Orthopedics Commons^™

Who Is Treating Periprosthetic Femur Fractures? An Analysis Of The Periprosthetic Research Consortium, Nicholas Pohl, Arjun Saxena, Jeffrey Stambough, John Martin, Simon Mears, Paul Lichstein, Eric Jordan, Cameron Egan, Antonia Chen, Greg Erens, Samir Chabib, Bryce Wall, Navin Fernando, Jordan Nichols, Ran Schwarzkopf, Katherine Lygrisse, Derek Amanatullah, Prerna Arora, David Ivanov, Galvin Loughran, James Browne, Danielle Hogarth, Parke Hudson, Thomas Donaldson, Frank Buttacavoli, Ravi Kari, Galen Mills

Rothman Institute Papers

Background: Periprosthetic femur fractures (PPFFs) following total hip arthroplasty (THA) have increased in the past decade as the demand for primary surgery continues to grow. Although there is now more evidence to describe the treatment of Vancouver B fractures, there is still limited knowledge regarding factors that cause surgeons to perform either an open reduction and internal fixation (ORIF) or revision THA (rTHA). The purpose of this study was to determine what type of surgeons treat Vancouver B PPFFs at 11 major academic institutions and if there are trends in treatment decision-making regarding the use of ORIF or rTHA based …

Rates Of Reporting And Analyzing Race And Ethnicity In Athlete-Specific Sports Medicine Research: A Systematic Review, John H. Sonnier, Carlo Coladonato, Irfan A. Khan, Gregory Connors, Ryan W. Paul, Anya T. Hall, Emma E. Johnson, Meghan E. Bishop, Fotios P. Tjoumakaris, Kevin B. Freedman

Rothman Institute Papers

BACKGROUND: Race- and ethnicity-based differences in treatment access and outcomes have been reported in the orthopaedic sports medicine literature. However, the rate at which race and ethnicity are reported and incorporated into the statistical analysis of sports medicine studies remains unclear.

PURPOSE: To determine the rate at which race and ethnicity are reported and analyzed in athlete-specific sports medicine literature.

STUDY DESIGN: Systematic review; Level of evidence, 4.

METHODS: Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, articles published by the 3 journals of the American Orthopaedic Society for Sports Medicine between 2017 and 2021 were considered …

Assessing The Impact Of Femur Morphological Variations On Pediatric Hip Joint Biomechanics Using Statistical Shape Modeling, Tamara Chambers

Doctoral Dissertations and Master's Theses

This dissertation aimed to (1) quantify morphological variations in the pediatric hip joint and (2) evaluate the sensitivity of an infant musculoskeletal model (MSM) to these variations, considering hip joint center estimation errors. A shape statistical model (SSM) of decedent infant femurs from the Ortolani collection was created using ShapeWorks, capturing key morphological features, such as variations in the femoral neck-shaft and anteversion angles. Seven synthetic femurs were generated from the SSM to create SSM-informed MSMs, which were systematically evaluated through kinematics and kinetics analyses in OpenSim. Incorporating the SSM led to slight changes in the pediatric MSMs’ kinematics but …

Radiographic Outcomes And Subsidence Rate In Hyperlordotic Versus Standard Lordotic Interbody Spacers In Patients Undergoing Anterior Cervical Discectomy And Fusion, Rajkishen Narayanan, Nicholas Pohl, Jonathan Dalton, Yunsoo Lee, Anthony Labarbiera, Meryem Guler, Emilie Sawicki, Sebastian Fras, Mark Kurd, John Mangan, I David Kaye, Jose Canseco, Alan Hilibrand, Alex Vaccaro, Christopher Kepler, Gregory Schroeder, Joseph Lee

Rothman Institute Papers

Background: Anterior cervical discectomy and fusion (ACDF) is a common surgery for patients with degenerative cervical disease and current interbody spacers utilized vary based on material composition, structure, and angle of lordosis. Currently, there is a lack of literature comparing subsidence rates or long-term radiographic outcomes with hyperlordotic and standard lordotic spacers. This study compares long-term radiographic outcomes, subsidence rate, and rate of fusion in patients who underwent ACDF with hyperlordotic or standard interbody placement. Materials and Methods: Patients who underwent 1-3-level ACDF with either a standard lordosis or hyperlordotic interbody were included. Standard radiographs were evaluated for C2-7 lordosis …

Intra-Articular Knee Neurofibroma In A Patient With Neurofibromatosis: A Case Report And Review Of Literature., Thomas Falconiero, Mark Lagreca, Arash Badragheh, Nathan Jones, Christopher Kester

Orthopedic Surgery Resident Research

INTRODUCTION: Neurofibromatosis type I (NF1) is an autosomal dominant disorder that typically results in Café-au-lait macules and peripheral nerve sheath tumors (i. e, neurofibromas). While peripheral neurofibromas are common, intra-articular knee neurofibromas are rarely described in the literature. To date, there only have been two other case reports noting intra-articular knee neurofibromas. The authors present the case of a patient with NF1 who was found to have an intra-articular knee neurofibroma incidentally discovered during the surgical approach to a retrograde femoral nail.

