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Barchi EI, Swensen S, Dimant OE, McKay TE, Rose DJ. Flexor Hallucis Longus Tenolysis and Tenosynovectomy in Dancers. J Foot Ankle Surg 2022; 61:84-87. [PMID: 34301473 DOI: 10.1053/j.jfas.2020.04.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 04/03/2020] [Accepted: 04/08/2020] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to report on a series of dancers who had undergone flexor hallucis longus (FHL) tenolysis/tenosynovectomy after having failed conservative management. Institutional human subjects committee approval was obtained prior to initiating this study. This study is a retrospective case series of 58 dancers and 63 ankles who underwent FHL tenolysis/tenosynovectomy via an open posteromedial approach by a single surgeon between 1993 and 2017. All patients were interviewed and charts reviewed. Collected variables included: preoperative and postoperative pain levels, time to return to dance, and subjective satisfaction with the procedure. Age, primary dance form, and level of dance were determined. Mean preoperative pain level decreased significantly postoperatively. Mean time to return to dance was 7.1 weeks. There was a 98% (62/63) return to dance at some level while 97% (61/63) of patients returned to dance symptom-free. There were no neurovascular or other major complications. Minor complications included stiffness at follow-up (6.3%, 4/63), superficial wound infection (3.1%, 2/63), and hypertrophic scar (4.8%, 3/63). Over 97% (61/63) of dancers considered the procedure a success and 98% (62/63) of dancers would repeat the procedure. This is one of the largest series reported of isolated FHL tenolysis/tenosynovectomy in dancers who have failed nonoperative management. Satisfactory pain relief and return to dance with a low complication rate may be expected from this surgical procedure. The results of this study can be used to help dancers and their providers make informed decisions about treatment in isolated FHL tendinitis.
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Affiliation(s)
- Elizabeth I Barchi
- Clinical Assistant Professor, Department of Orthopedics, NYU Langone Health, New York, NY.
| | - Stephanie Swensen
- Fellow, Department of Orthopedics, Hospital for Special Surgery, New York, NY
| | - Oscar E Dimant
- Resident, Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ
| | - Tracy Espiritu McKay
- Clinical Assistant Professor, Department of Physical Medicine and Rehabilitation, NYU Langone Health, New York, NY
| | - Donald J Rose
- Clinical Associate Professor, Department of Orthopedics, NYU Langone Health, New York, NY
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Heyer JH, Dai AZ, Rose DJ. Excision of Os Trigonum in Dancers via an Open Posteromedial Approach. JBJS Essent Surg Tech 2018; 8:e31. [PMID: 30775136 DOI: 10.2106/jbjs.st.18.00015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
An os trigonum is a potential source of posterior ankle pain in dancers, often associated with flexor hallucis longus (FHL) pathology. Surgical excision is indicated on failure of nonoperative management. Options for surgical excision include open excision (via a posterolateral or posteromedial approach), subtalar arthroscopy, and posterior endoscopy. Os trigonum excision via an open posteromedial approach with concomitant FHL tenolysis/tenosynovectomy is a safe and effective method for the operative treatment of a symptomatic os trigonum that allows for identification and treatment of associated FHL pathology. The major steps in the procedure, which are demonstrated in this video article, are: (1) preoperative planning with appropriate imaging; (2) patient is positioned in a supine position with the operative extremity in figure-of-4 position; (3) a 3-cm, slightly curvilinear longitudinal incision is made midway between the posterior aspect of the medial malleolus and the anterior aspect of the Achilles tendon, over the palpated FHL tendon, and the flexor retinaculum is exposed and incised; the neurovascular bundle is retracted anteriorly, exposing the FHL tendon and sheath; (4) FHL tenolysis/tenosynovectomy is performed; (5) the FHL is retracted anteriorly and a capsulotomy is performed over the os trigonum and the os trigonum is excised; (6) the capsule is repaired and closure is performed; and (7) dressings and a CAM (controlled ankle motion) walking boot are applied. The patient begins physical therapy at 2 weeks postoperatively and may return to dance at 4 to 6 weeks postoperatively as tolerated. In our series of 40 cases, 95% of patients who desired to return to dance were able to return to their pre-injury level of dance. There were no major neurovascular complications.
