The ‘Cruciform Test’: A diagnostic tool to detect pectoralis major rupture

2021 ◽  
pp. 175857322110584
Author(s):  
Timothy E Cobb ◽  
Susan Alexander ◽  
Andy P Reynolds ◽  
Andrew L Wallace
Keyword(s):  
Diagnostic Tool ◽  
Surgical Repair ◽  
Surgical Intervention ◽  
Current Treatment ◽  
Pectoralis Major ◽  
Return To Play ◽  
Previous Level ◽  
And Function ◽  
Method Of Assessment

Introduction Pectoralis major (PM) rupture is a severe injury that untreated can lead to a profound functional deficit. Early surgical repair can greatly improve outcomes and give a more predictable timetable for recovery, making this the goal of current treatment. Surgical intervention is also essential to return professional athletes to their previous level of competition. However, there is no single, reliable and easily reproducible test that can be used to establish the diagnosis. We describe ‘The Cruciform Test’; a method of identifying PM rupture that can be used for initial diagnosis either in clinic or a pitch-side environment, or to assess restoration of normal anatomy and function post-operatively. Methods We studied a series of 14 patients who underwent open PM repair in order to evaluate this method of assessment. Results All patients had a positive test pre-operatively. 5 were formally tested at post-operative follow-up and all had a negative result. Discussion The Cruciform Test is a simple and reproducible diagnostic tool that has potential as a clinical indicator of both PM rupture and successful repair. It can therefore contribute to earlier diagnosis, prompt surgical intervention and facilitate return to play at the earliest opportunity.

scholarly journals Long term outcomes for adults with complete atrioventricular septal defects

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S Seitler ◽  
N Al-Sakini ◽  
A Lacerna ◽  
C Flick ◽  
C West ◽  
...  
Keyword(s):  
Heart Block ◽  
Surgical Repair ◽  
Surgical Intervention ◽  
Systolic Dysfunction ◽  
Ventricular Outflow Tract ◽  
Outflow Tract ◽  
Ventricular Systolic Dysfunction ◽  
Long Term Outcomes

Abstract Background/Introduction Complete Atrio-Ventricular septal defect (AVSD) is a complex congenital cardiac disease, characterised by malformation at the atrio-ventricular junction and AV valve abnormalities. Long- term outcome data is limited. Purpose We sought to describe the long-term outcomes of adults with repaired complete AVSD in a tertiary adult congenital heart centre. Methods We retrospectively recruited patients with complete AVSD who underwent surgical repair between 1973 and 2001 in our centre. All clinical and echocardiographic data were collected and analysed for evidence of atrio-ventricular valve (AVV) deterioration, or cardiac dysfunction. We also assessed for the requirement for further surgical intervention throughout the follow up period. Results A total of 345 patients with AVSD were identified, partial AVSD 211, unrepaired 82. Fifty-two with repaired complete AVSD formed study group, female 36 (69%) and male 16 (31%), Trisomy 21 (23, 44%). Mean age at initial repair was 44 months (median 12, IQR 31.5). Mean follow up was 25.3 years (Median 24, IQR 9.75). Clinical status: At the latest follow-up, most patient were asymptomatic with NYHA I-II (n=46) Majority (n=36, 69%) required only initial repair and no further intervention. Further surgeries were performed in 16 patients including AVV repair (n=9) and LVOTO relief (n=3). Permanent pacemaker insertion needed in 6 (12%), all for heart block following valve repair. 7 patients (14%) had documented arrythmia, 4 (8%) requiring ablations and only 1 had endocarditis. Echo findings: AV Valve dysfunction was more commonly regurgitant rather than stenotic. More than moderate AVV regurgitation was present in 83% of patients, Left AVV (n=25, 48%), Right AVV (n=18, 35%) compared to 4% stenosis (LAVV n=1, RAVV n=1). Ventricular outflow tract obstruction was present in 8% of patients, RVOT obstruction (2, one native, one secondary to prior banding), LVOT obstruction (2, both native, one requiring surgical intervention). Right ventricular systolic dysfunction was present in 6% of patients (n=3), with mean TAPSE 14.1mm (SD± 3.1mm). Left ventricular dysfunction was present in 4% (n=2), mean LVEF 58.9% (SD±7.1%) and mean LV EDVi 55.06mL/m2 (SD±13.2 mL/m2). Only one patient had significant pulmonary hypertension (Mean PAP 48 mmHg). Conclusion Long-term outcomes of surgically repaired AVSD are highly favourable. Left AVV regurgitation is the most common residual lesion requiring further surgical intervention. Ventricular outflow tract obstruction was much less common, as was ventricular systolic dysfunction. Complete heart block was associated with surgical repair and arrhythmias were potential late complications. FUNDunding Acknowledgement Type of funding sources: None.

