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1.
J Am Acad Orthop Surg ; 28(14): e595-e603, 2020 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-32692095

RESUMO

Weight-bearing CT (WBCT) scans of the foot and ankle have improved the understanding of deformities that are not easily identified on radiographs and are increasingly being used by orthopaedic surgeons for diagnostic and preoperative planning purposes. In contrast to standard CT scans, WBCT scans better demonstrate the true orientation of the bones and joints during loading. They have been especially useful in investigating the alignment of complex pathologies such as adult-acquired flatfoot deformity in which patients have been found to have a more valgus subtalar joint alignment than in a normal cohort and high rates of subfibular impingement. Studies using WBCT scans have also provided new insight into more common lower extremity conditions such as hallux valgus, ankle fractures, and lateral ankle instability. WBCT scans have allowed researchers to investigate pronation of the first metatarsal in patients with hallux valgus compared with normal feet, and patients with lateral ankle instability have been found to have more heel varus than healthy control subjects. Understanding the application of WBCT scans to clinical practice is becoming more important as surgeons strive for improved outcomes in the treatment of complicated foot and ankle disorders.


Assuntos
Tornozelo/diagnóstico por imagem , Tornozelo/fisiopatologia , Pé Chato/diagnóstico por imagem , Pé Chato/fisiopatologia , Pé/diagnóstico por imagem , Pé/fisiopatologia , Tomografia Computadorizada por Raios X/métodos , Suporte de Carga , Tornozelo/cirurgia , Fraturas do Tornozelo/diagnóstico por imagem , Fraturas do Tornozelo/fisiopatologia , Fraturas do Tornozelo/cirurgia , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/fisiopatologia , Articulação do Tornozelo/cirurgia , Pé Chato/cirurgia , Pé/cirurgia , Hallux Valgus/diagnóstico por imagem , Hallux Valgus/fisiopatologia , Hallux Valgus/cirurgia , Humanos , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/fisiopatologia , Instabilidade Articular/cirurgia , Planejamento de Assistência ao Paciente
2.
PLoS One ; 15(7): e0236266, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32726351

RESUMO

The aim of this study was an evaluation of the musculoskeletal system in women and men with Generalized Joint Hypermobility (GJH). The study included 87 participants- 40 with Generalized Joint Hypermobility (aged 21.2 ±1.8 years) and 47 (aged 21.0 ±1.3 years) in the control group (CG). The study included the Beighton score, the measurements of body composition, muscle flexibility (Straight Leg Raise test, Popliteal Angle test, Modified Thomas Test), and the measurements of muscle strength and muscle power. T-test and Mann-Whitney U Test were applied to assess the differences between independent groups. The study showed that there were no significant differences (p>.05) in the assessed body composition and the muscle flexibility between both women and men with GJH and the participants in the CG. Under isokinetic conditions for the non-dominant lower extremity, men from the CG received significantly higher (p = .02) flexion peak torque at 180°/s angular velocity. Women from the CG received a statistically significantly lower (p = .04) F/E ratio at 180°/s velocity. Under isometric conditions for both women and men with GJH, there were no statistically significant differences (p>.05) in the maximum torques in knee extension and flexion compared to the CG. For women and men with GJH, the maximum power in the lower extremities and jumping ability were not significantly different (p>.05) compared to the CG participants. The body composition, muscle flexibility, muscle strength, and muscle power of adults with Generalized Joint Hypermobility did not differ compared to healthy participants. The fact that there are no differences does not exclude the efficacy of strength training in increasing levels of muscle strength and its impact on body posture and proprioception or coordination.


Assuntos
Instabilidade Articular/fisiopatologia , Articulação do Joelho/fisiopatologia , Força Muscular/fisiologia , Músculo Esquelético/fisiopatologia , Adulto , Composição Corporal/fisiologia , Feminino , Humanos , Instabilidade Articular/epidemiologia , Extremidade Inferior/fisiopatologia , Masculino , Amplitude de Movimento Articular/fisiologia , Adulto Jovem
3.
Clin Orthop Surg ; 12(2): 145-150, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32489534

