Efficacy of quantifying marker-cluster rigidity in a multi-segment foot model: a Monte-Carlo based global sensitivity analysis and regression model.

Marker-based clinical gait analysis and multi-segment foot models (MSFM) have been successfully used for the diagnosis and clinical management of various lower limb disorders. The accuracy and validity of the kinematics measured depend on the design of the model, as well as on the adherence to its inherent rigid body assumption. This study applies a Monte-Carlo based global sensitivity analysis to evaluate the efficacy of using 'rigid body error ()' in quantifying the rigidity of a MSFM marker-cluster.

Static postural differences between neutral and flat feet in children with and without symptoms.

Background: Flatfoot is a common variant of foot posture. Whilst usually benign, in some children flatfoot is accompanied by pain and functional complaints. Comparisons between the posture of asymptomatic and symptomatic flat feet are few.

Lever arm dysfunction in cerebral palsy gait.

Skeletal structures act as lever arms during walking. Muscle activity and the ground reaction against gravity exert forces on the skeleton, which generate torque (moments) around joints. These lead to the sequence of movements which form normal human gait.

The hereditary predisposition to hip osteoarthritis and its association with abnormal joint morphology.

Objective: Genetic factors and abnormalities of joint morphology are important in the aetiology of hip osteoarthritis (OA). The extent to which genetic influences are manifest through joint morphology has undergone limited investigation. Using a cohort with an hereditary predisposition to end-stage hip OA and a control group with no inherited risk, we aimed to identify associations with abnormal joint morphology and clinical features.

Effect of different angles of knee flexion on leg extensor power in healthy individuals.

Objectives: To investigate the effect of fixed flexion knee deformity on leg extensor power as measured by the Nottingham leg extensor power rig.

Design: Cross-sectional observational study.

Setting: Orthopaedic hospital.

Referral proformas improve compliance to national colorectal 2-week wait targets: does this affect cancer detection rates?

Aim: To facilitate implementation of National Institute for Health and Clinical Excellence (NICE) guidelines for urgent colorectal cancer referral, local cancer networks have promoted the use of standardized proformas in primary care. This clinical audit assessed use of the proforma within the Thames Valley Cancer Network (TVCN) to see whether increased proforma use was associated with higher compliance to NICE guidelines and higher cancer detection rates.

Method: All 2-week wait referrals for lower bowel cancer to the six Acute NHS Trusts in the TVCN received during the month of June 2010 were identified, anonymized and analysed in relation to colorectal cancer detection rates.

Persistent non-specific low back pain and patients' experience of general practice: a qualitative study.

Aim: This paper aims to present a conceptual analysis of patients' experience of general practice in relation to their persistent non-specific low back pain (PLBP).

Background: PLBP accounts for a considerable amount of the daily workload of the general practitioner (GP). GPs need to maintain a good relationship with their patient while following guidelines for best practice.

Muscle power and function two years after unicompartmental knee replacement.

Unicompartmental knee replacement (UKR) is a commonly performed procedure, suitable for one in four patients requiring knee replacement for end-stage osteoarthritis. Recovery and return of function is quicker than with total knee replacement (TKR), but little information is known about the recovery of muscle power. We prospectively studied a cohort of forty four patients undergoing medial UKR to document their functional recovery and leg extensor power.

Facet joint injections as a means of reducing the need for vertebroplasty in insufficiency fractures of the spine.

Objectives: Recent publications compared treatment of vertebral fractures reporting improvement in the majority but with no significant difference between the local anaesthetic and vertebroplasty groups. Potential explanations include placebo response or therapeutic response to the "control procedure". We investigated whether preliminary facet joint injection can identify those patients whose pain arises from paravertebral structures rather than the vertebral insufficiency fracture itself.

Imaging in the assessment and management of overuse injuries in the foot and ankle.

Overuse injuries of the ankle and foot are common in the general and athletic populations. The wide spectrum of overuse injuries includes ligamentous injuries, soft tissue and osseous impingement, osteochondral lesions, tendon injuries, and stress fractures. Some conditions such as impingement syndromes and stress fractures may be missed on initial physical examination, and patients with such injuries often present to a sports or orthopedic clinic with persistent symptoms.

Efficacy of ultrasound-guided steroid injections for pain management of midfoot joint degenerative disease.

Objective: To examine the efficacy of ultrasound (US)-guided injections for midfoot joint degenerative changes.

Materials And Methods: The US images and radiographs of 63 patients with midfoot joint degenerative changes were retrospectively reviewed. In those patients who had US-guided intra-articular steroid injection, the response to the injection was recorded by reviewing the 2-week pain diaries and clinical notes.

Stress fractures in the young athlete: a pictorial review.

Stress fractures are an uncommon but important source of pain and disability in young athletes. The presentation and differential diagnosis of stress fractures in young athletes differs from that of older athletes. This pictorial review outlines the pathogenesis and imaging features of stress fractures.

Review of common and unusual causes of lateral ankle pain.

