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Penny HA, Aziz I, Lam C. Mast cell activation and nutritional disorders in patients with hypermobility. Curr Opin Gastroenterol 2024; 40:225-232. [PMID: 38393310 DOI: 10.1097/mog.0000000000001008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
PURPOSE OF REVIEW Individuals with joint hypermobility disorders are increasingly referred to gastroenterology services for support with the investigation and management of gastrointestinal complaints. Individuals can present with a myriad of complex coexisting diagnoses, the inter-relationship of which is unclear. This review discusses the proposed association between hypermobile Ehlers-Danlos syndrome (hEDS) and hypermobility spectrum disorder (HSD) with disorders of mast cell activation and provides an overview of gastrointestinal symptoms and nutritional outcomes in this patient cohort. RECENT FINDINGS It is unclear whether a true association between hEDS/HSD and mast cell activation disorders exists. There is a high prevalence of nonspecific gastrointestinal symptoms in individuals with hEDS/HSD and patients may be at risk of macro-nutrient and micro-nutrient deficiencies, although the current evidence base is limited. SUMMARY We advocate a pragmatic approach to the investigation and management of gastrointestinal symptoms in patients with hEDS/HSD. This centres on excluding organic pathology, discussing the overlap with disorders of gut-brain interactions, trialling evidence-based therapies targeting individual symptoms, and supporting nutritional deficiencies where present via the least invasive approach. Engagement with a broad multidisciplinary team is also important to support the holistic needs of this patient cohort.
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Affiliation(s)
- Hugo A Penny
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals Foundation Trust
- Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Imran Aziz
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals Foundation Trust
- Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Ching Lam
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals Foundation Trust
- Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
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Peebles KC, Jacobs C, Makaroff L, Pacey V. The use and effectiveness of exercise for managing postural orthostatic tachycardia syndrome in young adults with joint hypermobility and related conditions: A scoping review. Auton Neurosci 2024; 252:103156. [PMID: 38401460 DOI: 10.1016/j.autneu.2024.103156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 02/06/2024] [Accepted: 02/10/2024] [Indexed: 02/26/2024]
Abstract
PURPOSE Postural Orthostatic Tachycardia Syndrome (POTS) is a form of dysautonomia. It may occur in isolation, but frequently co-exists in individuals with hypermobile variants of Ehlers-Danlos Syndrome (EDS) and related conditions (chronic fatigue syndrome [CFS] and fibromyalgia). Exercise is recommended for non-pharmacological POTS management but needs to be individualised. This scoping review explores the current literature on use and effectiveness of exercise-based management for POTS, with specific focus on individuals with joint hypermobility and related conditions who experience hypermobility, and/or pain, and/or fatigue. METHODS A systematic search, to January 2023, of Medline, EMBASE, AMED, CINAHL and the Cochrane library was conducted. Studies that reported on adolescents and adults who had been diagnosed with POTS using standard criteria and underwent an exercise-based training intervention were included. RESULTS Following full-text screening, 10 articles were identified (2 randomised control trials, 4 comparative studies and 4 case reports). One comparative study reported a small subset of participants with EDS and one case report included an individual diagnosed with CFS; the remainder investigated a wider POTS population. Overall, 3 months of endurance followed by resistance exercise, graduating from the horizontal-to-upright position reduced POTS symptoms and improved quality-of-life. CONCLUSION The findings highlight a paucity of higher-level studies documenting exercise for POTS management in people with joint hypermobility and related conditions. Results from the wider POTS population demonstrate exercise is safe and effective. Large, well-designed clinical studies exploring exercise for POTS management adapting to meet the complex musculoskeletal and non-musculoskeletal features of symptomatic joint hypermobility are needed.
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Affiliation(s)
- Karen C Peebles
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.
| | - Charl Jacobs
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Logan Makaroff
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Verity Pacey
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
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Isaacson E, Dowlut-McElroy T. Heavy Menstrual Bleeding in Adolescents with Joint Hypermobility Syndrome/Hypermobile-Type Ehlers-Danlos: A Review. Pediatr Ann 2024; 53:e104-e108. [PMID: 38466333 DOI: 10.3928/19382359-20240109-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Heavy menstrual bleeding has a high prevalence and is well documented in adult patients with hypermobile-type Ehlers-Danlos syndrome, but there is limited research surrounding work-up and treatment for the adolescent population. Excessive menstrual blood loss can significantly interfere with emotional and physical quality of life. A provider should acquire a comprehensive medical and menstrual history and focused physical examination, as well as baseline laboratory studies, to determine the presence of anemia or underlying bleeding disorder. Use of a pictorial blood assessment chart may be considered to help quantify the amount of bleeding. Treatment to reduce heavy menstrual flow and referral to specialty care should be initiated swiftly to improve quality of life for this population. [Pediatr Ann. 2024;53(3):e104-e108.].
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Guo Y, Cheng T, Yang Z, Huang Y, Li M, Wang T. A systematic review and meta-analysis of balance training in patients with chronic ankle instability. Syst Rev 2024; 13:64. [PMID: 38347564 PMCID: PMC10860262 DOI: 10.1186/s13643-024-02455-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 01/08/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Chronic ankle instability (CAI) is a common yet serious problem for elder patients. This meta-analysis aimed to evaluate the effects of balance training for CAI, to provide evidence for the clinical treatment, and care of CAI patients. METHODS Two investigators searched PubMed, EMBASE, Science Direct, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Wanfang, and Weipu Databases up to May 20, 2023, for randomized controlled trials (RCTs) on the effects of balance training for CAI. The mean difference (MD) with 95% confidence intervals (95%CIs) was calculated for each outcome with a fixed or random effect model. Review Manager 5.3 software was used for meta-analysis. RESULTS Nine RCTs involving 341 patients were included. Meta-analysis results showed that compared with blank controls, balanced training treatment of CAI could significantly improve the score of CAI [MD = 3.95, 95% CI (3.26, 4.64), P < 0.00001], SEBT-PM [MD = 4.94, 95% CI (1.88, 8.00), P = 0.002], SEBT-PL [MD = 5.19, 95% CI (1.57, 8.81), P = 0.005], and FAAM Sports [MD = 17.74, 95% CI (14.36, 21.11), P < 0.00001]. Compared with strength training, balance training treatment of CAI improved the score of CAIT [MD = 2.36, 95% CI (0.29, 4.44), P = 0.03], FAAM-ADL [MD = 4.06, 95% CI (1.30, 6.83), P = 0.004]. CONCLUSION The analysis outcomes indicate that balance training enhances daily activity capability, motor function, and dynamic balance to different extents. Additionally, when comparing the results of balance training and strength training, no significant difference was observed between the two methods in improving the dynamic stability of CAI patients. However, it is noteworthy that balance training exhibits a more pronounced impact on enhancing functional scale scores.
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Affiliation(s)
- Yiwei Guo
- Department of Rehabilitation, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200092, China
- Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongi University School of Medicine, Shanghai, China
- Department of Physical Therapy, Tongji University School of Medicine, Shanghai, China
| | - Tianyue Cheng
- Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongi University School of Medicine, Shanghai, China
- Department of Physical Therapy, Tongji University School of Medicine, Shanghai, China
- Jiading Town Street Community Health Service Center, Shanghai, China
| | - Zihao Yang
- Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongi University School of Medicine, Shanghai, China
- Department of Physical Therapy, Tongji University School of Medicine, Shanghai, China
- Sanlin Community Health Service Center, Shanghai, China
| | - Yonglei Huang
- Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongi University School of Medicine, Shanghai, China
| | - Ming Li
- Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongi University School of Medicine, Shanghai, China
| | - Taoli Wang
- Department of Rehabilitation, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200092, China.
- Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongi University School of Medicine, Shanghai, China.
- Department of Physical Therapy, Tongji University School of Medicine, Shanghai, China.
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Gottlieb U, Hayek R, Hoffman JR, Springer S. Exercise combined with electrical stimulation for the treatment of chronic ankle instability - A randomized controlled trial. J Electromyogr Kinesiol 2024; 74:102856. [PMID: 38198892 DOI: 10.1016/j.jelekin.2023.102856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 12/03/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024] Open
Abstract
PURPOSE To compare the short, medium, and long-term effects of balance exercises combined with either peroneal neuromuscular electrical stimulation (NMES) or peroneal transcutaneous electrical nerve stimulation (TENS) on dynamic postural control and patient reported outcome measures (PROMs) in patients with chronic ankle instability (CAI). METHODS Thirty-four participants with CAI were randomly assigned to a 12-session home based exercise program combined with NMES (Ex-NMES) or TENS (Ex- TENS). Baseline postural control was tested with the modified Star Excursion Balance Test (mSEBT) and time to stabilization (TTS) after a single-leg drop-jump. The self-reported function was measured using the Cumberland Ankle Instability Tool (CAIT), the Identification of Functional Ankle Instability (IdFAI), and the Sports subscale of the Foot and Ankle Ability Measure (FAAMSport). RESULTS Both groups showed significant improvements in all self-reported outcome measures at the 12-month follow-up. Subjects in the Ex-NMES group had significantly better IdFAI (-4.2 [95% CI -8.1, -0.2]) and FAAMSport (13.7 [95% CI 2.2, 25.2]) scores at 6- and 12-month follow-up, respectively, compared to the Ex-TENS group. Medium to large between-group effect sizes were observed in self-reported functional outcomes and the mSEBT. CONCLUSION The consistent trend of improvement in self-reported functional outcomes when training is combined with NMES compared with training with TENS may indicate a potential benefit that should be further investigated as a treatment for patients with CAI.
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Affiliation(s)
- Uri Gottlieb
- Neuromuscular and Human Performance Laboratory, Department of Physiotherapy, Ariel University, Israel.
| | - Roee Hayek
- Neuromuscular and Human Performance Laboratory, Department of Physiotherapy, Ariel University, Israel
| | - Jay R Hoffman
- Neuromuscular and Human Performance Laboratory, Department of Physiotherapy, Ariel University, Israel
| | - Shmuel Springer
- Neuromuscular and Human Performance Laboratory, Department of Physiotherapy, Ariel University, Israel.
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Estrella E, Frazier PA. Healthcare experiences among adults with hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorder in the United States. Disabil Rehabil 2024; 46:731-740. [PMID: 36772820 DOI: 10.1080/09638288.2023.2176554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/29/2023] [Accepted: 01/31/2023] [Indexed: 02/12/2023]
Abstract
PURPOSE This cross-sectional mixed-method study examined healthcare experiences among individuals in the US with hypermobile Ehlers-Danlos syndrome (hEDS) and hypermobility spectrum disorder (HSD), genetic connective tissue disorders. We hypothesized that many individuals with these conditions would report low satisfaction with healthcare and low health-related quality of life, and that lower healthcare satisfaction would be related to lower health-related quality of life and self-efficacy for symptom management. METHODS Adults living in the US with hEDS or HSD (N= 2125) completed an online survey assessing satisfaction with healthcare, health-related quality of life, and symptom management self-efficacy. Qualitative data also were gathered on desired changes to improve healthcare. RESULTS Participants reported low satisfaction with healthcare and lower health-related quality of life and symptom management self-efficacy than norm groups. Lower satisfaction with healthcare was associated with lower health-related quality of life and lower symptom management self-efficacy, ps <.001. The most common desired change to improve healthcare was more knowledge about hEDS and HSD among healthcare professionals. CONCLUSIONS U.S. adults with joint hypermobility report negative healthcare experiences and poor health-related quality of life. Future research should explore ways to improve the healthcare experiences and quality of care for individuals with hEDS and HSD.Implications for RehabilitationIndividuals with hypermobility spectrum disorder (HSD) and hypermobile Ehlers-Danlos syndrome (hEDS) score worse than the U.S. population on most health-related quality of life domains and symptom management self-efficacy.Individuals with HSD and hEDS report low levels of satisfaction with healthcare compared to norm groups.Participants particularly wanted to see improvements in the level of awareness and education about HSD and hEDS among healthcare professionals, provider attitudes about HSD and hEDS, and healthcare accessibility and convenience.Individuals who were less satisfied with their healthcare reported lower health-related quality of life and lower symptom management self-efficacy, underscoring the importance of improving healthcare experiences.
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Affiliation(s)
- Emma Estrella
- Department of Psychology, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Patricia A Frazier
- Department of Psychology, University of Minnesota Twin Cities, Minneapolis, MN, USA
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Kim KM, Needle AR, Kim JS, An YW, Cruz-Díaz D, Taube W. What interventions can treat arthrogenic muscle inhibition in patients with chronic ankle instability? A systematic review with meta-analysis. Disabil Rehabil 2024; 46:241-256. [PMID: 36650898 DOI: 10.1080/09638288.2022.2161643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 12/18/2022] [Indexed: 01/19/2023]
Abstract
PURPOSE To identify, critically appraise, and synthesize the existing evidence regarding the effects of therapeutic interventions on arthrogenic muscle inhibition (AMI) in patients with chronic ankle instability (CAI). MATERIALS AND METHODS Two reviewers independently performed exhaustive database searches in Web of Science, PubMed, Medline, CINAHL, and SPORTDiscus. RESULTS Nine studies were finally included. Five types of disinhibitory interventions were identified: focal ankle joint cooling (FAJC), manual therapy, fibular reposition taping (FRT), whole-body vibration (WBV), and transcranial direct current stimulation (tDCS). There were moderate effects of FAJC on spinal excitability in ankle muscles (g = 0.55, 95% CI = 0.03-1.08, p = 0.040 for the soleus and g = 0.54, 95% CI = 0.01-1.07, p = 0.046 for the fibularis longus). In contrast, manual therapy, FRT, WBV were not effective. Finally, 4 weeks of tDCS combined with eccentric exercise showed large effects on corticospinal excitability in 2 weeks after the intervention (g = 0.99, 95% CI = 0.14-1.85 for the fibularis longus and g = 1.02, 95% CI = 0.16-1.87 for the tibialis anterior). CONCLUSIONS FAJC and tDCS may be effective in counteracting AMI. However, the current evidence of mainly short-term studies to support the use of disinhibitory interventions is too limited to draw definitive conclusions.
