Search Results (406)

Virtual reality (VR) offers built-in wearable sensor-based tracking capabilities. Current research focusses on position and orientation error, with limited results on more clinically relevant metrics, such as joint angles. This leads us to our first objective, to characterize the accuracy of upper extremity VR motion capture. Since the intent is for clinical translation, our second objective is to compare the errors across people identified as healthy controls and people who had experienced a spinal cord injury (SCI). Spatially and temporally synced VR and infrared motion capture data were collected during a variety of custom VR Beat Saber levels. Error values were found with infrared motion capture as the ground truth. The median RMSE was found to be below 7° for shoulder horizontal adduction and elbow flexion and 5° for shoulder elevation and wrist joint metrics. The percentage median error for the range of motion was found to be below 30%, 15%, and 5% for the frontal wrist, sagittal wrist, and all other joints, respectively. Larger standard deviations suggest that repetitions are needed to obtain reliable measurements. No statistical difference in any error metric was found between the control cohort and SCI cohort, providing evidence for clinical translation for post-SCI treatment. Full article

Upper limb disabilities resulting from stroke affect millions worldwide, yet current rehabilitation systems face limitations in portability, cost-effectiveness, and multi-joint integration. This study presents a cable-driven parallel exoskeleton integrating elbow, wrist, and finger assistance into a single portable device. The design strategically separates actuation components, housing all motors in a backpack unit, while limb-mounted modules serve as cable routing guides, achieving seven degrees of freedom within practical constraints of portability (1.2–1.5 kg) and cost-effectiveness (3D-printed components). The device incorporates seven servo motors controlled via Arduino with IMU feedback and PID algorithms. Kinematic and dynamic analyses informed mechanical design, while ARMAX system identification enabled controller optimization achieving 87.96% model fit. Experimental validation with eight healthy participants performing four upper limb exercises demonstrated consistent trends toward reduced activation in four monitored agonist muscles with exoskeleton assistance (21.3% average reduction, p = 0.087), with moderate effect sizes for proximal muscles (Cohen’s d = 0.70–0.79) and significant reductions in brachioradialis during radial/ulnar deviation (23.4%, p = 0.045). These findings provide preliminary evidence of the device’s potential to reduce muscular effort during assisted movements, warranting further clinical validation with patient populations. Full article

A new version of the L-CADEL elbow joint assisting device is presented as version v5. The design is revised based on the experience of previous versions and on the requirements that consider the application for physical exercise for the elderly people at home. A laboratory prototype has been created with lightweight, portable and easy-to-use functionality that is confirmed by lab test results. A web interface was developed to manage the device as well as to acquire and elaborate data. Results of lab tests are discussed to validate the design feasibility and to characterize the operation performance for future clinical assessments. Full article

Background: The distal biceps brachii tendon inserts proximally and posteriorly on the bicipital tuberosity of the radius and it is a forearm supinator but also contributes to flexion of the elbow. Chronic distal biceps tendon ruptures are relatively rare, often complicated by tendon and muscle retraction, and, therefore, their primary repair is difficult or impossible. The gold standard treatment of these chronic lesions is its anatomic reinsertion at the radial tuberosity after tendon reconstruction, using autograft or allograft tissue, but there is no agreement about the most appropriate surgical technique. Untreated injuries usually result in elbow joint deficits and decreased muscular strength. We report the preliminary results in a group of patients treated with a tripled autologous semitendinosus graft. Methods: In the present retrospective study, we report the results in a series of 13 patients surgically treated using tripled autologous semitendinosus graft, fixed to the residual distal biceps tendon, starting from the myotendinous junction, and using tension-slide technique (Biceps Button—Arthrex, Inc, Naples, FL 34108, USA) in association with an interference screw. Eleven males and two females, with a mean age of 46, participated in the study. Results: At mean follow-up check-in of 35 months, clinical results were assessed using the DASH score and MEPS, with a mean value of 11 points and 87 points, respectively. Tensiomyography was also performed to evaluate muscular strength. Six patients had excellent results and seven had good results. No patient had either a tendon re-rupture, or a peripheral neurological deficit, or symptomatic heterotopic ossifications. Seven patients had a mild deficit in elbow motion and six patients had a mild deficit in forearm prono-supination. Upon tensiomyography evaluation, five patients showed a mild deficit in flexion and supination strength. All patients returned to their previous daily and sporting activities. Conclusions: According to our results, in patients affected by chronic distal biceps tendon rupture, surgical treatment performed using tripled autologous semitendinosus autograft secured to the radial tuberosity using the tension-slide technique and interference screw is associated with satisfactory outcomes. Full article

