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Mathieu T, Van Glabbeek F, Denteneer L, Van Winckel L, Schacht E, De Vlam B, Van Nassauw L. New Anatomical Concepts regarding Pubic-Related Groin Pain: A Dissection Study. Ann Anat 2024; 254:152238. [PMID: 38408529 DOI: 10.1016/j.aanat.2024.152238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 02/18/2024] [Accepted: 02/20/2024] [Indexed: 02/28/2024]
Abstract
OBJECTIVE Pubis-related groin pain remains a difficult topic in orthopedic and sports medicine. A better understanding of the anatomy of the adductors and the pubic ligaments is necessary. The aim of this study is to map all the musculotendinous attachments to the pubic ligaments and to investigate in detail all the possible inter-adductor fusions. METHODS The pubic symphyses were dissected in eight male and fourteen female embalmed cadavers (mean age 85 years), focusing on the fusion between the adductors, pubic ligaments, and musculotendinous attachments at the pubic ligaments. The 95% confidence intervals for the prevalence of the different conjoint tendons and tendon attachment to ligament were calculated. RESULTS The presence of three types of conjoint tendons was found: adductor brevis and gracilis (AB/G) 90.9 [72.2 - 97.5]%; adductor brevis and adductor longus (AB/AL) 50.0 [30.7 - 69.3]%; adductor longus and gracilis (AL/G) 50.0 [30.7 - 69.3]%. The AL, AB and G were in every cadaver attached to the anterior pubic ligament (APL). 64% of the AB and 100% of the G were attached to the inferior pubic ligament (IPL). CONCLUSION The proximal anatomy of the adductors is more complex than initially described. This study identified three possible conjoint tendons between the proximal adductors. The AB/G conjoint tendon was significantly more present than the AB/AL or AL/G conjoint tendon. The IPL has attachments only from the AB and G. Rectus Abdominis (RA) and AL were not attached to IPL. Mapping the musculotendinous attachments on the pubic ligaments creates more clarity on the pathophysiology of lesions in this area.
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Affiliation(s)
- Thomas Mathieu
- Department of ASTARC, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of Physical and Rehabilitative Medicine, Antwerp University Hospital, Edegem, Belgium.
| | - Francis Van Glabbeek
- Department of ASTARC, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of Orthopaedic Surgery and Traumatology, Antwerp University Hospital, Edegem, Belgium
| | - Lenie Denteneer
- Department of Rehabilitation Sciences & Physiotherapy, Research group MOVANT, University of Antwerp, Antwerp, Belgium; Education department, Horacio Oduber Hospital, Oranjestad, Aruba
| | - Levi Van Winckel
- Department of ASTARC, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Emile Schacht
- Department of ASTARC, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Benjamin De Vlam
- Department of ASTARC, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Luc Van Nassauw
- Department of ASTARC, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Tharnmanularp S, Muro S, Nimura A, Ibara T, Akita K. Significant relationship between musculoaponeurotic attachment of the abdominal and thigh adductor muscles to the pubis: implications for the diagnosis of groin pain. Anat Sci Int 2024; 99:190-201. [PMID: 37985575 PMCID: PMC10902015 DOI: 10.1007/s12565-023-00750-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/28/2023] [Indexed: 11/22/2023]
Abstract
Groin pain is prevalent in orthopedic and sports medicine, causing reduced mobility and limiting sports activity. To effectively manage groin pain, understanding the detailed anatomy of supporting muscles is crucial. This study aimed to investigate the musculoaponeurotic attachments on the pubis and the relationship among intramuscular aponeuroses of abdominal and thigh adductor musculatures. Macroscopic analyses were performed in 10 pelvic halves. The bone morphology of the pubis was assessed in two pelvic halves using microcomputed tomography. Histological investigations were conducted in two pelvic halves. The external oblique aponeurosis extended to the adductor longus aponeurosis, forming conjoined aponeurosis, which attached to a small impression distal to the pubic crest. The gracilis aponeurosis merges with the adductor brevis aponeurosis and is attached to the proximal part of the inferior pubic ramus. The rectus abdominis and pyramidalis aponeuroses were attached to the pubic crest and intermingled with the gracilis-adductor brevis aponeurosis, forming bilateral conjoined aponeurosis, which attached to a broad area covering the anteroinferior surface of the pubis. Histologically, these two areas of conjoined aponeuroses were attached to the pubis via the fibrocartilage enthesis. Microcomputed tomography revealed two distinctive bone morphologies, a small impression and an elongated osseous prominence on pubis, corresponded to the two areas of conjoined aponeuroses. This study demonstrated close relationships between the aponeurotic attachment of the external oblique and adductor longus, and between the rectus abdominis, pyramidalis, gracilis, and adductor brevis. The findings of aponeurotic complexes would aid in diagnostic and surgical approaches for athletic groin pain.
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Affiliation(s)
- Suthasinee Tharnmanularp
- Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
| | - Satoru Muro
- Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan.
| | - Akimoto Nimura
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Takuya Ibara
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Keiichi Akita
- Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
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Morano T, Lancia F, Di Marco A, Viscioni G, Bucci I, Grossi S, Pellegrino R, Cugusi L, Grassadonia A, Manca A, Bullo V, Di Giminiani R, Izzicupo P, Di Baldassarre A, Fusco A, Cortis C, Napolitano G, Di Blasio A. Flexibility and Strength Effects of Adapted Nordic Walking and Myofascial Exercises Practice in Breast Cancer Survivors and Analysis of Differences. Healthcare (Basel) 2024; 12:222. [PMID: 38255109 PMCID: PMC10815343 DOI: 10.3390/healthcare12020222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/07/2024] [Accepted: 01/13/2024] [Indexed: 01/24/2024] Open
Abstract
Breast cancer treatments can elicit negative kinesiological side effects concerning both the posture and functional status of breast cancer survivors. As our body is functionally organized in myofascial meridians, physical exercise practice should favor a whole-body approach rather than a local one. The aim of the study was to investigate and compare the effects of two whole-body disciplines, i.e., adapted Nordic Walking and myofascial exercise, on the flexibility and strength performances in BCS. One hundred and sixty breast cancer survivors were trained three times per week for 12 weeks through adapted Nordic Walking or myofascial exercise. Handgrip, sit and reach, back scratch, and single leg back bridge tests and body composition were assessed at the beginning and completion of the training period. Linear mixed models showed no significant changes in body composition, whereas flexibility (p < 0.001), strength (p < 0.001), and muscle quality index (p = 0.003) changed independently from the treatment. When data modification has been analyzed according to sub-sample membership, no significant differences have been observed. Age, radiation therapy, and chemotherapy seem to have independent effects on several investigated variables. Twelve weeks of adapted myofascial exercise and Nordic Walking led to significant changes in flexibility, strength, and muscle quality in breast cancer survivors, with no apparent superiority of one approach over the other.
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Affiliation(s)
- Teresa Morano
- Department of Medicine and Aging Sciences, “G. d’Annunzio” University of Chieti-Pescara, Via Polacchi L. 11, 66100 Chieti, Italy; (T.M.); (F.L.); (A.D.M.); (I.B.); (P.I.); (A.D.B.); (G.N.)
| | - Federica Lancia
- Department of Medicine and Aging Sciences, “G. d’Annunzio” University of Chieti-Pescara, Via Polacchi L. 11, 66100 Chieti, Italy; (T.M.); (F.L.); (A.D.M.); (I.B.); (P.I.); (A.D.B.); (G.N.)
| | - Alessandra Di Marco
- Department of Medicine and Aging Sciences, “G. d’Annunzio” University of Chieti-Pescara, Via Polacchi L. 11, 66100 Chieti, Italy; (T.M.); (F.L.); (A.D.M.); (I.B.); (P.I.); (A.D.B.); (G.N.)
| | - Gianluca Viscioni
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Piazzale Scuro L.A. 10, 37124 Verona, Italy;
| | - Ines Bucci
- Department of Medicine and Aging Sciences, “G. d’Annunzio” University of Chieti-Pescara, Via Polacchi L. 11, 66100 Chieti, Italy; (T.M.); (F.L.); (A.D.M.); (I.B.); (P.I.); (A.D.B.); (G.N.)
| | - Simona Grossi
- Eusoma Breast Center, “G. Bernabeo” Hospital, ASL02 Lanciano-Vasto-Chieti, c.da S. Liberata, 66026 Ortona, Italy;
| | - Raffaello Pellegrino
- Department of Scientific Research, Campus Ludes, Off-Campus Semmelweis University, 6912 Lugano, Switzerland;
| | - Lucia Cugusi
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43/B, 07100 Sassari, Italy; (L.C.); (A.M.)
| | - Antonino Grassadonia
- Department of Innovative Technologies in Medicine and Dentistry, “G. d’Annunzio” University of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy;
| | - Andrea Manca
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43/B, 07100 Sassari, Italy; (L.C.); (A.M.)
| | - Valentina Bullo
- Department of Medicine, University of Padova, Via Giustiniani 2, 35128 Padova, Italy;
| | - Riccardo Di Giminiani
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, Via Vetoio, 67100 L’Aquila, Italy;
| | - Pascal Izzicupo
- Department of Medicine and Aging Sciences, “G. d’Annunzio” University of Chieti-Pescara, Via Polacchi L. 11, 66100 Chieti, Italy; (T.M.); (F.L.); (A.D.M.); (I.B.); (P.I.); (A.D.B.); (G.N.)
| | - Angela Di Baldassarre
- Department of Medicine and Aging Sciences, “G. d’Annunzio” University of Chieti-Pescara, Via Polacchi L. 11, 66100 Chieti, Italy; (T.M.); (F.L.); (A.D.M.); (I.B.); (P.I.); (A.D.B.); (G.N.)
| | - Andrea Fusco
- Department of Human Sciences, Society and Health, University of Cassino and Lazio Meridionale, Via S. Angelo, 03043 Cassino, Italy; (A.F.); (C.C.)
| | - Cristina Cortis
- Department of Human Sciences, Society and Health, University of Cassino and Lazio Meridionale, Via S. Angelo, 03043 Cassino, Italy; (A.F.); (C.C.)
| | - Giorgio Napolitano
- Department of Medicine and Aging Sciences, “G. d’Annunzio” University of Chieti-Pescara, Via Polacchi L. 11, 66100 Chieti, Italy; (T.M.); (F.L.); (A.D.M.); (I.B.); (P.I.); (A.D.B.); (G.N.)
| | - Andrea Di Blasio
- Department of Medicine and Aging Sciences, “G. d’Annunzio” University of Chieti-Pescara, Via Polacchi L. 11, 66100 Chieti, Italy; (T.M.); (F.L.); (A.D.M.); (I.B.); (P.I.); (A.D.B.); (G.N.)
