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At least 361 records · Page 20Linked to original sources
PubMed2004

Pseudarthrosis of the first rib in the overhead athlete.

Fractures of the first rib are uncommon in athletes and present a different clinical entity from traumatic first rib fracture associated with high energy thoracic trauma. These fractures are stress induced and precipitated by chronic muscular forces acting on the first rib. Typically they heal with conservative treatment. This report describes a fracture of the first rib in a tennis player that developed into a symptomatic pseudarthrosis as a result of persistent overhead activities. Symptoms mimicked ipsilateral shoulder injury. Pseudarthrosis of the first rib should be included in the differential diagnosis of chronic persistent shoulder pain in the overhead athlete.

Adult↗
PubMedDate not supplied

Isokinetic eccentric-to-concentric strength ratios of the shoulder rotator muscles in throwers and nonthrowers.

BACKGROUND: One of the possible mechanisms leading to shoulder injury may be a strength imbalance between those muscles that accelerate the upper limb and those responsible for deceleration. Many studies have examined shoulder balance through a concentric strength ratio of external and internal shoulder rotator muscles. HYPOTHESIS: A functional external eccentric-to-internal concentric ratio may be a better identifier of muscular imbalance in dominant and nondominant shoulders of throwers and nonthrowers. STUDY DESIGN: Controlled laboratory study. METHODS: Eccentric external and concentric internal peak torques were measured bilaterally in 59 men (16 throwers and 43 nonthrowers) at 300 deg/sec. Subjects were tested in the supine position with the shoulder abducted to 90 degrees and the elbow flexed to 90 degrees. RESULTS: Throwers exhibited significantly lower ratios than nonthrowers in their dominant limb; there was no difference between groups for the nondominant limb. CONCLUSIONS: The lower ratio in the throwers' dominant limb was attributed to significantly greater concentric internal rotation torques without concomitant eccentric external torque gains. CLINICAL RELEVANCE: Rehabilitation and injury prevention regimens that include functional exercises to improve eccentric external rotation strength may bring more balance to the dominant shoulder of throwing athletes.

Adolescent↗
PubMed1998

Epidemiology of collegiate baseball injuries.

OBJECTIVE: We sought to establish injury incidence, onset, location, type, and severity for a collegiate baseball team. The second objective was to compare the number of musculoskeletal problems for which baseball players sought treatment with those that resulted in time lost or modified participation. METHODS: This was a prospective, epidemiologic study. A complaint was defined as any evaluation by a player to the medical staff that required either evaluation or treatment. An injury was defined as any complaint that resulted in altered participation or time lost from practice or game participation. Participants were Division I collegiate baseball team with one athletic trainer and one academic sports medicine specialist. All members of the collegiate baseball team were studied over a 3-year period to determine the overall incidence of injury per 1,000 exposures (A-E) to practice or participation, injuries sustained over 3 years by collegiate baseball players. RESULTS: Overall there were 277 complaints and 52 injuries (19%). The A-E rate was 5.83. Forty-six percent of the injuries occurred in practice and 54% in games. Seventy-three percent of the injuries resulted in < 7 days lost from sport, and 25% resulted in > 21 days lost participation. The most common origin of injury was strains (23%), sprains (19%), and contusions (17%). Fifty-eight percent of the injuries were to the upper extremity, 15% to the trunk/back, and 27% to a lower extremity. Upper extremity injuries accounted for 75% of the total time lost from the sport. When divided by position, the shoulder injuries occurred in pitchers (69%), infielders (19%), and outfielders (12%). Rotator cuff tendinitis was the most frequent complaint, was the most frequent injury, and resulted in the most time lost from the sport. CONCLUSIONS: Defining injury as time lost or as altered participation underestimates the frequency with which players seek evaluation and treatment. Injuries are divided widely across anatomic site, but upper extremity injuries cause the most time lost from the sport. Further study of the origin and prevention of upper extremity injuries in baseball is warranted.

Adult↗
PubMedDate not supplied

Injuries and overuse syndromes in golf.

