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المصدر: Arthroscopy : the journal of arthroscopicrelated surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 37(1)
مصطلحات موضوعية: musculoskeletal diseases, Adult, Male, medicine.medical_specialty, Torsion Abnormality, Adolescent, medicine.medical_treatment, Osteotomy, Abnormal femoral torsion, 03 medical and health sciences, Arthroscopy, Disability Evaluation, Young Adult, 0302 clinical medicine, medicine, Humans, Orthopedics and Sports Medicine, Femur, Range of Motion, Articular, Decreased femoral torsion, Retrospective Studies, 030222 orthopedics, biology, business.industry, 030229 sport sciences, Middle Aged, musculoskeletal system, medicine.disease, biology.organism_classification, Spine, Oswestry Disability Index, Surgery, Increased femoral torsion, Valgus, Female, Hip Joint, Slipped capital femoral epiphysis, business, Follow-Up Studies
الوصف: To evaluate the outcomes of proximal femoral derotation osteotomy (PFDO) on the hip and spine function of patients with abnormal femoral torsion.This retrospective study included patients who underwent PFDO to treat increased or decreased femoral torsion between July 2014 and February 2019. The exclusion criteria were: previous fracture, fixation of slipped capital femoral epiphysis or osteotomy in the ipsilateral femur; PFDO associated to varus or valgus osteotomy; Tönnis grade 2 or 3 osteoarthritis; and PFDO performed to treat knee abnormalities. Hip function was assessed through the modified Harris Hip Score (mHHS). A subgroup of consecutive patients with low back pain before the PFDO and operated after 2017 had the spine function assessed through the Oswestry disability index (ODI).A total of 37 hips (34 patients) were studied: 15 hips with increased femoral torsion and 22 with decreased femoral torsion. Eight patients were male and 26 were female. The average age at PFDO was 33 years (range, 15-54 years). At a mean follow-up of 24 months (range, 12-65 months), the mean mHHS improved from 58.1 ± 14.3 before PFDO to 82 ± 15.6 at the most recent follow-up (P.001). Improvement in the mHHS above the minimum clinically important difference (MCID) was observed in 33 hips (89%). In the subgroup of 14 consecutive patients with ODI available, the ODI improved from a mean of 45% ± 16% before the PFDO to 22% ± 17% at the most recent follow-up (P = .001). Nine (64.3%) of the 14 patients presented improvement in the ODI above the MCID. Revision procedure with a larger intramedullary nail was necessary in 2 hips to treat nonunion.Proximal femoral derotation osteotomy improves the hip and spine function in patients with increased or decreased femoral torsion and nonarthritic hips.Level IV, therapeutic case series.
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المؤلفون: Shane J. Nho, Jeffrey S. Grzybowski, Thomas H. Wuerz, Michael J. Salata, Alejandro A. Espinoza Orías, Hal David Martin, Richard C. Mather, Sang H. Song
المصدر: Arthroscopy: The Journal of Arthroscopic & Related Surgery. 32:1571-1580
مصطلحات موضوعية: Adult, Joint Instability, Male, musculoskeletal diseases, medicine.medical_specialty, Rotation, medicine.medical_treatment, Joint stability, Joint Capsule Release, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Cadaver, medicine, Humans, Orthopedics and Sports Medicine, Range of Motion, Articular, Aged, Aged, 80 and over, 030222 orthopedics, business.industry, Neutral zone, Soft tissue, 030229 sport sciences, Middle Aged, Biomechanical Phenomena, Surgery, Capsulotomy, Female, Hip Joint, Cadaveric spasm, Range of motion, business, Nuclear medicine
الوصف: To evaluate the effect of capsulotomy size and subsequent repair on the biomechanical stability of hip joint kinematics through external rotation of a cadaveric hip in neutral flexion.Eight fresh-frozen cadaveric hip specimens were used in this study. Each hip was tested under torsional loads of 6 N·m applied by a servohydraulic frame and transmitted by a pulley system. The test conditions were (1) neutral flexion with the capsule intact, (2) neutral flexion with a 4-cm interportal capsulotomy, (3) neutral flexion with a 6-cm capsulotomy, and (4) neutral flexion with capsulotomy repair. Soft tissue was retained during all interventions. Measures indicating joint kinematics (range of motion [ROM], hysteresis area [HA], and neutral zone [NZ]) were obtained for each