CASE REPORT: The patient is a 65-year-old female who presented to the emergency room after a fall from …

Hip Sideline Emergencies And Hip Injuries In Elite Athletes, Kevin K Chen, Emmanuel N Osadebey, Paul G Shupe, Bonnie P Gregory

Faculty, Staff and Student Publications

Purpose of review: Hip injuries in elite athletes are an increasingly recognized problem and range from chronic overuse injuries, such as adductor strains and labral tears, to acute traumatic injuries such as hip dislocations. In this article, we review common hip pathology experienced by elite athletes and sideline management of emergent hip injuries.

Recent findings: Elite athletes are subject to unique physical and mental stresses and therefore must be evaluated and treated in a unique manner. Hip and groin injuries account for approximately 6% of sport injuries overall and 3-15% of all injuries in professional sports. Hip sideline emergencies were …

Enhancing Recovery: Surgical Techniques And Rehabilitation Strategies After Direct Anterior Hip Arthroplasty, Alberto Di Martino, Christopher Keating, Micahel J. Butsick, Daniela Platano, Lisa Berti, Louis N. Hunter, Cesare Faldini

Department of Physical Therapy Faculty Papers

Total hip arthroplasty (THA) is a common surgical procedure for hip joint pathologies, with the direct anterior approach (DAA) gaining popularity due to potential benefits in postoperative recovery. This review aims to provide a comprehensive analysis of rehabilitation strategies following DAA THA, focusing on surgical techniques, postoperative care, and outcomes. The evolution of the DAA to THA is discussed, highlighting historical advancements and comparisons with other surgical approaches. Surgical techniques and considerations specific to the DAA are detailed, including outcomes and complications compared to alternative approaches. The role of the surgical technique in influencing postoperative rehabilitation is explored, emphasizing the …

Ao Spine-Dgou Osteoporotic Fracture Classification System: Internal Validation By The Ao Spine Knowledge Forum Trauma, Julian Scherer, Andrei Joaquim, Alex Vaccaro, Rishi Kanna, Mohammad El-Sharkawi, Masahiko Takahata, Mohamed M. Aly, Gaston Camino-Willhuber, Ulrich Spiegl, Cumhur Oner, Jose A. Canseco, Ratko Yurac, Lorin Michael Benneker, Eugen Cezar Popescu, Richard Bransford, Harvinder Cezar Chhabra, Frank Kandziora, Marko H. Neva, Klaus John Schnake

Rothman Institute Papers

Study Design: Cross-sectional survey.

Objectives: Injury classifications are important tools to identify fracture patterns, guide treatment-decisions and aid to identify optimal treatment plans. The AO Spine-DGOU Osteoporotic Fracture (OF) classification system was developed, and the aim of this study was to assess the reliability of this new classification system.

Methods: 23 Members of the AO Spine Knowledge Forum Trauma participated in the validation process. Participants were asked to rate 33 cases according to the OF classification at 2 time points, 4 weeks apart (assessment 1 and 2). The kappa statistic(κ) was calculated to assess inter-observer reliability and intra-rater reproducibility. The …

Surgical Technique For Glenoid Bone Defect In Revision Shoulder Arthroplasty: Distal Clavicle Excision And Grafting For 1-Stage Reverse Total Shoulder Prosthesis, Ryan Bialaszewski, Ross Chapel, Frank Gerold

Research Colloquium

Introduction: Reverse shoulder arthroplasty (RSA) has expanded its indications and use in North America since the early 1990s. Because of this, the prevalence of revision reverse total shoulder arthroplasty cases has continued to rise. On occasion, the need for revision of RSA can be due to and is complicated by glenoid bone loss defects, making this one of the most challenging cases for arthroplasty surgeons to perform. Historically, iliac crest or tibial grafts are most commonly used for these defects, although this comes with the disadvantage of requiring two surgical sites to be prepped and draped. The purpose of this …

Chatgpt Provides Acceptable Responses To Patient Questions Regarding Common Shoulder Pathology, Umar Ghilzai, Benjamin Fiedler, Abdullah Ghali, Aaron Singh, Benjamin Cass, Allan Young, Adil Shahzad Ahmed

Faculty, Staff and Students Publications

BACKGROUND: ChatGPT is rapidly becoming a source of medical knowledge for patients. This study aims to assess the completeness and accuracy of ChatGPT's answers to the most frequently asked patients' questions about shoulder pathology.

