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Children with a unilateral congenital below elbow deficiency (UCBED) have one typical upper limb and one that lacks a hand, ending below the elbow at the proximal/mid forearm. UCBED is an isolated condition, and affected children otherwise develop normal sensorimotor control. Unlike adults with upper limb absence, the majority of whom have an acquired loss, children with UCBED never developed a hand, so their residual muscles have never actuated an intact limb. Their ability to purposefully modulate affected muscle activity is often assumed to be limited, and this assumption has influenced prosthetic design and prescription practices for this population as many modern devices derive control signals from affected muscle activity. To better understand the motor capabilities of the affected muscles, we used ultrasound imaging to study 6 children with UCBED. We examined the extent to which subjects activate their affected muscles when performing mirrored movements with their typical and missing hands. We demonstrate that all subjects could intentionally and consistently enact at least five distinct muscle patterns when attempting different missing hand movements (e.g., power grasp) and found similar performance across affected and typically developed limbs. These results suggest that although participants had never actuated the missing hand they could distinctively and consistently activate the residual muscle patterns associated with actions on the unaffected side. These findings indicate that motor control still develops in the absence of the normal effector, and can serve as a guide for developing prostheses that leverage the full extent of these children's motor control capabilities.

Musculoskeletal simulations are a useful tool for improving our understanding of the human body. However, the physiological validity of predicted kinematics and forces is highly dependent upon the correct calibration of muscle parameters and the structural integrity of a model's internal skeletal structure. In this study, we show how ill-tuned muscle parameters and unphysiological deformations of a model's skeletal structure can be detected by using muscle elements as sensors with which modelling and parameterization inconsistencies can be identified through muscle and tendon strain injury assessment. To illustrate our approach, two modelling issues were recreated. First, a model repositioning simulation using the THUMS AM50 occupant model version 5.03 was performed to show how internal model deformations can occur during a change of model posture. Second, the muscle material parameters of the OpenSim gait2354 model were varied to illustrate how unphysiological muscle forces can arise if material parameters are inadequately calibrated. The simulations were assessed for muscle and tendon strain injuries using previously published injury criteria and a newly developed method to determine tendon strain injury threshold values. Muscle strain injuries in the left and right musculus pronator teres were detected during the model repositioning. This straining was caused by an unphysiologically large gap (12.92 mm) that had formed in the elbow joint. Similarly, muscle and tendon strain injuries were detected in the modified right-hand musculus gastrocnemius medialis of the gait2354 model where an unphysiological reduction of the tendon slack length introduced large pre-strain of the muscle-tendon unit. The results of this work show that the proposed method can quantify the internal distortion behaviour of musculoskeletal human body models and the plausibility of Hill-type muscle parameter choice via strain injury assessment. Furthermore, we highlight possible actions to avoid the presented issues and inconsistencies in literature data concerning the material characteristics of human tendons. [ABSTRACT FROM AUTHOR]

Background: Total elbow arthroplasty (TEA) is a mainstay treatment for elbow arthropathy and elbow fracture that can relieve pain and restore functional motion. The purpose of this study was to determine the role of surgical indication in the incidence of short-term adverse events and risk factors influencing complications in TEA to treat arthropathy compared to TEA for fracture. Matched cohorts were created to better isolate the impact of the surgical indication. Methods: The study identified patients within the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database that underwent TEA to treat arthropathy or fracture from 2010 to 2020. Matched cohorts were created to analyze the incidence of 30 day adverse events and risk factors for complications. Results: The study included 599 patients for analysis. The overall incidence of any adverse event was 9.7%. In matched cohorts of 218 patients, the fracture group experienced a higher incidence of overall adverse events (13.8% vs. 6.0% in the arthropathy group, p = 0.009) and postoperative transfusions (9.6% vs. 1.8% in the arthropathy group, p < 0.001). Logistic regression revealed an increased risk of any adverse event in the combined matched cohort with longer operative times (OR = 1.007, CI: 1.002–1.012, p = 0.006) and those undergoing fracture treatment (OR = 2.447, CI: 1.047–5.717, p = 0.039). Outpatient status was associated with a lower risk of adverse events in the combined matched cohort (OR = 0.207, CI: 0.058–0.739, p = 0.015). Conclusions: Even when controlling for comorbidities, patients undergoing TEA for fracture have a greater likelihood of short-term complications, particularly requiring a blood transfusion. Treatment of a fracture and increased operative time were risk factors for all patients, while outpatient status was protective. Level of evidence: III. [ABSTRACT FROM AUTHOR]

The purpose of this study was to compare the joint, racket, and ball kinematics between the different levels of male tennis players in tennis serve-return at slow and high serve speeds. Thirty male tennis players were divided into an advanced group (n = 15) and an intermediate group (n = 15) based on skill level. The advanced group and intermediate group matched shake hand-grip players performed serve-receive test at the different serve speeds. Kinematic data were collected on the trunk, upper limbs, racket and ball to compare the differences between the advanced and intermediate groups at different serve speeds. At both serve speeds, the AG has faster racket speed and ball speed, and is closer to the baseline placement (p<0.05). It is characterized by a faster trunk turn, greater speed with the shoulder joint forward and outward and greater angle of wrist flexion and extension during the stroke (p<0.05), and greater speed with the forearm inward and internal rotation during the follow-through swing, at the same time, there is a difference in the angle of the racket to the ground between the advanced group and an intermediate group(p<0.05). Elbow internal rotation and abduction angular velocity in the backswing phase, Timing of peak racket resultant velocity and Wrist extension in the stroke phase, and shoulder and elbow joint activities in the follow-through phase were significantly correlated with the ball speed of the return. With faster serve speeds, higher quality serve-receive can be achieved by shortening the duration of the backswing lifting the upper arm and rotating the forearm inward quickly, accelerating the speed of movement of wrist joints at the impact phase, adjusting the speed of shoulder adduction and elbow internal rotation to complete the follow-through swing. These findings help to improve elite players' serve-receive skills at faster serve speed. [ABSTRACT FROM AUTHOR]

Evaluating complicated stress across the elbow under joint motion remains difficult. Here, we aimed to evaluate the distribution of the subchondral bone density in the normal elbow bones and further characterize their spatial relationships during elbow motion to estimate the loading stress across the articular surface using three-dimensional computed tomography bone models. The normal elbow joint exhibited a consistent distribution pattern of subchondral bone density. High-density regions were distributed in the capitellum and posterior humeral trochlea, sagittal ridge of the ulnar trochlear notch and ulnar-volar side of the radial head. Motion analyses revealed that the high-density regions proximate with elbow flexion with forearm pronation in the radiocapitellar joint and in the fully extended position in the ulnohumeral joint. This reasonably reflects the stress acting on the joint surface under actual loading conditions. These findings suggest that daily activities involving lifting or carrying objects in these positions are stress-prone activities. [ABSTRACT FROM AUTHOR]

Objective: To explore whether anterior transposition of the ulnar nerve is necessary in patients with post-traumatic elbow stiffness. Method: This was a retrospective study of 177 patients with post-traumatic elbow stiffness treated at Shandong Provincial Hospital from 1 January 2012 to 31 October 2022. Sixty-one patients presented with ulnar nerve symptoms, and 116 patients had no nerve symptoms. Outcomes between patients with and without symptoms were compared using a range of clinical measures, namely range of motion (ROM), ulnar nerve symptoms, and various standardized scoring systems, namely, the Mayo Elbow Performance Score (MEPS), visual analog scale (VAS), improved Broberg and Morrey Score (BMS), Quick disabilities of the Arm, Shoulder, and Hand (DASH) score, Oxford Elbow Score (OES), and Amadio score. Results: Open elbow release surgery significantly improved elbow joint function in patients with post-traumatic elbow stiffness, regardless of the presence of ulnar nerve symptoms. Patients with ulnar nerve symptoms showed significant improvement after anterior transposition compared with in situ release. For patients without ulnar nerve symptoms, there was no significant difference in outcomes between the two types of ulnar nerve surgery. Conclusion: Anterior transposition of the ulnar nerve is preferable for patients with ulnar nerve symptoms, while the choice between anterior transposition and in situ release can be individualized for patients without symptoms, based on intraoperative findings. [ABSTRACT FROM AUTHOR]

