Magnetic resonance imaging findings in anterolateral impingement of the ankle

International Nuclear Information System (INIS)

Jordan, L.K. III.; Cooperman, A.E.; Helms, C.A.; Speer, K.P.

2000-01-01

Objective. To demonstrate the MR imaging findings of anterolateral impingement (ALI) of the ankle.Design and patients. Nine patients with a history of ankle inversion injury and chronic lateral ankle pain were imaged with MR imaging, and the findings correlated with the results of arthroscopy. Three additional patients with clinically suspected ALI of the ankle were also included. Ankle MR imaging studies from 20 control patients in whom ALI was not suspected clinically were examined for similar findings to the patient group.Results. MR imaging findings in the patients with ALI included a soft tissue signal mass in the anterolateral gutter of the ankle in 12 of 12 (100%) cases, corresponding to the synovial hypertrophy and soft tissue mass found at arthroscopy in the nine patients who underwent arthroscopy. Disruption, attenuation, or marked thickening of the anterior talofibular ligament was seen in all cases. Additional findings included signs of synovial hypertrophy elsewhere in the tibiotalar joint in seven of 12 patients (58%) and bony and cartilaginous injuries to the tibiotalar joint in five of 12 (42%). None of the control patients demonstrated MR imaging evidence of a soft tissue mass in the anterolateral gutter.Conclusions. ALI of the ankle is a common cause for chronic lateral ankle pain. It has been well described in the orthopedic literature but its imaging findings have not been clearly elucidated. The MR imaging findings, along with the appropriate clinical history, can be used to direct arthroscopic examination and subsequent debridement. (orig.)

Impingement syndrome of the shoulder

International Nuclear Information System (INIS)

Mayerhoefer, M.E.; Breitenseher, M.J.

2004-01-01

The impingement syndrome is a clinical entity characterized by shoulder pain due to primary or secondary mechanical irritation of the rotator cuff. The primary factors for the development of impingement are a curved or hook-shaped anterior acromion as well as subacromial osteophytes, which may lead to tearing of the supraspinatus tendon. Secondary impingement is mainly caused by calcific tendinopathy, glenohumeral instability, os acromiale and degenerative changes of the acromioclavicular joint. Conventional radiographs are initially obtained, mainly for evaluation of the bony structures of the shoulder. If available, sonography can be used for detection of lesions and tears of the rotator cuff. Finally, MR-imaging provides detailed information about the relationship of the acromion and the acromioclavicular joint to the rotator cuff itself. In many cases however, no morphologic cause for impingement syndrome can be found. While patients are initially treated conservatively, chronic disease usually requires surgical intervention. (orig.) [de

Is there any value to arthroscopic debridement of ankle osteoarthritis and impingement?

Science.gov (United States)

Phisitkul, Phinit; Tennant, Joshua N; Amendola, Annunziato

2013-09-01

This article summarizes the current literature regarding the use of arthroscopy for the various types of ankle osteoarthritis with impingement symptoms. Discussion includes the role of diagnostic arthroscopy and adjunctive use of arthroscopy with other modalities. The section on the authors' preferred technique describes our current operative and perioperative strategies in detail. Published by Elsevier Inc.

IMPINGEMENT-SYNDROME OF PERONEUS BREVIS TENDON AFTER CALCANEAL FRACTURES (MORPHOLOGICAL ASPECTS

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N. S. Konovalchuk

2017-01-01

Full Text Available Background. One of the main causes of pain in patients with consequences of calcaneal fractures is the lateral impingement syndrome. This term means lateral displacement of outer calcaneal wall at the moment of fracture, narrowing of anatomical space under the lateral malleolus and compression of soft tissues in this region, including tendons of short and long peroneal muscles. This leads to chronic traumatization of tendons, alteration of their normal tracking and development of tendinitis and tenosynovitis. At this moment there are no articles in foreign or Russian literature describing how prolonged traumatization influences the internal structure of the tendons. The purpose of this study was to evaluate the morphological changes in structure of peroneus brevis tendon after different duration of compression between outer wall of calcaneus and the tip of the lateral malleolus in patients with calcaneal malunion.Materials and methods. Fifteen patients with calcaneal malunion and lateral impingement syndrome were treated operatively between 2016 and 2017. To confirm the lateral impingement syndrome, the authors performed clinical examination and AP x-rays of ankle joint. Two peroneus brevis tendon specimens were obtained intraoperatively in each of 15 patients: one specimen from compressed and one from non-compressed area. Obtained specimens were histologically examined according to standard protocol.Results. Microscopically all specimens showed separation of collagen bundles with loose connective tissue degeneration, increase of vascularization and inflammation. The degree of these changes differed according to the compression duration. This allowed us to analyze the dynamics of these changes.Conclusion. The morphological changes in structure of peroneus brevis tendon during the compression between outer wall of calcaneus and the tip of the lateral malleolus correspond with dynamics of common pathologic reactions. Early stages showed signs of

Subacromial impingement syndrome

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Masood Umer

2012-05-01

Full Text Available Subacromial impingement syndrome (SAIS represents a spectrum of pathology ranging from subacromial bursitis to rotator cuff tendinopathy and full-thickness rotator cuff tears. The relationship between subacromial impingement and rotator cuff disease in the etiology of rotator cuff injury is a matter of debate. However the etiology is multi-factorial, and has been attributed to both extrinsic and intrinsic mechanisms. Management includes physical therapy, injections, and, for some patients, surgery. No high-quality RCTs are available so far to provide possible evidence for differences in outcome of different treatment strategies. There remains a need for high-quality clinical research on the diagnosis and treatment of SAIS.

Subacute posteromedial impingement of the ankle in athletes: MR imaging evaluation and ultrasound guided therapy

International Nuclear Information System (INIS)

Messiou, Christina; Robinson, Philip; O'Connor, Philip J.; Grainger, Andrew

2006-01-01

To describe the use of MR imaging and efficacy of ultrasound-guided steroid injection in the diagnosis and management of athletes with clinical posteromedial impingement of the ankle. A retrospective analysis of imaging findings on MR was undertaken in nine elite athletes with clinical posteromedial ankle impingement. MR studies from six professional athletes with posterolateral pain were also reviewed as an imaging control group. The two reviewing radiologists were blinded to the clinical details and the proportion of control and study subjects. The nine study athletes also underwent diagnostic ultrasound and ultrasound-guided injection of steroid and anaesthetic into the posteromedial capsular abnormality. Follow-up was by telephone interview. Posteromedial capsular thickening was seen only in athletes with posteromedial impingement (7/9). Posteromedial synovitis was present in all athletes with posteromedial impingement; however, posterior and posterolateral synovitis was also seen in these athletes. Mild posteromedial synovitis was present in two control athletes. Ultrasound identified abnormal posteromedial soft tissue thickening deep to tibialis posterior between the medial malleolus and talus in all nine athletes. After injection all athletes returned to their previous level of sport, with eight of the nine not experiencing any residual or recurrent symptoms. If MR imaging excludes significant coexistent abnormality, ultrasound can localise posteromedial soft tissue abnormality and guide injection therapy, allowing return to athletic activity without surgical intervention. (orig.)

Shoulder Girdle Muscles Endurance in Subjects with and without Impingement Syndrome

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Afsoun Nodehi-Moghadam

2011-07-01

Full Text Available Objective: Any minimal alteration in performance and coordination of scapular and glenohumeral muscles has the potential to lead to shoulder joint dysfunction. The impingement syndrome has been reported as is the most common diagnosis of shoulder pain. The purpose of this study was to determine whether endurance deficits could be detected in patients with shoulder impingement. Materials & Methods: By convenient sampling 15 patients with impingement syndrome at average of 45.3 years of age and 15 healthy persons (age 45.8 years through a case–control design participated in the study. Endurance of glenohumeral and scapulothoracic muscles were tested with a hand held dynamometer. Independent t–test was used to statistically analyze different groups. Results: Compared to non–impaired subjects, those with impingement syndrome demonstrated a significantly lower endurance of external rotation, scaption and scapular abduction and upward rotation movements (P<0.05. In impingement syndrome patients, the external–to–internal rotator muscles endurance ratio was significantly lower than the control group (P<0.05. Conclusion: The result of the study suggests that endurance deficit of rotator cuff and scapular upward rotator muscles may be an important aspect of the impingement syndrome. Shoulder girdle muscles endurance should be considered in evaluation and physical therapy of impingement syndrome patients.

Results of Treatment of Posterior Ankle Impingement Syndrome and Flexor Hallucis Longus Tendinopathy in Dancers: A Systematic Review.

Science.gov (United States)

Rietveld, A B M Boni; Hagemans, F M T; Haitjema, S; Vissers, T; Nelissen, R G H H

2018-03-15

Dancing on pointe and relevé requires extreme plantar flexion of the talo-crural joint. Hence, these positions may lead to posterior ankle impingement syndrome (PAIS). PAIS often coincides with flexor hallucis longus tendinopathy (FHL tendinopathy, or "dancers' tendinitis"). Both injuries can appear in isolation as well. The goal of this review is to evaluate the results and the available levels of evidence of conservative and operative treatment (both open and endoscopic) of PAIS and FHL tendinopathy in dancers. It also offers an insight into the history of dance medical publications on this subject. In October 2016, a systematic search of PubMed, Embase, Cochrane, CINAHL, Web of Science, and (in French) ScienceDirect databases was undertaken. Five hundred and seventy-six publications were found, of which a total of 27 reported the results of operative treatment in 376 ankles (344 open, 32 endoscopic) in 324 dancers. The outcome was good to excellent in most cases (89%). The mean period of return to dance for all surgeries combined (PAIS and FHL tendinopathy, open and endo) was 11 weeks (range: 4 to 36 weeks), and for isolated FHL tendinopathy 16 weeks (range: 8 to 36 weeks). Only six publications reported the results of conservative treatment in 33 ankles (13 PAIS, 20 FHL tendinopathy) of 28 dancers, which does not allow for any evidence-based recommendations. Most studies failed to include dance-specific baseline characteristics, like dance style and level of participation. We concluded that only retrospective studies with levels of evidence four and five show that operative treatment for PAIS and FHL tendinopathy is successful with few complications. Since isolated PAIS, PAIS combined with FHL tendinopathy, and isolated FHL injuries appear to be different pathological entities, more research taking into account demography, dance type, and level of participation is needed to find out in which cases early operative management should be considered or avoided. The

Clinical radiation diagnostics of shoulder joint impingement syndrome

International Nuclear Information System (INIS)

Litvin, Yu.P.; Logvinenko, V.V.

2014-01-01

46 patients about an impingement are investigated by a syndrome of a humeral joint. Among them men was 28 (60,9 %) the person, women 18 (39,1 %). Middle age of the surveyed has made 52,6 ± 2,0 year. The traditional roentgenography is executed to all patients, a spiral computer tomography - 5 (10,9 %), an ultrasonography - 44 (95,7 %), a magnetic resonance imaging - 11 (23,9 %). Operative treatment is spent 16 (34,8 %) by the patient. Direct radial symptoms are what specify an impingement of a syndrome of a humeral joint in the reasons, indirect - symptoms of an inflammation both degenerate and dystrophic changes of structures of area of a humeral joint which are involved in pathological process. The best results are given by complex radial research at which it is possible to find out direct and indirect symptoms a syndrome impingement

The clinical and radiological importance of extraarticular contrast material leakage into adjacent synovial compartments on ankle MR arthrography in patients with OCD and anterolateral impingement

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Ogul, Hayri, E-mail: drhogul@gmail.com [Department of Radiology, Medical Faculty, Ataturk University, Erzurum (Turkey); Guzel, Yunus [Department of Orthopaedics and Traumatology, Medical Faculty, Ordu University, Ordu (Turkey); Pirimoglu, Berhan [Department of Radiology, Medical Faculty, Ataturk University, Erzurum (Turkey); Tuncer, Kutsi [Department of Orthopedic, Medical Faculty, Ataturk University, Erzurum (Turkey); Polat, Gokhan; Ergun, Fatih; Sade, Recep; Bayraktutan, Ummugulsum; Yuce, Ihsan; Kantarci, Mecit [Department of Radiology, Medical Faculty, Ataturk University, Erzurum (Turkey)

2016-10-15

Purpose: To evaluate the tibiotalar joint capacity and the localisation, frequency and amount of extravasation in patients with extraarticular contrast material leakage into adjacent synovial compartments on ankle magnetic resonance (MR) arthrography. Materials and methods: Sites of extravasation were determined in the ankle MR arthrograms of 69 patients. Thirty-four patients without extraarticular contrast material leakage into locations unrelated to the injection path were included as a control group. Volumetric measurements of extraarticular contrast material leakage and the tibiotalar joint capacity were performed on a three dimensional (3D) volume measurement workstation. Results: Extravasation of contrast material occurred through the anterior, posterior, and anterolateral recesses of the tibiotalar joint. The most common site of extravasation was along the flexor hallucis longus tendon synovium (24.6%). The amount of extravasation was significantly higher in patients with ankle osteochondritis dissecans (OCD) than in patients with a different diagnosis (p = 0.039). Loose bodies were detected in all OCD’s patients with insufficient tibiotalar joint distention. Conclusions: Connections between the ankle joint and neighboring synovial compartments can decrease the diagnostic value of ankle MR arthrography examinations due to inadequate joint distention. Large injection volumes should be used for ankle MR arthrography of patients with OCD (especially OCD’s patients with loose body) and impingement syndrome.

The clinical and radiological importance of extraarticular contrast material leakage into adjacent synovial compartments on ankle MR arthrography in patients with OCD and anterolateral impingement

International Nuclear Information System (INIS)

Ogul, Hayri; Guzel, Yunus; Pirimoglu, Berhan; Tuncer, Kutsi; Polat, Gokhan; Ergun, Fatih; Sade, Recep; Bayraktutan, Ummugulsum; Yuce, Ihsan; Kantarci, Mecit

2016-01-01

Purpose: To evaluate the tibiotalar joint capacity and the localisation, frequency and amount of extravasation in patients with extraarticular contrast material leakage into adjacent synovial compartments on ankle magnetic resonance (MR) arthrography. Materials and methods: Sites of extravasation were determined in the ankle MR arthrograms of 69 patients. Thirty-four patients without extraarticular contrast material leakage into locations unrelated to the injection path were included as a control group. Volumetric measurements of extraarticular contrast material leakage and the tibiotalar joint capacity were performed on a three dimensional (3D) volume measurement workstation. Results: Extravasation of contrast material occurred through the anterior, posterior, and anterolateral recesses of the tibiotalar joint. The most common site of extravasation was along the flexor hallucis longus tendon synovium (24.6%). The amount of extravasation was significantly higher in patients with ankle osteochondritis dissecans (OCD) than in patients with a different diagnosis (p = 0.039). Loose bodies were detected in all OCD’s patients with insufficient tibiotalar joint distention. Conclusions: Connections between the ankle joint and neighboring synovial compartments can decrease the diagnostic value of ankle MR arthrography examinations due to inadequate joint distention. Large injection volumes should be used for ankle MR arthrography of patients with OCD (especially OCD’s patients with loose body) and impingement syndrome.

Imaging findings of femoroacetabular impingement syndrome

International Nuclear Information System (INIS)

Beall, Douglas P.; Sweet, Clifford F.; Martin, Hal D.; Lastine, Craig L.; Grayson, David E.; Ly, Justin Q.; Fish, Jon R.

2005-01-01

Femoroacetabular impingement syndrome (FAI) is a pathologic entity which can lead to chronic symptoms of pain, reduced range of motion in flexion and internal rotation, and has been shown to correlate with degenerative arthritis of the hip. History, physical examination, and supportive radiographic findings such as evidence of articular cartilage damage, acetabular labral tearing, and early-onset degenerative changes can help physicians diagnose this entity. Several pathologic changes of the femur and acetabulum are known to predispose patients to develop FAI and recognition of these findings can ultimately lead to therapeutic interventions. The two basic mechanisms of impingement - cam impingement and pincer impingement - are based on the type of anatomic anomaly contributing to the impingement process. These changes can be found on conventional radiography, MR imaging, and CT examinations. However, the radiographic findings of this entity are not widely discussed and recognized by physicians. In this paper, we will introduce these risk factors, the proposed supportive imaging criteria, and the ultimate interventions that can help alleviate patients' symptoms. (orig.)

Imaging findings of femoroacetabular impingement syndrome

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Beall, Douglas P.; Sweet, Clifford F.; Martin, Hal D.; Lastine, Craig L.; Grayson, David E.; Ly, Justin Q.; Fish, Jon R. [University of Oklahoma Health Sciences Center, Department of Radiologal Sciences, Oklahoma City (United States)

2005-11-01

Femoroacetabular impingement syndrome (FAI) is a pathologic entity which can lead to chronic symptoms of pain, reduced range of motion in flexion and internal rotation, and has been shown to correlate with degenerative arthritis of the hip. History, physical examination, and supportive radiographic findings such as evidence of articular cartilage damage, acetabular labral tearing, and early-onset degenerative changes can help physicians diagnose this entity. Several pathologic changes of the femur and acetabulum are known to predispose patients to develop FAI and recognition of these findings can ultimately lead to therapeutic interventions. The two basic mechanisms of impingement - cam impingement and pincer impingement - are based on the type of anatomic anomaly contributing to the impingement process. These changes can be found on conventional radiography, MR imaging, and CT examinations. However, the radiographic findings of this entity are not widely discussed and recognized by physicians. In this paper, we will introduce these risk factors, the proposed supportive imaging criteria, and the ultimate interventions that can help alleviate patients' symptoms. (orig.)

Síndrome do impacto posterior do tornozelo: um diagnóstico que deve ser lembrado pelo reumatologista. Relato de dois casos Posterior ankle impingement syndrome: a diagnosis rheumatologists should not forget. Two case reports

Directory of Open Access Journals (Sweden)

Adriano Chiereghin

2011-06-01

Full Text Available O tornozelo é sítio frequente de sintomas dolorosos em atletas e não atletas. A dor localizada na região posterior pode ser o resultado final de diversas patologias, sendo um desafio diagnóstico para o reumatologista. A síndrome do impacto (pinçamento posterior do tornozelo, também denominada síndrome os trigonum e síndrome compressiva tibiotalar posterior, é um distúrbio clínico caracterizado por dor aguda ou crônica na região posterior do tornozelo, desencadeada pela flexão plantar forçada, que promove microtrauma crônico repetitivo. A patologia do processo os trigonum-talar é a causa mais comum dessa síndrome, mas existem outras causas, como tenossinovite do flexor longo do hálux, osteocondrite de tornozelo, doença da articulação subtalar e fratura. O diagnóstico baseia-se na história clínica e exame físico, e complementado por achados na radiografia simples (RX, ultrassom (US, cintilografia, tomografia computadorizada (TC e ressonância magnética (RM. Destacamos o RX por seu baixo custo e boa sensibilidade, o US pela possibilidade de guiar infiltrações terapêuticas e a RM pela possibilidade de avaliar partes moles adjacentes.The ankle is a common site of painful symptoms in athletes and nonathletes. Posterior ankle pain can be the end result of several pathologies, and a diagnostic challenge for rheumatologists. The posterior ankle impingement syndrome, also known as os trigonum syndrome and posterior tibiotalar compression syndrome, is a clinical disorder characterized by acute or chronic posterior ankle pain triggered by forced plantar flexion, which causes chronic repetitive microtrauma. Pathology of the os trigonum-talar process is the most common cause of this syndrome, but there are other causes, such as tenosynovitis of the flexor hallucis longus, ankle osteochondritis, subtalar joint disease, and fracture. Diagnosis is based on clinical history and physical examination, and complemented by findings on

Shoulder impingement syndrome: diagnostic accuracy of magnetic resonance imaging and radiographic signs

International Nuclear Information System (INIS)

Williamson, M.P.; Chandnani, V.P.; Baird, D.E.; Deberardino, T.M.; Swenson, G.W.; Hansen, M.F.

1994-01-01

Shoulder impingement syndrome is commonly encountered in orthopaedics. In a blinded retrospective study, magnetic resonance imaging and roentgenographic signs in 41 patients with clinical signs of impingement syndrome were compared with 40 control patients. Statistically significant differences between the groups included the absence of subacromial fat, as well as the presence of a supraspinatus tear, subacromial osteophytes, and a decreased coracohumeral distance. Other signs reported to occur in patients with impingement syndrome did not vary significantly in the population studied. 20 refs., 12 figs

Comparison of Plain MRI and MR Arthrography in the Evaluation of Lateral Ligamentous Injury of the Ankle Joint

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Mei-Chun Chou

2006-01-01

Conclusion: For evaluating ankle disability, using plain MRI alone is not adequate for correctly detecting lateral collateral ligamentous injury of the ankle joint. MR arthrography improves the sensitivity and the accuracy for ATaF and CF ligament injuries. It also helps in assessing coexisting pathologic lesions of ankle joints, especially impingement syndromes and osteochondral lesions, and provides more information for therapeutic decision making.

Impingement syndrome of the shoulder; Schulterimpingement

Energy Technology Data Exchange (ETDEWEB)

Mayerhoefer, M.E. [Klinische Abteilung fuer Osteologie, Klinik fuer Radiodiagnostik der Universitaet Wien (Austria); Klinische Abteilung Radiodiagnostik fuer chirurgische Faecher, Klinik fuer Radiodiagnostik der Universitaet Wien (Austria); Klinische Abteilung fuer Osteologie, Klinik fuer Radiodiagnostik der Universitaet, Waehringer Guertel 18-20, 1090, Wien (Austria); Breitenseher, M.J. [Klinische Abteilung fuer Osteologie, Klinik fuer Radiodiagnostik der Universitaet Wien (Austria); Waldviertelklinikum Horn (Austria)

2004-06-01

The impingement syndrome is a clinical entity characterized by shoulder pain due to primary or secondary mechanical irritation of the rotator cuff. The primary factors for the development of impingement are a curved or hook-shaped anterior acromion as well as subacromial osteophytes, which may lead to tearing of the supraspinatus tendon. Secondary impingement is mainly caused by calcific tendinopathy, glenohumeral instability, os acromiale and degenerative changes of the acromioclavicular joint. Conventional radiographs are initially obtained, mainly for evaluation of the bony structures of the shoulder. If available, sonography can be used for detection of lesions and tears of the rotator cuff. Finally, MR-imaging provides detailed information about the relationship of the acromion and the acromioclavicular joint to the rotator cuff itself. In many cases however, no morphologic cause for impingement syndrome can be found. While patients are initially treated conservatively, chronic disease usually requires surgical intervention. (orig.) [German] Das Impingementsyndrom ist ein klinisches Krankheitsbild multifaktorieller Genese, bei dem es primaer oder sekundaer zu einer schmerzhaften mechanischen Beeintraechtigung der Rotatorenmanschette kommt. Als primaere Faktoren gelten ein gebogener oder hakenfoermiger Vorderrand des Akromions oder von diesem entspringende Osteophyten, was zu Laesionen der Supraspinatussehne fuehren kann. Zu den sekundaeren Faktoren zaehlt man v. a. eine Tendinitis calcarea, eine glenohumerale Instabilitaet, ein Os acromiale sowie degenerative Veraenderungen im Bereich des Akromioklavikulargelenks. Bildgebend steht an erster Stelle ein Nativroentgen, mit dem sich die knoechernen Strukturen gut darstellen lassen. Falls vorhanden, kann in weiterer Folge die Sonographie Auskunft ueber den Zustand der Rotatorenmanschette geben. Mit der MRT schliesslich laesst sich die Beziehung von Akromion und gelenkassoziierten Strukturen zur Rotatorenmanschette

Surgical criteria for femoroacetabular impingement syndrome

DEFF Research Database (Denmark)

Peters, Scott; Laing, Alisha; Emerson, Courtney

2017-01-01

BACKGROUND: The purpose of this review was to analyse and report criteria used for open and arthroscopic surgical treatment of femoroacetabular impingement syndrome (FAIS). METHODS: A librarian-assisted computer search of Medline, CINAHL and Embase for studies related to criterion for FAIS surgery...

Radiological aspects of sprained ankle syndrome

NARCIS (Netherlands)

Sijbrandij, E.S.

2001-01-01

This thesis addresses several problems related to sprained ankle syndrome. The purpose of this thesis is to evaluate the imaging features of sprained ankles, found on new radiological modalities, and to assess the additional diagnostic understanding and treatment planning of helical CT as well as

Imaging in the assessment and management of overuse injuries in the foot and ankle.

Science.gov (United States)

Teh, James; Suppiah, Ravi; Sharp, Robert; Newton, Julia

2011-02-01

Overuse injuries of the ankle and foot are common in the general and athletic populations. The wide spectrum of overuse injuries includes ligamentous injuries, soft tissue and osseous impingement, osteochondral lesions, tendon injuries, and stress fractures. Some conditions such as impingement syndromes and stress fractures may be missed on initial physical examination, and patients with such injuries often present to a sports or orthopedic clinic with persistent symptoms. With the increasing participation in sports, health-care professionals involved in the care of athletes at all levels must have a thorough understanding of overuse conditions of the foot and ankle, and the use of imaging in the management of these conditions. This article covers the clinical presentation, pertinent anatomy, imaging features, and management of overuse injuries of the foot and ankle. © Thieme Medical Publishers.

Subacromial Impingement Syndrome Caused by a Voluminous Subdeltoid Lipoma

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Jean-Christophe Murray

2014-01-01

Full Text Available Subacromial impingement syndrome is a clinical diagnosis encompassing a spectrum of possible etiologies, including subacromial bursitis, rotator cuff tendinopathy, and partial- to full-thickness rotator cuff tears. This report presents an unusual case of subdeltoid lipoma causing extrinsic compression and subacromial impingement syndrome. The patient, a 60-year-old man, presented to our institution with a few years' history of nontraumatic, posteriorly localized throbbing pain in his right shoulder. Despite a well-followed 6-months physiotherapy program, the patient was still suffering from his right shoulder. The MRI scan revealed a well-circumscribed 6 cm × 2 cm × 5 cm homogenous lesion compatible with a subdeltoid intermuscular lipoma. The mass was excised en bloc, and subsequent histopathologic examination confirmed a benign lipoma. At 6-months follow-up, the patient was asymptomatic with a complete return to his activities. Based on this case and a review of the literature, a subacromial lipoma has to be included in the differential diagnosis of a subacromial impingement syndrome refractory to nonoperative treatment. Complementary imaging modalities are required only after a failed conservative management to assess the exact etiology and successfully direct the surgical treatment.

Anterolateral ankle impingement: findings and diagnostic accuracy with ultrasound imaging

International Nuclear Information System (INIS)

McCarthy, C.L.; Wilson, D.J.; Coltman, T.P.

2008-01-01

The objective was to evaluate the findings and diagnostic accuracy of ultrasound in antero-lateral ankle impingement (ALI) with clinical and arthroscopic correlation. Seventeen elite footballers with chronic ankle pain were referred for ultrasound with a clinical diagnosis of ALI (n = 8) or a control condition (n = 9; lateral mechanical instability, osteochondral defect, intra-articular bodies and osteoarthritis). Ultrasound examination included the antero-lateral gutter for abnormal synovial tissue (synovitic lesion), lateral ligament integrity, tibiotalar joint and osseous spurs of the distal tibia and talus. Ultrasound findings were correlated with subsequent arthroscopic appearance. Ultrasound examination detected a synovitic mass in the antero-lateral gutter in all 8 footballers with clinical ALI (100%) and in 2 patients with a control diagnosis (22%). Arthroscopic correlation of antero-lateral synovitis and fibrosis was present in all 10 cases (100%). The synovitic lesion was seen at ultrasound as a nodular soft tissue mass of mixed echogenicity within the antero-lateral gutter, which extruded anteriorly with manual compression of the distal fibula against the tibia. Increased blood supply was detected using power Doppler imaging in only 1 patient. The synovitic lesion measured >10 mm in its maximum dimension in 7 footballers with clinical ALI and <10 mm in the control group. Additional ultrasound findings in patients with abnormal antero-lateral synovial tissue included an anterior talofibular ligament injury in all patients (n = 10), a tibiotalar joint effusion (n = 6) and osseous spurs (n = 4). Antero-lateral synovitic tissue was accurately identified at ultrasound in the absence of an effusion (n = 4). No synovitic lesion was detected at ultrasound or arthroscopy in the remaining 7 patients with a control diagnosis. Ultrasound is accurate in detecting synovitic lesions within the antero-lateral gutter, demonstrating associated ligamentous injuries and in

Physiotherapy improves patient reported shoulder function and health status in patients with subacromial impingement syndrome

DEFF Research Database (Denmark)

Storgaard, Filip Holst; Pedersen, Christina Gravgaard; Jensen, Majbritt Lykke

Physiotherapy improves patient reported shoulder function and health status in patients with subacromial impingement syndrome.......Physiotherapy improves patient reported shoulder function and health status in patients with subacromial impingement syndrome....

Effectiveness of Kinesiotaping and Subacromial Corticosteroid Injection in Shoulder Impingement Syndrome.

Science.gov (United States)

Şahin Onat, Şule; Biçer, Seda; Şahin, Zehra; Küçükali Türkyilmaz, Ayşegül; Kara, Murat; Özbudak Demir, Sibel

2016-08-01

The aim of this study was to investigate whether kinesiotaping or subacromial corticosteroid injection provides additional benefit when used with nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with shoulder impingement syndrome. Patients with shoulder impingement syndrome were divided into 3 groups as follows: NSAID group (n = 33), kinesiotaping group (kinesiotaping + NSAID) (n = 33), and injection group (subacromial corticosteroid injection + NSAID) (n = 33). Outcome measures including visual analog scale, shoulder ranges of motion, Shoulder Disability Questionnaire, and University of California-Los Angeles (UCLA) scale were evaluated before and after the treatment (fourth week). A total of 99 patients (21 male and 78 female patients) were enrolled in this study. Demographic and baseline clinical characteristics of the groups (except for body mass index and visual analog scale at night, both P = 0.05) were similar between the groups (all P > 0.05). Clinical parameters were found to have improved in the 3 groups (all P kinesiotaping and injection groups showed similar improvements (all P > 0.05), each group had better outcome than did the NSAID group as regards pain (activity visual analog scale), ranges of motion, and Shoulder Disability Questionnaire and UCLA scale scores (all P kinesiotaping or subacromial corticosteroid injection to NSAID treatment seems to have better/similar effectiveness in patients with shoulder impingement syndrome. Therefore, kinesiotaping might serve as an alternative treatment in case (injection of) corticosteroids are contraindicated. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES:: Upon completion of this article, the reader should be able to: (1) Delineate appropriate treatment options for shoulder impingement syndrome; (2) Identify treatment benefits of kinesiotaping and corticosteroid injections in shoulder impingement syndrome; and (3) Incorporate

Diagnosis of shoulder impingement syndrome; Diagnostik des Schulterimpingementsyndroms

Energy Technology Data Exchange (ETDEWEB)

Hodler, J. [Orthopaedische Universitaetsklinik Balgrist, Zuerich (Switzerland)

1996-12-01

This article reviews the pathogenesis and clinical and imaging findings in shoulder impingement syndrome. Different stages of impingement syndrome are described. Stage I relates to edema and hemorrhage of the supraspinatus tendon. Stage II is characterized by bursal inflammation and fibrosis, as well as tendinopathy. In stage III there is a tear of the rotator cuff. Clinical signs many overlap. Moreover, calcifying tendinitis, fractures and pain originating from the cervical spine may mimic shoulder impingement syndrome. Imaging is important for the exact diagnosis. Standard radiographs are the basis of imaging in shoulder impingement syndrome. They may demonstrate subchondral sclerosis of the major tuberosity, subacromial spurs, and form anomalies of the acromion. They are also important in the differential diagnosis of shoulder impingement syndrome and demonstrate calcifying tendinitis, fractures and neoplasm. Ultrasonography has found acceptance as a screening tool and even as a final diagnostic method by many authors. However, there is a high interobserver variability in the demonstration of rotator cuff tears. Its usefulness has therefore been questioned. MR imaging is probably the method of choice in the evaluation of the rotator cuff and surrounding structures. Several investigations have demonstrated that differentiation of early findings, such as tendinopathy versus partial tears, may be difficult with MR imaging. However, reproducibility for fullthickness tears appears to be higher than for sonography. Moreover, specificity appears to be superior to sonography. MR arthrography is not universally accepted. However, it allows for more exact differentiation of discrete findings and may be indicated in preoperative planning. Standard arthrography and CT have a limited role in the current assessment of the rotator cuff. (orig.) [Deutsch] Grundlage des Impingementsyndroms ist eine Kompression des Supraspinatus am akromioklavikularen Bogen vor allem bei Flexion

New arthroscopic assisted technique for ankle instability

International Nuclear Information System (INIS)

Gerstner Garces, Juan Ricardo

2004-01-01

An assisted arthroscopic technique for chronic ankle instability is presented by the author, together with his results for 27 patients treated between January 2000 and February 2004, with a minimum follow-up of six months. Indications for his technique, according to the rehabilitation protocol of the Medical Centre, included patients with chronic subjective and objective ankle instability, anteroposterior instability, associated anteromedical impingement syndromes, non competitive athletes, patients not displaying defects in the alignment of the axis of foot and ankle, or systemic disorders such as diabetes mellitus, collagenisis or hyperelasticity. Patients were evaluated according to the AOFAS scale for the outcome of ankle procedures, and followed up for a minimum period of six months. Positive results confirm an efficient and effective technique, simple and easy to reproduce, that does not hinder future open anatomical or non-anatomical reconstruction, and in which complications are minimal

Shoulder impingement syndrome : evaluation of the causes with MRI

Energy Technology Data Exchange (ETDEWEB)

Choi, Yong Ho; Song, In Sup; Chung, Hun Young; Yoon, Sang Jin; Kim, Yang Soo; Shim, Hyung Jin; Choi, Young Hee; Lee, Jong Beum; Lee, Yong Chul; Kim, Kun Sang [Chungang Univ. College of Medicine, Seoul (Korea, Republic of); Choi, Yun Sun [Eulji Hospital, College of Medicine, Seoul (Korea, Republic of)

1999-12-01

Various mechanical causes which induce shoulder impingement syndrome have been identified with the help of MRI. The aim of this study is to evaluate the incidence of such causes. A total of 54 patients with clinically confirmed shoulder impingement syndrome and a normal control group(n=20) without symptoms were included. We evaluated the incidence of hook shaped acromion, low lying acromion, downward slope of the acromion, subacromial spur, acromioclavicular joint hypertrophy, coracoacromial ligament hypertrophy, high cuff muscle bulk, and os acromiale. Among the 54 patients, the following conditions were present: acromioclavicular joint hypertrophy(n=36), coracoacromial ligament hypertrophy(n=20), subacromial spur(n=18), downward sloping of the acromion(n=16), hook shaped acromion(n=11), relatively high cuff muscle bulk(n=6), low lying acromion relative to the clavicle(n=3), and os acromiale(n=1). In the normal control group there were nine cases of acromioclavicular joint hypertrophy, nine of coracoacromial ligament hypertrophy, nine of downward sloping acromion, and three of low lying acromion, but hook shaped acromion, high cuff muscle bulk, and os acromiale were not found. Among 54 patients, the syndrome was due to five simultancous causes in one patient, four causes in two, three causes in 12, two causes in 22, and one cause in 17. Hook shaped acromion and subacromial spur are the statistically significant causes of shoulder impingement syndrome. In 69% of patients, the condition was due to more than one cause.

Shoulder impingement syndrome : evaluation of the causes with MRI

International Nuclear Information System (INIS)

Choi, Yong Ho; Song, In Sup; Chung, Hun Young; Yoon, Sang Jin; Kim, Yang Soo; Shim, Hyung Jin; Choi, Young Hee; Lee, Jong Beum; Lee, Yong Chul; Kim, Kun Sang; Choi, Yun Sun

1999-01-01

Various mechanical causes which induce shoulder impingement syndrome have been identified with the help of MRI. The aim of this study is to evaluate the incidence of such causes. A total of 54 patients with clinically confirmed shoulder impingement syndrome and a normal control group(n=20) without symptoms were included. We evaluated the incidence of hook shaped acromion, low lying acromion, downward slope of the acromion, subacromial spur, acromioclavicular joint hypertrophy, coracoacromial ligament hypertrophy, high cuff muscle bulk, and os acromiale. Among the 54 patients, the following conditions were present: acromioclavicular joint hypertrophy(n=36), coracoacromial ligament hypertrophy(n=20), subacromial spur(n=18), downward sloping of the acromion(n=16), hook shaped acromion(n=11), relatively high cuff muscle bulk(n=6), low lying acromion relative to the clavicle(n=3), and os acromiale(n=1). In the normal control group there were nine cases of acromioclavicular joint hypertrophy, nine of coracoacromial ligament hypertrophy, nine of downward sloping acromion, and three of low lying acromion, but hook shaped acromion, high cuff muscle bulk, and os acromiale were not found. Among 54 patients, the syndrome was due to five simultancous causes in one patient, four causes in two, three causes in 12, two causes in 22, and one cause in 17. Hook shaped acromion and subacromial spur are the statistically significant causes of shoulder impingement syndrome. In 69% of patients, the condition was due to more than one cause

Radiology of chronic diseases of the ankle joint

International Nuclear Information System (INIS)

Rand, T.; Trattnig, S.; Breitenseher, M.; Imhof, H.; Wagesreither, S.

1999-01-01

The etiology of chronic diseases of the ankle joint comprises a wide spectrum including chronic inflammatory processes and chronic degenerative, tumorous and neuropathic processes, as well as some specific syndromes based on chronic changes of the ankle joint. Of the inflammatory processes, chronic juvenile arthritis (JVC) is the most common disease. However, also Reiter disease, psoriasis or chronic monoarthritid diseases such as gout, as well as granulomatous diseases (tuberculosis, sarcoidosis) and fungal infections, may affect the ankle joint in a chronic course. Chronic degenerative changes are usually secondary due to abnormal positioning of the joint constituents or repetitive trauma. Neuropathic changes, as frequently seen in the course of diabetes, present with massive osseous destruction and malposition of the articular constituents. Chronic osseous as well as cartilaginous and synovial changes are seen in hemoplici patients. Chronic traumatic changes are represented by pigmented villonodular synovitis (PVNS), and chondromatosis, both with a predilection for the ankle joint. Due to the possibilities of magnetic resonance imaging (MRI), diagnosis of chronic ankle changes includes chronic ligamentous, tendinous and soft tissue changes. With the use MRI, specific syndromes can be defined which particularly affect the ankle joint in a chronic way, such as the os trigonum syndrome, the anterolateral impingement syndrome and the sinus tarsi syndrome. Nevertheless, plain film radiographs are still the basic element of any investigation. MRI, however, can be potentially used as a second investigation, saving an unnecessary cascade of investigations with ultrasound and CT. The latter investigations are used only with very specific indications, for instance CT for subtle bone structures and sonography for a limited investigation of tendons or evaluation of fluid. Particularly due to the possibilities of MRI and the development of special gradient-echo imaging or

Long-term prognosis of acute lateral ankle ligamentous sprains: high incidence of recurrences and residual symptoms.

Science.gov (United States)

Kemler, Ellen; Thijs, Karin M; Badenbroek, Ilse; van de Port, Ingrid G L; Hoes, Arno W; Backx, Frank J G

2016-12-01

Acute lateral ankle ligamentous sprains (ALALS) are common injuries. This injury does not always have a favourable long-term outcome. Studies reporting the prognosis of ALALS after functional treatment are scarce. To determine the prognosis of functionally treated ALALS, in terms of recurrent ALALS and residual symptoms. Retrospective cohort study. Patients were recruited from 20 family practices, nine physical therapy practices, the emergency departments of a regional hospital and a university hospital. Adult patients with an ALALS caused by an inversion trauma were invited to participate in this study 2.5-5 years after their initial injury. Functional treatment of the initial ALALS. Acute lateral ankle ligamentous sprain recurrences and residual symptoms. A total of 44 patients were included, with an average follow-up period after the initial ankle sprain of 204 weeks (range 150-274 weeks). Eight patients (18.1%) had reinjured their ankle. Explicit pain around the ankle joint at physical examination was experienced by 45.5%. Clinical symptoms of anterior ankle impingement were present in 25% (all athletes), with radiologically confirmed tibiotalar osteophyte bone formation in 82% of them. A large proportion of patients with ALALS experience recurrences and persistent symptoms after their initial ankle injury. The high percentage of patients with anterior ankle impingement syndromes illustrates the need for early assessment of this impairment in patients with persistent complaints. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

MR imaging in the diagnosis of impingement syndrome

International Nuclear Information System (INIS)

Seeger, L.L.; Gold, R.H.; Bassett, L.W.; Ellman, H.

1986-01-01

The impingement syndrome is entrapment of the supraspinatus tendon by either the acromion, or a subacromial or acromioclavicular spur. Arthrography is normal during stages I (tendon inflammation) and II (fibrosis). The lack of objective findings often delays diagnosis until stage III (ischemic rotator cuff tear) is present. The purpose was to determine if MR imaging is useful in diagnosing this condition. T1-weighted surface coil scans were obtained on eight patients using a 0.3-T MR system. An axial scout allowed oblique alignment for imaging the osseous-soft tissue relationship and the supraspinatus tendon. MR is capable of displaying the specific pathologic anatomy of this disorder. Impinging spurs can be seen, and the adjacent tendon shows inferior displacement and abnormal signal intensity

Acromion types and role of corticosteroid with shoulder impingement syndrome

International Nuclear Information System (INIS)

Akram, M.; Gillani, S.F.U.S.; Awais, S.M.

2016-01-01

To determine the association between shoulder impingement and morphological characteristics of acromion and the role of sub-acromial injection of methylprednisolone in the short-term treatment for relieving pain and improve functional disability of these patients. Study Design: A descriptive study. Place and Duration of Study: Department of Orthopedic Surgery and Traumatology Unit-I (DOST-I), Mayo Hospital, Lahore, between November 2013 to June 2014. Methodology: All patients presented in OPD with shoulder pain were included as subjects and evaluated by clinical test and categorised using X-ray scapula Y-view. Patients with impingement syndrome were correlated with Bigliani types and offered intra-lesional injection into sub-acromial space with 2ml of xylocaine 2% and 40 mg of methylprednisolone using 22 gauge needle. The effectiveness was assessed in terms of relieving pain and good functional outcomes; and rotator cuff tear was clinically assessed among impingement positive patient. The pain was assessed using visual analogue score before and after the administration of the injection. Demographic variables for frequencies and their associations were analysed using SPSS version 20.0. Significance level was p<0.05. Among the 101 cases, there was no case of tear of rotator cuff tendon on clinical assessment. Majority of the patients (58.4%) were females with mean age of 31.38 +-1.13 years. Majority 57 (56.4%) of the patients had acromion type II (curved), which was the most common cause of shoulder impingement. Most had moderate pain. Thirty-four patients required intralesional steroid, which relieved the pain in 31 of them. Conclusion: Shoulder impingement syndrome without tear of rotator cuff tendon was found in younger age group between 40 to 45 years, which was relieved by intralesional corticosteroid administration. These patients had type II (curved) acromion, according to Bigliani classification. (author)

Ischiofemoral impingement syndrome: a meta-analysis

Energy Technology Data Exchange (ETDEWEB)

Singer, Adam D.; Subhawong, Ty K.; Jose, Jean; Tresley, Jonathan; Clifford, Paul D. [Jackson Memorial Hospital, Department of Diagnostic Radiology, Section of Musculoskeletal Imaging, Miami, FL (United States)

2015-06-01

clinical findings. Using the proposed measurement thresholds may better identify patients with this impingement syndrome so that optimal treatment options can be pursued. (orig.)

Glyceryl trinitrate patches—An alternative treatment for shoulder impingement syndrome

Directory of Open Access Journals (Sweden)

Yusuf Assem

2015-01-01

Full Text Available Transdermal glyceryl trinitrate patches have been investigated as an alternative therapeutic intervention for a range of tendinopathies, due to the ease of titration of dosage and the ease of their application. Glyceryl trinitrate has been inferred to reduce pain and inflammation secondary to their nitric oxide-producing action. Shoulder impingement syndrome is a soft tissue condition that manifests as anterior shoulder pain, weakness, and difficulty in daily activities. This review will evaluate the efficacy of glyceryl trinitrate patches in treating a variety of rotator cuff tendinopathies related to shoulder impingement, based on human and animal trials, and suggest its practical application in future trials and management.

Methods on simple radiogaphy of impingement syndrome in shoulder joint

International Nuclear Information System (INIS)

Kweon, Dae Cheol; Kim, Moon Sun; Kim, Yong Seob; Chung, Kyung Mo

2000-01-01

To evaluation of patients who have shoulder impingement syndrome is by diagnostic radiography. Shoulder impingement is a problem which occurs in young, active individuals as well as older individuals. In fact, the pain is probably caused by repetitive stress placed on the shoulder joint either through recreational activities of your occupation. Impingement series approach to radiographic examination of the shoulder is take five projections. First anteroposterior oblique projection. Second standard anteroposterior projection. Third superoinferior axial projection. Fourth supraspinatus outlet projection offers a view of the outlet of the supraspinatus tendon unit as it passes under the coraacromial arch. Fifth anteroposterior 30 deg caudal projection will adequately demonstrate the anterior acromial spur or ossification in the coraacromial ligament and more reliable to demonstrate spurring of the anterior acromion than supraspinatus outlet projection. This decreased the need for additional radiographic veiws, reduces the patient's exposure to x-ray radiation and decreases use of film. This can lower the cost of the evaluation and improve patient satisfaction.=20

Methods on simple radiogaphy of impingement syndrome in shoulder joint

Energy Technology Data Exchange (ETDEWEB)

Kweon, Dae Cheol; Kim, Moon Sun; Kim, Yong Seob; Chung, Kyung Mo [Seoul National Univ. College of Medicine, Seoul (Korea, Republic of)

2000-06-01

To evaluation of patients who have shoulder impingement syndrome is by diagnostic radiography. Shoulder impingement is a problem which occurs in young, active individuals as well as older individuals. In fact, the pain is probably caused by repetitive stress placed on the shoulder joint either through recreational activities of your occupation. Impingement series approach to radiographic examination of the shoulder is take five projections. First anteroposterior oblique projection. Second standard anteroposterior projection. Third superoinferior axial projection. Fourth supraspinatus outlet projection offers a view of the outlet of the supraspinatus tendon unit as it passes under the coraacromial arch. Fifth anteroposterior 30 deg caudal projection will adequately demonstrate the anterior acromial spur or ossification in the coraacromial ligament and more reliable to demonstrate spurring of the anterior acromion than supraspinatus outlet projection. This decreased the need for additional radiographic veiws, reduces the patient's exposure to x-ray radiation and decreases use of film. This can lower the cost of the evaluation and improve patient satisfaction.=20.

Arthroscopy and Endoscopy of the Ankle and Hindfoot

NARCIS (Netherlands)

de Leeuw, Peter A. J.; van Sterkenburg, Maayke N.; van Dijk, C. Niek

2009-01-01

Ankle arthroscopy provides the surgeon with a minimally invasive treatment option for a wide variety of indications such as impingement, osteochondral defects, loose bodies, ossicles, synovitis, adhesions, and instability. Posterior ankle pathology can be treated using endoscopic hindfoot portals.

Flexor Digitorum Accessorius Longus: Importance of Posterior Ankle Endoscopy

Directory of Open Access Journals (Sweden)

Jorge Pablo Batista

2015-01-01

Full Text Available Endoscopy for the posterior region of the ankle through two portals is becoming more widespread for the treatment of a large number of conditions which used to be treated with open surgery years ago. The tendon of the flexor hallucis longus (FHL travels along an osteofibrous tunnel between the posterolateral and posteromedial tubercles of the talus. Chronic inflammation of this tendon may lead to painful stenosing tenosynovitis. The aim of this report is to describe two cases depicting an accessory tendon which is an anatomical variation of the flexor hallucis longus in patients with posterior friction syndrome due to posterior ankle impingement and associated with a posteromedial osteochondral lesion of the talus. The anatomical variation (FDAL described was a finding during an endoscopy of the posterior region of the ankle, and we have spared it by sectioning the superior flexor retinaculum only. The accessory flexor digitorum longus is an anatomical variation and should be taken into account when performing an arthroscopy of the posterior region of the ankle. We recommend this treatment on this type of injury although we admit this does not make a definite conclusion.

Impingement syndrome of the shoulder following double row suture anchor technique for arthroscopic rotator cuff repair: a case report

Directory of Open Access Journals (Sweden)

Rambani Rohit

2009-06-01

Full Text Available Abstract Introduction Arthroscopic repair of the rotator cuff is a demanding surgery. Accurate placement of anchors is key to success. Case presentation A 38-year-old woman received arthroscopic repair of her rotator cuff using a double row suture anchor technique. Postoperatively, she developed impingement syndrome which resulted from vertical displacement of a suture anchor once the shoulder was mobilised. The anchor was removed eight weeks following initial surgery and the patient had an uneventful recovery. Conclusion Impingement syndrome following arthroscopic repair of the rotator cuffs using double row suture anchor has not been widely reported. This is the first such case where anchoring has resulted in impingement syndrome.

Specific or general exercise strategy for subacromial impingement syndrome-does it matter?

DEFF Research Database (Denmark)

Shire, Alison R; Stæhr, Thor A B; Overby, Jesper B

2017-01-01

Background Exercise is frequently suggested as a treatment option for patients presenting with symptoms of subacromial impingement syndrome. Some would argue implementing a specific exercise strategy with special focus on correction of kinematic deficits would be superior to general exercise stra...

The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement.

Science.gov (United States)

Griffin, D R; Dickenson, E J; O'Donnell, J; Agricola, R; Awan, T; Beck, M; Clohisy, J C; Dijkstra, H P; Falvey, E; Gimpel, M; Hinman, R S; Hölmich, P; Kassarjian, A; Martin, H D; Martin, R; Mather, R C; Philippon, M J; Reiman, M P; Takla, A; Thorborg, K; Walker, S; Weir, A; Bennell, K L

2016-10-01

The 2016 Warwick Agreement on femoroacetabular impingement (FAI) syndrome was convened to build an international, multidisciplinary consensus on the diagnosis and management of patients with FAI syndrome. 22 panel members and 1 patient from 9 countries and 5 different specialties participated in a 1-day consensus meeting on 29 June 2016. Prior to the meeting, 6 questions were agreed on, and recent relevant systematic reviews and seminal literature were circulated. Panel members gave presentations on the topics of the agreed questions at Sports Hip 2016, an open meeting held in the UK on 27-29 June. Presentations were followed by open discussion. At the 1-day consensus meeting, panel members developed statements in response to each question through open discussion; members then scored their level of agreement with each response on a scale of 0-10. Substantial agreement (range 9.5-10) was reached for each of the 6 consensus questions, and the associated terminology was agreed on. The term 'femoroacetabular impingement syndrome' was introduced to reflect the central role of patients' symptoms in the disorder. To reach a diagnosis, patients should have appropriate symptoms, positive clinical signs and imaging findings. Suitable treatments are conservative care, rehabilitation, and arthroscopic or open surgery. Current understanding of prognosis and topics for future research were discussed. The 2016 Warwick Agreement on FAI syndrome is an international multidisciplinary agreement on the diagnosis, treatment principles and key terminology relating to FAI syndrome.Author note The Warwick Agreement on femoroacetabular impingement syndrome has been endorsed by the following 25 clinical societies: American Medical Society for Sports Medicine (AMSSM), Association of Chartered Physiotherapists in Sports and Exercise Medicine (ACPSEM), Australasian College of Sports and Exercise Physicians (ACSEP), Austian Sports Physiotherapists, British Association of Sports and Exercise

Subscapulais injuries associated with acromiohumeral instability in patients with shoulder impingement syndrome

Energy Technology Data Exchange (ETDEWEB)

Moon, Tae Young; Jeong, Hee Seok; Lee, Seung Jun; Jeong, Yeo Jin [Pusan National University Yangsan Hospital, Yangsan (Korea, Republic of)

2017-07-15

To evaluate the association of subscapularis (SSC) injuries with acromiohumeral instability (AHI) in patients with shoulder impingement syndrome with supraspinatus (SSP) tears. Pre-operative shoulder magnetic resonance images of 106 patients with subsequent arthroscopic confirmation of shoulder impingement syndrome were reviewed retrospectively. Patients with SSC injuries were divided into the following 3 groups: 1) those with no injury symbolized to the SSC[0] (n = 38), 2) those with partial injuries to the SSC[1] (n = 41), and 3) those with complete disruption of the SSC[2] (n = 27). AHI was categorized into 5 stages depending on the SSP lesions: partial tear or pretear tendinosis symbolized to the SSP[0] (n = 24) and according to retraction severity of the SSP tendon with complete tear such as SSP[1] (n = 19), SSP[2] (n = 27), SSP[3] (n = 29), and SSP[4] (n = 7). Also, AHI was divided into two groups such as the mild group summed with SSP plus SSP plus SSP and the severe group summed with SSP plus SSP, including 70 patients and 36 patients, respectively. Twenty-nine patients (63.0%) among 46 patients with SSC[0] and thirty-two patients (78.0%) among 41 patients with SSC[1] were related to mild AHI. Eighteen patients (66.7%) among 27 patients with SSC[2] were associated with severe AHI. The SSC injury groups were statistically significantly associated with AHI (estimate 0.207, standard error 0.057, p < 0.01). SSC injuries could be related to AHI in patients with shoulder impingement syndrome.

MR imaging as a problem solving tool in posterior ankle pain: A review

Energy Technology Data Exchange (ETDEWEB)

Wong, Gloria N.L., E-mail: gnlwong@gmail.com; Tan, Tien Jin, E-mail: tien_jin_tan@cgh.com.sg

2016-12-15

Highlights: • Conditions causing posterior ankle pain may occur in isolation or in co-existence. • Identification of the causative pathology is therefore often difficult. • The pathology and MR imaging findings of common causative conditions are discussed. • MRI aids accurate and timely diagnoses in cases of posterior ankle pain. - Abstract: Posterior ankle pain is a cause of chronic pain and disability, afflicting a wide range of individuals. While proper identification of the cause is essential for timely and adequate treatment, identifying the cause and excluding mimickers is often challenging for the physician due to the complex nature of the joint. In addition, pathology that can cause posterior ankle pain may occur on their own or in co-existence. Clinical conditions that can present as posterior ankle pain include: posterior ankle impingement, Achilles tendon pathology, medial flexor tendon pathology, peroneal pathology, retrocalcaneal bursitis, posterior subtalar tarsal coalition, sinus tarsi, and tarsal tunnel syndrome. In this review we introduce current concepts of pathophysiology in the main conditions involved in posterior ankle pain, and review the role of MR in the diagnosis and management of each condition. When pathology can be detected earlier and with more specificity, appropriate and time-sensitive treatment can be commenced, thus improving clinical outcomes.

MR imaging as a problem solving tool in posterior ankle pain: A review

International Nuclear Information System (INIS)

Wong, Gloria N.L.; Tan, Tien Jin

2016-01-01

Highlights: • Conditions causing posterior ankle pain may occur in isolation or in co-existence. • Identification of the causative pathology is therefore often difficult. • The pathology and MR imaging findings of common causative conditions are discussed. • MRI aids accurate and timely diagnoses in cases of posterior ankle pain. - Abstract: Posterior ankle pain is a cause of chronic pain and disability, afflicting a wide range of individuals. While proper identification of the cause is essential for timely and adequate treatment, identifying the cause and excluding mimickers is often challenging for the physician due to the complex nature of the joint. In addition, pathology that can cause posterior ankle pain may occur on their own or in co-existence. Clinical conditions that can present as posterior ankle pain include: posterior ankle impingement, Achilles tendon pathology, medial flexor tendon pathology, peroneal pathology, retrocalcaneal bursitis, posterior subtalar tarsal coalition, sinus tarsi, and tarsal tunnel syndrome. In this review we introduce current concepts of pathophysiology in the main conditions involved in posterior ankle pain, and review the role of MR in the diagnosis and management of each condition. When pathology can be detected earlier and with more specificity, appropriate and time-sensitive treatment can be commenced, thus improving clinical outcomes.

[Relieving pre-exam anxiety syndrome with wrist-ankle acupuncture: a randomized controlled trial].

Science.gov (United States)

Shu, Shi; Li, Tong-ming; Fang, Fan-fu; He, Hou-luo; Zhou, Qing-hui; Gu, Wei; Zhou, Shuang

2011-06-01

Pre-exam anxiety syndrome is a common condition occurring in pre-exam students and directly affects their examination performance and physical state. Wrist-ankle acupuncture has significant therapeutic effects in treating mental disorders and may also relieve the symptoms of pre-exam anxiety syndrome. To assess the therapeutic effect of wrist-ankle acupuncture on pre-exam anxiety syndrome. A total of 60 students who met the inclusion criteria of pre-exam anxiety syndrome were enrolled from a university in Shanghai and they were randomly divided into treatment group and control group. There were 30 cases in each group, and no case failed to follow-up. In the treatment group, wrist-ankle acupuncture was adopted to point upper 1 bilaterally (impression between flexor carpi ulnaris tendon and ulnar margin), and there was no requirement for Deqi (arrival of qi). In the control group, sham acupuncture was adopted. The treatment was applied 3 times totally in both groups one week before the exam, once every other day, each time with the needles retained for 30 min. The therapeutic effects were compared between two groups. Before and after 3 treatments, Sarason Test Anxiety Scale (TAS) and Expectation and Treatment Credibility Scale (ETCS) were measured and evaluated. The therapeutic effect experienced by the treatment group was better than that of the control group (PETCS before treatment between the two groups. The scores of TAS after treatment in two groups were higher than those before treatment (PETCS than those in the control group (P<0.05, P<0.01). No adverse reaction was reported. Wrist-ankle acupuncture can relieve the symptoms of pre-exam anxiety syndrome significantly, and this therapy is highly safe.

Chronic ankle instability: Arthroscopic anatomical repair.

Science.gov (United States)

Arroyo-Hernández, M; Mellado-Romero, M; Páramo-Díaz, P; García-Lamas, L; Vilà-Rico, J

Ankle sprains are one of the most common injuries. Despite appropriate conservative treatment, approximately 20-40% of patients continue to have chronic ankle instability and pain. In 75-80% of cases there is an isolated rupture of the anterior talofibular ligament. A retrospective observational study was conducted on 21 patients surgically treated for chronic ankle instability by means of an arthroscopic anatomical repair, between May 2012 and January 2013. There were 15 men and 6 women, with a mean age of 30.43 years (range 18-48). The mean follow-up was 29 months (range 25-33). All patients were treated by arthroscopic anatomical repair of anterior talofibular ligament. Four (19%) patients were found to have varus hindfoot deformity. Associated injuries were present in 13 (62%) patients. There were 6 cases of osteochondral lesions, 3 cases of posterior ankle impingement syndrome, and 6 cases of peroneal pathology. All these injuries were surgically treated in the same surgical time. A clinical-functional study was performed using the American Orthopaedic Foot and Ankle Society (AOFAS) score. The mean score before surgery was 66.12 (range 60-71), and after surgery it increased up to a mean of 96.95 (range 90-100). All patients were able to return to their previous sport activity within a mean of 21.5 weeks (range 17-28). Complications were found in 3 (14%) patients. Arthroscopic anatomical ligament repair technique has excellent clinical-functional results with a low percentage of complications, and enables patients to return to their previous sport activity within a short period of time. Copyright © 2016 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

Os acromiale causing shoulder impingement syndrome: a case report

International Nuclear Information System (INIS)

Romero, I.; Rodriguez, A.; Roca, M.; Garcia, Y.

