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Jan Friden - One of the best experts on this subject based on the ideXlab platform.
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patients with triangular fibrocartilage complex injuries and distal radioulnar joint instability gain improved forearm peak Pronation and supination torque after reinsertion
Hand, 2020Co-Authors: Jonny K Andersson, Jan Friden, Elisabet HagertAbstract:Background: Forearm peak Pronation and supination torque measurements are reduced up to 30% in patients with triangular fibrocartilage complex (TFCC) 1B injuries with concomitant distal radioulnar joint (DRUJ) instability. The aim of our study was to evaluate whether patients with TFCC 1B injuries, with concomitant DRUJ instability, improve in forearm peak Pronation and supination torque following TFCC reinsertion surgery where postoperative DRUJ stability was achieved. Methods: We report a retrospective case series with short-term follow-up (20 months) of the postoperative forearm peak torque in Pronation and supination in 11 patients (9 women/2 men, average age at surgery 32 years) operated on by TFCC reinsertion. Two of the initial 13 patients were later on reoperated due to recurring DRUJ instability and were therefore excluded in this follow-up study. Nine were treated by arthroscopic TFCC reinsertion and 2 by open technique. The forearm peak Pronation and supination torque were measured pre- and postoperatively and compared with the uninjured side. Results: On average, a 16% improvement of the forearm peak torque was achieved in the injured wrist, as well as clinically assessed DRUJ stability. Functional postoperative improvement was noted in all patients, with reduced pain, good satisfaction, and acceptance of the surgery and the final result. Conclusion: We conclude that patients with TFCC injuries and DRUJ instability gain improved forearm peak Pronation and supination torque after reinsertion. We also conclude that forearm peak Pronation and supination torque is a valuable tool in the preoperative diagnostics of TFCC injuries with DRUJ instability as well as in the postoperative follow-up.
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simultaneous powering of forearm Pronation and key pinch in tetraplegia using a single muscle tendon unit
Journal of Hand Surgery (European Volume), 2012Co-Authors: Jan Friden, Samuel R Ward, William J Peace, Carina Reinholdt, Andreas Gohritz, Richard L LieberAbstract:The purpose of this study was to provide a clinical evaluation of the concept that both thumb flexion and forearm Pronation can be restored by brachioradialis (BR)-to-flexor pollicis longus (FPL) tendon transfer if the BR is passed dorsal to the radius. This may be necessary when a tetraplegic patient requires restoration of key pinch function but has only a single muscle with pronatory effect (BR). Six patients (2 females, 4 males, 32.3 (4.9) (23 – 56) years) underwent tendon transfer of the BR-to-FPL dorsal to the radius and through the interosseus membrane (IOM). The operated upper extremities were categorized according to the International Classification as O1 to OCu3 group. Rehabilitation was divided into two training periods: The first period started on the first postoperative day and focused on early mobilization of the BR-driven forearm Pronation/thumb flexion action. The second period included task-oriented training that was introduced 4 weeks after restricted training of motion. Lateral key pinch strength and Pronation range of motion (ROM) were measured one year after surgery. A group of 6 patients (2 female, 4 males, 31.2 (5.0) (19 – 52) years) who underwent traditional palmar BR-to-FPL was included for comparison. Active Pronation was significantly greater in the dorsal transfer group postoperatively compared to the palmar group (149 (6°) vs. 75 (3°), respectively) when measured from the position of maximal supination to maximal Pronation. Increased Pronation was accomplished with no loss in pinch strength, as dorsal transfer patients were not significantly weaker compared to those having the traditional tendon transfer (1.28 (0.16) kg vs. 1.20 (0.21) kg, respectively). We conclude that it is both feasible and effective to reconstruct simultaneously, lateral key pinch and forearm Pronation using only the brachioradialis (BR) motor in this select subpopulation. To prevent loss in strength and range of motion due to muscle-tendon adhesions to surrounding tissues, the use of early controlled functional training is imperative.
