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Journal of Orthopaedic Surgery (Hong... Jan 2017C5 palsy is a serious complication after cervical decompression surgery in which the patient shows a deterioration in power of the deltoid or biceps brachii by at least... (Review)
Review
BACKGROUND
C5 palsy is a serious complication after cervical decompression surgery in which the patient shows a deterioration in power of the deltoid or biceps brachii by at least one grade in the manual muscle test without aggravation of lower extremity function. Although there are several hypotheses regarding the etiology of C5 palsy, the pathogenesis and preventive measures remain unidentified and many other controversies remain.
OBJECTIVE
To systematically review the clinical features, risk factors, mechanism, and preventive measures of C5 palsy after posterior cervical decompression surgery.
MATERIALS AND METHODS
PubMed was searched to identify eligible studies that contained more than 10 cases and focused on C5 palsy. Microsoft Excel was used to analyze the data. Statistical comparisons were made when appropriate.
RESULTS
Out of 718 papers involving C5 palsy, 28 met the inclusion criteria. The average incidence rate was 7.8% (range, 1.4-23.0%). Risk factors for C5 palsy included age, male gender, ossification of the posterior longitudinal ligament, and stenosis of the C4-C5 intervertebral foramen. C5 palsy occurred from immediately to 2 months after surgery, and recovery time ranged from 48 h to 41 months. Hypotheses for the mechanism of C5 palsy included root involvement and spinal cord impairment. Foraminotomy and intraoperative neuromonitoring were the two main methods used to prevent C5 palsy.
CONCLUSION
C5 palsy is a serious complication occurring at the early stage after cervical decompression surgery. Foraminotomy and intraoperative neuromonitoring were the two main methods to prevent C5 palsy. The incidence of C5 palsy is low, but it can place a serious burden on the patients' quality of life and finances. The risk factors and mechanism of C5 palsy are still controversial. However, under conservative therapy, the prognosis is usually good. Higher quality studies are necessary for drawing more reliable and convincing conclusions about this disease.
Topics: Brachial Plexus Neuropathies; Cervical Vertebrae; Decompression, Surgical; Female; Humans; Male; Postoperative Complications; Risk Factors
PubMed: 28176604
DOI: 10.1177/2309499016684502 -
PloS One 2017The bench press exercise (BP) plays an important role in recreational and professional training, in which muscle activity is an important multifactorial phenomenon. The... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The bench press exercise (BP) plays an important role in recreational and professional training, in which muscle activity is an important multifactorial phenomenon. The objective of this paper is to systematically review electromyography (EMG) studies performed on the barbell BP exercise to answer the following research questions: Which muscles show the greatest activity during the flat BP? Which changes in muscle activity are related to specific conditions under which the BP movement is performed?
STRATEGY
PubMed, Scopus, Web of Science and Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library were searched through June 10, 2016. A combination of the following search terms was used: bench press, chest press, board press, test, measure, assessment, dynamometer, kinematics and biomechanics. Only original, full-text articles were considered.
RESULTS
The search process resulted in 14 relevant studies that were included in the discussion. The triceps brachii (TB) and pectoralis major (PM) muscles were found to have similar activity during the BP, which was significantly higher than the activity of the anterior deltoid. During the BP movement, muscle activity changes with exercise intensity, velocity of movement, fatigue, mental focus, movement phase and stability conditions, such as bar vibration or unstable surfaces. Under these circumstances, TB is the most common object of activity change.
CONCLUSIONS
PM and TB EMG activity is more dominant and shows greater EMG amplitude than anterior deltoid during the BP. There are six factors that can influence muscle activity during the BP; however, the most important factor is exercise intensity, which interacts with all other factors. The research on muscle activity in the BP has several unresolved areas, such as clearly and strongly defined guidelines to perform EMG measurements (e.g., how to elaborate with surface EMG limits) or guidelines for the use of exact muscle models.