BACKGROUND: Although golf is becoming more popular, there is a lack of reliable epidemiologic data on golf injuries and overuse syndromes, especially regarding their severity. OBJECTIVE: To perform an epidemiologic study of the variety of different musculoskeletal problems in professional and amateur golfers and to find associations of age, sex, physical stature (body mass index), warm-up routine, and playing level with the occurrence of reported injuries. STUDY DESIGN: Retrospective cohort study. METHODS: We analyzed the injury data from a total of 703 golfers who were randomly selected over two golfing seasons and interviewed with the use of a six-page questionnaire. RESULTS: Overall, 82.6% (N = 526) of reported injuries involved overuse and 17.4% (N = 111) were single trauma events. Professional golfers were injured more often, typically in the back, wrist, and shoulder. Amateurs reported many elbow, back, and shoulder injuries. Severity of reported injuries was minor in 51.5%, moderate in 26.8%, and major in 21.7% of cases. Carrying one's bag proved to be hazardous to the lower back, shoulder, and ankle. Warm-up routines were found to have a positive effect if they were at least 10 minutes long. CONCLUSIONS: Overall, golf may be considered a rather benign activity, if overuse can be avoided. If not, golf can result in serious, chronic musculoskeletal problems.

Adult↗
PubMed1994

Brachial plexus injury with cough attack: case report.

Cough attacks elicited by movement of the neck and right arm are reported in a patient who had sustained several shoulder injuries and who had an anterior scalenectomy. The coughing was accompanied by weakness in the right upper limb. At exploration, the phrenic nerve was found adhered to the brachial plexus. The cough attacks disappeared, and the weakness of the right upper limb improved somewhat after lysis of the adhesions between the phrenic nerve and the plexus and after external neurolysis of the upper, middle, and lower trunks. Postoperatively, the patient could elevate his right arm without coughing.

Brachial Plexus↗
PubMed1984

Injuries of the shoulder and arm.

A systematic approach to the injured shoulder includes careful history taking and sequential examination of all anatomic components of the shoulder girdle in each and every patient. High quality radiographs, with two views at 90 degrees to one another, are essential. A specific diagnosis can and must be made on every patient with an injured shoulder to enable referral for proper care and follow-up.

Acromioclavicular Joint↗
PubMed2004

Nerve injury about the shoulder in athletes, part 2: long thoracic nerve, spinal accessory nerve, burners/stingers, thoracic outlet syndrome.

Nerve injuries about the shoulder in athletes are being recognized with increasing frequency. Prompt and correct diagnosis of these injuries is important to treat the patient and to understand the potential complications and natural history, so as to counsel our athletes appropriately. This 2-part article is a review and an overview of the current state of knowledge regarding some of the more common nerve injuries seen about the shoulder in athletes, including long thoracic nerve, spinal accessory nerve, burners and stingers, and thoracic outlet syndrome. Each of these clinical entities will be discussed independently, reviewing the anatomy, mechanism of injury, patient presentation (history and examination), the role of additional diagnostic studies, differential diagnosis, and management.

Accessory Nerve Injuries↗
PubMed1981

Brachial plexus compression: complication of delayed recognition of arterial injuries of the shoulder girdle.

In six cases of penetrating trauma to the subclavian or axillary arteries without primary coincident injury to the brachial plexus, the vascular injury was not initially recognized as there were no suggestive clinical signs. The first clinical sign of vascular injury in all cases was delayed onset of brachial plexus palsy due to compression by an expanding false aneurysm. Following vascular repair, neurological recovery occurred only in two of six cases. Since brachial plexus injuries are associated with a poor prognosis, and the functional impairment of the upper extremity is serious, an aggressive investigative approach to all penetrating shoulder girdle injuries is advocated. Arteriography should be considered, even when suggestive clinical signs of vascular injury are absent. Even relatively small false aneurysms should be repaired without delay before the onset of neurological symptoms.

Adolescent↗
PubMed2005

A systematic approach to magnetic resonance imaging interpretation of sports medicine injuries of the shoulder.

Magnetic resonance imaging has developed as a useful imaging modality in the evaluation of the athlete with shoulder pain. The multiplanar capabilities of magnetic resonance imaging make it ideal for detecting the anatomical variations of the osseous outlet that may contribute to the clinical syndrome of impingement. Its superb soft tissue contrast and spatial resolution allow for accurate differentiation between tendinopathy, partial-thickness tear, and full-thickness tear of the rotator cuff and also allow for detection of the subtle lesions of the capsule and labrum that are associated with shoulder instability. However, to accurately interpret the numerous images and pulse sequences obtained in a standard magnetic resonance examination of the shoulder, it is helpful to have a systematic approach to ensure that each of the pertinent anatomical structures are evaluated. This article will provide a systematic approach to the interpretation of a magnetic resonance examination of the shoulder. The normal imaging appearance of each anatomical structure will be described, and the most useful pulse sequences and imaging planes for the evaluation of each structure will be discussed. Finally, the signs of injury will be described and illustrated.

