Hand and wrist injuries in the preadolescent and adolescent athlete.

In this time when physical prowess has been elevated to such a high level, the prepubescent and adolescent athlete have increased demands for performance placed on their immature musculoskeletal system. Although improved skills may result the athlete is exposed to more injury. Prompt, appropriate treatment of the injury with a controlled return to participation may prevent reinjury and disability. To this end, athletes, parents, coaches, trainers, and team physicians must maintain a close rapport for the benefit of the athlete.     

Closed tendon injuries of the hand and wrist in the athlete.

Evaluation and treatment of closed tendon injuries in the athlete is usually fairly straightforward if seen in the acute stages. These usually respond well in most cases to nonoperative treatment; a small percentage require initial operative treatment, however. In most cases, continued participation in sports is possible during treatment as long as protective splinting is allowed.     

Labral tears, extra-articular injuries, and hip arthroscopy in the athlete

Labral tears in athletes can lead to disabling hip pain and affect their athletic performance. Other intra-articular lesions, including chondral injuries, capsular abnormalities, and ligamentum teres tears, commonly coexist with acetabular labral tears. Isolated athletic injury or repetitive traumatic activity can lead to labral tears; however, underlying structural (femoroacetabular impingement) and developmental abnormalities predisposing athletes to labral pathology must be addressed. Recent studies have demonstrated lesions associated with acetabular labral tears, and that labral tears rarely occur as isolated injuries. Return to sport is favorable in athletes who have labral tears if they are properly treated with arthroscopic intervention.     

Shoulder arthroscopy: its role in evaluating shoulder disorders in the athlete

We retrospectively reviewed 100 initial shoulder arthroscopies from a general sports medicine orthopaedic practice to determine if arthroscopy is helpful diagnostically and to see if specific lesions correlate well with specific diagnoses. Seventy-two percent of the patients in the review had glenoid labral tears. Ninety-two percent of patients who had a diagnosis of either recurrent anterior dislocation or recurrent anterior subluxation demonstrated a tear of the anterior inferior margin of the glenoid labrum. Sixty-eight percent of patients with a diagnosis of impingement demonstrated tears at the superior margin of the labrum. There was a significant difference between throwing and nonthrowing athletes. Partial rotator cuff tears were noted in 18 patients, the majority occurring in throwing athletes. Other abnormalities, such as degenerative joint changes and biceps tendon lesions, were also noted at the time of arthroscopy. A large number of glenoid labral tears found at the time of arthroscopy appeared to be associated with conditions other than instability, which may or may not affect the throwing athlete. There also appeared to be a high correlation between tears in the anterior inferior glenoid labrum and anterior instability. Arthroscopy enabled us to identify other significant information about the status of the biceps tendon or the undersurface of the rotator cuff. These are areas in which problems might otherwise have been missed. Degenerative changes of the articular surface, not apparent on plain radiographs, may also be better evaluated arthroscopically.     

Monopolar electrothermal arthroscopy for treatment of shoulder instability in the athlete

Arthroscopic stabilization of the shoulder has gained considerable interest as a treatment alternative for shoulder instability in athletes. Basic science and clinical studies are helping to define the ideal patient population, surgical techniques, and rehabilitation protocols that will enhance our surgical results and maximize patient satisfaction. We describe here our surgical program, basic science foundation, and early clinical results.[/]ab     

Hip arthroscopy in the adolescent and pediatric athlete.