Objectives: We evaluate the presence of sensitization-associated symptoms and neuropathic pain features and identify if there is an association between these symptoms and pressure pain sensitivity, pain, and related-disability in lateral elbow tendinopathy. Methods: Thirty-seven (43% women, age: 45.5 ± 9.5 years) patients with lateral elbow tendinopathy completed: demographic (i.e. age, height, and weight); clinical (i.e. pain history, pain intensity, and Disabilities of the Arm, Shoulder and Hand); and psychophysical (i.e. pressure pain thresholds at the elbow, cervical spine, hand, and leg) outcomes, and the Central Sensitization Inventory and Self-administered Leeds Assessment of Neuropathic Symptoms and Signs questionnaires. Step-wise multiple linear regression models were performed to identify predictors of sensitization- or neuropathic-associated symptoms. Results: Six (16%) patients exhibited sensitization-associated symptoms (mean: 46.5, SD: 6.1), whereas 13 (35%) patients showed neuropathic-associated symptoms (mean: 13.5; SD: 1.4). Sensitization-associated symptoms were positively associated with neuropathic-associated symptoms (r = 0.538, P =.001) and negatively associated with pressure pain thresholds at the leg (r = -0.378, P =.021). Neuropathic-associated symptoms were positively associated with related-disability (r = 0.479, P =.003) and negatively associated with pressure pain threshold at the elbow (r = -0.394, P =.017). Stepwise regression analyses revealed that neuropathic-like symptoms explained 26.8% of the variance of sensitization symptoms (r2: 0.268), whereas pressure pain threshold at the elbow explained an additional 6.6% to neuropathic-like symptoms (r2: 0.334). Conclusion: This explorative study identified sensitization- and neuropathic-associated symptoms in 16% and 35% of the people with lateral elbow tendinopathy. Sensitization- and neuropathic-associated symptoms were associated. Pressure pain sensitivity at the elbow (peripheral sensitization) was associated with neuropathic -associated symptoms. [ABSTRACT FROM AUTHOR]

This study assessed whether symptoms of muscle damage could be reduced by a combination of therapeutic ultrasound and electrical stimulations, and whether this could be enhanced by blood flow restriction. Before and 48 h after performing eccentric elbow flexion exercises, individuals completed assessments of muscle damage. A 10-min therapeutic ultrasound and electrical stimulation treatment was then applied with and without blood flow restriction to assess short (5 min) and long-term (24 h) improvements. Twenty-three individuals completed the study (11 females). Data were analysed using Bayesian repeated measures ANOVAs. The damaging exercise increased discomfort (BF10 = 2.93e14) and relaxed joint angle (BF10 = 2425.90) while decreasing pain pressure threshold (BF10 = 289.71). Each of these variables was acutely improved with the combination treatment protocol (all BF10 ≥ 74) with no added effect of blood flow restriction. A combination of therapeutic ultrasound and interferential electrical stimulations appeared effective at acutely alleviating symptoms of muscle damage with no additive effect of blood flow restriction. [ABSTRACT FROM AUTHOR]

The article from the Queensland History Journal explores the experiences of the Fryer family during World War I, focusing on the four Fryer brothers: William, Charles, Henry, and John Denis. It delves into their enlistment, service, injuries, and post-war lives, highlighting the impact of the war on their family. The article also draws parallels with contemporary conflicts, emphasizing the sacrifices made by young individuals in conflicts around the world. Through personal stories and historical records, the article sheds light on the human cost of war and the importance of preserving memories and experiences. [Extracted from the article]

Objective: Rare disease Background: Osteochondroma is the most common bone tumor and is a surface bone lesion that includes cortical and medullary bone with a hyaline cartilage cap. Benign osteochondroma is a common tumor in children that may be asymptomatic but can cause pain and limit joint movement when arising in a joint. This report describes the presentation, diagnosis, and management of an intra-articular osteochondroma of the right elbow joint in an 8-year-old boy. Case Report: An 8-year-old boy experienced persistent right elbow pain and limited motion, which were unresponsive to conservative measures. Examination revealed a firm swelling in the right cubital fossa. Radiographic and advanced imaging confirmed an osteochondroma originating from the capitellum and trochlea. Surgical exploration via a lateral approach and capsulotomy excised a lobulated intra-articular mass (5×2×1.5 cm). Histopathology showed a hyaline cartilage cap with typical chondrocytes and endochondral ossification, and normal fatty marrow and hematopoietic elements in the stroma. The procedure restored normal elbow function. This case is the first documented instance of an elbow joint intra-articular osteochondroma. Conclusions: This report has highlighted the importance of surgical removal and histopathology in the diagnosis of this common bone lesion to exclude the differential diagnoses of intra-articular masses that include a foreign body, enchondroma, chondroblastoma, periosteal chondroma, chondromyxoid fibroma, or malignant chondrosarcoma. [ABSTRACT FROM AUTHOR]

This study aimed to explore the differences in joint kinematic characteristics and stroke effect between fast and slow strokes of table tennis players. Thirty-four table tennis players were randomly selected as participants for this experiment. A high-speed infrared motion capture system was used to collect kinematic data of the right-side upper and lower limb joints during strokes. Simultaneously, a high-speed camera was used to measure the stroke effect. According to the duration of a stroke, the stroke data were classified into two types: fast-stroke and slow-stroke using a two-step clustering algorithm. The duration of the three phases of fast-stroke was shorter, with faster ball speed and stronger spin. Compared with slow-stroke, fast-stroke exhibited shorter displacements in the three lower limb joints and faster linear velocities in the three upper limb joints. In addition, the motion angles of the knee and ankle joints were smaller, while the angles of the hip, shoulder, and elbow joints were larger, with higher angular velocities. Increasing the extension speed of the lower limbs, the flexion speed of the elbow joints, and the wrist movement speed can achieve fast strokes, enhancing ball speed and spin. Small and quick hip joint movement can effectively transfer energy to the upper limbs, increasing the movement speed of the elbow and wrist joints, thus improving the ball speed and spin of the stroke. [ABSTRACT FROM AUTHOR]

The underwater manipulator is a versatile tool commonly used for various underwater operations. In this study, we developed a heavy-duty hydraulic manipulator capable of operating at full ocean depth. The overall system design integrates both the mechanical structure and the electric control system. The master arm controls the slave arm by transmitting control signals to the controller and valve box. The structural design of the elbow and wrist joints has been optimized to enhance the manipulator's underwater performance and operational range. Laboratory tests demonstrated the manipulator’s excellent response consistency and tracking capability across a wide range of motion. During sea trials in the Mariana Trench, the manned submersible Fendouzhe successfully deployed the manipulator, showcasing its exceptional ability to complete complex tasks. [ABSTRACT FROM AUTHOR]

The aim of the study was to determine the differences between tennis players and untrained peers in the development of upper limb proprioception in 10–15-year-olds. A group of 67 girls (12.75 ± 1.46 years old), including 33 tennis players and 34 age-matched untrained controls, was divided into three age groups: A1, 10–11-years-old; A2, 12–13-years-old; and A3, 14–15-years-old. Joint position sense (JPS) and force sense (FS) were assessed by reproducing memorized target angle or torque value of three joints: glenohumeral, elbow, and radiocarpal. The JPS error for the elbow joint in group A1 was 71% and 80% higher (p < 0.01) than that in groups A2 and A3, respectively, and the performance of all tennis players was 27.5% (p = 0.01) better than that of untrained controls. For FS, proprioception of only the more demanding task tested (reproduction of 50% maximal voluntary contraction) and specific function (elbow and radiocarpal extension, and glenohumeral internal rotation) showed development with age. The error values for elbow extension (A1, A2) and the glenohumeral joint (A3) of tennis players were lower than those of age-matched controls. We conclude that the development of FS in the upper limb varied and was related to the specific functions and joints. The 10–13-year-old tennis players showed elbow extensor FS performance at the level of the older participants, while the 14–15-year-old tennis players were characterized with superior FS internal rotation performance in the glenohumeral joint. [ABSTRACT FROM AUTHOR]

The primary aims of the study were to perform a descriptive analysis of hitting energetics off a pitching machine and to compare between the rear- and lead-side lower and upper extremities. Eighty-five high school to minor league baseball athletes participated. Five full-effort swings off a pitching machine with the fastest exit velocity were used for analysis. Energy flow was quantified using a segment power analysis. Wilcoxon signed-rank test revealed significant differences between rear- and lead-side energetics during both swing phases. During the stride, the rear knee and shoulder generated more energy than the lead side. Throughout the swing phase the lead knee, hip, and elbow generated more energy than the rear side, but at the shoulder the rear side generated significantly more energy than the lead. Most intriguing, differing energy transfer directions between the rear and lead knee and shoulder joints were reported. Furthermore, descriptive results revealed energy is predominantly transferred across the knee, shoulder, and elbow joints, while the hips primarily display energy generation. The descriptive nature of the study provides a foundation for future research and can be used as a resource for training personnel to design effective training protocols aimed at maximizing performance. [ABSTRACT FROM AUTHOR]

