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1.
Dan Med J ; 68(6)2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34704929

RESUMO

INTRODUCTION: Lateral hip pain (LHP) due to tendon pathologies of insertion of the M. gluteus medius and minimus at the greater trochanter are often misdiagnosed and may lead to unrecognised disability. The purpose of this study was to evaluate pain and patient-reported outcomes in patients presenting with LHP in the context of a publicly financed healthcare system. METHODS: Data were collected from September 2017 to November 2020 at a regional teaching hospital. Inclusion criteria were clinical and MRI-verified hip abductor tendon pathology. Baseline testing included pain scoring (numerical rating scale, NRS), and the following patient-reported outcome scores: Copenhagen Hip and Groin Outcome Score (HAGOS), Oxford Hip Score (OHS) and EuroQol-Visual Analogue Scale (EQ-VAS). RESULTS: A total of 151 patients (94% women) with a median age of 55 years were included. The mean LHP (NRS 0-10) at rest, during activity and worst pain at any given time was 4, 7 and 9, respectively. The mean patient-reported outcome scores were HAGOS: pain 42.9, symptoms 49.8, activities of daily living 42.2, sport/recreation 28.1, participation in physical activities 25, quality of life 27.8; OHS 24; EQ-VAS 59.6. CONCLUSIONS: We found that patients with hip abductor tendon pathology display poor patient-reported outcomes comparable to those of patients suffering from severe hip osteoarthrosis. Further research into this patient group is warranted. The results are based on a heterogeneous study population in terms of variety of hip abductor tendon pathology and comorbidities and need to be interpreted as such. FUNDING: none. TRIAL REGISTRATION: According to current Danish law, no formal ethical approval was required for this study. The National Data Protection Agency approved the study (1-16-02-125-19).


Assuntos
Atividades Cotidianas , Qualidade de Vida , Artralgia/etiologia , Feminino , Quadril , Humanos , Masculino , Pessoa de Meia-Idade , Dor/etiologia
2.
BMJ Open ; 11(10): e051392, 2021 10 22.
Artigo em Inglês | MEDLINE | ID: mdl-34686555

RESUMO

INTRODUCTION: Hip osteoarthritis (OA) is the leading cause for total hip arthroplasty (THA). Although, being considered as the surgery of the century up to 23% of the patients report long-term pain, and deficits in physical function and muscle strength may persist after THA. Progressive resistance training (PRT) appears to improve multiple outcomes moderately in patients with hip OA. Current treatment selection is based on low-level evidence as no randomised controlled trials have compared THA to non-surgical treatment. The primary aim of this trial is to investigate whether THA followed by standard care is superior to 12 weeks of supervised PRT followed by 12 weeks of optional unsupervised PRT for improving hip pain and function in patients with severe hip OA. METHODS AND ANALYSIS: This is a protocol for a multicentre, parallel-group, assessor-blinded, randomised controlled superiority trial conducted at four hospitals across three healthcare regions in Denmark. 120 patients aged ≥50 years with clinical and radiographic hip OA found eligible for THA by an orthopaedic surgeon will be randomised to THA followed by standard care, or 12 weeks of PRT (allocation 1:1). The primary outcome will be change in patient-reported hip pain and function, measured using the Oxford Hip Score, from baseline to 6 months after initiating the treatment. Key secondary outcomes will be change in the Hip disability and Osteoarthritis Outcome Score subscales, University of California Los Angeles Activity Score, 40 m fast-paced walk test, 30 s chair stand test and occurrence of serious adverse events. Patients declining participation in the trial will be invited into a prospective observational cohort study. ETHICS AND DISSEMINATION: The trial has been approved by The Regional Committees on Health Research Ethics for Southern Denmark (Project-ID: S-20180158). All results will be presented in peer-reviewed scientific journals and international conferences. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov (NCT04070027).


Assuntos
Artroplastia de Quadril , Osteoartrite do Quadril , Treinamento de Força , Quadril/cirurgia , Humanos , Estudos Multicêntricos como Assunto , Estudos Observacionais como Assunto , Osteoartrite do Quadril/cirurgia , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
3.
Phys Ther Sport ; 52: 224-233, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34628337

