RESUMEN
Shoulder glenohumeral joint dislocations and subluxations are a relatively common injury among athletic populations. Evaluating the patient both on the field initially and through early recovery helps to determine the best treatment strategies and predict the natural history of each unique injury.
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Traumatismos en Atletas , Inestabilidad de la Articulación , Luxación del Hombro , Humanos , Inestabilidad de la Articulación/diagnóstico , Traumatismos en Atletas/diagnóstico , Traumatismos en Atletas/terapia , Luxación del Hombro/terapia , Luxación del Hombro/diagnóstico , Examen Físico , Articulación del Hombro/fisiopatología , Lesiones del HombroRESUMEN
In-season management of anterior shoulder instability in athletes is a complex problem. Athletes often wish to play through their current season, though recurrent instability rates are high, particularly in contact sports. Athletes are generally considered safe to return to play when they are relatively pain-free, and their strength and range of motion match the uninjured extremity. If an athlete is unable to progress toward recovering strength and range of motion, surgical management is an option, though this is often a season-ending decision.
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Traumatismos en Atletas , Inestabilidad de la Articulación , Volver al Deporte , Humanos , Inestabilidad de la Articulación/cirugía , Inestabilidad de la Articulación/fisiopatología , Inestabilidad de la Articulación/diagnóstico , Traumatismos en Atletas/cirugía , Traumatismos en Atletas/diagnóstico , Articulación del Hombro/fisiopatología , Articulación del Hombro/cirugía , Luxación del Hombro/cirugía , Luxación del Hombro/diagnóstico , Luxación del Hombro/fisiopatología , Lesiones del Hombro , Rango del Movimiento Articular , Toma de Decisiones , AtletasRESUMEN
Overhead athletes with anterior, posterior, and multidirectional shoulder instability present with a wide range of symptoms, especially considering the injury mechanism and affected supportive structures. As such, the management of shoulder instability is widely variable and relies on rehabilitation, operative management, and sport-specific considerations, such as positional and seasonal demands on the athlete. Biomechanical analysis may further aid in the recovery process or serve as a predictive tool to identify an increased risk for injury.
Asunto(s)
Traumatismos en Atletas , Inestabilidad de la Articulación , Lesiones del Hombro , Articulación del Hombro , Humanos , Inestabilidad de la Articulación/diagnóstico , Inestabilidad de la Articulación/terapia , Traumatismos en Atletas/terapia , Traumatismos en Atletas/diagnóstico , Fenómenos Biomecánicos , Articulación del Hombro/fisiopatologíaRESUMEN
Duchenne muscular dystrophy (DMD) is an X-linked recessive genetic disorder with progressive proximal weakness as the principal sign. Glucocorticoids and physical therapy are the mainstay of treatment. Exercise intolerance is the hallmark of metabolic myopathies, which require a combination of laboratory testing, electrodiagnostic testing, and muscle biopsy for diagnosis. Joint hypermobility may be an isolated finding or be associated with hypermobility Ehlers-Danlos syndrome (EDS), other variants of EDS, or marfanoid syndromes. The latter conditions are associated with aortic and cardiac valvular abnormalities. Osteogenesis imperfecta encompasses a group of disorders characterized by bone fragility presenting with a low-impact fracture as a result of minimal trauma. Management includes multidiscipline specialists. Down syndrome (DS), or trisomy 21, is the most common chromosome abnormality identified in live births. Routine evaluation of atlantoaxial instability with x-ray is no longer recommended for children with DS without symptoms of atlantoaxial instability; however, clinical evaluation of symptoms is required for sports preparticipation. Achondroplasia is the most common skeletal dysplasia. Clinical signs are macrocephaly, short limb, short stature with disproportionately shorter humerus and femur, along with characteristic findings in pelvis and lumbar spine x-rays. Caregivers should be educated on proper positioning and handling to avoid complications, including car seat-related deaths.