Slide Tracheoplasty in the Management of Congenital Tracheal Stenosis

1997 ◽  
Vol 106 (11) ◽  
pp. 914-919 ◽  
Author(s):  
Steven H. Dayan ◽  
Michael E. Dunham ◽  
Constantine Mavroudis ◽  
Carl L. Backer ◽  
Lauren D. Holinger
Keyword(s):  
Early Diagnosis ◽  
Tracheal Stenosis ◽  
Surgical Repair ◽  
Surgical Intervention ◽  
Rare Condition ◽  
Pericardial Patch ◽  
Congenital Tracheal Stenosis ◽  
Slide Tracheoplasty ◽  
Lost To Follow Up

Long-segment congenital tracheal stenosis (LSCTS) is a rare condition. Originally, it was felt to be uniformly fatal; however, advances in technique have made surgical repair and survival possible. Our objective is to report results and technique of slide tracheoplasty for the treatment of LSCTS in the context of the overall experience at the Children's Memorial Hospital in Chicago. We reviewed 37 cases of infants and children with LSCTS. Thirty of the 37 infants underwent surgical intervention. Slide tracheoplasty resulted in survival in 1 of 2 infants, and pericardial patch tracheoplasty resulted in survival in 21 of 28 (75%). Of the 30 patients who had surgical repair, 7 (23%) have died, and 1 has been lost to follow-up (3%). Follow-up has ranged from 6 months to 13 years. Slide tracheoplasty is a satisfactory adjunct to existing techniques. With early diagnosis and appropriate management of LSCTS, survival is possible in a majority of patients.

Adult Aortotracheal Fistula as Sequela of Double Aortic Arch Repair in Infancy: A Case Report

2020 ◽  
Vol 129 (7) ◽  
pp. 649-652
Author(s):  
Andrew B. Rees ◽  
Jennifer P. Rodney ◽  
Mark R. Gilbert ◽  
Clayton A. Kaiser ◽  
Alexander H. Gelbard
Keyword(s):  
Aortic Arch ◽  
Digeorge Syndrome ◽  
Surgical Repair ◽  
Surgical Intervention ◽  
Vascular Ring ◽  
Clinical History ◽  
Double Aortic Arch ◽  
Aortic Arch Repair ◽  
Early Surgical Intervention

Introduction: Double aortic arch is a rare congenital malformation of the aortic arch that most frequently presents in childhood. Early surgical intervention typically yields excellent outcomes. Objectives: To describe aortotracheal fistula as a rare, yet serious complication of vascular ring and subsequent aortic aneurysm in an adult patient. Methods: Clinical history, as well as radiographic and endoscopic imaging were obtained to describe the development, diagnosis, and clinical course of this patient’s aortotracheal fistula. Additionally, follow up data was obtained to document the healing of this fistula after surgical repair. Results: We describe a case of a 46-year-old male with DiGeorge Syndrome and a double aortic arch, repaired in childhood, which developed into an aortotracheal fistula after tracheostomy placement as an adult. Conclusions: This case demonstrates that dangerous complications of a double aortic arch can persist into adulthood, even after surgical repair in infancy. Each patient’s unique anatomy must be considered when thinking about airway management and prevention of complications of this rare congenital anomaly.

scholarly journals Early Return to Play With Thumb Spica Gauntlet Casting for Ulnar Collateral Ligament Injuries Complicated by Adjacent Joint Dislocations in Collegiate Football Linemen

Hand ◽  
2018 ◽  
Vol 15 (1) ◽  
pp. 92-96 ◽  
Author(s):  
Derek T. Bernstein ◽  
Patrick C. McCulloch ◽  
Leland A. Winston ◽  
Shari R. Liberman
Keyword(s):  
Surgical Repair ◽  
Return To Sport ◽  
Ulnar Collateral Ligament ◽  
Return To Play ◽  
Additional Stress ◽  
Collateral Ligament ◽  
Spica Casting ◽  
Joint Dislocations ◽  
The Mean

Background: Treatment of thumb ulnar collateral ligament (UCL) ruptures in elite athletes aims to restore thumb stability while minimizing lost playing time. Thus, surgical repair with early protected return to play in a thumb spica cast has been advocated. The purpose of this study was to document adjacent joint dislocations after primary surgical repair sustained during protected return to play with thumb spica casting in elite-level football players. Methods: Three Division I collegiate starting linemen sustaining adjacent joint dislocations in thumb spica casts following acute surgical repair of ipsilateral thumb UCL ruptures were retrospectively reviewed. Demographic data were recorded as well as the timeline for injury, treatment, and subsequent return to sport. Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores were obtained at final follow-up. Results: The mean time from thumb UCL injury to surgical repair was 8.7 days, and the mean return to sport was 13.3 days from surgery. There were 4 simple dislocations including 3 proximal interphalangeal (PIP) joints and 1 elbow. Each PIP dislocation was close reduced and treated with buddy straps with immediate return to play. The elbow dislocation was close reduced and splinted with return to play 22 days after injury. The mean QuickDASH score was 2.3 at 12 month follow-up. Conclusions: This report highlights that while thumb spica casting protects the surgically repaired thumb UCL and allows for earlier return to play, it risks placing additional stress upon adjacent joints and therefore adjacent injury. Appropriate counseling of the risks and benefits of this treatment strategy is essential.

