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Biomedical subjects

G A Malanga

Publications and source records attributed to G A Malanga.

At least 19 recordsLinked to original sources
PubMed2001

The crossed femoral nerve stretch test to improve diagnostic sensitivity for the high lumbar radiculopathy: 2 case reports.

The femoral nerve stretch test (FNST) is commonly used to assess high lumbar radiculopathy. It may be falsely positive secondary to tight or injured muscles of the anterior thigh, and to osseous or joint pathology in and about the hip. We report on the crossed FNST, which may improve the specificity of the FNST. Two cases that occurred within 2 months are presented. The physical examinations suggested high lumbar radiculopathy, which was confirmed by both the FNST and crossed FNST. The crossed FNST may thus be a valuable screening test that further supports a diagnosis of upper lumbar radiculopathy. Further study is necessary to identify its prevalence in the assessment of the high lumbar radiculopathy.

Adult↗
PubMed2001

Relationship between hip muscle imbalance and occurrence of low back pain in collegiate athletes: a prospective study.

OBJECTIVE: To assess whether athletes with strength imbalance of the hip musculature would be more likely to require treatment for low back pain (LBP) over the ensuing year. DESIGN: The study population included 163 National Collegiate Athletic Association Division I college athletes (100 males and 63 females) undergoing preparticipation sports physicals. Institutional review board approval was obtained to acquire and analyze hip muscle strength data. A commercially available dynamometer (Chatillon, Lexington, KY) incorporated into a specially designed anchoring station was used for testing the hip extensors and abductors. The maximum force generated for the hip abductors and extensors was used to calculate a percentage difference between the right and left hip extensors and abductors. Treatment of athletes by the athletic trainers for LBP unrelated to blunt trauma over the ensuing year was recorded. RESULTS: Of all athletes, 5 of 63 females and 8 of 100 males required treatment for LBP. Logistic regression analysis indicated that for female athletes, the percentage difference between the right and left hip extensors was predictive of whether treatment for LBP was required over the ensuing year (P = 0.05). There was no significant association noted for the percentage difference between the right and left hip abductors in females and for the percentage difference between both the right and left hip abductors and right and left hip extensors in males requiring treatment for LBP. CONCLUSIONS: These data support our results from our previous cohort study, adding validity to the concept of hip muscle imbalance being associated with LBP occurrence in female athletes. This research further supports the need for the assessment and treatment of hip muscle imbalance in individuals with LBP.

Female↗
PubMed2000

Portable dynamometer anchoring station for measuring strength of the hip extensors and abductors.

OBJECTIVE: To assess the reliability of a specially designed dynamometer anchoring station in the measurement of hip muscle strength. DESIGN: Prospective study using test-retest design. SETTING: Outpatient clinic setting. PARTICIPANTS: Ten subjects, ages 25 to 35yrs. MAIN OUTCOME MEASURES: Using the apparatus, three consecutive measures were recorded for hip abduction and extension by an inexperienced examiner. Two weeks later, the same subjects were retested, with the evaluator blinded to the initial results. In both the test and retest, average and maximal values of strength were calculated for each muscle. Reliability of the device was assessed by computing the intraclass correlation coefficients and coefficients of variation (CVs). RESULTS: Intraclass correlation coefficients ranged from .94 to .98. The average CV for the maximal and average abduction strength had values of 4.77% and 4%, respectively. The maximal and average extension strength had average CV values of 8.06% and 7.83%, respectively. CONCLUSION: This specially designed dynamometer anchoring station has been found to be highly reliable in the measurement of hip girdle strength and has the advantage of easy adjustability and portability for large-scale screenings. This device enhances the reliability of the dynamometer, which may be subject to considerable variability when applied by hand to the powerful hip girdle musculature.

Adult↗
PubMed2000

The relationship between lower extremity injury, low back pain, and hip muscle strength in male and female collegiate athletes.

