INJURY TO THE THROWING ARM. A STUDY OF TRAUMATIC CHANGES IN THE ELBOW JOINTS OF BOY BASEBALL PLAYERS.
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X-ray studies were made of both elbows of 162 boys in the 9 to 14 year age group, divided into three categories: Pitchers, non-pitchers, and a control group who had never played organized baseball. Changes involving the medial epicondylar epiphysis and opposing articular surfaces of the capitulum and head of radius in the throwing arm appeared to be in direct proportion to the amount and type of throwing. The most striking changes were in the arms of pitchers. Some degree of accelerated growth, separation and fragmentation of the medial epicondylar epiphyses was noted in the throwing arm of all 80 pitchers in the study. Five cases of traumatic osteochondritis of the capitulum and head of radius, and one case of juvenile osteochondritis of the head of the radius were also found among the pitchers. Better medical supervision and stress on prevention are needed, especially in the Southern California area where climatic conditions favor prolonged seasons and throwing practice the year around. (+info)
Critical ischaemia of the upper limb.
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Fifty-seven patients who presented to the Royal Surrey County Hospital, Guildford, with critical upper limb ischaemia between 1980 and 1989 were studied. Only 13 patients had emboli, while 23 presented with arteritis, seven involving large vessels and 16 with small vessel disease. Other causes included nine patients with trauma, six with atherosclerosis (of whom five were women), and four with vascular complications of thoracic outlet obstruction. Single examples of ischaemia due to radiation fibrosis and disseminated intravascular coagulation were also seen. Critical ischaemia of the upper limb remains an uncommon yet challenging problem. The review demonstrates that total limb arteriography should be performed in all patients, except the minority who present with direct arterial trauma or classical emboli. (+info)
Left and right hand recognition in upper limb amputees.
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Previous research suggests a close similarity in brain activity between mental simulation of a movement and its real counterpart. To explore this similarity, we aimed to assess whether imagery is affected by the loss of a limb or of its motor skills. We examined the performance of 16 adult, upper limb amputees (and age-matched controls) in a left/right hand judgement task that implicitly requires motor imagery. The experimental group included subjects who had suffered the amputation of the dominant or the non-dominant limb. Although responding well above chance, amputees as a group were slower and less accurate than controls. Nevertheless, their response pattern was similar to that of controls, namely slower response times and more errors for stimuli depicting hands in unnatural orientations, i.e. postures difficult to reach with a real movement. Interestingly, for all stimuli, amputees' performance was strongly affected by the side of limb loss: subjects who underwent amputation of their preferred limb made more errors and required greater latencies to respond as compared with amputees of the non-dominant limb. In a further analysis we observed that the habit of wearing an aesthetic prosthesis significantly interfered with the ability to judge the corresponding hand. Our data lead to three main conclusions: (i) loss of a single limb per se does not prevent motor imagery but it significantly enhances its difficulty; (ii) these subjects apparently perform the hand recognition task using a strategy in which they initially mentally simulate movements of their dominant limb; (iii) wearing a prosthesis, devoid of any motor function, seems to interfere with motor imagery, consistent with the view that only 'tools' can be incorporated in a dynamic body schema. (+info)
Head injury and limb fracture in modern playgrounds.
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There were no serious head injuries in modern Cardiff municipal playgrounds with safety surfaces over five years injury surveillance. The literature suggests serious head injuries did occur before the introduction of safety surfaces. (+info)
Alcohol related falls: an interesting pattern of injuries.
