Prevalence and factors associated with lateral epicondylitis among hospital healthcare workers.

Background: Hospital healthcare workers have been reported to have a high prevalence of musculoskeletal disorders, but their association with lateral epicondylitis (LE) is unknown. This study aimed to clarify the prevalence of LE and its associated factors among hospital healthcare workers. Methods: The present study included all staff members of a secondary emergency hospital who provided their consent to participate. Participants with a history of elbow joint trauma were excluded from this study. The diagnostic criteria for definite LE were: (1) pain in the elbow joint within 2 weeks of the study; (2) pain in the lateral epicondyle region on resisted extension of the wrist with the elbow extended; and (3) tenderness in the lateral epicondyle. The diagnosis of LE was defined by meeting all criteria. Age, height, weight, sex, dominant hand, occupation, years of employment, smoking history, drinking history, personal computer usage history, and smartphone usage history were investigated using a questionnaire. A physical examination, in addition to evaluation of pain in the lateral epicondyle, grip strength and wrist extension strength were measured. A statistical analysis was used to assess the prevalence of LE and its associated factors. All investigations, including the diagnosis of LE, were performed by a single orthopedic specialist. Results: We evaluated 544 individuals, corresponding to approximately 80% of all staff members. The median age was 39 years (interquartile range, 30-48). The study population included 154 males and 390 females. The occupations of the participants were as follows: nurses (n = 265), doctors (n = 47), clerks (n = 93), therapists (n = 27), certified care workers (n = 23), medical technologists (n = 22), pharmacists (n = 19), and others (n = 48). LE was diagnosed in 30 limbs/30 individuals with a prevalence of approximately 5.5%. There was no difference in the prevalence of LE among occupations (P = .85). A logistic regression analysis revealed that age (odds ratio, 1.05; 95% confidence interval 1.01-1.1; P = .01) and smoking history (odds ratio, 2.94; 95% confidence interval 1.01-8.56; P = .04) were independently associated with LE. Conclusion: This study was conducted to evaluate the prevalence of LE among hospital healthcare workers. The prevalence of LE was 5.5%, and LE was independently associated with age and smoking history.

Relationship between coordination variability and Osgood-Schlatter disease in male junior youth soccer players -cross-sectional study using an inertial measurement unit.

BACKGROUND: Osgood-Schlatter disease is a common overuse injury, and motor coordination is discussed as a risk factor; however, no reports have examined motor coordination in young soccer players with Osgood-Schlatter disease. This study aimed to investigate the difference in motor coordination between Osgood-Schlatter disease-affected and non-affected soccer players on a junior youth soccer team. METHODS: This cross-sectional study investigated 35 young soccer players of 12-15 years of age, who completed a self-administered questionnaire covering general information, injury history, and athletic experience. An inertial measurement unit was attached to the participant's thoracic spine, lumbar spine, pelvis, thigh, and lower leg. The sagittal plane tilt angle of each body segment during squatting was analyzed. The continuous relative phase was calculated using the sagittal plane tilt angle. The mean absolute relative phase and continuous relative phase variabilities were calculated and compared between Osgood-Schlatter disease-affected and non-affected players. FINDINGS: The sagittal plane tilt angle of each body segment during static standing and maximum flexion did not differ between the two groups. However, the Osgood-Schlatter disease group had significantly less continuous relative phase variability between the lumbar spine and pelvis (P < 0.01, Cohen's d = 0.91). The Osgood-Schlatter disease group had significantly fewer participants with other sports experience (P = 0.032, φ = 0.36). INTERPRETATION: Dysfunctional lower trunk and hip muscles may be leading to Osgood-Schlatter disease. It is suggested that a variety of physical activities should be performed in the junior age group to allow players to acquire a variety of movement patterns.

Total elbow arthroplasty for hemophilic osteoproliferative elbow arthritis with severe flexion contracture: A case report.