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Affiliation(s)
- Kyung-Min Kim
- Department of Sport Science, Sungkyunkwan University, Suwon-si, Korea
- Department of Kinesiology and Sport Sciences, University of Miami, Coral Gables, FL, USA
| | - Alan R Needle
- Department of Public Health & Exercise Science, Appalachian State University, Boone, NC, USA
- Department of Rehabilitation Sciences, Appalachian State University, Boone, NC, USA
| | - Joo-Sung Kim
- Department of Kinesiology and Sport Sciences, University of Miami, Coral Gables, FL, USA
| | - Yong Woo An
- Department of Health and Human Sciences, Loyola Marymount University, Los Angeles, CA, USA
| | - David Cruz-Díaz
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, Jaén, Spain
| | - Wolfgang Taube
- Department of Neurosciences and Movement Sciences, University of Fribourg, Fribourg, Switzerland
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Wang L, Chen P, Ding Y, Fan S, Wang G, Jia S, Guo Z, Zheng C. Effects of Kinesio taping on lower limb biomechanical characteristics during unexpected jumping in patients with chronic ankle instability. Scand J Med Sci Sports 2024; 34:e14566. [PMID: 38268069 DOI: 10.1111/sms.14566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/06/2023] [Accepted: 01/05/2024] [Indexed: 01/26/2024]
Abstract
PURPOSE The current biomechanical research on the application of Kinesio taping (KT) to patients with chronic ankle instability (CAI) has focused on testing the expected movements. However, unexpected movements are more common in actual sports. Therefore, the present study aimed to investigate the effects of KT on the biomechanical characteristics of the knee and ankle joints during unexpected jumping movements. METHODS Twenty-one patients with unilateral CAI were recruited to capture the biomechanical parameters during unexpected jumping movements under different interventions: no taping (NT), placebo taping (PT), and KT. A one-way repeated measures analysis of variance was used to compare the differences in knee and ankle biomechanical characteristics among patients with CAI between the three intervention conditions. RESULTS At initial contact, the KT group demonstrated a significant decrease in ankle plantarflexion and knee flexion angles compared to the NT group (p < 0.05). At the early landing phase, the KT group had a significant increase in peak ankle dorsiflexion angle, peak ankle eversion angle, peak ankle dorsiflexion moment, and peak ankle eversion moment compared to the NT and PT groups (p < 0.05). Furthermore, the KT group had a significantly reduced peak knee flexion angle, peak knee eversion angle, and peak vertical ground reaction force (p < 0.05) compared to the NT and PT groups. CONCLUSION KT significantly improves the sprain-prone touchdown posture of patients with CAI. And reducing the risk of ankle sprains during the early landing phase by promoting ankle dorsiflexion and eversion angles and moments.
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Affiliation(s)
- Ling Wang
- School of Sports Medicine, Wuhan Sports University, Wuhan, Hubei, China
- Key Laboratory of Sports Engineering of General Administration of Sport of China, Wuhan Sports University, Wuhan, Hubei, China
| | - Peng Chen
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Yue Ding
- Taihe Hospital, Shiyan, Hubei, China
| | - Siyu Fan
- School of Sports Medicine, Wuhan Sports University, Wuhan, Hubei, China
| | - Guanglan Wang
- School of Sports Medicine, Wuhan Sports University, Wuhan, Hubei, China
| | - Shaohui Jia
- School of Sports Medicine, Wuhan Sports University, Wuhan, Hubei, China
- Hubei Provincial Key Laboratory of Sports Training and Monitoring, Wuhan Sports University, Wuhan, Hubei, China
| | - Zhihao Guo
- Key Laboratory of Sports Engineering of General Administration of Sport of China, Wuhan Sports University, Wuhan, Hubei, China
- Engineering Research Center of Sports Health Intelligent Equipment of Hubei Province, Wuhan Sports University, Wuhan, China
| | - Cheng Zheng
- Department of Sports Medicine, Affiliated Hospital, Wuhan Sports University, Wuhan, Hubei, China
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Moroder P, Karpinski K, Akgün D, Danzinger V, Gerhardt C, Patzer T, Tauber M, Wellmann M, Scheibel M, Boileau P, Lambert S, Porcellini G, Audige L. Neuromuscular Electrical Stimulation-Enhanced Physical Therapist Intervention for Functional Posterior Shoulder Instability (Type B1): A Multicenter Randomized Controlled Trial. Phys Ther 2024; 104:pzad145. [PMID: 37870503 PMCID: PMC10824628 DOI: 10.1093/ptj/pzad145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 05/26/2023] [Accepted: 10/18/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVE Functional posterior shoulder instability (FPSI) (type B1) is a severe type of instability, mainly in teenagers and young adults, that leads to loss of function, pain, and stigmatization among peers. An experimental nonsurgical treatment protocol based on neuromuscular electrical stimulation (NMES) showed very promising early results in the treatment of FPSI. The hypothesis of this study was that NMES-enhanced physical therapy leads to better outcomes than physical therapy alone as the current gold standard of treatment in patients with FPSI. METHODS In this multicenter randomized controlled trial, patients with FPSI were randomly allocated in a 1:1 ratio to either 6 weeks of physical therapy or 6 weeks of physical therapy with simultaneous motion-triggered NMES. Baseline scores as well as outcome scores at 6 weeks, 3 months, 6 months, and 12 months after the intervention were obtained. The predefined primary outcome of this trial was the Western Ontario Shoulder Instability Index (WOSI) at the 3-month time point. RESULTS Forty-nine patients were randomized and eligible for the trial. The group that received physical therapy with simultaneous motion-triggered NMES showed a significantly better main outcome measurement in terms of the 3-month WOSI score (64% [SD = 16%] vs 51% [SD = 24%]). Two-thirds of the patients from the physical therapist group crossed over to the group that received physical therapy with simultaneous motion-triggered NMES due to dissatisfaction after the 3-month follow-up and showed a significant increase in their WOSI score from 49% [SD = 8%] to 67% [SD = 24%]. The frequency of instability episodes showed a significant improvement in the group that received physical therapy with simultaneous motion-triggered NMES at the 3-month follow-up and beyond, while in the physical therapist group, no significant difference was observed. CONCLUSION The current study shows that NMES-enhanced physical therapy led to statistically significant and clinically relevant improvement in outcomes in the treatment of FPSI compared to conventional physical therapy alone-from which even patients with prior unsatisfactory results after conventional physical therapy can benefit. IMPACT Based on the results of this study, NMES-enhanced physical therapy is an effective new treatment option for FPSI, a severe type of shoulder instability. NMES-enhanced physical therapy should be preferred over conventional physical therapy for the treatment of patients with FPSI.
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Affiliation(s)
- Philipp Moroder
- Department of Shoulder and Elbow Surgery, Schulthess Clinic, Zurich, Switzerland
| | - Katrin Karpinski
- Department for Shoulder and Elbow Surgery, Charité - Centrum für Muskuloskeletale Chirurgie, Berlin, Germany
| | - Doruk Akgün
- Department for Shoulder and Elbow Surgery, Charité - Centrum für Muskuloskeletale Chirurgie, Berlin, Germany
| | - Victor Danzinger
- Department for Shoulder and Elbow Surgery, Charité - Centrum für Muskuloskeletale Chirurgie, Berlin, Germany
| | - Christian Gerhardt
- Department of Traumatology, Hand Surgery and Sports Medicine, ViDia Clinics Karlsruhe, Karlsruhe, Germany
| | - Thilo Patzer
- Department of Orthopaedics and Trauma Surgery, Schoenklinik Düsseldorf, Düsseldorf, Germany
| | - Mark Tauber
- Deutsches Schulterzentrum, ATOS Klinik, Munich, Germany
| | | | - Markus Scheibel
- Department of Shoulder and Elbow Surgery, Schulthess Clinic, Zurich, Switzerland
- Department for Shoulder and Elbow Surgery, Charité - Centrum für Muskuloskeletale Chirurgie, Berlin, Germany
| | - Pascal Boileau
- Institute for Sports & Reconstructive Surgery, Groupe Kantys, Nice, France
| | - Simon Lambert
- Department of Trauma and Orthopedics, University College London Hospital NHS Foundation Trust, London, UK
| | - Giuseppe Porcellini
- Department of Orthopedics and Traumatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Laurent Audige
- Department of Shoulder and Elbow Surgery, Schulthess Clinic, Zurich, Switzerland
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Moisan G, Chicoine D, McBride S, Farahpour N, Isabelle PL, Dagenais C, Griffiths I. Supination resistance variations in foot and ankle musculoskeletal disorders: implications for diagnosis and customised interventions with wedged insoles. J Foot Ankle Res 2023; 16:91. [PMID: 38129924 PMCID: PMC10740238 DOI: 10.1186/s13047-023-00681-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/03/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Supination resistance is a clinical outcome that estimates the amount of external force required to supinate the foot. A greater supination resistance may indicate greater loads on structures responsible for generating internal supination moments across the subtalar joint during static and dynamic tasks. As such, greater supination resistance may be an expected finding in medial foot and ankle musculoskeletal disorders, such as plantar fasciopathy (PF) and posterior tibial tendon dysfunction (PTTD), whereas reduced supination resistance may be present in lateral ankle disorders, such as chronic ankle instability (CAI). However, no studies have yet investigated the changes in supination resistance across these foot and ankle musculoskeletal disorders. This study aimed to quantify supination resistance in individuals with PF, PTTD and CAI compared to healthy controls. Additionally, this study aimed to explore the changes in supination resistance following the simulation of varus and valgus wedges, which are commonly used interventions for these disorders. METHODS Fourteen participants with PF, fourteen with PTTD, fourteen with CAI and fourteen healthy controls were recruited. Supination resistance was quantified on a level surface and on a 10-degree inclined surface with varus and valgus positions. RESULTS Supination resistance was lower for the injured foot for CAI (p < 0.001) and greater for PTTD (p < 0.001) compared to the healthy foot. There was no significant between-foot difference observed for PF (p = 0.275) and controls (p = 0.970). In the injured foot, CAI exhibited lower supination resistance compared to controls (p < 0.001), PF (p = 0.012) and PTTD (p = 0.014). Regardless of the groups, supination resistance increased when tested on a surface with valgus inclination (p < 0.001) and decreased when tested on a surface with varus inclination (p < 0.001). CONCLUSIONS Varus and valgus inclinations to the surface were effective in modifying supination resistance in PTTD and CAI, respectively. Supination resistance seemed unchanged in PF, and thus inclining the standing surface leads to greater between-feet asymmetries. This study also highlights the potential of wedged insoles as a mean to customise treatments and modify tissue stresses in these disorders. The findings contribute to the understanding of foot and ankle biomechanics and may aid in the development of more effective management and rehabilitation strategies.
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Affiliation(s)
- Gabriel Moisan
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivieres, Canada
- Groupe de recherche sur les affections neuro-musculo-squelettiques (GRAN), Université du Québec à Trois-Rivières, Trois-Rivieres, Canada
| | - Dominic Chicoine
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivieres, Canada
| | - Sean McBride
- Department of Physical Therapy, University of Findlay, Findlay, OH, USA
| | - Nader Farahpour
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivieres, Canada
- Department of Sport Biomechanics, Faculty of Sport Sciences, Bu Ali Sina University, Hamedan, Iran
| | - Pier-Luc Isabelle
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivieres, Canada
| | - Camille Dagenais
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivieres, Canada
| | - Ian Griffiths
- Sports and Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, London, UK.
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11
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Donovan L, Torp DM, Thomas AC. Within-session and between-session effects of auditory biofeedback training on center of pressure location during gait in patients with chronic ankle instability. Phys Ther Sport 2023; 64:156-162. [PMID: 37156655 DOI: 10.1016/j.ptsp.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVES To establish preliminary gait training dosage parameters for patients with chronic ankle instability (CAI) by determining the within-session and between-session effects of auditory biofeedback training on center of pressure (COP) location during gait. DESIGN Observational Longitudinal. SETTING Laboratory. PARTICIPANTS 19 participants with CAI, 8 participants who did not receive auditory biofeedback (NoFeedback group) and 11 participants who did receive auditory biofeedback (AuditoryFeedback group) over an 8-session 2-week intervention. MAIN OUTCOME MEASURES COP location was measured at the start and at each 5-min interval during treadmill walking across all eight 30-min training sessions. RESULTS The AuditoryFeedback group had significant within-session lateral-to-medial shifts in COP location during only session-1 at the 15-min (45% of stance; peak mean difference = 4.6 mm), 20-min (35% and 45%; 4.2 mm), and 30-min time intervals (35% and 45%; 4.1 mm). Furthermore, the AuditoryFeedback group had significant between-session lateral-to-medial shifts in COP location at session-5 (35-55% of stance; 4.2 mm), session-7 (35%-95%; 6.7 mm), and session-8 (35%-95%; 7.7 mm). The NoFeedback group had no significant changes in COP location within-sessions or between-sessions. CONCLUSIONS Participants with CAI who received auditory biofeedback during gait needed an average of 15-min during session-1 to meaningfully shift their COP location medially and 4-sessions before retaining the adapted gait pattern.
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Affiliation(s)
- Luke Donovan
- University of North Carolina at Charlotte, United States.
| | | | - Abbey C Thomas
- University of North Carolina at Charlotte, United States
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12
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Docampo E, Lehane F, Ribbens C. [The Ehlers Danlos syndrome : a rare disease although commonly suspected]. Rev Med Liege 2023; 78:626-633. [PMID: 37955292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
The Ehlers Danlos syndromes (EDS) are a heterogenous group of inherited connective tissue disorders characterized by generalized joint hypermobility and instability, tissue fragility and multiple functional disorders. The EDS hypermobility type (hEDS) is the most common but the mildest subtype of EDS and is defined by joint involvement. hSED diagnosis is based on clinical criteria because no genetic factors nor molecular basis have yet been identified. Since chronic pain constitutes one of hESD main symptoms, the diagnosis is frequently suspected although the syndrome is rare, with a prevalence estimated to be 1/10.000. An expert clinical evaluation is therefore necessary in order to establish an accurate diagnosis. This allows the implementation of physical therapy which is the only treatment that has proven efficacious in reducing joint instability, generalized pain and secondary osteoarthritis.
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Affiliation(s)
- Elisa Docampo
- Service de Rhumatologie, CHU Liège, Belgique
- Service de Génétique humaine, CHU Liège, Belgique
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13
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Fakontis C, Iakovidis P, Kasimis K, Lytras D, Koutras G, Fetlis A, Algiounidis I. Efficacy of resistance training with elastic bands compared to proprioceptive training on balance and self-report measures in patients with chronic ankle instability: A systematic review and meta-analysis. Phys Ther Sport 2023; 64:74-84. [PMID: 37801793 DOI: 10.1016/j.ptsp.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Proprioceptive training and resistance training are physiotherapy treatment methods for Chronic Ankle Instability (CAI). OBJECTIVE To compare the efficacy of proprioceptive training to resistance training with elastic bands for treating CAI as measured by the Star Excursion Balance Test (SEBT), the Foot and Ankle Ability Measure (FAAM), and the Cumberland Ankle Instability Tool (CAIT). METHOD Our systematic study and meta-analysis was based on the PICOS and PRISMA protocols. The PubMed, PEDro, and ScienceDirect databases were searched for randomized clinical trials on proprioceptive and resistance training. Risk of bias was assessed according to Cochrane guidelines and quality of evidence was reported using the Grading of Recommendations Assessment, Development, and Evaluation approach (GRADE). RESULTS Five studies involving 259 patients were included in the review. According to the findings of the meta-analysis, proprioceptive training was similarly effective with resistance training in SEBT and FAAM measures. Compared with resistance exercise, proprioceptive training demonstrated some benefits in CAIT scores (weighted mean difference [WMD] = -2.21, 95% CI = -4.05-0.36), but these intervention results were not clinically significant (MDC, MCID score >3 points). CONCLUSION Low-quality evidence from studies showed that neither of the interventions was superior on the SEBT or the FAAM scores in individuals with CAI because no clinically significant differences were found. More high-quality studies comparing the two interventions are needed to draw firm conclusions.