RESUMO

OBJECTIVES: To compare physical impairments between patients with hip-related pain and those with non-hip-related groin pain, and to compare both patient groups with healthy controls. DESIGN: Cross-sectional. PARTICIPANTS: Eighty-one hip and groin pain patients were consecutively included and categorized into having hip-related pain or non-hip-related groin pain. Twenty-eight healthy controls were recruited. SETTINGS: Tertiary care. MAIN OUTCOME MEASURES: All participants performed physical impairment testing including hip ROM, muscle function, and functional tasks. An analysis of covariates was used for analysis between patients groups and controls. RESULTS: Patients with hip-related pain showed reduced hip ROM in internal rotation compared to patients with non-hip-related groin pain and controls (p ≤ 0.026, d -0.65; -0.97). No differences in muscle function or performance in functional tasks were observed between patients with hip-related pain and those with non-hip-related groin pain (p ≥ 0.136, d 0.00; 0.68). Both patient groups had worse muscle function and worse performance in functional tasks compared to controls (p ≤ 0.048, d -0.67; -1.83). CONCLUSIONS: Both patients with and without hip-related pain had worse muscle function and worse performance in functional tasks compared to matched controls but no differences were observed between the patient groups. Only patients with hip-related pain had reduced ROM in internal rotation.


Assuntos
Virilha , Articulação do Quadril , Estudos Transversais , Quadril , Humanos , Dor Pélvica
4.
Phys Ther Sport ; 52: 263-271, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34678567

RESUMO

OBJECTIVE: To describe and compare hip and groin strength and function of male ice hockey players over one season in players with and without hip and groin problems in the previous season. DESIGN: Prospective cohort study. SETTING: Swedish male ice hockey. PARTICIPANTS: We followed 193 players from 10 teams during the 2017/2018 season. MAIN OUTCOME MEASURES: Hip adduction and abduction strength, 5 s squeeze test (5SST), and self-reported hip and groin function (Hip and Groin Outcome Score). Changes over the season and differences between players with and without problems in the previous season were analyzed by linear mixed models. RESULTS: Adduction strength decreased slightly from pre-to mid-season and abduction strength increased slightly over the full season. However, self-reported function or pain did not change. Players with hip and groin problems in the previous season had significantly worse self-reported function, and more groin pain during the 5SST compared to players without. Strength measurments did not differ between groups. CONCLUSIONS: Hip muscle strength, groin pain, and self-reported function appear to remain stable throughout the season in male ice hockey players. Remaining impairments in players with problems in the previous season suggest that function does not recover by ice hockey participation alone.


Assuntos
Hóquei , Virilha , Quadril , Humanos , Masculino , Estudos Prospectivos , Estações do Ano
5.
Nat Med ; 27(10): 1783-1788, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34635852

RESUMO

Above-knee amputation severely reduces the mobility and quality of life of millions of individuals. Walking with available leg prostheses is highly inefficient, and poor walking economy is a major problem limiting mobility. Here we show that an autonomous powered hip exoskeleton assisting the residual limb significantly improves metabolic walking economy by 15.6 ± 2.9% (mean ± s.e.m.; two-tailed paired t-test, P = 0.002) in six individuals with above-knee amputation walking on a treadmill. The observed metabolic cost improvement is equivalent to removing a 12-kg backpack from a nonamputee individual. All participants were able to walk overground with the exoskeleton, including starting and stopping, without notable changes in gait balance or stability. This study shows that assistance of the user's residual limb with a powered hip exoskeleton is a viable solution for improving amputee walking economy. By significantly reducing the metabolic cost of walking, the proposed hip exoskeleton may have a considerable positive impact on mobility, improving the quality of life of individuals with above-knee amputations.


Assuntos
Amputados/reabilitação , Exoesqueleto Energizado , Próteses e Implantes , Caminhada/fisiologia , Adulto , Amputação/tendências , Fenômenos Biomecânicos , Extremidades/fisiopatologia , Extremidades/cirurgia , Feminino , Marcha/fisiologia , Quadril/fisiopatologia , Quadril/cirurgia , Humanos , Joelho/fisiopatologia , Joelho/cirurgia , Masculino , Qualidade de Vida
6.
Clin Sports Med ; 40(4): 713-729, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34509207

RESUMO

Hip pain is a common and complex clinical entity. The causes of hip injuries in athletes are many and diverse, requiring efficient, accurate diagnosis for proper management. Imaging is an important step in the clinical evaluation of hip pain, and familiarity with multiple imaging modalities as well as characteristic imaging findings is a helpful tool for sports medicine clinicians. This article discusses imaging recommendations and gives imaging examples of common causes of intra-articular and extra-articular hip pain including femoroacetabular impingement, labral tears, cartilage defects, ligamentum teres injuries, snapping hip syndrome, femoral stress injuries, thigh splints, athletic pubalgia, avulsion injuries, and hip dislocation.


