A GONIOMETRIC STUDY OF CHANGES OF ELBOW FLEXION IN ADULT
POPULATION OF WESTERN RAJASTHAN.
Ms Samta Gaur, Dr. D.S. Chowdhary , Dr.G.V.Shah, Dr. Bondre.
Dr S.N. Medical College, Jodhpur, Rajasthan.
Sumandeep Vidyapeeth University, S.B.K.S. Medical Institute & Research
Center, Piparia, Vadodara, Gujarat.
Abstract: The measurement of joint motion is an important component of a
comprehensive physical examination of the extremities by which one enables health
professionals to accurately assess dysfunction and rehabilitative progress.
Goniometry is an important part of a comprehensive evaluation of joints and
surrounding soft tissue. The amount of motion that is available at a joint varies
according to the age, sex and the structure of joint. Most investigators who have
studied a wide range of age groups have found that older adult groups have
somewhat less ROM of extremities than younger adult groups. The purpose of this
study is to determine the effects of age and gender on elbow flexion in 250 normal
subjects on active side of hand through universal goniometer in western Rajasthan
population.
Introduction :Goniometry is an important part of a comprehensive evaluation of
joints and surrounding soft tissue. The amount of motion that is available at a joint
is called the range of motion (ROM). The type of motion that is available at a joint
varies according to the age, sex, and the structure of joint. The measurement of joint
position and ROM of the extremities with a universal Goniometer has found to have
good- to – excellent reliability. Gajdosik and Bohannon (1987) state, “physical
therapists judge the validity of most ROM measurements based on their anatomical
knowledge and their applied skills of visual inspection, palpation of bony
landmarks, and accurate alignment of the Goniometer. The reliability of
Goniometric ROM measurements varies somewhat depending on the joint and
motion. ROM measurements of upper extremity joints have been found to be more
reliable than ROM of other joints.
Method and material: The study has been carried out on 250 healthy adult
individuals. The subjects aged between 20 to 60 years and were further grouped as
follows:- Group 1 – Age 20 to 30 years. Group 2 – Age 31 to 40 years. Group 3 –
Age 41 to 50 years. Group 4 – Age 51 to 60 years.
Procedure: Motion occurs in the sagittal plane around a medial – lateral
(transverse) axis.
Recommended Testing Position- Subject lies down in supine position, no motion at
the shoulder joint, arm is close to the side of the body. A pad is placed under the
distal end of the humerus. The forearm is positioned in full supination with the palm
of the hand facing upwards.
Stabilization: Stabilize the distal end of the humerus to prevent flexion of
the shoulder.
Normal End –Feel: Usually the end-feel is soft because of compression of the muscle
bulk of anterior forearm with that of the anterior upper arm.
Goniometer alignment:



Center the fulcrum of Goniometer over the lateral epicondyle of the humerus.
Align the proximal arm with the lateral midline of the humerus, using the
center of the acromian process.
Align the distal arm with the lateral midline of the radius, using the radial head
and radial styloid process.
Observation table:
EFFECT OF AGE ON RANGE OF
MOTION AT ELBOW FLEXION
sex
Age group I
Age group II
Age group III
Age group IV
(20-30 Yrs.)
(31-40 Yrs.)
(41-50 Yrs.)
(51-60 Yrs.)
Range Mean
male
128- 138.6
145°
female
°
126- 137.5
148°
2°
SD
4.70
4.75
Range Mean
130- 138.
146°
24°
127- 137.
147°
44°
SD
4.47
4.86
Range
Mean
SD
126146°
127- 137.8
138.4
5.14
5.56
5°
144° 8°
127-
137.1
148°
6°
6.12
Range
Mean
129- 137.1
147°
2°
SD
6.24
Discussion: Boone DC, Azen SP (1970) reported that in American males an average
ROM of elbow 140.5° ± 5.2 in age group 20-29 years where as the age group 30-39
years shows an average ROM 141.7° ±3.2 and the age group 40-50 years shows an
average ROM 139.7° ± 5.8. As compared to our observations in the same age
groups of males the values of Boone and Azen are higher.
Green and Wolf (1989) in their study conducted on Rosemont population (10males
and 10 females) shows an average ROM of elbow 145.3° ± 1.2 in age group 18 to 55
years. As compared to our observations in the same age group of males and females
the value of Green and Wolf is higher.