Background: Terrible triad of the elbow (TTE) is a complex dislocation associating radial head (RH) and coronoid process (CP) fractures. There is at present no reproducible anatomic model for TTE, and pathophysiology is unclear. The main aim of the present study was to create and validate an anatomic model of TTE. Secondary objectives were to assess breaking forces and relative forearm rotation with respect to the humerus before dislocation. Methods: An experimental comparative study was conducted on 5 fresh human specimens aged 87.4 ± 8.6 years, testing 10 upper limbs. After dissection conserving the medial and lateral ligaments, interosseous membrane and joint capsule, elbows were reproducibly positioned in maximal pronation and 15° flexion, for axial compression on a rapid (100 mm/min) or slow (10 mm/min) protocol, applied by randomization between the two elbows of a given cadaver, measuring breaking forces and relative forearm rotation with respect to the humerus before dislocation. Results: The rapid protocol reproduced 4 posterolateral and 1 divergent anteroposterior TTE, and the slow protocol 5 posterolateral TTE. Mean breaking forces were 3,126 ± 1,066 N for the lateral collateral ligament (LCL), 3,026 ± 1,308 N for the RH and 2,613 ± 1,120 N for the CP. Comparing mean breaking forces for all injured structures in a given elbow on the rapid protocol found a p-value of 0.033. Comparison of difference in breaking forces in the three structures (LCL, RH and CP) between the slow and rapid protocols found a mean difference of -4%. Mean relative forearm rotation with respect to the humerus before dislocation was 1.6 ± 1.2° in external rotation. Conclusions: We create and validate an anatomic model of TTE by exerting axial compression on an elbow in 15° flexion and maximal pronation at speeds of 100 and 10 mm/min. [ABSTRACT FROM AUTHOR]

Introduction. Bone metastases occurring distally to the elbow or knee joint are called acrometastases. Acrometastases make up only 0.1% of all bone metastases, but only 0.007% to 0.3% occur in the bones of the foot or hand. In 10% of patients, bone metastases occur as the first sign of a previously undiagnosed primary tumor. Case report. A 64-year-old male reported to the hospital due to painful swelling and redness of the fifth finger of the dominant hand. Osteolysis of the proximal phalanx of the fifth finger was diagnosed radiographically. A working diagnosis of osteomyelitis and phlegmon of the proximal phalanx was made. After incisional drainage, a tumor mass was observed intraoperatively. Amputation of the finger was performed at the level of the metacarpophalangeal joint. Pathohistological analysis revealed squamous cell carcinoma metastasis. After a computed tomography scan and bronchoscopy with biopsy, a diagnosis of squamous cell carcinoma of the bronchus was made. The patient was given chemotherapy. During the application of the second cycle, there was a fatal outcome. Conclusion. Pathohistological verification and determination of the location of the primary tumor are important when acrometastasis is found because starting novel immunotherapy and targeted therapy in a timely manner could change the median survival of these patients. [ABSTRACT FROM AUTHOR]

Motorised arm supports for individuals with severe arm muscle weakness require precise compensation for arm weight and elevated passive joint impedance (e.g., joint stiffness as a result of muscle atrophy and fibrosis). Estimating these parameters in vivo, along with the arm's centre of mass, is challenging, and human evaluations of assistance can be subjective. To address this, a dummy arm was designed to replicate the human arm's anthropometrics, degrees of freedom, adjustable segment masses, and passive elbow joint impedance (eJimp). This study presents the design, anthropometrics, and verification of the dummy arm. It successfully mimics the human arm's range of motion, mass, and centre of mass. The dummy arm also demonstrates the ability to replicate various eJimp torque-angle profiles. Additionally, it allows for the tuning of the segment masses, centres of mass, and eJimp to match a representative desired target population. This simple, cost-effective tool has proven valuable for the development and verification of the Duchenne ARm ORthosis (DAROR), a motorised arm support, or 'exoskeleton'. This study includes recommendations for practical applications and provides insights into optimising design specifications based on the final design. It supplements the CAD design, enhancing the dummy arm's application for future arm-assistive devices. [ABSTRACT FROM AUTHOR]

Background: Softball pitchers frequently pitch at high volumes. Previous research has demonstrated changes in mechanics, range of motion, and perceived levels of fatigue and pain at high workloads. To date, little research has assessed changes in kinetics at high workloads across pitch types to understand the injury risk. Purpose: To examine changes in peak kinetics of the shoulder, elbow, and wrist of the pitching arm throughout a simulated game and doubleheader inning. Study Design: Descriptive laboratory study. Methods: A total of 19 high school softball pitchers (mean age, 15.1 ± 1.5 years; mean height, 1.6 ± 0.2 m; mean weight, 76.3 ± 16.9 kg) participated. Pitchers threw 4 innings of 25 randomly assigned pitches to mimic a game's high pitch count. Participants then rested for 30 minutes before subsequently proceeding to pitch the first inning of a doubleheader. Each pitcher threw a fastball, drop ball, curveball, and changeup. Peak shoulder, elbow, and wrist kinetics were compared across the first, last, and doubleheader innings and pitch types. Results: Compared with the first inning, significant decreases in kinetics were observed at the shoulder, elbow, and wrist in the last (P <.016) and doubleheader (P <.016) innings, particularly for shoulder and elbow compression force during the drop ball and curveball pitch types and wrist net force for all pitch types but the changeup. Significant decreases in elbow and wrist kinetics were observed during the changeup between the last and doubleheader innings (P <.016). Furthermore, differences in kinetics were observed between pitch types (P <.008); notably, the changeup had reduced kinetics compared with the fastball and breaking ball pitch types (drop ball, curveball) across innings. Conclusion: Across innings, attenuations in select joint kinetics of the pitching arm occurred that were specific to the pitch type. Across pitch types, peak kinetics was often greater during the fastball, while the changeup displayed the lowest peak kinetics. Clinical Relevance: The joints examined in this study are common sites of overuse injuries in pitchers. This work adds to previous findings on decrements in neuromuscular function as well as self-reported fatigue and pain with tournament-style pitching that may increase the injury risk. Collectively, these findings support developing a protocol combining functional testing and player-reported outcomes to aid sports specialists' decisions for pitchers to continue to pitch or return to play, which may help prevent musculoskeletal injuries and time loss from sports participation. [ABSTRACT FROM AUTHOR]

Pathological gait in patients with Hakim's disease (HD, synonymous with idiopathic normal-pressure hydrocephalus; iNPH), Parkinson's disease (PD), and cervical myelopathy (CM) has been subjectively evaluated in this study. We quantified the characteristics of upper and lower limb movements in patients with pathological gait. We analyzed 1491 measurements of 1 m diameter circular walking from 122, 12, and 93 patients with HD, PD, and CM, respectively, and 200 healthy volunteers using the Three-Dimensional Pose Tracker for Gait Test. Upper and lower limb movements of 2D coordinates projected onto body axis sections were derived from estimated 3D relative coordinates. The hip and knee joint angle ranges on the sagittal plane were significantly smaller in the following order: healthy > CM > PD > HD, whereas the shoulder and elbow joint angle ranges were significantly smaller, as follows: healthy > CM > HD > PD. The outward shift of the leg on the axial plane was significantly greater, as follows: healthy < CM < PD < HD, whereas the outward shift of the upper limb followed the order of healthy > CM > HD > PD. The strongest correlation between the upper and lower limb movements was identified in the angle ranges of the hip and elbow joints on the sagittal plane. The lower and upper limb movements during circular walking were correlated. Patients with HD and PD exhibited reduced back-and-forth swings of the upper and lower limbs. [ABSTRACT FROM AUTHOR]

