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Flexor Hallucis Longus Tenolysis/Tenosynovectomy in Dancers

Barchi, Elizabeth I; Swensen, Stephanie; Dimant, Oscar E; McKay, Tracy Espiritu; Rose, Donald J
The purpose of this study was to report on a series of dancers who had undergone flexor hallucis longus (FHL) tenolysis/tenosynovectomy after having failed conservative management. Institutional human subjects committee approval was obtained prior to initiating this study. This study is a retrospective case series of 58 dancers and 63 ankles who underwent FHL tenolysis/tenosynovectomy via an open posteromedial approach by a single surgeon between 1993 and 2017. All patients were interviewed and charts reviewed. Collected variables included: preoperative and postoperative pain levels, time to return to dance, and subjective satisfaction with the procedure. Age, primary dance form, and level of dance were determined. Mean preoperative pain level decreased significantly postoperatively. Mean time to return to dance was 7.1 weeks. There was a 98% (62/63) return to dance at some level while 97% (61/63) of patients returned to dance symptom-free. There were no neurovascular or other major complications. Minor complications included stiffness at follow-up (6.3%, 4/63), superficial wound infection (3.1%, 2/63), and hypertrophic scar (4.8%, 3/63). Over 97% (61/63) of dancers considered the procedure a success and 98% (62/63) of dancers would repeat the procedure. This is one of the largest series reported of isolated FHL tenolysis/tenosynovectomy in dancers who have failed nonoperative management. Satisfactory pain relief and return to dance with a low complication rate may be expected from this surgical procedure. The results of this study can be used to help dancers and their providers make informed decisions about treatment in isolated FHL tendinitis.
PMID: 34301473
ISSN: 1542-2224
CID: 4948822

Motion of the multi-segmented spine in elite dancers during passé and arabesque

Hagins, Marshall; Swain, Christopher T V; Orishimo, Karl F; Kremenic, Ian J; Liederbach, Marijeanne
BACKGROUND:The spinal biomechanics of dance tasks have received little study and no studies have used a multi-segmented spinal model. Knowledge of how the segments of the spine move may be useful to the dance clinician and dance educator. RESEARCH QUESTION/OBJECTIVE:What is the direction and amount of motion of the primary segments of the spine in elite dancers during an arabesque and a passé? METHODS:This observational study examined 59 elite dancers performing an arabesque and a passé using a three-dimensional motion analysis system with the trunk divided into a series of five segments: pelvis, lower lumbar, upper lumbar, lower thoracic and upper thoracic spine. RESULTS:For the arabesque, all spinal segments moved in the same direction within each plane and the majority of total spinal motion occurred in the thoracic spine. Thoracic segments were at or near end range position at completion of the arabesque. For the passé, the spinal segments moved in different directions within each plane and the majority of total spinal motion occurred in the lumbar spine. SIGNIFICANCE/CONCLUSIONS:Dance clinicians and dance educators may benefit from the knowledge that thoracic hypomobility in any plane may limit arabesque performance and that attempts to instruct dancers to achieve a position of passé without flexion of the lumbar spine may be a valid aesthetic ideal but also an unrealistic functional expectation.
PMID: 34116396
ISSN: 1879-2219
CID: 4900422

Unlikely SuspectPeroneus Tertius Tear in a Professional Ballet Dancer

Barchi, Elizabeth; Rose, Donald
Peroneus tertius tendon tears are uncommon and patients typically recover with conservative management. The objec-tive of this case report is to highlight this usual injury and provide an alternative treatment option when conserva-tive management fails. A 24-year-old female professional ballet dancer presented with acute right lateral foot pain after hyperflexing over her pointe shoe. She completed a full course of physical therapy and non-steroidal anti-inflammatory drugs. However, upon returning to dance, she developed worsening pain and swelling over the lateral ankle. Magnetic resonance imaging revealed a complete peroneus tertius tear with retraction. She underwent surgi-cal debridement of this tendon and was able to return to dancing en pointe in 9 weeks.
PMID: 33207150
ISSN: 2328-5273
CID: 4730532

Case Report of a Bifid Distal Biceps Tendon with Traumatic Rupture and Subsequent Repair of Short Head Tendon Limb

Aggarwal, Vinay K; Rose, Donald
Distal biceps tendon ruptures are a topic of great interest in the orthopedic literature with differentiation between complete and partial tears being difficult to recognize. Recent cadaveric and radiologic studies have shown that the muscle maintains two distinct tendons and tendinous insertions. In this clinical case report, we describe the rare case of a patient with a congenitally bifid distal biceps tendon who selectively ruptured a single bundle of the tendon and subsequently underwent surgical repair.
PMID: 31128587
ISSN: 2328-5273
CID: 4031612

Multi-segment spine range of motion in dancers with and without recent low back pain

