Neurovascular problems in the forearm, wrist, and hand

This article attempted to summarize the most common neurovascular injuries of the upper extremity, particularly the forearm, wrist, and hand. Although these injuries are rarely encountered in athletes, their pathology and treatment must be understood by the treating physician. Failure to recognize these injuries in a timely manner can lead to delay in diagnosis and weeks or months of lost participation by the athlete. The sports medicine physician must be aware of the potential risk for injury to the neurovascular structures, particularly in the athlete exposed to repetitive use or impact of the upper extremity. Timely recognition, diagnosis, and treatment will avoid the potential risk for permanent injury.     

The female athlete

Women's participation in sporting activities is now diverse with new opportunities arising yearly. As a result, care of the the female athlete's unique medical concerns has become an important challenge and issue to the primary care physician. The major focus when caring for the female athlete should be the diagnosis and treatment of the female athlete triad. The components of the triad--disordered eating, amenorrhea, and osteoporosis--can have serious implications for the health of the female athlete. Appropriate prevention and screening methods for early diagnosis of the female athlete triad require future study and improvement. Healthy pregnant, postpartum, and breastfeeding women can continue to maintain physical activity. Musculoskeletal injuries from sports are, in general, not gender specific but are more often sport specific. One exception is the increased prevalence of anterior cruciate ligament injuries occurring in women soccer and basketball players. The exact cause of this is unknown but is continuing to be investigated.     

Rehabilitation and use of protective devices in hand and wrist injuries

Hand and wrist injuries are common among athletes. Although the hand does not often bear weight and these injuries do not always sideline an athlete, careful attention must be paid when treating injuries of the hand and wrist. Rehabilitation is given for common injuries of the hand and wrist, including exercises and protective splints and braces. Details on how to fabricate a playing cast for athletes are also discussed.     

The thrifty-genotype hypothesis and its implications for the study of complex genetic disorders in man

The cases of eight Special Forces soldiers who sustained cold weather-related injuries while conducting winter training as part of Operation Arctic Saber in the Northwest Territories and Arctic Circle are reported. Environmentally related injuries can represent difficult diagnostic and treatment challenges in the field. Moreover, they may compromise the overall mission if they are not identified and treated early. Cold weather injuries can also result in long-term disfigurement and disability that may limit a soldier's future worldwide deployability. Mission requirements, equipment utilization, and environmental exposure place soldiers at particular risk for cold weather-related injuries in such austere settings. Nonetheless, with appropriate education and safety precautions, these potentially life-threatening risks can be greatly minimized.     

Rehabilitation of tendon injuries in sport

Clinicians are faced with a growing number of athletes with injured tendons. Treatment of both acute and chronic injuries has proven to be quite complex. It is difficult to maintain the balance between resting the injured tendon and preventing atrophy of the surrounding muscles and joints. Questions also arise as to when the tendon should be strengthened and when the athlete is ready to return to full activity in sport. Through an awareness of the structural and mechanical properties of the tendon, an exercise programme for the rehabilitation of tendon injuries has been developed. It is recommended that this programme be used in combination with ice and other physical modalities. This approach will resolve most tendon injuries within 6 weeks of its implementation. The use of anti-inflammatory medications and surgery can only be recommended in select situations where more conservative measures are inadequate.     

Metacarpal and phalangeal fractures in athletes

The high demands placed on the upper extremity in sporting activities subject the competitive athlete to common injuries of the hand. Treatment options are based on the fracture configuration, associated extremity injuries, and status of the surrounding soft tissue. Metacarpal and phalangeal fractures may usually be treated by closed, nonoperative methods, and most athletes may quickly return to play with a protective orthosis. Supplemental methods of fixation, such as percutaneous pins and tension-band wires, may be used for unstable fractures. When required, open reduction and internal fixation can provide optimum stability to the fracture, which allows immediate range-of-motion and early return to play.     

Groin pain in the soccer athlete: fact, fiction, and treatment

Groin pain in the soccer athlete is a common problem accounting for 5% of soccer injuries. Groin distribution has proved to be the most common cause of groin pain. Other causes are direct trauma, ostetis pubis, muscle injuries, fractures, bursitis, hip problems, and hernia and referred pain. Soccer players with groin pain present a complex management problem that is discussed.     

Sports medicine. 5. The physiatrist as team physician

This self-directed learning module highlights important aspects of the evaluation and care of the injured athlete by a team physician. It is part of the chapter on sports medicine in the Self-Directed Medical Knowledge Program for practitioners and trainees in physical medicine and rehabilitation. This article covers the components of a preparticipation examination, the on-field evaluation of head, spine, and limb injuries, and return-to-play criteria after specific injuries. Sports medicine for the physically challenged athlete, medicolegal considerations for the team physician, and anabolic steroids are also reviewed.     

