Musculoskeletal injuries in tactical law enforcement

Context. Tactical law enforcement combines special law enforcement tactics and elite level athletic movements. There is a lack of research surrounding the frequency and types of musculoskeletal injuries incurred by tactical law enforcement officers. It is postulated that the musculoskeletal injuries seen in the military and among elite level athletes are similar to those sustained by tactical officers. Objective. The primary purpose of this study is to determine how often tactical officers experience musculoskeletal injuries, what types are most common, and when they are occurring. The secondary purpose of this study is to determine how often tactical officers have access to medical professionals, and who is managing/treating their musculoskeletal injuries. Results. The mean age of participants was 39.6+/-6.5. Most participants were part time tactical officers (78%, n=39). The majority of tactical officers (38.5%, n=20) have been employed as such for more than 10 years. The majority of tactical officers polled (76.9%, n=40) spent less than 5 hours per week on call outs, and 45.1% (n=23) spent less than 5 hours training per week. Most indicated that their tactical unit employed the Tactical Emergency Medical Support (TEMS) system (78.8%, n=41). The most popular medical coverage was to use an outside medical professional with tactical training and TEMS certification as the TEMS provider (70.0%, n=28). When TEMS was not available an EMT in emergency situations only (61.1%, n=11) was the most common. Only 13.3% (n=4) could consider a medical provider having a full time commitment to the tactical unit. Most tactical officers claimed not having any previous injuries that were exacerbated by their tactical officer duties (71.2%, n=37). An even greater number admitted to experiencing some kind of musculoskeletal injury as a direct result of being employed as a tactical officer (80.8%, n=42), and only 67.3% (n=35) admitted to sustaining some kind of musculoskeletal injury while employed as a tactical officer as a result of non-work related activities. Common Lower extremity injuries were ankle ligament sprains (63.2%, n=12), knee tears/ruptures (68.8%, n=11), and general pain and discomfort of the knee (41.7%, n=5). The most common upper extremity injuries were shoulder dislocations (60.0%, n=6) and elbow tendinitis (62.5%, n=5). The most common trunk injuries were back muscle strains (42.1%, n=8) and vertebral disc involvement in the back (77.8%, n=7). Multiple ligament sprains (81.5%, n=13), Muscle strains (50.0%, n=9), dislocations (62.5%, n=5), tendinitis (55.5%, n=5), tears/ruptures (50%, n=7), vertebral disc involvement (55.5%, n=5), and general pain/discomfort (66.7%, n=8) were reported prior to tactical officer employment. Multiple cases of ligament sprains (73.7%, n=14), muscle strains (89.5%, n=17), fractures (58.3%, n=7), dislocations (55.5%, n=5), tendinitis (75.0%, n=6), tears/ruptures (66.7%, n=10), vertebral disc involvement (80.0%, n=8), contusions (91.0%, n=10), lacerations (84.7%, n=11), and general pain/discomfort (83.2%, n=10) were reported as a result of work related activities. Multiple ligament sprains (66.8%, n=10), muscle strains (73.6%, n=14), tendinitis (57.2%, n=4), tears/ruptures (53.9%, n=7), contusions (55.5%, n=5), and general pain/discomfort (54.6%, n=6) were reported while engaging in outside of work activities. Physicians treated the majority of all injuries regardless of when they occurred whether prior to tactical officer employment injuries (74.2%, n=23), work related injuries (82.9%, n=29), and outside of work injuries (78.1%, n=25). Most responded that injuries sustained pre-tactical officer employment (82.4%, n=28) and those sustained outside of work related activities (65.7%, n=23) resulted in no time lost from work due to injuries. While 63.2% (n=24) reported missing time from work due to injuries sustained on the job, with 34.3% (n=12) reporting missing 2-6 weeks of work due to injury. Conclusion. Ankle sprains, knee sprains, back strains, shoulder dislocations, elbow tendinitis, knee tears/ruptures, vertebral disc involvement of the back, hand lacerations, and general knee pain were the most commonly injured body parts in tactical officers. Work related injuries seemed to be the most prevalent. The information gained through this study represents a small population of tactical officers and the injuries experienced during their careers. This provides valuable information about common musculoskeletal injuries and when they are occurring. A more focused study with a larger sample size is needed to improve the validity and power of this information. (Abstract shortened by UMI.)