METHODS: ChatGPT (version 3.5) was queried to produce the five most common shoulder pathologies: biceps tendonitis, rotator cuff tears, shoulder arthritis, shoulder dislocation and adhesive capsulitis. Subsequently, it generated the five most common patient questions regarding these pathologies and was queried to respond. Responses were evaluated by three shoulder and elbow fellowship-trained orthopedic surgeons with a mean of 9 years of independent practice, on Likert scales …

Differential Analysis Of The Impact Of Lesions’ Location On Clinical And Radiological Outcomes After The Implantation Of A Novel Aragonite-Based Scaffold To Treat Knee Cartilage Defects, Pietro Conte, Giuseppe Anzillotti, Dennis C. Crawford, Vinod Dasa, David C. Flanigan, William E. Nordt, Jason M. Scopp, Robert J. Meislin, Eric J. Strauss, Sabrina M. Strickland, Gennaro Fiorentino, Christian Lattermann

School of Medicine Faculty Publications

Purpose: There is limited comparative evidence on patient outcomes following cartilage repair in various knee compartments. The aim of this study was to compare clinical and imaging outcomes after treating cartilage defects in femoral condyles and trochlea with either an aragonite-based scaffold or surgical standard of care (SSoC, i.e., debridement/microfractures) in a large multicentre randomized controlled trial. Methods: 247 patients with up to three knee joint surface lesions (ICRS grade IIIa or above) in the femoral condyles, trochlea or both (“mixed”), were enrolled and randomized to surgery with either a cell-free aragonite scaffold or SSoC. Patients were followed for up …

Rule Breakers Achieve Successful Shoulder Balance: Unraveling The Myth Of Upper Instrumented Vertebrae Selection Criteria, Luke C. Drake, Peter W. D’Amore, Bailli Fontenot, Tyler A. Tetreault, Manaf Younis, Claudia Leonardi, Jaquelyn Valenzuela-Moss, Lindsay M. Andras, Michael J. Heffernan

School of Medicine Faculty Publications

Purpose: This study compared shoulder balance outcomes in “rule breakers” (RB) vs. “rule followers” (RF) based on commonly utilized upper instrumented vertebrae (UIV) selection guidelines. Methods: Adolescent idiopathic scoliosis (AIS) patients (Lenke 1–4) who underwent posterior spine fusion (PSF) with minimum 2-year follow-up had radiographic measurement of shoulder balance including first rib angle (FRA), T1 tilt, coracoid process height difference (CPHD), and clavicle angle (CA) at preop, postop, 6-month, 1-year, and 2-year timepoints. Postoperative outcomes were compared between RB and RF groups defined based on the UIV selection guidelines of Rose and Lenke. Results: Among 88 patients (43 RF, 45 …

Synovial Fluid Cutibacterium Acnes Antigen Is Detected Among Shoulder Samples With High Inflammation And Early Culture Growth, Krista Toler, Pearl Paranjape, Alex Mclaren, Thomas Jefferson University

Rothman Institute Papers

Background: An emerging paradigm suggests that positive Cutibacterium acnes shoulder cultures can result from either true infection or contamination, with true infections demonstrating a host inflammatory response and early culture growth. This clinical retrospective study examines the relationship between C. acnes antigen, C. acnes culture results, and inflammation.

