Extremity Injuries Research Articles

Psychosocial Factors Associated With Lower Extremity Reinjury Risk in Soccer Players: Contribution of Self-Confidence and Reinjury Anxiety.

Despite the availability of specialized assessment tools, psychological readiness is usually not considered when deciding to return to sport (RTS) after sport injury. Reinjury anxiety, self-confidence, and functional attention may be associated with sport reinjury, making it important to evaluate these factors before RTS. To predict lower extremity reinjury in soccer players using self-confidence, functional attention, and reinjury anxiety as predictive variables. Prospective cohort study. Laboratory. Sixty-two male soccer players, who were older than 18 years of age, suffered from lower extremity injuries, had completed the rehabilitation program, and were ready to RTS. Before returning to the sport, participants completed a preseason questionnaire on their previous injuries, self-confidence, reinjury anxiety, and level of functional attention. The primary outcome measured was the risk of reinjury during the upcoming competitive season, and logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals (CIs) to determine the association between each risk factor and reinjury. The overall reinjury rate was 5.56 injuries per 1000 hours of play. Self-confidence scores of ≤47 increased the risk of reinjury by 2.26 times (relative risk = 2.26; 95% CI, 1.31-3.91; OR = 5.00; 95% CI, 1.56-16.04), and each unit increase in self-confidence score reduced the risk of reinjury by 10% (OR = 0.90; CI, 0.82-0.99; P = .03). Regarding reinjury anxiety, a score of >22 was associated with 2.43 times the risk of reinjury (relative risk = 2.43; 95% CI, 1.44-4.13; OR = 6.46; 95% CI, 1.93-21.69), and each unit increase in reinjury anxiety score increased the risk of injury by 45% (OR = 1.45; CI, 1.13-0.87; P = .004). Increased reinjury anxiety and decreased self-confidence are associated with higher odds of lower extremity reinjury in male soccer players. To reduce the risk of reinjury, athletic trainers and sport psychologists should take these psychological factors into account when evaluating the psychological readiness of soccer players with a history of lower extremity injury to RTS.

Impact of Spaceflight on Upper Extremity Orthopedic Health

INTRODUCTION: With increased access to commercial spaceflight and space tourism, plus a push for longer duration spaceflights, it is especially important to understand the impact of spaceflight on musculoskeletal health. Upper extremity injuries are the most common musculoskeletal injuries in spaceflight. It is, therefore, vital to determine the changes to the upper extremities during spaceflight. The purpose of this study was to examine the state of knowledge on the impact of spaceflight on upper extremity orthopedic health, and to identify knowledge gaps and future areas of research. METHODS: A literature review was performed and studies and reports that amassed data on shoulder, elbow, wrist, and hand health were included. RESULTS: Spaceflight decreases bone mineral density in the upper extremities and increases risk of fracture, especially upon return to gravitational environments. Spaceflight does not uniformly affect all muscles; in the shoulder, the various muscles crossing the joint appear to be variably affected: the deltoid experiences a greater degree of atrophy than the rotator cuff muscles. Spaceflight additionally affects the peripheral nervous system, with astronauts experiencing hand numbness and loss of manual dexterity but cause of these symptoms is undetermined. Spacesuits have also been implicated in causing upper extremity injury, especially while training for or performing extravehicular activities. DISCUSSION: While upper extremity orthopedic health in spaceflight is incompletely understood, known adaptations increase risk for weakening and injury. Existing research provides valuable information for best practices, but there is still much to be discovered to optimize upper extremity health in spaceflight. Fiedler B, Jami M, Rakauskas T, Ahmed AS. Impact of spaceflight on upper extremity orthopedic health. Aerosp Med Hum Perform. 2024; 95(10):777–783.

Compensatory Strategies Persist In Special Operations Forces Personnel With A Previous Lower Extremity Injury

Compensatory Strategies Persist In Special Operations Forces Personnel With A Previous Lower Extremity Injury

Correlation of Pre-Season Musculoskeletal Functional Tests with Lower Extremities Injuries in Elite Female Ballet Dancers (MOLED study): a study protocol for a prospective longitudinal study

Correlation of Pre-Season Musculoskeletal Functional Tests with Lower Extremities Injuries in Elite Female Ballet Dancers (MOLED study): a study protocol for a prospective longitudinal study

The role of 3D cinematic rendering in the evaluation of upper extremity trauma.