Total elbow arthroplasty is effective for pain relief and the functional improvement of severe symptomatic hemophilic osteoproliferative arthropathy. Nevertheless, high complication rates have been reported. This report describes clinical results obtained at 30-month follow-up of total elbow arthroplasty in a hemophilic patient with severe flexion contracture. A 50-year-old patient with advanced left elbow hemophilic arthropathy underwent unlinked total elbow arthroplasty. He had sustained an intraoperative fracture of the medial part of a supracondylar humerus complication. To control perioperative bleeding, strict factor VIII replacement therapy was performed under the guidance of hematologists. The total elbow range of motion was 35° preoperatively, but it had improved to 110° postoperatively. The Patient-Rated Elbow Evaluation Japanese version score, which was 53.7 preoperatively, improved to 10.7 postoperatively. During the 30 months after operation, no complication occurred. Good clinical results have been obtained under close collaboration with hematologists and close patient adherence following treatment.

Surgical Treatment of Distal Radius Fractures Complicated by Concomitant Flexor Carpi Radialis Brevis: A Case Series and Surgical Techniques.

Introduction: The flexor carpi radialis brevis (FCRB) is a rare anatomical variation, with a reported prevalence ranging from 0.9% to 8.7%. Our previous report showed three cases of FCRB in distal radius fracture (DRF) and found that hypoplastic pronator quadratus (PQ) adjacent to the FCRB muscle made it difficult to cover a volar locking plate (VLP). As we subsequently experienced additional six FCRBs, we report on new findings and surgical tips. Case Report: VLP fixation was performed on DRF with FCRB in nine limbs of eight patients. The prevalence was 2.9% (9 of 310 limbs). Of the seven patients that underwent unilateral surgery, six were muscle type and one was tendon type. One patient who underwent bilateral surgery had a muscle type on the left and a tendon type on the right. In three muscle types, as the FCRB muscle belly was widely attached to the radial side of the radius and the radial side of the PQ was hypoplastic, postoperative covering of the plate by repair of the PQ was impossible. Then, in two of those cases, the PQ and FCRB were sutured and the plate was covered. FCRB muscle could be retracted to the radial side in all cases. One patient with a tendon type had a ruptured tendon, which was left unrepaired. All patients had no postoperative problems. Conclusion: In the muscle-type FCRB, the muscle should be retracted to the radial side for VLP fixation. The muscle belly might occupy the radial side of the radius, and the PQ might be hypoplastic and unrepairable. However, the plate can be covered by suturing the PQ and FCRB.

Relationship between Nontraumatic Shoulder Disorders and Neuropathic Pain: Retrospective Observational Analyses of Clinical Features and Background Factors.

Background: Accurate identification of neuropathic pain is necessary for appropriate treatment; however, the relationship between nontraumatic shoulder disorders and neuropathic pain remains unknown. Therefore, this retrospective observational study aimed to investigate the relationship, features, background factors, and prevalence of neuropathic pain among patients with nontraumatic shoulder disorders. Methods: We evaluated 198 patients who visited our outpatient clinic, which specializes in shoulder disorders, from April 2015 to March 2016. The patients' age, sex, affected side, diagnosis, and pain duration were recorded, and the results of physical examination, including passive range of motion, impingement sign, and muscular strength assessments, were analyzed. The presence of neuropathic pain was assessed using the painDETECT questionnaire. Participants were divided into two groups according to the presence of neuropathic pain. Pain intensity was assessed using a visual analog scale, and the patient's mental status was assessed using the short-form McGill Pain Questionnaire and Hospital Anxiety and Depression Scale. The scores were compared between the groups. Results: Neuropathic pain was observed in 7.6% of patients. The visual analog scale score for pain, short-form McGill Pain Questionnaire score, and Hospital Anxiety and Depression Scale score were significantly associated with the presence of neuropathic pain in the univariate analysis. Patient background factors and physical function were not associated with the presence of neuropathic pain. The prevalence of neuropathic pain in patients with frozen shoulder was 33.3%, which was significantly higher than that in patients with other shoulder disorders. Conclusion: The occurrence of neuropathic pain may aggravate pain in patients with nontraumatic shoulder disorders. Neuropathic pain was not a rare condition in patients with nontraumatic shoulder disorders, particularly in those with frozen shoulder. The coexistence of neuropathic pain cannot be determined from background factors or physical function. Accurate diagnosis of neuropathic pain is essential in patients with nontraumatic shoulder disorders.

Post-traumatic Non-haemophilic Haemosiderotic Synovitis of the Elbow: A Case Report.

