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1.
Medicine (Baltimore) ; 98(44): e17728, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689815

RESUMO

The effects of soft tissue damage and ulnar angulation deformity on radial head instability in Monteggia fractures are unclear. We tested the hypothesis that radial head instability correlates with the magnitude of ulnar angular deformity and the degree of proximal forearm soft tissue injury in Bado type I Monteggia fractures.We performed a biomechanical study in 6 fresh-frozen cadaveric upper extremities. Monteggia fractures were simulated by anterior ulnar angulation osteotomy and sequential sectioning of ligamentous structures. We measured radial head displacement during passive mobility testing in pronation, supination, and neutral rotation using an electromagnetic tracking device. Measurements at various ligament sectioning stages and ulnar angulation substages were statistically compared with those in the intact elbow.Radial head displacement increased with sequential ligament sectioning and increased proportionally with the degree of anterior ulnar angulation. Annular ligament sectioning resulted in a significant increase in displacement only in pronation (P < .05). When the anterior ulnar deformity was reproduced, the radial head displaced least in supination. The addition of proximal interosseous membrane sectioning significantly increased the radial head displacement in supination (P < .05), regardless of the degree of anterior ulnar angulation.Our Monteggia fracture model showed that radial head instability is influenced by the degree of soft tissue damage and ulnar angulation. Annular ligament injury combined with a minimal (5°) ulnar deformity may cause elbow instability, especially in pronation. The proximal interosseous membrane contributes to radial head stability in supination, regardless of ulnar angulation, and proximal interosseous membrane injury led to significant radial head instability in supination.


Assuntos
Articulação do Cotovelo/fisiopatologia , Traumatismos do Antebraço/fisiopatologia , Instabilidade Articular/fisiopatologia , Fratura de Monteggia/fisiopatologia , Lesões dos Tecidos Moles/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos , Cadáver , Articulação do Cotovelo/lesões , Feminino , Traumatismos do Antebraço/complicações , Humanos , Instabilidade Articular/etiologia , Masculino , Pessoa de Meia-Idade , Fratura de Monteggia/complicações , Rádio (Anatomia)/lesões , Amplitude de Movimento Articular , Lesões dos Tecidos Moles/complicações , Ulna/lesões
2.
Med Clin North Am ; 103(6): 1021-1033, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31582002

RESUMO

Joint hypermobility may be syndromic or nonsyndromic, asymptomatic or symptomatic. However, asymptomatic joint hypermobility can cause repetitive use injury, alter biomechanics, or become symptomatic later in life. Symptomatic joint hypermobility can result from soft tissue injury or muscular strain caused by muscular imbalance. Treatment is straightforward once joint hypermobility is recognized. Generalized joint hypermobility can be assessed using a standardized in-office examination. Generalized joint hypermobility may also be a feature of a heritable connective tissue disorder with other systemic findings. Therefore, assessing joint hypermobility in the context of musculoskeletal complaints may lead to recognizing systemic manifestations and allow treatment accordingly.


Assuntos
Síndrome de Ehlers-Danlos , Instabilidade Articular , Síndrome de Ehlers-Danlos/classificação , Síndrome de Ehlers-Danlos/diagnóstico , Síndrome de Ehlers-Danlos/genética , Instabilidade Articular/etiologia , Instabilidade Articular/fisiopatologia , Instabilidade Articular/terapia , Administração dos Cuidados ao Paciente/métodos
3.
Medicine (Baltimore) ; 98(33): e16802, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415390

RESUMO

Impact of arterial stiffness on aortic morphology has not been well evaluated. We sought to investigate the association of brachial-ankle pulse wave velocity (baPWV) with aortic calcification and tortuosity.A total of 181 patients (65.4 ±â€Š10.4 years, males 59.7%) who underwent computed tomographic angiography and baPWV measurement within 1 month of study entry were retrospectively reviewed. Aortic calcification was quantified by the calcium scoring software system. Aortic tortuosity was defined as the length of the midline in the aorta divided by the length of linear line from the aortic root to the distal end of the thoraco-abdominal aorta. In simple correlation analyses, baPWV was correlated with aortic calcification (r = 0.36, P < .001) and tortuosity (r = 0.16, P = .030). However, these significances disappeared after controlling for confounders in multivariate analyses. Factors showing an independent association with aortic calcification were age (ß = 0.37, P < .001), hypertension (ß = 0.19, P = .003), diabetes mellitus (ß = 0.12, P = .045), smoking (ß = 0.17, P = .016), and estimated glomerular filtration rate (ß = -0.25, P = .002). Factors showing an independent association with aortic tortuosity were age (ß = 0.34, P < .001), body mass index (ß = -0.19, P = .018), and diabetes mellitus (ß = -0.21, P = .003).In conclusion, baPWV reflecting arterial stiffness was not associated with aortic calcification and tortuosity. Traditional cardiovascular risk factors were more influential to aortic geometry. Further studies with a larger sample size are needed to confirm our results.


