Clinics in diagnostic imaging (156). Golf-induced hamate hook fracture.

The wrist is a common site of injury and the most frequently injured body part among professional golfers. A 37-year-old, right-handed male golfer presented with pain at the ulnar aspect of his left palm, which grew worse after an initial traumatic impact from the golf club handle. There was tenderness over the hypothenar eminence of the left palm. Computed tomography of the left wrist showed an undisplaced fracture through the base of the hamate hook. The golf-induced hamate hook fracture was managed conservatively, with cessation of physical activity involving the left hand and wrist for eight weeks. The patient made a full recovery. Repetitive trauma, exacerbated by improper wrist motion, leads to typical wrist injuries affecting golfers, such as ulnar impaction syndrome, de Quervain's disease, and tendinopathy affecting the flexor carpi ulnaris and extensor carpi ulnaris, all of which can be diagnosed on imaging.

Comparison of autologous conditioned plasma injection, extracorporeal shockwave therapy, and conventional treatment for plantar fasciitis: a randomized trial.

OBJECTIVES: To evaluate the efficacy of autologous conditioned plasma (ACP) compared with extracorporeal shockwave (ESWT) and conventional treatments for plantar fasciitis. DESIGN: Randomized trial. SETTING: Sports medicine center in a tertiary care hospital. PATIENTS: Fifty-four subjects (age range, 29-71 years) with unilateral chronic plantar fasciitis with more than 4 months of symptoms. METHODS: Subjects randomized to 3 groups: 19 to ACP and conventional treatment (ACP group), 19 to ESWT and conventional treatment (ESWT group), and 16 to conventional treatment alone. Conventional treatment included stretching exercises and orthotics if indicated. MAIN OUTCOME MEASUREMENTS: Outcomes were pain-Visual Analog Scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, and ultrasound plantar fascia thickness assessed at baseline before treatment and at 1 month, 3 months, and 6 months after treatment. RESULTS: VAS, AOFAS ankle-hindfoot scale, and plantar fascia thickness improved in all groups. Significant VAS pain score improvements in the ACP group compared with conventional treatment at month 1 (P = .037) and for the ESWT group compared with conventional treatment at months 1, 3, and 6 (P = .017, P = .022, and P = .042). The AOFAS ankle-hindfoot scale score improved in the ACP group at months 3 and 6 (P = .004 and P = .013) and, for the ESWT group, at months 1 and 3 (P = .011 and P = .003) compared with conventional treatment. Significant improvements in plantar fascia thickness were seen in the ACP group at months 1 and 3 compared with conventional treatments (P = .015 and P = .014) and at months 3 and 6 compared with the ESWT group (P = .019 and P = .027). No adverse events reported. CONCLUSIONS: Treatment of plantar fasciitis with ACP or ESWT plus conventional treatments resulted in improved pain and functional outcomes compared with conventional treatment alone. There was no significant difference between ACP and ESWT in terms of VAS and AOFAS ankle-hindfoot scale improvements, although the ACP group demonstrated greater reductions in plantar fascia thickness.

Comparing effects of low- and high-volume moderate-intensity exercise on sexual function and testosterone in obese men.

