RESUMEN
Defining high-quality care and cost-effectiveness is not an easy task. In this article, the authors describe several strategies that have practical applicability for the clinician treating patients with sports-related injuries. Integration of some of these strategies may allow the more quality-based, cost-efficient use of available resources in sports rehabilitation.
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Traumatismos en Atletas/rehabilitación , Medicina Deportiva/economía , Traumatismos en Atletas/economía , Chicago , Control de Costos , Humanos , Control de Calidad , Resultado del Tratamiento , Estados UnidosRESUMEN
STUDY DESIGN: Multicenter, prospective, observational study. OBJECTIVES: To document the incidence of and factors associated with intravascular uptake during lumbar spinal injection procedures. SUMMARY OF BACKGROUND DATA: In prior reports, the incidence of inadvertent intravascular needle placement during contrast-enhanced, fluoroscopically guided lumbar spinal injection procedures has been incidentally noted to range from 6.4% to 9.2%. We present the first systematic prospective documentation of intravascular uptake of contrast dye during different types of lumbar injection procedures. METHODS: Fifteen interventional spine physicians in seven centers recorded data regarding intravascular uptake during 1219 contrast-enhanced, fluoroscopically guided lumbar spinal injection procedures. RESULTS: The overall incidence of intravascular uptake during lumbar spinal injection procedures as determined by contrast enhanced fluoroscopic observation is 8.5%. Caudal and transforaminal routes have the highest rates at 10.9% and 10.8%, respectively, followed by zygapophyseal joint (6.1%), sacroiliac joint (5.3%), and translaminar (1.9%) injections. Intravascular uptake is twice as likely to occur in those patients over rather than under 50 years of age. Preinjection aspiration failed to produce a flashback of blood in 74% of cases that proved to be intravascular upon injection of contrast dye. CONCLUSION: The incidence of intravascular uptake during lumbar spinal injection procedures is approximately 8.5%. The route of injection and the age of the patient greatly affect this rate. Absence of flashback of blood upon preinjection aspiration does not predict extravascular needle placement. Contrast-enhanced, fluoroscopic guidance is recommended when doing lumbar spinal injection procedures to prevent inadvertent intravascular uptake of injectate.
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Medios de Contraste/metabolismo , Inyecciones Espinales , Vértebras Lumbares/metabolismo , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/cirugía , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Radiografía , Distribución por SexoRESUMEN
Low back pain is the most common cause of disability in individuals below the age of 45 and the third most common cause of disability overall. Although acute back pain is generally felt to have a high probability of spontaneous resolution, the high recurrence rate of low back pain challenges the notion that resolution of symptoms is accompanied by restitution of function. Athletes who have lumbar spine dysfunction represent a particular challenge to the treating physician due to their high levels of activity and expectation of return to sport. Injuries to the intervertebral disc in the lumbar spine are a particular subset of spine injury. Management of intervertebral disc injuries, which is the focus of this section, is fraught with controversy. Although the majority of intervertebral disc injuries can be treated conservatively, the decision to follow an aggressive conservative versus surgical course in any given athlete must be made on an individual case basis.
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Traumatismos en Atletas/terapia , Terapia por Ejercicio , Disco Intervertebral/lesiones , Dolor de la Región Lumbar/terapia , Vértebras Lumbares/lesiones , Ciática/terapia , Humanos , Disco Intervertebral/cirugía , Dolor de la Región Lumbar/etiología , Vértebras Lumbares/cirugía , Rehabilitación/métodos , Factores de Riesgo , Procedimientos Quirúrgicos Operativos/normasRESUMEN
Analysis of shoulder dysfunction in throwing and overhead athletes can no longer be restricted to evaluation of the glenohumeral joint alone. The isolated shoulder is incapable of generating the force necessary to hurl a baseball at velocities of 90-100 miles per hour or serve a tennis ball in excess of 120 miles per hour. The purpose of this paper is to provide a literature based theoretical framework for the role of the spine during these activities. The spine is a pivotal component of the kinematic chain which functions as a transfer link between the lower and upper limbs, a force generator capable of accelerating the arm, and a force attenuator which dampens shear forces at the glenohumeral joint during the deceleration phase of the pitching motion. Side bending and rotation of the cervical spine facilitates visual acquisition of the intended target. Inflexibility of the hip musculature and weakness of the muscles which attach to the thoracolumbar fascia have profound effects upon spine function which secondarily places greater stress upon the glenohumeral joint and rotator cuff. Shoulder rehabilitation and injury prevention programs should include evaluation of and exercise regimens for the lumbar, thoracic and cervical spine.