Methods: From January 2021 to July 2023, 1,365 periprosthetic synovial fluid samples from 347 institutions were tested for shoulder infection at a centralized clinical laboratory. A biomarker scoring system based on the 2018 International Consensus Meeting (ICM) definition was utilized to assign each sample an inflammation score. Associations between inflammation, culture results, …

Safety And Efficacy Of Minimally Invasive Posterior Cervical Fusion: A Single Center, Single Surgeon Retrospective Review, George A. Crabill, Kaleb Derouen, Kierany B. Shelvin, John M. Wilson, Gabriel C. Tender

School of Medicine Faculty Publications

Standard posterior cervical fusion is a common surgical technique that utilizes lateral mass screws and rods for fixation. A relatively new, minimally invasive technique involving interfacet decortication and placement of spacers has shown promise in terms of outcomes. We sought to determine fusion rates and complications of this new technique at our institution to bolster current literature. We retrospectively reviewed all patients that underwent a 3-level or less minimally invasive posterior cervical fusions by a single surgeon. Patients were evaluated to determine fusion rates and postoperative complications. Twenty-eight patients underwent minimally invasive posterior cervical fusion. Twenty-seven demonstrated fusion (96%). One …

Knee Osteoarthritis: Disease Burden, Available Treatments, And Emerging Options, Michael Langworthy, Vinod Dasa, Andrew I. Spitzer

School of Medicine Faculty Publications

Osteoarthritis (OA) is a prevalent condition that affects nearly 528 million people worldwide, including 23% of the global population aged ⩾40, and is characterized by progressive damage to articular cartilage, which often leads to substantial pain, stiffness, and reduced mobility for affected patients. Pain related to OA is a barrier to maintaining physical activity and a leading cause of disability, accounting for 2.4% of all years lived with disability globally, reducing the ability to work in 66% of US patients with OA and increasing absenteeism in 21% of US patients with OA. The joint most commonly involved in OA is …

Systematic Review And Meta-Analysis Of Total Elbow Arthroplasty In Outpatient Versus Inpatient Settings, Blake Martin, Yolanda V. Gutierrez, Joshua Nwose, Robert H. Ablove, Juan Lopez-Alvarenga

Research Colloquium

Introduction: Total joint arthroplasties (TJA), including total elbow arthroplasty (TEA), are growing in number, shifting towards a younger age group, and moving more towards the outpatient setting. We are conducting this study to summarize the current knowledge about the outcomes of TEA in outpatient versus inpatient settings to allow for the best possible care when performing this procedure. We believe that outpatient TEA will have better outcomes with lower complication rates compared to inpatient TEA.

Methods: We conducted a systematic review and meta-analysis using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) framework. Electronic database searches were performed …

Clearance Of Recalcitrant Prosthetic Fungal Infection Utilizing Administration Of Voriconazole Through Intra-Articular Catheters Of The Knee, Blake Martin, Matthew Hnatow, Emma Herrera

Research Colloquium

Background: Prosthetic joint infection is a high cost and high morbidity complication of total joint arthroplasty accounting for about 1-2% of all joint replacements. Rarely fungal infections may complicate treatment and lower the rate of clearance of infection with rates as low as 50% or less in the literature. Intra-articular antibiotics have drawn more interest recently and may be a promising intervention for challenging prosthetic joint infections. We present a novel case utilizing voriconazole via intra-articular catheters with successful clearance of a recalcitrant fungal prosthetic joint infection with 2 year follow up.

Case Presentation: A case study is presented in …

Literature Review: Exploring The Efficacy Of Minimally Invasive Surgery (Mis) Techniques In Spinal Fusion For Degenerative Spondylolisthesis, Yolanda V. Gutierrez, Blake Martin, Joshua Nwose, Robert H. Ablove

Research Colloquium

Introduction: Spine diseases and degeneration of the spine are common causes of back pain. One common cause of back pain is spondylolisthesis which is the slipping of a vertebral body disc. A subtype of spondylolisthesis is degenerative spondylolisthesis which commonly occurs due to wasting of the intervertebral disc leading to an unstable spine. In patients with a lack of neurological issues, conservative treatment is recommended. If conservative treatment is ineffective, surgery is deemed the next step, involving decompression of and fusion of the vertebrae. Minimally invasive surgery (MIS) techniques have emerged in the last decade. This systematic literature review aims …

Understanding Hip Pain Through Social Media: An Initial Overview Of An International Web-Based Survey, John M. Gaddis, Ryan Bialaszewski, Bretton Laboret, Erika Shults, Joel Wells

Research Colloquium

Aims: In the adult population hip pain is often triggered by mechanical anatomic differences including hip dysplasia, femoroacetabular impingement (FAI), Perthes disease and osteoarthritis. We aimed to understand the adult experience of hip pain and develop a comprehensive hip-pain survey using a web-based REDCap platform via social media. This paper outlines our survey and analyzes the demographic composition and characteristics of our sample population.

