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Osteoarthritis is among the most prevalent of musculoskeletal disorders in the world that causes joint pain, deformity, and limited range of movement. The resulting osteochondral defect can significantly decrease the patient's quality of life, but current treatment options have not demonstrated the capacity to fully regenerate the entire osteochondral microenvironment. Structurally, the osteochondral unit is a composite system composed of three layers-articular cartilage, calcified cartilage, and subchondral bone. Collectively these distinct layers contribute to the distinct biomechanical properties that maintain the health and aid in load transfer during joint articulation. The purpose of this review was to examine the role of the osteochondral interface in tissue engineering. Topics of discussion include the biomechanics of the osteochondral unit and an overview of various strategies for osteochondral interface tissue engineering, with a specific focus on three-dimensional bioprinting. The goal of this review was to elucidate the importance of the osteochondral interface and overview some strategies of developing an interface layer within tissue engineered scaffolds. Impact Statement This review provides an overview of interface tissue engineering for osteochondral regeneration. It offers a detailed investigation into the biomechanics of the osteochondral unit as it relates to tissue engineering, and highlights the strategies that have been utilized to develop the osteochondral interface within tissue engineering scaffolds.

The knee is the largest modified hinge joint in the body, which provides the greatest range of movement in flexion of the joint.

Background: Commercially available wrist-mounted exercise monitors may offer objective data on disease and recovery. This study is the first to evaluate the potential of such devices in the assessment of frozen shoulder and the effects of treatment. Methods: Twenty-one patients with isolated, unilateral frozen shoulder wore a wrist-mounted accelerometer (Fitbit Fire II, Fitbit Inc. 2007, California, USA) on each wrist for two separate seven-day periods, one week before and six months after treatment. The monitors produced an activity count for each 24-hour period, accounting for all movements of the upper limb. Three values were calculated for each time period: (1) the mean activity count for each limb, (2) the total activity count for both limbs, and (3) an activity count ratio calculated by dividing the activity of the frozen limb by the unaffected limb. Constant score, American Shoulder and Elbow Surgeons, visual analog scale–pain, and range of movement were recorded before and after treatment. Results: Mean activity counts were significantly lower in the frozen shoulder limb than those in the unaffected limb over the initial seven-day period (6066 vs. 7516; P = .04). The activity count ratio significantly improved after treatment (0.83 vs. 096; p 0.01), whereas the mean total activity count remained similar before and after treatment (14915 vs. 12371; P = .18), demonstrating that activity transferred from the unaffected limb back to the previously frozen limb. Range of movement (P

Introducción. Los trastornos musculoesqueléticos de miembro superior en pacientes postquirúrgicas de cáncer de mama, son una de las complicaciones más frecuentes, llevando al desarrollo de limitaciones, disfunciones y hasta discapacidades, asociadas al dolor, debilidad y disminución del rango de movimiento de hombro, afectando su calidad de vida. Una intervención fisioterapéutica temprana puede reducir y prevenir estas condiciones. Objetivo: Determinar la efectividad de los ejercicios kinesioterapéuticos en miembro superior para la prevención de trastornos funcionales posteriores a cirugía por cáncer de mama. Material y métodos: La investigación fue de tipo cuantitativa, longitudinal, mediante la aplicación de un plan de ejercicios de 5 semanas, donde se evaluó antes y después de la intervención, la fuerza muscular (Escala de Oxford), la amplitud articular (Test Goniométrico) y la funcionalidad global (Test de Constant-Murley), a 22 mujeres de entre 18 a 60 años, previo consentimiento informado. Resultados: Se observaron mejorías clínicas y estadísticamente significativas en la fuerza muscular de todos los grupos musculares (P=0,000) pasando de un nivel 2 de movilidad en todo el arco articular sin gravedad, a nivel 3 de movilidad en todo el arco articular con gravedad; en la amplitud articular (P=0,000) mejoró el rango de desplazamiento de todos los movimientos de hombro, excepto en la aducción (P=1,000) y en la función global de hombro (P=0,000), pasando se obtuvo una mejoría promedio pasando de una pobre de funcionalidad de 44,60 a un nivel medio de funcionalidad de 78,08. Conclusiones: Los ejercicios kinesioterapéuticos en miembro superior son efectivos para la prevenir de trastornos funcionales posteriores a cirugía por cáncer de mama.

Isolated posterior cruciate ligament (PCL) injuries are rare but PCL injuries commonly occur as part of multiligament knee injuries. PCL is the largest ligament in the knee and has two main bundles: anterolateral and posteromedial. These two bundles are thought to work in a co-dominant relationship to provide restraint/stability to posterior tibial translation. The PCL also has good capacity to heal following an injury. Majority of isolated PCL injuries can be treated non-operatively with rehabilitation focusing on prevention of posterior tibial sag, progressive weight bearing, prone range of movement exercises and quadriceps strengthening. PCL reconstructions are undertaken in chronic injury with persistent symptoms, failure of non-operative treatment and combined multiligament knee injuries. Common PCL reconstruction techniques include single bundle vs. double bundle and transtibial vs. tibial inlay. There is controversy on which reconstructive method is best.

Studies have investigated the kinematics of the healthy canine thoracic limb (TL), but there is currently no research to the authors’ knowledge investigating the influence of the working harness on TL kinematics. The aim of this study was to compare the TL stride length (SL) and shoulder, elbow and carpal joint range of movement (ROM) of assistance dogs when wearing three different harnesses (H1 and H2 Y-shaped harnesses; H3 the dog's original harness) with differing handle designs (A and B type handles; all dogs used an A type handle with H3, their original harness), in comparison to a standard collar at walk. Thirteen dogs were analyzed at walk in each condition: Harness 1, H1 (B-handle); Harness 2, H2 (A-handle); Harness 3, H3 (A-handle, and the dog's original working harness); and the Collar with the lead held between 20 and 40cm. A series of Friedman's analyses with post-hoc Wilcoxon Signed Rank tests compared SL and joint ROM at peak protraction and retraction of the TL. Results: The results show significant TL kinematic changes in H1 (B-handle): SL in H1 was significantly reduced in comparison to the Collar (6%; P = 0.008). In TL protraction, a significant reduction in shoulder extension was recorded for H1 in comparison to H3 (6%; P = 0.005). In TL retraction, a significant reduction in carpal extension was observed in H1 in comparison to the collar (4%; P = 0.008), H2 (2%; P = 0.005), and H3 (4%; P = 0.005). Conclusions: Differences in canine locomotion were observed between conditions in comparison to when the dog was at walk in the collar. Our findings suggest the harness handle type may result in the TL kinematic changes observed. Significant TL SL and ROM restrictions were noted in H1, the only harness in the study with a specific handle design (B-handle type). The increase in proximal TL joint ROM and a subsequent reduction in distal TL joint ROM suggests an alteration to the energy efficiency of locomotion when compared to previous literature. These results were seen only in H1 and not H2, a similar design of harness, therefore suggesting the B-handle type may be the key factor in the kinematic changes observed.

