ABSTRACT
El músculo iliopsoas es el principal flexor de la cadera siendo un rotador lateral accesorio de ésta, sus fibras discurren posteriores al ligamento inguinal, cruzando anteriormente a la pelvis. Este trayecto ocurre en un surco que se localiza entre la eminencia iliopúbica, medialmente y la espina iliaca anteroinferior, lateralmente. Si bien existen antecedentes de este surco, no se encuentra expresado en la terminología anatómica internacional (TAI) como un surco relevante dentro de los relieves óseos pélvicos. Este surco se encuentra asociado al tendón en diferentes disfunciones de cadera, como la cadera en resorte (coxa saltans). El objetivo de la investigación es ampliar el conocimiento clínico y anatómico de este surco y su inclusión en la terminología anatómica internacional. Dentro de los criterios de inclusión se seleccionaron artículos publicados en español e inglés que aludieron referencia al surco y/o palabras claves como, "músculo iliopsoas", "músculo psoas ilíaco", "surco iliopsoas" "surco coxal", "groove iliopsoas" y "iliopsoas muscle" "surco coxal". Los motores de búsqueda utilizados fueron Pubmed, Google Académico y Springer Link. La relevancia del surco del músculo iliopsoas abre una puerta a las discusiones respecto a su forma y profundidad, así como también un punto de referencia asociada a diferentes situaciones clínicas relacionada con este surco y probables predisposiciones a lesiones o chasquidos que ocurren en cadera. Finalmente, el conocimiento del surco para el músculo iliopsoas es importante tenerlo en consideración en investigaciones que aborden esta región, así como su terminología anatómica, relaciones anatómicas, clínicas y quirúrgicas.
SUMMARY: The iliopsoas muscle is the main hip flexor being an accessory lateral rotator of this, its fibers run posterior to the inguinal ligament, crossing anterior to the pelvis. This course occurs in a groove located between the iliopubic eminence medially and the anterior inferior iliac spine laterally. Although there are antecedents of this groove, no relevant comments are found in international anatomical terminology (IAT) as a groove within the pelvic bone reliefs. This groove is associated with the tendon in different hip dysfunctions, such as the hip snap (coxa saltans). The objective of the research is to expand the clinical and anatomical knowledge of this groove and its inclusion in international anatomical terminology. Within the inclusion criteria, articles published in Spanish and English were selected that referred to the groove and/or keywords such as "iliopsoas muscle", "iliopsoas muscle", "iliopsoas groove", "coxal groove", "iliopsoas groove". and "iliopsoas muscle" "coxal groove". The search engines used were Pubmed, Google Scholar and Springer Link. The relevance of the iliopsoas muscle groove gives way to discussions regarding its shape and depth, as well as a point of reference associated with different clinical situations related to this groove and probable predispositions to injuries or snaps that occur in the hip. Finally, knowledge of the groove for the iliopsoas muscle is important to consider in research that addresses this region, as well as its anatomical terminology, anatomical, clinical, and surgical relationships.
Subject(s)
Humans , Pelvic Bones/anatomy & histology , Psoas Muscles/anatomy & histology , HipABSTRACT
Abstract Objective To evaluate the safety and reproducibility of the surgery for unstable slipped capital femoral epiphysis (SCFE) through the modified Dunn technique in a single center cohort from Brazil. Methods We retrospectively analyzed a cohort of patients submitted to this procedure by a single surgeon who was a hip preservation specialist. Demographic data and radiographic angles were evaluated for the relative risk (RR) of avascular necrosis (AVN) using a log-binomial regression model with simple and random effects. Results Among the 30 patients (30 hips) with a mean age of 11.79 years at the time of the operation, there were 17 boys and 18 left hips, which were operated on in a mean of 11.5 days after the slip. The mean follow-up was of 38 months. The preoperative Southwick angle averaged 60.69° against 4.52° postoperatively (p< 0.001). A larger preoperative slip angle was associated with the development of AVN (RR: 1.05; 95% confidence interval [95%CI]: 1.02-1.07; p< 0.01). The overall AVN rate was of 26.7%. Function was good or excellent in 86% of uncomplicated hips, and poor in 87.5% of the partients who developed AVN, as graded by the Harris Hip Score. There was no statistical relationship between epiphyseal bleeding and AVN development (p= 0.82). Conclusion The modified Dunn technique is associated with restoration of the femoral alignment and function after unstable SCFE, when uncomplicated. Moreover, it was shown to be reproducible in our population, with a rate of 26% of femoral head necrosis.
Resumo Objetivo Avaliar a segurança e a reprodutibilidade da cirurgia para escorregamento da epífise femoral proximal (EEPF) com instabilidade por meio da técnica de Dunn modificada em uma coorte unicêntrica no Brasil. Métodos Analisamos de forma retrospectiva uma coorte de pacientes submetidos a esse procedimento por um único cirurgião especialista em preservação do quadril. Avaliamos os dados demográficos e os ângulos radiográficos quanto ao risco relativo (RR) de necrose avascular (NAV) por meio do modelo de regressão log-binomial com efeitos simples e aleatórios. Resultados Entre os 30 pacientes (30 quadris) com idade média de 11,79 anos no momento da cirurgia, havia 17 meninos e 18 quadris esquerdos. O procedimento ocorreu em média 11,5 dias após o escorregamento. O tempo médio de acompanhamento foi de 38 meses. O ângulo de Southwick pré-operatório foi, em média, de 60,69° contra 4,52° após o procedimento (p< 0,001). O maior ângulo de escorregamento pré-operatório foi associado ao desenvolvimento de NAV (RR: 1,05; intervalo de confiança de 95% [IC95%]: 1,02-1,07; p< 0,01). A frequência geral de NAV foi de 26,7%. De acordo com a Escala de Quadril de Harris (Harris Hip Score), a função foi boa ou excelente em 86% dos quadris sem complicações, e ruim em 87,5% dos casos com NAV. Não houve relação estatística entre sangramento epifisário e desenvolvimento de NAV (p= 0,82). Conclusão A técnica de Dunn modificada restaura o alinhamento femoral e a função articular após o EEPF com instabilidade na ausência de complicações. Além disso, mostrou-se passível de reprodução em nossa população, com frequência de necrose da cabeça femoral de 26%.
