Traumatic Brachial Plexopathy in Athletes: Current Concepts for Diagnosis and Management of Stingers.

Traumatic upper trunk brachial plexopathy, also known as a stinger or burner, is the most common upper extremity neurologic injury among athletes and most commonly involves the upper trunk. Recent studies have shown the incidence of both acute and recurrent injuries to be higher in patients with certain anatomic changes in the cervical spine. In addition, despite modern awareness, tackling techniques, and protective equipment, some think the incidence to be slowly on the rise in contact athletes. The severity of neurologic injury varies widely but usually does not result in significant loss of playing time or permanent neurologic deficits if appropriate management is undertaken. Timely diagnosis allows implementation of means to minimize the risk of recurrent injury. It is important for treating physicians to understand the pathogenesis, evaluation, and acute and long-term management of stingers to improve recovery and minimize chronic sequela.

Cadaveric Investigation of Active Finger Range of Motion for Detection of Intratendinous Needle Placement.

BACKGROUND: The authors' purpose was to determine if investigators can predict whether a needle is within a finger's flexor tendon by postinsertion tactile and visualization evaluation in an active range-of-motion cadaver model. METHODS: In 48 cadaver fingers, a 25-gauge needle, with a 1-cc syringe attached, was placed into one of three randomly assigned positions at the A2 pulley level: within the flexor digitorum profundus, within the flexor digitorum superficialis, or outside both flexors and the sheath. Each finger was cycled through full active range of motion as three hand surgeons, blinded to each other's responses and needle position, recorded whether they thought the needle was intratendinous. The initial investigator confirmed needle position after each surgeon's assessment. RESULTS: Active cadaver finger range of motion did not allow surgeons to accurately determine whether a needle was in a flexor tendon. There was no statistically significant agreement among the surgeons about whether the needle was intratendinous. CONCLUSION: Because of poor interobserver agreement, sensitivity, and negative predictive value, we conclude that finger range of motion is not a reliable test to detect intratendinous needle placement in this cadaver model.

Ultrasonography for Hand and Wrist Conditions.

Ultrasonography facilitates dynamic, real-time evaluation of bones, joints, tendons, nerves, and vessels, making it an ideal imaging modality for hand and wrist conditions. Ultrasonography can depict masses and fluid collections, help locate radiolucent foreign bodies, characterize traumatic or overuse tendon or ligament pathology, and help evaluate compressive peripheral neuropathy and microvascular blood flow. Additionally, this modality improves the accuracy of therapeutic intra-articular or peritendinous injections and facilitates aspiration of fluid collections, such as ganglia.

Brachial plexus injury: a descriptive study of American football.

A stinger is a common, yet understudied, injury that involves stretching or compression of the brachial plexus, often occurring during contact sports. Five football teams, including high school, collegiate, and professional teams, completed questionnaires. Questions were designed to obtain descriptive information regarding the nature and consequence of this injury and assess effectiveness of current preventive measures. Three hundred and four surveys were returned with 153 players reporting a stinger in their career (50.3%). The prevalence increased with years played and was most common in running backs (69%), defensive linemen (60%), linebackers (55%), and defensive secondary (54%). Current protective equipment and neck-strengthening programs did not provide protective benefits. Players at greatest risk of developing a stinger include those having played 3 or more years and players whose primary position is running back, defensive back, or defensive lineman. Further study is needed to better evaluate the effectiveness of current preventive measures.

Flexor tendon repair rehabilitation protocols: a systematic review.

PURPOSE: To systematically review various flexor tendon rehabilitation protocols and to contrast those using early passive versus early active range of motion. METHODS: We searched PubMed and Cochrane Library databases to identify articles involving flexor tendon injury, repair, and rehabilitation protocols. All zones of injury were included. Articles were classified based on the protocol used during early rehabilitation. We analyzed clinical outcomes, focusing on incidence of tendon rupture and postoperative functional range of motion. We also analyzed the chronological incidence of published tendon rupture with respect to the protocol used. RESULTS: We identified 170 articles, and 34 met our criteria, with evidence ranging from level I to level IV. Early passive motion, including both Duran and Kleinert type protocols, results included 57 ruptures (4%) and 149 fingers (9%) with decreased range of motion of 1598 tendon repairs. Early active motion results included 75 ruptures (5%) and 80 fingers (6%) with decreased range of motion of 1412 tendon repairs. Early passive range of motion protocols had a statistically significantly decreased risk for tendon rupture but an increased risk for postoperative decreased range of motion compared to early active motion protocols. When analyzing published articles chronologically, we found a statistically significant trend that overall (passive and active rehabilitation) rupture rates have decreased over time. CONCLUSIONS: Analyzing all flexor tendon zones and literature of all levels of evidence, our data show a higher risk of complication involving decreased postoperative digit range of motion in the passive protocols and a higher risk of rupture in early active motion protocols. However, modern improvements in surgical technique, materials, and rehabilitation may now allow for early active motion rehabilitation that can provide better postoperative motion while maintaining low rupture rates.

Anterior cruciate ligament injuries in wakeboarding: prevalence and observations on injury mechanism.

BACKGROUND: Wakeboarding is an increasingly popular sport that involves aggressive stunts with high risk for lower extremity injury, including anterior cruciate ligament (ACL) rupture. Little has been reported on prevalence or mechanism of ACL injury while wakeboarding. HYPOTHESIS: The prevalence of ACL injury in wakeboarding approaches that of other high-risk sports. Analyzing the mechanism of ACL injury may aid in future efforts of prevention. STUDY DESIGN: Descriptive epidemiology study. METHODS: In sum, 1580 surveys were sent internationally to professional and amateur wakeboarders. The survey questioned the participants on their history of an ACL tear while wakeboarding and asked them to describe the mechanism of injury and treatment. RESULTS: A total of 123 surveys were returned. Of this group, 52 (42.3%) acknowledged having had an ACL tear while wakeboarding. The majority described feeling a pop or buckle after attempting to land a high jump. Only 5 participants (13.5%) described a rotational mechanism created by catching the board edge in the water. Thirty-seven participants (71.15%) said that the injury ruined their ability to wakeboard before reconstruction, and 41 (78.85%) had the injury repaired surgically. CONCLUSION: The prevalence of ACL tears in this data set, 42.3%, is the highest reported in the literature for wakeboarding and one of the highest for any sport. The main mechanism of injury appears to involve axial compression while one lands in a provocative position; it is not related to a rotational force created by fixed bindings. The injury should be surgically repaired to effectively continue the sport. Further study is needed to determine if wakeboarding represents a high-risk sport for ACL injury. CLINICAL SIGNIFICANCE: Wakeboarding may be a high-risk sport for ACL injury. Noncontact axial compression appears to be the main mechanism of injury.