Lower Limb Asymmetry Research Articles

Lower Limb Asymmetry Evaluation Using the Balance Tracking System (BTrackS) Single Leg Stance Protocol

Single Leg Stance (SLS) balance testing is a common means of determining lower limb asymmetries in motor behavior. The Balance Tracking System (BTrackS) Balance Plate is a low-cost, portable force plate for objectively obtaining balance measurements. The present study provides the first known balance results for the BTrackS SLS protocol. BTrackS SLS testing was conducted on 161 young adults (90 women, 71 men) according to the test’s standardized instructions. Specifically, participants performed one-legged (left or right) stance on the BTrackS Balance Plate for four, (2 practice, 2 actual) 20 s trials. SLS test outputs included total Center of Pressure path length and absolute symmetry index. Results showed that women had better SLS performance than men and that both sexes performed better on the actual compared to practice trial. Systematic one-sample t-tests of the Absolute Symmetry Index measures showed that a difference of 16% or greater between legs represented asymmetric performance. These results have clear value for individuals using BTrackS SLS testing to evaluate potential asymmetries. Additionally, these findings agree with previous reports showing sex differences favoring women on tests of static balance, and validate the use of a practice trial in the BTrackS SLS protocol.

Lower Extremity Kinematic Waveform Analysis During a Single Leg Drop Task - Including a Single Subject Design.

Lower limb asymmetries may be associated with increased injury risk in an active female population. However, an appropriate method for determining these asymmetries has not been established. The purpose of the present study was to examine the single leg drop landing (SLD) kinematic waveforms of female recreational athletes for the pelvis, hip, and knee using statistical parametric mapping (SPM). It was hypothesized that individual bilateral differences would be masked by the group analysis. Descriptive Laboratory Study. The current study examined the sagittal and frontal plane pelvis, hip, and knee kinematics of nine physically active females during a SLD. To better elucidate whether asymmetries were present between right and left limbs throughout the landing phase, data were analyzed with SPM. The time-series data were comprised from initial contact to the bottom of the landing. A single subject design was also included to account for potential interindividual variability. At the group level there were no statistical differences between the right and left limbs of participants for all variables. The single subject design yielded at least two significant asymmetries for all participants. Six out of the nine participants had bilateral differences for all six kinematic time-series. The lack of significant differences at the group level may have been masked by movement variability amongst participants. For example, when considering participants with significant differences for hip flexion, four participants had greater values on the left limb and three on the right. A similar observation was made for knee flexion where three participants had significantly greater kinematic values on the left versus four on the right. Until a method is developed to adequately dichotomize lower extremities during the SLD task, a single subject design strategy be used with group analysis when making bilateral comparisons. 3.

Relationship between Asymmetries and Functional Autonomy in Older Chilean Adults.

The objectives of this study were: (a) to determine asymmetries, both lower limb (LL) and upper limb (UL), in Chilean older adults, and (b) to relate asymmetries to FA in both LL and UL. Forty-one older adults voluntarily participated in this study (mean ± standard deviation [SD]: age 72.0 ± 8.0 years, LL asymmetries 13.78 ± 14.87%, UL asymmetries 10.70 ± 8.85%, FA 40.35 ± 16.26 points). The variables were: (1) asymmetries of LL and UL, assessed through a force platform and handgrip, respectively; (2) FA, assessed through the Latin American Group for Maturity (GDLAM) and the GDLAM index of autonomy (GI) protocol. The relationship between the variables was performed through Spearman's correlation. The analysis showed that 39% of the participants presented asymmetries above 15% in the LL. Likewise, this 39% of older adults presented a lower FA than their peers with asymmetries below 15% in the LL (≤15%: 35.64 ± 12.26 points vs. >15%: 47.69 ± 19.23 points, p = 0.003). The analysis showed a small correlation between LL and GI asymmetries (r = 0.27, p = 0.07) and a small but negative correlation between UL and GI (r = -0.21). The mean values of asymmetries of both LL and UL are within 'normal' parameters. However, several older adults were identified as being at risk. In parallel, older adults who presented a higher level of asymmetries in LL showed a lower level of FA.

