John Schrader

The Ability of 4 Single-Limb Hopping Tests to Detect Functional Performance Deficits in Individuals With Functional Ankle Instability

STUDY DESIGN Experimental laboratory testing using a cross-sectional design. OBJECTIVES To determine if functional performance deficits are present in individuals with functional ankle instability (FAI) in 4 single-limb hopping tests, including figure-of-8 hop, side hop, 6-meter crossover hop, and square hop. BACKGROUND Conflicting results exist regarding the presence of functional deficits in individuals with FAI. It is important to evaluate whether functional performance deficits are present in this population, as well as if subjective feelings of giving way can assist in identifying these deficits. METHODS Sixty college students volunteered for this study. Thirty participants with unilateral ankle instability were placed in the FAI group and 30 participants with no history of ankle injuries were placed in the control group. The FAI group was subsequently further divided to indicate those that reported giving way during the functional test (FAI-GW) and those that did not (FAI-NGW). Time to complete each test was recorded and the mean of 3 trials for each test were used for statistical analysis. To identify performance differences, we used 4 mixed-design 2-way (side-by-group) ANOVAs, 1 for each hop test. A Tukey post hoc test was completed on all significant findings. RESULTS We identified a significant side-by-group interaction for all 4 functional performance tests (P<.05). Specifically, for each functional performance test, the FAI limb performed significantly worse than the contralateral uninjured limb in the FAI-GW group. Additionally, the FAI limb in the FAI-GW group performed worse than the FAI limb in the FAI-NGW group, and the matched limb in the control group in 3 of the 4 functional performance tests. CONCLUSION We found that functional performance deficits were present in participants with FAI who also experienced instability during the test. This difference was identified when comparing the FAI limb to the contralateral uninjured limb as well as control participants. However, the performance deficits identified in this study were relatively small. Future research in this area is needed to further evaluate the clinical meaningfulness of these findings. Finally, we found that limb dominance did not affect performance.

Differences in Ankle Range of Motion Before and After Exercise in 2 Tape Conditions

Background Athletic tape has been used on the ankle to decrease range of motion and to prevent injuries. Results from previous research found that with physical exercise athletic tape loses some of its restricting properties; recently, a new self-adherent taping product was developed that may restrict range of motion regardless of exercise. Hypothesis Self-adherent tape will maintain ankle range of motion restriction more than traditional white cloth tape both before and after activity. Study Design Controlled laboratory study. Methods Twenty volunteers participated in testing procedures on 3 separate days, 1 for each taping condition (self-adherent, white cloth, and no tape). The participants ankle range of motion was measured with an electrogoniometer before application of the tape, immediately after application of the tape, and after 30 minutes of physical exercise. Range of motion was measured in 2 planes of motion: inversion to eversion and dorsiflexion to plantar flexion. Results White cloth tape and self-adherent tape both restricted inversion to eversion range of motion immediately after application, but with 30 minutes of exercise only the self-adherent tape maintained the decreased range of motion. For dorsiflexion to plantar flexion range of motion, the white tape and self-adherent tape both significantly decreased range of motion immediately after application and after the exercise protocol. Conclusions and Clinical Relevance The self-adherent tape maintained range of motion restriction both before and after exercise. Conversely, the white cloth tape lost some of its restrictive properties after 30 minutes of exercise.

Ankle strength and force sense after a progressive, 6-week strength-training program in people with functional ankle instability.

CONTEXT Although strength training is commonly used to rehabilitate ankle injuries, studies investigating the effects of strength training on proprioception have shown conflicting results. OBJECTIVE To determine the effects of a 6-week strength-training protocol on force sense and strength development in participants with functional ankle instability. DESIGN Randomized controlled clinical trial. SETTING University athletic training research laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 40 participants with functional ankle instability were recruited. They were randomly placed into a training group (10 men, 10 women: age = 20.9 ± 2.2 years, height = 76.4 ± 16.1 cm, mass = 173.0 ± 7.9 kg) or control group (10 men, 10 women: age = 20.2 ± 2.1 years, height = 78.8 ± 24.5 cm, mass = 173.7 ± 8.2 kg). INTERVENTION(S) Participants in the training group performed strength exercises with the injured ankle 3 times per week for 6 weeks. The protocol consisted of a combination of rubber exercise bands and the Multiaxial Ankle Exerciser, both clinically accepted strengthening methods for ankle rehabilitation. The progression of this protocol provided increasingly resistive exercise as participants changed either the number of sets or resistance of the Thera-Band or Multiaxial Ankle Exerciser. Main Outcome Measure(s): A load cell was used to measure strength and force sense. Inversion and eversion strength was recorded to the nearest 0.01 N. Force-sense reproduction was measured at 2 loads: 20% and 30% of maximal voluntary isometric contraction. RESULTS Increases in inversion (F(1,38) = 11.59, P < 0.01, η(p)(2) = 0.23, power = 0.91) and eversion (F(1,38) = 57.68, P < .01, η(p)(2) = 0.60, power = 0.99) strength were found in the training group at the posttest when compared with the control group. No significant improvements were noted in force-sense reproduction for either group. CONCLUSIONS Strength training at the ankle increased strength but did not improve force sense.

