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RESUMEN Introducción: Las lesiones musculares del dorsal ancho (DA) son poco comunes y se producen casi exclusivamente en atletas de alto nivel competitivo. Hasta la fecha, no encontramos reportes de casos similares que describan de manera detallada el proceso de rehabilitación. El objetivo de este reporte de caso es describir la evaluación y el tratamiento kinésico de una atleta de élite de CrossFit en un consultorio privado de kinesiología. Presentación del caso: Una paciente femenina de 28 años, atleta de élite de CrossFit, sufrió una lesión muscular del DA durante una competencia. Se realizó una ecografía 72 h después, la cual confirmó la lesión. El tratamiento kinésico posterior fue activo y se basó principalmente en la progresión de diferentes ejercicios terapéuticos. Se realizaron diversas evaluaciones para monitorear la adaptación de la atleta (fuerza isométrica del DA, cuestionarios autorreportados y valoración funcional de la extremidad superior). Conclusión: La óptima progresión de los ejercicios durante el tratamiento, junto con una comunicación fluida entre la atleta, el entrenador y el kinesiólogo, permitió una vuelta a los entrenamientos diarios con el mismo nivel de cargas, intensidad y volumen que tenía previamente. La paciente regresó a la competencia a los 45 días del alta kinésica.

ABSTRACT Introduction: Latissimus dorsi (LD) muscle injuries are rare and primarily occur in high-level competitive athletes. To date, no similar case reports detailing the rehabilitation process have been found. The objective of this case report is to describe the assessment and physical therapy treatment of an elite CrossFit athlete at a private physical therapy clinic. Case presentation: A 28-year-old female patient, an elite CrossFit athlete, suffered an LD muscle injury during a competition. An ultrasound performed 72 h later confirmed the injury. Subsequent physical therapy treatment was active and primarily focused on the progression of various therapeutic exercises. Several assessments were conducted to monitor the athlete's adaptation (LD isometric strength test, self-reported questionnaires, and functional assessment to the upper extremity). Conclusion: The optimal progression of exercises during treatment, along with fluid communication among the athlete, coach, and physiotherapist, allowed a return to daily training with the same level of loads, intensity, and volume as before the injury. The patient returned to competition 45 days after discharge from physiotherapy.

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Individuals with chronic ankle instability (CAI) present muscular weakness and potential changes in the activation of the peroneus longus muscle, which likely explains the high recurrence of ankle sprains in this population. However, there is conflicting evidence regarding the role of the peroneus longus activity in CAI, possibly due to the limited spatial resolution of the surface electromyography (sEMG) methods (i.e., bipolar sEMG). Recent studies employing high-density sEMG (HD-sEMG) have shown that the peroneus longus presents differences in regional activation, however, it is unknown whether this regional activation is maintained under pathological conditions such as CAI. This study aimed to compare the myoelectric activity, using HD-sEMG, of each peroneus longus compartment (anterior and posterior) between individuals with and without CAI. Eighteen healthy individuals (No-CAI group) and 18 individuals with CAI were recruited. In both groups, the center of mass (COM) and the sEMG amplitude at each compartment were recorded during ankle eversion at different force levels. For the posterior compartment, the sEMG amplitude of CAI group was significantly lower than the No-CAI group (mean difference = 5.6% RMS; 95% CI = 3.4-7.6; p = 0.0001). In addition, it was observed a significant main effect for group (F1,32 = 9.608; p = 0.0040) with an anterior displacement of COM for the CAI group. These findings suggest that CAI alters the regional distribution of muscle activity of the peroneus longus during ankle eversion. In practice, altered regional activation may impact strengthening programs, prevention, and rehabilitation of CAI.

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ABSTRACT BACKGROUND: Ankle taping (AT) is effective in preventing ankle sprain injuries in most common sports and is employed in rehabilitation and prevention sports. OBJECTIVE: This study aimed to investigate the effectiveness of AT to restricting excessive frontal plane ankle movements in semi-professional basketball players throughout the training session. DESIGN AND SETTING: A cross-sectional study was performed at the Universidad Europea de Madrid. METHODS: Forty male and female semi-professional basketball players were divided into two groups. The ankle dorsiflexion range of motion (ROM) and interlimb asymmetries in a weight-bearing lunge position were evaluated at four time points: 1) with no tape, 2) before practice, at 30 min of practice, and 3) immediately after practice. RESULTS: In male basketball players, no differences were observed in the right and left ankles between the baseline and 30 min and between baseline and 90 min of assessment. In female athletes, significant differences were reported between baseline and pre-training assessments for the right ankle and also significant differences between baseline and 90 min in both ankles. CONCLUSIONS: Ankle taping effectively decreased the ankle dorsiflexion ROM in male and female basketball players immediately after application. However, ROM restriction was very low after 30 and 90 min, as assessed in a single basketball practice. Therefore, the classic taping method should be revised to develop new prophylactic approaches, such as the implementation of semi-rigid bracing techniques or the addition of active stripes during training or game pauses.

