Measuring standing hindfoot alignment: reliability of goniometric and visual measurements

OBJECTIVE: To examine the reliability of a functional weight-bearing measure of hindfoot alignment, the standing tibiocalcaneal angle (STCA), and to compare the relative reliabilities of goniometrically and visually estimated STCAs. DESIGN: Prospective blinded comparison. SETTING: Sports medicine center. PARTICIPANTS: Eighteen asymptomatic volunteer subjects (10 men, 8 women; age range, 22-41y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Two experienced examiners completed 2 blinded goniometric STCA and 2 blinded visual STCA measurements on each subject's right and left ankles in random order. RESULTS: Quantitative visual and goniometric STCAs were similar (visual mean range, 5.61 degrees -6.50 degrees valgus vs goniometric mean range, 5.50 degrees -6.94 degrees valgus), and both measurements exhibited good to excellent intrarater reliabilities (intraclass correlation coefficient [ICC] range, .80-.94; 95% prediction limits, 1.51 degrees -2.06 degrees ). Interrater ICCs were only fair for both measurement methods (.50-.75; 95% prediction limits, 2.2 degrees -4.1 degrees ). In terms of relative reliability, the visual STCA and goniometric STCA exhibited good to excellent agreement (ICC range, .64-.95). CONCLUSIONS: The STCA as described herein exhibited acceptable intrarater reliability for clinical use but may not be acceptably reliable between experienced examiners. The visual and goniometric STCA measurements were quantitatively similar and exhibited similar reliability. Using either method, changes of up to 2 degrees over time may be attributable to measurement error. Clinicians may consider using either STCA measurement in evaluating patients with lower-limb injuries or during screening of high-risk populations.     

The Cumberland ankle instability tool: a report of validity and reliability testing

OBJECTIVE: To test the Cumberland Ankle Instability Tool (CAIT), a 9-item 30-point scale, for measuring severity of functional ankle instability. DESIGN: Cross-sectional study. SETTING: General community. PARTICIPANTS: Volunteer sample of 236 subjects. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Concurrent validity by comparison with the Lower Extremity Functional Scale (LEFS) and a visual analog scale (VAS) of global perception of ankle instability by using the Spearman rho. Construct validity and internal reliability with Rasch analysis using goodness-of-fit statistics for items and subjects, separation of subjects, correlation of items to the total scale, and a Cronbach alpha equivalent. Discrimination score for functional ankle instability by maximizing the Youden index and tested for sensitivity and specificity. Test-retest reliability by intraclass correlation coefficient, model 2,1 (ICC(2,1)). RESULTS: There were significant correlations between the CAIT and LEFS (rho=.50, P<.01) and VAS (rho=.76, P<.01). Construct validity and internal reliability were acceptable (alpha=.83; point measure correlation for all items, >0.5; item reliability index, .99). The threshold CAIT score was 27.5 (Youden index, 68.1); sensitivity was 82.9% and specificity was 74.7%. Test-retest reliability was excellent (ICC(2,1)=.96). CONCLUSIONS: CAIT is a simple, valid, and reliable tool to measure severity of functional ankle instability.     

Effectiveness of emergency nurses’ use of the Ottawa Ankle Rules to initiate radiographic tests on improving healthcare outcomes for patients with ankle injuries: A systematic review

BackgroundThe Ottawa Ankle Rules provide guidelines for clinicians on the recommendation of radiographic tests to verify fractures in patients with ankle injuries. The use of the Ottawa Ankle Rules by emergency nurses has been suggested to minimise unnecessary radiographic-test requests and reduce patients’ length of stay in emergency departments. However, the findings of studies in this area are inconsistent.DesignA systematic review was conducted to synthesise the most accurate evidence available on the extent to which emergency nurses’ use of the Ottawa Ankle Rules to initiate radiographic tests improves healthcare outcomes for patients with ankle injuries.Data sourcesThe systematic review attempted to identify all relevant published and unpublished studies in English and Chinese from databases such as Ovid MEDLINE, EMBASE, ProQuest Health and Medical Complete, EBM Reviews, SPORTDiscus, CINAHL Plus, the British Nursing Index, Scopus, the Chinese Biomedical Literature Database, China Journal Net, WanFang Data, the National Central Library Periodical Literature System, HyRead, the Digital Dissertation Consortium, MedNar and Google Scholar.Review methodsTwo reviewers independently assessed the eligibility of all of the studies identified during the search, based on their titles and abstracts. If a study met the criteria for inclusion, or inconclusive information was available in its title and abstract, the full text was retrieved for further analysis. The methodological quality of all of the eligible studies was assessed independently by the two reviewers.ResultsThe search of databases and other sources yielded 1603 records. The eligibility of 17 full-text articles was assessed, and nine studies met the inclusion criteria. All nine studies were subjected to narrative analysis, and five were meta-analysed. All of the studies investigated the use of the refined Ottawa Ankle Rules. The results indicated that emergency nurses’ use of the refined Ottawa Ankle Rules minimised unnecessary radiographic-test requests and reduced patients’ length of stay in emergency departments. However, the use of these rules in urgent-care departments did not reduce unnecessary radiographic-test requests or patients’ length of stay. The implementation of the refined Ottawa Ankle Rules by emergency nurses with different backgrounds, including nurse practitioners or general emergency nurses was found to reduce patients’ length of stay in emergency departments.ConclusionsThe results of the systematic review suggested that a nurse-initiated radiographic test protocol should be introduced as standard practice in emergency departments.     