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Affiliation(s)
- Christos Fakontis
- Laboratory of Biomechanics & Ergonomics, Department of Physiotherapy, Faculty of Health Sciences, International Hellenic University, Alexander Campus P.O. Box 141, 57 400, Sindos, Thessaloniki, Greece
| | - Paris Iakovidis
- Laboratory of Biomechanics & Ergonomics, Department of Physiotherapy, Faculty of Health Sciences, International Hellenic University, Alexander Campus P.O. Box 141, 57 400, Sindos, Thessaloniki, Greece
| | - Konstantinos Kasimis
- Laboratory of Biomechanics & Ergonomics, Department of Physiotherapy, Faculty of Health Sciences, International Hellenic University, Alexander Campus P.O. Box 141, 57 400, Sindos, Thessaloniki, Greece
| | - Dimitrios Lytras
- Laboratory of Biomechanics & Ergonomics, Department of Physiotherapy, Faculty of Health Sciences, International Hellenic University, Alexander Campus P.O. Box 141, 57 400, Sindos, Thessaloniki, Greece.
| | - Georgios Koutras
- Laboratory of Biomechanics & Ergonomics, Department of Physiotherapy, Faculty of Health Sciences, International Hellenic University, Alexander Campus P.O. Box 141, 57 400, Sindos, Thessaloniki, Greece
| | - Antonis Fetlis
- Laboratory of Biomechanics & Ergonomics, Department of Physiotherapy, Faculty of Health Sciences, International Hellenic University, Alexander Campus P.O. Box 141, 57 400, Sindos, Thessaloniki, Greece
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14
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Wenning M, Schmal H. Chronic Ankle Instability - Mechanical vs. Functional. Z Orthop Unfall 2023; 161:552-562. [PMID: 35158394 DOI: 10.1055/a-1696-2503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Chronic ankle instability arises from three interacting contributing factors: mechanical ankle instability, functional ankle instability, and perceived ankle instability. To decide on the most appropriate individual recommendation for therapeutic options, it is necessary to assess which of the two main aetiologies - functional vs. mechanical - is dominant in causing the perceived impairment. It is essential to perform a thorough analysis and diagnosis, even though quantifying mechanical ankle instability is still a challenge in the clinical approach to this common pathology. When diagnosing mechanical instability, the most established procedure is physical examination, although this unfortunately does not allow the deficit to be quantified. Additional options include stress-ultrasound, 3D stress-MRI (3SAM), ankle arthrometry, marker-based 3D motion analysis, and diagnostic ankle arthroscopy. Of these the latter is considered the gold standard, even though it is an invasive procedure, it may not be performed for diagnostic reasons only, and it also does not allow the mechanical instability to be quantified. For diagnosing functional instability there are non-instrumented tests such as the Star Excursion Balance Test or Y-Balance Test, posturography/stabilometry, and gait and running analysis, possibly combined with EMG acquisition and isokinetic strength testing.To date, the standard of care is conservative management of ankle instability, and the therapy should include sensorimotor training, strength training of the periarticular muscles, balance training, and gait and running exercises on different surfaces. However, it is increasingly clear that a certain degree of mechanical instability cannot be compensated for by functional training. Thus, it is the goal of differential diagnostics to identify those patients and guide them to mechanical therapy, including ankle bracing, taping, and surgical ligament reconstruction.
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Affiliation(s)
- Markus Wenning
- Department of Orthopedic and Trauma Surgery, Albert-Ludwigs-Universität Freiburg Medizinische Fakultät, Freiburg, Deutschland
| | - Hagen Schmal
- Department of Orthopedic and Trauma Surgery, Albert-Ludwigs-Universitat Freiburg Medizinische Fakultat, Freiburg, Deutschland
- Department of Orthopedic Surgery, Odense University Hospital Department of Orthopaedic Surgery, Odense, Denmark
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15
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Luan L, Zhu M, Adams R, Witchalls J, Pranata A, Han J. Effects of acupuncture or similar needling therapy on pain, proprioception, balance, and self-reported function in individuals with chronic ankle instability: A systematic review and meta-analysis. Complement Ther Med 2023; 77:102983. [PMID: 37666474 DOI: 10.1016/j.ctim.2023.102983] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 09/06/2023] Open
Abstract
OBJECTIVE Acupuncture or similar needling therapy has long been used to improve well-being, but its effectiveness in management of chronic ankle instability (CAI) is unclear. To investigate the efficacy of acupuncture or similar needling therapy on pain, proprioception, balance, and self-reported function in individuals with CAI. METHODS Nine databases (PubMed, Embase, Cochrane Library, Web of Science, EBSCO, PEDro, CNKI, WanFang, and CQVIP) were systematically searched from inception to April 2023. This study included randomized controlled trials involving acupuncture or similar needling therapy as an intervention for individuals with CAI. Data were extracted independently by two assessors using a standardized form. Literature quality and risk bias were assessed by using the PEDro scale. RESULTS Twelve trials (n = 571) were found, of which the final meta-analysis was conducted with eight. Different studies employ varying treatments, including specific needle types, techniques, and therapeutic frameworks. Compared to control without acupuncture or similar needling therapy, acupuncture or similar needling intervention resulted in improved pain (WMD 1.33, 95 % CI 0.14-2.52, I²=90 %, p = 0.03), proprioception (active joint position sense, WMD 1.71, 95 % CI 0.95-2.48, I²=0 %, p < 0.0001), balance (SMD 0.54, 95 % CI 0.03-1.04, I²=46 %, p = 0.04), and self-reported function (Cumberland Ankle Instability Tool (WMD 2.92, 95 % CI 0.94-4.90, I²=78 %, p = 0.004); American Orthopedic Foot and Ankle Society (WMD 9.36, 95 % CI 6.57-12.15, I²=0 %, p < 0.001); Foot and Ankle Ability Measure: activities of daily living (WMD 5.09, 95 % CI 1.74-8.44, I²=0 %, p = 0.003)) for individuals with CAI. CONCLUSIONS The available evidence suggests that acupuncture or similar needling therapy may improve pain, proprioception, balance, and self-reported function in individuals with CAI, but more trials are needed to verify these findings. Furthermore, various needles and techniques using in different studies have resulted in methodologic limitations that should be addressed in the future.
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Affiliation(s)
- Lijiang Luan
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Mengda Zhu
- Department of Physiotherapy, Monash University, VIC, Australia
| | - Roger Adams
- School of Physiotherapy, The University of Sydney, NSW, Australia; Research Institute for Sport and Exercise, University of Canberra, ACT, Australia
| | - Jeremy Witchalls
- Research Institute for Sport and Exercise, University of Canberra, ACT, Australia
| | - Adrian Pranata
- Department of Nursing and Allied Health, School of Health Sciences, Swinburne University of Technology, VIC, Australia
| | - Jia Han
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China; College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China; Research Institute for Sport and Exercise, University of Canberra, ACT, Australia; Department of Nursing and Allied Health, School of Health Sciences, Swinburne University of Technology, VIC, Australia.
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16
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Gobbell W, Edwards CM, Engel SR, Coyner KJ. Atraumatic Sternoclavicular Joint Instability: Prevalence, Etiology, and Management. Clin Sports Med 2023; 42:723-737. [PMID: 37716734 DOI: 10.1016/j.csm.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Sternoclavicular joint instability is a rare complaint in the orthopedic clinic, but patients can experience chronic pain and functional impacts. Causes of instability may be posttraumatic, infectious, autoimmune, degenerative, or secondary to generalized laxity. Conservative treatment is the initial approach to management and involves activity modification, physical therapy, oral nonsteroidal anti-inflammatory drugs, and corticosteroid injections. Surgery is indicated when conservative treatment does not manage symptoms. Figure-of-eight reconstruction techniques provide greatest biomechanical strength but are associated with risk of neurovascular injury. Other reconstruction methods have been shown to mitigate these risks with favorable short-term outcomes.
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Affiliation(s)
- Wade Gobbell
- Department of Orthopedic Surgery, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA
| | - Christopher M Edwards
- Department of Orthopedic Surgery, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA
| | - Samuel R Engel
- Department of Orthopedic Surgery, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA
| | - Katherine J Coyner
- Department of Orthopedic Surgery, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA.
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17
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Guedry SE, Langley BO, Schaefer K, Hanes DA. Patient experience of chronic illness care and complementary integrative health use: a cross-sectional study of patients with hypermobility spectrum disorders (HSD) and Ehlers-Danlos syndromes (EDS). Disabil Rehabil 2023; 45:3549-3559. [PMID: 36222285 DOI: 10.1080/09638288.2022.2131003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 09/25/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE Hypermobility spectrum disorders (HSD) and Ehlers-Danlos syndromes (EDS) are frequently underdiagnosed, contributing to patient dissatisfaction in the healthcare system. This study evaluated the health service utilization, care, and subjective experiences of living with chronic illness among adults with HSD and EDS in the United States and Canada. METHODS This was an anonymous, web-based, cross-sectional healthcare survey. The survey obtained basic demographic information, the Patient Assessment of Chronic Illness Care (PACIC+), as well as responses to questions on the use of healthcare and integrative medicine. RESULTS A total of 353 surveys were received. The most common complementary therapies used were physical therapy (82%), massage (68%), yoga (58%), chiropractic (48%), and meditation (43%). Mean (SD) summary PACIC and PACIC 5 As scores were 2.16 (0.77) and 2.25 (0.83), respectively. Across all PACIC domains, mean scores of individuals whose typical doctor visit was 30 min or at least an hour were significantly higher than those of individuals who indicated typical visits of 15 min (all p < 0.0001 by one-way ANOVA). There was widespread agreement on the importance of patient-provider relationship and trust, physicians' understanding of the individual's complete medical history, and prioritization of physical and emotional safety (>95% agree or strongly agree to each). CONCLUSION Individuals with HSD or EDS report low satisfaction with chronic illness care and commonly seek out complementary and self-administered therapies, likely in an attempt to manage symptoms. Respondents reported a desire for greater time and attention from physicians. Results from this study could educate the healthcare community to improve support mechanisms for HSD and EDS populations.IMPLICATIONS FOR REHABILITATIONPatients with hypermobility spectrum disorders (HSD) or Ehlers-Danlos syndromes (EDS) express a desire for patient-centered care and peer support from other individuals with HSD or EDS.Individuals with HSD or EDS have typically seen multiple doctors for their condition and their satisfaction with chronic care, as measured by the Patient Assessment of Chronic Illness Care (PACIC+), is low.The use of various complementary and integrative health treatments, as well as specialized diets, is common in this population, and might be beneficial for symptom management.Healthcare delivery for HSD and EDS may require a multidisciplinary healthcare team, as complementary and self-care modalities are typically used in addition to physical therapy, pain medication, and other conventional care.
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Affiliation(s)
- Sara E Guedry
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
| | - Blake O Langley
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
| | | | - Douglas A Hanes
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
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18
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Shadegani R, Khanmohammadi R, Olyaei G. Comparison of effects of Mulligan taping and Kinesio taping on ankle neuromuscular control in response to a sudden inversion perturbation in individuals with chronic ankle instability. Phys Ther Sport 2023; 63:58-66. [PMID: 37506655 DOI: 10.1016/j.ptsp.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/24/2023] [Accepted: 07/24/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVES This study was aimed to compare the effects of Mulligan taping (MT) with Kinesio taping (KT) and the un-taped ankle on neuromuscular control during a sudden inversion perturbation in individuals with chronic ankle instability (CAI). DESIGN Randomized, single blind cross-over. SETTING Biomechanics lab. PARTICIPANTS 16 individuals with chronic ankle instability. MAIN OUTCOME MEASURES The outcome measures were the onset time and magnitude of short (SLR) and medium latency response (MLR) for peroneus brevis (PB), peroneus longus (PL), tibialis anterior (TA), and soleus (SOL) muscles and the TA/P and SOL/TA antagonist co-activation. RESULTS In the groups of KT and MT, the onset time was significantly decreased at post-taping compared to pre-taping, such that for the onset time of PB MLR, the groups of KT and MT had an earlier onset time than the un-taped group. For the magnitude of TA SLR and PB MLR, groups exhibited different behaviors. In the KT group, the magnitude was significantly increased post-taping, however, in the MT group, it was decreased. Regarding the TA/P and SOL/TA co-activation, the groups of KT and MT showed significant changes post-taping. CONCLUSION This study suggests that KT and MT significantly affect neuromuscular control in response to a sudden perturbation in individuals with CAI, although the behavior of KT and MT appears to be somewhat different from each other.
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Affiliation(s)
- Roghaye Shadegani
- Physical Therapy Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Roya Khanmohammadi
- Physical Therapy Department, Tehran University of Medical Sciences, Tehran, Iran.
| | - Gholamreza Olyaei
- Physical Therapy Department, Tehran University of Medical Sciences, Tehran, Iran
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19
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Barroso Rosa S, Grant A, McEwen P. Patient-reported outcome measures for patellofemoral disorders: a systematic review. Arch Orthop Trauma Surg 2023; 143:3919-3927. [PMID: 36260119 DOI: 10.1007/s00402-022-04663-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 10/10/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Patellofemoral conditions include, but are not limited to, anterior knee pain syndrome and patellar instability. Patients and surgeons may find it difficult to identify the specific source of the symptoms and clinical scenarios, so patient-reported outcome measures (PROMs) may be a useful diagnostic aid. There are a number of available PROMs for patellofemoral conditions, which are often used indistinctly. This systematic review explores the available PROMs for patellofemoral conditions, their use and methodological quality. METHODS A systematic review was conducted, searching for scientific articles relating to PROMs in patellofemoral conditions, from inception to July 2022. Scoring systems including physician-directed or imagining assessment were not included. All types of conditions in the patellofemoral joint were considered. RESULTS Twenty-two relevant PROMs were encountered, divided into four categories: eight PROMs for anterior knee pain syndrome, five for patellar instability, four for other patellofemoral conditions and five for non-specific PROMs. CONCLUSIONS While many PROMs have been found used in patellofemoral research, only few of them have showed sufficient methodological quality. In addition, PROMs employed in PF literature are often inaccurately chosen. This review may help authors to better understand the characteristics of specific patellofemoral PROMs, in order to select the more appropriate and recommended ones. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Sergio Barroso Rosa
- Departamento de Ciencias Médicas y Quirúrgicas, Universidad de las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Canary Islands, Spain.
- The Orthopaedic Research Institute of Queensland, Townsville, QLD, Australia.
| | - Andrea Grant
- The Orthopaedic Research Institute of Queensland, Townsville, QLD, Australia
| | - Peter McEwen
- The Orthopaedic Research Institute of Queensland, Townsville, QLD, Australia
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20
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Abstract
The importance of distal radioulnar joint problems associated with distal radial fractures is recognized increasingly. But there remains considerable disagreement about how to treat these problems both acutely and chronically. This review outlines the knowledge about the natural history of ulnar-sided wrist problems with distal radials fractures. In particular, the recent increased understanding of the almost inevitable joint instability associated with distal radial fractures is highlighted, including the unreliability of clinical assessment and hence why there has been so much misunderstanding. Provided there is reasonable bony alignment, most ulnar-sided wrist problems can be treated non-operatively initially (typically for over a year) in anticipation of substantial improvement with time. The exception is early marked subluxation of the distal radioulnar joint (DRUJ) blocking forearm rotation, which needs urgent (typically closed) reduction.