Coaches can provide an appropriate environment for children to develop a range of movement skills, but there is a dearth of research exploring the creation of appropriate resources to support the coach in developing and assessing children’s Complex Movement Skills. There is also a lack of research around coaches’ perceived feasibility of the limited resources in this area. Therefore, the purpose of this study was to design and then assess the feasibility of a Movement-Oriented Games-Based Assessment (MOGBA) for children aged 8–12 years, to be used by coaches within “Made to Play” programs. Thirteen coaches from across the United States and the United Kingdom used pilot materials to assess the feasibility of MOGBA over a 9-week period. Individual, paired, and focus group interviews were structured and data were thematically analyzed using Bowen et al.’s feasibility framework. Findings suggested that MOGBA provided a welcomed and much needed enhancement to their programs, with effective use of technology-enhanced coaching. Coaching involved notions of pedagogy and assessment, with issues emerging around class size and complexity of assessment. Coaches often used MOGBA covertly and flavored the resource to the sport being delivered, and this revealed to coaches the capability of children not viewed before.

This study describes the learning curve associated with ArtiSential articulating laparoscopic instruments (ALI) in a simulated environment and the early paediatric clinical implementation of this skill set. The study was performed as a single-centre feasibility study. Baseline performance for a peg board transfer task requiring 3D object translation was established with standard instruments (SI) and ALI. Completion time and number of pegs dropped were recorded. Participants completed 5 h of distributed practice followed by a repeat timed performance. ArtiSential articulating instruments were subsequently used in 3 laparoscopic cases using an iterative learning model and the learning points are described. Median baseline completion time with SI and ALI were not significantly different [7.3 min SI vs 10.5 min ALI (p = 0.138), ALI times significantly improved with 5 h training (10.5 min vs 3.5 min (p = 0.014)]. 19 pegs were dropped using SI, while 7 were dropped with ALI (p = 0.028). Two laparoscopic cholecystectomies and a laparoscopic fundoplication were performed using a hybrid approach with articulating instruments and standard laparoscopic instruments with operating times of 164, 94 and 120 min, respectively. There is a short learning curve with rapid acquisition of the articulating skill set using this training program, with intuitive translation to the clinical setting, permitting increased dexterity and range of movement compared to SI. Limitations including air-leak and loss of angulation during dissection respond to modification of surgical set-up and refining technique.

Context Lateral-flexion range of movement (LF ROM) is used to assess and monitor recovery of side strain injury in athletes. Objective To establish a reliable and pragmatic measure of LF ROM and investigate the stability of the measure over time in athletes. Design (1) Cross-sectional reliability study and (2) cohort longitudinal study. Setting Elite cricket teams in Australia and England. Patients or Other Participants Ten healthy first-class cricket players recruited from Australia and England domestic and international competitions. Main Outcome Measures (1) The intrarater and interrater reliability of 2 methods of measuring LF ROM toward and away from the bowling arm was assessed (distance to the floor or distance to the fibular head). Three experienced physiotherapists obtained the measures. Intraclass correlations [2,1] were calculated for absolute agreement for all 3 testers. (2) Lateral-flexion ROM was measured monthly during the preseason and competitive season. A 1-way repeated-measures analysis of variance was performed to identify differences within the preseason, within the competitive season, and between competitive seasons. Results Both methods had good intratest and intertest reliability (intraclass correlations > 0.84). As LF ROM measurement to the floor was easier for clinicians, it was used for the longitudinal study. Lateral-flexion ROM did not alter throughout the preseason and competitive season or between seasons (P values > .05). Conclusions This new method of measuring LF ROM demonstrated good intrarater and interrater reliability and stability over time and can be used as an outcome measure in side strain injury.

Background Idiopathic stiff total knee arthroplasty (TKA) represents one of the most challenging subsets of the stiff TKA, as the etiology is unknown and there is no consensus on the most appropriate surgical treatment modality. Therefore, the aim of this study is to report on postoperative outcomes of revision surgery for idiopathic stiff TKA. Methods We retrospectively reviewed 189 consecutive patients (202 knees) who underwent revision TKA for stiffness: (1) 101 knees in the idiopathic stiffness cohort and (2) 88 in the non-idiopathic stiffness cohort. In the idiopathic stiffness cohort, 42 knees underwent isolated tibial insert exchange and 59 knees underwent component revision. Perioperative knee range of movement and complications were analyzed. Results The overall revision surgery outcomes of the idiopathic stiffness cohort were worse than those of the non-idiopathic stiffness cohort with regard to maximum flexion (91.7° vs 100.1°, P = .02) and flexion range of motion (ROM) (87.6° vs 97.1°, P = .01). In the idiopathic stiffness cohort, isolated tibial insert exchange demonstrated greater maximum flexion (96.8° vs 88.4°, P = .06) and flexion ROM (93.2° vs 83.9°, P = .07). In terms of re-revision rates, the isolated tibial insert exchange idiopathic stiffness cohort demonstrated lower re-revision rates compared to the component revision idiopathic stiffness cohort (16.7% vs 31.0%, P = .01). Conclusion This study demonstrates that the overall revision surgery outcome of idiopathic stiff TKA is worse than non-idiopathic TKA stiffness. In idiopathic stiffness cohorts, isolated tibial insert exchange was associated with lower re-revision rates than component revision, with similar efficacy in improving ROM, suggesting that isolated tibial insert exchange may be a preferred surgical treatment option in TKA patients with idiopathic stiffness.