The presence of a previous lower limb injury does not affect step asymmetry in elite basketball players: A prospective, longitudinal observational study

ABSTRACT This study investigates whether the presence of a previous lower limb injury influences “Lower limb asymmetry” (LLA) in elite basketball players. A prospective, longitudinal observational study was carried out with 13 players grouped based on lower limb injury history in the 3 months prior to the study (Injury = 7, non-injured = 6). A total of 68 measurements per player were collected over 3 months, using the “Inertial Measurement Unit (IMU)” device. The mean difference in, (i) % of step balance; (ii) the average of the number of impacts performed per minute during training and (iii) the player’s load was assessed. This intensive evaluation is in line with the assessment methodology proposed in the field of sports injury. Our results show no significant differences (p = 0.377) in the asymmetry of the step balance between players with/without a history of injury. However, there were differences when the player’s position was considered (p = 0.046). These findings confirm that the presence of a previous lower limb injury does not influence the asymmetry in lower limb step balance in male basketball players. For clinicians, the variables studied offer an indirect measurement of any capacity and/or deficit in the absorption of lower limb loads after an injury.

Agreement Between Isokinetic Dynamometer and Hand-held Isometric Dynamometer as Measures to Detect Lower Limb Asymmetry in Muscle Torque After Anterior Cruciate Ligament Reconstruction.

Two commonly used instruments to assess muscle strength after anterior cruciate ligament reconstruction are the isokinetic dynamometer, which measures isokinetic torque and the hand-held dynamometer, which measures isometric torque. Isokinetic dynamometers are considered superior to other instruments but may not be commonly used in clinical settings. Hand-held dynamometers are small, portable, and more clinically applicable devices. The purpose of this study was to assess agreement between a hand-held dynamometer and an isokinetic dynamometer, used to assess lower limb symmetry in knee muscle torque one year after anterior cruciate ligament (ACL) reconstruction. Cross-sectional measurement study. Seventy-two participants who had undergone ACL reconstruction (35 men, 37 women; age= 25.8 ± 5.4 years) were included. Isokinetic muscle torque in knee flexion and extension was measured with an isokinetic dynamometer. Isometric flexion and extension knee muscle torque was measured with a hand-held dynamometer. Bland & Altman plots and Cohen's Kappa coefficient were used to assess agreement between measurements obtained from the instruments. Bland & Altman plots showed wide limits of agreement between the instruments for both flexion and extension limb symmetry index. Cohen´s Kappa coefficient revealed a poor to slight agreement between the extension limb symmetry index values (0.136) and a fair agreement for flexion limb symmetry index values (0.236). Cross-tabulations showed that the hand-held dynamometer detected a significantly larger number of participants with abnormal flexion torque limb symmetry index compared to the isokinetic dynamometer. The wide limits of agreements and Cohen's Kappa coefficients values revealed insufficient agreement between the measurements taken with the two instruments, indicating that the instruments should not be used interchangeably. The hand-held dynamometer was more sensitive in detecting abnormal limb symmetry index in flexion torque, which promotes the option of use of hand-held dynamometers to detect differences between the injured and uninjured leg after ACL reconstruction. 3b.

Running Velocity and Longitudinal Bending Stiffness Influence the Asymmetry of Kinematic Variables of the Lower Limb Joints.

Running-related limb asymmetries suggest specific sports injuries and recovery circumstances. It is debatable if running speed affected asymmetry, and more research is required to determine how longitudinal bending stiffness (LBS) affected asymmetry. The purpose of this study was to investigate the influence of running velocity and LBS on kinematic characteristics of the hip, knee, ankle, metatarsophalangeal joint (MTP) and the corresponding asymmetry. Kinematic (200 Hz) running stance phase data were collected bilaterally for 16 healthy male recreational runners (age: 23.13 ± 1.17, height: 175.2 ± 1.6 cm, body mass: 75.7 ± 3.6 kg, BMI: 24.7 ± 1.3 kg/m2) running on a force plate at three different velocities (10, 12 and 14 km/h) and three increasing-LBS shoes in a randomized order. The symmetry angle (SA) was calculated to quantify gait asymmetry magnitude at each running velocity and LBS. Changes in running velocity and LBS led to differences in kinematic variables between the hip, knee, ankle and MTP (p < 0.05). Significant changes in SA caused by running velocity were found in the knee flexion angle (p = 0.001) and flexion angle peak velocity (p < 0.001), ankle plantarflexion angle (p = 0.001) and plantarflexion angle peak velocity (p = 0.043) and MTP dorsiflexion angle (p = 0.001) and dorsiflexion angle peak velocity (p = 0.019). A significant change in the SA caused by LBS was found in the MTP dorsiflexion peak angle velocity (p = 0.014). There were interaction effects between running velocity and LBS on the MTP plantarflexion angle (p = 0.033) and plantarflexion angle peak velocity (p = 0.038). These findings indicate the existence of bilateral lower limb asymmetry. Meanwhile, it was proved that running velocity and LBS can influence the asymmetry of lower limb joints. Additionally, there was an interaction between running velocity and LBS on the asymmetry of the lower limb. These findings can provide some information for sports injuries, such as metatarsal stress fractures and anterior cruciate ligament injuries. They can also provide some useful information for running velocities and running shoes.