Asunto(s)
Acondroplasia , Síndrome de Ehlers-Danlos , Osteogénesis Imperfecta , Humanos , Niño , Síndrome de Ehlers-Danlos/diagnóstico , Síndrome de Ehlers-Danlos/terapia , Adolescente , Acondroplasia/diagnóstico , Acondroplasia/genética , Acondroplasia/terapia , Osteogénesis Imperfecta/diagnóstico , Osteogénesis Imperfecta/terapia , Inestabilidad de la Articulación/diagnóstico , Inestabilidad de la Articulación/terapia , Distrofia Muscular de Duchenne/diagnóstico , Distrofia Muscular de Duchenne/complicaciones , Distrofia Muscular de Duchenne/genética , Distrofia Muscular de Duchenne/terapia , Síndrome de Down/complicaciones , Síndrome de Down/diagnóstico , Enfermedades Musculoesqueléticas/diagnóstico , Enfermedades Musculoesqueléticas/terapia , Síndrome de Marfan/diagnóstico , Síndrome de Marfan/terapia , Síndrome de Marfan/complicaciones , Síndrome de Marfan/genética , Glucocorticoides/uso terapéutico , Modalidades de FisioterapiaRESUMEN
BACKGROUND: Assessment of readability and reliability of online resources for orthopedic patients is an area of growing interest, but there is currently limited reporting on this topic for patellar instability (PI) and medial patellofemoral ligament reconstruction (MPFLR). METHODS: Utilizing the Searchresponse.io dataset, we analyzed inquiries related to PI and MPFLR. Readability and reliability were assessed using the Automated Reading Index, Flesch Reading Ease, and the JAMA benchmark criteria. RESULTS: Analysis of 363 frequently asked questions from 130 unique websites revealed a predominant interest in fact-based information. Readability assessments indicated that the average grade level of the resources was significantly higher than the 6th grade level and reliability varied between resources. CONCLUSION: Although the internet is an easily accessible resource, we demonstrate that PI and MPFLR resources are written at a significantly higher reading level than is recommended, and there is inconsistent reliability amongst resources with medical practice websites demonstrating the lowest reliability.
Asunto(s)
Comprensión , Internet , Inestabilidad de la Articulación , Humanos , Inestabilidad de la Articulación/diagnóstico , Reproducibilidad de los Resultados , Información de Salud al Consumidor/normas , Articulación PatelofemoralRESUMEN
Objective: The aim of this study was to document perceived frequency of medial shoulder syndrome and instability (MSS/MSI) among dogs, and preferred diagnostic and treatment options related to the condition, among American or European Colleges of Veterinary Surgeons (ACVS/ECVS) diplomates, American College of Veterinary Sports Medicine and Rehabilitation (ACVSMR) diplomates, and dual diplomates of ACVS/ECVS and ACVSMR (double-Boarded diplomates). Procedure: An invitation to complete an online survey was sent to diplomates via email listservs. Results: The known response rate for the survey was 15.8% (160 of 1014 email addresses). There was a difference (P = 0.006) among groups in number of cases of MSS/MSI seen, with ACVS/ECVS diplomates and double-Boarded diplomates seeing 0 to 5 cases per year (80.7 and 72.7%, respectively) and ACVSMR diplomates (32% of total respondents) seeing 11 to 26+ cases annually. The majority of all respondents (56.4%) felt the likely cause of MSS/MSI to be chronic/repetitive strain. Diagnostically, most respondents (78%) relied on shoulder abduction angles; however, most felt it was a questionable or somewhat accurate diagnostic test. The ACVSMR diplomates (88%) relied on musculoskeletal ultrasound as their preferred diagnostic modality, compared to only 35% of ACVS/ECVS diplomates and 45% of double-Boarded diplomates. Preferred treatment was rehabilitation with surgery for unresponsive cases, as reported by 86.9% of all respondents. Preferred surgical treatment was prosthetic ligament reconstruction (62.7%). Conclusion: Despite the low known response rate of this survey, there were significant differences among specialties regarding frequency of MSS/MSI cases seen per year and preferred diagnostic modalities. However, there were no differences among specialties regarding the suspected underlying causes of MSS/MSI and initial treatment strategies.
