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Context: Volleyball players are reported to have shoulder strength imbalances. Previous authors have primarily investigated small samples of male players at a single skill level, without considering playing position, and with inconsistent findings.Objective: To evaluate shoulder strength asymmetry and a history of shoulder injury in a large sample of professional volleyball players of both sexes across different playing positions and skill levels.Design: Descriptive laboratory study. Patients or Other Participants: A sample of 183 volleyball players (99 men, 84 women).Main Outcome Measure(s): We assessed shoulder internal-rotator and external-rotator concentric strength at 608/s using an isokinetic dynamometer and dominant-nondominant differences in shoulder strength and strength ratios using repeatedmeasures analyses of variance. Peak torque was normalized for body mass and external-rotation/internal-rotation concentric strength.Results: Internal-rotation strength was asymmetric in favor of the dominant side in both sexes, regardless of previous shoulder injury status. Male volleyball players had a lower shoulder strength ratio on the dominant side, regardless of previous shoulder injury status. However, this finding was valid only when hand dominance was taken into account. Female volleyball players playing at a higher level (ie, first versus second division) were 3.43 times more likely to have an abnormal strength ratio. Playing position was not associated with an abnormal shoulder strength ratio or strength asymmetry.Conclusions: In male volleyball players, the externalrotation/internal-rotation strength ratio of the dominant shoulder was lower, regardless of playing position, skill level, or a previous shoulder injury. In female players, the ratio was less only in those at a higher skill level. Although speculative, these findings generally suggest that female volleyball players could have a lower risk of developing shoulder-related problems than male volleyball players. Isokinetic shoulder testing may reveal important information about the possible risk factors for shoulder injuries, so we recommend including it in the functional screening of volleyball players.Key Words: isokinetic testing, muscle imbalances, injury prevention, muscle strength Key PointsMale volleyball players had a lower external-rotation/internal-rotation strength ratio of the dominant shoulder. Female volleyball players at a higher skill level were 2.5 times more likely to have abnormal strength ratios. When analyzing shoulder strength findings, we must consider hand dominance. Functional screening of volleyball players could include isokinetic testing.I sokinetic strength testing can play an important part in the comprehensive evaluation and rehabilitation of a patient with a shoulder injury. 1 Of all the muscle groups of the shoulder, evaluation of the shoulder external rotators (ERs) and internal rotators (IRs) is most informative because those muscle groups are responsible for dynamic stabilization of the glenohumeral joint. 2 One ...

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In patients who have sustained an avulsion fracture of the inferior patellar pole, the normal height of the patella can be maintained by preserving the patellar pole. In contrast with pole resection, which requires postoperative immobilization, internal fixation with a basket plate allows for immediate mobilization and early weight-bearing. The present study indicates that internal fixation with use of a basket plate can provide better clinical results.

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This study showed the feasibility and efficacy of intraarticular patient-controlled regional analgesia technique for pain relief after anterior cruciate ligament reconstruction. The combination of intraarticular ropivacaine, morphine, and ketorolac was superior to control or to a combination of ropivacaine and morphine.

Cyclops syndrome has been defined as a loss of knee extension due to impingement of a pedunculated proliferative tissue mass after anterior cruciate ligament reconstruction. We describe four patients who were operated on for progressive loss of knee extension after minor knee injury. During the arthroscopic procedure, the consistent finding was a fibrous pedunculated nodule adhering to the anterolateral aspect of the original anterior cruciate ligament, obstructing extension by impingement in the anterior aspect of the knee. At least part of the anterior cruciate ligament was intact in all cases. These patients were compared with seven patients who developed cyclops syndrome after anterior cruciate ligament reconstruction. Clinical and arthroscopic findings were the same in both groups. An arthroscopic excision of the nodule, performed an average of 12 weeks after knee trauma or after reconstruction, gave very good results. Histologic examination of the excised nodules from both groups showed fibroelastic connective tissue proliferation, thromboangiitis, and areas of necrotic bone and foreign body giant cell granuloma. On the basis of our observations, we conclude that formation of a fibrous pedunculated nodule may occur after an anterior cruciate ligament injury as well as after surgical reconstruction of the anterior cruciate ligament.

IV, prospective case series.