OBJECTIVE: To determine the relationship of previous lower extremity (LE) injury and/or low back pain (LBP) on hip abduction and extension strength. DESIGN: Cohort study of college athletes at time of preparticipation screening physical. SETTING: An NCAA Division I college. PARTICIPANTS: Two hundred ten college athletes (140 males and 70 females) from an NCAA Division I school. MAIN OUTCOME MEASURES: Mean and maximal hip abduction and extension strengths were recorded using a specially designed dynamometer anchoring station. Previous injury to the LE or LBP in the past year was recorded via personal interview at the time of screening and verified by review of previous injury records. RESULTS: A significant difference in side-to-side symmetry of maximum hip extension strength was observed in female subjects who reported LE injury or LBP as compared to those who did not. Side-to-side difference in hip strength, however, did not differ between male athletes, regardless of reported LE injury or LBP status. CONCLUSION: Female athletes appear to have a differing response of the proximal hip musculature to LE injury or LBP, as compared with their male counterparts. Research is under way to further validate these findings. CLINICAL RELEVANCE: This study provides some reasoning to support the screening of hip strength during the preparticipation physical, as it may be important in the prevention of LE injury and LBP in collegiate athletes.

Adult↗
PubMed1999

Nonoperative treatment of low back pain.

Low back pain is a common problem with substantial social and economic issues. Physicians continue to have difficulty managing this condition despite an increased awareness of its magnitude. In addition, there is a misperception about the outcome of patients affected with low back pain; most continue to suffer from pain. We present a nonoperative approach and review various diagnostic and treatment strategies with respect to both scientific and clinical merit. Although many treatment strategies have not been well proved in the scientific literature, thoughtful review of the available information provides a basis for the use of these treatment methods in the patient with refractory pain. This approach can be used in conjunction with existing information to assist clinicians in the management of patients with acute low back pain.

Bed Rest↗
PubMed1998

A randomized controlled evaluation of low-intensity laser therapy: plantar fasciitis.

OBJECTIVE: To determine whether low-intensity laser irradiation, a widespread but controversial physical therapy agent, is an effective treatment of plantar fasciitis. DESIGN: A randomized, double-blinded, placebo-controlled clinical study. SETTING: A sports medicine clinic. SUBJECTS: Thirty-two otherwise healthy individuals with plantar fasciitis of more than 1 month's duration. INTERVENTION: Dummy or active irradiation with a 30 mW .83 microm GaAlAs continuous-wave infrared (IR) diode laser three times a week for 4 weeks. MEASUREMENTS: Morning pain, pain with toe walking, tenderness to palpation, windlass test response, medication consumption, and orthotic use were evaluated immediately before the study, as well as at the midpoint and end of treatment. Subjects were also evaluated at a follow-up 1 month after their last treatment. RESULTS: No significant differences were found between the groups in any of the outcome measures either during treatment or at the 1-month follow-up. Treatment, however, was well tolerated and side effects were minimal. CONCLUSIONS: Low-intensity IR laser therapy appears safe but, at least within the parameters of this study, is not beneficial in the treatment of plantar fasciitis.

Adult↗
PubMed1997

Spondylolysis associated with Arnold-Chiari malformation and syringomyelia. A report of two cases.

STUDY DESIGN: This is a report of two cases. OBJECTIVE: To document the occurrence and association of spondylolysis and Arnold-Chiari malformation Type I. SUMMARY OF BACKGROUND DATA: The association of spinal dysraphism has been reported with Arnold-Chiari Type II, but not with Arnold-Chiari Type I. METHODS: The senior author was involved in the care of these patients. All medical records, laboratory and radiologic investigations, and related literature were reviewed. RESULTS: The presence of cephalic and caudal neuropore maldevelopment may be present in various combinations. The presence of spondylolysis, with or without spina bifida occulta, associated with Arnold-Chiari malformation type I and syringohydromyelia, is demonstrated. CONCLUSIONS: In some patients, the presence of spondylolysis may represent a congenital anomaly and may be associated with cephalic neuropore maldevelopment, such as cerebromedullary malformation syndrome (i.e., Arnold-Chiari malformation Type I).

Adolescent↗
PubMed1997

The diagnosis and treatment of cervical radiculopathy.

