3D assessment of the shoulder and the cervical spine : assessment methodologies and clinical applications

Le but de ce travail est d’améliorer les techniques de mesure cinématique tridimensionnelle (3D) afin d’étudier les schémas cinématiques du complexe de l’épaule et du rachis cervical chez des sujets sains et pathologiques. La première partie de ce travail propose un rappel d’anatomie fonctionnelle, une revue de la littérature de la cinématique du complexe scapulo-huméral et une mise au point sur les techniques de mesure de ces deux complexes articulaires. La deuxième partie de ce travail a pour objectif d’évaluer à partir d’études cliniques originales : - la reproductibilité des techniques de mesure des rotations des complexes scapulo-huméral et cervical et d’en proposer une amélioration par une analyse simultanée des translations du barycentre de la scapula ainsi que par la mesure couplée des deux complexes articulaire. - les schémas cinématiques de la scapula dans différents modèles de pathologies ostéo-articulaires au cours de gestes analytiques et fonctionnels. En conclusion, ce travail de thèse met en évidence : une variabilité intra-individuelle dans la capacité à reproduire un mouvement à l’identique avec le membre supérieur et à conserver la même précision dans le repositionnement de la tête. - des mouvements de translation 3D de la scapula, dont certains de grande amplitude, associés aux rotations des mouvements de faible amplitude du rachis cervical associés aux mouvements du membre supérieur en faveur de son rôle proprioceptif. - des schémas cinématiques scapulaires spécifiques : - de la lésion neurologique en cas de scapula alata dynamique. - de la nature fonctionnelle de la tâche en cas de pathologies ostéo-articulaires communesThe aim of this work was to improve the methods of kinematic assessment of the shoulder complex and of the cervical spine in order to improve understanding of scapular and cervical spine kinematics in asymptomatic and symptomatic subjects. The first part of this work provides a reminder of functional anatomy, a literature review of the 3D kinematics of the shoulder complex and issues relating to measurement techniques of both articular complexes. The second part is based on original clinical studies assessing: - the reliability of the measurement techniques of the rotations of both articular complexes and their enhancement by addition of scapular translations and the coupled mobility of the cervical spine and shoulder complexes. - the patterns of scapular kinematic in different ostéo-articular pathologies In conclusion, this work highlights: - intra-individual variability in the ability to reproduce a movement with the upper arm and in the accuracy of repositioning the head . -3D scapular translations (some with large ranges) associated with scapular rotations. - small movements of the cervical spine associated with upper limb movements relating to the proprioceptive role of the cervical. - spine specific scapular kinematic patterns depending on: - neurological lesions in the case of dynamic scapula alata, - the type of movement in common osteo articular pathologie

Evaluation tridimensionnelle du complexe scapulo-huméral et du rachis cervical (méthodologie d'évaluation et applications cliniques)

Le but de ce travail est d améliorer les techniques de mesure cinématique tridimensionnelle (3D) afin d étudier les schémas cinématiques du complexe de l épaule et du rachis cervical chez des sujets sains et pathologiques. La première partie de ce travail propose un rappel d anatomie fonctionnelle, une revue de la littérature de la cinématique du complexe scapulo-huméral et une mise au point sur les techniques de mesure de ces deux complexes articulaires. La deuxième partie de ce travail a pour objectif d évaluer à partir d études cliniques originales : - la reproductibilité des techniques de mesure des rotations des complexes scapulo-huméral et cervical et d en proposer une amélioration par une analyse simultanée des translations du barycentre de la scapula ainsi que par la mesure couplée des deux complexes articulaire. - les schémas cinématiques de la scapula dans différents modèles de pathologies ostéo-articulaires au cours de gestes analytiques et fonctionnels. En conclusion, ce travail de thèse met en évidence : une variabilité intra-individuelle dans la capacité à reproduire un mouvement à l identique avec le membre supérieur et à conserver la même précision dans le repositionnement de la tête. - des mouvements de translation 3D de la scapula, dont certains de grande amplitude, associés aux rotations des mouvements de faible amplitude du rachis cervical associés aux mouvements du membre supérieur en faveur de son rôle proprioceptif. - des schémas cinématiques scapulaires spécifiques : - de la lésion neurologique en cas de scapula alata dynamique. - de la nature fonctionnelle de la tâche en cas de pathologies ostéo-articulaires communesThe aim of this work was to improve the methods of kinematic assessment of the shoulder complex and of the cervical spine in order to improve understanding of scapular and cervical spine kinematics in asymptomatic and symptomatic subjects. The first part of this work provides a reminder of functional anatomy, a literature review of the 3D kinematics of the shoulder complex and issues relating to measurement techniques of both articular complexes. The second part is based on original clinical studies assessing: - the reliability of the measurement techniques of the rotations of both articular complexes and their enhancement by addition of scapular translations and the coupled mobility of the cervical spine and shoulder complexes. - the patterns of scapular kinematic in different ostéo-articular pathologies In conclusion, this work highlights: - intra-individual variability in the ability to reproduce a movement with the upper arm and in the accuracy of repositioning the head . -3D scapular translations (some with large ranges) associated with scapular rotations. - small movements of the cervical spine associated with upper limb movements relating to the proprioceptive role of the cervical. - spine specific scapular kinematic patterns depending on: - neurological lesions in the case of dynamic scapula alata, - the type of movement in common osteo articular pathologiesST ETIENNE-Bib. électronique (422189901) / SudocSudocFranceF

Immediate effect of passive hamstring stretching on flexibility and relationship with psychosocial factors in people with chronic low back pain

