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Physiotherapy Research International :... Jan 2018Pelvic girdle pain is a common musculoskeletal disorder which affects women during pregnancy and the postpartum period. In previous years, physiotherapists have focused... (Review)
Review
BACKGROUND
Pelvic girdle pain is a common musculoskeletal disorder which affects women during pregnancy and the postpartum period. In previous years, physiotherapists have focused on managing pelvic girdle pain through stabilizing exercises.
PURPOSE
The aim of this study was to systematically review studies investigating the effectiveness of the stabilizing exercises for pelvic girdle pain during pregnancy and the postpartum period.
METHODS
The following electronic databases were utilized to search for eligible studies: MEDLINE, EMBASE, CINAHL, Physiotherapy Evidence Database, and Cochrane Library. Inclusion and exclusion criteria were defined a priori. The quality assessment was performed by the two reviewers independently using the PEDro scale (Physiotherapy Evidence-based Database).
RESULTS
Six studies were identified as eligible with the inclusion and exclusion criteria. All studies evaluated the pain as an outcome measure. The evidence conflicted between the studies. Two studies showed that stabilizing exercises decrease pain and improve the quality of life for pregnant women when they are carried out on a regular basis. There is some limited evidence that stabilizing exercises decrease pain for postpartum women too.
CONCLUSION
In summary, there is limited evidence for the clinician to conclude on the effectiveness of stabilizing exercises in treating pelvic girdle pain during pregnancy and the postpartum periods.
Topics: Exercise Therapy; Female; Humans; Pelvic Girdle Pain; Physical Therapy Modalities; Postpartum Period; Pregnancy; Pregnancy Complications; Quality of Life
PubMed: 29115735
DOI: 10.1002/pri.1699 -
Clinical Anatomy (New York, N.Y.) Nov 2023The interpubic cavity (cleft) is a narrow, slit-like, oval-shaped cavity which has frequently been described within the fibrocartilaginous interpubic disc. The aim of... (Review)
Review
The interpubic cavity (cleft) is a narrow, slit-like, oval-shaped cavity which has frequently been described within the fibrocartilaginous interpubic disc. The aim of this article is to thoroughly analyze what is known about the interpubic cavity. The following three scientific databases (PubMed, Web of Science and Google Scholar) were systematically searched. Combinations of the search terms "interpubic cleft", "interpubic cavity", "symphysis pubis cleft", "symphysis pubis cavity" and "symphysis cleft sign" were used. All databases were searched from inception until August of 2022. Searching of the three databases resulted in 711 hits, of which 280 remained after checking for duplicates. In the first step, 152 studies were excluded due to irrelevant content. Thus, 128 proceeded to the second step, of which 23 were finally selected for meeting the objectives of this review. Until now the reason for the cavity forming remains unclear. The interpubic cavity is present in the anterior portion of the interpubic disc, within 2 mm from its anterior margin. There is no predilection in the craniocaudal dimension. The secondary cavity is usually called a "cleft sign". The results of our scoping review summarize information about the interpubic cavity. Its composition and morphology are still not well understood.
Topics: Humans; Pubic Symphysis
PubMed: 36959758
DOI: 10.1002/ca.24041 -
Journal of Rehabilitation Research and... 2015Symphysis pubis diastasis (SPD) is an infrequent complication of labor that can impair womens' general health through failure of the passive stability of the pelvic... (Review)
Review
Symphysis pubis diastasis (SPD) is an infrequent complication of labor that can impair womens' general health through failure of the passive stability of the pelvic girdle. Although conservative approaches are often used to decrease symptoms and interpubic separation, notably few studies have analyzed the effect of these methods on managing the symptoms of women with SPD. The purpose of this study was to review the available literature on the conservative treatment of SPD during pregnancy and labor. A computer-based search using PubMed, PEDro, and CINAHL was performed up to November 2014. We selected all studies that considered women with SPD during pregnancy or labor and treated them with conservative methods and excluded those that included surgical intervention. Eighteen studies were selected, most of which were case reports. Although the overall results of conservative treatment were unclear because of the type and design of the obtained studies, most of the studies reported bed rest in the lateral decubitus position and a pelvic girdle as basic treatments. Additionally, the few clinical trials reported recommended additional physiotherapy, including strengthening and stabilizing exercises, to reduce SPD symptoms.