Methods: The survey link was active from October 1, 2023, to May 1, 2024, on social media platforms. Respondents consented to the study before beginning. Responses were anonymous and only unique surveys were analyzed. The comprehensive …

Periacetabular Osteotomy: An Analysis Of Social Media To Determine The Most Common Questions Asked By The Periacetabular Osteotomy Population, John M. Gaddis, Ryan Bialaszewski, Bretton Laboret, Joel Wells, Adina Stewart

Research Colloquium

Background: Social media has become an increasingly popular resource for patients and a platform to share one’s experiences. Patients undergoing periacetabular osteotomy (PAO) may gravitate towards social media for support, guidance and understanding. The aim of this study was to investigate Facebook, Instagram and Twitter to further understand what the most common preoperative and postoperative questions patients undergoing PAO are asking.

Methods: Facebook, Instagram and Twitter were queried consecutively from February 1, 2023 to November 23, 2011. Facebook was searched for the two most populated interest groups; “Periacetabular Osteotomy (PAO)” and “Periacetabular Osteotomy Australia”. Instagram and Twitter were queried for …

Orthopedic Surgery Residency Trends 2019-2023: Insights And Dynamics, Zayd M. Ayas, Hassan Abou Adma, Juan C. Lopez Alvarenga, Michael Sander

Research Colloquium

Background: Historically, the Step 1 exam served as a major factor in the residency selection process. We aim to analyze how the shift of Step 1 to pass/fail impacts residency applications in terms of number of applicants and application criteria, such as research experiences, step 2 CK scores, etc.

We also aim to analyze how the shift in criteria will impact the quality of orthopedic surgery residents. Using the Orthopedic in Training Examination (OITE) which provides valuable insights into the performance and preparedness of orthopedic surgery residents.

Methods: We began by analyzing the data from the AAMC Report on Residents …

Cultural And Socioeconomic Determinants Of Hip And Knee Arthroplasty In The Rio Grande Valley Community, Blake Martin, John M. Gaddis, Jared Hensley, Juan Lopez Alvarenga, Kelsey Baker

Research Colloquium

Background: Joint arthroplasty is one of the most common procedures performed worldwide and the volume of these operations are on the rise. In this study we aimed to discover if there were differences in the demographics and social factors associated with individuals undergoing total knee arthroplasty (TKA) and total hip arthroplasty (THA) in the Rio Grande Valley. We hypothesized that women would have increased risk of THA whereas individuals who are older and have higher BMI would have increased risk of TKA.

Methods: We conducted a retrospective chart review using the UTRGV UTHealth electronic database from January 1, 2018 through …

The Prevalence Of Depression And Anxiety In Patients With Metastatic Disease To The Spine, Caleb Yeung, Jeremy Heard, Yunsoo Lee, Michael Mccurdy, Rajkishen Narayanan, Samantha Kolowrat, Liam Gibbons, Tim Hagan, Jose A. Canseco, Alan S. Hilibrand, Alex R. Vaccaro, Gregory D. Schroeder, Christopher K. Kepler

Rothman Institute Papers

Introduction:

The prevalence of depression and anxiety in cancer patients is approximately 15% and 20%. Unfortunately, depression has been demonstrated to negatively impact patients after spinal fusion surgeries and is associated with worse overall survival in cancer patients. The rates of depression and anxiety have yet to be reported in patients with metastatic spine disease. The objective of this study was to determine the rate of depression and anxiety in patients with metastatic spine disease.

Materials and Methods:

Patients >18 years of age at our institution who presented with metastatic spinal disease between 2017 and 2022 were identified through query …

A Novel Technique Utilizing External Fixation For Intramedullary Total Femur Arthroplasty, Blake Martin, Matthew Hnatow, Emma Herrera

Research Colloquium

Background: Total femur replacement (TFR) exists as a salvage procedure option after multiple failed hip and knee arthroplasties. It can restore a patient’s quality of life and function but is associated with a high complication rate. Historically, the procedure has been performed utilizing en bloc resection of the femur. More recently, intramedullary TFR has been utilized as a method of preserving critical soft tissue attachments. More studies are needed describing intramedullary TFR as to enhance the technique and outcomes for future procedures. We describe a case of intramedullary TFR utilizing external fixation as a means of maintaining critical aspects of …

