William J. Bryan

The axillary nerve and its relationship to common sports medicine shoulder procedures

Cadaveric dissections have demonstrated the precar ious nature of the axillary nerve with relationship to three common sports medicine shoulder procedures: the anteroinferior acromioplasty and rotator cuff repair incision, the inferior capsular shift procedure, and the posterior portal for shoulder arthroscopy.

Complications of distal radial fractures: Pins and plaster treatment

Recent advances in the treatment of comminuted distal radial fractures has led to the use of pins and plaster, a concept described by many authors. This paper examines whether the use of pins and plaster maintains reduction of distal comminuted radial fractures, and, if so, if it is accomplished with a minimum of complications. With follow-up ranging from 1 month to 1 year following pin removal, 80 consecutive comminuted distal radial fractures treated with pins and plaster were analyzed for change in fracture reduction, associated injuries, and complications incurred during and as a result of the treatment mode. Thirty-three percent of our patients had some complications due to their pins and 16% required reoperation for carpal tunnel syndrome or replacement of loose pins, sequestrectomy, or extended treatment in long arm casts.

Pediatric pelvic fractures: review of 52 patients.

Fifty-two patients (ages 1 to 16 years) with pelvic fractures were hospitalized at an urban medical center during a 5-year period. All patients with acetabular fractures had adjacent hemipelvis fractures. None were seen to develop symptomatic acetabular dysplasia. Stable breaks in the ring (anterior ring fracture) were encountered most frequently. While many patients were discharged ambulating within a short time, over 50% had prolonged hospitalizations due to associated truma. Only one child had serious urologic trauma, demonstrating that isolated anterior ring fractures in children are not as treacherous in terms of pelvic content injury as those one might encounter in adults. Unstable breaks (anterior and posterior ring fractures) pose acute and chronic management problems and associated injuries are often fatal. Life-threatening complications may overshadow proper fracture management. It is critical to maintain a symmetrical pelvis in order to prevent either cephalad translation or anterior-posterior hemipelvis rotation. A child with the latter problem is presented in detail.

Isolated infraspinatus atrophy A common cause of posterior shoulder pain and weakness in throwing athletes

A 24-year-old professional outfield baseball player experienced sudden pain in his posterior right throwing shoulder after a long, hard toss from center field during the 1985 spring training. The injury was considered minor and his shoulder pain dissipated over several days. In the ensuing weeks, however, posterior shoulder pain with long, hard tosses became common and was brought to the attention of the team trainer and physician. Examination revealed pain and decreased muscle bulk on palpation of the right infraspinatus muscle. Pain and weakness on resistance to exter-

Tuberculosis in a rheumatoid patient. A case report

A 72-year-old white woman with seropositive rheumatoid arthritis subsequently developed polyarticular tuberculosis. Clinical and radiographic evidence of deterioration of the right knee and left elbow was erroneously attributed to progressive rheumatoid arthritis. The diagnosis of a tuberculous infection was unduly delayed. Failure to recognize this infection might have been disastrous if a total knee arthroplasty had been performed as planned. This case illustrates the importance of awareness of other possible origins of joint destruction and infection in rheumatoid patients with rapid deterioration of joint function.

Chondrosarcoma of the trapezium: A case report

Roentgenograms of a 46-year-old Caucasian man with progressive swelling and pain at the base of the thumb who had been treated for arthritis showed an enlargement of the trapezium. The entire bone and surrounding ligaments were removed and an iliac bone graft was used to fuse the trapezoid to the first metacarpal. Sections of the tumor were diagnosed as chondrosarcoma. No recurrence is apparent 3 years after excision.

The use of epidural morphine in patients undergoing total knee arthroplasty.

Sixty-six patients undergoing total knee arthroplasty were offered epidural morphine as a method of postoperative analgesia. Of the 66 patients, 50 completed the minimum protocol of 3 days in a special epidural monitoring unit and were thus available for study. In this study group, 86% stated that they obtained 75-100% relief of pain with each epidural injection. Greater than 90% of the patients rated the overall experience with epidural analgesia as excellent or good. Ninety percent stated that they would choose epidural morphine analgesia again if given the choice. Nausea and vomiting were the most common adverse effects, occurring in 34%. One patient experienced respiratory depression, which was reversed with Narcan. The most frequent complaint related to the procedure itself was the use of an apnea monitor; 18% of the patients considered this monitoring device intolerable. The progress of total knee arthroplasties in the epidural unit was monitored by range of motion achieved. At 72 hours the average motion was 10 degrees-87 degrees and at the end of the hospital stay was 6 degrees-98 degrees. The total hospital bill for epidural morphine analgesic patients was

Hip endoprosthesis stabilization with a porous low modulus stem coating: Factors influencing stabilization

469 more than for a conventional arthroplasty patient, though the mean duration of hospital stay was 1.7 days less for the epidural morphine patients. Epidural morphine provided excellent but inconsistent postoperative pain relief. When relief was present, aggressive in-house rehabilitation could be instituted, and a shorter overall hospital stay was achieved when compared with conventional analgesia. Nonetheless, the related adverse effects and inconsistent pain relief on many patients may preclude the use of epidural morphine as a single postoperative analgesic agent.

Baseball shoulder and elbow injury rehabilitation of varsity, high school, intercollegiate, and professional baseball players

A polytetrafluoroethylene/vitreous carbon porous material has been investigated as an alternative to acrylic for hip endoprosthesis fixation. This material, which is mechanically fused to the endoprosthesis stem, has been shown to promote soft-tissue ingrowth. In 29 patients receiving a porous-coated Thompson endoprosthesis, stabilization of the porous-coated stem as observed by acceptable clinical results occurred in only about 50%. Stabilization of porous-coated endoprostheses is unsatisfactory for the following reasons: lack of press-fit, inadequate prosthetic design, infection, and technical difficulties. The major cause of 40% failure in this series was an initially inadequate press-fit.

Anatomic and radiographic analysis of arthroscopic tack placement into the superior glenoid

Principles of general and shoulder conditioning exercises for the healthy late adolescent and adult baseball player start this presentation. Subsequently, common throwing shoulder and elbow problems are discussed in a rehabilitative context. The reader will acquire skills in diagnosing and rehabilitating surgical and nonsurgical conditions of rotator cuff tendonitis, partial rotator cuff tears, superior labrum anterior posterior (SLAP) lesions, throwing acquired decreased shoulder internal rotation (TADSIR), microanterior shoulder instability, posterior elbow impingement, and medial elbow disorders. The alliance between athletic trainers, physical therapists, team physicians, and coaches is critical in returning mature serious baseball players to a game-ready state.