The list of standard abbreviations for JDS is available at adsa.org/jds-abbreviations-24. Nonstandard abbreviations are available in the Notes. The aim of this study was to evaluate the effect of hoof trimming on overall limb movements by comparing the changes in 8 limb joint angles 1 wk before and 1 wk after hoof trimming. Seventeen Holstein-Friesian dairy cows that were able to move freely and had no history of hoof diseases were included in the study. The cows were walked on rubber mats with a high friction coefficient (HFM) and a low friction coefficient (LFM) due to the spraying of sodium polyacrylate. Each cow had 15 reflective markers applied to its right side. A high-speed camera was set to 200 frames per second (fps) on the image analysis software, and the images of the cows were captured while cows walked on the test mat. The tests were conducted 1 wk before and 1 wk after hoof trimming, and the cows were trimmed by the functional hoof trimming method. With image analysis software, video clips of walking cows were confirmed visually and tracked during 1 gait cycle by each reflective marker attached to the hoof of the forelimb and hindlimb, after which the stance phase and swing phase were identified. The durations of the stance phase and swing phase of the forelimb and hindlimb, respectively, and the maximum, minimum, and range of motion (ROM) values of the 8 joint angles (shoulder joint, elbow joint, carpus joint, forelimb fetlock joint, hip joint, stifle joint, hock joint, and hindlimb fetlock joint) during 1 gait cycle were included in the analysis. The maximum and minimum angles of the hip and stifle joints were narrower after hoof trimming than before, although the ROM did not change and was clearer for HFM than for LFM. It was thought that the flexion of the proximal hindlimb would progress smoothly during walking after trimming. [ABSTRACT FROM AUTHOR]

The Late Oligocene is a period of high penguin diversity, following major changes in the marine environment at the Eocene/Oligocene boundary and prior to the emergence of crown penguins in the Miocene. Historically, a large morphological gap existed between the most crownward Platydyptes among the Oligocene penguins from New Zealand and the Early Miocene stem penguins such as Palaeospheniscus from South America. Here we describe a new species that contributes to filling this gap. Pakudyptes hakataramea gen. et sp. nov. is the earliest tiny penguin, overlapping in size with the little penguin Eudyptula minor. Its distinctive combination of a well-developed proximal end of the humerus and an archaic elbow joint provides clues to the evolution of penguin wings. Phylogenetic analysis indicates that penguin wings evolved rapidly from the Late Oligocene to the Early Miocene, together with the acquisition of morphofunctional and hydrodynamical characteristics that enable the excellent swimming ability of modern penguins. As an indicator of aquatic adaptation, bone microanatomy shows a comparable structure to that of Eudyptula. The appearance of the smallest body size and the evolution of modern wings may have led to the ecological diversity of modern penguins, which confirms the importance of Zealandia in penguin evolution. [ABSTRACT FROM AUTHOR]

Throwing events such as discus, shot put, and javelin involve repetitive and explosive overhead activities in a short period, which increases the risk of upper extremity injuries. Furthermore, the available data on seated throwers are inadequately documented. Thus, this study aims to (1) describe the muscle strength profiles of shoulder external and internal rotators and the elbow flexors and extensors in seated throwers, and (2) identify the differences in muscle strength between seated throwers competing at international levels and those at national levels. Twenty-one seated throwers participated in this study, including twelve at the international level and nine at the national level. We conducted isokinetic shoulder strength tests for shoulder internal rotation (IR), shoulder external rotation (ER), elbow flexion (EF), and elbow extension (EE) on the dominant side of the para-athletes using a Biodex isokinetic dynamometer at speeds of 60°/s and 300°/s. An independent t -test was utilized to assess the differences between international and national-level para-athletes. Except for total work (TW) at 60°/s and average power (AP) at 300°/s, the IR variables of the international group were significantly higher than those of the national group (p < 0.001). Additionally, some EF variables of the international group, including peak torque (PT) and TW at 60°/s, and PT, AP, and TW at 300°/s, were higher than those of the national group (p < 0.05, p < 0.01). The findings of this study are important for developing training programs, enhancing performance, and preventing injuries among seated throwers. [ABSTRACT FROM AUTHOR]

Background/Objectives: Periprosthetic joint infection (PJI) is one of the most common complications after joint replacement. Two-stage revision remains the standard of care in chronic infections. The aim of this systematic review was to investigate the outcomes, complications, and eradication rates of two-stage revision surgery to treat PJI of the shoulder, elbow, hip, and knee. Methods: A total of 36 studies were included. Patient demographics, follow-up, the visual analog scale (VAS) for pain, the Constant–Murley score (CMS) for shoulder, the Harris Hip Score (HHS) for hip, the Knee Society Score (KSS) for knee, the range of motion (ROM), number and types of complications, and eradication rate were recorded. Results: A total of 2484 patients were identified, of whom 145, 29, 1269, and 1041 underwent two-stage revision surgery for shoulder, elbow, hip, and knee infections, respectively. The overall mean follow-up was 5.7 ± 4.5 years. The overall mean time of re-implantation was 20.8 ± 21.3 weeks. The most common causative bacteria were Cutibacterium acnes (32.7%) for shoulder, Methicillin-Sensitive Staphylococcus aureus (44.4%) for elbow, and Staphylococcus coagulase negative (CNS) (31.3% and 23%) for hip and knee infection, respectively. The mean overall preoperative VAS score was 6.7 ± 2.3, while, postoperatively, the mean score was 4.5 ± 2.7 (p < 0.001). A total of 2059 out of 2484 patients (82.9%) experienced eradication. Conclusions: Two-stage revision is an effective procedure to treat PJI with an overall eradication rate of 83%. A significant recovery of functionality and a decrease in residual pain can be achieved after surgery. Aseptic loosening and re-infection were the most common complications in shoulder and hip infections. Death rate was high in knee infections. [ABSTRACT FROM AUTHOR]

Background: Growth-specific physical characteristics in adolescence may mediate throwing-related loads and movement patterns associated with elbow injuries. In a previous study, the authors calculated the forearm-hand inertia, which is the moment of inertia centered at the elbow joint. Purpose: To determine the relationship of forearm-hand inertia values with throwing motion patterns and elbow valgus load in adolescent baseball players. Study Design: Descriptive laboratory study. Methods: A total of 35 adolescent baseball players underwent measurements by dual-energy x-ray absorptiometry (DXA) scans and a throwing trial. Forearm-hand inertia was determined as the joint moment around the elbow using the subregion analysis mode of DXA. Elbow valgus torque and ball speed during throwing were measured using a dedicated sensor and speed gun, and throwing efficiency was calculated by dividing the elbow valgus load by the ball speed. Players were divided according to the throwing motion pattern in which maximum acceleration occurred: pelvis–upper arm–forearm (proximal-to-distal sequencing [PDS] group; n = 19) or pelvis-forearm–upper arm (proximal upper extremity [PUE] group; n = 16). The groups were compared in terms of ball speed, elbow valgus torque, throwing efficiency, and forearm-hand inertia using t tests and analysis of covariance, with forearm-hand inertia as covariates. The chi-square test was used to examine the relationship between throwing motion patterns and forearm-hand inertia. Results: The PUE group had a higher elbow valgus load (effect size [ES] = 0.65; P =.03), throwing efficiency (ES = 0.63; P =.02), and forearm-hand inertia values (ES = 0.64; P =.04) than the PDS group. In addition, a significant relationship was observed with throwing patterns when forearm-hand inertia values were 350 kg·m2 (OR, 2.36; 95% CI, 1.09-5.12; P =.012) and 400 kg·m2 (OR, 1.68; 95% CI, 0.99-2.85; P =.037). Conclusion: Study results indicated that growth-specific physical characteristics in adolescent baseball players exhibited in forearm-hand inertia mediated the relationship between high elbow valgus and poor throwing efficiency caused by poor throwing motion patterns. Clinical Relevance: A better understanding of the details in muscle function with throwing mechanics may prevent future injuries. [ABSTRACT FROM AUTHOR]

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Purpose: To investigate the clinical efficacy of endoscopic debridement combined with compression suture in the treatment of aseptic olecranon bursitis. Methods: A retrospective analysis was conducted on 28 patients, including 25 males and 3 females, who underwent endoscopic debridement combined with compression suture for the treatment of aseptic olecranon bursitis at Huzhou Central Hospital from February 2017 to January 2024. Visual analogue scale (VAS) scores, Mayo elbow function scores, complications, recurrence rates and wound scars were evaluated to assess the treatment efficacy. Results: The average follow-up time was 12 ± 5 months (range: 5–22 months). The VAS score was slightly greater on postoperative day 1 than preoperatively, but this difference was not statistically significant. Compared with the preoperative level, the VAS score was significantly lower at 2 weeks post-surgery, and the patients were generally free of pain. The patients' Mayo elbow function score was significantly improved at 2 weeks after the operation, and their elbow function was generally normal at 1 month after the operation. At the final follow-up, no recurrence or obvious scarring was found in any of the patients, and all of them exhibited normal elbow function without any reported pain. Conclusion: Endoscopic debridement combined with compression suture for the treatment of aseptic olecranon bursitis has several advantages: simple operation, minimal invasiveness, minimal postoperative pain, rapid recovery, a low recurrence rate, and satisfactory overall efficacy. Level of evidence Level IV [ABSTRACT FROM AUTHOR]

