Ruptures of the proximal biceps tendon in middle-aged patients.

Treatment of ruptures of the proximal biceps tendon has been based on clinical observations, with little objective data to substantiate treatment guidelines. Evaluation of 25 patients (all > 40 years of age) at an average of 7.9 years after injury found few objective or subjective differences between those treated nonoperatively and those treated operatively. Only 1 patient (treated nonoperatively) was dissatisfied with the result, and her dissatisfaction was with a cosmetic defect. Objective manual muscle testing and Cybex II (Cybex Corporation, Ronkonkoma, New York) evaluation of 19 patients found no significant differences in supination or elbow flexion strength in the two groups.

Overuse injuries in ultraendurance triathletes.

Overuse injuries represent the largest percentage of sports-related injuries requiring medical treatment. These injuries represent a substantial health issue for the millions of adults who have made physical activity an integral part of their lifestyle, but may be even more important to those pursuing ultraendurance exercise. The purposes of this study were to report the type and incidence of overuse injuries in ultraendurance triathletes and to relate training practices to injury occurrence. Data was gathered from the responses of 95 competitors (75 men, 20 women) in the 1986 Hawaii Ironman Triathlon who completed a training and medical history questionnaire. In this sample, virtually all (91%) sustained at least one soft tissue, overuse injury during the previous year's training. The area of the body most frequently involved was the back, but the most common pattern was to have multiple areas involved. Because of the consistent combinations of injuries, mechanical abnormalities, such as diminished shock absorption, may have contributed to injury. Training habits were extremely variable and not directly related to either the incidence or type of injury.

The mechanoreceptor innervation of the human fibular collateral ligament.

The mechanoreceptor innervation of fibular collateral ligaments from human knee joints is described. While a small number of 'non-Paciniform' endings were identified in 5 optimally-stained ligaments, 'Paciniform' endings were not identified. These 'non-Paciniform endings' were variable in shape, but each consisted of an encapsulated arborisation of neurites embedded in a granular matrix. The significance of these findings is discussed as they relate to (i) discrepancies of the extent to which certain periarticular tissues are innervated, and (ii) the role of periarticular mechanoreceptors in initiating protective muscular reflexes.

Effect of electrical stimulation on quadriceps strength after reconstructive surgery of the anterior cruciate ligament.

The effect of prolonged daily electrical stimulation (ES) on quadriceps strength in 22 patients during the 6 weeks following anterior cruciate reconstruction was investigated. Patients were randomly assigned to receive either a combination of ES and exercise or exercise alone. Isometric quadriceps strength was measured at the 7th, 8th, and 9th postoperative weeks. No significant difference in strength existed between the groups as a result of ES. A significant difference in strength did exist between competitive and recreational athletes regardless of treatment. Further research is needed to determine if the addition of ES to isometric exercise during immobilization can significantly retard strength loss after anterior cruciate reconstructive surgery.

Medical and physiological considerations in triathlons.

Triathlons (races involving consecutive swimming, bicycling, and running) have become commonplace in the United States. These races may involve from 30 minutes to 36 hours of continuous exercise, usually in warm or hot environments. Little has been published regarding the medical and physiological aspects of these events. This paper represents the first large study to date on the subject, including both an analysis of medical complications at six triathlons as well as a prospective electrolyte study conducted at two of these races. Medical records were kept and examined for all athletes requiring treatment during a typical United States Triathlon Series (USTS) race in 1986 (1,000 starters; finish times, 2 to 4 hours), a typical Ironman Qualifier (IQ) race in 1986 (622 starters; finish times, 4 to 8 hours), and the 1982 through 1985 Hawaii Ironman World Championships (4,583 starters; finish times, 9 to 17 hours). At the USTS race, fewer than 2% (17/1,000) of the starters required aid, at the IQ, approximately 10% (61/622) of the starters were treated, and at the Ironman, an average of 17% (794/4,583) received medical attention. The most common diagnoses at the USTS and IQ were dehydration and heat exhaustion. At the Ironman, dehydration and heat problems were complicated by hyponatremia. Because hyponatremia has been reported as a complication of ultraendurance events, a prospective study was performed on 36 athletes during a USTS race and 64 athletes at the 1984 Ironman race. Prerace and postrace blood samples showed that no athletes were hyponatremic following the shorter USTS race, but 27% (17/64) of the athletes studied were hyponatremic following the Ironman race.(ABSTRACT TRUNCATED AT 250 WORDS)

General principles and techniques of external skeletal fixation.

The general techniques for using external fixators are demanding, regardless of the specific fixator selected. Attention to detail is absolutely essential if maximum advantage of the device is to be gained and potentially serious complications are to be minimized. The initial treatment of the condition for which the external fixator is chosen must be considered first: irrigation, debridement, and reduction of the severe, open fracture; drainage, debridement, and sequestrectomy of the infected fracture or nonunion; removal of the components and cement in the infected failed arthroplasty, etc. Primary treatment in these and other conditions must be appropriately administered prior to fixator application. Fixator type, frame and pin configuration and application, care of the fracture, and maintenance of the fixation appliance are discussed.

External fixation. Historic review, advantages, disadvantages, complications, and indications.

The immobilization of fracture fragments by the insertion of pins connected externally by plaster, metal devices, or other appliances is not a new concept. In the past two centuries external fixation has enjoyed long periods of enthusiastic use alternating with intervals of total disrepute.

A chronicle of injuries of an American intercollegiate football team.

Many studies concerning the injuries occurring in high school and intercollegiate football have been reported, including those emphasizing the number and type of injuries, geographic distribution of injuries, and the rate of injury compared to position, conditioning, officiating, equipment, and type of playing surface. This report focuses on the individual player involved in a sports program for four or five years and emphasizes the statistical probability of that individual sustaining an injury during his playing career. Conclusions, drawn from statistics compiled at Memphis State University from 1975 through 1979, involved 265 athletes. These 265 athletes sustained 283 injuries during this period. Of these 283 injuries, 69% were mild, 20% were moderate, and 11% were severe. The knee was most often involved and suffered the most severe injuries. Ankle injuries accounted for the second highest incidence of injury, but these were primarily mild or moderate injuries. The defensive line, especially the defensive ends, received the greatest percentage of injuries. The probability of injury for the individual player was found to be 106.7% for a five-year participant, 99.1% for a four-year participant, and 46.6% for a one-year participant.