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Biomedical subjects

R J Hawkins

Publications and source records attributed to R J Hawkins.

At least 37 records · Page 2Linked to original sources
PubMed1996

Applications of electromyography in the throwing shoulder.

In the complex movement that makes up the baseball pitch, shoulder motion is a single link in an orderly chain of events. It can be argued, though, that herein lies the weakest link and by far the most commonly affected cog in the spectrum of overuse injuries in pitchers. Just why the shoulder receives the brunt of the stress has been the subject of numerous studies in the past several years. The tools of choice in many of these articles have been electromyography and high speed photography which have enabled researchers to study dynamically the phases of the pitch and the sequential firing of the muscles involved. With this information and the knowledge gained from studies looking at muscle activity during specific exercises, the clinician should be able to tailor a rehabilitation program that meets the needs of his or her patient. What has been learned from these articles as applied to the biomechanics of the pitch and the rehabilitation of the athlete who throws and the limitations of this form of study need to be clarified.

Biomechanical Phenomena↗
PubMed1996

Elbow injuries to the throwing athlete.

Elbow injuries in the throwing athlete are common. Because of the tremendous medial tensile forces and lateral compressive forces borne by the elbow, there is a wide array of injuries that occur. A detailed history and physical examination are necessary for an accurate diagnosis. Many of the injuries discussed can be treated successfully with conservative measures followed by aggressive physical therapy. Prompt recognition and early treatment is mandatory. In those conditions in which conservative treatment tends to fail, the detailed surgical options have been discussed. It is important to select highly motivated patients for those procedures that require extensive rehabilitation postoperatively. The keys to success in elbow surgery are a compliant patient and a well-regimented rehabilitation program.

Athletic Injuries↗
PubMed1995

Arthroscopic evaluation and treatment of shoulder instability.

The use of the arthroscope for shoulder instability has improved our understanding of normal and pathologic shoulder anatomy. We must emphasize, however, that the majority of shoulder problems can be accurately diagnosed with a thorough history and good physical examination. The arthroscope is helpful, however, to confirm a clinical diagnosis or assist in making a diagnosis in difficult or complex pathologic findings. Further, as our surgical techniques and understanding of shoulder instability improve, more pathologic entities about the shoulder become amenable to arthroscopic surgical procedures. We must emphasize that most of these arthroscopic procedures are technically demanding and significant learning curves exist. These procedures should be undertaken only by physicians who have excellent arthroscopic skills and are comfortable recognizing normal and pathologic arthroscopic anatomy of the shoulder.

Arthroscopy↗
PubMed1995

Prevention and rehabilitation of overuse injuries of the elbow.

Rehabilitation from injury and prevention of injury are terms that describe differing aspects of the same challenge. The clinician must be continually aware of the principles of rehabilitation and their order of priority (prevent further damage, restore motion, restore strength, reestablish coordination) while supervising patients' progress toward their goals. If patients are made aware of these principles at an early stage, and taught to take as much responsibility as possible for their own rehabilitative course, they will be more likely to reach their own ideal compromise of safety and speed of progress. In addition to helping with rehabilitation from injury, knowledge and self-awareness that patients obtain during this process may help in the prevention of future injuries.

Cumulative Trauma Disorders↗
PubMed1995

Operative treatment of nonunion of surgical neck fractures of the humerus.

Seventeen patients who had undergone operative treatment for painful nonunion of a surgical neck fracture of the proximal humerus were evaluated an average of 6.3 years (range, 2-11 years) from the time of surgery to determine clinical and radiographic outcome. Ten patients underwent open reduction and internal fixation with tension band wiring and Rush rods, and 7 underwent proximal humeral hemiarthroplasty. The average age of the patients was 60 years old. After surgery, pain, function, and range of motion improved for both groups. University of California Los Angeles scores improved from an average of 4.4 to 22 points in the internal fixation group and from 4.8 to 21.4 in the hemiarthroplasty group. All 17 patients were eventually able to perform activities of daily living independently. No patient in either group was able to return to his or her preinjury level of work. Nonunion persisted in 2 patients who had undergone internal fixation, and avascular necrosis developed in 2 others. Eight of 10 patients in the internal fixation group required removal of the Rush rods for treatment of symptomatic mechanical impingement. Painful nonunion of a surgical neck fracture of the proximal humerus is a difficult problem to manage operatively. Pain relief and functional improvement was similar in patients who underwent either procedure. However, 11 of 17 patients had fair or poor ultimate outcomes.

