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Byline: Atul. Goel, Saswat. Dandpat, Abhidha. Shah, Sagar. Bhambere, Hardik. Darji This is a report of two patients who were diagnosed to have NF-1. The patients had severe dystrophic soft [...]

Background: Volar instability of the distal radioulnar joint (DRUJ) is uncommon, and there is little written about it. The purpose of this study is to describe a new procedure to treat volar DRUJ instability and to present the outcomes of patients who received this unique surgical repair at a minimum of 1 year follow-up. Methods: We performed a retrospective case series of 6 consecutive patients treated with a volar and dorsal capsular plication procedure by an upper extremity specialist surgeon at a teaching hospital between April 1999 and October 2004. We evaluated measures, including wrist range of motion, grip strength, radiographs, Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and Patient-Rated Wrist Evaluation (PRWE), at final follow-up. Results: Five of 6 patients had resolution of pain and instability symptoms. The average difference in range of motion between operative and contralateral sides was -7[degrees]flexion, 2[degrees]extension, 4[degrees]radial deviation, 2[degrees]ulnar deviation, -17[degrees]supination and -2[degrees] pronation. Average grip strength measured 83% of the uninjured side. The average DASH score was 13.5 (range 0-46.7), and the average PRWE score was 26.7 (range 0-70). One patient had a low ulnar neuropathy, which resolved. One patient fractured the temporary DRUJ stabilization screw and had radiographic evidence of nonbridging heterotopic ossification. Conclusion: Joint capsular plication for DRUJ has not yet been described in the literature. It is less elaborate in that it does not require a tendon graft with bone tunnels. The results at an average 16.5 months postoperatively are promising. Contexte : L'instabilite palmaire de l'articulation radiocubitale distale est rare et peu de choses ont ete ecrites a ce sujet. Le but de la presente etude est de decrire une nouvelle intervention pour le traitement de l'instabilite palmaire de l'articulation radiocubitale distale et de presenter les resultats obtenus chez des patients qui ont beneficie de cette reparation chirurgicale unique, apres un suivi minimum d'un an. Methodes : Une analyse retrospective a regroupe une serie de 6 patients consecutifs traites par plicature capsulaire palmaire et dorsale realisee par un chirurgien specialiste des membres superieurs dans un hopital universitaire, entre avril 1999 et octobre 2004. Nous avons tenu compte de divers parametres, dont l'amplitude de mouvement du poignet, la force de prehension, les radiographies, les resultats au questionnaire DASH (pour Disabilities of the Arm, Shoulder and Hand) et a l'echelle PRWE (pour Patient-Rated Wrist Evaluation), lors du suivi final. Resultats : Chez 5 patients sur 6, les symptomes de douleur et d'instabilite sont rentres dans l'ordre. La difference d'amplitude de mouvement moyenne entre le cote opere et l'autre etait de -7[degrees]pour la flexion, 2[degrees]pour l'extension, 4[degrees]pour la deviation radiale, 2[degrees]pour la deviation cubitale, -17[degrees]pour la supination et -2[degrees]pour la pronation. La force de prehension moyenne etait de 83 % par rapport au cote indemne. Le score DASH moyen etait de 13,5 (entre 0 et 46,7) et le score PRWE moyen etait de 26,7 (entre 0 et 70). Un patient a presente une neuropathie cubitale basse qui s'est resorbee. La vis de stabilisation de l'articulation radiocubitale distale s'est cassee chez 1 patient, et la radiographie revelait une ossification heterotopique. Conclusion : La plicature capsulaire de l'articulation radiocubitale distale n'avait encore fait l'objet d'aucune description dans la litterature. L'intervention est plus simple, en ce sens qu'elle ne requiert pas de greffon tendineux au niveau des tunnels osseux. Les resultats observes au moment du suivi postoperatoire moyen, a 16,5 mois, sont prometteurs., Chronic instability of the distal radioulnar joint (DRUJ) can lead to substantial pain, decreased grip strength and other mechanical symptoms. (1) The most common form of instability is described as [...]