RESUMO

For proper treatment of recurrent anterior instability of the shoulder with a bone defect, the defect size should be assessed preoperatively with three-dimensional computed tomography or magnetic resonance imaging. In general, the risk of postoperative recurrence of instability is estimated on the basis of preoperative imaging of bipolar bone defects: more than 20%-25% glenoid bone loss and off-track Hill-Sachs lesions have been considered risk factors for recurrence. In patients with a glenoid bone defect more than 20%-25%, a bone graft procedure, such as the Latarjet procedure, is preferred regardless of the glenoid track concept, because compared with arthroscopic stabilization procedure, it provides greater postoperative stability. For patients with a borderline glenoid bone defect (around 20%), surgeons should discuss surgical options with the patients, considering their demand and physical activity level. In addition, the surgeon should take care to prevent postoperative instability and long-term complications. Arthroscopic soft-tissue reconstruction including labral repair and capsular plication combined with the additional remplissage procedure is an anatomical procedure and could be considered as one of the primary treatment methods for patients with glenoid bone defects around 20%. Therefore, treatment strategies for recurrent anterior shoulder instability combined with bone defects should be determined more flexibly on the basis of the patient's individual condition.


Assuntos
Instabilidade Articular/fisiopatologia , Instabilidade Articular/cirurgia , Articulação do Ombro/fisiopatologia , Articulação do Ombro/cirurgia , Lesões de Bankart/diagnóstico por imagem , Lesões de Bankart/fisiopatologia , Lesões de Bankart/cirurgia , Cavidade Glenoide/patologia , Humanos , Úmero/patologia , Instabilidade Articular/diagnóstico por imagem , Recidiva , Articulação do Ombro/diagnóstico por imagem
4.
Sports Med Arthrosc Rev ; 28(2): 36-40, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32345924

RESUMO

The pivot shift test is utilized for assessment of rotatory instability in the anterior cruciate ligament (ACL) deficient knee. There are multiple reports of the pivot shift maneuver, and there is a lack of consensus among clinicians as to a standardized maneuver. Measurement devices are a feasible option to evaluate rotatory knee instability, objectively or quantitatively. Traditionally, measurement systems have been invasive systems. More recently, electromagnetic system, inertial sensor, or imaging analysis systems, specifically with the utilization of a tablet computer, have emerged as noninvasive, and more importantly, validated options. It is important to recognize that anatomic structures other than the ACL contribute to rotatory knee stability. Addressing the tibial slope, anterolateral structures of the knee, specifically the iliotibial band, and menisci during ACL surgery may decrease residual pivot shift in an attempt to improve clinical outcomes and prevent reinjury. This review article describes the pivot shift maneuver, objective measurement tools, and clinical applications of the pivot shift test.


Assuntos
Lesões do Ligamento Cruzado Anterior/diagnóstico , Instabilidade Articular/diagnóstico , Exame Físico/normas , Lesões do Ligamento Cruzado Anterior/fisiopatologia , Humanos , Instabilidade Articular/fisiopatologia , Exame Físico/instrumentação
5.
Arch Orthop Trauma Surg ; 140(7): 933-940, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32232619

RESUMO

PURPOSE: Valgus deformity presents a particular challenge in total knee arthroplasty. This condition regularly leads to contractures of the lateral capsular ligament complex and to overstretching of the medial ligamentous complex. Reconstruction of the knee joint kinematics and anatomy often requires lateral release. However, data on how such release weakens the stability of the knee are missing in the literature. This study investigated the effects of sequential lateral release on the collateral stability of the ligament complex of the knee in vitro. METHODS: Ten knee prostheses were implanted in 10 healthy cadaveric knee joints using a navigation device. Soft tissue lateral release consisted of five release steps, and stiffness and stability were determined at 0, 30, 60 and 90° flexion after each step. RESULTS: Soft tissue lateral release increasingly weakened the ligament complex of the lateral compartment. Because of the large muscular parts, the release of the iliotibial band and the M. popliteus had little effect on the stability of the lateral and medial compartment, but release of the lateral ligament significantly decreased the stability in the lateral compartment over the entire range of motion. Stability in the medial compartment was hardly affected. Conversely, further release of the posterolateral capsule and the posterior cruciate ligament led to the loss of stability in the lateral compartment only in deep flexion, whereas stability decreased significantly in the medial compartment. CONCLUSION: Our study shows for the first time the association between sequential lateral release and stability of the ligamentous complex of the knee. To maintain the stability, knee surgeons should avoid releasing the entire lateral collateral ligament, which would significantly decrease stability in the lateral compartment.


