Vertical locking of the metacarpophalangeal joint of the little finger: A case report.

Locking of the metacarpophalangeal (MCP) joint is commonly caused by hyperextension of the thumb or moderate flexion of the index or middle finger. We report a rare case of vertical locking of the MCP joint of the little finger in a 16-year old female after blunt trauma to the little finger. The MCP joint was locked when positioned at approximately 90-degree-flexion and could not extend actively or passively. A manual reduction was easily achieved and no immobilization was applied. Vertical locking of the MCP joint can be easily reduced, and immobilization is unnecessary after reduction. Correct diagnosis prior to reduction and differentiation from other types of locking are essential to prevent overtreatment.

The effects of electromyography-triggered electrical stimulation on shoulder subluxation, muscle activation, pain, and function in persons with stroke: A pilot study.

OBJECTIVES: The purpose of this study was to examine the effects of task-oriented electromyography-triggered stimulation for shoulder subluxation, muscle activation, pain and upper extremity function in hemiparetic stroke patients. METHODS: Twenty participants with subacute hemiparetic stroke were recruited for this study and were randomly divided into two groups: experimental group (n = 10) and control group (n = 10). Subjects in the experimental group participated in task-oriented electromyography triggered stimulation for 30 minutes, five times a week for four weeks, whereas the control group received cyclic functional electrical stimulation for 30 minutes, five times a week for four weeks. Subjects in both groups received conventional physical therapy for four weeks (30 min/day, five times/week). Data collected included the degree of shoulder subluxation which had been confirmed by X-ray, muscle activation of the supraspinatus and posterior deltoid muscles by electromyography, pain by the Visual Analogue Scale (VAS), and hand function by the Fugl-Meyer Assessment (FMA) before and after the four week exercise period. RESULTS: The results showed significant improvement in shoulder subluxation, muscle activation, and VAS results in the experimental group, compared with the control group(p < 0.05). FMA scores showed no significant differences between the two groups. CONCLUSIONS: In conclusion, task-oriented electromyography-triggered stimulation improved shoulder subluxation, muscle activation, pain and upper extremity function. These results suggest that task-oriented electromyography-triggered stimulation is effective and beneficial for individuals with subacute stroke, and that further studies should be conducted on multivarious anatomical regions.

The Effects of a Home-Based Connective Tissue Targeting Therapy on Hip Development in Children With Cerebral Palsy: Six Case Reports.

Hip subluxation in children with Cerebral Palsy (CP) has an incidence of 10-30 %, and children with severe CP having the highest incidence. The condition deteriorates if left untreated. Surgery is the most common method used in managing hip subluxation because standard conservative therapies do not improve it. Surgery may have to be repeated and comes at a biological cost to the child. A new home-based CAM, Advanced Biomechanical Rehabilitation (ABR), has shown encouraging results leading to improved spinal stability and stability in sitting in children with severe CP. This case report examines hip development over time in six children with severe CP in the ABR Program. Changes in their clinical picture and pelvic X-Rays are reported. ABR appeared to help stabilize and improve hip subluxation, resulting in these children not requiring further surgical intervention. These findings warrant further investigation of ABR as a noninvasive therapy for hip subluxation.

Manual reduction of articular disc after traumatic extraction of mandibular third molar: a case report.

INTRODUCTION: Disc displacement without reduction with limited opening is an intracapsular biomechanical disorder involving the condyle-disc complex. With the mouth closed, the disc is in an anterior position in relation to the condylar head and does not reduce with mouth opening. This disorder is associated with persistent limited mandibular opening. CASE REPORT: The patient presented severe limitation to fully open the mouth, interfering in her ability to eat. Clinical examination also revealed maximum assisted jaw opening (passive stretch) with less than 40 mm of maximum interincisal opening. Magnetic resonance imaging was the method of choice to identify the temporomandibular disorders. CONCLUSION: By means of reporting this rare case of anterior disc displacement without reduction with limited opening, after traumatic extraction of a mandibular third molar, in which manual reduction of temporomandibular joint articular disc was performed, it was possible to prove that this technique is effective in the prompt restoration of mandibular movements.

