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Dustin J. Oranchuk, André R. Nelson, Adam G. Storey and John B. Cronin

, preferentially increasing distal MT and force production at long muscle lengths. 1 , 3 , 4 , 11 , 12 Two-dimensional B-mode ultrasonography is a commonly used technique to assess MT and PA, and to calculate FL. In addition to ultrasonography, the extended field-of-view (EFOV) technique, where a panoramic view of

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Josep C. Benítez-Martínez, Pablo Martínez-Ramírez, Fermín Valera-Garrido, Jose Casaña-Granell and Francesc Medina-Mirapeix

.1177/03635465020300040701 12130402 10.1177/03635465020300040701 6. Khan KM , Cook JL , Kiss ZS , et al . Patellar tendon ultrasonography and jumper’s knee in female basketball players: a longitudinal study . Clin J Sport Med . 1997 ; 7 ( 3 ): 199 – 206 . PubMed ID: 9262888 doi:10.1097/00042752-199707000-00009 10

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Jacinto Javier Martínez-Payá, José Ríos-Díaz, María Elena del Baño-Aledo, David García-Martínez, Ana de Groot-Ferrando and Javier Meroño-Gallut

The objective of this observational cross-sectional study was to investigate the normal motion of the median nerve when stretched during a neurodynamic exercise. In recent years, ultrasonography has been increasingly accepted as an imaging technique for examining peripheral nerves in vivo, offering a reliable and noninvasive method for a precise evaluation of nerve movement. Transverse motion of the median nerve in the arm during a neurodynamic test was measured. A volunteer sample of 22 healthy subjects (11 women) participated in the study. Nerve displacement and deformation were assessed by dynamic ultrasonography. Excellent interobserver agreement was obtained, with kappa coefficient of .7–.8. Ultrasonography showed no lateral motion during wrist extension in 68% of nerves, while 73% moved dorsally, with statistically significant differences between sexes (ORlat = 6.3; 95% CI = 1.4–27.7 and ORdor = 8.3; 95% CI = 1.6–44.6). The cross-sectional area was significantly greater in men (3.6 mm2). Quantitative analysis revealed no other statistically significant differences. Our results provide evidence of substantial individual differences in median nerve transverse displacement in response to a neurodynamic exercise.

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Theodore Croy, Susan Saliba, Ethan Saliba, Mark W. Anderson and Jay Hertel

Introduction:

Quantifying talocrural joint laxity after ankle sprain is problematic. Stress ultrasonography (US) can image the lateral talocrural joint and allow the measurement of the talofibular interval, which may suggest injury to the anterior talofibular ligament (ATFL). The acute talofibular interval changes after lateral ankle sprain are unknown.

Methods:

Twenty-five participants (9 male, 16 female; age 21.8 ± 3.2 y, height 167.8 ± 34.1 cm, mass 72.7 ± 13.8 kg) with 27 acute, lateral ankle injuries underwent bilateral stress US imaging at baseline (<7 d) and on the affected ankle at 3 wk and 6 wk from injury in 3 ankle conditions: neutral, anterior drawer, and inversion. Talofibular interval (mm) was measured using imaging software and self-reported function (activities of daily living [ADL] and sports) by the Foot and Ankle Ability Measure (FAAM).

Results:

The talofibular interval increased with anterior-drawer stress in the involved ankle (22.65 ± 3.75 mm; P = .017) over the uninvolved ankle (19.45 ± 2.35 mm; limb × position F1,26 = 4.9, P = .035) at baseline. Inversion stress also resulted in greater interval changes (23.41 ± 2.81 mm) than in the uninvolved ankles (21.13 ± 2.08 mm). A main effect for time was observed for inversion (F2,52 = 4.3, P = .019, 21.93 ± 2.24 mm) but not for anterior drawer (F2,52 = 3.1, P = .055, 21.18 ± 2.34 mm). A significant reduction in the talofibular interval took place between baseline and week 3 inversion measurements only (F1,26 = 5.6, P = .026). FAAM-ADL and sports results increased significantly from baseline to wk 3 (21.9 ± 16.2, P < .0001 and 23.8 ± 16.9, P < .0001) and from wk 3 to wk 6 (2.5 ± 4.4, P = .009 and 10.5 ± 13.2, P = .001).