Activities of Daily Living↗
PubMed1995

Rehabilitation of the shoulder in tennis players.

The tennis player places unique demands on the shoulder by creating a high risk for overuse and overloading of the soft tissues. Tennis requires concentric work to position and move the arm, eccentric work to stabilize the shoulder, effective depression of the humeral head to avoid impingement in the overhead position, and normal stability to prevent secondary impingement. The tennis serve produces enormous angular velocities about the shoulder joint. A comprehensive rehabilitation program has been described in which the therapist, trainer, player, and physician alike need to have an understanding of the basic biomechanics of this sport. This program can be used to treat the painful shoulder, prevent injury, and enhance performance.

Athletic Injuries↗
PubMed1995

Surgical treatment of shoulder injuries in tennis players.

There are a number of disorders that affect the shoulder of the tennis player. The majority of these disorders are approached conservatively at first, and surgery is generally reserved for those with advanced stages of disease, or those who fail conservative treatment. Most surgical procedures for the shoulder are done open; however, arthroscopic techniques are advancing rapidly, and are expected to eventually supersede open surgical procedures. In either case, the postoperative rehabilitation program is an essential part of the surgical treatment of these disorders, and should not be neglected.

Acromioclavicular Joint↗
PubMed1993

Arthroscopic assessment of glenoid component loosening after total shoulder arthroplasty.

Component loosening after total shoulder arthroplasty is uncommon. Evaluation of the painful total shoulder can be difficult. Radiography may not be accurate enough to assess component loosening. A retrospective study of nine patients undergoing arthroscopy and later open surgery to confirm arthroscopic findings was undertaken. Plain radiographs correlated with component loosening in two of six patients. Arthrography correlated in one of three patients. Arthroscopy accurately evaluated glenoid component loosening in all patients with this problem. After shoulder arthroplasty patients who develop increasing pain and loss of motion require further evaluation. Radiographic studies appear to be less sensitive than arthroscopic techniques in the evaluation of glenoid component loosening. Arthroscopy has proved to be a valuable technique for the evaluation of patients with painful total shoulder arthroplasty.

Adult↗
PubMed1993

Clinical examination of the shoulder complex.

A comprehensive and systematic approach to physical examination of the shoulder is described, with particular emphasis on findings pertinent to an athletic population. The format consists of initial impression, inspection, palpation, range of motion and strength testing, stability assessment, special tests, vascular examination, and general physical examination.

Athletic Injuries↗
PubMed1993

Results of nonoperative management of full-thickness tears of the rotator cuff.

The results of nonoperative management of 53 patients with full-thickness tears of the rotator cuff proven by arthroscopic examination was as follows. Patients were treated with nonsteroidal antiinflammatory medication, stretching, strengthening, and occasional steroid injections. Average age at presentation was 62.2 years. Patients were evaluated at an average of 7.6 years. Forty patients were male, and the dominant limb was involved in 40 cases. Thirty-four patients were reviewed by questionnaire and physical examination, whereas 19 patients were evaluated by telephone interview only. In 40 patients, the onset of symptoms was associated with an injury. In 12 patients, workmen's compensation was involved. At follow-up evaluation, the 34 shoulders that were available for examination were evaluated for pain, range of motion, strength, and function. Thirty-nine of the 53 patients (74%) assessed subjectively had only slight or no shoulder discomfort. Of the 28 shoulders presenting within three months of injury, 24 (86%) were rated as satisfactory at the time of latest evaluation. Of the 16 patients who initially had had shoulder pain for over 6 months, only nine (56%) were rated as satisfactory. Most patients showed improvement with regard to their ability to perform activities of daily living. Average active total elevation was 149 degrees compared with 121 degrees at initial presentation. Thirty-two of the 34 patients examined (94%) had evidence of weakness on muscle testing and 19 (56%) had demonstrable muscle atrophy.

