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1.
Clin Podiatr Med Surg ; 37(3): 577-592, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32471620

RESUMO

Optimal healing for fractures requires anatomic reduction and stable fixation. This optimizes not only bone healing, but optimal function within the limb including joint functioning. Proper ligamentous healing is also crucial for optimal functioning. In patients with injuries around the ankle involving distal tibiofibular syndesmotic injuries of the ankle, malreduction of the syndesmosis is a potential consequence that can lead to chronic pain and functional limitations. This article discusses proper ways of evaluating reduction of the syndesmosis and surgical revision for the chronic injury.


Assuntos
Fraturas do Tornozelo/cirurgia , Traumatismos do Tornozelo/cirurgia , Instabilidade Articular/cirurgia , Adulto , Fraturas do Tornozelo/complicações , Fraturas do Tornozelo/diagnóstico , Traumatismos do Tornozelo/complicações , Traumatismos do Tornozelo/diagnóstico , Artralgia/etiologia , Artralgia/cirurgia , Dor Crônica/etiologia , Dor Crônica/cirurgia , Humanos , Instabilidade Articular/complicações , Instabilidade Articular/diagnóstico , Masculino , Reoperação
2.
Sports Health ; 12(4): 390-394, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32223694

RESUMO

CONTEXT: Lesser metatarsophalangeal (MTP) instability is a common condition that can become debilitating and require surgery. EVIDENCE ACQUISITION: An extensive literature review was performed through MEDLINE and Google Scholar for publications relating to the etiology, diagnosis, and treatment of lesser MTP instability using the keywords metatarsophalangeal instability, athlete, forefoot pain, and metatarsalgia from database inception to 2019. STUDY DESIGN: Clinical review. LEVEL OF EVIDENCE: Level 4. RESULTS: Lesser MTP instability is a common condition, especially in the active and aging populations. It is frequently misdiagnosed, causing delays in treatment that allow for progressive pain and deformity, which prevents an active lifestyle. Fortunately, MTP instability can be diagnosed easily with the drawer test. Magnetic resonance imaging is helpful when still in doubt. Conservative treatment entails joint immobilization and gradual return to play with taping and offloading metatarsal pads. CONCLUSION: Lesser MTP instability is a common diagnosis. Its early detection and conservative treatment can help the patient regain their previous level of activity and avoid surgery.


Assuntos
Tratamento Conservador , Instabilidade Articular/diagnóstico , Instabilidade Articular/terapia , Metatarsalgia/etiologia , Fatores Etários , Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/etiologia , Traumatismos em Atletas/cirurgia , Traumatismos em Atletas/terapia , Humanos , Instabilidade Articular/complicações , Instabilidade Articular/cirurgia , Imagem por Ressonância Magnética , Metatarsalgia/diagnóstico , Metatarsalgia/cirurgia , Metatarsalgia/terapia , Exame Físico , Resultado do Tratamento
4.
Med. clín (Ed. impr.) ; 154(3): 94-97, feb. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-189061

RESUMO

ANTECEDENTES Y OBJETIVO: En este trabajo se pretende describir el tipo de pie y las alteraciones podológicas más frecuentes, el nivel de dolor, la discapacidad, la fatiga y la alteración de la calidad de vida que presentan los pacientes con síndrome de Ehlers-Danlos (SED). MATERIALES Y MÉTODOS: Treinta y ocho individuos con SED tipo hipermóvil o clásico fueron reclutados. Se registró el porcentaje de dolor en el pie y las deformidades, y se les aplicaron distintos cuestionarios. El tipo de pie se clasificó según la huella y el Foot Posture Index. RESULTADOS: Se registra un alto grado de dolor, discapacidad, intensidad de la fatiga y bajo nivel de calidad de vida en estos pacientes. Según la huella el 20% presentó pies planos, el 47% pies normales y el 33% pies cavos. CONCLUSIONES: Los participantes en este estudio presentaron un alto porcentaje de problemas podológicos, altos niveles de dolor y limitación de la funcionalidad en los pies. La calidad de vida de estos pacientes aparece disminuida. Se han observado tipos de pies según la huella y de deformidades similares a la población general


BACKGROUND AND OBJECTIVE: This paper aims to describe the type of foot and most frequent podiatric alterations, as well as the level of pain, disability, fatigue and alteration of quality of life in patients with Ehlers-Danlos syndrome (EDS). MATERIALS AND METHODS: Thirty-eight individuals with hypermobile or classic EDS participated. The percentage of pain in the foot and deformities was recorded, and several questionnaires were administered. The type of foot was classified according to the footprint and the Foot Posture Index. RESULTS: There was a high degree of pain, disability, intensity of fatigue and low quality of life in these patients. According to the footprint, 20% presented flat feet, 47% normal feet and 33% cavus feet. CONCLUSIONS: The participants in this study had a high percentage of foot problems related to high levels of pain and limited functionality in the feet. The quality of life of these patients appeared diminished. Foot types were observed according to the footprint and deformities similar to those of the general population


