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The saddle sign: bilateral thigh adductor compartment uptake of Tc-99m MDP.
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Acute exertional compartment syndrome of the forearm.
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Calcaneal osteochondritis: a new overuse injury.
This is a case report of osteochondritis of the medial plantar apophysis of the calcaneus presenting as medial plantar heel pain in a 15-year-old basketball player. The lesion was detected radiographically and by increased focal uptake on bone scan. Conservative treatment resulted in complete pain relief and normal calcaneal appearance with union of the osteochondral fragment. No recurrence was noted during 3 years of follow-up.
Projection of the point of force application onto a palmar plane of the hand during wheelchair propulsion.
The objective of this study was to develop and test a method for projecting the pushrim point of force application (PFA) onto a palmar plane model of the hand. Repetitive wheelchair use often leads to hand and wrist pain or injury. The manner by which the hands grasp the pushrim and how the forces and moments applied to the pushrim are directed may contribute to the high incidence of pain and injury. The projections of the PFA onto the palmar surface model of the hand reside primarily within zone II. These results are in agreement with previous studies which have assumed the PFA to be coincident with one of the metacarpophalangeal (MP) joints. However, the results from three subjects show different PFA patterns within the palmar surface of the hand which can be related to each subject's propulsion pattern, and the PFA is not focused at a single MP joint. Projection of the world coordinates of the four hand marker system onto the palmar plane show the resolution to be within 3 mm, or one half the diameter of the passive reflective markers. The errors in the planar model assumption were greatest for the second and fifth MP markers. This was expected because as the hand grasp changes these markers do not remain coplanar. The results of this study indicate that new knowledge about how forces are applied by the hand onto the pushrim can be obtained using this method. This technical note provides insight into understanding the details within the kinetics of wheelchair propulsion and describes a technique for estimation of the PFA on the palmar surface of the hand. This technical note provides initial results from three different wheelchair users.
Acquired coccygeal nodule due to repeated stimulation by a bicycle saddle.
Four Japanese male students, aged 14, 16, 18 and 19, were found to have a nodule in their coccygeal regions. The typical lesion was a rugby-ball-shaped, normal-colored or slightly erythematous nodule measuring 5 to 6 cm in its long axis. Histopathologically, it showed hyperplasia of collagen fibers and slight acanthosis. All four students rode to school by bicycle over long distances and long periods; three of them developed the nodule after they started bicycle riding to school. We found that the nodule shape corresponded to the saddle of the bicycle. X-ray abnormalities included bending or anterior dislocation of the coccyx in all cases and spina bifida in two cases. These nodules may have developed as a result of irritation of this region by the saddle of the bicycle.
Repetitive strain injuries: has the Australian epidemic burnt out?
In the 1980s Australia experienced an epidemic of medically certified claims for non-specific arm symptoms described as repetitive strain injury. Although a number of factors were mooted as causal of the epidemic, no single factor emerged as a compelling putative candidate. The present paper discusses the results of research which was published only after the epidemic had waned. It provides possible insights into the rise and fall of repetitive strain injury.
Pars interarticularis stress and disc degeneration in cricket's potent strike force: the fast bowler.
Cricket fast bowlers are the potent strike force in a multidiscipline team. They subject their spines to repetitive sagittal plane and rotatory movements over many years. The effect of this repetitive stress has not previously been analysed. This study examined 20 former fast bowlers to determine the incidence of spondylolysis, spondylolisthesis and degenerative change. Fast bowlers are noted to have an increased incidence of spondylolysis. A mixed front/side bowling style involving more lumbar hyperextension or rotation has significant association with spondylolysis when compared with side-on bowling styles. There was a high incidence of radiological thoracolumbar degenerative facet joint and disc disease in former fast bowlers.
RSI revisited: evidence for psychological and physiological differences from an age, sex and occupation matched control group.
The present study sought to examine psychological characteristics and function of primary afferent nociceptive mechanisms, as indexed by capsaicin-induced flare responses, in subjects suffering from RSI (n = 72) and in pain free control volunteers (n = 69). After completing a battery of psychological tests including the McGill Pain Questionnaire, Visual Analogue Scale and Word Descriptor Scale for pain, the Profile of Mood States, Illness Behaviour Questionnaire and Multidimensional Health Locus of Control, the neurogenic flare response was assessed on the right and left forearms and across the trapezius at the shoulder. When compared to controls RSI subjects displayed higher levels of mood disturbance and some abnormal patterns of illness behaviour. A reduction in flare size was observed in the pain affected limb of RSI subjects, but an increased response occurred in sites reported as unaffected by clinical pain. Multiple regression analysis revealed that the severity of clinical pain was strongly associated with the magnitude of reduction in flare size. Collectively, these findings provide objective evidence of altered nociceptor mechanisms in RSI subjects, and are consistent with the view that this chronic pain syndrome involves somatic pathophysiology. However, a strong conviction regarding the somatic basis of their symptoms, and a denial of psychological factors may have contributed to the more severe affective disturbance and greater subjective emphasis on the presence of pain.
