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Functional outcomes in athletes after modified anterior capsulolabral reconstruction.

During a 7-month period, 32 consecutive athletes underwent anterior capsulolabral reconstruction with modifications, consisting of a horizontal capsulotomy (rather than a T-capsulotomy) and suture anchors (rather than drill holes); 31 patients were available for follow-up examinations. At preoperative examinations all patients demonstrated positive relocation tests; 22 were diagnosed with recurrent anterior subluxation and 9 with recurrent anterior dislocation. After surgery, all patients underwent a rehabilitation program. Followup included physical examination, subjective questions, and radiographs. At a minimum of 24 months' followup, results measured by modified Rowe score were 24 patients (77%) excellent, 6 (19%) good, and 1 (3%) failure. Eighty-one percent of the patients returned to the same sport at the same level of competition, 13% returned to the same sport at a lower level of competition, and 6% did not return to the preinjury sport. Radiographic analyses at 2 years' followup revealed all Mitek anchors were well seated in the bone of the glenoid neck. No complications of the suture anchors occurred. This modification of anterior capsulolabral reconstruction simplified the procedure and allowed a more aggressive early rehabilitation program with 97% good or excellent results.

Adolescent↗

Wrist kinematics during pitching. A preliminary report.

A computerized hand and wrist motion analysis system was modified to capture data at a rate of up to 1000 Hz. Using this system, wrist flexion and extension data were collected on five right-handed professional pitchers (75 pitches). A wrist position versus time graph was generated for each pitch. The pitch data produced a reproducible analysis of motion for the majority of the pitches regardless of pitcher. Based on the graphic display of data points, four phases of wrist motion during a pitch were identified. The first phase is the cocking phase, or the motion of the wrist as it moves into maximum extension. This is then followed by the most explosive phase, the acceleration phase, which represents ball propulsion. At ball release, the wrist progresses through flexion and there is a consistent decrease in wrist velocity, known as the deceleration phase. Finally, there is the recovery phase, or the return of the wrist toward neutral. Average values for wrist range of motion, length of phase, and angular velocity (degrees per second) were calculated for each phase of the pitch. This study represents a major step toward quantifying motion of the wrist during a pitch. The ability to quantify this motion may prove valuable in the assessment of throwing athletes after injury and rehabilitation.

Acceleration↗

Functional treatment of patellar dislocation in an athletic population.

Fifty-eight athletically active study participants with 69 knees that had experienced patellar dislocations were available for followup after being selected for a functional rehabilitation program without antecedent immobilization. Follow-up evaluation was at a minimum of 24 months after onset of treatment and averaged 46.2 months. Good or excellent results occurred in 39 (66%) knees treated after an initial patellar dislocation and in 15 (50%) knees with a chronic history of patellar instability. Twenty-six percent of the 69 knees had experienced recurrent patellar instability at followup. Overall, 42 patients (73%) were satisfied with their knees after this nonsurgical management. Anatomic predisposition and onset of bilateral instability at an early age were found to be significant factors associated with a less favorable outcome.

Adolescent↗

Symptomatic thrower's exostosis. Arthroscopic evaluation and treatment.

A long-term follow-up was performed on 22 patients treated for a posterior glenoid osteophyte and symptomatic posterior shoulder pain during either the late cocking, acceleration, or follow-through phases of throwing. Arthroscopic evaluation of these patients revealed undersurface tearing of the rotator cuff in all but one. Fifteen patients also had tearing of the posterior labrum. Anterior labral fraying was noted in four patients. Treatment consisted of debridement of the rotator cuff and labral tears. The posterior glenoid osteophyte was removed arthroscopically in 11 patients. Eighteen of 22 throwers treated were available for long-term follow-up at a mean of 6.3 years (range, 1 to 12). Only 10 of 18 (55%) throwers evaluated had returned to their premorbid level of throwing. All 10 were asymptomatic and had maintained a high level of performance for a mean of 3.6 years (range, 1 to 8). At the time of latest follow-up, five players were still participating at the major league level and five had retired. One patient had recurrence of the exostosis 8 years after surgery. Among our patients a trend existed toward a poorer result and failure of return to activity with a posterior osteophyte greater than 100 mm2. A posterior glenoid exostosis, when identified in the symptomatic shoulder of the throwing athlete, can be considered a definite marker of internal impingement.

Adult↗

A new pain provocation test for superior labral tears of the shoulder.

