Name: diagnosis of musculus gastrocnemius tightness - key factors for the clinical examination
Uploaded: 2016-07-07T10:00:00
Description: Watch this Scientific Journal Video about Diagnosis of Musculus Gastrocnemius Tightness - Key Factors for the Clinical Examination at JoVE.com

We would like to thank Jakob Binder for his help in subject acquisition and organization of the examinations, Mrs. Hella Thun for designing Figure 1 and 2 and finally Mr. Dipl.-Ing. (FH), M.Sc. M. Saller for his statistical support.

Etik erklæring: Undersøgelsen var godkendt af den lokale etiske komité ved universitetet i München (# 007-14). Bemærk: En undersøgelse sofa frit tilgængelige på begge sider og fodenden er nødvendig for ikke-weightbearing test. er behov for en linje (bånd, ca. 2 meter) på jorden vinkelret på væggen for weightbearing test. En standard vinkelmåler med 2 ° trin og 20 cm længde er brugt. Vi anbefaler, at dokumentere resultaterne ved hjælp af en standardiseret firedobbelt tabel med ADF måling for knæet udvidet og bøjet...

<ol>
	<li>Wilder, R. P., Sethi, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Overuse+injuries:+tendinopathies,+stress+fractures,+compartment+syndrome,+and+shin+splints.">Overuse injuries: tendinopathies, stress fractures, compartment syndrome, and shin splints.</a> Clin Sorts Med. 23, 55-81 (2004).</li><li>Irving, D. B., Cook, J. L., Menz, H. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Factors+associated+with+chronic+plantar+heel+pain:+a+systematic+review.">Factors associated with chronic plantar heel pain: a systematic review.</a> J Sci Med Sport. 9, 11-22 (2006).</li><li>Patel, A., DiGiovanni, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Association+between+plantar+fasciitis+and+isolated+contracture+of+the+gastrocnemius.">Association between plantar fasciitis and isolated contracture of the gastrocnemius.</a> Foot Ankle Int. 32, 5-8 (2011).</li><li>DiGiovanni, C. W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Isolated+gastrocnemius+tightness.">Isolated gastrocnemius tightness.</a> JBJS Am. 84-A, 962-970 (2002).</li><li>Bol&#236;var, Y. A., Munuera, P. V., Padillo, J. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Relationship+between+tightness+of+the+posterior+muscles+of+the+lower+limb+and+plantar+fasciitis.">Relationship between tightness of the posterior muscles of the lower limb and plantar fasciitis.</a> Foot Ankle Int. 34, 42-48 (2013).</li><li>Hill, R. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ankle+equinus.+Prevalence+and+linkage+to+common+foot+pathology.">Ankle equinus. Prevalence and linkage to common foot pathology.</a> J Am Podiatr Med Assoc. 85, 295-300 (1995).</li><li>Silfverskiold, N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reduction+of+the+uncrossed+two-joints+muscles+of+the+leg+to+one-joint+muscles+in+spastic+conditions.">Reduction of the uncrossed two-joints muscles of the leg to one-joint muscles in spastic conditions.</a> Acta Chir Scand. 56, 315-330 (1923).</li><li>Krause, D. A., Cloud, B. A., Forster, L. A., Schrank, J. A., Hollman, J. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Measurement+of+ankle+dorsiflexion:+a+comparison+of+active+and+passive+techniques+in+multiple+positions.">Measurement of ankle dorsiflexion: a comparison of active and passive techniques in multiple positions.</a> J Sport Rehabil. 20, 333-344 (2011).</li><li>Bennell, K. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intra-rater+and+inter-rater+reliability+of+a+weight-bearing+lunge+measure+of+ankle+dorsiflexion.">Intra-rater and inter-rater reliability of a weight-bearing lunge measure of ankle dorsiflexion.</a> Aust J Physiother. 44, 175-180 (1998).</li><li>Munteanu, S. E., Strawhorn, A. B., Landorf, K. B., Bird, A. R., Murley, G. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+weightbearing+technique+for+the+measurement+of+ankle+joint+dorsiflexion+with+the+knee+extended+is+reliable.">A weightbearing technique for the measurement of ankle joint dorsiflexion with the knee extended is reliable.</a> J Sci Med Sport. 12, 54-59 (2009).