Search PubMed⌕ Search

Biomedical subjects

J S Torg

Publications and source records attributed to J S Torg.

At least 55 records · Page 3Linked to original sources
PubMed1987

Lachman test evaluated. Quantification of a clinical observation.

The Lachman test has become recognized as the most reliable noninvasive clinical method for determining the integrity of the anterior cruciate ligament. The original description provided for the test is reported as either positive or negative. The purpose of this study is to present a clinical grading system for positive examinations. The criteria are as follows: Grade I, proprioceptive appreciation of a positive test; Grade II, visible anterior translation of the tibia; Grade III, passive subluxation of the tibia with the patient supine; and Grade IV, ability of the patient with a cruciate-deficient knee to actively sublux the proximal tibia. Seventy-five patients with arthroscopically documented complete anterior cruciate ligament tears were examined clinically and graded using the above criteria. In addition, all patients had arthrometric examinations to measure the amount of anterior subluxation of the tibia in millimeters. A one-way analysis of variance followed by Scheffe multiple comparisons demonstrated the mean measurements of anterior displacement of the tibia in each laxity group to be significantly different.

Adolescent↗
PubMed1986

Neurapraxia of the cervical spinal cord with transient quadriplegia.

The purpose of this study was to define as a distinct clinical entity the syndrome of neurapraxia of the cervical spinal cord with transient quadriplegia. The sensory changes include burning pain, numbness, tingling, and loss of sensation, while the motor changes range from weakness to complete paralysis. The episodes are transient and complete recovery usually occurs in ten to fifteen minutes, although in some patients gradual resolution occurs over a period of thirty-six to forty-eight hours. Except for burning paresthesia, pain in the neck is not present at the time of injury and there is complete return of motor function and full, pain-free motion of the cervical spine. In our series, routine roentgenograms of the cervical spine were negative for fractures or dislocations in all patients. However, the roentgenographic findings did include developmental spinal stenosis in seventeen patients, congenital fusion in five patients, cervical instability in four patients, and intervertebral disc disease in six patients. Spinal stenosis was determined by two different roentgenographic methods. The first was the standard method, and the second was a ratio method devised by us. Both measurements were made at the level of the third through the sixth vertebral body on a routine lateral roentgenogram of the cervical spine that was available for twenty-four of the thirty-two patients and for a control group of forty-nine male subjects of similar age who did not have any neurological complaints. Using the ratio method, a measurement of less than 0.80 indicated significant spinal stenosis in the group of twenty-four patients for whom roentgenograms were available, as compared with a ratio of approximately 1.00 or more in the control group. There was statistically significant spinal stenosis (p less than 0.0001) in all of the patients as compared with the control subjects by both methods of determining spinal stenosis. A survey of 503 schools participating in National Collegiate Athletic Association (NCAA) football in the 1984 season found that 1.3 per 10,000 athletes had a history that was suggestive of neurapraxia of the cervical spinal cord. The phenomenon of neurapraxia of the cervical spinal cord occurs in individuals with developmental stenosis of the cervical spine, congenital fusion, cervical instability, or protrusion of an intervertebral disc in association with a decrease in the anteroposterior diameter of the spinal canal. We postulate that in athletes with diminution of the anteroposterior diameter of the spinal canal the spinal cord can, on forced hyperextension or hyperflexion, be compressed, causing transitory motor and sensory manifestations.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1985

The National Football Head and Neck Injury Registry. 14-year report on cervical quadriplegia, 1971 through 1984.

Data on cervical spine injuries resulting from participation in football have been compiled by a national registry. Analysis of epidemiologic data and cinematographic documentation clearly demonstrated that the majority of cervical fractures and dislocations were due to axial loading. On the basis of this observation, rule changes banning both deliberate "spearing" and the use of the top of the helmet as the initial point of contact in making a tackle were implemented at the high school and college level. Subsequently, a marked decrease in cervical spine injury rates has occurred. The occurrence of permanent cervical quadriplegia decreased from 34 in 1976 to five in the 1984 season. It is suggested that axial loading of the cervical spine is also responsible for the catastrophic injuries in diving, rugby, ice hockey, and gymnastics. Implementation of appropriate changes in playing techniques and/or equipment modifications could possibly reduce the incidence of cervical spine injuries in these activities.

Athletic Injuries↗
PubMed1985

Fibular head transposition for repair of cruciate-deficient stifle in the dog.

Fibular head transposition (FHT) was introduced as a surgical technique to reconstruct the cruciate-deficient stifle in the dog. Surgically moving the fibular head into a cranial position alters the orientation of the lateral collateral ligament, thereby preventing cranial drawer motion and minimizing internal rotation of the tibia. The technique was found to be safe, mechanically sound, and clinically effective. Comparison of clinical results for this technique with those for the fascial strip technique (using a uniform grading system) demonstrated an overall superior performance of FHT. Factors found to adversely influence clinical results were heavy body weight and meniscal damage. The interval between stifle injury and reconstructive surgery or the presence of associated osteoarthritic disease bore no relationship to clinical outcome. It was concluded that the clinical performance after FHT was equal or superior to other surgical methods for reconstructing the cruciate-deficient stifle in the dog.

