Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 34
Filtrar
1.
JMIR Mhealth Uhealth ; 11: e44929, 2023 07 05.
Artigo em Inglês | MEDLINE | ID: mdl-37405818

RESUMO

BACKGROUND: Women with urinary incontinence (UI) may consider using digital technologies (DTs) to guide pelvic floor muscle training (PFMT) to help manage their symptoms. DTs that deliver PFMT programs are readily available, yet uncertainty exists regarding whether they are scientifically valid, appropriate, and culturally relevant and meet the needs of women at specific life stages. OBJECTIVE: This scoping review aims to provide a narrative synthesis of DTs used for PFMT to manage UI in women across their life course. METHODS: This scoping review was conducted in accordance with the Joanna Briggs Institute methodological framework. A systematic search of 7 electronic databases was conducted, and primary quantitative and qualitative research and gray literature publications were considered. Studies were eligible if they focused on women with or without UI who had engaged with DTs for PFMT, reported on outcomes related to the use of PFMT DTs for managing UI, or explored users' experiences of DTs for PFMT. The identified studies were screened for eligibility. Data on the evidence base for and features of PFMT DTs using the Consensus on Exercise Reporting Template for PFMT, PFMT DT outcomes (eg, UI symptoms, quality of life, adherence, and satisfaction), life stage and culture, and the experiences of women and health care providers (facilitators and barriers) were extracted and synthesized by ≥2 independent reviewers. RESULTS: In total, 89 papers were included (n=45, 51% primary and n=44, 49% supplementary) involving studies from 14 countries. A total of 28 types of DTs were used in 41 primary studies, including mobile apps with or without a portable vaginal biofeedback or accelerometer-based device, a smartphone messaging system, internet-based programs, and videoconferencing. Approximately half (22/41, 54%) of the studies provided evidence for or testing of the DTs, and a similar proportion of PFMT programs were drawn from or adapted from a known evidence base. Although PFMT parameters and program compliance varied, most studies that reported on UI symptoms showed improved outcomes, and women were generally satisfied with this treatment approach. With respect to life stage, pregnancy and the postpartum period were the most common focus, with more evidence needed for women of various age ranges (eg, adolescent and older women), including their cultural context, which is a factor that is rarely considered. Women's perceptions and experiences are often considered in the development of DTs, with qualitative data highlighting factors that are usually both facilitators and barriers. CONCLUSIONS: DTs are a growing mechanism for delivering PFMT, as evidenced by the recent increase in publications. This review highlighted the heterogeneity in types of DTs, PFMT protocols, the lack of cultural adaptations of most of the DTs reviewed, and a paucity in the consideration of the changing needs of women across their life course.


Assuntos
Diafragma da Pelve , Incontinência Urinária , Gravidez , Feminino , Humanos , Idoso , Adolescente , Qualidade de Vida , Tecnologia Digital , Terapia por Exercício/métodos , Incontinência Urinária/terapia
2.
J Anat ; 243(1): 110-127, 2023 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-36882366

RESUMO

Understanding the musculoskeletal anatomy of soft tissues of the head and neck is important for surgical applications, biomechanical modelling and management of injuries, such as whiplash. Additionally, analysing sex and population differences in cervical anatomy can inform how biological sex and population variation may impact these anatomical applications. Although some muscles of the head and neck are well-studied, there is limited architectural information that also analyses sex and population variation, for many small cervical soft tissues (muscles and ligaments) and associated entheses (soft tissue attachment sites). Therefore, the aim of this study was to present architectural data (e.g., proximal and distal attachment sites, muscle physiological cross-sectional area, ligament mass, enthesis area) and analyse sex and population differences in soft tissues and entheses associated with sexually dimorphic landmarks on the cranium (nuchal crest and mastoid process) and clavicle (rhomboid fossa). Through the dissection and three-dimensional analysis of 20 donated cadavers from New Zealand (five males, five females; mean age 83 ± 8 years; range 67-93 years) and Thailand (five males, five females; 69 ± 13 years; range 44-87 years), the following soft tissues and their associated entheses were analysed: upper trapezius, semispinalis capitis and the nuchal ligament (nuchal crest); sternocleidomastoid, splenius capitis and longissimus capitis (mastoid process); the clavicular head of pectoralis major, subclavius, sternohyoid and the costoclavicular (rhomboid) ligament (rhomboid fossa). Findings indicate that although muscle, ligament and enthesis sizes were generally similar to previously published data, muscle size was smaller for six of the eight muscles in this study, with only the upper trapezius and subclavius demonstrating similar values to previous studies. Proximal and distal attachment sites were largely consistent with the current research. However, some individuals (six of 20) had proximal upper trapezius attachments on the cranium, with most attaching solely to the nuchal ligament, contrasting with existing literature, which often describes attachment to the occipital bone. With respect to sexual dimorphism, the Thai sample exhibited more sex differences in muscle size than the New Zealand sample, but for enthesis size (area), both samples had the same amount of statistically significant sex differences (5 of 10). Additionally, some significant population differences were found when comparing muscle and enthesis size data between the New Zealand and Thai samples. Despite these findings, no sex or population differences were found for ligament size (mass) in either group. This paper presents new architectural data for several understudied areas of the head and neck, as well as providing analyses on sex and population differences, two areas that have limited representation in anatomy.


Assuntos
Caracteres Sexuais , População do Sudeste Asiático , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Ligamentos Articulares , Músculos do Pescoço/anatomia & histologia , Nova Zelândia , Tailândia , Adulto , Pessoa de Meia-Idade
3.
Clin Anat ; 36(2): 190-223, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36177764

RESUMO

Knowledge of musculoskeletal anatomy is fundamental to physical therapy education. Although detailed anatomy syllabi have been developed for medical and other health professional students, none are available for training physical therapists. Therefore, the aim of this project was to produce a core musculoskeletal anatomy syllabus specific to physical therapy students, utilizing a modified Delphi approach. An international Delphi panel (n = 53) composed of anatomists and clinicians involved in physical therapy education considered a total of 2193 anatomical items arranged in four categories (musculoskeletal concepts; vertebral column; pectoral girdle and upper limb; pelvic girdle and lower limb). Using specific criteria, items were rated on the basis of whether they were considered essential knowledge for a competent physical therapy student, and were categorized as core, recommended, not recommended or not core. Of the 2193 items, 1700 (77.5%) were rated as core or recommended. For musculoskeletal concepts, 70% (233/332) of items were categorized as core/recommended. Approximately 80% of items in the other three categories were considered core/recommended-vertebral column (355/440), pectoral girdle and upper limb (513/657), and pelvic girdle and lower limb (599/764). This project presents a detailed musculoskeletal anatomy syllabus which may be used within a physical therapy curriculum. A key difference compared to published musculoskeletal anatomy syllabi for medical students is that a greater number of items are considered core/recommended (approximately 80% vs. 50%). These findings will now be considered and deliberated in accordance with the International Federation of Associations of Anatomists modified Delphi approach.