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Mitrousias V, Chytas D, Banios K, Fyllos A, Raoulis V, Chalatsis G, Baxevanidou K, Zibis A. Anatomy and terminology of groin pain: Current concepts. J ISAKOS 2023; 8:381-386. [PMID: 37308079 DOI: 10.1016/j.jisako.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 04/13/2023] [Accepted: 05/31/2023] [Indexed: 06/14/2023]
Abstract
Groin pain is a common symptom in athletes. The complex anatomy of the area and the various terms used to describe the etiology behind groin pain have led to a confusing nomenclature. To solve this problem, three consensus statements have been already published in the literature: the Manchester Position Statement in 2014, the Doha agreement in 2015, and the Italian Consensus in 2016. However, when revisiting recent literature, it is evident that the use of non-anatomic terms remains common, and the diagnoses sports hernia, sportsman's hernia, sportsman's groin, Gilmore's groin, athletic pubalgia, and core muscle injury are still used by many authors. Why are they still in use although rejected? Are they considered synonyms, or they are used to describe different pathology? This current concepts review article aims to clarify the confusing terminology by examining to which anatomical structures authors refer when using each term, revisit the complex anatomy of the area, including the adductors, the flat and vertical abdominal muscles, the inguinal canal, and the adjacent nerve branches, and propose an anatomical approach, which will provide the basis for improved communication between healthcare professionals and evidence-based treatment decisions.
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Affiliation(s)
- Vasileios Mitrousias
- Department of Anatomy, Faculty of Medicine, University of Thessaly, 41334 Larissa, Greece; Department of Orthopaedic Surgery and Musculoskeletal Trauma, General University Hospital of Larissa, 41110 Larissa, Greece.
| | - Dimitrios Chytas
- Department of Physiotherapy, University of Peloponnese, 23100 Sparta, Greece
| | - Konstantinos Banios
- Department of Anatomy, Faculty of Medicine, University of Thessaly, 41334 Larissa, Greece
| | - Apostolos Fyllos
- Department of Anatomy, Faculty of Medicine, University of Thessaly, 41334 Larissa, Greece
| | - Vasileios Raoulis
- Department of Anatomy, Faculty of Medicine, University of Thessaly, 41334 Larissa, Greece
| | - Georgios Chalatsis
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, General University Hospital of Larissa, 41110 Larissa, Greece
| | - Kyriaki Baxevanidou
- Department of General Surgery, General Hospital of Larissa, 41221, Larissa, Greece
| | - Aristeidis Zibis
- Department of Anatomy, Faculty of Medicine, University of Thessaly, 41334 Larissa, Greece
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Lee YM, Koo DK, Kwon JW. The efficacy of sling exercise combined with extracorporeal shock wave on office workers with chronic neck pain. Medicine (Baltimore) 2023; 102:e33940. [PMID: 37335668 DOI: 10.1097/md.0000000000033940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
This study aimed to investigate the effect of extracorporeal shockwave therapy on the anterior surface line of the fascia meridian, including the oblique muscle, combined with sling exercise, on the stability of the spine in the neck disability index (NDI), neck joint range of motion (ROM), craniovertebral angle, neck alignment, and posture control. A total of 20 office workers with chronic neck pain were randomly assigned to an experimental group that combined extracorporeal shock wave therapy and sling exercise (n = 10) and a control group (CG) consisting of sling exercise (n = 10) performed twice weekly for 4 weeks. All subjects were evaluated using the NDI, ROM, neck alignment, and spine stability tests. Following the intervention, there were significant differences in the For example, NDI, craniovertebral angle, Cobb's angle, Centaur data, and ROM. Except for Cobb's angle and Centaur data (-90 degrees), all variables showed significant differences in the CG. Comparing changes before and after the intervention, The For example, showed significantly more significant changes in all variables than the CG. The combination of extracorporeal shockwave therapy and sling exercises improved NDI, ROM, and neck and spine alignment in office workers with chronic neck pain more effectively than the sling exercise alone. This study could be recommended as a new approach to enable individuals with chronic neck pain to perform better.
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Affiliation(s)
- Young Min Lee
- Department of Public Health Sciences, Graduate School, Dankook University, Cheonan, Korea
| | - Dong Kyun Koo
- Department of Public Health Sciences, Graduate School, Dankook University, Cheonan, Korea
| | - Jung Won Kwon
- Department of Physical Therapy, College of Health and Welfare Sciences, Dankook University, Cheonan, Korea
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O'Donnell R, DeFroda S, Bokshan SL, Levins JG, Hulstyn MJ, Tabaddor RR. Cadaveric Analysis of Key Anatomic Structures of Athletic Pubalgia. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202306000-00008. [PMID: 37319366 PMCID: PMC10270532 DOI: 10.5435/jaaosglobal-d-23-00070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 04/24/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE This study proposes to establish in-depth inspection of the anatomic structures involved with the pathology of athletic pubalgia in a cadaver model. METHODS Eight male fresh frozen cadavers were dissected in a layered fashion. The rectus abdominis (RA) and adductor longus (AL) tendon insertions were isolated to quantify the size of the anatomic footprint and distance from the surrounding anatomy. RESULTS The RA insertional footprint was 1.65 cm (SD, 0.18) in width by 1.02 cm (SD, 0.26) in length, and the AL insertional footprint on the underside of the pubis was 1.95 cm (SD, 0.28) in length by 1.23 cm (SD, 0.33) in width. The ilioinguinal nerve was 2.49 cm (SD, 0.36) lateral to the center of the RA footprint and 2.01 cm (SD, 0.37) lateral to the center of the AL footprint. The spermatic cord and the genitofemoral nerve were just lateral to the ilioinguinal nerve and were 2.76 cm (SD, 0.44) and 2.66 cm (SD, 0.46) from the rectus and AL footprints, respectively. CONCLUSION Surgeons should be cognizant of these anatomic relations during both initial dissection and tendon repair to optimize repair and avoid iatrogenic injury to critical structures in the anterior pelvis.
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Affiliation(s)
- Ryan O'Donnell
- From the Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, RI
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Tamartash H, Bahrpeyma F, Dizaji MM. Effect of Remote Myofascial Release on Lumbar Elasticity and Pain in Patients With Chronic Nonspecific Low Back Pain: A Randomized Clinical Trial. J Chiropr Med 2023; 22:52-59. [PMID: 36844993 PMCID: PMC9947999 DOI: 10.1016/j.jcm.2022.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 10/17/2022] Open
Abstract
Objective The purpose of this study was to evaluate the effects of myofascial release technique of a remote area on lumbar elasticity and low back pain (LBP) in patients with chronic nonspecific LBP. Methods For this clinical trial, 32 participants with nonspecific LBP were assigned to a myofascial release group (n = 16) or a remote release group (n = 16). Participants in the myofascial release group received 4 sessions of myofascial release to the lumbar region. The remote release group received 4 myofascial release sessions to the crural and hamstring fascia of the lower limbs. Low back pain severity and elastic modulus of the lumbar myofascial tissue were assessed before and after treatment by the Numeric Pain Scale and ultrasonography examinations. Results The mean pain and elastic coefficient in each group before and after myofascial release interventions were significantly different (P ≤ .0005). The results showed that the changes in mean pain and elastic coefficient of the 2 groups after myofascial release interventions were not significantly different from each other (F1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22 = 1.48, P = .230, 95% confidence interval) (effect size = 0.22). Conclusion The improvements in the outcome measures for both groups suggest that remote myofascial release was effective in patients with chronic nonspecific LBP. The remote myofascial release of the lower limbs reduced the elastic modulus of the lumbar fascia and LBP.
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Affiliation(s)
- Hassan Tamartash
- Department of Physiotherapy, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Farid Bahrpeyma
- Department of Physiotherapy, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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Prusa G, Bauer L, Santos I, Thorwächter C, Woiczinski M, Kistler M. Strain evaluation of axially loaded collateral ligaments: a comparison of digital image correlation and strain gauges. Biomed Eng Online 2023; 22:13. [PMID: 36774524 PMCID: PMC9922447 DOI: 10.1186/s12938-023-01077-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 02/03/2023] [Indexed: 02/13/2023] Open
Abstract
The response of soft tissue to loading can be obtained by strain assessment. Typically, strain can be measured using electrical resistance with strain gauges (SG), or optical sensors based on the digital image correlation (DIC), among others. These sensor systems are already established in other areas of technology. However, sensors have a limited range of applications in medical technology due to various challenges in handling human soft materials. The aim of this study was to compare directly attached foil-type SG and 3D-DIC to determine the strain of axially loaded human ligament structures. Therefore, the medial (MCL) and lateral (LCL) collateral ligaments of 18 human knee joints underwent cyclic displacement-controlled loading at a rate of 20 mm/min in two test trials. In the first trial, strain was recorded with the 3D-DIC system and the reference strain of the testing machine. In the second trial, strain was additionally measured with a directly attached SG. The results of the strain measurement with the 3D-DIC system did not differ significantly from the reference strain in the first trial. The strains assessed in the second trial between reference and SG, as well as between reference and 3D-DIC showed significant differences. This suggests that using an optical system based on the DIC with a given unrestricted view is an effective method to measure the superficial strain of human ligaments. In contrast, directly attached SGs provide only qualitative comparable results. Therefore, their scope on human ligaments is limited to the evaluation of changes under different conditions.
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Affiliation(s)
- Gwendolin Prusa
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany.
| | - Leandra Bauer
- grid.5252.00000 0004 1936 973XDepartment of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Inês Santos
- grid.5252.00000 0004 1936 973XDepartment of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Christoph Thorwächter
- grid.5252.00000 0004 1936 973XDepartment of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Matthias Woiczinski
- grid.5252.00000 0004 1936 973XDepartment of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Manuel Kistler
- grid.5252.00000 0004 1936 973XDepartment of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
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Flores DV, Umpire DF, Sampaio ML, Cresswell ME, Pathria MN. US and MRI of Pelvic Tendon Anatomy and Pathologic Conditions. Radiographics 2022; 42:1433-1456. [PMID: 35960665 DOI: 10.1148/rg.220055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The bony pelvis serves as the attachment site for a large number of powerful muscles and tendons that drive lower extremity movement. Organizing the pelvic tendons into groups that share a common function and anatomic location helps the radiologist systematically evaluate these structures for injury, which can be caused by repetitive stress, acute trauma, or failure of degenerated tissues. Tears of the anteromedial adductors around the pubic symphysis and anterior flexors traversing anterior to the hip principally affect younger male athletes. Tears of the lateral abductors and posterior extensors are more common in older individuals with senescent tendinosis. The deep external rotators are protected and rarely injured, although they can be impinged. Imaging of the pelvic tendons relies primarily on US and MRI; both provide high spatial and contrast resolution for soft tissues. US offers affordable point-of-care service and dynamic assessment, while MRI allows simultaneous osseous and articular evaluation and is less operator dependent. While the imaging findings of pelvic tendon injury mirror those at appendicular body sites, radiologists may be less familiar with tendon anatomy and pathologic conditions at the pelvis. The authors review pertinent anatomy and imaging considerations and illustrate common injuries affecting the pelvic tendons. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Dyan V Flores
- From the Department of Medical Imaging, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F., M.L.S.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (M. E.C.); and Department of Radiology, UCSD Health System, San Diego, Calif (M.N.P.)
| | - Darwin Fernández Umpire
- From the Department of Medical Imaging, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F., M.L.S.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (M. E.C.); and Department of Radiology, UCSD Health System, San Diego, Calif (M.N.P.)
| | - Marcos Loreto Sampaio
- From the Department of Medical Imaging, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F., M.L.S.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (M. E.C.); and Department of Radiology, UCSD Health System, San Diego, Calif (M.N.P.)
| | - Mark Edward Cresswell
- From the Department of Medical Imaging, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F., M.L.S.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (M. E.C.); and Department of Radiology, UCSD Health System, San Diego, Calif (M.N.P.)
| | - Mini N Pathria
- From the Department of Medical Imaging, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F., M.L.S.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (M. E.C.); and Department of Radiology, UCSD Health System, San Diego, Calif (M.N.P.)