Aims: This systematic review examines the available evidence on the use of medical stretching devices to treat knee arthrofibrosis, it suggests a focus for future studies addressing limitations in current research and identifies gaps in the published literature to facilitate future works. Materials and methods: Articles were identified using the Cochrane Library, MEDLINE, PubMed and SCOPUS databases. Articles from peer reviewed journals investigating the effectiveness of medical stretching devices to increase range of movement when treating arthrofibrosis of the knee were included. Results: A total of 13 studies (558 participants) met the inclusion criteria with the devices falling into the following categories; CPM, load control or displacement control stretching devices. A statistically significant increase in range of movement was demonstrated in CPM, load-control and displacement-control studies (p ​

AimsThis study aimed to determine the minimal detectable change (MDC), minimal clinically important difference (MCID), and substantial clinical benefit (SCB) under distribution- and anchor-based methods for the Mayo Elbow Performance Index (MEPI) and range of movement (ROM) after open elbow arthrolysis (OEA). We also assessed the proportion of patients who achieved MCID and SCB; and identified the factors associated with achieving MCID.MethodsA cohort of 265 patients treated by OEA were included. The MEPI and ROM were evaluated at baseline and at two-year follow-up. Distribution-based MDC was calculated with confidence intervals (CIs) reflecting 80% (MDC 80), 90% (MDC 90), and 95% (MDC 95) certainty, and MCID with changes from baseline to follow-up. Anchor-based MCID (anchored to somewhat satisfied) and SCB (very satisfied) were calculated using a five-level Likert satisfaction scale. Multivariate logistic regression of factors affecting MCID achievement was performed.ResultsThe MDC increased substantially based on selected CIs (MDC 80, MDC 90, and MDC 95), ranging from 5.0 to 7.6 points for the MEPI, and from 8.2° to 12.5° for ROM. The MCID of the MEPI were 8.3 points under distribution-based and 12.2 points under anchor-based methods; distribution- and anchor-based MCID of ROM were 14.1° and 25.0°. The SCB of the MEPI and ROM were 17.3 points and 43.4°, respectively. The proportion of the patients who attained anchor-based MCID for the MEPI and ROM were 74.0% and 94.7%, respectively; furthermore, 64.2% and 86.8% attained SCB. Non-dominant arm (p = 0.022), higher preoperative MEPI rating (p < 0.001), and postoperative visual analogue scale pain score (p < 0.001) were independent predictors of not achieving MCID for the MEPI, while atraumatic causes (p = 0.040) and higher preoperative ROM (p = 0.005) were independent risk factors for ROM.ConclusionIn patients undergoing OEA, the MCID for the increased MEPI is 12.2 points and 25° increased ROM. The SCB is 17.3 points and 43.3°, respectively. Future studies using the MEPI and ROM to assess OEA outcomes should report not only statistical significance but also clinical importance. Cite this article: Bone Joint J 2021;103-B(2):366–372.

Primary immunoglobulin A vasculitis (IgAV) is one the most common childhood vasculitis. A 5-year and 10-month-old girl child patient presented with confluent palpable purple red rash, mainly over both ankles. This was associated with edematous, tender ankles, limited range of movement, and inability to walk. A concomitant coronavirus disease 2019 (COVID-19) was documented by nasopharyngeal swab. This case suggested that COVID-19 can trigger IgAV in children. Hence, awareness of COVID-19 infection in IgAV should be present, and it may be useful to investigate COVID-19 as one of the causes of IgAV, especially in the presence of an epidemic.

Objective: Our aim was to analyze whether shoulder pain is related to scapular upward rotation (SUR) or to the lengths of the pectoralis minor and levator scapulae muscles. Methods: This cross-sectional, observational study was carried out in 3 primary-care centers; 54 individuals with chronic shoulder pain participated. Scapular upward rotation and the lengths of the pectoralis minor and levator scapulae muscles were assessed. Results: The level of association was small between shoulder pain and function and (1) the lengths of the pectoralis minor (r = 0.08, P = .93) and levator scapulae (r = -0.01, P = .57) muscles and (2) SUR at 45 degrees (r = 0.17, P = .21), 90 degrees (r = 0.08, P = .57), and 135 degrees (r =0.10, P = 0.45) of shoulder elevation. Conclusion: The relationship was small between shoulder pain and function and (1) SUR (45 degrees, 90 degrees, and 135 degrees of shoulder elevation) and (2) the lengths of the pectoralis minor and levator scapulae muscles. Thus, the use of SUR and pectoralis minor and levator scapulae lengths in shoulder assessment should be undertaken with caution. Other factors such as psychological factors, central/peripheral sensitization, and intrinsic properties of the tissue have to be taken into account.

Introduction: To evaluate the function of Patella following Patelloplasty in Total Knee Replacementusing the Hospital for Special Surgery Patella score. Materials and methods: This is a prospectivestudy done on patients who have undergone Total Knee Replacement from March 2018 to March2019. The study was done in Sri Ramachandra Medical College, Chennai, and Velammal MedicalCollege, Madurai. Result: In the present study Pre-op Knee, Scoring System scores were 40.92 andFunctional Scores were 42.87. Postoperatively Scores increased to 87.66 and 88.24 respectively.Patella Score is 86.29. No patient had anterior knee pain and functional limitation at the end of oneyear. The fundamental basis of retaining the patella was that the autogenous patella may bettermeet the physiological and anatomical requirements and avoid complications resulting from patellarresurfacing. Conclusion: In the present study, Patelloplasty has shown good functional results andan early pain-free range of movement.

Background Distal thumb injuries are managed by multiple local and regional flaps. The cross-finger flap (CFF) is one versatile flap used to cover such defects. The donor finger to the thumb is classically described to be the index finger (IF). However, with the index finger being the second most important finger, it causes further debilitation of the already injured hand. Our aim was to find an alternate donor finger to spare the index finger. Methods and Materials A prospective observational study was conducted on 10 patients with distal thumb injuries who were admitted between November 2018 and July 2019. Ring finger (RF) was used as donor for CFF in all the cases. The subjects were assessed for first web space angle, Kapandji score, total range of movement (TRM) of long fingers, and global hand function using Michigan hand outcome questionnaire (MHQ) after flap division. Results There was no first web contracture and TRM of IF remained unaffected. However, TRM of RF was significantly reduced. But this being a relatively unimportant finger, there was no significant reduction in global hand function, as evaluated by the MHQ score. Conclusion The ring finger is a good alternative for index finger as donor for CFF to the thumb, because it provides adequate tissue along with comfortable positioning and easy maintenance of local hygiene. Moreover, it preserves global hand function by sparing the IF.

