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At least 811 records · Page 45Linked to original sources
PubMed2005

Efficacy of dextrose prolotherapy in elite male kicking-sport athletes with chronic groin pain.

OBJECTIVE: To determine the efficacy of simple dextrose prolotherapy in elite kicking-sport athletes with chronic groin pain from osteitis pubis and/or adductor tendinopathy. DESIGN: Consecutive case series. SETTING: Orthopedic and trauma institute in Argentina. PARTICIPANTS: Twenty-two rugby and 2 soccer players with chronic groin pain that prevented full sports participation and who were nonresponsive both to therapy and to a graded reintroduction into sports activity. INTERVENTION: Monthly injection of 12.5% dextrose and 0.5% lidocaine into the thigh adductor origins, suprapubic abdominal insertions, and symphysis pubis, depending on palpation tenderness. Injections were given until complete resolution of pain or lack of improvement for 2 consecutive treatments. MAIN OUTCOME MEASURES: Visual analog scale (VAS) for pain with sports and the Nirschl Pain Phase Scale (NPPS), a measure of functional impairment from pain. RESULTS: The final data collection point was 6 to 32 months after treatment (mean, 17 mo). A mean of 2.8 treatments were given. The mean reduction in pain during sports, as measured by the VAS, improved from 6.3+/-1.4 to 1.0+/-2.4 ( P <.001), and the mean reduction in NPPS score improved from 5.3+/-0.7 to 0.8+/-1.9 ( P <.001). Twenty of 24 patients had no pain and 22 of 24 were unrestricted with sports at final data collection. CONCLUSIONS: Dextrose prolotherapy showed marked efficacy for chronic groin pain in this group of elite rugby and soccer athletes.

Adult↗
PubMed2007

Consequences of a cross slope on wheelchair handrim biomechanics.

OBJECTIVE: To test the hypothesis that pushing on a cross slope leads to increased handrim loading compared with that found on a level surface. DESIGN: Case series. SETTING: Biomechanics laboratory. PARTICIPANTS: Twenty-six manual wheelchair users. INTERVENTION: Subjects pushed their own wheelchairs on a research treadmill set to level, 3 degrees , and 6 degrees cross slopes. Propulsion speed was self-selected for each cross-slope condition. Handrim biomechanics were measured for the downhill wheel, using an instrumented wheelchair wheel and a motion capture system. MAIN OUTCOME MEASURES: Speed, peak kinetics (force, rate of loading, torque), push angle, cadence, push distance, and power output were averaged over a 20-push set for each subject and each cross-slope condition. Outcomes were compared across cross slopes using a repeated-measures analysis of variance. RESULTS: Push angle and cadence were unaffected by cross slope. A trend of decreasing self-selected speeds with increasing cross slope was not significant. There were considerable increases in the peak kinetic measures, with the axial moment increasing by a factor of 1.8 on the 6 degrees cross slope (P=.000). More pushes were required to cover the same distance when on a cross slope (P<.034). The power required for propulsion increased by a factor of 2.3 on the 6 degrees cross slope (P=.000). CONCLUSIONS: Users must push harder when on a cross slope. This increased loading is borne by the users' arms, which are at risk for overuse injuries. Exposure to biomechanic loading can be reduced by avoiding cross slopes when possible.

Acceleration↗
PubMed2007

Stroke pattern and handrim biomechanics for level and uphill wheelchair propulsion at self-selected speeds.