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Mathieu T, Van Glabbeek F, Van Nassauw L, Van Den Plas K, Denteneer L, Stassijns G. New Insights into the Musculotendinous and Ligamentous attachments at the Pubic Symphysis: a systematic review. Ann Anat 2022; 244:151959. [PMID: 35659520 DOI: 10.1016/j.aanat.2022.151959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/16/2022] [Accepted: 05/18/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Collection and meta-analysis of all relevant anatomical studies related to the pubic symphysis to provide a state of the art review of its musculotendinous and ligamentous attachments from 2010 to date. METHODS A systematic search of published literature databases (PubMed, Web of Science and Embase) was conducted according to the PRISMA guidelines from January 2010 up until now. All papers investigating the anatomy of the musculotendinous attachments of the pubis and the pubic ligaments were eligible. Methodological quality was assessed using the Quality Appraisal for Cadaveric Studies (QUACS scale). A narrative analysis approach was adopted to synthesise the findings. RESULTS After screening and review of 1313 papers, a total of six studies investigating the anatomy of the pubic ligaments and tendons were included. Of the six articles included in this systematic review, five articles performed a macroscopic anatomical dissection, three articles performed a microscopic (histological) study, and one article combined microscopic examination with an MRI imaging examination. The anatomy of the pubic symphysis was examined in 76 anatomical cadavers (60 embalmed, 16 fresh frozen). In total 44 male cadavers (58%), 28 female cadavers (37%) and four cadavers whose gender was not stated were dissected. CONCLUSION The age-old accepted concept of the fusion of the rectus abdominis with the adductor longus via the aponeurotic plate is outdated. New anatomical concepts like the pyramidalis-anterior pubic ligament-adductor longus complex (PLAC), recto-gracilis tendon, fusion of adductor brevis with gracilis, etc. are recently introduced. The awareness of anatomy and morphology of the pubic ligaments plays a significant role in understanding the diagnosis and treatment of groin pain.
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Affiliation(s)
- Thomas Mathieu
- Department of ASTARC, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of Physical and Rehabilitative Medicine, Antwerp University Hospital, Edegem, Belgium.
| | - Francis Van Glabbeek
- Department of ASTARC, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of Orthopaedic Surgery and Traumatology, Antwerp University Hospital, Edegem, Belgium
| | - Luc Van Nassauw
- Department of ASTARC, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Katrien Van Den Plas
- Department of ASTARC, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Lenie Denteneer
- Department of ASTARC, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of Physical and Rehabilitative Medicine, Antwerp University Hospital, Edegem, Belgium
| | - Gaëtane Stassijns
- Department of ASTARC, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of Physical and Rehabilitative Medicine, Antwerp University Hospital, Edegem, Belgium
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11
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Read JW, Ibrahim N, Jacombs ASW, Elstner KE, Saunders J, Rodriguez-Acevedo O. Imaging Insights Into Abdominal Wall Function. Front Surg 2022; 9:799277. [PMID: 35284471 PMCID: PMC8913712 DOI: 10.3389/fsurg.2022.799277] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/28/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose The successful repair of any complex ventral hernia requires a thorough understanding of the underlying anatomical defect and its functional context. We describe an improved “functional” approach to CT imaging of the abdominal wall that can facilitate this understanding and assist surgical planning. Methods This invited article reports the observational experience gained from the functional abdominal wall CT examinations of 88 patients who underwent complex ventral hernia repair using pre-operative Botulinum toxin A (BTA) infiltration of the lateral oblique abdominal muscles as well as a further eight patients with diastasis rectus abdominis who were examined to exclude ventral hernia. Results The use of a functional CT protocol which supplements resting images with additional “crunching” images (acquired with the abdominal wall muscles all strongly contracted) can significantly improve the demonstration of ventral hernia defects. Crunching acquisitions can also help differentiate true hernias from dysfunctional bulges, identify muscle denervation or atrophic changes, reveal otherwise occult hernias that may be missed on resting or Valsalva images alone, and assist the pre-operative assessment of BTA effect. Conclusion A more functional approach to pre-operative CT imaging of the abdominal wall can significantly improve the understanding of complex ventral hernia defects and help formulate effective surgical plans that achieve low recurrence rates and good functional outcomes.
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Affiliation(s)
- John W. Read
- Department of Clinical Medicine, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
- Macquarie Medical Imaging, Macquarie University Hospital, Sydney, NSW, Australia
| | - Nabeel Ibrahim
- Department of Surgery, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
- Hernia Institute Australia, Sydney, NSW, Australia
- Department of Surgery, Macquarie University Hospital, Sydney, NSW, Australia
- *Correspondence: Nabeel Ibrahim
| | - Anita S. W. Jacombs
- Hernia Institute Australia, Sydney, NSW, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | | | - Jeni Saunders
- School of Medicine, University of Notre Dame, Sydney, NSW, Australia
- Spine & Sports Medicine, Sydney, NSW, Australia
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12
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Rajasekhar SSSN, Kumar VD, Raveendranath V, Kalayarasan R, Gnanasekaran S, Pottakkat B, Sivakumar M. Advanced training in laparoscopic gastrointestinal surgical procedures using Genelyn ®-embalmed human cadavers: A novel model. J Minim Access Surg 2021; 17:495-501. [PMID: 33605926 PMCID: PMC8486066 DOI: 10.4103/jmas.jmas_152_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background: Human cadaver is ideal for learning and acquiring new surgical skills. While cadavers preserved using Thiel’s embalming method are commonly used for training in laparoscopic surgery, it is a cumbersome technique. We report our experience of using Genelyn®-embalmed cadavers for training in advanced laparoscopic gastrointestinal procedures. Materials and Methods: A cross-sectional satisfaction survey corresponding to level 1 of the Kirkpatrick model for training evaluation was performed among 19 participants of advanced laparoscopy surgical skills training workshop, in December 2019, using Genelyn®-embalmed cadavers. Visual, haptic and tactile characteristics of the organs and tissues were assessed along with overall satisfaction of the workshop using Likert scale. Results: Five Genelyn®-embalmed cadavers were used for the workshop. All the 19 participants perceived that the cadavers were odourless and allowed adequate insufflation for laparoscopic procedures. Most of the participants(n=16, 84%) agreed that the appearance and tactile fidelity of the solid organs, luminal structures and tissues in Genelyn®-embalmed cadavers were similar to that of a live patient. There was a strong agreement among participants that the workshop will help improve the laparoscopic skills(median Likert score–4). Conclusion: The participants of the surgical skill training workshop felt that the Genelyn®-embalmed cadavers were ideal for use in practicing advanced laparoscopic procedures.
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Affiliation(s)
- S S S N Rajasekhar
- Department of Anatomy, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - V Dinesh Kumar
- Department of Anatomy, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - V Raveendranath
- Department of Anatomy, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Raja Kalayarasan
- Department of Surgical Gastroenterology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Senthil Gnanasekaran
- Department of Surgical Gastroenterology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Biju Pottakkat
- Department of Surgical Gastroenterology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - M Sivakumar
- Department of Anatomy, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
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13
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Dallaudiere B, Sylvain B, Poussange N, Reboul G, Silvestre A, Meyer P, Hocquelet A, Pesquer L. Ultrasound feature variants of the adductor longus tendon in asymptomatic sportive subjects: Management implications. Eur J Radiol 2021; 144:109928. [PMID: 34562742 DOI: 10.1016/j.ejrad.2021.109928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/28/2021] [Accepted: 08/13/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The potential contribution of ultrasound (US) to diagnose adductor longus (AL) tendinopathy in athletic pubalgia requires clarification. We investigate US findings from AL tendons of asymptomatic participants to identify the range and prevalence of common US features not associated with groin pain. METHODS We consecutively enrolled 45 volunteers physically active participants with no history of groin pain. US features of bilateral AL tendons were investigated and recorded by two experienced musculoskeletal radiologists (MSKR) in accordance with a defined ultrasound protocol. Two other MSKRs retrospectively and independently analyzed all US images. RESULTS Ninety AL tendons from 45 participants (4/45 women) were imaged (average age: 35 years ±14.6; dominant side: 37/45 (82.2%) right, 8/45 (17.8%) left). Abnormalities on US were found in all 45 (100%) AL tendons, including: abnormal echogenicity (98.9%/100% respectively according to reader), loss of fibrillar structure (92.2%/97.8%), irregularities of the superficial paratendon (23.3%/30%), calcifications (22.2%/25.5%), and cortical erosion (52%/55.5%), with excellent inter-observer assessment. No AL tears or hyperemia at color Doppler were detectable. CONCLUSIONS AL tendon abnormalities were identified via US in 100% of our asymptomatic athletes. The significance of these US findings should be interpreted cautiously with respect to clinical presentation. On the other hand, there is a need for supplemental investigation into the clinical relevance of US AL tendon tears not present in the present asymptomatic athlete population.
