Common upper extremity injuries in resistance training athletes include muscle strains, ligament sprains, pectoralis major tendon ruptures, distal biceps tendon ruptures, and chronic shoulder pain and capsulolabral injuries. While each injury is unique in its specific anatomic location and mechanism, each is preventable with proper exercise technique, safety and maintenance of muscle balance. Conservative treatment is the therapeutic modality of choice and these injuries generally resolve with workout modification, appropriate recovery, anti-inflammatory medication, and physical therapy. If conservative treatment fails, surgical intervention is often successful and can return the weightlifter to a level of performance near their pre-injury level.
BackgroundIn cases of total knee arthroplasty (TKA) threatened by potential hardware exposure, flap-based reconstruction is indicated to provide durable coverage. Historically, muscle flaps were favored as they provide vascular tissue to an infected wound bed. However, data comparing the performance of muscle versus fasciocutaneous flaps are limited and reflect a lack of consensus regarding the optimal management of these wounds. The aim of this study was to compare the outcomes of muscle versus fasciocutaneous flaps following the salvage of compromised TKA.MethodsA systematic search and meta-analysis were performed to identify patients with TKA who underwent either pedicled muscle or fasciocutaneous flap coverage of periprosthetic knee defects. Studies evaluating implant/limb salvage rates, ambulatory function, complications, and donor-site morbidity were included in the comparative analysis.ResultsA total of 18 articles, corresponding to 172 flaps (119 muscle flaps and 53 fasciocutaneous flaps) were reviewed. Rates of implant salvage (88.8% vs. 90.1%, P=0.05) and limb salvage (89.8% vs. 100%, P=0.14) were comparable in each cohort. While overall complication rates were similar (47.3% vs. 44%, P=0.78), the rates of persistent infection (16.4% vs. 0%, P=0.14) and recurrent infection (9.1% vs. 4%, P=0.94) tended to be higher in the muscle flap cohort. Notably, functional outcomes and ambulation rates were sparingly reported.ConclusionsRates of limb and prosthetic salvage were comparable following muscle or fasciocutaneous flap coverage of compromised TKA. The functional morbidity associated with muscle flap harvest, however, may support the use of fasciocutaneous flaps for coverage of these defects, particularly in young patients and/or high-performance athletes.
Background: The relationship of pain, function, and treatment in lateral epicondylitis is not fully understood. Improved understanding of this interrelationship may be required to optimize treatment strategies, particularly with regard to bracing and activity modification. Methods: A cohort of 36 patients diagnosed by a fellowship-trained hand surgeon over a 25-month period that received treatment in the form of a cock-up wrist splint (CUWS) and recommendations of activity modification was identified. The patients' function was defined by the QuickDash Outcome measure and pain by the Numeric Pain Rating. Retrospective analysis of prospectively collected pre-treatment data were compared to those obtained following treatment using Wilcoxon signed-rank test. Changes in QuickDash Outcome measures and Numeric Pain Rating following treatment were compared between those individuals that stated the treatment helped and those that stated it did not. Result: Following treatment with a CUWS and activity modification, the median QuickDash score was 8 compared to 40 prior to treatment (95% CI: -32 ~ -20, p-value < 0.0001) indicating statistically significant functional improvement. All 36 of 36 (100%) patients stated that they were able to return to a normal activity level at the time of follow-up. Numeric Pain Rating values improved from 6 to 1 following treatment (95% CI: -6 ~ -4, p-value < 0.0001). The Kendall's Tau-b correlation coefficient between Numeric Pain Ratings and QuickDash Outcome measure was 0.296 (p-value = 0.018) and 0.473 (p-value = 0.001) before and after treatment, respectively, suggesting a weak to moderate correlation. Patients who stated that the treatment was effective experienced a median change in their QuickDash outcome score of -23 compared to -37 for those whom did not think it was an effective treatment; the estimated difference between the two groups was 14 (CI: 2, 30, p-value 0.019) indicating that patients who thought treatment was not effective actually experienced greater functional improvement. Conclusions: These results indicate that use of a CUWS and recommendations of activity modification is an effective strategy to help improve patient function and pain levels. However, low to moderate correlation between pain and disability both before and after treatment indicate that other factors such as coping skills and psychosocial influences may effect the disease and treatment course. Furthermore, patients may still make gains in function while questioning the effectiveness of their treatment, which may make assessment of therapeutic response difficult. Future research should be directed at identifying which factors other than pain may influence disability and devising strategies to address them.
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