Topics: Electromyography; Exercise; Humans; Muscle Contraction; Muscle, Skeletal; Psychomotor Performance
PubMed: 28170449
DOI: 10.1371/journal.pone.0171632 -
Foot & Ankle Specialist Feb 2017The deltoid ligament is a complex structure of the tibiotalar joint that limits the translation and tilting of the talus. It is often associated with injuries of the... (Meta-Analysis)
Meta-Analysis Review
UNLABELLED
The deltoid ligament is a complex structure of the tibiotalar joint that limits the translation and tilting of the talus. It is often associated with injuries of the ankle joint. The deltoid complex ligament has 2 layers; one superficial with 4 bands and the other deep with 2 bands. Nevertheless, the prevalence and size of its components are reported with some variability in the literature. The aim of this meta-analysis is to generate weighted values of the prevalence, size, and attachment surface areas of its components. Eight studies met the inclusion criteria with a total of 142 ankle specimens. The analyses demonstrate that the most consistent component is the deep posterior tibiotalar (100%), followed by the tibiospring (≈94%), the tibionavicular (≈90%), and the tibiocalcaneal (85%). The superficial posterior ligament and the deep anterior tibiotalar ligament were the least prevalent (≈80% and ≈63%, respectively). The longest ligament was found to be the tibionavicular ligament and the shortest band was the deep posterior tibiotalar ligament. The tibionavicular ligament was the thinnest of all deltoid complex ligament components. This study yielded more accurate data on the frequency and size of its components. The possible absence of a component, particularly of the superficial layer, might compromise joint stability in acute ankle injuries.
LEVELS OF EVIDENCE
Systematic review of level III studies: prospective studies.
Topics: Ankle Joint; Cadaver; Humans; Ligaments, Articular; Prevalence
PubMed: 27807288
DOI: 10.1177/1938640016675409 -
Physical Therapy in Sport : Official... Nov 2016Systematic review. (Review)
Review
STUDY DESIGN
Systematic review.
OBJECTIVES
To identify the best evidenced-based approach for the conservative rehabilitation of patients with posterior glenohumeral instability.
BACKGROUND
Posterior glenohumeral instability is more common than previously thought. Proper management is imperative to control symptoms and maximize function.
METHODS
We conducted an electronic search, up to November 2014, for English-language studies involving rehabilitation of posterior shoulder instability. A manual search of reference lists of included articles and previously published reviews was also performed.
RESULTS
Five studies met the review inclusion criteria. Most studies demonstrated that rotator cuff and posterior deltoid strengthening could reduce instability recurrence and pain, and increase function, mainly in those with atraumatic posterior instability without previous surgery. These studies were mainly case series or retrospective designs.
CONCLUSIONS
Rotator cuff and posterior deltoid strengthening may help with symptom-management and functioning in those with posterior glenohumeral instability. Further research is needed to detect statistically significant outcomes from conservative treatment.
LEVEL OF EVIDENCE
Therapy, Level 3.
