Upper trunk brachial plexopathy. The stinger syndrome.

This study was designed to determine the cause of upper trunk brachial plexopathy, which is referred to as a "stinger" or a "burner." This injury often has been thought to occur secondary to traction when an athlete sustains a lateral flexion injury of the neck. At the United States Military Academy, a 4-phase study was begun with 261 tackle football players (236 intramural- and 25 varsity-level players) to investigate this injury. Electromyography and nerve root stimulation studies were used to delineate the lesion, which was found in a total of 32 players who continued throughout the study. This study demonstrated that a much more common mechanism of injury resulting in the stinger syndrome is probably compression of the fixed brachial plexus between the shoulder pad and the superior medial scapula when the pad is pushed into the area of Erb's point, where the brachial plexus is most superficial. An orthosis was designed to protect the brachial plexus from the compressive force of the shoulder pad. In preliminary trials, this orthosis had been very effective in decreasing the number of episodes in which stinger injuries occurred.

Functional rehabilitation of the cruciate-deficient knee.

'Functional rehabilitation' is an embellishment of the traditional concepts of rehabilitation which are motion and strength. Functional rehabilitation incorporates the concepts of agility, proprioception, and finally the confidence of the individual when performing whatever task he or she wishes to undertake. The determinants of rehabilitation include the patient, the type of injury the knee has sustained as well as its surgical treatment, and how innovative the director of rehabilitation is. The principles of rehabilitation include joint motion and stability as well as muscular endurance and strength. These should be considered during the immobilisation phase, the surgical and postsurgical phase, and continued through the early healing, late healing and final healing stages. The rehabilitation director must advance activity to levels of ever increasing complexity. Various modalities of rehabilitation such as bracing, passive motion machines and muscle stimulation units should be added in an effort to achieve a painless course. This course is progressive as long as errors of rehabilitation are avoided, including overtraining and too rapid a progression resulting in injury or reinjury. Realistic goals must be firmly established in the mind of the patient and the director at the outset. Determinants of rehabilitation are a guide to the reality of reaching a functional level. The functional activity programme depends upon knee stability, successful completion of lesser activities and healing of the injury or the surgery. Progressing from less difficult to more difficult activities before the patient is ready usually results in an injury or reinjury. Therefore, constant assessment of the performance level of the patient must be made before advancing to more demanding activities. Conservative and surgical treatment programmes for functional rehabilitation are essentially the same except for the time factors involved. The times of completion of different levels of activity are generally longer in the surgical programme. Time alone is not the signal for advancement from one programme to another. Attention should be paid to range of motion, strength, fluidity of performance of functional activities as well as functional testing.

Stress fractures.

Multiple biologic and mechanical factors are involved in creating a stress injury to bone. The most common factor found to modulate this injury in the healthy individual has been the application of cyclic stress. The cessation of stress will allow repair to dominate over resorption. If bony integrity has not yet been lost, immobilization or fixation is not necessarily appropriate. By modulating the application of stress in a judicial manner, the injury is preventable.

Rehabilitation of the anterior cruciate deficient knee.

Progressive rehabilitation of the anterior cruciate deficient knee requires attention to the signs of recovery or lack of it, so that the rehabilitation program can be adjusted. A close monitoring program by the physician or therapist, or both, is more effective than the introduction of complicated equipment. By dividing the rehabilitation program into segments with specific goals and responsibilities, an informed rehabilitation team (physician, therapist, patient) can progress from injury to complete neuro-musculo-skeletal re-education.

Agility training following anterior cruciate ligament reconstruction.

The treatment program after anterior cruciate ligament (ACL) injury or reconstruction at the United States Military Academy embraces the four cornerstones of rehabilitation--strength, aerobic fitness, coordination, and confidence. It is divided into six phases--presurgery, to prepare the patient for postoperative rehabilitation; postoperative (or postinjury), to allow healing and to prevent thrombosis and muscle atrophy; early healing, to maintain muscle tone and joint motion in a protective device; late healing (water stage), to begin proprioceptive and agility training while regaining joint motion; healed (land stage), to gain greater agility and confidence in controlled situations; competition, to demonstrate if the rehabilitation program has been successful. This paper concentrates on the criteria for advancing from the water phase to the land phase and then to competition. The patient reverts to the preceding phase if pain or swelling is apparent. Full participation in competition is not permitted unless the patient masters all phases and can compete in athletics without fear of reinjury.

Hand and forearm infections caused by Aeromonas hydrophila.

This is a report of two cases of hand and forearm infections caused by Aeromonas hydrophila. This organism is resistant to penicillin and most cephalosporins and is found in most freshwater environments. It is recommended that broad-spectrum coverage such as a combination of cephalosporin and aminoglycoside antibiotic be used.