Clinics in sports medicine
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Near-drowning and immersion hypothermia are important, preventable causes of mortality and morbidity. The most important consequences of an immersion accident are hypoxia and its effects on the cardiovascular system and the CNS. The mammalian diving reflex and hypothermia may offer some protection to the CNS despite prolonged hypoxia. ⋯ The presence of immersion hypothermia must be recognized. Hypothermic patients should be managed according to the severity and the duration of hypothermia. Active external rewarming is adequate for acute and mild hypothermia, whereas active core rewarming may be necessary for chronic and severe hypothermia.
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A comprehensive physical examination of the patellofemoral joint and the entire lower extremity is often required to detect some of the more subtle extensor mechanism disorders. The standing, sitting, and supine examinations of the patient with patellar complaints are presented. In addition, the various radiographic techniques available to evaluate the patellofemoral joint are reviewed.
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Traumatic injuries of the acromioclavicular and sternoclavicular joints are discussed. Treatment of acromioclavicular trauma is symptomatic, except for type III injuries with marked prominence of the clavicle, for which open reduction and internal fixation are recommended. Sternoclavicular injury with no instability requires only symptomatic treatment; acute dislocations should be reduced.