Improved glucose tolerance and insulin sensitivity after electrical stimulation-assisted cycling in people with spinal cord injury.

DESIGN: Longitudinal training. OBJECTIVES: The purpose was to determine the effect of electrical stimulation (ES)-assisted cycling (30 min/day, 3 days/week for 8 weeks) on glucose tolerance and insulin sensitivity in people with spinal cord injury (SCI). SETTING: The Steadward Centre, Alberta, Canada. METHODS: Seven participants with motor complete SCI (five males and two females aged 30 to 53 years, injured 3-40 years, C5-T10) underwent 2-h oral glucose tolerance tests (OGTT, n=7) and hyperglycaemic clamp tests (n=3) before and after 8 weeks of training with ES-assisted cycling. RESULTS: Results indicated that subjects' glucose level were significantly lower at 2 h OGTT following 8 weeks of training (122.4+/-10 vs 139.9+/-16, P=0.014). Two-hour hyperglycaemic clamps tests showed improvement in all three people for glucose utilisation and in two of three people for insulin sensitivity. CONCLUSIONS: These results suggested that exercise with ES-assisted cycling is beneficial for the prevention and treatment of Type 2 diabetes mellitus in people with SCI. SPONSORSHIP: Supported by Alberta Paraplegic Foundation, Therapeutic Alliance.

Stress fractures of the sacrum. An atypical cause of low back pain in the female athlete.

Low back pain is a common finding in an athletically active premenopausal female population. We describe an unusual cause of persistent low back/sacroiliac pain: a fatigue-type sacral stress fracture. Plain radiographs, bone scans, computed tomography, and magnetic resonance imaging studies were obtained in the female athletes to determine the nature of the pathologic abnormality. The most significant risk factor for fatigue-type sacral stress fractures was an increase in impact activity due to a more vigorous exercise program. Potential risk factors such as abnormal menstrual history, dietary deficiencies, and low bone mineral density were examined. The clinical course was protracted, with an average 6.6 months of prolonged low back pain before resolution of symptoms. Sacral fatigue-type stress fractures did not preclude the athletes from returning to their previous level of participation once healing had occurred.

Functional electrical stimulation exercise increases GLUT-1 and GLUT-4 in paralyzed skeletal muscle.

The study purpose was to determine the effect of functional electrical stimulation (FES)-leg cycle ergometer training (30 minutes on 3 d/wk for 8 weeks) on the GLUT-1 and GLUT-4 content of paralyzed skeletal muscle. Biopsy samples of vastus lateralis muscle were obtained pre- and post-training from five individuals with motor-complete spinal cord injury ([SCI] four men and one woman aged 31 to 50 years, 3 to 25 years postinjury involving C5-T8). Western blot analysis indicated that GLUT-1 increased by 52% and GLUT-4 increased by 72% with training (P < .05). This coincided with an increase in the muscle oxidative capacity as indicated by a 56% increase in citrate synthase (CS) activity (P < .05) and an improvement in the insulin sensitivity index as determined from oral glucose tolerance tests (P < .05). It is concluded that FES endurance training is effective to increase glucose transporter protein levels in paralyzed skeletal muscle of individuals with SCI.

Stress fractures of the femoral shaft in athletes--more common than expected. A new clinical test.

Athletes from 20 Division I AA collegiate varsity sports and 1 club sport were followed carefully for the development of stress fractures during the 1990 to 1991 and the 1991 to 1992 academic years. During this period, among 914 athletes, 34 stress fractures were sustained. Seven of these, or 20.6%, were of the femoral shaft. This represents a much higher incidence than previously observed in athletes. A new clinical test is described that significantly aids in the early diagnosis and follow-up treatment of femoral shaft stress fractures.

A Lisfranc's Fracture-Dislocation in a Collegiate Football Player.