Wantabe H. et al (1991) in their study conducted on Japanese infants (male and
females 2 weeks- 2 years, n = 45) shows range of motion at elbow is between 148°158° in.
Goodwin J. et al (1992) studied Disabil Rehabit 23 females and found that an
average ROM of elbow 148.9° in age group 18 to 31 years. As compared to our
observation in the same age groups of females the values of Goodwin J is higher
Result and summary:
• Range of motion at elbow flexion is greater in females than males in all
age groups. ROM is higher in age group III 41-50 years ( 126-146°) and
lowest in age group II 31-40 years (130-146°) in males whereas in females
it is higher in age group I 20-30 years (126-148°) and lowest in age group
IV 51-60 years (129-147°).
• Mean value of elbow flexion was higher in males than in females. Average
ROM at elbow flexion is higher in both age group I 20-30 years (138.6° ±
4.70) and age group III 41-50 years ( 138.45° ± 5.14), and lowest in age
group IV 51-60 years (137.88° ± 5.56) in males where as in females
higher in age group II 31-40 years (137.52° ± 4.75) and lowest in age
group IV 51-60 years (137.12°±6.24).
References:
1. Boone, DC, and Azen, SP: Normal range of motion in male subjects. J
Bone Joint Surg (Am)1979; 61:756.
2. Boone, DC, et al: Reliability of goniometric measurements. Phys Ther
1978; 58:1355.
3. Boone, DC: Techniques of measurement of joint motion. J Bone Joint
Surg (Am)1979; 61:756.
4. Cynthia, C. Norkin, D. Joyce White; Measurement of Motion a Guide to
Goniometry, 1998.
5. Walker, JM, et al: Active mobility of the extremities in older subjects. Phys
Ther 1984; 64:919.
6. Wanatabe, H, et al: The range of joint motions of the extremities in healthy
Japanese people: The difference according to age. Nippon Seikeigeka
Gokkai Zasshi 1979; 53:275.
8
THE EFFECT OF ALLIUM SATIVUM ON EXPERIMENTAL INDUCED
HYPERLIPIDEMIA IN GUINEA PIGS
Prema Ram Choudhary*, Kamlesh Kumar Swami**, Jaidev Singh Shekhawat***,
Jyotsna Dashora #
 Assistant Professor, Department of Physiology
**Associate Professor, Department of Biochemistry
***Assistant Professor, Department of Anatomy
*,**,*** C.U.Shah Medical College, Surendranagr (Gujarat).
#Assistant Professor, Department of Physiology, M.M.Medical College,
Mullana, Ambala (Haryana).
Corresponding author:( PREMA RAM CHOUDHARY )
Assistant Professor
Department of Physiology
C.U.Shah Medical College,
Dudhrej road, Surendranagar ,Gularat, (India.)
Ph.no.9558258818
Email: prema5252@gmail.com
ABSTRACT
Background: Garlic is naturally occurring sulphur containing dietary agent belongs
to liliaceace family. Members of this family like garlic and onions are found to have
beneficial effect on atherosclerosis and ischemic heart diseases in both experimental
animals and in human beings. Objective: To find out the effect of allium sativum on
experimental induced hyperlipidemia in guinea pigs
Methods: 25 guinea pigs were fed cholesterol (0.5g/kg body weight/day) for an initial
period of 4 weeks. Cholesterol was then discontinued and the animals were divided
into 3 groups. Group-I (control group) (n=7) was now fed with normal diet. GroupII (n=9) was given 1ml of aqueous extract and Group-III (n=9) was fed with 1ml of
alcoholic extract of garlic with normal diet daily for 4 weeks. The garlic content of
both extracts were 2 gm/ml by wt/vol. Fasting blood samples were collected at the
end of 4 weeks and finally at the end of the study i.e.8 weeks for estimation of total
serum cholesterol, serum triglyceride and High Density Liporotein (HDLc) and
LDLc, VLDLc; atherogenic index were calculated in all 3 groups.
Results: In the present study, the aqueous and alcoholic extracts of garlic showed a
significant hypolipidemic activity as they reduced significantly serum cholesterol,
serum triglyceride, LDLc,VLDLc and atheriogenic index in hyperlipidemic guinea
pigs (p<0.001) as compared to control group. The significant rise in HDLc was
observed in group II but not in group I & III animals. On comparison between two
extracts, aqueous extract of garlic was found to be more potent hypolipidemic agent
than to the alcoholic extract.