Capitellar fracture in the paediatric population is extremely rare. There have been only a handful of case reports or case series in the literature. For this reason, it is likely to be missed or misdiagnosed. An untreated capitellar fracture poses a risk of severe compromise of the elbow function and range of movement. We present a rare case of type I capitellar fracture in an 11-year-old girl. She underwent open reduction and percutaneous Kirschner wiring and she subsequently recovered with excellent outcome. A high index of suspicion is needed to diagnose a capitellar fracture. The lateral view of a plain radiograph must be carefully screened and sometimes an oblique view may be helpful in making the diagnosis. Keywords: capitellum; fracture; open reduction

Background & Objectives: In a country like India where the social habits and needs, require full range of knee flexion, the patella plays an important role. The most significant effect of patella fracture are loss of continuity of extensor mechanism of knee and potential incongruity of patello-femoral articulation. So it is necessary to preserve the patella and extensor apparatus. Hence the main objectives of this study are: To study the functional outcome by early mobilization, to study the complications of tension band wiring, to clinically evaluate the tension band wiring technique for fracture patella, to study the mode of injury for fracture patella. Methods: The present study consists of 30 selected cases of fractured patella treated by modified tension band wiring at Shri B M Patil Medical College Hospital and Research Centre, Vijayapur from December 2014 to March 2016. Results: In the present study 21 (70%) had excellent results, 7 (23.33%) had good results and 2(6.66%) had poor result. Interpretation and Conclusion: Early mobilization of the knee restores quadriceps power and range of Kneemotion within a short period. Excellent range of movement was achieved in 70%of cases, which is comparable to previous literature. In a country like India where the social habits and needs, require full range of knee flexion, the patella plays an important role.

There is a growing global interest in developing and accommodating sustainable modes of travel. Cycling is an important mode of travel which offers powerful solutions to chronic traffic problems of congestion and emissions. The accuracy of cyclist position is considered as an important parameter for the calculation of cyclist speed. Cyclist speed data is required for precise design of traffic control measures, for safety studies, and for sight distance analysis. Different speed measurement techniques and results are found in the literature. This study critically examines peer-reviewed studies which discuss different techniques for measuring cyclist speed. This review covers the accuracy of the measurement techniques and highlights limitations of the reviewed studies. These identified limitations are classified as: limited range of movement directions, selection of observed cyclists, seasonal variation in measurements, completeness of results reporting, reporting of equipment limitations, and measurement validation. The study summarizes previous findings of cyclist speed statistics. This study also reviews the level of automation in speed measurement. Any technique involving a human input during the field data collection or analysis to estimate cyclist speed is classified as a manual. Further categories for semi-automated and automated measurement techniques are established. Meta-analysis was conducted to test whether reported cyclist speed depends on where they were recorded; intersections or road segments. The result of the unpaired t-test showed that there is no significant difference between the means of the cyclists speed at road sections and signalized intersections at the 95% of confidence level. The study emphasizes the growing importance of the use of automated computer vision techniques for speed measurement. The paper contrasts the advantages of computer vision techniques with other measurement techniques. Keywords: Transportation engineering, Cyclist speed, Video analysis, Signalized intersection

Introduction: Prosthetic joint infections (PJIs) of total knee arthroplasty (TKA) are the one of the most dreaded complications resulting from TKA. Although different methods of treatment protocols are followed around the world, a two staged exchange arthroplasty is the considered gold standard for PJI’s. The purpose of the present study was to determine the recovery of knee ROM in patients undergoing two stage revision total knee arthroplasty with either dynamic or static antibiotic loaded cement spacers. Methods: This was a retrospective case series performed between 2016 and 2019, Patients with a documented TKA infection that under-went a two-stage revision of both the femoral and tibial component of their TKA were included into the study. A total number of 44 patients who were treated with a spacer made of antibiotic-loaded acrylic cement were included. Twenty two patients were treated with temporary static spacer and 22 patients were treated with dynamic spacers. Results: At 6 months post operative visit, none of the patients had a recurrence in infection. Knee flexion was higher in dynamic spacer group at 2 week, 3 months and 6 months during the post operative period when compared to static spacer group the operation time of revision implantation was also shorter for dynamic spacer group. Conclusion: Our study results suggest that patients treated with dynamic spacer had a faster recovery in terms of range of motion of the knee, and shorter operating time for reimplantation. Our results support the use of dynamic spacers in an infected TKA that are treated with two-stage revision of arthroplasty.

We report a case of blast injury to the left hand which resulted in fractures of the fingers with exposure of bones and joints of the phalanges. We used three reverse adipofascial cross finger flaps raised at the same time from 2 fingers to reconstruct adjacent fingers of the patient. The patient recovered well postoperatively and had good range of movement of the fingers. This avoided the complications of the use of regional or distal flaps. To our knowledge, this is the first case reported in which three reverse adipofascial cross fingers flaps are raised at the same time, two of them from an injured finger, to cover three raw areas on two fingers of a patient.

Highlights • Three case of radial head fracture treated with radial head arthroplasty. • Evaluation of the functional outcomes after operative treatment of radial head arthroplasty. • Functional outcomes assessment with active and passive range of motion. • Satisfying result on pain and a fair result on functional outcome on patient follow-up. • Good follow up is important to minimize the complications of radial head arthroplasty., Introduction Radial head arthroplasty (RHA) has become one of the mainstay surgical treatment for radial head fracture in certain conditions. Many previous studies compared the superiority of either open reduction and internal fixation (ORIF) and RHA with inconclusive result. Our case series aim to evaluate the functional outcome of the patients treated with RHA in our institution. Presentation of case We evaluated three patients who had RHA in 2018 and 2019. The function of flexion, extension, supination and pronation of the elbow was evaluated. The range of motion (ROM) was assessed in both active and passive way. Discussion An abundant of literatures stated that RHA result is superior than radial head resection and ORIF. Our case series present a satisfying result on pain and a fair result on functional outcome from the range of motion (ROM) evaluation on patient follow-up. Conclusion A good follow up for post-operative care plays an important role in management of RHA to minimize the rate of complications. In this case series, the functional outcomes after RHA is good, but a larger number of patient and longer follow up duration is needed for a better analysis.

Objectives: Current literature is scarce about the use of an inertial sensor to measure cervical active range of motion (aROM). The objective of the present study is to determine inter- and intra-reliability in the measurement of cervical aROM using inertial sensors in asymptomatic individuals.Materials and methods: Twenty asymptomatic individuals participated in the study. Two different physiotherapists measured each participant for cervical aROM (6 movements). The sequence of movements and the explanations given were standardized. The rater's order of measurement was randomized.Results: For the intra-rater results, the intraclass correlation coefficient (ICC) values for all cervical movements were good for Rater A (ICC >0.90) and Rater B (ICC >0.90). For the inter-rater results, the ICC values were above 0.75 for all movements, indicating a good level of reliability. Also, values obtained in SEM, MDC90 and LOA indicate good agreement.Conclusion: The data obtained in this study suggest that inertial sensors can be used in clinics due to their high intra- and inter-rater ICC (>0.80). Also, its low economic cost, easy handling, and various utilities make this tool a useful alternative in the measurement of cervical aROM.

