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Results for “Motion Therapy, Continuous Passive”

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PubMed2002

The stiff total knee arthroplasty: evaluation and management.

Arthrofibrosis after total knee arthroplasty is a relatively common complication. A variety of modalities have been employed to treat this problem, including physical therapy, injections, and manipulations. We examined a group of consecutive posterior stabilized total knee arthroplasties to determine the prevalence of arthrofibrosis, as defined by flexion <90 degrees, and the effect of manipulation under anesthesia on outcome. Approximately 11% of the patients met the criteria for arthrofibrosis. Manipulation under anesthesia was successful in improving flexion from an average of 67 degrees premanipulation to 111 degrees postmanipulation. The group that required manipulation did as well statistically as the group as a whole, which had a mean flexion of 114 degrees at 1 year.

Arthroplasty, Replacement, Knee↗
PubMed1992

Modified use of a dynamic bite opener--treatment and prevention of trismus in a child with head and neck cancer: a case report.

Trismus may be a complication arising during or after treatment of patients with head and neck cancer. Treatment of trismus is difficult, making prevention very important. To prevent and treat trismus in a patient with a nasopharyngeal tumor, the Contract-Relax-Antagonist-Contract (CRAC) technique was applied, with the aid of a custom-made dynamic bite opener (DBO). The CRAC technique in combination with the DBO, as a therapy/prevention program for trismus, is not referred to in the literature. The combination of CRAC and DBO appeared to be a gentle and effective method well tolerated by the patient.

Adolescent↗
PubMed1993

Results of Judet quadricepsplasty.

Eleven patients (with 12 supracondylar femur fractures) with knee extension contractures were followed for an average of 24.8 months (range 12-45) after Judet quadricepsplasty. An increase in motion of 53 degrees with active postoperative flexion of 91 degrees was noted. There was an average loss of 14 degrees of flexion from maximum intraoperative correction. One patient had an extensor lag of 30 degrees, which did not improve after quadricepsplasty, but no other patients developed an extensor lag, infection, or skin breakdown after the procedure.

Adult↗
PubMed2003

Judet's quadricepsplasty, surgical technique, and results in limb reconstruction.

Quadricepsplasty has been described by Thompson and Judet to improve flexion in severely ankylosed knees. Judet's technique has potential advantages because it is less damaging to the quadriceps mechanism and addresses the problem of external fixator pin site tethering on the lateral side of the thigh. The outcome of Judet's quadricepsplasty was assessed in 10 consecutive patients who were treated with external fixation either as a primary treatment (three patients) or as a secondary treatment for nonunion or malunion (seven patients) in a limb reconstruction unit. The patients were reviewed and examined at a minimal followup of 20 months. Their average prequadricepsplasty flexion of 33 degrees was improved to 105 degrees in the operating room and to 88 degrees on final review after an average followup of 24 months. According to Judet's criteria, there were one fair, seven good, and two excellent results. Two patients had postoperative complications, one hematoma and one infection. A minimal extension lag (10 degrees ) developed in one patient. Judet quadricepsplasty successfully increases flexion range with minimum impairment of quadriceps function. Familiarity with this technique might lower the surgeon's threshold for considering quadricepsplasty in patients with severe knee ankylosis after severe femoral fractures and in particular after a prolonged period of external fixation.

Adult↗
PubMed1994

Rerouting of the biceps brachii for paralytic supination contracture of the forearm in tetraplegia due to trauma.

Six tetraplegic patients (eight forearms) who had a supination contracture were evaluated after lengthening and rerouting of the biceps brachii. Preoperatively, the mean range of supination and pronation of the forearm was 85 and 14 degrees, respectively. Pronation increased a mean of 75 degrees without affecting the strength of flexion or the flexion-extension arc of motion of the elbow. The forearms that had a satisfactory result had a mean active range of supination of 69 degrees, while those that had a poor result had no active supination. The mean duration of follow-up was twenty-seven months (range, twelve to seventy-two months). The result was considered satisfactory for six limbs and unsatisfactory for two. Functional gains were made in the patients' ability to feed and groom themselves, in their ability to tend to personal hygiene, and in writing and typing skills when the dominant extremity was treated. The results were less predictable for the non-dominant extremity. The maximum gain in the range of motion occurred at three months and the maximum functional gain, by six months.

