Bilateral first rib and unilateral second rib stress fractures in a female athlete.
Explore the source record for details and available documents.
Adolescent↗
Biomedical subjects
L A Curl
Publications and source records attributed to L A Curl.
Treatment of grade III acromioclavicular separations in professional throwing athletes: results of a survey.
Forty-two team orthopedists representing all 28 major league baseball teams were surveyed to ascertain their definitive treatment for a hypothetical starting rotation pitcher who had sustained a grade III acromioclavicular (AC) separation to his throwing arm 1 week before the season. Twenty-nine (69%) of the physicians would treat the injury nonoperatively, while 13 (31%) would operate immediately. Twenty-five (60%) of the orthopedists had actually treated a pitcher or position baseball player with a grade III AC separation in the throwing arm, the 25 treating a total of 32 patients. Twenty (63%) of these injuries were treated nonoperatively, and 12 (37%) were treated operatively. The physicians reported that 16 (80%) of the patients treated nonoperatively regained normal function and achieved complete relief of pain, while 18 (90%) had normal range of motion after treatment; of those treated operatively, 11 (92%) regained normal function, achieved complete relief of pain, and had normal range of motion after surgery.
Acromioclavicular Joint↗
Use of demineralized bone matrix in hindfoot arthrodesis.
Fifty-five patients considering a hindfoot fusion performed by the senior author over a 5-year period were given the choice of having the fusion augmented by either iliac crest bone graft or demineralized bone graft in a study of the relative efficacy of these 2 methods of bone grafting. Eleven patients underwent subtalar fusion (average age, 40.1 +/- 14.0 years), and 44 had a triple arthrodesis (average age, 54.6 +/- 19.2 years). The most common indications for surgery were posterior tibial tendon insufficiency and traumatic arthritis. There were no significant differences between groups regarding underlying disease, medications, or associated medical conditions. In isolated subtalar fusions, all 3 patients who received an iliac crest bone graft experienced healing, as did 7 of 8 patients who received demineralized bone graft. The eighth patient had a radiographic non-union without clinical symptoms. Complete healing of triple arthrodeses was achieved in 13 of 15 patients who received an iliac crest bone graft and in 29 of 29 patients receiving a demineralized bone graft. There were no intergroup differences in the time to union, which generally was between 3 and 4 months. Intraoperative blood loss was significantly less with demineralized bone graft (33 +/- 25 ml) than with iliac crest bone graft (206 +/- 192 ml). This study demonstrated that demineralized bone graft aids arthrodesis at least as well as does iliac crest bone graft, without the increased blood loss, cost, and postoperative pain associated with iliac crest bone harvest.
Adult↗
Evaluation of shoulder laxity.
An understanding of the anatomy and biomechanical features of the glenohumeral joint is necessary when understanding the concept of shoulder laxity. Glenohumeral laxity is a normal feature of shoulder motion, but only when that laxity becomes excessive does instability occur. The clinician must use the history and physical examination to distinguish normal from pathological laxity. Several examination techniques are commonly used to evaluate anterior, posterior, inferior, and multidirectional shoulder laxity. It has become appreciated the subluxation of the shoulder is clinically or symptomatically unstable. This paper reviews the current techniques to evaluate shoulder laxity and discusses the interpretation of these examinations as they relate to normal and pathological laxities.
Biomechanical Phenomena↗
Glenohumeral joint stability. Selective cutting studies on the static capsular restraints.
The glenohumeral joint relies on static and dynamic contributions of the local soft tissues to maintain joint stability. Dynamic stabilizers consist of the local musculature (the rotator cuff and periscapular muscles), whereas static stabilizers include the glenoid labrum and associated capsuloligamentous components. The functional interaction of static and dynamic components is complex and not completely understood. Selective cutting studies have been done to define the effect of sectioning various static components on resultant glenohumeral translation. These studies have played a pivotal role in the understanding of static factors controlling shoulder stability: the anatomic variability in capsuloligamentous anatomy has been recognized, and the complex interaction among various regions of the shoulder capsule and their labral attachment sites has been shown. Additionally, it has been recognized that the function of the capsuloligamentous restraints is highly dependent on arm position.
