SPORTS INJURIES OF THE UPPER LIMBS

Design and Development of a Powered Myoelectric Elbow Orthosis for Neuromuscular Injuries

INTRODUCTION

Recovering from neuromuscular injuries or conditions can be a challenging journey that involves complex surgeries and extensive physical rehabilitation. During this process, individuals often rely on orthotic devices to support and enable movement of the affected limb. However, users have criticized current commercially available powered orthotic devices for their bulky and heavy design. To address these limitations, we developed a novel powered myoelectric elbow orthosis.

MATERIALS AND METHODS

The orthosis incorporates 3 mechanisms: a solenoid brake, a Bowden cable-powered constant torque elbow mechanism, and an extension limiter. The device controller and battery are in a backpack to reduce the weight on the affected arm. We performed extensive calculations and testing to ensure that the orthosis could withstand at least 15 Nm of elbow torque. We developed a custom software effectively control the orthosis, enhancing its usability and functionality. A certified orthotist fitted a subject who had undergone a gracilis free functioning muscle transfer surgery with the device. We studied the subject under Mayo clinic IRB no. 20-006849 and obtained objective measurements to assess the orthosis's impact on upper extremity functionality during daily activities.

RESULTS

The results are promising since the orthosis significantly improved elbow flexion range of motion by 40° and reduced compensatory movements at the shoulder (humerothoracic joint) by 50°. Additionally, the subject was able to perform tasks which were not possible before, such as carrying a basket with weights, highlighting the enhanced functionality provided by the orthosis.

CONCLUSION

In brief, by addressing the limitations of existing devices, this novel powered myoelectric elbow orthosis offers individuals with neuromuscular injuries/conditions improved quality of life. Further research will expand the patient population and control mechanisms.

Validity, Reliability and Reproducibility of OctoBalance Test as Tool to Measure the Upper Limb Compared to Modified-Upper Quarter Y-Balance Test

The articular evaluation of range of motion (ROM) is currently used to observe imbalance or limitations as possible risk factors or predispositions to suffer future injures. The main aim of this study is to verify the concurrent validity, reliability and reproducibility of the OctoBalance Test (OB) as a valid and reliable tool to measure articular ROM of the upper limb compared to the modified-Upper Quarter Y-Balance Test (mUQYBT). The twenty-five participants were male athletes. All of them were assessed with OB and mUQYBT in medial, superolateral, and inferolateral directions in both right and left arms with a three-minute break during these attempts. The process was repeated a second time with a week gap between measurements. Pearson correlation and linear logarithmic regression were used to examine the relationship between scores obtained with OB and mUQYBT. In order to verify the reliability, the intraclass correlation coefficient (ICC) was used (3.1). Concordance and reproducibility were assessed using Bland–Altman’s graph. A perfect correlation and an almost linear logarithmic regression (R² = 0.97) were observed between both measurement systems, with values of 73.531 ± 21.226 cm in mUQYBT and 69.541 ± 16.330 cm in OB. The differences were minimal between week one and week two. The assessment with Bland’s graph showed the concordance and reproducibility of scores, showing the dispersion and the upper and lower limits. OB is shown as valid in comparison to the other test as a reliable and reproducible tool for the assessment of the articular ROM in the upper limb, and it could be used for the evaluation of injuries.

Seated Single-Arm Shot-Put Test to Measure the Functional Performance of the Upper Limbs in Exercise Practitioners With Chronic Shoulder Pain: A Reliability Study

OBJECTIVE

To measure the intra- and interrater reliability of the seated single-arm shot-put test (SSPT) in the functional performance of the upper limbs of regular physical exercise practitioners with shoulder pain.

METHODS

This is a reliability study. Thirty individuals regularly practicing any sports modality that uses the upper limb effectively for at least 6 months, both sexes, ages between 18 and 30 years, with chronic shoulder pain were included. Chronic shoulder pain was measured by means of the shoulder pain and disability index, numerical rating scale, and catastrophic thoughts about pain scale. Functional performance of the upper limbs was measured by means of SSPT.

RESULTS

Excellent intrarater reliability was found, with intraclass correlation coefficient ≥0.93, standard error of the measurement values ≤4.63%, and minimum detectable change values for absolute and normalized score of 45.11 cm and 9.97, respectively. Excellent interrater reliability was found, with intraclass correlation coefficient ≥0.96, standard error of the measurement values ≤3.55%, and minimum detectable change values for absolute and normalized score of 32.29 cm and 7.70, respectively.

CONCLUSION

SSPT is a reliable tool for measuring the functional performance of the upper limbs in regular exercise practitioners with chronic shoulder pain.

Hand-Arm Vibration Assessment and Changes in the Thermal Map of the Skin in Tennis Athletes during the Service

During recent years the number of tennis athletes has increased significantly. When playing tennis, the human body is exposed to many situations which can lead to human injuries, such as the so-called tennis elbow (lateral epicondylitis). In this work a biomechanical analysis of tennis athletes, particularly during the service, was performed, considering three different types of over-grip and the presence of one anti-vibrator device. One part of the study evaluates the exposure to hand-arm vibration of the athlete, based on the European Directive 2002/44/EC concerning the minimum health and safety requirements, regarding the exposure of workers to risks from physical agents. The second part of the study considers an infrared thermography analysis in order to identify signs of risk of injury, particularly tennis elbow, one of the most common injuries in this sport. The results show that the presence of the anti-vibrator influences the vibration values greatly in the case of athletes with more experience and also for athletes with less performance. The presence of the Cork and/or Tourna on the racket grip does not have any significant effect on the hand-arm vibration (HAV), similarly in the case of athletes with the best performance and athletes with less technique. The results indicated that the infrared thermography technique may be used to identify the risk of injuries in tennis players.

[Muscular injuries of athletes : Importance of ultrasound]

CLINICAL/METHODICAL ISSUE

Muscular injuries represent the most common musculoskeletal lesions. Especially in professional athletes an imaging clarification is essential in order to define the exact location of the lesion, the affected muscles, the extent and degree of the injury as well as to define possible concomitant complications. The best possible therapy can be initiated and a necessary rest period for a low risk resumption of sporting activity can be individually specified.

STANDARD RADIOLOGICAL METHODS/METHODICAL INNOVATIONS

Due to technical improvements, for example mobile devices and thus increased rapid availability as well as relative cost-effectiveness compared to other modalities, the imaging evaluation of muscle injury would nowadays be unthinkable without ultrasound.

PERFORMANCE

The article discusses general prerequisites for the performance of muscle ultrasound as well as a standardized examination algorithm of muscle injuries beginning with general and leading to special tips and tricks.

ACHIEVEMENTS/PRACTICAL RECOMMENDATIONS

Despite the known investigator dependence, ultrasound enables a reliable and unerring imaging clarification of muscle injuries. For this reason, ultrasound should be considered as the first-line diagnostic imaging modality when dealing with muscle trauma.