Gymnast's wrist (pseudorickets growth plate abnormality) in adolescent athletes: findings on plain films and MR imaging.
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Child↗
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Overuse syndromes and injuries involving the elbow: MR imaging findings.
Most elbow injuries result not from acute trauma but from repetitive microtrauma and chronic stress overload of the joint. Such "overuse" injuries may be difficult to diagnose clinically. Occasionally, even acute traumatic injuries may be occult radiographically and difficult to detect. In patients with elbow pain of uncertain origin, MR imaging may improve diagnostic specificity and accuracy. In this essay, characteristic MR imaging findings in common traumatic and overuse syndromes of the elbow are illustrated.
Adolescent↗
Sports and occupational injuries of the elbow: MR imaging findings.
Elbow injuries may limit participation in sports and occupational endeavors, as well as activities of daily living. Conventional radiography is the appropriate initial screening technique for evaluation of possible osseous injury or arthritis/arthrosis, but often it offers little information concerning soft-tissue derangement, which is a common source of dysfunction. MR imaging can evaluate these soft tissue to assist in diagnosis, as well as in planning treatment and assessing response to treatment. This essay illustrates MR findings of both the chronic overuse and the more acute traumatic soft-tissue injuries involving ligaments, tendons, muscles, and neurovascular structures, as well as radiographically occult osteochondral injuries.
Athletic Injuries↗
Medial elbow pain in the throwing athlete: MR imaging evaluation.
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Adolescent↗
MR imaging of rotator cuff tears in individuals with paraplegia.
OBJECTIVE: The purpose of this study was to use MR imaging to evaluate the prevalence and extent of rotator cuff tears in paraplegic patients, who are at increased risk for impingement caused by overuse. MATERIALS AND METHODS: Sixty-four MR examinations of the shoulder were evaluated for partial or full-thickness rotator cuff tears and for single or multiple rotator cuff tendon tears. Thirty-seven MR studies were from paraplegic subjects (26 symptomatic, 11 asymptomatic), and 27 MR studies were from able-bodied subjects (17 symptomatic, 10 asymptomatic). RESULTS: Among subjects who were symptomatic and paraplegic, 73% of shoulders imaged showed evidence of rotator cuff tear on MR images compared with 59% of shoulders in able-bodied symptomatic subjects. Of all subjects with paraplegia, 57% of shoulders imaged showed rotator cuff tears. Among all paraplegic subjects, prevalence and severity of tears correlated positively with age and duration of spinal cord injury. Tears that involved the posterior portion of the rotator cuff were revealed on MR images in 74% of the paraplegic subjects compared with 50% of the able-bodied subjects. CONCLUSION: MR imaging revealed a high percentage and degree of severity of rotator cuff tears in individuals with paraplegia and thus proved useful in evaluating shoulders in these patients.
Adult↗
Avulsion fracture of the sublime tubercle of the ulna: a newly recognized injury in the throwing athlete.
OBJECTIVE: The purpose of this report is to describe the imaging features in three cases of avulsion injury of the sublime tubercle of the ulna that occurred in throwing athletes. CONCLUSION: Avulsion fracture of the sublime tubercle of the ulna is a potential cause of chronic medial elbow pain in the throwing athlete. This entity is best evaluated with a combination of plain radiographs and coronal MR images, particularly gradient-echo images that show the continuity of the avulsed fragment with the ulnar collateral ligament.
Adult↗
Femoral head osteochondral lesions in painful hips of athletes: MR imaging findings.
OBJECTIVE: This study describes the MR imaging findings of focal osteochondral lesions found in the hips of 11 athletes with persistent pain and normal findings on radiographs. CONCLUSION: Osteochondral lesions of the femoral head are seen on MR imaging as focal, medial areas of high T2-weighted and low T1-weighted signals and should be considered as a possible cause of persistent hip or groin pain in young, high-level athletes because the institution of appropriate treatment may help to prevent late degenerative sequelae.
Adolescent↗
Symphyseal cleft injection in the diagnosis and treatment of osteitis pubis in athletes.
