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ABSTRACT: Some clinical studies have suggested that distal radius plates placed distal to the watershed line have the potential to impinge on the traversing flexor tendons. However, the validity of this theory remains unclear. The purpose of this study was to evaluate the quantitative effect of volar plate position on flexor pollicis longus (FPL) tendon friction by measuring the contact pressure between the FPL tendon and the distal edge of the locking plate.
We used 7 fresh cadaveric upper extremities without wrist osteoarthritis or any deformity. External loads of 1.5 and 3.0 kgf were applied to the FPL tendon to simulate the pinch function of the thumb. A distal radius volar plate was applied to these cadaveric specimens in various positions relative to the watershed line. We measured contact pressure between the distal plate edge and the FPL tendon using a thin flexible pressure sensor and compared it among various positions of the volar plate for wrist extension angles of 0°, 30°, and 60° and ulnar deviation angles of 0° and 20°.
Under the 30° or 60° wrist extension condition, contact pressure significantly increased when the distal plate edge was placed distal to the watershed line, compared with when it was placed proximal to or at the watershed line.
Our quantitative results support the theory that plates placed distal to the watershed line have the potential to impinge on the traversing FPL tendon, even when a radius fracture heals anatomically.
This study clarifies a mechanism of FPL tendon irritation after volar plate fixation for distal radius fractures.
The Journal of hand surgery 11/2011; 36(11):1790-7. · 1.33 Impact Factor
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ABSTRACT: Bone-to-tendon contact in the origin of the common extensor tendons is considered to be one of the causes of lateral epicondylitis. Some factors, including elbow and forearm position, varus stress to the elbow, or contraction of the wrist extensor tendons, are considered to affect this bone-to-tendon contact. However, no studies have evaluated the effect of the elbow and forearm position on bone-tendon interface. The purpose of this study is to evaluate the effect of the position of the elbow and forearm on the contact pressure of the tendinous origin of the common wrist and finger extensors.
We used 8 fresh cadaveric upper extremities. Contact pressure between the origin of the common extensor tendons and the lateral side of the capitellum was measured with a pressure sensor and was compared among various conditions, including elbow flexion angle (0°, 30°, 60°, and 90°), forearm rotation position (neutral and 81.5° pronation position), and varus stress load of the elbow (none, gravity on the forearm, and gravity on the forearm +1.96 Nm). Contact pressure was also measured during tension force of the extensor carpi radialis longus, extensor carpi radialis brevis, and extensor digitorum communis by 0, 9.8, and 19.6 N.
Contact pressure was significantly increased with the elbow extension position, forearm pronation position, and varus stress to the elbow under tension of the extensor carpi radialis longus or extensor carpi radialis brevis.
This study provides data about the amount of contact pressure between bone and tendon at the origin of the common extensor tendons in the elbow. This information may lead to a better understanding of, and better treatment for, lateral epicondylitis.
The Journal of hand surgery 01/2011; 36(1):81-8. · 1.33 Impact Factor
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ABSTRACT: Contracture of the coracohumeral ligament is reported to restrict external rotation of the shoulder with arm at the side and restrict posterior-inferior shift of the humeral head. The contracture is supposed to restrict range of motion of the glenohumeral joint.
To obtain stretching position of the coracohumeral ligament, strain on the ligament was measured at the superficial fibers of the ligament using 9 fresh/frozen cadaver shoulders. By sequential measurement using a strain gauge, the ligament strain was measured from reference length (L0). Shoulder positions were determined using a 3 Space Tracker System. Through a combination of previously reported coracohumeral stretching positions and those observed in preliminary measurement, ligament strain were measured by passive external rotation from 10° internal rotation, by adding each 10° external rotation, to maximal external rotation.
Stretching positions in which significantly larger strain were obtained compared to the L0 values were 0° elevation in scapula plane with 40°, 50° and maximum external rotation (5.68%, 7.2%, 7.87%), 30° extension with 50°, maximum external rotation (4.20%, 4.79%), and 30° extension + adduction with 30°, 40°, 50° and maximum external rotation (4.09%, 4.67%, 4.78%, 5.05%)(P < 0.05). No positive strain on the coracohumeral ligament was observed for the previously reported stretching positions; ie, 90° abduction with external rotation or flexion with external rotation.
