Search Results (27)

Background: Blood Flow Restriction (BFR) training may be an alternative when traditional heavy-load training is unsuitable. This study compared BFR with light loads to traditional strength training for shoulder muscle development proximal to the occlusion site; Methods: A total of 22 healthy adults were randomized into Group A: BFR training (30% 1RM; n = 12) and Group B: Traditional strength training (70% 1RM; n = 10). Four-week protocol (2 sessions/week) included shoulder abduction and lateral rotation, and dumbbell overhead press. Arm circumference, Single Arm Seated Shot-Put Test (SAASPT), vertical lift strength (VLS) and Shoulder Endurance Test were assessed at baseline and at the end of the protocol. Cohen’s d effect size was calculated for significant outcomes; Results: Significant gains occurred in both groups across most parameters. The magnitude of effects was, in Group A, large on Arm circumference and SASSPT (Cohen’s d = 0.870 and 1.158, respectively) and very large in VLS and SET (Cohen’s d = 1.284 and 1.301, respectively). In Group B, the magnitude of effects was large in SASSPT and VLS (Cohen’s d = 0.962 and 0.922, respectively) and very large in SET (Cohen’s d = 1.238); Conclusion: BFR training with light loads effectively improved musculature proximal to the occlusion site, demonstrating comparable strength gains to heavy-load training in healthy individuals. Full article

This case report examines the impact of robotic-assisted therapy (Lokomat) on functional recovery in a 28-year-old male patient with acute dermatomyositis (DM), an autoimmune inflammatory myopathy causing progressive muscle weakness and disability. The patient underwent 21 sessions of robotic therapy combined with physical therapy, and occupational therapy over seven weeks. Assessments were conducted at baseline, week 10, and week 21 using standardized measures for balance, muscle strength, and functionality. Results demonstrated significant improvements across all domains: balance scores progressed from severe impairment (4/56 Berg, 0/28 Tinetti) to near-normal function (55/56, 24/28, respectively); muscle strength increased from grade 1/5 to 4/5 (MMT-8) in all tested muscle groups; and functionality improved from moderate dependence (59/126 FIM) to complete independence (126/126). The trunk functionality scores showed remarkable recovery from 12/100 to 100/100 (TCT), indicating restored trunk control. Lokomat-assisted therapy combined with conventional rehabilitation effectively improves proximal weakness and postural instability in DM. Robotic therapy enhances motor learning via repetitive movements and reduces therapist workload. Though limited by a single-case design, this study offers preliminary evidence for robotic rehabilitation in DM, previously unexplored. Controlled studies are needed to standardize protocols and validate results in larger cohorts. Advanced technologies show promise for functional recovery in inflammatory myopathies. Full article

Myopathic Ehlers-Danlos syndrome (RmEDS) is an emerging hybrid phenotype that combines connective and muscle tissue abnormalities. It has been associated with variants of the COL12A1 gene, which are known as Ullrich congenital muscular dystrophy-2 (UCMD2; 616470) and Bethlem myopathy-2 (BTHLM2; 616471). Here, we report two splicing mutations of COL12A1 identified in three patients from two unrelated families who present a combination of joint hypermobility and axial, distal, and proximal weakness. The muscular strength of their neck and limb muscles was assessed at 4/5 (MRC); however, when measured with a myometer, the expected percentage by age and sex ranged from 35% to 40% for elbow flexion, 37% to 75% for knee extension, and was 50% for neck flexion. In addition to confirming the characteristic atrophy of the rectus femoris, we presented evidence of involvement of the neck and lumbar muscles through MRI and CT imaging. In vitro studies revealed filamentous disorganization and an altered pattern of collagen XII alpha 1 chain migration due to the skipping of exons 55 and 56 of collagen XII. Additionally, we review the myopathic involvement of COL12-RM in 30 patients across 18 families with dominant mutations and 15 patients from 13 families with recessive mutations. Full article

