International Journal of Osteopathic Medicine - Articles in Press

A consideration of the elbow as a tensegrity structure - Corrected Proof

Graham Scarr — 2012-02-03

Abstract: The elbow is conventionally described as a uniaxial hinge joint and the pivot of proximal forearm rotation; the joint surfaces guide motion, the ligaments maintain joint integrity and the muscles cause motion. However, this simplicity is less clear on detailed examination and masks uncertainties over its component structures and their functions.Elbow anatomy is examined from a tensegrity perspective with a re-assessment of these functions. Tensegrity structures, like the elbow, are inherently stable and maintain a balanced equilibrium during changes in shape because of ‘continuous tension’. Connective tissues mechanically integrate local and distantly related components into a single functional unit while proprioceptive sensors neurally influence motor activity; both control joint dynamics.It is suggested that this has relevance to understanding the commonly encountered but vague pathologies such as ‘tennis elbow’ and ‘repetitive strain injury’; the aetiologies of these conditions continue to be the subject of debate.

Re: Groin pain in sacral insufficiency fracture. Avoiding delayed diagnosis - Corrected Proof

Julian Chakraverty, Nicolas Snelling — 2011-12-21

We read with interest the case study by Ungaro et al., which was published in the latest edition of the IJOM. The authors’ highlight important issues with regard to the consideration of alternative and potentially serious diagnoses should a patient fail to respond in a timely manner to osteopathic treatment. This serves as a reminder to us all to be on guard continually during our encounters with patients, and to be prepared to re-evaluate a diagnosis when a patient is not improving or worsening. In particular, it is not infrequent in the emergency department to see elderly women who have had pain after apparently innocuous injuries (or indeed there may be no history of antecedent trauma at all), who turn out to have insufficiency fractures.

The dorsal sacral rami and branches: Sonographic visualisation of their vascular signature - Corrected Proof

MauriceChristopher McGrath, Ruth Jeffery, Mark David Stringer — 2011-11-24

Abstract: Objectives: The differentiation of potential pain generating structures in the sacro-iliac region remains a diagnostic challenge. The aim of this proof of concept study was to evaluate the feasibility of using Doppler ultrasound to image the vascular components of dorsal sacral rami and their associated medial and lateral branches. Using the vascular signature of the dorsal sacral arteries to identify the dorsal sacral rami could assist with the diagnosis and treatment of localisable, extra-articular, posterior sacro-iliac joint pain.Methods: The posterior sacral region was scanned in 30 healthy adults using an Acuson X300 ultrasound machine with 7.5 MHz high-resolution linear transducer in spectral Doppler mode to assess the feasibility of identifying and measuring the Resistive Index (RI) of the dorsal sacral arteries.Results: The vascular signature of the dorsal sacral rami and associated branches was identified in 62% of participants; S2 70%, S1 57% and S3 59%. More than two vascular signatures were recorded in 23 (76.7%) cases; in only two (6.67%) were no vascular signatures detected. Mean RI was 0.82 ± 0.11, increasing significantly (P < 0.05) at each caudal sacral level. No statistically significant difference in RI was observed between rami arteries and their branches or between genders.Conclusions: Doppler ultrasound may be useful in identifying the individual dorsal sacral rami (S1-3) and their associated branches. This may assist with selective imaging of the dorsal sacral rami and their branches in the diagnosis and treatment of chronic localisable pain in the posterior sacro-iliac region and facilitate investigation of the hypothesis of entrapment neuropathy in this region.

Anterior hip pain – Have you considered femoroacetabular impingement? - Corrected Proof

J.K. Chakraverty, N.J. Snelling — 2011-11-03

Abstract: Anterior hip pain is a frequent presentation in both primary care and musculoskeletal practice. Common diagnoses of anterior hip pain include iliopsoas tendinopathy and bursitis, snapping hip syndrome, osteoarthritis of the hip and sacro-iliac joint dysfunction or spinal referred pain. More potentially serious conditions including inguinal hernias, avascular necrosis of the femoral head and psoas abcess all need to be considered.One cause of anterior hip pain is femoroacetabular impingement (FAI). Here follows a short review of the typical clinical presentations, imaging features and management options of FAI. The possible role of osteopathy in the management of this condition will also be briefly discussed.