I. Fayolle-Minon

Rotator Cuff Strength in Recurrent Anterior Shoulder Instability

BACKGROUND Although rotator-cuff muscle contraction plays an important role in stabilizing the glenohumeral joint, little is known about the role of these muscles in the pathophysiology of recurrent anterior instability. We intended to analyze the association between isokinetic internal rotator and external rotator muscle strength and glenohumeral joint instability in patients with recurrent anterior instability that was not previously treated surgically. METHODS We enrolled thirty-seven patients with unilateral recurrent anterior posttraumatic shoulder dislocation and eleven healthy nonathletic subjects in this controlled study. The association between internal rotator and external rotator strength and shoulder instability was analyzed by side-to-side comparisons and comparisons with a control group. Isokinetic internal rotator and external rotator strength was evaluated with a Con-Trex dynamometer, with the subject seated and the shoulder abducted 45° in the scapular plane. Tests were performed at 180°/s, 120°/s, and 60°/s in concentric mode for both sides. Peak torque normalized to body weight and external rotator to internal rotator ratio were calculated for each angular velocity. Clinical and isokinetic evaluation was done by the same rehabilitation physician. RESULTS The association between shoulder instability and internal rotator and external rotator strength was associated with side-to-side differences (p < 0.05). Compared with a control group, strength values were lower on the pathological shoulder side of the patients with shoulder instability than on the healthy contralateral shoulder of control subjects at 180°/s and 120°/s (p < 0.05). The side-to-side differences were increased when the nondominant upper-extremity side was involved and were decreased when the dominant side was involved. There was no association between glenohumeral joint instability and external rotator to internal rotator ratio. CONCLUSIONS Internal rotator and external rotator weakness was associated with recurrent anterior instability, and side-to-side differences depended on the side of hand dominance. Use of a control group may help in the analysis of the influence of constraints on shoulder strength. Further prospective studies are necessary to determine whether the weakness is a cause or an effect of the instability.

Relationship between maximal exercise capacity and walking capacity in adult hemiplegic stroke patients.

Courbon A, Calmels P, Roche F, Ramas J, Rimaud D, Fayolle-Minon I: Relationship between maximal exercise capacity and walking capacity in adult hemiplegic stroke patients. Am J Phys Med Rehabil 2006;85:436–442. Objective:To evaluate the relationship between maximal exercise capacity and walking capacity in hemiplegic stroke patients. Design:An uncontrolled observational study was conducted in the physical medicine and rehabilitation unit in an academic hospital. Participants were 21 hemiplegic stroke patients (18 men, 3 women; age, 18–70 yrs) whose stroke occurred >3 mos before the study and who could walk independently with or without walking aids. Main outcome measures were peak oxygen uptake, workload, walking capacity, and motor impairment. Results:There was a significant correlation between walking capacity (6-min-walk test) and both peak oxygen uptake (r = 0.602, P = 0.0032) and maximal power output (r = 0.867, P < 0.0001). Conclusions:Aerobic capacity and walking capacity are decreased in hemiplegic stroke patients and are correlated with each other. These results underscore the need for future studies, to confirm the role of fitness in relation to walking capacity, and to evaluate the benefit of integrating aerobic training into more traditional rehabilitation programs after stroke.

Relationship between strength and functional indexes (Rowe and Walch-Duplay scores) after shoulder surgical stabilization by the Latarjet technique

INTRODUCTION The rotator cuff muscles help stabilize the glenohumeral joint. Postoperative recovery of rotator cuff muscle strength appears to be an important factor for optimal joint stabilization and the resumption of professional and/or sports activities. OBJECTIVE To study the relationship between internal rotator (IR) and external rotator (ER) muscle strength, shoulder function and the resumption of sports activities (as typically evaluated with functional scores) following surgical stabilization with the Bristow-Latarjet procedure in cases of chronic shoulder instability. PATIENTS AND METHODS Twenty patients with anterior, post-traumatic, chronic shoulder instability were included prospectively in a cohort study. The Rowe and Walch-Duplay functional scores were rated for the operated shoulder and the isokinetic IR and ER peak torque values were evaluated with a Con-Trex(®) dynamometer before surgery and then 3, 6 and 21 months afterwards. The isokinetic evaluation was performed (at 180°/s, 120°/s and 60°/s) in the seated position, with the arms in 45° of abduction and 30° of antepulsion in the plane of the scapula. RESULTS There were no significant postoperative correlations between shoulder function (as judged by the Rowe and Walch-Duplay scores) and IR or ER muscle strength. CONCLUSION This study did not provide evidence for a correlation between IR and ER muscle strength and functional scores after surgical stabilization of the shoulder. However, it is necessary to objectively measure the rotator cuff strength recovery to adequate the strengthening of rotator muscle prior to the resumption of sports activities. Isokinetic strength assessment may thus be a valuable decision support tool for the resumption of sports activities and would complement the functional scores studied here.