Assuntos
Joelho , Músculo Esquelético , Procedimentos Ortopédicos/métodos , Artroplastia do Joelho , Humanos , Instabilidade Articular/fisiopatologia , Joelho/fisiologia , Joelho/cirurgia , Prótese do Joelho , Músculo Esquelético/fisiologia , Músculo Esquelético/cirurgia , Amplitude de Movimento Articular
6.
Medicine (Baltimore) ; 99(17): e19775, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32332619

RESUMO

Patients with chronic ankle instability (CAI) have postural-control deficits during center-of-pressure excursions than do healthy individuals. While an external analysis of center-of-pressure excursions in CAI has been performed, a quantitative analysis of center-of-gravity movements, to detect the balance deficits associated with CAI, has yet to be performed. Therefore, the aim of the study is to quantify the balance deficits in patients with unilateral CAI.Forty-four patients with unilateral CAI (24 men; age, 31.7 ±â€Š5.5 years) and 26 uninjured volunteers (12 men; age, 28.6 ±â€Š5.9 years) underwent Neurocom Balance Manager assessments of dynamic and static balance responses in limits of stability, unilateral stance, and forward lunge tests.In the limits of stability test, there were no significant group differences in the forward direction; however, reaction times were longer in the CAI group than in the control group in the backward (P = .037, effect size [ES] = 0.49) and rightward directions (P = .032, ES  = 0.47). Furthermore, the CAI group showed more excursions in the rightward (P = .046, ES = 0.50) and leftward directions (P = .002, ES = 0.80), and less directional control in the leftward direction (P = .036, ES = 0.59). In the unilateral stance test, the center of gravity sway velocity was faster in the CAI group than in the control group, whether eyes were opened or closed (P < .05). There were no significant group differences in forward lunge-test outcomes.Patients with CAI have poor static and dynamic balance performance compared to that in healthy counterparts. Thus, balance retraining should be an essential component of rehabilitation programs for patients with CAI.


Assuntos
Articulação do Tornozelo/fisiopatologia , Instabilidade Articular/classificação , Equilíbrio Postural/fisiologia , Adulto , Articulação do Tornozelo/anormalidades , China , Feminino , Humanos , Instabilidade Articular/fisiopatologia , Masculino , Entorses e Distensões/classificação , Entorses e Distensões/complicações , Entorses e Distensões/fisiopatologia , Estatísticas não Paramétricas
7.
Bone Joint J ; 102-B(4): 442-448, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32228066

RESUMO

AIMS: The objectives of this study were to assess the effect of anterior cruciate ligament (ACL) resection on flexion-extension gaps, mediolateral soft tissue laxity, maximum knee extension, and limb alignment during primary total knee arthroplasty (TKA). METHODS: This prospective study included 140 patients with symptomatic knee osteoarthritis undergoing primary robotic-arm assisted TKA. All operative procedures were performed by a single surgeon using a standard medial parapatellar approach. Optical motion capture technology with fixed femoral and tibial registration pins was used to assess study outcomes pre- and post-ACL resection with knee extension and 90° knee flexion. This study included 76 males (54.3%) and 64 females (45.7%) with a mean age of 64.1 years (SD 6.8) at time of surgery. Mean preoperative hip-knee-ankle deformity was 6.1° varus (SD 4.6° varus). RESULTS: ACL resection increased the mean extension gap significantly more than the flexion gap in the medial (mean 1.2 mm (SD 1.0) versus mean 0.2 mm (SD 0.7) respectively; p < 0.001) and lateral (mean 1.1 mm (SD 0.9) versus mean 0.2 mm (SD 0.6) respectively; p < 0.001) compartments. The mean gap differences following ACL resection did not create any significant mediolateral soft tissue laxity in extension (gap difference: mean 0.1 mm (SD 2.4); p = 0.89) or flexion (gap difference: mean 0.2 mm (SD 3.1); p = 0.40). ACL resection did not significantly affect maximum knee extension (change in maximum knee extension = mean 0.2° (SD 0.7°); p = 0.23) or fixed flexion deformity (mean 4.2° (SD 3.2°) pre-ACL release versus mean 3.9° (SD 3.7°) post-ACL release; p = 0.61). ACL resection did not significantly affect overall limb alignment (change in alignment = mean 0.2° valgus (SD 1.0° valgus; p = 0.11). CONCLUSION: ACL resection creates flexion-extension mismatch by increasing the extension gap more than the flexion gap. However, gap differences following ACL resection do not create any mediolateral soft tissue laxity in extension or flexion. ACL resection does not affect maximum knee extension or overall limb alignment. Cite this article: Bone Joint J 2020;102-B(4):442-448.