Activities of Daily Living↗
PubMed1993

Acute prosthetic replacement for severe fractures of the proximal humerus.

Nineteen patients with 20 severe proximal humeral fractures were treated early with a Neer humeral prosthesis from 1979 to 1986. There were 18 four-part and two three-part fractures. The average age of the patients at the time of injury was 64 years. Follow-up evaluation was performed at an average of 40 months. Pain relief was satisfactory in 18 of 20 fractures. Patients were satisfied with the result in 16 of the 20 shoulders. Functional evaluation was good or fair in 15 of 20 patients. Active forward elevation averaged 72 degrees and active external rotation 16 degrees. Complications consisted of one axillary nerve palsy, one postoperative posterior dislocation, loosening of one uncemented humeral prosthesis, and one breakage of fixation wire requiring subsequent removal. Patients who could not comply with the postoperative rehabilitation program had poor results. Poor function appeared to be directly related to lack of rotator cuff integrity. Surgical techniques designed to securing tuberosity union are essential.

Activities of Daily Living↗
PubMed1993

Classification and physical diagnosis of instability of the shoulder.

Recent clinical and basic science work has increased our knowledge of shoulder instability. Valuable information has been gained by cutting studies of the capsuloligamentous complex to clarify the biomechanics of instability. It is now clear that a significant overlap exists in the concepts of instability and impingement relating to anterior shoulder pain. These concepts have added new importance to organization and standardization when classifying and diagnosing shoulder instability. This manuscript presents an algorithmic approach to classification of shoulder girdle complaints that may be related to instability. This classification system is designed around the direction, degree, chronology, cause, and volition of instability. With accurate and detailed analysis of the historical presentation, most shoulder instability complaints can be classified using this approach. The physical examination also should proceed in an orderly fashion, including general impression of the musculoskeletal system, inspection, palpation, and range of motion of both the uninvolved and involved shoulder, neurologic examination, rotator cuff evaluation, and stability assessment. Stability assessment includes glenohumeral translation examination with apprehension and provocative testing. Management techniques are predicted on an accurate diagnosis. With a thorough and organized examination, the correct diagnosis can be achieved.

Adult↗
PubMed1992

Release of the subscapularis for internal rotation contracture and pain after anterior repair for recurrent anterior dislocation of the shoulder.

Ten patients who had an internal rotation contracture and pain after an anterior repair for recurrent dislocation of the shoulder were treated by release of the subscapularis muscle. For six of the patients, radiographs demonstrated severe osteoarthrotic changes in the shoulder as well. The release was done an average of eleven years after the original procedure, which, for most patients, had been a Putti-Platt repair. After release of the subscapularis, each patient had less pain in the shoulder and an average increase of 27 degrees of external rotation. Release of the subscapularis can offer relief of pain and of functional limitations associated with the symptoms caused by an internal rotation contracture after an anterior repair of the shoulder.

Adult↗
PubMed1991

Current concepts and recent advances in the athlete's shoulder.

The demands placed on the shoulder girdle during athletics can often exceed its physiologic limits and result in significant injury. The goal of orthopedists, therapists, trainers, and ancillary personnel who care for athletes involved in sports which require extreme demands of the shoulder is to enhance athletic performance, extend their longevity, and prevent injury. With the new concepts available from basic science and clinical research, a clear understanding of normal architecture and biomechanical function of the shoulder girdle is better appreciated. A greater understanding of sporting activities and their physiologic demands on the shoulder are also more clear. The future of all this research seems to be pointing toward maintenance and restoration of normal anatomy and physiology about the shoulder girdle.

Athletic Injuries↗