Skull fractures by glass bottles tested on cadaveric heads.

Head trauma is frequently related to the misuse of drinking vessels as weapons. Forensic reports usually evaluate these blunt injuries as having occurred in scenarios where the alcohol intake is high. Fatal consequences are seen in blows with glass bottles aiming at the head. To prove the outcome that a glass bottle thrown to the head could cause, three intact human cadaver heads were impacted with 1-liter glass bottles at 9.5 m/s using a drop-tower. The impact location covered the left temporal bone, sphenoid bone, and zygomatic arch. The contact between the head and the bottle was produced at an angle of 90° with (1) the valve of the bottle, (2) the bottom of the bottle, and (3) with the head rotated 20° in the frontal plane touching again with the bottom of the bottle. The three bottles remained intact after the impact, and the injury outcomes were determined by computed tomography (CT). The alterations were highly dependent on the impact orientation. The outcome varied from no injury to severe bone fractures. In the most injurious case (#3), fractures were identified in the cranial base, sphenoid bone, and zygomatic bone. These testing conditions were selected to replicate one specific legal case, as required by the plaintiff. Physical disputes with bar glassware can lead to complex combinations of blunt and sharp-force injuries. Controlled biomechanical studies can benefit forensic analyses of violence involving glassware by providing a better understanding of the underlying injury mechanisms.

Relationship Between Knee Frontal Plane Projection Angle and Lower Limb Muscle Activity in Female Athletes.

CONTEXT: Anterior cruciate ligament injuries are directly related to the control of dynamic knee valgus in the landing of a jump, and this is mainly due to the correct activation and neuromuscular function of the lower-extremity muscles. The aim of the study is to assess the relationship between lower limb muscle activity during a single-legged drop jump and knee frontal plane projection angle (FPPA). DESIGN: A correlation study. METHODS: Thirty healthy collegiate female athletes were included in the study. Main outcomes measures were peak knee FPPA and muscle activity (% of maximal voluntary isometric contraction). Peak knee FPPA during a single-legged drop jump test was identified using a 2-dimensional motion analysis system. Muscle activity was assessed using a surface electromyograph for gluteus maximus, gluteus medius, biceps femoris, semitendinosus, vastus medialis quadriceps, vastus lateralis quadriceps, medial gastrocnemius, and lateral gastrocnemius. All variables were assessed for both dominant and nondominant limbs. A correlation analysis between peak knee FPPA and muscle activity was performed. Statistical significance was set at P <.05. RESULTS: A mean peak knee FPPA of 14.52° and 13.38° was identified for dominant and nondominant limb single-legged drop jump test, respectively. Muscle activity (% of maximal voluntary isometric contraction) for muscles assessed ranged from 43.97% to 195.71% during the single-legged drop jump test. The correlation analysis found no significant correlation between any of the muscles assessed and peak knee FPPA during the single-legged drop jump test (Pearson coefficient between -.3 and .1). CONCLUSIONS: There is no association between muscle activity from the lower limb muscles and the knee FPPA during a single-legged drop jump in female athletes. Thus, different muscle properties should be assessed in order to understand such an important movement as the knee FPPA during a jump.

Changes Over Time in the Strain on the Inferior Iliofemoral Ligament During a Sustained 5-Minute High-Force Long-Axis Distraction Mobilization: A Cadaveric Study.

OBJECTIVE: To analyze the changes over time in the strain on the inferior iliofemoral (IIF) ligament when a constant high-force long-axis distraction mobilization (LADM) was applied over 5 minutes. DESIGN: A cross-sectional laboratory cadaveric study. SETTING: Anatomy laboratory. PARTICIPANTS: Thirteen hip joints from 9 fresh-frozen cadavers (mean age, 75.6±7.8 years; N=13). INTERVENTIONS: High-force LADM in open-packed position was sustained for a period of 5 minutes. MAIN OUTCOME MEASURE(S): Strain on IFF ligament was measured over time with a microminiature differential variable reluctance transducer. Strain measurements were taken at every 15 seconds for the first 3 minutes and every 30 seconds for the next 2 minutes. RESULTS: Major changes in strain occurred in the first minute of high-force LADM application. The greatest increase in strain on the IFF ligament occurred at the first 15 seconds (7.3±7.2%). At 30 seconds, the increase in strain was 10.1±9.6%, the half of the total increase at the end of the 5-minute high-force LADM (20.2±8.5%). Significant changes in strain measures were shown to occur at 45 seconds of high-force LADM (F=18.11; P<.001). CONCLUSIONS: When a 5-minute high-force LADM was applied, the major changes in the strain on IIF ligament occurred in the first minute of the mobilization. A high-force LADM mobilization should be sustained at least 45 seconds to produce a significant change in the strain of capsular-ligament tissue.

