Trunk, Pelvis, Hip, and Knee Kinematics, Hip Strength, and Gluteal Muscle Activation During a Single-Leg Squat in Males and Females With and Without Patellofemoral Pain Syndrome

STUDY DESIGN: Controlled laboratory study using a cross-sectional design. OBJECTIVES: To determine whether there are any differences between the sexes in trunk, pelvis, hip, and knee kinematics, hip strength, and gluteal muscle activation during the performance of a single-leg squat in individuals with patellofemoral pain syndrome (PFPS) and control participants. BACKGROUND: Though there is a greater incidence of PFPS in females, PFPS is also quite common in males. Trunk kinematics may affect hip and knee function; however, there is a lack of studies of the influence of the trunk in individuals with PFPS. METHODS: Eighty subjects were distributed into 4 groups: females with PFPS, female controls, males with PFPS, and male controls. Trunk, pelvis, hip, and knee kinematics and gluteal muscle activation were evaluated during a single-leg squat. Hip abduction and external rotation eccentric strength was measured on an isokinetic dynamometer. Group differences were assessed using a 2-way multivariate analysis of variance (sex by PFPS status). RESULTS: Compared to controls, subjects with PFPS had greater ipsilateral trunk lean (mean +/- SD, 9.3 degrees +/- 5.30 degrees versus 6.7 degrees +/- 3.0 degrees; P = .012), contralateral pelvic drop (10.3 degrees +/- 4.7 degrees versus 7.4 degrees 3.8 degrees; P = .003), hip adduction (14.8 degrees +/- 7.8 degrees versus 10.8 degrees +/- 5.6 degrees; P<.0001), and knee abduction (9.2 degrees +/- 5.0 degrees versus 5.8 degrees +/- 3.4 degrees; P<.0001) when performing a single-leg squat. Subjects with PFPS also had 18% less hip abduction and 17% less hip external rotation strength. Compared to female controls, females with PFPS had more hip internal rotation (P<.05) and less muscle activation of the gluteus medius (P = .017) during the single-leg squat. CONCLUSION: Despite many similarities in findings for males and females with PFPS, there may be specific sex differences that warrant consideration in future studies and when clinically evaluating and treating females with PFPS. J Orthop Sports Phys Ther 2012;42(6):491-501, Epub 8 March 2012. doi:10.2519/jospt.2012.3987

Fidélité et validité de la mesure clinique du déjettement du tronc auprès d’enfants et d’adolescents présentant une scoliose idiopathique

