thromboinflammatory response. Strong correlations were found between inflammatory and haemostatic markers. Conclusions: Combat trauma of large joints is associated with preoperative thromboinflammatory dysregulation, which is exacerbated by surgery. Monitoring specific biochemical and haematological markers—such as CRP, fibrinogen, D-dimer, and soluble fibrin complexes—may support preoperative risk assessment and postoperative monitoring strategies for hypercoagulable states in this high-risk group. These findings lay the groundwork for future prospective studies aimed at developing stratified therapeutic protocols and predictive models for thromboinflammatory complications in orthopaedic trauma care. Full article

The increasing aging population and the rise in sports injuries have led to greater demand for elbow function rehabilitation and daily assistance. To address the limitations of traditional rigid rehabilitation aids and existing flexible assistive systems, this paper designs a wearable elbow-assist robot that arranges pneumatic muscles based on the distribution of human elbow muscles. By integrating bionic design, experimental research, and mathematical modeling, the proposed approach determines the optimal scheme through comparative experiments on material structures and provides supporting data, while the mathematical model describes the force characteristics of the pneumatic muscles. Final experiments verify that the system can effectively assist elbow movement and significantly enhance flexion torque. Full article

Background/Objectives: Periprosthetic humeral fractures (PF) after reverse total shoulder arthroplasty (RSA) are expected to increase. This study investigated PF after RSA with short stems and reported outcomes. Methods: A total of 165 patients underwent short-stem RSAs between 2014 and 2023. Among them, patients who developed postoperative PFs were identified and classified by fracture location and stem loosening. Operative data, complications, and bone union time were analyzed. Clinical outcomes before injury and at final follow-up were evaluated. Results: PF occurred in 5/165 patients (3.0%). Based on our classification, four had type B1 fractures and one had a type B3 fracture. All underwent revision RSA (Re-RSA) with conversion to long-stem implants. Bone union was achieved in four patients, while one patient experienced infection without union. Among the four patients without complications, mean shoulder flexion declined from 138° pre-injury to 103°, abduction from 118° to 95°, external rotation from 37° to 31°, the American Shoulder and Elbow Surgeons (ASES) score from 82.0 to 68.7, Constant Score from 67 to 43, while the Visual Analog Scale (VAS) pain score increased from 1.7 to 2.6. Conclusions: All five cases of PF following short-stem RSA were stem-level (type B) fractures. All patients underwent Re-RSA using long-stem conversion. Four patients had bone union. Clinical outcomes at one year postoperatively had deteriorated mildly compared to pre-fracture. However, this change was not statistically significant. One patient had a postoperative infection, and bone union was not observed. This study indicates the need for caution regarding postoperative infections after RSA. Full article

Fishing is a widely practiced recreational activity that offers psychological, physical, and social benefits, but it also poses risks such as acute trauma and chronic overuse injuries. This narrative review aims to (1) synthesize current evidence on the musculoskeletal disorders, psychological outcomes, and environmental factors associated with recreational and sport fishing; (2) identify the physical, mental, and social health benefits reported across different angling disciplines; (3) characterize acute and chronic injury risks, including overuse syndromes and environment-related hazards; and (4) highlight gaps in the literature to guide future research directions in public health, rehabilitation, and preventive medicine. Materials and Methods: A narrative review was conducted in accordance with SANRA guidelines. A structured search of PubMed, Scopus, Web of Science and Google Scholar identified studies published between 2000 and 2025. Eligible sources included population surveys, clinical studies, therapeutic angling programs, epidemiological reports, and case studies addressing physical, psychological, or injury-related outcomes in recreational or sport fishing. Studies on commercial or occupational fishing were excluded. Evidence was synthesized thematically across benefit and risk domains. A total of 565 records were identified across four databases (PubMed, Scopus, Web of Science, Google Scholar). After screening, duplication, and full-text assessment, 41 studies met the eligibility criteria and were included in the narrative synthesis. The evidence indicates significant psychological benefits of fishing, including reductions in stress, improved mood, and clinically meaningful decreases in Post-Traumatic Stress Disorder (PTSD) symptoms reported in therapeutic fly-fishing programs. Musculoskeletal outcomes were more heterogeneous: chronic conditions such as low back pain and repetitive strain injuries of the shoulder, elbow, and wrist were commonly reported among regular anglers, particularly in physically demanding disciplines. Ice and sea fishing were associated with distinct environmental risks, including hypothermia, frostbite, and rare but documented fatal incidents. The results of this narrative review highlight the therapeutic potential of both recreational and sport fishing. However, they also point to the need for greater awareness of the risk of injury and environmental hazards associated with this type of fishing. Full article