Background/Objectives: Legg–Calvé–Perthes disease (LCPD) presents challenges in treatment due to its varied course and unclear etiology. This study aimed to evaluate the efficacy of combining proximal femoral varus osteotomy (PFVO) with a modified trochanteric flip osteotomy to address biomechanical consequences and improve hip abductor muscle strength. Methods: We present a modified approach combining PFVO with a trochanteric flip osteotomy. In this technique, the greater trochanter in compound with its muscular insertions is separated from the femur and attached distally using a varization blade plate. Nine patients (ten hips, mean age 8 years) with LCPD were treated using this technique. Clinical examination findings and radiographic evaluations were retrospectively analyzed. The median follow-up was 33 months. Results: At the last follow-up, two patients exhibited Trendelenburg gait, but hip abduction was improved in all patients. Radiographically, consolidation at the osteotomy site was observed in all cases with no delayed union or non-union. The median CE angle improved by 7°, while the median CCD decreased by 18°. The median MPFA decreased by 13°, resulting in a median of 82°. Conclusions: Combining PFVO with a modified trochanteric flip osteotomy addresses biomechanical issues associated with PFVO, potentially improving hip containment and abductor muscle strength. This approach may offer advantages over traditional osteotomy techniques in treating LCPD, and it appears to produce a superior functional outcome in particular in regard to limping when compared to conventional PFVO. Despite satisfactory radiological outcomes in most cases, further research is needed to assess long-term effectiveness and address challenges such as femoral head enlargement and persistent gait abnormalities. Full article

Background/Objectives: Type 2 diabetes (T2D) is associated with an increased risk of adverse musculoskeletal outcomes likely due to heightened chronic inflammation, oxidative stress, and advanced glycation end-products (AGE). Carnosine has been shown to have anti-inflammatory, anti-oxidative, and anti-AGE properties. However, no clinical trials have examined the impact of carnosine on musculoskeletal health in adults with prediabetes or T2D. Methods: In a randomized, double-blind clinical trial, 49 participants with prediabetes or T2D and without existing musculoskeletal conditions were assigned to receive either 2 g/day carnosine or matching placebo for 14 weeks. Whole-body dual-energy X-ray absorptiometry (DXA) was used to assess body composition, and peripheral quantitative computed tomography (pQCT) was used to assess bone health at the distal and proximal tibia. Results: Forty-three participants completed this study. Carnosine supplementation had no effect on change in hand grip strength (HGS) or upper-limb relative strength (HGS/lean mass) versus placebo. Change in appendicular lean mass, percentage of body fat, visceral fat area, proximal tibial cortical volumetric bone mineral density (vBMD), distal tibial trabecular vBMD, and stress-strain index did not differ with carnosine compared to placebo. Fourteen weeks of carnosine supplementation did not improve muscle strength, body composition, or bone health in adults with prediabetes or T2D. Conclusions: Carnosine supplementation may not be an effective approach for improving musculoskeletal health in adults with prediabetes and T2D without musculoskeletal conditions. However, appropriately powered trials with longer duration are warranted to confirm our findings. The trial was registered at clinicaltrials.gov (NCT02917928). Full article

Background and Objective: Although multimodal pain therapy (MPT) is widely used in pain management for chronic cervical radiculopathy, its effect on increasing muscle strength in patients with cervical radiculopathy is not well documented. This study aimed to evaluate the impact of a structured multimodal pain management program on muscle strength in these patients, using objective strength measurements as indicators of therapeutic success. Materials and Methods: This non-randomized, uncontrolled, prospective clinical study initially included 35 patients, but 10 were excluded due to incomplete data, resulting in a final sample of 25 patients (14 women and 11 men, aged 42 to 84 years) with cervical radiculopathy who underwent a multimodal pain management program at a specialized orthopedic clinic. Muscle strength was measured at admission and discharge using a hand-held dynamometer. Pain levels were assessed with the Numeric Rating Scale. An uncontrolled study design was chosen for ethical reasons, as it was deemed inappropriate to form a control group that would be deprived of necessary anti-inflammatory or analgesic medications. Result: Significant improvements were observed in overall muscle strength, with an 11% increase from 114.78 kg to 127.41 kg (p = 0.003). The strongest increase in strength was observed in the proximal cervical muscle groups, with a notable 22.9% (p < 0.001)improvement in the muscles involved in cervical inclination. However, no significant strength gains were detected in the peripheral muscle groups of the upper arm. Pain scores on the NRS decreased by 54.2% (p < 0.001). Conclusions: This study demonstrates that a multimodal pain management approach leads to significant improvements in muscle strength and pain reduction in patients with cervical radiculopathy. The increase in cervical muscle strength is closely associated with pain relief and improved functional outcomes, highlighting the value of conservative pain management strategies for these patients. Full article

