Sudden cardiac arrest in athletic medicine.
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Cardiopulmonary Resuscitation↗
Biomedical subjects
G C Terry
Publications and source records attributed to G C Terry.
Functional anatomy of the shoulder.
OBJECTIVE: Movements of the human shoulder represent the result of a complex dynamic interplay of structural bony anatomy and biomechanics, static ligamentous and tendinous restraints, and dynamic muscle forces. Injury to 1 or more of these components through overuse or acute trauma disrupts this complex interrelationship and places the shoulder at increased risk. A thorough understanding of the functional anatomy of the shoulder provides the clinician with a foundation for caring for athletes with shoulder injuries. DATA SOURCES: We searched MEDLINE for the years 1980 to 1999, using the key words "shoulder," "anatomy," "glenohumeral joint," "acromioclavicular joint," "sternoclavicular joint," "scapulothoracic joint," and "rotator cuff." DATA SYNTHESIS: We examine human shoulder movement by breaking it down into its structural static and dynamic components. Bony anatomy, including the humerus, scapula, and clavicle, is described, along with the associated articulations, providing the clinician with the structural foundation for understanding how the static ligamentous and dynamic muscle forces exert their effects. Commonly encountered athletic injuries are discussed from an anatomical standpoint. CONCLUSIONS/RECOMMENDATIONS: Shoulder injuries represent a significant proportion of athletic injuries seen by the medical provider. A functional understanding of the dynamic interplay of biomechanical forces around the shoulder girdle is necessary and allows for a more structured approach to the treatment of an athlete with a shoulder injury.
Journal Article↗
Reliability of the clinical assessment in predicting the cause of internal derangements of the knee.
The reliability of the clinical assessment, which comprised history, physical examination, and plain radiographs, was determined by comparing the initial preoperative diagnosis with the postoperative diagnosis as determined arthroscopically, and by comparing the results of the clinical evaluation with published reports of arthrography, computed tomography (CT), and magnetic resonance imaging (MRI). The study group included 206 patients (216 knees) scheduled for arthroscopic surgery for suspected internal derangements. The primary preoperative clinical diagnosis was correct in 175 knees (81%), with an overall accuracy of 93%, sensitivity of 89%, and specificity of 94%. The most common preoperative diagnoses were medial and lateral meniscal tears. Results of the clinical assessment were comparable or superior to published reports of arthrography, CT, and MRI. Thus, it may be unnecessary to routinely use these costly special studies to determine the need for arthroscopic surgery. We conclude that a thorough clinical assessment can provide sufficient information for the surgeon to make a definitive primary preoperative diagnosis, and that arthroscopy should not be performed without first completing a complete preoperative examination.
Adolescent↗
Distal femoral osteotomy for valgus deformity of the knee.
Distal femoral varus osteotomy and blade-plate fixation for valgus deformity of the knee proved effective in restoring axial alignment in 18 of 36 knees (34 patients). Patients were followed for an average of 5.4 years (range: 2 to 19 years). The osteotomies were performed on 14 men and 22 women (average age: 44 years; range: 14 to 77). The patients' average preoperative valgus deformity of the anatomical axis was 19.4 degrees (range: 8 degrees to 33 degrees). The surgical procedures performed were a medial closing wedge osteotomy (14 knees) and a lateral opening wedge osteotomy with bone grafting (22 knees). Postoperative correction of the anatomical axis averaged 3.8 degrees valgus (range: 8 degrees varus to 20 degrees valgus). Maximum improvement was reached within 6.3 months by patients who were less than 60 years old and within 5.1 months by patients who were more than 60 years old. Pain decreased or resolved in 21 of 35 knees (60%); activity level improved in 24 of 35 knees (69%). One patient was unavailable for follow up evaluation. Varus osteotomy in the distal femur was concluded to be an acceptable form of treatment in the valgus knee alone or associated with traumatic or osteoarthritis of the lateral compartment.
Adolescent↗
Accuracy of clinical isometry and preload testing during anterior cruciate ligament reconstruction.
To determine the effect of suture elongation on the accuracy of tension isometers, an anatomic specimen was used to measure peak loads on suture materials placed in extreme nonisometric positions. Accuracy and reproducibility were determined for three tension isometers, and the influence of suture elongation was determined for one of them. In one device, reproducible readings ranged from -12.3% to + 23.6% of mean static loads recorded by hydraulic testing equipment; average error approached 39.1%. Values tended to be overestimated if readings ranged as high as 32.5% over specific excursion ranges. Selected suture materials were subjected to these loads, using hydraulic testing equipment. Stainless steel exhibited extremely low levels of elongation but only at large diameters. Ethibond had similar low levels of elongation but only at large diameters. Monofilament nylon exhibited significant elongation that could cause erroneous readings and nonisometric placement. The measurement tolerances of a selected tension isometer should be considered by the surgeon performing anterior cruciate ligament (ACL) substitution. Several readings, both loading and unloading, can be used to determine preload and isometry. Material properties of the selected suture and the accuracy of the tension isometer should be considered when interpreting readings from isometric positioners. This brings into question the ability of currently available tension isometers to deliver readings within prescribed tolerances for either isometry of preload testing.
