mechanisms of limb collapse following a slip among young and older adults pdf

Mechanisms Of Limb Collapse Following A Slip Among Young And Older Adults Pdf

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Published: 25.05.2021

Dr Mak and Dr Yang provided data analysis. Margaret K. Little is known about why these patients fail to perform this transfer activity.

Dewitt, Jonathan Moore, Michael J. Despite sufficient evidence to suggest that lower-limb—related factors may contribute to fall risk in older adults, lower-limb and footwear influences on fall risk have not been systematically summarized for readers and clinicians. The purpose of this study was to systematically review and synethesize the literature related to lower-limb, foot, and footwear factors that may increase the risk of falling among community-dwelling older adults.

Evaluation of the Patient with Hip Pain

JOHN J. A more recent article on hip pain in adults is available. Patient information: See related handout on hip pain , written by the authors of this article. See CME Quiz questions. Hip pain is a common and disabling condition that affects patients of all ages. The differential diagnosis of hip pain is broad, presenting a diagnostic challenge.

Patients often express that their hip pain is localized to one of three anatomic regions: the anterior hip and groin, the posterior hip and buttock, or the lateral hip. Anterior hip and groin pain is commonly associated with intra-articular pathology, such as osteoarthritis and hip labral tears. Posterior hip pain is associated with piriformis syndrome, sacroiliac joint dysfunction, lumbar radiculopathy, and less commonly ischiofemoral impingement and vascular claudication. Lateral hip pain occurs with greater trochanteric pain syndrome.

Clinical examination tests, although helpful, are not highly sensitive or specific for most diagnoses; however, a rational approach to the hip examination can be used.

Radiography should be performed if acute fracture, dislocations, or stress fractures are suspected. Initial plain radiography of the hip should include an anteroposterior view of the pelvis and frog-leg lateral view of the symptomatic hip.

Magnetic resonance imaging should be performed if the history and plain radiograph results are not diagnostic. Magnetic resonance imaging is valuable for the detection of occult traumatic fractures, stress fractures, and osteonecrosis of the femoral head. Magnetic resonance arthrography is the diagnostic test of choice for labral tears.

Hip pain is a common presentation in primary care and can affect patients of all ages. In one study, The differential diagnosis of hip pain eTable A is broad, including both intra-articular and extra-articular pathology, and varies by age. A history and physical examination are essential to accurately diagnose the cause of hip pain.

Initial plain radiography of the hip should include an anteroposterior view of the pelvis and a frog-leg lateral view of the symptomatic hip.

Magnetic resonance imaging should be used for detection of occult hip fractures, stress fractures, and osteonecrosis of the femoral head. Ultrasonography is a helpful diagnostic modality for patients with suspected bursitis, joint effusion, or functional causes of hip pain e.

Obesity, pregnancy, tight pants or belt, conditions with increased intra-abdominal pressure. Dull, diffuse pain radiating to inner thigh; pain with direct pressure, sneezing, sit-ups, kicking, Valsalva maneuver. No hernia, tenderness of the inguinal canal or pubic tubercle, adductor origin, pain with resisted sit-up or hip flexion. Females especially with female athlete triad , endurance athletes, low aerobic fitness, steroid use, smokers. Mechanical symptoms, such as catching or painful clicking; history of hip dislocation.

Snap with FABER to extension, adduction, and internal rotation; reproduction of snapping with extension of hip from flexed position. Dynamic ultrasonography: Snapping of iliopsoas or iliotibial band over greater trochanter. Radiography: Early small femoral epiphysis, sclerosis and flattening of the femoral head.

Radiography: Presence of osteophytes at the acetabular joint margin, asymmetrical joint-space narrowing, subchondral sclerosis and cyst formation. Adults: Lupus, sickle cell disease, human immunodeficiency virus infection, corticosteroid use, smoking, and alcohol use; insidious onset, but can be acute with history of trauma. Radiography: Femoral head lucency and subchondral sclerosis, subchondral collapse i. Antalgic gait with foot externally rotated on occasion, positive log roll and straight leg raise against resistance tests, pain with hip internal rotation relieved with external rotation.

Children: 3 to 8 years of age, fever, ill appearance Adults: Older than 80 years, diabetes mellitus, rheumatoid arthritis, recent joint surgery, hip or knee prostheses. Hip aspiration guided by fluoroscopy, computed tomography, or ultrasonography; Gram stain and culture of joint aspirate. Lateral pain. Associated with knee osteoarthritis, increased body mass index, low back pain; female predominance.

Proximal iliotibial band tenderness, Trendelenburg gait is sensitive and specific. Posterolateral pain. Weak hip abduction, pain with resisted external rotation, Trendelenburg gait is sensitive and specific.

