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Magnetic resonance imaging of the elbow.

Magnetic resonance imaging (MRI) provides useful information regarding the elbow joint. Many abnormalities seen in the elbow are a result of trauma, often from sports such as baseball and tennis. Elbow problems are frequently related to the medial tension-lateral compression phenomenon where repeated valgus stress produces flexor-pronator strain, ulnar collateral ligament sprain, ulnar traction spurring, and ulnar neuropathy. The lateral compression causes osteochondritis dissecans of the capitellum and radial head, degenerative arthritis, and loose bodies. Other elbow abnormalities seen on MRI include radial collateral ligament injuries, biceps and triceps tendon injuries, other nerve entrapment syndromes, loose bodies, osseous and soft tissue trauma, arthritis, and masses, including bursae.

Arm Injuries↗

Expression of the Krüppel-like zinc finger gene biklf during zebrafish development.

The zebrafish biklf gene encodes a novel Krüppel-like transcription factor containing three contiguous zinc fingers at the C-terminus. Expression of biklf is detected from the shield stage onward in the developing prechordal plate, and as a 'baseball seam'-like lateral stripe beginning at the end of gastrulation. The latter expression domain is suppressed in the swirl mutant in which bmp2b is disrupted. At the 5-somite stage the lateral expression domain separates into two distinct stripes, one in the ectoderm, the other in blood islands in the lateral plate mesoderm. Blood island staining of biklf continues through somitogenesis as the most prominent area of biklf expression.

Amino Acid Sequence↗

A new class of hexahelical insect proteins revealed as putative carriers of small hydrophobic ligands.

BACKGROUND: THP12 is an abundant and extraordinarily hydrophilic hemolymph protein from the mealworm Tenebrio molitor and belongs to a group of small insect proteins with four highly conserved cysteine residues. Despite their sequence homology to odorant-binding proteins and pheromone-binding proteins, the function of these proteins is unclear. RESULTS: The first three-dimensional structure of THP12 has been determined by multidimensional NMR spectroscopy. The protein has a nonbundle helical structure consisting of six alpha helices. The arrangement of the alpha helices has a 'baseball glove' shape. In addition to the hydrophobic core, electrostatic interactions make contributions to the overall stability of the protein. NMR binding studies demonstrated the binding of small hydrophobic ligands to the single hydrophobic groove in THP12. Comparing the structure of THP12 with the predicted secondary structure of homologs reveals a common fold for this new class of insect proteins. A search with the program DALI revealed extensive similarity between the three-dimensional structure of THP12 and the N-terminal domain (residues 1-95) of recoverin, a member of the family of calcium-binding EF-hand proteins. CONCLUSIONS: Although the biological function of this new class of proteins is as yet undetermined, a general role as alpha-helical carrier proteins for small hydrophobic ligands, such as fatty acids or pheromones, is proposed on the basis of NMR-shift perturbation spectroscopy.

Amino Acid Sequence↗

Acute elbow injuries in the National Football League.

We performed a retrospective review to evaluate acute medial collateral ligament injuries of the elbow in professional football players from 1991 to 1996 (5 seasons). There were 5 acute medial collateral ligament injuries in 4 players (1 player with bilateral involvement). All injuries occurred with the hand planted on the playing surface while a valgus or hyperextension force was applied to the elbow. There were 2 centers, both involved with long-snapping situations, 1 running back, and 1 quarterback. All elbows had valgus instability on physical examination. Despite this instability, all players were able to function without operative reconstruction of the medial collateral ligament. No evidence of valgus instability was seen at the time of follow-up (average, 3.4 years). Next, we reviewed all acute elbow injuries in the National Football League from the same 5-season period. Ninety-one acute elbow injuries were reviewed. Overall, there were 70 (76.9%) elbow sprains, 16 (17.6%) dislocation/subluxation patterns, 4 (4.4%) fractures, and 1 (1.1%) miscellaneous injury. Review of the acute elbow sprains revealed 39 (55.7%) hyperextension injuries, 14 (20%) medial collateral ligament injuries, 2 (2.9%) lateral collateral ligament sprains, and 15 (21.4%) nonspecific sprains. The epidemiology of the 14 medial collateral ligament injuries was studied in more detail. The 2 most common mechanisms of injury were blocking at the line of scrimmage (50%) and the application of a valgus force with the hand planted on the playing surface (29%). There were 8 linemen, 4 receivers, 1 running back, and 1 quarterback. All injuries were managed with nonoperative treatment. The average time lost was 0.64 games (range, 0 to 4). We report 19 acute medial collateral ligament injuries of the elbow in elite football players, 2 of whom are considered overhead throwing athletes, who were able to function at a competitive level without surgical repair or reconstruction, in contrast to baseball players, in whom the mechanics and demands may differ.