Activities of Daily Living↗
PubMed2001

Intrasynovial flexor tendon repair. An experimental study comparing low and high levels of in vivo force during rehabilitation in canines.

BACKGROUND: Rehabilitation methods that generate increased tendon force and motion have been advocated to improve results following intrasynovial flexor tendon repair. However, the effects of rehabilitation force and motion on tendon-healing may be masked by the high stiffness produced by newer suture methods. Our objective was to determine whether the biomechanical properties of tendons repaired by one of two multistrand suture methods were sensitive to an increased level of applied rehabilitation force. METHODS: Two hundred and fourteen flexor digitorum profundus tendons from 107 adult dogs were transected and repaired. Dogs were assigned to one of four groups based on the rehabilitation method (low force [<5 N] or high force [17 N]) and the repair technique (four-strand or eight-strand core suture) and were killed between five and forty-two days after the procedure. Repair-site structural properties were determined by tensile testing, and digital range of motion was assessed with use of a motion-analysis system. RESULTS: Tensile properties did not differ between the low and high-force rehabilitation groups, regardless of the repair technique (p > 0.05). In contrast, tensile properties were strongly affected by the repair technique, with tendons in the eight-strand group having an approximately 35% increase in ultimate force and rigidity compared with those in the four-strand group (p < 0.05). Ultimate force did not change significantly with time during the first twenty-one days (p > 0.05); there was no evidence of softening in either of the repair or rehabilitation groups. Force increased significantly from twenty-one to forty-two days, while rigidity increased throughout the forty-two-day period (p < 0.05). CONCLUSIONS: Increasing the level of force applied during postoperative rehabilitation from 5 to 17 N did not accelerate the time-dependent accrual of stiffness or strength. Suture technique was of primary importance in providing a stiff and strong repair throughout the early healing interval. CLINICAL RELEVANCE: Our findings suggest that there be a reexamination of the concept that increases in force produced by more vigorous mobilization protocols are beneficial to tendon-healing. While more vigorous rehabilitation may help to improve hand function, we found no evidence that it enhances tissue-healing or strength in the context of a modern suture repair.

Animals↗
PubMed1997

The important role of motion in the rehabilitation of patients with mandibular hypomobility: a review of the literature.

The orthopedic literature has clearly demonstrated that the physical stimulus of motion is essential for the maintenance of the structural and functional integrity of synovial joints. As a result of this information, rehabilitation with passive motion has become an extremely important part of the rehabilitation of synovial joints throughout the body, especially when there is limited range of motion. This same biological principle must be applied to the temporomandibular joint, especially when there is limitation in mandibular mobility. The effects of limited joint mobility, as well as passive motion, on the articular and extra-articular components of synovial joints is reviewed in detail. The clinical application of these principles in the management of temporomandibular disorders is emphasized.

Adolescent↗
PubMed2005

Benefits of active motion for joint position sense.

Anterior cruciate ligament (ACL) ruptures lead to a proprioceptive deficit and therefore joint position sense. This study examined whether active motion is better suited than passive motion to address this deficit. Sixty patients with ACL rupture were prospectively randomised into two groups [continuous active motion (CAM)/continuous passive motion (CPM)]. All patients had an ACL reconstruction. An angle reproduction test was used to assess the proprioceptive deficit. The relevant examinations were performed before surgery (pre-op evaluation) and after the seventh postoperative day. No preoperative difference was found between the two groups. After postoperative treatment, the deficit was reduced in both groups. Significantly better results were, however, obtained in the CAM group (CPM, 4.2+/-1.6 degrees; CAM, 1.9+/-1.2 degrees; P<0.001). During the first postoperative week, a CAM device produced a significantly greater reduction in the proprioceptive deficit and should be the first choice in immediately postoperative rehabilitation after ACL replacement.

Adolescent↗
PubMedDate not supplied

The efficacy of continuous passive motion in the rehabilitation of anterior cruciate ligament reconstructions.

