Tear of the posterior shoulder stabilizers after posterior dislocation: MR imaging and MR arthrographic findings with arthroscopic correlation.

OBJECTIVE: The purpose of this article is to describe the findings on MR imaging and MR arthrography in posterior capsular tear and teres minor muscle injury after posterior dislocation. We also correlate MR imaging with the arthroscopic findings and present treatment options for these patients. CONCLUSION: MR imaging is helpful in diagnosing abnormalities caused by posterior dislocation injuries and in directing therapy. Teres minor muscle and capsular injuries may occur without the typical reverse Bankart lesion. Isolated teres minor muscle tears seen on MR imaging after posterior dislocation injury may cause pain. However, no consensus exists as to whether the lesions seen on MR images in these patients should be treated surgically or conservatively.

Primary total knee arthroplasty in stiff and ankylosed knees.

This study reviewed 71 patients who underwent 82 total knee arthroplasties between 1974 and 1987. All patients had severe limitations of motion preoperatively with a total preoperative arc of motion of < or = 50 degrees. Follow-up ranged from 2 to 12 years (average: 5.3 years). The average preoperative knee score was 38 (range: 14 to 54). The average preoperative arc of motion was 36 degrees (range: 0 degree to 50 degrees), with an average flexion contracture of 22 degrees average maximum flexion of 58 degrees. Postoperatively, the average knee score was 80 (range: 0 to 98). The average postoperative arc of motion was 93 degrees (range: 35 degrees to 130 degrees), with an average maximum flexion of 94 degrees. Nine knees had 5 degrees flexion contractures, while 5 knees had 10 degrees flexion contractures. Postoperatively, no knee had a flexion contracture > 10 degrees. Two knees had a decreased range of motion postoperatively. Two knees with severe flexion-valgus deformities developed peroneal nerve palsies that both resolved. Total knee arthroplasty in stiff or ankylosed knees can produce good or excellent results and can lead to significant improvement in range of motion and pain.

Functional outcomes in athletes after modified anterior capsulolabral reconstruction.

During a 7-month period, 32 consecutive athletes underwent anterior capsulolabral reconstruction with modifications, consisting of a horizontal capsulotomy (rather than a T-capsulotomy) and suture anchors (rather than drill holes); 31 patients were available for follow-up examinations. At preoperative examinations all patients demonstrated positive relocation tests; 22 were diagnosed with recurrent anterior subluxation and 9 with recurrent anterior dislocation. After surgery, all patients underwent a rehabilitation program. Followup included physical examination, subjective questions, and radiographs. At a minimum of 24 months' followup, results measured by modified Rowe score were 24 patients (77%) excellent, 6 (19%) good, and 1 (3%) failure. Eighty-one percent of the patients returned to the same sport at the same level of competition, 13% returned to the same sport at a lower level of competition, and 6% did not return to the preinjury sport. Radiographic analyses at 2 years' followup revealed all Mitek anchors were well seated in the bone of the glenoid neck. No complications of the suture anchors occurred. This modification of anterior capsulolabral reconstruction simplified the procedure and allowed a more aggressive early rehabilitation program with 97% good or excellent results.

Electromyographic analysis of hip and knee musculature during running.

The purpose of this study was to describe the firing pattern of 11 hip and knee muscles during running. Thirty recreational runners volunteered to run at 3 different paces with indwelling electromyographic electrodes while being filmed at 100 frames per second. Results demonstrated that medial and lateral vasti muscles acted together for knee extension during terminal swing and loading response, possibly providing a patella stabilizing role. The vastus intermedius muscle functioned with the other vasti, plus eccentrically controlled knee flexion during swing phase. The rectus femoris muscle fired with the vastus intermedius muscle and assisted the iliacus muscle with hip flexion. The hamstrings fired primarily to eccentrically control hip flexion. The adductor magnus, tensor fascia lata, and gluteus maximus muscles afforded pelvic stabilization while assisting with hip flexion and extension. Forward propulsion was provided mainly by hip flexion and knee extension, which is contrary to the view that posterior calf muscles provide propulsion during toe off. Faster running paces lead to increased activity in the muscles. This may lead to more injuries, primarily in the muscles that were contracting eccentrically.

Citizen response to cardiopulmonary emergencies.

Since 1985, it has become apparent that the key to survival from adult sudden cardiac death is prompt defibrillation. Any delay from the time of collapse to the initial countershock will decrease the likelihood of survival. It also has been determined that CPR performed by lay rescuers is not begun promptly and, once started, often is performed for more than one minute before the emergency medical services (EMS) system is accessed, which significantly delays the time to defibrillation. In adults, therefore, the rescuer should phone first to activate the EMS system before performing CPR. In the pediatric population, respiratory arrests are far more common than cardiac arrests. Therefore, a rescuer should perform one minute of rescue support before activating the EMS system (a concept termed phone fast). It is recognized that this change is dependent upon a national EMS system that is still evolving. It is hoped that this change to phone first and phone fast will provide an impetus for rapid development of the EMS infrastructure.

Prehospital cardiac arrest: the chain of survival concept.

Sudden cardiac death claims 1,000 lives per day in the United States and cardiovascular disease remains the number one cause of death in the United States. Morbidity and mortality will be reduced when a coordinated response to out-of-hospital cardiac arrest has been achieved nationwide. The implementation of an integrated system, the chain of survival which includes early access via a universal Emergency Medical Service (EMS) number, trained individuals to provide Cardiopulmonary Resuscitation (CPR), widespread early defibrillation and utilisation of automated external defibrillators, and early advanced care will yield survival rates in excess of 30%. The potential for saving 100,000-200,000 lives per year is achievable provided the chain of survival concept is adapted.

The development of standards and guidelines for cardiopulmonary resuscitation and emergency cardiac care in the United States.

There have been four major conferences since 1966 which have produced standards and guidelines for cardiopulmonary resuscitation and emergency cardiac care. These events and publications have served as the principal source and direction for the American Heart Association to develop training programmes for the treatment of sudden cardiac death. The process of standard setting and programme implementation has been very successful in stimulating lay public, health care professional and paraprofessional interest in cardiopulmonary resuscitation techniques. The results of the national campaign may result in as many as 100,000 to 200,000 lives saved per year and successful resuscitation rates from out of hospital sudden death via the chain of survival concept reaching 30% in the United States.