scholarly journals Foot Progression Angle Walking Test

2017 ◽  
Vol 5 (1) ◽  
pp. 232596711667964 ◽  
Author(s):  
Anil S. Ranawat ◽  
Michael A. Gaudiani ◽  
Pablo A. Slullitel ◽  
James Satalich ◽  
Brian J. Rebolledo
Keyword(s):  
Physical Examination ◽  
Clinical Diagnosis ◽  
External Rotation ◽  
Dynamic Assessment ◽  
Demographic Data ◽  
Hip Pain ◽  
Study Cohort ◽  
Level Of Evidence ◽  
Hip Instability ◽  
Foot Progression Angle

Background: Determining an accurate clinical diagnosis for nonarthritic hip pain may be challenging, as symptoms related to femoroacetabular impingement (FAI) or hip instability can be difficult to elucidate with current testing methods. In addition, commonly utilized physical examination maneuvers are static and do not include a dynamic or weightbearing assessment to reproduce activity-related symptoms. Therefore, implementing a dynamic assessment for FAI and hip instability could help to improve diagnostic accuracy for routine clinical examinations of patients with nonarthritic hip pain. Purpose: To assess the efficacy of a novel diagnostic foot progression angle walking (FPAW) test for identifying hip pathology related to FAI or hip instability. Study Design: Prospective cohort study; Level of evidence, 3. Methods: This prospective study included 199 consecutive patients who were evaluated for unilateral hip pain and who underwent FPAW testing along with standard physical examination testing. Demographic data, including age, sex and hip laterality, were collected from each patient. FPAW testing was performed with directed internal and external foot progression angles from their baseline measurements, with a positive test reproducing pain and/or discomfort. Comparisons were then made with flexion adduction internal rotation (FADIR) and flexion abduction external rotation (FABER) tests as the designated diagnostic standard examinations for FAI and hip instability, respectively. Sensitivity and specificity, along with the McNemar chi-square test for group comparison, were used to generate summary statistics. In addition, areas under the combined receiver operating characteristic curves (AUC) of test performance were calculated for both FPAW and the designated standard examination tests (FADIR, FABER). Radiographic imaging was used subsequently to confirm the diagnosis. Results: The average age of the study cohort was 35.4 ± 11.8 years, with 114 patients being female (57%). Positive internal FPAW testing demonstrated 61% sensitivity and 56% specificity for an FAI diagnosis, compared with the 96% sensitivity and 11% specificity seen with FADIR testing. Internal FPAW was less sensitive, yet more specific compared with FADIR ( P < .001). Combined testing had improved accuracy (AUC = 0.58; P < .05) compared with FADIR (AUC = 0.52; P = .21) or FPAW (AUC = 0.57; P = .057) alone. Positive external FPAW revealed 67% sensitivity and 70% specificity for hip instability, while FABER testing was 54% sensitive and 90% specific. External FPAW was significantly more specific but had similar sensitivity to FABER. Combined testing had greater accuracy (AUC = 0.77) compared with FABER (AUC = 0.70) or FPAW (AUC = 0.67) alone ( P < .001). Conclusion: The FPAW examination can be used as an adjunct examination to assist and improve the accuracy of the clinical diagnosis for FAI and hip instability.

scholarly journals EPIDEMIOLOGY OF HIP PAIN IN BRAZILIAN BODYBUILDERS

2021 ◽  
Vol 29 (3) ◽  
pp. 124-126
Author(s):  
LORENZO FAGOTTI ◽  
LEANDRO EJNISMAN ◽  
MARCOS ANTONIO ALMEIDA-SANTOS ◽  
HENRIQUE MELO CAMPOS GURGEL ◽  
HELDER DE SOUZA MIYAHARA ◽  
...  
Keyword(s):  
Informed Consent ◽  
Physical Examination ◽  
External Rotation ◽  
Case Series ◽  
Health Condition ◽  
Hip Pain ◽  
Level Of Evidence ◽  
Mean Values ◽  
History Of ◽  
Hip Flexion