Assuntos
Aorta/patologia , Artérias/anormalidades , Instabilidade Articular/fisiopatologia , Dermatopatias Genéticas/fisiopatologia , Calcificação Vascular/fisiopatologia , Malformações Vasculares/fisiopatologia , Rigidez Vascular/fisiologia , Idoso , Índice Tornozelo-Braço , Aorta/fisiopatologia , Artérias/patologia , Artérias/fisiopatologia , Índice de Massa Corporal , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Instabilidade Articular/patologia , Masculino , Pessoa de Meia-Idade , Análise de Onda de Pulso , Estudos Retrospectivos , Dermatopatias Genéticas/patologia , Calcificação Vascular/patologia , Malformações Vasculares/patologia
4.
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
5.
J Athl Train ; 54(6): 572-588, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31162943

RESUMO

Lateral ankle sprains (LASs) are among the most common injuries incurred during participation in sport and physical activity, and it is estimated that up to 40% of individuals who experience a first-time LAS will develop chronic ankle instability (CAI). Chronic ankle instability is characterized by a patient's being more than 12 months removed from the initial LAS and exhibiting a propensity for recurrent ankle sprains, frequent episodes or perceptions of the ankle giving way, and persistent symptoms such as pain, swelling, limited motion, weakness, and diminished self-reported function. We present an updated model of CAI that aims to synthesize the current understanding of its causes and serves as a framework for the clinical assessment and rehabilitation of patients with LASs or CAI. Our goal was to describe how primary injury to the lateral ankle ligaments from an acute LAS may lead to a collection of interrelated pathomechanical, sensory-perceptual, and motor-behavioral impairments that influence a patient's clinical outcome. With an underpinning of the biopsychosocial model, the concepts of self-organization and perception-action cycles derived from dynamic systems theory and a patient-specific neurosignature, stemming from the Melzack neuromatrix of pain theory, are used to describe these interrelationships.


Assuntos
Traumatismos do Tornozelo/complicações , Articulação do Tornozelo/fisiopatologia , Instabilidade Articular/etiologia , Ligamentos Laterais do Tornozelo/fisiopatologia , Traumatismos do Tornozelo/fisiopatologia , Doença Crônica , Humanos , Instabilidade Articular/fisiopatologia , Amplitude de Movimento Articular
6.
J Athl Train ; 54(6): 708-717, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31184955

RESUMO

CONTEXT: Patients with chronic ankle instability (CAI) exhibit deficits in neuromuscular control, resulting in altered movement strategies. However, no researchers have examined neuromuscular adaptations to dynamic movement strategies during multiplanar landing and cutting among patients with CAI, individuals who are ankle-sprain copers, and control participants. OBJECTIVE: To investigate lower extremity joint power, stiffness, and ground reaction force (GRF) during a jump-landing and cutting task among CAI, coper, and control groups. DESIGN: Cross-sectional study. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 22 patients with CAI (age = 22.7 ± 2.0 years, height = 174.6 ± 10.4 cm, mass = 73.4 ± 12.1 kg), 22 ankle-sprain copers (age = 22.1 ± 2.1 years, height = 173.8 ± 8.2 cm, mass = 72.6 ± 12.3 kg), and 22 healthy control participants (age = 22.5 ± 3.3 years, height = 172.4 ± 13.3 cm, mass = 72.6 ± 18.7 kg). INTERVENTION(S): Participants performed 5 successful trials of a jump-landing and cutting task. MAIN OUTCOME MEASURE(S): Using motion-capture cameras and a force plate, we collected lower extremity ankle-, knee-, and hip-joint power and stiffness and GRFs during the jump-landing and cutting task. Functional analyses of variance were used to evaluate between-groups differences in these dependent variables throughout the contact phase of the task. RESULTS: Compared with the coper and control groups, the CAI group displayed (1) up to 7% of body weight more posterior and 52% of body weight more vertical GRF during initial landing followed by decreased GRF during the remaining stance and 22% of body weight less medial GRF across most of stance; (2) 8.8 W/kg less eccentric and 3.2 W/kg less concentric ankle power, 6.4 W/kg more eccentric knee and 4.8 W/kg more eccentric hip power during initial landing, and 5.0 W/kg less eccentric knee and 3.9 W/kg less eccentric hip power; and (3) less ankle- and knee-joint stiffness during the landing phase. Concentric power patterns were similar to eccentric power patterns. CONCLUSIONS: The CAI group demonstrated altered neuromechanics, redistributing energy absorption from the distal (ankle) to the proximal (knee and hip) joints, which coincided with decreased ankle and knee stiffness during landing. Our data suggested that although the coper and control groups showed similar landing and cutting strategies, the CAI group used altered strategies to modulate impact forces during the task.


