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Medicine Oct 2022The lateral sprain of the ankle is a very frequent injury in the population in general, appearing in the emergency services frequently. The general objective was to... (Review)
Review
BACKGROUND
The lateral sprain of the ankle is a very frequent injury in the population in general, appearing in the emergency services frequently. The general objective was to review the current clinical practice guidelines (CPGs) on management and treatment of ankle sprains, assess their quality, analyze the levels of evidence and summarize the grades of recommendation.
METHODS
A systematic search of the literature in relevant databases with the search terms "ankle," "sprain," "practice guideline," and "guideline" was carried out. There were included those guidelines that had the system of grades of recommendation and level of evidence concerning to management and treatment of ankle sprain. The quality of the guides was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool.
RESULTS
Seven clinical practice guides were included in this review. The AGREE II scores ranged from 42% to 100%, with only six CPGs explicitly declaring the use of a systematic methodology. Seventeen recommendations were extracted and summarized.
DISCUSSION
Six of the recommendations analyzed present enough evidence to be applied in clinical practice and are highly recommended for ankle sprain management: Ottawa rules, manual therapy, cryotherapy, functional supports, early ambulation, short term NSAIDs and rehabilitation.
Topics: Humans; Ankle Injuries; Sprains and Strains; Ankle Joint; Early Ambulation; Anti-Inflammatory Agents, Non-Steroidal
PubMed: 36281183
DOI: 10.1097/MD.0000000000031087 -
Schmerz (Berlin, Germany) Aug 2022The treatment of carpal tunnel syndrome (CTS) usually involves surgical decompression of the nerve or splinting and additional medication. Physiotherapy and sports... (Review)
Review
BACKGROUND
The treatment of carpal tunnel syndrome (CTS) usually involves surgical decompression of the nerve or splinting and additional medication. Physiotherapy and sports therapy could be non-invasive and alternative treatment approaches with a simultaneous low risk of side effects.
OBJECTIVE
The review systematically summarizes the current studies on the effectiveness of physiotherapy and sports therapeutic interventions for treatment of CTS and focuses on the reduction of symptoms and, as a secondary outcome, improvement of hand function.
MATERIAL AND METHODS
The systematic review includes randomized controlled trials reporting on physiotherapy or sports therapy interventions published prior to February 2021 in the electronic databases PubMed, CINAHL and Web of Science. Following the guidelines of preferred reporting items for systematic reviews and meta-analyses (PRISMA) and the Cochrane Collaboration, a systematic search of the literature, data extraction and evaluation of the risk of bias using the Cochrane risk of bias tool were conducted by two independent researchers.
RESULTS
Out of 461 identified studies 26 were included in the qualitative analysis. The risk of bias in the individual studies was graded as moderate to low. Potential bias might arise due to inadequate blinding of patients and study personnel in some cases as well as due to selective reporting of study results and procedures. Manual therapy proved to be faster and equally effective in reducing pain and improving function in the long term compared to surgery. Mobilization techniques, massage techniques, kinesiotaping and yoga as therapeutic interventions also showed positive effects on symptoms.
CONCLUSION
For the management of mild to moderate CTS, physiotherapy and sports therapeutic interventions are characterized primarily by success after as little as 2 weeks of treatment as well as comparable success to surgery and 3 months of postoperative treatment. In addition, patients are not exposed to surgical risks. The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) with the number 42017073839.
Topics: Carpal Tunnel Syndrome; Humans; Medicine; Musculoskeletal Manipulations; Physical Therapy Modalities
PubMed: 35286465
DOI: 10.1007/s00482-022-00637-x -
Folia Morphologica 2022Carpal tunnel syndrome is the most common peripheral nerve entrapment encountered worldwide. The aetiology can be related to repetitive exposure to vibrations or...