Acromion↗
PubMedDate not supplied

[Injury and overuse pattern in professional ballet dancers].

AIM: The purpose of the study was to show the injury profile and common discomforts of professional ballet dancers and to examine factors that affect the frequency of the injuries, like age, gender, regeneration activities. METHOD: 42 female and 35 male dancers in German theaters were evaluated by a questionnaire, training observation, and physical examination. RESULTS: Common discomfort was described frequently in the lumbar spine (88%), the knee (80.5%), and the ankle (74%). 285 injuries occurred in the female, 282 in the male dancers during a 5-year period. The most frequent injuries were muscle strains and inflammations, mostly of the lower extremity (64%) and the torso (24%). Gender differences were found in shoulder injuries, which occurred in 9% of cases in men, compared to 2.5% in women. 73% of the injuries considered as severe were traumatically caused when performing jumps and lifts. Severe overuse injuries were mostly found in the lower extremity and the lumbar spine, caused by technical deficiencies. 54% still suffered from the consequences of the injury by returning pain, swelling or instability. CONCLUSION: This high amount of injuries can be reduced by continuous technical improvement, the use of auxiliary material like joint-protectors or mats and enough time for regeneration.

Adult↗
PubMed1988

[Sprains and dislocations of large joints. The shoulder joint].

Injuries of the shoulder joint require exact diagnostic assessment. Soft tissue lesions which lead to instability of the joint must be recognized and treated adequately. Besides clinical and radiological examination, arthroscopy and sonography are becoming increasingly important. Acute sprain of the shoulder joint without instability is treated by a short immobilisation followed by active exercises, sprain (distorsion) with instability (dislocation!) may be treated by short immobilisation (two weeks) and early functional exercises or operatively by repair of a Bankart lesion, rupture of the rotatorcuff etc. A correlation between duration of immobilisation and subsequent recurrent dislocation has not be proven yet.

Adult↗
PubMed2005

Low-energy arterial injury at the shoulder with progressive or delayed nerve palsy.

We describe 20 patients, aged between 43 and 88 years, with delayed nerve palsy or deepening of an initial palsy caused by arterial injury from low-energy injuries to the shoulder. The onset of palsy ranged from immediately after the injury to four months later. There was progression in all the patients with an initial partial nerve palsy. Pain was severe in 18 patients, in 16 of whom it presented as neurostenalgia and in two as causalgia. Dislocation of the shoulder or fracture of the proximal humerus occurred in 16 patients. There was soft-tissue crushing in two and prolonged unconsciousness from alcoholic intoxication in another two. Decompression of the plexus and repair of the arterial injury brought swift relief from pain in all the patients. Nerve recovery was generally good, but less so in neglected cases. The interval from injury to the repair of the vessels ranged from immediately afterwards to 120 days. Delayed onset of nerve palsy or deepening of a nerve lesion is caused by bleeding and/or impending critical ischaemia and is an overwhelming indication for urgent surgery. There is almost always severe neuropathic pain.

Adult↗
PubMed1989

Sports injuries of the shoulder.

Much strain is placed on the shoulder joint in all sports. Sports injuries may be caused by a single, violent incident. Fractures of the clavicle, acromioclavicular and sternoclavicular traumas, isolated fractures of the greater tuberosity and shoulder dislocations are frequent clinical pictures which today can be managed by well established procedures. Other sports injuries, however, involve over-use of the shoulder which, through repetitive harmful movements, can bring about microtraumatic lesions of the rotator cuff, glenoid labrum, acromioclavicular joint and certain peripheral nerves around the suprascapularis. In all cases, a programmed, comparative, clinical examination and complementary, sequential examinations will indicate suitable curative and preventive treatment.

Acromioclavicular Joint↗
PubMed2005

Glenohumeral range of motion deficits and posterior shoulder tightness in throwers with pathologic internal impingement.

