Stress fracture of the sacrum: brief report.
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Operation for non-union of stress fracture of the tarsal navicular.
Stress fractures of the tarsal navicular do not heal predictably with conservative treatment, so we recommend operation if the fracture remains symptomatic, and radiographs show wide separation of a complete fracture, extension of an incomplete fracture, delayed healing, or a medullary cyst. An autologous bone graft is inserted after en-bloc resection of the fracture surfaces. It is important that the fracture is fully exposed to its distal limits before the graft is inserted. We have grafted 19 fractures in 18 patients. Six fractures were complete, 12 incomplete and one had a residual medullary cyst. Of the 15 patients with adequate follow-up, 12 had been able to return to a pre-injury level of activity by five to 12 months.
Adolescent↗
Epiphysiolysis of the great tuberosity of the calcaneum: brief report.
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Calcaneus↗
Lesions of the patellar ligament.
We report 18 cases of pain and tenderness in the mid-part of the patellar ligament in athletes. The condition may be disabling, but it responds to surgery. Ultrasound and CT scans were positive in all 17 confirmed cases, but ultrasound gave a better distinction between the cysts, granulation tissue, metaplasia, mucoid degeneration and congenital defects found at operation.
Adolescent↗
Overuse injuries of the olecranon in young gymnasts.
We report overuse injuries in 14 elbows of ten élite young gymnasts. In 12 elbows of eight patients aged 11 to 15 years there was a spectrum of radiological abnormalities including widening of the olecranon physis and fragmentation of the epiphysis. The radiographs were compared with those of normal elbows matched for age and sex. The radiograph appearances were very similar to those of the Osgood-Schlatter lesion of the tibial tuberosity. Two older boys, aged 18 and 19, had stress fractures through the olecranon growth plate. Conservative management was successful in all except one case of stress fracture which required internal fixation.
Adolescent↗
Overuse syndrome?
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Cumulative Trauma Disorders↗
Overuse syndrome?
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Cumulative Trauma Disorders↗
Spinal abnormalities in young fast bowlers.
The action of fast bowling in the game of cricket is known to cause injuries to the lumbar spine. We studied a group of 16- to 18-year-old fast bowlers, selected for special training in Western Australia. All 24 had MR scans of the spine, 22 had radiographs and CT scans; in 20 the bowling technique was analysed biomechanically. There was a high incidence of back pain and this was always associated with a radiological abnormality. Pars interarticularis defects were diagnosed in 54% and intervertebral disc degeneration in 63%. Bowling actions which involved counter-rotation were associated with a higher incidence of both injuries.
Adolescent↗
Entrapment of the suprascapular nerve.
Operative release for entrapment of the suprascapular nerve was carried out in 35 patients. They were assessed at an average of 30 months (12 to 98) after operation using the functional shoulder score devised by Constant and Murley. The average age at the time of surgery was 40 years (17 to 67). Entrapment was due to injury in ten patients and no cause was found in three; 34 had diffuse posterolateral shoulder pain. The strength of abduction was reduced in all the patients. The average Constant score, unadjusted for age or gender, before operative release was 47% (28 to 53). In 25 of the patients both the supraspinatus and infraspinatus muscles were atrophied and seven had isolated atrophy of the infraspinatus muscle. The average conduction time from Erb's point to the supraspinatus muscle and to the infraspinatus muscle was 5.7 ms (2.8 to 12.8) and 7.4 ms (3.4 to 13.4), respectively. In two patients MRI revealed a ganglion in the infraspinatus fossa and, in another, a complete rupture of the rotator cuff. The average time from the onset of symptoms to operation was ten months (3 to 36). A posterior approach was advocated. The average Constant score, after operative release, unadjusted for age or gender was 77% (35 to 91). The overall result was excellent in ten of the patients, very good in seven, good in 14, fair in two, and poor in two. The symptomatic and functional outcome in our series confirmed the usefulness and safety of operative decompression for entrapment of the suprascapular nerve.
Adolescent↗
Interspinous bursitis in an athlete.
