Injuries Of Upper Extremity Research Articles

Reliability and Validity of the Star Excursion Balance Test for Evaluating Dynamic Balance of Upper Extremities.

Upper extremity (UE) dynamic balance is a significant physical fitness ability, which includes high-level neuromuscular proprioception, joint mobility, force, and coordination. The evaluation methods of UE dynamic balance are insufficient and lack experimental support. The Star Excursion Balance Test (SEBT) is a reliable assessment of dynamic balance and injury risk of the lower extremity. The UE-SEBT is a reliable and reproducible approach for evaluating dynamic balance of UEs. Observational study. Level 4. This cross-sectional study recruited 65 healthy adults. All participants were required to complete UE-SEBT, UE Y-balance test (UE-YBT), maximal voluntary isometric contraction (MVIC) of UE, closed kinetic chain UE stability test (CKCUEST), trunk flexor endurance test (TFET), trunk extensor endurance test (TEET), and lateral trunk endurance test (LTET). Intra- and inter-rater reliability and the correlation of UE-SEBT with other outcomes were measured. Among the participants, the intra- and interoperator reliability of UE-SEBT in all directions and composite score achieved a moderate-to-excellent (intraclass correlation coefficients [ICC], 0.729-0.946) reliability. For validity, the UE-SEBT had a moderate to very strong correlation with UE-YBT (r = 0.315-0.755, P < 0.01) and a strong correlation with CKCUEST (r = 0.4-0.67, P < 0.01). Furthermore, the UE-SEBT performance showed weak-to-strong correlations with MVIC (r = 0.26-0.43, P < 0.05). UE-SEBT was also correlated with LTET, TEET, and TFET to varying degrees. UE-SEBT has good reliability and validity to assess UE dynamic balance compared with other tests. UE-SEBT can be used as a clinical assessment method to evaluate UE dynamic balance and injury prevention.

Traumatic brain injury is common and undertreated in the orthopaedic trauma population

IntroductionTraumatic brain injuries (TBIs) can be difficult to diagnose and are often marginalized when compared to more obvious physical injuries. Despite this, recognition and early treatment can lead to improved outcomes. Even mild TBIs have the potential to cause significant long-term consequences for patients, which may affect their physical recovery from orthopaedic injuries. The objective of this study was to examine the incidence and treatment of TBI within the orthopaedic trauma population. MethodsInclusion criteria were all patients presenting after an acute trauma with an orthopaedic surgery consult over a continuous 3 month timeframe (n = 187). A retrospective review was completed at an academic tertiary referral trauma center. The primary outcome was the rate of TBI. Secondary outcomes included rate of TBI listed as a discharge diagnosis and rate of follow up plan. Several secondary variables were noted and their associations with TBI evaluated. Results27 % of the 187 patients had an acute TBI. 61 % of TBI patients had the diagnosis listed in their discharge summary. 6 % had a follow up plan. The positive TBI group was associated with more high energy injuries (p = 0.032), average limbs involved (p = 0.007), upper extremity injury (p < 0.001), bilateral lower extremity injury (p = 0.004), and Injury Severity Score (p < 0.001). 82 % of patients with an acute TBI had an occupational therapy consult and 39 % had a neurosurgery consult. 24 % of patients with a TBI were admitted to the orthopaedic primary service. ConclusionsPatients presenting after an acute trauma with orthopaedic injuries have high rates of TBI, but low rates of diagnosis and treatment. This lack of diagnosis and treatment can negatively impact recovery from orthopaedic injuries. Orthopaedic providers should be aware of the diagnostic criteria and initial treatment steps for TBI to ensure prompt and effective treatment, which has been shown to improve outcomes.

Use of Biodegradeable Temporizing Matrix Dermal Template for Reconstruction of Upper Extremity Soft Tissue Defects with Associated Tendon Injury.

