William G. Raasch

Ulnar stress fracture of the nondominant arm in a tennis player using a two-handed backhand.

Stress fractures are infrequently seen in non-weight-bearing bones. However, stress fractures may be present in any bone that undergoes repetitive stress. We report an unusual case of stress fracture in the nondominant arm of a tennis player who uses a two-handed backhand stroke.

Annular flexor pulley injuries in professional baseball pitchers: a case series.

Closed traumatic rupture of the annular pulley has been reported in rock climbers. However, injury to the digital flexor pulley system in baseball pitchers has not been reported. This is a report of 4 professional baseball pitchers with ruptures localized to the A4 pulley of the middle finger. History, proposed mechanism of injury, physical findings, radiographic confirmation, and a tailored treatment protocol are discussed.

In vitro evaluation of shoulder external rotation after a Bankart reconstruction.

The Bankart procedure is a commonly performed an terior shoulder reconstruction that may shorten the anterior capsule. In this study, biomechanical testing was performed to evaluate the effect of the classic Bankart reconstruction on external rotation of the shoulder. The procedure was performed on six fresh- frozen cadaveric specimens that were free of intraar ticular pathologic changes. With the arm in 0° of ab duction, resisting torques about the vertical axis were measured while the humerus was externally rotated. The intact specimens demonstrated a nonlinear load displacement behavior in which little resisting torque was measured until a moderate amount of external rotation was applied. Shortening the capsule by 2 mm resulted in a 40% decrease in the low-tension zone of external rotation, and shortening the capsule an addi tional 5 mm resulted in a 67% decrease in the low- tension zone. This study demonstrates that the normal shoulder capsule is quite sensitive to anterior capsular shortening and suggests that care must be exercised when performing a Bankart reconstruction to avoid overtightening this structure.

Management and Outcomes of Latissimus Dorsi and Teres Major Injuries in Professional Baseball Pitchers

Background: Very little data exist on latissimus dorsi (LD) and teres major (TM) injuries in professional baseball pitchers. Purpose: This review was undertaken to report on the management and outcomes of baseball pitchers with injury to 1 or both of these muscles. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review of 16 professional baseball pitchers diagnosed and treated for an LD and/or TM tear between 2002 and 2008 was performed. Magnetic resonance imaging confirmed the diagnosis in all cases. The mean age was 28.1 years. All were treated nonoperatively with rest, rehabilitation, and return to pitching after a throwing program. The injuries included tendon avulsions in 6 athletes and strains in 10. Length of disabled time, return to prior level of pitching, and recurrences were noted. Results: Fifteen of 16 pitchers (94%) returned to the same or higher level of play. The mean time to throwing was 35.6 days. Mean time to pitching was 61.9 days. Nine of 16 injuries (56%) were season-ending. Mean total time lost for athletes returning the same season was 82.4 days. Two of 16 pitchers (13%) sustained recurrent injuries. Prior shoulder and elbow injuries were noted in 75% (12 of 16). Conclusion: Injury of the LD and/or TM can occur in pitchers. Nonoperative treatment is successful in allowing a return to high-level pitching.

Effect of education and language on baseline concussion screening tests in professional baseball players.

Objective:The purpose of the present study was to investigate the possible effects of sociocultural influences, specifically pertaining to language and education, on baseline neuropsychological concussion testing as obtained via immediate postconcussion assessment and cognitive testing (ImPACT) of players from a professional baseball team. Design:A retrospective chart review. Setting:Baseline testing of a professional baseball organization. Participants:Four hundred five professional baseball players. Independent Variables:Age, languages spoken, hometown country location (United States/Canada vs overseas), and years of education. Main Outcome Measures:The 5 ImPACT composite scores (verbal memory, visual memory, visual motor speed, reaction time, impulse control) and ImPACT total symptom score from the initial baseline testing. Results:The result of t tests revealed significant differences (P < 0.05) when comparing native English to native Spanish speakers in many scores. Even when corrected for education, the significant differences (P < 0.05) remained in some scores. Conclusions:Sociocultural differences may result in differences in computer-based neuropsychological testing scores.

Biomechanical effect of in-line skating wrist guards on the prevention of wrist fracture

A biomechanical study was conducted in this study to investigate if in-line skating wrist guards can effectively reduce the impact forces so as to protect the wrist from fracture. The forearm specimens with and without wrist guards were dropped using a specially designed sled to simulate the impact on the wrist while falling. A force plate was used to measure the total impact force on the dropping weight whereas a load cell was attached to the proximal end of the specimen and used to quantify the impact transmitted through the wrist joint. From the nondestructive tests, mean peak force measured from a force plate showed no difference between the guarded and unguarded groups whereas mean impulse of the guarded group was significantly greater than that of the unguarded group (p<0.01). Comparing the peak force and impulse measured from the load cell, the peak force of the guarded group was significantly less than that of the unguarded group (p<0.001), while the impulse values were similar. When the specimens were dropped from a higher position (2.5 ft vs. 1 ft), all unguarded specimens had severe wrist fractures whereas fracture was found in three out of 5 guarded specimens. Comparison of mean peak forces and impulses showed a significant difference between the guarded and unguarded groups only in the mean impulse measured from the force plate. These results suggest that the wrist guard may protect the wrist by attenuating the peak force transmitted to radius and ulnar although it may not be effective when the wrist is subjected to an impact sufficiently large to cause fractures.

A stress fracture of the phalanx from rock climbing: a case report

Sport climbers are at high risk for overuse injuries. These injuries are usually soft tissue injuries. The following is the first case report of a stress fracture of the phalanx in a rock climber and a review of the literature of sport climbing injuries.

After the Fall: Symptoms in Bungee Jumpers

A survey of 100 professionally supervised bungee jumpers who used an ankle harness in a single leap from a platform reveals that 42 jumpers had a total of 59 minor medical complaints or symptoms after their jumps. Immediate symptoms included musculoskeletal pain in the ankle, neck, back, and chest, neurologic complaints such as dizziness and headache, and blurred vision. Dizziness was the most common symptom, and neurologic complaints outnumbered musculoskeletal symptoms. All complaints resolved within 1 week of the jump except for lacerations sustained by one person who tried to grab the platform as he was jumping.