Anterior Cruciate Ligament↗
The anatomy of the extensor mechanism.
The complex function of the extensor mechanism demands knowledge of not only its anatomic structures but of their balanced relationships as well. An awareness of a layer concept of tissue orientation is helpful in understanding surgical access as well as the normal function of the decelerator mechanism. This awareness is a prerequisite to the evaluation and treatment of mechanical disorders.
Biomechanical Phenomena↗
Office evaluation and management of the symptomatic knee.
In summary, data recorded during the office evaluation should include a chief complaint, a subjective history, a functional history, motion and strength analysis, and objective examination measurements. Storage and access of these data may be categorized on the basis of probable etiology. Finally, the historic and examination criteria for conservative or surgical care may be reviewed periodically to evaluate the results of a specific treatment and changes may be made as necessary to improve patient satisfaction and improve the physician's diagnostic and therapeutic capabilities.
Adolescent↗
Comparison of over-the-top and tunnel techniques for anterior cruciate ligament replacement.
The osseous tunnel technique of anterior cruciate ligament (ACL) reconstruction was compared to the over-the-top (OTT) technique in vivo. A prosthesis replaced the ACL in 35 dogs by one of three methods: double osseous tunnels, OTT, or a combined method utilizing the unique Y shape of the prosthesis by placing one fork through a femoral osseous tunnel and the other fork over the top of the femoral condyle in the same stifle. Rupture occurred in all prostheses placed in double osseous tunnels and in one of 12 prostheses placed by the OTT technique. When rupture occurred in only one fork of prostheses placed in the combined method, all occurred in the tunnel-placed fork. If the results of the three groups are combined, rupture occurred in 16.7% of all OTT-placed prostheses versus 91.3% rupture of all osseous tunnel-placed prostheses. Objective assessment of the in vivo testing clearly indicates that the OTT technique is superior to the tunnel technique under the conditions of this study. The relationship between placement technique and rupture of other prostheses should also be tested in vivo.
Animals↗
Isolated chondral fractures of the knee.
Eighteen patients with isolated chondral fractures of the knee were reviewed to reevaluate the clinical signs and symptoms. No other conditions had been present to account for the symptoms. Most of the patients had significant injuries often involving a flexed knee. All patients had had symptoms and physical findings strongly suggestive of meniscal abnormality. Roentgenographic examinations were noncontributory. The lesions occurred in four distinct patterns. All were full thickness. Many of the lesions occurred on the posterior aspect of a femoral condyle, a location where they could be easily overlooked if the condyle were not examined with the knee in extreme flexion. Abutment of the tibial spine against the medial femoral condyle may be one cause of these injuries. The incidence of isolated chondral fractures was found to be higher than previously reported. A negative arthroscopic meniscal examination in a patient with symptoms and physical findings suggestive of meniscal abnormality should alert the physician to the possibility of an isolated chondral fracture.
Adolescent↗
Associated joint pathology in the anterior cruciate ligament-deficient knee with emphasis on a classification system and injuries to the meniscocapsular ligament-musculotendinous unit complex.
This article defines the anterior cruciate ligament-deficient knee in terms of capsular instabilities. This definition lends itself to a better assessment of the associated pathology consisting of torn capsular ligaments, torn medial and lateral menisci, chondral fractures, subluxation of the patella, and acute contusion of the peroneal nerve. The specific incidence of torn medial meniscus was 70 per cent, with a torn lateral meniscus identified 77 per cent of the time.
Humans↗
Posterior shoulder approach.
A posterior shoulder surgical approach combines the subperiosteal detachment of the deltoid from the scapular spine, described by McWhorter, with a lateral extension to include the lateral deltoid splitting of Codman. The glenohumeral joint is superiorly approached between the supraspinatus and infraspinatus tendons, or inferiorly between the infraspinatus and teres minor tendons. This approach was used in 42 shoulders with rotator cuff tears or posterior instability without complications of infection, failure of deltoid healing, or compromise of suprascapular or axillary nerves. This combined surgical approach provides excellent exposure of the superior and posterior shoulder, which is difficult to obtain by anterior or superior approaches. This approach may be used for repair of rotator cuff tears, posterior instability, and displaced posterior glenoid fractures.
Humans↗
Extrication of the hand from a meat grinder.
A case is presented in which a patient arrived in the emergency room with his forearm firmly entrapped in a large commercial meat grinder. The arm was extricated without sacrificing additional forearm stump length by reversing the worm mechanism of the meat grinder.
Accidents, Occupational↗
Complex dislocation of the metacarpophalangeal joint. Correlative pathological anatomy.
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Adolescent↗
The intercondylar fossa of the normal canine stifle an anatomic and radiographic study.