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Ankle injuries are the most common musculoskeletal injuries in emergency rooms and are associated with a great social and economic impact. The need to request additional tests for ankle sprains is based on suspicion of fracture. The Ottawa Ankle Rules (OAR) establish criteria for ordering radiographs to avoid performing unnecessary examinations. OBJECTIVE: To evaluate the implementation of the Ottawa Rules as a protocol for treating ankle sprains in the emergency department of a university hospital. METHODS: This is a retrospective observational study, conducted over a period of three months before and three months after implementation of the protocol. RESULTS: In the first phase, all patients complaining of ankle sprain underwent radiographs. In the second phase, after the application of the OAR, out of 85 patients evaluated, only 58 underwent complementary exams, showing a reduction of 31.8% in the request for imaging exams. There was no significant difference in fracture detection between the two groups (p=0.476). CONCLUSION: The OAR can be used as a tool in diagnosing ankle sprains, and their implementation reduced the request for imaging exams. Level of Evidence III, Retrospective Comparative Study.

Os traumatismos de tornozelo são as lesões musculoesqueléticas mais comuns nas salas de emergência e estão associadas a um grande impacto social e econômico. A solicitação de exames complementares para a entorse de tornozelo baseia-se na suspeita de fratura. As Regras de Ottawa para Tornozelo (ROT) estabelecem critérios para a solicitação de radiografias com o intuito de evitar a realização de exames desnecessários. Objetivo: Avaliar a implementação das ROT como protocolo de atendimento das entorses de tornozelo no pronto-socorro de um hospital universitário. Métodos: Estudo observacional retrospectivo que visou comparar a solicitação de radiografias e a presença de fraturas três meses antes e três meses após a implantação do protocolo. Resultados: Na primeira fase, todos os pacientes com queixa de entorse de tornozelo realizaram radiografias. Na segunda fase, após aplicação das ROT, de 85 pacientes avaliados, apenas 58 realizaram exames complementares, apresentando uma redução de 31,8% na solicitação dos exames de imagem. Não houve diferença na detecção de fraturas entre os dois grupos (p=0,476). Conclusão: As ROT podem ser utilizadas como ferramenta no atendimento das entorses de tornozelo e sua implantação reduziu a solicitação de exames de imagem. Nível de Evidência III, Estudo Comparativo Retrospectivo.

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BACKGROUND: Syndesmotic injury in an athletic population is associated with a prolonged ankle disability after an ankle sprain and often requires a longer recovery than a lateral collateral ligament injury. Although several imaging tests are available, diagnosing syndesmotic instability remains challenging. PURPOSE: To determine the diagnostic accuracy of conventional ankle computed tomography (CT) scans with the joint in external rotation and dorsiflexion and compare it with that of conventional ankle CT scans in a neutral position. STUDY DESIGN: Cohort study (Diagnosis); Level of evidence, 2. METHODS: Between September 2018 and April 2021, this prospective study consecutively included adults visiting the foot and ankle outpatient clinic with a positive orthopaedic examination for acute syndesmotic injury. Participants underwent 3 CT scan tests. First, ankles were scanned in a neutral position. Second, ankles were scanned with 45° of external rotation, dorsiflexion, and extended knees. Third, ankles were scanned with 45° of external rotation, dorsiflexion, and flexed knees. Three measurements, comprising rotation (measurement a), lateral translation (measurement c), and anteroposterior translation (measurement f) of the fibula concerning the tibia, were used to diagnose syndesmotic instability in the 3 CT scans. Magnetic resonance imaging was used as a reference standard. The area under the curve (AUC) was used to compare the diagnostic accuracy, and Youden's J index was calculated to determine the ideal cutoff point. RESULTS: Images obtained in 68 participants (mean age, 36.5 years; range, 18-69 years) were analyzed, comprising 36 syndesmotic injuries and 32 lateral collateral ligament injuries. The best diagnostic accuracy occurred with the rotational measurement a, in which the second and third CT scans with stress maneuvers presented greater AUCs (0.97 and 0.99) than did the first CT scan in a neutral position (0.62). The ideal cutoff point for the stress maneuvers was 1.0 mm in the rotational measurement a and reached a sensitivity and specificity of 83% and 97% for the second CT scan with extended knees and 86% and 100% for the third CT scan with flexed knees, respectively. The ideal cutoff point for the first CT scan with a neutral position was 0.7 mm in the rotational measurement a, with a sensitivity of 25% and specificity of 97%. CONCLUSION: Conventional ankle CT with stress maneuvers has excellent performance for diagnosing subtle syndesmotic rotational instability, as it shows a greater AUC and enhanced sensitivity at the ideal cutoff point compared with ankle CT in the neutral position.

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ABSTRACT Ankle injuries are the most common musculoskeletal injuries in emergency rooms and are associated with a great social and economic impact. The need to request additional tests for ankle sprains is based on suspicion of fracture. The Ottawa Ankle Rules (OAR) establish criteria for ordering radiographs to avoid performing unnecessary examinations. Objective: To evaluate the implementation of the Ottawa Rules as a protocol for treating ankle sprains in the emergency department of a university hospital. Methods: This is a retrospective observational study, conducted over a period of three months before and three months after implementation of the protocol. Results: In the first phase, all patients complaining of ankle sprain underwent radiographs. In the second phase, after the application of the OAR, out of 85 patients evaluated, only 58 underwent complementary exams, showing a reduction of 31.8% in the request for imaging exams. There was no significant difference in fracture detection between the two groups (p=0.476). Conclusion: The OAR can be used as a tool in diagnosing ankle sprains, and their implementation reduced the request for imaging exams. Level of Evidence III, Retrospective Comparative Study.

