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PubMedDate not supplied

Stress changes of the distal radial growth plate. A radiographic survey and review of the literature.

We conducted a radiographic survey to determine skeletal age and the nature and prevalence of stress-related changes affecting the distal radial growth plate in 60 young competitive gymnasts (39 females, 21 males). Comparison of results for chronological and skeletal age revealed a significant delay in maturation for girls (P less than 0.001). Radiographic evaluation revealed 5 gymnasts (4 girls and 1 boy) with stress-related changes of the left wrist, and four of these were considered to be minimal. These results, in conjunction with our previous findings and the review of related literature, reveal three important observations. First, the widening and irregularities of the distal radial physis that we described previously appear to be the first in a spectrum of abnormal changes secondary to overuse and probably represent a stress fracture of the distal radial growth plate. The radiographic changes associated with this injury are not the normal adaptive changes seen in young, competitive gymnasts. Secondly, more serious long-term abnormality may result even though the injury may initially resemble a Salter-Harris type I or II stress fracture. Long-term complications may include symmetrical or asymmetrical retardation or halted growth at the affected site, positive ulnar variance, and associated pathoanatomic sequelae. Thirdly, the incidence of distal radial growth plate stress injury remains unclear; we recommend a further, large-scale prospective epidemiologic study involving both male and female gymnasts. We urge that physicians and other health professionals associated with gymnastics clubs educate coaches about the possibility of significant injury to the distal radial physis, risk factors, and suggested preventive measures.

Adolescent↗
PubMedDate not supplied

An electromyographic analysis of the elbow in normal and injured pitchers with medial collateral ligament insufficiency.

Electromyography and high-speed film were used to examine the muscle activity in the elbows of pitchers with medial collateral ligament insufficiency compared to the activity in uninjured elbows. Ten competitive baseball pitchers with medial collateral insufficiency and 30 uninjured competitive pitchers were tested while throwing the fastball and the curveball. The extensor carpi radialis brevis and longus in the injured pitchers showed greater activity than in the uninjured pitchers for both pitches. The triceps, flexor carpi radialis, and pronator teres all showed less activity in the injured pitchers during the fastball, but only the triceps had less activity during the curveball. The differences were seen during the late cocking and acceleration phases, which place the greatest stress on the medial collateral ligament. If the flexor carpi radialis and pronator teres were substituting for the deficient medial collateral ligament and functioning as dynamic stabilizers, one would expect enhanced muscle activity. However, the opposite was found. This pattern of asynchronous muscle action with medial collateral ligament injury may predispose the joint to further injury. The muscular differences seen are critical to the understanding of the pathomechanics of patients with medial collateral ligament deficiency, and provide a basis for rehabilitation.

Adolescent↗
PubMedDate not supplied

Shoulder strength, power, and endurance in college tennis players.

Twenty-four college tennis players were tested for bilateral shoulder internal/external rotation strength on a Cybex 340 isokinetic dynamometer; they were positioned supine with the glenohumeral joint abducted to 90 degrees. Subjects produced significantly (P less than 0.01) more torque in internal rotation at 60 and 300 deg/sec in the dominant arm compared to the nondominant arm. Subjects also produced significantly more power in internal rotation at 60 deg/sec in the dominant arm. No significant differences between the dominant and nondominant arms were seen in internal rotation power at 300 deg/sec or in the internal rotation endurance ratio. No significant differences were seen in external rotation on any measurement. By significantly increasing the strength of the dominant shoulder in internal rotation without subsequent strengthening of the external rotators, muscle imbalances may be created in the dominant arm that could possibly affect the tennis player's predisposition to injuries caused by overloading of the shoulder joint. This study suggests that external rotation strengthening exercises should be implemented in tennis conditioning programs to maintain muscle strength balance, and possibly reduce the chance of overload injury.

Adult↗
PubMedDate not supplied

Arthroscopic treatment of sports-related synovitis of the ankle.

We describe nine cases of sports-related synovitis of the ankle joint with a followup of 24 to 44 months (average, 30.9). It affects young athletes and occurs after episodes of acute or recurrent inversion ankle sprains or undisplaced ankle fractures. The patients complain of morning pain and stiffness along with increased pain and swelling with attempted athletic participation. All ankles were stable and all failed to respond to at least 6 months of conservative treatment. The technetium bone scans were positive in eight of the cases. During arthroscopy, a hypertrophic anterior-chamber synovitis was found and treated by arthroscopic partial synovectomy. The results were excellent in eight of the patients in whom symptoms resolved, allowing full return to their previous sports, and fair in one case. The only complication was one superficial wound infection.

Adolescent↗
PubMedDate not supplied

Tenotomy of the adductor longus tendon in the treatment of chronic groin pain in athletes.

