A case of Vernet syndrome associated with internal jugular phlebectasia.

A 36-year-old woman presented with right shoulder weakness after a left parotid tumor resection. The overall clinical presentation included severe paralysis and atrophy of the right sternocleidomastoid and upper trapezius, an absent right gag reflex, and diminished right posterior tongue pinprick sensation. A diagnosis of right-sided Vernet syndrome (cranial nerve IX, X, XI lesions) was made, presumably from compression of cranial nerves by internal jugular vein phlebectasia. To our knowledge, this is the first case report of spontaneous Vernet syndrome associated with internal jugular vein phlebectasia in the absence of other lesions of the jugular foramen.

Risk factors for volleyball-related shoulder pain and dysfunction.

OBJECTIVE: To identify risk factors for volleyball-related shoulder pain and dysfunction. DESIGN: Cross-sectional, observational. SETTING: National championship sporting event. PARTICIPANTS: Competitors at the 2006 National Intramural & Recreational Sports Association Collegiate Club Volleyball Championship competition were invited to volunteer for the study. A total of 422 athletes returned questionnaires, of whom 276 also underwent a structured physical examination. ASSESSMENT OF RISK FACTORS: Study participants provided information on any history of volleyball-related shoulder pain or dysfunction. The simple shoulder test (SST) and a visual analog scale permitted subjects to quantify the extent of their perceived functional limitation. Subjects also were invited to undergo a physical examination in which dynamic scapular positioning, glenohumeral range of motion, shoulder girdle strength, and core stability were assessed. MAIN OUTCOME MEASUREMENTS: Standard statistical methods of comparison and tests of association were used to identify risk factors for shoulder pain among participating volleyball athletes. RESULTS: Approximately 60% of participants reported a history of shoulder problems. Attackers and "jump" servers were more likely to have shoulder problems than setters, defensive specialists, and "float" servers. Nearly half of the athletes who reported shoulder problems perceived some associated functional limitation, with female athletes providing lower SST scores than male athletes (9.0 versus 10.1, P = .001). Athletes reporting shoulder pain and dysfunction were more likely to have SICK scapula scores of 3 or greater (P = .010). Participants who demonstrated core instability also had greater SICK scapula scores (3.9 versus 2.9, P = .038), and were more likely to report a history of shoulder problems (chi2 = 8.83, P = .032). Although the authors observed a significant mean left-right difference of 8.9 degrees in available glenohumeral internal rotation among participating athletes, this deficit was not associated with shoulder problems. However, there was an association between asymmetric coracoid tightness /pectoral shortening and shoulder pain (P = .030), as well as for restricted shoulder flexion in the sagittal plane and shoulder problems (P = .015). CONCLUSIONS: Although most risk factors for volleyball-related shoulder problems are similar to those identified for other overhead sports, there appear to be additional volleyball-specific risk factors that may reflect the biomechanical demands of the sport. An understanding of modifiable risk factors is critical to providing optimal care for overuse injuries and may facilitate future efforts to prevent shoulder problems among volleyball athletes.