Objective: Neuromuscular electrical stimulation (NMES) is a common approach to restore muscle strength of individuals with a neurological injury but restoring hand dexterity is still a challenge. This study sought to quantify the diversity of finger movements elicited by a multichannel nerve stimulation technique. Methods: A 2 × 8 stimulation grid, placed on the upper arm along the ulnar and median nerves, was used to activate different finger flexors by automatically switching between randomized bipolar electrodes. The forces from each individual finger as well as the high-density electromyogram (HDEMG) of the intrinsic and extrinsic flexors were recorded. The elicited finger forces were categorized using hierarchical clustering, and the 2D correlation of the spatial patterns of muscle activation was also calculated. Results: A wide range of movement patterns were identified, including multi-finger and single-digit movements. Additionally, a number of electrode pairs elicited similar finger movements. The muscle activation patterns showed similar and distinct spatial patterns, signifying activation redundancy. Conclusion: These results revealed the diversity of elicitable finger movements and muscle activations. The system redundancy can be explored to compensate for system instability due to fatigue or electrode shift. The outcomes can also enable the development of an automatic calibration of the stimulation.

The purpose of this study was to investigate the effects of edema, pain, and range of motion of knee by sterile kinesio taping within 3 days after ACLR. We hypothesized that sterile taping which is a new material of kinesio taping reduces knee pain and swelling and improves knee range of movement after ACLR. Fifty-sixth subjects who underwent an elective ACLR with were randomized into intervention(n=28) and control groups(n=28). Subjects from both groups received standardized postoperative physiotherapy. Pain by VAS, total ROM of the knee, and circumferential girth were measured at the first, second- and third-day post-surgery. There were found statistically significant differences in all study parameters within each group. Comparison of the study parameters between both groups revealed a statistical significance at various time points except the reduction of pain in the taping group in the early postoperative phase (between the first and second day) (P

The COVID-19 pandemic has led to a high-stress environment causing a significant impact on frontline workers, including pharmacists and nurses. In addition to the increased workload, scarcity of resources, and emotional challenges, the frontline health care workers are required to wear additional personal protective equipment that can further limit their range of movement and decrease efficiency. The potential for errors can increase in these types of high-stress situations. One way to reduce the risk of errors is to use manufacturer-prepared, ready-to-administer (RTA) prefilled syringes, when appropriate. The use of RTA prefilled syringes is supported by literature evidence, recommendations, and guidelines from various professional organizations and societies.

After an acupuncture treatment 24 times, the symptoms are recovered right shoulder both active and passive full range of movement in all directions, and pain‐free. Furthermore, no adverse effects were observed., After an acupuncture treatment 24 times, the symptoms are recovered right shoulder both active and passive full range of movement in all directions and pain‐free. Furthermore, no adverse effects were observed.

The diagnosis of musculoskeletal pathology is not always straightforward. This case challenge is designed to allow practitioners to familiarize themselves with the history of the presenting complaints and apply both imaging and examination techniques as diagnostic measures. Clinical diagnostic techniques are discussed, as well as pertinent treatment options.

Inappropriate posture and the presence of spinal disorders require specific monitoring systems. In clinical settings, posture evaluation is commonly performed with visual observation, electrogoniometers or motion capture systems (MoCaps). Developing a measurement system that can be easily used also in non-structured environments would be highly beneficial for accurate posture monitoring. This work proposes a system based on three magneto-inertial measurement units (MIMU), placed on the backs of seventeen volunteers on the T3, T12 and S1 vertebrae. The reference system used for validation is a stereophotogrammetric motion capture system. The volunteers performed forward bending and sit-to-stand tests. The measured variables for identifying the posture were the kyphosis and the lordosis angles, as well as the range of movement (ROM) of the body segments. The comparison between MIMU and MoCap provided a maximum RMSE of 5.6° for the kyphosis and the lordosis angles. The average lumbo-pelvic contribution during forward bending (41.8 ± 8.6%) and the average lumbar ROM during sit-to-stand (31.8 ± 9.8° for sitting down, 29.6 ± 7.6° for standing up) obtained with the MIMU system agree with the literature. In conclusion, the MIMU system, which is wearable, inexpensive and easy to set up in non-structured environments, has been demonstrated to be effective in posture evaluation.

Introduction/background Metacarpal fractures comprise approximately 35.5% of cases in daily emergencies, mostly due to road traffic accidents (RTA), fall, and assault. The classification is based on the site and pattern of fracture. High-level evidence is lacking for the management of metacarpal fractures. The primary goals of treatment are to achieve acceptable alignment, stable reduction, strong bony union, and unrestricted motion. It can be managed by non-operative methods like close reduction and splintage. Operative management will be required if there is shortening, rotation, and angulation in different planes including close reduction and fixation with percutaneous intramedullary pining/k-wires and open reduction and fixation with screws, plates (compression/locking), and external fixators. This study was done to compare the efficacy of k-wire, screws, and plates in the management of metacarpal fractures and their outcomes based on their union, postoperative pain, range of movement, and grip strength in a tertiary care center, i.e., Liaquat National Hospital and Medical College. Methods It was a retrospective study conducted at the Department of Plastics and Reconstruction Surgery, of a tertiary care hospital. A total of 113 patients who were operated upon for metacarpal fracture were included in the study (open/close) without soft tissue loss or tendon injury, were divided into three groups according to the technique of fracture fixation, i.e., group 1 (k-wire), group 2 (screw), and group 3 (plates). The data like post-operative pain (visual analog scale, VAS) and radiological evidence of union were extracted from the registry. All the patients were called for follow-up in the outpatient department. Out of 113, 97 patients showed up for follow-up and were examined by a hand surgeon, and range of movement (goniometer) and grip strength (sphygmomanometer method) were assessed. Results A total of 97 patients were included in the study (male 66%, female 34%). Group 1 (K-wire) includes n = 61 (62.9%), group 2 (screw) n = 15 (15.5%), and group 3 (plate) n = 21 (21.6%). The mean follow-up time was 12 + 2 weeks after the surgery for post-operative pain and radiological evidence of union while 24 + 6 months for a range of movement and grip strength. Less post-operative pain was noted in group 1 patients while no significant difference was noted in the evidence of radiological union in all groups. Range of movement was better in group 1 patients (89.74 + 0.750) than in group 2 (80 + 0.37°) or group 3 (80.2 + 0.62°). The grip strength (compared to the normal contralateral hand) was normal in the majority of the patients in group 1, i.e., 94% while it was 80% in group 2 and 82% in group 3. Conclusion The significance of these reported findings suggests that open reduction and internal fixation with screw or plate might be a less preferable surgical technique in comparison to k-wire fixation in the treatment of a metacarpal fracture.