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While there have been numerous reports in the literature of accidents in equestrian sports, no comprehensive study has been conducted to ascertain the nature and incidence of injuries incurred by professional horse-racing jockeys. A survey was conducted to determine the types of injuries to jockeys and racing-related health concerns, including weight reduction methods. The questionnaire was completed by 706 professional jockeys actively competing at United States racetracks between July and October 1990 about injuries they had sustained in their careers. More than 1,700 injuries were reported. Fractures (n = 1,113) accounted for 64% of the total. The most common cause of injury was becoming unseated, followed by the horse falling. Relationships between characteristics of jockeys and injuries were evaluated. There were significant numbers of serious injuries with prolonged periods of not riding. Recommendations for improving jockey safety are made.
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Traumatismos en Atletas/epidemiología , Absentismo , Accidentes de Trabajo/prevención & control , Accidentes de Trabajo/estadística & datos numéricos , Adulto , Animales , Traumatismos del Tobillo/epidemiología , Traumatismos del Brazo/epidemiología , Traumatismos en Atletas/clasificación , Traumatismos en Atletas/prevención & control , Femenino , Traumatismos de los Pies/epidemiología , Fracturas Óseas/epidemiología , Fracturas Óseas/prevención & control , Salud , Caballos , Humanos , Incidencia , Traumatismos de la Pierna/epidemiología , Masculino , Estudios Retrospectivos , Factores de Riesgo , Seguridad , Lesiones del Hombro , Deportes , Encuestas y Cuestionarios , Estados Unidos/epidemiología , Pérdida de PesoRESUMEN
Many individuals continue to exercise train and experience athletic success well into the eighth and ninth decades of their lives. This paper examines the interaction between aging and athletic performance with specific reference to how regular exercise training attenuates the decrements in performance typically attributed to the aging process. The importance of rehabilitation of musculoskeletal injuries to facilitate continued participation in athletics is also addressed.
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This article will discuss some of the common overload injuries that occur in runners. An approach to accurate diagnosis will be described in terms of tissue injuries, clinical symptoms, specific tissues overloaded, functional biomechanical deficits, and functional adaptations that occur. With this background, specific principles of rehabilitation of these disorders will be described.
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This self-directed learning module highlights important aspects of athletic spine and head injuries. It is part of the chapter on sports medicine in the Self-Directed Medical Knowledge Program for practitioners and trainees in physical medicine and rehabilitation. This article covers the presentation, pathomechanics, and classification of common and important cervical and lumbar injuries. Sports participation criteria for children with spine deformities are discussed. In addition, a description of the degrees of concussion, the general guidelines for return to play after a sports-related head injury, and postconcussion sequelae are reviewed.
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Traumatismos en Atletas/rehabilitación , Traumatismos Craneocerebrales/rehabilitación , Traumatismos Vertebrales/rehabilitación , Conmoción Encefálica/fisiopatología , Conmoción Encefálica/rehabilitación , Vértebras Cervicales/lesiones , Humanos , Desplazamiento del Disco Intervertebral/rehabilitación , Vértebras Lumbares/lesiones , Traumatismos de la Médula Espinal/rehabilitación , Medicina Deportiva/educaciónRESUMEN
This self-directed learning module highlights key elements in this topic area. It is part of the chapter on sports medicine in the Self-Directed Medical Knowledge Program for practitioners and trainees in physical medicine and rehabilitation. This article covers the role of the physiatrist in sports medicine and presents an overview of the diagnosis, treatment, and prevention of sports-related injuries. We describe how the physiatrist relates to other sports medicine practitioners and detail the stepwise physical examination of an injured athlete by a physiatrist.
