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Clinical Journal of Sport Medicine
Journal Prestige (SJR): 0.999
Citation Impact (citeScore): 2
Number of Followers: 36  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1050-642X - ISSN (Online) 1536-3724
Published by LWW Wolters Kluwer Homepage  [297 journals]
  • Subacromial Injections of Low- or High-Molecular-Weight Hyaluronate Versus
           Physical Therapy for Shoulder Tendinopathy: A Randomized Triple-Blind
           Controlled Trial

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      Authors: Esmaily; Hadi; Mohebbi, Rezvaneh; Rezasoltani, Zahra; Kasaiyan, Seyedalireza; Dadarkhah, Afsaneh; Mir, Mahshad
      Abstract: imageObjective: Shoulder tendinopathy is a prevalent and debilitating problem. We compared the effects of subacromial high- or low-molecular-weight hyaluronate injection with physical therapy (PT) in shoulder tendinopathy.Design: A triple-blinded randomized controlled trial.Setting: We conducted the trial in an outpatient clinic at a teaching hospital.Participants: In total, 79 patients with shoulder tendinopathy were randomly allocated to high- (n = 27) or low-molecular-weight (n = 28) hyaluronate or PT (n = 24) groups.Interventions: We administered a 20-mg injection of high- or low-molecular-weight hyaluronate. For PT, we prescribed 10 sessions of physiotherapy and exercise.Outcome Measures: The primary outcome was shoulder pain and the secondary outcomes included Disability of the Arm Shoulder and Hand score, shoulder range of movement and QoL. We measured the outcomes at baseline, 1, and 3 months of treatment, and assessed shoulder pain at the sixth month postintervention.Results: The interventions were all clinically beneficial in the management of tendinopathy for high- (n = 25) and low-molecular-weight (n = 24) hyaluronate and PT (n = 19) groups (all P < 0.05). However, between-group analyses indicated that hyaluronate preparations were more effective in controlling pain, decreasing disability, increasing range of motion, and improving the quality of life (all P < 0.05). The pain and subjective feeling of rigidity at the injection area (P = 0.012) were less prominent for low-molecular-weight hyaluronate.Conclusion: High- or low-molecular-weight hyaluronate is more effective than PT in the treatment of shoulder tendinopathy. The clinical benefits of hyaluronate last for at least 3 months, and the pain alleviation sustains partially for 6 months. Shoulder injection of low-molecular-weight hyaluronate is more tolerable to the patient than high-molecular-weight hyaluronate.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Do High-Volume Injections Affect the Ultrasonographic Neovascularization
           in Chronic Achilles Tendinopathy' A Randomized Placebo-Controlled
           Clinical Trial

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      Authors: van Oosten; Claire C. M.; van der Vlist, Arco C.; van Veldhoven, Peter L. J.; van Oosterom, Robert F.; Verhaar, Jan A. N.; de Vos, Robert Jan.
      Abstract: imageObjective: High-volume injections (HVIs) are thought to target neovascularization in chronic midportion Achilles tendinopathy (AT), yet the mechanism has not been clarified. Therefore, we aim to evaluate whether a HVI decreases ultrasonographic Doppler flow in patients with chronic midportion AT.Design: A double-blind, randomized, placebo-controlled clinical trial.Setting: Sports medicine department at a district general hospital.Patients: Sixty-two patients with clinically diagnosed chronic midportion AT were included and randomized into the intervention group (HVI-group, n = 30) and placebo group (n = 32).Intervention: A daily calf-muscle exercise program combined with either (1) a HVI (HVI-group: 50 mL) or (2) a placebo-injection (placebo-group: 2 mL) with a mixture of saline and lidocaine.Main Outcome Measures: Primary outcome was the surface area quantification (SAQ) score (%) of the Doppler flow during a 24-week follow-up period. Secondary outcome was the association between SAQ scores and symptoms [Victorian Institute of Sports Assessment–Achilles (VISA-A)]. Outcomes were measured before, directly after, and 1 hour after the injection and at 2, 6, 12, and 24 weeks of follow-up.Results: There was no significant between-group difference at 24 weeks [−0.1%; 95% confidence interval (CI), −4.9 to 4.7] or at any of the other time points. Change in SAQ score did not correlate with the change in VISA-A score (P = 0.93).Conclusion: A HVI does not affect Doppler flow in patients with chronic midportion AT. Also, changes in Doppler flow were not associated with the clinical outcome. These findings challenge the theoretical basis of a HVI.Trial registration: NCT02996409.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Calcific Tendinopathy of the Shoulder: A Retrospective Comparison of
           Traditional Barbotage Versus Percutaneous Ultrasonic Barbotage

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      Authors: Berrigan; William; Olufade, Oluseun; Negron, Giorgio; Easley, Kirk; Sussman, Walter I.
      Abstract: imageObjective: The purpose of this study was to compare a traditional barbotage technique with percutaneous ultrasonic barbotage (PUB) for the treatment of rotator cuff (RC) calcific tendinopathy.Design: Three-year retrospective review.Setting: Participants aged 18 to 75 presenting at 2 highly specialized outpatient orthopedic referral centers with symptomatic RC calcific tendinopathy.Patients: There were 75 patients included (23 patients in the traditional barbotage group; 52 patients in the PUB group) with an average age of 55.3(6.5) and 55.9(9.8), respectively. There was no significant difference in demographics between groups.Interventions: Traditional barbotage or PUB.Main Outcome Measures: Primary outcome measure was pain rated on the Numeric Pain Rating Scale (NPRS) with secondary outcomes investigating patient satisfaction.Results: The barbotage and PUB group demonstrated a significant improvement in pain (barbotage 2.4, P = 0.01; PUB = 2.6, P < 0.001) with no statistically significant difference between the 2 treatment modalities (95% CI: −1.8 to 2.2; P = 0.83, P = 0.83). Median follow-up for NPRS recordings was 17-weeks in the barbotage group and 8-weeks in the PUB group (P = 0.004). Both groups demonstrated similar patient-reported satisfaction, without major complications.Conclusion: The traditional barbotage and PUB procedures improved pain with a high patient satisfaction rate.Level of evidence: Level III.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Use of Monospot Testing in the Diagnosis of Infectious Mononucleosis in
           the Collegiate Student–Athlete Population

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      Authors: Wang; Eric X.; Kussman, Andrea; Hwang, Calvin E.
      Abstract: imageObjective: To determine the utility of monospot testing in the diagnosis of mononucleosis in the collegiate student–athlete clinical setting.Design: Retrospective cohort study.Setting: National Collegiate Athletic Association Division I sports medicine clinic.Patients: All varsity student athletes who had a monospot test and Epstein–Barr virus (EBV) titers obtained from January 1, 2016, through March 31, 2020, (n = 199) were included.Independent Variables: Monospot, EBV antibody titers, and liver transaminase results.Main Outcome Measures: Using EBV titers indicating acute or recent infection as the gold standard for diagnosing infectious mononucleosis (IM), the reliability of a positive monospot test and elevated liver transaminases for the diagnosis of IM were examined.Results: The monospot test had a sensitivity and specificity of 80.0% and 90.6%, respectively, with a positive predictive value of 36.4% and a negative predictive value of 98.5% in this cohort. All athletes diagnosed with IM also had elevated liver transaminases.Conclusions: The specificity of the monospot test is lower than previously reported in the literature, and a positive test is not sufficient to diagnose mononucleosis in this clinical setting. Positive monospot results should be confirmed with EBV antibody testing. Elevated transaminase levels are highly correlated with acute IM and could play a supporting role in the diagnosis.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Thorn in Your Side or Thorn in Your Head' Anxiety and Stress as
           Correlates of Exercise-Related Transient Abdominal Pain