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Affiliation(s)
- Jessica H Heyer
- Department of Orthopaedic Surgery, George Washington University Hospital, Washington, DC
| | - Amos Z Dai
- Department of Orthopaedic Surgery, Stony Brook University Hospital, Stony Brook, New York
| | - Donald J Rose
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY
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Costa MSS, Ferreira AS, Orsini M, Silva EB, Felicio LR. Characteristics and prevalence of musculoskeletal injury in professional and non-professional ballet dancers. Braz J Phys Ther 2017; 20:166-75. [PMID: 26786085 PMCID: PMC4900039 DOI: 10.1590/bjpt-rbf.2014.0142] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 09/22/2015] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND: Ballet is a high-performance activity that requires an advanced level of
technical skills. Ballet places great stress on tendons, muscles, bones, and
joints and may act directly as a trigger of injury by overuse. OBJECTIVES: 1) to describe the main types of injuries and affected areas related to classical
ballet and 2) to compare the frequency of musculoskeletal injuries among
professional and non-professional ballet dancers, considering possible gender
differences among the professional dancers. METHOD: A total of 110 questionnaires were answered by professional and non-professional
dancers. The questionnaire contained items related to the presence of injury, the
regions involved, and the mechanism of the injury. RESULTS: We observed a high frequency of musculoskeletal injuries, with ankle sprains
accounting for 69.8% of injuries in professional dancers and 42.1% in
non-professional dancers. Pirouettes were the most frequent mechanism of injury in
professional dancers, accounting for 67.9% of injuries, whereas in the
non-professional dancers, repetitive movement was the most common mechanism
(28.1%). Ankle sprains occurred in 90% of the women's injuries, and muscle sprains
occurred in 54.5% of the men's injuries. The most frequent injury location was the
ankle joint in both sexes among the professional dancers, with 67.6% in women and
40.9% in men. CONCLUSIONS: The identification of the mechanism of injury and time of practice may contribute
to better therapeutic action aimed at the proper function of the dancers' bodies
and improved performance by these athletes.
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Affiliation(s)
- Michelle S S Costa
- Programa de Pós-graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta (UNISUAM), Rio de Janeiro, RJ, Brazil , Centro Universitário Augusto Motta, Centro Universitário Augusto Motta, Rio de Janeiro RJ , Brazil
| | - Arthur S Ferreira
- Programa de Pós-graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta (UNISUAM), Rio de Janeiro, RJ, Brazil , Centro Universitário Augusto Motta, Centro Universitário Augusto Motta, Rio de Janeiro RJ , Brazil
| | - Marco Orsini
- Programa de Pós-graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta (UNISUAM), Rio de Janeiro, RJ, Brazil , Centro Universitário Augusto Motta, Centro Universitário Augusto Motta, Rio de Janeiro RJ , Brazil
| | - Elirez B Silva
- Programa de Pós-graduação em Exercício e Ciência do Esporte, Universidade Gama Filho (UGF), Rio de Janeiro, RJ, Brazil, Universidade Gama Filho, Universidade Gama Filho, Rio de Janeiro RJ , Brazil
| | - Lilian R Felicio
- Curso de Fisioterapia, Universidade Federal de Uberlândia (UFU), Uberlândia, MG, Brazil, Universidade Federal de Uberlândia, Universidade Federal de Uberlândia, Uberlândia MG , Brazil
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Abstract
BACKGROUND An os trigonum is a potential source of posterior ankle pain in dancers, often associated with flexor hallucis longus (FHL) pathology. Options for operative excision include open excision, subtalar arthroscopy, and posterior endoscopy. The purpose of this paper was to present a series of dancers who underwent excision of a symptomatic os trigonum via an open posteromedial approach. METHODS This study is a retrospective case series of 40 ankles in 38 dancers who underwent os trigonum excision via an open posteromedial approach with FHL tenolysis between 2000 and 2013. All patients were interviewed and charts retrospectively analyzed. Collected variables included pre- and postoperative pain level, time to return to dance, and subjective satisfaction. The average age was 19.2 years; ballet was the primary dance form in 36 (95%) of patient-cases. Eight (20%) of the patient-cases were professional dancers, and 30 (75%) were students or preprofessional dancers. RESULTS Average preoperative pain level was 7.7/10, which decreased to 0.6/10 postoperatively. Seventeen (42.5%) experienced concurrent preoperation-associated FHL symptomatology, all of whom experienced relief postoperatively. The average time to return to dance was 7.9 weeks, and time to pain-free dance was 17.7 weeks. Of the 37 patient-cases desiring to return to dance, 35 (94.6%) returned to their preoperative level of dance. There were no neurovascular or other major complications. Four (10%) had minor wound complications that resolved, and 38 cases (95%) considered the procedure a success. CONCLUSION Open posteromedial excision of an os trigonum in dancers provided satisfactory pain relief, return to dance, and complication rates compared to other approaches, and allowed for identifying and treating any associated FHL pathology. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Jessica H Heyer
- 1 Orthopaedic Surgery Department, George Washington University Hospital, Washington, DC, USA
| | - Donald J Rose
- 2 Department of Orthopaedic Surgery, Harkness Center for Dance Injuries, New York University Hospital for Joint Diseases, New York, NY, USA
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Iunes DH, Elias IF, Carvalho LC, Dionísio VC. Postural adjustments in young ballet dancers compared to age matched controls. Phys Ther Sport 2015; 17:51-7. [PMID: 26586041 DOI: 10.1016/j.ptsp.2015.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 02/27/2015] [Accepted: 04/28/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The purpose of the study was to use photogrammetry to evaluate the posture of ballet practitioners compared to an age-matched control group. DESIGN One hundred and eleven 7- to 24-year-old female volunteers were evaluated and were divided into two groups: the ballet practising group (n = 52) and the control group (n = 59), divided into three subgroups according to age and years of ballet experience. RESULTS Dancers with 1-3 years experience compared to controls of the same age shows alterations in External Rotation Angle (P < 0.05). Dancers 4-9 years experience show alterations in Lumbar Lordosis, Pelvis Tilt Angle and Navicular Angle Right and Left (P < 0.05). Dancers with over 9 years experience show alterations in External Rotation and Navicular Angle Left (P < 0.05). CONCLUSIONS Research shows there are differences between dancers and controls. In the groups 1-3 years and over 9 years of experience, the External Rotation Angle is greater. In the group 4-9 years of experience the Lumbar Lordosis Angle is greater and Pelvis Tilt, Navicular Angle Left and Right are smaller. In more than 9 years of ballet experience, the Navicular Angle Left is smaller.
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Affiliation(s)
- Denise H Iunes
- Physiotherapy Course, Federal University of Alfenas, Jovino Fernandes Sales, 2600 Avenue, Bairro Santa Clara, Alfenas, Minas Gerais, 37130-000, Brazil.
| | - Iara F Elias
- Physiotherapy Course, Federal University of Alfenas, Jovino Fernandes Sales, 2600 Avenue, Bairro Santa Clara, Alfenas, Minas Gerais, 37130-000, Brazil
| | - Leonardo C Carvalho
- Physiotherapy Course, Federal University of Alfenas, Jovino Fernandes Sales, 2600 Avenue, Bairro Santa Clara, Alfenas, Minas Gerais, 37130-000, Brazil
| | - Valdeci C Dionísio
- Physiotherapy Course, Federal University of Uberlândia, R. Benjamin Constant, 1286 - Bairro Aparecida, Uberlândia, Minas Gerais, 38400-678, Brazil
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Lehman RA, Kang DG, Lenke LG, Sucato DJ, Bevevino AJ. Return to sports after surgery to correct adolescent idiopathic scoliosis: a survey of the Spinal Deformity Study Group. Spine J 2015; 15:951-8. [PMID: 24099682 DOI: 10.1016/j.spinee.2013.06.035] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 03/29/2013] [Accepted: 06/14/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT There are no guidelines for when surgeons should allow patients to return to sports and athletic activities after spinal fusion for adolescent idiopathic scoliosis (AIS). Current recommendations are based on anecdotal reports and a survey performed more than a decade ago in the era of first/second-generation posterior implants. PURPOSE To identify current recommendations for return to sports and athletic activities after surgery for