Acute Musculoskeletal Injuries Research Articles

Concussion Increases Odds of Sustaining a Lower Extremity Musculoskeletal Injury After Return to Play Among Collegiate Athletes

Background: Previous studies have identified abnormalities in brain and motor functioning after concussion that persist well beyond observed clinical recovery. Recent work suggests subtle deficits in neurocognition may impair neuromuscular control and thus potentially increase risk of lower extremity musculoskeletal injury after concussion. Purpose: To determine the odds of sustaining an acute lower extremity musculoskeletal injury during the 90-day period after return to play from concussion in a cohort of National Collegiate Athletic Association (NCAA) Division I collegiate athletes. Study Design: Cohort study; Level of evidence, 3. Methods: Included in this study were 87 cases of concussion among 75 athletes (58 men; 17 women) participating in NCAA Division I football, soccer, hockey, softball, basketball, wrestling, or volleyball at a single institution from 2011 to 2014. The 90-day period after return to play for each case of concussion was reviewed for acute noncontact lower extremity musculoskeletal injury. Each 90-day period after return to play was matched to the same 90-day period in up to 3 controls. Control athletes without a history of concussion in the previous year were matched to concussed athletes by sport team/sex, games played, and position. A total of 182 control (136 men; 46 women) 90-day periods were reviewed for acute injury. Conditional logistic regression was used to assess the association between concussion and subsequent risk of acute lower extremity musculoskeletal injury. Results: The incidence of acute lower extremity musculoskeletal injury was higher among recently concussed athletes (15/87; 17%) compared with matched controls (17/182; 9%). The odds of sustaining an acute lower extremity musculoskeletal injury during the 90-day period after return to play were 2.48 times higher in concussed athletes than controls during the same 90-day period (odds ratio, 2.48; 95% CI, 1.04-5.91; P = .04). Conclusion: Concussed athletes have increased odds of sustaining an acute lower extremity musculoskeletal injury after return to play than their nonconcussed teammates. The study results suggest further investigation of neurocognitive and motor control deficits may be warranted beyond the acute injury phase to decrease risk for subsequent injury.

Acute Lower Extremity Injury Rates Increase after Concussion in College Athletes.

Dynamic postural control deficits and disrupted cortical pathways have been reported to persist beyond an athlete's return to activity after concussion, potentially increasing the risk of acute lower extremity musculoskeletal injury. This study aimed to investigate acute lower extremity musculoskeletal injury rates before and after concussion in athletes with concussion and their matched control. College athletes with concussion (n = 44; age, 20.0 ± 1.2 yr) were physician-diagnosed. Nonconcussed college athletes (n = 58; age, 20.5 ± 1.3 yr) were matched to individuals with concussion. Acute lower extremity musculoskeletal injury data were collected for 2 yr (±1 yr of the diagnosed concussion) using electronic medical records. Control participants' 2-yr window for exposure and musculoskeletal injury data were anchored to their match's concussion injury date. Pre- and postconcussion musculoskeletal injury rates were calculated for 90-, 180-, and 365-d periods for both study cohorts. Risk ratios were calculated to determine differences within and between groups for all periods. Within 1 yr after concussion, the group with concussion was 1.97 (95% confidence interval (CI), 1.19-3.28; P = 0.01) times more likely to have experienced an acute lower extremity musculoskeletal injury after concussion than before concussion and 1.64 times (95% CI, 1.07-2.51; P = 0.02) more likely to have experienced an acute lower extremity musculoskeletal injury after concussion than their matched nonconcussed cohort over the same period. Up to 180 d after concussion, the group with concussion was 2.02 (95% CI, 1.08-3.78; P = 0.02) times more likely to have experienced an acute lower extremity musculoskeletal injury after concussion than before concussion. Previous literature has identified dynamic postural control deficits along with increased motor evoked potential latency and decreased amplitude after concussion, suggesting that the brain may be unable to effectively coordinate movement. Our findings underscore the need to explore functional movement and dynamic postural control assessments in postconcussion injury assessment protocols.

Biological variation in musculoskeletal injuries: current knowledge, future research and practical implications

Evidence from familial and genetic association studies have reported that DNA sequence variants play an important role, together with non-genetic factors, in the aetiology of both exercise-associated and occupational-associated acute...