Traumatic upper extremity injuries are a common cause of emergency department visits, comprising between 10-30% of traumatic injury visits. Timely and accurate evaluation is important to prevent severe complications such as permanent deformities, ischemia, or even death. Computed tomography (CT) and CT angiography (CTA) are the favored non-invasive imaging techniques for assessing upper extremity trauma, playing a crucial role in both the treatment planning and decision-making processes for such injuries. In CT postprocessing, a novel 3D rendering method, cinematic rendering (CR), employs sophisticated lighting models that simulate the interaction of multiple photons with the volumetric dataset. This technique produces images with realistic shadows and improved surface detail, surpassing the capabilities of volume rendering (VR) or maximal intensity projection (MIP). Considering the benefits of CR, we demonstrate its use and ability to achieve photorealistic anatomic visualization in a series of 11 cases where patients presented with traumatic upper extremity injuries, including bone, vascular, and skin/soft tissue injuries, adding to diagnostic confidence and intervention planning.

A Lower Extremity Injury That Occurred While Playing Flag Football

A Lower Extremity Injury That Occurred While Playing Flag Football

Does A History Of Lower Extremity Injury Impact Female Athlete Jump Landing Performance Metrics?

Does A History Of Lower Extremity Injury Impact Female Athlete Jump Landing Performance Metrics?

Associations Between Diagnosed Concussion And Upper Extremity Injury In Community Rugby Players

Associations Between Diagnosed Concussion And Upper Extremity Injury In Community Rugby Players

VTE rates and risk factors in major trauma patients

BackgroundVenous thromboembolism (VTE) is a common and in some instances life-threatening complication following severe traumatic injury. Owing to a lack of high-quality evidence in VTE risk prediction and prevention in this cohort, major trauma patients receive variable VTE preventative care. The aim of this systematic review was to determine the reported rates of VTE in major trauma patients, and associated risk factors. MethodsA comprehensive database search was conducted using EBSCO/MEDLINE, EMBASE, CINAHL, Cochrane and Scopus to identify studies published between 1990 and 2023. Original Studies quantifying the occurrence of and/or evaluating risk factors for VTE, PE and DVT in a defined population were eligible for inclusion. Five reviewers screened, appraised, and extracted data from the selected studies. ResultsA total of 22 studies fulfilled the inclusion criteria. Most studies were conducted in Northern America (72%), followed by Asia (18%), and Europe (9%). Of the 22 studies, 17 were retrospective, 4 were prospective and 1 was the control arm of an RCT. The reported rates in included studies ranged from 0.39% to 32% (VTE), 0.59% to 57.60% (DVT) and 0.35% to 24.0% (PE). Operative procedure was the most consistently reported associated variable for DVT followed by delays to prophylaxis and pelvic injury. Lower extremity injury was the most frequently reported associated variable for PE followed by male sex and increased age. Age was the most frequently reported variable for both DVT and PE. ConclusionThere exists significant variation in the reported rates of VTE in major trauma patients globally. Operative procedure, delays to prophylaxis and pelvic injury were the most consistently reported associated variables for DVT. Lower extremity injury followed by male sex and increased age were the most frequently reported associated variables for PE. Although studies indicate possible differences in risk factors for DVT and PE, heterogeneity in study characteristics and outcome reporting impedes any meaningful conclusions. Reconciliation of VTE rates in major trauma patients is necessary when comparing populations.

Venous thromboembolic complications in wounded with combat-related extremity injuries

Venous thromboembolic complications in wounded with combat-related extremity injuries

Prevalence and Risk Factors of Upper Extremity Injuries in Indoor Bouldering: A Cross-Sectional Study.