</li><li>Wilken, J., Rao, S., Estin, M., Saltzman, C. L., Yack, H. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+new+device+for+assessing+ankle+dorsiflexion+motion:+reliability+and+validity.">A new device for assessing ankle dorsiflexion motion: reliability and validity.</a> J Orthop Sports Phys Ther. 41, 274-280 (2011).</li><li>Gatt, A., Chockalingam, N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Validity+and+reliability+of+a+new+ankle+dorsiflexion+measurement+device.">Validity and reliability of a new ankle dorsiflexion measurement device.</a> Prosthet Orthot Int. 37, 289-297 (2013).</li><li>Baggett, B. D., Young, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ankle+joint+dorsiflexion.+Establishment+of+a+normal+range.">Ankle joint dorsiflexion. Establishment of a normal range.</a> J Am Podiatr Med Assoc. 83, 251-254 (1993).</li><li>Menz, H. B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reliability+of+clinical+tests+of+foot+and+ankle+characteristics+in+older+people.">Reliability of clinical tests of foot and ankle characteristics in older people.</a> J Am Podiatr Med Assoc. 93, 380-387 (2003).</li><li>Rabin, A., Kozol, Z. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Weightbearing+and+Nonweightbearing+Ankle+Dorsiflexion+Range+of+Motion:+Are+We+Measuring+the+Same+Thing?.">Weightbearing and Nonweightbearing Ankle Dorsiflexion Range of Motion: Are We Measuring the Same Thing?.</a> J Am Podiatr Med Assoc. 12, 406-411 (2012).</li><li>You, J. Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Gastrocnemius+tightness+on+joint+angle+and+work+of+lower+extremity+during+gait.">Gastrocnemius tightness on joint angle and work of lower extremity during gait.</a> Clin Biomech (Bristol, Avon). 24, 744-750 (2009).</li><li>Baumbach, S. F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+influence+of+knee+position+on+ankle+dorsiflexion+-+a+biometric+study.">The influence of knee position on ankle dorsiflexion - a biometric study.</a> BMC Musculoskelet Disord. 15, 246 (2014).</li><li>Martin, R. L., McPoil, T. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reliability+of+ankle+goniometric+measurements:+a+literature+review.">Reliability of ankle goniometric measurements: a literature review.</a> J Am Podiatr Med Assoc. 95, 564-572 (2005).</li><li>Tiberio, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Evaluation+of+functional+ankle+dorsiflexion+using+subtalar+neutral+position.+A+clinical+report.">Evaluation of functional ankle dorsiflexion using subtalar neutral position. A clinical report.</a> Phys Ther. 67, 955-957 (1987).</li><li>Tiberio, D., Bohannon, R. W., Zito, M. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+subtalar+joint+position+on+the+measurement+of+maximum+ankle+dorsiflexic.">Effect of subtalar joint position on the measurement of maximum ankle dorsiflexic.</a> Clin Biomech (Bristol, Avon). 4, 189-191 (1989).</li><li>Bohannon, R. W., Tiberio, D., Waters, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Motion+measured+from+forefoot+and+hindfoot+landmarks+during+passive+ankle+dorsiflexion+range+of+motion.">Motion measured from forefoot and hindfoot landmarks during passive ankle dorsiflexion range of motion.</a> J Orthop Sports Phys Ther. 13, 20-22 (1991).</li><li>Johanson, M., Baer, J., Hovermale, H., Phouthavong, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Subtalar+joint+position+during+gastrocnemius+stretching+and+ankle+dorsiflexion+range+of+motion.">Subtalar joint position during gastrocnemius stretching and ankle dorsiflexion range of motion.</a> J Athl Train. 43, 172-178 (2008).</li><li>Kim, P. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Interrater+and+intrarater+reliability+in+the+measurement+of+ankle+joint+dorsiflexion+is+independent+of+examiner+experience+and+technique+used.">Interrater and intrarater reliability in the measurement of ankle joint dorsiflexion is independent of examiner experience and technique used.</a> J Am Podiatr Med Assoc. 101, 407-414 (2011).</li><li>Youdas, J. W., Krause, D. A., Egan, K. S., Therneau, T. M., Laskowski, E. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+effect+of+static+stretching+of+the+calf+muscle-tendon+unit+on+active+ankle+dorsiflexion+range+of+motion.">The effect of static stretching of the calf muscle-tendon unit on active ankle dorsiflexion range of motion.</a> J Orthop Sports Phys Ther. 33, 408-417 (2003).</li><li>Worrell, T. W., McCullough, M., Pfeiffer, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+foot+position+on+gastrocnemius/soleus+stretching+in+subjects+with+normal+flexibility.">Effect of foot position on gastrocnemius/soleus stretching in subjects with normal flexibility.</a> TJ Orthop Sports Phys Ther. 19, 352-356 (1994).</li><li>Norkin, C. C., White, D. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Measurement of Joint Motion: A Guide to Goniometry. , (2003).</li><li>Williams, C. M., Caserta, A. J., Haines, T. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+TiltMeter+app+is+a+novel+and+accurate+measurement+tool+for+the+weight+bearing+lunge+test.">The TiltMeter app is a novel and accurate measurement tool for the weight bearing lunge test.</a> J Sci Med Sport. 16, 392-395 (2013).</li><li>Burns, J., Crosbie, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Weight+bearing+ankle+dorsiflexion+range+of+motion+in+idiopathic+pes+cavus+compared+to+normal+and+pes+planus+feet.">Weight bearing ankle dorsiflexion range of motion in idiopathic pes cavus compared to normal and pes planus feet.</a> Foot (Edinb). 15, 91-94 (2005).</li><li>Konor, M. M., Morton, S., Eckerson, J. M., Grindstaff, T. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reliability+of+three+measures+of+ankle+dorsiflexion+range+of+motion.">Reliability of three measures of ankle dorsiflexion range of motion.</a> Int J Sports Phys Ther. 7, 279-287 (2012).</li><li>Basnett, C. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ankle+dorsiflexion+range+of+motion+influences+dynamic+balance+in+individuals+with+chronic+ankle+instability.">Ankle dorsiflexion range of motion influences dynamic balance in individuals with chronic ankle instability.</a> Int J Sports Phys Ther. 8, 121-128 (2013).</li><li>Kang, M. H., Lee, D. K., Park, K. H., Oh, J. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Association+of+ankle+kinematics+and+performance+on+the+y-balance+test+with+inclinometer+measurements+on+the+weight-bearing-lunge+test.">Association of ankle kinematics and performance on the y-balance test with inclinometer measurements on the weight-bearing-lunge test.</a> J Sport Rehabil. 24, 62-67 (2015).</li><li>Purcell, S. B., Schuckman, B. E., Docherty, C. L., Schrader, J., Poppy, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Differences+in+ankle+range+of+motion+before+and+after+exercise+in+2+tape+conditions.">Differences in ankle range of motion before and after exercise in 2 tape conditions.</a> Am J Sports Med. 37, 383-389 (2009).</li><li>Simondson, D., Brock, K., Cotton, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reliability+and+smallest+real+difference+of+the+ankle+lunge+test+post+ankle+fracture.">Reliability and smallest real difference of the ankle lunge test post ankle fracture.</a> Man Ther. 17, 34-38 (2012).</li><li>Hoch, M. C., Staton, G. S., Medina McKeon, J. M., Mattacola, C. G., Mckeon, P. O. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Dorsiflexion+and+dynamic+postural+control+deficits+are+present+in+those+with+chronic+ankle+instability.">Dorsiflexion and dynamic postural control deficits are present in those with chronic ankle instability.</a> J Sci Med Sport. 15, 574-579 (2012).</li><li>Hoch, M. C., Staton, G. S., Mckeon, P. O. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Dorsiflexion+range+of+motion+significantly+influences+dynamic+balance.">Dorsiflexion range of motion significantly influences dynamic balance.</a> J Sci Med Sport. 14, 90-92 (2011).</li><li>Charles, J., Scutter, S. D., Buckley, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Static+ankle+joint+equinus:+toward+a+standard+definition+and+diagnosis.">Static ankle joint equinus: toward a standard definition and diagnosis.</a> J Am Podiatr Med Assoc. 100, 195-203 (2010).</li></ol>