Short-Term Cryotherapy--Putting Dynamic Foot and Ankle Stability at Risk?

The application of ice or other forms of cooling represent a common method to treat acute musculoskeletal injuries during sporting events in order to reduce pain. Often athletes return to competition immediately after cooling. It is not known if short-term cryotherapy in the form of ice spray has an influence on the joint's dynamic stability. The aim of this study was to investigate if application of ice spray to the ankle has an effect on the dynamic stability of the joint in healthy participants. A randomized controlled single-blind pilot study with crossover-design was conducted. 22 healthy athletic participants (15 women, 7 men, mean age 31.8 years ± 5.7) were included. Time-to-stability (TTS) was used to investigate the effect of the interventions, ice spray and water spray, applied on the lateral ankle. TTS was assessed in medio-lateral (ML) and antero-posterior (AP) direction on a force plate with two different tests (side step down and 1-leg jump). Collected co-variables were age, gender, height, weight, previous ankle injuries, Tegner activity scale and leg dominance. There were no significant differences between the two tests (side step down and 1-leg jump) in TTS after the application of ice spray or a water spray compared to the baseline (p > 0.05). There was no significant difference between the two interventions. The testing of the co-variable "previous ankle injury" showed a significant influence on the TTS in medio-lateral direction in the 1-leg jump test of the non-dominant leg after application of ice spray (p = 0.027). On the dominant leg same tendency could be found (p = 0.062). The application of ice spray to the lateral ankle does not have an effect on dynamic stability in healthy participants. In participants with a previous ankle injury a significant decrease in dynamic stability after application of ice spray could be shown. Whether further factors affecting stability such as fatigue and the influence of an opponent player or the application of ice spray on adjacent muscles may augment this effect should be subject to future investigations.

Ultrasound of lower limb sports injuries.

Musculoskeletal ultrasound utilises high-frequency linear transducers to produce high-resolution images of soft tissue structures. It is an increasingly useful tool in the assessment of both acute and chronic musculoskeletal injuries; it is relatively cheap, portable and can be used to facilitate targeted injections. In this review paper, we aim to provide a summary on the normal and abnormal appearances of skeletal tissue in the setting of acute and chronic lower limb sporting injuries.

Investigation of Angiogenesis-associated Genes with Risk of Achilles Tendon Pathology

Genetic factors have been implicated with risk of Achilles tendon pathology (ATP). The angiogenesis signalling pathway plays a key role in extracellular matrix remodelling following mechanical loading. Increased levels of angiogenic cytokines and growth factors have been reported in injured Achilles tendons and after cyclic stretching of tendon fibroblasts. Vascular endothelial growth factor (VEGF) is a potent pro-angiogenic factor and the biological effects of VEGF are mediated through its receptor kinase insert-domain receptor (KDR). Recently, polymorphisms within the VEGFA and KDR genes were found to be associated with risk of anterior cruciate ligament ruptures. PURPOSE: To investigate if genes encoding proteins involved in angiogenesis-associated signalling are associated with risk of ATP in a South African and a British population. METHODS: A genetic-association study was conducted on 256 (125 SA & 130 UK) controls (CON), 194 (96 SA & 98 UK) participants with Achilles tendinopathy (TEN) and 80 (45 SA & 35 UK) participants with partial or complete ruptures of the Achilles tendon (RUP). All participants were genotyped for the functional VEGFA rs699947, VEGFA rs1570360, VEGFA rs2010963, KDR rs2071559 and KDR rs1870377 polymorphisms. Haplotypes were also inferred for VEGFA and KDR. Statistical analyses were conducted to determine any significant differences (p<0.05) between the groups (CON vs. TEN and CON vs. RUP). RESULTS: No independent significant differences were observed in the genotype frequency distributions of any of the polymorphisms between the CON vs. TEN or the CON vs. RUP groups for either population although there were trends towards significance. When the SA and UK groups were combined, the VEGFA rs699947 genotype frequency distribution was significantly different (p=0.017) between the male CON and male RUP groups, with the CA genotype significantly over-represented in the RUP group (p=0.006, OR: 2.6; 95% CI: 1.3-5.1). Inferred haplotype analyses showed the VEGFA A-A-G haplotype was significantly over-represented (p=0.023) in the UK CON group (37%) compared to the UK TEN group (28%). CONCLUSIONS: These novel findings provide preliminary evidence highlighting the potential biological significance of the angiogenesis signalling pathway in the aetiology of acute musculoskeletal injuries. Supported by the NRF, URC and MRC.