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Síndrome de Ehlers-Danlos/fisiopatologia , Deformidades do Pé/fisiopatologia , Instabilidade Articular/fisiopatologia , Deformidades do Pé/complicações , Avaliação da Deficiência , Qualidade de Vida , Fadiga/complicações , Inquéritos e Questionários , Instabilidade Articular/complicações , Estudos Transversais , Medição da Dor , Hallux Valgus/diagnóstico , Fatores de Risco
5.
Curr Pain Headache Rep ; 24(3): 8, 2020 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-32020393

RESUMO

PURPOSE OF REVIEW: Chronic ankle pain is a prevalent and significant cause of chronic pain. While the definition of chronic ankle pain is heterogeneous and poorly defined in the literature, systematic reviews and meta-analyses have estimated this condition to be a prevalent and debilitating source of chronic pain. The most identifiable and prominent cause of chronic ankle pain is chronic ankle instability (CAI), a condition defined by instability of the ankle-joint complex. It is a common consequence of lateral ankle sprains or ligamentous injuries and can be described as a failure of the lateral ankle joint complex after an acute, or recurring, ankle injury. The objective of this manuscript is to provide a comprehensive review of CAI diagnosis and our current understanding of minimally invasive treatment options. RECENT FINDINGS: First-line treatment is conservative management, some of which includes neuromuscular rehabilitation, balance training, nonsteroidal anti-inflammatory drugs (NSAIDs), manual mobilization, ice therapy, and compression. While conservative management is effective, additional treatments for those who fail conservative management, or who seek alternative options also have been explored. Recent advances and modern techniques have expanded available treatment options, many of which are becoming less invasive, and have shown improving functionality, recovery, and patient satisfaction. Minimally invasive treatments highlighted in this review include: arthroscopic surgery, steroid injections, plasma-rich plasma injections, hyaluronic acid (HA) injections, medicinal signaling cell injections, radiofrequency therapies, and shockwave therapies. This review will discuss some of these current treatments for minimally invasive treatment of CAI, as well as suggest novel treatments for clinical trials and further investigation.


Assuntos
Traumatismos do Tornozelo/terapia , Dor Crônica/etiologia , Dor Crônica/terapia , Instabilidade Articular/complicações , Corticosteroides/administração & dosagem , Traumatismos do Tornozelo/etiologia , Articulação do Tornozelo , Artroscopia/métodos , Ondas de Choque de Alta Energia/uso terapêutico , Humanos , Ácido Hialurônico/uso terapêutico , Injeções Intra-Articulares , Instabilidade Articular/terapia , Manejo da Dor/métodos , Plasma Rico em Plaquetas , Terapia por Radiofrequência/métodos
6.
J Shoulder Elbow Surg ; 29(6): 1259-1266, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32061512

RESUMO

BACKGROUND: We sought to determine injury mechanisms and soft tissue injury patterns of dislocation caused by posteromedial rotatory instability (PMRI) and simple posteromedial (PM) dislocation of the elbow joint that appear similar on simple radiographs. METHODS: In this retrospective case-series study, we reviewed 13 patients with PMRI dislocation and 10 patients with simple PM dislocation. Three-dimensional computed tomography and magnetic resonance imaging were performed in both groups. The ulnar collateral ligament, lateral collateral ligament complex (LCLC), overlying extensor muscle, and locus of bone contusion were identified. The direction of dislocation was categorized into the pure-posterior or PM type by simple radiographs. RESULTS: The LCLC was completely ruptured in both groups. A completely torn ulnar collateral ligament was observed in 3 patients (23%) in the PMRI dislocation group and 9 patients (90%) in the simple PM dislocation group (P = .005). Regarding injury patterns of the LCLC and overlying extensor muscle, the distraction type was found in 10 patients (77%) and the stripping type was found in 3 patients (23%) in the PMRI dislocation group, whereas all patients (100%) in the simple PM dislocation group had the distraction type (P = .103). Bone contusion was observed at the posterolateral olecranon in 2 patients (15%) in the PMRI dislocation group and at the PM olecranon in 4 patients (40%), posterolateral olecranon in 1 (10%), posterior olecranon in 1 (10%), and PM-posterolateral olecranon in 1 (10%) in the simple PM dislocation group (P = .008). In the PMRI dislocation group, 7 patients (54%) had the PM type and 6 (46%) had the pure-posterior type. CONCLUSIONS: Simple PM and PMRI dislocations of the elbow joint might have different soft tissue injury characteristics because of different injury mechanisms.


Assuntos
Articulação do Cotovelo/lesões , Luxações Articulares/complicações , Instabilidade Articular/complicações , Lesões dos Tecidos Moles/etiologia , Adulto , Idoso , Articulação do Cotovelo/fisiopatologia , Feminino , Humanos , Imageamento Tridimensional , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/fisiopatologia , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/fisiopatologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Estudos Retrospectivos , Lesões dos Tecidos Moles/diagnóstico por imagem , Lesões dos Tecidos Moles/fisiopatologia , Tomografia Computadorizada por Raios X , Adulto Jovem
7.
J Pediatr Orthop ; 40(2): 71-77, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31923166

