Elastic arm-torso harness JOHN A. FEAGIN, JR., M.D. The elastic arm-torso harness provides support to the glenohumeral joint where symptoms of recurrent subluxation impair playng ability m the athlete The harness has proved effective and acceptable m over 40 athletes at the college level The harness is less remore strictive and supportive than other presently available items.
Teatment
of recurrent subluxation of the shoulder can be a challenging problem for the team physician, especially when the athlete desires to finish the season before corrective surgery is performed. Such a
predicament
was forcibly impressed upon us in 1969 when three of our key athletes presented with symptoms of subluxation, manifested by the shoulder’s &dquo;going out&dquo; with blocking or tackling, followed by pain in the shoulder at the extremes of motion. Resistive exercises did not relieve the symptoms and improved techniques of blocking and tackling did not decrease the frequency of injury. It appeared as though the players would be lost for the season until our ingenious bracemaker designed a simple harness which proved effective for controlling the symptoms and yet did not prevent the players from participating in sports The harness is primarily applicable to symptoms of recurrent subluxation of the shoulder in football players, although hockey and lacrosse players have also found it beneficial.
Dr John A Feagm, Jr , is Assistant Chief, Orthopaedic Service, Letterman Army Medical
Center, Presidio of San Francisco, California 94129. He is former team physician at the United States Military Academy at West Point, New York.
to each player, the and has temshoulder, supportive porarily deferred surgery until after the player had successfully completed the sea-
It has
proved acceptable to
son.
The harness provides elastic support through straps which snugly encircle the shoulder girdle and upper arm and attach in front and back to a torso belt (Figure 1).
Abduction and overhead elevation therefore the elastic straps which provide elastic support to the glenohumeral joint. Although the extremes of motion are restricted elastically, a functional range is possible. The gradually restrictive tightening of the harness serves to warn the athlete when he approaches the extremes of motion; the added support about the joint provides a sense of reassurance. This harness differs from alternative items by providing elastic support (Figure 2) instead of inelastic restriction. We do not claim that the harness prevents dislocation of the shoulder; we offer it as a protective support for the athlete player during periods of participation in sports. Players with recurrent shoulder subluxation preferred it to other alternatives when tested.
tighten
ILLUSTRATIVE CASES
Patient I: A 22-year-old starting defensive fullback in his junior year had recurrent dislocations of the left shoulder while in high school. This was surgically repaired (PuttiPlatt)’ before college. After two successful collegiate seasons without symptoms, the shoulder was re-dislocated antero-inferiorly while he was making a tackle. It was reduced on the sidelines with the Milch maneuver (Figure 3).2 The patient was immobilized in a soft splint for three weeks and 99
allowed to resume play when he demonstrated a full range of motion and good strength to manual muscle testmg. However, he said he felt as though the shoulder &dquo;went out&dquo; on every tackle and was unable to play effectively Re-repair was considered, but the athlete elected to continue play with the aid of the harness which proved symptomatically effective; he completed the season. Re-repair was accomplished after the football season, and a large defect was found in the antero-mfenor capsule. Repair was ac3 complished after the manner of Bankhart.3 He convalesced satisfactorily, electing to wear the harness as a protective device when playing football. He completed his collegiate football career successfully without return of
symptoms. Patient 2: A 20-year-old offensive tackle in his freshman year at college had a PuttiPlatt repair for recurrent dislocation of the left shoulder. He did not complain of shoulder subluxation until spring practice of his sophomore year when he fell on his left elbow and felt something tear. He thought the shoulder might have dislocated on impact and spontaneously reduced. On the sideline it was determined that he had sustained a capsular injury He had pain with abduction and rotation and tenderness over the glenohumeral joint, particularly posteriorly. It was postulated that he might have sustained a posterior subluxation. A modified axillary view (Figure 4)’ showed only the old anterior glenoid defect. He discontinued participation in spring practice and his shoulder was immobilized for four weeks in a soft splint. The athlete had no symptoms throughout the summer but at fall practice he had pain and tenderness about the shoulder after each contact session. He elected to wear the harness and was able to participate freely throughout both his junior and senior seasons. Although on several occasions he had minor symptoms, they did not cause loss of playing time. Note- The patient was perhaps the most enthusiastic wearer of the harness and it was remarkable indeed that he completed two seasons after his injury. It is also noteworthy that although he frequently forgot his mouthpiece or other key items of equip100
Figure
I-Elastic arm-torso harness straps shoulder girdle and upper arm.