The HAR-index: a reliable method for evaluating the risk of total hip arthroplasty conversion after hip arthroscopy for femoroacetabular impingement.

PURPOSE: Hip arthroscopy is a growing technique in the treatment of femoroacetabular impingement (FAI), but can sometimes lead to unsatisfactory results such as the early conversion to total hip arthroplasty (THA). The purpose of this study is to describe a new tool for assessing the preoperative risk of THA conversion after hip arthroscopy in patients with FAI. METHODS: This study is a retrospective analysis of a prospective cohort of 584 patients with FAI who underwent hip arthroscopy at a single centre with a minimum 2 years follow-up. The preoperative variables of these patients were analysed to calculate the risk of each variable for THA. By selecting variables with an area under the receiver operating characteristic (ROC) curve greater than 0.7, a calculator was created to provide a risk index for each patient. RESULTS: Four variables (age, body mass index, Tönnis score and ALAD) were associated with an increased risk of THA conversion. The optimal cut-off points for each variable were determined, and a risk index was created. The Hip-Arthroplasty-Risk Index (HAR-Index) is a 0-4 points scale obtained from four binary scores of 0 or 1 depending on whether the cut-off point for each variable was reached or not. The increased risk of THA for each HAR-Index value was 1.1%, 6.2%, 17.9%, 55.1% and 79.3% respectively. The HAR-Index showed a very good predictive capacity with an area under the ROC curve of 0.89. CONCLUSION: The HAR-Index is a simple and practical tool for practitioners to make more informed decisions about performing hip arthroscopy in patients with FAI. With a very good predictive capacity, the HAR-Index can help to reduce the rate of conversion to THA. LEVEL OF EVIDENCE: Level III.

Safety of Dry Needling of the Pronator Teres Muscle in Cadavers: A Potential Treatment for Pronator Syndrome.

BACKGROUND: Entrapment of the median nerve at the pronator teres muscle can contribute to symptoms in the forearm and wrist. The pronator teres is also involved in patterns of spasticity observed in people who had suffered a stroke. Research on treatment efficacy with dry needling is scarce. OBJECTIVE: To determine if a solid filiform needle safely penetrates the pronator teres muscle during the clinical application of dry needling. DESIGN: A cadaveric descriptive study. METHODS: Needle insertion of the pronator teres was conducted in ten cryopreserved forearms with a 30 ×0.32 mm filiform needle. With the forearm supinated, the needle was inserted 3 cm distal to the mid-point between the biceps tendon insertion and the medial epicondyle. The needle was advanced in a cranial and medial direction to a depth clinically judged to be in the pronator teres muscle. Safety was assessed by measuring the distance from the needle to the surrounding neurovascular bundles. RESULTS: Accurate needle penetration of the pronator teres was observed in 100% of the specimens (mean needle penetration: 16.7 ± 4.3 mm, 95% confidence interval [CI] 13.6 to 19.7 mm). No neurovascular bundles were pierced in any of the specimen's forearms. The distances from the tip of the needle to the surrounding neurovascular bundles were 16.4 ± 3.9 mm (95% CI 13.6 to 19.2 mm) to the ulnar nerve (A), 9.0 ± 2.2 mm (95% CI 7.3 to 19.5 mm) to the median nerve (B), and 12.8 ± 4.0 mm (95% CI 10.0 to 15.7 mm) to brachial artery (C). CONCLUSIONS: The results from this cadaveric study support the assumption that needling of the pronator teres using described anatomical landmarks can be accurately and safely conducted by an experienced clinician.

Effectiveness of Blood Flow Restriction Training on Muscle Strength and Physical Performance in Older Adults: A Systematic Review and Meta-analysis.