RESUMO

BACKGROUND: The majority of research on medial (MCL) and lateral (LCL) collateral ligament injuries has focused on adults and combined collateral/cruciate injuries. The purpose of this study was to determine characteristics associated with isolated collateral ligament injuries in adolescents, and assess timing for return to sports. METHODS: Electronic medical records were queried to identify patients aged below 17 years who sustained a magnetic resonance imaging-confirmed isolated MCL or LCL injury over an 8-year period. Retrospective review then documented patient and injury characteristics and clinical course. General linear modeling was used to analyze risk factors for prolonged return to sports, continued pain or reinjury. RESULTS: Fifty-one knees (33 in males, 65%), mean age 13.8 years (range, 5 to 17), were identified, of which 40 (78%) had MCL injuries. Over half (29, 57%) of knees had an open distal femoral physis including all 5 bony avulsion injuries. Eleven (22%) had LCL injuries of which 3 (6%) had concurrent posterolateral corner injuries. Forty-two (82%) knees had injuries that occurred during sports. Eleven knees (28%) with MCL tears had a simultaneous patellar instability episode. Knee injuries that occurred during sports had 37% shorter recovery time (P=0.02). Eight knees (16%) experienced a reinjury and 12 (24%) were followed over an extended period of time for various knee issues. Football injuries were more likely to be grade 3 (P=0.03), and football and soccer accounted for all grade III injuries. The mean return to sports was 2.2 months, with grade III cases returning at 2.4 months, and 95% of cases within 4 months. CONCLUSIONS: Isolated collateral ligament injuries are rare in adolescent athletes. MCL injuries, one-quarter of which occurred in conjunction with patellar instability events, were 4 times more common than LCL injuries, one quarter of which have other posterolateral corner structures involved. Grade III injuries represent 20% to 25% of collateral ligament injuries and occurred most commonly in football and soccer. LEVEL OF EVIDENCE: Level IV-retrospective case series.


Assuntos
Instabilidade Articular/complicações , Traumatismos do Joelho/complicações , Ligamento Colateral Médio do Joelho/lesões , Articulação Patelofemoral/lesões , Volta ao Esporte , Adolescente , Traumatismos em Atletas/diagnóstico por imagem , Traumatismos em Atletas/terapia , Criança , Feminino , Humanos , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/terapia , Traumatismos do Joelho/diagnóstico por imagem , Traumatismos do Joelho/terapia , Imagem por Ressonância Magnética , Masculino , Ligamento Colateral Médio do Joelho/diagnóstico por imagem , Recidiva , Estudos Retrospectivos , Lesões dos Tecidos Moles/complicações , Lesões dos Tecidos Moles/diagnóstico por imagem , Lesões dos Tecidos Moles/terapia , Fatores de Tempo
8.
Spine Deform ; 8(1): 135-138, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31950479

RESUMO

STUDY DESIGN: Case report. OBJECTIVE: To describe the importance of preoperative halo-gravity traction and posterior vertebral column resection (PVCR) for severe proximal thoracic kyphoscoliosis associated with Desbuquois dysplasia, after breakage of a growing rod construct. Desbuquois dysplasia is a rare, autosomal recessive chondrodysplasia characterized by short stature, joint laxity, kyphoscoliosis, and characteristic facial dysmorphism. Our 8-year-old patient developed severe, progressive, infantile-onset kyphoscoliosis and had been initially treated with Vertical Expandable Prosthetic Titanium Rib (VEPTR) rods. She subsequently underwent growing rod placement, but the eventual rod fracture resulted in a severe angular kyphosis. METHODS: Clinical and radiographic case review. RESULTS: The broken implants were removed, and she was treated with 2.5 months of preoperative halo-gravity traction. She then underwent a T4 PVCR and C7-L4 instrumented posterior spinal fusion. The patient had an uneventful postoperative course without any neurologic problems. Two years postoperatively, correction was well maintained with appropriate alignment and balance without implant breakage. CONCLUSION: To our knowledge, this is the first report of treatment of spinal deformity associated with Desbuquois dysplasia. Our results suggest that preoperative halo-gravity traction and PVCR are safe and efficacious techniques for severe rigid kyphoscoliosis in the cervicothoracic region associated with broken growing rods in a patient with Desbuquois dysplasia. LEVEL OF EVIDENCE: Level IV.


Assuntos
Anormalidades Craniofaciais/cirurgia , Nanismo/cirurgia , Instabilidade Articular/cirurgia , Cifose/cirurgia , Ossificação Heterotópica/cirurgia , Polidactilia/cirurgia , Próteses e Implantes/efeitos adversos , Falha de Prótese/efeitos adversos , Escoliose/cirurgia , Fusão Vertebral/métodos , Vértebras Torácicas/cirurgia , Titânio/efeitos adversos , Criança , Anormalidades Craniofaciais/complicações , Remoção de Dispositivo , Nanismo/complicações , Feminino , Gravitação , Humanos , Instabilidade Articular/complicações , Cifose/complicações , Ossificação Heterotópica/complicações , Polidactilia/complicações , Escoliose/complicações , Índice de Gravidade de Doença , Tração/métodos , Resultado do Tratamento
9.
J Pediatr ; 218: 114-120.e3, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31955876