Clinical case of the surgical treatment of complete rupture of distal biceps tendon using two cortical buttons

Distal biceps tendon injuries mainly occur in men from the active groups of population. Among the athletes and military personnel, the incidence rate is 2–10  % of  the  upper limb tendon injuries. Comparative studies have shown the achievement of better functional results in surgical treatment, while maintaining overall complication rate of 4.6–25 %. The aim. To demonstrate a new reinsertion technique with two cortical buttons in case of complete rupture of distal biceps tendon as part of a clinical case. Materials and methods. The article presents a clinical case of surgical treatment of a patient with complete rupture of dominant limb distal biceps tendon which was more than 2 weeks old and was accompanied by lacertus fibrosus provocation and persistent muscle retraction. Results. We obtained the following clinical results by the week 24 after the surgery: VAS (Visual Analogue Scale) score – 1  cm, ASES (American Shoulder and Elbow Surgeons) score – 99  points, DASH (Disabilities of the Arm, Shoulder and Hand) score – 15 points. Dynamometry results: Dex. 85; sin. 90 (2daN); range of motion corresponds to the same of a healthy joint. MRI at 1.5 T shows no signs of synostosis or heterotopic ossification; MSCT shows no signs of migration of cortical buttons in comparison with intraoperative X-ray control. Discussion. Extracortical methods of distal biceps tendon positioning in anatomical reinsertion have lower strength indicators, comparable with the use of transosseous sutures and anchor fixators. A larger area of contact of the studied zone in case of minimal tendon compression in the area of proximal radioulnar space or inside the formed radial bone canal provides high strength indicators and reduces the risk of repeated injury. Conclusion. The scores of the scales (VAS, DASH, ASES) turned out to be better than when using other common methods. The technique of dipping distal biceps tendon stump into the formed oval canal of the “anatomical impression” using the proposed method meets the objectives of careful attitude to the tendon and provides the largest area of its contact with the bone

Surgical treatment of hamstring injuries and disorders – the clinical spectrum from chronic tendinopathy to complete rupture

Hamstring muscle injuries and tendon disorders are common, especially in sports. They can be severe and difficult to treat, often resulting in impaired athletic performance and long rehabilitation times. Previous studies considering treatment of these problems are scarce. The current study was designed to investigate the effect of surgery on different types of hamstring muscle injuries and on proximal hamstring tendinopathy. In addition, we wanted to study the typical histopathological findings relating to proximal hamstring tendinopathy. In the study of complete (all three muscles torn) proximal hamstring avulsions (41 patients), our results showed that early operative treatment gives significantly better results than late surgery, and is therefore recommended. Despite this, considerable improvement of symptoms could also be achieved in chronic cases. In the study of partial (one or two muscles torn) proximal hamstring tears (47 patients), we observed that these injuries can cause significant functional deficit and impaired performance in athletes. The main finding was that after surgical repair most of the patients were able to return to their pre-injury level of sports. In the study of distal hamstring tears (18 patients), the results showed that surgical treatment had a good effect in the majority of these cases. In proximal hamstring tendinopathy, the main problem is pain which limits sports. In this study (90 patients), we found that after unsuccessful conservative treatment, surgery was a good treatment option resulting in full return to sports in most cases. In tendinopathic hamstring tendons, the morphological changes of tendinosis were largely identical to those previously described in other common (e.g. Achilles and patellar) tendinopathies. In chronic proximal hamstring avulsions, and also in reoperations, a large defect between distally retracted tendons and the ischial tuberosity may occasionally prevent anatomic reinsertion. We have described a reconstruction method using fascia lata autograft augmentation to be used in these most challenging repairs. This technique was utilized in the treatment of five patients, with encouraging results.Siirretty Doriast

ICD-10-CM TABULAR LIST of DISEASES and INJURIES

Publication date from document properties.icd10cm-tabular-2022-April-1.pdf1. Certain infectious and parasitic diseases (A00-B99) -- 2. Neoplasms (C00-D49) -- 3. Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (D50-D89) -- 4. Endocrine, nutritional and metabolic diseases (E00-E89) -- 5. Mental, Behavioral and Neurodevelopmental disorders (F01-F99) -- 6. Diseases of the nervous system (G00-G99) -- 7. Diseases of the eye and adnexa (H00-H59) -- 8. Diseases of the ear and mastoid process (H60-H95) -- 9. Diseases of the circulatory system (I00-I99) -- 10. Diseases of the respiratory system (J00-J99) -- 11. Diseases of the digestive system (K00-K95) -- 12. Diseases of the skin and subcutaneous tissue (L00-L99) -- 13. Diseases of the musculoskeletal system and connective tissue (M00-M99) -- 14. Diseases of the genitourinary system (N00-N99) -- 15. Pregnancy, childbirth and the puerperium (O00-O9A) -- 16. Certain conditions originating in the perinatal period (P00-P96) -- 17. Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99) -- 18. Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99) -- 19. Injury, poisoning and certain other consequences of external causes (S00-T88) -- 20. External causes of morbidity (V00-Y99) -- 21. Factors influencing health status and conact with health services (Z00-Z99) -- 22. Codes for special purposes (U00-U85)

Complications and outcomes associated with 13 cases of triceps tendon disruption in dogs and cats (2003-2014).

