A prospective randomized study comparing a forearm strap brace versus a wrist splint for the treatment of lateral epicondylitis.

BACKGROUND: The outcome is unknown for 2 common bracing treatments utilized for patients with lateral epicondylitis. The purpose of this study was to compare the clinical outcomes of a wrist splint with that of a counterforce forearm strap for the management of acute lateral epicondylitis. MATERIALS AND METHODS: Forty-two patients (44 elbows) received either a wrist extension splint (Group I-24 elbows) or a counterforce forearm strap (Group II-20 elbows). Measures on the Mayo Elbow Performance (MEP) and American Shoulder and Elbow Society (ASES) Elbow Assessment Form were collected prior to treatment and at 6 weeks. A total score was derived, utilizing the ASES Elbow Assessment, as was a score utilizing the standard scoring system for the MEP. RESULTS: Group I's score derived from the ASES form improved 16 points and Group II's score improved 13 points. Group I's score on the MEP improved 13 points and Group II's score improved 12 points. There was no significant difference measured between the Groups with the ASES (P = .60) nor MEP (P = .63) scores. However, within the ASES derived score, pain relief was significantly better with the extension splint group (P = .027). No other variables were statistically significantly different. DISCUSSION: Significant pain relief with the wrist extension splint may be due to improved immobilization of the wrist extensor muscles in a resting position. CONCLUSION: The wrist extension splint allows a greater degree of pain relief than does the forearm strap brace for patients with lateral epicondylitis.

Biomechanical comparison of a modified Weaver-Dunn and a free-tissue graft reconstruction of the acromioclavicular joint complex.

BACKGROUND: Most surgical reconstructions of the separated acromioclavicular joint do not address the injured ligaments and capsule of the acromioclavicular joint. PURPOSE: This study was undertaken to compare the biomechanical characteristics of a modified Weaver-Dunn reconstruction and an intramedullary acromioclavicular joint reconstruction that uses a free-tissue graft for reconstruction of both the coracoclavicular and acromioclavicular ligaments. STUDY DESIGN: Controlled laboratory study. METHODS: Each pair of 6 matched pairs of cadaveric shoulders was randomly selected for a modified Weaver-Dunn reconstruction on 1 side and the contralateral side was used for free-tissue graft reconstruction of the coracoclavicular and acromioclavicular ligamentous complexes. Anterior-posterior and superior-inferior acromioclavicular joint translation (in millimeters) was measured with acromioclavicular joint compressions of 10, 20, and 30 N, and with translational loads of 10 and 15 N both before and after acromioclavicular joint reconstruction. Load-to-failure testing was then performed for each construct. Repeated-measures analysis of variance (translational testing) and Wilcoxon signed rank test (load-to-failure testing), both with P = .05, were used for statistical analysis. RESULTS: Mean anterior-posterior and superior-inferior translation of the intramedullary acromioclavicular joint reconstruction was significantly less than that of the modified Weaver-Dunn under all loading conditions (P < .001 and P = .001, respectively), but was not significantly different from that of the intact state (P = .656 and P = .173, respectively). Although the mean ultimate and yield loads and linear stiffness for the intramedullary acromioclavicular reconstruction were greater than that of the modified Weaver-Dunn reconstruction, this did not reach statistical significance (P = .625, P = .625, and P = .625, respectively). CONCLUSION: Acromioclavicular joint reconstruction with free-tissue graft for both the coracoclavicular and acromioclavicular ligamentous complexes demonstrates initial stability significantly better than a modified Weaver-Dunn and similar to that of intact specimens. CLINICAL RELEVANCE: This acromioclavicular joint reconstruction provides the surgeon with a relatively nondestructive option.

Relative contribution of acromioclavicular joint capsule and coracoclavicular ligaments to acromioclavicular stability.

