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A 30-year-old recreational baseball player developed dominant-sided infraspinatus atrophy and shoulder pain after throwing a baseball. Partial denervation of the infraspinatus muscle with delayed motor latency was documented. Isolated lesions of the branch to the infraspinatus may be more common than previously suspected, particularly in throwing athletes with shoulder pain.
Most sports-related peripheral neuropathies occurring from the elbow distally are compressive in nature. These result from overuse or overload principles superimposed on normal or variant anatomy. Tensile injury occurs less often and is usually associated with the extremes of the throwing motion, i.e., cocking and follow-through phases of throwing. Neurogenic syndromes are usually incomplete, indicating the absence of severe motor or sensory deficits, but typically with subjective complaints of pain or vague sensory disturbance. As a result, nerve injuries are frequently overlooked as a source of acute or, more usually, chronic symptomatology. Further, distal symptoms are not always representative of distal pathology as evidenced by the double-crush phenomenon. Therefore, a strong neurologic and musculoskeletal evaluation is necessary in diagnosing sports-induced peripheral nerve trauma. When positive, electrodiagnostic testing can assist with localization and extent of injury, although absence of NCV or EMG abnormalities is not unusual. Accurate diagnoses are essential for planning specific treatment.
PURPOSE: The purpose of our study was to evaluate a method of automated cutting needle biopsy (ACNB) that combines the use of a long-throw needle, higher mean number of needle passes, and tandem system, in terms of the accuracy of specific diagnosis of small and large lung lesions and the safety of the procedure. MATERIALS AND METHODS: Fifty-seven ACNBs were performed under computed tomography guidance using a tandem system with a 20-gauge and 18-gauge (through non-aerated lung) automated cutting needle with a throw length of 23 mm. We classified the nodules into 21 small nodules (< or =2 cm) and 36 large nodules (>2 cm). All ACNB diagnoses were divided into three groups: specific, non-specific, and false diagnoses. All of the complications were recorded. RESULTS: The mean number of ACNB specimens obtained was 2.0. Of the 35 ACNB procedures for malignant lesions, 33 yielded a specific malignant diagnosis (33/35, 94%). Of the 22 procedures for benign lesions, 17 gave a specific benign diagnosis (17/22, 77%). The diagnostic accuracy for small nodules was no lower than that for large nodules. Postbiopsy pneumothorax occurred in 18 patients (32%). CONCLUSION: The diagnostic accuracy of the combined method is as high for small lung nodules as for large ones. The procedure has high diagnostic accuracy for the subtypes of lung cancer and an acceptable complication rate.
The timely and qualitative diagnosis of physical fitness allows evaluation of the functional capacities and physical development of children starting from the age of 3 years and 6 months. The changes in the indices of development of child's motor skills are one of the major criteria for the efficiency of physical training in preschool educational establishments (PSEE). In the authors' opinion, a complex of basic (10- and 30-m running; long jumping; throwing medical balls into the distance from behind the head) and additional tests (throwing small sand-containing bags into the distance; bending forward; right and left hand dynamometry) is optimal to use in PSEE. The absolute majority of children can perform these tests that have the minimum medical contraindications, do not require much time and special conditions to be performed, and permit the changes in the parameters to be followed up.
The general objective of this study was to develop a sustainable waste disposal management model in Yom riverside communities by creating a sense of ownership in the project among the villagers and encourage the community to identify problems based on their socio-cultural background. The participatory approach was applied in developing a continual learning process between the researcher and stakeholders. The Tub Phueng community of Si Samrong, Sukhothai Province was selected as the location for this study. From the population of 240 households in the area, 40 stakeholders were selected to be on the research team. The team found that the waste in this community was comprised of 4 categories: 1. Occupation: discarded insecticide containers used for farming activities; 2. Consumption: plastic bags and wrappers form pre-packed foods; 3. Traditional activities: after holding ceremonies and festivities, the waste was dumped in the river; and 4. Environmental hygiene: waste water from washing, bathing, toileting, cooking and cleaning was directly drained into the Yom River. The sustainable waste disposal model developed to manage these problems included building simple waste-water treatment wells, digging garbage holes, prosecuting people who throw garbage into the river, withdrawing privileges from people who throw garbage into the river, and establishing a garbage center. Most of the villagers were satisfied with the proposed model, looked forward to the expected positive changes, and thought this kind of solution would be easy to put into practice.
