– when testing gameskeeper thumb (UCL injuries) – you decide based on stress in FLEXION. In extension, the MCP is stabilized by the accessory collateral ligament and volar plate. In flexion, the MCP is stabilized by the UCL proper. 35 degrees of instability warrants surgery.
– the most sensitive thing in diagnosing medial collateral ligament injuries of the elbow is history and physical.
– for dorsal thumb MCP dislocations – reduce by dorsiflexing, applying traction, then flexing it over the MC head.
– fragmentation of the entire capitellar ossific nucleus is Panner's disease, not osteochondritis dessicans. It usually does pretty well. In pitchers who get this, they should be off pitching for rest and rehab.
– for the throwing athlete who gets some rotator cuff pathology – beware that they may have subtle anterior shoulder instability.
– the long thoracic nerve can be injured after hiking with a heavy backpack (compression injury) or weight training (traction).
– for the overhead athlete with signs of impingement and instability – go after their instability!
– pitchers with elbow MCL instability often complain of pain during late cocking and early acceleration – significant number have ulnar nerve symptoms from traction on the nerve and localized inflammation.
– serratus anterior functions to control scapular protraction on the thorax during the follow through phase of throwing.
– when thinking about rotator cuff surgery – an acromioplasty provides pain relief but does not improve strength of the cuff per se; doing the repair will improve the strength of the cuff.
– rupture of long head of biceps leads to loss of forearm supination strength of 15-20%, and loss of elbow flexion strength of 8-20%.
– acute brachial neuritis is characterized by acute onset of severe pain, which decreases dramatically over several weeks. Etiology unknown. Present with patchy neurologic findings in C5-T1 distribution. Motor weakness predominates over sensory change. Consider this diagnosis if the clinical picture is abit confusing, with various parts of the plexus affected.
– little league pitchers can also get overgrowth and irregular ossification of the medial epicondylar apophysis – an overuse, tension stress injury. The treatment is to REST and get rehab.
– the most common mechanism of ligament failure is rupture of a sequential series of collagen fiber bundles. Ligaments do not plastically deform. They also usually do not occur tension failure.