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      Authors: Wynne; Jaison L.; Wilson, Patrick B.
      Abstract: imageObjectives: The etiology of exercise-related transient abdominal pain (ETAP) is not congruent among researchers notwithstanding numerous studies on the matter. No pursuit has sought to correlate ETAP with factors such as anxiety, stress, sleep dysfunction, and pain sensitivity that are linked to other gastrointestinal (GI) disturbances in athletes.Design: Cross-sectional observational study involving an anonymous survey.Setting: Online.Participants: One hundred sixty-eight male and female adults running at least 10 miles/wk.Assessments of risk factors: Age, body mass index, years of running experience, GI symptoms, the State-Trait Inventory for Cognitive and Somatic Anxiety (STICSA), Perceived Stress Scale (PSS)-14, Sleep Problems Index-I, and Pain Sensitivity Questionnaire.Main outcomes: Exercise-related transient abdominal pain prevalence over the past month as well as ETAP severity and frequency.Results: Exercise-related transient abdominal pain occurred in 39.9% of participants at least once in the past month. Exercise-related transient abdominal pain–positive runners were significantly younger and less experienced than ETAP-negative runners. Exercise-related transient abdominal pain–positive runners demonstrated higher resting and running-related GI symptoms, PSS-14, and STICSA scores compared with ETAP-negative runners. After accounting for age and experience, the ETAP-positive group had STICSA and PSS-14 scores that were 3.4 [95% confidence interval (CI), 1.0-5.8] and 4.1 (95% CI, 1.2-6.0) points higher, respectively, than the ETAP-negative group. State-Trait Inventory for Cognitive and Somatic Anxiety scores were significantly, modestly correlated (ρ = 0.27, P = 0.03) with ETAP frequency but not severity in runners who were ETAP-positive.Conclusions: In runners, this is the first investigation to reveal that anxiety and stress are associated with the presence of ETAP.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Validity of the McMurray Test for Meniscal Tear in Pediatric and
           Adolescent Patients

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      Authors: Sarkisova; Natalya; DeGuzman, Laura; Wren, Tishya A. L.; Zaslow, Tracy L.
      Abstract: imageObjective: The aim of this study was to identify the accuracy of the McMurray test in the adolescent and pediatric population.Design: Retrospective case series.Setting: Tertiary care, institutional.Patients: Inclusion criteria included patients who presented with unilateral knee pain and were seen by pediatric sports medicine physicians. Patients were excluded if their knee pain was related to any underlying conditions. Three hundred patient charts were reviewed, and 183 patients (age range: 8-18 years, mean: 14 years; 74 male) met the inclusion criteria.Interventions: Symptoms at initial visit (knee pain).Main Outcome Measures: Presence of a meniscal tear using the McMurray test.Results: Eighty-four percent (160/191) of patients had a McMurray test documented as performed by the physician, and 17% (27/160) elucidated a positive response. Of 26 patients who had a positive McMurray and underwent magnetic resonance imaging (MRI), 16 (62%) showed a meniscal tear on their MRI. However, of the 87 patients who had a negative McMurray and still underwent MRI, 25 (29%) had a positive meniscal tear. The sensitivity, specificity, positive predictive value, and negative predictive value were 39%, 86%, 62%, and 71%, respectively.Conclusion: In a pediatric and adolescent population, the McMurray test was negative for 61% (23/38) of meniscal tears identified on MRI.Clinical Relevance: Although the test can be a useful tool as a part of a thorough evaluation, combining it with mechanical symptoms, patient history and imaging may be more helpful to diagnose a meniscus tear.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Inter-rater Reliability of the Classification of the J-Sign Is Inadequate
           Among Experts

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      Authors: Hiemstra; Laurie A.; Sheehan, Brendan; Sasyniuk, Treny M.; Kerslake, Sarah
      Abstract: imageObjective: The purpose of this study was to determine the inter-rater and intra-rater reliability of the symmetry, classification, and underlying pathoanatomy associated with the J-sign in patients with recurrent lateral patellofemoral instability.Study design: Blinded, inter-rater reliability study.Setting: N/A.Participants: Thirty patellofemoral joint experts.Interventions: Thirty clinicians independently assessed 30 video recordings of patients with recurrent lateral patellofemoral instability performing the J-sign test.Main outcome measures: Raters documented J-sign symmetry and graded it according to the quadrant and Donell classifications. Raters indicated the most significant underlying pathoanatomy and presence of sagittal plane maltracking. Intra-rater reliability was assessed by 4 raters repeating the assessments. Mean pairwise simple and/or weighted Cohen's kappa were performed to measure inter-rater and intra-rater reliability, as well as calculation of percent agreement.Results: J-sign symmetry demonstrated fair inter-rater reliability (k = 0.26), whereas intra-rater reliability was moderate (k = 0.48). Inter-rater reliability for the quadrant and Donell classifications indicated moderate agreement, k = 0.51 and k = 0.49, respectively, whereas intra-rater reliability was k = 0.79 and k = 0.72, indicating substantial agreement. Inter-rater reliability of the foremost underlying pathoanatomy produced only slight agreement (k = 0.20); however, intra-rater reliability was substantial (k = 0.68). Sagittal plane maltracking demonstrated slight inter-rater agreement (k = 0.23) but substantial intra-rater agreement (k = 0.64).Conclusions: The symmetry, classification, and underlying pathoanatomy of the J-sign demonstrated fair to moderate inter-rater reliability and moderate to substantial intra-rater reliability among expert reviewers using video recordings of patients with recurrent lateral patellofemoral instability. These findings suggest individual raters have a consistent standard for assessing the J-sign, but that these standards are not reliable between assessors.Level of evidence: III.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Association of Social Media Use on Sleep Quality and Performance Among
           Collegiate Athletes