Assuntos
Anatomistas , Anatomia , Educação de Graduação em Medicina , Estudantes de Medicina , Humanos , Currículo , Coluna Vertebral , Anatomia/educação
4.
Gait Posture ; 100: 33-40, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-36469965

RESUMO

BACKGROUND: People with hip osteoarthritis (OA) typically display altered gluteus minimus (GMin) and gluteus medius (GMed) activity during gait, in addition to reduced walking speed and stride length. It is unknown if current rehabilitation programs address changes in gluteal muscle activity in people with hip OA. RESEARCH QUESTION: Can a targeted gluteal intervention restore normal gluteal muscle segment activity during gait in people with hip OA? METHODS: This study presents secondary outcomes from a multi-site, double-blinded clinical trial in which participants with radiologically confirmed mild-moderate hip OA were randomised into a targeted gluteal or sham intervention for 12-weeks following baseline testing. Electromyography (EMG) outcomes were only conducted at a single site and data were collected from 22 participants. Intramuscular electrodes were inserted into two segments of GMin (anterior, posterior) and three segments of GMed (anterior, middle, posterior) to record average amplitude, peak amplitude and time to peak (TTP) during the first 60 % of the gait cycle (stance phase) at baseline and post-intervention. RESULTS: Following the targeted gluteal intervention, posterior GMin displayed a decrease in average (P = 0.032, ES=1.04) and peak (P = 0.017, ES=1.17) muscle activity during late stance phase with a shift to an earlier TTP (P = 0.034, ES=1.02). There were no further significant changes between groups for other outcome measures. Similar trends for an earlier TTP were observed for the posterior segment of GMed following the targeted intervention (P = 0.095, ES=0.87). The earlier TTP in the posterior segments of both GMin and GMed post-intervention resembled patterns observed in a healthy young population. SIGNIFICANCE: A targeted gluteal intervention can positively impact activity in posterior GMin during gait in people with hip OA when compared to a sham intervention.


Assuntos
Osteoartrite do Quadril , Humanos , Músculo Esquelético/fisiologia , Coxa da Perna/fisiologia , Nádegas/fisiologia , Eletromiografia , Terapia por Exercício
5.
BMC Musculoskelet Disord ; 23(1): 944, 2022 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-36309690

RESUMO

BACKGROUND: People with hip osteoarthritis are typically offered a combination of education and exercise to address muscle atrophy and weakness. Limited evidence exists to assess the efficacy of exercise programs on muscle structure or function in this population. The aim of this study was to evaluate the effects of targeted resistance exercise on gluteal muscle hypertrophy and strength in people with mild-to-moderate hip osteoarthritis. METHODS: Twenty-seven participants with radiologically confirmed hip osteoarthritis recruited from a single site of a multi-site, double-blind clinical trial were randomly allocated to receive a 12-week targeted gluteal intervention or sham intervention. Magnetic resonance imaging and hand-held dynamometry were used to determine change in gluteal muscle volume, fatty infiltration and hip muscle strength. For gluteal muscle volume and strength outcomes mixed model analyses of variance (ANOVA) were conducted. A general linear model (ANOVA) analysis with fixed effects parameter estimates was used to assess the impact of sex on gluteal muscle size and strength of the affected limb only. For muscle fat index a mixed method ANOVA was used to assess the differences between groups and over time. RESULTS: In the targeted intervention group, gluteus minimus volume increased from baseline to post-intervention in both limbs (pooled mean difference: 0.06 cm3/kg, 95% confidence interval: 0.01 to 0.11) while no change occurred in the sham group (time x group effect: P = 0.025). Gluteus medius, gluteus maximus and tensor fascia lata volume did not change significantly over time. Hip strength (abduction, adduction, flexion, extension, external and internal rotation) improved similarly in both groups (time main effect: P ≤ 0.042). There was a consistent, albeit non-significant, pattern of reduced fatty infiltration after the targeted intervention. CONCLUSION: Targeted resistance exercise resulted in gluteus minimus hypertrophy, but improvements in hip strength occurred in both groups. Clinicians delivering hip osteoarthritis rehabilitation programs might consider implementing a targeted exercise program to attenuate disease associated changes within gluteal muscles. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ID: ACTRN12617000970347. Registered prospectively on 5 July 2017.


Assuntos
Osteoartrite do Quadril , Humanos , Osteoartrite do Quadril/diagnóstico por imagem , Osteoartrite do Quadril/terapia , Osteoartrite do Quadril/patologia , Austrália , Força Muscular/fisiologia , Músculo Esquelético/fisiologia , Nádegas , Hipertrofia/patologia
6.
Arthrosc Sports Med Rehabil ; 4(4): e1363-e1372, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36033180