OBJECTIVE: To analyze the effectiveness of the blood flow restriction training in improving muscle strength and physical performance in older adults. DATA SOURCES: A systematic review and meta-analysis of randomized controlled trials was conducted. The Cochrane Library, PubMed, Web of Sciences, PEDro, Scopus, and ScienceDirect databases were systematically searched. STUDY SELECTION: Articles were included if participants were 60 years or older and were considered healthy. DATA EXTRACTION: The search strategy found a total of 363 studies. Finally, 10 articles were included in the systematic review, with a total of 278 healthy older adults analyzed. DATA SYNTHESIS: The main results of the meta-analysis showed a statistical difference of muscle strength in favor of blood flow restriction training when compared with conventional training and no statistical differences when compared with high-intensity resistance training. Physical performance showed a nonstatistical difference between the blood flow restriction training, conventional training, and no training groups. CONCLUSIONS: Blood flow restriction training is an interesting alternative to high-intensity strength training for improving muscle strength in older individuals who cannot perform high-load exercises.

The posterior/medial dry needling approach of the tibialis posterior muscle is an accurate and safe procedure: a cadaveric study.

BACKGROUND: Evidence suggests that tibialis posterior muscle plays an important role in equinovarus foot deformity in patients who had suffered a stroke and it is one of the most frequently injected lower-extremity muscles for the management of spasticity. Our aim was to assess if a needle accurately and safely penetrates the tibialis posterior muscle during the application of dry needling.  METHODS : We conducted a cadaveric descriptive study. Needling insertion of the tibialis posterior was conducted in 11 cryopreserved cadavers with a 70 mm needle. The needle was inserted using two common approaches, at midpoint (posterior/medial approach) and at upper third (anterior approach) of the leg towards the tibialis posterior. The needle was advanced into the tibialis posterior based upon clinician judgement. Cross-sectional anatomical dissections were photographed and analyzed by photometry. Safety was assessed by calculating the distances from the tip and the path of the needle to proximate neurovascular structures. RESULTS: Accurate needle penetration of the tibialis posterior muscle was observed in all cadavers with both approaches. In general, distances from the needle to the neurovascular bundles were larger with the posterior/medial approach than with the anterior approach, reaching statistically significance for needle tip to nerve (mean difference: 0.6 cm, 95%CI 0.35 to 0.85 cm) and vascular bundle (mean difference: 0.55 cm, 95%CI 0.3 to 0.8 cm) distances (P < 0.001) and needle path to vascular bundle distance (difference: 0.25 cm, 95%CI 0.1 to 0.4 cm, P = 0.045). Age and gender did not influence the main results. CONCLUSIONS: This cadaveric study suggests that needling of the tibialis posterior muscle can be accurately and safely conducted. Safety seems to be larger with the posterior/medial approach when compared with the anterior approach.

The natural history of alpha angle in the last seventeen centuries.

INTRODUCTION: Hip osteoarthritis is one of the most important and debilitating diseases affecting thousands of people all over the world. On the other hand, femoroacetabular impingement (FAI) is one of the known important causes of hip osteoarthritis. Cam deformity frequently presents in FAI showing an increased alpha angle. Increased alpha angle has been observed among young patients involved in demanding physical activities such as in sports (40-60%), whereas among the non-athletic population, increased alpha angle was observed in 15-20%. Although femoroacetabular pathology has been described over the recent years, it is not possible to determine when the angle increase actually begins prior to diagnosis. The aim of our study is to evaluate the femoral alpha angle in different human femurs in different civilization eras in West Mediterranean area. MATERIALS AND METHODS: Available ancient femurs were selected from the Collection Center belonging to the archeological archives (ancient necropolis) from the fourth, fourteenth and eighteenth centuries. A comparison of the alpha angle was made of the measurements from the different groups accompanied by a sample of present-day femurs from the radiology database of CT scans. Data from 243 femoral bones were collected, 50 of which from the fourth century, 26 from the fourteenth century, 68 from the eighteenth century, and 99 femurs from the 20/twenty-first century. RESULTS: Alpha angles in all historical samples showed pathological values (> 55º) up to a maximum of 11.5% of the cases. Meanwhile, the actual series showed pathological alpha angle in 60.1% of the cases with statistical significant differences. CONCLUSION: The studied femurs of the western Mediterranean region from the fourth, fourteenth and eighteenth centuries showed pathological alpha angles in a smaller proportion than the actual sample. LEVEL OF EVIDENCE: Level III, retrospective studies.

