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PubMed2002

A nonlinear finite element model of the eye with experimental validation for the prediction of globe rupture.

Over 2.4 million eye injuries occur each year in the US, with over 30,000 patients left blind as a result of the trauma. The majority of these injuries occur in automobile crashes, military operations and sporting activities. This paper presents a nonlinear finite element model of the eye and the results of 22 experiments using human eyes to validate for globe rupture injury prediction. The model of the human eye consists of the cornea, sclera, lens, ciliary body, zonules, aqueous humor and vitreous body. Lagrangian membrane elements are used for the cornea and sclera, Lagrangian bricks for the lens, ciliary, and zonules, and Eulerian brick elements comprise the aqueous and vitreous. Nonlinear, isotropic material properties of the sclera and cornea were gathered from uniaxial tensile strip tests performed up to rupture. Dynamic modeling was performed using LS-Dyna. Experimental validation tests consisted of 22 tests using three scenarios: impacts from foam particles, BB's, and baseballs onto fresh eyes used within 24 hours postmortem. The energies of the projectiles were chosen so as to provide both globe rupture and no rupture tests. Displacements of the eye were recorded using high speed color video at 7100 frames per second. The matched simulations predicted rupture of the eye when rupture was seen in the BB and baseball tests, and closely predicted displacements of the eye for the foam tests. Globe rupture has previously been shown to occur at peak stresses of 9.4 MPa using the material properties included in the model. Because of dynamic effects and improvements in boundary conditions resulting from a more realistic modeling of the fluid in the anterior and posterior chambers, the stresses can be much higher than those previously predicted, with the globe remaining intact. The model is empirically verified to predict globe rupture for stresses in the corneoscleral shell exceeding 23 MPa, and local dynamic pressures exceeding 2.1 MPa. The model can be used as a predictive aid to reduce the burden of eye injury, and can serve as a validated model to predict globe rupture.

Journal Article↗
PubMed1998

Cardiovascular risks to young persons on the athletic field.

Sudden cardiac deaths of young athletes, which are usually associated with physical exertion, continue to achieve high public visibility and generate considerable concern. Despite broad community participation in sports, such catastrophes are uncommon, occurring in about 1/200000 high school athletes per academic year. Various unsuspected congenital cardiovascular diseases are usually responsible; the most common lesions are hypertrophic cardiomyopathy and several congenital coronary artery anomalies. Selected reports suggest that arrhythmogenic right ventricular dysplasia may be a more common cause of these deaths than previously suspected. In some trained athletes with borderline increases in thickness of the left ventricular wall, mild morphologic expression of hypertrophic cardiomyopathy can often be distinguished from the physiologic consequences of athlete's heart by noninvasive clinical assessment and testing. In addition, the recognized cardiovascular risks of the athletic field are now extended to include cardiac arrest resulting from relatively modest, nonpenetrating chest blows produced by projectiles (such as baseballs) or bodily contact in the absence of underlying cardiac disease and without structural injury to the chest wall or heart. These uncommon but usually fatal events seem to result when chest impact occurs precisely during the vulnerable phase of repolarization, and they may be reduced by use of softer baseballs. Preparticipation screening for cardiovascular disease, consisting of standard history and physical examination, is customary practice for most high school and college athletes in the United States. Evidence suggests, however, that the present screening process for cardiovascular disease in high school athletes may be largely inadequate, given the content of the approved screening questionnaires (which serve as guidelines for the process) and the use of examiners with little cardiovascular training. This emphasizes the need for national standardization of preparticipation screening. The recommendations of the 26th Bethesda Conference for disqualification from competitive athletics are now a standard for management decisions when cardiovascular abnormalities are identified in trained athletes.

Cardiovascular Diseases↗
PubMed2002

A patient's view on health. Spring training: a thoughtful approach.

As I write this, the weather is still cold and dry in the Pacific Northwest. The Olympics are history, and a slow transition is being made from indoor winter sports to outdoor spring sports. As I rush my son from his basketball game to an early season baseball practice, I myself am starting to feel the anticipation of another season on the baseball diamond.

Exercise↗
PubMed2002

Side-to-side comparisons of bone mineral density in upper and lower limbs of collegiate athletes.