Topics: Evidence-Based Medicine; Humans; Joint Instability; Shoulder Joint
PubMed: 27665529
DOI: 10.1016/j.ptsp.2016.06.002 -
American Journal of Orthopedics (Belle... 2016Reverse total shoulder arthroplasty (RTSA) is a treatment option for patients with rotator cuff tear arthropathy, pseudoparalysis, and a functional deltoid. Our... (Review)
Review
Reverse total shoulder arthroplasty (RTSA) is a treatment option for patients with rotator cuff tear arthropathy, pseudoparalysis, and a functional deltoid. Our hypothesis was that no significant difference in postoperative active range of motion (ROM) will be observed in patients with 135° and 155° humeral cup inclination. A systematic review was registered with PROSPERO and performed with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies evaluating RTSA that reported the type of prosthesis as well as active postoperative ROM were eligible for inclusion. Minimum follow-up was 12 months. Pre- and postoperative ROM (and difference, ▵) was compared between RTSA humeral components with cup inclination 135° and 155°. Descriptive statistics were calculated, and the 2 groups were compared using 2-proportion z-test. Sixty-five studies with 3302 patients (3434 shoulders; 1211 in the 135° group and 2223 in the 155° group) were included. Mean patient age was 71.1 ± 7.6 years, 71% were female, and mean follow-up was 37.2 ± 16.5 months. No significant difference existed between patient age at the time of surgery; the average age of patients in the 135° lateralized glenosphere group was 71.67 ± 3.8 years, while the average age of patients in the 155° group was 70.97 ± 8.8 years. Forward elevation, abduction, and external rotation all significantly improved following surgery in the 135° and 155° groups (P < .05). Patients in the 135° group had significantly greater improvement in external rotation (P < .001) and significantly more overall external rotation compared to the 155° group (P < .001). No significant difference existed between 135° and 155° groups in ROM improvements (▵) in forward elevation (P = .142) or abduction (P = .217). Patients with a 135° humeral cup inclination in RTSA gain significantly more external rotation from pre- to postsurgery and have an overall greater amount of external rotation than patients who receive a 155° prosthesis.
Topics: Aged; Aged, 80 and over; Arthroplasty, Replacement, Shoulder; Humans; Humerus; Middle Aged; Range of Motion, Articular; Rotator Cuff Injuries; Shoulder Joint; Treatment Outcome
PubMed: 27327922
DOI: No ID Found -
PM & R : the Journal of Injury,... Sep 2016To compare electromyographic activity in patients with symptomatic rotator cuff tears with healthy controls or to those with asymptomatic cuff tears. TYPE: Systematic... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To compare electromyographic activity in patients with symptomatic rotator cuff tears with healthy controls or to those with asymptomatic cuff tears. TYPE: Systematic review and meta-analysis.
LITERATURE SURVEY
PubMed, Scopus, Ovid Medline, and Web of Science were searched from inception to August 1, 2014, and a search update was performed on June 8, 2015.
METHODOLOGY
Case-control studies or intervention studies that had baseline comparisons for symptomatic versus healthy shoulders or those with asymptomatic rotator cuff tear were searched. Methodological quality was assessed with a modified Critical Appraisal Skills Programme score and meta-analyses were performed when 2 or more studies explored the same outcome measures.
SYNTHESIS
Nine studies were included, with the quality ranging from 1 to 3 (maximum 6). Electromyographic outcomes included amplitudes and ratios thereof, activity duration, and median frequency of shoulder girdle muscles during isometric contractions (4 studies) and functional tasks (5 studies). Longer activity duration was found for upper trapezius during glenohumeral movements, and greater fatigability of anterior and middle deltoids during isometric hand gripping for patients with rotator cuff tears compared to controls. The meta-analysis (3 studies) showed that patients with rotator cuff tears had lower activation ratios for latissimus dorsi during isometric abduction contraction compared to controls (P < .001), indicating greater co-contraction of adductors for the injured shoulders.
CONCLUSIONS
Although various electromyographic domains were explored, these were generally limited to one publication or research group. Current evidence for muscle activity differences between the rotator cuff tear group and controls is thus limited.
Topics: Humans; Rotator Cuff; Rotator Cuff Injuries; Rupture; Shoulder; Shoulder Joint
PubMed: 26972361
DOI: 10.1016/j.pmrj.2016.02.015 -
The Cochrane Database of Systematic... Nov 2015Fracture of the proximal humerus, often termed shoulder fracture, is a common injury in older people. The management of these fractures varies widely. This is an update... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Fracture of the proximal humerus, often termed shoulder fracture, is a common injury in older people. The management of these fractures varies widely. This is an update of a Cochrane Review first published in 2001 and last updated in 2012.
OBJECTIVES
To assess the effects (benefits and harms) of treatment and rehabilitation interventions for proximal humeral fractures in adults.
SEARCH METHODS
We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and other databases, conference proceedings and bibliographies of trial reports. The full search ended in November 2014.