La mesure du déjettement du tronc est un élément important pour évaluer la posture en ce qui a trait à la scoliose idiopathique. Cependant, il y a peu d'informations quant à sa mesure et les associations entre le déjettement du tronc et d'autres indicateurs ou facteurs pertinents. Les objectifs de cette étude sont : 1) d’évaluer la validité et la fiabilité de test-retest du fil à plomb pour mesurer le déjettement du tronc de C7 à S1 chez les personnes atteintes de scoliose idiopathique; et 2) d'étudier l'association entre le déjettement du tronc et les facteurs suivants : la douleur, l’angle de Cobb, le type de scoliose, la santé mentale et l’image de soi chez les personnes atteintes de scoliose idiopathique. Nous avons recruté 55 sujets âgés de 10 à 21 ans atteints de scoliose idiopathique (angle de Cobb : 15º à 60º) de la clinique de scoliose dans un hôpital pédiatrique de soins tertiaires. Le déjettement a été mesuré directement sur les sujets à deux reprises par la même physiothérapeute de même que sur les radiographies prises ce jour-là. Deux mesures ont été prises à chaque fois : une les pieds joints (FT) et l’autre en écartant les pieds (FA). Les sujets ont répondu au questionnaire adressé au patient de la Scoliosis Research Society-22, qui traite de la douleur, de l'image de soi et de la santé mentale. Le type de scoliose et l'angle de Cobb ont été mesurés sur les radiographies prises ce jour-là. Nous avons utilisé la théorie de la généralisabilité pour calculer la fidélité de test-retest pour les mesures FT et FA, en rapportant les coefficients de fiabilité (f) et les erreurs types de mesure (SEM). La validité de la mesure du fil à plomb a été calculée en comparant les mesures prises directement sur les radiographies en utilisant le coefficient de corrélation de Pearson. Les corrélations de Pearson ont été calculées entre le déjettement du tronc et la douleur, l'angle de Cobb, l'image de soi et la santé mentale. Les corrélations de Spearman ont été calculées entre le déjettement du tronc et le type de scoliose. Nous avons ensuite utilisé des modèles de régression linéaire multiple pour déterminer les associations entre ces variables. Nos résultats indiquent que les mesures de déjettement du tronc en utilisant un fil à plomb ont une forte corrélation (r = 0,87) avec la mesure obtenue par radiographie. La mesure du déjettement du tronc en utilisant un fil à plomb a démontré une excellente fidélité de test-retest (f: 0,98 pour la mesure FT et 0,99 pour la mesure FA) et les SEM étaient de 2,0 mm pour la mesure FT et 1,8 mm pour la mesure FA. Le déjettement du tronc est corrélé positivement avec l'angle de Cobb (r = 0,32, p = 0,02), mais il n'est pas corrélé à la douleur, la santé mentale, l'image de soi ou le type de scoliose. Les conclusions de notre étude ont montré que la mesure clinique du déjettement du tronc en utilisant un fil à plomb est une méthode fiable et valide et que le déjettement du tronc est associé à l'angle de Cobb. Une étude longitudinale est nécessaire pour déterminer si le déjettement du tronc est un indicateur pronostique de la progression de la scoliose. Mots-clés: la scoliose idiopathique, le déjettement du tronc, fil à plomb, posture, déplacement latéral du tronc

Non-invasive quantitative assessment of scoliosis spinal surgery outcome

Improving the appearance of the trunk is an important goal of scoliosis surgical treatment, mainly in patients' eyes. Unfortunately, existing methods for assessing postoperative trunk appearance are rather subjective as they rely on a qualitative evaluation of the trunk shape. In this paper, an objective method is proposed to quantify the changes in trunk shape after surgery. Using a non-invasive optical system, the whole trunk surface is acquired and reconstructed in 3D. Trunk shape is described by two functional measurements spanning the trunk length: the lateral deviation and the axial rotation. To measure the pre and postoperative differences, a correction rate is computed for both measurements. On a cohort of 36 scoliosis patients with the same spinal curve type who underwent the same surgical approach, surgery achieved a very good correction of the lateral trunk deviation (median correction of 76%) and a poor to moderate correction of the back axial rotation (median correction of 19%). These results demonstrate that after surgery, patients are still confronted with residual trunk deformity, mainly a persisting hump on the back. That can be explained by the fact that current scoliosis assessment and treatment planning are based solely on radiographic measures of the spinal deformity and do not take trunk deformity into consideration. It is believed that with our novel quantitative trunk shape descriptor, clinicians and surgeons can now objectively assess trunk deformity and postoperative shape and propose new treatment strategies that could better address patients' concern about their appearance. © (2013) COPYRIGHT Society of Photo-Optical Instrumentation Engineers (SPIE). Downloading of the abstract is permitted for personal use only.

Determinação da dose eritematosa mínima como marcador de risco e sensibilidade à radiação ultravioleta

