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Biomedical subjects

L J Micheli

Publications and source records attributed to L J Micheli.

At least 19 recordsLinked to original sources
PubMed1992

Patellofemoral pain in the pediatric patient.

The pediatric extensor mechanism is subject to a variety of congenital, developmental, and traumatic disorders. Growth related factors modulate the development of patellofemoral pathomechanics. Injuries to periarticular soft tissues, apophyseal, epiphyseal, and articular cartilage are identified by meticulous history and physical examination. Diagnostic radiographs and MR imaging are invaluable adjuncts. Specific rehabilitative programs are very effective and lead to a high degree of clinical success.

Child↗
PubMed1992

Overuse injuries to tendons and apophyses in children and adolescents.

Overuse injuries to tendons and apophyses are being seen with increasing frequency in children and adolescents as they increase their participation in organized sports, fitness, and dance activities. A retrospective review of 724 overuse tendon and apophyseal injuries seen in the Sports Medicine Clinic at the Boston Children's Hospital suggested that growth and maturation constitute additional risk factors for injury occurrence. Diagnosis and treatment of these injuries is discussed in the context of sports participation.

Adolescent↗
PubMed1992

Scapulothoracic motion in normal shoulders and shoulders with glenohumeral instability and impingement syndrome. A study using Moiré topographic analysis.

Qualitative visual inspection and manual muscle testing are traditional methods of evaluation that may overlook subtle weakness of the axioscapular musculature. A modification of the standard technique of Moiré topographic analysis of spinal deformity was applied to assess axioscapular muscle function in 51 subjects: 22 asymptomatic individuals, 22 with shoulder instability, and seven with impingement syndrome. Static Moiré evaluation demonstrated scapulothoracic asymmetry or increased topography in 14% of asymptomatic subjects, compared with 32% and 57% in the instability and impingement groups, respectively. The dynamic Moiré test demonstrated an abnormal Moiré pattern in 18% of asymptomatic individuals, compared with 64% and 100% in the instability and impingement groups, respectively. Axioscapular muscle dysfunction is common with both instability and impingement syndrome of the shoulder, although it remains to be determined whether this represents a primary or secondary phenomenon.

Adult↗
PubMed1992

Reflex sympathetic dystrophy in children. Clinical characteristics and follow-up of seventy patients.

We report on the experience with our first seventy patients who had reflex sympathetic dystrophy and were less than eighteen years old (average age, 12.5 years). In our series, the patients were predominantly girls (male to female ratio, 11:59) and the lower extremity was involved most often (sixty-one of the seventy patients). The average time from the initial injury to the diagnosis was one year, which indicates that the syndrome remains under-recognized in patients in this age-group. Conservative treatment with physical therapy, transcutaneous electrical nerve stimulation, psychological therapies including cognitive-behavioral management and relaxation training, and tricyclic anti-depressants was effective in improving the average scores for pain and function for forty patients. Sympathetic blocks were helpful for twenty-eight of thirty-seven patients. Thirty-eight of the seventy patients in the series continued to have some degree of residual pain and dysfunction. Reflex sympathetic dystrophy in children differs in presentation and clinical course from the syndrome in adults. It is best treated in a multidisciplinary fashion.

Algorithms↗
PubMed1991

Low-back pain in adolescent athletes: detection of stress injury to the pars interarticularis with SPECT.

The authors reviewed 1 year of experience with planar and single photon emission computed tomographic (SPECT) bone scintigraphy in 162 young patients with symptoms of low-back pain possibly related to stress injury to the pars interarticularis or spondylolysis. Planar scintigraphy and SPECT revealed no abnormality in 91 patients (56%). All abnormalities detected on planar images were also detectable with SPECT. SPECT showed an abnormal focus of radiotracer uptake in the lumbar spine in 71 patients (44%). In 32 of these 71 patients, these findings were also evident with planar scintigraphy. In 39 of these 71 patients, use of SPECT. Correlation with contemporaneous radiographs was made in 72 cases (including computed tomography in 10 cases). SPECT can be used to detect stress injury not seen with planar bone imaging or radiography and is recommended in evaluation of low-back pain in young athletes.

Adolescent↗
PubMed1989

Common painful sports injuries: assessment and treatment.

The increasing participation in organized sports has been paralleled by an increasing number of sports injuries. An exact diagnosis of the injury and an understanding of the mechanisms of injury are essential for proper management, relief of pain, and restoration of function. The two mechanisms of injury are single-impact macrotrauma and repetitive microtrauma. Overuse injuries, which result from repetitive microtrauma, are caused by the interaction of a number of risk factors. Determining the etiological factors present in a given injury is essential for proper management and prevention of overuse injuries. The roles of non-narcotic analgesics, muscle relaxants, and nonsteroidal anti-inflammatory drugs (NSAIDs) in aiding recovery and restoration of function in sports injuries have been extensively studied. NSAIDs, in particular, have been demonstrated in clinical and laboratory studies to speed recovery from overuse sports injury. Their place in acute sports injuries due to single-impact macrotrauma, however, is more controversial.

