Ankle instability can describe various impairments, including perceived instability (PI), mechanical instability (MI), and recurrent sprains (RSs), alone or combined.
To examine the prevalence of 8 ...ankle impairment subgroups and their effect on neuromuscular performance in prerecruitment combat soldiers.
Cross-sectional study.
Military infantry basic training base.
A total of 364 infantry male combat soldiers entering basic training (aged 18-21 years).
Participants were assessed for PI (via the Cumberland Ankle Instability Tool), MI (using the Anterior Drawer Test and Medial Talar Tilt Test), and RSs (based on history) of their dominant and nondominant legs. Injuries were categorized in 8 subgroups: PI, RSs, PI + RSs, MI, PI + MI, MI + RSs, PI + MI + RSs, and none. Participants were screened for neuromuscular performance (dynamic postural balance, proprioceptive ability, hopping agility, and triceps surae muscle strength) during the first week of military basic training.
For the dominant and nondominant legs, RSs were reported by 18.4% (n = 67) and 20.3% (n = 74) of the participants, respectively; PI was reported by 27.1% (n = 99) and 28.5% (n = 104) of the participants, respectively; and MI was seen in 9.9% (n = 36) and 8.5% (n = 31) of the participants, respectively. A 1-way analysis of variance showed differences in the mean proprioceptive ability scores (assessed using the Active Movement Extent Discrimination Apparatus) of all subgroups with impairments in both the dominant and nondominant legs (F = 6.943, η2 = 0.081, P < .001 and F = 7.871, η2 = 0.091, P < .001, respectively). Finally, differences were found in the mean muscle strength of subgroups with impairment in the nondominant leg (F = 4.884, η2 = 0.056, P = .001).
A high prevalence of ankle impairments was identified among participants who exhibited reduced abilities in most neuromuscular assessments compared with those who did not have impairments. Moreover, participants with 1 impairment (PI, MI, or RSs) exhibited different neuromuscular performance deficits than those with >1 impairment.
Tibial stress fractures in military recruits occur beginning with the fourth week of training. In and ex vivo tibial strain experiments indicate that the repetitive mechanical loading during this ...time may not alone be sufficient to cause stress fracture. This has led to the hypothesis that the development of tibial stress fracture is mediated by the bone remodeling response to high repetitive strains. This study assesses the differences in the strain and angle of the principal strain during military field activities versus common civilian activities.
In vivo strain measurements were made from a rosette strain gauge bonded to the midshaft of the medial tibia. Measurements of principal strains and their angles were made while performing level and inclined walking and running on an asphalt surface, while fast walking up and down stairs, while performing a standing vertical jump and while zig-zag running up and down a 30° inclined dirt hill.
The angle of the principal strain varied little (5.40° to +2.74°) during activities performed on engineered surfaces. During zig-zag running on a dirt hill the strain levels were higher (maximum shear = 4290 με). At the pivot points of zig-zag running the angle of the principal strain varied between −115° to −123° downhill and between −32.8° to −51° uphill.
Activities that mimic those performed by infantry recruits on irregular hilly surfaces result in higher tibial strains and have more variation in principal strain angles than activities of ordinary civilian life performed on engineered surfaces.
•The tibial principal strain angle varied little during activities on engineered surfaces.•The tibial principal strain angle on zig-zag running on a hilly terrain varied greatly.•Tibial shear strains was greater on hilly terrain than on manmade surface activities.•Infantry training may expose tibias to uncommon principal strain angles.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPUK, ZAGLJ, ZRSKP
Purpose of Review
Tendinopathy describes a combination of pain, swelling, and impaired performance of the tendon and around structures. There are various treatment options for tendinopathy with ...unclear efficacy. Dry needling involves inserting needles into the affected tendon, and it is thought to disrupt the chronic degenerative process and encourage localized bleeding and fibroblastic proliferation. The purpose of this review is to review the use of dry needling as a treatment modality for tendinopathy.
Recent Findings
The effectiveness of dry needling for treatment of tendinopathy has been evaluated in 3 systematic reviews, 7 randomized controlled trials, and 6 cohort studies. The following sites were studied: wrist common extensor origin, patellar tendon, rotator cuff, and tendons around the greater trochanter. There is considerable heterogeneity of the needling techniques, and the studies were inconsistent about the therapy used after the procedure. Most systematic reviews and randomized controlled trials support the effectiveness of tendon needling. There was a statistically significant improvement in the patient-reported symptoms in most studies. Some studies reported an objective improvement assessed by ultrasound. Two studies reported complications.