We prospectively evaluated the usefulness of a new pain provocation test to diagnose superior labral tears in 32 patients with diagnosed throwing injuries of the shoulder. Results of the pain provocation test were compared with findings on magnetic resonance arthrography (all 32 patients) and arthroscopic examination (15 patients). In 22 patients, detachment of the superior labrum was observed on arthrograms, and all of them had positive results on the new pain provocation test. Nine of the other 10 patients had negative results on the new pain provocation test. However, 1 of the 10 patients had a positive result. Eleven of 15 patients were found to have superior labral lesions arthroscopically, and all of them were classified as type II superior labral anterior posterior lesions. All the 11 patients had positive pain provocation tests. The other four patients without superior labral tears on arthroscopic findings had negative results on the new pain provocation test. The new pain provocation test identified all patients with detachment of the superior labrum confirmed by magnetic resonance arthrography, for a sensitivity of 100%, a specificity of 90%, and an accuracy of 97%. Results of the new pain provocation test were in accord with arthroscopic findings in the 15 patients who underwent arthroscopic examination.

Adolescent↗

Blue jay mania.

Explore the source record for details and available documents.

Adult↗

Closed posteromedial dislocation of the tibiotalar joint without fracture or diastasis: a case report.

Tibiotalar dislocation without fracture is an unusual injury. Seventy-three cases have been reported in the literature. Closed posteromedial dislocation of the tibiotalar joint without fracture or diastasis is a very rare phenomenon. Eight cases have been reported. A case of this unique injury is presented, along with a literature review of purely ligamentous ankle dislocations. The proposed mechanism and classification of these injuries are summarized.

Adult↗

Supracondylar process of the humerus causing brachial artery compression and digital embolization in a fast-pitch softball player. A case report.

The supracondylar process of the humerus is a rare abnormality found in 0.4-2.7% of the population. It has been documented to cause neurovascular compression in the upper extremity owing to its local impingement on the median nerve and brachial artery at its medial location on the humerus just proximal to the elbow. The authors report the first known case of digital ischemia from embolization of thrombus caused by local compression of the brachial artery attributed to a supracondylar process.

Adolescent↗

Equipment innovations and rules changes in sports.

Participation in competitive athletics carries an inherent risk for injury. The acceptable level of risk in certain sports is often a topic of considerable debate. The National Collegiate Athletic Association, and other sports governing bodies, use injury surveillance and input from coaches, administrators, officials, athletes, and sports medicine experts in considering rules and equipment changes. Equipment innovations and/or equipment rules changes may decrease the risk of injury. However, equipment and rules changes can alter the essence or style of play of a particular sport, thus possibly increasing the risk of injury. This article discusses recent changes in equipment in various sports. The reasons for change, controversy, and relevant research related to those changes are also reviewed.

Athletic Injuries↗

Backstage, frontstage: an analysis of work and leisure roles of women recreational softball players.

American culture and attitudes are profoundly homophobic. Studies abound that describe the violence and discrimination that traditionally have been part of a homosexual's life. Growing up "queer" in the United States prompts many homosexuals to consciously or unconsciously suppress homoerotic feelings (Forstein, 1988). The traditionally male and female identities in society are strongly connected to heterosexuality. Reality and fear that constrain a homosexual result in what Schwanberg (1993) states is a "rigidly segmented life in which one works as a straight person and plays as a gay one" (p. 47). Utilizing Goffmanian terminology, this study will explore the presentation of front and backstage selves of women recreational softball players in Alaska.

Adult↗

Partial tears of the anterior cruciate ligament. Progression to complete ligament deficiency.

In a prospective seven-year study, we treated 32 patients with partial ruptures of the anterior cruciate ligament (ACL) verified by arthroscopy. Twelve knees (38%) progressed to complete ACL deficiency with positive pivot shift tests and increased anteroposterior translation on tests with the KT-1000 arthrometer. Patients with partial ACL tears frequently had limitation for strenuous sports, while those developing ACL deficiency had additional functional limitations involving recreational activities. Three factors were statistically significant in predicting which partial tears would develop complete ACL deficiency: the amount of ligament tearing--one-fourth tears infrequently progressed, one-half tears progressed in 50% and three-fourth tears in 86%; a subtle increase in initial anterior translation; and the occurrence of a subsequent re-injury with giving-way.

Acute Disease↗

Attitudes on inclusion of a player with disabilities in a regular softball league.

Although attitudes of sports participants relate significantly to the successful inclusion of individuals with disabilities in regular sport programs, there has been no published research on attitudes toward inclusion or rule modifications. We examined attitudes of girls without disabilities, their parents, and their coaches towards inclusion of a child with disabilities in a regular girls' fast-pitch softball league. They completed the Attitudes Towards Integrated Sports Inventory prior to the season. Results suggest that players and parents had a favorable attitude towards inclusion and towards modifying the game rules to enable this player to have a safe, successful experience. Coaches were undecided about inclusion and rule modifications.