Increased Asymmetry of Lower Limbs and Leading Joint Angles during Crossing Obstacles in Healthy Male with Cold Exposure

Lower ambient temperatures impair neuromuscular function and balance. However, whether lower ambient temperatures could alter joint angles and symmetry of lower limbs during crossing obstacles in males still remains unknown. Therefore, we investigated whether there is reduction of ambient temperature (20°C; 15°C; 10°C) on lower limbs joint angles and symmetry when crossing obstacles in males. On three different occasions, eighteen male participants underwent 30 min exposure to three different environmental temperatures (10°C, 15°C, and 20°C), which was followed by the obstacle crossing test at 10%, 20%, and 30% of the participant leg length. In each trial, we assessed joint angles and symmetry of lower limbs when crossing obstacles at 10%, 20%, and 30% of the participants' leg length. The results showed that leading limb maximum joint angles were greater in 10°C than in 15°C and 20°C when leading limb crossed obstacle heights of 20% and 30% leg length (p < 0.05). Trailing limb maximum joint angles were not different (p > 0.05). Lower limb asymmetry increased when participants crossed obstacle heights of 20% and 30% leg length at 10°C (p < 0.05). This study concluded that in male participants, cold exposure can increase lower limb asymmetry to increase falling risk when crossing obstacles. Also, the increased leading limb joint angles and constant trailing limb joint angles increase safety during crossing obstacles.

Lower Limb Ground Reaction Force and Center of Pressure Asymmetry During Bodyweight Squats.

BackgroundPerformance asymmetries between the lower limbs have been reported across a variety of variables and for numerous motor tasks including double leg squats. Additionally, the degree of symmetry is often used as a recovery metric during rehabilitation programs.Hypothesis/PurposeThe purpose of this investigation was to examine leg asymmetry during a bodyweight double leg squat task and assess the effects of squat speed in a physically active population.Study DesignCross-over Study Design.MethodsEighteen healthy individuals completed two sets of 20 squats at two tempos (preferred tempo and 60 bpm) while ground reaction force and center of pressure data were recorded using dual force plates. Peak vertical ground reaction force, force impulse, and center of pressure (COP) standard deviation in the anterior-posterior (AP) and mediolateral (ML) direction were calculated and analyzed to identify any differences between legs, tempo, and as a function of repetitions. Significance was set at ρ ≤ .05.ResultsThe subjects exhibited greater ground reaction forces during the self-paced tempo compared to the metronome-paced tempo (F1,79 = 14.48, p < .001) with the preferred leg generating larger values than the non-preferred leg during the self-paced condition. There was also a significant tempo x leg interaction for force impulse (F1,79 = 5.927, p = 0.015). A greater amount of COP variability was found in the preferred leg compared to the non-preferred leg in both the AP (F1,79 = 30.147, p < 0.001) and ML (F1,79 = 41.204, p < 0.001) directions.ConclusionsThese findings highlight the importance of considering multiple levels of analysis when assessing lower limb symmetry as separate variables may provide differential evidence for asymmetry. Practically, these results emphasize the need for coaches and practitioners to consider different degrees of lower limb asymmetries that may impact the development and design of strength and rehabilitation programs.Level of Evidence3