Figure
2-Harness differs from alternative items by providing restriction. elastic ~Mppoyt c/a~c instead o/!’/!~/a~nc support tn~~a~ of inelastic y~~!c~o~.
snugly
ment, he never failed to have his arm-torso harness and to apply this with great care to his shoulder.
Patient 3: A
19-year-old college
junior
had symptoms of recurrent subluxation of the right shoulder which were aggravated particularly when he was completing the &dquo;slap&dquo; shot. Symptoms rarely
hockey player
encircle the
appeared during his routine activities Physical examination revealed tenderness about the glenohumeral joint anteriorly and inferiorly and pain at the extremes of motion. The modified axillary view did not reveal a Bankhart lesion. The occasional nature of the symptoms did not warrant surgery, but the player was desirous of symptomatic relief. The harness effectively provided the desired support and did not interfere with his shooting ability. COMMENT
simple elastic harness which is supportive glenohumeral joint is often symptomatically effective for recurrent subluxation A
of the
Figure
3-Shoulder dislocated anteroinferiorly and reduced on the sidelines with the Milch maneuver.2 (By
permission )
of the shoulder in the athlete. The harness illustrated in Figure I has been tried in approximately 40 athletes over a three-year period. It has proved acceptable to all users and amazingly unrestrictive to them while participating in their chosen sport. Although primarily applicable to the football player, it has been used by athletes playing other sports such as hockey and lacrosse. It is doubtful that the harness would prove either effective or acceptable to the non-athlete with spontaneous subluxation or dislocation. It is designed to support the glenohumeral joint only intermittently, for use specifically
during periods requiring the joint.
excessive stress in
ACKNOWLEDGMENT
The harness was designed by Drexel D. Fair, Fair Harness Company, Methuen, Mass.
References
Osmond-Clarke H Habitual Dislocation of the Shoulder. Putti-Platt operation J Bone Joint Surg 19 25, 1948 30 (Br) 2 Lacey T and Crawford, HB Reduction of Anterior Dislocation of the Shoulder by means of the Milch Adduction Technique J Bone Joint Surg (Am) 34 108 109, 1952 3 Bankhart ASB The Pathology and Treatment of Recurrent Dislocation of the Shoulder Joint Brit J Surg 26 23-29, 1938 4. Rokous JR, Feagin JA Modified Axillary Roentgenogram. A Useful Adjunct in the Diagnosis of Recurrent Instability of the Shoulder Clin Orthop 82 84 86, 1972 1
Figure 4-Modified axillary glenoid defect.
view
showing
the old
anterior
101
Teatment
of recurrent subluxation of the shoulder can be a challenging problem for the team physician, especially when the athlete desires to finish the season before corrective surgery is performed. Such a
predicament
was forcibly impressed upon us in 1969 when three of our key athletes presented with symptoms of subluxation, manifested by the shoulder’s &dquo;going out&dquo; with blocking or tackling, followed by pain in the shoulder at the extremes of motion. Resistive exercises did not relieve the symptoms and improved techniques of blocking and tackling did not decrease the frequency of injury. It appeared as though the players would be lost for the season until our ingenious bracemaker designed a simple harness which proved effective for controlling the symptoms and yet did not prevent the players from participating in sports The harness is primarily applicable to symptoms of recurrent subluxation of the shoulder in football players, although hockey and lacrosse players have also found it beneficial.
Dr John A Feagm, Jr , is Assistant Chief, Orthopaedic Service, Letterman Army Medical
Center, Presidio of San Francisco, California 94129. He is former team physician at the United States Military Academy at West Point, New York.
to each player, the and has temshoulder, supportive porarily deferred surgery until after the player had successfully completed the sea-
It has
proved acceptable to
son.
The harness provides elastic support through straps which snugly encircle the shoulder girdle and upper arm and attach in front and back to a torso belt (Figure 1).
Abduction and overhead elevation therefore the elastic straps which provide elastic support to the glenohumeral joint. Although the extremes of motion are restricted elastically, a functional range is possible. The gradually restrictive tightening of the harness serves to warn the athlete when he approaches the extremes of motion; the added support about the joint provides a sense of reassurance. This harness differs from alternative items by providing elastic support (Figure 2) instead of inelastic restriction. We do not claim that the harness prevents dislocation of the shoulder; we offer it as a protective support for the athlete player during periods of participation in sports. Players with recurrent shoulder subluxation preferred it to other alternatives when tested.
