The Impact of Blood Flow Restriction Training on Tibial Bone Stress Injury Rehabilitation: An Exploratory Case Series.

Background: Lower extremity bone stress injuries (BSI) are common injuries among athletes and military members. Typical management involves a period of restricted weightbearing which can have rapid detrimental effects upon both muscle and bone physiology. Few studies have investigated the effect of blood flow restriction (BFR) training on bone in the rehabilitative setting. Purpose: The purpose of this study was to investigate the effects of lower extremity exercise with the addition of BFR upon bone mineral density, bone mineral content, and lean body mass in military members with tibial BSIs. Study Design: Case series. Methods: Twenty military members with MRI-confirmed tibial BSI were recruited to complete lower extremity exercise with the addition of BFR twice per week for four weeks. The BFR cuff was applied proximally to the participant's involved limb while they performed gluteal, thigh, and leg resistance exercises. Outcomes were assessed at baseline and four weeks. The primary outcomes were whole leg bone mineral density (BMD), bone mineral content (BMC), and lean body mass (LM) as measured by dual-energy x-ray absorptiometry. Secondary outcomes included thigh and leg circumference measures and patient-reported outcomes, including the Lower Extremity Functional Scale (LEFS), Patient-Reported Outcomes Measurement Information System 57 (PROMIS-57), and Global Rating of Change (GROC). Results: No significant differences were found in BMD (p=0.720) or BMC (p=0.749) between limbs or within limbs over time. LM was generally less in the involved limb (p=0.019), however there were no significant differences between or within limbs over time (p=0.404). For thigh circumference, significant main effects were found for time (p=0.012) and limb (p=0.015), however there was no significant interaction effect (p=0.510). No significant differences were found for leg circumference (p=0.738). Participants showed significant mean changes in LEFS (15.15 points), PROMIS physical function (8.98 points), PROMIS social participation (7.60 points), PROMIS anxiety (3.26 points), and PROMIS pain interference (8.39 points) at four weeks. Conclusion: The utilization of BFR in the early rehabilitative management of tibial BSI may help mitigate decrements in both bone and muscle tissue during periods of decreased physical loading. Level of Evidence: 4.

Point of Care Ultrasound Guided Management of Lateral Ankle Sprains: A Case Series.

Background: Lateral ankle sprain (LAS) is a common injury with incidence rates reported at 7.2 per 1000 person-years. Physical examination strategies provide limited information to guide rehabilitation that can maximize clinical outcomes. Early and accurate diagnostic information using ultrasound imaging enables individualized care and the ability to monitor healing along with its response to activity and rehabilitation. Purpose: The purpose of this study was to describe and observe the outcomes associated with Point of Care Ultrasound (POCUS) guided early management of acute and sub-acute lateral ankle sprains. Study Design: Case series. Methods: Individuals with a LAS within the prior 28 days underwent a clinical evaluation to include a POCUS exam to assess ligamentous integrity. Objective and POCUS findings were integrated to classify each LAS into one of four categories. Each grade of ankle sprain corresponded to levels of bracing for the protection of injured structures with each patient receiving physical therapy care based on rehabilitation guidelines. Participants completed the Foot and Ankle Ability Measure (FAAM) activities of daily living and Sports subscale, the Foot and Ankle Outcome Score (FAOS), Patient Reported Outcomes Measurement Information Systems Global Health, Tampa Scale of Kinesiophobia (TSK-11), Cumberland Ankle Instability Tool (CAIT), and the Numeric Pain Rating Scale as well as the Ankle Lunge Test and Figure 8 measurements at baseline, 4 weeks, 8 weeks and 12 weeks post enrollment. The FAAM Sport subscale, all FAOS subscales, and the TSK-11 were also collected at 24 weeks while the CAIT was collected at baseline and 24 weeks. Results: Fourteen participants were enrolled with 11 participants completing all data collection. FAAM Sport scores significantly improved at 4, 8, 12 and 24 weeks. All components of the FAOS significantly increased except for Sport scores at four weeks and Quality of Life scores at four and eight weeks. Conclusion: POCUS guided early management and ligamentous protection of LASs resulted in significant short and long-term improvement in function and return to sporting activity. This case series highlights the feasibility of using ultrasound imaging to assess the severity of ligamentous injury and align bracing strategies for ligamentous protection. The observations from this case series suggest that functional bracing strategies focused on ligamentous protection to promote healing and reduce re-injury rates does not delay improvement in functional outcomes. Level of Evidence: Level IV, Case Series.

