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Treatment options for chondral and osteochondral defects of the patella have been few and results have been inconsistent at best. Autologous osteochondral transplantation presents a new way to revisit these patellar defects. We report the case of a young female softball player with a simple cyst in the patella and an osteochondral defect that serves as the indication for autograft osteochondral transplantation.
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.
BACKGROUND: Measures of joint position sense often test single-axis motions isolating a single joint. Such methods hamper our ability to apply findings to functional multijoint activities. Using a functional, active, multijoint test, we measured upper-extremity position reproduction in overhead-throwers. We compared acuity among four joints and examined individual joint contributions or patterns of contribution among joints to overall task acuity. METHODS: We used an electromagnetic tracking device to measure reproduction of two functional upper-extremity positions. We calculated absolute, constant and variable error at four upper-extremity joints around multiple axes of rotation: three axes at the scapulothoracic and glenohumeral joints and two axes at the elbow and wrist. To represent individual joint acuity, we calculated 3-dimensional variable error. Additional 3-dimensional variable error scores using deviation in hand position (with reference to the thorax) represented overall task acuity. We used principle component analyses to identify contributions of individual joints or patterns of contribution among joints to overall task acuity for absolute, constant and variable error. FINDINGS: Scapulothoracic and glenohumeral joints displayed better acuity compared with elbow and wrist joints. When examined separately, absolute, constant and variable error scores did not indicate any individual joint contributed more to task acuity. When we examined the principle components of all error score measures together, a distinct proximal-to-distal pattern of joint contribution to overall task acuity emerged. INTERPRETATION: Proximal joints display better reposition acuity compared with distal joints, however proximal joints contribute more to acuity of the overall task. Our results indicate that upper-extremity joints do not function independently in repositioning tasks and measures of absolute, constant and variable errors combined over multiple joints may better represent upper-extremity function.
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.
Overhead throwing motion imparts enormous forces on the elbow. Repetitive near-failure loads lead to chronic adaptive changes and occasionally acute injury to bone, ligaments, and the elbow's muscle-tendon complexes. Physicians treating the thrower must thoroughly understand the complex anatomy and function of the elbow joint and throwing biomechanics to diagnose and treat elbow pathology. Evaluation of elbow pain begins with a thorough, detailed throwing history, including symptom duration, location of pain, timing during phases of throwing motion, and associated symptoms. Physical examination should include inspection, range of motion, palpation, and specific tests to better define the pathology. A detailed history and physical examination often lead the astute clinician to the proper diagnosis and treatment without reliance on ancillary testing.
This article reviews basic concepts in fundamental elbow biomechanics, particularly how they relate to the skeletally immature elbow in throwing athletes. Adult phases of throwing and the forces generated in each phase are compared with the developmental phases of throwing in children. The impact of elevated forces, poor mechanics, and poor coordination are emphasized as they relate to potential areas of injury in the skeletally immature. Finally, concepts in prevention focused on biomechanics are offered.
The elbow joint is frequently injured in the overhead athlete, due to the large amount of forces in throwing. Injuries often occur due to repetitive microtrauma, especially in pitching. Rehabilitation following injury or surgery is vital to fully restore normal elbow function and return the athlete to competition as quickly and safely as possible. Elbow rehabilitation must follow a progressive and sequential order to ensure that healing tissues have not been compromised. Emphasis is on restoring full motion, muscular strength, and neuromuscular control, and gradually applying loads to healing tissue. This article provides an overview of a multiphased rehabilitation program for the thrower's elbow. Rehabilitation for specific nonoperative and postoperative pathologies often observed in the throwing athlete is also discussed.
A wide spectrum of abnormalities can affect the throwing shoulder. The injuries are often particular to a specific phase of the throw and are well demonstrated with MR imaging. In this article, the authors review the phases of the throw, MR imaging techniques, and the MR appearances of the injuries associated with particular phases.
We report a rare anatomic variation in which the median nerve travels in a bony canal of the distal humerus, separating from the brachial artery. We encountered this during neurolysis for posttraumatic median nerve palsy in a 10-year-old boy. We suggest that this anatomic variation was related strongly to this patient's median nerve palsy.
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Explore the source record for details and available documents.
The distribution of mineralization in the subchondral bone plate (DMSB) is used as a parameter for individual stress distribution of shoulder joints. We have analyzed 28 shoulder joints of throwing athletes by DMSB of the glenoid with computed tomography osteoabsorptiometry and described their mineralization patterns. The throwing motion imposes a heavy rotational load on the shoulder joint, and this, in turn, may lead to excessive translation of the humeral head on the glenoid. This could explain why the two most frequent density maxima were localized to the anterior and posterior portions of the glenoid. Our finding of a frequent bicentric density distribution of the shoulder joints of throwing athletes should be useful in any future analysis of the relationship between the DMSB and the bone morphology of the glenoid.
For 6 consecutive months all triage acceptable emergency room patients at the St. Francis Medical Center with blunt or penetrating trauma involving the abdomen were included in this review. Computed tomography and radionuclide imaging of the abdomen and urinary tract was performed in addition to the usually indicated diagnostic procedures. In our hospital the Radiology Department is adjacent to the Emergency Department. Close cooperation of the trauma team, the imaging physician and the technologists, has provided a stable, reproducible pattern in the performance and evaluation of nuclear medicine and radiographic techniques. Teleradiologic techniques of image transmission over the telephone lines permits immediate availability of the expertise of the radiologist. This correlation has provided an opportunity for improving patient care and refining our protocol in the care and management of the acutely traumatized patient. One-hundred-twenty-seven patients classed as acute trauma cases were processed during those 6 mo. Forty-two of these patients were not included in this study. They were triaged as immediate surgical emergencies, had incurred injury limited to the head, extremities or thorax, or were not injured sufficiently to require the special care of the designated trauma team. The 85 patients in this study included 56 males and 29 females. The patient age ranged from 3- to 71-yr-of-age. The median age was 29.3 yr. The author feels the findings in this evaluation of the complementary roles of radionuclide imaging and computed tomography should be of value to others in the formulation of their acute trauma care protocol. Nuclear medicine techniques retain an important role in the diagnosis of several sequelae of head trauma. Sensitivity and accuracy for detection of subdural hematoma are not as high as those of transmission computed tomography even if proper techniques are employed. Other important applications, however, include the diagnosis of normal pressure hydrocephalus, location of cerebrospinal fluid leakage, and confirmation of brain death.
Blunt chest impact-induced cardiac arrest on the athletic field (commotio cordis) is not necessarily fatal. The 3 survivors reported here emphasize the importance of recognizing this syndrome so that emergency resuscitative measures are more likely to be implemented promptly, and such catastrophes avoided.
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PURPOSE: To report traumatic, hemorrhagic detachment of the retinal pigment epithelium that was detected by optical coherence tomography. DESIGN: Observational case report. METHODS: A 17-year-old boy with hemorrhagic fundus lesions caused by blunt ocular trauma was examined by optical coherence tomography and angiography. RESULTS: Initially, two dark red, mounded lesions were seen, with one in the macula and the other adjacent to the optic disk. The lesions blocked the fluorescence on fluorescein and indocyanine green angiography. Optical coherence tomography demonstrated dome-shaped elevations of the retinal pigment epithelium at each lesion. Four months later, the retinal pigment epithelium detachments disappeared in the tomography images, and no scarring was evident ophthalmoscopically. Small choroidal ruptures were detected in each lesion by angiography. CONCLUSIONS: Optical coherence tomography was useful in evaluating the site of the hemorrhage in the chorioretinal layers caused by blunt ocular trauma.