Carpal tunnel syndrome is the most common peripheral nerve entrapment encountered worldwide. The aetiology can be related to repetitive exposure to vibrations or forceful angular motions, genetic predisposition, injury and specific conditions, such as diabetes, pregnancy and morbid obesity. This entity is observed with increased frequency in females and the elderly. The diagnosis is largely clinical and suspected when patients present with typical symptoms such as numbness, tingling, nocturnal paraesthesia and/or neuritic "pins-and-needles" pain in the radial 3.5 digits. Certain provocative manoeuvres can be employed to evoke the symptoms of the disease to guide the diagnosis. Further testing such as electrodiagnostic studies, ultrasound or magnetic resonance imaging is required in the case of diagnostic uncertainty or if there is a need for objective evaluation whether or not more invasive surgical intervention is required. If the presenting symptoms are mild and discontinuous, non-surgical measures are indicated. However, if the symptoms are moderate to severe, further testing modalities such as nerve conduction studies or needle electromyography are used to determine whether carpal tunnel syndrome is acute or chronic. If significant evidence of axonal injury is identified, surgical treatment may be indicated. Surgical release of the carpal tunnel has evolved over time to become the most common hand surgery procedure.
Topics: Female; Humans; Aged; Carpal Tunnel Syndrome; Wrist; Ultrasonography; Magnetic Resonance Imaging; Median Nerve
PubMed: 34783004
DOI: 10.5603/FM.a2021.0121 -
Journal of Athletic Training Jul 2023Adductor-related groin pain is a common problem in sports. Evidence-based management of athletes with adductor strains, adductor ruptures, and long-standing... (Review)
Review
Adductor-related groin pain is a common problem in sports. Evidence-based management of athletes with adductor strains, adductor ruptures, and long-standing adductor-related groin pain can be approached in a simple yet effective and individualized manner. In most cases, managing adductor-related pain in athletes should be based on specific exercises and loading strategies. In this article, I provide an overview of the different types of adductor injuries, from acute to overuse, including their underlying pathology, functional anatomy, diagnosis, prognosis, mechanisms, and risk factors. This information leads to optimal assessment and management of acute to long-standing adductor-related problems and includes primary, secondary, and tertiary prevention strategies that focus on exercise and load-based strategies. In addition, information on different options and contexts for exercise selection and execution for athletes, athletic trainers, and sports physical therapists in adductor injury rehabilitation is provided.
Topics: Humans; Athletic Injuries; Exercise; Exercise Therapy; Groin; Pain; Sprains and Strains
PubMed: 35834724
DOI: 10.4085/1062-6050-0496.21 -
European Review For Medical and... Mar 2022Lateral ankle sprains are very common injuries that can be treated with different strategies. The aim of the present systematic review was to provide a comprehensive... (Review)
Review
OBJECTIVE
Lateral ankle sprains are very common injuries that can be treated with different strategies. The aim of the present systematic review was to provide a comprehensive analysis on the treatment of acute lateral ankle sprains to clarify the possible differences in outcome between surgical and conservative management, different external supports, and different rehabilitation protocols.
MATERIALS AND METHODS
A literature search on three different topics was carried out on PubMed, Scopus, and Web of Science databases on June 25th, 2021. The main objective of the literature search was to identify the randomized trials comparing: (1) surgery to conservative management, (2) different external supports, and (3) different rehabilitation protocols for the treatment of acute lateral ankle sprains. Two investigators extracted independently relevant data from each paper and assessed the quality of the trials using the Cochrane Risk of Bias Assessment.
RESULTS
A total of 12 studies for the first topic, 8 for the second one and 4 for the last one were included in this review. 8 out of 12 RCTs demonstrated a superior outcome and better socio-economic impact of conservative treatment compared to surgical management. In the other two comparisons, due to the wide variety of braces used and the different rehabilitation protocols, inconclusive results were obtained.
CONCLUSIONS
Conservative treatment should be the first choice for severe acute lateral ankle sprains, as it provides satisfactory functional outcomes without the risks and costs of surgery. It was not possible to identify the best external support, but a preference toward flexible braces emerged since they allow an earlier return to daily activities. The paucity of studies comparing different rehabilitation protocols precluded the possibility of defining the ideal one.