Eccentric muscle contraction while hip flexed and leg extended Skeletal immaturity, eccentric muscle contraction cutting, kicking, jumping.

Ischial tuberosity tenderness, ecchymosis, weakness to leg flexion, palpable gap in hamstring. History of direct trauma to buttock or pain with sitting, weakness and numbness are rare compared with lumbar radicular symptoms.

MRI: Lumbar spine has no disk herniation, piriformis muscle atrophy or hypertrophy, edema surrounding the sciatic nerve. FABER test elicits posterior pain localized to the sacroiliac joint, sacroiliac joint line tenderness.

Radiography: Possibly no findings, narrowing and sclerotic changes of the sacroiliac joint space. The hip joint is a ball-and-socket synovial joint designed to allow multiaxial motion while transferring loads between the upper and lower body.

The acetabular rim is lined by fibrocartilage labrum , which adds depth and stability to the femoroacetabular joint. The articular surfaces are covered by hyaline cartilage that dissipates shear and compressive forces during load bearing and hip motion. The hip's major innervating nerves originate in the lumbosacral region, which can make it difficult to distinguish between primary hip pain and radicular lumbar pain. The hip joint's wide range of motion is second only to that of the glenohumeral joint and is enabled by the large number of muscle groups that surround the hip.

The flexor muscles include the iliopsoas, rectus femoris, pectineus, and sartorius muscles. The gluteus maximus and hamstring muscle groups allow for hip extension. Smaller muscles, such as gluteus medius and minimus, piriformis, obturator externus and internus, and quadratus femoris muscles, insert around the greater trochanter, allowing for abduction, adduction, and internal and external rotation.

In persons who are skeletally immature, there are several growth centers of the pelvis and femur where injuries can occur. Potential sites of apophyseal injury in the hip region include the ischium, anterior superior iliac spine, anterior inferior iliac spine, iliac crest, lesser trochanter, and greater trochanter. The apophysis of the superior iliac spine matures last and is susceptible to injury up to 25 years of age.

Age alone can narrow the differential diagnosis of hip pain. In prepubescent and adolescent patients, congenital malformations of the femoroacetabular joint, avulsion fractures, and apophyseal or epiphyseal injuries should be considered. In those who are skeletally mature, hip pain is often a result of musculotendinous strain, ligamentous sprain, contusion, or bursitis.

In older adults, degenerative osteoarthritis and fractures should be considered first. Patients with hip pain should be asked about antecedent trauma or inciting activity, factors that increase or decrease the pain, mechanism of injury, and time of onset. Questions related to hip function, such as the ease of getting in and out of a car, putting on shoes, running, walking, and going up and down stairs, can be helpful.

Localization of hip pain. A Posterior view. B Anterior view. The hip examination should evaluate the hip, back, abdomen, and vascular and neurologic systems. It should start with a gait analysis and stance assessment Figure 1 , followed by evaluation of the patient in seated, supine, lateral, and prone positions Figures 2 through 6 , and eFigure B. Physical examination tests for the evaluation of hip pain are summarized in Table 1. Gait testing. A C sign.

The patient is observed while walking to evaluate for limp or antalgic gait characteristics. C Modified Trendelenburg test single leg stance phase. The patient stands with feet shoulder width apart and lifts one leg. The examiner observes for a drop in the level of the iliac crest on the side of the lifted leg. Hip range-of-motion testing photos demonstrate normal range of motion. A Abduction. B Adduction. C Extension. D Internal and external rotation. The examiner moves the leg into 45 degrees of flexion, then A externally rotates and B abducts the leg so that the ankle rests proximal to the knee of the contralateral leg.

FADIR test flexion, adduction, internal rotation; impingement test. The examiner passively moves the leg into A full flexion, then into B adduction and internal rotation. Log roll test passive supine rotation; Freiberg test. Patient's leg is extended and relaxed on examination table as the examiner internally and externally rotates the leg log roll.

Straight leg raise against resistance test Stinchfield test. The patient lifts the straight leg to 45 degrees while the examiner applies downward force on the thigh. Ober test passive adduction. The patient is positioned on his or her side, with the unaffected hip on the examination table.

The examiner stands behind the patient with one hand on the patient's hip, and the other hand supporting the lower leg. A To evaluate the tensor fasciae latae: The hip and knee are held at 0 degrees of extension and allowed to passively adduct with gravity.

