Search Results (76)

Background and Objectives: The surgical management of displaced scapular fractures remains controversial, particularly regarding the importance of restoring scapular alignment. This study evaluated radiologic restoration and clinical outcomes following posterior fixation of displaced scapular fractures, with a particular focus on correction of lateral border offset (LBO) and angular deformity. Materials and Methods: This retrospective case series included 20 patients who underwent posterior open reduction and internal fixation for displaced scapular fractures between 2017 and 2024 with a minimum follow-up of 12 months. Surgical indications included lateral border offset (LBO) > 20 mm, angular deformity > 30°, or displaced intra-articular fractures with step-off > 3 mm. Radiologic parameters including LBO, angular deformity, and intra-articular step-off were measured using computed tomography before and after surgery. Clinical outcomes were evaluated using shoulder range of motion (ROM), Disabilities of the Arm, Shoulder and Hand (DASH) score, and modified American Shoulder and Elbow Surgeons (ASES) score. Results: Significant postoperative improvement was observed in all radiologic parameters. Mean LBO improved from 18.9 ± 10.7 mm (range, 0–45.5 mm) to 3.1 ± 7.1 mm (range, 0–29.9 mm), angular deformity improved from 28.7° ± 11.3° (range, 10.2–48.1°) to 0.9° ± 3.9° (range, 0–17.8°), and intra-articular step-off improved from 6.4 ± 2.0 mm (range, 3.7–9.7 mm) to 1.8 ± 0.5 mm (range, 1–2.5 mm). At final follow-up, mean forward flexion was 126° ± 34.4° (range, 10–170°) and external rotation was 62.3° ± 20.8° (range, 0–90°). Mean DASH and modified ASES scores were 27.3 ± 17.3 (range, 8.3–74.2) and 71.6 ± 15.0 (range, 25.8–89), respectively. Glenoid involvement was not associated with inferior clinical outcomes, whereas associated ipsilateral upper extremity injuries tended to be related to poorer functional results. Conclusions: Posterior fixation effectively restored scapular alignment and articular congruity in displaced scapular fractures. Restoration of LBO and correction of angular deformity may represent important surgical objectives for correction of glenoid medialization and restoration of normal scapular alignment. Full article

Upper-limb rehabilitation and elderly exercise programs require lightweight, reliable, and physiotherapy-oriented assistive technologies capable of supporting controlled joint motion while enabling objective performance assessment. This paper presents experimental validation of ASSIST-FEEv3, a cable-driven elbow assisting device that is designed for flexion–extension exercises with emphasis on usability, portability, and physiotherapy integration. The device employs a dual-cable antagonistic mechanism that is actuated by servomotors housed in a compact module, allowing guided motion in the arm sagittal plane with minimal wearable load mass. A testing campaign was conducted with 25 healthy volunteers under the supervision of physiotherapy experts following a properly designed protocol for three sessions of ten repetitions each. Joint kinematics was acquired through integrated sensing, and performance metrics including maximum flexion, maximum extension, and range of motion (ROM) were analyzed to assess repeatability, motion smoothness, and user-specific variability. The results demonstrate consistent motion assistance across repeated cycles, variability between sessions, and comparable ROM distributions between sexes. Observed deviations were considered due to individual temporary conditions rather than device-related limitations. The device operated with low energy consumption as required in home-based applications. Test findings validate both the mechanical reliability and the physiotherapy-oriented operational framework of the ASSIST-FEEv3 device. Full article