Youth sports participation carries an inherent risk of injury, including overuse injuries. Little leaguer's shoulder, a stress fracture of the proximal humerus that presents as lateral shoulder pain, usually is self-limited. Little leaguer's elbow is a medial stress injury; treatment consists of complete rest from throwing for four to six weeks followed by rehabilitation and a gradual throwing program. Spondylolysis is a stress fracture of the pars interarticularis. Diagnostic modalities include plain film radiography, bone scan, computed tomography, single photon emission computed tomography, and magnetic resonance imaging. Treatment usually is conservative. Spondylolisthesis is the forward or anterior displacement of one vertebral body over another and may be related to a history of spondylolysis. Diagnosis is made with plain film radiography and graded according to the amount of displacement. Osgood-Schlatter disease presents as anterior knee pain localized to the tibial tubercle. Diagnosis is made clinically, and most patients respond to conservative measures. Calcaneal apophysitis (or Sever's disease) is a common cause of heel pain in young athletes, presenting as pain in the posterior aspect of the calcaneus.
The athlete's elbow has been described as one of the last frontiers in orthopaedic sports medicine. It has been considered separately from other athletic injuries because of the unique constellation of pathology that results from repetitive overhead throwing. Tremendous gains in understanding the complex interplay between the dynamic and static stabilizers of the athlete's elbow have occurred over the past decade. The desire to treat these injuries in a minimally invasive manner has driven the development of techniques and instrumentation for elbow arthroscopy, a successful and essential technique in the treatment of the thrower's elbow. Medial collateral ligament injuries, ulnar neuritis, valgus extension overload with osteophyte formation and posteromedial impingement, flexor pronator strain, medial epicondyle pathology, and osteochondritis dissecans of the capitellum have all been described as consequences of the overhead throwing motion. In addition, loose body formation, bony spur formation, and capsular contracture can each be present in conjunction with these conditions or as isolated entities. Not all pathology in the thrower's elbow is amenable to arthroscopic treatment; however, the clinician must be familiar with all of these conditions to form a comprehensive differential diagnosis for an athlete with elbow pain. The surgeon treating the athlete's elbow should be comfortable with both open and arthroscopic treatments. An understanding of the anatomy and biomechanics of the thrower's elbow is essential for good patient care. The preoperative evaluation should focus on a thorough history and physical examination, as well as specific diagnostic imaging modalities.
The main areas of controversy in anterior shoulder instability are acute dislocation, recurrent instability, pain and instability in the "throwing athlete", and the role of arthroscopy. Treatment of the acute dislocation involves rest initially, followed by aggressive rehabilitation with protection of the shoulder until strength and motion have returned and pain and apprehension have resolved. Patients with recurrent instability may be seen with a variety of clinical scenarios. The surgical indications, pathology, and two methods of soft-tissue reconstruction are described along with an approach to postoperative rehabilitation. Return to sporting activity may be feasible by three months. The current thinking on the painful shoulder in the "throwing athlete" is outlined. Management must be based on an accurate diagnosis. Strengthening of the rotator cuff and scapular stabilizers is recommended with surgery to correct the pathology in those who fail this program. Arthroscopy is a valid tool in the diagnosis of anterior shoulder instability. The clinical significance of some intraarticular findings has not yet been clarified. Therapeutic use should be undertaken only in experienced hands, appreciating that failure of arthroscopic repair is higher than comparable open surgical techniques. The open approach to anterior stabilization is preferred.
