The effect of fatigued internal rotator and external rotator muscles of the shoulder on the shoulder position sense

The purpose of this study was to investigate which muscle group, the agonist or antagonist, contributes most to the shoulder position sense (SPS). The SPS was tested under 2 conditions: fatigued shoulder internal rotator (IR) muscles (pectoralis major and latissimus dorsi) and fatigued external rotator (ER) muscles (infraspinatus). In each condition, the SPS was measured before and after a fatiguing task involving the IR or ER muscles by repeating shoulder joint rotation. SPS was measured using a method in which subjects reproduced a memorized shoulder joint rotation angle. The position error values in all conditions (fatigued IR and ER muscles) and measurement periods (before- and after-fatigue task) were compared using 2-way analysis of variance with repeated measures (IR/ER × before/after). Position error increased significantly after both fatigue tasks (before- vs. after-fatigue: IR muscle, 2.68° vs. 4.19°; ER muscle, 2.32° vs. 4.05°). In other words, SPS accuracy decreased when either the agonist or antagonist muscle was fatigued. This finding indicated that SPS may be affected by an integrated information of the afferent signals in the agonist and antagonist muscles.     

Virtual Power Based Algorithm for Decoupling Large Motions from Infinitesimal Strains: Application to Shoulder Joint Biomechanics

New trends of numerical models of human joints require more and more computation of both large amplitude joint motions and fine bone stress distribution. Together, these problems are difficult to solve and very CPU time consuming. The goal of this study is to develop a new method to diminish the calculation time for this kind of problems which include calculation of large amplitude motions and infinitesimal strains. Based on the Principle of Virtual Power, the present method decouples the problem into two parts. First, rigid body motion is calculated. The bone micro-deformations are then calculated in a second part by using the results of rigid body motions as boundary conditions. A finite element model of the shoulder was used to test this decoupling technique. The model was designed to determine the influence of humeral head shape on stress distribution in the scapula for different physiological motions of the joint. Two versions of the model were developed: a first version completely deformable and a second version based on the developed decoupling method. It was shown that biomechanical variables, as mean pressure and von Mises stress, calculated with the two versions were sensibly the same. On the other hand, CPU time needed for calculating with the new decoupled technique was more than 6 times less than with the completely deformable model.     

锁骨远端解剖锁定钢板结合Nice结环扎与锁骨钩钢板治疗Neer Ⅱ型锁骨远端骨折的疗效比较研究

摘要 目的：以锁骨钩钢板为对照,探讨锁骨远端解剖锁定钢板结合Nice结环扎治疗Neer Ⅱ型锁骨远端骨折的临床疗效,为临床Neer Ⅱ型锁骨远端骨折的治疗提供合理方案。方法：回顾性分析自2017年1月~2020年1月宿迁市第一人民医院收治的38例Neer Ⅱ型锁骨远端骨折患者的临床资料,按内固定方式不同进行分组,其中18例采用锁骨远端解剖锁定板结合Nice结环扎固定（观察组）,20例采用锁骨钩钢板内固定（对照组）。记录两组手术时间、术中出血量、骨折愈合时间、术后并发症,并于术后3个月和6个月时进行视觉模拟评分法（VAS）评分及肩关节功能Constant-Murley和UCLA评分。结果：38例患者手术均顺利完成,两组手术时间及术中出血量比较无差异（P>0.05）。38例患者手术均获得随访,两组骨折愈合时间比较无差异（P>0.05）;观察组并发症发生率（11.11%）低于对照组（40.00%）（P<0.05）。观察组术后3个月和6个月的VAS评分均低于对照组,而Constant- Murley和UCLA评分均高于对照组（P<0.05）。结论：Neer Ⅱ型锁骨远端骨折采用锁骨远端解剖锁定钢板结合Nice结环扎治疗固定效果确切,患者术后肩关节功能恢复良好,并发症少,痛疼程度轻,相较于锁骨钩钢板治疗,其优势明显,可作为临床治疗Neer Ⅱ型锁骨远端骨折的推荐方案。     

