Objectives: To explore if joint mobility, as a measure of connective tissue quality, could be a predictor for pregnancy-related low back pain after pregnancy and to evaluate local corticosteroid injection treatment in women with persistent pelvic girdle pain long after childbirth. Material and methods: To investigate joint mobility in relation to pain, 200 women were examined repeatedly from early pregnancy until three months after delivery. Their mobility in left fourth finger abduction in early pregnancy was compared with clinically assessed low back and pelvic pain 3 months after delivery. To evaluate local corticosteroid injection treatment, 36 women with persistent PGP were included in a randomised controlled trial (RCT) and randomised to either corticosteroid injection or saline injection on one occasion at the ischial spine bilaterally, with a follow-up after four weeks. In both studies, the women were asked about obstetric history, to complete a pain drawing, estimate their level of pain on a visual analogue scale (0-100) and estimate how they manage their everyday activities on a questionnaire, Disability Rating Index (DRI). In the RCT, the 36 women also completed Short Form 36 (SF-36), a quality of life questionnaire, six-minute walk test (6MWT), and isometric trunk flexion and extension were examined. Results: Women with low back and pelvic pain three months after pregnancy had increased finger laxity in early pregnancy. The larger the finger angle and the more pregnancies, the greater the risk of low back and pelvic pain after pregnancy. In the RCT, at follow-up, the women who received corticosteroid injection treatment improved in walking ability, estimated physical ability and isometric trunk extension more than those who received saline injections. Conclusions: Increased joint mobility, as measured by finger joint mobility, together with the number of previous pregnancies, may be an indicator of low back and pelvic pain postpartum. One single corticosteroid injection treatment to intra-pelvic structures improved function in women with persistent PGP which may indicate a source of pain.

Author: Bc. Marie Zasadilová Title: Incidence of Joint Hypermobility Syndrome in Anxienty Patients Objectives: The aim of this study is to find out what ist he incidence of Joint hypermobility syndrome in the research group of probands with anxiety disorder, on the base of collected theoretical knowledge. Methods: The group of patients with diagnosis of anxiety disorder was examined on presence of joint hypermobility syndrome. For the examination was used standardised test scale Beighton score. The data was statistically processed, prevalence of hypermobility in the research group was compared with prevalece in common population. Results: Prevalence of joint hypermobility syndrome in the research group was 44,88%, that is about 31,88% more, than in common population. Hypermobility was found in 65% of female part oft he research group, that is about 25% more, than in common female population. Prevalence in male part of research group was 16,67%, about 5,17% more than in common male population. The hypotesis, that prevalence of joint hypermobility syndrome will be hihger in the research group than in common population, was affirmed. Average result of Beighton score in group of probands was 4,38 points, the most common result was 2 points. Skewness and krtosis of the histogram curve corresponds with...