SELECTION CRITERIA
We considered all randomised controlled trials (RCTs) and quasi-randomised controlled trials pertinent to the management of proximal humeral fractures in adults.
DATA COLLECTION AND ANALYSIS
Both review authors performed independent study selection, risk of bias assessment and data extraction. Only limited meta-analysis was performed.
MAIN RESULTS
We included 31 heterogeneous RCTs (1941 participants). Most of the 18 separate treatment comparisons were tested by small single-centre trials. The main exception was the surgical versus non-surgical treatment comparison tested by eight trials. Except for a large multicentre trial, bias in these trials could not be ruled out. The quality of the evidence was either low or very low for all comparisons except the largest comparison.Nine trials evaluated non-surgical treatment in mainly minimally displaced fractures. Four trials compared early (usually one week) versus delayed (three or four weeks) mobilisation after fracture but only limited pooling was possible and most of the data were from one trial (86 participants). This found some evidence that early mobilisation resulted in better recovery and less pain in people with mainly minimally displaced fractures. There was evidence of little difference between the two groups in shoulder complications (2/127 early mobilisation versus 3/132 delayed mobilisation; 4 trials) and fracture displacement and non-union (2/52 versus 1/54; 2 trials).One quasi-randomised trial (28 participants) found the Gilchrist-type sling was generally more comfortable than the Desault-type sling (body bandage). One trial (48 participants) testing pulsed electromagnetic high-frequency energy provided no evidence. Two trials (62 participants) provided evidence indicating little difference in outcome between instruction for home exercises versus supervised physiotherapy. One trial (48 participants) reported, without presentable data, that home exercise alone gave better early and comparable long-term results than supervised exercise in a swimming pool plus home exercise.Eight trials, involving 567 older participants, evaluated surgical intervention for displaced fractures. There was high quality evidence of no clinically important difference in patient-reported shoulder and upper-limb function at one- or two-year follow-up between surgical (primarily locking plate fixation or hemiarthroplasty) and non-surgical treatment (sling immobilisation) for the majority of displaced proximal humeral fractures; and moderate quality evidence of no clinically important difference between the two groups in quality of life at two years (and at interim follow-ups at six and 12 months). There was moderate quality evidence of little difference between groups in mortality in the surgery group (17/248 versus 12/248; risk ratio (RR) 1.40 favouring non-surgical treatment, 95% confidence interval (CI) 0.69 to 2.83; P = 0.35; 6 trials); only one death was explicitly linked with the treatment. There was moderate quality evidence of a higher risk of additional surgery in the surgery group (34/262 versus 16/261; RR 2.06, 95% CI 1.18 to 3.60; P = 0.01; 7 trials). Although there was moderate evidence of a higher risk of adverse events after surgery, the 95% confidence intervals for adverse events also included the potential for a greater risk of adverse events after non-surgical treatment.Different methods of surgical management were tested in 12 trials. One trial (57 participants) comparing two types of locking plate versus a locking nail for treating two-part surgical neck fractures found some evidence of slightly better function after plate fixation but also of a higher rate of surgically-related complications. One trial (61 participants) comparing a locking plate versus minimally invasive fixation with distally inserted intramedullary K-wires found little difference between the two implants at two years. Compared with hemiarthroplasty, one trial (32 participants) found similar results with locking plate fixation in function and re-operation rates, whereas another trial (30 participants) reported all five re-operations occurred in the tension-band fixation group. One trial (62 participants) found better patient-rated (Quick DASH) and composite shoulder function scores at a minimum of two years follow-up and a lower incidence of re-operation and complications after reverse shoulder arthroplasty (RSA) compared with hemiarthroplasty.No important between-group differences were found in one trial (120 participants) comparing the deltoid-split approach versus deltopectoral approach for non-contact bridging plate fixation, and two trials (180 participants) comparing 'polyaxial' and 'monaxial' screws in locking plate fixation. One trial (68 participants) produced some preliminary evidence that tended to support the use of medial support locking screws in locking plate fixation. One trial (54 participants) found fewer adverse events, including re-operations, for the newer of two types of intramedullary nail. One trial (35 participants) found better functional results for one of two types of hemiarthroplasty. One trial (45 participants) found no important effects of tenodesis of the long head of the biceps for people undergoing hemiarthroplasty.Very limited evidence suggested similar outcomes from early versus later mobilisation after either surgical fixation (one trial: 64 participants) or hemiarthroplasty (one trial: 49 participants).
