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  • 1.
    Arumugam, Ashokan
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Clinical versus radiological findings: A paradox in diagnosing minor hamstring injuries2018Inngår i: International Journal of Osteopathic Medicine, ISSN 1746-0689, E-ISSN 1878-0164, Vol. 27, s. 52-56Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Hamstring injuries occur commonly in athletes participating in sports that require sprinting/high velocity running, kicking a ball or agility. In the first instance, clinical assessment and management play a pivotal role in managing these injuries. Radiological investigations such as ultrasonography (US) and magnetic resonance imaging (MRI) are also recommended to confirm one or more parameters related to hamstring injury (the location, length, cross-sectional area, volume, edema, hemorrhage, etc.) and predicting return-to-play. However, hamstring injuries that are minor in nature, diagnosed clinically, may not be discernible on conventional US or MRI in some cases. Certain reasons for these paradoxical (clinical vs. radiological) findings may include pain referral to the posterior thigh from lumbosacral dysfunction or sciatic nerve pathoneurodynamics. Conversely, minor hamstring injuries might remain indiscernible within the threshold of conventional MRI sensitivity. To date, there is neither clear consensus on a standardized criteria nor strong evidence for using MRI to prognosticate return-to-play following hamstring injuries. This paper briefly discusses the controversy between contradicting clinical and radiological findings encountered by clinicians in the diagnosis of minor hamstring injuries. If posterior thigh pain appears with clinical signs and symptoms of a minor hamstring injury without pain referral from neighboring structures, but presents with negative findings on US or MRI, the diagnosis remains a challenge. However, such conditions are pragmatically treated as (nonstructural) hamstring injuries unless certain differential diagnoses can be established. 

  • 2.
    Arumugam, Ashokan
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Sacral Osteosarcoma Masquerading as Posterior Thigh Pain2018Inngår i: Journal of Orthopaedic and Sports Physical Therapy, ISSN 0190-6011, E-ISSN 1938-1344, Vol. 48, nr 8, s. 665-665Artikkel i tidsskrift (Annet vitenskapelig)
  • 3. Arumugam, Ashokan
    et al.
    Markström, Jonas
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Häger, Charlotte
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    A novel test reliably captures hip and knee kinematics and kinetics during unanticipated/anticipated diagonal hops in individuals with anterior cruciate ligament reconstruction2020Inngår i: Journal of Biomechanics, ISSN 0021-9290, E-ISSN 1873-2380, Vol. 99, artikkel-id 109480Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Unanticipated land-and-cut maneuvers might emulate lower limb mechanics associated with anterior cruciate ligament (ACL) injury. Reliability studies on landing mechanics of such maneuvers are however lacking. This study investigated feasibility and within-session reliability of landing mechanics of a novel one-leg double-hop test, mimicking a land-and-cut maneuver, in individuals with ACL reconstruction (ACLR). Our test comprised a forward hop followed by a diagonal hop in either of two directions (medial/lateral) under anticipated and unanticipated conditions. Twenty individuals with a unilateral ACLR (aged 24.2 ± 4.2 years, 0.7-10.8 years post-surgery) performed three successful hops/direction per leg. We determined reliability (intraclass correlation coefficient [ICC]) and agreement (standard error of measurement [SEM]) of 3-dimensional hip and knee angles and moments during the deceleration phase of the land-and-cut maneuver (vulnerable for non-contact ACL injuries). Mean success rate for unanticipated hops was 71-77% and for anticipated hops 91-95%. Both limbs demonstrated moderate-excellent reliability (ICC 95% confidence intervals: 0.50-0.99) for almost all hip and knee peak angles and moments in all planes and conditions, with a few exceptions: poor-good reliability for hip and knee frontal and/or transverse plane variables, especially for lateral diagonal hops. The SEMs were ≤5° and ≤0.23 N·m/kg·m for most peak angles and moments, respectively. Our test seems feasible and showed satisfactory reliability for most hip and knee angles and moments; however, low knee abduction and internal rotation angles and moments, and moderate reliability of these moments deserve consideration. The test appears to challenge dynamic knee control and may prove valuable in evaluation during knee rehabilitation.

