Kinematics of the Shoulder Girdle During Pointing: Coordination Between Joints and their Contribution to the Peri-Personal Workspace

International audienceThis study explored the coordination between the components of the shoulder girdle (clavicle, scapula and humerus), and how they contribute to hand movement in the peri-personal space. Shoulder girdle motion was recorded in 10 healthy subjects during pointing movements to 9 targets in the peri-personal space, using electromagnetic sensors fixed to the trunk, scapula and upper arm. Most of the 9 degrees of freedom (DoF) of the shoulder girdle were finely scaled to target position. Principle component analysis revealed that the 6 DoF of scapula-thoracic motion were coordinated in three elementary patterns (protraction, shrug and lateral rotation). The ratio of gleno-humeral to scapulo-thoracic global motion was close to 2:1. A direct kinematic procedure showed that if no scapular motion occurred, the workspace would be reduced by 15.8 cm laterally, 13.7 cm vertically and 4.8 cm anteriorly. Scapulo-thoracic motion should be taken into account when investigating the physiology of upper-limb movements

Determinants of apprehension to return to sport after reconstruction of the anterior cruciate ligament: an exploratory observational retrospective study

International audienceBackground: Only 65% of people return to a level of sport equivalent to that before after anterior cruciate ligament (ACL) surgery. Persisting apprehension may in part explain this observation. We aimed to describe characteristics of people with ACL-Return to Sport after Injury (RSI) scores ≥ 60/100 (low apprehension) at 6 months after injury and to identify variables independently associated with low apprehension at 6 months. Methods: We conducted a single-center retrospective study. People who had surgery for an ACL rupture and who participated in an outpatient post-operative rehabilitation program were included consecutively. The ACL-RSI questionnaire was self-administered at 6 months after injury. Baseline characteristics of people with ACL-RSI scores ≥ 60/100 and < 60/100 were described. Multiple logistic regression was performed to identify baseline variables associated with low apprehension at 6 months. Results: We included 37 participants: 13/37 (35.1%) were women and mean age was 27.2 (9.2) years. At 6 months, 21/37 (56.8%) had an ACL-RSI score ≥ 60/100. Participants who had an ACL-RSI score ≥ 60/100 more often received a preoperative rehabilitation (16/21 [76.2%] vs 5/16 [31.2%]), and had less often knee pain (7/21 [33.3%] vs 7/16 [43.7%]) and effusion (5/21 [23.8%] vs 8/16 [50.0%]) at 1 month after surgery, than participants who had an ACL-RSI score < 60/100. In the multivariate analysis, preoperative rehabilitation was associated with low apprehension at 6 months (OR [95% CI] = 0.107 [0.023 to 0.488], p = 0.002). Conclusions: Preoperative rehabilitation was independently associated with low apprehension at 6 months. Trial registration. Not applicable

A new description of scapulothoracic motion during arm movements in healthy subjects.

International audienceThe participation of scapula motion in arm movement is clinically well known and recent three dimensional (3D) analyses using kinematic techniques have confirmed its importance. Scapular motion relative to the thorax has a theoretical maximum of 6 degrees of freedom (DoF), resulting from rotations at both clavicular joints (3 rotational DoF each). However, most recent kinematic studies have only analysed the 3D rotations of the scapula relative to the thorax. In the present study, the 3D translations of the barycentre of the scapula were considered in order to complete the description of movement at the shoulder complex. Eight healthy subjects performed arm elevation in the sagittal and frontal planes, simulated activities of daily living (hair combing and back washing) and maximum voluntary scapula movement (forward and backward rolling). Measurements were recorded using a 6 DoF electromagnetic device and the acromial method of analysis was used. The results showed that 3D scapular rotations and translation of its barycentre were functionally consistent for all tasks. A principal component analysis (PCA) yielded three factors, explaining 97.6% of the variance. The first two factors (protraction and shrug, according to clinical descriptions) combined rotations and translations, consistent with the hypothesis that the scapula rolls over the curved thoracic surface. The third factor related to lateral-medial rotation, thus representing rotation in the plane tangential to the thorax. The PCA suggested that scapular motion can be described using these 3 DoF. This should be studied in a larger group of individuals, including patients with pathological conditions

