Mellan år 2020 och år 2021 registrerades 381 operationer av böjsenskador i Sverige. Rehabiliteringsprocessen efter en böjsenskada är lång och kräver kontinuerlig uppföljning. Uppföljningen sker genom mätningar av böj- och sträckförmågan i de fingrar som patienten opererat. Mätningarna utförs i nuläget manuellt med goniometer, där vinklarna i fingrarnas leder mäts, en gång per vecka på en handkirurgisk mottagning. Handkirurgiska kliniken på Södersjukhuset i Stockholm efterfrågade ett digitalt mätverktyg som skulle göra det möjligt för patienten att på ett tillförlitligt sätt mäta vinklarna hemma i stället för på kliniken. Målet med projektet var således att skapa ett mätverktyg som mäter vinklarna med ett mätfel på högst 5 grader. Ett mätverktyg utvecklades som utför mätning av vinklar med hjälp av en bild användaren tagit. Mätverktyget är kompatibelt med Androidenheter och kan implementeras i en redan existerande Androidapplikation. Tester visade att mätverktyget har ett mätfel med ett medelvärde på 5 grader eller lägre för proximala interfalangealleden och distala interfalangealleden. Vidare var medelfelet 7,3 grader respektive 6,4 grader för metakarpofalangealleden vid böjt respektive sträckt finger, samt 10 grader för totalt aktivt rörelseomfång (total active motion). / Between 2020 and 2021, 381 operations for flexor tendon injuries were registered in Sweden. The rehabilitation following surgery is long and requires continuous monitoring. Presently the monitoring is done through manual measurements of the patients flexing and extending capability of the fingers affected. The measurement is performed at a hand surgery department with a handheld goniometer, initially once a week. The hand surgery department at Södersjukhuset in Stockholm requested a digital tool that allows the patient to reliably measure the angles of the fingers bending and stretching capability at home instead of at the clinic. The objective of the project was therefore to create a measurement tool that measures these angles with a maximum error of 5 degrees. A measurement tool was developed where the measurement of angles takes place from an image taken by the user. The measurement tool is compatible with Android devices and can be implemented in an existing Android application. Tests showed that the measurement tool has a mean measurement error of 5 degrees or less for the proximal interphalangeal joint and the distal interphalangeal joint. In addition, the mean error was 7.3 degrees and 6.4 degrees for the metacarpophalangeal joint, bent and stretched respectively, and 10 degrees for total active motion.

Transforming growth factor beta 3 (TGF3) promotes tenogenic differentiation and may enhance tendon regeneration in vivo. This study aimed to apply TGF3 absorbed in decellularized equine superficial digital flexor tendon scaffolds, and to investigate the bioactivity of scaffold-associated TGF3 in an in vitro model. TGF3 could effectively be loaded onto tendon scaffolds so that at least 88% of the applied TGF3 were not detected in the rinsing fluid of the TGF3-loaded scaffolds. Equine adipose tissue-derived multipotent mesenchymal stromal cells (MSC) were then seeded on scaffolds loaded with 300 ng TGF3 to assess its bioactivity. Both scaffold-associated TGF3 and TGF3 dissolved in the cell culture medium, the latter serving as control group, promoted elongation of cell shapes and scaffold contraction (p < 0.05). Furthermore, scaffold-associated and dissolved TGF3 affected MSC musculoskeletal gene expression in a similar manner, with an upregulation of tenascin c and downregulation of other matrix molecules, most markedly decorin (p < 0.05). These results demonstrate that the bioactivity of scaold-associated TGF3 is preserved, thus TGF3 application via absorption in decellularized tendon scaffolds is a feasible approach.

No description available.

No description available.

