Todd P. Stitik

The relationship between lower extremity injury, low back pain, and hip muscle strength in male and female collegiate athletes.

ObjectiveTo determine the relationship of previous lower extremity (LE) injury and/or low back pain (LBP) on hip abduction and extension strength. DesignCohort study of college athletes at time of preparticipation screening physical. SettingAn NCAA Division I college. ParticipantsTwo hundred ten college athletes (140 males and 70 females) from an NCAA Division I school. Main Outcome MeasuresMean and maximal hip abduction and extension strengths were recorded using a specially designed dynamometer anchoring station. Previous injury to the LE or LBP in the past year was recorded via personal interview at the time of screening and verified by review of previous injury records. ResultsA significant difference in side-to-side symmetry of maximum hip extension strength was observed in female subjects who reported LE injury or LBP as compared to those who did not. Side-to-side difference in hip strength, however, did not differ between male athletes, regardless of reported LE injury or LBP status. ConclusionFemale athletes appear to have a differing response of the proximal hip musculature to LE injury or LBP, as compared with their male counterparts. Research is under way to further validate these findings. Clinical RelevanceThis study provides some reasoning to support the screening of hip strength during the preparticipation physical, as it may be important in the prevention of LE injury and LBP in collegiate athletes.

Relationship between hip muscle imbalance and occurrence of low back pain in collegiate athletes: a prospective study.

Nadler SF, Malanga GA, Feinberg JH, Prybicien M, Stitik TP, DePrince M: Relationship between hip muscle imbalance and occurrence of low back pain in collegiate athletes: a prospective study. Am J Phys Med Rehabil 2001;80:572–577. ObjectiveTo assess whether athletes with strength imbalance of the hip musculature would be more likely to require treatment for low back pain (LBP) over the ensuing year. DesignThe study population included 163 National Collegiate Athletic Association Division I college athletes (100 males and 63 females) undergoing preparticipation sports physicals. Institutional review board approval was obtained to acquire and analyze hip muscle strength data. A commercially available dynamometer (Chatillon, Lexington, KY) incorporated into a specially designed anchoring station was used for testing the hip extensors and abductors. The maximum force generated for the hip abductors and extensors was used to calculate a percentage difference between the right and left hip extensors and abductors. Treatment of athletes by the athletic trainers for LBP unrelated to blunt trauma over the ensuing year was recorded. ResultsOf all athletes, 5 of 63 females and 8 of 100 males required treatment for LBP. Logistic regression analysis indicated that for female athletes, the percentage difference between the right and left hip extensors was predictive of whether treatment for LBP was required over the ensuing year (P = 0.05). There was no significant association noted for the percentage difference between the right and left hip abductors in females and for the percentage difference between both the right and left hip abductors and right and left hip extensors in males requiring treatment for LBP. ConclusionsThese data support our results from our previous cohort study, adding validity to the concept of hip muscle imbalance being associated with LBP occurrence in female athletes. This research further supports the need for the assessment and treatment of hip muscle imbalance in individuals with LBP.

Osteoarthritis : Epidemiology, risk factors, and pathophysiology

Garstang SV, Stitik TP: Osteoarthritis: epidemiology, risk factors, and pathophysiology. Am J Phys Med Rehabil 2006;85(Suppl):S2–S11.

Osteoarthritis of the acromioclavicular joint: a review of anatomy, biomechanics, diagnosis, and treatment.

Shoulder pain is a frequent presenting complaint to physiatrists. Commonly encountered pathogeneses include rotator cuff pathology, bursitis, biceps tendonitis, and labral tears. Because the majority of shoulder pain originates within the subacromial region and the glenohumeral joint, the acromioclavicular, sternoclavicular, and scapulothoracic articulations may be overlooked. Osteoarthritis of the acromioclavicular joint is a common source of shoulder pain that is often neglected by clinicians and researchers. The proper diagnosis of acromioclavicular joint osteoarthritis requires a thorough physical exam, plain-film radiograph, and a diagnostic local anesthetic injection. Current treatment options are rather limited. Initial therapies are similar to that of osteoarthritis in other joints and include oral analgesics or anti-inflammatories and an emphasis on activity modification. Physical therapy, unfortunately, has little to offer, as therapeutic exercise and range of motion play only a minor role. If a diagnostic local anesthetic injection provides relief, there may be a role for corticosteroid injections. It seems that the administration of local corticosteroids into the acromioclavicular joint may provide short-term pain relief. The judicious administration of such injections remains controversial, and most experts agree that steroid injections do not alter the natural progression of the disease. Surgical options, indicated typically after a minimum of 6 mos of unsuccessful conservative treatment consist of open or arthroscopic distal clavicle resection.

A study of thyrotropin-releasing hormone for the treatment of spinal muscular atrophy: a preliminary report.