To describe the prevalence and risk factors associated with upper extremity injuries among indoor bouldering practitioners, focusing on dynamic movements and specific training methods. We conducted a cross-sectional study with 35 indoor bouldering climbers from a metropolitan area. Data were collected through an adapted online questionnaire and in-person orthopedic evaluations by certified specialists. Statistical analysis was performed using Stata 18 (StataCorp LLC, College Station, TX), calculating the prevalence of pain and injuries and associations between dynamic movements and specific injuries. The sample was predominantly male (80%, n = 28/35), with a mean age of 25.9 years. Shoulder anterior apprehension was significantly associated with dynamic climbing styles (p = 0.028), with a prevalence difference of 0.3(95% CI: 0.04, 0.57). Finger pulley and shoulder injuries affected 22.9% (n = 8/35) and 25.7% (n = 9/35) of participants, respectively. Our study found a significant association between dynamic movements and upper extremity injuries in bouldering climbers, highlighting the pressing need for injury prevention strategies. Despite climbing being an overhead sport, our findings suggest distinct pathophysiology from the thrower's shoulder, necessitating further investigation.

Low back pain or injury before collegiate athletics, a potential risk factor for non-contact athletic injuries.

Majority of research surrounding the predictive value of clinical measurements and assessments for future athletic injury does not differentiate between contact and non-contact injuries. We assessed the association between clinical measures and questionnaire data collected prior to sport participation and the incidence of non-contact lower extremity (LE) injuries among Division III collegiate athletes. Prospective cohort study. University setting, NCAA Division III. 488 Division III freshmen athletes were recruited to participate in the study during their preseason physical examinations. 10,983 public schools. Prospective incidence of non-contact Lower extremity Injury. Athletes completed questionnaires to collect demographics and musculoskeletal pain history. Clinical tests, performed by trained examiners, included hip provocative tests, visual appraisal of a single leg squat to identify dynamic knee valgus, and hip range of motion (ROM). Injury surveillance for each athlete's collegiate career was performed. The athletic training department documented each athlete-reported, new onset injury and documented the injury location, type, and outcome (days lost, surgery performed). Univariable Generalized Estimating Equations (GEE) models were used to analyze the relationship between each clinical measure and the first occurrence of non-contact LE injury. An exchangeable correlation structure was used to account for repeated measurements within athletes (right and left limbs). Of the 488 athletes, 369 athletes (75%) were included in the final analysis. 69 non-contact LE injuries were reported. Responding "Yes" to "Have you ever had pain or an injury to your low back" was associated with an increased risk of non-contact LE, odds ratio = 1.59 (95%CI 1.03- 2.45, p=.04). No other clinical measures were associated with increased injury risk. A history of prior low back pain or injury was associated with an increased risk of sustaining a non-contact LE injury while participating in NCAA Division III athletics.

Considerations of throwing athletes with upper extremity injury when completing the Single Assessment Numeric Evaluation (SANE).

The Single Assessment Numeric Evaluation (SANE) is a widely used patient-reported outcome (PRO) measure that provides an efficient, but limited view of patient perceptions of health. Knowledge of what throwing athletes with upper extremity injury consider when answering the SANE would inform score interpretation and increase its value for clinical decision-making in this patient population. To investigate the global rating of the SANE and its ability to capture constructs of health reflected in patient-reported outcome measures that are commonly used in throwing athletes with upper extremity sport-related injury. Cross-sectional study. Retrospective database review. De-identified patient records of baseball and softball athletes diagnosed with upper extremity sport-related injury between October 2009 and June 2021 were reviewed. Primary outcomes were scores on the SANE; Functional Arm Scale for Throwers (FAST) total; Disabilities of the Arm, Shoulder and Hand (DASH) total; and Global Rating of Daily Activities (GRODA). The first administration of all PROs that patients completed post-injury were analyzed as potential predictors of SANE scores. The proportion of variance uniquely accounted for in the SANE by each predictor (R2) variable was estimated. Fifty-five patients completed PRO measures. The FAST total uniquely accounted for 32.9% (P <.001), the GRODA uniquely accounted for 11.6% (P <.001), and the DASH total uniquely accounted for 4.6% (P=.036) of the variance in the SANE score. Overall, the predictors accounted for 49.2% of the variance in the SANE score (P <.001). Given that the SANE captures multiple constructs of health, it may be useful in gathering a quick, broad view of throwing athletes' perception of their health. When SANE scores suggest diminished health, then multi-item PROs should be considered to further explore constructs of health most impacted.

Pediatric Off-Road Vehicle Injuries: Side-by-Sides Worse for the Upper Extremity.

