Musculoskeletal System Commons^™

Clinical Practice Guidelines: The Road Map To Better Care, Mary I. Fisher

Physical Therapy Faculty Publications

Systematic reviews and meta-analyses are important tools in translating research evidence into clinical practice as they critically evaluate and summarize the body of evidence on clinical topics. Clinicians can use these studies to quickly survey the current literature base to increase understanding of a clinical diagnosis they make, with the intent of using this information to improve their clinical practice. A well-written systematic review or meta-analysis, with critical evaluation of study quality, is then that Cliffs Note version of what to know and what to do. Therefore, with the proliferation of systematic reviews and meta-analyses, we should see a corresponding …

Screening And Assessment Of Cancer-Related Fatigue: An Executive Summary And Road Map For Clinical Implementation, Joy C. Cohn, Shana Harrington, Jeannette Lee, Daniel Malone, Mary I. Fisher

Physical Therapy Faculty Publications

Background: Cancer-related fatigue (CRF) prevalence is reported as high as 90%. Cancer-related fatigue is multidimensional and associated with lower health-related quality of life. Effective screening and assessment are dependent upon use of valid, reliable, and clinically feasible measures. This Executive Summary of the Screening and Assessment of Cancer-related Fatigue Clinical Practice Guideline provides recommendations for best measures to screen and assess for CRF based on the quality and level of evidence, psychometric strength of the tools, and clinical utility.

Methods: After a systematic review of the literature, studies evaluating CRF measurement tools were assessed for quality; data extraction included psychometrics …

Combination Of Statistical Shape Modeling And Statistical Parametric Mapping To Quantify Cartilage Contact Mechanics In Hip Dysplasia, Penny R. Atkins Phd, Shireen Y. Elhabian Phd, Jeffrey A. Weiss Phd, Ross T. Whitaker Phd, Christopher L. Peters Md, Andrew E. Anderson Phd

PanaSoMM

Finite element models can predict subject-specific chondrolabral stresses and help to elucidate the effect of under-coverage and incongruency of the hip joint in patients with dysplasia. However, complex stress patterns are difficult to generalize and evaluate statistically. With an established correspondence across shapes from statistical shape modeling (SSM), statistical parametric mapping (SPM) allows for evaluation of local variability while preserving model subject-specificity. Herein, we evaluated the combined application of SSM and SPM to compare cartilage contact stress between control subjects and patients with dysplasia.

Previously published hip joint contact stresses were mapped onto chondrolabral surface meshes and incorporated into an …

Application Of Statistical Shape Modeling To Predict Clinical Metric Of Femoral Head Coverage In Patients With Developmental Dysplasia, Penny R. Atkins Phd, Praful Agrawal Phd, Joseph D. Mozingo Phd, Keisuke Uemura Md, Phd, Kunihiko Tokunaga Md, Christopher L. Peters Md, Shireen Y. Elhabian Phd, Ross T. Whitaker Phd, Andrew E. Anderson Phd

PanaSoMM

Developmental dysplasia of the hip (DDH) is described as under-coverage of the femoral head by the acetabulum, resulting in mechanical instability. Though DDH is often diagnosed using plain film radiographs, these images cannot adequately capture 3D joint coverage. Herein, we applied a 3D statistical shape model (SSM) to the femur and hemi-pelvis of patients with DDH to objectively measure shape variation and evaluated whether SSM outputs could predict measurements of joint coverage.

The femur and hemi-pelvis were semi-automatically segmented from CT images (83 hips from 47 females with DDH). Surfaces of each hip were reconstructed from segmentations, aligned, and input …

Screening And Assessment Of Cancer-Related Fatigue: A Clinical Practice Guideline For Health Care Providers, Mary I. Fisher, Joy C. Cohn, Shana Harrington, Jeannette Lee, Daniel Malone

Physical Therapy Faculty Publications

Cancer-related fatigue (CRF) is the most common side effect of cancer treatment. Regular surveillance is recommended, but few clinical practice guidelines transparently assess study bias, quality, and clinical utility in deriving recommendations of screening and assessment methods. The purpose of this clinical practice guideline (CPG) is to provide recommendations for the screening and assessment of CRF for health care professions treating individuals with cancer. Following best practices for development of a CPG using the Appraisal of Guidelines for Research and Evaluation (AGREE) Statement and Emergency Care Research Institute (ECRI) Guidelines Trust Scorecard, this CPG included a systematic search of the …

Trustworthiness And Quality In Research For Clinical Application, Mary I. Fisher

Physical Therapy Faculty Publications

No abstract provided.