RESUMO Os traumatismos de tornozelo são as lesões musculoesqueléticas mais comuns nas salas de emergência e estão associadas a um grande impacto social e econômico. A solicitação de exames complementares para a entorse de tornozelo baseia-se na suspeita de fratura. As Regras de Ottawa para Tornozelo (ROT) estabelecem critérios para a solicitação de radiografias com o intuito de evitar a realização de exames desnecessários. Objetivo: Avaliar a implementação das ROT como protocolo de atendimento das entorses de tornozelo no pronto-socorro de um hospital universitário. Métodos: Estudo observacional retrospectivo que visou comparar a solicitação de radiografias e a presença de fraturas três meses antes e três meses após a implantação do protocolo. Resultados: Na primeira fase, todos os pacientes com queixa de entorse de tornozelo realizaram radiografias. Na segunda fase, após aplicação das ROT, de 85 pacientes avaliados, apenas 58 realizaram exames complementares, apresentando uma redução de 31,8% na solicitação dos exames de imagem. Não houve diferença na detecção de fraturas entre os dois grupos (p=0,476). Conclusão: As ROT podem ser utilizadas como ferramenta no atendimento das entorses de tornozelo e sua implantação reduziu a solicitação de exames de imagem. Nível de Evidência III, Estudo Comparativo Retrospectivo.

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Introducción: Las lesiones en los futbolistas provocan limitaciones en la movilidad osteomuscular, provocando un descanso pasivo, y por ende el no cumplimiento del principio de sistematicidad del entrenamiento; por lo cual, puede provocar abandono deportivo en casos extremos, y normalmente disminución del rendimiento. La recuperación mediante terapia requiere una valoración de su eficiencia, siendo necesario estudiar las acciones más efectivas desde el punto de vista terapéutico. Objetivo: Valorar los efectos de un proceso de intervención con ejercicios terapéuticos para la rehabilitación del esguince de tobillo grado 1 en futbolistas. Métodos: Investigación descriptiva/explicativa de orden cuasiexperimental y enfoque longitudinal (4 años de estudio), investigando a 43 futbolistas con una lesión previa en el tobillo por esguince grado 1 (Grupo 1: Experimental, Grupo 2: Control), interviniendo al grupo experimental con tres fases de tratamiento, que incluye un grupo de ejercicios físicos especializados para fortalecer y mantener las condiciones óptimas del musculo. Resultados: El grupo experimental requiere menos tiempo para recuperarse de una lesión por esguince (p ( 0,001), mientras que la reincidencia de la lesión fue menor que en el grupo control (p ( 0,019) en un periodo de cuatro años. Conclusiones: El proceso de intervención ha sido efectivo al lograse una mejor rehabilitación en la muestra experimental, en términos de prontitud en el proceso de recuperación, y en términos de disminución de las recaídas en un periodo de cuatro años. Una vez recuperado el deportista, se recomienda proseguir sistemáticamente con el proceso de fortalecimiento y prevención en las sesiones de entrenamiento, y en el hogar(AU)

Introduction: Injuries in soccer players cause limitations in musculoskeletal mobility, causing a passive rest, and therefore non-compliance with the principle of systematic training; Therefore, it can cause sports abandonment in extreme cases, and usually a decrease in performance. Recovery through therapy requires an assessment of its efficiency, and it is necessary to study the most effective actions from the therapeutic point of view. Objective: To assess the effects of an intervention process with therapeutic exercises for the rehabilitation of grade 1 ankle sprain in soccer players. Methods: Descriptive/explanatory research of quasi-experimental order and longitudinal approach (4 years of study), researching 43 soccer players with a previous ankle injury due to grade 1 sprain (Group 1: Experimental, Group 2: Control), intervening in the experimental group. with three phases of treatment, which includes a group of specialized physical exercises to strengthen and maintain optimal muscle conditions. Results: The experimental group required less time to recover from a sprain injury (p ( 0.001), while the recurrence of the injury was less than in the control group (p ( 0.019) in a period of four years. Conclusions: The intervention process has been effective in achieving better rehabilitation in the experimental sample, in terms of speed in the recovery process, and in terms of reducing relapses in a four years period. Once the athlete has recovered, it is recommended to systematically continue with the strengthening and prevention process in training sessions and at home(AU)