Objective: Volleyball athletes require well-developed balance control during spiking, blocking, rapid movement, and landing. Joint range of motion (ROM) may also influence limb extension, support adjustment, and center-of-mass control. Previous studies have usually examined balance ability and joint ROM as separate factors related to volleyball performance. However, the associations between dynamic balance, static balance, and multi-joint ROM in the upper and lower limbs remain insufficiently understood. This study therefore aimed to examine the relationship between balance performance and upper- and lower-limb joint ROM in female college volleyball athletes. Methods: Thirty-five female college volleyball athletes were included. Dynamic balance of the upper and lower limbs was assessed using the Y-Balance Test, and static balance was evaluated under eyes-open and eyes-closed conditions using a static balance platform. Upper- and lower-limb ROM was measured using an electronic goniometer and the knee-to-wall test. Paired-sample t-tests were used to compare bilateral differences and differences between visual conditions. Pearson correlation analysis was performed to examine associations between joint ROM and balance performance, and false discovery rate (FDR) correction was applied to account for multiple comparisons. Results: (1) No significant bilateral difference was observed in upper-limb YBT-UQ performance (p > 0.05); for lower-limb YBT-LQ performance, a significant difference was found only in the anterior direction, with the right side showing higher values than the left side (p < 0.01). (2) Static balance parameters under the eyes-closed condition were significantly poorer than those under the eyes-open condition (p < 0.01); under the same visual condition, only the total sway path length of the right foot was significantly shorter than that of the left foot (p < 0.05). (3) The ranges of motion of right shoulder flexion, shoulder horizontal adduction, shoulder external rotation, elbow flexion, and knee-to-wall distance were significantly greater than that of the left side (all p < 0.05), and right hip internal rotation ROM was also significantly greater than that of the left side (p < 0.01). (4) Dynamic balance was correlated with selected joint ROM measures. Specifically, the anterior reach direction of the right YBT-LQ was positively correlated with hip flexion ROM (r = 0.593, p < 0.01) and knee-to-wall distance (r = 0.653, p < 0.01), and these correlations remained statistically significant after FDR correction. (5) Static balance parameters were correlated with selected lower-limb joint ROM measures in the original correlation analysis; however, these correlations did not remain significant after FDR correction. Conclusions: Female college volleyball athletes demonstrated a certain degree of bilateral asymmetry in dynamic balance and a pronounced dependence on visual input during static balance tasks. After FDR correction, the associations between the anterior reach direction of the right YBT-LQ and both hip flexion ROM and knee-to-wall distance remained stable, suggesting that these ROM measures may be related to anterior dynamic balance performance. These findings may provide a reference for postural control assessment and the development of sport-specific training programs for female volleyball athletes. Full article

Upper extremity impairments often lead to reduced joint range of motion (ROM), making reliable assessment essential for rehabilitation planning. This study investigated the within-day and between-day reliability of the Microsoft Kinect V2 depth camera for active upper extremity ROM assessment in 30 healthy adults. Ten predefined shoulder and elbow movements were recorded, and joint angles were computed using a custom vector-based algorithm. Within-day reliability ranged from moderate to excellent (ICC: 0.754–0.953), while between-day reliability ranged from moderate to good (ICC: 0.654–0.881). Absolute reliability varies substantially across movements. The SEM% values ranged from 2.1% to 17.3% within-day and from 2.8% to 23.6% between-day. The between-day MDC values were particularly high for certain movements (e.g., >20° for shoulder extension and >50° for elbow flexion), indicating limited sensitivity to detect small clinical changes. Additionally, shoulder adduction could not be reliably analyzed in 36.7% of participants due to self-occlusion-related tracking instability, highlighting a practical limitation of the Kinect V2 for certain upper extremity movements. These findings suggest that Kinect V2-based ROM assessment demonstrates acceptable reliability for large-amplitude planar movements under controlled conditions but shows substantial limitations for rotational and occlusion-prone tasks. The device may be suitable for research or screening applications; however, caution is warranted when interpreting small changes in clinical settings. Full article

Background/Objectives: The follow-up for pediatric elbow injuries often involves in-office visits to assess the range of motion (ROM). There is evidence for the use of telemedicine and digital assessments of elbow motion in adults but none in pediatrics. The aim of this study was to compare measurements of the joint range of motion and elbow alignment in children, taken in a doctor’s office, with those obtained from photographs and to evaluate the intra- and inter-observer reliability of these measurements. Methods: Fourteen children were prospectively included in this study during follow-ups after an arm fracture. Only the uninjured arm was evaluated: goniometric measurements performed in the office were compared with digital measurements obtained from photographs. For the uninjured arm, in-office goniometer measurements were compared to picture-based digital measurements. Mean digital values were compared to in-office goniometer measurements using a paired t-test, and the intra- and inter-rater reliability of the digital measurements was calculated. Results: When comparing photograph-based digital measurements to in-office goniometer measurements, the mean absolute error (average absolute difference between observer measurements and goniometer) showed differences of 4.5° for extension, 7.4° for flexion, and 4.8° for the carrying angle. The accuracy bias (average difference between observer measurements and goniometer) showed an overestimation of photographs for extension by 1.2°, an overestimation of photographs for flexion by 5.5°, and an underestimation of photographs for a carrying angle of 3.5°. Intra- and inter-rater reliability correlations were all within the good (0.75–0.9) to excellent (>0.9) ranges. The intra-rater intraclass correlation coefficient (ICC) was 0.91 for extension, 0.87 for flexion, and 0.87 for the carrying angle. The inter-rater ICC was 0.98 for extension, 0.93 for flexion, and 0.96 for the carrying angle. Conclusions: Photograph-based digital measurements appear to be an acceptable alternative compared to in-office goniometer measurements in pediatric patients. Full article

