David C. Reid

Spine Trauma and Associated Injuries

A longitudinal, prospectively gathered data base of spine trauma has been developed. A review of 508 consecutive hospital admissions identified the presence of associated injuries in 240 (47%) individuals, most frequently involving head (26%), chest (24%), or long bones (23%). Twenty-two per cent had one associated injury, 15% had two, and 10% had three or more. Most spine fractures involved the lower cervical (29%) or thoracolumbar junction (21%). Comparisons of presence or absence of associated injuries and spine fracture level showed significant differences (p less than 0.001). Eighty-two per cent of thoracic fractures and 72% of lumbar fractures had associated injuries compared to 28% of lower cervical spine fractures. While there was no significant relationship between type of associated injury and spine fracture level, those with associated injuries were less likely to have a neural deficit (p less than 0.05). After hospital admission, there were seven deaths. Early assessment and transport of spine trauma victims must be carried out with appropriate management of associated injuries. Conversely, multiple trauma victims must be handled with due regard for a possible spine fracture. The value of spinal units with specially trained personnel is emphasized.

Position of the cervical vertebrae during helmet removal and cervical collar application in football and hockey.

There is lack of consensus among prehospital personnel (athletic therapists, paramedics, sport physiotherapists) concerning specific aspects of initial care and assessment of injured athletes presenting signs and symptoms of a cervical spine injury (CSI). In instances of serious injury involving the head and/or spine, complicated by altered levels of consciousness, protective equipment such as helmets and shoulder pads may provide a hindrance to prompt, safe, and efficient management. Specifically, there is disagreement concerning the need or advisability of removing protective head gear, as in the case of football and hockey athletes. Using the technique of fluoroscopy, the cervical spine displacement of 21 male football and hockey athletes was determined while wearing protective shoulder pads and protective head equipment at the following times (a) during helmet removal, (b) during cervical collar application, and (c) as the helmetless head was allowed to rest. Subsequent frame-by-frame video arthokinematic analysis, using computer-assisted digitization, showed significant alterations in the position of adjacent cervical vertebrae during helmet removal, cervical collar application, and head rest. Results suggest that stabilization and transportation of football and hockey athletes with suspected CSI in their respective protective equipment is recommended in order to reduce the risk of further trauma by unnecessary cervical spine motion.

Factors predicting employment 1 year after traumatic spine fracture.

Study Design This prospective cohort study evaluates the employment status of 489 persons after traumatic spine fracture. Objectives To determine the rate, type, and predictors of employment 1 year after traumatic spine fracture. Summary of Background Data The limited existing literature regarding employment after spine fracture reports variable return‐to‐work rates, tends to be retrospective, and generally evaluates a limited number of predictor factors at a time. Methods Four hundred eighty‐nine persons ranging in age from 15 to 64 years who had experienced a spine fracture were assessed by a single examiner at hospital discharge and 1 year postinjury. Employment status and type, discharge neural and functional status, pain level, demographics, injury level and severity, and early treatment details were evaluated. Results At 1 year postinjury, 54% of subjects were working. A higher percentage of the employed were working part time and for fewer weeks per year than preinjury. A higher percentage were working at unskilled clerical, sales, or service jobs than preinjury. The significant positive (+) and negative (‐) predictors of employment were (from strongest to weakest): worked in year previous to injury (+); employed at time of injury (+); Workers Compensation Board coverage (‐); spinal fracture surgery (+); high‐level spine fracture (‐); pain (‐); Functional Independence Measure score (+); and days of stay in intensive care unit and spinal unit (‐). Conclusions For the first year spinal fracture, unemployment is common. Those who do return to work are more likely to modify the amount and type of work they do and to have been employed preinjury.

Reliability of scapular positioning measurement procedure using the Palpation Meter (PALM)

BACKGROUND AND OBJECTIVES Observation and measurement of the static position of the scapula is important for investigating both shoulder and neck pathology. Measurement of scapular position is complex and lacks a clinically useful instrument. The objective of this study was to investigate the reliability of the Palpation Meter (PALM) for measuring scapular position when the glenohumeral joint is held in various positions. METHODS Thirty normal subjects were recruited for a test-retest reliability study. Three raters conducted measurements on two different occasions to estimate intra- and inter-rater reliability. The scapular positions evaluated in this study were: (1) the horizontal distance between the scapula and the spine in the scapular resting position and during elevation of the arm in the scapular plane; and (2) the vertical distance between C(7) and the acromion (C(7)-A). Intraclass correlation coefficient (ICC), standard error of measurement (SEM) and Bland and Altman limits of agreement were calculated. RESULTS Reliability values for measurements of the horizontal distance between the scapula and the spine were generally good for both intra-rater (ICC 0.81 to 0.89; SEM 0.56 to 1.17cm) and inter-rater (ICC 0.67 to 0.89; SEM 0.59 to 0.98cm) evaluation. Reliability values of measurement of depression of the acromion were also good for both intra-rater (ICC 0.72 to 0.78; SEM 0.66 to 0.79) and inter-rater (ICC 0.76; SEM 0.64) evaluation. No systematic bias was observed with Bland and Altman analysis. CONCLUSIONS The PALM is a reliable tool for the measurement of scapular positioning in a healthy sample. Future studies should be conducted to further investigate the clinometric properties of the PALM in patient populations before its clinical usefulness for measuring scapular position can be established.

