RESUMO
Background: Clinical assessment of triceps brachii tendon tears is challenging, and conventional imaging methods have limitations. Timely surgical referral is important in high-grade tears to maximize patient outcomes, and musculoskeletal ultrasound (MSK US) can be used at the time of clinical examination to identify such injuries requiring advanced imaging and orthopedic referral. Hypothesis/Purpose: The purpose of this case report is to describe how MSK US was used to facilitate advanced imaging and timely orthopedic referral for a patient presenting to a physical therapist with a high-grade triceps tendon avulsion. Study Design: Case Report. Case Description: A 35-year-old male soldier presented to a direct access sports physical therapist with acute-on-chronic right elbow pain. Physical examination and MSK US were used to identify a high-grade partial triceps brachii tendon tear. The MSK US findings informed the physical therapist's decision-making process to refer the subject for timely advanced imaging studies as well as referral to an orthopedic physician. Outcomes: A high-grade partial triceps tendon avulsion was confirmed on magnetic resonance imaging (MRI). The subject was then seen by an orthopedic surgeon and underwent surgical repair of the tendon within the recommended three-week timeframe for optimal outcomes. The subject completed a post-operative rehabilitation program and returned to full physical and occupational activities. Conclusion: MSK US can assist in the diagnosis of challenging triceps tendon injuries, facilitating timely advanced imaging and orthopedic referrals for high-grade injuries to optimize patient outcomes. Level of Evidence: 5.
RESUMO
STUDY DESIGN: Controlled laboratory study. OBJECTIVE: To explore potential associations between foot posture index (FPI-6) composite scores and dynamic plantar pressure measurements, and to describe each of the 6 subscales and the FPI-6 composite scores across our sample. BACKGROUND: The FPI-6 is a static foot posture assessment comprised of 6 observations. Extreme scores have been associated with increased injury risk. However, knowledge describing the relationship between FPI-6 scores and plantar pressure distributions during gait is limited. METHODS: Participants (n = 1000; 566 males, 434 females) were predominantly active adults (mean ± SD age, 30.6 ± 8.0 years; body mass index, 26.2 ± 3.7 kg/m²), who ran 3.1 ± 1.4 d/wk. Static and dynamic foot characteristics were compared using the FPI-6 and a capacitance-based pressure platform. Correlation and hierarchical stepwise regression analyses were performed to determine the most parsimonious set of dynamic pressure data associated with FPI-6 scores. RESULTS: The mean ± SD FPI-6 score was 3.4 ± 2.9 (range, -6.0 to 11.0). Only 31 participants received a score of -2 (supinated foot) on any FPI-6 subscale. Classification of a pronated foot was 2.4 times more likely than a supinated foot. A 5-variable model (R = 0.57, R2 = 0.32) was developed to describe the association between dynamic plantar pressures and FPI-6 scores. CONCLUSION: The multivariate model associated with FPI-6 scores comprised clinically plausible variables which inform the association between static and dynamic foot postures. Different cutoff values may be required when using the FPI-6 to screen for individuals with supinated feet, given the limited number of high-arched participants identified by FPI-6 classifications.