Background/Objectives: Broccoli-derived glucoraphanin (a sulforaphane precursor that activates Nrf2 defenses) may aid repair; however, its short-term effects in humans remain unknown. This study aimed to evaluate whether short-term supplementation with broccoli-derived glucoraphanin improves recovery from exercise-induced muscle damage. We hypothesized that short-term supplementation with broccoli-derived glucoraphanin would attenuate exercise-induced muscle damage and accelerate recovery. Methods: In a randomized, double-blind, placebo-controlled crossover design, fifteen participants consumed either high-glucoraphanin broccoli powder (320 μg) or placebo for two weeks, followed by elbow flexor eccentric exercise. Strength, soreness, creatine kinase (CK), range of motion (ROM), arm girths, and ultrasound-assessed muscle and tendon morphology were measured at baseline, immediately post-exercise, and at 48 and 96 h post-exercise. Results: Significant main effects of time were observed for isometric and isokinetic torque (p < 0.05), CK (p < 0.05), soreness (p < 0.05), and structural swelling markers (p < 0.05), confirming exercise-induced muscle damage. However, there were no significant Time × Supplement interactions for any variable (p > 0.05), indicating that glucoraphanin did not influence recovery dynamics. Conclusions: These findings suggest that short-term high-dose broccoli supplementation reconstituted with hot water does not modulate recovery following eccentric muscle damage under the conditions tested, including the chosen preparation method and experimental context. Full article

Visual orthopedic gait assessment in dogs is recognized as subjective and is limited by interobserver variability. Objective detection of lameness is offered by biomechanical analysis, where asymmetry between limbs is quantified through kinematic parameters and symmetry indices. However, the minimum number of trials (full stride cycles) required to reliably discriminate lameness has remained a challenge. In this study, six healthy adult dogs were used. Mild, reversible lameness was induced in one forelimb using a cotton pad. Dogs were walked along a straight runway, and kinematic data were captured with a high-speed video camera. Stride length (SLE), support time (ST), and elbow range of motion (ROM) were measured. Symmetry indices (for linear and temporal parameters) and the symmetry angle (for angular parameters) were computed. The asymptotic distribution of these indices was derived using the delta method, which allowed for the construction of confidence intervals (CIs) and hypothesis tests for an asymmetry threshold of 3%. The number of trials required to achieve reliable detection was estimated through statistical simulations. Results indicated that the required number of trials was highly dependent on both the kinematic parameter and the magnitude of asymmetry. While detecting subtle asymmetries (≈4%) required a high number of trials (up to 347 for stride length), the requirements decreased substantially for more pronounced lameness. For a true asymmetry of 6%, 11–39 trials per limb were sufficient to achieve 80–90% power. It is concluded that the collection of only five trials is insufficient for detecting mild asymmetries. A statistical framework and practical recommendations for kinematic gait studies in dogs are provided. Full article