Summary
Current research provides initial support for the efficacy of dry needling for tendinopathy treatment. It seems that tendon needling is minimally invasive, safe, and inexpensive, carries a low risk, and represents a promising area of future research. In further high-quality studies, tendon dry needling should be used as an active intervention and compared with appropriate sham interventions. Studies that compare the different protocols of tendon dry needling are also needed.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Stress fractures can be seen as an undesired byproduct of demanding physical training. The threshold value of stress that places an individual bone at high risk for stress fracture has not been ...identified. In a prospective study of stress fractures in 1983, a 31% incidence was found during demanding Israeli infantry basic training by bone scan criteria. Within a subgroup of these recruits, an elite infantry unit was found to have a 40% incidence. Since then and until 2015, eight additional induction companies of the same elite infantry unit were prospectively monitored for stress fractures during their basic training. In all of the studies, stress fracture surveillance and the examining orthopedist were the same.
A retrospective review of all nine studies and of eight training changes was performed to look for a temporal trend in stress fracture incidence and to see if these might be related to training changes. There was a statistically significant trend for lower radiological proven stress fractures (p=0.0001) and radiological proven stress fractures plus clinical stress fractures (p=0.0013), as well as lower stress fracture severity by radiological criteria (p=0.0001) between 1983 and 2015.
The only training change that was associated, by multivariate logistic regression, with a decreased incidence of stress fracture was restricting training to the authorized training protocol (odds ratio, 3874; 95% CI, 1.526 to 9.931; p=0.004). Increased recruit weight was found by multivariate analysis to be associated with lower stress fracture incidence (odds ratio 1.034; 95% CI, 1.00 to 1.070; p=0.051). Moving the training to a base with flatter terrain and reducing the formal marching distance by 1/3 was associated with a decrease in high grade stress fractures (odds ratio, 10.03; 95% CI, 3.5 to 28.4; p=0.0001). Neither the combined changes of enforcing a seven hour a night sleep regimen, training in more comfortable boots and adding a physical therapist to the unit nor stopping specific running exercises and adding lower body strengthening exercises were associated with a decrease in stress fracture. 67% of recruits who sustained stress fractures and 69% who did not sustain stress fracture finished their military service as combat soldiers in the unit (p=0.87).
There are no magic bullets to prevent stress fractures. Stress cannot be lowered beyond the level which compromises the training goals. It is a problem that can be managed by awareness that identifies and treats stress fractures while they are still in the micro stage and not in the more dangerous macro stage.
•Elite infantry training in a single unit was used as a model to study stress fractures.•In over three decades only a few stress fracture interventions tried were effective.•Stress fracture was reduced by restricting training to the authorized protocol.•But not by 7hour/night sleep, more comfortable boots & a unit physical therapist•Reducing marching by 1/3 & training in flat terrain reduced stress fracture severity.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPUK, ZRSKP
Medial tibial stress fractures occur secondary to failure in shear. It has been proposed that the use of functional foot orthotics (FFOs) may decrease their incidence by positioning the subtalar ...joint in the neutral position at heel strike. The purpose of this study was to evaluate the scientific basis of this concept by in-vivo measurement of tibial principal strain, the principal strain angle and shear strains during treadmill walking from rosette strain gauges bonded to the tibia of a male subject at two sites prone to stress fracture. Recordings were made while wearing Rockport walking shoes without orthotics, with non-posted graphite orthotics, with neutral rearfoot posted polypropylene orthotics, with 4° varus rearfoot posted polypropylene orthotics, and with neutral rearfoot posted kinetic wedge polypropylene orthotics designed to treat hallux limitus. None of the various modifications of FFOs tested in this study had a statistically significant effect on the compression strains during treadmill walking compared to the walking shoe alone, indicating that they were not affective in attenuating the ground reaction force. Their use was associated with a 22-51% increase in principal (p < .001) and a 9-35% increase in tibial shear strains (p = .003). The compression and shear strains and the angle of the principal strains (p < .001) were higher at the distal than at the proximal recording site, (p < .001 for all). The findings do not support the use of FFOs in any of the posting configurations tested as a means for lowering tibial shear strains or the concept of the biomechanical importance of the neutral position of the subtalar joint at heel strike.
