The Role of the Hand Surgery Consultant in the Care of the Football Athlete.

PURPOSE: Return-to-play safely focusing on care for professional athletes. Variability on when return-to-play is possible due to differences in dexterity requirements of player's position and upper extremity injuries. This study covers the importance of trust between players and healthcare providers in the incident of upper extremity injury and aspects of when return-to-play is favorable. MATERIAL AND METHODS: The methods and materials used in this study were a collection of case reviews and documentation of injuries reported by national leagues. A retrospective review from 2000 to 2012 reviewing case series reported by the NFL Injury Surveillance System (NFL ISS). The case reviews included player activity, external bracing, and clinical notes. The review extracted from the National football league surveyed injuries over a 10-year period from 1996 - 2005. The National Football league's surveillance database was used focusing on the type of injury, the athlete's position, and the type of activity that was occurring at the time of injury. RESULTS: The 7 included articles reported most injuries occurred in defensive players. The majority of injuries were sustained while tackling. Additionally, the 7 articles included a discussion of injury types including those of the hand, wrist, forearm, and elbow. Treatment plans were also reviewed catering to the type of injury. Players who were treated non-operatively missed a mean of 25 days and players who were treated operatively missed a mean of 46 days. CONCLUSION: The importance of communication between surgeons, coaches, players, and general managers of teams is vital in caring for injured players. All parties need to be aware of how much time players will miss and the best management techniques to take to get them back on the playing field.

Traumatic Carpal Axial Instability in a Professional Football Player: A Case Report.

This is a case of traumatic carpal axial instability in a professional football player. Traumatic carpal axial instability characteristically involves longitudinal separation of the ulnar or radial distal carpal row along with intermetacarpal injury. Rarely, pancarpal ligament disruption occurs, as in this case. Early diagnosis and treatment of unstable wrist injuries is important in achieving a satisfactory outcome.

Lateral antebrachial cutaneous nerve compression after traumatic rupture of the long head of the biceps: a case series.

BACKGROUND: Lateral antebrachial cutaneous (LABC) nerve compression is a rare but debilitating injury. There are limited data on the association of LABC nerve compression and proximal biceps rupture. We theorized that because of distal migration, the biceps muscle and tendon cause compression on the nerve. METHODS: We present 2 cases in which patients had proximal biceps ruptures with tendon retraction and developed neurologic symptoms associated with the LABC nerve. To demonstrate our theory, we performed a cadaveric experiment. After making an incision to expose the entire biceps muscle and the musculocutaneous nerve and its branch into the LABC nerve, we marked each structure in 2-cm increments with a marking pen. The long head of the biceps was then cut to simulate a proximal biceps rupture. RESULTS: The relationship between the 3 structures was then studied, showing no change in position of the musculocutaneous nerve or LABC nerve. The biceps muscle and tendon had migrated distally toward the LABC nerve, demonstrating compression of the nerve. CONCLUSION: Proximal biceps tears commonly occur from trauma as well as iatrogenically after a biceps tenotomy for treatment of biceps tendinopathy. However, it is unusual for neuropathy of the LABC nerve to occur. Patients who develop neuropathy associated with the LABC nerve after a proximal biceps rupture can be effectively treated with LABC nerve decompression and biceps plasty. We found that this was an effective surgical treatment of LABC neuropathy without the need for proximal biceps tenodesis.

Anatomic reconstruction of thumb metacarpophalangeal joint ulnar collateral ligament using an interference screw docking technique.

Complete rupture of the ulnar collateral ligament injury of the thumb metacarpophalangeal (MCP) joint can be a debilitating injury resulting in decreased grip and pinch strength. The spectrum of injury to this ligament varies from simple strain to complete rupture of both proper and accessory ligaments. Generally, this is a result of an abduction force transmitted across the thumb MCP joint.Physical examination assists in identification of these injuries and the extent of ligamentous injury. Ecchymoses and pain over the ligament are usually present in the acute injury. Chronic injuries may not be painful. A palpable mass may be present. The valgus stress test across this joint in 30 degrees of flexion provides information on the competency of the proper ligaments, whereas valgus stress in extension assesses the accessory collateral ligaments. This stress test is useful in the acute or chronic setting.Stabilization of the thumb MCP joint in chronic injuries can require reconstruction. We describe an anatomic reconstruction using a tendon graft and a bioabsorbable interference screw.

