A bone of contention: A dynamic ultrasound assessment of the role of the radial head in the arthrokinematics of the proximal radioulnar joint

INTRODUCTION: The arthrokinematics of the proximal radioulnar joint (PRUJ) are believed to follow the convex-concave rule, meaning that when the convex radial head articulates with the concave radial notch on the ulna, rolling and gliding occur in opposite directions during forearm pronation and supination. Previous research using helical computerized tomography (CT) identified that the sequence of joint actions is in contrast with this rule, which would indicate a posterior glide of the radius on the ulna during pronation movement and the converse during supination. OBJECTIVES: The aims of this study are to determine the arthrokinematics of the PRUJ while being assessed via ultrasound (US) imaging and to assess the impact the direction of joint mobilization has on active and passive range of motion (ROM) during forearm supination and pronation at the PRUJ. METHODS: A convenience sample of 53 healthy individuals were recruited. The arthrokinematics of the PRUJ were observed via US cine-loops. A linear US transducer was applied in the transverse plane and placed over the radial head during all testing conditions. A metronome standardized the rate of forearm pronation and supination at 1Hz (60 bpm) during US cine-loops acquisition. Radial head motion was assessed in two different elbow positions during US and joint range of motion assessment. The elbow was flexed to 90° with a neutral forearm position and fully extended with a neutral forearm position. The glenohumeral joint was stabilized during all testing conditions. A repeated measures design randomizing joint mobilization direction to the radial head was utilized to assess forearm pronation and supination via inclinometer data measured in degrees. Joint glides were applied to the radial head according to the convex-concave rule to facilitate forearm supination and pronation. An anteromedial glide to facilitate forearm supination and a posterolateral glide to facilitate forearm pronation. A metronome standardized the rate of joint mobilization at a rate 2Hz (120 bpm). A bubble inclinometer assessed active and passive PRUJ ROM at the wrist during all testing conditions. RESULTS:US imaging cine-loops showed the radial head rolled anteromedially during pronation and posterolaterally during supination, with no translation/gliding evident. Multivariate analysis revealed that the direction of joint mobilization had a significant impact on ROM F(1,47.0)= 6.964, p=.011, partial η2 =.129), with anterior mobilization increasing pronation and posterior mobilization increasing supination. Supination ROM was significantly increased F1(1, 47.0) = 78.03, p CONCLUSION: Our findings are in conflict with the convex-concave rule, which is frequently used by physical therapists to improve joint motion. Should we now reconsider applying this rule to improve joint ROM at the PRUJ

Attitudes, beliefs and social norms regarding infant and young child feeding among Nigerian mothers, fathers and grandmothers across time

Abstract Infant and young child feeding (IYCF) interventions in low‐resource countries mainly target pregnant women and mothers of young children; however, fathers and grandmothers also influence IYCF practices. We conducted focus group discussions with mothers, fathers and grandmothers of young children across three time points in areas where an IYCF social and behaviour change intervention was implemented in Nigeria to explore differences by participant type and shifts over time in attitudes, beliefs and social norms related to breastfeeding and dietary diversity (DD). Overall, across time points, we found more discrepancies in attitudes, beliefs and social norms for early initiation of breastfeeding (EIBF) and exclusive breastfeeding (EBF) among different participant types than for DD. Although most participants agreed EIBF and EBF are good practices, mothers believed this more strongly than fathers and grandmothers; however, at endline, a shift towards acceptance of EIBF and EBF appeared among fathers and grandmothers. Across time points, all participant types acknowledged the nutritional and health benefits of green leafy vegetables and animal‐source foods but described various barriers to feeding them to children. Across time points, all participant types also highlighted the importance of health workers and antenatal visits as important sources of IYCF knowledge and facilitators to following recommended practices. Insights from this study highlight the importance of including key influencers of IYCF practices in qualitative research