Background: Inertial measurement units (IMUs) represent a relatively new and promising method for motion analysis. Their main advantages include small size and portability, combined with the use of advanced technologies. To date, few studies have investigated the application of these devices for proprioception assessment, and none have focused specifically on the elbow joint. Therefore, the aim of our study was to assess reliability and validate the protocol of elbow proprioception evaluation using inertial motion sensors. Methods: Twenty healthy participants underwent active and passive proprioception assessments based on joint position sense (JPS). Two researchers independently performed evaluation. The analyzed data was the error of reproduction of joint position (ERJP). IMU (RSQ Motion sensors) were used for angular joint position assessment and validated against Biodex System 4. Results: Inter-rater reliability for passive proprioception was good, with a Kendall’s coefficient of 0.77 (p < 0.05) for both RSQ Motion sensors and BIODEX, while active proprioception measured with RSQ Motion sensors showed slightly lower reliability (Kendall’s coefficient of 0.66, p < 0.05). Intra-rater reliability had similar results, with Kendall’s coefficients of 0.74 for passive BIODEX proprioception examination, 0.75 for passive RSQ Motion sensor testing and 0.65 for active proprioception (p < 0.05) measured with RSQ Motion sensors. The Bland–Altman plot revealed an equal distribution of results, which were within the limits of agreement (LoA). Conclusions: These results suggest proprioception assessment by JPS using inertial motion sensors is reliable and valid. It is an easy to use, light, portable, and inexpensive alternative for proprioception assessment, although further research in diverse clinical settings is needed. Full article

Background: The radiocapitellar articulation of the elbow joint is particularly susceptible to subluxation and dislocation. Joint stability can be quantified using the stability ratio, a biomechanical parameter of joint stability defined as the ratio of the maximum dislocating force the joint can resist in relation to the joint compressive force. The purpose of this study was to biomechanically assess the stability of the radiocapitellar joint in the anterior and posterior direction across varying degrees of elbow flexion. Methods: Eight fresh-frozen cadaveric elbows, average age 68.9 years (range 61–73 years; 3 males and 5 females; 7 left and 1 right) were tested. The distal humerus and proximal radius were dissected of all soft tissues to isolate the radiocapitellar articulation. The radius and humerus were mounted on a custom jig that allows for positional adjustment and incorporates a material testing machine. Each specimen was mounted at neutral forearm position and tested at 30, 45, and 60 degrees of anatomical elbow flexion. All specimens were subjected to 10 mm of anterior–posterior displacement for 5 cycles at 20 mm per minute with 40 N of compressive load. Subluxation force, displacement at subluxation force, linear stiffness, stability ratio, and energy absorbed were calculated. Results: In all degrees of elbow flexion, the stability ratio in the posterior direction was significantly higher than the anterior direction by an average of 39.8 ± 32.6% (p < 0.025). Maximum subluxation force was also significantly higher in the posterior direction when compared to the anterior direction (p < 0.027). There was no significant difference in any other parameters. Conclusions: The stability ratio and maximum subluxation force of the radiocapitellar joint when positioned in neutral forearm rotation are significantly greater in the posterior direction when compared to the anterior direction. This finding provides quantitative insights and a biomechanical rationale for the propensity of anterior instability in the radiocapitellar joint. Full article

