Biomedical subjects
Publications and source records attributed to J G Aronen.
Inflammations of the patellar and Achilles tendons, knee and ankle apophyses, and plantar fascia are common among professional and amateur athletes. The tendency to favor a sore leg and delay seeking medical attention often results in muscle atrophy. Many patients thus require physical as well as pharmacologic therapy to prevent further injury and regain full use of the leg.
The majority of upper extremity problems experienced by gymnasts are not considered injuries but are regarded as consequences of the sport. Treatment of these problems should include treatment of not only the injury but also the cause. This requires the cooperation of the gymnast, his or her coach, and a physician familiar with the demands placed upon the upper extremity in gymnastics. The level of a gymnast's capabilities must be recognized. Improper techniques must be corrected. Emphasis must be placed on rehabilitation for shoulder problems and strengthening exercises for the elbow and wrist in attempt to decrease the symptoms from repeated forced extension. In the words of Peter Kormann, an Olympic medalist in gymnastics, "All gymnasts work out and compete with ongoing problems in their upper extremities. These problems are only considered serious injuries when the gymnast can no longer compete."
All injuries to the shoulder either directly or indirectly involve the muscles of the shoulder. The involved muscles can easily be identified by examination and rehabilitated utilizing isotonic and isokinetic exercises. The majority of recurring injuries or symptoms following the treatment of a shoulder injury and return to activity are due to either lack of adequate rehabilitation or inappropriate rehabilitation.
Studies of adolescent and young adult males sustaining primary anterior shoulder dislocations reveal the likelihood of recurrence to be virtually always above 50% and as high as 79% to 94%. Common among these investigations is the lack of a specific, rigidly adhered to rehabilitation program. During a 3 1/2 year period, 20 midshipmen at the United States Naval Academy sustained primary anterior shoulder dislocations. All participated in an identical treatment regimen which included a restrengthening program emphasizing the muscles of internal rotation and adduction, plus rigid restrictions of activities until the goals of their rehabilitation program were satisfied. Exercises progressed from isometrics through isotonics and isokinetics. Goals included return to full active, unrestricted duty and athletic participation which included participation in the sport that resulted in the original dislocation. Patients were followed for an average of 35.8 months (with a range of 17 to 45 months). During the period of study there were five recurrences (25%). A success rate of 75% would suggest that adherence to a specific, aggressive postdislocation rehabilitation program, plus rigid restrictions of activities until the goals of the program are satisfied, can substantially improve the likelihood of a full return to activity without recurrent shoulder dislocation.
Anterior shoulder dislocations, primary and recurrent, are among the most disabling injuries to the shoulder that can plague the athlete. The diagnosis is easily made by the following: the physical appearance of the shoulder; loss of capability by the athlete to internally and externally rotate the shoulder with the elbow at his side; by evaluating the mechanism of injury; and x-rays. Anterior shoulder dislocations should be reduced as soon as possible after diagnosis, to minimise the stretching effect on the neurovascular structures while the humeral head is dislocated. The reduction is not done to allow the athlete to return immediately to sport. Use of a simple traction method in the first 10 to 15 minutes following the injury will result in a successful reduction in the vast majority of dislocations. Reduction of the humeral head can be confirmed by the athlete regaining the capability to internally and externally rotate his shoulder with his elbow at his side. Following reduction, the athlete should begin a treatment regimen which includes a restrengthening programme emphasising the muscles of internal rotation and adduction plus rigid restrictions of activities until the goals of the rehabilitation programme are satisfied. The author's experience with this treatment regimen with athletes at the United States Naval Academy, has shown a decrease of the recurrence rate of primary anterior shoulder dislocations to 25% versus the 80% recurrence rate we have become familiar with from studies done which did not stress specific rehabilitation programmes. The athlete should also be instructed in a self-performed traction method for reduction should a redislocation occur, to minimise the stretching effect on the neurovascular structures and allow relief from discomfort. Surgery for primary and recurrent anterior dislocations should only be considered when the athlete fails to achieve the desired goals after participating in a specific, progressive, adequate rehabilitation programme.