2001-01-01

Shoulder impingement syndrome is caused by repeated mechanical trauma to the rotator cuff due to encroachment of the coracoacromial ligament; in most cases, it is a primary lesion. Os acromiale, an anatomic variant of the shoulder structures, is one of the predisposing factors for the development of this entity. We present a case of os acromiale complicated by complete rupture of the tendon of the supraspinatus muscle and luxation of the long head of the biceps tendon. We stress the importance of magnetic resonance in the study of this anatomic variant and in the detection of complications or associated lesions. (Author) 10 refs

Ultrasound measurement of rotator cuff thickness and acromio-humeral distance in the diagnosis of subacromial impingement syndrome of the shoulder.

Science.gov (United States)

Cholewinski, Jerzy J; Kusz, Damian J; Wojciechowski, Piotr; Cielinski, Lukasz S; Zoladz, Miroslaw P

2008-04-01

The usefulness of ultrasound measurements in the diagnosis of the subacromial impingement syndrome of the shoulder was evaluated. Fifty-seven patients with unilateral symptoms of the impingement syndrome underwent ultrasound examination of both shoulder joints, which included assessment of rotator cuff integrity, measurement of rotator cuff thickness and the distance between the infero-lateral edge of acromion and the apex of the greater tuberosity of humerus (AGT distance) in the standard ultrasonographic positions. As a control group, 36 volunteers (72 shoulders) with no history of shoulder pain were examined sonographically. Ultrasonographic assessment of humeral head elevation, measured as the AGT distance, proved to be useful in establishing the diagnosis of the subacromial impingement syndrome of the shoulder. A difference in rotator cuff thickness of more than 1.1 mm and a difference in the AGT distance of more than 2.1 mm between both shoulder joints may reflect dysfunction of rotator cuff muscles.

Preoperative conventional magnetic resonance images versus magnetic resonance arthrography of subacromial impingement syndrome

International Nuclear Information System (INIS)

Ahn, Sang Hyuk; Park, Jung Hwan; Moon, Tae Yong; Lee, In Sook; Lee, Seung Jun

2012-01-01

To evaluate the usefulness of conventional magnetic resonance images (MRI) for arthroscopic surgery in subacromial impingement syndrome of the shoulder, as an alternative to MR arthrography with additional T2 fat saturation images (MRA). The preoperative MRI of 77 patients (45 females, 32 males) (52 right, 25 left) and MRA of 34 patients (14 females, 20 males) (24 right, 10 left) with subsequent arthroscopic confirmation of subacromial impingement syndrome were reviewed retrospectively. The lesions requiring arthroscopic surgery were 95 subacromial spurs, 101 subacromial bursitis, and 51 full-thickness and 44 partial thickness tears of the supraspinatus among 111 cases for both studies. A two by two table was constructed in order to calculate the sensitivity and specificity of both studies against arthroscopic outcomes. Also we analyzed the false positive and false negative cases of the full-thickness tears individually. The detection rates of subacromial spur and bursitis and full and partial thickness tears of the supraspinatus were 91%, 94%, 77%, and 65% in MRI and 93%, 100%, 83%, and 77% in MRA respectively. Their specificities were 33%, 33%, 90%, and 76% in MRI and 50%, 75%, 100%, and 71% in MRA respectively. Eleven false negative cases in regards to MRI resulted in Ellman's grade 3 partial thickness tear (72.7%), mild bursitis (63.6%), greater tuberosity erosion (45.5%), and negative fluid signal of the glenohumeral joint (81.8%). Three false positive cases on the MRI were induced from errors with lower window depth and width on the imagings. Two false negative cases on MRA were induced from the adhesion between Ellman's grade 3 rim rent tear and the glenohumeral joint cavity. Conventional MR images could be used to decide the arthroscopic surgery in subacromial impingement syndrome, as an alternative to MR arthrography with additional T2 fat saturation images

Preoperative conventional magnetic resonance images versus magnetic resonance arthrography of subacromial impingement syndrome

Energy Technology Data Exchange (ETDEWEB)

Ahn, Sang Hyuk; Park, Jung Hwan; Moon, Tae Yong [Pusan National Univ. Yangsan Hospital, Yangsan (Korea, Republic of); Lee, In Sook; Lee, Seung Jun [Pusan National Univ. Hospital, Busan (Korea, Republic of)

2012-09-15

To evaluate the usefulness of conventional magnetic resonance images (MRI) for arthroscopic surgery in subacromial impingement syndrome of the shoulder, as an alternative to MR arthrography with additional T2 fat saturation images (MRA). The preoperative MRI of 77 patients (45 females, 32 males) (52 right, 25 left) and MRA of 34 patients (14 females, 20 males) (24 right, 10 left) with subsequent arthroscopic confirmation of subacromial impingement syndrome were reviewed retrospectively. The lesions requiring arthroscopic surgery were 95 subacromial spurs, 101 subacromial bursitis, and 51 full-thickness and 44 partial thickness tears of the supraspinatus among 111 cases for both studies. A two by two table was constructed in order to calculate the sensitivity and specificity of both studies against arthroscopic outcomes. Also we analyzed the false positive and false negative cases of the full-thickness tears individually. The detection rates of subacromial spur and bursitis and full and partial thickness tears of the supraspinatus were 91%, 94%, 77%, and 65% in MRI and 93%, 100%, 83%, and 77% in MRA respectively. Their specificities were 33%, 33%, 90%, and 76% in MRI and 50%, 75%, 100%, and 71% in MRA respectively. Eleven false negative cases in regards to MRI resulted in Ellman's grade 3 partial thickness tear (72.7%), mild bursitis (63.6%), greater tuberosity erosion (45.5%), and negative fluid signal of the glenohumeral joint (81.8%). Three false positive cases on the MRI were induced from errors with lower window depth and width on the imagings. Two false negative cases on MRA were induced from the adhesion between Ellman's grade 3 rim rent tear and the glenohumeral joint cavity. Conventional MR images could be used to decide the arthroscopic surgery in subacromial impingement syndrome, as an alternative to MR arthrography with additional T2 fat saturation images.

Incidence of Complex Regional Pain Syndrome I Following Foot and Ankle Fractures Using the Budapest Criteria.

Science.gov (United States)

Bullen, Michael; Lang, Coran; Tran, Phong

2016-12-01

OBJECTIVE : Fractures are a well-recognized inciting event in the development of complex regional pain syndrome. This study aimed to prospectively determine the incidence of complex regional pain syndrome following foot and ankle fractures. METHODS : A prospective study was conducted of patients presenting to two metropolitan hospitals with plain radiograph diagnosis of fractures to the foot or ankle. Patients were initially screened by phone 3 months after injury using the validated International Association for the Study of Pain Budapest criteria. Patients who fulfilled the screening criteria were then physically examined by a pain specialist to assess clinical signs as part of the Budapest criteria. RESULTS : A total of 306 consecutive eligible patients were included. One hundred and ten patients reported at least one symptom of complex regional pain syndrome; however, only three fulfilled the minimum requirements to necessitate clinical review. Of these three, only one patient fulfilled the combination of symptom and sign criteria for a positive diagnosis according to the validated Budapest criteria. The incidence of complex regional pain syndrome following foot and ankle fracture in this study was 0.3%. CONCLUSION : Although many patients may experience vasomotor, sensory, and sudomotor disturbance following a fracture to the foot and ankle, the observed incidence of complex regional pain syndrome using a prospectively collected validated criteria is significantly lower than previously published. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Arthroscopy for problems after ankle fracture

NARCIS (Netherlands)

van Dijk, C. N.; Verhagen, R. A.; Tol, J. L.

1997-01-01

From 1990 to 1994 we undertook arthroscopy of the ankle on 34 consecutive patients with residual complaints following fracture. Two groups were compared prospectively. Group I comprised 18 patients with complaints which could be attributed clinically to anterior bony or soft-tissue impingement. In

Important clinical descriptors to include in the examination and assessment of patients with femoroacetabular impingement syndrome

DEFF Research Database (Denmark)

Reiman, M P; Thorborg, K; Covington, K

2017-01-01

PURPOSE: Determine which examination findings are key clinical descriptors of femoroacetabular impingement syndrome (FAIS) through use of an international, multi-disciplinary expert panel. METHODS: A three-round Delphi survey utilizing an international, multi-disciplinary expert panel operationally...

Risk of surgery for subacromial impingement syndrome in relation to neck-shoulder complaints and occupational biomechanical exposures

DEFF Research Database (Denmark)

Svendsen, Susanne Wulff; Dalbøge, Annett; Andersen, JH

2013-01-01

OBJECTIVES: The aim of this longitudinal study was to evaluate the risk of surgery for subacromial impingement syndrome (SIS) in relation to neck-shoulder complaints and occupational biomechanical shoulder exposures. METHODS: The study was based on the Musculoskeletal Research Database at the Dan......OBJECTIVES: The aim of this longitudinal study was to evaluate the risk of surgery for subacromial impingement syndrome (SIS) in relation to neck-shoulder complaints and occupational biomechanical shoulder exposures. METHODS: The study was based on the Musculoskeletal Research Database....... Using no neck-shoulder complaints and low shoulder load at baseline as a reference, no neck-shoulder complaints and high shoulder load showed an adjusted hazard ratio (HR adj) of 2.55 [95% confidence interval (95% CI) 1.59-4.09], while neck-shoulder complaints in combination with high shoulder load...

Force steadiness, muscle activity, and maximal muscle strength in subjects with subacromial impingement syndrome

DEFF Research Database (Denmark)

Bandholm, Thomas; Rasmussen, Lars; Aagaard, Per

2006-01-01

physically active in spite of shoulder pain and nine healthy matched controls were examined to determine isometric and isokinetic submaximal shoulder-abduction force steadiness at target forces corresponding to 20%, 27.5%, and 35% of the maximal shoulder abductor torque, and maximal shoulder muscle strength......We investigated the effects of the subacromial impingement syndrome (SIS) on shoulder sensory-motor control and maximal shoulder muscle strength. It was hypothesized that both would be impaired due to chronic shoulder pain associated with the syndrome. Nine subjects with unilateral SIS who remained...

Intraarticular glucocorticoid, morphine and bupivacaine reduces pain and convalescence after arthroscopic ankle surgery: a randomized study of 36 patients

DEFF Research Database (Denmark)

Rasmussen, S; Kehlet, H

2000-01-01

In a double-blind randomized study, 36 patients undergoing arthroscopic removal of bony spurs and synovitis causing impingement of the ankle were allocated to intraarticular saline or bupivacaine 15 mg + morphine 5 mg + intraarticular methylprednisolone 40 mg. Combined methylprednisolone, bupivac......In a double-blind randomized study, 36 patients undergoing arthroscopic removal of bony spurs and synovitis causing impingement of the ankle were allocated to intraarticular saline or bupivacaine 15 mg + morphine 5 mg + intraarticular methylprednisolone 40 mg. Combined methylprednisolone...

Trunk and lower limb biomechanics during stair climbing in people with and without symptomatic femoroacetabular impingement.

Science.gov (United States)

Hammond, Connor A; Hatfield, Gillian L; Gilbart, Michael K; Garland, S Jayne; Hunt, Michael A

2017-02-01

Femoroacetabular impingement is a pathomechanical hip condition leading to pain and impaired physical function. It has been shown that those with femoroacetabular impingement exhibit altered gait characteristics during level walking and stair climbing, and decreased muscle force production during isometric muscle contractions. However, no studies to-date have looked at trunk kinematics or muscle activation during dynamic movements such as stair climbing in this patient population. The purpose of this study was to compare biomechanical outcomes (trunk and lower limb kinematics as well as lower limb kinetics and muscle activation) during stair climbing in those with and without symptomatic femoroacetabular impingement. Trunk, hip, knee and ankle kinematics, as well as hip, knee and ankle kinetics and muscle activity of nine lower limb muscles were collected during stair climbing for 20 people with clinical and radiographic femoroacetabular impingement and compared to 20 age- and sex-matched pain-free individuals. Those with femoroacetabular impingement ascended the stairs slower (effect size=0.82), had significantly increased peak trunk forward flexion angles (effect size=0.99) and external hip flexion moments (effect size=0.94) and had decreased peak external knee flexion moments (effect size=0.90) compared to the control group. Findings from this study indicate that while those with and without femoroacetabular impingement exhibit many biomechanical similarities when ascending stairs, differences in trunk forward flexion and joint kinetics indicate some important differences. Further longitudinal research is required to elucidate the cause of these differences as well as the clinical relevance. Copyright © 2017 Elsevier Ltd. All rights reserved.

Unrecognized anterior compartment syndrome following ankle fracture surgery: a case report.

Science.gov (United States)

Seyahi, Aksel; Uludag, Serkan; Akman, Senol; Demirhan, Mehmet

2009-01-01

A 35-year-old male sustained a lateral malleolar fracture while playing football. The fracture was treated by open reduction and internal fixation with a tourniquet. The next day, the patient returned with pain and swelling of the ankle and was admitted again to the hospital with a suspected diagnosis of cellulitis. Ten hours later, the patient developed the symptoms of anterior compartment syndrome. Emergency open fasciotomy of the anterior compartment was performed. The retrospective analysis of the patient's history was suggestive of a predisposition to an exercise-induced compartment syndrome. We think that exertional increase of the compartmental pressure before the injury and the tourniquet used during surgery contributed together to the development of compartment syndrome. Physicians should be vigilant in identifying the features of compartment syndrome when managing patients injured during a sporting activity.

Shouldering the blame for impingement: the rotator cuff continuum ...

African Journals Online (AJOL)

The aim of this article was to summarise recent research on shoulder impingement and rotator cuff pathology. A continuum model of rotator cuff pathology is described, and the challenges of accurate clinical diagnosis, imaging and best management discussed. Keywords: shoulder impingement syndrome, subacromial ...

Injury of the ankle joint ligaments

International Nuclear Information System (INIS)

Breitenseher, M.J.

2007-01-01

The diagnosis of lateral collateral ankle ligament trauma is based on patient history, clinical examination and clinical stress tests. If the clinical stress test is positive, stress radiography can be performed. There is, however, no consensus about the usefulness of stress radiography in acute ankle sprain, and in particular about the cut-off talar tilt angle beyond which a two-ligament rupture would be certain, ranging from 5 to 30 . Today, magnetic resonance imaging (MRI) is not used in this area, although it does allow controlled positioning of the foot and defined section visualization of injured lateral collateral ankle ligaments. In acute and chronic sinus tarsi injuries, MRI forms the established basis for diagnostic imaging, and can provide a definitive answer in most cases. MRI is also the method of choice for chronic posttraumatic pain with anterolateral impingement after rupture of the anterior talofibular ligament. Generally, for the evaluation of acute ankle injuries, MRI has developed to be the most important second-step procedure when projection radiology is non-diagnostic. (orig.) [de

Localization of PDZD7 to the stereocilia ankle-link associates this scaffolding protein with the Usher syndrome protein network.

Science.gov (United States)

Grati, M'hamed; Shin, Jung-Bum; Weston, Michael D; Green, James; Bhat, Manzoor A; Gillespie, Peter G; Kachar, Bechara

2012-10-10

Usher syndrome is the leading cause of genetic deaf-blindness. Monoallelic mutations in PDZD7 increase the severity of Usher type II syndrome caused by mutations in USH2A and GPR98, which respectively encode usherin and GPR98. PDZ domain-containing 7 protein (PDZD7) is a paralog of the scaffolding proteins harmonin and whirlin, which are implicated in Usher type 1 and type 2 syndromes. While usherin and GPR98 have been reported to form hair cell stereocilia ankle-links, harmonin localizes to the stereocilia upper tip-link density and whirlin localizes to both tip and ankle-link regions. Here, we used mass spectrometry to show that PDZD7 is expressed in chick stereocilia at a comparable molecular abundance to GPR98. We also show by immunofluorescence and by overexpression of tagged proteins in rat and mouse hair cells that PDZD7 localizes to the ankle-link region, overlapping with usherin, whirlin, and GPR98. Finally, we show in LLC-PK1 cells that cytosolic domains of usherin and GPR98 can bind to both whirlin and PDZD7. These observations are consistent with PDZD7 being a modifier and candidate gene for USH2, and suggest that PDZD7 is a second scaffolding component of the ankle-link complex.

Subacromial impingement in patients with whiplash injury to the cervical spine

Directory of Open Access Journals (Sweden)

Giddins Grey E

2008-06-01

Full Text Available Abstract Background Impingement syndrome and shoulder pain have been reported to occur in a proportion of patients following whiplash injuries to the neck. In this study we aim to examine these findings to establish the association between subacromial impingement and whiplash injuries to the cervical spine. Methods and results We examined 220 patients who had presented to the senior author for a medico-legal report following a whiplash injury to the neck. All patients were assessed for clinical evidence of subacromial impingement. 56/220 patients (26% had developed shoulder pain following the injury; of these, 11/220 (5% had clinical evidence of impingement syndrome. Only 3/11 patients (27% had the diagnosis made prior to evaluation for their medico-legal report. In the majority, other clinicians had overlooked the diagnosis. The seatbelt shoulder was involved in 83% of cases (p Conclusion After a neck injury a significant proportion of patients present with shoulder pain, some of whom have treatable shoulder pathology such as impingement syndrome. The diagnosis is, however, frequently overlooked and shoulder pain is attributed to pain radiating from the neck resulting in long delays before treatment. It is important that this is appreciated and patients are specifically examined for signs of subacromial impingement after whiplash injuries to the neck. Direct seatbelt trauma to the shoulder is one possible explanation for its aetiology.

The Effect of Platelet-Rich Plasma (PRP on Improvement in Pain and Symptoms of Shoulder Subacromial Impingement Syndrome

Directory of Open Access Journals (Sweden)

Parisa Nejati

2015-08-01

Full Text Available Abstract Background: Subacromial impingement is one of the most common complaints of shoulder. Treatments include avoiding of painful activities, oral anti-pain drugs, physical therapy modalities, corticosteroid injection and exercise therapy. Some studies have shown that platelet- rich plasma(PRP is effective on tendinitis and tearing of tendons, ligaments and muscles, but evidence that has proved PRP as a conservative treatment in shoulder pathologies is very limited. This study aims to investigate the effect of PRP injection on relieving pain and improving daily function of patients with shoulder impingement syndrome. Materials and Methods: In this clinical trial study, patients older than 40 with pain more than three months were included. If they had three of four positive diagnostic clinical tests of shoulder impingement that were confirmed by shoulder MRI, could be injected PRP twice. The time between injections was 1 month. Pain was measured by visual analog scale (VAS and function was measured by two questionnaires named disabilities of the arm, shoulder and hand (DASH and western Ontario rotator cuff index (WORC. Range of motion (ROM of shoulder was measured in five directions by goniometry . All of these parameters were evaluated before intervention and in 1, 3, 6 months later. Results: with due attention to a six-month folloe-up, PRR injection was effective in pain reduction and improvement of patient's function (p<0.05. Shoulder Rom increased in all directions except external rotation and the power of shoulder muscles was evidently improved statistically in flexion, abduction and internal toration. Conclusion: PRP injection could effectively reduce pain and improve daily activities in patients with shoulder impingement syndrome.

Cadaver study of anatomic landmark identification for placing ankle arthroscopy portals.

Science.gov (United States)

Scheibling, B; Koch, G; Clavert, P

2017-05-01

Arthroscopy-assisted surgery is now widely used at the ankle for osteochondral lesions of the talus, anterior and posterior impingement syndromes, talocrural or subtalar fusion, foreign body removal, and ankle instability. Injuries to the vessels and nerves may occur during these procedures. To determine whether ultrasound topographic identification of vulnerable structures decreased the risk of iatrogenic injuries to vessels, nerves, and tendons and influenced the distance separating vulnerable structures from the arthroscope introduced through four different portals. Ultrasonography to identify vulnerable structures before or during arthroscopic surgery on the ankle may be useful. Twenty fresh cadaver ankles from body donations to the anatomy institute in Strasbourg, France, were divided into two equal groups. Preoperative ultrasonography to mark the trajectories of vessels, nerves, and tendons was performed in one group but not in the other. The portals were created using a 4-mm trocar. Each portal was then dissected. The primary evaluation criterion was the presence or absence of injuries to vessels, nerves, and tendons. The secondary evaluation criterion was the distance between these structures and the arthroscope. No tendon injuries occurred with ultrasonography. Without ultrasonography, there were two full-thickness tendon lesions, one to the extensor hallucis longus and the other to the Achilles tendon. Furthermore, with the anterolateral, anteromedial, and posteromedial portals, the distance separating the vessels and nerves from the arthroscope was greater with than without ultrasonography (P=0.041, P=0.005, and P=0.002), respectively; no significant difference was found with the anterior portal. Preoperative ultrasound topographic identification decreases the risk of iatrogenic injury to the vessels, nerves, and tendons during ankle arthroscopy and places these structures at a safer distance from the arthroscope. Our hypothesis was confirmed. IV

Compartment syndrome of the thigh complicating surgical treatment of ipsilateral femur and ankle fractures

Science.gov (United States)

Moore, M. R.; Garfin, S. R.; Hargens, A. R.

1987-01-01

A 26-year-old man presented with ipsilateral femur and ankle fractures. The patient was treated with interlocking nail of his femur fracture, followed by open reduction and internal fixation of his ankle fracture under tourniquet control. Postoperatively, the patient developed compartment syndrome of his thigh with elevated pressures, requiring decompressive fasciotomies. This case illustrates the possible complication of treating a femur fracture with intramedullary nailing and then immediately applying a tourniquet to treat an ipsilateral extremity fracture. Because of the complication with this patient, we feel the procedure should be staged, or a tourniquet should be avoided if possible.

Test-Retest Reliability of Handgrip Strength as an Outcome Measure in Patients With Symptoms of Shoulder Impingement Syndrome.

Science.gov (United States)

Savva, Christos; Mougiaris, Paraskevas; Xadjimichael, Christoforos; Karagiannis, Christos; Efstathiou, Michalis

The purpose of this study was to investigate the degree of test-retest reliability of grip strength measurement using a hand dynamometer in patients with shoulder impingement syndrome. A total of 19 patients (10 women and 9 men; mean ± standard deviation age, 33.2 ± 12.9 years; range 18-59 years) with shoulder impingement syndrome were measured using a hand dynamometer by the same data collector in 2 different testing sessions with a 7-day interval. During each session, patients were encouraged to exert 3 maximal isometric contractions on the affected hand and the mean value of the 3 efforts (measured in kilogram-force [Kgf]) was used for data analysis. The intraclass correlation coefficient (ICC 2,1 ) as well as the standard error of measurement (SEM) and Bland-Altman plot were used to estimate the degree of test-retest reliability and the measurement error, respectively. Grip strength data analysis revealed an ICC 2,1 score of 0.94, which, based on the Shrout classification, is considered as excellent test-retest reliability of grip strength measurement. The small values of SEMs reported in both sessions (SEM 1 , 2.55 Kgf; SEM 2 , 2.39 Kgf) and the small width of the 95% limits of agreement in the Bland-Altman plot (ranging from -7.39 Kgf to 7.03 Kgf) reflected the measurement precision and the narrow variation of the differences during the 2 testing sessions. Results from this study identified excellent test-retest reliability of grip strength measurement in shoulder impingement syndrome, indicating its potential use as an outcome measure in clinical practice. Copyright © 2018. Published by Elsevier Inc.

Effectiveness of Standardized Physiotherapy Exercises for Patients With Difficulty Returning to Usual Activities After Decompression Surgery for Subacromial Impingement Syndrome

DEFF Research Database (Denmark)

Christiansen, David Høyrup; Frost, Poul; Falla, Deborah

2016-01-01

BACKGROUND: Little is known about the effectiveness of exercise programs after decompression surgery for subacromial impingement syndrome. For patients with difficulty returning to usual activities, special efforts may be needed to improve shoulder function. OBJECTIVE: The purpose of this study w...

Radiology of chronic diseases of the ankle joint; Chronische Krankheitsbilder am Sprunggelenk

Energy Technology Data Exchange (ETDEWEB)

Rand, T. [Vienna Univ. (Austria). Einrichtung fuer Magnetresonanztomographie]|[Universitaetsklinik fuer Radiodiagnostik, Vienna (Austria); Trattnig, S.; Breitenseher, M.; Imhof, H. [Vienna Univ. (Austria). Einrichtung fuer Magnetresonanztomographie; Kreuzer, S. [Universitaetsklinik fuer Radiodiagnostik, Vienna (Austria); Wagesreither, S. [Vienna Univ. (Austria). Klinik fuer Zahn-, Mund- und Kieferheilkunde

1999-01-01

The etiology of chronic diseases of the ankle joint comprises a wide spectrum including chronic inflammatory processes and chronic degenerative, tumorous and neuropathic processes, as well as some specific syndromes based on chronic changes of the ankle joint. Of the inflammatory processes, chronic juvenile arthritis (JVC) is the most common disease. However, also Reiter disease, psoriasis or chronic monoarthritid diseases such as gout, as well as granulomatous diseases (tuberculosis, sarcoidosis) and fungal infections, may affect the ankle joint in a chronic course. Chronic degenerative changes are usually secondary due to abnormal positioning of the joint constituents or repetitive trauma. Neuropathic changes, as frequently seen in the course of diabetes, present with massive osseous destruction and malposition of the articular constituents. Chronic osseous as well as cartilaginous and synovial changes are seen in hemoplici patients. Chronic traumatic changes are represented by pigmented villonodular synovitis (PVNS), and chondromatosis, both with a predilection for the ankle joint. Due to the possibilities of magnetic resonance imaging (MRI), diagnosis of chronic ankle changes includes chronic ligamentous, tendinous and soft tissue changes. With the use MRI, specific syndromes can be defined which particularly affect the ankle joint in a chronic way, such as the os trigonum syndrome, the anterolateral impingement syndrome and the sinus tarsi syndrome. Nevertheless, plain film radiographs are still the basic element of any investigation. MRI, however, can be potentially used as a second investigation, saving an unnecessary cascade of investigations with ultrasound and CT. The latter investigations are used only with very specific indications, for instance CT for subtle bone structures and sonography for a limited investigation of tendons or evaluation of fluid. Particularly due to the possibilities of MRI and the development of special gradient-echo imaging or

Radiotherapy for shoulder impingement; Bestrahlung beim Impingementsyndrom des Schultergelenks

Energy Technology Data Exchange (ETDEWEB)

Adamietz, B. [Universitaetsklinikum Erlangen (Germany). Inst. fuer Radiologie; Sauer, R.; Keilholz, L. [Universitaetsklinikum Erlangen (Germany). Strahlentherapeutische Klinik

2008-05-15

Background and Purpose: Up to now, degenerative shoulder diseases were summarized by the term 'periarthritis humeroscapularis'. Actual shoulder diseases can be differentiated etiopathologically according to a primary and secondary impingement syndrome. Narrowing of the subacromial space, which is caused by an osseous shape variant, leads to primary impingement. Secondary impingement develops, when the subacromial space is reduced by swelling tissue below the osseous shoulder roof. This study aimed for the exact diagnosis to indicate therapy and to classify the results according to the Constant score. Patients and Methods: From August 1999 to September 2002, 102 patients with 115 shoulder joint conditions underwent radiation therapy (RT). All joints received two RT series (6 x 0.5 Gy/series) applied in two to three weekly fractions, totaling a dosage of 6.0 Gy (250 kV, 15 mAs, 1-mm Cu filter). The second RT course started 6 weeks after the end of the first. 115 shoulders were examined before RT, 6 weeks after the second RT course and, finally, during the follow-up from January to May 2003. Results: Pain relief was achieved in 94/115 shoulder joints (82%) after 18-month follow-up (median). A significant difference existed between secondary impingement and primary/non-impingement according to response. Tendinosis calcarea, bursitis subdeltoidea, tendovaginitis of the long biceps tendon, and capsulitis adhaesiva responded well to therapy. Conclusion: Shoulder diseases of secondary impingement demonstrate a good response to RT. Less or no benefit was found in primary impingement syndrome or complete rotator cuff disruption and acute shoulder injuries, respectively. (orig.)

The Use of Physiotherapy among Patients with Subacromial Impingement Syndrome

DEFF Research Database (Denmark)

Christiansen, David Høyrup; Frost, Poul; Frich, Lars Henrik

2016-01-01

BACKGROUND: Physiotherapy with exercises is generally recommended in the treatment of patients with subacromial impingement syndrome (SIS). OBJECTIVE: We aimed to investigate the use of physiotherapy in patients with SIS in Danish hospital settings as part of initial non-surgical treatment...... and after SIS-related surgery and to evaluate to which extent sex, socio-demographic and clinical factors predict the use of physiotherapy. METHODS: Using national health registers, we identified 57,311 patients who had a first hospital contact with a diagnosis of ICD-10, groups M75.1-75.9, 1 July 2007...... to 30 June 2011. Records of physiotherapy were extracted within 52 weeks after first contact (or until surgery), and for surgically treated patients within 26 weeks after surgery. Predictors of the use of physiotherapy after first contact and after surgery were analysed as time-to-event. RESULTS: Within...

Anterior internal impingement of the shoulder in rugby players and other overhead athletes

Directory of Open Access Journals (Sweden)

Siddharth R. Shah, MBBS, MSc Sports Medicine (UK, MRCS-Ed

2017-04-01

Conclusion: This series of anterior internal impingement, which we believe is the largest in the literature to date, demonstrates the value of an to assess and successfully treat overhead athletes with anterior impingement syndrome.

Magnetic Resonance Imaging of Rotator Cuff Tears in Shoulder Impingement Syndrome

International Nuclear Information System (INIS)

Freygant, Magdalena; Dziurzyńska-Białek, Ewa; Guz, Wiesław; Samojedny, Antoni; Gołofit, Andrzej; Kostkiewicz, Agnieszka; Terpin, Krzysztof

2014-01-01

Shoulder joint is a common site of musculoskeletal pain caused, among other things, by rotator cuff tears due to narrowing of subacromial space, acute trauma or chronic shoulder overload. Magnetic resonance imaging (MRI) is an excellent modality for imaging of soft tissues of the shoulder joint considering a possibility of multiplanar image acquisition and non-invasive nature of the study. The aim of this study was to evaluate the prevalence of partial and complete rotator cuff tears in magnetic resonance images of patients with shoulder impingement syndrome and to review the literature on the causes and classification of rotator cuff tears. We retrospectively analyzed the results of 137 shoulder MRI examinations performed in 57 women and 72 men in Magnetic Resonance facility of the Department of Radiology and Diagnostic Imaging at the St. Jadwiga the Queen Regional Hospital No. 2 in Rzeszow between June 2010 and February 2013. Examinations were performed using Philips Achieva 1.5T device, including spin echo and gradient echo sequences with T1-, T2- and PD-weighted as well as fat saturation sequences in transverse, frontal and sagittal oblique planes. Patients were referred from hospital wards as well as from outpatient clinics of the subcarpathian province. The most frequently reported injuries included partial supraspinatus tendon tear and complete tearing most commonly involved the supraspinatus muscle tendon. The smallest group comprised patients with complete tear of subscapularis muscle tendon. Among 137 patients in the study population, 129 patients suffered from shoulder pain, including 57 patients who reported a history of trauma. There was 44% women and 56% men in a group of patients with shoulder pain. Posttraumatic shoulder pain was predominantly reported by men, while women comprised a larger group of patients with shoulder pain not preceded by injury. Rotator cuff injury is a very common pathology in patients with shoulder impingement syndrome

The relationship of strength and muscle balance to shoulder pain and impingement syndrome in elite quadriplegic wheelchair rugby players.

Science.gov (United States)

Miyahara, M; Sleivert, G G; Gerrard, D F

1998-04-01

Wheelchair athletes are susceptible to injuries related to overuse of the shoulder, in particular shoulder impingement syndrome. The present study examined the relationship of shoulder pain to demographic details, isokinetic strength and muscle balance in 8 elite quadriplegic rugby players. Demographic data were collected using personal interviews and each subject was clinically examined for signs of impingement syndrome by a physician. In addition each subject underwent bilateral isokinetic strength testing of the shoulder at 60 and 180 deg/s for abduction/adduction and internal/external rotation. A series of step-wise multiple discriminant analysis successfully predicted clinical symptoms from demographic, muscular strength and balance data. In particular, there was a significant deficit in adductor strength and this was related to shoulder pain and wasting of the scapular muscles. This strength deficit may be due to the high level of spinal lesions in the quadriplegic population. The level of spinal lesion may contribute to the aetiology of shoulder pathology in quadriplegia, and differentiate it from that observed in able-bodied athletes who exhibit weak abductors.

Diagnostic imaging of shoulder impingement

International Nuclear Information System (INIS)

Merl, T.; Weinhardt, H.; Oettl, G.; Lenz, M.; Riel, K.A.

1996-01-01

Magnetic resonance imaging is a method that has been advancing in the last few years to the modality of choice for diagnostic evaluation of the bone joints, as the method is capable of imaging not only the ossous but also the soft tissue components of the joint. MRI likewise has become an accepted method for diagnostic evaluation of syndromes of the shoulder, with high diagnostic accuracy in detecting rotator cuff lesions, or as an efficient MRI arthrography for evaluation of the instability or lesions of the labrocapsular complex. In the evaluation of early stages of shoulder impingement, the conventional MRI technique as a static technique yields indirect signs which in many cases do not provide the diagnostic certainty required in order to do justice to the functional nature of the syndrome. In these cases, functional MRI for imaging of the arm in abducted position and in rotational movement may offer a chance to early detect impingement and thus identify patients who will profit from treatment at an early stage [de

Does taping in addition to physiotherapy improve the outcomes in subacromial impingement syndrome? A systematic review.

Science.gov (United States)

Saracoglu, Ismail; Emuk, Yusuf; Taspinar, Ferruh

2018-04-01

Taping is used with or without other interventions for many purposes, especially to manage pain and improve functional activity in patients with shoulder pain. The aim of this review was to determine whether any taping technique in addition to physiotherapy care is more effective than physiotherapy care alone in patients with shoulder impingement syndrome. A systematic search of Cochrane Database of Systematic Review, MEDLINE (EBSCO), Physiotherapy Evidence Database (PEDro), CINAHL (EBSCO), PUBMED, AMED, EMBASE (OVID), The Kinesio Kinesio® Taping Method, Kinesio® Tex Tape UK and International websites ( www.kinesiotaping.co.uk ; www.kinesiotaping.com ) was conducted to June 2015. The outcome measures were pain, disability, range of motion and muscle strength. As data were not suitable for meta-analysis, narrative synthesis were applied. Three randomized controlled trials and one controlled trial (135 patients) were included. The results were conflicting and weak on the effectiveness of taping as an adjunct therapy for improvement of pain, disability, range of motion and muscle strength. Clinical taping in addition to physiotherapy interventions (e.g. exercise, electrotherapy, and manual therapy) might be an optional modality for managing patients with shoulder impingement syndrome, especially for the initial stage of the treatment; however, we need further robust, placebo controlled and consistent studies to prove whether it is more effective than physiotherapy interventions without taping.

The Effect of Theraband Training on Position Sense of Internal and External Rotator Muscles in Male Athletes with Shoulder Impingement Syndrome

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Ramin Moharrami

2015-10-01

Full Text Available Objective: This study evaluated the effect of theraband training on Position sense of internal and external rotator muscles in male athletes with shoulder impingement syndrome. Materials & Methods: In this semi-experimental interventional study 30 cases of men with Shoulder syndrome with age range of 20 to 30 years participated. They were divided in test and control groups, each group including 15 people through non-random and purposeful method Biodex System 3 Made in America was used to measure position sense of internal and external rotator muscles. For data analysis independent 7 paired t-test was used in SPSS software (version 21. Results: The experimental group showed significant improvement after six weeks of theraband training in the internal and external rotator muscles in three 90,45,0 degree angle at a significance level of 0.05 (P=0.05. Conclusion: The results of this study showed that of theraband training resulted in improved position sense of internal and external rotator muscles in male athletes with impingement syndrome thus, the benefits of these exercises can be used widely in team sports and also for easy and quick rehabilitation of patients.

Injury of the ankle joint ligaments; Bandverletzungen des Sprunggelenks

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Breitenseher, M.J. [Institut fuer Radiologie, Landesklinikum Waldviertel Horn, Horn (Austria); Karl Landsteiner Institut, St. Poelten (Austria)

2007-03-15

The diagnosis of lateral collateral ankle ligament trauma is based on patient history, clinical examination and clinical stress tests. If the clinical stress test is positive, stress radiography can be performed. There is, however, no consensus about the usefulness of stress radiography in acute ankle sprain, and in particular about the cut-off talar tilt angle beyond which a two-ligament rupture would be certain, ranging from 5 to 30 . Today, magnetic resonance imaging (MRI) is not used in this area, although it does allow controlled positioning of the foot and defined section visualization of injured lateral collateral ankle ligaments. In acute and chronic sinus tarsi injuries, MRI forms the established basis for diagnostic imaging, and can provide a definitive answer in most cases. MRI is also the method of choice for chronic posttraumatic pain with anterolateral impingement after rupture of the anterior talofibular ligament. Generally, for the evaluation of acute ankle injuries, MRI has developed to be the most important second-step procedure when projection radiology is non-diagnostic. (orig.) [German] Die Diagnose einer lateralen Bandverletzung nach einem Sprunggelenktrauma basiert auf der Anamnese, der klinischen Untersuchung und klinischen Stresstests. Bei positiven klinischen Stresstests kann eine Stressradiographie durchgefuehrt werden. Es gibt keine Uebereinstimmung hinsichtlich des Stellenwerts der Stressradiographie beim frischen Supinationstrauma des Sprunggelenks, insbesondere fuer den Winkel der Aufklappbarkeit bei einer Zweibandverletzung, der von 5 -30 reicht. Die MRT wird bei dieser Indikation zurzeit nur in Einzelfaellen benutzt, obwohl sie mit definierter Fusspositionierung und Ausrichtung der Untersuchungsebene eine ausgezeichnete Beurteilung der Sprunggelenkbaender erlaubt. Sie ist im besonderen Masse geeignet, akute und chronische Verletzungen des Sinus tarsi zu beurteilen. Bei chronischen Beschwerden nach Bandverletzung ist die MRT zur

Shoe rim and shoe buckle pseudotumor of the ankle in elite and professional figure skaters and snowboarders: MR imaging findings

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Anderson, S.E.; Weber, M.; Steinbach, L.S.; Ballmer, F.T.

2004-01-01

To review MR imaging of figure skaters and snowboarders presenting with painful soft-tissue swelling of the lateral supramalleolar region with a clinical provisional diagnosis of soft-tissue tumor. MR imaging was prospectively reviewed by two sub-specialized musculoskeletal radiologists. The findings were correlated with a second clinical review and examination of the shoe wear. The patients were four female athletes undergoing heavy training regimes, ranging in age between 16 and 25 years. Two patients were elite figure skaters, and two were professional snowboarders. Three patients had unilateral masses with pain, and one patient presented with bilateral clinical findings. MR imaging showed subcutaneous, focal soft-tissue masses of the supramalleolar region in five ankles at the same level above the ankle joint. MR imaging prompted a second clinical review and correlation with the shoe wear. The MR imaging findings correlated to the level of the shoe rim or shoe buckle in all patients, confirming the suspected MR imaging diagnosis of an impingement syndrome. All four sportswomen were training excessively, ignoring safety advice regarding training duration, timing of breaks, and shoe wear rotation. (orig.)

The reliability of three-dimensional scapular attitudes in healthy people and people with shoulder impingement syndrome

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Hébert Luc J

2007-06-01

Full Text Available Abstract Background Abnormal scapular displacements during arm elevation have been observed in people with shoulder impingement syndrome. These abnormal scapular displacements were evaluated using different methods and instruments allowing a 3-dimensional representation of the scapular kinematics. The validity and the intrasession reliability have been shown for the majority of these methods for healthy people. However, the intersession reliability on healthy people and people with impaired shoulders is not well documented. This measurement property needs to be assessed before using such methods in longitudinal comparative studies. The objective of this study is to evaluate the intra and intersession reliability of 3-dimensional scapular attitudes measured at different arm positions in healthy people and to explore the same measurement properties in people with shoulder impingement syndrome using the Optotrak Probing System. Methods Three-dimensional scapular attitudes were measured twice (test and retest interspaced by one week on fifteen healthy subjects (mean age 37.3 years and eight subjects with subacromial shoulder impingement syndrome (mean age 46.1 years in three arm positions (arm at rest, 70° of humerothoracic flexion and 90° of humerothoracic abduction using the Optotrak Probing System. Two different methods of calculation of 3-dimensional scapular attitudes were used: relative to the position of the scapula at rest and relative to the trunk. Intraclass correlation coefficient (ICC and standard error of measure (SEM were used to estimate intra and intersession reliability. Results For both groups, the reliability of the three-dimensional scapular attitudes for elevation positions was very good during the same session (ICCs from 0.84 to 0.99; SEM from 0.6° to 1.9° and good to very good between sessions (ICCs from 0.62 to 0.97; SEM from 1.2° to 4.2° when using the method of calculation relative to the trunk. Higher levels of

The evaluation of the effectiveness of occupational therapy, using its different programs for the people who are experiencing shoulder impingement syndrome

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Sadauskytė, Sigita

2015-01-01

S. Sadauskytė: The evaluation of the effectiveness of occupational therapy, using its different programs for the people who are experiencing shoulder impingement syndrome. A Master‘s thesis. Research supervisor is dr. E. Sendžikaitė; Institute of sports, Faculty of nursing, Medical Academy,Lithuanian University of Health Sciences, – Kaunas, 2015.

Femoroacetabular impingement

International Nuclear Information System (INIS)

Kassarjian, Ara; Brisson, Melanie; Palmer, William E.

2007-01-01

Femoroacetabular impingement is a relatively recently appreciated 'idiopathic' cause of hip pain and degenerative change. Two types of impingement have been described. The first, cam impingement, is the result of an abnormal morphology of the proximal femur, typically at the femoral head-neck junction. Cam impingement is most common in young athletic males. The second, pincer impingement, is the result of an abnormal morphology or orientation of the acetabulum. Pincer impingement is most common in middle-aged women. This article reviews the imaging findings of cam and pincer type femoroacetabular impingement. Recognition of these entities will help in the selection of the appropriate treatment with the goal of decreasing the likelihood of early degenerative change of the hip

Ultrasound elastography-based assessment of the elasticity of the supraspinatus muscle in impingement syndrome: does elastography has any diagnostic value?

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Demirel, Adnan; Baykara, Murat; Koca, Tuba Tülay; Berk, Ejder

2018-06-01

Ultrasound elastography (UE) is a new ultrasound-based imaging technique that provides information about elasticity and stiffness of tissues. This cross-sectional study aimed to identify the diagnostic importance of UE in supraspinatus impingement syndrome. Forty-one subjects, aged 38-70 years, were included in the study. UE was used to determine the elasticity of the supraspinatus muscle. The strain ratio was calculated as the evaluation criteria to measure the elasticity of the muscle. High strain ratio indicated low elasticity. The measurements were made by the blinded radiologist while the patients sat with their shoulder in a neutral position. The diagnostic value of the strain ratio was evaluated using the receiver operating characteristic (ROC) analysis. The mean strain value of the supraspinatus muscle on the intact and pathological shoulders determined by UE was 0.74 ± 0.33 and 0.31 ± 0.24, respectively. A low strain ratio value in the supraspinatus muscle on the side with impingement syndrome was measured. When the test variable was evaluated as "strain ratio" according to ROC curve analysis, it was found to be above the reference line [0.849 (> 0.5)] (P = 0.00). When the cutoff value was selected as 0.495, the sensitivity and specificity were found to be 75.6 and 78% (the strain ratio value > 0.495), respectively. Measurement of strain ratio with UE can be used as a noninvasive, inexpensive, and practical diagnostic test for the shoulder impingement disease.

Co-occurrence of outlet impingement syndrome of the shoulder and restricted range of motion in the thoracic spine - a prospective study with ultrasound-based motion analysis

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Fuchs-Winkelmann Susanne

2010-06-01

Full Text Available Abstract Background Shoulder complaints, and especially the outlet-impingement syndrome, are a common condition. Among other things, poor posture has been discussed as a cause. A correlation between impingement syndrome and restricted mobility of the thoracic spine (T has been described earlier, but there has been no motion analysis of the thoracic spine to show these correlations. In the present prospective study, we intended to find out whether there is a significant difference in the thoracic sagittal range of motion (ROM between patients with a shoulder outlet impingement syndrome and a group of patients who had no shoulder pathology. Secondly, we wanted to clarify whether Ott's sign correlates with ultrasound topometric measurements. Methods Two sex- and age-matched groups (2 × n = 39 underwent a clinical and an ultrasound topometric examination. The postures examined were sitting up straight, sitting in maximal flexion and sitting in maximal extension. The disabilities of the arm, shoulder and hand (DASH score (obtained by means of a self-assessment questionnaire and the Constant score were calculated. Lengthening and shortening of the dorsal projections of the spine in functional positions was measured by tape with Ott's sign. Results On examination of the thoracic kyphosis in the erect seated posture there were no significant differences between the two groups (p = 0.66. With ultrasound topometric measurement it was possible to show a significantly restricted segmental mobility of the thoracic spine in the study group compared with the control group (p = 0.01. An in-depth look at the mobility of the subsegments T1-4, T5-8 and T9-12 revealed that differences between the groups in the mobility in the lower two sections of the thoracic spine were significant (T5-8: p = 0.03; T9-12: p = 0.02. The study group had an average Constant score of 35.1 points and the control group, 85.5 (p Conclusion The mobility of the thoracic spine should

The role of arthroscopy in the treatment of functional instability of the ankle.

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Kerr, Hui-Ling; Bayley, Edward; Jackson, Rosalyn; Kothari, Paresh

2013-12-01

Ankle sprains are common, the majority resolving with functional rehabilitation. Some patients are left with symptoms of functional instability (FI). Ankle arthroscopy in those with symptoms of FI is not well covered in the literature. Our aim was to assess its role in FI of the ankle. Retrospective case note analysis of patients with FI following an ankle sprain from 2005 to 2007. All underwent arthroscopy, provided mechanical instability was excluded (EUA and stress X-rays), and there were no signs of soft tissue impingement. These patients had exhausted all options of conservative therapy. Seventy-seven patients with a mean age of 38.1: five had true mechanical instability and were excluded. 72 underwent arthroscopy: 67 (93.1%) had significant amounts of scar tissue needing debridement, most commonly in the antero-lateral corner (58.3%). 52 patients improved (72.2%) at a minimum of 6 months follow-up. Our study supports the role of ankle arthroscopy in the treatment of FI following trauma. It should be considered when conservative measures have failed. Copyright © 2013 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

[Effectiveness of physiotherapy on painful shoulder impingement syndrome].

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Gomora-García, Mónica; Rojano-Mejía, David; Solis-Hernández, José Luis; Escamilla-Chávez, Carolina

2016-01-01

Painful shoulder impingement syndrome is one of the first reasons for care in rehabilitation centres. As the evidence regarding the effectiveness of physical measures as adjuvant treatment is limited, the aim of this study was to determine the effectiveness of physiotherapy on shoulder pain. A retrospective and analytical study was conducted using the medical records of patients with shoulder pain who attended in a rehabilitation centre from October 2010 to September 2011. The demographic and clinical data were collected, and the clinical improvement was determined as: complete, incomplete, or no improvement. Chi squared was used to determine whether there were differences between the different modalities of physiotherapy, as well as the level of improvement. The study included a total of 181 patients, with a mean age of 54.3 years, and a mean of 4.6 months of onset of pain. The physiotherapy treatments included: warm compresses plus interferential current (60.2%), and warm compresses plus ultrasound (17.1%). Just over half (53.6%) obtained a moderate recovery, 36.4% slight improvement, and 9.9% no improvement. No significant differences were found between the different forms of therapy. The supervised rehabilitation program consists of 9 sessions of physiotherapy. A functional improvement of 90% was obtained, without finding any statistical differences between the therapies used. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

Trunk, pelvis and hip biomechanics in individuals with femoroacetabular impingement syndrome: Strategies for step ascent.

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Diamond, Laura E; Bennell, Kim L; Wrigley, Tim V; Hinman, Rana S; Hall, Michelle; O'Donnell, John; Hodges, Paul W

2018-03-01

Femoroacetabular impingment (FAI) syndrome is common among young active adults and a proposed risk factor for the future development of hip osteoarthritis. Pain is dominant and drives clinical decision-making. Evidence for altered hip joint function in this patient population is inconsistent, making the identification of treatment targets challenging. A broader assessment, considering adjacent body segments (i.e. pelvis, trunk) and individual movement strategies, may better inform treatment programs. This exploratory study aimed to compare trunk, pelvis, and hip biomechanics during step ascent between individuals with and without FAI syndrome. Fifteen participants diagnosed with symptomatic cam-type or combined (cam plus pincer) FAI who were scheduled for arthroscopic surgery, and 11 age-, and sex-comparable pain- and disease-free individuals, underwent three-dimensional motion analysis during a step ascent task. Trunk, pelvis and hip biomechanics were compared between groups. Participants with FAI syndrome exhibited altered ipsilateral trunk lean and pelvic rise towards the symptomatic side during single-leg support compared to controls. Alterations were not uniformly adopted across all individuals with FAI syndrome; those who exhibited more pronounced alterations to frontal plane pelvis control tended to report pain during the task. There were minimal between-group differences for hip biomechanics. Exploratory data suggest biomechanics at the trunk and pelvis during step ascent differ between individuals with and without FAI syndrome. Those with FAI syndrome implement a range of proximal strategies for task completion, some of which may have relevance for rehabilitation. Longitudinal investigations of larger cohorts are required to evaluate hypothesized clinical and structural consequences. Copyright © 2018 Elsevier B.V. All rights reserved.

Impingement syndrome and rotator cuff tears: US findings in 140 patients

International Nuclear Information System (INIS)

Malvestiti, Oreste; Scorsolini, Alessandro; Ratti, Francesco; Ferraris, Giuseppe; Columbaro, Guido; Mariani, Claudio

1997-01-01

The authors investigated the role of rotator cuff impingement in causing tears of supraspinatus and biceps tendons and the comparative reliability of plain radiography and sonography (US). One hundred forty patients with symtoms referrable to the rotator cuff were examined with plain radiography and US of the shoulder. The differential diagnosis must distinguish all these common causes of shoulder dysfunction and cuff problems from other conditions. The authors conclude that US and plain radiography are accurate routine tests of rotator cuff integrity and rotator cuff impingement

[Athletic pubalgia and hip impingement].

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Berthaudin, A; Schindler, M; Ziltener, J-L; Menetrey, J

2014-07-16

Athletic pubalgia is a painful and complex syndrom encountered by athletes involved in pivoting and cutting sports such as hockey and soccer. To date, there is no real consensus on the criteria for a reliable diagnostic, the different investigations, and the appropriate therapy. Current literature underlines intrinsic and extrinsic factors contributing to athletic pubalgia. This review article reports upon two novelties related to the issue: the importance and efficience of prevention program and the association of femoro-acetabular impingement with the pubalgia.

The clinical and sonographic effects of kinesiotaping and exercise in comparison with manual therapy and exercise for patients with subacromial impingement syndrome: a preliminary trial.

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Kaya, Derya Ozer; Baltaci, Gul; Toprak, Ugur; Atay, Ahmet Ozgur

2014-01-01

The purpose of this study was to compare the effects of manual therapy with exercise to kinesiotaping with exercise for patients with subacromial impingement syndrome. Randomized clinical before and after trial was used. Fifty-four patients diagnosed as having subacromial impingement syndrome who were referred for outpatient treatment were included. Eligible patients (between 30 and 60 years old, with unilateral shoulder pain) were randomly allocated to 2 study groups: kinesiotaping with exercise (n = 28) or manual therapy with exercise (n = 26). In addition, patients were advised to use cold packs 5 times per day to control for pain. Visual analog scale for pain, Disability of Arm and Shoulder Questionnaire for function, and diagnostic ultrasound assessment for supraspinatus tendon thickness were used as main outcome measures. Assessments were applied at the baseline and after completing 6 weeks of related interventions. At the baseline, there was no difference between the 2 group characteristics (P > .05). There were significant differences in both groups before and after treatment in terms of pain decrease and improvement of Disability of Arm and Shoulder Questionnaire scores (P .05). The only difference between the groups was at night pain, resulting in favor of the kinesiotaping with exercise group (P kinesiotaping with exercise and manual therapy with exercise. Both treatments may have similar results in reducing pain and disability in subacromial impingement in 6 weeks. Copyright © 2014 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.

PERBANDINGAN ANTARA KOMBINASI LATIHAN STABILISASI BAHU DAN TRAKSI HUMERUS KE INFERIOR DENGAN KOMBINASI LATIHAN FUNGSIONAL BAHU DAN TRAKSI HUMERUS KE INFERIOR DALAM MENURUNKAN DISABILITAS BAHU DAN LENGAN PADA SUBACROMIAL IMPINGEMENT SYNDROME MAHASISWA AKAD

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Mawaddah -

2015-08-01

Full Text Available Shoulder impingement causing interference on the motion of the shoulder joint activities and result in functional activity disorder. These injuries usually are caused by faulty movement, overuse, poor posture, occupational factors and trauma. This will cause a burden on one part of the body and cause imbalances in anatomy, which will eventually lead to disruption of the body that experienced work. This study aimed to investigate the effect of functional shoulder exercise and traction humerus to inferior with shoulder stabilization exercises and traction humerus to inferior to the decline in the shoulder and arm disabilities in subacromial impingement syndrome. This research method was experimental clinical trials with pre test and post test group design. Population student Academy Physiotherapy Widya Husada Semarang, which consists of 3 men and 12 women, aged between 18-21 years, divided into two groups. Group I was given Shoulder Stabilization exercises and Traction humerus to Inferior (n=7 and group II Functional Shoulder Exercise and Traction humerus to Inferior (n=8. This research was conducted for 3 weeks. Measurement of the value of disability shoulder and arm by using the Shoulder Pain and Disability Index (SPADI. The test results on the group I average value pre 34.17, SB = 6.31, and the average value of post 11.54, SB = 4.02, p = 0.001 found significant differences obtained test results paired sample t-test, and testing group II average value pre 40.18, SB = 3.53, and the average value of post 7.82, SB = 1.57, p = 0.001 found significant differences obtained test results paired sample t-test. Comparison of Group I and II, p = 0.005 there were significant differences, test results obtained independent sample t-test. Conclusions: The combination of shoulder stabilization exercises and traction humerus to inferior can reduce disability shoulder and arm on subacromial impingement syndrome. The combination functional shoulder exercise and

Comparison of Ankle Joint Visualization Between the 70° and 30° Arthroscopes: A Cadaveric Study.

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Tonogai, Ichiro; Hayashi, Fumio; Tsuruo, Yoshihiro; Sairyo, Koichi

2018-02-01

Ankle arthroscopy is an important diagnostic and therapeutic tool. Arthroscopic ankle surgery for anterior ankle impingement or osteochondral lesions (OCLs) is mostly performed with a 30° arthroscope; however, visualization of lesions is sometimes difficult. This study sought to compare ankle joint visualization between 70° and 30° arthroscopes and clarify the effectiveness of 70° arthroscopy. Standard anterolateral and anteromedial portals were placed with 4-mm 70° or 30° angled arthroscopes in a fresh 77-year-old male cadaveric ankle. The medial ligament and surrounding tissue were dissected via a medial malleolar skin incision. Kirschner wires were inserted into the distal tibia anterior edge; 5-mm diameter OCLs were created on the medial talar gutter anteriorly, midway, and posteriorly. The talar dome and distal tibia anterior edge were visualized using both arthroscopes. The 70° arthroscope displayed the anterior edge of the distal tibia immediately in front of the arthroscope, allowing full visualization of the posterior OCL of the medial talar gutter more clearly than the 30° arthroscope. This study revealed better ankle joint visualization with the 70° arthroscope, and may enable accurate, safe, and complete debridement, especially in treatment of medial talar gutter posterior OCLs and removal of anterior distal tibial edge bony impediments. Level IV, Anatomic study.

Perspectives on fish impingement

International Nuclear Information System (INIS)

Sharma, R.K.

1977-01-01

Data on fish impingement and related parameters are being gathered at a large number of power stations throughout the country at substantial monetary and manpower costs. A national survey of fish impingement at power plants was conducted and much of the information compiled in a standardized format--an effort that we think will aid in planning improvements in the design, siting, and operation of the cooling-water intakes. This paper examines the objectives of the fish impingement studies, monitoring programs, variables affecting fish impingement, siting and design criteria, state-of-the-art of screening systems, and suggestions for meeting 316(b) requirements. It also discusses where the emphasis should be placed in future fish-impingement related activities

Surgical criteria for femoroacetabular impingement syndrome: a scoping review.

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Peters, Scott; Laing, Alisha; Emerson, Courtney; Mutchler, Kelsey; Joyce, Thomas; Thorborg, Kristian; Hölmich, Per; Reiman, Michael

2017-11-01

The purpose of this review was to analyse and report criteria used for open and arthroscopic surgical treatment of femoroacetabular impingement syndrome (FAIS). A librarian-assisted computer search of Medline, CINAHL and Embase for studies related to criterion for FAIS surgery was used in this study. Inclusion criteria included studies with the primary purpose of surgery or surgical outcomes for treatment of FAIS with and without labral tear, and reporting criteria for FAIS surgery. Diagnostic imaging was a criterion for surgery in 92% of the included studies, with alpha angle the most frequently reported (68% of studies) criterion. Reporting of symptoms was a criterion for surgery in 75%, and special tests a criterion in 70% of studies. Range-of-motion limitations were only a required criterion in 30%, only 12% of studies required intra-articular injection and 44% of studies described previously failed treatment (non-surgical or physiotherapist-led rehabilitation) as a criterion for surgery. Only 56% of included studies utilised the combination of symptoms, clinical signs and diagnostic imaging combined for diagnosis of FAIS as suggested by the Warwick Agreement on FAIS meeting. Diagnostic imaging evidence of FAIS was the most commonly reported criterion for surgery. Only 56% of included studies utilised the combination of symptoms, clinical signs and diagnostic imaging for diagnosis of FAIS as suggested by the Warwick Agreement on FAIS meeting, and only 44% of studies had failed non-surgical treatment (and 18% a failed trial of physiotherapy) as a criterion for surgery. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Effect of Adding Interferential Current in an Exercise and Manual Therapy Program for Patients With Unilateral Shoulder Impingement Syndrome: A Randomized Clinical Trial.

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Gomes, Cid André Fidelis de Paula; Dibai-Filho, Almir Vieira; Moreira, William Arruda; Rivas, Shirley Quispe; Silva, Emanuela Dos Santos; Garrido, Ana Claudia Bogik

The purpose of this study was to measure the additional effect of adding interferential current (IFC) to an exercise and manual therapy program for patients with unilateral shoulder impingement syndrome. Forty-five participants were randomly assigned to group 1 (exercise and manual therapy), group 2 (exercise and manual therapy + IFC), or group 3 (exercise and manual therapy + placebo ultrasound). Individuals participated in 16 treatment sessions, twice a week for 8 weeks. The primary outcome of the study was total score of the Shoulder Pain and Disability Index (SPADI). The secondary outcomes were the pain and disability subscales of SPADI, Numeric Rating Scale, and Pain-Related Self-Statement Scale. Adjusted between-group mean differences (MDs) and 95% confidence intervals (CIs) were calculated using linear mixed models. After 16 treatment sessions, statistically significant but not clinically important differences were identified in favor of the exercise and manual therapy program alone in the SPADI-total (group 1 vs group 2, MD 11.12 points, 95% CI 5.90-16.35; group 1 vs group 3, MD 13.43 points, 95% CI 8.21-18.65). Similar results were identified for secondary outcomes. The addition of IFC does not generate greater clinical effects in an exercise and manual therapy program for individuals with unilateral shoulder impingement syndrome. Copyright © 2018. Published by Elsevier Inc.

