Cirugía de "Tommy John" en paciente adolescente lanzador de béisbol / Tommy John surgery in adolescent baseball pitcher

La lesión del ligamento colateral cubital (LCC) es una patología debilitante del codo, con alta prevalencia en deportistas. En este trabajo expondremos el caso de una reconstrucción del ligamento colateral cubital realizada en un beisbolista masculino de dieciséis años, mediante un abordaje con la técnica quirúrgica de docking.

Ulnar collateral ligament (UCL) injury is a debilitating pathology of the elbow, with high prevalence in athletes. We describe the case of a UCL reconstruction performed in a 16-year-old male baseball player, using the Docking surgical technique.

Lesiones de cadera relacionadas con la actividad deportiva / Sports-Related Hip Injuries

Introducción: Las lesiones de la cadera relacionadas con las actividades deportivas han sido poco abordadas; sin embargo, han ido en aumento y su diagnóstico suele ser difícil o retardado. Incluyen múltiples afecciones y su recuperación suele ser larga. Objetivo: Actualizar conocimientos sobre algunas de las afecciones deportivas que afectan la cadera. Métodos: Se realiza una revisión bibliográfica sistemática y detallada sobre el tema, para lo cual se emplearon métodos teóricos, analítico-sintético, histórico-lógico e inductivo-deductivo y el análisis documental como método empírico. Se hizo una búsqueda sistemática sobre la temática en las bases de datos PubMed, Medscape y Google Academics desde junio de 2016 hasta la fecha. Se revisaron 500 artículos referentes al tema, de los cuales se seleccionaron 45 artículos para este trabajo. Análisis y síntesis de la información: Las lesiones de la cadera relacionadas con el deporte ocurren entre 5 y 9 por ciento de atletas adultos. Las actividades con movimientos rápidos, aceleraciones, desaceleraciones, y los cambios direccionales son la principal causa de tales lesiones. Provocan daños corporales provocados por una transferencia de energía, que excede la capacidad para mantener la estructura y/o la función íntegra, durante el entrenamiento o competición. Conclusiones: Las lesiones de la cadera relacionadas con el deporte pueden ser múltiples y son responsables de dolor en un gran número de atletas, fundamentalmente en el fútbol, la gimnasia y el beisbol. El diagnóstico precoz es fundamental para evitar la progresión de la lesión. Las mejoras en el diagnóstico radiológico y las posibilidades del uso de la artroscopia han mejorado la evolución y el pronóstico para los atletas(AU)

Introduction: Sports injuries of the hip have been little addressed; however, they have been increasing and their diagnosis is often difficult or delayed. They include multiple conditions and their recovery is usually long. Objective: To bring up to date knowledge on some of the sports conditions that affect the hip, which is particularly important to improve medical care. Methods: A systematic and detailed bibliographic review is carried out on the subject, for which theoretical, analytical-synthetic, historical-logical and inductive-deductive methods were used, as well as documentary analysis as an empirical method. A systematic search on the subject was carried out in PubMed, Medscape and Google Academics databases from June 2016 to date. Five hundred articles referring to the topic were reviewed. Forty-five articles the total were selected for this paper. Analysis and synthesis of the information: Sports-related hip injuries occur between 5 and 9 percent of adult athletes. Activities with rapid movements, accelerations, decelerations, and directional changes are the main cause of such injuries. They cause bodily harm produced by a transfer of energy, which exceeds the capacity to maintain the entire structure and, or function, during training or competition. Conclusions: Sports injuries of the hip can be multiple and are responsible for pain in a large number of athletes, mainly in soccer, gymnastics and baseball. Early diagnosis is essential to avoid progression of the lesion. Improvements in radiological diagnosis and the possibilities of the use of arthroscopy have improved the evolution and prognosis for athletes(AU)

Reconstrucción del ligamento colateral ulnar en atletas de béisbol mediante la técnica híbrido DANE TJ / Reconstruction of the ulnar collateral ligament in baseball athletes by DANE TJ hybrid technique / Réparation du ligament collatéral ulnaire par la technique hybride DANE TJ chez les joueurs de baseball

