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Berkane Y, Giorgino R, Ng ZY, Dukan R, Lellouch AG. Alternative Flap Options for Upper Extremity Reconstruction. Hand Clin 2024; 40:291-299. [PMID: 38553100 DOI: 10.1016/j.hcl.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
For major upper limb defects, a wide range of established pedicled and free flap options can be used. These include the latissimus dorsi/thoracodorsal artery perforator, lateral arm, posterior interosseous artery, rectus abdominis, gracilis, and anterolateral thigh flaps. Technical proficiency is essential, and favorable success rates in terms of functional and esthetic outcomes can be achieved. Herein, alternative flap options (both pedicled and free) are introduced and discussed through a few illustrative case examples.
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Affiliation(s)
- Yanis Berkane
- Department of Plastic, Reconstructive and Aesthetic Surgery, CHU Rennes, Rennes University, 16 Boulevard de Bulgarie, 35000 Rennes, France; Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Harvard Medical School, 50 Blossom Street, Boston, MA 02114, USA; UMR U1236-MICMAC, Immunology and Cell Therapy Lab, Rennes University Hospital, 2 Rue Henri Le Guillou, 35000 Rennes, France
| | - Riccardo Giorgino
- Residency Program in Orthopaedics and Traumatology, University of Milan, Via Cristina Belgioioso, 173, 20161 Milan, Italy; IRCCS Istituto Ortopedico Galeazzi, Via Cristina Belgioioso, 173, 20161 Milan, Italy; Plastic Surgery Research Laboratory, Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, 50 Blossom Street, Boston, MA 02114, USA
| | - Zhi Yang Ng
- Department of Plastic and Reconstructive Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford OX3 9DU, UK
| | - Ruben Dukan
- Department of Hand, Upper Limb & Peripheral Nerve Surgery, Georges-Pompidou European Hospital (HEGP), 20 Rue Leblanc, Paris, France
| | - Alexandre G Lellouch
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Harvard Medical School, 50 Blossom Street, Boston, MA 02114, USA; Department of Plastic, Reconstructive & Aesthetic Surgery, Georges-Pompidou European Hospital (HEGP), University of Paris, 20 Rue Leblanc, Paris, France; Innovative Therapies in Haemostasis, INSERM UMR-S 1140, University of Paris, F-75006, Paris, France.
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Abu Qasida A, Delay A, Guerid S, Gisquet H, Frobert P, Delay E. Latissimus dorsi seroma prevention with running quilting suture using barbed suture. ANN CHIR PLAST ESTH 2024; 69:239-248. [PMID: 37429801 DOI: 10.1016/j.anplas.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/14/2023] [Accepted: 06/22/2023] [Indexed: 07/12/2023]
Abstract
Dorsal seroma is a common complication of autologous latissimus dorsi flap (ALDF) in breast reconstruction, and has limited the use of this technique, despite its aesthetic success. It is important to find a right technique to limit the incidence of seroma formation after ALDF. The aim of this study was to evaluate the effectiveness and tolerance of a dorsal quilting technique called "running quilting" using barbed resorbable suture in seroma prevention. Three hundred patients who underwent ALDF breast reconstruction in the period between 2004 and 2014 were included in this study. The population was divided in 3 groups; without quilting, with simple quilting suture, and with running quilting using barbed suture. The incidence of small seromas (requiring 1 or 2 aspirations during routine postoperative visits without adding additional appointments to the follow-up routine) was not significantly decreased: it was 54% in the non-quilted group, 47% in group 2 Quilting, and 34% in group 3 running quilting. However, quilting reduced the duration of drainage, and the rate of late seromas (from 8% to 0%), and chronic sero-hematomas completely disappeared in our experience. Running quilting using barbed suture is highly effective in preventing late and refractory donor-site seromas. Its effectiveness is expected to increase the use of ALDF in breast reconstruction, which we consider currently as one of the best autologous reconstruction techniques.
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Affiliation(s)
- A Abu Qasida
- Département de Chirurgie Plastique et Reconstructrice, Centre Léon-Bérard, Lyon, France
| | - A Delay
- Département de Chirurgie Plastique et Reconstructrice, Centre Léon-Bérard, Lyon, France
| | - S Guerid
- Département de Chirurgie Plastique et Reconstructrice, Centre Léon-Bérard, Lyon, France
| | - H Gisquet
- Département de Chirurgie Plastique et Reconstructrice, Centre Léon-Bérard, Lyon, France
| | - P Frobert
- Département de Chirurgie Plastique et Reconstructrice, Centre Léon-Bérard, Lyon, France
| | - E Delay
- Département de Chirurgie Plastique et Reconstructrice, Centre Léon-Bérard, Lyon, France; Clinique Charcot, 51, rue du Commandant-Charcot, 69110 Sainte-Foy-lès-lyon, France.
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Wolff WL, Heinemann CM, Kartes JM, Ashton-Miller JA, Lipps DB. The influence of chair recline and head and neck position on upper trapezius activity and stiffness during seated computer work. Appl Ergon 2024; 117:104227. [PMID: 38290318 DOI: 10.1016/j.apergo.2024.104227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 12/06/2023] [Accepted: 01/05/2024] [Indexed: 02/01/2024]
Abstract
Increasing chair recline during seated computer work may reduce the load placed on the upper trapezius (UT), a common location of pain for those with idiopathic chronic neck pain. This study determined the effect of increasing chair recline on UT stiffness and muscle activity during computer work in people with and without idiopathic chronic neck pain. Surface electromyography and ultrasound shear wave elastography were collected from three subdivisions of the UT in 15 individuals with idiopathic chronic neck pain and 15 sex-matched healthy controls. Participants sat in a standardized computer-work setup while chair recline (0°, 25°, 45°) and head and neck position (self-selected, neutral, flexed) were systematically adjusted and maintained for 2.5-min intervals. Repeated-measures ANOVAs were completed for each sex, muscle, and data type, with group (chronic neck pain, control), chair recline (0°,25°,45°), head and neck position (self-selected, flexed, neutral), and side of collected data (dominant, non-dominant) as fixed factors. Men with idiopathic chronic neck pain demonstrated greater UT stiffness in the cranial subdivision when compared to healthy men. Additionally, the 25° and 45° recline levels increased the stiffness of men's dominant UT compared to men's non-dominant UT. Women's UT was more affected by head and neck position, and a neutral head and neck position resulted in lower UT activation, but higher UT stiffness for the cranial subdivision and midway between C-7 and the acromion process. Overall, our findings suggest that the commonly suggested neutral position may not be a beneficial prompt when positioning someone during seated computer work.
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Affiliation(s)
- Whitney L Wolff
- Department of Kinesiology and Community Health, University of Illinois, Urbana-Champaign, IL, USA.
| | | | - Jordan M Kartes
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA
| | - James A Ashton-Miller
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA; Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA; Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - David B Lipps
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA; Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
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Bustamante A, Zavala A, Iglesias M, Tornero R, Machaca L, De Pawlikowski W. Quality of Life After Lower Leg Reconstruction With the Latissimus Dorsi Free Flap in Pediatric Patients. Ann Plast Surg 2024; 92:418-423. [PMID: 38527349 DOI: 10.1097/sap.0000000000003812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
BACKGROUND The latissimus dorsi free flap is a widely used reconstructive technique for complex lower leg defects in the pediatric population due to its reliability and anatomical features. However, the impact of this technique on the postoperative quality of life in children and adolescents, who require appropriate lower extremity function during their developmental period, remains to be analyzed. METHODS Patients who underwent microsurgical lower leg reconstruction using the latissimus dorsi flap were analyzed retrospectively. The quality of life of these patients was assessed prospectively using the Lower Extremity Functional Scale (LEFS) at a minimum of 18 months after surgical reconstruction. RESULTS Sixteen pediatric patients who had severe lower extremity injuries and underwent latissimus dorsi free flap reconstruction met the inclusion criteria. The mean follow-up period was 33.9 months (22-64 months). Two patients experienced postoperative complications: one had partial flap necrosis and surgical site infection, while the other developed a surgical site infection. The LEFS scores ranged from 26 to 80, with a mean score of 64.6. Remarkably, 14 of 16 patients achieved LEFS scores consistent with at least the 10th percentile when compared with normative data. Patients with severe associated fractures presented with the lowest scores. CONCLUSIONS Based on our findings, the latissimus dorsi flap is reaffirmed to be an excellent choice for lower leg reconstruction in the pediatric population. It effectively restores the quality of life in patients who have experienced moderate to severe lower extremity injuries.
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Affiliation(s)
- Atenas Bustamante
- From the Department of Plastic and Reconstructive Surgery, Instituto Nacional de Salud del Niño-San Borja
| | - Abraham Zavala
- Department of Plastic and Reconstructive Surgery, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Martin Iglesias
- From the Department of Plastic and Reconstructive Surgery, Instituto Nacional de Salud del Niño-San Borja
| | - Ray Tornero
- From the Department of Plastic and Reconstructive Surgery, Instituto Nacional de Salud del Niño-San Borja
| | - Lucero Machaca
- From the Department of Plastic and Reconstructive Surgery, Instituto Nacional de Salud del Niño-San Borja
| | - Wieslawa De Pawlikowski
- From the Department of Plastic and Reconstructive Surgery, Instituto Nacional de Salud del Niño-San Borja
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Ali Ismail AM, Abd El-Azeim AS, El-Sayed Felaya ESE. Integrated neuromuscular inhibition technique versus spray and stretch technique in neck pain patients with upper trapezius trigger points: a randomized clinical trial. J Man Manip Ther 2024; 32:141-149. [PMID: 36951194 PMCID: PMC10956923 DOI: 10.1080/10669817.2023.2192899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 03/11/2023] [Indexed: 03/24/2023] Open
Abstract
OBJECTIVE This study aimed to investigate the difference between the integrated neuromuscular inhibition technique (INIT) and spray and stretch technique in patients with neck pain and upper trapezius active trigger points. Methods: A convenience sample of 60 patients with neck pain and active trigger points were recruited from physiotherapy students and allocated randomly to three groups INIT plus stretching exercise spray and stretch technique plus stretching exercise, and stretching exercise only. Treatment was three times per week for four weeks. Pain intensity by visual analogue scale (VAS), pain pressure threshold (PPT), neck disability by Arabic neck disability index (ANDI), and muscle amplitude in the form of root mean square (RMS) by electromyography (EMG) were measured at baseline and after four weeks. Results: Between groups analysis; the results revealed statistical significant difference between three groups after four weeks of intervention as p =0.0001. Within the group analysis, post hoc tests reported improvement at all variables in both INIT and spray and stretch technique groups with mean differences 64.5 and 65.1 in VAS, 20 and 18.15 in ANDI, -1.45 and -0.81 in PPT, and 2.47 and 1.88 in muscle amplitude, respectively. But there was no statistically significant difference in stretching only group in all variables except VAS. CONCLUSION Both INIT and spray and stretch techniques had a clinical and statistical effects on pain, function, PPT, and RMS. According to results, there were statistical significant differences between INIT and spray and stretch groups at post-treatment in all variables except VAS with more favor to INIT group, but there were no clinical differences between INIT and spray and stretch groups.
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Affiliation(s)
- Ali Mohamed Ali Ismail
- Department of Physical Therapy for Cardiovascular/Respiratory Disorder and Geriatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | | | - El-Sayed Essam El-Sayed Felaya
- Department of Physical Therapy for Cardiovascular/Respiratory Disorder and Geriatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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Baek CH, Kim BT, Kim JG, Kim SJ. Increased latissimus dorsi and teres major muscle volume after anterior transfer for irreparable anterior superior rotator cuff tear: correlation with improved internal rotation strength. Arch Orthop Trauma Surg 2024; 144:1491-1502. [PMID: 38316700 DOI: 10.1007/s00402-023-05192-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 12/19/2023] [Indexed: 02/07/2024]
Abstract
INTRODUCTION While the well-established correlation between increased muscle volume and enhanced muscle strength is widely recognized, there have been no studies assessing volumetric muscle changes in transfer surgery in the shoulder. This study aimed to evaluate changes in transferred muscle volume and their clinical implications in anterior latissimus dorsi and teres major (aLDTM) tendon transfer in patients with anterior superior irreparable rotator cuff tears (ASIRCTs). MATERIALS AND METHODS The study retrospectively examined 40 patients who underwent aLDTM tendon transfers for ASIRCTs between August 2018 and January 2022. Using ImageJ software, the LDTM muscle was segmented in T2-weighted oblique axial images, and total muscle volume (tLDTMV) of both immediate and postoperative 1-year were calculated. Pearson correlation analysis was used to determine the correlation between ΔtLDTMV and ΔASES scores, Δactive-ROM, and Δstrength. RESULTS The current study revealed an 11.4% increase in tLDTMV at 1-year postoperative. Patients were grouped based on postoperative ASES score: Group 1 (Optimal, n = 17) and Group 2 (Suboptimal, n = 23). Although tLDTMVimmediate postoperative values were similar between groups (P = 0.954), tLDTMV1-year postoperative value was significantly higher in Group 1 compared to Group 2 (P = 0.021). In correlation analysis, ΔtLDTMV showed significant correlations with ΔASES score (r = 0.525, P < 0.001), ΔaROM of forward elevation (FE) (r = 0.476, P = 0.002), ΔaROM of internal rotation (IR) at back (r = 0.398, P = 0.011), Δstrength of FE (r = 0.328, P = 0.039), Δ strength of IR at 90° abduction (r = 0.331, P = 0.037), and IR at side (r = 0.346, P = 0.029). CONCLUSIONS Significant increase in tLDTMV was observed at 1-year postoperative for ASIRCT patients. Notably, greater ΔtLDTMV exhibited a correlation with better ASES scores, increased aROM and strength in both FE and IR. Nevertheless, further research is required by employing more robust standardized measurement tools and a larger sample size.