Assuntos
Traumatismos em Atletas , Impacto Femoroacetabular , Lesões do Quadril , Traumatismos em Atletas/complicações , Traumatismos em Atletas/diagnóstico por imagem , Impacto Femoroacetabular/diagnóstico por imagem , Quadril , Lesões do Quadril/diagnóstico por imagem , Articulação do Quadril/diagnóstico por imagem , Humanos , Dor
7.
Arthroscopy ; 37(9): 2830-2831, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34481623

RESUMO

Iliopsoas tendon pain can be a frustrating condition for both patients and surgeons after total hip arthroplasty. It is difficult to diagnose definitively, as there is no imaging modality that offers reliable information and there are numerous causes of persistent groin pain in this patient population. The pain can ruin the results of an otherwise well-functioning total hip arthroplasty. Patients who respond best to arthroscopic iliopsoas tenotomy are those with isolated pain with hip flexion activities and reproducible pain with resisted hip flexion on examination or other provocative iliopsoas maneuvers. Patients with these symptoms in addition to more generalized pain findings (pain with weight-bearing, pain at night, pain with passive range of motion) tend not to respond as favorably to isolated iliopsoas tenotomy. In addition, optimal treatment for refractory cases has been controversial historically, as both acetabular component revision and iliopsoas tendon lengthening have been advocated. With the ever-increasing popularity of hip arthroscopy and recent clinical outcome reports, arthroscopic (or endoscopic) iliopsoas tenotomy has proven to be a very safe and effective treatment option for these patients, with one caveat: the diagnosis must be correct.


Assuntos
Artroplastia de Quadril , Tenotomia , Quadril/cirurgia , Articulação do Quadril/cirurgia , Humanos , Dor/cirurgia
8.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(9): 1105-1110, 2021 Sep 15.
Artigo em Chinês | MEDLINE | ID: mdl-34523274

RESUMO

Objective: To explore the different imaging manifestations of osteonecrosis of the femoral head (ONFH) and their correlation with the occurrence of pain during the peri-collapse period. Methods: The 372 patients (624 hips) with ONFH in the peri-collapse stage who were admitted between December 2016 and October 2019 and met the selection criteria were selected as the research objects. Among them, there were 270 males and 102 females, with an average age of 35.3 years (mean, 15-65 years). There were 120 cases of unilateral hip and 252 cases of bilateral hips. There were 39 cases (39 hips) of traumatic ONFH, 196 cases (346 hips) of hormonal ONFH, 102 cases (178 hips) of alcoholic ONFH, and 35 cases (61 hips) of idiopathic ONFH. Among them, there were 482 hips with pain symptoms and 142 hips without pain. The pain duration was less than 3 months in 212 hips, 3-6 months in 124 hips, 6-12 months in 117 hips, and more than 12 months in 29 hips. According to the Association Research Circulation Osseous (ARCO) staging, the ONFH was rated as stage Ⅱ in 325 hips and stage Ⅲ in 299 hips. The patients were grouped according to ONFH etiology and ARCO staging, and hip joint pain and X-ray film (crescent sign and cystic changes), CT (subchondral bone fractures and cystic changes), and MRI (bone marrow edema, joint effusion, and subchondral hypointensity zone) were compared. Spearman rank correlation was used to determine the correlation between ONFH pain duration and X-ray film, CT, and MRI imaging manifestations. Results: There were significant differences ( P<0.05) between ONFH patients with different etiologies in crescent sign on X-ray film, subchondral bone fracture on CT, and joint effusion on MRI. And there were significant differences ( P<0.05) between ONFH patients with different ARCO stages in hip pain duration and all imaging manifestations. Correlation analysis showed that the pain duration of ONFH patients was correlated with all imaging manifestations ( P<0.05). The cystic change on CT was correlated with the subchondral hypointensity zone and joint effusion grade on MRI, and subchondral hypointensity zone and joint effusion grade on MRI were also correlated ( P<0.05). Conclusion: The cystic changes, subchondral hypointensity zone, and joint effusion are closely related to the collapse of the femoral head and hip pain in patients with ONFH in the peri-collapse stage. The above-mentioned signals in stage Ⅱ ONFH indicate the instability of the femoral head, which is to predict the development of ONFH and the rational choice of hip-preserving treatment methods provides a basis.


Assuntos
Artroplastia de Quadril , Necrose da Cabeça do Fêmur , Adulto , Feminino , Cabeça do Fêmur/diagnóstico por imagem , Necrose da Cabeça do Fêmur/diagnóstico por imagem , Necrose da Cabeça do Fêmur/etiologia , Necrose da Cabeça do Fêmur/cirurgia , Quadril , Humanos , Imageamento por Ressonância Magnética , Masculino
9.
PLoS One ; 16(9): e0257081, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34543314