ObjectiveTo determine whether thyrotropin-releasing hormone (TRH) can increase muscle strength in children with spinal muscular atrophy types 2 and 3. DesignA randomized, double-blinded, controlled, 5-wk drug trial of six subjects and three controls. Subjects and controls ranged from 4 to 8 yr of age and were randomly assigned to treatment and placebo groups in a ratio of 2:1. TRH (protirelin) or placebo was delivered intravenously through percutaneous intravenous catheters at a dose of 0.1 mg/kg (in 50 ml of normal saline) for a total of 29 days. Patients were evaluated using electromyography and handheld dynamometry of the deltoids, biceps, triceps, wrist extensors, hip flexors, quadriceps, hamstrings, and grip strength before and immediately after 5 wk of treatment. A unidirectional t test was used to compare mean values. ResultsDynamometry improved significantly only for the six treated subjects (P < 0.02). Peroneal nerve conduction velocities were significantly faster in the treatment group (paired t test, P = 0.036). The parents of the treated children also provided anecdotal evidence of improvements in function. Improvements lasted 6–12 mo. ConclusionsTRH may be a useful treatment for spinal muscular atrophy. A larger, crossover design group comparison study is warranted.

Pain, dizziness, and central nervous system blood flow in cervical extension: vascular correlations to beauty parlor stroke syndrome and salon sink radiculopathy.

Foye PM, Najar MP, Camme A Jr, Stitik TP, DePrince ML, Nadler SF, Chen B: Prospective study of pain, dizziness, and central nervous system blood flow in cervical extension: Vascular correlations to beauty parlor stroke syndrome and salon sink radiculopathy. Am J Phys Med Rehabil 2002;81:395–399. Objective Professional shampoos have previously been implicated in beauty parlor stroke syndrome and salon sink radiculopathy. The purpose of this study was to record pain, dizziness, and cervical blood flow while subjects were specifically placed into the salon sink position and to determine whether an additional cervical support would alter these symptoms and measurements. Design In 25 volunteers who reported previous dizziness from salon shampoos, we recorded subjective levels of pain and dizziness and objective measurements of blood flow within the vertebral and carotid arteries at baseline and then during cervical extension into a salon sink, with and without additional cervical support. Results When the additional cervical support was not used, there was significantly greater dizziness, neck pain, and carotid blood flow. No statistically significant differences were seen in the vertebral artery blood flow when comparing the three positions. Conclusions Pain and dizziness were commonly reproduced in this previously symptomatic population but significantly less frequently when a supplemental cervical support was used. Individuals with a history of such symptoms should probably exercise caution when deciding whether to receive a salon sink shampoo.

Incidence Of Dislocation Following Hip Arthroplasty For Patients In The Rehabilitation Setting

Krotenberg R, Stitik T, Johnston MV: Incidence of dislocation following hip arthroplasty for patients in the rehabilitation setting. Am J Phys Med Rehabil 1995;74:444—447 Dislocation of a hip arthroplasty prosthesis is the most common serious complication after hip replacement. It is especially important in the rehabilitation setting because it is potentially preventable. The purpose of this study was to investigate differences in dislocation rates between rehabilitation and acute hospital settings. A retrospective chart review of total hip and bipolar hemiarthroplasty patients admitted to three rehabilitation hospitals was performed. Dislocation rates among 825 rehabilitation patients who met study eligibility criteria were compared with rates found among 5352 acute care patients reported in the published literature. The rate of hip dislocation among total hip replacement patients in rehabilitation hospitals was not significantly higher than that in acute settings (2.17% v 1.27%). Among bipolar hemiarthroplasty patients, however, the dislocation rate was markedly and significantly lower in rehabilitation than in acute settings (0% v 1.95%, P<0.01). Possible reasons for these results are discussed. Further research is needed to identify risk factors more precisely for prosthesis dislocation.

Phlebotomy-related lateral antebrachial cutaneous nerve injury.

Stitik TP, Foye PM, Nadler SF, Brachman GO: Phlebotomy-related lateral antebrachial cutaneous nerve injury. Am J Phys Med Rehabil 2001;80:230–234.Although phlebotomy is a common and widespread procedure, the medical literature provides limited information in terms of the documented complications of venipuncture. Documentation of phlebotomy-related nerve injuries is even more limited. The authors present a case report of a phlebotomy-induced lesion of the lateral antebrachial cutaneous nerve. According to our literature search, this is the first case in which electrodiagnostic studies were used to document venipuncture-related injury of the lateral antebrachial cutaneous nerve. Specific electrodiagnostic testing is used to definitively diagnose this rare injury and to track recovery. Electrodiagnostic testing can be helpful in evaluating cases of sensory disturbance after phlebotomy.

Pharmacotherapy of osteoarthritis.

Stitik TP, Altschuler E, Foye PM: Pharmacotherapy of osteoarthritis. Am J Phys Med Rehabil 2006;85(Suppl):S15–S28.

Corticosteroid injections for osteoarthritis.

Stitik TP, Kumar A, Foye PM: Corticosteroid injections for osteoarthritis. Am J Phys Med Rehabil 2006;85(Suppl):S51–S65.