The National Occupational Research Agenda stresses the importance of identifying work-related musculoskeletal disorder (WMSD) risk factors, understanding their exposure dependent nature, and identifying strategies to reduce their incidence and severity. We first examined behavioral changes after exposure to a low repetition low force (LRLF) reaching task for 12 weeks in young rats. We observed increased movement reversals in LRLF - week 8, indicative of a decline in fine motor control, and a small decrease in voluntary task participation in LRLF - week 12, compared to controls. This decline was associated temporally with a low-grade increase of macrophages in peripheral nerve and distal forelimb bones that correlated with nociceptive neurochemical increases in the spinal cord. We next examined motor behavior changes in young rats exposed to either a food retrieval high repetition negligible force (HRNF) task or a lever pulling high repetition low force (HRLF) reaching task. We found that both tasks led to motor declines, with more marked declines in fine motor control in the HRNF group. Thus, repetition, rather than the difference in force magnitude between the 2 tasks, appears to be the key factor in the induction of motor declines associated with repetitive motion injuries (RMIs). Also, these findings indicate that activities involving negligible force do not necessarily pose a lower risk than activities involving low force. Factors such as fine motor coordination requirements may even pose greater risks. Also, compared to the LRLF task, the high repetition tasks resulted in more motor performance declines, thus confirming exposure-dependency in the context of RMI. We also explored the effects of HRNF and HRLF tasks on supraspinatus tendon of young adult rats in 6 and 12 weeks. We found a small but non-significant elevation of ED1+ macrophages in 6 weeks. The supraspinatus tendon does not appear to develop as many pathological changes as forelimb flexor tendons (Barbe, et al., 2003) with task performance. Lastly, we examined the effects of performing HRLF tasks in aged rats. We found that aged rats demonstrate both declines in motor performance and pathological tissue changes over the course of 12 weeks of exposure to the HRLF lever pulling task. The observed declines in grip strength in aged trained control and HRLF rats over time suggest that both age and cumulative exposure to the repetitive task are factors in the development of WMSDs. Our findings suggest that additional study of exposure-dependency and risk factors is warranted. Deeper understanding of the relative contributions of various risk factors can help inform prophylactic programs and/or interventions for individuals who are at risk for, or suffer from, WMSDs. / Physical Therapy

More than 350,000 anterior cruciate ligament (ACL) injuries occur every year in the United States. A torn ACL is typically replaced with an allograft or autograft tendon (patellar, quadriceps or hamstring), with the choice of tissue generally dictated by surgeon preference. Despite the number of ACL reconstructions performed every year, the process of ligamentization, transformation of a tendon graft to a healthy functional ligament, is poorly understood. Previous research studies have relied on mechanical, biochemical and histological studies. However, these methods are destructive. Clinically, magnetic resonance imaging (MRI) is the most common method of graft evaluation, but it lacks adequate resolution and molecular specificity. There is a need for objective methodology to study the ligament repair process that would ideally be non- or minimally invasive. Development of such a method could lead to a better understanding of the effects of therapeutic interventions and rehabilitation protocols in animal models of ligamentization, and ultimately, in clinical studies. Fourier transform infrared (FT-IR) spectroscopy is a technique sensitive to molecular structure and composition in tissues. FT-IR fiber optic probes combined with arthroscopy could prove to be an important tool where minimally invasive tissue assessment is required, such as assessment of graft composition during the ligamentization process. Spectroscopic methods have been used to differentiate normal and diseased connective tissues, but have not been applied to investigate ligamentization, or to investigate differences in tendons and ligaments. In the proposed studies, we hypothesize that infrared spectroscopy can provide molecular information about the compositional differences between tendons and ligaments, which can serve as a foundation to non-destructively monitor the tissue transformation that occurs during ligamentization. / Bioengineering

No description available.

Current bio-robotic assistive devices have developed into intelligent and dexterous machines. However, the sophistication of these wearable devices still remains limited by the inherent difficulty in controlling them by sensing user-intention. Even the most commonly used sensing method, which detects the electrical activity of skeletal muscles, offer limited information for multi-function control. An alternative bio-sensing strategy is needed to allow for the assistive device to bear more complex functionalities. In this thesis, a different sensing approach is introduced using Pulsed-Wave Doppler ultrasound in order to non-invasively detect small tendon displacements in the hand. The returning Doppler shifted signals from the moving tendon are obtained with a new processing technique. This processing technique involves a unique way to acquire raw data access from a commercial clinical ultrasound machine and to process the signal with Fourier analysis in order to determine the tendon displacements. The feasibility of the proposed sensing method and processing technique is tested with three experiments involving a moving string, a moving biological beef tendon and a moving human hand tendon. Although the proposed signal processing technique will be useful in many clinical applications involving displacement monitoring of biological tendons, its uses are demonstrated in this thesis for ultrasound-based user intention analysis for the ultimate goal of controlling assistive exoskeletal robotic hands.