In cases of complex upper extremity soft tissue defects with exposed bone or tendon, the surgeon needs to consider both restoration of stable soft tissue coverage and functional outcomes, which requires early motion and a wound bed suitable for tendon gliding. Often, local, regional, or free flaps are necessary; however, good outcomes have also been reported after staged reconstruction with a dermal template and split-thickness skin grafting. To our knowledge, staged reconstruction with a dermal template has not been described for soft tissue defects with an associated underlying tendon injury requiring tenorrhaphy. We have previously reported our experience with a synthetic dermal template [Novosorb BTM (Biodegradable Temporizing Matrix), Polynovo North America LLC. Carlsbad, Calif.] for the reconstruction of complex upper extremity defects with exposed tendon and showed that it consistently and reliably integrates even when these patients were treated with an early, active therapy protocol. As a result of these findings, we hypothesized that BTM could potentially be used over a tendon repair site without compromising functional outcomes. Here, we report on clinical outcomes for two patients with upper extremity injury where BTM was applied directly over a tendon repair or transfer site and resulted in stable soft tissue coverage with excellent tendon gliding. These early results show that this approach might be considered as an alternative to autologous tissue reconstruction in these patients and could reduce donor site morbidity associated with flap harvest.

Vascular surgery experience for major vascular injuries in the Beirut Blast: Lessons learned

BackgroundThe Beirut Port Blast on August 4, 2020, was the largest non-nuclear blast in history. It heavily affected the fragile population already facing an ongoing political and socioeconomic crisis, and the coronavirus diease 2019 pandemic. This article is a review of major vascular injury patterns and mechanism, strategies of treatment, and physician experience. MethodsThis retrospective review was performed on all patients who presented to the Lebanese American University Medical Center—Rizk Hospital after the Beirut Blast owing to vascular injuries. All patients presenting with major vascular injuries requiring admission, operations, or who were deceased owing to vascular injuries were included. Basic identification and medical history data were extracted. The surgical procedures and postoperative care and outcomes were also recorded. ResultsEigtheen patients who presented to our institution during the day of the blast were included. Two patients passed away in the emergency room. The remaining 16 patients required surgeries. Most vascular injuries were caused by debris and shattered standard glass. The location of the vascular injuries were diverse; six patients (33.3%) had neck injuries, nine patients (50%) had upper extremity injuries, and three patients (16.6%) had lower extremity injuries. Furthermore, all patients had venous injuries (100%), and nine patients (50%) had arterial injuries. ConclusionsAfter the Beirut Blast, the major vascular injury seen was in the upper extremity, followed by the neck and lower extremity, mostly owing to shattered nonlaminated glass. Laminated or tempered glass should be considered superior to standard nonlaminated glass during Beirut renovation and areas at high risk for bombing, wars, and natural disasters like earthquakes. Awareness and knowledge of bleeding control is a must for people living in such risky environments. Venous injuries were more common and managed safely by ligation. Arterial injuries required a more extensive approach based on the location and extent of injury, but damage control surgery remains the mainstay strategy in disastrous situations.

Hand telerehabilitation for polytrauma patients following road traffic accidents

Aim: This study aimed to examine the characteristics of upper limb and shoulder injuries combined with chest trauma in road accident victims and evaluate the effectiveness of telemedical monitoring and a newly developed telerehabilitation model in patient recovery. Materials and Methods: Our study incorporated 136 medical records of inpatients who had sustained upper extremity and chest injuries, constituting a retrospective group. Additionally, in the main group, we included 73 patients with similar injuries of the upper extremity and chest. Results: We analyze the functional results between the retrospective group and the main group, providing valuable insights into the effectiveness of traditional rehabilitation versus telerehabilitation. Focusing first on the average time spent on rehabilitation exercises per day, we observe a noticeable difference: while the retrospective group dedicated an average of 29}8 minutes daily, the main group invested more time, averaging 42}4 minutes. The retrospective group reported an average of 12}2 visits, in stark contrast to the main group, which averaged only 4}2 visits. The rehabilitators spent considerably less time with each patient in the main group (92}14 minutes) compared to the retrospective group (263}15 minutes), with a significant difference (p&lt;0.005). The discovery in our study that there was no notable statistical difference in the functional outcomes, as evaluated by QuickDASH scores, between patients undergoing telerehabilitation and those receiving traditional rehabilitation is of significant importance. Conclusions: The findings reveal that telerehabilitation can significantly increase patient engagement in rehabilitation exercises, primarily due to its convenience and accessibility.

