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PubMed2000

[Groin pain in athletes: role of magnetic resonance].

INTRODUCTION: Aim of our work was to evaluate the diagnostic role and potentials of Magnetic Resonance Imaging (MRI) in the study of groin pain in athletes and in the differential diagnosis among the pathological conditions that cause this syndrome. MATERIAL AND METHODS: MRI examinations were performed with a 1.5 T superconductive magnet, and a 0.2 T permanent magnet. Spin-Echo (SE) T1-w, PD, SE T2-w, Gradient-Echo (GE) T2-w and fat saturation sequences were used, on axial, sagittal and coronal scan planes. We performed MRI on twenty-five athletes (22 men and 3 women; age range 17 to 32 years) with chronic groin pain of questionable origin who had been complaining of it for at least 6 months. In 22 cases, radiographs were available; Computed Tomography (CT) had been performed in 3 cases and Ultrasound (US) in 7 cases. Nine patients were submitted to MRI after the symptoms had disappeared. RESULTS: In all patients, MRI provided an accurate depiction of pubic bone alterations and of adjacent myotendinous structures. In 14 cases, osteitis pubis was diagnosed, which was bilateral in 2 cases only (muscular asymmetry of the rectus abdominis was found in 4 of these patients); 4 patients had myotendinous posttraumatic changes (1 hematoma of the psoas muscle and 3 injuries of the abductor muscles of the thigh); 4 patients presented isolated dysmetria of rectus abdominis muscles, with unilateral involvement of the sacroiliac joint in 1 patient; 3 patients had inguinal hernia, surgically confirmed in all cases. DISCUSSION: Osteitis pubis, intended as reactive intraspongiuos edema of the pubic bones, is the most frequent cause of groin pain in athletes. In the early diagnostic phases, both plain films and CT may be negative or not specific. On the other hand, MRI has always proved to be a valuable diagnostic technique in detecting the osteitic change as an area of low signal intensity on T1-w images and of high and homogeneous signal intensity on T2-w scans without fat suppression. Dysmetria of the straight muscles of the abdomen, which may be associated, is always well depicted by MRI on axial planes. Both posttraumatic and dysmetric changes of the muscular structures adjacent to the pubis are well documented by US and MRI. The latter, however, thanks to its multiplanar capabilities, allows better spatial assessment of the alteration, especially if located at peri-insertional level. Possible associated diseases such as the involvement of the sacroiliac joints are also well shown by MRI. Inguinal hernias are easily demonstrated by MRI, which allows the direct visualization of the hernial sac within the inguinal canal. CONCLUSIONS: In our experience, only MRI can permit an accurate and early diagnosis of the different sport-related pubic conditions. MRI is also a valuable tool in monitoring the alterations with reference to their response to treatment, which may also help bring the athletes back to their activities.

Abdominal Muscles↗
PubMed2002

Neuropsychological impairment in soccer athletes.

BACKGROUND: Soccer reportedly places participants at risk for neuropsychological impairment, although it is unknown if the risk is associated primarily with concussion, subconcussive blows from heading the ball, or some combination thereof. Moreover, the extent to which younger versus older athletes are at risk for soccer-related cognitive impairment is unclear. We hypothesized that soccer athletes, especially older ones, would show poorer neuropsychological test performance than comparable swimmers. METHODS: Thirty-two soccer (26 college and 6 professional) and 29 swimmers (22 college and 7 masters level), all involved for at least 4 years in their sport at collegiate or national levels, participated. In a 2 X 2 (sport X age category) factorial design, all participants underwent 4 neuropsychological tests with 11 outcome measures assessing motor speed, attention, concentration, reaction time, and conceptual thinking. RESULTS: Soccer athletes performed worse than swimmers on measures of conceptual thinking. The older soccer group in particular performed poorly on measures of conceptual thinking, reaction time, and concentration. Among non-goaltender soccer athletes, estimates of career exposure to brain trauma (based on length of career and level of play) predicted significantly poorer test performance on 6 of 11 measures, even after statistically controlling for age. CONCLUSIONS: Results provide additional evidence that participation in soccer may be associated with poorer neuropsychological performance, although the observed pattern of findings does not specifically implicate heading as the cause. Although deficits were most apparent among older soccer players, serial neuropsychological testing for early detection of impairment is recommended for younger players as well.