Lower Limb´S Lateral And Functional Asymmetries And Mechanical Performance In Professional Soccer Players

PURPOSE: As reported in the medical literature, lateral asymmetries (LA) in sports may lead to overload injuries and reduction in performance. Even a lateral asymmetry of ten percent can lead to structural and functional conditions which may precipitate sub-optimal performance or increase the risk of overload injuries. The aim of this study was to explore the influence of lateral lower extremity asymmetries in both functional and mechanical performance METHODS: We evaluated the lower limb LA of sixty-four Costa Rican professional soccer players (age 20 ± 4.3 years, weight 70.9 ± 7.3 kg, height 174.6 ± 4.9 cm, fat 13.9 ± 5 %). LA in lean mass (LM; kg), time of contraction (Tc) and muscle displacement (Dm) of both right and left lower limbs were evaluated. Anthropometry was measured using dual X-ray absorptiometry. Functional performance was assessed through countermovement jump (CMJ) and squat jump (SJ) using a force platform and mechanical performance was assessed measuring rectus femoris Tc and Dm using a tensiomyography. Pearson correlations between LA and CMJ, SJ, Tc and Dm were performed. Significance was previously set at p < 0.05. Lateral asymmetry was calculated as follows: [(higher score- lower score) / higher score) x100]; considering a 10% difference as significant asymmetry. RESULTS: There were no significant correlations between LA and CMJ (LA-LM, p = 0.44; LA-Tc, p = 0.46; LA-Dm, p = 0.88), SJ (LA-LM, p = 0.81; LA-Tc, p = 0.99; LA-Dm, p = 0.97), R-Tc (LA-LM, p = 0.22; LA-Tc, p = 0.43; LA-Dm, p = 0.67), L-Tc (LA-LM, p = 0.323; LA-Tc, p = 0.897; LA-Dm, p = 0.528), R-Dm (LA-LM, p = 0.76; LA-Tc, p = 0.612) or L-Dm (LA-LM, p = 0.195; LA-Tc, p = 0.56; LA-Dm, p = 0.284). CONCLUSIONS: Lateral asymmetries in lower limbs do not appear to exert a positive or negative influence on functional or mechanical performance in Costa Rican soccer players.

Asymmetry In Single Leg Vertical Countermovement Hop Kinematics In Collegiate Female Soccer Players

Multidirectional sports such as soccer have a high incidence rate of anterior cruciate ligament injury. Asymmetries between limb have been linked to such non-contact injuries, thereby outlining the importance of screening measures that may identify at-risk groups. Specifically, tasks such as a vertical single leg countermovement (SLC) jump can provide an objective measure of frontal and sagittal plane asymmetries. PURPOSE: To identify lower limb asymmetries during a SLC jump. METHODS: 25 collegiate female soccer players (height: 167.4 ± 6.0 cm, mass: 67.16 ± 6.6 kg) completed 3 maximum SLC jumps on each limb. The side with the highest average jump height was defined as the high performance (HP) side and compared to the low performance side (LP). An 8 camera markerless motion capture system was utilized to analyze kinematic data at peak knee flexion during both the takeoff (TO) and landing (LN) phase using advanced machine learning. Force platforms measured the peak takeoff and landing vertical ground reaction force (GRF). A two-factor repeated measures ANOVA (p < 0.05) was used to determine differences between side (HP, LP) and phase (TO, LN) during the SLC task. RESULTS: 52% of the players had greater jump performance on their preferred kicking side. A main effect of side (p = 0.035) and phase (p < 0.001) was found for knee flexion (HP: TO 67.2 ± 7.2°, LN 60.5 ± 10.8°; LP: TO 65.0 ± 6.5°, LN 58.8 ± 7.2°). Likewise, a main effect of side (p < 0.001) and phase (p < 0.001) was found for GRF (HP: TO 1373 ± 236 N, LN 2238 ± 435 N; LP: TO 1341 ± 224 N, LN 2088 ± 280 N). A phase main effect was found for both hip flexion (p = 0.002) (HP: TO 49.8 ± 10.9°, LN 42.5 ± 11.9°; LP: TO 50.8 ± 10.1°, LN 41.0 ± 12.8°) and adduction (p = <0.001) (HP: TO 8.1 ± 4.4°, LN 5.5 ± 4.9°; LP: TO 8.7 ± 3.8°, LN 5.1 ± 5.7°). Significant main effects were not present for knee abduction (p > 0.05). CONCLUSIONS: Collegiate female soccer players demonstrate greater knee and hip flexion and hip adduction occur during the take-off phase of the single leg vertical jump compared to the landing phase. Additionally, the leg with greater performance has increased knee flexion during both take-off and landing which corresponds to greater peak force. These identified asymmetries between phase and limb could be considered important factors in monitoring potentially at-risk populations.