RESUMO

OBJECTIVES: To evaluate the prevalence of orthostatic intolerance and joint hypermobility in schoolchildren with and without functional gastrointestinal disorders (FGIDs) and to assess autonomic nervous system dysfunction in children with FGIDs and joint hypermobility. STUDY DESIGN: Schoolchildren (10-18 years) attending public schools from 3 Colombian cities (Cali, Palmira, and Bucaramanga) completed validated questionnaires for FGIDs and underwent testing for hypermobility and autonomic nervous system dysfunction. Heart rate and blood pressure were assessed in recumbency and upright position at regular intervals. The differences in characteristics between schoolchildren with and without FGIDs were compared with a t-test for continuous variables and with a Fisher exact test (2 × 2 contingency tables) for categorical variables. RESULTS: In total, 155 children with FGIDs were matched with 151 healthy controls. Children with FGIDs had historically significant greater frequency of 10 of 12 symptoms of orthostatic intolerance, no significant difference in any symptoms of orthostatic intolerance during recumbency, significantly greater frequency in 6 of 12 symptoms of orthostatic intolerance during orthostasis, trend toward statistical significance for orthostatic intolerance (P = .0509), and no significant difference in prevalence of orthostatic hypotension (OH) and postural orthostatic tachycardia syndrome (POTS). There was no significant difference in prevalence of orthostatic intolerance, OH, and POTS between those with joint hypermobility and those without. CONCLUSIONS: Children with FGIDs have a greater prevalence of symptoms of orthostatic intolerance but were not more likely to have OH and POTS as compared with children without FGIDs. Children with joint hypermobility did not have a greater prevalence of orthostatic intolerance, OH, and POTS.


Assuntos
Doenças do Sistema Nervoso Autônomo/fisiopatologia , Gastroenteropatias/fisiopatologia , Instabilidade Articular/fisiopatologia , Intolerância Ortostática/fisiopatologia , Adolescente , Doenças do Sistema Nervoso Autônomo/complicações , Pressão Sanguínea , Estudos de Casos e Controles , Criança , Colômbia , Feminino , Gastroenteropatias/complicações , Frequência Cardíaca , Humanos , Instabilidade Articular/complicações , Masculino , Intolerância Ortostática/complicações , Síndrome da Taquicardia Postural Ortostática/complicações , Síndrome da Taquicardia Postural Ortostática/fisiopatologia , Prevalência , Inquéritos e Questionários
10.
Rev. logop. foniatr. audiol. (Ed. impr.) ; 39(4): 173-181, oct.-dic. 2019. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-191300

RESUMO

Introducción: La hiperlaxitud articular es un síndrome frecuente en niños y mujeres; sus repercusiones en el sistema musculoesquelético son variadas y cursan con distintos grados de severidad. Sus consecuencias en la función vocal han sido estudiadas escasamente impidiendo así, muchas veces, su óptimo abordaje clínico. Objetivo: Describir el comportamiento vocal de mujeres con síndrome de hiperlaxitud articular. Material y método: Se estudió a una muestra de 40 mujeres con diagnóstico médico de síndrome de hiperlaxitud articular. La evaluación se llevó a cabo utilizando videolaringoestroboscopia, electroglotografía, análisis acústico, pruebas de intensidad y de sobrecarga vocal. Resultados: En la videolaringoestroboscopia se pudo evidenciar menor desarrollo muscular, asimetría vibratoria y desbalance aritenoideo. En la electroglotografía el CQ de la muestra fue de 0.4+/-0.05. La intensidad máxima promedio fue de 85.8+/-6.2dB y el tiempo máximo fonatorio, de 11.8+/-3.1s. En las tareas de sobrecarga la muestra presentó rápida fatigabilidad. Conclusiones: El comportamiento vocal de los sujetos que presentan síndrome de hiperlaxitud articular expresa insuficiencia glótica, debido a la falta de resistencia muscular de los pliegues vocales


Introduction: Joint hypermobility is a frequent syndrome in children and women, its impact on the musculoskeletal system are diverse and occur with different degrees of severity. Its consequences on vocal function have been studied sparingly, often preventing its optimal clinical approach. Objective: To describe the vocal behaviour of women with joint hypermobility syndrome. Material and method: A sample of 40 women with a medical diagnosis of joint hypermobility syndrome was studied. The assessment was carried out using video laryngeal stroboscopy, electroglottography, acoustic analysis, intensity and vocal overload tests. Results: In video laryngeal stroboscopy it was possible to demonstrate less muscle development, vibratory asymmetry and arytenoid imbalance. In the electroglottography, the CQ of the sample was 0.4+/-0.05. The average maximum intensity was 85.8+/-6.2dB and the maximum phonatory time was 11.8+/-3.1s. In the tasks of the overload the sample showed rapid fatigability. Conclusions: The vocal behaviour of the subjects suffering from joint hypermobility syndrome implies glottic insufficiency, due to a lack of muscular development of the vocal folds


Assuntos
Humanos , Feminino , Adulto Jovem , Adulto , Instabilidade Articular/complicações , Distúrbios da Voz/diagnóstico , Laringoscopia/métodos , Estroboscopia/métodos , Síndrome de Ehlers-Danlos/diagnóstico , Instabilidade Articular/epidemiologia , Treinamento da Voz , Laringoscopia/estatística & dados numéricos , Disfunção da Prega Vocal/epidemiologia , Glote/fisiopatologia
11.
An. pediatr. (2003. Ed. impr.) ; 91(6): 401-407, dic. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-186788