Effects on Neuromuscular Function After Ischemic Compression in Latent Trigger Points in the Gastrocnemius Muscles: A Randomized Within-Participant Clinical Trial.

OBJECTIVE: The purpose of this study was to evaluate changes in neuromuscular function, pain perception, and basic physical properties in latent myofascial trigger points (TrPs) after a single treatment session of ischemic compression in the gastrocnemius muscle. METHODS: A randomized within-participant clinical trial with a blinded assessor was conducted. Twenty-nine asymptomatic volunteers with latent gastrocnemius-muscle TrPs were bilaterally explored. Each extremity was randomly assigned to the control group (no treatment) or the experimental group (90 seconds of ischemic compression over each TrP). Neuromuscular function of the gastrocnemius muscle was assessed using a MyotonPro. Muscle flexibility was analyzed using the lunge test and the passive ankle range of motion. The strength was determined with a handheld dynamometer (MicroFET2). Pain perception was analyzed with a 0-to-10 numerical pain rating scale and determination of pressure pain thresholds over each latent TrP. RESULTS: The results revealed a reduction of 15.8% in pain perception and an increment of pressure tolerance of 9.9% without pain in the treatment group. Changes in muscle flexibility (active and passive) and most parameters for neuromuscular response (rigidity, elasticity, and relaxation) were also observed, but they were not significantly different between groups. The clinical effect sizes were moderate for pain perception (d = 0.69), pressure pain threshold (d = 0.78), muscle tone (d = 0.51), and elasticity (d = 0.54) in favor of the treated extremity. Small clinical effect sizes were observed for muscle physical outcomes. CONCLUSION: The present study shows that the use of a single session of ischemic compression for latent gastrocnemius-muscle TrPs improved some sensory outcomes. The effects on ankle range of motion and neuromuscular responses were inconclusive.

The Effect of Scapular Fixation on Scapular and Humeral Head Movements during Glenohumeral Axial Distraction Mobilization.

Background and Objectives: Glenohumeral axial distraction mobilization (GADM) is a usual mobilization technique for patients with shoulder dysfunctions. The effect of scapular fixation on the movement of the scapula and the humeral head during GADM is unknown. To analyze the caudal movement of the humeral head and the rotatory movement of the scapula when applying three different intensities of GADM force with or without scapular fixation. Materials and Methods: Fifteen healthy subjects (mean age 28 ± 9 years; 73.3% male) participated in the study (twenty-eight upper limbs). Low-, medium- and high-force GADM in open-packed position were applied in scapular fixation and non-fixation conditions. The caudal movement of humeral head was evaluated by ultrasound measurements. The scapular rotatory movement was assessed with a universal goniometer. The magnitude of force applied during GADM and the region (glenohumeral joint, shoulder girdle, neck or nowhere) where subjects felt the effect of GADM mobilization were also recorded. Results: A greater caudal movement of the humeral head was observed in the non-scapular fixation condition at the three grades of GADM (p < 0.008). The rotatory movement of the scapula in the scapular fixation condition was practically insignificant (0.05−0.75°). The high-force GADM rotated scapula 18.6° in non-scapular fixation condition. Subjects reported a greater feeling of effect of the techniques in the glenohumeral joint with scapular fixation compared with non-scapular fixation. Conclusions: The caudal movement of the humeral head and the scapular movement were significantly greater in non-scapular fixation condition than in scapular fixation condition for the three magnitudes of GADM force.

Correlation between Physical Performance and Stabilometric Parameters in Older Adults.

