RESUMEN
AIM: This study aims to examine the mechanism and subsequent treatment modalities of hand and wrist injuries sustained in a professional cricket team. METHODS: We performed a retrospective review of prospectively collected injury data at Gloucestershire County Cricket Club (GCCC) over six seasons (2008-2013). We investigated all injuries sustained, treated by the team lead physiotherapist and senior author. RESULTS: There were a total of 64 injuries recorded, with 55 (86%) hand and 9 (14%) wrist injuries. The little and ring fingers were the most commonly injured, and the most commonly occurring specific injury was distal interphalangeal joint dislocations. The majority of injuries, 33 (52%), occurred during fielding activities. There were a total of 10 fractures (16%), predominantly phalangeal, and only 7 players (11%) had injuries that required operative intervention. CONCLUSIONS: The majority of injuries sustained by professional cricketers occur in the little and ring fingers, whilst fielding during match situations. We recommend buddy strapping of little and ring fingers during fielding to prevent injury.
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Traumatismos en Atletas/terapia , Traumatismos de la Mano/etiología , Traumatismos de la Mano/terapia , Traumatismos de la Muñeca/etiología , Traumatismos de la Muñeca/terapia , Traumatismos en Atletas/epidemiología , Inglaterra/epidemiología , Traumatismos de la Mano/epidemiología , Humanos , Incidencia , Vigilancia de la Población , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Traumatismos de la Muñeca/epidemiologíaRESUMEN
INTRODUCTION: A study conducted to establish the most accurate combination of questionnaire and physical signs for the diagnosis of carpal tunnel syndrome. METHOD: Nerve conduction studies confirmed 70 patients with having carpal tunnel syndrome who were enrolled along with 70 age- and sex-matched controls. Patients were assessed using a symptom questionnaire, Phalen's test, Hoffmann-Tinel's sign, hand elevation test, carpal compression test, tourniquet test, pressure aesthesiometry and two-point discrimination. RESULTS: Through multivariate analysis, the best combination of tests was tourniquet, carpal compression and Phalen's tests but the difference between these and hand elevation test alone was negligible. CONCLUSION: The hand elevation test may be used in isolation and is superior to questionnaires and other physical signs in the clinical diagnosis of carpal tunnel syndrome.
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Síndrome del Túnel Carpiano/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Síndrome del Túnel Carpiano/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Conducción Nerviosa , Examen Físico , Curva ROC , Encuestas y CuestionariosRESUMEN
Katz and Stirrat devised a hand diagram, which uses subjective information from the patient for the diagnosis of carpal tunnel syndrome (CTS). They reported a good result. We tested the inter-observer and intra-observer reliability of this hand diagram. Twenty five consecutive patients with a diagnosis of CTS, 25 with other common hand and wrist problems but CTS and 25 healthy individuals were prospectively recruited. Each patient filled in a hand diagram. Two experienced hand surgeon scored the diagrams blindly on two different sittings four-week apart. The intra-class correlation coefficient (ICC) and Cohen's Kappa were used for intra and inter-observer reliability respectively. The intra-observer agreement was poor (ICC 95% 0.33-0.65) and inter-observer was fair (Kappa = 0.241). This study does not support the use of Katz and Stirrat Hand Diagram for the diagnosis of carpal tunnel syndrome in place if a thorough clinical examination.
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Síndrome del Túnel Carpiano/diagnóstico , Encuestas y Cuestionarios , Síndrome del Túnel Carpiano/cirugía , Humanos , Variaciones Dependientes del Observador , Valor Predictivo de las Pruebas , Sensibilidad y EspecificidadRESUMEN
BACKGROUND: Post-traumatic MOF results from local tissue injury because of migration and activation of dysfunctional polymorphonuclear leukocytes (PMN). Although fracture surgery exacerbates the postinjury inflammatory response, it is usually beneficial. This study compared changes in PMN receptor expression and migratory activity, in whole blood and following PMN isolation. METHODS: IL-8 mediated PMN migration and expression of CXCR-1, CD11b, and CD18 was studied in isolated and whole blood PMN in normal controls. Migration was studied at admission and day 5 after surgery in trauma patients undergoing fracture surgery. RESULTS: PMN isolation results in increased expression of surface receptors and enhanced migration in normal controls. In trauma patient samples, isolated PMN migration is enhanced after injury, but suppressed when migration from whole blood is studied, both after injury and fracture surgery. CONCLUSION: PMN isolation results in priming for migration, which has a relatively greater impact upon PMN in trauma patients. The observation that PMN activity may decline but priming potential remains enhanced is novel. Further refinements of whole blood and isolated PMN techniques are clearly warranted. This may help to resolve the mismatch in clinical and scientific experience in those patients with major fractures requiring surgical stabilization.