Assuntos
Adaptação Fisiológica/fisiologia , Traumatismos do Tornozelo/fisiopatologia , Articulação do Tornozelo/fisiopatologia , Instabilidade Articular/fisiopatologia , Movimento/fisiologia , Adulto , Fenômenos Biomecânicos , Doença Crônica , Estudos Transversais , Feminino , Humanos , Masculino , Adulto Jovem
7.
J Athl Train ; 54(6): 698-707, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31184956

RESUMO

CONTEXT: Chronic ankle instability (CAI) is characterized by multiple sensorimotor deficits, affecting strength, postural control, motion, and movement. Identifying specific deficits is the key to developing appropriate interventions for this patient population; however, multiple movement strategies within this population may limit the ability to identify specific movement deficits. OBJECTIVE: To identify specific movement strategies in a large sample of participants with CAI and to characterize each strategy relative to a sample of uninjured control participants. DESIGN: Descriptive laboratory study. SETTING: Biomechanics laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 200 individuals with CAI (104 men, 96 women; age = 22.3 ± 2.2 years, height = 174.2 ± 9.5 cm, mass = 72.0 ± 14.0 kg) were selected according to the inclusion criteria established by the International Ankle Consortium and were fit into clusters based on movement strategy. A total of 100 healthy individuals serving as controls (54 men, 46 women; age = 22.2 ± 3.0 years, height = 173.2 ± 9.2 cm, mass = 70.7 ± 13.4 kg) were compared with each cluster. MAIN OUTCOME MEASURE(S): Lower extremity joint biomechanics and ground reaction forces were collected during a maximal vertical jump landing, followed immediately by a side cut. Data were reduced to functional output or curves, kinematic data from the frontal and sagittal planes were reduced to a single representative curve for each plane, and representative curves were clustered using a Bayesian clustering technique. Estimated functions for each dependent variable were compared with estimated functions from the control group to describe each cluster. RESULTS: Six distinct clusters were identified from the frontal-plane and sagittal-plane data. Differences in joint angles, joint moments, and ground reaction forces between clusters and the control group were also identified. CONCLUSIONS: The participants with CAI demonstrated 6 distinct movement strategies, indicating that CAI could be characterized by multiple distinct movement alterations. Clinicians should carefully evaluate patients with CAI for sensorimotor deficits and quality of movement to determine the appropriate interventions for treatment.


Assuntos
Traumatismos do Tornozelo/fisiopatologia , Articulação do Tornozelo/fisiopatologia , Instabilidade Articular/fisiopatologia , Movimento/fisiologia , Teorema de Bayes , Fenômenos Biomecânicos , Doença Crônica , Feminino , Humanos , Masculino , Adulto Jovem
8.
J Athl Train ; 54(6): 589-602, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31184957

RESUMO

Copious research exists regarding ankle instability, yet lateral ankle sprains (LASs) persist in being among the most common recurrent musculoskeletal injuries. Key anatomical structures of the ankle include a triform articulating structure that includes the inferior tibiofibular, talocrural, and subtalar joints. Functionally, force absorption and propulsion through the ankle complex are necessary for any task that occurs in weight bearing. For optimal ankle performance and avoidance of injury, an intricate balance between stability and mobility is necessary to ensure that appropriate force transfer occurs during sports and activities of daily living. Consideration for the many structures that may be directly or indirectly involved in LASs will likely translate into advancements in clinical care. In this clinical review, we present the structure, function, and relevant pathologic states of the ankle complex to stimulate a better understanding of the prevention, evaluation, and treatment of LASs.


Assuntos
Traumatismos do Tornozelo/fisiopatologia , Articulação do Tornozelo/anatomia & histologia , Instabilidade Articular/fisiopatologia , Amplitude de Movimento Articular/fisiologia , Suporte de Carga/fisiologia , Atividades Cotidianas , Traumatismos do Tornozelo/complicações , Humanos , Instabilidade Articular/etiologia
9.
J Athl Train ; 54(6): 727-736, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31184958