Use of Supinator Motor Branches in Targeted Muscle Reinnervation of the Superficial Radial Nerve.

Symptomatic neuromas of the superficial radial nerve (SRN) can cause debilitating pain. Traditional surgical management options have demonstrated inconsistent outcomes prompting a search for alternatives. Recent reports have emerged on the use of targeted muscle reinnervation (TMR) for neuromas of the SRN using donors that are well established in hand surgery, such as the brachioradialis (BR) or extensor capri radialis longus or brevis. Use of the brachioradialis or extensor capri radialis longus motor targets can require surgery at or above the level of the antecubital fossa, and denervation of these muscle groups may be undesirable in cases of complex upper extremity injury where these donors may be needed for tendon or nerve transfer. The supinator is an expendable and often overlooked donor nerve that has not been assessed as a target for TMR of the SRN. In this case series, three patients with SRN neuromas whose conservative management failed and who did not have an SRN lesion amenable to reconstruction were managed with TMR to the nerves to supinator. At latest follow-up (9-22 months), no patients had deficits in supination or evident donor site morbidity. Two patients reported complete resolution of their SRN neuroma pain, and one patient reported partial improvement. This case series reports early results of TMR of the SRN using nerves to supinator in cases of SRN neuromas not amenable to reconstruction, demonstrating technical feasibility, improvements in neuroma pain, and no discernible donor morbidity.

Admission of Upper Extremity Injuries Presenting to the Emergency Department: An NEISS Study.

Upper extremity injuries account for 36.5% of presentations to the emergency department in the United States. This study seeks to determine current rates of upper extremity injuries that present to the emergency department and the injury characteristics of patients requiring admission. National Electronic Injury Surveillance System was queried for a 10-year period for upper extremity injuries. Further analysis was done to evaluate specific patient demographics, injury characteristics, and mechanisms of injury of those patients who were admitted to the hospital. Between 2012 and 2021, 39 160 365 persons are estimated to have presented to 100 United States emergency departments for managing upper extremity injuries, accounting for 28.8% of total presentations. A total of 12 662 041 upper extremity patients were pediatric (32.3%). Admissions occurred in 4.6% of presentations. The most common presenting diagnosis was laceration (24.9%), while the most common admission diagnosis was fracture (49.7%). The majority had injuries involving their forearms (19.9%). The most common injury-associated consumer product group was stairs, ramps, landings, and floors at 28.5%. Of the 445 644 patients, those estimated to have been injured by stairs, ramps, landings, and floors adults were 429 435 or 96.4%. The most common injury-associated product in pediatric populations was playground equipment (23.6%), of which 53.7% was from monkey bars and other climbing apparatuses. This study demonstrates an overall increase in admissions for upper extremity injuries in the setting of similar rates of overall upper extremity injuries with fractures and forearm being the most common diagnosis and body part involved, respectively. IV; Database.

Neurocognitive and Reactive Return to Play Testing Protocol in Overhead Athletes Following Upper Extremity Injury.

