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Shoulder injuries in sports
Case reports
497
dorsal (Inoue and Maeda, 1990). Of the cases previously reported, five were anterior as in our patient. Carpal fractures and dislocations are particularly rare in children. The only such injury previously described was a transscaphoid perilunate dislocation in a lo-year-old boy (Peiro et al., 1981). In adults the majority of cases were rapidly diagnosed and a closed reduction under general anaesthesia easily achieved. Delay in diagnosis makes this procedure impossible and an open reduction is necessary (Amamilo et necrosis does not appear to be a al., 1985). Avascular problem (Thomas, 1977). Dislocation of the scaphoid in a child is an extremely rare event. In this case the diagnosis was missed originally, not surprisingly in view of the rarity and unusual method of injury. Open reduction has resulted in a good recovery and functional result. Figure 4. Radiograph Kirschner wire.
showing
reduction
of the fracture using a
an intact scaphoid lying outside the w-&t joint capsule. There was a hinge of soft tissue attached to the scaphoid. The defect in the joint capsule was enlarged and the scaphoid reduced and held by a Kirschner wire through the distal radius across the scaphoid and into the capitate (Figure4). Postoperative progress was uncomplicated and the K-wire was removed 1 month later. She has subsequently been reviewed on a regular basis and has continued to make good progress. Now, I year after the injury, she has a full range of movement in her wrist and is only troubled if someone pulls her hand. Radiographs show that a satisfactory reduction has been maintained.
Discussion
References Amamilo S. C., Uppal R. and Samuel A. W. (1985) Isolated dislocation of capral scaphoid. J Hand 5~. IOB, 385. Inoue G. and Maeda N. (1990)Isolated dorsal dislocation of the scaphoid. J. Bone Joint Surg. MB, 368. Peiro A., Martos F., Mut T. et al. (1981) Trans-scaphoid perilunate dislocation in a child. Ada Orhop. Scmd, 5~31. Thomas H. 0. (1977) Isolated dislocation of the carpal scaphoid. Acta Orthop.!bnd. 48,369.
Paper accepted 22 January 1993.
A total of 13 cases of scaphoid dislocation has been reported in the literature since 1930. All cases involved male adult patients. Excluding rotational subluxations, true dislocations have been classified into three groups, anterior, radial and
Requests for reprints should be addressed to: Miss Gillian Bryce,
Book reviews Shoulder Injuries in Sports P. J. Marone. Martin Ltd. I 85317095 X. f39.95.1992,163pp.
Dunitz
The title of this book excited me. Here at last was a book to unravel the mysteries, to explain the subtelties and to rationalize the many guises of sports injuries of the shoulder. Not so. I was disappointed. The publishers should be praised for a beautiful production. This is a splendidly presented, hard cover, relatively thin book with some excellent radiographic reproductions. At f39.95 it is good value. However, the contents are not so good. There are basic chapters on anatomy, biomechanics, examination, investigations and an overview followed by chapters on each part of the shoulder complex and finishing with neurological problems, vascular lesions and rehabilitation. One would expect this to be a comprehensive covering of the whole subject but at most levels it is incomplete; a difficulty is knowing for whom the book is intended; for orthopaedic surgeons it is too simple and superficial, especially the anatomy and biomechanics, and for sports coaches it is too detailed. This may be a biased European view, but I suspect that most European surgeons will not find it useful; a better title would be ‘Shoulder Injuries in North American Sports’. The chapter entitled The Shoulder in throwing sports’ is really a mini-chapter on
pitching. The Olympic throwing sports of the shot, javelin and hammer are not mentioned. Elsewhere the subject of throwing predominates and it is difficult to find mention of other sports in which the shoulder is frequently injured, e.g. rowing and crosscountry skiing, potent sources of overuse injuries. There are some interesting and possibly esoteric facts which were new to me. I was not aware of trap-shooter’s shoulder (stress fracture of the coracoid), how the coracoid could be fractured in a baseball pitcher, or of Bennett’s lesion (of the shoulder), although I found the latter unconvincing and as there was no reference to it I am still unconvinced. SLAP lesions are described with some helpful diagrams but no causation or symptoms are given, only the treatment. On the other hand there are conditions which do not need to be mentioned in a text on sports injuries, e.g. cervical cord neurapraxia, transient quadriplegia and the quadrilateral space syndrome. Effort thrombosis is perhaps appropriate, although I was surprised to learn that 12 per cent give rise to pulmonary eml;olism; again this is not referenced so it is difficult to check. It is interesting to read because of some interesting factors, but overall it is not a complete and comprehensive coverage of injuries of the shoulder in sport and I cannot recommend it for the libraries of European surgeons. Nigel Tubbs
497
dorsal (Inoue and Maeda, 1990). Of the cases previously reported, five were anterior as in our patient. Carpal fractures and dislocations are particularly rare in children. The only such injury previously described was a transscaphoid perilunate dislocation in a lo-year-old boy (Peiro et al., 1981). In adults the majority of cases were rapidly diagnosed and a closed reduction under general anaesthesia easily achieved. Delay in diagnosis makes this procedure impossible and an open reduction is necessary (Amamilo et necrosis does not appear to be a al., 1985). Avascular problem (Thomas, 1977). Dislocation of the scaphoid in a child is an extremely rare event. In this case the diagnosis was missed originally, not surprisingly in view of the rarity and unusual method of injury. Open reduction has resulted in a good recovery and functional result. Figure 4. Radiograph Kirschner wire.