Enquête en ligne sur le diagnostic et les recommandations thérapeutiques pour le syndrome et l'instabilité médiale de l'épaule chez le chien. Objectif: Le but de cette étude était de documenter la fréquence perçue du syndrome et de l'instabilité médiale de l'épaule (MSS/MSI) chez les chiens, ainsi que les options de diagnostic et de traitement préférées liées à cette maladie, parmi les spécialistes des collèges américains ou européens de chirurgiens vétérinaires (ACVS/ECVS), les spécialistes de l'American College of Veterinary Sports Medicine and Rehabilitation (ACVSMR) et les spécialistes doubles ACVS/ECVS et ACVSMR. Procédure: Une invitation à répondre à un sondage en ligne a été envoyée aux spécialistes via des listes de diffusion de courrier électronique. Résultats: Le taux de réponse connu pour l'enquête était de 15,8 % (160 sur 1 014 adresses courriel). Il y avait une différence (P = 0,006) entre les groupes dans le nombre de cas de MSS/MSI vus, les spécialistes de l'ACVS/ECVS et les spécialistes doubles voyant 0 à 5 cas par an (respectivement 80,7 et 72,7 %) et les spécialistes de l'ACVSMR (32 % du total des répondants) voient 11 à 26+ cas par an. La majorité de tous les répondants (56,4 %) ont estimé que la cause probable du MSS/MSI était une tension chronique/répétitive. Sur le plan diagnostique, la plupart des répondants (78 %) se sont appuyés sur les angles d'abduction de l'épaule; cependant, la plupart estimaient qu'il s'agissait d'un test diagnostique douteux ou quelque peu précis. Les spécialistes de l'ACVSMR (88 %) ont eu recours à l'échographie musculosquelettique comme modalité diagnostique privilégiée, contre seulement 35 % des spécialistes de l'ACVS/ECVS et 45 % des spécialistes doubles. Le traitement préféré était la réadaptation chirurgicale pour les cas qui ne répondaient pas, comme l'ont indiqué 86,9 % de tous les répondants. Le traitement chirurgical préféré était la reconstruction ligamentaire prothétique (62,7 %). Conclusion: Malgré le faible taux de réponse à cette enquête, il existe des différences significatives entre les spécialités concernant la fréquence des cas de MSS/MSI observés par an et les modalités de diagnostic préférées. Cependant, il n'y avait aucune différence entre les spécialités concernant les causes sous-jacentes suspectées de MSS/MSI et les stratégies de traitement initiales.(Traduit par Dr Serge Messier).
Asunto(s)
Enfermedades de los Perros , Internet , Inestabilidad de la Articulación , Perros , Animales , Enfermedades de los Perros/diagnóstico , Enfermedades de los Perros/terapia , Enfermedades de los Perros/cirugía , Encuestas y Cuestionarios , Inestabilidad de la Articulación/veterinaria , Inestabilidad de la Articulación/diagnóstico , Inestabilidad de la Articulación/cirugía , Veterinarios , Humanos , Medicina VeterinariaRESUMEN
INTRODUCTION: Hypermobility spectrum disorders (HSD) and hypermobile Ehlers-Danlos syndrome (hEDS) are often accompanied by varied and complex multisystemic comorbid symptoms/conditions. The Spider questionnaire was developed to evaluate the presence and impact of eight common multisystemic comorbidities. Thirty-one questions across eight symptom domains assess neuromusculoskeletal, pain, fatigue, cardiac dysautonomia, urogenital, gastrointestinal, anxiety, and depression symptoms. This study aimed to evaluate the Spider's construct validity in adults. METHOD: A cross-sectional observational study was conducted over four stages. Three international patient charities aided recruitment of participants through social media and website advertisements. Adults aged 18 to 65 years, with and without HSD/hEDS, were invited to participate. Validated, frequently used comparator questionnaires were used to establish convergent validity of Spider symptom domains. A control group was recruited for known-group validity analysis. Participants answered each Spider domain and the corresponding comparator questionnaire via surveys hosted by REDCap. Anonymous data were analysed using SPSS. Convergent validity was assessed through Spearman's correlational analysis and known-group validity through Mann-Whitney U analysis. RESULTS: A total of 11,151 participants were recruited across the four stages. Statistically significant, moderate-to-strong correlations were found between all Spider domains and their comparators (p < 0.001, r = 0.63 to 0.80). Known-group validity analysis showed statistically significant differences (p < 0.001) between the hypermobile and control groups in all eight domains. CONCLUSIONS: Convergent and known-group validity of the Spider was established with adults. These results suggest the Spider can measure the presence and impact of multisystemic comorbid symptoms/conditions in adults with HSD/hEDS, providing a tool which guides multidisciplinary management. Key Points ⢠The Spider questionnaire is a novel tool assessing the presence and impact of the multisystemic comorbid symptoms/conditions associated with HSD/hEDS. ⢠Convergent and known-group validity of the Spider questionnaire was established in adults aged 18 to 65. ⢠This tool provides a quick and easy method to visualise the symptom profile of those with HSD/hEDS to guide symptom management.