The shoulder is a complex joint with static and dynamic stabilising structures working synchronously. These allow a full range of movement while preserving stability of the joint. Patients may present with pain, stiffness, weakness, deformity or instability. The authors suggest a systematic examination sequence to ensure that important pathology is not overlooked. Adopting this approach allows common pathologies, including tears of the rotator cuff, impingement and tendinopathy, to be easily identified. This shoulder examination sequence may be used by all healthcare professionals and can also act as a revision aid for those undergoing exams in this field, at different levels of training.

Delayed-onset muscle soreness (DOMS) is associated with increases in acute inflammatory and biochemical markers, muscle swelling, pain, and reduced functional performance. This study aimed to investigate the preventative effects of crocodile blood supplementation on DOMS induced by eccentric exercise. Sixteen healthy males were randomly allocated to either a crocodile blood (CB, n = 8) or a placebo (PL, n = 8) treatment. Participants receiving the CB treatment consumed four capsules of freeze–dried CB powder (1 g day−1) over 18 days. Participants receiving the other treatment were administered a placebo over the same period. An eccentric exercise protocol was performed, and functional performance, visual analogue scale (VAS)-measured pain, knee range of movement (ROM), thigh circumference (swelling), and cytokines, enzymes, and biochemical parameters were assessed immediately after exercise as well as after 24 h, 48 h, and 72 h. CB supplementation could significantly maintain maximum voluntary isometric contraction (MVIC) at 24 h (p = 0.001) and 48 h after exercise (p = 0.001) when comparing values at different times for the CB group. In the CB group, thigh circumference decreased only immediately after eccentric exercise (p = 0.031) in comparison with pre-eccentric exercise values. An 18-day supplementation (1 g day−1) of crocodile blood does aid in the maintenance of functional performance and muscle swelling after eccentric exercise. Our data indicate that 1 g day−1 of crocodile blood supplementation should be safe for human consumption.

The anterior cruciate ligament (ACL) is one of the main stabilizing structures of the knee and its rupture is a common injury in young active adults. ACL reconstruction has been the preferred operative management of an ACL rupture for several decades; however, success rates are variable. Recently, interest in arthroscopic primary repair of the ligament has increased. The repair is augmented with an Internal Brace (IB), which is an ultra-high strength suture tape that bridges the ligament. This technique protects the ligament during the healing and the ligament is encouraged to heal naturally, whilst not requiring any external braces. It acts as a stabiliser to permit early mobilization and optimise rehabilitation. As understanding of rehabilitation has progressed, there has been an increased focus on early weight-bearing and achieving full range of movement. While detailed criterion-based rehabilitation protocols exist for ACL reconstruction, this is not the case for ACL repair. The purpose of this commentary is to present a novel criterion-based rehabilitation protocol following ACL repair surgery augmented with an IB. # Level of Evidence V

The present study aims to create a patient-specific hand model to simulate the passive rehabilitation on the index finger, quantifying the flexor digitorum profundus (FDP) tendon excursion and the stress experienced during simulated flexion. The computational model used in this analysis was created from an unknown patient dataset available in the Embodi3d online library. The segmentation, three-dimensional reconstruction, and modeling of the structures involved were performed using Materialise Mimics and Rhino3D. The FDP tendon excursion and stress values present in the model were calculated in the ANSYS environment. Based on the finite-element simulation, the FDP tendon presents an excursion of 10.1 mm during passive postoperative flexion. The highest-stress values were observed between the pulleys-FDP tendon contact surfaces. In particular, the pulley A1 exhibited the maximum principal stress of the model with a 58.7 MPa. The pulley A3 showed the same stress distribution pattern that A1 Pulley, but with the lowest values. The FDP Tendon excursion obtained is consistent with the results reported in the literature, which vary from 8 to 11 mm. The stress values found in the model explain the importance of the pulley mechanism keeping the FDP tendon attached to the finger bone during the range of motion experienced. The silico model proposed may potentially be used in the assessment of new medical device proposals in the field of hand reconstructive surgery.

Purpose Paediatric foot surgery is often performed to restore anatomical shape or range of movement (ROM). The purpose of this study was to determine how foot morphology and ROM are associated with foot function in children aged five to 16 years of age. Methods Participants included 89 patients with foot disorders and 58 healthy controls. In addition to measuring children's foot alignment and ankle ROM, children and parents completed the Oxford Ankle and Foot Questionnaire (OxAFQ). Results Mean age was 10.3 years for patients and 10.6 years for controls; 53 of 89 patients had clubfoot. All foot measurements and scores on the OxAFQ significantly differed (p < 0.001) between patients and controls. Patients and their parents significantly differed on the physical (p = 0.03) and emotional (p = 0.02) domains of the OxAFQ, with parents’ ratings being lower than their children. Moderate correlations (r = 0.54 to 0.059; p < 0.001) were found between physical domain (reported by parents on the OxAFQ) and dorsiflexion-knee flexed, and foot- arc-of-movement. Moderate correlations were found between physical domain (reported by children on OxAFQ) and foot-arc-of-movement (r = 0.56; p < 0.001). Patients in the surgical group showed moderate correlations (r = 0.57;, p < 0.001) between physical domain (reported by children on OxAFQ) and plantar flexion, and foot arc-of-movement. The control group and the patients in non-surgical subgroup showed no significant correlations. Conclusion Plantar flexion, arc of ankle ROM and hindfoot alignment impact foot function in children with foot deformities. Parents report significantly lower scores on the OxAFQ when judging foot functioning. Level of evidence Level II. Prognostic Studies

Background: Low Back Pain (LBP) is a symptom rather than a disease diagnosis. Pathology in the low back might affect the pattern of movement rather than only the range of movement ROM. Approximately 10% with LBP do not respond to treatment and develop chronic LBP. The cause for this non-response to treatment is lack of specific diagnosis and inability to distinguish, in some people, pain arising from the Sacroiliac Joints (SIJs) or the lumbar spine.Aim of Study: This study was conducted to identify the relationship between Sacroiliac joint dysfunction SIJD and lumbar spine movement in sagittal and frontal plan.Subjects and Methods: Forty participants aging 20:40 years divided into 2 groups. Group (A) consisted of 20 healthy participants, Group (B) SIJD consisted of 20 subjects were positive of at least 3 SIJ provocative test. All the participants on the study, pelvic asymmetry was measured by PALM device also spinal flexibilityof lumbar spine was assessed in sagittal and frontal plan.Results: There was negative weak significant correlation between mean difference of pelvic inclination and Extension-Flexion E-F of lumbar (r=–0.405, p=0.014*). While, no significant correlation between mean difference of pelvic inclination and lumbar flexion, left side bending, right side bending, and over all side bending L-R of lumbar.Conclusion: There was change of lumbar spine mobility in sagittal plan on extension and overall sagittal ROM with SIJD patients, though in comparison between groups it showed that patient with SIJD had less overall frontal plan ROM.

