Paul S. Sherbondy

The Anatomic Relationship of the Brachial Plexus and Axillary Artery to the Glenoid Implications for Anterior Shoulder Surgery

Iatrogenic brachial plexus injury is an uncommon but potentially severe complication of shoulder reconstruction for instability that involves dissection near the subscapularis muscle and potentially near the brachial plexus. We examined the relationship of the brachial plexus to the glenoid and the subscapularis muscle and evaluated the proximity of retractors used in anterior shoulder surgical procedures to the brachial plexus. Eight fresh-frozen cadaveric shoulders were exposed by a deltopectoral approach. The subscapularis muscle was split in the middle and dissected to reveal the capsule beneath it. The capsule was split at midline, and a Steinmann pin was placed in the equator of the glenoid rim under direct visualization. The distance from the glenoid rim to the brachial plexus was measured with calipers with the arm in 0°, 60°, and 90° of abduction. The brachial plexus and axillary artery were within 2 cm of the glenoid rim, with the brachial plexus as close as 5 mm in some cases. There was no statistically significant change in the distance from the glenoid rim to the musculocutaneous nerve, axillary artery, medial cord, or posterior cord with the arm in various degrees of abduction. Retractors placed superficial to the subscapularis muscle or used along the scapular neck make contact with the brachial plexus in all positions tested.

24-Week study on the use of collagen hydrolysate as a dietary supplement in athletes with activity-related joint pain.

ABSTRACT Background: Collagen hydrolysate is a nutritional supplement that has been shown to exert an anabolic effect on cartilage tissue. Its administration appears beneficial in patients with osteoarthritis. Objective: To investigate the effect of collagen hydrolysate on activity-related joint pain in athletes who are physically active and have no evidence of joint disease. Design and setting: A prospective, randomized, placebo-controlled, double-blind study was conducted at Penn State University in University Park, Pennsylvania. Parameters including joint pain, mobility, and inflammation were evaluated with the use of a visual analogue scale during a 24-week study phase. Study participants: Between September 2005 and June 2006, 147 subjects who competed on a varsity team or a club sport were recruited. Data from 97 of 147 subjects could be statistically evaluated. Intervention: One hundred and forty-seven subjects (72 male, 75 female) were randomly assigned to two groups: a group (n = 73) receiving 25 mL of a liquid formulation that contained 10 g of collagen hydrolysate (CH-Alpha)* and a group (n = 74) receiving a placebo, which consisted of 25 mL of liquid that contained xanthan. Main outcome measures: The primary efficacy parameter was the change in the visual analogue scales from baseline during the study phase in relation to the parameters referring to pain, mobility, and inflammation. Results: When data from all subjects (n = 97) were evaluated, six parameters showed statistically significant changes with the dietary supplement collagen hydrolysate (CH) compared with placebo: joint pain at rest, assessed by the physician (CH vs. placebo (–1.37 ± 1.78 vs. –0.90 ± 1.74 ( p = 0.025)) and five parameters assessed by study participants: joint pain when walking (–1.11 ± 1.98 vs. –0.46 ± 1.63, p = 0.007), joint pain when standing (–0.97 ± 1.92 vs. –0.43 ± 1.74, p = 0.011), joint pain at rest (–0.81 ± 1.77 vs. –0.39 ± 1.56, p = 0.039), joint pain when carrying objects (–1.45 ± 2.11 vs. –0.83 ± 1.71, p = 0.014) and joint pain when lifting (–1.79 ± 2.11 vs. –1.26 ± 2.09, p = 0.018). When a subgroup analysis of subjects with knee arthralgia (n = 63) was performed, the difference between the effect of collagen hydrolysate vs. placebo was more pronounced. The parameter joint pain at rest, assessed by the physician, had a statistical significance level of p = 0.001 (–1.67 ± 1.89 vs. –0.86 ± 1.77), while the other five parameters based on the participants’ assessments were also statistically significant: joint pain when walking ( p = 0.003 (– 1.38 ± 2.12 vs. – 0.54 ± 1.65)), joint pain when standing ( p = 0.015 (–1.17 ± 2.06 vs. –0.50 ± 1.68)), joint pain at rest with ( p = 0.021 (–1.01 ±1.92 vs. –0.47 ± 1.63)), joint pain when running a straight line ( p = 0.027 (–1.50 ± 1.97 vs. –0.80 ± 1.66)) and joint pain when changing direction ( p = 0.026 (–1.87 ± 2.18 vs. –1.20 ± 2.10)). Conclusion: This was the first clinical trial of 24-weeks duration to show improvement of joint pain in athletes who were treated with the dietary supplement collagen hydrolysate. The results of this study have implications for the use of collagen hydrolysate to support joint health and possibly reduce the risk of joint deterioration in a high-risk group. Despite the studys size and limitations, the results suggest that athletes consuming collagen hydrolysate can reduce parameters (such as pain) that have a negative impact on athletic performance. Future studies are needed to support these findings.

The Effect of Protective Equipment on Cervical Spine Alignment in Collegiate Lacrosse Players

Background Contact sports place athletes at risk for cervical spine injury. Protective helmets and shoulder pads worn by football and ice hockey athletes alter cervical spine alignment. The effect of helmet and shoulder pads on neck alignment in lacrosse athletes is not known. Hypothesis Helmets and shoulder pads worn by lacrosse athletes alter cervical spine alignment. Study Design Controlled laboratory study. Methods Sagittal plane cervical spine alignment was evaluated in 16 uninjured male collegiate lacrosse players using computed tomography. Patients were immobilized in the supine position on a standard spine board. Testing was performed without equipment, with both helmet and shoulder pads in place, and with the helmet removed. Angular measurements of the cervical spine were made and analyzed. Results The presence of both the helmet and shoulder pads caused an increase in overall cervical extension (mean, 6°) compared with the absence of both pieces of equipment (P =. 002). Helmet removal alone resulted in a mean increase in cervical flexion of 4.7° in the upper cervical spine compared with the presence of both pieces of equipment (P =. 011). Compared with the absence of equipment, shoulder pads caused increased cervical flexion in the lower cervical spine (mean, 4.4°; P =. 036). Conclusion Protective equipment worn by lacrosse athletes causes statistically significant increases in cervical extension, and its removal causes statistically significant increases in cervical flexion. This alteration is different from that previously reported for protective equipment in football and ice hockey. Clinical Relevance The authors’ recommendation is that both lacrosse helmets and shoulder pads be left in place until they can be completely removed in a controlled fashion. The effect of external equipment on neck position is different for lacrosse compared with football and ice hockey.