OBJECTIVES: To investigate the natural stroke patterns of wheelchair users pushing on a level surface, to determine if users adapt their stroke patterns for pushing uphill, and to assess whether there are biomechanic advantages to one or more of the stroke patterns. DESIGN: Case series. SETTING: Biomechanics laboratory. PARTICIPANTS: Twenty-six manual wheelchair users with a spinal cord injury. INTERVENTION: Subjects pushed their own wheelchairs at self-selected speeds on a research treadmill set to level, 3 degrees , and 6 degrees grades. Stroke patterns were measured using a motion capture system. Handrim biomechanics were measured using an instrumented wheel. MAIN OUTCOME MEASURES: Stroke patterns were classified for both level and uphill propulsion according to 1 of 4 common classifications: arcing, semi-circular, single-looping (SLOP), and double-looping (DLOP). Biomechanic outcomes of speed, peak handrim force, cadence, and push angle were all compared across stroke classifications using an analysis of variance. RESULTS: Only 3 of the 4 stroke patterns were observed. None of the subjects used the semi-circular pattern. For level propulsion, the stroke patterns were fairly balanced between arcing (42%), SLOP (31%), and DLOP (27%). Subjects tended to change their stroke pattern for pushing uphill, with 73% of the subjects choosing the arcing pattern by the 6 degrees grade. No statistically significant differences were found in handrim biomechanics or subject characteristics across stroke pattern groups. CONCLUSIONS: Wheelchair users likely adapt their stroke pattern to accommodate their propulsion environment. Based on the large percentage of subjects who adopted the arcing pattern for pushing uphill, there may be benefits to the arcing pattern for pushing uphill. In light of this and other recent work, it is recommended that clinicians not instruct users to utilize a single stroke pattern in their everyday propulsion environments.

Acceleration↗
PubMed2003

Thromboembolic complication after arthroscopic shoulder surgery.

Thromboembolic complications after arthroscopic shoulder surgery are very unusual and need thorough investigation of the possible origin. In this case of venous pulmonary thromboembolism after arthroscopy of the shoulder, neither a hint of coagulopathy nor an anatomic abnormality could be found that explains this complication. Therefore, irritation of the subclavian vein caused by compression by the motor-driven shaver is probably one cause for our thromboembolic complication. Careful attention to positioning, fluid management, and use of traction, as well as an appreciation of shoulder anatomy to select portal placement will help decrease the common complications associated with shoulder arthroscopy. A further option to prevent thrombembolic complications in shoulder arthroscopy patients might be prophylaxis with a low-weight heparin in patients with risk factors. In conclusion, awareness of uncommon complications such as deep venous thrombosis and pulmonary embolism will help the orthpaedic surgeon promptly diagnose and treat these problems.

Anticoagulants↗
PubMed2004

Posterior approach for arthroscopic treatment of posterolateral impingement syndrome of the ankle in a top-level field hockey player.

A case history of a 25-year-old field hockey player, a member of the German National Field Hockey Team, is presented. The patient could not remember any specific ankle injury, but since the World Indoor Championship in February 2003, he experienced significant but diffuse pain around the posterior ankle, especially while loading the forefoot in hockey training and competition. For 2 months, the patient was unable to run. Conservative treatment failed, and surgery was performed. Posterior ankle arthroscopy revealed a frayed posterior intermalleolar ligament and meniscoid-like scar tissue at the posterolateral ankle, indicating a posterolateral soft tissue ankle impingement syndrome. A concomitant inflammation of the posterolateral ankle and subtalar synovium was present. After arthroscopic resection and early functional aftertreatment, the patient returned to full high-level sports ability within 2 months.

Adult↗
PubMed2005

Treatment of glenohumeral subluxation using electrothermal capsulorrhaphy.

