Arthroscopic Shoulder Surgery in Female Professional Tennis Players: Ability and Timing to Return to Play.

OBJECTIVE: To assess the outcome and time to return to previous level of competitive play after shoulder surgery in professional tennis players. DESIGN: Retrospective case series. SETTING: Tertiary academic centre. PATIENTS AND INTERVENTIONS: The records of all female tennis players on the Women's Tennis Association (WTA) professional circuit between January 2008 and June 2010 were reviewed to identify players who underwent shoulder surgery on their dominant (serving) shoulder. MAIN OUTCOME MEASURES: Primary outcomes were the ability and time to return to professional play and if they were able to return to their previous level of function as determined by singles ranking. Preoperative and postoperative singles rankings were used to determine rate and completeness of return to preoperative function. RESULTS: During the study period, 8 professional women tennis players from the WTA tour underwent shoulder surgery on their dominant arm. Indications included rotator cuff debridement or repair, labral reconstruction for instability or superior labral anterior posterior lesion, and neurolysis of the suprascapular nerve. Seven players (88%) returned to professional play. The mean time to return to play was 7 months after surgery. However, only 25% (2 of 8) players achieved their preinjury singles rank or better by 18 months postoperatively. In total, 4 players returned to their preinjury singles ranking, with their peak singles ranking being attained at a mean of 2.4 years postoperatively. CONCLUSIONS: In professional female tennis players, a high return to play rate after arthroscopic shoulder surgery is associated with a prolonged and often incomplete return to previous level of performance. Thus, counseling the patient to this fact is important to manage expectations. LEVEL OF EVIDENCE: Level IV-Case Series.

The effect of long and short head biceps loading on glenohumeral joint rotational range of motion and humeral head position.

PURPOSE: To evaluate the effect of loading the long and short heads of the biceps on glenohumeral range of motion and humeral head position. METHODS: Eight cadaveric shoulders were tested in 60° abduction in the scapula and coronal plane. Muscle loading was applied based on cross-sectional area ratios. The short and long head of the biceps were loaded individually followed by combined loading. Range of motion was measured with 2.2 Nm torque, and the humeral head apex position was measured using a MicroScribe. A paired t test with Bonferroni correction was used for statistics. RESULTS: Long head loading decreased internal rotation in both the scapular (17.9 %) and coronal planes (5.7 %) and external rotation in the scapular plane (2.6 %) (P < 0.04). With only short head loading, maximum internal rotation was significantly increased in the scapular and coronal plane. Long head and short head loading shifted the humeral head apex posteriorly in maximum internal rotation in both planes with the long head shift being significantly greater than the short head. Long head loading also shifted the humeral apex inferiorly in internal rotation and inferiorly posteriorly in neutral rotation in the scapular plane. With the long head unloaded, there was a significant superior shift with short head loading in both planes. CONCLUSION: Loading the long head of the biceps had a much greater effect on glenohumeral range of motion and humeral head shift than the short head of the biceps; however, in the absence of long head loading, with the short head loaded, maximum internal rotation increases and the humeral head shifts superiorly, which may contribute to impingement following tenodesis of the long head of the biceps. These small changes in rotational range of motion and humeral head position with biceps tenodesis may not lead to pathologic conditions in low-demand patients; however, in throwers, biceps tenodesis may lead to increased contact pressures in late-cocking and deceleration that will likely translate to decreased performance therefore every effort should be made to preserve the biceps-labral complex.

High Incidence of Infraspinatus Muscle Atrophy in Elite Professional Female Tennis Players.

BACKGROUND: Isolated infraspinatus muscle atrophy is common in overhead athletes, who place significant and repetitive stresses across their dominant shoulders. Studies on volleyball and baseball players report infraspinatus atrophy in 4% to 34% of players; however, the prevalence of infraspinatus atrophy in professional tennis players has not been reported. PURPOSE: To investigate the incidence of isolated infraspinatus atrophy in professional tennis players and to identify any correlations with other physical examination findings, ranking performance, and concurrent shoulder injuries. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: A total of 125 professional female tennis players underwent a comprehensive preparticipation physical health status examination. Two orthopaedic surgeons examined the shoulders of all players and obtained digital goniometric measurements of range of motion (ROM). Infraspinatus atrophy was defined as loss of soft tissue bulk in the infraspinatus scapula fossa (and increased prominence of dorsal scapular bony anatomy) of the dominant shoulder with clear asymmetry when compared with the contralateral side. Correlations were examined between infraspinatus atrophy and concurrent shoulder disorders, clinical examination findings, ROM, glenohumeral internal rotation deficit, singles tennis ranking, and age. RESULTS: There were 65 players (52%) with evidence of infraspinatus atrophy in their dominant shoulders. No wasting was noted in the nondominant shoulder of any player. No statistically significant differences were seen in mean age, left- or right-hand dominance, height, weight, or body mass index for players with or without atrophy. Of the 77 players ranked in the top 100, 58% had clinical infraspinatus atrophy, compared with 40% of players ranked outside the top 100. No associations were found with static physical examination findings (scapular dyskinesis, ROM glenohumeral internal rotation deficit, postural abnormalities), concurrent shoulder disorders, or compromised performance when measured by singles ranking. CONCLUSION: This study reports a high level of clinical infraspinatus atrophy in the dominant shoulder of elite female tennis players. Infraspinatus atrophy was associated with a higher performance ranking, and no functional deficits or associations with concurrent shoulder disorders were found. Team physicians can be reassured that infraspinatus atrophy is a common finding in high-performing tennis players and, if asymptomatic, does not appear to significantly compromise performance.