The incidence of upper extremity (UE) injuries in sport, particularly with the shoulder and elbow in baseball/softball players, appears to be increasing yearly, especially in younger age athletes. Improving the objective criteria and testing methods used to determine return to play (RTP) readiness following non-operative or post-operative management of UE injuries is one aspect of the rehabilitation process that may significantly help in reducing reinjury rates. Currently, the majority of clinicians are still using post operative time frame and/or strength/range of motion as their main criteria for clearance to RTP following UE injury. This demonstrates an inadequate reflection of the actual unpredictable, dynamic environment athletes are returning to participate in. In our clinical experiences, objective testing to allow for clearance to sport participation should incorporate neurocognitive and reactive testing to promote improvements in the athlete's ability to dual task and focus/concentrate on the multi-dimensional tasks at hand. We know that neuroplastic changes occur following UE injury resulting in decreased proprioception and increased motor activation with simple UE tasks. Currently the research on UE return to play testing is limited. The purpose of this clinical commentary was to describe the utilization and provide reference values for a series of reactive neurocognitive UE tests, to assist with RTP, in high school and collegiate overhead athletes (baseball and softball) utilizing the Blaze Pod light system. The use of a more dynamic reactive testing battery may decrease the reinjury rates when an athlete is cleared for participation by measuring readiness in chaotic circumstances that are more reflective of the sporting environment the athlete is working to return to resulting in a greater sense of confidence, performance and prevention of reinjuries.

Proximal humerus fractures: Postoperative protocols and factors affecting treatment decisions among shoulder and elbow and orthopedic trauma surgeons

BackgroundProximal humerus fractures (PHFs) can lead to functional decline in geriatric and polytraumatized patients. Treatment of PHFs is an area of much debate and much variability between practitioners. ObjectivesWe surveyed orthopedic trauma (OT) and shoulder and elbow (SE) surgeons to evaluate differences in postoperative protocols when treating acute PHFs with open reduction internal fixation (ORIF), intramedullary nailing (IMN), or hemi or reverse shoulder arthroplasty (rTSA). Materials and methodsWe distributed a web-based survey to three OT and SE associations between August 2018–April 2019. Questions included practice characteristics, standard postoperative protocols for weight-bearing, lifting, and range of motion (ROM) by treatment modality, and factors affecting modality and postoperative protocol decisions. We compared the subspecialties. Results239 surgeons [100 (42.2 %) OT, 118 (49.8 %) SE] completed the survey. OT were more likely to allow immediate ROM, lifting, and weight bearing following intramedullary nailing (IMN), open reduction internal fixation with a locking plate (ORIF), or arthroplasty (all p < 0.025), and to allow earlier unrestricted use of the extremity following IMN and arthroplasty (p = 0.001, p = 0.021 respectively). OT were more likely to consider operating on a PHF if there was contralateral upper extremity injury or need of the injured arm for work or activities of daily living (all p < 0.026). The subspecialties did not differ significantly on factors affecting their postoperative protocols. OT preferred IMN and SE surgeons preferred rTSA for allowing immediate unrestricted postoperative weight bearing, ROM, or lifting (all p < 0.001). ConclusionThere are significant differences in postoperative protocols between trauma and SE surgeons when treating PHFs. Postoperative protocols should be further studied to balance surgical outcomes and the risks of functional decline when treating patients with PHFs.

Robust Multi-View Fracture Detection inthe Presence ofOther Abnormalities Using HAMIL-Net.

Foot and ankle fractures are the most common military health problem. Automated diagnosis can save time and personnel. It is crucial to distinguish fractures not only from normal healthy cases, but also robust against the presence of other orthopedic pathologies. Artificial intelligence (AI) deep learning has been shown to be promising. Previously, we have developed HAMIL-Net to automatically detect orthopedic injuries for upper extremity injuries. In this research, we investigated the performance of HAMIL-Net for detecting foot and ankle fractures in the presence of other abnormalities. HAMIL-Net is a novel deep neural network consisting of a hierarchical attention layer followed by a multiple-instance learning layer. The design allowed it to deal with imaging studies with multiple views. We used 148K musculoskeletal imaging studies for 51K Veterans at VA San Diego in the past 20 years to create datasets for this research. We annotated each study by a semi-automated pipeline leveraging radiology reports written by board-certified radiologists and extracting findings with a natural language processing tool and manually validated the annotations. HAMIL-Net can be trained with study-level, multiple-view examples, and detect foot and ankle fractures with a 0.87 area under the receiver operational curve, but the performance dropped when tested by cases including other abnormalities. By integrating a fracture specialized model with one that detecting a broad range of abnormalities, HAMIL-Net's accuracy of detecting any abnormality improved from 0.53 to 0.77 and F-score from 0.46 to 0.86. We also reported HAMIL-Net's performance under different study types including for young (age 18-35) patients. Automated fracture detection is promising but to be deployed in clinical use, presence of other abnormalities must be considered to deliver its full benefit. Our results with HAMIL-Net showed that considering other abnormalities improved fracture detection and allowed for incidental findings of other musculoskeletal abnormalities pertinent or superimposed on fractures.

