A 17-year-old high school football player sustained a chest contusion during football practice. He did not seek medical attention from his athletic trainer until the following day when he was referred to a physician. Radiographs were unremarkable, and he was cleared to play. There was no change in the athlete’s status, and he was referred for repeat radiographs. These, too, were unremarkable. Two weeks postinjury, the athlete was hospitalized with pneumothorax, acute respiratory distress, and pneumonia from 3 rib fractures. Relative difficulty in diagnosing this injury resulted in hospitalization with severe, life-threatening complications and may have led to death.
Markéta Schüblová and Barbara Billek-Sawhney
Raymond Chronister, George C. Balazs, Adam Pickett, John-Paul H. Rue and David J. Keblish
Acute lateral patellar dislocation is a common injury sustained by athletes, and often requires several months to recover and return to play.
To describe a novel protocol for the treatment of acute lateral patellar dislocation that returns patients to play far sooner than traditional treatment protocols.
Case series and review of the literature.
Division I NCAA institution.
Two collegiate athletes who sustained first-time acute lateral patellar dislocations.
Traditional standard of care for acute lateral patellar dislocation after reduction involves 1–7 weeks of immobilization in full extension. Knee stiffness commonly results from this method, and return to full activity typically takes 2–4 months. We used a protocol involving immobilization in maximal flexion for 24 hr, with early aggressive range of motion and quadriceps strengthening in the first week after injury.
Main Outcome Measures:
Time to return to play.
Immediate on-site reduction of the patella followed by 24 hr of immobilization in maximal knee flexion was performed. Following an accelerated rehabilitation regimen, patients were able to return to sport an average of 3 days postinjury. Neither patient has experienced a recurrent dislocation.
Our protocol is based on anatomic studies demonstrating reduced tension on the medial patellofemoral ligament, reduced hemarthrosis, and reduced soft tissue swelling in maximal knee flexion. This method apparently bypasses the knee stiffness and deconditioning commonly seen with traditional nonoperative regimens, allowing return to sport weeks or months sooner.
Brandon M. Ness, Kory Zimney and William E. Schweinle
Injury risk factors and relevant assessments have been identified in women’s soccer athletes. Other tests assess fitness (eg, the Gauntlet Test [GT]). However, little empirical support exists for the utility of the GT to predict time loss injury.
To examine the GT as a predictor of injury in intercollegiate Division I female soccer athletes.
Retrospective, nonexperimental descriptive cohort study.
College athletic facilities.
71 female Division I soccer athletes (age 19.6 ± 1.24 y, BMI 23.0 ± 2.19).
Main Outcome Measures:
GT, demographic, and injury data were collected over 3 consecutive seasons. GT trials were administered by coaching staff each preseason. Participation in team-based activities (practices, matches) was restricted until a successful GT trial. Soccer-related injuries that resulted in time loss from participation were recorded.
71 subjects met the inclusion criteria, with 12 lower body time loss injuries sustained. Logistic regression models indicated that with each unsuccessful GT attempt, the odds of sustaining an injury increased by a factor of 3.5 (P < .02). The Youden index was 2 GT trials for success, at which sensitivity = .92 and specificity = .46. For successive GT trials before success (1, 2, or 3), the predicted probabilities for injury were .063, .194, and .463, respectively.
The GT appears to be a convenient and predictive screen for potential lowerbody injuries among female soccer athletes in this cohort. Further investigation into the appropriate application of the GT for injury prediction is warranted given the scope of this study.
Shane R. Wurdeman, Jessie M. Huisinga, Mary Filipi and Nicholas Stergiou
Patients with multiple sclerosis (MS) have less-coordinated movements of the center of mass resulting in greater mechanical work. The purpose of this study was to quantify the work performed on the body’s center of mass by patients with MS. It was hypothesized that patients with MS would perform greater negative work during initial double support and less positive work in terminal double support. Results revealed that patients with MS perform less negative work in single support and early terminal double support and less positive work in the terminal double support period. However, summed over the entire stance phase, patients with MS and healthy controls performed similar amounts of positive and negative work on the body’s center of mass. The altered work throughout different periods in the stance phase may be indicative of a failure to capitalize on passive elastic energy mechanisms and increased reliance upon more active work generation to sustain gait.
Sally A. Perkins and John E. Massie
To determine whether patients were satisfied after thermal shrinkage on the capsule of the glenohumeral joint (GHJ).
Design and Setting:
The affected shoulder was assessed preoperatively and 2 months postoperatively. The assessment evaluated pain on activities of daily living (ADLs), physical activity level, satisfaction with shoulder function, and a modified UCLA pain scale.
