Sonographic pathoanatomy of greater trochanteric pain syndrome.

AIMS: To identify and highlight pertinent US features that could serve as imaging biomarkers to describe different patient phenotypes, within Great Trochanteric Pain Syndrome (GTPS) clinical diagnosis. MATERIALS AND METHODS: Using ultrasound we evaluated eighty-eight clinically diagnosed patients with GTPS, for tendon matrix changes and calcium deposits in the gluteus medius (superoposterior and lateral aspects) and in the gluteus minimus. Peritrochanteric examination included fascia lata, trochanteric bursa, cortical irregularities and the presence of enthesophytes. The association of pathological changes with pain and functionality was evaluated using multivariate regression models. RESULTS: Out of the 88 patients, 86 examinations (97.7%) detected gluteus medius tendinopathy, and 54 patients (61.4%) had gluteus minimus tendinopathy in addition. Calcium deposits were present in 97.7% of patients, associated with tenderness (p = 0.009), and most often located in the gluteus medius rather than in the gluteus minimus (p = 0.014); calcifications were associated with tendon thickness (p = 0.042), hypoechogenicity (p = 0.005) and the presence of partial tears (p = 0.030). Bursa swelling occurred in 36 patients (40.9%); multivariate regression models predicted less pain in patients with bursa distension (p = 0.008) and dysfunction in patients with gluteal muscle atrophy (p = 0.001) and loss of fibrillar pattern in the gluteus medius (p = 0.002). CONCLUSION: GTPS involves both degenerative calcifying gluteal tendinopathy and alterations in the peritrochanteric space associated with physical function and pain. The severity of GTPS can be assessed using ultrasound imaging biomarkers.

Mobile phone usage among Nigerians: Risk factors for musculoskeletal injuries and preventive strategies.

Aims: The increase in the usage of hand-held devices (HHDs) and smartphones (SPs), especially in Nigeria has resulted in an upsurge of musculoskeletal complaints. The aim of this study was to determine the incidence and risk factors for musculoskeletal injuries due to mobile phone usage among Nigerians and the preventive strategies. Materials and Methods: This study involved 630 male and female participants above 18 years old who were purposively recruited across designated study centres in public places. The instrument used was a questionnaire specifically designed to suit the Nigerian culture and environment and developed from previously validated questionnaires. Data were exported to Statistical Computing Programming R version 4.0.5 for analysis and Chi-square was used to compare the characteristics of those who experienced injury using SPs/HHDS and those who did not. Independent variables with a 95% confidence level and P < 0.05 in the multivariate model were considered statistically significant. Results: The most common daily use of SPs/HHDS by the participants was phone calls (98.4%) followed closely by social networking (96.0%) while the occupation and educational level of the participants had statistically significant (P < 0.05) impact on musculoskeletal injuries. The type of mobile device and the time spent using these devices were also significant (P < 0.05) risk factors for injuries. Some self-treatment strategies adopted by the participants were all significantly (P < 0.05) associated with reduction of musculoskeletal discomfort. Conclusion: The occupation, educational level, the types of mobile devices and time spent using the devices were risk factors for musculoskeletal injuries.

Mobile phone usage among nigerians: risk factors for musculoskeletal injuries and preventive strategies

Aims: The increase in the usage of hand-held devices (HHDs) and smartphones (SPs), especially in Nigeria has resulted in an upsurge of musculoskeletal complaints. The aim of this study was to determine the incidence and risk factors for musculoskeletal injuries due to mobile phone usage among Nigerians and the preventive strategies. Materials and Methods: This study involved 630 male and female participants above 18 years old who were purposively recruited across designated study centres in public places. The instrument used was a questionnaire specifically designed to suit the Nigerian culture and environment and developed from previously validated questionnaires. Data were exported to Statistical Computing Programming R version 4.0.5 for analysis and Chi-square was used to compare the characteristics of those who experienced injury using SPs/HHDS and those who did not. Independent variables with a 95% confidence level and P < 0.05 in the multivariate model were considered statistically significant. Results: The most common daily use of SPs/HHDS by the participants was phone calls (98.4%) followed closely by social networking (96.0%) while the occupation and educational level of the participants had statistically significant (P < 0.05) impact on musculoskeletal injuries. The type of mobile device and the time spent using these devices were also significant (P < 0.05) risk factors for injuries. Some self­treatment strategies adopted by the participants were all significantly (P < 0.05) associated with reduction of musculoskeletal discomfort. Conclusion: The occupation, educational level, the types of mobile devices and time spent using the devices were risk factors for musculoskeletal injuries