Subject(s)
Humans , Male , Female , Child , Osteotomy , Femur Head Necrosis , Slipped Capital Femoral Epiphyses , Hip/surgeryABSTRACT
Tanto la osteomielitis como la osteoartritis séptica en el período neonatal son patologías infrecuentes. La afectación ósea de la columna cervical es aún más rara, siendo excepcional en neonatos. Son patologías graves, con elevada morbimortalidad, donde el diagnóstico y tratamiento precoz agresivo son de suma importancia para el pronóstico vital y funcional. Presentamos el caso de un neonato que presentó una sepsis a S. Aureus multirresistente, asociada a una osteomielitis de la primera vértebra cervical y a una osteoartritis séptica de la cadera izquierda. Fue tratado precozmente de forma quirúrgica y con antibioticoterapia, presentando una buena evolución.
Both osteomyelitis and septic osteoarthritis in the neonatal period are infrequent pathologies. Bone involvement of the cervical spine is even rarer, being exceptional in neonates. These are serious pathologies, with high morbimortality, where early diagnosis and aggressive treatment are of utmost importance for the vital and functional prognosis. We present the case of a neonate who presented with sepsis due to multidrug-resistant S. Aureus, associated with osteomyelitis of the first cervical vertebra and septic osteoarthritis of the left hip. He was treated early surgically and with antibiotic therapy, presenting a good evolution
Tanto a osteomielite como a osteoartrose séptica no período neonatal são patologias raras. O envolvimento ósseo da coluna cervical é ainda mais raro, sendo excepcional nos recém-nascidos. Estas são patologias graves, com elevada morbimortalidade, onde o diagnóstico precoce e o tratamento agressivo são da maior importância para o prognóstico vital e funcional. Apresentamos o caso de um recém-nascido que apresentou sepse devido a S. Aureus multirresistente, associado a osteomielite da primeira vértebra cervical e osteoartrose séptica da anca esquerda. Foi tratado precocemente cirurgicamente e com terapia antibiótica, com uma boa evolução.
Subject(s)
Humans , Male , Infant, Newborn , Osteomyelitis/diagnosis , Cervical Atlas/pathology , Staphylococcal Infections/diagnosis , Hip/pathology , Osteomyelitis/drug therapy , Rifampin/therapeutic use , Staphylococcal Infections/drug therapy , Vancomycin/therapeutic use , Delayed Diagnosis , Neonatal Sepsis , Anti-Bacterial Agents/therapeutic use , Anticoagulants/therapeutic useABSTRACT
El objetivo de esta presentación es dar a conocer el manejo de la miositis piógena del músculo obturador interno en un paciente pediátrico que fue tratado mediante un drenaje percutáneo guiado por ecografía. Se trata de un niño de 5 años de edad, con manifestaciones clínicas y valores de laboratorio de infección muscular profunda en el obturador interno. Se identificó específicamente con resonancia magnética, es un área de difícil acceso quirúrgico, por lo cual se realizó un tratamiento percutáneo guiado por ecografía que permitió drenar el contenido purulento de la zona afectada. La resonancia magnética hizo posible lograr un diagnóstico más acertado en los casos de infección piógena temprana y, a su vez, decidir la vía de abordaje más adecuada. En ocasiones, se puede optar por la guía ecográfica con la cual se evita el abordaje quirúrgico formal y así disminuyen las complicaciones de la herida y la mayor morbimortalidad. La adición de procedimientos percutáneos guiados por imágenes es una herramienta muy útil para tratar enfermedades infecciosas y una gran ayuda para el ortopedista. Nivel de Evidencia: V
The objective of this case report is to present the management of a case of pyogenic myositis of the obturator muscle in a pediatric patient using ultrasound-guided percutaneous drainage. The patient is a 5-year-old pediatric patient with clinical and laboratory manifestations of deep muscular infection at the obturator level, an area of difficult surgical access, for which the least invasive treatment possible was used to drain purulent content from the affected area. The use of magnetic resonance imaging studies allows for a more accurate diagnosis in cases of early pyogenic infection, as well as determining the most effective approach to treatment. In some cases, ultrasound guidance can be used to avoid a formal surgical approach, reducing wound complications and morbidity and mortality. The addition of image-guided percutaneous procedures is a very useful tool for the treatment of infectious diseases and a great help to the orthopedist. Level of Evidence: V
Subject(s)
Child, Preschool , Drainage , Ultrasonography , Pyomyositis , Hip , MusclesABSTRACT
Introducción: La artroplastia total de cadera de revisión junto con la utilización de injerto óseo cadavérico de banco de tejidos es una alternativa de tratamiento eficaz ante los procedimientos de reemplazo con déficit óseo femoral o acetabular. El presente estudio, analizó los resultados post operatorios en pacientes intervenidos quirúrgicamente en el Hospital de Clínicas. Materiales y métodos: Estudio descriptivo. Muestreo no probabilístico de casos consecutivos atendidos en la Cátedra de Ortopedia y Traumatología de la Facultad de Ciencias Médicas (U.N.A). Fueron captados pacientes con indicación de artroplastia total de cadera de revisión (ATCR) más injerto óseo cadavérico de banco de tejidos, entre diciembre 2017 - octubre 2020, previo consentimiento informado. Se relevaron datos cuya caracterización fue posible mediante un instrumento establecido previamente, ingresado en base Excel. Resultados: 12 pacientes con déficit óseo femoral y acetabular han sido tratados con artroplastia total de cadera de revisión más injerto óseo cadavérico de banco de tejidos, en donde además de la funcionalidad y a través de seguimientos radiológicos se ha determinado la osteointegración total de los aloinjertos. La relación masculino-femenina fue 1/1, siendo el diagnóstico preoperatorio para la colocación de la prótesis de revisión más injerto óseo cadavérico de banco de tejidos el aflojamiento séptico en un 75%. El motivo de consulta más frecuente fue dolor y la secreción y el tiempo quirúrgico fue en promedio de 116 minutos. Conclusión: La artroplastia total de cadera de revisión más aloinjerto presenta óptimos resultados en relación a la osteointegración total y funcionalidad.