RESUMO

Purpose: To retrospectively evaluate the prevalence and characteristics of ligamentum teres (LT) lesions identified in a single-surgeon hip arthroscopy cohort and to compare surgical outcomes of those with, and without, identified LT lesions. Methods: Patients who underwent primary hip arthroscopy between 2005 and 2018 in one surgeon's clinic were identified. Those with a history involving extra-articular scoping or any previous surgery on the ipsilateral hip were excluded. Patient-reported outcome measures completed before and after surgery included the Hip Disability and Osteoarthritis Outcome Score, Nonarthritic Hip Score, and 12-item International Hip Outcome Tool. Conversion to hip joint replacement was ascertained through a national register. Results: A total of 1,935 primary hip arthroscopies (from 1,607 different patients) were included in this study. In total, 323 LT lesions were identified. Those with LT lesions were older than those without (40.3 ± 11.3 years compared with 33.9 ± 12.1 years; P < .001), and more frequently female (58.2% vs 41.8%; P = .001). Hips with lesions had a smaller lateral center-edge angle than other hips (33.0 ± 6.8° vs 34.1 ± 6.0°; P = .004). All patient-reported outcome measures improved significantly (P < .001) from pre- to post-surgery for patients with and without LT lesions. However, patients with LT lesions reported less improvement in the 12-item International Hip Outcome Tool (difference -5.60; P = .004) and in Hip Disability and Osteoarthritis Outcome Score symptoms (-4.41; P = .004), sports (-7.81; P < .001), and quality of life subscales (-8.85; P < .001) than those without lesions. Hips with LT lesions also had a 6.2% 2-year rate of subsequent hip replacement (20/323 hips) compared with those without lesions (0.9%; 14/1612 hips; P < .001). Conclusions: In this single-surgeon hip arthroscopy cohort, identification of LT lesions was associated with poorer patient-reported outcomes and increased likelihood of conversion to arthroplasty within 2 years. These findings suggest a poorer prognosis for patients with LT injury compared with those without. Level of Evidence: Level III, retrospective cohort study.

7.
Physiotherapy ; 115: 66-84, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35202976

RESUMO

OBJECTIVES: Pregnancy-related pelvic girdle pain (PPGP) contributes to significant prenatal and postpartum impairments; however, various clinical practices exist around the conservative treatment of this condition. This study sought to reach a consensus on the essential components of PPGP management through an international Delphi survey of experts in women's health. DESIGN AND PARTICIPANTS: Eighty-seven international experts in the field of PPGP were invited to participate and surveyed over three rounds. Round 1 of the survey utilised open-ended questions to gain feedback on 16 components of PPGP management previously identified by a focus group. Feedback from panel members guided modification and refinement of questions for Rounds 2 and 3. A 5-point Likert scale was used to rate level of agreement, with a minimum threshold for consensus of ≥75% agreement set across all survey rounds. RESULTS: Forty-four of the 87 (50%) invited professionals agreed to participate in the panel, with 77% (34/44) of panellists contributing to all three rounds. Of the 16 initial components, 15 were included in Round 2. The final consensus was reached on 10 important components of assessment and management after Round 3: pain education, postural and ergonomic advice, social and lifestyle factors, psychological factors, cultural considerations, strengthening exercise, other exercise, exercise precautions, manual therapy and the use of crutches. CONCLUSION: This study identified 10 key components that should be considered in the management of PPGP. In addition, these components provide a potential framework for future research around the conservative management of PPGP.


Assuntos
Dor da Cintura Pélvica , Consenso , Técnica Delfos , Feminino , Humanos , Dor , Dor da Cintura Pélvica/terapia , Modalidades de Fisioterapia , Gravidez
8.
J Anat ; 240(5): 941-958, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-34865216

RESUMO

Shoulder bursae are essential for normal movement and are also implicated in the pathogenesis of shoulder pain and dysfunction. The subacromial bursa (SAB), within the subacromial space, is considered a primary source of shoulder pain. Several other bursae related to the subcoracoid space, including the coracobrachial (CBB), subcoracoid (SCB) and subtendinous bursa of subscapularis (SSB), are also clinically relevant. The detailed morphology and histological characteristics of these bursae are not well described. Sixteen embalmed cadaveric shoulders from eight individuals (five females, three males; mean age 78.6 ± 7.9 years) were investigated using macro-dissection and histological techniques to describe the locations, dimensions and attachments of the bursae, their relationship to surrounding structures and neurovascular supply. Bursal sections were stained with haematoxylin and eosin to examine the synovium and with antibodies against von Willebrand factor and neurofilament to identify blood vessels and neural structures respectively. Four separate bursae were related to the subacromial and subcoracoid spaces. The SAB was large, with a confluent subdeltoid portion in all except one specimen, which displayed a distinct subdeltoid bursa. The SAB roof attached to the lateral edge and deep surface of the acromion and coracoacromial ligament, and the subdeltoid fascia; its floor fused with the supraspinatus tendon and greater tubercle. The CBB (15/16 specimens) was deep to the conjoint tendon of coracobrachialis and short head of biceps brachii and the tip of the coracoid process, while the inconstant SCB (5/16 specimens) was deep to the coracoid process. Located deep to the subscapularis tendon, the SSB was a constant entity that commonly displayed a superior extension. Synovial tissue was predominantly areolar (SAB and SSB) or fibrous (CBB and SCB), with a higher proportion of areolar synovium in the bursal roofs compared to their floors. Blood vessels were consistently present in the subintima with a median density of 3% of the tissue surface area, being greatest in the SSB and SAB roofs (4.9% and 3.4% respectively) and least in the SAB floor (1.8%) and CBB roof and floor (both 1.6%). Nerve bundles and free nerve endings were identified in the subintima in approximately one-third of the samples, while encapsulated nerve endings were present in deeper tissue layers. The extensive expanse and attachments of the SAB support adoption of the term subacromial-subdeltoid bursa. Morphologically, the strong attachments of the bursal roofs and floors along with their free edges manifest as fixed and mobile portions, which enable movement in relation to surrounding structures. The presence of neurovascular structures demonstrates that these bursae potentially contribute blood supply to surrounding structures and are involved in mechanoreception. The anatomical details presented in this study clarify the morphology of the shoulder bursae, including histological findings that offer further insight into their potential function.


Assuntos
Articulação do Ombro , Ombro , Idoso , Idoso de 80 Anos ou mais , Bolsa Sinovial/anatomia & histologia , Bolsa Sinovial/fisiologia , Feminino , Humanos , Masculino , Articulação do Ombro/anatomia & histologia , Dor de Ombro , Tendões
9.
Int Urogynecol J ; 32(7): 1977-1988, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33950309

RESUMO

INTRODUCTION AND HYPOTHESIS: Urinary incontinence (UI) is prevalent during pregnancy and postpartum. UI in pregnancy strongly predicts UI postpartum and later in life. UI reduces women's wellbeing and quality of life and presents a significant burden to healthcare resource. METHODS: A narrative review summarizing quantitative and qualitative evidence about pelvic floor muscle training (PFMT) for prevention and treatment of UI for childbearing women. RESULTS: There are clinically important reductions in the risk of developing UI in pregnancy and after delivery for pregnant women who start PFMT during pregnancy, and PFMT offers additional benefits preventing prolapse and improving sexual function. If women develop UI during pregnancy or postpartum then PFMT is an appropriate first-line treatment. For novice exercisers, a programme comprising eight contractions, with 8-s holds, three times a day, 3 days a week, for at least 3 months is a reasonable minimum and 'generic' prescription. All women need clear accurate verbal instruction in how to do PFMT. Incontinent women, and women who cannot do a correct contraction, require referral for pelvic floor rehabilitation. Behavioural support from maternity care providers (MCPs)-increasing women's opportunity, capability, and motivation for PFMT-is as important as the exercise prescription. CONCLUSION: PFMT is effective to prevent and treat UI in childbearing women. All pregnant and postpartum women, at every contact with a MCP, should be asked if they are continent. Continent women need exercise prescription and behavioural support to do PFMT to prevent UI. Incontinent women require appropriate referral for diagnosis or treatment.


