-
Journal of Hand Surgery Global Online Mar 2024Surgical reconstruction of elbow extension can help restore function in patients with tetraplegia and triceps paralysis because of spinal cord injury. Both posterior...
PURPOSE
Surgical reconstruction of elbow extension can help restore function in patients with tetraplegia and triceps paralysis because of spinal cord injury. Both posterior deltoid-to-triceps tendon transfer and transfer of the branch of the axillary nerve to the triceps motor branch of the radial nerve have been described for triceps reanimation. This systematic review aimed at reviewing current evidence in the two schools of surgery in terms of their outcome and complication profile.
METHODS
A systematic review was conducted using MEDLINE (1974-2023) and EMBASE (1946-2023) databases. The keyword terms "elbow extension," "triceps," "deltoid," "nerve transfer," "spinal cord injury," "tetraplegia," "quadriplegia," and "tetraplegic" were used in the initial search, which was supplemented with manual searches of the bibliographies of retrieved articles.
RESULTS
Twenty studies met our inclusion criteria, with 14 studies (229 limbs) on posterior deltoid-to-triceps tendon transfer, 5 studies (23 limbs) on axillary to radial nerve transfer, and 1 study (1 limb) on combined transfer. For the tendon transfer group, the majority of studies reported a median triceps power of grade 3, with a wide range of failure percentage to reach antigravity (0% to 87.5%). Common complications included gradual stretching of the musculotendinous unit, rupture of the tendon transferred, elbow contracture, and infection. For the nerve transfer group, the majority of studies also reported a median triceps power reaching grade 3. There were no reported complications or loss of power in donor action of shoulder abduction or external rotation.
CONCLUSIONS
Transfer of the axillary nerve branch to the triceps motor branch of the radial nerve in tetraplegia shows promising results, with comparable triceps muscle power compared to traditional tendon transfer and a low incidence of complication.
TYPE OF STUDY/LEVEL OF EVIDENCE
Systematic Review III.
PubMed: 38903844
DOI: 10.1016/j.jhsg.2023.11.012 -
Frontiers in Sports and Active Living 2024Unstable surfaces are commonly utilized to enhance the flexibility of the musculoskeletal system for achieving training or rehabilitation goals. However, their effects...
Electromyography of shoulder muscles in individuals without scapular dyskinesis during closed kinetic chain exercises on stable and unstable surfaces: a systematic review and meta-analysis.
INTRODUCTION
Unstable surfaces are commonly utilized to enhance the flexibility of the musculoskeletal system for achieving training or rehabilitation goals. However, their effects on shoulder muscle activation during various push-up (PU) exercises have not been thoroughly investigated. Therefore, the purpose of this study was to synthesize electromyography (EMG) data of shoulder muscles in individuals without scapular dyskinesis performing different PU exercises on both stable and unstable surfaces.
METHODS
A systematic online search was conducted in electronic databases, including Web of Science, PubMed, Scopus, and Google Scholar, up to January 16, 2024, using predefined sets of keywords. Out of the 1,971 titles and abstracts screened, 80 articles were reviewed in detail by two independent researchers to check the eligibility, of which 28 eligible studies were ultimately included. Following assessment of the quality and risk of bias, the studies were categorized based on exercises and muscle groups, and a meta-analysis using a random-effects model was performed to estimate the overall effect size.
RESULTS
The use of unstable surfaces led to a decrease in anterior deltoid activity during PU [ = 0.032; = 91.34%; SMD = -0.630 (95% CI -1.205, -0.055)], an increase in pectoralis major activity during PU [ = 0.006; = 63.72%; SMD = 0.282 (95% CI 0.079, 0.484)], as well as during knee PU [ = 0.018; = 32.29%; SMD = 0.309 (95% CI 0.052, 0.565)], and an increase in triceps brachii activity during PU [ = 0.000; = 85.05%; SMD = 0.813 (95% CI 0.457, 1.168)], knee PU [ = 0.000; = 0.00%; SMD = 0.589 (95% CI 0.288, 0.891)], as well as during push-up plus [ = 0.006; = 13.16%; SMD = 0.563 (95% CI 0.161, 0.965)]. However, the use of unstable surfaces did not show a significant effect on the EMG activity of the pectoralis major during push-up plus [ = 0.312; = 22.82%; SMD = 0.207 (95% CI -0.194, 0.609)].