Management of Hand and Wrist Injuries in NCAA Division I Football Players From a Single Institution: Factors Associated With Epidemiology, Surgical Intervention, and Return to Play

Background: Upper extremity injuries account for approximately 16.9% of football injuries in the National Collegiate Athletic Association (NCAA). Purpose: To determine the epidemiology, management, and outcomes of hand/wrist injuries in collegiate football athletes so as to identify factors associated with surgical intervention and delayed return to play (RTP). Study Design: Descriptive epidemiology study. Methods: We retrospectively reviewed hand/wrist injuries that occurred within a single NCAA Division I football team from January 1, 2003, to December 31, 2020. Data analyzed included player position, college seniority, injury characteristics, injury management, surgical procedures performed, and timing of RTP. A univariate analysis was performed to identify factors associated with increased risk for surgical intervention and delayed (&gt;21 days) RTP after hand and wrist injury in this cohort. Results: Overall, 124 patients with 168 hand/wrist injuries were identified (9.9 wrist/hand injuries per year). Sprain of the thumb metacarpophalangeal (MCP) joint ulnar collateral ligament (UCL) was the most common diagnosis (19.6%). Surgery was required in 22% of injuries, with injury of the UCL of the thumb MCP joint (8/37) being the most common indication. Injuries occurring during competitive games (odds ratio = 4.29; 95% CI, 1.2-15.9) were associated with an increased risk for surgery. Most (70%) injuries did not lead to time missed from football, whereas the remaining 30% resulted in an average of 33 ± 36 days missed. Conclusion: Over 17 athletic seasons, the annual incidence of hand and wrist injury in these NCAA Division I football players was 9.9 injuries per year, with 22% requiring surgical treatment. Injury to the UCL of the thumb MCP joint was the most common injury and indication for surgery, and 30% of injuries resulted in approximately 1 month lost. Injuries sustained in games were associated with operative management and delayed RTP.

Effectiveness of occupational therapy-led computer-aided interventions on function among adults with conditions of the hand, wrist, and forearm: A systematic literature review and meta-analysis.

Upper extremity injuries are common, and often treated by occupational therapists. The need to evaluate the effectiveness of occupational therapy interventions to guide practice is pertinent. This systematic review and meta-analysis investigate the effectiveness of occupational therapy-led computer-aided interventions among adults with conditions of the hand, wrist, and forearm. A systematic literature search of five databases was undertaken for randomized studies examining occupational therapy-led computer-aided interventions for the treatment of hand, wrist, and forearm conditions. The primary outcome was function, with secondary outcomes of pain, grip and pinch strength. The quality of the included studies was independently assessed using the Cochrane Risk of Bias V2 tool. Meta-analyses were completed. Three randomized controlled trials were included with 176 participants. One study reported on app use on a tablet and two studies reported on computer gaming. Participants had a variety of hand and wrist diagnoses, treated both conservatively and operatively. There is limited evidence demonstrating that computer-based interventions are as effective as other occupational therapy-led interventions in improving function, pain, grip and pinch strength post-intervention, including small effect size following meta-analysis: grip strength (Fixed Effects Model, SMD 0.13, 95% CI 2.63; -2.36, I2 = 0%) and pinch strength (Fixed Effects Model, SMD -0.12, 95% CI 1.25; -1.50, I2 = 11%). Limited evidence was found to support the use of computer-aided interventions for adults with a hand, wrist or forearm injury. Further high-quality research is recommended inclusive of a broader range of technologies and a broader range of clinical and patient-reported outcome measures.