Evaluating a Wearable Solution for Measuring Lower Extremity Asymmetry During Landing.

Force plates can be used to monitor landing asymmetries during rehabilitation, but they are not widely available. Accelerometer-based wearable technology may be a more feasible solution. The purpose of this article was to determine the agreement between impact accelerations measured with force plates and accelerometer-derived measures of (1) centre of mass (COM) acceleration and (2) tibial acceleration asymmetries during bilateral landings. Participants completed three countermovement jumps (CMJ) and three squat jumps (SJ) on dual force plates with triaxial accelerometers attached to each tibia and lower back, near the COM. Bland and Altman 95% limits of agreement (95% LOA) were calculated. 19 adults (n = 11; 58% women, n = 8; 42% men) participated in the study. The mean differences between impact and COM accelerations were 0.24 g (95% LOA: -1.34 g to 1.82 g) and 0.38 g (95% LOA: -1.15 to 1.91 g) for the CMJ and SJ, respectively. The mean differences between the impact and tibial acceleration-based lower limb asymmetries in the CMJ and SJ were -6% (95% LOA: -32% to 19%) and 0% (95% LOA: -45% to 45%), respectively. Our findings show acceptable agreement between impact acceleration and accelerometer-based COM acceleration and lack of agreement between impact accelerations and accelerometer-based tibial acceleration asymmetries. COM acceleration could be used to quantify landing impacts during rehabilitation, but we do not consider the accelerometer-based asymmetry measures to be a suitable alternative for force plate-based measures. Future work should focus on determining normative values for lower extremity asymmetries during landing tasks.

Effects of 8-Week In-Season Contrast Strength Training Program on Measures of Athletic Performance and Lower-Limb Asymmetry in Male Youth Volleyball Players.

Strength training using high and lower load such as contrast training (CST) seems to be beneficial as it addresses larger adaptive reserves in youth athletes. Therefore, the aim of this study was to investigate the effects of CST on dynamic balance (composite score during dynamic balance test (CS-YBT)), one repetition maximum lower-limb back squat (1RM), jumping performance (single-leg hop (SLH) or countermovement jump height (CMJ)), lower-limb asymmetry (predicted from the single-leg jump performance between two legs [ILA]) in elite youth male volleyball players. Thirty-one male youth volleyball players aged 14 years were randomly assigned to a CST group (n = 16) or a control group (n = 15). The tests were performed before and after 8 weeks of training. Significant group × time interactions was observed for CS-YBT [p < 0.001, ηp2 = 0.70], 1RM [p < 0.001, ηp2 = 0.95], SLH with right and left leg [p < 0.001, ηp2 = 0.69 and 0.51], CMJ [p < 0.001, ηp2 = 0.47]), whilst it was not notable in ILA [p < 0.294]. Post hoc tests showed that CST group demonstrated greater improvement in all of the dependent variables from medium to large effect size (for all p < 0.001). As a result, 8 weeks of CST twice a week can be an effective and efficient training along with volleyball training to improve skill-related fitness measures, except for lower-limb asymmetry in young volleyball players.

Individualized Analysis of Lateral Asymmetry Using Hip-Knee Angular Measures in Soccer Players: A New Methodological Perspective of Assessment for Lower Limb Asymmetry.

