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Sport-related dental injury claims to the New Zealand Accident Rehabilitation & Compensation Insurance Corporation, 1993-1996: analysis of the 10 most common sports, excluding rugby union.

A large number of New Zealanders participate in sport, either formally or informally; sporting injuries are common. In New Zealand, the Accident Rehabilitation & Compensation Insurance Corporation (ACC) is the main organisation that covers sports-related dental claims. Rugby union claims are the most common. The ACC's national data from 1993 to 1996 relating to dental claims for sports injuries (excluding rugby union) were analysed. This study identified 45 other sports in which participants are also at risk for dental injuries. Total claims per sport for each year were determined, and the "top 10" sports for claims per year were identified and compared for any change over the years studied. The top 10 sports for 1993 and 1994 were, in descending order: swimming, rugby league, basketball, cricket, hockey, soccer, netball, squash, softball-baseball, and tennis. Data for 1995 and 1996 revealed a similar trend, except that touch rugby displaced tennis as the tenth-ranked sport. The most common age group for claims was the age group 10-19 years, with a male:female ratio of approximately 2:1. Many sports, in addition to rugby union, place their participants at risk of dental injury. Awareness of prevention of dental injuries should be more widely promoted for all sports.

Adolescent↗

Lou Gehrig and amyotrophic lateral sclerosis. Is vitamin E to be revisited?

Investigators are beginning to reexamine the use of vitamin E for the treatment of amyotrophic lateral sclerosis. Vitamin E was isolated in the 1920s, and the results of animal studies led rapidly to clinical use. Regrettably, vitamin E did not ameliorate the progression of amyotrophic lateral sclerosis for Lou Gehrig, but more recent advances may identify subpopulations that do respond to vitamin E.

Amyotrophic Lateral Sclerosis↗

Paranasal sinus endoscopy and orbital fracture repair.

Although excellent results may be achieved in the management of many orbital floor injuries with standard transconjunctival or transcutaneous approaches, visualization of the posterior edge of the orbital floor or medial wall defect may be challenging at times. We describe our experience using endoscopic examination of the orbital floor through maxillary sinus approaches during the repair of selected orbital floor fractures. Owing to the posterosuperior angulation of the orbital floor, these approaches allow better visualization of the posterior edge of fractures involving the posterior portion of the orbital floor than do the standard transconjunctival approaches, and they facilitate confirmation that all orbital soft tissues have been elevated from the fracture site. We have used these techniques successfully in 9 patients with fractures involving either the posterior portion of the orbital floor or the medial wall or both.

Baseball↗

Decibeldome.

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Baseball↗

Softball sliding injuries. A prospective study comparing standard and modified bases.

In a previous retrospective study, base sliding was found to be responsible for 71% of recreational softball injuries. As most injuries occurred following rapid deceleration impact against stationary bases, quick-release (breakaway) bases were evaluated as a means to modify this mechanism of injury. Six hundred thirty-three softball games were played on breakaway-base fields and 627 games were played on stationary-base fields. Forty-five sliding injuries (7%) occurred on the stationary-base diamonds and only two sliding injuries (less than 1%) occurred on the breakaway-base fields. Implementing the use of breakaway bases in recreational softball leagues could potentially achieve a significant, cost-effective reduction of injuries.

Adult↗

Coronary artery stenting for spontaneous coronary artery dissection: a case report and review of the literature.

Spontaneous coronary artery dissection is an uncommon cause of acute coronary syndromes. It occurs in three major groups: in young women in the peripartum period, in patients with atherosclerotic disease, and in an idiopathic group. There are a number of associated conditions, but the pathogenesis remains unclear. Diagnosis can only be made at angiography. Treatments include medical therapy, coronary artery bypass grafts, and newer interventional procedures. We report on a case of spontaneous coronary artery dissection involving the left circumflex artery in a young adult male presenting with a myocardial infarction after exercise. There were no risk factors for coronary artery disease and no evidence of atherosclerosis on angiography. The dissection was treated with primary coronary artery stenting without predilation, achieving an excellent result. To our knowledge, this is the third known case of successful coronary artery stenting for this condition and the first case of primary stenting without prior angioplasty.

