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I'm sure most of you who are Orthopedic Section members recently received your July JOSPT issue by now. Have any of you had a chance to read Treatment of Cuboid Syndrome Secondary to Lateral Ankle Sprains: A Case Series?
I guess I'm still fairly new to this field because I haven't come across this before...at least as the primary diagnosis to treat. Have any of you used the technique they describe in the article to reposition the cuboid? I realize that the study has several limitations, but the outcomes they received were rather impressive.
I'd post the article, but JOSPT hasn't updated their 'feature article'. I'll post it when they decide to do the same. :)
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The cuboid whip is a high force manipulation for a "spun" cuboid, a phenomenon that can occur with severe sprains and also ballet dancers. The American Journal of Sports Medicine once had a good article on the injury, and while I know how to perform the manipulation, I have not had to personally perform.
John Duffy, PT OCS [URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
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John M. Duffy, PT Board Certified Orthopaedic Clinical Specialist www.PTupdate.com
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Duff,
You wouldn't happen to have that article handy would you? The technique the authors portray in the article appears fairly simple and the results they had, from decreased VAS scores to improved functional tasks, make the technique in my humble opinion worthwhile. Again, I realize their results cannot generalize to the population given their sample size, but returning to athletic competition immediately must say something of the effects of the manipulation.
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I have seen this a couple times. I have about a 50% success rate with the manipulation, which I attribute to my insufficient skill and the fact that I just haven't seen it too often. I think this is one of those problems where you could say that it has seen you a lot more than you have seen it, meaning I'm sure I've missed it in the past, not picking it up in the context of the chronic ankle sprain syndrome. J
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Does the symptom pattern with cuboid involvement present differently than with typical ankle sprains? Is is obvious to spot a "spun" cuboid by inspection and palpation of the area? There is an MPEG video of the technique on the Wainner, Flynn, and Whitman manipulation CD-ROM.
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Chris,
I would get you that article, but my sites host company has things really goofed up, and even I can't get into the site now! Hopefully they fix, and I will get you the article.
Duff
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Thanks for the replies.
Treybien,
I believe the article stated that the differential diagnosis can be rather tricky. However, they do state several ways to diff. diagnose for cuboid syndrome. I gotta see that video!
Duff,
Get those IT people in gear man and get me that article! :) At your convenience sir...I apprecaite it.
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I found a decent article [URL=http://hmpcommunications.com/PODTD/displayArticle.cfm?articleID=article3036]How To Treat Cuboid Syndrome In The Athlete[/URL] Here is a excerpt: " While facing the plantar surface of the patient?s foot, place your thumbs on the medial plantar surface of the cuboid with your fingers on the dorsal side. Doing so stabilizes the forefoot. Take care not to place the fingers directly over the cuboid on the dorsal side. Keeping the ankle joint in slight plantarflexion, apply a dorsally directed force to the medial side of the cuboid with a small amplitude, high-velocity thrust (see the photo at left). Often, the athlete experiences complete relief of symptoms with a successful reduction."
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Zack,
Thats very similar to what I do except the patient is in standing with their foot in my hands (Kind of like cleaning a shoe on a horse) and a rocking motion occurs with foot with a quick "Flick". Although I haven't used the technique frequently, I have found it can be quite beneficial in the appropriate circumstances, particularly if reinforced with some tape to hold the mid foot in supination following the manipulation. The difficulty in establishing which patient the technique is appropriate for and again comes back to classification; an ankle sprain could involve the mortise, subtalar joint, cuboid, peronei, osteochondral lesion or neural tissue and not necassarily just the ATFL.
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Well, here's the article for those of you who do not receive the JOSPT. Below the link for the article, you'll find a link to a video of the technique being performed. Very interesting stuff! :)
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Your welcome! I'm just waiting for the right patient to come along so I can crank on their foot! It's probably just me, but that technique looks rather brutal. Slam to the table while plantar flexing the foot. Guess I'm still young! :)
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LOL Greg! You must have seen the video. It appears pretty rough doesn't it? Since I've seen the video and read the article, I have gone back and re-checked my ankle folks for cuboid dysfunction. Luckily for them, they were all clear. I was ready to jerk the hell out of their feet. :)
Actually, I did come across one of my patients who had some pain at his cuboid, but all the tests showed no signs of cuboid syndrome. Compared to his left, his right was a little hypomobile and I tried the 'whip' in a small range and with less force. I re-tested and it moved much better and comparable to the left.
It just goes to show that cavitation isn't always necessary to restore normal arthrokinematics. :)
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Reminds me of when I'm trying to straighten out a kinked hose in my driveway while I'm washing the car...YANK!
Seems like it would darn near dislocate the hip. Tell you what, it would make a great technique for unlocking locked knees due to osteochondral fragments...YANK! Knee moving.
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That sounds like a good idea Greg. When I tore my medial meniscus (I posted this a LOONG time ago) I remember my dog bringing me her ball. My knee was still very locked up and I couldn't get it into full extension because of the meniscus sitting in the intercondylar notch. Well, without even thinking I kicked the hell out of the ball and SNAP! My knee regained full motion again.
I guess with the kicking motion combined with a little tibia/femoral distraction the meniscus slipped back to where it should be. Man...the relief was immediate and my gait was back to normal (whatever normal is). A week or so later, I was up in my attic with my father-in-law and I bent down too far and POP...back the meniscus went into stuck-dom (that's a Chris-ism). Surgery soon followed. :)
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