HUMERAL FRACTURES IN ‘ARM WRESTLERS‘

We report three cases of fractures of the shaft of the humerus occurring during arm wrestling contests, which have now become a common pub — and even professional — sport. We then review all the literature on the subject. This is an unusual injury occurring in arm wrestling, but does occur and it should be remembered that radiological assessment is vital if this injury is not to be missed and the injury mismanaged.     

Spiral fracture of the humerus in a ball thrower

Spiral fractures of the humerus in ball throwers are rare clinical entities that can be confused with pathologic fractures. These fractures have been reported in various throwing sports, arm wrestling, and hand grenade throwing. They most commonly occur in the distal third of the humerus in young, active individuals. They are often preceded by throwing arm pain. Neurologic sequelae are rare. Herein, a case is presented of spiral fracture of the humerus in a softball player, and the assessment and management of these fractures, as well as their etiologic contrast to stress and pathologic fractures, are reviewed.     

A Rare Case of Posterior Interosseous Nerve Palsy Associated With Radial Head Fracture

Background: Radial head fractures are the most common fractures occurring about the elbow in adults, but there have been few reported cases of associated nerve injury. The little-known posterior interosseous nerve travels in close proximity to the radial head and is particularly susceptible to injury. Objectives: The objectives of this case report include raising awareness of the possibility of posterior interosseous nerve palsy after radial head fracture and reviewing the clinical assessment of the posterior interosseous nerve to exclude occult injury. Case Report: Here we report a case of a 21-year-old man who developed a posterior interosseous nerve palsy after a fracture of the radial head sustained during a wrestling match. He also sustained frostbite to the extremity due to overaggressive icing of the injury. Conclusions: Physicians should screen patients with radial head fractures for associated nerve injury. A thorough neurovascular examination with attention to the motor innervation patterns in the hand and wrist will help identify posterior interosseous nerve involvement. Careful discharge instructions will help prevent iatrogenic frostbite from overaggressive icing of injuries.     

Total venous obstruction following atrioventricular sequential pacemaker implantation

We describe a case of a 79-year-old woman who developed pain and pitting edema of the upper right extremity due to total venous obstruction following the implantation of an atrioventricular sequential pacemaker. She was treated by arm elevation and anticoagulation after which the pain and edema subsided. To our knowledge, this is the first reported case of this complication occurring following implantation of a dual-chamber pacing system. We recommend that venographic studies be done after implantation if apparent arm swelling occurs, and that anticoagulant therapy be instituted if thrombosis is present.     

Total Venous Obstruction Following Atrioventricular Sequential Pacemaker Implantation

We describe a case of a 79-year-old woman who developed pain and pitting edema of the upper right extremity due to total venous obstruction following the implantation of an atrioventricular sequential pacemaker. She was treated by arm elevation and anticoagulation after which the pain and edema subsided. To our knowledge, this is the first reported case of this complication occurring following implantation of a dual-chamber pacing system. We recommend that venographic studies be done after implantation if apparent arm swelling occurs, and that anticoagulant therapy be instituted if thrombosis is present.     

Novel double-superior-trunk injury of the brachial plexus: a case report

Brachial plexus injuries are generally rare and a double-superior-trunk injury of the brachial plexus has never been reported before. We report the first case of a brachial plexus injury in a 43-year-old Chinese male with a double superior trunk. This was observed incidentally during an operation 1 month after initial traction injury sustained in a car accident. The double superior trunk of the brachial plexus was formed by the double roots of C5 and C6, respectively. Six months after discharge, the patient reported the recovery of most of the function of his left arm except the muscles innervated by the radial nerve. Two years after discharge, he reported almost full functional recovery of his left arm. We discuss what is known about anatomical variations of the brachial plexus, and the possible association between this novel brachial plexus anatomy and the almost complete functional recovery of the arm.     

Unilateral brachial plexus injury as a complication of thoracoscopic sympathectomy for hyperhidrosis: a case report

Unilateral brachial plexus injury is a rare complication of thoracoscopic sympathectomy, which is generally considered to be a simple and safe procedure. We report on a 26-year-old man who developed weakness and numbness of the right arm after thoracoscopic sympathectomy for hyperhidrosis. Electromyographic study revealed evidence of denervation in the upper trunk of the right brachial plexus. A nerve conduction study on the right axillary nerve revealed a reduced compound muscle action potential amplitude at the right deltoid muscle. We suggest that this complication was caused by stretch and/or compression when the arm was hyperabducted during the operation. The outcome was excellent, with almost complete recovery 3 months later. The complication can be prevented by minimizing operation time and avoiding hyperabduction of the arm. The prognosis for postoperative brachial plexopathy is usually good with conservative management.     

Burners and stingers

The burner or stinger syndrome is one of the most common injuries in football and most likely represents an upper cervical root injury. Other sports reported include wrestling, hockey, basketball, boxing, and weight lifting. The athlete experiences radiating pain, numbness, or tingling down one upper limb, usually lasting less than 1 minute. Recurrences are common and can lead to permanent neurologic deficits. Burners are usually diagnosed and treated based on physical examination findings, but radiographs, MR imaging, and electrodiagnostic testing may help localize the precise level of injury, identify other associated pathology, and quantify neurologic injury. Management should include education on proper tackling techniques, restoration of neck motion, functional strengthening, and carefully fitted orthosis.     

