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Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_11 | Pages 56 - 56
1 Jul 2014
Alizadehkhaiyat O Hawkes D Howard A Frostick S
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Summary Statement

Bio-impedance analysis (BIA) provides a convenient method for the estimation of whole body and segmental measurement of skeletal muscle mass (SMM). BIA-measured SMM parameters may be effectively used for the normalisation of muscle strength and removing body-size dependence.

Introduction

Despite an increasing interest in using bio-impedance analysis (BIA) for the estimation of segmental skeletal muscle mass (SMM); existing data is sparse. On the other hand, there is a need for better understanding of the influence of SMM on gender-related differences in muscle strength. Using BIA technique, this study aimed to measure the SMM, determine its correlation with muscle strength, and examine its relation with gender-related differences in muscle strength.


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_11 | Pages 269 - 269
1 Jul 2014
Alizadehkhaiyat O Kemp G Frostick S
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Summary Statement

Applying appropriate upper limb regional-specific and joint-specific tools along with suitable psychologic tools provides an effective assessment of supportive, interventional, and treatment strategies in TE.

Background

Tennis elbow (TE) is a painful pathologic condition with its origin in the common wrist extensor muscles at the lateral epicondyle. As the second most frequently diagnosed musculoskeletal disorder in the neck and upper limb in a primary care setting, with an annual incidence of 4 to 7 cases per 1000 patients in general practice (with a peak at 35 to 54 yrs of age), TE has considerable socioeconomic costs. As pain relief and improvement in functional performance are the 2 common aims of all treatment strategies, the importance of using appropriate tools for the assessment of pain and functional disability in TE is evident. In view of the high prevalence of TE, uncertainties about its treatment, and its substantial socioeconomic consequences, using more specific, patient-centred assessment tools is essential for providing more useful information on the level of pain and functional disability in TE. The Study aimed to: 1) compare pain and functional disability in tennis elbow (TE) patients with healthy controls; and 2) evaluate the relationship between the 2 major psychologic factors (anxiety and depression) and TE.


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_11 | Pages 273 - 273
1 Jul 2014
Alizadehkhaiyat O Vishwanathan K Frostick S
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Summary Statement

Discovery system produced effective functional improvement in both primary and revision total elbow replacement. The incidence of major complications was in an acceptable range.

Introduction

The search for the ideal elbow prosthesis continues as instability and loosening remain the prime reasons for total elbow replacement (TER) failure. The Discovery Elbow System (Biomet) is one of the latest generations of linked prosthesis and has been used in UK since 2003. We report outcome of TER using this system.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_34 | Pages 61 - 61
1 Dec 2013
Mandhari AA Kyriakos A Alizadehkhaiyat O Frostick S
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Objective:

Evaluation of the early results of the implementation of reverse shoulder arthroplasty prosthesis “Comprehensive Reverse” in primary and revision shoulder arthroplasties.

Material and Methods:

September 2010–December 2012, 48 patients (32 women, 16 men) underwent reverse shoulder arthroplasty using Comprehensive Reverse system. Average age of 69.88. A total of 46 patients were followed. In 22 patients the operation was performed for revision. Patients were pre-and postoperatively evaluated using Oxford, Constant, SF-12 scores, radiographs, pain and range of motion. Mean follow-up 13 months.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_34 | Pages 73 - 73
1 Dec 2013
Alizadehkhaiyat O Hawkes D Frostick S
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Introduction

Rehabilitation after shoulder arthroplasty is a fundamental in enabling patients achieve a good functional outcome. Therapists must consider the underlying diagnosis, operative technique employed and rotator cuff integrity, amongst other factors, in order to select the most appropriate exercise regime. There is an absence of comprehensive studies in the literature with regard to shoulder rotational exercises. Therefore, this study aimed to describe the shoulder girdle muscle activation strategies during eight commonly cited rotational shoulder exercises.

