Archive for the ‘How To Build Muscles’ Category
I am sure you have seen articles in magazines or here on Bodybuilding.com talking about how to stay motivated with tips and tricks to get you psyched to train. Although they help a lot of people, they don't help everybody.
Ladies, are you opting for a stay-at-home lifestyle, but still want to look good in a bikini? Use the following 11 at-home exercises to look better and save! Learn more.
The best lower body exercises are the ones that can be done anywhere with little or no equipment. Being single with no kids may allow for wasted time in the gym doing twelve sets per lower body part, but once in the real world of spouse, kids and job, those two hour gym visits are history.
The good news is this should be a welcome change because the old-school bodybuilder, weights and machine type workout routines can do more damage in the long run as compared to a smart, properly structured lower body exercise routine.
Lie on the floor face up. Place your arms down to each side of your hips. Extend one leg out straight and bend the other leg with your foot flat on the floor. Raise your body by extended hip of bent leg, keeping extended leg and hip straight. Return to your original position again, lowering your body with extended leg and hip straight. Repeat 15 times for one set. Then continue with the opposite side.
Leg crunches will certainly make your feel the muscles working. Lie flat on your back with your hands behind your head. Left the right leg up to the chest and at the same time bring the left elbow forward to meet the knee. Hold the place for five seconds and then repeat with the left leg and right elbow.
The leg press works the hamstrings and quadricep muscles. Generally, you’ll need a leg press machine to perform this exercise. Experiment with the weight to make sure you are able to press at least five or six times – and to prevent yourself from not being able to press the weight away from your body!
You are engaging your powerful hip flexors. Also, your back is straight and your chest is out. You should be leading with your hips when going up and down-not with your knees. Keep your weight on your heels throughout the movement. Remember this movement when you perform a regular squat.
Lower your body as low as you possibility can. If it is too uncomfortable then do not lower any further. When you have bent as far as you comfortably can pause and straighten the body and then repeat the exercise. Try and do ten of these if you can. Do them slowly and focus on getting the technique right. You can increase the number of reps as you build up your leg strength.
Ab exercises seem to be the logical thing to do to burn stomach fat, but all they do is strengthen your abdominal muscles. They are necessary to get a good hot six pack, however not essential to losing weight.
Sprinting is also said to be a good way to tone the thighs and butt muscles. Lying butt bridges, hip extensions with weights behind the knees while squeezing your glutes, leg presses using abductors and adductors, leg lifts, and one legged dead lifts or cable kick backs are all awesome ways to firm your lower body.
The type of exercise options you will choose depends on you. Make an effort to create strategies for you to keep motivated. Remember that you should always start off slowly and then gradually build up. Results will not come in a day so avoid pushing yourself too hard. What is important is that you choose the right programs for your lower body and to your whole body as well. Just take things one day at a time.
Article Source: http://www.articlesbase.com/diseases-and-conditions-articles/lower-body-exercises-3308819.html
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Best Shin Splint Stretches and Exercises
Pain along the outside front of lower leg commonly seen in runners is called shin splints. It is caused by an overload of the shin bone and the connective tissues that attach your muscles to the bone. If you feel pain on the front and outside of the shin, particularly when the heel touches the ground during running and if the pain becomes constant and the shin is painful to touch, you have the symptom, tibialis anterior.
You can Get rid of Shin Splints by doing proper muscle strengthening exercises & stretches at home.
Tibialis posterior and bony shin splints are the other symptoms of shin bones which arise from causes like tendinitis, stress fractures, compartment syndrome, high impact training, excessive training, poor technique or biomechanical problems, standing for long periods and wearing high heeled shoes.
Simple & Best Shin Splint Stretches and Exercises
Physical examination, taking patient history, radiology, measuring the pressure within the compartments, magnetic resonance imaging and high resolution x-ray computed tomography scans are the diagnostic techniques. Understanding, identifying and treating the underlying problems are necessary for choosing appropriate treatment.
Rest, ice, non-steroidal anti-inflammatory drugs and physiotherapy are used as treatment in the beginning. The patient may be asked to reduce the duration and intensity of his exercise. Specially fitted footwear is useful in reducing swelling.
There are best shin splint stretches and exercises like toe raises, calf raises and inner and outer thigh raises which are helpful in speedy recovery. For instance calf raises restore the balance between the two muscles. Do professionally designed training programs and get rid of shin splints for good.