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      Authors: Watkins; Rhonda A.; Sugimoto, Dai; Hunt, Danielle; Oldham, Jessie; Cacolice, Paul A.; Stracciolini, Andrea
      Abstract: imageObjective: (1) To examine the effect of social media (SM) use on sleep quality and (2) to determine the effect of SM on competition performance among college athletes.Design: Cross-sectional study.Setting: Two local Division III colleges, MA, USA.Participants: National Collegiate Athletic Association Division III swim and track and field athletes.Intervention: Data were collected onsite through an SM use form, the lifestyle survey, and the Patient-Reported Outcomes Measurement Information System Sleep Disturbance Questionnaire. Participants were divided into 3 groups based on their SM volume: (1) less active SM users (≤2 h/d), (2) moderately active SM users (>2-≤5 h/d), and (3) active SM users (>5 h/d) for analysis.Main Outcome Measures: Sleep quality and sport performance data collected through publicly available competition results. The independent variable, SM volume (hours of SM use per day over 7 days), was collected using the iPhone screen time function.Results: The cohort consisted of 40 male track and field athletes and 47 female track and field (37, 79%) and swimming (10, 21%) athletes. Mean SM use was 4.6 ± 3.4 h/d. The sleep quality of active SM users was worse than less active SM users (P = 0.033). There was an independent association between increased Facebook time and poor performance after adjusting confounders (adjusted odds ratio: 0.990, 95% confidence interval: 0.981-0.999, P = 0.049).Conclusions: High SM use has a negative impact on sleep quality and may hinder competition performance among college athletes. These findings may have implications for developing SM use guidelines for college athletes to improve their sleep quality and performance.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Sonographic Screening of Distance Runners for the Development of Future
           Achilles and Patellar Tendon Pain

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      Authors: Cushman; Daniel M.; Petrin, Ziva; Cummings, Keith; Eby, Sarah F.; English, Joy; Teramoto, Masaru
      Abstract: imageObjective: The 2 primary aims of this study were to identify ultrasonographic tendon abnormalities in asymptomatic runners and to examine the likelihood of developing pain in runners with ultrasound abnormalities compared with those without abnormalities.Design: Longitudinal, prospective cohort study.Setting: 2019 Salt Lake City Marathon.Participants: Recreational half-marathon and full-marathon runners.Assessment of Risk Factors: The Achilles and patellar tendons of asymptomatic runners were examined with ultrasound imaging before a running event. Runners were monitored for self-reported outcomes of pain in the examined tendons at 1, 3, 6, and 12 months after the event.Main Outcome Measures: Development of pain based on the presence of asymptomatic tendon abnormalities.Results: One hundred thirty-eight runners (36.2 ± 12.0 years, 49.3% men, and 31.2% full-marathon runners) were included. Ultrasound abnormalities of the Achilles and patellar tendons were identified in 24.6% and 39.1% of the runners before the race, respectively. Ultrasound abnormalities were significantly associated with approximately a 3-fold increase [hazard ratio (HR) = 2.55, P = 0.004] in the hazard of developing pain in the Achilles tendon and patellar tendon (HR = 1.67, P = 0.042) over the year after the race. Positive and negative predictive values of developing pain over the year were 34.1% and 87.2%, respectively, for abnormal findings in the Achilles tendon, and 22.9% and 85.0%, respectively, for the patellar tendon.Conclusions: The presence of ultrasonographic abnormalities is associated with increased development of pain in the Achilles and patellar tendons within 1 year of a marathon or half marathon.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Midseason Screening for Groin Pain, Severity, and Disability in 101 Elite
           American Youth Soccer Players: A Cross-Sectional Study

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      Authors: DeLang; Matthew D.; Garrison, J. Craig; Hannon, Joseph P.; McGovern, Ryan P.; Sheedy, Philip J.; Christoforetti, John J.; Thorborg, Kristian
      Abstract: imageObjective: To (1) systematically screen for groin pain and type in young elite soccer players and (2) assess whether hip and groin-related severity and disability differed between players with different levels of groin pain and tenderness.Design: Cross-sectional observational.Setting: Elite American soccer academy at midseason.Participants: One hundred one academy soccer players (mean age 14.3 ± 1.8 years).Intervention: All players underwent clinical examinations to classify groin pain by the Doha agreement taxonomy.Main Outcome Measures: Tests for groin-related severity and disability included the Copenhagen 5-second squeeze test, Copenhagen Hip and Groin Outcome Score (HAGOS), and Hip Outcome Score (HOS). Players were stratified into 3 groups: those with groin pain, those with tenderness, and those with no groin pain or tenderness.Results: Twenty-two players (22%) reported groin pain. Adductor-related groin pain was the most common (n = 14), followed by iliopsoas-related (n = 3), and pubic-related (n = 2). Multiple locations were present in 3 players. Thirty-nine players (39%) did not have groin pain but were tender to palpation in 1 or more structures related to the Doha agreement taxonomy. Copenhagen 5-second squeeze test differentiated between players with and without groin pain (groin pain vs tenderness group: P = 0.011; groin pain vs no groin pain group P < 0.001). Four HAGOS subscales (pain, symptoms, sport/recreation, and quality of life) differentiated between players with and without groin pain (P < 0.05).Conclusions: One in five academy soccer players experiences groin pain with adductor-related most common during a midseason screening. Both Copenhagen 5-second squeeze test and HAGOS subscales can differentiate between players with and without groin pain.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Injuries and Concussions in Female High School Rugby: Prevention is Worth
           a Try

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      Authors: Shill; Isla J.; West, Stephen W.; Sick, Stacy; Schneider, Kathryn; Hagel, Brent E.; Pasanen, Kati; Wiley, James Preston; Emery, Carolyn A.; Black, Amanda M.
      Abstract: imageObjectives: To describe injury and concussion rates and mechanisms in female high school rugby players.Design: Two-year prospective cohort study.Setting: High school rugby.Participants: Participants included 214 female High school rugby players (year 1) and 207 female High school players (year 2) from the Calgary Senior High School Athletics Association 2018 and 2019 rugby competition.Intervention: None.Main Outcome Measures: Match and training injury and concussion. Injury definition included any injury resulting in time loss, inability to complete a session, and/or requiring medical attention. Details of reported injuries were collected on injury report forms and validated by a certified athletic therapist on a validated online injury surveillance platform. Exposure hours for players were tracked using paper or virtual weekly exposure forms by team designates.Results: A match incidence rate (IR) = 93.7 injuries/1000 match hours (95% confidence intervals (CI): 78.6-11.7) and training IR = 5.3 injuries/1000 training hours (95% CI: 4.0-6.9) were estimated. The tackle accounted for 109 (70%) match and 37 (44%) training injuries. Tackling was the most frequent mechanism of injury (IR = 37.5 injuries/1000 match hours, 95% CI: 27.5-51.8 and 1.2 injuries/1000 training hours, 95% CI: 0.7-2.4). Sixty-two match concussions (IR = 37.5 concussions/1000 match hours, 95% CI: 26.8-52.3) and 16 training concussions (IR = 1.0 concussions/1000 training hours, 95% CI: 0.7-1.4) occurred. Of 78 reported concussions, 78% for match and 56% for training were physician diagnosed. Tackling was the most frequent mechanism of concussion in matches (IR = 18.1 concussions/1000 match hours, 95% CI:11.4-28.6).Conclusions: Injury and concussion rates in female high school rugby are high. The tackle accounted for the highest proportion of injuries. Prevention strategies (eg, tackle policy change, tackle-training programs, and neuromuscular training) should be explored to increase sport safety.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Marathon Runners' Knowledge and Strategies for Hydration

