Bone stress injuries can cause long-lasting damage, especially in young athletes and military conscripts, if not diagnosed and treated properly. Diagnosis has been traditionally based on clinical, radiographic and scintigraphic examinations, but MRI has become increasingly important. High resolution MRI is particularly valuable for the grading of bone stress injuries. The clinician should be aware of the wide range of bone stress injuries and available diagnostic methods. Early diagnosis is the prerequisite for avoiding long-lasting complications. Most bone stress injuries heal with closed treatment, but surgery is necessary in some cases. They heal well if the diagnosis is not delayed and the treatment adequate. n Bone stress injuries are mostly seen among longdistance runners, soldiers, dancers, athletes and other sportsmen. The patients are usually young or middle-aged (Table 1). About 400-500 sportsmen are affected by a bone stress injury annually in Finland (population 5 million; Hulkko and Orava 1991). The global incidence of bone stress injuries in sports has been estimated to be 2-4%: 2% in men and 7% in women (Johnson et al. 1994). Female athletes run an up to four times higher risk of a bone stress injury (Brunet et al. 1990, Zernicke et al. 1993). Among athletes, one fth of all musculoskeletal stress injuries are located in bones (Bennell et al. 1996). Bone stress injuries of the lower extremities are commonest in the shin of long-distance runners (Table 1).

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Morphological fatty changes and function of the liver and serum free fatty acids and triglycerides were investigated in 37 catabolic patients (22 men, 15 women) given different parenteral nutrition regimens. In the glucose group energy was supplied as carbohydrate alone, in the lipid group as carbohydrates and fats, and in addition both groups received amino acids. In the amino acid group amino acids were given in excess and less energy was supplied as carbohydrates. Each patient served as his own control. During parenteral nutrition liver steatosis rose from 5% to 35% (p less than 0.001) in the glucose group and from 7% to 23% (p less than 0.01) in the amino acid group, but no increase occurred in the lipid group. Liver fat accumulation was associated with the rises in serum aminotransferase activities and with the lack of or a poor rise in serum prothrombin and proconvertin. The conjugation function of the liver was not disturbed. No cholestatis was found. During lipid infusion serum free fatty acids increased to 4.41 mmol/l (p less than 0.01) and serum triglycerides to 3.06 mmol/l (p less than 0.01), but they decreased to normal range 12 h after lipid infusion was stopped. In the glucose and amino acid groups serum free fatty acid levels fell, as expected, below the normal range. Serum triglycerides rose 1.4-fold (p less than 0.05) in the amino acid group. On the basis of liver tests and histological examination steatosis in the liver caused only a minor disturbance in hepatocellular integrity. The very high levels of serum free fatty acids and triglycerides during lipid infusion may be harmful in certain pathological states.

BackgroundConservative treatment of acromioclavicular (AC) joint dislocation is not always successful. A consequence of persistent AC joint dislocation may be chronic pain and discomfort in the shoulder region as well a sensation of constant AC joint instability and impaired shoulder function. Stabilization of the AC joint may reduce these sequels.Materials and methodsDue to chronic AC joint dislocation, 39 patients in our hospital underwent coracoclavicular (CC) ligament reconstruction with autogenous semitendinosus and gracilis tendons between May 2005 and April 2011. We examined 25 patients after a mean of 4.2 years. The outcomes were Constant shoulder Score (CS), Disabilities of the Arm, Shoulder and Hand (DASH), pain (Visual Analog Scale, VAS), cross-arm test, stability of the AC joint, and complications. The follow-up visits included anteroposterior and axillary radiographs.ResultsMean CS was 83 in the injured shoulder and 91 in the uninjured shoulder (p = 0.002). Mean DASH was 14. In 14 patients, the AC joint was clinically stable; pain was minor. In radiographs, osteolysis of the lateral clavicle and tunnel widening were markedly common. Fracture of the coracoid process occurred in 5 patients, and 3 suffered a fracture of the clavicle; 2 had a postoperative infection.ConclusionsAnatomic reconstruction of CC ligaments showed a moderate subjective outcome at the 4-year follow-up. After surgery, almost half the AC joints failed to stabilize. Lateral clavicle osteolysis and tunnel widening were notably common complications.

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Background and purpose Long-term outcome after surgery for grade-V acromioclavicular joint dislocation has not been reported. We performed a retrospective analysis of functional and radiographic outcome 15–22 years after surgery.Patients and methods We examined 50 patients who were treated at our hospital between April 1985 and December 1993. Various methods of stabilization were used: K-wires (n = 36), 4.5-mm screw (n = 12), or biodegradable screw (n = 2). Osteosynthesis material was removed after 6–8 weeks. Mean follow-up time was 18 (15–22) years. Outcomes were assessed with the Constant shoulder (CS) score, Disabilities of the Arm, Shoulder, and Hand (DASH) score, the simple shoulder test (SST), the Copeland shoulder impingement test, the cross-arm test, pain, stability of the AC joint, and complications. From radiographs, we evaluated AC and glenohumeral (GH) arthrosis, osteolysis of the lateral clavicle, and alignment of the clavicle with the acromion.Results Mean values were 90 (75–100) in CS score, 5.1 (0–41) in DASH score, and 11 (2–12) in SST. There was no statistically significant difference in CS score between the injured shoulder and the uninjured shoulder. The AC joint was clinically stable in 42 patients. In 38 patients, the clavicle alignment with the acromion was normal in radiographs. Lateral clavicle osteolysis (10 patients) appeared to be associated with permanent AC joint dislocation.Interpretation Surgery with a temporary fixation for acute grade-V AC joint dislocation leads to successful long-term functional results. Only minor disability occurred in some patients.

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Muscle and blood metabolites, plasma insulin and cyclic adenosine 3',5'-monophosphate (cAMP) levels were investigated in five male runners before and after strenuous intermittent running exercise of short duration. Immediately after the exercise, the mean muscle creatine phosphate level (CrP) had fallen by 74% (P less than 0.02) and 30 min later the initial level was regained in only one subject. Other immediate results were increases in mean muscle lactate (460%, P less than 0.005), glucose (130%), glucose-6-phosphate (G6P, 320%) and fructose-1,6-diphosphate (FDP, 32%). Muscle ATP and glycogen concentration had decreased by 31 and 23% (P less than 0.05), respectively. However, ATP, glucose, G6P and FDP changes were not significant owing to the great individual variation. This may have been due to the different training programmes of the runners. Immediately after the exercise mean plasma insulin was 210% (P less than 0.01), blood glucose 71% (P less than 0.005) and plasma cAMP concentration 260% (P less than 0.01) higher than the pre-exercise values. After running urinary excretion of cAMP was 29% higher than before the exercise. It is concluded that exhaustive, short-term exercise activates the liver adenylate cyclase system so giving rise to an increased level of blood glucose, which is an important source of energy during this type of exercise.