The current literature offers only sparse reports of the use of hip arthroscopy in the pediatric patient injured during athletics. In contrast, the role of this technique in the diagnosis and treatment of multiple childhood hip conditions including pyarthrosis, Legg-Calvé-Perthes disease, slipped capital femoral epiphysis, coxa vara, juvenile chronic arthritis, chondrolysis, and avascular necrosis is well described. The application of this relatively uncommon technique to the young athlete has only recently become more attractive. The ability to examine and treat traumatic intra-articular pathology with minimal morbidity and prompt recovery is mandated by the young age of these patients and their demanding activity levels. Hip arthroscopists are now beginning to correlate preoperative physical exam findings and history with diagnosis and expectations for outcome. As our combined experience with this technique grows, the specific indications for its use in the young athlete become increasingly better defined. In pediatric and adolescent patients, the new onset of hip pain should warrant a high level of suspicion for the more common causes of pain such as infection, Legg-Calvé-Perthes disease, slipped capital femoral epiphysis, or developmental dysplasia. When these have been evaluated, further differential diagnosis should include labral tears, loose bodies, synovitis, and chondral lesions. As this review begins to elucidate, these conditions are amenable to arthroscopic evaluation and treatment. At this time, the presence of reproducible mechanical symptoms after a twisting or axial loading injury during athletics should prompt the orthopaedic surgeon to consider arthroscopic examination of the hip if conservative therapy fails. Satisfying and reproducible results have been achieved when using hip arthroscopy within these parameters.     

Fractures of the hand and wrist in the athlete.

The challenge of treating fractures of the hand and wrist in the athlete is finding innovative ways of internal and external fixation that will allow the athlete to continue participation while the fracture is healing. The challenge is to provide enough immobilization or restriction to allow optimal fracture healing while providing enough freedom to allow the athlete to participate in his sport.     

The use of arthroscopy in the athlete with knee osteoarthritis

Arthroscopy is an important technique in the diagnosis, classification, and treatment of the athlete with osteoarthritis (OA). Reliability of the current classification systems improves with training and experience. Arthroscopy remains superior to imaging in the diagnosis of OA. Arthroscopic lavage and debridement provide benefit in a significant percentage of patients. The reasons for improvement are not fully defined. Arthroscopic treatment of OA is not curative, and results deteriorate with time. Variability in the use of medical management, arthroscopy, osteotomy, and arthroplasty remains among different practitioners. Indications for arthroscopy require further clarification based upon empiric evidence.     

Complications of hand and wrist surgery in the athlete.

The hand injuries reviewed in this article are those about which the treating physician should be suspicious, whether an athlete presents with them on the field or shortly thereafter in the emergency department or clinic. Education on the part of the physician and the patient are the primary safeguards to limiting complications.     

Thoracolumbar injuries in the athlete

Acute thoracolumbar injury in the athlete can be a disabling condition that requires thorough evaluation and treatment. Although most thoracolumbar spine injuries are benign myofascial strains that respond well to nonsurgical management, the spectrum of injuries is broad and includes fractures and bony instability, ligamentous instability, and neurologic compromise. Evaluation of thoracolumbar injuries requires a rapid and focused evaluation at the time of injury to rule out catastrophic and neurologically threatening injuries; a detailed history and physical examination carried out at a later point in time should be paired with appropriate imaging studies. Initial radiographs may be combined with dynamic radiography, bone scanning, computed tomography, or magnetic resonance imaging to delineate the structural extent of injury. Acute treatment may be required and initiated at the time of injury; further treatment should be carried out once the nature and extent of the injury is fully understood. Nonoperative treatment is successful in most of the injuries. Operative treatment is applied in selected cases of structural instability or neurologic compromise.     

Back injuries in the athlete

In summary, the approach to the athlete with low back pain must include an emphasis on aggressive nonoperative intervention, education, and rehabilitation. A diligent attempt must be made to establish a correct diagnosis, though this may be difficult at first. A firm diagnosis allows individualized treatment that meets the strenuous needs of the athlete. Work-up should be standardized to avoid missing what will appear obvious in retrospect. Unlike most of the general patient population, athletes are unlikely to tolerate a long period of "wait and see" therapy. It is necessary to have qualified allied health personnel who can perform a full spectrum to have qualified allied health personnel who can perform a full spectrum of exercise, mobilization, and modality therapies. Return to competition should be gradual but steady, as previous performance levels can usually be obtained following lumbar injuries.     