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      Authors: Namineni; Neeharika; Potok, O. Alison; Ix, Joachim H.; Ginsberg, Charles; Negoianu, Dan; Rifkin, Dena E.; Garimella, Pranav S.
      Abstract: imageObjective: To study hydration plans and understanding of exercise-associated hyponatremia (EAH) among current marathon runners.Design: Cross-sectional studySetting: Southern California 2018 summer marathonParticipants: Two hundred ten marathon runners.Interventions: Survey administered 1 to 2 days before the race. Race times were obtained from public race website.Main Outcome Measures: Planned frequency of hydration; awareness of, understanding of, and preventative strategies for dehydration and EAH; resources used to create hydration plans; drink preferences.Results: When the participants were split into 3 equal groups by racing speed, the slower tertile intended to drink at every mile/station (60%), whereas the faster tertile preferred to drink every other mile or less often (60%), although not statistically significant. Most runners (84%) claimed awareness of EAH, but only 32% could list a symptom of the condition. Both experienced marathoners and the faster tertile significantly had greater understanding of hyponatremia compared with first-time marathoners and the slower tertile, respectively. Less than 5% of marathoners offered “drink to thirst” as a prevention strategy for dehydration or EAH.Conclusion: Slower runners plan to drink larger volumes compared with their faster counterparts. Both slower and first-time marathoners significantly lacked understanding of EAH. These groups have plans and knowledge that may put them at higher risk for developing EAH. Most marathon runners did not know of the guidelines to “drink to thirst,” suggesting the 2015 EAH Consensus statement may not have had the desired impact.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Variation in Patient-Reported Outcomes in Young and Old Patients Up to 4
           to 6 Years After Arthroscopic Partial Meniscectomy

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      Authors: Tayfur; Beyza; Pihl, Kenneth; Varnum, Claus; Lohmander, Stefan; Englund, Martin; Thorlund, Jonas Bloch
      Abstract: imageObjective: To assess the variation in changes in patient-reported outcomes 4 to 6 years after arthroscopic partial meniscectomy (APM).Design: Prospective cohort study.Setting: Orthopedic departments at public hospitals.Patients: Patients (n = 447) from the Knee Arthroscopy Cohort Southern Denmark undergoing APM.Interventions: All patients underwent APM.Main Outcome Measures: Change in KOOS4 scores from baseline before surgery to ∼5 years (range 4-6 years) after surgery. KOOS4 is the average aggregated score of 4 of 5 of the Knee injury and Osteoarthritis Outcome Score (KOOS) excluding the activities of daily living subscale (minimal clinical important improvement ∼10 points). A mixed linear model adjusted for sex and body mass index was used to assess change from baseline to ∼5-year follow-up. Change in KOOS4 was divided into 5 categories based on change from baseline to ∼5-year follow-up:
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Effects of Blood Flow Restriction Therapy for Muscular Strength,
           Hypertrophy, and Endurance in Healthy and Special Populations: A
           Systematic Review and Meta-Analysis

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      Authors: Perera; Edward; Zhu, Xi Ming; Horner, Nolan S.; Bedi, Asheesh; Ayeni, Olufemi R.; Khan, Moin
      Abstract: imageObjectives: Blood flow restriction (BFR) training is an increasingly applied tool with potential benefits in muscular hypertrophy, strength, and endurance. This study investigates the effectiveness of BFR training relative to other forms of training on muscle strength, hypertrophy, and endurance.Data sources: We performed systematic searches of MEDLINE, Embase, and PubMed and assessed the methodological quality of included studies using the Cochrane risk of bias tool.Main results: We included 53 randomized controlled trials with 31 included in meta-analyses. For muscular strength comparing low-intensity BFR (LI-BFR) training with high-intensity resistance training (HIRT), the pooled mean difference (MD) for 1 repetition maximum was 5.34 kg (95% CI, 2.58-8.09; P < 0.01) favoring HIRT. When comparing LI-BFR training with HIRT for torque, the MD was 6.35 N·m (95% CI, 0.5-12.3; P = 0.04) also favoring HIRT. However, comparing LI-BFR with low-intensity resistance training (LIRT) for torque, there was a MD of 9.94 N·m (95% CI, 5.43-14.45; P < 0.01) favoring BFR training. Assessing muscle hypertrophy, the MD in cross-sectional area was 0.96 cm2 (95% CI, 0.21-1.7; P = 0.01) favoring pooled BFR training compared with nonocclusive training. Assessing endurance, V̇o2 maximum demonstrated a greater mean increase of 0.37 mL/kg/min (95% CI, −0.97 to 3.17; P = 0.64) in BFR endurance training compared with endurance training alone.Conclusion: Blood flow restriction training produced increases in muscular strength, hypertrophy, and endurance. Comparing LI-BFR training with HIRT, HIRT was a significantly better training modality for increasing muscle hypertrophy and strength. However, LI-BFR was superior when compared with a similar low-intensity protocol. Blood flow restriction training is potentially beneficial to those unable to tolerate the high loads of HIRT; however, better understanding of its risk to benefit ratio is needed before clinical application.Level of evidence: Level 1.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Glenohumeral Internal Rotation Deficit in the Adolescent Overhead Athlete:
           A Systematic Review and Meta-Analysis

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      Authors: Gouveia; Kyle; Kay, Jeffrey; Memon, Muzammil; Simunovic, Nicole; Ayeni, Olufemi R.
      Abstract: imageObjective: The objective of this review was to investigate the average glenohumeral internal rotation deficit (GIRD) in the dominant arm of adolescent overhead athletes and to examine the association with shoulder and elbow injuries.Design: Systematic review and meta-analysis.Setting: MEDLINE, Embase, and PubMed were searched from inception to August 1, 2020.Participants: Adolescent overhead athletes with glenohumeral range of motion (ROM) measurements.Interventions: Nonoperative treatments of GIRD.Main Outcome Measures: Glenohumeral ROM measurements comparing the dominant and nondominant extremities were pooled in a meta-analysis.Results: Twenty-five studies were included in this review, which involved 2522 overhead athletes. Pooled internal rotation (IR) deficit of the dominant arm was 9.60° (95% confidence interval [CI] 7.87°-11.32°, P < 0.00001), with an external rotation (ER) gain of 6.78° (95% CI 4.97°-8.59°, P < 0.00001) and a total ROM (TROM) deficit of 1.78° (95% CI -0.70° to 4.26°, P = 0.16). The association between GIRD and shoulder or elbow injury was not clearly defined. Two studies reported treatment, and both used nonoperative treatment in the form of physiotherapy and sleeper stretches.Conclusions: The adolescent overhead athlete has roughly 10° of IR deficit in their dominant arm, accompanied by nearly 7° of ER gain, with similar ROM measurements for injured and uninjured athletes. Those with pathological GIRD have a greater degree of IR deficit, but without an accompanying compensatory increase in ER, leading to a TROM deficit of nearly 15°. Surgical treatment in the absence of other indications is rare, whereas physiotherapy and sleeper stretches remain the first-line treatment.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Data Collection Procedures and Injury Definitions in Badminton: A
           Consensus Statement According to the Delphi Approach