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Affiliation(s)
- Chang Hee Baek
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, 50, Yeoseo 1-Ro , Yeosu-Si, Jeollanam-Do, 59709, Republic of Korea.
| | - Bo Taek Kim
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, 50, Yeoseo 1-Ro , Yeosu-Si, Jeollanam-Do, 59709, Republic of Korea
| | - Jung Gon Kim
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, 50, Yeoseo 1-Ro , Yeosu-Si, Jeollanam-Do, 59709, Republic of Korea
| | - Seung Jin Kim
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, 50, Yeoseo 1-Ro , Yeosu-Si, Jeollanam-Do, 59709, Republic of Korea
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Baek CH, Kim BT, Kim JG, Kim SJ. Joint-preserving treatment for global irreparable rotator cuff tears: combined anterior Latissimus dorsi and Teres major tendon transfer. Arch Orthop Trauma Surg 2024; 144:1473-1483. [PMID: 38285220 DOI: 10.1007/s00402-023-05196-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 12/19/2023] [Indexed: 01/30/2024]
Abstract
INTRODUCTION Treating global irreparable rotator cuff tears (GIRCTs) that involve both antero-and postero-superior cuff tendon tears could be a challenging problem. There has been limited joint-preserving treatment options in high-demand patients with minimal glenohumeral arthritis. The study aims to assess the clinical outcome of combined anterior latissimus dorsi and teres major tendon (aLDTM) transfer for patients with both GIRCTs and minimal glenohumeral arthritis. MATERIALS AND METHODS This retrospective study included patients who underwent combined aLDTM transfer for GIRCTs between 2018 May and 2020 October. Clinical outcomes include pain VAS, Constant, American Shoulder and Elbow Society (ASES), University of California Los Angeles (UCLA), activities of daily living requiring active internal rotation (ADLIR) score, active range of motion (aROM), strength, rates of pseudoparalysis or pseudoparesis reversal and return to work. Radiographic assessment included the acromiohumeral distance (AHD), Hamada grade, and transferred tendon integrity at final follow-up. RESULTS 23 patients (mean age: 64.7 ± 5.9 years [55-74]) were included and the mean follow-up period was 28.2 ± 4.3 [24‒36] months. Postoperatively, VAS, Constant, ASES, UCLA, and ADLIR scores significantly improved at final follow-up (P < .001). Postoperative aROM was significantly improved in forward elevation (FE) to 129° ± 29°, abduction (ABD) to 105° ± t3°, and internal rotation (IR) at back to 5.9 ± 2.5. Strength of both FE and IR were also significantly improved (P < .001). Patients with preoperative pseudoparalysis (2 of 4 patients) and pseudoparesis (6 of 6 patients) experienced a reversal. No significant change in AHD and hamada grade was confirmed at final follow-up. 3 patients experienced partial tear of the transferred tendon. CONCLUSIONS In this study, we found significant improvement in clinical outcomes with no significant progression of arthritis by final follow-up. The aLDTM transfer could be an alternative choice of joint-preserving treatment option for young and active patients with GIRCTs and minimal glenohumeral arthritis. However, large and long-term studies should be conducted to establish its adequacy. STUDY DESIGN Case series. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Chang Hee Baek
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, 50, Yeoseo 1-ro, Yeosu-si, Jeollanam-do, 59709, Republic of Korea.
| | - Bo Taek Kim
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, 50, Yeoseo 1-ro, Yeosu-si, Jeollanam-do, 59709, Republic of Korea
| | - Jung Gon Kim
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, 50, Yeoseo 1-ro, Yeosu-si, Jeollanam-do, 59709, Republic of Korea
| | - Seung Jin Kim
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, 50, Yeoseo 1-ro, Yeosu-si, Jeollanam-do, 59709, Republic of Korea
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Dudek A, Sienkiewicz W, Lepiarczyk E, Kaleczyc J. Immunohistochemical properties of motoneurons supplying the porcine trapezius muscle. Pol J Vet Sci 2024; 27:75-84. [PMID: 38511605 DOI: 10.24425/pjvs.2024.149337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
The trapezius muscle (TRAP) belongs to the scapulothoracic group of muscles, which play a crucial role in the integrity and strength of the upper limb, trunk, head, and neck movements and, thus, in maintaining balance. Combined retrograde tracing (using fluorescent tracer Fast Blue, FB) and double-labelling immunohistochemistry were applied to investigate the chemical coding of motoneurons projecting to the porcine TRAP. FB-positive (FB+) motoneurons supplying the cervical (c-TRAP) and thoracic part (th-TRAP) of the right (injected with the tracer) TRAP were located within the IX-th Rexed lamina in the ipsilateral ventral horn of the grey matter of the spinal medulla. Immunohistochemistry revealed that nearly all the neurons were cholinergic in nature [choline acetyltransferase (CHAT)- or vesicular acetylcholine transporter (VACHT)-positive]. Many retrogradelly labelled neurons displayed also immunoreactivity to calcitonin gene-related peptide (CGRP; approximately 68% of FB+ neurons). The smaller number of nerve cells (5%, 3%, 2% or 1%, respectively) stained for nitric oxide synthase (n-NOS), vasoactive intestinal polypeptide (VIP), neuropeptide Y (NPY) and substance P (SP). The retrogradely labelled neurons were closely apposed by nerve fibres expressing immunoreactivity to CHAT, VACHT, CGRP, SP, DβH, VIP, n-NOS, NPY, GAL, Leu-Enk and Met-Enk. Taking into account the clinical relevance of TRAP, the present results may be useful in designing further research aimed at the management of various dysfunctions of the muscle.
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Affiliation(s)
- A Dudek
- Department of Animal Anatomy, Faculty of Veterinary Medicine, University of Warmia and Mazury in Olsztyn, Oczapowskiego 13, 10-719 Olsztyn, Poland
| | - W Sienkiewicz
- Department of Animal Anatomy, Faculty of Veterinary Medicine, University of Warmia and Mazury in Olsztyn, Oczapowskiego 13, 10-719 Olsztyn, Poland
| | - E Lepiarczyk
- Department of Human Physiology and Pathophysiology, School of Medicine, Collegium Medicum,University of Warmia and Mazury in Olsztyn, Warszawska 30, 10-082, Olsztyn, Poland
| | - J Kaleczyc
- Department of Animal Anatomy, Faculty of Veterinary Medicine, University of Warmia and Mazury in Olsztyn, Oczapowskiego 13, 10-719 Olsztyn, Poland
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Wu CH, Velazquez-Mujica J, Donfrancesco A, Lee JJ, Chen HC. Classification of the Conjoined Latissimus Dorsi-Groin Flap and Indications for the Four Types of the Flap. Plast Reconstr Surg 2024; 153:632e-635e. [PMID: 38385724 DOI: 10.1097/prs.0000000000010812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
SUMMARY The conjoined latissimus dorsi-groin flap is a versatile flap that not only can serve as an osteocutaneous flap to provide large soft tissue and bone for reconstruction of extensive defects but also can offer functioning muscle transfer and lymph node transfer for prevention of lymphedema after wide excision of tumors or major trauma. Over the past 24 years, the authors have classified the conjoined latissimus dorsi-groin flap into four categories. They propose precautions for application of the conjoined flaps.
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Affiliation(s)
- Cho-Han Wu
- From the Department of Plastic and Reconstructive Surgery, China Medical University Hospital
| | | | - Andrea Donfrancesco
- From the Department of Plastic and Reconstructive Surgery, China Medical University Hospital
| | - Jian-Jr Lee
- From the Department of Plastic and Reconstructive Surgery, China Medical University Hospital
| | - Hung-Chi Chen
- From the Department of Plastic and Reconstructive Surgery, China Medical University Hospital
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Seok H, Lee S, Jun D. The effect of deep neck flexor endurance on craniovertebral angle changes and neck and shoulder muscle activities during a computer task. Int J Occup Saf Ergon 2024; 30:100-107. [PMID: 37667557 DOI: 10.1080/10803548.2023.2254151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
The deep neck flexors are important for maintaining neck posture by stabilizing and supporting it through low-intensity contraction, ensuring static endurance. The subjects performed computer tasks after having their deep neck flexor endurance measured using a pressure biofeedback unit. The craniovertebral angle (CVA) and the muscle activities were measured while participants were completing computer tasks for 10 min. The deep neck flexor endurance was significantly negatively correlated with CVA changes at 0-2 min. The deep neck flexor endurance was significantly negatively correlated with sternocleidomastoid muscle and upper trapezius activity at 0-2 min. The deep neck flexor endurance negatively predicted CVA changes at 0-2 min and explained 28.8% of the variance in the CVA changes. The lower the deep neck flexor endurance, the earlier the simultaneous changes occurred in the CVA and the neck and shoulder muscle activities during computer tasks.
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Affiliation(s)
- Him Seok
- Department of Physical Therapy, Kyungsung University, Republic of Korea
| | - Sangyeol Lee
- Department of Physical Therapy, Kyungsung University, Republic of Korea
| | - Deokhoon Jun
- Department of Rehabilitation science, Daegu University, Republic of Korea
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Wang L, Zhang M, Li T, Chi Y, Zhang W, Huang J, Yu N, Long X. Nerve Distribution Method is Superior to the Conventional Method in BoNT-A Treatment of Trapezius Hypertrophy: A Randomized Controlled Trial. Aesthetic Plast Surg 2024; 48:1210-1217. [PMID: 37783864 DOI: 10.1007/s00266-023-03662-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/06/2023] [Indexed: 10/04/2023]
Abstract
The contour of the neck and shoulder is defined by the trapezius muscle (TM). Beyond facial procedures, botulinum toxin A (BoNT-A) injections has been increasingly adopted to create a smooth shoulder line. Several studies described the intramuscular nerve branching and the pattern of perforating branch of the accessory nerve in the trapezius muscle, providing essential information for botulinum neurotoxin injection. To this date, research groups seldom perform clinical investigations, especially randomized controlled trials, that demonstrates whether BoNT-A injections using the nerve distribution method for aesthetic purposes is more effective. Patients met the criteria for inclusion were randomized to either the Nerve Distribution group (ND group) or control group. Control group patients received injection using the conventional method while ND group patients received the nerve distribution method. Photographic and ultrasonographic evaluations were carried out at baseline, one month, three months, and six months after the procedure. Patients were also required to complete a questionnaire to evaluate their feedbacks to the injection. After screening, 30 healthy young Chinese women were included. At one-month follow-up, no statistically significant difference was observed between the two methods. At the three-month follow-up, the reduction of the TM thickness for the ND group (0.21 ± 0.09 cm) was more than that for the control group (0.27 ± 0.08 cm), with p = 0.047*. Similar differences were observed for the reduction of the shoulder area proportion (p = 0.031*) and the shoulder angle (p = 0.035*). At the six-month follow-up, the reduction in TM thickness in the ND group (0.2 ± 0.09 cm) was more than that of the control group (0.28 ± 0.06 cm), with p = 0.041*. The global aesthetic improvement scale feedbacks of the two methods showed no significant difference (3.4 ± 0.71 vs 3.8 ± 0.91, p = 0.207). The patients did not experience severe side effects. Compared to the conventional injection method, the nerve distribution method is more effective in reducing the trapezius muscle thickness, shoulder area proportion, and shoulder angle at three months, and shows longer lasting effects. The results of this study introduce unique insights into the design and tailoring of treatment protocols for shoulder-line contouring using BoNT-A.Level of Evidence I This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Liquan Wang
- Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, No.1, Shuaifuyuan, Dongcheng District, 100005, Beijing, China
| | - Mengyuan Zhang
- Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, No.1, Shuaifuyuan, Dongcheng District, 100005, Beijing, China
| | - Tianhao Li
- Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, No.1, Shuaifuyuan, Dongcheng District, 100005, Beijing, China
| | - Yarong Chi
- Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, No.1, Shuaifuyuan, Dongcheng District, 100005, Beijing, China
| | - Wenchao Zhang
- Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, No.1, Shuaifuyuan, Dongcheng District, 100005, Beijing, China
| | - Jiuzuo Huang
- Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, No.1, Shuaifuyuan, Dongcheng District, 100005, Beijing, China
| | - Nanze Yu
- Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, No.1, Shuaifuyuan, Dongcheng District, 100005, Beijing, China.
| | - Xiao Long
- Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, No.1, Shuaifuyuan, Dongcheng District, 100005, Beijing, China
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Aldabbas MM, Tanwar T, Iram I, Salman M, Veqar Z. A comparison of nocturnal upper trapezius muscle activity between chronic neck pain patients with sleep disturbance and healthy participants. Sleep Breath 2024; 28:95-102. [PMID: 37421519 DOI: 10.1007/s11325-023-02867-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 05/05/2023] [Accepted: 06/02/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND Sleep disturbances frequently occur in patients with chronic neck pain. In these patients, upper trapezius muscle dysfunction is observed during sleep. This study aimed to evaluate the trapezius muscle activity during sleep among patients with chronic neck pain and sleep disturbances for comparison with healthy subjects. STUDY DESIGN: Cross-sectional study. METHODS Patients with chronic neck pain and healthy subjects participated in the study. Two overnight polysomnography recordings were conducted for each subject. Surface electromyography was utilized to record the nocturnal activity of the right and left upper trapezius muscles throughout the night. The nocturnal upper trapezius activity recording was divided into the following parts: wakefulness, rapid eye movement sleep (REM), and non-rapid eye movement sleep (NREM). The nocturnal activity during NREM sleep was further divided into three parts (stage I NREM sleep, stage II NREM, and stage III NREM. Normalization of EMG signals was performed. The normalized value of nocturnal activity was derived for analysis. RESULTS Among 15 patients with chronic neck pain and 15 healthy subjects, statistically significant differences were observed in the nocturnal activity of the upper trapezius. Compared to healthy subjects, the nocturnal activity of the upper trapezius was significantly higher during wakefulness, REM sleep, and NREM II and III sleep in patients with chronic neck pain and sleep disturbances. CONCLUSION There was higher nocturnal upper trapezius activity in patients with chronic neck pain compared to healthy controls. The findings suggest a possible pathophysiological mechanism that may relate to chronic neck pain. TRIAL REGISTRATION CTRI/2019/09/021028.