The intercondylar fossa (ICF) in dogs consists of a cranial outlet, intercondylar shelf, caudal arch, caudal outlet, a medial wall, and a lateral wall. The normal cranial outlet is bell-shape and, in mixed-breed dogs (mean body weight 19.2 kg, N = 21), measured 5.8 mm cranially, 8.1 mm centrally, and 10.3 mm caudally. The ICF is oriented 12 degrees from the dorsal plane of the femoral diaphysis and obliqued 7 degrees, proximolateral to distomedial, in the sagittal plane. To adjust for dog size, a fossa width index (FWI) was calculated by dividing the cranial outlet width by the distance between epicondyles. The normal FWI as determined in this study was 0.18 cranially, 0.25 centrally, and 0.32 caudally. The fossa height index 0.31. Contact between the ICF and the cranial cruciate ligament began at about 115 degrees of extension. The contact area moved cranially in the intercondylar fossa as the stifle was extended. Evaluation of the ICF can be performed radiographically but positioning is critical.
Analysis of Variance↗
The effect of intercondylar notchplasty on the normal canine stifle.
This study evaluated the effect of notchplasty (enlargement of the intercondylar fossa) in stable and unstable canine stifles. Bilateral notchplasty and unilateral cranial cruciate ligament (CrCL) transection were performed in 6 dogs. Exercise, consisting of walking 1.5 miles three times a week, began 1 month after surgery and continued until euthanasia 6 months after surgery. Evaluation methods included orthopedic examination, serial radiographs, thin section radiography, histopathology, and gross pathology. Notchplasty in the stable stifle did not cause lameness beyond 3 weeks, joint instability, or degenerative joint disease. In the stable stifle, smooth resurfacing of the notchplasty site with fibrous and osseous tissue occurred. Stifles with notchplasty and CrCL transection exhibited persistent lameness, instability, and degenerative joint disease. In CrCL deficient stifles osteophytes formed within the notchplasty site, resulting in a rough surface. Our observations indicated significant refilling in notchplasties of both stable and unstable stifles (P < .05). However, the intercondylar fossa (ICF) width 6 months after notchplasty was significantly smaller in unstable stifles compared with stable stifles (P < .05) indicating that greater refilling of the notchplasties occurred in the unstable stifles. In clinical cases, notchplasty should be larger than the desired final result to accomodate the partial refilling that occurs even in stable stifles.
Animals↗
Shoulder posterior subluxation.
The records of 21 patients with chronic recurrent posterior subluxation were reviewed to document postoperative stability and level of athletic participation after opening wedge posterior scapular osteotomy and associated soft tissue procedures. At an average of 39.9 months after surgery, we objectively reevaluated 17 males and 2 females (from 16 to 46 years old). Patients with posterior instability caused by a direct trauma stabilized and effectively returned to athletic participation following osteotomy. Patients with posterior stability resulting from muscular contraction required additional soft tissue procedures for stability and effective return to athletics. Congenitally or habitually lax shoulders did not stabilize in this series. This study suggests that opening osteotomy is indicated for single plane, posterior instability which results from direct trauma or muscular contraction, and for combined anterior-posterior instability. Opening osteotomy is contraindicated in congenitally or habitually lax shoulders. A descriptive classification system which groups shoulders according to injury force and direction of instability facilitates preoperative prediction of subsequent glenohumeral joint stability and athletic participation or level of nonsportive activity.
Adolescent↗
The anatomy of the iliopatellar band and iliotibial tract.
Based on an extensive review of the literature and dissections of 17 fresh-frozen knee specimens, the authors divide the lateral fascia lata of the knee into two functional components: the iliopatellar band and the iliotibial tract. Aponeurotic, superficial, middle, deep, and capsulo-osseous layers contribute to these two functional components. The superficial layer of the iliotibial tract, combined with the deep, and capsulo-osseous layers, is hypothesized to function as an anterolateral ligament of the knee. The iliopatellar band provides stabilization of the patella against a medially directed force and is dynamically influenced by the vastus lateralis. The relationship of the iliotibial tract to extraarticular reconstructions of the knee with anterolateral rotatory instability is discussed.
Adult↗
The stabilizing function of passive shoulder restraints.
UNLABELLED: The static restraints of the scapulohumeral joint provide stability for the humeral head in the glenoid cavity, limit extremes of motion of the glenohumeral joint, and guide positioning of the humerus during normal shoulder movement. Eleven fresh-frozen cadaver shoulders of unknown age were attached to a shoulder motion device that allowed measurement of motion in three planes with an accuracy to 0.5 degrees. Four shoulders underwent motion analysis and seven were used for strain gauge analysis of the static scapulohumeral ligamentous restraints. The results of the motion analysis demonstrated that any attempt at simple motion (flexion, extension, abduction, internal or external rotation) resulted in coupled motion in two additional planes. The strain gauge data, expressed as a percent of total tension for each ligament tested, demonstrated a reciprocal tension-sharing relationship among all ligament components and a transference of tension among these components when original and new joint positions were compared. These data provide an in vitro model of shoulder restraint function to explain primary restraint, tension sharing, and transference of tension functions in the in vivo scapulohumeral joint. CLINICAL RELEVANCE: These principles of shoulder function have application in the treatment of instability and frozen shoulder syndrome, and provide an in vitro model to better understand static restraint function in the throwing mechanism.
Biomechanical Phenomena↗