Incidence of shoulder dislocation in the United States military: demographic considerations from a high-risk population

BACKGROUND

Little is known of the incidence of shoulder instability, despite some evidence that it may be a common injury in young, athletic individuals. The goal of this study was to determine the incidence of shoulder dislocation in United States military personnel, as well as to identify the demographic risk factors for injury.

METHODS

We performed a query of the Defense Medical Epidemiology Database with the code from the International Classification of Diseases, Ninth Revision, for acute shoulder dislocation for the years 1998 through 2006. An overall injury incidence was calculated, in addition to multivariate analysis, to determine independent risk factors among the following demographic considerations: sex, race, branch of military service, rank, and age.

RESULTS

The overall incidence rate was 1.69 dislocations per 1000 person-years. Significant demographic risk factors were male sex, white race, service in the Army, junior enlisted rank, and an age of less than thirty years (p<0.0001).

CONCLUSIONS

The incidence of shoulder instability among U.S. military personnel (1.69 per 1000 person-years) is considerably higher than previous reports for the general U.S. population (0.08 per 1000 person-years). Male sex, white race, and an age of less than thirty years were significant independent risk factors for injury.

Long-term follow-up of acute arthroscopic Bankart repair for initial anterior shoulder dislocations in young athletes

BACKGROUND

Little is known of the long-term results of acute arthroscopic Bankart repair for first-time traumatic anterior glenohumeral dislocations.

HYPOTHESIS

Acute arthroscopic Bankart repair for first-time traumatic anterior glenohumeral dislocations will provide good results at long-term follow-up.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

The authors evaluated a cohort of young patients who sustained first-time anterior glenohumeral dislocations and were acutely treated with arthroscopic Bankart repair using bioabsorbable tacks. Subjective outcome measures were obtained at a mean follow-up of 11.7 years (range, 9.1-13.9 years).

RESULTS

Thirty-nine patients (40 shoulders) were available of the original cohort of 49 shoulders (82%). Two of the 9 who were lost to follow-up had revision surgery before being lost and are carried forward in the calculations of recurrent instability and revision surgery but are not included in the calculation of the functional scores. The mean Single Assessment Numeric Evaluation was 91.7, the mean Western Ontario Shoulder Instability score was 371.7, the mean subjective Rowe score was 25.3, the mean Simple Shoulder Test was 11.1, the mean American Shoulder and Elbow Society score was 90.9, the mean Short Form-36 Physical Component score was 94.4, and the mean Tegner score was 6.5. Six patients sustained recurrent dislocations for a redislocation rate of 14.3%. Nine patients (21.4%) reported experiencing subluxation events. Six patients (14.3%) underwent revision stabilization surgery.

CONCLUSION

At long-term follow-up, acute arthroscopic Bankart repair for first-time traumatic anterior glenohumeral dislocations resulted in excellent subjective function and return to athletics in young, active patients with an acceptable rate of recurrence and reoperation.

Persistent prolongation of simple reaction time in sports concussion

A baseline computerized cognitive assessment was completed by 483 military cadets before their initial school year. Fourteen cadets concussed during physical education boxing were retested <1 hour after injury and again on return to full activity 4 days later. Compared with baseline testing, postinjury performance on simple reaction time and continuous performance tests was significantly slowed, even after cadets experienced resolution of physical symptoms and were cleared to resume full activity. These findings may be relevant to current concussion management guidelines.

A standardized protocol for the initial evaluation and documentation of mild brain injury

OBJECTIVE

To present a protocol for the initial assessment and documentation of mild brain injury, a protocol that is used within the Department of Physical Education at the United States Military Academy.

BACKGROUND

Recently, much attention has been given to the assessment and management of mild brain injury by the sports medicine community. Although the classification of and management strategies for mild brain injury have been well disputed, most experts agree on the essentials of the sideline or initial evaluation. According to leading experts, if an athlete has experienced an episode of mild brain injury, the initial signs and symptoms, as well as the course of those signs and symptoms, should be documented.

DESCRIPTION

Although many athletic training texts formerly discussed techniques for evaluating an episode of mild brain injury, few present an objective protocol to follow. Our protocol includes 3 components. The first component is the initial evaluation, which incorporates serial observations during the first 20 minutes after injury, with neurologic checks every 5 minutes. The second component includes a take-home sheet for athletes not referred to a physician for further evaluation. The third part of the protocol is a 24-hour postinjury follow-up examination for any signs or symptoms of postconcussion syndrome. Finally, we present the indications for referral to a physician for further evaluation. CLINICAL ADVANTAGES/RECOMMENDATIONS: Using a standard protocol to guide evaluation and to document the initial course of signs and symptoms after mild brain injury allows the sports medicine staff to make better management decisions. In addition, patient instructions and the course of follow-up evaluations can be improved if a standard protocol is employed. Our protocol has been developed to meet the needs both of athletes who are exposed to mild brain injury on a daily basis and of the certified athletic trainers who initially evaluate them; the protocol can be adapted to the individual needs of each athletic training setting.

Avulsion of the inferior canaliculus in a collegiate wrestler: a case study

OBJECTIVE

The purpose of this case study is to aid sports health care personnel in understanding the accurate identification and treatment of traumatic sports injuries involving structures of the lacrimal system.

BACKGROUND

A 21-year-old, 118-pound wrestler sustained an avulsion of the inferior canaliculus of the right eye during a match. The injury resulted when the athlete was struck on the right cheek by the opponent's head, producing an inferior and lateral force. Following the initial control of hemorrhage, the athlete was permitted to complete the match. Upon initial evaluation, it was determined that the medial aspect of the lower right lid had been avulsed. The injury was approximately 1 cm in length. The athlete completed the match before being referred to the hospital for further evaluation.

DIFFERENTIAL DIAGNOSIS

Avulsion of the medial one-sixth of the lower right eyelid, involving damage to the inferior canaliculus lus and complete avulsion of the inferior medial canthal tendon.

TREATMENT

Surgical intervention was indicated in order to restore the lacrimal drainage system and to ensure patency of the inferior canaliculus. A bicanalicular silicon intubation procedure edure was utilized by the physician. Initial postoperative treatment included the application of topical antibiotics for seven days. The athlete was permitted to return to full participation within 1 week with the use of a wrestling face mask. The superficial sutures were removed 14 days following surgery and at that time the athlete was cleared for unrestricted activity. The silicon-reinforced medial canthal tendon suture was removed 6 weeks following surgical repair. The bicanalicular silicon stent was removed 6 months following initial injury and surgical intervention. No complications were noted throughout the 6-month postoperative stage or at the time of a follow-up interview 2 years postinjury.

UNIQUENESS

This is a relatively uncommon injury to encounter in athletics and one that has not been well addressed in the existing sports medicine literature.

CONCLUSIONS

When injury to the medial aspect of the eye occurs, recognition of the potential for lacrimal system involvement is essential. Therefore, the athletic trainer should be familiar with the anatomy of the lacrimal system and the potential for such injuries.

Bishop Tuff Revisited: New Rare Earth Element Data Consistent with Crystal Fractionation

The Bishop Tuff of eastern California is the type example of a high-silica rhyolite that, according to Hildreth, supposedly evolved by liquid-state differentiation. New analyses establish that the Bishop Tuff "earlyllate" rare earth element trend reported by Hildreth mimics the relations between groundmass glasses and whole rocks for allanite-bearing pumice. Differences in elemental concentrations between whole rock and groundmass are the result of phenocryst precipitation; thus the data of Hildreth are precisely those expected to result from crystal fractionation.