Asunto(s)
Inestabilidad de la Articulación , Humanos , Adulto , Femenino , Encuestas y Cuestionarios , Persona de Mediana Edad , Estudios Transversales , Masculino , Adulto Joven , Adolescente , Anciano , Reproducibilidad de los Resultados , Inestabilidad de la Articulación/diagnóstico , Inestabilidad de la Articulación/epidemiología , Síndrome de Ehlers-Danlos/complicaciones , Síndrome de Ehlers-Danlos/diagnóstico , Fatiga/diagnóstico , Depresión/diagnóstico , Ansiedad/diagnóstico , Comorbilidad , Disautonomías Primarias/diagnósticoRESUMEN
Joint hypermobility syndromes, particularly chronic pain associated with this condition, including Hypermobile Ehlers-Danlos Syndrome (hEDS) and Hypermobility Spectrum Disorders (HSD), present diagnostic challenges due to their multifactorial origins and remain poorly understood from biomechanical and genomic-molecular perspectives. Recent diagnostic guidelines have differentiated hEDS, HSD, and benign joint hypermobility, providing a more objective diagnostic framework. However, incorrect diagnoses and underdiagnoses persist, leading to prolonged journeys for affected individuals. Musculoskeletal manifestations, chronic pain, dysautonomia, and gastrointestinal symptoms illustrate the multifactorial impact of these conditions, affecting both the physical and emotional well-being of affected individuals. Infrared thermography (IRT) emerges as a promising tool for joint assessment, especially in detecting inflammatory processes. Thermal distribution patterns offer valuable insights into joint dysfunctions, although the direct correlation between pain and inflammation remains challenging. The prevalence of neuropathies among hypermobile individuals accentuates the discordance between pain perception and thermographic findings, further complicating diagnosis and management. Despite its potential, the clinical integration of IRT faces challenges, with conflicting evidence hindering its adoption. However, studies demonstrate objective temperature disparities between healthy and diseased joints, especially under dynamic thermography, suggesting its potential utility in clinical practice. Future research focused on refining diagnostic criteria and elucidating the underlying mechanisms of hypermobility syndromes will be essential to improve diagnostic accuracy and enhance patient care in this complex and multidimensional context.
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Dolor Crónico , Inestabilidad de la Articulación , Termografía , Humanos , Termografía/métodos , Inestabilidad de la Articulación/diagnóstico , Inestabilidad de la Articulación/fisiopatología , Dolor Crónico/diagnóstico , Dolor Crónico/fisiopatología , Síndrome de Ehlers-Danlos/diagnóstico , Síndrome de Ehlers-Danlos/fisiopatología , Inflamación/diagnóstico , Rayos InfrarrojosRESUMEN
Posterior cruciate ligament (PCL) ruptures can cause severe knee instability and disability and thus, appropriate management is crucial for the successful restoration of patients' knee function. Rupture of the PCL can occur during sporting activity but more often, as a part of high-energy trauma. The diagnosis can be made using various clinical tests, such as the posterior drawer test or the quadriceps active test. MRI is the gold standard in imaging. PCL injuries can be classified from grade I to grade III, with increasing severity. Treatment can be conservative or surgical and should be personalized based on patients' demographic characteristics, grade of injury, level of instability, associated injuries and activity levels.
Les ruptures du ligament croisé postérieur (LCP) peuvent causer une instabilité sévère du genou et une incapacité importante, rendant ainsi une prise en charge appropriée cruciale pour le rétablissement d'une bonne fonction du genou. La rupture du LCP peut survenir lors d'une activité sportive, mais plus souvent, dans le cadre d'un traumatisme à haute énergie. Le diagnostic peut être posé à l'aide de différents tests cliniques, tels que le test du tiroir postérieur ou le test actif du quadriceps. L'IRM est l'examen de référence en imagerie. Les lésions du LCP peuvent être classées de grade I à III, avec une gravité croissante. Le traitement peut être conservateur ou chirurgical et doit être personnalisé en fonction des caractéristiques démographiques des patients, du grade de la lésion, du niveau d'instabilité, des lésions associées et des niveaux d'activité.
