In the last decade, growing attention has been placed on joint hypermobility and related disorders. The new nosology for Ehlers-Danlos syndrome (EDS), the best-known and probably the most common of the disorders featuring joint hypermobility, identifies more than 20 different types of EDS, and highlights the need for a single set of criteria to substitute the previous ones for the overlapping EDS hypermobility type and joint hypermobility syndrome. Joint hypermobility is a feature commonly encountered in many other disorders, both genetic and acquired, and this finding is attracting the attention of an increasing number of medical and non-medical disciplines. In this paper, the terminology of joint hypermobility and related disorders is summarized. Different types of joint hypermobility, its secondary musculoskeletal manifestations and a simplified categorization of genetic syndromes featuring joint hypermobility are presented. The concept of a spectrum of pathogenetically related manifestations of joint hypermobility intersecting the categories of pleiotropic syndromes with joint hypermobility is introduced. A group of hypermobility spectrum disorders is proposed as diagnostic labels for patients with symptomatic joint hypermobility but not corresponding to any other syndromes with joint hypermobility. © 2017 Wiley Periodicals, Inc.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/ajmg.c.31539

A framework for the classification of joint hypermobility and related conditions.

Annual Meeting of the American Academy of Orthopaedic Surgeons

There is an evolving body of knowledge regarding the acetabular labrum. Labral tears are most frequently anterior and often are associated with sudden twisting or pivoting motions. High clinical suspicion in association with positive physical findings are fundamental for the clinician to properly determine treatment for the suspected tear. Labral tears, especially those present for years, may contribute to the progression of hip osteoarthritis. Patients at risk include those with developmental dysplasia, those with tears greater than 5 years, and those with associated chondral full-thickness lesions. Chondral injuries may occur in association with a multitude of hip conditions including labral tears, loose bodies, osteonecrosis, slipped capital femoral epiphysis, dysplasia, and degenerative arthritis. Labral tears occurring at the watershed zone may destabilize the adjacent acetabular conditions. Arthroscopic observations support the concept that labral disruption, acetabular chondral lesions, or both frequently are part of a continuum of degenerative joint disease.

Anatomy, pathologic features, and treatment of acetabular labral tears : Hip arthroscopy

Background
Hip arthroscopy is an evolving procedure. One small study suggested that a low modified Harris hip score and arthritis at the time of surgery were predictors of poor prognosis.

What Factors Influence Long-term Survivorship After Hip Arthroscopy?

Background:The prevalence of abnormal magnetic resonance imaging (MRI) findings in an asymptomatic population has yet to be determined.Purpose:The purpose of this study was to assess a cohort of asymptomatic people to determine the prevalence of hip lesions.Study Design:Cross-sectional study; Level of evidence, 3.Methods:Forty-five volunteers with no history of hip pain, symptoms, injury, or surgery were recruited for enrollment in this institutional review board–approved study. The subjects underwent a unilateral MRI scan with a Siemens 3.0-tesla scanner. The extremity side evaluated by MRI was alternated. All MRI scans were reviewed by 3 fellowship-trained musculoskeletal radiologists. The scans were mixed randomly with 19 scans from symptomatic patients to blind the radiologists to the possibility of patient symptoms. An abnormal finding was considered positive when 2 of 3 radiologists agreed on its presence.Results:The average age of volunteers was 37.8 years (range, 15-66 y); 60% were men. Labral tea...

Prevalence of Abnormal Hip Findings in Asymptomatic Participants: A Prospective, Blinded Study

The hip labrum has many functions, including shock absorption, joint lubrication, pressure distribution, and aiding in stability, with damage to the labrum associated with osteoarthritis. The etiology of labral tears includes trauma, femoroacetabular impingement (FAI), capsular laxity/hip hypermobility, dysplasia, and degeneration. Labral tears present with anterior hip or groin pain, and less commonly buttock pain. Frequently, there are also mechanical symptoms including clicking, locking, and giving way. The most consistent physical examination finding is a positive anterior hip impingement test. Because of the vast differential diagnosis and the need for specialized diagnostic tools, labral tears frequently go undiagnosed during an extended period of time. Evaluation usually begins with plain radiographs to assess for dysplasia, degeneration, and other causes of pain. While magnetic resonance imaging (MRI) and computed tomography scans are unreliable for diagnosis, magnetic resonance arthrography (MRA) is the diagnostic test of choice, with arthroscopy being the gold standard. Typically, treatment begins conservatively with relative rest and non-steroid anti-inflammatory agents, with physical therapy (PT) being controversial. Often, surgical treatment is necessary, which entails, arthroscopic debridement of labral tears and surgical repair of associated structural problems.

