Biomedical subjects
R E Leach
Publications and source records attributed to R E Leach.
Leg and foot injuries in racquet sports.
Injuries to the lower extremity are common in racquet sports. The acute injuries usually respond well to treatment. Chronic injuries may require more patience and sometimes a change of playing habits on the part of the player. Some chronic injuries will respond well to operative intervention but most will do well with conservative care.
Lateral and medial epicondylitis of the elbow.
Tennis elbow is a common condition, with the extensor carpi radialis brevis attachment being the usual site of pain. Conservative care including decreased activity, ice, nonsteroidal anti-inflammatory medications, and muscle strengthening will help most people. The small percentage of cases that require surgery usually benefit from debridement of the damaged portion of the extensor carpi radialis brevis attachment. The postoperative course must include muscle strengthening and a gradual return to activity.
Injury and disability in the professional athlete.
An injury at work affects the professional athlete more than his nonathlete counterpart because it may portend the end of his playing career. The pertinent issues that concern the injured athlete are initial assessment of the injury, regulations governing treatment and rehabilitation of the injury, criteria for return-to-play status, determination of permanent impairment, and the athlete's rights. Permanent impairment determination procedures and compensation mechanisms are well established in each of the major professional leagues in the United States.
Results of surgery in athletes with plantar fasciitis.
Plantar fasciitis is a common cause of pain, particularly in runners and certain other athletic groups. This syndrome must be distinguished from certain other conditions, such as the tarsal tunnel syndrome and achillodynia. Conservative therapy including rest, orthotics, heel cups, anti-inflammatory agents, and icing reduce symptoms in most patients. A few athletes may need surgery to continue running. The authors released the plantar fascia and excised areas of mucinoid degeneration in 15 athletes. Fourteen returned to full athletic activity.
Ankle injuries in skiing.
With the development of new ski equipment and improvement in skiing techniques and slope grooming, the incidence, mechanism, and type of ankle injuries suffered during skiing have changed. Ankle sprains, peroneal tendon dislocations, Achilles tendon ruptures, and ankle fractures all can happen as the result of skiing. However, the incidence of these injuries has been dramatically lowered in the past two decades. All of these injuries should be treated aggressively to allow the skier to return to skiing. The early functional treatment of acute ankle sprains will return many skiers to activity quickly. With ankle fractures, lateral subluxation of the talus must be diagnosed and will be the determinant as to whether nonoperative or operative treatment is necessary. Open reduction with plating of the fibula and early weight-bearing in a brace allows early functional return to the ankle.
The use and abuse of anabolic steroids in Olympic-caliber athletes.
Self-medication with anabolic steroids by athletes, particularly in the sports of weight lifting and track and field, has become increasingly popular. In the 1983 Pan American Games, 15 athletes were disqualified for taking anabolic steroids. Athletes take steroids believing the steroids will allow increased periods of intensive training and will increase muscle strength with proper weight training. The athletes assume this increased strength and training will translate into better athletic performance. Most athletes taking anabolic steroids are taking very large doses with no thought as to the potential adverse side effects. They ignore the possibility of long-term problems relating to hypertension, liver dysfunction, and atherosclerosis for what they see as the immediate performance benefits. In an attempt to keep sports competition "clean" and to help protect athletes from harmful drugs, the International Olympic Committee (IOC) and the United States Olympic Committee have rules stating that the use of anabolic steroids is illegal. Drug testing is performed in Olympic and in many international competitions. Those people found using anabolic steroids are disqualified. This use of anabolic steroids indicates that for some athletes the need to win or to maximize performance supersedes any worries about future health.
Shoulder pain.
Disabling shoulder pain is common in those who engage in athletic activities and there is a wide spectrum of causes. Some entities are secondary to an acute injury such as a shoulder subluxation or dislocation with subsequent disability. More commonly, we see pain resulting from repeated insult, such as chronic tendinitis or attritional tears of the rotator cuff. Each entity has its own distinctive characteristics, so that a thorough history, physical examination, radiograms, and, occasionally, special studies should result in the proper diagnosis. The appropriate treatment can then be instituted, minimizing the period of disability as well as preventing future morbidity.
The disparate diameter. A sign of rotational deformity in fractures.
Although clinical assessment is usually better than radiographic evaluation in detecting rotational deformity at a fracture site, the forearm is an exception to this rule. A simple radiologic sign is here described which may uncover rotational fracture deformity: in the absence of comminution, whenever the diameter of a long bone changes abruptly across a fracture line, a significant rotational deformity must be considered. The basis for and applications of this sign are described.
The prevention and rehabilitation of soft tissue injuries.
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Results of a modified Putti-Platt operation for recurrent shoulder dislocations and subluxations.
In 78 consecutive cases of a modified Putti-Platt operation using an anterior shoulder incision, only on recurrent dislocation occurred in a 19-year-old male athlete who suffered an insulin seizure. All other patients have returned to athletic activity. This study indicates that external rotation is greater if measured with the arm at 90 degrees of abduction. Inasmuch as this is the more functional position for the arm, measurements to determine limitation of shoulder rotation should be done in this position. Results show that there is a definite individual variation in external rotation of the shoulder. The Putti-Platt operation limits external rotation by 12 degrees to 19 degrees as measured at 90 degrees of abduction. This however, has not been a functional problem in any of our patients. The modified Putti-Platt operation is a sound, surgical procedure that gives excellent functional results in an athletic population.
Rx exercise: effects and side effects.
More than ever before, physicians and patients alike are aware of the benefits of regular exercise. The involved physician must be able to prescribe individualized programs (e. g., for the post-MI patient) and to recognize side effects that may arise. Exercise is rarely ineffective as therapy: however, the potential for noncompliance is great unless the patient is motivated to begin at an appropriate level.
Secondary reconstruction of the lateral ligaments of the ankle.
Due to the increased number of participants in athletic activities and because such people continue to participate for many years, secondary reconstructions of the lateral ligaments of the ankle are performed with greater frequency. Physical examination and review of the patient's history are of more value than stress X-rays of the tibiotalar joint in determining whether or not secondary reconstructive surgery is advisable. The modified Chrisman-Snook procedure presented reconstructs the anterior talofibular ligament and the calcaneofibular ligament, thereby reducing excessive subtalar motion. The results are predictable and appear to be lasting.
Immunological characterization and quantitation of bovine vitamin K-dependent proteins.
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Cholestasis: current concepts and techniques.
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Endoscopic retrograde choledochopancreatography.
Endoscopic retrograde choledochopancreatography (ERCP) was attempted in 77 patients. Of 33 patients suspected of having bilitary tract disease, ductograms were obtained in 21. Of 56 patients suspected of having pancreatic disease, ductograms were obtained in 35. Since 12 patients were thought to have disease of both ductal systems, the total number of suspected ducts exceeds the number of patients. It is concluded that ERCP is a valuable diagnostic tool in the evaluation of pancreatic or biliary tract disease. Additional data from a prospective study are necessary to determine its clinical relevance.
Tibial osteotomy for the treatment of degenerative arthritis of the knee.
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