Adult↗

Suprascapular nerve rotator cuff compression syndrome in volleyball players.

Selective denervation of the infraspinatus muscle producing weakness and wasting has been reported in certain sports (eg, volleyball and baseball). Nerve kinking or friction caused by excessive infraspinatus motion and compression by superior or inferior transverse scapular ligament or ganglions have been proposed as possible causes. However, in extreme abduction with full external rotation of the shoulder, the medial tendinous margin between the infraspinatus and supraspinatus muscles impinges strongly against the lateral edge of scapular spine, compressing the intervening infraspinatus branch of the suprascapular nerve. Spinaglenoid notchplasty has been performed in 5 elite volleyball players with infraspinatus neuropathy, allowing recovery of shoulder function in all patients and correction of infraspinatus muscle wasting. All returned to the same or higher level of volleyball by 8 months after surgery. An alternative cause of infraspinatus compromise in volleyball players is proposed and has been treated surgically with satisfactory outcome.

Adult↗

Triceps tendon rupture in weight lifters.

Triceps tendon avulsion injuries are rare. We report four weight lifters with triceps tendon raptures, two of whom had received local steroid injections for pain in the triceps. All four patients had taken oral anabolic steroids before injury. All patients had closed avulsion of the triceps tendon from its insertion into the olecranon. Three patients were injured while bench pressing heavy weights, and one patient was injured while swinging a baseball bat. Satisfactory results were achieved after surgical reinsertion of the tendon.

Adult↗

A pilot survey of beta2-agonist inhaler availability for children with asthma during organized sporting events.

BACKGROUND: One of the main stimuli that cause asthma exacerbations in children is physical activity, and exercise-induced bronchospasm (EIB) occurs in most asthmatic patients. OBJECTIVE: To investigate the level of preparedness for a potential EIB event in suburban children involved in recreational sports. METHODS: A cross-sectional study, focusing on children 12 years and younger, who participated in Little League baseball or soccer in Lower Merion Township, PA, was conducted by clinical survey. The survey was performed during a face-to-face encounter with the parent or caretaker of the child. RESULTS: Five hundred seventy-nine children 12 years and younger were surveyed. The parents or caretakers of 80 reported a history of asthma, indicating a prevalence of 14%. Only 18 (22%) of these children with asthma were reported to have a rescue medicine readily available. The 95% confidence interval was 14.22% to 33.47%, indicating that we can be 95% certain that the true population with rescue medication lies between 14% and 33%. CONCLUSIONS: Despite having been diagnosed as having asthma, more than 75% of children surveyed were unprepared for an EIB event. Measures should be explored to improve the quality of care of asthmatic children involved in community sports. We also propose that it may be beneficial for first-aid kits to include a beta2-agonist bronchodilator.

Administration, Inhalation↗

Visually guided collision avoidance and collision achievement.

