The valgus stress flexion test for medial ligamentous incompetence

Background: Medial collateral ligament (MCL) injuries are common after elbow trauma and in overhead throwing athletes. A hinged elbow orthosis (HEO) is often used to protect the elbow from valgus stress early after injury and during early return to play. However, there is minimal evidence regarding the efficacy of these orthoses in controlling instability and their influence on long-term clinical outcomes. Purpose: (1) To quantify the effect of an HEO on elbow stability after simulated MCL injury. (2) To determine whether arm position, forearm rotation, and muscle activation influence the effectiveness of an HEO. Study Design: Controlled laboratory study. Methods: Seven cadaveric upper extremity specimens were tested in a custom simulator that enabled elbow motion via computer-controlled actuators and motors attached to relevant tendons. Specimens were examined in 2 arm positions (dependent, valgus) and 2 forearm positions (pronation, supination) during passive and simulated active elbow flexion while unbraced and then while braced with an HEO. Testing was performed in intact elbows and repeated after simulated MCL injury. An electromagnetic tracking device measured valgus angulation as an indicator of elbow stability. Results: When the arm was dependent, the HEO increased valgus angle with the forearm in pronation (+1.0°± 0.2°, P = .003) and supination (+1.5°± 0.0°, P = .006) during active motion. It had no significant effect on elbow stability during passive motion. In the valgus position, the HEO had no effect on elbow stability during passive or active motion in pronation and supination. With the arm in the valgus position with the HEO, muscle activation reduced instability during pronation (–10.3°± 2.5°, P = .006) but not supination ( P = .61). Conclusion: In this in vitro study, this HEO did not enhance mechanical stability when the arm was in the valgus and dependent positions after MCL injury. Clinical Relevance: After MCL injury, an HEO likely does not provide mechanical elbow stability during rehabilitative exercises or when the elbow is subjected to valgus stress such as occurs during throwing.

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Limiting the Pitch Count in Youth Baseball Pitchers Decreases Elbow Pain

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121989108 ◽

2021 ◽

Vol 9 (3) ◽

pp. 232596712198910

Author(s):

Tetsuya Matsuura ◽

Yuki Takata ◽

Toshiyuki Iwame ◽

Jyoji Iwase ◽

Kenji Yokoyama ◽

...

Keyword(s):

Range Of Motion ◽

Stress Test ◽

Daily Maximum ◽

Test Results ◽

Level Of Evidence ◽

Valgus Stress ◽

Radiographic Images ◽

Elbow Pain ◽

Youth Baseball ◽

Baseball Pitchers

Background: Reducing the number of pitches thrown is regarded as the most effective way to prevent throwing injuries in youth baseball pitchers. However, few studies have compared the effectiveness of limiting the pitch count versus the limiting the number of innings pitched in terms of elbow injuries. Hypothesis: We hypothesized that, compared with inning limits, pitch count limits would lead to greater decreases in elbow pain, range of motion deficits, positive moving valgus stress test results, and the risk of capitellar osteochondritis dissecans (OCD). Study Design: Cohort study; Level of evidence, 3. Methods: This study retrospectively reviewed baseball pitchers aged 8 to 12 years in 2017 and 2018. Inning and pitch count limits in games were set to a daily maximum of 7 innings in 2017 and 70 pitches in 2018. Elbow pain, range of motion, and moving valgus stress test results were evaluated. The presence of capitellar OCD was assessed on ultrasonographic and radiographic images. Results: A total of 352 pitchers in 2017 and 367 pitchers in 2018 participated. The mean pitch count per game was lower in the pitch count limit (CL) group (52.5 ± 16.0) than in the inning limit (IL) group (98.2 ± 19.5) ( P < .001). Compared with the IL group, the CL group had significantly lower rates of elbow pain (40.9% vs 31.9%, respectively; P = .01) and reduced flexion (19.0% vs 10.6%, respectively; P = .001). Multivariate analysis revealed a significant association between elbow pain and age in both the IL and the CL groups ( P < .0001 and P = .02, respectively) and between OCD and elbow pain in the CL group ( P = .04). Conclusion: A pitch count limit of ≤70 pitches per day for baseball pitchers ≤12 years could be more protective against elbow pain and reduced flexion than a limit of ≤7 innings per day, but it may not be effective for reducing the risk of capitellar OCD.