Abstract Achilles tendon rupture (ATR) conservative treatment result usually good clinical outcome, but despite the treatment method calf muscle strength deficit persist. Recent evidence suggests that surgery might surpass conservative treatment in restoring strength after ATR, but structural explanations for surgery-related improved strength remain uncertain. The purposes of this thesis were to compare calf muscle isokinetic strength recovery, calf muscle volume, fatty degeneration and AT elongation after conservative treatment or after open surgical repair of ATR. An additional aim was to assess the role of fascial augmentation in terms of calf muscle isokinetic strength recovery, AT elongation, calf muscle volume atrophy and fatty degeneration, and their relationship with calf muscle isokinetic strength in long-term follow-up after ATR surgery. Surgery resulted in 10% to 18% greater plantar flexion strength (P = 0.037) compared to conservative treatment. The mean differences between affected and healthy soleus muscle volumes were -18% after surgery and -25% after conservative treatment (P = 0.042). At 18 months, AT were, on average 19 mm longer in patients treated conservatively compared to surgery (P &#60; 0.001). At 18 months, patients with greater (2–3) fatty degeneration had lower soleus muscle volumes and plantar flexion strength in the healthy leg. In long term, augmentation did not affect any of the strength variables, but the injured side showed 12% to 18% strength deficit compared with the healthy side (P &#60; 0.001). The AT was, on average, 12 mm longer in the affected leg than in the healthy leg (P &#60; 0.001). The mean soleus muscle volume was 13% lower in the affected leg than in the healthy leg (P &#60; 0.001). The mean volumes of the medial- and lateral gastrocnemius muscles were 12% and 11% lower in the affected leg than in the healthy leg, respectively (P &#60; 0.001). AT elongation correlated substantially with plantar strength deficit (ρ = 0.51, P &#60; 0.001) and with both gastrocnemius (ρ = 0.46, P = 0.001) and soleus muscle atrophy (ρ = 0.42, P = 0.002). Calf muscle fatty degeneration was more common in the affected leg compared healthy leg (P &#8804; 0.018). In conclusion, surgery of ATR restored calf muscle isokinetic strength earlier and more completely than conservative treatment. Conservative treatment resulted in greater soleus muscle atrophy and AT elongation compared surgery, which may partly explain the surgery related better strength results. Augmentation provided no long-term benefits compared with simple suturation, and a 12 to 18% plantar flexion strength deficit compared to the healthy side persisted. AT elongation may explain the smaller calf muscle volumes, greater fatty degeneration, and plantar flexion strength deficit observed in long-term follow-up after surgical repair of ATR. / Tiivistelmä Akillesjännerepeämän (ATR) konservatiivisella ja leikkaushoidolla hoidolla saavutetaan hyvät kliiniset tulokset. Viimeisimmät tutkimukset kuitenkin viittaavat leikkaushoidolla saavutettavan paremmat voimat kuin konservatiivisella hoidolla, mutta rakenteelliset selitykset leikkaushoidon paremmalle pohjelihaksen voimille ovat epäselviä. Työn tarkoituksena oli verrata pohjelihaksen isokineettisten voimien palautumista, pohjelihastilavuuksia, rasvadegeneraatiota ja akillesjänteen (AT) pidentymistä ATR:n konservatiivisen- ja leikkaushoidon jälkeen. Tarkoituksena oli arvioida lihaskalvovahvikkeen merkitystä pohjelihaksen isokineettisten voimien palautumisessa pitkäaikaisseurannassa. Lisäksi tutkimme AT pidentymisen, pohjelihastilavuuksien ja rasvadegeneraation suhdetta pohjelihaksen isokineettisiin voimiin ATR:n leikkaushoidon jälkeen 14 v seurannassa. Leikkaushoidolla saavutettiin 10–18 % paremmat pohjelihaksen voimat verrattuna konservatiiviseen hoitoon. Leikkaushoidon jälkeen soleuslihasten tilavuuksien puoliero terveen jalan hyväksi oli 18 % ja konservatiivisen hoidon jälkeen 25 %. 18 kk kohdalla konservatiivisesti hoidettujen AT oli 19 mm pidempi verrattuna leikkauksella hoidettuihin. 18 kk kohdalla potilaat, joilla vamma jalan soleuslihaksen rasva-degeneraatio oli korkea (2–3), kärsivät suuremmasta soleuslihaksen atrofiasta ja pohjelihaksen voima puolierosta. Voimat eivät muuttuneet 12 kk ja 14 v kontrollien välillä. Lihaskalvovahvikkeella ei ollut merkitystä voimien palautumisessa pelkkään suoraan ompeluun verrattuna, mutta vammapuoli jäi 10–18 % heikommaksi verrattuna terveeseen jalkaan. Vammajalan akillesjänne oli 12 mm pidempi terveeseen jalkaan verrattuna. Vammajalan kolmipäisen pohjelihaksen tilavuus oli 11–13 % pienempi verrattuna terveeseen jalkaan. Akillesjänteen pituus korreloi pohjelihaksen voimapuolieron sekä pohjelihasatrofian kanssa. Akillesjännerepeämän leikkaushoidolla pohjelihaksen isokineettiset voimat palautuvat nopeammin ja täydellisemmin kuin konservatiivisella hoidolla. Leikkaushoitoon verrattuna konservatiivinen hoito johtaa suurempaan soleuslihaksen atrofiaan ja akillesjänteen pidentymään, mikä selittää osittain leikkaushoidon paremmat voimatulokset. 14 v seurannassa lihaskalvovahvikkeesta ei ole etua akillesjännerepeämän leikkaushoidossa. Akillesjännerepeämän leikkaushoidosta huolimatta potilaalle jää terveeseen jalkaan verrattuna 10–18 % pohjelihasten voimapuoliero. Akillesjänteen pidentyminen mahdollisesti selittää pohjelihasten atrofian, rasvadegeneraation ja pysyvän pohjelihasten voimapuolieron akillesjännerepeämän leikkaushoidon jälkeen 14 v seurannassa.