Manual reduction of articular disc after traumatic extraction of mandibular third molar: a case report

Introduction: Disc displacement without reduction with limited opening is an intracapsular biomechanical disorder involving the condyle-disc complex. With the mouth closed, the disc is in an anterior position in relation to the condylar head and does not reduce with mouth opening. This disorder is associated with persistent limited mandibular opening.Case report:The patient presented severe limitation to fully open the mouth, interfering in her ability to eat. Clinical examination also revealed maximum assisted jaw opening (passive stretch) with less than 40 mm of maximum interincisal opening. Magnetic resonance imaging was the method of choice to identify the temporomandibular disorders.Conclusion: By means of reporting this rare case of anterior disc displacement without reduction with limited opening, after traumatic extraction of a mandibular third molar, in which manual reduction of temporomandibular joint articular disc was performed, it was possible to prove that this technique is effective in the prompt restoration of mandibular movements.

Introdução: o deslocamento do disco articular sem redução com abertura limitada é uma desordem intracapsular que envolve o complexo côndilo-disco. Na posição de boca fechada, o disco articular se encontra numa posição anterior em relação à cabeça da mandíbula e não sofre redução com a abertura de boca. Essa desordem está associada à abertura mandibular limitada e persistente.Caso clínico:o paciente relatava travamento da mandíbula que não permitia uma abertura completa da boca, interferindo, assim, na capacidade de se alimentar. Também era possível observar-se uma abertura assistida (alongamento passivo) com uma distância vertical menor que 40 mm entre os incisivos. A ressonância magnética foi o método de escolha para o diagnóstico das desordens temporomandibulares.Conclusão:por meio da descrição de um caso raro de deslocamento anterior do disco articular sem redução e com abertura limitada, após exodontia traumática do terceiro molar inferior, em que foi realizada a redução manual do disco articular da articulação temporomandibular, provou-se ser essa uma técnica eficaz no rápido restabelecimento dos movimentos mandibulares.

The IFITM5 mutation c.-14C > T results in an elongated transcript expressed in human bone; and causes varying phenotypic severity of osteogenesis imperfecta type V.

BACKGROUND: The genetic mutation resulting in osteogenesis imperfecta (OI) type V was recently characterised as a single point mutation (c.-14C > T) in the 5' untranslated region (UTR) of IFITM5, a gene encoding a transmembrane protein with expression restricted to skeletal tissue. This mutation creates an alternative start codon and has been shown in a eukaryotic cell line to result in a longer variant of IFITM5, but its expression has not previously been demonstrated in bone from a patient with OI type V. METHODS: Sanger sequencing of the IFITM5 5' UTR was performed in our cohort of subjects with a clinical diagnosis of OI type V. Clinical data was collated from referring clinicians. RNA was extracted from a bone sample from one patient and Sanger sequenced to determine expression of wild-type and mutant IFITM5. RESULTS: All nine subjects with OI type V were heterozygous for the c.-14C > T IFITM5 mutation. Clinically, there was heterogeneity in phenotype, particularly in the manifestation of bone fragility amongst subjects. Both wild-type and mutant IFITM5 mRNA transcripts were present in bone. CONCLUSIONS: The c.-14C > T IFITM5 mutation does not result in an RNA-null allele but is expressed in bone. Individuals with identical mutations in IFITM5 have highly variable phenotypic expression, even within the same family.

Rare open hallux interphalangeal joint dislocations sustained in combatives training: a case series.

Hallux interphalangeal joint dislocations are a very rare occurrence, and open medial dislocations of the hallux interphalangeal joint, to our knowledge, have not been previously reported in the literature. We report two open medial dislocations, one with fracture, that were sustained within a year of each other at the same military installation. Both patients presented were active duty soldiers that were involved in barefoot combatives and caught their hallux in the fold of the mats while simultaneously experiencing a "twisting force" applied to their foot by their combatives partner. Each soldier required surgical intervention and healed uneventfully, able to return to full activities in an average of 10 weeks with no residual pain. Two injuries of this rarity occurring with the same mechanism of injury within a year at the same military base raise concerns about the surface and shoegear being used for combatives training. The initial analysis of these two separate but similar cases points to the fact that injuries to the foot and toes may be reduced by using seamless mats and/or wearing closed-toed shoes (wrestling style) during combatives training.

Judo-related traumatic posterior sternoclavicular joint dislocation in a child.

Judo is a combat sport with high risk of injury. We present a rare case of traumatic left posterior sternoclavicular (SC) joint dislocation, inflicted to a 12-year-old boy during a judo contest. An extensive literature review did not reveal any case of posterior SC joint dislocation in judo. The patient was treated with closed reduction under general anesthesia. At 2-year follow-up, his left upper extremity had full range of motion, and he did not complain of any residual symptoms. He decided to discontinue judo training; however, he participates in other physically demanding sports. Although not often encountered, posterior SC joint dislocation is a challenging and critical medical problem that can be fatal if not promptly diagnosed and treated on time and should be considered in the differential diagnosis of trauma-related anterior chest pain.