Topics: Analgesics; Bed Rest; Braces; Female; Humans; Patient Positioning; Physical Therapy Modalities; Pregnancy; Pubic Symphysis Diastasis
PubMed: 26560443
DOI: 10.1682/JRRD.2014.12.0302 -
Journal of Clinical Medicine Jul 2023Open reduction and reconstruction plate and screws fixation (RPSF) is considered the gold standard for the treatment of traumatic symphysis pubis diastasis (SPD).... (Review)
Review
Percutaneous Fixation for Traumatic Symphysis Pubis Disruption-Are the Results Superior Compared to Open Techniques? A Systematic Review and Meta-Analysis of Clinical and Biomechanical Outcomes.
INTRODUCTION
Open reduction and reconstruction plate and screws fixation (RPSF) is considered the gold standard for the treatment of traumatic symphysis pubis diastasis (SPD). Percutaneous cannulated screw fixation (PCSF) has recently gained popularity as it may reduce operative time and morbidity. The current systematic review aims to compare the clinical and radiological outcomes of PCSF and RPSF in traumatic SPD and analyze the biomechanical effectiveness of PCSF.
MATERIAL AND METHODS
The Medline, Scopus, and Cochrane databases were searched until February 2023. The primary outcomes were the incidence of implant failure and revision surgery and the amount of displacement of symphysis pubis. Secondary outcomes were the intraoperative blood loss, the scar length, the operative time, the wound infection, and the patients' functional improvement.
RESULTS
Six clinical trial studies with a total of 184 patients and nine biomechanical studies were included. There was no significant difference between the two groups regarding the incidence of implant failure, the prevalence of revision surgery, and the amount of postoperative loss of reduction ( > 0.05 for all outcomes). The intraoperative blood loss (14.9 ± 4.2 mL for PCSF versus 162.7 ± 47.6 mL for PCSF, < 0.001) and the incision length (1.7 ± 0.9 mL for PCSF versus 8 ± 1.4 mL for PCSF, < 0.001) were significantly lower after PCSF. The mean operative time was 37 ± 19.1 min for PCSF and 68.9 ± 13.6 min for RPSF ( < 0.001). The infection rate was less frequent in the PCSF group (3% for PCSF versus 14.3% for RPSF, = 0.01). One clinical trial reported better functional recovery after PCSF. In all biomechanical studies, the threshold for implant failure was beyond the applied forces corresponding to daily activities.
CONCLUSIONS
PCSF for traumatic SPD is associated with less operative time, less blood loss, and a lower infection rate when compared to conventional plate techniques without increasing the incidence of postoperative fixation failure and revision surgery. Moreover, PCSF has been proven to be biomechanically sufficient for stabilization. Therefore, it should be considered an efficient and viable alternative for the reconstruction of SPD when closed reduction can be adequately achieved.
PubMed: 37568389
DOI: 10.3390/jcm12154988 -
Annals of Anatomy = Anatomischer... Oct 2022Collection and meta-analysis of all relevant anatomical studies related to the pubic symphysis to provide a state of the art review of its musculotendinous and... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Collection and meta-analysis of all relevant anatomical studies related to the pubic symphysis to provide a state of the art review of its musculotendinous and ligamentous attachments from 2010 to date.
METHODS
A systematic search of published literature databases (PubMed, Web of Science and Embase) was conducted according to the PRISMA guidelines from January 2010 up until now. All papers investigating the anatomy of the musculotendinous attachments of the pubis and the pubic ligaments were eligible. Methodological quality was assessed using the Quality Appraisal for Cadaveric Studies (QUACS scale). A narrative analysis approach was adopted to synthesize the findings.