RESUMO

PURPOSE: To perform a systemic literature search to identify Chinese cross culturally adapted and new designed Patient Reported Outcome Measures (PROMs) used for hip assessment, then a standardized evaluation of available instruments in order to provide evidence of high-quality PROMs for clinical use and adoption in future hip registries. METHODS: A Systematic Review of the following databases: PUBMED, CINAHL, EMBASE, CNKI was performed to identify relevant PROMs. Instruments underwent standardized assessment and scoring using the EMPRO tool by two independent reviewers. Inter-rater reliability was assessed using intra-class correlation coefficients (ICC). RESULTS: 2188 articles were retrieved, with seven articles fitting the inclusion criteria consisting of six hip PROMs. Five PROMs were cross culturally adapted and one was originally designed in Mandarin Chinese. Total scores (/100) after EMPRO evaluation: Osteoarthritis of Knee and Hip Quality of Life (OAKHQOL): 55; Copenhagen Hip and Groin Outcome Score (HAGOS): 52; International Hip Outcome Tool (SC-iHOT-33): 45; Hip Disability and Osteoarthritis Outcome Score (HOOS): 37; Questionnaire on the Perceptions and Functions of Patients about Total Hip Arthroplasty (QPFPTHA): 36; Oxford Hip Score (OHS): 35. ICC values were 0.73 for the SC-iHOT-33 and ranged between 0.83-0.93 for the other PROMs indicating good to excellent inter-rater agreement. CONCLUSION: Among the commonly used hip-specific PROMs found in arthroplasty registries, none of the Chinese adapted versions evaluated by EMPRO is currently rated acceptable for clinical use. Only OAKHQOL and HAGOS reached acceptability threshold. Further research on the attributes of cross-cultural adaptation, interpretability and burden assessment would be helpful.


Assuntos
Comparação Transcultural , Quadril/patologia , Medidas de Resultados Relatados pelo Paciente , Humanos , Internacionalidade , Variações Dependentes do Observador , Padrões de Referência , Reprodutibilidade dos Testes
10.
Phys Ther Sport ; 52: 115-120, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34481341

RESUMO

Groin/hip injuries are prevalent in rugby union (RU). Assessment of hip muscle strength is important when designing bespoke injury prevention and rehabilitation programmes. OBJECTIVE: The primary aim of this study was to determine normative values of hip muscle strength in elite-level RU players. A secondary aim of this study was to compare the Copenhagen Hip and Groin Outcome Score (HAGOS) between players with and without a history of groin/hip injury. DESIGN: Cross-sectional cohort study. SETTING: Professional RU club. PARTICIPANTS: 58 male professional RU players competing in the PRO14 league elite club level competition. MAIN OUTCOME MEASURES: Handheld dynamometry eccentric strength values of hip abduction (ABD), adduction (ADD), internal rotation (IR) and external rotation (ER), HAGOS. RESULTS: Players' dominant (DOM) and non-dominant (NDOM) hip strength values were, 2.38 and 2.34 N m/kg for ABD, 2.79 and 2.71 N m/kg for ADD, 2.69 and 2.55 N m/kg for IR, and 2.65 and 2.54 N m/kg for ER. ADD:ABD strength ratio was 1.17 ± 0.26 for the DOM limb and 1.16 ± 0.24 for the NDOM limb. There was no clinically significant difference in strength between players' DOM and NDOM limbs. Players with a history of groin/hip injury scored lower on four of the HAGOS subscales (pain; symptoms; sport; quality of life) compared to those without a history of groin/hip injury. CONCLUSIONS: This study may help establish normative hip strength and HAGOS values for elite-level RU players. The results presented have important implications for the assessment of hip muscle strength and could provide clinical markers for return-to-play following injury.


Assuntos
Futebol Americano , Estudos Transversais , Virilha , Quadril , Humanos , Masculino , Força Muscular , Qualidade de Vida
11.
J Arthroplasty ; 36(10): 3478-3484, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34332792

RESUMO

BACKGROUND: The Patient-Reported Outcomes Measurement Information System (PROMIS) was developed by the National Institutes of Health to collect outcome data in rapid dynamic fashion on electronic platforms. The potential role of PROMIS in monitoring pain and function in young total hip arthroplasty (THA) patients has been under-investigated. The purpose of this study is to investigate correlation between PROMIS Physical Function (PF) and PROMIS Pain Interference (PI) and legacy scores with similar considerations. METHODS: We identified 298 hips who underwent primary THA over 40 months. Patients without preoperative PROMIS or legacy scores, or >50 years were excluded. Demographic data included age, gender, and body mass index. Outcome data included PF, PI, modified Harris Hip Score (mHHS), Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC) domains, and Short Form 12 components. Floor/ceiling effects were considered to be significant if ≥15% of patients responded with the lowest or highest possible score. Spearman correlation (R) was performed to investigate correlation between legacy scores and PROMIS domains. RESULTS: Mean age was 40 years, mean body mass index was 30.1 kg/m2, and 55% were female. None of the patient-reported outcome measures showed any floor/ceiling effects. PI showed moderate correlation to mHHS (R = -0.60), WOMAC Pain (R = -0.62), and WOMAC PF (R = -0.60). PF showed moderate correlation to mHHS (R = 0.66) and WOMAC PF (R = 0.55). Mean PF and PI scores differed significantly from the general population mean of 50 (36.7, 65.4, respectively; both P < .001). CONCLUSION: PROMIS is an attractive alternative to legacy scoring measures, showing moderate correlations between PROMIS physical domains and legacy PROMs of WOMAC and mHHS in young patients undergoing THA.