This study aimed to: (1) determine the magnitude and direction of lateral asymmetry in well-trained soccer players using hip and knee ROM tests; (2) inquire if asymmetry relies on the ROM test performed and/or gender; and (3) establish asymmetry thresholds for each ROM test to individualize lower-limbs asymmetry. One hundred amateur soccer players were assessed using hip–knee ROM tests: Straight Leg Raise, modified Thomas Test, hip internal rotation and external rotation, hip abduction (ABD) and adduction (ADD), Nachlas Test and Rigde Test. There are significant differences between tests when determining the magnitude of lateral asymmetry (F = 3.451; p = 0.001; ηp2 = 0.031) without significant differences between gender (F = 0.204; p = 0.651; ηp2 = 0.001). Asymmetry threshold results differ significantly between using a fixed or a specific threshold (F = 65.966; p = 0.001; ηp2 = 0.985). All tests indicate that the direction of asymmetry is towards the dominant limb. In conclusion, the ROM test used determines the magnitude and direction of the lateral asymmetry of the amateur soccer players. The ABD and ADD are the ROM tests that showed higher percentages of asymmetry, without differences between female and male soccer players. Using a specific asymmetry threshold formula can classify more players as asymmetrical than with a fixed threshold.

A Study on Lower Limb Asymmetries in Parkinson's Disease during Gait Assessed through Kinematic-Derived Parameters.

Unilaterality of motor symptoms is a distinctive feature of Parkinson’s Disease (PD) and represents an important co-factor involved in motor deficits and limitations of functional abilities including postural instability and asymmetrical gait. In recent times, an increasing number of studies focused on the characterization of such alterations, which have been associated with increased metabolic cost and risk of falls and may severely compromise their quality of life. Although a large number of studies investigated the gait alterations in people with PD (pwPD), few focused on kinematic parameters and even less investigated interlimb asymmetry under a kinematic point of view. This retrospective study aimed to characterize such aspects in a cohort of 61 pwPD (aged 68.9 ± 9.3 years) and 47 unaffected individuals age- and sex-matched (66.0 ± 8.3 years), by means of computerized 3D gait analysis performed using an optical motion-capture system. The angular trends at hip, knee and ankle joints of pwPD during the gait cycle were extracted and compared with those of unaffected individuals on a point-by-point basis. Interlimb asymmetry was assessed using angle–angle diagrams (cyclograms); in particular, we analyzed area, orientation, trend symmetry and range offset. The results showed that pwPD are characterized by a modified gait pattern particularly at the terminal stance/early swing phase of the gait cycle. Significant alterations of interlimb coordination were detected at the ankle joint (cyclogram orientation and trend symmetry) and at the hip joint (range offset). Such findings might be useful in clinical routine to characterize asymmetry during gait and thus support physicians in the early diagnosis and in the evaluation of the disease progression.

Bilateral lower limb asymmetry characteristics of female amateur high school football players

Bilateral lower limb asymmetry characteristics of female amateur high school football players

Effects of arm swing amplitude and lower limb asymmetry on motor variability patterns during treadmill gait

Motor variability is a fundamental feature of gait. Altered arm swing and lower limb asymmetry (LLA) may be contributing factors having been shown to affect the magnitude and dynamics of variability in spatiotemporal and trunk motion. However, the effects on lower limb joints remain unclear.Full-body kinematics of 15 healthy young adults were recorded during treadmill walking using the Computer-Assisted Rehabilitation Environment system. Participants completed six trials, combining three arm swing (AS) amplitude (normal, active, held) and two LLA (symmetrical, asymmetrical) conditions. The mean standard deviation (meanSD), maximum Lyapunov exponent (λmax), detrended fluctuation analysis scaling exponent of range of motion (DFAα), and sample entropy (SaEn) were computed for tridimensional trunk, pelvis, and lower limb joint angles, and compared using repeated-measures ANOVAs.Relative to normal AS, active AS increased meanSD of all joint angles, λmax of frontal plane hip and ankle angles, and SaEn of sagittal plane ankle angles. Active AS, however, did not affect λmax or SaEn of trunk or pelvis angles. LLA increased meanSD of sagittal plane joint angles, λmax of Euclidean norm trunk angle and of lower limb joint angles, and SaEn of ankle dorsiflexion/ plantarflexion, but decreased SaEn of tridimensional trunk angles and hip rotation in the slower moving leg.Alterations in lower limb variability with active AS and LLA suggest that young adults actively exploit their lower limb redundancies to maintain gait. This appears to preserve trunk stability and regularity during active AS but not during LLA.