Conclusion: It is concluded that both extracts have hypolipidemic activity but
aqueous extract of Allium Sativum is more potent than alcoholic extract.
Key Words-Allium Sativum, Hyperlipidemia,
INTRODUCTION
Allium Sativum L. (Garlic, ‘Lahsun’) is widely distributed in all parts of the world
and used not only as spice but also as a popular remedy for prevention and
treatment of a variety of diseases like rheumatism, dermatitis, abdominal disorders
and diabetes mellitus. Effect of garlic in cardiovascular diseases was more
encouraging in experimental studies, which prompted several clinical trials. Dietary
factors play a key role in the development of various human diseases, including
cardiovascular disease. Garlic has attracted particular attention of modern
medicine because of its widespread health use around the world, and the cherished
belief that it helps in maintaining good health warding off illnesses and providing
more vigor. To date, many favorable experimental and clinical effects of garlic
preparations, including garlic extract, have been reported. These biological
responses have been largely attributed to reduction of risk factors for
cardiovascular diseases, cancer and stimulation of immune functions, enhanced
detoxification of foreign compound, hepatoprotective, antimicrobial effect and
antioxidant effect.1 Garlic is reported to prevent cardiovascular disease by multiple
effects, one of which is the decrease total cholesterol and triglycerides2, LDLc,
VLDLc, while increase HDLc3 and suppression of the cholesterol
biosynthesis4.Studies prior to 1995 consistently concluded hypolipidemic action of
garlic5,6, however studies after 1995 performed using enteric–coated preparation of
raw garlic did not manifest and hypolipidemic effect.7, 8, 9 . These paradoxical
observation warrant a systemic study to resolve the controversy, therefore the
present study was under taken to examine the effect and relative potency of allium
sativum preparations (aqueous and alcoholic extracts) on induced hyperlipidemia in
guinea pigs.
MATERIAL AND METHODS
Twenty Five, healthy guinea pigs of sex, 2-4 month old; obtained from the
animal house of the Dr. S N. medical college Jodhpur (Rajasthan), India and
weighing about 460-582 g were selected for present study. The study was
conducted in the department of physiology. The animals were housed in
standard environmental conditions. Animal were fed standard pelleted feed
(manufactured by Lipton Ltd. India) containing 17% protein, 11% fat, 47%
carbohydrate, 2.5% minerals, 4.5% fiber, 11.5% water, green vegetables and
given filtered water in bowl ad libitum. All the animals were taken care of and
maintained as per guidelines of the CPCSEA with due approval from the
Institutional Animal Ethical Committee. All 25 guinea pigs were fed cholesterol
(0.5g/kg body weight/day) (Sigma, USA) orally, in 5ml of milk, for an initial period
of 4 weeks and experimental hyperlipidemia was induced. Cholesterol was then
discontinued After inducing hyperlipidemia and animals were randomly allocated
into three groups. Group-I (n=7), Group-II (n=9), Group-III (n=9). Group-I (control)
was kept on normal standard diet and fed with 1 ml of normal saline for four
weeks. Group-II and Group-III were also fed with standard normal diet
supplemented with 1ml of emulsified aqueous and alcoholic extract of garlic
respectively for 4 weeks. The garlic content in both extracts was 2gm garlic/ml
each. The garlic extract was prepared by crushing about 200 gm garlic in grinder
and was kept in distilled water (for aqueous extract) and in ethyl alcohol (for
alcoholic extract) in beaker at room temperature, packed in muslin cloth bags
and transferred into soxhlet extractor for completion of six cycles. Then the
solution was filtered and evaporated, to obtained 100ml of extract. At the end of
study, after supplementation of garlic extracts for 4 weeks, fasting blood samples
of all groups were collected carefully from the right ventricle of heart after
anesthetizing the animal with pentobarbitone (35mg/kg/I.P). These blood
samples were kept at room temperature for separation of serum, used for
estimation of serum total cholesterol, triglyceride, LDLc, HDLc, VLDLc and
atherogenic index 10-11. All parameters were estimated by using semi
autoanalyzer (Transasia, ERBA Chem-5 Plus, Transasia Bio-Medicals Ltd.) and
diagnostic kits by the same manufacturer. The parameters and the respective
methods applied are the following: Total serum cholesterol – CHOD/POD
method; Triglycerides-GPO method; High density Lipoproteins Cholesterol
(HDLc) –modified PGEME method. The results were analyzed statistically by
student t-test.
