Musculoskeletal System Commons^™

Blood Flow Restriction Therapy: A Review Of Physiology, Clinical Application, And Guidelines For Implementation, Nathan Schuliger

Senior Honors Theses

Blood flow restriction (BFR) therapy is an emerging clinical modality utilizing the metabolic stress of a hypoxic state to induce hypertrophic and strength adaptations in a manner allowing for reduced external loading. BFR has a variety of applications in rehabilitation settings, showing great potential for patients seeking the benefits of high intensity training without the associated degrees of mechanical stress. This literature review details the proposed mechanisms of BFR, along with various clinical applications of BFR including active and aerobic BFR. Concerns and contraindications for BFR usage are discussed regarding certain clinical populations, with risk stratification recommendations provided. Current BFR …

Idiopathic And Neuromuscular Scoliosis In A Female College Basketball Player Requiring Spinal Correction Surgery, Magan Kim

UNO Student Research and Creative Activity Fair

The purpose of this report is to present the case of a 20-year-old female collegiate basketball player who was diagnosed with a combination of idiopathic and neuromuscular scoliosis. Patient underwent thoracic spinal fusion surgery when she was 15 to resolve her extreme scoliosis. The uniqueness of this case stems from the athlete’s urgency to have to undergo a life-altering spine operation and still be able to successfully contribute to a collegiate basketball team. Athletic trainers should be knowledgeable and aware of how to maintain treatment/rehabilitation for athletes with scoliosis, operative or non-operative. Scoliosis should no longer be a reason to …

Acute Simultaneous Medial And Lateral Ankle Sprain In A Collegiate Football Player: A Case Report, Ian Matlack

UNO Student Research and Creative Activity Fair

The purpose of this case report is to present a twenty-year-old African American male with a complex ankle injury. During a collegiate football game, the athlete injured his left ankle, damaging his deltoid ligament complex, and lateral ankle complex, causing several bone bruises and tearing his peroneal retinaculum. With surgery being declined, standard rehabilitation protocols of POLICE for initial management of inflammation, strengthening, and ROM exercises were conducted. Manual therapies consisting of milking massage, scraping, and joint mobilizations were added to aid in pain and edema control. Comparative case studies suggest that the athlete may have experienced a subluxation of …

Anterior Cruciate Ligament Hybrid Remnant Preservation Reconstruction Demonstrates Similar Outcomes As Traditional Reconstruction After 6 Months: A Randomized Control Trial, Joshua P. Castle, Eleftherios L. Halkias, Brittaney Pratt, Ashley Frei, Matthew A. Gasparro, Vasilios Moutzouros

Medical Student Research Symposium

Background

The anterior cruciate ligament (ACL) is often debrided during reconstruction (ACLR) to improve visualization. However, remnant ACL tissue contains nerve fibers and including remnant tissue in ACLR could provide benefit. Therefore, a technique was developed that preserves the tibial remnant and incorporates it into ACLR: Hybrid Remnant Preservation Reconstruction (HRPR) ACLR. This study compares HRPR-ACLR to traditional reconstruction by comparing patient reported outcomes and complications.

Methods

Patients presenting to one surgeon's clinic with an ACL injury are screened. Exclusion criteria are patient age<14 years, multi-ligament injury, chronic tears, and revision ACLR. Patients are consented and randomized to HRPR or traditional ACLR. Demographics, patient-reported outcomes, range of motion (ROM) and complications were collected.

Results

Thirty-three patients were included, 20 HRPR and 13 controls. No demographic differences were noted. PROMIS-PF, …

An Emg Study To Evaluate Chewing Efficiency And Maximum Voluntary Clenching (Mvc) For Different Malocclusion Groups Before And During Orthodontic Treatment, Vivek Reddy

Annual Research Symposium

The purpose of this study was to investigate the efficacy of chewing and maximum voluntary clenching (MVC) of patients with different malocclusion types by measuring the EMG activity in the masseter and temporalis muscles before and during orthodontic treatment.