Assuntos
Incontinência Fecal , Serviços de Saúde Materna , Incontinência Urinária , Terapia por Exercício , Feminino , Humanos , Diafragma da Pelve , Gravidez , Qualidade de Vida , Incontinência Urinária/prevenção & controle
10.
Musculoskelet Sci Pract ; 48: 102151, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32560859

RESUMO

BACKGROUND: Symphyseal pain (SP) experienced during pregnancy is a common condition that can negatively influence function and wellbeing. Despite its adverse impact on quality of life, standardised diagnostic criteria for SP as a distinct type of pelvic girdle pain (PGP) are lacking. OBJECTIVES: To develop a reliable self-administered instrument that could differentiate SP from posterior PGP in pregnant women, and ultimately be used for epidemiological or clinical purposes. METHOD: Qualitative data from 17 women (four focus groups) were used to develop a questionnaire. The questionnaire was tested against physical therapy diagnoses based on clinical assessment in 122 pregnant women with SP (n = 41), posterior PGP (n = 41) or no PGP (n = 40); 30 women repeated the questionnaire a day later to assess reliability. Multinomial logistic regression models were used to assess the performance of candidate items in distinguishing between the groups. RESULTS/FINDINGS: The single questionnaire item relating to location of worst pain (diagrammatic form) is useful for differentiating SP from posterior PGP and individuals with no PGP. The worst pain location question with the addition of the Pelvic Girdle Questionnaire provides a measure of "SP with impact", and is the best combination for distinguishing SP and posterior PGP. Test-retest reliability scores were excellent. CONCLUSION: These findings provide new opportunities for diagnosing pregnancy-related SP, and highlight questionnaire items which best differentiate SP from posterior PGP. These items could be used in future epidemiological research, and in clinical settings as a quick, effective screening tool.


Assuntos
Complicações na Gravidez , Qualidade de Vida , Feminino , Humanos , Dor , Medição da Dor , Gravidez , Complicações na Gravidez/diagnóstico , Reprodutibilidade dos Testes , Autorrelato , Inquéritos e Questionários
11.
Cochrane Database Syst Rev ; 5: CD007471, 2020 05 06.
Artigo em Inglês | MEDLINE | ID: mdl-32378735

RESUMO

BACKGROUND: About one-third of women have urinary incontinence (UI) and up to one-tenth have faecal incontinence (FI) after childbirth. Pelvic floor muscle training (PFMT) is commonly recommended during pregnancy and after birth for both preventing and treating incontinence. This is an update of a Cochrane Review previously published in 2017. OBJECTIVES: To assess the effects of PFMT for preventing or treating urinary and faecal incontinence in pregnant or postnatal women, and summarise the principal findings of relevant economic evaluations. SEARCH METHODS: We searched the Cochrane Incontinence Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, CINAHL, ClinicalTrials.gov, WHO ICTRP, and handsearched journals and conference proceedings (searched 7 August 2019), and the reference lists of retrieved studies. SELECTION CRITERIA: We included randomised or quasi-randomised trials in which one arm included PFMT. Another arm was no PFMT, usual antenatal or postnatal care, another control condition, or an alternative PFMT intervention. Populations included women who, at randomisation, were continent (PFMT for prevention) or incontinent (PFMT for treatment), and a mixed population of women who were one or the other (PFMT for prevention or treatment). DATA COLLECTION AND ANALYSIS: We independently assessed trials for inclusion and risk of bias. We extracted data and assessed the quality of evidence using GRADE. MAIN RESULTS: We included 46 trials involving 10,832 women from 21 countries. Overall, trials were small to moderately-sized. The PFMT programmes and control conditions varied considerably and were often poorly described. Many trials were at moderate to high risk of bias. Two participants in a study of 43 pregnant women performing PFMT for prevention of incontinence withdrew due to pelvic floor pain. No other trials reported any adverse effects of PFMT. Prevention of UI: compared with usual care, continent pregnant women performing antenatal PFMT probably have a lower risk of reporting UI in late pregnancy (62% less; risk ratio (RR) 0.38, 95% confidence interval (CI) 0.20 to 0.72; 6 trials, 624 women; moderate-quality evidence). Antenatal PFMT slightly decreased the risk of UI in the mid-postnatal period (more than three to six months' postpartum) (29% less; RR 0.71, 95% CI 0.54 to 0.95; 5 trials, 673 women; high-quality evidence). There was insufficient information available for the late postnatal period (more than six to 12 months) to determine effects at this time point (RR 1.20, 95% CI 0.65 to 2.21; 1 trial, 44 women; low-quality evidence). Treatment of UI: compared with usual care, there is no evidence that antenatal PFMT in incontinent women decreases incontinence in late pregnancy (very low-quality evidence), or in the mid-(RR 0.94, 95% CI 0.70 to 1.24; 1 trial, 187 women; low-quality evidence), or late postnatal periods (very low-quality evidence). Similarly, in postnatal women with persistent UI, there is no evidence that PFMT results in a difference in UI at more than six to 12 months postpartum (RR 0.55, 95% CI 0.29 to 1.07; 3 trials; 696 women; low-quality evidence). Mixed prevention and treatment approach to UI: antenatal PFMT in women with or without UI probably decreases UI risk in late pregnancy (22% less; RR 0.78, 95% CI 0.64 to 0.94; 11 trials, 3307 women; moderate-quality evidence), and may reduce the risk slightly in the mid-postnatal period (RR 0.73, 95% CI 0.55 to 0.97; 5 trials, 1921 women; low-quality evidence). There was no evidence that antenatal PFMT reduces the risk of UI at late postpartum (RR 0.85, 95% CI 0.63 to 1.14; 2 trials, 244 women; moderate-quality evidence). For PFMT started after delivery, there was uncertainty about the effect on UI risk in the late postnatal period (RR 0.88, 95% CI 0.71 to 1.09; 3 trials, 826 women; moderate-quality evidence). Faecal incontinence: eight trials reported FI outcomes. In postnatal women with persistent FI, it was uncertain whether PFMT reduced incontinence in the late postnatal period compared to usual care (very low-quality evidence). In women with or without FI, there was no evidence that antenatal PFMT led to a difference in the prevalence of FI in late pregnancy (RR 0.64, 95% CI 0.36 to 1.14; 3 trials, 910 women; moderate-quality evidence). Similarly, for postnatal PFMT in a mixed population, there was no evidence that PFMT reduces the risk of FI in the late postnatal period (RR 0.73, 95% CI 0.13 to 4.21; 1 trial, 107 women, low-quality evidence). There was little evidence about effects on UI or FI beyond 12 months' postpartum. There were few incontinence-specific quality of life data and little consensus on how to measure it. AUTHORS' CONCLUSIONS: This review provides evidence that early, structured PFMT in early pregnancy for continent women may prevent the onset of UI in late pregnancy and postpartum. Population approaches (recruiting antenatal women regardless of continence status) may have a smaller effect on UI, although the reasons for this are unclear. A population-based approach for delivering postnatal PFMT is not likely to reduce UI. Uncertainty surrounds the effects of PFMT as a treatment for UI in antenatal and postnatal women, which contrasts with the more established effectiveness in mid-life women. It is possible that the effects of PFMT might be greater with targeted rather than mixed prevention and treatment approaches, and in certain groups of women. Hypothetically, for instance, women with a high body mass index (BMI) are at risk of UI. Such uncertainties require further testing and data on duration of effect are also needed. The physiological and behavioural aspects of exercise programmes must be described for both PFMT and control groups, and how much PFMT women in both groups do, to increase understanding of what works and for whom. Few data exist on FI and it is important that this is included in any future trials. It is essential that future trials use valid measures of incontinence-specific quality of life for both urinary and faecal incontinence. In addition to further clinical studies, economic evaluations assessing the cost-effectiveness of different management strategies for FI and UI are needed.