Background Jefferson fractures are classically described as burst fractures of C1. Traditional surgical treatment of these unstable fractures is either occipito-cervical or posterior C1-C2 fusion, resulting in a significant loss of range of cervical neck movement. This case report discusses the fixation of a Jefferson fracture using C1 lateral mass screws to achieve surgical stabilization while preserving the range of movement. We aim to add to the body of evidence supporting this fixation method. Methods A 39-year-old male presented to our emergency department with an unstable Jefferson fracture caused by trauma. The various treatment options, such as cervical collar, HALO immobilization, occipito-cervical fusion, and atlanto-axial fusion and direct fixation of C1, were evaluated and discussed with the patient. Informed consent was obtained from the patient prior to writing this case report. Results At 3 months postoperation, the patient demonstrated near full range of movement in his neck. He had also resumed driving. By 6 months, the patient returned to work, and at 12 months, imaging confirmed union. Conclusions This case report adds to the body of evidence supporting the technique of C1 lateral mass screws for direct stable fixation of Jefferson fractures. This fixation method preserves the cervical spine range of motion with minimal functional restriction.

The majority of studies examining botulinum toxin A (BTX-A) in the management of upper limb muscle overactivity and pain focus on the distal arm and hand. Research has begun to look at BTX-A efficacy in more proximal upper limb muscles, with literature showing equivocal findings. This scoping review identified 15 studies meeting inclusion criteria whose data were examined against three outcome variables: muscle overactivity, range of movement and pain. Overall, while the majority of injected participants improved on these variables, between-study methodological variability such as research design potentially underpowered studies and arbitrary decision making gave a high likelihood of influencing the interpretation of their results. Future research is warranted, with a robust focus on functional anatomy, a critical appraisal of how BTX-A may help the individual being studied and utilising individualised rather than protocol-driven research paradigms.

Frozen shoulder is the inflammation of shoulder joint, marked by a painful, adhesive, atrophic and shortened joint capsule. As a result, movement range of the joint becomes limited. In frozen shoulder patients, the limitation can affect and lessen functional ability. Therefore, this study is aimed to analyze the correlation between the limited range of movement of shoulder joint and the functional ability of frozen shoulder patients in Department of Medical Rehabilitation of RSUP Dr. Mohammad Hoesin Palembang. This study is an observational analysis using correlation test with cross-sectional design. Twenty nine frozen shoulder patients in Department of Medical Rehabilitation of RSUP Dr. Mohammad Hoesin Palembang in November 2018 that met the inclusion criteria were taken as subjects of this study by using consecutive sampling technique. Functional ability was assessed with quickDASH questionnaire while shoulder joint range of movement with goniometry. Data analysis was conducted subsequent to the assessments. The result of correlation test between functional ability and shoulder joint range of movement is significant. The study findings include active flexion (p=0,000; r=-0,669), active extension (p=0,004; r=-0,520), active abduction (p=0,000; r=-0,663), active adduction (p=0,022; r=-0,423), passive flexion (p=0,001; r=-0,589), extension passive (p=0,002; r=-0,543), passive abduction (p=0,000; r=-0,676) and passive adduction (p=0,038; r=-0,388).There is a significant correlation between limited range of movement and functional ability in frozen shoulder patients from Department of Medical Rehabilitation of RSUP Dr. Mohammad Hoesin Palembang.

BACKGROUND Functional and cosmetic outcomes affect reconstruction of the face more than any region of the body. To use a predetermined perforator flap freely designed allowing a wide range of movement and manipulation can give us an optimum outcome. We present our clinical experience with free style facial perforator flaps, surgical technique, and complications. METHODS Thirty patients with post-tumor resection of the face were reconstructed with free style local perforator flaps between January 2014 and November 2016. Doppler was used to identify the perforator vessels preoperatively. RESULTS Twenty-two clinical cases had no complications. Four had venous congestion that resolved spontaneously, three had a distal 1/3 superficial necrosis, and one suffered from hematoma. CONCLUSION Freestyle perforator flaps were applied to get better cosmetic facial reconstruction, allowing one stage procedure and decreasing donor site morbidity. Modern anatomical understanding, good planning, and meticulous surgical technique can affect clinical results.

Treatment of avascular necrosis is challenging and requires patient individual treatment planning. A 26-year-old HIV positive woman presented with increasing pain and stiffness in her left knee. We diagnosed an avascular necrosis of the knee with a severely limited range of movement. During her treatment, she also developed an avascular necrosis of both hips. To minimize the risks of prosthetic joint infection in an immunocompromised patient, we decided to perform a hip arthroplasty with an autologous full-thickness osteochondral transfer of the femoral head to the femoral condyle. Despite a lack of compliance and physiotherapy, the symptoms and range of movement significantly improved postoperatively, without the patient being pain-free. We propose that in cases of simultaneous avascular necrosis of hip and knee, a large autologous transfer is an option to prolong or prevent knee arthroplasty, especially in patients with risk factors for a poor outcome of arthroplasty.

The aim of this study was to determine whether there is a difference in functional outcome between the fixed-bearing and rotating-platform total knee replacement systems. One hundred twenty patients were randomised to receive either a fixed-bearing or rotating-platform total knee replacement. Range of movement (ROM), Oxford knee score (OKS) and Knee Society score (KSS) were assessed independently before and one year after surgery. Weight-bearing X-rays were taken immediately and one year post surgery to determine the incidence of osteolysis and loosening. At a mean follow-up of 13.4 months there was no statistically significant difference in mean ROM, OKS and KSS between the two groups. There was no evidence of osteolysis or loosening in either of the groups and no revision for infection or implant failure. This study shows that there is no statistically significant difference in functional outcome between the two types of implants at short-term follow-up.