Assuntos
Ligamento Cruzado Anterior/cirurgia , Artroplastia do Joelho/métodos , Articulação do Joelho/cirurgia , Adulto , Idoso , Fenômenos Biomecânicos , Mau Alinhamento Ósseo/cirurgia , Feminino , Humanos , Instabilidade Articular/fisiopatologia , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Osteoartrite do Joelho/fisiopatologia , Osteoartrite do Joelho/cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Amplitude de Movimento Articular/fisiologia , Procedimentos Cirúrgicos Robóticos/métodos
8.
Medicine (Baltimore) ; 99(17): e19862, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32332647

RESUMO

Recovery of postural control and proprioception in patients affected by chronic ankle instability (CAI) and operated on capsulo-ligaments reconstructive surgery lacks of objective assessment. The aim of this study was to evaluate long-term post-surgical postural and proprioceptive control through the DPPS device in a cohort of patients operated on ligaments reconstruction through the modified Brostrom procedure at a minimum follow up of 12 months.Eleven patients with post-traumatic lateral CAI, operated of external capsulo-ligamentous complex repair according to Brostrom technique at a minimum follow-up of 1 year were enrolled. Physical examination and American Orthopaedics Foot and Ankle Society (AOFAS) ankle-hindfoot score. Proprioceptive and postural stability was assessed by DPPS - Delos Postural Proprioceptive System, linked to a computer with a specific software and including a flat table, an electronic unstable proprioceptive board, a Delos Vertical Controller, a monitor and a horizontal bar fitted with an infra-red sensor for hand support.Patients were 5 males and 6 females, mean age of 38.4 ±â€Š12 years. Mean BMI of the patients was 26.8 ±â€Š4.4. Mean follow up was 13.4 ±â€Š2.1. The mean value of (AOFAS) clinical score was 90.3/100. Mean Static Stability Index (SSI) with open eyes was 87.7% (±7.6) in the operated leg and 90.4% (±6.1) in the contra-lateral. SSI with closed eyes was 64.5% (±11.2) in the operated leg and 61.6% (±16.8) in the contra-lateral. Mean Dynamic Stability Index (DSI) without restrictions was 56.2% (±14.6) in the operated leg and 56.8% (±10.6) in the contra-lateral. DSI with restricted upper limbs, had a mean value of 56.3% (±11.4) in the operated leg and 58.1% (±11.9) in the contra-lateral.Re-tensioning capsular-ligamentous surgery of the external compartment for CAI allow to recovery proprioceptive and postural control on the operated side, comparable with data from the contralateral limb and from the healthy population of the same age and sex.


Assuntos
Traumatismos do Tornozelo/fisiopatologia , Traumatismos do Tornozelo/cirurgia , Instabilidade Articular/fisiopatologia , Instabilidade Articular/cirurgia , Ligamentos Articulares/cirurgia , Procedimentos Ortopédicos/métodos , Equilíbrio Postural , Propriocepção , Adulto , Artroscopia , Doença Crônica , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade
9.
Arch Orthop Trauma Surg ; 140(5): 639-650, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32193678

RESUMO

Distal radioulnar joint (DRUJ) instability is often an underestimated or missed lesion which may entail fatal consequences. The triangular fibrocartilage complex is a biomechanically very important stabilizer of the DRUJ and guarantees unrestricted range of motion of the forearm. To detect DRUJ instability a systematic examination is of uppermost importance. The contralateral healthy arm will be used for comparison during clinical examination. X-rays are required to exclude osseous lesions or deformities. Computed tomography of both wrists in neutral forearm rotation, supination, and pronation may be necessary to verify DRUJ instability in ambiguous situations. Following a systematic clinical examination wrist and DRUJ arthroscopy detects lesions definitely. Tears of the distal radioulnar ligaments which entail DRUJ instability should be repaired preferably anatomically. Ulnar-sided ligament ruptures which cause instability are detected more often than radial-sided ones. Osseous ligament avulsions are mostly refixated osteosynthetically. Ligamentous tears of the distal radioulnar ligaments may be reconstructed using anchor suture or transosseous refixation. Secondary procedures such as tendon transplants are necessary for anatomical reconstruction in cases of unrepairable ligament tears.


