The patient was a 24-year-old woman who was evaluated by a physical therapist in a direct-access sports medicine clinic for a chief complaint of right anterior arm pain and swelling. Given the unusual mechanism and location of the injury, significant pain and weakness, and questionable tissue defect, diagnostic ultrasound was ordered. The ultrasound examination findings revealed a strain of the right short head of the biceps brachii with a partial tear more distally.

J Orthop Sports Phys Ther 2012;42(6):569. doi:10.2519/jospt.2012.0411

KEY WORDS: arm, elbow, ultrasound imaging

A 37-year-old male, referred to physical therapy by his physician, presented with a recent onset of left anterior hip and groin pain. Radiographs of the pelvis, left hip, and left femur were negative. After 2 weeks of rest and physical therapy, the patient was referred back to his physician for further investigation due to lack of improvement in symptoms. Magnetic resonance imaging revealed findings consistent with a stress fracture on the inferior (compression) side of the femoral neck. Stress fractures of the femoral neck can be difficult to diagnose, since standard radiographs are typically not diagnostic in the early stages. It is not until the healing phase, approximately 3 weeks after onset, that the stress fractures may become apparent on standard radiographs. Given the potential for dire outcomes, especially with superior (tension) side stress fractures, early diagnosis is paramount.

J Orthop Sports Phys Ther. 2008;38(8):517. doi:10.2519/jospt.2008.0408

KEY WORDS: femur, magnetic resonance imaging, radiographs

STUDY DESIGN: Case report. BACKGROUND: Determining the cause of painful snapping on the lateral aspect of the knee can be a challenge. The differential diagnosis includes iliotibial band friction syndrome, lateral meniscus tear, intra-articular loose body, discoid lateral meniscus, snapping biceps femoris tendon, degenerative joint disease, proximal tibiofibular joint instability, and snapping popliteus tendon. CASE DESCRIPTION: A 21-year-old female presented with a 7-year history of a painful snapping on the lateral aspect of her left knee. She reported the snapping occurred with all activities involving knee flexion and extension, including running and walking. With a diagnosis of snapping iliotibial band, she had received a variety of physical therapy interventions, including various lower extremity stretching and strengthening exercises. Nonsteroidal anti-inflammatory medications were also prescribed by her physician. Conservative and pharmoclogical interventions were unsuccessful in improving her symptoms. Similarly, our attempt with conservative treatment consisting of ice, taping, and a short period of immobilization was not successful. OUTCOMES: The patient underwent a surgical procedure consisting of removal of a prominent tubercle on the lateral femoral condyle and tenodesis of the popliteus tendon to the proximal aspect of the fibular (lateral) collateral ligament, followed by a postoperative program of physical therapy including range-of-motion and progressive strengthening exercises. At 6 weeks following surgery, the patient had returned to all activities with complete resolution of her symptoms. DISCUSSION: Painful snapping at the lateral aspect of the knee may be caused by a variety of disorders, including the popliteus tendon. Clinical diagnosis is challenging. Clinical suspicion of a snapping popliteus tendon as a source of the signs and symptoms of the condition is important for inclusion in the differential diagnosis. LEVEL OF EVIDENCE: Differential diagnosis, level 4.

J Orthop Sports Phys Ther. 2008;38(4):191-195, published online 14 December 2007. doi:10.2519/jospt.2008.2698

Study Design: Masked randomized trial. Objective: To examine the effects of a 6-week program of static stretching of the calf muscle-tendon unit (MTU) on active ankle dorsiflexion range of motion (ADFROM) in healthy subjects. Background: Static stretching of the calf MTU is often prescribed to increase flexibility in patients with shortened connective tissues or to maintain ADFROM in healthy individuals. Presently, physical therapists lack specific information on the optimal dosage of calf MTU stretching necessary to produce improvement in ADFROM. Methods and Measures: One hundred one adults (63 women, 38 men; mean age ± SD, 40.0 ± 10.9 years; range, 21-59) with no visual evidence of gait impairment due to lower-extremity dysfunction participated in the study. Active ADFROM was measured with a universal goniometer. Participants were randomly assigned to group 1, no stretch controls (n = 24), or to 1 of 3 experimental groups carrying out a 6-week program of standing wall stretches once per day: individuals in group 2 stretched for 30 seconds (n = 26); individuals in group 3 stretched for 1 minute (n = 24); individuals in group 4 stretched for 2 minutes (n = 27). Results: After 6 weeks, the results of an analysis of variance found no effect of treatment on active ADFROM. Conclusion: The results of this study show that a 6-week program of once-per-day static stretching for up to 2 minutes is not sufficient to increase active ADFROM in healthy subjects.

J Orthop Sports Phys Ther. 2003;33(7):408-417.

Key Words: flexibility, lower extremity, rehabilitation, triceps surae

Study Design: Cross-sectional descriptive study. Objectives: To examine the factors of gender and age, stratified by 10-year increments, on hamstring muscle length (HML) as measured by passive straight leg raise (PSLR) and popliteal angle (PA). Background: Differences in HML between men and women have not been examined for a large group of healthy adults over a wide range of ages. The usefulness of these data is to provide some typical values of HML for future reference. Methods and Measures: Two hundred fourteen adults (108 women, 106 men; age range, 20-79 years) with no known history of hip or knee joint disease and no history of recent hamstring strain participated in the study. PSLR (trunk-thigh angle) and PA (thigh-leg angle) were estimated with a goniometer. A 2-way analysis of variance (ANOVA) was used to analyze the effects of 2 independent variables (gender and age) on 2 dependent variables (PSLR and PA). Statistical significance was established at a<.05. Results: HML differed significantly (P<.001) between genders for both methods of measurement, with females demonstrating greater flexibility than their male counterparts. The difference between genders was 8° for PSLR and 11° for PA. HML was not influenced by age. Conclusions: This study provides physical therapists with typical values of HML in healthy men and women.

J Orthop Sports Phys Ther. 2005;35(4):246-252. doi:10.2519/jospt.2005.1428

Key Words: flexibility, hip extensors, lower extremity, straight-leg raise