Biomechanical Phenomena↗
Occult presentation of myotonia congenita in a 15-year-old athlete.
A case of myotonia congenita in an adolescent athlete was presented. Although this is a rare condition unknown to many treating physicians, the key to diagnosis was provocation of the patient's symptoms of muscle "tightening" and "cramping" during sustained exercise. The diagnosis would have been missed in routine office examinations with the patient at rest. The stereotypic generalized myotonic signs and symptoms were provoked after the patient was asked to play 20 minutes of basketball during one of his office evaluations. The provocative or postexercise examination was critical to the diagnosis as the resting office examination was completely normal. The diagnosis was subsequently confirmed by EMG and genetic testing. Myotonia congenita should be considered in the differential diagnosis of athletes with exercise-induced muscle "stiffness" or "cramping," particularly if the course is protracted and initial examinations are unremarkable. A provocative exercise period can be used to make the diagnosis. Once the diagnosis is established, appropriate pharmacologic treatment may improve symptoms and allow return to daily activity without restriction.
Adolescent↗
The value of weighted views of the acromioclavicular joint. Results of a survey.
One hundred twelve practicing members of the American Shoulder and Elbow Surgeons in the United States and Canada were surveyed regarding use of weighted views of the acromioclavicular joint. They were also asked about treatment for hypothetical patients seen in the emergency department or office with grade II or III acromioclavicular separations. One hundred five physicians (94%) responded to the survey. Eighty-five members (81 %) did not recommend obtaining weighted views in the emergency department. Sixty members (57%) did not use weighted views, and the majority commented that weighted views had no influence on their decision-making regarding treatment. Forty-five members (43%) used weighted views, but most did not use the results of this test to determine surgical intervention. Physicians recommending weighted views averaged 21 years of practice, compared with 16 years for those who did not obtain weighted views. Only nine physicians (9%) had changed treatment on the basis of weighted views. The patient's arm dominance, work, or athletic status did not influence most surgeons' decision to perform surgery when weighted views revealed a grade III separation. We found no correlation between obtaining weighted views and performing surgical reconstruction for patients with grade III acromioclavicular separations.
Acromioclavicular Joint↗
The sling. Shoulder immobilization devices.
Currently a myriad of devices are available for immobilization of the injured or postsurgical upper extremity. Some of these devices are straightforward and easily used, but some are more complicated and require more familiarity for their successful application. However, even simple devices have the potential for misapplication and thus prevent their benefit to the patient. This article is the first in a 3-part series. The goals of the series are (1) to present and review several devices on the market used by shoulder surgeons to immobilize the upper extremity, and (2) to discuss proper application and precautions of their use. It is intended that this series will benefit nurses, therapists, and trainers involved in the use of these devices.
External Fixators↗
Shoulder immobilizers. Shoulder immobilization devices.
Currently a myriad of devices are available for immobilization of the injured or postsurgical upper extremity. Some of these devices are straightforward and easily used, but some are more complicated and require more familiarity for their successful application. However, even simple devices have the potential for misapplication and thus prevent their benefit to the patient. This article is the second in a 3-part series. The goals of the series are (1) to present and review several devices on the market used by shoulder surgeons to immobilize the upper extremity, and (2) to discuss proper application and precautions of their use. It is intended that this series will benefit nurses, therapists, and trainers involved in the use of these devices.
Adult↗
Shoulder immobilization devices.
Currently a myriad of devices are available for immobilization of the injured or postsurgical upper extremity. Some of these devices are straightforward and easily used, but some are more complicated and require more familiarity for their successful application. However, even simple devices have the potential for misapplication and thus prevent their benefit to the patient. This article is the third in a 3-part series. The goals of the series are (1) to present and review several devices on the market used by shoulder surgeons to immobilize the upper extremity, and (2) to discuss proper application and precautions of their use. It is intended that this series will benefit nurses, therapists, and trainers involved in the use of these devices.
Braces↗