Background: Ehlers-Danlos syndrome (EDS) is a hereditary disease characterised by joint hypermobility, skin hyperextensibility and tissue fragility. Hypermobile EDS (hEDS is the more frequent subtype. Joint surgery may benefit certain patients after failure of medical treatments, but there is no consensus on the optimal surgical management of patients with hEDS. The aims of this retrospective study were to chart the surgical management of patients with hEDS, to determine the role of arthroscopy and to evaluate the functional results of joint surgery, including the reintervention rates. Results: A total of 69 patients with non-vascular EDS were evaluated (60 female; 87%). Mean (SD) age at first surgery was 25.6 ± 11.1 years. Among the 69 patients, first surgeries were carried out on the knee (n = 50; 39.4%), ankle (n = 28; 22.0%), shoulder (n = 22; 17.3%), wrist (n = 18; 14.2%) and elbow (n = 9; 7.1%). One-fifth of all first operations (20.8%) were carried out by arthroscopy, most often on the knee (36% of knee surgery cases). At the time of primary surgery, the surgeon was alerted to the diagnosis or suspicion of hEDS in only 33.9% of patients. The rate of reoperations (2 to ≥ 5) was 35.7% (10/28) for the ankle, 40.9% (9/22) for the shoulder, 44.4% (4/9) for the elbow, 50% (9/18) for the wrist and 60% (30/50) for the knee. Local or regional anaesthesia was badly tolerated or ineffective in 27.8%, 36.4% and 66.6% of operations on the wrist, shoulder and elbow, respectively. Overall, the majority of patients (> 70%) were satisfied or very satisfied with their surgery, particularly on the non-dominant side. The lowest satisfaction rate was for shoulder surgery on the dominant side (58.3% dissatisfied). Conclusions: Surgery for joint instability has a greater chance of success when it is carried out in patients with a known diagnosis of EDS before surgery. The majority of patients were satisfied with their surgery and, with the exception of the knee, there was a low rate of reoperations (≤ 50%). Arthroscopic procedures have an important role to play in these patients, particularly when surgery is performed on the knee. [ABSTRACT FROM AUTHOR]

Objective: Rare disease Background: Chronic nonbacterial osteomyelitis (CNO) is a multifocal autoinflammatory bone disease mainly affecting children and adolescents. Sacroiliitis is an inflammation of the sacroiliac joint, diagnosed with the use of musculoskeletal MRI due to its ability to visualize active inflammatory lesions. Ehlers-Danlos syndrome (EDS) is non-inflammatory hereditary disorder of connective tissue. Here, we report the case of a 17.5-year-old female patient with classical EDS and long-term course of the CNO with coexistence of sacroiliac arthritis. Case Report: On admission, a patient with CNO reported pain in the scapula, thoracic spine, shoulders, and iliac region, with morning stiffness present for 5 months. Physical examination revealed knee and elbow joint hyperextension, hypermobility of the phalanges, increased range of motion of the hip joints, and the presence of reticular rash on the face. In the laboratory blood tests, minor leukocytosis was reported. During hospitalization, a whole-body MRI was performed, detecting bone marrow edema in the Th3, Th4, and Th7 vertebral bodies and the head of seventh rib on the left side, as well as bilaterally in the sacroiliac joints. The patient was diagnosed with sacroiliitis and EDS and successfully treated with risedronate sodium, methotrexate with folic acid, sulfasalazine, and meloxicam, achieving CNO remission and reduced severity of axial skeleton pain. Conclusions: The coexistence of these 3 diseases – CNO, sacroiliac arthritis, and EDS – in the same patient is rare and requires interphysician collaboration to determine the correct diagnosis and subsequently arrange multi-speciality therapeutic management to achieve remission. [ABSTRACT FROM AUTHOR]

Background: To explore an artificial intelligence (AI) technology employing YOLOv8 for quality control (QC) on elbow joint radiographs. Methods: From January 2022 to August 2023, 2643 consecutive elbow radiographs were collected and randomly assigned to the training, validation, and test sets in a 6:2:2 ratio. We proposed the anteroposterior (AP) and lateral (LAT) models to identify target detection boxes and key points on elbow radiographs using YOLOv8. These identifications were transformed into five quality standards: (1) AP elbow positioning coordinates (XA and YA); (2) olecranon fossa positioning distance parameters (S17 and S27); (3) key points of joint space (Y3, Y4, Y5 and Y6); (4) LAT elbow positioning coordinates (X2 and Y2); and (5) flexion angle. Models were trained and validated using 2,120 radiographs. A test set of 523 radiographs was used for assessing the agreement between AI and physician and to evaluate clinical efficiency of models. Results: The AP and LAT models demonstrated high precision, recall, and mean average precision for identifying boxes and points. AI and physicians showed high intraclass correlation coefficient (ICC) in evaluating: AP coordinates XA (0.987) and YA (0.991); olecranon fossa parameters S17 (0.964) and S27 (0.951); key points Y3 (0.998), Y4 (0.997), Y5 (0.998) and Y6 (0.959); LAT coordinates X2 (0.994) and Y2 (0.986); and flexion angle (0.865). Compared to manual methods, using AI, QC time was reduced by 43% for AP images and 45% for LAT images (p < 0.001). Conclusion: YOLOv8-based AI technology is feasible for QC of elbow radiography with high performance. Relevance statement: This study proposed and validated a YOLOv8-based AI model for automated quality control in elbow radiography, obtaining high efficiency in clinical settings. Key Points: QC of elbow joint radiography is important for detecting diseases. Models based on YOLOv8 are proposed and perform well in image QC. Models offer objective and efficient solutions for QC in elbow joint radiographs. [ABSTRACT FROM AUTHOR]

Featured Application: We found that more students could reproduce therapeutic movement techniques by practicing with a robot that simulates the patient's pathological movements than by performing simulation exercises with other students. These results suggest that the use of simulation robots that can reproduce the pathological movements of patients may be effective in teaching therapeutic movement techniques. Furthermore, we believe that it is an effective new learning method for therapeutic movement techniques considering interpersonal infections. We aimed to compare the effects of practical learning using an educational robot arm (Samothrace: SAMO) and a student simulating a patient in students' acquisition of therapeutic motion techniques. For this study, twenty-five fourth-year students and eight therapists were included. Students were randomly assigned to the robot practice (Robo) group (n = 13) or conventional practice (Human) group (n = 12), wherein students practiced among themselves. The experimental procedure comprised a pre-practice test, practice, and post-practice test. We calculated the peak angle ratio, peak velocity, and movement time during flexion and extension using the elbow joint angle data. Machine learning was performed on students' pre-practice and used therapists' data to create identifiers that distinguish students and therapists to determine whether the students' skills improved to the level of a therapist. However, regarding other kinematics data, there were no main effects or interactions between groups pre- and post-practice. Identifiers were created from machine learning of kinematics data pre-practice, and the effect was evaluated post-practice. A higher number of students in the Robo group were determined to possess skills at a therapist's level. This study suggests the effectiveness of a simulation robot that can reproduce a patient's pathological motions in educating students on upper limb exercise therapy. [ABSTRACT FROM AUTHOR]

Purpose: The primary aim of the present study was to assess the prevalence of chronic lesions of the central band of the interosseous membrane (cbIOM) in complex elbow instability (CEI) in a consecutive series of patients who had previously undergone surgical treatment for Mason II and III radial head (RH) fractures. The secondary aim was to define its clinical significance. Methods: We performed a retrospective study on a prospective database. Our study population comprised 93 patients affected by CEI with type II or III RH fractures according to Mason's classification who were analyzed in the chronic setting. All patients were treated according to the current therapeutic algorithms. At the last follow-up, the "muscular hernia sign" was investigated by means of a bilateral ultrasonographic examination to assess any chronic cbIOM lesions; the Mayo Elbow Performance Score (MEPS) was used to evaluate the clinical significance of these lesions. Results: All 93 patients were assessed after a mean time of 7.3 years (range: 2–12). No positive "hernia signs" were found, while five patients (5.4%) displayed an increased laxity of the cbIOM when compared with the contralateral side despite a negative "hernia sign". The clinical outcome in all five patients was excellent with a mean MEPS of 96 (range, 90–100). Conclusions: Chronic cbIOM lesions are very rare in CEI with RH fractures. No patients in this large sample displayed a cbIOM complete lesion; in cases with increased laxity, satisfactory mid-term clinical results were observed. Considering that previous studies reported (1) a high prevalence of cbIOM lesions in patients with Mason II and III RH fractures and (2) the current expert opinion about the scarce healing potential of the cbIOM, this study also suggests that the IOM may heal better than previously believed when RH fractures are treated appropriately in the acute setting. [ABSTRACT FROM AUTHOR]