RESUMO

Introducción: En niños, los resultados que muestran asociación entre la presencia de hiperlaxitud articular generalizada (HAG) y trastornos digestivos funcionales (TDF) son limitados y polémicos. Objetivo: Determinar la asociación entre HAG y TDF y la búsqueda de factores de riesgo para la HAG en niñas de una Institución Educativa Pública de Tuluá, Colombia. Pacientes y métodos: Las escolares completaron el Cuestionario de Roma IV para identificar TDF. Cada niña con diagnóstico de algún TDF fue apareado con control sano de la misma edad. La laxitud articular se evaluó según el puntaje de Beighton y se consideró HAG cuando fue ≥ 4. Se comparó la prevalencia de HAG en niñas con y sin TDF. Resultados: En el estudio participaron 921 niñas entre los 10 y 18 años de edad. Doscientas diecinueve (23,8%) niñas presentaron algún TDF. Fueron analizadas 169 niñas con TDF y 169 niñas controles sanas. No hubo diferencias significativas en la HAG entre las niñas con y sin diagnóstico de algún TDF (OR = 1,12 IC95% = 0,71-1,77 p = 0,5838) ni se presentaron factores de riesgo. Conclusión: En este estudio no se logró determinar asociación entre HAG y la presencia de TDF, ni ningún factor de riesgo


Introduction: Although results show an association between the presence of generalised joint hypermobility (GJH) and functional gastrointestinal disorders (FGIDs) in children, they are limited and controversial. Objective: To determine the association between GJH and FGIDs and the search for risk factors for GJH in girls from a Public Educational Institution of Tuluá, Colombia. Patients and methods: The students completed the Rome IV Questionnaire to identify FGIDs. Each girl with a diagnosis of some FGIDs was matched with a healthy control of the same age. Joint laxity was assessed according to the Beighton score and was considered as GJH when it was ≥ 4. The prevalence of GJH was compared in girls with and without FGIDs. Results: Out of a total of 921 girls between 10 and 18 years of age that participated in the study, 219 (23.8%) of them had some FGIDs. The analysis was performed on a total of 169 girls with FGIDs and 169 healthy control girls. There were no significant differences in GJH between girls with and without a diagnosis of some FGIDs (OR = 1.12: 95% CI; 0.71-1.77, P = .5838), nor were there any risk factors. Conclusion: In this study, no relationship or any risk factor was found between GJH and the presence of FGIDs


Assuntos
Humanos , Feminino , Criança , Adolescente , Síndrome de Ehlers-Danlos/epidemiologia , Gastroenteropatias/etiologia , Instabilidade Articular/complicações , Instabilidade Articular/epidemiologia , Estudos de Casos e Controles , Fatores de Risco , Inquéritos e Questionários
12.
Medicine (Baltimore) ; 98(50): e18277, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852100

RESUMO

The aim of the study was to evaluate the clinical effect of the limited area decompression, intervertebral fusion, and pedicle screw fixation for treating degenerative lumbar spinal stenosis (DLSS) with instability. Hemilaminectomy decompression, intervertebral fusion, and pedicle screw fixation for treating DLSS with instability as the control group.Follow-up of 54 patients (26 males and 28 females; average age, 59.74 ±â€Š10.38 years) with DLSS with instability treated by limited area decompression, intervertebral fusion, and pedicle screw fixation (LIFP group), and 52 patients as control group with hemilaminectomy decompression, intervertebral fusion, and pedicle screw fixation (HIFP group). We assessed clinical effect according to the patients' functional outcome grading (good to excellent, fair, or poor), Oswestry Disability Index (ODI) and visual analogue scale (VAS) for low back pain and lower limb pain, which was administered preoperatively and at 3, 6, and 12 months postoperatively. Fusion status was assessed by radiologists at the last follow-up. Treatment satisfaction was assessed according to the subjective evaluations of the patients.At the 12-month follow-up, 96.2% (52/54) and 90.3% (47/52) of group LIFP and HIFP belonged to good to excellent outcome categories, respectively, while 3.7% (2/54) and 9.6% (5/52) of group LIFP and HIFP belonged to fair respectively, neither group belonged to poor. Satisfaction rates of patients in group LIFP and group HIFP were 98.1% (53/54) and 92.3% (48/52), respectively. The patients' functional outcome grading and satisfaction rate in group LIFP were better than that in group HIFP. The VAS for low back and lower limb pain and the ODI improved significantly during the 12 months after surgery (all P < .001) in 2 groups. The VAS for low back and lower limb pain were no difference between two groups, however, the ODI of group LIFP was lower than that of group HIFP (P < .001). All patients achieved radiological fusion.The limited area decompression, intervertebral fusion, and pedicle screw fixation had a satisfactory effect on patients with DLSS with instability.


