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Michael T. Tamburello

Reflex sympathetic dystrophy (RSD) is a debilitating and recalcitrant condition that has bewildered the medical community for decades. This article briefly reviews the pathophysiology of RSD and describes the clinical presentation and management of patients suffering from RSD. The case study describes the clinical and electrodiagnostic findings of a patient with RSD following arthroscopic surgery on the knee. The medical and physical interventions rendered in this case are described.

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Elizaveta Kon, Matej Drobnic, Phil A. Davidson, Andrew Levy, Ken Zaslav and Dror Robinson

Osteochondral defects are often symptomatic and lead to deranged joint function. The spontaneous healing capacity of osteochondral defects is limited. In this case study, use of an acellular scaffold capable of induction of mesenchymal stem-cell migration is described. This scaffold was used on an Outerbridge grade IV medical condylar defect measuring ~2 cm2. At 24 mo follow-up, the articular surface appeared restored by MRI, and the patient returned to sports.

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Thomas D. Brown

Numerical approximation of the solutions to continuum mechanics boundary value problems, by means of finite element analysis, has proven to be of incalculable benefit to the field of musculoskeletal biomechanics. This article briefly outlines the conceptual basis of finite element analysis and discusses a number of the key technical considerations involved, specifically from the standpoint of effective modeling of musculoskeletal structures. The process of conceiving, developing, validating, parametrically exercising, and interpreting the results of musculoskeletal finite element models is described. Pertinent case study examples are presented from two series of finite element models, one involving total hip implant dislocation and the other involving femoral head osteonecrosis.

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Danny Pincivero, Joe H. Gieck and Ethan N. Saliba

A treatment and rehabilitation protocol was implemented on a university football player sustaining a second-degree lateral ankle sprain. The initial treatment plan involved the application of the RICE principle (rest, ice, compression, and elevation). This particular rehabilitation protocol was aimed at restoring range of motion and function at the earliest possible time with the use of a cryokinetic technique developed by Knight and with progressive exercise. The subject in this case study returned to full participation 6 days postinjury. The results from this report indicate that a program of cryokinetics and functional progressive exercise performed within pain-free limits can greatly enhance the return of an athlete to competition.

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Rick W. Wilson

Suprascapular nerve palsy has been frequently reported in athletes, particularly baseball pitchers, volleyball players, and weight lifters, but it is easily overlooked during the evaluation of shoulder pain. Entrapment of the suprascapular nerve is usually suspected only after atrophy is noted. The presence of painless weakness of the external rotator muscles should alert the clinician to the presence of nerve damage, which can be confirmed by electromyography. This case study demonstrates the usefulness of isokinetic testing and magnetic resonance imaging in identifying cystic lesions causing neuropathy among athletes who have failed conservative treatment for shoulder pain.

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David J. Pezzullo

Plantar fasciitis is one of the most common foot injuries athletes sustain. The painful heel is the result of overloading and inflammation of the plantar fascia at its insertion into the medial process of the tuberosity of the calcaneus. Many different treatment approaches have been used to address this overuse problem. Treatment for plantar fasciitis has included decreased weight bearing, nonsteroidal anti-inflammatory drugs (NSAIDs), orthotics, arch taping, weight loss, steroid injections, ultrasound, ice, physical therapy, and surgical release. Clinically the use of night splints has been found to be very successful in the treatment of plantar fasciitis, as described in this case study.

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Andrew L. McDonough and Joseph P. Weir

The purpose of this case study was to investigate reflex inhibition of the quadriceps femoris in a subject with postsurgical edema of the left knee. The subject was a 45-year-old male with a traumatic knee injury with resultant edema who underwent elective arthroscopic surgery. Reflex inhibition was assessed by H-reflex elicitation in the femoral nerve and surface electromyography of the quadriceps. To assess the degree of edema, direct circumferential measurements were taken. On the first presurgical visit, the left knee demonstrated mild edema with a decrease in H-reflex amplitudes. Two days after surgery, a further reduction in amplitudes and more swelling were demonstrated followed by an increase in amplitudes and a reduction in edema on the 28th postoperative day. These findings document a relationship between reflex inhibition and joint swelling that was previously described in experimental models where joint edema was simulated.

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Charles J. Dillman, Tricia A. Murray and Robert A. Hintermeister

Confusion of the terms open and closed kinetic chain and scarcity of research comparing kinetic chain exercises that have similar mechanics and loading prompted this case study. Exercises were classified by the boundary condition of the distal segment and presence of an external load. Classifications included a fixed boundary condition with an external load (FEL), a movable boundary with an external load (MEL), and a movable boundary with no external load (MNL). It was hypothesized that if the direction and mass of loading in MEL and FEL exercises were similar, the electromyographic activity of the primary muscle groups involved would be comparable. Muscular activity was monitored from six shoulder muscles during one MNL, four MEL, and five FEL exercises. The results indicated that MEL and FEL exercises having similar biomechanics produced comparable muscular activity. Evaluation and selection of exercises for patients should be based upon mechanics and loading that achieve appropriate muscle activity.

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Jennifer J. Mancuso, Kevin M. Guskiewicz and Meredith A. Petschauer

Stress fractures, particularly those in the lower extremity, are disabling and time-consuming injuries commonly seen in athletes. A stress fracture of the posterior talus is rare and presents with signs and symptoms similar to those of soft-tissue injuries in the rear foot. This case study involves a Division-I collegiate female field-hockey athlete who developed a stress reaction in her posterior talus approximately 6 weeks after sustaining a mild eversion ankle sprain. Her chief complaint was pain with forceful plantar flexion during running and cutting. Clinicians must be cautious when an athlete presents with posterior foot pain, being sure to properly assess and rule out differential diagnoses such as tendinitis, os trigonal fracture, and muscle strains. This athlete was able to remain weight bearing during healing, so her rehabilitation protocol allowed for a variety of exercise options.

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Judith A. Rock and Marc V. Jones

Objectives:

To explore the usefulness of counseling skills for 3 athletes undergoing rehabilitation from anterior-cruciate-ligament-reconstruction surgery.

Design:

A series of 3 case studies explored the impact of a counseling-skills intervention over 12 weeks postsurgery. Semistructured interviews were conducted 12 weeks postsurgery for triangulation and social validation of intervention.

Participants:

3 athletes meeting selection criteria, recruited from a hospital waiting list and receiving standardized rehabilitation regime.

Intervention:

Participants each received 6 counseling skills interventions at 2-week intervals.

Main Outcome Measures:

Mood, perceived rehabilitation, pain ratings, social support.

Results:

Triangulation of interview data and outcome measures provided some evidence of the beneficial impact of counseling skills on psychological outcomes. It also indicated that setbacks could present challenges to rehabilitation.

Conclusions:

Counseling skills can enhance psychological well-being of athletes during rehabilitation and be especially important during setbacks.