AIS. STUDY DESIGN/SETTING Questionnaire-based survey. PATIENT SAMPLE Adolescent idiopathic scoliosis after corrective surgery. OUTCOME MEASURES Type and time to return to sports. METHODS A survey was administered to members of the Spinal Deformity Study Group. The survey consisted of surgeon demographic information, six clinical case scenarios, three different construct types (hooks, pedicle screws, hybrid), and questions regarding the influence of lowest instrumented vertebra (LIV) and postoperative physical therapy. RESULTS Twenty-three surgeons completed the survey, and respondents were all experienced expert deformity surgeons. Pedicle screw instrumentation allows earlier return to noncontact and contact sports, with most patients allowed to return to running by 3 months, both noncontact and contact sports by 6 months, and collision sports by 12 months postoperatively. For all construct types, approximately 20% never allow return to collision sports, whereas all surgeons allow eventual return to contact and noncontact sports regardless of construct type. In addition to construct type, we found progressively distal LIV resulted in more surgeons never allowing return to collision sports, with 12% for selective thoracic fusion to T12/L1 versus 33% for posterior spinal fusion to L4. Most respondents also did not recommend formal postoperative physical therapy (78%). Of all surgeons surveyed, there was only one reported instrumentation failure/pullout without neurologic deficit after a patient went snowboarding 2 weeks postoperatively. CONCLUSIONS Modern posterior instrumentation allows surgeons to recommend earlier return to sports after fusion for AIS, with the majority allowing running by 3 months, noncontact and contact sports by 6 months, and collision sports by 12 months.
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Affiliation(s)
- Ronald A Lehman
- Department of Orthopaedic Surgery and Rehabilitation, Walter Reed National Military Medical Center, 8901 Wisconsin Ave., Bethesda, MD 20889, USA; Division of Orthopaedics, Department of Surgery, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
| | - Daniel G Kang
- Department of Orthopaedic Surgery and Rehabilitation, Walter Reed National Military Medical Center, 8901 Wisconsin Ave., Bethesda, MD 20889, USA
| | - Lawrence G Lenke
- Department of Orthopaedic Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8233, St. Louis, MO 63110, USA
| | - Daniel J Sucato
- Department of Orthopaedic Surgery, Texas Scottish Rite Hospital for Children, 2222 Welborn Street, Dallas, TX 75219, USA
| | - Adam J Bevevino
- Department of Orthopaedic Surgery and Rehabilitation, Walter Reed National Military Medical Center, 8901 Wisconsin Ave., Bethesda, MD 20889, USA
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Hendry D, Campbell A, Ng L, Grisbrook TL, Hopper DM. Effect of Mulligan's and Kinesio knee taping on adolescent ballet dancers knee and hip biomechanics during landing. Scand J Med Sci Sports 2014; 25:888-96. [PMID: 25091570 DOI: 10.1111/sms.12302] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2014] [Indexed: 11/26/2022]
Abstract
Taping is often used to manage the high rate of knee injuries in ballet dancers; however, little is known about the effect of taping on lower-limb biomechanics during ballet landings in the turnout position. This study investigated the effects of Kinesiotape (KT), Mulligan's tape (MT) and no tape (NT) on knee and hip kinetics during landing in three turnout positions. The effect of taping on the esthetic execution of ballet jumps was also assessed. Eighteen pain-free 12-15-year-old female ballet dancers performed ballet jumps in three turnout positions, under the three knee taping conditions. A Vicon Motion Analysis system (Vicon Oxford, Oxford, UK) and Advanced Mechanical Technology, Inc. (Watertown, Massa chusetts, USA) force plate collected lower-limb mechanics. The results demonstrated that MT significantly reduced peak posterior knee shear forces (P = 0.025) and peak posterior (P = 0.005), medial (P = 0.022) and lateral (P = 0.014) hip shear forces compared with NT when landing in first position. KT had no effect on knee or hip forces. No significant differences existed between taping conditions in all landing positions for the esthetic measures. MT was able to reduce knee and the hip forces without affecting the esthetic performance of ballet jumps, which may have implications for preventing and managing knee injuries in ballet dancers.