Assuntos
Artroscopia/métodos , Fixação Interna de Fraturas/métodos , Instabilidade Articular/cirurgia , Amplitude de Movimento Articular/fisiologia , Supinação/fisiologia , Articulação do Punho/cirurgia , Humanos , Instabilidade Articular/etiologia , Instabilidade Articular/fisiopatologia , Masculino , Radiografia , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/fisiopatologia
10.
Phys Ther Sport ; 43: 84-88, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32135450

RESUMO

OBJECTIVE: To examine the factor structure and validity of the Quick-FAAM in individuals with chronic ankle instability (CAI) and those classified as ankle sprain copers (ASC). DESIGN: Cross-sectional. SETTING: Laboratory. PARTICIPANTS: Adult participants were included in both groups based on previously established criteria. MAIN OUTCOME MEASURE(S): The 12-item Quick-FAAM is scored on a 5-point Likert scale were scores are converted to a percentage (0-100%), and greater scores indicate greater function. The Cumberland Ankle Instability Tool (CAIT) is a 9-item scale used to assess impairments in individuals with a history of ankle sprain. Scores range from 0 to 30, and greater scores indicate greater impairment levels. Confirmatory factory analyses, internal consistency, and concurrent validity were determined. Known-groups validity and differences in scores between groups were examined. Alpha was set at p < 0.05. RESULTS: The instruments were strongly correlated (r = 0.76, p < 0.001), the Quick-FAAM internal consistency remained high (α = 0.94) and the single factor was confirmed. The cutoff score differentiating between the groups was 94.79%. CONCLUSIONS: The Quick-FAAM is a valid, shortened version of the FAAM. It also has the ability to discriminate between individuals with CAI and those classified as ASC. The Quick-FAAM should be considered for future use with individuals who have ankle sprain history.


Assuntos
Adaptação Psicológica , Traumatismos do Tornozelo/fisiopatologia , Articulação do Tornozelo/fisiopatologia , Instabilidade Articular/fisiopatologia , Medidas de Resultados Relatados pelo Paciente , Adolescente , Adulto , Traumatismos do Tornozelo/reabilitação , Doença Crônica , Estudos Transversais , Feminino , Humanos , Instabilidade Articular/reabilitação , Masculino , Pessoa de Meia-Idade , Adulto Jovem
11.
Phys Ther Sport ; 43: 127-133, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32146433

RESUMO

OBJECTIVES: To compare ankle, knee and hip isometric peak torque between young and middle-aged adults with CAI, copers and un-injured controls. DESIGN: Cross-sectional. SETTING: Research Laboratory. PARTICIPANTS: One hundred fifty-six young and middle-aged adults with or without CAI volunteered. MAIN OUTCOME MEASURES: A handheld dynamometer measured isometric dorsiflexion, plantarflexion, knee extension, hip extension and hip abduction peak force during a 5 s trial. Average peak torque was calculated and normalized to body mass. RESULTS: A significant Age by Injury interaction for dorsiflexion suggest middle-aged un-injured controls (p < 0.001) and copers (p < 0.001) had lower isometric peak torque compared to their young adult counterparts, but there were no differences between young and middle-aged adults with CAI (p > 0.05). Significant Injury main effects suggest the CAI group had decreased plantarflexion (p = 0.004) and hip extension (p = 0.010) strength compared to un-injured controls, but not copers (p > 0.05). Significant Age main effects for all primary outcome measures were observed, indicating peak torque decreased with age (p < 0.05). CONCLUSIONS: Regardless of age, isometric ankle and hip peak torque was lower in participants with CAI compared to un-injured controls, but not copers. These findings provide further evidence towards the impact of CAI in both young and middle-aged adults.


Assuntos
Adaptação Psicológica , Articulação do Tornozelo/fisiopatologia , Articulação do Quadril/fisiopatologia , Contração Isométrica/fisiologia , Instabilidade Articular/fisiopatologia , Adolescente , Adulto , Idoso , Doença Crônica , Estudos Transversais , Feminino , Humanos , Instabilidade Articular/psicologia , Masculino , Pessoa de Meia-Idade , Dinamômetro de Força Muscular , Adulto Jovem
12.
Invest Ophthalmol Vis Sci ; 61(3): 16, 2020 03 09.
Artigo em Inglês | MEDLINE | ID: mdl-32176264