Assuntos
Artroplastia de Quadril , Adulto , Feminino , Quadril , Humanos , Sistemas de Informação , Masculino , Dor , Medidas de Resultados Relatados pelo Paciente
12.
Eur J Radiol ; 143: 109876, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34419731

RESUMO

PURPOSE: Tendon pathology around the hip is a common entity. The aim of this study was to detect tendon abnormalities around the hip in a population of asymptomatic volunteers. MATERIALS AND METHODS: Fifty volunteers (100 hips) referred for non-musculoskeletal conditions were evaluated with an additional coronal STIR-weighted MRI imaging on a 1.5 MR unit. This group was composed of 27 women and 23 men with a mean age of 52 (19-91 years). The images were interpreted independently by 2 musculoskeletal radiologists. All tendons around the hip were given a score from 0 to 4, with a score 0 corresponding to no abnormality, score 1 to signal alteration around the tendon, score 2 to minimal signal abnormality in the tendon, score 3 partial tear and score 4 complete rupture. The trochanteric bursa was also evaluated and its size was measured. It was also given a score from 0 to 3 (0: no abnormality, 1: slight hypersignal, 2: bursitis < 10 mm, 3: bursitis ≥ 10 mm). RESULTS: High intratendinous signal was commonly found at the joined insertion of biceps femoris and semitendinosus (18% L, 20% R), the semimembranosus (24% L, 20% R), gluteus minimus (6% L, 11% R) and rectus femoris (9% L, 3% R). A small trochanteric bursa was seen in 33% of the volunteers on the left side and 32% on the right side. The interobserver correlation was very good with an intraclass correlation coefficient of 0.79 (CI: 0.74-0.85). CONCLUSION: Slight signal alterations might be found in the insertions of the rectus femoris, hamstrings and gluteus minimus tendons. A small to moderate trochanteric bursitis might also be seen. This suggests that care should be taken when interpreting MR scans to attribute symptoms to these findings.


Assuntos
Imageamento por Ressonância Magnética , Tendões , Idoso , Idoso de 80 Anos ou mais , Feminino , Quadril/diagnóstico por imagem , Articulação do Quadril/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Tendões/diagnóstico por imagem , Voluntários
13.
J Bodyw Mov Ther ; 27: 77-83, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34391316

RESUMO

BACKGROUND: While some studies of the asymmetry of lower limbs in individuals with idiopathic scoliosis exist, there is a need for multidirectional studies conducted on hip joint range of motion and its relationship to curve patterns in idiopathic scoliosis. OBJECTIVES: This study analyzes the hip joint range of multidirectional motions, hip motion asymmetry and investigates them according to curve patterns in individuals with idiopathic scoliosis. METHODS: The sample included 108 females with idiopathic scoliosis. Participants were divided into three groups: double curves, single thoracic curve and single lumbar curve. The range of hip flexion and extension, abduction and adduction, and internal and external rotations were assessed actively and passively with a universal goniometer. The range of motion, left-right asymmetry and the mid-points of the ranges of motion were analyzed. RESULTS: The passive range of the right hip abduction was higher in the thoracic curve group vs. the lumbar curve group. Active and passive ranges of hip extension were higher in the left hip vs. right hip. Active left-right asymmetry was higher than passive left-right asymmetry. CONCLUSION: Individuals with idiopathic scoliosis had different hip abduction motions according to curve pattern that originated from single curves. Left-right hip asymmetry was seen for the hip extension motion. Higher left-right asymmetry for active motion than passive motion in hip abduction may indicate a problem in motion perception in individuals with idiopathic scoliosis.