Hip range of motion and association with injury in female professional tennis players.

BACKGROUND: Adequate hip range of motion is required for the transfer of energy from the lower to the upper extremity along the kinetic chain. Repetitive rotational stresses in the lower extremities during tennis may lead to sport-specific range of motion adaptations, which may increase the risk of injury to other joints along the kinetic chain. PURPOSE: To assess whether such range of motion adaptations occur in the hip, and if so, to identify whether they are associated with injury. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: A total of 125 female professional tennis players, the majority of whom were ranked in the top 200 World Tennis Association singles rankings, underwent a comprehensive preparticipation physical health status examination. Hip range of motion was assessed using a digital inclinometer and side-to-side differences in rotational parameters calculated, and associations with previous injuries were identified. RESULTS: A history of an abdominal strain was reported by 10% of players, and there was an association between abdominal strains and the presence of hip flexion contractures (odds ratio, 6.1; P = .006). Hip flexion contractures were bilateral in 85% of those found, affected only the nondominant side in 9%, and affected only the dominant side in 6%. We were unable to identify any specific side-to-side rotational adaptations in the dominant or nondominant hips, and no association between loss of hip range of motion and shoulder, lower back, hip, knee, or ankle injuries was found. CONCLUSION: We report an association in female professional tennis players between abdominal strains and flexion contractures of the hip with iliopsoas tightness. We did not find evidence of specific hip adaptations in rotational range of motion. If hip flexion contractures are found on clinical examination, a stretching program may be indicated. Further studies are required to assess whether such a program can reduce the risk of abdominal injury.

Margin convergence anchorage to bone for reconstruction of the anterior attachment of the rotator cable.

PURPOSE: The purpose of this study was to compare the biomechanical characteristics of a massive L-shaped retracted rotator cuff tear repaired with either soft-tissue side-to-side sutures or margin convergence anchorage to bone. METHODS: Eight matched pairs of cadaveric shoulders were used. The supraspinatus and infraspinatus were secured in a clamp at 30° of glenohumeral abduction. The subscapularis was secured in a separate clamp, and a constant load was applied. A massive L-shaped rotator cuff tear of the supraspinatus and infraspinatus tendon was created. In all specimens the posterior aspect of the tear was repaired by a transosseous-equivalent technique. In 1 group we placed 2 margin convergence sutures between the supraspinatus and the rotator interval. In the comparison group, a suture anchor was inserted at the anterior attachment of the rotator cable. Margin convergence anchorage to bone was then performed between the supraspinatus and the rotator interval. Each specimen was tested with an Instron machine (Instron, Canton, MA) and a video digitizing system. A paired t test was used for statistical analysis. RESULTS: Margin convergence anchorage to bone decreased gap formation at cycle 1, cycle 30, and yield load across the entire footprint (P < .05). In both constructs the anterior gap was greater than the posterior gap at cycle 1, cycle 30, and yield load (P < .05). Margin convergence anchorage to bone decreased hysteresis and increased stiffness during the first cycle and increased yield load (P < .05). CONCLUSIONS: Using margin convergence anchorage to bone to restore the anterior attachment of the rotator cable decreased gap formation across the entire footprint and improved biomechanical properties for cycle 1 and yield load compared with soft-tissue margin convergence for massive rotator cuff repairs. CLINICAL RELEVANCE: Repairing the anterior rotator cuff with margin convergence anchorage to bone may improve clinical outcomes of an L-shaped massive tear repair.

Undergrowth: brachydactyly.

Brachydactyly simply means "short finger", but it has a clinical spectrum ranging from minor digital hypoplasia to complete aplasia. The index and small fingers are the most commonly affected digits, and the middle phalanx is the most commonly affected bone. Presentation of brachydactyly is highly variable-a digit may be just slightly shorter because of reduced growth of one phalanx or the metacarpal, or there may be complete absence of one or more phalanges, or there may be complete aplasia of the digit or multiple digits. This article discusses the results of conventional reconstruction using nonvascularized toe phalangeal bone grafting and distraction lengthening and the newer technique of microsurgical toe-to-hand transfers.