Proprioception: An evidence-based review

BackgroundProprioception is an essential sensory function of the body. Proprioception is defined as one’s awareness of their body’s position and movement through space. It contributes to both the conscious and unconscious awareness of limb and trunk position and movement. The purpose of this review is to provide an evidence-based review of proprioception and conditions that interfere with proprioceptive acuity. PurposeThe purpose of this review is to provide an evidence-based review of proprioception and conditions that interfere with proprioceptive acuity. Study DesignThis narrative literature review examines studies that determine proprioceptive systems and their implication for rehabilitation. MethodsRelevant study data were extracted as part of this review. ResultsTypes of proprioceptive interventions can include active or passive movement training, somatosensory stimulation training, force reproduction, and somatosensory discrimination training. Joint position sense error is the most widely used objective measure of proprioception. ConclusionsTherapists should consider using a standardized measure to ascertain proprioceptive deficits in their patients following upper extremity injury or disease to determine the deficits and measure change. There are a variety of interventions that can be used in hand rehabilitation to restore proprioceptive acuity, and active movement interventions have been found to be the most effective.

Pediatric lawn mower-related injuries and contributing factors for bystander injuries

BackgroundRiding lawn mower injuries are the most common cause of major limb loss in young U.S. children. Our study objective was to investigate the circumstances surrounding pediatric riding lawn mower injuries and to identify potential contributing risk factors and behaviors leading to these events.MethodsFollowers/members of both a public and a private lawn mower injury support and prevention Facebook page who had or were aware of children who had suffered a lawn mower-related injury were invited to complete an electronic survey on Qualtrics. Duplicate cases and those involving push mowers were removed. Frequencies and chi-square analyses were performed.Results140 injured children were identified with 71% of surveys completed by parents and 19% by an adult survivor of a childhood incident. The majority of injured children were Caucasian (94%), male (64%), and ≤ 5 years of age at the time of the incident (63%). Bystanders were 69% of those injured, 24% were lawn mower riders, and mower operators and others accounted for 7%. The lawn mower operator was usually male (77%), being the father/stepfather in almost half. Overall, 59% of injuries occurred while traveling in reverse, 29% while moving forward. Nearly all (92%) had an amputation and/or permanent disability. Subgroup analysis (n = 130) found injured bystanders were younger than injured passengers with 71% versus 45% being < 5 years of age, respectively (p = 0.01). Over three-quarters of bystander incidents occurred while moving in reverse as compared to 17% of passenger incidents (p < 0.01). Amputations and/or permanent disabilities were greater among bystanders (97%) as compared to passengers (79%, p = 0.01). Only 3% of bystanders had an upper extremity injury as compared to 21% of passengers (p = 0.01). Seventy-three percent of bystander victims had received at least one ride on a lawn mower prior to their injury incident.ConclusionsChild bystanders seriously injured by riding lawn mowers were frequently given prior rides likely desensitizing them to their inherent dangers and leading them to seek rides when mowers were being used. Engineering changes preventing blade rotation when traveling in reverse and not giving children rides (both when and when not mowing) may be critical in preventing mower-related injuries.

Keeping the Swing on Par: Golfers and Upper Extremity Injuries they Face

Golf is a sport enjoyed by a rapidly growing population. While it is perceived as a low-demand activity, golf and its thousands of high-energy rotational swings can result in a plethora of upper extremity injuries. We examine the biomechanics of the golf swing and carry out a review, divided by anatomical region of the upper extremity (shoulder, elbow, forearm, wrist, and hand), of common injuries associated with golf. Part I of this review details the shoulder and elbow pathology seen in golfers, while Part II covers the forearm, wrist, and hand injuries associated with the sport. PubMed was searched for articles using terms that corresponded to the specific injury and golf. Additional data was obtained via outside journal searches that did not appear in PubMed. This is a clinical review. Specific phases of the golf swing place golfers at risk for unique injuries that may affect either the leading (left side in a right-handed golfer) or trailing (right side in a left-handed golfer) extremity. Amateur and professional golfers are at higher risk for different injuries, as pros are more likely to suffer overuse injuries, while amateurs may have injuries secondary to improper grip or swing form. We identify and comment on six shoulders, two elbow, eight forearm and wrist, and three hand injuries associated with golf. Current trends in management, as well as golf-specific rehabilitation and return to sport timelines, are discussed for each injury. Growing participation and an aging population make golf a common source of upper extremity injury. We delineate 19 of the most common upper extremity injuries that golfers face and equip providers with up-to-date information to appropriately diagnose, manage, and rehabilitate these injuries.