Decreasing Pain Ratings in Chronic Arm Pain Through Changing a Virtual Body: Different Strategies for Different Pain Types

Modifying the visual aspect of a virtual arm that is felt as one's own using immersive virtual reality (VR) modifies pain threshold in healthy subjects, but does it modify pain ratings in chronic pain patients? Our aim was to investigate whether varying properties of a virtual arm co-located with the real arm modulated pain ratings in patients with chronic arm/hand pain because of complex regional pain syndrome (CRPS) type I (without nerve injury) or peripheral nerve injury (PNI). CRPS (n = 9) and PNI (n = 10) patients were immersed in VR and the virtual arm was shown at 4 transparency levels (transparency test) and 3 sizes (size test). We evaluated pain ratings throughout the conditions and assessed the virtual experience, finding that patients with chronic pain can achieve levels of ownership and agency over a virtual arm similar to healthy participants. All 7 conditions globally decreased pain ratings by half. Increasing transparency decreased pain in CRPS but did the opposite in PNI, whereas increasing size slightly increased pain ratings only in CRPS. We conclude that embodiment in VR can decrease pain ratings in chronic arm pain, although the type of pain determines which strategy to decrease pain is most useful. We discuss this through the interactions between body image and pain perception.Perspective“Embodiment” in VR is useful to decrease pain ratings in chronic pain patients, but the best strategy needs to be tuned to the pain etiology. This approach could potentially help patients with chronic pain and clinicians who seek alternatives to pain management for patients.     

Clavicle fractures

Clavicle fractures are most common in children and young adults, typically occurring in persons younger than 25 years. Its superficial location, its thin midshaft, and the forces transmitted across it make the clavicle a common site for injury. The most common mechanism of injury is a forceful fall with the arm at the side, which commonly occurs during contact sports. Diagnosis can often be made by the history and physical examination, although appropriate radiography should be used to confirm the diagnosis and guide treatment options. Most clavicle fractures occur in the midshaft and can be treated nonoperatively. A prominent callus is common in children, and parents may require reassurance. If a child has no history of trauma, then malignancy, rickets, and physical abuse should be considered. Surgery is an option in fractures that have high potential for nonunion (e.g., displaced or communited fractures, fractures with more than 15 to 20 mm clavicle shortening). Distal fractures are classified based on the relationship to the coracoclavicular ligaments, which determines the likelihood of displacement. Most distal fractures can also be treated nonoperatively; however, certain factors must be considered in children.     

Which type of observation for patients with high-risk mild head injury and negative computed tomography?

OBJECTIVE: Current guidelines suggest hospital admission followed by home monitoring for high-risk patients with mild head injury and negative computed tomography scan. We tested early home monitoring under the care of a competent observer. METHODS: A total of 1480 patients with mild head injury and negative computed tomography scan were prospectively studied. Based on clinical status and available home caretakers, patients were managed by in-hospital observation (n = 646) or early home monitoring (n = 834). Outcome measures were: (1) the detection of previously undiagnosed post-traumatic intracranial injury; (2) neurosurgical intervention; and (3) unfavourable outcome (death, permanent vegetative state or severe disability). RESULTS: In the in-hospital arm, nine cases (1.4%) developed intracranial injuries (in three after discharge). In the early home-monitoring arm, six patients (0.7%) had a previously undiagnosed lesion after re-admission (P = 0.773 versus in-hospital arm). No patients with previously undiagnosed intracranial injuries had a neurosurgical intervention. After 6 months, five patients had died in the home monitoring arm (0.8%) versus eight (1.0%) in the in-hospital arm (P=0.785). No permanent disability or vegetative state was observed. CONCLUSION: Early home monitoring may be safely proposed to selected "high-risk" patients, with an early negative computed tomography scan, normal clinical examination and feasible home monitoring.     

Musculocutaneous nerve injury after simulated freefall in a vertical wind-tunnel: a case report

We report a case of a skydiver with isolated musculocutaneous nerve injury, which occurred after prolonged positioning of the arm during simulated freefall in a vertical wind-tunnel. Musculocutaneous nerve injury is rare, and the mechanism of isolated injury to this nerve is not entirely understood. Isolated peripheral nerve injuries such as this easily mimic other injuries and can be difficult to diagnose. The skydiver complained of right arm weakness and numbness that began after training in a vertical wind-tunnel. Exam revealed weakness in right elbow flexion and forearm supination, and diminished sensation in the right lateral forearm. Electrodiagnostic testing revealed a decreased amplitude in the right lateral antebrachial cutaneous nerve sensory nerve action potential, and fibrillations and positive sharp waves in the biceps and brachialis muscles. By 5 months, the subject reported complete sensory and motor recovery. Physical and electrodiagnostic findings corresponded to the distribution of the musculocutaneous nerve. The mechanism of injury was likely the prolonged abducted, extended, and externally rotated position of the shoulder during simulated freefall. Although isolated nerve injuries are uncommon, unusual activities and physiologic demands of athletes can result in such injuries. It is important to be aware of peripheral nerve injuries to facilitate proper diagnosis and management.     