Article Source: http://www.articlesbase.com/alternative-medicine-articles/best-shin-splint-stretches-and-exercises-3896763.html
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I’m not going to mince words or pull any punches: If you’re not making steady bodybuilding gains, it’s because your ‘bodybuilding workout routine’ sucks – plain and simple. It’s because you haven’t customized a successful schedule of effective bodybuilding workouts and combined it with an adequate recuperation schedule for gaining muscle.
You’re not alone. I’ve seen thousands of gym-goers who are frustrated with their lack of bodybuilding progress. Yet like the proverbial creature of habit that epitomizes the definition of slight insanity, they keep doing the same thing over and over while seemingly expectant of a different result. This is not a good habit to develop if you want success in life – whether in natural bodybuilding or any other area.
If you find yourself among the ranks of the frustrated; if you think your bodybuilding workout routine isn’t producing returns commensurate with your investment in time, I empathize. For nearly a decade of my younger life, I struggled to make natural bodybuilding gains. I toiled away in gyms while imbibing every bit of bodybuilding information I could get my hands on. Still, with all that garbage I “learned”, I made progress that bare resemblance to taking two steps forward – one step back, then one step forward-two steps back. I got nowhere. My bodybuilding workout routines sucked.
Now in my mid forties, I’m making all the incredible natural bodybuilding gains I longed for in my youth. My muscles just keep expanding as much as I want them to. I have to admit – I love the feeling. I love knowing with dauntless expectancy that my body will be better built in a few months than it is now. And in a year’s time, I’ll have new and exciting gains added to what I’ve already built.
So let’s go over a few of the elements that cause a bodybuilding workout routine to leave its adherent mired in frustration due to a lack of muscle building gains. Let’s look at the fallacies that are running rampant so we can avoid them and get you gaining muscle in a non-stop manner.
Working Out Too Often
I would love to know who the pencil-necked geek is that determined a muscle’s standard recuperation time. This goofball created the widespread notion that muscles fully recuperate from bodybuilding workouts within 72 hours of muscle breakdown. Whoever was involved in this inaccurate determination, their assertion has caused more frustration for more natural bodybuilders than I’d want to know. Millions of gym-goers around the world are painstakingly wasting time and energy by going back and forth to the gym – faithfully working each muscle within this 72-hour window of time – and getting nowhere for the effort.
In response, a lot of bodybuilding gurus who are peddling their bodybuilding workout routines on the Internet are informing their readers that they should work each body part once-per-week. In my many years of experience, I’ve found this to be a step in the right direction, yet wholly inadequate for making ongoing natural muscle building gains.
The real “secret” to nonstop muscle growth is in knowing that one week might still not be enough time for a muscle group to fully recuperate from an intense workout. Another secret is in knowing and acknowledging that recuperation between workouts is the biggest component to progress and its rate can vary among people and even vary in the same person from one time to another.
If you are finding that your ‘bodybuilding workout routine’ sucks, try working out less often to see what happens. The worst that can happen is that you don’t make any progress, which is no worse than what is happening now. So there’s no excuse not to test.
Arbitrary ‘Bodybuilding Workouts’
Coupled with working out too often as being a prime reason for lack of muscle building gains is the common practice of random, hit-and-miss workouts. Walk into any gym and you can see this happening on a massive scale. For those who want to work out just for the sake of movement, this is fine. However, for those of you who actually want to have a better looking body down the road than you have now, this is disastrous.
Many gym-goers and home workout enthusiasts alike seem to think that any bodybuilding workout movement they undergo will result in tangible physique improvement down the line – as long as they’re consistent and persistent.
But this is reminiscent of the old analogy of “running east and looking for a sunset”; it’s not going to happen. Unless your bodybuilding workout routine is custom made for you in terms of having the right muscle breakdown/recuperation ratio, your routine is going to be more an exercise in futility than in muscle building progress.
If you want to squelch the frustration of slow or no progress in bodybuilding, you need to devise a workout schedule that provides ‘overload’ at just the right intervals. Most of all, you need to stop working out in a random and arbitrary manner.