Recovery Time Following Operative Versus Nonoperative Humeral Shaft Fracture Treatment, Susan Wager, Trevor D. Wolterink, Jager Haan, Yash Hedge, Chrystina James, Stephanie J. Muh

Medical Student Research Symposium

INTRODUCTION: Humeral shaft fractures represent approximately 5% of fractures in the United States. Treatment modalities include nonoperative, and operative with open reduction internal fixation (ORIF) or intramedullary nail (IMN). There is no consensus on which option is best. The purpose of this study was to compare the length of time from fracture care to radiographic union between nonoperative, ORIF, and IMN treatments for humeral shaft fractures.

METHODS: This retrospective study analyzed trends in the management of midshaft humerus fracture between July of 2013 and December of 2020. Fracture characteristics and treatment outcomes were recorded from patients with humeral shaft fractures …

Rate Of Intraoperative Proximal Femoral Fractures With Automated Broaching, Tyler Radack, Hope Skibicki, Julian Zangrilli, Ruchir Nanavati, Cole Kleinman, Michael Harrer

Rowan-Virtua Research Day

Intraoperative proximal femur fractures (PFF) occur in 3.7% of total hip arthroplasties (THA) using the standard mallet broaching technique and increase a patient’s risk of revision surgery from 3.4% to 10%. The Depuy KINCISE automatic broaching system is designed to attenuate the risk of these fractures by applying consistent co-linear force to the broach. The aim of this study is to determine if the KINCISE system decreases the rate of intraoperative PFF fracture during THA compared to the standard mallet technique.

Use Of Osteopathic Manipulative Treatment In Alleviating Hypertonic Chest Wall Pain, David Ho, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

We present the case of a 20-year-old male patient with no cardiac history coming in for left sided chest pain described as “burning” sensation. On physical exam, it was noted that patient had hypertonic chest wall muscles that were tight and spastic when palpated on the left chest wall. We used Osteopathic Manipulative Treatment (OMT) to help patient relieve hypertonic muscle. We chose to use muscle energy technique (MET) since this relies on reciprocal inhibition with the end result being relaxation of the target muscle.

The patient had resolution of chest pain after applying the technique. Although we did not …

Does Prehabilitation Prior To Ulnar Collateral Ligament Surgery Affect Return To Sport Rate Or Time In Baseball Players With Partial Ucl Tears?, Joshua Spada, Kourtney Snigar, Ryan W. Paul, Usman Zareef, Anya Hall, Brandon J. Erickson, Michael G. Ciccotti, Stephen J. Thomas

Rowan-Virtua Research Day

Those who suffer a partial thickness ulnar collateral ligament (UCL) tear often undergo a period of nonoperative management including physical therapy rehabilitation. This treatment is aimed at optimizing range of motion (ROM) and strengthening the supporting structures around the elbow to help offload the UCL.

Unfortunately, some of these patients fail nonoperative management and require surgical intervention. This creates a unique set of patients who essentially underwent “prehabilitation” prior to their UCL surgery. Prehabilitation is considered a period of structured physical therapy rehabilitation aimed at strengthening structures surrounding an injured tendon or ligament, to allow for dissipation of stress away …

A Review Of The Effectiveness Of Osteopathic Manipulative Medicine At Alleviating Pregnancy-Related Pain, Alexandria Lomanno, Olivia Choi, Danielle Cooley

Rowan-Virtua Research Day

Globally, more than a quarter of pregnant patients experience low back pain (LBP) during pregnancy with additional complaints of pelvic girdle pain (PGP) and other somatic dysfunctions. Though the standard of care for LBP in pregnancy is often analgesics, concerns about potential side effects that may cause lasting harm to the fetus may preclude pregnant patients from taking pain medications. Osteopathic Manipulative Medicine (OMM) is a nonpharmacologic treatment option that is routinely used for LBP in non-pregnant patients. Given the low risk of adverse effects, OMM may prove to be beneficial for pregnant patients suffering from LBP or PGP.

