-
Neurology Jul 2024Hand weakness is a frequent chief concern in neurology practice. We report a case of a 55-year-old woman presenting with a chronic, gradually worsening right hand...
Hand weakness is a frequent chief concern in neurology practice. We report a case of a 55-year-old woman presenting with a chronic, gradually worsening right hand weakness and atrophy, selectively affecting the thenar muscles, without any sensory symptoms. She had a history of carpal tunnel syndrome and previously underwent surgical carpal tunnel release. This case delves into the differential diagnosis of hand weakness and atrophy, emphasizing the significance of myotomal innervation in intrinsic hand muscles. Furthermore, it outlines a systematic approach to diagnosing an uncommon cause for a common clinical presentation, offering a comprehensive differential diagnosis, and exploring various possible causes.
Topics: Humans; Female; Middle Aged; Muscle Weakness; Hand; Clinical Reasoning; Diagnosis, Differential; Muscular Atrophy; Atrophy; Carpal Tunnel Syndrome
PubMed: 38833636
DOI: 10.1212/WNL.0000000000209561 -
Cureus May 2024Introduction Muscles, ligaments, tendons, bones, and cartilage undergo age-related changes, affecting the foot-ankle joint complex biomechanics in both genders. While...
Causal Relationships Between Physical Activity and Arthrokinematic Integrity of the Ankle Joint-Foot Complex Across Normal and Pathological Phenomena: A Case-Control Analysis.
Introduction Muscles, ligaments, tendons, bones, and cartilage undergo age-related changes, affecting the foot-ankle joint complex biomechanics in both genders. While international studies have extensively researched these dynamics, Indian studies are limited. Our study aims to fill this gap by analyzing the anthropometric and biomechanical function of the foot-ankle joint complex in normal individuals and those with painful pathologies at All India Institute of Medical Sciences (AIIMS) Rajkot's OPD. Methods In a two-year case-control study of the cross-sectional type conducted at AIIMS Rajkot's OPD, 158 patients with similar pain intensity on the Numeric Pain Rating Scale were examined. Anthropometric and biomechanical measurements were taken for both affected and non-affected foot and ankle joints. Cases comprised patients with foot and ankle joint pain, while controls were selected based on predefined criteria and were without such pain. Ethical approval was acquired from the Institutional Ethical Committee of AIIMS Rajkot. Results The sprain of the ankle joint and foot was the most common musculoskeletal pathology (65 out of 158 cases, i.e., 41.13%) affecting the ankle joint-foot complex. Patients involved in occupations requiring higher physical inactivity suffer more commonly from ankle joint-foot pathologies. The mean difference in the range of motion, i.e., dorsiflexion, plantar flexion, inversion, and eversion, between affected and non-affected feet was found to be lower in the patients who belonged to occupations involving low physical activity compared to those patients having occupations with high physical activity. Conclusion Reduced physical activity increases the stiffness and reduces the flexibility of the tendons, muscles, and ligaments of any joint (the ankle joint-foot complex in this study) and is associated with a higher incidence of musculoskeletal pathologies.
PubMed: 38832157
DOI: 10.7759/cureus.59578 -
Journal of Musculoskeletal & Neuronal... Jun 2024Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy in the body and impacts approximately 5% of the U.S. population costing nearly $5 billion/year....
OBJECTIVES
Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy in the body and impacts approximately 5% of the U.S. population costing nearly $5 billion/year. Electrodiagnostic (EDX) testing is considered the gold standard for CTS diagnosis. Classification systems exist that categorize CTS severity based on EDX findings. This investigation evaluated EDX findings across consecutive CTS severity categories within existing classification systems and classifications.
METHODS
This retrospective study analyzed 665 hands from 468 patients undergoing EDX testing for suspected CTS. Complete classification systems and classifications were evaluated for discrimination capability across consecutive CTS severity categories based on EDX findings. Additional analysis evaluated the relationship of sex and age factors and CTS severity.
RESULTS
classifications demonstrated superior discrimination capability between consecutive CTS severity categories regardless of classification system used. Demographic factors significantly influenced EDX findings and categorization of CTS severity.