Effects of Anteroposterior Talus Mobilization on Range of Motion,Pain, and Functional Capacity in Participants With Subacute and Chronic Ankle Injuries: A Controlled Trial

Objective

The purpose of this study was to measure the acute (1 session) and chronic effects (6 sessions) and the follow-up (2 weeks) of anteroposterior articular mobilization of the talus, grade III of Maitland, on the dorsiflexion range of motion (ROM), pain, and functional capacity of individuals with subacute and chronic traumatic injuries of the ankle.

The effects of Mobilization with Movement on dorsiflexion range of motion,dynamic balance,and self-reported function in individuals with chronic ankle instability

Previous studies have examined the effectiveness of a manual therapy intervention known as Mobilization with Movement (MWM) to increase dorsiflexion range of motion (ROM) in individuals with chronic ankle instability (CAI). While a single talocrural MWM treatment has increased dorsiflexion ROM in these individuals, examining the effects of multiple treatments on dorsiflexion ROM, dynamic balance, and self-reported function would enhance the clinical application of this intervention. This study sought to determine if three treatment sessions of talocrural MWM would improve dorsiflexion ROM, Star Excursion Balance Test (SEBT) reach distances, and self-reported function using the Foot and Ankle Ability Measure (FAAM) in individuals with CAI. Eleven participants with CAI (5 Males, 6 Females, age: 21.5 ± 2.2 years, weight: 83.9 ± 15.6 kg, height: 177.7 ± 10.9 cm, Cumberland Ankle Instability Tool: 17.5 ± 4.2) volunteered in this repeated-measures study. Subjects received three MWM treatments over one week. Weight-bearing dorsiflexion ROM (cm), normalized SEBT reach distances (%), and self-reported function (%) were assessed one week before the intervention (baseline), prior to the first MWM treatment (pre-intervention), and 24–48 h following the final treatment (post-intervention). No significant changes were identified in dorsiflexion ROM, SEBT reach distances, or the FAAM-Activities of Daily Living scale (p > 0.05). Significant changes were identified on the FAAM-Sport (p = 0.01). FAAM-Sport scores were significantly greater post-intervention (86.82 ± 9.18%) compared to baseline (77.27 ± 11.09%; p = 0.01) and pre-intervention (79.82 ± 13.45%; p = 0.04). These results indicate the MWM intervention did not improve dorsiflexion ROM, dynamic balance, or patient-centered measures of activities of daily living. However, MWM did improve patient-centered measures of sport-related activities in individuals with CAI.     

Manual therapies for migraine: a systematic review

Migraine occurs in about 15% of the general population. Migraine is usually managed by medication, but some patients do not tolerate migraine medication due to side effects or prefer to avoid medication for other reasons. Non-pharmacological management is an alternative treatment option. We systematically reviewed randomized clinical trials (RCTs) on manual therapies for migraine. The RCTs suggest that massage therapy, physiotherapy, relaxation and chiropractic spinal manipulative therapy might be equally effective as propranolol and topiramate in the prophylactic management of migraine. However, the evaluated RCTs had many methodological shortcomings. Therefore, any firm conclusion will require future, well-conducted RCTs on manual therapies for migraine.     

Manual therapies for cervicogenic headache: a systematic review

This paper systematically reviewed randomized clinical trials (RCT) assessing the efficacy of manual therapies for cervicogenic headache (CEH). A total of seven RCTs were identified, i.e. one study applied physiotherapy ± temporomadibular mobilization techniques and six studies applied cervical spinal manipulative therapy (SMT). The RCTs suggest that physiotherapy and SMT might be an effective treatment in the management of CEH, but the results are difficult to evaluate, since only one study included a control group that did not receive treatment. Furthermore, the RCTs mostly included participant with infrequent CEH. Future challenges regarding CEH are substantial both from a diagnostic and management point of view.     