Haemosiderotic synovitis (HS) is a rare synovial proliferative disease secondary to haemarthrosis, often with articular cartilage destruction. It is most frequently reported in patients with haemophiliacs, and the knee joint is most frequently affected. However, there are no reports on the elbow joint without haemophiliacs. A 60-year-old woman who had undergone osteosynthesis for a left radial head fracture 8 years earlier came to our clinic with left elbow pain. X-rays and CT scans showed osteopenia and osteoarthritic changes throughout the elbow joint. MRI revealed joint effusion and synovial membrane hyperplasia. Surgical synovectomy and screw removal were performed. The pathological diagnosis of the synovial membrane was HS. Postoperatively, the pain was relieved, osteopenia improved and there was no recurrence of symptoms. This is the first report of non-haemophilic HS of the elbow; post-traumatic HS caused elbow arthropathy, which was improved by screw removal and synovectomy. Level of Evidence: Level V (Therapeutic).

A case of solitary digital glomus tumor associated with neurofibromatosis type 1.

An association between glomus tumor and neurofibromatosis type 1 has been reported. It is characterized by multiple tumors and young age at onset. The early diagnosis of neurofibromatosis type 1 is important because it is associated with a high rate of malignancy. A 25-year-old man presented to our hospital with left index finger pain that had persisted for 6 years. Physical and imaging findings suggested a benign soft-tissue tumor. Surgery was performed, and the tumor was pathologically diagnosed as glomus tumor. In this case, the patient with a young-onset glomus tumor was suspected of having neurofibromatosis type 1. An additional medical examination led to the diagnosis of unrecognized neurofibromatosis type 1. We experienced a case in which the onset of a glomus tumor led to the diagnosis of neurofibromatosis type 1. Comorbid neurofibromatosis type 1 should be kept in mind when glomus tumors are diagnosed.

Relationship Between Malunion and Short-Term Outcomes of Nonsurgical Treatment of Distal Radius Fractures in the Elderly: Differences Between Early- and Late-Geriatric Patients.

PURPOSE: Previous studies have suggested little association between radiographic malalignment and long-term functional outcomes of nonsurgical treatment of distal radius fractures in geriatric patients. However, no report has stratified the elderly by age and focused on short-term outcomes. The purpose of this study was to determine how the relationship between malunion and patient outcomes differs between early- and late-geriatric patients in the short and long terms after injury, thereby informing explanations and decision-making on treatment options for geriatric patients with distal radius fractures. METHODS: One hundred patients treated nonsurgically for distal radius fractures were evaluated retrospectively; 52 were defined as early-geriatric patients (aged 60-72 years) and 48 as late-geriatric (aged >77 years). Malunion (dorsal tilt > 10°, ulnar variance > 3 mm, or intra-articular displacement or step-off > 2 mm), range of motion, and grip strength were investigated at 3 months. Multiple regression analysis was performed for each age group using Quick-Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores at 3 months as the dependent variable. QuickDASH scores over 1 year after injury were analyzed in the same way. RESULTS: The early-geriatric patients included 33 acceptable unions and 19 malunions. The late-geriatric patients included 12 acceptable unions and 26 malunions. The significant predictors of QuickDASH scores at 3 months were malunion for the early-geriatric group and grip strength for the late-geriatric group (standardized coefficient ß, 0.31 and -0.49, respectively). No factor significantly predicted the QuickDASH scores after at least 1 year in either group. CONCLUSIONS: Malunion was associated with worse QuickDASH scores at 3 months after injury in the early-geriatric patients but not in the late-geriatric patients and did not predict the QuickDASH scores at 1 year after injury in either age group. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.

Ultrasonographic appearance of the pronator quadratus muscle in high school baseball pitchers with and without elbow symptoms: a pilot study.