Plate fixation is a common treatment option for radial head fractures (RHFs). Due to the benefits of less invasiveness and fewer complications of internal fixation, the application of small-diameter headless compression screws (HCSs) to treat RHFs has become a new trend. This study aimed to compare the mechanical stability of four distinct internal fixation protocols for transversely unstable RHFs via finite element analysis. Using computed tomography data from 10 patients, we developed 40 patient-specific FE models of transversely unstable RHFs fixed by parallel, crossed, and tripod HCSs and mini-T plate (MTP). Under simulated physiological loading of the elbow joint, the construct stiffness, displacement, and von Mises stresses were evaluated and verified by a biomechanical experiment. Under shear loading, the MTP group exhibited lower construct stiffness, larger displacement, and higher Von Mises stress than the HCSs group. The stiffness of tripod HCSs was greater than parallel and crossed screw fixation techniques. There was a strong relationship between apparent bone density and construct stiffness (R = 0.98 to 0.99). In the treatment of transversely unstable RHFs, HCSs have superior biomechanical stability than MTP. The tripod technique was also more stable than parallel and crossed fixation. [ABSTRACT FROM AUTHOR]

Objective: Management of emergency care Background: Pediatric burn injuries are a global health concern, particularly in infants and toddlers, who face increased risks owing to their higher water content. Despite substantial medical treatment, the mortality rates remain challenging, especially in severe cases. This study explored non-surgical interventions for pediatric burn injuries, aiming to enhance care and alleviate the burden on affected children. Case Report: A 16-month-old boy with 30% mixed second- and third-degree burns presented with a scald injury. Initial measures included dressing and analgesia. The Plastic Surgery team led the treatment. Upon admission, the patient experienced convulsions due to hyponatremia in the burn unit and was subsequently transferred to the Pediatric Intensive Care Unit (PICU). Burn care management included the use of hyaluronic acid and occupational therapy. Scheduled dressing changes, including the use of glycerin-based dressings, resulted in satisfactory wound healing. Split skin grafting from the right thigh was performed to prevent elbow joint contracture. Preventive measures against hypertrophic scarring were also implemented. The patient was discharged after follow-up appointments. Consent for publication of case details and photographs was obtained from the patient's father. Conclusions: The presented non-surgical approach, incorporating hyaluronic acid, Bactigras, Elasto-Gel, and a multidisciplinary team, can effectively treat mixed partial- and full-thickness burn injuries in pediatric populations. Splitthickness grafts may be required in functional areas. Therefore, a comprehensive management strategy that considers tissue damage, electrolyte balance, and infection is crucial. This report underscores the importance of meticulous assessment and correction of overall patient condition, especially in pediatric cases of electrolyte imbalance. [ABSTRACT FROM AUTHOR]

Brachial artery access for coronary diagnostic or therapeutic procedures is associated with a greater risk of vascular complications. To determine whether 3D printing of a novel elbow joint fixation device could reduce postoperative complications after percutaneous coronary diagnostic or therapeutic procedures through the brachial artery. Patients who underwent percutaneous coronary diagnostic or therapeutic procedures by brachial access were randomly assigned to receive either a 3D-printed elbow joint fixation device (brace group) or traditional compression (control group) from March 2023 to December 2023. The severity of puncture site-related discomfort at 24 h postsurgery was significantly lower in the brace group (P = 0.014). Similarly, the upper arm calibration rate at 24 h postsurgery was significantly lower in the brace group [0.024 (0.019–0.046) vs. 0.077 (0.038–0.103), P < 0.001], as was the forearm calibration rate [0.026 (0.024–0.049) vs. 0.050 (0.023–0.091), P = 0.007]. The brace group had a significantly lower area of subcutaneous hemorrhage at 24 h postsurgery [0.255 (0–1.00) vs. 1 (0.25–1.75) cm2]. In patients who underwent percutaneous coronary diagnostic or therapeutic procedures by brachial access after manual compression hemostasis, the novel elbow joint fixation device was effective at reducing puncture site-related discomfort, alleviating the degree of swelling, and minimizing the subcutaneous bleeding area. Additionally, no significant complications were observed. Trial registration: China Clinical Trial Registration on 01/03/2023 (ChiCTR2300068791). [ABSTRACT FROM AUTHOR]

Medial elbow pain is a common musculoskeletal problem among individuals engaging in repetitive activities. Medial epicondylitis is the predominant cause of this pain. However, other potential causes must be considered as part of the differential diagnosis. This article discusses several etiologies of medial elbow pain, including medial epicondylitis, ulnar neuropathy, snapping triceps syndrome, ulnar collateral ligament injury, medial antebrachial cutaneous neuropathy, and diseases of the elbow joint, with an emphasis on ultrasound (US) findings. Awareness of possible diagnoses and their US features can assist radiologists in establishing a comprehensive diagnosis for medial elbow pain. [ABSTRACT FROM AUTHOR]

Background: Individual maximum joint and segment angular velocities have shown positive associations with throwing arm kinetics and ball velocity in baseball pitchers. Purpose: To observe how cumulative maximum joint and segment angular velocities, irrespective of sequence, affect ball velocity and throwing arm kinetics in high school pitchers. Study Design: Descriptive laboratory study. Methods: High school (n = 55) pitchers threw 8 to 12 fastball pitches while being evaluated with 3-dimensional motion capture (480 Hz). Maximum joint and segment angular velocities (lead knee extension, pelvis rotation, trunk rotation, shoulder internal rotation, and forearm pronation) were calculated for each pitcher. Pitchers were classified as overall fast, overall slow, or high velocity for each joint or segment velocity subcategory, or as population, with any pitcher eligible to be included in multiple subcategories. Kinematic and kinetic parameters were compared among the various subgroups using t tests with post hoc regressions and multivariable regression models created to predict throwing arm kinetics and ball velocity, respectively. Results: The lead knee extension and pelvis rotation velocity subgroups achieved significantly higher normalized elbow varus torque (P =.016) and elbow flexion torque (P =.018) compared with population, with equivalent ball velocity (P =.118). For every 1-SD increase in maximum pelvis rotation velocity (87 deg/s), the normalized elbow distractive force increased by 4.7% body weight (BW) (B = 0.054; β = 0.290; P =.013). The overall fast group was older (mean ± standard deviation, 16.9 ± 1.4 vs 15.4 ± 0.9 years; P =.007), had 8.9-mph faster ball velocity (32.7 ± 3.1 vs 28.7 ± 2.3 m/s; P =.002), and had significantly higher shoulder internal rotation torque (63.1 ± 17.4 vs 43.6 ± 12.0 Nm; P =.005), elbow varus torque (61.8 ± 16.4 vs 41.6 ± 11.4 Nm; P =.002), and elbow flexion torque (46.4 ± 12.0 vs 29.5 ± 6.8 Nm; P <.001) compared with the overall slow group. A multiregression model for ball velocity based on maximum joint and segment angular velocities and anthropometrics predicted 53.0% of variance. Conclusion: High school pitchers with higher maximum joint and segment velocities, irrespective of sequence, demonstrated older age and faster ball velocity at the cost of increased throwing shoulder and elbow kinetics. Clinical Relevance: Pitchers and coaching staff should consider this trade-off between faster ball velocity and increasing throwing arm kinetics, an established risk factor for elbow injury. [ABSTRACT FROM AUTHOR]