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      Authors: Gijon-Nogueron; Gabriel; Ortega-Avila, Ana Belen; Kaldau, Niels Christian; Fahlstrom, Martin; Felder, Hanno; Kerr, Stewart; King, Mark; McCaig, Steve; Marchena-Rodriguez, Ana; Cabello-Manrique, David
      Abstract: imageAbstract: Previous studies involving injury surveillance in badminton players have used nonstandardized injury definitions and data collection methodologies. The purpose of this study was to apply a Delphi method to (1) reach a consensus on an injury definition in badminton and (2) develop a standardized badminton injury report form. An Injury Consensus Group was established under the auspices of the Badminton World Federation, and initial injury definitions and injury report form were developed. An internal panel was formed from the Injury Consensus Group, and an external panel was selected based on a combination of profession, experience in the field, sport-specific knowledge/expertise, and geographical location to obtain a widely representative sample. Through 2 rounds of voting by the external panel, consensus was reached on both the definition of an injury in badminton and a standardized injury report form. The agreed injury definition was “Any physical injury sustained by a player during a match or training regardless if further diagnostic tests were done or if playing time was lost” and the injury report form contained the following 7 sections: Injury record, Diagnosis, Injury mechanism, Regarding pain, Pain and return to play/training after injury, Grade of severity, and Recurrence. We recommend the use of the definitions and methods presented in this consensus statement for the reporting of injury in all international and domestic badminton players. This should make future injury surveillance reports directly comparable and hence more informative in recognizing trends over time and differences between countries.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Examination of Near Point of Convergence Scores in High-School Athletes:
           Implications for Identifying Binocular Vision Dysfunction After Concussion
           Injury

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      Authors: Del Rossi; Gianluca
      Abstract: imageObjective: To identify normative near point of convergence (NPC) data for healthy high-school–aged athletes (13-19 years old) and determine the percentage of individuals with NPC scores that fall outside the currently accepted clinical cutoff value of 5 cm. Another objective was to determine the relationship between sex, concussion history, and attention deficit disorder/attention deficit hyperactivity disorder (ADD/ADHD) with NPC scores, if any.Design: Case series.Setting: High-school sports medicine clinic.Patients (or Participants): Near point of convergence was assessed in 718 high-school student athletes (141 females and 577 males) with an average age of 15.96 ± 1.16 years.Interventions: None.Main Outcome Measures: An accommodation convergence ruler was used to measure NPC. Near point of convergence scores were repeated a total of 3 times and the mean used for all statistical analyses.Results: The NPC scores for all participants averaged 3.58 cm, and the intraclass correlation coefficient for the 3 repeated measurements was 0.956. Approximately 20% of mean NPC scores were above the accepted upper limit of 5 cm. Although a statistically significant effect for sex was identified, the difference between them was considered clinically insignificant. No relationship between NPC and history of concussion or ADD/ADHD was identified.Conclusions: Results indicate that in high-school–aged subjects, approximately 20% of individuals may have NPC values that fall outside the current critical cutoff value and may lead to incorrect diagnosis of ocular dysfunction. In addition, NPC does not seem to be affected by the history of concussion or a diagnosis of ADD/ADHD.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Premorbid Primary Headache and Vestibular and Oculomotor Baseline
           Assessments in Collegiate Athletes

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      Authors: Burns; Karlee N.; Langford, Theresa Dianne; Tierney, Ryan; McDevitt, Jane
      Abstract: imageObjective: The purpose of this study was to determine the effects of premorbid headache status on vestibular and oculomotor baseline tests in collegiate club athletes.Design: Retrospective case–control study.Setting: Sport Concussion Laboratory.Patients (or Participants): Collegiate club athletes with a self-reported premorbid headache history (n = 32, 19.50 ± 1.98 years, and 31% women) and age–sex–sport–matched controls (n = 32, 19.56 ± 1.47 years, and 31% women) without a self-reported headache history were included.Interventions: Participants were grouped based on a self-reported headache history at baseline. Controls were randomly matched to self-reported headache participants by age, sex, and sport.Main Outcome Measures: Vestibular/ocular motor screen (VOMS) baseline symptoms, symptom provocation, near point of convergence (NPC) distance, and King–Devick (K-D) test time were compared between groups.Results: Athletes with a self-reported headache history at baseline are 3.82 times more likely to have abnormal NPC scores (P = 0.032) and 4.76 times more likely to have abnormal K-D test times (P = 0.014) than those without a headache history. There was no difference in VOMS baseline symptoms or symptom provocation between groups (P> 0.05).Conclusions: Club collegiate athletes with a headache history were more likely to screen as abnormal during a vestibular/ocular motor function assessment than athletes without a history of headaches. Healthcare professionals should screen for pre-existing headache during baseline concussion assessments before test interpretation.Clinical Relevance: A premorbid headache history at preseason baseline assessment may influence vestibular and oculomotor function, and care should be taken when interpreting these individuals' tests.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • The Effect of Sex, Sport, and Preexisting Histories on Baseline Concussion
           Test Performance in College Lacrosse and Soccer Athletes

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      Authors: Mihalik; Jason P.; Teel, Elizabeth F.; Ford, Cassie B.; Amalfe, Stephanie A.; Barczak-Scarboro, Nikki E.; Lynall, Robert C.; Riegler, Kaitlin E.; Wasserman, Erin B.; Putukian, Margot
      Abstract: imageObjective: To study sex and sport differences in baseline clinical concussion assessments. A secondary purpose was to determine if these same assessments are affected by self-reported histories of (1) concussion; (2) learning disability; (3) anxiety and/or depression; and (4) migraine.Design: Prospective cohort.Setting: National Collegiate Athletic Association D1 Universities.Participants: Male and female soccer and lacrosse athletes (n = 237; age = 19.8 ± 1.3 years).Assessment of Risk Factors: Sport, sex, history of (1) concussion; (2) learning disability; (3) anxiety and/or depression; and (4) migraine.Main Outcome Measures: Sport Concussion Assessment Tool 22-item symptom checklist, Standardized Assessment of Concussion, Balance Error Scoring System (BESS), Generalized Anxiety Disorder 7-item scale, and Patient Health Questionnaire.Results: Female athletes had significantly higher total symptoms endorsed (P = 0.02), total symptom severity (P < 0.001), and BESS total errors (P = 0.01) than male athletes. No other sex, sport, or sex-by-sport interactions were observed (P> 0.05). Previous concussion and migraine history were related to greater total symptoms endorsed (concussion: P = 0.03; migraine: P = 0.01) and total symptom severity (concussion: P = 0.04; migraine: P = 0.02). Athletes with a migraine history also self-reported higher anxiety (P = 0.004) and depression (P = 0.01) scores. No other associations between preexisting histories and clinical concussion outcomes were observed (P> 0.05).Conclusions: Our findings reinforce the need to individualize concussion assessment and management. This is highlighted by the findings involving sex differences and preexisting concussion and migraine histories.Clinical Relevance: Clinicians should fully inventory athletes' personal and medical histories to better understand variability in measures, which may be used to inform return-to-participation decisions following injury.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Sports-Related Concussions in Adults Presenting to Canadian Emergency
           Departments