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PURPOSE: This study aimed to determine the responsiveness of the Brazilian version of the Identification of Functional Ankle Instability (IdFAI) questionnaire in students who received an eight-week treatment for chronic ankle instability (CAI). METHODS: Twenty-five college students (aged 23.12 ± 2.80 years) with CAI, as identified by the IdFAI questionnaire, were recruited. We used distribution and anchor-based methods to assess the responsiveness of the questionnaire, and its ability to determine clinical changes in participants. Eleven anchors were used: Visual Analog Scale for instability (VAS-i); Cumberland Ankle Instability Tool (CAIT); Isometric dorsiflexion, plantar flexion, inversion, and eversion muscle strength measured using a manual dynamometer; Dynamic balance as assessed through the Star Excursion Balance Test (SEBT-Y); Active ankle dorsiflexion range of motion as measured using the weight-bearing lunge test; and Functional performance assessment using three hop tests: single hop, triple crossover hop, and side hop. The distribution-based method used effect size (ES) and standardized response mean (SRM), whereas the anchor-based method used paired t-tests. Both methods allowed the calculation of the minimal important difference (MID). RESULTS: The Brazilian IdFAI showed high responsiveness, with a large magnitude of change (ES = 1.34) and a high responsiveness index (SRM = 1.28) when assessed after a treatment for CAI. The IdFAI total score (p < .001) and all the 11 anchors [VAS-i (p < .001); CAIT (p < .001); Isometric dorsiflexion (p < .001), plantar flexion (p < .001), inversion (p < .001), and eversion (p < .001) muscle strength; SEBT-Y (p < .001); Lunge test (p = .002); Single hop (p < .001); triple crossover hop (p < .001); and side hop tests (p < .001)] showed significant differences. The anchor and distribution-based methods demonstrated MID values of 3.72 and 1.49-2.27, respectively. CONCLUSION: The Brazilian IdFAI questionnaire is a patient-reported outcome measure sensitive to clinical changes in individuals with CAI. It can be used as an identification of patients with CAI, and as a parameter to verify clinical changes of clinical trials or therapeutic interventions in the population with CAI.

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Objective To verify the applicability and agreement of the Ottawa ankle rules applied by medical students and orthopedic residents in a tertiary trauma service thus validating the Ottawa protocol for use on Brazilian soil. Prospective This was a prospective study, conducted in a tertiary hospital, including all patients with acute torsial trauma of the tibiotarsal joint. The patients underwent ankle and/or foot radiographs, and the questionnaire with the Ottawa ankle rules was applied by academics and, subsequently, by residents. The radiographs were evaluated by on-call orthopedists and specialist in foot and ankle, and the expert opinion was considered the gold standard for analysis. Results Two hundred and sixty-three patients were evaluated, and, after application of the established inclusion criteria, 226 cases remained for evaluation. The sensitivity to detect lesions and negative predictive value (NPV) was 100%. The most sensitive test with higher NPV for both academics and residents was palpation of the lateral malleolus. The study presented potential for a reduction of 30% in the total number of tests requested. Conclusion The data showed applicability and agreement between academics and residents, which allows for the validation of the Ottawa protocol in emergency care in Brazil.

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Abstract Objective To verify the applicability and agreement of the Ottawa ankle rules applied by medical students and orthopedic residents in a tertiary trauma service thus validating the Ottawa protocol for use on Brazilian soil. Prospective This was a prospective study, conducted in a tertiary hospital, including all patients with acute torsial trauma of the tibiotarsal joint. The patients underwent ankle and/or foot radiographs, and the questionnaire with the Ottawa ankle rules was applied by academics and, subsequently, by residents. The radiographs were evaluated by on-call orthopedists and specialist in foot and ankle, and the expert opinion was considered the gold standard for analysis. Results Two hundred and sixty-three patients were evaluated, and, after application of the established inclusion criteria, 226 cases remained for evaluation. The sensitivity to detect lesions and negative predictive value (NPV) was 100%. The most sensitive test with higher NPV for both academics and residents was palpation of the lateral malleolus. The study presented potential for a reduction of 30% in the total number of tests requested. Conclusion The data showed applicability and agreement between academics and residents, which allows for the validation of the Ottawa protocol in emergency care in Brazil.

Resumo Objetivo Verificar a aplicabilidade e a concordância das regras do tornozelo de Ottawa aplicadas por estudantes de medicina e residentes de ortopedia em um serviço de trauma terciário, validando assim as regras de Ottawa para utilização em solo brasileiro. Método Estudo prospectivo, realizado em um hospital terciário, incluindo todos os pacientes com trauma torcional agudo da articulação tibiotársica. Os pacientes realizaram radiografias de tornozelo e/ou pé, tendo sido aplicado o questionário com as regras do tornozelo de Ottawa por acadêmicos e, na sequência, por residentes. As radiografias foram avaliadas por ortopedistas plantonistas e especialista em pé e tornozelo, sendo a opinião do especialista considerada padrão-ouro da análise. Resultados Foram avaliados 263 pacientes e, após aplicados os critérios de inclusão estabelecidos, restaram para a avaliação 226 casos. A sensibilidade para detectar lesões e o valor preditivo negativo (VPN) foi de 100%. O teste mais sensível e com maior VPN para ambos, acadêmicos e residentes, foi a palpação do maléolo lateral. O estudo apresentou potencial de redução de 30% no total de exames solicitados. Conclusão Os dados demostraram aplicabilidade e concordância entre acadêmicos e residentes, o que permite a validação do protocolo de Ottawa nos atendimentos de urgência e emergência no Brasil.

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In the midst of our nation's growing primary care provider shortage and subsequent overutilization of the emergency room (ER), urgent care centers represent an accessible, convenient, and affordable alternative for the management of "urgencies" or nonemergent illnesses and injuries. Despite the presence of competent healthcare providers and a wide array of services at urgent care centers, patients continue to pursue care in the ER for urgencies. School nurses may utilize urgent care centers for the evaluation and management of students with nonemergent medical or traumatic chief complaints. This article discusses the field of urgent care medicine, describes the pediatric services provided at urgent care centers, and summarizes the capabilities of centers to deal with potential urgencies versus emergencies in children and adolescents based on their chief complaint.