Assuntos
Terapia por Exercício/métodos , Incontinência Fecal/terapia , Diafragma da Pelve , Complicações na Gravidez/terapia , Transtornos Puerperais/terapia , Incontinência Urinária/terapia , Incontinência Fecal/epidemiologia , Incontinência Fecal/prevenção & controle , Feminino , Humanos , Cuidado Pós-Natal , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/prevenção & controle , Cuidado Pré-Natal , Transtornos Puerperais/epidemiologia , Transtornos Puerperais/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Incontinência Urinária/epidemiologia , Incontinência Urinária/prevenção & controle
12.
Anat Sci Educ ; 13(3): 284-300, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32306555

RESUMO

Australian and New Zealand universities commenced a new academic year in February/March 2020 largely with "business as usual." The subsequent Covid-19 pandemic imposed unexpected disruptions to anatomical educational practice. Rapid change occurred due to government-imposed physical distancing regulations from March 2020 that increasingly restricted anatomy laboratory teaching practices. Anatomy educators in both these countries were mobilized to adjust their teaching approaches. This study on anatomy education disruption at pandemic onset within Australia and New Zealand adopts a social constructivist lens. The research question was "What are the perceived disruptions and changes made to anatomy education in Australia and New Zealand during the initial period of the Covid-19 pandemic, as reflected on by anatomy educators?." Thematic analysis to elucidate "the what and why" of anatomy education was applied to these reflections. About 18 anatomy academics from ten institutions participated in this exercise. The analysis revealed loss of integrated "hands-on" experiences, and impacts on workload, traditional roles, students, pedagogy, and anatomists' personal educational philosophies. The key opportunities recognized for anatomy education included: enabling synchronous teaching across remote sites, expanding offerings into the remote learning space, and embracing new pedagogies. In managing anatomy education's transition in response to the pandemic, six critical elements were identified: community care, clear communications, clarified expectations, constructive alignment, community of practice, ability to compromise, and adapt and continuity planning. There is no doubt that anatomy education has stepped into a yet unknown future in the island countries of Australia and New Zealand.


Assuntos
Anatomia/educação , Controle de Doenças Transmissíveis , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Austrália/epidemiologia , COVID-19 , Currículo , Educação a Distância , Humanos , Nova Zelândia/epidemiologia , Pandemias , Faculdades de Medicina , Ensino
13.
J Anat ; 234(6): 778-786, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30882902

RESUMO

The ligament of the head of femur (LHF), or ligamentum teres, is believed to provide blood supply to the head of femur and mechanical stability to the hip joint. But these functions in the adult are often debated. The existence and distribution of neurovascular structures within the ligament are not widely documented. This study examined the blood vessels and nervous tissue within the LHF to determine whether the ligament may have a vascular and proprioceptive function at the hip joint. Histological sections from the LHF from 10 embalmed hips (six female, four male; mean age 80.4 ± 8.7 years) were cut at three levels: the foveal attachment, mid-length and its base where it attaches to the transverse acetabular ligament. Sections were stained with haematoxylin and eosin to study general tissue architecture or with von Willebrand factor and neurofilament to identify blood vessels and nervous tissue, respectively. The proportion of the ligament's cross-sectional area occupied by blood vessels was expressed as a vascularity index (VI). Nerve endings within the ligament were identified and morphologically classified. Comparisons between the VI at the three levels, or between the tissue layers of the ligament, were made using 95% confidence intervals; statistical significance was set P < 0.05. The ligament tissue comprised three distinct layers: a synovial lining with cuboidal cells, a sub-synovial zone formed of loose connective tissue and the ligament proper composed of dense collagen bundles. Patent blood vessels and nerve fibres were present both in the sub-synovial zone and the ligament proper; Pacinian corpuscles and free nerve endings were found scattered only in the sub-synovial zone. The VI of the ligament proper at the fovea was significantly higher than its middle (P = 0.01) and basal levels (P = 0.04); it was also higher than that of the sub-synovial layer (P = 0.04). The LHF has three histologically distinct zones, and blood vessels and nerves are distributed both in the sub-synovial layer and ligament proper. Higher vascularity within the ligament proper at its foveal insertion suggests a possible nutritive role of the LHF to the adult head of femur. The presence of nerves and nerve receptors indicates the ligament is involved in the perception of pain and proprioception, thereby contributing to mechanical stability of the joint.