AUTHORS' CONCLUSIONS
There is high or moderate quality evidence that, compared with non-surgical treatment, surgery does not result in a better outcome at one and two years after injury for people with displaced proximal humeral fractures involving the humeral neck and is likely to result in a greater need for subsequent surgery. The evidence does not cover the treatment of two-part tuberosity fractures, fractures in young people, high energy trauma, nor the less common fractures such as fracture dislocations and head splitting fractures.There is insufficient evidence from RCTs to inform the choices between different non-surgical, surgical, or rehabilitation interventions for these fractures.
Topics: Adult; Bandages; Early Ambulation; Fracture Fixation; Humans; Immobilization; Physical Therapy Modalities; Randomized Controlled Trials as Topic; Self Care; Shoulder Fractures; Treatment Outcome
PubMed: 26560014
DOI: 10.1002/14651858.CD000434.pub4 -
The Clinical Journal of Pain Oct 2015This systematic review evaluated the effectiveness of physical and procedural interventions for reducing pain and related outcomes during vaccination.
BACKGROUND
This systematic review evaluated the effectiveness of physical and procedural interventions for reducing pain and related outcomes during vaccination.
DESIGN/METHODS
Databases were searched using a broad search strategy to identify relevant randomized and quasi-randomized controlled trials. Data were extracted according to procedure phase (preprocedure, acute, recovery, and combinations of these) and pooled using established methods.
RESULTS
A total of 31 studies were included. Acute infant distress was diminished during intramuscular injection without aspiration (n=313): standardized mean difference (SMD) -0.82 (95% confidence interval [CI]: -1.18, -0.46). Injecting the most painful vaccine last during vaccinations reduced acute infant distress (n=196): SMD -0.69 (95% CI: -0.98, -0.4). Simultaneous injections reduced acute infant distress compared with sequential injections (n=172): SMD -0.56 (95% CI: -0.87, -0.25). There was no benefit of simultaneous injections in children. Less infant distress during the acute and recovery phases combined occurred with vastus lateralis (vs. deltoid) injections (n=185): SMD -0.70 (95% CI: -1.00, -0.41). Skin-to-skin contact in neonates (n=736) reduced acute distress: SMD -0.65 (95% CI: -1.05, -0.25). Holding infants reduced acute distress after removal of the data from 1 methodologically diverse study (n=107): SMD -1.25 (95% CI: -2.05, -0.46). Holding after vaccination (n=417) reduced infant distress during the acute and recovery phases combined: SMD -0.65 (95% CI: -1.08, -0.22). Self-reported fear was reduced for children positioned upright (n=107): SMD -0.39 (95% CI: -0.77, -0.01). Non-nutritive sucking (n=186) reduced acute distress in infants: SMD -1.88 (95% CI: -2.57, -1.18). Manual tactile stimulation did not reduce pain across the lifespan. An external vibrating device and cold reduced pain in children (n=145): SMD -1.23 (95% CI: -1.58, -0.87). There was no benefit of warming the vaccine in adults. Muscle tension was beneficial in selected indices of fainting in adolescents and adults.
CONCLUSIONS
Interventions with evidence of benefit in select populations include: no aspiration, injecting most painful vaccine last, simultaneous injections, vastus lateralis injection, positioning interventions, non-nutritive sucking, external vibrating device with cold, and muscle tension.