Topics: Ankle Injuries; Conservative Treatment; Graft vs Host Disease; Humans; Sprains and Strains
PubMed: 35363336
DOI: 10.26355/eurrev_202203_28333 -
Journal of Athletic Training Oct 2019Sport specialization is a training method now commonly used by young athletes who hope to achieve elite-level success. This may be defined as (1) choosing a main sport,... (Review)
Review
Sport specialization is a training method now commonly used by young athletes who hope to achieve elite-level success. This may be defined as (1) choosing a main sport, (2) quitting all other sports to focus on 1 sport, and (3) year-round training (greater than 8 months per year). A number of sports medicine organizations have published recommendations based on the limited evidence available on this topic. The objective of this article was to perform a narrative review of the currently available evidence and sports medicine organizational recommendations regarding sport specialization and its effects on health to guide athletic trainers and sports medicine providers. To accomplish this goal, we conducted a narrative review of articles and position statements on sport specialization published from 1990 through 2018. Injury, overuse injury, serious overuse injury, and lower extremity injury were likely associated with higher degrees of sport specialization in various populations. Sports medicine organizations in general recommended against sport specialization in young athletes and instead promoted multisport participation for physical and psychological benefits. Few long-term data suggest that sport specialization has negative health-related quality-of-life consequences. Higher degrees of sport specialization likely pose risks of overuse injury; however, the age of specialization at which this risk occurs is not known. Because different populations and sports activities may put children at risk for certain injuries, future researchers should monitor large populations with sport-specific prospective active surveillance.
Topics: Adolescent; Athletic Injuries; Child; Cumulative Trauma Disorders; Humans; Risk Factors; Specialization; Sports Medicine; Stress, Psychological; Youth Sports
PubMed: 31633420
DOI: 10.4085/1062-6050-380-18 -
Sports Health 2020Shoulder injuries are highly prevalent in sports involving the upper extremity. Some risk factors have been identified in the literature, but consensus is still lacking.
CONTEXT
Shoulder injuries are highly prevalent in sports involving the upper extremity. Some risk factors have been identified in the literature, but consensus is still lacking.
OBJECTIVES
To identify risk factors of overuse shoulder injury in overhead athletes, as described in the literature.
DATA SOURCES
A systematic review of the literature from the years 1970 to 2018 was performed using 2 electronic databases: PubMed and Scopus.
STUDY SELECTION
Prospective studies, written in English, that described at least 1 risk factor associated with overuse shoulder injuries in overhead sports (volleyball, handball, basketball, swimming, water polo, badminton, baseball, and tennis) were considered for analysis.
STUDY DESIGN
Systematic review.
LEVEL OF EVIDENCE
Level 3.
DATA EXTRACTION
Data were extracted from 25 studies. Study methodology quality was evaluated using the Modified Coleman Methodology Score.
RESULTS
Intrinsic factors, previous injury, range of motion (lack or excess), and rotator cuff weakness (isometric and isokinetic) highly increase the risk of future injuries. Additionally, years of athletic practice, body mass index, sex, age, and level of play seem to have modest influence. As for the effect of scapular dysfunction on shoulder injuries, it is still controversial, though these are typically linked. Extrinsic factors, field position, condition of practice (match/training), time of season, and training load also have influence on the occurrence of shoulder injuries.
CONCLUSION
Range of motion, rotator cuff muscle weakness, and training load are important modifiable factors associated with shoulder injuries. Scapular dysfunction may also have influence. The preventive approach for shoulder injury should focus on these factors.
Topics: Athletic Injuries; Cumulative Trauma Disorders; Humans; Range of Motion, Articular; Risk Factors; Rotator Cuff; Scapula; Shoulder Injuries
PubMed: 32758080
DOI: 10.1177/1941738120931764 -
Sports Medicine (Auckland, N.Z.) May 2022The development of a pronounced iliotibial band (ITB) is an anatomically distinct evolution of humans. The mechanical behaviour of this "new" structure is still poorly... (Review)
Review
The development of a pronounced iliotibial band (ITB) is an anatomically distinct evolution of humans. The mechanical behaviour of this "new" structure is still poorly understood and hotly debated in current literature. Iliotibial band syndrome (ITBS) is one of the leading causes of lateral knee pain injuries in runners. We currently lack a comprehensive understanding of the healthy behaviour of the ITB, and this is necessary prior to further investigating the aetiology of pathologies like ITBS. Therefore, the purpose of this narrative review was to collate the anatomical, biomechanical and clinical literature to understand how the mechanical function of the ITB is influenced by anatomical variation, posture and muscle activation. The complexity of understanding the mechanical function of the ITB is due, in part, to the presence of its two in-series muscles: gluteus maximus (GMAX) and tensor fascia latae (TFL). At present, we lack a fundamental understanding of how GMAX and TFL transmit force through the ITB and what mechanical role the ITB plays for movements like walking or running. While there is a range of proposed ITBS treatment strategies, robust evidence for effective treatments is still lacking. Interventions that directly target the running biomechanics suspected to increase either ITB strain or compression of lateral knee structures may have promise, but clinical randomised controlled trials are still required.