Assuntos
Escoliose , Feminino , Quadril , Articulação do Quadril , Humanos , Amplitude de Movimento Articular , Vértebras Torácicas
14.
Isr Med Assoc J ; 23(8): 534-540, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34392634

RESUMO

BACKGROUND: Diagnosis and treatment of posterior hip pain has increased due to advancements in clinical, anatomical, biomechanical, and related pathological understandings of the hip. Due to its complexity and close anatomical relationship with many osseous, neurovascular, and musculotendinous structures, posterior hip pain must be appropriately categorized based on its origin. Therefore, it is crucial that clinicians are able to determine whether patient complaints are of extra-articular or intra-articular nature so that they can implement the optimal treatment plan. In the current review article, we discussed posterior hip pain with an emphasis on the main differential diagnoses of deep gluteal syndrome, ischiofemoral impingement, and hamstring tear/hamstring syndrome. For the appropriate diagnosis and etiology of posterior hip pain, a thorough and conclusive clinical history is imperative. Physicians should rule out the possibility of spinal involvement by physical examination and if necessary, by magnetic resonance imaging (MRI). Furthermore, because of the vicinity to other, non-orthopedic structures, an obstetric and gynecologic history, general surgery history, and urologic history should be obtained. Following the collection of patient history clinicians should adhere to an established and efficient order of evaluation starting with standing then to seated, supine, lateral, and prone testing. Imaging assessment of posterior hip pain begins with a standard anterior-posterior pelvic radiograph, in addition to frog-leg lateral. MRI is pivotal for assessing soft tissue-related extra-articular causes of hip in patients with posterior hip pain. Non-surgical treatment is preferred in most cases of deep gluteal syndrome, ischiofemoral impingement, pudendal nerve entrapment, and proximal hamstring pathologies. Surgical treatment is saved as a last resort option in cases of failed non-surgical treatment.


Assuntos
Quadril , Medição da Dor/métodos , Dor , Diagnóstico Diferencial , Quadril/diagnóstico por imagem , Quadril/patologia , Quadril/fisiopatologia , Humanos , Dor/diagnóstico , Dor/etiologia , Manejo da Dor/métodos , Planejamento de Assistência ao Paciente , Seleção de Pacientes
15.
Medicine (Baltimore) ; 100(33): e26760, 2021 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-34414932

RESUMO

ABSTRACT: The present study reported early clinical outcomes and perioperative precautions for medical staffs during joint arthroplasty procedures in SARS-CoV-2-infected patients.The medical records of 8 patients with SARS-CoV-2 infection who underwent joint arthroplasty from January 19 to September 24, 2020 were retrospectively reviewed and analyzed. Perioperative precautions and follow-up (time length varies from 6 month to 13 months, 11 months in average) for SARS-CoV-2 infection of medical staffs were reported.All patients recovered well from both the primary disease and SARS-CoV-2 infection. Significant improved Visual analogue scale was observed with no major complications or recurrence of the COVID-19 at discharge. There was no evidence indicating SARS-CoV-2 infection in any health providers.Elective joint arthroplasties for patients in recovery period of SARS-CoV-2 infection could be continued under comprehensive preoperative evaluation and appropriate medical protection. For patients with currently confirmed or highly suspected COVID-19, the operation should be carried out only if it was essential.


Assuntos
Artroplastia de Quadril , COVID-19/transmissão , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Corpo Clínico Hospitalar , Assistência Perioperatória/métodos , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/efeitos adversos , Protocolos Clínicos , Feminino , Quadril/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Equipamento de Proteção Individual , Cuidados Pós-Operatórios , Complicações Pós-Operatórias , Estudos Retrospectivos , SARS-CoV-2 , Resultado do Tratamento , Fluxo de Trabalho
16.
AORN J ; 114(3): P9-P12, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34436769
17.
Scand J Med Sci Sports ; 31(12): 2178-2186, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34418145

RESUMO

Conducting field-based strength assessments is embedded within football academy development processes. Yet, there is a limited understanding of how hip and groin strength assessments relate to vital game-based tasks such as sprinting and change of direction (COD) performance. Our aim was to explore field-based strength assessments and their relationships with both sprint and COD performance in male academy footballers. Participants (n = 146; age 14.2 ± 2.2 years; stature 166.3 ± 15.4 cm; body mass 55.6 ± 15.6 kg) performed maximal countermovement jump (CMJ), Nordic hamstring strength (NHS), isometric hip adductor (ADD)/abductor (ABD), 5 m, 10 m, 20 m sprints, and modified 505 agility test. All strength measures were allometrically scaled to account for body weight. Between-limb differences were reported as imbalance scores. Principal component analysis reduced sprint and COD variables to a single "running ability" component score. Scaled strength and imbalance, when controlled for age, were associated with "running ability" (adjusted R2  = 0.78, p < 0.001). Significant effects on "running ability" included the following: age, CMJ impulse, NHS, and hip-ADD. When the sprint and COD variables were explored independently, age and CMJ-impulse were featured in all sprint and COD models. For 10 m and 20 m sprint distances, hip-ADD emerged as a significant effect. Mean 505 performance was explained by age, CMJ-impulse, hip-ADD, but also with the addition of NHS. Our findings suggest that insight into the underpinning strength qualities of "running ability" of academy footballers can be obtained from a suite of field-based tests.


