All-terrain-vehicle injuries. A sport out of control.

All-terrain vehicles, originally introduced as utility vehicles to be used on farms or ranches, have now gained immense popularity in the United States as a form of recreational activity. With the increasing popularity of these vehicles, along with more powerful engines, a corresponding increase in the injury and death rates has been noted. We discuss the experience in the emergency department and trauma unit of a Southwest teaching hospital, an area where these vehicles are in use year round. We suggest ways to prevent and minimize accidents to reduce the number of injuries and deaths.

Tarsal coalition: a review of the literature and presentation of 13 cases.

Tarsal coalition refers to the condition that exists when there is absent or restricted movement between two or more of the bones of the hindfoot. The usual cause of the restricted movement is a congenital abnormality with a fibrous (syndesmosis), cartilagenous (synchondrosis), or bony (synostosis) union between the adjoining involved bones. The commonest site of these congenital anomalous attachments are reported in the literature as being located at the calcaneonavicular, the talocalcaneal, and, less commonly, the talonavicular areas. Limited movement in the hindfoot can also result from trauma, arthritis, tumor, or injury involving those joints in the foot. The congenital form may often go unrecognized until such time as a twist or sprain of the ankle or foot leads to its diagnosis. On the other hand, the condition may go unrecognized as a cause for chronic pain or discomfort in the hindfoot or ankle. In this article, a series of 13 feet in 11 patients with this condition that have been noted in the sports medicine clinic at the University of Arizona Health Sciences Center during the past 8 years is described. A detailed historical, clinical, and biomechanical account is also included.

Snapping scapula: a review of the literature and presentation of 14 patients.

The syndrome of pain at the vertebral edge of the scapula and snapping associated with movement of the shoulder that occurs spontaneously after trauma or surgical procedures to the shoulder girdle is relatively common. The snapping is described in the literature as being due to an exostosis on the undersurface of the vertebral angle of the scapula, which rides across the rib cage. The pain has been reported to be the result of inflamed bursae located between the scapula and adjacent thorax or over the scapular exostosis. This retrospective study of a small group of patients with the syndrome attempts to define, by detailed x-ray studies, the presence or absence of exostosis at the vertebral angle. In none of these cases was a bony abnormality or exostosis identified clinically or radiologically. The irritating symptoms can be relieved by physiotherapy; surgery is unnecessary.

Patellalgia.

In brief: Knee pain relating to or arising from the patellofemoral articulation is common in athletes. While direct trauma can cause this pain, patellofemoral malalignment and/or tracking problems seem to be its major source. This paper reviews the functional anatomy of the patella and describes the diagnostic and treatment procedures recommended for investigating and treating this condition. Most patients improve after an initial course of conservative treatment. Proximal or distal realignment may be surgically performed in patients who don't respond to conservative treatment. Patellectomy leaves some weakness in the quadriceps and should be used only as a last resort.

Anomalous muscle in the leg: soleus accessorium.

In the last 4 years we have had the opportunity to investigate an anomalous muscle mass on the medial aspect of the distal leg of three young athletes. A review of the clinical literature has revealed only nine reported cases of a similar muscle mass in this area. Surgical exploration was carried out in each of our three cases with relief of symptoms in two of the cases following decompression of the overlying fascial sheath. We believe this muscle to represent the soleus accessorius and its presence, which may be rare. The presence of this muscle should be considered in the differential diagnosis of a symptomatic or asymptomatic mass of the posteromedial aspect of the distal leg. Surgical exploration and fascial release is recommended.

Irreducible lateral dislocation of the patella: a case report.

Acute lateral dislocation of the patella is a common clinical entity. The dislocation often reduces spontaneously or with the assistance of the patient or someone in attendance at the time of the injury. Very occasionally the patient presents to an emergency room with the patella still dislocated, and it is usually easily reduced at that time without an anesthetic by a physician. It is extremely rare to find an irreducible lateral dislocation of the patella, which cannot be reduced by manipulation even with a general anesthetic. A case is herein reported of an irreducible lateral dislocation of the patella that required open reduction followed by soft tissue reconstruction.

