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This is a report on the possibility of employing functional dressing techniques in paratenonitis of the Achilles tendon. The causes for this condition are shown. The main part of the paper deals with the possibilities of conservative treatment.
A stress fracture atypical lesion caused by overstraining the bony skeleton could result in a long-term rest in training. Depending on the type of stress, the localisation changes. The lower extremities are without doubt afflicted most frequently. Complaints, findings and x-ray findings may be unspecific. This complicates the diagnosis in the same way as stress fractures with rare localisation. The concept "stress fracture" is often misleading and should preferably be replaced by "stress reaction". This applies particularly to non-typical radiological patterns. Diagnosis, differential diagnosis and therapeutical aspects are discussed.
This is a report of a girl of 16 years of age who complained of pain in both legs after intensive competitive sports, the main event being the 800 m race. Radiologically visualised were periostal reactions and new periostal bone formations at the femur and lower leg. Diagnosis was extremely difficult due to generalised signs and symptoms, such as temperature, associated with inappetence and a "run-down" feeling, increase of alkaline phosphatase and liver enzyme levels and of the blood sedimentation rate. Differential diagnosis of heterotopic ossifications is dealt with in detail.
In the badminton season 1983/1984, a prospective injury registration was done in 375 randomly chosen elite and recreational badminton players, of whom 81% could be followed. We found 257 injuries: an incidence of 2.9 injuries/player/1000 badminton hours. Men were more frequently injured than women. The prevalence was 0.3 injury per player. It was highest in men, and there was no difference between elite and recreational badminton players; 92% of the injured were playing with their injury. The pathophysiology was overuse in 74% (169/229), strains in 12% (28/229), sprains in 11% (26/229), and fractures in 1.5% (3/229). Possibilities for reducing the number of injuries and their severity are increased injury information to players and trainers and the introduction of stretching all involved muscle groups.
UNLABELLED: Surgical instability and repetitive impulsive loading was used to generate degenerative changes in knee joints of rabbits. Light- and electronmicroscopy was carried out at synovial membrane and cartilage samples. The instabilised joints had early synovial inflammation, preceding overall cartilage changes. Synoviocytes were activated and showed more and dilatated cytoplasmatic organells. Invaded round cells--potentially cartilage degenerative--were seen. In the loading model no initial synovial inflammation could be seen. Focal cartilage changes were located at the weight bearing zone. Two different inductive pathways may be involved in cartilage breakdown comparing the two arthrosis models. Mechanical factors seemed to trigger cartilage changes in the loading model, an inflammatory synovial pathway is likely to initiate cartilage breakdown in the instability model. CLINICAL RELEVANCE: The synovial membrane has the key-position for the cartilage degeneration in posttraumatic joint affections. The therapeutic use of antiphlogistic substances is indicated to supreme inflammatory mediators from the synovial membrane. This therapeutic concept seemed not to be useful in primary mechanical induced osteoarthrosis.
Suprascapular neuropathy may present with chronic shoulder pain and weakness of abduction and external rotation of the arm. Therefore, it should always be included in the differential diagnosis of shoulder pain. Usually, the nerve is compressed at the suprascapular notch or the spinoglenoid notch. Here, the nerve is relatively fixed. In the etiology, repeated and forceful movements around the shoulder joint, especially in athletes such as volleyball players, are considered to be frequent causes of suprascapular nerve damage, whereas ligament hypertrophy and ganglia are uncommon. If conservative therapy fails, surgical decompression of the nerve is required for relief of pain and resolution of weakness.
Chronic inflammations of the distal Achilles tendon correspond frequently to a mechanical irritation of the subcalcaneal bursa. On grounds of the biomechanical analysis an excessive inward bending of the hindfoot is postulated as the reason. So a conception for the clinical therapy is detected. The first measure will be a statics correction of the foot and a local application of antalgics. In case of unsuccessfulness after 3 months the surgical resection of the calcaneus exostosis is performed. After 3 months of conservative treatment 15 of 24 athletic patients are free of pain. The other 9 patients are free of pain 3 months after the surgical treatment. In either case all patients return to their former sports activity 6 months after the beginning of the treatment.
Pain and disturbed function in the sole of the foot leads to damage of the tendo Achilles and to abnormalities in its vicinity. They are frequent consequences of some sporting activities (jogging). Differentiation between bursitis, fat necrosis, degenerative changes in tendons and their rupture and from abnormalities of the ankle joint is important for treatment. In the symptomatic patients whom we examined, the bursa was involved in 72.9% and lesions of the tendo Achilles were found in 62.1%.