O teste do pivot shift é a manobra semiológica mais específica para o diagnóstico da lesão do ligamento cruzado anterior (LCA). É também o único teste que se correlaciona com a probabilidade de desenvolvimento de osteoartrose em joelhos com instabilidade rotacional persistente, após a reconstrução do LCA. Entretanto, há uma grande variabilidade na técnica utilizada para a realização deste teste, comprometendo a sua reprodutibilidade e a sua quantificação objetiva. O teste do pivot shift é influenciado pela associação entre a lesão do LCA e a de outras estruturas anatômicas do joelho. A padronização e a mensuração quantitativa do pivot shift auxiliam na categorização objetiva da frouxidão ligamentar do joelho. O objetivo desta tese foi o de compilar uma série de contribuições do autor, num total de seis publicações, na linha de pesquisa sobre a padronização, quantificação e interpretação do teste do pivot shift. A padronização do teste contribuiu para o aumento da reprodutibilidade da manobra semiológica. Nossos estudos laboratoriais em peças de cadáver demonstraram que a padronização do teste do pivot shift diminuiu de forma significativa a variação da aceleração da redução da tíbia no pivot shift (joelho esquerdo 3,0 ± 1,3 e joelho direito 2,5 ± 0,7 mm/s2) comparada ao teste realizado pela técnica de preferência do cirurgião (joelho esquerdo 4,3 ± 3,3 e joelho direito 3,4 ± 2,3 mm/s2) em cadáver cirurgicamente preparado para apresentar um pivot shift positivo com diferentes gradações em cada joelho. A validação de dispositivos não-invasivos de avaliação da frouxidão ligamentar do joelho, contribuiu para que o teste possa ser medido quantitativamente. Quando comparamos um método invasivo de referência para a mensuração do pivot shift (sensores eletromagnéticos fixados ao osso do fêmur e da tíbia) com três métodos não-invasivos (sensores eletromagnéticos fixados a pele, acelerômetro e um método de análise de imagens), constatamos que todos os métodos não-invasivos apresentaram correlação (r) positiva estatisticamente significante (p <0,01) com o método de referência. Os sensores fixos à pele tiveram r = 0,67 e r = 0,88 para os parâmetros de translação e de aceleração respectivamente. O acelerômetro apresentou r = 0,75 para o parâmetro de aceleração e o método de análise de imagens r = 0,24 para o parâmetro de translação anterior da tíbia. Portanto, neste estudo, métodos não invasivos, adequados para uso em consultório médico, puderam quantificar de forma reprodutível os parâmetros da aceleração e da translação anterior da tíbia no teste do pivot shift. A aplicação clínica destes resultados foi proposta pelo autor por meio de um novo algoritmo para o tratamento individualizado das lesões do LCA, em uma de suas recentes publicações. Embora este algoritmo precise ser validado, a sua proposta abre perspectiva para novos estudos que objetivem melhores resultados no tratamento de pacientes com lesão do ligamento cruzado anterior. / The pivot shift test is the most specific semiologic maneuver to diagnose the anterior cruciate ligament (ACL) injuries. It is also the only test capable of predicting the development of osteoarthritis in the presence of persistent rotatory knee laxity after an ACL reconstruction. However, the test has great technique variability among surgeons compromising reliability and objective quantification. The pivot shift test is influenced by the pattern of the ACL tear and associated lesions. The standardization and the quantitative measurement of the pivot shift can aid in the knee rotary laxity categorization and can provide valuable information on possible additional affected structures besides the ACL, thus contributing for an individualized treatment algorithm for this ligament injury. The purpose of this thesis was to compile a series of author\'s contributions, in a total of six publications, in the field of standardization, measurement and interpretation of the pivot shift test. The standardized technique for the pivot shift test improved the maneuver reliability. Our laboratory studies utilizing cadaveric knees demonstrated that the standardized technique significantly reduced the variation of the acceleration of the tibial reduction during the pivot shift test among surgeons (left knee 3.0 ± 1.3 mm/s2; right knee 2.5 ± 0.7 mm/s2) compared to the surgeons\' preferred technique (left knee 4.3 ± 3.3 mm/s2; right knee 3.4 ± 2.3 mm/s2) in a surgically prepared cadaver for a different positive grade pivot shift in each knee. The validation of non-invasive devices for the knee ligament laxity evaluation aided in the quantitative measurement of the pivot shift. The comparison of an invasive reference method for the pivot shift measurement (electromagnetic tracking device fixed to the femur and tibia) with three non-invasive devices (electromagnetic tracking device attached to the skin, accelerometer and image analysis system) showed statistically significant (p > 0.01) positive correlation (r) for all of them. The electromagnetic tracking device attached to the skin had r = 0,67 and r = 0,88 for the anterior translation and acceleration parameters respectively. The accelerometer has r = 0,75 for the acceleration parameter and the image analysis system had r = 0,24 for the anterior tibial translation parameter. Therefore, in this study, non-invasive methods, affordable for a clinical use, could reliably quantify the acceleration and anterior tibial translation parameters during the pivot shift test. The clinical application of these results was proposed by the author by means of a new algorithm for individualized treatment of the ACL injuries in one of his recent publications. Although this algorithm is yet to be validated, its proposal opens perspective for new studies that aim for better treatment results in patients with an anterior cruciate ligament injury.