PURPOSE: The purpose of this study was to review the results of a relatively homogenous group of patients with glenohumeral subluxation without labral pathology who were treated with an electrothermal capsulorrhaphy procedure. TYPE OF STUDY: Case series without controls. METHODS: From 1997 to 1998, 42 patients underwent electrothermal capsulorrhaphy using a monopolar radiofrequency probe (Oratec Interventions, Menlo Park, CA). Patients with prior capsular repairs, labral pathology that required repair, or capsular avulsion injuries were excluded from the study. Thirty-one patients met the inclusion criteria. Patients had a minimum of 2 years of follow-up (mean, 25 months), and a mean age of 25 years (range, 16 to 38 years). All of the patients had previously failed conservative treatment. There were 25 patients with unidirectional anterior instability, 2 patients with unidirectional inferior instability, 1 patient with unidirectional posterior instability, and 3 patients with multidirectional instability. The patients were assessed using a modified American Shoulder and Elbow Surgeons (ASES) score that examined pain (30 points), function (60 points), and patient satisfaction (10 points). In addition, subjective stability was assessed using a 10-point scale. RESULTS: The average modified ASES score increased to 88 points from 56 preoperatively (P < .01). The average subjective stability scale increased to 8.5 from 4.4 preoperatively (P < .01). Nineteen patients (61%) had an excellent result, 4 (13%) had a good result, 5 (16%) had a fair result, and 3 (10%) had a poor result; 22 of 26 patients who participated in sports were able to return to their preinjury level of play. The subset of patients with isolated anterior instability had results similar to the overall group. There were no instances of axillary neuritis or other neurologic injury. CONCLUSIONS: In carefully selected patients with shoulder instability, including unidirectional anterior instability without associated labral pathology, electrothermal capsulorrhaphy was effective and had few complications. LEVEL OF EVIDENCE: Level IV, case series without controls.

Adolescent↗
PubMed2005

Unstable isolated SLAP lesion: clinical presentation and outcome of arthroscopic fixation.

PURPOSE: The purpose of this study was to describe the clinical presentation and sensitivity of testing of unstable isolated SLAP (superior labrum anterior posterior) lesions and to evaluate the efficacy of arthroscopic treatment. TYPE OF STUDY: Case series. METHODS: A retrospective review was made of 44 unstable SLAP lesions in 41 patients (40 male, 1 female) who did not have other pathologic shoulder findings. The mean follow-up period was 33 months (range, 25 to 67 months) and the mean age at the time of surgery was 24 years (range, 17 to 43 years). Twenty-six patients had an injury on the dominant shoulder and 3 had bilateral shoulder involvement. Arthroscopic fixation was performed with the use of a biodegradable tack (Suretac; Acufex, Mansfield, MA) in 14 cases, and with a screw-type metallic suture anchor (mini-Revo; Linvatec, Largo, FL) in 30 cases. RESULTS: Pain (100%) and clicking (57%) were the most common symptoms. The compression-rotation test was positive in 84% of the patients before surgery. The average UCLA score at the last follow-up was 32.3 points; 22 cases were graded excellent, 16 good, and 6 poor. Based on the postoperative performance data collected from 33 athletes, 25 of them (76%) were able to return to their athletic activities. Among them, throwing athletes showed statistically better performance than did nonthrowing athletes (P = .011). CONCLUSIONS: Pain, followed by clicking, was the most common symptom, and the most common sign was a positive compression rotation test. Arthroscopic treatment of unstable isolated SLAP lesions resulted in good or excellent UCLA scores in 86% of the patients. Throwing athletes showed more satisfactory results than nonthrowing athletes. LEVEL OF EVIDENCE: Type IV, case series with no, or historical, control group.

Absorbable Implants↗
PubMed2006

Arthroscopic patellar release for the treatment of chronic patellar tendinopathy.

We describe an arthroscopic technique for the treatment of chronic patellar tendinopathy (jumper's knee). Preoperatively, tendon necrosis or rupture is excluded by sonography. Diagnostic arthroscopy is performed and hypertrophic synovitis around the inferior patellar pole is removed with a bipolar cautery system. Two outside-in cannulas mark the clinically symptomatic region, mainly found between the tendon insertion site and the lateral aspects of the patellar tendon. The bipolar cautery is used for a release of the paratenon and a bone denervation at the inferior patellar pole including the tendon insertion site within the marked area. No tendon or bone material is removed or excised throughout the procedure. We treated 15 athletes with stage 3 and 4 chronic patellar tendinopathies on a modified version of the Blazina score (0-5). Patients' mean age was 29 years and the mean follow-up period was 41 months. In 13 cases, clinical symptoms subsided completely within 3 months after surgery. The mean preoperative Blazina score was 3.7 (SD, 0.5) and the mean postoperative Blazina score was 0.4 (SD, 1.0; paired 2-tailed t test, P < .01). Ultrasound showed a reduction of tendon edema within 3 weeks and no signs of edema within a mean period of 5 weeks after surgery. The minimal surgical impact to the tendon allows early and functional rehabilitation. The technique is effective, easy to perform, and safe to apply.

