Preventing sudden death on the athletic field: The emergency action plan

Sudden cardiac arrest (SCA) is the leading cause of death in young athletes. Proper management of SCA in the athletic venue is critical. Preparation should include education and training, maintenance of emergency equipment and supplies, appropriate use of personnel, and the formation and implementation of an emergency action plan (EAP). The EAP should be specific to each individual athletic venue and encompass emergency personnel, emergency communication, emergency equipment, medical emergency transportation, and venue directions with map. With SCA, access to early defibrillation is essential. A target goal of under 5 minutes from time of collapse to first shock is strongly recommended. An automated external defibrillator should be part of standard emergency planning for coverage of athletic activities. Through development and implementation of an EAP, healthcare providers help to ensure that the athlete will have the best care provided when an emergency situation does arise.     

Posterior Chondrolabral Cleft: Clinical Significance and Associations with Shoulder Instability

Background

A high signal intensity cleft between the labrum and articular cartilage of the posterior glenoid is commonly visible on MRI and has been suggested to be anatomic variation [3, 10, 23]. The association of a posterior cleft with variations in glenoid morphology or with shoulder instability is unknown.

Questions/Purposes

The purposes of this study were to determine if posterior chondrolabral clefts are associated with variations in glenoid morphology, and to determine if they are associated with shoulder instability.

Patients and Methods

Shoulder MRI was performed in 1,264 shoulders, 1,135 male (89.8%), and 129 female (10.2%). A musculoskeletal radiologist blinded to history and outcomes evaluated the MR images for linear high signal intensity at the posterior chondrolabral junction and a rounded or truncated contour of the posterior glenoid. Glenoid version and depth were measured. Patients were followed prospectively for shoulder instability for 4 years. Univariate and multivariate statistical analysis were performed.

Results

Posterior chondrolabral cleft was present in 114/1,264. Posterior chondrolabral cleft was associated with a rounded or truncated posterior glenoid. There were 9.5° retroversion in shoulders with a posterior cleft, and 7.7° retroversion in shoulders without a cleft. Shoulders with a posterior chondrolabral cleft were more likely to develop shoulder instability.

Conclusions

Posterior chondrolabral clefts are not uncommon on MRI. They are associated with a rounded or truncated posterior glenoid and a small but significant increase in glenoid retroversion. They are associated with shoulder instability.     

Postoperative Falls After Total Knee Arthroplasty in Patients With a Femoral Nerve Catheter: Can We Reduce the Incidence?

A femoral nerve catheter (FNC) is often used to minimize pain following total knee arthroplasty (TKA), but complications including inpatient falls, may increase as a result, despite fall prevention protocols. We evaluated the rate of falls in 707 primary TKAs performed with an FNC at a major academic center from May 2009 to September 2012. Despite a formalized fall prevention protocol, we found 19 falls (2.7%). Three patients required further operative intervention. At a rate of 2.7%, postoperative fall is one of the most common complications of TKA at our institution. While pain control may be good with the use of FNCs following primary TKA, improvements in fall prevention strategies or the use of alternative postoperative pain control modalities may need to be considered.     

Intrinsic pedal musculature support of the medial longitudinal arch: an electromyography study

Much of the work describing support of the medial longitudinal arch has focused on the plantar fascia and the extrinsic muscles. There is little research concerning the function of intrinsic muscles in the maintenance of the medial longitudinal arch. Ten healthy volunteer adults served as subjects for this study, which was approved by the University Investigational Review Board. The height of the navicular tubercle above the floor was measured in both feet while subjects were seated with the foot in a subtalar neutral position and then when standing in a relaxed calcaneal stance. Subtalar neutral was found by palpating for talar congruency. Recordings of muscle activity from the abductor hallucis muscle were performed while the subjects maintained a maximal voluntary contraction in a supine position by plantarflexing their great toes. An injection of lidocaine (1% with epinephrine) was then administered by a Board-certified orthopedic surgeon in the region of the tibial nerve, posterior and inferior to the medial malleolus. Measurements were repeated and compared by using a paired t test. After the nerve block, the muscle activity was 26.8% of the control condition (P = .011). This corresponded with an increase in navicular drop of 3.8 mm. (P = .022). The observation that navicular drop increased when the activity of the intrinsic muscles decreased indicates that the intrinsic pedal muscles play an important role in support of the medial longitudinal arch.     

Rehabilitation including sport-specific functional progression for the competitive athlete

Rehabilitation of the injured athlete typically follows a pre-determined protocol utilizing clinic-based therapy techniques for the restoration of range of motion, flexibility, muscular strength, and endurance. While these techniques have proven to be successful in returning athletes back to activity, they often do not include exercises and activities related to the athlete's sport. The combination of clinic-based and sport-specific functional techniques will provide an individualized, sport-specific rehabilitation protocol for the athlete. This article serves three purposes for athletic therapists who are involved with the rehabilitation of competitive athletes. First, a discussion of clinic-based rehabilitation explores several areas to consider in the design of a protocol. Next, sport-specific functional exercises, progressions, and assessments are presented. Lastly, a rehabilitation protocol for a soccer forward illustrates the use of sport-specific exercises for his or her return to competitive activity.