Gymnastic wrist injuries.

During gymnastic activities, the wrist is exposed to many different types of stresses, including repetitive motion, high impact loading, axial compression, torsional forces, and distraction in varying degrees of ulnar or radial deviation and hyperextension. Many of these stresses are increased during upper extremity weight-bearing and predispose the wrist to high rates of injury during gymnastics. Distal radius stress injuries are the most common and most documented gymnastic wrist conditions. Other conditions include scaphoid impaction syndrome, dorsal impingement, scaphoid fractures, scaphoid stress reactions/fractures, capitate avascular necrosis, ganglia, carpal instability, triangular fibrocartilage complex tears, ulnar impaction syndrome, and lunotriquetral impingement. It is important to diagnose quickly and accurately the specific injury to initiate expediently the proper treatment and limit the extent of injury. In addition, a gymnast's training regimen should also include elements of injury prevention.

Primary osteoarthritis of the elbow: lack of radiographic evidence for morphologic predisposition, results of operative debridement at intermediate follow-up, and basis for a new radiographic classification system.

This study evaluated whether or not a morphologic predisposition exists to the development of primary osteoarthritis and establishes a classification tool to predict outcome in surgical treatment of elbow osteoarthritis. Detailed radiographic morphologic analysis of the ulnotrochlear and radio-capitellar joints in 90 normal and 24 osteoarthritic elbows showed few differences. Based upon commonly demonstrated radiographic features of degenerative changes, joint space narrowing, and marginal osteophytes, a classification system for rating the severity of primary osteoarthritis of the elbow was developed and applied retrospectively classified the preoperative radiographs of 18 patients (21 elbows) who had undergone elbow debridement and capsular release through a lateral collateral ligament preserving approach. Clinical and radiographic outcomes were assessed at an average 65 months postoperative. Total elbow motion and Mayo elbow performance scores were best in those who had been classified as class I preoperatively and worst in those in class III. This newly developed radiographic classification system is a useful tool in predicting surgical outcome following debridement of primary elbow osteoarthritis.

Silicone implant arthroplasty in patients with idiopathic osteoarthritis of the metacarpophalangeal joint.

PURPOSE: The outcome of silicone metacarpophalangeal (MCP) joint implant arthroplasty in the osteoarthritic patient population has not been well established. Typically patients with idiopathic osteoarthritis have no history of underlying systemic disease and may respond well to treatment with MCP joint implant arthroplasty. This study examined the efficacy of silicone MCP joint implant arthroplasty for patients with idiopathic osteoarthritis for whom nonsurgical treatment had failed. METHODS: Of 14 patients (15 arthroplasties) who had silicone MCP joint implant arthroplasty for idiopathic osteoarthritis 12 (13 arthroplasties) returned for follow-up evaluation at an average of 40 months after surgery. There were 9 index finger and 4 middle finger arthroplasties. The average age at the time of surgery was 62 years. Patients completed a subjective questionnaire and were examined by a certified therapist. Range of motion and strength were recorded and the Jebsen-Taylor examination was administered to assess function. Range of motion values at final follow-up evaluation were compared with preoperative and early postoperative values. Radiographs were taken at final follow-up evaluation and compared with preoperative and early postoperative films to assess joint position, wear, and radioulnar alignment. RESULTS: At final follow-up evaluation excellent (9 patients) and good (3 patients) overall improvement were reported. Nine patients (10 implants) reported greater than 75% functional improvement. A notable increase was seen in MCP joint flexion. Grip and lateral pinch strengths were below age-matched normative data. Of the 11 patients (12 implants) who came in for follow-up evaluation 7 performed all tasks of the Jebsen-Taylor examination within the allotted time. At final follow-up evaluation all silicone implants were located and showed no signs of subluxation. Radiographic radioulnar alignment was maintained. One implant was revised at 35 months secondary to fracture. CONCLUSIONS: Silicone implant arthroplasty is a motion-sparing procedure that provides good pain relief and maintenance of function at intermediate follow-up evaluation in patients with idiopathic osteoarthritis of the MCP joint.