Swain, Christopher T V; Bradshaw, Elizabeth J; Ekegren, Christina L; Orishimo, Karl F; Kremenic, Ian J; Liederbach, Marijeanne; Hagins, Marshall
BACKGROUND:Altered spine kinematics are a common in people with LBP. This may be especially true for populations such as dancers, who are required to perform repetitive movements of the spine, although this remains unclear. RESEARCH QUESTION/OBJECTIVE:Do dancers with recent LBP display altered spine kinematics compared to their asymptomatic counterparts? METHODS:A cross-sectional study of multi-segment spine kinematics was performed. Forty-seven pre-professional and professional female dancers either with LBP in the past two months (n = 26) or no LBP in the past 12 months (n = 21) participated. Range of motion (ROM) during standing side bending, seated rotation, and walking gait were compared. RESULTS:Female dancers with LBP displayed reduced upper lumbar transverse plane ROM in seated rotation (Effect Size (ES)= -0.61, 95% Confidence Interval (CI): -1.20, 0.02, p = 0.04), as well as reduced lower lumbar transverse plane ROM (ES=-0.65, 95% CI: -1.24, -0.06, p = 0.03) in gait. However, there was increased lower thoracic transverse plane ROM (ES = 0.62, 95% CI: 0.04, 1.21, p = 0.04) during gait. No differences in the frontal plane were observed. SIGNIFICANCE/CONCLUSIONS:Altered transverse plane spine kinematics were evident in dancers with recent LBP for select segments and tasks. This may reflect a protective movement strategy. However, as the effect sizes of observed differences were moderate, and the total number of differences between groups was small, collectively, it seems only subtle differences in spine kinematics differentiate dancers with LBP to dancers without.
PMID: 30825672
ISSN: 1879-2219
CID: 3698802

Comparison of lower limb stiffness between male and female dancers and athletes during drop jump landings

Ward, Rachel E; Fong Yan, Alycia; Orishimo, Karl F; Kremenic, Ian J; Hagins, Marshall; Liederbach, Marijeanne; Hiller, Claire; Pappas, Evangelos
Repetition of jumps in dance and sport training poses a potential injury risk, however non-contact landing injuries are more common in athletes than dancers. This study aimed to compare the lower limb stiffness characteristics of dancers and athletes during drop landings to investigate possible mechanisms of impact-related injuries. Kinematics and kinetics were recorded as 39 elite modern and ballet dancers (19 men, 20 women) and 40 college level team sport athletes (20 men, 20 women) performed single-legged drop landings from a 30-cm platform. Vertical leg stiffness and joint stiffness of the hip, knee and ankle were calculated using a spring-mass model. Stiffness data, joint kinematics and moments were compared with a group-by-sex 2-way analysis of variance. Multiple linear regression was used to assess the relative contribution of hip, knee and ankle joint stiffness to variance in overall vertical leg stiffness for dancers and athletes. Dancers had lower leg (p<0.001), knee joint (p=0.034) and ankle joint stiffness (p=0.043) than athletes. This was facilitated by lower knee joint moments (p=0.012), and greater knee (p=0.029) and ankle joint (p=0.048) range of motion in dancers. Males had higher leg (p<0.001) and ankle joint stiffness (p<0.001) than females. This occurred through lower ankle range of motion (p<0.001) and greater ankle moment (p=0.022) compared to females. Male and female dancers demonstrated reduced lower limb stiffness compared to athletes, indicating a more pliable landing technique. Dance training techniques could potentially inform approaches to injury prevention in athletes.
PMID: 30242920
ISSN: 1600-0838
CID: 3301962

Excision of Os Trigonum in Dancers via an Open Posteromedial Approach

Heyer, Jessica H; Dai, Amos Z; Rose, Donald J
An os trigonum is a potential source of posterior ankle pain in dancers, often associated with flexor hallucis longus (FHL) pathology. Surgical excision is indicated on failure of nonoperative management. Options for surgical excision include open excision (via a posterolateral or posteromedial approach), subtalar arthroscopy, and posterior endoscopy. Os trigonum excision via an open posteromedial approach with concomitant FHL tenolysis/tenosynovectomy is a safe and effective method for the operative treatment of a symptomatic os trigonum that allows for identification and treatment of associated FHL pathology. The major steps in the procedure, which are demonstrated in this video article, are: (1) preoperative planning with appropriate imaging; (2) patient is positioned in a supine position with the operative extremity in figure-of-4 position; (3) a 3-cm, slightly curvilinear longitudinal incision is made midway between the posterior aspect of the medial malleolus and the anterior aspect of the Achilles tendon, over the palpated FHL tendon, and the flexor retinaculum is exposed and incised; the neurovascular bundle is retracted anteriorly, exposing the FHL tendon and sheath; (4) FHL tenolysis/tenosynovectomy is performed; (5) the FHL is retracted anteriorly and a capsulotomy is performed over the os trigonum and the os trigonum is excised; (6) the capsule is repaired and closure is performed; and (7) dressings and a CAM (controlled ankle motion) walking boot are applied. The patient begins physical therapy at 2 weeks postoperatively and may return to dance at 4 to 6 weeks postoperatively as tolerated. In our series of 40 cases, 95% of patients who desired to return to dance were able to return to their pre-injury level of dance. There were no major neurovascular complications.
PMCID:6358335
PMID: 30775136
ISSN: 2160-2204
CID: 3687742

THE USE OF A BROAD OR NARROW DEFINITION OF INJURY IN DANCE SURVEILLANCE [Letter]

Liederbach, Marijeanne; Hagins, Marshall; Gamboa, Jennifer M.; Welsh, Thomas M.
ISI:000433055200015
ISSN: 0190-6011
CID: 3140372

Your Activities of Daily Life, YADL_Ballet: An Image-based Survey Technique for Healthy and Injured Dancers [Meeting Abstract]

Liederbach, Marijeanne; Pappas, Evangelos
ISI:000456870502701
ISSN: 0195-9131
CID: 4044522

Epidemiology and Clinical Presentation of Anterior Hip Pain among Elite Classical Dancers [Meeting Abstract]

Liederbach, Marijeanne
ISI:000456870502649
ISSN: 0195-9131
CID: 4044512