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Biomedical subjects

J S Torg

Publications and source records attributed to J S Torg.

At least 19 recordsLinked to original sources
PubMed1992

Arthroscopic resection of glenoid labral tears in the athlete: a report of 29 cases.

This article is a retrospective review of 28 overhead-throwing and striking athletes who underwent 29 arthroscopic partial glenoid labral resections. Indications for the procedure were a sudden inability to perform because of pain and the presence of a palpable "click" on clinical examination. At a minimum of 2 years follow-up, there was a statistically significant difference in the functional outcome between patients with stable and those with unstable glenohumral joints. In those with stable joints, there was a 91% good or excellent functional outcome. In those with unstable joints, there was a 25% good functional outcome and a 75% fair or poor functional outcome. We also noted a statistically significant difference in labral tear location between the stable and unstable glenohumeral joints. Seven of eight superior labral tears were in stable shoulders. Fourteen of 19 anterior labral tears were in stable shoulders. Both posterior labral tears were in unstable glenohumeral joints. Injury of the glenoid labrum without anatomic instability was observed in 72% of patients. Arthroscopic resection of a longitudinal labral tear in a stable shoulder can relieve the patient's discomfort and allow him or her to return to athletic competition. No patient developed clinical subluxation as a result of labral debridement, nor did any patient convert from a subluxing shoulder to a dislocating shoulder following surgery. In patients with anterior instability and labral tears, labral debridement was not a successful alternative to formal stabilization.

Adult↗
PubMed1990

Arthroscopic surgery of the knee under local anesthesia.

This report delineates the efficacy of local anesthesia in the performance of arthroscopic surgery of the knee. A retrospective review of 500 cases revealed that only three required administration of general anesthesia to successfully complete the procedure. A prospective study comparing fentanyl, midazolam, and fentanyl/midazolam combinations as intravenous supplements was performed. Meticulous surgical technique combined with local anesthesia and some form of intravenous sedation in minimal therapeutic dosage will provide satisfactory conditions to perform surgical arthroscopy of the knee.

Adult↗
PubMed1990

Cervical spinal stenosis with cord neurapraxia and transient quadriplegia.

The purpose of this article is to define as a distinct clinical entity, the syndrome of cervical spinal cord neurapraxia with transient quadriplegia. Sensory changes include burning pain, numbness, tingling, or loss of sensation, whereas motor changes consist of weakness or complete paralysis. The phenomenon of cervical spinal cord neurapraxia occurs in individuals with (1) developmental cervical spinal stenosis, (2) congenital fusions, (3) cervical instability, or (4) intervertebral disc protrusions when associated with a decrease in the anteroposterior diameter of the spinal canal. There is no evidence that the occurrence of cervical spinal cord neurapraxia predisposes an individual to permanent neurologic injury. However, patients with this syndrome and associated with cervical spine instability or acute or chronic degenerative changes should be precluded from further participation in contact sports. Those with developmental spinal stenosis or spinal stenosis associated with congenital abnormalities should be treated on an individual basis.

Adolescent↗
PubMed1990

Clinical prognosticators for the efficacy of retinacular release surgery to treat patellofemoral pain.

The purpose of this prospective study was to identify clinical, pathologic, and roentgenographic factors that might serve as prognosticators for acceptable results after a lateral retinacular release for treatment of patellofemoral pain unresponsive to conservative measures. Fifty-two knees in 45 patients were studied. The data indicated that acceptable results can be expected in patients who have a negative mal-loose sign (no evidence of patellar malalignment or hyperlaxity) or a positive Sage sign (tight lateral parapatellar soft-tissue structures). Poorer results are predictable in patients with patellar hypermobility.

Adolescent↗
PubMed1989

Natural history of the posterior cruciate ligament-deficient knee.

