Axillary-Subclavian Venous Thrombosis following a weightlifting injury in an elderly patient: a case report.

Background: Axillary-subclavian venous thrombosis (ASVT) is a type of upper extremity deep vein thrombosis (UEDVT). UEDVTs are classified as either primary or secondary depending on their etiology. Although uncommon, clinicians should be aware of the clinical presentation of UEDVT as timely diagnosis and early treatment is critical in preventing possible post-thrombotic complications. Case presentation: We report a rare case of axillary-subclavian and internal jugular vein thrombosis in the absence of clear risk factors in a 78-year-old male weightlifter who presented to the office with two-week duration of left upper extremity pain and swelling following strenuous exercise at the gym. Summary: The combination of unusual thrombi location, in addition to the unusual absence of existing thoracic-outlet compression or indwelling medical hardware, makes our case of UEDVT especially uncommon. Clinicians should be aware of this rare disease due to the debilitating effects both in the short and long term.

Myofascial treatment for patients with acetabular labral tears: a single-subject research design study.

STUDY DESIGN: Single-subject research design using 4 consecutive patients. OBJECTIVE: To assess whether treatment using soft tissue therapy (ART or Active Release Technique), stretching, and strengthening of the hip abductors, hip external rotators, and tensor fascia latae muscles reduces pain and improves self-reported hip function in patients with acetabular labral tears who also have posterolateral hip pain of suspected myofascial origin. BACKGROUND: Acetabular labral tears cause pain in some but not all patients. Pain commonly presents anteriorly but may also present posteriorly and laterally. The standard of care is arthroscopic repair, which helps many but not all patients. It is possible that these patients may present with extra-articular contributions to their pain, such as myofascial pain, making their clinical presentation more complex. No previous study has assessed soft tissue therapy as a treatment option for this subset of patients. METHODS: This A-B-A design used repeated measures of the Hip Outcome Score and visual analog scale for pain. Four patients were treated for 6 to 8 weeks, using a combination of soft tissue therapy, stretching, and strengthening for the hip abductors, external rotators, and tensor fascia latae. Data were assessed visually, statistically, and by comparing mean differences before and after intervention. RESULTS: All 4 patients experienced both statistically significant and clinically meaningful improvement in posterolateral hip pain and hip-related function. Three patients also experienced reduction in anteromedial hip pain. CONCLUSION: Myofascial hip pain may contribute to hip-related symptoms and disability in patients with acetabular labral tears and posterolateral hip pain. These patients may benefit from soft tissue therapy combined with stretching and strengthening exercises targeting the hip abductors, tensor fascia latae, and hip external rotator muscles. Level of Evidence Therapy, level 4.

Influence of MRI field strength on clinical decision making in knee cartilage injury - A case study.

OBJECTIVE: To increase clinicians' awareness of the differences in image resolution and potential diagnostic accuracy between small and large-field MR Scanners. To present an example of a clinical decision making challenge in how to proceed when knee MRI and clinical findings don't agree. CLINICAL FEATURES: A 38 year old female mountain biker presented with knee pain and clinical features strongly suggestive of a torn meniscus or loose bodies. An initial MRI using a small field strength (0.18T) scanner was reported as normal. Her clinical presentation was suspicious enough that a repeat MRI on a high-field (1.5T) scanner was ordered. The second MRI included high resolution 3D volumetric imaging which revealed cartilage damage and loose bodies. INTERVENTION AND OUTCOME: The patient was treated with arthroscopic surgery which confirmed the presence of meniscal and chondral injury and resulted in notable improvement in the patient's symptoms. CONCLUSION: Clinicians should consider scanner quality and diagnostic accuracy before discounting strongly suggestive clinical history and examination findings when MRIs are reported as normal.

OBJECTIF: Sensibiliser les cliniciens aux différences de résolution d'image et de précision potentielle du diagnostic entre les petits et grands imageurs par résonnance magnétique (IRM). Présenter un exemple de difficulté de prise de décision clinique quant à la façon de procéder lorsque l'IRM du genou et les résultats cliniques se contredisent. CARACTÉRISTIQUES CLINIQUES: Une vététiste de 38 ans souffre d'une douleur au genou et les caractéristiques cliniques indiquent clairement une déchirure du ménisque ou la présence de corps étrangers. Une IRM initiale à l'aide d'un petit appareil (0,18 T) n'a rien révélé d'anormal. Son tableau clinique était assez suspect pour qu'un nouvel examen par IRM à l'aide d'un appareil de 1,5 T soit prescrit. Le deuxième appareil d'IRM comportait une imagerie volumétrique haute résolution en 3D qui a révélé des lésions du cartilage et des corps étrangers. INTERVENTION ET RÉSULTATS: Le patient a subi une chirurgie arthroscopique qui a confirmé la présence de lésions du ménisque et de lésions chondrales. Une amélioration notable des symptômes du patient a été enregistrée. CONCLUSION: Les cliniciens devraient tenir compte de la qualité de l'imageur et de la précision du diagnostic avant d'écarter des antécédents cliniques fortement évocateurs et les résultats des examens « normaux ¼ effectués par une IRM.

