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PubMed1992

Returning injured athletes to competition: a role and ethical dilemma.

This study investigated the extent to which decisions by coaches and athletic trainers concerning the return of injured athletes to competition were influenced by the player's status and the game situation. Samples were drawn from Oregon high school and Canadian university basketball teams. Coaches and athletic trainers completed a questionnaire in which they decided whether an injured player should be returned to competition. The scenarios included winning, losing, or close games and involved a starter, first substitute, or bench player. Chi-square analyses revealed that coaches made decisions based on both a player's status and the game situation. In contrast, athletic trainers' decisions were not significantly influenced by these variables. Since the role of the coach seemingly makes it difficult to make health related decisions concerning injured players, athletic trainers should be responsible for such decisions.

Athletic Injuries↗
PubMed2004

Secondary school athletes: a study of mouthguards.

The purpose of this study was to determine the extent of mouthguard awareness and use, as well as the amount and type of oro-facial trauma associated with and without mouthguard wear in adolescent Nigerian athletes. A 13-item self-completion questionnaire was completed and returned by 1,127 secondary school athletes (completion rate of 93.9%) comprising 683 (60.6%) males and 444 (39.4%) females ranging in age from 12- to 19 years (mean age 15.18+/-2.97 SD). The athletes were randomly drawn from 23 secondary schools located in different parts of Ibadan city in Nigeria. Sixty-five-and-a-third percent of the athletes professed awareness of the need for mouthguards for sports, but only 19.6% claimed usage of the device. Thirty-four-and-a-half percent of the athletes reported having sustained one form of oro-facial injury or the other previously. The prevalence of oro-facial injuries was significantly lower while wearing a mouthguard (p<0.05), and most of the injuries occurred during contact sports. The study supports the need for the enforcement of mandatory mouthguard use in contact sports.

Adolescent↗
PubMed2004

The posterior impingement sign: diagnosis of rotator cuff and posterior labral tears secondary to internal impingement in overhand athletes.

We conducted this study to determine whether a test, the posterior impingement maneuver, could be used to prospectively identify articular side tears of the rotator cuff and/or posterior labrum. Sixty-nine athletes presented with posterior shoulder pain that developed during overhand athletics. Injured shoulders were placed into 90 degrees to 110 degrees of abduction, slight extension, and maximum external rotation, and an effort was made to elicit pain deep within the posterior aspect. Overall sensitivity of the test was 75.5%, and specificity was 85%. When only athletes with noncontact injuries (gradual onset of pain) were considered, sensitivity was 95% and specificity was 100%. A positive posterior impingement sign correlated highly with undersurface tearing of the rotator cuff and/or tearing of the posterior labrum in athletes with gradual onset of posterior shoulder pain during overhand athletics.

Adult↗
PubMed2006

"Stingers" in adolescent athletes.

Brachial plexus injuries commonly occur in athletes participating in contact sports. The incidence of transitory brachial plexus injury is approximately 30% to 50% over the course of a high school, college, or professional football player's career. These injuries are called "stingers" or "burners" because of the associated tingling that occurs in the upper extremity after the injury. Brachial plexus injuries are poorly understood and sometimes are difficult to manage. Appropriate knowledge and understanding of these injuries along with prompt recognition, diagnosis, and treatment are essential for optimal care of the injured athlete and for the athlete's timely return to play. Most injuries occur by one of three mechanisms: traction, compression, or hyperextension and compression. Injuries are clinically classified as neurapraxia, neurapraxia/axonotmesis, and neurotmesis according to their symptomatology and the pattern of symptom resolution. Most injuries are either a neurapraxia or a neurapraxia/axonotmesis. Most athletes recover completely and can return to play after they are asymptomatic and have regained full sensation, strength, and range of motion. Protective equipment has been introduced to decrease the occurrence of stingers. Education of the athlete, the family, and coaches is important to help them to understand and to assist in managing these injuries.

Adolescent↗
PubMed2006

Sports-related injuries among high school athletes--United States, 2005-06 school year.

Participation in high school sports helps promote a physically active lifestyle. High school sports participation has grown from an estimated 4 million participants during the 1971-72 school year to an estimated 7.2 million in 2005-06. However, despite the documented health benefits of increased physical activity (e.g., weight management, improved self-esteem, and increased strength, endurance, and flexibility), those who participate in athletics are at risk for sports-related injuries. High school athletes account for an estimated 2 million injuries, 500,000 doctor visits, and 30,000 hospitalizations annually. To date, the study of these injuries has been limited by inabilities to calculate injury rates, compare results among groups, and generalize findings from small, nonrepresentative samples. During the 2005-06 school year, researchers at a children's hospital in Ohio used an Internet-based data-collection tool to pilot an injury surveillance system among athletes from a representative national sample of U.S. high schools. This report summarizes the findings of that study, which indicated that participation in high school sports resulted in an estimated 1.4 million injuries at a rate of 2.4 injuries per 1,000 athlete exposures (i.e., practices or competitions). Surveillance of exposure-based injury rates in a nationally representative sample of high school athletes and analysis of injury patterns can help guide activities aimed at reducing these injuries.