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BFBNIB, GIS, IJS, KISLJ, NUK, PNG, UL, UM, UPUK
The "International Hip Outcome Tool 12" (iHOT.sub.12) is a self-administered patient-reported outcome tool for measuring health-related quality of life and physical functioning in young and active ...patients with hip pathology. Since the iHOT.sub.12 has become widely used, we sought to translate and validate it for Hebrew-speaking populations. The aims of this study were: (1) To translate and culturally adapt the iHOT.sub.12 into Hebrew using established guidelines. (2) To test the new Hebrew version for validity, and (3) reliability. The iHOT.sub.12 was translated and culturally adapted from English to Hebrew (iHOT.sub.12-H) according to the COSAMIN guidelines. For validity, the iHOT.sub.12-H and Western Ontario and McMaster universities osteoarthritis index (WOMAC) were completed by 200 patients with hip pathology. Exploratory factor analysis was used to assess structural validity. Subsequently, 51 patients repeated the iHOT.sub.12-H within a 2-week interval. Intraclass Correlation Coefficient (ICC), Cronbach alpha, and Standard Error of Measurement (SEM) were calculated to assess reliability. Construct validity: iHOT.sub.12-H correlated strongly to the WOMAC scores (r = -0.82, P < 0.001, Spearman). Factor analysis revealed a two-factor structure. Cronbach's alpha was 0.953 confirming internal consistency to be highly satisfactory. Test-retest correlation of the iHOT.sub.12-H was excellent with an ICC = 0.956 (95% CI 0.924-0.974). There was no floor or ceiling effect. The iHOT.sub.12 Hebrew version has excellent reliability, good construct validity and can be used as a measurement tool for physical functioning and quality of life in young, physically active patients with hip pathology. This study will serve Israeli researchers in evaluating treatment effectiveness for these patients. Moreover, it will also enable multinational cooperation in the study of hip pathology.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
To assess the status at 13 to 17 years follow-up of a cohort of young male traumatic shoulder dislocators.
Prospective cohort study.
A prospective study of first-time young male traumatic shoulder ...dislocators, began in 2004. Subjects were evaluated by the apprehension test after completing rehabilitation 6 to 9 weeks post dislocation. Between March 2021 and July 2022, a telephone questionnaire was administered to ascertain their current shoulder status. Subjects were questioned about avoidance of activities of daily living and sport, participation in sports, current instability, and self-assessed shoulder function by the SANE score.
50/53 (94.3%) of the study subjects, mean age 20.4 years, completed a mean follow-up of 181.8 ± 12 months. The non-redislocation survival was 13% for those with a positive apprehension test and 49% for those with a negative test (p = 0.007). SANE scores were 64.3 ± 23.7 for those with a positive apprehension test and 83.7 ± 19.7 for those with a negative test (p = 0.001). In the year before the follow-up, 33.3% of those treated conservatively and 42.9% treated surgically experienced subluxation (p = 0.5). Fifty-seven percent of those who were treated conservatively and 56% of those who underwent surgery avoided some ADL or sports because of their shoulder.
For young male first time traumatic shoulder dislocators a positive apprehension test after rehabilitation is associated with a high risk for reoccurrence and poorer long-term results. Most subjects were still dealing with shoulder symptoms at long-term follow-up.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPUK, ZAGLJ, ZRSKP
Background:
Distal metatarsal osteotomy has been used to alleviate plantar pressure caused by anatomic deformities. This study’s purpose was to examine the effect of minimally invasive floating ...metatarsal osteotomy on plantar pressure in patients with diabetic metatarsal head ulcers.
Methods:
We performed a retrospective case series of prospectively collected data on 32 patients with diabetes complicated by plantar metatarsal head ulcers without ischemia. Peak plantar pressure and pressure time integrals were examined using the Tekscan MatScan prior to surgery and 6 months following minimally invasive floating metatarsal osteotomy. Patients were followed for complications for at least 1 year.
Results:
Peak plantar pressure at the level of the osteotomized metatarsal head decreased from 338.1 to 225.4 kPa (P < .0001). The pressure time integral decreased from 82.4 to 65.0 kPa·s (P < .0001). All ulcers healed within a mean of 3.7 ± 4.2 weeks. There was 1 recurrence (under a hypertrophic callus of the osteotomy) during a median follow-up of 18.3 months (range, 12.2-27). Following surgery, adjacent sites showed increased plantar pressure and 4 patients developed transfer lesions (under an adjacent metatarsal head); all were managed successfully. There was 1 serious adverse event related to surgery (operative site infection) that resolved with antibiotics.