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21
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Jeong HJ, Engel JM, Wilwert O, Muriello M, Basel D, Slavens BA. Pain Characteristics and Symptom Management in Children with Hypermobile Ehlers-Danlos Syndrome and Hypermobility Spectrum Disorder. Phys Occup Ther Pediatr 2023; 43:630-643. [PMID: 36647261 DOI: 10.1080/01942638.2022.2163601] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 12/04/2022] [Accepted: 12/25/2022] [Indexed: 01/18/2023]
Abstract
AIMS This study aims to investigate pediatric hypermobile Ehlers-Danlos syndrome (hEDS) and hypermobility spectrum disorder (HSD) pain features and management strategies. METHODS This is a mixed-methods, cross-sectional study design using patient-reported outcomes in 21 children diagnosed with hEDS/HSD. Children who reported bothersome pain were interviewed for pain features. The Child Activity Limitation Interview-21, the Brief Pain Inventory pain interference items, and the Functional Disability Inventory were used to investigate pain interference. To evaluate psychological symptoms regarding pain, the pediatric version of the Survey of Pain Attitude and the child version of the Pain Catastrophizing Scale were used. RESULTS Nineteen children had bothersome pain and of them, eight children reported constant pain. The most frequently reported regions of pain were at the ankle (mild pain) and the back (moderate-to-severe pain). Children reported mild-to-moderate pain interference and believed medications were beneficial for their pain management. Nineteen children sought treatment and of those 16 children used to exercise and acetaminophen and 13 visited physicians as a means of treatment. Parents were overall satisfied with their child's treatment (13 out of 19). CONCLUSIONS Sufficient awareness of pain-related symptoms and understanding of the treatment strategies in early childhood is needed to prevent deleterious consequences in adulthood.
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Affiliation(s)
- Hyo-Jung Jeong
- Orthopaedic and Rehabilitation Engineering Center, Marquette University, Milwaukee, Wisconsin, USA
- Department of Rehabilitation Sciences & Technology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Joyce M Engel
- Department of Rehabilitation Sciences & Technology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Olivia Wilwert
- Department of Rehabilitation Sciences & Technology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Michael Muriello
- Division of Genetics, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Donald Basel
- Division of Genetics, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Brooke A Slavens
- Department of Rehabilitation Sciences & Technology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
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22
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Wang B, Zhang X, Zhu F, Zhu W, Wang X, Jia F, Chen W, Zhang M. A randomized controlled trial comparing rehabilitation with isokinetic exercises and Thera-Band strength training in patients with functional ankle instability. PLoS One 2022; 17:e0278284. [PMID: 36454876 PMCID: PMC9714719 DOI: 10.1371/journal.pone.0278284] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 10/06/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Although muscle strength training is a prevalent treatment for patients with functional ankle instability (FAI), previous investigations on the efficacy have yielded conflicting results. OBJECTIVE This study aims to compare the efficacy of 6-week isokinetic strength training and Thera-Band strength training on improving ankle strength, dynamic balance ability, and function in individuals with FAI. METHODS Fifty-two FAI patients were randomized into two treatment groups: an isokinetic strength training (IST, n = 26) group and a Thera-Band resistance training (TBT, n = 26) group. The IST group engaged in isokinetic concentric strength training with inversion, eversion, dorsiflexion, and plantar flexion, whereas the TBT group engaged in progressive resistance training with Thera-Band three times per week for six weeks. Before and after the training, an isokinetic concentric strength test of the involved ankle joint, Star Excursion Balance Test (SEBT), and Cumberland Ankle Instability Tool (CAIT) function assessment were performed. RESULTS After six weeks of intervention, the strength of inversion and eversion was significantly improved in both the IST and TBT groups (p < 0.05), with the IST group exhibiting a significant (p < 0.05) improvement when compared to the TBT group. The SEBT and CAIT results were significantly (p < 0.05) improved in the IST group compared to the TBT group. CONCLUSIONS The six-week of isokinetic strength training is more effective than the Thera-Band progressive resistance training in improving the physical function of FAI patients. CLINICAL TRIAL REGISTRATION NUMBER This randomized controlled clinical trial has been registered in the China Clinical Trial Registry (ChiCTR2100044444) https://www.google.com/search?client=firefox-b-d&q=ChiCTR2100044444.
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Affiliation(s)
- Bin Wang
- The Affiliated Xuzhou Rehabilitation Hospital of Xuzhou Medical University, Xuzhou Rehabilitation Hospital, Xuzhou, China
- Department of Rehabilitation Medicine, Xuzhou Central Hospital, The Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, China
| | - Xi Zhang
- Beijing Sport University, Beijing, China
| | - Feilong Zhu
- The Affiliated Xuzhou Rehabilitation Hospital of Xuzhou Medical University, Xuzhou Rehabilitation Hospital, Xuzhou, China
- Department of Rehabilitation Medicine, Xuzhou Central Hospital, The Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, China
- College of Physical Education and Sports, Beijing Normal University, Beijing, China
| | - Weiwei Zhu
- The Affiliated Xuzhou Rehabilitation Hospital of Xuzhou Medical University, Xuzhou Rehabilitation Hospital, Xuzhou, China
- Department of Rehabilitation Medicine, Xuzhou Central Hospital, The Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, China
| | - Xinyu Wang
- The Affiliated Xuzhou Rehabilitation Hospital of Xuzhou Medical University, Xuzhou Rehabilitation Hospital, Xuzhou, China
- Department of Rehabilitation Medicine, Xuzhou Central Hospital, The Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, China
| | - Fan Jia
- The Affiliated Xuzhou Rehabilitation Hospital of Xuzhou Medical University, Xuzhou Rehabilitation Hospital, Xuzhou, China
- Department of Rehabilitation Medicine, Xuzhou Central Hospital, The Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, China
| | - Wei Chen
- The Affiliated Xuzhou Rehabilitation Hospital of Xuzhou Medical University, Xuzhou Rehabilitation Hospital, Xuzhou, China
- Department of Rehabilitation Medicine, Xuzhou Central Hospital, The Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, China
- * E-mail: (WC); (MZ)
| | - Ming Zhang
- The Affiliated Xuzhou Rehabilitation Hospital of Xuzhou Medical University, Xuzhou Rehabilitation Hospital, Xuzhou, China
- Department of Rehabilitation Medicine, Xuzhou Central Hospital, The Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, China
- * E-mail: (WC); (MZ)
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Park SH, Oh YJ, Seo JH, Lee MM. Effect of stabilization exercise combined with respiratory resistance and whole body vibration on patients with lumbar instability: A randomized controlled trial. Medicine (Baltimore) 2022; 101:e31843. [PMID: 36401488 PMCID: PMC9678632 DOI: 10.1097/md.0000000000031843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Lumbar stability exercise promotes deep muscle functions, and it is an effective intervention method for increasing proprioceptive sensation. This study aims to explore and compare the effects of lumbar stability exercise with respiratory resistance and whole body vibration on patients with lumbar instability. METHODS This study is a 3-group randomized control trial. Through screening tests, 48 patients with lumbar instability were selected and randomly assigned to SE group (n = 16), stabilization exercise program using respiratory resistance (SER) group (n = 16), and stabilization exercise program using respiratory resistance and whole body vibration (SERW) group (n = 16). In order to compare the effects depending on the intervention methods, quadruple visual analogue scale (QVAS), Functional Ability Roland-Morris low back pain and disability questionnaire ([RMDQ], center of pressure path length, velocity, and area), Korean version of fear-avoidance beliefs questionnaire, and Pulmonary Function were used for measurement. RESULTS All of the groups showed significant improvements in QVAS, RMDQ, Korean version of fear-avoidance beliefs questionnaire, and balance abilities before and after the interventions. The SER group and SERW group showed a significant difference in QVAS and RMDQ than the SE group (P < .05). In addition, balance ability showed a significant difference in SERW group (P < .05), where only the SER group showed a significant difference in pulmonary function indexes including forced vital capacity, forced expiratory volume in 1 second, maximum inspiratory pressure, and maximum expiratory pressure (P < .05). CONCLUSION Stabilization exercise program using respiratory resistance and whole-body vibration administered according to the purpose of intervention methods may be effective exercise programs for people with lumbar instability.
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Affiliation(s)
- Sam-Ho Park
- Department of Rehabilitation and Assistive Technology, National Rehabilitation Research Institute, National Rehabilitation Center, Republic of Korea
| | - Youn-Jung Oh
- Department of Physical Therapy, Graduate School, Daejeon University, Republic of Korea
| | - Jin-Hyuk Seo
- Department of Physical Therapy, Graduate School, Daejeon University, Republic of Korea
| | - Myung-Mo Lee
- Department of Physical Therapy, Daejeon University, Republic of Korea
- * Correspondence: Myung-Mo Lee, Department of Physical Therapy, Daejeon University, 62, Daehak-ro, Dong-gu, Daejeon city 34520, Republic of Korea (e-mail: )
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Lv S, Chen Y, Liu M, Qin L, Liu Z, Liu W, Cui M, Zhang X, Yan H, Ning F, Zhang H, Xu Y. Progress of Proprioceptive Training in the Treatment of Traumatic Shoulder Instability. Comput Math Methods Med 2022; 2022:1429375. [PMID: 35495889 PMCID: PMC9054430 DOI: 10.1155/2022/1429375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/04/2022] [Accepted: 04/11/2022] [Indexed: 12/03/2022]
Abstract
In individuals with traumatic shoulder instability, there is a loss of proprioception. This paper reviews the academic literature on shoulder instability and functional impairment in recent years and combines it with clinical practice experience to summarize several techniques of proprioceptive regeneration following traumatic shoulder instability. Many issues were discovered, including a lack of literature on the role of sensory input, a lack of basic proprioceptive research, insufficient sample size in proprioceptive research, and a lack of systematic and standardized standards for the evaluation and training of proprioception in clinical practice, among others. In the future, we will need to better understand the mechanism of proprioception and conduct research on various groups of people, with a focus on discussing the optimal intensity, frequency, and duration of various training methods, as well as implementing proprioceptive training in stages throughout the rehabilitation process. The reestablishment of shoulder joint function, the restoration of proprioception, and the enhancement of daily activities are all critical.
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Affiliation(s)
- Shi Lv
- Department of Rehabilitation, The Second Affiliated Hospital of Shandong First Medical University, Taian, 271000 Shandong, China
| | - Yang Chen
- Department of Rehabilitation, Taian Maternal and Child Health Hospital, Taian, 271000 Shandong, China
| | - Mingliang Liu
- Department of Rehabilitation, The Second Affiliated Hospital of Shandong First Medical University, Taian, 271000 Shandong, China
| | - Lei Qin
- Department of Rehabilitation, The Second Affiliated Hospital of Shandong First Medical University, Taian, 271000 Shandong, China
| | - Ziyuan Liu
- Department of Rehabilitation, The Second Affiliated Hospital of Shandong First Medical University, Taian, 271000 Shandong, China
| | - Wenxin Liu
- Department of Rehabilitation, The Second Affiliated Hospital of Shandong First Medical University, Taian, 271000 Shandong, China
| | - Mengmeng Cui
- Department of Rehabilitation, The Second Affiliated Hospital of Shandong First Medical University, Taian, 271000 Shandong, China
| | - Xinlei Zhang
- Department of Rehabilitation, The Second Affiliated Hospital of Shandong First Medical University, Taian, 271000 Shandong, China
| | - Han Yan
- Department of Rehabilitation, The Second Affiliated Hospital of Shandong First Medical University, Taian, 271000 Shandong, China
| | - Fangli Ning
- Department of Rehabilitation, The Second Affiliated Hospital of Shandong First Medical University, Taian, 271000 Shandong, China
| | - Hanlin Zhang
- Department of Rehabilitation, The Second Affiliated Hospital of Shandong First Medical University, Taian, 271000 Shandong, China
| | - Yuzhen Xu
- Department of Rehabilitation, The Second Affiliated Hospital of Shandong First Medical University, Taian, 271000 Shandong, China
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Königshausen M, Pätzholz S, Coulibaly M, Nicolas V, Vandemeulebroecke M, Schildhauer TA, Seybold D. Instability and results after non-operative treatment of large anterior glenoid rim fractures: is there a correlation between fragment size or displacement and recurrence? Arch Orthop Trauma Surg 2022; 142:2727-2738. [PMID: 34338888 PMCID: PMC9474463 DOI: 10.1007/s00402-021-04020-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 06/23/2021] [Indexed: 10/27/2022]
Abstract
INTRODUCTION There is little data available on non-operative treatment of anterior glenoid rim fractures (GRF). Nothing is known about fracture size and displacement in comparison to clinical outcomes and instability in a mainly middle-aged patient population. The aim of this study was to demonstrate the results of non-operative treatment in anterior glenoid rim fractures with the special focus on potential instability/recurrence. METHODS The inclusion criteria were non-operatively treated anterior GRF of at least ≥ 5 mm width using the age- and gender-matched Constant/Murley score (a.-/g.-CMS) and the Western Ontario Instability Index (WOSI). Radiographic parameters (fracture morphology, displacement, major tuberosity fractures and Hill-Sachs lesion using initial CT and radiographs) and the proportion of the fractured glenoid were detected (2D-CT-circle-method) and osteoarthritis (A.P. and axial radiographs) was classified according to Samilson/Prieto. Proportion of fractured glenoid and medial displacement were correlated with the recurrence rate and the clinical scores. RESULTS N = 36 patients could be followed-up after a mean of 4.4 years [12-140 month, average age: 58 (± 13, 33-86) years]. The a.-/g.-CMS was 93 (± 11, 61-100) points, and the WOSI was 81% (± 22%, 35-100%) on average. The mean intraarticular displacement was 4 mm (± 3 mm; 0-14 mm). The 2D-circle-method showed a mean glenoid fracture involvement of 21% (± 11, 10-52%). Two cases of frozen shoulders and one case with biceps pathology were associated with the trauma. Within the followed-up patient group re-instability has occurred in n = 2 patients (6%) within the first two weeks after trauma. Osteoarthritis was found in n = 11 cases. There was no correlation between the scores and the fracture size/displacement [(a.-/g.-CMS vs. displacement: r = - 0.08; p = 0.6; vs. size: r = - 0.29; p = 0.2); (WOSI vs. displacement: r = - 0.14; p = 0.4; vs. size: r = - 0.37; p = 0.06)], but very large (≥ 21%) fractures with displacement ≥ 4 mm showed slightly worse results without significant difference (a.-/g.-CMS p = 0.2; WOSI p = 0.2). The apprehension test was negative in all patients at final follow-up. CONCLUSION Non-operative treatment of anterior GRF was associated with overall good results within a mainly middle-aged larger patient group. Re-instability is rare and is not associated with fragment size but can occur in the first weeks after trauma. Size and dislocation of the fracture is not a criterion for the prognosis of potential instability. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Matthias Königshausen
- Department of General and Trauma Surgery, University Bergmannsheil Bochum, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.
| | - Simon Pätzholz
- Department of Radiology and Interventional Radiology, University Bergmannsheil Bochum, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Marlon Coulibaly
- Department of General and Trauma Surgery, University Bergmannsheil Bochum, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Volkmar Nicolas
- Department of Radiology and Interventional Radiology, University Bergmannsheil Bochum, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Marc Vandemeulebroecke
- Biostatistical Sciences and Pharmacometrics, Novartis Pharma AG, Klybeckstrasse, 4057, Basel, Switzerland
| | - Thomas Armin Schildhauer
- Department of General and Trauma Surgery, University Bergmannsheil Bochum, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Dominik Seybold
- Department of General and Trauma Surgery, University Bergmannsheil Bochum, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
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Kendel NE, O'Brien SH, Laukaitis CM, Kumar M, Levy HP, Jesudas R. Physician practices in evaluation and treatment of patients with generalized joint hypermobility and bleeding. Blood Coagul Fibrinolysis 2021; 32:591-595. [PMID: 34446680 DOI: 10.1097/mbc.0000000000001059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The association between bleeding and joint hypermobility may not be as diagnostically obvious in patients with milder connective tissue disorders. We surveyed members of the Hemostasis and Thrombosis Research Society regarding their knowledge, evaluation, and management practices in patients with generalized hypermobility spectrum disorder/hypermobile Ehlers-Danlos syndrome (hEDS) and bleeding symptoms. The objectives of this study were to (1) evaluate hematologists' diagnosis and management practices for patients with bleeding symptoms and generalized hypermobility spectrum disorder/hEDS and (2) determine future education and research priorities regarding bleeding symptoms within this population. Evaluate hematologists' diagnosis and management practices for patients with bleeding symptoms and generalized hypermobility spectrum disorder/hEDS. Determine future education and research priorities regarding bleeding symptoms within this population. A web-based survey was sent to Hemostasis and Thrombosis Research Society physician members. Physician demographics, preferred evaluation for hEDS, management of bleeding episodes, and referral patterns were collected and descriptive statistics were performed. Only two-thirds of respondents reported evaluating for hypermobility, despite all respondents being aware of the association with bleeding. There were significant variations in referral patterns for genetic counseling, diagnostic evaluation, and management of nonhematologic symptoms. There were also significant variations in reported medical homes for this patient population. Research prioritization included understanding the evolution of bleeding symptoms with age in this population as well as the development of functional tests to identify the molecular mechanism of bleeding and the development of novel hemostatic agents for this population. Results from 33 respondents show differing physician practices regarding the evaluation and management of bleeding in hypermobile patients. Many physicians suggested further research priorities to include studying the natural history of the disease and development of functional diagnostic testing as well as targeted therapeutic options in this patient population.