Adolescent↗
PubMed2006

Arteriopathy in the high-performance athlete.

Pain occurs frequently in high-performance athletes and is most often due to musculoskeletal injury or strain. However, athletes who participate in sports that require highly frequent, repetitive limb motion can also experience pain from an underlying arteriopathy, which causes exercise-induced ischemia. We reviewed the clinical records and follow-up care of 3 high-performance athletes (mean age, 29.3 yr; range, 16-47 yr) who were admitted consecutively to our institution from January 2002 through May 2003, each with a diagnosis of limb ischemia due to arteriopathy. The study group comprised 3 males: 2 active in competitive baseball (ages, 16 and 19 yr) and a cyclist (age, 47 yr). Provocative testing and radiologic evaluation established the diagnoses. Treatment goals included targeted resection of compressive structures, arterial reconstruction to eliminate stenosis and possible emboli, and improvement of distal perfusion. Our successful reconstructive techniques included thoracic outlet decompression and interpositional bypass of the subclavian artery in the 16-year-old patient, pectoralis muscle and tendon decompression to relieve compression of the axillary artery in the 19-year-old, and patch angioplasty for endofibrosis affecting the external iliac artery in the 47-year-old. Each patient was asymptomatic on follow-up and had resumed participation in competitive athletics. The recognition and anatomic definition of an arteriopathy that produces exercise-induced ischemia enables the application of precise therapy that can produce a symptom-free outcome and the ability to resume competitive athletics.

Adolescent↗
PubMed1991

The use of dental implants in the treatment of athletic injuries.

This article is designed to help an athletic team dentist treat dental athletic injuries with implants. The different emergency situations that the team dentist will face are discussed, and an attempt is made to group the most likely implants that he or she may encounter. Advantages and disadvantages of each of the implant groups available are discussed in relation to the particular type of bone morphology resulting from athletic dental injuries. Currently, there are 58 root-form implants being sold, with new ones coming out monthly. The athletic team dentist is interested primarily in immediate single-tooth replacement systems, which can be classified into single-tooth blades and root forms. The latter groups can be subdivided into press-fit, cylindrical hollow baskets, cylindrical screws, and cylindrical fin-shaped implant systems. Certain implants systems have been selected, and their advantages and disadvantages described in detail. In addition, similar implants of each type are presented. Some implants which have more efficient prosthetic and delivery systems are mentioned. Several early devices are discussed as well, because the team dentist may encounter one of these in his practice. This paper will serve as a guide for the dentist who assumes the responsibility of treating athletic injuries with the use of dental implants.

Athletic Injuries↗
PubMed1991

Achilles tendon injuries in athletes.

During 1976-1986, 3,336 athletes consulted the Turku Sports Medical Research Unit, 455 (14%) of these for Achilles tendon injuries. Achilles tendon problems were more frequent among joggers (66%), tennis players (32%) and runners (24%), which emphasizes the aetiological role of running. Achilles tendon complaints (n = 698) consisted of paratenonitis (including tendinopathies) (66%), insertional (23%) and myotendineal (8%) pain syndromes and total tendon ruptures (3%). The mean age of Achilles tendon injury patients was 26.1 years; among other sport injury patients it was 21.9 years (P less than 0.001). Surgery was performed in 24% of the subjects with paratenonitis and insertional pains. Different structural faults were found in 60% of the athletes with Achilles tendon overuse injuries. Forefoot varus correlated (r = P less than 0.001) with paratenonitis. A markedly limited total passive subtalar joint mobility and/or ankle joint dorsiflexion with knee extended was found in 6% of the conscripts, in 44% of the control athletes and in 58% and 70% of athletes with Achilles tendon paratenonitis and insertional pains, respectively. The range of motion of the ankle and subtalar joints was much lower in athletes than conscripts (P less than 0.001).

Achilles Tendon↗
PubMed1990

Ulnar nerve problems in the athlete's elbow.