Can injury in major junior hockey players be predicted by a pre-season functional movement screen - a prospective cohort study.

BACKGROUND: The Functional Movement Screen (FMS) is a tool that is commonly used to predict the occurrence of injury. Previous studies have shown that a score of 14 or less (with a maximum possible score of 21) successfully predicted future injury occurrence in athletes. No studies have looked at the use of the FMS to predict injuries in hockey players. OBJECTIVE: To see if injury in major junior hockey players can be predicted by a preseason FMS. METHODS: A convenience sample of 20 hockey players was scored on the FMS prior to the start of the hockey season. Injuries and number of man-games lost for each injury were documented over the course of the season. RESULTS: The mean FMS score was 14.7+/-2.58. Those with an FMS score of ≤14 were not more likely to sustain an injury as determined by the Fisher's exact test (one-tailed, P = 0.32). CONCLUSION: This study did not support the notion that lower FMS scores predict injury in major junior hockey players.

HISTORIQUE: L'évaluation du mouvement fonctionnel (EMF) est un outil qui est couramment utilisé pour prévoir les blessures. Des études antérieures ont montré qu'une note de 14 ou moins (avec une note maximale possible de 21) réussit à prévoir les blessures futures chez les athlètes. Aucune étude n'a examiné le recours à l'EMF pour prévoir les blessures chez les joueurs de hockey. OBJECTIF: Déterminer s'il est possible de prévoir les blessures chez les joueurs de la ligue de hockey junior majeur par une EMF avant le début de la saison. MÉTHODOLOGIE: Un échantillon de commodité de 20 joueurs de hockey a été évalué par l'EMF avant le début de la saison de hockey. Les blessures et le nombre de joueurs perdus par jeu pour chaque blessure ont été enregistrés pendant la saison. RÉSULTATS: La note moyenne d'EMF était 14,7+/−2,58. Ceux qui ont obtenu une note d'EMF ≤14 n'étaient pas plus susceptibles de subir une blessure, telle que déterminée par la méthode exacte de Fisher (unilatérale, P = 0,32). CONCLUSION: Cette étude n'appuie pas l'idée que les notes d'EMF permettent de prévoir les blessures chez les joueurs de la ligue de hockey junior majeur.

The effect of weak hip abductors or external rotators on knee valgus kinematics in healthy subjects: a systematic review.

CONTEXT: It has been postulated that subjects with weak hip abductors and external rotators may demonstrate increased knee valgus, which may in turn raise risk of injury to the lower extremity. Recent studies have explored the potential link between hip strength and knee kinematics, but there has not yet been a review of this literature. OBJECTIVE: To conduct a systematic review assessing the potential link between hip-abductor or external-rotator strength and knee-valgus kinematics during dynamic activities in asymptomatic subjects. EVIDENCE ACQUISITION: An online computer search was conducted in early February 2011. Databases included Medline, EMBASE, CINAHL, SPORTDiscus, and Google Scholar. Inclusion criteria were English language, asymptomatic subjects, dynamometric hip-strength assessment, single or multicamera kinematic analysis, and statistical analysis of the link between hip strength and knee valgus via correlations or tests of differences. Data were extracted concerning subject characteristics, study design, strength measures, kinematic measures, subject tasks, and findings with regard to correlations or group differences. EVIDENCE SYNTHESIS: Eleven studies were selected for review, 4 of which found evidence that subjects with weak hip abductors or external rotators demonstrated increased knee valgus, and 1 study found a correlation to the contrary. CONCLUSIONS: There is a small amount of evidence that healthy subjects with weak hip abductors and perhaps weak external rotators demonstrate increased knee valgus. However, due to the variation in methodology and lack of agreement between studies, it is not possible to make any definitive conclusions or clinical recommendations based on the results of this review. Further research is needed.