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Affiliation(s)
- D Hendry
- School of Physiotherapy and Exercise Science, Centre for Health Innovation Research Institute, Curtin University, Perth, Western Australia, Australia
| | - A Campbell
- School of Physiotherapy and Exercise Science, Centre for Health Innovation Research Institute, Curtin University, Perth, Western Australia, Australia
| | - L Ng
- School of Physiotherapy and Exercise Science, Centre for Health Innovation Research Institute, Curtin University, Perth, Western Australia, Australia
| | - T L Grisbrook
- School of Physiotherapy and Exercise Science, Centre for Health Innovation Research Institute, Curtin University, Perth, Western Australia, Australia
| | - D M Hopper
- School of Physiotherapy and Exercise Science, Centre for Health Innovation Research Institute, Curtin University, Perth, Western Australia, Australia
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Smyth NA, Zwiers R, Wiegerinck JI, Hannon CP, Murawski CD, van Dijk CN, Kennedy JG. Posterior hindfoot arthroscopy: a review. Am J Sports Med 2014; 42:225-34. [PMID: 23868522 DOI: 10.1177/0363546513491213] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
In recent years, minimally invasive surgery has developed and progressed the standard of care in orthopaedics and sports medicine. In particular, the use of posterior hindfoot arthroscopy in the treatment of posterior ankle and hindfoot injury is increasing rapidly as a means of reducing pain, infection rates, and blood loss postoperatively compared with traditional open procedures. In athletes, hindfoot arthroscopy has been used effectively in expediting rehabilitation and ultimately in minimizing the time lost from competition at previous levels. Van Dijk et al were the first to describe the original 2-portal technique, which remains the most commonly used by surgeons today and forms the basis for this review. The current evidence in the literature supports the use of 2-portal hindfoot arthroscopy as a safe, primary treatment strategy for symptoms of posterior ankle impingement, including resection of os trigonum, treatment of flexor hallucis longus and peroneal tendon injury, treatment of osteochondral lesions of the ankle, and the resection of subtalar coalitions. In this review, we present where possible an evidence-based literature review on the arthroscopic treatment of posterior ankle and hindfoot abnormalities. Causes, diagnosis, surgical technique, outcomes, and complications are each discussed in turn.
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Affiliation(s)
- Niall A Smyth
- Niall A. Smyth, Hospital for Special Surgery, 523 East 72nd Street, Ste 507, New York, NY 10021.
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Wanke EM, McCormack M, Koch F, Wanke A, Groneberg DA. Acute injuries in student circus artists with regard to gender specific differences. Asian J Sports Med 2012; 3:153-60. [PMID: 23012634 PMCID: PMC3445642 DOI: 10.5812/asjsm.34606] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 03/26/2012] [Indexed: 11/16/2022] Open
Abstract
Purpose Student circus artists train as both artists and athletes with their bodies holding the key to professional success. The daily training load of student circus artists is often associated with maximum physical and psychological stress with injuries posing a threat to a potential professional career. The purpose of this study is the differentiated analysis and evaluation of work accidents in order to initiate the development of injury preventive programs. Methods The 17 years of data were obtained from standardized anonymous work accident records of the Berlin State Accident Insurance (UKB) as well as a State Artist Educational School (n = 169, Male: 70; Female: 99) from student artists. Evaluation and descriptive statistics were conducted with Excel 2007 and PASW Statistics 18. Results The injury risk seems to be relatively low (0.3 injuries/1000h). There are gender specific differences as to the location of injuries. Only 7% of the accidents demand a break of more than 3 days. Injury patterns vary depending on the activity and the employment of props/equipment. 75.2% of work accidents have multifactorial and 24.8% exogenous causes. Conclusions Because physical fitness is all important in the circus arts there are numerous options for injury prevention programs that should be realized subject to gender-specific differences. Follow-ups on chronic complaints and a more individual approach are indispensable due to the very specific activities in the circus arts.