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Affiliation(s)
- Nicole E Kendel
- Division of Pediatric Hematology/Oncology, Nationwide Children's Hospital/The Ohio State University, Columbus, Ohio
| | - Sarah H O'Brien
- Division of Pediatric Hematology/Oncology, Nationwide Children's Hospital/The Ohio State University, Columbus, Ohio
| | | | - Manjusha Kumar
- Indiana Hemophilia and Thrombosis Center, Indianapolis, Indiana
| | - Howard P Levy
- Division of General Internal Medicine, McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Rohith Jesudas
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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Coulthard C, Cairns MC, Williams D, Hughes B, Jaggi A. Management of atraumatic shoulder instability in physiotherapy (MASIP): a survey of physiotherapy practice. BMC Musculoskelet Disord 2021; 22:840. [PMID: 34592969 PMCID: PMC8485495 DOI: 10.1186/s12891-021-04677-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 08/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The impact of atraumatic shoulder instability (ASI) on patients can be extensive, its management complex, with a biopsychosocial approach recommended. Currently how physiotherapists manage ASI is unknown or the extent to which current clinical practice aligns with existing evidence. At the time of this study no national guidelines or consensus to direct practice existed. METHODS A cross-sectional electronic survey was distributed between July-September 2018, targeting UK-based physiotherapists managing shoulder pathology. Respondents were invited to describe their management of ASI, and rate their awareness and utilisation of various treatment techniques on a Likert-scale; median and interquartile ranges were calculated. Free text survey items were analysed using quantitative content analysis (QCA) to identify codes and categories. Means and percentages were calculated to summarise QCA and descriptive data. RESULTS Valid survey responses were analysed (n = 135). Respondents had between 2 and 39 years of physiotherapy experience (mean = 13.9 years); the majority (71.1 %) reported that ASI made up < 10 % of their caseload. Only 22.9 % (n = 31/135) of respondents reported feeling 'very confident' in managing ASI; the majority feeling 'somewhat confident' (70.4 %, n = 95/135) or 'not confident' (6.7 %, n = 9/135). The majority of respondents (59.3 %) used an ASI classification system, > 90 % citing the Stanmore Classification. Physiotherapists adapted their management according to clinical presentation, responding to differing biopsychosocial needs of the patient scenario. Most respondents (> 80 %) did not use a protocol to guide their management. Exercise was the most utilised management approach for ASI, followed by education; novel treatment strategies, including cortical rehabilitation, were also reported. CONCLUSION Findings indicate physiotherapists utilise a wide range of treatment strategies and respond to biopsychosocial cues when managing patients with ASI. The majority reported not being very confident in managing this condition, however only a minority use rehabilitation protocols to support their management. Some interventions that respondents reported using lacked evidence to support their use in ASI management and further research regarding effectiveness is required. Guidelines have been published since this survey; the impact of these will need evaluating to determine their effectiveness in the future.
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Affiliation(s)
- Caroline Coulthard
- Surrey iMSK Service, Ashford and St. Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, Surrey, KT16 0PZ, UK.
| | - Mindy C Cairns
- School of Health and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, AL10 9AB, UK
| | - Deborah Williams
- The Shoulder & Elbow Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
| | - Ben Hughes
- Wrightington, Wigan and Leigh NHS Foundation Trust, Wrightington Hospital, Hall Lane, Appley Bridge, Wigan, WN6 9EP, UK
| | - Anju Jaggi
- The Shoulder & Elbow Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
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Puntumetakul R, Saiklang P, Tapanya W, Chatprem T, Kanpittaya J, Arayawichanon P, Boucaut R. The Effects of Core Stabilization Exercise with the Abdominal Drawing-in Maneuver Technique versus General Strengthening Exercise on Lumbar Segmental Motion in Patients with Clinical Lumbar Instability: A Randomized Controlled Trial with 12-Month Follow-Up. Int J Environ Res Public Health 2021; 18:ijerph18157811. [PMID: 34360103 PMCID: PMC8345381 DOI: 10.3390/ijerph18157811] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 12/19/2022]
Abstract
Trunk stability exercises that focus on either deep or superficial muscles might produce different effects on lumbar segmental motion. This study compared outcomes in 34 lumbar instability patients in two exercises at 10 weeks and 12 months follow up. Participants were divided into either Core stabilization (deep) exercise, incorporating abdominal drawing-in maneuver technique (CSE with ADIM), or General strengthening (superficial) exercise (STE). Outcome measures were pain, muscle activation, and lumbar segmental motion. Participants in CSE with ADIM had significantly less pain than those in STE at 10 weeks. They showed significantly more improvement of abdominal muscle activity ratio than participants in STE at 10 weeks and 12 months follow-up. Participants in CSE with ADIM had significantly reduced sagittal translation at L4-L5 and L5-S1 compared with STE at 10 weeks. Participants in CSE with ADIM had significantly reduced sagittal translations at L4-L5 and L5-S1 compared with participants in STE at 10 weeks, whereas STE demonstrated significantly increased sagittal rotation at L4-L5. However, at 12 months follow-up, levels of lumbar sagittal translation were increased in both groups. CSE with ADIM which focuses on increasing deep trunk muscle activity can reduce lumbar segmental translation and should be recommended for lumbar instability.
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Affiliation(s)
- Rungthip Puntumetakul
- Research Center of Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Khon Kaen University, Khon Kaen 40002, Thailand;
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand
- Correspondence: ; Tel.: +66-834196186
| | - Pongsatorn Saiklang
- Faculty of Physical Therapy, Srinakharinwirot University, Nakhon Nayok 26120, Thailand;
| | - Weerasak Tapanya
- Department of Physical Therapy, School of Allied Health Sciences, University of Phayao, Phayao 56000, Thailand;
| | - Thiwaphon Chatprem
- Research Center of Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Khon Kaen University, Khon Kaen 40002, Thailand;
| | - Jaturat Kanpittaya
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand;
| | - Preeda Arayawichanon
- Department of Rehabilitation Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand;
| | - Rose Boucaut
- iCAHE (International Centre for Allied Health Evidence), School of Health Sciences (Physiotherapy), University of South Australia, Adelaide, SA 5001, Australia;
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Feichtinger X, Dahm F, Schallmayer D, Boesmueller S, Fialka C, Mittermayr R. Surgery improves the clinical and radiological outcome in Rockwood type IV dislocations, whereas Rockwood type III dislocations benefit from conservative treatment. Knee Surg Sports Traumatol Arthrosc 2021; 29:2143-2151. [PMID: 32748232 DOI: 10.1007/s00167-020-06193-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/27/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE Despite the available classifications, diagnostics and treatment of acute acromioclavicular joint (ACJ) injuries are still vague and challenging for trauma and shoulder surgeons. This study aimed to evaluate the dynamic radiographic as well as clinical outcome of operatively and conservatively treated Rockwood (RW) type III and IV ACJ dislocations. MATERIALS AND METHODS All patients with RW type III and IV ACJ dislocations between 2009 and 2016 (n = 226) were included in this retrospective data analysis with a prospective follow-up examination. According to their injury classification, patients were subdivided in an operative and conservative treatment group. Examiner blinded clinical evaluation including the constant score (CS), American shoulder and elbow surgery (ASES) score, the acromioclavicular joint instability (ACJI) score, visual analog scale (VAS), bilateral force measurements, and posttraumatic/postsurgical sequelae were assessed. Fluoroscopic evaluations including dynamic stability assessment with functional axillary views were performed for every patient. RESULTS For follow-up examination (mean 4.8 years ± 0.3 SEM) 56 patients (29 RW type III, 27 RW type IV) were available. In patients with RW type III ACJ dislocations [operative (n = 10); conservative (n = 19)] prolonged duration of treatment was seen in operatively treated patients (p < 0.05). Clear improvement could be shown for the ACJI score (p < 0.05) and coracoclavicular (CC) and acromioclavicular (AC) distance (p < 0.05) in the operative group. In patients with RW type IV ACJ dislocations [operative (n = 18); conservative (n = 9)] superior clinical results were found in operated patients with highly significant differences for the ACJI score (p < 0.001). Radiographic dynamic horizontal analysis showed nearly normalized anteroposterior translation in operated patients (p < 0.05). No differences were found regarding arthroscopic or open procedures. CONCLUSION Accurate diagnostics including sufficient dynamic stability assessment with functional axillary views are strongly advised for patients with ACJ dislocations. Conservative treatment should be recommended for patients with RW type III ACJ dislocations, due to shorter duration of treatment with good clinical results but lacking operative risks. In patients with RW type IV ACJ dislocations, surgical treatment is recommended because of superior clinical and radiological results. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Xaver Feichtinger
- AUVA Trauma Center Vienna-Meidling, Kundratstrasse 37, 1120, Vienna, Austria.
| | - F Dahm
- AUVA Trauma Center Vienna-Meidling, Kundratstrasse 37, 1120, Vienna, Austria
| | - D Schallmayer
- AUVA Trauma Center Vienna-Meidling, Kundratstrasse 37, 1120, Vienna, Austria
| | - S Boesmueller
- AUVA Trauma Center Vienna-Meidling, Kundratstrasse 37, 1120, Vienna, Austria
| | - C Fialka
- AUVA Trauma Center Vienna-Meidling, Kundratstrasse 37, 1120, Vienna, Austria
- Center for the Musculoskeletal System, Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - R Mittermayr
- AUVA Trauma Center Vienna-Meidling, Kundratstrasse 37, 1120, Vienna, Austria
- Center for the Musculoskeletal System, Medical Faculty, Sigmund Freud University, Vienna, Austria
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30
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Tennent DJ, Slaven SE, Slabaugh MA, Cameron KL, Posner MA, Owens BD, LeClere LE, Rue JPH, Tokish JM, Dickens JF. Recurrent Instability and Surgery Are Common After Nonoperative Treatment of Posterior Glenohumeral Instability in NCAA Division I FBS Football Players. Clin Orthop Relat Res 2021; 479:694-700. [PMID: 33724975 PMCID: PMC8083809 DOI: 10.1097/corr.0000000000001471] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 08/05/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND In-season return to play after anterior glenohumeral instability is associated with high rates of recurrent instability and the need for surgical stabilization. We are not aware of previous studies that have investigated in-season return to play after posterior glenohumeral instability; furthermore, as posterior shoulder instability in collision athletes occurs frequently, understanding the expected outcome of in-season athletes may improve the ability of physicians to provide athletes with a better understanding of the expected outcome of their injury and their ability to return to sport. QUESTIONS/PURPOSES (1) What proportion of athletes returned to play during the season after posterior instability in collegiate football players? (2) How much time did athletes lose to injury, what proportion of athletes opted to undergo surgery, and what proportion of athletes experienced recurrent instability after a posterior instability episode during a collegiate football season? METHODS A multicenter, prospective, observational study of National Collegiate Athletic Association (NCAA) Division 1 Football Bowl Subdivision athletes was performed at three US Military Service Academies. Ten athletes who sustained a posterior instability event during the regular football season and who pursued a course of nonoperative treatment were identified and prospectively observed through the subsequent season. All athletes in the observed cohort attempted an initial course of nonoperative treatment during the season. All athletes sustained subluxation events initially identified through history and physical examination at the time of injury. None of the athletes sustained a dislocation event requiring a manual reduction. Intraarticular pathology consisting of posterior labral pathology was further subsequently identified in all subjects via MRI arthrogram. Return to play was the primary outcome of interest. Time lost to injury, surgical intervention, and subsequent instability were secondary outcomes. RESULTS Of the 10 athletes who opted for a trial of initial nonoperative management, seven athletes were able to return to play during the same season. Although these seven athletes returned within 1 week of their injury (median of 1 day), 5 of 7 athletes sustained recurrent subluxation events with a median (range) of four subluxation events per athlete (0 to 8) during the remainder of the season. Seven athletes were treated surgically after the completion of their season, four of whom returned to football. CONCLUSION This study suggests that although collegiate football players are able to return to in-season sport after a posterior glenohumeral instability event, they will likely sustain multiple recurrent instability events and undergo surgery after the season is completed. The results of this study can help guide in-season management of posterior shoulder instability by allowing more appropriate postinjury counseling and decision making through the identification of those athletes who may require additional attention from medical staff during the season and possible modifications to training regimens to minimize long-term disability. Further prospective studies involving a larger cohort over several seasons should be performed through collaborative studies across the NCAA that better assess function and injury risk factors before beginning collegiate athletics. This would better characterize the natural history and associated functional limitations that athletes may encounter during their collegiate careers. LEVEL OF EVIDENCE Level IV, prognostic study.