Undersøgelser af 20 raske individer afslørede, at 20 grader af knæ fleksion allerede forhindrer påvirkning af M. gastrocnemius på ADF. Yderligere knæ fleksion resulterede ikke i nogen væsentlig ADF stigning. Den heri præsenteret video beskrivelse af en standardiseret ikke-weightbearing og weightbearing undersøgelse for MGT bygger forudsætningen for fremtidige undersøgelser oprettelse fysiologiske normværdierne. Undersøgelsen har begrænsninger. Først blev der ikke skr?...

Begrænset ankel dorsiflexion (ADF) ændrer gangart kinematik og holdes ansvarlig for fælles fod patologier, herunder Achilles tendinopati, stress frakturer, metatarsalgia og plantar hæl smerte 1-5. Den mest almindelige årsag til begrænset ADF er isoleret Musculus gastrocnemius tæthed (MGT) 3,6. De fælles kinematik anklen påvirkes af knæ fleksion som M. gastrocnemius broer begge leddene. Musklen er spændt, når knæet er fuldt udstrakt, som oprindelsen af ​​musklen er derefter længst proximal. M. gastrocnemius derefter fastholder ADF. Knæ fleksion tilnærmer musklen oprindelse og derved reducere spændingen af ​​M. gastrocnemius, og dermed øger ADF. Ankelryg derpå begrænset af andre anatomiske strukturer i ankelledet. Figur 1 illustrerer dette princip. I tilfælde af MGT, ADF er begrænset med knæet fuldt extended men i det væsentlige stiger med fleksion i knæet 4. Klinisk undersøgelse for MGT drager fordel af ovenfor skitserede principfast og blev første gang udgivet i 1923 af Silfverskiöld, en svensk ortopædkirurg 7. Siden da har adskillige undersøgelsesteknikker blevet beskrevet, som alle sammenligne ADF med knæet forlænget og bøjet. Udgivet kliniske tests kan kategoriseres i ikke-weightbearing 5,8, weightbearing 9,10, og instrumenteret 11,12. I dag er der ikke weightbearing undersøgelse oftest udført 13. Patienten anbringes i rygleje på en undersøgelse sofa og ADF vurderes med knæet helt ud, og typisk 90 ° bøjet (figur 2A). Tværtimod er weightbearing ADF målinger udført med emnet oprejst i lunge holdning. Den bageste knæ er udvidet eller bøjet, og motivet bliver bedt om at læne sig frem lige før hælen liftoff(Figur 2B). Til begge prøver MGT er diagnosticeret, hvis ADF&#39;en med knæet udvidet forringes og knæ fleksion resulterer i en betydelig stigning i ADF. Selvom ikke-weightbearing tests ofte udføres, weightbearing test har flere fordele. Først er der behov for kun en efterforsker for weightbearing undersøgelse, mens to eksaminatorer er nødvendige for at opnå pålidelige non-weightbearing målinger. For det andet weightbearing undersøgelse tættere afspejler belastningen under gang. Tredje, den kraft, hvormed anklen er uafhængig af undersøgeren. For det fjerde, weightbearing undersøgelse har en højere intra- og inter- rater pålidelighed 9,10,13-15. Den største begrænsning for alle tests for MGT er, at den minimale grad af knæ fleksion nødvendige for at eliminere den fastholdende virkning af M. gastrocnemius på ADF er ukendt 8,15. Betragtninger 90 ° af knæ fleksion er typisk appløj i ikke-weightbearing tester 5,8,16, dette ikke er muligt for weightbearing undersøgelse. Den brede befolkning er i stand til at udføre en Lunge med 90 ° i knæ fleksion uden at løfte hælen fra jorden. Følgelig har de fleste undersøgelser ledende weightbearing undersøgelser ikke styre for knæ fleksion 8,15. For at udføre pålidelige weightbearing undersøgelser er det vigtigt at identificere den minimale grad af knæ fleksion nødvendige for at eliminere den fastholdende virkning af M. gastrocnemius på ADF. Samlet set litteratur argumenterer for weightbearing test til diagnosticering af MGT. For at give et gyldigt procedure weightbearing undersøgelse, den minimale grad af knæ fleksion kræves for at fjerne ADF fastholdende effekt af M. gastrocnemius skal være kendt. Formålet med denne undersøgelse var at undersøge indflydelsen af ​​knæet fleksion på ADF i ikke-weightbearing og weightbearing test og til at give en trin-by-trin guide til at foretage ikke-weightbearing og weightbearing undersøgelse for MGT.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Examination couch</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Standard goniometer&#160;</td>
			<td colspan="2">MDF Instruments USA, Inc. Malibu, CA, USA</td>
			<td>2&#176; increments</td>
		</tr>
	</tbody>
</table>