INTRODUCCIÓN: la lesión del ligamento colateral medial del codo es una de las lesiones más frecuentes e incapacitantes en los atletas de béisbol. En muchos pacientes se requiere de una reconstrucción de esta estructura para lo cual se han descrito varias técnicas. OBJETIVO: evaluar los resultados de la técnica híbrido DANE TJ para el tratamiento de la insuficiencia del ligamento colateral ulnar en nuestros pacientes. MÉTODOS: se realizó un estudio en 12 jugadores de béisbol de alto rendimiento con diagnóstico de lesión del ligamento colateral medial, que no resolvieron con tratamiento conservador, por lo que se les aplicó tratamiento quirúrgico mediante la técnica híbrido DANE TJ. RESULTADOS: la mayoría de los atletas son lanzadores (75 %). En 9 de los 12 pacientes (75 %) existía algún grado de choque postero-medial. La neuritis del cubital estaba presente en el 58,3 % de los pacientes en los cuales se realizó transposición subcutánea anterior del nervio cubital. En 2 pacientes (16,7 %) se presentó un cuadro de parestesias transitorias del nervio cubital que se resolvió con tratamiento conservador. La puntuación promedio de la intensidad del dolor preoperatorio según la Escala Visual Analógica era de 8,1 puntos y se redujo a 1,4 después de un año de la intervención. El resultado fue excelente o bueno en el 83,3 % de los pacientes los cuales se incorporaron a sus actividades deportivas. CONCLUSIONES: la técnica híbrido que combina la fijación del injerto al húmero mediante la técnica Docking con la fijación al cúbito mediante tornillo interferencial, es de fácil ejecución, produce un mínimo daño a los tejidos blandos, y permite lograr un resultado similar al resto de los estudios revisados.

INTRODUCTION: the medial collateral ligament injury of the elbow joint is one of the most common and disabling injuries in baseball athletes. In many patients, a reconstruction of this structure is requires for which several techniques have been described. OBJECTIVE: evaluate the results of DANE TJ hybrid technique for treating ulnar collateral ligament insufficiency in our patients. METHODS: a study was conducted in 12 high-performance baseball players who were diagnosed to suffer medial collateral ligament injury. They did not heel with conservative treatment, so surgical treatment was applied by DANE TJ hybrid technique. RESULTS: most athletes are pitchers (75 %). 9 out of 12 patients (75 %) had some degree of posteromedial shock. Ulnar neuritis was present in 58.3 % of patients in whom anterior subcutaneous transposition of the ulnar nerve was performed. Transient ulnar nerve paresthesia occurred in 2 patients (16.7 %), which were remedied with conservative treatment. The average intensity of preoperative pain score according to the Visual Analogue Scale was 8.1 points and dropped to 1.4 after one year of intervention. The result was excellent or good in 83.3 % of patients who returned to their sports activities. CONCLUSIONS: the hybrid technique that combines the humerus graft fixation by Docking technique fixing the ulna using interferential screw is easily accomplished, minimal damage to soft tissue is caused, and similar results are achieved in comparison to the other studies reviewed.

INTRODUCTION: la lésion du ligament collatéral médial du coude est l'une des lésions les plus fréquentes et invalidantes chez les joueurs de baseball. Dans plusieurs cas, une réparation de cette structure s'avère nécessaire, c'est pourquoi plusieurs techniques opératoires ont été décrites. OBJECTIF: le but de cette étude est d'évaluer les résultats de la technique hybride DANE TJ dans le traitement de cette atteinte du ligament collatéral ulnaire chez nos patients. MÉTHODES: une étude de 12 joueurs de baseball de haut niveau, diagnostiqués d'une lésion du ligament collatéral médial, est réalisée. N'ayant pas répondu au traitement conservateur, on a décidé de leur traiter chirurgicalement par la technique hybride DANE TJ. RÉSULTATS: Neuf sur douze de ces joueurs, dont la plupart sont des lanceurs (75 %), souffraient un certain grade de choc postéro-médial. On a trouvé une névrite cubitale dans 53.3 % des patients ayant donc subi une transposition antérieure sous-cutanée du nerf cubital. Le score moyen de l'intensité de la douleur préopératoire, selon l'Échelle visuelle analogique, était 8.1 points, et a diminué 1.4 points un an après l'opération. Les résultats ont été excellents ou bons dans 83.3 % des patients qui sont donc rentrés aux activités sportives. CONCLUSIONS: la technique hybride combinant la fixation du greffon à l'humérus par la technique Docking et la fixation au cubitus par vis d'interférence est facile à réaliser; elle cause un dommage insignifiant aux tissus mous, et permet d'obtenir un résultat similaire au reste des études révisées.

Does Well Maintained Graft Provide Consistent Return to Play after Medial Ulnar Collateral Ligament Reconstruction of the Elbow Joint in Elite Baseball Players?