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Affiliation(s)
- Mosab M Aldabbas
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia Central University, New Delhi, India
| | - Tarushi Tanwar
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia Central University, New Delhi, India
| | - Iram Iram
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia Central University, New Delhi, India
| | - Mohammad Salman
- Deen Dayal Upadhyaya Kaushal Kendra, Jamia Millia Islamia Central University, New Delhi, India
| | - Zubia Veqar
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia Central University, New Delhi, India.
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Wendt M, Waszak M. Assessment of the stiffness of the upper trapezius muscle in a group of asymptomatic people with cervical spine rotation asymmetry. PLoS One 2024; 19:e0298544. [PMID: 38386652 PMCID: PMC10883562 DOI: 10.1371/journal.pone.0298544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 01/25/2024] [Indexed: 02/24/2024] Open
Abstract
This study investigated the relationship between the stiffness of the upper trapezius muscle and the range of rotational movement of the cervical spine. A total of 60 right-handed asymptomatic students participated in the study. Participants (N = 22) characterised by asymmetry in rotational movements were selected for the experimental group. A difference of ≥10° between right and left rotation of the cervical spine was considered asymmetrical. The control group (N = 38) included participants whose rotation difference was < 10°. Belonging to the experimental or control group did not significantly differentiate trapezius muscle stiffness. The rotation side differentiated the stiffness of the right and left trapezius muscles only in the group of people with rotational movement asymmetry. There were high correlation coefficients between right cervical rotation and the stiffness of the muscle on the right side, and between rotation to the left and the stiffness of the muscle on the left side. There is a relationship between the stiffness of the right and left upper trapezius muscles and the range of right and left rotational motion of the cervical spine. Stiffness of the upper trapezius correlates more strongly with rotation to the side on which the muscle lies than to the opposite side. Increased stiffness of the upper trapezius muscle on the side of limited cervical spine rotation is likely to be determined by the muscle fibre stretching mechanism.
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Affiliation(s)
- Michał Wendt
- Department of Medical Biology, Poznan University of Physical Education, Poznań, Poland
| | - Małgorzata Waszak
- Department of Medical Biology, Poznan University of Physical Education, Poznań, Poland
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D'Alessandro GS, Munhoz AM, Takeuchi FM, Povedano A, Góes JCS. Neoadjuvant chemotherapy impact on outcomes in immediate breast reconstruction with latissimus dorsi flap and silicone implant. J Surg Oncol 2024; 129:208-218. [PMID: 37792635 DOI: 10.1002/jso.27479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/06/2023] [Accepted: 09/24/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Neoadjuvant chemotherapy (NCH) has demonstrated efficacy in downsizing tumors and facilitating less extensive surgery. However, immediate breast reconstruction (IBR) after NCH has raised concerns regarding higher complication rates. This study evaluates the impact of NCH on outcomes following IBR with a latissimus dorsi flap and implant (LDI) after mastectomy. METHODS Cases from a prospective maintained database were reviewed, and patients classified according to whether or not they received NCH. Risk factors and major and minor complications in both groups were then analyzed. RESULTS Among the 196 patients who underwent 198 IBR procedures, 38.4% received NCH and 66.1% did not. The overall complication rate was 46.7% in the non-NCH group and 53.3% in the NCH group (p = 0.650). The presence of comorbidities increased the likelihood of any complication (odds ratio [OR]: 3.46; 95% confidence interval [CI]: 1.38-8.66; p = 0.008) as well as major complications (OR: 3.35; 95% CI: 1.03-10.95; p = 0.045). Although patients in the NCH group experienced more major complications (10.5% vs. 4.9%; p = 0.134) and early loss of breast reconstruction (3.9% vs. 0.8%; p = 0.128), these findings were not statistically significant. CONCLUSION This study found no statistically significant association between NCH and higher risk of complications or loss of IBR with LDI after mastectomy.
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Affiliation(s)
- Gabriel Salum D'Alessandro
- Breast and Plastic Surgery Division, Instituto Brasileiro de Controle do Cancer (IBCC), São Paulo, Brazil
| | - Alexandre Mendonça Munhoz
- Plastic Surgery Division, Hospital Sírio-Libanês, São Paulo, Brazil
- Plastic Surgery Division, Hospital Moriah, São Paulo, Brazil
| | - Fabiana Midori Takeuchi
- Plastic Surgery Division, Instituto Brasileiro de Controle do Cancer (IBCC), São Paulo, Brazil
| | - Alejandro Povedano
- Plastic Surgery Division, Instituto Brasileiro de Controle do Cancer (IBCC), São Paulo, Brazil
| | - João Carlos Sampaio Góes
- Breast and Plastic Surgery Division, Instituto Brasileiro de Controle do Cancer (IBCC), São Paulo, Brazil
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Moro MZ, de Oliveira Vidal EI, Pinheiro Módolo NS, Bono Fukushima F, Moreira de Barros GA. Dry needling, trigger point electroacupuncture and motor point electroacupuncture for the treatment of myofascial pain syndrome involving the trapezius: a randomised clinical trial. Acupunct Med 2024; 42:3-13. [PMID: 37905789 DOI: 10.1177/09645284231207865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
OBJECTIVE The objective of this study was to compare trigger point (TrP) dry needling, TrP electroacupuncture and motor point electroacupuncture of the trapezius muscle for the treatment of myofascial pain syndrome (MPS). METHODS This randomised clinical trial included 90 patients divided into three groups. Group 1 was treated with dry needling of TrPs, group 2 with intramuscular electrical stimulation of TrPs, and group 3 with electroacupuncture of motor points and/or the spinal accessory nerve. Each group received seven treatment sessions. The outcomes were the pain score measured by visual analogue scale (VAS) and quality of life evaluated by the 12-item short form (SF-12) health questionnaire. We compared the pain outcome over serial time points using growth curve analysis methods. RESULTS Participants in the three groups experienced significant improvements in pain scores over time. The average pain level of participants in group 3 across the repeated assessments was 0.98 units lower than in group 1 (mean difference (95% confidence interval (CI) = 1.74-0.23)), p = 0.012). There were no significant differences in pain scores between participants in groups 1 and 2, and there were no significant differences in quality of life across the three groups at the end of the treatment period. CONCLUSION Our results provide evidence that electrical stimulation of motor points and/or of the spinal accessory nerve may be superior in terms of pain relief (but not quality of life) to dry needling and possibly electrical stimulation of trigger points for the management of MPS involving the trapezius. TRIAL REGISTRATION NUMBER TRIAL-RBR-43R7RF (Brazilian Clinical Trials Registry).
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Affiliation(s)
- Marlene Zuccolotto Moro
- Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University (Unesp), Botucatu, Brazil
| | - Edison Iglesias de Oliveira Vidal
- Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University (Unesp), Botucatu, Brazil
| | - Norma Sueli Pinheiro Módolo
- Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University (Unesp), Botucatu, Brazil
| | - Fernanda Bono Fukushima
- Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University (Unesp), Botucatu, Brazil
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Kim JG, Lim C, Kim BT, Baek CH. Superior Capsular Reconstruction Versus Middle Trapezius Tendon Transfer for Isolated Irreparable Supraspinatus Tendon Tears: Static Versus Dynamic Reconstruction. Am J Sports Med 2024; 52:431-440. [PMID: 38179610 DOI: 10.1177/03635465231213340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
BACKGROUND Both superior capsular reconstruction (SCR) and middle trapezius tendon (MTT) transfer can be performed in nonarthritic young and active patients with isolated irreparable supraspinatus tendon tears (IISTTs). However, to our knowledge, no comparative clinical studies have been conducted on these procedures. PURPOSE To evaluate and compare the clinical and radiological outcomes of SCR and arthroscopic-assisted MTT transfer in patients with IISTTs. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 60 patients with IISTTs were categorized into 2 groups according to the surgical procedure-Group S underwent SCR (n = 34); Group M underwent MTT transfer (n = 26). The clinical outcomes included the visual analog scale score for pain, active shoulder range of motion, American Shoulder and Elbow Surgeons score, and University of California, Los Angeles, shoulder score. Radiological outcomes included the assessment of the acromiohumeral distance, progression of cuff tear arthropathy (Hamada grade), subacromial bone erosion, and graft failure. RESULTS The mean follow-up time was 39.3 ± 5.2 months (range, 26-59 months) and 37.6 ± 9.8 months (range, 27-54 months) in Group S and Group M, respectively. Significant improvements in clinical outcomes were observed in both groups, while the active forward flexion (148.2°± 24.1° vs 165.9°± 8.7°; P = .003) and abduction (131°± 37.3° vs 152.5°± 17.9°; P = .035) were significantly higher in Group M at the final follow-up. No significant differences were found in the postoperative Constant, American Shoulder and Elbow Surgeons, and University of California, Los Angeles, shoulder scores between the 2 groups. Radiologically, although no difference was found in the Hamada grade at the final follow-up between the 2 groups (P = .143), the rates of acromial wear (58.8% vs 15.4%; P < .001) and graft retear (47.1% vs 7.7%; P < .001) were significantly higher in Group S than in Group M. CONCLUSION Both SCR and MTT transfer improved the overall clinical outcomes of IISTTs postoperatively, whereas MTT transfer was superior to SCR in terms of active forward flexion and abduction range of motion. Although higher rates of graft failure and subacromial bone erosion were observed in Group S, no difference was found in the clinical scores between the 2 groups at the short-term follow-up. However, further well-structured, prolonged comparative trials should be conducted in the future.
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Affiliation(s)
- Jung Gon Kim
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, Jeollanam-do, Republic of Korea
| | - Chaemoon Lim
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, Jeollanam-do, Republic of Korea
| | - Bo Taek Kim
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, Jeollanam-do, Republic of Korea
| | - Chang Hee Baek
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, Jeollanam-do, Republic of Korea
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Kawabuchi K, Yamane K, Maniwa S, Inoue K, Nakamura M. Epimuscular myofascial force transmission between the levator scapulae muscle and the upper fiber of the serratus anterior or rhomboid minor muscles. Clin Biomech (Bristol, Avon) 2024; 112:106194. [PMID: 38335837 DOI: 10.1016/j.clinbiomech.2024.106194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/28/2024] [Accepted: 01/31/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND This study investigated the epimuscular myofascial force transmission between the levator scapulae, serratus anterior, and rhomboid minor muscles. METHODS The participants included 10 healthy males (a total of 20 shoulders). Differences in the shear moduli of the levator scapulae, serratus anterior, and rhomboid minor muscles were measured in the resting and levator scapulae stretching positions using shear wave elastography. The correlation between the rates of change for each muscle was also verified. FINDINGS The results demonstrated a notable increase in the shear modulus from the resting to stretching positions for levator scapulae (42.9 ± 17.6 kPa vs. 52.4 ± 15.2 kPa) and serratus anterior (32.8 ± 12.9 kPa vs. 58.4 ± 18.5 kPa) (P = 0.02, P < 0.01). However, there was no significant difference in the shear modulus for the rhomboid minor between the resting (44.0 ± 19.2 kPa) and stretching (41.0 ± 20.2 kPa) positions (P = 0.40). Moreover, a significant positive correlation was observed between rates of change for the levator scapulae and serratus anterior muscles (P = 0.04, r = 0.459). INTERPRETATION These findings indicate that the shear modulus of the serratus anterior increased with the stretching of the levator scapulae, suggesting the occurrence of epimuscular myofascial force transmission between these two muscles with different muscle insertions.
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Affiliation(s)
- Keita Kawabuchi
- Rehabilitation Room, Tottori Prefectural Central Hospital, 730 Ezu, Tottori City, Tottori 680-0901, Japan.
| | - Kenta Yamane
- Rehabilitation Room, Tottori Prefectural Central Hospital, 730 Ezu, Tottori City, Tottori 680-0901, Japan
| | - Shota Maniwa
- Rehabilitation Room, Tottori Prefectural Central Hospital, 730 Ezu, Tottori City, Tottori 680-0901, Japan
| | - Kyohei Inoue
- Rehabilitation Room, Tottori Prefectural Central Hospital, 730 Ezu, Tottori City, Tottori 680-0901, Japan
| | - Masatoshi Nakamura
- Faculty of Rehabilitation Science, Nishi Kyushu University, 4490-0 Ozaki, Kanzaki, Saga 842-8585, Japan
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Löfstrand J, Paganini A, Grimby-Ekman A, Lidén M, Hansson E. Long-term patient-reported back and shoulder function after delayed breast reconstruction with a latissimus dorsi flap: case-control cohort study. Br J Surg 2024; 111:znad296. [PMID: 37879120 PMCID: PMC10769156 DOI: 10.1093/bjs/znad296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/06/2023] [Accepted: 08/31/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Sacrifice of the latissimus dorsi (LD) muscle might entail donor site morbidity when used in delayed breast reconstruction. Previous studies are small, have short follow-up, and demonstrate diverging results. The aims of this study were to evaluate long-term patient-reported effects on shoulder and back function following LD flap harvest, and to investigate predictors for a worse outcome. METHOD This is a retrospective observational case-control cohort study. Cases were all patients who had undergone an LD flap reconstruction during the years 2007-2017. Controls were patients reconstructed with a deep inferior epigastric perforator (DIEP) flap during the same time period. Participants completed two validated questionnaires; the BREAST-Q reconstruction LD domains and the Western Ontario Shoulder Osteoarthritis Index (WOOS). RESULTS A total of 135 cases (75 per cent) and 118 controls (60 per cent) responded to the questionnaires. The mean follow-up time was 7 years. Patients reconstructed with a LD flap were significantly less satisfied with their back and shoulder function when compared to the DIEP controls, as measured with BREAST-Q and WOOS. Predictors for a poor patient-reported back and shoulder function included axillary surgery and axillary radiotherapy, especially when combined, as well as higher age at reconstruction. CONCLUSION Patients who have undergone LD flap for delayed breast reconstruction had a lower satisfaction with back and shoulder function, when compared to patients who had undergone a DIEP reconstruction. Delayed LD reconstruction should be used with care, especially in patients who have undergone axillary surgery and axillary radiotherapy.