Method

Thirty healthy subjects with no history of shoulder problems participated in the study. EMG was recorded from 16 shoulder girdle muscles (surface electrodes: anterior, middle and posterior deltoid, upper, middle and lower trapezius, upper and lower latissimus dorsi, upper and lower pectoralis major; fine wire electrodes: supraspinatus, infraspinatus, subscapularis and rhomboid major) using a telemetry based EMG system. Five external and three internal rotation exercises were included (table 1). Signal acquisition and processing were in accordance with standardised guidelines. Amplitude normalisation was to external and internal rotation maximum voluntary contraction as appropriate. Mean EMG amplitudes between exercises were compared using repeated measures ANOVA. Data for muscle groups was calculated by averaging the activation of the component muscles.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_15 | Pages 1 - 1
1 Mar 2013
Al Mandhari A Alizadehkhaiyat O Chrysanthou C Frostick S
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Background

The procedures of total elbow and shoulder replacements increased 6% to 13% annually from 1993 to 2007 with revision-related burden increasing from 4.5% to 7%. The revisions of the shoulder and elbow prostheses due to aseptic loosening, periprosthetic fractures, infections have led to the use of standard or custom-made implants due to significant bone loss. This study reports our experience in the management of complicated primary and revisions of total shoulder and elbow replacements with significant humeral bone loss and in metabolic diseases of the elbow and shoulder treated with bone resection using The Mosaic Humeral Replacement System.

Patients and Materials

A total of 20 patients underwent total elbow or shoulder arthroplasty using the Mosaic Humeral Replacement System (Biomet, UK). The Mosaic system was used in 8 shoulder arthroplasties (Group A) and in 12 elbow arthroplasties (Group B). The underlying pathologis in Group A included 2 malunited proximal humerus fracture, 1 humeral osteomyelitis, 1 shoulder chondrosarcoma, 1 aggressive Gigantic Cell Tumor with prosthetic fracture, 2 metastatic lytic lesion, and 1 failed fixation of non-union proximal humerus. Figure 1 shows Mosaic implant after complex fracture of proximal humerus. Reasons for Mosaic arthroplasty in Group B included 3 humeral component revisions due to periprosthetic fracture, 1 prosthesis breaking-up with fractures, 1 revision of loose Souter Strathclyde prosthesis, 1 loose prosthesis due to infection, 1 highly comminuted elbow fracture, 1 aseptic loosening of humeral component of total elbow replacement, 3 revision of total elbow replacement due loosening and 1 pathological distal humerus fracture due to metastasis. Figure 2&3 shows pre- and post-operative Mosaic implant following complex periprosthetic fracture of distal humerus.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_15 | Pages 124 - 124
1 Mar 2013
Alizadehkhaiyat O Kyriakos A Singer MS Frostick S Al Mandhari A
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Background

The Copeland shoulder resurfacing arthroplasty (CSRA) (Figure1) is a cementless, pegged humeral head surface replacement which has been in clinical use since 1986. The indications for CSRA are more or less the same as conventional stemmed arthroplasty. This procedure can be considered for all patients who require shoulder replacement due to GHJ arthritis resulted from primary or secondary OA, RA, and other variations of inflammatory arthritis. It is also suggested as the first choice option for relatively young patients with post-traumatic arthritis, avascular necrosis (AVN), and instability arthropathy. This observational study reports functional and radiological outcome in CSRA during 4 years follow-up.

Methods

109 consecutive patients with primary osteoarthritis (45.9%), rheumatoid arthritis (39.4%), rotator cuff arthropathy (9.2%), and avascular necrosis (5.5%) underwent CSRA. Patients including 68 females (63%) and 41 males (37%) underwent this procedure (63 right-sided and 46 left-sided including 9 bilateral shoulders). The outcome assessment included pain and satisfaction, Oxford Shoulder Score (OSS), Constant Score (CS), and SF-12. Imaging was reviewed for glenoid morphology (Walch classification) (Figure2) and humeral head migration. The average follow-up period was 4 years, (range: 1 to 10 years).