BACKGROUND: Several studies have reported the clinical outcomes of medial ulnar collateral ligament (MUCL) reconstruction of the elbow joint in throwing athletes, including the rate of return to sports. However, little has been known about the imaging outcomes after MUCL reconstruction. The aim of this study is to report the clinical and imaging outcomes after MUCL reconstruction using figure of eight fashion in the elite and professional baseball players. METHODS: This study included 17 baseball players, who underwent MUCL reconstruction between July 2007 and May 2010. The average follow-up period was 48.6 months. Imaging assessment consisted of preoperative plain and stress radiographs, magnetic resonance imaging, and postoperative serial ultrasonography. The clinical assessments were composed of visual analogue scale (VAS) for pain, range of motion, and the Conway scale. RESULTS: The mean VAS score was 6.4 (range, 3 to 8) preoperatively and 2.2 (range, 0 to 4) postoperatively (p < 0.05). There were nine players (53%) classified as excellent who returned to sports at the same or higher level compared to preinjury. Serial ultrasonography revealed well-maintained grafts at 3 and 12 months in all of the players. Five out of 17 players showed decreased echogenecity in the common flexor tendon at 3 months, which was considered as remaining tissue swelling and resolved completely at 12 months. CONCLUSIONS: All grafts are well-maintained until 12-months based on the ultrasonographic findings, although only 53% of the players returned to preinjury level.

comparative study on shoulder rotational strength, range of motion and proprioception between the throwing athletes and non-athletic persons

The repetitive micro traumatic stresses placed on the athletes shoulder joint complex during the throwing motion challenge the surrounding tissues. The purpose of this study was to compare shoulder rotational strength, range of motion and proprioception between the throwing athletes and non-athletic persons. Fifteen throwing athletes and 15 non-athletes participated in a nonrandom case - control study. Strength of shoulder rotational movements was tested with a hand held dynamometer. The ranges of internal and external rotation of shoulder were measured by a standard goniometer. The ability of subjects to replicate the target position and kinesthetic sense was examined on the subjects' right shoulder by using a continuous passive motion device. Independent and paired t tests were used to statistically analyze between and within group differences. No significant difference was detected on the range of internal rotation between throwing athletes and non-athletic candidates [P=0.3]. The range of external rotation was significantly more in athletic subjects [P=0.03]. The results also showed that throwing athletes demonstrated a significantly higher isometric strength of shoulder external and internal rotation than the nonathletic group [P<0.05]. However, the comparison of the internal and external rotation strength of dominant side in each group showed that throwing athletes showed a significant lower isometric strength of shoulder external rotation than internal rotation [P<0.001]. It was also demonstrated higher joint position acuity in the throwing athletes than non athlete subjects [P=0.01]. The repetitive nature of overhead throwing and the high forces that it causes result in adaptive changes of the dominant extremity. Throwing can lead to mobility, strength and neural adaptation

Suprascapular neuropathy in collegiate baseball player

Suprascapular neuropathy [SSN] is generally thought of as a diagnosis of exclusion. However, increasing attention is being paid to the diagnosis, treatment and rehabilitation of this pathology to prevent chronic supraspinatus and infraspinatus atrophy in patients. To date, literature has only articulated variable or customized treatment and rehabilitation plans without clear standardized care. This case study provides a detailed description of the diagnosis, treatment, and rehabilitation of a collegiate baseball player's recovery from suprascapular nerve release. A 20 year-old male baseball pitcher with right shoulder pain reported for athletic training evaluation, was treated conservatively, and due to lack of resolution was referred for further imaging and evaluation by an orthopedist. Following inconclusive magnetic resonance imaging findings the patient underwent electrodiagnostic testing which showed decreased nerve conduction velocity of the right suprascapular nerve. The patient elected for surgical intervention. Post-operative rehabilitation followed and the patient was able to pitch in 22 weeks. The patient provided positive subjective feedback and was able to return to unrestricted pitching without pain, loss of velocity, or loss in pitch control. This study demonstrates a need for further investigation into the most appropriate treatment and rehabilitation of suprascapular nerve injury

Lesao da pequena liga / Small ligament injury

Apresentamos o relato de um caso de lesao da pequena liga no ombro num jovem atleta de 14 anos e do sexo masculino, jogador da selecao Brasileira de Beisebol. Esta lesao é incomum e pouco descrita na literatura. O tratamento realizado foi a suspensao das atividades esportivas por três meses, seguida do retorno gradual aos arremessos. O paciente evoluiu com a resolucao do quadro clínico.