Background and Objectives: Falls are a common and serious threat to the health and independence of older adults. The decrease in functional capacity during aging means an increased risk of falls. To date, it is not known whether there is a relationship between balance and functional tests. The aim of the study was to evaluate the correlation between eyes-open and eyes-closed static balance with different functional tests. Materials and Methods: A correlation study was designed with 52 healthy subjects over 65 years of age. Results: Regarding the open eyes stabilometric parameters, significant correlations observed between the surface and the functional tests were weak in all cases. The correlations observed between length and the functional tests performed were moderate, except for that of the Timed Up and Go test (TUG) which was weak. No significant correlation between TUG and surface was found. Regarding the closed eyes stabilometric parameters, statistically significant moderate correlations were found between the surface and the Short Physical Performance Battery (SPPB) and the Five Times Sit to Stand test (5XSST). In the case of the length with eyes closed, a statistically significant moderate correlation (rho = 0.40-0.69) was found with the SPPB and 5XSST variables, and weak correlations with the 4 m Walk Speed test (4WS) and TUG variables. Conclusions: There is a mild to moderate correlation between some functional tests and stabilometric parameters in adults over 65 years old.

Is Tecar Therapy Effective on Biceps Femoris and Quadriceps Rehabilitation? A Cadaveric Study.

BACKGROUND: Capacitive-resistive electric transfer therapy is an interesting rehabilitation treatment to use in musculoskeletal injuries. The purpose is to analyze the temperature change and current flow in superficial and deep biceps femoris and quadriceps tissues when applying different protocols of capacitive-resistive electric transfer therapy. METHODS: Five cryopreserved cadavers (10 legs) were included in this study. Four interventions (high/low power) were performed for 5 minutes. Dynamic movements were performed to the biceps femoris and quadriceps. Superficial, middle, and deep temperature were recorded at 1-minute intervals and 5 minutes after the treatment using invasive temperature meters placed with ultrasound guidance. RESULTS: Low-power applications have generated a very low thermal effect and an important current flow. The high-power capacitive application achieves a greater increase in superficial temperature compared with low power (P < .001). The high-power resistive application recorded a greater increase in superficial, middle, and deep temperatures with a greater current flow compared with the other applications (P < .001). CONCLUSION: This study could serve as basic science data to justify the acceleration of the processes of muscle recovery, improving cell proliferation without increasing the temperature in acute muscle injuries and increasing the temperature and viscoelasticity of the tissues in chronic processes with this therapy.

Accuracy and safety of dry needling placement in the popliteus muscle: A cadaveric study.

BACKGROUND: The popliteus muscle attaches posteriorly to the joint capsule of the knee. Although it is an important rotational stabiliser and has been implicated in various knee pathologies, research on its treatment with dry needling is scarce. OBJECTIVE: To determine if a needle accurately and safely penetrates the popliteus muscle during the clinical application of dry needling. METHODS: A cadaveric descriptive study was conducted. Needling insertion of the popliteus muscle was conducted in 11 cryopreserved cadavers with a 50-mm needle. The needle was inserted at upper third of the posterior part of the tibia closest to the knee towards the popliteus. The needle was advanced into the muscle based upon clinician judgement. Cross-sectional anatomical dissections were photographed and analysed by photometry. Safety of the intervention was assessed by calculating the distance from the tip of the needle to the proximate neurovascular structures. RESULTS: Accurate needle penetration of the popliteus muscle was observed in 10 out of 11 (91%) of the cadavers (mean needle penetration: 25.7 ± 6.7mm, 95% CI 21.3-30.3 mm). The distances from the tip of the needle were 17±6mm (95% CI 13-21 mm) to the tibial nerve and 15 ± 0.7mm (95% CI 10-20 mm) to the popliteus vascular bundle. CONCLUSION: The results from this cadaveric study support the notion that needling of the popliteus can be accurately and safely conducted by an experienced clinician. Future studies investigating the clinical effectiveness of these interventions are needed.

The effectiveness of diacutaneous fibrolysis on pain, range of motion and functionality in musculoskeletal disorders: A systematic review and meta-analysis.