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BACKGROUND: We aimed to clinically evaluate the effect of platelet-rich plasma (PRP) therapy in patients with acute lateral ankle sprain treated with rigid immobilization. METHODS: Patients with first-time grade II lateral ankle sprain clinically diagnosed were evaluated (n=21). A rigid immobilization was placed in all patients for ten days; previously, an application of PRP over the anterior talofibular ligament was performed in patients from the experimental group. The Visual Analogue Scale, the American Orthopedic Foot and Ankle Score, and the Foot and Ankle Disability Index were applied at 3, 5, 8 and 24 weeks of follow-up period. RESULTS: The experimental group presented the highest reduction in pain and better functional scores than the control group at 8 weeks. At the end of follow-up period the results of both groups were similar. CONCLUSIONS: A similar evolution was observed in patients treated with rigid immobilization with or without PRP after 24 weeks. TRIAL REGISTRATION: Clinical Trials.gov with ID NCT02609308.

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INTRODUÇÃO: O tornozelo é considerado uma das regiões do corpo mais propensa às lesões esportivas, sendo 70% dessas lesões entorses de tornozelo. A recidiva de entorses pode provocar um prejuízo crônico na função proprioceptiva e sensório-motora. Não existe um tratamento específico para as entorses, sendo utilizados protocolos como o PRICE, abordagem passiva, imobilização da articulação e terapia manual. OBJETIVO: Trazer informações mais consistentes que elucidem os efeitos da terapia manual na recuperação da funcionalidade do paciente. MATERIAIS E MÉTODOS: Tratase de uma revisão sistemática baseada no PRISMA, com buscas realizadas nas bases de dados: PubMed, SciELO, LILACS e PEDro. Foram pesquisados apenas ensaios clínicos randomizados, com avaliação maior ou igual a 5/10 na escala PEDro, nos idioma português e inglês. Os estudos deveriam incluir população com idade entre 18 e 60 anos utilizando técnicas de terapia manual como: Mulligan, Maitland, mobilização neural, massoterapia, liberação miofascial, pompage e alongamento passivo. RESULTADOS: Foram incluídos 7 artigos com um total de 300 indivíduos. Os estudos incluídos investigaram a recuperação da funcionalidade de pacientes submetidos à terapia manual. Limitações: heterogeneidade no tempo de lesão. CONCLUSÃO: Os resultados evidenciaram melhora na capacidade física para correr, saltar, pousar e realizar movimentos de corte e laterais, melhora da cinemática, marcha, distribuição de descarga de peso e função global.

INTRODUCTION: The ankle is considered one of the regions of the body most prone to sports injuries, with 70% of these injuries ankle sprains. The recurrence of sprains can cause chronic impairment in proprioceptive and sensorymotor function. There is no specific treatment for sprains, using protocols such as PRICE, passive approach, immobilization of the joint and manual therapy. Manual therapy in patients who have undergone lateral ankle sprains can provide beneficial results by improving range of motion, subtalar joint slippage, speed and length of steps, distribution of gait forces, pain relief, and activities of daily living. OBJECTIVE: The objective of this study is to provide more consistent information that elucidates the effects of manual therapy on the recovery of the patient's functionality. MATERIALS AND METHODS: This is a systematic review that followed some PRISMA rules in the databases: PubMed, SciELO, LILACS and PEDro. The articles were searched in Portuguese and English. RESULTS: Seven articles with a total of 300 individuals were included. The included studies investigated the retrieval of the functionality of patients undergoing manual therapy. CONCLUSION: The results showed an improvement in physical ability to run, jump, land and perform lateral and lateral movements, improvement of kinematics, improvement of gait, better distribution of weight discharge and improvement of overall function.

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INTRODUCTION: Ankle instability often seen in people who have suffered repeated ankle sprains. Kinesio Tape is a technique widely applied in recent years, despite not having enough evidence to support its application. OBJETIVE: To determine the functional effectiveness of Kinesio Tape in individuals with ankle instability. DESIGN: Systematic review. DATA SOURCES: A systematic search of articles was performed where Kinesio Tape was applied in subjects with ankle instability in the following databases: PubMed Central; PubMed/Medline; Cochrane; Embase; Sciencedirect; Biomed Central; CINAHL; Lippincott Williams and Wilkins; SAGE and Wiley-Blackwell. METHODS OF THE REVIEW: Only clinical trials were selected, in which patients with ankle instability were intervened by applying Kinesio Tape and which included at least one outcome variable associated with ankle function. RESULTS: 364 articles were found. Ten met the inclusion criteria; five presented high and five moderate methodological quality. In most cases, one article measured more than one variable. Two articles showed improvements in muscle strength. Of four articles that evaluated balance, two observed improvements; one article observe improvements in proprioception; two articles measured postural control, without significant improvements; one article did not observe significant improvements in neuromuscular control. Stability (one article), muscular activity (one article) and functionality (one article) did not report significant improvements with the use of Kinesio Tape. On the other hand, Kinesio tape does not report significant improvements with respect to postural control, neuromuscular control, muscle activity, joint stability and functionality in subjects suffering from ankle instability. CONCLUSION: Kinesio Tape is effective for improvement of muscle strength, balance and proprioception in subjects with ankle instability. However, Kinesio Tape does not report significant improvement of postural control, neuromuscular control, muscle activity, joint stability and functionality in people with ankle instability.