BACKGROUND In this study we aim to compare two regional Anaesthesia techniques - the axillary brachial plexus block and Bier’s Block intravenous regional anesthesia (IVRA), with respect to the onset of analgesia, degree of sensory and motor blockade, duration of analgesia, and complications. MATERIALS AND METHODS The study was conducted on patients who were admitted to SVRRGGH, Tirupati for elective and urgent procedures of the upper limb below the elbow. In the current study, 60 patients were randomized into two groups of 30 patients each. Group I received an axillary brachial plexus block, while Group II received Bier’s block (IVRA). Patients were of either gender and between the ages of 18 and 50, came for either emergency or planned procedures below the elbow joint. RESULTS In comparing the duration of analgesia between the two atudy groups, the axillary block analgesia had a mean duration of 67.5 minutes while Bier's block lasted upto 46.8 minutes. CONCLUSION With regard to the onset of analgesia, the quality of the analgesia, and the degree of motor blockade, IVRA appears to be a better alternative based on the conclusions of the current study and recommendations from prior references. [ABSTRACT FROM AUTHOR]

OBJECTIVE Evaluate whether total elbow replacement (TER) through a lateral approach is accurate and stable. ANIMALS 12 skeletally mature large-breed dog cadavers were used. METHODS Limb alignment, elbow joint motion, and collateral ligament laxity were evaluated preoperatively. The order of surgery (left or right) and the approach (lateral or medial) were randomly selected for TER in each dog. The other approach was used in the contralateral elbow. Intraoperative technical difficulties, duration of surgery, and anatomic complications were recorded. Limb alignment, elbow joint motion, collateral ligament laxity, and prosthetic component alignment were evaluated after surgery. Data were collected from June 11 to 15, 2023. RESULTS The duration of surgery using a lateral or medial approach did not differ (P = .499). Anatomic complications were not observed. The lateral approach resulted in 8° more elbow extension (P = .003), 1.58° less lateral collateral ligament constraint (P = .033), 2.80° less medial collateral ligament constraint (P = .002), 4.38° less frontal plane constraint (P = .004), 8° greater humeral component inclination (P = .033), and 5.6° greater radioulnar component varus (P = .001) than the medial approach. Varus of the radius, mechanical axis deviation, limb supination, elbow flexion, mediolateral humeral component and craniocaudal radioulnar component orientation did not differ among joints operated using a lateral or medial approach. In normal cadaveric elbows, a lateral approach for TER appears feasible, producing equivalent limb alignment, joint laxity, and joint motion to normal elbows and to TER placed using a medial approach. CLINICAL RELEVANCE In dogs, TER can be performed using a lateral surgical approach. [ABSTRACT FROM AUTHOR]

Purpose: Searching for quick determinable biomarkers with high sensitivity and specificity is necessary to improve and optimise the early diagnosis of periprosthetic elbow infection (PEI). Therefore, this study's objective was to evaluate the diagnostic value of synovial fluid interleukin-6 (IL-6) levels for diagnosing PEI in total elbow arthroplasty. Method: Twelve prospective enrolled patients underwent total elbow arthroplasty revision surgery, during which synovial fluid was obtained. Between the initial implantation and the revision procedure were 33.5 ± 41 months (range, 2–144 months). Synovial fluid was collected for immediate IL-6 analysis parallel to the revision surgery. Furthermore, microbiological samples were obtained and analysed. Two groups were defined based on the microbiological results: non-infection and infection group. The ability of synovial fluid IL-6 analysis to predict infection status was explored using receiver operating characteristic curves and further statistical analysis. Results: Synovial fluid IL-6 analysis had a good diagnostic accuracy of 83% for PEI with an area under the curve of 0,79 and an ideal cutoff value (determined using Youden's criterion) of 15244 pg/mL. Discussion: This is the first study to clinically evaluate IL-6 as a diagnostical marker for periprosthetic joint infection (PJI) in total elbow arthroplasty. Our results suggest a good accuracy and high sensitivity for IL-6 to identify a PEI. The analysis of IL-6 can improve surgical decision-making regarding managing total elbow arthroplasty in terms of one- or two-staged revision. Conclusion: IL-6 can play an important role in the perioperative differentiation of infected and non-infected situations. [ABSTRACT FROM AUTHOR]

Shoulder dislocations and elbow dislocations are common presentations to the emergency department (ED). Simultaneous ipsilateral elbow and shoulder dislocations are rarely reported and typically occur secondary to trauma. A 45-year-old female presented to the ED after a fall from standing and complained of upper right extremity pain. Radiographs revealed posterior dislocation of the right elbow and anterior dislocation of the right shoulder without fractures. Successful reduction of the elbow and shoulder were both achieved, and the patient was placed in a long-arm splint and sling. This case describes the unique mechanism of injury of a simultaneous ipsilateral shoulder and elbow dislocation without trauma. [ABSTRACT FROM AUTHOR]

Performance during the baseball pitch is dependent on the flow of mechanical energy through the kinetic chain. Little is known about energy flow during the pitching motion and it is not known whether patterns of energy flow are related to pitching performance and injury risk. Therefore, the purpose of this study was to quantify energy generation, absorption, and transfer across the shoulder and elbow during the baseball pitch and explore the associations between these energetic measures, pitch speed, and traditional measures of upper extremity joint loading. The kinematics of 40 youth baseball pitchers were measured in a controlled laboratory setting. Energy flow between the thorax, humerus, and forearm was calculated using a segmental power analysis. Regression analyses revealed that pitch speed was best predicted by arm cocking phase shoulder energy transfer to the humerus and peak elbow valgus torque was best predicted by arm acceleration-phase elbow energy transfer to the forearm. Additionally, energy transfer across the shoulder and elbow generally exhibited the strongest correlations to pitch speed and upper extremity joint loads. These data reinforce the importance of energy transfer through the kinetic chain for producing high pitch speeds and provide descriptive data for energy flow during baseball pitching not previously found in the literature. [ABSTRACT FROM AUTHOR]

Background: The accuracy of decoding fine motor imagery (MI) tasks remains relatively low due to the dense distribution of active areas in the cerebral cortex. Methods: To enhance the decoding of unilateral fine MI activity in the brain, a weight-optimized EEGNet model is introduced that recognizes six types of MI for the right upper limb, namely elbow flexion/extension, wrist pronation/supination and hand opening/grasping. The model is trained with augmented electroencephalography (EEG) data to learn deep features for MI classification. To address the sensitivity issue of the initial model weights to classification performance, a genetic algorithm (GA) is employed to determine the convolution kernel parameters for each layer of the EEGNet network, followed by optimization of the network weights through backpropagation. Results: The algorithm's performance on the three joint classification is validated through experiment, achieving an average accuracy of 87.97%. The binary classification recognition rates for elbow joint, wrist joint, and hand joint are respectively 93.92%, 90.2%, and 94.64%. Thus, the product of the two-step accuracy value is obtained as the overall capability to distinguish the six types of MI, reaching an average accuracy of 81.74%. Compared to commonly used neural networks and traditional algorithms, the proposed method outperforms and significantly reduces the average error of different subjects. Conclusions: Overall, this algorithm effectively addresses the sensitivity of network parameters to initial weights, enhances algorithm robustness and improves the overall performance of MI task classification. Moreover, the method is applicable to other EEG classification tasks; for example, emotion and object recognition. [ABSTRACT FROM AUTHOR]

The distinct and specialized movements performed in different sports disciplines may significantly influence nerve performance, potentially affecting nerve responses and the overall function within the respective athletic activities. The purpose of this study is to find the effect of forearm supination and pronation across the elbow joint on ulnar and median nerve conduction velocity (NCV) in throwers, archers, and non-athletes. A total of 34 participants both male and females were recruited with a body mass index (BMI) between 18.5 and 24.9 kg/m2. Nerve conduction study (NeuroStim NS2 EMG/NCV/EP System) was used for measuring ulnar and median NCV across the elbow joint at different angles with the forearm in supination and pronation. Repeated measure analysis of variance (RMANOVA) revealed that there are statistically significant differences in mean values of forearm positions, angles, nerves and groups (p <.05). This study illuminates distinctive NCV variations across diverse athletic groups during forearm supination and pronation movements. Pronation consistently exhibited faster ulnar NCV compared to the median nerve across throwers, archers, and non-athletes, while in supination specific joint positions revealed notable differences within sports groups and nerve function. [ABSTRACT FROM AUTHOR]