Use of Sonographic Elastography in Emergency Medicine and Critical Care

The goal of this talk is to review the clinical application of Sonographic Elastography in Emergency Medicine and Critical Care. Applications involving sonographic elastography initiated in areas outside of acute care medicine, but emerging research has shown novel clinical uses that benefit patients in the ED and ICU. We will cover topics ranging from limited abdominal applications to acute musculoskeletal injuries and soft tissue infections. From plantar fasciitis to skin abscesses. We will also review more experimental cardiac applications. The goal of this talk is to review the clinical application of Sonographic Elastography in Emergency Medicine and Critical Care. Applications involving sonographic elastography initiated in areas outside of acute care medicine, but emerging research has shown novel clinical uses that benefit patients in the ED and ICU. We will cover topics ranging from limited abdominal applications to acute musculoskeletal injuries and soft tissue infections. From plantar fasciitis to skin abscesses. We will also review more experimental cardiac applications.

Is the use of STABHA™ for supplementation of damaged extracellular matrix of soft tissues in the musculoskeletal system an effective treatment of acute injuries and tendinopathies?

Viscosupplementation, or the intra articular administration of hyaluronic acid in order to stabilise synovial fluid chemistry and improve its functional quality, is now a popular therapeutic method whose efficacy, based on numerous published studies, makes it not only a form of symptomatic treatment, but also, to a considerable extent, a cause-oriented treatment. However, a possibly controversial aspect of this therapy is the use of “intra articular hyaluronate” in the treatment of post-traumatic or inflammatory soft-tissue lesions in in the musculoskeletal system. Inappropriate administration of this dosage form to the area of the injured soft tissue (Achilles tendon, periarticular tendon of tarsal joint or knee, tennis elbow, tendinopathy within the rotator cuff, etc.) may not only lead to a failure to achieve the desired therapeutic effect but can even increase the severity of the symptoms, including a rupture of the frayed tendon. The role and importance of hyaluronate in the process of natural regeneration of damaged soft tissue has been demonstrated unequivocally and beyond any doubt. Subsequent research aimed to produce forms of hyaluronic acid that would be characterised by a greater influence and support of the regeneration processes in musculoskeletal soft tissue after an acute or chronic injury, as well as to develop the technology to produce a formulation which would be biocompatible, efficient and adapted to the treatment of ligament and tendon injuries. Following administration, such formulation would also need to be identified by the body as a naturally produced hyaluronate, which plays an essential role in the repair of damaged tissue, beginning with the bleeding phase and involving in all phases of the healing process, as has been demonstrated in numerous scientific studies. The development of a technology for producing hyaluronic acid known as STABHA™ (Soft Tissue Adapted Biocompatible Hyaluronic Acid) in 2008 proved to be a significant achievement in this area. The therapeutic efficacy of STABHA™-containing preparations has been documented in many clinical trials with patients treated for common musculoskeletal disorders and injuries, such as talocrural sprain, so called tennis elbow or rotator cuff tendinopathy. This paper, based on the available literature and the authors’ clinical experience, reviews the therapeutic efficacy of preparations containing STABHA™ used in the treatment of acute and chronic musculoskeletal soft-tissue injuries to enable the reader to make decisions regarding the use of this form of treatment in clinical practice.

Prevalence of Musculoskeletal Injuries among Adolescent Recreational Netballers in Kwa-Zulu Natal, South Africa

Background: Netball injuries remain an area of concern for professional and recreational South African players. This study profiled the prevalence of acute musculoskeletal injuries among female adolescent non-elite recreational netball players in Kwa-Zulu Natal, South Africa. Materials and Methods: Data were collected from 413 high school players who participated in the Kwa-Zulu Natal Netball School league. Players completed a self-reporting questionnaire for demographic information, acute musculoskeletal injuries and training history, mechanism of injury, types and nature of symptom, and severity of pain during the previous 12 months. Results: Two hundred and fifty-eight (62.0%) players sustained acute musculoskeletal injuries, with the knee (31%) and ankle (23.7%) injuries being the most prevalent. The mechanisms producing Original Research Article Ellapen et al.; BJMMR, 9(3): 1-5, 2015; Article no.BJMMR.16966 2 the musculoskeletal injuries were poor landing (37.8%), being pushed by an opponent (22.7%), colliding with a team mate (20.8%) and rapid rotational movement (18.5%). The injured netballers have played netball for longer period of years than uninjured players (p<0.05). Conclusion: Netballers have a high prevalence of acute musculoskeletal injuries, which are predominant in the knee and ankle.