Ulnar neuritis at the elbow is a common entity affecting the athlete especially those involved in overhand sports. Inflammation of the ulnar nerve is a component of the disorders that affect the medial side of the elbow in athletics owing to the large tensile forces encountered. The treatment of the athlete with medial elbow pain should not be isolated to the findings of ulnar neuritis especially when attenuation of the ulnar collateral ligament is encountered. The prognosis of the athlete to return to their prior level of competition is related to their preoperative presentation. Patients with long-standing ulnar neuritis and severe lesions that include intrinsic muscle dysfunction and profound findings on EMG and nerve conduction studies have a less favorable outcome. The prognosis is also related to other associated conditions such as ulnar collateral ligament attenuation and degenerative arthritis. In athletes with symptoms primarily secondary to ulnar neuritis with minimal neurologic deficits and early treatment, the prognosis for return to competitive play is excellent.

Athletic Injuries↗
PubMed1989

Acute cardiac emergencies in the injured athlete.

In the previous discussion, emphasis has been placed on the detection of cardiac disorders that might lead to sudden death. Cardiac crises result from congenital structural defects in athletes aged 35 years or younger, and from acquired diseases in older individuals. Detection implies preparticipation screening, which, in order to be effective, requires considerable financial resources impractical for community-wide athletic programs. In young asymptomatic individuals, the prevalence of congenital heart disease is estimated at 0.5 per cent. Perhaps 1 per cent of these athletes has congenital lesions that could potentially result in sudden death and of these, only 10 per cent will, indeed, die suddenly. Identification of a group of 1000 athletes who have congenital cardiovascular disease of whom perhaps only one will die suddenly requires screening of 200,000 competitors. It is rather unlikely that any community would consider this type of undertaking economically feasible, especially considering that the most useful test for the younger age group, the echocardiogram, is also one of the most expensive. Noninvasive screening on an individual basis, in most instances, will identify those athletes at risk for sudden death if appropriate financial resources can be applied. History and physical examination, chest roentgenogram, 12-lead electrocardiogram, echocardiography, and exercise stress testing are useful tools in the recognition of those conditions associated with acute cardiac emergencies.

Acute Disease↗
PubMed1988

Acute soft-tissue injuries in the young athlete.

Although the incidence of soft-tissue injury is high in the young athlete, one must be constantly aware of the tendency toward epiphyseal and apophyseal injuries in individuals with open growth plates. After the diagnosis of a soft-tissue injury (sprain, strain, or contusion) has been made, treatment must include an initial 24- to 48-hour period of RICE. Appropriate splinting may be required. Rehabilitation then proceeds aggressively, with early restoration of strength, flexibility, and joint range of motion. Prior to return to full athletic activity, the athlete should meet the criteria outlined in this article. Protective taping or bracing may be necessary upon return to full activity. The treatment of soft-tissue injuries should start with prophylaxis. All predisposing factors to the development of injury should be sought on preparticipation physical examinations and corrected prior to allowing the young athlete to compete. Using the program described as a guide to treating the injured athlete should result in early return to function with low recurrence rates of injury.

Adolescent↗
PubMed1985

Shoulder impingement syndrome in athletes treated by an anterior acromioplasty.

Shoulder pain caused by a impingement syndrome commonly affects an athlete's performance. Thirty-five shoulders in 33 athletes had an impingement syndrome treated by an anterior acromioplasty after failure of conservative treatment. Thirty-one of 35 shoulders (89%) were subjectively judged improved by the patients from their preoperative status. The moderate and severe pain was reduced from 97% of the shoulders preoperation to 20% postoperation. The pain at rest and with activities of daily living was reduced from 71% of the shoulders preoperation to 9% postoperation. However, only 15 of 35 operated shoulders (43%) allowed return to the same preinjury level of competitive athletics, and only four of 18 athletes involved in pitching and throwing returned to their former preinjury status. This operation is satisfactory for pain relief but does not allow an athlete to return to his former competitive status. A prolonged rehabilitation program may improve the results.

Acromion↗
PubMed1978

Girls' sports injuries in high school athletics.

Because of appreciable increases in the number of participants, injuries resulting from girls' interscholastic athletic activities have become a concern for school administrators and medical care providers. Four girls' high school athletic programs were prospectively studied for two years. Specially trained athletic trainers placed at each school examined each injured athlete and collected epidemiologic data. The 870 participant-seasons in nine sports resulted in 192 injuries. Three times more injuries occurred in practices than in competitive events. Although more than one third required a physician's services, the majority (59%) had returned to full athletic activity within a week of injury. Strains and sprains accounted for nearly two thirds of the injuries. Generally, the type and frequency of injuries were comparable with those seen in noncontact boys' interscholastic sports.

Adolescent↗
PubMed1995

Rehabilitation of the injured athlete.

The authors have presented basic guidelines and considerations for rehabilitation of the injured athlete. The use of various physical agents and therapeutic exercise in the rehabilitation of the injured athlete has been discussed. Clinical pathways for improving range of motion and muscle function and eliminating functional limitations and disability have also been presented. It should be remembered that rehabilitation of the injured athlete at any point in time may focus on any one or combination of these areas. The ultimate goal for rehabilitation of injured athletes is to return them to their prior level of sports activity. Athletes should be discharged from rehabilitation when they have achieved this goal or when no further improvement in their level of function can be expected. Individuals unable to return to their prior level of activity should be provided with alternate activities that they can continue to participate in to maintain an active lifestyle.