Background: Humeral lateral condyle fracture is the most common elbow fracture in children after supracondylar fractures. Non-union of these fractures may cause ulnar nerve deficit, deformity and loss of joint motion, which are difficult to manage. Treatment of lateral condyle non-union can be done in two stages or one stage. However, despite all types of treatment, the chance of success is very variable. Many complications such as avascular necrosis, loss of motion, non-union, chronic pain, and heterotopic ossification have been reported as a result of surgeries performed for lateral condyle pseudoarthrosis. Objective: In this article, we applied two-stage surgical treatment to a pediatric patient who developed ulnar neuropathy and elbow valgus deformity as a result of lateral condyle non-union. Case report: A 8-year-old boy with lateral condyle nonunion presented to our clinic with pain and deformity. After initial examination, two-stage surgical treatment was planned to achieve union and deformity correction. In the first stage, we performed pseudoarthrosis surgery and ulnar nerve anterior transposition, and in the second stage, we performed elbow valgus deformity correction surgery. In three year follow-up, the range of elbow was 130/5/0 flexion/extension, with full supnation and pronation. Carrying angle was same with the opposite side. Conclusion: Pediatric humeral lateral condyle nonunions cause deformity, pain, loss of motion, instability and neuropathy. Surgical treatment of nonunions with a careful planning provide excellent clinical and functional results. [ABSTRACT FROM AUTHOR]

We tested if the movement slowness of individuals with Parkinson's disease is related to their decreased ability to generate adequate net torques and linearly coordinate them between joints. This cross-sectional study included ten individuals with Parkinson's disease and ten healthy individuals. They performed planar movements with a reversal over three target distances. We calculated joint kinematics of the elbow and shoulder using spatial orientation. The muscle, interaction, and net torques were integrated into the acceleration/deceleration phases of the fingertip speed. We calculated the linear correlations of those torques between joints. Both groups modulated the elbow and shoulder net torques with target distances. They linearly coupled the production of torques. Both groups did not modulate the interaction torques. The movement slowness in Parkinson's disease was related to the difficulty in generating the appropriate muscle and net torques in the task. The interaction torques do not seem to play any role in movement control. [ABSTRACT FROM AUTHOR]

The Nexel total elbow arthroplasty (TEA) is an evolution of the Coonrad-Morrey linked TEA. Theoretically, the new design has shown better mechanical properties, but the first clinical studies showed concerning rates of implant loosening, leading the authors to advocate for the discontinued use of the implant. The purpose of this study was to evaluate the short to mid-term results with the Nexel TEA in a single center cohort. Between 2016 and 2020, 41 consecutive patients received 45 Nexel primary TEA at one institution. The cohort consisted of 5 men and 36 women with a mean age at surgery was 70 years (range, 42-93 years). The indications for primary TEA included 18 cases of rheumatoid arthritis, 24 acute fractures, and 3 cases of primary osteoarthritis. Follow-up assessment included the Mayo Elbow Performance Score, Oxford Elbow Score, range of motion, radiographic evaluation of implant loosening, complications, reasons for revision. The mean follow-up was 35 months (range 12-75 months). The median Mayo Elbow Performance Score was 82.5 points (range, 65- 100 points) and the Oxford Elbow Score was median 41.5 points (range, 17- 48 points). Mean range of motion at follow-up was; flexion 134° (range, 90°-140°), extension deficit 16° (range, 0°-90°), supination 71° (range, 30°-90°) and pronation 71° (range, 30°-90°). Radiolucent lines were observed in five cases around the humeral component and in one case around the ulnar component. There were four minor complications including prominent medial epicondyle, superficial infection, and transient ulnar nerve dysesthesia. Five elbows underwent revision surgery, three due to aseptic loosening of the humeral component, one due to periprosthetic fracture of the humerus, and one due to deep infection. The implant survival rate was 93.8% at 3 years. The short- to mid-term clinical and functional results with the Nexel TEA in this series are promising. The study could not demonstrate a similar high revision rate as reported by other authors. However, longer follow-up time and larger series are warranted. [ABSTRACT FROM AUTHOR]

Our study presents a novel design for a cable-driven robotic arm, emphasizing low cost, low inertia movement, and long-term cable durability. The robotic arm shares similar specifications with the UR5 robotic arm, featuring a total of six degrees of freedom (DOF) distributed in a 1:1:1:3 ratio at the arm base, shoulder, elbow, and wrist, respectively. The three DOF at the wrist joints are driven by a cable system, with heavy motors relocated from the end-effector to the shoulder base. This repositioning results in a lighter cable-actuated wrist (weighing 0.8 kg), which enhances safety during human interaction and reduces the torque requirements for the elbow and shoulder motors. Consequently, the overall cost and weight of the robotic arm are reduced, achieving a payload-to-body weight ratio of 5:8.4 kg. To ensure good positional repeatability, the shoulder and elbow joints, which influence longer moment arms, are designed with a direct-drive structure. To evaluate the design's performance, tests were conducted on loading capability, cable durability, position repeatability, and manipulation. The tests demonstrated that the arm could manipulate a 5 kg payload with a positional repeatability error of less than 0.1 mm. Additionally, a novel cable tightener design was introduced, which served dual functions: conveniently tightening the cable and reducing the high-stress concentration near the cable locking end to minimize cable loosening. When subjected to an initial cable tension of 100 kg, this design retained approximately 80% of the load after 10 years at a room temperature of 24 °C. [ABSTRACT FROM AUTHOR]

This paper deals with the design and kinematic analysis of a novel mechanism for the elbow joint of an upper-limb exoskeleton, with the aim of helping operators, in terms of effort and physical resistance, in carrying out heavy operations. In particular, the proposed eight-bar elbow joint exoskeleton mechanism consists of a motorized Watt I six-bar linkage and a suitable RP dyad, which connects mechanically the external parts of the human arm with the corresponding forearm by hook and loop velcro, thus helping their closing relative motion for lifting objects during repetitive and heavy operations. This relative motion is not a pure rotation, and thus the upper part of the exoskeleton is fastened to the arm, while the lower part is not rigidly connected to the forearm but through a prismatic pair that allows both rotation and sliding along the forearm axis. Instead, the human arm is sketched by means of a crossed four-bar linkage, which coupler link is considered as attached to the glyph of the prismatic pair, which is fastened to the forearm. Therefore, the kinematic analysis of the whole ten-bar mechanism, which is obtained by joining the Watt I six-bar linkage and the RP dyad to the crossed four-bar linkage, is formulated to investigate the main kinematic performance and for design purposes. The proposed algorithm has given several numerical and graphical results. Finally, a double-parallelogram linkage, as in the particular case of the Watt I six-bar linkage, was considered in combination with the RP dyad and the crossed four-bar linkage by giving a first mechanical design and a 3D-printed prototype. [ABSTRACT FROM AUTHOR]

Background: Anconeus compartment syndrome is a rarely reported compartment syndrome in the anconeus muscle compartment of the forearm. It has anatomic and pathophysiological associations with posterolateral rotatory instability (PLRI) of the elbow. Purpose: To present the history, management, and outcomes of 4 patients with anconeus compartment syndrome. Secondary aims were to (1) establish normative anconeus pressures and (2) measure the volume of this compartment with and without PLRI in cadavers. Study Design: Case series; Level of evidence, 4. Methods: Four patients with clinical signs of anconeus compartment syndrome (2 gymnasts, 1 swimmer, and 1 footballer/weightlifter) were identified over a 3-year period (2015-2017 inclusive). Patient history, sporting activity, physical examination, anconeus compartment pressures, and treatment outcomes were recorded. Manometry of the anconeus compartment in 2 healthy male controls was performed to establish normative compartment pressures. Anconeus volumetric anatomy and the effect of creating PLRI on compartment volume was investigated in 4 cadaveric elbows. Results: All 4 patients had microtraumatic PLRI, and 2 patients had anconeus hypertrophy. Anconeus compartment pressures at rest and at 2-minutes postexercise were median 28.0 and 67.5 mm Hg, respectively, in the patients and mean 16.5 and 18 mm Hg, respectively, in the controls. Simultaneous fasciotomy and PLRI reconstructive procedures were performed in 2 patients, with outcomes showing full return to competition. Fasciotomy alone was performed in 2 patients to allow return to competition, with both requiring later reconstruction to address PLRI. Cadaver dissection revealed that the anconeus compartment was extremely small and that creation of PLRI reduced the direct volume of the compartment and increased the distance between the anconeus origin and insertion. Conclusion: Our case series demonstrated that anconeus compartment syndrome can occur in upper limb-dominant athletes in the presence of PLRI and anconeus hypertrophy. Pain is relieved by fasciotomy, but definitive treatment of the underlying instability prevents further symptomatology. [ABSTRACT FROM AUTHOR]