condition.For all hip specimens, the average ROM, HA, and NZ were calculated relative to the intact capsular state (100%) and expressed in terms of percentage (± SD). The findings for ROM were as follows: intact, 100%; 4 cm, 107.42% ± 5.69%; 6 cm, 113.40% ± 7.92%; and repair, 99.78% ± 3.77%. The findings for HA were as follows: intact, 100%; 4 cm, 108.30% ± 9.30%; 6 cm, 115.30% ± 13.92%; and repair, 99.47% ± 4.12%. The findings for NZ were as follows: intact, 100%; 4 cm, 139.61% ± 62.35%; 6 cm, 169.25% ± 78.19%; and repair, 132.03% ± 64.38%. Statistically significant differences in ROM existed between the intact and 4-cm conditions (P = .039), the intact and 6-cm conditions (P.0001), the 4-cm and repair conditions (P = .033), and the 6-cm and repair conditions (P.0001). There was no statistically significant difference between the intact and repair conditions (P.99) or between the 4- and 6-cm conditions (P = .126).Under laboratory-based conditions, larger-sized capsulotomies were accompanied by increases in all 3 measures of joint mobility: ROM, HA, and NZ at time zero. Complete capsular closure effectively restored these measures when compared with the intact condition.Cadaveric models consisting of the hip joint with surrounding soft tissue were used under laboratory testing conditions to investigate potential iatrogenic joint instability resulting from expansive capsulotomies, showing that complete capsular closure leads to reconstitution of original joint stability properties at time zero.
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المؤلفون: Jon K. Sekiya, Bryan T. Kelly, Nicholas G. H. Mohtadi, Marc J. Philippon, RobRoy L. Martin, Thomas G. Sampson, Ricardo Pietrobon, Michael Leunig, John C. Clohisy, Marc R. Safran, Hal David Martin
المصدر: Arthroscopy: The Journal of Arthroscopic & Related Surgery. 26:161-172
مصطلحات موضوعية: Adult, Male, musculoskeletal diseases, Straight leg raise, medicine.medical_specialty, Supine position, Knee Joint, Posture, Video Recording, Pain, Physical examination, Young Adult, Supine Position, Humans, Medicine, Orthopedics and Sports Medicine, Range of Motion, Articular, Muscle, Skeletal, Physical Examination, medicine.diagnostic_test, business.industry, Arthroscopy, Test (assessment), Prone position, Orthopedics, Orthopedic surgery, Lordosis, Physical therapy, Female, Hip Joint, Joint Diseases, business, Range of motion, Muscle Contraction
الوصف: Purpose The purpose of this study was to systematically evaluate the technique and tests used in the physical examination of the adult hip performed by multiple clinicians who regularly treat patients with hip problems and identify common physical examination patterns. Methods The subjects included 5 men and 6 women with a mean age (±SD) of 29.8 ± 9.4 years. They underwent physical examination of the hip by 6 hip specialists with a strong interest in hip-related problems. All examiners were blind to patient radiographs and diagnoses. Patient examinations were video recorded and reviewed. Results It was determined that 18 tests were most frequently performed (≥40%) by the examiners, 3 standing, 11 supine, 3 lateral, and 1 prone. Of the most frequently performed tests, 10 were performed more than 50% of the time. The tests performed in the supine position were as follows: flexion range of motion (ROM) (percentage of use, 98%), flexion internal rotation ROM (98%), flexion external rotation ROM (86%), passive supine rotation test (76%), flexion/adduction/internal rotation test (70%), straight leg raise against resistance test (61%), and flexion/abduction/external rotation test (52%). The tests performed in the standing position were the gait test (86%) and the single-leg stance phase test (77%). The 1 test in the prone position was the femoral anteversion test (58%). Conclusions There are variations in the testing that hip specialists perform to examine and evaluate their patients, but there is enough commonality to form the basis to recommend a battery of physical examination maneuvers that should be considered for use in evaluating the hip. Clinical Relevance Patients presenting with groin, abdominal, back, and/or hip pain need to have a basic examination to ensure that the hip is not overlooked. A comprehensive physical examination of the hip will benefit the patient and the physician and serve as the foundation for future multicenter clinical studies.
