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Lower extremity soft tissue conditions.

Lower extremity soft tissue injuries and overuse conditions are frequently encountered among athletes. Muscles are frequently strained or contused, arteries and nerves can become entrapped, and tendons and bursae can become inflamed. Familiarity with the anatomy of the involved area is essential for making the correct diagnosis. The majority of these conditions can be accurately diagnosed based on a thorough history and physical examination alone, without the need for expensive imaging or invasive tests. Most of these conditions can be successfully managed conservatively, avoiding surgical intervention.

Athletic Injuries↗

Neck and back pain in bicycling.

Neck and back pain are among the most common overuse injuries in cyclists. Bicycle fit, improper equipment, training errors, and individual anatomic factors are important evaluation considerations. By learning how to recognize and treat contributing factors, as well as learning a few simple bike-fitting techniques, physicians can treat and prevent many common problems of this popular activity.

Back Pain↗

Musculoskeletal injuries in the pediatric and adolescent athlete.

There are approximately 35 million children participating in organized sports in the United States. With this increasing participation, we have seen an overall increase in sports-related injuries in young athletes over the past 20 years. Young athletes suffer both acute and chronic, or overuse, injuries. They are susceptible to many of the same injuries as their adult counterparts, but due to the effects of growth on the musculoskeletal system, they are at risk for injuries to the growth plate, apophysis, and joint surface. Common acute and overuse injuries seen in young athletes are discussed here.

Acute Disease↗

A plyometric training model used to augment rehabilitation from tibial fasciitis.

Shin splints, an exercise-induced form of lower leg pain, is a common complaint among athletes. Considered an overuse injury that compromises the dense and tough fascial attachments of the tibialis posterior and/or tibialis anterior muscles from the tibia, it responds well to a multiphase treatment plan that incorporates plyometric strengthening and conditioning exercises. Plyometrics may be safely introduced as early as the third or functional phase of recovery. A progressive plyometric program that emphasizes a gradual development of eccentric stress loading to the musculoskeletal components of the deep posterior and anterior muscle compartments of the lower leg is described.

Athletic Injuries↗

Stitch in the side: causes, workup, and solutions.

Side stitch is an acute, localized, sharp, transient pain that occurs during exercise, most often in runners or swimmers, but also in those participating in team sports, and less often in cyclists. The pain is vexing and performance-limiting, but fleeting and benign. Three theories compete to explain it: diaphragmatic ischemia, stress on peritoneal ligaments, and irritation of the parietal peritoneum. The differential diagnosis seems broad, but the classic side stitch is so unique in its features and setting that a reasonable working diagnosis can be made from a careful history and physical examination. Practical tips, although anecdotal, offer lasting solutions.

Abdominal Pain↗

Repeat mild traumatic brain injury: how to adjust return to play guidelines.

Determining when it is safe for an athlete to return to play (RTP) after concussion is one of the most difficult decisions facing the team physician. There is significant variability in the evaluation and management of mild traumatic brain injury (mTBI). In the past decade, a tremendous amount of sport-specific research has improved our understanding of mTBI. The advent of neuro-psychologic (NP) testing batteries designed to assess concussive injury has improved the assessment of cognitive dysfunction that occurs in the absence of structural brain abnormalities. The severity of injury is determined by the nature, burden, and duration of symptoms. Athletes must be asymptomatic and have a normal neurologic and cognitive evaluation prior to RTP. Several factors aid in making the RTP decision, including age, the severity of injury, and history of prior mTBIs. Given the potential complications of mTBI, the RTP decision must be made using a thoughtful, individualized process.

Age Factors↗

Direct costs and patterns of injuries among residential carpenters, 1995-2000.

Workers' compensation records for residential contractors were combined with hours worked provided by the union to examine injury rates and costs among union carpenters between 1995 and 2000. Brief text descriptions were reviewed to describe more costly injuries. Costs per hour worked decreased over 6 years, largely because of declines in rates and mean costs for falls from elevations. Higher costs were associated with injuries from falls, raising framed walls, setting steel I-beams, and pneumatic nail guns. Prevention priorities should include fall protection; methods to safely set steel beams, raise and brace framed walls; and steps to prevent injuries from pneumatic tools. Cost data provide an important measure that is useful in focusing prevention; combined with even limited descriptions of injuries target areas for intervention can be identified based on frequency or severity.

Accidents, Occupational↗

Evaluation and treatment of medial ulnar collateral ligament injuries in the throwing athlete.

Medial ulnar collateral ligament (UCL) injuries are common and are seen most frequently in baseball pitchers. Appropriate recognition, treatment, and rehabilitation are necessary to ensure the best chance for return to preinjury levels of participation. Participation in competitive sports may be disrupted for 6 months to 1 year when treated optimally. Abstinence from play may be prolonged when treatment is delayed or if conservative treatment fails; this delay carries significant consequences to the professional, collegiate, and high school athlete. The orthopedic literature is replete with recommendations for the care of these athletes. These recommendations are generally based on retrospective reviews. The purposes of this paper are 3-fold: to provide background knowledge on this injury, to synthesize the current knowledge on the diagnosis, treatment, and rehabilitation of athletes with medial UCL injuries, and lastly, to provide a treatment algorithm for athletes with UCL injuries.