Conclusions:

Stress US methods identified increased talofibular interval changes suggestive of talocrural laxity and ATFL injury using anterior drawer and inversion stress that, despite significant improvements in self-reported function, only marginally improved during the 6 wk after ankle sprain. Stress US provides a safe, repeatable, and quantifiable method of measuring the talofibular interval and may augment manual stress examinations in acute ankle injuries.

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Manuel Trinidad-Fernández, Manuel González-Sánchez and Antonio I. Cuesta-Vargas

). Figure 1 —References system in scapula and processing of the ultrasonography images. (A) With ImageJ, we marked the angle between the rib and the medial border of the scapula in 2 different positions. (B) We selected the medial border of the scapula in the first position in order to perform the cross

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In-Ho Jeon, Hemanshu Kochhar, Jong-Min Lee, Hee-Soo Kyung, Woo-Kie Min, Hwan-Sung Cho, Ho-Wug Wee, Dong-Joo Shin and Poong-Taek Kim

Context:

Wheelchair tennis has been identified as a high-risk sport for shoulder injury, so understanding shoulder pathology in these athletes is important.

Objective:

This study investigated the incidence and pattern of shoulder injuries in wheelchair tennis players using high-resolution ultrasonography.

Design:

Descriptive study.

Setting:

International Wheelchair Tennis Open.

Participants:

33 elite-level wheelchair tennis players.

Outcome Measures:

Wheelchair tennis players completed a self-administered questionnaire, and shoulders of each athlete were investigated using high-resolution ultrasonography (linear probe 7.5 MHz).

Results:

The most common pathology in the dominant shoulder was acromioclavicular pathology, in 21 players (63.6%). Full-thickness rotator-cuff tears involving the supraspinatus were found in 8 dominant shoulders and 6 nondominant shoulders. There were no correlations between identified shoulder pathology and the different variables studied, such as age, training time per day, length of wheelchair use, and length of career as a wheelchair tennis player.

Conclusion:

High prevalence of rotator-cuff and acromioclavicular pathology was found by ultrasonographic examination in the elite wheelchair tennis players in both dominant and nondominant shoulders. A high index of suspicion of these pathologies in wheelchair athletes is required.

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Senshi Fukashiro, Dean C. Hay and Akinori Nagano

This paper reviews the research findings regarding the force and length changes of the muscle-tendon complex during dynamic human movements, especially those using ultrasonography and computer simulation. The use of ultrasonography demonstrated that the tendinous structures of the muscle-tendon complex are compliant enough to influence the biomechanical behavior (length change, shortening velocity, and so on) of fascicles substantially. It was discussed that the fascicles are a force generator rather than a work generator; the tendinous structures function not only as an energy re-distributor but also as a power amplifier, and the interaction between fascicles and tendinous structures is essential for generating higher joint power outputs during the late pushoff phase in human vertical jumping. This phenomenon could be explained based on the force-length/velocity relationships of each element (contractile and series elastic elements) in the muscle-tendon complex during movements. Through computer simulation using a Hill-type muscle-tendon complex model, the benefit of making a countermovement was examined in relation to the compliance of the muscle-tendon complex and the length ratio between the contractile and series elastic elements. Also, the integral roles of the series elastic element were simulated in a cyclic human heel-raise exercise. It was suggested that the storage and reutilization of elastic energy by the tendinous structures play an important role in enhancing work output and movement efficiency in many sorts of human movements.