Assuntos
Descompressão Cirúrgica/métodos , Instabilidade Articular/cirurgia , Laminectomia/métodos , Vértebras Lombares , Parafusos Pediculares , Fusão Vertebral/métodos , Estenose Espinal/cirurgia , Feminino , Fluoroscopia , Seguimentos , Humanos , Instabilidade Articular/complicações , Instabilidade Articular/diagnóstico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estenose Espinal/complicações , Estenose Espinal/diagnóstico , Cirurgia Assistida por Computador/métodos , Fatores de Tempo , Resultado do Tratamento
13.
Knee ; 26(6): 1192-1197, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31767513

RESUMO

BACKGROUND: Patellar dislocations account for two percent of all knee injuries with a 17% chance of re-dislocation. There are few validated scores specific to instability. One of these is the Norwich Patellar Instability Score. There has been limited assessment of the validity, floor-ceiling effect and responsiveness of the Norwich Patellar Instability (NPI) Score from an independent centre. The purpose of this paper is to address this limitation. METHODS: Data from 90 patients referred to a tertiary referral patellofemoral clinic were analysed. All routinely completed data including NPI Score, Kujala Patellofemoral Disorder Score, and demographic outcomes during appointments, up to 36 months following initial clinical assessment was analysed. Convergent validity was assessed by correlating outcomes of the Kujala Patellofemoral Disorder Score to the NPI Score. Effect size (ES) was determined between baseline to 12-month and 12 to 36-month assessments to determine responsiveness. Floor-ceiling effect was evaluated at baseline, 12-month and 12 to 36-month follow-up. RESULTS: NPI Score demonstrated good convergent validity to the Kujala Patellofemoral Disorder Score (p < .001; 95% confidence interval (CI): -0.71 to -0.52). NPI Score demonstrated good responsiveness to change both between baseline to 12 months (ES: 0.43; 95% CI: 0.42 to 0.10) and 12 to 36 months (ES: 0.67; 95% CI: 0.60 to 0.15). Whilst the NPI Score did not demonstrate a ceiling effect, there was moderate risk of a floor-effect where 13% of the cohort reported the lowest levels of NPI scores. CONCLUSIONS: The NPI Score is a valid and responsive outcome for people with recurrent patellar dislocation.


Assuntos
Instabilidade Articular/diagnóstico , Instabilidade Articular/psicologia , Luxação Patelar/psicologia , Luxação Patelar/terapia , Articulação Patelofemoral , Adolescente , Adulto , Estudos de Coortes , Feminino , Humanos , Instabilidade Articular/complicações , Masculino , Luxação Patelar/etiologia , Medidas de Resultados Relatados pelo Paciente , Psicometria , Adulto Jovem
14.
BMJ Case Rep ; 12(11)2019 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-31780615

RESUMO

Syncopal events are a concerning presentation and timely evaluation is warranted. Common aetiologies include cardiac and neurological pathology such as arrhythmias, vertebrobasilar arterial disease and vasovagal syncope. We describe the case of a 65-year-old man who presented to our emergency department with symptoms of vertigo and syncope. He was investigated extensively for both cardiac and neurological causes of his symptoms which returned negative results. An outpatient CT scan demonstrated the presence of Os odontoideum and dynamic instability of the atlantoaxial junction, with presumed dynamic obstruction of the vertebral arterial system. This was successfully managed with a posterior atlantoaxial lateral mass fusion with resolution of syncopal symptoms.


Assuntos
Articulação Atlantoaxial , Vértebra Cervical Áxis , Instabilidade Articular/complicações , Síncope/etiologia , Idoso , Humanos , Masculino
15.
World Neurosurg ; 131: 230-233, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31425782

RESUMO

BACKGROUND: Patients with Down syndrome (DS) have an increased incidence of multisystem disorders, like cardiovascular, neurologic, gastrointestinal, respiratory, and musculoskeletal disorders. Craniovertebral junction instability is a common illness in DS patients, and they may often be affected by vertebral artery (VA) anomalies. CASE DESCRIPTION: In this paper we present neuroradiologic findings of a 34-year-old female patient affected by DS with atlantoaxial subluxation, scheduled for transoral decompression of C1-C2 and posterior occipitocervical fixation. The preoperative angio-computed tomography scan showed a peculiar anatomic variation in the entrance of the VA at the level of the C2 transverse foramen (TF). Normally, the segment of VA, named V2, becomes intraforaminal on average at the TF of C6. CONCLUSIONS: We reviewed the literature about the incidence of anatomic variations of the V2 segment in both the general population and the one affected by DS, and although numerous cases of anomalous course, none reported a C2 TF entry point. Ignoring such extremely rare anatomic variation during anterior, posterior, or lateral surgical approach to the cervical spine can lead to inadvertent injury and potentially serious complications like arterial dissection, thrombus, vascular spasm, fistula, pseudoaneurysm, cerebral ischemia, and death.