Adult↗

Isoperformance curves in applied psychology.

Isoperformance is a technique for reading information out of a data-analytic model, comparable to expected mean square or omega squared analyses. It results in a trade-off function (an isoperformance curve) among the determinants of performance. The technique was developed primarily to generate trade-off functions between personnel aptitude and time in training or on the job. However, the technique is general and can be applied in any trade-off situation. In part, the purpose of this paper is to recall the antecedents of isoperformance in psychophysics and to recount the origins and development of the isoperformance readout. Its main purpose, however, is to present several examples of isoperformance curves in applied psychology and to make the case for their usefulness.

Analysis of Variance↗

Female collegiate windmill pitchers: influences to injury incidence.

Few studies have examined fast-pitch softball pitchers and associated injuries. The aim of this study was to investigate injuries occurring to collegiate softball pitchers and associated influential factors. A web-based survey of 181 Division I (n = 45), II (n = 30), and III (n = 54) collegiate softball pitchers was conducted. The survey involved self-reported data from the previous year that addressed (a) demographic information, (b) pitching and game data, (c) training program information, and (d) injury reporting. Demographic information, pitching and game data, and training program information were not statistically significant (p < 0.05) in relation to injury. Descriptive statistics were used to report totals and percentages of pitchers surveyed. Among 131 reported injuries, 36 were acute, 92 chronic/overuse, and 3 unspecified. Of the total injuries, 80 were directly from pitching, with 33 shoulder-related and 16 related to the lower back. Among injured pitchers, 109 took nonsteroidal anti-inflammatory drugs, 140 used modalities, 11 received surgeries, and 95 saw additional specialists. Pitchers are at a risk for injury, with 72.8% of surveyed pitchers being injured during the 2001-02 year.

Adolescent↗

Difference in isokinetic torque acceleration energy of the rotator cuff: competitive male pitchers versus male nonathletes.

Rotator cuff function is critical to the overhead athlete. Rotator cuff power is felt to be important in the overhead athlete during the throwing motion. Little research exists regarding torque acceleration energy (TAE) in overhead athletes. Twenty-five males were divided into 2 groups consisting of overhead athletes (pitchers) (n = 12) and nonoverhead athletes (controls) (n = 13). All participants were given a concentric velocity spectrum isokinetic test at speeds of 60 degrees (1.05 r), 180 degrees (3.16 r), and 300 degrees.s(-1) (5.26 r) to both the dominant and nondominant shoulder internal and external rotators. Significant differences were found for all internal rotator TAE scores (p = 0.000-0.016), at each of the 3 velocities, when comparing dominant to nondominant arms of both overhead athletes and nonoverhead athletes. Only 60 degrees.s(-1) (1.05 r) was found to be different during external rotation TAE testing of the overhead athletes (p = 0.027) but was not found in the control subjects. Post hoc analysis revealed no differences between dominant or nondominant TAE scores when comparisons were made between overhead athletes and controls. Results may reveal that power of the rotator cuff muscles may not be a critical component of the overhead throwing motion.

Adolescent↗

Determination of functional strength imbalance of the lower extremities.

The purposes of this study were (a) to determine whether a significant strength imbalance existed between the left and right or dominant (D) and nondominant (ND) legs and (b) to investigate possible correlations among various unilateral and bilateral closed kinetic chain tests, including a field test, and traditional isokinetic dynamometry used to determine strength imbalance. Fourteen Division I collegiate women softball players (20.2 +/- 1.4 years) volunteered to undergo measures of average peak torque for isokinetic flexion and extension at 60 degrees .s(-1) and 240 degrees .s(-1); in addition, measures of peak and average force of each leg during parallel back squat, 2-legged vertical jump, and single-leg vertical jump and performance in a 5-hop test were examined. Significant differences of between 4.2% and 16.0% were evident for all measures except for average force during single-leg vertical jump between the D and ND limbs, thus revealing a significant strength imbalance. The 5-hop test revealed a significant difference between D and ND limbs and showed a moderate correlation with more sophisticated laboratory tests, suggesting a potential use as a field test for the identification of strength imbalance. The results of this study indicate that a significant strength imbalance can exist even in collegiate level athletes, and future research should be conducted to determine how detrimental these imbalances could be in terms of peak performance for athletes, as well as the implications for injury risk.

Adult↗