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Affiliation(s)
- Benjamin Dallaudiere
- Centre d'imagerie ostéo-articulaire, clinique du sport de Bordeaux, 2, rue Georges-Negrevergne, 33700 Mérignac, France; Département d'imagerie musculo-squelettique, centre hospitalier universitaire Pellegrin, place Amélie-Léon-Rabat, 33000 Bordeaux, France.
| | - Bise Sylvain
- Centre d'imagerie ostéo-articulaire, clinique du sport de Bordeaux, 2, rue Georges-Negrevergne, 33700 Mérignac, France
| | - Nicolas Poussange
- Centre d'imagerie ostéo-articulaire, clinique du sport de Bordeaux, 2, rue Georges-Negrevergne, 33700 Mérignac, France
| | - Gilles Reboul
- Centre de chirurgie orthopédique et sportive, clinique du sport de Bordeaux, 2, rue Georges-Negrevergne, 33700 Mérignac, France
| | - Alain Silvestre
- Centre d'imagerie ostéo-articulaire, clinique du sport de Bordeaux, 2, rue Georges-Negrevergne, 33700 Mérignac, France
| | - Philippe Meyer
- Centre d'imagerie ostéo-articulaire, clinique du sport de Bordeaux, 2, rue Georges-Negrevergne, 33700 Mérignac, France
| | - Arnaud Hocquelet
- Service de radiologie et d'imagerie diagnostique et interventionnelle, CHU Vaudois, 1011 Lausanne, Suisse
| | - Lionel Pesquer
- Centre d'imagerie ostéo-articulaire, clinique du sport de Bordeaux, 2, rue Georges-Negrevergne, 33700 Mérignac, France
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Gozubuyuk OB, Koksal C, Tasdemir EN. Rehabilitation of a patient with bilateral rectus abdominis full thickness tear sustained in recreational strength training: a case report. Physiother Theory Pract 2021; 38:3216-3225. [PMID: 34423725 DOI: 10.1080/09593985.2021.1967537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
STUDY DESIGN Case Report. BACKGROUND Abdominal wall muscle injuries have been reported in handball, tennis, and baseball; however, a bilateral full-thickness tear of the rectus abdominis muscle and its rehabilitation have not previously been described. This report aims to describe a case of an acute bilateral full-thickness rectus abdominis tear simulating an acute abdomen that presented to an emergency department. CASE DESCRIPTION A 25-year-old male (169 cm, 84 kg) was transferred to the emergency room due to severe lancinating (Numerical Pain Rating 10/10) abdominal pain that occurred during weight training at a gym. An orthopedic surgeon, an internist, and a general surgeon assessed him for internal and surgical emergencies. The magnetic resonance imaging of his abdomen revealed a bilateral full-thickness tear of the rectus abdominis muscle. The patient was given an option of surgical repair of the RA, but he refused. Six weeks later, he attended our sports medicine department. A criteria-based rehabilitation program was planned, with weekly follow-ups. OUTCOMES The patient could walk pain-free at 4th week and jog at 10th week of rehabilitation. Significant improvements in the range of movement of the trunk, pain levels and functional capacity were noted at discharge and 6 and 12-month follow-ups. DISCUSSION Clinical management of this patient is described in detail, with emphasis on diagnostic ultrasonography. The structured rehabilitation program used for this patient resulted in a return to pre-injury level function.
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Affiliation(s)
- Omer B Gozubuyuk
- Istanbul Faculty of Medicine, Department of Sports Medicine, Istanbul University, Istanbul, Turkey.,LifeCare Croydon Sports Medicine Centre, Department of Sports and Exercise Medicine, Croydon, Australia
| | - Ceylan Koksal
- Istanbul Faculty of Medicine, Department of Sports Medicine, Istanbul University, Istanbul, Turkey
| | - Esin N Tasdemir
- Istanbul Faculty of Medicine, Department of Sports Medicine, Istanbul University, Istanbul, Turkey
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15
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Neurobiological tensegrity: The basis for understanding inter-individual variations in task performance? Hum Mov Sci 2021; 79:102862. [PMID: 34416490 DOI: 10.1016/j.humov.2021.102862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 08/07/2021] [Accepted: 08/10/2021] [Indexed: 12/24/2022]
Abstract
Bernstein's (1996) levels of movement organization includes tonus, the muscular-contraction level that primes individual movement systems for (re)organizing coordination patterns. The hypothesis advanced is that the tonus architecture is a multi-fractal tensegrity system, deeply reliant on haptic perception for regulating movement of an individual actor in a specific environment. Further arguments have been proposed that the tensegrity-haptic system is implied in all neurobiological perception and -action. In this position statement we consider whether the musculoskeletal system can be conceptualized as a neurobiological tensegrity system, supporting each individual in co-adapting to many varied contexts of dynamic performance. Evidence for this position, revealed in investigations of judgments of object properties, perceived during manual hefting, is based on each participant's tensegrity. The implication is that the background organizational state of every individual is unique, given that no neurobiological architecture (musculo-skeletal components) is identical. The unique tensegrity of every organism is intimately related to individual differences, channeling individualized adaptations to constraints (task, environment, organismic), which change over different timescales. This neurobiological property assists transitions from one stable state of coordination to another which is needed in skill adaptation during performance. We conclude by discussing how tensegrity changes over time according to skill acquisition and learning.
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16
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Behm DG, Alizadeh S, Drury B, Granacher U, Moran J. Non-local acute stretching effects on strength performance in healthy young adults. Eur J Appl Physiol 2021; 121:1517-1529. [PMID: 33715049 DOI: 10.1007/s00421-021-04657-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/01/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Static stretching (SS) can impair performance and increase range of motion of a non-exercised or non-stretched muscle, respectively. An underdeveloped research area is the effect of unilateral stretching on non-local force output. OBJECTIVE The objective of this review was to describe the effects of unilateral SS on contralateral, non-stretched, muscle force and identify gaps in the literature. METHODS A systematic literature search following preferred reporting items for systematic review and meta-analyses Protocols guidelines was performed according to prescribed inclusion and exclusion criteria. Weighted means and ranges highlighted the non-local force output response to unilateral stretching. The physiotherapy evidence database scale was used to assess study risk of bias and methodological quality. RESULTS Unilateral stretching protocols from six studies involved 6.3 ± 2 repetitions of 36.3 ± 7.4 s with 19.3 ± 5.7 s recovery between stretches. The mean stretch-induced force deficits exhibited small magnitude effect sizes for both the stretched (-6.7 ± 7.1%, d = -0.35: 0.01 to -1.8) and contralateral, non-stretched, muscles (-4.0 ± 4.9%, d = , 0.22: 0.08 to 1.1). Control measures exhibited trivial deficits. CONCLUSION The limited literature examining non-local effects of prolonged SS revealed that both the stretched and contralateral, non-stretched, limbs of young adults demonstrate small magnitude force deficits. However, the frequency of studies with these effects were similar with three measures demonstrating deficits, and four measures showing trivial changes. These results highlight the possible global (non-local) effects of prolonged SS. Further research should investigate effects of lower intensity stretching, upper versus lower body stretching, different age groups, incorporate full warm-ups, and identify predominant mechanisms among others.
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Affiliation(s)
- David G Behm
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's,, Newfoundland and Labrador, Canada.
| | - Shahab Alizadeh
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's,, Newfoundland and Labrador, Canada
| | - Ben Drury
- Department of Applied Sport Sciences, Hartpury University, Gloucester, UK
| | - Urs Granacher
- Division of Training and Movement Science, University of Potsdam, Potsdam, Germany
| | - Jason Moran
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Essex, UK
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17
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Surgical versus conservative management of traumatic proximal adductor longus avulsion injuries: A systematic review. Surgeon 2021; 20:123-128. [PMID: 33692004 DOI: 10.1016/j.surge.2021.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/05/2021] [Accepted: 01/27/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Proximal avulsion injuries of the adductor longus have been managed both conservatively and operatively with good clinical outcomes, but there is no consensus on which option yields the best results. Thus, the present study aimed to review the available literature, comparing the outcomes and the time to return to sports with different management options. MATERIAL AND METHODS This study was conducted according to the PRISMA statement. The literature search was conducted in September 2020. All the clinical trials investigating the management of traumatic proximal adductor longus avulsion injuries were considered for inclusion. Only studies reporting data from athletes were considered. The outcomes of interest were the time to return to sport and return to preinjury activity level. RESULTS Data from 46 patients were retrieved. The mean follow-up was 24.6 ± 23.8 months. The study population was represented by male athletes with a mean age of 30.0 ± 4.8. Mean stump retraction was 3.3 ± 0.6 cm in the surgical and 1.7 ± 0.6 in the conservative cohort (P = 0.07). The rate of patients returning to prior activity level was similar in the two groups, but surgically treated patients required a longer time to return to sport (3.9 ± 1.5 months vs. 2.2 ± 1.0 months, P = 0.0001). CONCLUSION Conservative management for traumatic avulsion of the proximal adductor longus insertion may produce shorter time to return to sport. Both conservative and operative strategies allowed to achieve similar pre-injury activity level. LEVEL OF EVIDENCE IV, systematic review.
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18
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The topography and morphometrics of the pubic ligaments. Ann Anat 2021; 236:151698. [PMID: 33582299 DOI: 10.1016/j.aanat.2021.151698] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 01/11/2021] [Accepted: 01/15/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Conflicting anatomical reports and the little attention given to the pubic ligaments impede the interpretation of radiological and clinical examinations on groin pain. Morphometric data on the pubic ligaments are lacking. METHODS The muscular relations of the symphysis pubis were examined in layered dissection (n = 10), hemipelves (n = 60) and (un)stained plastinated body slices of body donors (n = 3). The sagittal and coronal areas, width, mean and maximum thickness of pubic ligaments were determined. RESULTS The adductor longus, brevis, rectus abdominis and pyramidalis muscles are attached to the anterior pubic ligament (APL). The adductor brevis and gracilis muscle are connected to the inferior pubic ligament (IPL). The IPL and superior pubic ligament (SPL) are thicker than the APL and posterior pubic ligament (PPL). The PPL is the thinnest pubic ligament. The APL has a larger sagittal area in women than in men compared to the IPL. The SPL and IPL are thicker in men compared to women. CONCLUSION The APL is the ligamentous anchor for the originating and inserting muscles. Investigations of the pubic ligaments might help to determine symphysis instability or severity of injury and should be included as a further criterion for surgical management.
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Abstract
Core muscle injury is a common but difficult problem to treat. Although it can affect all individuals, it is most commonly seen in male athletes in cutting, twisting, pivoting, and explosive sports. Owing to the high association of femoroacetabular impingement, we believe these individuals are best treated with a multidisciplinary approach involving both orthopedic and general surgeons. Conservative treatment should be the first step in management. When conservative means are unsuccessful, operative intervention to correct all the pathologic issues around the pubis can have extremely high success rates.
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Affiliation(s)
- Timothy J Mulry
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medicine School, Worcester, MA, USA
| | - Paul E Rodenhouse
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medicine School, Worcester, MA, USA. https://twitter.com/PaulRodenhouse
| | - Brian D Busconi
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medicine School, Worcester, MA, USA.
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20
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Behm DG, Alizadeh S, Anvar SH, Drury B, Granacher U, Moran J. Non-local Acute Passive Stretching Effects on Range of Motion in Healthy Adults: A Systematic Review with Meta-analysis. Sports Med 2021; 51:945-959. [PMID: 33459990 DOI: 10.1007/s40279-020-01422-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Stretching a muscle not only increases the extensibility or range of motion (ROM) of the stretched muscle or joint but there is growing evidence of increased ROM of contralateral and other non-local muscles and joints. OBJECTIVE The objective of this meta-analysis was to quantify crossover or non-local changes in passive ROM following an acute bout of unilateral stretching and to examine potential dose-response relations. METHODS Eleven studies involving 14 independent measures met the inclusion criteria. The meta-analysis included moderating variables such as sex, trained state, stretching intensity and duration. RESULTS The analysis revealed that unilateral passive static stretching induced moderate magnitude (standard mean difference within studies: SMD: 0.86) increases in passive ROM with non-local, non-stretched joints. Moderating variables such as sex, trained state, stretching intensity, and duration did not moderate the results. Although stretching duration did not present statistically significant differences, greater than 240-s of stretching (SMD: 1.24) exhibited large magnitude increases in non-local ROM compared to moderate magnitude improvements with shorter (< 120-s: SMD: 0.72) durations of stretching. CONCLUSION Passive static stretching of one muscle group can induce moderate magnitude, global increases in ROM. Stretching durations greater than 240 s may have larger effects compared with shorter stretching durations.