Lack of a “Feedback Mechanism” in ‘Bodybuilding Workouts’
One of the biggest reasons that arbitrary bodybuilding workout routines are ineffective is that they don’t provide a constant feedback mechanism for making successful adjustments to both workout intensity and recuperation timing. These are the two most important pieces of feedback information you’ll need in order to keep your body making muscle gains. When you’re just “winging it” in the gym and then applying a rigid number of rest days between workouts, it’s difficult to determine whether you’re making progress and where you need to make small adjustments in order to move steadily forward.
I strongly recommend bodybuilding workout routines that employ what I call “micro-feedback.” This is feedback to which you can make adjustments on a level that will keep your body moving forward at maximum efficiency because you won’t be constantly making mistakes that cause overtraining, under-training, and “recuperation mismatches.”
So whatever routine you choose, make sure it doesn’t have you: – Working out too often – Arbitrarily choosing exercises, sets, and repetitions – Training without a built-in Feedback Mechanism
It’s these things that cause too many bodybuilding routines to exercise one’s tolerance to frustration rather than the body’s ever-expanding musculature.
Article Source: http://www.articlesbase.com/fitness-articles/your-bodybuilding-workout-routine-sucks-why-most-natural-bodybuilders-are-frustrated-1330484.html
About the Author
Scott Abbett is the author of HardBody Success: 28 Principles to Create Your Ultimate Body and Shape Your Mind for Incredible Success. To see his personal transformation, visit >www.hardbodysuccess.com
If you really want to bring amazing biceps, triceps and shoulders to the 'gun show' then try this circuit of 9 exercises to see explosive arm muscle growth! Learn about each exercise, reps, sets and intensity below!
We've all heard the screams, the crashes, the grunts–training that sounds more like battle. Can that mentality be turned to your own advantage? Read on to find out.
You know how the old saying goes, No pain no gain! I can hear it now coming from the mouth of my high school football coach. However, is that really true? Is pain the essence of new muscle being built, or is it our body telling us to stop?
The debate on whether bodybuilding should be an Olympic sport has been raging for years amongst the bodybuilding community and those interested in the Olympics. Ardent fans argue that weightlifting has been an Olympic sport for years, so why not bodybuilding? To diehard fans, bodybuilding and the Olympics seems to be a perfect fit, and questions like “Why is bodybuilding not already an Olympic sport?” are routinely aired.
Perhaps the more telling questions to ask are “Should bodybuilding be an Olympic sport?”, and “Would making bodybuilding an Olympic sport help the Olympics?”
Bodybuilding And The Olympics: Why It Is Not Already An Olympic Sport
The current Olympic program consists of 35 sports, 53 disciplines and more than 400 events, ranging from archery through to weightlifting and wrestling. The bodybuilding fan base, competitors, and sponsors are all ready and willing to take the step to Olympic level. The stumbling block is the International Olympic Committee and the OPC, who state simply that according to their criteria, bodybuilding is not a sport and there has no place in the Olympics.
This stand begs the question, “what determines a sport in the first place?”. A simple definition by the Australian Sports Foundation says that sport is “a human activity capable of achieving a result requiring physical exertion and/or physical skill, which, by its nature and organization, is competitive and is generally accepted as being a sport.”
Arguably, bodybuilding fits within this definition, and one would think this should be enough for the IOC. However, the primary problem the IOC has with allowing bodybuilding into the Olympics concerns drug abuse. They claim that the widespread use of performance enhancing drugs by bodybuilders would prevent bodybuilding from complying with Olympic drug policies. There are harsh and vigilant doping rules for Olympic competitors, which would certainly exclude many professional bodybuilders.
However, the natural bodybuilding fraternity does not use performance enhancing drugs. The Olympics could uphold their drug policies, allowing only natural bodybuilders to compete at the Olympics. This also aligns with the tradition of the Olympics being a competition for sporting amateurs, not professionals.
Another reason stated by the IOC for excluding bodybuilding from the Olympics was that the judging in competitive bodybuilding was far too subjective for an Olympic judge to critique. Given the controversy surrounding the subjective judging of sports such as ice skating, diving, and gymnastics this argument hardly seems to hold water. In fact, bodybuilding would seem to be a perfect fit!
How Bodybuilding Could Help The Olympics
As competitive bodybuilding has never been a mainstream sport, including it as an Olympic Sport would allow the sport to be better known and recognized. It would also make the sport more accessible, allowing people to learn more about bodybuilding, and possibly participate themselves.