OBJECTIVE: The purpose of this study was to describe the application, technique, and results of symphyseal cleft injection in athletes with osteitis pubis. CONCLUSION: Symphyseal cleft injection is a useful technique for the diagnosis and treatment of osteitis pubis in athletes. The procedure is well tolerated and may facilitate early resumption of competitive duties.
Adult↗
"Baby wrist": MRI of an overuse syndrome in mothers.
OBJECTIVE: The purpose of our study was to describe the MRI findings and interesting clinical aspects of a postpartum overuse syndrome of the wrist and thumb, de Quervain's tenosynovitis, or "baby wrist." CONCLUSION: Mothers may experience a wrist and thumb overuse syndrome, which can be diagnosed by MRI with an increase in size and low signal intensity on both T1- and T2-weighting, in and around the first dorsal tendon sheath compartment of the wrist.
Adult↗
Ability of middle-school soccer players to localize overuse leg pain correctly using a graphic self-report form.
This study was conducted to assess the probability of success with which middle-school-age soccer players could correctly localize lower leg pain to sites of common overuse injuries, using a graphic self-report instrument. Subjects included 98 middle-school soccer players, ages 12 to 15 years. Players' self-reports of leg pain were compared with the results of a blind physical examination. Players reporting pain of more than two weeks' duration successfully localized a statistically significant number of their sites of pain using the graphic form, providing evidence of concurrent validity. Further development is needed before the measure can be used in surveillance of overuse injuries in youth sports.
Adolescent↗
Medial plantar nerve conduction velocities among patients with vibration syndrome due to rock-drill work.
OBJECTIVE: The present study was aimed at clarifying the effect of vibration syndrome (VS) on the peripheral nervous system in the lower extremities of patients with VS due to rock-drill work. METHODS: Fifty-three patients with VS due to previous exposure to vibration from rock-drilling work and 55 age-matched controls were examined for sensory nerve conduction velocities in the medial plantar nerve (SCV-P). The patient group was divided into three subgroups, outdoor rock-drill workers with vibration-induced white finger (VWF) (N = 10), tunnel workers with VWF (N = 27) and tunnel workers without VWF (N = 16). RESULTS: ANOVA of SCV-P for the four groups showed F = 3.23 (dF = 3, 104, p = 0.0253). A significant difference was found between the controls and outdoor rock-drill workers with VWF group (p = 0.0261) by multiple comparison using Scheffe's method. CONCLUSION: These findings suggest that peripheral nervous system function in the lower extremities of patient with VS is affected by cold exposure and circulatory disturbance manifested as VWF.
Action Potentials↗
Performing arts medicine: the musical athlete.
Musicians and dancers in the performing arts place abnormal stresses on their musculoskeletal systems, resulting in overuse injuries. The purpose of this paper is to address the factors contributing to musculoskeletal injuries sustained by musicians. Recommendations for evaluative procedures, treatment, and education in dealing with the needs of this population are discussed.
Adult↗
Retro runner with ischial tuberosity enthesopathy.
In reviewing the literature, no studies were found reporting the use of retro running on flat and hilly terrain, which elicited enthesopathy (stress reaction) at the ischial tuberosity. Therefore, this case study of an atypical enthesopathy condition warrants careful scrutiny in order to generate future research. This case study describes the clinical management of a female runner with bilateral patellofemoral pain who self-initiated a program of backward running and stationary bicycling after reading an article about retro running in a runners' magazine. She subsequently developed ischial tuberosity enthesopathy verified by scintigraphy (bone scan). Her symptoms gradually resolved with physical therapy intervention. Eventually, she was able to forward jog 2 miles on flat surfaces without complaint of pain but did not resume retro running. This case not only suggests the need for further research in retro running kinetics and kinematics but highlights the proactive role health professionals must assume in injury prevention.
Adult↗
Current concepts in the rehabilitation of the athletic shoulder.