Surgical repair of acute and chronic pectoralis major tendon rupture: clinical and ultrasound outcomes at a mean follow-up of 5 years

2014 ◽  
Vol 25 (1) ◽  
pp. 91-98 ◽  
Author(s):  
Giovanni Merolla ◽  
Paolo Paladini ◽  
Stefano Artiaco ◽  
Pierluigi Tos ◽  
Nicola Lollino ◽  
...  
Keyword(s):  
Tendon Rupture ◽  
Surgical Repair ◽  
Pectoralis Major

Pediatric Jaw Fractures: Indications for Open Reduction

1979 ◽  
Vol 87 (3) ◽  
pp. 318-322 ◽  
Author(s):  
Anthony S. Krausen ◽  
Martin Samuel
Keyword(s):  
Open Reduction ◽  
Surgical Intervention ◽  
Normal Anatomy ◽  
The Past ◽  
Fractures In Children ◽  
Dental Anatomy ◽  
Jaw Fractures ◽  
The One ◽  
And Function

Jaw fractures in children are generally managed without major surgical intervention. Closed reduction usually is sufficient to restore normal anatomy and function. The one inviolate principle is early treatment. During the past three years, four pediatric jaw fractures that required open reduction were treated. This mode of treatment was necessitated by the limitations imposed by pediatric dental anatomy and by the type of fractures encountered. In at least 24 months of follow-up, no dental problems have been seen.

Eighty-two per cent of male professional football (soccer) players return to play at the previous level two seasons after Achilles tendon rupture treated with surgical repair

2019 ◽  
Vol 54 (8) ◽  
pp. 480-486 ◽  
Author(s):  
Alberto Grassi ◽  
Guendalina Rossi ◽  
Pieter D'Hooghe ◽  
Randeep Aujla ◽  
Massimiliano Mosca ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Tendon Rupture ◽  
Surgical Repair ◽  
Achilles Tendon Rupture ◽  
Return To Play ◽  
Soccer Players ◽  
Football Players ◽  
The Public ◽  
Return To Competition

ObjectiveTo evaluate the time to return to playing following acute Achilles tendon rupture (ATR) and surgical repair in professional male football (soccer) players.MethodsProfessional male football (soccer) players who sustained an ATR and underwent surgical repair were identified through internet-based injury reports from January 2008 to August 2018. Only League 1 and 2 players with injuries who had at least 1 year of follow-up from the search date were included. Injury history and time to return to play were retrieved from the public platform transfermarkt.com. For athletes who competed for at least two seasons after returning to play, re-ruptures and number of matches played were reported.Results118 athletes (mean age 27.2±7.2 years) were included. 113 (96%) returned to unrestricted practice after a mean of 199±53 days, with faster recovery in players involved in national teams. Return to competition was after a mean of 274±114 days. In the 76 athletes with at least two seasons of follow-up, 14 (18%) did not compete at the pre-injury level during the two seasons following the index injury. Six players (8%) sustained a re-rupture within the first two seasons after return to play; four re-ruptures were in footballers who returned to play <180 days after injury. Age >30 years and re-ruptures had higher odds ratios of not returning to the same level of play.Conclusions96% of professional male football players who underwent surgery to repair an ATR returned to unrestricted practice and then competition after an average time of 7 and 9 months, respectively. However, 18% did not return to the same level of play within the two seasons following their return, with a higher risk in those experiencing a re-rupture.

scholarly journals Outcomes following surgical management of inguinal-related groin pain in athletes: a case series

2020 ◽  
Vol 7 (1) ◽  
pp. 103-108
Author(s):  
Michael Gerhardt ◽  
Josh Christiansen ◽  
Benjamin Sherman ◽  
Alejandro Miranda ◽  
William Hutchinson ◽  
...  
Keyword(s):  
Groin Pain ◽  
Surgical Intervention ◽  
Case Series ◽  
Return To Sport ◽  
Scar Tissue ◽  
Nerve Entrapment ◽  
Return To Play ◽  
Retrospective Case ◽  
Operative Findings