BACKGROUND: Joint hypermobility is considered to be both an advantage and a disadvantage. However, the degree of hypermobility in members of particular occupations requiring intense physical activity and the nature of the association between symptoms referable to specific joints and their hypermobility are unknown. METHODS: We interviewed 660 musicians (300 women and 360 men) about work-related symptoms such as joint pain and swelling and examined them for joint hypermobility according to a standard protocol. We then determined the relation between the mobility of their fingers, thumbs, elbows, knees, and spine and any symptoms referable to these regions. RESULTS: Five of the 96 musicians (5 percent) with hypermobility of the wrists, mostly instrumentalists who played the flute, violin, or piano, had pain and stiffness in this region, whereas 100 of the 564 musicians (18 percent) without such hypermobility had symptoms (P = 0.001). Hypermobility of the elbow was associated with symptoms in only 1 of 208 musicians (< 1 percent), whereas 7 of 452 (2 percent) without this hypermobility had symptoms (P = 0.45). Among the 132 musicians who had hypermobile knees, 6 (5 percent) had symptoms, whereas only 1 of 528 (< 1 percent) with normal knees had symptoms (P < 0.001). Of the 462 musicians who had normal mobility of the spine, 50 (11 percent) had symptoms involving the back, as compared with 46 of the 198 musicians (23 percent) who had hypermobility of the spine (P < 0.001). CONCLUSIONS: Among musicians who play instruments requiring repetitive motion, hypermobility of joints such as the wrists and elbows may be an asset, whereas hypermobility of less frequently moved joints such as the knees and spine may be a liability.
Overuse injuries are a very common cause of pain in athletes, accounting for a significant loss of training time and missed competitions. Magnetic resonance imaging (MRI) is playing an increasing role in facilitating the expeditious and safe return of these individuals to their preinjury level of physical performance by allowing accurate diagnosis. Sports physicians are increasingly relying on the exquisite anatomic detail afforded by this technique to formulate diagnoses that assist with the optimal management of these athletic injuries. Some upper extremity overuse entities are well recognized; two examples are medial epicondylitis, classically appearing in baseball pitchers, and lateral epicondylitis, in tennis players. Other less well-known injuries of the upper extremity, such as intersection syndrome in rowers and distal clavicular stress fractures in weightlifters, are frequent occurrences in certain circles of athletes. The following article is a pictorial review of the MRI findings of upper extremity overuse injuries encountered in the competitive athlete, with an emphasis on the sports scenarios in which they occur. We will depict mechanisms of injury and applicable anatomy and show characteristic imaging findings. A wide range of entities are addressed, including but not limited to overuse injuries occurring in baseball, swimming, gymnastics, weightlifting, bowling, and cycling.
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The mechanical response of the inferior glenohumeral ligament to varying subfailure cyclic strains was studied in 33 fresh frozen human cadaver shoulders. The specimens were tested as bone-ligament-bone preparations representing the 3 regions of the inferior glenohumeral ligament (superior band and anterior and posterior axillary pouches) through use of uniaxial tensile cycles. After mechanical preconditioning, each specimen was subjected to 7 test segments, consisting of a baseline strain level L1 (400 cycles) alternating with either 1 (group A, 10 shoulders), 10 (group B, 13 shoulders), or 100 (group C, 10 shoulders) cycles at increasing levels (L2, L3, L4) of subfailure strain. Cycling to higher levels of subfailure strain (L2, L3, L4) produced dramatic declines in the peak load response of the inferior glenohumeral ligament for all specimens. The group of ligaments subjected to 100 cycles of higher subfailure strains demonstrated a significantly greater decrease in load response than the other 2 groups. Ligament elongation occurred with cyclic testing at subfailure strains for all 3 groups, averaging 4.6% +/- 2.0% for group A, 6.5% +/- 2.6% for group B, and 7.1% +/- 3.2% for group C. Recovery of length after an additional time of nearly 1 hour was minimal. The results from this study demonstrate that repetitive loading of the inferior glenohumeral ligament induces laxity in the ligament, as manifested in the peak load response and measured elongations. The mechanical response of the ligament is affected by both the magnitude of the cyclic strain and the frequency of loading at the higher strain levels. The residual length increase was observed in all of the specimens and appeared to be largely unrecoverable. This length increase may result from accumulated microdamage within the ligament substance, caused by the repetitively applied subfailure strains. The clinical relevance of the study is that this mechanism may contribute to the development of acquired glenohumeral instability, which is commonly seen in the shoulders of young athletes who participate in repetitive overhead sports activities.