Seventy-five patients undergoing arthroscopically-assisted anterior cruciate ligament reconstruction by the same surgeon were divided into three random subgroups. All of the anterior cruciate ligament reconstructions used the middle third of the ipsilateral patellar tendon autograft. Patients undergoing meniscal repair, extraarticular procedures, or repair of other ligaments were excluded. The 75 patients were divided into subgroups to assess the benefits or disadvantages of early active motion (25 patients), continuous passive motion (25 patients), and a combination of both (25 patients) during the first 30 days after surgery. All patients were evaluated at specific intervals for 6 months after surgery. Data recorded included drain output, medication usage, tourniquet time, leg involved, hospital stay length, KT-1000 testing (before surgery in the anesthetized patient, after the procedure was completed, and 2 and 6 months after surgery), and range of motion. Radiographs and the International Knee Evaluation Form were also used to evaluate the results. No statistically significant differences were found between the three groups. Side-to-side anterior-posterior differences, stability, and restoration of full range of motion were similar in each subgroup at each evaluated interval. In this prospective study of motion, started immediately after anterior cruciate ligament reconstruction, passive and active methods were shown to have identical results. A supervised active and passive motion program during the 1st month had the same results as either one used individually.

Adult↗
PubMedDate not supplied

Use of continuous passive motion in pediatric orthopedics.

Continuous passive motion (CPM) was used to maintain or gain hip and knee range of motion in 18 postoperative or postinjury pediatric orthopedic patients. Continuous passive motion was started in the early postoperative period and augmented with physical therapy. The device was well-tolerated in 16 of the 18 patients. In all but one, motion was improved with a progressive decrease in joint pain. In these patients, CPM was found to be a valuable tool in rehabilitation, and did not interfere with traction, open wounds, nursing care, nor external fixation devices.

Adolescent↗
PubMed1995

Squatting following total knee arthroplasty.

This prospective study was performed to investigate whether postoperative alternate flexion and extension splinting (daily change in position of immobilization by splinting) was useful in restoring full range of motion (ROM) after total knee arthroplasty as compared with continuous passive motion. The alternate flexion and extension splinting group and the continuous passive motion group were each composed of 34 knees. Final ROM was measured at an average of 3.5 years postoperatively. Squatting was possible in 31 knees (45.6%) of the alternate flexion and extension splinting group. The postoperative ROM of the osteoarthritic knees (131.8 degrees +/- 12.3 degrees) was significantly greater than that of the rheumatoid knees (121.9 degrees +/- 22.4 degrees) (p < 0.05). The postoperative ROM of the alternate flexion and extension splinting group (135.1 degrees +/- 11.9 degrees) also was significantly greater than that of the continuous passive motion group (120.0 degrees +/- 19.7 degrees) (p < 0.01). There was no statistically significant relationship between the posterior slope of tibial cutting and the postoperative ROM. It is suggested that alternate flexion and extension splinting is effective in restoring full ROM after total knee arthroplasty.

Adult↗
PubMed1994

[A new motorized dynamic splint for the hip joint].

The authors present a new mechanical exercise splint for the hip. The appliance carries out movements in three dimensions and is used early in the postoperative period following surgical treatment of the hip and surrounding structures for continuous passive motion (CPM) treatment. When the hip is flexed, the knee bends at the same time. It is possible, however, for the part of the leg cradle that holds the lower leg to be locked in the extended position to avoid any problems for patients with arthrodesis in the knee. It is also advisable for knee movement to be blocked when the patient does exercises involving spreading and closing of the legs and inward and outward rotation. In this case the leg concerned should be bent about 10 degrees at the hip to avoid friction losses against sheets and mattress. The main indications for use of the new splint are internal fixation following acetabular fractures, periacetabular fractures, dislocation, joint fractures with dislocation of the same joint and fractures or pseudarthrosis at the upper end of the femur. Other appropriate forms of treatment are synovectomy, surgery to improve the form of the cup, including pelvic osteotomy, all kinds of transformation osteotomy, especially for hip necrosis or osteochondrosis dissecans, soft tissue surgery such as capsulotomy, tenotomy or resection following ectopic bone formation and flaccid paralysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Contraindications↗
PubMed1996

Surgical closing in primary total knee arthroplasties: flexion versus extension.

One hundred eight consecutive patients with primary osteoarthritis of the knee undergoing primary arthroplasty were compared retrospectively to determine whether surgical closure of the entire wound in flexion has any effect on range of motion postoperatively over a period of up to 6 months. The knees of the first 52 patients were surgically closed in extension. In the second group of 56 patients, the knees were closed in 90 degrees to 110 degrees flexion depending on the available motion of the joint. Although the patients were not randomized, the groups were closely matched in age, weight, height, and gender. Preoperative and postoperative patellar heights were similar in both groups. The patients were started on a continuous passive motion device in the recovery room. At all intervals the flexion measurements were significantly better in the flexion closure group. By 6 months the flexion closure group had surpassed their preoperative measurements, whereas the extension closure group had not yet achieved this goal. The flexion group required less home physical therapy than the extension group. Closing the knee in flexion permits the patients to regain knee motion faster with less effort, thereby saving money and enhancing patient satisfaction.

