RESUMO
Background: The risks of indoor skydiving have not been extensively studied. Indoor skydiving facilities are often used for corporate events and parties and by relatively inexperienced participants who may not appreciate the risks involved. The abducted and externally rotated shoulder position, combined with nearby walls, tight spaces, and the strong airstream, has resulted in a pattern of shoulder dislocation injuries. Case Report: A 26-year-old male presented with recurrent left shoulder instability after developing an engaging Hill-Sachs lesion following traumatic anterior shoulder dislocation while indoor skydiving. He entered the wind tunnel with his arms abducted and externally rotated. The wind created an upward force that held his arms in this position. As he reached with his left arm for the side of the tunnel to exit, his arm was forced into further external rotation, dislocating the shoulder. The patient was treated arthroscopically with a remplissage procedure and repair of the glenoid labrum. Postoperatively, he resumed his active lifestyle and sports without further dislocations or instability. Conclusion: Indoor skydiving may pose a high risk of anterior dislocation because the shoulder is forced into abduction and external rotation in the free-fall position. We advise caution before participation in indoor skydiving by any individual, but especially those with a history of shoulder instability.
RESUMO
BACKGROUND: Compared with similarly injured patients of a younger age, elderly patients have worse outcomes from acute injury. One factor adversely affecting outcomes is sarcopenia, which has been assessed in healthy elderly populations through established clinical and radiological criteria. However, in the acute care setting, no such criteria have been established. Sarcopenia has been opportunistically assessed via radiographic means but there is as of yet no gold standard. The purpose of this review is to summarize the radiological methods used to diagnose sarcopenia in the acute care setting, and suggest ways in which these methods may lead to a consensus definition of sarcopenia and its relationship to patient outcomes. METHODS: A systematic survey of medical databases was conducted, with 902 unique publications identified. After screening and application of inclusion and exclusion criteria, data regarding study population, outcome, imaging modality, and criteria for assessment of sarcopenia were extracted from 20 studies. Quality was assessed with the Newcastle-Ottawa Scale. RESULTS: CT was the imaging modality for 18 of the studies, with total psoas muscle cross-sectional area at the level of L3 and L4 being the dominant method for assessing sarcopenia. Adjustment for body morphology most commonly used patient height or L4 vertebral body area. The majority of articles found radiographically assessed sarcopenia to be significantly correlated to outcomes such as mortality, length of hospital stay, morbidity, and in-hospital complications. CONCLUSIONS: Establishing a consistent definition would strengthen its applicability and generalizability to admission and discharge planning. LEVEL OF EVIDENCE: Systematic review, level III.