CONCLUSIONS
This study underscores the value of classifications for enhancing discrimination between consecutive CTS severity categories based on EDX findings. Demographic factors should be considered when interpreting EDX findings for the purpose of categorizing CTS severity. Future research should refine existing classification systems and explore additional factors influencing CTS severity used to inform medical management.
Topics: Humans; Carpal Tunnel Syndrome; Male; Female; Middle Aged; Retrospective Studies; Electrodiagnosis; Adult; Aged; Severity of Illness Index
PubMed: 38826005
DOI: No ID Found -
Knee Surgery, Sports Traumatology,... May 2024To investigate the clinical efficacy and prognostic factors associated with autologous osteoperiosteal transplantation for the treatment of single cystic osteochondral...
Autologous osteoperiosteal transplantation is effective in the treatment of single cystic osteochondral lesions of the talus and the prognostic impact of age should be emphasized.
PURPOSE
To investigate the clinical efficacy and prognostic factors associated with autologous osteoperiosteal transplantation for the treatment of single cystic osteochondral lesions of the talus (OLT).
METHODS
The clinical data of patients with single cystic OLT undergoing autologous osteoperiosteal transplantation at the Department of Foot and Ankle Surgery of our hospital between 2018 and 2022, including complete follow-up, were retrospectively analyzed. Imaging data from each patient were imported into Mimics software to measure the surface area, volume and depth of the lesions. Then, the talus nine-compartment partitioning method was used to partition the injury site. Preoperative and final follow-up assessments were performed using the American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS) for pain and 36-item Short-Form Health Survey (SF-36) to evaluate treatment efficacy and analyze prognostic factors.
RESULTS
Of the 31 patients with single cystic OLT with a complete set of follow-up data, there were 17 males and 14 females, with a mean age of 43.3 ± 13.6 years, a mean follow-up time of 30.1 ± 14.0 months and a mean illness duration of 30.4 ± 20.0 months. The postoperative final follow-up AOFAS score was 90.7 ± 5.5; this represented significant improvement when compared to the preoperative score of 57.0 ± 8.5 (P < 0.001). The final postoperative follow-up VAS score was 18.5 ± 8.3; this was significantly better than the preoperative score of 57.8 ± 8.7 (P < 0.001). The physical component summary (PCS) score and mental component summary (MCS) score on the SF-36 scale showed significant improvement at the final postoperative follow-up when compared to preoperative scores (p < 0.001). No other complications were observed during follow-up, such as wound infection or pain at the donor site. One of the patients showed less improvement, which may be related to premature weight-bearing or re-sprained ankle after surgery. There was no significant correlation between the duration of illness, gender and the location, depth, surface area and volume of the OLT and the postoperative scores. However, patient age showed a significant negative correlation with the postoperative SF-36 PCS and MCS scores.
CONCLUSION
Autologous osteoperiosteal transplantation for single cystic OLT demonstrated good clinical efficacy with a low incidence of complications. Furthermore, age represents an important factor influencing prognosis.
LEVEL OF EVIDENCE
Level II.
PubMed: 38819934
DOI: 10.1002/ksa.12301 -
PM & R : the Journal of Injury,... May 2024Injury characteristics of high school track and field throwing athletes in the United States are not well studied. Understanding epidemiology of injuries is important to...
BACKGROUND
Injury characteristics of high school track and field throwing athletes in the United States are not well studied. Understanding epidemiology of injuries is important to identify treatment and prevention strategies.
OBJECTIVE
To describe injury rates and patterns in U.S. high school track and field throwing events from a longitudinal national sports injury surveillance system.
DESIGN
Descriptive epidemiology study.
SETTING
Data were provided by the National High School Sports Related Injury Surveillance System, High School RIO (Reporting Information Online).
METHODS
Athletic trainers reported injury and exposure data through the High School RIO website on a weekly basis. An athlete exposure (AE) was defined as one athlete participating in one school-sanctioned practice or competition. Throwing events of discus, shot put, and javelin were analyzed in this study.