Asunto(s)
Traumatismos de la Rodilla , Ligamento Cruzado Posterior , Humanos , Ligamento Cruzado Posterior/lesiones , Rotura/diagnóstico , Traumatismos de la Rodilla/diagnóstico , Traumatismos de la Rodilla/terapia , Imagen por Resonancia Magnética/métodos , Inestabilidad de la Articulación/diagnóstico , Inestabilidad de la Articulación/terapia , Traumatismos en Atletas/diagnóstico , Traumatismos en Atletas/terapiaRESUMEN
BACKGROUND: For children with Osteogenesis Imperfecta (OI), a rare genetic bone disease, walking can be difficult to carry out due to a combination of bone fragility and deformity, muscle weakness, joint hypermobility, and pain. Bisphosphonate treatment has facilitated more children being able to walk, but for many, foot and ankle hypermobility is a limiting factor. Current evidence on foot orthoses in children with OI is sparse. This study aimed to evaluate gait characteristics in children with OI walking barefoot as compared to walking with foot orthoses. METHODS: Twenty-three children with OI and hypermobility (mean age 8.3 ± 3.0 years) were included in this cross-sectional study. Children conducted three-dimensional gait analysis barefoot, and with foot orthoses and appropriate foot wear (stable yet light-weight), respectively. Walking speed, step length, lower limb kinematics and kinetics were collected. Differences in gait characteristics between test conditions were evaluated using paired sample t-tests. RESULTS: When walking with foot orthoses, the external foot progression angle was reduced, peak ankle dorsiflexion angle increased, and peak plantarflexion moment increased as compared to barefoot. No difference was found in walking speed between test conditions, however, children with OI walked with longer steps with foot orthoses as compared to barefoot. CONCLUSION: The observed gait alterations suggest that foot orthoses, aiming to support the foot and ankle joint, contributed to reduced overall foot rotation as measured by external foot progression, increased peak plantarflexion moment, and increased step length. In a wider perspective, the ability to walk provides the opportunity to be physically active, and thereby increase skeletal loading and prevent fractures, thus, foot orthoses may be an important treatment option to consider in children with OI. LEVEL OF EVIDENCE: III.
Asunto(s)
Ortesis del Pié , Marcha , Osteogénesis Imperfecta , Humanos , Osteogénesis Imperfecta/terapia , Osteogénesis Imperfecta/complicaciones , Osteogénesis Imperfecta/fisiopatología , Estudios Transversales , Niño , Femenino , Masculino , Fenómenos Biomecánicos , Preescolar , Adolescente , Caminata/fisiología , Análisis de la Marcha , Inestabilidad de la Articulación/fisiopatología , Inestabilidad de la Articulación/terapia , Inestabilidad de la Articulación/diagnósticoRESUMEN
PURPOSE: Lesions of the peroneal tendons are frequently overseen after ankle sprain. The symptoms consist of stress-dependent pain that extends from the inframalleolar to the proximal part along the course of the peroneal tendons as well as ankle instability and soft-tissue swelling. In case of unsuccessful conservative treatment, surgical therapy is recommended. The aim of the study was to evaluate the clinical and functional outcome after open reconstruction of the peroneus brevis tendon. METHODS: 13 patients were included in this retrospective study. All of them received a single reconstruction of the peroneus brevis tendon in open technique. Postoperative results were evaluated with the AOFAS score, a functional and perdobargraphic analysis as well as measuring postural stability with the Biodex balance system. The participants were matched with a healthy control group according to age, sex and BMI. RESULTS: The results of the AOFAS score showed significantly convincing results in all subscores postoperatively. A bilateral comparison of the postural stability showed that the affected side had become functionally similar to the healthy side. No statistical significant difference was detected concerning both one-legged and two-legged standing with the control group. Pedobarographic results revealed no difference between the affected and contralateral side, as well as between the patients and the healthy control group. CONCLUSION: Open reconstruction of the peroneus brevis tendon leads to significant better postoperative results and can be recommended after unsuccessful conservative treatment as promising option.
Asunto(s)
Traumatismos del Tobillo , Equilibrio Postural , Traumatismos de los Tendones , Humanos , Masculino , Femenino , Estudios Retrospectivos , Adulto , Persona de Mediana Edad , Traumatismos de los Tendones/cirugía , Traumatismos de los Tendones/diagnóstico , Traumatismos de los Tendones/fisiopatología , Equilibrio Postural/fisiología , Traumatismos del Tobillo/cirugía , Procedimientos de Cirugía Plástica/métodos , Adulto Joven , Tendones/cirugía , Resultado del Tratamiento , Inestabilidad de la Articulación/cirugía , Inestabilidad de la Articulación/diagnóstico , Articulación del Tobillo/cirugía , Articulación del Tobillo/fisiopatologíaRESUMEN
The pediatric cervical spine is structurally and biomechanically unique in comparison to adults. Guidelines to assess for cervical spine instability and standard of care treatments in the pediatric population have yet to be delineated. This is due to the rarity of the condition and the lack of multicenter data published on the topic. Our review explores the biomechanics of the pediatric cervical spine and highlights evolving concepts/research over the last several decades, with special attention to the Down syndrome and complex Chiari malformation cohorts.