RESULT
In hyperlipidemic guinea pigs level cholesterol level was 114±20). A significant
decrease was observed in total serum cholesterol levels in all three groups (I,II,and
III) as compared to hyperlipidemic guinea pigs (p˂0.001), after lapse of four weeks.
Similar results were also obtained in the levels of triacylglycerol (p˂0.001), and
various lipoproteins LDLc (p˂0.001) and VLDLc (p˂0.001) when group I,II & III
were compared with hyperlipidemic guinea pigs.
In hyperlipidemic guinea pigs HDLc level was slightly higher than base line HDLc,
where as a non significant difference (p˃0.05) was observed on comparison between
group I & III v/s hyperlipidemic guinea pigs. Surprisingly a significant increase was
observed when group II was compared with hyperlipidemic guinea pigs in HDLc
levels (p˂0.001).
Atherogenic index was also calculated to find out the decreased risk of
atherosclerosis by diet with supplementation of garlic preparations from
LDLc/HDLc ratio and TC/HDLc ratio (p˂0.001). Results indicate that LDLc/HDLc
ratios were significantly decreases in all three groups as compared to
hyperlipidemic guinea pigs. Similar trend was also observed in TC/HDLc ratio
(p˂0.001).
On comparison with group-I both aqueous and alcoholic extract of garlic produces
significant reduction in the serum cholesterol, triacylglycerol and LDLc and VLDLc
(p<0.001). On comparison between aqueous and alcoholic extracts of garlic, aqueous
extract was found more potent as compared to alcoholic extract as it showed very
significant fall in serum cholesterol, triglycerides, LDLc and VLDLc (p<0.001) levels
compared to group I and group III and decreases atherogenic index significantly by
lowering LDLc and VLDLc and rising HDLc.
DISCUSSION
There are many herbs which are used as hypolipidemic agents. Garlic is one these
herbs that has protective and curative effect against the increase in serum
cholesterol and triacyl glycerol (induced by dietary fat), by decreasing them and
increasing the HDLc, fibrinolytic activity and clotting time in patient with
myocardial infarction and coronary artery disease12,13. Garlic has been reported to
minimize the adverse effect of hyperlipidemia14. Bordia and verma have shown
reversibility of cholesterol induced experimental atherosclerosis in rabbits by
garlic15.Garlic contains sulphur containing compound allin, which is converted to an
active ingredient “allicin” when garlic bulb is crushed. This compound has
inhibitory effect upon the key enzymes involved in cholesterol biosynthesis, such as
HMG CoA reductase.16 Hypocholesterolemic effect of garlic is exerted by decreasing
hepatic cholestrol biosynthesis, whereas the triglyceride lowering effect appears to
be due to the inhibition of fatty acid synthesis by mallic enzymes, fatty acid synthase
and glucose-6- phosphate dehydrogenase17. Among water soluble compounds sallylcysteine, s-ethylcysteine and s-propylcysteine reduces cholesterol synthesis by
40-60%. Lipid soluble sulphur compounds like diallylsulphide, diallyldisulphide
diallyltrisulphide, dipropylsulphide and di-propyl disulphide inhibits cholesterol
synthesis by 10-15%.17
Our results also indicates that garlic has hypolipidemic activity and decreases the
atherogenic index and protect from the cardio vascular disordes. Results of this
study are comparable to the findings of. Banerjee SK and Maulik SK , Lam F,
Bordia A, Bansal HC, Jain RC et.al.
CONCLUSION
It is concluded that both extracts aqueous as well as alcoholic have hypolipidemic
activity but aqueous extract of Allium Sativum is more potent than alcoholic extract
so it rapidly decreases the bad cholesterol in blood and increases the good
cholesterol and decreases the risk of atherosclerosis. In view of this study it can be
recommended that garlic or aqueous extract of garlic should be encouraged to
reduce hyperlipidemea as it is the cheapest way to prevent the coronary heart
disease.
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