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Affiliation(s)
- David J Tennent
- D. J. Tennent, K. L. Cameron, M. A. Posner, J. F. Dickens, John A. Feagin Jr. Orthopaedic Sports Medicine Fellowship at West Point, West Point, NY, USA
- D. J. Tennent, Department of Surgery, Evans Army Community Hospital, Fort Carson, CO, USA
- S. E. Slaven, J. F. Dickens, Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
- S. E. Slaven, K. L. Cameron, J. F. Dickens, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- M. A. Slabaugh, United States Air Force Academy, Colorado Springs, CO, USA
- B. D. Owens, Department of Orthopedic Surgery, Brown University, East Providence, RI, USA
- L. E. LeClere, J.-P. H. Rue, United States Naval Academy, Annapolis, MD, USA
- J. M. Tokish, Mayo Clinic, Phoenix, AZ, USA
| | - Sean E Slaven
- D. J. Tennent, K. L. Cameron, M. A. Posner, J. F. Dickens, John A. Feagin Jr. Orthopaedic Sports Medicine Fellowship at West Point, West Point, NY, USA
- D. J. Tennent, Department of Surgery, Evans Army Community Hospital, Fort Carson, CO, USA
- S. E. Slaven, J. F. Dickens, Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
- S. E. Slaven, K. L. Cameron, J. F. Dickens, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- M. A. Slabaugh, United States Air Force Academy, Colorado Springs, CO, USA
- B. D. Owens, Department of Orthopedic Surgery, Brown University, East Providence, RI, USA
- L. E. LeClere, J.-P. H. Rue, United States Naval Academy, Annapolis, MD, USA
- J. M. Tokish, Mayo Clinic, Phoenix, AZ, USA
| | - Mark A Slabaugh
- D. J. Tennent, K. L. Cameron, M. A. Posner, J. F. Dickens, John A. Feagin Jr. Orthopaedic Sports Medicine Fellowship at West Point, West Point, NY, USA
- D. J. Tennent, Department of Surgery, Evans Army Community Hospital, Fort Carson, CO, USA
- S. E. Slaven, J. F. Dickens, Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
- S. E. Slaven, K. L. Cameron, J. F. Dickens, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- M. A. Slabaugh, United States Air Force Academy, Colorado Springs, CO, USA
- B. D. Owens, Department of Orthopedic Surgery, Brown University, East Providence, RI, USA
- L. E. LeClere, J.-P. H. Rue, United States Naval Academy, Annapolis, MD, USA
- J. M. Tokish, Mayo Clinic, Phoenix, AZ, USA
| | - Kenneth L Cameron
- D. J. Tennent, K. L. Cameron, M. A. Posner, J. F. Dickens, John A. Feagin Jr. Orthopaedic Sports Medicine Fellowship at West Point, West Point, NY, USA
- D. J. Tennent, Department of Surgery, Evans Army Community Hospital, Fort Carson, CO, USA
- S. E. Slaven, J. F. Dickens, Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
- S. E. Slaven, K. L. Cameron, J. F. Dickens, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- M. A. Slabaugh, United States Air Force Academy, Colorado Springs, CO, USA
- B. D. Owens, Department of Orthopedic Surgery, Brown University, East Providence, RI, USA
- L. E. LeClere, J.-P. H. Rue, United States Naval Academy, Annapolis, MD, USA
- J. M. Tokish, Mayo Clinic, Phoenix, AZ, USA
| | - Matthew A Posner
- D. J. Tennent, K. L. Cameron, M. A. Posner, J. F. Dickens, John A. Feagin Jr. Orthopaedic Sports Medicine Fellowship at West Point, West Point, NY, USA
- D. J. Tennent, Department of Surgery, Evans Army Community Hospital, Fort Carson, CO, USA
- S. E. Slaven, J. F. Dickens, Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
- S. E. Slaven, K. L. Cameron, J. F. Dickens, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- M. A. Slabaugh, United States Air Force Academy, Colorado Springs, CO, USA
- B. D. Owens, Department of Orthopedic Surgery, Brown University, East Providence, RI, USA
- L. E. LeClere, J.-P. H. Rue, United States Naval Academy, Annapolis, MD, USA
- J. M. Tokish, Mayo Clinic, Phoenix, AZ, USA
| | - Brett D Owens
- D. J. Tennent, K. L. Cameron, M. A. Posner, J. F. Dickens, John A. Feagin Jr. Orthopaedic Sports Medicine Fellowship at West Point, West Point, NY, USA
- D. J. Tennent, Department of Surgery, Evans Army Community Hospital, Fort Carson, CO, USA
- S. E. Slaven, J. F. Dickens, Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
- S. E. Slaven, K. L. Cameron, J. F. Dickens, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- M. A. Slabaugh, United States Air Force Academy, Colorado Springs, CO, USA
- B. D. Owens, Department of Orthopedic Surgery, Brown University, East Providence, RI, USA
- L. E. LeClere, J.-P. H. Rue, United States Naval Academy, Annapolis, MD, USA
- J. M. Tokish, Mayo Clinic, Phoenix, AZ, USA
| | - Lance E LeClere
- D. J. Tennent, K. L. Cameron, M. A. Posner, J. F. Dickens, John A. Feagin Jr. Orthopaedic Sports Medicine Fellowship at West Point, West Point, NY, USA
- D. J. Tennent, Department of Surgery, Evans Army Community Hospital, Fort Carson, CO, USA
- S. E. Slaven, J. F. Dickens, Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
- S. E. Slaven, K. L. Cameron, J. F. Dickens, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- M. A. Slabaugh, United States Air Force Academy, Colorado Springs, CO, USA
- B. D. Owens, Department of Orthopedic Surgery, Brown University, East Providence, RI, USA
- L. E. LeClere, J.-P. H. Rue, United States Naval Academy, Annapolis, MD, USA
- J. M. Tokish, Mayo Clinic, Phoenix, AZ, USA
| | - John-Paul H Rue
- D. J. Tennent, K. L. Cameron, M. A. Posner, J. F. Dickens, John A. Feagin Jr. Orthopaedic Sports Medicine Fellowship at West Point, West Point, NY, USA
- D. J. Tennent, Department of Surgery, Evans Army Community Hospital, Fort Carson, CO, USA
- S. E. Slaven, J. F. Dickens, Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
- S. E. Slaven, K. L. Cameron, J. F. Dickens, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- M. A. Slabaugh, United States Air Force Academy, Colorado Springs, CO, USA
- B. D. Owens, Department of Orthopedic Surgery, Brown University, East Providence, RI, USA
- L. E. LeClere, J.-P. H. Rue, United States Naval Academy, Annapolis, MD, USA
- J. M. Tokish, Mayo Clinic, Phoenix, AZ, USA
| | - John M Tokish
- D. J. Tennent, K. L. Cameron, M. A. Posner, J. F. Dickens, John A. Feagin Jr. Orthopaedic Sports Medicine Fellowship at West Point, West Point, NY, USA
- D. J. Tennent, Department of Surgery, Evans Army Community Hospital, Fort Carson, CO, USA
- S. E. Slaven, J. F. Dickens, Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
- S. E. Slaven, K. L. Cameron, J. F. Dickens, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- M. A. Slabaugh, United States Air Force Academy, Colorado Springs, CO, USA
- B. D. Owens, Department of Orthopedic Surgery, Brown University, East Providence, RI, USA
- L. E. LeClere, J.-P. H. Rue, United States Naval Academy, Annapolis, MD, USA
- J. M. Tokish, Mayo Clinic, Phoenix, AZ, USA
| | - Jonathan F Dickens
- D. J. Tennent, K. L. Cameron, M. A. Posner, J. F. Dickens, John A. Feagin Jr. Orthopaedic Sports Medicine Fellowship at West Point, West Point, NY, USA
- D. J. Tennent, Department of Surgery, Evans Army Community Hospital, Fort Carson, CO, USA
- S. E. Slaven, J. F. Dickens, Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
- S. E. Slaven, K. L. Cameron, J. F. Dickens, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- M. A. Slabaugh, United States Air Force Academy, Colorado Springs, CO, USA
- B. D. Owens, Department of Orthopedic Surgery, Brown University, East Providence, RI, USA
- L. E. LeClere, J.-P. H. Rue, United States Naval Academy, Annapolis, MD, USA
- J. M. Tokish, Mayo Clinic, Phoenix, AZ, USA
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Jensen AM, Andersen JQ, Quisth L, Ramstrand N. Finger orthoses for management of joint hypermobility disorders: Relative effects on hand function and cognitive load. Prosthet Orthot Int 2021; 45:36-45. [PMID: 33834743 PMCID: PMC7978036 DOI: 10.1177/0309364620956866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 08/06/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Joint hypermobility refers to joints that move beyond their normal limits. Individuals with hypermobility of the fingers experience difficulties in activities of daily living. Finger orthoses are available for managing hypermobility of the fingers, but their effectiveness has received little attention in scholarly literature. OBJECTIVES To determine if use of custom fit finger orthoses leads to improvements in time needed to perform standardised hand function tests, and attentional demand required to perform these tests, in individuals with joint hypermobility syndrome, Hypermobile Ehlers-Danlos syndrome or Classical Ehlers-Danlos syndrome. STUDY DESIGN Repeated-measures study. METHODS Fourteen participants performed three different hand function tests (target box and block test, writing and picking up coins), with and without their finger orthoses. Time to complete each test was recorded as a measure of functional performance. Brain activity was recorded in the pre-frontal cortices as a measure of attentional demand. RESULTS Functional performance significantly improved for all but one test (picking up coins with non-dominant hand) when participants wore finger orthoses (p < 0.05). Activity in the pre-frontal cortex was lower when using the orthosis to perform the coin test (dominant hand; p < 0.05). No differences were observed in other tests (p > 0.05). CONCLUSIONS Results suggested that finger orthoses improved hand function and provided limited evidence to suggest that they may also affect attentional demand. While the limited sample does not provide conclusive evidence supporting the use of finger orthosis in this clinical population, results warrant further investigation in large scale longitudinal studies or randomised controlled trials.
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Affiliation(s)
| | | | | | - Nerrolyn Ramstrand
- CHILD Research Group, School of Health and Welfare, Jönköping University, Jönköping, Sweden
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Park SH, Lee MM. Effects of progressive neuromuscular stabilization exercise on the support surface on patients with high obesity with lumbar instability: A double-blinded randomized controlled trial. Medicine (Baltimore) 2021; 100:e23285. [PMID: 33530156 PMCID: PMC7850769 DOI: 10.1097/md.0000000000023285] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/22/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Intensive neuromuscular stabilization exercise on highly obese patients with low back pain results in positive effects of body fat decline and prevention of complications. The purpose of this study is to investigate the effects of progressive neuromuscular stabilization exercise on unstable surface on pain, motor function, psychosocial factors, balance, and abdominal contraction with highly obese patients with lumbar instability. METHODS This study is a double-blinded randomized controlled trial. A total of 46 highly obese patients (body mass index [BMI] ≥ 30 kg/m2) with lumbar instability were assigned randomly to experimental group (n = 23) and control group (n = 23). The control group performed the intensive progressive exercise on a stable surface and the experimental group on an unstable surface. RESULT Significant differences were shown for BMI, QVAS, K-ODI, FABQ, and balance ability for both groups before and after the intervention (P < .05), and only the experimental group showed significant difference for transverse abdominis muscle thickness in contraction and contraction rate (P < .05). Compared to the control group, the experimental group showed significant difference (P < .05) in the amount of changes for QVAS, K-ODI, balance ability, transverse abdominis muscle thickness in contraction, and contraction rate. CONCLUSION Progressive neuromuscular stabilization exercise program on unstable surfaces demonstrated to be an effective and clinically useful method to decrease pain level, increase motor function, balance, and transverse abdominis muscle thickness in contraction and contraction rate for highly obese patients with lumbar instability.
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Affiliation(s)
- Sam-Ho Park
- Department of Physical Therapy, Graduate School
| | - Myung-Mo Lee
- Department of Physical Therapy, Daejeon University, Dong-gu, Daejeon city, Republic of Korea
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33
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O'Brien MJ, Ramsey ML, Conway JE, Savoie FH. Traumatic Elbow Instability: How to Fix It and When to Phone a Friend. Instr Course Lect 2021; 70:55-72. [PMID: 33438904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Traumatic elbow instability is a difficult condition to manage. Many surgeons consider the elbow a perplexing black box and evaluating damaged structures in the setting of pain and swelling a diagnostic challenge. Injury most commonly occurs from a fall onto an outstretched hand but also results from elbow dislocation, direct trauma, and sporting activities. The injury can initiate on the medial or lateral side, depending on forearm position at the time of injury, and usually follows a predictable pattern, with progressive instability caused by soft-tissue disruption and fractures of the medial or lateral column. Primary medial instability, lateral instability, and
combined injury patterns have been described and discussed. Simple elbow dislocations and certain fractures can be managed nonsurgically, whereas complex patterns of instability and fracture-dislocations routinely require surgery. Stiffness and nerve injury are the most common complications and occur from both surgical and nonsurgical management. This chapter describes the diagnosis and management of traumatic elbow instability and the management of its sequela.
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Verweij LPE, Pruijssen EC, Kerkhoffs GMMJ, Blankevoort L, Sierevelt IN, van Deurzen DFP, van den Bekerom MPJ. Treatment type may influence degree of post-dislocation shoulder osteoarthritis: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2021; 29:2312-2324. [PMID: 32936334 PMCID: PMC8225537 DOI: 10.1007/s00167-020-06263-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 08/28/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Age at primary dislocation, recurrence, and glenoid bone loss are associated with development of osteoarthritis (OA). However, an overview of OA following traumatic anterior shoulder instability is lacking and it is unclear to what degree type of surgery is associated with development of OA in comparison to non-operative treatment. The aim of this study was to determine the degree of OA at long-term follow-up after non-operative and operative treatments for patients with anterior shoulder instability. Surgery is indicated when patients experience recurrence and this is associated with OA; therefore, it was hypothesized that shoulders show a higher proportion or degree of OA following operative treatment compared to non-operative treatment. METHODS A literature search was performed in the PubMed/Medline, EMBASE, and Cochrane databases. Articles reporting the degree of OA that was assessed with the Samilson-Prieto or Buscayret OA classification method after non-operative and operative treatment for anterior shoulder instability with a minimum of 5 years follow-up were included. RESULTS Thirty-six articles met the eligibility criteria of which 1 reported the degree of OA for non-operative treatment and 35 reported the degree of OA for 9 different operative procedures. A total of 1832 patients (1854 shoulders) were included. OA proportions of non-operative and operative treatments are similar at any point of follow-up. The Latarjet procedure showed a lower degree of OA compared to non-operative treatment and the other operative procedures, except for the Bristow procedure and Rockwood capsular shift. The meta-analyses showed comparable development of OA over time among the treatment options. An increase in OA proportion was observed when comparing the injured to the contralateral shoulder. However, a difference between the operative subgroups was observed in neither analysis. CONCLUSION Non-operative and operative treatments show similar OA proportions at any point of follow-up. The hypothesis that shoulders showed a higher proportion or degree of OA following operative treatment compared to non-operative treatment is not supported by the data. Operative treatment according to the Latarjet procedure results in a lower degree of OA compared to other treatments, including non-operative treatment. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Lukas P E Verweij
- Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands.
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands.
| | - Erik C Pruijssen
- Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Leendert Blankevoort
- Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Inger N Sierevelt
- Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
- Specialized Center of Orthopedic Research and Education (SCORE), Xpert Orthopedics, Amsterdam, The Netherlands
| | - Derek F P van Deurzen
- Department of Orthopedic Surgery, Shoulder and Elbow Unit, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Michel P J van den Bekerom
- Department of Orthopedic Surgery, Shoulder and Elbow Unit, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
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Porcellini G, Cecere AB, Giorgini A, Micheloni GM, Tarallo L. The GLAD Lesion: are the definition, diagnosis and treatment up to date? A Systematic Review. Acta Biomed 2020; 91:e2020020. [PMID: 33559615 PMCID: PMC7944697 DOI: 10.23750/abm.v91i14-s.10987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 12/03/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Although GLAD lesions are quite common, only sporadic case reports describe surgical techniques and clinical outcomes. Even if cartilage defects can result from various pathogenic mechanisms, the resulting defect has some similarities with GLAD, and its management can be a starting point to treat both types of lesion. Aim of the present study is to find a commonly accepted definition for GLAD lesions in order to understand its pathogenesis, diagnosis and possible treatments. METHODS A search of PubMed (MEDLINE) database has been performed in June 2020 to identify relevant articles including a combination of the following search terms: "GlenoLabral Articular Disruption" OR "GLAD" AND "shoulder" AND "cartilage, articular". RESULTS Abstract evaluation included 31 articles in the full-text review. Various studies showed that the performance of MR arthrography in the detection of glenohumeral cartilage lesions, including GLAD lesions, was moderate. Different therapeutic solutions have been described. Arthroscopic debridement of the lesion and reattachment of the labrum have been often used. In case of large articular defects, the labrum could be advanced in the cartilage defect to cover it. In case of cartilage flap with reparable margins, this could be reattached with different suture constructs. Neglected GLAD lesions following a chronic trauma or shoulder instability have not been described in literature. CONCLUSIONS The definition of GLAD injury has changed over the time. Many authors associate this lesion with shoulder instability, with trauma in abduction and extra rotation, while Neviaser's original definition described stable shoulders following a trauma in adduction.