INTRODUCTION: Obesity and inactivity are associated with erectile dysfunction and hypogonadism. AIM: To compare the effects of low volume (LV) and high volume (HV) of moderate-intensity exercise on sexual function, testosterone, lower urinary tract symptoms (LUTS), endothelial function, and quality of life (QoL) in obese men. MAIN OUTCOME MEASURES: Weight, waist circumference (WC), body composition, International Index of Erectile Function 5-item (IIEF-5), International Prostate Symptom Scale (IPSS) (for LUTS), and 36-item Short Form Survey version 2 Instrument (SF-36) (for QoL) scores, plasma testosterone, sex-hormone binding globulin, glucose, insulin and lipids, and endothelial function (by Reactive Hyperaemia Index [RHI] using finger plethysmography) were measured at baseline and 24 weeks. METHODS: Ninety abdominally obese (body mass index > 27.5 kg/m(2), WC > 90 cm), sedentary (exercise ≈ 80 minutes/week) Asian men (mean age 43.6 years, range 30-60) were prescribed a diet to reduce daily intake by ≈ 400 kcal below calculated requirement and randomized to perform moderate-intensity exercise of LV (<150 minutes/week) or HV (200-300 minutes/week) (n = 45 each) for 24 weeks. Seventy-five men (83.3%) completed the study. RESULTS: Weekly exercise volume was significantly greater in the HV (236 ± 9 minutes) than the LV (105 ± 9 minutes) group. The HV group had significantly greater increases in IIEF-5 score (2.6 ± 0.5 points) and testosterone (2.06 ± 0.46 nmol/L) and reductions in weight (-5.9 ± 0.7 kg, -6.2%), WC (-4.9 ± 0.8 cm, -4.9%), and fat mass (-4.7 ± 1.0 kg, -14.5%) than the LV group (-2.9 ± 0.7 kg, -3.0%; -2.7 ± 0.7 cm, -2.5%; -1.1 ± 0.8 kg, -3.2%; 0.79 ± 0.46 nmol/L; and 1.8 ± 0.5 points). Improvements in IPSS and SF-36 scores, and RHI, were similar. CONCLUSIONS: Moderate-intensity HV aerobic exercise > 200 minutes/week produces greater improvements in sexual function, testosterone, weight, WC, and fat mass than smaller exercise volume.

Comparison of quadriceps angle measurements using short-arm and long-arm goniometers: correlation with MRI.

OBJECTIVE: To compare the reliability of quadriceps-angle (Q-angle) measurements performed using a short-arm goniometer and a long-arm goniometer and to assess the accuracy of goniometer-based Q-angle measurements compared with anatomic Q angles derived from magnetic resonance imaging (MRI). DESIGN: An intra- and interobserver reliability study. SETTING: University hospital. PARTICIPANTS: Eighteen healthy subjects with no history of knee pain, trauma, or prior surgery were examined. METHODS: Two physicians, blinded to subject identity, measured Q angles on both knees of all subjects using 2 goniometers: (1) a short-arm goniometer and (2) a long-arm goniometer. Q angles were derived from axial MRIs of the subjects' hip and knees. MAIN OUTCOME MEASUREMENTS: The intra- and interobserver reliabilities of each goniometer were assessed using the intraclass correlation coefficient (ICC). The comparison between clinical and MRI-based Q angles was assessed by using the ICC and a paired t-test. RESULTS: Intra- and interobserver reliabilities of the long-arm goniometer (intraobserver ICC, 0.92; interobserver ICC, 0.88) were better than those of the short-arm goniometer (intraobserver ICC, 0.78; interobserver ICC, 0.56). Although both goniometers measured Q angles that were moderately correlated to the MRI-based measurements (ICC, 0.40), the clinical Q angles were underestimated compared with the MRI-based anatomic Q angles (P < .05). CONCLUSION: The results of this study suggest that, although reproducible Q-angle measurements can be performed using standardized patient positioning and a long-arm goniometer, methods to improve the accuracy of clinical Q-angle measurements are needed.

Osteochondral lesions of the talus.

Osteochondral lesions of the talus can present as a late complication of ankle injuries. As the talus is largely covered by articular cartilage, it has a limited ability for repair. Early and accurate diagnosis is important as talar integrity is required for optimal function of the ankle. The common presentation is chronic ankle pain with a history of ankle trauma. Conservative treatment involving a period of casting and non-weight-bearing is recommended for acute, non-displaced osteochondral lesions. Surgical management is recommended for unstable lesions or failed conservative management.

Introduction to diagnostic musculoskeletal ultrasound: part 2: examination of the lower limb.

This is the second of two articles focusing on ultrasound examination of musculoskeletal components of the upper and lower limbs. Treatment of musculoskeletal injuries is based on establishing an accurate diagnosis. No one would dispute that a good history and physical examination by a competent clinician can help achieve that in the majority of cases. However, musculoskeletal imaging is also an essential adjunct in the work-up of many musculoskeletal disorders. This article describes the ultrasound examination of the lower limb in terms of anatomic structure. Normal and pathologic ultrasound features of these structures, including muscles, tendons, ligaments, bursae, and other soft tissues of the lower limb, will be described by reviewing several representative pathologies commonly seen in musculoskeletal medicine.