Guideline for diagnosis and treatment of subacromial pain syndrome

NARCIS (Netherlands)

Diercks, Ronald; Bron, Carel; Dorrestijn, Oscar; Meskers, Carel; Naber, René; de Ruiter, Tjerk; Willems, Jaap; Winters, Jan; van der Woude, Henk Jan

Treatment of "subacromial impingement syndrome" of the shoulder has changed drastically in the past decade. The anatomical explanation as "impingement" of the rotator cuff is not sufficient to cover the pathology. "Subacromial pain syndrome", SAPS, describes the condition better. A working group

Ankle arthroscopy

Science.gov (United States)

Ankle surgery; Arthroscopy - ankle; Surgery - ankle - arthroscopy; Surgery - ankle - arthroscopic ... Arthroscopy may be recommended for these ankle problems: Ankle pain. Arthroscopy allows the surgeon to explore what ...

Relationship between viscosity of the ankle joint complex and functional ankle instability for inversion ankle sprain patients.

Science.gov (United States)

Lin, Che-Yu; Kang, Jiunn-Horng; Wang, Chung-Li; Shau, Yio-Wha

2015-03-01

Measurement of viscosity of the ankle joint complex is a novel method to assess mechanical ankle instability. In order to further investigate the clinical significance of the method, this study intended to investigate the relationship between ankle viscosity and severity of functional ankle instability. Cross-sectional study. 15 participants with unilateral inversion ankle sprain and 15 controls were recruited. Their ankles were further classified into stable and unstable ankles. Ankle viscosity was measured by an instrumental anterior drawer test. Severity of functional ankle instability was measured by the Cumberland Ankle Instability Tool. Unstable ankles were compared with stable ankles. Injured ankles were compared with uninjured ankles of both groups. The spearman's rank correlation coefficient was applied to determine the relationship between ankle viscosity and severity of functional ankle instability in unstable ankles. There was a moderate relationship between ankle viscosity and severity of functional ankle instability (r=-0.64, pankles exhibited significantly lower viscosity (pankle instability (pankles. Injured ankles exhibited significantly lower viscosity and more severe functional ankle instability than uninjured ankles (pankle viscosity and severity of functional ankle instability. This finding suggested that, severity of functional ankle instability may be partially attributed to mechanical insufficiencies such as the degenerative changes in ankle viscosity following the inversion ankle sprain. In clinical application, measurement of ankle viscosity could be a useful tool to evaluate severity of chronic ankle instability. Copyright © 2014 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Correction of tibial malunion in a patient with ipsilateral total knee and ankle prostheses using external ring fixation and the ilizarov method

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Alexander M Smith

2017-01-01

Full Text Available Total ankle replacement (TAR aims at reestablishing a functional and painless ankle joint while maintaining motion and preventing adjacent joint arthritis. TAR can be complicated by comorbidities such as ipsilateral knee arthritis and deformity with subsequent arthroplasty and/or other lower extremity malalignment issues. We present a case of a 67-year-old female with severe right ankle pain and a history of ipsilateral subtalar and calcaneocuboid fusion, bilateral total knee arthroplasty, and a malunion of a conservatively treated ipsilateral segmental tibial fracture. Following TAR, there was recurrent lateral hindfoot pain due to subtle malalignment from the tibial malunion which resulted in persistent hindfoot valgus. This caused symptomatic subfibular impingement in addition to limb length discrepancy. To address that, a circular external fixator was applied to realign the ankle and lengthen the tibia, eliminating pain and avoiding complications with either implant.

Coupled Lagrangian impingement spray model for doublet impinging injectors under liquid rocket engine operating conditions

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Qiang WEI

2017-08-01

Full Text Available To predict the effect of the liquid rocket engine combustion chamber conditions on the impingement spray, the conventional uncoupled spray model for impinging injectors is extended by considering the coupling of the jet impingement process and the ambient gas field. The new coupled model consists of the plain-orifice sub-model, the jet-jet impingement sub-model and the droplet collision sub-model. The parameters of the child droplet are determined with the jet-jet impingement sub-model using correlations about the liquid jet parameters and the chamber conditions. The overall model is benchmarked under various impingement angles, jet momentum and off-center ratios. Agreement with the published experimental data validates the ability of the model to predict the key spray characteristics, such as the mass flux and mixture ratio distributions in quiescent air. Besides, impinging sprays under changing ambient pressure and non-uniform gas flow are investigated to explore the effect of liquid rocket engine chamber conditions. First, a transient impingement spray during engine start-up phase is simulated with prescribed pressure profile. The minimum average droplet diameter is achieved when the orifices work in cavitation state, and is about 30% smaller than the steady single phase state. Second, the effect of non-uniform gas flow produces off-center impingement and the rotated spray fan by 38°. The proposed model suggests more reasonable impingement spray characteristics than the uncoupled one and can be used as the first step in the complex simulation of coupling impingement spray and combustion in liquid rocket engines.

Coupled Lagrangian impingement spray model for doublet impinging injectors under liquid rocket engine operating conditions

Institute of Scientific and Technical Information of China (English)

Qiang WEI; Guozhu LIANG

2017-01-01

To predict the effect of the liquid rocket engine combustion chamber conditions on the impingement spray,the conventional uncoupled spray model for impinging injectors is extended by considering the couplingof the jet impingement process and the ambient gas field.The new coupled model consists of the plain-orifice sub-model,the jet-jet impingement sub-model and the droplet collision sub-model.The parameters of the child droplet are determined with the jet-jet impingement sub-model using correlations about the liquid jet parameters and the chamber conditions.The overall model is benchmarked under various impingement angles,jet momentum and offcenter ratios.Agreement with the published experimental data validates the ability of the model to predict the key spray characteristics,such as the mass flux and mixture ratio distributions in quiescent air.Besides,impinging sprays under changing ambient pressure and non-uniform gas flow are investigated to explore the effect of liquid rocket engine chamber conditions.First,a transient impingement spray during engine start-up phase is simulated with prescribed pressure profile.The minimum average droplet diameter is achieved when the orifices work in cavitation state,and is about 30％ smaller than the steady single phase state.Second,the effect of non-uniform gas flow produces off-center impingement and the rotated spray fan by 38°.The proposed model suggests more reasonable impingement spray characteristics than the uncoupled one and can be used as the first step in the complex simulation of coupling impingement spray and combustion in liquid rocket engines.

Impingement: an annotated bibliography

International Nuclear Information System (INIS)

Uziel, M.S.; Hannon, E.H.

1979-04-01

This bibliography of 655 annotated references on impingement of aquatic organisms at intake structures of thermal-power-plant cooling systems was compiled from the published and unpublished literature. The bibliography includes references from 1928 to 1978 on impingement monitoring programs; impingement impact assessment; applicable law; location and design of intake structures, screens, louvers, and other barriers; fish behavior and swim speed as related to impingement susceptibility; and the effects of light, sound, bubbles, currents, and temperature on fish behavior. References are arranged alphabetically by author or corporate author. Indexes are provided for author, keywords, subject category, geographic location, taxon, and title

Shoulder functionality after manual therapy in subjects with shoulder impingement syndrome: a case series.

Science.gov (United States)

Heredia-Rizo, Alberto Marcos; López-Hervás, Antonia; Herrera-Monge, Patricia; Gutiérrez-Leonard, Ana; Piña-Pozo, Fernando

2013-04-01

The aim of the study was to identify the differences in functionality of the upper limb in subjects suffering from shoulder impingement syndrome after intervention by two manual therapy protocols. Randomized, single-blind study with a sample of 22 subjects (58 ± 10.86 years old) divided into two groups. The conventional-group (n = 11) received mobilizations of the shoulder and the experimental-group (n = 11) was treated with soft tissue techniques in the cervical and upper thoracic regions. These two groups received electrotherapy and postural advices. The treatment lasted three weeks (15 daily sessions of 1 h and 30 min). Both active and passive range of motion (ROM) and self-perceived functionality of the upper limb (DASH questionnaire) were measured. The experimental group showed a significant improvement in the DASH scores and both groups improved mobility in the intra-group comparison pre-intervention versus post-intervention (p .05). Our results suggest that a combined treatment with electrotherapy, postural hygiene and manual therapy, regardless of the protocol, improves shoulder mobility and functionality. Copyright © 2012 Elsevier Ltd. All rights reserved.

Ankle replacement

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Ankle arthroplasty - total; Total ankle arthroplasty; Endoprosthetic ankle replacement; Ankle surgery ... Ankle replacement surgery is most often done while you are under general anesthesia. This means you will ...

Femoroacetabular impingement

International Nuclear Information System (INIS)

Anderson, Suzanne E.; Siebenrock, Klaus Arno; Tannast, Moritz

2012-01-01

Femoroacetabular impingement (FAI) is a pathomechanical concept describing the early and painful contact of morphological changes of the hip joint, both on the acetabular, and femoral head sides. These can lead clinically to symptoms of hip and groin pain, and a limited range of motion with labral, chondral and bony lesions. Pincer impingement generally involves the acetabular side of the joint where there is excessive coverage of the acetabulum, which may be focal or more diffuse. There is linear contact of the acetabulum with the head/neck junction. Cam impingement involves the femoral head side of the joint where the head is associated with bony excrescences and is aspheric. The aspheric femoral head jams into the acetabulum. Imaging appearances are reviewed below. This type is evident in young males in the second and third decades. The main features of FAI are described.

Internal Impingement of the Shoulder: A Risk of False Positive Test Outcomes in External Impingement Tests?

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Tim Leschinger

2017-01-01

Full Text Available Background. External impingement tests are considered as being particularly reliable for identifying subacromial and coracoid shoulder impingement mechanisms. The purpose of the present study was to evaluate if these tests are likely to provoke an internal shoulder impingement mechanism which, in cases of a pathologic condition, can lead to a positive test result. Method. In 37 subjects, the mechanical contact between the glenoid rim and the rotator cuff (RC was measured quantitatively and qualitatively in external impingement test positions using an open MRI system. Results. Mechanical contact of the supraspinatus with the posterosuperior glenoid was present in 30 subjects in the Neer test. In the Hawkins test, the subscapularis was in contact with the anterosuperior glenoid in 33 subjects and the supraspinatus in 18. In the horizontal impingement test, anterosuperior contact of the supraspinatus with the glenoid was identified in 35 subjects. Conclusion. The Neer, Hawkins, and horizontal impingement tests are likely to provoke the mechanism of an internal shoulder impingement. A posterosuperior internal impingement mechanism is being provoked predominately in the Neer test. The Hawkins test narrows the distance between the insertions of the subscapularis and supraspinatus and the anterosuperior labrum, which leads to an anterosuperior impingement mechanism.

Assessment of female ballet dancers' ankles in the en pointe position using high field strength magnetic resonance imaging.

Science.gov (United States)

Russell, Jeffrey A; Yoshioka, Hiroshi

2016-08-01

The en pointe position of the ankle in ballet is extreme. Previously, magnetic resonance imaging (MRI) of ballet dancers' ankles en pointe was confined to a low field, open MR device. To develop a reproducible ankle MRI protocol for ballet dancers en pointe and to assess the positions of the key structures in the dancers ankles. Six female ballet dancers participated; each was randomly assigned to stand en pointe while one of her feet and ankles was splinted with wooden rods affixed with straps or to begin with the ankle in neutral position. She lay in an MR scanner with the ankle inside a knee coil for en pointe imaging and inside an ankle/foot coil for neutral position imaging. Proton density weighted images with and without fat suppression and 3D water excitation gradient recalled echo images were obtained en pointe and in neutral position in sagittal, axial, and coronal planes. We compared the bones, cartilage, and soft tissues within and between positions. No difficulties using the protocol were encountered. En pointe the posterior articular surface of the tibial plafond was incongruent with the talar dome and rested on the posterior talus. The posterior edge of the plafond impinged Kager's fat pad. All participants exhibited one or more small ganglion cysts about the ankle and proximal foot, as well as fluid accumulation in the flexor and fibularis tendon sheaths. Our MRI protocol allows assessment of female ballet dancers' ankles in the extreme plantar flexion position in which the dancers perform. We consistently noted incongruence of the talocrural joint and convergence of the tibia, talus, and calcaneus posteriorly. This protocol may be useful for clinicians who evaluate dancers. © The Foundation Acta Radiologica 2015.

High resolution ultrasonography in ankle joint pain: Where does it stand?

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Mennatallah Hatem Shalaby

2017-09-01

Full Text Available Background: The ankle is frequently injured in trauma, overuse syndrome and inflammatory processes. Different imaging modalities assess the ankle, including plain radiography, computed tomography (CT, magnetic resonance imaging (MRI, and ultrasonography (US. Purpose: Our objective is to assess the role of high resolution US as a valuable tool in the depiction of causes of ankle joint pain. Patients and methods: The study included 28 patients presented with ankle pain ranging in age from 17 to 60 years. They were examined by US and findings were correlated with MRI. Results: US was capable to detect various lesions (synovitis, arthritis, plantar fasciitis, tendon and ligamentous lesions. It had a sensitivity of 95.4%, a specificity of 83.3% and an overall accuracy of 92.8%. US had a limited value in detection of avascular necrosis (AVN, bone marrow oedema and fractures. Conclusion: US can be used as a first step diagnostic tool in cases of ankle pain. MRI should be spared to cases with negative or equivocal US findings. Keywords: High resolution ultrasound, Ankle joint pain, Tendons, Ligaments, Synovitis, Arthritis

Os Trigonum Syndrome

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... other conditions, such as an Achilles tendon injury, ankle sprain or talus fracture. Diagnosis of os trigonum syndrome begins with questions from the doctor about the development of symptoms. After the foot and ankle are examined, x-rays or other imaging tests ...

Ankle and toe muscle strength characteristics in runners with a history of medial tibial stress syndrome.

Science.gov (United States)

Saeki, Junya; Nakamura, Masatoshi; Nakao, Sayaka; Fujita, Kosuke; Yanase, Ko; Morishita, Katsuyuki; Ichihashi, Noriaki

2017-01-01

A high proportion of flexor digitorum longus attachment is found at the posteromedial border of the tibia, which is the most common location of medial tibial stress syndrome (MTSS). Therefore, plantar flexion strength of the lesser toes could be related to MTSS; however, the relationship between MTSS and muscle strength of the hallux and lesser toes is not yet evaluated due to the lack of quantitative methods. This study investigated the muscle strength characteristics in runners with a history of MTSS by using a newly developed device to measure the muscle strength of the hallux, lesser toes, and ankle. This study comprised 27 collegiate male runner participants (20.0 ± 1.6 years, 172.1 ± 5.1 cm, 57.5 ± 4.0 kg). Maximal voluntary isometric contraction (MVIC) torque of the plantar flexion, dorsiflexion, inversion, and eversion of the ankle were measured by using an electric dynamometer. MVIC torque of the 1st metatarsophalangeal joint (MTPJ) and 2nd-5th MTPJ were measured by using a custom-made torque-measuring device. MVIC torques were compared between runners with and without a history of MTSS. MVIC torque of the 1st MTPJ plantar flexion was significantly higher in runners with a history of MTSS than in those without it. In contrast, there were no significant differences in the MVIC torque values of the 2nd-5th MTPJ plantar flexion and each MVIC torque of the ankle between runners with and without a history of MTSS. A history of MTSS increased the isometric FHL strength.

Surgery for subacromial impingement syndrome in relation to intensities of occupational mechanical exposures across 10-year exposure time windows

DEFF Research Database (Denmark)

Dalbøge, Annett; Frost, Poul; Andersen, Johan Hviid

2018-01-01

OBJECTIVES: We aimed to identify intensities of occupational mechanical exposures (force, arm elevation and repetition) that do not entail an increased risk of surgery for subacromial impingement syndrome (SIS) even after prolonged durations of exposure. Additionally, we wanted to evaluate...... if exposure to hand-arm vibration (HAV) is an independent risk factor. METHODS: We used data from a register-based cohort study of the entire Danish working population (n=2 374 403). During follow-up (2003-2008), 14 118 first-time events of surgery for SIS occurred. For each person, we linked register...... of exposure at specific intensities above minimal (low, medium and high). We used a logistic regression technique equivalent to discrete survival analysis adjusting for cumulative effects of other mechanical exposures. RESULTS: We found indications of safe exposure intensities for repetition (median angular...

The Natural History of Femoroacetabular Impingement

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Benjamin D. Kuhns

2015-11-01

Full Text Available Femoroacetabular impingement (FAI is a clinical syndrome resulting from abnormal hip joint morphology and is a common cause of hip pain in young adults. FAI has been posited as a precursor to hip osteoarthritis, however, conflicting evidence exists and the true natural history of the disease is unclear. The purpose of this article is to review the current understanding of how FAI damages the hip joint by highlighting its pathomechanics and etiology. We then review the current evidence relating FAI to osteoarthritis. Lastly, we will discuss the potential of hip preservation surgery to alter the natural history of FAI, reduce the risk of developing osteoarthritis and the need for future arthroplasty.

An Unusual Os Trigonum Syndrome Case Secondary to Car Accident: A Case Report

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Safer

2016-03-01

Full Text Available Introduction The os trigonum syndrome is a common cause of posterior ankle pain, often affecting ballet dancers, soccer players, runners and gymnasts who frequently force the ankle into plantar flexion. In rare cases, onset of the os trigonum syndrome followed an acute injury. Case Presentation A 62-year-old female patient was admitted with load depended ankle pain and swelling, lasting for five years which promptly started after a car accident. We incidentally discovered os trigonum on plain radiography on a lateral view of the right ankle. Conclusions The os trigonum syndrome should take in consideration in elderly subject who had posterior ankle pain starting after a car accident.

The Comparison of Ankle Muscles Isometric Strength and Foot Eversion in Male Individuals with Patellofemoral Pain Syndrome and Healthy Peers: A Case-Control Study

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V. Mazloum

2017-01-01

Full Text Available Introduction: Proximal and distal factors to the knee joint can be assumed as etiology of patellofemoral pain syndrome (PFPS. Some distal factors include excessive foot pronation and medial tibia torsion. The purpose of this study was to compare ankle musculature strength and rearfoot eversion in individuals with and without PFPS. Methods: Forty males (20 healthy and 20 patients voluntarily participated in this case-control study. Isometric ankle dorsiflexor and invertor muscles strength, rearfoot eversion range of motion (ROM, and Navicular depression were respectively evaluated by handheld dynamometer, goniometry, and Navicular Drop Test by a single examiner for both groups. To analyze the measurements, Independent Samples t test for parametric data and Mann-Whitney U test for nonparametric data at P0.05. Furthermore, no significant differences were observed between patients with PFPS and healthy counterparts regarding rearfoot eversion and Navicular depression (P>0.05. Conclusion: It can be deduced that isometric ankle dorsiflexor and invertor muscles strength, rearfoot eversion ROM, and foot pronation are not difference in patients with PFPS and healthy persons. 

Ankle replacement - discharge

Science.gov (United States)

... total - discharge; Total ankle arthroplasty - discharge; Endoprosthetic ankle replacement - discharge; Osteoarthritis - ankle ... You had an ankle replacement. Your surgeon removed and reshaped ... an artificial ankle joint. You received pain medicine and were ...

Ankle instability

NARCIS (Netherlands)

Krips, Rover; de Vries, Jasper; van Dijk, C. Niek

2006-01-01

The ankle joint is the most congruent joint of the human body. Stability is provided by the bony configuration of the ankle mortise and the talar dome and by the ankle ligaments. During ankle motions, rotation and translation around and along the movement axes occur. Soft tissue stability is

The impact of chiropractic manipulative therapy on chronic recurrent lateral ankle sprain syndrome in two young athletes.

Science.gov (United States)

Gillman, Scott F

2004-01-01

To describe two cases of abrupt resolution of chronic, recurrent, inversion sprain to ankles in young recreational athletes. A 13-year-old, female, avid recreational soccer player with ankles that would spontaneously invert during various inconsistent points in the weight bearing gait cycle, sometimes with acute pain or sprain to the ankle. No intervention was attempted prior to her entry to the chiropractic office. A 17-year-old male avid skate- boarder and snowboarder whose left ankle routinely "gave out" into inversion upon mundane weight bearing activity, usually with pain and with dependence on wearing an ankle support when skateboarding to lessen ankle pain. The patient had used an ankle support prior to seeking chiropractic care. High velocity, low amplitude chiropractic manipulative therapy applied to the spine, pelvis and extremity joints was the primary intervention in both cases, with particular focus on the ankle. Other procedures used included taping and orthotics, but not before the manipulation effect was noted. High velocity, low amplitude chiropractic manipulative therapy to the spine, pelvis, and extremities, particularly at the ankle, should be considered when managing young recreational athletes with functional chronic, recurrent, ankle inversion sprains.

Syndesmotic ankle sprain.

Science.gov (United States)

Childs, Sharon G

2012-01-01

Ankle sprain injuries are the most common type of joint sprain. The prevalence of ankle joint sprains accounts for 21% of joint injuries in the body. Although somewhat rare, high-ankle or syndesmotic ankle sprains occur in up to 15% of ankle trauma. This article will present the pathomechanics of the high-ankle or syndesmotic sprain.

Ankle sprain (image)

Science.gov (United States)

An ankle sprain is a common injury to the ankle. The most common way the ankle is injured is when ... swelling, inflammation, and bruising around the ankle. An ankle sprain injury may take a few weeks to many ...

Value of imaging modalities in sinus tarsi syndrome

International Nuclear Information System (INIS)

Young, J.W.R.; Resnick, C.S.; Kenzora, J.E.

1989-01-01

Sinus tarsi syndrome consists of ankle pain, giving way of the ankle, and tenderness over the sinus tarsi after acute ankle injury (usually inversion). Plan radiographic evaluation is unrewarding. This paper reports on stress CT scanning performed in 25 patients with sinus tarsi syndrome; 18 of these patients also underwent MR imaging; and all patients had routine radiographs. No consistent significant abnormalities were seen on CT. Ligamentous injury of the calcaneofibular or talocalcaneal ligament was suggested on MR images in six cases. Therefore, CT was not helpful in evaluating sinus tarsi syndrome, and the MR findings were present in only one-third of cases, suggesting either that MR imaging is not at present sufficiently accurate to detect all abnormalities or ligamentous injury is not the underlying cause for sinus tarsi syndrome

Ankle sprain - aftercare

Science.gov (United States)

Lateral ankle sprain - aftercare; Medial ankle sprain - aftercare; Medial ankle injury - aftercare; Ankle syndesmosis sprain - aftercare; Syndesmosis injury - aftercare; ATFL injury - aftercare; CFL injury - ...

Fish impingement at Montecello Nuclear Plant

International Nuclear Information System (INIS)

Grotbeck, L.M.; Bechthold, J.L.

1975-01-01

To properly evaluate total impact of power generation facilities on aquatic systems, it is necessary to perform site specific fish impingement studies. Intake and screen approach velocities should not be averaged when considering potential screen impingement problems because of wide vertical and horizontal variation in velocity which tend to trap fish. It was estimated that 2,952 fish were impinged during 4 months of sampling with 90.9% of these comprised of black bullheads (Ictalurus melas) and black crappies (Pomoxis nigromaculatus). Distinct relationships can be found between number of impinging fish and river flow, percentage river diverted through the plant, water temperature, and the time of year. For the months of June, July, August, and September, approx 55% of all impingement occurs in June

MAGNETIC RESONANCE IMAGING EVALUATION OF ROTATOR CUFF IMPINGEMENT

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Chandrakanth K. S

2017-06-01

Full Text Available BACKGROUND Shoulder pain is a common clinical problem. Impingement syndrome of the shoulder is believed to be the most common cause of shoulder pain. The term ‘impingement syndrome’ was first used by Neer to describe a condition of shoulder pain associated with chronic bursitis and partial thickness tear of Rotator Cuff (RC. The incidence of Rotator Cuff (RC tear is estimated to be about 20.7% in the general population. This study is intended to analyse various extrinsic and intrinsic causes of shoulder impingement. MATERIALS AND METHODS 110 consecutive patients referred for MRI with clinical suspicion of shoulder impingement were prospectively studied. All the patients were evaluated for Rotator Cuff (RC degeneration and various extrinsic factors that lead to degeneration like acromial shape, down-sloping acromion, Acromioclavicular (AC joint degeneration and acromial enthesophyte. Intrinsic factors like degeneration and its correlation with age of the patients were evaluated. RESULTS Of the total 110 patients, 19 (17.3% patients had FT RC tear and 31 (28.2% had PT (both bursal and articular surface tears. There was no statistically significant correlation (p=0.76 between acromion types and RC tear. Down-sloping acromion and enthesophytes had statistically significant association with RC tear (p=0.008 and 0.008, respectively. Statistically significant (0.008 correlation between the severity of AC joint degeneration and RC tears was noted. AC joint degeneration and RC pathologies also showed a correlation with the age of the patients with p values of <0.001 and 0.001, respectively. CONCLUSION No statistically significant correlation between RC pathologies with hooked acromion was found, that makes the role played by hooked acromion in FT RC tear questionable. AC joint degeneration association with RC tear is due to the association of both RC tear and AC joint degeneration with age of the patient. Down-sloping acromion, AC joint degeneration

Ankle Sprains

Science.gov (United States)

... Staying Safe Videos for Educators Search English Español Ankle Sprains KidsHealth / For Teens / Ankle Sprains What's in this ... How Do I Know if I Have a Sprain? If your ankle hurts enough after an injury that you need ...

Expecting ankle tilts and wearing an ankle brace influence joint control in an imitated ankle sprain mechanism during walking.

Science.gov (United States)

Gehring, Dominic; Wissler, Sabrina; Lohrer, Heinz; Nauck, Tanja; Gollhofer, Albert

2014-03-01

A thorough understanding of the functional aspects of ankle joint control is essential to developing effective injury prevention. It is of special interest to understand how neuromuscular control mechanisms and mechanical constraints stabilize the ankle joint. Therefore, the aim of the present study was to determine how expecting ankle tilts and the application of an ankle brace influence ankle joint control when imitating the ankle sprain mechanism during walking. Ankle kinematics and muscle activity were assessed in 17 healthy men. During gait rapid perturbations were applied using a trapdoor (tilting with 24° inversion and 15° plantarflexion). The subjects either knew that a perturbation would definitely occur (expected tilts) or there was only the possibility that a perturbation would occur (potential tilts). Both conditions were conducted with and without a semi-rigid ankle brace. Expecting perturbations led to an increased ankle eversion at foot contact, which was mediated by an altered muscle preactivation pattern. Moreover, the maximal inversion angle (-7%) and velocity (-4%), as well as the reactive muscle response were significantly reduced when the perturbation was expected. While wearing an ankle brace did not influence muscle preactivation nor the ankle kinematics before ground contact, it significantly reduced the maximal ankle inversion angle (-14%) and velocity (-11%) as well as reactive neuromuscular responses. The present findings reveal that expecting ankle inversion modifies neuromuscular joint control prior to landing. Although such motor control strategies are weaker in their magnitude compared with braces, they seem to assist ankle joint stabilization in a close-to-injury situation. Copyright © 2013 Elsevier B.V. All rights reserved.

Can Chronic Ankle Instability be Prevented? Rethinking Management of Lateral Ankle Sprains.

Science.gov (United States)

Denegar, Craig R.; Miller, Sayers J., III

2002-01-01

Investigates whether chronic ankle instability can be prevented, discussing: the relationship between mechanical and functional instability; normal ankle mechanics, sequelae to lateral ankle sprains, and abnormal ankle mechanics; and tissue healing, joint dysfunction, and acute lateral ankle sprain management. The paper describes a treatment model…

Guideline for diagnosis and treatment of subacromial pain syndrome: a multidisciplinary review by the Dutch Orthopaedic Association

NARCIS (Netherlands)

Diercks, R.; Bron, C.; Dorrestijn, O.; Meskers, C.; Naber, R.; Ruiter, T. de; Willems, J.; Winters, J.; Woude, H.J. van der; et al.,

2014-01-01

Treatment of "subacromial impingement syndrome" of the shoulder has changed drastically in the past decade. The anatomical explanation as "impingement" of the rotator cuff is not sufficient to cover the pathology. "Subacromial pain syndrome", SAPS, describes the condition better. A working group

Fluorescence Imaging Study of Impinging Underexpanded Jets

Science.gov (United States)

Inman, Jennifer A.; Danehy, Paul M.; Nowak, Robert J.; Alderfer, David W.

2008-01-01

An experiment was designed to create a simplified simulation of the flow through a hole in the surface of a hypersonic aerospace vehicle and the subsequent impingement of the flow on internal structures. In addition to planar laser-induced fluorescence (PLIF) flow visualization, pressure measurements were recorded on the surface of an impingement target. The PLIF images themselves provide quantitative spatial information about structure of the impinging jets. The images also help in the interpretation of impingement surface pressure profiles by highlighting the flow structures corresponding to distinctive features of these pressure profiles. The shape of the pressure distribution along the impingement surface was found to be double-peaked in cases with a sufficiently high jet-exit-to-ambient pressure ratio so as to have a Mach disk, as well as in cases where a flow feature called a recirculation bubble formed at the impingement surface. The formation of a recirculation bubble was in turn found to depend very sensitively upon the jet-exit-to-ambient pressure ratio. The pressure measured at the surface was typically less than half the nozzle plenum pressure at low jet pressure ratios and decreased with increasing jet pressure ratios. Angled impingement cases showed that impingement at a 60deg angle resulted in up to a factor of three increase in maximum pressure at the plate compared to normal incidence.

Femoroacetabular impingement surgery

DEFF Research Database (Denmark)

Reiman, Michael P; Thorborg, Kristian

2015-01-01

both the examination and treatment of FAI does not appear to accommodate this exponential growth. In fact, the direction currently taken for FAI is similar to previously described paths of other orthopaedic and sports medicine pathologies (eg, shoulder impingement, knee meniscus tear) for which we have......Femoroacetabuler impingement (FAI) is becoming increasingly recognised as a potential pathological entity for individuals with hip pain. Surgery described to correct FAI has risen exponentially in the past 10 years with the use of hip arthroscopy. Unfortunately, the strength of evidence supporting...

Prospective study of the " Inside-Out" arthroscopic ankle ligament technique: Preliminary result.

Science.gov (United States)

Nery, Caio; Fonseca, Lucas; Raduan, Fernando; Moreno, Marcus; Baumfeld, Daniel

2017-03-22

Lateral ankle ligament injury is among the most common orthopedic injuries. The objective of this study is to present the preliminary prospective results of treatment using the "Inside-Out" variant of the fully arthroscopic Broström-Gould technique. Twenty six patients were included: 20 male and 6 female, aged 19-60 years, mean 41 years. All patients had positive "anterior drawer" and "talar tilt" tests. When necessary, cartilage injuries were treated with microfracture and arthroscopic resection for anterior impingement; three patients had hindfoot varus, on whom Dwyer osteotomy was performed; one patient had peroneal tendinopathy and was treated with tendoscopic debridement and another one had partial injury of the deltoid ligament, which was treated by direct repair. Two arthroscopic surgery portals were used; the anteromedial and anterolateral. After careful inspection of the joint, the anterior surface of the fibula was cleaned to resect the remains of the anterior talo-fibular ligament. An anchor with two sutures was placed on the anterior aspect of the fibula, 1cm from the distal apex of the malleolus. The sutures were passed through the remnant of the anterior talo-fibular ligament as well as the extensor retinaculum using special curved needles. Duncan knots were used to tie the ligament and the inferior extensor retinaculum while the ankle was kept in a neutral position. Patients were kept immobilized non-weight bearing for 2 weeks and were then allowed to start weight bearing in a removable protective boot for 4 weeks. The patients were able to return to sporting activities 6 months after surgery. After a mean follow-up of 27 months (range 21-36 months), patients were functionally evaluated using the American Orthopedics Foot and Ankle Society (AOFAS) ankle score. The mean preoperative value was 58 points, while the mean postoperative value increased to 90 points. One patient had paresthesia in the superficial fibular nerve area, which resolved

Influence of Elastic Bandage and Neoprene Ankle Support on Ankle Position Sense and Pain in Subjects with Ankle Sprain (Grade I & II

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Basir Majdoleslami

2004-06-01

Full Text Available Objective: to investigate whether a neoprene ankle support and elastic bandage around the ankle joint of subjects with ankle sprain (grade I&II would , in short term (a reduce pain (b improve ankle joint position sense and comparison of their effect with each other if they have. Materials & Methods: In a semi-experimental study, 30 subjects (16men, 14 women, age between 16-52 with ankle sprain grade I&II. Subjects had to have at least 2cm from 10cm visual analogue scale (VAS of ankle pain for study entry. All patients were randomly assigned to either an elastic bandage or a neoprene ankle support. One week later they were assigned to the opposite selection. Joint position sense was assessed in the sitting position using an electrogoniometer and pain by VAS where 0cm equals no pain and 10 cm equals worst pain. ankle pain and JPS were assessed for each selection one week apart. During each visit assessment were performed at baseline and after 20 min of bandage/neoprene ankle support application. Results: the mean of scores for ankle variables JPS and VAS was taken and paired-t test and Wilcoxon signed rank test was employed to calculate the different between two trails. Neoprene ankle support had significant effect on ankle JPS (P=0.034. But elastic bandage had no effect (P=0.539. Both of them had significantly reduced ankle pain. (P=0.000  Conclusion: In subjects with both neoprene ankle support and elastic bandage reduced ankle pain with more effect of neoprene ankle support. Only the neoprene ankle support had effect on knee JPS.

Dynamic ankle control in athletes with ankle instability during sports maneuvers.

Science.gov (United States)

Lin, Cheng-Feng; Chen, Chin-Yang; Lin, Chia-Wei

2011-09-01

Ankle sprain is a common sports injury. While the effects of static constraints in stabilizing the ankle joint are relatively well understood, those of dynamic constraints are less clear and require further investigation. This study was undertaken to evaluate the dynamic stability of the ankle joint during the landing phase of running and stop-jump maneuvers in athletes with and without chronic ankle instability (CAI). Controlled laboratory study. Fifteen athletes with CAI and 15 age-matched athletes without CAI performed running and stop-jump landing tasks. The dynamic ankle joint stiffness, tibialis anterior (TA)/peroneus longus (PL) and TA/gastrocnemius lateralis (GL) co-contraction indices, ankle joint angle, and root-mean-square (RMS) of the TA, PL, and GL electromyographic signals were measured during each task. During running, the CAI group exhibited a greater ankle inversion angle than the control group in the pre-landing phase (P = .012-.042) and a lower dynamic ankle joint stiffness in the post-landing phase (CAI: 0.109 ± 0.039 N·m/deg; control: 0.150 ± 0.068 N·m/deg; P = .048). In the stop-jump landing task, athletes with CAI had a significantly lower TA/PL co-contraction index during the pre-landing phase (CAI: 49.1 ± 19; control: 64.8 ± 16; P = .009). In addition, the CAI group exhibited a greater ankle inversion (P = .049), a lower peak eversion (P = .04), and a smaller RMS of the PL electromyographic signal in the post-landing phase (CAI: 0.73 ± 0.32; control: 0.51 ± 0.22; P = .04). Athletes with CAI had a relatively inverted ankle, reduced muscle co-contraction, and a lower dynamic stiffness in the ankle joint during the landing phase of sports maneuvers and this may jeopardize the stability of the ankle. Sports training or rehabilitation programs should differentiate between the pre-landing and post-landing phases of sports maneuvers, and should educate athletes to land with an appropriate ankle position and muscle recruitment.

Ankle fracture - aftercare

Science.gov (United States)

... this page: //medlineplus.gov/ency/patientinstructions/000548.htm Ankle fracture - aftercare To use the sharing features on this page, please enable JavaScript. An ankle fracture is a break in 1 or more ankle ...

Influence of ankle joint plantarflexion and dorsiflexion on lateral ankle sprain: A computational study.

Science.gov (United States)

Purevsuren, Tserenchimed; Kim, Kyungsoo; Batbaatar, Myagmarbayar; Lee, SuKyoung; Kim, Yoon Hyuk

2018-05-01

Understanding the mechanism of injury involved in lateral ankle sprain is essential to prevent injury, to establish surgical repair and reconstruction, and to plan reliable rehabilitation protocols. Most studies for lateral ankle sprain posit that ankle inversion, internal rotation, and plantarflexion are involved in the mechanism of injury. However, recent studies indicated that ankle dorsiflexion also plays an important role in the lateral ankle sprain mechanism. In this study, the contributions of ankle plantarflexion and dorsiflexion on the ankle joint were evaluated under complex combinations of internal and inversion moments. A multibody ankle joint model including 24 ligaments was developed and validated against two experimental cadaveric studies. The effects of ankle plantarflexion (up to 60°) and dorsiflexion (up to 30°) on the lateral ankle sprain mechanism under ankle inversion moment coupled with internal rotational moment were investigated using the validated model. Lateral ankle sprain injuries can occur during ankle dorsiflexion, in which the calcaneofibular ligament and anterior talofibular ligament tears may occur associated with excessive inversion and internal rotational moment, respectively. Various combinations of inversion and internal moment may lead to anterior talofibular ligament injuries at early ankle plantarflexion, while the inversion moment acts as a primary factor to tear the anterior talofibular ligament in early plantarflexion. It is better to consider inversion and internal rotation as primary factors of the lateral ankle sprain mechanism, while plantarflexion or dorsiflexion can be secondary factor. This information will help to clarify the lateral ankle sprain mechanism of injury.

Ankle Sprain Treatment

Science.gov (United States)

... Issues Listen Español Text Size Email Print Share Ankle Sprain Treatment Page Content Article Body Acute ankle and ... Pediatrics summarizing the treatment phases of rehabilitation for ankle sprain. Phase Summary Description I Phase I treatment involves ...

Fish impingement at Lake Michigan power plants

International Nuclear Information System (INIS)

Sharma, R.K.; Freeman, R.F.; Spigarelli, S.A.

1976-01-01

A study was initiated in 1974 to survey the magnitude and to evaluate the impact of fish impingement at 20 power plants on the Great Lakes. Data on impingement rates, site characteristics, intake designs and operational features have been collected and analyzed. Interpretive analyses of these data are in progress. The objectives of this study were: to summarize fish impingement data for Lake Michigan (16/20 plants surveyed are on Lake Michigan); to assess the significance of total and source-related mortalities on populations of forage and predator species; and to expand the assessment of power plant impingement to include all water intakes on Lake Michigan. Data are tabulated

Performance of jet impingement in unglazed air collectors

Energy Technology Data Exchange (ETDEWEB)

Belusko, M.; Saman, W.; Bruno, F. [Institute for Sustainable Systems and Technologies, University of South Australia, Mawson Lakes Boulevard, Mawson Lakes, SA 5095 (Australia)

2008-05-15

Jet impingement is effective at improving the heat transfer between air and a heated surface. Studies have shown that jet impingement can marginally improve the thermal efficiency of a glazed collector. However, little attention has been placed on applying jet impingement to an unglazed solar air collector. This paper presents a theoretical and experimental investigation identifying the performance characteristics of jet impingement. Overall, jet impingement was able to improve the thermal efficiency of the collector by 21%. An increase in the pressure loss was also measured but found to be small. The flow distribution of jets along the collector was the most significant factor in determining the efficiency. Increasing the hole spacing was found to improve the efficiency. (author)

LATERAL ANKLE INJURY

OpenAIRE

Pollard, Henry; Sim, Patrick; McHardy, Andrew

2002-01-01

Background: Injury to the ankle joint is the most common peripheral joint injury. The sports that most commonly produce high ankle injury rates in their participating athletes include: basketball, netball, and the various codes of football. Objective: To provide an up to date understanding of manual therapy relevant to lateral ligament injury of the ankle. A discussion of the types of ligament injury and common complicating factors that present with lateral ankle pain is presented along with ...

Clinical tests of ankle plantarflexor strength do not predict ankle power generation during walking.

Science.gov (United States)

Kahn, Michelle; Williams, Gavin

2015-02-01

The aim of this study was to investigate the relationship between a clinical test of ankle plantarflexor strength and ankle power generation (APG) at push-off during walking. This is a prospective cross-sectional study of 102 patients with traumatic brain injury. Handheld dynamometry was used to measure ankle plantarflexor strength. Three-dimensional gait analysis was performed to quantify ankle power generation at push-off during walking. Ankle plantarflexor strength was only moderately correlated with ankle power generation at push-off (r = 0.43, P < 0.001; 95% confidence interval, 0.26-0.58). There was also a moderate correlation between ankle plantarflexor strength and self-selected walking velocity (r = 0.32, P = 0.002; 95% confidence interval, 0.13-0.48). Handheld dynamometry measures of ankle plantarflexor strength are only moderately correlated with ankle power generation during walking. This clinical test of ankle plantarflexor strength is a poor predictor of calf muscle function during gait in people with traumatic brain injury.

The use of evidence-based practices for the management of shoulder impingement syndrome among Indian physical therapists: a cross-sectional survey

Directory of Open Access Journals (Sweden)

Vandana Phadke

2015-12-01

Full Text Available ABSTRACT Background: The understanding of the pathomechanics of shoulder impingement has evolved over the years. Likewise, assessment techniques and effective treatment strategies have also been developed. Physical therapists should keep up-to-date on the current evidence. Objective: This study explored the practices currently used by Indian physical therapists for the assessment and management of shoulder impingement syndrome (SIS. Method: Using an online questionnaire, therapists were asked to declare the causes, methods of assessment and their choices of physical therapy techniques for the management of SIS. The proportions of therapists using different techniques were analyzed descriptively, and comparisons across gender, experience level, and training were made. Data were analyzed to see if the choices of respondents compared with their responses for etiology. Results: A total of 211 responses were analyzed. Most respondents (>75% believed that overuse and abnormal motion/posture are the most significant causes of SIS. However, fewer respondents reported assessing posture (60.2% and dyskinesis, especially in women (24.2%. Ninety-four percent of the respondents reported using exercises, but exercise prescription was rather generic. Therapists additionally trained in the techniques of joint mobilization or taping declared using these techniques more frequently. The use of interferential therapy and ultrasound was reported by 89.5% and 98.4% of respondents, respectively Conclusion: Most therapists declared awareness of current recommended practices, but patient assessment, exercise prescription, and use of electrotherapy modalities were only partially based on current evidence. The study helps to identify gaps in current physical therapy approaches to SIS in India.

Comparison of custom-moulded ankle orthosis with hinged joints and off-the-shelf ankle braces in preventing ankle sprain in lateral cutting movements.

Science.gov (United States)

Lee, Winson C C; Kobayashi, Toshiki; Choy, Barton T S; Leung, Aaron K L

2012-06-01

A custom moulded ankle orthosis with hinged joints potentially offers a better control over the subtalar joint and the ankle joint during lateral cutting movements, due to total contact design and increase in material strength. To test the above hypothesis by comparing it to three other available orthoses. Repeated measures. Eight subjects with a history of ankle sprains (Grade 2), and 11 subjects without such history performed lateral cutting movements in four test conditions: 1) non-orthotic, 2) custom-moulded ankle orthosis with hinges, 3) Sport-Stirrup, and 4) elastic ankle sleeve with plastic support. A VICON motion analysis system was used to study the motions at the ankle and subtalar joints. The custom-moulded ankle orthosis significantly lowered the inversion angle at initial contact (p = 0.006) and the peak inversion angle (p = 0.000) during lateral cutting movements in comparison to non-orthotic condition, while the other two orthoses did not. The three orthoses did not affect the plantarflexion motions, which had been suggested by previous studies to be important in shock wave attenuation. The custom-moulded ankle orthosis with hinges could better control inversion and thus expected to better prevent ankle sprain in lateral cutting movements. Custom-moulded ankle orthoses are not commonly used in preventing ankle sprains. This study raises the awareness of the use of custom-moulded ankle orthoses which are expected to better prevent ankle sprains.

Temporally stratified sampling programs for estimation of fish impingement

International Nuclear Information System (INIS)

Kumar, K.D.; Griffith, J.S.

1977-01-01

Impingement monitoring programs often expend valuable and limited resources and fail to provide a dependable estimate of either total annual impingement or those biological and physicochemical factors affecting impingement. In situations where initial monitoring has identified ''problem'' fish species and the periodicity of their impingement, intensive sampling during periods of high impingement will maximize information obtained. We use data gathered at two nuclear generating facilities in the southeastern United States to discuss techniques of designing such temporally stratified monitoring programs and their benefits and drawbacks. Of the possible temporal patterns in environmental factors within a calendar year, differences among seasons are most influential in the impingement of freshwater fishes in the Southeast. Data on the threadfin shad (Dorosoma petenense) and the role of seasonal temperature changes are utilized as an example to demonstrate ways of most efficiently and accurately estimating impingement of the species

The effects of total ankle replacement on ankle joint mechanics during walking

Directory of Open Access Journals (Sweden)

Henry Wang

2017-09-01

Conclusion: Three months after surgeries, the STAA patients experienced improvements in ankle function and gait parameters. The STAA ankle demonstrated improved ankle mechanics during daily activities such as walking.

Hip morphology predicts posterior hip impingement in a cadaveric model.

Science.gov (United States)

Morris, William Z; Fowers, Cody A; Weinberg, Douglas S; Millis, Michael B; Tu, Leigh-Anne; Liu, Raymond W

2018-05-01

Posterior hip impingement is a recently-identified cause of hip pain. The purpose of this study is to characterise posterior femoroacetabular and ischiofemoral impingement and identify its predisposing morphologic traits. Two hundred and six cadaveric hips were randomly selected and taken through controlled motion in two pure axes associated with posterior hip impingement: external rotation (through the mechanical axis) and adduction (coronal plane). The range of motion and location of impingement was noted for each specimen. Morphologic traits including femoral/acetabular version, and true neck-shaft angle (TNSA) were also measured. External rotation impingement occurred between the femoral neck and acetabulum in 83.0% of hips, and between the lesser trochanter and ischial tuberosity in 17.0%. Adduction impingement occurred between the lesser trochanter and ischial tuberosity in 78.6% of hips, and between the femoral neck and acetabulum in 21.4%. Multiple regression revealed that increased femoral/acetabular version predicted earlier external rotation and adduction impingement. Unstandardised betas ranging from -0.39 to -0.64 reflect that each degree of increased femoral/acetabular version individually accounts for a loss of external rotation or adduction of approximately half a degree before impingement ( p < 0.001 for each). Increased TNSA was associated with earlier adduction impingement only (unstandardised beta -0.35, p = 0.005). Relative femoral/acetabular anteversion was associated with earlier posterior hip impingement. Coxa valga was associated with earlier adduction impingement, but protective against external rotation impingement. These findings highlight the importance of monitoring correction during femoral/acetabular osteotomies, as overcorrection of retroversion may predispose to earlier posterior impingement.

Reliability and smallest real difference of the ankle lunge test post ankle fracture.

Science.gov (United States)

Simondson, David; Brock, Kim; Cotton, Susan

2012-02-01

This study aimed to determine the reliability and the smallest real difference of the Ankle Lunge test in an ankle fracture patient population. In the post immobilisation stage of ankle fracture, ankle dorsiflexion is an important measure of progress and outcome. The Ankle Lunge test measures weight bearing dorsiflexion, resulting in negative scores (knee to wall distance) and positive scores (toe to wall distance), for which the latter has proven reliability in normal subjects only. A consecutive sample of ankle fracture patients with permission to commence weight bearing, were recruited to the study. Three measurements of the Ankle Lunge Test were performed each by two raters, one senior and one junior physiotherapist. These occurred prior to therapy sessions in the second week after plaster removal. A standardised testing station was utilised and allowed for both knee to wall distance and toe to wall distance measurement. Data was collected from 10 individuals with ankle fracture, with an average age of 36 years (SD 14.8). Seventy seven percent of observations were negative. Intra and inter-rater reliability yielded intra class correlations at or above 0.97, p Ankle Lunge test is a practical and reliable tool for measuring weightbearing dorsiflexion post ankle fracture. Copyright © 2011 Elsevier Ltd. All rights reserved.

Primary ankle arthrodesis for neglected open Weber B ankle fracture dislocation.

Science.gov (United States)

Thomason, Katherine; Ramesh, Ashwanth; McGoldrick, Niall; Cove, Richard; Walsh, James C; Stephens, Michael M

2014-01-01

Primary ankle arthrodesis used to treat a neglected open ankle fracture dislocation is a unique decision. A 63-year-old man presented to the emergency department with a 5-day-old open fracture dislocation of his right ankle. After thorough soft tissue debridement, primary arthrodesis of the tibiotalar joint was performed using initial Kirschner wire fixation and an external fixator. Definitive soft tissue coverage was later achieved using a latissimus dorsi free flap. The fusion was consolidated to salvage the limb from amputation. The use of primary arthrodesis to treat a compound ankle fracture dislocation has not been previously described. Copyright © 2014 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Ankle Problems

Science.gov (United States)

... Read MoreDepression in Children and TeensRead MoreBMI Calculator Ankle ProblemsFollow this chart for more information about problems that can cause ankle pain. Our trusted Symptom Checker is written and ...

Total ankle joint replacement.

Science.gov (United States)

2016-02-01

Ankle arthritis results in a stiff and painful ankle and can be a major cause of disability. For people with end-stage ankle arthritis, arthrodesis (ankle fusion) is effective at reducing pain in the shorter term, but results in a fixed joint, and over time the loss of mobility places stress on other joints in the foot that may lead to arthritis, pain and dysfunction. Another option is to perform a total ankle joint replacement, with the aim of giving the patient a mobile and pain-free ankle. In this article we review the efficacy of this procedure, including how it compares to ankle arthrodesis, and consider the indications and complications. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Effects of ankle eversion taping using kinesiology tape in a patient with ankle inversion sprain

OpenAIRE

Lee, Sun-Min; Lee, Jung-Hoon

2016-01-01

[Purpose] The aim of this study was to report the effects of ankle eversion taping using kinesiology tape on ankle inversion sprain. [Subject] The subject was a 21-year-old woman with Grade 2 ankle inversion sprain. [Methods] Ankle eversion taping was applied to the sprained left ankle using kinesiology tape for 4 weeks (average, 15?h/day). [Results] Ankle instability and pain were reduced, and functional dynamic balance was improved after ankle eversion taping for 4 weeks. The Cumberland Ank...

Effectiveness of individualized physiotherapy on pain and functioning compared to a standard exercise protocol in patients presenting with clinical signs of subacromial impingement syndrome. A randomized controlled trial

Directory of Open Access Journals (Sweden)

de Bie Rob A

2010-06-01

Full Text Available Abstract Background Shoulder impingement syndrome is a common musculoskeletal complaint leading to significant reduction of health and disability. Physiotherapy is often the first choice of treatment although its effectiveness is still under debate. Systematic reviews in this field highlight the need for more high quality trials to investigate the effectiveness of physiotherapy interventions in patients with subacromial impingement syndrome. Methods/Design This randomized controlled trial will investigate the effectiveness of individualized physiotherapy in patients presenting with clinical signs and symptoms of subacromial impingement, involving 90 participants aged 18-75. Participants are recruited from outpatient physiotherapy clinics, general practitioners, and orthopaedic surgeons in Germany. Eligible participants will be randomly allocated to either individualized physiotherapy or to a standard exercise protocol using central randomization. The control group will perform the standard exercise protocol aiming to restore muscular deficits in strength, mobility, and coordination of the rotator cuff and the shoulder girdle muscles to unload the subacromial space during active movements. Participants of the intervention group will perform the standard exercise protocol as a home program, and will additionally be treated with individualized physiotherapy based on clinical examination results, and guided by a decision tree. After the intervention phase both groups will continue their home program for another 7 weeks. Outcome will be measured at 5 weeks and at 3 and 12 months after inclusion using the shoulder pain and disability index and patients' global impression of change, the generic patient-specific scale, the average weekly pain score, and patient satisfaction with treatment. Additionally, the fear avoidance beliefs questionnaire, the pain catastrophizing scale, and patients' expectancies of treatment effect are assessed. Participants

Effects of the application of ankle functional rehabilitation exercise on the ankle joint functional movement screen and isokinetic muscular function in patients with chronic ankle sprain.

Science.gov (United States)

Ju, Sung-Bum; Park, Gi Duck

2017-02-01

[Purpose] This study was conducted to investigate the effects of ankle functional rehabilitation exercise on ankle joint functional movement screen results and isokinetic muscular function in patients with chronic ankle sprain patients. [Subjects and Methods] In this study, 16 patients with chronic ankle sprain were randomized to an ankle functional rehabilitation exercise group (n=8) and a control group (n=8). The ankle functional rehabilitation exercise centered on a proprioceptive sense exercise program, which was applied 12 times for 2 weeks. To verify changes after the application, ankle joint functional movement screen scores and isokinetic muscular function were measured and analyzed. [Results] The ankle functional rehabilitation exercise group showed significant improvements in all items of the ankle joint functional movement screen and in isokinetic muscular function after the exercise, whereas the control group showed no difference after the application. [Conclusion] The ankle functional rehabilitation exercise program can be effectively applied in patients with chronic ankle sprain for the improvement of ankle joint functional movement screen score and isokinetic muscular function.

Ankle taping can reduce external ankle joint moments during drop landings on a tilted surface.

Science.gov (United States)

Sato, Nahoko; Nunome, Hiroyuki; Hopper, Luke S; Ikegami, Yasuo

2017-09-20

Ankle taping is commonly used to prevent ankle sprains. However, kinematic assessments investigating the biomechanical effects of ankle taping have provided inconclusive results. This study aimed to determine the effect of ankle taping on the external ankle joint moments during a drop landing on a tilted surface at 25°. Twenty-five participants performed landings on a tilted force platform that caused ankle inversion with and without ankle taping. Landing kinematics were captured using a motion capture system. External ankle inversion moment, the angular impulse due to the medio-lateral and vertical components of ground reaction force (GRF) and their moment arm lengths about the ankle joint were analysed. The foot plantar inclination relative to the ground was assessed. In the taping condition, the foot plantar inclination and ankle inversion angular impulse were reduced significantly compared to that of the control. The only component of the external inversion moment to change significantly in the taped condition was a shortened medio-lateral GRF moment arm length. It can be assumed that the ankle taping altered the foot plantar inclination relative to the ground, thereby shortening the moment arm of medio-lateral GRF that resulted in the reduced ankle inversion angular impulse.

Differences in kinematic control of ankle joint motions in people with chronic ankle instability.

Science.gov (United States)

Kipp, Kristof; Palmieri-Smith, Riann M

2013-06-01

People with chronic ankle instability display different ankle joint motions compared to healthy people. The purpose of this study was to investigate the strategies used to control ankle joint motions between a group of people with chronic ankle instability and a group of healthy, matched controls. Kinematic data were collected from 11 people with chronic ankle instability and 11 matched control subjects as they performed a single-leg land-and-cut maneuver. Three-dimensional ankle joint angles were calculated from 100 ms before, to 200 ms after landing. Kinematic control of the three rotational ankle joint degrees of freedom was investigated by simultaneously examining the three-dimensional co-variation of plantarflexion/dorsiflexion, toe-in/toe-out rotation, and inversion/eversion motions with principal component analysis. Group differences in the variance proportions of the first two principal components indicated that the angular co-variation between ankle joint motions was more linear in the control group, but more planar in the chronic ankle instability group. Frontal and transverse plane motions, in particular, contributed to the group differences in the linearity and planarity of angular co-variation. People with chronic ankle instability use a different kinematic control strategy to coordinate ankle joint motions during a single-leg landing task. Compared to the healthy group, the chronic ankle instability group's control strategy appeared to be more complex and involved joint-specific contributions that would tend to predispose this group to recurring episodes of instability. Copyright © 2013 Elsevier Ltd. All rights reserved.

Therapeutic interventions for increasing ankle dorsiflexion after ankle sprain: a systematic review.

Science.gov (United States)

Terada, Masafumi; Pietrosimone, Brian G; Gribble, Phillip A

2013-01-01

Clinicians perform therapeutic interventions, such as stretching, manual therapy, electrotherapy, ultrasound, and exercises, to increase ankle dorsiflexion. However, authors of previous studies have not determined which intervention or combination of interventions is most effective. To determine the magnitude of therapeutic intervention effects on and the most effective therapeutic interventions for restoring normal ankle dorsiflexion after ankle sprain. We performed a comprehensive literature search in Web of Science and EBSCO HOST from 1965 to May 29, 2011, with 19 search terms related to ankle sprain, dorsiflexion, and intervention and by cross-referencing pertinent articles. Eligible studies had to be written in English and include the means and standard deviations of both pretreatment and posttreatment in patients with acute, subacute, or chronic ankle sprains. Outcomes of interest included various joint mobilizations, stretching, local vibration, hyperbaric oxygen therapy, electrical stimulation, and mental-relaxation interventions. We extracted data on dorsiflexion improvements among various therapeutic applications by calculating Cohen d effect sizes with associated 95% confidence intervals (CIs) and evaluated the methodologic quality using the Physiotherapy Evidence Database (PEDro) scale. In total, 9 studies (PEDro score = 5.22 ± 1.92) met the inclusion criteria. Static-stretching interventions with a home exercise program had the strongest effects on increasing dorsiflexion in patients 2 weeks after acute ankle sprains (Cohen d = 1.06; 95% CI = 0.12, 2.42). The range of effect sizes for movement with mobilization on ankle dorsiflexion among individuals with recurrent ankle sprains was small (Cohen d range = 0.14 to 0.39). Static-stretching intervention as a part of standardized care yielded the strongest effects on dorsiflexion after acute ankle sprains. The existing evidence suggests that clinicians need to consider what may be the limiting factor of

Ankle fracture spur sign is pathognomonic for a variant ankle fracture.

Science.gov (United States)

Hinds, Richard M; Garner, Matthew R; Lazaro, Lionel E; Warner, Stephen J; Loftus, Michael L; Birnbaum, Jacqueline F; Burket, Jayme C; Lorich, Dean G

2015-02-01

The hyperplantarflexion variant ankle fracture is composed of a posterior tibial lip fracture with posterolateral and posteromedial fracture fragments separated by a vertical fracture line. This infrequently reported injury pattern often includes an associated "spur sign" or double cortical density at the inferomedial tibial metaphysis. The objective of this study was to quantitatively establish the association of the ankle fracture spur sign with the hyperplantarflexion variant ankle fracture. Our clinical database of operative ankle fractures was retrospectively reviewed for the incidence of hyperplantarflexion variant and nonvariant ankle fractures as determined by assessment of injury radiographs, preoperative advanced imaging, and intraoperative observation. Injury radiographs were then evaluated for the presence of the spur sign, and association between the spur sign and variant fractures was analyzed. The incidence of the hyperplantarflexion variant fracture among all ankle fractures was 6.7% (43/640). The spur sign was present in 79% (34/43) of variant fractures and absent in all nonvariant fractures, conferring a specificity of 100% in identifying variant fractures. Positive predictive value and negative predictive value were 100% and 99%, respectively. The ankle fracture spur sign was pathognomonic for the hyperplantarflexion variant ankle fracture. It is important to identify variant fractures preoperatively as patient positioning, operative approach, and fixation construct of variant fractures often differ from those employed for osteosynthesis of nonvariant fractures. Identification of the spur sign should prompt acquisition of advanced imaging to formulate an appropriate operative plan to address the variant fracture pattern. Level III, retrospective comparative study. © The Author(s) 2014.