ABSTRACT Objective: To determine the frequency of hip pain in competitive bodybuilders over three different bodybuilding competitions. Methods: This study evaluated bodybuilders recruited from three competitions during the year of 2016. All participants provided their informed consent and the study received IRB approval. Training routine, health condition, level of success on competitions, history of hip pain and physical examination of the hip were evaluated. Results: 113 bodybuilders were evaluated, mean age was 30.5 ± 8.65 years and mean BMI was 25.2 ± 3.65 kg/m2. Mean values for hip flexion, adduction, abduction, internal rotation, external rotation and distance between the knee and the table (FABER distance) were 116 ± 13, 23 ± 8, 71 ± 12, 40 ± 10, 36 ± 9 and 19 ± 4, respectively. Eight (7%) participants presented hip pain within the week prior to examination and only 2 (1,7%) presented with anterior impingement sign. None of the athletes who reported hip pain interrupted their physical training or performance. Conclusion: Symptomatic athletes continued their training program under the presence of hip pain. The frequency of hip pain among bodybuilders is high and may be underestimated in this study. Level of Evidence IV, Case series.

Acute and Subacute Changes in Hip Strength and Range of Movement After Arthroscopy to Address Chondrolabral Pathology

2019 ◽  
Vol 47 (8) ◽  
pp. 1939-1948 ◽  
Author(s):  
Matthew D. Freke ◽  
Kay Crossley ◽  
Kevin Sims ◽  
Trevor Russell ◽  
Patrick Weinrauch ◽  
...  
Keyword(s):  
Hip Arthroscopy ◽  
Repeated Measures ◽  
External Rotation ◽  
Case Series ◽  
Hip Pain ◽  
Range Of Movement ◽  
Level Of Evidence ◽  
Hip Strength ◽  
Hip Flexion ◽  
And Function

Background:Hip pain is associated with reduced muscle strength, range of movement (ROM), and function. Hip arthroscopy is undertaken to address coexistent intra-articular pathologies with the aim of reducing pain and improving function.Purpose:To evaluate changes in strength and ROM in a cohort with chondrolabral pathology before surgery to 3 and 6 months after hip arthroscopy.Study Design:Case series; Level of evidence, 4.Methods:Sixty-seven individuals with hip pain who were scheduled for hip arthroscopy were matched with 67 healthy controls. Hip strength and ROM were collected preoperatively and at 3 and 6 months postoperatively. Repeated measures analysis of variance evaluated whether strength and ROM differed between limbs and among time points. Bonferroni post hoc tests determined differences in hip strength and ROM among testing times and between the hip pain group and matched controls.Results:Hip extension, internal rotation (IR), external rotation (ER), and adduction ( P < .040) strength were greater at 3 months after surgery; all directions, including flexion, abduction, and squeeze, were greater at 6 months ( P < .015). Hip flexion ROM was greater at 3 months after surgery ( P = .013). Flexion, IR, and ER ROM was greater at 6 months ( P < .041). At 6 months, IR ROM ( P = .003) and flexion, IR, and ER strength ( P < .005) remained less than matched controls.Conclusion:With the exception of squeeze and flexion, all directions of hip strength and hip flexion ROM are significantly improved 3 months after arthroscopy to address chondrolabral pathology. By 6 months after arthroscopy, strength in all directions and flexion and rotation ROM are significantly improved in both limbs, but hip flexion, IR, and ER strength and IR ROM remain significantly less than that of healthy matched controls in both limbs.

Screw Removal Can Resolve Unexplained Anterior Pain Without Recurrence of Shoulder Instability After Open Latarjet Procedures

2020 ◽  
Vol 48 (6) ◽  
pp. 1450-1455 ◽  
Author(s):  
Arnaud Godenèche ◽  
Lorenzo Merlini ◽  
Steven Roulet ◽  
Morgane Le Chatelier ◽  
Damien Delgrande ◽  
...  
Keyword(s):  
Shoulder Instability ◽  
External Rotation ◽  
Case Series ◽  
Anterior Shoulder Instability ◽  
Study Cohort ◽  
Analog Scale ◽  
Recurrent Instability ◽  
Level Of Evidence ◽  
Unexplained Pain ◽  
Spine Segment

