Physical Medicine Rehabilitation

Gait variability in women with hip osteoarthritis before and after total hip replacement: A prospective cohort study Objective Gait variability changes before and after total hip arthroplasty (THA) are unclear. This study aimed to investigate gait variability changes in hip osteoarthritis (OA) patients before and after THA and to examine the relationships between gait variability changes and hip function. Design Twenty-three female patients with hip OA (61.0±7.1 years) and 10 healthy female participants (57.8±3.9 years) were assessed 1 month before and 12 months after surgery. Heel and lower trunk accelerations were measured using two triaxial accelerometers. The coefficient of variation (CV) of stride time for gait variability of lower limb motions and the harmonic ratio (HR) for trunk variability were calculated. Radiographic leg-length discrepancy, hip abductor strength, hip abduction, extension range of motion (ROM), and pain level during gait were measured. Results CV was significantly decreased after THA and was comparable to that in healthy individuals. While postoperative HRs were greater than preoperative HRs, they were not comparable with those in healthy individuals. CV changes were associated with pain relief during gait. HR changes were associated with hip abductor strength, extension ROM, and limb lengthening. Conclusion Gait variability improved after THA due to improved hip function. However, trunk variability was insufficient compared to that in healthy individuals. Correspondence: Osamu Wada, Anshin Hospital, 1-4-12, Minatojima Minamimachi, Chuo-ku, Kobe City, Hyogo, Japan. Tel: +81-78-304-5252. Email: osamuw19841013@gmail.com Author Disclosures Funding or grants: None Financial benefits: None Previous presentation: None Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Bone Marrow Edema: A Case of Regional Migratory Osteoporosis Bone marrow edema represents a typical pattern on magnetic resonance imaging consisting of an area of abnormal bone signal with low to intermediate intensity on T1 weighted images and a high intensity on fat suppressed T2 weighted images. Bone marrow edema syndromes are a group of entities characterized by idiopathic bone marrow edema and osteoporosis. Regional migratory osteoporosis is a bone marrow edema syndrome characterized by a self-limited migrating arthralgia of the lower limbs not related to trauma or other events. Its clinical presentation is variable and may include a less frequent form of migration of the bone marrow edema within the same joint, illustrated here by means of a case report. Conservative treatment is the preferred approach to this condition and usually it resolves completely and with no sequelae. Physicians should be made aware of this condition in order to avoid unnecessary and costly diagnostic and therapeutic measures. Correspondence: All correspondence and requests for reprints should be addressed to: Tiago Pimenta, Department of Physical Medicine & Rehabilitation, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, PORTUGAL.E-mail: tiago.pmt@gmail.com. Phone number: (+351) 22 551 2100 Disclosures: no conflicts of interest related to the manuscript have been reported by the authors or by any individuals in control of the content of this article. No funding or equipment was provided for the project from any source. There are no financial benefits to the authors. This manuscript has not been previously submitted to any other publication. Authorship has been granted only to those individuals who have contributed substantially to the manuscript. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Pathological thoracic spine scoliosis due to ganglioneuroma No abstract available