Background Contrary to acute posterior cruciate ligament (PCL) bony tibial avulsions, surgical management of chronic injuries is technically challenging and appears to be controversial. We sought to assess the outcome of a novel screw post augmentation technique in neglected cases. Methods 16 patients were followed up in a tertiary single-center retrospective study. The bony fragment was fixed using a lag screw with a spiked washer and an additional screw post through an open posterior approach. The pre- and postoperative knee range of movement (ROM), laxity, and modified Tegner–Lysholm (TL) scores were compared. Results The median time from injury to surgery was 10 weeks (range, 3–260). The mean clinical follow-up time was 24.25 ± 9.21 months. At the final follow-up, the mean knee ROM flexion was 130° ± 11.55° with no extension lag. 3 patients had grade 1 laxity. The TL grade was predominantly excellent, and the overall median score improved from 76 preoperatively to 95 postoperatively (p Conclusion The described screw post fixation technique results in an excellent outcome for these rare injuries. Level of evidence Level IV, case series.

Background Identifying the physical impairments associated with worse symptoms and greater functional limitations in people with hip pain could enable targeted rehabilitation programmes designed to improve quality of life. The objective of this study was to compare physical characteristics between subgroups of symptoms and functional limitation severity in individuals with hip pain scheduled for arthroscopic surgery. Methods Hip range of motion (ROM) and muscle strength were measured in 114 individuals (48 women; aged 32 ± 8 years) with hip pain scheduled for hip arthroscopy. Pain and disability were measured with the International Hip Outcome Tool (iHOT33) subscale of Symptoms and Functional Limitation, and a cluster analysis was used to identify mild, moderate and severe subgroups. Between-group differences were then evaluated using multivariate analysis of covariance, including sex as a covariate, followed by post hoc testing. Significance was set at 0.05. Results Lesser hip muscle strength in all directions was reported in the severe symptoms and functional limitation group compared to the mild group. Hip flexion ROM differed when comparing the moderate to both the mild and severe subgroups. Hip internal rotation did not differ between subgroups of severity. Conclusions Individuals with hip pain and severe scores in the iHOT33 subscale of symptoms and functional limitations present with significantly lesser hip muscle strength and hip flexion ROM than individuals with moderate or mild scores. Targeted programmes to improve hip strength and flexion ROM in more severe patients may help reduce symptoms and improve function. Significance Individuals with severe hip pain and functional limitation possess significantly lesser muscle strength and flexion ROM than individuals with moderate or mild scores.

Background A prognostic clinical prediction rule (whiplash CPR) has been validated for use in individuals with acute whiplash associated disorders (WAD). The clinical utility of this tool is unknown. Objectives To investigate: 1) the level of agreement between physiotherapist- and whiplash CPR-determined prognostic risk classification of people with acute WAD; 2) which clinical findings are used by physiotherapists to classify prognostic risk; and 3) whether physiotherapists plan to differ the number of treatment sessions provided based on prognostic risk classification. Design Pragmatic, observational. Method 38 adults with acute WAD were classified as low, medium, or high risk of poor recovery by their treating physiotherapist (n = 24) at the conclusion of the initial consultation. A weighted Cohen's kappa examined the agreement between physiotherapist estimated risk classification and the whiplash CPR. Physiotherapists' reasons for classification were provided and summarised descriptively. Kruskal-Wallis and post-hoc Dunn's tests compared projected number of treatment sessions between risk subgroups. Results Physiotherapist agreement with the whiplash CPR occurred in 29% of cases (n = 11/38), which was less than what is expected by chance (K = −0.03; 95%CI -0.17 to 0.12). Physiotherapists most frequently considered range of movement (n = 23/38, 61%), a premorbid pain condition (n = 14/38, 37%), response to initial physiotherapy treatment (n = 12/38, 32%), and pain intensity (n = 12/38, 32%) when classifying prognostic risk. The projected number of treatment sessions was not different between risk groups using classifications provided by the physiotherapists (χ2(2) = 2.69, p = 0.26). Conclusions Physiotherapists should consider incorporating the whiplash CPR into current assessment processes to enhance accuracy in prognostic decision-making.

Background: Glenohumeral subluxation (GHS) is a commonly reported post-stroke complication which has a negative effect on rehabilitation.Objective: To explore the association between GHS an...

Background Passive oscillatory mobilizations are often employed by physiotherapists to reduce shoulder pain and increase function. However, there is little data about the neurophysiological effects of these mobilizations. Objectives To investigate the initial effects of an anteroposterior (AP) shoulder joint mobilization on measures of pain and function in overhead athletes with chronic shoulder pain. Design Double-blind, controlled, within-subject, repeated-measures design. Method Thirty-one overhead athletes with chronic shoulder pain participated. The effects of a 9-min, AP mobilization of the glenohumeral joint were compared with manual contact and no-contact interventions. Self-reported pain, pressure pain threshold (PPT), range of movement (ROM), muscle strength, and disability were measured immediately before and after each intervention. Results/findings No significant differences were found among the treatment conditions in any of the variables investigated. A significantly greater mean decrease in self-reported shoulder pain was observed following treatment condition [0.63 (0.12, 1.14); p = 0.01]. PPT at the affected shoulder increased significantly following both the treatment [0.23 (−0.43, 0.02); p = 0.02] and manual contact [0.28 (−0.51, 0.04); p = 0.01] conditions. Shoulder AP joint mobilization also increased PPT at a distal, non-painful site [0.42 (−0.85, 0.01); p = 0.04]. No changes were observed in shoulder ROM or muscle strength. Conclusions This study found no superior effects in various pain or function-related outcome measures of a passive oscillatory anteroposterior mobilization applied to the glenohumeral joint compared to manual contact and no-contact interventions in overhead athletes with chronic shoulder pain. Some ability to modulate shoulder pain and local and widespread pain sensitivity was observed in the short term after the passive oscillatory anteroposterior mobilization.

Introduction: Posterior sternoclavicular joint dislocations are extremely rare and emergent injuries. Presentation of case: We presented a case of a seventeen-year-old male patient who was diagnosed with traumatic posterior dislocation. He underwent joint reconstruction using sternocleidomastoid tendon autograft, and the operation went well. Discussion: At four-week and fourteen-week follow-up post-operatively revealed a surgical wound that healed well, regained stable sternoclavicular joint that was marked by a normal left sternoclavicular notch, full range of movement of the left shoulder and the pain subsided. Conclusion: These findings provide evidence that the method of joint reconstruction and augmentation may produce good outcome for posterior dislocation of the sternoclavicular joint. Keywords: Sternocleidomastoid tendon, Posterior dislocation, Sternoclavicular joint, Reconstruction