Background: Anterior shoulder instability can be successfully treated using Latarjet procedures, although a small proportion of patients report unexplained pain. Purpose/Hypothesis: The purpose was to report the prevalence and characteristics of patients with unexplained pain without recurrent instability after open Latarjet procedures and to determine whether screw removal can alleviate pain. The hypothesis was that unexplained pain without recurrent instability might be due to soft tissue impingements against the screw heads and that the removal of screws would alleviate or reduce pain. Study Design: Case series; Level of evidence, 4. Methods: We retrospectively reviewed the clinical and radiographic records of 461 consecutive shoulders treated by open Latarjet procedures for anterior instability between 2002 and 2014. Unexplained anterior pain was present in 21 shoulders (4.6%) and treated by screw removal at 29 ± 37 months (mean ± SD). Postoperative assessment at >12 months after screw removal included complications, visual analog scale for pain (pVAS), subjective shoulder value, Rowe score, Walch-Duplay score, and ranges of motion. The study cohort comprised the shoulders of 20 patients (9 women, 11 men) aged 25 ± 6 years (median, 25 years; range, 16-34 years) at screw removal and involved the dominant arm in 13 (62%) shoulders. Results: Screw removal alleviated pain completely in 14 shoulders (67%; pVAS improvement, 6.4 ± 1.8; median, 6; range, 3-8) and reduced pain in the remaining 7 (33%; pVAS improvement, 2.4 ± 1.4; median, 2; range, 1-5). At 38 ± 23 months after screw removal, 2 recurrences of instability unrelated to screw removal occurred. The subjective shoulder value was 79% ± 22% (median, 90%; range, 0%-95%); Rowe score, 85 ± 20 (median, 95; range, 30-100); and Walch-Duplay score, 82 ± 19 (median, 85; range, 25-100). Mobility improved in active forward elevation (171°± 14°), external rotation with the elbow at the side (61°± 12°), and external rotation with the arm at 90° of abduction (67°± 13°) and especially in internal rotation, with only 2 shoulders (10%) limited to T12 spine segment. Conclusion: The present findings confirm that unexplained anterior pain after Latarjet procedures can be related to the screws used to fix bone blocks, which can safely be alleviated or reduced by screw removal.

The Resisted Supination External Rotation Test

2005 ◽  
Vol 33 (9) ◽  
pp. 1315-1320 ◽  
Author(s):  
Thomas H. Myers ◽  
Jason R. Zemanovic ◽  
James R. Andrews
Keyword(s):  
Physical Examination ◽  
Predictive Value ◽  
External Rotation ◽  
Random Order ◽  
Clinical History ◽  
Clinical Test ◽  
Level Of Evidence ◽  
Rotation Test ◽  
Supination External Rotation ◽  
Anterior Posterior

Purpose To evaluate a new clinical test, the resisted supination external rotation test, for the diagnosis of superior labral anterior posterior lesions of the shoulder. Study Design Cohort study (diagnosis); Level of evidence, 2. Methods Forty athletes (average age, 23.9 years) with activity-related shoulder pain were enrolled in the study. The patients underwent 3 different tests designed specifically to detect superior labral anterior posterior lesions (the resisted supination external rotation test, the crank test, and the active compression test); the tests were performed in a random order on the affected shoulder. The results of the tests were compared with arthroscopic findings. Results Out of 40 athletes, 29 (72.5%) had superior labral anterior posterior tears. The resisted supination external rotation test had the highest sensitivity (82.8%), specificity (81.8%), positive predictive value (92.3%), negative predictive value (64.3%), and diagnostic accuracy (82.5%) of all tests performed. Conclusion By re-creating the peel-back mechanism, the resisted supination external rotation test is more accurate than 2 other commonly used physical examination tests designed to diagnose superior labral anterior posterior tears in overhead-throwing athletes. By using this test in the context of a thorough clinical history and physical examination, lesions of the superior labrum can be more reliably diagnosed.