Manual wheelchair propulsion is a frequent activity among people with spinal cord injury (SCI) and is linked to upper limb loading and shoulder pain. We compared propulsion strategies at cadences of 30 and 50 bpm. Kinematics and surface electromyography (EMG) were recorded across the propulsion cycle, push/recovery phases, and events. Ranges of motion for shoulder flexion/extension, adduction/abduction, and elbow flexion/extension did not differ significantly, although ROM tended to be smaller at 50 bpm; push angle was larger at 50 bpm but not significant. Propulsion cycle duration was shorter at 50 bpm (p < 0.001). Push duration was similar, but its proportion of the cycle increased at 50 bpm (p < 0.001). Recovery duration was shorter at 50 bpm (p < 0.001), yet its cycle proportion increased (p < 0.01). EMG showed cadence-specific redistribution: higher activity at 50 bpm at preparation (anterior deltoid, pectoralis major, biceps brachii, upper trapezius; p < 0.01) and at contact (posterior deltoid; p < 0.05); higher biceps brachii at release and higher anterior deltoid at end-range extension at 30 bpm (both p < 0.05). Cadence manipulation reorganized timing and muscle demands without large ROM changes, supporting rhythm-based training and propulsion design to mitigate shoulder loading. Full article

Background/Objectives: Acromioclavicular (AC) joint injuries account for 9–12% of shoulder injuries, predominantly affecting young male athletes. While conservative treatment is established for Rockwood type I–II injuries and surgery is widely regarded as indicated for type V–VI, management of type III–IV injuries remains controversial. Biomechanical studies have shown superior results in combined reconstruction of the coracoclavicular and AC ligament complex, however clinical data is scarce. Therefore, the present study aimed to assess whether the addition of an acromioclavicular ligament reconstruction to an isolated coracoclavicular repair offers superior clinical and radiographic outcomes in the treatment of acute AC joint dislocations. Methods: A retrospective multicenter study was conducted on patients with Rockwood type III–VI AC joint injuries who underwent surgical treatment between 2019 and 2024. Patients were divided into two groups: isolated CC reconstruction (group I) and combined CC and AC ligament reconstruction (group II). Clinical outcome was assessed using patient-reported outcome measures (American Shoulder and Elbow Surgeons Score, Simple Shoulder Test, Single Assessment Numeric Evaluation, Visual Analogue Scale) and radiographic evaluations were performed regularly up to 6 months postoperatively. Results: Fifty-five patients (94.5% male, mean age 33.5 ± 10.9 years) were included in the present study. High patient satisfaction (group I: ASES 96.3 ± 7.9, SST 99.2 ± 3.3, SANE 95.3 ± 7.0; group II: ASES 95.8 ± 8.8, SST 96.8 ± 8.2, SANE 93.6 ± 12.8) was documented in both groups, but no significant differences were observed. The median coracoclavicular loosening ratio was 24.7% in the CC group and 32.6% in the CC and AC ligament reconstruction group (p = 0.830). Five complications occurred: two infections and three revision surgeries due to excessive secondary dislocations. Conclusions: Both surgical techniques demonstrated excellent clinical outcomes. In this study combined CC and AC ligament reconstruction did not yield superior clinical or radiological results compared to isolated coracoclavicular reconstruction. Our findings suggest that a routine AC ligament augmentation may not be necessary in all patients. Further randomized controlled trials are needed to validate these results. Full article