Introduction: Revision total hip arthroplasty with use of cadaveric bone graft is an effective treatment for replacement procedures in patients with bone loss femoral or acetabular. The present study analyzed the postoperative results in patients who underwent surgery at the Hospital de Clínicas. Materials and methods: Descriptive study. Non-probabilistic sampling of consecutive cases treated at the Department of Orthopedics and Traumatology of Hospital de Clínicas. Data of patients with indication for revision total hip arthroplasty plus cadaveric bone graft from a tissue bank with prior informed consent,were analyzed between December 2017 and October 2020. Results: 12 patients with femoral and acetabular bone deficits have been treated with revision total hip arthroplasty plus cadaveric bone graft from a tissue bank. A radiological and functional follow up was made. The male-female ratio was 1/1, with the preoperative diagnosis for placement of the revision prosthesis plus cadaveric bone graft,from the tissue bank,was septic loosening in 75%. The most frequent symptom was pain, all revision total hip arthroplasties were performed through a posterior approach, and the surgical time was an average of 116 minutes,using a later approach in all cases.Two intraoperative fracture was presented, and were resolved. Conclusion: Revision total hip arthroplasty plus allograft presents optimal results in relation to total osseointegration and functionality.
Subject(s)
Transplants , Tissue Banks , Tissues , Traumatology , HipABSTRACT
El objetivo de este trabajo es determinar las mediciones radiológicas del extremo proximal del fémur en pacientes adultos cuyos casos fueron presentados en las discusiones clínico-radiológicas del servicio de Traumatología y Ortopedia del Hospital Central de San Cristóbal entre 2015 y 2021. Se realizó un estudio prospectivo, descriptivo, transversal, que incluyó los estudios radiológicos de cadera sana en proyección anteroposterior de pelvis centrada en pubis con rotación interna de 15 %, de 126 pacientes entre 20 y 95 años. Se midieron: ángulo cervicodiafisario, lateralización femoral, longitud y ancho del cuello femoral y diámetro de la circunferencia cefálica, mediante el sotfware MicroDicom DICOM 4.0.0. La media de ángulo cervicodiafisario fue 130,8 ± 4,5 grados, en 57 individuos (45,2 %) estuvo entre 127,4 y 133,3 grados (p = 0,001); la circunferencia cefálica media fue 42,0 ± 2,4 mm, en 60 personas (47,6 %) estuvo entre 40,2 y 45,7 mm (p = 0,001); la longitud cervical media fue 78,6 ± 16,4 mm, en 54 individuos (42,9 %) estuvo entre 69,4 y 92 mm (p = 0,001); el ancho cervical medio fue 75,9 ± 12,1 mm, en 64 casos, (50,8 %) estuvo entre 62,9 y 78,7 mm (p = 0,001). En 60 individuos (47,6 %) la lateralización del fémur estuvo entre 92,6 - 117,7 mm. Las medidas son independientes del sexo; a medida que aumenta la edad, el ángulo cervicodiafisario es menor (p= 0,021). Se realizaron tablas percentiladas de las medidas radiológicas del extremo proximal del fémur, según edad y sexo, que pueden servir de referencia en pacientes futuros(AU)
The objective of this work is to determine the radiological measurements of the proximal end of the femur in adult patients whose cases were presented in the clinical-radiological discussions of the Traumatology and Orthopedics service of the Central Hospital of San Cristóbal between 2015 and 2021. A prospective study was carried out, descriptive, crosssectional, which included radiological studies of a healthy hip in anteroposterior projection of the pelvis centered on the pubis with internal rotation of 15%, of 126 patients between 20 and 95 years of age. The following were measured: cervicodiaphyseal angle, femoral lateralization, length and width of the femoral neck, and diameter of the head circumference, using the MicroDicom DICOM 4.0.0 software. The mean neck-diaphyseal angle was 130.8 ± 4.5 degrees, in 57 individuals (45.2%) it was between 127.4 and 133.3 degrees (p = 0.001); the mean head circumference was 42.0 ± 2.4 mm, in 60 people (47.6%) it was between 40.2 and 45.7 mm (p = 0.001); the mean cervical length was 78.6 ± 16.4 mm, in 54 individuals (42.9 %) it was between 69.4 and 92 mm (p = 0.001); the mean cervical width was 75.9 ± 12.1 mm, in 64 cases (50.8%) it was between 62.9 and 78.7 mm (p= 0.001). In 60 individuals (47.6%), the lateralization of the femur was between 92.6 - 117.7 mm. The measurements are independent of sex; as age increases, the cervical shaft angle is less (p= 0.021). Percentage tables of the radiological measurements of the proximal end of the femur were made, according to age and sex, which can serve as a reference in future patients(AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Femur/surgery , Hip , Radiology , Arthroplasty, Replacement , Proximal Femoral Fractures , Hip Fractures/surgeryABSTRACT
Abstract Objectives The present study aimed to assess whether preoperative spinopelvic parameters can influence the gain of segmental lordosis after one level of lateral lumbar interbody fusion. Methods The following radiological parameters were measured in the X-rays: pelvic incidence, lumbar lordosis, pelvic tilt, L4S1 lordosis, index level segmental lordosis, intraoperative index segmental lordosis, pelvic mismatch (IP-LL), distal lordosis proportion, delta segmental lordosis, Pelvic Titlt (PT) > 20, actual sacral slope, and ideal sacral slope, and the correlation of these variables with the gain of segmental lordosis was investigated. Afterwards, an exploratory cluster analysis was performed to identify common characteristics between patients and segmental lordosis gain. Results The sample of the present study comprised 104 patients, of which 76% presented segmental lordosis gain. The most correlated parameters with the segmental lordosis gain were preoperative segmental lordosis (−0.50) and delta intraoperative lordosis (0.51). Moreover, patients in the high PI groups had a trend to gain more segmental lordosis (p< 0.05) and a reduced risk of losing segmental lordosis (Odds 6.08). Conclusion Patients with low-medium PI profiles presented higher odds of loss of segmental lordosis. However, the preoperative spinopelvic parameters alone do not seem to play a significant role in the fate of segmental lordosis gain.
