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The Journal of Bone and Joint Surgery. British volumeVol. 87-B, No. 11 Aspects of Current ManagementFree AccessCurrent concepts in the management of femoroacetabular impingementJ. R. Crawford, R. N. VillarJ. R. CrawfordOrthopaedic Specialist RegistrarCambridge Hip and Knee Unit, BUPA Cambridge Lea Hospital, Impington, Cambridge CB4 9EL, UK.Search for more papers by this author, R. N. VillarConsultant Orthopaedic SurgeonCambridge Hip and Knee Unit, BUPA Cambridge Lea Hospital, Impington, Cambridge CB4 9EL, UK.Search for more papers by this authorPublished Online:1 Nov 2005https://doi.org/10.1302/0301-620X.87B11.16821AboutSectionsPDF/EPUB ToolsDownload CitationsTrack CitationsPermissionsAdd to Favourites ShareShare onFacebookTwitterLinked InRedditEmail Secondary osteoarthritis of the hip occurs due to a known precipitating cause. In primary or idiopathic osteoarthritis the cause remains unknown although some studies1,2 have suggested that femoroacetabular impingement (FAI) may be responsible for the progression of degenerative changes in this group of patients. FAI is a distinct pathological entity and can be defined as the abutment between the proximal femur and the acetabular rim.3 It affects active, young adults and presents clinically with groin pain. FAI can occur either in patients with an abnormal morphology of the hip or in patients with a normal anatomical structure but who have an excessive range of hip movement.Mechanism of femoroacetabular impingementA widening of the femoral neck or a decreased offset at the anterolateral head-neck junction results in decreased joint clearance.4 This results in repetitive contact between the femoral neck and the acetabular rim which is responsible for a range of injuries including anterior hip pain, labral tears and damage to the acetabular articular cartilage.5 Several studies have shown that FAI can cause a progressive degenerative process and lead to early osteoarthritis of the hip.1,2,6,7There are two distinct types of FAI. The first type, ‘cam impingement’, is more common in young, athletic men. It is commonly due to a nonspherical portion of the femoral head abutting against the acetabular rim especially in flexion and internal rotation.1,8 This causes an outside-in abrasion of the acetabular cartilage which may result in its avulsion from the labrum and subchondral bone. Damage to the acetabular cartilage occurs in the anterosuperior area of the acetabulum and can lead to separation of cartilage from the labrum.9The second type of FAI, ‘pincer impingement’, is more common in middle-aged athletic women. It is due to the contact between the femoral head-neck junction and the acetabular rim. Repeated abutment leads to degeneration of the labrum resulting in intrasubstance ganglion formation, ossification of the acetabular rim and deepening of the acetabulum. The chondral damage is located more circumferentially and usually includes only a narrow strip of acetabular cartilage. Changes in the labrum occur at adjacent areas often present as ossification of the labrum.9Cam and pincer impingement rarely occur in isolation. In their study of 149 hips, Beck et al9 found that only 26 hips had an isolated cam and 16 hips had an isolated pincer impingement. They found that most cases of FAI involve a combination of these two mechanisms and are classified as having mixed campincer impingement.Histologically, FAI is characterised by a gentle chronic irritation of the labrum located at the site of rupture that elicits a degenerative reaction.10 In a study of 25 patients with symptomatic FAI, there was no difference in the histopathological features of the acetabular labrum between cam and pincer impingement.10AetiologySeveral predisposing conditions reduce the femoral head-neck offset resulting in cam impingement.1 These include slipped capital femoral epiphysis with posterior tilt of the femoral head,2,11 femoral head necrosis with subsequent flattening,12 previous fracture of the femoral neck with minor rotational mal-union13 or a femoral head with a nonspherical extension anterosuperiorly.14 Histological analysis of these resected nonspherical lesions suggests that this is the cause of the impingement rather than the result of repetitive trauma.15Pincer impingement may be due to acetabular retroversion where the anterolateral acetabular edge obstructs flexion16 or due to coxa profunda which increases the relative depth of the acetabulum.17Establishing a diagnosisFAI effects young and middle-aged active adults who typically present with groin pain and little or no history of precipitating trauma. The pain is usually exacerbated by activities and also by sitting for long periods. Clinical examination reveals some restriction of movement of the hip especially in flexion with adduction and internal rotation and a positive impingement test.18 Posteroinferior impingement can be detected by extending the patient’s legs over the end of the bed and rotating them externally which reproduces their symptoms.Plain radiographs of the hip may detect underlying bony abnormalities. The anteroposterior view may show a flattened head-neck junction or pistol-grip deformity of the proximal femur.19 Herniation pits are often present in the femoral neck.20,21 The lateral radiograph can also show a pistol-grip deformity with a resultant loss of the anterior femoral neck offset.5 There may be specific acetabular changes present such as an os acetabulare or ossification of the acetabular rim. More generalised changes detectable radiologically include hip dysplasia, coxa vara, coxa valga, protrusio acetabuli and coxa profunda.Magnetic resonance imaging (MRI) is now commonly used in the evaluation of hip pain in the young adult, particularly if plain radiographs are normal. One study has found reduced femoral neck anteversion and head-neck offset on MRI scans of hips in patients with symptomatic impingement.1 Magnetic resonance arthrography (MRA) is fast becoming the standard investigation for FAI. It is helpful in detecting nonsphericity of the femoral head, a decreased head-neck offset, herniation pits or rim ossification. MRA is also good at detecting labral tears and chondral damage but has poor specificity for detecting chondral separations that remain undetached.Non-operative treatmentAn initial trial of non-operative treatment for patients presenting with FAI is recommended by some authors.3 This may include modification of activity, avoiding excessive hip movement and regular non-steroidal anti-inflammatory medication. Usually, only temporary relief of symptoms is achieved and surgical intervention may subsequently be required.Operative treatmentThe aim of surgery is to improve the clearance for hip movement and to alleviate the abutment of the proximal femur against the acetabular rim.3 Both open17,22,23 and arthroscopic24 techniques have been described. For either technique it is important to address both the damage to the labrum and the underlying cause.9Open surgery for femoroacetabular impingementOperative technique.The open surgical approach is a well-recognised technique for the treatment of FAI.3,22 The patient is placed in the lateral position and either a lateral or a posterior approach can be used. A trochanteric osteotomy is usually performed to improve exposure. Care must be taken to protect the medial femoral circumflex artery which is the main blood supply to the femoral head. Specific sites of FAI may be identifiable before dislocation of the hip. Dislocation is necessary to provide a 360° view of both the femoral head and the acetabulum.If the femoral head-neck junction is the cause of FAI due to a nonspherical femoral head or a prominent anterior femoral neck then an excision osteoplasty can be performed. The aim is to recreate the normal concave contour of the femoral neck by sequential osteotomies of small sleeves of bone from the femoral head-neck junction.3 In one cadaver study, it has been shown that the total amount of bone resected should not exceed 30% of the antero-lateral quadrant of the head-neck junction due to the increased risk of a subsequent fracture.25Retroversion of the acetabulum describes a posteriorly-orientated acetabular opening with reference to the sagittal plane.16 It is a predisposition to the development of osteoarthritis.26 The prominent anterolateral rim of the acetabulum can affect hip flexion and internal rotation, causing impingement with subsequent anterior labral disruption and adjacent cartilage lesions.4 This can be treated by resection of the excessive anterior acetabular rim. Alternatively, some authors advocate performing a periacetabular osteotomy as an effective way to reorientate the acetabulum. In one study of 29 patients, 26 had a good or excellent result after this procedure.27If the acetabular articular cartilage remains intact but there is a lack of posterior cover, a reverse periacetabular osteotomy can be performed.3 If there is adequate posterior cover an excision osteoplasty may be preferred. Any labral tears should be treated with partial resection or repair as appropriate.Results of open surgeryOutcomes after open surgical procedures for the treatment of FAI have been encouraging. In a study of 19 patients undergoing open surgery with a mean follow-up of 4.7 years, 14 had a good outcome and there were no cases of osteonecrosis.17 In another study, 23 patients underwent open surgical debridement and were followed up for between two and 12 years.23 At their last follow-up seven patients had required total hip arthroplasty, one had a further arthroscopic debridement of a recurrent labral tear and 15 had no further surgery. No patients in this study developed osteonecrosis.Arthroscopic surgery for femoroacetabular impingementOperative technique.Arthroscopic assessment of the hip can include examination of both the central and peripheral compartments.28 The central compartment includes the labrum and all structures located further medially. The peripheral compartment consists of all the structures that are lateral to the labrum but are inside the capsule which includes the femoral head, the femoral neck with its synovial folds and the joint capsule itself.29 Arthroscopy of the peripheral compartment is increasingly undertaken and is certainly indicated when impingement from osteophytes is suspected.30Hip arthroscopy can be performed with the patient placed in the lateral or supine position31–33 with traction applied using a standard distractor and a perineal post. Image-intensifier screening is essential to ensure safe entry of the guide wire and trocars into the joint. Anterolateral and anterior portals are usually required and an additional posterolateral portal may be used if necessary. Characteristic findings include a tear of the labrum anterolaterally and damage to the acetabular cartilage anteriorly which can also extend from the mid-lateral to the posterior portions.24 The labral lesions and any areas of chondral damage are debrided until they are stable.34 Labral repair may be possible for specific tears although the long-term outcome is not yet known.35 For areas of exposed subchondral bone a microfracture technique36 may be performed.After completing arthroscopy of the central compartment, the traction is released and the peripheral compartment is entered with the arthroscope from the anterolateral portal (Fig. 1). A partial capsulectomy may be required to achieve a satisfactory exposure.24 Any osteophytes located around the femoral head-neck junction can be resected using a burr or a radiothermal device to restore the concavity of the femoral neck (Figs 2 and 3). The external portion of the labrum can also be visualised and rim osteophytes can be resected.Results of arthroscopic surgeryArthroscopy has helped to determine the role of FAI in the development of labral tears and to establish appropriate treatment.37 Favourable results have been reported for the treatment specifically of FAI.24 In a study of 158 patients who underwent arthroscopic surgery, most patients found that 50% of their pain had resolved by three months, 75% by five months and 95% by one year. These results are comparable with those reported for open procedures,17 although the patients recovered much earlier after arthroscopic surgery.Outcome and future developmentsFrom the limited number of studies performed addressing the treatment of FAI, surgery gives good results in patients with early degenerative changes of the hip. However, it is not as effective in patients with extensive articular damage or advanced osteoarthritis.Initial results of arthroscopic surgery for FAI are very favourable and allow a faster post-operative recovery. Early correction of FAI may improve hip pain but long-term studies are still required to determine whether such treatment prevents the progression of osteoarthritis of the hip.Fig. 1 Flouroscopic image showing the arthroscope in the peripheral compartment at the inferior aspect of the femoral neck.Fig. 2 Operative photograph showing an impingement lesion at the antero-superior aspect of the femoral neck (FH, femoral head; IL, impingement lesion; C, capsule).Fig. 3 Operative photograph showing resection of the impingement lesion using a burr (FH, femoral head; IL, impingement lesion; C, capsule).References1 Ito K, Minka MA 2nd, Leunig M, Werlen S, Ganz R. Femoroacetabular impingement and the cam-effect: a MRI based quantitative anatomical study of the femoral head-neck offset. J Bone Joint Surg [Br] 2001;83-B:171–6. Link, Google Scholar2 Leunig M, Casillas MM, Hamlet M, et al. 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Arthroscopic treatment of femoroacetabular impingement. Techniques in Orthopaedics 2005;20:56–62. Crossref, Google Scholar25 Mardones RM, Gonzalez C, Chen Q, et al. Surgical treatment of femoroacetabular impingement: evaluation of the effect of size of the resection. J Bone Joint Surg [Am] 2005;87-A:273–9. Google Scholar26 Tonnis D, Hienecke A. Acetabular and femoral anteversion: relationship with osteoarthritis of the hip. J Bone Joint Surg [Am] 1999;81-A:1747–70. Crossref, Google Scholar27 Siebenrock KA, Schoeniger R, Ganz R. Anterior femoro-acetabular impingement due to acetabular retroversion: treatment with peracetabular osteotomy. J Bone Joint Surg [Am] 2003;85-A:278–86. Crossref, Medline, ISI, Google Scholar28 Dorfmann H, Boyer T. Arthroscopy of the hip: 12 years of experience. Arthroscopy 1999;15:67–72. Medline, ISI, Google Scholar29 Dienst M, Godde S, Seil R, Hammer D, Kohn D. Hip arthroscopy without traction: in vivo anatomy of the peripheral hip joint cavity. 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The Journal of Bone and Joint Surgery. British volumeVol. 87-B, No. 2 AnnotationsFree AccessThe use of outcome scores in surgery of the shoulderP. Harvie, T. C. B. Pollard, R. J. Chennagiri, A. J. CarrP. HarvieSpecialist Registrar in Trauma and OrthopaedicsThe John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK.Search for more papers by this author, T. C. B. PollardClinical Research FellowDepartment of Orthopaedics, Frenchay Hospital, Park Road, Frenchay, Bristol BS16 1LE, UK.Search for more papers by this author, R. J. ChennagiriSpecialist Registrar in Trauma and OrthopaedicsThe John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK.Search for more papers by this author, A. J. CarrNuffield Professor of Orthopaedic SurgeryNuffield Department of Orthopaedic Surgery, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford OX3 7LD, UK.Search for more papers by this authorPublished Online:1 Feb 2005https://doi.org/10.1302/0301-620X.87B2.15305AboutSectionsView articleSupplemental MaterialPDF/EPUB ToolsDownload CitationsTrack CitationsPermissionsAdd to Favourites ShareShare onFacebookTwitterLinked InRedditEmail View articleThe pursuit of ‘best practice’, health economic planning, the increasing awareness and expectations of patients, pressure from politicians and the media, and the emergence of league tables for surgeons are some of the reasons why orthopaedic surgeons are encouraged to adopt evidence-based strategies for managing their patients. Levels of evidence have been devised which allow publications to be ranked or given a grade of recommendation.1,2 The highest levels are assigned to well-designed, randomised, controlled trials and systematic reviews of such trials.Lower levels are offered by cohort studies in which patients are compared with a control group treated at the same time and in the same institution. Such studies are ranked higher than randomised trials of poor quality, retrospective cohort studies or case-control studies. Individual case series and poorly designed cohort studies are lower still while the final level is expert opinions without critical appraisal and descriptive studies or reports from expert committees (Table I). Proper studies require good design and the use of validated outcome measures. We have carried out a systematic review of the use of outcome scores and research methods in surgery of the shoulder to establish whether the literature provides suitable evidence on which to establish best practice.Review of the literatureA systematic review was undertaken of all articles relating to the shoulder published in the Journal of Shoulder and Elbow Surgery, the Journal of Bone and Joint Surgery [Br] and the Journal of Bone and Joint Surgery [Am] between January 1992 and December 2002. After manual searching, all papers which documented any form of clinical outcome were included for more detailed review.3–53 Those relating to anatomy, pathology, biomechanics, engineering design or technical aspects which did not involve a clinical outcome were excluded. Each paper chosen was placed into one of 16 broad categories according to its subspecialty. The exact number of patients studied as well as the minimum, maximum and mean periods of follow-up were recorded. A ‘grade of recommendation’ and ‘level of evidence’ were assigned to each paper in accordance with the standards shown in Table I. All criteria used to describe a clinical outcome were recorded, whether in the form of observations such as power or range of movement, or by the use of a recognised scoring system. Each paper was reviewed to ascertain whether a description of the outcome method used and the reasons for its selection were included in the text. In particular, we looked for details of the original group of patients on which any outcome score was based. An outcome score was regarded as appropriate if it was used unmodified for a validated group of patients.ResultsWe reviewed 1106 articles relating to surgery on the shoulder. Of these, 496 were excluded on the basis of non-clinical content. The remaining 610 underwent more detailed review. There were 198 case reports and 379 cohort studies, the latter including 19 RCTs, but no systematic reviews (Table I). The mean sample size was 42 (1 to 1063). The overall mean follow-up was 27 months (1 to 540) with a minimum of 12 (1 to 540) and a maximum of 68 months (1 to 540). A formal outcome was described in 569 (93.3%) articles. Of these, 271 (47.6%) used clinical assessment, 217 (38.1%) an outcome score and 81 (14.2%) both. A total of 44 different outcome scores were encountered, 22 clinician-based (50.0%), 21 patient-based (47.7%) and one clinician- and patient-based (2.3%). Of 439 applications of an outcome score, 266 (60.6%) were clinician-based, 105 (23.9%) patient-based and 68 (15.5%) clinician- and patient-based. Trends in the use of the different types of score are shown in Figure 1. Of 298 articles using outcome scores, 126 (42.3%) described the details of the score within the text, but only eight (2.7%) made clear the reasons for the choice of the particular score.Closer scrutiny of the use of clinical assessment in 352 articles showed a mean of 2.3 observations (1 to 6) per article. Those used were range of movement (208), pain (202), function/activities of daily living (129), power (88), radiological appearance (83), patient satisfaction (67) and stability (47). In the 298 articles using a formal outcome score a mean of 1.5 outcomes (1 to 6) was used per article. Overall, of the 439 applications of an outcome score 282 (64.2%) were regarded as being appropriate (Fig. 2). All formal outcome measures identified during the course of this review are listed.DiscussionThe proposal that clinical outcome in orthopaedic surgery could be analysed systematically so that patients would receive increased benefits from their treatment was first introduced by Codman et al3 in the second decade of the 20th century, and is the basis of his concept of the “End Result”. Unfortunately, his peers did not share his enthusiasm. Codman’s frustration culminated at a meeting on January 6, 1915 in which he ridiculed his colleagues and members of the hospital board, portraying them in a large cartoon as an ostrich burying its head in the sand and choosing to ignore what was happening around it. Codman’s career declined thereafter and he died in relative anonymity. Systematic reviews of randomised, controlled trials offer the maximum levels of evidence upon which clinical decisions can be based. No such reviews were found in the course of this investigation. Although 19 randomised, controlled trials (3.1%) were identified, 538 papers (88.2%) described case series offering low levels of evidence. The undertaking of a randomised, controlled trial for a surgical procedure is costly and time-consuming. Nevertheless, increased use of cohort or case-control studies would considerably improve the level of evidence available.The use of validated outcome scores allows comparisons to be made between studies. If scores are modified or used on inappropriate groups of patients, such comparisons are flawed. The European Society for Surgery of the Shoulder and Elbow and the Japanese Orthopaedic Association have each given guidance on the preferred use of outcome scores. However, such recommendations are not uniformly accepted. Our review has shown that study cohorts are generally small, periods of follow-up short and levels of evidence low. The overall pattern of the application of an outcome score is highly variable and at times inappropriate. We have identified changes made to outcome scores, often without proper testing of the modification and without justification. For example, the Neer rating4 was initially used to assess the outcome of displaced fractures of the proximal humerus, but was modified to assess total shoulder arthroplasty5 and, more recently, repair of the rotator cuff,6 although its formal statistical validation for use with these differing groups has not been undertaken.The score of Constant and Murley7 is widely used, but large variations occur in how it is formulated. Pain is often assessed using separate visual analogue scales, the methods of measuring power vary and, most importantly, the fact that scores should be normalised for age and gender is selectively ignored.8 The application of objective clinical assessment of pain, range of movement, power and stability are acceptable means of measuring outcome. However, the means by which such assessments are measured and documented and the number of such criteria used in studies is variable. Scores may be patient-based such as the Oxford shoulder score,9 clinician-based as the Constant-Murley score or a combination of both as in the modified American Shoulder and Elbow Surgeons form.10 There are condition-specific scores such as the Oxford shoulder instability score11 and non-condition-specific scores such as the simple shoulder test.12 In recent years there has been a proliferation of patient-based outcome scores recognising the benefits of such scores compared with clinician-based assessments. The latter are susceptible to bias and error, and may not represent the view of the patient.13 Patient-based scores are designed for use in clinical trials and are valid for comparing and aggregating cohort studies.14–16 Their use will directly improve levels of evidence. Despite the trend to move away from the application of clinician-based outcome scores, our review has shown that in practice the magnitude of this shift is highly variable. Over the last decade the use of clinician-based scores has remained high. An overall understanding of the initial population upon which scores were first based is lacking. Newer scores such as the shoulder pain and disability index (SPADI)17 were initially based on a cohort of 37 male patients with shoulder pain which was either musculoskeletal, neurogenic or of unknown aetiology. The patient self-reporting section of the modified American Shoulder and Elbow Surgeons assessment form (M-ASES) has undergone validation. However, this was based on only 63 patients, 25 of whom had impingement, but only one had undergone hemiarthroplasty and two had tears of the rotator cuff.18 The use of outcome scores on cohorts for which they have not been validated casts doubt on the validity of the results.ConclusionForty-four different outcome scores were encountered in the course of this review, many being applied inappropriately. There is a trend towards the increased use of validated patient-based scores, but many have not been properly tested for validity, repeatability and sensitivity to change. Scores are not valid when used in a modified form and their use should be discouraged. Levels of evidence were generally low, with 88.2% of level 4, and with only a small number of RCTs. Improvement in the design of the studies and the use of appropriately validated outcome scores would substantially increase the levels of evidence on which to base best practice in surgery of the shoulder.Supplementary materialA table showing the list of outcome scores identified in the course of this review is available with the electronic version of this article, on our website at www.jbjs.org.uk.Table I. Hierarchy of evidence of reviewed papers with sample sizes and minimum, maximum and mean follow-up (range)Follow-up (mths)Grade of recommendationLevel of evidenceStudy designNumberSample sizeMinimumMaximumMeanA1aSystematic review (with homogeneity) of randomised, controlled trials0NANANANA1bIndividual randomised, controlled trials with independent blinding1285 (29 to 245)24 (3 to 120)32 (3 to 120)24 (3 to 120)1c‘All-or-none’ case series162124925B2aSystematic review (with homogeneity) of cohort studies0NANANANA2bIndividual cohort studies and low-quality randomised, controlled trials2573 (6 to 300)24 (1 to 180)66 (1 to 120)36 (1 to 194)2cOutcomes research29184 (8 to 1063)NANANA3aSystematic review of case-control studies0NANANANA3bIndividual case-control studies5154 (29 to 538)30 (5 to 120)32 (12 to 120)37 (9 to 120)C4Case series and poor-quality cohort and case-control studies538131 (1 to 667)22 (1 to 540)68 (1 to 540)27 (1 to 540)D5Expert opinion without explicit critical appraisal0NANANANAFig. 1 Proportion of combined and clinician- and patient-based scores used to assess outcome over the period of study.Fig. 2 Manner of application of frequently encountered outcome scores (CMS, Constant-Murley shoulder score; ASES, American Shoulder and Elbow Surgeons standardised shoulder assessment form; UCLA, University of California Los Angeles shoulder rating scale; Neer, Neer shoulder rating; Rowe, Rowe instability score; SST, simple shoulder test; SF-36, 36-item short-form health survey; HSS, Hospital for Special Surgery shoulder assessment; MSTS, Musculo-skeletal tumour score; DASH, Disabilities of the arm shoulder and hand questionnaire; SPADI, shoulder pain and disability index).We wish to thank Mrs Pat Deeley, Academic Secretary to Professor A. 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J Shoulder Elbow Surg Crossref, Medline, ISI, Google the outcomes shoulder and concept and of outcome measures used for evaluating patients with proximal and No. Evaluation for instability as an to the Rowe of Shoulder and Elbow Surgery, No. in Shoulder A of on range of and outcomes total shoulder arthroplasty in rotator and rotator Shoulder Elbow, Evaluation with American Shoulder and Elbow Surgeons score and index in patients rotator of Shoulder and Elbow Surgery, No. Evaluation scores with American Shoulder and Elbow Surgeons scores in patients rotator of Shoulder and Elbow Surgery, No. in the of Joint January Orthopaedic Journal of No. in and Research and 4, No. Systematic of Outcomes in in Outcomes of A Systematic and The American Journal of No. of in rotator with Shoulder December Journal of Orthopaedic Surgery, No. for as UCLA proximal No. between the UCLA and Constant-Murley scores in rotator and proximal humeral fractures No. of shoulder and No. of of shoulder outcome measures in a systematic Shoulder Elbow, No. no no No. assessment in the treatment of rotator what is in No. in Orthopaedic Journal of No. outcomes of rotator between the University of Los Angeles and American Shoulder and Elbow Surgeons of Shoulder and Elbow Surgery, No. of the Japanese Orthopaedic Association score to Constant scores for evaluating outcomes in rotator Journal of Orthopaedic Surgery, No. clinical of system for shoulder function No. in for A Systematic The Journal of Surgery, No. of functional outcomes and to in and of Shoulder and Elbow Surgery, No. of in of of the The Journal of Surgery, No. medicine for of the shoulder: study for a controlled and No. assessment in rotator what are we of Shoulder and Elbow Surgery, No. in in of Bone and Joint Surgery, No. American Shoulder and Elbow Surgeons and Evaluation After or The Journal of Surgery, No. outcomes of Surgery, No. for displaced proximal humeral fractures in the a study of two surgical total replacement No. of on shoulder function and in proximal December European Journal of Orthopaedic Surgery No. for treatment for of the No. best combination of and self-report measures to function in patient December No. of Outcomes in Shoulder Bankart A December Clinical for of the December Scores for Shoulder Constant-Murley is to a Clinical and No. to the of shoulder The Shoulder score Surgery No. score Shoulder et No. and outcomes by treatment in proximal humeral fractures: a systematic literature review from in Surgery, No. shoulder A review of the and basis of shoulder British Journal of No. of the proximal December No. development and validation of a scoring system for shoulder in British Journal of No. evaluation of upper function: disability and of Journal of No. a of shoulder pain, not to be Surgery No. et No. Outcomes of No. controlled trial comparing the of with in patients with shoulder of Shoulder and Elbow Surgery, No. of and in on the of for The American Journal of No. Scores for Shoulder and outcome is there a European Journal of Trauma and Surgery, No. for Evaluation of No. rotator repair by the of Surgery, No. and validation of the version of the Oxford shoulder of Orthopaedic and Trauma Surgery, No. of to Research and on the Effectiveness of for Shoulder Elbow, No. of in the treatment of proximal of Shoulder and Elbow Surgery, No. for head and No. development and validation of an appraisal method for rotator The Shoulder of Shoulder and Elbow Surgery, No. of in the of Displaced of the American Academy of Orthopaedic Surgeons, No. retrospective application of the Oxford Shoulder of Shoulder and Elbow Surgery, No. Constant score for Surgery, No. of surgery for of the rotator T. M. M. J. The Journal of Bone and Joint Surgery. British No. for A No. should we use the Constant of Shoulder and Elbow Surgery, No. surgical treatment of the on the shoulder joint with minimum No. of of Orthopaedic No. to years follow-up of repair using the a retrospective of Orthopaedic and Trauma Surgery, No. from the on for Journal of and No. orthopaedic J. December The Journal of Bone and Joint Surgery. British 87-B, No. 87-B, No. 2 1 in 1 The British Society of Bone and Joint All