Analysis of the Effects of Normal Walking on Ankle Joint Contact Characteristics After Acute Inversion Ankle Sprain.

Science.gov (United States)

Bae, Ji Yong; Park, Kyung Soon; Seon, Jong Keun; Jeon, Insu

2015-12-01

To show the causal relationship between normal walking after various lateral ankle ligament (LAL) injuries caused by acute inversion ankle sprains and alterations in ankle joint contact characteristics, finite element simulations of normal walking were carried out using an intact ankle joint model and LAL injury models. A walking experiment using a volunteer with a normal ankle joint was performed to obtain the boundary conditions for the simulations and to support the appropriateness of the simulation results. Contact pressure and strain on the talus articular cartilage and anteroposterior and mediolateral translations of the talus were calculated. Ankles with ruptured anterior talofibular ligaments (ATFLs) had a higher likelihood of experiencing increased ankle joint contact pressures, strains and translations than ATFL-deficient ankles. In particular, ankles with ruptured ATFL + calcaneofibular ligaments and all ruptured ankles had a similar likelihood as the ATFL-ruptured ankles. The push off stance phase was the most likely situation for increased ankle joint contact pressures, strains and translations in LAL-injured ankles.

Exercises versus arthroscopic decompression in patients with subacromial impingement: a randomised, controlled study in 90 cases with a one year follow up

DEFF Research Database (Denmark)

Haahr, J. P.; Ostergaard, S.; Dalsgaard, J.

2005-01-01

, the difference being non-significant. No group differences in mean pain and dysfunction score improvement were found. CONCLUSIONS: Surgical treatment of rotator cuff syndrome with subacromial impingement was not superior to physiotherapy with training. Further studies are needed to qualify treatment choice...

Primary ankle arthrodesis for neglected open weber B ankle fracture dislocation.

LENUS (Irish Health Repository)

Thomason, Katherine

2014-07-01

Primary ankle arthrodesis used to treat a neglected open ankle fracture dislocation is a unique decision. A 63-year-old man presented to the emergency department with a 5-day-old open fracture dislocation of his right ankle. After thorough soft tissue debridement, primary arthrodesis of the tibiotalar joint was performed using initial Kirschner wire fixation and an external fixator. Definitive soft tissue coverage was later achieved using a latissimus dorsi free flap. The fusion was consolidated to salvage the limb from amputation. The use of primary arthrodesis to treat a compound ankle fracture dislocation has not been previously described.

Impingement jet cooling in gas turbines

CERN Document Server

Amano, R S

2014-01-01

Due to the requirement for enhanced cooling technologies on modern gas turbine engines, advanced research and development has had to take place in field of thermal engineering. Impingement jet cooling is one of the most effective in terms of cooling, manufacturability and cost. This is the first to book to focus on impingement cooling alone.

Ankle and knee biomechanics during normal walking following ankle plantarflexor fatigue.

Science.gov (United States)

Hunt, Michael A; Hatfield, Gillian L

2017-08-01

The purpose of this study was to investigate the immediate effects of unilateral ankle plantarflexor fatigue on bilateral knee and ankle biomechanics during gait. Lower leg kinematics, kinetics, and muscle activation were assessed before and after an ankle plantarflexor fatiguing protocol in 31 healthy individuals. Fatigue (defined as >10% reduction in maximal isometric ankle plantarflexor torque production and a downward shift in the median power frequency of both heads of the gastrocnemius muscle of the fatigued limb) was achieved in 18 individuals, and only their data were used for analysis purposes. Compared to pre-fatigue walking trials, medial gastrocnemius activity was significantly reduced in the study (fatigued) limb. Other main changes following fatigue included significantly more knee flexion during loading, and an associated larger external knee flexion moment in the study limb. At the ankle joint, participants exhibited significantly less peak plantarflexion (occurring at toe-off) with fatigue. No significant differences were observed in the contralateral (non-fatigued) limb. Findings from this study indicate that fatigue of the ankle plantarflexor muscle does not produce widespread changes in gait biomechanics, suggesting that small to moderate changes in maximal ankle plantarflexor force production capacity (either an increase or decrease) will not have a substantial impact on normal lower limb functioning during gait. Copyright © 2017 Elsevier Ltd. All rights reserved.

Clinical examination results in individuals with functional ankle instability and ankle-sprain copers.

Science.gov (United States)

Wright, Cynthia J; Arnold, Brent L; Ross, Scott E; Ketchum, Jessica; Ericksen, Jeffrey; Pidcoe, Peter

2013-01-01

Why some individuals with ankle sprains develop functional ankle instability and others do not (ie, copers) is unknown. Current understanding of the clinical profile of copers is limited. To contrast individuals with functional ankle instability (FAI), copers, and uninjured individuals on both self-reported variables and clinical examination findings. Cross-sectional study. Sports medicine research laboratory. Participants consisted of 23 individuals with a history of 1 or more ankle sprains and at least 2 episodes of giving way in the past year (FAI: Cumberland Ankle Instability Tool [CAIT] score = 20.52 ± 2.94, episodes of giving way = 5.8 ± 8.4 per month), 23 individuals with a history of a single ankle sprain and no subsequent episodes of instability (copers: CAIT score = 27.74 ± 1.69), and 23 individuals with no history of ankle sprain and no instability (uninjured: CAIT score = 28.78 ± 1.78). Self-reported disability was recorded using the CAIT and Foot and Ankle Ability Measure for Activities of Daily Living and for Sports. On clinical examination, ligamentous laxity and tenderness, range of motion (ROM), and pain at end ROM were recorded. Questionnaire scores for the CAIT, Foot and Ankle Ability Measure for Activities of Daily Living and for Sports, ankle inversion and anterior drawer laxity scores, pain with palpation of the lateral ligaments, ankle ROM, and pain at end ROM. Individuals with FAI had greater self-reported disability for all measures (P < .05). On clinical examination, individuals with FAI were more likely to have greater talar tilt laxity, pain with inversion, and limited sagittal-plane ROM than copers (P < .05). Differences in both self-reported disability and clinical examination variables distinguished individuals with FAI from copers at least 1 year after injury. Whether the deficits could be detected immediately postinjury to prospectively identify potential copers is unknown.

Impingement of juvenile and adult fishes during cooling water withdrawal

International Nuclear Information System (INIS)

McFarlane, R.W.

1978-01-01

Juvenile and adult fishes are impinged upon trash removal screens as Savannah River water is withdrawn for use on the Savannah River Plant (SRP). Thirty-six species of fish, representing half of all riverine species known from the area, were impinged on the screens at three SRP pumping stations during 1977. Based on the average of 11.2 fish impinged per day, annual impingement is estimated to be 4088 fish. SRP thus ranks third lowest for impingement recently reported for 33 electric power plants

Ultrasonography of the ankle joint

Energy Technology Data Exchange (ETDEWEB)

Park, Jung Won; Lee, Sun Joo; Choo, Hye Jung; Kim, Sung Kwan; Gwak, Heui Chul [Inje University Busan Paik Hospital, Inje University College of Medicine, Busan (Korea, Republic of); Lee, Sung Moon [Dept. of Radiology, Dae Kyung Imaging Center, Daegu (Korea, Republic of)

2017-10-15

Ankle disorders are a relatively common pathological condition, and ankle injuries account for approximately 14% of sports-related orthopedic emergency visits. Various imaging modalities can be used to make a diagnosis in cases of ankle pain; however, ultrasound (US) has several benefits for the evaluation of ankle pain, especially in the tendons, ligaments, and nerves of the ankle. The purpose of this article is to review the common causes of ankle pathology, with particular reference to US features. In addition, the importance of a dynamic evaluation and a stress test with US is emphasized.

Ultrasonography of the ankle joint

International Nuclear Information System (INIS)

Park, Jung Won; Lee, Sun Joo; Choo, Hye Jung; Kim, Sung Kwan; Gwak, Heui Chul; Lee, Sung Moon

2017-01-01

Ankle disorders are a relatively common pathological condition, and ankle injuries account for approximately 14% of sports-related orthopedic emergency visits. Various imaging modalities can be used to make a diagnosis in cases of ankle pain; however, ultrasound (US) has several benefits for the evaluation of ankle pain, especially in the tendons, ligaments, and nerves of the ankle. The purpose of this article is to review the common causes of ankle pathology, with particular reference to US features. In addition, the importance of a dynamic evaluation and a stress test with US is emphasized

Unsuspected reason for sciatica in Bertolotti's syndrome.

Science.gov (United States)

Shibayama, M; Ito, F; Miura, Y; Nakamura, S; Ikeda, S; Fujiwara, K

2011-05-01

Patients with Bertolotti's syndrome have characteristic lumbosacral anomalies and often have severe sciatica. We describe a patient with this syndrome in whom standard decompression of the affected nerve root failed, but endoscopic lumbosacral extraforaminal decompression relieved the symptoms. We suggest that the intractable sciatica in this syndrome could arise from impingement of the nerve root extraforaminally by compression caused by the enlarged transverse process.

Mechanical instability destabilises the ankle joint directly in the ankle-sprain mechanism.

Science.gov (United States)

Gehring, Dominic; Faschian, Katrin; Lauber, Benedikt; Lohrer, Heinz; Nauck, Tanja; Gollhofer, Albert

2014-03-01

Despite massive research efforts, it remains unclear how mechanical ankle instability (MAI) and functional ankle instability (FAI) affect joint control in the situation of ankle sprain. Thus, the purpose of this study was to evaluate whether individuals with MAI have deficits in stabilising their ankle joint in a close-to-injury situation compared with those with FAI and healthy controls. Ankle-joint control was assessed by means of three-dimensional motion analysis and electromyography in participants with FAI and MAI (n=19), in participants with pure FAI (n=9) and in healthy controls (n=18). Close-to-injury situations were simulated during standing, walking and jumping by means of a custom-made tilt platform. Individuals with FAI and MAI displayed significantly greater maximum ankle inversion angles (+5°) and inversion velocities (+50°/s) in the walking and jumping conditions compared to those with pure FAI and controls. Furthermore, individuals in the FAI and MAI group showed a significantly decreased pre-activation of the peroneus longus muscle during jumping compared to those with FAI. No differences between groups were found for plantar flexion and internal rotation, or for muscle activities following tilting of the platform. The present study demonstrates that MAI is characterised by impairments of ankle-joint control in close-to-injury situations. This could make these individuals more prone to recurrent ankle sprains, and suggests the need for additional mechanical support such as braces or even surgery. In addition, the study highlights the fact that dynamic experimental test conditions in the acting participant are needed to further unravel the mystery of chronic ankle instability.

Ankle Injuries and Disorders

Science.gov (United States)

Your ankle bone and the ends of your two lower leg bones make up the ankle joint. Your ligaments, which connect bones to one ... muscles and tendons move it. The most common ankle problems are sprains and fractures. A sprain is ...

Os trigonum syndrome: A retrospective and comparative study

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Nihat Taşdemir

2012-03-01

Full Text Available Objectives: The aim of this study was to evaluate the os trigonum syndrome by magnetic resonance imaging (MRI.Materials and methods: A total of 76 ankle MRI images were evaluated, retrospectively. All MRI examinations were done in supine position with the injured foot in neutral position and then in forced plantar flexion.Results: Os trigonum syndrome was seen in 16/76 cases. Four of 16 os trigonum syndrome patients are female. The average age of this 16 patients who were defined as os trigonum syndrome by MRI was 34.81±14.16 years. Twelve of 16 os trigonum syndrome was seen in right ankle. Disruption of the cartilaginous synchondrosis between the accessory bone and the talus was observed in 12 patients. Tenosynovitis of the flexor halluces longus was associated in 7 patients. Subcutan edema, surrounding the os trigonum was detected in 11 patients.Conclusion: In patients with ostrigonum syndrome MR imaging allows complete diagnosis.

Sprained Ankles

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... away before the ligament is injured. Types of Sprains In young children, the ankle is the most commonly sprained joint, followed by ... A walking cast may be necessary if the ankle or foot injury has been severe. Most grade 1 sprains will heal within two weeks without subsequent complications. ...

Advancements in ankle arthroscopy

NARCIS (Netherlands)

van Dijk, C. Niek; van Bergen, Christiaan J. A.

2008-01-01

Important progress has been made during the past 30 years in arthroscopic ankle surgery. Ankle arthroscopy has gradually changed from a diagnostic to a therapeutic tool. Most arthroscopic procedures can be performed by using the anterior working area with the ankle in dorsiflexion or plantar

Complications in ankle arthroscopy

NARCIS (Netherlands)

Zengerink, Maartje; van Dijk, C. Niek

2012-01-01

To determine the complication rate for ankle arthroscopy. A review of a consecutive series of patients undergoing ankle arthroscopy in our hospital between 1987 and 2006 was undertaken. Anterior ankle arthroscopy was performed by means of a 2-portal dorsiflexion method with intermittent soft tissue

X-Ray Exam: Ankle

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... for Educators Search English Español X-Ray Exam: Ankle KidsHealth / For Parents / X-Ray Exam: Ankle What's in this article? What It Is Why ... You Have Questions Print What It Is An ankle X-ray is a safe and painless test ...

Ankle sprain

NARCIS (Netherlands)

Struijs, Peter; Kerkhoffs, Gino

2007-01-01

Injury of the lateral ligament complex of the ankle joint occurs in about one per 10,000 people a day, accounting for a quarter of all sports injuries. We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatment strategies for acute ankle

Ankle sprain

NARCIS (Netherlands)

Struijs, Peter Aa; Kerkhoffs, Gino Mmj

2010-01-01

Injury of the lateral ligament complex of the ankle joint occurs in about one in 10,000 people a day, accounting for a quarter of all sports injuries. We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatment strategies for acute ankle

Ankle inversion taping using kinesiology tape for treating medial ankle sprain in an amateur soccer player

OpenAIRE

Lee, Sun-Min; Lee, Jung-Hoon

2015-01-01

[Purpose] The purpose of this study was to report the effects of ankle inversion taping using kinesiology tape in a patient with a medial ankle sprain. [Subject] A 28-year-old amateur soccer player suffered a Grade 2 medial ankle sprain during a match. [Methods] Ankle inversion taping was applied to the sprained ankle every day for 2 months. [Results] His symptoms were reduced after ankle inversion taping application for 2 months. The self-reported function score, the reach distances in the S...

Ankle Plantarflexor Spasticity Does Not Restrict the Recovery of Ankle Plantarflexor Strength or Ankle Power Generation for Push-Off During Walking Following Traumatic Brain Injury.

Science.gov (United States)

Williams, Gavin; Banky, Megan; Olver, John

2016-01-01

The main aim of this project was to determine the impact of plantarflexor spasticity on muscle performance for ambulant people with traumatic brain injury (TBI). A large metropolitan rehabilitation hospital. Seventy-two ambulant people with TBI who were attending physiotherapy for mobility limitations. Twenty-four participants returned for a 6-month follow-up reassessment. Cross-sectional cohort study. Self-selected walking speed, Tardieu scale, ankle plantarflexor strength, and ankle power generation (APG). Participants with ankle plantarflexor spasticity had significantly lower self-selected walking speed; however, there was no significant difference in ankle plantarflexor strength or APG. Participants with ankle plantarflexor spasticity were not restricted in the recovery of self-selected walking speed, ankle plantarflexor strength, or APG, indicating equivalent ability to improve their mobility over time despite the presence of spasticity. Following TBI, people with ankle plantarflexor spasticity have significantly greater mobility limitations than those without spasticity, yet retain the capacity for recovery of self-selected walking speed, ankle plantarflexor strength, and APG.

Dynamic balance deficits in individuals with chronic ankle instability compared to ankle sprain copers 1 year after a first-time lateral ankle sprain injury.

Science.gov (United States)

Doherty, Cailbhe; Bleakley, Chris; Hertel, Jay; Caulfield, Brian; Ryan, John; Delahunt, Eamonn

2016-04-01

To quantify the dynamic balance deficits that characterise a group with chronic ankle instability compared to lateral ankle sprain copers and non-injured controls using kinematic and kinetic outcomes. Forty-two participants with chronic ankle instability and twenty-eight lateral ankle sprain copers were initially recruited within 2 weeks of sustaining a first-time, acute lateral ankle sprain and required to attend our laboratory 1 year later to complete the current study protocol. An additional group of non-injured individuals were also recruited to act as a control group. All participants completed the anterior, posterior-lateral and posterior-medial reach directions of the star excursion balance test. Sagittal plane kinematics of the lower extremity and associated fractal dimension of the centre of pressure path were also acquired. Participants with chronic ankle instability displayed poorer performance in the anterior, posterior-medial and posterior-lateral reach directions compared with controls bilaterally, and in the posterior-lateral direction compared with lateral ankle sprain copers on their 'involved' limb only. These performance deficits in the posterior-lateral and posterior-medial directions were associated with reduced flexion and dorsiflexion displacements at the hip, knee and ankle at the point of maximum reach, and coincided with reduced complexity of the centre of pressure path. In comparison with lateral ankle sprain copers and controls, participants with chronic ankle instability were characterised by dynamic balance deficits as measured using the SEBT. This was attested to reduced sagittal plane motions at the hip, knee and ankle joints, and reduced capacity of the stance limb to avail of its supporting base. III.

Ankle Fractures: The Operative Outcome

Directory of Open Access Journals (Sweden)

Ahmad Hafiz Z

2011-03-01

Full Text Available Ankle fractures are commonly seen in orthopaedic practice. This retrospective study of patients with ankle fractures who underwent surgical treatment in our institution from January 2000 to December 2003 was undertaken to analyze the common causes and patterns of ankle fractures; and the functional outcome of operative treatment for these fractures. Eighty patients were identified and reviewed. There were 65 male (81.3% and 15 female patients (18.7% with age ranging from 13 to 71 years old (mean, 32.3y. Common causes of ankle fractures were trauma (especially motor vehicle accidents, sports injuries and the osteoporotic bones in the elderly. Weber C (64.0% was the most common pattern of fracture at presentation. The most common operative treatment for ankle fractures was open reduction and internal fixation (73 patients, 91.2%. Excellent and good outcomes were achieved in 93.8% of cases when measured using the Olerud and Molander scoring system for foot and ankle. In conclusion, operative treatment for ankle fractures restores sufficient stability and allowed mobility of the ankle joint.

Assessment of Ankle Injuries

Science.gov (United States)

Mai, Nicholas; Cooper, Leslie

2009-01-01

School nurses are faced with the challenge of identifying and treating ankle injuries in the school setting. There is little information guiding the assessment and treatment of these children when an injury occurs. It is essential for school nurses to understand ankle anatomy, pathophysiology of the acute ankle injury, general and orthopedic…

Empirical model of impingement impact. Environmental Sciences Division publication No. 1289

International Nuclear Information System (INIS)

Barnthouse, L.W.; DeAngelis, D.L.; Christensen, S.W.

1979-01-01

A simple model, derived from Ricker's (1975) theory of fisheries dynamics, that can be used to estimate the impact of impingement of juvenile fish by power plants on year-class abundance in vulnerable species is described. The only data required are estimates of the initial number of impingeable juveniles, the number impinged, and the rate of total mortality during the period of vulnerability. The impact of impingement is expressed in the model as the conditional mortality rate, rather than the more commonly used exploitation rate. The conditional mortality rate is superior as a measure of impact for two reasons: it accounts for the differential impact of impinging fish of different ages, and it is numerically equivalent to the fractional reduction in year-class abundance due to impingement. We present an application of the model using the 1974 year-class of the Hudson River striped bass population as an example. We then show how the model can be modified to account for seasonal fluctuations in the rate of impingement, discuss the effect of these fluctuations on the calculated impact, and discuss the influence on model output of errors in the measurement of abundance, impingement, and total mortality. It is evident from this analysis that estimates of impingement impact are as sensitive to errors in estimates of population size and mortality as to estimates of the number of fish impinged. Thus, it is not possible to reliably estimate the impact of impingement on a vulnerable fish species unless a substantial effort is devoted to population studies

Chronic Ankle Instability

Science.gov (United States)

... top of the talus is dome-shaped and... Softball Injuries to the Foot and Ankle Your feet ... ankles take a beating when you are playing softball. Softball players should be aware of the following ...

Talofibular compartment of the ankle joint after recent ankle sprain

International Nuclear Information System (INIS)

Lindstrand, A.; Mortensson, W.; Norman, O.

1978-01-01

The validity of predicting the condition of the anterior talofibular ligament from the shape of the lateral compartment of the ankle joint was investigated in patients with recent ankle sprain. The diagnostic value of the method was found to be restricted. (Auth.)

Anterior ankle arthroscopy, distraction or dorsiflexion?

Science.gov (United States)

de Leeuw, Peter A J; Golanó, Pau; Clavero, Joan A; van Dijk, C Niek

2010-05-01

Anterior ankle arthroscopy can basically be performed by two different methods; the dorsiflexion- or distraction method. The objective of this study was to determine the size of the anterior working area for both the dorsiflexion and distraction method. The anterior working area is anteriorly limited by the overlying anatomy which includes the neurovascular bundle. We hypothesize that in ankle dorsiflexion the anterior neurovascular bundle will move away anteriorly from the ankle joint, whereas in ankle distraction the anterior neurovascular bundle is pulled tight towards the joint, thereby decreasing the safe anterior working area. Six fresh frozen ankle specimens, amputated above the knee, were scanned with computed tomography. Prior to scanning the anterior tibial artery was injected with contrast fluid and subsequently each ankle was scanned both in ankle dorsiflexion and in distraction. A special device was developed to reproducibly obtain ankle dorsiflexion and distraction in the computed tomography scanner. The distance between the anterior border of the inferior tibial articular facet and the posterior border of the anterior tibial artery was measured. The median distance from the anterior border of the inferior tibial articular facet to the posterior border of the anterior tibial artery in ankle dorsiflexion and distraction was 0.9 cm (range 0.7-1.5) and 0.7 cm (range 0.5-0.8), respectively. The distance in ankle dorsiflexion significantly exceeded the distance in ankle distraction (P = 0.03). The current study shows a significantly increased distance between the anterior distal tibia and the overlying anterior neurovascular bundle with the ankle in a slightly dorsiflexed position as compared to the distracted ankle position. We thereby conclude that the distracted ankle position puts the neurovascular structures more at risk for iatrogenic damage when performing anterior ankle arthroscopy.

Transfibular ankle arthrodesis: A novel method for ankle fusion - A short term retrospective study

Directory of Open Access Journals (Sweden)

S Muthukumar Balaji

2017-01-01

Full Text Available Background: Ankle arthrodesis has long been the traditional operative treatment for posttraumatic arthritis, rheumatoid arthritis, infection, neuromuscular conditions, and salvage of failed ankle arthroplasty. It remains the treatment of choice for patients in whom heavy and prolonged activity is anticipated. We present our short term followup study of functional outcome of patients who underwent transfibular ankle arthrodesis for arthritis of ankle due to various indications. Materials and Methods: 29 transfibular ankle arthrodesis in 29 patients performed between April 2009 and April 2014 were included in this study. The mean age was 50 years (range 22-75 years. The outcome analysis with a minimum of 1-year postoperative followup were included. All the patients were assessed with the American Orthopaedic Foot and Ankle Society (AOFAS Hindfoot scale. Results: All cases of ankle fusions (100% progressed to solid union in a mean postoperative duration of 3.8 months (range 3-6 months. All patients had sound arthrodesis. The mean followup period was 32.52 months (standard deviation ± 10.34. The mean AOFAS score was 74 (pain score = 32, functional score = 42. We found that twenty patients (68.96% out of 29, had excellent results, 7 (24.13% had good, and 2 (6.89% showed fair results. Conclusion: Transfibular ankle arthrodesis is a simple and effective procedure for ankle arthritis. It achieves a high rate of union and good functional outcome on midterm followup.

Active ankle motion may result in changes to the talofibular interval in individuals with chronic ankle instability and ankle sprain copers: a preliminary study.

Science.gov (United States)

Croy, Theodore; Cosby, Nicole L; Hertel, Jay

2013-08-01

Alterations in talocrural joint arthrokinematics related to repositioning of the talus or fibula following ankle sprain have been reported in radiological and clinical studies. It is unclear if these changes can result from normal active ankle motion. The study objective was to determine if active movement created changes in the sagittal plane talofibular interval in ankles with a history of lateral ankle sprain and instability. Three subject groups [control (n = 17), ankle sprain copers (n = 20), and chronic ankle instability (n = 20)] underwent ultrasound imaging of the anterolateral ankle gutter to identify the lateral malleolus and talus over three trials. Between trials, subjects actively plantar and dorsiflexed the ankle three times. The sagittal plane talofibular interval was assessed by measuring the anteroposterior distance (mm) between the lateral malleolus and talus from an ultrasound image. Between group and trial differences were analyzed with repeated measures analysis of variance and post-hoc t-tests. Fifty-seven subjects participated. A significant group-by-trial interaction was observed (F4,108 = 3.5; P = 0.009). The talofibular interval was increased in both copers [2.4±3.6 mm; 95% confidence interval (CI): 0.73-4.1; P = 0.007] and chronic ankle instability (4.1±4.6 mm; 95% CI: 1.9-6.2; P = 0.001) at trial 3 while no changes were observed in control ankle talar position (0.06±2.8mm; 95% CI: -1.5-1.4; P = 0.93). The talofibular interval increased only in subjects with a history of lateral ankle sprain with large clinical effect sizes observed. These findings suggest that an alteration in the position of the talus or fibula occurred with non-weight bearing sagittal plane motion. These findings may have diagnostic and therapeutic implications for manual therapists.

The adult ball-and-socket ankle joint: surgical management of late ankle and subtalar arthritis.

Science.gov (United States)

Lewis, John S; DeOrio, James K

2015-04-01

We review the surgical management of 4 adult patients with ball-and-socket ankle deformity who developed end-stage subtalar and/or ankle joint arthritis. We retrospectively reviewed a series of 4 adult patients with ball-and-socket ankle configurations who underwent surgical treatment for either end-stage tibiotalar or subtalar arthritis, with either subtalar arthrodesis or total ankle replacement (TAR). Clinical outcome, including subjective pain assessment, limitation of activities, and difficulty with shoe wear, were assessed at follow-up. A total of 5 ankles in 4 patients were identified that met the inclusion criteria. There were 3 subtalar arthrodeses in 2 patients and 2 primary TARs in 2 patients. At an average follow-up of 30.5 (range = 17 to 59) months, there were no failures, although 1 patient who underwent TAR was considered an impending failure with aseptic component loosening. Of the 4 patients, 3 resumed normal activity with minimal pain and were very pleased with their overall outcome. Standard surgical interventions for ankle and subtalar arthritis, such as total ankle arthroplasty and subtalar arthrodesis, can be successfully performed in patients with ball-and-socket ankles; clinical outcome and survivorship, however, may be inferior to that in patients with normal ankle configurations. Therapeutic, Level IV: Case Series. © 2014 The Author(s).

Effects of circumferential ankle pressure on ankle proprioception, stiffness, and postural stability: a preliminary investigation.

Science.gov (United States)

You, Sung H; Granata, Kevin P; Bunker, Linda K

2004-08-01

Cross-sectional repeated-measures design. Determine the effects of circumferential ankle pressure (CAP) intervention on proprioceptive acuity, ankle stiffness, and postural stability. The application of CAP using braces, taping, and adaptive shoes or military boots is widely used to address chronic ankle instability (CAI). An underlying assumption is that the CAP intervention might improve ankle stability through increased proprioceptive acuity and stiffness in the ankle. METHOD AND MEASURES: A convenience sample of 10 subjects was recruited from the local university community and categorized according to proprioceptive acuity (high, low) and ankle stability (normal, CAI). Proprioceptive acuity was measured when blindfolded subjects were asked to accurately reproduce a self-selected target ankle position before and after the application of CAP. Proprioceptive acuity was determined in 5 different ankle joint position sense tests: neutral, inversion, eversion, plantar flexion, and dorsiflexion. Joint position angles were recorded electromechanically using a potentiometer. Passive ankle stiffness was computed from the ratio of applied static moment versus angular displacement. Active ankle stiffness was determined from biomechanical analyses of ankle motion following a mediolateral perturbation. Postural stability was quantified from the center of pressure displacement in the mediolateral and the anteroposterior directions in unipedal stance. All measurements were recorded with and without CAP applied by a pediatric blood pressure cuff. Data were analyzed using a separate mixed-model analysis of variance (ANOVA) for each dependent variable. Post hoc comparison using Tukey's honestly significant difference (HSD) test was performed if significant interactions were obtained. Significance level was set at P<.05 for all analyses. Significant group (high versus low proprioceptive acuity) x CAP interactions were identified for postural stability. Passive ankle stiffness was

Ankle ligament injuries

Directory of Open Access Journals (Sweden)

Per A.F.H. Renström

1998-06-01

Full Text Available Acute ankle ligament sprains are common injuries. The majority of these occur during athletic participation in the 15 to 35 year age range. Despite the frequency of the injury, diagnostic and treatment protocols have varied greatly. Lateral ligament complex injuries are by far the most common of the ankle sprains. Lateral ligament injuries typically occur during plantar flexion and inversion, which is the position of maximum stress on the anterotalofibular liagment (ATFL. For this reason, the ATFL is the most commonly torn ligament during an inversion injury. In more severe inversion injuries the calcaneofibular (CFL, posterotalofibular (PTFL and subtalar ligament can also be injured. Most acute lateral ankle ligament injuries recover quickly with nonoperative management. The treatment program, called "functional treatment," includes application of the RICE principle (rest, ice, compression, and elevation immediately after the injury, a short period of immobilization and protection with an elastic or inelastic tape or bandage, and early motion exercises followed by early weight bearing and neuromuscular ankle training. Proprioceptive training with a tilt board is commenced as soon as possible, usually after 3 to 4 weeks. The purpose is to improve the balance and neuromuscular control of the ankle. Sequelae after ankle ligament injuries are very common. As much as 10% to 30% of patients with a lateral ligament injury may have chronic symptoms. Symptoms usually include persistent synovitis or tendinitis, ankle stiffness, swelling, and pain, muscle weakness, and frequent giving-way. A well designed physical therapy program with peroneal strengthening and proprioceptive training, along with bracing and/or taping can alleviate instability problems in most patients. For cases of chronic instability that are refractory to bracing and external support, surgical treatment can be explored. If the chronic instability is associated with subtalar instability

Diagnostic performance of susceptibility-weighted magnetic resonance imaging for the assessment of sub-coracoacromial spurs causing subacromial impingement syndrome.

Science.gov (United States)

Nörenberg, Dominik; Armbruster, Marco; Bender, Yi-Na; Walter, Thula; Ebersberger, Hans U; Diederichs, Gerd; Hamm, Bernd; Ockert, Ben; Makowski, Marcus R

2017-03-01

To evaluate the potential of susceptibility-weighted-magnetic-resonance-imaging (SWMR) for the detection of sub-coracoacromial spurs in patients with clinically suspected subacromial impingement syndrome (SAIS), compared to standard MR-sequences and radiographs. Forty-four patients with suspected SAIS were included. All patients underwent radiography, standard MRI of the shoulder and SWMR. Radiograph-based identification of sub-coracoacromial spurs served as goldstandard. Radiographs identified twenty-three spurs in twenty-three patients. Twenty-one patients without spur formation served as reference group. Detection rate, sensitivity/specificity and interobserver-agreements were calculated. Linear regression was applied to determine the relationship between size measurements on radiographs and MRI. Detection rates for spurs on standard MRI and SWMR were 47.8 % and 91.3 % compared to radiography (pformation in patients with SAIS and is superior to standard MR-sequences using radiography as goldstandard. • SWMR has the potential to reliably identify sub-coracoacromial spurs without radiation exposure. • SWMR provides comparable detection rates to conventional radiography for sub-coracoacromial spur formation. • SWMR yields higher detection rates compared to standard-MR regarding sub-coracoacromial spur formation. • SWMR can be implemented in routine shoulder MRI protocols.

All-inside, anatomical lateral ankle stabilization for revision and complex primary lateral ankle stabilization: a technique guide.

Science.gov (United States)

Prissel, Mark A; Roukis, Thomas S

2014-12-01

Lateral ankle instability is a common mechanical problem that often requires surgical management when conservative efforts fail. Historically, myriad open surgical approaches have been proposed. Recently, consideration for arthroscopic management of lateral ankle instability has become popular, with promising results. Unfortunately, recurrent inversion ankle injury following lateral ankle stabilization can occur and require revision surgery. To date, arthroscopic management for revision lateral ankle stabilization has not been described. We present a novel arthroscopic technique combining an arthroscopic lateral ankle stabilization kit with a suture anchor ligament augmentation system for revision as well as complex primary lateral ankle stabilization. © 2014 The Author(s).

Accessory ossicles and sesamoid bones of the ankle and foot: imaging findings, clinical significance and differential diagnosis

International Nuclear Information System (INIS)

Mellado, J.M.; Ramos, A.; Salvado, E.; Camins, A.; Sauri, A.; Danus, M.

2003-01-01

Accessory ossicles and sesamoid bones are frequent findings in routine radiographs of the ankle and foot. They are commonly considered fortuitous and unrelated to the patient's complaint; however, they may eventually cause painful syndromes or degenerative changes in response to overuse and trauma. They may also suffer or simulate fractures. Our aim was to review, illustrate and discuss the imaging findings of some of the more frequent accessory ossicles and sesamoid bones of the ankle and foot region, with particular emphasis on those that may be of clinical significance or simulate fractures. (orig.)

Atomization of Impinging Droplets on Superheated Superhydrophobic Surfaces

Science.gov (United States)

Emerson, Preston; Crockett, Julie; Maynes, Daniel

2017-11-01

Water droplets impinging smooth superheated surfaces may be characterized by dynamic vapor bubbles rising to the surface, popping, and causing a spray of tiny droplets to erupt from the droplet. This spray is called secondary atomization. Here, atomization is quantified experimentally for water droplets impinging superheated superhydrophobic surfaces. Smooth hydrophobic and superhydrophobic surfaces with varying rib and post microstructuring were explored. Each surface was placed on an aluminum heating block, and impingement events were captured with a high speed camera at 3000 fps. For consistency among tests, all events were normalized by the maximum atomization found over a range of temperatures on a smooth hydrophobic surface. An estimate of the level of atomization during an impingement event was created by quantifying the volume of fluid present in the atomization spray. Droplet diameter and Weber number were held constant, and atomization was found for a range of temperatures through the lifetime of the impinging droplet. The Leidenfrost temperature was also determined and defined to be the lowest temperature at which atomization ceases to occur. Both atomization and Leidenfrost temperature increase with decreasing pitch (distance between microstructures).

Ankle Sprains. A Round Table.

Science.gov (United States)

Physician and Sportsmedicine, 1986

1986-01-01

Types of ankle sprains, surgical versus nonsurgical treatment, tape versus brace for support, rehabilitation, exercise, and prevention of ankle sprains are discussed by a panel of experts. An acute ankle taping technique is illustrated. (MT)

Role of Ankle Arthroscopy in Management of Acute Ankle Fracture.

Science.gov (United States)

Chan, Kwok Bill; Lui, Tun Hing

2016-11-01

To report the operative findings of ankle arthroscopy during open reduction and internal fixation of acute ankle fractures. This was a retrospective review of 254 consecutive patients with acute ankle fractures who were treated with open reduction and internal fixation of the fractures, and ankle arthroscopy was performed at the same time. The accuracy of fracture reduction, the presence of syndesmosis disruption and its reduction, and the presence of ligamentous injuries and osteochondral lesions were documented. Second-look ankle arthroscopy was performed during syndesmosis screw removal 6 weeks after the key operation. There were 6 patients with Weber A, 177 patients with Weber B, 51 patients with Weber C, and 20 patients with isolated medial malleolar fractures. Syndesmosis disruption was present in 0% of patients with Weber A fracture, 52% of patients with Weber B fracture, 92% of patients with Weber C fracture, and 20% of the patients with isolated medial malleolar fracture. Three patients with Weber B and one patient with Weber C fracture have occult syndesmosis instability after screw removal. Osteochondral lesion was present in no patient with Weber A fracture, 26% of the Weber B cases, 24% of the Weber C cases, and 20% of isolated medial malleolar fracture cases. The association between the presence of deep deltoid ligament tear and syndesmosis disruption (warranting syndesmosis screw fixation) in Weber B cases was statistically significant but not in Weber C cases. There was no statistically significant association between the presence of posterior malleolar fracture and syndesmosis instability that warrant screw fixation. Ankle arthroscopy is a useful adjuvant tool to understand the severity and complexity of acute ankle fracture. Direct arthroscopic visualization ensures detection and evaluation of intra-articular fractures, syndesmosis disruption, and associated osteochondral lesions and ligamentous injuries. Level IV, case series

Calculations of slurry pump jet impingement loads

International Nuclear Information System (INIS)

Wu, T.T.

1996-01-01

This paper presents a methodology to calculate the impingement load in the region of a submerged turbulent jet where a potential core exits and the jet is not fully developed. The profile of the jet flow velocities is represented by a piece-wise linear function which satisfies the conservation of momentum flux of the jet flow. The adequacy of the of the predicted jet expansion is further verified by considering the continuity of the jet flow from the region of potential core to the fully developed region. The jet impingement load can be calculated either as a direct impingement force or a drag force using the jet velocity field determined by the methodology presented

Difference in balance measures between patients with chronic ankle instability and patients after an acute ankle inversion trauma

NARCIS (Netherlands)

de Vries, J. S.; Kingma, I.; Blankevoort, L.; van Dijk, C. N.

2010-01-01

Neuromuscular control of the ankle is disturbed in patients with chronic ankle instability due to an initial ankle inversion trauma. Static balance is assumed to be a measure for this disturbance. Functional (ankle) scores are another way to evaluate ankle impairment. The hypothesis was that there

Foot, leg, and ankle swelling

Science.gov (United States)

Swelling of the ankles - feet - legs; Ankle swelling; Foot swelling; Leg swelling; Edema - peripheral; Peripheral edema ... Foot, leg, and ankle swelling is common when the person also: Is overweight Has a blood clot in the leg Is older Has ...

Spring-like Ankle Foot Orthoses reduce the energy cost of walking by taking over ankle work.

Science.gov (United States)

Bregman, D J J; Harlaar, J; Meskers, C G M; de Groot, V

2012-01-01

In patients with central neurological disorders, gait is often limited by a reduced ability to push off with the ankle. To overcome this reduced ankle push-off, energy-storing, spring-like carbon-composite Ankle Foot Orthoses (AFO) can be prescribed. It is expected that the energy returned by the AFO in late stance will support ankle push-off, and reduce the energy cost of walking. In 10 patients with multiple sclerosis and stroke the energy cost of walking, 3D kinematics, joint power, and joint work were measured during gait, with and without the AFO. The mechanical characteristics of the AFO were measured separately, and used to calculate the contribution of the AFO to the ankle kinetics. We found a significant decrease of 9.8% in energy cost of walking when walking with the AFO. With the AFO, the range of motion of the ankle was reduced by 12.3°, and the net work around the ankle was reduced by 29%. The total net work in the affected leg remained unchanged. The AFO accounted for 60% of the positive ankle work, which reduced the total amount of work performed by the leg by 11.1% when walking with the AFO. The decrease in energy cost when walking with a spring-like energy-storing AFO in central neurological patients is not induced by an augmented net ankle push-off, but by the AFO partially taking over ankle work. Copyright © 2011 Elsevier B.V. All rights reserved.

Acute ankle sprain in dancers.

Science.gov (United States)

Russell, Jeffrey A

2010-01-01

Ankle sprain is a common injury in dancers. Because of the relative frequency of this injury and its wide acceptance as a likely part of an active lifestyle, in many individuals it may not receive the careful attention it deserves. An extreme ankle range of motion and excellent ankle stability are fundamental to success in dance. Hence, following a proper treatment protocol is crucial for allowing a dancer who suffers an ankle sprain to return to dance as soon as possible without impaired function. This article reviews the basic principles of the etiology and management of ankle sprain in dancers. Key concepts are on-site examination and treatment, early restoration, dance-specific rehabilitation, and a carefully administered safe return to dance. Additionally, injuries that may occur in conjunction with ankle sprain are highlighted, and practical, clinically relevant summary concepts for dance healthcare professionals, dance scientists, dance teachers, and dancers are provided.

Functional Instability of the Ankle Joint: Etiopathogenesis

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Aydan ÖRSÇELİK

2016-09-01

Full Text Available Ankle sprain is one of the most common sports injuries. Chronic ankle instability is a common complication of ankle sprains. Two causes of chronic ankle instability are mechanical instability and functional instability. It is important to understand functional instability etiopathogenesis of the ankle joint in order to guide diagnosis and treatment. This article aims to understand the etiopathogenesis of functional ankle instability.

Experimental investigation of submerged single jet impingement using Cu–water nanofluid

International Nuclear Information System (INIS)

Li Qiang; Xuan Yimin; Yu Feng

2012-01-01

Jet impingement cooling is a vital technique for thermal management of electronic devices of high-heat-flux by impinging fluid on a heater surface due to its high local heat transfer rates. In this paper, two types of Cu–water nanofluids (Cu particles with 25 nm diameter or 100 nm) are introduced into submerged single jet impingement cooling system as the working fluid. The heat transfer features of the nanofluids were experimentally investigated. The effects of the nanoparticle concentration, Reynolds number, nozzle-to-plate distance, fluid temperature, and nanoparticle diameter on the heat transfer performances of the jet impingement of nanofluids are discussed. The experimental results show that the suspended nanoparticles remarkably increase the convective heat transfer coefficient of the base fluid. The convective heat transfer coefficient of Cu–water nanofluid with the volume fraction of 3.0% has 52% higher than the pure water. The experiments also revealed that the suspended nanoparticles brought almost no extra addition of pressure drop in both submerged single jet impingement. In addition, by considering the effects of the suspended nanoparticles as well as the condition of impinging jet, a new heat transfer correlation of nanofluids for the submerged single jet impingement has been proposed. - Highlights: ► Cu–water nanofluids are introduced into submerged single jet impingement. ► The affecting parameters on the heat transfer performances of nanofluids are discussed. ► New heat transfer correlation of nanofluid for single jet impingement is proposed.

Comparison of Multisegmental Foot and Ankle Motion Between Total Ankle Replacement and Ankle Arthrodesis in Adults.

Science.gov (United States)

Seo, Sang Gyo; Kim, Eo Jin; Lee, Doo Jae; Bae, Kee Jeong; Lee, Kyoung Min; Lee, Dong Yeon

2017-09-01

Total ankle replacement (TAR) and ankle arthrodesis (AA) are usually performed for severe ankle arthritis. We compared postoperative foot segmental motion during gait in patients treated with TAR and AA. Gait analysis was performed in 17 and 7 patients undergoing TAR and AA, respectively. Subjects were evaluated using a 3-dimensional multisegmental foot model with 15 markers. Temporal gait parameters were calculated. The maximum and minimum values and the differences in hallux, forefoot, hindfoot, and arch in 3 planes (sagittal, coronal, transverse) were compared between the 2 groups. One hundred healthy adults were evaluated as a control. Gait speed was faster in the TAR ( P = .028). On analysis of foot and ankle segmental motion, the range of hindfoot sagittal motion was significantly greater in the TAR (15.1 vs 10.2 degrees in AA; P = .004). The main component of motion increase was hindfoot dorsiflexion (12.3 and 8.6 degrees). The range of forefoot sagittal motion was greater in the TAR (9.3 vs 5.8 degrees in AA; P = .004). Maximum ankle power in the TAR (1.16) was significantly higher than 0.32 in AA; P = .008). However, the range of hindfoot and forefoot sagittal motion was decreased in both TAR and AA compared with the control group ( P = .000). Although biomechanical results of TAR and AA were not similar to those in the normal controls, joint motions in the TAR more closely matched normal values. Treatment decision making should involve considerations of the effect of surgery on the adjacent joints. Level III, case-control study.

Vladimir Byurchiev, Ankle Bones

OpenAIRE

Churyumov, Anton

2017-01-01

Vladimir says that today not many children play with ankle bones. He recalls when he was young, children played with bones more often. According to Vladimir, various games using ankle bones develop flexibility, agility, and muscle in children’s hands. Ankles bones are taken from the back legs of a cow or a sheep. It is possible to determine the age and health of animals by examining this particular bone. Arcadia

Prospective Computed Tomographic Analysis of Osteochondral Lesions of the Ankle Joint Associated With Ankle Fractures

NARCIS (Netherlands)

Nosewicz, Tomasz L.; Beerekamp, M. Suzan H.; de Muinck Keizer, Robert-Jan O.; Schepers, Tim; Maas, Mario; Niek van Dijk, C.; Goslings, J. Carel

2016-01-01

Osteochondral lesions (OCLs) associated with ankle fracture correlate with unfavorable outcome. The goals of this study were to detect OCLs following ankle fracture, to associate fracture type to OCLs and to investigate whether OCLs affect clinical outcome. 100 ankle fractures requiring operative

Prospective Computed Tomographic Analysis of Osteochondral Lesions of the Ankle Joint Associated With Ankle Fractures.

Science.gov (United States)

Nosewicz, Tomasz L; Beerekamp, M Suzan H; De Muinck Keizer, Robert-Jan O; Schepers, Tim; Maas, Mario; Niek van Dijk, C; Goslings, J Carel

2016-08-01

Osteochondral lesions (OCLs) associated with ankle fracture correlate with unfavorable outcome. The goals of this study were to detect OCLs following ankle fracture, to associate fracture type to OCLs and to investigate whether OCLs affect clinical outcome. 100 ankle fractures requiring operative treatment were prospectively included (46 men, 54 women; mean age 44 ± 14 years, range 20-77). All ankle fractures (conventional radiography; 71 Weber B, 22 Weber C, 1 Weber A, 4 isolated medial malleolus and 2 isolated posterior malleolus fractures) were treated by open reduction and internal fixation. Multidetector computed tomography (CT) was performed postoperatively. For each OCL, the location, size, and Loomer OCL classification (CT modified Berndt and Harty classification) were determined. The subjective Foot and Ankle Outcome Scoring (FAOS) was used for clinical outcome at 1 year. OCLs were found in 10/100 ankle fractures (10.0%). All OCLs were solitary talar lesions. Four OCLs were located posteromedial, 4 posterolateral, 1 anterolateral, and 1 anteromedial. There were 2 type I OCLs (subchondral compression), 6 type II OCLs (partial, nondisplaced fracture) and 2 type IV OCLs (displaced fracture). Mean OCL size (largest diameter) was 4.4 ± 1.7 mm (range, 1.7 mm to 6.2 mm). Chi-square analysis showed no significant association between ankle fracture type and occurrence of OCLs. OCLs did occur only in Lauge-Hansen stage III/IV ankle fractures. There were no significant differences in FAOS outcome between patients with or without OCLs. Ten percent of investigated ankle fractures had associated OCLs on CT. Although no significant association between fracture type and OCL was found, OCLs only occurred in Lauge-Hansen stage III/IV ankle fractures. With the numbers available, OCLs did not significantly affect clinical outcome at 1 year according to FAOS. Level IV, observational study. © The Author(s) 2016.

Clinical value of the Ottawa ankle rules for diagnosis of fractures in acute ankle injuries.

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Xin Wang

Full Text Available BACKGROUND: The Ottawa ankle rules (OAR are clinical decision guidelines used to identify whether patients with ankle injuries need to undergo radiography. The OAR have been proven that their application reduces unnecessary radiography. They have nearly perfect sensitivity for identifying clinically significant ankle fractures. OBJECTIVES: The purpose of this study was to assess the applicability of the OAR in China, to examine their accuracy for the diagnosis of fractures in patients with acute ankle sprains, and to assess their clinical utility for the detection of occult fractures. METHODS: In this prospective study, patients with acute ankle injuries were enrolled during a 6-month period. The eligible patients were examined by emergency orthopedic specialists using the OAR, and then underwent ankle radiography. The results of examination using the OAR were compared with the radiographic results to assess the accuracy of the OAR for ankle fractures. Patients with OAR results highly suggestive of fracture, but no evidence of a fracture on radiographs, were advised to undergo 3-dimensional computed tomography (3D-CT. RESULTS: 183 patients with ankle injuries were enrolled in the study and 63 of these injuries involved fractures. The pooled sensitivity, specificity, positive predictive value and negative predictive value of the OAR for detection of fractures of the ankle were 96.8%, 45.8%, 48.4% and 96.5%, respectively. Our results suggest that clinical application of the OAR could decrease unnecessary radiographs by 31.1%. Of the 21 patients with positive OAR results and negative radiographic findings who underwent 3D-CT examination, five had occult fractures of the lateral malleolus. CONCLUSIONS: The OAR are applicable in the Chinese population, and have high sensitivity and modest specificity for the diagnosis of fractures associated with acute ankle injury. They may detect some occult fractures of the malleoli that are not visible on

Recalcitrant Lateral Premalleolar Bursitis of the Ankle Associated with Lateral Ankle Instability

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Masashi Naito

2017-01-01

Full Text Available Lateral premalleolar bursitis of the ankle is a rarely reported disorder in the English literature although it is not uncommon in Asian countries where people commonly sit on their feet. Here, we present the case of a 66-year-old woman with recalcitrant lateral premalleolar bursitis associated with lateral ankle instability which was successfully treated with surgical resection of the bursa and repair of the anterior talofibular ligament. Operative findings revealed a communication between the bursa and articular cavity of the ankle joint via the sheath of the extensor digitorum longus tendon, which was considered to act as a check valve leading to a large and recalcitrant bursitis. This report provides a novel concept about the etiology of recalcitrant lateral premalleolar bursitis of the ankle.

A three-dimensional model to assess the effect of ankle joint axis misalignments in ankle-foot orthoses.

Science.gov (United States)

Fatone, Stefania; Johnson, William Brett; Tucker, Kerice

2016-04-01

Misalignment of an articulated ankle-foot orthosis joint axis with the anatomic joint axis may lead to discomfort, alterations in gait, and tissue damage. Theoretical, two-dimensional models describe the consequences of misalignments, but cannot capture the three-dimensional behavior of ankle-foot orthosis use. The purpose of this project was to develop a model to describe the effects of ankle-foot orthosis ankle joint misalignment in three dimensions. Computational simulation. Three-dimensional scans of a leg and ankle-foot orthosis were incorporated into a link segment model where the ankle-foot orthosis joint axis could be misaligned with the anatomic ankle joint axis. The leg/ankle-foot orthosis interface was modeled as a network of nodes connected by springs to estimate interface pressure. Motion between the leg and ankle-foot orthosis was calculated as the ankle joint moved through a gait cycle. While the three-dimensional model corroborated predictions of the previously published two-dimensional model that misalignments in the anterior -posterior direction would result in greater relative motion compared to misalignments in the proximal -distal direction, it provided greater insight showing that misalignments have asymmetrical effects. The three-dimensional model has been incorporated into a freely available computer program to assist others in understanding the consequences of joint misalignments. Models and simulations can be used to gain insight into functioning of systems of interest. We have developed a three-dimensional model to assess the effect of ankle joint axis misalignments in ankle-foot orthoses. The model has been incorporated into a freely available computer program to assist understanding of trainees and others interested in orthotics. © The International Society for Prosthetics and Orthotics 2014.

Retrospective comparison of the Low Risk Ankle Rules and the Ottawa Ankle Rules in a pediatric population.

Science.gov (United States)

Ellenbogen, Amy L; Rice, Amy L; Vyas, Pranav

2017-09-01

A recent multicenter prospective Canadian study presented prospective evidence supporting the Low Risk Ankle Rules (LRAR) as a means of reducing the number of ankle radiographs ordered for children presenting with an ankle injury while maintaining nearly 100% sensitivity. This is in contrast to a previous prospective study which showed that this rule yielded only 87% sensitivity. It is important to further investigate the LRAR and compare them with the already validated Ottawa Ankle Rules (OAR) to potentially curb healthcare costs and decrease unnecessary radiation exposure without compromising diagnostic accuracy. We conducted a retrospective chart review of 980 qualifying patients ages 12months to 18years presenting with ankle injury to a commonly staffed 310 bed children's hospital and auxiliary site pediatric emergency department. There were 28 high-risk fractures identified. The Ottawa Ankle Rules had a sensitivity of 100% (95% CI 87.7-100), specificity of 33.1% (95% CI 30.1-36.2), and would have reduced the number of ankle radiographs ordered by 32.1%. The Low Risk Ankle Rules had a sensitivity of 85.7% (95% CI 85.7-96), specificity of 64.9% (95% CI 61.8-68), and would have reduced the number of ankle radiographs ordered by 63.1%. The latter rule missed 4 high-risk fractures. The Low Risk Ankle Rules may not be sensitive enough for use in Pediatric Emergency Departments, while the Ottawa Ankle Rules again demonstrated 100% sensitivity. Further research on ways to implement the Ottawa Ankle Rules and maximize its ability to decrease wait times, healthcare costs, and improve patient satisfaction are needed. Copyright © 2017 Elsevier Inc. All rights reserved.

The ANKLE TRIAL (ANKLE treatment after injuries of the ankle ligaments: what is the benefit of external support devices in the functional treatment of acute ankle sprain? : a randomised controlled trial

Directory of Open Access Journals (Sweden)

Witjes Suzanne

2012-02-01

Full Text Available Abstract Background Acute lateral ankle ligament injuries are very common problems in present health care. Still there is no hard evidence about which treatment strategy is superior. Current evidence supports the view that a functional treatment strategy is preferable, but insufficient data are present to prove the benefit of external support devices in these types of treatment. The hypothesis of our study is that external ankle support devices will not result in better outcome in the treatment of acute ankle sprains, compared to a purely functional treatment strategy. Overall objective is to compare the results of three different strategies of functional treatment for acute ankle sprain, especially to determine the advantages of external support devices in addition to functional treatment strategy, based on balance and coordination exercises. Methods/design This study is designed as a randomised controlled multi-centre trial with one-year follow-up. Adult and healthy patients (N = 180 with acute, single sided and first inversion trauma of the lateral ankle ligaments will be included. They will all follow the same schedule of balancing exercises and will be divided into 3 treatment groups, 1. pressure bandage and tape, 2. pressure bandage and brace and 3. no external support. Primary outcome measure is the Karlsson scoring scale; secondary outcomes are FAOS (subscales, number of recurrent ankle injuries, Visual Analogue Scales of pain and satisfaction and adverse events. They will be measured after one week, 6 weeks, 6 months and 1 year. Discussion The ANKLE TRIAL is a randomized controlled trial in which a purely functional treated control group, without any external support is investigated. Results of this study could lead to other opinions about usefulness of external support devices in the treatment of acute ankle sprain. Trial registration Netherlands Trial Register (NTR: NTR2151

The ANKLE TRIAL (ANKLE treatment after injuries of the ankle ligaments): what is the benefit of external support devices in the functional treatment of acute ankle sprain? : a randomised controlled trial

Science.gov (United States)

2012-01-01

Background Acute lateral ankle ligament injuries are very common problems in present health care. Still there is no hard evidence about which treatment strategy is superior. Current evidence supports the view that a functional treatment strategy is preferable, but insufficient data are present to prove the benefit of external support devices in these types of treatment. The hypothesis of our study is that external ankle support devices will not result in better outcome in the treatment of acute ankle sprains, compared to a purely functional treatment strategy. Overall objective is to compare the results of three different strategies of functional treatment for acute ankle sprain, especially to determine the advantages of external support devices in addition to functional treatment strategy, based on balance and coordination exercises. Methods/design This study is designed as a randomised controlled multi-centre trial with one-year follow-up. Adult and healthy patients (N = 180) with acute, single sided and first inversion trauma of the lateral ankle ligaments will be included. They will all follow the same schedule of balancing exercises and will be divided into 3 treatment groups, 1. pressure bandage and tape, 2. pressure bandage and brace and 3. no external support. Primary outcome measure is the Karlsson scoring scale; secondary outcomes are FAOS (subscales), number of recurrent ankle injuries, Visual Analogue Scales of pain and satisfaction and adverse events. They will be measured after one week, 6 weeks, 6 months and 1 year. Discussion The ANKLE TRIAL is a randomized controlled trial in which a purely functional treated control group, without any external support is investigated. Results of this study could lead to other opinions about usefulness of external support devices in the treatment of acute ankle sprain. Trial registration Netherlands Trial Register (NTR): NTR2151 PMID:22340371

Measurement of passive ankle stiffness in subjects with chronic hemiparesis using a novel ankle robot

Science.gov (United States)

Roy, Anindo; Bever, Christopher T.; Forrester, Larry W.; Macko, Richard F.; Hogan, Neville

2011-01-01

Our objective in this study was to assess passive mechanical stiffness in the ankle of chronic hemiparetic stroke survivors and to compare it with those of healthy young and older (age-matched) individuals. Given the importance of the ankle during locomotion, an accurate estimate of passive ankle stiffness would be valuable for locomotor rehabilitation, potentially providing a measure of recovery and a quantitative basis to design treatment protocols. Using a novel ankle robot, we characterized passive ankle stiffness both in sagittal and in frontal planes by applying perturbations to the ankle joint over the entire range of motion with subjects in a relaxed state. We found that passive stiffness of the affected ankle joint was significantly higher in chronic stroke survivors than in healthy adults of a similar cohort, both in the sagittal as well as frontal plane of movement, in three out of four directions tested with indistinguishable stiffness values in plantarflexion direction. Our findings are comparable to the literature, thus indicating its plausibility, and, to our knowledge, report for the first time passive stiffness in the frontal plane for persons with chronic stroke and older healthy adults. PMID:21346215

Mobile ankle and knee perturbator.

Science.gov (United States)

Andersen, Jacob Buus; Sinkjaer, Thomas

2003-10-01

A mobile ankle and knee perturbator has been developed. It consists of a functional joint with an integrated clutch. Four Bowden wires connect the joint to a powerful motor and a double pneumatic cylinder. When needed during any time of the gait cycle, it is possible to impose an ankle rotation by engaging the clutch and rotating the ankle or knee joint with a predefined displacement. The system is designed to investigate electrophysiological and biomechanical features of the human ankle or knee joint during gait.

Four-jet impingement: Noise characteristics and simplified acoustic model

International Nuclear Information System (INIS)

Brehm, C.; Housman, J.A.; Kiris, C.C.; Barad, M.F.; Hutcheson, F.V.

2017-01-01

Highlights: • Large eddy simulation of unique four jet impingement configuration. • Characterization of flow features using POD, FFT, and wavelet decomposition. • Noise source identification utilizing causality method. • Development of simplified acoustic model utilizing equivalent source method. • Comparison with experimental data from BENS experiment. - Abstract: The noise generation mechanisms for four directly impinging supersonic jets are investigated employing implicit large eddy simulations with a higher-order weighted essentially non-oscillatory scheme. Although these types of impinging jet configurations have been used in many experiments, a detailed investigation of the noise generation mechanisms has not been conducted before. The flow field is highly complex and contains a wide range of temporal and spatial scales relevant for noise generation. Proper orthogonal decomposition is utilized to characterize the unsteady nature of the flow field involving unsteady shock oscillations, large coherent turbulent flow structures, and the sporadic appearance of vortical flow structures in the center of the four-jet impingement region. The causality method based on Lighthills acoustic analogy is applied to link fluctuations of flow quantities inside the source region to the acoustic pressure in the far field. It will be demonstrated that the entropy fluctuation term plays a vital role in the noise generation process. Consequently, the understanding of the noise generation mechanisms is employed to develop a simplified acoustic model of the four-jet impingement device by utilizing the equivalent source method. Finally, three linear acoustic four-jet impingement models of the four-jet impingement device are used as broadband noise sources inside an engine nacelle and the acoustic scattering results are validated against far-field acoustic experimental data.