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dorsal transfer of the brachioradialis to the flexor pollicis longus enables simultaneous powering of key pinch and forearm Pronation
Journal of Hand Surgery (European Volume), 2006Co-Authors: Samuel R Ward, William J Peace, Jan Friden, Richard L LieberAbstract:Purpose To show biomechanically that the brachioradialis (BR) muscle can be transferred to restore key pinch and forearm Pronation simultaneously. Methods Nine fresh-frozen forearms were thawed and instrumented with a custom muscle–tendon excursion jig. Maximum BR muscle–tendon excursion was measured with the wrist and thumb mobile. Muscle–tendon excursion then was measured from 60° of supination to 60° of Pronation in 15° increments with the wrist and thumb fixed. Measurements were performed in 3 configurations: the native BR, the BR transferred volarly to the flexor pollicis longus (FPL) tendon, and the BR transferred dorsally (posterior to the radius) through the interosseous membrane to the FPL tendon. Muscle excursion–joint angle data were differentiated to compute Pronation/supination moment arms. Two-way analyses of variance and post hoc Tukey tests were used to compare transfer conditions. Results Maximum muscle excursion was nearly identical when volar and dorsal transfer conditions were compared. When Pronation/supination motions were isolated, however, the volar transfer was associated with muscle shortening and small Pronation moment arms through 30° ± 9° of supination. Importantly, the dorsal transfer was associated with muscle shortening and larger Pronation moment arms through 28° ± 10° of Pronation, a significant difference of 58.0° ± 16.0° compared to the traditional volar transfer. Conclusions These data suggest that dorsal BR-to-FPL transfers can power key pinch and forearm Pronation simultaneously even in the absence of other functional pronators. This transfer can be accomplished without changes to total muscle excursion compared with the traditional volar BR-to-FPL transfer. This result may enable the use of the BR-to-FPL transfer in patients who need key pinch but who lack functional Pronation muscle groups (eg, ocular cutaneous 3). As result a larger patient population may benefit from the BR-to-FPL reconstructive procedure.
Hyo Suk Nam - One of the best experts on this subject based on the ideXlab platform.
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an objective pronator drift test application ipronator using handheld device
PLOS ONE, 2012Co-Authors: Soo Jeong Shin, Eunjeong Park, Dong Hyun Lee, Kijeong Lee, Ji Hoe Heo, Hyo Suk NamAbstract:Background The pronator drift test is widely used to detect mild arm weakness. We developed an application that runs on a handheld device to objectify the pronator drift test and investigated its feasibility in stroke patients. Methods The iPronator application, which uses the built-in accelerometer in handheld devices, was developed. We enrolled acute ischemic stroke patients (n = 10) with mild arm weakness and healthy controls (n = 10) to validate the iPronator. In addition to conventional neurological examinations, the degree of average, maximum, and oscillation in drift and Pronation were measured and compared using the iPronator. Follow-up tests using the iPronator were also conducted in the patient group one week later. Results There was a strong correlation between the average degree of Pronation and drift measured by the iPronator (r = 0.741, p<0.001). The degrees of average and maximum in Pronation were greater in the patient group than in the control group [in average, 28.9°, interquartile range (IQR) 18.7–40.3 vs. 3.8° (IQR 0.3–7.5), p<0.001], in maximum, 33.0° (IQR 24.0–52.1) vs. 6.2° (IQR 1.4–9.4), p<0.001]. The degree of oscillation in Pronation was not different between the groups (p = 0.166). In drift, the degrees of average, maximum, and oscillation were greater in the patient group. In stroke patients, a follow-up study at one week revealed improvements in the degrees of Pronation and drift compared with baseline parameters. Conclusions The iPronator can reliably detect mild arm weakness of stroke patients and was also useful in detecting functional recovery for one week in patients with acute stroke.
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An Objective Pronator Drift Test Application (iPronator) Using Handheld Device
2012Co-Authors: Soo Jeong Shin, Eunjeong Park, Dong Hyun Lee, Kijeong Lee, Ji Hoe Heo, Hyo Suk NamAbstract:Background: The pronator drift test is widely used to detect mild arm weakness. We developed an application that runs on a handheld device to objectify the pronator drift test and investigated its feasibility in stroke patients. Methods: The iPronator application, which uses the built-in accelerometer in handheld devices, was developed. We enrolled acute ischemic stroke patients (n = 10) with mild arm weakness and healthy controls (n = 10) to validate the iPronator. In addition to conventional neurological examinations, the degree of average, maximum, and oscillation in drift and Pronation were measured and compared using the iPronator. Follow-up tests using the iPronator were also conducted in the patient group one week later. Results: There was a strong correlation between the average degree of Pronation and drift measured by the iPronator (r = 0.741, p,0.001). The degrees of average and maximum in Pronation were greater in the patient group than in the control group [in average, 28.9u, interquartile range (IQR) 18.7–40.3 vs. 3.8u (IQR 0.3–7.5), p,0.001], in maximum, 33.0u (IQR 24.0–52.1) vs. 6.2u (IQR 1.4–9.4), p,0.001]. The degree of oscillation in Pronation was not different between the groups (p = 0.166). In drift, the degrees of average, maximum, and oscillation were greater in the patient group. In stroke patients, a follow-up study at one week revealed improvements in the degrees of Pronation and drift compared with baseline parameters
Richard L Lieber - One of the best experts on this subject based on the ideXlab platform.