Made available in DSpace on 2016-12-06T17:07:26Z (GMT). No. of bitstreams: 1 DISSERTACAO PRONTA.pdf: 1254266 bytes, checksum: f6cd46c7547dc4db63544d5dade63617 (MD5) Previous issue date: 2011-03-03 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The anterior knee laxity has been described as a risk factor for anterior cruciate ligament injuries of the knee. During exercise it has been verified an increase in knee laxity due to cyclic loading. This increase can alter the neuromuscular control and also decrease the joint dynamic stability. Thus, this study aimed to evaluate the neuromuscular response during jump landing after incresing anterior knee laxity. Nineteen male subjects were evaluated (mean age 27,47 ±4,56 years; mean body mass 73 ±9,41 kg; mean height 1,75 ±0,05 m). Neuromuscular response was verified through semitendinosus, biceps femoris, vastus medialis and vastus lateralis muscular activation. In order to evaluate joint dynamic stability, the co-activation index between medialis and lateralis muscles was also verified. Subjects performed five trials of unipodal jumps from a 30 cm height. The subject s knee was submitted to cyclic passive anterior traction for 15 min, with 0,1 Hz frequency. Traction load was normalized for 40% of body mass to induce increase laxity. The knee was positioned at 30 degrees of flexion, and a cable was fixed right below the tuberosity of the tibia. After cyclic loads, subjects were revaluated. The jump was divided in three windows: 100ms before landing, 100ms after landing and 200ms after landing. Paired t test was used to compare muscle activities before and after inducing anterior knee laxity. The results showed a decrease in semitendinosus activity during 100ms after landing, as well as decrease in vastus lateralis in 100ms before and after landing. However, vastus medialis, biceps femoris and co-activation index were not affected by anterior knee laxity. The results show that increased anterior knee laxity can change the neuromuscular control. However, this alteration may not be sufficient to reduce the dynamic joint stability / A lassidão anterior do joelho tem sido descrita como um dos fatores de risco para as lesões do ligamento cruzado anterior do joelho. Tem-se verificado que cargas cíclicas durante o exercício provocam o aumento dessa lassidão. Esse aumento pode alterar o controle neuromuscular e diminuir a estabilidade articular dinâmica. Dessa forma este estudo teve por objetivo avaliar a resposta neuromuscular durante o salto após o aumento da lassidão anterior do joelho. Para isso foram avaliados 19 sujeitos do sexo masculino, com idade média de 27,47 anos (±4,56), massa corporal de 73 kg (±9,41), e estatura de 1,75 m (±0,05). Para a avaliação da resposta neuromuscular foi mensurada a atividade muscular dos músculos semitendíneo, bíceps femoral, vasto medial, e vasto lateral. Para a avaliação da estabilidade articular dinâmica foi obtido ainda o índice de co-ativação entre os músculos mediais e laterais da coxa. Estas variáveis foram obtidas em 5 saltos unipodais, realizados de uma altura de 30 cm. Em seguida, o aumento da lassidão foi provocado por meio de uma força de tração anterior cíclica passiva aplicada à tíbia por 15 min., a uma freqüência de 0,1 Hz, com a magnitude da força correspondente a 40% da massa corporal do sujeito. Para a aplicação da carga o joelho foi posicionado a 30 ° de flexão e um cabo fixado abaixo da tuberosidade da tíbia. Para a avaliação da atividade muscular o salto foi dividido em três instantes: 100ms pré-aterrissagem, 100ms pós-aterrissagem e 200ms pós-aterrissagem.Em cada instante do salto analisado a atividade muscular foi comparada estatisticamente nas situações pré e pós-aumento da lassidão por meio de teste t de student para medidas repetidas. O resultado do teste t demonstrou que houve diminuição significativa na ativação do músculo semitendíneo no instante 100ms pós-aterrissagem, e do músculo vasto lateral no instante 100ms pré-aterrissagem e 100ms pós-aterrissagem. Nos demais músculos e no índice de co-ativação não foram observados alterações. A partir dos resultados concluiu-se que o aumento da lassidão anterior do joelho pode alterar o controle neuromuscular. Todavia, estas alterações podem não ser suficientes para alterar a estabilidade articular dinâmica

