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Chronic musculoskeletal pain is becoming increasingly common in young athletes. When these athletes do not respond well to standard treatments, for example physical theraphy and anti-inflammatories, other diagnoses must be considered, such as reflex sympathetic dystrophy, fibromyalgia, and/or overtraining syndrome.
This article provides an overview of common upper extremity injuries in youth sports, including injuries to the shoulder, elbow, and wrist. Pain in the shoulder and elbow is common among youngsters who participate in throwing sports, raquet sports, and swimming, while wrist pain is common among young gymnasts. Acute trauma to the shoulder and elbow can occur in almost any sporting activity. This article provides descriptions of common injuries and guidelines for treatment.
The majority of pediatric sports-related injuries are relatively benign and are easily treated with conservative measures. When surgical intervention is required, it is usually effective in returning the athlete to participation within a reasonable time frame. Effective care of pediatric athletes, however, involves not only knowledge of the many types of injuries and their treatments but also insight into the demands of the various sports and the needs of individual athletes. Treatment and resumption of participation recommendations frequently vary depending on the patient's sport, level of participation, and willingness to substitute alternative sports for his or her primary one. As always, individualizing treatment leads to greater patient satisfaction and improved results.
Overuse syndromes are one of the most common occupational illnesses treated by primary care providers. Their pathophysiology parallels that of tenosynovitis. Occupational risk factors for overuse syndromes include repetition, high force, awkward joint posture, direct pressure, and vibration. Initial treatment is aimed at preventing fibrosis through rest, immobilization, and anti-inflammatory agents. Treatment must include identification and adjustment of occupational risk factors. Specific overuse syndromes are discussed, including tenosynovitis of the dorsal wrist extensor compartments and flexor tendons of the wrist, trigger finger, and carpal tunnel syndrome.
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Biopsy specimens were taken from the affected first dorsal interosseous muscle in 29 women with painful chronic overuse syndrome and from 8 volunteer controls. Structural differences in samples from the women with overuse syndrome included increased type 1 fibres with type grouping, decreased type 2 fibres, type 2 fibre hypertrophy, increased internal nuclear count, mitochondrial changes, and various ultrastructural abnormalities. These changes were related to clinical severity, and point to an organic cause for the syndrome.
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BACKGROUND: Groin pain is common among athletes. A major cause of long-standing problems is adductor-related groin pain. The purpose of this randomised clinical trial was to compare an active training programme (AT) with a physiotherapy treatment without active training (PT) in the treatment of adductor-related groin pain in athletes. METHODS: 68 athletes with long-standing (median 40 weeks) adductor-related groin pain--after examination according to a standardised protocol--were randomly assigned to AT or PT. The treatment period was 8-12 weeks. 4 months after the end of treatment a standardised examination was done. The examining physician was unaware of the treatment allocation. The ultimate outcome measure was full return to sports at the same level without groin pain. Analyses were by intention to treat. FINDINGS: 23 patients in the AT group and four in the PT group returned to sports without groin pain (odds ratio, multiple-logistic-regression analysis, 12.7 [95% CI 3.4-47.2]). The subjective global assessments of the effect of the treatments showed a significant (p=0.006) linear trend towards a better effect in the AT group. A per-protocol analysis did not show appreciably different results. INTERPRETATION: AT with a programme aimed at improving strength and coordination of the muscles acting on the pelvis, in particular the adductor muscles, is very effective in the treatment of athletes with long-standing adductor-related groin pain. The potential preventive value of a short programme based upon the principles of AT should be assessed in future, randomised, clinical trials.
34.8% of Italian schoolchildren carry more than 30% of their bodyweight at least once a week, exceeding limits proposed for adults. Given increasing evidence of back pain in children, the time has come to propose some limitations to backpack load.
Pain without accompanying tissue pathology poses a classic puzzle, presented in extreme form by phantom pain in a non-existent amputated limb. A clue to the origin of such pain is given by the recent discovery of a region of cortex active in response to incongruence between motor intention, awareness of movement, and visual feedback. Phantom-limb sensation, and repetitive strain injuries or focal hand dystonias in writers, musicians, or keyboard operators, are accompanied by plastic changes in sensorimotor cortex and by pathological pain. Disorganised or inappropriate cortical representation of proprioception may falsely signal incongruence between motor intention and movement, which results in pathological pain in the same way that incongruence between vestibular and visual sensation results in motion sickness.
As interest and participation in sports and recreational activities continue to increase, so do problems of the skin associated with sports participation. Primary care physicians and dermatologists may find the diagnosis of these sometimes unusual skin lesions difficult without knowledge of their association with sporting activities. Likewise, treatment of these skin lesions may be unsatisfactory without an understanding of the unique factors that contributed to the problem. This article reviews the cutaneous manifestations of sports participation. Traumatic and environmental skin injuries, skin infections, and exacerbation of preexisting dermatoses, as well as descriptions, predisposing conditions or causative agents, diagnosis, treatment, and prevention are discussed.