Use Of Pocus And Omt For Anterior Shoulder Reduction, David Ho, James Espinosa, Alan Lucerna, Neeharika Bhatnagar

Rowan-Virtua Research Day

Shoulder dislocations are very a common presentation in the emergency department. This represents about 50% of all joint dislocations presenting to the ER. Over 95% of the dislocations are anterior. Approximately 70% of shoulder dislocations occur in men and in both genders, the prevalence of shoulder dislocations occurs in a bimodal distribution in age in those younger than 20 and over 60 years old. Shoulder dislocation can occur anteriorly, posteriorly, and inferiorly. In an anterior dislocation, excessive force from external rotation and abduction causes a tear in the anterior ligamentous capsule3, causing the humeral head to dislocate from the glenoid …

Comparing The Relapse Rate Between Medication Assisted-Only Treatment And Medication-Assisted Treatment With An Osteopathic Manipulative Treatment Regimen In Patients With Musculoskeletal Pain, Karen Huang, Danielle Cooley

Rowan-Virtua Research Day

Since the opioid crisis first began in 1991, opioid-related overdoses in the United States have continued to increase dramatically, killing nearly 47,000 people in 2018, and making it one of the most pressing issues in healthcare. The most reported reason for misuse of pain relievers was to relieve physical pain. The increase in opioid abuse has also led to an increase in patients seeking medication-assisted treatment (MAT).

Osteopathic manipulative treatment (OMT) has been shown to have efficacy in relieving both chronic and acute pain. No current studies have investigated the use of OMT as an adjunct treatment to MAT for …

Return To Sport Following Closed Reduction Of Acute Traumatic Posterior Sternoclavicular Joint Dislocations: A Systematic Review, Seungkyu Park, Joseph Galvin, Matthew Nowak, Jordan Damschen

Rowan-Virtua Research Day

Acute traumatic posterior sternoclavicular (SC) joint dislocation is a serious injury given its potential to cause cardiovascular and airway compromise that typically will require emergent closed reduction. Posterior SC joint dislocations are usually caused by a high energy mechanism. Typical treatment involves closed reduction followed by observation. There is limited data on the rate of return to sport following this injury pattern when treated in a closed fashion.

Lung Hernia: An Uncommon Cause Of Pleuritic Chest Pain, Brittany Fera

Rowan-Virtua Research Day

Lung hernia is a rare but important consideration in the differential diagnosis of chest pain in patients with recent thoracic trauma or a history of thoracic surgery. Patients who undergo an anterior approach to thoracotomy, as was the case with our patient, are at a higher risk for developing lung herniation as a result of inherent anatomical weakness and wider intercostal spaces anteriorly and inferiorly.

Duchenne’S Muscular Dystrophy & Occupational Therapy, Vanessa Sagredo, Meagan C. Romero

Client Educational Handouts

No abstract provided.

Effective Therapies And Nursing Approaches: Improving Cognition In Older Adult Stroke Patients, Selyna Baltazar

Nursing | Senior Theses

Background

Ischemic stroke occurs in thousands of older adults throughout the year. Due to the lack of oxygen entering the brain, many patients experience a decline in cognitive function due to ischemic stroke. Cognition is the ability to understand, learn, and remember information which is needed for completing daily tasks. Modern technology has allowed for patients to survive ischemic strokes but has yet to provide proper screening tools and methods for stroke-related cognitive impairment.

Objective

To investigate the best practices for identifying, treating, and caring for patients with a cognitive injury related to a stroke. A review of the research …

Self-Reported Arm Function Is Associated With Stress And Fear Of Physical Activity Among Women Treated For Breast Cancer, Mary Insana Fisher, Anne Fleischer, Kimberly Ulmer, Megan Mcclure, Renee Waldron, Lynn Difede

Physical Therapy Faculty Publications

Background: Self-reported upper extremity function and objective measures are not strongly associated with each other in women treated for breast cancer (BC). It is not known if the lack of relationship between self-reported upper extremity function and objective measurements may be influenced by perceived levels of stress and fear of physical activity. The purpose of this study was to investigate the relationships between self-reported upper extremity function and the following: perceived stress levels (PS), fear of physical activity (FPA), health-related quality of life (HRQOL), and objective measures of upper extremity function among women treated for BC.

Methods: This cross-sectional observational …

Mountains Of Evidence, Mary I. Fisher

Physical Therapy Faculty Publications

No abstract provided.

