Evidence of Generalized Muscle Stiffness in the Presence of Latent Trigger Points Within Infraspinatus.

OBJECTIVE: To evaluate stiffness of infraspinatus muscle tissue, both with and without latent trigger points, using ultrasound shear wave elastography (SWE). The primary hypothesis is that muscle with a latent trigger point will demonstrate a discrete region of increased shear wave speed. The secondary hypothesis is that shear wave speed (SWS) in the region with the trigger point will be higher in patients compared with controls, and will be similar between the two groups in the uninvolved regions. DESIGN: Case-control. SETTING: Hospital-based outpatient physical therapy center. PARTICIPANTS: Convenience sample (N=18) of patients (6 female, 3 male, mean age=44) (range=31-61y) diagnosed with latent trigger points in infraspinatus and matched controls without trigger points. MAIN OUTCOME MEASURES: Shear wave speed (m/s). RESULTS: SWS of the latent trigger point (mean=4.09±SD1.4 m/s) did not differ from the adjacent muscle tissue (3.92±1.6 m/s, P>.05), but was elevated compared to corresponding tissue in controls (2.8±0.75 m/s, P=.02). SWS was generally greater in patients' uninvolved tissue (3.83±1.6 m/s) when compared to corresponding tissue in controls (2.62±0.2 m/s, P=.05). CONCLUSION: Although discrete regions of increased SWS corresponding to the trigger point were not observed in patients, evidence of generally increased muscle stiffness in infraspinatus was exhibited compared to healthy controls. Further study of additional muscles with SWE is warranted.

Management of a Patient With Acute Acetabular Labral Tear and Femoral Acetabular Impingement With Intra-articular Steroid Injection and a Neuromotor Training Program.

Study Design Case report. Background Intra-articular hip pathologies can be difficult to diagnose, and evidence to guide physical therapy interventions is lacking. The purpose of this case report is to describe a clinical pathway for conservative management of a patient with an acute acetabular labral tear and femoroacetabular impingement. Case Description The patient was an 18-year-old woman with recent onset of right groin pain who underwent intra-articular corticosteroid injection and therapeutic exercise for the management of an acute acetabular labral tear identified on radiographic imaging. Prior to physical therapy, the patient received an intra-articular hip injection for diagnostic purposes and pain relief. Upon initial evaluation, the patient presented with improved pain but with continued kinesthetic deficits, inflexibility, muscle imbalances, and reproduction of symptoms with end-range hip motions. A physical therapy plan was implemented using neuromuscular re-education to address her continued impairments. Outcomes Marked improvements were noted at discharge and 6-month follow-up for pain, strength, and function as demonstrated on the Patient-Specific Functional Scale, global rating of change scale, and International Hip Outcome Tool-33. Discussion This case demonstrates a clinical pathway for collaborative medical management of a patient with confirmed intra-articular pathology. Details illustrate the clinical reasoning and rationale used to guide the clinical decision-making process. Level of Evidence Therapy, level 4. J Orthop Sports Phys Ther 2016;46(11):965-975. Epub 29 Sep 2016. doi:10.2519/jospt.2016.6573.

Perturbation of object location during bimanual prehension: the role of visual feedback.

In this series of studies on the coordination of the two hands during a bimanual perturbation task, 10 right-handed volunteers were asked to reach to grasp and lift two illuminated cubic objects. Upon initiation of the reach a perturbation could occur by extinguishing one or both objects and illuminating new objects located directly away from the start position in the para-sagittal plane (Experiment 1) or toward the start position in the para-sagittal plane (Experiment 2). In Experiment 2 we also manipulated position of the targets within the visual span by having the targets move toward the midline or away from the midline. Dependent measures included kinematic data for the reach movement as well as the timing of eye movements. Results of both experiments indicated little interference between the hands when one object was perturbed while the other remained stationary. We hypothesize that when visual feedback about limb movement is available, participants can independently reorganize the trajectory of the perturbed limb with minimal interference on the non-perturbed limb. Furthermore, results of Experiment 2 indicated that the position of the targets within the visual span at the final target location dictates the number of eye movements made to acquire both targets and can lead to asynchronies at movement termination in a task-dependent manner. Finally, we found that when targets were perturbed away from the body movement time results indicated a right-hand advantage for dealing with a single perturbation. In contrast, perturbations toward the body abolished the movement time advantage. We suggest that differences in the use of visual feedback when working in the upper versus lower visual fields may influence hand advantages.