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Performance in the cranio-cervical flexion test is altered in elderly subjects

Manual Therapy ◽

10.1016/j.math.2008.12.003 ◽

2009 ◽

Vol 14 (5) ◽

pp. 475-479 ◽

Cited By ~ 15

Author(s):

Sureeporn Uthaikhup ◽

Gwendolen Jull

Keyword(s):

Elderly Subjects ◽

Flexion Test

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The Efficacy of Core Stability Assessment as a Determiner of Performance in Dynamic Balance and Agility Tests.

10.20944/preprints201608.0081.v2 ◽

2016 ◽

Author(s):

Kieran McCartney ◽

Jacky Forsyth

Keyword(s):

Significant Relationship ◽

Dynamic Balance ◽

Core Stability ◽

Stability Assessment ◽

Stability Tests ◽

Active Population ◽

The Mean ◽

Physiological Tests ◽

The Relationship ◽

Flexion Test

Aim: The aim of this study was to investigate if tests used to assess core stability could be used to determine success in physiological tests applied to assess dynamic balance and agility for a young active population. Methods: Pearson's r correlation coefficient was used to assess the relationship between the core stability tests and the dynamic balance and agility tests. Evaluation of the tests was established using Cronbach's coefficient of variance as part of intra-rater reliability tests. An analysis of 18 active college aged students was conducted (males: n= 13, females: n= 5). The mean ± SD age for males was 19.2 years ± 3.22 years and for females was 19.4 years ± 1.14 years. Conclusion: The results indicate that there is no significant relationship between tests that assess core stability and tests conducted to assess dynamic balance in active young adults. With the exception of the abdominal flexion test, no significant relationship exists between the remaining core stability tests and agility T-Test. Core stability is not a determinant of balance and agility.

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Correlation between Core Strength and Stability with Body Mass Index among Postmenopausal Women.

International Journal of Pharma and Bio Sciences ◽

10.22376/ijpbs/lpr.2021.11.4.l23-28 ◽

2021 ◽

Vol 11 (4) ◽

Author(s):

S Bhosale Komal ◽

V Bhosale Siddhi ◽

Anandh Dr. S

Keyword(s):

Body Mass Index ◽

Postmenopausal Women ◽

Body Mass ◽

Pearson Correlation ◽

The Body ◽

P Value ◽

Endurance Test ◽

Core Strength ◽

The Core ◽

Flexion Test

Women in postmenopausal period of their life face various physical and physiological changes causing lack of estrogen and progesterone hormones, changes in the reproductive and genitals organs, vasomotor system in the body along with mood related symptoms such as anxiety, etc. Lifestyle, body fat distribution and anthropometric changes adds on to the bone strength in postmenopausal women. It may be a risk factor for osteoporotic fracture, cardiovascular, metabolic diseases, etc. Core strength and stability is greatly influenced by body composition and adiposity. The aim of the study was to correlate the core strength assessed with the Body Mass Index (BMI) among postmenopausal women. The objective of the study is to find the correlation between the core strength assessed with the Body Mass Index using 60° flexion test, Beiring Sorenson test and Unilateral Hip Bridge Endurance test among postmenopausal women with age ranging from 46-70 years. 96 healthy postmenopausal women in Karad city with a natural history of menopause were selected for the study. Based upon BMI values, the subjects were grouped as Underweight (<18.5 kg/m2), Normal weight (18.5-24.9 kg/m2), Overweight (25-29.9 kg/m2 and more). The outcome values for strength were correlated with the BMI of postmenopausal women. In the study, the Pearson correlation(r) was -0.361 and the P value was 0.0003 showing extremely significant correlation between the BMI and 60° Flexion test. For the Beiring Sorenson Test, the Pearson correlation value was -0.305 and the P value was 0.0025 showing very significant correlation between the BMI and Beiring Sorenson Test. Correlation of BMI and Unilateral Hip Bridge Endurance Test shows a Pearson Correlation value of -0.322 and the P value 0.0013 claiming very significant correlation between the BMI and Unilateral Hip Bridge Endurance Test. The study concludes that there is a significantly negative correlation between the core strength and stability with the Body Mass Index among postmenopausal women.