Eighteen tenotomies of the adductor longus tendon were performed in 16 consecutive male athletes (aged 20 to 42) as treatment for chronic groin pain. The criteria for surgery was a history of long-standing (range, 2.5 to 48 months) and distinct pain at the origin of the adductor longus muscle, refractory to conservative treatment. At followup 35 months (range, 4 to 84) after surgery, all patients were improved or free of symptoms. All but 1 of the athletes returned to the same sport within a mean of 6.6 weeks, and 12 of 16 returned to competitive sports within a mean of 14 weeks after surgery. A majority of the patients (10 of 16) returned to full athletic activity, whereas 5 of 16 performed at a reduced level. One patient discontinued his sports activity due to other causes. In conclusion, when conservative treatment fails, tenotomy of the adductor longus tendon gives good long-term functional results in the treatment of chronic groin pain that is localized at the origin of the adductor longus muscle. A decreased muscle strength was observed in this study and did not seem to influence participation in sports.

Adult↗
PubMedDate not supplied

Women's gymnastics injuries. A 5-year study.

A 5-year prospective study on the time course of women's gymnastics injuries was conducted on a successful NCAA Division I team. Gymnasts recorded injuries on a computer terminal or via computer dot sheets immediately before each training session, including the injured body part, the event or activity, and the date of the injury. The definition of injury was "any damaged body part that would interfere with training." Athletes recorded injuries on the 1st day of onset and subsequently until the injury was healed. The initial onset of injury was considered a new injury. Subsequent records of the injury were considered continuing injury. Thirty-seven athletes participated through five collegiate seasons. They accounted for 5602 total training exposures with an average of 151.4 exposures per athlete. The analyses showed that gymnasts trained with an injury approximately 71% of the exposures, and a new injury could be expected from a gymnast during approximately 9% of the exposures. The largest number of injuries were of the repetitive stress syndrome type. The time series information showed that total injuries tended to increase until the middle of the competitive season, while new injuries showed prominent increases during specific training periods and during competition preparation and performance.

Adult↗
PubMedDate not supplied

Iliotibial band syndrome in cyclists.

Iliotibial band syndrome is an overuse injury caused by repetitive friction of the iliotibial band across the lateral femoral epicondyle. Once considered an injury indigenous to runners, it is now frequently being seen in cyclists. The purpose of this paper is to identify iliotibial band syndrome as a significant problem in cyclists and to propose both operative and nonoperative measures for treating cyclists. Nonoperative measures specific to cyclists consist of bicycle adjustments and training modifications. These are adjunctive therapies to stretching, icing, rest, and oral nonsteroidal antiinflammatory drugs. For cyclists requiring operative intervention, a new surgical technique for excising or releasing the distal iliotibial band is presented. This technique, used by the senior author (JCH) since 1984, involves excision of an elliptical piece of the distal posterior band off the lateral femoral epicondyle.

Bicycling↗
PubMedDate not supplied

Helicopter skiing wrist injuries. A case report of "bugaboo forearm".

Of the 42 skiers, 5 (11.9%) experienced symptoms of intersection syndrome early in their week of powder skiing. According to the mountain guides employed by the helicopter service, this overuse injury is quite common and does not represent an unusual incidence for this group of skiers. The mechanism of injury is likely repetitive dorsiflexion and radial deviation of the wrist against the resistance of deep snow on withdrawal of the planted ski pole. Interestingly, the more advanced competitive alpine skiers appeared to be most at risk, possibly because of their more aggressive pole plants. Preventive measures should include instruction in proper pole technique for powder skiing, avoidance of pole dragging and deep pole plants, and downsizing baskets from the standard 4-inch diameter to 2.5-inches and pole length 2 inches shorter than the recommended length for that skier. Once symptoms occur, switching to a different diameter grip, using the pole strap, nonsteroidal antiinflammatory medications, ice, taping of the thumb and wrist, and night splinting appear to offer some relief. Surgical treatment as described by others. is generally successful for those who fail conservative treatment.

Adult↗
PubMedDate not supplied

Surgical management of Achilles tendon overuse injuries. A long-term follow-up study.

We studied 79 cases of surgically treated Achilles tendon overuse injuries in 66 patients. Fifty-three (80%) of these patients were competitive or serious recreational runners operated on between 1978 and 1991. There were 49 men and 17 women with a mean age of 33 years (range, 17 to 59). The cases were divided into surgical subgroups based on their site of primary symptoms and abnormalities: paratenonitis (23), tendinosis (partial rupture or degeneration) (15), retrocalcaneal bursitis (24), insertional tendinitis (7), and combined abnormalities (10). Followup included a comprehensive patient questionnaire and office examination. There were 79% satisfactory (51% excellent, 28% good) and 21% unsatisfactory (17% fair, 4% poor) results. The percentages of satisfactory results in the paratenonitis group (87%) were best and those in the tendinosis group were the worst (67%). Satisfactory results were obtained in 75% of the patients with retrocalcaneal bursitis and 86% with insertional tendinitis. Seven of the 45 cases with longer than 5-year followup with initially satisfactory results deteriorated with time and required reoperation (16%). Of these, 4 were in the tendinosis group, 2 had retrocalcaneal bursitis, and 1 had paratenonitis. One of the 34 patients followed less than 5 years required reoperation.