Orientation of the Head and Trunk During Functional Upper Limb Movement

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Facteurs biomécaniques impliqués dans le syndrome douloureux fémoro-patellaire : revue narrative des dispositifs de mesure

International audienceObjectif : Réaliser une synthèse de la littérature des dispositifs utilisés pour étudier les facteurs biomécaniques statiques et dynamiques associés au syndrome douloureux fémoro-patellaire (SDFP).Matériel/Patients et méthodes : Revue de littérature narrative actualisée (années 2017-2022). La recherche a été effectuée sur Pubmed, la sélection des articles a tenu compte de l’expertise des auteurs.Résultats : Dix-sept articles ont été sélectionnés. De nombreux dispositifs technologiques sont utilisés pour décrire les caractéristiques de positionnement patellaire et d’alignement fémoro-tibial associées au SDFP. L’échographie et l’IRM permettent de mesurer avec précision le tilt (bascule mediale) de la patella. Les dispositifs électromagnétiques et optoélectroniques 3D montrent une augmentation de la rotation médiale du fémur, de l’adduction de la hanche et du valgus du genou lors de gestes fonctionnels et sportifs, en charge, chez les sujets avec SDFP comparés à des sujets asymptomatiques. Les dispositifs électromagnétiques et optoélectroniques 3D sont également utilisés en tant que biofeedback visuel, pour modifier l'attaque du pas et la cadence lors de la marche et de la course. Les capteurs inertiels sont proposés pour mesurer l’instabilité dynamique (irrégularité de déplacement du centre de pression) liée à la fatigue musculaire. Le recours à l’intelligence artificielle pour analyser un grand nombre de données électromyographiques et biomécaniques est proposée pour développer des modèles de SDFP.Discussion - Conclusion : Les dispositifs technologiques sont au service d’une connaissance plus précise des paramètres biomécaniques impliqués dans le SDFP. Combinées avec les caractéristiques neuro-musculaires, ces informations doivent permettre d’identifier des phénotypes spécifiques et ainsi améliorer la précision des diagnostics et des traitements.Mots clés : syndrome douloureux fémoro-patellaire, biomécanique, revue de littérature, dispositifs de mesureLiens d'intérêts : Aucu

Impact of a multidisciplinary team meeting on patient-reported outcomes at 2 years after lumbar surgery: A prospective comparative exploratory study

Failed back surgery syndrome is a challenge. We hypothesized that a multidisciplinary team meeting (MTM) may be useful to select patients who are the most likely to benefit from lumbar surgery. We conducted an observational, prospective, comparative, exploratory study. We aimed to compare core clinical patient-reported outcomes at 2 years after lumbar surgery between patients who attended a MTM and those who did not. Patients who underwent lumbar surgery for a degenerative disease, in a single academic orthopedic department, between January and September 2018, were consecutively screened. Eligible patients were surveyed between April and June 2020. Patient-reported outcomes included lumbar and radicular pain, spine-specific activity limitations and health-related quality of life assessed via self-administered questionnaires. Outcomes were compared between respondents who attended the MTM and those who did not. Overall, 211 patients underwent lumbar surgery, 108 were eligible and 44 included: 11 attended the MTM and 33 did not. Mean participants' age was 57.4 (15.4) years, symptom duration was 14.8 (15.3) months, lumbar pain was 51.3 (18.2) and radicular pain was 53.4 (18.6). At 2 years, we found no evidence that lumbar and radicular pain, activity limitations and health-related quality of life differed between the 2 groups. The decrease was −26.8 (41.1) versus −20.8 (30.4) in lumbar pain and −25.5 (43.0) versus −19.5 (27.5) in radicular pain, in participants who attended the MTM versus those who did not, respectively. We found no evidence that core clinical patient-reported outcomes at 2 years after lumbar surgery differed between participants who attended the MTM and those who did not. However, the exploratory design of our study does not allow concluding that MTMs do not have an impact