Assuntos
Articulação Atlantoaxial/cirurgia , Síndrome de Down/complicações , Luxações Articulares/cirurgia , Artéria Vertebral/anormalidades , Adulto , Angiografia por Tomografia Computadorizada , Descompressão Cirúrgica/métodos , Feminino , Humanos , Luxações Articulares/complicações , Luxações Articulares/diagnóstico , Instabilidade Articular/complicações , Instabilidade Articular/diagnóstico , Instabilidade Articular/cirurgia , Imagem por Ressonância Magnética , Fusão Vertebral/métodos , Tomografia Computadorizada por Raios X
16.
J Electromyogr Kinesiol ; 48: 197-204, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31442925

RESUMO

PURPOSE: People with Joint Hypermobility Syndrome (JHS) suffer with fatigue. The purpose of this project was to investigate the contribution of central and peripheral fatigue. METHODS: Electrical stimulation of the musculocutaneous nerve to biceps brachii, and transcranial magnetic stimulation over the motor cortex supplying biceps brachii were used. Peripheral and central fatigue were assessed during a control, fatiguing and recovery phase protocol. RESULTS: JHS participants perceived greater fatigue during the protocol compared to a control group and did not recover. Central and peripheral fatigue did not occur in the control group. However, the JHS group showed central fatigue. MEP amplitude increased in the JHS group during the fatiguing protocol (p < 0.01) before recovering. Superimposed twitch amplitude increased in the JHS group during the fatiguing protocol and stayed elevated during the recovery phase (p < 0.04). Time to peak (TTP) amplitude of the torque generated by the TMS was longer in the JHS group (p < 0.05). RMS during MVCs decreased during the fatiguing protocol reaching significance during the recovery phase (p < 0.01). CONCLUSION: JHS participants suffered central but not peripheral fatigue. A modified strength programme to target this is discussed.


Assuntos
Fadiga/etiologia , Instabilidade Articular/fisiopatologia , Córtex Motor/fisiopatologia , Fadiga Muscular , Nervos Periféricos/fisiopatologia , Adulto , Fadiga/fisiopatologia , Feminino , Humanos , Instabilidade Articular/complicações , Masculino , Músculo Esquelético/inervação , Músculo Esquelético/fisiopatologia , Torque
17.
Medicine (Baltimore) ; 98(26): e16217, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31261576

RESUMO

BACKGROUND: Athletes with chronic ankle instability (CAI) often develop complications such as pain, instability, and reduced postural control and balance stability, all of which affect athletic performance. This study investigated the effects of a 4° medal wedge intervention on static and dynamic balance in athletes with CAI. METHODS: The participants were 24 healthy and 25 CAI athletes. Participants received a 4° medial wedge applied at the rear foot insole and completed the experiment measurements before and after the wedge intervention. The main outcome measures included the area and path length of the center of pressure when participants performed single-leg standing balance in the closed eye condition and the dynamic balance scores of a multiple single-leg hop stabilization test. RESULTS: The single-leg standing balance significantly improved in CAI (P = .027) and control groups (P = .005) after the medial wedge intervention. The dynamic balance scores significantly decreased from 53.00 ±â€Š25.22 to 41.24 ±â€Š21 48 (P = .015) in CAI group after medial wedge intervention. CONCLUSION: Wearing a 4° medial wedge applied at the rear foot insole improved static and dynamic balance immediately in athletes with CAI. We suggest that clinicians may provide the foot insole to improve balance deficit in athletes having CAI.


Assuntos
Articulação do Tornozelo , Traumatismos em Atletas/terapia , Órtoses do Pé , Instabilidade Articular/terapia , Transtornos das Sensações/terapia , Traumatismos em Atletas/complicações , Doença Crônica , Desenho de Equipamento , Feminino , Calcanhar , Humanos , Instabilidade Articular/complicações , Masculino , Transtornos das Sensações/etiologia , Resultado do Tratamento , Adulto Jovem
18.
Am J Sports Med ; 47(9): 2102-2109, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31233339

RESUMO

BACKGROUND: Most lateral extra-articular tenodesis (LET) procedures rely on passing a strip of the iliotibial band (ITB) under the fibular (lateral) collateral ligament and fixing it proximally to the femur. The Ellison procedure is a distally fixed lateral extra-articular augmentation procedure with no proximal fixation of the ITB. It has the potential advantages of maintaining a dynamic element of control of knee rotation and avoiding the possibility of overconstraint. HYPOTHESIS: The modified Ellison procedure would restore native knee kinematics after sectioning of the anterolateral capsule, and closure of the ITB defect would decrease rotational laxity of the knee. STUDY DESIGN: Controlled laboratory study. METHODS: Twelve fresh-frozen cadaveric knees were tested in a 6 degrees of freedom robotic system through 0° to 90° of knee flexion to assess anteroposterior, internal rotation (IR), and external rotation laxities. A simulated pivot shift (SPS) was performed at 0°, 15°, 30°, and 45° of flexion. Kinematic testing was performed in the intact knee and anterolateral capsule-injured knee and after the modified Ellison procedure, with and without closure of the ITB defect. A novel pulley system was used to load the ITB at 30 N for all testing states. Statistical analysis used repeated measures analyses of variance and paired t tests with Bonferroni adjustments. RESULTS: Sectioning of the anterolateral capsule increased anterior drawer and IR during isolated displacement and with the SPS (mean increase, 2° of IR; P < .05). The modified Ellison procedure reduced both isolated and coupled IR as compared with the sectioned state (P < .05). During isolated testing, IR was reduced close to that of the intact state with the modified Ellison procedure, except at 30° of knee flexion, when it was slightly overconstrained. During the SPS, IR with the closed modified Ellison was less than that in the intact state at 15° and 30° of flexion. No significant differences in knee kinematics were seen between the ITB defect open and closed. CONCLUSION: A distally fixed lateral augmentation procedure can closely restore knee laxities to native values in an anterolateral capsule-sectioned knee. Although the modified Ellison did result in overconstraint to isolated IR and coupled IR during SPS, this occurred only in the early range of knee flexion. Closure of the ITB defect had no effect on knee kinematics. CLINICAL RELEVANCE: A distally fixed lateral extra-articular augmentation procedure provides an alternative to a proximally fixed LET and can reduce anterolateral laxity in the anterolateral capsule-injured knee and restore kinematics close to the intact state.