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      Authors: Rowe; Brian H.; Yang, Esther H.; Gaudet, Lindsay A.; Lowes, Justin; Eliyahu, Leeor; Villa-Roel, Cristina; Beach, Jeremy; Mrazik, Martin; Cummings, Garnet; Voaklander, Donald
      Abstract: imageObjective: To document the occurrence and recovery outcomes of sports-related concussions (SRCs) presenting to the Emergency Department (ED) in a community-based sample.Design: A prospective observational cohort study was conducted in 3 Canadian hospitals.Setting: Emergency Department.Patients: Adults (≥17 years) presenting with a concussion to participating EDs with a Glasgow Coma Scale score ≥13 were recruited.Interventions: Patient demographics (eg, age and sex), clinical characteristics (eg, history of depression or anxiety), injury characteristics (eg, injury mechanisms and loss of consciousness and duration), and ED management and outcomes (eg, imaging, consultations, and ED length of stay) were collected.Main outcome measures: Patients' self-reported persistent concussion symptoms, return to physical activity status, and health-related quality of life at 30 and 90 days after ED discharge.Results: Overall, 248 patients were enrolled, and 25% had a SRC. Patients with SRCs were younger and reported more physical activity before the event. Although most of the patients with SRCs returned to their normal physical activities at 30 days, postconcussive symptoms persisted in 40% at 90 days of follow-up. After adjustment, there was no significant association between SRCs and persistent symptoms; however, patients with concussion from motor vehicle collisions were more likely to have persistent symptoms.Conclusion: Although physically active individuals may recover faster after a concussion, patients returning to their physical activities before full resolution of symptoms are at higher risk of persistent symptoms and further injury. Patient–clinician communications and tailored recommendations should be encouraged to guide appropriate acute management of concussions.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Concussions and Injuries in Sledge Hockey: Grassroots to Elite
           Participation

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      Authors: Sobry; Alexandra J.; Kolstad, Ash T.; Janzen, Leticia; Black, Amanda M.; Emery, Carolyn A.
      Abstract: imageObjective: To examine injury (including concussion) rates, location, type, mechanisms, and risk factors in sledge hockey players.Design: Cross-sectional survey.Setting: Sledge hockey players, worldwide, across all levels of play.Participants: Sledge hockey players (ages ≥14 years) who played in the 2019 to 2020 season were recruited through email, social media, and word of mouth communication.Assessment of Risk Factors: Participant characteristics (eg, age, sex, disability) were examined as potential injury risk factors.Main Outcome Measures: Injury rates (IR) and incidence rate ratios (IRR) examining potential risk factors were reported based on univariate Poisson regression analyses. Injury proportions by type, location, and mechanism were described.Results: Ninety-two players initiated the survey, and 77 (83.7%) provided some injury information. Forty-seven injuries included 16 concussions in 9 of 77 players (11.7%) and 31 non-concussion injuries in 20 of 77 players (26.0%) were reported. The overall IR was 13.2 injuries/1000 athlete-exposures [95% confidence interval (CI); 9.6-17.6]. The game IR (28.4 injuries/1000 game-exposures, 95% CI; 18.6-41.7) was higher than practice IR (4.4 injuries/1000 practice-exposures, 95% CI; 2.2-7.9) (IRR = 6.5, 95% CI; 3.1-14.5). The most common injury locations were the head (34.0%), wrist/hand (14.8%), and shoulder (10.6%). The most common significant injury types were concussion (36.2%) and bone fracture (8.5%). Body checking was the primary mechanism for injuries caused by contact with another player (42.1%) Age, sex, disability, and level of play were not found as injury risk factors.Conclusions: Concussions and upper extremity injuries were the most common sledge hockey injuries reported, with body checking being the most common mechanism. This research will inform development of prevention strategies in sledge hockey.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Cardiac Remodeling in Elite Aquatic Sport Athletes

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      Authors: Coates; Alexandra M.; Cheung, Christian P.; Currie, Katharine D.; King, Trevor J.; Mountjoy, Margo L.; Burr, Jamie F.
      Abstract: imageObjective: To characterize and compare the sport-specific cardiac structure of elite swimmers (SW), water polo players (WP), and artistic swimmers (AS).Design: A cross-sectional assessment of elite aquatic athletes' hearts.Setting: The athletes' village at the 2019 FINA World Championships.Participants: Ninety athletes from swimming (SW) (20 M/17 F), water polo (WP) (21 M/9 F), and artistic swimming (AS) (23 F).Assessment and Main Outcome Measures: An echocardiographic assessment of cardiac structure was performed on noncompetition days.Results: Male SW displayed primarily eccentric volume-driven remodeling, whereas male WP had a greater incidence of pressure-driven concentric geometry (SW = 5%, WP = 25%) with elevated relative wall-thickness (RWT) (SW = 0.35 ± 0.04, WP = 0.44 ± 0.08, P < 0.001). Female SW and WP hearts were similar with primarily eccentric-remodeling, but SW and WP had greater concentricity index than artistic swimmers (SW = 6.74 ± 1.45 g/(mL)2/3, WP = 6.80 ± 1.24 g/(mL)2/3, AS = 5.52 ± 1.08 g/(mL)2/3, P = 0.007). AS had normal geometry, but with increased posterior-wall specific RWT (SW = 0.32 ± 0.05, AS = 0.42 ± 0.11, P = 0.004) and greater left atrial area than SW (SW = 9.7 ± 0.9 cm2/m2, AS = 11.0 ± 1.1 cm2/m2, P = 0.003). All females had greater incidence of left ventricular (LV) posterior/septal wall-thickness ≥11 mm than typically reported (SW = 24%, WP = 11%, AS = 17%).Conclusions: Male athletes presented classic sport-specific differentiation, with SW demonstrating primarily volume-driven eccentric remodelling, and WP with greater concentric geometry indicative of pressure-driven remodeling. Female SW and WP did not display this divergence, likely because of sex-differences in adaptation. AS had unique LV-specific adaptations suggesting elevated pressure under low-volume conditions. The overall incidence of elevated wall-thickness in female athletes may point to an aquatic specific pressure-stress.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • The Relationships Between 25-Hydroxyvitamin D and Echocardiographic
           Parameters in Female Basketball Players