The Journal of Bone and Joint Surgery. British volumeVol. 86-B, No. 3 Aspects of Current ManagementFree AccessPosterior dislocation of the shoulderN. CicakN. CicakOrthopaedic SurgeonSearch for more papers by this authorPublished Online:1 Apr 2004https://doi.org/10.1302/0301-620X.86B3.14985AboutSectionsPDF/EPUB ToolsAdd to FavouritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited bySurgical management of bilateral concomitant posterior fracture-dislocation of the shoulderTrauma Case Reports, Vol. 41Posterior shoulder dislocation with associated reverse Hill–Sachs lesion: clinical outcome 10 years after joint-preserving surgery3 June 2022 | Archives of Orthopaedic and Trauma Surgery, Vol. 39Posterior Shoulder InstabilityTreatment of chronic locked posterior dislocation of the shoulder with the modified McLaughlin procedureJournal of Shoulder and Elbow Surgery, Vol. 31, No. 1Principles of Radiological Examination28 September 2022Posterior Instability4 October 2022Mid-Term outcomes following fresh-frozen humeral head osteochondral allograft reconstruction for reverse Hill Sachs lesion: a case series8 September 2021 | BMC Musculoskeletal Disorders, Vol. 22, No. 1Management of Locked Posterior Shoulder Dislocation with Reverse Hill–Sachs Lesions via Anatomical Reconstructions11 October 2021 | Orthopaedic Surgery, Vol. 232Traumi della spalla e del braccioEMC - Urgenze, Vol. 25, No. 3Arthroscopic Knotless Subscapularis Bridge Technique for Reverse Hill-Sachs Lesion With Posterior Shoulder InstabilityArthroscopy Techniques, Vol. 10, No. 1A Modified Reverse Remplissage Procedure for Management of a Locked Posterior Shoulder DislocationCase Reports in Orthopedics, Vol. 2020Shoulder Dislocations in the Emergency Department: A Comprehensive Review of Reduction TechniquesThe Journal of Emergency Medicine, Vol. 58, No. 4Missed posterior shoulder fracture dislocations: a new protocol from a London major trauma centre18 March 2020 | BMJ Open Quality, Vol. 9, No. 1New Reduction Technique for Traumatic Posterior Glenohumeral Joint Dislocations24 January 2020 | Clinical Practice and Cases in Emergency Medicine, Vol. 4, No. 1Glenohumeral Joint16 April 2020Conservative Treatment in Posterior Dislocation16 June 2020Surgical Treatment of Humeral Head Defect in Shoulder Posterior Instability16 June 2020Shoulder and proximal humerusIndications for Reverse Shoulder ArthroplastyAll-Arthroscopic McLaughlin's Procedure in Patients with Reverse Hill–Sachs Lesion Caused by Locked Posterior Shoulder Dislocation31 December 2019 | Joints, Vol. 07, No. 03The dual subscapularis procedure: a modified Hawkins’ technique for neglected posterior fracture/dislocation of the shoulder19 March 2019 | European Journal of Orthopaedic Surgery & Traumatology, Vol. 29, No. 5Remplissage With Bankart Repair in Anterior Shoulder Instability: A Systematic Review of the Clinical and Cadaveric LiteratureArthroscopy: The Journal of Arthroscopic & Related Surgery, Vol. 35, No. 4McLaughlin artroscópico modificado no tratamento de luxação glenoumeral posterior – nota técnica10 May 2019 | Revista Brasileira de Ortopedia, Vol. 54, No. 02Posterior Shoulder Dislocation During Morning PT: A Case Report13 June 2018 | Military Medicine, Vol. 184, No. 3-4The aetiology of posterior glenohumeral dislocations and occurrence of associated injuriesa systematic reviewM. 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InstabilityAmerican Journal of Roentgenology, Vol. 201, No. 2Modified arthroscopic McLaughlin procedure for treatment of posterior instability of the shoulder with an associated reverse Hill-Sachs lesion7 October 2012 | Knee Surgery, Sports Traumatology, Arthroscopy, Vol. 21, No. 7Modified McLaughlin Technique for Neglected Locked Posterior Dislocation of the ShoulderOrthopedics, Vol. 36, No. 7Posterior shoulder dislocationReliability of a New Standardized Measurement Technique for Reverse Hill-Sachs Lesions in Posterior Shoulder DislocationsArthroscopy: The Journal of Arthroscopic & Related Surgery, Vol. 29, No. 3Bilateral locked posterior shoulder dislocation after an undiagnosed brain tumorCurrent Orthopaedic Practice, Vol. 24, No. 2WITHDRAWN: Posterior dislocation of the shoulder: a case reportJournal of Clinical Orthopaedics and TraumaTraumatic bilateral posterior dislocation of the shoulder: a case reportOpen Medicine, Vol. 8, No. 6Uncommon Indications for Reverse Total Shoulder ArthroplastyClinics in Orthopedic Surgery, Vol. 5, No. 4Orthopedic Pitfalls of the Upper Extremity15 November 2012Recurrent Posterior Shoulder Instability After Rifle ShootingOrthopedics, Vol. 35, No. 11Shoulder and Proximal Humerus22 October 2012Shoulder Resurfacing for Acute Locked Posterior Dislocation Allows Early Rehabilitation6 February 2017 | Shoulder & Elbow, Vol. 4, No. 4Bilateral Neglected Posterior Fracture–Dislocation of the ShouldersOrthopedics, Vol. 35, No. 10Eine neue Repositionstechnik für die verhakte hintere Schulterluxation9 December 2011 | Der Unfallchirurg, Vol. 115, No. 8Delayed Diagnosis of Bilateral Scapula Fractures in a Patient with Cardiac Syncope1 July 2012 | Shoulder & Elbow, Vol. 4, No. 3Bilateral Talar Avulsion Fractures Secondary to Seizure: A Case ReportThe Journal of Foot and Ankle Surgery, Vol. 51, No. 3Anatomical Reconstruction of Reverse Hill-Sachs Lesions Using the Underpinning TechniqueOrthopedics, Vol. 35, No. 5Acute bilateral posterior dislocation of the shoulder: One-stage reconstruction of both humeral heads with cancellous autograft and cartilage preservationChirurgie de la Main, Vol. 31, No. 1Recurrent, Locked Posterior Glenohumeral Dislocation Requiring Hemiarthroplasty and Posterior Bone Block With Humeral Head AutograftOrthopedics, Vol. 35, No. 2Acute Posterior Dislocations22 June 2011Failed Arthroscopic Repair of a Large Reverse Hill-Sachs Lesion Using Bone Allograft and Cannulated Screws: A Case ReportArthroscopy: The Journal of Arthroscopic & Related Surgery, Vol. 28, No. 1Posterior Shoulder Dislocation: Systematic Review and Treatment AlgorithmArthroscopy: The Journal of Arthroscopic & Related Surgery, Vol. 27, No. 11Lateral Clavicular Autograft for Repair of Reverse Hill-Sachs DefectThe Open Orthopaedics Journal, Vol. 5, No. 1Bilateral posterior shoulder dislocation with defect secondary to hypoglycemic comaJournal of Orthopaedic Science, Vol. 16, No. 1Shoulder and humerusGlenohumeral instabilityClosed Reduction of Bilateral Posterior Shoulder Dislocation with Medium Impression Defect of the Humeral Head: A Case Report and Review of Its TreatmentCase Reports in Medicine, Vol. 2011Die dorsal verhakte Schulterluxation6 November 2010 | Obere Extremität, Vol. 5, No. 4Articular cartilage and labral lesions of the glenohumeral joint: diagnostic performance of 3D water-excitation true FISP MR arthrography17 December 2009 | Skeletal Radiology, Vol. 39, No. 5Chronic locked posterior shoulder dislocation with severe head involvement20 March 2009 | International Orthopaedics, Vol. 34, No. 1ShoulderSHOULDERLes luxations invétérées de l’épauleRéférencesBilateral Traumatic Locked Posterior Dislocation of the Shoulder - A Case Report -The Journal of the Korean Shoulder and Elbow Society, Vol. 12, No. 2Reconstruction of Humeral Head Defect for Locked Posterior Shoulder DislocationOrthopedics, Vol. 32, No. 9Rehabilitation and Functional Outcomes in Collegiate Wrestlers Following a Posterior Shoulder Stabilization ProcedureJournal of Orthopaedic & Sports Physical Therapy, Vol. 39, No. 7Modified MacLaughlin procedure in the treatment of neglected posterior dislocation of the shoulder16 March 2009 | MUSCULOSKELETAL SURGERY, Vol. 93, No. S1Tratamiento quirúrgico de la inestabilidad posterior del hombroEMC - Técnicas Quirúrgicas - Ortopedia y Traumatología, Vol. 1, No. 1Reconstruction of a missed posterior locked shoulder fracture-dislocation with bone graft and lesser tuberosity transfer: a case report5 August 2008 | Journal of Medical Case Reports, Vol. 2, No. 1Acute Traumatic Posterior Shoulder Dislocation: MR FindingsRadiology, Vol. 248, No. 1Arthroscopy-assisted reduction of impression fracture of the humeral head: A case reportJournal of Shoulder and Elbow Surgery, Vol. 17, No. 3Diagnostik und Behandlungsregime der traumatischen dorsalen Schulterluxation2 June 2007 | Der Unfallchirurg, Vol. 110, No. 12Posterior shoulder subluxation most likely caused by retching in the lateral head-down position for prevention of aspirationJournal of Clinical Anesthesia, Vol. 19, No. 8Allografts in the Treatment of Athletic Injuries of the ShoulderSports Medicine and Arthroscopy Review, Vol. 15, No. 3Anatomical reconstruction for Reverse Hill-Sachs lesions after posterior locked shoulder dislocation fracture: a case series of six patients24 May 2007 | Archives of Orthopaedic and Trauma Surgery, Vol. 127, No. 7Emergency Department Management of Selected Orthopedic InjuriesEmergency Medicine Clinics of North America, Vol. 25, No. 3One-stage operation for locked bilateral posterior dislocation of the shoulderA. Ivkovic, I. Boric, N. Cicak1 June 2007 | The Journal of Bone and Joint Surgery. British volume, Vol. 89-B, No. 6Closed Reduction for Traumatic Posterior Dislocation of the Shoulder Using the ‘Lever Principle’: Two Case Reports and a Review of the Literature4 December 2016 | Journal of Orthopaedic Surgery, Vol. 14, No. 3The success of closed reduction in acute locked posterior fracture-dislocations of the shoulderJournal of Shoulder and Elbow Surgery, Vol. 15, No. 6Humeral head impression fracture in acute posterior shoulder dislocation: new surgical technique5 January 2006 | Knee Surgery, Sports Traumatology, Arthroscopy, Vol. 14, No. 7Traitement chirurgical de la luxation post-traumatique gléno-humérale postérieureJournal de Traumatologie du Sport, Vol. 23, No. 2Traitement chirurgical de l'instabilité postérieure de l'épauleEMC - Techniques chirurgicales - Orthopédie - Traumatologie, Vol. 1, No. 1POSTERIOR SHOULDER DISLOCATIONS AND FRACTURE-DISLOCATIONSThe Journal of Bone and Joint Surgery-American Volume, Vol. 87, No. 3 Vol. 86-B, No. 3 Metrics History Published online 1 April 2004 Published in print 1 April 2004 InformationCopyright © 2004, The British Editorial Society of Bone and Joint Surgery: All rights reservedPDF download

