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PubMedDate not supplied

The Mumford procedure in athletes. An objective analysis of function.

No report in the English literature exists on objective muscle testing following the Mumford procedure (distal clavicular resection). Twenty-three athletes, including six at the professional level, were evaluated an average 3.7 years after the Mumford procedure was performed for degenerative changes after a Grade I or Grade II dislocation. All athletes were evaluated with an in depth questionnaire, physical examination, and radiographic study. Seventeen performed Cybex testing of both shoulders. All but one were satisfied with the surgery. Sixteen returned to their same level of sports activity, including five of the six professional athletes. The most common complaint of all those not achieving the previous level of sports was the inability to achieve their previous maximum bench press strength. All athletes demonstrated full motion; five exhibited painless crepitation at the acromioclavicular joint. Ten of the twenty-three exhibited increased horizontal clavicular motion. Radiographs demonstrated an average of 1.9 cm of bone resection, with varying amounts of ossification present between the remaining clavicle and acromion in eight athletes. The involved limb performed significantly more work than the sound limb in flexion (P = 0.0133) and internal rotation (P = 0.0575) at 300 deg/sec. The involved limb performed significantly more repetitions at 300 deg/sec than the sound limb in the extension plane (P = 0.0373). The sound limb was significantly stronger during extension (P = 0.0759) and flexion (P = 0.0063) at 60 deg/sec compared to the involved limb. The sound limb performed significantly more total repetitions at 300 deg/sec in the abduction-abduction plane than the involved limb (P = 0.0843).(ABSTRACT TRUNCATED AT 250 WORDS)

Acromioclavicular Joint↗
PubMedDate not supplied

Arterial abnormalities of the shoulder in athletes.

Vascular lesions of the shoulder may be misinterpreted as one of the more familiar shoulder abnormalities by a treating physician. We are reporting on 13 athletes who were found to have symptoms related to compression of the subclavian or axillary artery or their tributaries. Nine were amateur or professional baseball pitchers. Severe arm fatigue or finger ischemia, secondary to embolization, were presenting symptoms. Arm fatigue was noted in all pitchers. After complete history and physical examination, including auscultation for bruits in functional positions, all athletes were evaluated by noninvasive tests (Doppler and Duplex scanning). Arteriography was performed with positional testing, recreating overhead activity, and complete radiographic visualization of the dye to the digital arteries. Two patients were found to have subclavian artery aneurysm. The remaining athletes were found to have compression of the subclavian artery beneath the anterior scalene muscle (five patients), the axillary artery beneath the pectoralis minor (two patients), both arterial segments (two patients), and one was found to have arterial compromise at the level of the humeral head. Branch artery compression was also noted. One pitcher occluded the posterior circumflex humeral artery with embolization to the digit. The two patients with subclavian aneurysms underwent saphenous vein bypass with cervical rib resection. All of the other athletes except one underwent resection of a 2 to 3 cm segment of the anterior scalene muscle or pectoralis minor muscles. All returned to their previous level of activity except one patient who developed impingement type symptoms and required acromioplasty. He is currently undergoing rehabilitation. Proper recognition of vascular compromise in the upper extremity of athletes is essential to avoid the catastropic complications of arterial thrombosis.

Athletic Injuries↗
PubMedDate not supplied

Intercondylar notch size and anterior cruciate ligament injuries in athletes. A prospective study.

Published reports agree that there is a strong association between intercondylar notch stenosis and anterior cruciate ligament injuries. In a previously published retrospective study on bilateral anterior cruciate ligament injuries and associated intercondylar notch stenosis, we formulated the notch width index to measure and compare intercondylar notch width. The purpose of this prospective study was to establish a normal range for the notch width index and to correlate intercondylar notch size and anterior cruciate ligament injuries. We gathered data on 902 high school athletes, including range of motion, thigh girth, ligament stability and intercondylar notch width using the notch width index. The population was then followed prospectively and anterior cruciate ligament injuries were recorded and correlated with notch width index in a blind manner. Two-year results showed that the overall anterior cruciate ligament injury rate was 3%. The normal intercondylar notch ratio was 0.231 +/- 0.044. Intercondylar notch width index for men was larger than that for women. Athletes sustaining noncontact anterior cruciate ligament tears have statistically significant intercondylar notch stenosis (notch width index, 0.189). Ten of 14 athletes with noncontact anterior cruciate ligament injuries had a notch width index that was at least 1 SD below the mean. Athletes with contact anterior cruciate ligament injuries had a mean of 0.233. We conclude that athletes with a stenotic intercondylar notch are at significantly greater risk for sustaining noncontact anterior cruciate ligament injury.

