Evaluation of apparent and absolute supraspinatus strength in patients with shoulder injury using the scapular retraction test.

Background: Physical examination of patients with shoulder injury not involving actual rotator cuff tears frequently demonstrates decreased rotator cuff strength on manual muscle testing. This decrease has been attributed to supraspinatus muscle weakness, but it may be owing to alterations in scapular position.

Hypothesis: The position of stabilized scapular retraction, by minimizing proximal kinetic chain factors and providing a stable base of muscle origin, positively influences demonstrated supraspinatus strength.

The role of core stability in athletic function.

The importance of function of the central core of the body for stabilisation and force generation in all sports activities is being increasingly recognised. 'Core stability' is seen as being pivotal for efficient biomechanical function to maximise force generation and minimise joint loads in all types of activities ranging from running to throwing. However, there is less clarity about what exactly constitutes 'the core', either anatomically or physiologically, and physical evaluation of core function is also variable.

Surgical treatment of obstructive sleep apnea.

THE PRIMARY TREATMENT for obstructive sleep apnea (OSA) has been continuous positive airway pressure (CPAP) therapy, but the minimum acceptable number of hours of nightly CPAP use remains unclear. INTEGRATED SOFT TISSUE and bone surgery may be a viable alternative for patients who have rejected CPAP as a treatment option. Formal sleep testing has shown that surgery and CPAP therapy are equally successful at resolving OSA.

The effect of limb support on muscle activation during shoulder exercises.

The purpose of this study was to determine the difference in demands on glenohumeral musculature during unsupported and supported active range-of-motion (AROM) shoulder exercises. Twenty healthy subjects volunteered for this study. Surface or fine-wire bipolar electrodes were applied to the infraspinatus, posterior deltoid, anterior deltoid, pectoralis major, and supraspinatus muscles.

Kinetic chain contributions to elbow function and dysfunction in sports.

The elbow functions in throwing and other athletic activities as a link in the kinetic chain of force development, regulation, and transfer. Efficient function, with maximal performance and minimal injury risk, requires optimum activation of all the link in the kinetic chain. Injury is often associated with alterations in force production or regulation capabilities in links that may be distant to the site of injury.

Comprehensive reconstructive surgery for obstructive sleep apnea.

Obstructive sleep apnea (OSA) is commonly treated by continuous positive airway pressure (CPAP). Patients can be intolerant, noncompliant, or avoidant of CPAP therapy but incur increased risk of cardiopulmonary disease, stroke, and shortened life span without treatment. Comprehensive hard and soft tissue surgical therapy directed at the nasal, retro-palatal, and retro-lingual airway has been shown to optimize surgical outcomes compared with isolated soft tissue procedures.

Rehabilitation of rotator cuff tendinopathy.

Rehabilitation of the dysfunction that is associated with rotator cuff tendinopathy should be based on the evidence known about the pathoetiology of the tendinopathy, what is known about the extent of the local anatomic injury, the local and distant physiological and biomechanical alterations, and on the knowledge developed regarding progressive loading of the injured or altered structures. Prehabilitation, or prospective exercises to minimize future rotator cuff loading stresses, should be included at the end of rehabilitation as part of the return to function.

Qualitative clinical evaluation of scapular dysfunction: a reliability study.

The purpose of this study was to determine the intrarater and interrater reliability of a clinical evaluation system for scapular dysfunction. No commonly accepted terminology presently exists for describing the abnormal dynamic scapular movement patterns that are commonly associated with shoulder injury. A method of observation was devised for clinical evaluation of scapular dysfunction.

Injuries to the glenoid labrum: a diagnostic and treatment challenge.

The glenoid labrum contributes to shoulder stability by increasing the glenoid surface and providing attachments for the shoulder capsule and various ligaments and tendons. Overhead arm activities, especially throwing, can stress the shoulder excessively and cause labral injury. Symptoms include poorly localized pain, exacerbated by overhead and behind-the-back motions, and popping, catching, or grinding.

History of the operating microscope: from magnifying glass to microneurosurgery.

The advent of the microscope in the operating room revolutionized neurosurgery. We traced the origin and evolution of this important invention from the first magnifying lens to its practical application in neurosurgery. The concept of magnification evolved from unexplained observations in ancient times to the invention of the microscope by the late 16th century.

Shoulder rehabilitation: principles and practice.

The goal of shoulder rehabilitation is to restore the function of the shoulder. Function can be described in many different ways, but the framework for restoration of function should include restoration of the anatomy plus normalization of physiology and biomechanics. Without the normalization of physiology and biomechanics, the shoulder will not function in a normal fashion.

The role of the scapula in athletic shoulder function.

The exact role and the function of the scapula are misunderstood in many clinical situations. This lack of awareness often translates into incomplete evaluation and diagnosis of shoulder problems. In addition, scapular rehabilitation is often ignored.

Diagnosis, treatment and rehabilitation principles in complete tendon ruptures in sports.

Complete tendon ruptures may occur in any tendon subjected to athletic stress. This article discusses diagnostic, treatment and rehabilitation principles that are common to all tendon ruptures. The most common tendon ruptures are then discussed more specifically, presenting pertinent diagnostic tests, treatment considerations and principles of rehabilitation.

Shoulder rehabilitation: clinical application, evaluation, and rehabilitation protocols.

This chapter has discussed and illustrated a shoulder rehabilitation protocol based on restoration of the anatomy, biomechanics, physiology, and motor firing organization that is responsible for normal shoulder function. Many protocols exist in the literature, most of which appear to achieve good results. There are no outcomes data to suggest the most efficacious protocols.

Arthroscopic findings in ankle ligament reconstruction.

The author believes that there are several reasons that justify the use of a preliminary diagnostic and therapeutic arthroscopic examination in conjunction with an ankle ligament reconstruction. First, a high percentage of symptomatic unstable ankles demonstrate associated intra-articular pathologic conditions. Second, not all of these conditions are appreciated on preoperative clinical examination.

Recognizing the allergic child.

The delivery of health care is currently in a state of transition with managed care emerging as a frequently used method for health care delivery. A major tenet of many managed care systems is that specialized care is costly and thus is to be delayed or avoided when possible. The end result of this philosophy is that primary care physicians will find themselves providing patient care which, in the past, had been provided by the specialist.

Shoulder range of motion in elite tennis players. Effect of age and years of tournament play.

We studied glenohumeral rotational range of motion in 39 members of the United States Tennis Association National Tennis Team and touring professional program. We took goniometric measurements of internal and external rotation of dominant and nondominant shoulders at the glenohumeral joint with the humerus at 90 degrees of abduction. We categorized the tennis players by age and by years of tournament play.

Helicobacter pylori and gastrointestinal disease.

Helicobacter pylori infection is quite common. In the United States, prevalence varies considerably with race, nationality, socio-economic status and location of residence. In Western countries, the prevalence of the infection has shown a steady increase with increasing age.

Specificity and sensitivity of the anterior slide test in throwing athletes with superior glenoid labral tears.

This study documents the sensitivity and specificity of a clinical test to aid in the diagnosis of superior glenoid labral lesions. The anterior slide test, a method of applying an anteriorly and superiorly directed force to the glenohumeral joint, was performed on several groups of athletes. These included symptomatic athletes with isolated superior labral tears, rotator cuff tears, and instabilities, and asymptomatic athletes with rotational deficits.