Background/Objectives: This study investigated biomechanical differences between right-handed (RHPs) and left-handed (LHPs) youth baseball players by analyzing shoulder and elbow range of motion (ROM), muscle strength, and humeral torsion. Side-to-side asymmetries were also examined to identify potential handedness-related adaptations. Methods: This cross-sectional study included 2008 youth baseball players (1829 RHPs and 179 LHPs) aged 9–13 years; female players were excluded because of their small number, and only male participants were analyzed. Shoulder and elbow ROM, muscle strength, and humeral torsion were evaluated, with humeral torsion data collected from 1024 measurements (946 RHPs, 78 LHPs). Group differences were analyzed using the Mann–Whitney U and Wilcoxon Signed-Rank tests. Logistic regression analysis identified independent factors associated with being an LHP, while Pearson correlation analyses explored the relationships between humeral torsion and external/internal rotation. Results: LHPs exhibited significantly larger nondominant shoulder external rotation (p < 0.001), dominant internal rotation (p = 0.003), dominant shoulder horizontal adduction (p = 0.007), dominant elbow flexion (p = 0.006), and side-to-side prone internal rotation strength ratio (p < 0.001). LHPs also showed smaller dominant shoulder external rotation (p = 0.012), nondominant shoulder internal rotation (p = 0.001), nondominant horizontal adduction (p = 0.037), dominant prone external rotation strength (p = 0.002), and humeral torsion (p = 0.031). Humeral torsion differences correlated with external rotation in LHPs (r = 0.236) and internal rotation in RHPs (r = −0.153). Predictors of left-handedness included lower dominant shoulder external rotation (OR = 0.937) and higher dominant elbow flexion (OR = 1.410). Conclusions: This study provides novel insights into the normal functional characteristics of LHPs, an area that has been relatively underexplored. These findings serve as a basis for future studies on risk assessment, injury prevention, and performance optimization in youth baseball players. Full article

Background/Objectives: Distal biceps tendon rupture is a disabling injury that compromises elbow flexion and forearm supination strength, particularly in high-performance athletes. Although several fixation techniques have been proposed, no single method has proven optimal in combining mechanical stability, anatomical restoration, and early functional recovery. This study aimed to evaluate the efficacy, safety, and reproducibility of a hybrid dual-fixation technique combining a Tightrope^® cortical button (Arthrex, Naples, FL, USA) with a PEEK interference screw for anatomic reinsertion of the distal biceps tendon in athletic individuals. Methods: A prospective observational study was conducted on 13 high-performance athletes who underwent distal biceps tendon repair using the hybrid Tightrope–PEEK construct between March 2024 and September 2025. Functional recovery, muscle strength, esthetic contour, and patient satisfaction were evaluated using the Visual Analog Scale (VAS), Mayo Elbow Performance Score (MEPS), Quick Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH), and a 5-point Likert scale over a 12-month follow-up. Descriptive statistical analysis was performed using IBM SPSS Statistics, version 29.0. Results: All patients achieved secure fixation with no intraoperative or postoperative complications, loss of reduction, or hardware failure. Early controlled mobilization began within the first postoperative week. At 6 months, flexion and supination strength were fully restored, and at 12 months, all patients achieved full range of motion and optimal functional scores (mean MEPS 100; QuickDASH 0). No “Popeye” deformities or contour irregularities were observed, and mean patient satisfaction was 5/5. Conclusions: The hybrid Tightrope–PEEK dual-fixation technique provides excellent mechanical stability, allowing early mobilization and rapid functional recovery with minimal complications. Its reproducibility and cosmetic advantages suggest that it represents a safe and effective option for distal biceps tendon reinsertion in high-demand athletes. Full article