Diagnostic Accuracy of Physical Examination Tests in Core Muscle Injury

2020 ◽  
Vol 48 (8) ◽  
pp. 1983-1988 ◽  
Author(s):  
Jennifer Kurowicki ◽  
Matthew J. Kraeutler ◽  
Iciar M. Dávila Castrodad ◽  
Alexander K. Hahn ◽  
Erica S. Simone ◽  
...  
Keyword(s):  
Physical Examination ◽  
Diagnostic Accuracy ◽  
Muscle Injury ◽  
External Rotation ◽  
Senior Author ◽  
Consecutive Series ◽  
Reference Standard ◽  
Level Of Evidence ◽  
Mri Scans ◽  
The Cross

Background: Core muscle injury (CMI), often referred to as a sports hernia, is a common cause of groin pain in athletes characterized by concomitant injury to the insertion of the adductor longus and the rectus abdominis muscles. Currently, the literature on CMI is sparse with no standardized physical examination tests used in the diagnosis of this type of injury. Purpose: To determine the diagnostic accuracy of various physical examination tests in the diagnosis of CMI. Study Design: Cohort study (Diagnosis); Level of evidence, 3. Methods: A consecutive series of patients evaluated by the senior author with symptoms consistent with CMI were included. Four physical examination tests were routinely performed in these patients by the senior author and were noted in each patient’s chart as positive or negative: (1) pain with resisted cross-body sit-up in figure-of-4 position, (2) pain with straight-leg sit-up, (3) pain with resisted hip flexion in external rotation (external rotation Stinchfield test), and (4) the presence of an adductor contracture. CMI was independently diagnosed by a reference standard (magnetic resonance imaging [MRI]). All MRI scans were read by a musculoskeletal fellowship-trained radiologist. The sensitivity and specificity of each physical examination test alone and in combination were calculated based on this reference standard. Results: A total of 81 patients were included in this study. MRI was positive for a CMI in 39 patients (48%) overall. Both the cross-body sit-up test and the presence of an adductor contracture were found to have a sensitivity of 100% (specificity, 3% for both). The external rotation Stinchfield test was found to have the highest specificity of 60% (sensitivity, 15%). The sensitivity of all 4 physical examination tests in combination was found to be 100% (specificity, 0%). Conclusion: Certain physical examination maneuvers can be used to assist in the diagnosis of a CMI. The cross-body sit-up test and the presence of an adductor contracture are highly sensitive but nonspecific tests for CMI and therefore should be used in conjunction with diagnostic imaging before deciding on an appropriate treatment course.

scholarly journals Deferring Routine Wrist Radiography Does Not Affect Management of de Quervain Tendinopathy Patients

2017 ◽  
Vol 07 (02) ◽  
pp. 115-120 ◽  
Author(s):  
Tiffany Liu ◽  
Chia Wu ◽  
David Steinberg ◽  
David Bozentka ◽  
L. Levin ◽  
...  
Keyword(s):  
Physical Examination ◽  
Medical Center ◽  
Academic Medical Center ◽  
Diagnostic Study ◽  
Level Of Evidence ◽  
Radiographic Findings ◽  
Academic Medical ◽  
De Quervain ◽  
Clinical Records ◽  
Surgical Release

Background Obtaining wrist radiographs prior to surgeon evaluation may be wasteful for patients ultimately diagnosed with de Quervain tendinopathy (DQT). Questions/Purpose Our primary question was whether radiographs directly influence treatment of patients presenting with DQT. A secondary question was whether radiographs influence the frequency of injection and surgical release between cohorts with and without radiographs evaluated within the same practice. Patients and Methods Patients diagnosed with DQT by fellowship-trained hand surgeons at an urban academic medical center were identified retrospectively. Basic demographics and radiographic findings were tabulated. Clinical records were studied to determine whether radiographic findings corroborated history or physical examination findings, and whether management was directly influenced by radiographic findings. Frequencies of treatment with injection and surgery were separately tabulated and compared between cohorts with and without radiographs. Results We included 181 patients (189 wrists), with no differences in demographics between the 58% (110 wrists) with and 42% (79 wrists) without radiographs. Fifty (45%) of imaged wrists demonstrated one or more abnormalities; however, even for the 13 (12%) with corroborating history and physical examination findings, wrist radiography did not directly influence a change in management for any patient in this series. No difference was observed in rates of injection or surgical release either upon initial presentation, or at most recent documented follow-up, between those with and without radiographs. No differences in frequency, types, or total number of additional simultaneous surgical procedures were observed for those treated surgically. Conclusion Wrist radiography does not influence management of patients presenting DQT. Level of Evidence This is a level III, diagnostic study.