This cross-sectional study investigated the effects of participation in various sports on side-to-side (contralateral) differences in bone mineral density (BMD) of the upper and lower limbs. The BMD of the arms and legs was measured using dual energy X-ray absorptiometry. The subjects were 184 collegiate athletes, both men and women, who participated in NCAA Division I-A baseball, basketball, football, golf, soccer, tennis, cross-country, indoor/outdoor track, and volleyball. Results revealed greater BMD of the right arms compared with the left arms for all teams, with the most pronounced differences observed in men's and women's tennis and men's baseball. Differences in the lower limbs were less common. No significant differences in lower limb BMD were found in the women. In men, differences in lower limb BMD were found in the football and tennis teams, with the nondominant leg having greater bone mass. Recognition of contralateral differences in bone density may be of particular interest to strength and conditioning professionals as they consider the need to include bilateral and unilateral training programs in an effort to maximize performance and minimize stress-related injuries.

Absorptiometry, Photon↗
PubMed1999

Injury patterns in selected high school sports: a review of the 1995-1997 seasons.

OBJECTIVE: To characterize the risk of injury associated with 10 popular high school sports by comparing the relative frequency of injury and selected injury rates among sports, as well as the participation conditions within each sport. DESIGN AND SETTING: A cohort observational study of high school athletes using a surveillance protocol whereby certified athletic trainers recorded data during the 1995-1997 academic years. SUBJECTS: Players listed on the school's varsity team rosters for football, wrestling, baseball, field hockey, softball, girls' volleyball, boys' or girls' basketball, and boys' or girls' soccer. MEASUREMENTS: Injuries and opportunities for injury (exposures) were recorded daily. The definition of reportable injury used in the study required that certified athletic trainers evaluate the injured players and subsequently restrict them from participation. RESULTS: Football had the highest injury rate per 1000 athlete- exposures at 8.1, and volleyball had the lowest rate at 1.7. Only boys' (59.3%) and girls' (57.0%) soccer showed a larger proportion of reported injuries for games than practices, while volleyball was the only sport to demonstrate a higher injury rate per 1000 athlete-exposures for practices than for games. More than 73% of the injuries restricted players for fewer than 8 days. The proportion of knee injuries was highest for girls' soccer (19.4%) and lowest for baseball (10.5%). Among the studied sports, sprains and strains accounted for more than 50% of the injuries, except in field hockey (45.7%). Of the injuries requiring surgery, 60.3% were to the knee. CONCLUSIONS: An inherent risk of injury is associated with participation in high school sports based on the nature of the game and the activities of the players. Therefore, injury prevention programs should be in place for both practices and games. Preventing reinjury through daily injury management is a critical component of an injury prevention program. Although sports injuries cannot be entirely eliminated, consistent and professional evaluation of yearly injury patterns can provide focus for the development and evaluation of injury prevention strategies.

Journal Article↗
PubMed1989

Oral trauma in adolescent athletes: a study of mouth protectors.

The purpose of this study was to determine the extent of mouth protector use, as well as the amount and type of oral trauma associated with and without mouth guard wear in adolescent athletes. Coaches' perceptions and regulations involving the use of mouth protectors also were examined. Interviews were collected from 2470 junior and senior high school football players with all oral trauma being documented, regardless of the sport during which the injury occurred. Nine per cent of all players suffered from some form of oral injury while another 3% reported a loss of consciousness. Seventy-five per cent of the injuries occurred while not wearing mouth guards, and of this total 40% occurred during baseball and basketball. Fifty-six per cent of all concussions were suffered while not wearing mouth guards. Despite the ability of mouth protectors to significantly help reduce oral injuries, trauma related to sports is more prevalent than previously reported. This study supports the recommendation of mandatory mouth guards in baseball and basketball.

Adolescent↗
PubMed1995

Injury prevention in an urban setting: challenges and successes.

