Biomedical subjects

S A Herring

Publications and source records attributed to S A Herring.

11 recordsLinked to original sources

PubMed2000

Spondylolysis: a critical review.

AIM: To provide an understanding of the current concepts in the natural history, pathophysiology, diagnosis, and treatment of spondylolysis based on the available medical literature. METHODS: Articles were selected for review by the following methods: (a) MEDLINE searches with review of abstracts to select relevant articles; (b) review of multiple textbooks considered likely to contain information on spondylolysis; (c) review of references in articles identified by (a) and (b). Over 125 articles were ultimately reviewed fully. Publications were selected for inclusion in this article on the basis of perceived scientific and historical merit, particularly as thought to be relevant to achieving the stated purpose of this review. As no controlled clinical trials were identified, this could not be used as an inclusion criterion. CONCLUSIONS: Isthmic spondylolysis is considered to represent a fatigue fracture of the pars interarticularis of the neural arch. There is a relatively high incidence of radiographically identified spondylolysis in the general population, but the vast majority of these lesions probably occur without associated symptoms. Symptomatic pars lesions appear to be particularly a clinical problem in adolescents, especially adolescent athletes. The optimal diagnostic and treatment algorithms are not well identified in the current literature. Multiple imaging studies may have a role in the diagnosis of a pars lesion, and treatment seems likely to require at least relative rest and physical rehabilitation with consideration of bracing or, rarely, surgical intervention depending on the clinical context.

Humans↗

PubMed2000

Spondylolysis.

Spondylolysis is a relatively common incidental radiographic finding that, most frequently, is asymptomatic. Isthmic spondylolysis with a lesion in the pars interarticularis may be a significant cause of pain in a given individual, particularly in adolescent athletes involved in sports with repetitive spinal motions. The pars lesion likely represents a stress fracture of the bone caused by the cumulative effect of repetitive stress imposed by physical activity. The lesion frequently presents as focal LBP and can often be identified on plain radiography. Advanced imaging with SPECT, CT, and MR imaging may be needed to ascertain the acuity of the lesion, assist in identifying a particular pars lesion as potentially symptomatic, and to exclude other spinal pathology that may be present. Conservative treatment is usually successful in controlling symptoms and restoring function; only a small percentage of patients require surgical intervention for pain or progressive spondylolisthesis. Based on current evidence, treatment requires activity restriction (i.e., temporary discontinuation of the aggravating sport or activity) and may require bracing to achieve treatment goals, although healing, pain relief or both may occur without brace application. A full understanding of spinal biomechanics and pathophysiology, the role of diagnostic imaging, and treatment options is needed to care for these patients.

Braces↗

PubMed1997

The disc at risk in athletes: perspectives on operative and nonoperative care.

Low back pain is the most common cause of disability in individuals below the age of 45 and the third most common cause of disability overall. Although acute back pain is generally felt to have a high probability of spontaneous resolution, the high recurrence rate of low back pain challenges the notion that resolution of symptoms is accompanied by restitution of function. Athletes who have lumbar spine dysfunction represent a particular challenge to the treating physician due to their high levels of activity and expectation of return to sport. Injuries to the intervertebral disc in the lumbar spine are a particular subset of spine injury. Management of intervertebral disc injuries, which is the focus of this section, is fraught with controversy. Although the majority of intervertebral disc injuries can be treated conservatively, the decision to follow an aggressive conservative versus surgical course in any given athlete must be made on an individual case basis.

Athletic Injuries↗

PubMed1995

Lumbar zygapophysial (facet) joint injections.

The lumbar zygapophysial joints are a potential cause of back and lower extremity pain. Absolute diagnosis of lumbar zygapophysial joint-mediated pain is based on selective analgesic injections of these joints or their nerve supply. The therapeutic role of zygapophysial joint injections is controversial. This contemporary concepts paper reviews the anatomy, mechanics, pathology, and diagnosis of this condition. A critical review of previous studies assessing the role of diagnostic and potentially therapeutic zygapophysial joint injection procedures is presented. The need for future studies is addressed, and current recommendations for the role of zygapophysial joint injection procedures based on this critical scientific review are provided.

Analgesics↗

PubMed1995

Spine rehabilitation. Secondary and tertiary nonoperative care.

