The effects of single-axis balance board intervention on balance parameters in the elderly.

Falls among the elderly contribute in large part to the morbidity and mortality statistics of this age group. To date, few institutionalized programs exist to enhance balance among the elderly as a fall prevention adjunct. A 30-day balance program was instituted at independent living facilities in our community, and the effects were assessed for subjective and objective improvement in balance parameters. The results indicated that 97% of the participants enjoyed the program and found it to be nonstressful. Subjective improvement in confidence level and a diminished sense of balance loss was seen in 95% of the subjects. Significant improvement was noted in all tests measuring balance parameters. Objective improvement over baseline levels was seen in 90% of the study group.

The in vivo assessment of tibial motion in the transverse plane in anterior cruciate ligament-reconstructed knees.

Twenty-one knees with acutely injured anterior cruciate ligaments were reconstructed with patellar tendon autografts. Eight of the knees had concomitant medial ligament injuries that were not addressed surgically. Follow-up evaluation (average, 25 months) included computed tomography measurements to analyze transverse-plane laxity in both translation and rotation. These measurements were performed with the patient's leg in a load cell device that stabilizes the distal femur and applies known anterior translational force to the proximal tibia at approximately 20 degrees of flexion. A torque apparatus was used to apply internal and external rotational torque to the leg. Images of the tibial plateau in neutral, internal, and external rotation were performed, with and without an anterior translational force. Both knees of each patient were tested and categorized as group I (anterior cruciate ligament-reconstructed) or group II (uninjured). Translation as measured by computed tomography averaged 1 mm side-to-side difference. Internal rotation averaged 8.7 degrees in group I knees and 10.8 degrees in group II knees. External rotation averaged 9.1 degrees in group I knees and 7.4 degrees in group II knees. The eight knees with concomitant medial ligament injuries were analyzed separately; external rotation without anterior load in group I was 9.5 degrees, compared with 5 degrees in group II. This difference was significant (P < 0.01).

The measurement of subacromial contact pressure in patients with impingement syndrome.

This study presents the subacromial contact pressure findings in 25 patients who underwent an arthroscopic acromioplasty for impingement syndrome. All patients failed a course of conservative management before surgery. Patients were evaluated, both before and after acromioplasty, by examination, UCLA functional score, and radiographic assessment of acromial morphology. At the time of surgery, a 4 x 10 mm air-filled catheter was placed beneath the anterior aspect of the acromion under arthroscopic visualization. Subacromial contact pressures were recorded throughout an arc of shoulder motion. Mean pressure and standard deviation were derived from three trials. This protocol was performed on all patients and the results were statistically evaluated. The mean subacromial pressure before acromioplasty was 11.7, 35.6, 50.1, 51.1, and 57.4 mm Hg at abduction arcs of 0 degrees , 90 degrees , and 180 degrees, hyperabduction (forced passive limit of abduction), and cross-reach (arm adducted across the patient's chest with the shoulder internally rotated), respectively. The pressure after acromioplasty decreased to 1.6, 7.8, 15.9, 22.8, and 16.5 mm Hg, respectively. This decrease was significant in all positions (P = .016 at 0 degrees and <.001 in all other positions). At 90 degrees of abduction, pressure always decreased in internal rotation and increased in external rotation. Maximal contact pressure developed in either hyperabduction or cross-reach in all patients except two. Preoperative testing for the position of maximum impingement pain generally correlated with the position of maximum contact pressure.

Maneuvers for reducing dislocated hips. A new technique and a literature review.

Twelve consecutive dislocated hip prostheses and one dislocated hip joint were reduced in the emergency room using the method described in this paper. This method has multiple advantages. It uses a lever and fulcrum technique and therefore is capable of producing substantial levels of force with less effort. The patient and physician are in relatively comfortable positions and little assistance is necessary.