Reflex sympathetic dystrophy. A review of the literature and a long-term outcome study.

According to the literature, approximately half of all patients diagnosed with reflex sympathetic dystrophy respond to nonoperative treatment. Because no long-term studies exist, however, the relapse rate and outcome of this condition are not known. In this paper, a historical review and a brief discussion of the theories of pathogenesis of the disease are presented. The results of treatment, as documented in the literature, are also presented. This paper also reports on 10 patients with reflex sympathetic dystrophy who were treated nonoperatively and for whom a follow-up of at least 1 year was documented. The patient population and short-term results are consistent with those found in the literature. Nine of the 10 patients were contacted for long-term follow-up at an average of more than 5 years after diagnosis. A significant number of patients experienced worsening of symptoms (56%) and reported that their condition negatively affected their activities of daily living (78%). Of those who were employed prior to diagnosis, 67% reported a job change or unemployment directly related to the disease. Therefore, the long-term results of nonoperative treatment are not as encouraging as is indicated in the literature.

Isolated traumatic avulsion of the flexor digitorum sublimis. A case report.

Like the FDP, the FDS may be avulsed at its insertion. The diagnosis can be made based on a history of resisted extension, palmar pain and tenderness, lack of FDS function, and inability to completely extend the DIP joint secondary to the looping affect of the FDS. In the seven reported cases of FDS rupture no surgical intervention was required. This case represents a case in which surgical intervention was required secondary to an isolated avulsion of the FDS in a football player.

Functional assessment of bilateral wrist arthrodeses.

We studied the functional results of 18 wrist arthrodeses in nine patients with rheumatoid arthritis. Objective evaluation included radiographic assessment, goniometer assessment of the upper extremity (UE), range of motion (ROM), grip and pinch strength, and the Jebsen-Taylor function test. Subjective evaluation consisted of a questionnaire that compared the upper extremity function of various activities of daily living preoperatively and postoperatively. The mean total range of motion for all patients was below normal on the dominant and nondominant sides, as was the average grip and pinch strength. Results of the Jebsen-Taylor test, compared with results of normal persons, were normal 38% of the time and abnormal 62% of the time. Subjective evaluation revealed postoperative improvement of the hand function in seven patients, whereas the function in two patients remained the same. Bilateral wrist arthrodeses does not seem to adversely affect function of the upper extremity in spite of abnormal grip strength and upper extremity range of motion.

Evaluation of injuries in youth soccer.

Soccer has rapidly gained in interest in the United States. A paucity of available data on soccer injuries led us to formulate this study to quantitate and categorize injuries acquired during a program of youth soccer (under age 19). A prospective study of 1,272 players showed an injury rate of 2.6 injuries per 100 participants. The injury rate for girls was twice as great as for boys. The under 10-age group was seldom injured (less than 1 injury per 100 participants), but the overall injury rate in the players of secondary school age was 7.7 injuries per 100 participants. Most injuries were not serious. Soccer appears to be a safe activitiy for adolescents and children.