Knowledge Regarding Cancer-Related Fatigue: A Survey Of Physical Therapists And Individuals Diagnosed With Cancer, Shana Harrington, Mary Insana Fisher, Jeannette Lee, Joy C. Cohn, Daniel Malone

Physical Therapy Faculty Publications

Background: Cancer-related fatigue (CRF) is a common side effect and remains under-diagnosed. Screening of CRF by physical therapists (PTs) and patient perspectives of their experiences has not been comprehensively examined.

Purpose: To survey PTs to understand the frequency of CRF screening, and to assess the knowledge and experiences of survivors as it relates to CRF.

Methods: Two separate electronic surveys developed by the authors were distributed. One targeted oncology PTs, the other for adult survivors of cancer.

Results: Of the 199 PT respondents, 36% reported screening for CRF at every encounter. Screening included interviews (46%) and/or standardized questionnaires (37%). The …

Forty Years, Mary I. Fisher

Physical Therapy Faculty Publications

No abstract provided.

Comparison Of Landing Biomechanics Between Different Competitive Levels Of Irish Dance, Jade Shields

West Chester University Master’s Theses

Abstract

Objectives: To determine differences in lower limb landing biomechanics and lower extremity function scale scores between champion levels, in young female Irish dancers.

Design: Cross-sectional.

Setting: McDade-Cara School of Irish Dance

Participants: 12 Open Champion (OC) level female Irish dancers (11.9 ± 3.37 years) and 9 Preliminary Champion (PC) Irish dancers (13.5 ± 3.37 years) performed the landing error scoring system test (LESS), and completed the lower extremity functional scale (LEFS) and a descriptive data questionnaire

Main outcome measures: LESS scoring sheet and LEFS PRO

Results: No significant differences found between OC and PC levels on …

Severe Mixed Mitral Valve Disease Due To Massive Mitral Annular Calcification: A Case Report And Literature Review, Fateh Ali Tipoo Sultan, Sheema Saadia

Section of Cardiology

We present an unusual case of massive mitral annular calcification (MAC) leading to severe mixed mitral valve disease, viz severe mitral regurgitation and severe mitral stenosis. To our knowledge, severe mixed mitral valve disease secondary to MAC is extremely rare. The patient (a 65-year-old lady) presented with worsening shortness of breath and signs of congestive heart failure. Echocardiographic examination revealed massive mitral annular calcification. Despite the massive annular calcification, she had experienced neither embolism nor endocarditis in the past. Because of severe symptomatic mitral regurgitation and mitral stenosis, surgery was advised; however, the patient declined it.

Perceived Instability, Pain, And Psychological Factors Predict Function And Disability In Individuals With Chronic Ankle Instability, Ashley M.B. Suttmiller, Julie M. Cavallario, Shelby E. Baez, Jessica C. Martinez, Ryan S. Mccann

Rehabilitation Sciences Faculty Publications

Context:

Chronic ankle instability (CAI) is associated with residual instability, pain, decreased function, and increased disablement. Injury-related fear has been associated with CAI, although its relationship to other impairments is unclear. The Fear-Avoidance Model is a theoretical framework hypothesizing a relationship between injury-related fear, chronic pain, pain catastrophizing, and disability. It has been useful in understanding fear's influence in other musculoskeletal conditions but has yet to be studied in those with CAI.

Objective:

To explore relationships between instability, pain catastrophizing, injury-related fear, pain, ankle function, and global disability in individuals with CAI.

Design:

Cross-Sectional Study

Setting:

Anonymous online survey

Patients …

The Effect Of Concussion History On Lower Extremity Injury Risk In College Athletes: A Systematic Review And Meta Analysis, Vanessa Ramirez, Ryan Mccann, Eric Schussler, Jessica Martinez

Rehabilitation Sciences Faculty Publications

INTRODUCTION: Collegiate athletes who suffer a concussion may possess prolonged impairments even after clearance for return-to-participation, which may place them at an increased risk of lower extremity injury.

OBJECTIVE: To conduct a systematic review and meta-analysis of studies examining risk of lower extremity musculoskeletal injury following a concussion in collegiate athletes.