Bodybuilding would also help the Olympics by widening the scope of sports on display. By showcasing bodybuilding, the Olympics would be encouraging people of all ages to eat good food, work out, become fit, and look after their health. These are important messages in a world where so many people are overweight.
A look back into history reveals that the Olympics were first introduced by the Greeks, who idolized and revered well toned, aesthetic bodies with healthy strong physiques.
Bodybuilding And The Olympics: The Main Argument Against
Besides the drug doping issue, perhaps the most prominent argument against including bodybuilding in the Olympics is the subjectivity of judges and the fact that there is often no clear winner. Even though other Olympic sports like ice skating are also in this category, the majority of Olympic sporting events feature clear winners, either by time, distance, height or lifting weight. No one can argue that judging mistakes have been made when a competitor clearly wins an event.
Although the jury is still out on bodybuilding and Olympics, it seems for the time being at least, that the Olympic Committee has no intention of including bodybuilding as an Olympic sport. Despite the fact that the bodybuilding fraternity is ready and willing to take the step to Olympic level, it looks like they will be waiting for some time yet.
Article Source: http://www.articlesbase.com/health-articles/bodybuilding-and-the-olympics-an-ongoing-controversy-262514.html
About the Author
Jean Littman is co-owner of BodyBuilderWeb.com which provides quality tools and resources on bodybuilding, gaining muscle and losing fat.
Introduction
Burman in 1931 scoped 3 ankles using a 4.Omm sheath without distraction, he found it too tight for satisfactory visualisation. Ankle arthroscopy really came of age in the 90′s with the development of 2.5mm arthroscopes, noninvasive distraction techniques and irrigation systems.
Historical developments
Tagaki was the real father of the arthroscope. He developed a 2.7mm arthroscope. However Watanabe developed matters further producing a self-focusing 1.7mm arthroscope and arthroscoped 28 ankles, describing the standard portals and normal anatomy.
Andrews wrote one of many texts on the subject in the late 80′s. Guhl developed a skeletal distracter for the ankle and wrote an excellent text.
Yates was the first to develop a non invasive distraction technique.
Advantages and Contra-indications
ADVANTAGES
Arthroscopy allows direct articular inspection + assessment of ligaments and synovial change. One can perform intraoperative stress testing.
The following diagnoses can be made. OCD – 23.5%, Impingement – 21.3%, Chrondromalacia – 7.9%, Instability – 7.2%, DJD – 7.2%, Acute Fracture – 6.5%, Arthrofibrosis – 4.8%, Loose Bodies, Osteophytes, Synovitis, Ossicles, Torn ATFL, Cryptogenic Pain, Cyst, Chondral Fracture, Peroneal Subluxation, Torn Peroneal Tendon.
The following procedures can be performed. Debride lateral gutter – 21.8%, Excise/Drill OCD – 19.4%, Chondroplasty – 13.3%, Excise fibrous bands – 6.8%, Loose bodies – 5.7%, Rx of fracture, Diagnostic, Synovectomy, Osteophytes, Ossicles, Arthrodesis, Stabilisation CONTRA-INDICATIONS – Relative – DJD, Oedema, Impaired vascularity.
Absolute – Soft tissue infection, Advanced DJD.
Instrumentation
Ankle arthroscopy developed from the principles of knee arthroscopy and hence initially the same instruments were applied. However as experience developed with smaller instruments, distraction, and fluid management systems, arthroscopy evolved.
Irrigation – Gravity, Gravity assist, Pumps.
Athroscopes – Hopkins 2.3mm, 2.7mm and 1.9mm diameters, 30 & 70 degree.
Distraction – Non invasive.
Instrumentation – Spinal needles, Probes, Dissectors – elevating OCD lesions, ossicles, Graspers – flat tipped or pitbull for small or large loose bodies (2.7-3.Omm), Basket forceps – straight, right and left, up and down angles (2.53.00mm), Knives, Curettes, Osteotomes, Power Instruments, Thigh/Ankle Holder, Aiming jigs.
Diagnostic Arthroscopic Examination of the Ankle
Ankle arthroscopy is a useful diagnostic modality to evaluate pathology and determine correct treatment. It should not be used as a substitute for careful history taking, examination and investigation. Its main advantages are that it allows direct inspection and probing of all intra-articular structures and their dynamic assessment. As such it is virtually 100% accurate in diagnosing intra-articular disorders.