There is some debate in the literature as to whether strength deficits exist at the ankle in individuals with chronic ankle instability (CAI). Additionally, there is evidence to suggest that knee and hip performance is altered in those with CAI. Therefore, the purpose of this study was to determine whether CAI is associated with deficits in ankle, knee, and hip torque. Fifteen subjects with unilateral CAI and fifteen subjects with healthy ankles participated. Subjects reported to the laboratory for one session during which the torque production of ankle plantar flexion/dorsiflexion, knee flexion/extension, and hip flexion/ extension were measured with an isokinetic device. Subjects performed 5 maximum-effort repetitions of a concentric/ concentric protocol at 60[degrees] x [s.sup.-1] for both extremities. Average peak torque (APT) values were calculated. The subjects with CAI demonstrated significantly less APT production for knee flexion ([F.sub.1,28] = 5.40; p = 0.03) and extension ([F.sub.1,28] = 5.34; p = 0.03). Subjects with CAI exhibited significantly less APT for ankle plantar flexion in the injured limb compared with their noninjured limb ([F.sub.1,28] = 6.51; p = 0.02). No significant difference in ankle dorsiflexion or hip flexion/extension APT production existed between the 2 groups. Individuals with CAI, in addition to deficits in ankle plantar flexion torque, had deficits in knee flexor and extensor torque, suggesting that distal joint instability may lead to knee joint neuromuscular adaptations. There were no similar deficits at the hip. Future research should determine what implications this has for prevention and rehabilitation of lower-extremity injury. Clinicians may need to consider including rehabilitation efforts to address these deficits when rehabilitating patients with CAI. KEY WORDS strength, lower extremity, isokinetics

30 subjects with BJHS (Hypermobile) (M age = 32.3 yr., SD = 10.4) and two control groups, 25 healthy subjects (Healthy) (M age = 33.9 yr., SD = 9.3) and 30 fibromyalgic patients (Fibromyalgic) (M age = 32.2 yr., SD = 9.4), were given the Symptom Checklist-90-R, the Illness Behavior Questionnaire, the Female Functional Symptoms Frequency (FFF) and the Male Functional Symptoms Frequency (MFF), derived from the DSM-III-R, evaluating functional somatic disturbances and their intensity, and the Symptom Questionnaire. The mean scores for the Hypermobile group showed significant psychological distress and increased frequency and intensity of somatic symptoms. Scores on Anxiety and Somatic Symptoms, General Hypochondriasis, Disease Conviction, Affective Disturbance, Denial, and Irritability were significantly higher in the Hypermobile than in the Healthy group. Elevated scores were found for the Fibromyalgic group on the Illness Behavior Questionnaire subscales for Psychological vs Somatic Focus, Disease Affirmation, and Discriminating Factors when compared with the Hypermobile group. Considerable emotional symptoms were detected which should not be underestimated by physicians when establishing an integrated biopsychosocial therapy.

Background: Various surgical techniques to treat posterolateral knee instability have been described. To date, the recommended treatment is an anatomical form of reconstruction, in which the 3 key structures of the posterolateral corner are addressed: the lateral collateral ligament, the popliteofibular ligament, and the popliteus tendon. Hypothesis: Two methods of surgical reconstruction will restore posterolateral knee instability, in terms of static laxity as well as dynamic 6 degrees of freedom kinematics, to statistically significant levels compared with the intact state. Study Design: Controlled laboratory study. Methods: Two surgical techniques (A and B) were used to reconstruct the posterolateral structures in 10 cadaveric knees. Static tests were performed on the intact, sectioned, and reconstructed knees at 30° and 90° of flexion for anterior-posterior laxity and external rotational laxity, as well as at 0° and 30° of flexion for varus laxity; dynamic 6 degrees of freedom kinematic testing, through a path of motion from 90° of flexion to full extension, was also performed. Results: For the static varus tests, external rotation and varus laxity were significantly increased after the posterolateral structures were cut. Both reconstruction techniques restored external rotation and varus laxity to levels not significantly different from the intact state. For technique B, dynamic testing did not show any significant difference for all degrees of freedom kinematics compared with the intact state. However, for technique A, a significant internal tibial rotation was observed throughout the entire path of motion from 0° to 90° of knee flexion. Conclusions: Both surgical techniques for anatomical posterolateral corner reconstruction showed good results in the static laxity tests. The anatomical reconstruction of all structures, including the popliteus tendon, resulted in ah abnormal internal tibial rotation during dynamic testing. Keywords: posterolateral knee; knee reconstructions; popliteus complex; knee kinematics, Injuries to the posterolateral corner of the knee can easily be missed on knee examination, although their identification is important clinically, as they may cause posterolateral rotatory instability of the [...]

A postural load assessment system is developed based on a macro-postural load classification scheme. The classification scheme is constructed based on perceived discomfort for various joint motions and previous research outcomes.

ABSTRACT: Shoulder pathology includes a variety of disorders that often have similar symptoms. Rotator cuff injury is the most common cause of shoulder pain. Other conditions include glenohumeral joint instability, [...]

The reliability of functional-performance tests when used to diagnose ankle impairment is examined. Sixteen college students with ankle instability were tested using hopping and shuttle running and then asked to answer a questionnaire about pain, swelling, instability and other symptoms. The tests were ineffective in identifying the injured ankle.