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Affiliation(s)
- Jonas Löfstrand
- Department of Plastic Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Plastic Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna Paganini
- Department of Plastic Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Plastic Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Grimby-Ekman
- School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mattias Lidén
- Department of Plastic Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Plastic Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Emma Hansson
- Department of Plastic Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Plastic Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
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Musso M, Oliveira AS, Bai S. Influence of an upper limb exoskeleton on muscle activity during various construction and manufacturing tasks. Appl Ergon 2024; 114:104158. [PMID: 37890312 DOI: 10.1016/j.apergo.2023.104158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/31/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023]
Abstract
Musculoskeletal disorders (MSDs) significantly impact workers in the manufacturing and construction sectors. One solution that has gained interest to reduce MSDs incidence is the use of exoskeletons. In this study, the influence of an upper limb exoskeleton on muscle activity was investigated experimentally for three commonly performed tasks in the manufacturing and construction sectors. The tasks tested were overhead assembly, bricklaying, and box moving tasks. Eighteen males participated in the tests. The results showed a reduction in shoulder flexor muscle activation during all three tasks (up to -45.46 ± 4.52% for the anterior deltoid), but increased extensor activation (up to 15.47 ± 8.01% for the latissimus dorsi) was observed when the task was not primarily performed above shoulder level. The results revealed the dependence of the upper-body exoskeleton on tasks and arm posture, which should be considered for both in-field applications and designing new exoskeletons for performance enhancement.
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Affiliation(s)
- Matteo Musso
- Department of Material and Production, Aalborg University, Fredrik Bajers Vej 7K, Aalborg, 9220, Denmark.
| | - Anderson Souza Oliveira
- Department of Material and Production, Aalborg University, Fredrik Bajers Vej 7K, Aalborg, 9220, Denmark.
| | - Shaoping Bai
- Department of Material and Production, Aalborg University, Fredrik Bajers Vej 7K, Aalborg, 9220, Denmark.
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Namin AW, Ong AA, Agamawi YM, Shumrick C, Ducic Y. Interpreting Lower Trapezius Musculocutaneous Flap Skin Paddle Perfusion with Indocyanine Green Angiography. Facial Plast Surg Aesthet Med 2024; 26:52-57. [PMID: 37428534 DOI: 10.1089/fpsam.2022.0401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
Background: The lower trapezius myocutaneous flap (LTF) is a pedicled flap with clinically significant variability of distal skin flap perfusion. Objective: To compare the incidence of partial flap necrosis before and after the institution of routine intraoperative laser-assisted indocyanine green (ICG) angiography. Methods: This is a retrospective review of all LTF performed between November 2021 and July 2022. The outcomes measured in this study are the distance distal to the inferior border of the trapezius muscle with adequate perfusion, and incidence and degree of partial flap necrosis. Results: Sixteen patients met inclusion criteria with a median age of 64.5 years, and a median defect size of 147 cm2. Most patients (11/16) had undergone previous treatment for malignancy. Before utilizing ICG angiography, 40% (2/5) had partial flap necrosis, whereas after utilizing ICG angiography, 9% (1/11) of patients had partial flap necrosis. Seventy-three percent (8/11) of cases who underwent ICG angiography demonstrated a portion of the skin paddle with inadequate perfusion. The range of skin perfusion distal to the inferior border of the trapezius muscle was 0-7 cm (median, 4). Conclusions: The incidence of partial flap necrosis decreased after institution of routine ICG angiography.
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Affiliation(s)
- Arya W Namin
- Mercy Clinic Ear, Nose, and Throat, Mercy Hospital St. Louis, St. Louis, Missouri, USA
| | | | - Yusuf M Agamawi
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas, USA
| | - Christopher Shumrick
- Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas, USA
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Rezende MS, Rossi DM, Ribeiro de Lima AM, Clemente GS, Siriani de Oliveira A, Caldeira de Oliveira Guirro E. Shoulder and scapulothoracic impairments in women with breast cancer-related lymphedema in the upper limb: A cross-sectional study shoulder and breast cancer-related lymphedema. J Bodyw Mov Ther 2024; 37:177-182. [PMID: 38432802 DOI: 10.1016/j.jbmt.2023.11.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/21/2023] [Accepted: 11/26/2023] [Indexed: 03/05/2024]
Abstract
INTRODUCTION Lymphedema in the upper limb as a complication of breast cancer may lead to shoulder pain and dysfunctions. OBJECTIVE To compare the scapular positioning, the shoulder range of motion, and muscle strength among women undergoing treatment for breast cancer with and without lymphedema and a control group. METHODS This cross-sectional study evaluated women undergoing treatment for breast cancer (N = 25) and without lymphedema (N = 25), and a control group (N = 25). Static scapular positions and shoulder range of motion were measured by using an inclinometer. The shoulder and periscapular muscle strength were measured by using a hand-held dynamometer and the Disabilities of the Arm, Shoulder, and Hand Questionnaire was applied. Linear regression of the mixed effects model was used to compare the groups. RESULTS Both groups of mastectomized women had reduced shoulder range of motion, scapular upward rotation, and muscle strength for shoulder and periscapular muscles compared to the control group. Also, women undergoing treatment for breast cancer with lymphedema had reduced shoulder range of motion, scapular upward rotation, increased anterior tilt, reduced muscle strength of the upper trapezius, and greater upper limb disability compared to women without lymphedema. CONCLUSION Women undergoing treatment for breast cancer with lymphedema had even greater shoulder and scapulothoracic impairments when compared to the control group and women without lymphedema.
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Affiliation(s)
- Monique Silva Rezende
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.
| | - Denise Martineli Rossi
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil; Department of Applied Physiotherapy, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil.
| | - Aline Maria Ribeiro de Lima
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.
| | - Giovani Sanches Clemente
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.
| | - Anamaria Siriani de Oliveira
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.
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Borthakur BB, Boro SS, Sahewalla A, De M. A case series of use of pedicled latissimus dorsi muscle for functional reconstruction of deltoid and triceps muscle following total oncological resection. J Plast Reconstr Aesthet Surg 2024; 88:378-380. [PMID: 38064915 DOI: 10.1016/j.bjps.2023.11.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/31/2023] [Accepted: 11/22/2023] [Indexed: 01/02/2024]
Affiliation(s)
| | - Sumanjit S Boro
- Department of Plastic Surgery, All India Institute of Medical Sciences, Guwahati, Assam, India
| | - Ashutosh Sahewalla
- Department of Surgical Oncology, Dr B. Borooah Cancer Institute, Guwahati, Assam, India.
| | - Moumita De
- Department of Plastic Surgery, All India Institute of Medical Sciences, Guwahati, Assam, India
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Abrahao A, Phung L, Fam D, Escorcio-Bezerra ML, Robinson LR, Jones KE, Zinman L. Motor Unit Number Index of the Upper Trapezius: A Meta-Analysis and Cross-sectional Study of Its Reliability. Can J Neurol Sci 2024; 51:129-133. [PMID: 36751865 DOI: 10.1017/cjn.2023.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Motor unit number index of the upper trapezius (MUNIX-Trapezius) is a candidate biomarker for bulbar lower motor neuron function; however, reliability data is incomplete. To assess MUNIX-Trapezius reliability in controls, we conducted a systematic review, a cross-sectional study (n = 20), and a meta-analysis. We demonstrated a high inter- and intra-rater intraclass correlation (0.86 and 0.94, respectively), indicating that MUNIX-Trapezius is reliable with between-study variability moderated by age and MUNIX technique. With further validation, this measure can serve as a disease monitoring and response biomarker of bulbar function in the therapeutic development for amyotrophic lateral sclerosis.
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Affiliation(s)
- Agessandro Abrahao
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Liane Phung
- Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - David Fam
- St. Joseph's Health Centre Toronto, United Health, Toronto, Ontario, Canada
| | | | - Lawrence R Robinson
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Kelvin E Jones
- Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Lorne Zinman
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
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24
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Ciller Martínez M, Rodríguez Palero S, Vara Arias T, Cartas Carrión S, Escribano Pérez M, Ortiz Cabrera NV, Manzarbeitia Arroba P. [Case report: Scapular asymmetry caused by congenital unilateral absence of trapezius]. Rehabilitacion (Madr) 2024; 58:100825. [PMID: 38141278 DOI: 10.1016/j.rh.2023.100825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 09/07/2023] [Accepted: 09/13/2023] [Indexed: 12/25/2023]
Abstract
Congenital unilateral absence of trapezius is a rare condition, previously reported in cadaveric specimens. It can cause static shoulder asymmetry and affects the scapular biomechanics and functionality, so complete physical examination of the patient becomes important in order to dimiss or suspect an anomaly. We present a case of a 8 years old boy with asymmetry and scapular winging, who was referred to rehabilitation, suspected facioscapulohumeral dystrophy. An MRI scan of cervical spine and shoulder confirmed the absence of the right trapezius muscle. There were no functional disabilities. No other significant congenital anomalies were found.
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Affiliation(s)
- M Ciller Martínez
- Servicio de Medicina Física y Rehabilitación, Hospital Infantil Universitario Niño Jesús, Madrid, España.
| | - S Rodríguez Palero
- Servicio de Medicina Física y Rehabilitación, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - T Vara Arias
- Servicio de Medicina Física y Rehabilitación, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - S Cartas Carrión
- Servicio de Medicina Física y Rehabilitación, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - M Escribano Pérez
- Servicio de Radiología, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - N V Ortiz Cabrera
- Servicio de Genética, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - P Manzarbeitia Arroba
- Servicio de Traumatología, Hospital Infantil Universitario Niño Jesús, Madrid, España
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25
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Busch A, Sarver X, Comstock K. Electromyographic analysis of shoulder-complex muscles performing overhead presses with dumbbell, kettlebell, and bottom-up kettlebell. J Bodyw Mov Ther 2024; 37:308-314. [PMID: 38432822 DOI: 10.1016/j.jbmt.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 09/12/2023] [Accepted: 10/03/2023] [Indexed: 03/05/2024]
Abstract
INTRODUCTION Kettlebell exercises, specifically the bottom-up grip, have become increasingly popular in training programs. The purpose of this research was to determine if a bottom-up kettlebell grip favorably alters the electromyography (EMG), activity in the medial deltoid (MD), serratus anterior (SA), and lower trapezius (LT), muscles compared to using a dumbbell or traditional kettlebell grip during overhead shoulder presses. METHODS Twenty-eight healthy, male, Division III collegiate baseball players (mean age = 19.8 ± 1.28 years) performed five overhead presses of equal weight, 11.34 kg (25 lbs), using a dumbbell (DB), kettlebell w/traditional grip (KB), and kettlebell held with a bottom-up grip (KBU). RESULTS For the MD, there was significantly greater EMG activity using the DB compared to KBU, but no significant differences between the DB and KB, or KB and KBU. For the SA, greater EMG activity was noted using the KBU compared to KB, and KBU compared to DB, but no differences between KB and DB. For the LT, greater EMG activity was noted using the DB compared to KB, but no differences between DB and KBU, or KB and KBU. CONCLUSION The KBU press only elicited greater EMG activity in the SA. The DB elicited greater EMG activity in both the MD and LT. Shoulder-complex EMG activity varies with different types of overhead presses using equivalent loads.
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Affiliation(s)
- Andrew Busch
- Department of Health and Human Kinetics, Ohio Wesleyan University, Delaware, OH, USA.
| | - Xavier Sarver
- Department of Health and Human Kinetics, Ohio Wesleyan University, Delaware, OH, USA
| | - Katie Comstock
- Department of Health and Human Kinetics, Ohio Wesleyan University, Delaware, OH, USA
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26
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Xu G, Sun XW, Chen J, Gu BH, Zhou ZJ, Shi PH. [Arthroscopic assistance of latissimus dorsi tendon transposition for the treatment of unrepairable rotator cuff tear]. Zhongguo Gu Shang 2023; 36:1153-8. [PMID: 38130224 DOI: 10.12200/j.issn.1003-0034.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
OBJECTIVE To explore clinical effect of arthroscopy-assisted rotator cuff tendon transfer in treating irreparable rotator cuff tears (IRCT). METHODS From May 2015 to May 2018, 23 patients with unrepairable rotator cuff tears were treated with arthroscopy-assisted rotator cuff tendon transfer, and 21 patients were followed up finally, including 8 males and 13 females, aged from 48 to 82 years old with an average of(64.3±9.1) years old;the courses of disease ranged from 6 to 36 months with an average of (14.0±6.4) months. American Rotator and Elbow Surgeons Score(ASES) and Constant-Murley score were used to evaluate clinical efficacy before surgery and at the latest follow-up. RESULTS All 21 patients were followed up for 36 to 54 months with an average of (39.4±4.4) months. Axillary incision of 1 patient was redness, swelling and exudation after surgery, which healed after 3 weeks of dressing change, and exudate culture was negative. At the latest follow-up, MRI showed partial tearing of the metastatic tendon in 2 patients, but pain and movement of the affected shoulder were still better than before surgery. ASES increased from preoperative (41.0±9.6) scores to the latest follow-up (75.6±14.0) scores, and had statistical difference (t=10.50, P<0.01). Constant-Murley score increased from (49.8±7.1) scores before operation to (67.5±11.6) scores at the latest follow-up (t=11.27, P<0.01). CONCLUSION Arthroscopic assisted latissimus dorsalis tendon transposition restores physiological and anatomical structure of glenohumeral joint by reconstructing balance of horizontal and vertical couples of shoulder joint, thus achieving the stability of the shoulder joint, relieving shoulder pain and improving shoulder joint function.