Tissue reaction surrounding surgical knots was assessed histologically using a semiquantitative scoring system in 40 male Wistar rats. We tested sizes 2/0 and 4/0 (United States Pharmacopeia [USP]) coated polyglycolic acid and coated polyglactin-910 sutures, and two different knots. In addition, we measured the volume of the different knots and the total volume of tissue reaction surrounding the knots. Multivariate analysis showed only suture material and suture size to be independent factors determining tissue reaction. An increase of suture size resulted in a more than four- to sixfold increase in knot volume and a more than two- to threefold increase in the amount of the tissue-reaction sheath; however, the addition of extra throws to the knot enlarged the knot body by a factor of ony 1.5 and the tissue-reaction sheath by a factor of 1.0-1.9. These findings suggest that the use of thick-gauge suture material adds much more to the total amount of foreign body and tissue reaction in the wound than the addition of extra throws to the knot and might, therefore, be deleterious to optimum wound healing.
Common sports, involving raising the arms above the head, i.e., throwing, racquet games and swimming, often result in rotator cuff tendinitis. During the throwing motion, the humeral head and its overlying biceps tendon and rotator cuff must pass rapidly under the coraco-acromial arch. Damage to these structures can occur by several mechanism. First, an increase in the size of the structures passing underneath the arch may lead to impingement. This can occur either by way of hypertrophy of the musculotendinous cuff or by way of inflammation of the cuff. Second, a decreased space available underneath the arch secondary to osteophyte formation of the acromion and fibrosis of the subacromial space may lead to impingement. Third, weakness or incompetence of the rotator cuff allows the humerus to ride up and impinge on the coracoacromial arch with motion of the shoulder. Tendinitis can be combined with increased laxity of the glenohumeral joint and/or acquired instability due to a labral tear. Prevention of overuse injuries is a cornerstone of our treatment concept. The muscle tendon unit requires passive and neuromuscular facilitated streching after warming-up exercises. Muscular imbalance and weakness are prevented by balanced eccentric strenthening with particular attention to the external rotators and scapular muscles. Knowledge of the mechanics of the pitching motion, tennis serve, swimming stroke, etc. is of paramount importance in the prevention of injuries. As the onset of shoulder problems contributes to a particularly fatiguing situation, extreme fatique performance severity should be avoided. Every effort must be made to apply conservative treatment when overuse problems arise in the athlete's shoulder.(ABSTRACT TRUNCATED AT 250 WORDS)
A method of ergometric tests furnishing a quantitative evaluation of the coronary and contractile function reserves and also ensuring safe examination has been devised. The veloergometric tests proceed under a continuous ECG and integral rheographic control with automatic throwing-off the load in case of ischemic changes of the ECG or reduction of the circulation volume. The amount of work done by the moment of throwing off the load was taken as a quantitative measure of the corresponding functional reserve. This principle served as a basis for constructing an electronic system automating the conduct and assessment of the veloergometric test. Examinations covered 890 healthy persons and patients. Future prospects for the use of biologically controlled ergometric tests are outlined.
By the analysis of 54 traffic accidents involving prone, run-over people it is shown that the vast majority were drunken males who lay on the road during the night and were there driven over. There are many reasons for the "lying on the road" including, falling due to sickness, voluntary lying for suicide, falling of lying due to an alcoholic condition. For evidence respectively exclusion a previous accident, the clothing must be precisely examined for trace evidence (textile changes, transfer of paint, glass fragments, tyretread patterns, skidmarks from shoes). An analysis of skin, bones and internal organs indicates the cause of the injuries (driving into, throwing on to, throwing off and rolling over).
In the German Democratic Republic a representative sample of 300 twin pairs of normal 10 years old school children was measured and tested. From a subset of 480 pairs (153 pairs of opposite sex and 327 of the same sex) the heritabilities are calculated: stature 0,89; weight 0,88; 60 meters run 0,85; long jump 0,74; cricketball throw 0,54; push up 0,85; hop jump 0,66; endurance run 0,93; shot throw 0,71. The use of heritabilities as weighting factors in the construction of selection indices for purposes of personnel selection is discussed.
Roentgenographic changes consistent with osteochondrosis of the proximal humeral epiphysis were observed in five young baseball pitchers complaining of shoulder pain in the throwing arm. The symptoms and findings were quite similar to the previously reported involvement of the medial epicondylar epiphysis or "Little Leaguer's elbow."The act of throwing a baseball hard is an abnormal whip-like action which places a forceful repetitious traction strain on the shoulder joint. Shoulder pain in youngsters engaged in organized competitive swimming programs can also be explained in this way. Since these entities became evident with the establishment of organized baseball programs for boys in this age group, better medical supervision and rule changes to limit the amount of pitching until the epiphyses close, are urgently needed.