Resumo Objetivos O presente estudo teve como objetivo avaliar se os parâmetros espinopélvicos pré-operatórios podem influenciar o ganho da lordose segmental após fusão intersomática lombar por via lateral de um nível. Métodos Os seguintes parâmetros radiológicos foram medidos nos raios X: incidência pélvica, lordose lombar, versão pélvica, lordose L4S1, lordose segmental do nível operado, índice intraoperatório de lordose segmentar, mismatch pélvico (IP-LL), proporção de lordose distal, delta de lordose segmentar, PT > 20, inclinação sacral real e inclinação sacral ideal, e a correlação dessas variáveis com o ganho da lordose segmentar foi investigada. Posteriormente, foi realizada uma análise exploratória de cluster para identificar características comuns entre os pacientes e o ganho de lordose segmentar. Resultados O presente estudo contou com 144 pacientes, dos quais 76% apresentaram ganho de lordose segmentar. Os parâmetros mais correlacionados com o ganho de lordose segmentar foram lordose segmentar pré-operatória (−0,50) e delta intraoperatório de lordose (0,51). Além disso, os pacientes dos grupos de incidência pélvica (IP) alto tiveram tendência de ganho de lordose segmental maior (p< 0,05) e redução do risco de perda de lordose segmental (chances 6.08). Conclusão Pacientes com perfis de IP médios baixos apresentaram maiores chances de perda de lordose segmentar. No entanto, os parâmetros espinopélvicos pré-operatórios por si só não parecem desempenhar um papel significativo no destino do ganho da lordose segmentar.
Subject(s)
Humans , Male , Female , Pain , Arthroscopy , Pain Measurement , Femoracetabular Impingement , Hip , LordosisABSTRACT
Introducción: Los medios de enseñanzas son los ejes vertebrales de gran parte de las acciones de enseñanzas y aprendizaje desarrolladas en cualquiera de los niveles o modalidades de la educación. Objetivos: Sistematizar y resaltar los fundamentos y ventajas de la guía de autoayuda sobre la fractura de cadera en el adulto mayor, como medio de enseñanza en la superación profesional del médico de la atención primaria. Métodos: Analítico sintético, hipotético deductivo, análisis documental y la entrevista. Resultados: Se elaboró una guía de autoayuda sobre fractura de cadera en el adulto mayor, a partir de falencias detectadas en la atención primaria de salud, que limitan el desempeño de los médicos de este nivel en actividades de promoción de salud en este grupo social. La guía de autoayuda fue diseñada y estructurada, como medio de enseñanza de estrategias de superación profesional, determinando las particularidades del contenido que se desea enseñar y las que se necesitan aprender por estos profesionales, para mejorar su desempeño en la promoción de salud en relación con el adulto mayor con fractura de cadera. Su creación fue concebida como elemento dinamizador del contenido unido a los demás componentes del proceso en busca de lograr los objetivos propuestos. Conclusiones: Se presenta una guía de la colección de autoayuda sobre fractura de cadera en el adulto mayor, diseñado, pensado y elaborado como medio de enseñanza a utilizar en la superación profesional del médico de la atención primaria de salud donde se resaltan los fundamentos teóricos que lo sustentan.
