Stress fracture of the metacarpal in a adolescent tennis player.
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Adolescent↗
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Stress fracture of the clavicle leading to nonunion secondary to coracoclavicular reconstruction with Dacron.
We have reported the case of a nonunion of a clavicle fracture in which the Dacron had eroded the bone and acted as a stress riser contributing to the fracture. The Dacron then became interposed in the fracture site preventing union.
Acromioclavicular Joint↗
Overuse injuries in ultraendurance triathletes.
Overuse injuries represent the largest percentage of sports-related injuries requiring medical treatment. These injuries represent a substantial health issue for the millions of adults who have made physical activity an integral part of their lifestyle, but may be even more important to those pursuing ultraendurance exercise. The purposes of this study were to report the type and incidence of overuse injuries in ultraendurance triathletes and to relate training practices to injury occurrence. Data was gathered from the responses of 95 competitors (75 men, 20 women) in the 1986 Hawaii Ironman Triathlon who completed a training and medical history questionnaire. In this sample, virtually all (91%) sustained at least one soft tissue, overuse injury during the previous year's training. The area of the body most frequently involved was the back, but the most common pattern was to have multiple areas involved. Because of the consistent combinations of injuries, mechanical abnormalities, such as diminished shock absorption, may have contributed to injury. Training habits were extremely variable and not directly related to either the incidence or type of injury.
Adult↗
Stress fracture of the patella.
Stress fractures are rarely an indication for surgical treatment. In our case we decided to operate on the patient because of distraction of the fragments. Solid bony healing took longer than in traumatic fractures, but the good functional result confirmed our regimen.
Adult↗
The accident-prone and overuse-prone profiles of the young athlete.
A 1 year prospective study was done to develop an accident-prone and overuse-prone profile of young athletes. A group of 185 freshman physical education students (118 males; 67 females of the same age (18.3 +/- 0.5 years) trained under the same conditions and were exposed to similar extrinsic risk factors. Using a descriptive statistical technique, an analysis of correspondence, the complex interrelation between the criterium variables (acute injuries and overuse injuries) and the predictor variables (intrinsic risk factors; physical characteristics--anthropometric data, physical fitness parameters, flexibility aspects and malalignment of the lower extremities; and psychological factors--16 personality traits) was estimated for males and females separately. Although dynamic strength seems to be an important risk factor in acute injuries, sports accidents must be seen in relation to psychological factors. However, the overuse-prone profile is mainly based on physical traits: a combination of muscle weakness, ligamentous laxity, and muscle tightness predisposes to stress injuries. In addition, these overuse effects are intensified by large body weight and length, a high explosive strength, and malalignment of the lower limbs. Nevertheless, it has to be kept in mind that psychosomatic factors play a role in how one experiences these overuse phenomena.
Accident Proneness↗
A mechanical model of metatarsal stress fracture during distance running.
A model of metatarsal mechanics has been proposed as a link between the high incidence of second and third metatarsal stress fractures and the large stresses measured beneath the second and third metatarsal heads during distance running. Eight discrete piezoelectric vertical stress transducers were used to record the forefoot stresses of 21 male distance runners. Based upon load bearing area estimates derived from footprints, plantar forces were estimated. Highest force was estimated beneath the second and first metatarsal head (341.1 N and 279.1 N, respectively). Considering the toe as a hinged cantilever and the metatarsal as a proximally attached rigid cantilever allowed estimation of metatarsal midshaft bending strain, shear, and axial forces. Bending strain was estimated to be greatest in the second metatarsal (6662 mu epsilon), a value 6.9 times greater than estimated first metatarsal strain. Predicted third, fourth, and fifth metatarsal strains ranged between 4832 and 5241 mu epsilon. Shear force estimates were also greatest in the second metatarsal (203.0 N). Axial forces were highest in the first metatarsal (593.2 N) due to large hallux forces in relationship to the remaining toes. Although a first order model, these data highlight the structural demands placed upon the second metatarsal, a location of high metatarsal stress fracture incidence during distance running.
Biomechanical Phenomena↗
Overuse injuries in triathletes. A study of the 1986 Seafair Triathlon.
A questionnaire was mailed to 600 to 657 finishers in the Seafair Triathlon (July 20, 1986); 45% of those polled returned the questionnaire. Over the preceding year, 49% of the respondents suffered a training-related injury serious enough to cause them to stop training for at least 1 day, seek medical care, or take medicine, Seventy percent of the injuries were due solely or partly to running. The knee, shoulder, and ankle were most frequently affected. Female triathletes and those more than 40 years of age showed a similar injury incidence and distribution. Elite triathletes averaged more miles per week in each sport than the athletes as a whole and showed a higher incidence of injury (60%), although this was not a significant difference. Higher weekly swimming, cycling, and running mileages did not lead to a higher incidence of injury. The likelihood of injury was independent of age, sex, body mass index, mileage per week, or other training factors evaluated in the study.
