Clinics in sports medicine
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This article summarizes both the various techniques for an open subpectoral biceps tenodesis as well as the biomechanics associated with these procedures. It provides information regarding the indications and contraindications to support the surgeon's decision. ⋯ A short summary of the recent literature regarding potential complications is included to provide further insight on this technique. The open subpectoral tenodesis of the long head of the biceps is a safe and reproducible technique with a low complication rate for patients with pathologies of the proximal biceps.
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The long head of biceps tendon (LHBT) is a well-recognized cause of anterior shoulder pain. Tenotomy or tenodesis of the LHBT is an effective surgical solution for relieving pain arising from the LHBT. Cosmetic deformity of the arm, cramping or soreness in the biceps muscle, and strength deficits in elbow flexion and supination are the three most common adverse events associated with tenotomy of the LHBT. Complications associated with tenodesis of the LHBT include loss of fixation resulting in cosmetic deformity, residual groove pain, pain or soreness in the biceps muscle, infection, stiffness, hematoma, neurologic injury, vascular injury, proximal humerus fracture, and reflex sympathetic dystrophy.
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This article presents an overview of the legal and ethical issues in the cardiovascular care of elite athletes. An important distinction between the assessment and care of elite athletes and the general population necessitates an understanding of the applicable legal standard and the limitation of potential exposures. Important recommendations and pertinent case law is presented that can assist the medical provider in comprehending important considerations with regard to preparticipation evaluations, return-to-play decisions, and second opinions in elite athletes.
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Scaphoid fractures are the most common carpal bone fracture, usually occurring in young men, although the incidence in women has increased over the past decade. Snuffbox tenderness and/or pain with axial loading of the thumb should be treated as a scaphoid fracture until proved otherwise and the diagnosis confirmed with serial radiographs and/or advanced imaging. ⋯ Nondisplaced fractures have high union rates with cast treatment, but require extended periods of immobilization. Consideration may be given to operative fixation of these fractures to allow early return to sport.
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CECS is a common source of lower extremity disability among young athletic cohorts and military personnel. The five cardinal symptoms are pain, tightness, cramps, weakness, and diminished sensation. History and clinical examination remain the hallmarks for identifying CECS, although ICP measurements during exercise stress testing may be used to confirm diagnosis. ⋯ When conservative measures have failed, operative management may be considered with fascial release of all affected compartments. Although clinical success has been documented in civilian cohorts, the results of surgical treatment in military service members have been far less reliable. Only approximately half of the military service members experience complete resolution of symptoms and at least 25% are unable to return to full duty.