Adolescent↗
PubMed2002

The injury risk associated with pes planus in athletes.

Despite the common prophylactic use of rigid orthotics in athletes with flat feet to prevent subsequent injury, there is little scientific data in the literature examining the relationship between pes planus and athletic injuries to the lower extremity. The current prospective study was undertaken to establish what relationship, if any, exists between foot morphology and subsequent lower extremity injury. A total of 196 subjects were enrolled in the study, of which 143 (73%) were male and 53 (27%) were female. Forty-two percent of the participants (83) engaged in contact sports. There were a total of 227 episodes of injury involving the lower extremity. Logistic regression using contact sports, gender, and all of the different foot contact areas that were measured at the beginning of the study was undertaken. Although gender and participation in contact sports was predictive of some lower extremity injuries, the existence of pes planus as measured by medial midfoot contact area as a percentage of total contact area was not a risk factor for any injury of the lower extremity. This study shows that in an athletic population that is representative of collegiate athletics, the existence of flat footedness does not predispose to subsequent lower extremity injury. The routine prophylactic use of orthotics in flat-footed athletes to prevent future injury may therefore not be justified based on the data available.

Ankle Injuries↗
PubMed1986

Thermographic diagnosis in athletes with patellofemoral arthralgia.

Pain in front of the knee is common in athletes and is often called patellofemoral arthralgia, but it is difficult to prove that the pain arises in that joint. Thermograms of 30 athletes clinically considered to have patellofemoral arthralgia were compared with those of a similar number of unaffected athletes matched for age and sex. A comparison was also made with thermograms of two older groups of 30 patients with knee involvement from either rheumatoid arthritis or osteoarthritis. Twenty-eight of the athletes with patellofemoral arthralgia had a diagnostic pattern on thermography. The anterior knee view showed a rise in temperature on the medial side of the patella and the medialis knee view showed that this temperature rise radiated from the patellar insertion of the vastus medialis into the muscle itself. The possible aetiological role of quadriceps muscle imbalance in athletes with patellofemoral arthralgia is discussed in relation to these findings.

Adolescent↗
PubMed2006

Assessment of total and segmental body composition in spinal cord-injured athletes in Okayama prefecture of Japan.

This study assessed total and segmental distribution of fat mass (FM) in athletes with spinal cord injury (SCI) and examined the relationships between segmental distribution of fat mass and age, injury level, athletic history, and training load in order to provide useful information for improvements in their physical strength and training. Twenty-five male athletes with SCI participated in the study. The whole bone composition was measured by a dual-energy X-ray absorptiometry (DXA) method for the calculation of bone minerals, FM, and fat-free mass. The percent fat of the trunk, arms, and legs was also calculated. The percent fat in the legs was highest in comparison with that in the trunk and arms (p < 0.001), and the percent fat in the trunk was higher than that in the arms (p < 0.001). The body fat (p < 0.01), waist circumference (p < 0.01), and waist-to-hip ratio (p < 0.0001) were higher in the group aged 40 or older in comparison with that aged 39 or younger. Path analysis revealed that training load was a factor decreasing the percent fat on the arms and trunk (p < 0.01), and athletic history was a factor reducing the percent fat on the arms (p < 0.05). Our study suggests that exercise is effective in reducing the waist circumference, waist-to-hip ratio, and percent body fat of SCI individuals, and that such effects can help to enhance athletic performance and likely to protect against development of metabolic syndromes resulting from a sedentary lifestyle.

Adipose Tissue↗
PubMed2005

Use of discretionary protective equipment in high school athletes: prevalence and determinants.