OBJECTIVE: To assess the effectiveness of diacutaneous fibrolysis in reducing musculoskeletal disorders symptoms such as pain, range of motion and functionality. DATA SOURCES: A systematic review of MEDLINE, Cochrane, PEDro and Science Direct was conducted until September 2020. REVIEW METHODS: Computerized search strategy was performed to identify randomized controlled trials applying diacutaneous fibrolysis, on subjects with musculoskeletal disorders. Eligible articles and data extraction were conducted independently by two reviewers. Methodology quality and risk of bias were assessed by Risk of Bias 2 tool from the Cochrane Collaboration and Physiotherapy Evidence Database. Outcomes assessed were pain intensity, range of motion and functionality. RESULTS: Search strategy identified 98 potential randomized control trials and six studies involving 386 participants, were finally included. Diacutaneous fibrolysis intervention added to usual physiotherapy treatment was compared to control group. Pain intensity immediately after treatment showed a pooled Standard Mean Difference (SMD) of -0.58 with 95% confidence interval (CI) from -1.12 to -0.04, and in the longest follow-up SMD was -0.63 with 95% CI (-1.21 to -0.05). Functionality showed a pooled SMD of -1.02 with 95% CI (-1.67 to -0.36) immediately after intervention and a SMD of -0.84 with 95% CI (-1.54 to -0.14). Range of motion could not be included in the quantitative synthesis. CONCLUSION: Diacutaneous fibrolysis is an effective treatment, when combined with conventional physiotheraphy, reducing pain immediately after treatment and long term follow-up and improving function in both, short and long term in musculoskeletal disorders.

"Short- and mid-term effects of adding upper cervical manual therapy to a conventional physical therapy program in patients with chronic mechanical neck pain. Randomized controlled clinical trial."

OBJECTIVE: To evaluate the effect of adding an Upper Cervical Translatoric Mobilization (UCTM) or an Inhibitory Suboccipital Technique (IST) to a physiotherapy treatment in the symptomatology and function of mechanical chronic neck pain patients. DESIGN: Randomized controlled trial. SETTING: Primary Care Center in Cornellà, Spain. SUBJECTS: 78 patients (64 women), with mean age (SD) of 59.96 (13.30) years with mechanical chronic neck pain were divided in three groups: control, IST and UCTM groups. INTERVENTIONS: All groups received 15 physiotherapy sessions for three weeks. The UCTM and IST groups added 5 minutes of the assigned technique during six sessions. MAIN MEASURES: Neck disability index (NDI) and numeric pain rating scale (NPRS) for neck pain were measured baseline, three-weeks and 15-weeks follow-up. RESULTS: NDI (SD) at baseline, three-weeks and 15-weeks were 11.62 (7.08), 9.65 (6.25), 7.58 (5.64) for the control group, 14.38 (6.92), 8.50 (6.11), 7.12 (4.98) for the IST group and 13.19(7.23), 5.35(6.10), 4.35(2.76) for the UCTM group. NPRS (SD) at baseline, three-weeks and 15-weeks were 58.69 (19.46), 45.19 (23.43), 44.58 (24.08) for the control group; 64.08 (19.26), 42.19 (19.69), 34 (21.14) for the IST group; and 67.65 (20.65), 36.23 (20.10), 39.85 (25.44) for the UCTM group. CONCLUSIONS: Compared with no treatment, both forms of mobilization were associated with reduced disability at three weeks, and UCTM remained better than control at 15 weeks; there were no significant differences between the two mobilization groups. TRIAL REGISTRATION: This study was registered in Clinicaltrials.gov (NCT02832232).

Temperature and current flow effects of different electrode placement in shoulder capacitive-resistive electric transfer applications: a cadaveric study.

BACKGROUND: Impingement syndrome is currently estimated to represent 60% of all shoulder pain disorders. Capacitive-Resistive electric transfer therapy is aimed to provoke temperature and current flow changes in superficial and deep tissues. This in vitro study has evaluated the variation of temperature and current flow in the shoulder tissues during two different areas of application of the movable capacitive-resistive electric transfer electrode. METHODS: A cross-sectional study designed, five fresh cryopreserved cadavers (10 shoulders) were included in this study. Four interventions (capacitive and resistive modes; low- and high-power) were performed for 5 min each by a diathermy "T-Plus" device in two shoulder regions: postero-superior and antero-lateral. Supraspinatus tendon, glenohumeral capsule and superficial temperatures were recorded at 1-min intervals and 5 min after treatment. RESULTS: A statistically significant difference was found only for the superficial area and time interaction, with high power-resistive application at the postero-superior shoulder area (P< 0.035). All the applications showed a 5 min after treatment temperature increase compared with the basal data, in all the application points. Superficial temperature in the high power-resistive application showed the greatest percent increase (42.93% ± 22.58), followed by the temperature in the tendon area with the same high power-resistive application (22.97% ± 14.70). The high power-resistive application showed the greatest percent of temperature increase in the applications, reaching 65.9% ± 22.96 at 5-min at the superficial level, and 32% ± 24.25 at 4-min at the level of the supraspinatus tendon. At the capsule level, high power-resistive was also the application that showed the greatest percent of increase, with 21.52% ± 16.16. The application with the lowest percent of temperature increase was the low power-capacitive, with a mean value of 4.86% at supraspinatus tendon level and 7.47% at capsular level. CONCLUSION: The shoulder postero-superior or antero-lateral areas of application of capacitive-resistive electric transfer did not cause statistically significant differences in the temperature changes in either supraspinatus tendon or glenohumeral capsule tissues in cadaveric samples. The high power-resistive application in the postero-superior area significantly increased superficial temperature compared with the same application in the antero-lateral position area.