NEW GENES AND DISEASES: EP.304 Early onset lower limp assymmetry: a new clinical phenotype of calsequestrin mutation

Calsequestrin is a protein that handles calcium in sarcoplasmic reticulum (SR),Ca2+ transients are crucial in skeletal muscle excitation-contraction coupling. Synchronous Ca2+ release from the SR terminal cisternae into the cytoplasm and its reuptake into the SR store are granted by a structural and functional unit and their defect causes myopathy. In an 11-year-old girl, affected by lower limb asymmetry (R limb shorter of 3 cm), upper limb hypotrophy and winging scapulae were found; she had high CK:2900 U/l, her sister presented myalgias and CK:1500 U/l, the mother CK 500 U/l and grandmother had both congenital club foot. We investigated the causes of the high CK by EMG that was myopathic, muscle biopsy that showed few atrophic fibres, in ATPase rare 2C fibres, some increased NADH-TR stain at the periphery, increased central nuclei and rare basophilic fibres. We performed immunohistochemistry for dystrophin, caveolin-3, alpha-sarcoglycan, western blot for dysferlin: all normal. The girl was operated at 15 years for elongation of right femur and by epiphysiodesis left femur and the limb asymmetry was reduced to only half a centimeter: however she complained of fatiguability, especially after physical education at school, and high CK (2186 U). She presented with scoliosis, difficulty walking with calf hypertrophy. A search for the causes for hyperCKemia was done with WGS at TIGEM and resulted in detection of a pathogenetic variant of CASQ1 gene (p.ASP244Gly), coding for calsequestrin, which allowed the solution of this puzzling familial case. In 7 members of 4 Italian families with vacuolar myopathy with CASQ1 mutation calsequestrin aggregates and a similar variant was found. In CASQ1 myopathy in several cases hyperCKemia, myalgia or other vague symptoms are present: in 22 CASQ1-mutated patients from 12 families 21 sharing the same variant of our case presented symptoms in the sixth decade with exercise intolerance and myalgias and later developed mild to moderate, slowly progressive proximal weakness with quadriceps atrophy and scapular winging. In the present family, clubfoot, early onset, limb asymmetry were the predominant clinical symptoms, they could be the effect of somatic mosaicism. In this respect our patient presents an early onset and a new clinical phenotype of lower limb asymmetry that is unique. The present familial case expands the clinical phenotype of CASQ1-myopathy.

The prevalence and clinical features of pulmonary embolism in patients with AE-COPD: A meta-analysis and systematic review.

BackgroundThe prevalence of pulmonary embolism (PE) in the acute exacerbation of chronic obstructive pulmonary disease (AE-COPD) is highly controversial. We conducted a systematic review and meta-analysis to summarize the epidemiology and characteristics of PE with AE-COPD for current studies.MethodsWe searched the PubMed, EMBASE, Cochrane Library and Web of Science databases for studies published prior to October 21, 2020. Pooled proportions with 95% confidence intervals (95% CIs) were calculated using a random effects model. Odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals were used as effect measures for dichotomous and continuous variables, respectively.ResultsA total of 17 studies involving 3170 patients were included. The prevalence of PE and deep vein thrombosis (DVT) in AE-COPD patients was 17.2% (95% CI: 13.4%-21.3%) and 7.1% (95% CI: 3.7%-11.4%%), respectively. Dyspnea (OR = 6.77, 95% CI: 1.97–23.22), pleuritic chest pain (OR = 3.25, 95% CI: 2.06–5.12), lower limb asymmetry or edema (OR = 2.46, 95% CI:1.51–4.00), higher heart rates (MD = 20.51, 95% CI: 4.95–36.08), longer hospital stays (MD = 3.66, 95% CI: 3.01–4.31) were associated with the PE in the AE-COPD patients. Levels of D-dimer (MD = 1.51, 95% CI: 0.80–2.23), WBC counts (MD = 1.42, 95% CI: 0.14–2.70) were significantly higher and levels of PaO2 was lower (MD = -17.20, 95% CI: -33.94- -0.45, P<0.05) in the AE-COPD with PE group. The AE-COPD with PE group had increased risk of fatal outcome than the AE-COPD group (OR = 2.23, 95% CI: 1.43–3.50).ConclusionsThe prevalence of PE during AE-COPD varies considerably among the studies. AE-COPD patients with PE experienced an increased risk of death, especially among the ICU patients. Understanding the potential risk factors for PE may help clinicians identify AE-COPD patients at increased risk of PE.Prospero registration numberCRD42021226568.