Review of sports-related concussion: Potential for application in military settings.

This article reviews current issues and practices in the assessment and clinical management of sports-related concussion. An estimated 300,000 sports-related concussions occur annually in the United States. Much of what has been learned about concussion in the sports arena can be applied to the diagnosis and management of concussion in military settings. Current military guidelines for assessing and managing concussion in war zones incorporate information and methods developed through sports-concussion research. We discuss the incidence, definition, and diagnosis of concussion; concussion grading scales; sideline evaluation tools; neuropsychological assessment; return-to-action criteria; and complications of concussion.

Current evidence and clinical applications of therapeutic knee braces.

Braces are commonly used for the management of musculoskeletal injuries. With improvements in design and application, the knee brace has gained recognition by many as a treatment and prevention modality. However, there exist many different categories of knee braces, leading to confusion among many end users. The theoretical basis of the mechanism of action of the unloader, prophylactic, patellofemoral, and functional knee braces are explained in this review. This article also provides an update on the various knee braces in terms of the clinical efficacy and appropriate prescription recommendations.

Regional bone mineral density in male athletes: a comparison of soccer players, runners and controls.

OBJECTIVES: To investigate the association of soccer playing and long-distance running with total and regional bone mineral density (BMD). DESIGN: Cross-sectional study. SETTING: Academic medical centre. PARTICIPANTS: Elite male soccer players (n = 15), elite male long-distance runners (n = 15) and sedentary male controls (n = 15) aged 20-30 years. MAIN OUTCOME MEASUREMENTS: BMD (g/cm2) of the lumbar spine (L1-L4), right hip, right leg and total body were assessed by dual-energy x-ray absorptiometry, and a scan of the right calcaneus was performed with a peripheral instantaneous x-ray imaging bone densitometer. RESULTS: After adjustment for age, weight and percentage body fat, soccer players had significantly higher whole body, spine, right hip, right leg and calcaneal BMD than controls (p = 0.008, p = 0.041, p<0.001, p = 0.019, p<0.001, respectively) and significantly higher right hip and spine BMD than runners (p = 0.012 and p = 0.009, respectively). Runners had higher calcaneal BMD than controls (p = 0.002). Forty percent of the runners had T-scores of the lumbar spine between -1 and -2.5. Controls were similar: 34% had T-scores below -1 (including 7% with T-scores lower than -2.5). CONCLUSIONS: Playing soccer is associated with higher BMD of the skeleton at all sites measured. Running is associated with higher BMD at directly loaded sites (the calcaneus) but not at relatively unloaded sites (the spine). Specific loading conditions, seen in ball sports or in running, play a pivotal role in skeletal adaptation. The importance of including an appropriate control group in clinical studies is underlined.

Introduction to musculoskeletal diagnostic ultrasound: examination of the upper limb.

With recent advances in computer technology and equipment miniaturization, the clinical application of diagnostic ultrasonography (U/S) has spread across various medical specialties. Diagnostic U/S is attractive in terms of its noninvasiveness, lack of radiation, readiness of use, cost-effectiveness, and its ability to make dynamic examinations possible. Dynamic imaging deserves special emphasis because it is useful in differentiating full-thickness from partial-thickness tendon tears, muscle tears, and tendon and nerve subluxations or dislocations. It is also a quick and easy avenue for side-to-side comparisons. When appropriately used, diagnostic U/S can be considered as an extension of one's physical examination. However, there are limitations of U/S, which will be discussed in this review article. This is part 1 of two articles; this first part will focus on the ultrasound examination of the upper extremity, using selected examples relevant to musculoskeletal medicine. Part 2 will cover common pathologies of the lower extremity.

Myotonia congenita in a young active man: symptoms and physique tip the diagnosis.

A 19-year-old man had a 7-year history of leg cramps and a tendency for his legs to "seize up" when he participated in sports. The condition was initially mild, and clinical examination revealed an extremely muscular physique and percussion and action myotonia. Electromyography was consistent with myotonic discharges, and myotonia congenita was the diagnosis. Carbamazepine therapy relieved all symptoms, except for a short time when the patient stopped taking medication. Physicians should carefully document family history and symptom triggers to facilitate making the correct diagnosis.