Preoperative risk factors in hip arthroscopy.

PURPOSE: Arthroscopic surgery is a usual technique to repair hip femoroacetabular impingement. Correlation exists among surgical indication, postoperative evolution, the final result, and the necessity of prosthesis in the near future. The assessment of specific parameters allowing us to evaluate the prognosis becomes vital to improve the results. The objective of this study is to check the variables found in patients with femoroacetabular impingement (FAI) treated with hip arthroscopy, and determine which of these variables would serve as key indicators in predicting the need for subsequent arthroplasty. METHODS: Data from FAI surgical indications (age, weight, height, BMI, gender, side, radiographic Tönnis degree, cartilage lesion degree by Acetabular Labrum Articular Disruption (ALAD) degree, VAS value, HOS, mHHS and WOMAC) were collected from cases which should have had a minimum monitoring period of 2 years from 2007 to 2017. The results of the group which needed prosthesis were compared to the results of the ones who did not. RESULTS: Among 452 patients who were monitored for an average of 5.8 years, 82 (18.1%) required conversion to prosthesis. The variables that indicated relatively high risk were fourth-degree acetabular labrum articular disruption (ALAD) chondral injury, preoperative radiographic Grade 2 Tönnis classification, age of over 55 years, WOMAC over 45 points, and HOS-ADL under 50 points. There were no significant differences between side, gender, VAS level, nor HOS. CONCLUSIONS: The presence of chondral injuries such as acetabular labrum articular disruption (ALAD) 4, radiographic Grade 2 Tönnis classification, higher age, higher BMI, and worse WOMAC, along with mHHS and HOS-ADL preoperative results, are factors which lead to a poor prognosis following FAI hip arthroscopic surgery, increasing the risk of prosthetic conversion in the short or medium term. LEVEL OF EVIDENCE: Level IV.

The Effect of Diacutaneous Fibrolysis on Local and Widespread Hyperalgesia and Muscle Length in Patients With Patellofemoral Pain Syndrome: Secondary Analysis of a Pretest-Posttest Clinical Trial.

CONTEXT: Localized and widespread hyperalgesia has been observed in patients with patellofemoral pain. Diacutaneous fibrolysis (DF) has shown to be effective in reducing pain in several musculoskeletal conditions including patellofemoral pain syndrome, but no studies have evaluated the effects of this technique in reducing localized and widespread hyperalgesia. OBJECTIVE: To assess the effect of DF on the pressure pain threshold and muscle length tests in patients with patellofemoral pain syndrome. DESIGN: A single-group, pretest-posttest clinical trial. SETTING: University of Zaragoza. PARTICIPANTS: Forty-six subjects with patellofemoral pain (20 males and 26 females: age 27.8 [6.9] y). INTERVENTION: Three sessions of DF. MAIN OUTCOME MEASURES: Pressure pain threshold using a handheld pressure algometer (4 sites around the knee, on tibialis anterior muscle, and one remote site on the upper contralateral limb); muscle length test of the iliotibial band, rectus femoris, and hamstring muscles; and patient-perceived treatment effect score. RESULTS: The application of 3 sessions of DF significantly increased the pressure pain threshold in all sites at posttreatment evaluation (P < .001) and at a 1-week follow-up (P < .001). A significant increase in muscle length was also observed at the posttreatment evaluation (P < .001) and 1-week follow-up (P < .001). Ninety-seven percent of the patients reported subjective improvement at posttreatment and at 1-week follow-up. CONCLUSION: This study found that local and widespread hyperalgesia was significantly reduced after 3 sessions of diacutaneous fibrolysis and at the 1-week follow-up. A significant improvement on muscle length tests was also observed, with high clinical satisfaction among patients.