Ankle fractures can lead to issues such as limited dorsiflexion, strength deficits, swelling, stiffness, balance disorders, and functional limitations, which complicate daily activities. This study aimed to describe neuromuscular adaptations at 6 and 12 months post-surgery during static and dynamic balance tasks, specifically using the Y-Balance Test (YBT). Additionally, the relationship between neuromuscular patterns, balance, and musculoskeletal deficits was evaluated. In 21 participants (14 at 6 months and 21 at 12 months) with bimalleolar fractures, hip strength, ankle dorsiflexion, ankle functionality, and static and dynamic balance were assessed using electromyography of five lower limb muscles (tibialis anterior, peroneus longus, lateral gastrocnemius, biceps femoris, and gluteus medius). A significant interaction effect (limb × proximal [hip]—distal [ankle] muscle) (F = 30.806, p < 0.001) was observed in the anterior direction of the Y-Balance Test (YBT_A) at 6 months post-surgery. During the YBT_A and YBT posteromedial (YBT_PM), it was found that a lower dorsiflexion range of movement was associated specifically at 6 months with greater activation of the lateral gastrocnemius. However, these differences tended to diminish by 12 months. These findings suggest that neuromuscular patterns differ between operated and non-operated limbs during the YBT_A at 6 months post-surgery. The Y-Balance Test, particularly its anterior direction, effectively highlighted these neuromuscular changes. This is a preliminary study; further research is needed to explore these findings in depth. Full article

Objectives: This study aims to compare the effects of kinesio tape (KT) on the rectus femoris muscle in athletes and novices under pre- and post-fatigue conditions. Methods: Nineteen male volunteers took part, and fatigue was assessed using the Borg CR10 Scale. Kinematic and kinetic data were collected using Vicon MX13+ infrared cameras (250 Hz) and Kistler force platforms (1500 Hz), respectively. Visual 3D v5.0 software analyzed the data, focusing on parameters like angular displacement, ground reaction forces (GRFs), impulse, and joint moments during a stop-jump task. A two-way mixed-design ANOVA was used to assess group, fatigue, and KT effects. Results: There was a significant effect after applying KT. The results showed significant differences in knee flexion range of motion (ROM), hip flexion moment, vertical impulse, and peak vertical GRFs between pre- and post-fatigue conditions (all p < 0.05). The trained group exhibited less knee valgus ROM, higher hip flexion velocity at initial contact, and prolonged time to peak proximal tibia anterior shear force. Conclusions: KT application was found to reduce lower limb loading, improve force acceptance and joint stability, and alleviate fatigue-induced disparities. These findings highlight the potential of KT in enhancing lower limb strength and performance, particularly under fatigue. Full article

Background: This study evaluated the effectiveness of radio electric asymmetric conveyer (REAC) neurobiological optimization treatments on muscle strength (MS) in individuals with post-polio syndrome (PPS), a condition causing new muscle weakness in polio survivors. Traditional treatments focus on symptom management, whereas REAC technology uses radio electric symmetric conveyed fields to modulate neurotransmission and cellular function. Methods: This open-label study involved 17 PPS patients who maintained their existing medications. The participants underwent four REAC treatment protocols: neuro-postural optimization (NPO), neuro-psycho-physical optimization (NPPO), neuro-psycho-physical optimization—cervical brachial (NPPO-CB), and neuromuscular optimization (NMO). MS was assessed using manual muscular tests (MMT) before and after each protocol. Results: A statistical analysis via repeated measures ANOVA showed significant MS improvements, particularly in the proximal muscles of the left lower limb (LLL), distal muscles of both lower limbs (LLs), and distal muscles of the left upper limb. The LLL, the most severely affected limb at this study’s start, exhibited the greatest improvement. Conclusions: These results suggest REAC treatments could enhance MS in PPS patients, potentially reorganizing motor patterns and reducing functional overload on less affected limbs. Full article

Background: Sarcopenia poses a risk factor for falls, disability, mortality, and unfavorable postoperative outcomes. Recently, the Ultrasound Sarcopenia Index (USI) has been validated to assess muscle mass, and this study aimed to apply the USI in the clinical setting. Methods: This prospective observational study included 108 patients aged >65 years, hospitalized for proximal femoral traumatic fracture. Patients were divided into two groups based on anamnestic data: patients with independent walking (IW) and patients requiring walking aid (WA) before admission. All the participants received an ultrasound examination. Other parameters evaluated were handgrip strength, limb circumferences, nutrition (MNA), and activity of daily living (ADL) scores. Results: Fifty-six IW patients (83 ± 6 y; 38 females) and 52 WA patients (87 ± 7 y; 44 females) were recruited. The USI was significantly higher in the IW group compared to the WA group (p = 0.013, Cohen’s d = 0.489). Significant correlations were found between the USI and other sarcopenia-associated parameters, such as handgrip strength, MNA, ADLs, other muscle ultrasound parameters, and limb circumferences. Conclusion: The application of the USI in the orthopedic surgery setting is feasible and might support the diagnosis of sarcopenia when combined with other measures of strength and function. Full article