O teste do pivot shift é a manobra semiológica mais específica para o diagnóstico da lesão do ligamento cruzado anterior (LCA). É também o único teste que se correlaciona com a probabilidade de desenvolvimento de osteoartrose em joelhos com instabilidade rotacional persistente, após a reconstrução do LCA. Entretanto, há uma grande variabilidade na técnica utilizada para a realização deste teste, comprometendo a sua reprodutibilidade e a sua quantificação objetiva. O teste do pivot shift é influenciado pela associação entre a lesão do LCA e a de outras estruturas anatômicas do joelho. A padronização e a mensuração quantitativa do pivot shift auxiliam na categorização objetiva da frouxidão ligamentar do joelho. O objetivo desta tese foi o de compilar uma série de contribuições do autor, num total de seis publicações, na linha de pesquisa sobre a padronização, quantificação e interpretação do teste do pivot shift. A padronização do teste contribuiu para o aumento da reprodutibilidade da manobra semiológica. Nossos estudos laboratoriais em peças de cadáver demonstraram que a padronização do teste do pivot shift diminuiu de forma significativa a variação da aceleração da redução da tíbia no pivot shift (joelho esquerdo 3,0 ± 1,3 e joelho direito 2,5 ± 0,7 mm/s2) comparada ao teste realizado pela técnica de preferência do cirurgião (joelho esquerdo 4,3 ± 3,3 e joelho direito 3,4 ± 2,3 mm/s2) em cadáver cirurgicamente preparado para apresentar um pivot shift positivo com diferentes gradações em cada joelho. A validação de dispositivos não-invasivos de avaliação da frouxidão ligamentar do joelho, contribuiu para que o teste possa ser medido quantitativamente. Quando comparamos um método invasivo de referência para a mensuração do pivot shift (sensores eletromagnéticos fixados ao osso do fêmur e da tíbia) com três métodos não-invasivos (sensores eletromagnéticos fixados a pele, acelerômetro e um método de análise de imagens), constatamos que todos os métodos não-invasivos apresentaram correlação (r) positiva estatisticamente significante (p <0,01) com o método de referência. Os sensores fixos à pele tiveram r = 0,67 e r = 0,88 para os parâmetros de translação e de aceleração respectivamente. O acelerômetro apresentou r = 0,75 para o parâmetro de aceleração e o método de análise de imagens r = 0,24 para o parâmetro de translação anterior da tíbia. Portanto, neste estudo, métodos não invasivos, adequados para uso em consultório médico, puderam quantificar de forma reprodutível os parâmetros da aceleração e da translação anterior da tíbia no teste do pivot shift. A aplicação clínica destes resultados foi proposta pelo autor por meio de um novo algoritmo para o tratamento individualizado das lesões do LCA, em uma de suas recentes publicações. Embora este algoritmo precise ser validado, a sua proposta abre perspectiva para novos estudos que objetivem melhores resultados no tratamento de pacientes com lesão do ligamento cruzado anterior. / The pivot shift test is the most specific semiologic maneuver to diagnose the anterior cruciate ligament (ACL) injuries. It is also the only test capable of predicting the development of osteoarthritis in the presence of persistent rotatory knee laxity after an ACL reconstruction. However, the test has great technique variability among surgeons compromising reliability and objective quantification. The pivot shift test is influenced by the pattern of the ACL tear and associated lesions. The standardization and the quantitative measurement of the pivot shift can aid in the knee rotary laxity categorization and can provide valuable information on possible additional affected structures besides the ACL, thus contributing for an individualized treatment algorithm for this ligament injury. The purpose of this thesis was to compile a series of author\'s contributions, in a total of six publications, in the field of standardization, measurement and interpretation of the pivot shift test. The standardized technique for the pivot shift test improved the maneuver reliability. Our laboratory studies utilizing cadaveric knees