INTRODUCCIÓN: La inestabilidad de tobillo presenta mayor frecuencia en personas que han sufrido repetidos esguinces de tobillo. Aunque el Kinesio Tape es una técnica masificada en los últimos años en el tratamiento de esta lesión, se desconoce su efectividad. OBJETIVO: Determinar la efectividad funcional del Kinesio Tape en individuos con inestabilidad de tobillo. DISEÑO: Revisión sistemática. FUENTES DE DATOS: Se realizó una búsqueda sistemática de artículos en donde se aplicó Kinesio Tape en sujetos con inestabilidad de tobillo en las siguientes bases de datos: PubMed Central; PubMed/Medline; Cochrane; Embase; Sciencedirect; Biomed Central; CINAHL; Lippincott Williams and Wilkins; SAGE y Wiley-Blackwell. MÉTODOS DE LA REVISIÓN: Se seleccionaron solo estudios experimentales tipo ensayo clínico, en donde se interviniera a pacientes con inestabilidad de tobillo mediante la aplicación de Kinesio Tape y que incluyeran al menos una variable de resultado asociada a la función del tobillo. Se aplicó la escala PEDro a cada artículo para medir su calidad metodológica. RESULTADOS: Se obtuvieron 364 artículos. Diez cumplieron los criterios de inclusión; cinco de alta y cinco de moderada calidad metodológica. En la mayoría de los artículos se midió más de una variable. Dos artículos presentaron mejoras en la fuerza muscular; cuatro artículos midieron equilibrio, dos observaron mejoras; un artículo observó mejoras en la propiocepción; dos artículos midieron control postural, sin mejoras significativas y un artículo no observó mejoras significativas en control neuromuscular. Estabilidad articular (un artículo), actividad muscular (un artículo) y funcionalidad (un artículo), no reportaron mejoras significativas con el uso de Kinesio Tape. CONCLUSIÓN: El Kinesio Tape es efectivo para obtener mejoras en la fuerza muscular, el equilibrio y la propiocepción en individuos con inestabilidad de tobillo. Sin embargo, el Kinesio tape no reporta mejoras significativas en control postural, control neuromuscular, actividad muscular, estabilidad articular y funcionalidad en sujetos con inestabilidad de tobillo.

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Resumen: Introducción: La inestabilidad crónica de tobillo se define como un estado clínico caracterizado por la presencia de esguinces de repetición. Puede ser funcional o mecánica. Objetivo: El objetivo general del presente trabajo es determinar mediante la escala de AOFAS y radiografías, los resultados de la técnica de Broström-Gould modificada con anclas en pacientes con inestabilidad crónica lateral de tobillo en el Instituto Nacional de Rehabilitación (INR) en un período comprendido de 2008-2016. Material y métodos: Es un estudio transversal, prospectivo, descriptivo, con pacientes del INR que contaron con el diagnóstico de Inestabilidad crónica lateral de tobillo manejados mediante el procedimiento de Broström-Gould modificado con anclas. Resultados: Fueron 13 en seguimiento, un hombre y 12 mujeres, con promedio de edad de 38 años (± 13), con predominio del tobillo izquierdo siete (54%) sobre el derecho seis (46%). En la escala AOFAS, el promedio prequirúrgico obtenido fue de 39.3 (± 13.1) en comparación con el postquirurgico a seis meses de 73.4 (± 18). Conclusión: El uso de anclas aunado a la técnica de Broström-Gould modificado con anclas es una alternativa simple y efectiva, que permite la sustitución y/o reparación de los ligamentos peroneoastragalino anterior y peroneocalcáneo.

Abstract: Introduction: Chronic ankle instability is defined as a clinical condition characterized by the presence of repetitive sprains. It can be functional or mechanical. Objective: The general objective of this study is to determine the results of the technique using the AOFAS scale and radiographs. of Broström-Gould modified with anchors in patients with chronic lateral ankle instability in the INR in a period comprised of 2008-2016. Material and methods: This is a cross-sectional, prospective, descriptive study with INR patients who had the diagnosis of chronic lateral ankle instability managed using the Broström-Gould procedure modified with anchors. Results: 13 were in follow-up, 1 man and 12 women, with an average age of 38 years (± 13), with predominance of the left ankle 7 (54%) over the right 6 (46%). On the AOFAS scale, the pre-surgical average obtained was 39.3 (± 13.1) compared to the 6-month post-surgery of 73.4 (± 18). Conclusion: The use of anchors combined with the modified Broström-Gould technique with anchors is a simple and effective alternative that allows the replacement or repair of the anterior peroneal and peroneocalcaneal fibular ligaments.

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Illness and injury associated with sport and physical activities may occur in the school setting. Although most sport-related illness and injury in students are considered minor emergencies, life- and limb-threatening illnesses or injuries may occur, such as sudden cardiac arrest, heat stroke, status asthmaticus, catastrophic brain or cervical spine injuries, hypoglycemia, blunt chest/abdominal injuries, or extremity fractures requiring surgery. It is important for the school nurse to recognize potential life- and limb-threatening emergencies associated with sport and physical activity, to initiate stabilization of the student with life- and limb-threatening symptoms, and to triage these students to an appropriate level of care (back to the classroom, home with their guardian with follow up at their primary healthcare provider's office, or directly to the closest emergency department via emergency medical services). This article describes the initial assessment and management of three common emergencies associated with sport and physical activities.