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Ejercicio Físico/fisiología , Medicina Deportiva , Adaptación Fisiológica , Traumatismos en Atletas/diagnóstico , Traumatismos en Atletas/prevención & control , Traumatismos en Atletas/rehabilitación , Humanos , Sistema Musculoesquelético/lesiones , Examen Físico , Medicina Física y Rehabilitación/educación , Medicina Deportiva/educaciónRESUMEN
This self-directed learning module highlights important aspects of the evaluation and care of the injured athlete by a team physician. It is part of the chapter on sports medicine in the Self-Directed Medical Knowledge Program for practitioners and trainees in physical medicine and rehabilitation. This article covers the components of a preparticipation examination, the on-field evaluation of head, spine, and limb injuries, and return-to-play criteria after specific injuries. Sports medicine for the physically challenged athlete, medicolegal considerations for the team physician, and anabolic steroids are also reviewed.
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Traumatismos en Atletas/rehabilitación , Medicina Física y Rehabilitación , Medicina Deportiva , Adulto , Traumatismos en Atletas/diagnóstico , Humanos , Jurisprudencia , Grupo de Atención al Paciente , Examen Físico , Medicina Física y Rehabilitación/educación , Medicina Deportiva/educación , Recursos HumanosRESUMEN
This case illustrates the importance of intraoperative monitoring of neuronal function to help separate tumor tissue from neural tissue in a 54-year-old patient with left shoulder pain resulting from a desmoid tumor. Preoperative nerve conduction and electromyographic studies showed a lesion in the lateral cord of the brachial plexus, which was found to be intimately involved with the tumor mass and was splayed into a very thin effaced sheet of neural tissue. Stimulation of the tumor/nerve tissue mass proximal to the lesion was impossible due to the invasion of the brachial plexus by the tumor. The technique that was adapted for this unusual presentation was to stimulate the tumor/nerve tissue mass itself and record compound muscle action potentials distally. With the technique described, a subtotal resection of an aggressive fibromatosis enmeshed in the proximal brachial plexus was possible, and excellent relief of pain symptoms and retention of functional capabilities of the involved extremity were achieved.
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Plexo Braquial/cirugía , Fibroma/cirugía , Monitoreo Intraoperatorio/métodos , Neoplasias de Tejido Nervioso/cirugía , Potenciales de Acción , Plexo Braquial/patología , Electrodiagnóstico , Electromiografía , Femenino , Fibroma/diagnóstico , Fibroma/patología , Humanos , Persona de Mediana Edad , Neoplasias de Tejido Nervioso/diagnóstico , Neoplasias de Tejido Nervioso/patologíaRESUMEN
There is little information available regarding management of apraxic gait. We present a 61-year-old man with a five-year history of right-sided cerebrovascular accident, apraxic gait, difficulty in walking, and frequent falls. A CT head scan revealed moderate cerebral atrophy, a small lacunar infarction. The patient was unable to initiate walking, was bed ridden and housebound. Traditional gait training and balance exercises failed to improve his gait. Two straight canes were modified by fixing florescent horizontal projections approximately two inches up from the tip of the cane. The patient was instructed to step over the horizontal projected portion, making use of visual cues from the florescent painted projections. The patient became independent with safe ambulation after practicing for approximately three weeks and was discharged home.
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Apraxias/rehabilitación , Bastones , Trastornos Cerebrovasculares/complicaciones , Marcha , Apraxias/etiología , Diseño de Equipo , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The hand and wrist of both athletes and musicians are very susceptible to injuries. Proper conditioning of the muscles, tendons, ligaments, and joints of the hand and wrist are crucial for injury prevention. Often, orthotic devices, from simple taping to polyethylene casts, can provide adequate protection and support to allow injuries to heal properly or prevent injuries from recurring in susceptible tissues.