OBJECTIVES: We sought to describe the use of discretionary protective equipment among high school athletes and to examine social and behavioral determinants contributing to equipment usage. METHODS: We analyzed data from a 3-year (1996-1999), stratified, 2-stage cluster sample of athletes engaged in 12 organized sports in 100 North Carolina high schools (n=19728 athlete-seasons) (an athlete-season represents an individual student who participates in a particular sport in a particular season). We used generalized logistic regression to model the association of social and behavioral determinants and demographic variables with discretionary protective equipment use. RESULTS: About one third of high school athletes self-reported using lower extremity discretionary protective equipment. Girls, seniors, those who played limited-contact sports, and those who played multiple sports reported higher usage. Small school size, low player/coach ratio, high proportion of team usage, and history of previous lower extremity injury were important predictors of usage. Coaches' experience, qualifications, and training, however, were not predictive of usage. CONCLUSIONS: Intervention efforts to promote use of discretionary protective equipment need to target school-level factors and should consider both team requirements and the role of peers in setting and reinforcing norms.

Adolescent↗
PubMedDate not supplied

Knee injuries in athletes. Review of exertion injuries and retrospective study of outpatient sports clinic material.

About one third of all sports injuries admitted to outpatient sports clinics concern knees. The incidence of different knee disorders in an outpatient sports clinic material and a review of the literature concerning the wide and problematic area of knee exertion injuries in athletes is presented. Exertion injury is defined as non-traumatic pain syndrome in the musculoskeletal system, including typical stress injuries and pain syndromes associated with physical activity but also has other important aetiological factors. 2762 athletes were admitted to the Turku Sports Medical Research Unit's outpatient sports clinic from 1976 to 1983 and 886 (32%) of them, 697 male and 189 female athletes, had suffered knee disorders. Football (soccer) [20.8%], long-distance running (13.1%), volleyball (11.6%), orienteering (7.6%) and ice-hockey (7.2%) had the highest incidence and the most common knee disorders were patellar apicitis (20.4%), Osgood-Schlatter's disease (10.1%), patellar chondropathy (10.0%), ligamentous sprains (9.0%) and meniscus tears (6.9%). The mean age of all athletes with knee disorders was 20.8 years. On an average each complaint caused 2.16 appointments. Careful evaluation of malalignments predisposing the athlete to exertion injury is necessary in the treatment of knee disorders and to avoid the recurrence of the exertion injury due to some biomechanical reason. The authors emphasise the importance of careful clinical examination. Although our review does not include detailed information about injuries originating in a single trauma, it is important to pick up the cases of ligamentous tears early so they can be appropriately repaired. Diagnostic and operative arthroscopy adds a new method in avoiding diagnostic errors and in shortening the postoperative rehabilitation.

Adult↗
PubMed1990

Intrinsic risk factors and athletic injuries.

The benefits of physical activity are widely known. However, the risk of a musculoskeletal injury is an unfavourable consequence in physical training. Age, gender, injury history, body size, local anatomy and biomechanics, aerobic fitness, muscle strength, imbalance and tightness, ligamentous laxity, central motor control, psychological and psychosocial factors as well as general mental ability are factors in the predisposition to injury. Junior (15 to 16 years) and senior athletes seem to be at a higher risk of injury in many types of sport. However, the relationship between age and injuries apparently depends on both the type and intensity of activity practiced. The majority of injured athletes in many studies have been males. Men are, however, more likely to participate in vigorous exercise and sport and it is not known if men are at a generally higher risk of injury when the exposure is taken into account. Certain lesions, such as sprains, strains and dislocations, tend to recur. Previous injuries may necessarily not cause a repetition of injury if treated adequately, but certain individuals may be at a higher risk of injury due to injury-prone biological characteristics. Excessive height and weight have been shown to predispose to stress injuries in physical training. Idiopathic or acquired abnormalities in the anatomy or biomechanics in any joint may lead to a local injury. However, physical requirements vary widely between different types of activity and predisposition to injury due to anatomical or biomechanical factors seems to be characteristic for each type of exercise. Lack of fitness, muscle weakness, joint looseness and poor general flexibility have been suggested as factors in the outcome of athletic injuries but no definite conclusions can be made on the basis of the existing literature. Long simple reaction times to visual stimuli and long choice reaction times to visual stimuli have recently been related to musculoskeletal injuries. No exceptional personality dimension in injury proneness as a whole has been found and the results from specific groups cannot be extrapolated generally. Accumulation of life stress apparently predisposes to an athletic injury. Musculoskeletal injuries seem to be more common in subjects with lower scores in intelligence tests but no causation has been shown yet. Altogether, a complex network of risk factors for athletic injuries has been found. However, no prospective study including all the recognised injury risk factors has been presented in the literature.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1997

