Frank C. McCue

Athletic Injuries of the Proximal Interphalangeal Joint Requiring Surgical Treatment

The proximal interphalangeal joint is commonly injured in vigorous sports, but often the severity of the injury is not appreciated and the onset of treatment delayed for weeks or months. In an eight-year period, 143 athletic injuries to the proximal interphalangeal joint required surgery; these cases are reviewed. The anatomy of the joint, the indications for surgery, the details of operative technique and postoperative management, and the results are discussed in the various clinical categories of injury to the joint: articular fractures, fracture-dislocations, compound dislocations, collateral-ligament ruptures, boutonniere deformities, hyperextension deformities, and pseudo-boutonniere deformities. Early surgical repair of the injuries gives good results in those young athletes who are cooperative and well motivated and who have the benefits of supervised rehabilitation. Surgical reconstruction yields satisfactory results even in the athletic injuries that receive attention late; the results are better than those following comparable industrial and occupational injuries to the proximal interphalangeal joints in older patients. The importance of this joint in future athletic competition and in later life makes the correct diagnosis and early treatment imperative.

Quadrilateral space syndrome in a throwing athlete

was capable of a 95 mph fastball, described the pain as a progressive dull ache occurring after one or two innings of pitching. He described a numb shoulder without radiation of the symptoms down the arm. He stated that the shoulder started to feel weak on elevation. Eventually, he described the shoulder as &dquo;having no life in it and feeling dead.&dquo; He denied distal paresthesias or cyanosis. He denied previous trauma to the shoulder. Pertinent findings on physical examination included the following: pain with palpation over the right quadrilateral space, and, within several minutes, development of severe pain about the right shoulder with hyperabduction and external rotation. These symptoms could not be reproduced on the left side. The patient reported that these symptoms were identical to those experienced while on the mound.

Magnetic resonance imaging of injury to the lateral ankle ligaments

To establish the value of magnetic resonance imaging in determining which patients with ankle sprains will benefit from surgical treatment, 1 uninjured volunteer and 15 patients with acute, subacute, and chronic injuries of the lateral ankle ligaments were imaged at 1.0 tesla using a fast imaging with steady-state preci sion three-dimensional technique and 1.5-mm slice thickness. A dedicated knee coil was used to hold the foot in a neutral or plantar-flexed position. In cases of acute, low-grade injuries, fraying of the anterior talofib ular ligaments with intact calcaneofibular ligaments was observed in the presence of edema and hemorrhagic fluid. In cases of acute, high-grade sprains, the calca neofibular ligament appeared wavy or was visualized only partially or not at all. Subacute injuries showed ligament disruption; chronic lesions, on occasion, showed atrophy of the calcaneofibular ligament but no edema or hemorrhagic fluid. These findings showed a good qualitative correlation with the results of graded stress radiography. Magnetic resonance imaging can definitely determine the ligaments involved in lateral ankle sprains and pro vide useful anatomic information in cases in which acute or reconstructive surgery is contemplated. However, the magnetic resonance imaging findings do not directly correlate with degree of instability and do not replace those of physical examination or routine radiographic studies.

Hand and wrist injuries in the athlete

Injuries to the hand and wrist are probably among the most common injuries incurred by the athlete. Neglect of such injuries may result in irreparable damage to the hand or wrist. This summary of the more common injuries to these areas seen in the athlete, with a description of the recognition and treat ment, gives the reader insight into the multiple considerations the athlete and coach must have. Even seemingly minor injuries must be carefully evaluated and treated by a physician. Early diagnosis, accurate precise treatment, and proper rehabilitation are extremely important to regain optimal function after these injuries. They may have a significant impact not only in athletic competition but also in the athletes selection of an occupation. It is psychologically important also that the participant be returned to his particular sport as soon as possible. Most of the injuries can be controlled by conservative means. However, when surgical repair is indicated, it is important for the surgeon to be trained and familiar with the anatomy and techniques of surgery of the hand and wrist.

Instrumented Arthrometry for Diagnosing Partial Versus Complete Anterior Cruciate Ligament Tears

Nineteen patients with the clinical diagnosis of anterior cruciate ligament injury were examined by KT-1000 ar thrometry before arthroscopy in an effort to differentiate partial from complete tears. To this end, the KT-1000 arthrometer was equipped with a strain gauge and pro cessor that permitted the required force to increase the anterior displacement by 1-mm increments, to be read on a light-emitting diode. The measured force has been plotted against anterior displacement expressed in non linear increments along the x-axis to allow for the vis coelastic nature of the ligament. The results show that stress-strain diagrams of partially torn and completely torn ligaments are similar to those obtained by graded stress radiography. Using arthroscopy as the standard of measurement, partial tears can be differentiated from complete tears with a sensitivity of 80% and a specificity of 100%. The figures for complete tears versus partial tears are 100% and 80%, respectively. Graded arthrom etry with x-y recording of the force-displacement rela tionship that allows for the viscoelastic qualities of liga ment further extends the capabilities of instrumented arthrometry.