HYPOTHESIS: We hypothesized that both the AC joint capsule and CC ligaments are biomechanically robust structures in the anterior-posterior (AP) and superior-inferior (SI) planes with low loads, and that these ligaments provide essential function in AC joint stability. MATERIALS AND METHODS: Anterior-posterior (AP) and superior-inferior (SI) AC joint translations were quantified in 6 cadaver matched pairs with AC joint compressions of 10N, 20N and 30N, and with translational loads of 10N and 15N. Either the AC joint capsule or CC ligaments were transected, and measurements were then repeated. Biomechanical characteristics of the remaining AC joint capsule or CC ligaments were compared. RESULTS: There were significant increases in AP translation with the cut AC joint capsule, and significant increases in SI translation with the cut CC ligaments (P < 0.0001). Compression significantly decreased translation (P < 0.0001). DISCUSSION: Our study is supported by, and further develops, recent studies and anatomical knowledge. It offers two interpreted pieces of information for the sports medicine physician to consider for reconstruction of the AC joint. First, resection of the distal clavicle may have a detrimental effect. Second, repair of the AC joint capsule, in addition to the customarily repaired CC ligaments, appears to have a beneficial effect. CONCLUSION: The AC joint capsule is a robust anatomical structure that contributes significantly to the AC joint stability, especially in the AP plane. Compression increases stability. LEVEL OF EVIDENCE: Basic science study.

Neurovascular injuries to the athlete's shoulder: part II.

Athletes are at particular risk of compromise of the neurovascular structures of the shoulder-specifically, neurovascular conditions distal to the brachial plexus. These conditions include thoracic outlet syndrome, axillary artery occlusion, effort thrombosis, suprascapular nerve entrapment, quadrilateral space syndrome, and complex regional pain syndrome. When diagnosed properly and in a timely fashion, function of the limb can be preserved. To accomplish this, the physician must possess a detailed understanding of the various clinical presentations, diagnostic techniques, and treatment options.

Neurovascular injuries to the athlete's shoulder: Part I.

The neurovascular structures traversing the shoulder region can be compromised in a number of ways. Athletes are particularly at risk of neurovascular injury to the shoulder as the result of extreme force and stress on the shoulder girdle. Many such injuries have been described in the literature as cervical radiculitis, spinal accessory nerve injury, long thoracic nerve palsy, burner (stinger) syndrome, and brachial neuritis. A high index of diagnostic acumen and proper selection of clinical assessment and imaging techniques are needed to diagnose such injuries.

Biomechanical comparison of traditional and locked suture configurations for arthroscopic repairs of the rotator cuff.

BACKGROUND: The optimal suture configuration for arthroscopic rotator cuff repairs is controversial. "Locked" suture configurations, which use a combination of simple and transverse suture loops, have demonstrated better fixation strength than have traditional simple and horizontal mattress techniques. PURPOSE: To compare traditional arthroscopic suture configurations to locked arthroscopic configurations in ability to resist gap formation under cyclic loading. STUDY DESIGN: Controlled laboratory study. METHODS: Crescent-shaped defects were created at the infraspinatus tendon insertion in 32 bovine shoulders. Four arthroscopic suture configurations were tested (8 specimens in each group): simple (group 1), horizontal mattress (group 2), locked mattress (group 3), and locked inverted mattress (group 4). A metal corkscrew suture anchor doubly loaded with No. 2 Fiberwire suture was used for the repairs. A cyclic loading protocol with application of forces from 10 to 180 N for a maximum of 2,500 cycles was used. The number of cycles required to form gaps of 5 mm and 10 mm was recorded. RESULTS: The locked mattress configuration (group 3) outperformed all other groups in resisting 5-mm gap formation (P < .0001), requiring a mean of 628 cycles in comparison to 65, 193, and 197 cycles for groups 1, 2, and 4, respectively. Both locked configurations (groups 3 and 4) were superior to traditional simple and horizontal mattress configurations in resisting 10-mm gap formation. CONCLUSION: The locked mattress suturing technique (group 3) provided the most secure tendon fixation of all arthroscopic configurations tested. CLINICAL RELEVANCE: The use of locked suture configurations for arthroscopic rotator cuff repairs may enhance tendon fixation and limit gap formation in the early postoperative period.