An audio podcast accompanies this article.Listen at www.archives-pmr.org.With the remarkable growth of disability- and rehabilitation-related research in the last decade, it is imperative that we support the highest quality research possible. With cuts in research funding, rehabilitation research is now under a microscope like never before, and it is critical that we put our best foot forward. An audio podcast accompanies this article. Listen at www.archives-pmr.org. To ensure the quality of the disability and rehabilitation research that is published, the 28 rehabilitation journals simultaneously publishing this editorial (see acknowledgments) have agreed to take a more aggressive stance on the use of reporting guidelines. ∗Physical Therapy, the Journal of Orthopaedic & Sports Physical Therapy, the Journal of Physiotherapy, and the European Journal of Physical and Rehabilitation Medicine have already successfully required reporting guidelines, one for as many as 10 years. Research reports must contain sufficient information to allow readers to understand how a study was designed and conducted, including variable definitions, instruments and other measures, and analytical techniques.1Moher D. Simera I. Schulz K.F. Hoey J. Altman D.G. Helping editors, peer reviewers and authors improve the clarity, completeness and transparency of reporting health research.BMC Med. 2008; 6: 13Crossref PubMed Scopus (126) Google Scholar For review articles, systematic or narrative, readers should be informed of the rationale and details behind the literature search strategy. Too often articles fail to include their standard for inclusion and their criteria for evaluating quality of the studies.2Simera I. Altman D.G. Moher D. Schulz K.F. Hoey J. Guidelines for reporting health research: the EQUATOR network's survey of guideline authors.PLoS Med. 2008; 5: e139Crossref PubMed Scopus (157) Google Scholar As noted by Doug Altman, co-originator of the Consolidated Standards of Reporting Trials (CONSORT) statement and head of the Centre for Statistics in Medicine at Oxford University: “Good reporting is not an optional extra: it is an essential component of good research…we all share this obligation and responsibility.”3Altman D. Why we need transparent reporting of health research. Excerpt from a presentation delivered at the launch of the EQUATOR Network, June 2008. Available at: http://www.equator-network.org/2008/06/26/achieving-transparency-in-reporting-health-research/. Accessed January 9, 2013.Google Scholar Reporting guidelines are documents that assist authors in reporting research methods and findings. They are typically presented as checklists or flow diagrams that lay out the core reporting criteria required to give a clear account of a study's methods and results. The intent is not just that authors complete a specific reporting checklist but that they ensure that their articles contain key elements. Reporting guidelines should not be seen as an administrative burden; rather, they are a template by which an author can construct their articles more completely. Reporting guidelines have been developed for almost every study design. More information on the design, use, and array of reporting guidelines can be found on the website for the Enhancing the Quality and Transparency of Health Research (EQUATOR) network,4EQUATOR network. Available at: www.equator-network.org. Accessed October 21, 2013.Google Scholar an important organization that promotes improvements in the accuracy and comprehensiveness of reporting. Examples include the following:(1)CONSORT for randomized controlled trials (www.consort-statement.org);(2)Strengthening the Reporting of Observational studies in Epidemiology (STROBE) for observational studies (http://strobe-statement.org/);(3)Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for systematic reviews and meta-analyses (www.prisma-statement.org/);(4)Standards for the Reporting of Diagnostic accuracy studies (STARD) for studies of diagnostic accuracy (www.stard-statement.org/); and(5)Case Reports (CARE) for case reports (www.care-statement.org/). There is accumulating evidence that the use of reporting guidelines improves the quality of research. Turner et al5Turner L. Shamseer L. Altman D.G. Schulz K.F. Moher D. Does use of the CONSORT Statement impact the completeness of reporting of randomised controlled trials published in medical journals? A Cochrane review.Syst Rev. 2012; 1: 60Crossref PubMed Scopus (397) Google Scholar established that the use of the CONSORT statement improved the completeness of reporting in randomized controlled trials. Diagnostic accuracy studies appeared to show improvement in reporting standards when the STARD guidelines were applied.6Smidt N. Rutjes A.W. van der Windt D.A. et al.The quality of diagnostic accuracy studies since the STARD statement: has it improved?.Neurology. 2006; 67: 792-797Crossref PubMed Scopus (205) Google Scholar Early evidence also suggests that inclusion of reporting standards during peer review raises manuscript quality.7Cobo E. Cortés J. Ribera J.M. et al.Effect of using reporting guidelines during peer review on quality of final manuscripts submitted to a biomedical journal: masked randomised trial.BMJ. 2011; 343: d6783Crossref PubMed Scopus (8) Google Scholar The International Committee of Medical Journal Editors now encourages all journals to monitor reporting standards and collect associated reporting guideline checklists in the process.8International Committee of Medical Journal Editors. Preparing a manuscript for submission to a medical journal. Available at: http://www.icmje.org/manuscript_a.html. Accessed October 21, 2013.Google Scholar Furthermore, the National Library of Medicine also now actively promotes the use of reporting guidelines.9U.S. National Library of Medicine. Research reporting guidelines and initiatives: by organization. Available at: http://www.nlm.nih.gov/services/research_report_guide.html. Accessed October 21, 2013.Google Scholar By January 1, 2015, all of the journals publishing this editorial will have worked through implementation and the mandatory use of guidelines and checklists will be firmly in place. Because each journal has its unique system for managing submissions, there may be several ways that these reporting requirements will be integrated into the manuscript flow. Some journals will make adherence to reporting criteria and associated checklists mandatory for all submissions. Other journals may require them only when the article is closer to acceptance for publication. In any case, the onus will be on the author not only to ensure the inclusion of the appropriate reporting criteria but also to document evidence of inclusion through the use of the reporting guideline checklists. Authors should consult the Instructions for Authors of participating journals for more information. We hope that simultaneous implementation of this new reporting requirement will send a strong message to all disability and rehabilitation researchers of the need to adhere to the highest standards when performing and disseminating research. Although we expect that there will be growing pains with this process, we hope that within a short period, researchers will begin to use these guidelines during the design phases of their research, thereby improving their methods. The potential benefits to authors are obvious: articles are improved through superior reporting of a study's design and methods, and the usefulness of the article to readers is enhanced. Reporting guidelines also allow for greater transparency in reporting how studies were conducted and can help, hopefully, during the peer review process to expose misleading or selective reporting. Reporting guidelines are an important tool to assist authors in the structural development of a manuscript, eventually allowing an article to realize its full potential. As this issue went to press, the following Editors agreed to participate in the initiative to mandate reporting guidelines and publish this Position Statement in their respective journals. As a collective group, we encourage others to adopt these guidelines and welcome them to share this editorial with their readerships.•Sharon A. Gutman, PhD, OTREditor-in-ChiefAmerican Journal of Occupational Therapy•Walter R. Frontera, MD, PhDEditor-in-ChiefAmerican Journal of Physical Medicine and Rehabilitation•Leighton Chan, MD, MPH, and Allen W. Heinemann, PhDCo-Editors-in-ChiefArchives of Physical Medicine and Rehabilitation•Helene J. Polatajko, PhD, OT(C)Editor-in-ChiefCanadian Journal of Occupational Therapy•Derick T. Wade, MDEditor-in-ChiefClinical Rehabilitation•Suzanne McDermott, PhD, and Margaret A. Turk, MDCo-Editors-in-ChiefDisability and Health Journal•Stefano Negrini, MDEditor-in-ChiefEuropean Journal of Physical and Rehabilitation Medicine•Steven Vogel, DO(Hon)Editor-in-ChiefThe International Journal of Osteopathic Medicine•Črt Marinček, MD, PhDEditor-in-ChiefInternational Journal of Rehabilitation Research•M. Solomonow, PhD, MD(hon)Editor-in-ChiefJournal of Electromyography & Kinesiology•Paolo Bonato, PhDEditor-in-ChiefJournal of NeuroEngineering and Rehabilitation•Edelle [Edee] Field-Fote, PT, PhDEditor-in-ChiefJournal of Neurologic Physical Therapy•Guy G. Simoneau, PhD, PT Editor-in-ChiefJournal of Orthopaedic & Sports Physical Therapy (JOSPT)•Mark Elkins, PhD, MHSc, BA, BPhtyEditor-in-ChiefJournal of Physiotherapy•Stacieann C. Yuhasz, PhD Editor-in-Chief Journal of Rehabilitation Research and Development•Bengt H. Sjölund, MD, DMScEditor-in-ChiefJournal of Rehabilitation Medicine•Carl G. Mattacola, PhD, ATCEditor-in-ChiefJournal of Sport Rehabilitation•Ann Moore, PhD and Gwendolen Jull, PhDCo-Editors-in-ChiefManual Therapy•Randolph J. Nudo, PhDEditor-in-ChiefNeurorehabilitation & Neural Repair•Kathleen Matuska, PhD, OTR/LEditor-in-ChiefOccupational Therapy Journal of Research: Occupation, Participation, and Health•Ann F Van Sant, PT, PhDEditor-in-ChiefPediatric Physical Therapy•Greg Carter, MDConsulting EditorPhysical Medicine and Rehabilitation Clinics of North America•Rebecca L. Craik, PT, PhDEditor-in-ChiefPhysical Therapy•Dina Brooks, PhDScientific EditorPhysiotherapy Canada•Stuart M. Weinstein, MDEditor-in-ChiefPM&R•Elaine L. Miller, PhD, RNEditor-in-ChiefRehabilitation Nursing•Elliot J. Roth, MDEditor-in-ChiefTopics in Stroke Rehabilitation•Dilşad Sindel, MDEditor-in-ChiefTurkish Journal of Physical Medicine and Rehabilitation /cms/asset/a66a59ab-3f3a-452e-9c20-c118b25a580f/mmc1.mp3Loading ... Download .mp3 (5.96 MB) Help with .mp3 files Audio

