Faculty Bibliography

Rock climbing, whether practiced in nature on cliffs and boulders or indoors on walls made of resin and wood, has grown in popularity in recent years. An estimated five million people participate in 'rocking' at least three times a year. Climbing places unique demands on the upper extremity, especially the hands. The flexor tendons and flexor pulleys are prone to sprains and ruptures. Pulley injuries occur in up to 20% of climbers. The A2 pulley of the ring finger is the most frequently injured. Most pulley injuries can be successfully treated with a week of immobilization, followed by a range of motion (ROM) exercises for one week. Isometric training on a finger board can be started once ROM exercises are painless. A return to climbing can be initiated when the climber is able to avoid grip positions that produce pain; however, the closed crimp grip should be avoided at this time. Surgical reconstruction using the technique described by Widstrom is recommended for acute injuries with clinical evidence of bowstringing. Ultrasound and MRI are the current modalities best suited for confirming clinical findings

We describe the case of a 76-year-old man with a renal cell carcinoma thrombus extending into the right atrium, prolapsing across the tricuspid valve into the right ventricle during diastole, and producing sufficient portal venous pressure to result in intestinal venous thrombosis and necrosis of the upper gastrointestinal mucosa. The related published studies are reviewed and discussed

Traumatic STA aneurysm is a rare complication of facial trauma occuring typically in young men. We present the case of a minor league baseball player who developed 2 pseudoaneurysms after being struck by a baseball and review all cases associated with sports activities. Reports associated with sports activities are increasing and may represent an increasing incidence. The team physician should suspect this condition when a player presents with a new temporal mass after facial trauma. Diagnosis is typically made on history and physical examination, but can be confirmed by duplex ultrasound. Definitive treatment is surgical resection of the aneurysm after proximal and distal ligation of the vessel

SLAP lesions are becoming a more recognized cause of shoulder pain and disability. The diagnosis of these lesions is difficult due to vague symptoms and high degree of overlap with other shoulder disorders, and this requires a high index of suspicion. Advances in MR arthrography may lead to advances in preoperative diagnosis of labral tears, but definitive diagnosis, classification, and management is greatly facilitated with the use of the shoulder arthroscopy. Further basic science and clinical research should enhance our ability to manage patients with these lesions effectively

Injury to the anterior cruciate ligament removes the major stabilizing structure to anterior tibial translation. The initial trauma may lead to meniscal and cartilage damage, predisposing the knee to early degenerative changes. Moreover, a knee with an isolated ACL rupture may have recurrent episodes of instability that can lead to a similar degenerative course. At this time, one cannot accurately predict which patients will tolerate ACL deficiency, and which patients will not. Current long-term studies support a progressive worsening condition in the ACL and meniscal deficient knees. Physical therapy together with lifestyle modifications may be necessary. Those unwilling to make these types of changes or those with associated injuries may benefit from ACL reconstruction