Introduction: Teaching media are the backbone of a large part of the teaching and learning actions developed at every educational level or modality. Objectives: To systematize and highlight the rationale and advantages of the self-help guide for hip fracture in the elderly, considered as a teaching tool in the professional improvement of primary health care ( PHC). Methods: Analytical - synthetic, hypothetical - deductive, documentary analysis and interview. Results: A self-help guide for hip fracture in the elderly was developed, based on deficiencies detected on PHC, which limit the performance of doctors at this level in health promotion activities for the mentioned social group. The self-help guide was designed and structured as a means of teaching professional improvement strategies by determining the content particularities to be taught and those to be learned by these professionals, in order to improve their performance in health promotion for the elderly with hip fracture. This self- help guide was conceived as a dynamic element of the content, that relates to the other components of the process in search of achieving the proposed objectives. Conclusions: We present a self-help collection guide for hip fracture in the elderly, designed, conceived, and elaborated as a teaching tool to be used in the professional improvement of the PHC, and we highlight theoretical foundations
Subject(s)
Aged , Fractures, Bone , Primary Health Care , Teaching , HipABSTRACT
O kip é uma habilidade fundamental amplamente utilizada nas rotinas de treinamento da ginástica artística. No entanto, faltam materiais didáticos que auxiliem o processo de ensino-aprendizagem dos alunos e dos professores iniciantes. OBJETIVO: Apresentar uma análise biomecânica qualitativa do kippe realizado na barra inferior das paralelas assimétricas. MÉTODOS: Esta foi uma revisão narrativa baseada no Google Acadêmico. Os termos utilizados para a busca dos materiais foram kippe e biomecânica, em Português e Inglês, considerando estudos experimentais e não experimentais. RESULTADOS: A literatura aponta diferentes termos para designar este mesmo movimento. Os movimentos articulares predominantes são extensão e flexão, o que justifica a maioria dos textos abordar a análise do plano sagital. O kippe tem seis instantes e três fases de movimento, Glide, Pike e Pull Up. A literatura mostra pequenas diferenças na execução em cada uma dessas fases. No entanto, alguns erros comuns de execução são apontados com algum consenso como deslizar muito curto, não alcançar o pike, abaixar as pernas muito rápido após o pike e flexionar os cotovelos na tentativa de encerrar o movimento. CONCLUSÃO: Há um número reduzido de estudos que integram a avaliação biomecânica ao processo ensino-aprendizagem na ginástica, bem como no contexto do esporte de alto rendimento. Demonstramos que essa abordagem qualitativa pode ser útil para o processo de ensino-aprendizagem desse exercício específico. A decomposição do movimento em fases permite estabelecer prioridades com base nas forças e fraquezas apresentadas pelos atletas / alunos, otimizando assim as intervenções para melhorar o seu desempenho. (AU)
Kip is a fundamental skill widely used in artistic gymnastics trai-ning routines. However, there is a lack of didactic material that helps students' tea-ching-learning process and beginning teachers. OBJECTIVE: To present a qualitative biomechanical analysis of the kippe performed on the lower bar of the asymmetric parallel bars. METHODS: This was an narrative review based on Google Scholar. The terms used to search for materials were kippe and biomechanics, in Portuguese and English, considering experimental and nonexperimental studies. RESULTS: The lite-rature points out different terms to designate this same movement. The predominant articular movements are extension and flexion, which justifies the majority of the texts to approach the sagittal plane analysis. The kippe has six instants and three phases of movement, Glide, Pike, and Pull Up. The literature show small differences in executi-on in each of these phases. However, some common execution errors are pointed out with consensus as glide too short, do no reach the pike, lower the legs too fast after the pike, and flexing the elbows in an attempt to end the movement. CONCLUSION: The-re is a low number of studies that integrate biomechanical assessment with the tea-ching-learning process in gymnastics, as well as in the context of high-performance sport. We have demonstrated that this qualitative approach might be useful to the tea-ching-learning process of this specific exercise. The decomposition of the movement in critical phases allows establishing priorities based on the strengths and weaknesses exhibited by the athletes/students, thereby optimizing the interventions to improve their performance. (AU)
Subject(s)
Humans , Teaching , Biomechanical Phenomena , Exercise , Gymnastics , Shoulder , Sports , Students , Physical Fitness , Review , Efficiency , Faculty , Athletes , Hip , Learning , MusclesABSTRACT
Introdução: A terapia Cuevas Medek Exercises (CME) é um método fisioterapêutico de manuseio sem comandos verbais, pois não busca reações voluntárias e, sim, acessar a via cortical involuntária. As correções dos movimentos acontecem pelo estímulo sensorial da mão do terapeuta. Objetivo: Avaliar o efeito da CME na displasia do desenvolvimento de quadril (DDQ) de uma paciente com paralisia cerebral (PC). Métodos: A pesquisa é caracterizada como estudo de caso, tendo como participante uma menina de seis anos com PC, tetraparesia e displasia bilateral de quadril. As intervenções começaram após avaliação desenvolvida pelo método CME, radiografia de quadril e classificação nos níveis do Sistema de Classificação da Função Motora Grossa (GMFCS). A criança foi submetida a terapia CME para tratar a DDQ durante 10 meses, totalizando 136 sessões (45 minutos cada), composta de quatro a seis exercícios repetidos, seis vezes em média. Foram registrados o tempo e/ou quantas repetições conseguiu realizar. Resultados: Evoluiu de 55 para 61 pontos no score do CME, melhorou sua idade motora e, na radiografia de quadril, o esquerdo passou de subluxado para quadril de risco. Conclusão: A paciente melhorou idade motora, controle de tronco e bipedestação, autonomia e encaixe do quadril em ambos os lados. (AU)
Subject(s)
Child , Cerebral Palsy , Hip , Methods , Developmental Disabilities , Physical Therapy ModalitiesABSTRACT
Objetivo: analisar os efeitos de um programa de prevenção de lesão sobre a função muscular do quadril, a amplitude de movimento (ADM) de dorsiflexão do tornozelo e o controle postural em militares. Metodologia: foram incluídos no estudo nove militares (30,56±8,33 anos), que foram avaliados pré e pós intervenção por meio dos seguintes instrumentos: a) Avaliação funcional do quadril através dos testes funcionais para o músculo glúteo máximo e glúteo médio; b) Avaliação da ADM de dorsiflexão do tornozelo, por meio do teste de Lunge realizado com uma fita métrica; c) Avaliação do equilíbrio, por meio da Posturografia Dinâmica Computadorizada (sistema EquiTest® NeuroCom), incluindo os testes de organização sensorial (TOS), que é dividido em seis condições e o índice geral do equilíbrio (composite). Os militares foram submetidos a um programa de prevenção de lesão durante 10 semanas, aplicado 2 vezes semanais com duração de aproximadamente 50 minutos. O programa foi constituído de exercícios em 4 categorias, incluindo aquecimento / corrida, fortalecimento muscular, equilíbrio e alongamento. Resultados: houve melhorias significativas sobre a função muscular de glúteo médio não-dominante (p=0,01), a ADM de dorsiflexão do tornozelo dominante (p=0,02) e sobre o controle postural, através do aumento da condição V dos TOS (p=0,04), valor de composite (p=0,02) e do sistema vestibular (p=0,03). Conclusão: O programa de exercícios proposto melhorou os parâmetros de função muscular glútea, mobilidade de tornozelo e controle postural em militares.