PURPOSE: Earlier reports have described forearm flexor muscles as active stabilizers of the elbow to valgus stress during throwing motion. The pronator quadratus (PQ) muscle acts in coordination with the pronator teres muscle for forearm pronation. This study of high school pitchers was conducted to assess the association between sonographic appearance and a history of elbow symptoms. METHODS: We examined 123 high school baseball pitchers, all of whom had completed a self-administered questionnaire, including items related to throwing-related elbow joint pain sustained during the prior year. Ultrasound examination was made of the pitchers with and without valgus stress of the medial aspect of the bilateral elbows. The sonographic appearance of the PQ was assessed on sagittal and axial images on the bilateral side. For participants with and without a history of elbow symptoms, we compared the maximum thickness of the PQ on sagittal and axial images of the throwing side. RESULTS: Regarding maximum thickness of the PQ on the sagittal and axial images, a significant difference was found between the throwing and non-throwing sides (throwing side vs non-throwing side mean: sagittal 6.3 mm vs 5.7 mm, axial 8.2 mm vs 7.5 mm, 95% confidence interval: sagittal 0.41-0.70, p < 0.001, axial 0.53-0.82, p < 0.001). The maximum thickness of the PQ on axial images with elbow symptoms was significantly greater than the PQ thickness of those without elbow symptoms. Nevertheless, no association was found between elbow valgus instability and the maximum thickness of the PQ on sagittal and axial images of the throwing side. CONCLUSION: Sonographic appearance of the PQ might be associated with elbow joint conditions in high school baseball players.

Shoulder stretching versus shoulder muscle strength training for the prevention of baseball-related arm injuries: a randomized, active-controlled, open-label, non-inferiority study.

Glenohumeral internal rotation deficit (GIRD) and weakness in prone external rotation are risk factors for shoulder and elbow injuries in high school baseball pitchers. While a shoulder-stretching prevention program to improve GIRD decreases the injury rate, the effects of external rotation strength remain unclear. This non-inferiority (NI) study investigates the hypothesis that external rotation strength training is not inferior to sleeper stretching for shoulder and elbow injury prevention in high school baseball pitchers. Participants were randomly allocated to the stretching (n = 62; active control group) and muscle-training (n = 51) groups. Specific exercises were performed each night. Elbow and shoulder injuries were monitored for 150 days. Kaplan-Meier survival curves were generated, and the hazard ratios (HRs) for injury occurrence were calculated using multivariate Cox regression. The log-rank test was used to compare the injury-free time. A one-sided NI test using a fixed NI margin was performed (significance level, P = 0.025). The injury rates were 22.6% (n = 14) in the stretching group and 9.8% (n = 5) in the muscle-training group. The muscle-training group had a lower injury rate (P < 0.001) and a lower risk of injury than the stretching group (HR = 0.489). Therefore, external rotation muscle strength training is not inferior to stretching for preventing baseball-related arm injuries.

Closed rupture of a flexor profundus tendon to the little finger caused by asymptomatic pisotriquetral osteoarthritis: A case required differentiation from the tendon rupture due to hamate bony irregularity by bone erosion.

Carpal joint osteoarthritis and the formation of bony irregularities of the carpal bone cause closed flexor tendon ruptures. This report describes a case of a flexor profundus tendon closed rupture of the little finger due to asymptomatic pisotriquetral osteoarthritis in a 73-year-old woman, which required differentiation from tendon rupture due to hamate bony irregularity due to bone erosion. Computed tomography showed cortical bone irregularities of the hamate and the narrowing of the pisotriquetral joint space, and a bony spur on the radial side of the pisiform. Intraoperative findings revealed the capsule of the pisotriquetral joint was torn on the radial side. Pisiform-hamate ligament disruption and the bony spur on the pisiform were found on this side. However, the flexor tendon floor on the hamate was intact. Surgical resection of the pisiform and a free tendon interposition graft for tendon rupture restored the good function of the little finger. Particular attention should be paid in making the diagnosis in cases with multiple possible triggers for closed flexor tendon rupture.

Risk factors for shoulder osteoarthritis with rotator cuff tear in the elderly general population.