RESULTS
After screening and review of 1313 papers, a total of six studies investigating the anatomy of the pubic ligaments and tendons were included. Of the six articles included in this systematic review, five articles performed a macroscopic anatomical dissection, three articles performed a microscopic (histological) study, and one article combined microscopic examination with an MRI imaging examination. The anatomy of the pubic symphysis was examined in 76 anatomical cadavers (60 embalmed, 16 fresh frozen). In total 44 male cadavers (58%), 28 female cadavers (37%) and four cadavers whose gender was not stated were dissected.
CONCLUSION
The age-old accepted concept of the fusion of the rectus abdominis with the adductor longus via the aponeurotic plate is outdated. New anatomical concepts like the pyramidalis-anterior pubic ligament-adductor longus complex (PLAC), recto-gracilis tendon, fusion of adductor brevis with gracilis, etc. are recently introduced. The awareness of anatomy and morphology of the pubic ligaments plays a significant role in understanding the diagnosis and treatment of groin pain.
Topics: Humans; Male; Female; Pubic Symphysis; Thigh; Tendons; Ligaments, Articular; Cadaver
PubMed: 35659520
DOI: 10.1016/j.aanat.2022.151959 -
Journal of Forensic Sciences Jan 2022Suchey-Brooks method has been studied many times with varying reports of accuracy and reliability. A systematic review and meta-analyses were utilized to quantitatively... (Meta-Analysis)
Meta-Analysis
Suchey-Brooks method has been studied many times with varying reports of accuracy and reliability. A systematic review and meta-analyses were utilized to quantitatively determine the accuracy and reliability of the Suchey-Brooks (S-B) method. A systematic search of PubMed and EBSCO health and medical databases was performed. Meta-analyses were performed to quantify the relationship between actual known age at death and the S-B method using Spearman's Rho and Pearson's r for (1) combined males and females estimates, (2) male-only estimates, and (3) female-only estimates. Overall correlation coefficient using Cohen's kappa, Spearman's Rho, and Pearson's r was also calculated to determine the interrater and intrarater reliability using the S-B method. Eighteen studies classified as moderate-to-high methodological quality met the inclusion criteria. The sample sizes were different for the combined male and female (n = 2620), male-only (n = 2602), and female-only (n = 1431) meta-analyses. The effect size of the age at death meta-analyses was large and significant for combined males and females (Spearman's Rho = 0.62; Pearson's r = 0.65), male-only (Spearman's Rho = 0.77; Pearson's r = 0.75), and female-only (Spearman's Rho = 0.71; Pearson's r = 0.71). The overall correlation coefficients of the interrater (Kappa = 0.76; Spearman's Rho = 0.73; Pearson's r = 0.80) and intrarater (Kappa = 0.81; Spearman's Rho = 0.91; Pearson's r = 0.83) reliability meta-analyses were large and significant. A significant degree of heterogeneity was present in all meta-analyses, with minimal evidence of publication bias. The meta-analyses results suggest the S-B method is highly reliable with a moderate-to-high degree of accuracy. Our results also identified sample size and accuracy differences between male and female individuals.
Topics: Age Determination by Skeleton; Female; Humans; Male; Pubic Symphysis; Reproducibility of Results
PubMed: 34617597
DOI: 10.1111/1556-4029.14911 -
BMC Pregnancy and Childbirth Feb 2015Fetal growth restriction is among the most common and complex problems in modern obstetrics. Symphysis-fundus (SF) height measurement is a non-invasive test that may... (Review)
Review
BACKGROUND
Fetal growth restriction is among the most common and complex problems in modern obstetrics. Symphysis-fundus (SF) height measurement is a non-invasive test that may help determine which women are at risk. This study is a systematic review of the literature on the accuracy of SF height measurement for the prediction of small-for-gestational-age (SGA) status at birth in unselected and low-risk pregnancies.
METHODS
The Medline, Embase, Cinahl, SweMed, and Cochrane Library databases were searched with no limitation on publication date (through September 2014), which returned 722 citations. Two reviewers then developed a short list of 51 publications of possible relevance and assessed them using the following inclusion criteria: cohort study of test accuracy performed in a routine prenatal care setting; SF height measurement for all participants; classification of SGA, defined as birth weight (BW) < 10th, 5th, or 3rd percentile or ≥ one or two standard deviations below the mean; study conducted in Northern, Western, or Central Europe; USA; Canada; Australia; or New Zealand; and sufficient data for 2 × 2 table construction. Quality of the included studies was assessed in duplicate using criteria suggested by the Cochrane Collaboration. Review Manager 5.3 software was used to analyze the data, including plotting of summary receiver operating curve spaces.