/pdf/a-comprehensive-review-of-hip-labral-tears-4ndav9031s.pdf

A comprehensive review of hip labral tears

Chapter 1: Preparticipation Evaluation Jennifer Kurz, MD Joseph E. Herrera, DO Robert S. Gotlin, DO Chapter 2: Traumatic Brain Injury in Sports Danielle Marie Perret, MD Barry D. Jordan, MD, MPH Chapter 3: Facial Trauma Fani Thomson, D.O. Stephen Gelfman, DDS, MD Chapter 4: Cervical Spine Injuries Dorothy A. Miller, MD Thomas N. Bryce, MD Chapter 5: Shoulder Injuries Necolle Morgado DO Joseph E. Herrera, DO Chapter 6: Elbow Injuries Victor Ibrahim, MD Elise Weiss, MD Chapter 7: Wrist and Hand Injuries Elise Weiss, MD Chapter 8: Lower Back Injuries Grant Cooper, MD Joseph E. Herrera, DO Michael Dambeck, DO Chapter 9:Hip Injuries Necolle Morgado DO Parag Sheth, MD Chapter 10: Knee Injuries Marc Effron, MD Gregory E. Lutz, MD Chapter 11: Ankle and Foot Injuries Aaron Levine, MD Dov Kolker, MD Chapter 12: Hydration and Nutrition Earl Smith, MD, PhD Jeffery I. Mechanick, MD, FACP, FACE, FACN Chapter 13: Banned and Approved Substances Daniel Leung, DO Joseph E. Herrera, DO Lisa Bartoli, DO

Essential sports medicine.

Low back pain is a common, debilitating problem for athletes as well as the general population. It is the number one cause for athletes to miss a professional sporting event. Most cases of lower back pain are self-limiting, lasting no more than a few weeks. Occasionally, however, back pain lasts longer than 3 months, at which point it is termed chronic back pain. There are many potential pain generators in the lower back. The discs, facet joints, sacroiliac joint, bones, ligaments, muscles, tendons, and soft tissues can all cause pain. In younger athletes who have axial back pain with trunk flexion, the disc is often suspected as the potential underlying cause. Younger athletes with pain on extension may be suspected of having a pars interarticularis fracture. Older patients may be more likely to have facet joint disease as an underlying cause, particularly if their pain is more extension based. Of course, these are very broad brush strokes and are just meant to keep in the back of your mind to give you a framework within which to work. Each athlete must naturally be treated as an individual and interrogated appropriately. This chapter is aimed to help guide you along that path.

Lower Back Injuries

Stroke is the leading cause of permanent motor disability in the United States (US), but there has been little progress in developing novel, effective strategies for treating post-stroke motor deficits. The past decade has seen the rapid development of many promising, gamified neurorehabilitation technologies; however, clinical adoption remains limited. The purpose of this review is to evaluate the recent literature surrounding the adoption and use of gamification in neurorehabilitation after stroke. Gamification of neurorehabilitation protocols is both feasible and effective. Deployment strategies and scalability need to be addressed with more rigor. Relationship between engaged time on task and rehabilitation outcomes should be explored further as it may create benefits beyond repetitive movement. As gamification becomes a more common and feasible way of delivering exercise-based therapies, additional benefits of gamification are emerging. In spite of this, questions still exist about scalability and widespread clinical adoption. 

/pdf/gamified-neurorehabilitation-strategies-for-post-stroke-1isrgjfm.pdf

Gamified Neurorehabilitation Strategies for Post-stroke Motor Recovery: Challenges and Advantages

Neck Pain and Shooting Arm Pain Shoulder Pain Elbow Pain Wrist and Hand Pain Lower Back and Shooting Leg Pain Hip and Groin Pain Knee Pain Ankle and Foot Pain

Joseph E. Herrera

Papers

A comprehensive review of hip labral tears

Essential sports medicine.

Lower Back Injuries

Gamified Neurorehabilitation Strategies for Post-stroke Motor Recovery: Challenges and Advantages

Manual of Musculoskeletal Medicine