RESUMO

CONTEXT: Motor planning, a prerequisite for goal-driven movement, is a complex process that occurs in the cortex. Evidence has suggested that motor planning is altered in patients with chronic ankle instability (CAI). We know balance training can improve balance, but we do not know if it also improves motor planning. Such changes in cortical activity can be assessed using electroencephalography. OBJECTIVE: To evaluate changes in cortical measures of motor planning after balance training in patients with CAI. DESIGN: Controlled laboratory study. SETTING: Research laboratory. PATIENTS OR OTHER PARTICIPANTS: Fifteen patients with CAI (age = 20.80 ± 2.37 years, height = 169.47 ± 7.95 cm, mass = 70.45 ± 19.25 kg). INTERVENTION(S): A 4-week progression-based balance-training program. MAIN OUTCOME MEASURE(S): Motor planning was assessed via electroencephalography before a lateral-stepping task. We calculated event-related spectral perturbations in the θ (4-8 Hz), α (8-12 Hz), ß (14-25 Hz), and γ (30-50 Hz) bands. The change in power (in decibels) was calculated in each band for the 500 milliseconds before the onset of the lateral-stepping movement. Additional outcomes were the Foot and Ankle Ability Measure (FAAM)-Activities of Daily Living and Sport subscales; the anterior-, posteromedial-, and posterolateral-reach directions of the Star Excursion Balance Test; and static balance. Patients completed 3 test sessions: baseline, 24- to 48-hour posttest, and 1-week posttest. Repeated-measures analyses of variance were used to assess changes over time. The α level was set at .05. RESULTS: The FAAM-Activities of Daily Living subscale score was improved at both posttests (P < .05), and the FAAM-Sport subscale score was improved at the 1-week posttest (P = .008). Balance was better in all 3 directions of the Star Excursion Balance Test at both posttest sessions (P < .001). After balance training, no differences were identified in cortical activity at either posttest session (P > .05). CONCLUSIONS: No improvements were identified in electroencephalography measures of motor planning during lateral stepping in patients with CAI. Improved balance suggested that sensorimotor adaptations occurred, but they may not have transferred to the lateral-stepping task or they may have been mediated via other processes in patients with CAI.


Assuntos
Atividades Cotidianas , Traumatismos do Tornozelo/fisiopatologia , Articulação do Tornozelo/fisiopatologia , Córtex Cerebral/fisiologia , Instabilidade Articular/fisiopatologia , Movimento/fisiologia , Equilíbrio Postural/fisiologia , Doença Crônica , Eletroencefalografia , Feminino , Humanos , Extremidade Inferior/fisiologia , Masculino , Adulto Jovem
10.
J Athl Train ; 54(6): 639-649, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31238016

RESUMO

Ankle sprains are common injuries involving the lateral ankle ligaments and affect athletes of all levels. Most patients heal uneventfully, but those with symptoms persisting past 3 months should be evaluated for chronic ankle instability and its associated conditions as well as for the presence of varus malalignment. Chronic ankle instability is initially treated nonoperatively, with surgical management reserved for those who have failed to improve after 3 to 6 months of bracing and functional rehabilitation. Anatomic repair using a modification of the Broström procedure is the preferred technique for initial surgery. Anatomic reconstruction with tendon graft should be considered when repair is not possible, as it maintains physiological joint kinematics. Nonanatomic reconstructions are seldom indicated. Arthroscopic repair or reconstruction of the lateral ankle ligaments is a promising new technique with results similar to those of open surgery.


Assuntos
Traumatismos do Tornozelo/cirurgia , Articulação do Tornozelo/cirurgia , Traumatismos em Atletas/cirurgia , Instabilidade Articular/cirurgia , Ligamentos Laterais do Tornozelo/lesões , Procedimentos Ortopédicos/métodos , Traumatismos do Tornozelo/complicações , Traumatismos do Tornozelo/fisiopatologia , Articulação do Tornozelo/fisiopatologia , Traumatismos em Atletas/complicações , Traumatismos em Atletas/fisiopatologia , Humanos , Instabilidade Articular/etiologia , Instabilidade Articular/fisiopatologia , Ligamentos Laterais do Tornozelo/cirurgia
11.
Int J Sports Med ; 40(7): 477-483, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31189191

RESUMO

The purpose of this study was to clarify the relationship between knee biomechanics and clinical assessments in ACL deficient patients. Subjects included 22 patients with unilateral ACL rupture and 22 healthy controls. Knee kinematics and kinetics during walking and running were examined using a 3-dimensional motion analysis system. The passive knee joint laxity, range of motion of knee joint, and knee muscle strength were also measured. Correlations between the knee kinematic and kinetic data and clinical assessments were evaluated. In the ACL deficient patients, there were no significant relationships between tibial translation during walking and running and passive knee joint laxity. The correlations between knee kinematics and kinetics and range of motion of knee joint were also not significant. Additionally, there were no significant correlations between knee kinematics during walking and knee muscle strength. However, there were several significant correlations between knee kinematics during running and knee muscle strength. The results demonstrate the importance of knee muscle strength for knee kinematics and kinetics during running in ACL deficient patients. Patients with stronger knee muscle strength may demonstrate more nearly normal knee joint movement during dynamic activities such as running.


