Faculty Bibliography

BACKGROUND: The kinetic chain of the throwing motion functions to optimize efficiency of proximal segments to decrease force loads seen at smaller, distal segments such as the ulnar collateral ligament. Several studies have shown that shoulder internal rotation forms the physiologic counter to the valgus torque generated during the late cocking phase of throwing. Previous studies have implicated decreased glenohumeral internal rotation as a cause of shoulder internal impingement. To date, an association between pathologic glenohumeral internal rotation deficit and elbow injury has not been exhibited. HYPOTHESIS: Throwers with ulnar collateral ligament insufficiency will exhibit significantly increased glenohumeral internal rotation deficit. STUDY DESIGN: Case control study; Level of evidence, 3. METHODS: Twenty-nine baseball players with ulnar collateral ligament insufficiency were demographically matched with 29 control baseball players who had no history of shoulder, elbow, or cervical spine injury. The investigators measured passive glenohumeral internal and external rotation, elbow flexion and extension, and forearm pronation and supination. The Mann-Whitney test was used to analyze continuous variables. RESULTS: There were no significant differences between the groups in terms of demographics. There was a significant difference in dominant arm internal rotation, with injured players having significantly less (P < .004), and in glenohumeral internal rotation deficit between players with ulnar collateral ligament insufficiency and those who were asymptomatic (28.5 degrees vs 12.7 degrees ; P < .001). Also, total range of motion was significantly decreased in the injured group. There were no significant differences in elbow or forearm range of motion between the groups. CONCLUSION: Our results indicate that pathologic glenohumeral internal rotation deficit may be associated with elbow valgus instability. This has important clinical implications both in terms of preventing ulnar collateral ligament injury and with regard to rehabilitating throwers after ulnar collateral ligament reconstruction

OBJECTIVE:Because serum C-reactive protein (CRP) levels correlate with the extent of inflammatory reactions, including acute strokes, we tested whether serum CRP levels on admission to a stroke rehabilitation unit help to predict functional outcome at discharge. DESIGN/METHODS:We measured serum CRP level within 72 hrs of admission to an inpatient stroke rehabilitation unit in 102 successive patients transferred to rehabilitation within 4 wks following stroke and who met inclusion criteria. RESULTS:Patients with normal levels of serum CRP (< or =9.9 mg/dl) on admission to our rehabilitation service were more likely to be discharged home rather than to an institution (66% vs. 44%, P < 0.03). These patients with normal serum CRP had higher absolute values for total functional independence measures and functional independence measures motor scores on admission, as well as on discharge (i.e., less disability). They also had fewer infections or other medical complications. However, the absolute magnitude of improvement (DeltaFIM) and length of stay were similar in the normal and elevated CRP groups. Multivariable logistic regression model did not show serum CRP level on admission to predict rehabilitation functional outcomes. CONCLUSIONS:Serum CRP level does not predict functional outcome at discharge on inpatient rehabilitation for stroke.

BACKGROUND:We reviewed previous studies comparing schizophrenia patients and healthy subjects for performance on the Iowa Gambling Task (IGT) (a laboratory task designed to measure emotion-based decision-making), and found mixed results. We hypothesize that deficits in IGT performance in schizophrenia may be more specifically related to concurrent substance use disorders. To test this hypothesis, we compared schizophrenia patients with (SCZ((+))) or without (SCZ((-))) cannabis use disorders, to healthy subjects, on measures of cognition and IGT performance. METHODS:A comprehensive battery of cognitive tests and the IGT were administered to three groups of subjects: (1) 13 subjects with DSM-IV diagnosis of schizophrenia and no concurrent substance use disorders (mean age: 28+/-12 (SD); 54% males); (2) 14 subjects with schizophrenia and concurrent cannabis use disorders (mean age: 29+/-9 (SD); 71% males); and (3) 20 healthy subjects (mean age 33+/-10 (SD); 60% males). RESULTS:Compared to the healthy group, both schizophrenia groups were cognitively more impaired, and did worse on IGT performance. There were no differences between SCZ((+)) and SCZ((-)) patients on most of the cognitive tests, and IGT performance. CONCLUSIONS:Schizophrenia patients show widespread impairments in several cognitive domains and emotion-based decision-making. These results are consistent with the evidence that schizophrenia reflects a dorsolateral and orbitofrontal/ventromedial prefrontal cortex dysfunction. More intriguing, it appears that the concurrent abuse of cannabis has no compounding effects on cognition, as well as emotion/affect-based decision-making.