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OBJECTIVE: To discover if there is a significant difference in the pattern and severity of injury sustained during falls in patients who have consumed alcohol and those who have not. To determine how pattern and severity of injury correlates with blood alcohol concentration. METHOD: A prospective quasi-randomised controlled study between November 2001 and July 2002. All healthy adults between 16 and 60 years who had fallen from standing height were included. A systematic history and examination permitted calculation of injury severity scores as per abbreviated injury scale update 1998. Blood alcohol concentrations were obtained from intoxicated patients with consent. RESULTS: 351 healthy adult patients were included in the study, there were 238 in the no alcohol group, 113 had consumed alcohol and blood alcohol intake were obtained for 47. The alcohol group had a higher incidence of head injuries (46 (48%) versus 22 (9%)) with a lower incidence of limb injuries (39 (39%) versus 183 (76%)) than the no alcohol group. There was a significant difference in the pattern of injury between the alcohol and no alcohol groups (chi(2), p<0.001) and there was a significant difference in the injury severity scores (p<0.001, Z = -2.5). In the alcohol group severity and pattern correlated with alcohol concentration at the time of injury. Patients with an alcohol concentration<2 g/l had mostly soft tissue limb injuries (58%), 2-2.5 mostly significant limb fractures (55%), and >2.5 mostly significant head injuries (90%). CONCLUSIONS: Alcohol related falls are more often associated with severe craniofacial injury. The severity of both limb and head injury is greater and correlates directly with blood alcohol concentration. (+info)
The effect of time delay on infection in open long-bone fractures: a 5-year prospective audit from a district general hospital.
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OBJECTIVES: To determine whether a time delay of greater than 6 h from injury to surgical debridement affected the infection rate in open long-bone fractures in a typical district general hospital in the UK. DESIGN: Prospective audit over 5 years. METHODS: 142 open long-bone fractures in 130 patients were seen over a 5-year period between 1996 and 2001 in our hospital. 115 fractures in 103 patients were available for study. The data were collected prospectively in weekly audit meetings. Patients were followed until clinical or radiological union occurred or until a secondary procedure for non-union or infection was carried out. RESULTS: Surgical debridement was carried out in less than 6 h from injury in 60% of cases and in greater than 6 h from injury in 40% of cases. Infection rates were 10.1% and 10.8%, respectively. CONCLUSIONS: We could not demonstrate a significantly increased infection rate in patients in whom surgical debridement occurred greater than 6 h after injury. (+info)
Perfectionism and coping strategies as risk factors for the development of non-specific work-related upper limb disorders (WRULD).
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BACKGROUND: The incidence of non-specific work-related upper limb disorders (WRULD) is rising throughout western society. Literature and our own WRULD file (>1200 patients) revealed that both physical and psychosocial work-related factors are major causes of non-specific WRULD. It also appeared that non-specific WRULD was more likely to develop in patients with neurotic-perfectionist personalities. AIM: To see if, alongside physical and psychosocial work-related factors, personality factors play an important role in developing non-specific WRULD. METHOD: This was a case-control study with two control groups, comparing 45 computer workers with non-specific WRULD with 45 computer workers free from upper limb disorder (first control group) and 42 chronic pain patients (second control group). Main questionnaires administered were: the Utrecht Coping List (UCL), measuring coping-styles; the Multidimensional Perfectionism Scale (MPS), measuring neurotic perfectionism; and the Symptom Check List (SCL-90), measuring general psychological complaints (psychoneuroticism). The SCL-90 was added because of its known high correlation with neurotic perfectionism. RESULTS: Logistic regression analysis revealed significant differences in SCL-90 scores (chi(2) = 17.2, P < 0.0001), thereby potentially negating the significance of the higher neurotic perfectionism in the non-specific WRULD group. A second control group of chronic pain patients, with prospective high score on the SCL-90, was added. Logistic regression showed that, after controlling for psychoneuroticism, non-specific WRULD patients had more neurotic perfectionist traits (chi(2) = 22.83, P < 0.0001). There were no significant differences in mean UCL scores (P > 0.05). CONCLUSION: Alongside physical and psychosocial work-related factors, psychoneuroticism and neurotic perfectionism appear to be important risk factors for developing non-specific WRULD. (+info)
Early management of upper limb fractures in general practice.
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BACKGROUND: Upper limb injuries are very common and patients frequently present to general practitioners for treatment. Circumstances of the injury and varied patient factors are critical to assessment. Outcome of these injuries involves short term pain control and diagnosis; fracture immobilisation, comfort and function in the treatment device medium term; and longer term, the best functional outcome. OBJECTIVE: This article aims to guide GPs through the initial assessment and early management of fractures and provides a logical, simple structure for this process. Understanding of different injury patterns and patient characteristics to assist correct overall management is emphasised and the correct timing for early follow up is discussed. DISCUSSION: Many upper limb fractures can be comprehensively managed in general practice. Bad outcomes from injuries are not uncommon and most commonly occur due to relatively minor errors in early decision making. These 'second accidents' are often completely preventable. (+info)