The Journal of Bone and Joint Surgery. British volumeVol. 76-B, No. 1 ArticlesFree AccessComparison of MRI with bone scanning for suspected hip fracture in elderly patientsPD Evans, C Wilson, K LyonsPD EvansSearch for more papers by this author, C WilsonSearch for more papers by this author, K LyonsSearch for more papers by this authorPublished Online:1 Jan 1994https://doi.org/10.1302/0301-620X.76B1.8300666AboutSectionsPDF/EPUB ToolsAdd to FavouritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited byMusculoskeletal Trauma and InfectionMagnetic Resonance Imaging Clinics of North America, Vol. 30, No. 3Diagnostic Performance of CT for Occult Proximal Femoral Fractures: A Systematic Review and Meta-AnalysisAmerican Journal of Roentgenology, Vol. 213, No. 6Clinical applications of a computed tomography color “marrow mapping” algorithm to increase conspicuity of nondisplaced trabecular fractures9 August 2018 | Emergency Radiology, Vol. 26, No. 1Evaluation of Occult Femoral Neck Fractures – Computed Tomography or Magnetic Resonance Imaging?30 December 2019 | Indian Journal of Musculoskeletal Radiology, Vol. 1Color postprocessing of conventional CT images: preliminary results in assessment of nondisplaced proximal femoral fractures14 July 2018 | Emergency Radiology, Vol. 25, No. 6Hip Fractures: A Practical Approach to Diagnosis and Treatment3 May 2018 | Current Radiology Reports, Vol. 6, No. 7Computed tomography for occult fractures of the proximal femur, pelvis, and sacrum in clinical practice: single institution, dual-site experience11 January 2018 | Emergency Radiology, Vol. 25, No. 3Rapid Geriatric Assessment of Hip FractureClinics in Geriatric Medicine, Vol. 33, No. 3A computer-assisted systematic quality monitoring method for cervical hip fracture radiography5 December 2016 | Acta Radiologica Open, Vol. 5, No. 12Computed tomography compared to magnetic resonance imaging in occult or suspect hip fractures. A retrospective study in 44 patients8 January 2016 | European Radiology, Vol. 26, No. 11Groin Pain Etiology: Hip-Referred Groin PainSensitivity and specificity of CT- and MRI-scanning in evaluation of occult fracture of the proximal femurInjury, Vol. 46, No. 8Initial clinical experience of the use of digital tomosynthesis in the assessment of suspected fracture neck of femur in the elderly17 April 2015 | European Journal of Orthopaedic Surgery & Traumatology, Vol. 25, No. 5A Growing ProblemOrthopedic Clinics of North America, Vol. 46, No. 2Magnetic Resonance Imaging of the Hip: Poor Cost Utility for Treatment of Adult Patients With Hip PainClinical Orthopaedics & Related Research, Vol. 472, No. 3A vast increase in the use of CT scans for investigating occult hip fracturesEuropean Journal of Radiology, Vol. 82, No. 8Adult Hip Imaging for the Arthroscopist25 May 2012Magnetic Resonance Imaging in OrthopaedicsHip Fracture in AdulJournal of Nihon University Medical Association, Vol. 72, No. 4Traumatismes de la hancheEMC - Radiologie et imagerie médicale - Musculosquelettique - Neurologique - Maxillofaciale, Vol. 7, No. 3Magnetic Resonance Imaging Identifies Occult Hip Fractures Missed by 64-slice Computed TomographyThe Journal of Emergency Medicine, Vol. 43, No. 2The value of T1-weighted coronal MRI scans in diagnosing occult fracture of the hipT. Iwata, S. Nozawa, T. Dohjima, T. Yamamoto, D. Ishimaru, M. Tsugita, M. Maeda, K. Shimizu1 July 2012 | The Journal of Bone and Joint Surgery. British volume, Vol. 94-B, No. 7Abbreviated MRI for Patients Presenting to the Emergency Department With Hip PainAmerican Journal of Roentgenology, Vol. 198, No. 6Clinical approach to hip painIndian Journal of Rheumatology, Vol. 6, No. 3Review Article: Magnetic Resonance Imaging and Computed Tomography in the Diagnosis of Occult Proximal Femur Fractures1 April 2011 | Journal of Orthopaedic Surgery, Vol. 19, No. 1Emergency Department Applications of Musculoskeletal Magnetic Resonance Imaging: An Evidence-Based AssessmentEmergency Orthogeriatrics: Concepts and Therapeutic AlternativesEmergency Medicine Clinics of North America, Vol. 28, No. 4The use of MRI to detect occult fractures of the proximal femurA STUDY OF 102 CONSECUTIVE CASES OVER A TEN-YEAR PERIODR. A. Sankey, J. Turner, J. Lee, J. Healy, C. E. R. Gibbons1 August 2009 | The Journal of Bone and Joint Surgery. British volume, Vol. 91-B, No. 8Imaging Choices in Occult Hip FractureThe Journal of Emergency Medicine, Vol. 37, No. 2Intertrochanteric Hip FracturesDigital Image Enhancement Improves Diagnosis of Nondisplaced Proximal Femur FracturesClinical Orthopaedics & Related Research, Vol. 467, No. 1Magnetic Resonance Imaging in OrthopaedicsOccult Acetabular Fracture in an Elderly RunnerJournal of Orthopaedic & Sports Physical Therapy, Vol. 36, No. 6The role of MRI in the diagnosis of proximal femoral fractures in the elderlyInjury, Vol. 37, No. 2Early diagnosis of occult hip fracturesInjury, Vol. 36, No. 6MRI diagnosis of occult hip fractures8 July 2009 | Acta Orthopaedica, Vol. 76, No. 4Patterns of injury in patients with radiographic occult fracture of neck of femur as determined by magnetic resonance imagingAustralasian Radiology, Vol. 48, No. 1Rehabilitation of Missed Subcapital Femoral Neck Fracture in a Hemiparetic Patient: A Case Report16 January 2010 | Journal of Musculoskeletal Pain, Vol. 12, No. 1Occult trauma in high-risk populationsEmergency Medicine Clinics of North America, Vol. 21, No. 4Early Detection of Occult Fractures around the Hip with Magnetic Resonance Imaging26 January 2018 | HIP International, Vol. 13, No. 2Comparison of Scintigraphy and Magnetic Resonance Imaging for Stress Injuries of BoneClinical Journal of Sport Medicine, Vol. 12, No. 2Radiologic Analysis of TraumaCURRENT CONCEPTS IN IMAGING THE ADULT HIPClinics in Sports Medicine, Vol. 20, No. 4EMERGENCY MR IMAGING OF ORTHOPEDIC TRAUMARadiologic Clinics of North America, Vol. 37, No. 5Limited magnetic resonance imaging in the diagnosis of occult hip fracturesThe American Journal of Emergency Medicine, Vol. 16, No. 4SELECTED TOPICS IN ORTHOPEDIC NUCLEAR MEDICINEOrthopedic Clinics of North America, Vol. 29, No. 1The role of MRI in the diagnosis of occult hip fracturesInjury, Vol. 29, No. 1MR IMAGING OF ACUTE ORTHOPEDIC TRAUMA TO THE EXTREMITIESRadiologic Clinics of North America, Vol. 35, No. 3IMAGING OF STRESS INJURIES TO BONEClinics in Sports Medicine, Vol. 16, No. 2Double take--fracture fishing in accident and emergency practice.Emergency Medicine Journal, Vol. 14, No. 2Magnetic resonance imaging of acute orthopedic trauma to the lower extremityEmergency Radiology, Vol. 4, No. 1The Superiority of Magnetic Resonance Imaging in Differentiating the Cause of Hip Pain in Endurance Athletes23 April 2016 | The American Journal of Sports Medicine, Vol. 24, No. 2Adult Hip Imaging Vol. 76-B, No. 1 Metrics History Published online 1 January 1994 Published in print 1 January 1994 InformationCopyright © 1994, The British Editorial Society of Bone and Joint Surgery: All rights reservedPDF download