Background/Objectives: Haemophilia-related bleedings primarily affect the musculoskeletal system, and functional tests are used in clinical management. Yet, fine motor skills of the upper extremities have not been evaluated in adult persons with haemophilia (PwH). The Moberg Pick-Up Test (MPUT) assesses fine motor skills but has only been psychometrically evaluated in other cohorts. This study aims to examine its psychometric properties in PwH. Methods: A total of 40 moderate or severe PwH A or B were included. The MPUT, consisting of three trials, was conducted twice by rater A and once by rater B. The best performance per hand of each MPUT was used. Subjective hand function (Duruöz Hand Index (DHI) and numeric rating scale (NRS)), elbow joint status (Haemophilia Joint Health Score (HJHS)), pain (NRS), and wrist range of motion (ROM) were utilised for convergent validity evaluation. Inter-rater and test–retest reliability were determined through intraclass correlation coefficients (ICCs) for raw and log10-transformed data. Results: Inter-rater and test–retest reliability demonstrated moderate-to-excellent ICCs for both data types (ICC range: 0.624–0.918). The DHI correlated moderately with the average MPUT score of both hands (r = 0.410; p = 0.016). Left-hand MPUT scores did not correlate with left elbow HJHS scores, whereas right-hand MPUT scores correlated with right elbow HJHS scores (r = 0.396, p = 0.018). Subjective left-hand function (NRS) correlated with the results of the MPUT (r = 0.433; p = 0.009). Conclusions: The MPUT is a reliable and partially valid tool and can be useful to assess fine motor skills in PwH. Full article

Markerless human pose estimation is increasingly used for kinematic assessment, but evidence of its applicability to upper limb movements across different ranges of motion (ROM) remains limited. This study examined the accuracy and reliability of a markerless pose estimation system for shoulder, elbow and wrist flexion–extension analysis under full and partial ROM tasks. Ten healthy participants performed standardized movements which were synchronously recorded, with an optoelectronic motion capture system used as a reference. Joint angles were compared using RMSE, percentage RMSE (%RMSE), accuracy (Acc), intraclass correlation coefficients (ICC), and Pearson correlation of ROM values. The markerless system reproduced the temporal morphology of the movement with high coherence, showing ICC values above 0.91 for the elbow and 0.94 for the shoulder in full ROM trials. Wrist tracking presented the lowest RMSE values and low inter-subject variability. The main critical aspect was a systematic underestimation of maximum flexion, especially at the shoulder, indicating a magnitude bias likely influenced by occlusion and joint geometry rather than by temporal fluctuations. Despite this limitation, the system adapted consistently to different ROM amplitudes, maintaining proportional variations in joint excursion across tasks. Overall, the findings outline the conditions in which markerless pose estimation provides reliable upper limb kinematics and where methodological improvements are still required, particularly in movements involving extreme flexion and occlusion. Full article

Background/Objectives: Non-traumatic (degenerative) rotator cuff tendinopathy with partial supraspinatus tear (NT-RCTT) is a common source of shoulder pain and disability. Comparative evidence between radial extracorporeal shock wave therapy (rESWT) and multimodal physical therapy modalities (PTMs) remains scarce. Methods: In this single-center randomized controlled trial, 60 adults with MRI-confirmed NT-RCTT were assigned (1:1) to rESWT (one session weekly for six weeks; 2000 impulses per session, 2 bar air pressure, positive energy flux density 0.08 mJ/mm²; 8 impulses per second) or a multimodal PTM program (interferential current, shortwave diathermy and magnetothermal therapy; five sessions weekly for six weeks). All participants performed standardized home exercises. The primary outcome was the American Shoulder and Elbow Surgeons (ASES) total score; secondary outcomes included pain (visual analog scale, VAS), satisfaction, range of motion (ROM), supraspinatus tendon (ST) thickness and acromiohumeral distance (AHD). Assessments were conducted at baseline, and at week 6 (W6) and week 12 (W12) post-baseline. Results: Both interventions significantly improved all outcomes, but rESWT produced greater and faster effects. Mean ASES total scores increased by 31 ± 5 points with rESWT versus 26 ± 6 with PTMs (p < 0.05). VAS pain decreased from 5.2 ± 0.7 to 1.0 ± 0.7 with rESWT and from 5.2 ± 0.8 to 1.7 ± 0.8 with PTMs (p < 0.01). rESWT achieved higher satisfaction and larger gains in abduction, flexion and external rotation. Ultrasound showed reduced ST thickness and increased AHD after rESWT but not after PTMs. No serious adverse events occurred. Conclusions: rESWT yielded superior pain relief, functional recovery and tendon remodeling compared with a multimodal PTM program, with markedly lower treatment time and excellent tolerability. 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: 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

