The effects of cryotherapy on quadriceps electromyographic activity and isometric strength in patient in the early phases following knee surgery.

PURPOSE: To determine the effects of cryotherapy on quadriceps electromyographic (EMG) activity and isometric strength in early postoperative knee surgery patients. METHODS: Twenty-two volunteers with recent knee surgeries were included. EMG readings of the vastus medialis (VM), rectus femoris (RF), and vastus lateralis (VL) from the surgical leg were collected during a maximal voluntary quadriceps setting (QS) activity. Maximum isometric knee extension force measurements were also recorded. Subjects were randomly assigned to receive an ice bag or a sham room-temperature bag to the front of their postsurgical knee for 20 min. After treatment, the subjects repeated the above mentioned maximum QS and isometric knee extension force measurements. The subjects returned 24 h later to conduct the same test protocol but received the treatment (ice or sham) not applied during their first test session. RESULTS: A 38% increase in VM EMG activity during QS and a 30% increase in maximum isometric knee extension strength were found after cryotherapy treatment. No significant differences were found in RF or VL EMG activity during QS after cryotherapy. No significant differences were found in any measurements after the sham treatment. CONCLUSION: Clinicians should consider applying ice to knee joints prior to exercise for patients following knee surgery with inhibited quadriceps.

Construct validity of Comprehensive High-Level Activity Mobility Predictor (CHAMP) for male servicemembers with traumatic lower-limb loss.

This study examined the convergent construct validity of a new performance-based assessment instrument called the Comprehensive High-Level Activity Mobility Predictor (CHAMP) as a measure of high-level mobility in servicemembers (SMs) with traumatic lower-limb loss (LLL). The study was completed by 118 SMs. Convergent construct validity of the CHAMP was established using the 6-minute walk test (6MWT) as a measure of overall mobility and physical function and the Amputee Mobility Predictor (AMP) as a measure of basic prosthetic mobility. The known group methods construct validity examined disparities in high-level mobility capability among SMs with different levels of LLL. The CHAMP score demonstrated a strong positive relationship between 6MWT distance (r = 0.80, p < 0.001) and AMP score (r = 0.87, p < 0.001), respectively. In addition, the CHAMP can discriminate between different levels of LLL. Study findings support the CHAMP as a valid performance-based assessment instrument of high-level mobility for SMs with traumatic LLL.

Comparison of 6-minute walk test performance between male Active Duty soldiers and servicemembers with and without traumatic lower-limb loss.

The rehabilitation of U.S. military servicemembers (SMs) who have sustained a traumatic loss of one or both lower limbs requires outcome measures that can assess their physical capabilities in comparison with their uninjured colleagues. Describing reference ranges for the 6-minute walk test (6MWT) in both populations will help clinicians develop appropriate goals for rehabilitation and document progress toward those goals. A convenience sample of 118 male U.S. SMs with and 97 without traumatic lower-limb loss participated in this study. All participants completed a 6MWT, and comparisons were made between SMs with and without limb loss and among the levels of limb loss. The SMs without lower-limb loss performed significantly better than all SMs with lower-limb loss. The SMs with transtibial limb loss performed significantly better than those with all other levels of limb loss. Statistically significant and clinically relevant differences were also noted between the other levels of limb loss. No differences were found between different prosthetic components. Reference ranges were established for U.S. SMs with and without various levels of limb loss, and the 6MWT was able to identify functional differences between groups.

Association of generalized joint hypermobility with a history of glenohumeral joint instability.

CONTEXT: Little is known about the relationship among sex, generalized joint hypermobility, and glenohumeral joint instability. OBJECTIVE: To examine the relationship among sex, generalized joint hypermobility scores, and a history of glenohumeral joint instability within a young, physically active cohort and to describe the incidence of generalized joint hypermobility within this population. DESIGN: Cross-sectional cohort study. SETTING: United States Military Academy at West Point, New York. PATIENTS OR OTHER PARTICIPANTS: Of the 1311 members of the entering freshman class of 2010, 1050 (80%) agreed to participate. MAIN OUTCOME MEASURE(S): Generalized joint hypermobility was assessed using the Beighton Scale. A history of glenohumeral joint instability was identified via a baseline questionnaire. RESULTS: Most participants (78%) had no signs of generalized joint hypermobility. Only 11 volunteers (1.5%) had Beighton Scale scores of 4 or greater. Logistic regression analysis revealed a relationship between generalized joint hypermobility and a history of glenohumeral joint instability (P = .023). When sex and race were controlled, those with a total Beighton Scale score of >or=2 were nearly 2.5 times as likely (odds ratio = 2.48, 95% confidence interval = 1.19, 5.20, P = .016) to have reported a history of glenohumeral joint instability. A relationship was observed between sex and nearly all individual Beighton Scale items. Although women had higher total Beighton Scale scores than men, sex (P = .658) and race (P = .410) were not related to a history of glenohumeral joint instability when other variables in the model were controlled. CONCLUSIONS: In these participants, generalized joint hypermobility and a history of glenohumeral joint instability were associated.

Patellar tendon versus hamstring tendon autografts for anterior cruciate ligament reconstruction: a randomized controlled trial using similar femoral and tibial fixation methods.