Assuntos
Lesões do Ligamento Cruzado Anterior/fisiopatologia , Articulação do Joelho/fisiopatologia , Traumatismos em Atletas/fisiopatologia , Fenômenos Biomecânicos , Estudos de Casos e Controles , Humanos , Instabilidade Articular/fisiopatologia , Cinética , Força Muscular , Amplitude de Movimento Articular , Corrida/fisiologia , Estudos de Tempo e Movimento , Caminhada/fisiologia
12.
Phys Ther ; 99(6): 711-720, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31155663

RESUMO

BACKGROUND: People with cerebral palsy (CP) experience increased muscle stiffness, muscle weakness, and reduced joint range of motion. This can lead to an abnormal pattern of gait, which can increase the energy cost of walking and contribute to reduced participation in physical activity. OBJECTIVE: The aim of the study was to examine associations between lower-body joint angles, moments, power, and walking efficiency in adolescents with CP. DESIGN: This was a cross-sectional study. METHODS: Sixty-four adolescents aged 10 to 19 years with CP were recruited. Walking efficiency was measured as the net nondimensional oxygen cost (NNcost) during 6 minutes of overground walking at self-selected speed. Lower-body kinematics and kinetics during walking were collected with 3-dimensional motion analysis, synchronized with a treadmill with integrated force plates. The associations between the kinematics, kinetics, and NNcost were examined with multivariable linear regression. RESULTS: After adjusting for age, sex, and Gross Motor Function Classification System level, maximum knee extension angle (ß = -0.006), hip angle at midstance (ß = -0.007), and maximum hip extension (ß = -0.008) were associated with NNcost. Age was a significant modifier of the association between the NNcost and a number of kinematic variables. LIMITATIONS: This study examined kinetic and kinematic variables in the sagittal plane only. A high interindividual variation in gait pattern could have influenced the results. CONCLUSIONS: Reduced knee and hip joint extension are associated with gait inefficiency in adolescents with CP. Age is a significant factor influencing associations between ankle, knee, and hip joint kinematics and gait efficiency. Therapeutic interventions should investigate ways to increase knee and hip joint extension in adolescents with CP.


Assuntos
Paralisia Cerebral/fisiopatologia , Marcha/fisiologia , Instabilidade Articular/fisiopatologia , Caminhada/fisiologia , Adolescente , Fenômenos Biomecânicos , Criança , Estudos Transversais , Feminino , Análise da Marcha/métodos , Humanos , Masculino
13.
J Athl Train ; 54(6): 611-616, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31161942

RESUMO

Lateral ankle sprains (LASs) are a common injury sustained by individuals who participate in recreational physical activities and sports. After an LAS, a large proportion of individuals develop long-term symptoms, which contribute to the development of chronic ankle instability (CAI). Due to the prevalence of LASs and the propensity to develop CAI, collective efforts toward reducing the risk of sustaining these injuries should be a priority of the sports medicine and sports physiotherapy communities. The comprehensive injury-causation model was developed to illustrate the interaction of internal and external risk factors in the occurrence of the inciting injury. The ability to mitigate injury risk is contingent on a comprehensive understanding of risk factors for injury. The objective of this current concepts review is to use the comprehensive injury-causation model as a framework to illustrate the risk factors for LAS and CAI based on the literature.


Assuntos
Traumatismos do Tornozelo/complicações , Articulação do Tornozelo/fisiopatologia , Traumatismos em Atletas/complicações , Instabilidade Articular/etiologia , Amplitude de Movimento Articular/fisiologia , Traumatismos do Tornozelo/fisiopatologia , Doença Crônica , Humanos , Instabilidade Articular/fisiopatologia , Recreação , Fatores de Risco
14.
J Athl Train ; 54(6): 684-697, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31162941