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Affiliation(s)
- David G Behm
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, NL, Canada.
| | - Shahab Alizadeh
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Saman Hadjizadeh Anvar
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, NL, Canada.,Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran
| | - Ben Drury
- Department of Applied Sport Sciences, Hartpury University, Hartpury, UK
| | - Urs Granacher
- Division of Training and Movement Science, University of Potsdam, Potsdam, Germany
| | - Jason Moran
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Essex, UK.
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21
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Proximal adductor avulsions are rarely isolated but usually involve injury to the PLAC and pectineus: descriptive MRI findings in 145 athletes. Knee Surg Sports Traumatol Arthrosc 2021; 29:2424-2436. [PMID: 32767053 PMCID: PMC8298372 DOI: 10.1007/s00167-020-06180-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 07/20/2020] [Indexed: 11/06/2022]
Abstract
PURPOSE The purpose of the study is to review the MRI findings in a cohort of athletes who sustained acute traumatic avulsions of the adductor longus fibrocartilaginous entheses, and to investigate related injuries namely the pyramidalis-anterior pubic ligament-adductor longus complex (PLAC). Associated muscle and soft tissue injuries were also assessed. METHODS The MRIs were reviewed for a partial or complete avulsion of the adductor longus fibrocartilage, as well as continuity or separation of the adductor longus from the pyramidalis. The presence of a concurrent partial pectineus tear was noted. Demographic data were analysed. Linear and logistic regression was used to examine associations between injuries. RESULTS The mean age was 32.5 (SD 10.9). The pyramidalis was absent in 3 of 145 patients. 85 of 145 athletes were professional and 52 competed in the football Premier League. 132 had complete avulsions and 13 partial. The adductor longus was in continuity with pyramidalis in 55 athletes, partially separated in seven and completely in 81 athletes. 48 athletes with a PLAC injury had a partial pectineus avulsion. Six types of PLAC injuries patterns were identified. Associated rectus abdominis injuries were rare and only occurred in five patients (3.5%). CONCLUSION The proximal adductor longus forms part of the PLAC and is rarely an isolated injury. The term PLAC injury is more appropriate term. MRI imaging should assess all the anatomical components of the PLAC post-injury, allowing recognition of the different patterns of injury. LEVEL OF EVIDENCE Level III.
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22
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Rajasekhar SSSN, Dinesh Kumar V, Senthil G, Pottakat B, Kalayarasan R, Raveendranath V, Gurram RP. Learning Gains of Liver Resection and Transplantation Workshop on Genelyn® Embalmed Human Cadavers: Surgical Gastroenterologists' Perceptions. J Clin Exp Hepatol 2021; 11:550-556. [PMID: 34511815 PMCID: PMC8414311 DOI: 10.1016/j.jceh.2021.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 01/19/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In the light of increased requirement for liver transplantation procedures, it is pertinent to develop bankable human expertise in the areas of liver resection and anastomoses. The alternative simulator sources available for learning surgical skills might not always provide the realistic learning gains as provided by human cadavers, especially in terms of haptic and tactile fidelity. For the first time, we have used Genelyn® embalmed cadavers (GEC) for training the surgical gastroenterologists in liver resection and transplantation procedures and we wish to document our experience of using them to facilitate the learning of liver resection procedures. MATERIALS AND METHODS A cross-sectional satisfaction survey fitting to the first level of the Kirkpatrick model for training evaluation was performed among participating surgical gastroenterologists of liver resection and transplantation training workshop using GEC. Visual, haptic and tactile characteristics of the liver and related structures were assessed along with overall satisfaction of the workshop. RESULTS Eleven surgical gastroenterologists had participated in the workshop conducted using three GEC. Nine participants agreed that the transection of liver parenchyma was similar to reality. However, two opined that the liver parenchyma was a bit harder to resect. Identification of portal pedicle, dissection of the peri-portal area and securing vascular anastomoses also had an acceptable level of similarity to real life. The two parameters that received a unanimous degree of the agreement are mobilization of liver and cannulation of key vessels for perfusion. CONCLUSION Participants of the cadaveric surgical skills training workshop opined that the soft-embalmed cadaver using Genelyn® is an excellent realistic model for practicing liver resection and transplantation surgery.
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Affiliation(s)
| | | | - Gnanasekaran Senthil
- Department of Surgical Gastroenterology, JIPMER, Puducherry, India,Address for correspondence. Dr Senthil Gnanasekaran, Assistant Professor, Department of Surgical Gastroenterology, Room no 5442, Fourth Floor, Superspeciality Block, JIPMER, Puducherry 605006, India.
| | - Biju Pottakat
- Department of Surgical Gastroenterology, JIPMER, Puducherry, India
| | - Raja Kalayarasan
- Department of Surgical Gastroenterology, JIPMER, Puducherry, India
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Ajimsha MS, Shenoy PD, Gampawar N. Role of fascial connectivity in musculoskeletal dysfunctions: A narrative review. J Bodyw Mov Ther 2020; 24:423-431. [PMID: 33218543 DOI: 10.1016/j.jbmt.2020.07.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 07/19/2020] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Musculoskeletal dysfunctions happen to be the most common reason for referral to physiotherapy and manual therapy services. Therapists use several articular and/or soft tissue concepts/approaches to evaluate and treat such dysfunctions that may include integration of myofascial system. Despite the research in this area spanning more than three decades, the role played by fascia has not received its duly deserved attention, owing to the lack of definitive research evidence. The concept of 'fascial connectivity' evolved two decades ago from a simple anatomical hypothesis called 'myofascial meridians'. Since then it has been widely researched, as conceptually it makes more sense for functional movements than 'single-muscle' theory. Researchers have been exploring its existence and role in musculoskeletal dysfunctions and clinicians continue to practice based on anecdotal evidence. This narrative review attempts to gather available evidence, in order to support and facilitate further research that can enhance evidence based practice in this field. METHODS A search of most major databases was conducted with relevant keywords that yielded 272 articles as of December 2019. Thirty five articles were included for final review with level of evidence ranging from 3b to 2a (as per Center of Evidence Based Medicine's scoring). RESULTS Findings from cadaveric, animal and human studies supports the claim of fascial connectivity to neighboring structures in the course of specific muscle-fascia chains that may have significant clinical implications. Current research (level 2) supports the existence of certain myofascial connections and their potential role in the manifestation of musculoskeletal dysfunctions and their treatment. CONCLUSION Although these reviews and trials yield positive evidence for the objective reality/existence of fascial connectivity and continuity, several aspects need further exploration and in-depth analysis, which could not be evidenced entirely in this review. Manual and physical therapists may utilize the concept of fascial connectivity as a convincing justification to deal with clinical problems, but need to remain vigilant that functional implications are still being investigated.
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Affiliation(s)
- M S Ajimsha
- Department of Physiotherapy, Hamad Medical Corporation, Doha, Qatar.
| | - Pramod D Shenoy
- Department of Physiotherapy, Hamad Medical Corporation, Doha, Qatar
| | - Neeraj Gampawar
- Department of Physiotherapy, Hamad Medical Corporation, Doha, Qatar
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Koh E, Boyle J. Pubic apophysitis in elite Australian Rules football players: MRI findings and the utility of VIBE sequences in evaluating athletes with groin pain. Clin Radiol 2020; 75:293-301. [PMID: 32019672 DOI: 10.1016/j.crad.2019.12.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 12/30/2019] [Indexed: 11/23/2022]
Abstract
AIM To confirm that pubic apophysitis is common in Australian Rules footballers with groin pain. MATERIALS AND METHODS Thirteen male Australian Football League (AFL) players with groin pain were assessed with volumetric interpolated breath-hold examination (VIBE) MRI over the 2017, 2018, and 2019 AFL seasons. Images were reviewed for pubic maturation, the presence of pubic apophysitis, and associated bone pathology and correlated with side of groin pain. RESULTS Pubic apophysitis was seen in 92% of AFL players with groin pain. Delayed maturation of the pubic apophyses was observed in 85%. Pubic bone erosions and cyst-like changes were common (100% and 46%, respectively), but due to delayed maturation of the apophyses and apophysiolysis. Apophysitis associated with adductor brevis-gracilis was more common than adductor longus-associated apophysitis. CONCLUSION Pubic apophysitis associated with delayed maturation of the pubic apophyses is common in AFL players and is potentially a significant cause of groin pain in these athletes. Imaging findings in this group are the same as those conventionally describing osteitis pubis. Pubic apophysitis is best visualised with VIBE magnetic resonance imaging (MRI) and may be a more pathologically correct description of early, adductor load-related pubic bone pathology.
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Affiliation(s)
- E Koh
- Envision Medical Imaging, Wembley, Western Australia, Australia; Medical Department, Fremantle Football Club, Cockburn Central, Western Australia, Australia.
| | - J Boyle
- Medical Department, Fremantle Football Club, Cockburn Central, Western Australia, Australia; School of Physiotherapy and Exercise Science, Curtin University, Bentley, Western Australia, Australia
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25
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Riff AJ, Movassaghi K, Beck EC, Neal WH, Inoue N, Coleman SH, Nho SJ. Surface Mapping of the Musculotendinous Attachments at the Pubic Symphysis in Cadaveric Specimens: Implications for the Treatment of Core Muscle Injury. Arthroscopy 2019; 35:2358-2364. [PMID: 31395170 DOI: 10.1016/j.arthro.2019.02.043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 02/18/2019] [Accepted: 02/19/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To characterize the 3-dimensional muscular, musculotendinous, and neurovascular anatomy about the pubic symphysis relevant to core muscle injury (CMI). METHODS Ten cadaveric hips were dissected to characterize the musculotendinous insertion of the rectus abdominis and inguinal ligament, origins of the adductor longus and adductor brevis, and the pubic cartilage plate. A 3-dimensional coordinate measuring system and data acquisition software were used to calculate structure cross-sectional area, and the landmark anatomical relationships to 1 another and relevant neurovascular structures. RESULTS All specimens were male with an average age of 62 ± 2 years. The mean footprints of the rectus abdominis, inguinal ligament, adductor longus, and adductor brevis were 8.4 ± 3.1, 1.2 ± 0.5, 3.8 ± 1.6, and 2.9 ± 1.3 cm2, respectively. The mean pectineus and gracilis footprints were 6.3 ± 2.4 and 3.4 ± 0.9 cm2, respectively. The mean cross-sectional area of the cartilage plate was 24.8 ± 5.6 cm2. The adductor longus was an average 1.5 ± 0.25 cm from the adductor brevis and 0.69 ± 0.52 cm from the rectus abdominis. The genital branch of the genitofemoral nerve was an average of 4.3 cm (range, 2.8-6.4) lateral to the insertion of the inguinal ligament. The femoral vein and artery were 3.0 cm (range, 2.5-3.6) and 3.7 cm (range, 2.5-5.9) lateral to the inguinal ligament footprint. The obturator nerve was 2.5 cm (range, 1.6-3.4) lateral to the adductor longus. CONCLUSIONS Familiarity with the anatomy of the pubic symphysis is essential for surgeons treating patients with CMI. We have shown that this relatively small area is the site of many muscular, musculotendinous, and neurovascular structures with various sized footprints and described the 3-dimensional anatomy of the anterior pubic symphysis. The origin of the adductor longus lies in close proximity to other structures, such as the adductor brevis, the insertion of the rectus abdominis, and the obturator nerve. These findings should be considered when operating in this region and treating patients with chronic groin pain. CLINICAL RELEVANCE The anatomy of the pelvic region and pubic symphysis has not been well characterized. Intimate knowledge of relevant anatomy is essential to treating CMI, also known as athletic pubalgia or sports hernia.