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Vértebras Cervicales , Inestabilidad de la Articulación , Humanos , Vértebras Cervicales/diagnóstico por imagen , Inestabilidad de la Articulación/fisiopatología , Inestabilidad de la Articulación/diagnóstico , Niño , Fenómenos Biomecánicos/fisiología , Malformación de Arnold-Chiari/diagnóstico por imagen , Síndrome de Down/fisiopatologíaRESUMEN
AIM: To develop a new tool for identifying joint hypermobility of the paediatric foot and ankle, based on a dichotomous scoring system utilising the Lower Limb Assessment Score (LLAS), to separate the foot and ankle items. MATERIAL AND METHODS: A total of 205 children, aged between 5 and 10 years, participated in a cross-sectional study. The new tool Foot and Ankle Flexibility Index (FAFI) was predicated upon the last 7 items of LLAS, which are specific to the foot and ankle. The internal consistency was measured with Cronbach's test. Kappa statistics with 95% CI were calculated to verify the level of inter-rater and intra-rater agreement for the FAFI. RESULTS: Cronbach's alpha returned 0.82. The correlations between items returned a mean of 0.59 (range: 0.43-0.74). The discrimination score on the ROC curve (4 points) showed that the model can be used to identify children with joint hypermobility of the foot and ankle. Inter-rater reliability was largely good (ICC = 0.89). Excellent intra-rater reliability was found (ICC = 0.96) CONCLUSIONS: This study identified high reliability between evaluators, and high sensitivity and specificity, for a new reliable and valid tool for the identification of foot and ankle joint hypermobility.
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Psicometría , Humanos , Masculino , Femenino , Estudios Transversales , Niño , Reproducibilidad de los Resultados , Psicometría/métodos , Psicometría/instrumentación , Preescolar , Inestabilidad de la Articulación/diagnóstico , Inestabilidad de la Articulación/fisiopatología , Rango del Movimiento Articular/fisiología , Articulación del Tobillo/fisiopatología , Pie/fisiopatología , Pie/fisiologíaRESUMEN
PURPOSE: Managing the distal tibiofibular (DTF) joint remains a challenge despite recent developments. Ankle arthroscopy is emerging as a diagnostic and therapeutic means. Our study aimed to compare preoperative imaging data and arthroscopic data, with the hypothesis that imaging alone is insufficient to evaluate acute laxity, and with arthroscopy as the reference examination. METHODS: All patients treated in 2023 in our department for an acute isolated DTF lesion were included prospectively. Preoperative radiographic and MRI imaging were compared with arthroscopic data. RESULTS: Ten patients were treated. For five patients, the instability was doubtful after carrying out an appropriate imaging assessment (X-rays of both ankles, MRI). For four of these five patients, instability was confirmed by arthroscopy. Arthroscopy was useful for suturing the anterior bundle of the DTF joint for two patients and allowed for verifying the reduction in the sagittal and coronal planes for two patients. No complications were detected. CONCLUSIONS: Arthroscopy in isolated acute DTF lesions seems to provide a diagnostic and therapeutic advantage. Its use may allow for exhaustive assessment and complete repair of lesions. It must be offered as soon as possible; a delay in specialized imaging may delay therapeutic care.
Asunto(s)
Articulación del Tobillo , Artroscopía , Inestabilidad de la Articulación , Imagen por Resonancia Magnética , Humanos , Artroscopía/métodos , Masculino , Femenino , Adulto , Articulación del Tobillo/cirugía , Articulación del Tobillo/diagnóstico por imagen , Articulación del Tobillo/patología , Imagen por Resonancia Magnética/métodos , Inestabilidad de la Articulación/cirugía , Inestabilidad de la Articulación/diagnóstico , Inestabilidad de la Articulación/diagnóstico por imagen , Estudios Prospectivos , Persona de Mediana Edad , Adulto Joven , Traumatismos del Tobillo/cirugía , Traumatismos del Tobillo/diagnóstico , Traumatismos del Tobillo/diagnóstico por imagen , Peroné/cirugía , Peroné/diagnóstico por imagen , Resultado del Tratamiento , Radiografía/métodos , Adolescente , Tibia/cirugía , Tibia/diagnóstico por imagen , Tibia/patologíaRESUMEN
BACKGROUND: Benign Joint Hypermobility Syndrome (BJHS) is a most common hereditary connective tissue disorders in children and adolescents. This study aimed to investigate the prevalence and subtypes of headache in children with BJHS. METHODS: This observational-analytical study was conducted in a case-control setting on school children aged 7 to 16 years in 2021-2023 in Isfahan, Iran. Students were examined for BJHS using Beighton criteria by a pediatric rheumatologist. Headache disorder was diagnosed according to the Child Headache-Attributed Restriction, Disability, and Social Handicap and Impaired Participation (HARDSHIP) questionnaires for child and adolescent and International Classification of Headache Disorders (ICHD-III). RESULTS: A total of 4,832 student (mean age 10.3 ± 3.1 years), 798 patients with BJHS and 912 healthy children were evaluated. The probability of headache in children aged 7-11 with hypermobility was 3.7 times lower than in children aged 12-16 with hypermobility (P = 0.001). The occurrence of headache in children with BJHS was more than the control group (P = 0.001), and the probability of headache in children with BJHS was 3.7 times higher than in healthy children (P = 0.001). Migraine was the most common headache type reported of total cases. The probability of migraine in children with BJHS was 4.5 times higher than healthy children ( P = 0.001). CONCLUSION: This study showed a significant correlation between BJHS and headache (especially migraine) in children and adolescents.