scholarly journals Comparison of short-term outcomes of anterolateral supine approach and posterolateral approach for primary total hip arthroplasty: a retrospective study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Taku Ukai ◽  
Goro Ebihara ◽  
Masahiko Watanabe
Keyword(s):  
Total Hip Arthroplasty ◽  
Hospital Stay ◽  
Clinical Outcomes ◽  
Hip Arthroplasty ◽  
External Rotation ◽  
Posterolateral Approach ◽  
Level Of Evidence ◽  
Total Hip ◽  
Hip Flexion ◽  
Primary Total Hip Arthroplasty

Abstract Background This study aims to evaluate postoperative pain and functional and clinical outcomes of anterolateral supine (ALS) and posterolateral (PL) approaches for primary total hip arthroplasty. Materials and methods We retrospectively examined the joints of 110 patients who underwent primary total hip arthroplasty (THA). The ALS group was compared with the PL group using the pain visual analog scale (VAS) and narcotic consumption as pain outcomes. Functional outcomes included postoperative range of motion (ROM) of hip flexion, day on which patients could perform straight leg raising (SLR), day on which patients began using a walker or cane, duration of hospital stay, rate of transfer, and strength of hip muscles. Clinical outcomes included pre and postoperative Harris Hip Scores. Results No significant differences were found in the pain VAS scores or narcotic consumption between the two groups. The PL group could perform SLR earlier than the ALS group (P < 0.01). The ALS group started using a cane earlier (P < 0.01) and had a shorter hospital stay (P < 0.01) than the PL group. Degrees of active ROM of flexion at postoperative day (POD) 1 were significantly lower in the ALS group than in the PL group (P < 0.01). Regarding hip muscle strength, hip flexion was significantly weaker in the ALS group than in the PL group until 1-month POD (P < 0.01). External rotation from 2 weeks to 6 months postoperatively was significantly weaker in the PL group than in the ALS group (P < 0.01). Conclusion The ALS approach was more beneficial than the PL approach because ALS enabled better functional recovery of the strength of external rotation, improved rehabilitation, and involved a shorter hospital stay. Level of Evidence Level IV retrospective observational study.

scholarly journals Correlation of Ultrasound Findings With Clinical Stages and Impairment in Adhesive Capsulitis of the Shoulder

2021 ◽  
Vol 9 (5) ◽  
pp. 232596712110036
Author(s):  
Jong Geol Do ◽  
Jin Tae Hwang ◽  
Kyung Jae Yoon ◽  
Yong-Taek Lee
Keyword(s):  
Structural Changes ◽  
External Rotation ◽  
Biceps Tendon ◽  
Adhesive Capsulitis ◽  
Case Series ◽  
Tendon Sheath ◽  
Level Of Evidence ◽  
Cutoff Values ◽  
Diagnostic Values ◽  
Ultrasound Parameters

Background: Ultrasound is an essential tool for diagnosing shoulder disorders. However, the role of ultrasound in assessing and diagnosing adhesive capsulitis has not been fully studied. Purpose: To evaluate the ultrasound features of adhesive capsulitis and estimate the correlations between clinical impairment and ultrasound parameters. Study Design: Case series; Level of evidence, 4. Methods: A total of 61 patients with clinically diagnosed unilateral adhesive capsulitis were retrospectively reviewed using high-resolution ultrasound. To compare ultrasound parameters, we performed ultrasound examinations on both affected and unaffected shoulders. Ultrasound parameters, including thickness of the coracohumeral ligament (CHL), rotator interval (RI), axillary recess (AR), hypervascularity of the RI, and effusion of the long head of the biceps tendon sheath, were measured. Passive range of motion (PROM), visual analog scale for pain, and the Shoulder Pain and Disability Index were used for clinical assessment. Results: The CHL, the RI, and the AR in affected shoulders were significantly thicker than in unaffected shoulders ( P < .05). CHL thickness in affected shoulders was significantly correlated with PROM limitation, which included forward elevation, abduction, external rotation (ER), and internal rotation (IR) ( P < .05). AR thickness correlated with passive forward elevation limitation and passive IR limitation ( P < .05). The CHL was significantly thicker in stage 2 compared with stage 1, and the RI was thicker in stage 2 compared with stage 3. The diagnostic cutoff values for adhesive capsulitis were 2.2 mm for CHL thickness (77% sensitivity, 91.8% specificity) and 4 mm for AR thickness (68.9% sensitivity, 90.2% specificity). Conclusion: The ultrasound parameters associated with structural changes were correlated with clinical characteristics of adhesive capsulitis. Thickened CHL, RI, and AR were observed in affected shoulders. The cutoff values of 2.2 mm for CHL thickness and 4 mm for AR thickness can be used as cutoff diagnostic values for adhesive capsulitis.