To survive on today's highways, a driver must have highly developed skills in visually guided collision avoidance. To play such games as cricket, tennis or baseball demands accurate, precise and reliable collision achievement. This review discusses evidence that some of these tasks are performed by predicting where an object will be at some sharply defined instant, several hundred milliseconds in the future, while other tasks are performed by utilizing the fact that some of our motor actions change what we see in ways that obey lawful relationships, and can therefore be learned. Several monocular and binocular visual correlates of the direction of an object's motion relative to the observer's head have been derived theoretically, along with visual correlates of the time to collision with an approaching object. Although laboratory psychophysics can identify putative neural mechanisms by showing which of the known correlates are processed by the human visual system independently of other visual information, it is only field research on, for example, driving, aviation and sport that can show which visual cues are actually used in these activities. This article reviews this research and describes a general psychophysically based rational approach to the design of such field studies.

Journal Article↗

Kinetics of the upper extremity in the open and square stance tennis forehand.

Seven right-handed teaching professionals and eight intermediate tennis players were filmed using two high-speed cameras (100 Hz) as they performed open and square stance forehand drives. Three-dimensional coordinates (3D) were reconstructed using the DLT method. A three-segment rigid body model of the racket and upper extremity was used to calculate the kinetics of the wrist, elbow, and shoulder joints up to impact. The open stance created lower resultant velocities of the racket at impact (21.2 and 15.8 m/s) than the square stance (22.3 and 16.4 m/s) for professional and intermediate subjects, respectively. The largest components of the resultant joint torques were generated by the shoulder horizontal adductors, followed by elbow varus torques, and shoulder internal rotation torques. Torques were similar across stance and skill level except for significantly (p < 0.05) greater peak shoulder internal rotation torques in the square compared to the open stance, greater peak wrist flexion torques in the intermediate compared to the professionals, and greater peak wrist flexion torques in the square stance compared to the open stance. The data did not support the hypothesis that the open stance technique creates greater loading throughout the upper extremity than the square stance technique. Peak upper extremity torques were similar to peak torques reported for baseball pitching and represent loads that could contribute to strength imbalances and overuse injuries.

Biomechanical Phenomena↗

Looking for the evidence: a systematic review of prevention strategies addressing sport and recreational injury among children and youth.

OBJECTIVES: To examine evidence on the effectiveness of current injury prevention strategies in selected sport and recreational activities, determine the applicability of the evidence to children and youth and discuss the implications related to policy, programming and future research. METHODS: Research questions and relevance criteria were developed a priori. Potentially relevant studies were located through electronic and hand searches. Two independent assessors assessed articles for first relevance and then quality. Relevant articles were abstracted and synthesised for activities that had three or more relevant articles. RESULTS: A total of 21,499 articles identified through database and manual searching yielding 117 that met inclusion criteria. The majority of the studies (93 or 89%) involved eight activities: baseball, basketball, cycling, football, ice hockey, rugby, alpine skiing and soccer. Children and youth were identified as the specific target group in 45% of the studies and another 12% included children in their sample. Studies addressed a range of intervention strategies and varied on quality of evidence. CONCLUSIONS: Surprisingly few well-designed and controlled studies investigating strategies to prevent injuries were found and an even smaller number evaluated strategies to reduce injury in children and youth. As governments in developed countries continue to focus on increasing physical activity among children and youth, thought must be given to the issue of risk of injury and the relative lack of evidence of effective preventive measures.

Adolescent↗

Longevity, mortality and body weight.

The purpose of this study was to analyze the relation of total body weight to longevity and mortality. The MEDLINE database was searched for data that allow analysis of the relationship between absolute body weight and longevity or mortality. Additional data were used involving US veterans and baseball players. Trend lines of age at death versus body weight are presented. Findings show absolute body size is negatively related to longevity and life expectancy and positively to mortality. Trend lines show an average age at death versus weight slope of -0.4 years/kg. We also found that gender differences in longevity may be due to differences in body size. Animal research is consistent with the findings presented. Biological mechanisms are also presented to explain why increased body mass may reduce longevity. Life expectancy has increased dramatically through improved public health measures and medical care and reduced malnutrition. However, overnourishment and increased body size have promoted an epidemic of chronic disease and reduced our potential longevity. In addition, both excess lean body mass and fat mass may promote chronic disease.

Animals↗

Investigation of management models in elite athlete injuries.