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      Authors: Radovanović; Dragan; Stoičkov, Viktor; Pechanova, Olga; Scanlan, Aaron T.; Jakovljević, Vladimir; Stojanović, Emilija
      Abstract: imageObjective: This study was undertaken to (1) describe the cardiac structure and function and (2) to quantify the relationships between 25-hydroxyvitamin D [25(OH)D] and echocardiographic parameters in female basketball players.Design: A cross-sectional experimental design.Setting: Controlled laboratory setting.Participants: Professional, female basketball players (n = 18).Intervention: 25(OH)D and echocardiographic screening at the midpoint of the in-season phase, over a 2-week period in late Fall.Main Outcome Measures: 25(OH)D and echocardiographic parameters.Results: A high prevalence of vitamin D insufficiency was observed in the female players examined (77.8%), with most also displaying eccentric cardiac hypertrophy (77.8%). Nonsignificant, moderate correlations were found between 25(OH)D and structural echocardiographic parameters, including left atrium diameter (r = 0.34, P = 0.16), left ventricular (LV) end-systolic diameter (r = −0.46, P = 0.06), posterior wall thickness (r = 0.36, P = 0.14), LV mass (r = 0.30, P = 0.23), and LV index (r = 0.33, P = 0.18). Significant, large correlations were found between 25(OH)D and echocardiographic parameters indicative of systolic function, including LV ejection fraction (r = 0.59, P = 0.01), fractional shortening (r = 0.59, P = 0.01), and peak systolic mitral tissue velocity (r = 0.51, P = 0.003). Similarly, a significant, large correlation was found between 25(OH)D and diastolic function as indicated by mitral valve inflow deceleration time (r = 0.51, P = 0.03).Conclusions: Our findings suggest the importance of female basketball players maintaining 25(OH)D concentration, given its possible physiological benefits on cardiac structure and function.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • The Role of Age, Sex, Body Mass Index, and Sport Type on the Dynamic
           Exertion Test in Healthy Athletes: A Cross-Sectional Study

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      Authors: Sinnott; Aaron M.; Eagle, Shawn R.; Kochick, Victoria; Preszler, Jonathan; Collins, Michael W.; Sparto, Patrick J.; Flanagan, Shawn D.; Elbin, Robert J.; Connaboy, Christopher; Kontos, Anthony P.
      Abstract: imageBackground: The dynamic exertion test (EXiT) was developed to help inform return to play after sport-related concussion, but some factors may threaten the internal validity of EXiT and affect clinical interpretation.Objective: To compare age, sex, BMI, and sport types across EXiT physiological [pre-EXiT and post-EXiT percentage of maximum heart rate (HR %max) and blood pressure (BP)], performance (change-of-direction task completion time and committed errors), and clinical [symptoms and rating of perceived exertion (RPE)] outcomes among healthy adolescents and adults.Study design: Cross-sectional.Methods: Eighty-seven participants (F = 55, 37.4%) reported symptoms and RPE during the EXiT, which consists of a 12-minute treadmill running protocol, and the dynamic circuit, ball toss, box shuffle (SHUF) and carioca (CAR), zig zag (ZZ), proagility (PA), and arrow agility (AA) tasks. Independent samples t tests were conducted for pre-EXiT and post-EXiT HR %max and BP and change-of-direction task completion time and Mann–Whitney U tests for errors, symptoms, and RPE. A series of 1-way analysis of variance (ANOVAs) and Kruskal–Wallis H tests were conducted to compare collision, contact, and noncontact sport types.Results: Adolescents had lower completion time across AA (P = 0.01) and male athletes lower than female athletes on CAR, ZZ, PA, and AA (P < 0.04). Male athletes reported greater RPE after the SHUF, CAR, and AA (P < 0.03). HR %max, errors, and symptoms were equivocal across all subgroups (P> 0.05).Conclusion: Age and sex should be considered in the interpretation of performance and clinical, but not physiological, EXiT outcomes. The EXiT is a standardized exercise assessment and generalizable to healthy athletes.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Analysis of Injuries in Competitive Equestrian Events

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      Authors: Haines; Carver; Jensen, Hanna K.; Karim, Saleema A.; McGhee, Linda
      Abstract: imageObjective: Current equestrian sport-related acute injury research is sparse. The goal of this study is to explore equestrian injury types stratified by population and equestrian discipline.Design: Injury reports from the US Equestrian Federation (USEF) were compiled from 2015 through 2019, and the prevalence of different injury types within the main equestrian disciplines was calculated.Setting: Retrospective cohort study from USEF accident report data.Participants: Athletes competing at USEF sanctioned equestrian events.Independent Variables: Equestrian participant's age group, sex, and equestrian event type are the independent variables.Main Outcome Measures: Frequency of types of injuries in equestrian events stratified by equestrian discipline, age (junior vs senior), and sex.Results: Three thousand four hundred thirty equestrian athletes injured from 441 816 total athlete exposures during 2015 to 2019 were analyzed showing an injury rate between 0.06% and 1.18% for each discipline with an overall injury rate of 780 per 100 000 athlete exposures. Hunter–jumper and 3-day eventing had the highest injury rates. Head injuries and bone injuries were the most common types. No clinically significant differences in injury rates were observed between males and females or junior and senior equestrian athletes.Conclusions: Equestrian sports have an overall injury rate of 780 per 100 000 athlete exposures in the certified competition setting. Hunter–jumper and 3-day eventing have an increased injury rate compared with nonjumping disciplines. These data should help equestrian event clinicians to anticipate the types of injuries and help outpatient clinicians make preparticipation medical eligibility and assist in counseling for equestrian sports.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Electrocardiographic Findings in Professional Male Athletes

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      Authors: Raman; Karanvir S.; Vyselaar, John R.
      Abstract: imageObjective: To generate granular normative electrocardiogram (ECG) data and characterize the variation by ethnicity and sport played.Design: Cross-sectional study; ECGs were collected from preseason screening programs from 2012 to 2019 and interpreted in accordance with athlete-specific guidelines.Setting: Of the professional athletes based in Vancouver, the North Shore Heart Centre performs the annual preparticipation ECG screening.Participants: Seven hundred fifty-three professional male athletes competing in hockey, football, lacrosse, skiing, and snowboarding.Interventions: Independent variables include commonly transcribed electrocardiographic findings, for example, those indicating benign and pathologic findings.Main outcome measures: Prevalence of and variance in electrocardiographic findings by sport played and ethnicity.Results: Of the 753 athletes, 171 (22.3%) were National Hockey League, 358 (47.5%) were Canadian Football League, 163 (21.6%) were Major League Soccer and/or the Canadian National Soccer team, and 61 (8%) others. The most common finding, sinus bradycardia, was more likely in both soccer (P < 0.001) and hockey (P < 0.001) versus football players. Early repolarization (ER) was more likely in soccer players versus both hockey (P < 0.001) and football players (P = 0.001). Within football, Black athletes (BA) were more likely than White athletes to display ER (P = 0.009), left ventricular hypertrophy (P = 0.004), and nonspecific ST changes (P = 0.027).Conclusion: Our study contributes to the generation of normative data for ECG findings while accounting for ethnic and sport-specific variation. The expected clinical presentation of endurance athletes, including soccer players, and the possible predisposition of BA to develop distinct adaptations can augment clinical care by delineating physiology from pathologic changes.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Evidence to Eliminate Double-Leg Conditions From the Modified Balance
           Error Scoring System and Balance Error Scoring System