Arm Injuries↗

Road bicycle fit.

Explore the source record for details and available documents.

Athletic Injuries↗

Intrinsic factors associated with exercise-related leg pain in collegiate cross-country runners.

OBJECTIVES: This study (1) examined the occurrence of exercise-related leg pain (ERLP) in collegiate cross-country athletes and (2) compared structural factors in runners with and without ERLP history. STUDY DESIGN: Cross-sectional design comparing 2 groups of cross-country athletes (with and without ERLP history). SETTING: Intercollegiate athletics. PARTICIPANTS: A total of 63 athletes (30 males, 33 females) representing 2 cross-country teams consented to participate. MEASURES: Athlete examination included self-report of ERLP history, active ankle dorsiflexion with knee extended and flexed, navicular drop (ND), and 1st ray length. ND index was calculated by dividing ND by 1st ray length. Athletes on 1 team (n = 32) were followed through 1 season to identify incidence of ERLP over the course of 1 season. Independent t tests were used to compare structural measures of those with and without ERLP history, and chi2 was used to examine frequencies. RESULTS: Of the 63 athletes, 33 (52%) reported ERLP history; most reported medial leg pain and also bilateral symptoms. No differences in structural measures were found between those with and without ERLP history. Ten of 32 athletes (31%) reported the occurrence of ERLP during the fall season, 8 of whom had a history of ERLP. CONCLUSIONS: Exercise-related leg pain was a common complaint among these athletes, usually occurring bilaterally and located along the medial leg. Athletes with ERLP history did not have a greater foot pronation as measured by ND, nor was there limited ankle range of motion as compared with those without ERLP history. Further research is needed to identify factors associated with the development of ERLP.

Adolescent↗

Femoral neck stress fracture in a sanitary worker.

Stress fractures of the femoral neck are uncommon, it is important to have a high index of suspicion in young active people who perform repetitive vigorous activity or have recently had an increase in frequency of such activity. We report a case of femoral neck stress fracture in a sanitary worker which was treated successfully with a dynamic hip screw.

Adult↗

Foot and ankle injuries in the adolescent runner.

PURPOSE OF REVIEW: To evaluate the increase in overuse injuries in the adolescent athlete, specifically sports-related injuries to the foot and ankle of the adolescent runner. Factors affecting these injuries include anatomic considerations, gender, rate of development, growth, training errors, shoe wear, and running surface. RECENT FINDINGS: Most injuries in adolescent runners are overuse injuries rather than sudden traumatic events. Adolescent athletes are as prone as adults to poor form, poor habits, and poor training patterns. In addition, anatomic variants in the hindfoot, midfoot, and forefoot may predispose an athlete to specific injury. SUMMARY: Adolescent running injuries are common and becoming more frequent as trainers and athletes place increasing demands on the growing body. There is no evidence that this increased demand produces long-term adverse effects; however, a significant amount of time can be lost to injuries unless training patterns are constructed to allow for repair of the adolescent athlete.

Adolescent↗

A comparison of flexor tenosynovectomy, open carpal tunnel release, and open carpal tunnel release with flexor tenosynovectomy in the treatment of carpal tunnel syndrome.

The purpose of this study was to identify the advantages and disadvantages of performing a flexor tenosynovectomy without dividing the transverse carpal ligament, an open carpal tunnel release, and an open carpal tunnel release with flexor tenosynovectomy in the treatment of carpal tunnel syndrome. From 1990 to 1998, a retrospective study was done in which a flexor tenosynovectomy was performed in 133 patients without division of the transverse carpal ligament and compared with 68 patients who had an open carpal tunnel release and 75 patients who had an open carpal tunnel release and flexor tenosynovectomy. Patients were followed up for an average period of 30 weeks with history and physical findings and nerve conduction velocities and for an average period of 2.6 years with telephone interviews. There was a 2.3 percent incidence of pillar pain in the flexor tenosynovectomy group, which may explain the earlier return to their regular jobs at an average time of 9.9 weeks, compared with 10.7 weeks for the carpal tunnel release group and 12.0 weeks for the carpal tunnel release/flexor tenosynovectomy group. The latter two groups had an incidence of pillar pain of 12.1 percent and 25.3 percent, respectively. Postoperative grip strength was statistically significantly improved in the flexor tenosynovectomy group compared with the other two groups, where adjustments were made for sex and preoperative grip strengths with standard error of adjusted means. In the flexor tenosynovectomy group, 20.6 percent of patients had a previous open or endoscopic carpal tunnel release with recurrent carpal tunnel syndrome, compared with 5.2 percent in the open carpal tunnel release group and 21.6 percent in the open carpal tunnel release with flexor tenosynovectomy group. Excisional biopsies of flexor tenosynovium in the flexor tenosynovectomy, open carpal tunnel release, and open carpal tunnel release with flexor tenosynovectomy groups revealed an incidence of fibrosis in 89.2 percent, 88.9 percent, and 87.7 percent of specimens, respectively. Edema was a frequent finding, but an active inflammatory response was seldom seen. The findings in this study indicate that because of a significant decrease in pillar pain, a flexor tenosynovectomy in the treatment of carpal tunnel syndrome would likely benefit workers who use the palm of the hand in heavy manual or highly repetitive work by allowing them to return to regular duty sooner.

Adult↗