Bracing and taping in an office sports medicine practice.

Braces can be divided according to their use: rehabilitative, functional, or prophylactic. Rehabilitative braces are used following injury or surgery to allow protection of the injured part while rehabilitation is taking place. Functional braces are used following injury or surgery to allow an individual player to return to athletic activities while protecting the injured part from further damage. Prophylactic braces are used in an attempt to prevent injury to a normal area while engaged in athletic endeavors. Braces are available for the neck, back, and both the upper and lower extremities. There are many commercially available braces that are quite useful and effective. It is still controversial whether or not prophylactic braces prevent knee injuries in contact sports. However, prophylactic braces and/or taping have proved to be quite effective in preventing ankle injuries. It should always be kept in mind, however, whether one is using rehabilitative, functional, or prophylactic braces, that a good rehabilitation program and conditioning should be instituted along with their use to strengthen the involved area and prevent further injuries.

Retrospective comparison of taping and ankle stabilizers in preventing ankle injuries.

The effectiveness of taping and the effectiveness of wearing a laced stabilizer in preventing ankle injuries and reinjuries over six seasons of collegiate football practices and games were assessed retrospectively. For 1 1/2 years the players all had taped ankles, and for the remaining 4 1/2 years the players chose their type of ankle support. Over the entire period, the players chose high-top or low-top shoes as preferred. During 51,931 exposures to injury (46,789 practice-exposures and 5,142 game-exposures), the 297 players sustained 224 ankle injuries and 24 reinjuries. Tape was worn during 38,658 exposures to injury (233 players), stabilizers during 13,273 exposures (127 players). Tape had been worn when 159 of the injuries and 23 of the reinjuries occurred; a stabilizer had been worn when 37 of the injuries (P = 0.003) and one of the reinjuries occurred. The combination allowing the fewest injuries overall was low-top shoes and laced ankle stabilizers.

Pathologic fractures of the humerus.

In a study of 57 actual or impending pathologic fractures of the humerus in 52 patients with inoperable cancer treated between 1972 and 1982, we retrospectively reviewed the charts for analysis and comparison of the functional result and pain relief afforded by the various treatments used. Function of the extremity and relief of pain were each graded as excellent, good, fair, or poor using a modification of Perez's rating system. Seven pathologic fractures were treated nonoperatively. These patients generally had only fair pain relief and a poor functional result. Forty-six pathologic fractures were treated with intramedullary fixation using a Rush rod (n = 16), a Küntscher rod (n = 29), or an Ender rod (n = 1); the Neer endoprosthesis was used in four patients. Thirty-one patients received radiation to the humerus. There were seven operative complications, the most common (n = 3) being prominence of an intramedullary rod at the insertion site which required a second minor procedure for advancement of the rod. From this series, we conclude that any patient who has a pathologic fracture or impending fracture of the humerus and a predicted survival of six weeks or more is likely to benefit from rigid internal fixation with an appropriately selected device, adjunctive use of methylmethacrylate, and postoperative local irradiation therapy as needed.

Prophylactic knee bracing in college football.

We report on the number of knee injuries sustained by a major college football team during 2 full years when all players were required to wear laterally placed prophylactic knee braces during all practice sessions and all games. We found that the incidence rates of knee injuries were higher when the braces were worn compared to a similar period when the braces were not worn. There was also an increased number of ACL injuries during the brace period. Several indices characterizing the nature of the injuries were analyzed and were found not to be altered significantly when the prophylactic braces were used. These facts lead us to question the efficacy of prophylactic knee braces in preventing knee injuries in college football. The use of the braces was associated with increased episodes of muscle cramping in the triceps surae muscle group, required the constant attention of coaches and trainers to remind the players to wear the braces and to apply them correctly, and was costly. These findings indicate the need for other carefully controlled clinical and biomechanical studies of these devices before their routine use can be advocated.

Low Back Pain in Athletes.

In brief: Low back pain in seasoned athletes is not common, but when present it can limit participation. While direct blows or hyperlor-dotic positions can cause low back pain in certain sports, the most common cause is overuse and resultant strains or sprains of the paravertebral muscles and ligaments. Such injuries cause acute pain and spasm, which sometimes do not appear for 24 hours or longer. Diagnosis is based on history, ruling out of systemic maladies, physical examination, and, if necessary, supplemental tests such as x-rays, myelograms, and bone scans. Treatment of low back pain due to overuse is, sequentially, bed rest and ice for 24 to 36 hours, heat and massage, analgesics as needed, and a lumbosacral support until flexion and strengthening exercises have returned the damaged part to normal.

Drug Testing in a University Athletic Program: Protocol and Implementation.