RESULTS
Eight studies were included in the final dataset and seven were included in summary analyses. The sensitivity of SF height measurement for SGA (BW < 10(th) percentile) prediction ranged from 0.27 to 0.76 and specificity ranged from 0.79 to 0.92. Positive and negative likelihood ratios ranged from 1.91 to 9.09 and from 0.29 to 0.83, respectively.
CONCLUSIONS
SF height can serve as a clinical indicator along with other clinical findings, information about medical conditions, and previous obstetric history. However, SF height has high false-negative rates for SGA. Clinicians must understand the limitations of this test. The protocol has been registered in the international prospective register of systematic reviews, PROSPERO (Registration No. CRD42014008928, http://www.crd.york.ac.uk/prospero/display_record.asp?ID=CRD42014008928 ).
Topics: Adult; Female; Fetal Growth Retardation; Humans; Infant, Newborn; Infant, Small for Gestational Age; Predictive Value of Tests; Pregnancy; Pubic Symphysis; Ultrasonography, Prenatal
PubMed: 25884884
DOI: 10.1186/s12884-015-0461-z -
Orthopaedic Journal of Sports Medicine Sep 2021Controversies remain regarding the surgical treatment of inguinal-, pubic-, and adductor-related chronic groin pain (CGP) in athletes. (Review)
Review
BACKGROUND
Controversies remain regarding the surgical treatment of inguinal-, pubic-, and adductor-related chronic groin pain (CGP) in athletes.
PURPOSE
To investigate the outcomes of surgery for CGP in athletes based on surgical technique and anatomic area addressed.
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHODS
The PubMed and Embase databases were searched for articles reporting surgical treatment of inguinal-, pubic-, or adductor-related CGP in athletes. Inclusion criteria were level 1 to 4 evidence, mean patient age >15 years, and results presented as return-to-sport, pain, or functional outcomes. Quality assessment was performed with the CONSORT (Consolidated Standards of Reporting Trials) statement or MINORS (Methodological Index for Non-randomized Studies) criteria. Techniques were grouped as inguinal, adductor origin, pubic symphysis, combined inguinal and adductor, combined pubic symphysis and adductor, or mixed.
RESULTS
Overall, 47 studies published between 1991 and 2020 were included. There were 2737 patients (94% male) with a mean age at surgery of 27.8 years (range, 12-65 years). The mean duration of symptoms was 13.1 months (range, 0.3-144 months). The most frequent sport involved was soccer (71%), followed by rugby (7%), Australian football (5%), and ice hockey (4%). Of the 47 articles reviewed, 44 were classified as level 4 evidence, 1 study was classified as level 3, and 2 randomized controlled trials were classified as level 1b. The quality of the observational studies improved modestly with time, with a mean MINORS score of 6 for articles published between 1991 and 2000, 6.53 for articles published from 2001 to 2010, and 6.9 for articles published from 2011 to 2020. Return to play at preinjury or higher level was observed in 92% (95% CI, 88%-95%) of the athletes after surgery to the inguinal area, 75% (95% CI, 57%-89%) after surgery to the adductor origin, 84% (95% CI, 47%-100%) after surgery to the pubic symphysis, and 89% (95% CI, 70%-99%) after combined surgery in the inguinal and adductor origin.
CONCLUSION
Return to play at preinjury or higher level was more likely after surgery for inguinal-related CGP (92%) versus adductor-related CGP (75%). However, the majority of studies reviewed were methodologically of low quality owing to the lack of comparison groups.
PubMed: 34541009
DOI: 10.1177/23259671211023116 -
Annals of Medicine and Surgery (2012) May 2022Cleidocranial dysplasia (CCD) is a rare disease characterized by craniofacial, skeletal, and oral anomalies. The disease prevalence is estimated to be 1 per million... (Review)
Review
INTRODUCTION
Cleidocranial dysplasia (CCD) is a rare disease characterized by craniofacial, skeletal, and oral anomalies. The disease prevalence is estimated to be 1 per million inhabitants; thus, only a few studies have described large cohorts of CCD patients. This study reviewed the clinical-radiological and demographic characteristics of patients with CCD in South America.