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المؤلفون: Edward Shatzen, David L. Lacey, Victoria Shalhoub, Sean Morony, L. Munyakazi, David Martin, M. Guo, C. R. Dunstan, J. Padagas, Matthew Colloton, Hong-Lin Tan, Zhaopo Geng, D. Gianneschi, Paul J. Kostenuik
المصدر: Calcified Tissue International. 78:35-44
مصطلحات موضوعية: Male, musculoskeletal diseases, medicine.medical_specialty, Endocrinology, Diabetes and Metabolism, Receptors, Cytoplasmic and Nuclear, Parathyroid hormone, Receptors, Tumor Necrosis Factor, Bone remodeling, Rats, Sprague-Dawley, Absorptiometry, Photon, Endocrinology, Osteoprotegerin, Osteoclast, Internal medicine, medicine, Animals, Humans, Orthopedics and Sports Medicine, Glycoproteins, Bone mineral, Membrane Glycoproteins, Receptor Activator of Nuclear Factor-kappa B, biology, business.industry, Hyperparathyroidism, RANK Ligand, medicine.disease, Rats, Osteopenia, Disease Models, Animal, medicine.anatomical_structure, Parathyroid Hormone, RANKL, biology.protein, Kidney Failure, Chronic, Secondary hyperparathyroidism, Carrier Proteins, business
الوصف: Osteoprotegerin (OPG) acts by neutralizing the receptor activator of nuclear factor-kappaB ligand (RANKL), the primary mediator of osteoclast differentiation, function, and survival. We examined whether OPG could affect the bone loss associated with chronic kidney disease (CKD) in a rodent model of CKD and secondary hyperparathyroidism (SHPT). SHPT was induced in rats by 5/6 nephrectomy (5/6 Nx) and a 1.2% P/0.6% Ca(2+) diet. Starting 1 week after 5/6 Nx, rats were treated with vehicle (veh) or OPG-Fc (3 mg/kg, intravenously) every 2 weeks for 9 weeks. At baseline, 3, 6, and 9 weeks, blood was taken and bone mineral density (BMD) and bone mineral content (BMC) were assessed by dual-energy X-ray absorptiometry. Serum parathyroid hormone (sPTH) levels reached 912 pg/ml in 5/6 Nx rats vs. 97 pg/ml in shams at 9 weeks. OPG-Fc had no effect on sPTH or Ca(2+) levels throughout the 9-week study, indicating that SHPT was a renal effect independent of bone changes. At 3 weeks, 5/6 Nx-veh rats had osteopenia compared with sham-veh rats and 5/6 Nx-OPG-Fc rats had significantly higher percent changes in whole-body BMC, leg BMD, and lumbar BMD versus 5/6 Nx-veh rats. By 6-9 weeks, elevated sPTH was associated with reversal of bone loss and osteitis fibrosa in the proximal tibial metaphysis. OPG-Fc decreased this sPTH-driven high bone turnover, resulting in augmented thickness of proximal tibial trabeculae in 5/6 Nx rats. Thus, RANKL inhibition with OPG-Fc can block the deleterious effects of continuously elevated sPTH on bone, suggesting that RANKL may be an important therapeutic target for protecting bone in patients with CKD and SHPT.
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المؤلفون: Hal David Martin
المصدر: Arthroscopy: The Journal of Arthroscopic & Related Surgery. 32:1807
مصطلحات موضوعية: Adult, musculoskeletal diseases, 030222 orthopedics, medicine.medical_specialty, Adolescent, business.industry, Daily life activities, Radiography, Arthroscopy, 03 medical and health sciences, 0302 clinical medicine, Physical therapy, Humans, Medicine, Hip Joint, Orthopedics and Sports Medicine, In patient, business
الوصف: Hip health is a critical factor in preserving daily life activities and wellbeing for both adults and adolescents. There are several potential economic influences in developing arthroscopic hip techniques for the evaluation and treatment of hip pathology in patients of all ages.