Adult↗
Body load in heel-strike running: the effect of a firm heel counter.
The effect of a firm heel counter in the shoe was studied in 11 athletes during submaximal heel-strike running on a treadmill under standardized conditions. The runners were tested in identical shoes with and without the distal 2 cm of the firm heel counter. Body load was expressed by absolute and relative VO2, surface EMG on the right leg, and g-force registration from an accelerometer below the right tibial tuberosity. The heel counter caused a 2.4% significant decrease in VO2, a reduction in musculoskeletal transients, and a decrease in the activity of the triceps surae and quadriceps muscles at heel strike. The changes found are expressions of kinematic adaptations in the body to increased or decreased load and provide functional evidence for the loading factor in the pathophysiology of overuse injuries.
Adolescent↗
Prevention of common overuse injuries by the use of shock absorbing insoles. A prospective study.
Sedentary individuals, particularly new military recruits, who start a physical training program have a substantial risk of developing an overuse injury of the lower limb. In this study we investigated the effect of neoprene insoles on the incidence of overuse injuries during 9 weeks of basic military training. The experimental group consisted of 237 randomly selected new recruits, while 1151 recruits were the control group. Insoles were given to the experimental group and compliance was monitored. A panel of doctors documented and classified all injuries occurring during the 9 week period. A total of 54 (22.8%) and 237 (31.9%) injuries were reported in the experimental and control groups, respectively. In both groups, the majority of injuries were overuse (experimental group, 90.7%; control group, 86.4%). The mean weekly incidence of total overuse injuries and tibial stress syndrome was significantly lower (P less than 0.05) in the experimental group. The mean incidence of stress fractures was lower in the experimental group but not significantly so (0.05 less than P less than 0.1). This study shows that the incidence of total overuse injuries and tibial stress syndrome during 9 weeks of basic military training can be reduced by wearing insoles.
Adolescent↗
Subscapular elastofibroma in a young pitcher. A case report.
Subscapular elastofibromas and scapulothoracic bursitis can cause symptomatic masses in baseball pitchers. Both processes appear to represent reactive soft tissue responses to repetitive stress at the inferior border of the scapula. It is assumed that most masses in the subscapular area represent scapulothoracic bursitis rather than an elastofibroma. However, it is possible that some of the masses treated conservatively as scapulothoracic bursitis may be elastofibromas. A study is currently under way to evaluate the incidence of subscapular masses in college and professional pitchers in the United States. A follow-up report is anticipated when the study has been completed. The author requests information concerning any confirmed cases of elastofibroma in baseball pitchers.
Adolescent↗
Isolated rupture of the flexor hallucis longus tendon. A case report.
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Adult↗
Isokinetic torque imbalances in the rotator cuff of the elite water polo player.
The specific repetitive activity of water polo, like baseball pitching, emphasizes adduction and internal rotation. This study used the Cybex II to evaluate the isokinetic strength of the rotator cuff in elite water polo players and in a group of control subjects. The water polo players were significantly stronger than the controls. Of greater importance was the confirmation of imbalances in the rotator cuff force couples of adduction/abduction and external/internal rotation. These changes are similar to those reported for pitchers. The adductors in the water polo group had gained in relative strength resulting in an increase in the adduction/abduction ratio to about 2:1. The internal rotators had gained in relative strength resulting in a decrease in the external/internal ratio to about 0.6:1. For both force couples the differences are more apparent at a slow speed. Side-to-side differences were not significant.
Biomechanical Phenomena↗
Sports-related Kienböck's disease.
Ten patients with Kienböck's disease who were actively engaged in sports activities involving repeated minimal trauma to the wrist are presented. Comparative studies between the 10 patients with sports-related Kienböck's disease and 82 manual laborers with Kienböck's disease showed no difference in clinical presentation or radiographic findings. The history of repeated minimal trauma appeared to be similar in the two groups. Therefore, sports activities in which the wrist suffers repeated impact can lead to the development of Kienböck's disease identical to that occurring in manual laborers, although the sports group was younger and had smaller ulnar variance. Radial osteotomy improved clinical symptoms even in sports-related Kienböck's disease.
Adolescent↗
Soccer injuries among elite female players.
