Rotational ligamentous injuries to the ankle in football

It is the author's belief that supination injuries with tear of the talofibular ligament are the most frequent ankle ligamentous injuries encountered on the football field (Figure 4). However, the author believes that the more significant injury is the rupture of the tibiofibular ligament and interosseous ligament incurred in pronation and external rotation. (Figure 5). Twenty time-loss injuries of significance, encountered over a five year period in one football team, are presented. The mechanism of injury and the force encountered at the ankle during an interruption of the normal sequence of running and turning on the football field are presented. It is the author's opinion that rigid immobilization of the more significant injury is necessary in order to return the participant to active athletics within a reasonable length of time. It is hoped that this report will stimulate others to closely evaluate ankle injuries occurring on the football field.

Athletic injuries: Heat vs. cold

Cryotherapy is the treatment of choice in the management of acute athletic injuries. Ice is readily available and simple to apply. The rationale for its use is based on well-defined physiologic observations. The application of heat is not indicated in the immediate treatment of acute athletic injuries. If applied early and injudiciously, heat may adversely affect resolution of the trauma and prolong the rehabilitation of the athlete.

The lumbar disc

Some cases of low back pain and sciatica can be due to chemical radiculitis caused by irritant glycoprotein from the nucleus pulposus in contact with the nerve root. The beneficial effects of active and maintenanc f mobilization of the nerve root.

Pulled elbow: a study of 100 patients

Pulled elbow is a common condition but may not be recognized by practitioners unaware of its existence. Most of a series of 100 children with this condition were aged 1 or 2 years, and none were over 6 years. An important precipitating factor was the normal recalcitrance of the 1-3 age group. The three children who were over 5 years had all had earlier episodes which may have stretched the annular ligament. The wrist was the most common site of pain after the elbow. A single manipulation was successful in 96 cases but multiple manipulations may be needed.

Proximal interphalangeal joint injuries and their initial treatment

Many PIP joint injuries which appear to be innocuous are actually very severe injuries to this small hinged joint and carry a high percentage of disability for the hand as well as the individual digit. A flexion contracture of the PIP joint of one digit may significantly reduce the functional capacity of the entire hand. To prevent such physical impairment, the type of PIP joint injury must be defined and the proper treatment for the particular injury must be initiated. Second, it is paramount that prolonged immobilization of this joint be prevented. It has been found, through clinical experience and experimental projects, that the early healing process is complete by 3 weeks and active motion may then be initiated without any detrimental effects. Extensor and flexor contractures of this joint are apt to occur in digits which have been immobilized for significantly longer than 3 weeks. Finally, the well-publicized "position of function" for the hand is not necessarily the ideal position for the rehabilitation of the hand. The "intrinsic plus position" is the position of choice for immobilization of the MP and PIP joints to prevent contractures. This concept has been confirmed by our clinical experience and the biomechanical studies performed in the laboratory.

Injuries of the midtarsal joint

Injuries involving the midtarsal joint, which are frequently misdiagnosed, have been studied to clarify the mechanism, classification and treatment. The necessity for routine antero-posterior, lateral and oblique radiographs is emphasised. Seventy-one injuries have been classified according to the direction of the deforming force:medial, longitudinal compression, lateral, plantar and crush types are described. Included in the medial and lateral types is a hitherto undescribed tarsal rotation or "swivel" injury. The mechanism whereby longitudinal compression causes fractures of the body of the navicular is described, and two varieties having different prognoses are defined: one due to purely longitudinal compression and the other due to longitudinal compression with a medial component. The results of treatment have been assessed clinically and radiologically. Reduction, open if necessary, with internal fixation, is recommended for displace fractures: primary arthrodesis is not indicated. For severe persistent symptoms from medial and longitudinal force injuries triple arthrodesis is recommended, and from lateral force injuries, calcaneo-cuboid arthrodesis.

Treatment of soft-tissue injuries by pulsed electrical energy

Twenty pairs of patients matched for sex, age, weight, and degree of trauma were treated either with an active Diapulse machine emitting pulsed, high-frequency electrical energy or with a non-active placebo machine. They were examined for swelling, pain, and disability before treatment and after three days under double-blind conditions. The results show that the pulsed, high-frequency electrical treatment has a definite biological effect on recently injured soft tissues, especially in the reduction of pain and disability.