Achilles Tendon↗
PubMedDate not supplied

Profiles of exercise history and overuse injuries among United States Navy Sea, Air, and Land (SEAL) recruits.

This prospective study examined running history as a risk factor for subsequent overuse injury in Navy Sea, Air, and Land (SEAL) recruits. Recruits preparing to be Navy SEALs undergo 6 months of rigorous physical training programs, which place these recruits at high risk for developing an overuse injury. We assessed the independent variables of age; prior running frequency, duration, and pace; and training surface. Univariate and multivariate estimates of risk were determined for each variable. We observed an incidence of 3.4 overuse injuries per 1000 recruit-days. Assessing the physical activity of the recruits in the 6 months before entrance into basic training, we found that the recruits who ran at a pace slower than 8 minutes per mile and on softer training surfaces were more likely to sustain an overuse injury during basic training, in both univariate and multivariate estimates of risk. Recruits who ran fewer weekly miles and for shorter durations before basic training were also more likely to sustain an overuse injury according to univariate estimates of risk. Our findings suggest that risk of overuse injuries can be reduced by adjusting exercise routines before training. Running on different type surfaces with a gradual increase in speed, duration, and weekly mileage in the period preceding basic training may reduce risk of overuse injury.

Adolescent↗
PubMedDate not supplied

An in vitro investigation into the effects of repetitive motion and nonsteroidal antiinflammatory medication on human tendon fibroblasts.

Soft tissue injuries due to repetitive motion are common sports injuries and are often treated with antiinflammatory therapies. We investigated the in vitro effects of repetitive motion and nonsteroidal antiinflammatory medication on human tendon fibroblasts. In addition, we studied the effects related to the presence of inflammatory cells. Repetitive motion was associated with an increased release of prostaglandin E2 and increased deoxyribonucleic acid (DNA) and protein synthesis. The presence of nonsteroidal antiinflammatory medication decreased prostaglandin E2 release and DNA synthesis but increased protein synthesis. Contact with macrophages caused a marked additional increase in prostaglandin E2 and a concomitant increase in DNA synthesis. Release of interleukin-6 by the macrophages also suggested that this cytokine plays a role in the response to repetitive motion. Our results can aid in the search for a more scientific approach to the treatment of soft tissue injuries associated with repetitive motion. They suggest that nonsteroidal antiinflammatory medication may have potentially negative effects during the proliferative phase of a healing since it was associated with decreased DNA synthesis. However, it may be beneficial in the maturation and remodeling phase since it stimulated protein synthesis.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMedDate not supplied

Degenerative joint disease in female ballet dancers.

The relationship between long-term ballet dancing and eventual arthrosis of the hip, ankle, subtalar, and first metatarsophalangeal joint was examined in 19 former professional female dancers, aged 50 to 70 years. The dancers were compared with pair-matched controls. All 38 women underwent medical history taking, clinical examination, and roentgenography of the joints studied. The roentgenographs were independently judged by two investigators and grouped according to a modified classification of Hermodsson. We found a statistically significant increase in roentgenologic arthrosis of the ankle, subtalar, and first metatarsophalangeal joints in the ballet group compared with the control group. There was no significant difference regarding degenerative changes of the hip joint. However, subjects in the dance group who had evidence of degenerative changes on roentgenographs had no clinical complaints. There was a statistically significant increase in hallux valgus deformity in the ballet group (P < 0.05). The dancers also showed a statistically significant increase in flexion, external rotation, and abduction of the hip joint, dorsal flexion of the first metatarsophalangeal joint, and inversion and eversion of subtalar joint. But the control group had statistically significant increased plantar flexion of the first metatarsophalangeal joint. The most important cause of the statistically significant increase of arthrosis of the ankle and first metatarsophalangeal joints must be explained by repetitive microtrauma.

Aged↗
PubMedDate not supplied

Tibial stress reaction in runners. Correlation of clinical symptoms and scintigraphy with a new magnetic resonance imaging grading system.