Admittedly, it may appear incongruous that a review of a disease that infected the nervous system of persons in the first half of the twentieth century would appear in the Journal of Orthopaedic & Sports Physical Therapy at the start of the twenty-first century. As will be described, however, most of the physical therapy procedures developed during the polio epidemic involved muscles and their interaction with the skeletal system. Many of the treatments and rehabilitation philosophies created during this time are still very evident today. The “polio days” presented an enormous challenge and an equally enormous opportunity for the budding profession of physical therapy. Much of the growth had to do with timing. Managing the rehabilitation of hundreds of thousands of persons, many in the prime of their own lives or careers, required just the services that a physical therapist could potentially provide. In essence, the polio epidemic created a unique void in the medical arena-a void that was filled by the rapid expansion of the profession of physical therapy. A full appreciation of the impact that the polio epidemic had on the profession requires a history lesson of the many interrelated and concurrent events that transpired in this country between 1916 and 1955. Within these turbulent times, the United States experienced 2 world wars, the Great Depression, the Korean War, and the insidious rise and swift fall of the polio epidemic-one of the most significant public health epidemics ever to strike the United States. For more than 2 decades leading up to the success of the Salk vaccine in 1955, the treatment and care of persons with polio dominated virtually every aspect of the physical therapy profession. The full story of how the growth, politics, philosophy, and even “personality” of physical therapy were shaped by the interactions between physical therapists and those infected by polio has been well chronicled. Two notable works are a recent article by Dr Marilyn Moffat and a very well presented text, Healing the Generations: A History of Physical Therapy and the American Physical Therapy Association, by Ms Wendy Murphy. This present historical review, intentionally less global than the aforementioned works, focuses more on the poliovirus itself, its impact on those it infected, and, most importantly, on several important lessons and benefits gained by the profession's steadfast involvement with the epidemic. J Orthop Sports Phys Ther. 2004;34(8):479–492. doi:10.2519/jospt.2004.0301