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Anterior Cruciate ligament injuries of the knee:

South African Journal of Sports Medicine ◽

10.17159/2078-516x/2018/v30i1a5265 ◽

2018 ◽

Vol 30 (1) ◽

pp. 1-6

Author(s):

G Linde Strauss ◽

D Janse van Rensburg ◽

C Grant ◽

A Jansen van Rensburg ◽

M Velleman ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Cruciate Ligament ◽

Acl Injury ◽

Mechanism Of Injury ◽

Mri Scan ◽

Chi Square ◽

Valgus Stress ◽

Acl Injuries ◽

Anterior Cruciate Ligament Injuries ◽

Anterior Cruciate

Abstract Background and problem statement Anterior cruciate ligament injuries are common among athletes and the general public. These injuries may lead to significant absence from activity with an associated financial and social burden. No definitive association has been described between mechanism of injury and pathology to enable us to put preventative measures in place in order to limit these injuries. Aim To determine whether there is an association between the mechanism of injury and the pathology seen on a magnetic resonance imaging (MRI) scan in anterior cruciate ligament (ACL) injuries. Methods This was a cross-sectional analytical study. Eighty seven male patients with an ACL injury, who had an MRI scan of the knee within the last two years participated in this study. Participants were contacted to give consent that their information be used in this study. The mechanism of injury and the pathology seen on the MRI scan was noted and categorised into different mechanism of injury groups and associated pathology groups. Statistical analyses included summaries of the data and a test for association between mechanism of injury and pathology. Since there were multiple pathology responses to each mechanism, a modified version of the chi-square test for independence was used. A 5% level of significance was specified. Results MRI scans of ACL injuries indicated that the mechanism of a solid foot plant with rotation of the knee has a greater tendency to be associated with medial meniscal injuries (77%), and also a 54% possibility to be associated with lateral meniscal injuries. A solid foot plant with a valgus stress on the knee showed a higher incidence of associated medial collateral ligaments (MCL) injuries (41%) and femoral bone bruising (62 %). These two mechanisms of injury are the most common in ACL injuries and contribute to the clinical significance found in this study. The p-value was however not statistically significant (p=0.44, chi-square value=20.27, df=45) for any association between pathology and mechanism of injury. Conclusion Some injury mechanisms causing ACL injury were more common than others and also had more associated pathology. The most common mechanism of injury noted is a solid foot plant with either rotation of the knee or valgus stress on the knee. Strengthening tissue structures involved in those movement patterns that cause these mechanisms can possibly limit ACL injuries in athletes and the general public. Key words Anterior cruciate ligament injury, mechanism, association, pathology, MRI scan, prevention.

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Does Transection of the Superficial MCL During HTO Result in Progressive Valgus Instability?

The American Journal of Sports Medicine ◽

10.1177/03635465211059162 ◽

2021 ◽

pp. 036354652110591

Author(s):

Joo-Hwan Kim ◽

Dong Jin Ryu ◽

Sung-Sahn Lee ◽

Seung Pil Jang ◽

Jae Sung Park ◽

...

Keyword(s):