The Relationship between the Bevel of the Radial Head Epiphysis and the Posterior Synovial Fringe During Rotation of the Elbow: An Ultrasonography Study with Possible Implications Regarding the Pathophysiology of Nursemaid's Elbow.

Nursemaid's elbow is the most common upper extremity injury in children under 5 years of age. However, the exact pathomechanism underlying the nursemaid's elbow remains elusive, and approximate one-third of patients present with a nonclassical history. Using a high-frequency ultrasound probe, we attempted to determine the relationship between the anterior edge of the posterior synovial fringe and the peripheral rim of the radial head epiphysis during rotation. It is possible that the primary reason for the nursemaid's elbow is due to the pronator position. Twenty-one patients had a history of nursemaid's elbow and had a successful reduction before enrollment in this study. A high-frequency linear array 6 to 24 MHz hockey stick transducer was used to detect small morphologic changes in the peripheral rim of the radial head epiphysis and the posterior synovial fringe during rotation of the capitellum-radial joint. In complete pronation, the anterior edge of the posterior synovial fringe contacts the beveled articular surface of the radial head peripheral rim in all 21 patients. In neutral and complete supination, the anterior edge of the posterior synovial fringe contacts the convexly nonarticular surface of the radial head peripheral rim and extends deep into the foveal radius. The posterior synovial fringe and the capsule-aponeurotic membrane were tightened in passive pronation in all 21 cases. The posterior synovial fringe and the capsule-aponeurosis membrane were all loose in the neutral and supination positions. The anterior edge of the posterior synovial fringe touches the beveled peripheral rim of the radial head epiphysis during complete pronation, and the tension of the lateral collateral ligament complex during pronation may further cause unstable conditions of the anterior edge of the posterior synovial fringe. We hypothesized that the beveled peripheral rim of the radial epiphysis and its relationship with the anterior edge of the posterior synovial fringe could be the reason why nursemaid's elbow only occurs while the elbow is in the pronator position.

The role of osteopathic principles and practice in upper extremity injuries of the overhead athlete.

The role of osteopathic principles and practice in upper extremity injuries of the overhead athlete.

Kinematic and Kinetic Comparisons of Arm Slot Position Between High School and Professional Pitchers.

Throwing arm kinetics differ in pitchers at varying arm slot (AS) positions (frontal-plane arm position at ball release relative to the vertical axis). To determine how kinematic and kinetic values differ between professional and high school pitchers with varying AS positions, and whether these differences are similarly observed in both populations. High school (n = 130) and professional (n = 288) pitchers threw 8 to 12 fastballs under 3-dimensional motion capture technology. Pitchers in each cohort were subdivided based on mean AS position at ball release: AS1 (least degree of AS: most overhand throwing styles), AS2 (intermediate degree of AS: three-quarter throwing styles), or AS3 (greatest degree of AS: most sidearm throwing styles). Kinetic and kinematic parameters were compared between groups. Controlled laboratory study. High school pitchers had a more overhand AS at ball release (50° ± 11°) compared with professional pitchers (58° ± 14°) (P < .001). In both cohorts, AS1 pitchers had significantly greater shoulder abduction (high school, P <0.001; professional, P <0.0001) and lateral trunk flexion (high school, P < 0.001; professional, P <0.0001) at ball release compared with AS3 pitchers. Professional pitchers with an AS3 position had significantly delayed timing of maximum upper trunk angular velocity compared with AS1 pitchers (64% ± 7% vs 57% ± 7% of pitch time, respectively; P < .0001). A significant positive correlation between AS and elbow flexion torque was found in high school pitchers (P = .002; β = 0.28), and a significant negative correlation between AS and elbow varus torque (P < .001; β = -0.22) and shoulder internal rotation torque (P < .001; β = -0.20) was noted in professional pitchers. AS position was related to shoulder abduction and trunk lateral tilt. Professional and high school pitchers with varying AS positions did not experience similar changes in throwing arm kinetics. In professional pitchers, the earlier onset of maximum upper trunk angular velocity with overhand throwing style may reflect inappropriate pelvis-trunk timing separation, a parameter implicated in upper extremity injury, and the negative correlation between AS and elbow varus and shoulder internal rotation torque suggests that both excessive and minimal AS positions have negative implications.