Invariant ankle moment patterns when walking with and without a robotic ankle exoskeleton.

Science.gov (United States)

Kao, Pei-Chun; Lewis, Cara L; Ferris, Daniel P

2010-01-19

To guide development of robotic lower limb exoskeletons, it is necessary to understand how humans adapt to powered assistance. The purposes of this study were to quantify joint moments while healthy subjects adapted to a robotic ankle exoskeleton and to determine if the period of motor adaptation is dependent on the magnitude of robotic assistance. The pneumatically powered ankle exoskeleton provided plantar flexor torque controlled by the wearer's soleus electromyography (EMG). Eleven naïve individuals completed two 30-min sessions walking on a split-belt instrumented treadmill at 1.25m/s while wearing the ankle exoskeleton. After two sessions of practice, subjects reduced their soleus EMG activation by approximately 36% and walked with total ankle moment patterns similar to their unassisted gait (r(2)=0.98+/-0.02, THSD, p>0.05). They had substantially different ankle kinematic patterns compared to their unassisted gait (r(2)=0.79+/-0.12, THSD, probotic ankle exoskeleton (Gordon and Ferris, 2007). Our results strongly suggest that humans aim for similar joint moment patterns when walking with robotic assistance rather than similar kinematic patterns. In addition, greater robotic assistance provided during initial use results in a longer adaptation process than lesser robotic assistance. Copyright 2009 Elsevier Ltd. All rights reserved.

Lower limb biomechanics in femoroacetabular impingement syndrome: a systematic review and meta-analysis.

Science.gov (United States)

King, Matthew G; Lawrenson, Peter R; Semciw, Adam I; Middleton, Kane J; Crossley, Kay M

2018-05-01

(1) Identify differences in hip and pelvic biomechanics in patients with femoroacetabular impingement syndrome (FAIS) compared with controls during everyday activities (eg, walking, squatting); and (2) evaluate the effects of interventions on hip and pelvic biomechanics during everyday activities. Systematic review. Medline, CINAHL, EMBASE, Scopus and SPORTDiscus until February 2017. Primary aim: studies that investigated hip or pelvic kinematics and/or joint torques of everyday activities in patients with FAIS compared with the asymptomatic contralateral limb or a control group. Secondary aim: studies that evaluated effects of conservative or surgical interventions on patients with FAIS using pre-post or controlled clinical trial designs. Biomechanical data must have been collected using three-dimensional motion capture devices. Reporting quality was assessed using the Epidemiological Appraisal Instrument and data were pooled (standardised mean difference (SMD), 95% CI) where populations and primary outcomes were similar. Fourteen studies were included (11 cross-sectional and three pre/post intervention), varying between low and moderate reporting quality. Patients with FAIS walked with a lower: peak hip extension angle (SMD -0.40, 95% CI -0.71 to -0.09), peak internal rotation angle (-0.67, 95% CI -1.19 to -0.16) and external rotation joint torque (-0.71, 95% CI -1.07 to -0.35), and squatted to a lesser depth with no difference in hip flexion range. Pre/post intervention data were limited in number and quality, and to surgical cohorts. This review suggests that patients with FAIS may demonstrate hip biomechanical impairments during walking and squatting, with minimal literature available to comment on other tasks. The information presented in the review provides insight into the biomechanical differences associated with FAIS; however, the between-group differences were small to moderate. This information may aid in the development of management strategies for

The American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale; translation and validation of the Dutch language version for ankle fractures.

Science.gov (United States)

de Boer, A Siebe; Tjioe, Roderik J C; Van der Sijde, Fleur; Meuffels, Duncan E; den Hoed, Pieter T; Van der Vlies, Cornelis H; Tuinebreijer, Wim E; Verhofstad, Michael H J; Van Lieshout, Esther M M

2017-08-03

The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale is among the most commonly used instruments for measuring outcome of treatment in patients who sustained a complex ankle or hindfoot injury. It consists of a patient-reported and a physician-reported part. A validated, Dutch version of this instrument is currently not available. The aim of this study was to translate the instrument into Dutch and to determine the measurement properties of the AOFAS Ankle-Hindfoot Scale Dutch language version (DLV) in patients with a unilateral ankle fracture. Multicentre (two Dutch hospitals), prospective observational study. In total, 142 patients with a unilateral ankle fracture were included. Ten patients were lost to follow-up. Patients completed the subjective (patient-reported) part of the AOFAS Ankle-Hindfoot Scale-DLV. A physician or trained physician-assistant completed the physician-reported part. For comparison and evaluation of the measuring characteristics, the Foot Function Index and the Short Form-36 were completed by the patient. Descriptive statistics (including floor and ceiling effects), reliability (ie, internal consistency), construct validity, reproducibility (ie, test-retest reliability, agreement and smallest detectable change) and responsiveness were determined. The AOFAS-DLV and its subscales showed good internal consistency (Cronbach's α >0.90). Construct validity and longitudinal validity were proven to be adequate (76.5% of predefined hypotheses were confirmed). Floor effects were not present. Ceiling effects were present from 6 months onwards, as expected. Responsiveness was adequate, with a smallest detectable change of 12.0 points. The AOFAS-DLV is a reliable, valid and responsive measurement instrument for evaluating functional outcome in patients with a unilateral ankle fracture. This implies that the questionnaire is suitable to compare different treatment modalities within this population or to compare outcome across

Supersonic impinging jet noise reduction using a hybrid control technique

Science.gov (United States)

Wiley, Alex; Kumar, Rajan

2015-07-01

Control of the highly resonant flowfield associated with supersonic impinging jet has been experimentally investigated. Measurements were made in the supersonic impinging jet facility at the Florida State University for a Mach 1.5 ideally expanded jet. Measurements included unsteady pressures on a surface plate near the nozzle exit, acoustics in the nearfield and beneath the impingement plane, and velocity field using particle image velocimetry. Both passive control using porous surface and active control with high momentum microjet injection are effective in reducing nearfield noise and flow unsteadiness over a range of geometrical parameters; however, the type of noise reduction achieved by the two techniques is different. The passive control reduces broadband noise whereas microjet injection attenuates high amplitude impinging tones. The hybrid control, a combination of two control methods, reduces both broadband and high amplitude impinging tones and surprisingly its effectiveness is more that the additive effect of the two control techniques. The flow field measurements show that with hybrid control the impinging jet is stabilized and the turbulence quantities such as streamwise turbulence intensity, transverse turbulence intensity and turbulent shear stress are significantly reduced.

Investigation of impingement attack mechanism of copper alloy condenser tubes

Energy Technology Data Exchange (ETDEWEB)

Fukumura, Takuya; Nakajima, Nobuo; Arioka, Koji; Totsuka, Nobuo; Nakagawa, Tomokazu [Institute of Nuclear Safety System Inc., Mihama, Fukui (Japan)

2001-09-01

In order to investigate generation and growth mechanisms of impingement attacks of sea water against copper alloy condenser tubes used in condensers of nuclear power plants, we took out condenser tubes from actual condensers, cut them into several pieces and carried out several material tests mainly for impinged spots. In addition water flow inside of a pit was analyzed. From the results of the investigation, it was found that all of impingement attacks were found in the marks left by sessile organisms and none were found in downstream of the marks as frequently proposed so far. At the pits generated inside the marks, iron coating was striped and zinc content was deficient in some cases. Combining these data and the result of flow analysis, we considered the following mechanism of the impingement attacks: sessile organisms clinging to the surface of the condenser tube and growth, occlusion of the tube, extinction and decomposition of sessile organisms, pollution corrosion under the organisms and cavity formation, occlusion removal by the cleaning, generation of impingement attacks by flow collision inside the cavity, growth of the impingement attacks. (author)

Differences in lateral ankle laxity measured via stress ultrasonography in individuals with chronic ankle instability, ankle sprain copers, and healthy individuals.

Science.gov (United States)

Croy, Theodore; Saliba, Susan A; Saliba, Ethan; Anderson, Mark W; Hertel, Jay

2012-07-01

Cross-sectional. To use stress ultrasonography to measure the change in anterior talofibular ligament length during the simulated anterior drawer and ankle inversion stress tests. In approximately 30% of individuals, ankle sprains may eventually develop into chronic ankle instability (CAI) with recurrent symptoms. Individuals with CAI and those who have a history of ankle sprain (greater than 1 year prior) without chronic instability (copers) may or may not have mechanical laxity. Sixty subjects (n=60 ankles) were divided into 3 groups: 1) Control subjects without ankle injury history (n=20; mean ± SD age; 24.8 ± 4.8 years; height, 173.7 ± 9.4 cm; weight, 77.2 ± 19.5 kg), ankle sprain copers (n=20; 22.3 ± 2.9 years; 172.8 ± 11.3 cm; 72.4 ± 14.3 kg), and subjects with CAI (n=20; 23.5 ± 4.2 years; 174.6 ± 9.6 cm; 74.8 ± 17.3 kg). Ligament length change with the anterior drawer and end range ankle inversion was calculated from ultrasound images. The Foot and Ankle Ability Measure (FAAM) was used to quantify self-reported function on activities-of-daily living (ADL) and sports. The anterior drawer test resulted in length changes that were greater (F₂,₅₇=6.2, P=.004) in the CAI (mean ± SD length change, 15.6 ± 15.1%, P=.006) and the coper groups (14.0 ± 15.9%, P=.016) compared to the control group (1.3 ± 10.7%); however the length change for the CAI and coper groups were not different (P=.93). Ankle inversion similarly resulted in greater ligament length change (F₂,₅₇=6.5, P=.003) in the CAI (25.3 ± 15.5%, P=.003) and coper groups (20.2 ± 19.6%, P=.039) compared to the control group (7.4 ± 12.9%); with no difference in length change between the copers and CAI groups (P=.59). The CAI group had a lower score on the FAAM-ADL (87.4 ± 13.4%) and FAAM-Sports (74.2 ± 17.8%) when compared to the control (98.8 ± 2.9% and 98.9 ± 3.1%, P<.0001) and coper groups (99.4 ± 1.8% and 94.6 ± 8.8%, P<.0001). Stress ultrasonography identified greater

Altered Knee and Ankle Kinematics During Squatting in Those With Limited Weight-Bearing–Lunge Ankle-Dorsiflexion Range of Motion

Science.gov (United States)

Dill, Karli E.; Begalle, Rebecca L.; Frank, Barnett S.; Zinder, Steven M.; Padua, Darin A.

2014-01-01

Context: Ankle-dorsiflexion (DF) range of motion (ROM) may influence movement variables that are known to affect anterior cruciate ligament loading, such as knee valgus and knee flexion. To our knowledge, researchers have not studied individuals with limited or normal ankle DF-ROM to investigate the relationship between those factors and the lower extremity movement patterns associated with anterior cruciate ligament injury. Objective: To determine, using 2 different measurement techniques, whether knee- and ankle-joint kinematics differ between participants with limited and normal ankle DF-ROM. Design: Cross-sectional study. Setting: Sports medicine research laboratory. Patients or Other Participants: Forty physically active adults (20 with limited ankle DF-ROM, 20 with normal ankle DF-ROM). Main Outcome Measure(s): Ankle DF-ROM was assessed using 2 techniques: (1) nonweight-bearing ankle DF-ROM with the knee straight, and (2) weight-bearing lunge (WBL). Knee flexion, knee valgus-varus, knee internal-external rotation, and ankle DF displacements were assessed during the overhead-squat, single-legged squat, and jump-landing tasks. Separate 1-way analyses of variance were performed to determine whether differences in knee- and ankle-joint kinematics existed between the normal and limited groups for each assessment. Results: We observed no differences between the normal and limited groups when classifying groups based on nonweight-bearing passive-ankle DF-ROM. However, individuals with greater ankle DF-ROM during the WBL displayed greater knee-flexion and ankle-DF displacement and peak knee flexion during the overhead-squat and single-legged squat tasks. In addition, those individuals also demonstrated greater knee-varus displacement during the single-legged squat. Conclusions: Greater ankle DF-ROM assessed during the WBL was associated with greater knee-flexion and ankle-DF displacement during both squatting tasks as well as greater knee-varus displacement during

Acute ankle sprain: conservative or surgical approach?

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Al-Mohrej, Omar A.; Al-Kenani, Nader S.

2016-01-01

Ankle sprains fall into two main categories: acute ankle sprains and chronic ankle instability, which are among the most common recurrent injuries during occupational activities, athletic events, training and army service. Acute ankle sprain is usually managed conservatively and functional rehabilitation failure by conservative treatment leads to development of chronic ankle instability, which most often requires surgical intervention. Enhancing the in-depth knowledge of the ankle anatomy, biomechanics and pathology helps greatly in deciding the management options. Cite this article: Al-Mohrej OA, Al-Kenani NS. Acute ankle sprain: conservative or surgical approach? EFORT Open Rev 2016;1:34-44. DOI: 10.1302/2058-5241.1.000010. PMID:28461926

Inter- and intrarater reliability of goniometry and hand held dynamometry for patients with subacromial impingement syndrome.

Science.gov (United States)

Fieseler, Georg; Laudner, Kevin G; Irlenbusch, Lars; Meyer, Henrike; Schulze, Stephan; Delank, Karl-Stefan; Hermassi, Souhail; Bartels, Thomas; Schwesig, René

2017-12-01

The purpose of this study was to examine the intra- and interrater reliability of measuring shoulder range of motion (ROM) and strength among patients diagnosed with subacromial impingement syndrome (SAIS). Twenty-five patients (14 female patients; mean age, 60.4± 7.84 years) diagnosed with SAIS were assessed to determine the intrarater reliability for glenohumeral ROM. Twenty-five patients (16 female patients; mean age, 60.4± 7.80 years) and 76 asymptomatic volunteers (52 female volunteers; mean age, 29.4± 14.1 years) were assessed for interrater reliability. Dependent variables were active shoulder ROM and isometric strength. Intrarater reliability was fair-to-excellent for the SAIS patients (intraclass correlation coefficient [ICC], 0.52-0.97; standard error of measurement [SEM], 4.4°-9.9° N; coefficient of variation [CV], 7.1%-44.9%). Based on the ICC, 11 of 12 parameters (92%) displayed an excellent reliability (ICC> 0.75). The interrater reliability showed fair-to-excellent results (SAIS patients: ICC, 0.13-0.98; SEM, 2.3°-8.8°; CV, 3.6%-37.0%; controls: ICC, 0.11-0.96; SEM, 3.0°-35.4°; CV, 5.6%-26.4%). In accordance with the intrarater reliability, glenohumeral adduction ROM was the only parameter with an ICC below 0.75 for both samples. Painful shoulder ROM in the SAIS patients showed no influence on the quality of reliability for measurement. Therefore, these protocols should be considered reliable assessment techniques in the prevention, diagnosis, and treatment of painful shoulder conditions such as SAIS.

Incidence of greater trochanteric pain syndrome in patients suspected for femoroacetabular impingement evaluated using magnetic resonance arthrography of the hip.

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Pozzi, Grazia; Lanza, Ezio; Parra, Cleber Garcia; Merli, Ilaria; Sconfienza, Luca Maria; Zerbi, Alberto

2017-03-01

We evaluated the incidence of greater trochanter pain syndrome (GTPS) in patients who underwent magnetic resonance arthrography (MRA) of the hip for a suspected femoroacetabular impingement (FAI) syndrome. Hip MRA performed at our institution (3/2012-1/2014) were reviewed. The absence/presence of FAI (cam, pincer, and mixed) was noted. GTPS diagnosis was based on gluteus medius/minimus tendinopathy/tears, trochanteric bursitis, fascia lata thickening, and trochanter bone oedema/erosion. Subgroup analysis for age (under/over 40 years) and FAI type (cam, pincer, and mixed) was also performed. N = 189 patients were included (n = 125 males; age 39 ± 12 years). FAI was diagnosed in n = 133 (70, 4%): cam type, n = 85 (63, 9%); pincer type, n = 22 (16, 6%); and mixed type, n = 26 (19, 5%). N = 72 patients (38.1%) had tendinopathy, n = 14 (7.4%) had trochanter erosion, n = 31 (16.4%) had bursitis, n = 4 had bone oedema (2.1%), and n = 3 (1.6%) had fascia lata thickening, resulting in GTPS diagnosis in n = 74 patients (39.2%). The association of normal hip morphology/GTPS was significantly higher (P = 0.023) than that of FAI/GTPS. Under 40 years, GTPS incidence was higher in patients with normal hip and pincer-type FAI (P = 0.028). Over 40 years, no difference between patients with/without FAI (P = 0.119) was seen. GTPS was more frequently observed in patients with normal hip morphology than in patients with FAI, particularly in patients under 40.

The Influence of Mulligan Ankle Taping on Dynamic Balance in the Athletes with and without Chronic Ankle Instability

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Tahereh Pourkhani

2014-04-01

Full Text Available Objective: The ankle joint is the most frequently injured anatomical site in athletes. Ankle instability is responsible for 25% of all time lost from sport. Clinical efficacy of the effect of taping in athletes with chronic ankle instability is unknown. So the purpose of this investigation is the study of the influence of Mulligan ankle taping on dynamic balance in the athletes with and without chronic ankle instability. Materials & Methods: 32 athletes participated in this investigation: 16 subjects with chronic ankle instability, 6 women and 10 men (age 23.5±0.3 years, height 175.4±10.3 cm, weight 73.6±14.5 kg, Foot Ankle Disability Index 74.5±8.62% and Foot Ankle Disability Index Sport 63.5±7.86% and 16 healthy subjects, 6 women and 10 men (age 22.81±7.1 years, height 173.6±12.26 cm, weight 66.4±11.4 kg, Foot Ankle Disability Index and Foot Ankle Disability Index Sport 100%. Dynamic balance was assessed with Star Excursion Balance Test in 3 reaching directions (medial, antero-medial and postero-medial before and after Mulligan ankle taping. Independent and paired t-test were used for statistical analysis. Results: Dynamic balance in healthy group significantly was better than injured group (P&le0.05. Application of taping caused significantly improvement in dynamic balance in both groups (reaching in media, antero-medial and postero-medial directions (P&le0.05 (except reaching in antero-medial direction in healthy group (P>0.05. Conclusion: So it seems that Mulligan ankle taping can improve dynamic balance in the athletes with and without chronic ankle instability.

[Relationship between brachial-ankle pulse wave velocity and metabolic syndrome].

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Liu, Miao; He, Yao; Jiang, Bin; Wu, Lei; Wang, Jian-hua; Yang, Shan-shan; Wang, Yi-yan; Li, Xiao-ying

2014-06-18

To evaluate the association between brachial-ankle pulse wave velocity (ba-PWV) and metabolic syndrome (MetS) among the Chinese elderly and the gender difference. We conducted a population-based cross-sectional study in a representative urban area of Beijing, China. A sample of 2 102 community elderly (848 males, and 1 254 females) aged 60 to 95 years were included in the study. MetS was defined according to the 2009 harmonizing definition. The prevalence of MetS was 59.1% (50.1% in males and 65.2% in females, P<0.001). The baPWV value was between 8.2 to 45.6 (20.0 ± 4.4) m/s, and showed an increasing trend with age (P<0.001). The partial correlation showed baPWV was positively associated with BMI (r=0.076, P=0.037), systolic blood pressure (r=0.380, P<0.001), diastolic blood pressure (r=0.276, P<0.001), triglyceride (r=0.040, P=0.046), fasting blood glucose (r=0.140, P<0.001), 2-hour post-meal blood glucose (r=0.121, P<0.001), and negatively associated with HDL-C (r=-0.128, P=0.048). There was a strong association between baPWV and prevalence of MetS and its component number in females but not in males. Compared with the lowest quartile of baPWV, the adjusted ORs were 1.22 (95%CI 0.83-1.79), 1.32 (95%CI 0.90-1.93), 1.46(95%CI 1.00-2.14) in males and 1.28 (95%CI 0.93-1.77), 1.55 (95%CI 1.12-2.16), 1.86(95%CI 1.32-2.61) in females for the second, third and top quartiles. The prevalence of MetS increases substantially with increasing levels of baPWV among the Chinese elderly, especially in females.

Direct Flame Impingement

Energy Technology Data Exchange (ETDEWEB)

None

2005-09-01

During the DFI process, high velocity flame jets impinge upon the material being heated, creating a high heat transfer rate. As a result, refractory walls and exhaust gases are cooler, which increases thermal efficiency and lowers NOx emissions. Because the jet nozzles are located a few inches from the load, furnace size can be reduced significantly.

Thermal-hydraulic performance of convective boiling jet array impingement

International Nuclear Information System (INIS)

Jenkins, R; De Brún, C; Kempers, R; Lupoi, R; Robinson, A J

2016-01-01

Jet impingement boiling is investigated with regard to heat transfer and pressure drop performance using a novel laser sintered 3D printed jet impingement manifold design. Water was the working fluid at atmospheric pressure with inlet subcooling of 7 o C. The convective boiling performance of the impinging jet system was investigated for a flat copper target surface for 2700≤Re≤5400. The results indicate that the heat transfer performance of the impinging jet is independent of Reynolds number for fully developed boiling. Also, the investigation of nozzle to plate spacing shows that low spacing delays the onset of nucleate boiling causing a superheat overshoot that is not observed with larger gaps. However, no sensitivity to the gap spacing was measured once boiling was fully developed. The assessment of the pressure drop performance showed that the design effectively transfers heat with low pumping power requirements. In particular, owing to the insensitivity of the heat transfer to flow rate during fully developed boiling, the coefficient of performance of jet impingement boiling in the fully developed boiling regime deteriorates with increased flow rate due to the increase in pumping power flux. (paper)

Effects of ankle foot orthoses on body functions and activities in people with floppy paretic ankle muscles : a systematic review

NARCIS (Netherlands)

Wilk, van der Dymphy; Dijkstra, Pieter Ubele; Postema, Klaas; Verkerke, Gijsbertus Jacob; Hijmans, Juha Markus

2015-01-01

Background: People with floppy ankle muscles paresis use ankle foot orthoses to improve their walking ability. Ankle foot orthoses also limit ankle range of motion thereby introducing additional problems. Insight in effects of ankle foot orthoses on body functions and activities in people with

[Influence of Ankle Braces on the Prevalence of Ankle Inversion Injuries in the Swiss Volleyball National League A].

Science.gov (United States)

Jaggi, J; Kneubühler, S; Rogan, S

2016-06-01

Ankle inversion is a common injury among volleyball players. The injury rate during a game is 2.1 times higher than during training. As a result, the preventive use of ankle braces is frequently observed in Swiss volleyball leagues. Studies have shown that ankle braces have a preventive effect on the prevalence of ankle inversion. In Switzerland there has been no investigation into the preventive use of braces and their influence on prevalence. For this reason, the goals of this study are 1) to determine when, why and by whom ankle braces are worn and 2) to evaluate the injury rate of users and non-users of ankle braces. A modified questionnaire was sent to 18 men's and women's teams of the Swiss National League A. The questionnaire included questions about injury rates and the circumstances of ankle inversion injuries. The data were statistically analysed with Microsoft Excel 2012 and SPSS Version 20. The overall response rate was 61 %, allowing data from 181 players to be analysed. 33 % (59 of 181) of the players used an ankle brace. There was a statistically significant difference in the prevalence of ankle inversion between users (12 injured) and non-users (8 injured) (p = 0.006). Wearing an ankle brace during training or during a game made no difference in the prevention of injuries (p = 0.356). More athletes were injured during training (n = 13) than during a game (n = 7). The results of the present study indicate that volleyball players preferably wear ankle braces to prevent injury. More than one third of the players in the study wore an ankle brace, 60 % for primary prevention and 40 % for secondary prevention due to a previous injury. The study shows that significantly more users than non-users of ankle braces were injured. This is contrary to literature. Furthermore it was shown that more injuries occur during training than during a game. This finding results from the fact that ankle braces were rarely worn during training. It is

Current concepts in the diagnosis and treatment of shoulder impingement

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Bijayendra Singh

2017-01-01

Full Text Available Subacromial impingement syndrome (SIS is a very common cause of shoulder pain in the young adults. It can cause debilitating pain, dysfunction, and affects the activities of daily living. It represents a spectrum of pathology ranging from bursitis to rotator cuff tendinopathy which can ultimately lead to degenerative tear of the rotator cuff. Various theories and concepts have been described and it is still a matter of debate. However, most published studies suggest that both extrinsic and intrinsic factors have a role in the development of SIS. The management is controversial as both nonoperative and operative treatments have shown to provide good results. This article aims to provide a comprehensive current concepts review of the pathogenesis, etiologies, clinical diagnosis, appropriate use of investigations, and discussion on the management of SIS.

Ball-and-socket ankle joint

International Nuclear Information System (INIS)

Pistoia, F.; Ozonoff, M.B.; Wintz, P.; Hartford Hospital, CT

1987-01-01

The ball-and-socket ankle joint is a malformation of the ankle in which the articular surface of the talus is hemispherical in both the anteroposterior and lateral projections and has a congruent, concave tibial articular surface. Fourteen patients with this condition were identified retrospectively. Thirteen patients were thought to have the congenital type of ball-and-socket ankle joint which in many was associated with tarsal coalition, short limb, and ray fusion and deletion anomalies. One case of the acquired type, demonstrating less geometric rounding of the talar margins, was seen in a patient with myelomeningocele, probably resulting from sensory and motor deficits. Although the exact etiology of the congenital type is unknown, its association with other malformations suggests that the ball-and-socket ankle joint results from an overall maldevelopment of the ankle and foot. (orig.)

Joint stability characteristics of the ankle complex in female athletes with histories of lateral ankle sprain, part II: clinical experience using arthrometric measurement.

Science.gov (United States)

Kovaleski, John E; Heitman, Robert J; Gurchiek, Larry R; Hollis, J M; Liu, Wei; Pearsall, Albert W

2014-01-01

This is part II of a 2-part series discussing stability characteristics of the ankle complex. In part I, we used a cadaver model to examine the effects of sectioning the lateral ankle ligaments on anterior and inversion motion and stiffness of the ankle complex. In part II, we wanted to build on and apply these findings to the clinical assessment of ankle-complex motion and stiffness in a group of athletes with a history of unilateral ankle sprain. To examine ankle-complex motion and stiffness in a group of athletes with reported history of lateral ankle sprain. Cross-sectional study. University research laboratory. Twenty-five female college athletes (age = 19.4 ± 1.4 years, height = 170.2 ± 7.4 cm, mass = 67.3 ± 10.0 kg) with histories of unilateral ankle sprain. All ankles underwent loading with an ankle arthrometer. Ankles were tested bilaterally. The dependent variables were anterior displacement, anterior end-range stiffness, inversion rotation, and inversion end-range stiffness. Anterior displacement of the ankle complex did not differ between the uninjured and sprained ankles (P = .37), whereas ankle-complex rotation was greater for the sprained ankles (P = .03). The sprained ankles had less anterior and inversion end-range stiffness than the uninjured ankles (P ankle-complex laxity and end-range stiffness were detected in ankles with histories of sprain. These results indicate the presence of altered mechanical characteristics in the soft tissues of the sprained ankles.

Osteoligamentous injuries of the medial ankle joint.

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Lötscher, P; Lang, T H; Zwicky, L; Hintermann, B; Knupp, M

2015-12-01

Injuries of the ankle joint have a high incidence in daily life and sports, thus, playing an important socioeconomic role. Therefore, proper diagnosis and adequate treatment are mandatory. While most of the ligament injuries around the ankle joint are treated conservatively, great controversy exists on how to treat deltoid ligament injuries in ankle fractures. Missed injuries and inadequate treatment of the medial ankle lead to inferior outcome with instability, progressive deformity, and ankle joint osteoarthritis.

Spring-like Ankle Foot Orthoses reduce the energy cost of walking by taking over ankle work

NARCIS (Netherlands)

Bregman, D.J.J.; Harlaar, J.; Meskers, C.G.M.; de Groot, V.

2012-01-01

In patients with central neurological disorders, gait is often limited by a reduced ability to push off with the ankle. To overcome this reduced ankle push-off, energy-storing, spring-like carbon-composite Ankle Foot Orthoses (AFO) can be prescribed. It is expected that the energy returned by the

Analysis of impingement impacts on Hudson River fish populations

International Nuclear Information System (INIS)

Barnthouse, L.W.; van Winkle, W.

1988-01-01

Impacts of impingement, expressed as reductions in year-class abundance, were calculated for six Hudson River fish populations. Estimates were made for the 1974 and 1975 year classes of white perch, striped bass, Atlantic tomcod, and American shad, and the 1974 year classes of alewife and blueback herring. The maximum estimated reductions in year-class abundance were less than 5% for all year classes except the 1974 and 1975 white perch year classes and the 1974 striped bass year class. Only for white perch were the estimates greater than 10% per year. For striped bass, the 146,000 fish from the 1974 year class that were killed by impingement could have produced 12,000-16,000 5-year-old fish or 270-300 10-year-olds. Also estimated were the reductions in mortality that could have been achieved had closed-cycle cooling systems been installed at one or more of three power plants (Bowline point, Indian Point, and Roseton) and had the screen-wash systems at Bowline Point and Indian Point been modified to improve the survival of impinged fish. Closed-cycle cooling at all three plants would have reduced impingement impacts on white perch, striped bass, and Atlantic tomcod by 75% or more; installation of closed-cycle cooling at Indian Point alone would have reduced impingement impacts on white perch and Atlantic tomcod by 50%-80%. Modified traveling screens would have been less effective than closed-cycle cooling, but still would have reduced impingement impacts on white perch by roughly 20%. 23 refs., 1 fig., 3 tabs

Acute fractures of the pediatric foot and ankle.

Science.gov (United States)

Halai, Mansur; Jamal, Bilal; Rea, Paul; Qureshi, Mobeen; Pillai, Anand

2015-02-01

Injuries around the foot and ankle are challenging. There is a paucity of literature, outside that of specialist orthopedic journals, that focuses on this subject in the pediatric population. In this review, we outline pediatric foot and ankle fractures in an anatomically oriented manner from the current literature. Our aim is to aid the emergency department doctor to manage these challenging injuries more effectively in the acute setting. These injuries require a detailed history and examination to aid the diagnosis. Often, plain radiographs are sufficient, but more complex injuries require the use of magnetic resonance imaging. Treatment is dependent on the proximity to skeletal maturity and the degree of displacement of fracture. Children have a marked ability to remodel after fractures and therefore mainstay treatment is immobilization by a cast or splint. Operative fixation, although uncommon in this population, may be necessary with adolescents, certain unstable injuries or in cases with displaced articular surface. In the setting of severe foot trauma, skin compromise and compartment syndrome of the foot must be excluded. The integrity of the physis, articular surface and soft tissues are all equally important in treating these injuries.

Minor or occult ankle instability as a cause of anterolateral pain after ankle sprain.

Science.gov (United States)

Vega, Jordi; Peña, Fernando; Golanó, Pau

2016-04-01

The aim of this study was to determine which intra-articular injuries are associated with chronic anterolateral pain and functional instability after an ankle sprain. From 2008 to 2010, records of all patients who underwent ankle joint arthroscopy with anterolateral pain and functional instability after an ankle sprain were reviewed. A systematic arthroscopic examination of the intra-articular structures of the ankle joint was performed. Location and characteristics of the injuries were identified and recorded. A total of 36 ankle arthroscopic procedures were reviewed. A soft-tissue occupying mass over the lateral recess was present in 18 patients (50%). A partial injury of the anterior talofibular ligament (ATFL) was observed in 24 patients (66.6%). Cartilage abrasion due to the distal fascicle of the anteroinferior tibiofibular ligament coming into contact with the talus was seen in 21 patients (58.3%), but no thickening of the ligament was observed. Injury to the intra-articular posterior structures, including the transverse ligament in 19 patients (52.7%) and the posterior surface of the distal tibia in 21 patients (58.3%), was observed. Intra-articular pathological findings have been observed in patients affected by anterolateral pain after an ankle sprain. Despite no demonstrable abnormal lateral laxity, morphologic ATFL abnormality has been observed on arthroscopic evaluation. An injury of the ATFL is present in patients with chronic anterolateral pain and functional instability after an ankle sprain. A degree of microinstability due to a deficiency of the ATFL could explain the intra-articular pathological findings and the patients' complaints. IV.

Design of a simple, lightweight, passive-elastic ankle exoskeleton supporting ankle joint stiffness

Science.gov (United States)

Kim, Seyoung; Son, Youngsu; Choi, Sangkyu; Ham, Sangyong; Park, Cheolhoon

2015-09-01

In this study, a passive-elastic ankle exoskeleton (PEAX) with a one-way clutch mechanism was developed and then pilot-tested with vertical jumping to determine whether the PEAX is sufficiently lightweight and comfortable to be used in further biomechanical studies. The PEAX was designed to supplement the function of the Achilles tendon and ligaments as they passively support the ankle torque with their inherent stiffness. The main frame of the PEAX consists of upper and lower parts connected to each other by tension springs (N = 3) and lubricated hinge joints. The upper part has an offset angle of 5° with respect to the vertical line when the springs are in their resting state. Each spring has a slack length of 8 cm and connects the upper part to the tailrod of the lower part in the neutral position. The tailrod freely rotates with low friction but has a limited range of motion due to the stop pin working as a one-way clutch. Because of the one-way clutch system, the tension springs store the elastic energy only due to an ankle dorsiflexion when triggered by the stop pin. This clutch mechanism also has the advantage of preventing any inconvenience during ankle plantarflexion because it does not limit the ankle joint motion during the plantarflexion phase. In pilot jumping tests, all of the subjects reported that the PEAX was comfortable for jumping due to its lightweight (approximately 1 kg) and compact (firmly integrated with shoes) design, and subjects were able to nearly reach their maximum vertical jump heights while wearing the PEAX. During the countermovement jump, elastic energy was stored during dorsiflexion by spring extension and released during plantarflexion by spring restoration, indicating that the passive spring torque (i.e., supportive torque) generated by the ankle exoskeleton partially supported the ankle joint torque throughout the process.

Trochanteric impingement: is it a source of pain after THR?

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Mark J. Isaacson, DO

2015-09-01

Full Text Available While uncommon, trochanteric-pelvic impingement may lead to significant lateral hip pain. We defined “impingement distance” as the radiographic distance from the medial aspect of the greater trochanter and the corresponding lateral edge of the acetabular bone or component and compared this to the contralateral normal hip. We present two painful total hip replacement (THR cases, each featuring a patient with severe lateral hip pain when walking and sitting. Both patients had diminished femoral offset and trochanteric-pelvic clearance, compared to the contralateral normal hip. The impingement distance was increased an average of 10 mm with the exchange to a longer femoral head. Both patients had immediate and complete pain relief with operative treatment to increase the impingement distance.

MR imaging in the diagnosis of the os trigonum syndrome

International Nuclear Information System (INIS)

Tamburrini, O.; Porpiglia, H.; Barresi, D.; Bertucci, B.; Console, D.

1999-01-01

In this paper is investigated the yield of Magnetic Resonance Imaging (MRI) in hind foot conditions, particularly the os trigonum syndrome, which are very difficult to diagnose clinically. 7 consecutive patients were examined. They were complaining of hind foot pain for more than 4 months (male:female=1:6; age range 16-22 years, average 18.6). Three patients practiced competitive sports and 4 ballet. It was performed conventional radiography (orthogonal projections) and then MRI with a 0.5 T superconductive unit with surface coils; MR images were acquired with T1-weighted spin-echo (SE), T2-weighted gradient-echo (GRE), and fast inversion recovery (FIR) fat-suppressed sequences with 4 mm thickness and 0 mm gap. In 2 cases the os trigonum had irregular margins with subchondral sclerosis and widened synchondrosis. In 3 patients it was found flessor hallucis longus tenosynovitis, likely caused by tendon compression and displacement within its sheath; there were neither os trigonum marrow edema nor synchondrosis widening. One patient had os trigonum hypertrophy, mild synchondrosis widening and marrow edema, in the os trigonum and the posterior aspect of talus. One patient had the os trigonum, but no signs referable to the os trigonum syndrome. In the posterior impingement syndrome, the objective is to show inflammatory changes in the posterior capsule of the ankle joint, adjacent ligaments, tendons and chondrosynovial surface. MR provides important information on soft tissues involvement, synovial reaction, chondral and subchondral bone injuries and the association of flexor hallucis longus synovitis, if present. MRI also yields detailed information for correct therapeutic approach. In conclusion, MRI appears to be the technique of choice, after conventional radiography, thanks to its non invasiveness, multi planarity, and high spatial and contrast resolution [it

Outcome of ankle arthrodesis in posttraumatic arthritis

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B S Narayana Gowda

2012-01-01

Full Text Available Background: Ankle arthrodesis is still a gold standard salvage procedure for the management of ankle arthritis. There are several functional and mechanical benefits of ankle arthrodesis, which make it a viable surgical procedure in the management of ankle arthritis. The functional outcomes following ankle arthrodesis are not very well known. The purpose of this study was to perform a clinical and radiographic evaluation of ankle arthrodesis in posttraumatic arthritis performed using Charnley′s compression device. Materials and Methods: Between January 2006 and December 2009 a functional assessment of 15 patients (10 males and 5 females who had undergone ankle arthrodesis for posttraumatic arthritis and/or avascular necrosis (AVN talus (n=6, malunited bimalleolar fracture (n=4, distal tibial plafond fractures (n=3, medial malleoli nonunion (n=2. All the patients were assessed clinically and radiologically after an average followup of 2 years 8 months (range 1-5.7 years. Results: All patients had sound ankylosis and no complications related to the surgery. Scoring the patients with the American Orthopaedic Foot and Ankle Society (AOFAS Ankle-Hindfoot scale, we found that 11 of the 15 had excellent results, two had good, and two showed fair results. They were all returned to their preinjury activities. Conclusion: We conclude that, the ankle arthrodesis can still be considered as a standard procedure in ankle arthritis. On the basis of these results, patients should be counseled that an ankle fusion will help to relieve pain and to improve overall function. Still, one should keep in mind that it is a salvage procedure that will cause persistent alterations in gait with a potential for deterioration due to the development of subtalar arthritis.

Directing clinical care using lower extremity biomechanics in patients with ankle osteoarthritis and ankle arthroplasty.

Science.gov (United States)

Queen, Robin

2017-11-01

Ankle osteoarthritis is a debilitating disease with approximately 50,000 new cases per year leading to skeletal deformity, severe and recurrent pain, cartilage breakdown, and gait dysfunction limiting patient mobility and well-being. Although many treatments (total ankle arthroplasty [TAA], ankle fusion [arthrodesis], and ankle distraction arthroplasty) relieve pain, it is not clear that these procedures significantly improve patient mobility. The goal of the research presented here is to summarize what is presently known about lower extremity gait mechanics and outcomes and to quantify the impact of ankle osteoarthritis and TAA have on these measures using an explicitly holistic and mechanistic approach. Our recent studies have explored physical performance and energy recovery and revealed unexpected patterns and sequelae to treatment including incomplete restoration of gait function. These studies demonstrated for the first time the extreme levels and range of gait and balance dysfunction present in ankle osteoarthritis patients as well as quantifying the ways in which the affected joint alters movement and loading patterns not just in the painful joint, but throughout both the ipsilateral and contralateral lower extremity. Through this work, we determined that relieving pain alone through TAA is not enough to restore normal walking mechanics and balance due to underlying causes including limited ankle range of motion and balance deficits leading to long-term disability despite treatment. The results indicate the need to consider additional therapeutic interventions aimed at restoring balance, ankle range of motion, and movement symmetry in order to improve long-term health and function. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2345-2355, 2017. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

Anatomy of the ankle ligaments: a pictorial essay

NARCIS (Netherlands)

Golanó, Pau; Vega, Jordi; de Leeuw, Peter A. J.; Malagelada, Francesc; Manzanares, M. Cristina; Götzens, Víctor; van Dijk, C. Niek

2010-01-01

Understanding the anatomy of the ankle ligaments is important for correct diagnosis and treatment. Ankle ligament injury is the most frequent cause of acute ankle pain. Chronic ankle pain often finds its cause in laxity of one of the ankle ligaments. In this pictorial essay, the ligaments around the

Anatomy of the ankle ligaments: a pictorial essay

NARCIS (Netherlands)

Golanó, Pau; Vega, Jordi; de Leeuw, Peter A. J.; Malagelada, Francesc; Manzanares, M. Cristina; Götzens, Víctor; van Dijk, C. Niek

2016-01-01

Understanding the anatomy of the ankle ligaments is important for correct diagnosis and treatment. Ankle ligament injury is the most frequent cause of acute ankle pain. Chronic ankle pain often finds its cause in laxity of one of the ankle ligaments. In this pictorial essay, the ligaments around the

Cumulative occupational shoulder exposures and surgery for subacromial impingement syndrome: a nationwide Danish cohort study.

Science.gov (United States)

Dalbøge, Annett; Frost, Poul; Andersen, Johan Hviid; Svendsen, Susanne Wulff

2014-11-01

The primary aim was to examine exposure-response relationships between cumulative occupational shoulder exposures and surgery for subacromial impingement syndrome (SIS), and to compare sex-specific exposure-response relationships. The secondary aim was to examine the time window of relevant exposures. We conducted a nationwide register study of all persons born in Denmark (1933-1977), who had at least 5 years of full-time employment. In the follow-up period (2003-2008), we identified first-time events of surgery for SIS. Cumulative exposure estimates for a 10-year exposure time window with a 1-year lag time were obtained by linking occupational codes with a job exposure matrix. The exposure estimates were expressed as, for example, arm-elevation-years in accordance with the pack-year concept of tobacco consumption. We used a multivariable logistic regression technique equivalent to discrete survival analysis. The adjusted OR (ORadj) increased to a maximum of 2.1 for arm-elevation-years, repetition-years and force-years, and to 1.5 for hand-arm-vibration-years. Sex-specific exposure-response relationships were similar for men and women, when assessed using a relative risk scale. The ORadj increased gradually with the number of years contributing to the cumulative exposure estimates. The excess fraction was 24%. Cumulative occupational shoulder exposures carried an increase in risk of surgery for SIS with similar exposure-response curves for men and women. The risk of surgery for SIS increased gradually, when the period of exposure assessment was extended. In the general working population, a substantial fraction of all first-time operations for SIS could be related to occupational exposures. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Realignment Surgery for Malunited Ankle Fracture.

Science.gov (United States)

Guo, Chang-Jun; Li, Xing-Cheng; Hu, Mu; Xu, Yang; Xu, Xiang-Yang

2017-02-01

To investigate the characteristics and the results of realignment surgery for the treatment of malunited ankle fracture. Thirty-three patients with malunited fractures of the ankle who underwent reconstructive surgery at our hospital from January 2010 to January 2014 were reviewed. The tibial anterior surface angle (TAS), the tibiotalar tilt angle (TTA), the malleolar angle (MA), and the tibial lateral surface angle (TLS) were measured. Clinical assessment was performed with use of the American Orthopaedic Foot and Ankle Society (AOFAS) scale and visual analogue scale (VAS) scores, and the osteoarthritis stage was determined radiographically with the modified Takakura classification system. The Wilcoxon matched-pairs test was used to analyze the difference between the preoperative and the postoperative data. The mean follow-up was 36 months (range, 20-60 months). The mean age at the time of realignment surgery was 37.1 years (range, 18-62 years). Compared with preoperation, the TAS at the last follow-up showed a significant increase (88.50° ± 4.47° vs. 90.80° ± 3.49°, P = 0.0035); similar results were observed in TTA (1.62° ± 1.66° vs. 0.83° ± 0.90°, P ankle osteoarthritis, and was treated by ankle joint distraction. Realignment surgery for a malunited ankle fracture can reduce pain, improve function, and delay ankle arthrodesis or total ankle replacement. Postoperative large talar tilt and advanced stages of ankle arthritis are the risk factors for the surgery. © 2017 Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.

Effectiveness of telerehabilitation programme following surgery in shoulder impingement syndrome (SIS): study protocol for a randomized controlled non-inferiority trial.

Science.gov (United States)

Pastora-Bernal, Jose-Manuel; Martín-Valero, Rocío; Barón-López, Francisco Javier; García-Gómez, Oscar

2017-02-23

Shoulder pain is common in society, with high prevalence in the general population. Shoulder impingement syndrome (SIS) is the most frequent cause. Patients suffer pain, muscle weakness and loss of movement in the affected joint. Initial treatment is predominantly conservative. The surgical option has high success rates and is often used when conservative strategy fails. Traditional physiotherapy and post-operative exercises are needed for the recovery of joint range, muscle strength, stability and functionality. Telerehabilitation programmes have shown positive results in some orthopaedic conditions after surgery. Customized telerehabilitation intervention programmes should be developed to recover shoulder function after SIS surgery. The objective of this study is to evaluate the feasibility and effectiveness of a telerehabilitation intervention compared with usual care in patients after subacromial decompression surgery. We will compare an intervention group receiving videoconferences and a telerehabilitation programme to a control group receiving traditional physiotherapy intervention in a single-blind, randomized controlled non-inferiority trial study design. Through this study, we will further develop our preliminary data set and practical experience with the telerehabilitation programmes to evaluate their effectiveness and compare this with traditional intervention. We will also explore patient satisfaction and cost-effectiveness. Patient enrolment is ongoing. ClinicalTrials.gov, NCT02909920 . 14 September 2016.

Impinging jets - a short review on strategies for heat transfer enhancement

Science.gov (United States)

Nastase, Ilinca; Bode, Florin

2018-02-01

In industrial applications, heat and mass transfer can be considerably increased using impinging jets. A large number of flow phenomena will be generated by the impinging flow, such as: large scale structures, large curvature involving strong shear and normal stresses, stagnation in the wall boundary layers, heat transfer with the impinged wall, small scale turbulent mixing. All these phenomena are highly unsteady and even if nowadays a substantial number of studies in the literature are dedicated, the impinging jets are still not fully understood due to the highly unsteady nature and more over due to great difficulty of performing detailed numerical and experimental investigations.

Quantitative evaluation of the viscoelastic properties of the ankle joint complex in patients suffering from ankle sprain by the anterior drawer test.

Science.gov (United States)

Lin, Che-Yu; Shau, Yio-Wha; Wang, Chung-Li; Chai, Huei-Ming; Kang, Jiunn-Horng

2013-06-01

Biological tissues such as ligaments exhibit viscoelastic behaviours. Injury to the ligament may induce changes of these viscoelastic properties, and these changes could serve as biomarkers to detect the injury. In the present study, a novel instrument was developed to non-invasive quantify the viscoelastic properties of the ankle in vivo by the anterior drawer test. The purpose of the study was to investigate the reliability of the instrument and to compare the viscoelastic properties of the ankle between patients suffering from ankle sprain and controls. Eight patients and eight controls participated in the present study. The reliability test was performed on three randomly chosen subjects. In patient and control test, both ankles of each subject were tested to evaluate the viscoelastic properties of the ankle. The viscosity index was defined for quantitatively evaluating the viscosity of the ankle. Greater viscosity index was associated with lower viscosity. Injured and uninjured ankles of patient and both ankles of controls were compared. The instrument exhibited excellent test-retest reliability (r > 0.9). Injured ankles exhibited significantly less viscosity than uninjured ankles, since injured ankles of patients had significantly higher viscosity index (8,148 ± 5,266) compared with uninjured ankles of patients (948 ± 617; p = 0.008) and controls (1,326 ± 613; p ankle can serve as sensitive and useful clinical biomarkers to differentiate between injured and uninjured ankles. The method may provide a clinical examination for objectively evaluating lateral ankle ligament injuries.

The cost-effectiveness of semi-rigid ankle brace to facilitate return to work following first-time acute ankle sprains.

Science.gov (United States)

Fatoye, Francis; Haigh, Carol

2016-05-01

To examine the cost-effectiveness of semi-rigid ankle brace to facilitate return to work following first-time acute ankle sprains. Economic evaluation based on cost-utility analysis. Ankle sprains are a source of morbidity and absenteeism from work, accounting for 15-20% of all sports injuries. Semi-rigid ankle brace and taping are functional treatment interventions used by Musculoskeletal Physiotherapists and Nurses to facilitate return to work following acute ankle sprains. A decision model analysis, based on cost-utility analysis from the perspective of National Health Service was used. The primary outcomes measure was incremental cost-effectiveness ratio, based on quality-adjusted life years. Costs and quality of life data were derived from published literature, while model clinical probabilities were sourced from Musculoskeletal Physiotherapists. The cost and quality adjusted life years gained using semi-rigid ankle brace was £184 and 0.72 respectively. However, the cost and quality adjusted life years gained following taping was £155 and 0.61 respectively. The incremental cost-effectiveness ratio for the semi-rigid brace was £263 per quality adjusted life year. Probabilistic sensitivity analysis showed that ankle brace provided the highest net-benefit, hence the preferred option. Taping is a cheaper intervention compared with ankle brace to facilitate return to work following first-time ankle sprains. However, the incremental cost-effectiveness ratio observed for ankle brace was less than the National Institute for Health and Care Excellence threshold and the intervention had a higher net-benefit, suggesting that it is a cost-effective intervention. Decision-makers may be willing to pay £263 for an additional gain in quality adjusted life year. The findings of this economic evaluation provide justification for the use of semi-rigid ankle brace by Musculoskeletal Physiotherapists and Nurses to facilitate return to work in individuals with first-time ankle

Effects of visual feedback balance training on the balance and ankle instability in adult men with functional ankle instability.

Science.gov (United States)

Nam, Seung-Min; Kim, Kyoung; Lee, Do Youn

2018-01-01

[Purpose] This study examined the effects of visual feedback balance training on the balance and ankle instability in adult men with functional ankle instability. [Subjects and Methods] Twenty eight adults with functional ankle instability, divided randomly into an experimental group, which performed visual feedback balance training for 20 minutes and ankle joint exercises for 10 minutes, and a control group, which performed ankle joint exercise for 30 minutes. Exercises were completed three times a week for 8 weeks. Bio rescue was used for balance ability. It measured limit of stability at one minute. For ankle instability was measured using Cumberland ankle instability tool (CAIT). This measure was performed before and after the experiments in each group. [Results] The experimental group had significant increase in the Limit of Stability and CAIT score. The control group had significant increase in CAIT score. While the Limit of Stability increased without significance. [Conclusion] In conclusion, visual feedback balance training can be recommended as a treatment method for patients with functional ankle instability.

Spontaneous resolution of posterior ankle joint loose bodies after total ankle replacement: A case report.

Science.gov (United States)

Lee, Raymond P; Cheng, Sally H S

2017-06-01

Late stage ankle osteoarthritis often presents with debilitating pain. It is common to find osteophytes and loose body formation around the joint. Total ankle arthroplasty can preserve joint mobility and pain relieve for such patient. However, when trying to remove the osteophytes and loose bodies at the posterior ankle joint, there is risk of damaging posterior structures such as the neurovascular bundle during the procedure. We are presenting a case where the posterior loose bodies remained untouched during the operation, and patient showed spontaneous resolution of the lesions with time. Patient enjoyed good function outcome after the surgery. Copyright © 2016 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

Rotational effects on impingement cooling

Science.gov (United States)

Epstein, A. H.; Kerrebrock, J. L.; Koo, J. J.; Preiser, U. Z.

1987-01-01

The present consideration of rotation effects on heat transfer in a radially exhausted, impingement-cooled turbine blade model gives attention to experimental results for Reynolds and Rossby numbers and blade/coolant temperature ratio values that are representative of small gas turbine engines. On the basis of a model that encompasses the effects of Coriolis force and buoyancy on heat transfer, bouyancy is identified as the cause of an average Nusselt number that is 20-30 percent lower than expected from previous nonrotating data. A heuristic model is proposed which predicts that the impingement jets nearest the blade roots should deflect inward, due to a centripetal force generated by their tangential velocity counter to the blade motion. Potentially serious thermal stresses must be anticipated from rotation effects in the course of blade design.

Musculoskeletal ultrasonography delineates ankle symptoms in rheumatoid arthritis.

Science.gov (United States)

Toyota, Yukihiro; Tamura, Maasa; Kirino, Yohei; Sugiyama, Yumiko; Tsuchida, Naomi; Kunishita, Yosuke; Kishimoto, Daiga; Kamiyama, Reikou; Miura, Yasushi; Minegishi, Kaoru; Yoshimi, Ryusuke; Ueda, Atsuhisa; Nakajima, Hideaki

2017-05-01

To clarify the use of musculoskeletal ultrasonography (US) of ankle joints in rheumatoid arthritis (RA). Consecutive RA patients with or without ankle symptoms participated in the study. The US, clinical examination (CE), and patients' visual analog scale for pain (pVAS) for ankles were assessed. Prevalence of tibiotalar joint synovitis and tenosynovitis were assessed by grayscale (GS) and power Doppler (PD) US using a semi-quantitative grading (0-3). The positive US and CE findings were defined as GS score ≥2 and/or PD score ≥1, and joint swelling and/or tenderness, respectively. Multivariate analysis with the generalized linear mixed model was performed by assigning ankle pVAS as a dependent variable. Among a total of 120 ankles from 60 RA patients, positive ankle US findings were found in 21 (35.0%) patients. The concordance rate of CE and US was moderate (kappa 0.57). Of the 88 CE negative ankles, US detected positive findings in 9 (10.2%) joints. Multivariate analysis revealed that ankle US, clinical disease activity index, and foot Health Assessment Questionnaire, but not CE, was independently associated with ankle pVAS. US examination is useful to illustrate RA ankle involvement, especially for patients who complain ankle pain but lack CE findings.

The conservative treatment of ankle osteoarthritis

NARCIS (Netherlands)

Witteveen, A.G.H.

2015-01-01

In 70% to 78% of patients with ankle osteoarthritis (OA), they present themselves with the sequelae of a traumatic event in the past. Ankle trauma occurs in many patients at a relatively young age. Consequently, the expected life span of many patients with ankle OA is relatively long. Many treatment

Shear layer characteristics of supersonic free and impinging jets

Science.gov (United States)

Davis, T. B.; Kumar, R.

2015-09-01

The initial shear layer characteristics of a jet play an important role in the initiation and development of instabilities and hence radiated noise. Particle image velocimetry has been utilized to study the initial shear layer development of supersonic free and impinging jets. Microjet control employed to reduce flow unsteadiness and jet noise appears to affect the development of the shear layer, particularly near the nozzle exit. Velocity field measurements near the nozzle exit show that the initially thin, uncontrolled shear layer develops at a constant rate while microjet control is characterized by a rapid nonlinear thickening that asymptotes downstream. The shear layer linear growth rate with microjet control, in both the free and the impinging jet, is diminished. In addition, the thickened shear layer with control leads to a reduction in azimuthal vorticity for both free and impinging jets. Linear stability theory is used to compute unstable growth rates and convection velocities of the resultant velocity profiles. The results show that while the convection velocity is largely unaffected, the unstable growth rates are significantly reduced over all frequencies with microjet injection. For the case of the impinging jet, microjet control leads to near elimination of the impingement tones and an appreciable reduction in broadband levels. Similarly, for the free jet, significant reduction in overall sound pressure levels in the peak radiation direction is observed.

Practicality of profile-wire screen in reducing entrainment and impingement

International Nuclear Information System (INIS)

Hanson, B.N.; Bason, W.H.; Beitz, B.E.; Charles, K.E.

1978-01-01

Experimental studies indicated that 1.01-mm slot profile-wire well screen operated at an intake velocity of 15.24 cm/s virtually eliminated impingement of fishes larger than 15 mm fork length (FL). Intake velocities as high as 53.34 cm/s produced low impingement. Tests of fish less than 40 mm FL held near a functioning intake (15.24 cm/s) for as long as 3 hr yielded no impingement or stress. Many striped bass between 8 and 17 mm FL were capable of resisting impingement at more than 30.48 cm/s velocity for longer than 30 min; larger specimens (12 to 17 mm) showed excellent ability to escape when impinged. The screen excluded virtually all striped bass eggs from the cooling water. Preliminary egg mortality studies indicate that at least 95% survival can be expected at an approach velocity of 15.24 cm/s and impingement durations up to 2 min. Fouling studies showed that screens were highly resistant to clogging, essentially self-cleaning in a current, and easily backwashed. In-situ studies in the Chesapeake and Delaware Canal have shown that a 61.0- x 76.2-cm, 1.01-mm-slot screen is capable of providing its designed capacity for weeks without backwashing or cleaning. Biofouling proved to be the greatest operational problem. Entrainment samples from the in-situ intake have shown significant reductions in organisms/m 3 of filtered versus ambient water

Predicted percentage dissatisfied with ankle draft.

Science.gov (United States)

Liu, S; Schiavon, S; Kabanshi, A; Nazaroff, W W

2017-07-01

Draft is unwanted local convective cooling. The draft risk model of Fanger et al. (Energy and Buildings 12, 21-39, 1988) estimates the percentage of people dissatisfied with air movement due to overcooling at the neck. There is no model for predicting draft at ankles, which is more relevant to stratified air distribution systems such as underfloor air distribution (UFAD) and displacement ventilation (DV). We developed a model for predicted percentage dissatisfied with ankle draft (PPD AD ) based on laboratory experiments with 110 college students. We assessed the effect on ankle draft of various combinations of air speed (nominal range: 0.1-0.6 m/s), temperature (nominal range: 16.5-22.5°C), turbulence intensity (at ankles), sex, and clothing insulation (thermal sensation and air speed at ankles are the dominant parameters affecting draft. The seated subjects accepted a vertical temperature difference of up to 8°C between ankles (0.1 m) and head (1.1 m) at neutral whole-body thermal sensation, 5°C more than the maximum difference recommended in existing standards. The developed ankle draft model can be implemented in thermal comfort and air diffuser testing standards. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Clinical evaluation of a new noninvasive ankle arthrometer.

Science.gov (United States)

Nauck, Tanja; Lohrer, Heinz; Gollhofer, Albert

2010-06-01

A nonradiographic arthrometer was developed to objectively quantify anterior talar drawer instability in stable and unstable ankles. Diagnostic validity of this device was previously demonstrated in a cadaver study. The aim of the present study was to validate the ankle arthrometer in an in vivo setting. Twenty-three subjects participated in the study. An orthopedic surgeon first performed a manual anterior talar drawer test to classify the subjects' ankles as stable or unstable. The subjects were then evaluated using the ankle arthrometer, and filled out a validated self-reported questionnaire (German version of the Foot and Ankle Ability Measure [FAAM-G]). Ankle stiffness was calculated from the low linear region (40-60 N) of the load deformation curves obtained from the ankle arthrometer. Reliability testing of these stiffness values was done based on load deformation curves, with 150 and 200 N maximum anterior drawer loads applied in the ankle arthrometer. Using the manual anterior drawer test, 16 ankles were classified as stable and 7 were classified as unstable. Arthrometer stiffness analysis differentiated stable from unstable ankles (P = 0.00 and P = 0.01, respectively). Test-retest demonstrated an accurate reliability (intraclass correlation coefficient = 0.80). A significant correlation was found between both FAAM-G subscales and the arthrometer stiffness values (r = 0.43 and 0.54; P = 0.04 and 0.01). Discussion Subjects with and without mechanical ankle instability could be differentiated by ankle arthrometer stiffness analysis and the FAAM-G questionnaire results. This nonradiographic device may be relevant for screening athletes at risk for ankle injuries, for clinical follow-up studies, and implementing preventive strategies. Validity and reliability of the new ankle arthrometer is demonstrated in a small cohort in an in vivo setting.