Adolescent↗
PubMed2002

Characteristics of stress fractures in young athletes under 20 years.

BACKGROUND: With the popularization of organized sports among adolescents and children, the clinical cases of stress fractures in young athletes have increased. This study was carried out to investigate the characteristics of stress fractures in young athletes. METHODS: During the 18-month period between January 1996 and June 1997, new clinical cases of stress fracture due to sports activities were collected from 39 hospitals in Japan. RESULTS: We analyzed 222 stress fractures in 208 athletes under 20 years of age (108 males: 14.4+/-2.2 years, 100 females: 15.2+/-1.5 years). Among these cases, the peak age of occurrence was 16. The most common sport causing stress fracture was basketball. The tibia was the most common location. About 70% of the patients participated in the respective sport for 6 or 7 days per week. High school students trained significantly more often than the primary and junior high school students (p<0.0001). There was a statistically significant difference in the return time to the sport between the cases who visited a hospital within 3 weeks and those who waited for more than 3 weeks after the onset of symptoms (return time, 10.4 vs 18.4 wks). Several cases visited a hospital beyond 8 weeks after the onset of symptoms regardless of the continuous pain of stress fracture, and their recovery was prolonged. CONCLUSIONS: It is important to educate young athletes that continuous pain lasting over 3 weeks is a warning signal to the body, and that early diagnosis leads to early recovery.

Adolescent↗
PubMed2002

Neurologic considerations for adolescent athletes.

Sports-related head injuries in young athletes can have both acute and long-term complications. Concussions are the most common type of diffuse brain injury in young athletes. Research on concussions in young athletes is limited. Most current management guidelines are based on expert opinion and consensus. The role neuropsychological testing as an objective measure is increasingly being recognized in the management of concussions. This article reviews practical aspects of concussion management. The implications for sport participation by athletes with epilepsy, sport-related headaches, and burner syndrome are also reviewed.

Adolescent↗
PubMed2003

Dynamics of muscle strength improvement during isokinetic rehabilitation of athletes with ACL rupture and chondromalacia patellae.

AIM: To assess quantitatively dynamics and extent of the increase in muscle strength during isokinetic rehabilitation. METHODS EXPERIMENTAL DESIGN: daily measurements of muscle strength; detailed testing at the beginning and at the end of rehabilitation. SETTING: Cybex Rehabilitation Center, Zagreb. SUBJECTS: 44 athletes (31 m, 13 F, age 16-35), 3 injury-defined groups: athletes with ACL rupture (non-reconstructed and reconstructed) and chondromalacia patellae. INTERVENTIONS: all subjects underwent isokinetic rehabilitation on Cybex Orthotron KT2 device, using individually designed protocols (extension and flexion exercises, concentric muscle contractions, 15 treatments). MEASUREMENTS: monitoring of daily progress on rehabilitation device and detailed testing on diagnostic device. RESULTS: All patients showed considerable improvement. Muscle strength improved on average 141% (SD=110) in ACL-reconstructed group, 144% (SD=130) for chondromalacia patellae group and 150% (SD=74) for ACL-non-reconstructed group, comparing to initial strength. Dynamic status tested on Cybex Otrhotron diagnostic device prior and after rehabilitation strongly correlated with final progress monitored on the rehabilitation device. CONCLUSION: Isokinetic rehabilitation is a quick and effective method in treating knee injuries in athletes. Both types of objective criteria have shown significant increase in muscle strength. The improvement of muscle strength was on the average 149% (SD=101), which is about 10% daily for 15 treatments. The greatest progress, 19% per day, occurred during first five days. The athletes were able to resume their sport activities as follows: patients from chondromalacia patellae group, and most of them from the non-reconstructed ACL group were back in competition within a month, while 75% from the ACL reconstructed group came back within 3 months, and the rest of them within 5 months.