This study reports data from a larger number of cases of triceps tendon disruption. Records from 10 veterinary referral hospitals between 2003 and 2014 were searched for canine and feline cases diagnosed with triceps tendon disruption, based on orthopaedic examination confirmed during surgery. Long-term follow-up and owner satisfaction were assessed using a questionnaire. There were 13 cases of triceps tendon disruption diagnosed across seven hospitals (nine dogs, four cats). Trauma, history or presence of a wound, surgery in the region of tendon attachment or corticosteroid treatment preceded triceps tendon disruption. Radiographic signs or histopathology suggestive of a chronic tendinopathy was common. All cases underwent surgical repair involving a tendon suture pattern, 12 of which were secured through bone tunnels. Immobilisation was used in all cases in the form of transarticular external skeletal fixation (TAESF) (8/9 dogs) or spica splint (four cats, two dogs; in one dog a TAESF was applied after complications associated with the spica splint). Complications occurred in 11 cases (17 total complications), frequently associated with the immobilisation method. One case had traumatic tendon rerupture two years following surgery. A wound at presentation was associated with the development of multiple complications. Nine cases had long-term follow-up; five achieved normal function, four achieved acceptable function. Despite the complications, overall return to subjective normal or acceptable function, as assessed by the owners, was achieved in the majority of cases

A review of chronic pectoralis major tears: what options are available?

Rupture of the pectoralis major muscle typically occurs in the young, active male. Acute management of these injuries is recommended; however, what if the patient presents with a chronic tear of the pectoralis major? Physical exams and magnetic resonance imaging can help identify the injury and guide the physician with a plan for management. Nonoperative management is feasible, but is recommended for elderly, low-demand patients whose functional goals are minimal. Repair of chronic tears should be reserved for younger, healthier patients with high functional demands. Although operative management provides better functional outcomes, operative treatment of chronic pectoralis tears can be challenging. Tendon retraction, poor tendinous substance and quality of tissue, muscle atrophy, scar formation, and altered anatomy make direct repairs complicated, often necessitating auto- or allograft use. We review the various graft options and fixation methods that can be used when treating patients with chronic pectoralis major tears

What Treatment and Prevention Options are the Most Effective for Elbow, Knee, and Plantar Tendinopathies?

Objective: Tendinopathies of the upper and lower extremity are one of the most common injuries in athletes and non-athletes in the United States. This literature review aimed to determine the most effective preventions and treatments for patients with tendinopathies. Methods: A literature search was conducted primarily through Google Scholar and PubMed, for articles related to effective preventions and treatments for tendinopathies. Discussion: Based on the literature review, there were multiple effective treatments and preventative measures for tendinopathies in the upper and lower extremity. The most effective preventative measures consisted of risk factors, dynamic warmups, and prevention programs. Treatments were broken down into three categories: elbow, patella, and plantar tendinopathies. The diamond tape job and counterforce brace improved symptoms in patients with elbow tendinopathies, and improved function throughout the body. Corticosteroids improved symptoms short term in the UE and LE, while PRP improved symptoms and promoted long term tissue healing. Physical therapy (eccentric exercises) appeared to show abundant benefit on tendinopathies regardless of the location. Conclusion: For tendinopathies that fail conservative treatments, preventative measures can help avert tendinopathies. Corticosteroids, PRP, and physical therapy can be used for treatment. Specific prevention programs can inhibit elbow tendinopathies and improve function throughout the whole body, while a reduction in risk factors could prevent elbow, patella, and plantar tendinopathies. Regarding the elbow and plantar fascia, the best long-term results were PRP or physical therapy (eccentric exercises). For the knee, eccentric exercises were the most effective treatment, while PRP had mixed results. Despite an increase in research on these topics, more RCT’s are needed in upper/lower tendinopathies, and standard protocols for PRP