Background Clinical trial registration has become an important part of editorial policies of various biomedical journals, including a few physical therapy journals. However, the extent to which editorial boards enforce the need for trial registration varies across journals. Objective The purpose of this study was to identify editorial policies and reporting of trial registration details in MEDLINE-indexed English-language physical therapy journals. Design This study was carried out using a cross-sectional design. Methods Editorial policies on trial registration of MEDLINE-indexed member journals of the International Society of Physiotherapy Journal Editors (ISPJE) (Journal of Geriatric Physical Therapy, Journal of Hand Therapy, Journal of Neurologic Physical Therapy, Journal of Orthopaedic and Sports Physical Therapy, Journal of Physiotherapy [formerly Australian Journal of Physiotherapy], Journal of Science and Medicine in Sport, Manual Therapy, Physical Therapy, Physical Therapy in Sport, Physiotherapy, Physiotherapy Research International, Physiotherapy Theory and Practice, and Revista Brasileira de Fisioterapia) were reviewed in April 2013. Full texts of reports of clinical trials published in these journals between January 1, 2008, and December 31, 2012, were independently assessed for information on trial registration. Results Among the 13 journals, 8 recommended trial registration, and 6 emphasized prospective trial registration. As of April 2013, 4,618 articles were published between January 2008 and December 2012, of which 9% (417) were clinical trials and 29% (121/417) of these reported trial registration details. A positive trend in reporting of trial registration was observed from 2008 to 2012. Limitations The study was limited to MEDLINE-indexed ISPJE member journals. Conclusions Editorial policies on trial registration of physical therapy journals and a rising trend toward reporting of trial registration details indicate a positive momentum toward trial registration. Physical therapy journal editors need to show greater commitment to prospective trial registration to make it a rule rather than an option.