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Affiliation(s)
- Andrew J Riff
- Department of Orthopaedic Surgery, Indiana University Health, Indianapolis, Indiana, U.S.A
| | - Kamran Movassaghi
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Edward C Beck
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A..
| | - William H Neal
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nozomu Inoue
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Struan H Coleman
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Shane J Nho
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
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Balta JY, Twomey M, Moloney F, Duggan O, Murphy KP, O'Connor OJ, Cronin M, Cryan JF, Maher MM, O'Mahony SM. A comparison of embalming fluids on the structures and properties of tissue in human cadavers. Anat Histol Embryol 2018; 48:64-73. [PMID: 30450564 DOI: 10.1111/ahe.12412] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/02/2018] [Accepted: 10/09/2018] [Indexed: 12/11/2022]
Abstract
Cadaveric material has long been used to teach anatomy and more recently to train students in clinical skills. The aim of this study was to develop a systematic approach to compare the impact of four embalming solutions on the tissues of human cadavers. To this end, a formalin-based solution, Thiel, Genelyn and Imperial College London soft-preservation (ICL-SP) solution were compared. The effect of these chemicals on the properties of the tissue was assessed by measuring the range of motion (ROM) of joints and measuring the dimensions of different structures on computed tomography (CT) images before and after embalming. The mean changes in the ratio (angle to ROM) differed statistically between embalming methods (Welch Statistic 3,1.672 = 67.213, p = 0.026). Thiel embalmed cadavers showed an increase in range of motion while ICL-SP cadavers remained relatively the same. Genelyn and formalin embalmed cadavers registered a notable decrease in range of motion. Furthermore, investigation into the impact of the embalming chemicals on the dimensions of internal organs and vessels revealed that Thiel embalming technique leads to a decrease in the dimension of the cardiovascular system alone while formalin-based solutions maintain the shape of the organs and vessels investigated. Our findings suggest that the joints of cadavers' embalmed using ICL-SP technique may faithfully mimic that of unembalmed cadavers and that formalin is necessary to retain shape and size of the organs and vessels investigated in this study. Despite this, a study with larger numbers of cadavers is required to confirm these findings.
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Affiliation(s)
- Joy Y Balta
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
| | - Maria Twomey
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - Fiachra Moloney
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland.,Department of Radiology, Cork University Hospital, Cork, Ireland
| | - Orla Duggan
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Ireland
| | - Kevin P Murphy
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - Owen J O'Connor
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - Michael Cronin
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
| | - John F Cryan
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
| | - Michael M Maher
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - Siobhain M O'Mahony
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
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Hopp S, Ojodu I, Jain A, Fritz T, Pohlemann T, Kelm J. Novel pathomorphologic classification of capsulo-articular lesions of the pubic symphysis in athletes to predict treatment and outcome. Arch Orthop Trauma Surg 2018; 138:687-697. [PMID: 29417208 DOI: 10.1007/s00402-018-2893-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Radiographic abnormalities of the symphysis as well as the formation of accessory clefts, indicating injury at the rectus-adductor aponeurosis, reportedly relate to longstanding groin pain in athletes. However, yet, no systematic classification for clinical and scientific purposes exists. We aimed to (1) create a radiographic classification based on symphysography; (2) test intra- and interobserver reliability; (3) characterise clinical significance of the morphologic patterns by evaluating success of injection therapy. PATIENTS AND METHODS We retrospectively reviewed symphysography, AP radiographs, and MRI of the pelvis from 70 consecutive competitive athletes, with chronic groin pain. Symphysographs were evaluated for intra- and interobserver variance using cohen's kappa statistics. Morphologic studies of the different contrast distribution patterns and their clinical and radiological correlation with symptom relief were investigated. All patients were followed up to evaluate immediate and long-term response to the initial therapeutic injection with steroid. RESULTS Four reproducible symphysographic patterns were identified: type 0, no changes; type 1, symphyseal disk degeneration; types 2a with unilateral clefts, bilateral clefts (2b), suprapubic clefts (2c); and type 3, with expanded or multidirectional clefts. Analysis revealed excellent intra (0.94)-and interobserver (0.90) reliability. Our findings showed that 78.6% of our patients had significant short-term improvement enabling early resumption of physiotherapy, only in types 1 and 2 (p = 0.001), while type 0 and 3 did not respond. At follow-up, only 21.8% had permanent pain relief. Regarding the detection of pathologic clefts with symphysography, sensitivity (88%) and specifity (77%) were superior to that of MRI. CONCLUSIONS A reproducible symphysography-based classification of distinct morphologic patterns is proposed. It serves as a predictive tool for response to injection therapy in a select group of pathologic lesions. Complete recovery after injection can only be expected in a lesser percentage, as this might indicate surgical treatment for long-term non-responders.
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Affiliation(s)
- Sascha Hopp
- Lutrina Clinic Kaiserslautern, Centre for Knee Surgery, Orthopaedics and Sports Traumatology, Groin Pain and Core Muscle Injury Centre, Karl-Marx-Strasse 33, 67655, Kaiserslautern, Germany. .,Department of Trauma, Hand and Reconstructive Surgery, University of Saarland, Homburg, Saar, Germany.
| | - Ishaq Ojodu
- Department of Trauma, Hand and Reconstructive Surgery, University of Saarland, Homburg, Saar, Germany.,Ondo State Trauma Centre, Ondo, Nigeria
| | - Atul Jain
- Department of Trauma, Hand and Reconstructive Surgery, University of Saarland, Homburg, Saar, Germany.,Department of Orthopaedics, Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi, India
| | - Tobias Fritz
- Department of Trauma, Hand and Reconstructive Surgery, University of Saarland, Homburg, Saar, Germany
| | - Tim Pohlemann
- Department of Trauma, Hand and Reconstructive Surgery, University of Saarland, Homburg, Saar, Germany
| | - Jens Kelm
- Chirurgisch-Orthopädisches Zentrum, Illingen, Germany
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Wilke J, Schleip R, Yucesoy CA, Banzer W. Not merely a protective packing organ? A review of fascia and its force transmission capacity. J Appl Physiol (1985) 2018; 124:234-244. [DOI: 10.1152/japplphysiol.00565.2017] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Recent research indicates that fascia is capable of changing its biomechanical properties. Moreover, as it links the skeletal muscles, forming a body-wide network of multidirectional myofascial continuity, the classical conception of muscles as independent actuators has been challenged. Hence, the present synthesis review aims to characterize the mechanical relevance of the connective tissue for the locomotor system. Results of cadaveric and animal studies suggest a clinically relevant myofascial force transmission to neighboring structures within one limb (e.g., between synergists) and in the course of muscle-fascia chains (e.g., between leg and trunk). Initial in vivo trials appear to underpin these findings, demonstrating the existence of nonlocal exercise effects. However, the factors influencing the amount of transmitted force (e.g., age and physical activity) remain controversial, as well as the role of the central nervous system within the context of the observed remote exercise effects.
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Affiliation(s)
- Jan Wilke
- Department of Sports Medicine, Goethe University, Frankfurt am Main, Germany
| | - Robert Schleip
- Fascia Research Group, Neurosurgical Clinic Guenzburg of Ulm University, Ulm, Germany
| | - Can A. Yucesoy
- Institute of Biomedical Engineering, Bogazici University, Instanbul, Turkey
| | - Winfried Banzer
- Department of Sports Medicine, Goethe University, Frankfurt am Main, Germany
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Evans KL, Hughes J, Williams MD. Reduced severity of lumbo-pelvic-hip injuries in professional Rugby Union players following tailored preventative programmes. J Sci Med Sport 2017; 21:274-279. [PMID: 28797830 DOI: 10.1016/j.jsams.2017.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 07/01/2017] [Accepted: 07/05/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this study was to tailor lumbo-pelvic-hip (LPH) injury reduction programmes in professional rugby union players based on screening data and examine its effectiveness. DESIGN Prospective case controlled study. METHODS Twenty-eight professional rugby union players were screened pre- and immediately post- the YO-YO intermittent recovery level 1 test using six hip and groin strength tests (adductor squeeze at 0°, 60° and 90°, prone hip extension, abductor, adductor hand held dynamometry). The changes in hip and groin measures, were analysed using hierarchical cluster analysis. Three clusters emerged and a tailored LPH injury reduction programme was administered for each cluster. In addition, 22 players who were not involved in the initial testing received a generic LPH injury reduction programme and were used as the control. Seasonal information for LPH injury incidence, severity and prevalence were compared to the previous season. RESULTS The same number of injuries were observed when the prospective injury surveillance data was compared to the previous season, however a reduced injury severity (936days vs 468days), average severity (78±126days vs 42±37days) and prevalence (21% vs 19%) were found. Moreover, LPH injury severity for players who were prescribed a tailored injury reduction programme (209days) were 50days less than players given a generic LPH injury reduction programme (259days). CONCLUSIONS Our preliminary observations support the effectiveness of grouping players and tailoring intervention based on common group characteristics in reducing the severity of LPH injuries in professional Rugby Union.