Significant strain of the coracohumeral ligament will be achieved by passive external rotation at lower shoulder elevations, extension, and extension with adduction.
Sports Medicine Arthroscopy Rehabilitation Therapy & Technology 01/2011; 3(1):2.
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ABSTRACT: Thoracic outlet syndrome is thought to be caused by compression of the brachial plexus or subclavian artery in the interscalene, costoclavicular, or subcoracoid space. Some provocative tests are widely used for diagnosing thoracic outlet syndrome. However, whether provocative positions actually compress the neurovascular bundle in these spaces remains unclear. The purpose of this study was to investigate the possibility of neurovascular bundle compression in the costoclavicular space by measuring the pressure applied to the brachial plexus and subclavian artery in provocative positions.
Bilateral shoulders of eight fresh-frozen transthoracic human cadavers with no obvious anatomical abnormalities were used in this study. There were three female and five male cadavers with a mean age of 81.7 years (range 72-90 years). The pressure on the brachial plexus and subclavian artery between the clavicle and first rib were measured using a 0.13-mm thin pressure sensor in each of four provocative positions (depressed position, alternative Eden position, throwing position, Wright position).
Nerve contact pressure was increased in seven shoulders in the Wright position (2.87 +/- 3.13 N/cm(2); range 0.81-9.76 N/cm(2)). The frequency of nerve compression in the Wright position was significantly higher when compared to that in the other three limb positions (P = 0.018). Artery contact pressure was increased in three shoulders in the Wright position (mean 0.59 +/- 0.13 N/cm(2); range 0.45-0.7 N/cm(2)). As was the case with nerve compression, the frequency of compression tended to be higher for the Wright position, but no significant difference was seen.
In four of eight specimens with no obvious anatomical abnormalities, the brachial plexus was compressed in the costoclavicular space in the Wright position. The Wright position thus may be a useful position for inducing nerve compression in the costoclavicular space.
Journal of Orthopaedic Science 01/2010; 15(1):118-24. · 0.84 Impact Factor
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ABSTRACT: Lengthening of the pectoralis minor muscle (PMi) during passive shoulder motions and the effect of stretching techniques for this muscle are unclear. The purposes of this study were: (1) to investigate the amount and pattern of the lengthening between passive shoulder motions and (2) to determine which stretching technique effected the greatest change in PMi length.
Nine fresh cadaveric transthoracic specimens were used. Lengthening in the lateral and medial fiber group of the PMi was directly measured during 3 passive shoulder motions (flexion, scaption, and external rotation at 90 degrees of abduction) and 3 stretching techniques (scapular retraction at 0 degrees and 30 degrees of flexion and horizontal abduction) for this muscle. The measurement was conducted by using a precise displacement sensor.
Although the length of the PMi linearly increased during all shoulder motions, lengthening during flexion and scaption was steeper and significantly larger than that during external rotation at 90 degrees of abduction. For the stretching techniques, scapular retraction at 30 degrees of flexion and horizontal abduction stretched the PMi more than scapular retraction at 0 degrees of flexion. In comparison with lengthening at 150 degrees of flexion, scapular retraction at 30 degrees of flexion significantly stretched the medial fiber group of the muscle.
The extensive lengthening of the PMi is necessary during shoulder motions, especially flexion and scaption. Scapular retraction at 30 degrees of flexion makes the greatest change in PMi length. This study suggests the importance of the PMi in shoulder motion and provides anatomical and biomechanical evidence that might guide appropriate selection of stretching techniques.
