Study Design: A 2 × 4 mixed-design ANOVA with a fixed factor of group (posterior tibialis tendon dysfunction [PTTD] and asymptomatic controls), and a repeated factor of phase of stance (loading response, midstance, terminal stance, and preswing).
Objective: To compare 3-dimensional stance period kinematics (rearfoot eversion/inversion, medial longitudinal arch [MLA] angle, and forefoot abduction) of subjects with stage II PTTD to asymptomatic controls.
Background: Abnormal foot postures in subjects with stage II PTTD are clinical indicators of disease progression, yet dynamic investigations of forefoot, midfoot, and rearfoot kinematic deviations in this population are lacking.
Methods: Fourteen subjects with stage II PTTD were compared to 10 control subjects with normal arch index values. Subjects were matched for age, gender, and body mass index. A 5-segment, kinematic model of the leg and foot was tracked using an Optotrak Motion Analysis System. The dependent kinematic variables were rearfoot inversion/eversion, forefoot abduction/adduction, and the MLA angle. An ANOVA model was used to compare kinematic variables between groups across 4 phases of stance.
Results: Subjects with PTTD demonstrated significantly greater rearfoot eversion (P = .042), MLA angle (P = .008) and forefoot abduction angles (P<.005) during specific phases of stance. Subjects with PTTD demonstrated significantly greater rearfoot eversion (P<.004) and MLA angles (P<.009) by 6.2° and 8.0°, respectively, during loading response when compared to controls. During preswing, the subjects with PTTD demonstrated a significantly greater MLA angle (P<.002) and a forefoot abduction angle (P<.001) which exceeded that of the controls by 10.0°.
Conclusions: The abnormal kinematics observed at the rearfoot, midfoot, and forefoot across all phases of stance implicate a failure of compensatory muscle and secondary ligamentous support to control foot kinematics in subjects with stage II PTTD.

J Orthop Sports Phys Ther. 2006;36(9):635-644. doi:10.2519/jospt.2006.2293

Key Words: biomechanics, foot kinematics, tendinopathy, tendonitis

Study Design: Test-retest reliability study.
Objective: To determine interrater reliability of the modified scapular assistance test (SAT). The modified SAT is designed to assess the contribution of scapular motion to shoulder pain.
Background: Abnormal scapular motion has been implicated in different shoulder disorders. However, there is a lack of clinical evaluation tools to assess the scapular component of shoulder dysfunction.
Methods and Measures: Forty-six subjects who were referred to physical therapy for treatment of various shoulder pathologies were recruited for this study. The modified SAT was performed on each participant by 2 different examiners. Percent agreement and kappa coefficient were utilized to determine interrater reliability of the modified SAT.
Results: The kappa coefficient and percent agreement were 0.53 and 77%, respectively, when the test was performed in the scapular plane, and 0.62 and 91%, respectively, when the test was performed in the sagittal plane.
Conclusions: The modified SAT possesses acceptable interrater reliability for clinical use.

 J Orthop Sports Phys Ther. 2006;36(9):653-660. doi:10.2519/jospt.2006.2234

Key Words: measurement, scapula, shoulder

Study Design: Case series.
Background: Traditionally, all forms of diathermy have been contraindicated over metal implants. There is a lack of research-based evidence for harm regarding the use of pulsed shortwave diathermy (PSWD) over orthopaedic metal implants. Because PSWD is an effective modality for deep heating, we investigated whether ankle range of motion (ROM) could improve with the cautious use of PSWD and joint mobilizations, despite orthopaedic metal implants being in the treatment field.
Case Descriptions: Four subjects presented with decreased ankle ROM due to extensive fractures from traumatic injuries. All subjects were postsurgical, with several internal fixation devices. Subjects previously received rehabilitation therapy involving joint mobilizations, therapeutic exercises, moist heat, and ice, but continued to lack 15° to 23° of ankle dorsiflexion. The Human Subjects Review Board of Brigham Young University approved the methods of this case series. Subjects gave written informed consent. Initial dorsiflexion active ROM for each patient was –3°, 0°, 8°, and 5°, respectively. Treatment regime consisted of PSWD to the ankle for 20 minutes at 27.12 MHz, 800 pps, 400 microseconds (48 W). Immediately after PSWD, mobilizations were administered to the joints of the ankle and foot. Ice was applied posttreatment.
Outcomes: Dorsiflexion improved 15°, 15°, 10°, and 14°, respectively, after 8 or 13 visits. All patients returned to normal activities with functional ROM in all planes. Follow-up 4 to 6 weeks later indicated that the subjects maintained 78% to 100% of their dorsiflexion. No discomfort, pain, or burning was reported during or after treatment. No negative effects were reported during the short-term follow-up.
Discussion: When applied with appropriate caution, we propose PSWD (48 W) may be an appropriate adjunct to joint mobilizations to increase ROM in peripheral joints, despite implanted metal. We continue to advise caution when applying diathermy with machines other than the Megapulse II. Further research is needed to determine the safety parameters of other diathermy machines. As a final caution, we advise that diathermy not be used in the presence of a cardiac pacemaker or neurostimulator.

J Orthop Sports Phys Ther. 2006;36(9):669-677. doi:10.2519/ jospt.2006.2198

Key Words: heat, internal fixation, modalities, physical agents, shortwave diathermy

Study Design: Resident’s case problem.
Background: A 21-year-old healthy athletic male military cadet with complaint of worsening diffuse left knee pain was evaluated 4 days after onset. The knee pain began 2 hours after completing a long car trip, worsened over the subsequent 3 days, and became almost unbearable during the return trip. The patient reported constant pain, limited knee motion, and difficulty ambulating. In addition, he was unable to perform physical military training or attend academic classes due to the severe left knee pain. Past medical history revealed a mild left lateral calf strain 21⁄2 weeks prior, which completely resolved within 24 hours of onset.
Diagnosis: Our physical examination led us to either monoarticular arthritis, pseudothrombophlebitis (ruptured Baker’s cyst), or a lower leg deep vein thrombosis (DVT) as the cause of knee pain. Diagnostic imaging of this patient revealed a left superficial femoral vein thrombosis and popliteal DVT, with bilateral pulmonary emboli (PE).
Discussion: A systematic differential diagnosis was undertaken to rule out a potentially fatal DVT diagnosis as the cause of knee pain, despite minimal DVT risk factors. The physical therapist in a direct-access setting must ensure timely evaluation and referral of a suspected DVT, even when patient demographics cause the practitioner to question the likelihood of this diagnosis. The physical examination findings, clinical suspicion, and established clinical prediction rules can accurately dictate the appropriate referral action necessary.

J Orthop Sports Phys Ther. 2006;36(9):686-697. doi:10.2519/jospt.2006.2251

Key Words: blood, pulmonary embolism, screening