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Affiliation(s)
- Kate L Evans
- School of Sport, Health and Outdoor Education, Faculty of Business & Management, University of Wales Trinity Saint David, United Kingdom; Gwent Dragons Rugby, United Kingdom.
| | - Jonathan Hughes
- School of Sport and Exercise, Faculty of Applied Sciences, University of Gloucestershire, United Kingdom
| | - Morgan D Williams
- School of Health, Sport and Professional Practice, Faculty of Life Sciences and Education, University of South Wales, United Kingdom
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31
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The ability of athletes with long-standing groin pain to maintain a stable lumbopelvic position: A laboratory study. Phys Ther Sport 2017; 23:45-49. [DOI: 10.1016/j.ptsp.2016.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 05/10/2016] [Accepted: 06/24/2016] [Indexed: 11/19/2022]
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Schilders E, Bharam S, Golan E, Dimitrakopoulou A, Mitchell A, Spaepen M, Beggs C, Cooke C, Holmich P. The pyramidalis-anterior pubic ligament-adductor longus complex (PLAC) and its role with adductor injuries: a new anatomical concept. Knee Surg Sports Traumatol Arthrosc 2017; 25:3969-3977. [PMID: 28866812 PMCID: PMC5698379 DOI: 10.1007/s00167-017-4688-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 08/16/2017] [Indexed: 12/30/2022]
Abstract
PURPOSE Adductor longus injuries are complex. The conflict between views in the recent literature and various nineteenth-century anatomy books regarding symphyseal and perisymphyseal anatomy can lead to difficulties in MRI interpretation and treatment decisions. The aim of the study is to systematically investigate the pyramidalis muscle and its anatomical connections with adductor longus and rectus abdominis, to elucidate injury patterns occurring with adductor avulsions. METHODS A layered dissection of the soft tissues of the anterior symphyseal area was performed on seven fresh-frozen male cadavers. The dimensions of the pyramidalis muscle were measured and anatomical connections with adductor longus, rectus abdominis and aponeuroses examined. RESULTS The pyramidalis is the only abdominal muscle anterior to the pubic bone and was found bilaterally in all specimens. It arises from the pubic crest and anterior pubic ligament and attaches to the linea alba on the medial border. The proximal adductor longus attaches to the pubic crest and anterior pubic ligament. The anterior pubic ligament is also a fascial anchor point connecting the lower anterior abdominal aponeurosis and fascia lata. The rectus abdominis, however, is not attached to the adductor longus; its lateral tendon attaches to the cranial border of the pubis; and its slender internal tendon attaches inferiorly to the symphysis with fascia lata and gracilis. CONCLUSION The study demonstrates a strong direct connection between the pyramidalis muscle and adductor longus tendon via the anterior pubic ligament, and it introduces the new anatomical concept of the pyramidalis-anterior pubic ligament-adductor longus complex (PLAC). Knowledge of these anatomical relationships should be employed to aid in image interpretation and treatment planning with proximal adductor avulsions. In particular, MRI imaging should be employed for all proximal adductor longus avulsions to assess the integrity of the PLAC.
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Affiliation(s)
- Ernest Schilders
- Fortius Clinic, 17 Fitzhardinge Street, W1H 6EQ, London, UK. .,School of Sport, Leeds Beckett University, Leeds, West Yorkshire, UK. .,Orthopaedics, Lennox Hill Hospital, New York, NY, USA.
| | - Srino Bharam
- Orthopaedics, Lennox Hill Hospital, New York, NY USA ,Mount Sinai School of Medicine, New York, NY USA
| | - Elan Golan
- Orthopaedics, Maimonides Medical Center, Brooklyn, NY USA
| | - Alexandra Dimitrakopoulou
- School of Sport, Leeds Beckett University, Leeds, West Yorkshire UK ,The Wellington Hospital, The London Hip Arthroscopy Centre, London, UK
| | | | | | - Clive Beggs
- School of Sport, Leeds Beckett University, Leeds, West Yorkshire UK
| | | | - Per Holmich
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Copenhagen, Denmark ,Aspetar Orthopaedic and Sports Medicine Hospital, Sports Groin Pain Center, Doha, Qatar
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Wilke J, Vogt L, Niederer D, Banzer W. Is remote stretching based on myofascial chains as effective as local exercise? A randomised-controlled trial. J Sports Sci 2016; 35:2021-2027. [PMID: 27819537 DOI: 10.1080/02640414.2016.1251606] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Lower limb stretching based on myofascial chains has been demonstrated to increase cervical range of motion (ROM) in the sagittal plane. It is, however, unknown whether such remote exercise is as effective as local stretching. To resolve this research deficit, 63 healthy participants (36 ± 13 years, ♂32) were randomly assigned to one of three groups: remote stretching of the lower limb (LLS), local stretching of the cervical spine (CSS) or inactive control (CON). Prior (M1), immediately post (M2) and 5 min following intervention (M3), maximal cervical ROM was assessed. Non-parametric data analysis (Kruskal-Wallis tests and adjusted post hoc Dunn tests) revealed significant differences between the disposed conditions. With one exception (cervical spine rotation after CSS at M2, P > .05), both LLS and CSS increased cervical ROM compared to the control group in all movement planes and at all measurements (P < .05). Between LLS and CSS, no statistical differences were found (P > .05). Lower limb stretching based on myofascial chains induces similar acute improvements in cervical ROM as local exercise. Therapists might consequently consider its use in programme design. However, as the attained effects do not seem to be direction-specific, further research is warranted in order to provide evidence-based recommendations.
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Affiliation(s)
- J Wilke
- a Department of Sports Medicine , Goethe University Frankfurt am Main , Frankfurt am Main , Germany
| | - L Vogt
- a Department of Sports Medicine , Goethe University Frankfurt am Main , Frankfurt am Main , Germany
| | - D Niederer
- a Department of Sports Medicine , Goethe University Frankfurt am Main , Frankfurt am Main , Germany
| | - W Banzer
- a Department of Sports Medicine , Goethe University Frankfurt am Main , Frankfurt am Main , Germany
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Abstract
Athletic pubalgia, or "sports hernia", represents a constellation of pathologic conditions occurring at and around the pubic symphysis. These injuries are primarily seen in athletes or those involved in athletic activity. In this article, we review the sonographic appearance of the relevant complex anatomy, scanning technique for ultrasound evaluation of athletic pubalgia, and the sonographic appearances of associated pathologic conditions.
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Wilke J, Niederer D, Vogt L, Banzer W. Remote effects of lower limb stretching: preliminary evidence for myofascial connectivity? J Sports Sci 2016; 34:2145-2148. [PMID: 27124264 DOI: 10.1080/02640414.2016.1179776] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The skeletal muscles and the fibrous connective tissue form an extensive, body-wide network of myofascial chains. As fascia can modify its stiffness, strain transmission along these meridians is supposable. The goal of this trial therefore was to collect pilot data for potential remote effects of lower limb stretching on cervical range of motion (ROM). Twenty-six healthy participants (30 ± 6 years) were included in the matched-pairs intervention study. One group (n = 13) performed three 30 s bouts of static stretching for the gastrocnemius and the hamstrings, respectively. An age- and sex-matched control group (CG; n = 13) remained inactive. Pre- and post-intervention, maximal cervical ROM in flexion/extension was assessed. A repeated measures ANOVA revealed systematic differences between groups (P < .05). ROM increased following stretching (143.3 ± 13.9 to 148.2 ± 14°; P < .05) but remained unchanged in the CG (144.6 ± 16.8 to 143.3 ± 16.8°; P > .05). Our data point towards existence of a strain transfer along myofascial meridians. Further randomised controlled studies on conditions, factors and magnitude of tensile transmission are warranted.
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Affiliation(s)
- Jan Wilke
- a Department of Sports Medicine , Goethe University Frankfurt/Main , Frankfurt/Main , Germany
| | - Daniel Niederer
- a Department of Sports Medicine , Goethe University Frankfurt/Main , Frankfurt/Main , Germany
| | - Lutz Vogt
- a Department of Sports Medicine , Goethe University Frankfurt/Main , Frankfurt/Main , Germany
| | - Winfried Banzer
- a Department of Sports Medicine , Goethe University Frankfurt/Main , Frankfurt/Main , Germany
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Krause F, Wilke J, Vogt L, Banzer W. Intermuscular force transmission along myofascial chains: a systematic review. J Anat 2016; 228:910-8. [PMID: 27001027 DOI: 10.1111/joa.12464] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2016] [Indexed: 01/08/2023] Open
Abstract
The present review aims to provide a systematic overview on tensile transmission along myofascial chains based on anatomical dissection studies and in vivo experiments. Evidence for the existence of myofascial chains is growing, and the capability of force transmission via myofascial chains has been hypothesized. However, there is still a lack of evidence concerning the functional significance and capability for force transfer. A systematic literature research was conducted using MEDLINE (Pubmed), ScienceDirect and Google Scholar. Studied myofascial chains encompassed the superficial backline (SBL), the back functional line (BFL) and the front functional line (FFL). Peer-reviewed human dissection studies as well as in vivo experiments reporting intermuscular tension transfer between the constituents of a myofascial chain were included. To assess methodic quality, two independent investigators rated studies by means of validated assessment tools (QUACS and PEDro Scale). The literature research identified 1022 articles. Nine studies (moderate to excellent methodological quality) were included. Concerning the SBL and the BFL, there is moderate evidence for force transfer at all three transitions (based on six studies), and one of two transitions (three studies). One study yields moderate evidence for a slight, but not significant force transfer at one transition in the FFL. The findings of the present study indicate that tension can be transferred between some of the examined adjacent structures. Force transfer might have an impact in overuse conditions as well as on sports performance. However, different methods of force application and measurement hinder the comparability of results. Considering anatomical variations in the degree of continuity and histological differences of the linking structures is crucial for interpretation. Future studies should focus on the in vivo function of myofascial continuity during isolated active or passive tissue tensioning.
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Affiliation(s)
- Frieder Krause
- Department of Sports Medicine, Goethe University Frankfurt/Main, Frankfurt am Main, Germany
| | - Jan Wilke
- Department of Sports Medicine, Goethe University Frankfurt/Main, Frankfurt am Main, Germany
| | - Lutz Vogt
- Department of Sports Medicine, Goethe University Frankfurt/Main, Frankfurt am Main, Germany
| | - Winfried Banzer
- Department of Sports Medicine, Goethe University Frankfurt/Main, Frankfurt am Main, Germany
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What Is Evidence-Based About Myofascial Chains: A Systematic Review. Arch Phys Med Rehabil 2016; 97:454-61. [DOI: 10.1016/j.apmr.2015.07.023] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 07/28/2015] [Accepted: 07/29/2015] [Indexed: 01/26/2023]
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Drew MK, Lovell G, Palsson TS, Chiarelli PE, Osmotherly PG. Do Australian Football players have sensitive groins? Players with current groin pain exhibit mechanical hyperalgesia of the adductor tendon. J Sci Med Sport 2016; 19:784-8. [PMID: 26794720 DOI: 10.1016/j.jsams.2015.12.516] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 12/02/2015] [Accepted: 12/19/2015] [Indexed: 01/17/2023]
Abstract
OBJECTIVES This is the first study to evaluate the mechanical sensitivity, clinical classifications and prevalence of groin pain in Australian football players. DESIGN Case-control. METHODS Professional (n=66) and semi-professional (n=9) Australian football players with and without current or previous groin injuries were recruited. Diagnoses were mapped to the Doha Agreement taxonomy. Point and career prevalence of groin pain was calculated. Pressure pain thresholds (PPTs) were assessed at regional and distant sites using handheld pressure algometry across four sites bilaterally (adductor longus tendon, pubic bone, rectus femoris, tibialis anterior muscle). To assess the relationship between current groin pain and fixed effects of hyperalgesia of each site and a history of groin pain, a mixed-effect logistic regression model was utilised. Receiver Operator Characteristic (ROC) curve were determined for the model. RESULTS Point prevalence of groin pain in the preseason was 21.9% with a career prevalence of 44.8%. Adductor-related groin pain was the most prevalent classification in the pre-season period. Hyperalgesia was observed in the adductor longus tendon site in athletes with current groin pain (OR=16.27, 95% CI 1.86 to 142.02). The ROC area under the curve of the regression model was fair (AUC=0.76, 95% CI 0.54 to 0.83). CONCLUSIONS Prevalence data indicates that groin pain is a larger issue than published incidence rates imply. Adductor-related groin pain is the most common diagnosis in pre-season in this population. This study has shown that hyperalgesia exists in Australian football players experiencing groin pain indicating the value of assessing mechanical pain sensitivity as a component of the clinical assessment.
