1/150. MR imaging of the thrower's shoulder. Internal impingement, latissimus dorsi/subscapularis strains, and related injuries. In conclusion, internal impingement apparently occurs in nearly all patients and is demonstrable on MR imaging. Pathologic changes associated with internal impingement seem to develop with repetitive placement of the arm into a position of extreme external rotation and abduction. Findings may include lesions of the posterior superior labrum, undersurface irritation, or tearing of the supraspinatus-infraspinatus junction near the attachment site and cystic changes of the posterior superior glenoid and posterior lateral greater tuberosity. There is no evidence for a particular sequence of pathologic changes. Instability may be associated with but does not appear to be a prerequisite for the development of the pathologic lesions of internal impingement. ( info) |
2/150. Strategy of exercise prescription using an unloading technique for functional rehabilitation of an athlete with an inversion ankle sprain. STUDY DESIGN: Case study. OBJECTIVES: To demonstrate how an exercise program can be designed with specific sets, repetitions, and rest periods, and to enhance the healing process in early stages of rehabilitation when injured tissues cannot tolerate full body weight. Our goal was to enhance ankle tissue healing by reducing gravitational force through a prescriptive exercise and unloading program. BACKGROUND: This report describes a treatment method that we used to rehabilitate a collegiate soccer player with a Grade II inversion ankle sprain. This athlete sprained his ankle 6 weeks before the start of rehabilitation and was unable to participate in soccer due to persistent pain and impaired function. methods AND MEASURES: A 2-week functional training program was implemented, consisting of exercises chosen for specific task simulation related to soccer. Gravitational force was mechanically altered by suspending the subject or by supporting the subject on a variable incline plane. weight-bearing was controlled so that the subject could perform exercises without pain. The outcome measures were ankle range of motion (ROM), maximum pain-free isometric strength, vertical force during unilateral squats, and unilateral hop time and distance. RESULTS: Pain-free weight-bearing capacity increased over the 2-week course of rehabilitation and the subject was able to return to playing soccer without pain. The ratios (involved to uninvolved extremity) at time of discharge from physical therapy were 87% to 103% for ankle ROM, 75% to 93% for isometric ankle strength, 91% for unilateral squats, 88% for unilateral hop time, and 86% for unilateral hop distance. CONCLUSIONS: Return to function can be achieved in a short period by exercise that is performed with a gradual increase in pain-free weight-bearing capacity. ( info) |
| axillary vein thrombosis may occur on strenuous activity with a clinical picture similar to a simple strain. It carries significant morbidity but a good outcome is possible with early treatment. The aetiology, investigation, and treatment are discussed. ( info) |
| STUDY DESIGN: Case study. OBJECTIVES: To describe a protocol used in the rehabilitation of a grade II lateral ankle sprain, emphasizing brief immobilization with a removable boot, weight bearing as tolerated, and progression of early exercise. BACKGROUND: The optimum conservative treatment of severe grade II ankle sprains remains undefined. Short-term benefits of early mobilization have won favor over immobilization by casting; however, pain and ankle joint instability often linger. The timing of weight bearing as a variable that influences recovery has largely been ignored when either treatment is considered. methods AND MEASURES: The patient was a 17-year-old girl who had sustained a left ankle inversion sprain while playing high school basketball. The sprained ankle was placed in an immobilizer boot for 1 week, and weight bearing was encouraged. She received instructions for active exercise and for resistive exercise with elastic tubing. Volumetric and active range of motion measurements and gait observation provided indicators of rehabilitation progress. A digital inclinometer was used to measure active range of motion in the sagittal plane. Vertical ground reaction forces recorded with an instrumented treadmill documented gait symmetry. RESULTS: The patient responded well to the course of treatment, returning to full participation in basketball 2 weeks after the injury. The injured ankle had 29% (19 degrees) less active range of motion than the nonimpaired ankle at the beginning of physical therapy. The injured ankle also displaced 50 mL more water compared with the nonimpaired ankle at the start of treatment. Four weeks after beginning treatment, the sprained ankle had 4 degrees less active range of motion and displaced 5 mL more water compared with the nonimpaired ankle. As a college athlete, the patient has remained free of subjective complaints of ankle pain, instability, and swelling. CONCLUSION: weight-bearing immobilization combined with early exercise provided safe and effective treatment for this patient, who suffered a grade II lateral ankle sprain. ( info) |