Anxiety And Depression Amongst Female Athletes, Dp Golden, Re Obmann, Em Moore

Clinical Practice in Athletic Training

Context: Anxiety (categorized by a feeling of fear, dread, and uneasiness) and depression (mood disorder causing feelings of persistent sadness and loss of interest in things an individual once loved) are two major mental health disorders effecting females considerably who participate in sport. Females are more likely to present with anxiety (55-60%)1 and depression (1.844 times)2 compared to males. The purpose of this study was to examine the prevalence between mental health comorbidities (anxiety and depression), across female athletes aged 18-40. Methods: An anonymous survey was distributed via snowball sampling using social media. Demographic data, Generalized Anxiety Disorder-7 (GAD-7), validated …

Effects Of Sex Hormones And The Menstrual Cycle On Knee Joint Laxity In Physically Active Females: A Critically Appraised Topic, Ae Eicher, Rj Gage, K Park-Braswell

Clinical Practice in Athletic Training

Clinical Scenario: In recent years, females have exhibited increased physical activity and sport participation than ever before. Recent studies have identified a rising incidence rate of ACL injuries and indicate that the risk of ACL tears is greater in females than males. Knee laxity and physiological variation in women during the menstrual cycle have demonstrated increased ligament laxity, therefore, varying hormone concentrations may contribute to changes in ligamentous mechanical properties. Despite these findings, it remains unclear whether fluctuating sex hormone concentrations directly correlate to measurable changes in knee laxity. Clinical Question: How do fluctuations in sex hormones throughout the menstruation …

Individual Goal And Velocity Based Throwing Program For Collegiate Baseball Pitchers With Medial Elbow Injuries, Le Trail, Jm Cline, Ap Jacobsen

Clinical Practice in Athletic Training

Background: A 22-year-old male collegiate baseball pitcher experienced sudden pain in the medial left elbow following feeling a pop when pitching. The pitcher was removed from the competition and was evaluated with a point-of-care ultrasound at the conclusion of the competition. Ultrasound revealed an intact ulnar collateral ligament (UCL) and no edema. Differential Diagnosis: UCL sprain, Wrist flexor strain Treatment: The patient was referred to a primary care sports medicine physician for further evaluation. The physician found no tenderness or laxity at the UCL and ordered an MRI arthrogram for further diagnostic information. MRI revealed a grade II flexor digitorum …

Presentation Of An Accessory Navicular Bone In A Collegiate Women’S Field Hockey Player: A Type 3 Clinical Case Study, N Sutker, J Franco, K Mallory, B Hansberger

Clinical Practice in Athletic Training

Background: The accessory navicular is an extra bone located posterior and medial to the navicular tuberosity. The prevalence of accessory navicular has been reported to be 4 - 21% in the general population though this anatomical variant may often be overlooked during differential diagnosis. This case presents a female collegiate field hockey patient that was initially diagnosed with a midfoot sprain but was later determined to have an accessory navicular bone which required surgical removal. Patient: A 19-year-old female Division I collegiate field hockey patient presented to the athletic training clinic with pain in her left medial foot. The patient …

Changes In Neural Excitability Following 6-Week Of Balance Training In Individuals With Chronic Ankle Instability, Sh Chung, J Freeman, Rs Mccann

Clinical Practice in Athletic Training

Context: Individuals with chronic ankle instability (CAI) often struggle with balance issues due to changes in the central nervous system (CNS). Specifically, difficulties in modulating spinal reflexive excitability and enhancing corticospinal excitability contribute to poor balance, indicating challenges in transferring control to supraspinal centers. A recent study found that a single session of balance training could positively impact the CNS, improving spinal reflexive excitability modulation and corticospinal excitability in CAI patients. However, there is limited research on the effects of long-term balance training on neural excitability in CAI individuals. Therefore, this study aimed to investigate the effects of a 6-week …

Chronic Neck Pain, Vasculopathy, And Pre-Syncope In A Young Adult: A Type 4 Case Study, Tn Crane, K Moore, A Field

Clinical Practice in Athletic Training

Background: The patient is a 23-year-old college female presenting with chronic cervicalgia, bilateral upper extremity neurovascular symptoms, and insidious pre-syncope episodes over the past 3.5 years. Upper extremity neurovascular symptoms include bilateral numbness and tingling into the hands and bilateral throbbing arm pain originating proximal to the elbow and traveling to the fingers, which worsens with cervical rotation bilaterally. The patient has experienced 10 episodes of pre-syncope lasting less than 30 seconds that occur with cervical flexion, extension, or bilateral rotation. Pre-syncope symptoms include lightheadedness, blurry vision, increased neck/arm pain, headache, and malaise. Upon clinical evaluation, no obvious deformity, discoloration, …