Aged↗
PubMed2004

[CPM--Continuous Passive Motion: treatment of injured or operated knee-joints using passive movement. A meta-analysis of current literature].

There is still a controversial discussion in literature about the use of motor driven splints in knee surgery--as the principle of continuous passive motion, CPM. For this reason it seemed useful for an evaluation to look through the papers which were published since 1990. It was obvious, that negative results were published often before this year, but this papers are still quoted standard works. In medical data bases subito-doc.de, medscape.com, medica.de and zbmed.de 230 papers were found by search CPM, continuous passive motion and arthromot. Coincidentally there was a search for authors who were already quoted in other papers. 36 papers concerning CPM after knee surgery were utilized. The role of CPM regarding the range of motion, swelling, duration of hospital stay, use of analgesics, costs, postoperative manipulations, wound healing and thrombo embolic complications was evaluated. Although the results of this partial retrospective, partial prospective, sometimes randomized or double blinded studies are in contradiction, there can only be found a trend to better results. New clinical studies for evidence based guidelines in the handling of continuous passive motion after knee surgery are necessary.

Edema↗
PubMed1991

The effect of continuous passive motion on knee ligament reconstruction with carbon fibre. An experimental investigation.

Our purpose was to determine whether continuous passive motion enhanced the quality of knee ligament reconstruction using carbon fibre. In 46 rabbits the medial collateral ligaments were excised and replaced with carbon fibre prostheses. The animals were treated postoperatively by either continuous passive motion, cast immobilisation or cage activity, termed intermittent active motion. At six weeks, the ligaments were compared histologically and biomechanically with normal (control) medial collateral ligaments and with sham-operated controls. The ligaments treated with continuous passive motion were superior to those in the other two treatment groups. There were no ligament failures in any of the groups. This study suggests that continuous passive motion, initiated immediately postoperatively, enhances the biomechanical properties of carbon fibre ligament replacement of the medial collateral ligament while preventing the harmful effects of joint immobilisation.

Animals↗
PubMed1994

Locked posterior dislocation of the shoulder: treatment using rotational osteotomy of the humerus.

This study reports the use of rotational osteotomy in 10 patients with locked posterior dislocation of the shoulder. The average interval between injury and diagnosis was 155 days (range, 21-400 days). Patients were aged 40-78 years old, with an average age of 53 years. Articular impaction fracture of the humeral head involved 20-40% of the articular surface as determined by CT analysis. There were no postoperative complications except a transient axillary nerve palsy. Patients were started on immediate passive motion followed by an active program at 2-3 weeks. Using the Rowe/Zarins scale, six patients had good-excellent results, two fair results, and two poor results. The poor results were seen in cases where articular cartilage damage was advanced. Rotational osteotomy is an effective procedure at restoring glenohumeral congruity and early functional activity in the patient with locked posterior shoulder dislocation given the following criteria: (a) healthy articular cartilage, (b) a humeral head defect involving less than 40% of the articular surface, and (c) a patient who is able to participate in an active rehabilitation program.

Adult↗
PubMedDate not supplied

Frozen shoulder: arthroscopy and manipulation under general anesthesia and early passive motion.

During a 15-month period, 24 patients with arthroscopically verified frozen shoulders were treated with manipulation while under general anesthesia and early passive motion. The minimum follow-up was 12 months, and the average duration from onset of the disease until treatment was 8 months. All patients had moderate to severe pain, and the average range of motion was less than 40% of the opposite shoulder. During the follow-up period, 75% of the patients obtained normal or almost full range of motion, and 79% had slight pain or no pain at all. Eighteen (75%) patients returned to work 9 weeks (mean) after treatment. There was no relationship between the end result and the initial pathologic condition. We believe that manipulation combined with arthroscopy is an effective way of shortening the course of an apparently self-limiting disease and should be considered when conservative treatment has failed.

Adult↗