Injuries in judo: a systematic literature review including suggestions for prevention.

BACKGROUND: There is limited knowledge on epidemiological injury data in judo. OBJECTIVE: To systematically review scientific literature on the frequency and characteristics of injuries in judo. METHODS: The available literature up to June 2013 was searched for prospective as well as retrospective studies on injuries in judo. Data extraction and presentation focused on the incidence rate, injury risk, types, location and causes of injuries. RESULTS: During the Olympic Games in 2008 and 2012, an average injury risk of about 11-12% has been observed. Sprains, strains and contusions, usually of the knee, shoulder and fingers, were the most frequently reported injuries, whereas being thrown was the most common injury mechanism. Severe injuries were quite rare and usually affected the brain and spine, whereas chronic injuries typically affected the finger joints, lower back and ears. The most common types of injuries in young judo athletes were contusions/abrasions, fractures and sprains/strains. Sex-differences data on judo injuries were mostly inconsistent. Some studies suggested a relationship between nutrition, hydration and/or weight cycling and judo injuries. Also, psychological factors may increase the risk of judo injuries. CONCLUSIONS: The present review provides the latest knowledge on the frequency and characteristics of injuries in judo. Comprehensive knowledge about the risk of injury during sport activity and related risk factors represents an essential basis to develop effective strategies for injury prevention. Thus, the introduction of an ongoing injury surveillance system in judo is of utmost importance.

Atlantoaxial rotatory subluxation after surgical relocation of Sprengel deformity: a case report.

We report a case of atlantoaxial rotatory subluxation developed after scapular relocation for Sprengel deformity in a 5-year-old girl. Scapular relocation descended the scapula by 60%, and achieved a normal shoulder joint motion. However, atlantoaxial rotatory subluxation developed, probably by pulling force of the tightened anterior fibers of upper trapezius muscle. Atlantoaxial joint was reduced easily under general anesthesia and muscle relaxant, along with surgical release of the tight band at the anterior part of trapezius muscle, which was maintained by halovest immobilization.

Mixed martial arts: injury patterns and issues for the ringside physician.

Mixed martial arts (MMA) is a fast-growing combat sport. There are limited studies investigating MMA's injury incidence. However, from the data available, closed head injuries and lacerations commonly are experienced by competitors. Sanctioned events require the presence of ringside physicians, who should be well versed in handling these types of injuries. Additionally, sports-medicine providers should have an appropriately equipped medical bag, and before providing coverage, they need to coordinate with emergency medical personnel in order to more efficiently deliver care if urgent situations arise. More research is needed on injury incidence and prevention in MAA.

[Sport-medical aspects concerning Asian martial arts Aikidô and Ving Tsun]. / Sportmedizinische Aspekte bei den asiatischen Kampfkünsten Aikidô und Ving Tsun.

INTRODUCTION: Asian martial arts became very popular in Germany during the last years, nevertheless there are only few clinical inquiries concerning sportorthopaedic or -traumatological aspects. In this study we analyzed the risk and the prevalence of sport-injuries and sport-damages in Aikidô and Ving Tsun. METHODS: 19 Aicidôca and 24 Ving Tsun athletes were to undergo broad survey and sport-orthopedic inspection. In this process an especially adapted examination-sheet after Baumann was used. RESULTS: 68.4 % of the Aikidoca and 79.2 % of the Ving Tsun athletes reported injuries, whereupon soft injuries dominated, severe injuries like luxations, ligamental und muscular ruptures appeared infrequently, the incidence of fractures was 1 % resp. 0.2 %. 37 % resp. 33.3 % of all injuries where related to the lower limb, 14.8 % resp. 16.7 % to the head and neck. Disorders dominated with 60 % resp. 50 % in the range of the knees. Persistent sport-damages could not be found in the clinical examinations. CONCLUSION: There is even just a low risk for severe sport-injuries and sport-damages while intensely practicing martial arts Aikidô and Ving Tsun for years. In the range of prevention the consequent use of protective gear (specificly bump cap and footwear) is important.

A noncontiguous 2-level spinal injury in a young female driver due to a 3-point seat belt restraint.