This paper documents the clinical course of the posterior cruciate ligament-deficient knee. By obtaining an understanding of the natural history of this lesion, the indications for surgical repair, reconstruction, and conservative treatment will be more clearly defined, and the clinician will be able to more critically evaluate the results of both acute repair and reconstruction of this ligament. Forty-three patients with an average interval of 6.3 years (range, one to 37 years) between injury and evaluation were included in this study. Fourteen patients had a straight unidirectional posterior instability and 29 had a combined multidirectional instability. The follow-up evaluation included functional assessment, physical and roentgenographic evaluation, arthrometric laxity measurement, and isokinetic dynametric testing of quadriceps function. Statistical treatment of the data, utilizing both nonparametric methods and logistic modeling, clearly delineated the natural history of the injury to the posterior cruciate ligament (PCL). It was established that the functional outcome can be predicted on the basis of the instability type. Specifically, those knees with PCL disruption without associated ligamentous laxity will probably remain symptom-free. However, when PCL disruption is associated with combined instabilities, a less than desirable functional result will probably occur. Application of logistic modeling to the data demonstrated that the functional result was not due to the type of instability per se, but rather to associated factors, i.e., chondromalacia of the patella, meniscal derangement, quadriceps atrophy, or degenerative changes. A direct correlation has been established between combined multidirectional instability and the occurrence of those associated secondary problems resulting in the patient's complaints and functional disability.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed1987

Cervical spinal stenosis: determination with vertebral body ratio method.

Transient bilateral sensory and motor symptoms after trauma, including complete paralysis, have been identified in patients with cervical spinal stenosis. Radiographs of 23 patient athletes with cervical spinal neurapraxia were used for measurement of the cervical spinal canal. Two methods of measurement were used. In the conventional method, sagittal diameter is measured from the posterior surface of the vertebral body to the nearest point of the corresponding laminar line. In the ratio method, the sagittal diameter of the spinal canal is divided by the sagittal diameter of the corresponding vertebral body. Results indicate the ratio method is reliable for determining cervical spinal stenosis and is independent of technical factor variables.

Adolescent↗
PubMed1987

Fractures of the base of the fifth metatarsal distal to the tuberosity: a review.

Fractures of the proximal part of the fifth metatarsal can be separated into two types: those involving the tuberosity, and those involving the proximal part of the diaphysis distal to the tuberosity. Recently it has been recognized that the latter group, Jones' fractures, may be difficult to treat. Although reports in the literature have indicated the potential difficulties in the treatment of Jones' fractures, prevailing guidelines for their management are ambiguous. Apparently the varied clinical and roentgenographic manifestations of these fractures have not been correlated with their response to treatment. In this paper we describe a classification of these fractures and a plan of treatment based on clinical and roentgenographic criteria that were developed to define acute fractures, delayed unions, and nonunions. The treatment of choice for acute fractures is immobilization of the limb in a toe to knee cast with nonweight-bearing. Fractures with delayed union may eventually heal if they are treated conservatively, but an active athlete with delayed union or an established nonunion will benefit from operative intervention. The procedures of choice are medullary curettage and bone grafting, and closed axial intramedullary screw fixation using a 4.0-mm ASIF malleolar screw.

Adult↗
PubMed1987

Overuse injuries in sport: the foot.

The authors discuss the clinical characteristics and treatment of such overuse injuries of the foot as plantar fasciitis, Haglund's syndrome, Jones' fracture, and tarsal navicular stress fractures. A consideration of orthotic devices is also provided.

Athletic Injuries↗
PubMed1987

Roentgen examination of cervical spine injuries in the athlete.

The roentgen evaluation of the cervical spine must be performed immediately following the possibility of injury and in such a manner as not to compromise the neurologic status of the patient. Subtle roentgen findings indicating ligamentous injuries must be recognized so that they can be treated prior to developing cervical spine instability. Occult fractures, which may be difficult to diagnose on plain films and require multiple radiographic modalities, must be diagnosed so as to prevent prolonged intractable neck pain. Most importantly, recognizing the mechanism of injury and prevention of cervical spine injuries are critical to prevent catastrophic cervical spine injuries secondary to athletic participation.

Athletic Injuries↗
PubMed1987

Cervical spinal stenosis with cord neurapraxia and transient quadriplegia.

Cervical spinal cord neurapraxia with transient quadriplegia is defined as a distinct clinical entity. The authors identify diminution of the anteroposterior diameter of the spinal canal as the factor that explains the described neurologic picture of the injury. Based on the result of a study of 39,377 athletes, the authors conclude that the prevalence of the injury is high and warrants attention. Given that of the patients interviewed, none recalled prodromal experience of transient motor paresis and none sustained further injury, this injury does not predispose individuals to permanent neurologic injury. No definite recurrence patterns have been established that would warrant the restriction of individuals from further activity. Activity restrictions are called for in the case of individuals with stability or chronic degenerative changes. Individuals with developmental spinal stenosis or spinal stenosis should be treated on an individual basis.