BACKGROUND: Controversy remains over the most appropriate graft for anterior cruciate ligament reconstruction. HYPOTHESIS: There is no significant difference in outcomes after 4-strand hamstring and patellar tendon autograft anterior cruciate ligament reconstructions using similar fixation techniques. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: Between August 2000 and May 2003, 64 Keller Army Hospital patients with complete anterior cruciate ligament tears were randomized to hamstring (n = 32) or patellar tendon (n = 32) autograft anterior cruciate ligament reconstruction. Operative graft fixation and rehabilitative techniques were the same for both groups. Follow-up assessments included the Single Assessment Numeric Evaluation score, Lysholm score, International Knee Documentation Committee score, and Knee Injury and Osteoarthritis Outcome Score. Postoperative radiographs were analyzed for tunnel location and orientation. RESULTS: Eleven women and 53 men were randomized. Eighty-three percent of the patients (53 of 64) had follow-up of greater than 2 years, or to the point of graft rupture or removal (average follow-up, 36 months). Four hamstring grafts (12.5%) and three patellar tendon grafts (9.4%) (P = .71) ruptured. One deep infection in a hamstring graft patient necessitated graft removal. Forty-five of the 56 patients with intact grafts had greater than 2-year follow-up. Patients with patellar tendon grafts had greater Tegner activity scores (P = .04). Single Assessment Numeric Evaluation scores were 88.5 (95% confidence interval: 83.1, 93.8) and 90.1 (95% confidence interval: 85.2, 96.1) for the hamstring and patellar tendon groups, respectively (P = .53). Lysholm scores were 90.3 (95% confidence interval: 84.4, 96.1) and 90.4 (95% confidence interval: 84.5, 96.3) for the hamstring and patellar tendon groups, respectively (P = .97). There were no significant differences in knee laxity, kneeling pain, isokinetic peak torque, International Knee Documentation Committee score, or Knee Injury and Osteoarthritis Outcome Scores. Postoperative graft rupture correlated with more horizontal tibial tunnel orientation. CONCLUSION: Hamstring and patellar tendon autografts provide similar objective, subjective, and functional outcomes when assessed at least 2 years after anterior cruciate ligament reconstruction.

The clinical efficacy of kinesio tape for shoulder pain: a randomized, double-blinded, clinical trial.

STUDY DESIGN: Prospective, randomized, double-blinded, clinical trial using a repeated-measures design. OBJECTIVES: To determine the short-term clinical efficacy of Kinesio Tape (KT) when applied to college students with shoulder pain, as compared to a sham tape application. BACKGROUND: Tape is commonly used as an adjunct for treatment and prevention of musculoskeletal injuries. A majority of tape applications that are reported in the literature involve nonstretch tape. The KT method has gained significant popularity in recent years, but there is a paucity of evidence on its use. METHODS AND MEASURES: Forty-two subjects clinically diagnosed with rotator cuff tendonitis/impingement were randomly assigned to 1 of 2 groups: therapeutic KT group or sham KT group. Subjects wore the tape for 2 consecutive 3-day intervals. Self-reported pain and disability and pain-free active ranges of motion (ROM) were measured at multiple intervals to assess for differences between groups. RESULTS: The therapeutic KT group showed immediate improvement in pain-free shoulder abduction (mean +/- SD increase, 16.9 degrees +/- 23.2 degrees ; P = .005) after tape application. No other differences between groups regarding ROM, pain, or disability scores at any time interval were found. CONCLUSION: KT may be of some assistance to clinicians in improving pain-free active ROM immediately after tape application for patients with shoulder pain. Utilization of KT for decreasing pain intensity or disability for young patients with suspected shoulder tendonitis/impingement is not supported. LEVEL OF EVIDENCE: Therapy, level 1b-.

Comparison of a lateral hop test versus a forward hop test for functional evaluation of lateral ankle sprains.

The purposes of this study were to determine whether a lateral hop test was a more sensitive functional test over time than a forward hop test in assessing lateral ankle sprains, and whether lateral hop performance can predict a subjective score from an ankle rating scale. At the United States Military Academy, cadets presenting with ankle sprains during an 8-month period were included in this observational study. Patients were asked to perform a lateral hop for distance and a forward hop for distance on both the injured and uninjured lower extremities. The order of testing was randomized. After the hop trials, individuals completed a subjective questionnaire designed to assess functional ankle health. The lateral hop and subjective scores are components of the Sports Ankle Rating System. Patients were evaluated at the day of consent and at 1 week, 3 weeks, and 6 weeks. There were 29 patients, ages 18 to 22 years; 8 were women and 21 were men. A multivariable regression of analysis was performed to determine which subjective factors best predict the individual's subjective score. Although both the lateral and forward hop were statistically significant factors, neither was determined to be better than the other.

Deep vein thrombosis in an athletic military cadet.

STUDY DESIGN: Resident's case problem. BACKGROUND: A 21-year-old healthy athletic male military cadet with complaint of worsening diffuse left knee pain was evaluated 4 days after onset. The knee pain began 2 hours after completing a long car trip, worsened over the subsequent 3 days, and became almost unbearable during the return trip. The patient reported constant pain, limited knee motion, and difficulty ambulating. In addition, he was unable to perform physical military training or attend academic classes due to the severe left knee pain. Past medical history revealed a mild left lateral calf strain 21/2 weeks prior, which completely resolved within 24 hours of onset. DIAGNOSIS: Our physical examination led us to either monoarticular arthritis, pseudothrombophlebitis (ruptured Baker's cyst), or a lower leg deep vein thrombosis (DVT) as the cause of knee pain. Diagnostic imaging of this patient revealed a left superficial femoral vein thrombosis and popliteal DVT, with bilateral pulmonary emboli (PE). DISCUSSION: A systematic differential diagnosis was undertaken to rule out a potentially fatal DVT diagnosis as the cause of knee pain, despite minimal DVT risk factors. The physical therapist in a direct-access setting must ensure timely evaluation and referral of a suspected DVT, even when patient demographics cause the practitioner to question the likelihood of this diagnosis. The physical examination findings, clinical suspicion, and established clinical prediction rules can accurately dictate the appropriate referral action necessary.