To achieve desirable behavioral outcomes, physicians treating spinal pain patients should be aware of appropriate algorithms for conservative care. Lower cost secondary rehabilitation can be effective if deconditioning, severity of physical symptoms, surgical equivocation, or psychosocial barriers to recovery are not present. Patients who have extended disability in excess of 6 months, recognized psychosocial barriers (depression, substance abuse, personality disorders, secondary gain), or severe deconditioning have a better prognosis with tertiary care.

Humans↗

PubMed1995

Contemporary concepts in spine care. Epidural steroid injections.

Epidural steroid injections are commonly used for the management of lumbosacral radicular syndromes. The literature is replete with case reports and noncontrolled studies, but relatively few controlled studies exist. The well-designed studies that are available, however, do show a significantly positive pain reducing benefit from lumbar epidural steroid injections. This Contemporary Concepts review summarizes theoretic concepts, clinical applications, and data from the literature regarding the use of lumbar epidural steroid injections and provides current recommendations and suggestions for future research.

Adrenal Cortex Hormones↗

PubMed1992

Nerve problems and compartment syndromes in the hand, wrist, and forearm.

Most sports-related peripheral neuropathies occurring from the elbow distally are compressive in nature. These result from overuse or overload principles superimposed on normal or variant anatomy. Tensile injury occurs less often and is usually associated with the extremes of the throwing motion, i.e., cocking and follow-through phases of throwing. Neurogenic syndromes are usually incomplete, indicating the absence of severe motor or sensory deficits, but typically with subjective complaints of pain or vague sensory disturbance. As a result, nerve injuries are frequently overlooked as a source of acute or, more usually, chronic symptomatology. Further, distal symptoms are not always representative of distal pathology as evidenced by the double-crush phenomenon. Therefore, a strong neurologic and musculoskeletal evaluation is necessary in diagnosing sports-induced peripheral nerve trauma. When positive, electrodiagnostic testing can assist with localization and extent of injury, although absence of NCV or EMG abnormalities is not unusual. Accurate diagnoses are essential for planning specific treatment.

Arm Injuries↗

PubMed1990

Rehabilitation of muscle injuries.

Rehabilitation of muscle injuries is directed toward restoration of function, not just relief of symptoms. This philosophy is reflected in the goals of rehabilitation, which can be stated as 1) establishment of an accurate diagnosis; 2) minimization of deleterious local effects of the acute injury; 3) allowance for proper healing; 4) maintenance of other components of athletic fitness; and 5) return to normal athletic function. The goals fit well into the framework of the tissue injury cycle described earlier in this symposium. Details of the rehabilitation goals and the relationship to the tissue injury cycle will be discussed.

Anti-Inflammatory Agents, Non-Steroidal↗

PubMed1987

Introduction to overuse injuries.

An understanding of the cellular response to injury helps to explain overuse trauma. Tendons, bursae, cartilage, bone and nerves all can break down owing to the repetitive forces from sporting activities. A precise diagnosis and thoughtful use of medication and modalities in a complete rehabilitation program help to minimize disability.

Athletic Injuries↗

PubMed1984

Basic elements of maritime health care.

The goal is to do everything possible to facilitate the captain-patient relationship so that the patient receives the best care possible. As the MTRC consults on medical problems at sea, a data base is generated relative to specific medical problems, preferred treatment modalities, medical facilities available in various ports around the world, availability and safety of evacuation services, and epidemiologic and occupational medicine data. This cumulative body of information can be relayed to all companies on an industry-wide basis. The data can be used to generate recommendations for the contents of a ship's medicine chest (including those supplies that are necessary and those that are not necessary). A secondary benefit of this system is that the medical staff in the MTRC knows in advance the ship's medicine chest inventory. Thus, valuable time is not lost asking the captain to check on the availability of a medication or supply. An MTRC is ideally situated to discern occupational patterns of disease that might be related to a certain port of call or a certain rating aboard ship. This information can be shared with company officials and seafarers who otherwise might not have ready access to it. The availability of a central storage site for medical records is important because of the high degree of mobility of the patient population. The medical record should be easily accessible to medical professionals, with the consent of the patient. An MTRC is a logical respository for medical records because around-the-clock availability of the medical record is particularly important for the medical staff when advising treatment for the patient at sea.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMedDate not supplied

The role of exercise in the prevention and management of acute low back pain.

This chapter describes the treatment guidelines for acute low back pain that were established by the Agency for Health Care Policy Research and analyzes some of the current literature on the topic. The conclusion is drawn that rehabilitation and conditioning exercises in patients with low back pain can be beneficial.

Acute Disease↗