Objetivos: Determinar a dose eritematosa mínima (DEM) medida por exposição controlada à radiação ultravioleta-B (RUV-B), como limiar para dano solar agudo nos diversos fototipos, e medir a cor da pele constitucional pelo sistema colorimétrico CIELAB. Pacientes e Métodos: Um total de 194 voluntários, sadios, com idades acima de 18 anos, distribuídos em um mínimo de 30 participantes por fototipo. Todos foram classificados por fototipos segundo os critérios de Fitzpatrick. As regiões infra-axilar torácica e nádega foram irradiadas em 4 áreas de 1 cm2, assim como foi registrada a cor da pele desses locais pelo sistema CIELAB. Delineamento: Estudo transversal. Resultados: A média de idade dos participantes foi de 38 anos, sendo 68% do sexo feminino. A avaliação da associação entre as medidas das DEMs e dos valores colorimétricos da coordenada L*, mostrou uma correlação de Pearson negativa com r = -0,91 para um valor p<0,05. Para os valores das DEMs e os escores da classificação dos voluntários por fototipos, obteve-se correlação de Spearman (rs) de +0,95 para p<0,05 e, correlacionando os valores colorimétricos com os escores dos fototipos, encontrou-se em tórax um rs de -0,93 e em nádega -0,92 para um p < 0,05. Conclusões – Concluiu-se que: 1)- a mensuração dos valores colorimétricos da coordenada L* nas regiões infra-axilar torácica e nádega mostraram uma forte correlação com os valores das DEMs, sendo de menor poder invasivo e de maior praticidade para mensuração de sensibilidade à radiação ultravioleta; 2)- apesar de os escores de Fitzpatrick terem alta correlação com os valores das DEMs, mostraram superposição de valores nos fototipos adjacentes; 3)- o grau de associação das classes dos fototipos com a cor da pele permite dizer que a categoria numérica do fototipo aumenta à medida que a pele fica mais escura.

Avaliação postural em pacientes com doença pulmonar obstrutiva crônica

O objetivo deste estudo foi avaliar alterações posturais em pacientes com Doença Pulmonar Obstrutiva Crônica (DPOC), por meio do Software para Avaliação Postural (SAPO). Trinta indivíduos constituíram 2 grupos: 15 pacientes com DPOC e 15 idosos saudáveis (controle). Os grupos realizaram espirometria e foram fotografados para avaliação postural. As imagens obtidas foram digitalizadas e, posteriormente, avaliou-se dez alterações posturais com o SAPO [inclinação lateral da cabeça (ILC), desnivelamento dos ombros (DO), desnivelamento pélvico anterior (DPA), inclinação lateral do tronco (ILT), desnivelamento das escápulas (DE), desnivelamento pélvico posterior (DPP), protusão da cabeça (PC), protusão de ombro (PO), báscula anterior da pelve (BAP) e cifose torácica (CT)]. Essas alterações, obtidas no grupo controle, foram conferidas com o padrão de normalidade para adultos jovens, proposto em estudo prévio. Para a comparação das alterações posturais entre grupo controle e DPOC, foi utilizado o teste de Mann-Whitney em grupo controle, e em adultos jovens, o teste t de Student não pareado, ambos com nível de significância estatística de 5%. Dentre as dez alterações posturais, o grupo controle apresentou sete (ILC, DPA, DE, DPP, PC, PO, BAP) com valores angulares significativamente maiores em relação aos adultos jovens. Quando comparados a idosos saudáveis, indivíduos com DPOC apresentaram um aumento significante na angulação de BAP, DPP e CT. Pacientes com DPOC apresentam três alterações posturais que provavelmente estão relacionadas à doença.

Frontal Plane Biomechanics in Males and Females with and without Patellofemoral Pain

