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Both recreational and elite athletes often sustain musculoskeletal injuries. Common problems--muscle cramps, burners (or stingers), and ankle and shoulder injuries--can be managed effectively with certain basic techniques. Initial measures are particularly important in facilitating the injured athlete's rapid return to activity.
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OBJECTIVE: To review current concepts of the pathophysiology, diagnosis, and treatment of rotator cuff and impingement injuries in the athlete. DATA SOURCES: The information we present was compiled from a review of classic and recently published material regarding rotator cuff and impingement injuries. These materials were identified through a search of a personal literature database compiled by the authors, as well as by selective searching of the MEDLINE. In addition, much of the information presented represents observations and opinions of the authors developed over 8 to 10 years of treating shoulder injuries in athletes. DATA SYNTHESIS: Biomechanics of the normal shoulder and pathophysiology of rotator cuff injuries in the athletic population are discussed, followed by a summary of the important diagnostic features of rotator cuff and impingement injuries. The principles of rehabilitation are extensively presented, along with indications and important technical aspects of selected surgical procedures. General principles and specific protocols of postoperative rehabilitation are also summarized. CONCLUSIONS/RECOMMENDATIONS: Rotator cuff and impingement injuries in the athletic population are multifactorial in etiology, exhibiting significant overlap with glenohumeral instability. Nonoperative treatment is successful in most athletic patients with rotator cuff and impingement injuries. When nonoperative treatment fails, arthroscopic surgical techniques such as rotator cuff repair and subacromial decompression may be successful in returning the athlete to competition.
In 14 adult patients with brachial plexus injuries, shoulder arthrodesis was completed in a position of 30 degrees abduction, 30 degrees flexion, and 30 degrees internal rotation. Abduction was measured by the position of the arm in relation to the side of the body with the scapula in the anatomic position. Internal fixation was used in each case. Six patients had had Steindler procedures. Three patients with complete paralysis were treated by above-elbow amputation. All shoulders fused. Mean follow-up time was 32 months. All patients noted that shoulder fusion had improved the function of their extremities. Minimum shoulder motion was 60 degrees abduction and 50 degrees flexion. Three procedures failed because of continued pain that was not relieved by surgery. One patient with an elbow flexion contracture disliked the combination of shoulder and elbow flexion. Seven patients required plate removal. Only one of the three patients who had had above-elbow amputation became a good prosthetic user. Shoulder arthrodesis is a reliable procedure that improves function in adult patients with brachial plexus palsy.
CONTEXT: Muscular fatigue impedes sensorimotor function and may increase the risk of shoulder injury during activity. The effects of fatigue on the sensorimotor system of the shoulder have been studied with various results. Deceleration times have been used to study neuromuscular control of the shoulder; however, no studies involving the effects of fatigue on deceleration times have been reported. OBJECTIVE: To compare shoulder deceleration times after a shoulder internal rotation perturbation before and after a repetitive throwing exercise protocol. DESIGN: A 2 x 2 repeated-measures design. SETTING: Exercise and sport injury laboratory. PATIENTS OR OTHER PARTICIPANTS: Twenty healthy, recreationally active men (age = 24.76 +/- 4.03 years, height = 178.41 +/- 8.36 cm, mass = 80.16 +/- 15.20 kg) volunteered to participate in the study. To ensure familiarity with the overhead motion, all subjects chosen had previously participated in an overhead throwing sport. INTERVENTION(S): The independent variables were time (preintervention and postintervention) and session (experimental and control). The intervention consisted of continuous overhead throwing. The subjects were considered fatigued when a 10% decrease in velocity was noted on 3 consecutive pitches. MAIN OUTCOME MEASURE(S): Time necessary to decelerate from an internal rotation perturbation. RESULTS: Deceleration time was significantly increased by the fatiguing intervention ( P = .001). CONCLUSIONS: The decreased ability to decelerate may be an adaptive response by the subjects to dissipate a lower percentage of force per second.
We evaluated the frequency of posterior subluxations on physical examination of athletes who had no symptoms of shoulder injuries and correlated the findings with other measures of joint laxity. During routine sports physical examinations, 356 shoulders in 178 athletes were examined for posterior subluxation and graded as either positive or negative for subluxation. Sulcus signs were performed and graded as I (< 1.0 cm), II (1.0 to 1.5 cm), or III (> 1.5 cm). Standard hyperlaxity tests of other joints were used to measure general ligamentous laxity. Statistical analysis included the Student's t-test and chi-square analysis (P < 0.05). Overall, 55% of the shoulders could be subluxated posteriorly. More female shoulders (65%) than male shoulders (51%) could be subluxated posteriorly. Ten percent of the athletes had asymmetrical posterior shoulder laxity. Men had statistically significant less inferior translation (sulcus signs of grade I, 49%; grade II, 46%; grade III, 3%) than women (grade I, 36%; grade II, 54%; grade III, 9%). Five percent of the shoulders had posterior subluxation and a grade III sulcus sign. Asymptomatic posterior subluxation present at physical examination may represent normal laxity and may not indicate pathologic instability.