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Josep C. Benitez-Martinez, Jose Casaña-Granell, Yasmin Ezzatvar de Llago, Carlos Villaron-Casales, Gemma V. Espi-Lopez and Fernando Jimenez-Diaz

Context:

The supraspinatus muscle has an important role in the stabilization of the glenohumeral joint. Identifying abnormalities concerning its size and the subacromial space in the presence of pain may be relevant to provide more specific treatments focused on the etiology of pain.

Objective:

To determinate whether painful shoulder causes changes in the supraspinatus cross-sectional area (CSA) and the acromio-humeral distance (AHD) between overhead athletes.

Design:

Cross-sectional study.

Setting:

University campus and local sports clubs’ Physical Therapist room.

Participants:

81 male overhead athletes were divided into 2 groups according to the presence of shoulder pain and clinical symptoms.

Main Outcome Measures:

Ultrasonography measurements of the supraspinatus CSA and the AHD in 2 groups of overhead athletes with and without pain.

Results:

In the pain group, the CSA was significantly smaller compared with the no pain group. No differences between groups were found in the AHD measurement.

Conclusions:

Shoulder pain in overhead athletes was associated with a reduction in their supraspinatus muscle CSA, but not in the AHD. These findings suggest that muscle atrophy exists in the presence of pain. However, in active overhead athletes, the AHD is not clearly reduced in overhead athletes with shoulder pain. Further studies are needed to understand this condition.

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Keitaro Kubo, Takanori Teshima, Norikazu Hirose and Naoya Tsunoda

The purpose of this study was to compare the morphological and mechanical properties of the human patellar tendon among elementary school children (prepubertal), junior high school students (pubertal), and adults. Twenty-one elementary school children, 18 junior high school students, and 22 adults participated in this study. The maximal strain, stiffness, Young’s modulus, hysteresis, and cross-sectional area of the patellar tendon were measured using ultrasonography. No significant difference was observed in the relative length (to thigh length) or cross-sectional area (to body mass2/3) of the patellar tendon among the three groups. Stiffness and Young’s modulus were significantly lower in elementary school children than in the other groups, while no significant differences were observed between junior high school students and adults. No significant differences were observed in maximal strain or hysteresis among the three groups. These results suggest that the material property (Young’s modulus) of the patellar tendons of elementary school children was lower than that of the other groups, whereas that of junior high school students was already similar to that of adults. In addition, no significant differences were observed in the extensibility (maximal strain) or viscosity (hysteresis) of the patellar tendon among the three groups.

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Tetsuro Muraoka, Tadashi Muramatsu, Daisuke Takeshita, Hiroaki Kanehisa and Tetsuo Fukunaga

This study estimated the passive ankle joint moment during standing and walking initiation and its contribution to total ankle joint moment during that time. The decrement of passive joint moment due to muscle fascicle shortening upon contraction was taken into account. Muscle fascicle length in the medial gastrocnemius, which was assumed to represent muscle fascicle length in plantarflexors, was measured using ultrasonography during standing, walking initiation, and cyclical slow passive ankle joint motion. Total ankle joint moment during standing and walking initiation was calculated from ground reaction forces and joint kinematics. Passive ankle joint moment during the cyclical ankle joint motion was measured via a dynamometer. Passive ankle joint moment during standing and at the time (Tp) when the MG muscle-tendon complex length was longest in the stance phase during walking initiation were 2.3 and 5.4 Nm, respectively. The muscle fascicle shortened by 2.9 mm during standing compared with the length at rest, which decreased the contribution of passive joint moment from 19.9% to 17.4%. The muscle fascicle shortened by 4.3 mm at Tp compared with the length at rest, which decreased the contribution of passive joint moment from 8.0% to 5.8%. These findings suggest that (a) passive ankle joint moment plays an important role during standing and walking initiation even in view of the decrement of passive joint moment due to muscle fascicle shortening upon muscle contraction, and (b) muscle fascicle shortening upon muscle contraction must be taken into account when estimating passive joint moment during movements.