苍龟探穴电针疗法联合肩关节功能锻炼对肩周炎患者肩关节功能、炎症因子和血清5- HT、PGE2的影响

摘要 目的：观察苍龟探穴电针疗法联合肩关节功能锻炼对肩周炎患者肩关节功能、炎症因子和血清5-羟色胺（5-HT）、前列腺素E₂（PGE₂）的影响。方法：选择2019年7月~2021年7月期间我院收治的肩周炎患者80例,按照入院的奇偶顺序分为对照组和研究组,各为40例,对照组接受肩关节功能锻炼,研究组接受苍龟探穴电针疗法联合肩关节功能锻炼,对比两组疗效、视觉疼痛模拟评分量表（VAS）评分、血清5- HT、PGE₂水平、肩关节活动度（前屈、后伸、外展、内收、内旋、外旋）和肩关节周围肌力相关指标、血清炎症因子水平。结果：研究组的临床总有效率高于对照组（P<0.05）。治疗后,两组VAS评分均下降,且研究组较对照组低（P<0.05）。治疗后,两组主动和被动状态下患肢前屈、后伸、内收、外展、内旋、外旋活动度均改善,且研究组优于对照组（P<0.05）。治疗后,两组前屈峰力矩（PT）、前屈平均功率（AP）、外展PT、外展AP均升高,且研究组高于对照组（P<0.05）。治疗后,两组血清PGE₂、5-HT水平均下降,且研究组低于对照组（P<0.05）。治疗后,两组血清白介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）、C反应蛋白（CRP）水平均下降,且研究组较对照组低（P<0.05）。结论：苍龟探穴电针疗法联合肩关节功能锻炼可促进肩周炎患者肩关节功能改善,减轻疼痛症状,作用机制可能与降低血清5- HT、PGE₂及炎症因子水平有关。     

Effect of shoulder stability exercises on hand grip strength in patients with shoulder impingement syndrome

Background: Shoulder impingement syndrome (SIS) is the second most common musculoskeletal condition that causes shoulder pain in the general population. Shoulder girdle muscle imbalance and posterior capsule tightness have been implicated as contributing factors.

Objective: The purpose of this study was to investigate the effect of shoulder stability exercises (SSEs) on hand grip strength in patients with unilateral SIS.

Methods: A total of 16 patients with a mean age of 32?±?9.3?years diagnosed with stage II unilateral SIS participated in this study. A standardized SSE programme was conducted in the clinic under the direct 1-to-1 supervision of a physical therapist thrice weekly for 4?weeks for a total of 12 sessions on the affected and non-affected shoulders. The effect of the SSE programme on isometric hand grip strength was analysed.

Results: A significant difference (p?=?.016) was observed in the hand grip strength of the affected shoulder side before and after the intervention, but no significant difference (p?=?1.0) was found in the hand grip strength of the non-affected shoulder side post-intervention.

Conclusion: The reduction in isometric hand grip strength of the affected shoulder side compared to that of the non-affected shoulder side in the same subject before the intervention shows that SIS significantly affects the hand grip strength of the affected side. SSEs significantly affect the isometric hand grip strength of SIS patients.     

关节镜下半月板部分切除术与理疗治疗不稳定半月板撕裂的前瞻性对照研究

目的：评估针对不稳定半月板撕裂,关节镜下半月板部分切除术（APM）是否优于单纯理疗。方法：纳入36 例经磁共振确诊 为不稳定半月板撕裂的患者,平均年龄35 岁,其中9 例伴轻度骨关节炎。所有患者于前8 周,每周行3 次物理治疗,包括股四头 肌功能锻炼和神经-肌肉功能锻炼。完成康复训练后1 周行关节镜下半月板部分切除术。在治疗前、理疗结束后以及术后第4 周 随访时行VAS 评分进行疼痛评估并行Lysholm 评分进行功能评估。结果：36 例患者的VAS 评分由治疗前的5.66± 1.10,改善为 理疗结束后的4.39± 0.95（P＜0.05）,行APM 术后则达到1.82± 0.77（P＜0.05）,并且理疗对VAS 的改善不如APM 明显（P＜ 0.05）。治疗前,伴骨关节炎患者的疼痛症状更为明显,而APM 术后则与不伴骨关节炎的患者无明显差异（P＞0.05）。患者 Lysholm 评分理疗结束后由58.11± 8.06 提高到62.11± 8.34（P＜0.05）,APM术后则达到86.78± 5.50（P＜0.05）。相对于骨关节炎 患者,不伴骨关节炎患者的Lysholm 评分更高（P＜0.05）。结论：物理治疗能有效减轻疼痛和肿胀症状,但是对关节活动受限等改 善不明显。APM相对于理疗能有效缓解症状,改善膝关节功能。     