Lateral ankle pain is a common clinical presentation having several important causes, including lateral ligament injury, peroneal tendon injury, sinus tarsi syndrome, and nerve entrapments. However, other causes should be kept in mind in patients with unusual patterns of pain or intractable symptoms. We present a review of common and some unusual causes of lateral ankle pain including a review of post-operative imaging findings following surgery for lateral ankle ligament and peroneal tendon injuries.

Femoroacetabular impingement and classification of the cam deformity: the reference interval in normal hips.

Background And Purpose: Most patients with femoroacetabular impingement (FAI) have a cam deformity, which may be quantified by measuring the alpha angle and anterior offset ratio (AOR). Knowledge of what constitutes a "normal" alpha angle and AOR is limited. We defined the reference intervals of these measurements from normal hips in the general population.

Are pain and function better measures of outcome than revision rates after TKR in the younger patient?

Revision is the gold standard outcome measurement for survival analyses of orthopaedic implants but reliance on revision as an endpoint has been recently questioned. This study, that assesses long-term outcome in a specific group of patients who had undergone total knee replacement (TKR) for osteoarthritis, highlights the main problems facing modern survival analyses. Minimum 12-year survival and outcome data were reviewed for a series of sixty patients under the age of 60 years (mean age 55.

Divided by a lack of common language? A qualitative study exploring the use of language by health professionals treating back pain.

Background: The importance of using a common language when communicating to others about back pain is acknowledged in the literature. There are broadly three areas where difficulties in communication about back pain arise. Firstly, patients seeking information from health care professionals can experience difficulties understanding them and the medical literature; secondly, misunderstandings among health professionals concerning terminology can arise.

The role of foot and ankle assessment of patients with lower limb osteoarthritis.

Objectives: Physiotherapists do not routinely examine the feet of patients with lower limb osteoarthritis, and there is no widely used tool for measuring foot posture. However, differences in foot posture have been demonstrated between patients with medial compartment osteoarthritis of the knee and osteoarthritis of the hip, and guidelines for managing these patients include interventions such as orthotics which presume foot assessment. This study considers a new clinical tool, the Foot Posture Index (FPI).

Patients' views of a multimedia resource featuring experiences of rheumatoid arthritis: pilot evaluation of www.healthtalkonline.org.

The Internet is used increasingly for health information and patient support. Online health information users gravitate to websites that feature patient experiences. However, experiential accounts may mislead if they are unrepresentative.

A Jejunal Gastrointestinal Stromal Tumour: an unusual cause of massive acute gastrointestinal haemorrhage with emphasis on pre intervention MDCT.

Gastrointestinal stromal tumors (GIST) most commonly arise from the stomach followed by the small intestine and are common cause for an occult gastrointestinal (GI) bleeding. We present an unusual case of a jejunal GIST, which presented as an acute gastrointestinal haemorrhage. This case highlights the importance of an intravenous contrast enhanced abdominal CT with neutral oral contrast for the assessment of gastrointestinal bleeding where non-obstructive enhancing tumour, active extravasations and arteriovenous malformations (AVM) could potentially be obscured by the use of positive oral contrast.

Acquired adult flat foot due to isolated plantar calcaneonavicular (spring) ligament insufficiency with a normal tibialis posterior tendon.

Background: We present nine cases of acquired flat foot deformity (AFFD) in adults caused by isolated spring ligament insufficiency.

Methods: We present the clinical sign that allows differentiation of this diagnosis from posterior tibialis tendon (PTT) dysfunction namely the ability to single leg tiptoe, but with persistent forefoot abduction and heel valgus. In addition we illustrate the unique radiological features which allow confirmation of the diagnosis.

Comparison of two patient-based outcome measures for shoulder instability after nonoperative treatment.

This study compared the responsiveness and minimal clinically important differences of the Oxford Instability Shoulder Score (OISS) and Shoulder Rating Questionnaire (SRQ). Ninety-three patients referred to physiotherapy with shoulder instability (100 shoulders) completed the questionnaires at the initial appointment and at 1 and 9 months later. A subjective rating of change was also obtained.

Native hip joint septic arthritis in 20 adults: delayed presentation beyond three weeks predicts need for excision arthroplasty.

Objectives: Septic arthritis of native hip joints is an uncommon condition in adults in Western Europe, but continues to present a challenge to medical and surgical management. We set out to study the natural history and bacteriology of the disease in this group, with a particular focus on patients requiring excision arthroplasty (EA).

Methods: We retrospectively studied 26 secondary referral cases (20 adults) managed by a specialist bone infection unit over a 12 year period.

After partial knee replacement, patients can kneel, but they need to be taught to do so: a single-blind randomized controlled trial.

Background And Purpose: Kneeling is an important functional activity frequently not performed after knee replacement, thus affecting a patient's ability to carry out basic daily tasks. Despite no clinical reason preventing kneeling, many patients fail to resume this activity. The purpose of this study was to determine whether a single physical therapy intervention would improve patient-reported kneeling ability following partial knee replacement (PKR).