Adrenal Cortex Hormones↗
PubMed2005

Ulnar collateral ligament of the elbow.

Recent advances in the diagnosis and treatment of the overhead athlete's elbow has led the medical community to understand that the ulnar collateral ligament (UCL) of the elbow is more commonly injured than originally thought. Injury can result in secondary symptoms and problems in other regions of the elbow. Sports requiring an overhead motion, such as throwing a ball, hitting a ball overhead, or serving a tennis ball, imparts a valgus stress on the elbow that is resisted by the UCL. Throwing sidearm or hitting a forehand in tennis, squash, or racquetball may also impart a valgus stress to the elbow. Repeated or excessive valgus stress places a force on the UCL that may result in injury to the ligament. Injury to the UCL may result in problems in other areas of the elbow, including the ulnar nerve, the flexor-pronator musculotendinous unit, the radiocapitellar joint and the posterior compartment of the elbow, in addition to being a cause of loose bodies within the elbow. This article reviews the anatomy, biomechanics, and pathophysiology of injury to the UCL and injuries to the other structures that result from UCL injury. Also reviewed are patient history, examination techniques, tests that help confirm the diagnosis of UCL injury, and treatment of the injured UCL.

Arthroscopy↗
PubMed2005

Forced shoulder abduction and elbow flexion test: a new simple clinical test to detect superior labral injury in the throwing shoulder.

PURPOSE: Although several clinical tests for detecting superior labral injury of the shoulder have been reported, some of the maneuvers involved are complicated and diagnosis is still inaccurate. The purpose of this report is to introduce our forced shoulder abduction and elbow flexion test (forced abduction test) along with an assessment of its efficacy in the throwing shoulder in comparison with other clinical tests. TYPE OF STUDY: Prospective nonrandomized clinical trial. METHODS: Fifty-four throwing athletes who underwent arthroscopic surgery were prospectively studied. Superior labral injury was present in 24 cases (Snyder's classification was type 2 in 22, and type 3 in 2). Several clinical tests were performed preoperatively and the results were recorded on our original chart. The condition of the superior labrum was then examined during arthroscopic surgery. The results of these tests were compared with the arthroscopic findings as a standard. The forced abduction test was defined as positive when pain at the posterosuperior aspect of the shoulder on forced maximal abduction was relieved or diminished by elbow flexion. RESULTS: The sensitivity, specificity, and accuracy of the forced abduction test were 67%, 67%, and 67%, respectively. It was one of the most useful tests, along with the crank test and O'Brien's test (crank test, 58%, 72%, 66%; O'Brien's test, 54%, 60%, 57%; respectively). Furthermore, the results of the forced abduction test showed a significant correlation with the presence of superior labral injury (P = .0275, chi-square test). CONCLUSIONS: The forced abduction test was technically simple and its usefulness was comparable to the O'Brien's and crank tests for diagnosing superior labral injury in throwing shoulders. LEVEL OF EVIDENCE: Level II.

Adolescent↗
PubMed2004

Differences in normal and perturbed walking kinematics between male and female athletes.