Accurate range of motion (ROM) assessment is essential for evaluating musculoskeletal function and guiding rehabilitation, particularly in pediatric populations. Traditional methods, such as optical motion capture and handheld goniometry, are often limited by cost, accessibility, and inter-rater variability. This study evaluated the feasibility and accuracy of the Microsoft Azure Kinect-powered Monitored Augmented Rehabilitation System (MARS) compared to Kinovea. Sixty-five pediatric participants (ages 5–18) performed standardized shoulder and elbow movements in the frontal and sagittal planes. ROM data were recorded using MARS and compared to Kinovea. Measurement reliability was evaluated using intraclass correlation coefficients (ICC3k), and accuracy was evaluated using root mean squared error (RMSE) analysis. MARS demonstrated excellent reliability with an average ICC3k of 0.993 and met the predefined accuracy threshold (RMSE ≤ 8°) for most movements, with the exception of sagittal elbow flexion. These findings suggest that MARS is a reliable, accurate, and cost-effective alternative for clinical ROM assessment, offering a markerless solution that enhances measurement precision and accessibility in pediatric rehabilitation. Future studies should enhance accuracy in sagittal plane movements and further validate MARS against gold-standard systems. Full article

This study aimed to investigate the influence of different walking speeds on shoulder and elbow joint kinematics, specifically focusing on range of motion, angular velocity, and angular acceleration during arm swing. The natural rhythm of human gait was studied to develop an effective mechanical interface, particularly with respect to joint impedance and force controllability. The independent variable in this study was walking speed, operationalized at four levels—3.6 km/h (slow), 4.2 km/h (preferred walking speed, PWS), 5.4 km/h (normal), and 7.2 km/h (fast)—and defined as a within-subject factor. The dependent variables consisted of quantitative kinematic parameters, including joint range of motion (ROM, in degrees), peak and minimum joint angular velocity (deg/s), and peak and minimum joint angular acceleration (deg/s²). For each subject, data from twenty gait cycles were extracted for analysis. The kinematic variables of the shoulder and elbow were analyzed, showing increasing trends as the walking speed increased. As walking speed increases, adequate arm swing contributes to gait stability and energy efficiency. Notably, the ROM of shoulder was slightly reduced at the PWS compared to the slowest speed (3.6 km/h), which may reflect more natural and coordinated limb movements at the PWS. Dynamic covariation of torque patterns in the shoulder and elbow joints was observed, reflecting a synergistic coordination between these joints in response to human body movement. Full article

Introduction: Elbow flexor spasticity is a common and debilitating consequence of stroke, significantly impacting patients’ quality of life. Botulinum toxin A (BoNT-A) injections have emerged as an effective treatment, but the optimal muscle selection strategy remains unclear. This study investigates the impact of different BoNT-A injection strategies targeting specific elbow flexor muscles in post-stroke patients. Materials and Methods: A non-randomized observational study was conducted on 52 participants with upper limb spasticity (pattern IV) following a stroke. Participants were divided into three groups based on the elbow flexor muscles injected with BoNT-A: biceps brachii (n = 15), brachialis (n = 9), and brachialis plus brachioradialis (n = 28). Assessments included spasticity angle, paresis angle, and active supination range of motion (ROM) measured using the Tardieu Scale and goniometry at baseline and at 4-week follow-up. Non-parametric statistical analyses were employed to compare outcomes between groups. Results: While all groups showed a general trend of decreased spasticity and improved motor control, analysis revealed statistically significant differences across the groups at baseline. The brachialis plus brachioradialis group demonstrated the most substantial improvement in paresis angle and active supination ROM. Notably, this group also exhibited greater capacity for the improvement of the paresis angle. The biceps brachii group showed comparable improvements in the paresis angle and the greatest effect on improving passive extension at slow velocity with increasing stroke onset but required higher pronator teres BoNT-A doses overall. Discussion: These findings suggest that individualized muscle selection strategies are crucial in BoNT-A treatment for elbow flexor spasticity. The superior outcomes observed in the brachialis plus brachioradialis group may be attributed to the synergistic action of these muscles in elbow flexion and forearm positioning. The higher pronator teres BoNT-A doses required in the biceps brachii group may reflect compensatory mechanisms or differences in muscle fiber recruitment patterns. Conclusions: Combining brachialis and brachioradialis muscles in BoNT-A injections appears to offer superior benefits for supination and motor control in post-stroke patients with elbow flexor spasticity, particularly those with significant elbow flexion and pronation. Full article