The ankle is first distended with approximately 30cc of saline. Then the anteromedial portal is established just medial to tibialis anterior at the level of the joint line carefully avoiding the saphenous nerve. Then the anterolateral portal is established using transillumination, avoiding the superficial branch of the lateral popliteal nerve. A full diagnostic inspection of the anterior compartment is then carried out. Then the posterolateral portal is made localising the entry point with a spinal needle. Then a full inspection of the posterior compartment is made. Using these three portals a full 21 point systemic ankle examination can be carried out.
SOFT TISSUE LESIONS OF THE ANKLE
These are difficult to diagnose without arthroscopy despite careful assessment and investigation. They represent some 3050% of lesions found within the ankle joint and are diagnosed and treated by arthroscopy.
Patients with such lesions present with a combination of pain, swelling, tenderness, locking and giving way.
On examination one finds a combination of tenderness, wasting, swelling, restricted range and instability.
Investigations include XR, CT, MRI, Arthritis tests. These all may be negative.
CLASSIFICATION
Congenital – Plicae / bands – excise
Traumatic – sprains, fractures, prior surgery – excise generalised synovitis, excise localised bands, excise meniscoid lesions secondary to impingement.
Impingement lesions
Lateral ligament injuries are very common, with 1 ankle sprain per 10,000 occurring per day. Some 1-50% have some chronic pain.
Anterolateral impingement is the commonest soft tissue impingement lesion and cause of pain after ankle inversion injury – Wolin coined the term “the meniscoid lesions” for the arthroscopic appearance of the lateral gutter in these patients.
Arthroscopic treatment is very successful in alleviating chronic pain in 84% both subjectively and objectively.
During dorsiflexion of the ankle the malleoli are separated and the syndesmosis is stressed, syndesmotic injuries are undoubtedly underestimated. Syndesmotic injuries are best diagnosed by a localised tenderness and a positive squeeze test pressing the tibia and fibula together proximal to the syndesmosis half way up the calf. Syndesmotic impingement is also associated with a separate distal fascicle to the anterior talo-fibula ligament. The incidence of syndesmotic injury is 3% of all ankle sprains.
Posterior impingement can occur and was first described by Hamilton with posterior “meniscus” displacing inferiorly. Also a labrum on the posterior lip of the tibia can hypertrophy when injured.
Inflammatory Lesions
Rheumatoid arthritis, X-tal synovitis, PVNS and Synovial Chondromatosis can all affect the ankle. Rheumatoid arthritis has been reported to have an arthroscopic cure. A 95% synovectomy is possible, and early synovectomy is better than later.
PVNS can be treated arthroscopically in the ankle as elsewhere. Synovial Chondromatosis is rare in the ankle, but is treated along standard arthroscopic lines.
Other arthritides have been described such as gonarthritis, Crohn’s gout, chondrocalcinosis and are treated with arthroscopic synovectomy.
Infections
Bacterial and fungal infections occur and are best treated with arthroscopic aspiration and synovial biopsy followed by washout and irrigation then appropriate antibiotic therapy.
Degenerative disease
Primary and secondary osteoarthritis can be treated arthroscopically.
Miscellaneous
Arthrofibrosis post fracture or sprain can occur and is satisfactorily treated by arthroscopic resection of the fibrous bands and early physiotherapy.
ARTICULAR SURFACE DEFECTS, LOOSE BODIES AND OSTEOPHYTES
OCD Lesions of the talus – OLT
Osteochondral lesions of the talus as such were first described in 1856 by Monro but Konning coined the term “osteochondritis” when he found similar pathology elsewhere in the body and thought the aetiology was osteonecrosis. Kappis in 1922 first applied the term osteochondritis to the ankle joint.
Berndt and Harty in 1959 postulated a traumatic aetiology and used the term transchondral fracture of the talus. O’Donoghue said the lesions were intra-articular fractures and Campbell and Ranawat felt the cause was ischaemia in 1966. Alexander and Lichtman + Canale and Belding have subsequently lent support to the traumatic aetiology in 1980. However the exact aetiology remains uncertain.
It is certainly a condition which tends to be under diagnosed bearing in mind that talar osteochondritis accounts for 4-10% of all osteochondritides. It affects males more commonly than females and a peak incidence at 20-30-years of age.