Experimental and Computational Study of Underexpanded Jet Impingement Heat Transfer

Science.gov (United States)

Rufer, Shann J.; Nowak, Robert J.; Daryabeigi, Kamran; Picetti, Donald

2009-01-01

An experiment was performed to assess CFD modeling of a hypersonic-vehicle breach, boundary-layer flow ingestion and internal surface impingement. Tests were conducted in the NASA Langley Research Center 31-Inch Mach 10 Tunnel. Four simulated breaches were tested and impingement heat flux data was obtained for each case using both phosphor thermography and thin film gages on targets placed inside the model. A separate target was used to measure the surface pressure distribution. The measured jet impingement width and peak location are in good agreement with CFD analysis.

Ankle mechanics during sidestep cutting implicates need for 2-degrees of freedom powered ankle-foot prostheses.

Science.gov (United States)

Ficanha, Evandro M; Rastgaar, Mohammad; Kaufman, Kenton R

2015-01-01

The ankle joint of currently available powered prostheses is capable of controlling one degree of freedom (DOF), focusing on improved mobility in the sagittal plane. To increase agility, the requirements of turning in prosthesis design need to be considered. Ankle kinematics and kinetics were studied during sidestep cutting and straight walking. There were no significant differences between the ankle sagittal plane mechanics when comparing sidestep cutting and straight walking; however, significant differences were observed in ankle frontal plane mechanics. During straight walking, the inversion-eversion (IE) angles were smaller than with sidestep cutting. The ankle that initiated the sidestep cutting showed progressively increasing inversion from 2 to 13 degrees while the following contralateral step showed progressively decreasing inversion from 8 to -4 degrees during normal walking speed. The changes in IE kinematics were the most significant during sidestep cutting compared with straight walking. The IE moments of the step that initiated the sidestep cutting were always in eversion, acting as a braking moment opposing the inverting motion. This suggests that an ankle-foot prosthesis with active DOFs in the sagittal and frontal planes will increase the agility of gait for patients with limb loss.

What Is a Foot and Ankle Surgeon?

Science.gov (United States)

... A A | Print | Share What is a Foot & Ankle Surgeon? Foot and ankle surgeons are the surgical ... every age. What education has a foot and ankle surgeon received? After completing undergraduate education, the foot ...

Modeling and stress analyses of a normal foot-ankle and a prosthetic foot-ankle complex.

Science.gov (United States)

Ozen, Mustafa; Sayman, Onur; Havitcioglu, Hasan

2013-01-01

Total ankle replacement (TAR) is a relatively new concept and is becoming more popular for treatment of ankle arthritis and fractures. Because of the high costs and difficulties of experimental studies, the developments of TAR prostheses are progressing very slowly. For this reason, the medical imaging techniques such as CT, and MR have become more and more useful. The finite element method (FEM) is a widely used technique to estimate the mechanical behaviors of materials and structures in engineering applications. FEM has also been increasingly applied to biomechanical analyses of human bones, tissues and organs, thanks to the development of both the computing capabilities and the medical imaging techniques. 3-D finite element models of the human foot and ankle from reconstruction of MR and CT images have been investigated by some authors. In this study, data of geometries (used in modeling) of a normal and a prosthetic foot and ankle were obtained from a 3D reconstruction of CT images. The segmentation software, MIMICS was used to generate the 3D images of the bony structures, soft tissues and components of prosthesis of normal and prosthetic ankle-foot complex. Except the spaces between the adjacent surface of the phalanges fused, metatarsals, cuneiforms, cuboid, navicular, talus and calcaneus bones, soft tissues and components of prosthesis were independently developed to form foot and ankle complex. SOLIDWORKS program was used to form the boundary surfaces of all model components and then the solid models were obtained from these boundary surfaces. Finite element analyses software, ABAQUS was used to perform the numerical stress analyses of these models for balanced standing position. Plantar pressure and von Mises stress distributions of the normal and prosthetic ankles were compared with each other. There was a peak pressure increase at the 4th metatarsal, first metatarsal and talus bones and a decrease at the intermediate cuneiform and calcaneus bones, in

The Cumberland Ankle Instability Tool (CAIT) in the Dutch population with and without complaints of ankle instability.

Science.gov (United States)

Vuurberg, Gwendolyn; Kluit, Lana; van Dijk, C Niek

2018-03-01

To develop a translated Dutch version of the Cumberland Ankle Instability Tool (CAIT) and test its psychometric properties in a Dutch population with foot and ankle complaints. The CAIT was translated into the Dutch language using a forward-backward translation design. Of the 130 subsequent patients visiting the outpatient clinic for foot and ankle complaints who were asked to fill out a questionnaire containing the CAIT, the Foot and Ankle Outcome Score (FAOS), and the numeric rating scale (NRS) pain, 98 completed the questionnaire. After a 1-week period, patients were asked to fill out a second questionnaire online containing the CAIT and NRS pain. This second questionnaire was completed by 70 patients. With these data, the construct validity, test-retest reliability, internal consistency, measurement error, and ceiling and floor effects were assessed. Additionally, a cut-off value to discriminate between stable and unstable ankles, in patients with ankle complaints, was calculated. Construct validity showed moderate correlations between the CAIT and FAOS subscales (Spearman's correlation coefficient (SCC) = 0.36-0.43), and the NRS pain (SCC = -0.55). The cut-off value was found at 11.5 points of the total CAIT score (range 0-30). Test-retest reliability showed to be excellent with an intraclass correlation coefficient of 0.94. Internal consistency was high (Cronbach's α = 0.86). No ceiling or floor effects were detected. Based on the results, the Dutch version of the CAIT is a valid and reliable questionnaire to assess ankle instability in the Dutch population and is able to differentiate between a functionally unstable and stable ankle. The tool is the first suitable tool to objectify the severity of ankle instability specific complaints and assess change in the Dutch population. Level of evidence II.

Ankle Fractures Often Not Diagnosed

Science.gov (United States)

... top of the talus is dome-shaped and... Softball Injuries to the Foot and Ankle Your feet ... ankles take a beating when you are playing softball. Softball players should be aware of the following ...

Postoperative MRI of the ankle

International Nuclear Information System (INIS)

Sharabianlou Korth, M.; Fritz, L.B.

2017-01-01

Postoperative imaging of the ankle can be challenging, even for the experienced radiologist. Pathological and postoperative changes to the primarily complex anatomy of the ankle with its great variety of bone structures, tendons, ligaments, and soft tissue in a very limited space may cause great difficulty in differentiating underlying pathology from expected postoperative changes and artifacts, especially in magnetic resonance imaging (MRI). Selecting the appropriate radiological modality is key to making the correct diagnosis. Therefore, knowledge of the initial and current symptoms is just as important as familiarity with the most frequently performed operations in the ankle. This article aims to give its reader a summary of the most important and frequently performed operation techniques of the ankle and discusses the expected appearance and possible complications in postoperative imaging. (orig.) [de

Impact of impingement on the Hudson River white perch population

International Nuclear Information System (INIS)

Barnthouse, L.W.; Van Winkle, W.

1980-01-01

The impact of power plant impingement on the 1974 and 1975 year classes of the Hudson River white perch population is assessed using a simple model derived from Ricker's theory of fisheries dynamics. The impact of impingement is expressed in the model as the conditional mortality rate, rather than as the more commonly used exploitation rate. Since the calculated impact is sensitive to errors in the estimation of population size and total mortality, ranges of probable values of these quantities are used to compute upper and lower bounds on the fractional reduction in abundance of each year class. Best estimates of abundance and mortality are used to compute the conditional impingement mortality rate separately for each plant and month. The results are used to assess the relative impacts of white perch impingement at six Hudson River power plants and to identify the seasons during which the impact is highest

Intrinsic ankle stiffness during standing increases with ankle torque and passive stretch of the Achilles tendon

Science.gov (United States)

Gill, Jaspret

2018-01-01

Individuals may stand with a range of ankle angles. Furthermore, shoes or floor surfaces may elevate or depress their heels. Here we ask how these situations impact ankle stiffness and balance. We performed two studies (each with 10 participants) in which the triceps surae, Achilles tendon and aponeurosis were stretched either passively, by rotating the support surface, or actively by leaning forward. Participants stood freely on footplates which could rotate around the ankle joint axis. Brief, small stiffness-measuring perturbations (torque or passive stretch. Sway was minimally affected by stretch or lean, suggesting that this did not underlie the alterations in stiffness. In quiet stance, maximum ankle stiffness is limited by the tendon. As tendon strain increases, it becomes stiffer, causing an increase in overall ankle stiffness, which would explain the effects of leaning. However, stiffness also increased considerably with passive stretch, despite a modest torque increase. We discuss possible explanations for this increase. PMID:29558469

Experimental study on boiling heat transfer to an impinging jet on a hot block

International Nuclear Information System (INIS)

Kamata, Choko

1997-01-01

Previous studies on boiling heat transfer by impinging jets are mainly concerned with the impinging point by using small heat transfer surfaces of about 20 mm. An experimental study of the boiling heat transfer to an impinging water jet on a massive hot block is made. The upward heating surface is made of copper. Its diameter and nozzle diameter are 80 mm and 2.2 mm, respectively. The velocity of the impinging jet was varied from 0.6 to 2.1 m/s. Saturated water normally impinged on the heating surface, flowed radially, and subsequently dispersed into the atmosphere. The present study clarifies that heat transfer characteristics vary with the temperature of heat transfer surface, and also with the distance from the impinging point. (author)

Ankle Arthrodesis Following Trauma, a Useful Salvage Procedure ...

African Journals Online (AJOL)

progressive loss of ankle-joint motion, weight-bearing pain, and functional disability. ... of patients after the reconstructionof ankle malunions.[6] ... Three patients with severe open ankle ... diabetic nor was he known to be on any steroid medication. He was .... Charnley J. Compression arthrodesis of the ankle and shoulder.

Noise characteristics and flow field of an impinging jet on a conical obstacle

Energy Technology Data Exchange (ETDEWEB)

Liu, Xin; Xie, Junlong; Shu, Shuiming; Zhang, Yi, E-mail: hustxjl@163.com [School of Energy and Power Engineering, Huazhong University of Science and Technology, Wuhan, 430074 (China)

2017-12-15

The noise characteristics and flow field of a low-speed impinging jet on a conical obstacle have been numerically simulated using the kinetic energy transport subgrid-scale model of the large-eddy simulation method. Noise measurement is carried out to validate the proposed simulation method. The effects of the impinging distance on the development, separation and diffusion of vortices on the back of the conical obstacle are investigated. The jet structure is better preserved and the vorticity value becomes larger as the impinging distance increases. Simulation results of the noise spectrums and overall sound pressure level (OASPL) agree well with the experimental data. The noise spectrums are analyzed and combined with simulation results for the flow field. When the impinging distance is small, the main acoustic sources with the broadband characteristic consist of the dipole source produced by pressure fluctuation on the surface of the obstacle, and the quadrupole source produced by vortices. As the impinging distance increases, the quadrupole source becomes the major acoustic source with low-frequency characteristics. In addition, the OASPL of the impinging jet is obtained at different impinging distances. (paper)

The foot and ankle

International Nuclear Information System (INIS)

Berquist, T.H.

1985-01-01

Imaging of the foot and ankle can be difficult because of the complex anatomy. Familiarity with the bony and ligamentous anatomy is essential for proper evaluation of radiographic findings. Therefore, pertinent anatomy is discussed as it applies to specific injuries. Special views, tomography, arthrography, and other techniques may be indicated for complete evaluation of foot and ankle trauma

Validity of an ankle joint motion and position sense measurement system and its application in healthy subjects and patients with ankle sprain.

Science.gov (United States)

Lin, Chueh-Ho; Chiang, Shang-Lin; Lu, Liang-Hsuan; Wei, Shun-Hwa; Sung, Wen-Hsu

2016-07-01

Ankle motion and proprioception in multiple axis movements are crucial for daily activities. However, few studies have developed and used a multiple axis system for measuring ankle motion and proprioception. This study was designed to validate a novel ankle haptic interface system that measures the ankle range of motion (ROM) and joint position sense in multiple plane movements, investigating the proprioception deficits during joint position sense tasks for patients with ankle instability. Eleven healthy adults (mean ± standard deviation; age, 24.7 ± 1.9 years) and thirteen patients with ankle instability were recruited in this study. All subjects were asked to perform tests to evaluate the validity of the ankle ROM measurements and underwent tests for validating the joint position sense measurements conducted during multiple axis movements of the ankle joint. Pearson correlation was used for validating the angular position measurements obtained using the developed system; the independent t test was used to investigate the differences in joint position sense task performance for people with or without ankle instability. The ROM measurements of the device were linearly correlated with the criterion standards (r = 0.99). The ankle instability and healthy groups were significantly different in direction, absolute, and variable errors of plantar flexion, dorsiflexion, inversion, and eversion (p ankle joint motion and position sense measurement system is valid and can be used for measuring the ankle ROM and joint position sense in multiple planes and indicate proprioception deficits for people with ankle instability. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Lower extremity thrust and non-thrust joint mobilization for patellofemoral pain syndrome: a case report

OpenAIRE

Simpson, Brad G; Simon, Corey B

2014-01-01

A 40-year old female presented to physical therapy with a one-year history of insidious right anteromedial and anterolateral knee pain. Additionally, the patient had a history of multiple lateral ankle sprains bilaterally, the last sprain occurring on the right ankle 1 year prior to the onset of knee pain. The patient was evaluated and given a physical therapy diagnosis of patellofemoral pain syndrome (PFPS), with associated talocrural and tibiofemoral joint hypomobility limiting ankle dorsif...

Effects of Nintendo Wii Fit Plus training on ankle strength with functional ankle instability.

Science.gov (United States)

Kim, Ki-Jong; Jun, Hyun-Ju; Heo, Myoung

2015-11-01

[Purpose] The objective of this study was to examine the effects of a training program using the Nintendo Wii Fit Plus on the ankle muscle strengths of subjects with functional ankle instability. [Subjects and Methods] This study was conducted using subjects in their 20s who had functional ankle instability. They were randomized to a strengthening training group and a balance training group with 10 subjects in each, and they performed an exercise using Nintendo Wii Fit Plus for 20 minutes. In addition, every participant completed preparation and finishing exercises for 5 minutes, respectively. [Results] The muscle strengths after conducting plantar flexion and dorsiflexion significantly increased at the angular velocities of 60° and 120° in the strengthening training group. Furthermore, the muscle strengths after conducting plantar flexion, dorsiflexion, eversion, and inversion significantly increased at the angular velocities of 60° and 120° in the balance training group. [Conclusion] The balance training group using Nintendo Wii Fit Plus showed better results than the strengthening training group. Consequently, it is recommended to add the balance training program of the Nintendo Wii Fit Plus to conventional exercise programs to improve ankle muscle strength in functional ankle instability at a low cost.

The origin of the ankle

International Nuclear Information System (INIS)

Codino, Antonio; Plouin, Francois

2007-01-01

The differential intensity of cosmic radiation shows a sequence of depressions referred to as knees in a large energy band above 10 15 eV. The global depression entailed in the complete spectrum with respect to the extrapolated intensity based on low energy data, amounts to a maximum factor of 8, occurring at 5x10 18 eV, where flux measurements exhibit a relative minimum, referred to as the ankle. It is demonstrated by a full simulation of cosmic ray trajectories in the Galaxy that the intensity minimum around the ankle energy is primarily due to the nuclear interactions of the cosmic ions with the interstellar matter and to the galactic magnetic field. Ankles signal the onset energies of the rectilinear propagation in the Milky Way at Earth, being for example, 4x10 18 eV for helium and 6x10 19 eV for iron. The ankle, in spite of its notable importance at Earth, is a local perturbation of the universal spectrum which, between the knee and the ankle, decreases by a round factor 10 9 regaining its unperturbed status above 10 19 eV

Selection criteria for patients with chronic ankle instability in controlled research: a position statement of the international ankle consortium

NARCIS (Netherlands)

Gribble, P.A.; Delahunt, E.; Bleakley, C.; Caulfield, B.; Docherty, C.L.; Fourchet, F.; Fong, D.; Hertel, J.; Hiller, C.; Kaminski, T.W.; McKeon, P.O.; Refshauge, K.M.; Wees, P.J. van der; Vicenzino, B.; Wikstrom, E.A.

2013-01-01

The International Ankle Consortium is an international community of researchers and clinicians whose primary scholastic purpose is to promote scholarship and dissemination of research-informed knowledge related to pathologies of the ankle complex. The constituents of the International Ankle

Open and Arthroscopic Surgical Treatment of Femoroacetabular Impingement

Directory of Open Access Journals (Sweden)

Benjamin D. Kuhns

2015-12-01

Full Text Available Femoroacetabular impingement (FAI is a common cause of hip pain, and when indicated, can be successfully managed through open surgery or hip arthroscopy. The goal of this review is to describe the different approaches to the surgical treatment of FAI. We present the indications, surgical technique, rehabilitation, and complications associated with (1 open hip dislocation, (2 reverse peri-acetabular osteotomy, (3 the direct anterior mini-open approach, and (4 arthroscopic surgery for femoroacetabular impingement.

Peculiarities in Ankle Cartilage.

Science.gov (United States)

Kraeutler, Matthew J; Kaenkumchorn, Tanyaporn; Pascual-Garrido, Cecilia; Wimmer, Markus A; Chubinskaya, Susanna

2017-01-01

Posttraumatic osteoarthritis (PTOA) is the most common form of osteoarthritis (OA) of the ankle joint. PTOA occurs as a result of several factors, including the poor regenerative capacity of hyaline articular cartilage as well as increased contact stresses following trauma. The purpose of this article is to review the epidemiology, pathogenesis, and potential targets for treatment of PTOA in the ankle joint. Previous reviews primarily addressed clinical approaches to ankle PTOA, while the focus of the current article will be specifically on the newly acquired knowledge of the cellular mechanisms that drive PTOA in the ankle joint and means for potential targeted therapeutics that might halt the progression of cartilage degeneration and/or improve the outcome of surgical interventions. Three experimental treatment strategies are discussed in this review: (1) increasing the anabolic potential of chondrocytes through treatment with growth factors such as bone morphogenetic protein-7; (2) limiting chondrocyte cell death either through the protection of cell membrane with poloxamer 188 or inhibiting activity of intracellular proteases, caspases, which are responsible for cell death by apoptosis; and (3) inhibiting catabolic/inflammatory responses of chondrocytes by treating them with anti-inflammatory agents such as tumor necrosis factor-α antagonists. Future studies should focus on identifying the appropriate timing for treatment and an appropriate combination of anti-inflammatory, chondro- and matrix-protective biologics to limit the progression of trauma-induced cartilage degeneration and prevent the development of PTOA in the ankle joint.

Quantifying normal ankle joint volume: An anatomic study

Directory of Open Access Journals (Sweden)

Draeger Reid

2009-01-01

Full Text Available Background: Many therapeutic and diagnostic modalities such as intraarticular injections, arthrography and ankle arthroscopy require introduction of fluid into the ankle joint. Little data are currently available in the literature regarding the maximal volume of normal, nonpathologic, human ankle joints. The purpose of this study was to measure the volume of normal human ankle joints. Materials and Methods: A fluoroscopic guided needle was passed into nine cadaveric adult ankle joints. The needle was connected to an intracompartmental pressure measurement device. A radiopaque dye was introduced into the joint in 2 mL boluses, while pressure measurements were recorded. Fluid was injected into the joint until three consecutive pressure measurements were similar, signifying a maximal joint volume. Results: The mean maximum ankle joint volume was 20.9 ± 4.9 mL (range, 16-30 mL. The mean ankle joint pressure at maximum volume was 142.2 ± 13.8 mm Hg (range, 122-166 mm Hg. Two of the nine samples showed evidence of fluid tracking into the synovial sheath of the flexor hallucis longus tendon. Conclusion: Maximal normal ankle joint volume was found to vary between 16-30 mL. This study ascertains the communication between the ankle joint and the flexor hallucis longus tendon sheath. Exceeding maximal ankle joint volume suggested by this study during therapeutic injections, arthrography, or arthroscopy could potentially damage the joint.

Total ankle arthroplasty: An imaging overview

Energy Technology Data Exchange (ETDEWEB)

Kim, Da Rae; Choi, Yun Sun; Chun, Ka Young; Jung, Yoon Young; Kim, Jin Su; Young, Ki Won [Eulji Hospital, Eulji University, Seoul (Korea, Republic of); Potter, Hollis G.; Li, Angela E. [Dept. of Radiology and Imaging, Hospital for Special Surgery, New York (United States)

2016-06-15

With advances in implant technology, total ankle arthroplasty (TAA) has become an increasingly popular alternative to arthrodesis for the management of end-stage ankle arthritis. However, reports in the literature do not focus on the imaging features of TAA. Through a literature review, we demonstrate basic design features of the current ankle arthroplasty system, and the normal and abnormal postoperative imaging features associated with such devices. Pre- and postoperative evaluations of ankle arthroplasty mainly include radiography; in addition, computed tomography and magnetic resonance imaging provide further characterization of imaging abnormalities. Familiarization with multimodal imaging features of frequent procedural complications at various postoperative intervals is important in radiological practice.

Personalised Hip Therapy: development of a non-operative protocol to treat femoroacetabular impingement syndrome in the FASHIoN randomised controlled trial.

Science.gov (United States)

Wall, Peter Dh; Dickenson, Edward J; Robinson, David; Hughes, Ivor; Realpe, Alba; Hobson, Rachel; Griffin, Damian R; Foster, Nadine E

2016-10-01

Femoroacetabular impingement (FAI) syndrome is increasingly recognised as a cause of hip pain. As part of the design of a randomised controlled trial (RCT) of arthroscopic surgery for FAI syndrome, we developed a protocol for non-operative care and evaluated its feasibility. In phase one, we developed a protocol for non-operative care for FAI in the UK National Health Service (NHS), through a process of systematic review and consensus gathering. In phase two, the protocol was tested in an internal pilot RCT for protocol adherence and adverse events. The final protocol, called Personalised Hip Therapy (PHT), consists of four core components led by physiotherapists: detailed patient assessment, education and advice, help with pain relief and an exercise-based programme that is individualised, supervised and progressed over time. PHT is delivered over 12-26 weeks in 6-10 physiotherapist-patient contacts, supplemented by a home exercise programme. In the pilot RCT, 42 patients were recruited and 21 randomised to PHT. Review of treatment case report forms, completed by physiotherapists, showed that 13 patients (62%) received treatment that had closely followed the PHT protocol. 13 patients reported some muscle soreness at 6 weeks, but there were no serious adverse events. PHT provides a structure for the non-operative care of FAI and offers guidance to clinicians and researchers in an evolving area with limited evidence. PHT was deliverable within the National Health Service, is safe, and now forms the comparator to arthroscopic surgery in the UK FASHIoN trial (ISRCTN64081839). ISRCTN 09754699. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Paratrooper's ankle fracture: posterior malleolar fracture.

Science.gov (United States)

Young, Ki Won; Kim, Jin-su; Cho, Jae Ho; Kim, Hyung Seuk; Cho, Hun Ki; Lee, Kyung Tai

2015-03-01

We assessed the frequency and types of ankle fractures that frequently occur during parachute landings of special operation unit personnel and analyzed the causes. Fifty-six members of the special force brigade of the military who had sustained ankle fractures during parachute landings between January 2005 and April 2010 were retrospectively analyzed. The injury sites and fracture sites were identified and the fracture types were categorized by the Lauge-Hansen and Weber classifications. Follow-up surveys were performed with respect to the American Orthopedic Foot and Ankle Society ankle-hindfoot score, patient satisfaction, and return to preinjury activity. The patients were all males with a mean age of 23.6 years. There were 28 right and 28 left ankle fractures. Twenty-two patients had simple fractures and 34 patients had comminuted fractures. The average number of injury and fractures sites per person was 2.07 (116 injuries including a syndesmosis injury and a deltoid injury) and 1.75 (98 fracture sites), respectively. Twenty-three cases (41.07%) were accompanied by posterior malleolar fractures. Fifty-five patients underwent surgery; of these, 30 had plate internal fixations. Weber type A, B, and C fractures were found in 4, 38, and 14 cases, respectively. Based on the Lauge-Hansen classification, supination-external rotation injuries were found in 20 cases, supination-adduction injuries in 22 cases, pronation-external rotation injuries in 11 cases, tibiofibular fractures in 2 cases, and simple medial malleolar fractures in 2 cases. The mean follow-up period was 23.8 months, and the average follow-up American Orthopedic Foot and Ankle Society ankle-hindfoot score was 85.42. Forty-five patients (80.36%) reported excellent or good satisfaction with the outcome. Posterior malleolar fractures occurred in 41.07% of ankle fractures sustained in parachute landings. Because most of the ankle fractures in parachute injuries were compound fractures, most cases had to

Evidence-based treatment for ankle injuries: a clinical perspective

OpenAIRE

Lin, Chung-Wei Christine; Hiller, Claire E; de Bie, Rob A

2010-01-01

The most common ankle injuries are ankle sprain and ankle fracture. This review discusses treatments for ankle sprain (including the management of the acute sprain and chronic instability) and ankle fracture, using evidence from recent systematic reviews and randomized controlled trials. After ankle sprain, there is evidence for the use of functional support and non-steroidal anti-inflammatory drugs. There is weak evidence suggesting that the use of manual therapy may lead to positive short-t...

Comparison of Endotoxin Exposure Assessment by Bioaerosol Impinger and Filter-Sampling Methods

OpenAIRE

Duchaine, Caroline; Thorne, Peter S.; Mériaux, Anne; Grimard, Yan; Whitten, Paul; Cormier, Yvon

2001-01-01

Environmental assessment data collected in two prior occupational hygiene studies of swine barns and sawmills allowed the comparison of concurrent, triplicate, side-by-side endotoxin measurements using air sampling filters and bioaerosol impingers. Endotoxin concentrations in impinger solutions and filter eluates were assayed using the Limulus amebocyte lysate assay. In sawmills, impinger sampling yielded significantly higher endotoxin concentration measurements and lower variances than filte...

Effects of 2 ankle destabilization devices on electromyography measures during functional exercises in individuals with chronic ankle instability.

Science.gov (United States)

Donovan, Luke; Hart, Joseph M; Hertel, Jay

2015-03-01

Randomized crossover laboratory study. To determine the effects of ankle destabilization devices on surface electromyography (sEMG) measures of selected lower extremity muscles during functional exercises in participants with chronic ankle instability. Ankle destabilization devices are rehabilitation tools that can be worn as a boot or sandal to increase lower extremity muscle activation during walking in healthy individuals. However, they have not been tested in a population with pathology. Fifteen adults with chronic ankle instability participated. Surface electromyography electrodes were located over the anterior tibialis, fibularis longus, lateral gastrocnemius, rectus femoris, biceps femoris, and gluteus medius. The activity level of these muscles was recorded in a single testing session during unipedal stance with eyes closed, the Star Excursion Balance Test, lateral hops, and treadmill walking. Each task was performed under 3 conditions: shod, ankle destabilization boot, and ankle destabilization sandal. Surface electromyography signal amplitudes were measured for each muscle during each exercise for all 3 conditions. Participants demonstrated a significant increase, with moderate to large effect sizes, in sEMG signal amplitude of the fibularis longus in the ankle destabilization boot and ankle destabilization sandal conditions during the unipedal eyes-closed balance test, the Star Excursion Balance Test in the anterior and posteromedial directions, lateral hops, and walking, when compared to the shod condition. Both devices also resulted in an increase in sEMG signal amplitudes, with large effect sizes of the lateral gastrocnemius, rectus femoris, biceps femoris, and gluteus medius during the unipedal-stance-with-eyes-closed test, compared to the shod condition. Wearing ankle destabilization devices caused greater muscle activation during functional exercises in individuals with chronic ankle instability. Based on the magnitude of the effect, there were

[Eleven-Year Experience with Total Ankle Arthroplasty].

Science.gov (United States)

Popelka, S; Sosna, A; Vavřík, P; Jahoda, D; Barták, V; Landor, I

2016-01-01

PURPOSE OF THE STUDY Total joint replacement is one of the options in surgical treatment of advanced ankle arthritis. It allows the ankle to remain mobile but, unfortunately, it does not provide the same longevity as total knee or hip replacements. Therefore, decisions concerning the kind of treatment are very individual and depend on the clinical status and opinion of each patient. MATERIAL AND METHODS A total of 132 total ankle replacements were carried out in the period from 2004 to 2015. The prostheses used included the Ankle Evolutive System (AES) in 52 patients, Mobility Total Ankle System (DePuy) in 24 patients and, recently, Rebalance Total Ankle Replacement implant in 53 patients. Three patients allergic to metal received the Taric prosthesis. Revision arthroplasty using the Hintegra prosthesis was carried out in four patients. The outcome of arthroplasty was evaluated on the American Orthopaedic Foot and Ankle Society (AOFAS) scoring scale. Indications for total ankle arthroplasty included post-traumatic arthritis in 83 patients, rheumatoid arthritis in 37 and primary arthritis in 12 patients. There were 78 women and 54 men, with an average age of 55.6 years at the time of surgery. RESULTS The average follow-up was 6.1 years (1-11 years). The average AOFAS score of the whole group increased from 33.2 before surgery to 82.5 after it. The primary indication had an important role. Arthroplasty outcomes were poorer in patients with post-traumatic arthritis than in those with rheumatoid arthritis or primary arthritis. In patients with post-traumatic arthritis, the average AOFAS score rose to 78.6 due to restricted motion of the ankle, and some patients continued to have pain when walking. The average AOFAS score in a total of 49 patients who had rheumatoid arthritis or primary arthritis reached a value of 86.4. Post-operative complications were recorded in ten patients (7.6%) in whom part of the wound was healing by second intention. Ossification was also a

Arthroscopy of the ankle joint

NARCIS (Netherlands)

van Dijk, C. N.; Scholte, D.

1997-01-01

Ankle arthroscopy has become a standard procedure for a variety of indications. Joint distraction is applied by many authors. A recent retrospective multicentre study provoked the following questions. Is there an indication for diagnostic arthroscopy? Can arthroscopic surgery of the ankle joint be

MR imaging of nerve root impingement in the lumbar spine

International Nuclear Information System (INIS)

Teresi, L.M.; Bradley, W.G. Jr.; Bloze, A.E.; Davis, S.J.; Amster, J.; Berger, P.E.

1990-01-01

This paper determines the relationship between MR imaging findings of nerve root impingement, presenting symptoms, and physical examination findings, and physiologic data (DSEP and EMG) in a population of patients presented with classic radicular symptoms. Fifty-eight patients presenting with classic radicular pain were studied with MR imaging, DSER, and EMG, MR imaging was performed with a GE Signa imaging system with use of T1- and T2-weighted sequences and 5-mm-thick sections. Nerve root impingement in the subarticular recess (the root exiting the next lowest level) was distinguished from nerve root impingement in the superior intervertebral foramen (the root exiting the same level)

Impaired hip muscle strength in patients with femoroacetabular impingement syndrome.

Science.gov (United States)

Kierkegaard, Signe; Mechlenburg, Inger; Lund, Bent; Søballe, Kjeld; Dalgas, Ulrik

2017-12-01

Patients with femoroacetabular impingement (FAI) experience hip pain as well as decreased function and lowered quality of life. The aim was to compare maximal isometric and isokinetic muscle strength (MVC) during hip flexion and extension and rate of force development (RFD) during extension between patients with FAI and a matched reference group. Secondary, the aim was to compare patient hips and subgroups defined by gender and age as well as to investigate associations between hip muscle strength and self-reported outcomes. Design Cross-sectional, comparative study Methods Sixty patients (36±9 years, 63% females) and 30 age and gender matched reference persons underwent MVC tests in an isokinetic dynamometer. During hip flexion and extension, patients' affected hip showed a strength deficit of 15-21% (phip of the patients was significantly weaker than their contralateral hip. RFD was significantly decreased for both patient hips compared to the reference group (phip muscle strength. Patients with FAI demonstrate decreased hip flexion and extension strength when compared to (1) reference persons and (2) their contralateral hip. There seems to be a gender specific affection which should be investigated further and addressed when planning training protocols. Furthermore, self-reported measures were associated with isometric muscle strength, which underlines the clinical importance of the reduced muscle strength. Copyright © 2017 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Impact of impingement on the Hudson River white perch population. Final report

Energy Technology Data Exchange (ETDEWEB)

Barnthouse, L.W.; Van Winkle, W.; Kirk, B.L.; Vaughan, D.S.

1982-02-01

This report summarizes a series of analyses of the magnitude and biological significance of the impingement of white perch at the Indian Point Nuclear Generating Station and other Hudson River power plants. Included in these analyses were evaluations of: (1) two independent lines of evidence relating to the magnitude of impingement impacts on the Hudson River white perch population; (2) the additional impact caused by entrainment of white perch; (3) data relating to density-dependent growth among young-of-the-year white perch; (4) the feasibility of performing population-level analyses of impingement impacts on the white perch populations of Chesapeake Bay and the Delaware River; and (5) the feasibility of using simple food chain and food web models to evaluate community-level effects of impingement and entrainment. Estimated reductions in the abundances of the 1974 and 1975 white perch year classes, caused by impingement and entrainment, were high enough that the possibility of adverse long-term effects cannot be excluded.

Postoperative MR study of the ankle

International Nuclear Information System (INIS)

Tosch, U.; Sander, B.; Schubeus, P.; Tepe, H.; Goudarzi, Y.M.

1991-01-01

20 patients with acute traumatic rupture of the anterior talofibular ligament and ligamental suture were studied postoperatively by MRI. MR results were correlated with stress X-ray studies. We found a normal anterior talofibular ligament in eight cases. However, stress X-ray images showed normal stability of the ankle joint in eighteen cases. In six patients the anterior talofibular ligament was thickened, in another six cases it could not be separated from scar tissue. Therefore MR imaging of ankle ligaments did not allow a diagnosis of their function. Nevertheless, sequelae of the ankle trauma such as osteochondrosis, exsudation into the ankle joint and tendovaginitis of the flexor muscles were sensitively visualised by MR. (orig.) [de

A study on the velocity characteristics of the spray formed by two impinging jets

International Nuclear Information System (INIS)

Choo, Yeon Jun; Seo, Kwi Hyun; Kang, Bo Seon

2001-01-01

In this study, the velocity characteristics of liquid elements formed by two impinging jets is analysed using double pulse image capturing technique. For the droplets formed by low speed impinging jets, the droplet velocities are higher with smaller azimuthal and impingement angle. The maximum droplet velocities are about 25% lower than jet velocity. With an increase of azimuthal angle, the shedding angles increases but remains lower than azimuthal angle. The velocities of ligaments formed by high speed impinging jets gradually decreases with an increase of azimuthal angle. The maximum ligament velocities are about 40% lower than jet velocity. Higher impingement angles produce lower ligament velocities. The shedding angles of ligament almost increases with the same value of azimuthal angle, which implies that the moving direction of ligaments is radial from the origin as the impingement point

Apollo Video Photogrammetry Estimation Of Plume Impingement Effects

Science.gov (United States)

Immer, Christopher; Lane, John; Metzger, Philip T.; Clements, Sandra

2008-01-01

The Constellation Project's planned return to the moon requires numerous landings at the same site. Since the top few centimeters are loosely packed regolith, plume impingement from the Lander ejects the granular material at high velocities. Much work is needed to understand the physics of plume impingement during landing in order to protect hardware surrounding the landing sites. While mostly qualitative in nature, the Apollo Lunar Module landing videos can provide a wealth of quantitative information using modem photogrammetry techniques. The authors have used the digitized videos to quantify plume impingement effects of the landing exhaust on the lunar surface. The dust ejection angle from the plume is estimated at 1-3 degrees. The lofted particle density is estimated at 10(exp 8)- 10(exp 13) particles per cubic meter. Additionally, evidence for ejection of large 10-15 cm sized objects and a dependence of ejection angle on thrust are presented. Further work is ongoing to continue quantitative analysis of the landing videos.

Trailing edge cooling using angled impingement on surface enhanced with cast chevron arrangements

Science.gov (United States)

Lee, Ching-Pang; Heneveld, Benjamin E.; Brown, Glenn E.; Klinger, Jill

2015-05-26

A gas turbine engine component, including: a pressure side (12) having an interior surface (34); a suction side (14) having an interior surface (36); a trailing edge portion (30); and a plurality of suction side and pressure side impingement orifices (24) disposed in the trailing edge portion (30). Each suction side impingement orifice is configured to direct an impingement jet (48) at an acute angle (52) onto a target area (60) that encompasses a tip (140) of a chevron (122) within a chevron arrangement (120) formed in the suction side interior surface. Each pressure side impingement orifice is configured to direct an impingement jet at an acute angle onto an elongated target area that encompasses a tip of a chevron within a chevron arrangement formed in the pressure side interior surface.

Foot and ankle problems in Thai monks.

Science.gov (United States)

Vaseenon, Tanawat; Wattanarojanaporn, Thongaek; Intharasompan, Piyapong; Theeraamphon, Nipon; Auephanviriyakul, Sansanee; Phisitkul, Phinit

2015-01-01

Foot and ankle problems in Thai monks have not been explored. This is an unshod population, and its members have a unique lifestyle living among others in our modern era. Beginning at their ordainment, they follow strict rules about barefoot walking, the amount of daily walking, and their sitting position, practices that theoretically can increase their risk of developing foot and ankle problems. To evaluate the prevalence ofcommon foot and ankle problems in Thai monks. A cross-sectional survey was conducted in combination with foot and ankle examinations of monks living in northern Thailand Foot morphology was examined using a Harris mat footprint. Results of the interviews and the foot and ankle examinations were evaluated. Two hundred and nine monks from 28 temples were included in this study. Common foot and ankle problems found included callosity (70.8%), toe deformities (18.2%), plantar fasciitis (13.4%), metatarsalgia (3.8%), and numbness (2.9%). Callosity and toe deformities were associated with prolonged barefoot walking over extended periods since ordainment (p < 0.05). The callosity was found on the forefoot (47.3%), lateral malleolus (40.7%), and heel (12%). Arch types were considered normal in 66.4% of cases, high in 21.6%, and low in 12%. No association was found between arch type and foot and ankle problems. Callosity and toe deformity were the most common foot and ankle problems found in Thai monks, especially those with prolonged period of barefoot walking and long-term duration ofordainment. The unique pattern of walking and sitting of Thai monks may have contributed to the development of those feet and ankle problems.

The jet impingement phase of molten core-concrete interactions

International Nuclear Information System (INIS)

Sienicki, J.J.; Spencer, B.W.

1986-01-01

Scoping calculations have been carried out demonstrating that a significant and abrupt reduction in the corium temperature may be realized when molten corium drains as a jet from a localized breach in the RPV lower head to impinge upon the concrete basemat. The temperature decrease may range from a value of ∼170 K (∼140 K) for limestone (basaltic) aggregate concrete to a value approaching the initial corium superheat depending upon whether the forced convection impingement heat flux is assumed to be controlled by either thermal conduction across a slag film layer or the temperature boundary condition represented by a corium crust. The magnitude of the temperature reduction remains significant as the initial corium temperature, impinging corium mass, and initial localized breach size are varied over their range of potential values

Effect of Ankle Taping and Fatigue on Dynamic Stability in Athletes With and Without Chronic Ankle Instability

Directory of Open Access Journals (Sweden)

Tahereh Pourkhani

2017-07-01

Conclusion In the athletes with chronic ankle instability, taping without fatigue improved dynamic balance in the vertical direction. Taping after fatigue could not improve dynamic stability in the athletes with and without chronic ankle instability. Future researchers should examine injured and uninjured participants tested under these conditions to determine if these results are useful in selecting appropriate prophylactic method that can treat or prevent injury to the ankle during functional activities.

Anterior ankle arthroscopy, distraction or dorsiflexion?

OpenAIRE

de Leeuw, P.A.J.; Golanó, P.; Clavero, J.A.; van Dijk, C.N.

2010-01-01

Anterior ankle arthroscopy can basically be performed by two different methods; the dorsiflexion- or distraction method. The objective of this study was to determine the size of the anterior working area for both the dorsiflexion and distraction method. The anterior working area is anteriorly limited by the overlying anatomy which includes the neurovascular bundle. We hypothesize that in ankle dorsiflexion the anterior neurovascular bundle will move away anteriorly from the ankle joint, where...

Trends of Concurrent Ankle Arthroscopy at the Time of Operative Treatment of Ankle Fracture: A National Database Review.

Science.gov (United States)

Ackermann, Jakob; Fraser, Ethan J; Murawski, Christopher D; Desai, Payal; Vig, Khushdeep; Kennedy, John G

2016-04-01

The purpose of this study was to report trends associated with concurrent ankle arthroscopy at the time of operative treatment of ankle fracture. The current procedural terminology (CPT) billing codes were used to search the PearlDiver Patient Record Database and identify all patients who were treated for acute ankle fracture in the United States. The Medicare Standard Analytic Files were searchable between 2005 and 2011 and the United Healthcare Orthopedic Dataset from 2007 to 2011. Annual trends were expressed only between 2007 and 2011, as it was the common time period among both databases. Demographic factors were identified for all procedures as well as the cost aspect using the Medicare data set. In total, 32 307 patients underwent open reduction internal fixation (ORIF) of an ankle fracture, of whom 313 (1.0%) had an ankle arthroscopy performed simultaneously. Of those 313 cases, 70 (22.4%) patients received microfracture treatment. Between 2005 and 2011, 85 203 patients were treated for an ankle fracture whether via ORIF or closed treatment. Of these, a total of 566 patients underwent arthroscopic treatment within 7 years. The prevalence of arthroscopy after ankle fracture decreased significantly by 45% from 2007 to 2011 (Pankle fracture treatment, it appears that only a small proportion of surgeons in the United States perform these procedures concurrently. Therapeutic, Level IV: Retrospective. © 2015 The Author(s).

The Incidence of Ankle Sprains in Orienteering.

Science.gov (United States)

Ekstrand, Jan; And Others

1990-01-01

Investigates relationship between ankle sprains and participation time in competitive orienteering. Examined 15,474 competitors in races in the Swedish O-ringen 5-day event in 1987. Injuries requiring medical attention were analyzed, showing 137 (23.9 percent) ankle sprains. Injury incidence was 8.4/10,000 hours. Incidence of ankle sprains was…

Arthrography of the ankle sprains

International Nuclear Information System (INIS)

Han, Moon Hee

1985-01-01

Ankle arthrography, by direct puncture of joint cavity, is considered to be a simple and accurate diagnostic method for a precise evaluation of ligamentous injury. Forty-seven cases of ankle arthrography were successively performed in the patients of acute ankle sprains. The purpose of this study is to demonstrate how ankle arthrography can delineate the pathologic anatomy in such cases. The results are as follows: 1. Thirty cases among forty seven revealed the findings of ligament tears. 2. For better diagnostic accuracy, the arthrography should be performed within 72 hrs. after injury. 3. The anterior talofibular ligament tears were the most common (twenty-nine cases) of all and seventeen of them revealed tears without association of any other ligament tears. 4. There were ten cases of calcaneofibular ligament tears and nine of them were associated with anterior talofibular ligament tears. 5. Three cases of anterior tibiofibular and one deltoid ligament tears were demonstrated

EFFECT OF KINESIO TAPE VERSUS ATHLETIC TAPE ON MYOELECTRIC ACTIVITY OF ANKLE MUSCLES IN PATIENTS WITH CHRONIC ANKLE SPRAIN

Directory of Open Access Journals (Sweden)

Asmaa F Abdelmonem

2018-04-01

Full Text Available Background: Sprained ankle a common orthopedic injury. The standard treatment for ankle sprains remains nonoperative. Ankle taping was used to protect and prevent ligaments excessive strain. So, the current study aimed at investigating the effect of spa-care Kinesio tape versus standard white athletic tape on myoelectric activities (EMG of ankle evertors (peroneus longus and invertors (tibialis anterior in a chronic ankle sprain. Methods: A convenient sample of 30 patients with a chronic ankle sprain (18 females and 12 males were included in this study. Their mean age ±SD was 24 ±1.2 years. Their height was 175±4.8 cm among men & 163±5.2 cm for females, and weight was 85±5.2 kg for males & 74±5.5 kg for women. It was a within-group design in which the same participant experienced the two types of taping compared to no taping condition. Root mean square (RMS was measured while participants were moving the isokinetic dynamometer at an angular velocity of 120°/sec using concentric contraction mode through full ankle range of motion. The EMG (RMS of evertors and invertors was measured immediately after the three taping ways (no tape, Kinesio tape, and athletic tape with a one-week interval between each taping. Results: Spa-care Kinesiotape significantly reduced evertors and invertors EMG (RMS compared with no tape or athletic tape in patients with chronic ankle sprain. Mean± SD of the evertors was 0.7 (±0.1 for no tape and 0.58 (±0.2 for Kinesio tape. The P value was 0.000 for kinesio tape in evertors compared with no tape. Also, mean± SD of the invertors was 0.87 (±0.23 for no tape, and 0.54 (±0.1 for Kinesio tape and the P value was 0.001 for Kinesio tape in invertors compared with no tape. Conclusion: Spa-care Kinesio tape may be useful for reducing EMG activity of ankle muscles in a chronic ankle sprain.

Acute injury of the ankle joint

International Nuclear Information System (INIS)

Breitenseher, M.J.

1999-01-01

The diagnosis of lateral collateral ankle ligament trauma is based on patient history, clinical examination, and clinical stress tests. If the clinical stress test is positive, stress radiography could be performed. There is no consensus about the usefulness of stress radiography in acute ankle sprain, particularly about the cut-off talar tilt angle beyond which a two-ligament rupture would be certain, ranging from 5 to 30 . Today MRI is not used for this indication, although it allows, with controlled positioning of the foot and with defined sections, visualization of injured lateral collateral ankle ligaments. In ankle injuries, plain radiographs form the established basis of diagnostic imaging and can provide definitive answers in most cases. CT is used in complex fractures for complete visualization. MRI is the method of choice for several diagnostic problem cases, including occult fractures and post-traumatic avascular necrosis. In tendon injuries, MRI is important if ultrasound is not diagnostic. Generally, for the evaluation of acute ankle injuries, MRI is the most important second-step procedure when radiographs are nondiagnostic. (orig.) [de

Bilateral Arthrodesis of the Ankle Joint: Self-Reported Outcomes in 35 Patients From the Swedish Ankle Registry.

Science.gov (United States)

Henricson, Anders; Kamrad, Ilka; Rosengren, Björn; Carlsson, Åke

Bilateral ankle arthrodesis is seldom performed, and results concerning the outcome and satisfaction can only sparsely be found in published studies. We analyzed the data from 35 patients who had undergone bilateral ankle arthrodesis in the Swedish Ankle Registry using patient-reported generic and region-specific outcome measures. Of 36 talocrural arthrodeses and 34 tibio-talar-calcaneal arthrodeses, 6 ankles (9%) had undergone repeat arthrodesis because of nonunion. After a mean follow-up period of 47 ± 5 (range 12 to 194) months, the mean scores were as follows: self-reported foot and ankle score, 33 ± 10 (range 4 to 48); the EuroQol Group's EQ-5D ™ score, 0.67 ± 0.28 (range -0.11 to 1), the EuroQol Group's visual analog scale score, 70 ± 19 (range 20 to 95), 36-item Short Form Health Survey (SF-36) physical domain, 39 ± 11 (range 16 to 58); and SF-36 mental domain, 54 ± 14 (range 17 to 71). Patients with rheumatoid arthritis seemed to have similar self-reported foot and ankle scores but possibly lower EQ-5D ™ and SF-36 scores. Those with talocrural arthrodeses scored higher than did those with tibio-talar-calcaneal arthrodeses on the EQ5D ™ and SF-36 questionnaires (p = .03 and p = .04). In 64 of 70 ankles (91%), the patients were satisfied or very satisfied with the outcome. In conclusion, we consider bilateral ankle arthrodesis to be a reasonable treatment for symptomatic hindfoot arthritis, with high postoperative mid-term satisfaction and satisfactory scores on the patient-reported generic and region-specific outcome measures, when no other treatment option is available. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Incidence and Cost of Ankle Sprains in United States Emergency Departments

Science.gov (United States)

Shah, Shweta; Thomas, Abbey C.; Noone, Joshua M.; Blanchette, Christopher M.; Wikstrom, Erik A.

2016-01-01

Background: Ankle sprains represent a common injury in emergency departments, but little is known about common complications, procedures, and charges associated with ankle sprains in emergency departments. Hypothesis: There will be a higher incidence of ankle sprains among younger populations (≤25 years old) and in female patients. Complications and procedures will differ between ankle sprain types. Lateral ankle sprains will have lower health care charges relative to medial and high ankle sprains. Study Design: Descriptive epidemiological study. Level of Evidence: Level 3. Methods: A cross-sectional study of the 2010 Nationwide Emergency Department Sample was conducted. Outcomes such as charges, complications, and procedures were compared using propensity score matching between lateral and medial as well as lateral and high ankle sprains. Results: The sample contained 225,114 ankle sprains. Female patients sustained more lateral ankle sprains (57%). After propensity score adjustment, lateral sprains incurred greater charges than medial ankle sprains (median [interquartile range], $1008 [$702-$1408] vs $914 [$741-$1108]; P sprain of the foot (2.96% vs 0.70%, P ankle sprain events. Among procedures, medial ankle sprains were more likely to include diagnostic radiology (97.91% vs 83.62%, P ankle sprains (0.87% vs 2.79%, P ankle sprains than lateral ankle sprains (24 [6.06%] vs 1 [0.25%], P Ankle sprain emergency department visits account for significant health care charges in the United States. Age- and sex-related differences persist among the types of ankle sprains. Clinical Relevance: The health care charges associated with ankle sprains indicate the need for additional preventive measures. There are age- and sex-related differences in the prevalence of ankle sprains that suggest these demographics may be risk factors for ankle sprains. PMID:27474161

Modelling of soft impingement during solidification

Indian Academy of Sciences (India)

TECS

soft impingement problem and related to shape instability by constitutional supercooling theory. This analysis ... the context of the stir casting process, it has been pointed ... This transformation when applied to Fick's second law gives the ...

Trends in Ankle Arthroscopy and Its Use in the Management of Pathologic Conditions of the Lateral Ankle in the United States: A National Database Study.

Science.gov (United States)

Werner, Brian C; Burrus, M Tyrrell; Park, Joseph S; Perumal, Venkat; Gwathmey, F Winston

2015-07-01

This study aimed to investigate current trends in ankle arthroscopy across time, sex, age, and region of the United States as well as the use of ankle arthroscopy in the management of lateral ankle instability. Patients who underwent ankle arthroscopy and those who underwent ankle arthroscopy and lateral ankle ligament repair or peroneal retinacular repair from 2007 through 2011 were identified using the PearlDiver national database. These searches yielded volumes of unique patients, sex and age distribution, and regional volumes of patients. Χ-square linear-by-linear association analysis was used for comparisons, with P arthroscopy procedures in the database from 2007 to 2011. Over the 5-year study period, there was a significant increase in the overall number of ankle arthroscopies being performed, from 2,814 in 2007 to 3,314 in 2011 (P arthroscopy more frequently than did male patients (P = .027). The majority of patients who had ankle arthroscopy were between the ages of 30 and 49 years. The use of ankle arthroscopy during lateral ligament repair procedures increased from 37.2% in 2007 to 43.7% in 2011 (P arthroscopy and peroneal tendon retinacular repair increased 50%, from 2.8/100 ankle arthroscopies in 2007 to 4.2/100 ankle arthroscopies in 2011 (P arthroscopy increased significantly from 2007 to 2011, outpacing shoulder, knee, and elbow arthroscopy. Ankle arthroscopy was performed more frequently in female patients and most commonly in patients younger than 50 years. The use of ankle arthroscopy in the surgical management of lateral ankle instability also increased significantly. The incidence of concomitant ankle arthroscopy and lateral ligament repair increased significantly, as did the incidence of concomitant ankle arthroscopy and repair of peroneal tendon subluxation. Level IV, therapeutic case series. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Hydrodynamics and PIV study in the impingement zone formed by a droplet train

Science.gov (United States)

Kanjirakat, Anoop; Sadr, Reza; Zhang, Taolue; Muthusamy, Jayaveera; Alvarado, Jorge; Texas A; M University at Qatar Collaboration; Texas A; M University College Station Collaboration

2016-11-01

Droplet impingement is encountered in numerous technical applications, such as ink jet printing, spray cooling, and fuel injection in internal combustion engines. Even though many studies in droplet impingement were conducted in past, not many have measured the near-wall velocities in the droplet impingement zone. With the goal of gaining a better understanding of the hydrodynamics in the impingement zone, well-controlled experiments are performed in combination with micro-PIV measurements and numerical simulations. Hydrodynamics of HFE-7100 droplets generated using a piezoelectric droplet generator, impinging on a pre-wetted surface is investigated. Micro-PIV studies in the high-velocity impingement zone are performed using one-micron meter fluorescent particles dispersed in HFE-7100 along with the double exposed images. Three-dimensional and 2D-axisymmetric numerical modeling for a transient droplet crown development is performed. The interface between the gas and the liquid is modeled using a Volume of Fluid (VOF) method. Numerical simulation results obtained are observed to be in good agreement with that of the experimental observations. Supported by National Priority Research Program (NPRP) of Qatar National Research Fund (QNRF), Grant No.: NPRP 6-1304-2-525.

Modular jet impingement assemblies with passive and active flow control for electronics cooling

Energy Technology Data Exchange (ETDEWEB)

Zhou, Feng; Dede, Ercan Mehmet; Joshi, Shailesh

2016-09-13

Power electronics modules having modular jet impingement assembly utilized to cool heat generating devices are disclosed. The modular jet impingement assemblies include a modular manifold having a distribution recess, one or more angled inlet connection tubes positioned at an inlet end of the modular manifold that fluidly couple the inlet tube to the distribution recess and one or more outlet connection tubes positioned at an outlet end of the modular manifold that fluidly coupling the outlet tube to the distribution recess. The modular jet impingement assemblies include a manifold insert removably positioned within the distribution recess and include one or more inlet branch channels each including an impinging slot and one or more outlet branch channels each including a collecting slot. Further a heat transfer plate coupled to the modular manifold, the heat transfer plate comprising an impingement surface including an array of fins that extend toward the manifold insert.

Operative Fixation Options for Elective and Diabetic Ankle Arthrodesis.

Science.gov (United States)

Ramanujam, Crystal L; Stapleton, John J; Zgonis, Thomas

2017-07-01

Ankle arthrodesis remains one of the most definitive treatment options for end-stage arthritis, paralysis, posttraumatic and postinfectious conditions, failed total ankle arthroplasty, and severe deformities. The general aims of ankle arthrodesis are to decrease pain and instability, correct the accompanying deformity, and create a stable plantigrade foot. Several surgical approaches have been reported for ankle arthrodesis with internal fixation options. External fixation has also evolved for ankle arthrodesis in certain clinical scenarios. This article provides a comprehensive analysis of midterm to long-term outcomes for ankle arthrodesis using internal and/or external fixation each for elective and diabetic conditions. Copyright © 2017 Elsevier Inc. All rights reserved.

Multicentre study on capsular closure versus non-capsular closure during hip arthroscopy in Danish patients with femoroacetabular impingement (FAI)

DEFF Research Database (Denmark)

Dippmann, Christian; Kraemer, Otto; Lund, Bent

2018-01-01

in patients without additional risk factors for instability such as hypermobility or dysplasia of the hip. We hypothesised that capsular closure will lead to a superior outcome in hip arthroscopy for femoroacetabular impingement syndrome (FAIS) compared with non-capsular closure. METHODS AND ANALYSIS...... years and FAIS according to the Warwick agreement. Exclusion criteria are: previous hip surgery in either hip, previous conditions of Legg-Calvé-Perthes or slipped capital femoral epiphysis, malignant disease, recent hip or pelvic fractures, arthritis, Ehlers-Danlos or Marfan disease, recent (within 6...

Understanding acute ankle ligamentous sprain injury in sports

Directory of Open Access Journals (Sweden)

Fong Daniel TP

2009-07-01

Full Text Available Abstract This paper summarizes the current understanding on acute ankle sprain injury, which is the most common acute sport trauma, accounting for about 14% of all sport-related injuries. Among, 80% are ligamentous sprains caused by explosive inversion or supination. The injury motion often happens at the subtalar joint and tears the anterior talofibular ligament (ATFL which possesses the lowest ultimate load among the lateral ligaments at the ankle. For extrinsic risk factors to ankle sprain injury, prescribing orthosis decreases the risk while increased exercise intensity in soccer raises the risk. For intrinsic factors, a foot size with increased width, an increased ankle eversion to inversion strength, plantarflexion strength and ratio between dorsiflexion and plantarflexion strength, and limb dominance could increase the ankle sprain injury risk. Players with a previous sprain history, players wearing shoes with air cells, players who do not stretch before exercising, players with inferior single leg balance, and overweight players are 4.9, 4.3, 2.6, 2.4 and 3.9 times more likely to sustain an ankle sprain injury. The aetiology of most ankle sprain injuries is incorrect foot positioning at landing – a medially-deviated vertical ground reaction force causes an explosive supination or inversion moment at the subtalar joint in a short time (about 50 ms. Another aetiology is the delayed reaction time of the peroneal muscles at the lateral aspect of the ankle (60–90 ms. The failure supination or inversion torque is about 41–45 Nm to cause ligamentous rupture in simulated spraining tests on cadaver. A previous case report revealed that the ankle joint reached 48 degrees inversion and 10 degrees internal rotation during an accidental grade I ankle ligamentous sprain injury during a dynamic cutting trial in laboratory. Diagnosis techniques and grading systems vary, but the management of ankle ligamentous sprain injury is mainly conservative

Ankle and subtalar synovitis in a ball-and-socket ankle joint causing posterolateral painful coarse crepitus: a case report.

Science.gov (United States)

Fan, Ka Yuk; Lui, Tun Hing

2014-01-01

A 17-year-old girl with bilateral ball-and-socket ankles reported left medial heel pain. Her left heel had gone into a varus position on tiptoeing, and a painful clunk had occurred when returning to normal standing. The clunk persisted after physiotherapy and treatment with an orthosis. Subtalar arthroscopy and peroneal tendoscopy showed mild diffuse synovitis of the ankle joint, especially over the posterior capsule, and a patch of inflamed and fibrotic synovium at the posterolateral corner of the subtalar joint. The clunk subsided immediately after arthroscopic synovectomy and had not recurred during 5 years of follow-up. We found no other reported cases of ankle and subtalar synovitis occurring in patients with a ball-and-socket ankle joint. Copyright © 2014 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Progress in the clinical imaging research of bone diseases on ankle and foot sesamoid bones and accessory ossicles

Science.gov (United States)

Li, Xiaozhong; Shi, Lenian; Liu, Taiyun; Wang, Lin

2012-01-01

Summary Sesamoid bones and accessory ossicles are research focuses of foot and ankle surgery. Pains of the foot and ankle are related to sesamoid bones and accessory ossicles. The specific anatomical and functional relationship of sesamoid bones and accessory ossicles can cause such bone diseases as the dislocation of sesamoid bones and accessory bones, infection, inflammation and necrosis of sesamoid bones, cartilage softening, tenosynovitis of sesamoid bones and the sesamoid bone syndrome. However, these bone diseases are often misdiagnosed or mistreated. In patients with trauma history, relevant diseases of sesamoid bones and accessory ossicles as above mentioned are highly probable to be misdiagnosed as avulsion fractures. In such cases, radiographic findings may provide a basis for clinical diagnosis. PMID:25343083

Arthroscopic ankle arthrodesis with intra-articular distraction.