Topics: Biomechanical Phenomena; Humans; Iliotibial Band Syndrome; Knee Injuries; Knee Joint; Muscle, Skeletal; Posture
PubMed: 35072941
DOI: 10.1007/s40279-021-01634-3 -
Orthopaedics & Traumatology, Surgery &... Feb 2021At the elbow, the ulnar nerve (UN) may be the site of a static compression (by the cubital tunnel retinaculum and Osborne's ligament between the two heads of the flexor... (Review)
Review
At the elbow, the ulnar nerve (UN) may be the site of a static compression (by the cubital tunnel retinaculum and Osborne's ligament between the two heads of the flexor carpi ulnaris), or a dynamic compression, especially when the nerve is unstable (subluxation/dislocation outside the ulnar groove). The clinical basis for the diagnosis of ulnar neuropathy involves looking for subjective and objective signs of sensory and/or motor deficit in the ulnar nerve's territory in the hand, a pseudo-Tinel's sign, and doing manipulations to provoke UN irritation. The diagnosis is confirmed by electromyography and ultrasonography. In the early stages, patient education and elimination of flexion postures or repeated elbow flexion motions can provide relief. If this fails or signs of sensory and/or motor deficit are present, surgical treatment is proposed. If the nerve is stable, in-situ nerve decompression is typically done as the first-line treatment. If the nerve is unstable, anterior nerve transposition - generally subcutaneous - or more rarely, a medial epicondylectomy can be done. If surgical treatment fails, the patient's history is reviewed, and diagnostic tests can be repeated. Except in cases of a fibrotic scar, the main causes of failure are neuroma of a branch of the medial cutaneous nerve of the forearm, instability of the nerve and persistence of a compression point. In the latter two cases, surgical revision is justified and anterior nerve transposition or epicondylectomy can be proposed.
Topics: Cubital Tunnel Syndrome; Decompression, Surgical; Elbow; Humans; Neurosurgical Procedures; Ulnar Nerve; Ulnar Neuropathies
PubMed: 33321238
DOI: 10.1016/j.otsr.2020.102754 -
Effect of Chronic Ankle Sprain on Pain, Range of Motion, Proprioception, and Balance among Athletes.International Journal of Environmental... Jul 2020: Ankle sprains are common among physically active individuals, especially among athletes. Majority of those who suffer ankle sprains have residual symptoms including...
: Ankle sprains are common among physically active individuals, especially among athletes. Majority of those who suffer ankle sprains have residual symptoms including pain, episodes of giving way, compromised proprioception and neuromuscular control, and re-injury leading to chronic ankle instability. The aim of this study was to see the effect of chronic ankle sprain on pain, range of motion, proprioception, and, static and dynamic balance among athletes. : A total of 80 athletes, aged 18 to 25 years, involved in track-and-field sports were invited to participate in this study. They were divided in two groups. Athletes with history of grade 1 or 2 ankle sprain on either side requiring medical care who reported at least three episodes of ankle giving way in past 12 months were included in group A. An equal number of healthy athletes without any history of ankle sprain or injury in the lower limbs in the past one year matched by sex, age, height, weight, and limb dominance, were included in group B (control). : Participant's pain, range of motion, proprioception and balance (static and dynamic) was measured using visual analog scale, half circle goniometer, degree of foot position sense, single leg stance time and Y-balance test respectively. : Although there were no differences in the active ankle joint range of motion ( > 0.05) in comparison to the control group, athletes with chronic ankle sprain reported mild pain and statistically significant ( < 0.05) deficits in foot proprioception, static and dynamic balance. : Deficits in foot proprioception, static and dynamic balance even one year after the ankle sprain could be the reason for limitations in the dynamic defense system of the joint that predisposes to recurrent injury and instability. It is essential to understand the normal clinical course and risk factors for athletes who sustain sprain before devising a long term comprehensive rehabilitation program that focuses on mechanical and functional insufficiencies in order to improve their functional performance and prevent the risk of recurrent sprain.
Topics: Adolescent; Ankle Injuries; Athletes; Athletic Injuries; Chronic Disease; Female; Humans; Male; Pain; Postural Balance; Proprioception; Range of Motion, Articular; Sprains and Strains; Young Adult
PubMed: 32718066
DOI: 10.3390/ijerph17155318