Bioelectrical impedance analysis as a means of quantifying upper and lower limb asymmetry in youth elite tennis players: An explorative study

ABSTRACT This study aimed to examine side-to-side differences in phase angle (PhA) in both upper and lower limbs of youth elite tennis players. Among other outcomes, PhA was directly determined using segmental multifrequency bioelectrical impedance analysis (BIA) in 26 tennis players (11.6 ± 1.1 years, 54% boys) and compared against a sex- and age-matched reference population. Significant upper limb asymmetry in PhA (p < 0.001), with a higher value on the dominant side of the body, was observed in the tennis players. At lower limb level, the tennis players showed a tendency towards a significantly higher PhA in the contralateral compared to the ipsilateral limb (p = 0.089). Using vector analysis (BIVA), a significant degree of PhA asymmetry (p = 0.002) was only reflected in the tennis players’ upper limb. Additional segmental outcomes also demonstrated a significant degree of upper limb asymmetry in terms of tennis players’ lean mass (p < 0.001), total segmental water (p < 0.001), fat mass (p < 0.001), extracellular water (p < 0.001) and extracellular water ratio (p < 0.001), whereas lower limb asymmetry was only observed in tennis players’ fat mass (p = 0.037) and extracellular water (p = 0.001). This is the first study to report significantly more pronounced BIA-based side-to-side differences in youth elite tennis players compared to a non-athletic reference population at the upper limb level, whereas no significant between-group differences in the lower limbs were found. This explorative study should trigger future research to further scrutinize the role of BI(V)A as a promising field-method in monitoring bodily asymmetries in youth elite tennis players in view of sport performance and athletic health. Highlights Bioelectrical Impedance Analysis is a promising field-method to monitor side-to-side asymmetry in youth elite tennis players. Youth elite tennis players displayed a more pronounced degree of BIA-based side-to-side differences compared to a non-athletic reference population at the upper limb level, whereas whilst between-group differences appeared to be less evident in the lower limbs. Future research is warranted to scrutinize whether and to what extent these degrees of segmental bodily asymmetry may be related to injury risk (prevention) and athletic development of (pre)adolescent tennis players.

Comparison of Different Functional Tests for Leg Power and Normative Bilateral Asymmetry Index in Healthy Collegiate Athletes.

BackgroundBilateral leg power is being increasingly investigated as a proxy for the recovery of muscle performance after injury. Functional tests like the single leg hop for distance (SLHD) and single leg vertical jump (SLVJ) are often used to determine symmetry and return to play (RTP) readiness. As an injury predictor, leg power is accurately measured with the Keiser Air420 seated leg press.PurposeTo measure and analyze lower leg asymmetry in healthy collegiate athletes across each test battery.MethodsEighty-eight healthy student-athletes (44 males, 44 females) across 14 varsity teams at Wake Forest University performed the SLHD, SLVJ, and the Keiser. Horizontal and vertical displacement were measured via the SLHD and SLVJ, respectively. Peak power was recorded via the Keiser Air420 leg press. Pearson correlations and repeated measures ANOVA were used to calculate associations and compare bilateral asymmetry indices (BAI) and raw scores.ResultsThere was a significant effect on each test’s raw BAI (P < 0.01). The mean absolute BAI were 5.42 ± 4.9%, 6.64 ± 4.9% and 5.36 ± 4.7% for the SLHD, SLVJ and Keiser, respectively. The SLVJ and Keiser (dominant leg r = 0.832, nondominant leg r = 0.826) were more highly correlated than the SLHD and Keiser (dominant leg r = 0.645, nondominant leg r = 0.687), all of which were statistically significant (P < 0.01).ConclusionAt the 90th percentile, healthy collegiate athletes attained <15% BAI. We recommend the implementation of a battery of tests to determine normative lower limb asymmetry. A battery of functional tests may present different asymmetry indices as opposed the 10% reference asymmetry.