To provide a comprehensive review of the presentation, evaluation, differential diagnosis, treatment and return-to-play criteria which can be useful to the clinician caring for athletes with cervical radiculopathy. A review of the literature on cervical radiculopathy and sports injuries of the cervical spine was performed. This information was used in conjunction with the author's clinical experience to present a literature based approach to the diagnosis and treatment of cervical radiculopathy in athletic individuals. There was limited scientific literature on the evaluation and treatment of cervical radiculopathy in athletes. Many studies reported on the evaluation and treatment of the "burner" or "stinger" in the younger athlete which may represent a cervical radiculopathy in many of these cases. A nonoperative treatment plan using a logical step-wise approach is successful in the vast majority of these patients. Using the history and a detailed physical examination, along with imaging and other diagnostic studies when necessary, a proper diagnosis of cervical radiculopathy can be made. Once a discrete diagnosis is made, then a systematic approach to the treatment and rehabilitation can be implemented to optimize a safe return to competition.

Athletic Injuries↗
PubMed1996

EMG analysis of shoulder positioning in testing and strengthening the supraspinatus.

We examined the electromyographic (EMG) activity of the supraspinatus and other rotator cuff muscles, the three portions of the deltoid muscle, and the pectoralis major muscle in two previously suggested positions for isolating the supraspinatus. The position suggested by Jobe and colleagues is with the elbow extended, the shoulder in full internal rotation, and the arm in the scapular plane. Blackburn and colleagues recommended the prone position, with the elbow extended and the arm abducted to 100 degrees and externally rotated. Fine-wire EMG activity was obtained from the rotator cuff muscles and surface EMG from the other muscles in 17 subjects tested in these two positions. Both positions resulted in significant activity of the supraspinatus, but the difference between these two positions was not statistically significant. The Jobe position produced greater activation of the anterior deltoid and pectoralis major, whereas the Blackburn position caused greater activation of the posterior deltoid. Both positions produced significant activation of the middle deltoid. We conclude that either position can be used to strengthen the supraspinatus; however, neither position selectively isolates the supraspinatus during manual muscle testing.

Adult↗
PubMed1996

Lower extremity injuries in in-line skaters: a report of two cases.

In-line skating has become a very popular sport over the past several years. Previous studies examining the injuries associated with this sport have emphasized the incidence upper extremity injuries. Two cases are described in which patients suffered severe lower extremity injuries while in-line skating: one had a femoral shaft spiral fracture and the other bilateral anterior cruciate ligament and medial collateral ligament injuries. Although a predominance of upper extremity injuries associated with this sport has been widely noted, increased numbers of participants, higher speeds and changing skate designs may further predispose skaters to leg, knee and ankle injuries.

Adult↗
PubMed1995

In-line skating injuries.

OBJECTIVE: To assess the type and site of injuries associated with in-line skating in patients encountered during an 18-month period. DESIGN: We retrospectively reviewed the medical records of patients in our emergency department and Sports Medicine Center with injuries that had resulted from in-line skating between July 1992 and December 1993. MATERIAL AND METHODS: A computer search was conducted to identify medical records on which in-line skating was denoted as the mechanism of injury. The records were then manually reviewed to confirm that the injury had occurred during in-line skating. The patient's sex, age, type of injury, and injured body part were recorded. RESULTS: During the designated study period, 32 in-line skating injuries were recorded in 32 patients (19 female and 13 male skaters). The mean age of the study group of injured skaters was 17 years (range, 6 to 46). An upper extremity was involved in 78% of all injuries, and the wrist was the body part most often injured (56%). A lower extremity was involved in 16% of all injuries, including two that were severe. Of the 32 injuries, 62% were fractures, and surgical treatment was necessary for only 1 injury during the study period. CONCLUSION: In this study, in-line skating injuries most commonly involved the upper extremities. Fractures, particularly of the distal radius, were the most common type of injury. Lower extremity trauma was less frequent, but severe injuries can occur. Further prospective studies are needed.

Adolescent↗
PubMed1993

Continuous passive motion in the rehabilitation setting. A retrospective study.