Clinical and electrodiagnostic abnormalities of the median nerve in Army dental assistants before and after training as preventive dental specialists.

PURPOSE: Dentists and dental hygienists have been reported as having a high prevalence of upper-extremity musculoskeletal disorders, including carpal tunnel syndrome. Unfortunately, previous research has not involved the impact of preventive dental specialist training on dental assistants. Therefore, the purpose of this study was to determine the presence of median and ulnar neuropathies in US Army dental assistants before and after training as preventive dental specialists. METHODS: Thirty-five US Army dental assistants (24 female, 11 male; age range 18-41 years) volunteered for the study. Twenty-eight preventive dental specialist students completed both the pretraining and posttraining data collections. Subjects were evaluated during the first and last weeks of their 12-week course. Subjects completed a history form, were interviewed, and underwent a physical examination. Nerve conduction status of the median and ulnar nerves of both upper extremities were obtained by performing motor, sensory, comparison (unilateral median to ulnar distal motor and sensory latencies), and F-wave nerve conduction studies (NCS). Descriptive statistics for subject demographics and pre to post physical examination and nerve conduction variables were calculated. Chi square (χ²) analysis was also conducted to determine if a significant shift in the prevalence of neuropathies occurred following dental training. RESULTS: With the exception of comparison studies, pre-NCS and post-NCS electrophysiological variables were normal. Specifically, 9 subjects (26%) involving 14 hands (20%) were found to have meaningful (>1.0 millisecond) delayed median to ulnar distal motor latency comparisons in the pretraining assessment. Additionally, there was no statistically significant shift in the prevalence of electrodiagnostic abnormalities of the median nerve following the 12-week training program (χ²=0.280, P=.60). CONCLUSION: The prevalence of clinical and electrodiagnostic abnormalities of the median nerve in this sample of US Army dental assistants closely mirrors the prevalence reported for other dental professionals. This study also demonstrates that, for this sample, the 12-week training program did not appear to affect the electrophysiologic status of the median or ulnar nerves.

Clinical and electrodiagnostic abnormalities of the median nerve in dental assistants.

STUDY DESIGN: Descriptive. OBJECTIVES: To determine the presence of clinical and electrodiagnostic abnormalities of the median and ulnar nerves in both upper extremities of dental assistants. BACKGROUND: A high prevalence of median neuropathies at, or distal to, the wrist have been reported in dentists and dental hygienists. But there is a paucity of literature on the incidence of abnormalities of the median or ulnar nerves in dental assistants. METHODS: Thirty-five United States Army dental assistants (24 female, 11 male; age range, 18-41 years) volunteered for the study. Subjects completed a standardized history and physical examination. Nerve conduction status of the median and ulnar nerves of both upper extremities was obtained by performing motor, sensory, and F-wave (central) nerve conduction studies. RESULTS: All electrophysiological variables were normal for motor, sensory, and F-wave (central) values when compared to a chart of normal values. Based on comparison studies of median and ulnar motor latencies within the same hand, 9 subjects (26%) involving 14 hands (20%) were found to have electrodiagnostic abnormalities of the median nerve at, or distal to, the wrist. The other 26 dental assistants demonstrated normal comparison studies of the median and ulnar nerves in both upper extremities. CONCLUSIONS: In this descriptive study of 35 dental assistants, 9 subjects (26%) were found to have electrodiagnostic abnormalities of the median nerve at, or distal to, the wrist (when compared to the ulnar nerve of the same hand). Ulnar nerve electrophysiological function was within normal limits for all subjects examined.