Orthobiologic Treatment of Throwing Related Injuries in Sport: A Focused Review of the Published Literature.

ABSTRACT: Because of the growth and development of orthobiologics, in particular platelet-rich plasma, as a potential treatment modality in sports related injuries, it is imperative that providers are aware of the up-to-date published data on the usage of this treatment. While some data are promising, prospective studies are needed to determine the effectiveness of platelet-rich plasma treatment for throwing related injuries. There are limitations with all of the published data that include their retrospective nature, heterogeneity between study designs, and platelet-rich plasma characteristics if reported. While platelet-rich plasma may be used as a likely safe adjuvant to conservative and surgical treatments, prospective randomized controlled studies using appropriately reported platelet-rich plasma concentrations and characteristics will help physicians make more definitive recommendations in regard to platelet-rich plasma treatment. Based on the currently available published data, this treatment may be trialed in the right setting and based on severity and location of injury.

Diagnostic Imaging of A2 Pulley Injuries: A Review of the Literature.

Injury to the A2 pulley is caused by high eccentric forces on the flexor-tendon-pulley system. Accurate diagnosis is necessary to identify the most appropriate treatment options. This review summarizes the literature with respect to using ultrasound (US) to diagnose A2 pulley injuries, compares ultrasound to magnetic resonance imaging and computed tomography, and identifies current knowledge gaps. The results suggest that US should be used as the primary imaging modality given high accuracy, relatively low cost, ease of access, and dynamic imaging capabilities. Manual resistance is beneficial to accentuate bowstringing, but further research is needed to determine best positioning for evaluation.

Benefit of Outpatient Musculoskeletal Medicine Experience Early in Physical Medicine and Rehabilitation Residency.

ABSTRACT: Musculoskeletal care for persons with disabilities is an important competency in physical medicine and rehabilitation training. The optimal timing of musculoskeletal medicine rotations in the physical medicine and rehabilitation residency curriculum is unknown. The objective of this study is to determine whether outpatient experience in musculoskeletal medicine increases resident use of musculoskeletal examination skills in the inpatient setting. An eight-item multiple-choice questionnaire was administered monthly to 19 physical medicine and rehabilitation residents rotating on inpatient services inquiring about number and types of musculoskeletal examinations performed on each inpatient rotation. Seventy-one surveys were collected with a 90% response rate. Significant increases were noted in number of knee examinations and shoulder examinations performed on inpatient rotations after residents completed 2 mos of outpatient musculoskeletal medicine. Most postgraduate year 2 residents (76%) felt that they would perform more musculoskeletal examinations on their inpatient rotations if they had more outpatient musculoskeletal experience at that point in their training. The results suggest that outpatient musculoskeletal experience increases resident use of musculoskeletal examination skills in the inpatient setting. Earlier outpatient musculoskeletal experience in combination with a greater focus on teaching musculoskeletal examination skills in the inpatient setting can support residents in learning how to provide comprehensive musculoskeletal care to individuals with disabilities.

A scoping review of methods used in musculoskeletal soft tissue and nerve shear wave elastography studies.

This scoping review of shear wave elastography (SWE) articles in musculoskeletal soft tissue and nerve research demonstrates methodological heterogeneity resulting from a lack of standardized data collection and reporting requirements. Seven literature databases were searched for original articles published in English from 2004-2020 that examine human skeletal muscles, tendons, and nerves in vivo. Although 5,868 records were initially identified, only 375 reports met inclusion criteria. Of the 375 articles, 260 examined 89 unique muscles, 94 examined 14 unique tendons, and 43 examined 8 unique nerves. Cohorts were often small (n = 11-20) and young (mean = 20-29 years), and participants were typically tested in the prone position. Regarding equipment, a variety of ultrasound systems (n = 11), ultrasound models (n = 18), and transducers (n = 19) were identified. Only 11% of articles contained information on the use of electromyography to confirm absence of muscle activity, and only 8% reported measurement depth. Since musculoskeletal soft tissue and nerve stiffness can vary significantly based on data collection methods, it is essential to standardize SWE collection and reporting procedures. This will allow SWE to serve as a valid and reproducible tool for assessing tissue pathology, disease progression, and response to intervention within a variety of musculoskeletal and nerve-related disorders.

Nontraumatic Acute Hyperextension Myelopathy Associated With Weightlifting.

ABSTRACT: We describe the clinical course of a 56-yr-old woman without a significant medical history presenting with nontraumatic paraplegia found to have an infarction of the conus medullaris after intensive lumbar hyperextension exercises. This condition, known as surfer's myelopathy, has been described in multiple case reports that attributed a similar mechanism and presentation. We present a case of surfer's myelopathy associated with weightlifting, which has not been previously reported. We conclude that this diagnosis should be considered in patients who present after spine hyperextension activity with nontraumatic paraplegia. Furthermore, we support the nomenclature change to "acute hyperextension myelopathy," better reflecting the underlying pathophysiology.