Upper Body Injuries in Golfers.

PURPOSE OF REVIEW: Golf is a sport that can be played by an athlete of any age, which enhances its popularity. Each golfer's swing is unique, and there is no "right" way to swing the golf club; however, the professional golfer often has more of a consistent swing as opposed to an amateur golfer. A collaborative, team approach involving the golfer with a swing coach, physical therapist, and physician often can be informative on how to prevent golf injury, but also how to treat golf injury if it occurs. RECENT FINDINGS: As a rotational sport, the golfer needs to be trained and treated with respect for how the body works as a linkage system or kinetic chain. A warm-up is recommended for every golfer before practicing or playing, and this warm-up should account for every segment of the linkage system. Though it has been thought of as a relatively safe sport, injuries can be seen with golfers of any age or skill level, and upper body injuries involving the cervical and thoracic spine, shoulder, elbow, and wrist are common. A narrative review is provided here of the epidemiology of golf injury and common injuries involving each of these upper body regions. In addition, treatment and injury prevention recommendations are discussed.

Thoracic and lumbar spine responses in high-speed rear sled tests.

OBJECTIVE: This study analyzed thoracic and lumbar spine responses with in-position and out-of-position (OOP) seated dummies in 40.2 km/h (25 mph) rear sled tests with conventional and all-belts-to-seat (ABTS) seats. Occupant kinematics and spinal responses were determined with modern (≥2000 MY), older (<2000 MY), and ABTS seats. METHODS: The seats were fixed in a sled buck subjected to a 40.2 km/h (25 mph) rear sled test. The pulse was a 15 g double-peak acceleration with 150 ms duration. The 50th percentile Hybrid III was lap-shoulder belted in the FMVSS 208 design position or OOP, including leaning forward and leaning inboard and forward. There were 26 in-position tests with 11 <2000 MY, 8 ≥2000 MY, and 7 ABTS and 14 OOP tests with 6 conventional and 8 ABTS seats. The dummy was fully instrumented. This study addressed the thoracic and lumbar spine responses. Injury assessment reference values are not approved for the thoracic and lumbar spine. Conservative thresholds exist. The peak responses were normalized by a threshold to compare responses. High-speed video documented occupant kinematics. RESULTS: The extension moments were higher in the thoracic than lumbar spine in the in-position tests. For <2000 MY seats, the thoracic extension moment was 76.8 ± 14.6% of threshold and the lumbar extension moment was 50.5 ± 17.9%. For the ≥2000 MY seats, the thoracic extension moment was 54.2 ± 26.6% of threshold and the lumbar extension moment was 49.8 ± 27.7%. ABTS seats provided similar thoracic and lumbar responses. Modern seat designs lowered thoracic and lumbar responses. For example, the 1996 Taurus had -1,696 N anterior lumbar shear force and -205.2 Nm extension moment. There was -1,184 N lumbar compression force and 1,512 N tension. In contrast, the 2015 F-150 had -500 N shear force and -49.7 Nm extension moment. There was -839 N lumbar compression force and 535 N tension. On average, the 2015 F-150 had 40% lower lumbar spine responses than the 1996 Taurus. The OOP tests had similar peak lumbar responses; however, they occurred later due to the forward lean of the dummy. CONCLUSIONS: The design and performance of seats have significantly changed over the past 20 years. Modern seats use a perimeter frame allowing the occupant to pocket into the seatback. Higher and more forward head restraints allow a stronger frame because the head, neck, and torso are more uniformly supported with the seat more upright in severe rear impacts. The overall effect has been a reduction in thoracic and lumbar loads and risks for injury.

Double Level Extension Distraction Thoracic Spine Injuries with Concomitant Double Level Sternal Fractures: A Case Report

Extension distraction injury of the spine is rare. A majority of these cases occur in the cervical region and at an isolated level. Rare instances of this injury have been described in an ankylosed or fused spine. This case report describes a rare two level extension distraction thoracic spine injury in an otherwise healthy adult resulting from a motor vehicle accident.

Clinical Analyzed of Thoracic Level Spinal Cord Injured Patients

We analyzed 10 cases who had received surgery for acute injuries of the thoracic spine complicated by paralysis. Of those 10 cases, 4 patients had a complete and remaining 6 had an incomplete lesion of the spinal cord. Of the 4 patients who had a complete lesion of the spinal cord, significant neurologic function did not recover in 3, regardless of the type and timing of the surgery. In one of 4 patients who had a complete lesion, there was some improvement of sensation. Of the 6 patients who had an incomplete lesion of the spinal cord, 4 received a surgery within 24 hours of injury, and remaining 2 had surgery on posttrauma 30th and 35th days respectively. Average neurologic improvement was 1.75 Frankel grades per patient in the early surgery group and was 1 Frankel grade in the delayed surgery group. Of 6 patients with incomplete lesion, 4 were treated with laminectomy and fusion with instrumentation, and they improved by average 1.75 Frankel grades. And remaining 2 were treated by laminectomy or anterior transthoracic decompression and fusion respectively and they improved by 1 Frankel grade respectively. Based on the results of this study and other references, we suggest that early surgical intervention improves neurologic recovery in comparison to late surgical intervention and that posterior surgical instrumentation is indicated in acute unstable bursting fracture and flexion-dislocation injury. Also we suggest that anterior transthoracic decompression and fusion is indicated in cases of neural compression by bone or disc fragments.