demonstrated that the standardized technique significantly reduced the variation of the acceleration of the tibial reduction during the pivot shift test among surgeons (left knee 3.0 ± 1.3 mm/s2; right knee 2.5 ± 0.7 mm/s2) compared to the surgeons\' preferred technique (left knee 4.3 ± 3.3 mm/s2; right knee 3.4 ± 2.3 mm/s2) in a surgically prepared cadaver for a different positive grade pivot shift in each knee. The validation of non-invasive devices for the knee ligament laxity evaluation aided in the quantitative measurement of the pivot shift. The comparison of an invasive reference method for the pivot shift measurement (electromagnetic tracking device fixed to the femur and tibia) with three non-invasive devices (electromagnetic tracking device attached to the skin, accelerometer and image analysis system) showed statistically significant (p > 0.01) positive correlation (r) for all of them. The electromagnetic tracking device attached to the skin had r = 0,67 and r = 0,88 for the anterior translation and acceleration parameters respectively. The accelerometer has r = 0,75 for the acceleration parameter and the image analysis system had r = 0,24 for the anterior tibial translation parameter. Therefore, in this study, non-invasive methods, affordable for a clinical use, could reliably quantify the acceleration and anterior tibial translation parameters during the pivot shift test. The clinical application of these results was proposed by the author by means of a new algorithm for individualized treatment of the ACL injuries in one of his recent publications. Although this algorithm is yet to be validated, its proposal opens perspective for new studies that aim for better treatment results in patients with an anterior cruciate ligament injury.

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No description available.

La pose d’une prothèse totale de genou (PTG) se fait selon la technique d’alignement mécanique (AM) qui corrige les déformations constitutionnelles du membre pour créer un membre rectiligne. La survie à long terme des implants est excellente mais les résultats fonctionnels sont décevants avec notamment de nombreux symptômes résiduels. Une nouvelle technique chirurgicale, l’alignement cinématique (AC), vise à rétablir l’anatomie constitutionnelle pré-arthrosique du genou, et permet une amélioration des résultats fonctionnels des PTG. Cette technique est actuellement réalisée avec des implants destinés à un positionnement mécanique, et qui ont un design trochléen ne reproduisant pas l'anatomie trochléaire native. Ceci pourrait affecter la biomécanique de l’articulation patello-fémorale et donc rendre les résultats fonctionnels des PTG cinématiques non optimal. Ce travail vise à démontrer 1) les limitations de la technique mécanique, 2) la fiabilité de la technique cinématique pour le positionnement de l’implant fémoral, et 3) que les implants actuels ne permettent pas une restauration de l’anatomie trochléenne des patients. / The conventional technique for TKA, namely mechanical alignment (MA), does not preserve the constitutional limb anatomy but systematically creates a straight limb. Excellent long-term implant survivorship has been reported, but functional outcomes are disappointing. To solve this problem, an alternative technique for TKA, namely kinematic alignment (KA), has recently been promoted and aims at restoring the constitutional (pre-arthritic) knee anatomy and laxity. Mid-term outcomes have shown excellent functional outcomes with this new KA technique. However, KA technique is currently done with TKA implants designed to be mechanically inserted. Their trochlea design does not reproduce the native trochlear anatomy, which could lead to increased rate of patellar complications with KA TKA. This work aims at demonstrating technical limitations of MA technique, good reproducibility of KA technique, and inappropriateness of current implant to restore patient trochlea anatomy.