This cross-sectional study investigated management models among elite athletes participating in sports including baseball, basketball, soccer, volleyball, tennis, softball, football, handball, track and field, swimming, judo, tae-kwon-do, gymnastics, archery, and weight lifting at the Tsoying National Sport Training Center. Data were collected by questionnaire. Of the 393 athletes investigated, 56% were male and 44% were female, with an average age of 20.9 years and average length of athletic experience of 9.8 years. At the time of the survey, 74.8% had sporting injuries and were being treated with Chinese and/or Western medicine. Among injured athletes, 14.5% chose Western treatment, 8.1% chose Chinese medicine, and 75.4% received combined treatment. There were various reasons for choosing the management model. Most athletes had ordinary self-recognition of sports injury prevention. Their qualified ability for sports injury prevention was 70%. This ability was significantly correlated with age, education, and sports experience. Within Taiwan's current medical and social environment, elite athletes prefer a combination of Eastern and Western treatments for sports injuries. Each of the medical approaches are widely accepted by elite athletes and their coaches. Doctors trained in Western medicine should learn these alternative treatment methods and apply them effectively in athletes, so that a better medical network can be established.

Adult↗

Processing of extrafoveal objects during multiple-object naming.

In 3 experiments, the authors investigated the extent to which objects that are about to be named are processed prior to fixation. Participants named pairs or triplets of objects. One of the objects, initially seen extrafoveally (the interloper), was replaced by a different object (the target) during the saccade toward it. The interloper-target pairs were identical or unrelated objects or visually and conceptually unrelated objects with homophonous names (e.g., animal- baseball bat). The mean latencies and gaze durations for the targets were shorter in the identity and homophone conditions than in the unrelated condition. This was true when participants viewed a fixation mark until the interloper appeared and when they fixated on another object and prepared to name it while viewing the interloper. These results imply that objects that are about to be named may undergo far-reaching processing, including access to their names, prior to fixation.

Attention↗

Automated external defibrillator arrhythmia detection in a model of cardiac arrest due to commotio cordis.

INTRODUCTION: Cardiac arrest due to chest wall blows (commotio cordis) has been reported with increasing frequency in children, and only about 15% of victims survive. Automated external defibrillators (AEDs) have been shown to be life saving in adults with cardiac arrest, but data on their use in children are limited. In a swine model of commotio cordis designed to be most relevant to young children, we assessed the efficacy of a commercially available AED for recognition and termination of ventricular fibrillation. METHODS AND RESULTS: Ventricular fibrillation was produced in anesthetized juvenile swine by precordial impact from a baseball under controlled conditions. Animals were randomized to defibrillation after 1, 2, 4, or 6 minutes of ventricular fibrillation. Twenty-six swine underwent 50 ventricular fibrillation inductions. Sensitivity of the AED for recognition of ventricular fibrillation was 98%, and specificity for nonshockable episodes was 100%. All episodes of ventricular fibrillation were successfully terminated by the AED. CONCLUSION: In this experimental model of commotio cordis, the AED proved to be highly sensitive and specific for recognition of ventricular fibrillation and effective in terminating the arrhythmia and restoring sinus rhythm. These findings suggest that early defibrillation with the AED could save young lives on the athletic field.

Animals↗

Commodio cordis: an underappreciated cause of sudden cardiac death in young patients: assessment and management in the ED.

Commotio cordis is the condition of sudden cardiac death or near sudden cardiac death after blunt, low-impact chest wall trauma in the absence of structural cardiac abnormality. Ventricular fibrillation is the most commonly reported induced arrhythmia in commotio cordis. Blunt impact injury to the chest with a baseball is the most common mechanism. Survival rates for commotio cordis are low, even with prompt CPR and defibrillation.

Adolescent↗

Central nervous system stimulants.

