Our objective is to review the prevalence and natural history of hyperkyphosis, associated health implications, measurement tools, and treatments to prevent this debilitating condition.t LeVeL oF eVidenCe: Diagnosis/prognosis/ therapy, level 5.

IntroductionBreast-cancer-related lymphedema affects ∼25% of breast cancer (BC) survivors and may impact use of the upper limb during activity. The purpose of this study is to compare upper extremity (UE) impairment and activity between women with and without lymphedema after BC treatment.Methods144 women post BC treatment completed demographic, symptom, and Disability of Arm-Shoulder-Hand (DASH) questionnaires. Objective measures included Purdue pegboard, finger-tapper, Semmes-Weinstein monofilaments, vibration perception threshold, strength, range of motion (ROM), and volume.ResultsWomen with lymphedema had more lymph nodes removed (p < .001), more UE symptoms (p < .001), higher BMI (p = .041), and higher DASH scores (greater limitation) (p < .001). For all participants there was less strength (elbow flexion, wrist flexion, grip), less shoulder ROM, and decreased sensation at the medial upper arm (p < .05) in the affected UE. These differences were greater in women with lymphedema, particularly in shoulder abduction ROM (p < .05). Women with lymphedema had bilaterally less elbow flexion strength and shoulder ROM (p < .05). Past diagnosis of lymphedema, grip strength, shoulder abduction ROM, and number of comorbidities contributed to the variance in DASH scores (R2 of 0.463, p < .001).Implications for cancer survivorsUE impairments are found in women following treatment for BC. Women with lymphedema have greater UE impairment and limitation in activities than women without. Many of these impairments are amenable to prevention measures or treatment, so early detection by health care providers is essential.

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respond to the mechanical stresses imposed upon them during movement. 27 Neurodynamic tests are used to assess the nervous system's mechanosensitivity through monitoring the response to movements that are known to alter the mechanical stresses acting on the nervous system. The most common lower quarter neurodynamic test is the passive straight-leg raise (SLR) test. 13,31 The basic SLR test consists of the tester performing passive hip flexion, with the patient in a supine position and the knee held in full extension. 9A recent systematic review of SLR testing indicated a lack of standardization, including the use of various criteria for determining the test end point. 31 The authors of this review reintroduced standardized methodology proposed by Breig and Troup 8 in 1979, including the use of the first onset of pain as the end point during the SLR test.31 Despite these recommendations, alternative end points, such as maximally tolerated symptom, are still utilized.17 Because SLR testing is performed in both symptomatic and C linical neurological examinations are an integral part of clinical decision making for determining neural involvement in individuals with altered physical function and activity participation. One aspect of a standard neurological examination involves assessing the sensitivity of peripheral nerves to limb movement, termed mechanosensitivity. Mechanosensitivity is thought to be a normal protective mechanism that allows the nerves to t STudy deSiGn: Cross-sectional, observational study.t objecTiveS: To explore how ankle position affects lower extremity neurodynamic testing. t backGround: Upper extremity limb movements that increase neural loading create a protective muscle action of the upper trapezius, resulting in shoulder girdle elevation during neurodynamic testing. A similar mechanism has been suggested in the lower extremities.t meThodS: Twenty healthy subjects without low back pain participated in this study. Hip flexion angle and surface electromyographic measures were taken and compared at the onset of symptoms (P1) and at the point of maximally tolerated symptoms (P2) during straight-leg raise tests performed with ankle dorsiflexion (DF-SLR) and plantar flexion (PF-SLR).t reSuLTS: Hip flexion was reduced during DF-SLR by a mean  SD of 5.5°  6.6° at P1 (P = .001) and 10.1°  9.7° at P2 (P.001), compared to PF-SLR. DF-SLR induced distal muscle activation and broader proximal muscle contractions at P1 compared to PF-SLR. t concLuSion: These findings support the hypothesis that addition of ankle dorsiflexion during straight-leg raise testing induces earlier distal muscle activation and reduces hip flexion motion. The straight-leg test, performed to the onset of symptoms (P1) and with sensitizing maneuvers, allows for identification of meaningful differences in test outcomes and is an appropriate end point for lower extremity neurodynamic testing.

Background The peripheral nervous system has an inherent capability to tolerate the gliding (excursion), stretching (increased strain), and compression associated with limb motions necessary for functional activities. The biomechanical properties during joint movements are well studied but the influence of other factors such as limb pre-positioning, age and the effects of diabetes mellitus are not well established for the lower extremity. The purposes of this pilot study were to compare the impact of two different hip positions on lower extremity nerve biomechanics during an active ankle dorsiflexion motion in healthy individuals and to determine whether nerve biomechanics are altered in older individuals with diabetes mellitus. Methods Ultrasound imaging was used to quantify longitudinal motion of the tibial nerve and transverse plane motion of the tibial and common fibular nerves in the popliteal fossa during active ankle movements. Findings In healthy individuals, ankle dorsiflexion created mean tibial nerve movement of 2.18 millimeters distally, 1.36 millimeters medially and 3.98 millimeters superficially. When the hip was in a flexed position there was a mean three-fold reduction in distal movement. In people with diabetes mellitus there was significantly less distal movement of the tibial nerve in the neutral hip position and less superficial movement of the nerve in both hip positions compared to healthy individuals. Interpretation We have documented reductions in tibial nerve excursion due to limb pre-positioning thought to pre-load the nervous system using a non-invasive methodology. Thus, lower limb pre-positioning impacts nerve biomechanics during ankle motions common in functional activities. Additionally, our findings indicate that nerve biomechanics have the potential to be altered in older individuals with diabetes mellitus compared to younger healthy individuals.