CONCLUSIONS
Unstable surfaces can modulate muscle activity in different PU exercises, while the effects on the targeted muscles depend on the type of exercise. The findings of this review provide a framework based on the level of activity of each shoulder muscle during different PU exercises, which can help coaches, trainers, and sports therapists select the most suitable type of PU for designing training or rehabilitation programs. Particularly, the most suitable exercise for increasing anterior deltoid activity is PU on a stable surface. To concurrently increase activity of the pectoralis major and triceps brachii, adding unstable surfaces under hands during knee PU and standard PU is recommended.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO, identifier CRD42021268465.
PubMed: 38840951
DOI: 10.3389/fspor.2024.1385693 -
Journal of Sport and Health Science Jul 2024Near-infrared spectroscopy (NIRS) technology has allowed for the measurement of cerebral and skeletal muscle oxygenation simultaneously during exercise. Since this... (Review)
Review
BACKGROUND
Near-infrared spectroscopy (NIRS) technology has allowed for the measurement of cerebral and skeletal muscle oxygenation simultaneously during exercise. Since this technology has been growing and is now successfully used in laboratory and sports settings, this systematic review aimed to synthesize the evidence and enhance an integrative understanding of blood flow adjustments and oxygen (O) changes (i.e., the balance between O delivery and O consumption) within the cerebral and muscle systems during exercise.
METHODS
A systematic review was conducted using PubMed, Embase, Scopus, and Web of Science databases to search for relevant studies that simultaneously investigated cerebral and muscle hemodynamic changes using the near-infrared spectroscopy system during exercise. This review considered manuscripts written in English and available before February 9, 2023. Each step of screening involved evaluation by 2 independent authors, with disagreements resolved by a third author. The Joanna Briggs Institute Critical Appraisal Checklist was used to assess the methodological quality of the studies.
RESULTS
Twenty studies were included, of which 80% had good methodological quality, and involved 290 young or middle-aged adults. Different types of exercises were used to assess cerebral and muscle hemodynamic changes, such as cycling (n = 11), treadmill (n = 1), knee extension (n = 5), isometric contraction of biceps brachii (n = 3), and duet swim routines (n = 1). The cerebral hemodynamics analysis was focused on the frontal cortex (n = 20), while in the muscle, the analysis involved vastus lateralis (n = 18), gastrocnemius (n = 3), biceps brachii (n = 5), deltoid (n = 1), and intercostal muscle (n = 1). Overall, muscle deoxygenation increases during exercise, reaching a plateau in voluntary exhaustion, while in the brain, oxyhemoglobin concentration increases with exercise intensity, reaching a plateau or declining at the exhaustion point.
CONCLUSION
Muscle and cerebral oxygenation respond differently to exercise, with muscle increasing O utilization and cerebral tissue increasing O delivery during exercise. However, at the exhaustion point, both muscle and cerebral oxygenation become compromised. This is characterized by a reduction in blood flow and a decrease in O extraction in the muscle, while in the brain, oxygenation reaches a plateau or decline, potentially resulting in motor failure during exercise.
Topics: Humans; Muscle, Skeletal; Oxygen Consumption; Spectroscopy, Near-Infrared; Exercise; Brain; Hemodynamics; Oxygen; Cerebrovascular Circulation; Adult
PubMed: 38462172
DOI: 10.1016/j.jshs.2024.03.003 -
Asian Journal of Surgery May 2024Surgical repair of rotator cuff tears is performed routinely; however, the risks of re-tears and the associated consequences are significant. Sonoelastography, an... (Review)
Review
Surgical repair of rotator cuff tears is performed routinely; however, the risks of re-tears and the associated consequences are significant. Sonoelastography, an imaging modality that evaluates the mechanical properties of tissues, can examine the dynamic transitions in rotator cuff stiffness following retear and investigate the relationship between these changes and the occurrences of retears. This systematic review aimed to summarize the role of perioperative sonoelastography in repaired rotator cuffs. A comprehensive search of the PubMed, Embase, and Cochrane databases was conducted, covering studies published until June 19, 2023. The Newcastle-Ottawa scale was used for quality assessment. The key information extracted from each study included the injury/surgery type, follow-up duration, sonoelastography mode, and main sonoelastographic findings. Eleven eligible studies comprising 355 patients were included. All studies focused on supraspinatus muscles and tendons with previous arthroscopic repairs. During the postoperative 1st - 6th months, muscle stiffness increased in the supraspinatus and decreased in the ipsilateral deltoid. Failure to recover supraspinatus muscle elasticity might be indicative of potential tendon re-tear; however, it is imperative to first establish correlations with other imaging modalities. Conflicting findings have been observed regarding stiffening or softening of the supraspinatus tendon after surgical repair. The preoperative stiffness of the supraspinatus tendon did not correlate with postoperative tendon integrity or function.