HYPOTHESIS AND/OR BACKGROUND: The relationship between shoulder osteoarthritis (OA) and rotator cuff tear (RCT) is unclear. We hypothesized that there is a difference between the pathogenesis of OA complicating RCT and that of RCT complicating OA. In this study, our primary objective was to determine the prevalence of shoulder OA without RCT, RCT without OA, and OA with RCT in the general older population. Our secondary objective was to identify risk factors for the association with OA+RCT in shoulder OA alone or RCT alone, respectively. METHODS: We enrolled patients from the public health checkup conducted in Gunma prefecture (Japan) in 2014. Subjects' shoulder pain at rest, during motion, and at night was evaluated using a questionnaire. Moreover, active and passive range of motions (ROMs) in flexion, abduction, and external rotation were measured. For RCT parameters, we evaluated as no tear, partial-thickness supraspinatus (SSP) tear, full-thickness SSP tear, and SSP-infraspinatus tears. For further analysis, the shoulders were divided into three groups according to the presence of RCT and/or OA: OA, RCT, and OA + RCT groups. Risk factors for OA + RCT were identified in a logistic regression analysis. RESULTS: Overall, 944 of 1148 shoulders were eligible for inclusion. The prevalence rates of shoulder OA, RCT, and OA + RCT were 5.8%, 21.1%, and 4.2%, respectively. Furthermore, 650 shoulders were excluded, and 55, 199, and 40 shoulders had OA, RCT, and OA + RCT, respectively. There were significant differences for age, ROM of active external rotation, strength of abduction, external rotation, and morphology of the rotator tears. However, there were no significant differences for pain visual analog scale score, passive ROM, Simple Shoulder Test, and grades of OA. Older age decreased active ROM in external rotation, and the presence of both subscapularis and SSP-infraspinatus tears was a risk factor for the association of OA with an RCT shoulder. Older age, weaker power in external rotation, and affected dominant side were risk factors for the association of RCT with an OA shoulder. DISCUSSION AND/OR CONCLUSION: This study is the first to report risk factors by considering both shoulder OA and RCT in the general population. Our findings will be useful for the treatment and management of OA and RCT as well as for the prevention of these conditions in the older adults.

Proliferative flexor tenosynovitis in the index finger of a 10-year-old baseball player gloved hand: A case report.

Flexor tenosynovitis is rare in young children. This case report describes that of a 10-year-old boy with diffuse swelling of the left index finger, pain when catching a ball, and progressive inability for full flexing of the finger 2 months after starting baseball play. Magnetic resonance imaging showed a defined lesion with iso-signal intensity to muscle on T1-weighted imaging, and with high signal intensity to muscle on T2-weighted imaging. It was enhanced in T1-weighted fat suppression imaging with gadolinium enhancement. Surgical excision relieved the symptom. Histopathological findings mainly indicated proliferation of synoviocytes and plasma cell and lymphocyte infiltration. We speculated that the physical impact of the ball on the left index finger of his gloved hand during catching activated some immunological mechanism and thereby caused nonspecific tenosynovitis in this young baseball player. Awareness of this pathophysiology might raise confidence in proper diagnosis for assessing the swelling of fingers in young baseball players.

Risk factors for severe lower extremity ischemia following venoarterial extracorporeal membrane oxygenation: an analysis using a nationwide inpatient database.

Objectives: Venoarterial extracorporeal membrane oxygenation is increasingly being used as a life-saving modality in critically ill patients. Despite its necessity, severe lower extremity ischemia associated with venoarterial extracorporeal membrane oxygenation remains a potentially devastating complication. We aimed to investigate the incidence and risk factors for severe lower extremity ischemia requiring fasciotomy or amputation following venoarterial extracorporeal membrane oxygenation. Methods: All patients who received venoarterial extracorporeal membrane oxygenation during hospitalization were identified in a Japanese national inpatient database from July 1, 2010 to March 31, 2018. The primary outcome was occurrence of severe lower extremity ischemia that required fasciotomy or amputation. We used cause-specific proportional hazard models to examine the associations between potential risk factors and outcomes. We also performed a competing-risk analysis to estimate the cause-specific HR for severe lower extremity ischemia using a multivariable competing-risk Cox proportional hazard model with adjustment for potential risk factors. Results: A total of 29 231 patients who underwent venoarterial extracorporeal membrane oxygenation during hospitalization were identified. Of these, 98 patients (0.3%) had lower extremity ischemia requiring fasciotomy or amputation. The young group (≤18 years) had a significantly higher proportion of severe lower extremity ischemia cases than the adult (19-59 years) and elderly (≥60 years) groups (1.4%, 0.5%, and 0.2%, respectively; p<0.001). In a multivariable competing-risk Cox proportional hazards regression model, younger age (HR 3.06; 95% CI 1.33 to 7.02; p<0.008) and consciousness disturbance on admission (HR 2.53; 95% CI 1.60 to 3.99; p<0.001) were significantly associated with higher likelihood of severe lower extremity ischemia. Conclusion: In this study using a nationwide database, younger age and consciousness disturbance on admission were associated with higher risk of severe lower extremity ischemia following venoarterial extracorporeal membrane oxygenation. Level of evidence: Level Ⅲ-prognostic and epidemiological.