South African orthopaedic surgeons have been in the forefront of the development of reconstructive procedures performed for recurrent anterior shoulder dislocation. In addition to the Johannesburg stapling operation described by G. T. du Toit and D. Roux, Professor A. Helfet of Cape Town was the first to describe the coracoid transplantation operation in 1958. A modified form of this operation was performed on 31 patients between August 1975 and February 1981. Patients were followed up for a mean period of 38 months, and no recurrences were encountered in patients who had had true involuntary recurrent subluxation or dislocation. The operative technique is described in detail as it is considered that adequate exposure and accurate placement of the coracoid process are very important factors in obtaining a satisfactory result and in the prevention of complications. It has been postulated that this operation, which does not attempt to shorten the capsular structures or subscapularis tendon, affords a superior result in respect of patients who participate in throwing sports. It has been noted that patients who play cricket, baseball and basketball have encountered problems in regaining their ability to throw overhand after having had operations such as the Putti-Platt procedure, which entails intentional shortening of the capsular structures and subscapularis tendon.
A subliminal psychodynamic activation experiment was conducted in which the effects of five subliminal stimuli were sought on the dart-throwing performance of male subjects. The stimuli consisted of the following messages, each accompanied by a congruent picture: BEATING DAD IS OK, BEATING DAD IS WRONG, BEATING HIM IS OK, BEATING HIM IS WRONG, and PEOPLE ARE WALKING. The first two stimuli were intended to activate competitive motives within the context of the Oedipus complex; the next two, competitive motives outside that context; and the last was intended as a control stimulus. BEATING DAD IS OK led to greater dart-throwing accuracy than each of the other four conditions, which in turn did not differ from each other. This finding replicated a result reported by Silverman, L. H., Ross, D., Adler, J., and Lustig, D. (J. Abnorm. Psychol., 87: 341-357, 1978) and is in keeping with the formulation that the activation of oedipal motives can affect competitive performance. Neither a subject variable (fear of success) nor the differential effects of two experimenters was found to interact with stimulus conditions in affecting dart scores.
The purpose of the study was to determine which kinematic factors changes and how they changed during the process of skill acquisition. A novel throwing task, involving only the elbow joint, was selected that could be learned during one session. Biomechanical data were collected on-line by a program in a PDP - 11/34 computer via an A to D converter. Angular displacement, linear acceleration, and instant of ball release were continuously monitored and velocity was calculated. The subjects acquired the task within the first ten out of forty learning trials. Consequently, group analyses were limited to the first ten throws. The mechanical factors showed changes with skill acquisition, with elbow angle and elbow velocity at release accounting for 99% of the variance in score. It was found that to obtain the desired performance outcome, each subject selected his own limited range of angles and velocities at release. Although pertinent biomechanical factors are task specific, individuals in this case selected their own strategies to get the same outcome on a task.
Elbow injuries are becoming more common as increasing numbers of people participate in throwing and racquet sports. The understanding and treatment of elbow injuries is becoming more sophisticated in conjunction with better noninvasive and invasive diagnostic techniques. The majority of injuries to the elbow in the athlete are chronic, overuse injuries. These injuries are the result of repetitive intrinsic or extrinsic overload, or both, resulting in microrupture of soft tissue such as ligament or tendon. In children, apophyses, being the weakest link in the immature musculoskeletal system, are susceptible to stress injuries. Elbow injuries are most commonly caused by valgus stress, from throwing or axial compression, resulting in increased force absorbed by the medial elbow. With repetitive valgus stress, patients may develop chondromalacia, loose bodies in the posterior or lateral compartments, injury to the ulnar collateral ligament, myotendinous injury to the flexor-pronator muscle group, osteochondritis dissecans, or ulnar neuritis. The purpose of this paper is to (1) define the significance of elbow injuries in athletics, (2) review the anatomy and biomechanics of the elbow, and (3) discuss the prevention and treatment of elbow injuries.