OKOJ, Volume 11, No. 11

A multitude of disease processes can affect the small joints of the hand, including osteoarthritis, posttraumatic arthritis, rheumatoid arthritis, and neuromuscular disorders. Tendon incompetence and ligamentous laxity can also lead to deformities of the digital joints, such as mallet finger, swan neck deformity, and boutonnière deformity. However, although these pathologies affect joint function in a variety of ways, many of them can be treated nonsurgically. Surgical treatment becomes necessary when the patient’s symptoms are intolerable, or when joint deformity or instability compromises hand function. The purpose of this review is to elucidate the roles of arthroplasty and arthrodesis in the treatment of degenerative arthritis and other pathologies affecting the digital joints of the hand.

Partial-thickness tears of the rotator cuff are among the clinical manifestations of disease of the rotator cuff. The true prevalence of such tears is unknown, making it difficult to formulate guidelines for their treatment, and their etiology is obscure. Their pathophysiology is often multifactorial, and the anatomic variation in these tears results from the multiple factors that contribute to them. Injury to the rotator cuff typically involves traumatic or microtraumatic lesions, often in association with superior labrum from anterior to posterior (SLAP) tears and/or lesions, creating instability of the shoulder. In general, if nonsurgical management fails, the standard of care for partial-thickness tears of the rotator cuff should involve arthroscopic management. An in-depth understanding of both the static and dynamic anatomy of the rotator cuff and associated structures will assist the physician in determining the appropriate treatment for tears of the rotator cuff.

Injuries are the last thing anyone wants to see at a sporting event. They nevertheless do occur, and an important function of the team physician is the ability to deal with emergency situations should they arise. Certain emergency scenarios occur with sufficient frequency on the playing field as to require team physicians or other clinicians responsible for the care of injured athletes to be familiar with the initial management of their injuries, pending the provision of care at a higher level. Apart from the preventive value of knowing how and when such emergencies may arise, these steps may decrease the likelihood of worsening an injury and allow an injured athlete a greater and more rapid chance of regaining full function. The emergency situations that must be addressed include the acute management of an athlete with a possible injury to the cervical spine and the unconscious athlete in whom such an injury cannot be ruled out. The team physician must also be familiar with the management scheme for concussion and other head injuries at the site of their occurrence. Beyond this, the team physician must be familiar with initial management of heatstroke, cardiac events, and dislocations of major joints in the members of an athletic team.