Adolescent↗
PubMed1992

Stress fractures in young athletic women: case reports of unsuspected cortisol-induced osteoporosis.

Stress fractures in the female athlete are common events, usually occurring in the lower limb and less often in the pelvic girdle. Two cases are presented of young women athletes who presented with initial lower limb stress fractures, but subsequently fractures of the pelvis and hip thought to be associated with their athletic activity. After careful medical evaluation, they were diagnosed with Cushing's syndrome. One patient had a microadenoma of the pituitary gland secreting excessive amounts of ACTH, and the other had a benign adenoma of the left adrenal gland. Both women had significant decreases in their spinal mineral density. After treatment, partial reversal of these spinal losses occurred. Although stress fractures in the female athlete might be common and thought to be associated with problems of amenorrhea, presentation of unusual anatomical sites for these fractures necessitates a more thorough evaluation for correctable secondary causes.

Adenoma↗
PubMed2003

[Subacromial impingement syndrome in athletes: prevention and exercise programs].

The shoulder joint, the most mobile joint in the human body, is at greater risks for injuries. Several factors contribute to shoulder impingement syndrome including rotator cuff weakness, capsular tightness, poor scapulohumeral rhythm, and muscle imbalance of the scapular upward rotation force couple. Rehabilitation and training of the shoulder in throwing and overhead athletes has dramatically improved during the last decade. There are numerous reasons for rapid return to athletic training and competition. A preventive program designed for the glenohumeral joint is mainly based on an appropriate preparation, which should include overall body conditioning, flexibility, and strengthening of the musculature around the glenohumeral joint and the scapula. Activity levels represent a helpful guide in determining an appropriate rehabilitation program for shoulder patients ranging from disabled to those competing at the highest levels of athletics. This article discusses issues related to prophylactic measures, non-operative treatment, postoperative treatment, and rehabilitation programme of impingement syndrome in athletes.

Athletic Injuries↗
PubMed1992

Hand and wrist injuries in the preadolescent and adolescent athlete.

In this time when physical prowess has been elevated to such a high level, the prepubescent and adolescent athlete have increased demands for performance placed on their immature musculoskeletal system. Although improved skills may result the athlete is exposed to more injury. Prompt, appropriate treatment of the injury with a controlled return to participation may prevent reinjury and disability. To this end, athletes, parents, coaches, trainers, and team physicians must maintain a close rapport for the benefit of the athlete.

Adolescent↗
PubMed2005

Plate fixation of middle-third fractures of the clavicle in the semi-professional athlete.

From 1995 to 2003, 39 semi-professional athletes (34 men and 5 women) aged 17-34 years (mountain bike racers, soccer players, swimmers and cyclists) with a displaced fracture of the middle-third of the clavicle were treated operatively using rigid plate fixation within one week after the initial trauma. In 90% of the athletes, radiographic union was achieved after 12 weeks. At 6 weeks post-operatively the mean Constant score was 88 points, the mean visual analogue pain score was 3 out of 10 and the average time for return to sports was 45 days. Seventy-five percent of the patients were very satisfied with the end-result and 95% would chose to have the same operation again. In 5% of the cases the end-result was unsatisfactory. The most frequent postoperative complication was wound infection (18% of the cases). Nevertheless, this did not affect the outcome. Other postoperative complications in our athletic population included refracture (5%), transient neurological complications (7%) and non-union (5%), which were equally low in the literature. These data suggest that rigid plate fixation of middle-third clavicle fractures gives good results in the semi-professional athlete and may result in early return to sports activity, at the expense of a significant risk for complications, which would not be considered acceptable in patients with lower functional demands.

Adolescent↗
PubMed2006

Evaluation of the medial elbow in the throwing athlete.