Eight athletes, 4 men and 4 women, with a mean age of 21 years, participated. Each had sustained a traumatic injury to the GHJ resulting in multidirectional instability.
Subjects were evaluated preoperatively and 2 months postoperatively for GHJ laxity and labral deformity. Goniometric measurements of flexion/extension, abduction/adduction, and internal/external rotation of the GHJ were completed.
Six of the 8 subjects had reduced pain. Active extension increased significantly in 7. ADLs were all improved. All 8 subjects were satisfied with the thermal-shrinkage procedure.
Thermal shrinkage of the capsule of the GHJ results in patient satisfaction and reduced pain.
Jennifer J. Mancuso, Kevin M. Guskiewicz and Meredith A. Petschauer
Stress fractures, particularly those in the lower extremity, are disabling and time-consuming injuries commonly seen in athletes. A stress fracture of the posterior talus is rare and presents with signs and symptoms similar to those of soft-tissue injuries in the rear foot. This case study involves a Division-I collegiate female field-hockey athlete who developed a stress reaction in her posterior talus approximately 6 weeks after sustaining a mild eversion ankle sprain. Her chief complaint was pain with forceful plantar flexion during running and cutting. Clinicians must be cautious when an athlete presents with posterior foot pain, being sure to properly assess and rule out differential diagnoses such as tendinitis, os trigonal fracture, and muscle strains. This athlete was able to remain weight bearing during healing, so her rehabilitation protocol allowed for a variety of exercise options.
Zheng Wang, Peter C. M. Molenaar and Karl M. Newell
The experiment was set up to investigate the inter- and intrafoot coordination dynamics of postural control on balance boards. A frequency domain principal component analysis (PCA) was applied on 4 center of pressure (COP) time series collected from two force platforms to reveal their contributions to postural stability. The orientation of support played a more significant role than its width in channeling the foot coordination dynamics. When the support was oriented along the AP-challenging direction, the 4 COPs revealed a parallel contribution to the 1st principal component (PC1) indicating an interdependence of the foot coordination in both directions. When the support was positioned along the ML-challenging direction, the COPs in the AP direction showed larger weightings to PC1 implying an interfoot coordination. These findings provide evidence that COP coordination operates in adaptive ways to sustain postural stability in light of changing support constraints to standing.
Andrea Cripps and Scott C. Livingston
Sport-related concussions are a significant health issue due to the high incidence of concussions sustained each sports season. Current approaches to the evaluation of acutely concussed athletes include the use of balance assessments to identify and monitor underlying postural instability arising from concussion. Balance assessment has been recommended as a primary measurement tool for monitoring recovery and for making return-to-play decisions. Balance impairments have been shown to occur in the initial postconcussion period (ie, 1–10 d). Numerous clinical and laboratory measures have been used in the assessment of balance immediately after concussion, and clinicians are faced with deciding which measures to use.
Focused Clinical Question:
How do clinical or field-based balance-assessment tools compare to laboratory-based balance measures in identifying deficits in postural stability among acutely concussed athletes?
Szabolcs Lajos Molnár, Péter Hidas, György Kocsis, Gábor Rögler, Péter Balogh, Miklós Farkasházi and Péter Lang
Upper extremity injuries are common in wrestling, most of which do not require surgery.
We retrospectively documented the case histories of six elite wrestlers who sustained elbow injuries that required surgical treatment, three of which involved reinjury and another surgical procedure.
All but one of the six initial injuries were associated with a defensive maneuver. Reinjury was more common for freestyle wrestling than for Greco-Roman style. The average time between the initial elbow injury and surgical intervention was 22 months. One-half of the wrestlers with elbow injuries that required surgery were reinjured and underwent revision surgery.
All of the elite wrestlers waited for a long period of time before receiving surgery for the initial injury, and the reinjury rate was high.
Bryan L. Riemann and Kevin M. Guskiewicz
Mild head injury (MHI) represents one of the most challenging neurological pathologies occurring during athletic participation. Athletic trainers and sports medicine personnel are often faced with decisions about the severity of head injury and the timing of an athlete's return to play following MHI. Returning an athlete to competition following MHI too early can be a catastrophic mistake. This case study involves a 20-year-old collegiate football player who sustained three mild head injuries during one season. The case study demonstrates how objective measures of balance and cognition can be used when making decisions about returning an athlete to play following MHI. These measures can be used to supplement the subjective guidelines proposed by many physicians.