Animals↗
PubMed1985

Application of electrothermal energy in arthroscopy.

Bovine stifle joints were utilized for the application of electrothermal energy in arthroscopic surgical procedures. The anatomy of the bovine stifle joint was comparable to that of the human knee and proved to be a suitable model for arthroscopic surgery. Partial and total meniscectomies were performed in vitro and in situ on cadaveric stifle joints using 1.5% glycine as a liquid medium. Histologic preparations revealed no adverse effects associated with the use of glycine, and coagulation necrosis never extended more than 0.1 mm into the meniscal substance. Instrumentation designed specifically for the intraarticular application of electrothermal energy facilitated arthroscopic meniscectomy with minimal effect on adjacent tissue.

Animals↗
PubMed1985

Maintenance of hamstring strength following knee surgery.

Following a variety of surgical procedures on the knee, routine clinical Cybex testing demonstrated that the hamstring muscle group loses less strength than the quadriceps group, regardless of whether the hamstrings were exercised during the rehabilitation. Two groups of postsurgical patients were randomly selected to evaluate the effects of surgery on the muscle strength of the quadriceps and hamstrings. Group I (N = 15) underwent arthrotomy and medial meniscectomy. Group II (N = 20) underwent an extraarticular substitution of the anterior cruciate ligament. All subjects were tested on a Cybex II at 60 degrees/s: Group I at 5-10 wk (mean, 7.0), and Group II at 15-22 wk (mean, 18.6). Peak torque for the quadriceps and hamstrings was measured at 30, 60, and 90 degrees. The percent deficits of the quadriceps and hamstrings were analyzed by a three-way ANOVA. The hamstring deficit was significantly less (P = 0.041) than the quadriceps deficit. A significant difference (P less than 0.001) was found between the two surgery groups. No significant difference in percent strength deficit was found at the various joint angles (30, 60, and 90 degrees). Lastly, the factors examined in the ANOVA did not contribute to a significant first or second order interaction. The authors conclude that specific hamstring strengthening postsurgically is not always indicated.

Adolescent↗
PubMed1985

Trampoline and minitrampoline injuries to the cervical spine.

The purpose of this paper is to (1) examine the world's literature documenting cervical spine injuries; (2) attempt to identify common factors regarding patient characteristics, environment, injury mechanisms, and pathology; (3) review policy statements and safety guidelines of various medical and athletic administrative bodies; and (4) evaluate what effect, if any, these policies and guidelines have had on documented injuries. On the basis of this review, we believe that the American Academy of Pediatrics was ill-advised in altering its position on the use of trampolines. It is our opinion that both the trampoline and the minitrampoline are dangerous devices when used in the best of circumstances, and their use has no place in recreational, educational, or competitive gymnastics.

Accident Prevention↗
PubMed1985

Epidemiology, pathomechanics, and prevention of athletic injuries to the cervical spine.

Athletic injuries to the cervical spine associated with quadriplegia most commonly occur as a result of axial loading. Whether it be a football player striking an opponent with the top or crown of his helmet, a poorly executed dive into a shallow body of water where the subject strikes his head on the bottom, or a hockey player pushed into the boards head first, the fragile cervical spine is compressed between the rapidly decelerated head and the continued momentum of the body. Appropriate rule changes recognizing this mechanism have resulted in a reduction of football quadriplegia by two-thirds. Presumably, educational efforts designed to inform the public of the dangers of diving would have a similar effect. The predominance of the axial loading mechanism is not as clearly defined in trampoline and minitrampoline injuries. However, both of these devices are dangerous when used in the best of circumstances, and their use has no place in recreational, educational, or competitive gymnastics. The emergence of severe cervical spine injuries resulting from ice hockey is recognized. Methods, based on sound scientific evidence, to modify the games so as to prevent these injuries are lacking.

Adolescent↗
PubMed1984

Trampoline-related quadriplegia: review of the literature and reflections on the American Academy of Pediatrics' position statement.

A review of the world's literature documenting cervical spine injuries has been made in an attempt to determine common factors regarding patient characteristics, environment, injury mechanisms, and pathology. The policy statements and safety guidelines of both the American Academy of Pediatrics and athletic administrative bodies have been reviewed in order to evaluate what effect, if any, these policies and guidelines have had on documented injuries. On the basis of this review, it is believed that the AAP was ill-advised in altering its position on the use of trampolines. The opinion is presented that both the trampoline and minitrampoline are dangerous devices when used in the best of circumstances, and their use has no place in recreational, educational, or competitive gymnastics.