Topics: Humans; Elasticity Imaging Techniques; Rotator Cuff Injuries; Rotator Cuff; Arthroscopy; Elasticity
PubMed: 38383203
DOI: 10.1016/j.asjsur.2024.02.094 -
Journal of Orthopaedic Trauma Nov 2023To determine the diagnostic accuracy of various stress tests for deltoid ligament and syndesmosis injury in patients with ankle fracture. (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To determine the diagnostic accuracy of various stress tests for deltoid ligament and syndesmosis injury in patients with ankle fracture.
DATA SOURCES
A systemic literature search was conducted in the MEDLINE, Embase, and Cochrane Library databases to identify studies published from January 1990 to August 2022.
STUDY SELECTION
Studies that evaluated external rotation or gravity stress tests or hook or tap tests for the diagnosis of deltoid ligament or syndesmosis injury were included.
DATA EXTRACTION
Authors, publication years, study design, index tests, reference standards, demographic features of participants, reliability, and the numbers of true-positive, true-negative, false-positive, and false-negative subjects were extracted from 14 included studies. Article quality was assessed through the revised Quality Assessment of Diagnostic Accuracy Studies tool.
DATA SYNTHESIS
The pooled sensitivity and specificity of each index test for each structure were calculated with a random-effects model using the extracted data of true-positive, true-negative, false-positive, and false-negative outcomes in all relevant studies. The overall diagnostic performance of the different index tests for different structures was determined with the estimation of the area under the curve using the summary receiver operating characteristics curve.
CONCLUSIONS
The gravity stress test and the tap test exhibited high sensitivity and specificity in diagnosing deltoid ligament injury. The hook test has relatively high accuracy in diagnosing syndesmosis injury. Further studies with large sample sizes are warranted to confirm the results of this review.
LEVEL OF EVIDENCE
Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Topics: Humans; Ankle Fractures; Exercise Test; Reproducibility of Results; Ankle Injuries; Ligaments; Sensitivity and Specificity
PubMed: 37448133
DOI: 10.1097/BOT.0000000000002651 -
Journal of Bodywork and Movement... Jul 2023The objective of this study is to determine the upper limb muscle electromyographic (EMG) activity required during various manual wheelchair transfers in the population... (Review)
Review
BACKGROUND AND PURPOSE
The objective of this study is to determine the upper limb muscle electromyographic (EMG) activity required during various manual wheelchair transfers in the population of spinal cord injury (SCI).
METHODS
This review included observational studies reporting the (EMG) activity of upper limb muscles during wheelchair transfers in people with SCI. We searched electronic databases and reference lists of relevant literature between 1995 and March 2022 with English language limits, yielding 3870 total articles. Two independent researchers performed data extraction and conducted quality assessment using two checklists, the Modified Downs and Blacks and National Heart, Lung, and Blood Institute for observational cohort and cross-sectional studies.
RESULTS
After eligibility screening, seven studies were included in this review. The sample size ranged from 10 to 32 participants aged 31-47 years. They assessed four types of transfers and mostly evaluated six upper limb muscles were biceps, triceps, anterior deltoid, pectoralis major, latissimus dorsi and ascending fibres of the trapezius. The peak EMG value indicated that muscle recruitment varied in both upper limbs according to the task demand, and the highest activity was seen during the lift-pivot transfer phase. Because of the data heterogeneity, a meta-analysis of study results was not feasible.
CONCLUSION
There were various ways of reporting the upper limb EMG muscle activity profile across all the included studies with a limited sample size. The crucial role of upper limb muscles during different types of manual wheelchair transfers was interpreted in this review. This is essential for predicting functional independence of individuals with SCI and warranting optimal rehabilitation strategies for wheelchair transfer skills.
Topics: Humans; Cross-Sectional Studies; Electromyography; Spinal Cord Injuries; Upper Extremity; Wheelchairs
PubMed: 37330798
DOI: 10.1016/j.jbmt.2023.04.077 -
Experimental and Therapeutic Medicine Jun 2023The present review and meta-analysis aimed to summarize the currently available data and to compare the important clinical and functional outcomes in patients with...