5/150. Osteoid osteoma of the lateral talar process presenting as a chronic sprained ankle. Pathologic conditions of the lateral talar process may be difficult to diagnose using physical examination and roentgenographs. A computed tomography scan of the hindfoot is often useful to define lesions of the lateral process. We report a case of osteoid osteoma of the lateral talar process that defied diagnosis for 4 years. The patient had an antecedent history of an inversion injury, which had been treated as a chronically painful sprained ankle without resolution of symptoms. The tumor was ultimately identified on a computed tomography scan, best seen on a coronal section through the talus. The patient had complete relief of pain after excisional biopsy of the tumor. ( info) |
6/150. Dynamic axial carpal instability: a case report. The concept of distal carpal row dissociation is not new. It has occurred secondary to high-energy crush or blast injuries, with resultant axial dislocations of both carpal rows and metacarpals. Axial carpal sprains without disruption or dynamic axial carpal instability have not been previously described. The evaluation of this new type of carpal instability with radiographs, tomography, arthrography, and magnetic resonance imaging failed to demonstrate its etiology. Arthroscopic evaluation of the midcarpal and radiocarpal joints demonstrated a dynamic axial carpal instability with incompetence of the capitohamate and scapholunate ligaments. Stabilization of the axial instability by capitohamate arthrodesis relieved the chronic wrist pain. ( info) |
7/150. frostbite at the gym: a case report of an ice pack burn. The case is reported of a 59 year old woman who suffered a 1% total body surface area superficial partial thickness burn to her calf following the application of an ice pack. The cause, resulting injury, and subsequent management are discussed. It is possible that such injuries are common, but no similar reports were found in a literature search. awareness of the risk of this type of injury is important for all those entrusted with advising patients on the treatment of minor soft tissue injuries. ( info) |
8/150. Complex regional pain syndrome. Complex regional pain syndrome is a chronic pain syndrome that is often instigated by postoperative or post-traumatic events. The disease process can progress through three stages, the first of which tends to respond best to treatment. A review of the literature is presented, followed by a report of a patient who developed symptoms of complex regional pain syndrome following a water-skiing accident. ( info) |
9/150. Modified arthroscopic excision of the symptomatic os trigonum and release of the flexor hallucis longus tendon: operative technique and case study. This article presents an operative technique for modified arthroscopic excision of the symptomatic os trigonum and release of the flexor hallucis longus tendon sheath. The procedure uses two stacked posterolateral subtalar joint portals, rather than the customary anterolateral and posterolateral portal combination. By visualizing the os trigonum with an arthroscope positioned in a distal portal and introducing instrumentation through a proximal portal, the ossicle may be quickly exposed and excised with minimal dissection. A case study with a 22-month follow-up and a discussion of os trigonum syndrome are included to illustrate this procedure as an alternative to open excision or traditional arthroscopic excision. ( info) |
10/150. Pseudoaneurysm of the lateral malleolar artery after an ankle sprain: case report and review of the literature. A pseudoaneurysm of the peroneal artery or one of its branches is rare after trauma. The diagnosis is frequently delayed, resulting in substantial morbidity to the patient. The infrequent occurrence of this condition has resulted in a lack of diagnostic and treatment guidelines. However, when recognized, prompt attention involving either surgical ligation or embolization of the injured arterial branch is the most reliable method of treatment. Presented is a report of a patient who developed a lateral malleolar arterial pseudoaneurysm after an ankle sprain, which was treated successfully with aneurysmal excision and surgical ligation of the injured arterial branch. A review of the literature and treatment recommendations follow. ( info) |