BACKGROUND: Low back pain (LBP) is responsible for considerable personal suffering worldwide. Those with persistent disabling symptoms also contribute to substantial costs to society via healthcare expenditure and reduced work productivity. While there are many treatment options, none are universally endorsed. The idea that chronic LBP is a condition best understood with reference to an interaction of physical, psychological and social influences, the 'biopsychosocial model', has received increasing acceptance. This has led to the development of multidisciplinary biopsychosocial rehabilitation (MBR) programs that target factors from the different domains, administered by healthcare professionals from different backgrounds. OBJECTIVES: To review the evidence on the effectiveness of MBR for patients with chronic LBP. The focus was on comparisons with usual care and with physical treatments measuring outcomes of pain, disability and work status, particularly in the long term. SEARCH METHODS: We searched the CENTRAL, MEDLINE, EMBASE, PsycINFO and CINAHL databases in January and March 2014 together with carrying out handsearches of the reference lists of included and related studies, forward citation tracking of included studies and screening of studies excluded in the previous version of this review. SELECTION CRITERIA: All studies identified in the searches were screened independently by two review authors; disagreements regarding inclusion were resolved by consensus. The inclusion criteria were published randomised controlled trials (RCTs) that included adults with non-specific LBP of longer than 12 weeks duration; the index intervention targeted at least two of physical, psychological and social or work-related factors; and the index intervention was delivered by clinicians from at least two different professional backgrounds. DATA COLLECTION AND ANALYSIS: Two review authors extracted and checked information to describe the included studies, assessed risk of bias and performed the analyses. We used the Cochrane risk of bias tool to describe the methodological quality. The primary outcomes were pain, disability and work status, divided into the short, medium and long term. Secondary outcomes were psychological functioning (for example depression, anxiety, catastrophising), healthcare service utilisation, quality of life and adverse events. We categorised the control interventions as usual care, physical treatment, surgery, or wait list for surgery in separate meta-analyses. The first two comparisons formed our primary focus. We performed meta-analyses using random-effects models and assessed the quality of evidence using the GRADE method. We performed sensitivity analyses to assess the influence of the methodological quality, and subgroup analyses to investigate the influence of baseline symptom severity and intervention intensity. MAIN RESULTS: From 6168 studies identified in the searches, 41 RCTs with a total of 6858 participants were included. Methodological quality ratings ranged from 1 to 9 out 12, and 13 of the 41 included studies were assessed as low risk of bias. Pooled estimates from 16 RCTs provided moderate to low quality evidence that MBR is more effective than usual care in reducing pain and disability, with standardised mean differences (SMDs) in the long term of 0.21 (95% CI 0.04 to 0.37) and 0.23 (95% CI 0.06 to 0.4) respectively. The range across all time points equated to approximately 0.5 to 1.4 units on a 0 to 10 numerical rating scale for pain and 1.4 to 2.5 points on the Roland Morris disability scale (0 to 24). There was moderate to low quality evidence of no difference on work outcomes (odds ratio (OR) at long term 1.04, 95% CI 0.73 to 1.47). Pooled estimates from 19 RCTs provided moderate to low quality evidence that MBR was more effective than physical treatment for pain and disability with SMDs in the long term of 0.51 (95% CI -0.01 to 1.04) and 0.68 (95% CI 0.16 to 1.19) respectively. Across all time points this translated to approximately 0.6 to 1.2 units on the pain scale and 1.2 to 4.0 points on the Roland Morris scale. There was moderate to low quality evidence of an effect on work outcomes (OR at long term 1.87, 95% CI 1.39 to 2.53). There was insufficient evidence to assess whether MBR interventions were associated with more adverse events than usual care or physical interventions.Sensitivity analyses did not suggest that the pooled estimates were unduly influenced by the results from low quality studies. Subgroup analyses were inconclusive regarding the influence of baseline symptom severity and intervention intensity. AUTHORS' CONCLUSIONS: Patients with chronic LBP receiving MBR are likely to experience less pain and disability than those receiving usual care or a physical treatment. MBR also has a positive influence on work status compared to physical treatment. Effects are of a modest magnitude and should be balanced against the time and resource requirements of MBR programs. More intensive interventions were not responsible for effects that were substantially different to those of less intensive interventions. While we were not able to determine if symptom intensity at presentation influenced the likelihood of success, it seems appropriate that only those people with indicators of significant psychosocial impact are referred to MBR.

BACKGROUND: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. METHODS: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. FINDINGS: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990-2010 time period, with the greatest annualised rate of decline occurring in the 0-9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10-24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10-24 years were also in the top ten in the 25-49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50-74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. INTERPRETATION: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and development investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. FUNDING: Bill & Melinda Gates Foundation.

The American Physical Therapy Association (APTA) provided funding for a series of meetings among a small group of leaders representing the research and clinical communities whose task was to plan a conference, the outcome of which would be a “road map” for the process of generating evidence that would be implemented by clinicians so that the provision of services might be enhanced. Two of these planning sessions were held and resulted in a decision to focus a conference on the identification of strategies to lessen perceived “gaps” between physical therapist clinicians and researchers and the development of strategies to bridge the “gaps” between the 2 groups. These meetings ultimately resulted in the Vitalizing Practice Through Research and Research Through Practice Conference hosted by APTA. A perceived gap between research and practice has been cited as a problem by others within and outside the profession as well. In a recent editorial in the Journal of Orthopaedic and Sports Physical Therapy , Bechtel et al stated, “We have a problem in manual therapy, and perhaps in the whole profession of physical therapy. Our problem is the growing chasm between researchers on the one hand, and clinicians on the other.”1(p451) A recent Institute of Medicine workshop titled “Transforming Clinical Research in the United States: Challenges and Opportunities” echoed this theme and identified bridging the divide between research and practice as one of the most critical needs facing clinical research.2 Discussion of the perceived gap between research and practice extends internationally, as Demers and Poissant3 lamented that research would be meaningless if it did not affect clinical practice. Furthermore, Demers and Poissant discussed the value of creating partnerships across the research process, from conception to dissemination of results. Translational research , at its most macroscopic level, essentially refers to efficient movement …

Background: Patellofemoral pain syndrome (PFPS) is a prevalent condition in sports medicine, and as sports competitions become more popular, the incidence of sports injuries is on the rise. Despite the increasing research on PFPS, there remains a lack of bibliometric analyses on this topic. The aim of this study was to identify the research hotspots and trends in the field of PFPS by reviewing 23 years of literature in this field. Methods: By analyzing the literature on PFPS research from 2000 to 2023 in the core dataset of the Web of Science database and utilizing bibliometric tools like CiteSpace 6.1, VOSviewer 1.6.18, R-bibliometrix 4.6.1, Pajek 5.16, and Scimago Graphica 1.0.26, our aim was to gain insights into the current status and key areas of PFPS research. The study examined various aspects including the number of publications, countries, institutions, journals, authors, collaborative networks, keywords, and more. Through the visualization of relevant data, we also attempted to forecast future trends in the field. Results: There were 2,444 publications were included in this visualization study, published in 322 journals by 1,247 authors from 818 institutions in 67 countries. The Journal of Orthopaedic and Sports Physical Therapy had the highest number of publications, with the USA leading in article count. La Trobe University contributed the most articles, while Rathleff MS and Barton CJ emerged as the most prolific authors. Hip and knee strength and core strength, lower extremity kinematics and biomechanics, females (runners), muscle activation, risk factors, gait retraining, clinical practice guidelines, and rehabilitation were research hotspot keywords. Conclusion: Current research suggests that there is still significant potential for the development of PFPS research. Key areas of focus include the clinical effectiveness of combined hip and knee strengthening to address PFPS, characterization of lower limb kinematics and biomechanics, gait retraining, risk factors, and clinical practice guidelines. Future research could explore the effectiveness of innovative exercise therapies such as blood flow restricting training, gait retraining, and neuromuscular control training for PFPS improvement. Further investigation into gait retraining for runners, particularly females, and clinical efficacy study of a novel PRP formulation for the treatment of PFPS.