Side-by-side (SXS) and all-terrain vehicles (ATVs) are different off-road vehicles (ORVs) but often categorized together in the literature. We hypothesized pediatric upper extremity (UE) fracture patterns and injury severity scores (ISS) differ between ORV types. The authors' home-state trauma repository identified 157 pediatric patients aged 0 to 17 years with UE fractures after ORV accidents during 2011-2021. ORV injuries, fracture type, and procedures were identified using International Classification of Diseases, 9th Revision and 10th Revision coding followed by manual chart review or phone calls. We identified specific ORV type, driver/passenger status, and restraint use to compare differences between fracture characteristics, number of surgeries, and ISS. Groups were compared for differences at P < 0.05 significance. Among 157 ORV injuries, 75 resulted from ATVs (48%), 50 SXSs (32%), and 32 from all other vehicles (20%). Average age was 12 years, and 49% (n = 77) required surgery. SXS injuries had significantly higher open fracture rates (42%, n = 21) compared with ATVs (7%, n = 5) and all other ORV types (16%, n = 5; P < 0.0001). Seventy percent of fractures (n = 35) sustained after SXS accidents required surgery compared with 41% (n = 31) for ATVs and 34% (n = 11) for all other ORV types (P < 0.001). SXS drivers had 71% left-sided injuries, whereas 85% passengers had right-sided injuries (P < 0.0001). Patients younger than 13 years (n = 73) had significantly higher surgery rates (59%) compared with 40% for those 13 years and older (n = 84; P = 0.02). There were no significant differences in mean ± SD ISS between ATV (8 ± 6), SXS (8 ± 6), and other vehicles (7 ± 4; P = 0.34). UE fractures caused by SXS were more likely to be open and require surgery compared with ATVs and other ORVs. SXS drivers were more likely to sustain left-sided injuries, whereas passengers had significantly higher right-sided injuries. Patients younger than 13 years were more likely to require surgery compared with teenagers.

Challenges and Clinical Impact of Medical Search and Rescue Efforts Following the Kahramanmaraş Earthquake.

This study assesses the operational challenges and clinical outcomes encountered by a university-based Emergency Medical Team (EMT) during the medical search and rescue (mSAR) response to the February 2023 earthquakes in Kahramanmaraş, Turkey. In this observational study, data were retrospectively collected from 42 individuals who received mSAR services post-earthquake. The challenges were categorized as environmental, logistical, or medical, with detailed documentation of rescue times, patient demographics, injury types, and medical interventions. In this mSAR study, 42 patients from 30 operations were analyzed and divided into environmental (26.2%), logistical (52.4%), and medical (21.4%) challenge groups. Median rescue times were 29 (IQR 28-30), 36.5 (IQR 33.75-77.75), and 30.5 (IQR 29.5-35.5) hours for each group, respectively (P = .002). Age distribution did not significantly differ across groups (P = .067). Hypothermia affected 18.2%, 45.5%, and 66.7% in the respective groups. Extremity injuries were most common in the medical group (88.9%). Intravenous access was highest in the medical group (88.9%), while splinting was more frequent in the medical (55.6%) and logistical (18.2%) groups. Hypothermia was most prevalent in the medical group (66.7%), followed by the logistical group (45.5%). Ambulance transport post-rescue was utilized for a minority in all groups. The study concludes that logistical challenges, more than environmental or medical challenges, significantly prolong the duration of mSAR operations and exacerbate clinical outcomes like hypothermia, informing future enhancements in disaster response planning and execution.

Lower extremity injury and return to sports of elite taekwondo athletes

Abstract Objective We attempted to analyze the characteristics of lower-extremity injuries that occur during training based on the sex and weight class of elite taekwondo (TKD) athletes and the effect of pain scores on the return to sports periods (RTSP). Methods and Methods: We included 198 elite TKD athletes who participated in January–December 2023 and were trained in Korea. Injury incidence rates (IIR) were expressed as Poisson rates with 95% confidence intervals per 1,000 h of training. One-way analysis of variance was conducted to determine the pain score and RTSP according to sex, weight, and injury type. In addition, we performed simple linear regression to determine the effects of pain score on the RTSP. Results The lower-extremities IIR was 2.45 injuries per 1000 training hours, including 0.77 contact and 1.68 non-contact injuries. The IIR was lower in male than in female athletes (p&lt;0.001), the most common injuries occurred in the ankle (0.78) and knee(0.53). In addition, the ligament (0.99) and muscle (0.70) were the most common injury types. All athletes demonstrated significant differences in pain scores (p&lt;0.001) and RTSP (p&lt;0.001) based on the injury type. In addition, we observed a significant difference between the pain score (p&lt;0.001) and RTSP (p=0.004) based on sex. For every 1-point increase in pain score, all athletes had a 1.43-day increase in RTSP. Conclusion These results can be used as data to develop injury prevention programs for TKD athletes and to determine their RTSP.