The valgus forces generated by throwing athletes can cause injuries and permanently damage the medial elbow structures. Clinicians must have a clear understanding of the ulnar collateral ligament complex and the associated medial elbow structures at risk in these athletes. Taking a detailed history, conducting a physical examination, and obtaining imaging studies will aid in making the correct diagnosis and giving these injuries the appropriate treatment. Pain around the medial elbow is of concern to throwing athletes, coaches, and medical staff. Valgus forces generated by the throwing motion add considerable stress to the medial elbow structures and thus potentially cause injury. Baseball players, particularly pitchers, are most often affected, but athletes participating in sports such as football, volleyball, water polo, tennis, and javelin throwing can also be affected.

Athletic Injuries↗
PubMed2006

The relationship between perfectionism, eating disorders and athletes: a review.

Perfectionism is a potentially maladaptive personality trait implicated in a number of psychopathologies. As our understanding of the construct perfectionism has shifted from more unidimensionally focused conceptualizations to multidimensional ones, our ability to assess its bearing on various disorders has grown. One particular area in which perfectionism appears to play an important role is among eating disorder patients. The personalities of both those with anorexia nervosa (AN) and bulimia nervosa (BN) are thought to be intrinsically perfectionistic, which suggests a need to understand the role perfectionism plays in the development, course and outcome of these disorders. There is also an increased focus on perfectionism among athletes and its relationship to the higher prevalence of eating disorders in this group. With the institution of Title IX in the United States (which prohibited sex discrimination in higher educational settings) the participation of women in various sports has increased exponentially and with it concerns about their well-being in a milieu where a risk for menstrual irregularities, osteoporosis and eating disorders (the female athlete triad) are common. However, conflicting data suggests that athletics may be a protective factor in the development of eating disorders on the one hand, or it may be a risk factor on the other. Thus, it has become important to examine other variables, such as perfectionism, that may influence the outcome, one way or another. This review examines the current evidence about the relations between perfectionism, athletics and eating disorders.

Adolescent↗
PubMed2006

Lumbar spine injuries in athletes.

Lumbar spine injuries in athletes are not uncommon and usually take the form of a mild muscle strain or sprain. More severe injuries sustained by athletes include disc herniations, spondylolistheses, and various types of fracture. The recognition and management of these injuries in athletes involve the additional consideration that to return to play, the lumbar spine must be able to withstand forces similar to those that were injurious. The authors consider common lumbar spine injuries in athletes and discuss management principles for neurosurgeons that are relevant to this population.

Athletic Injuries↗
PubMed2006

Participation in contact or collision sports in athletes with epilepsy, genetic risk factors, structural brain lesions, or history of craniotomy.

Despite a plethora of guidelines for return to play following mild head injury, a discussion of when and if an athlete should be allowed to participate in contact or collision sports if he or she sustains a structural brain lesion or after a head injury requiring craniotomy is lacking. The structural lesions discussed include arachnoid cyst, Chiari malformation Type I, cavum septum pellucidum, and the presence of ventriculoperitoneal shunts. Issues unique to this population with respect to the possibility of increased risk of head injury are addressed. The population of athletes with epilepsy and certain genetic risk factors is also discussed. Finally, the ability of athletes to participate in contact or collision sports after undergoing craniotomies for traumatic or congenital abnormalities is evaluated. Several known instances of athletes returning to contact sports following craniotomy are also reviewed.

Athletic Injuries↗
PubMed1991

Survey of health care available to child athletes.

Surveys were sent to 84 children's hospitals and 397 sportsmedicine clinics to characterize the care available for the child athlete (aged 4 to 12 years); they were completed by 209 facilities (43% response rate). Fourteen of the facilities had a sportsmedicine clinic specifically for children; care was available for the child athlete in an additional 46 facilities, but less than 10% of the clinic visits were made by athletes aged 4 to 12 years. All responding clinics were further characterized by location, length of operation, composition, referral base, profitability and funding, etc. Although there are few sportsmedicine clinics specifically for children, many facilities provide experienced personnel in existing clinics to care for young athletes.

