Hip and shoulder internal rotation range of motion deficits in professional tennis players.

One hundred tennis players were recruited from the professional men's tennis tour to investigate the correlation between hip internal rotation deficits and low back pain (LBP), as well as shoulder internal rotation deficits and shoulder pain. A statistically significant correlation was observed between dominant shoulder internal rotation deficits and shoulder pain. Also observed was a statistically significant correlation between lead hip internal rotation deficits and lumbar extension deficits with LBP. We conclude that due to repetitive demands on the dominant shoulder and repetitive pivoting at the lead hip, the cycle of microtrauma and scar formation leads to capsular contracture and subsequent reduction in internal range of motion. It is likely that the limitation in lumbar extension in the symptomatic group is not only due to decreased flexibility from an increased load on the spine, but also due to a protective mechanism to prevent further exacerbation of the LBP. Physical conditioning that includes shoulder as well as hip internal rotation stretching programs should therefore be essential aspects in the treatment of tennis players with shoulder pain and LBP respectively.

The athlete with early knee arthritis.

Athletes participating in contact sports or activities, such as excessive running, are at higher risk for the development of knee osteoarthritis. Newer minimally invasive, nonsurgical treatment options, and medications in the management of knee osteoarthritis, have enabled many athletes with knee osteoarthritis to regain most of their mobility. These new treatments have no down time and, when combined with proper rehabilitation protocol, have helped patients to regain and maintain their mobility gains and overall quality of their life. In the years to come newer technologies, such as autologous cultured chondrocyte implantation, tissue engineered cartilage, growth factors, and acellular matrices, may play an important role in the management of knee osteoarthritis.

Fluoroscopic transforaminal lumbar epidural steroids: an outcome study.

OBJECTIVES: To determine the therapeutic value and long-term effects of fluoroscopic transforaminal epidural steroid injections in patients with refractory radicular leg pain. BACKGROUND DATA: Although numerous studies have evaluated the efficacy of traditional transsacral (caudal) or translaminar (lumbar) administration of epidural steroids, to our knowledge no studies have assessed specifically the therapeutic value of fluoroscopic transforaminal epidural steroids. STUDY DESIGN: A prospective case series that investigated the outcome of patients with lumbar herniated nucleus pulposus and radiculopathy who received fluoroscopic transforaminal epidural steroid injections. METHODS: Patients who met our inclusion criteria received fluoroscopically guided, contrast-enhanced transforaminal epidural administration of anesthetic and steroid directly at the level and side of their documented pathology. Patients were evaluated by an independent observer and received sequential questionnaires before and after injection, documenting pain level, activity level, and patient satisfaction. RESULTS: Sixty-nine patients met our inclusion criteria and were followed for an average period of 80 weeks (range, 28 to 144 weeks); 75.4% of patients had a successful long-term outcome, reporting at least a >50% reduction between preinjection and postinjection pain scores, as well as an ability to return to or near their previous levels of functioning after only 1.8 injections per patient (range, 1 to 4 injections). Of our patients, 78.3% were satisfied with their final outcomes. CONCLUSIONS: Fluoroscopic transforminal epidural steroids are an effective nonsurgical treatment option for patients with lumbar herniated nucleus pulposus and radiculopathy in whom more conservative treatments are not effective and should be considered before surgical intervention.