Background: Hamstring muscle tightness contributes to disability in people with chronic low back pain (CLBP). HM stretching improves flexibility in healthy individuals, but the immediate effect of stretching is unknown in people with CLBP. Moreover, the stretching effect could be influenced by psychosocial factors. Objectives: To evaluate the immediate effect of passive HM stretching on flexibility in people with CLBP and the relationships between psychosocial factors and change in hamstring flexibility. Design: Non-randomized, pilot trial. Method: One minute of passive stretching was performed in 90 people with CLBP. Change in Active Knee Extension and Straight Leg Raise angles (digital inclinometer), and Fingertips-to-Floor distance (measuring tape) were measured before and immediately after stretching. Correlations between change in flexibility and baseline Fear-Avoidance Beliefs Questionnaire (FABQ) and Hospital Anxiety and Depression Scale (HADS) scores were analyzed. Results: Hamstring flexibility improved significantly after stretching; Active Knee Extension mean difference was 4° (95% CI, 2.4 to 5.1; p  0.05). Conclusions: Passive hamstring stretching induced an immediate, statistically significantly improvement in hamstring flexibility, but only the change in Straight Leg Raise amplitude was clinically important. Psychosocial factors were not related to improvements in flexibility after hamstring stretching

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

Orientation of the Head and Trunk During Functional Upper Limb Movement

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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

Exercise programmes for ankylosing spondylitis

International audienceObjective To describe the criteria used to guide clinical decision-making regarding when a patient is ready to return to running (RTR) after ACL reconstruction. Design Scoping review. Data sources The MEDLINE (PubMed), EMBASE, Web of Science, PEDro, SPORTDiscus and Cochrane Library electronic databases. We also screened the reference lists of included studies and conducted forward citation tracking. Eligibility criteria for selecting studies Reported at least one criterion for permitting adult patients with primary ACL reconstruction to commence running postoperatively. Results 201 studies fulfilled the inclusion criteria and reported 205 time-based criteria for RTR. The median time from when RTR was permitted was 12 postoperative weeks (IQR=3.3, range 5–39 weeks). Fewer than one in five studies used additional clinical, strength or performance-based criteria for decision-making regarding RTR. Aside from time, the most frequently reported criteria for RTR were: full knee range of motion or >95% of the non-injured knee plus no pain or pain 70% plus extensor and flexor LSI>70%; and hop test LSI>70%. Conclusions Fewer than one in five studies reported clinical, strength or performance-based criteria for RTR even though best evidence recommends performance-based criteria combined with time-based criteria to commence running activities following ACL reconstruction

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

Neuralgic amyotrophy and hepatitis E infection: 6 prospective case reports

International audienceIntroduction Hepatitis E virus (HEV) represents the main cause of enterically transmitted hepatitis worldwide. It is known that neuralgic amyotrophy (NA) is one of the most frequent neurological manifestations of HEV. However, clinical, electrodiagnostic (EDX) and MRI characteristics, as well as long-term follow-up of HEV-related NA have not been fully described yet. Case reports We describe longitudinally clinical, EDX, biological and MRI results of six cases of HEV-associated NA, diagnosed from 2012 to 2017. Patients were between the ages of 33 and 57 years old and had a positive HEV serology. Clinical patterns showed the whole spectrum of NA, varying from extensive multiple mononeuropathy damage to single mononeuropathy. EDX results showed that the patients totalised 26 inflammatory mononeuropathies (1 to 8 per patient). These involved classical nerves such as suprascapular (6/6 cases), long thoracic (5/6 cases) and accessory spinal nerves (2/6 cases) and, some less frequent more distal nerves like anterior interosseous nerve (3/6 cases), as well as some unusual ones such as the lateral antebrachial cutaneous nerve (1/6 case), sensory fibres of median nerve (1/6 case) and phrenic nerves (1/6 case). After 2 to 8 years, all nerves had clinically recovered (muscle examination above 3/5 on MRC scale for all muscles except in one patient). Discussion HEV should be systematically screened when NA is suspected, whatever the severity, if the onset is less than 4 months (before IgM HEV-antibodies disappear) and appears to be frequently associated with severe clinical and EDX pattern, without increasing the usual recovery time

Is physical activity, practiced as recommended for health benefit, a risk factor for osteoarthritis?

International audienceIn this critical narrative review, we examine the role of physical activity (PA), recreational and elite sports in the development of knee/hip osteoarthritis (OA), taking into account the role of injury in this relationship. The process of article selection was unsystematic. Articles were selected on the basis of the authors’ expertise, self-knowledge, and reflective practice. In the general adult population, self-reported diagnosis of knee/hip OA was not associated with low, moderate or high levels of PA. For studies using radiographic knee/hip OA as a primary outcome, the incidence of asymptomatic radiographic OA was higher for subjects with the highest quartile of usual PA than the least active subjects. The risk of incident radiographic knee/hip OA features was increased for subjects with a history of regular sports participation (for osteophyte formation but not joint space narrowing). This risk depended on the type of sport (team and power sports but not endurance and running), and certain conditions (high level of practice) were closely related to the risk of injury. The prevalence of radiographic OA was significantly higher, especially the presence of osteophytes, in former elite athletes than controls. The risk of OA was higher with participation in mixed sports, especially soccer or power sports, than endurance sport. However, the prevalence of clinical OA between former elite athletes and controls was similar, with less hip/knee disability in former athletes. Moderate daily recreational or sport activities, whatever the type of sport, are not a consistent risk factor for clinical or radiographic knee/hip OA. Risk of injury in different sports may be the key factor to understanding the risk of OA related to spor