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simultaneous powering of forearm Pronation and key pinch in tetraplegia using a single muscle tendon unit
Journal of Hand Surgery (European Volume), 2012Co-Authors: Jan Friden, Samuel R Ward, William J Peace, Carina Reinholdt, Andreas Gohritz, Richard L LieberAbstract:The purpose of this study was to provide a clinical evaluation of the concept that both thumb flexion and forearm Pronation can be restored by brachioradialis (BR)-to-flexor pollicis longus (FPL) tendon transfer if the BR is passed dorsal to the radius. This may be necessary when a tetraplegic patient requires restoration of key pinch function but has only a single muscle with pronatory effect (BR). Six patients (2 females, 4 males, 32.3 (4.9) (23 – 56) years) underwent tendon transfer of the BR-to-FPL dorsal to the radius and through the interosseus membrane (IOM). The operated upper extremities were categorized according to the International Classification as O1 to OCu3 group. Rehabilitation was divided into two training periods: The first period started on the first postoperative day and focused on early mobilization of the BR-driven forearm Pronation/thumb flexion action. The second period included task-oriented training that was introduced 4 weeks after restricted training of motion. Lateral key pinch strength and Pronation range of motion (ROM) were measured one year after surgery. A group of 6 patients (2 female, 4 males, 31.2 (5.0) (19 – 52) years) who underwent traditional palmar BR-to-FPL was included for comparison. Active Pronation was significantly greater in the dorsal transfer group postoperatively compared to the palmar group (149 (6°) vs. 75 (3°), respectively) when measured from the position of maximal supination to maximal Pronation. Increased Pronation was accomplished with no loss in pinch strength, as dorsal transfer patients were not significantly weaker compared to those having the traditional tendon transfer (1.28 (0.16) kg vs. 1.20 (0.21) kg, respectively). We conclude that it is both feasible and effective to reconstruct simultaneously, lateral key pinch and forearm Pronation using only the brachioradialis (BR) motor in this select subpopulation. To prevent loss in strength and range of motion due to muscle-tendon adhesions to surrounding tissues, the use of early controlled functional training is imperative.
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dorsal transfer of the brachioradialis to the flexor pollicis longus enables simultaneous powering of key pinch and forearm Pronation
Journal of Hand Surgery (European Volume), 2006Co-Authors: Samuel R Ward, William J Peace, Jan Friden, Richard L LieberAbstract:Purpose To show biomechanically that the brachioradialis (BR) muscle can be transferred to restore key pinch and forearm Pronation simultaneously. Methods Nine fresh-frozen forearms were thawed and instrumented with a custom muscle–tendon excursion jig. Maximum BR muscle–tendon excursion was measured with the wrist and thumb mobile. Muscle–tendon excursion then was measured from 60° of supination to 60° of Pronation in 15° increments with the wrist and thumb fixed. Measurements were performed in 3 configurations: the native BR, the BR transferred volarly to the flexor pollicis longus (FPL) tendon, and the BR transferred dorsally (posterior to the radius) through the interosseous membrane to the FPL tendon. Muscle excursion–joint angle data were differentiated to compute Pronation/supination moment arms. Two-way analyses of variance and post hoc Tukey tests were used to compare transfer conditions. Results Maximum muscle excursion was nearly identical when volar and dorsal transfer conditions were compared. When Pronation/supination motions were isolated, however, the volar transfer was associated with muscle shortening and small Pronation moment arms through 30° ± 9° of supination. Importantly, the dorsal transfer was associated with muscle shortening and larger Pronation moment arms through 28° ± 10° of Pronation, a significant difference of 58.0° ± 16.0° compared to the traditional volar transfer. Conclusions These data suggest that dorsal BR-to-FPL transfers can power key pinch and forearm Pronation simultaneously even in the absence of other functional pronators. This transfer can be accomplished without changes to total muscle excursion compared with the traditional volar BR-to-FPL transfer. This result may enable the use of the BR-to-FPL transfer in patients who need key pinch but who lack functional Pronation muscle groups (eg, ocular cutaneous 3). As result a larger patient population may benefit from the BR-to-FPL reconstructive procedure.
Moshe Ayalon - One of the best experts on this subject based on the ideXlab platform.
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a prospective biomechanical study of the association between foot Pronation and the incidence of anterior knee pain among military recruits
Journal of Bone and Joint Surgery-british Volume, 2006Co-Authors: Iftach Hetsroni, Aharon S Finestone, C Milgrom, Ben D Sira, Meir Nyska, Denitsa Radevapetrova, Moshe AyalonAbstract:Excessive foot Pronation has been considered to be related to anterior knee pain. We undertook a prospective study to test the hypothesis that exertional anterior knee pain is related to the static and dynamic parameters of foot Pronation. Two weeks before beginning basic training lasting for 14 weeks, 473 infantry recruits were enrolled into the study and underwent two-dimensional measurement of their subtalar joint displacement angle during walking on a treadmill. Of the 405 soldiers who finished the training 61 (15%) developed exertional anterior knee pain. No consistent association was found between the incidence of anterior knee pain and any of the parameters of foot Pronation. While a statistically significant association was found between anterior knee pain and Pronation velocity (left foot, p = 0.05; right foot, p = 0.007), the relationship was contradictory for the right and left foot. Our study does not support the hypothesis that anterior knee pain is related to excessive foot Pronation.