Is genu varum a risk factor for the prevalence and severity of achilles tendinopathy? A cross-sectional study of Nigerian elite track and field athletes.

BACKGROUND: Achilles tendinopathy (AT) is one of the most frequently reported ankle and foot overuse injuries. Prior studies have reported altered biomechanical variables of the lower limb as risk factors for the prevalence and severity of AT in athletes, especially in Caucasians, but there are few reports on African elite athletes. Because it is established that anthropometric and biomechanical values vary with racial disposition, this study was designed to investigate the association between selected physical and biomechanical variables of the lower limb and the prevalence and severity of AT in Nigerian elite track and field athletes. SUBJECTS AND METHODS: Eighty-five elite Nigerian track and field athletes participated in this cross-sectional study. Biomechanical variables of Q-angle, tibial torsion, limb-length discrepancy (LLD) and foot posture index (FPI) were evaluated using standard procedures. The presence of AT was confirmed with ultrasonography and clinical assessments, whereas the severity was evaluated with VISA-A questionnaire. Inferential statistics of Chi-square was used to determine the association between prevalence of AT and the biomechanical variables. RESULTS: The prevalence of AT was 15.3%, made up of participants who tested positive to both clinical test and ultrasound scan. There was no significant association between AT and LLD, tibial torsion and FPI. Most of the participants with AT had genu varum, which was significantly associated with both the prevalence and severity of AT. CONCLUSION: It was concluded that genu varum had a significant association with both the prevalence and severity of AT in elite Nigerian track and field athletes.

Lower Limb Biomechanical Variables Are Indicators of the Pattern of Presentation of Patella Tendinopathy in Elite African Basketball and Volleyball Players.

Objective The present study determined the pattern of presentation and severity of patellar tendinopathy (PT) and its relationship with selected biomechanical variables in elite athletes. Methods The study involved 98 elite Nigerian basketball and volleyball players aged between 18 and 35 years. Clinical tests and ultrasound imaging were used to divide the participants into symptomatic and asymptomatic groups. Standard procedures were used to assess the quadriceps angle (Q-angle), tibial torsion, ankle dorsiflexion, hamstring flexibility, and foot posture. The Victorian Institute of Sport Assessment Questionnaire, Patellar Tendon (VISA-P) was used to assess the severity of the symptoms. The statistical analysis was performed using analysis of variance (ANOVA), and a post hoc analysis and Pearson correlation with significance level set at p < 0.05 were also performed. Results Significantly lower sit-and-reach scores ( p = 0.01), increased foot posture index score ( p = 0.01) and reduced ankle dorsiflexion range ( p = 0.03) were found in participants of both sexes with symptomatic PT. Higher Q-angles ( p = 0.02) in males and tibial torsion angles ( p = 0.001) in females were also found in the symptomatic PT groups. Symptom severity was significantly higher in the group with clinical symptoms only ( p = 0.042), and it was significantly correlated with hamstring flexibility in both males (r = -0.618) and females (r = -0.664). Conclusion Reduced hamstring flexibility, increased foot pronation and reduced ankle dorsiflexion range were significant in participants with symptomatic PT.