Underwater treadmill (UWTM) therapy is increasingly applied in canine rehabilitation, yet evidence on its effects after multiple sessions on joint mobility remains limited. The aim of this pilot study was to evaluate the impact of a 10-session UWTM programme on passive range of motion (PROM) in dogs with various disorders. Clinical records from 50 dogs were analysed. Each patient completed two 20 min sessions per week over five consecutive weeks. PROM in the carpal, elbow, shoulder, tarsal, stifle, and hip joints was measured using a goniometer before and after the programme. After ten sessions, a significant improvement was observed in all joints, both in flexion and extension. Flexion angles decreased from 2.89% in the tarsal joint to 12.21% in the carpal joint, while extension angles increased from 0.61% in the elbow to 2.55% in the stifle joint. Consequently, overall PROM improved, with median increases ranging from 1.9% in the tarsus to 5.6% in the hip. These improvements were observed consistently across diagnostic groups. No significant correlations were found between age and the degree of PROM improvement. In summary, the findings indicate that a 10-session UWTM programme is associated with measurable improvements in joint mobility and may be a valuable component of multimodal canine rehabilitation. Full article

Background: Incongruity is a primary cause of elbow dysplasia. The aims of this study included assessing the prevalence of incongruity, determining reference ranges for joint space widths of the elbow joints in asymptomatic animals, and analyzing the correlations between incongruity and other primary causes of elbow dysplasia. Methods: The study was conducted in 108 dogs of different sexes and aged from 3 to 15 months. The animals were divided into two groups: group I (50 dogs) comprising healthy animals and group II (58 dogs) comprising sick animals. Results: All the dogs in group I were considered healthy. In these dogs, the mean radioulnar “step” height based on the X-ray examination was 0.85 ± 0.33 mm, the mean joint space width of the humeroulnar joint assessed in the computed tomography (CT) examination was 1.34 ± 0.34 mm, and the mean joint space width of the humeroradial joint was 1.43 ± 0.31 mm. In group II, incongruity was detected in 30 and 41 dogs based on the X-ray and CT scan images, respectively. The mean radioulnar “step” height in the dogs with incongruity based on the X-ray examination was 2.05 ± 0.53 mm, while that in the CT examination was 2.33 ± 0.74 mm. The mean joint space width of the humeroulnar joint based on the computed tomography (CT) examination was 3.189 ± 1.03 mm, and the mean joint space width of the humeroradial joint was 2.916 ± 0.702 mm. The most common diagnosis was a combination of incongruity with medial coronoid process disease. Conclusions: Based on the conducted studies, the following reference values were determined: for the height of the radioulnar “step” measured on radiographs, 0.3–1.5 mm; for the height of the radioulnar “step” measured in the CT examination, 0–1.5 mm; for the width of the joint space of the humeroulnar joint measured on MPR images in the sagittal section, 0.8–2.2 mm; and, for the width of the joint space of the humeroradial joint measured on MPR images in the sagittal section, 0.7–2.5 mm. An elbow incongruity was the most frequently diagnosed primary cause of elbow dysplasia, most often occurring in combination with other causes, particularly medial coronoid process disease. Full article

Lateral elbow pain is a common condition often misattributed solely to tendinopathy, while subtle instability may represent a significant underlying cause. Traditional classifications of elbow instability primarily address traumatic or grossly unstable patterns, leaving minor forms underrecognized. Recent evidence has emphasized the role of the Radial-Lateral Collateral Ligament (R-LCL) in maintaining joint stability, and its elongation has been linked to Symptomatic Minor Instability of the Lateral Elbow (SMILE). This model describes a horizontal type of radiocapitellar instability, where ligamentous incompetence leads to compensatory overload of the extensor carpi radialis brevis, ultimately producing chronic pain. Advances in diagnostic tools—including dynamic ultrasound (HELP-US test), CT arthrography with the SMILE Index, and arthroscopic signs such as the Loose Collar Sign—have improved recognition of this condition. However, surgical controversies remain, particularly regarding the potential destabilizing role of lateral release in patients with unrecognized R-LCL pathology. Arthroscopic stabilization techniques, such as R-LCL plication or imbrication, have shown promising outcomes, offering pain relief and functional recovery with minimally invasive approaches. This review integrates anatomical, biomechanical, and clinical evidence into a structured diagnostic and therapeutic algorithm, aiming to reduce diagnostic uncertainty and guide tailored interventions. Recognition of microinstability, and, in particular, the SMILE model, is crucial to optimize management of patients with chronic lateral elbow pain refractory to conservative measures. Full article