Körperliche Aktivität während der Schwangerschaft wirkt sich positiv auf die Gesundheit von Mutter und Kind aus. Trotzdem werden Schwangere häufig gewarnt, sich aufgrund der abnehmenden Muskelkraft, den nachgiebigeren Bändern und Sehnen sowie der verschlechterten Stabilität beim Sport verletzen zu können. Um Verletzungen während der Schwangerschaft vorbeugen zu können, wird in dieser Arbeit erstmalig der Einfluss von Schwangerschaft auf den Muskel-Sehnen-Komplex der unteren Extremitäten untersucht. Weiterhin werden der Effekt auf das statische Gleichgewicht und der Einsatz eines Schwangerschaftsgurtes als potentielle Präventionsmaßnahme gegen Sturzunfälle überprüft. Zur Untersuchung des Muskel-Sehnen-Komplexes wurde die Morphologie des m. vastus lateralis, die Muskelkraft der Knieextensoren und die Eigenschaften der Patellasehne am Anfang und am Ende der Schwangerschaft sowie ein halbes Jahr nach der Entbindung mittels Ultraschall und Dynamometrie analysiert. Das Gleichgewicht wurde anhand der Grenzen der Stabilität nach anterior und posterior und anhand des Körperschwankens im ruhigen Stand auf einer Kraftmessplatte bei Schwangeren in den unterschiedlichen Schwangerschaftstrimestern und bei Nicht-Schwangeren mit und ohne Schwangerschaftsgurt beurteilt. Diese Arbeit liefert relevante Erkenntnisse, die für die Beurteilung des Verletzungsrisikos von Schwangeren und für die Entwicklung geeigneter präventiver Maßnahmen nützlich sind. Es wurde zum wiederholten Male bestätigt, dass Schwangerschaft zu einer Verschlechterung der posturalen Stabilität führt. Ein Schwangerschaftsgurt stellt jedoch keine geeignete Methode zur Verbesserung der Stabilität dar. Während Muskelmorphologie und Sehnensteifigkeit keinen negativen Einfluss zeigen, könnte die zunehmende Sehnenruhelänge zu einer vergrößerten Gelenkbeweglichkeit beitragen und das Risiko für Verletzungen und Stürze erhöhen. / Physical activity during pregnancy has beneficial effects on maternal and fetal health. However, pregnant women are frequently cautioned when exercising since a loss in muscle strength, an increased compliance of ligaments and tendons as well as impairments in postural stability are assumed to lead to injuries in pregnant women. This thesis investigates for the first time the effect of pregnancy on the muscle-tendon unit of the lower extremities for the prevention of injuries during pregnancy. Furthermore, this thesis analyzes the effect of pregnancy on static postural stability and examines whether a maternity support belt is an appropriate method for fall prevention in pregnant women. To investigate the muscle-tendon unit, the morphology of the vastus lateralis muscle, muscle strength of the knee extensors and the properties of the patellar tendon were analyzed in the early and late stage of pregnancy as well as six months after delivery by means of ultrasound and dynamometry. Balance ability was assessed determining the limits of stability in the anterior and posterior directions and the postural sway during motionless upright standing on a force plate in pregnant women in different trimesters of pregnancy and in non-pregnant women with and without maternity support belt. This thesis provides relevant evidence for the assessment of the risk of injury in pregnant women and the development of appropriate prevention strategies. It confirmed that pregnancy is accompanied by impaired postural stability. However, a maternity support belt is not an appropriate method to improve stability. While muscle morphology and tendon stiffness were not negatively affected during pregnancy, the increase in tendon rest length might contribute to an increased joint mobility that may increase the fall and injury risk.