An appreciation of posterior instability of the shoulder.
Humans; Osteotomy; Joint Instability/classification/*surgery; Shoulder Joint/*surgery
Fortunately, posterior instability of the shoulder is a relatively uncommon occurrence in the athlete. Acute traumatic posterior dislocations can be readily managed by conservative measures. Recurrent posterior subluxation, however, represents a more challenging problem for the orthopedic surgeon. As has been discussed, most patients with this disorder respond to nonsurgical treatment including physical therapy and modification of the offending activities. Should these modalities fail, operative treatment may be necessary. Careful assessment of the patient to rule out the associated presence of excessive ligamentous laxity or a voluntary component to the instability is mandatory. Pain is clearly the principal indicator for surgical treatment. Painless subluxation, either voluntary or involuntary, should first be treated conservatively. The surgical options discussed in this article range from simple soft-tissue repair to more complex osteotomies with combined capsular plication. It is important that the procedure be appropriate to the pathology. We do not believe that one technique alone can address all variants of posterior instability. Most instances of recurrent posterior subluxation represent unidirectional instability in patients with otherwise normal bony morphology. In these patients, a posterior capsulorrhaphy combined with appropriate immobilization should be effective. In select instances, when either excessive glenoid retroversion or deficiency is encountered, a glenoid osteotomy and posterior capsulorrhaphy have proved successful. This technique, more than any other, carries a number of potential technical pitfalls and should be employed cautiously. Multidirectional posterior instability, now a well-recognized entity, requires a different surgical approach–the capsular shift. Designed to address the inferior redundancy, as well as posterior laxity, this procedure is applicable to the multidirectional posterior subluxator. In conclusion, posterior instability of the athlete's shoulder is an increasingly recognized entity. Most instances are amenable to nonsurgical care. Should surgical treatment be necessary, optimal results may be achieved by careful attention to patient assessment, instability categorization, determination of the presence of ligamentous laxity, and appropriate surgical technique.
Bell R H; Noble J S
Clinics in sports medicine
1991
1991-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Forefoot pain in the athlete.
Humans; Pain/*diagnosis; Athletic Injuries/*diagnosis; Cumulative Trauma Disorders/diagnosis; Infarction/diagnosis; Neuroma/diagnosis; Tendinopathy/diagnosis; Fractures; Forefoot; Human/blood supply/*injuries/pathology; Stress/diagnosis
Forefoot pain in the athlete is common. Generally, the symptoms are a result of overuse. The initial treatment strategy is to modify both exercise and shoewear. Specific diagnoses of the problem is key to proper treatment. Usually, the history and physical examination are sufficient, but noninvasive as well as invasive diagnostic testing may be needed.
Kay D B
Clinics in sports medicine
1994
1994-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Degenerative sternoclavicular arthritis and hyperostosis.
Adult; Female; Male; Osteoarthritis; Arthroplasty; Middle Age; Arthritis; Ossification; Osteitis; Heterotopic; Arthritis – Classification; Arthritis – Drug Therapy; Arthritis – Surgery; Athletic Injuries – Complications; Sternoclavicular Joint – Pathology
Symptomatic arthritic involvement of the sternoclavicular joint is relatively uncommon and can be a result of distant trauma, infection, and sternocostoclavicular hyperostosis, post-menopausal arthritis, condensing osteitis of the proximal clavicle, or secondary to an underlying arthropathy. Patients with degenerative osteoarthritis due to trauma most commonly have had either an anterior or posterior dislocation, subluxation, or periarticular fracture. Medical claviculectomy with or without ligamentous stabilization is indicated only in situations of painful primary and secondary rheumatoid arthritis, or in patients with neoplastic lesions. Numerous authors have recommended surgical reconstruction but few have reported series larger than two or three cases. This article reviews a few specific arthropathy conditions about the sternoclavicular joint and discusses their nonoperative and operative management. Copyright © 2003 by Elsevier Science (USA).
Noble J S
Clinics in sports medicine
2003
2003-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/s0278-5919(02)00097-2" target="_blank" rel="noreferrer noopener">10.1016/s0278-5919(02)00097-2</a>
Degenerative sternoclavicular arthritis and hyperostosis.
*Sternoclavicular Joint/injuries; Adult; Aged; Arthritis; Arthroplasty/methods; Bone/complications; Clavicle/surgery; Female; Fractures; Humans; Hyperostosis/diagnosis/etiology/*therapy; Joint Dislocations/complications; Joint Instability/surgery; Male; Middle Aged; Osteitis/diagnosis/etiology; Osteoarthritis/diagnosis/etiology/*therapy; Postmenopause; Reactive/etiology/therapy
Symptomatic arthritic involvement of the sternoclavicular joint is relatively uncommon and can be a result of distant trauma, infection, and sternocostoclavicular hyperostosis, post-menopausal arthritis, condensing osteitis of the proximal clavicle, or secondary to an underlying arthropathy. Patients with degenerative osteoarthritis due to trauma most commonly have had either an anterior or posterior dislocation, subluxation, or periarticular fracture. Medical claviculectomy with or without ligamentous stabilization is indicated only in situations of painful primary and secondary rheumatoid arthritis, or in patients with neoplastic lesions. Numerous authors have recommended surgical reconstruction but few have reported series larger than two or three cases. This article reviews a few specific arthropathy conditions about the sternoclavicular joint and discusses their nonoperative and operative management.
Noble Jeffrey S
Clinics in sports medicine
2003
2003-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/s0278-5919(02)00097-2" target="_blank" rel="noreferrer noopener">10.1016/s0278-5919(02)00097-2</a>
Arthroscopic anterior cruciate ligament reconstruction.
Humans; Arthroscopy/*methods; Knee Joint/*surgery; Postoperative Care; Ligaments; Articular/*surgery
Our understanding of the structure and function of the anterior cruciate ligament has progressed rapidly over the past decade. Arthroscope-assisted anterior cruciate ligament replacement is a new procedure that allows isometric placement of the anterior cruciate ligament graft. Postoperative rehabilitation is enhanced by preservation of the extensor mechanism.
Wilcox P G; Jackson D W
Clinics in sports medicine
1987
1987-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).