The emerging use of platelet-rich plasma in musculoskeletal medicine.

Platelet-rich plasma (PRP) is one of many new developments within the expanding field of regenerative medicine. Specialists in areas such as orthopedics, physical medicine and rehabilitation, and rheumatology have been exploring the benefits of this novel therapy. Although PRP therapy remains controversial and has minimal clinical trial support, the use of orthobiologics such as PRP continues to advance as patients seek nonsurgical approaches to acute and chronic musculoskeletal injury and disease. However, academic acceptance as well as insurance reimbursement remain reliant on solid and repeatable positive results from large clinical trials. The authors summarize the evolution of PRP therapy and report on its status.

Trabecular bone loss at a distant skeletal site following noninvasive knee injury in mice.

Traumatic injuries can have systemic consequences, as the early inflammatory response after trauma can lead to tissue destruction at sites not affected by the initial injury. This systemic catabolism may occur in the skeleton following traumatic injuries such as anterior cruciate ligament (ACL) rupture. However, bone loss following injury at distant,unrelated skeletal sites has not yet been established. In the current study, we utilized a mouse knee injury model to determine whether acute knee injury causes a mechanically significant trabecular bone loss at a distant, unrelated skeletal site (L5 vertebral body).Knee injury was noninvasively induced using either high-speed (HS; 500 mm/s) or lowspeed(LS; 1 mm/s) tibial compression overload. HS injury creates an ACL rupture by midsubstance tear, while LS injury creates an ACL rupture with an associated avulsion bone fracture. At 10 days post-injury, vertebral trabecular bone structure was quantified using high-resolution microcomputed tomography (lCT), and differences in mechanical properties were determined using finite element modeling (FEM) and compressive mechanical testing. We hypothesized that knee injury would initiate a loss of trabecular bone structure and strength at the L5 vertebral body. Consistent with our hypothesis, we found significant decreases in trabecular bone volume fraction (BV/TV) and trabecular number at the L5 vertebral body in LS injured mice compared to sham (8.8% and 5.0%, respectively), while HS injured mice exhibited a similar, but lower magnitude response (5.1% and 2.5%, respectively). Contrary to our hypothesis, this decrease intrabecular bone structure did not translate to a significant deficit in compressive stiffness or ultimate load of the full trabecular body assessed by mechanical testing or FEM. However,we were able to detect significant decreases in compressive stiffness in both HS and LS injured specimens when FE models were loaded directly through the trabecular bone region (9.9% and 8.1%, and 3, respectively). This finding may be particularly important for osteoporotic fracture risk, as damage within vertebral bodies has been shown to initiate within the trabecular bone compartment. Altogether, these data point to a systemic trabecular bone loss as a consequence of fracture or traumatic musculoskeletal injury, which may be an underlying mechanism contributing to increased risk of refracture following an initial injury. This finding may have consequences for treatment of acute musculoskeletal injuries and the prevention of future bone fragility.

Effect of ice massage on lower extremity functional performance and weight discrimination ability in collegiate footballers.