Objective: to analyze the effects of an injury prevention program on hip muscle function, range of motion (ADM) of ankle dorsiflexion and postural control in the military. Methodology: nine military personnel (30.56 ± 8.33 years) were included in the study, who were evaluated before and after intervention through the following instruments: a) Functional assessment of the hip through functional tests for the gluteus maximus and gluteus medius muscles; b) Evaluation of the ADM of ankle dorsiflexion by means of the Lunge test performed with a tape measure; c) Evaluation of balance through Computational Dynamic Posturography (EquiTest® NeuroCom system), including sensory organization tests (TOS), which is divided into six conditions and the general equilibrium index (composite). The military underwent an injury prevention program for 10 weeks, applied twice weekly with a duration of approximately 50 minutes. The program consisted of exercises in 4 categories, including warm up / running, muscle strengthening, balance and stretching. Results: there were significant improvements in non-dominant gluteus medial muscle function (p = 0.01), dominant ankle dorsiflexion ROM (p = 0.02) and postural control, through an increase in the TOS V condition (p = 0.04), composite value (p = 0.02) and vestibular system (p = 0.03). Conclusion: a exercises program improved of gluteal muscle function, ankle mobility and postural control in the military.
Subject(s)
Humans , Male , Adult , Buttocks , Exercise , Postural Balance , Muscle Strength , Hip , Ankle , Military Personnel , Epidemiology, Descriptive , Evaluation Studies as TopicABSTRACT
This study is aimed to estimate and measure reference values in the normal range of motion of extremity joints in females and to provide a database for the assessment of impairments related to the mobility of the joints. This observational cross-sectional study was conducted at seven major educational institutes areas of Rawalpindi and Islamabad in Pakistan from January to June 2020 with a sample size of 600 healthy females aged 15 to 45 years and divided into three groups through non-probability sampling technique. In study Instruments, an electronic Goniometer was used for the measurement of the range of motions for different joints and then those ranges were recorded. The questionnaire had two sections demographic characteristics and ROM for both upper and lower limbs. Data was analyzed using SPSS V21. A p < 0.05 was considered statistically significant.In the result,Out of 600 participants,there was a statistically significant difference of (p < 0.001) in both upper and lower extremities motion between all the three groups for the measurements and noticeably no significant difference (p > 0.005) between group 1, 2 comparisons for the knee joint extension.To conclude, In most joints, the range of motion increases with age. The transition from group 1 to group 2 was aided by increased hormone participation in growth, an active lifestyle, and generally good health. Because of degenerative changes and joint stiffness, group 3's range of motion deteriorated, leading to a sedentary lifestyle and lack of physical activity. Standardized biomechanical measurements can help health practitioners, such as physiotherapists, choose appropriate therapy interventions to assess musculoskeletal disorders. To resolve the inconsistencies in the reliability and validity of goniometry values, more research is required.
Subject(s)
Humans , Female , Adolescent , Adult , Reference Values , Range of Motion, Articular , Shoulder Joint/physiology , Biomechanical Phenomena/physiology , Exercise/physiology , Body Mass Index , Cross-Sectional Studies/methods , Multicenter Study , Elbow Joint/physiology , Arthrometry, Articular , Sedentary Behavior , Physical Therapists , Hip/physiology , Knee Joint/physiology , Life StyleABSTRACT
Objectives: This cross-sectional study aimed to investigate (1) postural control performance in different postural tasks and (2) muscle strength and power of the hip, knee, and ankle of active vs inactive older adults. Methods: The sample consisted of 61 healthy community-dwelling older adults, classified into 2 groups: active, consisting of participants of a multicomponent exercise program offered through the Exercise Orientation Service; and inactive. Participants were considered physically active/inactive in the past 3 months. Postural control was assessed using a force plate in 8 postural tasks. Muscle function was evaluated using an isokinetic dynamometer. T-tests were used to compare clinical characteristics between the groups. ANCOVA and MANCOVA were used to compare differences in variables of postural control and muscle function. Results: Active participants had higher levels of physical activity, clinical balance, and quality of life than inactive participants. The active group had lower values for area (center of pressure) than the inactive group under the following conditions: bipedal stance on an unstable surface with eyes open and with eyes closed, and semi-tandem stance on an unstable surface with eyes open. The active group showed greater muscle power, with higher mean power values for hip abduction and adduction, knee extension, and knee flexion and shorter time to peak torque for hip adduction and ankle dorsiflexion than the inactive group. Conclusions: Multicomponent exercise programs delivered in primary health care settings contributed to improving postural control and muscle power in this sample of older adults, which can potentially help prevent falls and improve quality of life.