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a prospective biomechanical study of the association between foot Pronation and the incidence of anterior knee pain among military recruits
Journal of Bone and Joint Surgery-british Volume, 2006Co-Authors: Iftach Hetsroni, Aharon S Finestone, C Milgrom, Ben D Sira, Meir Nyska, Denitsa Radevapetrova, Moshe AyalonAbstract:Excessive foot Pronation has been considered to be related to anterior knee pain. We undertook a prospective study to test the hypothesis that exertional anterior knee pain is related to the static and dynamic parameters of foot Pronation. Two weeks before beginning basic training lasting for 14 weeks, 473 infantry recruits were enrolled into the study and underwent two-dimensional measurement of their subtalar joint displacement angle during walking on a treadmill. Of the 405 soldiers who finished the training 61 (15%) developed exertional anterior knee pain. No consistent association was found between the incidence of anterior knee pain and any of the parameters of foot Pronation. While a statistically significant association was found between anterior knee pain and Pronation velocity (left foot, p = 0.05; right foot, p = 0.007), the relationship was contradictory for the right and left foot. Our study does not support the hypothesis that anterior knee pain is related to excessive foot Pronation.
Soo Jeong Shin - One of the best experts on this subject based on the ideXlab platform.
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an objective pronator drift test application ipronator using handheld device
PLOS ONE, 2012Co-Authors: Soo Jeong Shin, Eunjeong Park, Dong Hyun Lee, Kijeong Lee, Ji Hoe Heo, Hyo Suk NamAbstract:Background The pronator drift test is widely used to detect mild arm weakness. We developed an application that runs on a handheld device to objectify the pronator drift test and investigated its feasibility in stroke patients. Methods The iPronator application, which uses the built-in accelerometer in handheld devices, was developed. We enrolled acute ischemic stroke patients (n = 10) with mild arm weakness and healthy controls (n = 10) to validate the iPronator. In addition to conventional neurological examinations, the degree of average, maximum, and oscillation in drift and Pronation were measured and compared using the iPronator. Follow-up tests using the iPronator were also conducted in the patient group one week later. Results There was a strong correlation between the average degree of Pronation and drift measured by the iPronator (r = 0.741, p<0.001). The degrees of average and maximum in Pronation were greater in the patient group than in the control group [in average, 28.9°, interquartile range (IQR) 18.7–40.3 vs. 3.8° (IQR 0.3–7.5), p<0.001], in maximum, 33.0° (IQR 24.0–52.1) vs. 6.2° (IQR 1.4–9.4), p<0.001]. The degree of oscillation in Pronation was not different between the groups (p = 0.166). In drift, the degrees of average, maximum, and oscillation were greater in the patient group. In stroke patients, a follow-up study at one week revealed improvements in the degrees of Pronation and drift compared with baseline parameters. Conclusions The iPronator can reliably detect mild arm weakness of stroke patients and was also useful in detecting functional recovery for one week in patients with acute stroke.
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An Objective Pronator Drift Test Application (iPronator) Using Handheld Device
2012Co-Authors: Soo Jeong Shin, Eunjeong Park, Dong Hyun Lee, Kijeong Lee, Ji Hoe Heo, Hyo Suk NamAbstract:Background: The pronator drift test is widely used to detect mild arm weakness. We developed an application that runs on a handheld device to objectify the pronator drift test and investigated its feasibility in stroke patients. Methods: The iPronator application, which uses the built-in accelerometer in handheld devices, was developed. We enrolled acute ischemic stroke patients (n = 10) with mild arm weakness and healthy controls (n = 10) to validate the iPronator. In addition to conventional neurological examinations, the degree of average, maximum, and oscillation in drift and Pronation were measured and compared using the iPronator. Follow-up tests using the iPronator were also conducted in the patient group one week later. Results: There was a strong correlation between the average degree of Pronation and drift measured by the iPronator (r = 0.741, p,0.001). The degrees of average and maximum in Pronation were greater in the patient group than in the control group [in average, 28.9u, interquartile range (IQR) 18.7–40.3 vs. 3.8u (IQR 0.3–7.5), p,0.001], in maximum, 33.0u (IQR 24.0–52.1) vs. 6.2u (IQR 1.4–9.4), p,0.001]. The degree of oscillation in Pronation was not different between the groups (p = 0.166). In drift, the degrees of average, maximum, and oscillation were greater in the patient group. In stroke patients, a follow-up study at one week revealed improvements in the degrees of Pronation and drift compared with baseline parameters