Background:Cryotherapy, in the form of ice massge is used to reduce inflammation after acute musculoskeletal injury or trauma. The potential negative effects of ice massage on proprioception are unknown, despite equivocal evidence supporting its effectivenessObjectives:The purpose of the study was to test the influence of cooling on weight discrimination ability and hence the performance in footballers.Patients and Methods:The study was of same subject experimental design (pretest-posttest design). Thirty male collegiate football players, whose mean age was 21.07 years, participated in the study. The participants were assessed for two functional performance tests, single leg hop test and crossed over hop test and weight discrimination ability before and after ice massage for 5 minutes on hamstrings muscle tendon.Results:Pre cooling scores of Single Leg Hop Test of the dominant leg in the subjects was 166.65 (± 10.16) cm and post cooling scores of the dominant leg was 167.25 (± 11.77) cm. Pre cooling scores of Crossed Over Hop Test of the dominant leg in the subjects was 174.14 (± 8.60) cm and post cooling scores of the dominant leg was 174.45 (± 9.28) cm. Pre cooling scores of Weight Discrimination Differential Threshold of the dominant leg in the subjects was 1.625 ± 1.179 kg compared with post cooling scores of the dominant leg 1.85 (± 1.91) kg. Pre cooling scores of single leg hop and crossed over hop test of the dominant leg in the subjects compared with post cooling scores of the dominant leg showed no significant differences and it was also noted that the weight discrimination ability (weight discrimination differential threshold) didn’t show any significant difference. All the values are reported as mean ± SD.Conclusions:This study provides additional evidence that proprioceptive acuity in the hamstring muscles (biceps femoris) remains largely unaffected after ice application to the hamstrings tendon (biceps femoris).

Ultrasound Elastography: The New Frontier in Direct Measurement of Muscle Stiffness

The use of brightness-mode ultrasound and Doppler ultrasound in physical medicine and rehabilitation has increased dramatically. The continuing evolution of ultrasound technology has also produced ultrasound elastography, a cutting-edge technology that can directly measure the mechanical properties of tissue, including muscle stiffness. Its real-time and direct measurements of muscle stiffness can aid the diagnosis and rehabilitation of acute musculoskeletal injuries and chronic myofascial pain. It can also help monitor outcomes of interventions affecting muscle in neuromuscular and musculoskeletal diseases, and it can better inform the functional prognosis. This technology has implications for even broader use of ultrasound in physical medicine and rehabilitation practice, but more knowledge about its uses and limitations is essential to its appropriate clinical implementation. In this review, we describe different ultrasound elastography techniques for studying muscle stiffness, including strain elastography, acoustic radiation force impulse imaging, and shear-wave elastography. We discuss the basic principles of these techniques, including the strengths and limitations of their measurement capabilities. We review the current muscle research, discuss physiatric clinical applications of these techniques, and note directions for future research.

Platelet-rich therapies for musculoskeletal soft tissue injuries.

Platelet-rich therapies for musculoskeletal soft tissue injuries.

Common acute and chronic musculoskeletal injuries among female adolescent field hockey players in KwaZulu-Natal, South Africa

Objective. To document the prevalence and nature of musculoskeletal injuries among female adolescent hockey players over a 12-month period (1 November 2011 - 31 October 2012). Methods. Data were collected from 148 high school players who belonged to the KwaZulu-Natal Hockey League via voluntary, parentalinformed consent. Players completed a self-report musculoskeletal questionnaire probing the prevalence and nature of acute and chronic injuries. Probability was set at p ≤0.05. Results. Ninety-four players sustained acute musculoskeletal injuries in the 12-month study period, indicating the knee (23%) and lower back (18%) to be the most prevalent sites of injury ( p <0.001). The mechanisms producing the acute injuries were rapid rotational movement (36%) and physical trauma (63%) ( p <0.05). The hip/lower back was the most prevalent anatomical site of chronic musculoskeletal injury ( p <0.001). The intrinsic factors predisposing players to chronic hip/lower-back injury were hip flexion contractures and posture ( p <0.05). Conclusion. Hockey players experience a high prevalence of acute musculoskeletal knee injuries and chronic hip/lower-back injuries. The hockey fraternity should be educated about the various ways in which to prevent injury by complying with appropriate training regimes, alterations in technique and stretching exercises.

Injury-Related Fear in Acutely Injured Interscholastic and Intercollegiate Athletes

Unrecognized and unaddressed injury-related fears may hinder the rehabilitation process in injured athletes. Currently, 3 scales have been reported to measure injury-related fears in general orthopedic patient populations: the Tampa Scale of Kinesiophobia-11 (TSK-11), the Fear-Avoidance Beliefs Questionnaire (FABQ), and the Re-Injury Anxiety Inventory (RIAI). However, these instruments have not been studied extensively in athletes with musculoskeletal injuries. The purpose of this case series was to describe changes in injury-related fear in intercollegiate and interscholastic athletes with acute musculoskeletal injuries. Twenty-six athletes completed the 3 questionnaires at 48 hours, 1 week, and 3 weeks postinjury. Responses to all 3 questionnaires and their subscales, except for the RIAIRehab subscale, changed signifi cantly over the course of the study. In addition, signifi cant correlations were found among most measures, as each appears to be measuring diff erent constructs of the same phenomena. Following acute musculoskeletal injury, injury-related fear scores decreased as the athletes’ condition improved. [Athletic Training & Sports Health Care. 2013;x(x):xxx-xxx.]