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Affiliation(s)
- Giuseppe Porcellini
- 1 Orthopaedic Department, University of Modena and Reggio Emilia, 41124 Modena, Italy.
| | - Antonio Benedetto Cecere
- Multidisciplinary Department of Medico-Surgical and Dentistry Specialties, University "Campana Luigi Vanvitelli", Naples, Italy.
| | - Andrea Giorgini
- Orthopaedic Department, University of Modena and Reggio Emilia, 41124 Modena, Italy.
| | | | - Luigi Tarallo
- Orthopaedic Department, University of Modena and Reggio Emilia, 41124 Modena, Italy.
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Luchetti TJ, Abbott EE, Baratz ME. Elbow Fracture-Dislocations: Determining Treatment Strategies. Hand Clin 2020; 36:495-510. [PMID: 33040962 DOI: 10.1016/j.hcl.2020.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Elbow dislocations represent common injuries. A quarter of these injuries involve at least 1 fracture. The sequel of elbow fracture-dislocations can be fraught with complications, including recurrent instability, posttraumatic arthritis, elbow contracture, and poor functional results. The 3 main patterns of injury are valgus posterolateral rotatory instability, varus posteromedial rotatory instability, and transolecranon fracture-dislocation. This article discusses each pattern individually, including the anatomy, the typical injury pattern, and treatment strategies. It also discusses common complications that can occur.
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Tokish JM, Thigpen CA, Kissenberth MJ, Tolan SJ, Lonergan KT, Tokish JM, Dickens JF, Hawkins RJ, Shanley E. The Nonoperative Instability Severity Index Score (NISIS): A Simple Tool to Guide Operative Versus Nonoperative Treatment of the Unstable Shoulder. Sports Health 2020; 12:598-602. [PMID: 32609577 DOI: 10.1177/1941738120925738] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The management of the adolescent athlete after initial shoulder instability remains controversial. HYPOTHESIS Individual risk factors in athletes with shoulder instability who are managed nonoperatively can be integrated into a scoring system that can predict successful return to sport. STUDY DESIGN Retrospective cohort study. LEVEL OF EVIDENCE Level 4. METHODS A total of 57 scholastic athletes with primary anterior shoulder instability who were managed nonoperatively were reviewed. Success was defined as a return to index sport at the same level and playing at least 1 subsequent season without missed time as a result of the shoulder. Patient-specific risk factors were individually evaluated, and odds ratios were calculated. A 10-point Nonoperative Injury Severity Index Score (NISIS) incorporated the risk factors for failure. This score was then retrospectively applied with regression analysis and a chi-square analysis to determine the overall optimal score that predicted failure of nonoperative management. RESULTS In total, 6 risk factors for failure were included in the NISIS: age (>15 years), bone loss, type of instability, type of sport (contact vs noncontact), male sex, and arm dominance. Overall, 79% of patients treated nonoperatively were able to successfully return to sport. Nearly all (97%) low-risk patients (NISIS <7) successfully returned to sport, while only 59% of high-risk patients returned to sport, a relative risk of 12.2 (P = 0.001). High-risk patients with unipolar bone loss successfully returned (100%), but 67% of high-risk patients with bipolar bone loss failed. CONCLUSION The NISIS is a simple and effective clinical tool to determine successful nonoperative management following anterior shoulder instability and may be helpful in guiding decision making when presented with the unstable shoulder in the scholastic athlete.
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Hadadi M, Haghighat F, Mohammadpour N, Sobhani S. Effects of Kinesiotape vs Soft and Semirigid Ankle Orthoses on Balance in Patients With Chronic Ankle Instability: A Randomized Controlled Trial. Foot Ankle Int 2020; 41:793-802. [PMID: 32383634 DOI: 10.1177/1071100720917181] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Chronic ankle instability (CAI) is a frequent complication of ankle sprain that may be associated with long-term consequences. Although taping and bracing are common interventions that are widely used by clinicians and athletic trainers for patients with CAI, no studies have compared the effects of kinesiotaping and bracing on balance performance in these patients. The present study aimed to compare the effects of ankle kinesiotaping, a soft ankle orthosis, and a semirigid ankle orthosis on balance performance in patients with CAI. METHODS Sixty patients with CAI were randomly assigned to 4 groups that received kinesiotaping, a soft orthosis, a semirigid orthosis, or no treatment (control group). Dynamic and static balance were measured with the modified Star Excursion Balance Test, single leg hop test, and single leg stance test before and after a 4-week intervention period. RESULTS Significant between-group differences were seen in all evaluated outcomes (P ≤ .003). The lowest reach distances in all directions in the modified Star Excursion Balance Test were found in the control group, and these patients also had a significantly shorter measured distance in the single leg hop test, and more errors in the single leg stance test compared with the 3 intervention groups. No significant differences were found among the 3 intervention groups. CONCLUSION Use of kinesiotaping and a soft or a semirigid ankle brace for 4 weeks were all beneficial in improving static and dynamic balance in individuals with CAI. None of the interventions was superior to the other 2. LEVEL OF EVIDENCE Level I, randomized controlled trial.
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Affiliation(s)
- Mohammad Hadadi
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
- Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farzaneh Haghighat
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Navid Mohammadpour
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sobhan Sobhani
- Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
- Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Wattananon P, Prasertkul W, Sakulsriprasert P, Laskin JJ. Effect of increased relative stiffness of the lumbar spine on hamstring muscle stretching in individuals with a history of low back pain suspected to have a clinical lumbar instability: A randomized crossover design. Clin Biomech (Bristol, Avon) 2020; 75:104996. [PMID: 32339943 DOI: 10.1016/j.clinbiomech.2020.104996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/09/2020] [Accepted: 04/14/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Theoretically, lumbopelvic stabilization techniques during hamstring muscle stretching could increase lumbar stiffness relative to hamstring muscle in individuals with a history of low back pain and suspected clinical lumbar instability. However, evidence to support this theory is limited. This study aimed to 1) determine changes in lumbopelvic, lumbar, and hip motions, and hamstring muscle length after stretching exercises with lumbopelvic stiffening or relaxing techniques, and 2) compare those changes between techniques. METHODS This study used a randomized crossover design. Thirty-two participants with a history of low back pain and bilateral hamstring muscle tightness were recruited. The order of the first technique was randomly assigned. After a 2-day washout, participants were crossed over to the second technique. Motion data during active forward trunk bending and bilateral hamstring muscle length during passive knee extension were collected pre- and post-intervention. FINDINGS Significant increases (P < 0.05) were found in bilateral hamstring muscle length for both techniques. However, stiffening technique demonstrated a significant decrease in lumbar motion (P < 0.05) and increase in hip motion (P < 0.05), while relaxing technique demonstrated trends showing increases in lumbar and hip motions (P = 0.134 and 0.115, respectively). The findings showed significantly greater improvement (P < 0.05) in lumbar and hip motions with stiffening technique. INTERPRETATION The findings suggest increased relative stiffness of the lumbar spine during hamstring muscle stretching can specifically lengthen bilateral hamstring muscle and decrease excessive lumbar motion. This stiffening technique may prevent excessive movement of the lumbar spine, thereby reducing the risk of recurrent low back pain.
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Affiliation(s)
- Peemongkon Wattananon
- Motor Control and Neural Plasticity Lab, Faculty of Physical Therapy, Mahidol University, 999 Phuttamonthon 4 Road, Salaya, Nakhon Pathom 73170, Thailand.
| | - Wallika Prasertkul
- Physical Therapy Clinic, Faculty of Physical Therapy, Mahidol University, 999 Phuttamonthon 4 Road, Salaya, Nakhon Pathom 73170, Thailand..
| | - Prasert Sakulsriprasert
- Biomechanics and Sport Lab, Faculty of Physical Therapy, Mahidol University, 999 Phuttamonthon 4 Road, Salaya, Nakhon Pathom 73170, Thailand.
| | - James J Laskin
- School of Physical Therapy and Rehabilitation Science, University of Montana, 135 Skaggs Building, Missoula, MT 59812, USA.
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Aerni G, Tirabassi J. Shoulder Conditions: Traumatic Instability and Laxity. FP Essent 2020; 491:22-26. [PMID: 32315145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Shoulder instability involves increased translation of the humeral head in relation to the glenoid that results in symptoms. Anterior dislocation is the most common type of traumatic instability and typically involves younger male athletes. A comprehensive patient history should include the mechanism of injury, number and severity of episodes, neurovascular symptoms, and personal or family history of connective tissue disorders. Tests to assess instability on physical examination include the anterior apprehension and Jobe relocation tests, load and shift test, sulcus sign, and jerk test. X-rays are the initial imaging modality of choice, followed by 3 T magnetic resonance arthrogram. If concerns exist about significant bone loss, computed tomography scan with 3-dimensional reconstruction can be considered. Multidirectional instability often can be managed with physical therapy. Surgery should be considered if there is no improvement after 3 months. Patients with traumatic dislocations may pursue conservative treatment, but the risk of recurrence and difficulty in returning to the prior level of sport indicate that surgical intervention may be more beneficial, particularly for younger active patients. Patients with significant bone loss may benefit from bone block surgery, such as the Latarjet procedure.
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Affiliation(s)
- Giselle Aerni
- WellSpan York Hospital Sports Medicine Fellowship, 1001 S George St, York, PA 17403
| | - Jill Tirabassi
- UMass Memorial HealthAlliance-Clinton Hospital Burbank Campus, 275 Nichols Road, Fitchburg, MA, 01420
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Tsikopoulos K, Sidiropoulos K, Kitridis D, Cain Atc SM, Metaxiotis D, Ali A. Do External Supports Improve Dynamic Balance in Patients with Chronic Ankle Instability? A Network Meta-analysis. Clin Orthop Relat Res 2020; 478:359-377. [PMID: 31625960 PMCID: PMC7438122 DOI: 10.1097/corr.0000000000000946] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 08/08/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND To improve ankle stability in patients who have experienced an ankle sprain with residual symptoms of instability and/or objective joint laxity, external supports (such as taping, bracing, and orthotic insoles) are used sometimes. However, available randomized trials have disagreed on whether restraints improve balance in those individuals. In this situation, a network meta-analysis can help because it allows for comparing multiple treatments simultaneously, taking advantage not only of direct but also indirect evidence synthesis. QUESTIONS/PURPOSES The aim of this network meta-analysis was to assess (1) the impact of taping and orthotic devices on dynamic postural control in individuals with ankle instability and (2) the presence of a placebo effect in participants treated with sham taping and complications resulting from the administered treatments. METHODS We searched the PubMed, Scopus, and CENTRAL databases up to February 13, 2019 for completed studies. Randomized trials assessing the results of real and/or sham taping, wait-and-see protocols, ankle bracing, and foot orthotics for ankle instability as determined by one or more ankle sprains followed by ongoing subjective symptoms and/or mechanical laxity were included. We evaluated dynamic postural control in terms of the Star Excursion Balance Test in the posteromedial direction (SEBT-PM), which is considered the most representative of balance deficits in patients with ankle instability. Standardized mean differences were re-expressed to percentage differences in SEBT-PM, with higher scores representing possible improvement. Subsequently, those data were checked against the established minimal detectable change of 14% for this scale to make judgements on clinical importance. We also assessed the presence of a placebo effect by comparing the results of sham taping with no treatment and complications resulting from the administered treatments. Additionally, we judged the quality of trials using the Cochrane risk of bias tool and quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. A total of 22 trials met our inclusion criteria, 18 of which were deemed to be at a low risk of bias. A network of treatments consisting of 13 studies was created, and the level of evidence was judged to be high. As far as participants' allocation to treatment arms, 85 patients followed a wait-and-see protocol, 29 received placebo taping, 99 were treated with taping, 16 were treated with bracing, 27 were administered insoles, and six individuals were offered a combination of insoles with bracing. Of note, with statistical power set at 80%, a minimum of 16 patients per treatment group was required to provide sufficient statistical power and detect a SEBT-PM percentage difference of 14%. RESULTS A network meta-analysis did not demonstrate a benefit of taping or bracing over no treatment (percentage difference in SEBT-PM between taping and bracing versus control: -2.4 [95% CI -6 to 1.1]; p = 0.18, and -7.5 [95% CI -15.9 to 1]; p = 0.08, respectively). This was also the case for sham taping because the measurement increase failed to exceed the minimal detectable change (percentage difference in SEBT-PM between sham taping and untreated control: -1.1 [95% CI -6.9 to 4.7]; p = 0.72). Importantly, there were no reported adverse events after treatment application. CONCLUSIONS Evidence of moderate strength indicated that external supports of any type were no more effective than controls in improving dynamic postural control in patients with at least one ankle sprain and residual functional or mechanical deficits. Therefore, implementing those tools as a standalone treatment does not appear to be a viable strategy for the primary management of ankle instability. It is conceivable that combinations of rehabilitation and external supports could be more effective than external supports alone, and future trials should evaluate the potential of such combinations in enhancing not only clinician-reported but also patient-oriented outcomes using long-term follow-up measurements. LEVEL OF EVIDENCE Level I, therapeutic study.
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Affiliation(s)
- Konstantinos Tsikopoulos
- K. Tsikopoulos, D. Kitridis, 424 Army General Training Hospital, Thessaloniki, Greece
- K. Tsikopoulos, Orthopedic Department, University Hospitals of North Midlands, Stoke-on-Trent, UK
| | | | - Dimitrios Kitridis
- K. Tsikopoulos, D. Kitridis, 424 Army General Training Hospital, Thessaloniki, Greece
- D. Kitridis, First Orthopedic Department of Aristotle University, G. Papanikolaou General Hospital, Exohi, Thessaloniki, Greece
| | - Spencer M Cain Atc
- S. M. Cain, Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Dimitrios Metaxiotis
- D. Metaxiotis, Second Orthopedic Department, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Ashique Ali
- A. Ali, Orthopedic Department, University Hospitals of North Midlands, Stoke-on-Trent, UK
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Abstract
BACKGROUND The majority of research on medial (MCL) and lateral (LCL) collateral ligament injuries has focused on adults and combined collateral/cruciate injuries. The purpose of this study was to determine characteristics associated with isolated collateral ligament injuries in adolescents, and assess timing for return to sports. METHODS Electronic medical records were queried to identify patients aged below 17 years who sustained a magnetic resonance imaging-confirmed isolated MCL or LCL injury over an 8-year period. Retrospective review then documented patient and injury characteristics and clinical course. General linear modeling was used to analyze risk factors for prolonged return to sports, continued pain or reinjury. RESULTS Fifty-one knees (33 in males, 65%), mean age 13.8 years (range, 5 to 17), were identified, of which 40 (78%) had MCL injuries. Over half (29, 57%) of knees had an open distal femoral physis including all 5 bony avulsion injuries. Eleven (22%) had LCL injuries of which 3 (6%) had concurrent posterolateral corner injuries. Forty-two (82%) knees had injuries that occurred during sports. Eleven knees (28%) with MCL tears had a simultaneous patellar instability episode. Knee injuries that occurred during sports had 37% shorter recovery time (P=0.02). Eight knees (16%) experienced a reinjury and 12 (24%) were followed over an extended period of time for various knee issues. Football injuries were more likely to be grade 3 (P=0.03), and football and soccer accounted for all grade III injuries. The mean return to sports was 2.2 months, with grade III cases returning at 2.4 months, and 95% of cases within 4 months. CONCLUSIONS Isolated collateral ligament injuries are rare in adolescent athletes. MCL injuries, one-quarter of which occurred in conjunction with patellar instability events, were 4 times more common than LCL injuries, one quarter of which have other posterolateral corner structures involved. Grade III injuries represent 20% to 25% of collateral ligament injuries and occurred most commonly in football and soccer. LEVEL OF EVIDENCE Level IV-retrospective case series.