  • 4.
    Arumugam, Ashokan
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Markström, Jonas L.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Häger, Charlotte K.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Introducing a novel test with unanticipated medial/lateral diagonal hops that reliably captures hip and knee kinematics in healthy women2019Inngår i: Journal of Biomechanics, ISSN 0021-9290, E-ISSN 1873-2380, Vol. 82, s. 70-79Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Despite a vast literature on one-leg hops and cutting maneuvers assessing knee control pre/post-injury of the anterior cruciate ligament (ACL), comprehensive and reliable tests performed under unpredictable conditions are lacking. This study aimed to: (1) assess the feasibility of an innovative, knee-challenging, one-leg double-hop test consisting of a forward hop followed by a diagonal hop (45°) performed medially (UMDH) or laterally (ULDH) in an unanticipated manner; and (2) determine within- and between-session reliability for 3-dimensional hip and knee kinematics and kinetics of these tests. Twenty-two healthy women (22.3 ± 3.3 years) performed three successful UMDH and ULDH, twice 1–4 weeks apart. Hop success rate was 69–84%. Peak hip and knee angles demonstrated moderate to excellent within-session reliability (intraclass correlation coefficient [ICC] 95% confidence interval [CI]: 0.67–0.99, standard error of measurement [SEM] ≤  3°) and poor to excellent between-session reliability (ICC CI: 0.22–0.94, SEM ≤ 3°) for UMDH and ULDH. The smallest real difference (SRD) was low (≤ 5°) for nearly all peak angles. Peak hip and knee moments demonstrated poor to excellent reliability (ICC CI: 0–0.97) and, in general, moments were more reliable within-session (SEM ≤ 0.14 N.m/kg.m, both directions) than between-session (SRD ≤ 0.43 N.m/kg.m). Our novel test was feasible and, in most but not all cases, provided reliable angle estimates (within-session > between-session, both directions) albeit less reliable moments (within-session > between-session, both directions). The relatively large hip and knee movements in the frontal and transverse planes during the unanticipated hops suggest substantial challenge of dynamic knee control. Thus, the test seems appropriate for evaluating knee function during ACL injury rehabilitation.

  • 5.
    Arumugam, Ashokan
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Strong, Andrew
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Tengman, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Röijezon, Ulrik
    Häger, Charlotte
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Psychometric properties of knee proprioception tests targeting healthy individuals and those with anterior cruciate ligament injury managed with or without reconstruction: a systematic review protocol2019Inngår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, nr 4, artikkel-id e027241Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Introduction: An anterior cruciate ligament (ACL) injury affects knee proprioception and sensorimotor control and might contribute to an increased risk of a second ACL injury and secondary knee osteoarthritis. Therefore, there is a growing need for valid, reliable and responsive knee proprioception tests. No previous study has comprehensively reviewed all the relevant psychometric properties (PMPs) of these tests together. The aim of this review protocol is to narrate the steps involved in synthesising the evidence for the PMPs of specific knee proprioception tests among individuals with an ACL injury and knee-healthy controls.

    Methods and analysis: The Preferred Reporting Items for Systematic reviews and Meta-Analyses will be followed to report the review. A combination of four conceptual groups of terms-(1) construct (knee proprioception), (2) target population (healthy individuals and those with an ACL injury managed conservatively or with a surgical reconstruction), (3) measurement instrument (specific knee proprioception tests) and (4) PMPs (reliability, validity and responsiveness)-will be used for electronic databases search. PubMed, AMED, CINAHL, SPORTDiscus, Web of Science, Scopus, the Cochrane Central Register of Controlled Trials and ProQuest will be searched from their inception to November 2018. Two reviewers will independently screen titles, abstracts and full text articles, extract data and perform risk of bias assessment using the updated COnsensus-based Standards for the selection of health Measurement INstruments risk of bias checklist for the eligible studies. A narrative synthesis of the findings and a meta-analysis will be attempted as appropriate. Each PMP of knee proprioception tests will be classified as 'sufficient', 'indeterminate' or 'insufficient'. The overall level of evidence will be ascertained using an established set of criteria.

    Ethics and dissemination: Ethical approval or patient consent is not required for a systematic review. The review findings will be submitted as a series of manuscripts for peer-review and publication in scientific journals.

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