Manual therapies for primary chronic headaches: a systematic review of randomized controlled trials

This is to our knowledge the first systematic review regarding the efficacy of manual therapy randomized clinical trials (RCT) for primary chronic headaches. A comprehensive English literature search on CINHAL, Cochrane, Medline, Ovid and PubMed identified 6 RCTs all investigating chronic tension-type headache (CTTH). One study applied massage therapy and five studies applied physiotherapy. Four studies were considered to be of good methodological quality by the PEDro scale. All studies were pragmatic or used no treatment as a control group, and only two studies avoided co-intervention, which may lead to possible bias and makes interpretation of the results more difficult. The RCTs suggest that massage and physiotherapy are effective treatment options in the management of CTTH. One of the RCTs showed that physiotherapy reduced headache frequency and intensity statistical significant better than usual care by the general practitioner. The efficacy of physiotherapy at post-treatment and at 6 months follow-up equals the efficacy of tricyclic antidepressants. Effect size of physiotherapy was up to 0.62. Future manual therapy RCTs are requested addressing the efficacy in chronic migraine with and without medication overuse. Future RCTs on headache should adhere to the International Headache Society’s guidelines for clinical trials, i.e. frequency as primary end-point, while duration and intensity should be secondary end-point, avoid co-intervention, includes sufficient sample size and follow-up period for at least 6 months.     

Immediate effect of myofascial release on range of motion,pain and biceps and rectus femoris muscle activity after total knee replacement

Objectives

The role of a myofascial release (MFR) on flexion contractures after total knee arthroplasty (TKA) has not yet been elucidated. Therefore, the purpose of this study was to determine its immediate effect on such patients.

Nucleus pulposus deformation following application of mechanical diagnosis and therapy: a single case report with magnetic resonance imaging

Background

The McKenzie management strategy of mechanical diagnosis and therapy (MDT) is commonly used for the assessment and management of spinal problems. Within this system, ‘derangement syndrome’ is the most common classification, for which the conceptual model is an intra-discal displacement. However, the reduction of an intra-discal displacement by MDT has never been documented. The purpose of this study was to compare, using magnetic resonance imaging (MRI), the nucleus pulposus (NP) profiles before and after the use of this approach.

Patient characteristics

The patient was a 34-year-old female with a long history of right sided low back and buttock pain classified with ‘derangement syndrome’.

Examination

T2-weighted images of the L4–5 disc at initial assessment were compared with that at final assessment 1 month later. Initially, the MRI showed a portion of the NP displaced right and posteriorly towards the side of pain, and an overall NP position in the coronal plane shifted to the left.

Intervention

The patient was managed with a 1-month course of the McKenzie management strategy treatment.

Outcomes

One month later, the displaced portion of the NP was no longer present and the left-shifted NP was centrally located.

Discussion

These intervertebral disc changes coincided with centralization and abolition of symptoms. This case may support the conceptual model of MDT.     

Clinical Tests Have Limited Predictive Value for Chronic Ankle Instability When Conducted in the Acute Phase of a First-Time Lateral Ankle Sprain Injury

Objective

To evaluate whether a battery of clinical assessments for acute lateral ankle sprain (LAS) can be used to predict long-term recovery.

A cadaveric study of strain on the subscapularis muscle

OBJECTIVES: To measure the strain on 3 fiber groups of the subscapularis muscle at various glenohumeral joint positions and to determine the appropriate shoulder position for subscapularis muscle stretching. DESIGN: Repeated-measures design. SETTING: Biomechanics laboratory. SPECIMENS: Nine frozen-thawed glenohumeral joints obtained from 9 fresh cadavers. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The strain on the upper, middle, and lower fiber groups of the subscapularis were measured by precise displacement sensors during 14 different glenohumeral joint positions. RESULTS: The glenohumeral joint position that showed the largest strain varied among the 3 fiber groups. Although no position showed significantly large strain on the upper and middle fiber groups, external rotation at 30 degrees , 60 degrees , and 90 degrees of elevation, abduction, flexion, and horizontal abduction revealed significantly greater strain on the lower fiber groups (P<.005). Additionally, except for external rotation at 0 degrees of elevation, the strain on the lower fiber group was significantly greater than that on the upper and middle fiber groups in external rotation (P<.005). CONCLUSIONS: The stretching position of each fiber group of the subscapularis differs depending on the glenohumeral joint position. External rotation at 30 degrees to 60 degrees of glenohumeral elevation, abduction, flexion, and horizontal abduction can significantly stretch the lower fiber group of the subscapularis muscle.     