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Affiliation(s)
- Dennis E Kramer
- Boston Childrens Hospital, Harvard Medical School, Boston, MA
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Lu Y, Okoroha KR, Patel BH, Nwachukwu BU, Baker JD, Idarraga AJ, Forsythe B. Return to play and performance after shoulder instability in National Basketball Association athletes. J Shoulder Elbow Surg 2020; 29:50-57. [PMID: 31439428 DOI: 10.1016/j.jse.2019.05.035] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/21/2019] [Accepted: 05/21/2019] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS We hypothesized that players in the National Basketball Association (NBA) who sustained a shoulder destabilizing injury could return to play (RTP) successfully at a high rate regardless of treatment type. METHODS We used publicly available data to identify and evaluate 50 players who sustained an in-season shoulder instability event (subluxation/dislocation) while playing in the NBA. Demographic variables, return to NBA gameplay, incidence of surgery, time to RTP, recurrent instability events, and player efficiency rating (PER) were collected. Overall RTP was determined, and players were compared by type of injury and mode of treatment. RESULTS All players (50/50) returned to game play after sustaining a shoulder instability event. In those treated nonoperatively, athletes who sustained shoulder subluxations returned after an average of 3.6 weeks, compared with 7.6 weeks in those who sustained a shoulder dislocation (P = .037). Players who underwent operative management returned after an average of 19 weeks. Athletes treated operatively were found to have a longer time interval between a recurrent instability event (70 weeks vs. 28.5 weeks, P = .001). CONCLUSION We found 100% rate of RTP after a shoulder instability event in an NBA athlete. Players who experience shoulder dislocations were found to miss more time before RTP and were more likely to undergo surgical intervention compared with those who experienced a subluxation. Surgical repair maintained a longer interval between recurrent instability. Future investigations should aim to evaluate outcomes based on surgical procedures and identify possible risk factors predictive of recurrent instability or failure to RTP.
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Affiliation(s)
- Yining Lu
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Kelechi R Okoroha
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Bhavik H Patel
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Benedict U Nwachukwu
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - James D Baker
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Alexander J Idarraga
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Brian Forsythe
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA.
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Abstract
Joint hypermobility may be syndromic or nonsyndromic, asymptomatic or symptomatic. However, asymptomatic joint hypermobility can cause repetitive use injury, alter biomechanics, or become symptomatic later in life. Symptomatic joint hypermobility can result from soft tissue injury or muscular strain caused by muscular imbalance. Treatment is straightforward once joint hypermobility is recognized. Generalized joint hypermobility can be assessed using a standardized in-office examination. Generalized joint hypermobility may also be a feature of a heritable connective tissue disorder with other systemic findings. Therefore, assessing joint hypermobility in the context of musculoskeletal complaints may lead to recognizing systemic manifestations and allow treatment accordingly.
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Affiliation(s)
- Brad T Tinkle
- Division of Medical Genetics, Peyton Manning Children's Hospital, 8402 Harcourt Road, Suite 300, Indianapolis, IN 46260, USA.
| | - Howard P Levy
- Division of General Internal Medicine, McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University, 10753 Falls Road, Suite 325, Baltimore, MD 21093, USA
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Abstract
BACKGROUND Athletes with chronic ankle instability (CAI) often develop complications such as pain, instability, and reduced postural control and balance stability, all of which affect athletic performance. This study investigated the effects of a 4° medal wedge intervention on static and dynamic balance in athletes with CAI. METHODS The participants were 24 healthy and 25 CAI athletes. Participants received a 4° medial wedge applied at the rear foot insole and completed the experiment measurements before and after the wedge intervention. The main outcome measures included the area and path length of the center of pressure when participants performed single-leg standing balance in the closed eye condition and the dynamic balance scores of a multiple single-leg hop stabilization test. RESULTS The single-leg standing balance significantly improved in CAI (P = .027) and control groups (P = .005) after the medial wedge intervention. The dynamic balance scores significantly decreased from 53.00 ± 25.22 to 41.24 ± 21 48 (P = .015) in CAI group after medial wedge intervention. CONCLUSION Wearing a 4° medial wedge applied at the rear foot insole improved static and dynamic balance immediately in athletes with CAI. We suggest that clinicians may provide the foot insole to improve balance deficit in athletes having CAI.
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Affiliation(s)
- Hsiao-Yun Chang
- Department of Athletic Training and Health, National Taiwan Sport University, Taoyuan
| | - Yun-Chi Chang
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei
| | - Shih-Chung Cheng
- Graduate Institute of Athletics and Coaching Science, National Taiwan Sport University, Taoyuan
| | - Chun-Hou Wang
- Department of Physical Therapy, Chung Shan Medical University, and Physical Therapy Room, Chung Shan Medical University Hospital, Taichung, Taiwan
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Tan DMK, Lim JX. Treatment of Carpal Instability and Distal Radioulnar Joint Instability. Clin Plast Surg 2019; 46:451-468. [PMID: 31103089 DOI: 10.1016/j.cps.2019.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Carpal instability and distal radioulnar joint instability represent an important set of conditions responsible for pain and disability in the wrist. Either condition can occur as a result of ligamentous failure or loss of articular congruity from fractures or a combination of both. Instability itself is a clinical diagnosis supported by relevant imaging modalities. Carpal and distal radioulnar joint instability needs to be considered according to its stage and severity as well as other factors like etiology and chronicity to determine the optimal treatment option. This article summarizes the conditions most relevant to the practice of a hand surgeon, with emphasis divided equally between assessment and diagnosis, staging, and treatment. The 3 most common carpal instability conditions are outlined in this article together with a review on acute and chronic distal radioulnar joint instability.
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Affiliation(s)
- David Meng Kiat Tan
- Department of Hand and Reconstructive Microsurgery, National University Hospital Singapore, 1E Kent Ridge Road, Tower Block, Level 11, Singapore 119228, Singapore.
| | - Jin Xi Lim
- Department of Hand and Reconstructive Microsurgery, National University Hospital Singapore, 1E Kent Ridge Road, Tower Block, Level 11, Singapore 119228, Singapore
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Díaz-Rodríguez B, Martín Guerrero-Rubio T. [Treatment of anterior shoulder instability with remplissage for Hill-Sachs injuries and Bankart injury compared to pure Bankart injuries]. Acta Ortop Mex 2019; 33:162-165. [PMID: 32246607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Anterior shoulder dislocation occurs in more than 90% of the time, the main cause is traumatic, describing two main lesions in this pathology: Bankarts and Hill-Sachss injury, the recurrence rate is not similar in open repair and with a possible advantage of arthroscopic surgery with less loss of movement range, lower risk of subscapular muscle damage, faster return to daily activities and increased patient satisfaction. OBJECTIVE Assessing functionality, mobility and stability of the shoulder in patients treated: arthroscopic Bankart repair versus arthroscopic Bankart repair + remplissage. METHODS Clinical records of patients with shoulder instability were reviewed Hill-Sachs and Bankart lesions were doumented; 21 post-surgical patients and were physically examined to evaluate the range of motion, Rowe functional scales and Western Ontario Shoulder Instability Index were used. 13 months of follow up as an average. RESULTS There was no recurrence of dislocation with either technique, greater satisfaction was observed in the remplissage group; however, the limitation of the motion arc is greater. CONCLUSION Both groups reduce instability, control pain and mostly satisfy patients in the 13-month follow-up.
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Affiliation(s)
- B Díaz-Rodríguez
- Centro Médico del Instituto de Seguridad Social del Estado de México y Municipios (ISSEMyM) Ecatepec, Estado de México. México
| | - T Martín Guerrero-Rubio
- Centro Médico del Instituto de Seguridad Social del Estado de México y Municipios (ISSEMyM) Ecatepec, Estado de México. México
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Weerasekara I, Osmotherly PG, Snodgrass SJ, Tessier J, Rivett DA. Effects of mobilisation with movement (MWM) on anatomical and clinical characteristics of chronic ankle instability: a randomised controlled trial protocol. BMC Musculoskelet Disord 2019; 20:75. [PMID: 30760256 PMCID: PMC6375188 DOI: 10.1186/s12891-019-2447-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 02/01/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Up to 40% of individuals who sprain their ankle develop chronic ankle instability (CAI). One treatment option for this debilitating condition is joint mobilisation. There is preliminary evidence that Mulligan's Mobilisation With Movement (MWM) is effective for treating patients with CAI, but the mechanisms by which it works are unclear, with Mulligan suggesting a repositioning of the fibula. This randomised controlled trial aims to determine the effects of MWM on anatomical and clinical characteristics of CAI. METHODS Participants 18 years or over with CAI will be accepted into the study if they satisfy the inclusion and exclusion criteria endorsed by the International Ankle Consortium. They will be randomised into the experimental group (MWM) or the placebo group (detuned laser) and will receive the assigned intervention over 4 weeks. General joint hypermobility and the presence of mechanical instability of the ankle will be recorded during the first visit. Further, position of the fibula, self-reported function, ankle dorsiflexion range, pressure pain threshold, pain intensity, and static and dynamic balance will be assessed at baseline, and at the conclusion of course of intervention. Follow-up data will be collected at the twelfth week and at the twelfth month following intervention. DISCUSSION Effectiveness of MWM on clinically relevant outcomes, including long term benefits will be evaluated. The capacity of MWM to reverse any positional fault of the fibula and the association of any positional fault with other clinically important outcomes for CAI will be explored. Proposed biomechanical mechanisms of fibular positional fault and other neurophysiological mechanisms that may explain the treatment effects of MWM will be further explored. The long term effectiveness of MWM in CAI will also be assessed. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry; ACTRN12617001467325 (17/10/2017).
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Affiliation(s)
- Ishanka Weerasekara
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia
| | - Peter Grant Osmotherly
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia
| | - Suzanne Jordan Snodgrass
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia
| | - John Tessier
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia
| | - Darren Anthony Rivett
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia
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Westad K, Tjoestolvsen F, Hebron C. The effectiveness of Mulligan's mobilisation with movement (MWM) on peripheral joints in musculoskeletal (MSK) conditions: A systematic review. Musculoskelet Sci Pract 2019; 39:157-163. [PMID: 30583976 DOI: 10.1016/j.msksp.2018.12.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 11/29/2018] [Accepted: 12/05/2018] [Indexed: 12/26/2022]
Abstract
UNLABELLED Musculoskeletal (MSK) conditions are very common and represent a major concern for the society and global health. The manual therapy technique Mulligan's Mobilisation with Movement (MWM) has shown promising results in treating a variety of MSK conditions. The aim of this review was to systematically review the literature to establish whether MWM treatment is effective for improving pain and function in patients with MSK conditions related to peripheral joints. METHODS Seven electronic databases (MEDLINE (through Ovid), EMBASE (through ovid), CINAHL (through EBSCO), Cochrane (CENTRAL), Web of Science, SPORTDiscus (through EBSCO) AND PEDro) were searched up to November 2017 for randomized controlled trials (RCTs). The quality of the evidence was rated using the GRADE approach. RESULTS Seven published trials were identified in which all trials presented positive clinical outcome in pain and function of MWM. Moderate quality evidence was found for the effectiveness of MWM in pain and function in patients with chronic ankle instability (CAI) and hip osteoarthritis (OA). There was found low quality evidence for shoulder impingement syndrome (SIS) and low and very low quality evidence for lateral epicondylalgia. CONCLUSION Overall MWM interventions applied to peripheral joints seems to be superior to placebo and no intervention controls, but not in comparison with other medical or physiotherapy interventions. There is a need for more high quality trials that investigate the short and long-term effect of a series of MWM interventions.
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Affiliation(s)
- Kim Westad
- University of Brighton, Health Sciences, Robert Dodd Building, 49 Darley Road, Eastbourne, BN20 7UR, UK.
| | - Frode Tjoestolvsen
- University of Brighton, Health Sciences, Robert Dodd Building, 49 Darley Road, Eastbourne, BN20 7UR, UK
| | - Clair Hebron
- University of Brighton, Health Sciences, Robert Dodd Building, 49 Darley Road, Eastbourne, BN20 7UR, UK
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Gil JA, Ebert K, Blanchard K, Goodman AD, Crisco JJ, Katarincic JA. Efficacy of a radial-based thumb metacarpophalangeal-stabilizing orthosis for protecting the thumb metacarpophalangeal joint ulnar collateral ligament. J Hand Ther 2019; 32:80-85. [PMID: 28711411 PMCID: PMC6107430 DOI: 10.1016/j.jht.2017.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 05/31/2017] [Accepted: 06/11/2017] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Basic research (biomechanics). INTRODUCTION The high degree of motion that occurs at the thumb metacarpophalangeal (MCP) joint must be taken into account when immobilizing a partially torn or repaired thumb ulnar collateral ligament. PURPOSE OF THE STUDY To determine the efficacy of a radial-based thumb MCP-stabilizing orthosis in resisting abduction across the thumb ulnar collateral ligament. METHODS Ten fresh cadaveric hands were mounted to a custom board. An anteroposterior radiograph of the thumb was obtained with a 2 N preload valgus force applied to the thumb, and the angle between the Kirschner wires was measured as a baseline. Subsequently, 20, 40, 60, 80, and 100 N valgus forces were applied 15 mm distal to the MCP joint. Anteroposterior radiographs of the thumb were obtained after each force was applied. The angle of displacement between the wires was measured and compared with the baseline angle. The angles were measured with an imaging processing tool. A custom radial-based thumb MCP-stabilizing orthosis was fashioned for each cadaveric thumb by a certified hand therapist. The aforementioned loading protocol was then repeated. RESULTS The radial-based thumb MCP-stabilizing orthosis significantly reduced mean abduction angles at each applied load. DISCUSSION We found that our orthosis, despite being hand-based and leaving the thumb IP and CMC joints free, significantly reduced mean abduction angles at each applied load. CONCLUSIONS This investigation provides objective evidence that our radial-based thumb MCP-stabilizing orthosis effectively reduces the degree of abduction that occurs at the thumb MCP joint up to at least 100 N. LEVEL OF EVIDENCE n/a (cadaveric).
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Affiliation(s)
- Joseph A Gil
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA.
| | - Kerry Ebert
- University Orthopedics, Hand Therapy, Providence, RI, USA
| | - Keri Blanchard
- University Orthopedics, Hand Therapy, Providence, RI, USA
| | - Avi D Goodman
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Joseph J Crisco
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Julia A Katarincic
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA
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