diagnosis of musculus gastrocnemius tightness - key factors for the clinical examination

Fælles fod og ankel patologier er blevet knyttet til isolerede Musculus gastrocnemius tæthed (MGT). Forskellige undersøgelsesteknikker er blevet beskrevet til vurdering MGT. Alligevel er en standardiseret undersøgelsesprocedure mangler. Litteratur argumenterer for weightbearing undersøgelse men graden af knæet fleksion nødvendige for at eliminere den fastholdende virkning af M. gastrocnemius på ankel dorsiflexion (ADF) er ukendt. Dette håndskrift undersøger virkningen af ​​knæet fleksion på ankelryg og indeholder en detaljeret beskrivelse af en standardiseret undersøgelse protokol. Undersøgelse på 20 raske individer afslørede, at 20 ° af knæ fleksion er tilstrækkelig til fuldstændigt at eliminere indflydelsen af M. gastrocnemius på ADF. Dette bygger forudsætningen for en standardiseret undersøgelse for MGT. Ikke-weightbearing og weightbearing undersøgelse af ADF skal udføres med knæet helt ud, og mindst 20 ° bøjet. To efterforskere børudføre ikke-weightbearing test med emnet i liggende stilling. For at opnå pålidelige resultater, bør akse fibula mærkes. En censor kan foretage weightbearing undersøgelse med emnet i lunge holdning. Isoleret MGT er til stede, hvis ADF er nedsat med knæet helt ud, og knæ flexion resulterer i en signifikant ADF stigning. Den her præsenterede standardiserede undersøgelse er en forudsætning for fremtidige undersøgelser med henblik på opstilling normværdierne.

Begge ankler af 20 raske individer (gennemsnitsalder på 27,1 ± 3,9 år), 50% kvinder, blev undersøgt. Ikke-weightbearing og weightbearing test på seks forskellige grader af knæ fleksion (fuld extension, 20 °, 30 °, 45 °, 60 °, 75 °) og Lunge Test (ukontrolleret knæ flexion) blev gennemført. En funktionel brace blev anvendt til at styre knæ fleksion. Målingerne blev udført af to efterforskere blindede til hinandens resultater. Mellem hver enkelt blev rækkefølgen af ​​...

