Measurements of the intercondylar notch by plain film radiography and magnetic resonance imaging.

The purpose of this investigation was twofold. In Part I, we determined the accuracy of morphometric analysis of the knee using magnetic resonance imaging and plain film radiography. The results of Part I validated the accuracy of magnetic resonance measurements and its superiority over plain film measurements. In Part II, we evaluated knee morphometry in 20 asymptomatic athletes with chronic anterior cruciate ligament insufficiency to determine if any predisposing factors to anterior cruciate ligament disruption could be detected. With our analysis, we could detect no predisposing factors to explain the anterior cruciate ligament disruption in the cohort group.

Neurovascular injuries to the shoulder complex.

The shoulder complex is particularly vulnerable to neurovascular injuries due to its intimate anatomical relationship with the brachial plexus and axillary vessels. Therapists, trainers, and physicians who cover athletic events witness the violence of injury to the neck and shoulder. Fortunately, permanent neurovascular deficits are rare, and many are subtle. However, tragically, some can be career-ending and even life-threatening. Neurovascular injuries may occur in association with musculoskeletal injury or as an isolated finding. Symptoms may present on an acute basis or in a chronic fashion. On the playing field or in the emergency room, focus is often placed on the obvious musculoskeletal injury, ie., dislocation or fracture. Medical personnel must always have a high index of suspicion of neurovascular injuries to the shoulder complex to avoid misdiagnosis. They must consider that failure to progress in rehabilitation for musculoskeletal injuries may be secondary to a previously unrecognized neurovascular lesion. The purpose of this review is to provide a basic reference for diagnosis and treatment of neurovascular injuries to the shoulder complex for therapists, trainers, and physicians. Also, we hope to raise the index of suspicion for neurovascular injuries during evaluation of patients with common shoulder injuries. The review is organized by location and association with specific musculoskeletal injuries.

Classification and physical diagnosis of instability of the shoulder.

Recent clinical and basic science work has increased our knowledge of shoulder instability. Valuable information has been gained by cutting studies of the capsuloligamentous complex to clarify the biomechanics of instability. It is now clear that a significant overlap exists in the concepts of instability and impingement relating to anterior shoulder pain. These concepts have added new importance to organization and standardization when classifying and diagnosing shoulder instability. This manuscript presents an algorithmic approach to classification of shoulder girdle complaints that may be related to instability. This classification system is designed around the direction, degree, chronology, cause, and volition of instability. With accurate and detailed analysis of the historical presentation, most shoulder instability complaints can be classified using this approach. The physical examination also should proceed in an orderly fashion, including general impression of the musculoskeletal system, inspection, palpation, and range of motion of both the uninvolved and involved shoulder, neurologic examination, rotator cuff evaluation, and stability assessment. Stability assessment includes glenohumeral translation examination with apprehension and provocative testing. Management techniques are predicted on an accurate diagnosis. With a thorough and organized examination, the correct diagnosis can be achieved.

Current concepts and recent advances in the athlete's shoulder.

The demands placed on the shoulder girdle during athletics can often exceed its physiologic limits and result in significant injury. The goal of orthopedists, therapists, trainers, and ancillary personnel who care for athletes involved in sports which require extreme demands of the shoulder is to enhance athletic performance, extend their longevity, and prevent injury. With the new concepts available from basic science and clinical research, a clear understanding of normal architecture and biomechanical function of the shoulder girdle is better appreciated. A greater understanding of sporting activities and their physiologic demands on the shoulder are also more clear. The future of all this research seems to be pointing toward maintenance and restoration of normal anatomy and physiology about the shoulder girdle.