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Rebecca Feuerherd Mark A. Sutherlin Joseph M. Hart Susan A. Saliba 《International Journal of Sports Physical Therapy》2014,9(7):938-947
Purpose/Background:
Differences in humeral torsion have been observed between overhead athletes and non‐athletes. Although humeral torsion may be an adaptive process for athletic performance, it may be associated with injury. Methods for measuring humeral torsion have consisted of radiography, computer tomography, and ultrasound imaging. However, diagnostic imaging may be costly and not available to all clinicians. The implementation of clinical assessments may be an alternative way to measure humeral torsion. Before clinical measures can be recommended, these assessments need to be evaluated for validity and reliability of each test. The purpose of this study was to assess the intratester and intertester reliability of three clinical tests, intratester reliability of ultrasound measures, and the validity of each clinical test to ultrasound measures.Methods
Thirty participants (male: 12, female: 18; age: 20±2 years; height: 174.24±9.35 cm; mass: 70.53±11.06 kg; body mass index: 23.13±2.47 kg/m2; years in sport: 9±4 years) with experience in overhead sports were assessed for humeral torsion, bilaterally. Humeral torsion was assessed using musculoskeletal ultrasound by a single assessor, and using three separate clinical assessments by two independent assessors. Clinical assessments included the angle of rotation during both the bicipital tuberosity palpation with the shoulder abducted at 90 degrees (Palp90) or 45 degrees (Palp45), and the angle of external rotation during horizontal adduction (HADD).Results
Intratester reliability for the ultrasound measure was good (ICC=0.907), along with intratester reliability for both assessors across each clinical assessment (ICC''s > 0.769). Poor to moderate reliability was observed between assessors for each clinical assessment (ICC=0.256 Palp90, ICC=0.419 Palp45, ICC=0.243 HADD. Only the Palp90 measure had a fair but significant (r=0.326, p=0.011) relationship with ultrasound measures.Conclusion
Individual assessors can achieve reliable ultrasound, bicipital tuberosity palpation and HADD values across multiple trials; however, these measures are not consistent between assessors. Additionally, only one clinical test had a fair but significant relationship with ultrasound measures. Improved testing procedures may be needed to increase between assessor reliability and strength of relationships to ultrasound measures. Current application of clinical assessments to measure humeral torsion is limited.Level of Evidence:
3b; Grade of Recommendation C 相似文献7.
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Abby Morris Chad Cook Amy Hassen 《International Journal of Sports Physical Therapy》2014,9(5):674-690
Background:
A strong understanding of diagnostic imaging has been advocated for physical therapists. There have been recent changes in physical therapy curricula and increased opportunities to utilize imaging during clinical practicePurpose:
The aim of this study was to explore the ability of practicing clinicians to accurately identify selected musculoskeletal conditions on plain‐film radiograph (X‐ray), magnetic resonance imaging (MRI), and computed tomography scan (CT scan). Further, to determine whether improvements in identification of pathology occur when the clinical scenario is added to the imaging and whether there are related training/exposure factors.Methods:
A cross‐ sectional electronic survey was sent out to physical therapists in the state of Ohio. Participants were asked to identify conditions (cervical fracture, anterior cruciate ligament tear, and avascular necrosis of the femoral head) first given diagnostic images only, and then given the images and a clinical scenario.Results:
Eight hundred sixty‐six surveys of the 7537 sent out were eligible for analysis. With clinical scenarios, 61.3% of respondents were correct with the ACL injury identified on MRI, 36.4% for identification of the cervical spine fracture on CT and 25.6% for identification of avascular necrosis on plain film. The accuracy significantly improved (p<0.01) with the addition of the clinical information for all three of the diagnoses. The most remarkable improvement was seen with the AVN diagnosis on plain film radiograph (365.5% improvement), followed by the ACL injury on MRI (27.2% improvement) and cervical fracture diagnosis on CT scan (17.8% improvement). Finally, formal and informal training, board certification through the APTA and to a lesser extent, degree level, all improved diagnostic accuracy.Conclusions:
A clinical scenario paired with images notably improved identification of pathology. Physical therapists were better at identifying the ACL pathology that was presented on MRI. This is a common diagnosis to physical therapists and was paired with a relatively common imaging modality. This study suggests that physical therapists can improve accuracy with identifying pathologies on diagnostic images through a physical therapy curriculum or post‐graduation through certifications and continuing education.Level of Evidence:
Level 4 相似文献11.
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Margaret Kedia Michael Williams Lisa Jain Marie Barron Nick Bird Brian Blackwell David R. Richardson Susan Ishikawa G. Andrew Murphy 《International Journal of Sports Physical Therapy》2014,9(4):488-497
Study Design:
Single‐blind, randomized, clinical trial.Background:
The effect of eccentric training for mid‐portion Achilles tendinopathy is well documented; however, its effect on insertional Achilles tendinopathy is inconclusive. The primary purpose of this study was to investigate the effect of eccentric training on pain and function for individuals with insertional Achilles tendinopathy.Methods:
All patients received a 12‐week conventional strengthening protocol. Patients who were randomly assigned to the experimental group received additional eccentric exercises. Patients completed the Short Form‐36 Health and Bodily Pain Surveys, the Foot and Ankle Outcomes Questionnaire, and the Visual Analog Scale at initial evaluation, after 6 weeks of therapy, and at 12 weeks after therapy.Results:
Thirty‐six patients (20 control and 16 experimental; average age 54 years; 72% women) completed the study. Both groups experienced statistically significant decreases in pain and improvements in function. No statistically significant differences were noted between the groups for any of the outcome measures.Conclusion:
Conventional physical therapy consisting of gastrocnemius, soleus and hamstring stretches, ice massage on the Achilles tendon, and use of heel lifts and night splints with or without eccentric training is effective for treating insertional Achilles tendinopathy.Level of Evidence:
Level 2 相似文献13.