Deep Infrapatellar Bursitis in Preadolescent Baseball Players: A Cross-Sectional Study.

Background: Deep infrapatellar bursitis (DIB) has been detected in cases of Osgood-Schlatter disease (OSD). However, the clinical implications of DIB in the apophyseal stage, during the period when OSD has not yet developed, remain unclear. Purpose: To investigate the factors related to DIB in the apophyseal stage in preadolescent baseball players. Study Design: Cross-sectional study, Level of evidence, 3. Methods: The study participants were junior baseball players who participated in a medical checkup in 2020. We included knees in the apophyseal stage evaluated using ultrasonography, and classified them into the bursitis and no-bursitis groups using color-enhanced Doppler ultrasonography. We also investigated bone lesions of the tibial tuberosity, determined by fragmentation of the bone and irregularity of the ossification center. Demographic data, practice duration, pressure pain on tuberosity, pain while playing baseball (visual analog scale), heel-buttock distance (HBD), straight-leg raise angle, and range of hip internal and external rotation were evaluated. Group comparisons were performed using the Mann-Whitney U test and Fisher exact test, and a logistic regression analysis was performed. Results: A total of 261 knees (139 male players; age 10.5 ± 1.1 years) were included, 30 in the bursitis group and 231 in the no-bursitis group. Bone lesions were present in 4 knees in the bursitis group and in 32 knees in the no-bursitis group; there was no significant relationship between the presence of bone lesions and bursitis. Compared with the no-bursitis group, the bursitis group had a significantly longer practice duration (12.9 ± 3.3 vs 15.2 ± 3.8 hours/week, respectively; P = .003) and larger HBD (0.5 ± 1.3 vs 1.4 ± 2.4 cm, respectively; P = .003). The logistic regression analysis showed that practice duration (P = .001) and HBD (P = .004) were significantly related to the presence of bursitis. Conclusion: DIB in the apophyseal stage was related to practice duration and thigh muscle tightness. These findings may help predict overload and thigh muscle tightness at a very early stage.

Factors Affecting Functional Recovery After Volar Locking Plate Fixation for Distal Radius Fractures.

BACKGROUND: There is still no certainty about factors delaying functional recovery after surgery, although volar locking plate (VLP) fixation is the mainstay of treatment for distal radius fractures (DRFs), and several good postoperative recoveries have been reported. The purpose of this study was to investigate factors affecting functional recovery after VLP fixation for DRF. METHODS: The subjects included 104 patients (84 females, 20 males, mean age: 63.2 ± 13.8 years) treated with VLP fixation for DRF, who could be followed for 1 year. The Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, grip strength, and range of motion of the wrist joint were measured at 3, 6, and 12 months postoperatively, and the primary outcome was the QuickDASH score. A multiple regression analysis adjusted for age and sex was used to analyze factors affecting functional recovery at 12 months. RESULTS: A multiple regression analysis showed that the factors that significantly influenced the QuickDASH score at 1 year postoperatively were the grip strength ratio to the uninjured side, dominancy of the injured hand, and postoperative ulnar variance, in descending order of involvement. Trauma energy, history of diabetes, fracture type, complications, and range of motion were not included in the model. CONCLUSIONS: Smaller grip strength, dominant-hand injury, and larger postoperative ulnar variance significantly worsened the QuickDASH score at 1 year postoperatively. In order to achieve satisfactory functional recovery at 1 year after surgery, we confirmed that it is important to surgically achieve smaller postoperative ulnar variance and increase grip strength.

Players' satisfaction with daily pitching performance could predict shoulder and elbow injuries in high-school baseball pitchers: a prospective time-to-event study.

