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Ice application is one of the most extensively used treatments for athletic injuries. Frostbite is a recognized danger. Five cases of nerve palsy resulting from ice application are reported here. These palsies were temporary. They usually resolve spontaneously without any significant sequelae. This complication can be avoided by not using ice for more than 30 minutes and by guarding superficial nerves in the area.
A modified Jones intraarticular anterior cruciate reconstruction was combined with a distal iliotibial band transfer (Ellison) and a pes anserinus transfer (Slocum) for patients with symptomatic anterior cruciate deficient knees. The procedure was performed on 15 young (average age, 22.5 years) athletes, in a single operation through a long, straight, anterior, midline incision. Preoperatively, all 15 patients (15 knees) had symptomatic instability and all but one had a positive pivot shift. At follow up (averaging 39 month range 24-60 months) 13 (93%) had the pivot shift eliminated and only one, with 36 months followup, had instability on return to sports. Postoperatively, patients were immobilized 3 weeks and then were started on a physical therapy program which ended in return to sports at 1 year.
Studies have shown that the presence of impacted third molars places the mandible at increased risk for fracture. Individuals participating in high contact sports are subject to maxillofacial trauma; therefore, participants with impacted third molars are at increased risk for fractured mandibles. Three cases are reviewed to illustrate this problem.
The two basic sliding techniques, head-first and feet-first, were analyzed kinematically with high speed cinematography. Four phases were identified with each technique: sprint, attainment of sliding position, airborne, and landing. The velocity and displacement of the center of gravity were measured with each technique. The study was primarily descriptive but demonstrated potential for injury with each technique. Further studies are needed to determine which technique is safer and faster.
A prospective investigation of slow-pitch softball injuries incurred in Hawaii was undertaken to study the nature of these injuries and analyze their causes. The injured players were involved in league softball with referees. There were 83 athletes and 93 injuries. A retrospective review of all Army softball-related admissions was also done. Thirty-five athletes or 42% were injured while sliding, 29 "foot first" and the remainder "hand first". Twenty-five of 27 ankle injuries caused by sliding included 20 fractures, 3 sprains, and 2 complete closed posterior dislocations. Analysis of these injuries suggests that the injury occurs when the individual uses the base to rapidly decelerate and avoid overrunning the base. Eighty-four percent of the athletes were injured from three mechanisms; 42% from sliding, 25% from "jamming" injuries, and 17% from falls. The only preventable group of injuries appears to be the sliding injuries. Recessing the bases, using "quick release" rather than anchored bases, teaching safer sliding techniques, or eliminating the slide are suggested as means of preventing these injuries.
A 13-year-old male Little League pitcher sustained a displaced spiral fracture of the right midhumerus while in midpitch. Deep ache prodrome symptoms in the midhumerus at rest and during pitching occurred during the preceeding week, suggestive of a stress fracture that later completed to an overt fracture during the added stress of a forceful side-arm curve ball pitch, his specialty. Osteonal remodeling in stress fractures is discussed.
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Explore the source record for details and available documents.
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The clinical features and preoperative and postoperative electrodiagnostic studies were reviewed in two professional pitchers with a suprascapular neuropathy. These studies demonstrate that denervation of the infraspinatus and/or supraspinatus muscle is not always due to entrapment of the nerve at the suprascapular or spinoglenoid notches, as is often proposed. Similar studies in healthy pitchers during spring training and again at midseason demonstrate that slowing of suprascapular nerve conduction is detectable in some cases as the season progresses. Sagittal sections of a cadaver with the arm fixed in the acceleration phase of the pitching motion demonstrate five possible sites of trauma to the suprascapular nerve. Mechanisms proposed to explain these progressive, but potentially reversible, changes include consideration of biomechanical factors as well as anatomical features. An alternative hypothesis to nerve trauma that explains this symptom complex is intimal damage to the axillary or suprascapular artery and subsequent production of microemboli which become trapped in the suprascapular nerve vasa nervorum.