NAKAGAWA, T. H., E. T. U. MORIYA, C. D. MACIEL, and F. V. SERRAO. Frontal Plane Biomechanics in Males and Females with and without Patellofemoral Pain. Med. Sci. Sports &ere., Vol. 44, No. 9, pp. 1747-1755, 2012. Purpose: The study's purpose was to compare trunk, pelvis, hip, and knee frontal plane biomechanics in males and females with and without patellofemoral pain syndrome (PFPS) during stepping. Methods: Eighty recreational athletes were equally divided into four groups: female PFPS, female controls, male PFPS, and male controls. Trunk, pelvis, hip, and knee frontal plane kinematics and activation of the gluteus medius were evaluated at 15 degrees, 30 degrees, 45 degrees, and 60 degrees of knee flexion during the downward and upward phases of the stepping task. Isometric hip abductor torque was also evaluated. Results: Females showed increased hip adduction and knee abduction at all knee flexion angles, greater ipsilateral trunk lean and contralateral pelvic drop from 60 degrees of knee flexion till the end of the stepping task (P = 0.027-0.001), diminished hip abductor torque (P < 0.001), and increased gluteus medius activation than males (P = 0.008-0.001). PFPS subjects presented increased knee abduction at all the angles evaluated; greater trunk, pelvis, and hip motion from 45 of knee flexion of the downward phase till the end of the maneuver; and diminished gluteus medius activation at 60 degrees of knee flexion, compared with controls (P = 0.034-0.001). Females with PFPS showed lower hip abductor torque compared with the other groups. Conclusions: Females presented with altered frontal plane biomechanics that may predispose them to knee injury. PFPS subjects showed frontal plane biomechanics that could increase the lateral patellofemoral joint stress at all the angles evaluated and could increase even more from 45 degrees of knee flexion in the downward phase untill the end of the maneuver. Hip abductor strengthening and motor control training should be considered when treating females with PFPS.

Postural control of the trunk in response to lateral support surface translations during trunk movement and loading

The postural response to translation of the support surface may be influenced by the performance of an ongoing voluntary task. This study was designed to test this proposal by applying lateral perturbations while subjects handled a load in the frontal plane. Measurements were made of medio-lateral displacement of the centre of pressure, angular displacement of the trunk and thigh in the frontal plane and intra-abdominal pressure. Subjects were translated randomly to the left and right in a variety of conditions that involved standing either quietly or with a 5 kg load in their left hand, which they were required either to hold statically or to lift or lower. The results indicate that when the perturbation occurred towards the loaded left side the subjects were able to return their centre of pressure, trunk and thigh rapidly and accurately to the initial position. However, when the perturbation occurred towards the right (away from the load) this correction was delayed and associated with multiple changes in direction of movement, suggesting decreased efficiency of the postural response. This reduced efficiency can be explained by a conflict between the motor commands for the ongoing voluntary task and the postural response, and/or by the mechanical effect of the asymmetrical addition of load to the trunk.

Evaluation of Reducibility of Trunk Asymmetry in Lateral Bending

The value of the lateral bending test is important in the assessment of spinal curve mobility and prediction of surgical outcome in the treatment of adolescent idiopathic scoliosis (AIS). However, radiographic bending tests are unable to assess the reducibility of trunk asymmetry. This study aims to exploit surface topography measurement in order to evaluate the changes in shape of the trunk (a) between bending and neutral standing positions, and (b) between standing pre- and post-operative visits, in a cohort of adolescents with AIS having undergone surgical correction; and to correlate the differences measured in cases (a) and (b). Our cohort includes 13 patients with right thoracic AIS. Each patient had their 3D trunk surface digitized with a multi-head InSpeck system in standing posture (at the pre-op and post-op visits) and in maximum voluntary right and left bending (at the pre-op visit). We developed a novel trunk shape analysis method which produces a set of inclined trunk cross-sections allowing comparison between different postures. Two asymmetry indices, trunk rotation (TR) and back surface rotation (BSR), were computed in all cases and a statistical analysis was performed. Our correlation study (Pearson test) showed fair correlations in most cases between the changes in side-bending and those post-surgery, with the strongest relationship (p-value < 0.01) when combining the TR measurements from both bendings. These results provide evidence that the bending test can be used to assess trunk asymmetry reducibility. The proposed approach could provide a non-invasive trunk asymmetry reducibility test for routine clinical use in AIS surgery planning.