OBJECTIVE: To identify differences in lower extremity kinematic movement patterns between genders during walking through the application of an expected perturbation. DESIGN: Randomized limb kinematics were compared between healthy active males and females. BACKGROUND: Lower extremity kinematics during jump landing and cutting have been implicated as a potential source of the discrepancy in anterior cruciate ligament injury rates between genders. Kinematic differences between genders have been identified during tasks that are not provocative of anterior cruciate ligament injury but do result in increased ligament strain. Repetition of movement patterns that increase anterior cruciate ligament strain may increase the likelihood they will be reproduced during athletic tasks that produce force loads that exceed anterior cruciate ligament tensile strength. METHODS: Twenty subjects (10 women, 10 men) classified as a level I or II athlete underwent motion analyses while performing self-paced walking trials. Five trials were undisturbed, and five each with a platform translating either laterally or anteriorly at heel contact. Sagittal, frontal, and transverse hip angles as well as sagittal and frontal knee angles were collected during stance. RESULTS: Excursions in the frontal and transverse planes were greater at the hip and knee for females compared to males in each walking condition. The rate of these excursions also occurred more rapidly for females than males. There was no difference for joint angles at initial contact between genders, and there was no difference in the amount of sagittal plane excursion for the hip and knee when comparing genders. CONCLUSIONS: Females demonstrate characteristics during both normal and perturbed gait that may potentially contribute to increased anterior cruciate ligament strain. Repetition of these potentially harmful movement patterns during provocative athletic maneuvers may lead to anterior cruciate ligament injury. RELEVANCE: Females exhibit lower extremity kinematic patterns that differ from males. Female kinematic patterns may contribute to an increased risk for anterior cruciate ligament injury.

Adaptation, Physiological↗
PubMed2004

Muscular effort in multiple sclerosis patients during powered wheelchair manoeuvres.

BACKGROUND: This study applied EMG analysis methods to identify muscle group activity profiles and potential overload risks in powered wheelchair use. METHODS: We quantified muscle effort and fatigue using EMG analysis methods during powered wheelchair manoeuvres by 10 multiple sclerosis patients. Video recordings of the different sub-tasks were related to information on surface EMG amplitude (rectified EMG) and spectral information (Median frequency) from M. trapezius, M. deltoideus (pars medius), M. deltoideus (pars anterior), M. pectoralis, M. biceps, M. triceps, wrist extensors and flexors, using Joint Analysis of EMG Spectrum and Amplitude (JASA analysis). FINDINGS: Task durations and subjective data indicated that tasks requiring finer motor control took longer and were perceived as more difficult. Kinesiological functions of all muscle groups identified forward steering to be associated with activation of M. deltoideus (pars anterior), M. pectoralis, M. trapezius and M. deltoideus (pars medius); backwards steering with predominant activation of M. deltoideus (pars medius), M. biceps brachii and wrist flexors; left steering with maximal activation of M. biceps and wrist flexors, and right steering with maximal activation of M. triceps and wrist extensors. These profiles were confirmed in analysis of the functional tasks. JASA analysis documented muscle fatigue in the wrist extensors, whereas increased activation was found in M. trapezius, M. deltoideus (pars anterior) and wrist flexors. INTERPRETATION: EMG based kinesiological analysis gives insight in muscle activity and fatigue during powered wheelchair manoeuvres.

Adult↗
PubMed2005

Identifying the time of occurrence of a hamstring strain injury during treadmill running: a case study.

BACKGROUND: While hamstring strain injuries are common during sprinting, the mechanisms of injury are not well understood. In this study, we analyzed the running kinematics of an athlete obtained at the time of an acute hamstring strain injury. The purpose was to identify the period of the gait cycle during which the hamstring was likely injured, as well as to characterize the biomechanical conditions associated with the injury. METHODS: A male professional skier injured his right biceps femoris long head while running at 5.36 m/s on a treadmill with a 15% incline. Whole body kinematics were recorded at the time of injury. A linear periodic prediction model was used to determine when individual marker trajectories deviated from a cyclic periodic pattern, indicating the mechanical response to injury. A three-dimensional musculoskeletal model was used to compute joint angles and hamstring musculotendon lengths during the injurious running trial. These data were used with estimates of neuromuscular latencies and electromechanical delays to identify the most likely time period of injury. FINDINGS: Based upon the earliest indications in marker trajectories, a 130 ms period during the late swing phase of the gait cycle was identified as the period of injury. During this period, the biceps femoris reached a peak musculotendon length that was estimated to be 12% beyond the length seen in an upright posture and exceeded the normalized peak length of the medial hamstrings. INTERPRETATION: This case provides quantitative data suggesting that the biceps femoris muscle is susceptible to an lengthening contraction injury during the late swing phase of the running gait cycle.

