Sports-related injuries of the elbow

Technique Selection 'the Coaches Challenge' Influencing Injury Risk During the First Contact Hand of the Round off Skill in Female Gymnastics

The importance of technique selection on elbow injury risk has been identified for the key round off skill in female gymnastics, with a focus on the second contact limb. The aim of this study was to shift the focus to the first contact limb and investigate the biomechanical injury risk during parallel and T-shape round-off (RO) techniques. Seven international-level female gymnasts performed 10 trials of the RO to back-handspring with parallel and T-shape hand positions. Synchronized kinematic (3D motion analysis system; 247 Hz) and kinetic (two force plates; 1235 Hz) data were collected for each trial. The t-test with effect size statistics determined differences between the two techniques. No significant differences were found for vertical, anterior posterior and resultant ground reaction force, elbow joint kinematics and kinetics. Specifically, the results highlighted that change in technique in RO skills did not influence first contact limb elbow joint mechanics and therefore, injury risk. The findings of the present study suggest the injury potential of this skill is focused on the second limb during the parallel technique of this fundamental gymnastic skill.

Valgus extension overload syndrome in adolescent baseball players: clinical characteristics and surgical outcomes

BACKGROUND

Little is known about the clinical characteristics and surgical outcomes of valgus extension overload syndrome (VEOS) in adolescent athletes. We evaluated posteromedial compartment pathology, including combined lesions, and reported the surgical outcomes in adolescent baseball players.

METHODS

We retrospectively reviewed the medical records of 13 male adolescent baseball players (mean age, 15.4 years) who underwent arthroscopic olecranon tip resection (n = 9) or staged operations (arthroscopic olecranon tip resection, followed by medial collateral ligament reconstruction 2 weeks later; n = 4). The shape of the tip fragment was used to classify the olecranon into 2 types: type 1, dot-like fragment (n = 3); type 2, triangular-shape fragment (n = 10). Four outcome measures were analyzed: range of motion, visual analog scale (VAS) pain score, rate of return to play, and Conway scale score.

RESULTS

At a mean follow-up of 3.3 years (range, 2-6 years), the mean VAS pain score decreased from 4.1 preoperatively to 1.1 postoperatively (P < .05). Preoperative mean extension and supination were 4.2° and 70.0°, which improved to 1° (P < .05) and 76.2° (P < .05), respectively. The overall rate of return to play was 85% (11 of 13). On the Conway scale, 8 of 13 patients (62%) were classified as excellent. Patients who underwent isolated arthroscopic surgery reported less pain postoperatively and achieved a higher grade on the Conway scale than patients who underwent staged operations.

CONCLUSIONS

Arthroscopic resection of olecranon tip yielded favorable outcomes at a minimum of 2 years of follow-up. Patients with concomitant ulnar collateral ligament insufficiency had less optimal outcomes than those with isolated posteromedial impingement.

Dynamic hinged orthosis following a surgical reattachment and therapy protocol of a distal triceps tendon avulsion

Triceps avulsion injuries are not very common injuries. These authors describe an orthosis and protocol they utilized to successfully treat a client following a triceps avulsion injury. - Victoria Priganc, PhD., OTR, CHT, CLT, Practice Forum Editor.

Upper body contributions to power generation during rapid, overhand throwing in humans

High-speed and accurate throwing is a distinctive human behavior. Achieving fast projectile speeds during throwing requires a combination of elastic energy storage at the shoulder, as well as the transfer of kinetic energy from proximal body segments to distal segments. However, the biomechanical bases of these mechanisms are not completely understood. We used inverse dynamics analyses of kinematic data from 20 baseball players fitted with 4 different braces that inhibit specific motions to test a model of power generation at key joints during the throwing motion. We found that most of the work produced during throwing is generated at the hips, and much of this work (combined with smaller contributions from the pectoralis major) is used to load elastic elements in the shoulder and power the rapid acceleration of the projectile. Despite rapid angular velocities at the elbow and wrist, the restrictions confirm that much of the power generated to produce these distal movements comes from larger proximal segments, such as the shoulder and torso. Wrist hyperextension enhances performance only modestly. Together, our data also suggest heavy reliance on elastic energy storage may help explain some common throwing injuries and can provide further insight into the evolution of the upper body and when our ancestors first developed the ability to produce high speed throws.

A survey of practice patterns for rehabilitation post elbow fracture

BACKGROUND AND PURPOSE

Elbow fractures amount to 4.3% of all the fractures. The elbow is prone to stiffness after injury and fractures can often lead to significant functional impairment. Rehabilitation is commonly used to restore range of motion (ROM) and function. Practice patterns in elbow fracture rehabilitation have not been defined. The purpose of this study was to describe current elbow fracture rehabilitation practices; and compare those to the existing evidence base.

METHODS

Hand therapists (n=315) from the USA (92%) and Canada (8%) completed a web-based survey on their practice patterns and beliefs related to the acute (0-6 weeks) and functional (6-12 weeks) phases of elbow fracture rehabilitation.

RESULTS

More than 99% of respondents agreed that fracture severity, co-morbidities, time since fracture, compliance with an exercise program, psychological factors, and occupational demands are important prognostic indicators for optimal function. Strong agreement was found with the use of patient education (95%) and active ROM (86%) in the acute stage while, home exercise programs (99%), active ROM (99%), stretching (97%), strengthening (97%), functional activities (ADLs and routine tasks) (97%), passive ROM (95%), and active assisted ROM (95%) were generally used in the functional stage. The most commonly used impairment measures were goniometry (99%), Jamar dynamometry (97%), and hand held dynamometry (97%). Agreement on the use of patient-reported outcome measures was very minimal (1.3%- 35.6%).

CONCLUSIONS

Exercise, education, and functional activity have high consensus as components of elbo fracture rehabilitation. Future research should focus on defining the optimal dosage and type of exercise/activity, and establish core measures to monitor outcomes of these interventions.

Arthroscopic treatment of posterior impingement of the elbow in athletes: a medium-term follow-up in sixteen cases

HYPOTHESIS

Evaluate the effectiveness of arthroscopic treatment of posterior impingement in the athletes elbow.

MATERIALS AND METHODS

16 elbows were included. An arthroscopic debridement of the posterior fossa of the elbow was performed. All Patients were evaluated preoperatively and after an average of 38 (30-53) months using range of motion, the Modified Andrews Elbow Scoring System (MAESS), VAS in rest and after provocation.

RESULTS

The average flexion increased from 138 degrees to 140 degrees . The extension deficit of 8 degrees preoperatively increased to a deficit of average 2 degrees (P < 0.05). The MAESS increased from average preoperative to excellent postoperative (P < 0.05). The average VAS in rest decreased from 3 to 0 and during sporting activities the VAS decreased from 7 to 2 (P < 0.05).

DISCUSSION AND CONCLUSION

In this series, arthroscopic debridement of the posterior fossa in athletes with posterior impingement is a procedure that showed excellent mid term results and can therefore be recommended.

LEVEL OF EVIDENCE

Level 4; Retrospective case series, no control group.