Quantitative assessment of postural alignment in young adults based on photographs of anterior, posterior, and lateral views

Objective: Postural assessment through photography is a simple method that allows the acquisition of quantitative values to define the alignment of body segments. The purpose of this study was to quantitatively assess the postural alignment of several body segments in standing through anterior, posterior, and lateral views. Methods: In this cross-sectional study, 122 subjects were initially evaluated. Seven subjects were excluded from the study after cluster analysis. The final sample had 115 subjects, 75% women with a mean age of 26 + 7 years. Photographs were taken from anterior, posterior, and lateral views after placement of markers on specific anatomical points. Photographs were analyzed using free Postural Analysis Software/Software of Postural Analysis (PAS/SAPO). Quantitative values for postural analysis variables were ascertained for head, upper and lower limbs, and trunk, along with the frequency of inclinations to the left and to the right. Results: Regarding the head, 88% of the sample presented some inclination, 67% of which was to the right. There was a predominance of right inclination of the shoulder and pelvis in 68% and 43% of study subjects, respectively. Lower limbs presented mean alignment of 178 in the anterior view, and the trunk showed predominant right inclination in 66% of participants. Conclusion: Small asymmetries were observed in anterior and posterior views. This study suggests that there is no symmetry in postural alignment and that small asymmetries represent the normative standard for posture in standing. (J Manipulative Physiol Ther 2011;34:371-380)

EMG activity normalization for trunk muscles in subjects with and without back pain

Purpose: The aims of the present study were to examine electromyographic (EMG) activity of six bilateral trunk muscles during maximal contraction in three cardinal planes, and to determine the direction of contraction that gives maximal activation for each muscle. both for healthy subjects and back-pain patients. Methods: Twenty-eight healthy subjects and 15 back-pain patients performed maximum voluntary contractions in three cardinal planes, Surface EMG signals were recorded from rectus abdominis, external oblique, internal oblique, latissimus dorsi, iliocostalis lumborum, and multifidus bilaterally. Root mean square values of the EMG data were calculated to quantify I the amplitude of EMG signals. Results: For both healthy subjects and back-pain patients. one single direction of contraction was found to give the maximum EMG signals for most muscles. Rectus abdominis demonstrated maximal activity in trunk flexion, external oblique in lateral flexion. internal oblique in axial rotation, and multifidus in extension. For the latissimus dorsi and iliocostalis lumborum. maximal activity was demonstrated in more than one cardinal plane. Conclusion: This study has implications for future research involving normalization of muscle activity to maximal levels required in many trunk EMG studies. As the latissimus dorsi and iliocostalis lumborum demonstrate individual differences in the plane that gives maximal activity, these muscles may require testing in more than one plane.

Persistence of the embryonic lateral marginal vein: report of two cases

PURPOSE: Congenital venous malformations of the lower limbs represent a particular challenge for the vascular surgeon. Persistence of fetal veins is a rare malformation, and the most common is the persistence of the lateral marginal vein usually observed in patients with Klippel-Trenaunnay Syndrome. The persistence of this embryonic vein as an isolated venous malformation without the other characteristics of the Klippel-Trenaunnay Syndrome has not yet been reported. This paper describes two cases. METHODS: Two patients, a 17-year-old male patient and a 16-year-old female, have had since their birth a large venous trunk in the lateral aspect of the right leg and thigh. The limbs underwent duplex scanning and phlebography. The surgical removal of the lateral marginal vein was performed. RESULTS: Surgical treatment resulted in very good functional and aesthetic results. Follow-up at 26 months showed no evidence of varicose vein recurrence. CONCLUSIONS: To achieve good results, surgical intervention may be indicated in cases of orthopedic deformity, hemorrhage, symptomatic, and unaesthetic lesions.

Variação anatômica da artéria torácica interna lateral: relato de caso

The objective of this report was to describe a variation in the origin of the lateral internal thoracic artery (LITA), a variable large-caliber artery in the thoracic wall. This report presents a case in which a trunk coming from the subclavian artery (SCA) bifurcates and gives origin to the LITA and internal thoracic artery (ITA). This case demonstrates an unusual bilateral origin for the LITA, which emerges together with the ITA rather than directly from the SCA, as could be expected. Although such presentation is uncommon, the possibility that it could be damaged during surgical interventions such as thoracotomy and pleural drainage justifies our report .