肱骨近端锁定接骨板结合抗骨质疏松药物治疗老年骨质疏松性肱骨近端粉碎性骨折的疗效观察

目的:探讨肱骨近端锁定接骨板(LPHP)结合抗骨质疏松药物治疗老年骨质疏松性肱骨近端粉碎性骨折(OP-CFPH)的疗效价值。方法:抽选我院2012年1月-2014年2月收治的45例老年OP-CFPH患者,采用随机分层法分为对照组(n=22例,采用三叶形普通钢板治疗)和观察组(n=23例,采用LPHP+入院后抗骨质疏松治疗),比较两组手术参数、术后肩关节Neer评分及并发症发生率的差异。结果:观察组手术时间、术中出血量、术后引流量及术后骨折愈合时间均显著低于对照组的,组间差异具有统计学意义(P0.05);观察组术后肩关节Neer评分优良率明显高于对照组(P0.05);术后观察组并发症发生率低于对照组,但比较差异无统计学意义(P0.05)。结论:LPHP联合抗骨质疏松治疗老年OP-PHF具有创伤小、疗效好的优点,有利于骨折愈合,是目前治疗该类骨折一种理想的方法。     

腓骨短肌腱外侧韧带重建术治疗慢性踝关节外侧不稳的临床疗效

目的:研究外侧副韧带重建手术结合关节镜检查治疗慢性踝关节外侧不稳的临床疗效。方法:选取2012年7月-2014年7月我院收治的慢性踝关节外侧不稳患者60例,随机分为研究组和对照组,每组30例。对照组患者给予保守治疗,研究组患者采取踝关节镜探查清理联合腓骨短肌腱外侧韧带重建手术进行治疗。应用美国足踝外科裸-后足功能评分系统(AOFAS)评价两组患者治疗前后的踝关节功能评分,并比较两组的优良率、复发率以及并发症的发生率。结果:两组治疗前的AOFAS功能评分比较无统计学差异(P0.05),两组治疗后的AOFAS功能评分均较治疗前显著升高,且研究组显著高于对照组,差异具体统计学意义(P0.05)。研究组的优良率为96.7%(29/30),显著高于对照组的73.3%(22/30);研究组的复发率为0.0%(0/30),显著低于对照组的13.3%(4/30);研究组并发症的发生率为3.3%(1/30),显著低于对照组的20.0%(6/30),两组比较差异均具有统计学意义(P0.05)。结论:外侧副韧带重建手术结合关节镜检查治疗慢性踝关节外侧不稳具有较好的临床疗效,且复发率较低,并发症较少。     

关节镜下髁间窝成形术治疗髁间窝撞击综合征病人膝关节屈伸功能受限

目的:对髁间窝撞击综合征致膝关节屈伸功能受限患者关节镜下髁间窝成形手术疗效的探讨。方法:2008年2月-2009年7月选择关节镜下确诊骨性关节炎伴髁间窝撞击综合征病人45例,对所有患者行关节镜下髁间窝扩大成形术。结果:术后患者膝关节屈伸功能明显改进,对其中42例患者进行术后6个月随访,发现患者膝关节疼痛明显缓解或消失,关节屈伸功能较术前得到明显改善。术前Lysholm评分平均(48.7±13.1)分(差),术后平均(87.0±7.3()良),关节功能均获明显改善(P<0.001)。结论:髁间窝撞击综合征是导致该病患者膝关节疼痛及屈伸功能受限的主要原因,关节镜下髁间窝扩大成形术对该病有明显的疗效。     

Mediolateral reaction forces and forelimb anatomy in quadrupedal primates: implications for interpreting locomotor behavior in fossil primates

The forelimb joints of terrestrial primate quadrupeds appear better able to resist mediolateral (ML) shear forces than those of arboreal quadrupedal monkeys. These differences in forelimb morphology have been used extensively to infer locomotor behavior in extinct primate quadrupeds. However, the nature of ML substrate reaction forces (SRF) during arboreal and terrestrial quadrupedalism in primates is not known. This study documents ML-SRF magnitude and orientation and forelimb joint angles in six quadrupedal anthropoid species walking across a force platform attached to terrestrial (wooden runway) and arboreal supports (raised horizontal poles). On the ground all subjects applied a lateral force in more than 50% of the steps collected. On horizontal poles, in contrast, all subjects applied a medially directed force to the substrate in more than 75% of the steps collected. In addition, all subjects on arboreal supports combined a lower magnitude peak ML-SRF with a change in the timing of the ML-SRF peak force. As a result, during quadrupedalism on the poles the overall SRF resultant was relatively lower than it was on the runway. Most subjects in this study adduct their humerus while on the poles. The kinetic and kinematic variables combine to minimize the tendency to collapse or translate forelimbs joints in an ML plane in primarily arboreal quadrupedal primates compared to primarily terrestrial quadrupedal ones. These data allow for a more complete understanding of the anatomy of the forelimb in terrestrial vs. arboreal quadrupedal primates. A better understanding of the mechanical basis of morphological differences allows greater confidence in inferences concerning the locomotion of extinct primate quadrupeds.