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Affiliation(s)
- Michael K Drew
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Australia; Department of Physical Therapies, Australian Institute of Sport, Australia.
| | - Gregory Lovell
- Department of Sports Medicine, Australian Institute of Sport, Australia
| | - Thorvaldur S Palsson
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Denmark
| | - Pauline E Chiarelli
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Australia
| | - Peter G Osmotherly
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Australia
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Wilke J, Engeroff T, Nürnberger F, Vogt L, Banzer W. Anatomical study of the morphological continuity between iliotibial tract and the fibularis longus fascia. Surg Radiol Anat 2015; 38:349-52. [PMID: 26522465 DOI: 10.1007/s00276-015-1585-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 10/26/2015] [Indexed: 01/26/2023]
Abstract
PURPOSE Recent research indicates that the skeletal muscles of the human body do not function as independent actuators. Instead, they seem to be linked by connective tissue forming myofascial chains. While the existence of such meridians has been demonstrated for the ventral and the dorsal side of the body, no data are available for morphological fusion of lateral muscles. This study aimed to provide evidence for the inferior part of the lateral myofascial chain. METHODS Fourteen legs (7 embalmed cadavers, four ♂, 86 ± 7 years) were dissected to reveal a potential myofascial continuity between the fibularis longus muscle, more detailed, its fascia, and the iliotibial tract (ITT). Three investigators judged the general existence as well as the degree and characteristics of the continuity. If an anatomical continuity was evident, strain was applied to both structures in order to evaluate the tissues' ability for tensile transmission. RESULTS An indirect connection between the iliotibial tract and the fascia of the fibularis longus muscle was found: in all examined legs, the ITT fused strongly with the crural fascia. The latter was hardly separable from the fibularis longus fascia. Application of strain to the ITT caused local movement in the crural fascia and the underlying fascia of the fibularis muscle. CONCLUSIONS The iliotibial tract fuses firmly with the crural fascia and the degree of continuity suggests that moderate amounts of strain might be transmitted. However, biomechanical studies precisely quantifying this tensile transmission are warranted in order to estimate the relevance of the linkage for the locomotor system.
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Affiliation(s)
- Jan Wilke
- Department Sports Medicine, Institute of Sports Sciences, Goethe University Frankfurt, Ginnheimer Landstraße 39, 60487, Frankfurt am Main, Germany.
| | - Tobias Engeroff
- Department Sports Medicine, Institute of Sports Sciences, Goethe University Frankfurt, Ginnheimer Landstraße 39, 60487, Frankfurt am Main, Germany
| | - Frank Nürnberger
- Department of Anatomy (II), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Lutz Vogt
- Department Sports Medicine, Institute of Sports Sciences, Goethe University Frankfurt, Ginnheimer Landstraße 39, 60487, Frankfurt am Main, Germany
| | - Winfried Banzer
- Department Sports Medicine, Institute of Sports Sciences, Goethe University Frankfurt, Ginnheimer Landstraße 39, 60487, Frankfurt am Main, Germany
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Drew MK, Palsson TS, Izumi M, Hirata RP, Lovell G, Chiarelli P, Osmotherly PG, Graven-Nielsen T. Resisted adduction in hip neutral is a superior provocation test to assess adductor longus pain: An experimental pain study. Scand J Med Sci Sports 2015; 26:967-74. [DOI: 10.1111/sms.12529] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2015] [Indexed: 11/28/2022]
Affiliation(s)
- M. K. Drew
- School of Health Sciences; Faculty of Health and Medicine; University of Newcastle; Newcastle Australia
- Department of Physical Therapies; Australian Institute of Sport; Canberra Australia
| | - T. S. Palsson
- Center for Neuroplasticity and Pain (CNAP); SMI; Department of Health Science and Technology; Faculty of Medicine; Aalborg University; Denmark
| | - M. Izumi
- Center for Neuroplasticity and Pain (CNAP); SMI; Department of Health Science and Technology; Faculty of Medicine; Aalborg University; Denmark
- Department of Orthopedic Surgery; Kochi University; Kochi Japan
| | - R. P. Hirata
- Center for Neuroplasticity and Pain (CNAP); SMI; Department of Health Science and Technology; Faculty of Medicine; Aalborg University; Denmark
| | - G. Lovell
- Department of Sports Medicine; Australian Institute of Sport; Canberra Australia
| | - P. Chiarelli
- School of Health Sciences; Faculty of Health and Medicine; University of Newcastle; Newcastle Australia
| | - P. G. Osmotherly
- School of Health Sciences; Faculty of Health and Medicine; University of Newcastle; Newcastle Australia
| | - T. Graven-Nielsen
- Center for Neuroplasticity and Pain (CNAP); SMI; Department of Health Science and Technology; Faculty of Medicine; Aalborg University; Denmark
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Balta JY, Cronin M, Cryan JF, O'Mahony SM. Human preservation techniques in anatomy: A 21st century medical education perspective. Clin Anat 2015; 28:725-34. [PMID: 26118424 DOI: 10.1002/ca.22585] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 05/29/2015] [Accepted: 05/29/2015] [Indexed: 11/06/2022]
Abstract
Anatomy is the cornerstone of education for healthcare professionals with the use of human material providing an excellent teaching tool in the modern curricula. The ability and quality of preservation of human remains has enabled such use. The introduction of formaldehyde as a preservative in 1893 was an important step in the history of preservation. With the European Union directive on the use of formaldehyde and its expected banning, anatomists are trying to find a more convenient and safe substitute. In this review, we compare the different techniques used based on the need for embalming, fixative used, period of preservation and the features of the embalmed specimen. The fact that embalming is used in different disciplines, multiple purposes and described in different languages has led to the development of ambiguous interchangeable terminology. Overall, there is a lack of information specifically classifying, listing and comparing different embalming techniques, and this may be due to the fact that no internationally recognized experimental standards are adhered to in this field. Anatomists strive to find an embalming technique that allows the preserved specimen to accurately resemble the living tissue, preserve the body for a long period of time and reduces health risk concerns related to working with cadavers. There is a need for embalming to shift to an independent modern day science with well-founded research at the heart of it. While this may take time and agreement across nations, we feel that this review adds to the literature to provide a variety of different methods that can be employed for human tissue preservation depending on the desired outcome.
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Affiliation(s)
- Joy Y Balta
- Department of Anatomy and Neuroscience, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Michael Cronin
- Department of Anatomy and Neuroscience, College of Medicine and Health, University College Cork, Cork, Ireland
| | - John F Cryan
- Department of Anatomy and Neuroscience, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Siobhain M O'Mahony
- Department of Anatomy and Neuroscience, College of Medicine and Health, University College Cork, Cork, Ireland
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Affiliation(s)
- Michael K Drew
- Department of Physical Therapies, Australian Institute of Sport, Canberra, Australia Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Callaghan, Australia Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University, Australia Department of Physiotherapy, Faculty of Health, University of Canberra, Canberra, Australia
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Cheatham SW, Hanney WJ, Kolber MJ, Salamh PA. Adductor-related groin pain in the athlete. PHYSICAL THERAPY REVIEWS 2014. [DOI: 10.1179/1743288x14y.0000000147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Abstract
Every element or cell in the human body produces substances that communicate and respond in an autocrine or paracrine mode, consequently affecting organs and structures that are seemingly far from each other. The same also applies to the skin. In fact, when the integrity of the skin has been altered, or when its healing process is disturbed, it becomes a source of symptoms that are not merely cutaneous. The skin is an organ, and similar to any other structure, it has different functions in addition to connections with the central and peripheral nervous system. This article examines pathological responses produced by scars, analyzing definitions and differences. At the same time, it considers the subcutaneous fascias, as this connective structure is altered when there is a discontinuous cutaneous surface. The consequence is an ample symptomatology, which is not limited to the body area where the scar is located, such as a postural or trigeminal disorder.
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Affiliation(s)
- Bruno Bordoni
- Rehabilitation Cardiology Institute of Hospitalization and Care with Scientific Address, S Maria Nascente Don Carlo Gnocchi Foundation. CRESO Osteopathic Centre for Research and Studies
| | - Emiliano Zanier
- EdiAcademy, Milano, Italy. CRESO Osteopathic Centre for Research and Studies
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Hölmich P, Thorborg K, Dehlendorff C, Krogsgaard K, Gluud C. Incidence and clinical presentation of groin injuries in sub-elite male soccer. Br J Sports Med 2013; 48:1245-50. [PMID: 23956334 DOI: 10.1136/bjsports-2013-092627] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Groin injuries cause major problems in the football codes, as they are prevalent and lead to prolonged symptoms and high recurrence. The aim of the present study was to describe the occurrence and clinical presentation of groin injuries in a large cohort of sub-elite soccer players during a season. METHODS Physiotherapists allocated to each of the participating 44 soccer clubs recorded baseline characteristics and groin injuries sustained by a cohort of 998 sub-elite male soccer players during a full 10-month season. All players with groin injuries were examined using the clinical entity approach, which utilises standardised reproducible examination techniques to identify the injured anatomical structures. The exposure time and the injury time were also recorded. Injury time was analysed using multiple regression on the log of the injury times as the data were highly skewed. Effects are thus reported at relative injury time (RIT). RESULTS Adductor-related groin injury was the most common entity found followed by iliopsoas-related and abdominal-related injuries. The dominant leg was significantly more often injured. Age and previous groin injury were significant risk factors for sustaining a groin injury. Groin injuries were generally located on the same side as previously reported groin injuries. Adductor-related injuries with no abdominal pain had significantly longer injury times compared to injuries with no adductor and no abdominal pain (RIT 2.28, 95% CI 1.22 to 4.25, p=0.0096). Having both adductor and abdominal pain also increased the injury time significantly when compared to injuries with no adductor and no abdominal pain (RIT=4.56, 95% CI 1.91 to 10.91, p=0.001). CONCLUSION Adductor-related groin injury was the most common clinical presentation of groin injuries in male soccer players and the cause of long injury time, especially when combined with abdominal-related injury.
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Affiliation(s)
- Per Hölmich
- Arthroscopic Center Amager, Sports Orthopaedic Research Center - Copenhagen, Copenhagen University Hospital, Amager-Hvidovre, Copenhagen, Denmark Aspetar Sports Groin Pain Center, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Kristian Thorborg
- Arthroscopic Center Amager, Sports Orthopaedic Research Center - Copenhagen, Copenhagen University Hospital, Amager-Hvidovre, Copenhagen, Denmark
| | - Christian Dehlendorff
- Arthroscopic Center Amager, Sports Orthopaedic Research Center - Copenhagen, Copenhagen University Hospital, Amager-Hvidovre, Copenhagen, Denmark Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Kim Krogsgaard
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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