Science.gov (United States)

Kim, Hyong Nyun; Jeon, June Young; Noh, Kyu Cheol; Kim, Hong Kyun; Dong, Quanyu; Park, Yong Wook

2014-01-01

Arthroscopic ankle arthrodesis has shown high rates of union comparable to those with open arthrodesis but with substantially less postoperative morbidity, shorter operative times, less blood loss, and shorter hospital stays. To easily perform arthroscopic resection of the articular cartilage, sufficient distraction of the joint is necessary to insert the arthroscope and instruments. However, sometimes, standard noninvasive ankle distraction will not be sufficient in post-traumatic ankle arthritis, with the development of arthrofibrosis and joint contracture after severe ankle trauma. In the present report, we describe a technique to distract the ankle joint by inserting a 4.6-mm stainless steel cannula with a blunt trocar inside the joint. The cannula allowed sufficient intra-articular distraction, and, at the same time, a 4.0-mm arthroscope can be inserted through the cannula to view the joint. Screws can be inserted to fix the joint under fluoroscopic guidance without changing the patient's position or removing the noninvasive distraction device and leg holder, which are often necessary during standard arthroscopic arthrodesis with noninvasive distraction. Copyright © 2014 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Developing a Framework for Ankle Function: A Delphi Study

Science.gov (United States)

Snyder, Kelli R.; Evans, Todd A.; Neibert, Peter J.

2014-01-01

Context: Addressing clinical outcomes is paramount to providing effective health care, yet there is no consensus regarding the appropriate outcomes to address after ankle injuries. Compounding the problem is the repetitive nature of lateral ankle sprains, referred to as functional (FAI) or chronic (CAI) ankle instability. Although they are commonly used terms in practice and research, FAI and CAI are inconsistently defined and assessed. Objective: To establish definitions of a healthy/normal/noninjured ankle, FAI, and CAI, as well as their characteristics and assessment techniques. Design: Delphi study. Setting: Telephone interviews and electronic surveys. Patients or Other Participants: Sixteen experts representing the fields of ankle function and treatment, ankle research, and outcomes assessment and research were selected as panelists. Data Collection and Analysis: A telephone interview produced feedback regarding the definition of, functional characteristics of, and assessment techniques for a healthy/normal/noninjured ankle, an unhealthy/acutely injured ankle, and FAI/CAI. Those data were compiled, reduced, and returned through electronic surveys and were either included by reaching consensus (80% agreement) or excluded. Results: The definitions of a healthy/normal/noninjured ankle and FAI reached consensus. Experts did not agree on a definition of CAI. Eleven functional characteristics of a healthy/normal/noninjured ankle, 32 functional characteristics of an unhealthy/acutely injured ankle, and 13 characteristics of FAI were agreed upon. Conclusions: Although a consensus was reached regarding the definitions and functional characteristics of a healthy/normal/noninjured ankle and FAI, the experts could only agree on 1 characteristic to include in the FAI definition. Several experts did, however, provide additional comments that reinforced the differences in the interpretation of those concepts. Although the experts could not agree on the definition of CAI, its

Kinematic analysis of a televised medial ankle sprain

Directory of Open Access Journals (Sweden)

Francesca E. Wade

2018-04-01

Full Text Available Ankle sprains are one of the most prevalent athletic injuries. Prior work has investigated lateral ankle sprains, but research on generally more severe medial sprains is lacking. This case report performs a kinematic analysis using novel motion analysis methods on a non-contact medial ankle sprain. Peak eversion (50° occurred 0.2 seconds following ground contact, maximum velocity of 426°/s, while peak dorsiflexion (64° occurred with a greater maximum velocity (573°/s. The combination of dorsiflexion at ground contact and rapid eversion is associated with a non-contact eversion sprain. This study provides a quantitative analysis of the eversion ankle sprain injury mechanism. Keywords: Athletic injury, Biomechanics, Ankle injury, Kinematics

Ankle manual therapy for individuals with post-acute ankle sprains: description of a randomized, placebo-controlled clinical trial

OpenAIRE

Fisher Beth E; Kulig Kornelia; Davenport Todd E

2010-01-01

Abstract Background Ankle sprains are common within the general population and can result in prolonged disablement. Limited talocrural dorsiflexion range of motion (DF ROM) is a common consequence of ankle sprain. Limited talocrural DF ROM may contribute to persistent symptoms, disability, and an elevated risk for re-injury. As a result, many health care practitioners use hands-on passive procedures with the intention of improving talocrural joint DF ROM in individuals following ankle sprains...

Single-leg drop landing movement strategies in participants with chronic ankle instability compared with lateral ankle sprain 'copers'.

Science.gov (United States)

Doherty, Cailbhe; Bleakley, Chris; Hertel, Jay; Caulfield, Brian; Ryan, John; Delahunt, Eamonn

2016-04-01

To compare the movement patterns and underlying energetics of individuals with chronic ankle instability (CAI) to ankle sprain 'copers' during a landing task. Twenty-eight (age 23.2 ± 4.9 years; body mass 75.5 ± 13.9 kg; height 1.7 ± 0.1 m) participants with CAI and 42 (age 22.7 ± 1.7 years; body mass 73.4 ± 11.3 kg; height 1.7 ± 0.1 m) ankle sprain 'copers' were evaluated 1 year after incurring a first-time lateral ankle sprain injury. Kinematics and kinetics of the hip, knee and ankle joints from 200 ms pre-initial contact (IC) to 200 ms post-IC, in addition to the vertical component of the landing ground reaction force, were acquired during performance of a drop land task. The CAI group adopted a position of increased hip flexion during the landing descent on their involved limb. This coincided with a reduced post-IC flexor pattern at the hip and increased overall hip joint stiffness compared to copers (-0.01 ± 0.05 vs. 0.02 ± 0.05°/Nm kg(-1), p = 0.03). Individuals with CAI display alterations in hip joint kinematics and energetics during a unipodal landing task compared to LAS 'copers'. These alterations may be responsible for the increased risk of injury experienced by individuals with CAI during landing manoeuvres. Thus, clinicians must recognise the potential for joints proximal to the affected ankle to contribute to impaired function following an acute lateral ankle sprain injury and to develop rehabilitation protocols accordingly. Level III.

Compression therapy after ankle fracture surgery

DEFF Research Database (Denmark)

Winge, R; Bayer, L; Gottlieb, H

2017-01-01

PURPOSE: The main purpose of this systematic review was to investigate the effect of compression treatment on the perioperative course of ankle fractures and describe its effect on edema, pain, ankle joint mobility, wound healing complication, length of stay (LOS) and time to surgery (TTS). The aim...... undergoing surgery, testing either intermittent pneumatic compression, compression bandage and/or compression stocking and reporting its effect on edema, pain, ankle joint mobility, wound healing complication, LOS and TTS. To conclude on data a narrative synthesis was performed. RESULTS: The review included...

Fracture line index of fibular stalk and the ankle joint bone in the classification of the ankle joint trauma

International Nuclear Information System (INIS)

Wu Jun; Zhang Qiang

2003-01-01

Objective: To evaluate the fracture line index of fibular stalk and the ankle joint bone in the classification of the ankle joint trauma. Methods: Measure fracture line index of fibular stalk and the ankle joint in 217 adult cases of fracture and dislocation of ankle joint. And the cases were classified by the results of the measurement. Results: Measurement was unavailable in 9 cases of tearing fracture. In 31 cases, the lesions could not be particularly classified. And in the rest 176 cases the trauma were precisely classified. The over all successful rate was 81.6%. Conclusion: Fracture line index of fibular stalk and the ankle joint bone are valuable in classification of the trauma of the angle joint. While the specificity of this method is low in differentiating the adducting and abducting fracture of the medial angle, in which a combined investigation is recommended

Intra-articular fibrous band of the ankle: an uncommon cause of post-traumatic ankle pain

International Nuclear Information System (INIS)

Slavotinek, J.P.; Martin, D.K.

2006-01-01

A case of an intra-articular fibrous band of the ankle is presented with emphasis on the MR imaging appearances. This entity is an important but uncommon cause of post-traumatic ankle pain and is well recognized within the arthroscopy literature, but there is little if any documentation of this condition in the imaging literature

The impact of subacromial impingement syndrome on muscle activity patterns of the shoulder complex: a systematic review of electromyographic studies

Directory of Open Access Journals (Sweden)

Smith Toby O

2010-03-01

Full Text Available Abstract Background Subacromial impingement syndrome (SIS is a commonly reported cause of shoulder pain. The purpose of this study was to systematically review the literature to examine whether a difference in electromyographic (EMG activity of the shoulder complex exists between people with SIS and healthy controls. Methods Medline, CINAHL, AMED, EMBASE, and grey literature databases were searched from their inception to November 2008. Inclusion, data extraction and trial quality were assessed in duplicate. Results Nine studies documented in eleven papers, eight comparing EMG intensity and three comparing EMG onset timing, representing 141 people with SIS and 138 controls were included. Between one and five studies investigated each muscle totalling between 20 and 182 participants. The two highest quality studies of five report a significant increase in EMG intensity in upper trapezius during scaption in subjects with SIS. There was evidence from 2 studies of a delayed activation of lower trapezius in patients with SIS. There was otherwise no evidence of a consistent difference in EMG activity between the shoulders of subjects with painful SIS and healthy controls. Conclusions A difference may exist in EMG activity within some muscles, in particular upper and lower trapezius, between people with SIS and healthy controls. These muscles may be targets for clinical interventions aiding rehabilitation for people with SIS. These differences should be investigated in a larger, high quality survey and the effects of therapeutically targeting these muscles in a randomised controlled trial.

Two ankle joint laxity testers: reliability and validity

NARCIS (Netherlands)

Kerkhoffs, Gino M. M. J.; Blankevoort, Leendert; Sierevelt, Inger N.; Corvelein, Ruby; Janssen, Guido H. W.; van Dijk, C. Niek

2005-01-01

Two test devices were manufactured to objectively measure ankle joint laxity: the dynamic anterior ankle tester (DAAT) and the quasi-static anterior ankle tester (QAAT). The primary aim was to analyse the reliability of both testers; The secondary aim was to assess validity in correlation with TELOS

Physics of Particle Entrainment Under the Influence of an Impinging Jet

Science.gov (United States)

2008-12-01

Approved for public release; distribution unlimited 1 PHYSICS OF PARTICLE ENTRAINMENT UNDER THE INFLUENCE OF AN IMPINGING JET Robert Haehnel...Ing. Wesen. Heft 361). Phares, D.J., Smedley , G.T. and Flagan, R.C. (2000) "The wall shear stress produced by the normal impingement of a jet on a

Reliability of impingement sampling designs: An example from the Indian Point station

International Nuclear Information System (INIS)

Mattson, M.T.; Waxman, J.B.; Watson, D.A.

1988-01-01

A 4-year data base (1976-1979) of daily fish impingement counts at the Indian Point electric power station on the Hudson River was used to compare the precision and reliability of three random-sampling designs: (1) simple random, (2) seasonally stratified, and (3) empirically stratified. The precision of daily impingement estimates improved logarithmically for each design as more days in the year were sampled. Simple random sampling was the least, and empirically stratified sampling was the most precise design, and the difference in precision between the two stratified designs was small. Computer-simulated sampling was used to estimate the reliability of the two stratified-random-sampling designs. A seasonally stratified sampling design was selected as the most appropriate reduced-sampling program for Indian Point station because: (1) reasonably precise and reliable impingement estimates were obtained using this design for all species combined and for eight common Hudson River fish by sampling only 30% of the days in a year (110 d); and (2) seasonal strata may be more precise and reliable than empirical strata if future changes in annual impingement patterns occur. The seasonally stratified design applied to the 1976-1983 Indian Point impingement data showed that selection of sampling dates based on daily species-specific impingement variability gave results that were more precise, but not more consistently reliable, than sampling allocations based on the variability of all fish species combined. 14 refs., 1 fig., 6 tabs

Impingement of water droplets on wedges and diamond airfoils at supersonic speeds

Science.gov (United States)

Serafini, John S

1953-01-01

An analytical solution has been obtained for the equations of motion of water droplets impinging on a wedge in a two-dimensional supersonic flow field with a shock wave attached to the wedge. The closed-form solution yields analytical expressions for the equation of the droplet trajectory, the local rate of impingement and the impingement velocity at any point on the wedge surface, and the total rate of impingement. The analytical expressions are utilized to determine the impingement on the forward surfaces of diamond airfoils in supersonic flow fields with attached shock waves. The results presented include the following conditions: droplet diameters from 2 to 100 microns, pressure altitudes from sea level to 30,000 feet, free-stream static temperatures from 420 degrees to 460 degrees R. Also, free-stream Mach numbers from 1.1 to 2.0, semi-apex angles for the wedge from 1.14 degrees to 7.97 degrees, thickness-to-chord ratios for the diamond airfoil from 0.02 to 0.14, chord lengths from 1 to 20 feet, and angles of attack from zero to the inverse tangent of the airfoil thickness-to-chord ratio.

Possible factors for ankle fractures

Directory of Open Access Journals (Sweden)

Tabaković Dejan

2010-01-01

Full Text Available Background/Aim. Classification of ankle fractures is commonly used for selecting an appropriate treatment and prognosing an outcome of definite management. One of the most used classifications is the Danis-Weber classification. To the best of our knowledge, in the available literature, there are no parameters affecting specific types of ankle fractures according to the Danis-Weber classification. The aim of this study was to analyze the correlation of the following parameters: age, body weight, body mass index (BMI, height, osteoporosis, osteopenia and physical exercises with specific types of ankle fractures using the Danis-Weber classification. Methods. A total of 85 patients grouped by the Danis-Weber classification fracture types were analyzed and the significance of certain parameters for specific types of ankle fractures was established. Results. The proportion of females was significantly higher (p < 0.001 with a significantly higher age (59.9 years, SD ± 14.2 in relation to males (45.1 years, SD ± 12.8 (p < 0.0001. Type A fracture was most frequent in the younger patients (34.2 years, SD ± 8.6, and those with increased physical exercises (p = 0.020. In type B fracture, the risk factor was osteoporosis (p = 0.0180, while in type C fracture, body weight (p = 0.017 and osteoporosis (p = 0.004 were significant parameters. Conclusion. Statistical analysis using the Danis-Weber classification reveals that there are certain parameters suggesting significant risk factors for specific types of ankle fractures.

Knowledge of practising radiographers of the supraspinatus outlet projection for shoulder impingement syndrome in the Eastern Cape, South Africa

International Nuclear Information System (INIS)

Williams, R.; Morton, D.G.

2016-01-01

Background/Aim: There are many projections in plain film imaging to demonstrate the specific aspects of the anatomy of the shoulder. However, reproducing the required projections can be challenging especially if radiographers are not familiar with the projections and their evaluation criteria. The aim of the study was to explore and describe the knowledge of practising radiographers regarding the supraspinatus outlet projection for shoulder impingement syndrome. Method: A quantitative, exploratory and descriptive design was followed. The population served as the sample and included all the practising radiographers in the public and private hospitals of a metropolitan municipality in the Eastern Cape, South Africa. A total of 84 respondents completed the structured, self-administered questionnaire. Results: The data revealed that in many cases, the majority of radiographers in the study, due to inadequate knowledge levels would not be able to produce an optimal radiographic image of the supraspinatus outlet. The results of the chi-squares indicated statistically significant differences (p < 0.05) between public and private hospitals regarding certain aspects of the scapular Y projection and SOP. Conclusion: It was found that the radiographers in the study had inadequate knowledge of scapular Y projections and SOPs in relation to SIS. Therefore, it is essential to ensure that radiographers are updated on their knowledge of radiographic practice on a continuous basis. - Highlights: • Many radiographers unable to produce an optimal image of the supraspinatus outlet. • Radiographers had poor knowledge of scapular Y and supraspinatus outlet projections. • It is essential that radiographers update their knowledge of radiographic practice.

Transverse jet-cavity interactions with the influence of an impinging shock

International Nuclear Information System (INIS)

Zare-Behtash, H.; Lo, K.H.; Kontis, K.; Ukai, T.; Obayashi, S.

2015-01-01

Highlights: • Experimental study of shock-jet-cavity in a supersonic freestream is conducted. • Shock impingement at the cavity leading edge lifts the shear layer, encouraging momentum transfer. • Shock impingement close to the jet location increases the number of smaller turbulent structures. - Abstract: For high-speed air breathing engines, fuel injection and subsequent mixing with air is paramount for combustion. The high freestream velocity poses a great challenge to efficient mixing both in macroscale and microscale. Utilising cavities downstream of fuel injection locations, as a means to hold the flow and stabilise the combustion, is one mechanism which has attracted much attention, requiring further research to study the unsteady flow features and interactions occurring within the cavity. In this study we combine the transverse jet injection upstream of a cavity with an impinging shock to see how this interaction influences the cavity flow, since impinging shocks have been shown to enhance mixing of transverse jets. Utilising qualitative and quantitative methods: schlieren, oilflow, PIV, and PSP the induced flowfield is analysed. The impinging shock lifts the shear layer over the cavity and combined with the instabilities generated by the transverse jet creates a highly complicated flowfield with numerous vertical structures. The interaction between the oblique shock and the jet leads to a relatively uniform velocity distribution within the cavity

Investigation of vertical liquid film width upon impingement on flat plate

International Nuclear Information System (INIS)

Kim, Won J.; Son, Hyung M.; Suh, Kune Y.

2003-01-01

In the early, high pressure phase during a Large-Break Loss-Of-Coolant Accident (LBLOCA), the Emergency Core Cooling (ECC) water of the Direct Vessel Injection (DVI) system is supplied from the Safety Injection Tank (SIT). After the shortage of the SIT, the In-containment Refueling Water Storage Tank (IRWST) supplies water to the safety system. Velocity of the injection flow varies during the process from the initial value of over 10 m/s in the blowdown phase to 2∼3 m/s in the later phase of reflood. During the safety injection, such important phenomena are observed as impingement, bypass, entrainment and sweepout, and condensation. The impingement is referred to the case where the ECC water is injected to strike on the reactor inner vessel. Accordingly, the water generates a liquid film to form a ridge on the wall. The liquid film then flows down the wall due to gravity. This impingement is interrupted by the steam-water mixture bypass flow to the break. The bypass, in turn, is affected by the impingement. This study is intended to understand the impinged water flow behavior neglecting such secondary effects as the temperature-dependent thermodynamic properties and the reactor vessel curvature. An emphasis is put on interpreting the results of visual inspection to understand the underlying mechanism of rather complex turbulent flow in the downcomer

MRI of injuries of the lateral ankle ligaments

International Nuclear Information System (INIS)

Breitenseher, Martin

2011-01-01

The most frequent sport injury of the ankle is located in the lateral ankle ligaments. The diagnosis of lateral collateral ankle ligament trauma is based on patient history, clinical examination, and stress radiography, allowing a fair diagnosis for the daily routine. For the direct visualization and precise diagnosis of the lateral ankle ligaments MRI provides the best answer. MRI is used with controlled positioning of the foot, correct angulation of sequenzes, and distinct analysis of MR findings. Sinus tarsi ligaments and ligaments of the distal syndesmosis should be included to the report. In selected patients MRI allows the best evaluation of the extent of the lateral ankle ligaments. MRI is the method of choice for combined osteochondral injuries and soft tissue lesions too. (orig.)

Sports hernia and femoroacetabular impingement in athletes: A systematic review.

Science.gov (United States)

Munegato, Daniele; Bigoni, Marco; Gridavilla, Giulia; Olmi, Stefano; Cesana, Giovanni; Zatti, Giovanni

2015-09-16

To investigate the association between sports hernias and femoroacetabular impingement (FAI) in athletes. PubMed, MEDLINE, CINAHL, Embase, Cochrane Controlled Trials Register, and Google Scholar databases were electronically searched for articles relating to sports hernia, athletic pubalgia, groin pain, long-standing adductor-related groin pain, Gilmore groin, adductor pain syndrome, and FAI. The initial search identified 196 studies, of which only articles reporting on the association of sports hernia and FAI or laparoscopic treatment of sports hernia were selected for systematic review. Finally, 24 studies were reviewed to evaluate the prevalence of FAI in cases of sports hernia and examine treatment outcomes and evidence for a common underlying pathogenic mechanism. FAI has been reported in as few as 12% to as high as 94% of patients with sports hernias, athletic pubalgia or adductor-related groin pain. Cam-type impingement is proposed to lead to increased symphyseal motion with overload on the surrounding extra-articular structures and muscle, which can result in the development of sports hernia and athletic pubalgia. Laparoscopic repair of sports hernias, via either the transabdominal preperitoneal or extraperitoneal approach, has a high success rate and earlier recovery of full sports activity compared to open surgery or conservative treatment. For patients with FAI and sports hernia, the surgical management of both pathologies is more effective than sports pubalgia treatment or hip arthroscopy alone (89% vs 33% of cases). As sports hernias and FAI are typically treated by general and orthopedic surgeons, respectively, a multidisciplinary approach for diagnosis and treatment is recommended for optimal treatment of patients with these injuries. The restriction in range of motion due to FAI likely contributes to sports hernias; therefore, surgical treatment of both pathologies represents an optimal therapy.

Measurement of blood pressure, ankle blood pressure and calculation of ankle brachial index in general practice

DEFF Research Database (Denmark)

Nexøe, Jørgen; Damsbo, Bent; Lund, Jens Otto

2012-01-01

BACKGROUND: Low ankle brachial index (ABI) is a sensitive measure of 'burden' of atherosclerosis, indicating cardiovascular risk of the asymptomatic patient. Conventionally, ABI values......BACKGROUND: Low ankle brachial index (ABI) is a sensitive measure of 'burden' of atherosclerosis, indicating cardiovascular risk of the asymptomatic patient. Conventionally, ABI values...

The role of series ankle elasticity in bipedal walking.

Science.gov (United States)

Zelik, Karl E; Huang, Tzu-Wei P; Adamczyk, Peter G; Kuo, Arthur D

2014-04-07

The elastic stretch-shortening cycle of the Achilles tendon during walking can reduce the active work demands on the plantarflexor muscles in series. However, this does not explain why or when this ankle work, whether by muscle or tendon, needs to be performed during gait. We therefore employ a simple bipedal walking model to investigate how ankle work and series elasticity impact economical locomotion. Our model shows that ankle elasticity can use passive dynamics to aid push-off late in single support, redirecting the body's center-of-mass (COM) motion upward. An appropriately timed, elastic push-off helps to reduce dissipative collision losses at contralateral heelstrike, and therefore the positive work needed to offset those losses and power steady walking. Thus, the model demonstrates how elastic ankle work can reduce the total energetic demands of walking, including work required from more proximal knee and hip muscles. We found that the key requirement for using ankle elasticity to achieve economical gait is the proper ratio of ankle stiffness to foot length. Optimal combination of these parameters ensures proper timing of elastic energy release prior to contralateral heelstrike, and sufficient energy storage to redirect the COM velocity. In fact, there exist parameter combinations that theoretically yield collision-free walking, thus requiring zero active work, albeit with relatively high ankle torques. Ankle elasticity also allows the hip to power economical walking by contributing indirectly to push-off. Whether walking is powered by the ankle or hip, ankle elasticity may aid walking economy by reducing collision losses. Copyright © 2013 Elsevier Ltd. All rights reserved.

The Horsens-Aarhus Femoro Acetabular Impingement (HAFAI) cohort: outcome of arthroscopic treatment for femoroacetabular impingement. Protocol for a prospective cohort study.

Science.gov (United States)

Kierkegaard, Signe; Lund, Bent; Dalgas, Ulrik; Sørensen, Henrik; Søballe, Kjeld; Mechlenburg, Inger

2015-09-07

During the past decade, it has become increasingly more common to offer hip arthroscopic surgery when treating people with femoroacetabular impingement (FAI). Nevertheless, the latest reviews conclude that it still remains to be properly investigated how surgery affects the patients. Specifically, detailed information on the functional, muscular and mechanical impact of surgery in larger groups is lacking. Furthermore, the long-term outcome of the surgery is still to be investigated. In this prospective cohort study, a total of 60 patients with FAI scheduled for arthroscopic surgery will be followed and tested preoperatively, and again after 3, 6, 9 and 12 months. Assessment includes isokinetic dynamometry evaluating hip flexion and extension; evaluation of functional capacity in a three-dimensional motion laboratory; pain assessment; self-reported function, quality of life, expectation and satisfaction with the surgery; recording of previous and present sporting activities and accelerometry. In addition, data on surgical procedure, rehabilitation progress, adverse events and failure will be recorded. Patients will be compared with an age-matched and gender-matched reference group of 30 persons with no hip, knee, ankle or back problems. Long-term follow-up of this cohort may evaluate possible reoperations and development of hip osteoarthritis. Furthermore, analysis on how subgroups respond to the treatment could be performed together with identification of possible "non-responders". The study is approved by the Central Denmark Region Committee on Biomedical Research Ethics (Journal No 1-10-72-239-14). The results from this study will be presented at national and international congresses and published in peer-reviewed journals. NCT02306525. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Multivariable Dynamic Ankle Mechanical Impedance With Active Muscles

Science.gov (United States)

Lee, Hyunglae; Krebs, Hermano Igo; Hogan, Neville

2015-01-01

Multivariable dynamic ankle mechanical impedance in two coupled degrees-of-freedom (DOFs) was quantified when muscles were active. Measurements were performed at five different target activation levels of tibialis anterior and soleus, from 10% to 30% of maximum voluntary contraction (MVC) with increments of 5% MVC. Interestingly, several ankle behaviors characterized in our previous study of the relaxed ankle were observed with muscles active: ankle mechanical impedance in joint coordinates showed responses largely consistent with a second-order system consisting of inertia, viscosity, and stiffness; stiffness was greater in the sagittal plane than in the frontal plane at all activation conditions for all subjects; and the coupling between dorsiflexion–plantarflexion and inversion–eversion was small—the two DOF measurements were well explained by a strictly diagonal impedance matrix. In general, ankle stiffness increased linearly with muscle activation in all directions in the 2-D space formed by the sagittal and frontal planes, but more in the sagittal than in the frontal plane, resulting in an accentuated “peanut shape.” This characterization of young healthy subjects’ ankle mechanical impedance with active muscles will serve as a baseline to investigate pathophysiological ankle behaviors of biomechanically and/or neurologically impaired patients. PMID:25203497

Ankle fractures have features of an osteoporotic fracture.

Science.gov (United States)

Lee, K M; Chung, C Y; Kwon, S S; Won, S H; Lee, S Y; Chung, M K; Park, M S

2013-11-01

We report the bone attenuation of ankle joint measured on computed tomography (CT) and the cause of injury in patients with ankle fractures. The results showed age- and gender-dependent low bone attenuation and low-energy trauma in elderly females, which suggest the osteoporotic features of ankle fractures. This study was performed to investigate the osteoporotic features of ankle fracture in terms of bone attenuation and cause of injury. One hundred ninety-four patients (mean age 51.0 years, standard deviation 15.8 years; 98 males and 96 females) with ankle fracture were included. All patients underwent CT examination, and causes of injury (high/low-energy trauma) were recorded. Mean bone attenuations of the talus, medial malleolus, lateral malleolus, and distal tibial metaphysis were measured on CT images. Patients were divided into younger age (fractures than the younger age group. With increasing age, bone attenuations tended to decrease and the difference of bone attenuation between the genders tended to increase in the talus, medial malleolus, lateral malleolus, and distal tibial metaphysis. Ankle fracture had features of osteoporotic fracture that is characterized by age- and gender-dependent low bone attenuation. Ankle fracture should not be excluded from the clinical and research interest as well as from the benefit of osteoporosis management.

Numerical modeling of normal turbulent plane jet impingement on solid wall

Energy Technology Data Exchange (ETDEWEB)

Guo, C.Y.; Maxwell, W.H.C.

1984-10-01

Attention is given to a numerical turbulence model for the impingement of a well developed normal plane jet on a solid wall, by means of which it is possible to express different jet impingement geometries in terms of different boundary conditions. Examples of these jets include those issuing from VTOL aircraft, chemical combustors, etc. The two-equation, turbulent kinetic energy-turbulent dissipation rate model is combined with the continuity equation and the transport equation of vorticity, using an iterative finite difference technique in the computations. Peak levels of turbulent kinetic energy occur not only in the impingement zone, but also in the intermingling zone between the edges of the free jet and the wall jet. 20 references.

Complications of ankle fracture in patients with diabetes.

Science.gov (United States)

Chaudhary, Saad B; Liporace, Frank A; Gandhi, Ankur; Donley, Brian G; Pinzur, Michael S; Lin, Sheldon S

2008-03-01

Ankle fractures in patients with diabetes mellitus have long been recognized as a challenge to practicing clinicians. Complications of impaired wound healing, infection, malunion, delayed union, nonunion, and Charcot arthropathy are prevalent in this patient population. Controversy exists as to whether diabetic ankle fractures are best treated noninvasively or by open reduction and internal fixation. Patients with diabetes are at significant risk for soft-tissue complications. In addition, diabetic ankle fractures heal, but significant delays in bone healing exist. Also, Charcot ankle arthropathy occurs more commonly in patients who were initially undiagnosed and had a delay in immobilization and in patients treated nonsurgically for displaced ankle fractures. Several techniques have been described to minimize complications associated with diabetic ankle fractures (eg, rigid external fixation, use of Kirschner wires or Steinmann pins to increase rigidity). Regardless of the specifics of treatment, adherence to the basic principles of preoperative planning, meticulous soft-tissue management, and attention to stable, rigid fixation with prolonged, protected immobilization are paramount in minimizing problems and yielding good functional outcomes.

Computations of droplet impingement on airfoils in two-phase flow

International Nuclear Information System (INIS)

Kim, Sang Dug; Song, Dong Joo

2005-01-01

The aerodynamic effects of leading-edge accretion can raise important safety concerns since the formulation of ice causes severe degradation in aerodynamic performance as compared with the clean airfoil. The objective of this study is to develop a numerical simulation strategy for predicting the particle trajectory around an MS-0317 airfoil in the test section of the NASA Glenn Icing Research Tunnel and to investigate the impingement characteristics of droplets on the airfoil surface. In particular, predictions of the mean velocity and turbulence diffusion using turbulent flow solver and continuous random walk method were desired throughout this flow domain in order to investigate droplet dispersion. The collection efficiency distributions over the airfoil surface in simulations with different numbers of droplets, various integration time-steps and particle sizes were compared with experimental data. The large droplet impingement data indicated the trends in impingement characteristics with respect to particle size; the maximum collection efficiency located at the upper surface near the leading edge, and the maximum value and total collection efficiency were increased as the particle size was increased. The extent of the area impinged on by particles also increased with the increment of the particle size, which is similar as compared with experimental data

Complications in ankle fracture surgery

OpenAIRE

Ovaska, Mikko

2015-01-01

Mikko Ovaska. Complications in Ankle Fracture Surgery. Helsinki Bone and Joint Research Group, Department of Orthopaedic Surgery and Traumatology, Faculty of Medicine, University of Helsinki, Finland. Helsinki 2014. Ankle fractures are among the most frequently encountered surgically treated fractures. The operative treatment of this fracture may be associated with several complications. The most frequently encountered complications are related wound healing, and deep infection may have d...

Entrainment and impingement of aquatic fauna at cooling water system of Madras Atomic Power Station (MAPS)

International Nuclear Information System (INIS)

Barath Kumar, S.; Das, N.P.I.; Satpathy, K.K.

2015-01-01

Marine organisms get impinged to the intake screens of Madras Atomic Power Station (MAPS) due to the suction force of the cooling water system of the power plant. The present work has studied the loss of aquatic organism at MAPS due to impingement at cooling water screens. In total 67 species of marine faunas impinged on the water intake screens of MAPS during the study. The proportion of fish, shrimp, crab, jellyfish and others, with respect to the total biomass of impinged organisms are 1.59 % (33 species), 0.30% (9), 2.77 % (16), 95.10% (3) and 0.24% (4), respectively. Jellyfishes were observed to be the largest entrained group covering around 44.85% of individual and constituting almost 94.82 % of biomass recorded during the study period and sea nettle jelly (Chrysaora quinquecirrha) was impinged with highest frequency. The diel study shows higher impingement occurred during night time, on full moon day and at low tides in contrast to their counterparts. Fishes accounts for 14.84 % of individual count and mere 1.67 % of biomass. Totally 33 number of fish species were observed. The highest impinged species were pony fishes (Secutor ruconius, Secutor insidiator, Photopectoralis bindus, Alepes kleinii and Leiognathus equulus) (21% occurrence). These few entrained fishes are mostly very small in size and have less commercial value. The total loss of marine fauna by impingement during study period was estimated to be 4779 (or 463.46 kg). The present data when compared with the impingement data from other coastal power plants, shows that the impinged fish biomass at MAPS cooling water system is much less than the other temperate and tropical power plants. (author)

A study of semi-rigid support on ankle supination sprain kinematics.

Science.gov (United States)

Tang, Y M; Wu, Z H; Liao, W H; Chan, K M

2010-12-01

Ankle sprain injury is very common in sports and the use of ankle support is crucial. This research investigated the effect of an ankle brace in reducing the ankle angular displacement and angular velocity during sudden supination. In the experiment, 11 healthy males were tested. The bracing condition, semi-rigid ankle braces were investigated. The angular displacement and angular velocity of the ankle were computed. The motion-capture system was adopted to capture the three-dimensional coordinates of the reflective markers. The coordinates of the reflective markers were used to compute the ankle kinematics during simulated ankle supination. A mechanical supination platform was used to simulate the sprain motions. Experimental results showed that the semi-rigid brace tested significantly reduced the ankle angular displacement and angular velocity compared with control conditions during sudden supination. In conclusion, the semi-rigid-type brace can provide significant restriction to reduce the magnitudes of the angular displacement and angular velocity of the ankle during sudden supination sprain. The semi-rigid-type brace is suggested as the prophylactic bracing for the ankle. © 2009 John Wiley & Sons A/S.

Os peroneum friction syndrome complicated by sesamoid fatigue fracture: a new radiological diagnosis? Case report and literature review.

Science.gov (United States)

Bashir, Waseem A; Lewis, Steve; Cullen, Nicholas; Connell, David A

2009-02-01

Injuries to the peroneal tendons are relatively common worldwide but tendon rupture without significant trauma is uncommon. Ankle mechanics can be seriously affected by disruption of one or both of the peroneal tendons although complete rupture can also remain asymptomatic. Accessory ossicles are sesamoid bones and are common findings in routine radiology of the foot and ankle. Although in the vast majority these "os" are normal variants of anatomy, they can lead to painful syndromes and suffer fractures and even undergo degenerative changes in response to overuse and trauma. Although similar syndromes have been discussed in the surgical literature, there is a lack of literature describing the use of modern imaging in the accurate diagnosis and its subsequent assistance towards appropriate management of os peroneum friction syndrome complicated by sesamoid fatigue syndrome. This article presents the plain film, sonographic and magnetic resonance imaging findings in a case of os peroneum friction syndrome complicated by a sesamoid fatigue fracture as well as reviewing the pertinent literature.

Os peroneum friction syndrome complicated by sesamoid fatigue fracture: a new radiological diagnosis? Case report and literature review

International Nuclear Information System (INIS)

Bashir, Waseem A.; Connell, David A.; Lewis, Steve; Cullen, Nicholas

2009-01-01

Injuries to the peroneal tendons are relatively common worldwide but tendon rupture without significant trauma is uncommon. Ankle mechanics can be seriously affected by disruption of one or both of the peroneal tendons although complete rupture can also remain asymptomatic. Accessory ossicles are sesamoid bones and are common findings in routine radiology of the foot and ankle. Although in the vast majority these ''os'' are normal variants of anatomy, they can lead to painful syndromes and suffer fractures and even undergo degenerative changes in response to overuse and trauma. Although similar syndromes have been discussed in the surgical literature, there is a lack of literature describing the use of modern imaging in the accurate diagnosis and its subsequent assistance towards appropriate management of os peroneum friction syndrome complicated by sesamoid fatigue syndrome. This article presents the plain film, sonographic and magnetic resonance imaging findings in a case of os peroneum friction syndrome complicated by a sesamoid fatigue fracture as well as reviewing the pertinent literature. (orig.)

An in Silico Analysis of Ankle Joint Loads in Secondary Ankle Osteoarthritis. Case Study.

Science.gov (United States)

Lorkowski, Jacek; Mrzygłód, Mirosław W; Grzegorowska, Oliwia; Kotela, Ireneusz

2015-01-01

Secondary, post-traumatic, degenerative lesions of the ankle joint remain a serious clinical challenge. This paper presents the case of a 66-year-old patient with secondary, post-traumatic ankle osteoarthritis and subchondral cysts. The use of rapid computer modelling FEM 2D enabled optimization of surgical treatment. A FEM 2D model of biomechanical changes in bones may help in streamlining treatment as well as improve our understanding of the pathomechanism of osteoarthritis.

Lateral ankle injury. Literature review and report of two cases.

Science.gov (United States)

Pollard, Henry; Sim, Patrick; McHardy, Andrew

2002-07-01

Injury to the ankle joint is the most common peripheral joint injury. The sports that most commonly produce high ankle injury rates in their participating athletes include: basketball, netball, and the various codes of football. To provide an up to date understanding of manual therapy relevant to lateral ligament injury of the ankle. A discussion of the types of ligament injury and common complicating factors that present with lateral ankle pain is presented along with a review of relevant anatomy, assessment and treatment. Also included is a discussion of the efficacy of manual therapy in the treatment of ankle sprain. A detailed knowledge of the anatomy of the ankle as well as the early recognition of factors that may delay the rate of healing are important considerations when developing a management plan for inversion sprains of the ankle. This area appears to be under-researched however it was found that movement therapy and its various forms appear to be the most efficient and most effective method of treating uncomplicated ankle injury. Future investigations should involve a study to determine the effect chiropractic treatment (manipulation) may have on the injured ankle.

Incidence of hockey ankle injuries in Kwa-Zulu Natal, South Africa ...

African Journals Online (AJOL)

ankle injuries amongst hockey players was 26.41%. The most frequent ankle injury sustained by male adolescent hockey players was an inversion ankle sprain (84.62% of the 26.41% injured subjects of the sample cohort). The mechanisms of ankle injuries were attributed to rapid rotational movements of the ankle joint ...

Pitfalls in the ankle-brachial index and brachial-ankle pulse wave velocity

Directory of Open Access Journals (Sweden)

Ato D

2018-04-01

Full Text Available Dai Ato Gakujutsu Shien Co., Ltd., Tokyo, Japan Background: The ankle-brachial index (ABI and pulse wave velocity (PWV are indices of atherosclerosis and arterial stiffness. The Japan-made measuring devices of those indices have spread widely because of their convenience and the significance of the parameters. However, studies that comprehensively discuss the various pitfalls in using these indices are not available.Methods: This study presents several representative pitfalls in using the ABI and brachial-ankle PWV (baPWV by showing the result sheets of the device, “the Vascular Profiler”. Furthermore, some considerations when utilizing these indices in the future are also discussed.Results: Several diseases such as arteriosclerosis obliterans (ASO, arterial calcification in the lower limb, arterial stenosis in the right upper-limb, aortic valve diseases, arterial stenosis in the upper-limb of the contralateral side of the hemodialysis access, are the representative pitfalls when evaluating ABI and baPWV. Moreover, a measurement error is found to actually exist. Furthermore, same phenomena are considered most likely to occur when using other similar indices and devices.Conclusion: The ABI and baPWV are the useful and significant biomarkers. Nevertheless, caution is sometimes necessary when interpreting them. Moreover, rigorous patient exclusion criteria should be considered when using those indices in the severely conditioned patient population. And the results of this study can be applied to enhance the literacy using other indices, such as the cardio-ankle vascular index and other similar devices. Keywords: ankle-brachial index, pulse wave velocity, peripheral arterial disease, aortic valve disease, hemodialysis

Hip arthroscopy for femoroacetabular impingement: the changing nature and severity of associated complications over time.

Science.gov (United States)

Park, Myung-Sik; Yoon, Sun-Jung; Kim, Yong-Jin; Chung, Woo-Chul

2014-08-01

The aim of this study was to assess complications related to arthroscopy for femoroacetabular impingement (FAI) and how these complications have changed as we have gained more experience with this procedure. The authors reviewed 200 hips (197 patients). The average patient age was 44.64 years and the mean follow-up time was 28.2 months. All patients underwent hip arthroscopy in the supine position. Clinically, Modified Harris Hip Scores (MHHS) and patient satisfaction with outcome were used. We divided complications into 3 groups: Group 1 related to traction, group 2 related to surgical technique or implant failure, and group 3 related to outcomes. Clinically, the MHHS improved from 69.96 (±6.10) to 80.45 (±7.00), and patient satisfaction with the achieved outcome increased to 8.87 (±0.76). The overall complication rate was 15% (30 of 200 hips). Group 1 consisted of 4 patients with pudendal neuropraxia and 2 patients with ankle joint pain (P = .013). Group 2 consisted of 2 patients with lateral femoral cutaneous neuropraxia, 2 patients with iatrogenic labral perforations, one patient with a labral tear, and 4 patients with femoral head scuffs. There were 4 incidents of instrument breakage. Furthermore, 3 suture anchors failed, a second-degree burn occurred in one patient, and there was incomplete reshaping in 5 hips (P = .045). Group 3 included one patient with a snapping sound and heterotopic ossification. Second-look arthroscopy was performed for 5 hips. All the complications outlined in groups 1 and 2 are related to the learning curve and have statistical significance (P arthroscopy took different forms during the early learning period, but overall complication rates decreased along the learning curve. Surgical technique-related complications such as problems with suture anchors and the reshaping of cam impingements were also considered during the later stage. Level IV, therapeutic case series. Copyright © 2014 Arthroscopy Association of North America

Diagnosis of ligament injuries in the superior ankle joint

International Nuclear Information System (INIS)

Gebing, R.; Fiedler, V.

1991-01-01

Nearly 40 years after ankle arthrography was first introduced, the anterior and inversion stress views of the ankle are still widely preferred as a noninvasive method of evaluating ligament injuries in the upper ankle. We consider the stress test, bilaterally performed using a standardized stress apparatus, as a basic examination by which to differentiate between slight and severe sprain. Intensive muscel splinting due to painful swelling can sometimes be treated by injection of local anesthetic. Like many authors, we perform ankle arthrography in cases where there is a significant difference between the clinical findings and the stress test. The technique of ankle arthrography can be readily learned and is extremely accurate in delineating the extent of ligamentous injury produced by moderate or severe ankle sprains. It can be performed in any X-ray department. (orig.) [de

Postural steadiness and ankle force variability in peripheral neuropathy

Science.gov (United States)

Paxton, Roger J.; Feldman-Kothe, Caitlin; Trabert, Megan K.; Hitchcock, Leah N.; Reiser, Raoul F.; Tracy, Brian L.

2015-01-01

Introduction The purpose was to determine the effect of peripheral neuropathy (PN) on motor output variability for ankle muscles of older adults, and the relation between ankle motor variability and postural stability in PN patients. Methods Older adults with (O-PN) and without PN (O), and young adults (Y) underwent assessment of standing postural stability and ankle muscle force steadiness. Results O-PN displayed impaired ankle muscle force control and postural stability compared with O and Y groups. For O-PN, the amplitude of plantarflexor force fluctuations was moderately correlated with postural stability under no-vision conditions (r = 0.54, P = 0.01). Discussion The correlation of variations in ankle force with postural stability in PN suggests a contribution of ankle muscle dyscontrol to the postural instability that impacts physical function for older adults with PN. PMID:26284897

Prospective study of ankle and foot fractures in elderly women

Directory of Open Access Journals (Sweden)

Yadagiri Surender Rao

2015-01-01

Full Text Available The epidemiology of ankle fractures in old people is changing as time passes on. The incidence of ankle fractures increases with advancing age. The study conducted was among a rural popula-tion which comprised of 68 women (32 women with ankle fractures & 36 women with foot fractures. Patients studied were in the age group more than 50 years. The study highlights the etiological & risk factors for fractures of ankle & foot. The commonest ankle fracture was the lateral malleolar fracture & the commonest foot fracture was the 5th Metatarsal fracture. Diabetes is a risk factor which increases the occurrence of ankle and foot injuries.

Application of the Superelastic NiTi Spring in Ankle Foot Orthosis (AFO to Create Normal Ankle Joint Behavior

Directory of Open Access Journals (Sweden)

Amirhesam Amerinatanzi

2017-12-01

Full Text Available Hinge-based Ankle Foot Orthosis (HAFO is one of the most common non-surgical solutions for the foot drop. In conventional HAFOs, the ankle joint is almost locked, and plantar flexion is restricted due to the high stiffness of the hinge mechanism. This often leads to a rigid walking gate cycle, poor muscle activity, and muscle atrophy. Since the ankle torque-angle loop has a non-linear profile, the use of a superelastic NiTi spring within the hinge, due to its nonlinear behavior, could recreate a close-to-normal stiffness of the normal ankle joint, which, in turn, could create a more natural walk. The focus of this study is to evaluate the performance of a superelastic NiTi spring versus a conventional Stainless Steel spring in a hinge mechanism of a custom-fit HAFO. To this aim, a custom-fit HAFO was fabricated via the fast casting technique. Then, motion analysis was performed for two healthy subjects (Case I and Case II: (i subjects with bare foot; (ii subjects wearing a conventional HAFO with no spring; (iii subjects wearing a conventional Stainless Steel-based HAFO; and (iv subjects wearing a NiTi spring-based HAFO. The data related to the ankle angle and the amount of moment applied to the ankle during walking were recorded using Cortex software and used for the evaluations. Finally, Finite Element Analysis (FEA was performed to evaluate the safety of the designed HAFO. The NiTi spring offers a higher range of motion (7.9 versus 4.14 degree and an increased level of moment (0.55 versus 0.36 N·m/kg. Furthermore, a NiTi spring offers an ankle torque-angle loop closer to that of the healthy subjects.

Application of the Superelastic NiTi Spring in Ankle Foot Orthosis (AFO) to Create Normal Ankle Joint Behavior.

Science.gov (United States)

Amerinatanzi, Amirhesam; Zamanian, Hashem; Shayesteh Moghaddam, Narges; Jahadakbar, Ahmadreza; Elahinia, Mohammad

2017-12-07

Hinge-based Ankle Foot Orthosis (HAFO) is one of the most common non-surgical solutions for the foot drop. In conventional HAFOs, the ankle joint is almost locked, and plantar flexion is restricted due to the high stiffness of the hinge mechanism. This often leads to a rigid walking gate cycle, poor muscle activity, and muscle atrophy. Since the ankle torque-angle loop has a non-linear profile, the use of a superelastic NiTi spring within the hinge, due to its nonlinear behavior, could recreate a close-to-normal stiffness of the normal ankle joint, which, in turn, could create a more natural walk. The focus of this study is to evaluate the performance of a superelastic NiTi spring versus a conventional Stainless Steel spring in a hinge mechanism of a custom-fit HAFO. To this aim, a custom-fit HAFO was fabricated via the fast casting technique. Then, motion analysis was performed for two healthy subjects (Case I and Case II): (i) subjects with bare foot; (ii) subjects wearing a conventional HAFO with no spring; (iii) subjects wearing a conventional Stainless Steel-based HAFO; and (iv) subjects wearing a NiTi spring-based HAFO. The data related to the ankle angle and the amount of moment applied to the ankle during walking were recorded using Cortex software and used for the evaluations. Finally, Finite Element Analysis (FEA) was performed to evaluate the safety of the designed HAFO. The NiTi spring offers a higher range of motion (7.9 versus 4.14 degree) and an increased level of moment (0.55 versus 0.36 N·m/kg). Furthermore, a NiTi spring offers an ankle torque-angle loop closer to that of the healthy subjects.

Translation, cross-cultural adaption and validation of the German version of the Foot and Ankle Ability Measure for patients with chronic ankle instability.

Science.gov (United States)

Nauck, T; Lohrer, H

2011-08-01

The evaluation of health-related quality of life and physical function is important for determining therapeutic strategies following ankle injuries. The Anglo-American Foot and Ankle Ability Measure (FAAM) is a valid and reliable self-reported measure to detect functional deficits in chronic lateral ankle instability. The purpose of this study was to translate, cross-culturally adapt and validate the FAAM questionnaire for use with German-speaking patients with chronic lateral ankle instability. Preoperative and conservatively treated patients with chronic lateral ankle instability. Sport students and volleyball athletes served as control groups. The FAAM was forward and back translated, cross-culturally adapted and validated. The study population completed the FAAM-G questionnaire twice within 3-5 days. Additionally, the patients were scored with the Good ankle laxity classification system. Test-Retest reliability, construct validity and internal consistency were calculated. Reliability and validity of the FAAM-G were examined in presurgical chronic ankle instability patients (n=24), conservatively treated chronic ankle instability patients (n=17), university sport students (n=31) and volleyballers (n=37). Test-retest reliability revealed fair, good, or excellent reliability (inter-class correlation coefficient (ICC)=0.590-0.998; ρ=0.528-1.000). Construct validity, tested between the FAAM-G subscores and the Good et al ankle laxity classification system demonstrated strong correlations (ρ = -0.819 to -0.861). The original FAAM questionnaire was successfully translated and cross-culturally adapted from English to German. Corresponding to the Anglo-American version, the FAAM-G is a reliable and valid questionnaire for self-reported assessment of pain and disability in German-speaking patients suffering from chronic ankle instability.

Direct measurement of the intrinsic ankle stiffness during standing

NARCIS (Netherlands)

Vlutters, Mark; Vlutters, M.; Boonstra, Tjitske; Schouten, Alfred Christiaan; van der Kooij, Herman

2015-01-01

Ankle stiffness contributes to standing balance, counteracting the destabilizing effect of gravity. The ankle stiffness together with the compliance between the foot and the support surface make up the ankle-foot stiffness, which is relevant to quiet standing. The contribution of the intrinsic

Analysis of PITFL injuries in rotationally unstable ankle fractures.

Science.gov (United States)

Warner, Stephen J; Garner, Matthew R; Schottel, Patrick C; Hinds, Richard M; Loftus, Michael L; Lorich, Dean G

2015-04-01

Reduction and stabilization of the syndesmosis in unstable ankle fractures is important for ankle mortise congruity and restoration of normal tibiotalar contact forces. Of the syndesmotic ligaments, the posterior inferior tibiofibular ligament (PITFL) provides the most strength for maintaining syndesmotic stability, and previous work has demonstrated the significance of restoring PITFL function when it remains attached to a posterior malleolus fracture fragment. However, little is known regarding the nature of a PITFL injury in the absence of a posterior malleolus fracture. The goal of this study was to describe the PITFL injury pattern based on magnetic resonance imaging (MRI) and intraoperative observation. A prospective database of all operatively treated ankle fractures by a single surgeon was used to identify all supination-external rotation (SER) types III and IV ankle fracture patients with complete preoperative orthogonal ankle radiographs and MRI. All patients with a posterior malleolus fracture were excluded. Using a combination of preoperative imaging and intraoperative findings, we analyzed the nature of injuries to the PITFL. In total, 185 SER III and IV operatively treated ankle fractures with complete imaging were initially identified. Analysis of the preoperative imaging and operative reports revealed 34% (63/185) had a posterior malleolus fracture and were excluded. From the remaining 122 ankle fractures, the PITFL was delaminated from the posterior malleolus in 97% (119/122) of cases. A smaller proportion (3%; 3/122) had an intrasubstance PITFL rupture. Accurate and stable syndesmotic reduction is a significant component of restoring the ankle mortise after unstable ankle fractures. In our large cohort of rotationally unstable ankle fractures without posterior malleolus fractures, we found that most PITFL injuries occur as a delamination off the posterior malleolus. This predictable PITFL injury pattern may be used to guide new methods for

Managing ankle ligament sprains and tears: current opinion

Directory of Open Access Journals (Sweden)

McGovern RP

2016-03-01

Full Text Available Ryan P McGovern,1 RobRoy L Martin,1,2 1Department of Physical Therapy, Rangos School of Health Sciences, Duquesne University, 2Centers for Sports Medicine – University of Pittsburgh, Pittsburgh, PA, USA Abstract: The purpose of this paper is to present a current review of pathoanatomical features, differential diagnosis, objective assessment, intervention, and clinical course associated with managing lateral ankle ligament sprains. Proper diagnosis and identification of affected structures should be obtained through history and objective assessment. From this information, an individualized evidence-based intervention plan can be developed to enable recovery while decreasing the risk of reinjury. An appropriate evaluation is needed not only to determine the correct diagnosis but also to allow for grading and determining the prognosis of the injury in those with an acute lateral ankle sprain. Examination should include an assessment of impairments as well as a measure of activity and participation. Evidence-based interventions for those with an acute lateral ankle sprain should include weight bearing with bracing, manual therapy, progressive therapeutic exercises, and cryotherapy. For those with chronic ankle instability (CAI, interventions should include manual therapy and a comprehensive rehabilitation program. It is essential to understand the normal clinical course for athletes who sustain a lateral ankle sprain as well as risk factors for an acute injury and CAI. Risk factors for both an acute lateral ankle sprain and CAI include not using an external support and not participating in an appropriate exercise program. Incorporating the latest evidence-based rehabilitation techniques provides the best course of treatment for athletes with an acute ankle sprain or CAI. Keywords: reinjury, chronic ankle instability, rehabilitation techniques, diagnosis, intervention, athlete

Foot and ankle problems in Muay Thai kickboxers.

Science.gov (United States)

Vaseenon, Tanawat; Intharasompan, Piyapong; Wattanarojanapom, Thongaek; Theeraamphon, Nipon; Auephanviriyakul, Sansanee; Phisitkul, Phinit

2015-01-01

Muay Thai kickboxing is a common sport that uses the foot and ankle in fighting. Muay Thai kickboxing trainees usually receive training in Thailand Foot and ankle problems in this group ofpeople who usually train barefoot remain unexplored To evaluate the prevalence of common foot and ankle problems in Muay Thai kick boxers. The present study is a cross-sectional survey of Muay Thai kick boxers practicing in northern Thailand. Interviews were conducted and foot and ankle examinations were evaluated Foot morphology was examined using a Harris mat footprint. One hundred and twenty-three Muay Thai kickbox ersinnine training gyms were included in this study. Common foot and ankle problems found in the Muay Thai kick boxers were callosity (59%), gastrocnemius contracture (57%), toe deformities (49.3%), wounds (10%) and heel pain (9%). Callosity was most commonly found on the forefoot (77.5%), on the plantar first metatarsal (55.3%) and on the big toe (33.3%). An association was found between a tight heel cord and a history of foot injury with prolonged periods of weekly training. Toe deformities such as hallux rigidus (37.6%) were also associated with prolonged periods of training (p = 0.001). No correlation was found between type of foot arch and foot and ankle problems. Plantar forefoot callosities and wounds as well as toe deformities including tight heel cords are some of the foot and ankle problems commonly found in Muay Thai kick boxers. They are associated with prolonged periods of barefoot training. The unique pattern of training and of the kicks in Muay Thai might be a path mechanism, leading to the development of foot and ankle problems.

Effect of kinesio-taping on ankle joint stability

Directory of Open Access Journals (Sweden)

Mervat A. Mohamed

2016-05-01

Full Text Available Ankle Instability is characterized by recurrent giving way and often develops after repeated lateral ankle sprains. Kinesiotape is more elastic than traditional athletic tape and is becoming increasingly popular. It is reported to decrease pain, improve muscle function, circulation and proprioception, however, research examining the effects of Kinesiotape in ankle instability is limited. The objective of this study was to determine if applying Kinesiotape to unstable ankle may improve performance in the Star Excursion Balance Test (SEBT, which has been shown to be a sensitive and reliable measure for quantifying dynamic balance. Thirty subjects with first degree ankle sprain were participated in this study. SEBT was used to test the subject dynamic balance under three conditions; without taping, with white athletic tape and with kinesiotape. One way repeated measure ANOVA using Greenhouse-Geisser corrections were conducted to evaluate differences in SEBT for the three conditions. Pairwise comparison of the outcome measures in the three occasions (without taping, with athletic taping, and with kinesio taping revealed statistically significant differences of all outcomes between occasion 1 (without taping and occasion 2 (with athletic taping favoring the athletic taping (p < 0.05. Also, a statistically significant difference between occasion 1 (without taping and occasion 3 (with kinesio taping were found (p < 0.05 favoring kinesio taping. Moreover, pairwise comparison of the ankle stability outcomes using athletic taping versus kinesio taping indicated a statistically significant difference (p < 0.05 in favor of kinesio taping measures. Conclusion: kinesiotape has superior effect than athletic tape in patients with first degree ankle sprain and can be used safely for improving ankle joint stability.

The Use of Physiotherapy among Patients with Subacromial Impingement Syndrome: Impact of Sex, Socio-Demographic and Clinical Factors

Science.gov (United States)

Christiansen, David Høyrup; Frost, Poul; Frich, Lars Henrik; Falla, Deborah; Svendsen, Susanne Wulff

2016-01-01

Background Physiotherapy with exercises is generally recommended in the treatment of patients with subacromial impingement syndrome (SIS). Objective We aimed to investigate the use of physiotherapy in patients with SIS in Danish hospital settings as part of initial non-surgical treatment and after SIS-related surgery and to evaluate to which extent sex, socio-demographic and clinical factors predict the use of physiotherapy. Methods Using national health registers, we identified 57,311 patients who had a first hospital contact with a diagnosis of ICD-10, groups M75.1–75.9, 1 July 2007 to 30 June 2011. Records of physiotherapy were extracted within 52 weeks after first contact (or until surgery), and for surgically treated patients within 26 weeks after surgery. Predictors of the use of physiotherapy after first contact and after surgery were analysed as time-to-event. Results Within 52 weeks after first contact, 43% of the patients had physiotherapy and 30% underwent surgery. Within 26 weeks after surgery, 80% had a record of physiotherapy. After first contact and after surgery, exercise was part of physiotherapy in 65% and 84% of the patients, respectively. A public hospital contact, physiotherapy before hospital contact, administrative region, female sex, a diagnosis of other or unspecified disorders (M75.8-M75.9), and surgical procedure predicted higher use of physiotherapy. Low education level predicted slightly lower use of physiotherapy after first contact, but not after surgery. Conclusion In patients with SIS in Danish hospital settings, physiotherapy was more often used after surgery than as part of initial non-surgical treatment. The use of physiotherapy was less common among men than women, whereas unequal use of physiotherapy in relation to education level was not noticeable. The use of physiotherapy with exercises in initial non-surgical treatment was relatively limited. PMID:26954692

Adaptive sports ankle prosthetics. Interview by Sarah A. Curran.

Science.gov (United States)

Lyle, David K

2012-09-01

Participating in sport at all levels is gaining a dedicated following and this is also apparent in individuals with an amputation. Currently, there is a wide variety of ankle prostheses available which attempt to provide function, control, and comfort, as well as good aesthetic appeal. Participation in sport, however, increases the demands placed upon ankle prostheses. This can compromise function and performance, and constrain the opportunities of participation in various outdoor and water sports. In acknowledging this limitation and the need to develop more versatile ankle prostheses, this article introduces the evolution of a prototype ankle prosthesis referred to as "Adaptive Sports Ankle." The ankle prosthesis, which is compatible with any foot pyramid adapter, offers the same range of motion as the normal human ankle joint and is made up of components that are chemical and corrosion resistant. These design features that are specifically created to accommodate below-the-knee amputees provide an ideal prosthesis for those wishing to lead an active lifestyle and participate in aquatic (i.e. swimming, surfing, and scuba diving), snowboarding, and equestrian activities. Although it is acknowledged that there is a need to establish research on the Adaptive Sports Ankle, its introduction to the market will enhance and expand opportunities of those individuals with a lower limb amputation to lead an active and healthy lifestyle.