Postoperative C5 palsy is a common complication of cervical spine surgery. Inadequate recovery from C5 palsy can result in significant impairment of activities of daily living. However, no effective treatment has been established for persistent cases. In the present report, we describe a novel therapeutic approach using the Hybrid Assistive Limb (HAL) in a patient with severe, prolonged postoperative C5 palsy. The patient was a 46-year-old man who developed severe right C5 palsy following cervical spine surgery performed 41 months earlier. Despite undergoing conventional rehabilitation, no improvement was observed, and the muscle strength of the right deltoid and biceps remained at manual muscle testing (MMT) grade 2. HAL training, using both shoulder and elbow devices, was initiated at our institution. Training was conducted once weekly for a total of 106 sessions over 21 months. At baseline, the right shoulder range of motion was limited to 50° in flexion and 35° in abduction. With HAL-assisted training, flexion improved to 150° and abduction improved to 95° by the final (106th) session and further increased to 165° and 170°, respectively, at long-term follow-up. Deltoid strength, assessed using handheld dynamometry, increased from 3.5 Nm/kg at baseline to 28.5 Nm/kg after training. In this case, a long-term therapeutic program incorporating shoulder and elbow HAL training successfully improved severe and prolonged postoperative C5 palsy to a functionally useful level. This case highlights the potential effectiveness of HAL therapy for treatment-resistant postoperative C5 palsy. Full article

Weld seam detection is a fundamental prerequisite for robotic welding automation, yet it remains challenging due to the elongated shape of welds, weak contrast against metallic backgrounds, and significant environmental interference in industrial scenarios. To address these challenges, we propose a novel deep neural network architecture termed SANet (Strip-Aware Network). The model is constructed upon a U-shaped backbone and integrates strip-aware feature modeling with multistage supervision. It mainly consists of two complementary modules: the Paralleled Strip and Spatial Context-Aware (PSSCA) module and the Multistage Fusion (MF) module. The PSSCA module enhances the extraction of elongated strip-like features by combining parallel strip perception with spatial context modeling, thereby improving fine-grained weld seam representation. In addition, SANet integrates the StripPooling attention mechanism as an auxiliary component to enlarge the receptive field along strip directions and enhance feature discrimination under complex backgrounds. Meanwhile, the MF module performs cross-stage feature fusion by aggregating encoder and decoder features at multiple levels, ensuring accurate boundary recovery and robust global-to-local interaction. The weld seam detection task is formulated as a two-dimensional segmentation problem and evaluated on a self-built dataset consisting of over 4000 weld seam images covering diverse industrial scenarios such as pipe joints, trusses, elbows, and furnace structures. Experimental results show that SANet achieves an IoU of 96.23% and a Dice coefficient of 98.07%, surpassing all compared models and demonstrating its superior performance in weld seam detection. These findings validate the effectiveness of the proposed architecture and highlight its potential as a low-cost, flexible, and reliable pure vision solution for intelligent welding applications. Full article

Speed and load effects on the number and type of pair interactions between six elbow and shoulder muscles or muscle (m.) heads were evaluated by the intercriteria decision-making method (ICrA). The surface electromyography (sEMG) signals of the m. deltoideus pars clavicularis (Dcla), m. deltoideus pars spinata (Dspi), m. biceps brachii (BB), m. triceps brachii caput longum (TB), m. brachialis (BR), and m. anconeus (AN) of ten healthy subjects were recorded. The data was collected during cycling movements (CMs) for continuous flexions and extensions in the elbow joint in the horizontal plane. The CMs were performed with and without an added load at four different speeds. The obtained sEMG data were subjected to the ICrA to identify muscle activity and speed correlations. The ICrA results demonstrate that added load resulted in a higher number of consonance relations between muscle activities. Positive consonance (PosC) appears between the Dcla-Dspi, Dspi-BR, BB-BR, and TB-BR criteria pairs for the loaded flexion phases. When extension is in the focus, Dcla-BB is in a consonance relation for no loaded phases, while for the loaded ones, five muscle pairs, namely Dcla-BB, Dcla-BR, Dspi-BR, BB-BR, and TB-BR, hit PosC. Also, the most correlations are found for the fastest phase (1 s) of flexion and extension, regardless of the load. Additionally, correlation dependencies between the two faster (Sp2-Sp1) and the two slower speeds (Sp10-Sp6) were found. Full article

