DISSERTATION PROPOSAL
“ A Study to Verify The Bilateral Symmentry Of The Quadriceps (Q) Angle in Normal Healthy Individuals ”
- A comparative study
Submitted By :
SREEJITH M NAMPPOTHIRY
1ST Yr M.P.T. Student
Shridevi College of Physiotherapy,
Sira Road, Lingapur
Tumkur-06
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
KARNATAKA- BANGALORE
ANNEXURE-II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1 / Name of the Students and Address / SREEJITH M NAMPPOTHIRY1ST Yr M.P.T. Student
Shridevi College of Physiotherapy,
Sira Road, Lingapur
Tumkur-06
2 / Name of the Institution / Shridevi College of Physiotherapy,
Sira Road, Lingapur
Tumkur-06
3 / Course and Subject / Master Of Physiotherapy in Musculo-Skeletal Disorders & Sports Physiotherapy
4 / Date of Admission to course / 03/05/2007
5 / Title of the Topic / “ A Study to Verify The Bilateral Symmentry Of The Quadriceps (Q) Angle in Normal Healthy Individuals ”
6. Brief resume of the intended work :
6.1) Need for the study :
Pain in the knee joint is felt by all individuals at least once in their journey of life. Pain in knee joint is a common prevalent problem experienced and complained by all human beings of both sex’s irrespective of their built, profession and age. Knee joint works in tandem with hip joint and ankle joint to support and stalilize the entire body in erect standing positive. Dynamically the knee complex which is largest and complex joint in our body is responsible for moving and supporting the body in locomotor activities of life.
The quadriceps (Q) angle is that angle formed between the vectors for the combined pull of the quadriceps femoris musculative relative to the under lying skeletal structures of pelvis, femur and tibia and the patellar tendon. When measured the knee in extension and forntal plane provides a reasonable estimate of the lateral resultant force vector between the quadriceps muscle group and the patella and tibial tuberosity.
The quadriceps (Q) angle is an important indicator of biomechnanical function on the lower extremity. This measurement reflects the effect of quadriceps mechanism on the knee. When assessed correctly it supplies the most correct and reliable information concerning the alignement of pelvis, leg and foot. The normal Quadriceps (Q) angle for a healthy individuals ranges.
Males 10o - 14o
Females 14o - 17o
The Quadriceps (Q) angle in excess to 150 – 200 in common thought to contribute to knee dysfunction and patello – fermoral pain and frequently cited as an auatomical risk factor in occurrence of chondro malacia patella and patellar subluxation or dislocation.
The Quadriceps (Q) angle measured at higher and of normal range indicates a tendency for added bio-mechanical stress during strenuous or repetitive activities using the knee joint. A high Quadriceps (Q) angle inter with smooth groove over time and especially with sports activites and stair climbing. Thes micro trauma causes patello femoral pain syndrome develops when abnormal tracking continues and causes muscle imbalance eventually leading to wearing away of cartilage on the under side of patella (chondro malacia patella) and degeneration of articular surface of knee (degenerative joint disease).
Research and investigation often report and publish a single quadriceps (Q) angle for each individuals or group studied. This is to be questioned for its limits, the genralizability of the reported data and it implies that quadriceps (Q) angle are bilaterally symmetric an assumption that based evidence available to data is questionable. There fore, the purpose of this study is to verify the bilateral symmetry of the quadriceps (Q) angle (with in subject )
6.2 ) Review of the Literature :
Ø Livingston L et al, ( 1997) Seventy five young adult males (n=36) , females ( n=39) ranging in age from 15- 48 years were studied under three groups (a) Asymptomatic control (b) unilateral knee pain suffers (c) Bilateral knee pain suffers. Quadriceps (Q) angle measured with goniometer found no significant difference in Quadriceps (Q) angle by gender and limb.
Ø Livingston L et al, (1998) , To examine the difference in Quadriceps (Q) angle from side to side within subjects statistically showed quadriceps (Q) angle symmetry.
Ø Shambugh et al, (1998) noted similar bilateral differences in Quadriceps (Q) angle averaging 1.30& 2.70 in a group of non injured vis,. Injured basket ball players respectively.
Ø Buedert R M et al, (2001), The purpose to evaluate the significance of quadriceps (Q) angle with respect to patella position fifty six knee joints of 34 patients (15 bilateral ) with chronic patello femoral pain are prospectively evaluated by the same orthopedic surgeon and Quadriceps (Q) angle measured clinically, long radio graph and axial computed Tomography (CT) scan. In conclusion there is no significant difference between the Quadriceps (Q) angle and patella position.
Ø Bayraletar B et al, (2004) concluded that right and left quadriceps (Q) angles values within both groups were statistically insignificant. He conclude that children and adolescents have greater Quadriceps (Q) angle than adults. A change in Quadriceps strength and tone caused by both growth and actively results in decrease of quadriceps (Q) angle, activity of sports has remarkable change in quadriceps (Q) angle.