METHODS
We conducted a systematic review of all cases of CCD reported in South America following the PRISMA guidelines. Demographic information (sex, age at diagnosis, origin, reason for consultation, and family history) was also recorded. CCD signs were divided into "craniofacial" and "skeletal" categories.
RESULTS
A total of 72 cases were included. We found that oral anomalies were the most common reason for consultation leading to a diagnosis in patients, with a median age at diagnosis of 14 years. Fifty percent of the patients were women. Open fontanels or cranial sutures, the presence of at least one of the typical CCD facies (frontal bossing, brachycephaly, hypertelorism, or depression of the nasal bridge), and supernumerary teeth were reported in 92%, 85%, and 88% of cases, respectively. Clavicular dysplasia was present in 98.6% of cases, and other skeletal abnormalities such as scoliosis, pubic symphysis diastasis, and flat feet were found; short stature was present in 71% of cases, and one case presented cognitive deficits.
CONCLUSION
Although the phenotypic spectrum of CCD is variable, clavicular dysplasia, open fontanels or cranial sutures, dental anomalies, and at least one of the typical CCD facies are present in at least 80% of cases.
PubMed: 35638029
DOI: 10.1016/j.amsu.2022.103611 -
The Cochrane Database of Systematic... Sep 2015Symphysis fundal height (SFH) measurement is commonly practiced primarily to detect fetal intrauterine growth restriction (IUGR). Undiagnosed IUGR may lead to fetal... (Review)
Review
BACKGROUND
Symphysis fundal height (SFH) measurement is commonly practiced primarily to detect fetal intrauterine growth restriction (IUGR). Undiagnosed IUGR may lead to fetal death as well as increase perinatal mortality and morbidity.
OBJECTIVES
The objective of this review is to compare SFH measurement with serial ultrasound measurement of fetal parameters or clinical palpation to detect abnormal fetal growth (IUGR and large-for-gestational age), and improving perinatal outcome.
SEARCH METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (14 July 2015) and reference lists of retrieved articles.
SELECTION CRITERIA
Randomised controlled trials including quasi-randomised and cluster-randomised trials involving pregnant women with singleton fetuses at 20 weeks' gestation and above comparing tape measurement of SFH with serial ultrasound measurement of fetal parameters or clinical palpation using anatomical landmarks.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy.
MAIN RESULTS
One trial involving 1639 women was included. It compared SFH measurement with clinical abdominal palpation.There was no difference in the two reported primary outcomes of incidence of small-for-gestational age (risk ratio (RR) 1.32; 95% confidence interval (CI) 0.92 to 1.90, low quality evidence) or perinatal death.(RR 1.25, 95% CI 0.38 to 4.07; participants = 1639, low quality evidence). There were no data on the neonatal detection of large-for-gestational age (variously defined by authors). There was no difference in the reported secondary outcomes of neonatal hypoglycaemia, admission to neonatal nursery, admission to the neonatal nursery for IUGR (low quality evidence), induction of labour and caesarean section (very low quality evidence). The trial did not address the other outcomes specified in the 'Summary of findings' table (intrauterine death; neurodevelopmental outcome in childhood). GRADEpro software was used to assess the quality of evidence, downgrading of evidence was based on including a small single study with unclear risk of bias and a wide confidence interval crossing the line of no effect.
AUTHORS' CONCLUSIONS
There is insufficient evidence to determine whether SFH measurement is effective in detecting IUGR. We cannot therefore recommended any change of current practice. Further trials are needed.
Topics: Abdomen; Female; Fetal Growth Retardation; Humans; Palpation; Pregnancy; Pubic Symphysis; Randomized Controlled Trials as Topic; Ultrasonography, Prenatal; Uterus
PubMed: 26346107
DOI: 10.1002/14651858.CD008136.pub3