Mary Jones, Amanda K. Andrews and Janenne Ellis
Column-editor : Joseph J. Piccininni
Kelly Copperthite Ranalli
Total talar dislocations without associated fractures are extremely rare traumatic events that are described sparingly in research and are currently without a standardized treatment protocol. This report highlights rehabilitation for this injury following a fall from a great height with eventual return to prior level of function and with minimal complications.
W. Craig Stevens, Rebecca A. Brey, Jeffrey E. Harris and Sandra Fowkes-Godek
Sandra Fowkes Godek and Arthur R. Bartolozzi
Jason S. Scibek and Christopher R. Carcia
The efficacy of a variety of noninvasive, conservative management techniques for calcific tendinopathy has been investigated and established for improving pain and function and/or facilitating a decrease in the size or presence of calcium deposits. Surprisingly, few have reported on the use of traditional therapeutic exercise and rehabilitation alone in the management of this condition, given the often spontaneous resorptive nature of calcium deposits. The purpose of this case is to present the results of a conservative approach, including therapeutic exercise, for the management of calcific tendinopathy of the supraspinatus, with an emphasis on patient outcomes.
The patient was a self-referred 41-y-old man with complaints of acute right-shoulder pain and difficulty sleeping. Imaging studies revealed liquefied calcium deposits in the right supraspinatus. The patient reported constant pain at rest (9/10) and tenderness in the area of the greater tuberosity. He exhibited a decrease in all shoulder motions and had reduced strength. The simple shoulder test (SST) revealed limited function (0/12). Conservative management included superficial modalities and medication for pain and a regimen of scapulothoracic and glenohumeral range-of-motion (ROM) and strengthening exercises.
At discharge, pain levels decreased to 0/10 and SST scores increased to 12/12. ROM was full in all planes, and resisted motion was strong and pain free. The patient was able to engage in endurance activities and continue practicing as a health care provider.
The outcomes with respect to pain, function, and patient satisfaction provide evidence to support the use of conservative therapeutic interventions when managing patients with acute cases of calcific tendinopathy. Successful management of calcific tendinopathy requires attention to outcomes and an understanding of the pathophysiology, prognostic factors, and physical interventions based on the current stage of the calcium deposits and the patient’s status in the healing continuum.
Jennifer Burt, Mary Beth Zwart and Trevor C. Roiger
An 18-year-old NCAA Division I women’s softball player presented with a sudden onset of pain in her left wrist during a strength and conditioning workout. Initial examination revealed pain, loss of AROM, decreased muscle strength, and paresthesia. The patient experienced symptomology for 12+ weeks. Corticosteroid injections were administered which finally confirmed diagnosis, reduced pain, and paresthesia. Intersection syndrome is generally an overuse condition which resolves within approximately 2 weeks. This case demonstrates that examination findings, imaging, immobilization, and a therapeutic exercise plan may not be sufficient to decrease patient symptomology.
Eric Emmanuel Coris, Stephen Walz, Jeff Konin and Michele Pescasio
Heat illness is the third leading cause of death in athletics and a leading cause of morbidity and mortality in exercising athletes. Once faced with a case of heat related illness, severe or mild, the health care professional is often faced with the question of when to reactivate the athlete for competitive sport. Resuming activity without modifying risk factors could lead to recurrence of heat related illness of similar or greater severity. Also, having had heat illness in and of itself may be a risk factor for future heat related illness. The decision to return the athlete and the process of risk reduction is complex and requires input from all of the components of the team. Involving the entire sports medicine team often allows for the safest, most successful return to play strategy. Care must be taken once the athlete does begin to return to activity to allow for re-acclimatization to exercise in the heat prior to resumption particularly following a long convalescent period after more severe heat related illness.
John A. Nyland, Dean P. Currier, J. Michael Ray and Mitchell J. Duby
This paper discusses function changes during an accelerated rehabilitation program at 6, 10, and 52 weeks postsurgery for a college athlete following anterior cruciate ligament reconstruction/meniscectomy of the left knee. The effects of combined pulsed electromagnetic field (PEMF) and neuromuscular electrical stimulation (NMES) on knee extensor torque, thigh girth, and pain level are presented. PEMF-NMES decreased stimulation pain by 76%. Knee extensor isometric torque increased by 23%, and thigh girth decreased less than 5% at 6 weeks. Knee extensor isokinetic torque was 13% and 3% deficient at 90°/s and 240°/s, and standing single-leg broad jump distance was 19% deficient at 10 weeks. Knee extensor isokinetic torque was 1% and 1.5% greater at 90°/s and 240°/s, and standing single-leg broad jump distance was 11% deficient at 52 weeks. Knee anterior laxity was 2 mm at 10 weeks and 3 mm at 52 weeks. PEMF-NMES appears to comfortably enhance knee extensor torque gains and diminish thigh girth loss. Despite early return to practice, functional deficit remained and anterior laxity was increased at 52 weeks.
Michael J. Carroll
Dislocation with an associated fracture of the ankle is a rare injury. A medial dislocation of the subtalar joint is uncommon, because the normal direction of the subtalar dislocation is lateral. This paper discusses a fracture medial dislocation of the ankle in a high school football player. Initial treatment of the injury included on-the-field management and referral to a hospital and an orthopedic surgeon. Rehabilitation of this injury was very slow and conservative in the initial stage after surgery. This included range of motion exercises for the ankle, full leg conditioning, and ice. After the fracture site was found stable the injury was treated much the same as a Grade II ankle sprain. The goal of rehabilitation was to return the range of motion, strength, and girth measurements of the affected side to those of the contralateral side as quickly as possible, so the athlete could resume athletics. When the affected side met these criteria, there was little to no pain with activity, and the orthopedic physician granted clearance, the athlete was allowed to return to competition.