Ø Green C C et al, ( 2001) demonstrated that poor inter observer and intra observer reliability of Quadriceps (Q) angle measurement and poor correlation between clinically and radiologically derived quadriceps (Q) angles.
Ø Hvid et al, (1998) concluded that both quadriceps (Q) angle and internal hip rotation was significantly higher in women than in men and was statistically.
Hypothesis
Null Hypothesis :
There is no significant difference between the Quadriceps (Q) angle of right and left lower extremity of the same healthy individual.
6.3) Objectives of Study :
a) To measure the Quadriceps (Q) angle value for an individual in right and left lower exteremity.
b) To verify the bilateral symmetry of Quadriceps (Q) angle within normal healthy individuals.
Material and Methods :
7.1) Source of Data :
The study will conducted from the Normal healthy individuals from the Shridevi College of Physiothrapy and Shridevi College of Nursing, Tumkur.
7.2 ) Method of Collection of Data : ( including sampling procedure if any samples of the study )
This study consist of seventy five volunteers (bilateral knee) normal healthy individuals.
Methods Of Sampling :
The sample will be selected based on purposive sampling method.
Criteria for the Study :
a) Inclusion Criterial :
Only healthy makes subjects
Age group between 20-35 years
Free from any history or signs of disease or injury
b) Exclusion Criteria :
Females
Anterior knee pain suffers
Congenital deformities affecting Quadriceps (Q) angle
Anatomical patella conditions
# Patella Alta
# Patella Baja
Study Design :
It is a comparing bilateral within subject (observation study design )
Materials Used :
1. Universl Goniometer (3600) with large arms made of metal
2. Pen marker
3. Sand bags
4. High Couch
Universal goniometer (3600) remains instrument of choice. The validity, reliability accuracy provided by no significant differences according to Cynthia C norkin, Joyce white- measurement of joint motion.
Procedure :
Quadriceps (Q) angle is measured with subject supine lying position with knee and hip in extension position, were foot in neutral position and quadriceps is relaxed.
All the anatomical land marks are marked with pen marker as follows.
Anterior Superior Iliac Spine (ASIS)
Centre of Patella
Tibial Tubercle
The centre axis of movable long arm of goniometer is to be placed over the centre of patella. The stationery long arm is to be aligned along the patellar tendon to the tibial tuberocity. The movable long arm is taken and pointed directly at the ASIS . The small angel (Quadriceps (Q) angle) measured by the goniometer.
7.3 ) Data Analysis :
1) Mean (X) = x
n
Where X = Sum of right & left lower limb ( in degrees)
n= Number of observations
2) Standard Deviation ()
= x2 – (x)2
n 2
3) t- test between two means
l t l = x1 – x2
S ( 1 + 1 )
n.1 n2
Where , x1 = Mean of First Sample
X2 = Mean of Second Sample
S = n1 S12 + n2S22
.n1+n2-2
*** . n1 and n2 are sample sizes
***. S12 and S22
7.4 : Assessment Procedure :
All the patients will be assessed by using general orthopedic assessment.
7.5) Does the study require any investigation to be conducted on patients.
Yes, This study need to be conducted investigation on seventy five normal healthy individuals to verify the symmentry of the Quadriceps (Q) angle.
7.6) Has ethical clearance been obtained from your institution.
The main study will be conduct after the approval of research committee permission will be obtained from the concerned head of institutions. The purpose and other details fo the study will be explaining to the study subject and will be inform consent obtained from them. Assurance will be given to the study subjects on the confidentially of the data collection from them.
List of Reference :
1. Livingston, Mandegos et al., (Biomedical Science Vol.33, 1997) Bilateral within subject quadriceps (Q) angle symmetry in young adult females and males.
2. L. A Livingston et al., (vol.28, No.2 Aug 1998, JOSPT)- the quadriceps (Q) angle : review of literature.
3. Shambugh et al, (Medical Science Sports Exercises, 23(5), 1991)- structure measures as prediction of injury in basket ball players.
4. Buedert L M et al., (Arch.Orthop Trauma Surg., 2001)- Co-relation between the Q angle and the patella position a clinical and axial computed tomography evaluation.
5. Bayraleta B et al, ( Saudi Med, 2004) –changes of Quadriceps angle values with age and activity.
6. Greene C C et al., ( Amj Knee Surg ; 2001)- Reliability of the Quadriceps angle measurement.
7. Hvid I . et al,. (Acta Ortho. Scand)- The Quadriceps angle and treatment relation to femoral torsion.
8. HSV RW, Himew S et al., (Clinical Ortho, 1990)- Normal axial alignment of the lower extremity and load bearing distribution at knee.