showing
reduction
of the fracture using a
an intact scaphoid lying outside the w-&t joint capsule. There was a hinge of soft tissue attached to the scaphoid. The defect in the joint capsule was enlarged and the scaphoid reduced and held by a Kirschner wire through the distal radius across the scaphoid and into the capitate (Figure4). Postoperative progress was uncomplicated and the K-wire was removed 1 month later. She has subsequently been reviewed on a regular basis and has continued to make good progress. Now, I year after the injury, she has a full range of movement in her wrist and is only troubled if someone pulls her hand. Radiographs show that a satisfactory reduction has been maintained.
Discussion
References Amamilo S. C., Uppal R. and Samuel A. W. (1985) Isolated dislocation of capral scaphoid. J Hand 5~. IOB, 385. Inoue G. and Maeda N. (1990)Isolated dorsal dislocation of the scaphoid. J. Bone Joint Surg. MB, 368. Peiro A., Martos F., Mut T. et al. (1981) Trans-scaphoid perilunate dislocation in a child. Ada Orhop. Scmd, 5~31. Thomas H. 0. (1977) Isolated dislocation of the carpal scaphoid. Acta Orthop.!bnd. 48,369.
Paper accepted 22 January 1993.
A total of 13 cases of scaphoid dislocation has been reported in the literature since 1930. All cases involved male adult patients. Excluding rotational subluxations, true dislocations have been classified into three groups, anterior, radial and
Requests for reprints should be addressed to: Miss Gillian Bryce,
Book reviews Shoulder Injuries in Sports P. J. Marone. Martin Ltd. I 85317095 X. f39.95.1992,163pp.
Dunitz
The title of this book excited me. Here at last was a book to unravel the mysteries, to explain the subtelties and to rationalize the many guises of sports injuries of the shoulder. Not so. I was disappointed. The publishers should be praised for a beautiful production. This is a splendidly presented, hard cover, relatively thin book with some excellent radiographic reproductions. At f39.95 it is good value. However, the contents are not so good. There are basic chapters on anatomy, biomechanics, examination, investigations and an overview followed by chapters on each part of the shoulder complex and finishing with neurological problems, vascular lesions and rehabilitation. One would expect this to be a comprehensive covering of the whole subject but at most levels it is incomplete; a difficulty is knowing for whom the book is intended; for orthopaedic surgeons it is too simple and superficial, especially the anatomy and biomechanics, and for sports coaches it is too detailed. This may be a biased European view, but I suspect that most European surgeons will not find it useful; a better title would be ‘Shoulder Injuries in North American Sports’. The chapter entitled The Shoulder in throwing sports’ is really a mini-chapter on
pitching. The Olympic throwing sports of the shot, javelin and hammer are not mentioned. Elsewhere the subject of throwing predominates and it is difficult to find mention of other sports in which the shoulder is frequently injured, e.g. rowing and crosscountry skiing, potent sources of overuse injuries. There are some interesting and possibly esoteric facts which were new to me. I was not aware of trap-shooter’s shoulder (stress fracture of the coracoid), how the coracoid could be fractured in a baseball pitcher, or of Bennett’s lesion (of the shoulder), although I found the latter unconvincing and as there was no reference to it I am still unconvinced. SLAP lesions are described with some helpful diagrams but no causation or symptoms are given, only the treatment. On the other hand there are conditions which do not need to be mentioned in a text on sports injuries, e.g. cervical cord neurapraxia, transient quadriplegia and the quadrilateral space syndrome. Effort thrombosis is perhaps appropriate, although I was surprised to learn that 12 per cent give rise to pulmonary eml;olism; again this is not referenced so it is difficult to check. It is interesting to read because of some interesting factors, but overall it is not a complete and comprehensive coverage of injuries of the shoulder in sport and I cannot recommend it for the libraries of European surgeons. Nigel Tubbs