tighten
ILLUSTRATIVE CASES
Patient I: A 22-year-old starting defensive fullback in his junior year had recurrent dislocations of the left shoulder while in high school. This was surgically repaired (PuttiPlatt)’ before college. After two successful collegiate seasons without symptoms, the shoulder was re-dislocated antero-inferiorly while he was making a tackle. It was reduced on the sidelines with the Milch maneuver (Figure 3).2 The patient was immobilized in a soft splint for three weeks and 99
allowed to resume play when he demonstrated a full range of motion and good strength to manual muscle testmg. However, he said he felt as though the shoulder &dquo;went out&dquo; on every tackle and was unable to play effectively Re-repair was considered, but the athlete elected to continue play with the aid of the harness which proved symptomatically effective; he completed the season. Re-repair was accomplished after the football season, and a large defect was found in the antero-mfenor capsule. Repair was ac3 complished after the manner of Bankhart.3 He convalesced satisfactorily, electing to wear the harness as a protective device when playing football. He completed his collegiate football career successfully without return of
symptoms. Patient 2: A 20-year-old offensive tackle in his freshman year at college had a PuttiPlatt repair for recurrent dislocation of the left shoulder. He did not complain of shoulder subluxation until spring practice of his sophomore year when he fell on his left elbow and felt something tear. He thought the shoulder might have dislocated on impact and spontaneously reduced. On the sideline it was determined that he had sustained a capsular injury He had pain with abduction and rotation and tenderness over the glenohumeral joint, particularly posteriorly. It was postulated that he might have sustained a posterior subluxation. A modified axillary view (Figure 4)’ showed only the old anterior glenoid defect. He discontinued participation in spring practice and his shoulder was immobilized for four weeks in a soft splint. The athlete had no symptoms throughout the summer but at fall practice he had pain and tenderness about the shoulder after each contact session. He elected to wear the harness and was able to participate freely throughout both his junior and senior seasons. Although on several occasions he had minor symptoms, they did not cause loss of playing time. Note- The patient was perhaps the most enthusiastic wearer of the harness and it was remarkable indeed that he completed two seasons after his injury. It is also noteworthy that although he frequently forgot his mouthpiece or other key items of equip100
Figure
I-Elastic arm-torso harness straps shoulder girdle and upper arm.
Figure
2-Harness differs from alternative items by providing restriction. elastic ~Mppoyt c/a~c instead o/!’/!~/a~nc support tn~~a~ of inelastic y~~!c~o~.
snugly
ment, he never failed to have his arm-torso harness and to apply this with great care to his shoulder.
Patient 3: A
19-year-old college
junior
had symptoms of recurrent subluxation of the right shoulder which were aggravated particularly when he was completing the &dquo;slap&dquo; shot. Symptoms rarely
hockey player
encircle the
appeared during his routine activities Physical examination revealed tenderness about the glenohumeral joint anteriorly and inferiorly and pain at the extremes of motion. The modified axillary view did not reveal a Bankhart lesion. The occasional nature of the symptoms did not warrant surgery, but the player was desirous of symptomatic relief. The harness effectively provided the desired support and did not interfere with his shooting ability. COMMENT
simple elastic harness which is supportive glenohumeral joint is often symptomatically effective for recurrent subluxation A
of the
Figure
3-Shoulder dislocated anteroinferiorly and reduced on the sidelines with the Milch maneuver.2 (By
permission )
of the shoulder in the athlete. The harness illustrated in Figure I has been tried in approximately 40 athletes over a three-year period. It has proved acceptable to all users and amazingly unrestrictive to them while participating in their chosen sport. Although primarily applicable to the football player, it has been used by athletes playing other sports such as hockey and lacrosse. It is doubtful that the harness would prove either effective or acceptable to the non-athlete with spontaneous subluxation or dislocation. It is designed to support the glenohumeral joint only intermittently, for use specifically
during periods requiring the joint.
excessive stress in
ACKNOWLEDGMENT
The harness was designed by Drexel D. Fair, Fair Harness Company, Methuen, Mass.
References
Osmond-Clarke H Habitual Dislocation of the Shoulder. Putti-Platt operation J Bone Joint Surg 19 25, 1948 30 (Br) 2 Lacey T and Crawford, HB Reduction of Anterior Dislocation of the Shoulder by means of the Milch Adduction Technique J Bone Joint Surg (Am) 34 108 109, 1952 3 Bankhart ASB The Pathology and Treatment of Recurrent Dislocation of the Shoulder Joint Brit J Surg 26 23-29, 1938 4. Rokous JR, Feagin JA Modified Axillary Roentgenogram. A Useful Adjunct in the Diagnosis of Recurrent Instability of the Shoulder Clin Orthop 82 84 86, 1972 1
Figure 4-Modified axillary glenoid defect.
view
showing
the old
anterior
101