Medial tibial pain in runners has traditionally been diagnosed as either a shin splint syndrome or as a stress fracture. Our work using magnetic resonance imaging suggests that a progression of injury can be identified, starting with periosteal edema, then progressive marrow involvement, and ultimately frank cortical stress fracture. Fourteen runners, with a total of 18 symptomatic legs, were evaluated and, within 10 days, referred for radiographs, a technetium bone scan, and a magnetic resonance imaging scan. In 14 of the 18 symptomatic legs, magnetic resonance imaging findings correlated with an established technetium bone scan grading system and more precisely defined the anatomic location and extent of injury. We identified clinical symptoms, such as pain with daily ambulation and physical examination findings, including localized tibial tenderness and pain with direct or indirect percussion, that correlated with more severe tibial stress injuries. When clinically warranted, we recommend magnetic resonance imaging over bone scan for grading of tibial stress lesions in runners. Magnetic resonance imaging is more accurate in correlating the degree of bone involvement with clinical symptoms, allowing for more accurate recommendations for rehabilitation and return to impact activity. Additional advantages of magnetic resonance imaging include lack of exposure to ionizing radiation and significantly less imaging time than three-phase bone scintigraphy.

Adolescent↗
PubMedDate not supplied

Characteristics of the leg extensors in male volleyball players with jumper's knee.

The aim of the present study was to characterize the performance ability of the leg extensor apparatus in a group of athletes with jumper's knee and to compare the results with those of a matched control group without knee symptoms. Patient and control groups (12 players in each) were selected from a population of 141 well-trained male Norwegian volleyball players, of which 55 (39%) satisfied the diagnostic criteria for jumper's knee. The testing program consisted of a standing jump, a countermovement jump, a 15-second rebound jump test, a standing jump with a 20-kg load, and a standing jump with a load corresponding to one-half of the subject's body weight. Jump height and power were measured using a contact mat connected to an electronic timer. The test results of the patient group were significantly higher than those of the control group for the countermovement jump (15% increase), power during rebound jump (41%), work done in standing jump (12%) and countermovement jump (22%), and the difference between countermovement jump and standing jump (effect of adding eccentric component). Athletes with jumper's knee demonstrated better performance in jump tests than uninjured athletes, particularly in ballistic jumps involving eccentric force generation.

Adult↗
PubMedDate not supplied

Predictors of injury among 1638 riders in a recreational long-distance bicycle tour: Cycle Across Maryland.

To assess the incidence of and risk factors for injuries in a group of bicyclists with a well-defined exposure to bicycling, we conducted a prospective study of 1638 recreational bicyclists who rode in the 6-day 339-mile Cycle Across Maryland tour in 1994. The mean age of participants was 39 years (range, 7 to 79), and two-thirds were male. All riders wore helmets. During the tour there were 85 acute traumatic injuries (15.4 per 100,000 person-miles), 76 overuse injuries (13.7 per 100,000 person-miles), and 37 other medical problems (6.7 per 100,000 person-miles). Acute traumatic injuries were associated with a history of racing versus none (relative risk = 2.2, 95% confidence limits = 1.3, 3.7) and with inexperience, no previous Cycle Across Maryland tours versus one or more (relative risk = 1.7, 95% confidence limits = 1.04, 2.8), but not with sex, training, or prior injuries. Inexperience and lack of preride conditioning were risk factors for overuse injuries. The most common overuse injuries and medical problems were knee pain, hand or wrist numbness, foot blisters, insect stings and bites, and heat and dehydration. Study results provide exposure-based incidence rates of bicyclist injuries and suggest overuse injuries may be reduced by increased preride conditioning.

Adolescent↗
PubMedDate not supplied

Arthroscopic distal clavicle resection for isolated atraumatic osteolysis in weight lifters.

Ten consecutive patients with isolated atraumatic osteolysis of the distal clavicle who had failed results with conservative treatment were treated with arthroscopic resection of the involved distal clavicle (average, 4.5 mm). All patients were men with an average age of 30.4 years, had unilateral involvement, and were considered aggressive amateur to elite weight lifters or bodybuilders. Postoperative symptoms consisted of pain at the incision and discomfort from extravasation of the irrigation fluid. At an average followup of 18.7 months, all patients had returned to their sport (average, 3.2 days) and to their preoperative weight training program (average, 9.1 days). They continued to be asymptomatic throughout the follow-up period and were able to increase both their training volume and strength from preoperative levels. Limited arthroscopic resection of the distal clavicle for isolated atraumatic osteolysis is a viable alternative for the weight lifter or bodybuilder. The ability to continue training without significant interruption as well as a more acceptable cosmetic appearance are benefits for these patients. Limited arthroscopic resection of the distal clavicle may be sufficient for this entity in this patient population, rather than the 1 to 2 cm previously reported. A sport-specific functional outcome questionnaire has been developed for this patient population.

Acromioclavicular Joint↗