Watch this Scientific Journal Video about Diagnosis of Musculus Gastrocnemius Tightness - Key Factors for the Clinical Examination at JoVE.com

Diagnosis of Musculus Gastrocnemius Tightness - Key Factors for the Clinical Examination

Isoleret Musculus gastrocnemius tæthed er en almindelig årsag til fod og ankel patologier. I øjeblikket findes der ingen standardiseret undersøgelsesprocedure. Dette håndskrift viser, at 20 grad af knæ fleksion eliminerer begrænsende effekt af M. gastrocnemius på ankelryg og præsenterer en video beskrivelse af en standardiseret undersøgelse protokol.

diagnose af<em&gt; Musculus Gastrocnemius</em&gt; Tæthed - nøglefaktorer for den kliniske undersøgelse

Common foot and ankle pathologies have been linked to isolated Musculus gastrocnemius tightness (MGT). Various examination techniques have been described ...

The overall goal of this diagnostic study is to define a standardized evidence-based examination procedure to assess ankle dorsiflexion with the knee extended and flexed. As there's no standardized test to assess ankle dorsiflexion, this examination method can help to define physiological and pathological values of ankle dorsiflexion. Clinicians will then be able to identify patients with impaired ankle dorsiflexion, which is the root of various pathologies to the foot and ankle.The main advantage of this technique is that it is a standardized evidence-based diagnostic approach. We first had the idea of this study when review literature on impaired ankle dorsiflexion. Many of the existing examination protocols vary significantly, therefore we aim to define a more standardized test to assess impaired ankle dorsiflexion.The visual demonstration of this examination technique is very beneficial, as it shows all of the key elements of this procedure in great detail.Mrs. Alena Sint is a member of our foot and ankle research group, and will help us to present the examination procedure. Begin by asking the subject to remove footwear and any clothing covering the legs.Have two investigators perform the measurement. One conducting the test, and the other measuring the degree of ankle dorsiflexion. Place the subject in a supine position on the examination couch.Mark the axis of the fibula by drawing a line connecting the center of the distal fibula at five centimeters and 15 centimeters above the tip of the distal fibula. Then have the first investigator place one hand at the level of the subtalar joint to ensure a neutral pronation supination position of the rear foot. And place the other hand around the mid-foot.Note that one hand stabilizes the subtalar joint and the other hand stabilizes the talonavicular joint, and applies force on the plantar aspect of the forefoot. To achieve maximum ankle dorsiflexion, ensure that the knee is fully extended. Next have the second investigator perform the measurement of the ankle dorsiflexion using a goniometer.Place one arm of the goniometer connecting the start and end point of the previously-marked axis of the fibula and align the other arm with the plantar aspect of the foot. Note this result on the documentation sheet. Then have the subject flex their knee 90 degrees and repeat this measurement procedure.Finally, repeat this entire procedure for the contralateral side. Note these results on the documentation sheet. Begin by asking the subject to stand opposite a wall.Ask the subject to get into a lunge position with the leg to be measured being the rear leg. Help the subject place their rear foot centered on the previously-marked line. Ensure that the heel and second toe of the rear leg are centered on the line.Have the subject hold on to the wall to stabilize the stance. Then ask the subject to fully extend their rear leg. Ensure that the knee is fully extended.Next have the subject move the hips toward the wall just before the heel of the rear leg lifts off the ground. The investigator has to ensure that the heel has not lifted off the ground. Place one hand on the dorsal aspect of the subtalar joint to ensure a neutral pronation supination position of the rear foot.With the other hand, perform the measurement of the ankle dorsiflexion by placing one arm of the goniometer on the floor, and align the other arm along the previously marked axis of the fibula. Note the result on the documentation sheet. Next have the subject move closer to the wall.Again, have the subject get into the lunge position, where their rear foot is centered on the previously-marked line. Have the subject hold on to the wall to stabilize their stance. Now ask the subject to flex their rear leg and move their hip toward the wall, just before the heel of the rear leg lifts off the ground.Use the goniometer to ensure that the rear knee is flexed at least 20 degrees. Then place one hand on the dorsal aspect of the subtalar joint to ensure a neutral pronation supination position of the rear foot. With the other hand, perform the measurement of the ankle dorsiflexion in the same manner as previously measured.Note the result. Repeat all steps for the contralateral side. Review the ankle dorsiflexion data on the documentation sheet, based on the subject's symptomatic side.Identify whether ankle dorsiflexion with the knee extended is less than 10 degrees on the symptomatic side. Then compare ADF with the knee extended and flexed. If ADF is greater than 10 degrees, compare ankle dorsiflexion with the knee extended between both legs.Consider musculus gastrocnemius tightness to be a possible cause, if ankle dorsiflexion is reduced on the symptomatic compared to the non-symptomatic side. This protocol demonstrates a standardized examination protocol for musculus gastrocnemius tightness, using a Non-weightbearing and a Weightbearing technique. The mean Ankle dorsiflexion of each step of Knee flexion indicated significantly higher values for Weightbearing measurements, compared to Non weightbearing measurements.Here, the difference of ADF between each step of knee flexion is shown. Significant differences were only observed between full knee extension and 20 degrees of knee flexion. After watching this video, you should have a good understanding of how to conduct this standardized examination to assess ankle dorsiflexion with the knee extended and flexed.Based on this, one can diagnose impaired ankle dorsiflexion as well as musculus gastrocnemius tightness. Once internalized, this technique can be done in a couple of minutes. While performing this procedure, it's important to keep the hind foot in neutral position, to stabilize the talonavicular joint and to ensure the appropriate knee position.This technique will pave the way for researchers in the field of foot and ankle disorders to finally agree on a consistent definition for physiological and pathological values of ankle dorsiflexion.

