Heather Myers

Functional Performance on the Upper Quarter Y-Balance Test Differs Between High School Wrestlers and Baseball Players

CONTEXT The Upper Quarter Y-Balance Test (YBT-UQ) is a unique movement test where individuals perform at the limits of their stability, requiring the coordination of balance, proprioception, range of motion, and stabilization. It is not yet clear if performance on the YBT-UQ differs between sports with dissimilar emphasis on upper-extremity performance. OBJECTIVE To compare performance on the YBT-UQ between wrestlers, whose sport requires some degree of closed-chain activity, and baseball players, whose sport is primarily open kinetic chain in nature. DESIGN Cross-sectional. SETTING High school preparticipation physical assessment. PARTICIPANTS 24 healthy high school male wrestlers (mean age 16.12 ± 1.24 y) and 24 healthy high school male baseball players (mean age 15.79 ± 1.25 y). INTERVENTIONS All subjects performed the YBT-UQ, which requires reaching in 3 directions while maintaining a push-up position. MAIN OUTCOME MEASURES The variables of interest include the maximum reach in each direction, as well as the composite score. In addition, asymmetries between limbs for each reach direction were compared. RESULTS Wrestlers performed significantly better than baseball players in the medial direction, inferolateral direction, and in composite scores. In the medial direction, wrestlers exhibited greater scores (P < .01) on both left and right limbs, 10.5 ± 10.2%LL and 9.95 ± 10.2%LL, respectively. Significant differences (P < .01) were also observed in the inferolateral direction, with a difference of 11.3 ± 12.0%LL on the left and 8.7 ± 11.0%LL on the right. Composite scores were higher (P < .01) for the wrestlers, with a difference of 7.0% on the left and 7.1% on the right. CONCLUSIONS This study suggests that wrestlers perform better on the YBT-UQ than baseball players. The findings may suggest sport-specific normative data for the YBT-UQ in high school athletes.

Correction to: Factors associated with poorer outcomes in the surgical treatment of multiligament knee injuries

The author would like to correct the following errors in the publication of the original article:

Factors predictive of poorer outcomes in the surgical repair of multiligament knee injuries

PurposeTo investigate the influence of injury and treatment factors on clinical/functional outcomes in multiligament knee injuries (MLKI).MethodsThirty-nine consecutive patients with confirmed and surgically treated MLKI who met inclusion criteria were scheduled for a follow-up visit to obtain: SF-12 and subjective feeling of normalcy between the operated and healthy knee, and IKDC, active range of motion (ROM), and stability exam (Lachman test, posterior drawer, and dial test at 30°). A chart review was used to obtain data on injury and treatment factors.ResultsThe postoperative mean (SD) outcomes were: IKDC score 62.7 (25.9), flexion–extension ROM 125° (29°), and percentage of normalcy 74% (20%). The postoperative normal/nearly normal stability exam was: Lachman test 36 (95%) patients, posterior drawer at 90° 38 (97%) patients, and dial test of 39 (100%) patients. There were 24 (61.5%) and 23 (59%) patients with complications and reoperations, respectively. The presence of bicruciate injuries was associated with worse Lachman (p = 0.03) and posterior drawer tests (p = 0.03). Presence of injury to meniscal structures was associated with worse Lachman test (p = 0.03), lower percentage of normalcy (p = 0.02) and extension lag (p = 0.04). Injury to cartilage structures was associated with worse IKDC scores (p = 0.04). IKDC was lower in cases of posterolateral corner reconstruction (p = 0.03) and use of allograft tendons for reconstruction (p = 0.02); ROM was lower in allograft reconstruction (p = 0.02) and need for meniscal repair (p = 0.01). Bicruciate reconstruction led to worst posterior drawer test (p = 0.006).ConclusionsThe outcomes of MLKI might be negatively influenced by bicruciate ligament, meniscal, and cartilage injuries; with regards to treatment characteristics, need for posterolateral corner or bicruciate ligament reconstruction, use of allografts, or need for meniscal repair may similarly diminish outcomes. While surgical treatment provides good overall function, ROM and stability, it rarely results in a “normal” knee and the chances of complications and reoperations are high.Level of evidenceCross-sectional comparative study, Level III

The validity and reliability of ultrasound on identifying supraspinatus tears during passive external rotation from 0° to 30°: a pilot project