Ulnar collateral ligament injuries of the thumb in athletes.

The ulnar collateral ligament of the metacarpophalangeal joint of the thumb is frequently injured during competitive sports. Unfortunately, this ligamentous tear is not infrequently overlooked when it is fresh, especially in the young, poorly supervised athlete. Inadequately treated, or untreated, complete tear of the ulnar collateral ligament results in instability of the joint when it is stressed-m abduction. This situation jeopardizes one of the most important functions of the hand-the thumb-index pinch. In most sports, normal thumb-index pinch is a vital function for the athlete to be able to

Common sports hand injuries. An overview of aetiology, management and prevention.

SummaryInjuries to the hand are among the most common in all of sports. Appropriate care should include prompt diagnosis and treatment. Dislocations of the digits should be reduced promptly, particularly the carpometacarpal joint of the thumb. Volar dislocations of the proximal inter-phalangeal joint need to be splinted in full extension, and the more common dorsal dislocations in slight flexion. Collateral ligament injuries of the fingers respond well to initial immobilisation followed by early motion. Although ligament injuries to the thumb metacarpophalangeal joint may be treated closed, they generally respond better to operative management. This is true particularly for those occurring on the ulnar side which are at risk for soft tissue interposition.Metacarpal shaft fractures can usually be treated closed with acceptance of more significant deformity in the ulnar 2 shafts. Open reduction is reserved for multiple shaft fractures and deformity in the second and third metacarpals. Near-perfect alignment should be the goal in extra-articular fractures of the phalanges as well as fractures involving the articular surface. Closed tendon injuries occurring on the extensor side, i.e. mallet finger, may be treated with prolonged splinting if a congruous reduction can be achieved with closed reduction. Flexor side avulsions occurring most commonly in the ring finger also require prompt attention with the level of retraction of the tendon dictating the need for the immediacy of repair.Although often not initially debilitating, lack of recognition of hand injuries and improper treatment can lead to debilitating sequelae. Therefore, early recognition and diagnosis can easily avoid many of the pitfalls of care resulting in a less than optimal outcome.

Transfer of the Brachioradialis for Hands Deformed by Cerebral Palsy

Some patients with cerebral palsy can be helped by surgical reconstruction of the hand and forearm. These patients require careful evaluation and a trial of conservative therapy before undertaking the reconstructive procedure. In selected cases appropriate tendon transfers can be extremely beneficial to the patient. The brachioradialis has been found to be strong and under voluntary control in a high proportion of patients with spastic paralysis. Thorough mobilization of the muscle gives it sufficient amplitude for use as a transfer. The use of the brachioradialis as a motor has been described in thirty-three tendon transfers in patients with cerebral palsy. Twenty-eight hands were improved and five showed no improvement in hand and forearm function.

Intercollegiate Lacrosse Injuries.

In brief:Injury data for an intercollegiate lacrosse team were collected after one season of practices and games and compared with injury data from a summer league team. Only five players (15%) completed the season without injury, and there were 78 total injuries to the 34 players. The most frequent injury was ankle sprain. The experience, skills, and age of collegiate athletes are more homogeneous and they often have superior equipment and playing surfaces, which suggests that they should have fewer injuries. However, the authors believe that the competitiveness of collegiate lacrosse results in higher frequency of injury.

GRADED STRESS RADIOGRAPHY OF INJURED ANTERIOR CRUCIATE LIGAMENTS

Fifty-five patients with clinical suspicion of injury to their anterior cruciate ligament (ACL) were examined by graded stress radiography before arthroscopic verification in an effort to determine the loss of ACL function as a result of ligament tearing. Using a commercially available stress device capable of applying varying pressures to the mid-calf, anterior drawers were measured from lateral radiographs at 0-, 7-, 14-, and 21-kiloPascal pressures and used to calculate the equivalent elastic modulus of the remaining ACL fibers. According to viscoelastic theory, this modulus is proportional to the number of elastically active fibers in the ligament. To verify the validity of this concept, the stress-strain relationship of a freshly excised ACL ligament was examined in a tensile testing machine, and the procedure was repeated after the ligament had been partially transsected with a scalpel. Comparison with the elastic modulus of the (intact) ACL of the opposite knee permits an estimate of the percentage of rupture in cases of partial tears. Overstretched ligaments show essentially normal viscoelastic properties once the slack in the ligament has been taken up. Complete tears, on the other hand, show a complete breakdown in the viscoelastic properties of the ACL. The results show that partial tears can be diagnosed by graded stress radiography with a sensitivity of 20% and specificity of 90%. Diagnosis of overstretched ligaments had sensitivity of 50% and specificity of 94%. Complete tears were detected with sensitivity of 88% and specificity of 75% as diagnosed against all other ACL lesions and including normals.(ABSTRACT TRUNCATED AT 250 WORDS)