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Tal Marom, David Itskoviz, Haim Lavon and Ishay Ostfeld

Introduction:

Exertional heat stroke (EHS) is a major concern in military trainees performing intense physical exercise, with substantial morbidity rates. Prehospital diagnosis of EHS is essentially clinical. Thus, soldiers, command personnel, and medical staff are taught to recognize this injury and immediately begin aggressive treatment to prevent further deterioration.

Patients and Methods:

During 2007, 5 otherwise healthy Israeli Defense Forces (IDF) soldiers were diagnosed with EHS while performing strenuous exercise. They were treated vigorously according to the IDF EHS-treatment protocol and were referred to the emergency department.

Results:

On arrival at the emergency department, physical examination including rectal temperature was unremarkable in all soldiers. Blood and urine workup showed near-normal values. No other medical conditions that could have explained the clinical presentation were found. All soldiers were discharged shortly afterward, with no further consequences. A heat-tolerance test was performed several weeks after the event and was interpreted as normal. All soldiers returned to active service.

Conclusion:

Because the initial clinical findings were very suggestive of EHS and because no other condition could have explained the prehospital transient hyperthermia, we suggest that these soldiers were correctly diagnosed with EHS, and we propose that rapid vigorous cooling prevented further deterioration and complications. We suggest calling this condition aborted heat stroke.

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Byron Moran and Eric E. Corris

A 19-year-old male intercollegiate football player presented to the athletic training room with symptoms of sore throat, nasal congestion, fatigue, and bleeding, experienced for 3 weeks. His clinical and laboratory evaluation was consistent with infectious mononucleosis and severe thrombocytopenia. The athlete was immediately removed from participation and evaluated by a hematologist who confirmed the diagnosis and started oral glucocorticoid therapy. The athlete’s symptoms improved and thrombocytopenia resolved with therapy. Timely identification of severe thrombocytopenia allows for safe removal from participation. Collaboration among the sports medicine team as well as specialists, when needed, allows for optimal management of these rare complications.

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Kenneth J. Richter

A 57-year-old patient who was on Coumadin was placed on a very vigorous sports medicine rehabilitation program for a left hemiparesis. His prothrombin was stable at 16 seconds with a control of 12.4 seconds. After doing knee flexion and extension exercises on an isokinetic machine, he developed an extensive posterior thigh ecchymosis. Rehabilitation clinicians need to be aware of the possibility of such a complication in an anticoagulated patient.

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Jeffery T. Podraza and Scott C. White

Background:

Isolated atraumatic posterior glenohumeral instability is rare. Use of thermal capsulorraphy for glenohumeral instability is considered controversial. This case study describes a modified rehabilitation protocol for a patient who underwent a multistep arthroscopic procedure for isolated posterior glenohumeral instability with a postoperative complication of adhesive capsulitis.

Case Description:

A 30-y-old man with a 15-y history of bilateral posterior glenohumeral instability related to generalized hypermobility underwent right-shoulder arthroscopy consisting of a combined posterior labral repair, capsular imbrication, and thermal capsulorraphy. A gunslinger orthosis was prescribed for 6 wk of immobilization. Adhesive capsulitis was diagnosed at the 5-wk postoperative visit and immobilization was discontinued. A modified treatment protocol was devised to address both the surgical procedures performed and the adhesive capsulitis. Residual symptoms resolved with release of an adhesion while stretching 10 months postoperatively.

Outcomes:

Scores of 5 shoulder-assessment tools improved from poor to excellent/good with subjective report of a very good outcome.

Discussion:

The complication of adhesive capsulitis required an individualized treatment protocol. In contrast to the standard protocol, our modified approach allowed more time to be spent in each phase of the program, was aggressive with restoring range of motion (ROM) without excessively stressing the posterior capsule, and allowed the patient to progress to activities that were tolerated regardless of protocol phase. Shoulder stiffness or frank adhesive capsulitis after stabilization, as in this case, requires a more aggressive modification to prevent permanent ROM limitations. Conversely, patients with early rapid gains in ROM must be protected from overstretching the repaired tissue with a program that allows functional motion to be incorporated over a longer time frame. This study indicates the use of thermal capsulorraphy as a viable surgical modality when it is used judiciously with the proper postoperative restrictions and rehabilitation.

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Martin Poirier and Richard DeMont

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Esmie P. Smith, Andrew P. Hill and Howard K. Hall

has examined the relationships between them and offer three alternative theoretical models that might explain their inter-relationships over time (vulnerability model, complication/scar model, and reciprocal relations model). Athlete Burnout Athlete burnout is one possible outcome of competing within

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Sonia DelBusso and Michael Matheny

intervention in the literature, non-weight-bearing (NWB) conservative treatment is considered the gold standard treatment, with a 96% success rate. 1 Allowing a patient to remain weight bearing has been shown to increase the likelihood of complications, including re-fracture, nonunion, delayed union, fracture

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Erin Macaronas, Shannon David and Nicole German

resolution, without aspiration. The athlete finished the season without any further complications. Comparative Outcomes Because hematomas and ecchymosis are commonly seen by athletic trainers, understanding Morel-Lavallée lesions is important as it the ability to differentiate between these and other

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Myles Murphy, Marshall Stockden, Ken Withers, William Breidahl and Jonathon Charlesworth

subluxation. 10 The most common postoperative complications are significantly reduced shoulder range of motion ( P  < .05), signs of instability (13.4%), and nonunion (11.5%). 8 Specifically, bone graft osteolysis can be a severe complication leading to recurrent instability. 11 A review by Fedorka and