The present review and meta-analysis aimed to summarize the currently available data and to compare the important clinical and functional outcomes in patients with proximal humerus fractures who were treated using deltoid split (DS) or deltopectoral (DP) surgical approaches. The PubMed, EMBASE, Scopus and Cochrane Central Register of Controlled Trials databases were systematically searched for randomized controlled trials or observational studies that reported functional outcome data of patients with fracture of proximal humerus who were surgically treated using DS and DP approaches. A total of 14 studies were included in the present meta-analysis. The duration of surgery [min; weighted mean difference (WMD), -16.44; 95% CI, -(25.25-7.63)], amount of blood loss [ml; WMD, -57.99; 95% CI, -(102.74-13.23)] and time to bone union [weeks WMD, -1.66; 95% CI, -(2.30-1.02)] was comparatively lower in patients that underwent DS. There were no statistically significant differences in the pain and quality of life scores, range of movement and risk of complications between the DS and the DP groups. Patients in the DS group had improved shoulder function and constant shoulder score (CSS) at 3 months post-surgery (WMD, 6.36; 95% CI, 1.06-11.65). No differences were observed between the two groups in terms of CSS and disabilities of the arm, shoulder and hand scores at 12 and 24 months post-operatively. The activity of daily living (ADL) score was significantly improved in the DS group at 3 (WMD, 1.23; 95% CI, 0.40-2.06), 6 (WMD, 0.99; 95% CI, 0.72-1.25) and 12 months (WMD, 0.83; 95% CI, 0.18-1.47) after the surgery. The present results suggested that DS and DP surgical approaches were associated with similar clinical outcomes. The DS approach was associated with certain perioperative benefits, as well as reduced time to bone union, improved shoulder function in the early postoperative period and improved ADL scores. These benefits may be considered while choosing between these two surgical approaches.
PubMed: 37229316
DOI: 10.3892/etm.2023.11995 -
JBJS Reviews Jan 2023Persistent shoulder pain and dysfunction after vaccination are relatively rare but well-known complications after inoculations into the deltoid muscle. The term SIRVA...
BACKGROUND
Persistent shoulder pain and dysfunction after vaccination are relatively rare but well-known complications after inoculations into the deltoid muscle. The term SIRVA (shoulder injury related to vaccine administration) is frequently used to encompass many of these occurrences; however, multiple distinct pathologies with similar presentations have been reported after vaccination. We performed a systematic review of the literature on vaccine-related shoulder injuries to help guide practitioners in appropriate workup and treatment based on specific diagnoses.
METHODS
PubMed was used to search for combinations of multiple keywords (including vaccine, immunization, SIRVA, injury, inflammation, bursitis, Parsonage-Turner syndrome, and neuritis), and all references of each potential article were reviewed. A total of 56 articles were included. Patient demographics, vaccine information, presentation, diagnostic studies, treatment, and outcomes were recorded.
RESULTS
Diagnoses were divided into 3 categories: (1) local inflammatory reaction (SIRVA), (2) brachial neuritis, and (3) direct nerve injury. The included articles reported on 57 cases of SIRVA, 18 of brachial neuritis, and 4 of direct nerve injury. The diagnoses reported for the SIRVA cases included frozen shoulder, pseudoseptic arthritis, subacromial bursitis, rotator cuff injury, and lytic lesions of the humeral head. Various treatments were used, and most patients had resolution of symptoms with conservative treatment including physical therapy, analgesics, and/or corticosteroid injections. Advanced imaging rarely provided information that affected treatment. The brachial neuritis and direct nerve injury cases were typically confirmed with electromyography/nerve conduction studies. Treatment of these 2 categories was nonoperative in all cases, typically with analgesics and/or corticosteroids, and most patients had symptomatic improvement after a few months, with most patients regaining strength. However, some (1 of 3 patients with brachial neuritis and >1 year of follow-up and 2 of 4 patients with direct injury) had residual weakness.
CONCLUSIONS
Medical professionals should be aware of the various pathologies that can lead to prolonged shoulder pain after vaccination. Fortunately, most of these conditions can be treated successfully with nonoperative modalities, although differentiating among the diagnoses can help guide treatment, as some likely benefit from systemic corticosteroids or localized corticosteroid injections. Outcomes for most patients have been good, with the majority recovering without residual pain or deficits.
LEVEL OF EVIDENCE
Prognostic Level IV.
