RESUMO
BACKGROUND: Musculoskeletal injuries are recognized as the leading health problem and primary source of injury, disability, and financial burden across the military.1-5 Special Operations Forces are at an increased risk of musculoskeletal injury due to increased physical demands, precipitous deployments, and continual training and deployment cycles.6,4 Multiple injury screening tools exist, yet decisions to return to duty are frequently deferred to individual institutional protocol or provider clinical decision making, with no accepted gold standard.2,3,4,5. PURPOSE: The purpose of this case report is to describe the application of a system to return a Special Operations Forces candidate to duty following an ankle injury sustained during a military static line airborne operation while in the Special Forces Qualification Course. CASE DESCRIPTION: The subject was a 34-year-old male with surgical fixation of a left distal fibular fracture with syndesmotic tear after landing from a static line airborne jump during the Special Forces Qualification Course. This case report provides a system to determine return to duty following an ankle fracture and provides a guide to returning a subject to participation, duty, and tactical performance training. OUTCOMES: Outcome measures recorded were vast, as the use of multiple measures are more indicative of overall function than any single measure. Impairment based measures included Global Rating of Change Scale (GROC), Numeric Pain Rating Scale (NPRS), lateral step down and Closed Chain Dorsiflexion (CCDF). Functional outcome measures included: the Functional Movement Screen™ (FMS™), Lower Quarter Y-Balance (LQYB), three hop tests for distance, and physical performance metrics. DISCUSSION: The most substantial challenge to this process was the lack of standardized and validated military return to duty testing and guidelines in the literature. Ideally, pre-injury assessment would provide a baseline; however, compared to peers, the subject was well within acceptable ranges for all physical performance metrics at final Return to Duty testing. The subject was returned to duty 10 months after initial injury being physically comparable to his cohorts and being able to complete all military requirements. LEVELS OF EVIDENCE: 5.
RESUMO
UNLABELLED: PURPOSEBACKGROUND: Quadriceps function is an important outcome following lower extremity injury and surgery. Measurements of quadriceps function are particularly helpful initially post surgery, however traditional quadriceps strength measures like isokinetic testing are contraindicated during this time period. Inclusion of dynamic musculoskeletal ultrasound imaging in the clinical setting has been beneficial in understanding quadriceps activation specifically rectus femoris (RF) contraction; however, there is a paucity of literature in this area. The purpose of the current study was to describe the cross-sectional area (CSA) of the RF across varying knee flexion angles. METHODS: Forty-five adult recreational athletes were recruited for the study (21 males, 24 females). All subjects underwent tests of maximal volitional isometric contractions of the knee extensors at 0, 30, 60 and 90 degrees of knee flexion. During the trials, musculoskeletal ultrasound images of the RF at 15 cm from the superior pole of the patella were taken at rest and during contraction for each of the angular positions. Mixed model ANOVAs (angle x sex) were utilized to examine the differences between males and females for different angular positions. These analyses were conducted for the resting CSA, active CSA, and the contractile index (resting - active). RESULTS: RF cross-sectional area increased with increasing angles of knee flexion for both the resting and active conditions. The contractile index consistently decreased as knee flexion angle increased. No statistically significant interactions or main effects for sex were observed, although differences were observed in the trajectories of the data sets for males and females. CONCLUSIONS: RF CSA is dependent on knee flexion angle in both males and females. As a result, the assessment of RF CSA should be conducted in a standardized position if this variable is to be utilized as a meaningful measure of muscle size during rehabilitation. Additional research should seek out which factors are associated with clinically relevant factors that effect RF CSA across the range of knee flexion. LEVEL OF EVIDENCE: 3b.