Adolescent↗
PubMed1989

Postoperative radiographic evidence for fatigue fracture as the etiology in spondylolysis.

The postoperative radiographs of 48 patients who underwent posterolateral in situ fusion for spondylolysis and Grade 1 or less spondylolisthesis over an 11-year period showed healing of the pars defects in 90% of the cases. The patients who showed healing had an average preoperative duration of symptoms of 17 months (mean, 12 months). The five patients whose radiographs showed persistent defects postoperatively were found to have had preoperative symptoms for an average of 47 months (mean, 48 months). This significantly greater (P 0.05) duration of symptoms prior to stabilization was the only variable that proved to be statistically significant. Controversy continues to exist as to the etiology of spondylolysis; however, the ability to heal the defect with lumbar spinal stability certainly supports the theory that the defect is a result of fatigue stresses, which finally manifest as a fracture seen on radiographs as the spondylolytic defect. Posterior spinal stabilization in those patients with symptoms for a period of less than 2 years who have failed conservative management can be expected to heal the pars defects.

Adolescent↗
PubMed1989

Tips of the trade #11. A technique for tendon and capsule separation in shoulder surgery.

Difficulty is frequently encountered in separating the rotator cuff tendons, particularly the subscapularis tendon, from the underlying and often adherent capsule. A safe and quick method of dissecting the tendon from the capsule using a Cobb elevator has proven effective without causing capsular penetration in well over 100 consecutive primary shoulder stabilizations.

Humans↗
PubMed1988

Overuse injuries in the young athlete.

Overuse injuries are now well known to sports enthusiasts at any age or level of competition. The seeming explosion of overuse stress fractures of lower extremity bones in high-profile professional basketball players has brought about widespread media attention and a better understanding of the phenomenon of "overuse syndrome" by the public. However, the spectrum of overuse injuries in the child or adolescent athlete has only recently been recognized. These injuries can range from the permanent disability of osteochondritis dissecans of the elbow to the completely nonspecific "growing pains" of active youngsters.

Adolescent↗
PubMed1988

Musculoskeletal assessment and training: the young athlete.

The primary purpose of a preparticipation physical examination is to identify risk factors that may predispose an athlete to physical and/or psychological injury. Inclusion of a physiological assessment complements the more traditional preparticipation health examination by contributing valuable information toward the specific physical strengths and weaknesses of the young athlete. This information when combined with the orthopedic and medical components of a preparticipation examination can dramatically enhance the safety of sports participation.

Adolescent↗
PubMed1988

Psychological considerations in youth sports.

Childhood participation in sports involves a complex interaction of many physical, psychological, and social factors. Some children and teenagers cope well with the stress of performance and competition and their participation leads to enhanced self-esteem and personal growth; others cope poorly, however, and are at a higher risk for injury. Based on clinical observations of patients seen through the sports and orthopedic services at a major children's hospital, this article has identified two groups of children and adolescents at risk for psychological complications following injury. Psychotherapeutic intervention is seen as a fundamental component in the overall treatment planning for patients manifesting a difficult recovery course, prolonged interference in athletic injury, and a tendency toward reinjury.

Adolescent↗
PubMed1987

The traction apophysitises.

The traction apophysitises are one of the frequently encountered overuse injuries to children. Although known for many years and classed as osteochondroses, the traumatic origin of these disorders--from repetitive microtrauma--is now receiving wider acceptance. Discussion of the assessment, treatment, and prevention of these disorders is included.

Adolescent↗
PubMed1986

Lower extremity overuse injuries.

Increased number of overuse injuries, particularly of the lower extremity, occurs in exercise. It is important for the physician who prescribes exercise to understand the mechanism of injury-repetitive microtrauma-and the risk factors for occurrence of these injuries. In the lower extremity, risk factors include inappropriate progression of the rate, intensity and duration of training; anatomic malalignment; muscle-tendon imbalances of strength, endurance, or flexibility; shoewear; surface; and pre-existent disease states. Specific recommendations for training progression, technique, and sports equipment may have to come from the physician, since the recreational athlete often does not have access to coach or athletic trainer. These are described.

Adult↗
PubMed1986

Patella alta and the adolescent growth spurt.

The presence of patella alta has been linked to recurrent dislocation of the patella and the patello-femoral stress syndrome. It is not known whether patella alta is an inherited or acquired trait. To investigate the relationship of patella during the adolescent growth spurt, serial orthoroentgenograms (growth study films) were retrospectively analyzed in 19 patients. Two were found in whom proximal patella migration could be correlated (r = 0.85) with femoral growth rate. This was significant at the p = 0.01 level. Girls had a higher correlation of patella height to growth rate than boys. In certain cases, patella alta is an acquired rather than inherited condition; this supports the theory that overgrowth during the growth spurt can lead to patella alta in some individuals.

Adolescent↗