Athletic Injuries↗
PubMed1991

Sports medicine in Hawaii: care of the high school athlete in Oahu's public schools.

A recent study by the National Athletic Trainers Association indicated that injuries occur more often during practice than during games in high school athletics. Results of the 3-year study indicated that 60% of basketball injuries occurred in boys and young men during practice and 59% occurred in women. About 2/3 of the estimated 120,000 injuries suffered by prep wrestlers each year happen during practice. The study found that an average of 331,865 high school football players (1/3 of the million who play football each year) were sidelined by an injury at least once. With these statistics in mind, our study looks at the approach to the management of injury in the public schools that make up the Oahu Inter-scholastic Association (OIA) in the state of Hawaii. The estimated number of student athletes that participate in organized athletics in the OIA is 7,960 and the number of coaches is 1,189.

Adolescent↗
PubMed1991

Diagnosis and treatment of delayed and non-union stress fractures in athletes.

Stress fractures in athletes usually heal well with merely rest and conservative treatment. It has been estimated that in Finland 400-500 athletic stress fractures occur annually per year. In sports clinic series stress fractures comprise 3.3 to 4.6 per cent of all overuse injuries. Delayed and non-union have been reported to occur in athletes quite often, up to 10 per cent of athletic stress fractures in Finland. The reason is on the one hand delayed diagnosis due to late consultation of expert physicians, and on the other hand too short a rest from hard physical activity. Delayed and non-union are most often seen in the hallux sesamoids, mid-tibial staft, base of fifth metatarsal, tarsal navicular and olecranon. The pars articularis of the fourth and fifth lumbar vertebra is a site of stress fracture and spondylolysis. In this report the diagnosis, symptoms and findings as well as the operative treatment of these overuse injuries is discussed.

Athletic Injuries↗
PubMed1990

Problematic fractures and dislocations in the foot and ankle of athletes.

Foot fractures can significantly compromise an athlete's career. Early recognition and treatment of occult fractures will reduce lay-off time and decrease the likelihood of prolonged impairment of performance. The appropriate treatment of radiographically obvious fractures will have a similar effect. The key to making an early diagnosis is the recognition of characteristic patterns on physical examination and the aggressive investigation of persistent foot pain in the athlete, whether it follows an injury or not. When a fracture is not apparent on routine radiographs, special diagnostic techniques, particularly technetium bone scanning, can effectively screen for bony injury. In the competitive athlete there is no reason to adopt a "wait-and-see" attitude. The approach in treating these injuries in athletes should be similarly definitive. If continued participation will delay healing or resolution of the symptoms, it should not be tolerated.

Ankle Injuries↗
PubMed1990

Closed head injuries in athletes.

Nervous system sports-related injuries constitute a major source of serious morbidity and mortality in athletes. In particular, acute closed head injuries account for some 6000 potentially preventable deaths and literally millions of episodes of less severe head injuries each year. The long-term significance of chronic head injuries resulting from repetitive blows to the brain is only now being fully appreciated. Similarly subtle neuropsychological changes are being increasingly recognized resulting from milder head injuries. Although head injuries are almost inevitable and unavoidable sequelae of most contact and competitive sports, much can and should be done to reduce the serious acute and chronic neurologic complications inherent in these activities. Prevention of catastrophic sports injuries by careful preseason examination, education, training, and conditioning, and ongoing counseling of the athlete is of paramount importance. The use of carefully fitted protective headgear, and avoidance of maneuvers that may directly result in serious head injuries are also key. The immediate evaluation, evacuation, and triage of the injured athlete must take place carefully and expeditiously. Skillful, experienced, and compassionate definitive care must then ensue. In the long term, the complications and analysis of accurate statistical data on the magnitude of sports injuries in general, and nervous system involvement in particular, must be studied. Presently, only a few sports have accumulated such data, such as in the National Football Head and Neck Injury Registry. In the final analysis, it is the cooperative responsibility of the medical and athletic communities to strive to reduce these tragic injuries.

Athletic Injuries↗

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