Stress fractures in female athletes. Diagnosis, management and rehabilitation.

Stress fractures are a common overuse injury among athletes. The incidence of stress fractures among females is higher in the military, but this difference is not as evident in the athletic population. The history of the patient with stress fracture is typically one of insidious onset of activity-related pain. If the patient continues to exercise, the pain may well become more severe or occur at an earlier stage of exercise. As well as obtaining a history of the patient's pain and its relation to exercise, it is important to determine the presence of predisposing factors. On physical examination, the most obvious feature is localised bony tenderness. Occasionally, redness, swelling or periosteal thickening may be present at the site of the stress fracture. The diagnosis of stress fracture is primarily a clinical one; however, if the diagnosis is uncertain, various imaging techniques can be used to confirm the diagnosis. In the majority of stress fractures, there is no obvious abnormality on plain radiograph. Although the triple phase bone radiograph is extremely sensitive, the fracture itself is not visualised and it may be difficult to precisely locate the site, especially in the foot. The radionuclide scan will detect evolving stress fractures at the stage of accelerated remodelling, so the findings must be closely correlated with the clinical picture. The characteristic bone scan appearance of a stress fracture is of a sharply marginated area of increased uptake, usually involving one cortex of the bone. Computerised tomography scanning is a helpful addition if the fracture needs to be visualised, or to distinguish between a stress reaction and stress fracture. Magnetic resonance imaging (MRI) is being used increasingly as the investigation of choice for stress fractures. The typical findings on MRI are of periosteal and marrow oedema, as well as fracture line. The basis of treatment of a stress fracture involves rest from the aggravating activity. Most stress fractures will heal in a straightforward manner, and return to sport occurs within 6 to 8 weeks. The rate of resumption of activity should be influenced by symptoms and physical findings. When free of pain, the aggravating activity can be resumed and slowly increased. It is important that the athlete with a stress fracture maintain fitness during this period of rehabilitation. The most commonly used methods are cycling, swimming, upper body weights and water running. There are a number of specific stress fractures that require additional treatment because of a tendency to develop delayed union or nonunion. These include stress fractures of the neck of the femur, anterior cortex of the tibia, navicular and second and fifth metatarsals. An essential component of the management of stress fractures, as with any overuse injury, involves identification of the factors that have contributed to the injury and, where possible, correction or modification of some of these factors to reduce the risk of the injury recurring. Stress fractures are more common in female athletes with menstrual disturbances. This may be due to the effect on bone density. The role of hormonal replacement in the management of these athletes is unclear at this stage.

Adolescent↗
PubMed1998

Elbow, forearm and wrist injuries in the athlete.

Competitive and recreational athletes sustain a wide variety of soft tissue, bone, ligament, tendon and nerve damage to their upper extremities. Most such injuries are related to direct trauma or repetitive stress, and account for a significant amount of 'down time' for athletes participating in a wide range of sports, particularly those in which the arm is utilised for throwing, catching or swinging. Overuse injuries to the elbow include musculotendinous injuries, ulnar nerve injuries and ligamentous injuries. Osteochondrol lesions of the capitellum and posterior impingement injuries in the joint are frequently seen in athletes as well. Acute traumatic injuries to the elbow include tendon ruptures, elbow dislocations and intra-articular fractures. Forearm overuse injuries in athletes include fracture of the carpal scaphold, fracture of the hook of the hamate, Kienbock's syndrome and pisoquetral syndromes. ligamentous injuries include scapholunate, lunotriquetral and midcarpal instability injuries. Injuries to the distal radio-ulnar joint and triangular fibrocartilage are also quite common in athletes, and require careful evaluation and treatment.