The effectiveness of extracorporeal shock wave therapy for improving upper limb spasticity and functionality in stroke patients: a systematic review and meta-analysis.

OBJECTIVE: To assess the effectiveness of Extracorporeal Shock Wave Therapy for reducing spasticity and improving functionality of the upper limb in stroke survivors. DATA SOURCES: A systematic review of MEDLINE, Cochrane Central Register of Controlled Trials, CINAHL, PEDro, REHABDATA, Scielo, Scopus, Web of Science, Tripdatabase and Epistemonikos from 1980 to April 2020 was carried out. REVIEW METHODS: The bibliography was screened to identify randomized controlled clinical trials that applied extracorporeal shock waves to upper limb spastic muscles in post-stroke individuals. Two reviewers independently screened references, selected relevant studies, extracted data and assessed risk of bias using the PEDro scale. The primary outcome was spasticity and functionality of the upper limb. RESULTS: A total of 1,103 studies were identified and 16 randomized controlled trials were finally included (764 individuals) were analyzed. A meta-analysis was performed and a beneficial effect on spasticity was found. The mean difference (MD) on the Modified Ashworth Scale for comparison extracorporeal shock wave versus sham was -0.28; with a 95% confidence interval (CI) from -0.54 to -0.03. The MD of the comparison of extracorporeal shock wave plus conventional physiotherapy versus conventional physiotherapy was -1.78; 95% CI from -2.02 to -1.53. The MD for upper limb motor-function using the Fugl Meyer Assessment was 0.94; 95% CI from 0.42 to 1.47 in the short term and 0.97; 95% CI from 0.19 to 1.74 in the medium term. CONCLUSION: The extracorporeal shock wave therapy is effective for reducing upper limb spasticity. Adding it to conventional therapy provides an additional benefit.

Thermal and non-thermal effects off capacitive-resistive electric transfer application on the Achilles tendon and musculotendinous junction of the gastrocnemius muscle: a cadaveric study.

BACKGROUND: Calf muscle strain and Achilles tendon injuries are common in many sports. For the treatment of muscular and tendinous injuries, one of the newer approaches in sports medicine is capacitive-resistive electric transfer therapy. Our objective was to analyze this in vitro, using invasive temperature measurements in cadaveric specimens. METHODS: A cross-sectional study designed with five fresh frozen cadavers (10 legs) were included in this study. Four interventions (capacitive and resistive modes; low- and high-power) was performed for 5 min each by a diathermy "T-Plus" device. Achilles tendon, musculotendinous junction and superficial temperatures were recorded at 1-min intervals and 5 min after treatment. RESULTS: With the low-power capacitive protocol, at 5 min, there was a 25.21% increase in superficial temperature, a 17.50% increase in Achilles tendon temperature and an 11.27% increase in musculotendinous junction temperature, with a current flow of 0.039 A ± 0.02. With the low-power resistive protocol, there was a 1.14% increase in superficial temperature, a 28.13% increase in Achilles tendon temperature and an 11.67% increase in musculotendinous junction temperature at 5 min, with a current flow of 0.063 A ± 0.02. With the high-power capacitive protocol there was an 88.52% increase in superficial temperature, a 53.35% increase in Achilles tendon temperature and a 39.30% increase in musculotendinous junction temperature at 5 min, with a current flow of 0.095 A ± 0.03. With the high-power resistive protocol, there was a 21.34% increase in superficial temperature, a 109.70% increase in Achilles tendon temperature and an 81.49% increase in musculotendinous junction temperature at 5 min, with a current flow of 0.120 A ± 0.03. CONCLUSION: The low-power protocols resulted in only a very slight thermal effect at the Achilles tendon and musculotendinous junction, but current flow was observed. The high-power protocols resulted in a greater temperature increase at the Achilles tendon and musculotendinous junction and a greater current flow than the low-power protocols. The high-power resistive protocol gave the greatest increase in Achilles tendon and musculotendinous junction temperature. Capacitive treatments (low- and high-power) achieved a greater increase in superficial temperature.