Subject(s)
Cross-Cultural Comparison , Running , Humans , Universities , Wisconsin , Surveys and Questionnaires , Reproducibility of Results , Psychometrics , TranslationsABSTRACT
Purpose: To evaluate the variations in hip muscles strength following arthroscopy and 6-month rehabilitation in patients treated for femoroacetabular impingement (FAI). Methods: A retrospective analysis was carried out on a series of patients who were arthroscopically treated for FAI at La Tour Hospital between 2020 and 2022. Bilateral isometric strengths of 8 hip-related muscles (abductors, adductors, hamstrings, quadriceps, extensors, flexors, internal and external rotators) were assessed using a handheld dynamometer before surgery and postoperatively after 6 months of rehabilitation in terms of relative strength changes between time points. Results: A total of 29 patients (aged 26.9 ± 7.1 years, 86% of women) were included. Except for the abductors, which remained of comparable strength than before surgery, a statistically significant (P < .05) increase in hip muscle strength on the operated side could be noted at 6 postoperative months for hamstrings (9% ± 17%, P = .041), quadriceps (11% ± 27%, P = .045), extensors (17% ± 32%, P = .006), flexors (17% ± 29%, P = .003), adductors (18% ± 23%, P < .001), and internal rotators (32% ± 36%, P < .001). The proportion of patients who reached a strength level above their preoperative status ranged from 62% (quadriceps) to 86% (adductors and flexors), depending on the muscle studied. The external rotators were the only muscles that remained significantly weakened at 6 months on both operated (-13% ± 26%, P = .002) and nonoperated (-17% ± 25%, P < .001) sides, with a decrease beyond 15% in almost half of the patients (45% and 48%, respectively). Conclusions: Arthroscopic treatment followed by 6-month rehabilitation granted to most FAI patients a higher strength level for several hip muscles, except for abductors and external rotators, which remained comparable and weakened, respectively. Level of Evidence: Level IV, therapeutic case series.
ABSTRACT
Optimizing treatments requires the prevention of diagnostic errors. The use of shortcuts, cognitive biases, may lead to errors of judgement that can impair clinical reasoning and distort decision-making. Objective, quantifiable and comparable assessment is a safeguard against this, and for instance force quantification is used for this purpose. We will present here the use of hand-held dynamometers with recommendations for best practice as well as simple but essential tools for interpreting the results. Indeed, the use of these easy-to-use dynamometers requires rigour to ensure the quality of measurements and data analysis by/for the clinician. The use of this equipment should be widely promoted and democratized in informed clinical practice.
L'optimisation des traitements passe par la prévention des erreurs de diagnostic. L'utilisation de raccourcis et les biais cognitifs peuvent engendrer des erreurs de jugement nuisant au raisonnement clinique et risquant de pervertir les prises de décision. L'évaluation objective, quantifiable et comparable en est un rempart et la quantification de la force est, par exemple, utilisée à cette fin. Nous présentons ici l'utilisation des dynamomètres à main avec des recommandations de bonne pratique ainsi que des outils d'interprétation des résultats simples mais indispensables. En effet, l'emploi de ces dynamomètres d'utilisation aisée nécessite de la rigueur pour assurer la qualité des mesures et l'analyse des données par/pour le clinicien. Le recours à ce matériel doit être largement promu et démocratisé en pratique clinique éclairée.