The Harlem Hospital Injury Prevention Program (HHIPP) was established in 1988 with the goal of reducing injuries to children in central Harlem by providing safe play areas, supervised activities, and injury prevention education. To achieve this goal, a broad-based coalition was formed with state and local governmental agencies interested in injury prevention and with community groups, schools, parents, and hospital staff. An evaluation of the program in terms of both process and outcome formed a critical element of this effort. Since 1988 the HHIPP, as the lead agency for the Healthy Neighborhoods/Safe Kids Coalition, developed or participated in two types of programs: injury-prevention education programs and programs that provide safe activities and/or environments for children. The educational programs included Window Guards campaign; Safety City Program; Kids, Injuries and Street Smarts Program (KISS); Burn Prevention Curriculum and Smoke Detector Distribution; Harlem Alternative to Violence Program; Adolescent Outreach Program; and Critical Incident Stress Management Teams. The safe activities and environmental programs included the Bicycle Safety Program/Urban Youth Bike Corps; Playground Injury Prevention Program; the Greening of Harlem Program; the Harlem Horizon Art Studio; Harlem Hospital Dance Clinic; Unity through Murals project; baseball at the Harlem Little League; winter baseball clinic; and the soccer league. Each program was conceived using injury data, coupled with parental concern and activism, which acted as catalysts to create a community coalition to respond to a specific problem. Data systems developed over time, which monitored the prevalence and incidence of childhood injuries in northern Manhattan, including central Harlem, became essential not only to identify specific types of childhood injuries in this community but also to evaluate these programs for the prevention of injuries in children.

Accident Prevention↗
PubMed1996

Pitcher's arm: an electrodiagnostic enigma.

Every major league baseball pitcher, most minor league pitchers, but only few amateur pitchers that we have studied have had reduced sensory nerve action potentials in the throwing arm. We present 6 clinical cases which demonstrate the spectrum of "pitcher's arm." These cases suggest that the phenomenon is a pathologic process, probably an example of a repetitive use syndrome affecting the brachial plexus. Although it does not appear to impact performance, it has clear implications for the interpretation of electrodiagnostic studies in symptomatic pitchers.

Action Potentials↗
PubMedDate not supplied

Longitudinal growth study of male Japanese junior high school athletes.

The aim of this study was to establish the pattern of adolescent growth in height of male Japanese athletes, and to compare their growth with appropriate controls. The sample consisted of 126 baseball, 39 basketball, 83 soccer, and 53 volleyball players, and 36 nonathletes. The data were collected retrospectively in six public schools in Fukui Prefecture of Western Japan between 1970 and 1987. All subjects were measured at yearly intervals between the age of 6 and 18 years. The total number of measurement occasions for the 337 subjects amounted to 4,134. Athletes trained between 13 and 18 h/week. Individual growth patterns were determined by fitting Preece Baines model I to each individual's serial data. Various biological parameters were derived from the fitted curves. The results indicated that the average growth pattern of these adolescent athletes did not differ substantially from the control group. Volleyball players were significantly taller at 18 years (+3 cm) than the nonathletes (Student's t-test, P < 0.05). Soccer players showed a slight tendency towards late maturation with age at take-off and at peak velocity about half a year later than in nonathletes (Student's t-test, P < 0.05). The 2.3 cm gain in body height due to the later onset of the pubertal growth spurt in soccer players was counterbalanced by a 0.7 cm smaller prepubertal height and a 0.9 cm smaller adolescent gain, so that they ended up slightly, but not significantly, taller than the controls (+0.7 cm). The small differences in growth pattern observed between the nonathletes and the various sports suggest that, in contrast with top-level athletes, body size and maturation rate were not important selective factors in the various groups of athletes of the present study.

Adolescent↗
PubMedDate not supplied

Two methods for recommending bat weights.

Baseball players swung very light and very heavy bats through our instrument and the speed of the bat was recorded. These data were used to make mathematical models for each person. Then these models were coupled with equations of physics for bat-ball collisions to compute the Ideal Bat Weight for each individual. However, these calculations required the use of a sophisticated instrument that is not conveniently available to most people. So, we tried to find items in our database that correlated with Ideal Bat Weight. However, because many cells in the database were empty, we could not use traditional statistical techniques or even neural networks. Therefore, three new methods were used to estimate the missing data: (i) a neural network was trained using subjects that had no empty cells, then that neural network was used to predict the missing data, (ii) the data patching facility of a commercial software package was used, and (iii) the empty cells were filled with random numbers. Then, using these fully populated databases, several simple models were derived for recommending bat weights.