We present a case of L2/3 interspinous bursitis treated with extraspinal injections. No previous investigations have used fluoroscopically guided spinal injections to confirm the clinical relevance of the MRI features of this type of bursae. Autopsy studies have revealed an increased incidence of interspinous lumbar bursal cavities with advancing age. Afflicted patients present with localised, midline lower lumbar pain exacerbated by extension. In young athletes these symptoms can mimic spondylolysis. MRI is useful in detecting soft-tissue injury of the posterior elements. Fluoroscopically guided diagnostic and therapeutic extraspinal injections can be used for confirmation and treatment of pain from such bursae.
Adolescent↗
Workers' safety in milking premises.
Dairy cattle rearing techniques have evolved, and milking has moved from stalls to specialized premises. A survey was carried out on a representative sample of dairy farms in central Italy to investigate workers' safety in milking premises. Results indicated acceptable sound level and microclimatic conditions, whereas repetitive motion of the upper limbs should be carefully monitored for the possible effects it can induce on the milkers, who were devoid of adequate personal protective equipment (PPE). Floor antislipping characteristics represented a major deficiency in the building material, in spite of its strength and durability.
Adult↗
Interpreter's wrist. Repetitive stress injury and carpal tunnel syndrome in sign language interpreters.
Forty interpreters attending a regional Registry of Interpreters for the Deaf conference completed a questionnaire regarding symptoms related to repetitive stress injury (RSI), a generic classification of problems that occur after extensive, repetitive motion. RSIs, including the most prevalent form, Carpal Tunnel Syndrome (CTS), were surveyed. The vast majority (87.5%) of the interpreters in the sample reported that they had at sometime experienced at least two symptoms associated with RSI. Some (12.5%) who had CTS reported that they had been misdiagnosed. When asked how many other interpreters they knew with RSI problems, they reported, on average, that they knew more than four others. The data indicate that RSI is a severe problem among sign language interpreters and warrants immediate action. The term interpreter's wrist may best describe the malady.
Adult↗
Prevalence of upper extremity neuropathy in a clinical dentist population.
When asked about altered sensation in hands or arms, forearms, cervical area or neck, 29 percent of Nebraska dentists surveyed said they felt pain, followed by numbness and tingling. The prevalence suggests the possibility of an occupational concern.
Absenteeism↗
Evaluating the fit of ambidextrous and fitted gloves: implications for hand discomfort.
Ambidextrous gloves stretch significantly more and exert greater force than fitted gloves when worn. Over time, this force could contribute to vascular constriction, nerve compression, muscle fatigue and hand pain. This study suggests that research on the effects of glove use by dental care personnel is needed.
Carpal Tunnel Syndrome↗
Head and neck lesions commonly found in musicians.
Common problems in playing musical instruments include soft tissue lesions, tooth mobility, malocclusion, TMD and endodontic pathoses. This article illustrates the basic playing positions of the instruments and their effects on head and neck structures to help dentists provide appropriate diagnosis and treatment.
Cumulative Trauma Disorders↗
Occupational hazards.
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Cumulative Trauma Disorders↗
Continuous assessment of back stress (CABS): a new method to quantify low-back stress in jobs with variable biomechanical demands.
Jobs with a high degree of variability in manual materials handling requirements expose limitations in current low-back injury risk assessment tools and emphasize the need for a probabilistic representation of the biomechanical stress in order to quantify both acute and cumulative trauma risk. We developed a hybrid assessment methodology that employs established assessment tools and then represents their evaluations in a way that emphasizes the distributions of biomechanical stress. Construction work activities in the home building industry were evaluated because of the high degree of variability in the manual material handling requirements. Each task was evaluated using the Revised NIOSH Lifting Equation, The University of Michigan Three-Dimensional Static Strength Prediction Program, and the Ohio State University Lumbar Motion Monitor Model. The output from each model was presented as time-weighted histograms of low-back stress, and the assessments were compared. The results showed considerable differences in what were considered high-risk activities, indicating that these 3 assessment tools consider the risk of low-back injury from different perspectives. The time-weighted distribution aspect of this methodology also contributed vital information toward the identification of high-risk activities. These results illustrate the necessity for more advanced low-back injury risk assessment techniques for jobs with highly variable manual materials handling requirements.
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