MAIN OUTCOME MEASURES
Injury rate, rate ratios (RR), injury proportion ratios (IPR).
PARTICIPANTS
U.S. high school athletes.
RESULTS
A total of 267 track and field throwing injuries occurred during 5,486,279 AEs. Overall, the rate of injuries in competition was higher than in practice (RR 1.35, 95% confidence interval [CI] 1.01-1.80). In practice, the rate of injuries was higher for girls than boys (RR 1.53, 95% CI 1.12-2.08). The most frequently injured body part was the shoulder (21.7%), followed by the ankle (16.5%) and knee (12.0%). The most common types of injury were muscle strains (26.14%) and ligament sprains (25%). Recurrent injuries accounted for a higher proportion of chronic injuries compared to new injuries (IPR 1.85, 95% CI 1.16-2.97).
CONCLUSION
This study described injury characteristics of high school track and field throwing athletes from 2008 to 2019. Based on our results, injury prevention may be particularly important for female throwers with prior injury.
PubMed: 38818973
DOI: 10.1002/pmrj.13188 -
Medical Problems of Performing Artists Jun 2024Ballet dancers have a high injury risk. We aimed to gain insight into the causes for acute and overuse injuries in ballet dancers and the level of implementation of...
OBJECTIVES
Ballet dancers have a high injury risk. We aimed to gain insight into the causes for acute and overuse injuries in ballet dancers and the level of implementation of injury prevention by ballet teachers/masters, as perceived by dancers.
METHODS
An international cross-sectional online-survey was based on the Fit-to-Dance Questionnaire and literature. Adult amateur, pre-professional, and professional ballet dancers reported the perceived causes of their injuries sustained in the previous 2 years. Multiple answers per injury were possible. Also, dancers rated the level of implementation of measures to prevent injury by their ballet teachers and ballet masters based on 21 items using a 5-point Likert scale. Causes were analyzed per-injury as well as per-dancer.
RESULTS
188 ballet ensembles and 51 dance organizations were contacted, from which 192 ballet dancers (mean age 27 ±7.8 yrs, 83% females) responded. 119 dancers (62%) reported 203 acute and 164 (85%) reported 469 overuse injuries. Fatigue was the most frequently perceived cause for acute injuries in the per-injury (n=89, 43.8%) and per-dancer analysis (n=63, 32.8%). For overuse injuries, pressure from the teacher/master was most frequently perceived as cause in the per-injury analysis (n=240, 51.2%), specifically in pre-/professional dancers (n=233, 61.3%). In the per-dancer analysis, fatigue/overtraining scored highest for overuse injuries (n=107; 55.7%). Other causes were previous/repetitive injuries (acute-per-injury 26.1%, acute-per-dancer 22.4%; overuse-per-injury 46.3%, overuse-per-dancer 53.1%) or erroneous dance technique (acute-per-injury 24.6%, acute-per-dancer 21.9%; overuse-per-injury 47.8%, overuse-per-dancer 45.3%). With regard to perceived level of implementation of injury preventive measures by ballet teachers/masters to prevent musculoskeletal injuries, 2 items received high ratings, 12 moderate ratings and 6 low ratings.
CONCLUSIONS
Fatigue and pressure accounted for the majority of perceived causes for injuries. Perceived support by ballet teachers/masters regarding injury prevention was moderate to low. Future research should focus on the awareness, attitudes, and the important role of ballet teachers/masters for injury prevention in dancers.
Topics: Humans; Dancing; Female; Male; Cross-Sectional Studies; Adult; Cumulative Trauma Disorders; Surveys and Questionnaires; Young Adult; Athletic Injuries; Occupational Injuries
PubMed: 38814128
DOI: 10.21091/mppa.2024.2007 -
Zhongguo Zhong Yao Za Zhi = Zhongguo... May 2024The Shexiang Zhuifeng Zhitong Ointment with the effects of dispelling wind, removing dampness, dissipating cold, and relieving pain is used for treating arthralgia,... (Randomized Controlled Trial)
Randomized Controlled Trial
[Randomized,double-blind,parallel controlled,multicenter clinical trial of effectiveness and safety of Shexiang Zhuifeng Zhitong Ointment in alleviating pain in knee osteoarthritis(syndrome of cold-dampness obstruction)].