Assuntos
Extremidade Inferior/fisiologia , Destreza Motora/fisiologia , Força Muscular , Corrida/fisiologia , Futebol/fisiologia , Adolescente , Fatores Etários , Peso Corporal , Criança , Árvores de Decisões , Músculos Isquiossurais/fisiologia , Quadril/fisiologia , Humanos , Masculino , Análise de Componente Principal , Análise de Regressão
18.
Orthopedics ; 44(4): e577-e582, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34292835

RESUMO

The relationship among the severity of the imaging features of femoroacetabular impingement syndrome (FAIS), patient symptoms, and function has not been elucidated. Understanding this relationship helps to improve the prognostic value of imaging. The goal of this study was to examine the correlation of clinical findings, patient pain, and function with severity, as measured with radiographic and 3-dimensional magnetic resonance imaging (3D-MRI). Data collected prospectively through a longitudinally maintained hip database were reviewed, and 37 hips from 31 patients were included. All patients were examined by an experienced orthopedic surgeon, and preoperative radiographs and 3D-MRI were obtained. Preoperatively, the patients completed validated patient-reported outcome measures (PROMs). Mean±SD alpha angles were 69.4°±10.3°, 70.0°±10.3°, 70.6°±8.4°, and 74.8°±9.2° at 12 o'clock, 1 o'clock, 2 o'clock, and 3 o'clock, respectively. Mean lateral center edge angle was 30.1°±5.3°. The authors did not observe a statistically significant correlation between PROMs and the features measured by radiographs and 3D-MRI (P>.05). In this subset of prospectively imaged patients with FAIS, the authors did not find a correlation between the severity of symptoms measured by PROMs and features on radiographs and 3D-MRI. The severity of dysfunction is multifactorial, and anatomic severity, as measured radiographically and with 3D-MRI, may not correlate with symptoms. Further investigation is necessary to address the sources of patient pain. [Orthopedics. 2021;44(4):e577-e582.].


Assuntos
Impacto Femoroacetabular , Impacto Femoroacetabular/diagnóstico por imagem , Impacto Femoroacetabular/cirurgia , Quadril , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/cirurgia , Humanos , Imageamento Tridimensional , Radiografia , Estudos Retrospectivos
19.
Cochrane Database Syst Rev ; 7: CD013424, 2021 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-34231877