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المؤلفون: Hal David Martin, RobRoy L. Martin, Ian James Palmer
المصدر: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. 20(6)
مصطلحات موضوعية: musculoskeletal diseases, Adult, Joint Instability, Male, Models, Anatomic, medicine.medical_specialty, Arthroscopy, medicine, Humans, Orthopedics and Sports Medicine, Clinical significance, Retrospective Studies, Rupture, Retrospective review, medicine.diagnostic_test, business.industry, Anatomy, Middle Aged, musculoskeletal system, Functional description, Biomechanical Phenomena, body regions, Orthopedic surgery, Ligaments, Articular, Squatting position, Surgery, Biomechanical model, Female, Hip Joint, business, human activities, Surgical patients, Follow-Up Studies, Hip Injuries
الوصف: The primary purpose of this study was to investigate the role the ligamentum teres has in providing hip stability using a biomechanical model. The second purpose was to review arthroscopic findings in those with a complete ligamentum teres rupture and question them regarding instability to determine how clinical findings related to the biomechanical model. A string model was created to examine ligamentum teres excursion during various hip positions. A retrospective review of 350 consecutive surgical patients identified 20 subjects with a complete ligamentum teres rupture that was not repaired at the time of surgery. The model found the ligamentum teres to have the greatest excursion when the hip was externally rotated in flexion (ER/FLEX) and internally rotated in extension (IR/EXT). During operative assessment, it was noted that all 20 subjects had laxity during dynamic impingement testing when their hip was in a position of ER/FLEX. Nine (45%) of the 20 subjects with ligamentum teres rupture were available for follow-up (mean 31 months post-op). Five out of these 9 subjects noted instability: 5 of 9 with squatting (ER/FLEX) and 4 of 9 with crossing one leg behind of the other (IR/EXT). These 5 subjects had osseous risk factors that compromised hip stability including inferior acetabular insufficiency. The ligamentum teres may contribute to hip stability when the hip is in ER/FLEX and IR/EXT. Individuals with osseous risk factors for instability, including inferior acetabular insufficiency, may have instability with squatting (ER/FLEX) and crossing one leg behind of the other (IR/EXT). IV.
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المصدر: The Journal of Hand Surgery. 18:455-458
مصطلحات موضوعية: Adult, Male, musculoskeletal diseases, medicine.medical_specialty, Exacerbation, Wrist, Recurrence, Risk Factors, medicine.artery, Catheterization, Peripheral, medicine, Humans, Orthopedics and Sports Medicine, Prospective Studies, Radial artery, Carpal tunnel syndrome, Aged, Aged, 80 and over, business.industry, Perioperative, Middle Aged, medicine.disease, Carpal Tunnel Syndrome, Surgery, body regions, Catheter, medicine.anatomical_structure, Anesthesia, Acute Disease, Radial Artery, Upper limb, Female, business, Artery
الوصف: Acute carpal tunnel syndrome that follows radial artery cannulation has been described. To determine the incidence and predisposing factors, we prospectively studied 151 patients who had perioperative radial artery cannulation. Postoperatively 9 of the 151 patients had symptoms of carpal tunnel syndrome with positive Phalen and Tinel signs on the side on which the radial artery catheter had been inserted. Eight of 12 patients with a prior history of carpal tunnel syndrome had acute exacerbation of symptoms postoperatively. By contrast, only 1 of 139 patients with no prior history of the disorder had symptoms. Fourteen patients had multiple arterial artery punctures or perforations of the posterior wall of the radial artery. In three of these, postoperative symptoms of carpal tunnel syndrome developed but did not reach statistical significance. The only patient with postoperative acute carpal tunnel syndrome but no prior history of the syndrome had multiple arterial punctures. The use of perioperative anticoagulation, the use of wrist-extension splints, and the duration of radial artery cannulation did not influence acute exacerbation of carpal tunnel syndrome. Patients with a prior history of carpal tunnel syndrome are at increased risk of recurrent symptoms after radial artery cannulation. We found no statistically significant relationship between traumatic cannulations and the development of symptoms of carpal tunnel syndrome.