Assuntos
Ligamento da Cabeça do Fêmur/irrigação sanguínea , Ligamento da Cabeça do Fêmur/inervação , Idoso , Idoso de 80 Anos ou mais , Cadáver , Feminino , Fêmur/anatomia & histologia , Articulação do Quadril/anatomia & histologia , Humanos , Masculino
14.
Clin Anat ; 32(8): 974-1007, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30521127

RESUMO

The study of human anatomy is fundamental to medical education globally. Knowledge of musculoskeletal anatomy is essential for safe and effective clinical practice, yet this topic often receives insufficient medical program time and perceptions differ regarding which knowledge is core. Given the lack of syllabuses specific to musculoskeletal anatomy, this article aims to provide a detailed syllabus for the vertebral column and limbs relevant to medical students. A Delphi panel comprising anatomists and clinicians rated 2,260 anatomical structures and concepts as "essential," "important," "acceptable," or "not required," with evaluations based around the core knowledge deemed acceptable for a competent medical student. Based on the percentage of panelist agreement for an item to be considered "essential," each item was then classified as core (≥60%), recommended (30%-59%), not recommended (20%-29%), or not core (<20%). Items not classified as core or recommended but rated important by greater than 50% of the panel were highlighted for future consideration. A total of 252/389 musculoskeletal concept items were categorized as core or recommended. The number of core or recommended items for the vertebral column, upper limb, and lower limb were 220/438, 322/663, and 318/770, respectively. Ninety-six items were recommended for future consideration. The results of this Delphi panel will be published on the International Federation of Associations of Anatomists website for continuing international consideration and deliberation by relevant stakeholders. The aim is to set an internationally recognized syllabus, that covers the minimum musculoskeletal content that is academically and clinically relevant. Clin. Anat. 32:974-1007, 2019. © 2019 Wiley Periodicals, Inc.


Assuntos
Anatomia/educação , Músculos do Dorso/anatomia & histologia , Educação Médica/normas , Coluna Vertebral/anatomia & histologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
15.
Clin Anat ; 32(3): 396-407, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30592090

RESUMO

The sacrotuberous ligament (STL) has been linked to conditions such as pelvic girdle pain and pudendal nerve entrapment, yet its contribution to pelvic stability is debated. The purpose of this review was to explore the current understanding of the STL and highlight any gaps in knowledge regarding its anatomy and function. A systematic search of the literature was conducted, focussing on the morphology and attachments of the STL, the relationship of the STL with surrounding structures, and its neurovascular supply and function. A total of 67 papers and four textbooks were obtained. The attachment sites of the STL are largely consistent; however, the extent of its connections with the long head of biceps femoris, gluteus maximus, piriformis, the posterior layer of the thoracolumbar fascia, and sacrospinous ligament are unclear. Morphometric parameters, such as mean STL length (6.4-9.4 cm), depth (0.3-0.4 cm), and width (1.8-3.5 cm, at its mid-point) are variable within and between studies, and little is known about potential side-, age-, or sex-related differences. The STL is pierced in several sites by the inferior and superior gluteal arteries, but information on its innervation pattern is sparse. Functionally, the STL may limit sacral nutation but it appears to have a limited contribution to pelvic stability. Some morphological aspects of the STL warrant further investigation, particularly its connections with surrounding structures, innervation pattern and function. Knowledge of the detailed anatomy and function of this ligament is important to better understanding its role in clinical conditions. Clin. Anat. 32:396-407, 2019. © 2018 Wiley Periodicals, Inc.


Assuntos
Ligamentos Articulares/anatomia & histologia , Pelve/anatomia & histologia , Fenômenos Biomecânicos , Nádegas/anatomia & histologia , Feminino , Humanos , Masculino , Articulação Sacroilíaca/anatomia & histologia
16.
Clin Anat ; 32(1): 90-98, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30318771

RESUMO

The ligament of the head of femur (LHF) has gained clinical attention recently and is reported to contribute to hip stability. This study explores its morphology and morphometry, information that may help inform surgical decision making. Gross anatomical dissections were undertaken on 229 embalmed hips from European (n = 105) and Thai (n = 124) adult cadavers to examine LHF anatomy. Ligament morphometry was statistically compared at different sites, between sexes and sides. The origin of ligamental arteries and absence of the ligament were documented. The LHF was pyramidal or quadrangular in shape. Sub-synovial fibrous bands originated from the transverse acetabular ligament, edges of the acetabular notch, and acetabular floor; less frequently from the hip joint capsule. Distally, the ligament flattened and converged onto the fovea capitis. The ligament was 22.3 ± 4.4 mm long and was significantly wider (P = 0.001) and thicker (P = 0.0003) at the fovea, compared to its mid-zone. Branches of the obturator artery entered the acetabular foramen inferomedially and penetrated the middle third of the LHF. Blood vessels ran within the LHF and appeared to enter the fovea. The ligament was absent in 2.8% of Thai hips and there were no significant sex or side differences in ligament dimensions. The morphology of the LHF is complex. While individual variation was apparent, blood vessels were seen in the distal ligament. Precise information on LHF morphometry and attachment sites will help inform appropriate graft dimensions and choice of fixation sites necessary for ligament reconstruction. Clin. Anat., 2018. © 2018 Wiley Periodicals, Inc. Clin. Anat., 2018. © 2018 Wiley Periodicals, Inc.