Continuous passive motion (CPM) has been commonly used in the postoperative rehabilitation of patients after total knee arthroplasty. In the acute care hospital, most studies have found CPM to be useful in improving range of motion and reducing length of stay. The benefit of CPM in the rehabilitation hospital has not been studied. The charts of 61 patients who had undergone total knee arthroplasty and subsequently were admitted to the East facility of the Kessler Institute for Rehabilitation were reviewed. Patients were separated into two groups: Group 1 received CPM for 3 to 4 hours/day and physical therapy for 2 hours/day. Group 2 received only physical therapy. There was no significant difference in passive range of motion or length of stay between Group 1 and Group 2. An analysis of the 16 patients who underwent bilateral replacement was undertaken. Patients in Group 1 (n = 7) achieved an average increase in passive range of motion of 20.1 degrees, whereas those in Group 2 (n = 9) achieved an increase of 12.7 degrees (P = 0.18). Power analysis demonstrated the need for 50 patients per subgroup to achieve significance. The lack of statistical significance in this subgroup may be a reflection of the small study population (n = 16). The following conclusions can be drawn concerning the use of CPM in the rehabilitation setting: (1) CPM was of no added benefit to those patients admitted after single knee replacement, and (2) CPM may be beneficial to those patients admitted after bilateral knee replacement.

Aged↗
PubMedDate not supplied

Intracranial venous thrombosis in a patient with multiple sclerosis. A case report and review of contraceptive alternatives in patients with disabilities.

Intracranial thrombosis is a rare complication of oral contraceptive use. A case is presented of a 35-yr-old woman with multiple sclerosis who took oral contraceptives and, subsequently, experienced intracranial transverse and sigmoid sinus thromboses and, later, deep venous thrombosis of the calf. A review of the relationship between oral contraceptives and venous thrombosis is presented. In addition, the diagnostic work-up and treatment options for intracranial venous thrombosis are discussed, and appropriate birth control alternatives for disabled patients, that is, diaphragm, sponges, condoms and levonorgestrel, are reviewed.

Adult↗
PubMedDate not supplied

Clarification of the pronator reflex.

The pronator reflex has been used in evaluating the 6th and 7th cervical roots. It has been described as a muscle stretch reflex of the pronator muscles; however, a review of the literature did not elucidate which muscles are active in this reflex. We examined 10 healthy subjects with surface electromyograms recorded over the pronator quadratus and pronator teres and used a Teca reflex hammer to produce a muscle stretch and trigger the electromyogram sweep. A reproducible response was found in all patients when recordings were made over the pronator teres (mean latency, 9.7 +/- 1.8 ms). No response was found in any of the subjects when recordings were made over the pronator quadratus. We conclude that the pronator reflex represents a muscle stretch reflex of the pronator teres (and not the pronator quadratus), which would make it helpful in evaluating C6 and C7 root lesions.

Electromyography↗
PubMedDate not supplied

Activation of the rotator cuff in generating isometric shoulder rotation torque.

This study compared and quantified electromyographic muscle activation of the rotator cuff with the isometric torque generated by performing shoulder rotation in various positions. Twenty healthy volunteers were tested in 29 shoulder positions. Using a Cybex II dynamometer synchronously with electromyography, surface electrodes were placed over the pectoralis major muscle and three parts of the deltoid muscle. Intramuscular wire electrodes were inserted into the four rotator cuff muscles. We found that the greatest external rotation isometric force is generated in the frontal and scapular planes in the neutral or full internal rotation positions. The sagittal, dependent, and the scapular plane with 45 degrees of elevation in rotational positions of either full or half external rotation generated the greatest torques for internal rotation isometric force. The rotator cuff muscles generated greatest electromyographic activity in neutral to midrotational positions. The scapular plane with 90 degrees of shoulder elevation in neutral rotation best isolated the subscapularis muscle. The infraspinatus-teres minor muscles were isolated in the sagittal plane with 90 degrees of shoulder elevation in a half externally rotated position. We were unable to isolate the supraspinatus muscle in any of these tested positions. These positions are recommended for manual muscle testing and for strengthening these muscles.

Adult↗