The role of arthroscopy in the treatment of wrist injuries in the athlete

Wrist arthroscopy provides an ideal means of evaluating intraarticular soft-tissue injuries of the wrist. Many lesions such as tears of the triangular fibrocartilage complex can be treated by arthroscopic means as well. Reduction of articular fractures of the distal radius and pin fixation, reduction of scaphoid fractures and intramedullary fixation, and arthroscopic reduction and transcutaneous pin stabilization of acute carpal dissociation patterns can all be accomplished with minimally invasive techniques under arthroscopic control. These measures often provide the athlete with shorter periods of immobilization and earlier return to athletic competition. Wrist arthroscopy provides a very useful adjunct to the treatment armamentarium of all sports medicine physicians.     

Case-control study of agricultural injuries to women in central Wisconsin

A small number of women are the owner/operators of farms and women often participate in the work of production agriculture. Estimates of the percentage of females involved in agricultural injuries range from 11-45% and it is not clear if the risk factors associated with injuries to women are different from those for men. In a two year case-control study of injuries to farm residents, there were 40 injuries involving adult women. Multivariable analysis revealed that the two major risk factors for agricultural injury to females were number of hours worked and the presence of bulls on the farm. Most (55%) of the women were injured while in a barn. A cow was the primary agent of injury in 17 (42.5%) of the cases. Efforts to reduce the rate of injuries to women in agriculture should be targeted to the particular risks they experience.     

'Clearing' cervical spine injuries in polytrauma patients: is it really safe to remove the collar?

Polytrauma patients are at increased risk for occult cervical spine injuries. Those unable to provide clinical clues to injury either remain in hard collars until they are able to cooperate with the physical examination or are deemed "clear of cervical injury" if the emergency room screening radiographs are without obvious bony abnormality. Cervical immobilization for a lengthy period of time is not without morbidity. Missed ligamentous injuries can lead to cervical instability, which in turn can result in permanent neurologic sequelae. This article reviews the current methodologies to "clear the cervical spine" and highlights the inadequacies.     

Medical coverage analysis for Wisconsin''s Olympics: the Badger State Games

The objective of this analysis is to determine the prevalence and severity of injuries encountered during the 1994-96 Badger State Summer Games Finals. Allocation of available medical personnel can be determined with this information. Medical contact with an athlete required an evaluation form to be completed by the health care professional covering the event. Information was compiled and analyzed to determine injury frequency and severity. Of the 31,580 athletes competing over the three year period in the 11 sports provided with medical personnel, 285 suffered a reportable injury. Soccer and basketball had the highest number of reported injuries with 68 and 65 injuries respectively. Basketball (2.00%), cycling (1.59%), wrestling (1.50%) and roller hockey (1.24%) had the highest injury rates. Severity of injury determined by the number of injuries transported to a medical facility found wrestling (23), soccer (22), basketball (11), and cycling (6) with the highest numbers of severe injuries. Wrestling (1.27%), basketball (.34%), soccer (.32%), and cycling (.21%) had the highest rate of severe injury. The most common sustained injuries were found to be sprains, strains, skin wounds, and contusions. These four types of injuries made up 70.18% of the injuries sustained. In conclusion, non-physician medical presence may be adequate coverage in most venues at multi-sport athletic competitions like the Badger State Games because of the relatively low frequency of severe injuries.     

Mammalian Rh/T2/S-glycoprotein ribonuclease family genes: cloning of a human member located in a region of chromosome 6 (6q27) frequently deleted in human malignancies

OBJECTIVE: To implement a low-cost system of transmitting high-quality digital photographs of mutilating extremity injuries using the speed of the Internet. DESIGN: A high-resolution digital camera and simple hardware and software platform are used to take and transmit images via electronic mail. The images are received within minutes by the consultant, and an assessment can be made. RESULTS: A low-cost and high-quality system can easily be implemented. Images can be seen by consultants only a few minutes after they are obtained. The quality of the reproductions is excellent, and they are handled exactly as other photographs. CONCLUSION: This technique can be widely applicable and inexpensive to initiate in any emergency room. It allows rapid assessment of extremity injuries and x-ray images by expert consultants, who can then evaluate the replantation or revascularization potential of extremity trauma cases. This can eliminate unnecessary and often expensive transfer of patients who are not candidates for replantation.     

The imaging of sports injuries

Radiology plays a critical role in the evaluation of a traumatized athlete. The goal is to provide as much information as possible to allow timely and appropriate patient care. To select the best "diagnostic pathway," close communication between the clinician and the radiologist is mandatory. This saves time, money, and radiation exposure. Although plain radiographs remain the primary imaging technique for the diagnosis of musculoskeletal trauma, certain injuries can be more fully evaluated by fluoroscopy, arthrography, nuclear medicine scanning, computed tomography (CT), arthrography followed by CT, or magnetic resonance imaging. This article reviews the uses of each imaging technique in the diagnosis of musculoskeletal trauma and its most appropriate application. A discussion of pediatric skeletal trauma is included.     

Are women really more aggressive than men in intimate relationships? Comment on Archer.