Globally, 2.5% of upper limb amputations are transhumeral, and both mechanical and electronic prosthetics are being developed for individuals with this condition. Mechanics often require compensatory movements that can lead to awkward gestures. Electronic types are mainly controlled by superficial electromyography (sEMG). However, in proximal amputations, the residual limb is utilized less frequently in daily activities. Muscle shortening increases with time and results in weakened sEMG readings. Therefore, sEMG-controlled models exhibit a low success rate in executing gestures. The LIBRA NeuroLimb prosthesis is introduced to address this problem. It features three active and four passive degrees of freedom (DOF), offers up to 8 h of operation, and employs a hybrid control system that combines sEMG and electroencephalography (EEG) signal classification. The sEMG and EEG classification models achieve up to 99% and 76% accuracy, respectively, enabling precise real-time control. The prosthesis can perform a grip within as little as 0.3 s, exerting up to 21.26 N of pinch force. Training and validation sessions were conducted with two volunteers. Assessed with the “AM-ULA” test, scores of 222 and 144 demonstrated the prosthesis’s potential to improve the user’s ability to perform daily activities. Future work will prioritize enhancing the mechanical strength, increasing active DOF, and refining real-world usability. Full article

The anatomical complexity of brachial plexus injury requires specialized in-depth diagnostics. The clinical examination should include clinical neurophysiology tests, especially with reference to the proximal part, with innovative devices used as sources of precise functional diagnostics. However, the principles and clinical usefulness of this technique are not fully described. The aim of this study was to reinvestigate the clinical usefulness of motor evoked potential (MEP) induced by a magnetic field applied over the vertebrae and at Erb’s point to assess the neural transmission of brachial plexus motor fibers. Seventy-five volunteer subjects were randomly chosen to participate in the research. The clinical studies included an evaluation of the upper extremity sensory perception in dermatomes C5–C8 based on von Frey’s tactile monofilament method, and proximal and distal muscle strength by Lovett’s scale. Finally, 42 healthy people met the inclusion criteria. Magnetic and electrical stimuli were applied to assess the motor function of the peripheral nerves of the upper extremity and magnetic stimulus was applied to study the neural transmission from the C5–C8 spinal roots. The parameters of compound muscle action potential (CMAP) recorded during electroneurography and MEP induced by magnetic stimulation were analyzed. Because the conduction parameters for the groups of women and men were comparable, the final statistical analysis covered 84 tests. The parameters of the potentials generated by electrical stimulus were comparable to those of the potentials induced by magnetic impulse at Erb’s point. The amplitude of the CMAP was significantly higher following electrical stimulation than that of the MEP following magnetic stimulation for all the examined nerves, in the range of 3–7%. The differences in the potential latency values evaluated in CMAP and MEP did not exceed 5%. The results show a significantly higher amplitude of potentials after stimulation of the cervical roots compared to potentials evoked at Erb’s point (C5, C6 level). At the C8 level, the amplitude was lower than the potentials evoked at Erb’s point, varying in the range of 9–16%. We conclude that magnetic field stimulation enables the recording of the supramaximal potential, similar to that evoked by an electric impulse, which is a novel result. Both types of excitation can be used interchangeably during an examination, which is essential for clinical application. Magnetic stimulation was painless in comparison with electrical stimulation according to the results of a pain visual analog scale (3 vs. 5.5 on average). MEP studies with advanced sensor technology allow evaluation of the proximal part of the peripheral motor pathway (between the cervical root level and Erb’s point, and via trunks of the brachial plexus to the target muscles) following the application of stimulus over the vertebrae. Full article