In brief: Much attention is being focused on drug abuse by athletes. As sports medicine physicians become increasingly involved in the drug abuse issue, they are called upon not only to educate and counsel athletes but also to test them for drugs. This paper discusses an athletic drug education/counseling screening program at Wake Forest University. Such a program requires practical decisions regarding which athletes to test under informed consent, which drugs to test for and how to test for them, in what way and how often to collect urine samples for testing, and what measures to take when an athlete has a positive test result. Constant feedback from everyone involved allows for modification of the program as needed to make it more confidential, acceptable, and beneficial.

Medial synovial shelf plica syndrome. Treatment by intraplical steroid injection.

Medial synovial shelf plica syndrome is caused by acquired thickening and inflammation of a commonly present residual embryonic synovial fold. Treatment with a local injection into the plica and surrounding synovium of a steroid and a long-acting local anesthetic was tested in a series of 30 patients to see if more involved and expensive treatment could be avoided. Thirty-one knees were studied and treated prospectively; rigid criteria for making the diagnosis were maintained. Twenty-two (73%) patients had complete relief of pain and full return to activity; five patients had some amelioration of their symptoms and partial return to activity; and three patients had poor results. Two of the poor results were secondary to errors in diagnosis, and one was secondary to the presence of mature fibrosis confirmed during subsequent arthroscopic resection. As a control, ten patients were injected with long-acting local anesthetic alone. In all ten, symptoms were relieved only for the duration of the anesthetic. Intraplical steroid injection appears to be a reasonable, prudent, initial step in the treatment of medial synovial shelf plica syndrome. For competitive athletes, it provides very short morbidity and the ability to return to full practice and participation in a very short period of time.

Frequency, associated factors, and treatment of breaststroker's knee in competitive swimmers.

Thirty-six competitive breaststroke swimmers were interviewed and examined for knee pain specifically related to the breaststroke kick. Eighty-six percent of the subjects had a history of at least one episode of breaststroke knee pain, while 47.2% had breaststroke knee pain that occurred at least once a week. There was a significant relationship between more frequent knee pain and increasing swimmer's age, increasing years of competitive swimming, increasing breaststroke training distance, and decreasing warm-up distance. The subjects with frequent knee pain were found to have less internal rotation at the hip joint. The most common site of breaststroke knee pain was the medial portion of the knee, with specific sites differing among the individuals. The medial synovial plica syndrome may be a cause of breaststroke knee pain, since 47% of subjects with weekly knee pain had tender, thickened medial plicae. Palpation of those plicae produced pain similar to that experienced with the breaststroke kick. The findings in this study suggest that reducing or eliminating breaststroke training distance should be an initial measure in treatment. Applications of ice, changes in kick technique, stretching exercises to increase hip rotation, and administration of aspirin may also be effective. The breaststroke training distance should be increased very gradually in the early season, and warm-up distance should be adequate to help prevent the symptoms of breaststroker's knee.

Anabolic steroids: a review of the literature.

The use of anabolic steroids by athletes is controversial. On the one hand, many athletes believe that steroids improve athletic performance and thus provide an advantage to those who use them. On the other hand, the medical and scientific communities believe that inadequate scientific data exist to support the claim that anabolic steroids can improve athletic performance while overwhelming scientific data demonstrate their deleterious effects. Therefore, a large information and credibility gap concerning anabolic steroids exists between the athletes and the medical and scientific communities. We believe that this gap can be closed if both groups are better informed about anabolic steroids. We provide a detailed review of the literature on anabolic steroids that provides to the reader the information needed to make an informed decision on the relative risks and benefits of anabolic steroids to the athlete.

Anterior cruciate-deficient knees: a review of the literature.

Injury to the anterior cruciate ligament may lead to functional instability, meniscal injury, and premature degenerative changes of the knee or, if treatment and rehabilitation are carried out carefully, to a functionally stable knee with no premature degenerative changes. Unfortunately, the complex anatomy of the three fiber bundles, consisting of multiple collagenous strands, which constitutes the anterior cruciate ligament combined with variation of injuries to the ligament, with or without injury to other structures of the knee, makes any standardization of surgical treatment difficult. In this paper, we review the biomechanics of the knee, the anatomy and vascularization of the anterior cruciate ligament, the healing characteristics of ligamentous material, and the types of surgical repair that have appeared in recent articles. Those repairs can be divided into direct repair, extraarticular substitution and intraarticular augmentation, freeze-dried fascia lata allografts, and temporary supportive prosthesis such as carbon fiber. Essential to the success of any surgical repair of the anterior cruciate-deficient knee is a prolonged, carefully organized rehabilitation program that allows adequate healing and strengthening of the ligament before it is used normally again. The patient's clear understanding of the importance of a prolonged rehabilitation is best established before the surgical procedure is done.

Musculoskeletal injuries in theatrical dance students.

Three hundred and fifty-two injuries in 185 theatrical dance students at the North Carolina School of the Arts were diagnosed and treated from September 1981 through May 1982, the most recent academic year. The total number of dancers enrolled in the school was 218; thus, 84.9% of the dance students were evaluated for an injury by a physician, with 87.8% of the injuries sustained during dance. Approximately one-fourth of the dance-related injuries involved the foot or ankle. The injuries were usually not severe, and proved amenable to treatment by conservative measures.