The lesions are either posteromedial or anterolateral. If they are posteromedial – 70% are traumatic – are deep and not usually displaced. They are usually caused by inversion of the dorsiflexed foot (torsional impaction) ref. Of the anterolateral lesions – 90% are traumatic – are usually thinner and are more commonly displaced. They are typically caused by inversion of the plantar flexed foot.
Clinically patients present with a history of trauma, pain, swelling, catching, givingway or locking. On examination one may find swelling and tenderness.
The diagnosis is best made by CT or MRI. A classification based on CT correlates better with the arthroscopic findings than the original classification of Berndt and Harty. Zinman and his colleagues found CT to be superior to XR’s in diagnosis, but MRI also has been advocated particularly by Dipaoala. Anderson has developed an MRI based classification and found CT to be as good as MRI except in diagnosing grade 1 lesions.
Cheng and Ferkel went on to show CT to be the scan of choice if the diagnosis is known but MRI if it is not. They have also developed an arthroscopic classification.
Treatment of the stage 1& 2 lesions is 6-12 weeks in a cast, but arthroscopy if conservative treatment fails. Stages 3 & 4 lesions are treated arthroscopically immediately.
Results of treatment are good with Loomer showing 80% good or excellent results.
The surgical approach is as follows for acute OLT. They are palpated with a hook. Loose chondral fragments alone are excised but osteochondral fragments are pinned or screwed into the base of the defect whether displaced or undisplaced.
For chronic OLT again palpate with a hook, see if it is loose. Fix it if it is loose and the underlying bone is healthy, if the underlying bone is unhealthy you need to excise the loose fragment and drill the base of the defect. Large areas can be treated by osteochondral graft large.
It has been shown by Buckwalter that penetration of subchondral bone disrupts subchondral vessels, this produces bleeding, a clot and fibrocartilagenous repair. The cells responsible for this enter from the marrow. Significant cartilage defects can be repaired by tissue which grows up drill holes to cover exposed subchondral bone.
The results of arthroscopic treatment of OLT are as good if not better than open surgery i.e. 80% plus.
Osteophytes, loose bodies, and chondral lesions of the ankle
Arthroscopic ankle surgery is also successful other pathologies apart from impingement and OLT. Martin and Ferkel in 1989 reported 71% good/excellent results for OLT lesions, 57% good/excellent results for loose bodies and osteophytes and 12% good/excellent results for DJD.
With loose bodies it is necessary to inspect the posterior compartment and you need to check all the articular surfaces carefully after their removal.
Osteophytes in the ankle are a common condition known as the “anterior kissing lesions” or “Footballers Ankle”. It is O’Donoghue in 1966 who reported a 45% incidence in American Football players, there is an even higher incidence of 59.3% in dancers. Patients with “Footballers Ankle” present with pain catching and restricted joint motion (dorsiflexion) and swelling.
Treatment aims to reproduce the normal 60 degree tibiotalar angle. One must be careful to avoid neurovascular injury when performing surgery open or closed. Arthroscopically the borders of the osteophyte are exposed with a 3.5mm soft tissue resector then the bony spurs themselves are removed with burrs. Per operative lateral x-ray prior to completion can be taken to ensure sufficient bony resection, it has been shown that one obtains better results if the patients have isolated spurs than generalised DJD but overall excellent results are achievable.
A classification with grades I-N was described by Scranton, (1-111 treatable arthroscopically) but even grade IV lesions can be addressed arthroscopically. Interestingly talofibular bony impingement can also occur.
Chondral lesions also occur and are usually caused by a sprain or also by an RTA with direct compression of the articular cartilage. The pathologies range from blistering to full thickness flap tears. These lesions are frequently missed because of normal XR in A/E. If such lesions are suspected then ankle arthroscopy is the only sure way to diagnose them with a full examination of anterior and posterior compartments required. Arthroscopic surgery is straight forward resecting chondral flaps to stable base and drill exposed bone to encourage vascular invasion and fibrocartilage formation.
Ankle arthroscopic debridement and lavage parallels that of arthroscopic treatment of DJD in other joints.
Lateral ligament instability
Lateral ligament injury of the ankle is very common; with one person in 10,000 sustaining the injury per day it is the commonest ligament injury seen by surgeons. Repeated lateral ligament injuries interfere with normal daily life and with chronic instability a minor trauma can cause a significant inversion injury with unpredictable outcome.
