Forearm compartment pressures and grip strength in elite motorbike racers with chronic exertional compartment syndrome.

BACKGROUND: Remarkably little research has been published on chronic exertional compartment syndrome (CECS) of the forearm. This study investigated forearm flexor compartment pressure pre- and post-exercise in elite motorbike racers clinically diagnosed with CECS and assessed their grip strength before and after arm pump exercise. METHODS: Elite motorbike riders with a clinical diagnosis of CECS of the right forearm when racing were recruited during the opening rounds of a British Superbike season. Their grip strength and forearm flexor compartment pressures were measured before and after a set exercise programme. RESULTS: Of the 11 riders recruited to the study, 10 completed the full testing regime. The mean pre-exercise forearm compartment pressures [11.7 mmHg (range 7-17 mmHg)] significantly increased post-exercise [30.5 mmHg (range 15-45 mmHg)], with a mean increase of 18.80 mmHg (P < 0.0001). The mean pre-exercise grip strength [50.61 mmHg (range 37-66.7 mmHg)] decreased post-exercise to [35.62 mmHg (range 17.1-52.5 mmHg)], a mean decrease of 14.99 mmHg (P < 0.0001). CONCLUSION: There is a statistically significant increase in the forearm flexor compartment pressures in elite motorbike racers with CECS, but with marked variability of these values. Grip strength decreases statistically significantly following onset of symptoms of CECS of the forearm.

Midterm Outcomes of a Synthetic Cartilage Implant for the First Metatarsophalangeal Joint in Advanced Hallux Rigidus.

BACKGROUND:: A prospective, randomized, noninferiority clinical trial of synthetic cartilage implant hemiarthroplasty for hallux rigidus demonstrated functional outcomes and safety equivalent to first metatarsophalangeal (MTP) joint arthrodesis at 24 months. We prospectively assessed safety and efficacy outcomes for synthetic cartilage implant hemiarthroplasty at a minimum of 5 years. METHODS:: Of 135 eligible patients from the original trial, 112 (83.0%) were enrolled (mean age, 58.2 ± 8.8 years; 87 females). Pain visual analog scale (VAS), Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL), and FAAM Sports subscales were completed preoperatively and 2 and 5 years postoperatively. Great toe active dorsiflexion, weightbearing radiographs, secondary procedures, and safety parameters were also evaluated. RESULTS:: At 24 months, 14/152 (9.2%) patients had undergone implant removal and conversion to arthrodesis. In years 2 to 5, 9/119 (7.6%) patients underwent implant removal and conversion to arthrodesis. At mean 5.8 ± 0.7 (range, 4.4-8.0) years' follow-up, pain VAS, FAAM ADL, and FAAM Sports scores improved by 57.9 ± 18.6 points, 33.0 ± 17.6 points, and 47.9 ± 27.1 points, respectively, from baseline. Clinically significant changes in VAS pain, FAAM ADL, and FAAM Sports were reported by 103/106 (97.2%), 95/105 (90.5%), and 97/104 (93.3%) patients, respectively. Patient-reported outcomes at 24 months were maintained at 5.8 years in patients who were not revised. Active MTP joint peak dorsiflexion was maintained. Ninety-nine of 106 (93.4%) patients would have the procedure again. CONCLUSION:: Clinical and safety outcomes for synthetic cartilage implant hemiarthroplasty observed at 2 years were maintained at 5.8 years. The implant remains a viable treatment option to decrease pain, improve function, and maintain motion for advanced hallux rigidus. LEVEL OF EVIDENCE:: Level IV, case series.

The Limping Child - What a Pediatrician Should Know?

Diagnosis of a limping child can be challenging for the clinician given the vast array of conditions that present in this manner. This review article discusses the history, examination and subsequent differential diagnoses that should be considered along with the most appropriate investigations for each diagnosis. The latest evidence regarding choice of investigation to make the clinician's task less onerous is also discussed.

Managing Developmental Dysplasia of the Hip.

Developmental dysplasia of the hip (DDH) involves a spectrum of hip disorders that affect hip anatomy and development and can range from mild anatomical deformity with a reduced but subluxatable hip to a frankly dislocated hip. It was previously known as congenital dislocation of the hip (CDH) but this name is no longer used due to the fact that the hip may be anatomically abnormal whilst not being dislocated. The key aim of clinical management of DDH is early diagnosis and referral as this can often mean less invasive treatment is possible, and outcomes are significantly improved if treatment is initiated at an early stage and certainly before 6 wk of age.

High volume image guided injections in chronic Achilles tendinopathy.

PURPOSE: To determine the effectiveness of high volume image guided injections (HVIGI) for chronic Achilles tendinopathy. METHODS: We included in the study 30 consecutive patients (mean age 37.2 years, range 24 - 58 years) with Achilles tendinopathy for a mean of 35.8 months (range 2 - 276 months) who had failed to improve after a three-month programme of eccentric loading of the gastro-soleus complex. Patients were injected with 10 ml of 0.5% Bupivacaine Hydrochloride, 25 mg Hydrocortisone acetate, and up to 40 ml of injectable normal saline. A study-specific questionnaire and the Victorian Institute of Sport Assessment - Achilles tendon (VISA-A) were retrospectively administered to assess short- and long-term pain and functional improvement. RESULTS: Some 21 patients (70%) responded. Patients reported significant short-term improvement at 4 weeks of both pain (mean change 50 mm, [SD 28, p < 0.0001], from a mean of 76 mm [SD 18.2], to a mean of 25 mm [SD 23.3]), and function scores (mean change 51 mm, [SD 31.2, p < 0.0001], from a mean of 78 mm [SD 20.8], to a mean of 27 mm [SD 28.4]). Patients also reported significant long-term improvement in symptoms using the VISA-A questionnaire (mean change 31.2 points, [SD = 28, p < 0.0001], from a mean of 44.8 points [SD 17.7], to a mean of 76.2 points [SD 24.6]) at a mean of 30.3 weeks from the injection. CONCLUSIONS: HVIGI significantly reduces pain and improves function in patients with resistant Achilles tendinopathy in the short- and long-term.