RESUMO

Purpose: In this experimental study, we quantify retinal microvasculature morphological features with depth, region, and age in immature and mature ovine eyes. These data identify morphological vulnerabilities in young eyes to inform the mechanics of retinal hemorrhage in children. Methods: Retinal specimens from the equator and posterior pole of preterm (n = 4) and adult (n = 9) sheep were imaged using confocal microscopy. Vessel segment length, diameter, angular asymmetry, tortuosity, and branch points were quantified using a custom image segmentation code. Significant differences were identified through two-way ANOVAs and correlation analyses. Results: Vessel segment lengths were significantly shorter in immature eyes compared to adults (P < 0.003) and were significantly shorter at increasing depths in the immature retina (P < 0.04). Tortuosity significantly increased with depth, regardless of age (P < 0.05). These data suggest a potential vulnerability of vasculature in the deeper retinal layers, particularly in immature eyes. Preterm retina had significantly more branch points than adult retina in both the posterior pole and equator, and the number increased significantly with depth (P < 0.001). Conclusions: The increased branch points and decreased segment lengths in immature microvasculature suggest that infants will experience greater stress and strain during traumatic loading compared to adults. The increased morphological vulnerability of the immature microvasculature in the deeper layers of the retina suggest that intraretinal hemorrhages have a greater likelihood of occurring from trauma compared to preretinal hemorrhages. The morphological features captured in this study lay the foundation to explore the mechanics of retinal hemorrhage in infants and identify vulnerabilities that explain patterns of retinal hemorrhage in infants.


Assuntos
Hemorragia Retiniana/patologia , Vasos Retinianos/anatomia & histologia , Envelhecimento/patologia , Envelhecimento/fisiologia , Animais , Animais Recém-Nascidos , Artérias/anormalidades , Artérias/patologia , Artérias/fisiopatologia , Fenômenos Biomecânicos , Feminino , Humanos , Instabilidade Articular/patologia , Instabilidade Articular/fisiopatologia , Microscopia Confocal , Microvasos/anatomia & histologia , Microvasos/fisiologia , Variações Dependentes do Observador , Hemorragia Retiniana/etiologia , Vasos Retinianos/fisiologia , Ovinos , Dermatopatias Genéticas/patologia , Dermatopatias Genéticas/fisiopatologia , Malformações Vasculares/patologia , Malformações Vasculares/fisiopatologia
13.
J Electromyogr Kinesiol ; 51: 102399, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32028104

RESUMO

The objective of this study was to quantify the kinematic, kinetic and electromyography differences between individuals with and without chronic ankle instability (CAI) during comfortable (CW) and fast (FW) walking. Twenty-one individuals with CAI and 21 healthy controls were recruited to walk at CW and FW speeds. The dependent variables were gluteus medius, vastus lateralis, gastrocnemius lateralis, gastrocnemius medialis, peroneus longus and tibialis anterior muscles mean activity, ankle and knee angles and moments. Kinematic, kinetic and electromyography variables were compared between groups with a one-dimensional statistical non-parametric mapping analysis. The CAI group exhibited no significant difference for ankle angles and moments compared to the control group. However, the CAI group showed less external knee rotation from 56 to 100% (CW) and 51 to 98% (FW) and more knee abduction moment from 1 to 6% and 7 to 9% (CW) and 1 to 2% (FW) of the stance phase. Less gluteus medius muscle activity was also observed from 6 to 9% and 99 to 100% (CW) of the stance phase for the CAI group. These results suggest proximal biomechanical compensations and will help better understand the underlying deficits associated with CAI. They also indicate that regardless of walking speeds, individuals with CAI exhibit similar differences compared to healthy participants.


Assuntos
Articulação do Tornozelo/fisiopatologia , Instabilidade Articular/fisiopatologia , Contração Muscular , Caminhada , Fenômenos Biomecânicos , Feminino , Humanos , Masculino , Músculo Esquelético/fisiopatologia , Adulto Jovem
14.
J Orthop Sports Phys Ther ; 50(2): 52-54, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32005097

RESUMO

Shoulder instability has varying mechanisms of injury, direction, and severity. Classification systems based on clustering signs and symptoms have been developed to define subgroups of shoulder instability. Despite this attempt at homogeneity, multidirectional instability (MDI) suffers from the same lack of diagnostic clarity as low back pain. In this Viewpoint, the authors outline 3 key areas to address when diagnosing MDI: patient interview, medical comorbidities, and specific shoulder tests and measures. J Orthop Sports Phys Ther 2020;50(2):52-54. doi:10.2519/jospt.2020.0602.