Conclusion:
This study showed that the minimally invasive floating metatarsal osteotomy successfully reduced local plantar pressure and that the method was safe and effective, both in treatment and prevention of recurrence.
Level of Evidence:
Level III, retrospective case series of prospectively collected data.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
PURPOSETo evaluate the intra/inter observer and diagnostic reliability of 3-dimensional (3D) model reconstruction computed tomography (CT) compared to the traditional two-dimensional (2D) CT when ...evaluating Lisfranc (LF) injuries. METHODSA retrospective study was performed on CT studies of patients with clinically suspected LF injuries examined in the emergency department at medium size medical center. Each CT study was evaluated for metatarsal fractures and subluxations employing both standard 2D and 3D CT model reconstruction. Four orthopaedists, 2 senior and 2 residents, were assigned to review and evaluate each CT. Each CT study was reviewed twice by each reader in a randomized order. Descriptive statistics were calculated for all measured variables. The intra-observer and inter-observer agreement Kappa coefficients were calculated to evaluate reliability and reproducibility between and within readers for each modality. RESULTSThe study included 44 patients. Median age was 41.4 years (interquartile range, 23-58). The intra-observer and inter-observer reliability was good (intra-observer; 3D Kappa; 0.76 and 2D Kappa 0.73 p<0.001, inter-observer; 3D Kappa 0.68, 2D Kappa 0.63 and combined 2D and 3D kappa 0.68, p<0.001). Three dimensional CT was found to be more sensitive than 2D CT, specifically when evaluating for second metatarsal dislocation (sensitivity: 70% vs 47%). Combined evaluation of 2D and 3D CT, greatly improved sensitivity rate to 85.7%. In terms of fracture diagnosis, combined evaluation of 2D and 3D CT showed higher sensitivity and specificity rates as compared to 2D or 3D alone. CONCLUSIONThe employment of 3D CT in LF injury diagnosis, in isolation and in combination with 2D CT, seems to improve the diagnostic accuracy and reliability between and within observers compared to 2D CT alone.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPUK, ZAGLJ, ZRSKP
The Hadassah Medical Organization operates two hospitals in Jerusalem. During the COVID-19 pandemic it made an administrative decision to operate one hospital as a COVID-19 treatment hospital (CTH) ...and to have the second function as a non-COVID-19 treating hospital (NCTH) offering general medical services. The purpose of this study was to assess how this decision affected hospital worker anxiety.
From April 27 to May 1, during the COVID-19 pandemic in Israel, while the country was under lock-down, an electronic questionnaire survey was carried out among hospital workers of the CTH and NCTH. The questionnaire includes personal demographics and attitudes about COVID-19 and assesses present anxiety state using the State-Trait Anxiety Inventory for Adults (STAI-S) validated questionnaire. A STAI-S score of ≥45 was considered to represent clinical anxiety.
Completed questionnaires were received from 1570 hospital employees (24%). 33.5% of responders had STAI-S scores ≥45. Multivariable regression analysis showed that being a resident doctor (odds ration OR 2.13; 95% CL, 1.41-3.23; P = 0.0003), age ≤ 50 (OR, 2.08; 95% Cl, 1.62-2.67; P < .0001), being a nurse (OR, 1.29; 95% CL, 1.01-1.64; P = 0.039), female gender (OR, 1.63; 95% CL, 1.25-2.13; P = 0.0003) and having risk factors for COVID-19 (OR, 1.51; 95% CL, 1.19-1.91; P = 0.0007), but not hospital workplace (p = 0.08), were associated with the presence of clinical anxiety. 69% of the responders had been tested for COVID-19, but only nine were positive. CTH workers estimated that the likelihood of their already being infected with COVID-19 to be 21.5 ± 24.7% as compared to the 15.3 ± 19.5% estimate of NCTH workers (p = 0.0001). 50% (545/1099) of the CTH workers and 51% (168/330) of the NCTH workers responded that the most important cause of their stress was a fear of infecting their families (p = 0.7).
By multivariable analysis the creation of a NCTH during the COVID-19 pandemic was not found to be associated with a decrease in the number of hospital workers with clinical anxiety. Hospital worker support resources can be focused on the at-risk groups identified in this study.
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