The Lisfranc's fracture-dislocation is an extremely serious injury that needs immediate recognition and treatment. In displaced fractures, swelling and deformity will be evident. But, often, because of spontaneous reduction, chronic midfoot pain and arthritis may result if the injury goes unrecognized. The tarsometatarsal joint, referred to as Lisfranc's joint, can be fractured and dislocated by direct or indirect forces. In football, one possible injury mechanism occurs when a foot that is planted on the ground receives an axial force applied to the heel as the forefoot is hyperextended. Using a classification system, the dislocation can be identified and treated in reference to the damage done. Treatment should consist of a thorough examination, including evaluation of the vascular supply. The athlete should be immobilized and transported properly, nonweight-bearing, for medical referral. Correct rehabilitation will allow the athlete to return to competition.

Avulsion Fracture of the Olecranon Process.

In brief A young wrestler with an avulsion fracture of the olecranon process was treated conservatively without success. Internal fixation was done, but when no improvement was demonstrated at follow-up, a removable cast was used so that he could do range-of-motion exercises to facilitate healing. This case demonstrates that young patients who complain of elbow pain should be followed carefully because of possible damage to the epiphysis.

Non-operative treatment of meniscal tears.

In a retrospective review of the results of 3,612 arthroscopic procedures that were performed for the treatment of an acute or a chronic meniscal lesion, with or without an associated ligamentous lesion, we identified eighty meniscal tears (in seventy-five patients) that had been assumed to be stable. Seventy were vertical longitudinal tears and ten were vertical radial tears. The seventy longitudinal tears included fifty-two lateral and eighteen medial meniscal lesions. All of the radial tears were in the lateral meniscus. Of the seventy-five patients, fifty-two had been followed for two to ten years. At the time of follow-up, only six of these fifty-two patients had needed additional intervention because of symptoms that were related to the meniscal tear. Four of them had the intervention after a sports-related traumatic extension of a stable tear, and two, because persistent symptoms were caused by the original meniscal lesion. A repeat arthroscopy was performed on thirty-two patients (twenty-six of whom had a longitudinal tear and six of whom had a radial tear), at an average of twenty-six months after the original arthroscopy. Seventeen of the twenty-six longitudinal tears had completely healed. Five of the six radial tears had no evidence of healing and one had extended. Neither ligamentous laxity nor a meniscal tear that was chronic at the time when it was discovered appeared to preclude healing of the stable longitudinal tears. No localized degenerative changes in the adjacent articular cartilage were found in association with any of the stable vertical longitudinal or radial meniscal lesions. Excluding the six patients who had had additional surgical treatment, none of the fifty-two patients who filled out a questionnaire reported that they had symptoms of a meniscal lesion, and none of the forty-two patients who were re-examined two years or more after the operation had signs of a meniscal lesion. Stable vertical longitudinal tears, which tend to occur in the peripheral vascular portions of the menisci, have great potential for healing. The tear should be left alone unless it is the only abnormality that is found and it is causing symptoms that warrant treatment. Stable radial tears, which tend to occur in the avascular inner one-third of the meniscus, have little potential for healing. Whether it is best to leave these lesions alone or to fashion an intact rim by contouring the meniscus was not established by this study.

The roentgenographic evaluation of anterior shoulder instability.

Retrospective evaluations of roentgenograms of 83 patients with unilateral shoulder instability were surveyed to evaluate the usefulness of various radiographic projections and to correlate the information with the osseous pathology associated with prior glenohumeral dislocation. The Hill-Sachs and the osseous Bankart defects were considered pathognomonic radiographic signs of glenohumeral joint instability. Based on history, physical examination, and examination under general anesthesia, patients were divided into three categories--(1) dislocation group, (2) subluxation group, and (3) combination group. Roentgen projections evaluated included the anteroposterior view with the humerus in internal and external rotation, axillary view, West Point view, Stryker notch, and Didiee view. The Hill-Sachs defect on the posterolateral aspect of the humeral head was best demonstrated on the combination of an internal rotation and a Stryker notch view. The osseous Bankart defect on the anteroinferior glenoid rim was best documented on the Didiee and West Point views. The external rotation and axillary view did not add significantly to the preoperative radiographic findings. In a patient with an unstable shoulder, a radiographic series that includes an internal rotation, a Stryker notch view, and either a West Point or a Didiee view would maximize the diagnostic yield per radiographic cost, time, and exposure.