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Affiliation(s)
- Guang Xu
- Department of Orthopaedics, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang, China; Department of Orthopaedics, Jiangshan People's Hospital, Jiangshan Branch of Sir Run Run Shaw Hoppital, Zhejiang Univesity School of Medicine, Jiangshan 324100, Zhejiang, China
| | - Xue-Wu Sun
- Department of Orthopaedics, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang, China
| | - Jian Chen
- Department of Orthopaedics, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang, China
| | - Bei-Hao Gu
- Department of Orthopaedics, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang, China
| | - Zhi-Jie Zhou
- Department of Orthopaedics, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang, China
| | - Pei-Hua Shi
- Department of Orthopaedics, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang, China
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Alqahtani S, Delay A, Meruta A, Dupre A, Frobert P, Delay E. Dorsal Lipomodeling to Treat Donor Site After Latissimus Dorsi Flap: Safety and Effectiveness. Aesthet Surg J 2023; 44:NP51-NP59. [PMID: 37768715 DOI: 10.1093/asj/sjad302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/29/2023] [Accepted: 09/01/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND The latissimus dorsi flap (LDF) is a classic and efficient technique for breast reconstruction. However, its use has recently diminished in surgical practice due to dorsal disadvantages and to the increased use of microsurgical techniques for breast reconstruction, such as the deep inferior epigastric artery perforator flap. OBJECTIVES The aim of this study was to evaluate the safety and efficacy of managing dorsal problems such as asymmetry, irregularities, and dysesthesia by lipomodeling the back region during the associated surgery for breast reconstruction. METHODS A series of 300 patients operated by the last author for dorsal lipomodeling to correct sequelae after harvesting the total LDF, between November 2012 and March 2019, was analyzed. RESULTS The results show a very good improvement in the dorsal region in 6.7% of cases, good improvement in 86.7% cases, and fair improvement in 6.7% of cases. There was a good improvement in dorsal comfort in 90% of cases, a very good improvement in 6.66% of cases, and a fair improvement in 6.66% of cases. In 5% of cases 2 sessions were required to obtain a satisfactory result. No major complications were registered, and the only complication encountered were oil cysts in 2.6% of cases that were treated during consultation with percutaneous puncture. CONCLUSIONS This study showed that lipomodeling in the back area after LDF harvesting is an efficient and safe technique that corrects secondary dorsal sequelae such as irregularities, asymmetry, sensitivity, and dysesthesia. This technique should increase the indications for LDF because it decreases donor site sequelae, which are some of the main drawbacks of the LDF approach. LEVEL OF EVIDENCE: 3
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Lee JB, Kholinne E, Ben H, So SP, Alsaqri H, Koh KH, Jeon IH. Superior Capsular Reconstruction Combined With Lower Trapezius Tendon Transfer Improves the Biomechanics in Posterosuperior Massive Rotator Cuff Tears. Am J Sports Med 2023; 51:3817-3824. [PMID: 37975524 DOI: 10.1177/03635465231207834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
BACKGROUND Surgical treatments for chronic posterosuperior massive rotator cuff tear (MRCT) are still controversial. Superior capsular reconstruction (SCR), which provides a static stabilizer to decrease superior humeral head translation, and lower trapezius tendon transfer (LTTT) with centralization of the humeral head, which prevents superior humeral head migration, are potential surgical options. To date, SCR combined with LTTT has not been fully investigated. HYPOTHESIS Restoration of static stabilizer and dynamic stabilizer together would effectively improve shoulder kinematics in posterosuperior MRCT. STUDY DESIGN Controlled laboratory study. METHODS A custom-made shoulder mechanics testing system was used to test 8 fresh-frozen cadaveric shoulders. The testing conditions were as follows: (1) intact; (2) posterosuperior MRCT (supraspinatus and infraspinatus removed); (3) SCR using the fascia lata; (4) LTTT; and (5) SCR combined with LTTT. The total rotational range of motion (ROM), superior translation, anteroposterior translation, and peak subacromial contact pressure were evaluated at 0°, 30°, and 60° of shoulder abduction. Repeated-measures analysis of variance and Tukey post hoc tests were performed. RESULTS The total rotational ROM, superior translation, anteroposterior translation, and peak subacromial contact pressure increased in posterosuperior MRCTs (all, P < .05). The rotational ROM, superior translation, anteroposterior translation, and peak subacromial contact pressure at 0° and 30° of shoulder abduction decreased in SCR (all, P < .05). However, there was no significant improvement in rotational ROM, superior translation, and peak subacromial contact pressure at 60° of shoulder abduction (P > .05). LTTT resulted in a significant decrease in the superior translation, anteroposterior translation, and peak subacromial contact pressure at 0°, 30°, and 60° of shoulder abduction (P < .05). SCR combined with LTTT restored the total rotational ROM, superior translation, anteroposterior translation, and peak subacromial contact pressure at 0°, 30°, and 60° of shoulder abduction (all, P < .05). CONCLUSION In the cadaveric model, SCR combined with LTTT showed improved shoulder kinematics and contact pressures in the posterosuperior MRCT model compared with SCR or LTTT alone. CLINICAL RELEVANCE SCR combined with LTTT may be regarded as an alternative surgical procedure for posterosuperior MRCTs.
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Affiliation(s)
- Jun-Bum Lee
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Erica Kholinne
- Department of Orthopedic Surgery, Saint Carolus Hospital, Faculty of Medicine, Universitas Trisakti, Jakarta, Indonesia
| | - Hui Ben
- Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Pil So
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hood Alsaqri
- Department of Orthopaedic Surgery, Rustaq Hospital, Rustaq, Sultanate of Oman
| | - Kyoung-Hwan Koh
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - In-Ho Jeon
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Kim D, Nicoletti C, Soedirdjo SDH, Baghi R, Garcia MG, Läubli T, Wild P, Botter A, Martin BJ. Effect of Periodic Voluntary Interventions on Trapezius Activation and Fatigue During Light Upper Limb Activity. Hum Factors 2023; 65:1491-1505. [PMID: 34875887 DOI: 10.1177/00187208211050723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The effects of diverse periodic interventions on trapezius muscle fatigue and activity during a full day of computer work were investigated. BACKGROUND Musculoskeletal disorders, including trapezius myalgia, may be associated with repeated exposure to prolonged low-level activity, even during light upper-extremity tasks including computer work. METHODS Thirty healthy adults participated in a study that simulated two 6-hour workdays of computer work. One workday involved imposed periodic passive and active interventions aimed at disrupting trapezius contraction monotony (Intervention day), whereas the other workday did not (Control day). Trapezius muscle activity was quantified by the 3-dimensional acceleration of the jolt movement of the acromion produced by electrically induced muscle twitches. The spatio-temporal distribution of trapezius activity was measured through high-density surface electromyography (HD-EMG). RESULTS The twitch acceleration magnitude in one direction was significantly different across measurement periods (p = 0.0156) on Control day, whereas no significant differences in any direction were observed (p > 0.05) on Intervention day. The HD-EMG from Intervention day showed that only significant voluntary muscle contractions (swing arms, Jacobson maneuver) induced a decrease in the muscle activation time and an increase in the spatial muscle activation areas (p < 0.01). CONCLUSION Disruption of trapezius monotonous activity via brief voluntary contractions effectively modified the ensuing contraction pattern (twitch acceleration along one axis, active epochs reduction, and larger spatial distribution). The observed changes support an associated reduction of muscle fatigue. APPLICATION This study suggests that disruptive intervention activity is efficient in reducing the impact of trapezius muscle fatigue.
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Affiliation(s)
| | - Corine Nicoletti
- Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, Switzerland
- Institute of Health Sciences, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Subaryani D H Soedirdjo
- Laboratory for Engineering of the Neuromuscular System (LISiN), Department of Electronics and Telecommunications, Politecnico di, Torino, Turin, Italy
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Raziyeh Baghi
- Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Maria-Gabriela Garcia
- Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, Switzerland
- Department of Industrial Engineering, School of Engineering, Universidad San Francisco de Quito, Quito, Ecuador
| | - Thomas Läubli
- Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, Switzerland
- Institute of Occupational and Social Medicine and Health Services Research, University of Tübingen, Tübingen, Germany
| | - Pascal Wild
- French National Research and Safety Institute (INRS), Vandœuvre lès Nancy, France
| | - Alberto Botter
- Laboratory for Engineering of the Neuromuscular System (LISiN), Department of Electronics and Telecommunications, Politecnico di, Torino, Turin, Italy
| | - Bernard J Martin
- Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, Switzerland
- Department of Industrial and Operations Engineering, School of Engineering, University of Michigan, Ann Arbor, MI, USA
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30
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Lee G, Chang YJ, Park J, Ryu JY, Choi KY, Yang JD, Chung HY, Cho BC, Kang B, Lee J, Lee JS. Free Vertical Latissimus Dorsi Flap for Tongue Reconstruction After Total Glossectomy. In Vivo 2023; 37:2710-2718. [PMID: 37905654 PMCID: PMC10621451 DOI: 10.21873/invivo.13381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 08/06/2023] [Accepted: 08/28/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND/AIM The tongue is an important anatomical structure, playing an significant role in natural speech, swallowing, and sense of taste. Immediate reconstruction using autologous tissue must be performed following glossectomy for tongue cancer to improve patient quality of life. This study aimed to demonstrate the usefulness of a surgical technique using the free vertical latissimus dorsi flap (FvLDF) for tongue reconstructions using autologous tissue. PATIENTS AND METHODS Among patients who underwent total glossectomy for tongue cancer from November 2014 to February 2023, we selected 10 patients who underwent immediate tongue reconstruction with a radial free forearm flap (RFFF) or free anterolateral thigh flap and four patients who underwent FvLDF. The patients were compared regarding postoperative function (width of oropharyngeal space in computed tomography, language-speech evaluation), aesthetic results, and features. RESULTS All four patients who underwent FvLDF showed successful flap survival, with no severe complications. Because vertical incision was made during flap harvest with primary closure possible with the mid-axillary line, donor morbidity was significantly lower in patients who underwent reconstruction with FvLDF than in those who underwent reconstruction with RFFF, and good aesthetic results were obtained. In comparing the oropharyngeal space of patients on neck CT preoperatively and postoperatively, the width increase rate of patients who underwent reconstruction with FvLDF was significantly smaller. FvLDF patients demonstrated good speech and swallowing functions. CONCLUSION Considering the advantages of reconstruction with FvLDF in terms of features and aesthetic results, this surgical technique may be a reliable alternative technique for tongue defects after glossectomy.
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Affiliation(s)
- Giljoon Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Yong June Chang
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jongmoo Park
- Department of Radiation Oncology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jeong Yeop Ryu
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Kang Young Choi
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jung Dug Yang
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Ho Yun Chung
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Byung Chae Cho
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Byungju Kang
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jeeyeon Lee
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Joon Seok Lee
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea;
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31
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Kobayashi Y, Uchiyama Y, Yoshida S, Saito I, Ishii T, Nakajima D, Yanagisawa S, Watanabe M. Functional reconstruction of elbow flexion with latissimus dorsi muscle rotational transfer: two case reports. J Med Case Rep 2023; 17:454. [PMID: 37904251 PMCID: PMC10617077 DOI: 10.1186/s13256-023-04178-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 09/13/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND We report two cases of biceps brachii and brachialis paralysis due to musculocutaneous nerve injury in which elbow joint flexion was reconstructed using rotational transfer of the latissimus dorsi muscle with sutures to the radial and ulnar tuberosities, thereby enabling flexion by simultaneous activation of the humeroradial and humeroulnar joints. In cases of associated brachialis paralysis, weaker flexion strength can be expected when the forearm is in a pronated position than when it is in a supinated state. To the best of our knowledge, no previous study has reported the rotational position of the forearm during elbow joint flexion reconstruction. CASE PRESENTATION Case 1 involved a 30-year-old Asian male who presented with a rupture of the musculocutaneous, median, radial, and ulnar nerves. Reconstruction was performed by rotational transfer of the latissimus dorsi muscle. In this case, the supination and pronation flexion forces were equal. Case 2 involved a 50-year-old Asian man who presented with partial loss of the musculocutaneous nerve, biceps brachii, and pectoralis major due to debridement. Reconstruction was performed by rotational transfer of the latissimus dorsi muscle. In this case, supination and pronation flexion strengths were demonstrated to be equal. Our reconstruction method used the rotational transfer of the latissimus dorsi muscle; the distal muscle flap was divided into radial and ulnar sides to allow elbow joint flexion by simultaneously activating the humeroradial and humeroulnar joints. These sides were then fixed to the anchors at the radial and ulnar tuberosities. Finally, they were wrapped around the myotendinous junction of the biceps brachii or brachialis and secured using sutures. CONCLUSIONS Although larger studies are required to verify these methods, this case study successfully demonstrates the following: (1) the flexion strength in the supinated position was equal to that in the pronated position; (2) the stability of the humeroradial and humeroulnar joints was unaffected by the forearm's rotational position; and (3) a satisfactory range of motion of the elbow joint was obtained, with no complications.
