Acute Carpal Tunnel Syndrome from Horseshoe Abscess: A Case Report.

CASE: A 53-year-old man presented with a puncture wound to his right thumb, resulting in a horseshoe abscess, its infectious clinical picture muddled by dense paresthesias from the ensuing acute carpal tunnel syndrome. He was treated with irrigation and debridement of the thumb and small finger flexor tendon sheaths, carpal tunnel release, and bootlacing and dermal substitute application to the proximal forearm with eventual split-thickness skin grafting. CONCLUSION: Although a horseshoe abscess resulting in acute carpal tunnel syndrome is a rare entity unquantified in the literature, the treating orthopaedic surgeon should be aware of its association and initiate appropriate treatment accordingly.

Performance-based outcomes following patellar tendon repair in professional athletes.

Objectives: There are limited data on the impact of a patellar tendon repair to a professional athlete's career. The purpose of this study was to determine differences return to play (RTP) rate, career length, and performance-based outcomes after a patellar tendon repair in professional athletes of four different sports.Methods: Participants met inclusion criteria if initial reports of the date and type of surgery were corroborated by at least two independent sources of information through a well-established protocol of public newspaper archives, team injury reports, and player profiles. Players with other concomitant injuries of the knee or treated nonoperatively were excluded. One hundred and three athletes across professional baseball, basketball, American football, and soccer athletes were identified and met inclusion criteria. RTP rate, career length, and sports-specific performance statistics (i.e. player efficiency rating (PER) for professional basketball players) before and after surgery were collected for each athlete.Results: Seventy-nine (76.7%) professional athletes successfully RTP. American football athletes had the lowest RTP rate and the largest drop in performance in post-operative season 1 (P < 0.001). These athletes also experienced the shortest adjusted career lengths (P = 0.003) compared to players in the other sports. Basketball athletes played significantly less games through post-operative seasons 1 to 3 (P < 0.05). Soccer athletes had less goals and assists per game and played fewer games (P < 0.05) in post-operative season 1 that recovered to baseline by seasons 2 and 3.Conclusion: A patellar tendon rupture is a potentially devastating injury for the professional athlete. American football players appeared to have the worst postoperative outcome with the lowest RTP rate and a most significant decrease in performance in the first postoperative season. This procedure also had a significant short-term impact on soccer athletes who sustained decreases in short-term game performance. These findings are likely explained by the unique physical demands imposed by each sport.

Quantitative Risk Factor Analysis of Postoperative Dysphagia After Anterior Cervical Discectomy and Fusion (ACDF) Using the Eating Assessment Tool-10 (EAT-10).

STUDY DESIGN: A retrospective case series. OBJECTIVE: The aim of this study was to utilize the Eating Assessment Tool-10 (EAT-10) to quantitatively analyze risk factors contributing to dysphagia after anterior cervical discectomy and fusion (ACDF). SUMMARY OF BACKGROUND DATA: ACDF is one of the most common procedures performed in the United States, with postoperative dysphagia rates ranging from 2% to 60%. The EAT-10 is a self-administered, symptom-specific 10-item clinical instrument to document dysphagia symptom severity and has demonstrated excellent internal consistency, test-retest reliability, and criterion-based validity. METHODS: This study utilized a retrospective chart review of 163 patients from July 2013 to October 2017 who underwent ACDF at a single institution and prospectively completed EAT-10 surveys pre- and postoperatively. EAT-10 scores were collected preoperatively and at postoperative day 1, day 14, 1 month, 3 months, 6 months, and 12 months. Preselected risk factors were abstracted from the patients' chart. Univariate analyses were performed to identify candidate variables that correlated with abnormal EAT-10 scores at each time point. Multivariate logistic regression was then utilized to identify risk factors that were independently correlated with abnormal EAT-10 scores at each time point. RESULTS: Female gender, younger patients, and increased operating room (OR) time was associated with increased rates of dysphagia in the early postoperative period. History of obstructive sleep apnea, history of asthma, increased American Society of Anesthesiologists (ASA) score, and a larger number of spinal levels included in the surgery were correlated with increased dysphagia in the later postoperative periods. CONCLUSION: Dysphagia is common following ACDF. Factors associated with longer-term dysphagia seem to be more associated with pre-existing medical comorbidities. Understanding risk factors that correlate with increased rates of dysphagia has the potential to improve preoperative patient counseling and changes in operative management. LEVEL OF EVIDENCE: 4.