Objetivo: Este estudo transversal visou investigar: (1) o desempenho no controle postural em diferentes tarefas e (2) a força e a potência musculares de quadril, joelho e tornozelo de idosos ativos vs. inativos. Metodologia: A amostra foi composta de 61 idosos comunitários saudáveis, classificados em dois grupos: os ativos, participantes do programa de exercício multicomponente ofertado pelo Serviço de Orientação ao Exercício, e os inativos. Os participantes foram considerados fisicamente ativos/inativos nos três meses anteriores. O controle postural foi avaliado em oito tarefas usando-se uma plataforma de força. A função muscular foi mensurada com um dinamômetro isocinético. Foram utilizados testes t para comparar as características clínicas entre os grupos. Análise de covariância e análise multivariada de covariância foram utilizadas para comparar diferenças nas variáveis de controle postural e função muscular. Resultados: Os participantes ativos apresentaram maiores níveis de atividade física, equilíbrio e qualidade de vida que os inativos. O grupo ativo apresentou menores valores de área (centro de pressão) que o inativo nas seguintes condições: base bipodal em superfície instável com olhos abertos e fechados e base semitandem em superfície instável com olhos abertos. O grupo ativo apresentou maior potência que o inativo, com maior valor de potência média para abdução e adução de quadril, extensão e flexão de joelho, e menor tempo de pico de torque para adução de quadril e dorsiflexão de tornozelo. Conclusão: Programas de exercício multicomponente ofertados na Atenção Primária à Saúde contribuíram para melhorar o controle postural e a potência muscular nesta a
Subject(s)
Humans , Male , Female , Aged , Primary Health Care , Exercise , Postural Balance/physiology , Muscle Strength/physiology , Life Style , Geriatric Assessment/methods , Cross-Sectional Studies , Healthy Volunteers , Hip/physiology , Knee/physiology , Ankle/physiologyABSTRACT
La displasia ósea esclerosante es una afectación en el desarrollo intrínseco del esqueleto, por alteración en la formación y modelado del hueso, que lleva a una excesiva acumulación ósea con un aumento de la densidad (esclero-sis). Existen varios tipos y todos ellos son de origen genético. Presentamos el caso de una paciente de 37 años que llega a la consulta sin diagnóstico previo, por dolor en miembros inferiores de larga evolución con reagudizaciones, asociado a deformidad e impotencia funcional, que cedía parcialmente con analgésicos comunes. (AU)
Bone sclerosing dysplasia is an affectation of the intrinsic development of the skeleton by an alteration in bone formation and modeling. It causes excessive bone accumulation with an increase in density (sclerosis). There are several types of bone sclerosing dysplasia. They are of genetic origin. We report here a 37 year-old patient without a previous diagnosis of sclerosing bone dysplasia who was seen in the clinic for pain in the lower limbs associated with bone deformity with only partial response to analgesics. (AU)
Subject(s)
Humans , Female , Adult , Bone Diseases, Developmental/diagnostic imaging , Melorheostosis/diagnostic imaging , Magnetic Resonance Imaging , Radiography , Tomography, Spiral Computed , Pain Management , Hip/pathology , Leg/pathologyABSTRACT
La prevalencia de artrosis de cadera en personas mayores de 45 años es de 9.2% y 27% de ellos evidencian signos radiológicos de la enfermedad, siendo el dolor uno de los motivos de consulta más comunes de quienes acuden al médico general y al ortopedista. La historia clínica precisa y el examen físico adecuado pueden llevar al clínico a determinar el origen del dolor. Sin embargo, nuestra experiencia en la consulta es que la mayoría de los médicos generales no conocen cuáles son los síntomas de la patología de la cadera. El objetivo de este artículo es presentar una guía práctica de su evaluación clínica y la patología más común, que sea útil para el estudiante de medicina, el médico general y el especialista. El artículo se desarrollará en el orden en que se realiza la evaluación de la cadera para al final poder tener un diagnóstico claro.
The prevalence of osteoarthritis of the hip among people over 45 years of age is 9.2% and 27% of them show radiological signs of this joint disorder, with pain being one of the most common reasons for consultation of patients seen by general practitioners and orthopedic surgeons. An accurate clinical history and a proper physical examination can lead the clinician to determine the origin of the pain. However, our experience in office visits shows that most general practitioners are unaware of the symptoms of hip disorders. The purpose of this article is to present a practice guideline for clinical examination of the hip and the most common disorders, which is useful for the medical student, general practitioner and specialist. The article will outline the steps in which hip evaluation is performed to obtain a clear diagnosis in the end
Subject(s)
Humans , Male , Female , Middle Aged , Physical Examination , Hip , Pain , Osteoarthritis, Hip , JointsABSTRACT
Introducción: Se presenta el caso clínico de una mujer con avulsión aguda completa del glúteo medio en su inserción distal en el trocánter mayor, con cuadro de evolución menor de 24 horas desde la aparición del dolor peritrocantérico, en ausencia de un claro desencadenante o desgaste crónico degenerativo documentado. En la evaluación por urgencias ante la sospecha diagnóstica, se hace radiografía anteroposterior (AP) de pelvis y lateral de la cadera afectada, con posterior confirmación de hallazgos por resonancia magnética nuclear (RMN). El tratamiento se realiza mediante una técnica quirúrgica reconstructiva dentro de la primera semana de la lesión, con excelentes resultados clínicos y funcionales. Conclusión: La avulsión traumática aguda del músculo glúteo medio es una patología con una baja incidencia, lo que hace que la evidencia disponible para guiar su manejo sea escasa. Se presenta este caso clínico con la intención de exponer el abordaje clínico y diagnóstico de esta entidad y mostrar una opción de manejo con resultados satisfactorios. Nivel de Evidencia: IV
Introduction: We report a clinical case of a woman with a complete acute avulsion of the gluteus medius muscle at its distal insertion in the greater trochanter, with an evolution of less than 24 hours from the onset of peritrochanteric pain and in the absence of a clear trigger or documented chronic degenerative wear. Anteroposterior (AP) pelvis and lateral hip radiographs were taken during her evaluation in the emergency department in view of the suspected diagnosis, with subsequent confirmation of the findings with magnetic resonance imaging (MRI). The patient was treated with a reconstructive surgical technique within the first week of the injury with excellent clinical and functional outcomes. Conclusion: Acute traumatic avulsion of the gluteus medius muscle is a pathology with a low incidence, which means that the available evidence to guide its management is scarce. This clinical case is presented with the intention of exposing the clinical and diagnostic approach to this entity and showing a management option with satisfactory results. Level of Evidence: IV