Lower Limb Biomechanical Variables Are Indicators of the Pattern of Presentation of Patella Tendinopathy in Elite African Basketball and Volleyball Players / Variáveis biomecânicas dos membros inferiores são indicadores do padrão de apresentação da tendinopatia patelar em atletas de elite africanos de basquetebol e voleibol

Abstract Objective The present study determined the pattern of presentation and severity of patellar tendinopathy (PT) and its relationship with selected biomechanical variables in elite athletes. Methods The study involved 98 elite Nigerian basketball and volleyball players aged between 18 and 35 years. Clinical tests and ultrasound imaging were used to divide the participants into symptomatic and asymptomatic groups. Standard procedures were used to assess the quadriceps angle (Q-angle), tibial torsion, ankle dorsiflexion, hamstring flexibility, and foot posture. The Victorian Institute of Sport Assessment Questionnaire, Patellar Tendon (VISA-P) was used to assess the severity of the symptoms. The statistical analysis was performed using analysis of variance (ANOVA), and a post hoc analysis and Pearson correlation with significance level set at p < 0.05 were also performed. Results Significantly lower sit-and-reach scores (p = 0.01), increased foot posture index score (p = 0.01) and reduced ankle dorsiflexion range (p = 0.03) were found in participants of both sexes with symptomatic PT. Higher Q-angles (p = 0.02) in males and tibial torsion angles (p = 0.001) in females were also found in the symptomatic PT groups. Symptom severity was significantly higher in the group with clinical symptoms only (p = 0.042), and it was significantly correlated with hamstring flexibility in both males (r = -0.618) and females (r = -0.664). Conclusion Reduced hamstring flexibility, increased foot pronation and reduced ankle dorsiflexion range were significant in participants with symptomatic PT.

Resumo Objetivo Este estudo determinou o padrão de apresentação e gravidade da tendinopatia patelar (TP) e sua relação com variáveis biomecânicas selecionadas em atletas de elite. Métodos O estudo envolveu 98 jogadores de elite nigerianos de basquetebol e voleibol com idades entre 18 e 35 anos. Testes clínicos e ultrassonografia foram usados para separar os participantes em grupos sintomáticos e assintomáticos. Procedimentos padrão foram utilizados para avaliar o ângulo do quadríceps (ângulo Q), a torção da tíbia, a dorsiflexão do tornozelo, a flexibilidade dos isquiotibiais, e a postura do pé. Usou-se o questionário Victorian Institute of Sport Assessment Questionnaire, Patellar Tendon (VISA-P) para avaliar a gravidade dos sintomas nos grupos sintomáticos. A análise estatística foi realizada por meio de análise de variância (ANOVA, na sigla em inglês), análise post hoc, e correlação de Pearson, com nível de significância estabelecido em p < 0,05. Resultados Pontuações significativamente menores de sentar e alcançar (p = 0,01), aumento da pontuação do índice de postura do pé (p = 0,01), e redução da amplitude de dorsiflexão do tornozelo (p = 0,03) foram encontrados em participantes de ambos os sexos com TP sintomática. Ângulos Q (p = 0,02) maiores nos homens e ângulos de torção tibial maiores (p = 0,001) nas mulheres também foram encontrados nos grupos de TP sintomática. A gravidade dos sintomas foi significativamente maior no grupo que tinha apenas sintomas clínicos (p = 0,042), e estava significativamente correlacionada com a flexibilidade dos isquiotibiais tanto nos homens (r = -0,618) quanto nas mulheres (r = -0,664). Conclusão A redução da flexibilidade dos isquiotibiais, o aumento da pronação do pé, e a redução da amplitude de dorsiflexão do tornozelo foram significativos em participantes com TP sintomática.

Reliability and validity of the Yoruba version of the Oswestry disability index.

CONTEXT: Low back pain (LBP) is a major cause of disability, and the Oswestry Disability Index (ODI) is a validated assessment tool for evaluating disability in LBP patients. Cross-cultural adaptation of the ODI is important because not all populations are proficient in English. The Yoruba language is an indigenous language spoken by 40 million people in the Western part of Nigeria and some countries in West Africa and Latin America. Currently, no validated Yoruba version of ODI is available. AIMS: The aim of the study was to translate, culturally adapt and validate the ODI in Yoruba language for participants with LBP. SUBJECTS AND METHODS: The ODI was translated into Yoruba, and this translated version was analysed in terms of semantics and linguistics. Then, the Yoruba version was translated back into English and both versions administered to 160 participants with LBP. The internal consistency using Cronbach's alpha coefficient, criterion validity and test-retest reliability were assessed using Spearman's rank correlation with significance set at P< 0.05. The inter-rater reliability was evaluated by two different observers and the intra-rater reliability was determined by the same observer, a week apart. RESULTS: The internal consistency of the Yoruba ODI with Cronbach's alpha was 0.97, the intrarater reliability yielded an intraclass correlation coefficient of 0.93 and criterion validity assessed using Spearman's rank correlation was r = 0.92 for highest score and 0.63 for lowest score. CONCLUSION: The Yoruba ODI is a reliable and valid tool for assessing functional disability in LBP patients.