The Shexiang Zhuifeng Zhitong Ointment with the effects of dispelling wind, removing dampness, dissipating cold, and relieving pain is used for treating arthralgia, muscular pain, and sprain pain caused by cold-dampness obstruction. To evaluate the efficacy and safety of Shexiang Zhuifeng Zhitong Ointment in relieving the pain due to knee osteoarthritis(syndrome of cold-dampness obstruction), a randomized, double-blind, parallel controlled, multicenter clinical trial was conducted. The stratified randomization method was used to randomize the 240 subjects into a treatment group and a control group in a ratio of 1∶1. In each group, 60 patients received external application for 12 h and the other 60 patients received external application for 6 h. The treatment group received external application of Shexiang Zhuifeng Zhitong Ointment, while the control group received external application of Shexiang Zhuifeng Ointment. The treatment lasted for 21 days in both groups. Follow-up was conducted on days 7, 14, and 21 of treatment. The results based on the full analysis set were as follows.(1)In visual analog scale(VAS) score, the mean difference in the VAS score between baseline and 12 h post-treatment was 3.02 in the treatment group and 2.31 in the control group, with a significant difference(P<0.05). The mean difference in the VAS score between baseline and 6 h post-treatment was 3.19 in the treatment group and 2.48 in the control group, with a significant difference(P<0.05).(2)Response rate in terms of VAS score, after treatment for 12 h, the response rate was 93.22% in the treatment group and 73.33% in the control group, with a significant difference(P<0.05). After treatment for 6 h, theresponse rate in the treatment group was 88.33%, which was higher than that(63.33%) in the control group(P<0.05).The results showed that Shexiang Zhuifeng Zhitong Ointment applied for 12 and 6 h effectively relieved the knee joint pain of patients with knee osteoarthritis due to cold-dampness obstruction, as demonstrated by the reduced VAS score, Western Ontario and McMaster Universities Arthritis Index(WOMAC), stiffness, and joint function score. Moreover, Shexiang Zhuifeng Zhitong Ointment outperformed the positive control Shexiang Zhuifeng Ointment in terms of reducing the VAS score, demonstrating a definitetherapeutic effect on the pain due to knee osteoarthritis(syndrome of cold-dampness obstruction).In addition, Shexiang Zhuifeng Zhitong Ointment did not cause other adverse reactions except for mild allergic reactions, which were common in the external application of traditional Chinese medicine plasters on the skin, inseveral patients.Neither other adverse reactions nor abnormalities of liver and kidney functions and electrocardiogram were observed. This ointment had high safety and could be popularized in clinical application.
Topics: Humans; Osteoarthritis, Knee; Drugs, Chinese Herbal; Male; Middle Aged; Female; Ointments; Double-Blind Method; Aged; Treatment Outcome; Adult; Pain
PubMed: 38812155
DOI: 10.19540/j.cnki.cjcmm.20240202.501 -
Sports Health May 2024Studies routinely evaluate high ankle sprains in isolation, but recent data suggest that these injuries are often associated with concomitant pathology, potentially...
BACKGROUND
Studies routinely evaluate high ankle sprains in isolation, but recent data suggest that these injuries are often associated with concomitant pathology, potentially influencing return to full participation.
HYPOTHESIS
In National Football League (NFL) players, isolated high ankle sprains are rare and syndesmosis injuries with concomitant pathology will result in increased time to return to full participation.
STUDY DESIGN
Cross-sectional study.
LEVEL OF EVIDENCE
Level 3.
METHODS
Distal tibiofibular syndesmosis injuries sustained by NFL players between 2017 and 2019 were identified through NFL Injury Surveillance Database queries and verified with video analysis. Each injury underwent a comprehensive magnetic resonance imaging (MRI) review. Regression modeling was utilized to explore the influence of numerous imaging findings on time to return to full participation.