Subject(s)
Fenbendazole , Muscle Strength , Humans , Bias , Diagnostic Errors , CognitionABSTRACT
Hip arthroscopy and surgical hip dislocation (SHD) can be adequate surgical options for patients suffering from femoroacetabular impingement (FAI) syndrome, but there is to date no published data on their impact on hip muscles strength. The purpose of this retrospective study was, therefore, to evaluate it on a consecutive series of 50 FAI patients treated either by arthroscopy (n = 29, aged 27.4 ± 7.5 years, 76% of women) or SHD (n = 21, aged 25.9 ± 6.5 years, 38% of women) at La Tour Hospital between 2020 and 2021. The bilateral isometric strengths of eight hip-related muscles were evaluated before and three months after surgery (halfway through the rehabilitation program). For arthroscopy, a statistically significant (p < 0.05) reduction in hip muscles strength could be noted on the operated hamstrings (1.49 ± 0.43 vs. 1.39 ± 0.38 Nm/kg), flexors (1.88 ± 0.46 vs. 1.73 ± 0.41 Nm/kg), abductors (1.97 ± 0.42 vs. 1.72 ± 0.40 Nm/kg) and external rotators (1.17 ± 0.40 vs. 1.04 ± 0.37 Nm/kg). The abductors were the most affected muscles, with 45% of the patients suffering from a strength reduction ≥15%. The non-operated external rotators were also affected but to a lesser extent (1.21 ± 0.38 vs. 1.10 ± 0.36 Nm/kg). For SHD, a statistically significant strength reduction could be noted on the operated extensors (2.28 ± 0.84 vs. 2.05 ± 0.70 Nm/kg), abductors (1.87 ± 0.49 vs. 1.65 ± 0.41 Nm/kg), quadriceps (2.96 ± 0.92 vs. 2.44 ± 0.89 Nm/kg), external rotators (1.16 ± 0.42 vs. 0.93 ± 0.36 Nm/kg) and internal rotators (1.26 ± 0.38 vs. 0.96 ± 0.30 Nm/kg). The internal rotators were the most affected muscles, with 75% of the patients suffering from a strength reduction ≥15%. To conclude, particular attention should be paid to operated abductors for patients treated by arthroscopy as well as operated internal/external rotators, abductors and quadriceps for those treated by surgical hip dislocation. It reinforces that a rehabilitation method based on isolated muscle reinforcement and functional exercises that goes beyond three postoperative months is needed.
ABSTRACT
Running related injury is a complex, multifactorial phenomenon that remains difficult to explain. However, there are available tools for clinicians allowing prevention (primary or tertiary) and rehabilitation optimization, thus reducing the consequences of the injury and time before returning to participation. These tools rely mainly on training load monitoring and clinical evaluation of stride biomechanical analysis. Unfortunately, they currently remain poorly known by practitioners, while allowing the opportunity to address the challenge of managing the injured runner, including a faster return to run, but also the prevention of a potential recurrence. It requires targeted intervention and education of the patient on the factors leading to the injury.
La blessure liée à la course à pied est un phénomène complexe, multifactoriel dont l'explication reste difficile. Cependant, des outils à disposition des cliniciens permettent d'agir de manière préventive (primaire ou tertiaire) et d'optimiser la rééducation afin de réduire les conséquences de la blessure et le délai avant la reprise de l'activité. Ces outils portent principalement sur le suivi de la charge d'entraînement et l'utilisation clinique de l'analyse biomécanique de la foulée. Ils sont toutefois aujourd'hui mal connus par les praticiens alors que leur utilisation permet de répondre à l'enjeu de la prise en charge du coureur comprenant un retour le plus rapide possible à la pratique, mais également la prévention d'une potentielle récidive. Cela sous-tend un travail ciblé et une éducation du patient sur les facteurs entraînant la blessure.
Subject(s)
Athletic Injuries , Running , Athletic Injuries/etiology , Athletic Injuries/prevention & control , Biomechanical Phenomena , Humans , Running/injuriesABSTRACT
Trail running races are a real challenge for medical and paramedical workers committed to aid station/medical support system, because of their technical and geographical particularities. In this article, we review the different etiologies of collapse, digestive problems, kidney complications, diseases related to the environment and musculoskeletal injuries. Field care and prevention are also examined. Although injuries are often benign, some more serious problems may require rapid and effective intervention. Medical teams must be prepared for each of the different situations discussed in this article.
Les courses de trail présentent, du fait de leurs particularités techniques et géographiques, un réel défi pour les intervenants médicaux et paramédicaux engagés au sein des dispositifs sanitaires. Dans cet article, nous passons en revue les différentes causes de malaise, les problèmes digestifs et les complications rénales, les affections liées à l'environnement, ainsi que les principales lésions musculosquelettiques. La prise en charge sur le terrain et la prévention sont également discutées. Même si les affections rencontrées lors d'un trail sont souvent bénignes, certaines problématiques plus graves peuvent nécessiter l'intervention rapide et efficace des secours qui doivent être préparés aux différentes situations abordées.
