scholarly journals Wrinkle sign for the Silfverskiöld test

2021 ◽  
Vol 15 (2) ◽  
pp. 188-190
Author(s):  
José Antonio Veiga Sanhudo ◽  
Giorgio Marin Canuto
Keyword(s):  
Physical Examination ◽  
Expert Opinion ◽  
Objective Measurement ◽  
Triceps Surae ◽  
Level Of Evidence ◽  
Examination Technique

Shortening of the triceps surae is evaluated using the Silfverskiöld test. The increase in dorsiflexion with the knee in flexion compared to the knee in extension makes the test positive. To perform the test, the examiner uses both hands and is not able to hold any device for objective measurement while assessing the magnitude of dorsiflexion. In view of this obstacle, this paper aims to describe a tip of a physical examination technique for evaluating the shortening of the triceps surae through the evaluation of the anterior wrinkle of the ankle. We performed the technique in a patient with shortening of the gastrocnemius and recorded the test, showing an increase in the anterior skinfold of the ankle. The test is simple, reproducible, requires no additional apparatus and shows variety in the severity of shortening. Level of Evidence V; Therapeutic Studies; Expert Opinion.

scholarly journals The Virtual Foot and Ankle Physical Examination

2020 ◽  
Vol 41 (8) ◽  
pp. 1017-1026
Author(s):  
Stephanie K. Eble ◽  
Oliver B. Hansen ◽  
Scott J. Ellis ◽  
Mark C. Drakos
Keyword(s):  
Physical Examination ◽  
Expert Opinion ◽  
Orthopedic Surgery ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Patient Instruction ◽  
Evidence Level ◽  
Virtual Visits ◽  
Routine Physical Examination

The COVID-19 pandemic has necessitated a rapid and drastic shift for clinicians and patients away from traditional in-person visits and toward internet-based virtual visits. The adoption of telehealth services is likely to persist in some capacity even as in-person visits resume, given the convenience and efficiency of telehealth consultations for patients and perhaps surgeons. A primary challenge of virtual visits, particularly in the field of orthopedic surgery, is the physical examination. However, for the foot and ankle, routine physical examination maneuvers can be completed virtually with little modification given proper patient instruction. We present a comprehensive virtual foot and ankle examination for telehealth visits, including instructions that can be provided to patients verbatim and a corresponding checklist for provider documentation. Level of Evidence: Level V, expert opinion.

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.

Use of Small-Pin Distraction and Low-Speed, High-Torque Burring for Talar Osteochondral Allografts: Technique Tip

2021 ◽  
pp. 107110072110031
Author(s):  
Ryan O’Leary ◽  
Ian M. Foran ◽  
David J. Dalstrom
Keyword(s):  
Expert Opinion ◽  
Level Of Evidence ◽  
Low Speed ◽  
Evidence Level ◽  
High Torque ◽  
Osteochondral Allografts

Level of Evidence: Level V, expert opinion.

scholarly journals Telemedicine Foot and Ankle Visits in the COVID-19 Era

2021 ◽  
Vol 6 (1) ◽  
pp. 247301142199406
Author(s):  
Sameh A. Labib ◽  
Rahul Goel ◽  
Wesley Manz ◽  
Jason Bariteau
Keyword(s):  
Patient Experience ◽  
Expert Opinion ◽  
Foot And Ankle ◽  
Office Visits ◽  
Level Of Evidence ◽  
Excellent Care ◽  
Musculoskeletal Care

Background: The COVID-19 pandemic created a difficult environment to provide musculoskeletal care to patients with foot and ankle pathology given the limitations placed on in-office visits. Telemedicine offered a unique avenue to reach these patients; however, the efficacy of telemedicine visits in patients with foot and ankle pathology is not well studied. We propose a telemedicine protocol that has allowed us to effectively see and treat patients with foot and ankle pathology. Methods: A 12-step standardized telemedicine protocol was created within the Foot and Ankle division that was used for seeing patients through telemedicine. Also included in this is previsit preparation and follow-up recommendations. Press Ganey surveys were retrospectively reviewed to understand patient experience with telemedicine. Results: 85.2% of patients surveyed responded with scores indicating excellent care. When comparing patients who were seen in-office and through telemedicine, 89.2% and 83.4% responded with scores indicating excellent care, respectively ( P = .37). Conclusion: Telemedicine offers an effective and convenient way to provide excellent musculoskeletal care to patients affected with foot and ankle pathology. This is the first study that evaluated a comprehensive protocol for telemedicine encounters and can be used to implement telemedicine by others using this approach. Level of Evidence: Level V, expert opinion.

scholarly journals Calcaneonavicular coalition resection

2020 ◽  
Vol 14 (3) ◽  
pp. 297-300
Author(s):  
Mercedes Juncay ◽  
Rafael Sposeto ◽  
Alexandre Godoy-Santos ◽  
Túlio Fernandes
Keyword(s):  
Surgical Treatment ◽  
Surgical Technique ◽  
Conservative Treatment ◽  
Treatment Option ◽  
Expert Opinion ◽  
Tarsal Bone ◽  
Tarsal Coalition ◽  
Level Of Evidence ◽  
Calcaneonavicular Coalition ◽  
Tarsal Bones