RESULTS
There were 83 external rotation ankle injuries involving the syndesmosis. Isolated distal tibiofibular syndesmosis injuries were rare (n = 11; 13%) and more often associated with other ligamentous injury (deltoid ligament and lateral ligamentous complex) and/or fractures. Regression modeling resulted in clustering of 3 injury pattern groups for time to return to full participation across numerous imaging findings: syndesmosis injury-fracture combinations (250 days [interquartile range [IQR,] 142-266 days]), syndesmosis injury with complete deep deltoid tear or acute diastasis (175 days [IQR, 20-248 days]), and all other syndesmosis injuries (27 days [IQR, 18-46 days]).
CONCLUSION
In NFL athletes with external rotation ankle injuries, isolated distal tibiofibular syndesmosis injuries were rare and more often associated with concomitant pathology. Time to return to full participation was affected by an associated fracture and complete deep deltoid ligament tear or diastasis but no other relevant MRI variables such as lateral ligament complex involvement or the presence of osteochondral lesions or bone contusions.
PubMed: 38804171
DOI: 10.1177/19417381241253223 -
Injury Epidemiology May 2024Musculoskeletal injuries are a common occurrence in sport. The goal of sport injury epidemiology is to study these injuries at a population level to inform their... (Review)
Review
BACKGROUND
Musculoskeletal injuries are a common occurrence in sport. The goal of sport injury epidemiology is to study these injuries at a population level to inform their prevention and treatment.
MAIN BODY
This review provides an overview of musculoskeletal sport injuries and the musculoskeletal system from a biological and epidemiologic perspective, including injury mechanism, categorizations and types of sport injuries, healing, and subsequent injuries. It is meant to provide a concise introductory substantive background of musculoskeletal sport injuries for epidemiologists who may not have formal training in the underlying anatomy and pathophysiology.
CONCLUSION
An understanding of sport injuries is important for researchers in sport injury epidemiology when determining how to best define and assess their research questions and measures.
PubMed: 38802864
DOI: 10.1186/s40621-024-00507-3 -
Journal of Neuroradiology = Journal de... May 2024The cervical spine in children has marked anatomical and biomechanical differences compared to adults, leading to significantly different patterns and incidence of...
BACKGROUND AND PURPOSE
The cervical spine in children has marked anatomical and biomechanical differences compared to adults, leading to significantly different patterns and incidence of spinal injury, and consequently to different X-ray and computed tomography (CT) imaging recommendations. Magnetic resonance imaging (MRI) has been validated to clear cervical spine trauma in adults, but not in pediatric patients. We hypothesized that MRI findings have a low probability to change management in children with spine trauma and negative CT findings.
MATERIALS AND METHODS
We reviewed records for admitted pediatric patients due to blunt trauma from January 2011 to May 2021, and identified 212 patients who underwent MRI within 3 days of a negative CT. Two neuroradiologists independently reviewed all CT and MRI images for the following categories: fracture, subluxation, spinal canal compromise, ligamentous injury, spinal canal hemorrhage, cord contusion and soft tissue hemorrhage. We identified follow-up MRI examinations as negative or positive for the above categories, and calculated the prevalence of each category as a percentage of cases with negative CT. We also evaluated whether negative and positive MRI groups differed significantly with respect to age and sex of the patients.
RESULTS AND CONCLUSIONS
In our study of 212 children with cervical spine trauma and a negative CT, most follow-up MRI scans were found to be negative (79.9 %). Positive MRI findings consisted mainly of ligamentous sprain without disruption (15.1 %). Ligamentous disruption and epidural or soft tissue hemorrhage were found in 4.5 %, and focal cord contusion in 0.5 %. There was no statically significant difference between negative and positive MRI groups with respect to age (P = 0.45) and sex (P = 0.52).
CONCLUSION
In our patient group with a negative CT, MRI did not significantly impact management nor contribute to cervical spine clearance in children.
PubMed: 38801971
DOI: 10.1016/j.neurad.2024.101206