Adolescent↗
PubMed2003

Ultrasound treatment of nonunion of the hook of the hamate in sports activities.

Two cases of nonunion of the hook of the hamate were treated with low-intensity pulsed ultrasound. The patients were baseball players and had been injured as a result of hitting repeatedly. Nonunion was detected on computed tomography (CT) and was exposed to ultrasound for 20 min a day for 4 months. In both cases pain at the hypothenar eminence disappeared, and bone union was confirmed on CT at the end of the ultrasound treatment.

Adolescent↗
PubMed2004

A simple rule for controlling overarm throws to different targets.

We investigated the central programming of overarm throws by determining whether throws to spatially separate targets in the vertical direction (sagittal plane) are produced by changes in hand (i.e., finger) path direction or by changes in the timing of ball release. Six skilled throwers made 30 throws at the same speed with a baseball, from a sitting position with the chest fixed, at targets at different heights and distances. Arm segment angular positions in 3D were recorded with the search-coil technique. Videotaping revealed that ball direction was not, as commonly assumed, the tangent to the finger path at ball release. Rather ball direction was the tangent to the finger path at a point about half way between initial uncoupling of the ball from the hand and final ball release. When viewed from the side, finger paths were tilted upwards for the high and the far targets and downwards for the low and near targets. This was associated with changes in angular orientation of the upper arm in space. Throwing at spatially different targets was not associated with changes in the timing of ball release. We propose that there is a simple rule by which throws to targets in different directions and at different distances are controlled: throws of the same speed are produced by different finger path directions, but the same timing of ball release. Such a mechanism would simplify the neural control of throwing to different targets.

Analysis of Variance↗
PubMed2004

Sonography of injury of the ulnar collateral ligament of the elbow-initial experience.

OBJECTIVE: The purpose of this study is to describe the sonographic appearance of injuries of the ulnar collateral ligament (UCL) of the elbow. DESIGN AND PATIENTS: Eight non-professional male baseball pitchers, ages 13-35 years, with medial elbow pain and clinical suspicion of ulnar collateral ligament injury, were referred for imaging. All eight underwent sonography of the affected and contralateral asymptomatic elbow, and six also underwent MR imaging. Neither valgus stress nor power Doppler was used during the sonographic examinations. Time from onset of symptoms to imaging was 1.5 weeks to 6 months. Three patients had surgical confirmation of their injuries, with time from imaging to surgery of 2 days to 9 months. RESULTS: In four patients, the UCL was ruptured, manifest sonographically in three cases as discontinuity of the normally hyperechoic ligament with anechoic fluid in the gap and in one case as non-visualization of the ligament with heterogeneous echogenicity in the expected location of the ligament. Two adolescent patients had avulsions of the UCL from the medial epicondyle, with sonographic demonstration of the avulsed echogenic bony fragment in both cases. One patient had a mild sprain, manifest as mild thickening and decreased echogenicity of the ligament sonographically compared with the contralateral normal elbow, with mild surrounding hypoechoic edema. The eighth patient had a small partial tear of the deep surface of the distal aspect of the ligament, visualized as a hypoechoic focus between the deep surface of the ligament and its ulnar attachment. CONCLUSION: Tears of the ulnar collateral ligament are manifested sonographically as non-visualization of the ligament or alteration of the normal morphology.

Adolescent↗
PubMed2005

MRI findings in Little Leaguer's shoulder.

Little leaguer's shoulder, a stress injury of the proximal humeral physis, should be considered in the differential diagnosis for an adolescent baseball player with shoulder pain, especially if the player is pitching regularly in a competitive environment. While roentgenographs may or may not be helpful, depending on the duration and severity of the injury, we report the MRI appearance of a case of little leaguer's shoulder. We found MRI helpful in diagnosing injury to the growth plate that was radiographically occult; furthermore, we were able to document the patient's progress with a follow-up MRI examination, which showed improvement with treatment.

Adolescent↗
PubMed2002

The critical level of water deficit causing a decrease in human exercise performance: a practical field study.