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Cefalea , Inestabilidad de la Articulación , Inestabilidad de la Articulación/congénito , Humanos , Adolescente , Niño , Masculino , Femenino , Estudios de Casos y Controles , Irán/epidemiología , Inestabilidad de la Articulación/epidemiología , Inestabilidad de la Articulación/diagnóstico , Inestabilidad de la Articulación/complicaciones , Prevalencia , Cefalea/epidemiología , Cefalea/diagnóstico , Síndrome de Ehlers-Danlos/epidemiología , Síndrome de Ehlers-Danlos/diagnóstico , Síndrome de Ehlers-Danlos/complicacionesRESUMEN
Syndesmotic ankle injuries, though rare in isolation, are complex destabilizing injuries often accompanied by fractures. Misdiagnoses, particularly overlooking posterior malleolus fractures, are common in ankle sprains. Thorough physical examinations, emphasizing high fibular pain and anterior tibia palpation, aid in accurate diagnosis. Grading helps assess injury severity and guiding treatment. Initial imaging involves three ankle views, with stress radiographs enhancing accuracy. If conservative care fails, MRI reveals ligament and tendon damage. Physical therapy may suffice for functional instability; surgical intervention addresses mechanical instability. Syndesmotic fixation debates center on cortices, screw size, reduction methods, and optimal positioning.
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Traumatismos del Tobillo , Humanos , Traumatismos del Tobillo/cirugía , Traumatismos del Tobillo/diagnóstico , Fijación Interna de Fracturas/métodos , Imagen por Resonancia Magnética , Masculino , Fracturas de Tobillo/cirugía , Fracturas de Tobillo/diagnóstico por imagen , Femenino , Inestabilidad de la Articulación/cirugía , Inestabilidad de la Articulación/etiología , Inestabilidad de la Articulación/diagnósticoRESUMEN
Current international consensus of the appropriate Beighton score cut-off to define if a child has generalised joint hypermobile or not is based upon expert opinion. Our aim was to determine the prevalence of Beighton scores of children worldwide to provide a recommendation for establishing the Beighton score cut-off to identify generalised joint hypermobility in children. We used AMED, OVID Medline, Embase and CINAHL to find published articles from inception to April 2024 describing Beighton scores of children up to and including 18 years from the general population. We extracted study demographics including country of publication, total number of participants, summary data about the age and sex of participant, Beighton scores and any cut-off used where authors deemed children hypermobile and how many children were rated at the corresponding Beighton scores. There were 37 articles reporting on the prevalence or incidence of hypermobility at cut-off scores from 28,868 participants. Using the cut-off of ≥ 6 resulted in a prevalence of 6% for studies reporting male data and 13% for studies reporting female data. Limited data reporting availability precluded further sub-analysis at a Beighton score of ≥ 7, age, pubertal status and ethnicity. Conclusion: The working threshold for identifying generalised joint hypermobility in children should be a Beighton score of 6 or more. Our analysis also suggests a Beighton score of 7 or greater may be appropriate in childhood, particularly for females. What is Known: ⢠The working threshold for identifying generalised joint hypermobility in children previously was set based on expert opinion. What is New: ⢠The threshold to identify hypermobility in children should be at a minimum of ≥ 6 on the Beighton score.