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Affiliation(s)
- Yuka Kobayashi
- Department of Orthopaedic Surgery, Tokai University Hachioji Hospital, Ishikawacho, Hachioji, Tokyo, 192-0032, Japan.
| | - Yoshiyasu Uchiyama
- Department of Orthopaedic Surgery, Tokai University Hachioji Hospital, Ishikawacho, Hachioji, Tokyo, 192-0032, Japan
| | - Shinji Yoshida
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Kanagawa, 259‑1193, Japan
| | - Ikuo Saito
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Kanagawa, 259‑1193, Japan
- Department of Orthopaedic Surgery, Isehara Kyodo Hospital, Kanagawa, 259-1187, Japan
| | - Takayuki Ishii
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Kanagawa, 259‑1193, Japan
| | - Daisuke Nakajima
- Department of Orthopaedic Surgery, Tokai University Hachioji Hospital, Ishikawacho, Hachioji, Tokyo, 192-0032, Japan
| | - Shou Yanagisawa
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Kanagawa, 259‑1193, Japan
| | - Masahiko Watanabe
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Kanagawa, 259‑1193, Japan
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Szurmik T, Ogrodzka-Ciechanowicz K, Kurzeja P, Gąsienica-Walczak B, Prusak J, Bibrowicz K. Assessment of the functional state of the back muscles in girls with C-shaped low-grade scoliosis in a tensiomyographic image: An observational cross-sectional study. PLoS One 2023; 18:e0292555. [PMID: 37847728 PMCID: PMC10581459 DOI: 10.1371/journal.pone.0292555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/22/2023] [Indexed: 10/19/2023] Open
Abstract
PURPOSE The study aimed to test the feasibility of using tensiomyography to assess the functional status of the latissimus dorsi and erector spinae muscles in girls with C-shaped low back scoliosis. MATERIALS AND METHODS Twenty-five girls aged 13-15 took part in an observational (cross-sectional) study. The examination involved measurements using the tensiomyography method (TMG). Two groups of muscles were tested: latissimus dorsi and erector spinae on the concave and convex side of low-grade scoliosis. The following indicators were analyzed: Td-delay time, Tc-contraction time, and Dm-maximal muscle displacement. RESULTS The analysis of Td revealed that values of this variable on the concave side were slightly lower compared to the convex side in both tested groups of muscles. Similarly, Tc values on the concave side were slightly lower than on the convex side of the curvature in both groups of muscles. In the case of Dm, lower displacement values and, consequently, greater muscle rigidity were observed on the concave side of the latissimus dorsi and the convex side of the erector spinae. CONCLUSIONS The TMG method can be potentially used to diagnose the functional condition of muscles in patients with low-grade scoliosis. There were differences between the functional condition of the muscles on the concave and convex sides of the curvature.
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Affiliation(s)
- Tomasz Szurmik
- Faculty of Arts and Educational Science, University of Silesia, Cieszyn, Poland
| | | | - Piotr Kurzeja
- Institute of Health Sciences, Podhale State College of Applied Sciences, Nowy Targ, Poland
| | | | - Jarosław Prusak
- Institute of Health Sciences, Podhale State College of Applied Sciences, Nowy Targ, Poland
| | - Karol Bibrowicz
- Science and Research Center of Body Posture, Kazimiera Milanowska College of Education and Therapy, Poznań, Poland
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Escandón JM, Catanzaro M, Christiano JG, Gooch JC, Weiss A, Langstein HN, Manrique OJ. Autologous breast reconstruction with latissimus dorsi flap in obese patients: Time-to-event analysis. J Plast Reconstr Aesthet Surg 2023; 84:605-617. [PMID: 37453148 DOI: 10.1016/j.bjps.2023.06.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 04/26/2023] [Accepted: 06/05/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Obesity is a multisystem disease process that confers increased surgical risk. In patients who are not surgical candidates for breast reconstruction with implants/tissue expanders or abdomen-based flaps, the latissimus dorsi flap (LDF) remains a versatile alternative due to its safety profile. We conducted an analysis of patients who underwent reconstruction with LDFs and compared outcomes between two groups: obese and nonobese patients. METHODS We reviewed records from patients undergoing total mastectomy and breast reconstruction with LDFs between January 2011 and December 2021. We compared the surgical outcomes between obese and nonobese patients. Associations between risk factors and the presence of wound-related complications were analyzed using multivariable Cox proportional-hazards models. RESULTS One-hundred ten reconstructions were performed in obese patients (67.5%) and fifty-three in nonobese patients (32.5%). The median body mass index was 34.96 kg/m2 [32.6-39.2] in the obese patients' group and 26.8 kg/m2 [25.7-28.9] in the nonobese group (P < 0.001). The mean age was comparable between groups (54 years; P = 0.632). The rate of donor-site and recipient-site complications was similar between groups. The rate of revision procedures for secondary fat grafting and donor- or recipient-site revisions was comparable between obese and nonobese patients. Preoperative radiotherapy (hazard ratio [HR], 2.44), nipple-sparing mastectomy (HR, 3.26), and vertical pattern mastectomy (HR, 2.86) were associated with an increased risk of wound disruption. CONCLUSION The LDF is a reliable and safe alternative for autologous breast reconstruction in obese patients. The rates of surgical site complications were comparable between obese and nonobese patients.
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Affiliation(s)
- Joseph M Escandón
- Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, NY, USA
| | - Michael Catanzaro
- Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, NY, USA
| | - Jose G Christiano
- Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, NY, USA
| | - Jessica C Gooch
- Division of Surgical Oncology, Department of Surgery, Pluta Cancer Center, Wilmot Cancer Center, University of Rochester Medical Center, NY, USA
| | - Anna Weiss
- Division of Surgical Oncology, Department of Surgery, Pluta Cancer Center, Wilmot Cancer Center, University of Rochester Medical Center, NY, USA
| | - Howard N Langstein
- Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, NY, USA
| | - Oscar J Manrique
- Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, NY, USA.
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Baek GR, Kim JG, Baek CH, Baek G, Chung MS, Kao O, McGarry MH, Lee TQ. Latissimus Dorsi and Teres major tendon transfer increases internal rotation torque following lateralized reverse shoulder arthroplasty with subscapularis insufficiency. Arch Orthop Trauma Surg 2023; 143:5759-5766. [PMID: 37069412 DOI: 10.1007/s00402-023-04861-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/22/2023] [Indexed: 04/19/2023]
Abstract
INTRODUCTION Limitation of active Internal Rotation (IR) following Reverse Shoulder Arthroplasty (RSA) in patients with massive Rotator Cuff Tears (mRCTs) with subscapularis insufficiency remains a challenge. Recently, RSA with Latissimus dorsi and Teres major (LDTM) transfer in patients with limited active IR has been demonstrated as a reliable treatment option. The purpose of this study was to biomechanically compare the IR torque following LDTM transfer with RSA in mRCT with subscapularis insufficiency to RSA without tendon transfer. METHODS Eight cadaveric shoulders were tested (mean age: 64.5 ± 1.9 years) using a custom shoulder testing system that permits loading conditions of mRCT with subscapularis insufficiency. Two conditions were tested and compared. The first condition was RSA alone and the second condition was RSA with LDTM transfer. RSA with a medialized glenoid and lateralized humerus design was used for all specimens. The specimens were tested at 0°, 20° and 40° abduction at three different muscle loads: baseline, double, and triple, while the Teres minor and deltoid loads were kept constant. IR torque was measured with a torque wrench at 0°, 20°, and 40° abduction and 60° and 45° IR positions. Force required for anterior dislocation was measured at 20° abduction and 10° IR position. RESULTS RSA with LDTM transfer had significantly higher IR torque at all abductions and muscle loading compared with RSA without transfer (average at all positions; RSA without transfer: 0.80 ± 0.02 Nm, LDTM transfer for all loads: 1.43 ± 0.10 Nm). RSA with LDTM transfer (91.4 ± 3.9 N) needed higher force for anterior dislocation compared to RSA alone (89.4 ± 4.1 N), but there was no significant difference. CONCLUSION LDTM transfer with RSA increases IR torque compared to RSA without tendon transfer in a cadaveric model. LDTM transfer with RSA may be a reliable treatment option for patients with mRCT and subscapularis insufficiency who are expected to have limited active IR following RSA.
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Affiliation(s)
- Gyu Rim Baek
- Orthopedic Biomechanics Laboratory, Congress Medical Foundation, 800 S Raymond Ave, Pasadena, CA, 91105, USA
| | - Jung Gon Kim
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, Yeosu-si, Jeollanam-do, Republic of Korea
| | - Chang Hee Baek
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, Yeosu-si, Jeollanam-do, Republic of Korea
| | - Gyuna Baek
- Orthopedic Biomechanics Laboratory, Congress Medical Foundation, 800 S Raymond Ave, Pasadena, CA, 91105, USA
| | - Min-Shik Chung
- Orthopedic Biomechanics Laboratory, Congress Medical Foundation, 800 S Raymond Ave, Pasadena, CA, 91105, USA
| | - Owen Kao
- Orthopedic Biomechanics Laboratory, Congress Medical Foundation, 800 S Raymond Ave, Pasadena, CA, 91105, USA
| | - Michelle H McGarry
- Orthopedic Biomechanics Laboratory, Congress Medical Foundation, 800 S Raymond Ave, Pasadena, CA, 91105, USA
| | - Thay Q Lee
- Orthopedic Biomechanics Laboratory, Congress Medical Foundation, 800 S Raymond Ave, Pasadena, CA, 91105, USA.
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Lim HY, Kim SH, Choi JW, Chang SY, Kim GH, Kim IB, Nam YS, Lee JI. Optimal needle electromyography approach to the serratus anterior muscle. Muscle Nerve 2023; 68:303-307. [PMID: 37439385 DOI: 10.1002/mus.27933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 06/01/2023] [Accepted: 06/18/2023] [Indexed: 07/14/2023]
Abstract
INTRODUCTION/AIMS There are two conventional needle electromyography (EMG) approaches to the serratus anterior (SA), both of which can result in erroneous insertion into adjacent structures such as the latissimus dorsi (LD), teres major, or external oblique abdominis muscles and pose a risk of long thoracic nerve (LTN) injury. Therefore, we identified a novel needle insertion point for the SA in cadavers that avoids other muscles and LTN injury. METHODS This study included 17 cadavers: 12 to devise the new method and 5 to verify its accuracy. Novel landmarks were the inferior angle of the scapula (I), sternal notch (S), and xiphoid process (X). The relationships of the LD, pectoralis major (PM), SA, and LTN were determined relative to these landmarks. RESULTS When inserting a needle into the proximal one third along the line connecting points I and X, there were adequate safety margins around the LD, PM, and LTN, and the new method had excellent accuracy. DISCUSSION Compared to the conventional midaxillary method, our novel method improved the accuracy of needle EMG of the SA. Follow-up studies using clinical imaging techniques are needed to verify whether above findings are equally applicable in living subjects.
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Affiliation(s)
- Hee Young Lim
- Department of Rehabilitation Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sang-Hyun Kim
- Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jung-Woo Choi
- Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - So-Youn Chang
- Department of Rehabilitation Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Ga Hye Kim
- Department of Rehabilitation Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - In-Beom Kim
- Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Yong-Seok Nam
- Department of Anatomy, College of Korean Medicine, Dongshin University, Jeollanamdo, Korea
| | - Jong In Lee
- Department of Rehabilitation Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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Löfstrand J, Paganini A, Lidén M, Hansson E. Comparison of patient-reported achievements of goals and core outcomes with delayed breast reconstruction in irradiated patients: latissimus dorsi with an implant versus DIEP. J Plast Surg Hand Surg 2023; 58:74-81. [PMID: 37615328 DOI: 10.2340/jphs.v58.12417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/01/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Different women's individual goals with a breast reconstruction vary, and few studies compare techniques in light of the different goals. This study aimed to compare patient-reported core outcomes in patients reconstructed with deep inferior epigastric artery perforator (DIEP) flaps and latissimus dorsi (LD) flaps. Second, breast-related factors that the patients were particularly satisfied/dissatisfied with were analyzed. METHODS This was a retrospective cross-sectional study, which includes women who had undergone mastectomy and radiation, followed by delayed breast reconstructions with either LD flap and implant or DIEP flap during 2007-2017. The patient-reported core outcomes of overall breast-specific quality of life, normality, women's cosmetic satisfaction, self-esteem, emotional well-being, and physical well-being were analyzed using BREAST-Q. RESULTS The patients were divided into LD and implant (n = 135 patients) and DIEP (n = 118 patients) groups, and both were demographically similar. The median follow-up was 8 years. The DIEP group scored significantly higher than the LD and implant group in five out of six domains. A high satisfaction was reported in questions regarding the feeling or appearance when having clothes on, whereas the greatest dissatisfaction was reported regarding questions entailing symmetry and the appearance without clothes. CONCLUSION After 7 years, patients' breast-specific quality of life, normality, women's cosmetic satisfaction, self-esteem, emotional well-being, and physical well-being seem to be higher in irradiated patients who have been reconstructed with DIEP flap as compared to patients reconstructed with LD flap and implant. In both groups, patient satisfaction is high regarding their appearance when clothed, whereas the lowest satisfaction scores were reported in situations without clothing.
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Affiliation(s)
- Jonas Löfstrand
- Department of Plastic Surgery, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Plastic Surgery, Gothenburg, Sweden
| | - Anna Paganini
- Department of Plastic Surgery, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Plastic Surgery, Gothenburg, Sweden; Department of Diagnostics, Acute and Critical Care, Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg
| | - Mattias Lidén
- Department of Plastic Surgery, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Plastic Surgery, Gothenburg, Sweden
| | - Emma Hansson
- Department of Plastic Surgery, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Plastic Surgery, Gothenburg, Sweden.
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Cankurtaran D, Aykın Yığman Z, Güzel Ş, Umay E. The importance of myofascial trigger points in chronic neck pain: An ultrasonography preliminary study. PM R 2023; 15:954-964. [PMID: 36989071 DOI: 10.1002/pmrj.12974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 03/04/2023] [Accepted: 03/14/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Ultrasonographic evaluation of trigger points detected by physical examination in patients with myofascial pain syndrome is being used more frequently in clinical care. However, the sonographic appearance of trigger points, in association with pain and disability, has not been adequately described. OBJECTIVE To reveal the presence of trigger points with ultrasonography in those with myofascial pain syndrome and to determine if ultrasound images can help discriminate between demographic and disease characteristics. METHODS Fifty-two participants with chronic neck pain (NP) were in this cross-sectional study. The pain intensity was evaluated using a 0-10 cm visual analog scale (VAS). The neck disability index measured the NP-induced disability status of the participants. Ultrasonography was used to measure the thicknesses of the paraspinal muscles and the presence of hypoechoic areas within these muscles. RESULTS There was a positive correlation between the VAS scores of the participants and the ultrasonographic detection of myofascial trigger points (MTPs) in the multifidus and middle trapezius muscles (right/left r = .30, p = .027; r = .29, p = .029; r = .32, p = .009, r = .30, p = .011, respectively). These features correlated with the disability levels of the participants and the MTPs on both the right and left sides of the splenius, multifidus, upper trapezius, and middle trapezius (r = .32, p = .028; r = .38, p = .013, r = .25, p = .027; r = .33, p = .016; r = .25, p = .025, r = .32, p = .018, r = .28, p = .013, r = .29, p = .016, respectively). A significant correlation was present between the detection of MTP at ultrasonography and decreased muscle thickness in the relevant muscles (between p = .001 and p = .034). CONCLUSION The detection of MTPs with ultrasonography is associated with the severity of pain and disability in those with chronic NP. Features on ultrasound include hypoechoic changes within muscle and reduced muscle thickness associated with MTPs.