BACKGROUND: Alterations in glenohumeral range of motion, including increased posterior shoulder tightness and glenohumeral internal rotation deficit that exceeds the accompanying external rotation gain, are suggested contributors to throwing-related shoulder injuries such as pathologic internal impingement. Yet these contributors have not been identified in throwers with internal impingement. HYPOTHESIS: Throwers with pathologic internal impingement will exhibit significantly increased posterior shoulder tightness and glenohumeral internal rotation deficit without significantly increased external rotation gain. STUDY DESIGN: Case control study; Level of evidence, 3. METHODS: Eleven throwing athletes with pathologic internal impingement diagnosed using both clinical examination and a magnetic resonance arthrogram were demographically matched with 11 control throwers who had no history of upper extremity injury. Passive glenohumeral internal and external rotation were measured bilaterally with standard goniometry at 90 degrees of humeral abduction and elbow flexion. Bilateral differences in glenohumeral range of motion were used to calculate glenohumeral internal rotation deficit and external rotation gain. Posterior shoulder tightness was quantified as the bilateral difference in passive shoulder horizontal adduction with the scapula retracted and the shoulder at 90 degrees of elevation. Comparisons were made between groups with dependent t tests (P < .05). RESULTS: The throwing athletes with internal impingement demonstrated significantly greater glenohumeral internal rotation deficit (P = .03) and posterior shoulder tightness (P = .03) compared with the control subjects. No significant differences were observed in external rotation gain between groups (P = .16). CLINICAL RELEVANCE: These findings could indicate that a tightening of the posterior elements of the shoulder (capsule, rotator cuff) may contribute to impingement. The results suggest that management should include stretching to restore flexibility to the posterior shoulder.

Adult↗
PubMed2002

Mountain biking injuries: an update.

This article reviews the available literature regarding injuries in off-road bicyclists. Recent progress in injury research has allowed the description of several patterns of injury in this sport. Mountain biking remains popular, particularly among young males, although sales and participation figures have decreased in the last several years. Competition in downhill racing has increased, while cross-country racing has decreased somewhat in popularity. Recreational riders comprise the largest segment of participants, but little is known about the demographics and injury epidemiology of noncompetitive mountain cyclists. Most mountain bikers participating in surveys reported a history of previous injuries, but prospective studies conducted at mountain bike races have found injury rates of <1%. The most common mechanism of injury involves a forward fall over the handlebars, usually while riding downhill, which can result in direct trauma to the head, torso and upper extremities. A variety of factors can be associated with this type of fall, including trail surface irregularities, mechanical failures and loss of control. In mountain bike racing the risk of injury may be higher for women than men. Minor injuries such as abrasions and contusions occur frequently, but are usually of little consequence. Fractures usually involve the torso or upper extremities, and shoulder injuries are common. Head and face injuries are not always prevented by current helmet designs. Fatal injuries are rare but have been reported. Improvements in safety equipment, rider training and racecourse design are suggested injury prevention measures. The authors encourage continued research in this sport.

Accident Prevention↗
PubMed1991

Osteonecrosis: an overuse injury of the shoulder in paraplegia: case report.

The shoulder of the wheelchair dependent paraplegic is subject to overuse injury with subsequent pain. The major overuse syndromes observed include soft tissue injuries and secondary degenerative arthritis. This report presents a case in which bilateral osteonecrosis of the humeral heads was found to be the source of pain in the shoulders of an active paraplegic without any evidence of disease or medical treatment associated with the development of osteonecrosis. Osteonecrosis should be entertained in the differential diagnosis of overuse injuries of the shoulder in paraplegia.

Adult↗
PubMedDate not supplied

Instrumented measurement of glenohumeral joint laxity and its relationship to passive range of motion and generalized joint laxity.

The purpose of this study was to objectively characterize in vivo glenohumeral joint laxity using an instrumented shoulder arthrometer. Secondary objectives were to examine the relationship of glenohumeral joint laxity with passive range of motion and generalized joint laxity. Fifty-one recreational athletes with no history of shoulder injury or long-term participation in overhead sports participated in this study. Anterior and posterior laxity data were obtained at displacement forces of 67, 89, 111, and 134 N. Bilateral passive shoulder range of motion measures were obtained, and a modified Beighton Mobility Score was used to quantify generalized joint laxity. There were no significant differences in glenohumeral joint laxity between the right and left shoulders (P values = 0.14 to 0.73). No significant differences in laxity were seen between directions (F(1,400) = 1.35, P = 0.25). However, significant differences were observed between force levels (F(3,400) = 27.17, P < 0.0001). No moderate or stronger correlations between laxity, passive range of motion, and generalized joint laxity were seen. These data confirm the presence of a wide spectrum of symmetric laxity in subjects that fails to correlate strongly with passive range of motion or generalized joint laxity.

Adult↗