Personalized 3D reconstruction of the rib cage for clinical assessment of trunk deformities

Scoliosis is a 3D deformity of the spine and rib cage. Extensive validation of 3D reconstruction methods of the spine from biplanar radiography has already been published. In this article, we propose a novel method to reconstruct the rib cage, using the same biplanar views as for the 3D reconstruction of the spine, to allow clinical assessment of whole trunk deformities. This technique uses a semi-automatic segmentation of the ribs in the postero-anterior X-ray view and an interactive segmentation of partial rib edges in the lateral view. The rib midlines are automatically extracted in 2D and reconstructed in 3D using the epipolar geometry. For the ribs not visible in the lateral view, the method predicts their 3D shape. The accuracy of the proposed method has been assessed using data obtained from a synthetic bone model as a gold standard and has also been evaluated using data of real patients with scoliotic deformities. Results show that the reconstructed ribs enable a reliable evaluation of the rib axial rotation, which will allow a 3D clinical assessment of the spine and rib cage deformities.

Changes in Trunk Appearance After Scoliosis Spinal Surgery and Their Relation to Changes in Spinal Measurements

Study Design Retrospective study of surgical outcome. Objectives To evaluate quantitatively the changes in trunk surface deformities after scoliosis spinal surgery in Lenke 1A adolescent idiopathic scoliosis (AIS) patients and to compare it with changes in spinal measurements. Summary of Background Data Most studies documenting scoliosis surgical outcome used either radiographs to evaluate changes in the spinal curve or questionnaires to assess patients health-related quality of life. Because improving trunk appearance is a major reason for patients and their parents to seek treatment, this study focuses on postoperative changes in trunk surface deformities. Recently, a novel approach to quantify trunk deformities in a reliable, automatic, and noninvasive way has been proposed. Methods Forty-nine adolescents with Lenke 1A idiopathic scoliosis treated surgically were included. The back surface rotation and trunk lateral shift were computed on trunk surface acquisitions before and at least 6 months after surgery. We analyzed the effect of age, height, weight, curve severity, and flexibility before surgery, length of follow-up, and the surgical technique. For 25 patients with available three-dimensional (3D) spinal reconstructions, we compared changes in trunk deformities with changes in two-dimensional (2D) and 3D spinal measurements. Results The mean correction rates for the back surface rotation and the trunk lateral shift are 18% and 50%, respectively. Only the surgical technique had a significant effect on the correction rate of the back surface rotation. Direct vertebral derotation and reduction by spine translation provide a better correction of the rib hump (22% and 31% respectively) than the classic rod rotation technique (8%). The reductions of the lumbar Cobb angle and the apical vertebrae transverse rotation explain, respectively, up to 17% and 16% the reduction of the back surface rotation. Conclusions Current surgical techniques perform well in realigning the trunk; however, the correction of the deformity in the transverse plane proves to be more challenging. More analysis on the positive effect of vertebral derotation on the rib hump correction is needed. Level of evidence III.

A Novel Method for the 3-D Reconstruction of Scoliotic Ribs From Frontal and Lateral Radiographs

Among the external manifestations of scoliosis, the rib hump, which is associated with the ribs' deformities and rotations, constitutes the most disturbing aspect of the scoliotic deformity for patients. A personalized 3-D model of the rib cage is important for a better evaluation of the deformity, and hence, a better treatment planning. A novel method for the 3-D reconstruction of the rib cage, based only on two standard radiographs, is proposed in this paper. For each rib, two points are extrapolated from the reconstructed spine, and three points are reconstructed by stereo radiography. The reconstruction is then refined using a surface approximation. The method was evaluated using clinical data of 13 patients with scoliosis. A comparison was conducted between the reconstructions obtained with the proposed method and those obtained by using a previous reconstruction method based on two frontal radiographs. A first comparison criterion was the distances between the reconstructed ribs and the surface topography of the trunk, considered as the reference modality. The correlation between ribs axial rotation and back surface rotation was also evaluated. The proposed method successfully reconstructed the ribs of the 6th-12th thoracic levels. The evaluation results showed that the 3-D configuration of the new rib reconstructions is more consistent with the surface topography and provides more accurate measurements of ribs axial rotation.