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Shoulder injury in professional surfers
Thursday 1 November Posters / Journal of Science and Medicine in Sport 15 (2012) S127–S187
outcomes. Demineralized bone matrix (DBM) is known for its osteoinductive and osteoconductive properties. This study tested the hypothesis that DBM administered to the bone bed prior to the reattachment of the tendon, will result in enhanced tissue morphology that more closely resembles that of a normal enthesis using an ovine rotator cuff model. Methods: Following ethics approval, 10 adult wethers (18 months) were randomly allocated to control, n = 4 (without DBM) or DBM, n = 6 (DBM administered to bone bed) groups. The infraspinatus tendon was detached from its insertion and repaired in a transosseous equivalent fashion using PEEK suture anchors in an established model. Ovine DBM that was prepared using a modified Urist protocol was injected into the bony tendon footprint. Animals were culled at 4 weeks following surgery and processed for tissue histology and micro-computed tomography (CT) endpoints. Results: No infection or tendon detachment following repair was noted in either group. 3D reconstructed images of CT scans verified correct DBM and suture anchor placement. Histological images demonstrated distinct differences in tissue morphology between the two groups; however there was no evidence of the four-zoned structure characteristic of a healthy tendon-bone insertion, in any specimens. In the control group specimens, the tendon midsubstance was highly disorganized with randomly arranged collagen fibres. Diminutive areas of fibrocartilage were noted. In the treatment group, large regions between tendon and bone were occupied by fibrocartilage. Fibrocartilage was organized and chondrocytes were orientated in the direction of the insertional collagen fibres. Organized collagen fibre orientation within the tendon midsubstance was observed, though this was not consistent throughout all the specimens. DBM particles were resorbed and trabecular bone occupied the DBM holes. The PEEK anchors were all well integrated and fixed. Discussion: This study showed that DBM augmented tendon to bone repair leads to increased amounts of fibrocartilage between the repaired tendon and underlying bone. This results in improved organization which more closely resembles the morphology of the normal enthesis. Introduction of osteoinductive DBM at the tendon-bone interface during surgery may reduce failure rates associated with rotator cuff repair and improve clinical outcomes. http://dx.doi.org/10.1016/j.jsams.2012.11.335 333 Shoulder injury in professional surfers A. McBride 1,∗ , J. Fisher 2 1 2
Gold Coast Hospital Hobart Private Hospital
Introduction: Shoulder pain and injury is a common problem in both recreation and competitive surfing. A survey of 451 surfers conducted by Nathanson et al. found that musculoskeletal strains were the most common chronic surfing injury accounting for 59% of all cases. Among musculoskeletal strains, the shoulder (27%) was the most common joint affected. This study aimed to examine the incidence of shoulder injury in a group of professional surfers that qualified for the World Championship Tour. Methods: Fifteen athletes were examined over the first two days of competition of a world tour event. Athletes were asked whether they had a past history of shoulder injury or pain. Both the left and right shoulders were assessed on all athletes for range of motion, strength, scapula winging, shoulder impingement and instability. Results: Six out of thirty athletes reported a past history of shoulder injury on a total of eight shoulders. There was one case of
S139
anterior shoulder dislocation, four cases of shoulder tendonitis and three cases of impingement. The average range of shoulder internal rotation was 48.83 degrees, external rotation was 90.16 degrees. All shoulders had full range of motion of abduction in the scapula plane and no surfers reported a painful arc through range. Eight of the thirty shoulders examined had winging of the scapula during shoulder abduction. Two patients had active signs of external impingment as evident by a positive Hawkins Kennedy Test and Neer’s test. Three of the thirty shoulders had grade one anterior instability on clinical examination. Discussion: This was a small cross sectional study which demonstrated the incidence of shoulder injury in a group of professional surfers. The overall incidence of injury was 28%. Further studies performed on a larger population of surfers are required to further clarify the incidence of injury and identify risk factors for injury in this population. http://dx.doi.org/10.1016/j.jsams.2012.11.336 334 Recommendations for a golf conditioning program based on examination and golf swing analysis–A case series A. McHardy ∗ Synergy Healthcare Introduction: Given the popularity of golf in the senior age groups (over 50 years as determined by golfing associations) and the complex movement patterns required for the golf swing, tailored exercise and treatment programs for individuals based on their physical capabilities are required for both injury prevention and performance enhancement. Methods: A history and orthopaedic physical examination is performed on the golfer, a 9 point physical swing assessment highlighting areas of concern, and a tailored physical fitness program is developed for improved results. At each point the physical positioning of each part of the body is assessed, with comments made on areas of concern. These recommendations are designed to help the golfer reduce the risk of developing a golf injury. This assessment is designed to highlight the stresses and strains being placed on the body and make suggestions to prevent these, and Identify inefficiencies in the use of the body that might be impacting the effectiveness of the swing. Results: Five golfers, all male and aged between 35 and 70 years were assessed by a golf injury specialist (Doctorate on golf injuries) and recommendations were made based on the findings of golf swing video analysis and physical examination. Recommendations included treatment to improve joint function, and muscular hypertonicity (soft tissue therapy, stretches, mobilisations/manipulations) as well as specific conditioning exercises designed to strengthen tissue under increased stress during the golf swing. Specifically, one golfer was devised a treatment program aimed at improving function/range in restricted motions. Specifically neck and shoulder motion dysfunction and Improving lower limb soft tissue tightness through deep soft tissue massage therapy. Exercises specific for his golf swing included Wall squats to Strengthen quadriceps muscles and quadraped exercises to strengthen gluteal muscles. Conclusions: Whilst a general golf conditioning program can aid some golfers, a program matched to the individual requirements of a golfer in terms of their physical limitations/capabilities and their individual golf swing will provide optimal benefit. Not only can such a program improve compliance as the individual knows that the program is structured with them in mind, it can reduce the risk
