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PubMed2003

Desmitis of the straight sesamoidean ligament in horses: 9 cases (1995-1997).

OBJECTIVE: To determine clinical signs, diagnostic findings, and outcome for horses with desmitis of the straight sesamoidean ligament (SSL) near its insertion on the middle phalanx. DESIGN: Retrospective study. ANIMALS: 9 horses. PROCEDURE: Medical records were reviewed, and information on signalment, history, clinical signs, diagnostic findings, and treatment was obtained. Follow-up information was obtained through telephone conversations with owners. RESULTS: In all horses, the diagnosis was made by use of high-resolution ultrasonography. Seven horses had moderate lameness on initial examination; lameness was exacerbated in 6 horses following flexion of the distal limb joints. The cause of lameness could not be determined on the basis of clinical signs, and diagnostic local anesthesia was necessary to localize the source of lameness to the distal portion of the limb. Five horses had forelimb involvement (1 bilateral), and 4 had hind limb involvement (1 bilateral). Treatment consisted primarily of a 6-month rest and rehabilitation program. Six of the 9 horses were able to return to their intended use. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that injury to the SSL proximal to its insertion on the middle phalanx should be considered as a possible cause of lameness in horses, particularly performance horses, with lameness localized to the distal portion of the forelimb or hind limb that do not have any radiographic abnormalities. High-resolution ultrasonography was necessary to make the diagnosis. Horses with an acute injury appeared to have a reasonable chance of responding to treatment and returning to their intended use.

Animals↗
PubMed2004

Assessment of the ultrasonographic characteristics of the podotrochlear apparatus in clinically normal horses and horses with navicular syndrome.

OBJECTIVE: To characterize the normal ultrasonographic appearance of the podotrochlear apparatus in horses by use of standardized measurements and identify soft tissue changes associated with navicular syndrome. DESIGN: Prospective study. ANIMALS: 7 clinically normal horses and 28 horses with navicular syndrome. PROCEDURE: The feasibility of identifying and measuring the soft tissue structures of the podotrochlear apparatus ultrasonographically via the transcuneal approach was assessed in 2 additional horses without navicular syndrome; both horses were euthanatized, and the structures identified ultrasonographically were confirmed at necropsy. Ultrasonographs were obtained in the study horses. Objective and subjective data were obtained to characterize ultrasonographic changes associated with navicular syndrome. RESULTS: Abnormalities of the flexor surface of the distal sesamoid (navicular) bone, the impar ligament, the distal digital annular ligament, deep digital flexor tendon (DDFT), and the podotrochlear (navicular) bursa were assessed via the transcuneal ultrasonographic approach. No significant differences were found between the measurements of the podotrochlear apparatus in normal horses and those with navicular syndrome; however, important subjective differences were detected ultrasonographically in horses with navicular syndrome. In horses with navicular syndrome, ultrasonographic findings were indicative of navicular bursitis, dystrophic mineralization of the DDFT and impar ligament, tendonitis and insertional tenopathy of the DDFT, desmitis of the impar ligament, and cortical changes in the flexor surface of the navicular bone. CONCLUSIONS AND CLINICAL RELEVANCE: Findings of ultrasonographic evaluation of the hoof appear to be useful in determining the cause of caudal heel pain and characterizing the components of navicular syndrome in horses.

Animals↗
PubMed2003

Treatment of fabella syndrome with manual therapy: a case report.

STUDY DESIGN: Clinical case report. OBJECTIVES: To educate clinicians about fabella syndrome as a possible cause for posterolateral knee pain and dysfunction. Also to describe a physical therapy intervention strategy for posterolateral knee pain secondary to hypomobility or malposition of a fabella. BACKGROUND: A 44-year-old, physically fit, Caucasian male with a 10-year history of left posterolateral knee pain and functional limitations during athletic activities, walking, and activities of daily living presented for evaluation and treatment. He had previously experienced relief of symptoms after experimenting with a mechanical maneuver administered by his wife. METHODS AND MEASURES: A thorough examination for strength, range of motion, and accessory motions was performed. A fabella was palpable in the lateral head of the gastrocnemius muscle and a provisional diagnosis of fabella syndrome was made. While in a prone position, the patient received soft tissue mobilization of the lateral gastrocnemius, followed by medial, lateral, and inferior glides of the fabella. RESULTS: The patient reported an immediate reduction in posterolateral knee pain and demonstrated a 30 degrees increase in active knee flexion. CONCLUSIONS: Physical therapists may be unaware that fabella syndrome is a possible source of posterolateral knee pain and dysfunction. This simple manual therapy intervention was effective in reducing symptoms of pain and increasing tolerance for activities involving knee flexion, extension, and rotation. Physical therapists may wish to add this diagnosis and the corresponding examination and intervention techniques to their management strategy for patients with fabella syndrome.

