Schiffner Erik, Lakomek Felix, Hilsmann Falk, Schoeps Dominique, Prost Max, Beyersdorf Christoph, Windolf Joachim, Latz David
Department of Orthopedic and Trauma Surgery, University Hospital, Düsseldorf, Germany.
JSES Int. 2024 Nov 1;9(2):542-548. doi: 10.1016/j.jseint.2024.09.028. eCollection 2025 Mar.
Every joint participates in a specific range of motion (ROM) while operating a motor vehicle safely. In current literature, there is a paucity of how movement restrictions of the elbow flexion and extension can be compensated by adjacent joints to ensure safe driving. The aim of this study was to analyze movement patterns of the kinematic chain consisting of wrist, elbow, and shoulder while driving with restricted elbow joint.
Twenty participants completed a driving course in a driving simulator in two conditions: a) free ROM of all joints vs. b) restricted right elbow in 90° flexion but with free pronation and supination. To evaluate driving performance, speed, lane accuracy, and shifting time was measured. To analyze the movement pattern, ROM of wrist, elbow, and shoulder were recorded using a full-body motion capture system. Each driving course consisted of three maneuvers, as follows: I shifting, II left turns, and III right turns. Driving performance and movement patterns of condition a) and b) were compared on maneuver I-III.
Driving performance: Participants drove their car slower while driving right turns with elbow restriction (a) 37.45 ± 1.66 km/h vs. b) 32.53 ± 1.18 km/h; = .02). Driving performance was not affected while driving left turns or shifting gears ( > .05). Movement pattern: Participants used their right shoulder in a higher ROM while driving turns with restricted right elbow ( < .05) but the left arm showed no significant different movement pattern ( > .05). The ROM of the left elbow and both shoulders were significantly higher when shifting gears with restricted right elbow ( < .05).
This study first describes the changes in movement patterns of the upper extremity while driving with a restricted right elbow. Our data suggest that restricted right elbow flexion or extension can be compensated by the left arm and a different posture of the right shoulder when driving left turns. A different movement pattern of the left elbow and both shoulders is used when changing gears while driving straight. Drivers should be aware when driving turns while shifting gears, and special attention should be paid to the shoulders and left elbow when evaluating the driving capability of patients with movement restriction of the right elbow by physicians.
在安全驾驶机动车时，每个关节都参与特定范围的运动（ROM）。在当前文献中，关于肘关节屈伸运动受限如何通过相邻关节进行代偿以确保安全驾驶的研究较少。本研究的目的是分析在肘关节受限的情况下，由腕关节、肘关节和肩关节组成的运动链的运动模式。
20名参与者在驾驶模拟器中完成了两种情况下的驾驶课程：a）所有关节自由活动范围（ROM）与b）右肘关节屈曲90°受限，但旋前和旋后自由。为了评估驾驶性能，测量了速度、车道准确性和换挡时间。为了分析运动模式，使用全身运动捕捉系统记录腕关节、肘关节和肩关节的ROM。每个驾驶课程包括三个动作，如下：I换挡、II左转和III右转。比较了动作I-III中a）和b）两种情况下的驾驶性能和运动模式。
驾驶性能：在右肘关节受限的情况下进行右转时，参与者驾驶速度较慢（a）37.45±1.66 km/h vs. b）32.53±1.18 km/h；P = 0.02）。在左转或换挡时，驾驶性能不受影响（P>0.05）。运动模式：在右肘关节受限的情况下进行转弯时，参与者右肩的活动范围更大（P<0.05），但左臂的运动模式没有显著差异（P>0.05）。在右肘关节受限时换挡时，左肘关节和双肩的ROM显著更高（P<0.05）。
本研究首次描述了右肘关节受限时上肢运动模式的变化。我们的数据表明，在左转时，右肘关节屈伸受限可由左臂和右肩的不同姿势进行代偿。在直线行驶换挡时，左肘关节和双肩会采用不同的运动模式。驾驶员在换挡转弯时应保持警觉，医生在评估右肘关节运动受限患者的驾驶能力时，应特别关注其肩部和左肘关节。
