Clinics in sports medicine
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Review
Decision making: operative versus nonoperative treatment of acromioclavicular joint injuries.
The classification system devised by Allman and Tossy, and revised by Rockwood, defines the extent of injury to the AC joint and helps to guide management of AC joint injuries [1,4,6]. In general, type I and II injuries may be treated nonoperatively with a sling, mainly for comfort, for a short period of time. Once this is removed, strength and motion are regained with rehabilitation. ⋯ There is no correlation between reduction and improvement in pain, strength, or motion, however. These patients usually are able to return to full sport with no deficits if rehabilitation is emphasized. For those patients who fail conservative management, a multitude of surgical techniques, such as the modified Weaver-Dunn procedure, exist to reconstruct the AC joint.
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Acromioclavicular injuries are common and most often can be accurately diagnosed using history, physical examination, and routine radiography. Sternoclavicular subluxations and dislocations may also be accurately characterized with only history, physical examination, and routine radiography (i.e., serendipity view). ⋯ When this is suspected, angiography or CT angiography is indicated. Physeal injuries should be suspected at either end of the clavicle in adolescent patients.
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Surgical treatment of patellar dislocations, acute and chronic, has evolved significantly over the past decade with the advance of biomechanical knowledge of patellofemoral restraints and injury patterns identified by physical examination and improved imaging techniques. There continues to be no consensus on treatment parameters. Despite the presence of predisposing factors, such as dysplasia or generalized hyperlaxity, medial retinacular injury associated with primary (first-time) patellar dislocations represents a ligament injury, which may result in residual laxity of the injured structure. ⋯ A practical approach to surgery after patellar dislocation is the minimal amount of surgery necessary to re-establish objective constraints of the patella. Correcting dysplastic factors, in particular tibial tubercle transfers and trochleoplasties, are best reserved if more minimal surgery has failed. This failure is defined as continued functional instability of the kneecap.
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Continual improvements in MR imaging, technology and MR imaging-compatible monitoring and fixation devices have allowed the incorporation of this relatively new imaging modality into standard algorithms for cervical spine trauma assessment. The ability of MR imaging to define the type of spinal cord injury, the cause and severity of spinal cord compression, and the stability of the spinal column is unmatched. The heavy reliance of the spinal surgeon on MR imaging for decisions regarding the type of therapy, the timing, the approach of surgical intervention, and for predicting patient outcome attests to the usefulness of this modality.
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The early studies on IDET are very promising. IDET offers patients with chronic discogenic low back pain an option other than chronic pain [figure: see text] management or spinal fusion. Studies currently under way will help answer questions relative to mechanism of action, placebo effect, and biomechanical changes after treatment. ⋯ This may be especially true for the young patient with preserved disc height, and patients with inoperable multilevel disease. The technology was designed to be used for a specific diagnostic subset of disc disorders by specialists skilled in performing intradiscal techniques who possess the ability to accurately diagnose and effectively manage patients with complex spinal disorders. Abuse of this ground-breaking technology can be avoided if patient selection criteria are carefully observed and only skilled, technically proficient physicians perform the procedure.