RESUMO

CONTEXT: The literature on gait kinematics and muscle activation in chronic ankle instability (CAI) is limited. A comprehensive evaluation of all relevant gait measures is needed to examine alterations in gait neuromechanics that may contribute to recurrent sprain. OBJECTIVE: To compare walking neuromechanics, including kinematics, muscle activity, and kinetics (ie, ground reaction force [GRF], moment, and power), between participants with and those without CAI by applying a novel statistical analysis to data from a large sample. DESIGN: Controlled laboratory study. SETTING: Biomechanics laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 100 participants with CAI (49 men, 51 women; age = 22.2 ± 2.3 years, height = 174.0 ± 9.7 cm, mass = 70.8 ± 14.4 kg) and 100 individuals without CAI serving as controls (55 men, 45 women; age = 22.5 ± 3.3 years, height = 173.1 ± 13.3 cm, mass = 72.6 ± 18.7 kg). INTERVENTION(S): Participants performed 5 trials of walking (shod) at a self-selected speed over 2 in-ground force plates. MAIN OUTCOME MEASURE(S): Three-dimensional GRFs, lower extremity joint angles, internal joint moments, joint powers, and activation amplitudes of 6 muscles were recorded during stance. RESULTS: Compared with the control group, the CAI group demonstrated (1) increased plantar flexion or decreased dorsiflexion, increased inversion or decreased eversion, decreased knee flexion, decreased knee abduction, and increased hip-flexion angles; (2) increased or decreased inversion, increased plantar flexion, decreased knee extension, decreased knee abduction, and increased hip-extension moments; (3) increased vertical, braking, and propulsive GRFs; (4) increased hip eccentric and concentric power; and (5) altered muscle activation in all 6 lower extremity muscles. CONCLUSIONS: The CAI group demonstrated a hip-dominant strategy by limiting propulsive forces at the ankle while increasing force generation at the hip. The different walking neuromechanics exhibited by the CAI group could represent maladaptive strategies that developed after the initial sprain or an injurious gait pattern that may have predisposed the participants to their initial injuries. Increased joint loading and altered kinematics at the foot and ankle complex during initial stance could affect the long-term health of the ankle articular cartilage.


Assuntos
Articulação do Tornozelo/fisiopatologia , Marcha/fisiologia , Instabilidade Articular/fisiopatologia , Movimento/fisiologia , Caminhada/fisiologia , Adolescente , Adulto , Fenômenos Biomecânicos , Doença Crônica , Feminino , Humanos , Imagem Tridimensional , Masculino , Adulto Jovem
15.
J Athl Train ; 54(6): 718-726, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31162942

RESUMO

CONTEXT: Chronic ankle instability (CAI) is characterized by repetitive ankle sprains and perceived instability. Whereas the underlying cause of CAI is disputed, alterations in cortical motor functioning may contribute to the perceived dysfunction. OBJECTIVE: To assess differences in cortical activity during single-limb stance among control, coper, and CAI groups. DESIGN: Cross-sectional study. SETTING: Biomechanics laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 31 individuals (10 men, 21 women; age = 22.3 ± 2.4 years, height = 169.6 ± 9.7 cm, mass = 70.6 ± 11.6 kg), who were classified into control (n = 13), coper (n = 7), and CAI (n = 11) groups participated in this study. INTERVENTION(S): Participants performed single-limb stance on a force platform for 60 seconds while wearing a 24-channel functional near-infrared spectroscopy system. Oxyhemoglobin (HbO2) changes in the supplementary motor area (SMA), precentral gyrus, postcentral gyrus, and superior parietal lobe were measured. MAIN OUTCOME MEASURE(S): Differences in averages and standard deviations of HbO2 were assessed across groups. In the CAI group, correlations were analyzed between measures of cortical activation and Cumberland Ankle Instability Tool (CAIT) scores. RESULTS: No differences in average HbO2 were present for any cortical areas. We observed differences in the standard deviation for the SMA across groups; specifically, the CAI group demonstrated greater variability than the control (r = 0.395, P = .02; 95% confidence interval = 0.34, 0.67) and coper (r = 0.38, P = .04; 95% confidence interval = -0.05, 0.69) groups. We demonstrated a strong correlation that was significant in the CAI group between the CAIT score and the average HbO2 of the precentral gyrus (ρ = 0.64, P = .02) and a strong correlation that was not significant between the CAIT score and the average HbO2 of the SMA (ρ = 0.52, P = .06). CONCLUSIONS: The CAI group displayed large differences in SMA cortical-activation variability. Greater variations in cortical activation may be necessary for similar static postural-control outcomes among individuals with CAI. Consequently, variations in cortical activation for these areas provide evidence for an altered neural mechanism of postural control among populations with CAI.


Assuntos
Traumatismos do Tornozelo/fisiopatologia , Articulação do Tornozelo/fisiopatologia , Instabilidade Articular/fisiopatologia , Extremidade Inferior/fisiopatologia , Equilíbrio Postural/fisiologia , Doença Crônica , Estudos Transversais , Feminino , Humanos , Masculino , Adulto Jovem
16.
J Sci Med Sport ; 22(9): 976-980, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31122877