Overlooked Dental Disease In Cbct Imaging And The Impact Of Oral Radiologist Interpretation, Jared Fausnaught

Annual Research Symposium

This study aims to underscore the necessity for a comprehensive interpretation of Cone Beam Computed Tomography (CBCT) volume images obtained by dentists. The research demonstrates and quantifies potentially overlooked dental pathology, categorizing incidental findings into three groups: 1) requiring some form of treatment or follow-up, 2) necessitating follow-up (monitoring) only, and 3) demanding no further treatment or follow-up.

Actin Depolymerization Of Tenocytes Promotes A Tendinosis-Like Gene Expression, Kameron Inguito, Ba, Valerie West, Karl Matthew Ebron, Justin Parreno, Phd

Alpha Omega Alpha Research Symposium Posters

Optimal cellular mechanotransduction is essential for tendon matrix homeostasis. We recently developed an in vivo rat model of tendinosis, where the plantaris tendon are overloaded through ablation of the synergistic Achilles tendon. Using this model we determined that tissue overload disrupts matrix-cell interactions, which results in under-stimulation of tendon cells (tenocytes) (Fig.1)

Using an ex vivo model of tendon stress deprivation by maintaining tail tendon fascicles in floating culture we showed that tenocyte under-stimulation results in destabilization of filamentous (F-)actin (Fig.2). F-actin destabilization coincides with tendinosis-like gene expression: downregulation of tenogenic genes (Col1, Tnc, asma, Scx), upregulation of chondrogenic (Acan, …

Influences Of Athletic Trainers' Return-To-Activity Assessments For Patients With An Ankle Sprain, Ryan S. Mccann, Cailee E. Welch Bacon, Ashley M. B. Suttmiller, Phillip A. Gribble, Julie M. Cavallario

Rehabilitation Sciences Faculty Publications

Context: Athletic trainers (ATs) inconsistently apply rehabilitation-oriented assessments (ROASTs) when deciding return-to-activity readiness for patients with an ankle sprain. Facilitators and barriers that are most influential to ATs' assessment selection remain unknown.

Objective: To examine facilitators of and barriers to ATs' selection of outcome assessments when determining return-to-activity readiness for patients with an ankle sprain.

Design: Cross-sectional study.

Setting: Online survey.

Patients or other participants: We sent an online survey to 10 000 clinically practicing ATs. The survey was accessed by 676 individuals, of whom 574 submitted responses (85% completion rate), and 541 respondents met the inclusion criteria.

Main outcome …

Assessments Used By Athletic Trainers To Decide Return-To-Activity Readiness In Patients With An Ankle Sprain, Ryan S. Mccann, Cailee E. Welch Bacon, Ashley M. B. Suttmiller, Phillip A. Gribble, Julie M. Cavallario

Rehabilitation Sciences Faculty Publications

Context: Athletic trainers (ATs) often care for patients with ankle sprains. Expert consensus has been established for rehabilitation-oriented assessments (ROASTs) that should be included in ankle-sprain evaluations. However, the methods ATs use to determine return-to-activity readiness after an ankle sprain are unknown.

Objectives: To identify ATs' methods for determining patients' return-to-activity readiness after an ankle sprain and demographic characteristics of the ATs and their methods.

Setting: Online survey.

Design: Cross-sectional study.

Patients or Other Participants: We recruited 10 000 clinically practicing ATs. A total of 676 accessed the survey, 574 submitted responses (85% completion rate), and 541 respondents met the …

Sex Differences In The Effects Of Cortisol On Muscle Characteristics: A Meta-Analysis, Natalie Bitetti

CMC Senior Theses

Background: Cortisol plays a central role in both muscle breakdown and growth. These effects are highly dependent on dose and interactions with other hormones. It is known that men and women show considerable differences in their muscle structure and physiology, which are largely driven by hormonal differences. Cortisol release patterns may also vary between the sexes, with current research showing considerable disagreement. The interplay between cortisol and muscle, two highly variable and sexually dimorphic factors, may prove to have different effects in males versus females.