Tarsal coalition is an abnormal connection between tarsal bones, caused by an embryogenic failure. Its most common forms are calcaneonavicular and talocalcaneal coalition, which are present in 53% and 37% of the cases, respectively. The onset of symptoms is related to tarsal bone ossification, and mean age for this event is estimated at 16 years for calcaneonavicular coalition. Surgical treatment is indicated for patients who did not improve symptoms with conservative treatment. The aim of this study is to present a surgical technique as a treatment option for resection of calcaneonavicular coalition associated with abnormal cuboid-navicular joint. Level of Evidence V; Therapeutic Studies; Expert Opinion.

scholarly journals MODERATE INTENSITY PHYSICAL EXERCISE: PSYCHONEUROIMMUNOLOGICAL ASPECTS

2018 ◽  
Vol 24 (5) ◽  
pp. 395-398
Author(s):  
Eduardo Vignoto Fernandes ◽  
Celio Estanislau ◽  
Emerson José Venancio
Keyword(s):  
Mental Health ◽  
Nervous System ◽  
Immune System ◽  
Physical Exercise ◽  
Chronic Stress ◽  
Expert Opinion ◽  
Moderate Intensity ◽  
Anxiety And Depression ◽  
Physical And Mental Health ◽  
Level Of Evidence

ABSTRACT The literature presents several instances of interaction between the nervous system (NS) and the immune system (IS). These interactions are promoted by several molecules, such as cytokines and hormones, with modulating action for both the NS and IS. In this sense, the two systems may influence each other: changes in behavior may be accompanied by alterations in the IS (e.g., immunosuppression) and immunological disorders, such as infections, may modulate behavior (e.g., anxiety and depression). Considering that chronic stress, in addition to affecting behavior, also modulates the IS and that there is evidence that moderate intensity physical exercise (PE) protects physical and mental health, the objective of this review is to explore the influence of moderate-intensity PE on behavior and immunity. Level of Evidence V; Expert opinion.

Interosseous Talocalcaneal Ligament Reconstruction with Hamstring Autograft under Subtalar Arthroscopy: Case Report

2011 ◽  
Vol 32 (11) ◽  
pp. 1089-1094 ◽  
Author(s):  
Chen Liu ◽  
Chen Jiao ◽  
Yuelin Hu ◽  
Qin Wei Guo ◽  
Cheng Wand ◽  
...  
Keyword(s):  
Case Report ◽  
Expert Opinion ◽  
Ligament Reconstruction ◽  
Hamstring Autograft ◽  
Level Of Evidence

Level of Evidence: V, Expert Opinion

Locked Floating First Metatarsal: Open Reduction and no Fixation - Case Report

2012 ◽  
Vol 33 (1) ◽  
pp. 70-73 ◽  
Author(s):  
Jae Jung Jeong ◽  
Jong-Hoon Ji ◽  
Sang Eun Park ◽  
Young Yul Kim
Keyword(s):  
Case Report ◽  
Expert Opinion ◽  
Open Reduction ◽  
Level Of Evidence ◽  
First Metatarsal

Level of Evidence: V, Expert Opinion

scholarly journals 2018 update of the EULAR recommendations for the management of hand osteoarthritis

2018 ◽  
Vol 78 (1) ◽  
pp. 16-24 ◽  
Author(s):  
Margreet Kloppenburg ◽  
Féline PB Kroon ◽  
Francisco J Blanco ◽  
Michael Doherty ◽  
Krysia S Dziedzic ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Expert Opinion ◽  
Task Force ◽  
Treatment Options ◽  
Symptom Relief ◽  
Information Provision ◽  
Hand Osteoarthritis ◽  
Level Of Evidence ◽  
Eular Recommendations ◽  
Systemic Treatments

Since publication of the European League Against Rheumatism (EULAR) recommendations for management of hand osteoarthritis (OA) in 2007 new evidence has emerged. The aim was to update these recommendations. EULAR standardised operating procedures were followed. A systematic literature review was performed, collecting the evidence regarding all non-pharmacological, pharmacological and surgical treatment options for hand OA published to date. Based on the evidence and expert opinion from an international task force of 19 physicians, healthcare professionals and patients from 10 European countries formulated overarching principles and recommendations. Level of evidence, grade of recommendation and level of agreement were allocated to each statement. Five overarching principles and 10 recommendations were agreed on. The overarching principles cover treatment goals, information provision, individualisation of treatment, shared decision-making and the need to consider multidisciplinary and multimodal (non-pharmacological, pharmacological, surgical) treatment approaches. Recommendations 1–3 cover different non-pharmacological treatment options (education, assistive devices, exercises and orthoses). Recommendations 4–8 describe the role of different pharmacological treatments, including topical treatments (preferred over systemic treatments, topical non-steroidal anti-inflammatory drugs (NSAIDs) being first-line choice), oral analgesics (particularly NSAIDs to be considered for symptom relief for a limited duration), chondroitin sulfate (for symptom relief), intra-articular glucocorticoids (generally not recommended, consider for painful interphalangeal OA) and conventional/biological disease-modifying antirheumatic drugs (discouraged). Considerations for surgery are described in recommendation 9. The last recommendation relates to follow-up. The presented EULAR recommendations provide up-to-date guidance on the management of hand OA, based on expert opinion and research evidence.

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