RESUMO

OBJECTIVES: The purpose of this study was to compare dynamic balance and weight-bearing dorsiflexion range of motion between young and middle-aged adults with and without chronic ankle instability. DESIGN: Cross-sectional. METHODS: One hundred and two young adults were classified as either having chronic ankle instability (n = 38), coper (n = 27) or a healthy-control (n = 37). A total of 55 middle-aged adults were identified as having chronic ankle instability (n = 16), coper (n = 15) or a healthy-control (n = 24). Participants completed the weight-bearing lunge test and the anterior, posteromedial and posterolateral reach directions of the star excursion balance test. RESULTS: Middle-aged adults had shorter reach distances for each direction of the star excursion balance test compared to the young adults (p < 0.001). Regardless of age, participants with chronic ankle instability performed worse on the star excursion balance test compared to the coper (p < 0.05) and healthy-control group (p < 0.05). Similarly, participants with chronic ankle instability had less dorsiflexion compared to healthy-controls (p < 0.05), but not the coper group (p > 0.05). CONCLUSIONS: Deficits in dynamic postural control do not continue to decline with advancing age in individuals with chronic ankle instability, however, these impairments appear to continue to persist compared to uninjured controls.


Assuntos
Articulação do Tornozelo/fisiopatologia , Instabilidade Articular/fisiopatologia , Equilíbrio Postural , Amplitude de Movimento Articular , Adulto , Idoso , Traumatismos do Tornozelo/fisiopatologia , Estudos de Casos e Controles , Estudos Transversais , Humanos , Pessoa de Meia-Idade , Suporte de Carga , Adulto Jovem
17.
Int J Sports Med ; 40(7): 468-476, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31096292

RESUMO

The risk of anterior cruciate ligament injury in female handball players is high. Fatigue of active stabilizers and increases in joint laxity are often mentioned in the literature as causal factors. However, no studies have been carried out on this population. Our objective is to determine the effect of muscle fatigue on active and passive knee stability in female handball players. This prospective study assessed tibiofemoral joint laxity, as well as hamstring and quadriceps strength, before (Tinitial), during and 3 min after (Tfinal) an isokinetic fatigue protocol (25 repetitions of knee flexion / extension at 180°.s-1). Laxity values (slope of the displacement-load curve and anterior tibial translation) were measured using a GNRB-Rotab® arthrometer; torque values were measured at specific joint angles and peak muscle torque using an isokinetic dynamometer. Nineteen women (20.9±2.4 years, 62.0±4.9 kg, 166±5 cm) were included. Normalized peak torque decreased significantly between the first three and last three repetitions of the fatigue protocol (p<0.0001, ES=3.2 and 3.2). Slope of the displacement-load curve and anterior tibial translation, functional and conventional ratios did not change significantly between Tinitial and Tfinal. Active and passive markers of knee stability were not altered by a fatigue protocol in female handball players, suggesting these players have a large capacity for recovery. These results suggest that muscle strengthening to prevent ACL injury in female handball players may be inappropriate.Level of evidence: Level 2b, Prospective Cohort.


Assuntos
Instabilidade Articular/fisiopatologia , Articulação do Joelho/fisiologia , Fadiga Muscular/fisiologia , Esportes/fisiologia , Lesões do Ligamento Cruzado Anterior/fisiopatologia , Feminino , Músculos Isquiotibiais/fisiologia , Humanos , Articulação do Joelho/fisiopatologia , Força Muscular , Estudos Prospectivos , Músculo Quadríceps/fisiologia , Fatores de Risco , Torque , Adulto Jovem
18.
J Shoulder Elbow Surg ; 28(7): 1298-1307, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31129017

RESUMO

BACKGROUND: The Latarjet and iliac crest bone graft transfer (ICBGT) procedures are competing treatment options for anterior shoulder instability with glenoid bone loss. METHODS: In this bicentric prospective randomized study, 60 patients with anterior shoulder instability and glenoid bone loss were included and randomized to either an open Latarjet or open ICBGT (J-bone graft) procedure. Clinical evaluation was completed before surgery and 6, 12, and 24 months after surgery, including the Western Ontario Shoulder Instability index, Rowe score, Subjective Shoulder Value, pain level, satisfaction level, and work and sports impairment, as well as assessment of instability, range of motion, and strength. Adverse events were prospectively recorded. Radiographic evaluation included preoperative, postoperative, and follow-up computed tomography analysis. RESULTS: None of the clinical scores showed a significant difference between the 2 groups (P > .05). Strength and range of motion showed no significant differences except for diminished internal rotation capacity in the Latarjet group at every follow-up time point (P < .05). A single postoperative traumatic subluxation event occurred in 2 ICBGT patients and 1 Latarjet patient. The type and severity of other adverse events were heterogeneous. Donor-site sensory disturbances were observed in 27% of the ICBGT patients. Computed tomography scans revealed a larger glenoid augmentation effect of the ICBGTs; this, however, was attenuated at follow-up. CONCLUSION: The Latarjet and ICBGT procedures for the treatment of anterior shoulder instability with glenoid bone loss showed no difference in clinical and radiologic outcomes except for significantly worse internal rotation capacity in the Latarjet group and frequently noted donor-site sensory disturbances in the ICBGT group.