OBJECTIVES: The purpose of this case is to describe noncontiguous fracture and dislocations of the thoracolumbosacral spine in a 23-year-old female driver with a 3-point seat belt restraint. CLINICAL FEATURES: A 23-year-old woman presented to us after a motor vehicle accident while driving with a 3-point seat belt restraint. She was neurologically intact except for loss of motor function in the distribution of the L5 nerve root in the right lower limb. Computed tomography and magnetic resonance imaging showed fracture and dislocation of T3 with considerable retrolisthesis and complete anterolisthesis of L5 over the sacrum. INTERVENTION AND OUTCOME: Both fractures were reduced and fixed with bone graft and instrumentation. She was discharged a month later without any further neurologic deterioration. CONCLUSIONS: To our knowledge, this case is the first report in the literature of a seat belt safety restraint causing 2 noncontiguous fracture dislocations of the spine. Although the consensus is that seat belts can prevent most spine injuries, this case shows that the seat belt can be a contributor to spine injury. It shows that the shoulder-lap restraint can act as 2 fulcrums at the upper and lower bands causing 2 separate fracture dislocations. A thorough radiologic evaluation of the spine with respect to the clinical findings is mandatory in seat belt-restrained road traffic accidents cases.

[Delayed diagnosis of a postanaesthesia temporomandibular joint dislocation]. / Luxation de l'articulation temporomandibulaire diagnostiquée au décours d'une anesthésie générale.

Temporomandibular joint (TMJ) dislocation during anaesthesia is a rare occurrence. Patients with a history of prior dislocations or TMJ dysfunction, and patients with mandibular retrognathism are at risk of this complication. This is a case report of delayed diagnosis of TMJ dislocation after a general anaesthesia for aortic valvular replacement surgery in a predisposed patient. Considering this unusual presentation, TMJ evaluation should be performed during preoperative anaesthetic assessment. In at-risk patients, one should not worry about TMJ dislocation during intubation but concentrate on glottic exposure. However, afterwards, one should be highly aware of this possible complication in order to detect it early, allowing an immediate simple manual reduction. This manoeuver may be performed with or without sedation by a practitioner, familiar with this way of resetting a dislocated jaw.

Sternoclavicular dislocation--reconstruction with semitendinosus tendon autograft: a case report.

Traumatic sternoclavicular dislocation is a rare injury corresponding to less than 5% of all injuries of the scapular belt. It is preferentially treated through reduction of the sternoclavicular joint, symptom relief, a brief period of immobilization and rehabilitation, with the aim of gaining strength and range of motion. In some patients, however, this type of injury may progress with instability and pain, thus causing discomfort and pain. On such occasions, surgical treatment is chosen. The objective of this study was to report the clinical case of a sports player who progressed with chronic traumatic anterior instability of the sternoclavicular joint and underwent reconstruction using the ipsilateral semitendinosus tendon. This was a 16-year-old male patient who was a state-level judo player. Following a fall during a fight, he presented pain, slight deformity and edema in the right sternoclavicular joint, and he underwent conservative treatment for 12 months, without success. In the end, reconstruction of the sternoclavicular joint was carried out using the ipsilateral autologous semitendinosus, with resection of the intra-articular disc and suturing of the costoclavicular ligaments. We have presented a case of dislocation of the sternoclavicular joint in a high-performance judo player who underwent reconstruction using the semitendinosus, with excellent functional results after 1 year of follow-up.

A case of vertebral metastasis with pathologic c2 fracture.

OBJECTIVE: This report discusses a patient with a pathologic fracture of the C2 vertebra secondary to osteolytic metastasis from squamous cell carcinoma of the lung. CLINICAL FEATURES: The patient was a 68-year-old man with a chief complaint of neck pain who was referred by his physician to a chiropractic office. The initial onset of neck pain began after a forceful sneeze that resulted in a sensation of "a twig snapping" in the neck. Radiographs revealed osteolytic destruction and pathologic fracture of the C2 spinous process. INTERVENTION AND OUTCOME: The patient was referred back to his primary care physician, who then referred him to an oncologist, who immediately initiated a course of radiation therapy and pain medication. Palliative care by the chiropractor consisted of soft tissue massage of the cervical spine musculature to treat associated muscle spasms and pain. The patient responded well to gentle myofascial therapy. However, the osteolytic destruction of the C2 posterior elements progressed, resulting in an unstable subluxation of C2 and associated cord compression. The spine was stabilized with a rigid collar, but the metastatic destruction progressed, eventually resulting in quadriplegia and subsequent death from respiratory distress. CONCLUSION: Patients with a history of cancer complaining of new onset of back or neck pain should be assumed to have vertebral metastasis until proven otherwise. Trivial trauma should be taken seriously in these cases and investigated with appropriate clinical, laboratory, and imaging examinations. Vertebral malignancies may be a contraindication to spinal manipulation; however, the chiropractic physician plays a significant role in early detection and diagnosis.