Asunto(s)
Inestabilidad de la Articulación , Humanos , Inestabilidad de la Articulación/diagnóstico , Inestabilidad de la Articulación/epidemiología , Niño , Adolescente , Femenino , Masculino , Prevalencia , PreescolarRESUMEN
PURPOSE: The Instability Severity Index (ISI) Score was developed to preoperatively assess the risk of recurrent shoulder instability after an arthroscopic Bankart repair. This study aims to validate the use of ISI Score for predicting the risk of recurrence after an arthroscopic Bankart repair in a heterogeneous population and proposes an appropriate cut-off point for treating patients with an arthroscopic Bankart repair or otherwise. METHODS: This study analysed 99 shoulders after a traumatic dislocation that underwent arthroscopic Bankart repair with at least 3 years follow-up. Patients were divided into subcategories based on their respective ISI Score. Recurrence includes either a postoperative dislocation or perceived instability. RESULTS: The overall recurrence rate was found to be 26.3%. A significant correlation was identified between ISI Score and the recurrence rate (odds ratio [OR]: 1.545, 95% confidence interval [CI]: 1.231-1.939, p < 0.001). Furthermore, ISI Score 4-6 (OR: 4.498, 95% CI: 1.866-10.842, p < 0.001) and ISI Score > 6 (OR: 7.076, 95% CI: 2.393-20.924, p < 0.001) both had a significantly higher risk of recurrence compared to ISI Score 0-3. In ISI Score subcategories 0-3, 4-6 and >6, the recurrence rate was, respectively, 15.4%, 40.7% and 71.4%. CONCLUSION: ISI Score has predictive value in determining the recurrence risk of shoulder instability following an arthroscopic Bankart repair in a heterogeneous population. Based on the findings of this study, we recommend using arthroscopic Bankart repair in patients with ISI Score 0-3. Clinical and shared decision-making are essential in the group with ISI Score 4-6, since the recurrence rate is significantly higher than in patients with ISI Score 0-3. Arthroscopic Bankart repair is not suitable for patients with ISI Score > 6. LEVEL OF EVIDENCE: Level III.
Asunto(s)
Artroscopía , Inestabilidad de la Articulación , Recurrencia , Luxación del Hombro , Humanos , Inestabilidad de la Articulación/cirugía , Inestabilidad de la Articulación/diagnóstico , Femenino , Masculino , Adulto , Luxación del Hombro/cirugía , Luxación del Hombro/diagnóstico , Adulto Joven , Estudios Retrospectivos , Lesiones de Bankart/cirugía , Lesiones de Bankart/diagnóstico , Índice de Severidad de la Enfermedad , Adolescente , Articulación del Hombro/cirugía , Valor Predictivo de las PruebasRESUMEN
PURPOSE: Instability of the glenohumeral joint remains a complex clinical issue with high rates of surgical failure and significant morbidity. Advances in specific radiologic measurements involving the glenoid and the humerus have provided insight into glenohumeral pathology, which can be corrected surgically towards improving patient outcomes. The contributions of capsular pathology to ongoing instability remain unclear. The purpose of this study is to provide a systematic review of existing glenohumeral capsular measurement techniques published in the last 15 years. METHODS: A systematic review of multiple databases was performed following PRISMA guidelines for all primary research articles between 2008 and 2023 with quantitative measurements of the glenohumeral capsule in patients with instability, including anterior, posterior and multi-directional instability. RESULTS: There were a total of 14 articles meeting the inclusion criteria. High variability in measurement methodology across studies was observed, including variable amounts of intra-articular contrast, heterogeneity among magnetic resonance sequence acquisitions, differences in measurements performed and the specific approach taken to compute each measurement. CONCLUSION: There is a need for standardization of methods in the measurement of glenohumeral capsular pathology in the setting of glenohumeral instability to allow for cross-study analysis. LEVEL OF EVIDENCE: Level III.
Asunto(s)
Cápsula Articular , Inestabilidad de la Articulación , Articulación del Hombro , Humanos , Inestabilidad de la Articulación/diagnóstico , Inestabilidad de la Articulación/diagnóstico por imagen , Articulación del Hombro/diagnóstico por imagen , Cápsula Articular/diagnóstico por imagen , Imagen por Resonancia Magnética/métodosRESUMEN
An internal derangement of the temporomandibular joint is described as a deviation in the position or shape of the joint tissues. Such a change is only functionally manifest if it interferes with smooth movements of the jaw joint. There are a number of internal derangements associated with jaw movements in which popping jaw joint sounds can occur. Examples are an anteriorly or posteriorly displaced disc and hypermobility of the condylar head. Although most internal derangements are harmless and only cause minor discomfort to patients, disc displacements can in some cases develop into a clinical problem, for example when there is a limitation of mouth opening (so-called closed lock) or an inability to close the mouth (so-called open lock). Most patients with these conditions do not require any or only conservative treatment.