A six-year-old, neutered male Pomeranian weighing 4.25 kg was presented with a two-year history of non-weight-bearing lameness of the left thoracic limb following an untreated traumatic olecranon fracture. Orthopedic examination revealed markedly reduced elbow joint range of motion and muscle atrophy. Radiographs demonstrated a distinct fracture line with proximolateral displacement of the olecranon fragment. Preoperative computed tomography (CT) and three-dimensional (3D) reconstruction were used to establish the surgical plan and to pre-contour a locking plate. Surgical treatment was performed in sequential steps, including removal of scar tissue, reopening of the bone marrow channel, and internal fixation. Considering the compromised biological environment of a chronic non-union, a bioactive graft composed of porous leaf-stacked structure (LSS) polycaprolactone particles incorporating recombinant human bone morphogenetic protein-2 (rhBMP-2) and mesenchymal stem cells (MSCs) was applied in combination with plate-screw fixation. The patient showed progressive improvement after surgery, achieving full weight-bearing and restoration of elbow joint motion comparable to the contralateral side. Follow-up radiographs and CT confirmed fracture union, and the radiolucency of the LSS scaffold enabled precise monitoring of bone healing. This case highlights the potential utility of combining patient-specific surgical planning with sustained delivery of rhBMP-2 and MSCs using LSS particles for the management of chronic non-union fractures in small animals. Full article

Background: Pronator teres syndrome is a rare proximal median neuropathy caused by compression of the median nerve at various points. It is a rare condition, and many times it is mistaken for carpal tunnel syndrome. Methods: There are many authors who refer to the pronator syndrome as a compression of the median nerve at several potential sites of en-trapment in the region of the antecubital fossa, more proximal compression at the Liga-ment of Strutters, and more distally, including lacerus fibrosus within the pronator teres muscle and the anterior interosseous nerve. Results: The diagnostic difficulties in a patient with severe right forearm pain during elbow flexion and pronation are presented. Routine test results, including MRI of the right elbow joint, nerve conduction study of the brachial plexus and ulnar nerve, and electromyographic study of the muscles of the right upper ex-tremity, were normal. Ultrasonography showed an enlarged pronator teres muscle. Conclusions: The patient underwent surgical removal of the lacertus fibrosus. All symptoms resolved. Full article

Conductive hydrogels (CHs) have attracted significant attention in the fields of flexible electronics, human–machine interaction, and electronic skin (e-skin) due to their self-adhesiveness, environmental stability, and multi-stimuli responsiveness. However, integrating these diverse functionalities into a single conductive hydrogel system remains a challenge. In this study, polyvinyl alcohol (PVA) and polyacrylamide (PAM) were used as the dual-network matrix, lithium chloride and MXene were added, and a simple immersion strategy was adopted to synthesize a multifunctional MXene-based conductive hydrogel in a glycerol/water (1:1) binary solvent system. A subsequent investigation was then conducted on the hydrogel. The prepared PVA/PAM/LiCl/MXene hydrogel exhibits excellent tensile properties (~1700%), high electrical conductivity (1.6 S/m), and good self-healing ability. Furthermore, it possesses multimodal sensing performance, including humidity sensitivity (sensitivity of −1.09/% RH), temperature responsiveness (heating sensitivity of 2.2 and cooling sensitivity of 1.5), and fast pressure response/recovery times (220 ms/230 ms). In addition, the hydrogel has successfully achieved real-time monitoring of human joint movements (elbow and knee bending) and physiological signals (pulse, breathing), as well as enabled monitoring of spatial pressure distribution via a 3 × 3 sensor array. The performance and versatility of this hydrogel make it a promising candidate for next-generation flexible sensors, which can be applied in the fields of human health monitoring, electronic skin, and human–machine interaction. Full article