Case Series ◽

Preoperative Assessment ◽

International Knee Documentation Committee ◽

Clinical Results ◽

Osteotomy Site ◽

Tibial Osteotomy ◽

Level Of Evidence ◽

Valgus Stress ◽

Valgus Instability

Background: During high tibial osteotomy (HTO), the superficial medial collateral ligament (sMCL) is cut or released at any degree to expose the osteotomy site and achieve the targeted alignment correction according to the surgeon’s preference. However, it is still unclear whether transection of sMCL increases valgus laxity. Purpose: We aimed to assess the outcomes and safety of sMCL transection, especially focusing on iatrogenic valgus instability. Study Design: Case series; Level of evidence, 4. Methods: Seventy-two patients (89 knees) who underwent medial open wedge HTO (MOWHTO) with transection of the sMCL between October 2013 and September 2018 were retrospectively investigated. Clinical evaluations, including the International Knee Documentation Committee (IKDC) score, Knee injury and Osteoarthritis Outcome Score (KOOS), and Tegner and Lysholm scores, were performed preoperatively and at 2 years postoperatively. The radiographic parameters hip-knee-ankle (HKA) angle, joint line convergence angle on standing radiographs (standing JLCA), and weightbearing line (WBL) ratio were assessed preoperatively and at 3 months, 6 months, 1 year, and 2 years postoperatively. To evaluate valgus laxity, we assessed the valgus JLCA and medial joint opening (MJO) at the aforementioned time points using valgus stress radiographs. Results: All clinical results at the 2-year follow-up were significantly improved compared with those obtained at the preoperative assessment ( P < .001). The postoperative HKA angle significantly differed from the preoperative one, and no significant valgus progression was observed during follow-up (preoperative, 8.5°± 2.7°; 3 months, –3.5°± 2.0°; 6 months, –3.2°± 2.3°; 1 year, –3.1°± 2.3°; 2 years, –2.9°± 2.5°; P < .001) The mean WBL ratio was 62.5% ± 9.0% at 2 years postoperatively. The postoperative valgus JLCA at all follow-up points did not significantly change compared with the preoperative valgus JLCA (preoperative, –0.1°± 2.1°; 3 months, –0.2°± 2.4°; 6 months, –0.1°± 2.5°; 1 year, 0.1°± 2.5°; 2 years, 0.2°± 2.2°) The postoperative MJO at all follow-up points did not significantly change compared with the preoperative MJO (preoperative, 7.1 ± 1.7 mm; 3 months, 7.0 ± 1.7 mm; 6 months, 6.9 ± 1.9 mm; 1 year, 6.7 ± 1.8 mm; 2 years, 6.8 ± 1.8 mm). Conclusion: Transection of the sMCL during MOWHTO does not increase valgus laxity and could yield desirable clinical and radiographic results.

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The Lateral Side

Unicompartmental Arthroplasty with the Oxford Knee ◽

10.23912/978-1-910158-45-6-4338 ◽

2015 ◽

Author(s):

John Goodfellow ◽

John O'Connor ◽

Hemant Pandit ◽

Christopher Dodd ◽

David Murray

Keyword(s):

Rare Disease ◽

Surgical Techniques ◽

Lateral Compartment ◽

Clinical Results ◽

Medial Compartment ◽

Lateral Side ◽

Normal Anatomy ◽

Valgus Stress ◽

Pathological Lesions ◽

As If

Lateral unicompartmental OA is a relatively rare disease said to account for about one eighth of all unicompartmental arthritis 1 . However, the incidence may be higher because it is a disease of flexion and is commonly missed on standing AP radiographs. To identify lateral OA reliably, either a valgus stress radiograph in 45° flexion or a Rosenberg view is necessary. The clinical results of UKA in the lateral compartment have sometimes been worse than in the medial compartment 2 and sometimes better 3 . Some early papers reported results of series containing both medial and lateral operations as if they were essentially the same, but the normal anatomy and the pathological lesions of the two compartments are very different so the surgical techniques are different.

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Radial head fractures

Shoulder & Elbow ◽

10.1177/1758573219876921 ◽

2019 ◽

Vol 12 (3) ◽

pp. 212-223 ◽

Cited By ~ 1

Author(s):

RP van Riet ◽

MPJ van den Bekerom ◽

A Van Tongel ◽

C Spross ◽

R Barco ◽

...

Keyword(s):

Radial Head ◽

Long Term Results ◽

Valgus Stress ◽

Proximal Ulna ◽

Radial Head Fractures ◽

Radial Head Arthroplasty ◽

Radial Head Replacement ◽

Treatment Type ◽

Radial Head Resection ◽

Type 3

The shape and size of the radial head is highly variable but correlates to the contralateral side. The radial head is a secondary stabilizer to valgus stress and provides lateral stability. The modified Mason–Hotchkiss classification is the most commonly used and describes three types, depending on the number of fragments and their displacement. Type 1 fractures are typically treated conservatively. Surgical reduction and fixation are recommended for type 2 fractures, if there is a mechanical block to motion. This can be done arthroscopically or open. Controversy exists for two-part fractures with >2 mm and <5 mm displacement, without a mechanical bloc as good results have been published with conservative treatment. Type 3 fractures are often treated with radial head replacement. Although radial head resection is also an option as long-term results have been shown to be favourable. Radial head arthroplasty is recommended in type 3 fractures with ligamentous injury or proximal ulna fractures. Failure of primary radial head replacement may be due to several factors. Identification of the cause of failure is essential. Failed radial head arthroplasty can be treated by implant removal alone, interposition arthroplasty, revision radial head replacement either as a single stage or two-stage procedure.

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