Agreement among physiotherapists in assessing patient performance of exercises for low-back pain

International audienceBACKGROUND: There is no agreement for the performance assessment of patients who practice exercises.. (2 points to withdraw) This assessment is currently left to the physiotherapist's personal judgement. We studied the agreement among physiotherapists in rating patient performance during exercises recommended for chronic low-back pain (LBP).METHODS: A vignette-based method was used. We first identified ten exercises recommended for LBP in the literature. Then, 42 patients with chronic LBP participating in a rehabilitation program were videotaped during their performance of one of the ten exercises. A vignette was an exercise video preceded by clinical information. Ten physiotherapists from primary (4) and tertiary care (6) viewed the 42 vignettes twice, one month apart, and rated patient performance from zero (worse performance) to ten (excellent performance) by considering the position and duration of the contraction or stretching. Intra-class correlation coefficients (ICCs) and 95% confidence intervals (95% CIs) were computed to assess inter- and intra-rater reliability.RESULTS: The overall inter-rater agreement was fair (ICC 0.48 [95% CI 0.33-0.56]) but was better for stretching exercises (0.55 [0.35-0.64]) than strengthening exercises (0.42 [0.20-0.52]) and for tertiary-care physiotherapists (0.66 [0.54-0.76]) than primary-care physiotherapists (0.28 [0.09-0.37]). The intra-rater agreement was overall good (0.72 [0.57-0.81] to 0.88 [0.79-0.94]). It was better for stretching exercises (from 0.68 [0.46-0.81] to 0.96 [0.91-0.98]) than strengthening exercises (from 0.68 [0.38-0.84]) to 0.82 [0.56-0.92]).CONCLUSION: The agreement in rating patient performance of exercises for LBP is good among physiotherapists trained in managing LBP but is low among non-trained physiotherapists

Disability induced by hand osteoarthritis: are patients with more symptoms at digits 2–5 interphalangeal joints different from those with more symptoms at the base of the thumb?

AbstractBackground: The contribution of osteoarthritis (OA) at the base of the thumb (BT) and digits 2–5 interphalangeal joints (IP) to disability in the hand has never been assessed.Objectives: To evaluate and compare disability in patients with clinical hand OA and more severe symptoms at BT or IP.Design: Observational, prospective, correlational.Setting: Rheumatology and rehabilitation departments in two tertiary care teaching hospitals.Participants: One hundred and sixteen patients (107 women, mean age 62±7 years) fulfilling the American College of Rheumatology criteria for OA in the hand, with more symptomatic BT (67 patients) or IP (49 patients).Main outcome measure: Disability assessment with Cochin hand functional scale (CHFS) was the primary outcome. Assessment of impairment by the visual analog scale of pain (VAS pain), Ritchie articular index (RAI), modified Kapandji index (mKI), Kallman radiological classification and handicap assessment with visual analog scale (VASHd) was the secondary outcome. Group comparisons were assessed by use of Student’s t-test for quantitative variables and Chi-square test for categorical variables. Results of the CHFS analysis were assessed by factorial analysis followed by Varimax rotation. Correlation between scores of disability, impairment, and handicap measures were calculated with use of Spearman rank correlation coefficient.Results: Demographic data, disease duration, and level of global pain were similar between the BT and IP groups. The BT and IP groups did not differ significantly according to disability and handicap level (P=0.42 and P=0.94 for CHFS total score and VASHd, respectively). Factor analysis of the CHFS revealed similar results for the two groups of patients, especially for the first extracted factor. Disability scores correlated best with global hand pain (r=0.65) in the BT group and with RAI scores (r=0.71) in the IP group.Conclusions: Disability and perceived handicap levels are comparable in clinical hand OA patients with more symptomatic BT or IP. These two groups should not be considered different during trials assessing treatments for hand OA when the primary outcome measure assesses disability