scholarly journals Foot Progression Angle Walking Test- An Effective Dynamic Test for the Diagnosis of Femoroacetabular Impingement and Hip Instability

2015 ◽  
Vol 3 (7_suppl2) ◽  
pp. 2325967115S0014
Author(s):  
Anil S. Ranawat ◽  
Caroline Park ◽  
Thomas Licatesi ◽  
Brian J. Rebolledo ◽  
James Satalich
Keyword(s):  
Femoroacetabular Impingement ◽  
Dynamic Test ◽  
Hip Instability ◽  
Walking Test ◽  
Foot Progression Angle ◽  
Effective Dynamic

Evaluating the Outcomes of Rotator Cuff Repairs With Polytetrafluoroethylene Patches for Massive and Irreparable Rotator Cuff Tears With a Minimum 2-Year Follow-up

2018 ◽  
Vol 46 (13) ◽  
pp. 3155-3164 ◽  
Author(s):  
Vasanth Seker ◽  
Lisa Hackett ◽  
Patrick H. Lam ◽  
George A.C. Murrell
Keyword(s):  
Rotator Cuff ◽  
Range Of Motion ◽  
External Rotation ◽  
Case Series ◽  
Shoulder Function ◽  
Rotator Cuff Tears ◽  
Level Of Evidence ◽  
Irreparable Tear ◽  
Pain At Rest

Background: Massive and irreparable rotator cuff tears are difficult to manage surgically. One technique is to use a synthetic polytetrafluoroethylene (PTFE) patch to bridge the tear. However, there is little information regarding the outcomes of this procedure. Purpose: To determine the ≥2-year outcomes of patients for whom synthetic patches were used as tendon substitutes to bridge irreparable rotator cuff defects. Study Design: Case series; Level of evidence, 4. Methods: This retrospective cohort study used prospectively collected data. Patients included those with a synthetic patch inserted as an interposition graft for large and/or irreparable rotator cuff tears with a minimum 2-year follow-up. Standardized assessment of shoulder pain, function, range of motion, and strength was performed preoperatively, at 6 and 12 weeks, and at 6 months and ≥2 years. Radiograph and ultrasound were performed preoperatively, at 6 months, and ≥2 years. Results: At a mean of 36 months, 58 of 68 eligible patients were followed up, and 53 of 58 (90%) patches remained in situ. Three patches failed at the patch-tendon interface, while 1 patient (2 shoulders/patches) went on to have reverse total shoulder replacements. Patient-ranked shoulder stiffness ( P < .001), frequency of pain with activity and sleep ( P < .0001), level of pain at rest and overhead ( P < .0001), and overall shoulder function improved from bad to very good ( P < .0001) by 6 months. Supraspinatus (mean ± SEM: 29 ± 16 N to 42 ± 13 N) and external rotation (39 ± 13 N to 59 ± 15 N) strength were the most notable increases at the ≥2-year follow-up ( P < .0001). Passive range of motion also improved by 49% to 67%; forward flexion, from 131° to 171°; abduction, from 117° to 161°; external rotation, from 38° to 55°; and internal rotation, from L3 to T10 ( P < .0001) preoperatively to ≥2 years. The most improvement in passive range of motion occurred between 12 months and ≥2 years. The mean (SD) Constant-Murley score was 90 (12), while the American Shoulder and Elbow Surgeons score was 95 (8). Conclusion: At 36 months postoperatively, patients who had synthetic patches used as tendon substitutes to bridge irreparable rotator cuff defects reported less pain and greater overall shoulder function as compared with preoperative assessments. They demonstrated improved range of passive motion and improved strength. The data support the hypothesis that the technique of using a synthetic PTFE patch to bridge a large and/or irreparable tear has good construct integrity and improves patient and clinical outcomes.

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