Injuries in male and female semi-professional football (soccer) players in Nigeria: prospective study of a National Tournament.

BACKGROUND: Research on the epidemiology of football injuries in Africa is very sparse despite its importance for injury prevention planning in a continent with limited sports medicine resources. The vast majority of studies available in literature were conducted in Europe and only a very few studies have prospectively reported the pattern of football injury in Africa. The purpose of this study was to evaluate the incidence and pattern of injuries in a cohort of male and female semi-professional football players in Nigeria. METHODS: A prospective cohort design was conducted, in which a total of 756 players with an age range of 18-32 years (356 males and 300 females) from 22 different teams (12 male and 10 female teams), were prospectively followed in a National Football Tournament. Physiotherapists recorded team exposure and injuries. Injuries were documented using the consensus protocol for data collection in studies relating to football injury surveillance. RESULTS: An overall incidence of 113.4 injuries/1000 h (95% CI 93.7-136.0) equivalent to 3.7 injuries/match and time-loss incidence of 15.6 injuries/1000 h were recorded for male players and 65.9 injuries/1000 h (95% CI 48.9-86.8) equivalent to 2.2 injuries/match and time-loss incidence of 7.9 injuries/1000 h were recorded for female players. Male players had a significantly higher risk of injuries [IRR = 1.72 (95% CI 1.23-2.45)]. Injuries mostly affected the lower extremity for both genders (n = 81, 70% and n = 31, 62% for males and females respectively). Lower leg contusion (n = 22, 19%) and knee sprain (n = 9, 18%) were the most common specific injury types for male and female players respectively. Most of the injuries were as a result of contact with another player (n = 102, 88%-males; n = 48, 96%-females). Time-loss injuries were mostly estimated as minimal (n = 11, 69%) for male players and severe (n = 4, 66%) for female players. CONCLUSION: The overall incidence of injuries among Nigerian semi-professional football players is high but most of the injuries do not result in time-loss. Pattern of injuries is mostly consistent with previous studies. More prospective studies are needed to establish injury prevention initiatives among African players.

Effects of Aerobic Exercise on the Pulmonary Functions, Respiratory Symptoms and Psychological Status of People Living With HIV.

BACKGROUND: Pulmonary complications, respiratory symptoms and depression are common occurrences which contribute to the morbidity and mortality seen in individuals living with HIV/AIDS. This study investigated the effect of aerobic exercise on the pulmonary functions, respiratory symptoms and psychological status of people living with HIV. METHODS: This study was conducted in Lagos, Nigeria from October 2014 to May 2015. Forty eligible individuals with HIV aged 18 yr and above participated, of which 33 cooperated to the end. They were recruited from the HIV/AIDS Prevention and Intervention Initiative (APIN) Clinic, Lagos University Teaching Hospital, Nigeria and were randomly assigned to either the study or the control group. The study group received aerobic exercise training three times a week for six weeks and counselling while the control group received only counselling. Pulmonary functions, respiratory symptoms and psychological status were evaluated at baseline and at six weeks. Inferential statistics of paired and independent t-test were used to analyse the data. RESULTS: Comparison of mean changes in the pulmonary variables of the study group with those of the control group showed significant differences in all but in the respiratory rate (RR) - [Forced Expiratory Volume in one second: P=0.001, Forced Vital Capacity: P=0.001, Peak Expiratory Flow: P=0.001]. There were also significant differences between the mean changes in respiratory symptoms (P=0.001) and depressive symptoms (P=0.001) of study group and those of the control group. CONCLUSIONS: Aerobic exercise training significantly improved pulmonary functions as well as significantly reduced respiratory and depressive symptoms in people living with HIV.