Adolescent↗
PubMed1987

Trampoline-induced quadriplegia.

This review of the world's literature documenting cervical spine injuries attempts to determine common factors regarding patient characteristics, environment, injury mechanisms, and pathology. The policy statements and safety guidelines of both the American Academy of Pediatrics and athletic administrative bodies are reviewed in order to evaluate what effect, if any, these policies and guidelines have had on documented injuries. On the basis of this review, it is believed that the AAP was ill-advised in altering its position on the use of trampolines. The opinion is presented that both the trampoline and minitrampoline are dangerous devices when used in the best of circumstances, and their use has no place in recreational, educational, or competitive gymnastics.

Athletic Injuries↗
PubMed1987

Rehabilitation of cervical spine, brachial plexus, and peripheral nerve injuries.

The cervical spine is placed at risk of injury in a number of athletic activities. It is important to understand the principles and methods of therapeutic and rehabilitative exercises both to prepare the athlete for the demands each sport will place on his or her body and to return the injured athlete to activity safely. General principles of rehabilitation are reviewed, followed by a discussion of the clinical entities of concern and descriptions of specific rehabilitation exercises for each injury.

Athletic Injuries↗
PubMed1987

Spinal injury at the level of the third and fourth cervical vertebrae resulting from the axial loading mechanism: an analysis and classification.

The traumatic C3-C4 level injuries sustained by young athletes and documented by the National Football Head and Neck Injury Registry are discussed. Twenty-eight of 885 (2.8 per cent) injuries involved the C3-C4 vertebrae. Review of these cases reveals that the response to energy inputs at the C3-C4 level differ from that of those involving the upper (C1-C2) and lower (C5-C6) cervical segments. Specifically, these lesions appear unique with regard to infrequency of bony fracture, difficulty in effecting and maintaining reduction, and their more favorable response to early aggressive treatment. It is the authors' belief that these lesions resulting from athletic activity are due to axial loading.

Adolescent↗
PubMed1987

Management guidelines for head injuries in athletics.

The spectrum of athletic head injuries is presented with discussion of on-site recognition, definite diagnosis, and specific treatment. Emphasis is placed on the proper medical evaluation of athletes to ensure recovery and prevent serious consequences of repeated injury.

Athletic Injuries↗
PubMed1987

Management guidelines for athletic injuries to the cervical spine.

The potential or actual involvement of the nervous system in injuries to the cervical spine requires that management must proceed with particular care. Prevention of further injury is the main objective. Proper management must begin with the removal of the athlete from the field, and the correct procedures for doing this are reviewed. Treatment procedures for the following injuries are discussed: (1) nerve root and brachial plexus neurapraxia; (2) acute cervical sprain syndrome; (3) cervical vertebral subluxation without fracture; (4) cervical fractures and dislocations; (5) cervical spinal cord neurapraxia with transient quadriplegia; and (6) cervical spinal instability. Also, guidelines for activity restrictions are presented.

Athletic Injuries↗
PubMed1987

The National Football Head and Neck Injury Registry: 14-year report on cervical quadriplegia (1971-1984).

The specter of catastrophic cervical neurotrauma resulting from athletic participation, although infrequent, has been consistently associated with football, water sports, gymnastics, rugby, and ice hockey. Injury involving intracranial hemorrhage can result in death or permanent neurologic impairment, whereas certain fractures and dislocations of the cervical spine are associated with quadriplegia. Athletic injuries to both the central nervous system and spinal cord demand our attention as an active area of clinical and basic injury. A review of the available literature reveals changing injury patterns as well as current concepts regarding the mechanism responsible for most athletic injuries to these structures. Accurate descriptions of the mechanism(s) responsible for a particular injury transcend simple academic interest. In order that preventive measures be implemented, the manner in which injury occurs must be accurately defined. The purpose of this article is to describe how the application of this principle resulted in the significant reduction of cervical spine injuries associated with quadriplegia that have occurred in tackle football since 1976.

Athletic Injuries↗