Background/Objectives: The Kerlan-Jobe Orthopaedic Clinic Shoulder & Elbow Score (KJOC) is used to identify dysfunctions and estimate injury risk in overhead sports athletes. Although it has been validated in several countries, a European Portuguese version is currently unavailable. This study aimed to translate, culturally adapt and assess psychometric properties (validity and reliability) of the European Portuguese KJOC (KJOC-PT). Methods: The KJOC-PT was translated and culturally adapted according to international guidelines. One hundred athletes were selected (median age 24 [IQR 17] years, 72% male) and divided into two groups: asymptomatic and symptomatic athletes. The convergent validity was assessed by correlating the KJOC-PT with the Disabilities of the Arm, Shoulder and Hand (DASH) and DASH-Sports. 31 athletes from the initial sample were considered to assess between-day reliability and agreement (Bland-Altman analysis). Floor and ceiling effects were also calculated. Sampling adequacy was assessed using the Kaiser Meyer-Olkin (KMO) test. Results: Minor cultural and linguistic changes were made in the KJOC-PT. This version demonstrated excellent internal consistency (Cronbach’s α = 0.91 to 0.97) and moderate negative correlations for validity (KJOC-PT with DASH, rho = −0.595; with DASH-Sports, rho = −0.533, both p < 0.001). Good reliability (ICC_2,1 = 0.77 to 0.89 [95%CI 0.36 to 0.96]), measurement error (SEM = 4.11 to 6.90; MDC = 11.39 to 19.13) and mean difference ranging from −0.08 ± 6.14 to 3 ± 9.17 were found. No floor effect (0%) and ceiling effects of 24.2% for the total sample (50% for asymptomatic and 5.1% for symptomatic athletes) were found. Conclusions: KJOC-PT is now available and is a valid and reliable instrument for use by athletes in overhead sports. Full article

Virtual reality (VR) offers built-in wearable sensor-based tracking capabilities. Current research focusses on position and orientation error, with limited results on more clinically relevant metrics, such as joint angles. This leads us to our first objective, to characterize the accuracy of upper extremity VR motion capture. Since the intent is for clinical translation, our second objective is to compare the errors across people identified as healthy controls and people who had experienced a spinal cord injury (SCI). Spatially and temporally synced VR and infrared motion capture data were collected during a variety of custom VR Beat Saber levels. Error values were found with infrared motion capture as the ground truth. The median RMSE was found to be below 7° for shoulder horizontal adduction and elbow flexion and 5° for shoulder elevation and wrist joint metrics. The percentage median error for the range of motion was found to be below 30%, 15%, and 5% for the frontal wrist, sagittal wrist, and all other joints, respectively. Larger standard deviations suggest that repetitions are needed to obtain reliable measurements. No statistical difference in any error metric was found between the control cohort and SCI cohort, providing evidence for clinical translation for post-SCI treatment. Full article

Background/Objectives: Elbow fractures are the most common injuries in children and are frequently evaluated with plain radiographs in the acute setting. As dedicated pediatric radiology services are not widely available, diagnosis of fractures could be delayed. Since 2023, ChatGPT-4 has offered image analysis capabilities, which has untapped potential for radiographic analysis. This study represents the first evaluation of ChatGPT-4o, a multimodal large language model, in interpreting pediatric elbow radiographs for fracture detection, thereby demonstrating its potential as a generalist AI tool distinct from domain-specific pediatric models. Methods: A curated set of 200 pediatric elbow radiographs (100 normal, 100 abnormal with at least one fracture site, 105 right elbow, and 95 left elbow radiographs) acquired between October 2023 and March 2024 at a tertiary pediatric hospital were analyzed in this case–control study. Each anonymized radiograph was evaluated by ChatGPT-4o via a standardized prompt. ChatGPT-4o’s prediction outputs (fracture vs. no fracture) were subsequently compared against verified radiology reports (ground-truth). Diagnostic performance metrics such as sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), and F1 score were calculated. Results: ChatGPT-4o achieved an overall accuracy of 85% in detecting elbow fractures on pediatric radiographs, with a sensitivity of 87% and specificity of 82%. PPVs and NPVs were 83% and 86%, respectively. The F1 score was 0.85. ChatGPT-4o correctly identified the fracture site in 68 (78%) of the 87 studies in which it had detected fractures accurately. Cohen’s kappa coefficient was 0.69, indicating substantial agreement with actual diagnoses. Conclusions: This study highlights the utility and potential applications of ChatGPT-4o as a valuable point-of-care tool in aiding the detection of pediatric elbow fractures in emergency settings, particularly where specialist access is limited. Full article