Adult↗
PubMed2005

Cyclic loading alters biomechanical properties and secretion of PGE2 and NO from tendon explants.

BACKGROUND: Tendon overuse injuries are a common occurrence; accounting for a large proportion of occupational and athletic injuries. The concept examined in this study is the role of load-induced intrinsic inflammation to the mechanism of these injuries. This study examined the influence of cyclical loading on the mechanical properties, cell viability, and inflammatory mediators of cultured tendon explants. METHODS: Chicken digital flexor tendon explants were isolated and separated into no-load (24 h rest), moderate load (0.25-3.0 MPa, 1 Hz, 4 h, 20 h rest), and aggressive load (0.25-12.0 MPa, 1 Hz, 24 h) treatment groups. Tissue loading was carried out with a pneumatic device under load-control. The loading regimens for each explant treatment group started at a uniform time point (day 3 from isolation, t = 0 h). Medium was collected at t = 24 and t = 48 h and analyzed for the inflammatory mediators prostaglandin E(2) and nitric oxide. Viability was evaluated at t = 48 h. FINDINGS: Biomechanical data revealed a significantly (P < 0.05) lower strength in the aggressively loaded specimens compared to the moderately loaded samples. Prostaglandin E(2) concentrations of aggressively loaded samples showed significantly higher values compared to moderately loaded samples at t = 48 h. Nitric oxide concentrations were greater in the moderately loaded samples relative to the no-load group at t = 24 h. Viability was not found to differ among the groups. INTERPRETATION: Alterations in cyclical loading of tendon may cause a change in fibroblast-mediated inflammatory mediator production in tendon. This response is of clinical significance as it may have a role in the pathology of tendon overuse injuries.

Adaptation, Physiological↗
PubMed2006

Kinematic analysis of handbike propulsion in various gear ratios: implications for joint pain.

BACKGROUND: Though considered more efficient and less constraining than the hand-rim wheelchair, the handbike has rarely been studied especially as regards its kinematic parameters. The hypothesis of this investigation is that the range of upper extremity motions are risk factors for joint pain during handbiking as is the case during hand-rim wheelchair propulsion. This paper aims to study handbike propulsion in maximal sprint conditions in order to determine potential risk factors for joint pain. METHODS: Eight able-bodied participants with no experience in handbike propulsion performed three sprints of 8 s each using three gear ratios in a handbike mounted on a home-trainer. The mean velocity per arm cycle, the cycle frequency, the angular parameters for the upper extremities were calculated, as well as the corresponding angular accelerations, with the help of a 3D movement analysis. FINDINGS: An increase in gear ratio (22/21, 32/21, and 44/21) significantly increases the maximal velocity, the flexion/extension of the trunk, as well as the adduction/abduction of the elbow, while it reduces the frequency of movements and the flexion/extension angular accelerations of the shoulder and the elbow. Regardless of what gear ratio is used, maximal angular amplitudes of the upper extremities are comparable to the values obtained with a hand-rim wheelchair. Interpretation. The high amplitudes and fast angular joint accelerations of the upper extremity found in this study are near or superior to the ergonomic recommendations generally advised. These considerations could be taken into account to prevent overuse injuries.

Acceleration↗
PubMedDate not supplied

Little Leaguer's shoulder.

A case of Little Leaguer's shoulder (LLS) in a 12-year-old male is presented. Classically, LLS is an overuse injury affecting adolescent pitchers. The diagnosis is the result of a thorough history, physical examination, and radiographic evaluation. Clinicians unfamiliar with LLS may fail to detect this injury and order a magnetic resonance imaging (MRI) study without radiographs. The objective of this case report is to help radiologists become more familiar with the MRI and radiographic findings of LLS.

Baseball↗