Physical Therapy 02/2009; 89(4):333-41. · 3.11 Impact Factor
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ABSTRACT: The ilio-femoral ligament is known to cause flexion contracture of the hip joint. Stretching positioning is intended to elongate the ilio-femoral ligaments, however, no quantitative analysis to measure the effect of stretching positions on the ligament has yet been performed. Strains on the superior and inferior ilio-femoral ligaments in 8 fresh/frozen trans-lumbar cadaveric hip joints were measured using a displacement sensor, and the range of movement of the hip joints was recorded using a 3Space Magnetic Sensor. Reference length (L(0)) for each ligament was determined to measure strain on the ligaments. Hip positions at 10 degrees adduction with maximal external rotation, 20 degrees adduction with maximal external rotation, and maximal external rotation showed larger strain for the superior ilio-femoral ligament than the value obtained from L(0), and hip positions at 20 degrees external rotation with maximal extension and maximal extension had larger strain for the inferior ilio-femoral ligament than the value obtained from L(0) (p<0.05). Superior and inferior ilio-femoral ligaments exhibited positive strain values with specific stretching positions. Selective stretching for the ilio-femoral ligaments may contribute to achieve lengthening of the ligaments to treat flexion contracture of the hip joint.
Manual therapy 10/2008; 14(4):427-32. · 2.32 Impact Factor
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ABSTRACT: Various stretches have been introduced for the posterior shoulder; however, little quantitative analysis to measure stretching of the posterior capsule has been performed.
The current shoulder stretching program is not sufficient to stretch the entire posterior capsule.
Controlled laboratory study.
Using 8 fresh-frozen cadaver shoulders (average age, 82.4 years), 8 stretching positions for the posterior capsule were simulated by passive internal rotation. Stretching positions of 0 degrees , 30 degrees , 60 degrees , and 90 degrees of elevation in the scapular plane; 60 degrees of flexion; 60 degrees of abduction; 30 degrees of extension; and 60 degrees of flexion and horizontal adduction were adopted. Strain was measured in the upper, middle, and lower parts of the capsule. The measurement of strain was instituted from reference length.
With internal rotation, mean strain on the upper capsule was 3.02% at 0 degrees of elevation and 3.35% at 30 degrees of extension. Strain on the middle capsule at 0 degrees and 30 degrees elevation was 0.78% and 4.77%, respectively; on the lower capsule, it was 5.65% and 2.24% at 30 degrees and 60 degrees of elevation, respectively, and 2.88% at 30 degrees of extension. Increase in strains of the upper, middle, and lower capsule with internal rotation at 0 degrees , 30 degrees , and 60 degrees of elevation were statistically significant, respectively (P < .01). Other shoulder positions demonstrated no positive strain values.
Based on the results of this cadaver study, large strains on the posterior capsule of the shoulder were obtained at a stretching position of 30 degrees of elevation in the scapular plane with internal rotation for the middle and lower capsule, while a stretching position of 30 degrees of extension with internal rotation was effective for the upper and lower capsule.
The current posterior capsule stretching program of the shoulder was not sufficient to stretch the entire posterior capsule.
The American journal of sports medicine 06/2008; 36(10):2014-22. · 3.61 Impact Factor
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ABSTRACT: Experimental laboratory design.
To measure the strain at the proximal origin of the extensor carpi radialis brevis (ECRB), and to determine the influence of a forearm support band.
A forearm support band is often used with the intent to decrease stresses around the origin of the wrist extensors. However, the influence of the location of the band has not been studied.
The forearm support band was applied on 8 cadaver arms (mean +/- SD age, 78.4 +/- 10.3 years) and 2 experimental conditions were performed. First, strain measurements were made without applying tension to the distal ECRB tendon, then strain measurements were made with a traction force of 21.5 N being applied to the distal ECRB tendon. Strain of the proximal origin of the ECRB, 1.0 cm distal from the lateral epicondyle, was recorded using a strain gauge. The band was mounted on the forearm at distances equal to 80%, 70%, 60%, 50%, 40%, 30%, and 20% of the forearm length as measured from the wrist. Testing order was randomized. Tension applied to the band was 19.6 N.
When no tension was applied to the ECRB, there was no statistically significant difference (P>.05) in strain values at the ECRB origin by mounting the band at any of the forearm positions. In the tension condition, the average (SD) strain with no band was 2.40% (1.40%). The average strain value of 0.85% (0.65%), when the band was mounted 80% of the forearm length proximal to the wrist, was statistically smaller than that obtained without the band (P<.05).
The strain on the ECRB origin was less when the forearm support band was applied 80% proximal from the wrist joint.
Therapy, level 5.
Journal of Orthopaedic and Sports Physical Therapy 05/2008; 38(5):257-61. · 3.00 Impact Factor
