Clinics in sports medicine
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The role of arthroscopy in the management of degenerative knee arthritis in the older athlete remains controversial. This patient population desires symptomatic improvement to maintain active lifestyles. For advanced tricompartmental osteoarthritis, total knee arthroplasty provides the most predictable results. ⋯ It has low morbidity and does not preclude future reconstructive procedures. Although long-term success is difficult to predict, certain patient variables are associated with a better outcome: normal limb alignment, history of mechanical symptoms, minimal radiographic signs of degeneration, and short duration of symptoms. Long-term randomized prospective studies are needed to define the role of arthroscopy further in the older athlete with degenerative knee arthritis.
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One of the greatest challenges when examining an injured athlete is ensuring that the examination encompasses the whole patient and not just the obvious deformity. Bony injuries of the wrist, forearm, and elbow are uncommon in athletes and when present should always lead to suspicion of possible concomitant soft tissue injury. ⋯ Appropriate expectations with regard to both treatment and the possible return to sports are critical in providing successful treatment for these often complex injuries. There is no substitute for a careful clinical history and physical examination in not only establishing the diagnosis but ensuring that a complete diagnosis with its subsequent prognostic outcome can be rendered.
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Strong statements regarding the efficacy of anti-inflammatory medication are based primarily on experience with rheumatic disease. Such experience, over 32 years, involving more than 400,000 injections in more than 12,000 patients, has led Hollander and associates to conclude that "no other form of treatment for arthritis has given such consistent local symptomatic relief in so many for so long with so few harmful effects." Such endorsement has not been clearly transferrable to sports medicine experience. Anti-inflammatory medications can unquestionably affect excessive inflammation. ⋯ Increasing knowledge of the pathobiology of sports injury and the various treatments required for complete recovery has led the experienced clinician to rely far less upon anti-inflammatory medication as a long-term solution. Nevertheless, until more biologically selective drugs become available, the judicious application of anti-inflammatory therapy remains a useful, albeit adjunctive therapy for sports injury. The successful clinical rationale is best arrived at not by random selection but by cautious individualized prescription.
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Upper extremity injuries in athletes cause pain, impairment of function, and time loss from sport participation. This article briefly discusses the epidemiology of elbow, forearm, and wrist injuries in various athletic endeavors. Included is an overview of the epidemiology of nerve dysfunction, tendon ruptures, fractures about the wrist and forearm, ligamentous injuries of the wrist, distal radioulnar joint injuries, and overuse injuries.
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In conclusion, the sports medicine specialist is able to use a spectrum of diagnostic, surgical, and rehabilitation techniques to identify etiologic factors and to choose optimal treatment regimens for patients with Achilles tendinitis or traumatic rupture. Correction of pathomechanic factors, anatomic restoration, and aggressive postoperative rehabilitation allows an early return to sport without significant loss of strength or mobility.