Sean Gallagher's Profile

back pain is reported by approximately 30% of athletes

11% of gymnasts and 50% of football lineme

Several risk factors for lumbar injury and back pain have been described for athletes: prior back injury, decreased range of motion, poor conditioning, excessive or repetitive loading, improper play technique, and abrupt increases in trainin

history of prior lumbar spine injury was found to be the most significant predictor of further lumbar injur

risk of injury in the following year three times greater

among girls, significant predictors included decreased lower lumbar range of motion, low maximal lumbar extension, and high body weight

participation in sports and low maximal lumbar flexion were predictive of low back pa

authors of another study of top athletes from several different sports found no relationship between mobility in the lumbar spine and back pain

outer third of the anulus is innervated; the inner two thirds and nucleus are not.⁹ This innervation primarily comes from the sinuvertebral nerve

formed by branches of the somatic ventral rami and autonomic gray ramus communicans

both nociceptive (capable of transmitting pain) and proprioceptive stimuli can be detected

intensity

a cohort of athletes of varied types studied as part of the Northeast Collaborative Group on Low Back Pain failed to show an increased incidence of cervical or lumbar disk herniation in athletes compared with the general population

improves with lying supine

radicular symptoms. Pain generally worsens with flexion or performance of the Valsalva maneuver

most common levels for disk herniation are at L4-5 and L5-S1; together, these two levels account for 90% of symptomatic disk herniations.

plain radiographs can be useful to assess disk height and segmental stability. MRI is the study of choice to define disk anatomy and neural element compression

The patient with acute disk herniation requires rest for a period of several weeks. This should be accompanied by oral anti-inflammatory medication to decrease the degree of nerve root irritation

corticosteroid dose pack to decrease swelling and reduce inflammation may be considered when symptoms warrant.

As symptoms improve, physical therapy with an emphasis on truncal strengthening is generally advocated.

most symptoms gradually resolve. This reduction in pain is associated with disk resorption and decreased root irritation

increased incidence in disk degeneration in professional volleyball players compared with professional swimmers,

impact activities may accelerate this process

initial phase of segmental dysfunction, pain emanates from the facets (synovitis) or the intervertebral disk (circumferential or radial annular tears). This can be associated with muscle spasm and limitation of mobility

second phase, instability is observed because of reduced functionality of the anulus and laxity of the facet capsules

Pain that worsens with flexion activities and improves with extension is characteristic, similar to early annular disk injuries

Treatment of discogenic back pain in the athlete is primarily nonsurgical

use of lumbosacral corsets or orthoses for discogenic back pain is not conclusively supported in the literature.

examining the use of the Boston brace in adolescent athletes, Micheli et al²⁶ found bracing treatment to be beneficial in 50% of the patients with discogenic back pain

Fredrickson et al²⁹ reported the incidence of spondylolisthesis to be 4.4% at age 6 years and 6% in adults. Although spondylolysis is asymptomatic in most patients, some authors have reported long-term pain in as many as 13% of cases

Most bilateral pars defects (85% to 95% of cases) occur at L5, with a smaller percentage at L4.

gymnasts or football linemen, appear to be predisposed

classic gait seen in patients with spondylolysis and spondylolisthesis is described as "stiff-legged," in which stride length is shortened secondary to hamstring spasm and limitation in forward flexion

neutral to 5 degrees of ulnar deviation is preferred

no differences found in the stability of the standard 3.5-mm plate and the precontoured low-profile plates.

precontoured low-contact plates through a dorsal approach to the wrist. In the absence of these plates, an eight-hole or nine-hole, 3.5-mm reconstruction or dynamic compression plate can be used. In this case, the plate must be contoured intraoperatively to fit the dorsal wrist.

curvilinear skin incision beginning 2 cm and extending in an ulnar direction over the distal radioulnar joint and ending over the midshafts of the second and third metacarpals

Make an I-shaped incision in the capsule, crossing proximally over the radiocarpal joint and distally over the carpometacarpal joints

Using an osteotome, remove Lister's tubercle and the dorsal cortices of the carpal bones to allow flat apposition of the precontoured plate

A 3.5-mm cortex lag screw may be placed through the radial styloid into the capitate to pull the carpus against the radial styloid and help prevent impingement of the distal radioulnar joint

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