How I Manage Skier's Thumb.

In brief: Skiing, hockey, and boxing, as well as occupational hazards and falls in general, are potential causes of skier's thumb-a sprain of the ulnar support structures of the metacarpophalangeal joint. History, physical characteristics, and the findings on plain and special x-rays are necessary for a correct diagnosis. The mechanism of injury is usually excessive extension or radial deviation of the thumb. Minor sprains can be immobilized by taping. More severe injuries require a thumb spica cast. For acute injuries surgery is necessary to reattach the ulnar collateral ligament to the base of the proximal phalanx.

Wrestling Injuries in North Carolina High Schools.

In brief: Using data on 1,091 North Carolina high school wrestlers during 49 team-seasons, the authors attempted to relate the number, type, and severity of wrestling injuries to factors such as mat surfaces, endurance exercises, weight- reducing methods, protective equipment, and coaching experience. Most of the 248 injuries were minor, causing little time loss, but 57 (23%) were so severe that athletes missed an entire season. Possible contributory factors were inappropriate endurance training shoes, infrequent headgear use during practice, less than optimum wrestler-to-coach ratios, and potentially dangerous weight-reduction methods.

Posterior approach for total hip arthroplasty.

Experience with the posterolateral approach to total hip replacement arthroplasty in 229 patients is reported. The technic has the advantages of providing excellent exposure and decreased operative time, minimal blood loss, and absence of the complications associated with removal and replacement of the greater trochanter. Capsulectomy may be done or not, as desired. Classification of results was based on absence of pain and increased range of motion. Of the 229 patients, 95% were classified as having a good to excellent result; 2%, a fair result; and 3%, a poor result. There was no statistically significant correlation between the postoperative formation of ectopic bone and whether or not capsulectomy was done.

Hemidiaphysectomy to control chronic osteomyelitis.

A retained Küntscher nail in the left femur of a 34-year-old man was complicating the course of chronic, unremitting osteomyelitis. The nail was bent and could not be removed by routine methods. A hemidiaphysectomy of the femur allowed easy removal of the nail and radical curettage of the chronically infected intramedullary granulation tissue. The portion of the diaphysis removed at osteotomy was replaced without internal fixation. Postoperative external fixation was considered unnecessary because of the bulk of the femoral diaphysis secondary to the chronic sclerosis of osteomyelitis. Roentgenograms taken seven months after operation showed healing of the femur and no evidence of sequestration of the bone fragment. At 23 months' follow-up, the patient has no pain, no drainage, and no limitation of activities. Long-term follow-up is planned.

In vitro effects of bone cement on S. aureus growth and phagocytosis and glucose metabolism of macrophage: a preliminary study.

A preliminary study of the effects of Surgical Simplex, mixed for various time periods, was performed on S. aureus growth rate, and phagocytosis and glucose metabolism of macrophage in vitro. Quantitatively, no significant effects of the mixture on S. aureus growth rate were observed. The cement mixed for less than 4 min tended to cause adverse effects on phagocytosis rate and hexose monophosphate shunt activity of macrophage. This information may not be directly applicable to in vivo, but in vitro the cement mixture in a certain situation can cause decreased phagocytosis and hexose monophosphate shunt activity of macrophage.

An in vitro study of bacterial response to inert and reactive metals and to methyl methacrylate.

The clinical use of inert materials for internal fixation and joint replacement devices is increasing rapidly; studies on the effect of these materials on bacteria and host resistance to infection have not kept apace. Any substance placed within the body may interfere with host-parasite interaction, either by its physical presence or by physiochemical activity at its interface with the surrounding tissue. Either mechanism, by altering the normal host defense mechanism, may promote or retard bacterial growth. Bacterial growth may also be altered if a trace element essential to or inhibitory to the bacteria or an element that antagonizes or potentiates humoral antibacterial systems is leached from the substance. We have tested bacterial growth and inhibition in vitro in the presence of substances used as implant materials: surgical silver, iron, zinc-coated galvanized iron, aluminum alloy, stainless steel, Vitallium, and methyl methacrylate. Our results showed: 1) metals that have low grades of tissue reactivity and little bacteriotoxic effect provided a framework along which bacterial growth and propagation occurred; 2) metals that have higher levels of cellular reactivity, specifically aluminum and galvanized wire, caused selective bacterial toxicity. The in vitro response of bacteria to methyl methacrylate was similar to that of Vitallium and other inert substances, i.e., growth and propagation were abundant adjacent to methyl methacrylate. These studies led us to speculate that, if similar phenomena occur in vivo, bacterial growth and dissemination might be increased when an inert implant material was used and decreased when the implant material was more reactive.