Objective: Discrepancies in the definition of adductor canal block (ACB) lead to inconsistent results. To investigate the actual analgesic and motor-sparing effects of ACB by anatomically defining femoral triangle block (FTB), proximal ACB (p-ACB), and distal ACB (d-ACB), we re-classified the previously claimed ACB approaches according to the ultrasound findings or descriptions in the corresponding published articles. A meta-analysis with subsequent subgroup analyses based on these corrected results was performed to examine the true impact of ACB on its analgesic effect and motor function (quadriceps muscle strength or mobilization ability). An optimal ACB technique was also suggested based on an updated review of evidence and ultrasound anatomy. Materials and Methods: We systematically searched studies describing the use of ACB for knee surgery. Cochrane Library, PubMed, Web of Science, and Embase were searched with the exclusion of non-English articles from inception to 28 February 2022. The motor-sparing and analgesic aspects in true ACB were evaluated using meta-analyses with subsequent subgroup analyses according to the corrected classification system. Results: The meta-analysis includes 19 randomized controlled trials. Compared with the femoral nerve block group, the quadriceps muscle strength (standardized mean difference (SMD) = 0.33, 95%-CI [0.01; 0.65]) and mobilization ability (SMD = −22.44, 95%-CI [−35.37; −9.51]) are more preserved in the mixed ACB group at 24 h after knee surgery. Compared with the true ACB group, the FTB group (SMD = 5.59, 95%-CI [3.44; 8.46]) has a significantly decreased mobilization ability at 24 h after knee surgery. Conclusion: By using the corrected classification system, we proved the motor-sparing effect of true ACB compared to FTB. According to the updated ultrasound anatomy, we suggested proximal ACB to be the analgesic technique of choice for knee surgery. Although a single-shot ACB is limited in duration, it remains the candidate of the analgesic standard for knee surgery on postoperative day 1 or 2 because it induces analgesia with less motor involvement in the era of multimodal analgesia. Furthermore, data from the corrected classification system may provide the basis for future research. Full article

(1) Background and purpose: Muscular control and motor function in a patient with Patellofemoral pain syndrome (PFPS) have not yet been investigated systematically. Therefore, this review synthesis the previous results about the association of PFPS with gluteus muscle activation, hip strength, and kinematic characteristic of the hip and knee joint, to deepen understanding of the PFPS etiology and promote the establishment of an effective treatment strategy. (2) Methods: A literature search was conducted from January 2000 to July 2022 in four electronic databases: Medline, Embase, Google scholar, and Scopus. A total of 846 articles were initially identified, and after the screening process based on the inclusion criteria, 12 articles were eventually included. Means and SDs of gluteus medius (GMed), gluteus maximus (GMax), hip strength, and kinematic variation of hip and knee were retrieved from the present study. (3) Results and conclusion: Regarding kinematic variation, moderate evidence indicates that an increased peak hip adduction was found in PFPS groups during running and single leg (SL) squat activities. There is no difference in the GMed and GMax activation levels between the two groups among the vast majority of functional activities. Most importantly, strong evidence suggests that hip strength is weaker in individuals with PFPS, showing less strength of hip external rotation and hip abduction compared to the control group. However, without prospective studies, it is difficult to determine whether hip strength weakness is a cause or a result of PFPS. Therefore, further research is needed to evaluate the hip strength level in identifying individuals most likely to associated with PFPS development is needed. Full article

Background: Limited hip internal rotation range of motion (IR-ROM) and hip abductor weakness are recognized in low back pain (LBP) sufferers. The main aim was to investigate the effect of a ultrasound (US)-guided percutaneous neuromodulation (PNM) technique on hip strength in people with LBP. A second purpose was to discover whether the location along the sciatic nerve, where percutaneous neuromodulation was applied, could influence the change of strength response in these patients. Methods: Sixty LBP sufferers were recruited and divided randomly into three groups. All participants received an isolated percutaneous electrical stimulation at one of three different locations of the sciatic nerve pathway (proximal, middle, and distal), depending on the assigned group. Pain intensity, hip passive IR-ROM, hip muscle strength, and the Oswestry disability index (ODI) were analyzed. All variables were calculated before the intervention and one week after the intervention. Results: All interventions significantly decreased pain intensity and improved the IR-ROMs, strength, and functionality after one week (p = 0.001). However, between-group (treatment x time) differences were reported for flexion strength in the non-intervention limb (p = 0.029) and ODI (p = 0.021), although the effect size was small (Eta² = 0.1) in both cases. Conclusions: The application of an isolated intervention of the US-guided PNM technique may be a useful therapeutic tool to increase the hip muscle strength in patients with chronic LBP. Full article