The demise of repetitive strain injury in sceptical governing rationalities of workplace managers.
In the mid-1990s, RSI (repetitive strain injury) loomed as an occupational health epidemic in industrialised countries. A decade later, the problem appears to have faded away, but there has been little explanation for how this problem might have diminished. This paper offers an explanation for the decline of RSI in the social relations of workplaces, in the pragmatic, day-to-day governance of occupational health by workplace managers. Using the conceptual lens of governmentality theory, this study examined how workplace managers conceptualised, rationalised and responded to RSI in their work organisations. Open-ended interviews were conducted with 35 managers at four Ontario newspaper workplaces. This paper describes managers as guided by a discourse of scepticism about the legitimacy of RSI complaints. This discourse was 'practised' in different ways at each newspaper in varied RSI-management strategies, but each strategy privileged ideas about RSI being problematic in certain types of workers rather than in types of physical work environments. This conceptualisation of RSI splintered, subordinated and collapsed the problem within a broad human resources framework. This paper suggests that the 'taming' of RSI might have occurred in the context of micro-political, workplace-level shifts in the conceptualisation and management of RSI as an occupational health problem.
Forearm blood flow and oxygen consumption in patients with bilateral repetitive strain injury measured by near-infrared spectroscopy.
Despite the social impact of repetitive strain injury (RSI), little is known about its pathophysiological mechanism. The main objective of this study was to assess the local muscle oxygenation (mVO2) and blood flow (mBF) of the forearm in individuals with RSI during isometric contractions of the forearm. We employed the non-invasive optical technique near-infrared spectroscopy to assess forearm VO2 and BF. These variables were assessed at 10%, 20%, and 40% of their individual maximal voluntary strength. Twenty-two patients with RSI symptoms in both arms (bilateral RSI) and 30 healthy age-matched subjects participated in this cross-sectional study. The results showed lower mVO2 during exercise and a reduced mBF after exercise. The results suggest that mVO2 and mVO2 are lower in the forearms of individuals with RSI compared with their controls at similar working intensities. This finding indicates that the underlying vasculature may be impaired. Although these findings contribute to the understanding of RSI, future research is necessary to further unravel the mechanisms of this area.
Stress fractures of the acetabulum in 26 racing Greyhounds.
Acetabular fractures in 26 racing Greyhounds were reviewed. All fractures occurred during racing or training and were unrelated to any external trauma. All fractures had similar configurations, were minimally displaced, and involved only the acetabulum. Affected dogs were young (16-36 months). Fractures occurred unilaterally (22 dogs) and bilaterally (4 dogs). There was no sex predilection, and both right and left sides were equally represented. Bilateral fractures were associated with retraining between the occurrence of the first and second fractures. Radiographically, a fracture line was consistently visible in the caudal third of the acetabulum. Fractures in gross specimens resembled an inverted "Y." Results of histologic evaluation of two fractured acetabula showed changes characteristic of a nonunion fracture. Microfractures were evident in the grossly normal acetabulum opposite the fractured side. Evidence obtained from this study suggests a common pathogenesis of the fractures related to tremendous repetitive stresses produced during running. Greyhounds with unilateral acetabular fractures may provide a reproducible model for future studies of stress fractures in animals and humans because of the high incidence of bilateral fractures that develop during retraining. Surgical repair of the acetabular stress fracture was more successful than conservative management in returning the dogs to competitive racing.
Overuse injuries of the lower extremity in runners.
The purpose of this article is to review the literature on overuse injuries of the lower extremity in runners and to discuss briefly today's knowledge concerning etiology, diagnosis and treatment. Running is a natural entity in many sports and a majority of runners will sustain one or more overuse injuries throughout the career, in most cases affecting the lower extremity. A runner may be regarded as an athlete who regularly runs as the predominant physical activity. From that point, we should subdivide the definition "runner" considering the character of different sports or recreational activities performed. Overuse injuries are often described merely from symptoms, including several different etiological and pathoanatomic correlates covering a variety of ailments. The clinical approach should be focused on a thorough history and physical examination. Analysis of possible injury mechanisms, correction of associated extrinsic and intrinsic factors and advice on alternative training should be given. A knowledge of specific demands from the type of running performed is necessary to evaluate the symptoms presented. Overuse etiology has to be considered multifactorial with a yet unsolved exact pathophysiology needing further research. The definition of a "runner", of "running" and of "overuse injury" should be established and agreed upon. This review attempts to draw attention to the huge multidisciplinary work that has to be done to better understand the mechanisms causing an overuse injury in a runner and to define diagnoses on a scientific base, whether or not excentric or intrinsic factors predispose or trigger.