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Affiliation(s)
- Eileen M. Wanke
- Dance Medicine Department, Institute of Occupational Medicine, Berlin, Germany
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Germany
- Corresponding Author:Address: Department Dance Medicine, Institute of Occupational Medicine, Charité, University Berlin, Thielallee 73. 14195 Berlin, Germany. E-mail:
| | - Moira McCormack
- The Royal Ballet Company, Royal Opera House, Covent Garden, London, UK
| | - Franziska Koch
- Dance Medicine Department, Institute of Occupational Medicine, Berlin, Germany
| | - Alice Wanke
- Hamburg University of Applied Sciences, Department Nursing and Management, Germany
| | - David A. Groneberg
- Dance Medicine Department, Institute of Occupational Medicine, Berlin, Germany
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Germany
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Abstract
Overuse injuries in the pediatric and adolescent population are a growing problem in the United States as more children participate in recreational and organized sports. It is not uncommon for children and adolescents to play on multiple teams simultaneously or to be involved in sports year-round. Without adequate rest, the demands of exercise can exceed the body's ability to repair tissues, leading to repetitive microtrauma and overuse injury. Unlike in adults, the consequences of overuse injury in the pediatric and adolescent athlete are far more serious because the growing bones are vulnerable to stress. The ability to identify individuals who are at risk of overuse injuries is key so that education, prevention, and early diagnosis and treatment can occur. Preventive measures of modifying training factors (ie, magnitude, intensity, and frequency of sports participation) and correcting improper biomechanics (alignment, laxity, inflexibility, and muscle imbalance) should always be part of the management plan.
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Affiliation(s)
- Quynh B Hoang
- Sports Medicine Program, Department of Orthopedics, Children's Hospital Colorado, University of Colorado Denver Health Sciences Center, Aurora, 80045, USA.
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Soprano JV, Fuchs SM. Common Overuse Injuries in the Pediatric and Adolescent Athlete. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2007. [DOI: 10.1016/j.cpem.2007.02.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Michelson J, Dunn L. Tenosynovitis of the flexor hallucis longus: a clinical study of the spectrum of presentation and treatment. Foot Ankle Int 2005; 26:291-303. [PMID: 15829213 DOI: 10.1177/107110070502600405] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Symptoms associated with flexor hallucis longus (FHL) pathology can manifest themselves anywhere along its length from the posterior leg to the plantar foot and the hallux. This study describes the spectrum of clinical presentations seen with FHL pathology, illustrates the relevant physical examination findings, and outlines a treatment approach. MATERIALS Computerized medical data was prospectively collected on 81 patients treated between January, 1997 and March, 2002. The 55 females and 26 males had an average age of 38.3 years, with a mean follow-up of 21.3 months. Forty-five of 81 had previous therapy that failed, usually for "plantar fasciitis." Twenty-seven were active athletically and 24 related the onset of symptoms to a specific traumatic episode. Pain was located at the posteromedial ankle in 40, plantar heel in 23, plantar midfoot in 22, and multiple locations in 16. All patients had tenderness of the FHL. Restriction of FHL excursion was demonstrated in 30 patients by limited hallux metatarsophalangeal joint dorsiflexion when the ankle was dorsiflexed ("FHL stretch test"). Thirty-four patients had magnetic resonance imaging of the FHL, 28 (82%) of which were positive for synovitis of the FHL. Treatment included an FHL stretching program, short-term immobilization, and operative decompression and synovectomy in patients for whom nonoperative treatment failed. RESULTS Of the 58 patients treated nonoperatively, 37 (64%) had successful results. Twenty-three patients had surgery, 20 at the posterior ankle fibro-osseous tunnel, and three in the sesamoid region. All patients treated operatively had successful outcomes. A subset of 10 patients had hallux rigidus symptoms without significant osteophyte formation. All 10 obtained successful results with treatment directed at restoring normal FHL excursion (nine nonoperatively, one by FHL release). This suggests that limited FHL excursion may be an etiology for the development of hallux rigidus. CONCLUSIONS Clinical syndromes related to the FHL are more frequent than previously reported. The close relationship of the FHL to commonly injured structures (such as the plantar fascia) contributes to significant delays in effective treatment.
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Affiliation(s)
- James Michelson
- Department of Orthopaedics, University of Vermont, Stafford 428B, Burlington, VT 05405, USA.
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Toledo SD, Akuthota V, Drake DF, Nadler SF, Chou LH. Sports and performing arts medicine. 6. Issues relating to dancers. Arch Phys Med Rehabil 2004; 85:S75-8. [PMID: 15034860 DOI: 10.1053/j.apmr.2003.12.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
UNLABELLED This self-directed study module highlights biomechanics unique to dance that predispose to common injuries of the lower extremity and discusses preventative strategies. It is part of the study guide on sports and performing arts medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. OVERALL ARTICLE OBJECTIVE To summarize lower-limb and back injuries commonly seen in dancers.