Background Controversy exists regarding how much external rotation should be allowed following rotator cuff repair. Clinicians may use ultrasound imaging (USI) to visualize the supraspinatus (SSp) tendon during passive external rotation. However, the validity and reliability of USI used to assess supraspinatus tendon gap formation during external rotation needs to be established prior to using this technique in patient cohorts. Methods Ten subjects with magnetic resonance imaging (MRI) confirmation of full-thickness SSp tears were matched to 10 control subjects. Images of the SSp were obtained at 0°, 10°, 20° and 30° of external rotation by a blinded tester on two occasions to establish both validity and reliability of the measure. Results Validity was established as 70% agreement between the USI and MRI confirmed SSp tear group; reliability was established at greater than 0.90 at all positions of external rotation measured. Conclusions USI may be used to detect SSp tears with 70% validity, and the technique is reliable in all positions of external rotation.

Reliability and Validity of a Novel Approach to Measure Hip Rotation

CONTEXT Currently, hip-rotation range of motion (ROM) is clinically measured in an open kinetic chain in either seated or prone position using passive or active ROM. However, during activities of daily living and during sports participation the hip must be able to rotate in a loaded position, and there is no standard measurement for this. OBJECTIVE To determine if a novel method for measuring hip rotation in weight bearing will result in good to very good reliability as demonstrated by an intraclass correlation coefficient (ICC) of >.80 and to investigate if weight-bearing hip measurements will result in significantly reduced hip ROM compared with non-weight-bearing methods. DESIGN Repeated measures. SETTING Outpatient sports physical therapy clinic. PARTICIPANTS 20 healthy participants (10 men, 10 women) recruited for hip-rotation measurements. METHODS Three trials of both internal and external rotation were measured in sitting, prone, and weight bearing. Two therapists independently measured each participant on the same day. The participants returned the following day to repeat the same measurements with the same 2 therapists. MAIN OUTCOME MEASURES Degrees of hip internal and external rotation measured in prone, sitting, and loaded positions. RESULTS In general, the measurement of hip ROM across the different conditions was reliable. The intrarater reliability was .67-.95, while interrater reliability was .59-.96. Interrater reliability was improved when values were averaged across the measures (.75-.97). ICCs for active loaded ROM were .67-.81, while interrater ICCs were .53-.87. In general, prone hip ROM was greater than supine and supine was greater than loaded. CONCLUSIONS Loaded hip rotation can be measured in a clinical setting with moderate to good reliability. The rotation ROM of a loaded hip can be significantly decreased compared with unloaded motion.

Interaction of Gender and Body Composition on Rectus Femoris Morphology as Measured With Musculoskeletal Ultrasound Imaging

Background: Quadriceps function is an important measure in patients recovering postoperatively. Traditionally, strength measures that require high levels of resistance are contraindicated during the early postoperative phase. Thus it may be helpful to evaluate the utilization of other tools, such as ultrasound imaging, that allow for assessment during a position of low resistance. Hypothesis: The rectus femoris cross-sectional area (CSA) is affected by sex and body composition in healthy subjects. Study Design: Cross-sectional study. Level of Evidence: Level 4. Methods: Thirty-two healthy subjects (16 women, 16 men), selected from a previously larger study, were chosen for analysis. All subjects underwent a maximal volitional isometric contraction protocol from 0° to 90° of knee motion controlled by an isokinetic dynamometer. In the contracted and resting positions, the rectus femoris CSA was measured at each angle using ultrasound imaging. The contractile index (contracted − resting CSA) was calculated at each position. Subjects were separated into 1 of 4 groups based on sex and fat percentage (low or high). These data were analyzed using mixed-factor analysis of variance (group × angle) for each variable, with a critical α level of 0.05. Results: A significant interaction was noted for the CSA of the rectus femoris at rest (P < 0.03) and during contraction (P < 0.02). For both variables, all groups performed similarly, with the exception of women with high body fat percentage. No statistically significant interaction existed for the contractile index; however, a main effect for angle (P < 0.01) was observed. Conclusion: Rectus femoris CSA appears to depend on sex as well as the body composition of individuals. Clinical Relevance: Traditional subjective assessment measures of quadriceps strength and function have low reliability and functional validity. With the improved feasibility of ultrasound imaging in the clinical setting, quadriceps size may be more accurately measured during the early postoperative stages.