Effects of Protective Equipment on Frequency and Intensity of Aggression-Provoked Staff Injury

We evaluated the effects of protective equipment on arm and scalp injuries caused by aggressive behavior in a child with autism. During intervention phases in a multiple baseline design, teachers wore arm guards and baseball caps. Wearing the protective equipment reduced the frequency and intensity of arm and scalp injuries. Overall daily frequency of aggression also decreased across baseline and intervention phases. The clinical implications of wearing protective equipment for injury prevention and reduction are discussed.     

Lésion isolée du tendon réfléchi du complexe semi-membraneux chez un volleyeur professionnel. À propos d’un cas

We present the case of a professional volleyball player, referred for posteromedial knee pain following a competition. MRI diagnosed an anterior arm of the semi-membraneous tendinitis associated with a semimembranosus–tibial collateral ligament bursitis. Some key points of the anatomy of the distal semimembranosus complex must be identified; five tendinous arms (including the anterior, or tibial arm) are to be seen with regard to the two synovial bursae associated. Indeed, a fluid distension of the semimembranosus–tibial collateral ligament, recently described, must be considered as a sentinel lesion and could turn the radiologist toward an injury of the distal semimembranosus complex. The physiopathological mechanism of the injury of the distal semimembranosus complex distinguishes two kinds of lesion: the tendinous overstressing and the hyperextension of the young and athletic subject will be responsible respectively for isolated tendinitis of the direct and reflected tendons. The tendinosis of the middle-aged subject will be secondary in repeated microtraumas.     

PICC上肢置管患者贴膜处张力性损伤的调查分析

目的调查并分析PICC贴膜处张力性损伤的发生情况及相关因素,为临床实践提供一定参考。方法采用自行编制的一般资料调查表及张力性损伤影响因素问卷,于2015年3月对在复旦大学附属肿瘤医院PICC门诊进行导管维护的5 444例患者进行调查。结果张力性损伤发生176例,发生率为3. 23%。导管置管部位、贴膜种类、贴膜内是否使用物品及维护护士专业年资对张力性损伤的发生有显著影响(P 0. 05)。结论加强护士相关知识和技能培训,对患者进行有效评估,针对性选择维护用品等措施可在一定程度上降低PICC置管患者贴膜处张力性损伤的发生率。     

Spontaneous migration of bullet from arm to forearm and its ultrasound guided removal

Spontaneous migration of a retained bullet is rare. We are presenting here a case of a 24-year-old male with spontaneous migration of bullet from arm to forearm. At the time of initial injury, bullet was left inside the arm as it was deep and patient had no complaints. Three months after injury, he started complaining of pain over forearm and tingling sensations in the forearm and hand over median nerve distribution. Radiographs showed bullet in the proximal forearm. The bullet was than precisely localized and removed under ultrasound guidance. This case report emphasizes the fact that spontaneous migration of bullet in extremities may occur and have the potential to cause neurovascular damage. Removal under ultrasound guidance is a viable option in such locations.     

Wrestling injuries

The sport of wrestling has a history dating back to ancient times as one of the original Olympic sports. It particularly appeals to adolescents as equally matched opponents engage in competition. There can be no argument that participation in sports helps promote a physically active lifestyle. However, despite the documented health benefits of increased physical activity, those who participate in athletics are at risk for sports-related injuries. This article will discuss wrestling injuries and recommend prevention strategies to keep athletes safe.     

Absolute oral bioavailability of ciprofloxacin.

We evaluated the absolute bioavailability of ciprofloxacin, a new quinoline carboxylic acid, in 12 healthy male volunteers. Doses of 200 mg were given to each of the volunteers in a randomized, crossover manner 1 week apart orally and as a 10-min intravenous infusion. Half-lives (mean +/- standard deviation) for the intravenous and oral administration arms were 4.2 +/- 0.77 and 4.11 +/- 0.74 h, respectively. The serum clearance rate averaged 28.5 +/- 4.7 liters/h per 1.73 m2 for the intravenous administration arm. The renal clearance rate accounted for approximately 60% of the corresponding serum clearance rate and was 16.9 +/- 3.0 liters/h per 1.73 m2 for the intravenous arm and 17.0 +/- 2.86 liters/h per 1.73 m2 for the oral administration arm. Absorption was rapid, with peak concentrations in serum occurring at 0.71 +/- 0.15 h. Bioavailability, defined as the ratio of the area under the curve from 0 h to infinity for the oral to the intravenous dose, was 69 +/- 7%. We conclude that ciprofloxacin is rapidly absorbed and reliably bioavailable in these healthy volunteers. Further studies with ciprofloxacin should be undertaken in target patient populations under actual clinical circumstances.