Topics: Humans; Pain; Pain Management; Physical Examination; Physical Therapy Modalities; Randomized Controlled Trials as Topic; Vaccination
PubMed: 26352919
DOI: 10.1097/AJP.0000000000000264 -
Arthroscopy : the Journal of... Nov 2015To summarize the clinical findings of adult patients undergoing arthroscopy-assisted open reduction-internal fixation for acute ankle fractures. (Review)
Review
PURPOSE
To summarize the clinical findings of adult patients undergoing arthroscopy-assisted open reduction-internal fixation for acute ankle fractures.
METHODS
A systematic electronic search of the PubMed databases was performed for all published literature on December 8, 2014. All English-language clinical studies on acute ankle fractures treated with arthroscopy-assisted open reduction-internal fixation were eligible for inclusion. Basic information related to the surgical procedure was collected.
RESULTS
The search criteria initially identified 187 articles, and 10 studies were included in this systematic review. There were 2 prospective, randomized studies; 2 prognostic studies; and 6 case-series studies. There were a total of 861 patients included in this systematic review. Danis-Weber type B fractures (335 of 483 patients) and supination-external rotation fractures (187 of 366 patients) were the most common types of all the ankle fractures. Concomitant injuries were common: 63.3% of patients had chondral lesions, 60.9% had deltoid ligament injuries, and 77.9% had tibiofibular syndesmosis injuries. Lavage and debridement of the ankle joint were performed by almost all the surgeons. Chondral lesions were treated with shaving, excision, or microfracture. The mean American Orthopaedic Foot & Ankle Society hindfoot score was 91.7. Only mild complications were reported.
CONCLUSIONS
Acute ankle fractures are commonly concomitant with multiple soft-tissue injuries in which arthroscopy may serve as a method for accurate diagnosis and appropriate treatment.
LEVEL OF EVIDENCE
Level IV, systematic review of Level I, II, III, and IV studies.
Topics: Ankle Fractures; Ankle Joint; Arthroscopy; Fracture Fixation; Fracture Fixation, Internal; Humans; Surgery, Computer-Assisted
PubMed: 26051353
DOI: 10.1016/j.arthro.2015.03.043 -
Journal of Clinical Nursing Sep 2015To review the available evidence on aspirating when administering intramuscular injections and suggest recommendations for practice. (Review)
Review
AIMS AND OBJECTIVES
To review the available evidence on aspirating when administering intramuscular injections and suggest recommendations for practice.
BACKGROUND
The process of aspiration has been ingrained in the intramuscular injection procedure, and whilst many policies no longer recommend this practice, it often continues to be taught and practiced. The result is a variation in this procedure not always consistent with an evidence-based approach.
DESIGN
A systematic literature review.
METHODS
A systematic approach to searching the literature was undertaken using identified academic databases from inception to May 2014. Citation searching identified additional data sources. Six studies met the search criteria.
RESULTS
The majority of health professionals do not aspirate for the recommended 5-10 seconds. Administering an injection faster without aspiration is less painful than injecting slowly and aspirating. The main influences on the decision of whether or not to aspirate are based on what health professionals are taught and fear of injecting into a blood vessel.
CONCLUSIONS
In the paediatric vaccination setting, the practice of aspirating during the administration of an intramuscular injection is unnecessary and there is no clinical reason to suggest that these principles may not be applied when using the deltoid, ventrogluteal and vastus lateralis sites in other settings. Owing to its proximity to the gluteal artery, aspiration when using the dorsogluteal site is recommended. Nurses must be supported in all settings, by clear guidance which rejects traditional practice and facilitates evidence-based practice.
RELEVANCE TO CLINICAL PRACTICE
Educators need to ensure that their knowledge is up to date so that what they teach is based on evidence. This may be facilitated via regular educational updates. Further research and subsequent guidance are needed to support evidence-based practice in intramuscular injection techniques in all nursing settings.
Topics: Evidence-Based Nursing; Humans; Injections, Intramuscular
PubMed: 25871949
DOI: 10.1111/jocn.12824