Assuntos
Instabilidade Articular/cirurgia , Articulação do Joelho/cirurgia , Ligamentos Articulares/cirurgia , Tenodese/métodos , Adulto , Lesões do Ligamento Cruzado Anterior/complicações , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior , Fenômenos Biomecânicos , Cadáver , Feminino , Fêmur/cirurgia , Humanos , Instabilidade Articular/complicações , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Rotação
19.
Clin Rheumatol ; 38(10): 2925-2932, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31177398

RESUMO

OBJECTIVES: Clinical recognition of vascular acrosyndromes is often challenging. The term Raynaud's phenomenon (RP) is commonly overused to describe any form of cold-related disorder. This study aims to formally evaluate peripheral vascular symptoms affecting the population, aged ≤ 40 years, and identify any correlations to joint hypermobility (JH). PATIENTS AND METHODS: Fifty patients (31 males, 19 females) with vasomotor symptoms enrolled in this five-year prospective observational study. Clinical examination by a rheumatologist and a vascular surgeon was performed along with cardiology, echocardiographic and Doppler evaluation. Patients underwent blood cell count, biochemistry, thyroid and selectively immunologic testing. Twenty-four (48%) of them performed nailfold capillaroscopy. The SPSS for Windows, v.17.0, Chicago, USA, was used for the statistical analyses. RESULTS: Twenty-eight patients (56%) presented with erythromelalgia (EM), 6 (12%) with acrocyanosis (AC) and 9 (18%) as a combination of the above disorder. RP diagnosed in five (10%) while two patients (4%) presented as a mix of EM-RP. There was no correlation with abnormal laboratory tests. Increased incidence of JH was found in EM and AC patients. Among those who were tested with nailfold capillaroscopy, 75% had abnormalities ranged from mild to autoimmune-like diseases. CONCLUSIONS: Erythromelalgia is the commonest functional vasculopathy in young population followed by acrocyanosis and a combination of these conditions. Joint hypermobility is markedly increased, indicating that dysautonomy may be considered the causative factor following a trigger event. Overall, RP was observed in 14% of patients. Clinical recognition of these disorders avoids unnecessary investigation. Key Points • Vascular acrosyndromes in young adults are commonly functional disorders resembling vascular algodystrophy induced by thermic stress. • Dysautonomy of joint hypermobility is the co-factor influencing the appearance of the vascular disorders. • Raynaud's phenomenon accounts to approximately 14% of vascular acrosyndromes presented in the young adult population.


Assuntos
Instabilidade Articular/complicações , Doença de Raynaud/complicações , Doenças Vasculares/complicações , Adolescente , Adulto , Cianose/complicações , Eritromelalgia/complicações , Feminino , Humanos , Incidência , Masculino , Angioscopia Microscópica , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto Jovem
20.
Phys Ther ; 99(9): 1189-1200, 2019 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-31158283

RESUMO

Hypermobility spectrum disorder (HSD) and hypermobile Ehlers-Danlos syndrome (hEDS) can cause widespread or chronic pain, fatigue, and proprioceptive and coordination deficits resulting in functional restrictions. These conditions are common and often unrecognized, and patients are likely to present in physical therapy for musculoskeletal injuries, pain, or coordination deficits. Although physical therapy is considered central to managing these conditions, many patients report pain and iatrogenic injuries due to inappropriate interventions. The diagnostic classification for these conditions was revised in 2017 to supersede previous diagnostic categories of Joint Hypermobility Syndrome and Ehlers-Danlos Syndrome-hypermobility type/type III. It is now known that these conditions affect multiple body systems and not just joints and that patients require a holistic approach. This Perspective article will describe the 2017 diagnostic classification system, clinical presentation, examination, evaluation, and management of patients with HSD/hEDS. Both adult and pediatric cases are presented to illustrate the patient management concepts discussed. This knowledge can lead to more effective management of this patient population.


Assuntos
Síndrome de Ehlers-Danlos , Instabilidade Articular , Síndrome de Ehlers-Danlos/complicações , Síndrome de Ehlers-Danlos/diagnóstico , Síndrome de Ehlers-Danlos/terapia , Fadiga/etiologia , Fadiga/terapia , Humanos , Instabilidade Articular/complicações , Instabilidade Articular/diagnóstico , Instabilidade Articular/terapia , Mastocitose/complicações , Modalidades de Fisioterapia , Síndrome da Taquicardia Postural Ortostática/complicações , Prognóstico , Avaliação de Sintomas
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