Adult↗
PubMed2004

The effect of sesamoid mobilization, flexor hallucis strengthening, and gait training on reducing pain and restoring function in individuals with hallux limitus: a clinical trial.

STUDY DESIGN: Clinical trial. OBJECTIVE: To determine the effect of 2 conservative intervention approaches for functional hallux limitus. BACKGROUND: Metatarsophalangeal joint (MPJ) sprains are common and can result in long-term sequelae such as persistent pain and loss of range of motion (ROM) secondary to bony proliferation and articular degeneration. It is important to determine the most effective intervention for functional hallux limitus to decrease pain and restore function. METHODS AND MEASURES: Twenty individuals with first MPJ pain, loss of motion, and weakness participated in the study. All patients received whirlpool, ultrasound, first MPJ mobilizations, calf and hamstring stretching, marble pick-up exercise, cold packs, and electrical stimulation. Ten of the 20 patients (experimental group) also received sesamoid mobilizations, flexor hallucis strengthening exercises, and gait training. Treatment was provided 3 times a week for 4 weeks. Measurements of first MPJ extension ROM, flexor hallucis strength, and subjective pain level were performed on the first and last visits. RESULTS: Following the 12 therapy sessions, the experimental group achieved significantly greater MPJ extension ROM and flexor hallucis strength and had significantly lower pain levels as compared to the control group (P<.001). CONCLUSIONS: These results suggest that sesamoid mobilization, flexor hallucis strengthening, and gait training should be included in the plan of care when treating an individual with functional hallux limitus.

Adult↗
PubMed1975

Patella cubiti. Report of an operated case.

A case of incapacitating patella cubiti, probably of congenital origin, in a 45-year-old farm labourer is described. The fragment was extirpated, the pain disappeared and the patient returned to work.

Elbow Joint↗
PubMed1986

Dynamic post-surgical hallux varus after lateral sesamoidectomy: treatment and prevention.

Hallux varus and clawing are occasionally seen after a McBride procedure, due to the severance of the flexor hallucis brevis, when the lateral sesamoid is removed. The present study includes six patients, (involving ten feet), who developed hallux varus and great toe clawing after McBride procedures were performed by various orthopedic surgeons. Treatment utilized partial proximal phalangeal resection, with and without silicone single-stem implants, extensor hallucis longus tendon transfer to the great toe metatarsal, and interphalangeal joint arthrodesis, or tenodesis of the great toe to correct clawing. One patient eventually required a great toe metatarsophalangeal joint fusion. This reconstructive surgery is generally effective by correcting capsular malalignment, the "bowstringing" tendency of the extensor hallucis longus, and great toe clawing that develops simultaneously with hallux varus. Lateral sesamoidectomy is risky, and believed unnecessary as adductor hallucis tenotomy is effective in relieving hallux valgus. Although, it can occur with excessive excision of the medial emminence and distal advancement of the abductor hallucis. The author is unaware of hallux varus developing after adductor hallucis tenotomies.

Adult↗
PubMed1986

Shelling the sesamoid in the McBride procedure.

A method which markedly facilitates the excision of the lateral sesamoid in the McBride procedure is described. It is carried out by using an instrument commonly used in arthroscopic knee surgery.

Humans↗
PubMedDate not supplied

Congenital absence of the lateral sesamoid.

Congenital absence of the lateral sesamoid is an extremely rare condition. We present a case of congenital absence of the lateral sesamoid in which magnetic resonance imaging was performed. The literature is reviewed regarding the clinical significance of this anomaly.

Adolescent↗
PubMedDate not supplied

Tibial sesamoid fracture in a softball player.

A single case of a tibial sesamoid fracture in a softball player is reported here. A review of the literature confirms that this is an unusual and difficult problem to treat in the athletic population given the significant loads placed on the sesamoids during athletic activity. In the case presented, conservative care was not effective, and the athlete underwent surgical excision of the fractured sesamoid. With use of a postoperative orthosis and cleat modification, surgical management was successful and allowed the athlete to return to her athletic endeavors without restrictions in 8 weeks.

Adult↗