Assuntos
Ligamento da Cabeça do Fêmur/anatomia & histologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Cabeça do Fêmur/anatomia & histologia , Humanos , Masculino , Valores de Referência
17.
Cochrane Database Syst Rev ; 12: CD007471, 2017 12 22.
Artigo em Inglês | MEDLINE | ID: mdl-29271473

RESUMO

BACKGROUND: About one-third of women have urinary incontinence and up to one-tenth have faecal incontinence after childbirth. Pelvic floor muscle training (PFMT) is commonly recommended during pregnancy and after birth for both prevention and treatment of incontinence.This is an update of a review previously published in 2012. OBJECTIVES: To determine the effectiveness of pelvic floor muscle training (PFMT) in the prevention or treatment of urinary and faecal incontinence in pregnant or postnatal women. SEARCH METHODS: We searched the Cochrane Incontinence Specialised Register (16 February 2017) and reference lists of retrieved studies. SELECTION CRITERIA: Randomised or quasi-randomised trials in pregnant or postnatal women. One arm of the trial included PFMT. Another arm was no PFMT, usual antenatal or postnatal care, another control condition, or an alternative PFMT intervention. DATA COLLECTION AND ANALYSIS: Review authors independently assessed trials for inclusion and risk of bias. We extracted data and checked them for accuracy. Populations included: women who were continent (PFMT for prevention), women who were incontinent (PFMT for treatment) at randomisation and a mixed population of women who were one or the other (PFMT for prevention or treatment). We assessed quality of evidence using the GRADE approach. MAIN RESULTS: The review included 38 trials (17 of which were new for this update) involving 9892 women from 20 countries. Overall, trials were small to moderate sized, and the PFMT programmes and control conditions varied considerably and were often poorly described. Many trials were at moderate to high risk of bias. Other than two reports of pelvic floor pain, trials reported no harmful effects of PFMT.Prevention of urinary incontinence: compared with usual care, continent pregnant women performing antenatal PFMT may have had a lower risk of reporting urinary incontinence in late pregnancy (62% less; risk ratio (RR) for incontinence 0.38, 95% confidence interval (CI) 0.20 to 0.72; 6 trials, 624 women; low-quality evidence). Similarly, antenatal PFMT decreased the risk of urinary incontinence in the mid-postnatal period (more than three to six months' postpartum) (29% less; RR 0.71, 95% CI 0.54 to 0.95; 5 trials, 673 women; moderate-quality evidence). There was insufficient information available for the late (more than six to 12 months') postnatal period to determine effects at this time point.Treatment of urinary incontinence: it is uncertain whether antenatal PFMT in incontinent women decreases incontinence in late pregnancy compared to usual care (RR 0.70, 95% CI 0.44 to 1.13; 3 trials, 345 women; very low-quality evidence). This uncertainty extends into the mid- (RR 0.94, 95% CI 0.70 to 1.24; 1 trial, 187 women; very low-quality evidence) and late (RR 0.50, 95% CI 0.13 to 1.93; 2 trials, 869 women; very low-quality evidence) postnatal periods. In postnatal women with persistent urinary incontinence, it was unclear whether PFMT reduced urinary incontinence at more than six to 12 months' postpartum (RR 0.55, 95% CI 0.29 to 1.07; 3 trials; 696 women; very low-quality evidence).Mixed prevention and treatment approach to urinary incontinence: antenatal PFMT in women with or without urinary incontinence (mixed population) may decrease urinary incontinence risk in late pregnancy (26% less; RR 0.74, 95% CI 0.61 to 0.90; 9 trials, 3164 women; low-quality evidence) and the mid-postnatal period (RR 0.73, 95% CI 0.55 to 0.97; 5 trials, 1921 women; very low-quality evidence). It is uncertain if antenatal PFMT reduces urinary incontinence risk late postpartum (RR 0.85, 95% CI 0.63 to 1.14; 2 trials, 244 women; low-quality evidence). For PFMT begun after delivery, there was considerable uncertainty about the effect on urinary incontinence risk in the late postnatal period (RR 0.88, 95% CI 0.71 to 1.09; 3 trials, 826 women; very low-quality evidence).Faecal incontinence: six trials reported faecal incontinence outcomes. In postnatal women with persistent faecal incontinence, it was uncertain whether PFMT reduced incontinence in the late postnatal period compared to usual care (RR 0.68, 95% CI 0.24 to 1.94; 2 trials; 620 women; very low-quality evidence). In women with or without faecal incontinence (mixed population), antenatal PFMT led to little or no difference in the prevalence of faecal incontinence in late pregnancy (RR 0.61, 95% CI 0.30 to 1.25; 2 trials, 867 women; moderate-quality evidence). For postnatal PFMT in a mixed population, there was considerable uncertainty about the effect on faecal incontinence in the late postnatal period (RR 0.73, 95% CI 0.13 to 4.21; 1 trial, 107 women, very low-quality evidence).There was little evidence about effects on urinary or faecal incontinence beyond 12 months' postpartum. There were few incontinence-specific quality of life data and little consensus on how to measure it. We found no data on health economics outcomes. AUTHORS' CONCLUSIONS: Targeting continent antenatal women early in pregnancy and offering a structured PFMT programme may prevent the onset of urinary incontinence in late pregnancy and postpartum. However, the cost-effectiveness of this is unknown. Population approaches (recruiting antenatal women regardless of continence status) may have a smaller effect on urinary incontinence, although the reasons for this are unclear. It is uncertain whether a population-based approach for delivering postnatal PFMT is effective in reducing urinary incontinence. Uncertainty surrounds the effects of PFMT as a treatment for urinary incontinence in antenatal and postnatal women, which contrasts with the more established effectiveness in mid-life women.It is possible that the effects of PFMT might be greater with targeted rather than mixed prevention and treatment approaches and in certain groups of women. Hypothetically, for instance, women with a high body mass index are at risk factor for urinary incontinence. Such uncertainties require further testing and data on duration of effect are also needed. The physiological and behavioural aspects of exercise programmes must be described for both PFMT and control groups and how much PFMT women in both groups do, to increase understanding of what works and for whom.Few data exist on faecal incontinence or costs and it is important that both are included in any future trials. It is essential that future trials use valid measures of incontinence-specific quality of life for both urinary and faecal incontinence.