Effectiveness of the Auto Edema Reduction (AER) Boot for Treatment of Edema in Acute Ankle Sprains: A Single Case Study

Abstract

This case study illustrates the use of the Auto Edema Reduction (AER) Boot in the treatment of an acute ankle sprain. The effectiveness of the AER Boot was determined by assessing pain, ankle volume, girth, and range of motion before and after a five-day treatment period.

A 22-year-old female was evaluated within 24 hours of injury. She was non-weight bearing on the left lower extremity. Observation revealed marked discoloration distal to both the malleoli and diffuse swelling.

Initial pain assessment was 3.4 on the visual analogue scale. The amount of displaced water during volumetric measurement was 985 milliliters. Two consecutive figure-eight girth measurements averaged 47.25 cm. Active range of motion for dorsiflexion averaged minus 15.5° and 60.5° for plantarflexion.

After initial measurements were taken, the injured foot and ankle were placed into the AER Boot. Once adequate pressure was obtained, the subject was asked to perform 20 “pump presses” every five minutes throughout the 20-minute treatment. On the following four treatment days stretching and walking in the AER Boot were added to the protocol.

Final measurements following the five day study revealed a pain rating of 0.8, 870 milliliters through volumetry, 45.25 cm girth, 9° of dorsiflexion, and 64.5° of plantarflexion. The patient was full weight bearing, ankle discoloration was improved, and she had resumed her normal activities.

The AER Boot appears to be effective in reducing pain and edema in acute ankle sprains.     

磁共振成像对腰肌劳损腰痛的诊断价值

目的探讨腰肌劳损MRI检查方法与影像学表现。方法症状性慢性腰肌劳损患者30例,对照组为无症状健康志愿者35例,两组间性别及年龄构成比差异均无统计学意义(前者P=0.084,后者P=0.850)。MRI检查方法包括:常规梯度回波小角度激发T1加权横断面成像(GRET1WI)、快速自旋回波T2加权横断面成像(TSET2WI)和短时反转恢复T2加权横断面成像+脂肪抑制(T2-STIR-FS)、快速反转恢复T2加权横断面成像+脂肪抑制(T2-TIRM-FS)、快速自旋双回波T2加权横断面成像+脂肪抑制(T2+T2-TSE-FS)、弥散加权横断面成像(DWI)。评价征象包括:(1)腰骶背肌-肌间隙改变;(2)腰骶背肌-骨间隙改变;(3)多裂肌厚度改变;(4)多裂肌内脂肪浸润程度。结果腰骶背肌间隙不规则扭曲、积液,棘突旁间隙积液,横突窝积液和小关节突窝积液,髂骨-髂周肌间隙积液这些征象在症状组的发生率显著高于对照组(P<0.05)。多裂肌厚度和脂肪浸润程度在两组间差异无统计学意义(P>0.05)。各种征象中,诊断试验真实性最好的是棘突旁间隙积液征象(YI=0.73)。联合多种MRI征象诊断症状性腰肌劳损的准确性较依靠某一种征象的高,以联合2种MRI征象诊断腰肌劳损的真实性最好(YI=0.79)。检查方法STIR-FS、DWI、TIRM-FS和T2+T2-TSE-FS可以敏感地显示积液征象,显示敏感性基本相同(P>0.05)。结论合理地选择应用MRI常规T1WI和T2WI序列和特殊成像序列STIR-FS、DWI、TIRM-FS或T2+T2-TSE-FS可以很好地显示慢性腰肌劳损的病理生理改变,包括肌-肌间隙改变,肌-骨间隙改变,腰背肌形态结构改变。     

手术治疗三踝骨折的临床研究

目的:探讨三踝骨折手术治疗方法和围手术期处理。方法:对54例采用切开复位内固定治疗的三踝骨折患者的资料进行回顾性分析,其中男38例,女16例,年龄21～76岁。AO分型,B型24例,C型30例。开放伤14例,闭合伤40例。手术距受伤时间4h～14d,骨折复位顺序为后踝-外踝-内踝。后踝选用可吸收螺钉或金属螺钉固定,外踝用1/3管状钢板螺钉固定,内踝用1～2枚拉力螺钉固定。术后行系统性功能锻炼。结果:随访时间10个月～2.5年,平均14个月,骨折均愈合。以改良Bird-Jackson踝关节疗效评定标准评判总优良率89%。结论:适当的手术入路,准确的骨折复位,有效的内外固定,积极的术后康复可使大多数三踝骨折患者恢复踝关节的正常功能。