Head Motion Predicts Transient Loss of Consciousness in Human Head Trauma: a Case-Control Study of Mixed Martial Artists Objective Concussion with transient loss of consciousness (tLOC) is a commonly observed but poorly understood phenomenon with mounting clinical significance. This study aimed to examine the relationship between head motion in varying planes and tLOC in athletes with brain injuries. Study Design A case-control design was utilized. The Ultimate Fighting Championship database was screened for events ending with knockouts (KO) from 2013 to 2016. Time of strike, striking implement, strike location, and head motion were recorded for all KO strikes (cases), and for a subset of non-KO strikes (controls). Characteristics of winners and losers were compared using 2-tailed t-tests. Multivariate logistic regression was used to determine odds ratios for strike characteristics associated with tLOC. The Kaplan-Meier estimate was used to describe the temporal distribution of KO's. Results 136 fights were identified and 110 videos were included. Head motion in the axial plane was strongly associated with tLOC (OR, 45.3; 95% CI, 20.8 - 98.6). Other predictors of tLOC were head motion in sagittal and coronal planes, non-fist striking implements and strikes to the mandible or maxilla. The Kaplan-Meier survival curve demonstrated a decreasing rate of KO's through time. Conclusion Rotational head acceleration, particularly in the axial plane, is strongly associated with tLOC. CORRESPONDENCES: Alexandra Fogarty, Washington University, PM&R Division, 4444 Forest Park Avenue, St Louis, MO. Tel: (314) 319-9807, alexandra.fogarty@wustl.edu DISCLOSURES: The authors have no competing interests. No funding, grants or equipment was provided for the project from any source. There were no financial benefits to the authors. The manuscript has not been previously presented or published. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Rapid Onset of Femoral Head Osteonecrosis after a Single Intraarticular Hip Joint Injection of Corticosteroid – A Case Report We outline a case in which osteonecrosis of the femoral head developed in temporal association with a single intraarticular injection of corticosteroid (triamcinolone acetonide) in a 72 year old woman, resulting in a total hip arthroplasty. We conclude that the risk of developing osteonecrosis after a single intraarticular injection of corticosteroid needs to be considered in the informed consent process. Corresponding Author: Erik Ensrud, MD, Sam Jackson Hall, Suite 2360, 3181 S.W. Sam Jackson Park Road, Portland, OR 97239. ph. 503-494-5661. fax. 503-494-5050. ensrud@ohsu.edu Sources of Funding: No funding was received. Disclosures: Authors AT and EE have nothing to disclose. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Extracorporeal shock wave therapy immediately affects Achilles tendon structure and widespread pressure pain thresholds in healthy people: a repeated-measures observational study Objectives Extracorporeal shockwave therapy (ESWT) is a common clinical treatment for tendinopathy, yet negative effects on tendon structure have been shown in animal studies. This study aimed to investigate the effect of ESWT in healthy participants (i.e. no Achilles tendon pain or pathology). Design This study examined the effect of three helpbouts of weekly ESWT over 3-weeks in 13 healthy participants. Outcomes measures assessed were; (1) Achilles tendon structure, quantified using ultrasound tissue characterisation (before and 3-hours post ESWT), (2) pressure pain thresholds, over the Achilles tendon and common extensor tendon origin (before, immediately after and 3-hours post ESWT) and (3) hop pain (before and immediately post ESWT). Results There was a significant reduction in echo-type-I (p<0.05) and increase in echo-type-II (p<0.05) at 3-hours after the first ESWT session that recovered to baseline levels before week 2. There were no significant changes in UTC echopattern observed in subsequent sessions. There were increased pressure pain thresholds (PPTs) immediately following ESWT at the common extensor tendon origin but no significant change at the Achilles tendon. PPTs returned to baseline at 3-hours after ESWT. There were no significant changes in PPT in subsequent sessions. Conclusions ESWT resulted in transient changes to tendon structure and widespread hyperalgesia. Disclosures Conflicts of Interest: None Funding or financial benefits: None Corresponding author: Dr. Ebonie Rio, 03 9479 3785, La Trobe Sport & Exercise Medicine Research Centre, La Trobe University, Bundoora VIC 3086, Australia. e.rio@latrobe.edu.au Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Does a web-based exercise programming system improve home exercise adherence for people with musculoskeletal conditions? Randomized controlled trial Objective To evaluate whether a web-based exercise programming system improves adherence to a home exercise program for people with musculoskeletal conditions. Design Eligible patients with a musculoskeletal condition presenting to a physical therapist in private practice were randomised to: 1) control (home exercise prescribed by therapist's usual methods), or 2) intervention (home exercise prescribed using a web-based exercise programming system). The primary outcome was self-rated exercise adherence measured at week 3 via 11-point numeric rating scales (NRS). Secondary outcomes were satisfaction with exercise delivery and confidence in ability to undertake prescribed exercise. Process measures were also included. Results We enrolled 305 participants, with loss-to-follow-up of 14.5% (22/152) and 13.7% (21/153) in intervention and control groups, respectively. Compared with controls, the intervention group reported higher exercise adherence (mean difference NRS units (95% confidence intervals): adherence overall -1.0 (-1.6,-0.3) and regarding number of exercises in session -0.7 (-1.3,-0.1), number of repetitions -0.8 (-1.4,-0.2) and number of sessions -1.0 (-1.6,-0.3)). The intervention group showed greater confidence to exercise than control, with no difference in satisfaction. Conclusions A web-based exercise programming system improved home exercise adherence and confidence in ability to undertake exercise, although the clinical relevance of the results needs to be established. Corresponding author: Dr Kim Bennell, Department of Physiotherapy, The University of Melbourne, Parkville, Victoria, 3010. ph: + 61 3 83444135, email: k.bennell@unimelb.edu.au Authors Disclosures: This trial was funded by the National Health and Medical Research Council (NHMRC, Program Grant #631717). Physitrack® provided use of the program as well as iPads for the physical therapists. Neither the funder nor Physitrack® had any role in the collection or analysis of the data nor in the interpretation of the findings. KLB is funded by a NHMRC Principal Research Fellowship (#1058440). RSH is funded by an Australian Research Council Future Fellowship (FTFT0991413). KB previously received funds as a consultant for Physitrack®. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Biceps femoris and semitendinosus conjoint tendon avulsion in a dancer No abstract available

One Year of Knee Pain in a 21-year-old Male Frisbee Player A 21-year-old male ultimate Frisbee player presented with one year of anterolateral right knee pain that was worse with activity. There was a remote history of trauma. Physical exam was unremarkable except for tenderness at the superolateral patella. X-ray revealed a bipartite patella. MRI revealed mild cystic change, sclerosis and bone marrow edema around the synchondrosis of the bipartite patella. Bipartite patella is an uncommon anatomic variant that is often asymptomatic and discovered incidentally; however, it rarely can be a primary cause of knee pain, can be diagnosed with MRI, and is amenable to conservative and surgical interventions. Treatment options are varied and include conservative management, injections, and various surgical approaches. Corresponding Author: Perry Zelinger, MD, 515 E. 82nd St. Apt 1C, New York, NY 10028, Perryzelinger@gmail.com, 516-317-0063 All authors have nothing to disclose No funding was received for this study. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Evidence-Based Physiatry: Relative Energy Deficiency in Sport (RED-S) No abstract available