Research

JoVE Journal

Medicine

Diagnosis of Musculus Gastrocnemius Tightness - Key Factors for the Clinical Examination

Clinical Examination Protocol to Detect Atypical and Classical Scrapie in Sheep

Klinisk undersøgelse protokol til påvisning atypisk og klassisk scrapie hos får

The diagnosis of scrapie, a transmissible spongiform encephalopathy (TSEs) of sheep and goats, is currently based on the detection of disease-associated ...

Echocardiographic and Histological Examination of Cardiac Morphology in the Mouse

Ekkokardiografisk og histologisk undersøgelse af hjertets morfologi i mus

An increasing number of genetically modified mouse models has become available in recent years. Moreover, the number of pharmacological studies performed ...

Observational Study Protocol for Repeated Clinical Examination and Critical Care Ultrasonography Within the Simple Intensive Care Studies

Observationsstudie protokol for gentagne klinisk undersøgelse og kritiske Care ultrasonografi inden for Simple intensiv pleje undersøgelser

Longitudinal evaluations of critically ill patients by combinations of clinical examination, biochemical analysis and critical care ultrasonography (CCUS) ...

Transthoracic Echocardiographic Examination in the Rabbit Model

Transthoracic ekkokardiografisk undersøgelse i kanin modellen

Large animal models such as the rabbit are valuable for translational preclinical research. Rabbits have a similar cardiac electrophysiology compared to ...

OP-IVM: Combining In vitro Maturation after Oocyte Retrieval with Gynecological Surgery

OP-IVM: Kombination af in vitromodning efter oocyt-hentning med gynækologisk kirurgi

The use of in vitro maturation (IVM) before gynecological operation (OP-IVM) is an extension of conventional IVM that combines IVM following oocyte ...

Udvikling af en effektiv musemodel til undersøgelse af oronasale fistler

Establishment of an Oronasal Fistula Mice Model

Forfatter Spotlight: Undersøgelse af sårheling i musemodeller af oronasale fistler 

Etablering af en oronasale fistelmusmodel

This study presents a method utilizing heated ophthalmologic cautery to develop a viable model for investigating oronasal fistulas. C57BL/6 mice were used ...

Subclavian vene punkteringsmetode til gentagen blodopsamling hos bevidste rotter

Subclavian Vein Blood Sampling in Conscious Rats

Forfatter Spotlight: Udvikling af en effektiv blodopsamlingsmetode hos ikke-bedøvede rotter 

Subclavian vene blodprøvetagning i bevidste rotter

There are several established methods for obtaining repeated blood samples from rats, with the most commonly employed methods being lateral tail vein ...