outcomes. Demineralized bone matrix (DBM) is known for its osteoinductive and osteoconductive properties. This study tested the hypothesis that DBM administered to the bone bed prior to the reattachment of the tendon, will result in enhanced tissue morphology that more closely resembles that of a normal enthesis using an ovine rotator cuff model. Methods: Following ethics approval, 10 adult wethers (18 months) were randomly allocated to control, n = 4 (without DBM) or DBM, n = 6 (DBM administered to bone bed) groups. The infraspinatus tendon was detached from its insertion and repaired in a transosseous equivalent fashion using PEEK suture anchors in an established model. Ovine DBM that was prepared using a modified Urist protocol was injected into the bony tendon footprint. Animals were culled at 4 weeks following surgery and processed for tissue histology and micro-computed tomography (CT) endpoints. Results: No infection or tendon detachment following repair was noted in either group. 3D reconstructed images of CT scans verified correct DBM and suture anchor placement. Histological images demonstrated distinct differences in tissue morphology between the two groups; however there was no evidence of the four-zoned structure characteristic of a healthy tendon-bone insertion, in any specimens. In the control group specimens, the tendon midsubstance was highly disorganized with randomly arranged collagen fibres. Diminutive areas of fibrocartilage were noted. In the treatment group, large regions between tendon and bone were occupied by fibrocartilage. Fibrocartilage was organized and chondrocytes were orientated in the direction of the insertional collagen fibres. Organized collagen fibre orientation within the tendon midsubstance was observed, though this was not consistent throughout all the specimens. DBM particles were resorbed and trabecular bone occupied the DBM holes. The PEEK anchors were all well integrated and fixed. Discussion: This study showed that DBM augmented tendon to bone repair leads to increased amounts of fibrocartilage between the repaired tendon and underlying bone. This results in improved organization which more closely resembles the morphology of the normal enthesis. Introduction of osteoinductive DBM at the tendon-bone interface during surgery may reduce failure rates associated with rotator cuff repair and improve clinical outcomes. http://dx.doi.org/10.1016/j.jsams.2012.11.335 333 Shoulder injury in professional surfers A. McBride 1,∗ , J. Fisher 2 1 2
Gold Coast Hospital Hobart Private Hospital
Introduction: Shoulder pain and injury is a common problem in both recreation and competitive surfing. A survey of 451 surfers conducted by Nathanson et al. found that musculoskeletal strains were the most common chronic surfing injury accounting for 59% of all cases. Among musculoskeletal strains, the shoulder (27%) was the most common joint affected. This study aimed to examine the incidence of shoulder injury in a group of professional surfers that qualified for the World Championship Tour. Methods: Fifteen athletes were examined over the first two days of competition of a world tour event. Athletes were asked whether they had a past history of shoulder injury or pain. Both the left and right shoulders were assessed on all athletes for range of motion, strength, scapula winging, shoulder impingement and instability. Results: Six out of thirty athletes reported a past history of shoulder injury on a total of eight shoulders. There was one case of
S139
anterior shoulder dislocation, four cases of shoulder tendonitis and three cases of impingement. The average range of shoulder internal rotation was 48.83 degrees, external rotation was 90.16 degrees. All shoulders had full range of motion of abduction in the scapula plane and no surfers reported a painful arc through range. Eight of the thirty shoulders examined had winging of the scapula during shoulder abduction. Two patients had active signs of external impingment as evident by a positive Hawkins Kennedy Test and Neer’s test. Three of the thirty shoulders had grade one anterior instability on clinical examination. Discussion: This was a small cross sectional study which demonstrated the incidence of shoulder injury in a group of professional surfers. The overall incidence of injury was 28%. Further studies performed on a larger population of surfers are required to further clarify the incidence of injury and identify risk factors for injury in this population. http://dx.doi.org/10.1016/j.jsams.2012.11.336 334 Recommendations for a golf conditioning program based on examination and golf swing analysis–A case series A. McHardy ∗ Synergy Healthcare Introduction: Given the popularity of golf in the senior age groups (over 50 years as determined by golfing associations) and the complex movement patterns required for the golf swing, tailored exercise and treatment programs for individuals based on their physical capabilities are required for both injury prevention and performance enhancement. Methods: A history and orthopaedic physical examination is performed on the golfer, a 9 point physical swing assessment highlighting areas of concern, and a tailored physical fitness program is developed for improved results. At each point the physical positioning of each part of the body is assessed, with comments made on areas of concern. These recommendations are designed to help the golfer reduce the risk of developing a golf injury. This assessment is designed to highlight the stresses and strains being placed on the body and make suggestions to prevent these, and Identify inefficiencies in the use of the body that might be impacting the effectiveness of the swing. Results: Five golfers, all male and aged between 35 and 70 years were assessed by a golf injury specialist (Doctorate on golf injuries) and recommendations were made based on the findings of golf swing video analysis and physical examination. Recommendations included treatment to improve joint function, and muscular hypertonicity (soft tissue therapy, stretches, mobilisations/manipulations) as well as specific conditioning exercises designed to strengthen tissue under increased stress during the golf swing. Specifically, one golfer was devised a treatment program aimed at improving function/range in restricted motions. Specifically neck and shoulder motion dysfunction and Improving lower limb soft tissue tightness through deep soft tissue massage therapy. Exercises specific for his golf swing included Wall squats to Strengthen quadriceps muscles and quadraped exercises to strengthen gluteal muscles. Conclusions: Whilst a general golf conditioning program can aid some golfers, a program matched to the individual requirements of a golfer in terms of their physical limitations/capabilities and their individual golf swing will provide optimal benefit. Not only can such a program improve compliance as the individual knows that the program is structured with them in mind, it can reduce the risk