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_15 | Pages 2 - 2
1 Mar 2013
Alizadehkhaiyat O Vishwanathan K Frostick S Al Mandhari A
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Background

The quest for the perfectly designed elbow prosthesis continues as instability and loosening remain the foremost reasons for the failure of total elbow replacement (TER). The Discovery® Elbow System (Biomet, UK) (Figure 1), which has been used in UK since 2003, is one of the latest generations of linked prosthesis. This system was designed to decrease polyethylene-bushing wear, improve anatomic stem design, restore elbow joint biomechanics, and produce a hinge that could be easily revised. This report describes the short term outcome of TER using the Discovery® Elbow System.

Patients and Methods

A total of 60 TERs including 48 primary and 12 revisions were performed between 2003 and 2008. Patients included 21 males (37%) and 36 females (63%) with a mean age of 63 years. The indications for primary TER were advanced rheumatoid arthritis (n=19), osteoarthritis (n=16), post traumatic osteoarthritis (n=9), acute fractures (n=3), and haemophilic arthropathy (n=1). The outcome was assessed using pain score, Liverpool Elbow Score (LES), and range of movement during a mean follow-up of 26 months. Associated complications were documented. Radiological assessment included evaluation for loosening, instability and periprosthetic fractures.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_15 | Pages 3 - 3
1 Mar 2013
Alizadehkhaiyat O Kyriakos A Williams A Frostick S Al Mandhari A
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BACKGROUND

Reverse total shoulder arthroplasty (RTSA) provides an alternative to standard total shoulder arthroplasty in the treatment of selected complex shoulder problems including failed shoulder replacements. The purpose of this report is to present outcome of RTSA using Comprehensive Reverse System (CRS) as either primary or revision treatment choice.

PATIENTS AND MATERIALS

Between September 2010 and April 2012, 54 patients (36 females, 18 males) with the mean age of 68.4 (±10) underwent RTSA-CRS. In 27 patients RTSA-CRS was performed as a revision due to failed previous arthroplasty. Primary underlying conditions included AVN (2), massive irreparable rotator cuff tear (2), primary osteoarthritis (7), post-traumatic osteoarthritis (2), rheumatoid arthritis (6), and rotator cuff arthropathy (8). It was not possible to complete the operation in 6 patients (4 revisions group 2 AVN cases) due to substantial glenoid erosion. Preoperative CT scan was performed in 50% of patients to assess the bony stock of the glenoid. In some patients ultrasound and MRI were performed to acquire additional information. A total of 46 patients were followed-up by means of antroposterior and axial plain X-rays, pain and satisfaction level (VAS/0–10), stiffness, Constant Score, Oxford Shoulder Score, SF-12 (Physical and mental Subscales), and range of movement for a mean duration of 6.5 months (±4.2).


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XL | Pages 64 - 64
1 Sep 2012
Hawkes D Alizadehkhaiyat O Fisher A Kemp G Roebuck M Frostick S
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Introduction

Shoulder motion results from a complex interaction between the interconnected segments of the shoulder girdle. Coordination is necessary for normal shoulder function and is achieved by synchronous and coordinated muscle activity. During rotational movements, the humeral head translates on the glenoid fossa in the anterior-posterior plane. Tension developed by the rotator cuff muscles compresses the humeral head into the glenoid fossa. This acts to limit the degree of humeral head translation and establishes a stable GH fulcrum about which the arm can be moved. Previous studies have been limited by the use of contrived movement protocols and muscular coordination has not been previously considered with regard to shoulder rotation movements. This study reports the activation profile and coordination of 13 muscles and 4 muscle groups during a dynamic rotational movement task based on activities of daily living.