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INTRODUCTION: Chronic ankle instability is defined as a clinical condition characterized by the presence of repetitive sprains. It can be functional or mechanical. OBJECTIVE: The general objective of this study is to determine the results of the technique using the AOFAS scale and radiographs. of Broström-Gould modified with anchors in patients with chronic lateral ankle instability in the INR in a period comprised of 2008-2016. MATERIAL AND METHODS: This is a cross-sectional, prospective, descriptive study with INR patients who had the diagnosis of chronic lateral ankle instability managed using the Broström-Gould procedure modified with anchors. RESULTS: 13 were in follow-up, 1 man and 12 women, with an average age of 38 years (± 13), with predominance of the left ankle 7 (54%) over the right 6 (46%). On the AOFAS scale, the pre-surgical average obtained was ± 13.1) compared to the 6-month post-surgery of 73.4 (± 18). CONCLUSION: The use of anchors combined with the modified Broström-Gould technique with anchors is a simple and effective alternative that allows the replacement or repair of the anterior peroneal and peroneocalcaneal fibular ligaments.

INTRODUCCIÓN: La inestabilidad crónica de tobillo se define como un estado clínico caracterizado por la presencia de esguinces de repetición. Puede ser funcional o mecánica. OBJETIVO: El objetivo general del presente trabajo es determinar mediante la escala de AOFAS y radiografías, los resultados de la técnica de Broström-Gould modificada con anclas en pacientes con inestabilidad crónica lateral de tobillo en el Instituto Nacional de Rehabilitación (INR) en un período comprendido de 2008-2016. MATERIAL Y MÉTODOS: Es un estudio transversal, prospectivo, descriptivo, con pacientes del INR que contaron con el diagnóstico de Inestabilidad crónica lateral de tobillo manejados mediante el procedimiento de Broström-Gould modificado con anclas. RESULTADOS: Fueron 13 en seguimiento, un hombre y 12 mujeres, con promedio de edad de 38 años (± 13), con predominio del tobillo izquierdo siete (54%) sobre el derecho seis (46%). En la escala AOFAS, el promedio prequirúrgico obtenido fue de 39.3 (± 13.1) en comparación con el postquirurgico a seis meses de 73.4 (± 18). CONCLUSIÓN: El uso de anclas aunado a la técnica de Broström-Gould modificado con anclas es una alternativa simple y efectiva, que permite la sustitución y/o reparación de los ligamentos peroneoastragalino anterior y peroneocalcáneo.

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INTRODUCCIÓN La inestabilidad de tobillo presenta mayor frecuencia en personas que han sufrido repetidos esguinces de tobillo. Aunque el Kinesio Tape es una técnica masificada en los últimos años en el tratamiento de esta lesión, se desconoce su efectividad. OBJETIVO Determinar la efectividad funcional del Kinesio Tape en individuos con inestabilidad de tobillo. DISEÑO Revisión sistemática. FUENTES DE DATOS Se realizó una búsqueda sistemática de artículos en donde se aplicó Kinesio Tape en sujetos con inestabilidad de tobillo en las siguientes bases de datos: PubMed Central; PubMed/Medline; Cochrane; Embase; Sciencedirect; Biomed Central; CINAHL; Lippincott Williams &Wilkins; SAGE y Wiley-Blackwell. MÉTODOS DE LA REVISIÓN Se seleccionaron solo estudios experimentales tipo ensayo clínico, en donde se interviniera a pacientes con inestabilidad de tobillo mediante la aplicación de Kinesio Tape y que incluyeran al menos una variable de resultado asociada a la función del tobillo. Se aplicó la escala PEDro a cada artículo para medir su calidad metodológica. RESULTADOS Se obtuvieron 364 artículos. Diez cumplieron los criterios de inclusión; cinco de alta y cinco de moderada calidad metodológica. En la mayoría de los artículos se midió más de una variable. Dos artículos presentaron mejoras en la fuerza muscular; cuatro artículos midieron equilibrio, dos observaron mejoras; un artículo observó mejoras en la propiocepción; dos artículos midieron control postural, sin mejoras significativas y un artículo no observó mejoras significativas en control neuromuscular. Estabilidad articular (un artículo), actividad muscular (un artículo) y funcionalidad (un artículo), no reportaron mejoras significativas con el uso de Kinesio Tape. CONCLUSIÓN El Kinesio Tape es efectivo para obtener mejoras en la fuerza muscular, el equilibrio y la propiocepción en individuos con inestabilidad de tobillo. Sin embargo, el Kinesio tape no reporta mejoras significativas en control postural, control neuromuscular, actividad muscular, estabilidad articular y funcionalidad en sujetos con inestabilidad de tobillo.

