Context: Quadriceps dysfunction is a common consequence of knee joint injury and disease, yet its causes remain elusive.Objective: To determine the effects of pain on quadriceps strength and activation and to learn if simultaneous pain and knee joint effusion affect the magnitude of quadriceps dysfunction.Design: Crossover study. Setting: University research laboratory.Patients or Other Participants: Fourteen (8 men, 6 women; age ¼ 23.6 6 4.8 years, height ¼ 170.3 6 9.16 cm, mass ¼ 72.9 6 11.84 kg) healthy volunteers.Intervention(s): All participants were tested under 4 randomized conditions: normal knee, effused knee, painful knee, and effused and painful knee.Main Outcome Measure(s): Quadriceps strength (Nm/kg) and activation (central activation ratio) were assessed after each condition was induced.Results: Quadriceps strength and activation were highest under the normal knee condition and differed from the 3 experimental knee conditions (P , .05). No differences were noted among the 3 experimental knee conditions for either variable (P . .05).Conclusions: Both pain and effusion led to quadriceps dysfunction, but the interaction of the 2 stimuli did not increase the magnitude of the strength or activation deficits. Therefore, pain and effusion can be considered equally potent in eliciting quadriceps inhibition. Given that pain and effusion accompany numerous knee conditions, the prevalence of quadriceps dysfunction is likely high.Key Words: arthrogenic muscle inhibition, central activation failure, voluntary activation, muscles Key PointsKnee pain and effusion resulted in arthrogenic muscle inhibition and weakness of the quadriceps. The simultaneous presence of pain and effusion did not increase the magnitude of quadriceps dysfunction. To reduce arthrogenic muscle inhibition and improve muscle strength, clinicians should employ interventions that target removing both pain and effusion.
Background: Averaging length of stay (LOS) ignores patient complexity and is a poor metric for quality control in geriatric hip fracture programs. We developed a predictive model of LOS that compares patient complexity to the logistical effects of our institution's hip fracture care pathway. Methods:A retrospective analysis was performed on patients enrolled into a hip fracture comanagement pathway at an academic level-one trauma center from 2014-15. Patient complexity was approximated using the Charlson Comorbidity Index (CCI) and ASA score. A predictive model of LOS was developed from patient-specific and system-specific variables using a multivariate linear regression analysis; it was tested against a sample of patients from 2016.Results: LOS averaged 5.95 days. Avoidance of delirium and reduced time to surgery were found to be significant predictors of reduced LOS. CCI was not a strong predictor of LOS, but ASA score was. Our predictive LOS model worked well for 63% of patients from the 2016 group; for those it did not work well for, 80% had post-operative complications.
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