Nontraumatic glenohumeral instability and coracoacromial impingement in swimmers.
Competitive swimming is one of the most demanding and time-consuming sports. Swimmers at elite level practice 20-30 h per week. During 1 year's practice, the average top level swimmer performs more than 500,000 stroke revolutions per arm. These innumerable repetitions over many years of hard training together with an increasing muscular imbalance around the shoulder girdle seem to be the main etiological factors in the development of the over-use syndrome swimmer's shoulder. Shoulder pain in swimmers has in general been regarded as synonymous with coracoacromial impingement, i.e. anterior shoulder pain due to rotator cuff tendinitis, but new knowledge suggests that a concomitant glenohumeral instability plays an additional role. The diagnostic complexity of the problem is as challenging as the search for the gold standard of treatment. The condition should ideally be diagnosed as early as possible, and intensive functional rehabilitation of the shoulder girdle including the scapular muscles should be started in order to restore muscle balance. The surgical possibilities include subacromial decompression in cases of purely mechanical impingement. If a painful glenohumeral instability persists after intensive functional rehabilitation, anterior capsulolabral reconstruction can be performed. Still, however, short- and long-term results show that surgery is less successful in elite athletes involved in overhead sports. Prevention protocols include education of coaches in primary injury prophylaxis and the institution of resistance strength training in prepubescent swimmers. Emphasis should be made to improve muscular balance around the glenohumeral and scapulothoracic joints.
Age, body composition, aerobic fitness and health condition as risk factors for musculoskeletal injuries in conscripts.
Musculoskeletal injuries occur frequently in connection with physical activity. More information was sought on pretraining factors that may predispose to such injuries. Data were obtained on the age, height, weight, aerobic fitness as measured by a 3000-m run test, and health as assessed on the basis of a medical examination, of 912 male conscripts prior to an 8-week period of basic military and physical training. Injuries were registered as they occurred by doctors attached to the training camp. Every fourth to fifth conscript suffered one or more musculo-skeletal injuries during basic training. Achilles tendinitis, low back pain, periostitis or compartment syndromes, and overuse knee injuries were the most frequent diagnosis groups. In 74% of the injuries, a tentative cause was related to organized service activities. According to univariate analyses, risk factors were age over 23 years, high body mass index (BMI), slow run times and dysfunctions of the back or lower limbs. A lower classification of mental health, but not dysfunctions of the lower limbs, was an additional risk factor if only injuries with causes connected with organized service activities were considered. Height and weight were not associated with injuries. In multiple logistic regression analysis, age and 3000-m run times were masked by correction for BMI, while BMI, dysfunctions of the back and lower limbs, and reduced mental health showed the same significance as in the univariate analyses.
Injuries in elite volleyball.
During the 1993-1994 volleyball season, injuries to players in the two Danish elite divisions were registered by means of a questionnaire survey. Eighty per cent of the players returned the questionnaire. A total of 70 female players reported 79 injuries and 67 male players reported 98 injuries, representing an overall incidence of 3.8 injuries per player per 1000 volleyball hours played. The injury incidence was the same for female and male players. Most injuries occurred in spiking (32%) and in blocking (28%). The injuries were predominantly either acute injuries to fingers (21%) and ankles (18%) or overuse injuries to shoulders (15%) and knees (16%). Shoulder injuries seemed to be a more serious problem in females. During the past 10 years the rate of overuse injuries has increased from 16% to 47% in male elite volleyball, corresponding to a significant increase in the incidence of these injuries from 0.5 to 1.8 injuries per player per 1000 played hours (P < 0.001). A possible explanation for this could be a 50% increase in training activity during this period.
A prospective study of injuries in licensed floorball players.
Injuries occurring among 457 licensed floorball players in the Swedish National League were analysed prospectively during the season from 1993 to 1994. Fifty-one (11%) players sustained 58 injuries. The majority (76%) of the injuries were due to trauma mostly during the gama (55%). Twenty-three (52%) of the traumatic injuries were caused by an opponent or a stick. Ankle sprain (35%) was the most common diagnosis. Injury severity classified with regard to time of absence from sport participation were similarly distributed for minor (36%), moderate (29%) and major (35%) injuries. The total rate of injury was 2.5 per 1000 hours for female and 2.6 for male players. Although this rate is lower than for contact sports like soccer and ice-hockey, we feel that further investigation of floorball injuries and improvement of protection devices would be valuable.