Athletic Injuries↗
PubMed2005

Experience with cervical stenosis and temporary paralysis in athletes.

OBJECT: Transient spinal cord injury (TSCI) in athletes presents one of the most challenging clinical scenarios. Management difficulties in and subsequent return-to-play decisions are especially important in those with cervical canal stenosis. METHODS: Ten athletes (nine male and one female patients) were evaluated for TSCI. The diagnostic survey included physical and neurological examinations, plain radiographs with flexion-extension dynamic studies, computerized tomography, and magnetic resonance (MR) imaging. Clinical courses were followed and, in those who returned to contact sports activities, subsequent experience was noted. Symptoms consisted of paralysis, weakness, or numbness in all four extremities, their duration ranging from 15 minutes to 48 hours. Radiography revealed no evidence of fracture/dislocation or ligamentous instability. Spinal stenosis of 8 to 13 mm in length at three or more levels was evident in all cases. Four patients returned to competition without recurrent TSCI (mean follow-up duration 40 months); six individuals retired. The occurrence of TSCI is not uncommon in athletes involved in contact sports. The diagnostic workup focuses on excluding fracture/dislocation, cord contusion, ligamentous infolding or instability, herniated nucleus pulposus, syrinx, or other surgically correctable lesions. There appear to be two groups of athletes who sustain TSCI: those who experience TSCI yet in whom radiographic studies are normal, and those with cervical stenosis, the most difficult management group. CONCLUSIONS: It does not appear that a single episode of TSCI in an athlete with spinal stenosis will substantially increase the risk of subsequent catastrophic spinal cord injury in those in whom MR imaging demonstrates preservation of cerebrospinal fluid signal.

Athletic Injuries↗
PubMed1998

Treatment of articular cartilage defects in athletes: an analysis of functional outcome and lesion appearance.

This article characterizes chondral injuries and reviews the results of microfracture treatment in high-level competitive and recreational athletes. Thirty-eight high-level and 140 recreational athletes completed functional questionnaires preoperatively and yearly postoperatively, recording symptoms, function, and activity level. Second-look arthroscopy tapes were available in 26 high-level and 54 recreational athletes. The mean follow-up for the high-level athletes was 3.7 +/- 1.4 years. Chondral defects averaged 223 +/- 180 mm2. Lesion size and follow-up were not significantly different in the recreational group. Functional questionnaire responses demonstrated significant improvements from the time of microfracture to final follow-up. Improvement in function and symptoms was similar for the competitive and recreational athletes.

Adolescent↗
PubMedDate not supplied

On-the-field management of athletic head injuries.

Head injuries are prevalent in collision sports. Concussions represent the relatively benign end of the spectrum of injuries. Severe closed head injuries include epidural hematomas, acute subdural hematomas, intracerebral hematomas, intraventricular hematomas, subarachnoid hemorrhages, and diffuse axonal injuries. Second impact syndrome represents a severe cerebral autoregulatory dysfunction that can lead to death in an athlete who sustains a second (often minor) closed head trauma while still symptomatic from a previous head injury. Generally, athletes who have suffered a severe closed head injury should not return to play. Exceptions include athletes asymptomatic for 1 year who return to a noncontact sport and those who recover completely from an epidural hematoma without underlying brain injury. Several guidelines for returning athletes to play have been proposed and are commonly used. The team physician has the responsibility of on-the-field evaluation and management of athletes with head injuries, as well as of advising them when it is safe to return to play.

Athletic Injuries↗
PubMed2001

A survey of sports injuries among a convenience sample of Israeli athletes.