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المؤلفون: Ian James Palmer, Shea A. Shears, Hal David Martin
المصدر: Sports medicine and arthroscopy review. 18(2)
مصطلحات موضوعية: musculoskeletal diseases, Adult, Joint Instability, medicine.medical_specialty, Hip, Fractures, Stress, business.industry, Diagnostic test, Pain, Physical Therapy, Sports Therapy and Rehabilitation, Comorbidity, Diagnosis, Differential, Orthopedic surgery, Physical therapy, Medicine, Humans, Orthopedics and Sports Medicine, Range of Motion, Articular, business, Physical Examination, Hip examination, Hip Injuries
الوصف: The evaluation of the hip has evolved over generations of orthopedic surgeons. A number of diagnostic tests have been described for specific pathologies that include a common base of maneuvers. A consistent hip examination is conducted to screen the hip, back, abdominal, neurovafscular, and neurologic systems and to find any comorbidities that often exist with complex hip pathology. Provided is a comprehensive evaluation of the hip with proposed descriptions of traditional tests along with provocative maneuvers. Through the use of a common set of diagnostic procedures and terminology, there will be improvement in the accuracy of diagnostic exams for determining hip pathology.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::9ff57580b47dfcdc6af9155522308b10
https://pubmed.ncbi.nlm.nih.gov/20473124 -
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المؤلفون: RobRoy L. Martin, Jon K. Sekiya, Michael Leunig, Marc R. Safran, Bryan T. Kelly, Marc J. Philippon, Nicholas G. H. Mohtadi, Hal David Martin
المصدر: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. 18(5)
مصطلحات موضوعية: musculoskeletal diseases, Adult, Male, medicine.medical_specialty, Physical examination, Young Adult, medicine, Humans, Orthopedics and Sports Medicine, Hip pain, Physical Examination, Femoroacetabular impingement, Hip surgery, Observer Variation, medicine.diagnostic_test, business.industry, medicine.disease, Surgery, Clinical diagnosis, Orthopedic surgery, Female, Hip Joint, Hip arthroscopy, Surgical diagnosis, Clinical Competence, Joint Diseases, business, Joint Capsule
الوصف: This study investigated the ability of experienced orthopedic surgeons to agree on a diagnosis of labral tear, femoroacetabular impingement (FAI), and capsular laxity using clinical examination. Eight patients under the care of an experienced hip arthroscopist underwent independent clinical evaluations by six orthopedic surgeons who specialized in management hip pain. No attempt was made to regulate the evaluation process as surgeons performed their examination as they would in their own practice. Average subject age was 27 years (19-47 years) with five females and three males. Subjects subsequently underwent arthroscopic surgery by the treating surgeon. Surgical findings were recorded with respect to the presence or absence of a labral tear, FAI, and/or capsular laxity. The percent agreement between the surgical findings and clinical examinations were determined. Surgical findings noted four subjects had a labral tear, five FAI, and three laxity. Based on clinical examination, surgeons agreed 63, 65 and 58% of the time with the surgical diagnosis of labral tear, FAI, and capsular laxity, respectively. The level of agreement did not seem to be dependent on the size or type of labral tear. Also, the ability to detect FAI did not seem to depend on whether the lesion was a cam, pincer, combined cam/pincer or size of the cam lesion. This study offers support that clinical examination techniques used for making a diagnosis needs to be improved and standardized if they are to be useful in diagnosing specific pathologies found with arthroscopic hip surgery.
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المصدر: Clinics in sports medicine. 25(2)
مصطلحات موضوعية: musculoskeletal diseases, Joint Instability, medicine.medical_specialty, Rotation, Neuromuscular Junction, Physical Therapy, Sports Therapy and Rehabilitation, Electromyography, Joint mechanics, medicine, Humans, Orthopedics and Sports Medicine, Hip injury, Range of Motion, Articular, Muscle, Skeletal, Gait, Hip, biology, medicine.diagnostic_test, Athletes, business.industry, Biomechanics, biology.organism_classification, Biomechanical Phenomena, Athletic Injuries, Ligaments, Articular, Physical therapy, Hip Joint, Neuromuscular control, Range of motion, business, Hip Injuries
الوصف: Although hip arthroscopic techniques have been developed and evolved over the last 5 to 10 years to help active athletes, the mechanisms of athletic hip injuries across various sports are not well understood. The purpose of this article is to review the literature related to the osseous and ligamentous support as well as the neuromuscular control strategies associated with hip joint mechanics. The neuromuscular contributions to hip stability and mobility with respect to gait will be provided because this data represents the largest body of knowledge regarding hip function. Further, this article will present and describe probable mechanisms of injury in sporting activities most often associated with hip injury in the young athlete.
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