Efficacy of a Neuromuscular Warm-up Program in Reducing the Risk of School Sports Injury among Chinese Children: A Cluster Randomized Controlled Trial.

Children who participate in sports have reduced cardiovascular risk, obesity, and type 2 diabetes. However, sports participation also comes with an inherent risk of sports-related injuries. To examine the efficacy of a school-based neuromuscular warm-up program (NWP) in reducing the risk of school sports injury (SSI) in children and the impact of different levels of compliance on the effectiveness of the program. Randomized controlled trial; Level of evidence, 1. A total of 421 students from grades 4 to 6 at a single school (age range, 9-14 years) were randomized by grade to an intervention group and a control group. The intervention group participated in a 13-week simplified (8-minute) NWP designed to reduce SSI risk. The control group participated in a standard warm-up of the same length and duration. Exposure, compliance, and injury data were collected via a weekly form. The primary injury outcome was all SSIs. Secondary outcomes included injuries from physical education (PE) and non-PE class, upper and lower extremity injuries, other location injuries, and time-loss injuries. A Poisson regression model using an intent-to-treat analysis was performed to estimate the incidence rate ratio (IRR) for all injuries in the intervention group compared with the control group. To examine the influence of level of compliance, we divided the intervention group into low compliance (participation 1-2 times/wk) and high compliance (participation >2 times/wk) then compared the difference on injury rates (IRs) between these groups and the control group. There were significant differences between the intervention and control groups regarding all SSIs (IRR, 0.47; 95% CI, 0.23-0.96; P = .038), PE class injuries (IRR, 0.37; 95% CI, 0.14-0.99; P = .048), and other location injuries (IRR, 0.20; 95% CI, 0.05-0.82; P = .025). The compliance analysis revealed that although the low-compliance group was able to reduce the risk of SSIs (IR, 4.43; 95% CI, 2.49-6.37) compared with the control group (IR, 7.60; 95% CI, 5.61-9.59), the high-compliance group produced a better effect in reducing the SSI risk (IR, 1.80; 95% CI, 0.04-3.56). The simplified NWP used in this study was efficacious in the reduction of SSIs in children. ChiCTR2100043875 (Chinese Clinical Trial Registry; http://www.chictr.org.cn).

Homodigital Unipedicled Islanded Neurovascular Pulp Advancement Flap/Colombo Flap for Fingertip Reconstruction: A Case Series with a Novel Technique.

Fingertip injury is the most common type of upper extremity injury. Operative treatment with flap cover is required for tissue loss causing bone exposure and when there is a compelling need to preserve the length, unless microvascular replantation is possible. There are many techniques described for this purpose offering varying degrees of good outcomes. Yet there are limitations and long-term problems. We report a case series with a novel technique named "Colombo flap," which is a neurovascular islanded advancement flap based on a single pedicle. Five fingers of four consented patients were operated using this technique and they were followed up for 2.5 years. All had satisfactory sensory recovery (S3 +/S4), preserved range of motion (ROM) at interphalangeal joints, good grip strengths, and satisfactory outcomes based on Michigan Hand Questionnaire (MHQ). There were no complications such as flap necrosis, infection, and neuroma formation. Hook nail deformity was minimal and none had pain or cold intolerance.