INTRODUCTION Ankle instability often seen in people who have suffered repeated ankle sprains. Kinesio Tape is a technique widely applied in recent years, despite not having enough evidence to support its application. OBJECTIVE To determine the functional effectiveness of Kinesio Tape in individuals with ankle instability. DESIGN Systematic review. DATA SOURCES A systematic search of articles was performed where Kinesio Tape was applied in subjects with ankle instability in the following databases: PubMed Central; PubMed/Medline; Cochrane; Embase; Sciencedirect; Biomed Central; CINAHL; Lippincott Williams & Wilkins; SAGE and Wiley-Blackwell. METHODS OF THE REVIEW Only clinical trials were selected, in which patients with ankle instability were intervened by applying Kinesio Tape and which included at least one outcome variable associated with ankle function. RESULTS364 articles were found. Ten met the inclusion criteria; five presented high and five moderate methodological quality. In most cases, one article measured more than one variable. Two articles showed improvements in muscle strength. Of four articles that evaluated balance, two observed improvements; one article observe improvements in proprioception; two articles measured postural control, without significant improvements; one article did not observe significant improvements in neuromuscular control. Stability (one article), muscular activity (one article) and functionality (one article) did not report significant improvements with the use of Kinesio Tape. On the other hand, Kinesio tape does not report significant improvements with respect to postural control, neuromuscular control, muscle activity, joint stability and functionality in subjects suffering from ankle instability. CONCLUSION Kinesio Tape is effective for improvement of muscle strength, balance and proprioception in subjects with ankle instability. However, Kinesio Tape does not report significant improvement of postural control, neuromuscular control, muscle activity, joint stability and functionality in people with ankle instability.

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BACKGROUND: The most frequent sequel to the ankle sprain is the instability of the lateral ligament complex; the results of surgical treatment have not been evaluated with multiple scales simultaneously. The objective of the study was to assess the clinical and functional results with three scales in patients with lateral instability of ankle undergoing Broström-Gould technique, using for fixation, anchors with suture to distal fibula. MATERIAL AND METHODS: The design of the study was cross-sectional and descriptive; we included patients with lateral instability of ankle and partial or complete rupture of the APA or CP ligament subject to repair with Broström-Gould technique. Magnetic resonance imaging was performed to confirm the diagnosis; clinical and functional outcomes were determined with three scales: EVA, SF-36 and AOFAS. Patients were evaluated at six months, or more, after the surgical procedure. RESULTS: We included 13 patients; quality of life (SF-36 questionnaire) showed a good result with average score of 90; 10 (77%) patients showed excellent results in function, absence of pain and alignment of the ankle (AOFAS 90-100). Also found significant improvement in pain (presurgical EVA: 6, compared with 1 in the postoperative period). CONCLUSIONS: The surgical procedure showed excellent results, in the short term with resolution of pain and ankle stability.

ANTECEDENTES: La secuela más frecuente del esguince de tobillo es la inestabilidad del complejo ligamentario lateral; los resultados del tratamiento quirúrgico no han sido evaluados con varias escalas simultáneamente. El objetivo del estudio fue evaluar los resultados clínicos y funcionales con tres escalas en pacientes con inestabilidad lateral de tobillo sometidos a plastía de Broström-Gould, utilizando para su fijación anclas con sutura al peroné distal. MATERIAL Y MÉTODOS: El diseño del estudio fue transversal y descriptivo; se incluyeron pacientes con inestabilidad lateral de tobillo y ruptura parcial o completa del ligamento PAA y/o PC, sometidos a reparación con plastía de Broström-Gould. Se realizó resonancia magnética nuclear para confirmar el diagnóstico; los resultados clínicos y funcionales se determinaron con tres escalas: EVA, SF-36 y AOFAS. Los pacientes fueron evaluados a los seis meses o más posteriores al procedimiento quirúrgico. RESULTADOS: Se incluyeron 13 pacientes; la calidad de vida (cuestionario SF-36) arrojó un resultado bueno con promedio de 90; 10 (77%) pacientes mostraron resultados excelentes en la función, ausencia de dolor y alineación del tobillo (AOFAS 90-100). Asimismo, se observó mejoría importante en el dolor (EVA prequirúrgico: 6, comparado con 1 en el período postquirúrgico). CONCLUSIONES: El procedimiento quirúrgico demostró excelentes resultados en el corto plazo con resolución del dolor y estabilidad del tobillo.

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The diagnosis and stabilization of ankle syndesmotic injuries after acute injury remains an area of controversy in the foot and ankle surgical literature, seemingly without universal consensus. The primary objective of this investigation was to determine the frequency of agreement and reliability of the stress examination of the ankle syndesmosis. Secondary objectives were to determine surgeon preferences and protocols with respect to the ankle syndesmosis and to use gaze recognition software to perform an eye-tracking assessment during performance of stress examinations. Twelve foot and ankle surgeons, 12 residents, and 12 students were shown 5 intraoperative fluoroscopic still images and videos of the stress examination of the ankle syndesmosis. They were asked to evaluate the result as being "positive" or "negative" for syndesmotic stability. The overall reliability of the interpretation of the stress examination of the ankle syndesmosis was a kappa of 0.123 (surgeons 0.087; residents 0.019; students 0.237), indicating "slight" agreement. Survey results indicated wide variability in the perioperative preferences and protocols of surgeons dealing with the evaluation and treatment of the ankle syndesmosis. Eye-tracking results also demonstrated variability in the anatomic structures of interest focused on during performance of this testing. The results of this investigation provide evidence of reliability well below what would be expected of a gold standard test during stress examination of the ankle syndesmosis. These results indicate that future scientific endeavors are required to standardize the performance and interpretation of this testing.

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