Athletic injuries of the wrist and hand. Part I: traumatic injuries of the wrist

Hand and wrist injuries in sports are some of the most common injuries reported. This review discusses briefly the causes of hand and wrist injuries in sports and discusses pertinent biomechanical findings regarding the range of motion required in different sports activities. The bulk of the review discusses specific traumatic and overuse injuries to the hand and wrist commonly seen in the athlete. Emphasis is placed on problematic traumatic injuries such as carpal scaphoid fractures and hook of the hamate fractures, as well as ligament injuries to the wrist with regard to diagnosis, treatment, and return to athletic competition.     

Ligamentous injuries of the wrist in athletes.

The athlete's wrist is particularly prone to injury. Although many wrist injuries are dismissed as sprains or strains, a number of these injuries involve significant ligamentous damage that can lead to chronic carpal instability. A complete knowledge of the carpal ligamentous anatomy and classification of wrist instability patterns is necessary for the adequate diagnosis and treatment of these injuries.     

Elbow injuries in the throwing athlete: Diagnosis and arthroscopic treatment

The elbow is a frequent site of pathology in sports injuries, especially in the throwing athlete. This is because of thesignificant stresses that are produced at the elbow joint by the throwing activity. Many of these injuries occur insidiously over time from accumulated microtrauma caused by repetitive overuse and can be quite debilitating if not properly diagnosed. Recent advances in knowledge of elbow anatomy, function, and biomechanics have greatly increased our awareness of the diagnosis and treatment of sports-related elbow injuries. Elbow arthroscopy has been invaluable in the diagnosis and treatment of intra-articular pathology frequently observed in the elbow. In addition, treatment of elbow throwing injuries has been greatly facilitated by allowing an accelerated rehabilitation and return to competition over open procedures. Meticulous arthroscopic technique and knowledge of regional elbow anatomy is essential to avoid neurovascular complications and articular damage. When performed by an experienced arthroscopist, the procedure carries minimal morbidity and allows a rapid return to competition.     

Shoulder injuries in the childhood athlete

Shoulder dysfunction in the young athlete usually is manifested differently than the adult counterpart. The physiology and biomechanics of a growing child and adolescents result in different injury patterns that require different and thoughtful approaches to diagnosis and treatment. Most of these conditions are served well by nonsurgical treatment modalities. Judicious use of surgical interventions, however, can significantly improve patient outcome and return them to their sport of interest. Postoperative rehabilitation, and proper training techniques are essential to ensure continued participation of the athlete.     

Acromioclavicular injuries in the throwing athlete

Acromioclavicular injuries in the overhead or throwing athlete are frequently encountered by team physicians. Treatment regimens vary greatly, depending on dominant versus nondominant arm, injury in-season or out-of-season, and the athlete's goals for future seasons. This article focuses on each of these unique issues with regards to acromioclavicular separations and fractures, acromioclavicular arthritis, and acromioclavicular osteolysis.     

Overuse injuries in the young athlete

Overuse injuries are now well known to sports enthusiasts at any age or level of competition. The seeming explosion of overuse stress fractures of lower extremity bones in high-profile professional basketball players has brought about widespread media attention and a better understanding of the phenomenon of "overuse syndrome" by the public. However, the spectrum of overuse injuries in the child or adolescent athlete has only recently been recognized. These injuries can range from the permanent disability of osteochondritis dissecans of the elbow to the completely nonspecific "growing pains" of active youngsters.     

Elbow injuries in the young athlete

Young athletes sustain fractures, dislocations, and overuse injuries to their elbows. Overuse injuries are particularly troublesome because they begin insidiously. The majority of elbow overuse injuries can be attributed to excessive baseball pitching and are part of the “Little League elbow” syndrome. Elbow overuse problems also occur in overhead racquet sports and in gymnastics. The key to diagnosis, treatment, and prevention is knowledge of the forces about the elbow, strengths of the growing tissues and sequelae to the elbow if injuries are left untreated. Although most of the conditions are managed nonsurgically, arthroscopic techniques are useful to correct those requiring surgical intervention.