Recreational sports injuries are expensive to society. Prevention of such injuries must be a major public health goal. In a previous retrospective study, base sliding was found to be responsible for 71% of recreational softball injuries. Because most injuries occurred during rapid deceleration against stationary bases, quick-release (break-away) bases were evaluated as a means to modify this mechanism of injury. In a prospective study, 633 softball games were played on a break-away base fields and 627 games were played on stationary base fields. Forty-five sliding injuries occurred on the stationary base diamonds (1 injury for every 13.9 games) and only two sliding injuries occurred on the break-away fields (1 injury for every 316.5 games). The medical costs for injuries on the stationary base fields was 79 times greater than that on the break-away fields. In a 1035 game follow-up study performed on all fields equipped with break-away bases, two sliding injuries occurred (1 injury for every 517.5 games). Installing break-away bases in fields used by recreational leagues would achieve a significant reduction of serious softball injuries (98%) and, therefore, should be mandatory. Based on our findings, the Centers for Disease Control has estimated 1.7 million injuries would be prevented nationally per year, saving $2.0 billion per year nationally in acute medical care costs.
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We have reported three cases of fatigue fracture of the ulna in male pitchers of fast-pitch softball. To elucidate the etiology of injury, we first selected three healthy male and three healthy female pitchers from a well-trained college team and analyzed their forearm movement by high-speed cinematography. This showed slight flexion of the elbow joints during wind-up motion, dorsal flexion of the hand joints upon releasing the ball, and extreme pronation of the forearms during the follow-through. We then took 8 mm CT scanning sections of the forearms. Using these images, we investigated shapes and areas of cross-sections of the ulna and its cortical and cancellous bones from the elbow to the hand joints. Our results reveal that the shapes of the sections are significantly different from circles at around the center of the ulna, and the cross-sectional areas are smaller in the middle one-third of the ulna than in other parts. These observations imply that fatigue fractures of the ulna in pitchers of fast-pitch softball must be torsionally induced, tending to occur at the middle one-third of the bone.
Bilateral rupture of the infrapatellar tendons is a rare event in an otherwise healthy athletic individual. The event is usually quite severe and diagnosis can be readily made on a clinical examination. In the case presented here, predisposing factors consisted of an underlying patella alta and a long history of repetitive trauma to the knee. Prompt diagnosis and surgical repair will lead to a good functional result.
From April 1, 1985, through June 30, 1987, 25 skilled athletes with shoulder pain secondary to anterior glenohumeral instability that had failed to improve with conservative therapy had an anterior capsulolabral reconstruction. All but one athlete completed a formal rehabilitation program with an average followup of 39 months. The results at followup were rated excellent in 68%, good in 24%, fair in 4%, and poor in 4%. Seventeen patients returned to their prior competitive level for at least 1 year. This operation and rehabilitation program may allow many athletes who participate in overhand activities or throwing sports to return to their prior level of competition.
An injury survey of eight college softball teams ranked among the top 15 during the 1989 women's NCAA tournament championship by their athletic trainers found 26 injuries and complaints in 20 of 24 players. There were 15 grade I (nontime-loss) injuries, all musculotendinous except for a leg contusion and an ankle sprain. The 6 grade II injuries (altered play) were also musculotendinous except for 2 sprains to the hand and wrist. The 5 grade III (stopped play) injuries were somewhat more varied in type and resulted in an average of almost 7 weeks of time lost per injured player. Eighty-two percent of the time-loss injuries (grades II and III) involved the upper extremity. This survey suggests that there are likely to be a significant number of injuries involving loss of time from practice or games among elite women's fast-pitch softball pitchers.
We report the recent occurrence of spontaneous humeral shaft fractures in 12 pitchers. The subjects were interviewed over the telephone using a standard questionnaire. Radiographs and medical records were solicited from their physicians. Their average age was 36 years and they had pitched an average of 11.4 years with an average layoff of 14 years (range, 7 to 24). Mean time between games pitched was 21 days (range, 3 to 56). The average number of pitches before the fracture occurred was 38 (range, 10 to 100). Pain was experienced at some point before the fracture in 75% of the pitchers and 75% of the fractures were spiral. These fractures were most probably spontaneous fractures brought on by accumulated fatigue damage. The period of buildup after a prolonged period of layoff was probably insufficient time for proper bone remodeling to occur in these men. While a large percentage of these men had pain before their injury, suggesting a predisposing stress fracture, there is no doubt that their fractures could still be caused by a sudden torsional load without the presence of a stress fracture.