Adult↗

Traumatic arteriovenous malformation of the external carotid arterial system.

Traumatic arteriovenous (AV) malformations of the face and scalp are rare lesions characterized by multiple endothelial-lined channels between the arterial and venous systems. If improperly managed they have a high propensity to recur, and may result in severe cosmetic deformity. Lesions should be delineated by arteriography unless small and localized. They are managed by complete excision and ligation of arterial feeding vessels. Five cases of traumatic AV malformation of the face and scalp and their management are reported.

Adolescent↗

Biomechanical study of the pitching elbow.

Medial-tension injuries of the pitching elbow are well recognized. One contributing factor is the extreme valgus which has been noted to occur during the acceleration phase of throwing. It is hypothesized that breaking pitches generate higher medial loading because of the pronation and supination required to impart spin to the ball. The pitching motion is a complex action of all body segments to produce maximum linear and angular acceleration of the ball. The purpose of this study was to correlate elbow loading with pitching style. We measured the forearm segment for axial and tangential (varus-valgus plane) acceleration using accelerometers attached to the forearm and hand. Muscle activity was measured by EMG. Forearm rotation was assessed by stroboscopic photography. Despite different delivery styles when throwing breaking pitches, each pitcher demonstrated patterns of muscle activity and acceleration which were similar. Deceleration forces were lower than acceleration forces. Pronation and supination were documented and contribute to the direction of ball spin. Accelerometers can be used to evaluate pitching mechanics. We suggest that the main factors causing an elbow injury are the amount of throwing and the force with which the ball is thrown.

Baseball↗

Kinematics of wrist joint flexion in overarm throws made by skilled subjects.

Previous studies of multijoint arm movements have shown that the CNS holds arm kinematics constant in different situations by predictively compensating for the effects of interaction torques. We determined whether this was also the case for wrist joint flexion in natural overarm throws performed by skilled subjects in 3D, a situation where large passive torques can occur at the wrist. Specifically, we investigated whether wrist flexion amplitudes are held constant in throws of different speeds. Joint rotations were recorded at 1,000 Hz with the search-coil technique. Contrary to a previous study on constrained 2D throwing, indirect evidence was found that in fast throws passive torques associated with forearm deceleration were exploited to increase wrist flexion velocity. This increase in wrist flexion velocity was associated with constant wrist flexion amplitudes at ball release (mean 27 degrees) for throws of different speeds. Furthermore, final wrist flexion positions after ball release were similar for a particular subject irrespective of the speed of the throw. This was associated in faster throws with increased magnitudes of wrist flexor and wrist extensor EMG activity which damped passive torques associated with forearm angular deceleration. It is concluded that wrist flexion in overarm throws of different speeds is produced by central signals which precisely control net joint torque by both exploiting and damping passive torques during different parts of the throw to keep wrist joint angular position parameters constant. As such the results show that control strategies for natural 3D throwing are different from those for constrained 2D throwing.

Arm↗

Inter- and intra-limb generalization of adaptation during catching.

We have previously shown that healthy adults require a few trials to adapt to a changed ball weight during catching. It is not known whether this adaptation generalizes to the opposite arm or to different configurations of the same arm. We tested healthy adult subjects catching balls of different weight while maintaining the hand within a vertical spatial "window." In experiment 1, subjects caught a series of light and heavy balls, first with one hand and then with the other. In experiment 2, subjects caught a series of light and heavy balls, first with the catching arm in either a "bent" or a "straight" configuration and then with the same arm in the other configuration. A percentage transfer value was calculated to determine the degree to which previous experience with a given ball weight in one context affected performance of the same task in a new context (i.e., different arm or different arm configuration). Results showed that generalization occurred both between arms and within an arm. However, the subjects who switched arms showed less generalization than those who switched arm positions. Specifically, the percentage transfer value for subjects who switched arms was 58%, while the percentage transfer for those who switched arm positions was 100%. These results support the idea that the motor system is able to generalize adaptive control of ball catching to the contralateral arm and to different arm configurations. Our findings are also in agreement with the recent notion that multiple internal representations of a task may exist in the CNS. Because there was partial generalization between the two arms, we conclude that there must be a representation stored and used for catching that is not effector specific, but rather can be utilized by brain regions controlling either arm. However, because generalization was only complete within an arm, we conclude that another sensorimotor representation exists, which might only be stored in brain regions specific to a single arm.

