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Epidemiology of Shoulder Dislocations Presenting to Emergency Departments in the United States, 2007–2020

Rebecca R. Rodriguez and Kenneth C. Lam

Context: Shoulder dislocations are the most commonly treated joint dislocation in the emergency department. Zacchilli and Owens previously reported on the epidemiology of shoulder dislocations presenting to the emergency department in the United States from 2002 to 2006. At the time of data collection and analysis, no epidemiological report had been published to update these findings. Purpose: The purpose of our study was to provide an updated epidemiological report from 2007 to 2020. Results : A total of 26,203 shoulder dislocations were recorded in the National Electronic Injury Surveillance System database from 2007 to 2020. The highest rates occurred in males (71.4%, n = 18,722) and patients aged 20–29 years old (28.2%, n = 7,292). The most common mechanism of injury was sports involvement (48.6%, n = 12,735). Interpretation: Our findings suggest that rates of shoulder dislocations have remained consistent with previous research on this topic, indicating no significant changes over the past 19 years. More effective prevention strategies are needed, especially for at-risk populations.

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Pain Mechanosensitivity in Individuals With and Without a History of Lateral Ankle Sprain: A Critically Appraised Topic

Ilana Patlan, Elisabeth Ohrnberger, and Kyle B. Kosik

Clinical Scenario: Pain is a common symptom experienced by individuals who sustain an acute lateral ankle sprain and can continue to persist among those who develop chronic ankle instability. Most rehabilitation protocols for individuals with acute ankle sprains or chronic ankle instability focus on restoring physical impairments and have largely omitted any pain-relieving therapies. This impairment-based focus has led pain to be an understudied symptom among individuals with an ankle sprain history. Overlooking the role of pain has also left clinicians with little insight into whether pain experienced after an ankle sprain is local (i.e., peripheral sensitization) or widespread (i.e., central sensitization). Understanding the pain profiles for those with an ankle sprain history may represent an unexploited area for clinicians and future research to improve health outcomes for this patient population. Clinical Question: Is there evidence to suggest that pain mechanosensitivity levels are different between those with and without a history of lateral ankle sprain? Summary of Key Findings: The literature was systematically searched for Level 4 evidence or higher. The search yielded two cross-sectional case-control studies and one cross-sectional study that met the inclusion and exclusion criteria. Based on the available evidence, pain mechanosensitivity levels are lower across ligamentous stabilizers immediately after an acute ankle sprain and over lower extremity neuromuscular structures among individuals with chronic ankle instability. Clinical Bottom Line: There is weak evidence to support an ankle sprain history can affect local pain mechanosensitivity levels of structures surrounding the ankle but not at distant locations. Strength of Recommendation: Level 4 evidence is available according to the Center for Evidence-Based Medicine.

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Continuing Education Assessment

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Volume 29 (2024): Issue 2 (Mar 2024)

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Are Irish Athletic Therapy Students Confident in Concussion Assessment and Management? A Cross-Sectional Study of Final Year Students’ Self-Efficacy

Anna P. Postawa, Enda F. Whyte, and Siobhán O’Connor

Concussion is one of the most challenging injuries for sports medicine clinicians. It is crucial that students develop high self-efficacy for concussion-relevant skills during professional education, as it impacts the quality of their patient care. This study aimed to explore Irish final year athletic therapy students’ self-efficacy in concussion assessment and management and the factors that impact its development. Participants’ level of self-efficacy varied, from low to high, depending on the skill assessed. Lack of practice and lecturer’s positive feedback impacted student self-efficacy the most. Educators should provide students with an opportunity to practice their skills in an environment that facilitates feedback.

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Economic Analysis of Secondary School Outreach Athletic Training Services

Brian A. Czajka

The health care benefit of athletic trainers in secondary schools is well established; however, the economic effects of athletic training outreach programs on the organization providing the services are not well researched. The purpose of this study was to determine the economic effects of outreach athletic training services on the organization the outreach athletic training services. The daily number of patient visits and procedure charges were compiled and compared between a time period when outreach athletic training services were provided to local secondary schools and a time period when these services were not provided. The findings of this study showed that an organization providing outreach athletic training services may experience significant increases in daily patient visits and daily procedure charges.

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Trunk Endurance and Low Back Pain Outcomes in College Golfers

Andrew Skibski, John Goetschius, and L. Colby Mangum

Low back pain (LBP) is a common injury in golf. There are several outcomes used to quantify LBP-related disability, such as core endurance tests and questionnaires. The primary purpose of this study was to compare clinical outcomes between college golfers with and without LBP. A secondary purpose was to determine relationships between these measures. We found no difference between groups for Biering-Sørensen endurance (p = .558). Episodes of LBP were significantly related to the Oswestry Disability Index (ρ = .491) and Golf-specific LBP questionnaire (ρ = −.576). Oswestry Disability Index and Golf-specific LBP questionnaire also demonstrated a moderate relationship (ρ = −.604).

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Overuse Injury Definitions and Rates of Overuse Injury in Epidemiology Studies Concerning High School-Aged Athletes: A Critically Appraised Topic

Tricia Cich and Kevin M. Biese

Context: The definition of an “overuse injury” had some ambiguity until recent publications. It is unknown whether the improved definition of “overuse injury” has been applied to epidemiology studies that examine high school-aged athletes. This population may be predisposed to overuse injuries due to several factors. Clinical Question: Is there more consistency in how the term “overuse injury” is being used, and has the rate of overuse injuries in high school-aged athletes’ epidemiology studies changed since Roos and Marshall’s 2014 systematic review on overuse injury definitions? Clinical Bottom Line: Since Roos and Marshall’s systematic review, more studies are recognizing “overuse injuries” as needing a specific mechanism of injury; however, several studies failed to differentiate “overuse injuries” from “noncontact injuries.” The rate of overuse injuries does not appear to have changed significantly.

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The Perceptions and Experiences Among Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, and Agender Patients of Quality of Care With Health Care Services

Lauren G. Ford, Connor Lewis, and Jennifer Lynn Volberding

Clinical Scenario: The lesbian, gay, bisexual, transgender, queer/questioning, intersex, agender (LGBTQIA+) community has a unique set of health care needs and experience barriers to services. Many providers assume these needs are similar to heterosexual counterparts. Investigating experiences and perceptions with health care and recommendations on how to improve care can provide insight for professionals. Clinical Question: What are the perceptions of quality of health care and experiences among the LGBTQIA+ patients? Summary of Key Findings: A search was performed for articles exploring perceptions and experiences of LGBTQIA+ patients with health care. Four articles were included. All were Level VI qualitative studies. All demonstrated a lack of cultural competency leading to poor experiences with providers. Common themes included: misgendering, stigmatization, and negative provider attitude leading to poor experiences. Experiences improved if providers used inclusive language, created welcoming environments, and had knowledge/experience about needs of LGBTQIA+ patients. Clinical Bottom Line: LGBTQIA+ patients felt providers lacked adequate knowledge to understand and care for their needs. Future research should include facts contributing to accessing health care services, solutions to these barriers, and increasing geographic areas. Strength of Recommendation: According to the Strength of Recommendation Taxonomy (SORT) scale, there is Level C evidence that LGBTQIA+ patients experience providers who are not adequately prepared to properly care for their unique needs.

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