Subject(s)
Middle Aged , Pain , HipABSTRACT
Medidas autorreportadas de atividade física (AF) são comumente usadas em pesquisas populacionais, contudo ainda é incerto o viés destas quando comparadas com acelerometria. Assim, o objetivo deste estudo foi comparar medidas de AF obtidas por questionário e acelerometria em adultos e idosos. Realizouse uma análise transversal do estudo de base populacional denominado Study of Health in Pomerode - SHIP-Brazil, com 2488 participantes entre 20 e 79 anos, conduzido nos anos de 2014/18. Uma subamostra de indivíduos que teve medidas válidas de uso do acelerômetro (ActiGraph GT3X+) e dados do questionário (International Physical Activity Questionnaire-Short Form - IPAQ-SF) foi incluída na análise. As medidas autorreportadas de caminhada e AF de intensidades moderada e vigorosa (AFMV) foram obtidas pelo IPAQ-SF e as medidas mensuradas pelo acelerômetro. Para comparação utilizou-se o teste de Wilcoxon e análise de dispersão de Bland-Altman, com nível de significância p < 0,05. A amostra final foi de 451 pessoas (312 adultos e 103 idosos; 55,2% mulheres; idade média = 49,4 anos ± 13,83). Entre homens adultos houve diferença estatística nas medidas de AFMV entre acelerômetro e IPAQ-SF (p < 0,05). Para os idosos e entre as mulheres adultas e idosas não foi observada diferença estatística na medida de AFMV autorreportada (IPAQ-SF) e acelerômetro (p > 0,05). Em todos os grupos houve maior concordância até valores de 300 minutos/semana de AFMV. Por fim, pode-se concluir que as medidas de AFMV oriundas do IPAQ-SF podem ser utilizadas em estudos populacionais com mulheres e com idosos. Sugere-se cautela na utilização entre homens que tendem a subestimar a AFMV em relação a medida de acelerometria. (AU)
Self-reported measures of physical activity (PA) are commonly used in population surveys, however their bias is still uncertain when compared with accelerometry. The goal is to compare PA measurements obtained by questionnaire and accelerometry in adults and the elderly. The Study of Health in Pomerode - SHIP-Brazil database was used, with 2488 participants between 20 and 79 years old, conducted in 2014/18. A subsample of individuals who had valid accelerometer measurements (ActiGraph GT3X+) and questionnaire data (International Physical Activity Questionnaire-Short Form - IPAQ-SF) was included in the analysis. The self-reported measures of walking and moderate and vigorous PA (MVPA) were obtained by the IPAQ-SF and the measured by the accelerometer. For comparison, the Wilcoxon test and Bland-Altman dispersion analysis were used, with significance level p < 0.05. The final sample was 451 people (312 adults and 103 elderly; 55.2% women; mean age = 49.4 years ± 13.83). Among adult men, there was a statistical difference in MVPA measurements between accelerometer and IPAQ-SF (p < 0.05). For the elderly and between adult and elderly women, no statistical difference was observed in the measure of self-reported MVPA (IPAQ-SF) and accelerometer (p > 0.05). In all groups there was greater agreement up to values of 300 minutes / week for MVPA. Finally, it can be concluded that MVPA measures from the IPAQ-SF can be used in population studies with women and the elderly. Caution is suggested in the use among men who tend to underestimate MVPA in relation to the accelerometer measurement. (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Epidemiology , Surveys and Questionnaires , Validation Study , Accelerometry , Motor Activity , Social Conditions , Women , Aged , Exercise , Health , Surveys and Questionnaires , Walking , Adult , Clinical Laboratory Techniques , Hip , MenABSTRACT
Introducción: Las enfermedades que afectan la articulación de la cadera son numerosas, y dentro de las variantes de tratamiento quirúrgico se encuentra la artroscopia, la que ha ganado gran popularidad en la actualidad por sus ventajas. Objetivo: Actualizar la información sobre la artroscopia de cadera como modalidad de tratamiento quirúrgica mínimo-invasiva en relación con sus indicaciones y contraindicaciones. Métodos: Se realiza una búsqueda y análisis de la información sobre el tema en el período comprendido entre el primero de septiembre y el 31 de octubre de 2020. Se emplearon las siguientes palabras para la búsqueda: hip arthroscopy, snapping hip syndrome, impingement hip síndrome, y a partir de la información obtenida se revisaron 307 artículos publicados en las bases de datos PubMed, Hinari, SciELO y Medline, mediante el gestor de búsqueda y administrador de referencias EndNote. De ellos se seleccionaron 47 citas de los últimos cinco años para la revisión. Análisis y síntesis de la información: Se hace referencia a los trabajos publicados que abordan información sobre la artroscopia de cadera. Se analizan las indicaciones tanto en entidades intrarticulares como periarticulares, con especial énfasis en las primeras y el choque femoroacetabular. Con relación a las contraindicaciones se dividen en absolutas y relativas para su mejor comprensión. Conclusiones: La artroscopia de la cadera es un método quirúrgico útil en una gran variedad de afecciones de la articulación y sus ventajas son numerosas. Esta modalidad quirúrgica permite el diagnóstico de entidades difíciles de detectar por los métodos imagenológicos disponibles en la actualidad y por ende el tratamiento efectivo desde etapas tempranas con el propósito de conservar la articulación(AU)
Introduction: The diseases that affect the hip joint are numerous, and among the variants of surgical treatment is arthroscopy, which has gained great popularity today due to its advantages. Objective: To bring up to date the information on hip arthroscopy as a minimally invasive surgical treatment modality in relation to its indications and contraindications. Methods: A search and analysis of information on the subject was carried out from September 1 to October 31, 2020. The following search words were used: hip arthroscopy, snapping hip syndrome, impingement hip syndrome. Founded on the information obtained, 307 articles published in PubMed, Hinari, SciELO and Medline databases were reviewed, using the EndNote search manager and reference manager. Forty-seven citations of the total were selected for this review. They were published in the last five years. Analysis and synthesis of the information: Reference is made to published papers that address information on hip arthroscopy. Indications for both intra-articular and peri-articular entities are analyzed, with special emphasis on the former and femoroacetabular impingement. In relation to the contraindications, they are divided into absolute and relative for their better understanding. Conclusions: Arthroscopy of the hip is a useful surgical method in wide variety of joint conditions and its advantages are numerous. This surgical modality allows the diagnosis of entities that are difficult to detect by currently available imaging methods and therefore effective treatment from early stages in order to preserve the joint(AU)