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Karate white belt finger
No full textDear Editor-in-chief
Traditional Shotokan Karate training requires hand conditioning using the Okinawan traditional padded punching board, the “makiwara ”(maki -“roll up ”or “wrap”, and wara- to “straw”). Karate practitioners used to work out for hours with this device, to toughen the hands and strengthen the wrists to be able to deliver more powerful hand techniques. However, even though they may not use a makiwara, modern karatekas practice their karate strikes on sandbags. This training may produce different injuries (Adams and Mutasim, 2001; Vayssairat et al., 1984). Crosby (Crosby, 1985) radiographed the hands and wrists of 22 karate instructors, 17 of whom punched regularly the makiwara and performed pushups on the knuckles every day. He concluded that zealous use of the makiwara was a cause of pain and stiffness in the hands and wrists, but neither practice had a consistently deleterious effect on the mobility of the index and middle fingers metacarpo- phalangeal joints which bore the brunt of the impact.
“Karate Kid finger ”(Chiu, 1993) is a traumatic condition of the little finger occurring in karate participants. It may become clinically evident as pain and paraesthesiae along the ulnar border of the little finger and hand. The ulnar dorsal digital nerve of the little finger can be damaged by repetitive contusion when the hand performs karate chop called “tsuki”. The repetitive impact may cause fibrosis within the nerve sheaths and between the nerve fibres. The “Karate Kid finger ”is managed surgically by neurolysis. Overuse and poor technique are considered risk factors. Gichin Funakoshi, the father of modern karate, in the book Karate Jitsu (Funakoshi, 2001), decribes the correct way of performing the karate chop “tsuki”. Precisely, he pointed out that the “seiken ”(the traditional karate “tsuki”) has four point of contact: the first two knuckles and the proximal interphalangeal joint of the index and middle finger. Even though Funaskoshi recommended to practice on makiwara, he was aware of the risks which can be carried out by an uncontrolled and excessive training. Infact, he also wrote: “Then there are those who, having a superficial knowledge of one or two karate techniques, hold their fists in such a way as to call attention to their callused knuckles while pushing their way through crowds as if looking for a fight - foolish beyond words”(Funakoshi, 1995). As proper technique to perform the karate “tsuki ”requires impact to be driven on the first two knuckles and the proximal interphalangeal joint of the index and middle finger, the forearm pronated and the wrist slightly ulnar deviated. The causative factor of the “Karate Kid finger ”is poor technique. The ulnar dorsal digital nerve of the little finger can be damaged only if the “tsuki ”is performed as usually the lower level karatekas (white belt) do, namely with the knuckles of the middle, ring, and little finger as the points of impact. Hence, we suggest that this condition should be more aptly named “karate white belt finger”
Neovascularization in Achilles tendinopathy: have we been chasing a red herring?
No full textThe concept of neovascularization in tendinopathy seems to have gained nearly mythological proportions and quasi-religious state: it is considered of diagnostic and prognostic value, related to clinical outcome, and the exclusive target of some therapeutic interventions. However, we question whether these assumptions are based on scientific evidence, and we come to the conclusion that, in the light of recent well-performed research, it seems that detecting neovessels has no additional value for the diagnosis, no firmly confirmed prognostic value, and no proven relation with symptoms. The role of neovascularization in this field should be re-thought
Single minimal incision fasciotomy for chronic exertional compartment syndrome of the lower leg
No full textBACKGROUND:
Chronic exertional compartment syndrome (CECS) involves a painful increase in compartment pressure caused by exercise and relieved by rest, common in athletes. The most common site for CECS in the lower limbs is the anterior leg compartment. The aim of this study is to evaluate the outcomes of a single minimal incision fasciotomy in athletes and their capability to return to high level sport activity.
METHODS:
The study reports mid-term results in a series of 18 consecutive athletes with chronic exertional compartment syndrome of the leg who had undergone minimally invasive fasciotomy. Between 2000 and 2007, we prospectively enrolled 18 consecutive athletes (12 males and six females, median age 27 years) with unilateral or bilateral chronic exertional compartment syndrome undergoing unilateral or bilateral minimally invasive fasciotomy. Clinical outcomes were assessed with Short-Form Health Survey-36 (SF-36) and European Quality of Life-5 Dimension (EQ-5D) scale. The ability to participate in sport before and after surgery and the time to return to training (RTT) and to sport (RTS) were recorded.
RESULTS:
The median follow-up after surgery was 36 months. Both questionnaires showed a statistically significant improvement (P < 0.0001) after surgery. At the time of the latest follow-up, 17 of 18 patients (94 %) had returned to pre-injury or higher levels of sport. Only one patient (6 %) returned to sport at lower levels than those of pre-injury status. The median time to return to training and to return to sport was 8 and 13 weeks, respectively. No severe complications or recurrence of the symptoms were recorded.
CONCLUSIONS:
Minimally invasive fasciotomy is effective and safe for athletes suffering from unilateral or bilateral chronic exertional compartment syndrome of the anterior and lateral compartments of the leg with good results in the mid-term
Free hamstrings tendon transfer and interference screw fixation for less invasive reconstruction of chronic avulsions of the Achilles tendon.
No full textReconstruction of chronic avulsions of the Achilles tendon can be technically difficult, as the calcaneus can be totally denuded of tendon, or only a small tuft of frayed tissue may have remain attached to the calcaneus, and be inadequate to allow a direct repair. In these patients, if it is not possible to directly reattach the Achilles tendon, a tendon graft can be necessary. We developed a less invasive technique using a free semitendinosus tendon graft with interference screw fixation in the calcaneus through a Cincinnati incision. Using this approach, a wide exposure of the insertion of the Achilles tendon is possible, preserving the integrity of the skin overlying the site most prone to wound breakdown
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