Objective: This meta-analysis integrates existing research on sex differences in cortisol-muscle physiology with existing research …

Quality Improvement Of X-Ray Imaging For Unspecified Chronic Knee Pain And Suspected Knee Osteoarthritis In The Primary Care Setting, Ty E. Bever

Family Medicine Clerkship Student Projects

Although a comprehensive history and physical exam are the mainstays of initial evaluation, plain X-rays are clinically indicated for chronic knee pain of greater than 6 weeks duration and acute traumatic pain in patients who meet specific evidence-based criteria, according to the American Academy of Family Physicians (AAFP). However, there remains significant variation in what radiographic protocols are used in clinical practice, specifically in terms of what radiographic views are ordered and whether the imaging is performed with the patient weight-bearing (WB) or non-weight-bearing (NWB). In fact, several studies have shown that non-weight-bearing knee radiographs are frequently ordered by general …

Arachnoid Webs With Spinal Cord Compression: Insights From Three Cases, Kaleb Derouen, Kierany B. Shelvin, Tayler Payton, George A. Crabill, John M. Wilson, Gabriel Tender

School of Medicine Faculty Publications

Spinal arachnoid webs are intradural bands of abnormally formed arachnoid tissue, located within the subarachnoid space and causing compression of the dorsal aspect of the spinal cord. Arachnoid webs are uncommon and can be difficult to treat. We report 3 patients presenting with a spinal arachnoid web within a 6-month period. All of them exhibited signs of thoracic myelopathy and the MRI showed the pathognomonic 'scalpel sign'. Two of the patients underwent surgery for removal of their spinal arachnoid web, whereas the third patient case is currently being managed conservatively. We also present our 2D intraoperative video for arachnoid web …

First-Generation Cephalosporins For Treatment Of Acute Hematogenous Osteomyelitis In Children: A Study Of Efficacy And Adverse Effects, Lisa Hiskey, Hiba Saifuddin, Emily R. Levy, Roland Hentz, Nipunie S. Rajapakse, Laura M. Dinnes, Elizabeth H. Ristagno

School of Medicine Faculty Publications

BACKGROUND: Acute hematogenous osteomyelitis (AHO) is a relatively infrequent but significant infection in pediatric patients. As is the most common cause of AHO, intravenous and oral first-generation cephalosporins are common therapies. Cephalexin is a commonly prescribed oral therapy for pediatric AHO, although it requires frequent dosing that may affect adherence. Cefadroxil is a comparable oral first-generation cephalosporin with a more desirable dosing schedule. METHODS: We reviewed pediatric patients admitted to Mayo Clinic between March 2002 and September 2020 for management of AHO who received treatment with a first-generation cephalosporin. We reviewed timing of oral therapy transition, therapy-associated adverse effects, and …

Preoperative Computed Tomography Scan In Distal Radius Fractures And The Effect On Preoperative Planning, Adam L. Haydel, Ryan C. Roubion, Cristina T. Graphia, Corinne E. Cloud, Claudia Leonardi, Christopher E. Marrero

School of Medicine Faculty Publications

Purpose: It is unclear whether computed tomography (CT) scans alter the surgical plan when ordered before surgery for fixation of intra-articular distal radius fractures (DRFs). The purpose of this study was to determine whether a preoperative CT scan alters the planned approach (PA) or planned fixation strategy (PFS) for open reduction internal fixation of intra-articular DRFs. Methods: Radiology records were retrospectively reviewed by one trauma surgeon and two hand surgeons for 33 intra-articular DRFs that met the inclusion criteria and previously underwent open reduction internal fixation. Surgeons were initially provided only preoperative radiographs; they were asked for their PA and …

Is There Room For Individual Patient-Specified Preferences In The Patient-Reported Outcome Measurement Revolution?, Leif I. Solberg, Jeanette Y. Ziegenfuss, Rachael L. Rivard, Christine K. Norton, Robin R. Whitebird, Glyn Elwyn, Mark Swiontkowski

Journal of Patient-Centered Research and Reviews

Purpose: The study aim was to test the feasibility of collecting qualitative patient-preferred outcomes or goals and the degree of their attainment as an addition to a standardized process for collecting quantitative composite patient-reported outcome measures (PROMs) from patients undergoing knee joint replacement..