Abstract To determine the outcomes of a limited surgical intervention, consisting of neurolysis, inguinal wall repair and/or adductor debridement of adhesions based on intraoperative findings. Retrospective case series. Outpatient orthopedic/general surgery clinic. Fifty-one athletes treated surgically for inguinal-related groin pain from 2009 to 2015. Limited surgical intervention, consisting of neurolysis, inguinal wall repair and/or adductor debridement based on intra-operative findings. Ability to return to sport at the same level, time to return to play. Fifty-one athletes were included in the study with an average follow-up of 4.42 years (range 2.02–7.01). The average age was 24.2 years (range 16–49) and consisted of 94.0% males and 6.0% females. Nerve entrapment was demonstrated in 96.2% of cases with involvement of the ilioinguinal in 92.5%, the iliohypogastric in 30.8% and the genitofemoral in 13.2%. Attenuation of the posterior inguinal wall was present and repaired in 79.3% of cases. Scar tissue was present around the adductor origin and required debridement in 56.7% of cases. Forty-nine (96.1%) athletes returned to sport at the same level of play at an average of 5.9 weeks. Two athletes required a revision surgery. High rates of return to sport were achieved after surgery for inguinal-related groin pain that addresses the varying pathology and associated nerve entrapment.

Rehabilitation of a Cellist After Surgery for de Quervain’s Tenosynovitis and Intersection Syndrome

2003 ◽  
Vol 18 (3) ◽  
pp. 106-112
Author(s):  
Barbara S Robinson
Keyword(s):  
Physical Therapy ◽  
Surgical Intervention ◽  
Current Treatment ◽  
Therapeutic Exercise ◽  
Joint Mobilization ◽  
De Quervain’S Tenosynovitis ◽  
Previous Level ◽  
Computer Keyboard ◽  
Therapy Intervention ◽  
Intersection Syndrome

This article describes the physical therapy intervention for a musician after surgery for de Quervain’s tenosynovitis and intersection syndrome, and briefly reviews these two tendon conditions. The patient, an 18-year-old female cellist, initially presented with symptoms of de Quervain’s tenosynovitis, including marked fibrosis of the first dorsal compartment, to the extent that surgical intervention was required. Seven months after decompression of the first dorsal tunnel, the second dorsal compartment was surgically released secondary to intersection syndrome. Physical therapy included the use of therapeutic exercise, joint mobilization, scar mobilization, soft tissue massage, stretching, and physical agents. Patient education regarding activity modification, management of cello playing, and posture while playing the cello and using a computer keyboard was vital to successful rehabilitation. The musician was able to return to playing the cello at her previous level of performance, practicing and performing an average of 3 to 4 h/day. Conservative treatment intervention during the 10 months preceding the current treatment may have been unsuccessful due to the absence of activity modification.

scholarly journals Femur Fractures in Professional Athletes: A Case Series

2015 ◽  
Vol 50 (4) ◽  
pp. 442-448 ◽  
Author(s):  
Robby Sikka ◽  
Gary Fetzer ◽  
Thomas Hunkele ◽  
Eric Sugarman ◽  
Joel Boyd
Keyword(s):  
Case Series ◽  
Return To Sport ◽  
Return To Play ◽  
Professional Athletes ◽  
Retrograde Nailing ◽  
Retrograde Intramedullary Nail ◽  
Femur Fractures ◽  
Previous Level ◽  
Significant Injury

Objective To discuss return to play after femur fractures in several professional athletes. Background Femur fractures are rare injuries and can be associated with significant morbidity and mortality. No reports exist, to our knowledge, on return to play after treatment of isolated femur fractures in professional athletes. Return to play is expected in patients with femur fractures, but recovery can take more than 1 year, with an expected decrease in performance. Treatment Four professional athletes sustained isolated femur fractures during regular-season games. Two athletes played hockey, 1 played football, and 1 played baseball. Three players were treated with anterograde intramedullary nails, and 1 was treated with retrograde nailing. All players missed the remainder of the season. At an average of 9.5 months (range, 7–13 months) from the time of injury, all athletes were able to return to play. One player required the removal of painful hardware, which delayed his return to sport. Final radiographs revealed that all fractures were well healed. No athletes had subjective complaints or concerns that performance was affected by the injury at an average final follow-up of 25 months (range, 22–29 months). Uniqueness As the size and speed of players increase, on-field trauma may result in significant injury. All players returned to previous levels of performance or exceeded previous statistical performance levels. Conclusions In professional athletes, return to play from isolated femur fractures treated with either an anterograde or retrograde intramedullary nail is possible within 1 year. Return to the previous level of performance is possible, and it is important to develop management protocols, including rehabilitation guidelines, for such injuries. However, return to play may be delayed by subsequent procedures, including hardware removal.

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