METHODS: A literature search was performed using the following databases: PubMed, CINAHL, SPORTDiscus. The following search terms were used to identify relevant articles, ["concussion" OR "brain injury" OR "mild traumatic brain injury" OR "mTBI"] AND ["lower extremity injury" OR "musculoskeletal injury"]. Articles were included if they were published between …

Eagle Syndrome: Efficacies Of Medical And Surgical Treatments, Kirklin Mitchell

Capstone Showcase

Eagle Syndrome is a rare syndrome caused by elongation of the styloid process of the temporal bone or calcification of the stylohyoid ligament occurring in a very small percentage of the population that can cause a wide range of common symptoms, leading to it being often misdiagnosed. While there are no set standards for treating Eagle Syndrome, both pharmaceutical and surgical options exist. Pharmaceutical options are often ineffective in long term treatment so surgery is usually required for full symptom resolution. Transoral and Transcervical surgeries have similar efficacies but each come with important drawbacks when considering which type of surgery …

The Morbidity Of Greater Trochanteric Pain Syndrome Is Similar To That Of Pre-Tha Hip Osteoarthritis, Sonia Wadekar, Avneesh Chhabra, Emily Middleton, Yin Xi, Joel Wells

MEDI 9331 Scholarly Activities Clinical Years

Aims: We sought to characterize the morbidity upon presentation of GTPS and compared it to patients with end-stage, hip osteoarthritis (OA) awaiting total hip arthroplasty (THA). We hypothesize that patients with GTPS will have similar or worse morbidity than hip OA patients.

Methods: This retrospective case-control study examined patient reported outcomes measures (PROMs) on activity limitations, quality of life, pain, and level of disability, in 156 GTPS patients (193 hips) and 300 pre-THA hip OA patients (326 hips). All patients presented at a single academic medical center. Patients with secondary hip conditions or previous hip surgeries were excluded from the …

Load Sharing Assessment Of Osseoligamentous Structures Within A Thoracic Spine Segment During Surgical Release, Michael Polanco, James Bennett, Austin Tapp, Michel Audette, Stacie Ringleb, Sebastian Bawab

Electrical & Computer Engineering Faculty Publications

Spinal surgical procedures often require release of intervertebral discs and ligaments to optimally achieve postural correction on a patient-specific basis. In this paper, a T7-T8 Finite Element (FE) model is utilized to examine internal load sharing during resection steps performed in a Ponte osteotomy. The FE model was rotated bidirectionally along three anatomical planes using an externally applied moment. In each step, the Ranges of Motion (RoM), Instantaneous Centers of Rotation (ICR), and forces from ligaments, discs, facet, and costovertebral joints were calculated. The product of each component’s force and the distance between the ICR and their position were used …

The Influence Of Shoe And Cleat Type On Lower Extremity Muscle Activation In Youth Baseball Pitchers, Jacob R. Gdovin, Chip Wade, Lauren A. Luginsland, Charles C. Williams, Riley Galloway, John C. Garner

Human Movement Studies & Special Education Faculty Publications

Background: Baseball pitching is a dynamic movement where the lower extremities generate and sequentially transfer energy to the upper extremities to maximize ball velocity. The need for lower body muscular strength to produce adequate push-off and landing forces has been documented; however, the influence footwear and surface inclination has on muscle activation remains unknown.

Objectives: Determine how pitching in molded cleats and turf shoes from a pitching mound and flat ground affects stride-leg muscle activation in youth baseball pitchers while determining percent activation during each pitching phase.

Methods: Cross – sectional study analyzing mean muscle activity and percent activation of …

Investigating The Role Of The Skeletal Muscle In Amyotrophic Lateral Sclerosis Neuromuscular Junction Dysfunction, Agnes Badu-Mensah

Electronic Theses and Dissertations, 2020-2023

Neuromuscular junction (NMJ) dysfunction has been identified as one of the earliest events in Amyotrophic Lateral Sclerosis (ALS) pathology. However, which tissue type induces NMJ disruption; be it the motoneurons (hMN), Schwann cells or skeletal muscle (hSKM) remains unresolved. While mechanisms by which ALS hMN contribute to NMJ dysfunction are well-described in literature, limited information exist on how the other tissue types in the tripartite synapse (hSKM and Schwann cells) induce and/or contribute to ALS NMJ disruption. A fair understanding of the role of each tissue type in NMJ dysfunction would help shape the trajectory of future ALS research and …