The rehabilitative process of the overhead athlete represents a significant challenge to the clinician. Overhead athletes (thrower, tennis player, swimmer) repetitively subject their shoulder joints to high microtraumatic stresses that, due to the accumulative effects, may lead to a variety of shoulder injuries. This type of athletic patient exhibits uniquely specific physical characteristics, such as hypermobility of the anterior shoulder capsule, excessive external rotation, hypomobility of the posterior capsule, limited internal rotation, and generalized ligamentous laxity of the glenohumeral joint. However, the overhead athlete must exhibit functional stability for pain-free sports participation. Functional stability is accomplished through the proficient balance of static (passive) and dynamic (active) stabilizers. During the rehabilitation process, various concepts, such as neuromuscular control, proprioception, force couple efficiency, plyometrics, eccentrics, and scapular stability, can enhance dynamic functional stability for the overhead athlete. The evaluation and treatment of the shoulder patient is in perpetual change, and the purpose of this paper is to discuss several current concepts in the rehabilitative treatment of the athletic shoulder patient.
Athletic Injuries↗
Rehabilitation for the overhead athlete.
Rehabilitation of the shoulder of the overhead athlete has undergone significant changes during the past few years. This article illustrates shoulder problems related to repetitive overhead activities, such as throwing. Additionally, we present basic science contributions in this area, principles of shoulder rehabilitation, and a comprehensive rehabilitation program for the symptomatic or asymptomatic athlete based on these principles.
Adult↗
The effects of foot orthotics on the EMG activity of selected leg muscles during gait.
Foot orthotics have been successfully used to treat muscular overuse leg injuries in athletes. The purpose of this study was to examine the effects of foot orthotics on the electromyographic (EMG) activity of the tibialis anterior, peroneus longus, and gastrocnemius muscles during walking. Ten volunteers with leg symptoms resulting from compensatory subtalar joint pronation were fitted with foot orthotics. The duration of tibialis anterior EMG activity following heel strike and the average EMG activity of the tibialis anterior, peroneus longus, and gastrocnemius muscles were collected with surface electrodes. Comparisons were made between the orthotic and nonorthotic conditions. A t-test for nonindependent samples with a significance level of p < 0.05 was used for data analysis. There was a statistically significant increase in the duration of tibialis anterior activity following heel strike in the orthotic condition. There were no significant differences in the average EMG activity for any of the three muscles between the orthotic and the nonorthotic conditions. This study suggests that foot orthotics had minimal effects on the muscles studied and that further research is necessary to determine the effectiveness of orthotics on the EMG activity of other leg muscles.
Adult↗
Lumbosacral dysfunctions in elite cross-country skiers.
While the incidence of injury in cross-country skiing remains relatively low, overuse problems affecting the lumbosacral region may be on the rise, particularly among elite athletes. In this study, a certified "Part A" (Canadian Physiotherapy Association) manual therapist performed lumbosacral physical assessments on 18 elite cross-country skiers and 15 normal subjects. Results indicated sacroiliac (SI) joint dysfunction occurred significantly more often in the skier population (p < 0.007). Incidences of SI joint asymmetry and lumbar spine dysfunction did not differ between groups. The predominant use of asymmetrical ski-skating techniques may play an influential role in the pathogenesis of SI joint dysfunction in elite cross-country skiers.
Adolescent↗
Clinical implications of secondary impingement of the shoulder in freestyle swimmers.
Swimming has become a popular recreational activity as well as a highly competitive sport in the United States. The repetitive nature of swimming can predispose the shoulder to mechanical impingement and microtrauma, which may lead to laxity, rotator cuff fatigue, and subsequent secondary impingement. Improper stroke mechanics can place the swimmer's shoulder at further risk. The purpose of this paper is to describe the pathology of secondary impingement in freestyle swimmers and to discuss the clinical implications for rehabilitation of swimmers with the pathology. A thorough subjective and objective evaluation is necessary to design a successful rehabilitation program. The rehabilitation program for swimmers with secondary impingement includes modification of training, flexibility, range of motion, strengthening, and mobilization as indicated. Functional and proprioceptive training may also be useful techniques in the rehabilitation of swimmer's shoulder. Improper stroke mechanics can also have clinical implications on swimmer's shoulders with secondary impingement. The clinical implication of secondary impingement in freestyle swimmers suggests that the primary goal of rehabilitation is to promote equilibrium of the shoulder complex while accounting for the demands of the sport.
Biomechanical Phenomena↗