BACKGROUND: Israel lacks a systematic surveillance of sports injuries, and knowledge of risk factors and specific patterns of injury is inadequate. In order to promote prevention of sports-related injuries, the magnitude of the problem must first be identified and the incidence and severity of sports injuries described. OBJECTIVE: To conduct a survey on previous sports injuries among a sample of Israeli athletes. METHODS: A convenience sample of Israeli amateur athletes participating in the 1997 15th Maccabiah Games was randomly selected. The study group answered an anonymous self-administered questionnaire that included sociodemographic data, and information regarding their sports activity and sports-related injuries that had occurred during the previous 2 years. RESULTS: The study group, aged 12-73 years (median age 21), comprised 301 consenting athletes in 28 different sports. Of these athletes 56.1% reported having had at least one injury. Most injuries (75.6%) involved the upper and lower extremities, and 37.8% of the injured sportsmen had received medical attention from a physician. Half of the athletes participated in contact sports--both collision and limited impact. This group had a much greater proportion of reported injuries in all age groups. CONCLUSION: Surveillance of sports injuries should be expanded in order to develop appropriate prevention programs in Israel.

Adolescent↗
PubMedDate not supplied

Oral piercing in athletes: implications for general dentists.

General dentists need to be aware of the growing number of athletes who display various forms of body art. Intraoral piercing and tongue jewelry place athletes at greater risk for serious medical and dental consequences that are confounded when the athlete attempts to compete while wearing a mouthguard with the tongue jewelry in place. All body jewelry should be removed during sporting events. General dentists have a professional responsibility to: become more aware of the extent and implications associated with tongue piercing in athletes to discourage athletes from having the tongue pierced; be prepared to manage postpiercing intraoral and dental complications; provide proper advice for the care and use of a mouthguard in the presence of tongue jewelry; and develop educational strategies that address the medical and dental complications of intraoral piercing.

Airway Obstruction↗
PubMed2002

Results of inguinal canal repair in athletes with sports hernia.

AIMS: To evaluate the role of surgical exploration and repair of the inguinal canal in athletes suspected of having a sports hernia. METHODS: Thirty-five (34 males, 1 female) athletes with a suspected sports hernia underwent surgical exploration and inguinal hernia repair. After six months, all athletes were sent questionnaires to assess any improvement in analogue pain scores, return to sport, recurrence of symptoms and the overall result of surgery. RESULTS: Operative findings revealed a tear in the external oblique aponeurosis with or without a significant posterior bulge (n=20), a lone significant posterior bulge (n=10), a tear in the conjoint tendon with dilated superficial ring (n=3), small direct hernial sac (n=1) and lipoma of the spermatic cord (n=1). Surgery consisted of repair of external oblique tear (when present) and prolene darn or lichtenstein mesh repair of the posterior inguinal canal. Twenty-seven patients replied to the questionnaire giving a response rate of 78%; of these, 25 patients (93%: 95% CI 83-100) had returned to normal athletic activities at pre-injury level. There was a marked improvement in level of pain (median pain level=8 pre-operative vs 2 post-operative, p<0.001). Eleven patients (41%) rated the results as excellent, eleven (41%) as good and five (18%) as fair and none worse. Six patients complained of occasional discomfort related to the scar. Three patients complained of recurrence of their symptoms after 4 to 5 months following strenuous exercise. CONCLUSION: Sports hernia presents with a spectrum of surgical findings. Athletes with sports hernia should be considered for routine hernia repair, as the majority of the patients benefit from surgery. It is important to offer a structured rehabilitation programme to maximise the benefits of surgery.

Adult↗
PubMedDate not supplied

The preparticipation physical examination for athletics: a critical review of current recommendations.

The preparticipation physical examination (PPE) has become the standard of care for the millions of high school students in the United States as they prepare for athletic participation. These assessments are intended to identify medical conditions that may affect safe and effective participation in organized sports. The PPE has become an integral aspect of the athletic and sports medicine system during the last three decades. Over time, the PPE has been revised, largely based upon the recommendations of large medical organizations. Several primary and secondary goals have been presented to be accomplished through the PPE. One particular goal of these assessments is to identify individuals with underlying cardiovascular disease, a significant cause of acute sudden cardiac death in high school and college athletes. While current research continues to demonstrate that the PPE has no effect on the overall morbidity and mortality rates in athletes, other objectives may be fulfilled by these examinations. In order to improve the ability of these examinations in fulfilling their primary objectives, instruments that have better results in preventing the injuries and deaths associated with athletic participation should be developed and investigate.

Adolescent↗