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Fracturas del Fémur/sangre , Interleucina-8/farmacología , Neutrófilos/metabolismo , Receptores de Interleucina-8A/sangre , Fracturas de la Tibia/sangre , Adulto , Fracturas del Fémur/complicaciones , Fracturas del Fémur/cirugía , Humanos , Interleucina-8/sangre , Persona de Mediana Edad , Insuficiencia Multiorgánica/etiología , Neutrófilos/efectos de los fármacos , Receptores de Interleucina-8A/efectos de los fármacos , Fracturas de la Tibia/complicaciones , Fracturas de la Tibia/cirugíaRESUMEN
BACKGROUND: Elevated plasma elastase levels have been reported following major trauma and isolated femoral fracture. Reamed femoral nailing has been shown to further increase plasma elastase levels. The aim of this study was to investigate polymorphonuclear neutrophil (PMN) priming for degranulation following major trauma and isolated long-bone/pelvis fracture by assessing the ability of PMN to release elastase in vitro in response to a stimulus. METHODS: We further analyzed PMN surface expression of the integrins CD11b and CD18 as markers of PMN activation. Ten major trauma (Injury Severity Score>or=18) patients and 12 patients with isolated long-bone/pelvis fracture were included in the study. Patients in the isolated fracture group were further stratified into reamed nail and external-fixation groups following surgery. RESULTS: A significant increase in the capacity of PMN to release elastase was seen following major trauma, but not in isolated fracture patients. Surgery did not further alter PMN elastase release. CD11b and CD18 expression was essentially unaltered in all groups. CONCLUSIONS: PMN is primed for increased degranulation following major trauma but not following isolated long-bone/pelvis fracture. Accumulation of primed, hyperactive PMN into tissues can lead to severe tissue damage and thus multiple organ failure.
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Elastasa de Leucocito/sangre , Traumatismo Múltiple/inmunología , Activación Neutrófila/inmunología , Neutrófilos/inmunología , Síndrome de Respuesta Inflamatoria Sistémica/inmunología , Heridas no Penetrantes/inmunología , Adolescente , Adulto , Antígeno CD11b/sangre , Antígenos CD18/sangre , Femenino , Fracturas del Fémur/inmunología , Fijación Intramedular de Fracturas , Humanos , Técnicas In Vitro , Puntaje de Gravedad del Traumatismo , Masculino , Huesos Pélvicos/lesiones , Complicaciones Posoperatorias/inmunología , Valores de Referencia , Factores de Riesgo , Fracturas de la Tibia/inmunologíaRESUMEN
BACKGROUND: Neutrophil migration into the lung is a critical, but poorly understood step in the pathogenesis of post-traumatic, acute respiratory distress syndrome (ARDS). We investigated changes in interleukin-8 (IL-8) mediated neutrophil migration and associated changes in receptor expression, of the IL-8 receptors CXCR1, the integrins CD11b/CD18 and platelet endothelial cell adhesion molecule-1 (PECAM-1) in patients sustaining major trauma. METHODS: Eleven patients with major trauma, injury severity score (ISS), median 22 (range 18-41), were followed prospectively. Eleven normal volunteers were used as controls. Blood samples were obtained within 4+/-2 h of injury, at 24 h, day 3 and day 5. Neutrophils migration was assessed by an in vitro IL-8 assay and neutrophil surface receptor expression by FACS analysis. RESULTS: IL-8 mediated neutrophil migration was significantly increased on admission following major trauma and remained elevated for 3 days (p<0.05). This was associated with up-regulation of CXCR1 (p<0.01) and down-regulation of PECAM-1 (p<0.05). CD11b and CD18 although initially unchanged, became down-regulated on day 3 (p<0.05). CONCLUSIONS: These data show that major trauma primes circulating neutrophils for increased migration in response to IL-8. This response is sustained for 72 h and is associated with changes in neutrophil surface receptor expression.