Self-Reported Hip Problems in Professional Ballet Dancers: The Impact on Quality of Life.

Hip problems are common in ballet dancers, and it is likely that dancers' perceived quality of life is impaired by their presence. There are no instruments to detect functional impairments related to hip injuries in young, athletic populations. The aim of this study was to evaluate the impact of hip related problems on the quality of life in professional ballet dancers. Thirty-seven professional ballet dancers, ages 18 to 33, completed a post-hire health screening prior to the start of their company's season. Participants completed the Hip Disability and Osteoarthritis Outcome Score (HOOS) questionnaire, which assesses level of disability due to a hip problem, and answered additional questions regarding the presence of pain with ballet-specific movements. Subjects were also asked to self-report current or prior history of hip problems or injuries. Dancers with a self-reported history of a hip problem (8 of 37, 21.6%) recorded relatively low HOOS sub-scores (indicative of enhanced disability) for pain and quality of life. The remaining sub-scores-for symptoms, activities of daily living (ADLs), and sports-were not significantly different from those of dancers who were problem-free. Dancers with a history of hip problem were also more likely to report hip pain with two or more dance movements. The impact of hip problems on the quality of life in professional ballet dancers tends to persist despite a lack of significant effect on the ability to perform ADLs or sports-related tasks. Therefore, the self-reported presence of a hip problem should be viewed as a risk factor for decreased quality of life in this population.

Lumbar Intraspinal Spindle Cell Rhabdomyosarcoma as a Rare Cause of Spinal Stenosis: A Case Report.

Rhabdomyosarcoma (RMS) represents the most common sarcoma in childhood yet is extremely rare in adults, with only a handful of cases reported. Here we present a case of intraspinal spindle cell RMS in an adult who presented as a typical case of spinal stenosis. To our knowledge, this is the first reported case of lumbar intraspinal spindle cell RMS in an adult patient. Furthermore, RMS phenotypically presents more aggressively in adults compared with children. LEVEL OF EVIDENCE: V.

Anxiety and Insomnia in Young and Middle-Aged Adult Hip Pain Patients With and Without Femoroacetabular Impingement and Developmental Hip Dysplasia.

BACKGROUND: In young and middle-aged adults with and without hip deformity, hip pain receives treatment focused primarily related to hip structure. Because this hip pain may be chronic, these patients develop other coexisting, modifiable disorders related to pain that may go undiagnosed in this young and active population, including insomnia and anxiety. OBJECTIVE: The objective of this study was to compare assessments of insomnia and anxiety in young and middle-aged adults presenting with hip pain with no greater than minimal osteoarthritis (OA) compared to asymptomatic healthy controls. Comparisons between types of hip deformity and no hip deformity in hip pain patients were performed to assess whether patients with specific hip deformities were likely to have insomnia or anxiety as a cofounding disorder to their hip pain. DESIGN: Prospective case series with control comparison. SETTING: Two tertiary university physiatry outpatient clinics. PARTICIPANTS: A total of 50 hip pain patients aged 18-40 years and 50 gender- and age-matched healthy controls. METHODS: Patients were enrolled if 2 provocative hip tests were found on physical examination and hip radiographs had no or minimal OA. Radiographic hip deformity measurements were completed by an independent examiner. Comparisons of insomnia and anxiety were completed between 50 hip pain patients and 50 controls and between patients with different types of hip deformity. MAIN OUTCOME MEASURES: Insomnia Severity Index (ISI) and Pain Anxiety Symptoms Scale (PASS). RESULTS: A total of 50 hip pain patients (11 male and 39 female) with mean age of 31.2 ± 8.31 years enrolled. Hip pain patients slept significantly less (P = .001) per night than controls. Patients experienced significantly greater insomnia (P = .0001) and anxiety (P = .0001) compared to controls. No differences were found in insomnia and anxiety scores between hip pain patients with and without hip deformity or between different types of hip deformity. CONCLUSION: Hip pain patients with radiographs demonstrating minimal to no hip arthritis with and without hip deformity experience significant cofounding yet modifiable disorders of sleep and anxiety. If recognized early in presentation, treatment of insomnia and anxiety ultimately will improve outcomes for hip patients treated either conservatively or surgically for their hip disorder. LEVEL OF EVIDENCE: II.

Influence of Menstrual Cycle and Oral Contraceptive Phase on Spinal Excitability.

BACKGROUND: Rates of musculoskeletal injury differ substantially between the genders, with females more likely to experience conditions such as anterior cruciate ligament (ACL) injuries than males in the same sports. Emerging evidence suggests a significant hormonal contribution. Most research has focused solely on how hormonal fluctuations affect connective tissue, but a direct link between hormonal shifts, ligamentous laxity, and ACL injury has not been borne out. There is also evidence to suggest that sex hormones can modulate the central nervous system, but how this affects neuromuscular control is not well understood. OBJECTIVE: To determine whether changes in sex hormone concentrations would alter spinal excitability, measured across the menstrual and oral contraceptive pill cycle. We hypothesized that spinal excitability would fluctuate across the menstrual cycle (with increased excitability during the periovulatory phase due to peak estradiol concentration), but that there would be no fluctuation in oral contraceptive users. DESIGN: This was a prospective cohort study. SETTING: The study took place at a biomechanics laboratory at a rehabilitation hospital. PARTICIPANTS: A total of 30 healthy women aged 18-35 who were similar in age, body composition, and exercise-training status were included. Fifteen of the women were eumenorrheic and nonusers of oral contraceptives (nonusers), and 15 of the women were taking oral contraceptives (users). MAIN OUTCOME MEASURES: H-reflex (Hmax/Mmax ratio), serum estradiol, and progesterone concentrations were measured at 3 time points during the menstrual and contraceptive pill cycle. RESULTS: The H-reflex (Hmax/Mmax ratio) remained stable across the menstrual and contraceptive pill cycle. Spinal excitability was lower in the users compared with the nonusers across all testing sessions, but this was not statistically significant. CONCLUSIONS: Our results suggest that acute fluctuations of endogenous estradiol and progesterone do not modulate spinal excitability. However, long-term exposure to exogenous estrogen and progesterone (oral contraceptives) might have an impact on spinal excitability and neuromuscular control. Further research is necessary to better understand the potential differential effect of endogenous and exogenous sex hormones on spinal excitability.

Transient osteoporosis of pregnancy of the bilateral hips in twin gestation: a case series.

Transient osteoporosis of pregnancy has been described as a rare, self-limiting disease of unclear etiology that presents as severe pain, which typically affects pregnant women in their third trimester. We describe 3 cases of primigravid pregnant women with twin gestation who reported unilateral hip pain and who were diagnosed with transient osteoporosis of pregnancy of the hip by magnetic resonance imaging. These women were advised to undergo limited weight bearing and activity modification to minimize the risk of fracture. Each patient was able to proceed through her pregnancy, delivery, and postpartum course without complication, with symptom resolution, and return to unrestricted activity.