Assuntos
Terapia por Exercício/métodos , Incontinência Fecal/terapia , Diafragma da Pelve , Complicações na Gravidez/terapia , Incontinência Urinária/terapia , Incontinência Fecal/prevenção & controle , Feminino , Humanos , Cuidado Pós-Natal , Gravidez , Complicações na Gravidez/prevenção & controle , Cuidado Pré-Natal , Ensaios Clínicos Controlados Aleatórios como Assunto , Incontinência Urinária/prevenção & controle
18.
Surg Radiol Anat ; 39(9): 1017-1027, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28324130

RESUMO

PURPOSE: Despite being the largest ligament on the posterior aspect of the knee, relatively little is known about the normal morphology of the oblique popliteal ligament (OPL). The aim of this study was to investigate the detailed anatomy of the OPL in cadavers and healthy volunteers. METHODS: The posterior knee was investigated in 25 cadaver lower limbs (mean age 76 ± 9.5 years; 7 men) by dissection, histology, and serial plastination and in 14 healthy individuals (mean age 23 ± 3.2 years; 11 men) using magnetic resonance (MR) imaging. OPL morphology, attachments sites, ligament length and width, relationship to surrounding structures and histological composition were recorded. Intraobserver reliability was assessed using intraclass correlation coefficients. RESULTS: The OPL is a distinct expansion of the semimembranosus (SM) tendon and sheath, which courses superolaterally to attach to the posterolateral joint capsule or fabella (when present), at the medial margin of the lateral femoral condyle. The ligament blends with the joint capsule medially and laterally, serves as an attachment site for plantaris, and has connections with popliteus. In 70% of dissections, the OPL divided into two bands, separated by small branches of the middle genicular neurovascular bundle that pierced the posterior joint capsule. Differences in mediolateral length were noted between dissection and MR imaging (43.6 ± 6.2 vs. 57.6 ± 4.4 mm; p < 0.001). At its medial and lateral attachments, the OPL was 23.2 ± 6.9 and 17.4 ± 8.7 mm wide (proximodistal), respectively. The OPL was predominantly composed of transverse collagen layers, with little elastin. While visible on axial MR scans, delineation of its most lateral extent was difficult. Repeatability of selected measurements ranged from good to almost perfect. CONCLUSIONS: The OPL is a distinct ligament with identifiable anatomical limits. Based on its morphological characteristics, it appears more tendinous than ligamentous in nature. A better understanding of the OPL may help define its importance in the assessment and treatment of posterior knee injuries.


Assuntos
Articulação do Joelho/anatomia & histologia , Articulação do Joelho/diagnóstico por imagem , Ligamentos Articulares/anatomia & histologia , Ligamentos Articulares/diagnóstico por imagem , Imageamento por Ressonância Magnética , Idoso , Pontos de Referência Anatômicos , Cadáver , Dissecação , Voluntários Saudáveis , Técnicas Histológicas , Humanos , Reprodutibilidade dos Testes , Adulto Jovem
19.
Surg Radiol Anat ; 39(8): 849-857, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28258300

RESUMO

PURPOSE: Morphological data pertaining to the pelvis and lower extremity muscles are increasingly being used in biomechanical modeling to compare healthy and pathological conditions. Very few data sets exist that encompass all of the muscles of the lower limb, allowing for comparisons between regions. The aims of this study were to (a) provide physiological cross-sectional area (PCSA) data for the pelvic, thigh, and leg muscles in young, healthy participants, using magnetic resonance imaging (MRI), and (b) to compare these data with summarized PCSAs obtained from the literature. MATERIALS AND METHODS: Six young and healthy volunteers participated and were scanned using 3 T MRI. PCSAs were calculated from volumetric segmentations obtained bilaterally of 28 muscles/muscle groups of the pelvis, thigh, and leg. These data were compared to published, summarized PCSA data derived from cadaveric, computed tomography, MRI and ultrasound studies. RESULTS: The PCSA of the pelvis, thigh, and leg muscles tended to be 20-130% larger in males than in females, except for the gemelli which were 34% smaller in males, and semitendinosus and triceps surae which did not differ (<20% different). The dominant and the non-dominant sides showed similar and minutely different PCSA with less than 18% difference between sides. Comparison to other studies revealed wide ranges within, and large differences between, the cadaveric and imaging PCSA data. Comparison of the PCSA of this study and published literature revealed major differences in the iliopsoas, gluteus minimus, tensor fasciae latae, gemelli, obturator internus, biceps femoris, quadriceps femoris, and the deep leg flexor muscles. CONCLUSIONS: These volume-derived PCSAs of the pelvic and lower limb muscles alongside the data synthesised from the literature may serve as a basis for comparative and biomechanical studies of the living and healthy young, and enable calculation of muscle forces. Comparison of the literature revealed large variations in PCSA from each of the different investigative modalities, hampering comparability between studies. Sample size, age, post-mortem changes of muscle tone, chemical fixation of cadaveric tissues, and the underlying physics of the imaging techniques may potentially influence PCSA calculations.


Assuntos
Imageamento por Ressonância Magnética/métodos , Músculo Esquelético/anatomia & histologia , Pelve/anatomia & histologia , Coxa da Perna/anatomia & histologia , Voluntários Saudáveis , Humanos , Fatores Sexuais
20.
Surg Radiol Anat ; 39(7): 791-798, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28097394

RESUMO

BACKGROUND: There is little published information on the anatomy of the fovea capitis femoris (FCF), the distal attachment site of the ligament of the head of femur (LHF). This study investigates the morphology of the FCF on dry bones in an attempt to answer some of the debate around the functional significance of the LHF. METHODS: The morphological and morphometric details of the FCF were analysed on 125 dry isolated femora (n = 125) from the Anatomy Museum, University of Otago, New Zealand. RESULTS: All femora had a single distinct FCF. The proximal half of the foveal floor was rough indicating the attachment of the LHF, while the distal half or receptacle zone, was smooth. The long axis of most FCF (63.2%) was directed posteroinferiorly. The FCF measured 1.77 ± 0.4 cm (SD) in the longitudinal plane and 1.3 ± 0.32 cm (SD) in the transverse plane and occupied 17% of the surface area of the femoral head. The shape of the FCF was oval in 66%, circular in 28%, and triangular in 6%. In 123 of 125 bones, the FCF was located on the posteroinferior quadrant of the femoral head. Multiple vascular foramina were found in the ligament attachment zone in 76% of the bones and a quarter of the samples showed a shallow perifoveal groove (24%) or a deep perifoveal notch (26%) on the dry bones. DISCUSSION: This study shows that the fovea consistently lies posteroinferior to the true centre of the femoral head and is usually oval in shape. Patent vascular foramina clustered within the LHF attachment site suggest that the ligament conveys some blood supply to the femoral head in adults.


Assuntos
Cabeça do Fêmur/anatomia & histologia , Variação Anatômica , Humanos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...