Assuntos
Processo Coracoide/transplante , Cavidade Glenoide/cirurgia , Ílio/transplante , Instabilidade Articular/cirurgia , Articulação do Ombro/cirurgia , Adolescente , Adulto , Feminino , Seguimentos , Cavidade Glenoide/patologia , Humanos , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/fisiopatologia , Masculino , Pessoa de Meia-Idade , Força Muscular , Período Pós-Operatório , Estudos Prospectivos , Amplitude de Movimento Articular , Rotação , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/fisiopatologia , Tomografia Computadorizada por Raios X , Adulto Jovem
19.
Scand J Med Sci Sports ; 29(8): 1130-1140, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31050053

RESUMO

Centrally mediated changes in sensorimotor function have been reported in patients with chronic ankle instability (CAI). However, little is known regarding supraspinal/spinal adaptations during lower-extremity dynamic movement during a multiplanar, single-leg landing/cutting task. The purpose of this study was to investigate the effect of CAI on landing/cutting neuromechanics, including lower-extremity kinematic, electromyography (EMG) activation, and ground reaction force (GRF) characteristics. One hundred CAI patients and 100 matched healthy controls performed five trials of a jump landing/cutting task. Sagittal- and frontal-plane ankle, knee and hip kinematics, EMG activation in eight lower-extremity muscles, and 3D GRF were collected during jump landing/cutting. Functional analyses of variance (FANOVA) were used to evaluate between-group differences for dependent variables throughout the entire ground contact of the task. Relative to the control group, the CAI group revealed (a) reduced dorsiflexion, increased knee and hip flexion angles, (b) increased inversion and hip adduction angles, (c) increased EMG activation of medial gastrocnemius, peroneus longus, adductor longus, vastus lateralis, gluteus medius, and gluteus maximus, and (d) increased posterior and vertical GRF during initial landing, and reduced medial, posterior, and vertical GRF during mid-landing and mid-cutting. CAI patients demonstrated alterations in landing/cutting movement strategies as demonstrated by a higher susceptibility of foot placement for lateral ankle sprains, and more flexed positions of the knee and hip with higher EMG activation of knee and hip extensors to modulate GRF to compensate for the unstable ankle. This apparent compensation may be due to mechanical (limited dorsiflexion angle) and/or sensorimotor deficits in the ankle.


Assuntos
Articulação do Tornozelo/fisiopatologia , Instabilidade Articular/fisiopatologia , Movimento , Músculo Esquelético/fisiologia , Adulto , Fenômenos Biomecânicos , Estudos de Casos e Controles , Eletromiografia , Feminino , Articulação do Quadril/fisiologia , Humanos , Articulação do Joelho/fisiologia , Masculino , Exercício Pliométrico , Adulto Jovem
20.
Biomed Res Int ; 2019: 4398469, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31080818

RESUMO

An ankle brace is commonly used by patients after they suffer from initial ankle sprains, reducing the incidents of recurrent sprain or limiting laxity in joints with functional ankle instability (FAI). However, whether the application of a semirigid ankle brace can improve the abnormal ankle gait kinematics of patients with FAI remains unknown. This study aimed to determine the effect of a semirigid ankle brace on the gait kinematics of ankle joints through 3D-2D fluoroscopy image registration. A total of 8 subjects with FAI (3 males and 5 females, 10 feet) as FAI group and 10 subjects without FAI (6 males and 4 females, 10 feet) as control group were enrolled in this study. Three-dimensional bone models created from computed tomography images were matched to fluoroscopic images to compute the 6 degrees of freedom (DOF) talocrural, subtalar, and ankle joints complex kinematics for control and FAI group with or without brace during the stance phase of walking. FAI patients had significantly less ROMs in inversion/eversion rotation of the talocrural and subtalar joint after wearing semirigid ankle brace. Laxity was observed in most of the displacements of the talocrural and subtalar joints in FAI group. The brace partly altered the ankle joints movement in opposite directions, especially joint rotation, and restricted the talocrural and subtalar joints in the dorsiflexion position during the touch down phase of walking.


Assuntos
Articulação do Tornozelo/fisiopatologia , Tornozelo/fisiopatologia , Instabilidade Articular/fisiopatologia , Caminhada/fisiologia , Adulto , Traumatismos do Tornozelo/fisiopatologia , Fenômenos Biomecânicos/fisiologia , Braquetes , Feminino , Fluoroscopia/métodos , Pé/fisiopatologia , Humanos , Imagem Tridimensional/métodos , Masculino , Amplitude de Movimento Articular/fisiologia , Rotação , Articulação Talocalcânea/fisiopatologia , Suporte de Carga/fisiologia , Adulto Jovem
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