PURPOSE OF REVIEW: Shoulder dystocia is an obstetric emergency that is often unpredictable and unanticipated. Despite the identification of various clinical risk factors, our ability to predict and prevent shoulder dystocia is very limited. Effective and timely clinical management is essential to offer the best chance of a satisfactory outcome. RECENT FINDINGS: Upon diagnosis of the condition, a team working in tandem to resolve the problem is very effective. Use of the McRoberts maneuver, application of suprapubic pressure, with an adequate episiotomy allow resolution of over 50% of cases, with a low risk of fetal injury. Secondary maneuvers include rotation of the shoulders and delivery of the posterior shoulder. These are technically more challenging and may be associated with a higher risk of fetal injury. More drastic action may be considered in dire cases where even secondary maneuvers fail. These include the Zavanelli maneuver, symphysiotomy or iatrogenic clavicular fracture. These techniques, while seldom required, may be lifesaving in extremely severe cases. SUMMARY: Upon resolution of the clinical event, it is essential to document the entire event, and to discuss the clinical problem and management with the parents. These actions will reduce the risk of medical litigation, and improve patient satisfaction with clinical care.
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The author reports on the rupture of subscapular artery that followed the reduction of an anterior dislocation of the shoulder joint. On this occasion, vascular injuries associated with shoulder joint dislocation, their diagnosis and treatment is discussed in the article. The aim of the author was to remind the reader to a complication of our everyday activity. He wants to call attention to the importance of gentle manipulation and the careful observation of the circulation after reduction.
We studied 37 fractures lateral to the spinoglenoidal notch to evaluate the validity of collectively handling these fractures as an acromion fracture and to ascertain the mechanism of injury. We divided them into three groups according to the location of the fracture line. Fracture of the anatomic acromion or the extremely lateral scapular spine (groups I and II, 28 fractures) was frequently associated with fracture of the coracoid base, acromioclavicular joint injury, or both. The mechanism of injury in most cases was presumed to be indirect force brought to bear on the shoulder from the lateral direction. Fracture descending to the spinoglenoidal notch (group III, nine fractures) was seldom associated with other shoulder injuries, and surgery was rarely needed. The mechanism was assumed to be direct force brought to bear on the shoulder from the posterior direction. Therefore fractures of the anatomic acromion and the extremely lateral scapular spine may be managed collectively. However, fracture descending to the spinoglenoidal notch should be managed separately. We advocate that these fractures should be classified into two types in terms of clinical consideration: type I fractures, comprising those of the anatomic acromion and the extremely lateral scapular spine, and type II fractures, located in the more medial spine and descending to the spinoglenoidal notch.
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Musculoskeletal injuries are the most common injuries in youth sports. A number of growth-related factors unique to the adolescent age group play an important role in the epidemiology, types, and management of these injuries. These mainly relate to the physical and psychosocial growth and development during adolescence and are discussed in this article. Overuse injuries are more commonly seen in this age group in the primary care setting. Shoulder impingement, elbow and shoulder injuries related to throwing, stress injuries of the wrist, spondylolysis, and anterior knee pain are some of the overuse injuries reviewed in this article.
A review of the literature shows that 3% to 9% of all athletic injuries occur to the hand or wrist. Also, hand and wrist injuries are more common in pubescent and adolescent athletes than adults. Although knee and shoulder injuries are more common athletic injuries, an injury to the hand or wrist significantly can impair the athlete's ability to throw or catch a ball, or swing a bat or racquet. A college football player trains year round for just 11 or 12 hours of playing time. An athletic injury that occurs during the season can have profound consequences for the athlete's career and emotions. When defining a management plan for a particular wrist athletic injury, the time to heal the injury and the time to rehabilitate fully must be considered. The athlete must be informed fully of the length of recovery. The continued advancement of fixation methods and techniques are diminishing fracture morbidity considerably. Small-cannulated compression screws that provide rigid fixation can be inserted with decreased surgical dissection, thus preserving critical vascular supply and promoting accelerated healing and earlier rehabilitation. The arthroscope as a valuable adjunct in the management of wrist fractures was virtually unheard of years ago, but is now common. The ability to arthroscopically guide a cannulated compression screw to stabilize a scaphoid fracture without a formal open volar approach can reduce surgical morbidity significantly and allow the athlete to return to competition more quickly. Mechanisms of injury that cause osseous fractures of the wrist are fairly high energy. A high index of suspicion for associated soft tissue injuries should be kept in mind when fractures of the wrist are identified. The wrist is composed of eight carpal bones tightly interwoven with each other by intrinsic and extrinsic wrist ligaments. The management of carpal fractures depends on prompt diagnosis, stable and anatomic alignment of the involved carpal bone, protective immobilization of the injury, and thorough rehabilitation. Displaced fractures of the hook of the hamate, trapezial ridge fractures, and comminuted pisiform fractures are managed best by early excision to promote uncomplicated recovery and early return to sport. For most athletes, return to competition can be expedited safely with the use of padded gloves and custom playing splints or casts. The sports medicine physician always must put the athlete's safety first when deciding the appropriate time for return to competition.
Owing to the exceptional mechanical precariousness of the glenohumeral joint, dislocations and instabilities are common. Because posterior dislocation or instability of the joint occurs infrequently, these abnormalities may be misdiagnosed on routine radiographic examinations in acute shoulder injuries. We present five patients in whom sonographic examination was used to diagnose posterior shoulder instability (three cases) and posterior shoulder dislocation (two cases). The sonographic technique demonstrates the presence of instability or dislocation and permits dynamic examination of the shoulder joint. Ultrasonography emerges as a useful and efficient novel technique for detecting these disorders. The accuracy, sensitivity, and specificity of the technique presented here are currently being determined.
Sonography is a useful tool for the examination of the shoulder joint. Concomitant cartilaginous and soft tissue lesions (Hill-Sachs, effusion, cuff-tears) can be visualized. Subacromial pathology can be differentiated. The type of instability in the unstable shoulder can be documented. The ultrasound investigation is of diagnostic value for the unstable shoulder as well as for the impingement shoulder in athletes. Therefore it may be helpful for planning the adequate treatment and also for the follow up of the patients.
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