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Biomedical subjects

A M Pappas

Publications and source records attributed to A M Pappas.

43 records · Page 3Linked to original sources
PubMedDate not supplied

Posterior ossification of the shoulder: the Bennett lesion. Etiology, diagnosis, and treatment.

We report a series of ossific lesions of the posterior inferior glenoid in a group of elite baseball players. We hope to clarify the etiology, diagnosis, and treatment of the Bennett lesion. From August 1985 to August 1991, we identified six professional baseball pitchers and one college pitcher with evidence of ossification of the shoulder on plain radiographs, computed tomography, or magnetic resonance imaging. Arthroscopic examination was performed in all cases. All seven players had identifiable posterior labral injury on arthroscopic examination; six of these seven also had varying degrees of undersurface posterior rotator cuff damage. No anterior tissue damage, anterior instability, or subacromial impingement was noted. No ossification was identified arthroscopically. Intraarticular labral and rotator cuff tears were debrided arthroscopically and patients underwent rehabilitation for 4 to 6 months after surgery. Six of the seven athletes returned to preinjury performance levels; however, one pitcher is no longer playing competitive baseball. The Bennett lesion is an extraarticular posterior ossification associated with posterior labral injury and posterior undersurface rotator cuff damage. It is not, however, a result of traction stresses in the region of the triceps insertion. Recognition is important for identification and treatment of the lesion and associated pathologic damage.

Adolescent↗
PubMedDate not supplied

Wrist kinematics during pitching. A preliminary report.

A computerized hand and wrist motion analysis system was modified to capture data at a rate of up to 1000 Hz. Using this system, wrist flexion and extension data were collected on five right-handed professional pitchers (75 pitches). A wrist position versus time graph was generated for each pitch. The pitch data produced a reproducible analysis of motion for the majority of the pitches regardless of pitcher. Based on the graphic display of data points, four phases of wrist motion during a pitch were identified. The first phase is the cocking phase, or the motion of the wrist as it moves into maximum extension. This is then followed by the most explosive phase, the acceleration phase, which represents ball propulsion. At ball release, the wrist progresses through flexion and there is a consistent decrease in wrist velocity, known as the deceleration phase. Finally, there is the recovery phase, or the return of the wrist toward neutral. Average values for wrist range of motion, length of phase, and angular velocity (degrees per second) were calculated for each phase of the pitch. This study represents a major step toward quantifying motion of the wrist during a pitch. The ability to quantify this motion may prove valuable in the assessment of throwing athletes after injury and rehabilitation.

Acceleration↗
PubMedDate not supplied

Chronic, painful ankle instability in skeletally immature athletes. Ununited osteochondral fractures of the distal fibula.

We report 10 cases of chronic, painful ankle instability in skeletally immature athletes associated with ununited osteochondral fragments of the distal fibula. All the patients experienced multiple inversion injuries with recurrent pain and instability that failed to improve after a supervised exercise and rehabilitation program. Osteochondral fragments of the distal fibula were visible on all standard radiographs of the affected ankles. Treatment consisted of operative excision of the bony fragment and an anatomic nonaugmented repair of the lateral ligament complex and capsule. All 10 patients were available for long-term followup an average of 6.5 years (+/-2) after surgery; all ankles improved functionally, with no recurrences of instability.

Adolescent↗
PubMedDate not supplied

Osteochondrosis dissecans.

Osteochondrosis dissecans ia an osteochondrosis limited to the periphery of secondary ossification centers of diarthrodial joints. It is most frequently diagnosed in the second decade of life, and the knee is the most frequently involved joint; other commonly involved joints include the ankle, hip and elbow. Concepts of pathogenesis consist of reaction to mechanical trauma or spontaneous focal avascular osteonecrosis, but the etiology is not known; however, there is a definite correlation between skeletal maturation and outcome. The objective of treatment should be to prevent the formation of a partially detached or free osteochondral fragment. The preferred treatment in younger individuals is primarily immobilization with bivalved casts or splints. Surgery is to be recommended infrequently in the younger age group but with relatively increasing frequency with older individuals. In the older individuals, tomography, arthrography, and arthroscopy are helpful diagnostic aids in determining the appropriate treatment program. The primary objective of treatment in the older patient is preservation of a congruous articular surface.

Adolescent↗
PubMedDate not supplied

Excision of the radial head in patients younger than 18 years.

We evaluated the results of an excision of the radial head in 25 patients (27 operated-on elbows) younger than 18 years with stiff painful radiocapitellar joints. The mean age was 14.2 years (range, 4.6-17.8 years) with average follow-up of 7.8 years. Analysis of the results with a postoperative elbow score revealed excellent or good results in 19 of the 27 elbows of patients. Skeletal maturity of the patient did not alter the results based on the rating scale. Revision surgery to remove appositional bone growth was needed in six of the 12 posttraumatic cases and one of 15 developmental elbows. Cubitus valgus, wrist pain, and ulnar neuropathy were not clinical problems at follow-up examination. Excision of the radial head was beneficial for 70% of patients younger than 18 years with stiff, painful radiocapitellar joints. Results were not improved in patients who had reached skeletal maturity.

Adolescent↗