To analyse the critical level of water deficit which causes a decrease in aerobic and anaerobic exercise performance, a step test score (STS) and 10 s maximal anaerobic power (MAP) output during cycling exercise were measured in two experiments (Ex-1, n=7, and Ex-2, n=9), before and after baseball practice, using subjects who played regularly. The measurements in both Ex-1 and Ex-2 were repeated under four conditions of fluid ingestion (FI) (FI of 80%, 60%, 40%, and 20% of the total sweat loss) on hot summer days. The subjects were allowed free access to a sports beverage, maintained at 10-15 degrees C, within any given FI condition during the exercise. The [mean (SEM)] duration of the exercise and the environmental conditions (wet bulb globe temperature) were similar between Ex-1 [3.52 (0.14) h and 29.2 (0.6) degrees C, respectively] and Ex-2 [3.82 (0.12) h and 29.2 (0.4) degrees C, respectively]. In both Ex-1 and Ex-2, the loss of body mass (Delta m(b)) increased significantly as FI decreased. In Ex-1, the STS significantly decreased ( P<0.05) at values of delta m(b) in excess of 2.4 (0.2)% (40%FI). In Ex-2, the MAP remained unchanged at values of delta m(b) up to 2.5 (0.3)% (40%FI), while the MAP significantly decreased ( P<0.05) at values of delta m(b) of 3.9 (0.2)% (20%FI). These results suggest that there is a critical level of water deficit at which a decrease in aerobic and anaerobic performance occurs, and that aerobic performance may be more adversely influenced by dehydration than anaerobic power output during exercise-induced dehydration.

Adult↗
PubMed1999

Tibial artery false aneurysm: uncommon result of blunt injury occurring during athletics.

Two young men presented with symptoms following lower extremity injuries sustained in the normal course of participation in sports. One played baseball while the other competed in Tae Kwon Do. One case presented with digital ischemia, the other developed a pulsating hematoma. Each came to angiography, and each proved to have a false aneurysm of a tibial artery. The tibial artery was ligated in each case, without further complications. The patient with digital ischemia was thought to have sustained microemboli, and also underwent lumbar sympathectomy.

Adolescent↗
PubMed2003

Stress fractures in athletes: review of 196 cases.

The purpose of this study was to investigate the association of stress fractures with age, sex, sport level, sporting activity, and skeletal site in athletes seen at our sports medicine clinic between September 1991 and May 2001. During these 10 years, 10 726 patients (6415 males, 3861 females) visited our clinic because of sport-related injuries, and 196 patients [125 males (1.9%), 71 females (1.8%)] sustained stress fractures. The average age of the patients with stress fractures was 20.1 years (range 10-46 years); 84 patients (42.6%) were 15-19 years of age, and 68 (34.7%) were 20-24 years of age. Altogether, 74 patients (37.8%) were active at the high recreational level and 122 (62.2%) at the competitive level. The sites of the stress fractures varied from sport to sport. The ulnar olecranon was the most common stress fracture site among baseball athletes and the rib among the rowing athletes. Classical ballet, aerobics, tennis, and volleyball athletes predominantly sustained stress fractures of the tibial shaft. Basketball athletes predominantly sustained stress fractures of the tibial shaft and medial malleolus and the metatarsal bone, whereas track and field and soccer athletes predominantly sustained stress fractures of the tibial shaft and pubic bone. Our results show that stress fractures are seen even in high-level adolescent athletes, with similar proportions for males and females, and that particular sports are associated with specific sites for stress fractures.

Adolescent↗
PubMed1993

Elbow arthroscopy in a mostly athletic population.

The effectiveness of elbow arthroscopy was assessed in 35 consecutive patients (primarily weight lifters and baseball players) treated by one surgeon. The most commonly treated lesions were loose bodies and impinging spurs. Most elbow problems resulted from repetitive or acute athletic trauma. Repetitive stress injuries usually involved the athlete's dominant arm (91%). A standardized rating system demonstrated significant improvement at 24 months' average follow-up. Flexion and extension improved an average of 9 and 6 degrees, respectively. Elbow arthroscopy appears to be a safe and effective treatment for athletes, allowing most a full return to participation in sports.

Activities of Daily Living↗