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Muscles within the anterior tibial compartment (extensor digitorum longus: EDL, tibialis anterior: TA, and extensor hallucis longus muscles: EHL) and within the peroneal compartment were excited simultaneously and maximally. The ankle joint was fixed kept at 90 degrees. For EDL length force characteristics were determined. This was performed first with the anterior tibial compartment intact (1), and subsequently after: (2) blunt dissection of the anterior and lateral interface of EDL and TA. (3) Full longitudinal lateral fasciotomy of the anterior tibial compartment. (4) Full removal of TA and EHL muscles. Length-force characteristics were changed significantly by these interventions. Blunt dissection caused a force decrease of approximately 10% at all lengths, i.e., without changing EDL optimum or active slack lengths. This indicates that intermuscular connective tissue mediates significant interactions between adjacent muscles. Indications of its relatively stiff mechanical properties were found both in the physiological part of the present study, as well as the anatomical survey of connective tissue. Full lateral compartmental fasciotomy increased optimum length and decreased active slack length, leading to an increase of length range (by approximately 47%), while decreasing optimal force. As a consequence an increase in force for the lower length range was found. Such changes of length force characteristics are compatible with an increased distribution of fiber mean sarcomere length. On the basis of these results, it is concluded that extramuscular connective tissue has a sufficiently stiff connection to intramuscular connective tissue to be able to play a role in force transmission. Therefore, in addition to intramuscular myofascial force transmission, extramuscular force transmission has to be considered within intact compartments of limbs. A survey of connective tissue structures within the compartment indicated sheet-like neuro-vascular tracts to be major components of extramuscular connective tissue with connections to intramuscular connective tissue stroma. Removal of TA and EHL yielded yet another decrease of force (mean for optimal force approximately 10%). No significant changes of optimum and active slack lengths could be shown in this case. It is concluded that myofascial force transmission should be taken into account when considering muscular function and its coordination, and in clinical decisions regarding fasciotomy and repetitive strain injury.
This study is based on an ergonomic job analysis designed to develop a hazard prevention program for the premixing and compounding processes in animal health products plants. Animal health products plants are "pharmaceutical facilities" for livestock or domestic animals. A hazardous aerosol (highly concentrated antibiotics, anthelmintics, mineral oil, and animal hormones) is generated in the premixing or compounding processes. The animal health premixing jobs are heavy-duty jobs and have high potential for chemical exposure, heat stress, and ergonomic hazards. Ergonomic job analysis was used to recognize, identify, and evaluate actuarial and potential risks of injures or irritations. Chemical hazards and eight ergonomic factors were discussed: (1) forceful exertions, (2) awkward postures, (3) localized contract stresses, (4) vibration, (5) noise, (6) temperature extremes, (7) repetitive activities, and (8) prolonged activities. The results show that (1) current practices do not violate occupational safety and health regulations or recommended guidelines, but that hazards should be identified to protect worker health and safety; (2) for chemical hazards prevention, operators wear whole-body protection equipment, which also causes heat stress and increases the noise level in the work zone; and (3) the loading weight of the bags used needs to be reduced.
The study examined the effectiveness of behaviorally-induced vasodilation (hypnosis with biofeedback and autogenics) in the treatment of upper extremity repetitive strain injuries (RSI). Thirty patients with recent onset of upper extremity RSI symptoms were randomly assigned to 1 of 2 treatment conditions, i.e., hypnotically-induced vasodilation or a waiting-list control. Treatments were given on an individual basis, once a week for 6 weeks. Patients in the treatment condition showed highly significant increases in hand temperature between pre- and post-treatment. Patients in the treatment condition also showed highly significant reductions in pain in comparison to the waiting list condition.
Many women's expectancies when they assume the role of patient include the experiences of regression, helplessness, passivity and fear. This paper describes techniques for interrupting this negative set and for facilitating the development of a self-efficacious state in which the woman experiences herself as an active and informed participant in her encounters with medical personnel.