The morphology of the healing tendon: a comparison of the effects of intrasound therapy and therapeutic pulsed ultrasound.

BACKGROUND AND PURPOSE: This study investigated the effects of low- and high-intensity intrasound therapy (LITR and HITR) and low-intensity pulsed ultrasound (LIPUS) on the morphology of the healing tendon. METHODS: Forty-five male Sprague-Dawley albino rats, randomized into five groups, were further subdivided into groups A and B except Group 1. Groups 2-5 underwent an induced crush injury to the Achilles tendon. The groups were allocated to serve as controls (Group 1), received no treatment (Group 2), LIPUS once daily (Group 3), LITR twice daily (Group 4), and HITR twice daily (Group 5). Treatment commenced 24 hr post-injury over the first 14 days. Subgroup A animals were killed on day 15 and those in subgroup B were killed on day 31. The tendons were excised and processed for histological studies. RESULTS: LITR and HITR given twice daily caused a significant (p < 0.05) proliferation of tenoblasts in the proliferative phase and enhanced their terminal differentiation to tenocytes in the remodeling phase compared with the untreated and LIPUS-treated groups. LITR and HITR also resulted in a significant increase in the volume fraction of collagen fibers compared with LIPUS. CONCLUSION: Intrasound therapy has a better morphological effect on the healing tendon than LIPUS and may be an option to consider in the treatment of acute tendon injuries.

Predictive factors for flatfoot: The role of age and footwear in children in urban and rural communities in South West Nigeria.

BACKGROUND: Flatfoot is common in children and its prevalence influenced by several factors. This study investigated the role of age and type of foot wear as predictors of flatfoot in school age children in urban and rural areas in south-western Nigeria. METHODS: 560 children between 6 and 12 years, divided into two groups; rural and urban were studied. Each subject's static footprint was taken on a white duplicating paper after which the instep was measured for classification into high arch, normal, flat or severe flat. The BMI of each subject was calculated from the anthropometric data. The type of footwear with which the subjects were shod was also recorded. Data analysis was by Epi Info statistical package version 3.5.1 (2008). RESULTS: Chi-square showed a significant (p<0.05) association between the presence of flatfoot, age and type of footwear. Comparison of the prevalence of flatfoot by age group indicated a significant difference at age 10 years. Simple logistic regressions, however, showed that age was a significant (p<0.05) predictor for flat foot while the type of footwear was not. CONCLUSION: In this study, age is the primary predictor for flatfoot while the type of footwear is not.

A comparative study of the effects of bromelain and fresh pineapple juice on the early phase of healing in acute crush achilles tendon injury.

Bromelain, an enzyme extracted from the stem of the pineapple plant, has been reported to reduce pain and swelling in acute soft tissue injuries, but no study has been done to compare its effect with that of fresh pineapple juice on the healing of acute tendon injuries. This study compared the effects of commercial bromelain and fresh pineapple juice on tenocyte proliferation and the malondialdehyde (MDA) level in the early stage of healing in a crush injury to the Achilles tendon of Sprague-Dawley rats. Twenty-four male rats were divided randomly into three groups of eight rats each; all the rats had induced crush injury to the Achilles tendon: Group 1 (control), no treatment; Group 2, oral bromelain treatment at a dosage of 7 mg/kg of body weight daily; and Group 3, fresh diluted pineapple juice at a dosage of 30 mg/kg of body weight. Treatment was given over the first 14 days post-injury. On day 15 post-injury, the animals were sacrificed, and the tendons were excised and processed for histological study and MDA assay. Results show a significant difference in the tenocyte population between the bromelain group and the control (P < .05), whereas pineapple juice also increased the tenocyte population, although not significantly (P = .36). Pineapple juice, however, significantly lowered the MDA level compared with both the control and bromelain-treated groups. Based on this study, 600 GDU bromelain given at a dosage of 7 mg/kg had a better effect on tenocyte proliferation than fresh pineapple juice given once daily in acute tendon injury.