B The gluteus medius: The hip is held at 0 degrees of extension and 45 to 90 degrees of knee flexion. C The gluteus maximus: The shoulders are rotated back toward the table, with the hip in flexion and knee in extension. Antalgic gait, Trendelenburg gait, pelvic wink rotation of more than 40 degrees in the axial plane toward the affected hip when terminally extending the hip , excessive pronation or supination of the ankles, and limps caused by differing leg lengths.

Modified Trendelenburg test Figure 1C. ROM testing Figure 2. Posterior pain localized to the sacroiliac joint, lumbar spine, or posterior hip; groin pain with the test is sensitive for intra-articular pathology.

Slip and Fall Risk Assessment

Handbook of Human Motion pp Cite as. The cumulative effect of falls on older adults and on the healthcare system is immense; the results are debilitating injuries, loss of independence, and transfer to a healthcare institution, or even death. Therefore, it is pressing to develop fall prevention interventions to prevent falls from happening. To identify individuals with high risk of falls could be equivalently important to the development of fall prevention paradigms because it allows the limited resources assigned to fall prevention to be directed to those who truly need the interventions. It is thus essential to establish accurate and effective fall risk assessment tools to identify those with elevated risk of falls.


Request PDF | Role of stability and limb support in recovery against a fall When slip-induced instability was combined with inadequate limb support, Angular momentum regulation may dictate the slip severity in young adults would prevent a collapse following perturbation (Pai et al., ; Yang et al.


Slip, Trip, Stumble, Fall: An Overview of Falls in the Elderly and How to Prevent Them

When year-old Doris fell getting out of the bathtub late on a Tuesday in the apartment she shared with her year-old husband of 65 years, the ambulance took her to the hospital. As suspected, she had broken her right hip, which was surgically corrected Wednesday morning. Doris was up from bed Thursday and scheduled to transfer to a rehabilitation center that afternoon—but the hospital learned no bed would be available until Friday. Doris was a close family friend whose story, sadly, is not uncommon. Falls in the elderly are not like falls in the young, who can get up, dust themselves off, and move on.

Falls frequently cause injury-related hospitalization or death among older adults. This article reviews a new conceptual framework on dynamic stability and weight support in reducing the risk for falls resulting from a forward slip, based on the principles of motor control and learning, in the context of adaptation and longer-term retention induced by repeated-slip training. Although an unexpected slip is severely destabilizing, a recovery step often is adequate for regaining stability, regardless of age. Consequently, poor weight support quantified by reduction in hip height , rather than instability, is the major determinant of slip-related fall risk. Promisingly, a single session of repeated-slip training can enhance neuromechanical control of dynamic stability and weight support to prevent falls, which can be retained for several months or longer.

JOHN J. A more recent article on hip pain in adults is available. Patient information: See related handout on hip pain , written by the authors of this article. See CME Quiz questions. Hip pain is a common and disabling condition that affects patients of all ages.

Evaluation of the Patient with Hip Pain

Slip, Trip, Stumble, Fall: An Overview of Falls in the Elderly and How to Prevent Them

When year-old Doris fell getting out of the bathtub late on a Tuesday in the apartment she shared with her year-old husband of 65 years, the ambulance took her to the hospital. As suspected, she had broken her right hip, which was surgically corrected Wednesday morning. Doris was up from bed Thursday and scheduled to transfer to a rehabilitation center that afternoon—but the hospital learned no bed would be available until Friday. Doris was a close family friend whose story, sadly, is not uncommon. Falls in the elderly are not like falls in the young, who can get up, dust themselves off, and move on. Falls are a frequent and significant challenge for this population, with numerous studies detailing associations with mortality, morbidity, reduced functionality, and premature nursing home admission. Every year, 3 million older adults are treated in the emergency department ED for fall-related injuries—most often head trauma or hip fracture.

Either your web browser doesn't support Javascript or it is currently turned off. In the latter case, please turn on Javascript support in your web browser and reload this page. Falls frequently cause injury-related hospitalization or death among older adults. This article reviews a new conceptual framework on dynamic stability and weight support in reducing the risk for falls resulting from a forward slip, based on the principles of motor control and learning, in the context of adaptation and longer-term retention induced by repeated-slip training. Although an unexpected slip is severely destabilizing, a recovery step often is adequate for regaining stability, regardless of age.


provements in stability against balance loss and in limb support slip-related falls by older adults, important questions remain. Notably, walking, not their locking mechanism. collapse following a slip among young and older adults. J Bio-.


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Он спрятал свой ключ, зашифровав его формулой, содержащейся в этом ключе. - А что за файл в ТРАНСТЕКСТЕ? - спросила Сьюзан. - Я, как и все прочие, скачал его с сайта Танкадо в Интернете. АНБ является счастливым обладателем алгоритма Цифровой крепости, просто мы не в состоянии его открыть.

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