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Affiliation(s)
- Santiago D Toledo
- Department of Physical Medicine and Rehabilitation, Rehabilitation Institute of Chicago, IL 60611, USA.
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Nadler SF, Chou LH, Toledo SD, Akuthota V, Drake DF. Sports and performing arts medicine. 1. general considerations for sports and performing arts medicine11A commercial party with a direct financial interest in the results of the research supporting this article has conferred or will confer a financial benefit upon the author or one or more of the authors. Nadler is a consultant for Proctor & Gamble. Arch Phys Med Rehabil 2004; 85:S48-51. [PMID: 15034855 DOI: 10.1053/j.apmr.2003.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
UNLABELLED This self-directed learning module highlights general considerations in sports and performing arts medicine. It is part of the study guide on sports and performing arts medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. OVERALL ARTICLE OBJECTIVE To discuss similarities and differences of injuries sustained in sports and performing arts using case vignettes.
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Affiliation(s)
- Scott F Nadler
- Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey, Newark, 07103, USA.
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Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES To compare the relationship between the degrees of turnout, passive hip external rotation range of motion, and self-reported history of low back and lower extremity injury in ballet dancers. BACKGROUND Ballet dancers are encouraged to externally rotate their lower extremities (turnout) as far as possible. This may cause stress on the dancers' low back and lower extremities, putting them at risk for injury. METHODS AND MEASURES Thirty college-level ballet dancers and instructors were evaluated. Each participant completed an injury questionnaire that placed the participant either in a group with a self-reported history of low back and lower extremity injury or in a group without a self-reported history of low back and lower extremity injury. Each dancer's first-position turnout and passive external rotation range of motion for both hips were measured. The comparison between each dancer's first-position turnout and the measured hip external rotation range of motion was called "compensated turnout." A 2-sample test was used to determine if the average compensated turnout was significantly different in the injured and noninjured groups. RESULTS The mean (+/- SD) compensated turnout values for the injured and noninjured groups were 25.40 degrees (+/- 21.3 degrees) and 4.7 degrees (+/- 16.3 degrees), respectively. This difference was significant at P = 0.006. CONCLUSION Based on a self-reported history of low back and lower extremity injuries, ballet dancers have a greater risk of injury if they reach a turnout position that is greater than their available bilateral passive hip external rotation range of motion.
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Affiliation(s)
- Julie A Coplan
- Rubin Institute for Advanced Orthopedics, Sinai Hospital Lifebridge Health Center, Baltimore, MD 21215, USA.
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17
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Abstract
Today more and more children with diagnoses of adolescent spinal deformity are participating in athletic competitions. Certain sports appear to have an increased association with spinal deformity, especially in the adolescent female population. Modern treatment techniques including bracing will allow participation in most athletic endeavors. Those treated with surgery need to have their postoperative care individualized. However, modern surgical techniques still allow continued participation in most activities.
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18
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Abstract
Teenaged girls constitute the fastest growing segment of children and adolescents participating in organized athletics. Adolescent girls appear to have similar injury rates as boys in comparable activities but different injury patterns. To properly diagnose and manage athletic injuries in adolescent girls, pediatric health care providers must be aware of these differences, especially as the literature and their knowledge base may be skewed to the traditional predominance of males in sport. This review identifies athletic injuries that are unique to or especially common in adolescent girls, including apophyseal injuries; breast and pelvic injuries; scoliosis and spondylolysis; multidirectional shoulder instability and "gymnast's wrist"; anterior cruciate ligament injuries and patellofemoral pain syndrome; chronic exertional lower-leg compartment syndrome, ankle sprains, and reflex sympathetic dystrophy; and stress fractures. It also briefly discusses possible risk factors for these injuries, emphasizing the female athlete triad.
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Affiliation(s)
- K J Loud
- Department of Pediatrics, Harvard Medical School, and Division of Adolescent Medicine, Children's Hospital Boston, Boston, Massachusetts 02115, USA.
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