Methods

Eleven healthy male volunteers were included in the study. Electromyography (EMG) was recorded from 13 muscles (10 surface and 3 fine-wire intramuscular electrodes) using a wireless EMG system. EMG was recorded during a movement task in which the shoulder was consecutively rotated internally (phase 1) and externally (phase 2) with a weight in the hand. Muscle group data was calculated by ensemble averaging the activity of the individual component muscles. Mean signal amplitude and Pearson correlation coefficient (PCC) analysed muscle activation and coordination, respectively.


Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_II | Pages 389 - 389
1 Jul 2008
Alizadehkhaiyat O Fisher A Kemp G Frostick S
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Purpose: It is known from previous studies that reduced grip strength is associated with tennis elbow; however; assessment of muscular strength over other parts of upper limb, particularly wrist and shoulder, has received a little or no attention in the literature. To address possible other upper extremity muscular strength weakness-imbalances in Tennis Elbow, this study aimed to investigate the strength of various upper limb muscle groups in tennis elbow patients and compare them with those of healthy subjects.

Methods: A total of 32 participants were assigned into two groups of Control (N=16) and Tennis Elbow (N=16). In both groups, upper limb maximal isometric muscular of dominant and non-dominant sides was measured at various joints including metacarpophalan-geal (extension & flexion), wrist extension & flexion), grip, and shoulder (internal and external rotation and abduction) using appropriate either commercial or purpose-built dynamometers. Muscular strength and important strength ratios were analyzed and compared in each group (dominant vs non-dominant) and also between Control and Tennis Elbow group using various statistical methods.

Results: Significant dominance difference was found in all strength measurements for Control group but not for Tennis Elbow group indicating a generalized and widespread upper limb muscular weakness associated with tennis elbow. In addition, significant differences were found not only for various hand strength measurements but also for shoulder strength between Control and Tennis Elbow groups (p < 0.05).

Conclusion: This is the most comprehensive study of upper limb isometric muscular strength assessment in Tennis Elbow during recent years. Distributed upper limb muscle strength weakness exists in Tennis Elbow which needs to be addressed within both preventative and treatment strategies.


Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_II | Pages 386 - 386
1 Jul 2008
Alizadehkhaiyat O Kemp J Vishwanathan K Frostick S
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Purpose: It is known from the literature that gripping, which is commonly used in various work-related, sport-related, and daily activities, activates both wrist extensors and flexors. Pain aggravation occurs during grip due to over-exertion of the extensor muscle group in lateral epicondylitis and grip strength is reduced. Of grip strength studies, few studies have simultaneously investigated muscular response using electromyography as a method of monitoring muscular fatigue or muscular activity of forearm muscles. The fatigability and activity of wrist antagonistic muscles in patients with lateral epicondylitis has not been previously investigated.

Methods: 16 tennis elbow patients (Tennis Elbow Group) and 16 healthy volunteers (Control Group) were participated in this study. In both groups, local muscular fatigue and muscular activity were measured for 3 forearm muscles contributing to the wrist extension and 2 muscles contributing to the wrist flexion using EMG and during gripping at 50% maximum voluntary contraction (MVC). Fatigability and activity of muscles then were compared between control and tennis elbow groups.

Results: Grip strength was significantly lower in tennis elbow group than that in control group (p < 0.05). Median frequency (MDF) and root mean square (RMS) of electromyographic signals were used as parameters to measure muscular fatigue and muscular activity, respectively. Further analysis showed no significant difference in the fatigability of forearm muscles between two groups. The activity of Extensor Carpi Radialis (ECR) showed statistically significant reduction in tennis elbow group compared to the control group (p < 0.05).

Conclusion: This is the first study to simultaneously investigate the fatigability and activity of the forearm antagonistic muscle groups in patients with lateral epi-condylitis. The fact that ECR showed similar level of muscular fatigue to other muscles despite decreased muscular activity may indicate of higher fatigability of this muscle in tennis elbow. Furethermore, decreased muscular activity of ECR may be a part of mechanism to protect the muscle from further injury in tennis elbow patients.