ASSOCIATION OF DEMENTIA WITH DELAYED ED ANALGESIA IN PATIENTS OVER 70 WITH ACUTE MUSCULOSKELETAL INJURY

Objectives & BackgroundPatients with dementia and traumatic injury require prompt and adequate pain relief. However we hypothesised that they may be at risk of under-treatment with analgesia in the emergency...

Ibuprofen vs acetaminophen vs their combination in the relief of musculoskeletal pain in the ED: a randomized, controlled trial

Non-opioid analgesics are often administered to emergency department (ED) patients with musculoskeletal pain but if inadequate, opioids are given with associated potential adverse events. We tested the hypothesis that the reduction in pain scores with the combination of ibuprofen and acetaminophen would be at least 15 mm greater than with either of the agents alone. We conducted a double-blind, randomized, controlled trial of adult ED patients with acute musculoskeletal pain. Patients were randomized to oral ibuprofen 800 mg, acetaminophen 1 g, or their combination. Pain scores across the groups were compared with repeated measures analysis of variance at 20, 40, and 60 minutes. A sample of 30 patients in each group had 80% power to detect a 15 mm difference in pain scores across the groups (α = .05). Thirty patients were randomized to each study group. Mean (SD) age was 36 (15), 54% were male, 73% were white, and 13% were Hispanic. Groups were well balanced in baseline characteristics including initial pain scores (59, 61, and 62 for ibuprofen, acetaminophen, and their combination). Pain decreased over the one hour study period for all groups (P < .001) with mean (SD) scores about 20 mm lower on the Visual Analogue Scale than the mean initial score. However, there was no significant difference among treatments (P = .59). The need for rescue analgesics was similar across groups. We conclude that the combination of ibuprofen and acetaminophen did not reduce pain scores or the need for rescue analgesics compared with either agent alone in ED patients with pain secondary to acute musculoskeletal injuries.

Effectiveness and Safety of Topical versus Oral Nonsteroidal Anti-inflammatory Drugs: A Comprehensive Review

Introduction: Topical nonsteroidal anti-inflammatory drugs (NSAIDs) represent a relatively recent alternative to oral NSAIDs. Topical NSAIDs are designed to target their therapeutic effect locally to damaged tissue while minimizing systemic exposure. To better inform patients considering topical NSAIDs as an alternative to oral NSAIDs, this is the first comprehensive review to present all available evidence comparing topical NSAIDs with oral NSAIDs in the treatment of both acute and chronic musculoskeletal injury. Methods: Six studies, including 600 subjects, compared the use of topical versus oral NSAIDs in the treatment of a variety of acute injuries. Nine trials, including 2403 subjects, studied topical versus oral NSAIDs for chronic injury treatment, almost exclusively for osteoarthritis (OA) of the knee. This review included all available comparative studies, the majority of which were well-designed, double-dummy, placebo-controlled trials. Relevant meta-analyses were also reviewed. Results: Topical and oral NSAIDs performed statistically better than placebo for chronic injury treatment. Limited evidence comparing topical NSAIDs with placebo for acute injury treatment was available in the included studies, but supported greater effectiveness for topical NSAIDs. In all head-to-head comparisons, topical and oral NSAIDs demonstrated similar efficacy for treatment of both acute and chronic injuries. There were more gastrointestinal side effects in patients receiving oral NSAIDs, while local skin reactions occurred more frequently in patients treated with topical NSAIDs. Conclusion: Overall, topical NSAIDs may be considered as comparable alternatives to oral NSAIDs and are associated with fewer serious adverse events (specifically GI reactions) when compared with oral NSAIDs. Caution should be exercised with the use of both topical and oral NSAIDs, including close adherence to dosing regimens and monitoring, particularly for patients with previous adverse reactions to NSAIDs.

Changes on the expression of CD44 in immobilized knee in rats

Changes on the expression of CD44 in immobilized knee in rats