Drug Tests for Athletes-Pro and Con.

Concerns about the costs and effectiveness of drug testing in reducing drug use and abuse among athletes has sparked a debate about whether testing should be continued, expanded in scope, or discontinued. THE PHYSICIAN AND SPORTSMEDICINE has asked physicians Daniel F. Hartley, Herman Adlercreutz. K. D. Fitch, and E. C. Percy for their views on the subject. Their comments are preceded by an introduction by Allan J. Ryan. MD.

The use of DMSO in tennis elbow and rotator cuff tendonitis: a double-blind study.

Over a 1-yr period, 102 patients with a clinical diagnosis of either medial or lateral epicondylitis (tennis elbow) or rotator cuff tendonitis were treated with topical applications of dimethyl sulfoxide (DMSO). A double-blind controlled study was carried out on these patients in the private practice of an orthopaedic surgeon to determine the efficacy of this material in the treatment of these two common clinical conditions. Beneficial effects were assessed with respect to improvement in pain, tenderness or swelling, and increase in the range of motion. Forty patients were treated for each of the two ailments; patients treated with the 70% DMSO aqueous solution did not receive any more beneficial effect from the drug than patients who received 5% DMSO aqueous placebo solution.

Chemical warfare: drugs in sports.

A number of substances have been used by athletes in an attempt to improve performance in sports. The use of these substances, which are referred to as ergogenic aids, has become widespread; some pose serious health hazards. Ergogenic aids are divided into five broad classifications: physiological, physical, psychological, nutritional and chemical. It is possible, although conclusive proof is lacking, that some substances may give an athlete who takes them an advantage over one who does not. However, the health hazards posed in general by these materials far outweigh any possible advantage.

An epiphyseal stress fracture of the foot and shin splints in an anomalous calf muscle in a runner.

The following case is presented as one of unusual foot and leg lesions encountered in an adolescent long-distance runner. The associated problems of a first metatarsal Salter Harris type II epiphyseal stress fracture, and an accessory calf muscle with "shin splints" in the contralateral leg are discussed. Treatment of these conditions is outlined with eventual return to full function by the athlete.

Athletic aids: fact or fiction?

A major problem facing physicians involved in the daily care of amateur athletes in international competition is that of so-called doping. While there are many substances used that might be considered ineffectual or physiologic, the two main categories of substances considered as doping agents are stimulants and anabolic steroids. No substance is as yet known that will improve an athlete's performance. Often such substances are taken in error rather than in a misguided attempt to improve one's ability. These substances can be dangerous and, because of this, doping rules were established basically to protect the athlete. Anabolic steroids are particularly dangerous; they usually are taken by those engaged in lifting or throwing sports in an attempt to improve performance by increasing muscle bulk. There is as yet no scientific proof that performance is improved. Dope testing for stimulants should be carried out in a quantitative rather than qualitative manner so that the athlete who has taken a small amount of a so-called stimulant (such as an asthma or common cold preparation) would not be excluded from competition. Rigid testing for anabolic steroids should be continued.

Experience of the Canadian medical team at the 21st Olympiad.

The Canadian medical team at the 21st Olympiad--11 therapists, 8 physicians and 2 nurses--was larger than necessary, partly because the Canadian athletes were not affected by the stresses of competition in a foreign land and partly because many used the medical facilities established by le comité organisateur des Jeux olympiques. There were few injuries of a serious nature or of lasting consequence among the Canadian athletes; only 10 of the 475 athletes were withdrawn from competition on the advice of the medical staff. On the average the athletes had two visits to a physician and five treatments by a therapist. Track and field competitors accounted for the largest number of visits to the therapy clinic, and musculoskeletal problems were the most frequent type. Most of the treatment consisted of local supportive measures.