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2018. / Background: Rhythmic Gymnastics is a sporting discipline involving the use of an apparatus (hoop, ball, clubs, ribbon or rope) to a choreographed routine with music. It requires agility, grace, co-ordination and most of all flexibility. Safety in Rhythmic Gymnastics is questionable when one takes training hours and the extreme flexibility required into consideration. An awareness and understanding of the prevalence and risk factors in Rhythmic Gymnastics will allow event organisers, medical personnel, managers, and coaches to adapt training approaches that will minimize the development of injuries. This information will also aid in developing monitoring systems to prevent adaptation injuries, which will lead to safer training and better management of gymnasts Objectives: This study aimed to investigate the prevalence of musculoskeletal injuries in rhythmic gymnasts within the eThekwini municipality and to identify selected factors associated with an increased risk of injury, in order to improve the management of gymnasts. Methods: A quantitative, descriptive questionnaire-based survey with a Beighton Score assessment was conducted on 67 Rhythmic gymnasts in the eThekwini municipality. Statistical analysis was performed on the results obtained from the questionnaire and the Beighton Score using IBM SSS version 23.0. The Chi-squared test was used (Fisher’s Exact Test was used when the Chi-squared test was violated); A p value of less than 0.05 was considered as statistically significant. Graphical representation of scores by groups was done using various types of tables and graphs. Risk factors for injuries were assessed using logistic regression. Factors were entered individually into the model to determine the co- efficients and odds ratios. Trend tests were computed in order to better assess associations between specific factors and injury. Results: A 100% response rate was achieved in this study. The average age of the participants was 12.3 years (95% CI= 11.7-12.8), average height was 148.5 centimetres (95% CI= 145.1-151.9), average weight was 41.0 kilograms (95% CI= 38.3-43.7), the average level of performance was 4.9 (95% CI= 4.1-5.8) and the average Beighton Score was 5.8 (95% CI= 5.3-6.3). The most commonly previously injured areas were the ankle (n=25) (14.0%), hip and knee (each n=19) (each 10.6%) and the low back (n=18) (10.1%). When considering the two most severe previous injuries the results stay similar, with the ankle being most commonly injured (n=15) (28.0%), followed by the hip (n=9) (17.0%) and the knee (n=6) (11.0%). When considering current injuries, the most commonly injured area is the knee and low back (each n=11) (each 14.5%), and the hip and ankle (each n=9) (each 11.8%). From the above it can be deduced that RG results in more injuries to the lower limb than the upper limb, or core/abdomen or the spine. The most common types of RG injury were muscle strains (n=16) (23.9%), followed by unsure (n=9) (13.4%) and joint sprains (n=8) (11.9%). The most common cause of injury for both previous and current RG injuries were overstretching and overuse ((n=23) (34.3%) for previous injuries; (n=15) (22.4%) for current injuries). Risk factors for injury were significant for the following: training hours per week (36.5 times for 5-8 hours of training per week; 15.7 times for under five hours of training per week; both when compared to more than 8 hours) and lack of balance skills included in RG training (4.5 times more likely than not). When considering treatment option used to keep the body in a good condition, a participant was 4.3 times more likely to utilize home remedies than any other treatment option. Trend tests noted that there is an increase in the mean of injuries as one goes up in age, up until a certain age (13-14 years of age for current injuries; 15-16 years of age for previous injuries), thereafter, there is a decease. Trend tests were also constructed for training hours per week; there was a directly proportional relationship between training hours per week and injury. Conclusion: When considering risk of injury in RG, many of the risk factors cannot be modified (such as age). Those risk factors that can be modified (such as training amount and components of training) should be considered by gymnasts and their coaches in order to implement strategies that could prevent injury. / M

No description available.