Three major types of CNS stimulant are currently abused in sport: amphetamine, cocaine and caffeine. Each drug type has its own characteristic mechanism of action on CNS neurones and their associated receptors and nerve terminals. Amphetamine is widely abused in sports requiring intense anaerobic exercise where it prolongs the tolerance to anaerobic metabolism. It is addictive, and chronic abuse causes marked behavioural change and sometimes psychosis. Major sports abusing amphetamine are cycling, American football, ice-hockey and baseball. Cocaine increases tolerance to intense exercise, yet most of its chronic effects on energy metabolism are negative. Its greatest effects seem to be as a central stimulant and the enhancement of short-term anaerobic exercise. It is highly addictive and can cause cerebral and cardiovascular fatalities. Caffeine enhances fatty acid metabolism leading to glucose conservation, which appears to benefit long-distance endurance events such as skiing. Caffeine is also addictive, and chronic abuse can lead to cardiac damage. Social abuse of each of the three drugs is often difficult to distinguish from their abuse in sport.

Caffeine↗

Arthroscopy of the elbow: a long-term clinical review.

PURPOSE: The purpose of this study was to review a large group of patients who had arthroscopy of the elbow to determine the efficacy and relative risks of this procedure. TYPE OF STUDY: We retrospectively reviewed a convenient sample of 172 patients who underwent 187 arthroscopies of the elbow over a 7-year period. MATERIALS AND METHODS: All patients had their charts and radiographs reviewed, and 104 of these patients were also contacted for a telephone interview at an average follow-up of 42.3 months (range, 7 to 115 months). RESULTS: The procedures were performed primarily by 7 different surgeons, using all 3 standard operating positions and a variety of arthroscopic portals. The most common diagnosis was posterior impingement in 96 patients (51%), followed by loose bodies in 72 patients (31%), and degenerative joint disease in 32 patients (22%). The average preoperative modified Figgie score was 27.7 points (range, 17-43) for all patients. The average postoperative score was 45.4 points (range, 29-50), with the largest increase occurring in the pain score. There were 51 patients (56%) with an excellent surgical result, 37 patients (36%) with a good result, 12 patients (11%) with a fair result, and 4 patients (4%) with a poor result. The average modified Figgie score increased from 31.2 points (range, 22-43) to 46.9 (range, 29-50) postoperatively in professional athletes; from 26.3 to 42.6 in patients who had Workers' Compensation claims but were not professional athletes; from 29.4 to 45.6 in patients with a diagnosis of loose bodies; and from 30.1 to 43.7 in patients with degenerative joint disease. There were 3 known surgical complications (1.6%) overall, 1 of which was a patient who had a transection of the ulnar nerve requiring microsurgical repair. Of the 104 patients who were contacted, 6 patients felt that their symptoms had not improved after surgery. Eight of the 55 baseball players contacted were not able to return to their same level of competition. CONCLUSIONS: Arthroscopy of the elbow appears to be a safe and efficacious procedure with a relatively low complication rate.

Adolescent↗

[Eye injuries caused by "Hornussen"--a traditional Swiss team game].

BACKGROUND: "Hornussen" is a traditional Swiss team game played in rural areas of Switzerland. A puck made out of hard plastic called "Hornuss" or "Nouss" is hit with a lash like racket into the field. The opposing team has to capture the flying puck with shovel like shields. Eye injuries are rare, however, very severe. PATIENTS: We report on three patients who were seen and treated at the university eye clinic Berne in the last four years. RESULTS: All injuries were blunt contusions with involvement of the periorbital soft tissues by a hit with the "Hornuss". In two cases orbital fractures were observed and in one case there was a rupture of the globe in a pre-injured aphakic eye. Only in one case was there a direct hit to the eye by the "Hornuss", the other injuries were caused by indirect hit after the "Hornuss" bounced off the shovel like shields. No protection gear was used. One patient showed complete recovery, whereas in the other two cases significant impairment remained. CONCLUSIONS: Without adequate protection gear, injuries caused by "Hornussen" are generally severe. The injury pattern with periorbital involvement resembles eye injuries caused by baseballs. This is probably due to the similar size of the balls. The mandatory wearing of protection helmets issued by the federal "Hornusser" association for young players should be extended as a general requirement for all players.

Adult↗