The development and validation of a functional assessment tool for the upper extremity in the overhead athlete.

BACKGROUND: There are no validated upper extremity instruments designed specifically to evaluate the performance and function of overhead athletes. Current shoulder and elbow scoring systems may not be sensitive to subtle changes in performance in this high-demand population. HYPOTHESIS: The scoring system developed in this study will be valid, reliable, and responsive in the evaluation of overhead athletes. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Based on the results of a pilot questionnaire administered to 21 overhead athletes, a final 10-item questionnaire was developed. Two hundred eighty-two healthy, competitive overhead athletes completed the new questionnaire, as well as 2 established upper extremity questionnaires, and were self-assigned into injury categories: (1) playing without pain, (2) playing with pain, and (3) not playing due to pain. Correlations between the scores and differences between injury categories were measured. Responsiveness testing was performed in an additional group of 55 injured athletes, comparing their scores before and after an intervention. RESULTS: The new score showed high correlation with the Disabilities of the Arm, Shoulder and Hand (DASH) score and the DASH sports/performing arts module. The new score correctly stratified overhead athletes by injury category (P < .0001). The new score also demonstrated excellent responsiveness, varying appropriately with improvements in injury category after treatment of injuries (P < .05). CONCLUSION: The new patient-reported instrument is valid and responsive in the evaluation of overhead athletes. Reliability was also demonstrated for the 13-item pilot questionnaire. The results support its use for the functional assessment of overhead athletes in future studies.

Transpedicular hemiepiphysiodesis and posterior instrumentation as a treatment for congenital scoliosis.

Anterior and posterior hemiepiphysiodesis using a transpedicular approach is an effective alternative treatment when compared with the traditional convex hemiepiphysiodesis or hemivertebrae excision. No study has reported the results of instrumentation with transpedicular hemiepiphysiodesis. Our study was a retrospective radiographic evaluation to assess the efficacy of transpedicular convex hemiepiphysiodesis with short segment instrumented posterior spinal fusion for congenital scoliosis. Ten hemivertebrae in 9 patients were evaluated. The average patient age was 10.5 years (range, 2.9-14.5 years). The average follow-up was 29.7 months. Cobb angles were recorded for the instrumented segment (segmental main curve) and the global or entire curve (total main curve). These values were compared preoperatively, postoperatively, and at 2-year follow-up. The average total main curve improved in 6 of 10 curves, from 35.0 to 29.6 degrees (15.4%). The average segmental main curve improved in 8 of 10 curves, from 30.0 to 21.5 degrees (28.3%). Seven of 10 curves demonstrated either no progression or improvement at the average 2-year follow-up. Two curves in older patients (greater than 9 years, 10 months) progressed until a comprehensive posterior spinal fusion was required. Multiple surgical techniques have been developed to provide treatment for progressive congenital scoliosis. Transpedicular hemiepiphysiodesis with a short segment instrumented posterior spinal fusion is a safe and effective treatment method to halt the progression of congenital scoliosis due to a hemivertebra in patients who are skeletally immature.