Adaptation, Physiological↗

Little Leaguer's shoulder.

A case of Little Leaguer's shoulder in a skeletally immature patient is described with a review of the English literature. This entity manifests as widening of the proximal humeral physis and is well known to our orthopedic colleagues. To our knowledge, however, there is little in the current radiologic literature describing Little Leaguer's shoulder. We describe such a case.

Baseball↗

Ball-thrower's fracture of the humerus.

A relatively rare case of ball-thrower's fracture of the humerus is presented. Severe muscular action is an uncommon cause of humeral fractures but has been well documented in the orthopedic literature. To our knowledge, this fracture has not been described in the radiology literature, and awareness of this entity could preclude further unnecessary workup. The mechanism of injury and its typical radiographic appearance is described.

Adult↗

MRI of Little Leaguer's shoulder.

The MRI appearance of 'Little Leaguer's shoulder' has not been previously reported in the radiology literature. Purported etiologies include proximal humeral epiphyseolysis, osteochondrosis of the proximal humeral epiphysis, stress fracture of the proximal humeral epiphyseal plate, and rotational stress fracture of the proximal humeral epiphyseal plate. We describe magnetic resonance imaging findings in four patients and review the literature.

Adolescent↗

MR arthrography of elbow: evaluation of the ulnar collateral ligament of elbow.

OBJECTIVE: The purpose of this study was to evaluate ulnar collateral ligament (UCL) injury of the elbow in throwing athletes by MRI and MR arthrography. DESIGN: Ten elbows of throwing athletes were examined on both plain MRI and MR saline arthrography and the injuries subsequently surgically proven. Spin-echo (SE) T1-weighted and fast SE T2-weighted coronal images were obtained. RESULTS: The UCL was unclear in all ten cases on T1-weighted MRI. In five cases an avulsion fracture was also found on T1-weighted MRI. On T2-weighted MRI, abnormal high-intensity areas were identified in or around the UCL. On T2-weighted MR arthrography images, extracapsular high-intensity areas, which represent extracapsular leakage, were found in four of five cases with avulsion fracture. At surgery, all these four cases showed avulsion fractures with instability; the other case had a fracture but it was stable and adherent to the humerus. On T2-weighted MR arthrography images, an extracapsular high-intensity area was found in one of the five cases without avulsion fracture. At surgery this patient had a complete tear of the UCL itself. CONCLUSION: MR arthrography provided additional information for evaluating the degree of UCL injury.

Adolescent↗

Chondromalacia of trochlear notch after healing of olecranon stress fracture: a case report.

INTRODUCTION: Chondromalacia of the trochlear notch and stress fracture of olecranon are uncommon injuries in the throwing athletes. MATERIALS AND METHODS: We report an 18-year-old high school pitcher who had persistent postero-lateral elbow pain after a healed olecranon stress fracture of the right elbow. Diagnostic arthroscopy revealed chondromalacia of the trochlear notch. RESULTS: After treatment with arthroscopic drilling and abrasion chondroplasty, he returned to competitive pitching 1 year later postsurgery. This rare association between chondromalacia and stress fracture of the olecranon has not been reported previously in the literatures. CONCLUSION: Chondromalacia of the trochlear notch should be included as a differential diagnosis in evaluating athletes with persistent elbow pain after healed olecranon stress fractures.

Adolescent↗

Simultaneous double interphalangeal dislocation in one finger.

Isolated dislocation of the proximal or distal interphalangeal joint of a finger is common, but simultaneous dislocation of both joints is rare. Three cases of simultaneous dislocations of both interphalangeal joints in the same finger are reported. Closed reduction was easily achieved in all cases.

Adult↗