2016 consensus statement of the International Ankle Consortium: prevalence, impact and long-term consequences of lateral ankle sprains.

Science.gov (United States)

Gribble, Phillip A; Bleakley, Chris M; Caulfield, Brian M; Docherty, Carrie L; Fourchet, François; Fong, Daniel Tik-Pui; Hertel, Jay; Hiller, Claire E; Kaminski, Thomas W; McKeon, Patrick O; Refshauge, Kathryn M; Verhagen, Evert A; Vicenzino, Bill T; Wikstrom, Erik A; Delahunt, Eamonn

2016-12-01

The Executive Committee of the International Ankle Consortium presents this 2016 position paper with recommendations for information implementation and continued research based on the paradigm that lateral ankle sprain (LAS), and the development of chronic ankle instability (CAI), serve as a conduit to a significant global healthcare burden. We intend our recommendations to serve as a mechanism to promote efforts to improve prevention and early management of LAS. We believe this will reduce the prevalence of CAI and associated sequelae that have led to the broader public health burdens of decreased physical activity and early onset ankle joint post-traumatic osteoarthritis. Ultimately, this can contribute to healthier lifestyles and promotion of physical activity. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Diagnostic performance of susceptibility-weighted magnetic resonance imaging for the assessment of sub-coracoacromial spurs causing subacromial impingement syndrome

Energy Technology Data Exchange (ETDEWEB)

Noerenberg, Dominik; Armbruster, Marco [Munich University Hospitals Campus Grosshadern, Department of Clinical Radiology, Munich (Germany); Bender, Yi-Na; Walter, Thula; Diederichs, Gerd; Hamm, Bernd [Charite - University Medicine Berlin, Department of Radiology, Berlin (Germany); Ebersberger, Hans U. [Heart Center Munich-Bogenhausen, Department of Cardiology and Intensive Care Medicine, Munich (Germany); Ockert, Ben [Munich University Hospitals Campus Grosshadern, Department of Trauma and Orthopedic Surgery, Shoulder and Elbow Service, Munich (Germany); Makowski, Marcus R. [Charite - University Medicine Berlin, Department of Radiology, Berlin (Germany); King' s College London, Division of Imaging Sciences and Biomedical Engineering, London (United Kingdom)

2017-03-15

To evaluate the potential of susceptibility-weighted-magnetic-resonance-imaging (SWMR) for the detection of sub-coracoacromial spurs in patients with clinically suspected subacromial impingement syndrome (SAIS), compared to standard MR-sequences and radiographs. Forty-four patients with suspected SAIS were included. All patients underwent radiography, standard MRI of the shoulder and SWMR. Radiograph-based identification of sub-coracoacromial spurs served as goldstandard. Radiographs identified twenty-three spurs in twenty-three patients. Twenty-one patients without spur formation served as reference group. Detection rate, sensitivity/specificity and interobserver-agreements were calculated. Linear regression was applied to determine the relationship between size measurements on radiographs and MRI. Detection rates for spurs on standard MRI and SWMR were 47.8 % and 91.3 % compared to radiography (p<0.001). SWMR demonstrated a sensitivity of 97.7 % (CI=0.92-1) and a specificity of 91.3 % (CI=0.788-1) for the identification of spurs. Standard MR-sequences achieved a sensitivity of 47.8 % (CI=0.185-0.775) and a specificity of 80.8 % (CI=0.642-0.978). Size measurements between SWMR and radiography showed a good correlation (R{sup 2}=0.75;p<0.0001), while overestimating lesion size (5.7±1.2 mm; 4.3±1.3 mm;p<0.0001). Interobserver-agreement for spurs was high on SWMR (R{sup 2}=0.74;p<0.0001), but low on standard MRI (R{sup 2}=0.24;p<0.0001). SWMR allows a reliable detection of sub-coracoacromial spur formation in patients with SAIS and is superior to standard MR-sequences using radiography as goldstandard. (orig.)

Diagnostic performance of susceptibility-weighted magnetic resonance imaging for the assessment of sub-coracoacromial spurs causing subacromial impingement syndrome

International Nuclear Information System (INIS)

Noerenberg, Dominik; Armbruster, Marco; Bender, Yi-Na; Walter, Thula; Diederichs, Gerd; Hamm, Bernd; Ebersberger, Hans U.; Ockert, Ben; Makowski, Marcus R.

2017-01-01

To evaluate the potential of susceptibility-weighted-magnetic-resonance-imaging (SWMR) for the detection of sub-coracoacromial spurs in patients with clinically suspected subacromial impingement syndrome (SAIS), compared to standard MR-sequences and radiographs. Forty-four patients with suspected SAIS were included. All patients underwent radiography, standard MRI of the shoulder and SWMR. Radiograph-based identification of sub-coracoacromial spurs served as goldstandard. Radiographs identified twenty-three spurs in twenty-three patients. Twenty-one patients without spur formation served as reference group. Detection rate, sensitivity/specificity and interobserver-agreements were calculated. Linear regression was applied to determine the relationship between size measurements on radiographs and MRI. Detection rates for spurs on standard MRI and SWMR were 47.8 % and 91.3 % compared to radiography (p<0.001). SWMR demonstrated a sensitivity of 97.7 % (CI=0.92-1) and a specificity of 91.3 % (CI=0.788-1) for the identification of spurs. Standard MR-sequences achieved a sensitivity of 47.8 % (CI=0.185-0.775) and a specificity of 80.8 % (CI=0.642-0.978). Size measurements between SWMR and radiography showed a good correlation (R 2 =0.75;p<0.0001), while overestimating lesion size (5.7±1.2 mm; 4.3±1.3 mm;p<0.0001). Interobserver-agreement for spurs was high on SWMR (R 2 =0.74;p<0.0001), but low on standard MRI (R 2 =0.24;p<0.0001). SWMR allows a reliable detection of sub-coracoacromial spur formation in patients with SAIS and is superior to standard MR-sequences using radiography as goldstandard. (orig.)

Managing ankle ligament sprains and tears: current opinion

Science.gov (United States)

McGovern, Ryan P; Martin, RobRoy L

2016-01-01

The purpose of this paper is to present a current review of pathoanatomical features, differential diagnosis, objective assessment, intervention, and clinical course associated with managing lateral ankle ligament sprains. Proper diagnosis and identification of affected structures should be obtained through history and objective assessment. From this information, an individualized evidence-based intervention plan can be developed to enable recovery while decreasing the risk of reinjury. An appropriate evaluation is needed not only to determine the correct diagnosis but also to allow for grading and determining the prognosis of the injury in those with an acute lateral ankle sprain. Examination should include an assessment of impairments as well as a measure of activity and participation. Evidence-based interventions for those with an acute lateral ankle sprain should include weight bearing with bracing, manual therapy, progressive therapeutic exercises, and cryotherapy. For those with chronic ankle instability (CAI), interventions should include manual therapy and a comprehensive rehabilitation program. It is essential to understand the normal clinical course for athletes who sustain a lateral ankle sprain as well as risk factors for an acute injury and CAI. Risk factors for both an acute lateral ankle sprain and CAI include not using an external support and not participating in an appropriate exercise program. Incorporating the latest evidence-based rehabilitation techniques provides the best course of treatment for athletes with an acute ankle sprain or CAI. PMID:27042147

Comparing Arc-shaped Feet and Rigid Ankles with Flat Feet and Compliant Ankles for a Dynamic Walker

DEFF Research Database (Denmark)

Kuhlemann, Ilyas; Matthias Braun, Jan; Wörgötter, Florentin

2014-01-01

In this paper we show that exchanging curved feet and rigid ankles by at feet and compliant ankles improves the range of gait parameters for a bipedal dynamic walker. The new lower legs were designed such that they t to the old set-up, allowing for a direct and quantitative comparison. The dynamic...

Ankle manual therapy for individuals with post-acute ankle sprains: description of a randomized, placebo-controlled clinical trial.

Science.gov (United States)

Davenport, Todd E; Kulig, Kornelia; Fisher, Beth E

2010-10-19

Ankle sprains are common within the general population and can result in prolonged disablement. Limited talocrural dorsiflexion range of motion (DF ROM) is a common consequence of ankle sprain. Limited talocrural DF ROM may contribute to persistent symptoms, disability, and an elevated risk for re-injury. As a result, many health care practitioners use hands-on passive procedures with the intention of improving talocrural joint DF ROM in individuals following ankle sprains. Dosage of passive hands-on procedures involves a continuum of treatment speeds. Recent evidence suggests both slow- and fast-speed treatments may be effective to address disablement following ankle sprains. However, these interventions have yet to be longitudinally compared against a placebo study condition. We developed a randomized, placebo-controlled clinical trial designed to test the hypotheses that hands-on treatment procedures administered to individuals following ankle sprains during the post-acute injury period can improve short-, intermediate-, and long-term disablement, as well as reduce the risk for re-injury. This study is designed to measure the clinical effects of hands-on passive stretching treatment procedures directed to the talocrural joint that vary in treatment speed during the post-acute injury period, compared to hands-on placebo control intervention. http://www.clinicaltrials.gov identifier NCT00888498.

Biomechanical Study about Lateral Ankle Laxity

Directory of Open Access Journals (Sweden)

Bogdan Voicu

2009-12-01

Full Text Available The objective of this paper is to study the contribution of the anterior talofibular ligament to ankle laxity at 18 cadaver ankles. For this, there was made an original, bipolar transoseus system, in a monitorized test stand Mx-500N Schmidt with a digital force gauge Imada. It was measured the motion response for applied antero-posterior force, inversion-eversion moment and internal-external rotary torque, in three positions of flexion of the ankle, with an intact anterior talofibular ligament and after it’s sectioning. The results showed a significant increases in laxity in plantar flexion for the inversion and internal rotary torque, this mechanism coresponding with common modes of injury.

Assessment and management of patients with ankle injuries.

Science.gov (United States)

Walker, Jennie

2014-08-19

Foot and ankle injuries are common and can have a significant effect on an individual's daily activities. Nurses have an important role in the assessment, management, ongoing care and support of patients with ankle injuries. An understanding of the anatomy and physiology of the ankle enables nurses to identify significant injuries, which may result in serious complications, and communicate effectively with the multidisciplinary team to improve patient care and outcomes.

An experimental study of the supersonic, dual, coaxial jets impinging on an inclined flat plate

International Nuclear Information System (INIS)

Kim, Jung Bae; Lee, Jun Hee; Woo, Sun Hoon; Kim, Heuy Dong

2002-01-01

The impinging supersonic jets have been applied for rocket launching system, thrust control, gas turbine blade cooling, etc. Recently the supersonic, dual, coaxial jets are being extensively used in many diverse fields of industrial processes since they lead to more improved performance, compared with the conventional supersonic jets impinging on an object. In the present study, experimentation is carried out to investigate the supersonic, dual, coaxial jets impinging on an inclined flat plate. A convergent-divergent nozzle with a design Mach number of 2.0 and annular sonic nozzle are used to make the dual, coaxial jet flows. The angle of the impinging flat plate is varied from 30 .deg. to 60 .deg. and the distance between the dual coaxial nozzle and flat plate is also varied. Detailed pressures on the impinging plate are measured to analyze the flow fields, which are also visualized using Schlieren optical method

[Advances on biomechanics and kinematics of sprain of ankle joint].

Science.gov (United States)

Zhao, Yong; Wang, Gang

2015-04-01

Ankle sprains are orthopedic clinical common disease, accounting for joint ligament sprain of the first place. If treatment is not timely or appropriate, the joint pain and instability maybe develop, and even bone arthritis maybe develop. The mechanism of injury of ankle joint, anatomical basis has been fully study at present, and the diagnostic problem is very clear. Along with the development of science and technology, biological modeling and three-dimensional finite element, three-dimensional motion capture system,digital technology study, electromyographic signal study were used for the basic research of sprain of ankle. Biomechanical and kinematic study of ankle sprain has received adequate attention, combined with the mechanism research of ankle sprain,and to explore the the biomechanics and kinematics research progress of the sprain of ankle joint.

Impinging jet spray formation using non-Newtonian liquids

Science.gov (United States)

Rodrigues, Neil S.

Over the past two decades there has been a heightened interest in implementing gelled propellants for rocket propulsion, especially for hypergolic bi-propellants such as monomethylhydrazine (MMH) and nitrogen tetroxide oxidizer (NTO). Due to the very high level of toxicity of hypergolic liquid rocket propellants, increasing safety is an important area of need for continued space exploration and defense operations. Gelled propellants provide an attractive solution to meeting the requirements for safety, while also potentially improving performance. A gelling agent can be added to liquid propellants exhibiting Newtonian behavior to transform the liquid into a non-Newtonian fluid with some solid-like behavior, i.e. a gel. Non-Newtonian jet impingement is very different from its Newtonian counterpart in terms of fluid flow, atomization, and combustion. This is due to the added agents changing physical properties such as the bulk rheology (viscosity) and interfacial rheology (surface tension). Spray characterization of jet impingement with Newtonian liquids has been studied extensively in existing literature. However, there is a scarcity in literature of studies that consider the spray characterization of jet impingement with gelled propellants. This is a rather critical void since a major tradeoff of utilizing gelled propellants is the difficulty with atomization due to the increased effective viscosity. However, this difficulty can be overcome by using gels that exhibit shear-thinning behavior---viscosity decreases with increasing strain rate. Shear-thinning fluids are ideal because they have the distinct advantage of only flowing easily upon pressure. Thereby, greatly reducing the amount of propellant that could be accidentally leaked during both critical functions such as liftoff or engagement in the battlefield and regular tasks like refilling propellant tanks. This experimental work seeks to help resolve the scarcity in existing literature by providing drop size

A real-time computational model for estimating kinematics of ankle ligaments.

Science.gov (United States)

Zhang, Mingming; Davies, T Claire; Zhang, Yanxin; Xie, Sheng Quan

2016-01-01

An accurate assessment of ankle ligament kinematics is crucial in understanding the injury mechanisms and can help to improve the treatment of an injured ankle, especially when used in conjunction with robot-assisted therapy. A number of computational models have been developed and validated for assessing the kinematics of ankle ligaments. However, few of them can do real-time assessment to allow for an input into robotic rehabilitation programs. An ankle computational model was proposed and validated to quantify the kinematics of ankle ligaments as the foot moves in real-time. This model consists of three bone segments with three rotational degrees of freedom (DOFs) and 12 ankle ligaments. This model uses inputs for three position variables that can be measured from sensors in many ankle robotic devices that detect postures within the foot-ankle environment and outputs the kinematics of ankle ligaments. Validation of this model in terms of ligament length and strain was conducted by comparing it with published data on cadaver anatomy and magnetic resonance imaging. The model based on ligament lengths and strains is in concurrence with those from the published studies but is sensitive to ligament attachment positions. This ankle computational model has the potential to be used in robot-assisted therapy for real-time assessment of ligament kinematics. The results provide information regarding the quantification of kinematics associated with ankle ligaments related to the disability level and can be used for optimizing the robotic training trajectory.

Development of a clinically relevant impingement test method for a mobile bearing lumbar total disc replacement.

Science.gov (United States)

Siskey, Ryan; Peck, Jonathan; Mehta, Hitesh; Kosydar, Allison; Kurtz, Steven; Hill, Genevieve

2016-09-01

Total disc arthroplasty is an alternative therapy to spinal fusion for the treatment of neck or low back pain and is hypothesized to reduce the risk of disease progression to the adjacent spinal levels. Radiographic and retrieval analyses of various total disc replacements (TDRs) have shown evidence of impingement damage. Impingement of TDRs can occur when the device reaches the limits of its functional range of motion, causing contact between peripheral regions of the device. Impingement can be associated with increased wear and mechanical damage; however, impingement conditions are not simulated in current standardized mechanical bench test methods. This study explored the test conditions necessary to apply clinically relevant impingement loading to a lumbar TDR in vitro. An experimental protocol was developed and evaluated using in vivo retrievals for qualitative and quantitative validation. Retrieval analysis was conducted on a set of 11 size 3 retrieved Charité devices using American Society for Testing and Materials F561 as a guide. The impingement range of motion was determined using a combination of modeling and experiments, and was used as an input in vitro testing. A 1-million cycle in vitro test was then conducted, and the in vitro samples were characterized using methods similar to the retreived devices. All in vitro tested samples exhibited impingement regions and damage patterns consistent with retrieved devices. Consistent with the retrievals, the impingement damage on the rim was a combination of abrasive wear and plastic deformation. Micro computed tomography (microCT) was used to quantitatively assess rim damage due to impingement. Rim penetration was statistically lower in the retrievals when compared with both in vitro groups. Rim elongation was comparable among all groups. The simulated-facet group had statistically greater angular rim deformations than the retrieval group and the no-facet group. Results demonstrate that clinically relevant

Computed tomography assessment of hip joints in asymptomatic individuals in relation to femoroacetabular impingement.

Science.gov (United States)

Kang, Alan C L; Gooding, Andrew J; Coates, Mark H; Goh, Tony D; Armour, Paul; Rietveld, John

2010-06-01

Femoroacetabular impingement has become a well-recognized entity predisposing to acetabular labral tears and chondral damage, and subsequently development of osteoarthritis of the hip joint. In the authors' experience, it is common to see bony abnormalities predisposing to femoroacetabular impingement in the contralateral asymptomatic hips in patients with unilateral femoroacetabular impingement. This study was undertaken to investigate the prevalence of bony abnormalities predisposing to femoroacetabular impingement in asymptomatic individuals without exposing study participants to unnecessary radiation. Cross-sectional study; Level of evidence, 4. Fifty individuals (100 hip joints), ranging from 15 to 40 years of age, who were seen at a local hospital between March and August 2008 with abdominal trauma or nonspecific abdominal pain in whom abdominal computed tomography was performed to aid diagnosis were prospectively studied. These patients were not known to have any history of hip-related problems. Raw data from the abdominal computed tomography scan, performed on a 64-slice multidetector computed tomography scanner, were reformatted using bone algorithm into several different planes. Several measurements and observations of the hip joints were made in relation to femoroacetabular impingement. The 100 hip joints from 50 patients with no history of hip problems demonstrated that 39% of the joints (31% of female, 48% of male joints) have at least 1 morphologic aspect predisposing to femoroacetabular impingement. The majority (66% to 100% ) of the findings were bilateral; 33% of female and 52% of male asymptomatic participants in our study had at least 1 predisposing factor for femoroacetabular impingement in 1 or both of their hip joints. Based on the data collected from this study, the acetabular crossover sign had a 71% sensitivity and 88% specificity for detecting acetabular retroversion. Nonquantitative assessment of the femoral head at the anterior

Sampling designs and methods for estimating fish-impingement losses at cooling-water intakes

International Nuclear Information System (INIS)

Murarka, I.P.; Bodeau, D.J.

1977-01-01

Several systems for estimating fish impingement at power plant cooling-water intakes are compared to determine the most statistically efficient sampling designs and methods. Compared to a simple random sampling scheme the stratified systematic random sampling scheme, the systematic random sampling scheme, and the stratified random sampling scheme yield higher efficiencies and better estimators for the parameters in two models of fish impingement as a time-series process. Mathematical results and illustrative examples of the applications of the sampling schemes to simulated and real data are given. Some sampling designs applicable to fish-impingement studies are presented in appendixes

Vascular affection in relation to oxidative DNA damage in metabolic syndrome.

Science.gov (United States)

Abd El Aziz, Rokayaa; Fawzy, Mary Wadie; Khalil, Noha; Abdel Atty, Sahar; Sabra, Zainab

2018-02-01

Obesity has become an important issue affecting both males and females. Obesity is now regarded as an independent risk factor for atherosclerosis-related diseases. Metabolic syndrome is associated with increased risk for development of cardiovascular disease. Urinary 8-oxo-7,8-dihydro-2'-deoxyguanosine concentration has been used to express oxidation status. Twenty-seven obese patients with metabolic syndrome, 25 obese patients without metabolic syndrome and 31 healthy subjects were included in our study. They were subjected to full history and clinical examination; fasting blood sugar (FBS), 2 hour post prandial blood sugar (2HPP), lipid profile, urinary 8-oxo-7,8-dihydro-2'-deoxyguanosine and carotid duplex, A/B index and tibial diameters were all assessed. There was a statistically significant difference ( p = 0.027) in diameter of the right anterior tibial artery among the studied groups, with decreased diameter of the right anterior tibial artery in obese patients with metabolic syndrome compared to those without metabolic syndrome; the ankle brachial index revealed a lower index in obese patients with metabolic syndrome compared to those without metabolic syndrome. There was a statistically insignificant difference ( p = 0.668) in the 8-oxodG in the studied groups. In obese patients with metabolic syndrome there was a positive correlation between 8-oxodG and total cholesterol and LDL. Urinary 8-oxodG is correlated to total cholesterol and LDL in obese patients with metabolic syndrome; signifying its role in the mechanism of dyslipidemia in those patients. Our study highlights the importance of anterior tibial artery diameter measurement and ankle brachial index as an early marker of atherosclerosis, and how it may be an earlier marker than carotid intima-media thickness.

Analysis of factors influencing the impingement of threadfin shad (Dorosoma pretenense) at power plants in the southeastern United States

International Nuclear Information System (INIS)

Loar, J.M.; Griffith, J.S.; Kumar, K.D.

1977-01-01

Data on intake design and location, plant operating procedures, water quality, numbers of fish impinged, and sampling procedures were analyzed for 27 fossil-fueled and 5 nuclear power plants located on inland waters in the southeastern United States. Small (less than 9 cm) clupeids, especially threadfin shad (Dorosoma pretenense), comprised the majority of the fish impinged at these facilities. The parameter that was most strongly associated with shad impingement was water temperature. Maximum impingement rates occurred during the winter when intake temperatures dropped below 10 0 C. Analyses of differences in impingement rates between plants failed to adequately demonstrate that the magnitude of impingement at a particular plant was the result of any site-specific characteristics associated with intake design or location. High approach velocities at the traveling screens did not necessarily result in high levels of impingement. Results obtained from inter-unit comparisons at several plants indicate that unit and screen differences do exist, but it is unclear from existing data whether or not such inter-unit differences determine the magnitude of impingement losses or merely affect the distribution of impinged fish at a given intake structure. Recommendations for monitoring fish impingement include the identification of impinged fish by species, collection of data on water temperatures and various plant operational parameters, periodic analyses of localized velocity regimes near the intake, and frequent estimates of the relative density of the fish population in the vicinity of the intake

Prevalence of Os Trigonum on CT Imaging

NARCIS (Netherlands)

Zwiers, Ruben; Baltes, Thomas P. A.; Opdam, Kim T. M.; Wiegerinck, Johannes I.; van Dijk, C. Niek

2017-01-01

The os trigonum is known as one of the main causes of posterior ankle impingement. In the literature, a wide variation of occurrence has been reported. All foot and/or ankle computed tomography (CT) scans made between January 2012 and December 2013 were reviewed. CT images were assessed, blinded for

What is the impingement-free range of motion of the asymptomatic hip in young adult males?

Science.gov (United States)

Larkin, Brian; van Holsbeeck, Marnix; Koueiter, Denise; Zaltz, Ira

2015-04-01

Femoroacetabular impingement is a recognized cause of chondrolabral injury. Although surgical treatment for impingement seeks to improve range of motion, there are very little normative data on dynamic impingement-free hip range of motion (ROM) in asymptomatic people. Hip ultrasound demonstrates labral anatomy and femoral morphology and, when used dynamically, can assist in measuring range of motion. The purposes of this study were (1) to measure impingement-free hip ROM until labral deflection is observed; and (2) to measure the maximum degree of sagittal plane hip flexion when further flexion is limited by structural femoroacetabular abutment. Forty asymptomatic adult male volunteers (80 hips) between the ages of 21 and 35 years underwent bilateral static and dynamic hip ultrasound examination. Femoral morphology was characterized and midsagittal flexion passive ROM was measured at two points: (1) at the initiation of labral deformation; and (2) at maximum flexion when the femur impinged on the acetabular rim. The mean age of the subjects was 28 ± 3 years and the mean body mass index was 25 ± 4 kg/m(2). Mean impingement-free hip passive flexion measured from full extension to initial labral deflection was 68° ± 17° (95% confidence interval [CI], 65-72). Mean maximum midsagittal passive flexion, measured at the time of bony impingement, was 96° ± 6° (95% CI, 95-98). Using dynamic ultrasound, we found that passive ROM in the asymptomatic hip was much less than the motion reported in previous studies. Measuring ROM using ultrasound is more accurate because it allows anatomic confirmation of terminal hip motion. Surgical procedures used to treat femoroacetabular impingement are designed to restore or increase hip ROM and their results should be evaluated in light of precise normative data. This study suggests that normal passive impingement-free femoroacetabular flexion in the young adult male is approximately 95°.

Ankle and Other Signatures in Uhecr

Science.gov (United States)

Berezinsky, Veniamin

2015-03-01

The interaction signatures of UHE protons propagating through CMB are discussed. Much attention is given to ankle, which starting from 1963 is usually interpreted as a feature of transition from galactic to extragalactic cosmic rays. We argue here that this interpretation is now excluded. It gives more credit to alternative explanation of the ankle as an intrinsic part of the pair-production dip.

[Theoretical origin and clinical application of wrist-ankle acupuncture therapy].

Science.gov (United States)

Wang, Qiong; Zhou, Qinghui

2017-05-12

The theory of wrist-ankle acupuncture is consistent with traditional meridian-collateral theory. For example, the body divisions of wrist-ankle acupuncture are corresponding to the distribution of 12 cutaneous regions of meridians, the needling sites of it are to the running courses of 12 meridians; the indications of it are to those of 12 meridians. The needling sites of wrist-ankle acupuncture are relevant with some special acupoints of acupuncture theory. For example, the 12-needling sites of wrist-ankle acupuncture are located similar to those of 12 meridian points and have very similar indications. The needling sites of it are located in the wrist and ankle regions, in which the five- shu points are located nearby, for meridian disorders. Most luo -connecting points are located near to the needling sites of wrist-ankle acupuncture or the needle tip points to. Additionally, the needling method of wrist-ankle acupuncture is consistent with some of the subcutaneous needling methods in traditional acupuncture therapy. On the basis of the aspects mentioned above, it is explained that wrist-ankle acupuncture is the development of traditional acupuncture and cannot be independent from the traditional theories of acupuncture and meridians. It is necessary to seek for the evidence from the traditional theories of TCM. The traditional theories of TCM are summarized from clinical practice, which can be newly verified from the practice of wrist-ankle acupuncture.

Relationship between stress ankle radiographs and injured ligaments on MRI

International Nuclear Information System (INIS)

Lee, Kyoung Min; Chung, Chin Youb; Chung, Myung Ki; Won, Sung Hun; Lee, Seung Yeol; Park, Moon Seok; Kwon, Soon-Sun

2013-01-01

This study was performed to investigate the relationship between the injured lateral ankle ligaments on MRI and stress ankle radiographs. Two hundred and twenty-nine consecutive patients (mean age 35.5 years, SD 14.6 years; 136 males and 93 females) that underwent ankle stress radiographs and MRI for lateral ankle instability were included. Tibiotalar tilt angle and anterior translation of talus were measured on stress ankle radiographs. Degree of lateral ligaments (anterior talofibular, calcaneofibular, and posterior talofibular) and deltoid ligament injuries were evaluated and scored as intact (0), partial injury (1), and complete injury (2) on MR images. Effusion of ankle joint was also recorded. The effects of gender, age, injuries of ligaments, and ankle joint effusion on stress radiographs were statistically analyzed. Gender (p = 0.010), age (p = 0.020), and anterior talofibular ligament (ATFL) injury (p < 0.001) were the factors significantly affecting tibiotalar tilt angle. Posterior talofibular ligament (PTFL) injury (p = 0.014) was found to be the only significant factor affecting the anterior translation on the anterior drawer radiographs. ATFL injury and PTFL injury on MRI significantly affected tibiotalar tilt angle and anterior drawer on stress radiographs. Other factors, such as age and gender, need to be considered in evaluating radiographic lateral ankle instability. (orig.)

Recycling energy to restore impaired ankle function during human walking.

Directory of Open Access Journals (Sweden)

Steven H Collins

Full Text Available BACKGROUND: Humans normally dissipate significant energy during walking, largely at the transitions between steps. The ankle then acts to restore energy during push-off, which may be the reason that ankle impairment nearly always leads to poorer walking economy. The replacement of lost energy is necessary for steady gait, in which mechanical energy is constant on average, external dissipation is negligible, and no net work is performed over a stride. However, dissipation and replacement by muscles might not be necessary if energy were instead captured and reused by an assistive device. METHODOLOGY/PRINCIPAL FINDINGS: We developed a microprocessor-controlled artificial foot that captures some of the energy that is normally dissipated by the leg and "recycles" it as positive ankle work. In tests on subjects walking with an artificially-impaired ankle, a conventional prosthesis reduced ankle push-off work and increased net metabolic energy expenditure by 23% compared to normal walking. Energy recycling restored ankle push-off to normal and reduced the net metabolic energy penalty to 14%. CONCLUSIONS/SIGNIFICANCE: These results suggest that reduced ankle push-off contributes to the increased metabolic energy expenditure accompanying ankle impairments, and demonstrate that energy recycling can be used to reduce such cost.

Experimental observations and modelling of thermal history within a steel plate during water jet impingement

International Nuclear Information System (INIS)

Liu, Z.D.; Fraser, D.; Samarasekera, I.V.; Lockhart, G.T.

2002-01-01

In order to investigate heat transfer of steel plates under a water jet impingement and to further simulate runout table operation in a hot strip mill, a full-scale pilot runout table facility was designed and constructed at the University of British Columbia (UBC). This paper describes the experimental details, data acquisition and data handling techniques for steel plates during water jet impingement by one circular water jet from an industrial header. Recorded visual observations at the impinging surface were obtained. The effects of cooling water temperature and impingement velocity on the heat transfer from a steel plate were studied. A two-dimensional finite element method-based transient inverse heat conduction model was developed. With the help of the model, heat fluxes and heat transfer coefficients along the impinging surface under various cooling conditions were calculated. The microstructural evolution of the steel plate was also investigated for the varying cooling conditions. Samples were obtained from each plate, polished, etched and then photographed. (author)

The implementation effectiveness of the 'Strengthen your ankle' smartphone application for the prevention of ankle sprains: design of a randomized controlled trial.

Science.gov (United States)

Van Reijen, Miriam; Vriend, Ingrid I; Zuidema, Victor; van Mechelen, Willem; Verhagen, Evert A

2014-01-07

Ankle sprains continue to pose a significant burden to the individual athlete, as well as to society as a whole. However, despite ankle sprains being the single most common sports injury and despite an active approach by various Dutch organisations in implementing preventive measures, large-scale community uptake of these preventive measures, and thus actual prevention of ankle sprains, is lagging well behind. In an attempt to bridge this implementation gap, the Dutch Consumer Safety Institute VeiligheidNL developed a freely available interactive App ('Strenghten your ankle' translated in Dutch as: 'Versterk je enkel; available for iOS and Android) that contains - next to general advice on bracing and taping - a proven cost-effective neuromuscular program. The 'Strengthen your ankle' App has not been evaluated against the 'regular' prevention approach in which the neuromuscular program is advocated through written material. The aim of the current project is to evaluate the implementation value of the 'Strengthen your ankle' App as compared to the usual practice of providing injured athletes with written materials. In addition, as a secondary outcome measure, the cost-effectiveness will be assessed against usual practice. The proposed study will be a randomised controlled trial. After stratification for medical caregiver, athletes will be randomised to two study groups. One group will receive a standardized eight-week proprioceptive training program that has proven to be cost-effective to prevent recurrent ankle injuries, consisting of a balance board (machU/ MSG Europe BVBA), and a traditional instructional booklet. The other group will receive the same exercise program and balance board. However, for this group the instructional booklet is exchanged by the interactive 'Strengthen your ankle' App. This trial is the first randomized controlled trial to study the implementation effectiveness of an App for proprioceptive balance board training program in comparison to

Minimal clinically important difference and the effect of clinical variables on the ankle osteoarthritis scale in surgically treated end-stage ankle arthritis.

Science.gov (United States)

Coe, Marcus P; Sutherland, Jason M; Penner, Murray J; Younger, Alastair; Wing, Kevin J

2015-05-20

There is much debate regarding the best outcome tool for use in foot and ankle surgery, specifically in patients with ankle arthritis. The Ankle Osteoarthritis Scale (AOS) is a validated, disease-specific score. The goals of this study were to investigate the clinical performance of the AOS and to determine a minimal clinically important difference (MCID) for it, using a large cohort of 238 patients undergoing surgery for end-stage ankle arthritis. Patients treated with total ankle arthroplasty or ankle arthrodesis were prospectively followed for a minimum of two years at a single site. Data on demographics, comorbidities, AOS score, Short Form-36 results, and the relationship between expectations and satisfaction were collected at baseline (preoperatively), at six and twelve months, and then yearly thereafter. A linear regression analysis examined the variables affecting the change in AOS scores between baseline and the two-year follow-up. An MCID in the AOS change score was then determined by employing an anchor question, which asked patients to rate their relief from symptoms after surgery. Surgical treatment of end-stage ankle arthritis resulted in a mean improvement (and standard deviation) of 31.2 ± 22.7 points in the AOS score two years after surgery. The MCID of the AOS change score was a mean of 28.0 ± 17.9 points. The change in AOS score was significantly affected by the preoperative AOS score, smoking, back pain, and age. Patients undergoing arthroplasty or arthrodesis for end-stage ankle arthritis experienced a mean improvement in AOS score that was greater than the estimated MCID (31.2 versus 28.0 points). Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

Direct measurement of the intrinsic ankle stiffness during standing.

Science.gov (United States)

Vlutters, M; Boonstra, T A; Schouten, A C; van der Kooij, H

2015-05-01

Ankle stiffness contributes to standing balance, counteracting the destabilizing effect of gravity. The ankle stiffness together with the compliance between the foot and the support surface make up the ankle-foot stiffness, which is relevant to quiet standing. The contribution of the intrinsic ankle-foot stiffness to balance, and the ankle-foot stiffness amplitude dependency remain a topic of debate in the literature. We therefore developed an experimental protocol to directly measure the bilateral intrinsic ankle-foot stiffness during standing balance, and determine its amplitude dependency. By applying fast (40 ms) ramp-and-hold support surface rotations (0.005-0.08 rad) during standing, reflexive contributions could be excluded, and the amplitude dependency of the intrinsic ankle-foot stiffness was investigated. Results showed that reflexive activity could not have biased the torque used for estimating the intrinsic stiffness. Furthermore, subjects required less recovery action to restore balance after bilateral rotations in opposite directions compared to rotations in the same direction. The intrinsic ankle-foot stiffness appears insufficient to ensure balance, ranging from 0.93±0.09 to 0.44±0.06 (normalized to critical stiffness 'mgh'). This implies that changes in muscle activation are required to maintain balance. The non-linear stiffness decrease with increasing rotation amplitude supports the previous published research. With the proposed method reflexive effects can be ruled out from the measured torque without any model assumptions, allowing direct estimation of intrinsic stiffness during standing. Copyright © 2015 Elsevier Ltd. All rights reserved.

Orthopaedic management of haemophilia arthropathy of the ankle.

Science.gov (United States)

Pasta, G; Forsyth, A; Merchan, C R; Mortazavi, S M J; Silva, M; Mulder, K; Mancuso, E; Perfetto, O; Heim, M; Caviglia, H; Solimeno, L

2008-07-01

Joint bleeding, or haemarthrosis, is the most common type of bleeding episode experienced by individuals with haemophilia A and B. This leads to changes within the joints, including synovial proliferation, which results in further bleeding and chronic synovitis. Blood in the joint can also directly damage the cartilage, and with repeated bleeding, there is progressive destruction of both cartilage and bone. The end result is known as haemophilic arthropathy. The joints most commonly affected are the knees, elbows and ankles, although any synovial joint may be involved. In the ankle, both the tibiotalar and subtalar joints may be affected and joint bleeding and arthropathy can lead to a number of deformities. Haemophilic arthropathy can be prevented through regular factor replacement prophylaxis and implementing physiotherapy. However, when necessary, there are multiple surgical and non-surgical options available. In early ankle arthropathy with absent or minimal joint changes, both radioisotopic and chemical synoviorthesis can be used to reduce the hypertrophied synovium. These procedures can decrease the frequency of bleeding episodes, minimizing the risk of articular cartilage damage. Achilles tendon lengthening can be performed, in isolation or in combination with other surgical measures, to correct Achilles tendon contractures. Both arthroscopic and open synovectomies are available as a means to remove the friable villous layer of the synovium and are often indicated when bleeding episodes cannot be properly controlled by factor replacement therapy or synoviorthesis. In the later stages of ankle arthropathy, other surgical options may be considered. Debridement may be indicated when there are loose pieces of cartilage or anterior osteophytes, and can help to improve the joint function, even in the presence of articular cartilage damage. Supramalleolar tibial osteotomy may be indicated in patients with a valgus deformity of the hindfoot without degenerative

Spray Formation of Herschel-Bulkley Fluids using Impinging Jets

Science.gov (United States)

Rodrigues, Neil; Gao, Jian; Chen, Jun; Sojka, Paul E.

2015-11-01

The impinging jet spray formation of two non-Newtonian, shear-thinning, Herschel-Bulkley fluids was investigated in this work. The water-based gelled solutions used were 1.0 wt.-% agar and 1.0 wt.-% kappa carrageenan. A rotational rheometer and a capillary viscometer were used to measure the strain-rate dependency of viscosity and the Herschel-Bulkley Extended (HBE) rheological model was used to characterize the shear-thinning behavior. A generalized HBE jet Reynolds number Rej , gen - HBE was used as the primary parameter to characterize the spray formation. A like-on-like impinging jet doublet was used to produce atomization. Shadowgraphs were captured in the plane of the sheet formed by the two jets using a CCD camera with an Nd:YAG laser beam providing the back-illumination. Typical behavior for impinging jet atomization using Newtonian liquids was not generally observed due to the non-Newtonian, viscous properties of the agar and kappa carrageenan gels. Instead various spray patterns were observed depending on Rej , gen - HBE. Spray characteristics of maximum instability wavelength and sheet breakup length were extracted from the shadowgraphs. Multi-University Research Initiative Grant Number W911NF-08-1-0171.

Ankle manual therapy for individuals with post-acute ankle sprains: description of a randomized, placebo-controlled clinical trial

Directory of Open Access Journals (Sweden)

Fisher Beth E

2010-10-01

Full Text Available Abstract Background Ankle sprains are common within the general population and can result in prolonged disablement. Limited talocrural dorsiflexion range of motion (DF ROM is a common consequence of ankle sprain. Limited talocrural DF ROM may contribute to persistent symptoms, disability, and an elevated risk for re-injury. As a result, many health care practitioners use hands-on passive procedures with the intention of improving talocrural joint DF ROM in individuals following ankle sprains. Dosage of passive hands-on procedures involves a continuum of treatment speeds. Recent evidence suggests both slow- and fast-speed treatments may be effective to address disablement following ankle sprains. However, these interventions have yet to be longitudinally compared against a placebo study condition. Methods/Design We developed a randomized, placebo-controlled clinical trial designed to test the hypotheses that hands-on treatment procedures administered to individuals following ankle sprains during the post-acute injury period can improve short-, intermediate-, and long-term disablement, as well as reduce the risk for re-injury. Discussion This study is designed to measure the clinical effects of hands-on passive stretching treatment procedures directed to the talocrural joint that vary in treatment speed during the post-acute injury period, compared to hands-on placebo control intervention. Trial Registration http://www.clinicaltrials.gov identifier NCT00888498.

Os peroneum friction syndrome complicated by sesamoid fatigue fracture: a new radiological diagnosis? Case report and literature review

Energy Technology Data Exchange (ETDEWEB)

Bashir, Waseem A.; Connell, David A. [Royal National Orthopaedic Hospital NHS Trust, Department of Radiology, London, Middlesex (United Kingdom); Lewis, Steve [Craven Cottage, Fulham Football Club, London (United Kingdom); Cullen, Nicholas [The Royal National Orthopaedic Hospital NHS Trust, Department of Orthopaedics, London, Middlesex (United Kingdom)

2009-02-15

Injuries to the peroneal tendons are relatively common worldwide but tendon rupture without significant trauma is uncommon. Ankle mechanics can be seriously affected by disruption of one or both of the peroneal tendons although complete rupture can also remain asymptomatic. Accessory ossicles are sesamoid bones and are common findings in routine radiology of the foot and ankle. Although in the vast majority these ''os'' are normal variants of anatomy, they can lead to painful syndromes and suffer fractures and even undergo degenerative changes in response to overuse and trauma. Although similar syndromes have been discussed in the surgical literature, there is a lack of literature describing the use of modern imaging in the accurate diagnosis and its subsequent assistance towards appropriate management of os peroneum friction syndrome complicated by sesamoid fatigue syndrome. This article presents the plain film, sonographic and magnetic resonance imaging findings in a case of os peroneum friction syndrome complicated by a sesamoid fatigue fracture as well as reviewing the pertinent literature. (orig.)

Benign and malignant tumors of the foot and ankle

Energy Technology Data Exchange (ETDEWEB)

Singer, Adam D.; Datir, Abhijit; Langley, Travis [Emory University Hospital, Department of Radiology, Section of Musculoskeletal Imaging, Atlanta, GA (United States); Tresley, Jonathan [University of Wisconsin, Department of Radiology, Madison, WI (United States); Clifford, Paul D.; Jose, Jean; Subhawong, Ty K. [University of Miami, Department of Radiology, Miami, FL (United States)

2016-03-15

Pain and focal masses in the foot and ankle are frequently encountered and often initiate a workup including imaging. It is important to differentiate benign lesions from aggressive benign or malignant lesions. In this review, multiple examples of osseous and soft tissue tumors of the foot and ankle will be presented. Additionally, the compartmental anatomy of the foot and ankle will be discussed in terms of its relevance for percutaneous biopsy planning and eventual surgery. Finally, a general overview of the surgical management of benign, benign aggressive and malignant tumors of the foot and ankle will be discussed. (orig.)

Hip kinematics and kinetics in persons with and without cam femoroacetabular impingement during a deep squat task.

Science.gov (United States)

Bagwell, Jennifer J; Snibbe, Jason; Gerhardt, Michael; Powers, Christopher M

2016-01-01

Previous studies have indicated that hip and pelvis kinematics may be altered during functional tasks in persons with femoroacetabular impingement. The purpose of this study was to compare hip and pelvis kinematics and kinetics during a deep squat task between persons with cam femoroacetabular impingement and pain-free controls. Fifteen persons with cam femoroacetabular impingement and 15 persons without cam femoroacetabular impingement performed a deep squat task. Peak hip flexion, abduction, and internal rotation, and mean hip extensor, adductor, and external rotator moments were quantified. Independent t-tests (αsquat descent compared to the control group, resulting in a more anteriorly tilted pelvis at the time peak hip flexion (12.5° (SD 17.1°) vs. 23.0° (SD 12.4°); P=0.024). The decreased hip internal rotation observed in persons with cam femoroacetabular impingement may be the result of bony impingement. Furthermore, the decrease in posterior pelvis tilt may contribute to impingement by further approximating the femoral head-neck junction with the acetabulum. Additionally, decreased hip extensor moments suggest that diminished hip extensor muscle activity may contribute to decreased posterior pelvis tilt. Copyright © 2015 Elsevier Ltd. All rights reserved.

Role of coherent structures in supersonic impinging jetsa)

Science.gov (United States)

Kumar, Rajan; Wiley, Alex; Venkatakrishnan, L.; Alvi, Farrukh

2013-07-01

This paper describes the results of a study examining the flow field and acoustic characteristics of a Mach 1.5 ideally expanded supersonic jet impinging on a flat surface and its control using steady microjets. Emphasis is placed on two conditions of nozzle to plate distances (h/d), of which one corresponds to where the microjet based active flow control is very effective in reducing flow unsteadiness and near-field acoustics and the other has minimal effectiveness. Measurements include unsteady pressures, nearfield acoustics using microphone and particle image velocimetry. The nearfield noise and unsteady pressure spectra at both h/d show discrete high amplitude impinging tones, which in one case (h/d = 4) are significantly reduced with control but in the other case (h/d = 4.5) remain unaffected. The particle image velocimetry measurements, both time-averaged and phase-averaged, were used to better understand the basic characteristics of the impinging jet flow field especially the role of coherent vortical structures in the noise generation and control. The results show that the flow field corresponding to the case of least control effectiveness comprise well defined, coherent, and symmetrical vortical structures and may require higher levels of microjet pressure supply for noise suppression when compared to the flow field more responsive to control (h/d = 4) which shows less organized, competing (symmetrical and helical) instabilities.

Return to sports after ankle fractures: a systematic review.

Science.gov (United States)

Del Buono, Angelo; Smith, Rebecca; Coco, Manuela; Woolley, Laurence; Denaro, Vincenzo; Maffulli, Nicola

2013-01-01

This review aims to provide information on the time athletes will take to resume sports activity following ankle fractures. We systematically searched Medline (PubMED), EMBASE, CINHAL, Cochrane, Sports Discus and Google scholar databases using the combined keywords 'ankle fractures', 'ankle injuries', 'athletes', 'sports', 'return to sport', 'recovery', 'operative fixation', 'pinning', 'return to activity' to identify articles published in English, Spanish, French, Portuguese and Italian. Seven retrospective studies fulfilled our inclusion criteria. Of the 793 patients, 469 (59%) were males and 324 (41%) were females, and of the 356 ankle fractures we obtained information on, 338 were acute and 18 stress fractures. The general principles were to undertake open reduction and internal fixation of acute fractures, and manage stress fractures conservatively unless a thin fracture line was visible on radiographs. The best timing to return to sports after an acute ankle fracture is still undefined, given the heterogeneity of the outcome measures and results. The time to return to sports after an acute stress injury ranged from 3 to 51 weeks. When facing athletes with ankle fractures, associated injuries have to be assessed and addressed to improve current treatment lines and satisfy future expectancies. The best timing to return to sports after an ankle fracture has not been established yet. The ideas of the return to activity parameter and surgeon databases including sports-related information could induce research to progress.

Internal- and External-Rotation Peak Toque in Little League Baseball Players With Subacromial Impingement Syndrome: Improved by Closed Kinetic Chain Shoulder Training.

Science.gov (United States)

Lee, Dong-Rour; Kim, Laurentius Jongsoon

2016-08-01

Many studies have explored closed kinetic chain (CKC) shoulder exercises (SEs) with a sling because they are safer and more effective than open-chain exercises, especially in early stages of treatment. However, the application of CKC SE in youth baseball players has rarely been attempted, although teenage baseball players also experience shoulder pain. To investigate the effects of CKC SE on the peak torque of shoulder internal rotation (IR) and external rotation (ER) in youth baseball players. Single-group pretest, posttest. Biomechanics laboratory. 23 Little League Baseball players with subacromial impingement syndrome. The CKC SE with a sling was CKC shoulder-flexion exercise, extension exercise, IR exercise, and ER exercise. This exercise regimen was conducted 2 or 3 times/wk for 8 wk. The peak torque of shoulder IR and ER was measured using an isokinetic dynamometer. Concentric shoulder rotation was performed, with 5 repetitions at an angular velocity of 60°/s and 15 at 180°/s. The IR and ER peak torque significantly increased at each angular velocity after the exercise program. In particular, the increase in IR and ER peak torque values was statistically significant at an angular velocity of 180°/s. CKC SE was effective in increasing shoulder IR and ER strength, demonstrating its potential benefits in the prevention and treatment of shoulder injury. In addition, increased IR peak torque appears to improve throwing velocity in baseball players.

Experimental and numerical investigation of liquid jet impingement on superhydrophobic and hydrophobic convex surfaces

International Nuclear Information System (INIS)

Kibar, Ali

2017-01-01

Experiments and numerical simulations were carried out to examine the vertical impingement a round liquid jet on the edges of horizontal convex surfaces that were either superhydrophobic or hydrophobic. The experiments examine the effects on the flow behaviour of curvature, wettability, inertia of the jet, and the impingement rate. Three copper pipes with outer diameters of 15, 22, and 35 mm were investigated. The pipes were wrapped with a piece of a Brassica oleracea leaf or a smooth Teflon sheet, which have apparent contact angles of 160° and 113°. The Reynolds number ranged from 1000 to 4500, and the impingement rates of the liquid jets were varied. Numerical results show good agreement with the experimental results for explaining flow and provide detailed information about the impingement on the surfaces. The liquid jet reflected off the superhydrophobic surfaces for all conditions. However, the jet reflected or deflected off the hydrophobic surface, depending on the inertia of the jet, the curvature of the surface, and the impingement rate. The results suggest that pressure is not the main reason for the bending of the jet around the curved hydrophobic surface. (paper)

Experimental and numerical investigation of liquid jet impingement on superhydrophobic and hydrophobic convex surfaces

Energy Technology Data Exchange (ETDEWEB)

Kibar, Ali, E-mail: alikibar@kocaeli.edu.tr [Department of Mechanical and Material Technologies, Kocaeli University, Arslanbey Campus, 41285, Kocaeli (Turkey)

2017-02-15

Experiments and numerical simulations were carried out to examine the vertical impingement a round liquid jet on the edges of horizontal convex surfaces that were either superhydrophobic or hydrophobic. The experiments examine the effects on the flow behaviour of curvature, wettability, inertia of the jet, and the impingement rate. Three copper pipes with outer diameters of 15, 22, and 35 mm were investigated. The pipes were wrapped with a piece of a Brassica oleracea leaf or a smooth Teflon sheet, which have apparent contact angles of 160° and 113°. The Reynolds number ranged from 1000 to 4500, and the impingement rates of the liquid jets were varied. Numerical results show good agreement with the experimental results for explaining flow and provide detailed information about the impingement on the surfaces. The liquid jet reflected off the superhydrophobic surfaces for all conditions. However, the jet reflected or deflected off the hydrophobic surface, depending on the inertia of the jet, the curvature of the surface, and the impingement rate. The results suggest that pressure is not the main reason for the bending of the jet around the curved hydrophobic surface. (paper)

The Relationship Between Pulsatile Flow Impingement and Intraluminal Thrombus Deposition in Abdominal Aortic Aneurysms.

Science.gov (United States)

Lozowy, Richard J; Kuhn, David C S; Ducas, Annie A; Boyd, April J

2017-03-01

Direct numerical simulations were performed on four patient-specific abdominal aortic aneurysm (AAA) geometries and the resulting pulsatile blood flow dynamics were compared to aneurysm shape and correlated with intraluminal thrombus (ILT) deposition. For three of the cases, turbulent vortex structures impinged/sheared along the anterior wall and along the posterior wall a zone of recirculating blood formed. Within the impingement region the AAA wall was devoid of ILT and remote to this region there was an accumulation of ILT. The high wall shear stress (WSS) caused by the impact of vortexes is thought to prevent the attachment of ILT. WSS from impingement is comparable to peak-systolic WSS in a normal-sized aorta and therefore may not damage the wall. Expansion occurred to a greater extent in the direction of jet impingement and the wall-normal force from the continuous impact of vortexes may contribute to expansion. It was shown that the impingement region has low oscillatory shear index (OSI) and recirculation zones can have either low or high OSI. No correlation could be identified between OSI and ILT deposition since different flow dynamics can have similar OSI values.

Effects of focal ankle joint cooling on unipedal static balance in individuals with and without chronic ankle instability.

Science.gov (United States)

Kim, Kyung-Min; Hart, Joseph M; Saliba, Susan A; Hertel, Jay

2015-01-01

Application of cryotherapy over an injured joint has been shown to improve muscle function, yet it is unknown how ankle cryotherapy affects postural control. Our purpose was to determine the effects of a 20-min focal ankle joint cooling on unipedal static stance in individuals with and without chronic ankle instability (CAI). Fifteen young subjects with CAI (9 males, 6 females) and 15 healthy gender-matched controls participated. All subjects underwent two intervention sessions on different days in which they had a 1.5L plastic bag filled with either crushed ice (active treatment) or candy corn (sham) applied to the ankle. Unipedal stance with eyes closed for 10s were assessed with a forceplate before and after each intervention. Center of pressure (COP) data were used to compute 10 specific dependent measures including velocity, area, standard deviation (SD), and percent range of COP excursions, and mean and SD of time-to-boundary (TTB) minima in the anterior-posterior (AP) and mediolateral directions. For each measure a three-way (Group-Intervention-Time) repeated ANOVAs found no significant interactions and main effects involving intervention (all Ps > 0.05). There were group main effects found for mean velocity (F(1,28) = 6.46, P = .017), area (F(1,28) = 12.83, P = .001), and mean of TTB minima in the AP direction (F(1,28) = 5.19, P = .031) indicating that the CAI group demonstrated greater postural instability compared to the healthy group. Postural control of unipedal stance was not significantly altered following focal ankle joint cooling in groups both with and without CAI. Ankle joint cryotherapy was neither beneficial nor harmful to single leg balance. Copyright © 2014 Elsevier B.V. All rights reserved.

A novel tool for measuring ankle dorsiflexion

DEFF Research Database (Denmark)

Larsen, Peter; B Nielsen, Henrik; Lund, Christoffer

2016-01-01

correlation coefficients (ICC). RESULTS: The study sample consisted of 24 patients: fifteen females and nine males post-immobilisation following surgery for ankle fractures. The mean age was 51.0 years, ranging from 22–92 years. All patients had sustained an AO classification 44- fracture of the ankle...

Common Types and Countermeasures of Ankle Ligament Injury ...

African Journals Online (AJOL)

2017-09-14

Sep 14, 2017 ... Objective: To analyze ankle ligament injury of basketball players caused during movement, summarize ... players with ankle ligament injury during basketball movement and admitted to different .... Road Success 2010;8:70. 5.

Delayed latency of peroneal reflex to sudden inversion with ankle taping or bracing.

Science.gov (United States)

Shima, N; Maeda, A; Hirohashi, K

2005-01-01

The purpose of the present study was to examine the effects of ankle taping and bracing based on the peroneal reflex in the hypermobile and normal ankle joints with and without history of ankle injury. Thirty-six ankle joints of 18 collegiate American football athletes with and without previous history of injury were studied. The angle of talar tilt (TT) was measured by stress radiograph for classifying normal (TT5 degrees ) ankles. They were tested with taping, bracing, and without any supports as a control. The latency of peroneus longus muscle was measured by a sudden inversion of 25 degrees using surface EMG signals. The results of the present study show no significant three-way Group (hypermobile or normal ankles) by History (previously injured or uninjured ankles) by Condition (control, taping, or bracing) interaction, while Condition main effect was significant (p0.05). In conclusion, ankle taping and bracing delayed the peroneal reflex latency not only for hypermobile ankles and/or injured ankle joints but also for intact ankle joints.

Surgery for subacromial impingement syndrome in relation to intensities of occupational mechanical exposures across 10-year exposure time windows.

Science.gov (United States)

Dalbøge, Annett; Frost, Poul; Andersen, Johan Hviid; Svendsen, Susanne Wulff

2018-03-01

We aimed to identify intensities of occupational mechanical exposures (force, arm elevation and repetition) that do not entail an increased risk of surgery for subacromial impingement syndrome (SIS) even after prolonged durations of exposure. Additionally, we wanted to evaluate if exposure to hand-arm vibration (HAV) is an independent risk factor. We used data from a register-based cohort study of the entire Danish working population (n=2 374 403). During follow-up (2003-2008), 14 118 first-time events of surgery for SIS occurred. For each person, we linked register-based occupational codes (1993-2007) to a general population job exposure matrix to obtain year-by-year exposure intensities on measurement scales for force, upper arm elevation >90° and repetition and expert rated intensities of exposure to HAV. For 10-year exposure time windows, we calculated the duration of exposure at specific intensities above minimal (low, medium and high). We used a logistic regression technique equivalent to discrete survival analysis adjusting for cumulative effects of other mechanical exposures. We found indications of safe exposure intensities for repetition (median angular velocity 90° >2 min/day implied an increased risk reaching ORs of 1.7 and 1.5 after 10 years at low intensities. No associations were found for HAV. We found indications of safe exposure intensities for repetition. Any intensities of force and upper arm elevation >90° above minimal implied an increased risk across 10-year exposure time windows. No independent associations were found for HAV. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Hot air impingement on a flat plate using Large Eddy Simulation (LES) technique

Science.gov (United States)

Plengsa-ard, C.; Kaewbumrung, M.

2018-01-01

Impinging hot gas jets to a flat plate generate very high heat transfer coefficients in the impingement zone. The magnitude of heat transfer prediction near the stagnation point is important and accurate heat flux distribution are needed. This research studies on heat transfer and flow field resulting from a single hot air impinging wall. The simulation is carried out using computational fluid dynamics (CFD) commercial code FLUENT. Large Eddy Simulation (LES) approach with a subgrid-scale Smagorinsky-Lilly model is present. The classical Werner-Wengle wall model is used to compute the predicted results of velocity and temperature near walls. The Smagorinsky constant in the turbulence model is set to 0.1 and is kept constant throughout the investigation. The hot gas jet impingement on the flat plate with a constant surface temperature is chosen to validate the predicted heat flux results with experimental data. The jet Reynolds number is equal to 20,000 and a fixed jet-to-plate spacing of H/D = 2.0. Nusselt number on the impingement surface is calculated. As predicted by the wall model, the instantaneous computed Nusselt number agree fairly well with experimental data. The largest values of calculated Nusselt number are near the stagnation point and decrease monotonically in the wall jet region. Also, the contour plots of instantaneous values of wall heat flux on a flat plate are captured by LES simulation.

The correlation of the morphological changes of ankle point and ankle joint function after surgery on the Ruedi-Allgouer type III Pilon fracture: A case series study.

Science.gov (United States)

Zhou, Yifei; Cai, Leyi; Lu, Xiaolang; Yu, Yang; Hong, Jianjun

2017-08-01

To analyze the relationship between imaging findings and postoperative curative effect by measuring the morphology of the ankle mortise in patients with the Ruedi-Allgouer type III Pilon fractures. Forty-seven patients with Ruedi-Allgouer type III Pilon fractures who underwent surgical treatment from January 2011 to January 2015 were retrospectively analyzed. At the last follow-up, x-rays of the affected ankle and the healthy side were measured. According to the Kitaoka score of ankle joint function at the last follow-up. All patients were followed up for 18-24 months (mean 21 months). This study demonstrated that compared with the healthy side, the index of the width, depth, and coronal/sagittal angles of the ankle mortise were significantly different (P  0.05). According to the Kitaoka score, the difference between the affected and the healthy sides of each index of the ankle mortise was compared between the 3 groups. That is, the intraoperative treatment of the width and depth of the ankle mortise as well as the coronal and sagittal angles of the ankle mortise were significantly correlated with the postoperative curative effect. The intraoperative treatment of ankle mortise width, depth, and ankle coronal/sagittal angle in patients with severe Pilon fractures has a significant impact on postoperative efficacy. In order to prevent the occurrence of traumatic arthritis, the anatomical morphology of the ankle should be restored as much as possible in the course of surgery. Copyright © 2017. Published by Elsevier Ltd.