Methods: Patients of a large Midwestern medical group scheduled to have total replacement of their knee joint have been asked to complete a PROMs survey preoperatively and at 3 and 12 months after surgery since 2014. In March 2020, an open-ended question about their most important preferred outcome was added to the existing questionnaire. The responses for …

Botulinum Toxin Type A Injections For Refractory Abdominal Dystonia: A Case Report, William J. Naber Ii, Jodi M. Wilhelm, Kurt A. Kuhlman, Gabriel Howard

Graduate Medical Education Research Journal

Background: A 58-year-old male with chronic bilateral treatment resistant abdominal spasms secondary complications of ascites/ alcoholic cirrhosis. Spasms would occur 4-5 times/day, lasting minutes to hours despite a 2-year course of therapeutic and pharmacological interventions. Due to treatment refraction, 6 uniformly spaced botulinum toxin type A (BTX-A) injections were placed per side, using electromyography for audible intramuscular syringe placement confirmation, while visual confirmation was made via ultrasound. During the initial trial, 6 evenly spaced injections were performed bilaterally, uniformly distributing 80U/side. Injections began bilaterally just medial to the junction of the inferior rib cage border/ anterior axillary line and progressed …

Variation In Functional Pelvic Tilt In Patients Undergoing Total Hip Arthroplasty With Acetabular Dysplasia, Myung-Jin Cha, Joel Wells, Yin Xi, Avneesh Chhabra

Research Colloquium

Purpose: It is important to clarify the link between acetabular dysplasia and pelvic tilt to optimize surgical planning and postoperative outcomes. We sought to investigate functional pelvic tilt in patients undergoing total hip arthroplasty with acetabular dysplasia.

Materials & Methods: From 2014 to 2020, pre-operative AP Pelvis X-rays, CT scans, and other patient-specific data such as pelvic tilt, lumbar lordotic angle, etc were collected as part of surgical planning for total hip arthroplasty. From this database, we investigated 678 female patients under the age of 50 that had undergone preoperative standing AP pelvis X-rays. Analysis was performed by investigating how …

Wrist Motion Is Distinct Between Touch Screen And Manual Or Digital Devices, Mandi J. Lopez, Catherine Takawira, Mary P. Fox, Pengju Wang, Evan Boatwright, Thomas Lucak, Chin Chi Liu, Bryce Fugarino

School of Medicine Faculty Publications

Background Restricted motion during touch screen device use may contribute to wrist overuse injuries. Wrist radioulnar deviation and extension while using touch screen devices and digital or manual counterparts in male and female medical professional dominant and non-dominant hands were quantified to test the hypothesis that mobile touch screen device use reduces wrist motion. Methods An active motion detection system was used to record wrist motion of 12 participants while: tablet swiping and turning book pages; raising a cell and traditional phone to the ear; texting and typing; and entering numbers on a cell phone and manual calculator. Medial and …

Characterization Of Epithelial Growth Factor Transcripts Identified In Crotalus Atrox Venom, Ivan Lopez, Ying Jia

Research Symposium

Epithelial Growth Factor (EGF) is the primary source in regeneration and stimulation of essential fibroblasts cells commonly found in epithelium. Studies have shown that snake venom components are becoming a growing factor in treating illnesses such as cancer, muscular dystrophy, chronic pain, blood pressure, blood clotting, etc. EGF in human cells contains a promising quaternary structure that can bind to snake venom metalloproteinases, proposing a means of activating biochemical responses through protein-protein interactions to regulate unwanted cellular functions. This supports promising research in achieving a greater understanding of regulation along cellular pathways through ligands, increasing the likelihood of targeting unwanted …

Changes In Severity Of Pelvic Floor Dysfunction After Hip Surgery, Amisha Mehta, Joel E. Wells, Sonia Wadekar, Taylor Price, Donald Kasitinon

Research Symposium

Introduction: Despite growing evidence that suggests an association between hip pathology and pelvic floor disorder (PFD), the comprehensive effects of hip surgery on PFD symptoms are not well understood. The primary purpose of this study was to report the role of surgical hip procedures on the severity of PFD symptoms.

Methods: A prospective database of demographic and outcome data for all female patients that were operated on between 2019-2020 at a single institution was queried. The PDFI-20 was used to assess symptom severity, and cases with both pre and postoperative surveys were included (n=62). MCID was used to determine significance …