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      Authors: Fraser; Melissa A.; Kuo, Michael; Boeckmann, Anne Marie; Kilchrist, Leah M.
      Abstract: imageObjective: The purpose of our study was to assess the differences between the Balance Error Scoring System (BESS), modified BESS (mBESS), and both measures with the double-leg (DL) stances removed [BESS-revised (BESS-R) and mBESS-revised (mBESS-R)] among healthy and concussed collegiate student-athletes.Design: Retrospective, repeated-measures cohort study.Setting: Clinical.Patients or Other Participants: Healthy and concussed collegiate athletes (baseline n = 622, postinjury n = 41) from 12 National Collegiate Athletic Association Division I sports cheer and dance at a single university.Intervention (Or Independent Variables): Balance Error Scoring System, mBESS, BESS-R, and mBESS-R test versions from baseline and postinjury testing.Main Outcome Measures: The mBESS and BESS and their revised versions with DL stances removed (mBESS-R and BESS-R) scores were compared at baseline. Baseline and postinjury scores for all 4 BESS variations and the 6 BESS conditions were compared for those who sustained a concussion.Results: The BESS and BESS-R were statistically different at baseline for the entire sample (99.6% confidence interval 0.32, 0.38, P> 0.0001). None of the other comparisons were significantly different (P> 0.004).Conclusion: Although our results do suggest statistically significant differences between the BESS and BESS-R test versions, they do not represent clinically meaningful differences. The greatest mean difference between all test versions was
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Little or No Differences in Hip Morphology Between Professional Dancers
           and Controls: A Systematic Review

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      Authors: Nogier; Alexis; Tourabaly, Idriss; Barreau, Xavière; Ramos-Pascual, Sonia; van Rooij, Floris; Saffarini, Mo; Courtin, Cyril
      Abstract: imageObjective: To systematically evaluate and synthesize the literature on bony hip morphology of professional dancers, as measured by 2D or 3D imaging techniques.Data Sources: A literature search was performed on November 20, 2020, using MEDLINE, Embase, and Cochrane. Clinical studies were eligible if they reported on hip morphology of professional dancers. Two independent reviewers screened titles, abstracts, and full-texts to determine eligibility; performed data extraction; and assessed the quality of eligible studies according to the Joanna Briggs Institute (JBI) checklist. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.Main Results: The search returned 1384 records; 449 were duplicates, 923 were excluded after title/abstract/full-text screening, and 12 were eligible, reporting on 447 individuals (352 professional dancers and 95 controls). The JBI checklist indicated that 11 studies scored ≥4 points. For professional dancers, lateral center edge angle was 22.4 to 30.8 degrees, acetabular version was 6.7 to 13.5 degrees, neck–shaft angle was 132.5 to 139.5 degrees, and femoral version was 4.7 to 14.4 degrees. Statistically significant differences between dancers and controls were found in some of the studies for acetabular version, neck–shaft angle, and femoral version, although only femoral version showed clinically relevant differences.Conclusions: The bony hip morphology of professional dancers is similar to that of other athletes and age-matched controls, which is in contrast to the authors' clinical experience. We presume that the abnormal morphology we have seen at the clinic is only present in symptomatic dancers who require total hip arthroplasty (THA) and is not a general characteristic of all dancers. Further studies should compare the hip morphology of dancers undergoing THA with matched nondancers.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Double Major for Slashing: Management of Blunt Popliteal Fossa Trauma in
           Ice Hockey in the Setting of Popliteal Artery Entrapment Syndrome

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      Authors: Singh; Brij M.; Galimova, Irina; Singh, Tej M.
      Abstract: imageAbstract: Popliteal artery entrapment syndrome (PAES) is a rare condition that produces calf claudication in young patients. It is most commonly a result of aberrant anatomy of the popliteal fossa. If undiagnosed, PAES can lead to acute ischemia and a threatened limb as a result of complete arterial occlusion or embolism. Ice hockey is a contact sport, and slashing on the covered legs is well described as a strategy and contact point. We present a unique case that highlights a blunt popliteal artery injury in a young player with an underlying type 2 PAES. We discuss the initial diagnosis and endovascular/vascular surgical treatment, followed by the delayed management of the popliteal artery injury. We also provide considerations for popliteal fossa blunt trauma and need for future protection of the popliteal fossa for athletes.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Ultrasound Diagnosis of a Pseudotumor Secondary to a Partial Thickness
           Distal Biceps Tear Resulting in Pronator Syndrome: A Case Report

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      Authors: Boettcher; Brennan J.; Camp, Christopher L.; Jelsing, Elena J.
      Abstract: imageAbstract: A 53-year-old right-handed female weightlifter presented to our clinic for evaluation of left elbow pain and intermittent numbness in her first 3 digits. She reported an elbow injury while weight lifting and carrying heavy planters 6 months earlier. A magnetic resonance imaging obtained previously was interpreted as bicipital-radial bursitis, and she had previously undergone a comprehensive nonoperative management program for her pain and numbness. A diagnostic ultrasound performed in clinic revealed distal biceps tendinopathy, bicipital-radial bursitis, and “pseudotumor,” which was dynamically compressed between the biceps tendon and radius with pronation and also caused a mass effect on the median nerve at the level of the pronator teres. Surgical excision of the mass resulted in near-complete resolution of her symptoms, and histology was consistent with scar tissue. This is the first case to the best of our knowledge to describe point-of-care ultrasound diagnosis of a biceps tendon “pseudotumor,” as well as demonstrating dynamic impingement of this pseudotumor causing mass effect on the median nerve.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Occipital Neuralgia May Be a Possible Limitation on the Utility of the
           Buffalo Treadmill Test for Concussion Assessments: 2 Case Reports

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      Authors: Cook; Laura; Herman, Daniel C.
      Abstract: imageAbstract: Two female athletes presented to clinic following a head injury and exhibited signs of concussion. Both athletes experienced exacerbation of symptoms secondary to dysautonomia related to concussion injury on the Buffalo Concussion Treadmill Test (BCTT). On repeat evaluation, both athletes exhibited neck pain with symptoms immediately provoked by palpation of the occipital nerves. After a third occipital nerve block, both athletes had complete resolution of symptoms and subsequently tolerated BCTT to the maximum rate of perceived exertion with no provoked symptoms. The athletes were cleared for return to sport without issue. These cases indicate a potential limitation in the utility of the BCTT for determining the etiology and management of concussion and postconcussion syndrome.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Overuse Injury to Proximal Phalanx in Throwing Athlete (Little Leaguer's
           Finger): A Case Report

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      Authors: Goodeill; Teigen; Umberhandt, Robert; Vela, Luis
      Abstract: imageAbstract: The young, overhead throwing athlete is prone to overuse injuries because of their variable skeletal maturity and often improper technique. An overuse injury to the digit(s) in the overhead throwing athlete, Little Leaguer's Finger, has never been discussed in the literature to our knowledge. We present a case of a 14-year-old man with atraumatic pain, swelling, and edema to his dominant pitching index finger after throwing greater than 90 pitches in one setting. Initial workup of the patient, including an MRI, ruled out an infectious process, and it was determined that there was a stress epiphysitis within the proximal phalanx of the digit. Symptoms within the digit resolved given time, rest, and cessation of throwing activities. The purpose of this report was to stress the importance of establishing the etiology of finger pain in the throwing athlete and to describe a previously unreported overuse injury, Little Leaguer's Finger.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
 
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