HYPOTHESIS AND BACKGROUND: The relationship between baseball pitchers' satisfaction with their performance and the incidence of shoulder and elbow injuries is unclear. We hypothesized that self-evaluated satisfaction with pitching performance before an injury and incidence of shoulder and elbow injuries are related. METHODS: Baseline data on baseball experience, height, weight, elbow and shoulder range of motion, and shoulder muscle strength of high-school baseball pitchers were collected. During the season, all participants completed a self-recorded questionnaire regarding satisfaction scores, presence of shoulder and/or elbow pain, and pitching limitations due to shoulder and/or elbow pain experienced daily to determine when injuries occurred and record the satisfaction scores. The optimal satisfaction score cutoff value was determined through receiver operating characteristic curve analysis; participants were categorized into satisfied and unsatisfied groups. Statistical tests were performed to evaluate the differences between the groups, obtain the time-to-event curves, and calculate the hazard ratios for the incidence of injury. RESULTS: Overall, 108 participants aged 15-17 years were enrolled and divided into satisfied (88) and unsatisfied (20) groups. The injury incidence rate was 10.2% and 50.0% in the satisfied and unsatisfied groups, respectively. High-school baseball pitchers with low satisfaction had a significantly increased risk of shoulder and elbow injuries; these players had a 7.3-times greater risk of injuries and 1.9-times earlier occurrence of injuries than pitchers who were satisfied with their performance. CONCLUSION: Daily evaluation of players' self-satisfaction could predict shoulder and elbow injuries in high-school baseball pitchers.

Relationship Between Morphological Change of Median Nerve and Clinical Outcome Before and After Open Carpal Tunnel Release: Ultrasonographic 1-Year Follow-up After Operation.

Background: The aims of this study were 2-fold: (1) to assess the morphological change of the median nerve in patients with carpal tunnel syndrome (CTS) preoperatively and at 6 and 12 months postoperatively; and (2) to analyze correlation between the changes in ultrasonographic findings and the changes in clinical findings after surgical decompression. Methods: Of the 28 patients with CTS, 34 wrists were treated with open carpal tunnel release. We evaluated them using the Boston questionnaire, Japanese Society for Surgery of the Hand Version of the Quick Disability of the Arm, Shoulder, and Hand questionnaire, nerve conduction study (NCS), and ultrasound preoperatively and at 6 and 12 months postoperatively. We measured the cross-sectional area (CSA) of the median nerve at the level of the proximal inlet of the carpal tunnel (CSAc) and more proximally at the level of the distal radioulnar joint (CSAd). Paired t tests and repeated measures analysis of variance of ranks were used to identify changes over time. The Spearman correlation coefficient by rank test was used for the analysis of the relation between the amount of change of CSA and the patient-rated questionnaire score and NCS findings. Results: Findings for CSAc, CSAd, and NCS and patient-rated outcomes at 6 and 12 months postoperatively were significantly lower than their preoperative values. However, no significant correlation was found between the postoperative changes in CSAc, CSAd, and clinical variables obtained preoperatively and postoperatively. Conclusions: Evaluation of sonographic imaging might not be helpful for assessing clinical conditions in patients with CTS after surgical decompression.

Neuroplasticity Caused by Peripheral Proprioceptive Deficits.

PURPOSE: Proprioceptive feedback is crucial for motor control and stabilization of the shoulder joint in everyday life and sports. Shoulder dislocation causes anatomical and proprioceptive feedback damage that contributes to subsequent dislocations. Previous recurrent anterior shoulder instability (RSI) studies did not investigate functional neuroplasticity related to proprioception of the injured shoulder. Thus, we aimed to study the differences in neuroplasticity related to motor control between patients with RSI and healthy individuals, using functional magnetic resonance imaging, and assess the effects of peripheral proprioceptive deficits due to RSI on CNS activity. METHODS: Using passive shoulder motion and voluntary shoulder muscles contraction tasks, we compared the CNS correlates of proprioceptive activity between patients having RSI (n = 13) and healthy controls (n = 12) to clarify RSI pathophysiology and the effects of RSI-related peripheral proprioceptive deficits on CNS activity. RESULTS: Decreased proprioception-related brain activity indicated a deficient passive proprioception in patients with RSI (P < 0.05 family-wise error, cluster level). Proprioceptive afferent-related right cerebellar activity significantly negatively correlated with the extent of shoulder damage (P = 0.001, r = -0.79). Functional magnetic resonance imaging demonstrated abnormal motor control in the CNS during voluntary shoulder muscles contraction. CONCLUSION: Our integrated analysis of peripheral anatomical information and brain activity during motion tasks can be used to investigate other orthopedic diseases.