Assuntos
Transtornos Traumáticos Cumulativos/diagnóstico , Instabilidade Articular/diagnóstico , Articulação do Ombro/lesões , Voleibol/lesões , Adolescente , Transtornos Traumáticos Cumulativos/classificação , Transtornos Traumáticos Cumulativos/fisiopatologia , Feminino , Humanos , Instabilidade Articular/classificação , Instabilidade Articular/fisiopatologia , Anamnese , Exame Físico , Articulação do Ombro/fisiopatologia
15.
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
16.
J Athl Train ; 55(2): 169-175, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31895591

RESUMO

CONTEXT: Individuals with chronic ankle instability (CAI) demonstrate altered lower limb movement dynamics during jump landings, which can contribute to recurrent injury. However, the literature examining lower limb movement dynamics during a side-cutting task in individuals with CAI is limited. OBJECTIVE: To assess lower limb joint kinetics and sagittal-plane joint stiffness during the stance phase of a side-cutting task in individuals with or without CAI. DESIGN: Cohort study. SETTING: Motion-capture laboratory. PATIENTS OR OTHER PARTICIPANTS: Fifteen physically active, young adults with CAI (7 men, 8 women; age = 21.3 ± 1.6 years, height = 171.0 ± 11.2 cm, mass = 73.4 ± 15.2 kg) and 15 healthy matched controls (7 men, 8 women; age = 21.5 ± 1.5 years, height = 169.9 ± 10.6 cm, mass = 75.5 ± 13.0 kg). INTERVENTION(S): Lower limb 3-dimensional kinematic and ground reaction force data were recorded while participants completed 3 successful trials of a side-cutting task. Net internal joint moments, in addition to sagittal-plane ankle-, knee-, and hip-joint stiffness, were computed from 3-dimensional kinematic and ground reaction force data during the stance phase of the side-cutting task and analyzed. MAIN OUTCOME MEASURE(S): Data from each participant's stance phase were normalized to 100% from initial foot contact (0%) to toe-off (100%) to compute means, standard deviations, and Cohen d effect sizes for all dependent variables. RESULTS: The CAI group exhibited a reduced ankle-eversion moment (39%-81% of stance phase) and knee-abduction moment (52%-75% of stance phase) and a greater ankle plantar-flexion moment (3%-16% of stance phase) than the control group (P range = .009-.049). Sagittal-plane hip-joint stiffness was greater in the CAI than in the control group (t28 = 1.978, P = .03). CONCLUSIONS: Our findings suggest that altered ankle-joint kinetics and increased hip-joint stiffness were associated when individuals with CAI performed a side-cutting task. These lower limb kinetic changes may contribute to an increased risk of recurrent lateral ankle sprains in people with CAI. Clinicians and practitioners can use these findings to develop rehabilitation programs for improving maladaptive movement mechanics in individuals with CAI.


Assuntos
Articulação do Tornozelo/fisiologia , Articulação do Tornozelo/fisiopatologia , Instabilidade Articular/fisiopatologia , Extremidade Inferior/fisiopatologia , Traumatismos do Tornozelo/fisiopatologia , Fenômenos Biomecânicos , Doença Crônica , Estudos de Coortes , Feminino , Pé/fisiopatologia , Articulação do Quadril/fisiopatologia , Humanos , Cinética , Articulação do Joelho/fisiopatologia , Masculino , Movimento , Recidiva , Adulto Jovem
17.
J Athl Train ; 55(2): 159-168, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31935136

RESUMO

CONTEXT: Ankle-joint mobilization and neuromuscular and strength training have been deemed beneficial in the management of patients with chronic ankle instability (CAI). CrossFit training is a sport modality that involves these techniques. OBJECTIVE: To determine and compare the influence of adding self-mobilization of the ankle joint to CrossFit training versus CrossFit alone or no intervention in patients with CAI. DESIGN: Randomized controlled clinical trial. SETTING: Research laboratory. PATIENTS OR OTHER PARTICIPANTS: Seventy recreational athletes with CAI were randomly allocated to either self-mobilization plus CrossFit training, CrossFit training alone, or a control group. INTERVENTION(S): Participants in the self-mobilization plus CrossFit group and the CrossFit training-alone group pursued a CrossFit training program twice a week for 12 weeks. The self-mobilization plus CrossFit group performed an ankle self-mobilization protocol before their CrossFit training, and the control group received no intervention. MAIN OUTCOME MEASURE(S): Ankle-dorsiflexion range of motion (DFROM), subjective feeling of instability, and dynamic postural control were assessed via the weight-bearing lunge test, Cumberland Ankle Instability Tool, and Star Excursion Balance Test (SEBT), respectively. RESULTS: After 12 weeks of the intervention, both the self-mobilization plus CrossFit and CrossFit training-alone groups improved compared with the control group (P < .001). The self-mobilization plus CrossFit intervention was superior to the CrossFit training-alone intervention regarding ankle DFROM as well as the posterolateral- and posteromedial-reach distances of the SEBT but not for the anterior-reach distance of the SEBT or the Cumberland Ankle Instability Tool. CONCLUSIONS: Ankle-joint self-mobilization and CrossFit training were effective in improving ankle DFROM, dynamic postural control and self-reported instability in patients with CAI.