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Courtney Bohne Steven Z. George Giorgio Zeppieri Jr. 《International Journal of Sports Physical Therapy》2015,10(4):464-475
Background
Information on baseball injury prevention and pitch count recommendations is growing, however, the incidence of throwing injuries continues to rise. This study is the first to assess knowledge of safe throwing guidelines and risk factors from the perspective of youth athletes.Purpose
The purpose of this study is two‐fold: (1) to evaluate knowledge of safe throwing guidelines and (2) to assess the reporting of risk factors for throwing injuries in a sample of youth baseball players.Study Design
Survey study of 98 overhead athletes between the ages of 4 and 18.Methods
A 35‐question survey was developed with questions related to knowledge of injury prevention, presence of risk factors associated with throwing injuries, and understanding and compliance with USA Baseball Medical & Safety Advisory Committee (USA BMSAC) overhead throwing guidelines.Results
Respondents demonstrated variability in their knowledge of the USA BMSAC guidelines related to throwing frequencies. The 13‐16 year old age group displayed the least knowledge of USA BMSAC guidelines. The 9‐10 and 11‐12 year old age groups demonstrated the greatest knowledge of recommended BMSAC guidelines. Eighty‐five (82/98) percent of the respondents reported that they had never heard of the USA BMSAC guidelines. Sixty‐two percent (59/98) disagreed with the statement, “The more you throw, the more likely you are to get an injury”. Fifty‐seven percent of respondents (39/98) indicated that they would not seek medical help if they experienced a tired or sore arm during a game.Conclusion
The results of this study suggest that young baseball players demonstrate the need for education on the following topics: the USA Baseball Medical and Safety Advisory Committee throwing guidelines, risk factors for developing throwing‐related injuries, the long‐term implications of playing with an injured or fatigued arm, and the benefit of seeking medical help when fatigue or soreness is experienced in the throwing arm.Level of Evidence
Level 3 相似文献18.
Aaron Horschig Stephen P. Sayers Tom LaFontaine Scott Scheussler 《International Journal of Sports Physical Therapy》2012,7(6):663-671
Background:
Complete rupture of the distal tendon of the biceps brachii is relatively rare and there is little information to guide therapists in rehabilitation after this injury. The purposes of this case report are to review the rehabilitation concepts used for treating such an injury, and discuss how to modify exercises during rehabilitation based on patient progression while adhering to physician recommended guidelines and standard treatment protocols.Case Presentation:
The patient was an active 38‐year old male experienced in weight‐training. He presented with a surgically repaired right distal biceps tendon following an accident on a trampoline adapted with a bungee suspension harness. The intervention focused on restoring range of motion and strengthening of the supporting muscles of the upper extremity without placing undue stress on the biceps brachii.Outcomes:
The patient was able to progress from a moderate restriction in ROM to full AROM two weeks ahead of the physician''s post‐operative orders and initiate a re‐strengthening protocol by the eighth week of rehabilitation. At the eighth post‐operative week the patient reported no deficits in functional abilities throughout his normal daily activities with his affected upper extremity.Discussion:
The results of this case report strengthen current knowledge regarding physical therapy treatment for a distal biceps tendon repair while at the same time providing new insights for future protocol considerations in active individuals. Most current protocols do not advocate aggressive stretching, AROM, or strengthening of a surgically repaired biceps tendon early in the rehabilitation process due to the fear of a re‐rupture. In the opinion of the authors, if full AROM can be achieved before the 6th week of rehabilitation, initiating a slow transition into light strengthening of the biceps brachii may be possible.Level of evidence:
4‐Single Case report 相似文献19.
Jason S. Scibek Christopher R. Carcia 《International Journal of Sports Physical Therapy》2014,9(5):644-656
Background:
Electromagnetic tracking systems have enabled some investigators and clinicians to measure tri‐planar scapular motion; yet, they are not practical and affordable options for all clinicians. Currently, the ability to affordably quantify scapular motion is limited to monitoring only the motion of scapular upward rotation, with use of a digital inclinometer.Hypothesis/Purpose:
The objective of this study was to determine the criterion‐related validity of a modified digital inclinometer when used to measure the motion of scapular anterior‐posterior (AP) tilt.Materials & Methods:
Thirteen volunteers, free from any history of shoulder injury, reported for a single testing session. Each subject underwent a brief shoulder and posture examination in order to confirm the absence of pathology. Subjects actively performed clinically relevant amounts of humeral elevation in the scapular plane while in a seated position. An electromagnetic tracking system (Ascension Technology, Burlington, VT) and a modified inclinometer (Pro 360, Baseline®, Fabrication Enterprises, White Plains, NY) were used to acquire scapular AP tilt over the same shoulder motions. Criterion‐related validity was determined using Pearson Product Moment correlations.Results:
Correlation analyses revealed significant moderate to good associations (r = 0.63 to 0.86, p < 0.01) between scapular AP tilt measures obtained with a digital inclinometer and an electromagnetic tracking system.Conclusions
A modified digital inclinometer is a moderately valid device to use for the quantification of scapular AP tilt. Further study is warranted to establish reliability and to validate use of the device in patients with shoulder injury or pathology. The modified inclinometer expands the clinician''s ability to quantify scapular kinematic motion during the clinical evaluation and rehabilitation process.Level of Evidence:
Level 3 相似文献20.
Mitchell J. Rauh Michelle Barrack Jeanne F. Nichols 《International Journal of Sports Physical Therapy》2014,9(7):948-958