Ulnar Collateral Ligament Reconstruction.

Ulnar collateral ligament (UCL) injuries can significantly impair the overhead athlete. Reconstruction of the anterior bundle of the UCL (UCL-R) has allowed a high proportion of these individuals to return to their previous level of play. Several techniques for UCL-R are described that produce acceptable results with an overall low complication rate. Transient ulnar neuritis is the most common complication following UCL-R. The rate of UCL injury in young athletes is rising with increased youth involvement and year-round participation in overhead sports. The sports medicine community must broaden its focus to not only treat UCL injuries but also prevent them.

Elbow Surgery in Athletes.

Injuries and disorders of the elbow in athletes are common especially among throwing athletes. Common injuries encountered in the throwing athlete include ulnar collateral ligament injuries, ulnar neuritis, capitellar osteochondritis dissecans, valgus extension overload with posterior olecranon impingement, olecranon stress fracture, and loose bodies. A thorough knowledge of both the functional anatomy as well as throwing biomechanics are required to properly diagnosis and treat these problems. Nonoperative and surgical techniques have continued to advance over the last 25 years allowing for improved prognosis and return to play for athletes affected with elbow pathology.

Traumatic Instability: Treatment Options and Considerations for Recurrent Posttraumatic Instability.

Recurrent traumatic glenohumeral instability is a complex problem with multiple variables to consider, but patient demographics, activities, as well as clinical and radiographic findings provide significant information to help choose the best treatment option. Although nonoperative treatment is a viable option for primary glenohumeral instability and in-season instability, recurrent instability exhibits anatomic factors which render nonsurgical treatment limited in scope. A proper patient history, clinical examination, and standard and advanced imaging are necessary in the assessment of patients with recurrent traumatic instability. Age, activity, hypermobility, tissue quality, glenoid and humeral head bone stock, and any prior surgical treatment are factors that must be considered for surgical planning. Open and arthroscopic Bankart repairs are good surgical options when bone loss is not an issue but increasing glenoid or humeral osseous deficiency in this setting frequently warrants additional procedures which address bony insufficiency. Controversy remains concerning the threshold value for glenoid bony deficiency and combined, bipolar defects, but this critical number may be less than previously suspected. Despite this controversy, successful surgical treatment of recurrent glenohumeral instability is possible when properly assessed and the correct surgery applied.

Return to Play Following Ulnar Collateral Ligament Reconstruction.

Ulnar collateral ligament injury in the overhead athlete typically presents as activity-related pain with loss of velocity and control. Treatment options range from nonoperative rehabilitation to ligament reconstruction. Surgical reconstruction is frequently required to allow the athlete to return to competition and many surgical techniques have been described. The rehabilitation process to return back to overhead athletics, in particular pitching, is prolonged and requires progression through multiple phases. Despite this, surgical treatment has been shown by multiple investigators to be successful at returning athletes to their previous level of competition.

Paramedic Recognition of Sepsis in the Prehospital Setting: A Prospective Observational Study.

Background. Patients with sepsis benefit from early diagnosis and treatment. Accurate paramedic recognition of sepsis is important to initiate care promptly for patients who arrive by Emergency Medical Services. Methods. Prospective observational study of adult patients (age ≥ 16 years) transported by paramedics to the emergency department (ED) of a Canadian tertiary hospital. Paramedic identification of sepsis was assessed using a novel prehospital sepsis screening tool developed by the study team and compared to blind, independent documentation of ED diagnoses by attending emergency physicians (EPs). Specificity, sensitivity, accuracy, positive and negative predictive value, and likelihood ratios were calculated with 95% confidence intervals. Results. Overall, 629 patients were included in the analysis. Sepsis was identified by paramedics in 170 (27.0%) patients and by EPs in 71 (11.3%) patients. Sensitivity of paramedic sepsis identification compared to EP diagnosis was 73.2% (95% CI 61.4-83.0), while specificity was 78.8% (95% CI 75.2-82.2). The accuracy of paramedic identification of sepsis was 78.2% (492/629, 52 true positive, 440 true negative). Positive and negative predictive values were 30.6% (95% CI 23.8-38.1) and 95.9% (95% CI 93.6-97.5), respectively. Conclusion. Using a novel prehospital sepsis screening tool, paramedic recognition of sepsis had greater specificity than sensitivity with reasonable accuracy.