A traumatic elbow dislocation that remains unreduced for more than three weeks is considered a neglected elbow dislocation. We report a case of a patient with a neglected elbow dislocation combined with a terrible triad injury (elbow dislocation with fractures of the coronoid process and radial head). Initially, the patient was managed with three weeks of cast immobilization followed by physiotherapy. However, six months after the trauma, he presented to our clinic with severe heterotopic ossification, significant pain, and nearly complete elbow stiffness. An open surgical intervention was performed, involving excision of the heterotopic bone, reduction in the dislocation, and suturing of the anterior capsule to the coronoid process. Given the irreparable fracture of the radial head, radial head arthroplasty was also performed. At 18-month follow-up, the elbow was stable and pain-free, with flexion–extension of 80°, pronation of 85°, and supination of 80°. This case underscores the critical importance of early diagnosis and intervention to prevent long-term complications in neglected elbow dislocations. Full article

Background: The distal biceps brachii tendon inserts proximally and posteriorly on the bicipital tuberosity of the radius and it is a forearm supinator but also contributes to flexion of the elbow. Chronic distal biceps tendon ruptures are relatively rare, often complicated by tendon and muscle retraction, and, therefore, their primary repair is difficult or impossible. The gold standard treatment of these chronic lesions is its anatomic reinsertion at the radial tuberosity after tendon reconstruction, using autograft or allograft tissue, but there is no agreement about the most appropriate surgical technique. Untreated injuries usually result in elbow joint deficits and decreased muscular strength. We report the preliminary results in a group of patients treated with a tripled autologous semitendinosus graft. Methods: In the present retrospective study, we report the results in a series of 13 patients surgically treated using tripled autologous semitendinosus graft, fixed to the residual distal biceps tendon, starting from the myotendinous junction, and using tension-slide technique (Biceps Button—Arthrex, Inc, Naples, FL 34108, USA) in association with an interference screw. Eleven males and two females, with a mean age of 46, participated in the study. Results: At mean follow-up check-in of 35 months, clinical results were assessed using the DASH score and MEPS, with a mean value of 11 points and 87 points, respectively. Tensiomyography was also performed to evaluate muscular strength. Six patients had excellent results and seven had good results. No patient had either a tendon re-rupture, or a peripheral neurological deficit, or symptomatic heterotopic ossifications. Seven patients had a mild deficit in elbow motion and six patients had a mild deficit in forearm prono-supination. Upon tensiomyography evaluation, five patients showed a mild deficit in flexion and supination strength. All patients returned to their previous daily and sporting activities. Conclusions: According to our results, in patients affected by chronic distal biceps tendon rupture, surgical treatment performed using tripled autologous semitendinosus autograft secured to the radial tuberosity using the tension-slide technique and interference screw is associated with satisfactory outcomes. Full article

Background/Objectives: Hajj is a physically demanding mass gathering that presents distinct health risks, particularly for older adults and individuals with comorbidities. Falls are a major cause of injury in such environments; however, limited data exist on their prevalence and determinants during Hajj. This study aimed to (1) estimate the prevalence of falls among adult pilgrims during the Hajj pilgrimage in Saudi Arabia and (2) identify key demographic, behavioural/clinical, and musculoskeletal predictors of fall risk, stratified by age group. Methods: A cross-sectional survey was conducted among 1429 adult pilgrims. Data were collected at major pilgrimage sites in Mecca during the Hajj season. Variables included age, sex, body mass index, smoking status, hypertension, diabetes, physical exhaustion, and musculoskeletal pain. Bivariate chi-square tests and multivariable regression analyses were performed. Age-stratified models were developed for younger adults (≤29 years) and older adults (≥50 years) to account for physiological differences. Results: The overall fall prevalence was 13.6%, with significantly higher rates among older adults (21%) than younger adults (10.5%). In the full sample, independent predictors of falls included older age, obesity, hypertension, diabetes, physical exhaustion, and musculoskeletal pain in the upper arm, elbow, and hip/pelvis. In age-specific models, obesity, physical exhaustion, and upper arm pain predicted falls among younger adults, while obesity, hypertension, physical exhaustion, and hip/pelvis pain were significant among older adults. Conclusions: Falls during Hajj result from a multifactorial interplay of age, comorbidities, fatigue, and site-specific musculoskeletal pain. These findings support the development of targeted, age-specific fall prevention strategies in mass gathering contexts. Full article