J. Archer's (see record 2000-15524-001) conclusion that women engage in slightly more physical aggression than men in intimate relationships but sustain more injuries is reasonable in representative samples. However, his conclusions will provoke negative reactions because they do not fit with the data and belief that men are generally more aggressive than women. In addition, they are incompatible with observations of professionals who serve battered women. Basically, the meta-analytic conclusion about aggression cannot be generalized to samples of physically abusive men and their partners. Nonetheless, the studies reviewed by Archer provide convincing data that physical aggression by women must be taken seriously if there is a sincere desire to prevent partner abuse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Injuries in restrained motor vehicle accident victims

Passenger restraints reduce fatalities and serious injuries. Restraint systems alter the distribution of injuries seen in accident victims, and they cause a number of injuries. The distribution of injuries is dependent on the type of restraint. Automatic motorized shoulder belts are being used without the accompanying manual lap belt. This greatly reduces the effectiveness of the system and is equal to the two-point shoulder belt of the 1960s. Airbag injuries include abrasions to the face, neck, and chest; minor burns to the upper extremities; and chemical keratitis. Airbags have been shown to reduce injuries overall, especially when used in conjunction with a lap and shoulder belt. Elderly patients incur more rib and sternal fractures due to seat belts than do younger patients. Nevertheless, restraint systems are effective at reducing serious internal injuries in this population. Children who are too large for child safety seats but too small for adult seat belts are at increased risk for injury. Improvement in restraint systems for children in this age range is recommended. All pregnant women should be encouraged to wear seat belts because they reduce maternal injuries, and there is no evidence that they increase the risk of fetal loss. In view of the injury reduction associated with passenger restraint systems, emergency physicians should emphasize to their patients the importance of wearing seat belts.     

Nailgun injuries of the hand

Nailgun injuries of the digits and palm are an occupational hazard for carpenters. Sixty-five percent of all nailgun injuries have been reported to involve the hand. Clinically they can be further classified into three types, varying with the injury and the prognosis. Prompt nail removal after i.v. antibiotics, minimal wound debridement, operative curettement of the nail tract with removal of any foreign material, irrigation, open wound drainage, and nonoperative treatment of skeletal injuries resulted in healing without infection and with good function in seven cases.     

Risk-Based Framework for Safety Investment in Construction Organizations

The costs of construction injuries can have a substantial impact on the financial success of construction organizations and increase the overall costs of construction up to 15%. Following the Occupational Safety and Health Act of 1970, construction firms began to implement a variety of management techniques to reduce the frequency of injuries. Although these strategies decrease the cost of injuries, they consume time and other significant resources. Thus, it is imperative for construction organizations to objectively evaluate the cost-benefit of investments in injury prevention through formal and robust processes. This paper presents a risk-based framework that can be used to evaluate the incremental return on investment of a series of investments in highly effective injury prevention strategies. The framework was developed using foundational risk quantification and analysis techniques and is illustrated using a hypothetical case study that is based on archival data published by United States government agencies. The conclusion of this study is that the optimal investment strategy can be identified through a formal analysis and that optimization depends on the frequency and cost of injuries, the sequence in which the specific injury prevention techniques are implemented, the risk mitigated by each strategy, and the organization’s attitude toward acceptable risk.     

Ethical dimensions of nurse-physician relations in critical care

The exact role and the function of the scapula are misunderstood in many clinical situations. This lack of awareness often translates into incomplete evaluation and diagnosis of shoulder problems. In addition, scapular rehabilitation is often ignored. Recent research, however, has demonstrated a pivotal role for the scapula in shoulder function, shoulder injury, and shoulder rehabilitation. This knowledge will help the physician to provide more comprehensive care for the athlete. This "Current Concepts" review will address the anatomy of the scapula, the roles that the scapula plays in overhead throwing and serving activities, the normal biomechanics of the scapula, abnormal biomechanics and physiology of the scapula, how the scapula may function in injuries that occur around the shoulder, and treatment and rehabilitation of scapular problems.     

High-versus low-dose erythropoietin in extremely low birth weight infants. The European Multicenter rhEPO Study Group

BACKGROUND: Road traffic accidents (RTA) are an important yet preventable cause of death and disability in developing countries like Pakistan. Yet accurate epidemiological data on injuries in developing country injuries is often difficult to obtain. We applied the capture-recapture method to estimate the death and injury rates due to RTA in Karachi. METHODS: We applied the two-sample capture-recapture method using traffic police records as one source of capture and the logs of a non-government ambulance service as the second capture source for the same 10 months and 20 days for which 1994 data were available. We generated a conservative adjusted estimate of injuries and deaths by considering entries in the two sources as matched if they reported the same date, time, and place, and at least one of the other matching variables, of name, vehicle registration number, vehicle types or patient outcome. We then compared the estimated rates with the police rates. RESULTS: In 1994 police reported 544 deaths and 793 injuries due to RTA while ambulance records noted 343 deaths and 2048 injuries. The capture-recapture analysis estimated at least 972 (95% CI: 912-1031) deaths and 18,936 (95% CI: 15,507-22,342) injuries attributable to RTA during the study period. Official sources counted only 56% of deaths and 4% of serious injuries. The estimated rates for the year 1994 were 185 injuries and 11.2 deaths per 100,000 population. CONCLUSION: Road traffic injuries and deaths in Karachi are a much more substantial health problem than is evident from official statistics.