Injuries occurring in two female elite soccer teams were recorded during 1 year. Of 41 players, 33 (80%) sustained 78 injuries. The incidence of injury during games was 24/1000 hours, while the incidence during training was 7/1000 hours. The majority (88%) of injuries were localized to the lower extremities, with equal occurrence in the left and right legs. Forty-nine percent of the injuries occurred in the knee or ankle. Most of the injuries were minor (49%), while 36% were moderate and 15% were major. Of the major injuries (N = 12), 10 were due to trauma and 7 (58%) were knee ligament or meniscal tears. Overuse injuries constituted 28% of all injuries and occurred mainly during preseason training and at the beginning and end of the competitive season. Traumatic injuries (72%) occurred mainly during games with a predominance at the beginning of the competitive season. Almost 80% of the traumatic injuries occurred during physical contact with an opponent. Extrinsic factors such as weather, playing surface, temperature, or the position of the player within the team did not influence the injury rate. We conclude that female elite soccer players sustain a high incidence of injury. Few injuries were major, but 17% of the players sustained a major knee injury during the year.
Adolescent↗
Stress fractures. Identifiable risk factors.
To answer the question why such large differences in stress fracture morbidity rates (2% to 64%) exist in different countries, we prospectively evaluated 312 recruits for possible risk factors for stress fractures. Prior to training, each recruit underwent an evaluation including the following: orthopaedic examination, foot and tibial radiographs, measurements of tibial bone width, bone mineral content, bone density, aerobic physical fitness and leg power, assessments of somatotype and smoking habits, and evaluation of sociological and psychological factors. Using a multivariate analysis, two risk factors were identified: recruits with stress fractures had significantly narrower tibiae (P less than 0.001), and a higher degree of external rotation of the hip (P = 0.016). These two variables were independent and cumulative. Stress fracture morbidity was 17%, 29%, and 45% when neither, one, or both risk factors were present, respectively (P less than 0.001). Identification of these risk factors might explain the susceptibility of some people to stress fractures.
Adult↗
Technique and ground reaction forces in the back handspring.
The ground reaction forces at the hand that produced compression forces and varus/valgus moments at the elbow joint during the double-arm support phase of the back handspring were studied. The relationship of technique, namely elbow joint flexion, to these forces were also studied. Compression forces and forces producing valgus moments have been implicated in overuse injuries to the elbow joint. Video and force plate analysis of six young female gymnasts showed that 1) the elbow joint flexed during the double-arm support phase, and 2) the reaction forces at the hand produced large compression forces (an average of 2.37 times body weight) and sizable valgus moments at the elbow (an average of 0.03 times body weight times body height). The combination of these forces may contribute to the occurrence of lateral compression injuries of the elbow joint (e.g., osteochondritis dissecans of the capitellum). Correlations of measures of elbow angle and measures of reaction force showed that large elbow flexions may protect the elbow from large valgus moments.
Adolescent↗
Syndesmosis sprains of the ankle. The influence of heterotopic ossification.
A retrospective study of 50 syndesmosis sprains in 44 football players was performed. Five patients (6 ankles) were lost to follow-up, allowing review of 44 injuries. Average follow-up was 47 months. The patients were evaluated for recurrent injury, overall ankle function, and for persistent ankle symptoms, including stiffness, pain, limping, and swelling. Follow-up radiographs of the injured ankle were obtained in 22 patients. The average return time to full activity was 31 days. Pain with pushing-off was a major factor preventing return to activity. At final followup, 36% of the patients complained of persistent mild to moderate stiffness of the ankle. Twenty-three percent had mild to moderate pain, usually with activity. One patient had a mild limp with activity, and 18% of the ankles had persistent mild to moderate swelling. Ankle function was rated as good to excellent in 86%. All patients with fair results had recurrent ankle sprains. There were no poor results. Eleven of the 22 patients with follow-up radiographs developed heterotopic ossification within the interosseous membrane, but no patient developed a frank synostosis. The patients with heterotopic ossification required an average of 11 days more recovery time than those without ossification. There was no significant difference between the 2 groups' ultimate ratings of ankle function or ankle symptoms, but the ankles with heterotopic ossification were associated with more recurrent lateral ankle sprains. We conclude that syndesmosis sprains require a longer recovery period than other types of ankle sprains. Most of these injuries showed good to excellent ankle function after recovery, unless there was a recurrent ankle sprain.2+ formation of heterotopic ossification.
Adult↗
A profile of the musculoskeletal characteristics of elite professional ballet dancers.
Twenty-eight principal dancers and soloists from America's two most famous ballet companies were examined for anthropometric measurements, including flexibility, muscle strength, and joint range of motion. Both male and female dancers were flexible, but not hypermobile, and did not differ significantly from each other. Marked differences were found between the range of motion of the hip and ankle in the dancers and the norms for the general population. The increased external rotation of the hip in women was accompanied by a loss in internal rotation, resulting in an increased range of motion with an externally rotated orientation. The men, however, lost more internal rotation than they gained in external rotation. These data raise the possibility of a torsional component to the turned-out hip position in elite female professional ballet dancers. In addition, significant anatomic differences separate elite dancers of both sexes from the normal population.
Adult↗