BACKGROUND AND OBJECTIVE: Professional meetings, such as the American Physical Therapy Association's (APTA's) Combined Sections Meeting (CSM), provide forums for sharing information relevant to physical therapy. An indicator of whether therapists fully disseminate their work is the number of full-text peer-reviewed publications that result. The purposes of this study were: (1) to determine the full-text publication rate of work presented in abstract form at CSM and (2) to investigate factors influencing this rate. METHODS: A systematic search was undertaken to locate full-text publications of work presented in abstract form within the Orthopaedic and Sports Physical Therapy sections at CSM between 2000 and 2004. Eligible publications were published within 5 years following abstract presentation. The influences of APTA section, year of abstract presentation, institution of origin, study design, sample size, study significance, reporting of a funding source, and presentation type on full-text publication rate were assessed. Characteristics of full-text publications were explored. RESULTS: Work presented in 1 out of 4 abstracts (25.4%) progressed to full-text publication. Odds of full-text publication increased if the abstract originated from a doctorate-granting or "other" institution, reported findings of an experimental study, reported a statistically significant finding, included a larger sample size, disclosed a funding source, or was presented as a platform presentation. More than one third (37.8%) of full-text publications were published in the Journal of Orthopaedic and Sports Physical Therapy or Physical Therapy, and 4 out of 10 full-text publications (39.2%) contained at least one major change from information presented in abstract form. CONCLUSIONS: The full-text publication rate for information presented in abstract form within the Orthopaedic and Sports Physical Therapy sections at CSM is low relative to comparative disciplines. Caution should be exercised when translating information presented at CSM into practice.

Hamstring injuries are one of the most common lower limb injuries found in sport and this study illustrates the utility of bibliometric analysis in examining a topic from a strength and conditioning coach perspective. This study identifies key areas of scholarship relating to the rehabilitation of hamstring injury among athletes and compares this with the total corpus of literature on the topic. A range of bibliometric measures are used that entail multi-dimensional scaling to identify clusters of related themes, authors, countries, and journals central to the evolution of the evidential-base. A corpus of 2439 articles on hamstring rehabilitation were retrieved and of these 815 papers relating to hamstring rehabilitation and athletes. Indexed research on the topic commenced in the early 1980s and has expanded at an exponential rate since then. Key authors (Dr J.I. Tol and Dr D.A. OPAR) and prolific countries (USA, Australia, and UK) have been identified. Examination of journal sources reveals that scholarship on this topic conforms to Bradford’s law of scattering and a total of 7 journals forms the core of published work in this space - British Journal of Sports Medicine; American Journal of Sports Medicine; Scandinavian Journal of Medicine and Science in Sport; Sports Medicine; Journal of Orthopaedic and Sports Physical Therapy; and Medicine and Science in Sports and Exercise. This study demonstrates the utility of bibliometric analysis in identifying areas of significant importance to strength and conditioning coaches, documents prolific authors, and highlights countries that dominate knowledge development. Neophyte practitioners can use these findings to seek out collaborative partners, pursue under-researched areas of inquiry and target their work for publication at relevant journals adding to the evidential-base.

INTRODUCTION: Noncombat injuries ("injuries") greatly impact soldier health and United States (U.S.) Army readiness; they are the leading cause of outpatient medical encounters (more than two million annually) among active component (AC) soldiers. Noncombat musculoskeletal injuries ("MSKIs") may account for nearly 60% of soldiers' limited duty days and 65% of soldiers who cannot deploy for medical reasons. Injuries primarily affect readiness through increased limited duty days, decreased deployability rates, and increased medical separation rates. MSKIs are also responsible for exorbitant medical costs to the U.S. government, including service-connected disability compensation. A significant subset of soldiers develops chronic pain or long-term disability after injury; this may increase their risk for chronic disease or secondary health deficits potentially associated with MSKIs. The authors will review trends in U.S. Army MSKI rates, summarize MSKI readiness-related impacts, and highlight the importance of standardizing surveillance approaches, including injury definitions used in injury surveillance. MATERIALS/METHODS: This review summarizes current reports and U.S. Department of Defense internal policy documents. MSKIs are defined as musculoskeletal disorders resulting from mechanical energy transfer, including traumatic and overuse injuries, which may cause pain and/or limit function. This review focuses on various U.S. Army populations, based on setting, sex, and age; the review excludes combat or battle injuries. RESULTS: More than half of all AC soldiers sustained at least one injury (MSKI or non-MSKI) in 2017. Overuse injuries comprise at least 70% of all injuries among AC soldiers. Female soldiers are at greater risk for MSKI than men. Female soldiers' aerobic and muscular fitness performances are typically lower than men's performances, which could account for their higher injury rates. Older soldiers are at greater injury risk than younger soldiers. Soldiers in noncombat arms units tend to have higher incidences of reported MSKIs, more limited duty days, and higher rates of limited duty days for chronic MSKIs than soldiers in combat arms units. MSKIs account for 65% of medically nondeployable AC soldiers. At any time, 4% of AC soldiers cannot deploy because of MSKIs. Once deployed, nonbattle injuries accounted for approximately 30% of all medical evacuations, and were the largest category of soldier evacuations from both recent major combat theaters (Iraq and Afghanistan). More than 85% of service members medically evacuated for MSKIs failed to return to the theater. MSKIs factored into (1) nearly 70% of medical disability discharges across the Army from 2011 through 2016 and (2) more than 90% of disability discharges within enlisted soldiers' first year of service from 2010 to 2015. MSKI-related, service-connected (SC) disabilities account for 44% of all SC disabilities (more than any other body system) among compensated U.S. Global War on Terrorism veterans. CONCLUSIONS: MSKIs significantly impact soldier health and U.S. Army readiness. MSKIs also figure prominently in medical disability discharges and long-term, service-connected disability costs. MSKI patterns and trends vary between trainees and soldiers in operational units and among military occupations and types of operational units. Coordinated injury surveillance efforts are needed to provide standardized metrics and accurately measure temporal changes in injury rates.

The present research investigates the effectiveness of using a telepresence system compared to a video conferencing system and the effectiveness of using two cameras compared to one camera for remote physical therapy. We used Telegie as our telepresence system, which allowed users to see an environment captured with RGBD cameras in 3D through a VR headset. Since both telepresence and the inclusion of a second camera provide users with additional spatial information, we examined this affordance within the relevant context of remote physical therapy. Our dyadic study across different time zones paired 11 physical therapists with 76 participants who took on the role of patients for a remote session. Our quantitative questionnaire data and qualitative interviews with therapists revealed several important findings. First, after controlling for individual differences between participants, using two cameras had a marginally significant positive effect on physical therapy assessment scores from therapists. Second, the spatial ability of patients was a strong predictor of therapist assessment. And third, the video clarity of remote communication systems mattered. Based on our findings, we o

Using "Analyze Results" at the Web of Science, one can directly generate overlays onto global journal maps of science. The maps are based on the 10,000+ journals contained in the Journal Citation Reports (JCR) of the Science and Social Science Citation Indices (2011). The disciplinary diversity of the retrieval is measured in terms of Rao-Stirling's "quadratic entropy." Since this indicator of interdisciplinarity is normalized between zero and one, the interdisciplinarity can be compared among document sets and across years, cited or citing. The colors used for the overlays are based on Blondel et al.'s (2008) community-finding algorithms operating on the relations journals included in JCRs. The results can be exported from VOSViewer with different options such as proportional labels, heat maps, or cluster density maps. The maps can also be web-started and/or animated (e.g., using PowerPoint). The "citing" dimension of the aggregated journal-journal citation matrix was found to provide a more comprehensive description than the matrix based on the cited archive. The relations between local and global maps and their different functions in studying the sciences in terms of journal lit

Robot-Assisted Therapy (RAT) has successfully been used in Human Robot Interaction (HRI) research by including social robots in health-care interventions by virtue of their ability to engage human users in both social and emotional dimensions. Robots used for these tasks must be designed with several user groups in mind, including both individuals receiving therapy and care professionals responsible for the treatment. These robots must also be able to perceive their context of use, recognize human actions and intentions, and follow the therapeutic goals to perform meaningful and personalized treatment. Effective interactions require for robots to be capable of coordinated, timely behavior in response to social cues. This means being able to estimate and predict levels of engagement, attention, intentionality and emotional state during human-robot interactions. An additional challenge for social robots in therapy and care is the wide range of needs and conditions the different users can have during their interventions, even if they may share the same pathologies their current requirements and the objectives of their therapies can varied extensively. Therefore, it becomes crucial for