Accidents↗
PubMed1984

Fractures of the base of the fifth metatarsal distal to the tuberosity. Classification and guidelines for non-surgical and surgical management.

Between 1973 and 1982 forty-six fractures of the base of the fifth metatarsal, distal to the tuberosity, were treated and followed for a mean of forty months (range, six to 108 months). Roentgenographic criteria were used to define three types of fractures: acute fractures characterized by a narrow fracture line and absence of intramedullary sclerosis; those with delayed union, with widening of the fracture line and evidence of intramedullary sclerosis; and those with non-union and complete obliteration of the medullary canal by sclerotic bone. Of the twenty-five acute fractures in this series, fifteen were treated with a non-weight-bearing toe-to-knee cast, and fourteen of them healed in a mean of seven weeks. Only four of the other ten, which were treated with various weight-bearing methods, progressed to union. Of the twelve patients with delayed union, one refused treatment, one was treated with a bone graft, and ten were treated initially by immobilization of the limb in a plaster cast and weight-bearing. Of these ten fractures, seven healed in a mean of 15.1 months and three eventually required grafting for non-union. Of the nine non-unions in the series, which were treated primarily with medullary curettage and bone-grafting, eight healed in a mean of three months. In all, twenty fractures were treated surgically with an autogenous corticocancellous graft that was inlaid after thorough curettage and drilling of the sclerotic bone that obliterated the intramedullary cavity. Of these twenty fractures, nineteen progressed to complete healing and one, to asymptomatic non-union.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1983

Tarsal navicular stress fractures: radiographic evaluation.

Tarsal navicular stress fractures are a potential source of disabling foot pain in physically active individuals. The diagnosis of tarsal navicular stress fracture requires a high index of clinical and radiographic suspicion because the fracture is only rarely evident on routine radiographs or standard tomograms. The radiographic diagnosis of a tarsal navicular stress fracture may require anatomic anteroposterior tomograms or a radionuclide bone scan with plantar views. Radiographic examinations of 23 fractures in 21 patients are evaluated.

Adult↗
PubMed1982

Stress fractures of the pubic ramus. A report of twelve cases.

Twelve stress fractures of the pubic arch were seen in eleven patients who were joggers, long-distance runners, or marathoners. In two of the fractures there were complications of healing; that is, delayed union or refracture. With two exceptions, the lesions occurred in women between the ages of nineteen and forty-eight. In all of the patients the fracture was in the inferior pubic ramus near the symphysis pubis, and caused pain in the groin, buttock, or thigh. All fractures were non-displaced and easy to overlook on the initial radiographic examination; when a fracture of the pubic arch was clinically suspected but the radiographs were normal, a radionuclide bone scan was diagnostic. After identification of the fracture, running had to be curtailed until the symptoms disappeared in order for healing to occur.

Adult↗
PubMed1981

Salter-Harris type-III fracture of the medial femoral condyle occurring in the adolescent athlete.

This report adds six Salter-Harris type-III fractures of the medial femoral condyle to the fourteen such fractures that have been previously reported in the English literature. The injury results from a valgus force applied to the knee. As the fracture may reduce spontaneously, radiographs may not be diagnostic and the fracture may be unrecognized or be mistaken for disruption of the medial collateral ligament. If a fracture is suspected, a cross-table lateral radiograph should be made in an attempt to detect fat within the joint fluid and confirm the existence of an intra-articular fracture. An oblique, tunnel (notch), or over-penetrated radiograph may demonstrate the fracture. However, if it fails to do so, radiographs made with valgus stress applied to the knee while the patient is under general anesthesia may be necessary. In our six patients, satisfactory healing of the fracture occurred after either spontaneous or manipulative reduction and subsequent non-weight-bearing immobilization in cylinder cast. Minimum femoral shortening developed in two patients, late anterior cruciate laxity was demonstrable in two patients, and one patient required arthrotomy for removal of an osteochondral fracture fragment.

Adolescent↗
PubMed1979

The National Football Head and Neck Injury Registry. Report and conclusions 1978.

The National Football Head and Neck Injury Registry has documented 1,129 injuries since 1971 that involved hospitalization for more than 72 hours, surgical intervention, fracture-dislocation, permanent paralysis, or death. Of this group of injuries, 550 were fracture-dislocations of the cervical spine, of which 176 were associated with permanent quadriplegia. It appears that during the last two decades, there has been a decrease in the incidence of direct fatalities, head injuries associated with intracranial hemorrhage, and injuries associated with death. Conversely, cervical spine injuries with fracture-dislocation and with permanent quadriplegia have increased. We believe that these observations are the result of the development of a protective helmet-face mask system that has effectively protected the head, and by so doing has allowed it to be used as a battering ram in tackling and blocking techniques, thus placing the cervical spine at risk of injury.

Athletic Injuries↗