RESUMO

BACKGROUND: Chronic kidney disease (CKD) is an independent risk factor for osteoporosis and is more prevalent among people with CKD than among people who do not have CKD. Although several drugs have been used to effectively treat osteoporosis in the general population, it is unclear whether they are also effective and safe for people with CKD, who have altered systemic mineral and bone metabolism. OBJECTIVES: To assess the efficacy and safety of pharmacological interventions for osteoporosis in patients with CKD stages 3-5, and those undergoing dialysis (5D). SEARCH METHODS: We searched the Cochrane Kidney and Transplant Register of Studies up to 25 January 2021 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. SELECTION CRITERIA: Randomised controlled trials comparing any anti-osteoporotic drugs with a placebo, no treatment or usual care in patients with osteoporosis and CKD stages 3 to 5D were included. DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies, assessed their quality using the risk of bias tool, and extracted data. The main outcomes were the incidence of fracture at any sites; mean change in the bone mineral density (BMD; measured using dual-energy radiographic absorptiometry (DXA)) of the femoral neck, total hip, lumbar spine, and distal radius; death from all causes; incidence of adverse events; and quality of life (QoL). Summary estimates of effect were obtained using a random-effects model, and results were expressed as risk ratios (RR) and their 95% confidence intervals (CI) for dichotomous outcomes, and mean difference (MD) for continuous outcomes. Confidence in the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. MAIN RESULTS: Seven studies involving 9164 randomised participants with osteoporosis and CKD stages 3 to 5D met the inclusion criteria; all participants were postmenopausal women. Five studies included patients with CKD stages 3-4, and two studies included patients with CKD stages 5 or 5D. Five pharmacological interventions were identified (abaloparatide, alendronate, denosumab, raloxifene, and teriparatide). All studies were judged to be at an overall high risk of bias. Among patients with CKD stages 3-4, anti-osteoporotic drugs may reduce the risk of vertebral fracture (RR 0.52, 95% CI 0.39 to 0.69; low certainty evidence). Anti-osteoporotic drugs probably makes little or no difference to the risk of clinical fracture (RR 0.91, 95% CI 0.79 to 1.05; moderate certainty evidence) and adverse events (RR 0.99, 95% CI 0.98 to 1.00; moderate certainty evidence). We were unable to incorporate studies into the meta-analyses for BMD at the femoral neck, lumbar spine and total hip as they only reported the percentage change in the BMD in the intervention group. Among patients with severe CKD stages 5 or 5D, it is uncertain whether anti-osteoporotic drug reduces the risk of clinical fracture (RR 0.33, 95% CI 0.01 to 7.87; very low certainty evidence). It is uncertain whether anti-osteoporotic drug improves the BMD at the femoral neck because the certainty of this evidence is very low (MD 0.01, 95% CI 0.00 to 0.02). Anti-osteoporotic drug may slightly improve the BMD at the lumbar spine (MD 0.03, 95% CI 0.03 to 0.04, low certainty evidence). No adverse events were reported in the included studies. It is uncertain whether anti-osteoporotic drug reduces the risk of death (RR 1.00, 95% CI 0.22 to 4.56; very low certainty evidence). AUTHORS' CONCLUSIONS: Among patients with CKD stages 3-4, anti-osteoporotic drugs may reduce the risk of vertebral fracture in low certainty evidence. Anti-osteoporotic drugs make little or no difference to the risk of clinical fracture and adverse events in moderate certainty evidence. Among patients with CKD stages 5 and 5D, it is uncertain whether anti-osteoporotic drug reduces the risk of clinical fracture and death because the certainty of this evidence is very low. Anti-osteoporotic drug may slightly improve the BMD at the lumbar spine in low certainty evidence. It is uncertain whether anti-osteoporotic drug improves the BMD at the femoral neck because the certainty of this evidence is very low. Larger studies including men, paediatric patients or individuals with unstable CKD-mineral and bone disorder are required to assess the effect of each anti-osteoporotic drug at each stage of CKD.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Osteoporose Pós-Menopausa/terapia , Insuficiência Renal Crônica/complicações , Conduta Expectante , Anticorpos Monoclonais/efeitos adversos , Anticorpos Monoclonais/uso terapêutico , Viés , Densidade Óssea/efeitos dos fármacos , Conservadores da Densidade Óssea/efeitos adversos , Denosumab/efeitos adversos , Denosumab/uso terapêutico , Feminino , Colo do Fêmur/efeitos dos fármacos , Fraturas Espontâneas/epidemiologia , Fraturas Espontâneas/prevenção & controle , Quadril , Humanos , Indóis/efeitos adversos , Indóis/uso terapêutico , Vértebras Lombares/efeitos dos fármacos , Osteoporose Pós-Menopausa/tratamento farmacológico , Osteoporose Pós-Menopausa/mortalidade , Proteína Relacionada ao Hormônio Paratireóideo/efeitos adversos , Proteína Relacionada ao Hormônio Paratireóideo/uso terapêutico , Cloridrato de Raloxifeno/efeitos adversos , Cloridrato de Raloxifeno/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Diálise Renal , Insuficiência Renal Crônica/terapia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/prevenção & controle , Teriparatida/efeitos adversos , Teriparatida/uso terapêutico , Tiofenos/efeitos adversos , Tiofenos/uso terapêutico
20.
J Sports Sci Med ; 20(3): 457-465, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34267585

RESUMO

The round house kick (RHK) is a common technique in taekwondo (TKD). The kicking action originates from the dynamic stability of the pivot leg. However, some knee injuries are caused by more difficult kicking strategies, such as kicks to the opponent's head. This study analyses the effects on TKD players in the lower extremity kinematic and neuromuscular reactions from different kicking heights. This study recruited 12 TKD players (age=20.3 ± 1.3 years, height = 1.72 ± 0.09 m, mass = 62.17 ± 9.45 kg) with no previous lower extremity ligament injuries. All athletes randomly performed 3 RHK at different heights (head, chest, and abdomen), repeating each kick 5 times. During the RHK action, the kinematics and muscle activations of the pivot leg were collected using six high-speed cameras and electromyography devices. The results found that during the RHK return period a high kicking position demonstrated larger knee valgus with the straight knee, and more hamstring activation on the pivot leg. The RHK pivot foot for TKD players encountered more risk of injury from high target kicking. The hamstring muscle played an important stabilizing role. It is recommended that sports medicine clinicians or sports coaches use this information to provide further protective injury prevention strategies.


Assuntos
Perna (Membro)/fisiologia , Artes Marciais/fisiologia , Músculo Esquelético/fisiologia , Lesões do Ligamento Cruzado Anterior/fisiopatologia , Fenômenos Biomecânicos , Eletromiografia , Feminino , Músculos Isquiossurais/fisiologia , Quadril/fisiologia , Humanos , Traumatismos do Joelho/fisiopatologia , Articulação do Joelho/fisiologia , Masculino , Amplitude de Movimento Articular , Fatores de Risco , Análise e Desempenho de Tarefas , Adulto Jovem
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