Prevalence of chronic ankle instability in high school and Division I athletes

Objective. The purpose of this study was to determine the prevalence of chronic ankle instability among high school and collegiate athletes. Design. Descriptive epidemiological survey. Methods. Athletes from four high schools and a division I university were contacted to participate. For collegiate athletes, a questionnaire packet was distributed during preparticipation physicals. For high school athletes, parental consent was obtained and then questionnaires were distributed during preparticipation physicals, parent meetings, or individual team meetings. All athletes completed the Cumberland Ankle Instability Tool for both their left and right ankles. Subjects also provided general demographic data and completed the Ankle Instability Instrument regarding history of lateral ankle sprains and giving way. Athletes were identified as having chronic ankle instability if they scored less than 24 on the Cumberland Ankle Instability Tool. Results. Of the 512 athletes who completed and returned surveys, 23.4% were identified as having chronic ankle instability. High school athletes were more likely to have chronic ankle instability than their collegiate counterparts (P < .001). Chronic ankle instability was more prevalent among women than among men in both high school (P = .01) and collegiate settings (P = .01). Conclusions. Findings of this study revealed differences in the distribution of chronic ankle instability that warrant further study. Levels of Evidence: Prognostic, Level IV, case series

Severity of Functional and Mechanical Ankle Instability in an Active Population

Background: The purpose of this investigation was to evaluate the relationship between the severity of functional and mechanical ankle instability in physically active individuals. Materials and Methods: Eighty college aged physically active individuals from a large university were recruited for this study. All subjects had unilateral functional ankle instability (FAI). FAI was defined as a history of at least two ankle sprains and a score less than or equal to 27 on the Cumberland Ankle Instability Tool (CAIT). The contralateral limb had no history of ankle injury or instability. Anterior displacement (mm) and talar tilt (degrees) were measured using the LigMaster™ joint arthrometer to identify mechanical ankle instability(MAI). Individuals were tested bilaterally and the maximum value attained during talar tilt and anterior displacement was used for statistical analysis. Results: First we evaluated side-to-side differences in MAI in all subjects. We found no significant difference between the FAI and the non-FAI ankle for anterior displacement (t 1.79 = 1.66, p = 0.10) or talar tilt (t 1.79 = −0.07, p = 0.95). Secondly, we evaluated the relationship between the FAI and MAI measures and found no significant correlations between the severity of FAI and magnitude of anterior displacement(r = 0.18, p = 0.12) or talar tilt (r = 0.09, p = 0.42). Conclusion: This study demonstrated there was no side-to-side difference in MAI in individuals with unilateral functional ankle instability. Similarly, we also conclude there was no significant relationship between the severity of FAI and MAI. We feel that these findings suggest the symptoms of FAI may not be related to ankle joint laxity, but instead due to other factors associated with FAI. Level of Evidence: III, Comparative Series

A review of clinical tests and signs for the assessment of ulnar neuropathy.

UNLABELLED NARRATIVE REVIEW: As part of a comprehensive assessment for suspected ulnar neuropathy, clinical testing plays an important role in the initial identification of a lesion and determining subsequent changes from baseline. The purpose of this article was to review ulnar nerve provocative testing and the substantial collection of diagnostic signs and tests. Administration procedures for each maneuver are described as well as the resulting positive and negative outcomes. The clinical tests described constitute only one aspect of the examination and should not substitute for other key components, such as taking a thorough medical and occupational history. Empirical research studies are indicated to further quantify the relationship between the testing outcomes and the severity of a lesion as well as to determine the most robust motor signs seen in the early stages of the disease. LEVEL OF EVIDENCE 5.

Analysis of Clinical Motor Testing for Adult Patients With Diagnosed Ulnar Neuropathy at the Elbow

OBJECTIVE To compare the dichotomous results for 7 ulnar nerve clinical motor tests (Froments sign, Wartenbergs sign, finger flexion sign, Jeannes sign, crossed finger test, Egawas sign, presence of clinical fasciculations) with motor nerve conduction velocity findings. DESIGN A static group comparison design assessed for differences among dichotomous test outcomes with respect to motor nerve conduction velocity. SETTING Five medical facilities throughout the United States provided data for this study. PARTICIPANTS Records from participants (N=26) with diagnosed ulnar neuropathy at the elbow were included for data analysis. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Demographic data included age, sex, handedness, duration of symptoms, and the number of days between the clinical and electrodiagnostic exam. Other dependent variables included motor conduction velocity of the ulnar nerve, compound muscle action potential amplitude, and the dichotomous clinical motor test outcomes. RESULTS Two motor signs, the presence of clinical fasciculations and a positive finger flexion sign, were identified more frequently (each present in 11 patients) than the other motor signs. An analysis of covariance revealed significant differences in motor nerve conduction velocity between positive and negative results for all the clinical motor tests except for the finger flexion sign. Significant chi-square analyses were found for the following comparisons: the presence of clinical fasciculations and Froments sign, the finger flexion sign and the crossed finger test, Egawas sign and Froments sign, Wartebergs sign and Froments sign, the crossed finger test and Froments sign, and Egawas sign and Wartenbergs sign. CONCLUSIONS Some clinical motor tests are better than others at identifying early motor involvement, providing the rehabilitation professional some insight regarding the relative decrement of motor nerve conduction velocity when a selected test is positive.

Erratum to “A Review of Clinical Tests and Signs for the Assessment of Ulnar Neuropathy” [J Hand Ther 2009;22(3):209–220]

In the above-mentioned article, the authors have noted that two figures were not printed in the final version: Figure 3 (Spurling’s test) and Figure 4 (combined pressure and flexion test). This resulted in the incorrect numbering of all subsequent figures; therefore, Figure 3 in the original article should be listed as Figure 5, Figure 4 should be Figure 6, Figure 5 should be Figure 7, Figure 6 should be Figure 8, Figure 7 should be Figure 9, Figure 8 should be Figure 10, and Figure 9 should be Figure 11. The two missing figures appear below.