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Affiliation(s)
- Damla Cankurtaran
- Department of Physical Medicine and Rehabilitation, University of Health Sciences Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Zeynep Aykın Yığman
- Department of Physical Medicine and Rehabilitation, Ankara Mamak State Hospital, Ankara, Turkey
| | - Şükran Güzel
- Department of Physical Medicine and Rehabilitation, University of Health Sciences Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Ebru Umay
- Department of Physical Medicine and Rehabilitation, University of Health Sciences Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
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Schwartz M, Desbrosses K, Theurel J, Mornieux G. Biomechanical Consequences of Using Passive and Active Back-Support Exoskeletons during Different Manual Handling Tasks. Int J Environ Res Public Health 2023; 20:6468. [PMID: 37569010 PMCID: PMC10418652 DOI: 10.3390/ijerph20156468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023]
Abstract
The aim of this study was to assess, for both men and women, the consequences of using different back-support exoskeletons during various manual material tasks (MMH) on the activity of back muscles and trunk kinematics. Fifteen men and fourteen women performed MMH involving a 15 kg load (a static task, a symmetric lifting task, and an asymmetric lifting task). Four exoskeleton conditions were tested: without equipment (CON) and with three exoskeletons passive (P-EXO), and active (A-EXO1 and A-EXO2)). The electromyographic activity of the lower trapezius (TZ), latissimus dorsi (LD), erector spinae (ES), gluteus maximus (GM), and biceps femoris (BF) muscles was recorded. Trunk kinematics were evaluated to provide average thoracic, lumbar, and hip angles. The use of the P-EXO decreased the activity of LD, GM, and BF from -12 to -27% (p < 0.01) compared to CON, mostly during the static task. The A-EXO1 and A-EXO2 reduced the muscle activity of all studied muscles from -7 to -62% (p < 0.01) compared to CON and from -10 to -52% (p < 0.005) compared to the P-EXO, independently of the modalities of the experimental tasks. A statistical interaction between the sex and exoskeleton was only observed in a few rare conditions. Occupational back-support exoskeletons can reduce trunk extensor muscle activity compared to no equipment being used. However, these reductions were modulated by the exoskeleton technology (passive vs. active), design (weight and anthropomorphism), and the modalities of the task performed (static vs. dynamic). Our results also showed that the active exoskeletons could modify the trunk kinematics.
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Affiliation(s)
- Mathilde Schwartz
- Working Life Department, French National Research and Safety Institute for the Prevention of Occupational Accidents and Diseases (INRS), 54500 Vandœuvre-les-Nancy, France
| | - Kévin Desbrosses
- Working Life Department, French National Research and Safety Institute for the Prevention of Occupational Accidents and Diseases (INRS), 54500 Vandœuvre-les-Nancy, France
| | - Jean Theurel
- Working Life Department, French National Research and Safety Institute for the Prevention of Occupational Accidents and Diseases (INRS), 54500 Vandœuvre-les-Nancy, France
| | - Guillaume Mornieux
- Développement Adaptation et Handicap (DevAH), Université de Lorraine, 54000 Nancy, France
- Faculty of Sport Sciences, Université de Lorraine, 54000 Nancy, France
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Christensen SWM, Palsson TS, Krebs HJ, Graven-Nielsen T, Hirata RP. Prolonged slumped sitting causes neck pain and increased axioscapular muscle activity during a computer task in healthy participants - A randomized crossover study. Appl Ergon 2023; 110:104020. [PMID: 36958253 DOI: 10.1016/j.apergo.2023.104020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 03/15/2023] [Accepted: 03/17/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Sitting posture may contribute to spinal pain. Effects of postures on pain, sensitivity and muscle activity during computer tasks were investigated. METHODS Twenty-five healthy participants, seated at a workstation without backrest, completed four, 15-min typing tasks: A)Upright with forearm-support; B)Upright without forearm-support; C)Slumped with forearm-support; D)Slumped without forearm-support. Participants rated pain every minute on a numerical rating scale (NRS). RMS-EMG was recorded from upper/lower trapezius (UT, LT), serratus anterior and anterior/middle deltoid. At baseline and after tasks, pressure pain thresholds (PPTs) were recorded bilaterally over the head, UT, and leg. RESULTS All tasks caused clinically relevant increased NRS (≥2/10) compared to baseline (P < 0.001). NRS was higher in Task-D (P < 0.003) and lower in Task-B (P < 0.005) than others. PPTs did not change from baseline. Task-D caused higher UT and LT RMS-EMG (P < 0.02) than other tasks. CONCLUSION A 15-min task caused pain irrespective of posture with some causing larger changes than others.
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Affiliation(s)
- Steffan Wittrup McPhee Christensen
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Denmark; Department of Physiotherapy, University College of Northern Denmark (UCN), Aalborg, Denmark.
| | - Thorvaldur Skuli Palsson
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Denmark; Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Denmark
| | - Hans Jørgen Krebs
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Denmark
| | - Thomas Graven-Nielsen
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Denmark
| | - Rogerio Pessoto Hirata
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Denmark; Sport Sciences - Performance and Technology, Department of Health Science and Technology Aalborg University, Denmark
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Kong YK, Park SS, Shim JW, Choi KH, Shim HH, Kia K, Kim JH. A passive upper-limb exoskeleton reduced muscular loading during augmented reality interactions. Appl Ergon 2023; 109:103982. [PMID: 36739780 DOI: 10.1016/j.apergo.2023.103982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 06/18/2023]
Abstract
The aim of this study was to evaluate a passive upper-limb exoskeleton as an ergonomic control to reduce the musculoskeletal load in the shoulders associated with augmented reality (AR) interactions. In a repeated-measures laboratory study, each of the 20 participants performed a series of AR tasks with and without a commercially-available upper-limb exoskeleton. During the AR tasks, muscle activity (anterior, middle, posterior deltoid, and upper trapezius), shoulder joint postures/moment, and self-reported discomfort were collected. The results showed that the exoskeleton significantly reduced muscle activity in the upper trapezius and deltoid muscle groups and self-reported discomfort. However, the shoulder postures and task performance measures were not affected by the exoskeleton during the AR interactions. Given the significant decrease in muscle activity and discomfort without compromising task performance, a passive exoskeleton can be an effective ergonomic control measure to reduce the risks of developing musculoskeletal discomfort or injuries in the shoulder regions.
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Affiliation(s)
- Yong-Ku Kong
- Department of Industrial Engineering, Sungkyunkwan University, Corvallis, OR, USA
| | - Sang-Soo Park
- Department of Industrial Engineering, Sungkyunkwan University, Corvallis, OR, USA
| | - Jin-Woo Shim
- Department of Industrial Engineering, Sungkyunkwan University, Corvallis, OR, USA
| | - Kyeong-Hee Choi
- Department of Industrial Engineering, Sungkyunkwan University, Corvallis, OR, USA
| | - Hyun-Ho Shim
- Department of Industrial Engineering, Sungkyunkwan University, Corvallis, OR, USA
| | - Kiana Kia
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Jeong Ho Kim
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA.
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Kim KH, Park HB, Kim D, Rhyu IJ, Kim DH. A Cadaveric Study of a Safe and Accurate Electromyographic Needle Approach to the Rhomboid Major. Am J Phys Med Rehabil 2023; 102:404-408. [PMID: 36099586 DOI: 10.1097/phm.0000000000002104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to investigate a safe and accurate electromyographic needle insertion site of the rhomboid major (RM) muscle using cadaver dissection. DESIGN Dissection of the trapezius and rhomboid major muscles around the scapula was performed in 18 scapulae from nine fresh cadavers. The point (point A) at which the lateral margin of the lower trapezius muscle crossed the medial border of the scapula and the distal insertion point (point DI) of the rhomboid major muscle to the medial scapula were determined. The midpoint (point M) between points A and DI was also determined. The distance from the inferior angle of the scapula to each point was measured. RESULTS The length of the medial scapula was 12.9 ± 1.2 cm from the root of the scapular spine to the inferior angle of the scapula. Points A, DI, and M were located at a mean distance of 8.4 ± 0.7, 1.8 ± 0.4, and 5.1 ± 0.5 cm proximal to the inferior angle of the scapula, respectively. CONCLUSIONS Needle electromyographic examination of the rhomboid major muscle can be performed safely and accurately using the lower part of the rhomboid major muscle, as investigated in this anatomical study.
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Affiliation(s)
- Ki Hoon Kim
- From the Department of Physical Medicine and Rehabilitation, College of Medicine, Korea University, Ansan, Republic of Korea (KHK, HBP, DHK); Department of Anatomy, Korea University College of Medicine, Seoul, Republic of Korea (DK, IJR); and Department of Biomedical Sciences, Brain Korea 21 FOUR, Korea University College of Medicine, Seoul, Republic of Korea (IJR)
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Shi X, Zhang F. Analysis of the Hanging Actions and Operating Heights of Storage Furniture Suitable for the Elderly. Sensors (Basel) 2023; 23:3850. [PMID: 37112191 PMCID: PMC10145950 DOI: 10.3390/s23083850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/10/2023] [Accepted: 03/31/2023] [Indexed: 06/19/2023]
Abstract
The current functional scale design of storage furniture which the elderly use does not meet their needs, and unsuitable storage furniture may bring many physiological and psychological problems to their daily lives. The purpose of this study is to start with the hanging operation, to study the factors influencing the hanging operation heights of elderly people undergoing self-care in a standing posture and to determine the research methods to be used to study the appropriate hanging operation height of the elderly so as to provide data and theoretical support for the functional design scale of storage furniture suitable for the elderly. This study quantifies the situations of elderly people's hanging operation through an sEMG test performed on 18 elderly people at different hanging heights combined with a subjective evaluation before and after the operation and a curve fitting between the integrated sEMG indexes and the test heights. The test results show that the height of the elderly subjects had a significant effect on the hanging operation, and the main power muscles of the suspension operation were the anterior deltoid, upper trapezius and brachioradialis. Elderly people in different height groups had their own performance of the most comfortable hanging operation ranges. The suitable range for the hanging operation was 1536-1728 mm for seniors aged 60 or above whose heights were within the range of 1500-1799 mm, which could obtain a better action view and ensure the comfort of the operation. External hanging products, such as wardrobe hangers and hanging hooks, could also be determined according to this result.
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Ibrahim MR, Abdelmaksoud IM, Ahmad MH, Semaya AE. Comparing the Results of Latissimus Dorsi Versus Teres Major Transfer in Children With Obstetric Brachial Plexus Injury and Residual Shoulder Sequelae. Ann Plast Surg 2023; 90:144-150. [PMID: 36688857 DOI: 10.1097/sap.0000000000003434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Obstetric brachial plexus injury (OBPI) remains a fairly common problem in newborns despite the improved obstetric care. Children who do not show complete recovery often present with residual shoulder deformity of limited external rotation and abduction. Secondary interventions in the form of tendon transfer and soft tissue release are aimed at correcting the implicated muscular imbalance to restore shoulder function. AIM The aim of this work was to compare the results of latissimus dorsi versus teres major tendon transfer in patients with OBPI with limited shoulder external rotation. PATIENTS AND METHODS This study included 40 patients admitted to El Hadara University Hospital with OBPI and limited shoulder abduction and external rotation aged between 1.5 and 4 years. Half of the patients had a latissimus dorsi transfer, and the other half, a teres major one. Children with limited preoperative passive external rotation in both groups required a subscapularis slide. Patients were evaluated preoperatively, at 6 months, and 12 months postoperatively using the Gilbert scale. RESULTS Teres major tendon transfer showed better results in restoring limited shoulder abduction and external rotation than latissimus dorsi transfer. Limited shoulder internal rotation was the main complication occurring postoperatively. Loss of the last degree of internal rotation occurred in most patients who had subscapularis slide. Most patients regained functional midline abilities with physiotherapy and required no further interventions. CONCLUSIONS Isolated teres major transfer has shown better results in improving the range of external rotation and abduction compared with isolated latissimus dorsi tendon transfer. Age of the patients did not affect the overall final improvement in shoulder range of motion. Limited internal rotation is the main complication postoperatively, which was prevalent in patients who required a subscapularis slide but was not statistically significant.