Assuntos
Articulação do Tornozelo/fisiopatologia , Instabilidade Articular/fisiopatologia , Condicionamento Físico Humano/métodos , Adulto , Doença Crônica , Feminino , Ginástica , Humanos , Masculino , Equilíbrio Postural/fisiologia , Amplitude de Movimento Articular , Treinamento de Resistência , Autorrelato , Método Simples-Cego , Suporte de Carga
18.
J Am Acad Orthop Surg ; 28(3): e100-e107, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-31977608

RESUMO

Os odontoideum is a rare entity of the second cervical vertebra, characterized by a circumferentially corticated ossicle separated from the body of C2. The ossicle is a distinct entity from an odontoid fracture or a persistent ossiculum terminale. The diagnosis may be made incidentally on imaging obtained for the workup of neck pain or neurologic signs and symptoms. Diagnosis usually can be made with plain radiographs. MRI and CT can assess spinal cord integrity and C1-C2 instability. The etiology of os odontoideum is a topic of debate, with investigative studies supporting both congenital and traumatic origins. A wide clinical range of symptoms exists. Symptoms may present as nondescript pain or include occipital-cervical pain, myelopathy, or vertebrobasilar ischemia. Asymptomatic cases without evidence of radiologic instability are typically managed with periodic observation and serial imaging. The presence of atlantoaxial instability or neurological dysfunction necessitates surgical intervention with instrumentation and fusion for stability.


Assuntos
Vértebra Cervical Áxis/fisiopatologia , Vértebra Cervical Áxis/cirurgia , Instabilidade Articular/fisiopatologia , Instabilidade Articular/cirurgia , Fusão Vertebral/métodos , Vértebra Cervical Áxis/diagnóstico por imagem , Criança , Humanos , Instabilidade Articular/diagnóstico por imagem
19.
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
20.
Br J Sports Med ; 54(14): 839-847, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31937576

RESUMO

OBJECTIVE: Determine whether impairments in lower limb muscle strength exist in individuals with chronic ankle instability (CAI) compared with uninjured controls. DESIGN: Systematic review with meta-analysis. DATA SOURCE: A comprehensive search of PubMed, Cochrane, CINAHL, Web of Science and EMBASE electronic databases from inception to 10 February 2019. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Cross-sectional and case-control studies were included if they objectively measured lower limb muscle strength in individuals with CAI compared with controls. Risk of bias and quality of included studies were assessed. Data of included studies were extracted, and meta-analysis was conducted where appropriate. RESULTS: 12 397 unique studies were identified, of which 20 were included and 16 were eligible for meta-analysis. Reviewed studies clearly described the aim/hypothesis and main outcome measure, but most lacked sample size calculation and assessor blinding. Meta-analyses showed individuals with CAI had lower eccentric and concentric evertor strength (30 and 120°/s; Nm; standardised mean difference (SMD) between -0.73 and -0.95), eccentric invertor strength (60 and 120°/s; both Nm and Nm/kg; SMD between -0.61 and -1.37), concentric invertor strength (60 and 120°/s; Nm; SMD=-0.7) and concentric knee extensor strength (SMD=-0.64) compared with control participants. Ankle eccentric dorsiflexor strength was not different between groups. Although pooling was not possible, data from three separate studies indicated that hip flexor, abductor and external rotator strength, but not hip adductor and extensor strength, was lower in individuals with CAI than in control participants. CONCLUSION: Individuals with CAI have ankle inversion and eversion strength deficits. Our data also point to differences between individuals with CAI and controls in hip and knee strength. These elements of the kinetic chain should be evaluated by clinicians who rehabilitate individuals with CAI. PROSPERO REGISTRATION NUMBER: CRD42016037759.


Assuntos
Tornozelo/fisiopatologia , Quadril/fisiopatologia , Instabilidade Articular/fisiopatologia , Joelho/fisiopatologia , Força Muscular/fisiologia , Humanos
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