Topics: Humans; Shoulder Pain; Brachial Plexus Neuritis; Vaccination; Inflammation; Bursitis
PubMed: 36722836
DOI: 10.2106/JBJS.RVW.22.00134 -
Frontiers in Surgery 2022Irreparable rotator cuff tears (IRCT) are defined as defects that cannot be repaired due to tendon retraction, fat infiltration, or muscle atrophy. One surgical remedy... (Review)
Review
BACKGROUND
Irreparable rotator cuff tears (IRCT) are defined as defects that cannot be repaired due to tendon retraction, fat infiltration, or muscle atrophy. One surgical remedy for IRCT is superior capsular reconstruction (SCR), which fixes graft materials between the larger tuberosity and the superior glenoid.
PATIENTS AND METHODS
The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) criteria were followed for conducting the systematic review and meta-analysis. From their inception until February 25, 2022, Pubmed, Embase, and Cochrane Library's electronic databases were searched. Studies using cadavers on SCR for IRCT were also included. The humeral head's superior translation and subacromial peak contact pressure were the primary outcomes. The humeral head's anteroposterior translation, the kind of graft material used, its size, and the deltoid load were the secondary outcomes.
RESULTS
After eliminating duplicates from the search results, 1,443 unique articles remained, and 20 papers were finally included in the quantitative research. In 14 investigations, the enhanced superior translation of the humeral head was documented in IRCTs. In 13 studies, a considerable improvement following SCR was found, especially when using fascia lata (FL), which could achieve more translation restraints than human dermal allograft (HDA) and long head of bicep tendon (LHBT). Six investigations reported a subacromial peak contact pressure increase in IRCTs, which could be rectified by SCR, and these studies found a substantial increase in this pressure. The results of the reduction in subacromial peak contact pressure remained consistent regardless of the graft material utilized for SCR. While there was a statistically significant difference in the change of graft material length between FL and HDA, the change in graft material thickness between FL and HDA was not significant. The humeral head's anterior-posterior translation was rising in IRCTs and could be returned to its original state with SCR. In five investigations, IRCTs caused a significant increase in deltoid force. Furthermore, only one study showed that SCR significantly decreased deltoid force.
CONCLUSION
With IRCT, SCR might significantly decrease the glenohumeral joint's superior and anterior-posterior stability. Despite the risks for donor-site morbidity and the longer recovery time, FL is still the best current option for SCR.
PubMed: 36700024
DOI: 10.3389/fsurg.2022.939096 -
BMJ Open Jan 2023(1) Assess the distribution of skin-to-deltoid-muscle distance (SDMD) at the deltoid intramuscular (IM) injection site; (2) its relationship with demographic and...
OBJECTIVES
(1) Assess the distribution of skin-to-deltoid-muscle distance (SDMD) at the deltoid intramuscular (IM) injection site; (2) its relationship with demographic and anthropometric variables and (3) Consider the findings in relation to clinical guidance on IM injection, such as COVID-19 vaccines.
DESIGN
Systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
DATA SOURCES
MEDLINE, EMBASE, ClinicalTrials.gov, Cochrane Library, CINAHL and SCOPUS between June and July 2021 with no publication date limit.
ELIGIBILITY CRITERIA
Studies reporting measurements of the SDMD in living adults aged 16 years and older, at the deltoid IM injection site, published in English were considered.
DATA EXTRACTION AND SYNTHESIS
Two independent reviewers performed each stage of screening, data extraction and quality assessments using the Joanna Briggs Institute Critical Appraisal Checklist for analytical cross sectional studies.
RESULTS
16 105 papers were identified, of which 11 studies were suitable for review, representing 1414 participants. Heterogeneity in the definition of the deltoid IM injection site, locations measured and methods of measurement precluded meta-analysis. Evidence from ultrasound SDMD measurements demonstrated some patients in all but 'underweight' body mass index (BMI) categories, may require needles longer than 25 mm for successful IM injection. Calliper measurements overestimated SDMD compared with ultrasound. Female sex, higher BMI categories and greater weight in women were associated with greater SDMD.
CONCLUSIONS
The reviewed evidence was insufficient to inform definitive needle length 'cut points' for IM injection based on demographic or anthropomorphic variables. Contemporary clinical guidance currently based on this evidence, including the site of injection and choice of needle length, may result in subcutaneous administration in a small proportion of recipients, particularly if obese or of female sex.
PROSPERO REGISTRATION NUMBER
CRD42021264625.
Topics: Adult; Humans; Female; Injections, Intramuscular; COVID-19 Vaccines; Cross-Sectional Studies; COVID-19; Needles
PubMed: 36669836
DOI: 10.1136/bmjopen-2022-063530