Adolescent↗
PubMed1994

Athletic injury and self diminution.

A review of the literature examining the effects of athletic injury on persons have suggested a deleterious effect. Specifically, results indicated that following traumatic injury, athletes suffer a diminution of affect and feelings of self-worth. Because studies published in this area have been post-injury in design, the present study was fashioned to examine changes from baseline values in the self-concept of university varsity football players following a disabling injury. There were 29 athletes in the subject pool. Sixteen subjects were severely injured during the season. Measures were taken on the first day of fall practice and at the end of the season. Injured athletes were assessed each week while they were unable to participate in practice. Analysis revealed a significant decrease in generalized self-concept following athletic injury (p < 0.001) which persisted through the course of treatment. Suggestions for continued research and treatment are proffered.

Adolescent↗
PubMed1994

Orthopaedic issues for active and athletic women.

The last quarter century has witnessed great change in the participation and abilities of female athletes. Many myths regarding the inability of women to participate in sport and recreational pursuits are being dispelled. Whereas there is still much to learn about the potential and limitations of female athletes, education concerning that which is already known should be a goal. It is only through education of those caring for female athletes and their families, and education of the athletes themselves, can one hope to have all women pursue and reach their full athletic potential safely.

Adolescent↗
PubMed1997

[Conservative treatment of stress fractures of the tarsal navicular in athletes].

PURPOSE OF THE STUDY: The purpose of the study was to propose an algorhythm for nonoperative treatment of partial tarsal navicular stress fractures in athletes, based on the results of the authors prospective research, conducted in 17 athletes. MATERIALS AND METHODS: The series included 17 patients with 18 partial tarsal navicular stress fractures (9 women and 8 men), average age 20.1 years. Patients were 10 track and field athletes mainly sprinters, 3 basketball players, two handball players, one soccer player and one volleyball player. After undergoing detailed physical examination which included x-ray examination, all patients also underwent bone scanning, and some kind of tomographic imaging (CT, MR) was done in all patients. Since all patients suffered from partial tarsal navicular stress fracture (fracture spreaded saggitally to maximal dorsal half of the bone) nonoperative treatment was conducted. Immobilization in a non weight bearing short-leg cast for a period of 6-8 weeks was followed by rehabilitation treatment consisting of 4 consecutive stages, each lasting 2 weeks. Control examination after each stage determined if patients could proceed to the following stage or if they should remain in the same stage for another two weeks. RESULTS: Patients were followed up from one to five years (average 33.9 months) and proposed algorhythm of nonoperative treatment resulted in all, except two athletes, returning to their previous level of competition activity. The average time period between initiation of treatment and resumption of full sports activity was 24 weeks (range 17 to 32 weeks). One stress fracture recurrence was encountered although all patients returned to sports activities and are constantly being monitored. DISCUSSION: No complex tarsal navicular stress fractures was found in our series. In our opinion the diminishing number of complete fractures is a consequence if quicker and more precise diagnosis. The period between the onset of symptoms and the time of correct diagnosis is becoming shorter. In our patients, this period was 3.3 months. The nonoperative treatment for tarsal navicular stress fractures was suggested with a wide variety of procedures. Based on the results if their prospective study the authors propose an algorhythm of conservative procedures in the treatment of partial tarsal navicular stress fracture. CONCLUSION: If clinical indication of tarsal navicular stress fracture is confirmed by a positive bone-scan, a CT or MRI exploration is required to distinguish stress reaction from stress fracture. In partial tarsal navicular stress fractures, immobilisation in a short-leg cast with nonweightbearing for 6 to 8 weeks depending of the magnitude of the fracture is required. This is followed by a treatment consisting of 4 two-weeks stages which clinically monitored. The previous phase can be repeated for another two weeks, depending of clinical findings. This algorhythm of nonoperative treatment of partial tarsal navicular stress fractures allowed in all athletes a return to competitive activity.

Adolescent↗
PubMed1998

The physically challenged athlete.

Several studies note that the relative risk of injury for physically challenged athletes is approximately the same as that of nondisabled athletes. Since the 1940s physically challenged athletes have increasingly competed on national and international levels. This chapter describes sport-specific adaptations (such as a prosthesis or wheelchair), classifies the suitability of sports activities according to disability, and outlines measures to prevent injury in disabled athletes. The author also includes a resource list of publications, organizations, and web sites for disabled athletes.

Adaptation, Physiological↗