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Affiliation(s)
- Marwa Raafat Ibrahim
- From the Department of Orthopedics Surgery and Traumatology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
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Pacifico I, Aprigliano F, Parri A, Cannillo G, Melandri I, Sabatini AM, Violante FS, Molteni F, Giovacchini F, Vitiello N, Crea S. Evaluation of a spring-loaded upper-limb exoskeleton in cleaning activities. Appl Ergon 2023; 106:103877. [PMID: 36095895 DOI: 10.1016/j.apergo.2022.103877] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 08/09/2022] [Accepted: 08/11/2022] [Indexed: 06/15/2023]
Abstract
In the past few years, companies have started considering the adoption of upper-limb occupational exoskeletons as a solution to reduce the health and cost issues associated with work-related shoulder overuse injuries. Most of the previous research studies have evaluated the efficacy of these devices in laboratories by measuring the reduction in muscle exertion resulting from device use in stereotyped tasks and controlled conditions. However, to date, uncertainties exist about generalizing laboratory results to more realistic conditions of use. The current study aims to investigate the in-field efficacy (through electromyography and perceived exertion), usability, and acceptance of a commercial spring-loaded upper-limb exoskeleton in cleaning job activities. The operators were required to maintain prolonged overhead postures while holding and moving a pole equipped with tools for window and ceiling cleaning. Compared to the normal working condition, the exoskeleton significantly reduced the total shoulder muscle activity (∼17%), the activity of the anterior deltoid (∼26%), medial deltoid (∼28%), and upper trapezius (∼24%). With the exoskeleton, the operators perceived reduced global effort (∼17%) as well as a reduced local effort in the shoulder (∼18%), arm (∼22%), upper back (∼14%), and lower back (∼16%). The beneficial effect of the exoskeleton and its suitability in cleaning settings are corroborated by the acceptance and usability scores assigned by operators, which averaged ∼5.5 out of 7 points. To the authors' knowledge, this study is the first to present an experience of exoskeleton use in cleaning contexts. The outcomes of this research invite further studies to test occupational exoskeletons in various realistic applications to foster scientific-grounded ergonomic evaluations and encourage the informed adoption of the technology.
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Affiliation(s)
| | | | - Andrea Parri
- IUVO S.r.l., Via Puglie 9, 56025, Pontedera, Pisa, Italy
| | - Giusi Cannillo
- Formula Servizi, Via Monteverdi, 31, 47122, Forlì, Italy
| | | | - Angelo Maria Sabatini
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Viale Rinaldo Piaggio 34, 56025, Pontedera, Pisa, Italy
| | - Francesco Saverio Violante
- Division of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna.Occupational Medicine Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Italy
| | - Franco Molteni
- Villa Beretta Rehabilitation Center, Valduce Hospital, Via N. Sauro 17, 23845, Costa Masnaga, Lecco, Italy
| | | | - Nicola Vitiello
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Viale Rinaldo Piaggio 34, 56025, Pontedera, Pisa, Italy; Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà, 33, 56127, Pisa, Italy; IRCCS Fondazione Don Carlo Gnocchi, 50143, Florence, Italy
| | - Simona Crea
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Viale Rinaldo Piaggio 34, 56025, Pontedera, Pisa, Italy; Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà, 33, 56127, Pisa, Italy; IRCCS Fondazione Don Carlo Gnocchi, 50143, Florence, Italy.
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M E, M A, M M, A A, M ES. Determination of the adequate vascular perfusion time of cross-leg free latissimus dorsi myocutaneous flaps in reconstruction of complex lower extremity defects. Acta Chir Plast 2023; 64:124-128. [PMID: 36868818 DOI: 10.48095/ccachp2022124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
BACKGROUND Lower limb defects may be present due to various causes including infections, vascular diseases, tumor resections, and crush or avulsion injuries. Management of lower leg defects is a complex problem, especially when they are large with deep soft tissue loss. These wounds are difficult to be covered with local skin flaps, distant skin flaps or even conventional free flaps because of the compromised recipient vessels. In such cases, the vascular pedicle of the free flap could be anastomosed to the recipient vessels of the contralateral healthy leg temporarily and then divided after adequate neo-vascularization of the flap from the wound bed. The ideal time to divide such pedicles should be investigated and accurately assessed to have the maximum success rate possible for these challenging conditions and procedures. METHODS Sixteen patients who did not have a suitable adjacent recipient vessel for free flap reconstruction had been operated with cross leg free latissimus dorsi flap between February 2017 and June 2021. The mean soft tissue defect dimension was 12 × 11 cm (the smallest 6 × 7 cm; the largest 20 × 14 cm). Gustilo type 3B tibial fractures were present in 12 patients, while no fractures were present in the other 4 patients. Preoperatively, arterial angiography was performed on all patients. After the fourth week post-operatively, non-crushing clamp was applied around the pedicle for 15 minutes. The clamping time was increased by 15 minutes on each consequent day (average 14 days). On the last 2 days, the pedicle was clamped for 2 hours, and bleeding was assessed by a needle prick test. RESULTS Clamping time was assessed in each case to reach a scientific calculation of the adequate vascular perfusion time needed for full flap nourishment. All flaps survived completely except two cases of distal flaps necrosis. CONCLUSION Cross-leg free latissimus dorsi can provide a solution for large soft-tissue defects in lower extremities especially with absence of any suitable recipient vessels or when the use of vein grafts would not be feasible. However, ideal time before dividing the cross vascular pedicle should be identified to have the maximum success rate possible.
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Francés-Monasterio M, Fernández-Palacios FP, García-Duque O, Cano-Contreras L, Freixinet-Gilart J. Vertical musculocutaneous trapezius flap for the closure of postpneumonectomy empyema. CIR CIR 2023; 91:615-619. [PMID: 37844885 DOI: 10.24875/ciru.22000210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 07/29/2022] [Indexed: 10/18/2023]
Abstract
OBJECTIVE The aim of the study was to present our experience with the vertical musculocutaneous trapezius (VMCT) flap and highlight its utility in the thoracic wall reconstruction in patients with bronchopleural fistula (BPF). MATERIALS AND METHODS We present a five case series of patients with long-standing cavities and BPF. The VMCT flap was used, and a direct pathway into the defect was made through a separate posterior thoracotomy shortening the distance between the flap and the defect. RESULTS In 80% of the cases, the flap succeeded in solving the fistula and filling the defect, quality of life improved, and the need for oxygen decreased. CONCLUSIONS Management of open window thoracostomy is challenging. Debridement, thoracoplasty, and flap coverage are the mainstream of their treatment, but these patients have scarce available muscle. The VMCT flap represents the major non-affected musculocutaneous unit in the thoracic area after lung surgery. Its dermal component offers a rigid matrix to form a seal over the bronchial stump. Its muscular component adds a good amount of vascularized tissue. No functional impairment has been described after its use.
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Affiliation(s)
| | | | | | - Laura Cano-Contreras
- Department of Thoracic Surgery. Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Jorge Freixinet-Gilart
- Department of Thoracic Surgery. Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
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Błażkiewicz M, Hadamus A. The Effect of the Weight and Type of Equipment on Shoulder and Back Muscle Activity in Surface Electromyography during the Overhead Press-Preliminary Report. Sensors (Basel) 2022; 22:s22249762. [PMID: 36560129 PMCID: PMC9781216 DOI: 10.3390/s22249762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/01/2022] [Accepted: 12/10/2022] [Indexed: 05/14/2023]
Abstract
The overhead press is a multi-joint exercise that has the potential to use a high external load due to the cooperation of many muscle groups. The purpose of this study was to compare the activity of shoulder and back muscles during the overhead press with a kettlebell and a dumbbell. Surface electromyography (EMG) for the anterior and posterior deltoid, upper and lower trapezius, serratus anterior, and spinal erectors was analysed for 20 subjects. Participants performed the four trials of pressing kettlebell and dumbbell, weighted at 6 kg, and 70% of one maximum repetition (1RM) in the sitting position. Statistical analysis was performed using a non-parametric Friedman test and a post-hoc test of Dunn Bonferroni. No significant differences were found in the activation of assessed muscles when comparing dumbbell to kettlebell press trials with the same load (6 kg and 70% of 1RM). However, muscle activity of all muscles except the upper trapezius was always higher for kettlebell pressing. Different center of gravity locations in the kettlebell versus the dumbbell can increase shoulder muscle activity during the overhead press. However, more studies are required to confirm these results.
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Affiliation(s)
- Michalina Błażkiewicz
- Faculty of Rehabilitation, The Józef Piłsudski University of Physical Education in Warsaw, 00-809 Warsaw, Poland
| | - Anna Hadamus
- Department of Rehabilitation, Faculty of Dental Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland
- Correspondence:
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Khanittanuphong P, Saesim A. Comparison of the effectiveness between dry needling with and without needle retention in myofascial trigger points in upper trapezius muscle: A randomized comparative trial. J Back Musculoskelet Rehabil 2022; 35:1247-1255. [PMID: 35570477 DOI: 10.3233/bmr-210177] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Dry needling (DN) is commonly used to treat myofascial trigger points (MTrPs). OBJECTIVE To compare the effect between DN with and without needle retention in the treatment of MTrPs in the upper trapezius muscle. METHODS Fifty-four patients who had active MTrPs in the upper trapezius muscle were randomly allocated into the DN group or the DN with retention group. The DN group received DN only, while the DN with retention group received DN with needle retention for 30 minutes. The visual analogue scale (VAS) and pressure pain threshold (PPT) were recorded both before and after 7 and 14 days of the treatment sessions. RESULTS Both groups showed a significant decrease of the VAS at 7 and 14 days (mean difference DN group -53.0, DN with retention group -57.0, p< 0.001). The PPT was also significantly improved in both groups (mean difference DN group 109.8 kPa, DN with retention group 132.3 kPa, p< 0.001). However, there were no significant differences in the VAS or PPT between the groups. CONCLUSIONS Both DN and DN with retention had significant improvement of pain intensity in the treatment of MTrPs in the upper trapezius muscle at 14 days. However, pain reduction was not significantly different between the interventions.
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Song DJ, Li Z, Zhang Y. [Free anterolateral thigh myocutaneous flap combined with pedicled latissimus dorsi myocutaneous flap transfer for functional reconstruction after resection of huge shoulder tumor]. Zhonghua Wai Ke Za Zhi 2022; 60:1011-1017. [PMID: 36323584 DOI: 10.3760/cma.j.cn112139-20220405-00140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Objective: To investigate the method and effect of free anterolateral thigh myocutaneous flap combined with pedicled latissimus dorsi myocutaneous flap transfer for functional reconstruction after resection of huge shoulder tumor. Methods: The clinical data of 6 patients who were treated with pedicled latissimus dorsi myocutaneous flap combined with free anterolateral thigh myocutaneous flap to repair large-area complex defects after shoulder tumor resection at Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital from December 2015 to December 2020 were retrospectively analyzed. There were 2 males and 4 females, with an average age of 41.7 years (range:29 to 56 years). There were 2 cases of synovial sarcoma,2 cases of phylloid cell sarcoma,1 case of liposarcoma and 1 case of fibrosarcoma. Before this operation, tumor resection had been performed for 1 to 5 times on each case,and the course of disease was 6 to 24 months. Pedicled latissimus dorsi myocutaneous flap combined with free anterolateral thigh myocutaneous flap were used to repair soft tissue defects and reconstruct deltoid function. Postoperative flap status, complications, appearance and function of upper limbs and tumor recurrence were recorded. Results: Six patients were followed up for an average of 21.6 months (range: 12 to 36 months). There were no serious complications after operation,and all flaps survived. No tumor recurrence was found. The appearance of shoulder contour reconstructed by flaps was satisfactory. The reinnervation effect of lateral femoral muscle was confirmed recovered smoothly by neuroelectromyography 3 months after operation. Shoulder function was mildly limited in 3 patients,moderately limited in 2 patients and severely limited in 1 patient. All patients reported significant improvement in shoulder discomfort.The overall functional results of all patients were satisfactory. Conclusion: Combined myocutaneous flaps transplantation can perfectly repair the wound left after the resection of huge shoulder tumor,minimize the recurrence of tumor,reconstruct the function of shoulder joint and greatly improve the quality of life of patients.
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Affiliation(s)
- D J Song
- Department of Oncology Plastic Surgery,Hunan Province Cancer Hospital,Changsha 410008,China
| | - Z Li
- Department of Oncology Plastic Surgery,Hunan Province Cancer Hospital,Changsha 410008,China
| | - Yixin Zhang
- Department of Plastic and Reconstructive Surgery,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China
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Jung JY, Cho HY, Kang CK. Effects of a Traction Device for Head Weight Reduction and Neutral Alignment during Sedentary Visual Display Terminal (VDT) Work on Postural Alignment, Muscle Properties, Hemodynamics, Preference, and Working Memory Performance. Int J Environ Res Public Health 2022; 19:14254. [PMID: 36361134 PMCID: PMC9655747 DOI: 10.3390/ijerph192114254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/25/2022] [Accepted: 10/27/2022] [Indexed: 06/16/2023]
Abstract
The forward head posture of visual display terminal (VDT) users induces various physical and cognitive clinical symptoms. However, few studies have been conducted to identify and solve problems associated with VDT posture. This study aimed to examine the adverse effects of VDT posture and the positive effects of traction-combined workstations by measuring postural alignment, muscle properties, blood velocity, preference, and working memory. Thirty-four healthy VDT users (18 males and 16 females aged 20-30 years) participated in the experiment at three workstations, including conventional (VDT_C), head support (VDT_S), and upright (VDT_U) workstations. They conducted 2-back working memory task. The craniovertebral angle (CVA), muscle tone and stiffness, blood velocity and visual analogue discomfort scale (VADS) were measured to examine the influence of workstations. VDT_C showed increased muscle tone or stiffness in the levator scapulae (LS), suboccipital muscle (SM), and sternocleidomastoid muscle (SCM) and an increased reaction time (RT) in working memory. However, VDT_S showed decreased stiffness and tone of SM and improved comfort. In addition, VDT_U showed decreased stiffness or tone of the LS and SCM and improved blood velocity and RT. In conclusion, maintaining neutral alignment significantly improved working memory performance, muscle properties, and blood velocity.
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Affiliation(s)
- Ju-Yeon Jung
- Department of Health Science, Gachon University Graduate School, Gachon University, Incheon 21936, Korea
| | - Hwi-Young Cho
- Department of Health Science, Gachon University Graduate School, Gachon University, Incheon 21936, Korea
- Department of Physical Therapy, College of Health Science, Gachon University, Incheon 21936, Korea
| | - Chang-Ki Kang
- Department of Health Science, Gachon University Graduate School, Gachon University, Incheon 21936, Korea
- Neuroscience Research Institute, Gachon University, Incheon 21565, Korea
- Department of Radiological Science, College of Health Science, Gachon University, Incheon 21936, Korea
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