Évaluation du handicap et de la qualité de vie chez les blessés médullaires: Étude d'un échantillon de population de 58 sujets vivant à domicile

Resume Objectif. – L’objectif principal est de determiner la relation entre des parametres objectifs, socio-economiques, de deficience et d’incapacite fonctionnelle et le retentissement subjectif en terme de qualite de vie sur un echantillon de sujets presentant des sequelles d’une lesion medullaire traumatique et vivant a domicile. Population et methode. – Il s’agit d’une etude descriptive transversale d’un echantillon de blesses medullaires au sein d’une unite de medecine physique et de readaptation. Apres information et accord de participation, chaque sujet beneficie d’un examen clinique et fonctionnel et repond a divers questionnaires. L’evaluation associe le releve de donnees generales et socio-economiques, une evaluation de la deficience (scores moteur et sensitif et classification Asia), du niveau d’incapacite (Index de Barthel et Mesure de l’independance fonctionnelle) et du niveau de qualite de vie (Index de reintegration a la vie normale et Index de sante perceptuelle de Nottingham). Resultats. – Cinquante-huit sujets ont ete examines (âge moyen 41,38 ±13,55 ans et delai moyen depuis le traumatisme 6,24 ± 6,06 ans). Il existe une relation significative forte entre le niveau de qualite de vie et l’âge du sujet, l’âge de survenue du traumatisme et le niveau d’incapacite fonctionnelle, preferentiellement dans les dimensions d’independance physique, d’integration sociale et de mobilite. Conclusion. – Les resultats de cette etude sont comparables aux donnees de la litterature. Ils rapportent surtout l’âge comme un facteur determinant. Cependant, compte tenu de donnees de la litterature sur l’influence de la duree de la lesion medullaire sur la qualite de vie, il est necessaire de proposer une etude longitudinale, prenant en compte les specificites individuelles de participation sociale.

The faisability and the effects of cycloergometer interval-training on aerobic capacity and walking performance after stroke. Preliminary study

BACKGROUND After stroke, the early and persistent decline in aerobic capacity leads to diminish walking capacities. The aim of the study is to investigate the effects of aerobic cycloergometer interval-training on the walking performances in subacute and chronic stroke survivors. METHOD A prospective design was used. Fourteen patients whose stroke had occurred more than 3 months and less than 2 years performed an aerobic training session with a cycloergometer for 8 weeks. A maximal exercise test, a 6-min walking test, a 20-m test and an isokinetic muscle strength test were realized before and after training session. RESULTS There was a significant increase after aerobic training in maximal power (Pmax) (mean 23.2%, P<0.0001), in VO(2peak) (mean 14.8%, P=0.04), and in the knee extension and flexion muscle peak torque on the nonparetic side and extension on the paretic side in isokinetic mode (mean from 13 to 29%, P=from 0.019 to P=0.0007) and in the walking performances on the 6-min walk test (mean 15.8%, P=0.0002). CONCLUSION Patients with subacute and chronic stroke can improve aerobic capacity, muscle strength and walking performances after cycloergometer interval-training. Although these results must be interpreted with caution considering the small size of our sample, they suggest that aerobic training is a safe and potentially effective training after stroke and an alternative to walking treadmill training.

Are there indications (other than scoliosis) for rigid orthopaedic brace treatment in chronic, mechanical low back pain?

OBJECTIVES Mechanical low back pain (LBP) is a major public health problem. Todays standard care strategy involves a combination of drug-based and non-drug therapies. The use of conservative orthopaedic brace treatment is subject to debate. The lack of data and consensus in the literature on the value of this treatment in chronic LBP prompted to us to seek to estimate the modalities and indications for brace use in France. MATERIALS AND METHOD We performed a questionnaire-based survey of physician members of the French Society of Physical Medicine and Rehabilitation (SOFMER). RESULTS We received 55 completed questionnaires. Although the indications for this treatment were very heterogeneous (in both clinical and paraclinical terms), the prescribing behaviour was rather uniform. The brace is worn during the day for less than 3 months (with a progressive reduction in use over 1 to 2 months), together with physiotherapy before and after immobilization. The patient keeps the brace at the end of the treatment period. Orthopaedic treatment appears to be prescribed in many chronic LBP situations. Analysis of spinal posture and magnetic resonance imaging results (and Modic changes in particular) influence the therapeutic decisions. CONCLUSION Clinical and paraclinical indications of this treatment must be precisely defined and evaluated in prospective, multicenter studies with homogeneous cohorts.