Felt augmentation for thumb dislocation.

OBJECTIVE: To describe a nonsurgical approach for the treatment of an isolated dorsal dislocation of the carpometacarpal joint of the thumb that remained unstable immediately following closed reduction and casting. BACKGROUND: An isolated dorsal dislocation of the thumb is an uncommon injury. The dislocation that remains stable following closed reduction has been treated conservatively with immobilization. Dislocations that remain unstable following closed reduction have been stabilized surgically with favorable results. DESCRIPTION: Materials and application guidelines for a thumb spica cast are presented. Anatomic alignment of the dislocation can be revealed with postcasting radiographs. Possible complications from the immobilization are also presented. CLINICAL ADVANTAGES: This nonsurgical approach can be used to avoid percutaneous pinning, to return the athlete to competition without loss of playing time, to provide an effective closed reduction, and also to allow full range of motion of the elbow and uninvolved fingers.

Surgical treatment of chronic patellar tendinitis in a collegiate football player.

In the competitive athlete, there are many causes of anterior knee pain, one of which is patellar tendinitis. Repetition of explosive movements can cause microtrauma to the tendon and its insertion, resulting in patellar tendinitis and occasional tearing, either partial or total. Due to its refractory nature, the treatment of this disorder can be quite frustrating to all involved. A 20-year-old collegiate football player with patellar tendinitis was treated conservatively for more than 2 years. Despite aggressive training regimens, including quadriceps stretching, eccentric strengthening, and therapeutic modalities, the athlete was unable to participate at his preinjury level. Physical examination of his knee revealed inflammation and crepitation. Radiographs demonstrated an avulsion fragment from the inferior pole of the patella and magnetic resonance imaging showed cystic degeneration of the tendon. These findings confirmed the diagnosis of chronic patellar tendinitis. The patient underwent surgical debridement of the patellar tendon without complications. His postoperative rehabilitation was divided into three phases: passive range of motion, active strengthening, and sport-specific activities. At 14 weeks post-surgery, the athlete was able to return to his previous level of activity without pain. Follow-up 30 weeks postoperatively revealed no return of symptoms. At 40 weeks postsurgery, the athlete was participating at his preinjury level. This case report demonstrates the successful outcome of the surgical treatment of chronic patellar tendinitis, which was unresponsive to conservative treatment, in a competitive collegiate football player.