Scapular dyskinesis following displaced fractures of the middle clavicle.

PURPOSE: To evaluate the rate of scapular dyskinesis and resulting patient outcomes after treatment of displaced midshaft clavicle fractures. METHODS: Skeletally mature patients with isolated, displaced midshaft clavicle fractures treated with or without surgery over a 16-month period were recruited. The minimum length of follow-up at study examination was 12 months. Patient outcomes were documented using the SICK (scapular malposition, inferomedial border prominence, coracoid pain and malposition, and dyskinesis of scapular movement) Scapula Rating Scale, the Simple Shoulder Test, 3 visual analog scales (VAS) for pain, and shoulder range-of-motion and strength measurements. Of the 32 eligible patients, 24 (75%) were successfully recruited. RESULTS: The mean participant age was 46 ± 17 years, with a mean length of follow-up at study evaluation of 1.7 ± 1 years. Surgical fixation was performed in 12 patients (50%). Scapular dyskinesis was present in 37.5% of patients (n = 9). Patients with scapular dyskinesis had worse SICK scapula scores (5.8 ± 2.2 vs 3.1 ± 2.4, P = .01), worse Simple Shoulder Test scores (10.5 ± 1.6 vs 11.7 ± 0.8, P = .029), higher maximum VAS pain scores (4.1 ± 3.1 vs 0.97 ± 1.2, P = .002), and worse average VAS pain scores in the week before the examination (2.7 ± 2.5 vs 0.2 ± 0.4, P < .001) compared with patients without scapular dyskinesis. Range of motion and abduction strength were similar between the groups. Scapular dyskinesis developed in 1 patient treated with surgery (8% [1 of 12]) compared with 8 patients treated nonoperatively (67% [8 of 12]) (P = .009). CONCLUSIONS: Scapular dyskinesis is common after displaced middle-third clavicle fractures, and these patients have more pain and worse functional outcomes compared with patients without scapular dyskinesis. Surgical treatment may reduce a patient's risk of scapular dyskinesis developing and improve short-term outcomes.

Strategies for Gait Retraining in a Collegiate Runner with Transfemoral Amputation: A Case Report.

BACKGROUND: More than fifty percent of people with limb amputations participate in sports or physical activity following amputation. Athletes with limb amputations may face additional challenges including phantom limb pain (PLP), psychological barriers, prosthetic complications, and gait abnormalities. Prevalence of PLP in the general amputee population is estimated to be as high as 85%. Despite the high prevalence of PLP, there is little research regarding the use of gait training as a treatment for PLP among both the general amputee population and athletes. CASE DESCRIPTION: A 20-year old female collegiate track and field athlete presented with phantom knee pain brought on with running. The athlete demonstrated deficits in core and hip strength as well as decreased single leg stability bilaterally. Running gait analysis revealed circumduction with the prosthesis for limb advancement and increased vaulting with push off on the sound (uninvolved) limb. Gait retraining strategies were implemented to address video analysis findings and create a more efficient running gait and address phantom limb pain symptoms. OUTCOMES: Rehabilitation and gait retraining strategies were effective in improving several clinical and functional outcomes in this case. Significant improvements were noted in PLP, running gait mechanics, and the patient's psychological and functional status as measured with a standardized outcome tool, the Patient-Reported Outcomes Measurement Information System® (PROMIS®). DISCUSSION: Running gait training following amputation could be a crucial component of rehabilitation for athletes in an attempt to lessen pain while running, especially in those experiencing phantom limb pain (PLP). Utilization of a multidisciplinary team in the gait retraining process is recommended. There is a need for further research to determine the effects of running gait retraining for management of PLP in athletes with amputation. LEVEL OF EVIDENCE: 5.