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The Effect of Limited Elbow Range of Motion on Gait Mechanics
Samir K. Trehan, MD; Aviva L. Wolff, OT, CHT; Mandi Gibbons, MS; Mauro Miranda, MA; Howard J. Hillstrom, PhD; Aaron Daluiski, MD
Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, NY

Introduction: Limited elbow range of motion can be functionally debilitating. Extensive research has been published on treatments to restore elbow motion, but few have discussed the clinical implications of limited elbow motion beyond the affected extremity.

Reciprocal arm swing in normal gait has been shown to increase stability/balance and reduce energy expenditure. The importance of arm swing in gait has been correlated clinically in patients with cerebral palsy, stroke and Parksinson's disease. However, no studies have reported the gait implications of an isolated upper extremity orthopedic injury or pathology.

Hypothesis: We hypothesized that limited elbow motion would result in an abnormal gait. We also hypothesized increased asymmetry of temporal distance footfall parameters in stiff elbow conditions compared to controls.
Methods: Forty healthy adult volunteers were recruited. Demographic data obtained included age, gender, height, weight and handedness. Each subject walked 2 times (five times per condition) on the Gaitmat II (EQ Inc, Chalfont, PA) which provided real-time analysis of temporal and distance gait parameters. Conditions tested were no brace (control), elbow brace unlocked (control), elbow brace locked in 30 flexion, locked in 90 flexion and locked in 120 flexion. The hinged elbow brace was applied to the dominant upper extremity by an occupational therapist to simulate the stiff elbow positions. Condition order was randomized for each subject. After assessing normality (Shapiro) and group variance homogeneity (Levene's test), repeated measures analysis of variance (ANCOVA) was performed across the control and stiff elbow conditions (30, 90 and 120) for single variables and generalized estimating equation (GEE) for bilateral variables. Significance was set at p < 0.05.
Results: All three stiff elbow conditions demonstrated significantly decreased gait velocity, decreased stride length and increased single leg stance and double support times compared to control conditions (see Table). There was no statistically significant difference in cadence and no evidence of increased limb asymmetry (data not shown) between stiff elbow and control conditions.

Discussion: Despite the well-established functional limitations of elbow contracture patients and role of arm swing in normal gait, no research has been published on the impact of limited elbow range of motion on gait mechanics.

We have identified a direct impact of simulated elbow contracture in healthy subjects on gait mechanics. Specifically, data indicate significant differences in gait velocity, stride length, single leg stance and double support times. Future research will focus on joint kinematics, gait efficiency and energy expenditure in elbow contracture patients.

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