Surgery to correct lateral ligament instability was described as early as 1949 by Nilsonne who described a peroneus brevis transfer. But it was Brostrom who showed that direct repair of the lateral ligament was possible even years after acute injury and Hamilton reported 93% good or excellent results with a modified Brostrom procedure. With lateral ligament tears it is the anterior talo-fibular ligament fails first, calcaneo fibular ligament rupture is rare. A repair/reconstruction ideally needs to reproduce the ATFL in its anatomic position and this is what a Brostrom or Hamilton procedure does.
The diagnosis of lateral ligament instability is straight forward, there is a history of instability the lateral ligaments are tender and moving the ankle demonstrates excessive inversion and an exaggerated anterior draw test, this is when the foot and talus are translocated anteriorly in the mortis and the amount of anterior movement recorded and compared with the normal side.
Radiographic lateral stress views can be performed applying set forces of inversion. But results of such instability testing can be questionable if the calcaneofibular ligament is intact and these patients still have instability.
Arthroscopically there is ballooning of the anterolateral capsule which appears and feels thinner than normal. One frequently sees scarring of the lateral gutter and syndesmosis with associated loose bodies or ossicles and lateral dome or plafond chondral changes.
Treatment is either an open or closed modified Brostrom repair with three weeks in a below-knee cast then standard physiotherapy. Arthroscopic results are as good as open.
Ankle arthrodesis
An ankle arthrodesis if successful allows a patient to return to work and some sports with a virtually normal gait. Fusion rates have been reported from any series as in the order of 80% and infection occurring in 5-25%. Morgan in 1985 reported a 96% fusion rate with 90% good/excellent results. He maintained the contour of the talar dome, kept the ankle in neutral and used cross-screw internal fixation.
Two years earlier Schneider first described arthroscopic ankle arthrodesis. But it was Morgan who published the first report in 1987. Myerson compared open and closed techniques of ankle arthrodesis with a reported quicker fusion time arthroscopically of 8.7 versus 14.5 weeks theoretically because of the lack of disruption of the soft tissues and therefore a better blood supply to the fusing surfaces. The faster fusion rate was backed up by Ogilvie-Harris who reported an 89% fusion rate arthroscopically with 88% fused by the third post operative month!
The advantages of an arthroscopic arthrodesis are reduced morbidity, shorter Hospital stay, faster fusion rate, better cosmesis and lower complication rates. Against these are long learning curve for the surgeon and theatre staff, it is a longer procedure and requires expensive arthroscopic equipment. Also it cannot correct large varus, or rotational deformities.
The contra-indications for an arthroscopic arthrodesis are >15 Degrees deformity, a previously failed arthrodesis, the presence of infection, RSD and a charcot joint. Mann showed that the best fusion position is with the ankle in neutral, avoiding >10 Degrees plantar-flexion and with the os-calcis in 5 degrees valgus. Also the “Mann” position results in the best gait. You do however lose 70% of your total motion arc with an ankle fusion and tarsal hypermobility is increased 85%.
The arthroscopic technique is to have the standard arthroscopic set up with either invasive or non-invasive distraction. Remove all articular cartilage initially from the talar dome and planfond then the gutters to expose bleeding underlying bone and finally the anterior osteophyte needs removal as this would otherwise resist talar reduction. The fusion is secured with crossed cannulated screws. Screw positioning is arthroscopically assisted and the length of the screws can be image intensifier assisted.
The patients then spend 3 weeks non weight bearing followed by 4-6 weeks partial weight bearing. The screws can be removed later if they are causing pain. A range of 3-12 months has been reported for standard open fusion to occur, this compares unfavourably with the arthroscopic technique. Mann from a multi-centre trial recently demonstrated a 91% fusion and 84% good/excellent results. This fusion rate leaps to 96% if known poor techniques are avoided, e.g. laser, external charley type compression.
This article was specifically written for Chiropody Review and we thank Mr Simon Moyes for the time and trouble he took.
CHIROPODY REVIEW,DECEMBER 1998
Article Source: http://www.articlesbase.com/medicine-articles/the-current-state-of-ankle-arthroscopy-173938.html
About the Author
Mr Simon Moyes MB FRCS FRCSOrth is a Consultant Orthopaedic Surgeon at the Wellington & Devonshire Hospitals, London and webmaster of www.simonmoyes.com which is the source of this article.