Injury Profiles in Wheelchair Athletes: Results of a Retrospective Survey

Little is known about the nature and mechanism of sports injuries among wheelchair athletes. The purpose of this study was to develop an injury profile for this group. A total of 90 wheelchair athletes were surveyed retrospectively by means of a questionnaire. Three hundred forty-six injuries were reported in 18 different sports, 107 (30.9%) of which occurred in basketball, 106 (30.6%) in track, and 42 (12.1%) in road racing. Eighty percent of the athletes were competitive, with 60% competing at a national level. Most of the athletes trained 6–10 h/week. Injuries to the soft tissue of the upper extremities were most common, with the hand involved 21.3% and the shoulder 16.7% of the time. Blisters and abrasions accounted for 47.4% of the injuries. All of the athletes surveyed sustained injuries, yet little protective gear was worn except for gloves (60%). In view of the potentially serious long-term complications of some of these injuries, and the corresponding impact on the ability of these athletes to carry out their functions of daily living, prompt diagnosis and treatment are mandatory. Despite this, less than one-third (30.8%) of all wheelchair athletes sought medical assistance for their sports injuries.

Relationship of turnout to hip abduction in professional ballet dancers

The ability to externally rotate or turn out the hip is fundamental to ballet. Every classical dancer aims to achieve perfect turnout. The purpose of this study was to determine how much turnout is necessary for maxi mal abduction. It was hypothesized that moderate turnout is sufficient for this purpose. Twenty-two professional dancers from the Alberta Ballet Company were studied. Measurements of passive hip abduction were taken at 0°, 45°, 60°, 70°, 80°, 90° and maximum hip lateral rotation using a goniometer and Leighton flexometer. Statistical analysis was done using Pearson correlation coefficients. A significant positive correlation was found between abduction and lateral rotation (P < 0.05). The greater the position of external rotation, the more abduction achieved. In conclusion, the traditional emphasis on good turnout has some scientific merit and functional implications.

Incomplete neural deficits in thoracolumbar and lumbar spine fractures : reliability of Frankel and Sunnybrook scales

Because neural status is used both as a treatment determiner and outcome measure, a universal, reliable scale is required. Experienced personnel, provided with concise definitions, demonstrated high inter-rater reliability of Frankel and Sunnybrook scales (Pearson correlation coefficients 0.71–0.91), with 94–100% intra-rater agreement. Both scales correspond to total sensory and motor function but are insensitive to walking and bladder function. Frankels wide clinical use, reliability, and simplicity identify it to be the preferred measurement system until a better alternative is developed. Discussion of neural status must include description of bladder and walking fucntion.

Shoulder abduction strength measurement in football players: reliability and validity of two field tests

Musculoskeletal and neurologic injuries affecting shoulder strength are common in contact sports. Full-strength recovery is desired before resumption of competition. On-field assessment of shoulder strength is usually done by manual muscle testing, which lacks sensitivity and reliability. Our objective was to determine the reliability and validity of two field instruments capable of quantifying shoulder abduction strength. Twenty junior football players underwent bilateral isokinetic (60°/s) and isometric shoulder abduction strength measurements using a Cybex 340 isokinetic dynamometer. Test-retest measurements of both shoulders of each player were made using strain gauge (SG) and handheld dynamometer (HHD) instruments. Players were tested during rested and competition conditions. Within and between session reliabilities were calculated using the intraclass coefficient, and validity was assessed using Pearsons correlation coefficient. Overall reliability for each device was calculated using Lisrel analysis. SG was found to be superior to HHD in overall reliability and validity. Within-session reliability in the rested and competition states was 0.75 and 0.78, respectively, for SG and 0.60 and 0.81, respectively, for HHD. Between-session reliability in the rested and competition states dropped to 0.51 and 0.63, respectively, for SG and 0.55 and 0.70, respectively, for HHD. Validity was 0.41 and 0.70 for SG when correlated with Cybex at 0° and 60°/s respectively. Validity for HHD was 0.28 and 0.42 for Cybex speeds of 0° and 60°/s, respectively. SG reliability and validity were similar when testing was done one shoulder at a time or both shoulders concurrently. Mean (SD) dominant/no dominant SG ratios were 1.04 (0.11) when the player was rested and 1.09 (0.15) during competition. SG reliability and validity are superior to those of HHD. SG appears to be an acceptable quantitative tool for on-field measurement of shoulder abduction strength in football players.

Anterior compartment pressures in cross-country skiers A comparison of classic and skating skis

This paper compares the pressure changes in the an terior compartment of the leg when cross-country skiing using the skating method on either skating skis or classic skis. Intracompartmental pressures of the right leg were recorded from the tibialis anterior muscle of 10 subjects at rest and 15 seconds after 10 to 12 minutes of cross-country skiing on a designated course. All subjects completed two trials on different days. In one trial, subjects used skating skis and for the other trial, classic skis were used for the skating technique. Although the average pressure increase was higher for the classic ski trials than for the skating ski trials, the difference was not significant. This finding indicates that cross-country skiers who skate on a classic ski as opposed to a shorter skating ski do not experience a significantly greater increase in their anterior compart ment pressure. Thus, it appears that the type of ski used is not the most significant factor contributing to chronic compartment syndrome.

Ankle injuries in sports

1971, 33% of the injuries treated by physical therapists and trainers were ankle injuries. Of these, 61 % occurred in basketball, 23% in volleyball, 7% in hockey, and 8% in all other sports. By contrast, there were no cases of ligamentous ankle injuries at the World Amateur Wrestling Championships in 1970. Severe ankle sprains, producing loss of game or competition time, rank behind hamstring and adductor muscle tears, shoulder injuries, and medial collateral ligament knee injuries, with and without meniscus problems, as a major category of sports injury.