Pattern of Road Traffic Injuries Presenting at a Tertiary Hospital in North-Central Nigeria

Abstract Background: Road traffic injuries (RTIs) constitute a major economic and health challenge globally, particularly in developing countries. Nasarawa state, north-central Nigeria, is heavily motorised due to the use of motorcycles as a popular means of transportation. The study aims to determine the pattern and prevalence of RTIs within the state. Materials and Methods: A 6-year retrospective study was conducted at the Dalhatu Araf Specialist Hospital (DASH) in Lafia, Nasarawa state. Data were obtained from the medical records of patients admitted with RTIs at the hospital and were analysed using the Statistical Package for the Social Sciences version 26. Results: A total of 929 patients with 1307 injuries were reported. There were 518 (55.8%) males and 411 (44.2%) females, with a male-to-female ratio of 1.3:1. The age of the patients ranged from 1–85 years, with a mean age of 30 ± 20 years. Young adults aged 18–44 years constituted the most injured age group. Motorcycle-related crashes accounted for injuries in 530 (57.1%) patients. These injuries were predominantly traumatic brain injuries (TBIs) and extremity injuries. The body region most affected was the head and face (560, 42.8%), with traumatic brain injuries (448, 32.7%) being the most common type. After treatment, most patients (571, 61.5%) were discharged home, while the mortality rate was 2.4%. Conclusion: In our study, motorcycle-related crashes were prevalent. Young adult males were mostly the victims of RTIs. Traumatic brain injuries and extremity injuries were the predominant types of injuries, often associated with motorcycle and pedestrian crashes. Multisystem injuries and TBIs were major factors contributing to mortality.

Injury Patterns in Fencing Athletes - A Retrospective Review.

Fencing is a unique and increasingly popular sport, but limited data exist regarding related injuries. To examine the types of injuries incurred by fencing athletes, and to analyze associations between age, sex, and hand dominance with type and location of injury. Cross-sectional. Retrospective chart reviews were performed to evaluate fencing related injuries in athletes evaluated in the sports medicine and orthopedic clinics of a large teaching hospital. One hundred and eighty-six patients (98 male, 88 female) were included. Average age at time of injury was 14.6 years (range 9 - 32 years). 73% of injuries involved the lower extremity, 16% involved the upper extremity and 10% affected the back. In the lower extremity, the knee (49%), ankle (16%) and hip (11%) were most commonly affected. 80% of injuries were treated with physical therapy. Only 5% required surgical intervention. Injuries of both upper and lower extremities were more commonly seen on the athlete's dominant side, and the majority of injuries (77%) occurred in athletes 13 years or older. The majority of injuries in these fencing athletes affected the lower extremity, most commonly the knee. Extensor mechanism dysfunction, primarily patellofemoral pain, was the most common diagnosis. Hand dominance, patient age, and patient sex did affect different injury characteristics. 2b.

Think fast, stay healthy? A narrative review of neurocognitive performance and lower extremity injury

BackgroundLower extremity (LE) injury has been problematic in athletic populations. While previous research has identified biomechanical and neuromuscular risk factors, more recent efforts have determined that neurocognitive performance (NP) may influence LE injury risk. ObjectivesTo describe the present findings pertaining to the relationship between NP and LE injury. This review described potential cerebral neural mechanisms underpinning LE injury with a particular emphasis on the role of vision in sensorimotor integration. Lastly, newer technology such as stroboscopic eyewear, smartboards, and virtual/augmented reality were discussed for their utility in assessing and training NP. MethodsNarrative review that described NP and LE injury, as well as plausible mechanisms and training interventions. ResultsNP appears to influence both LE biomechanics and LE injury risk. Athletes with worse NP demonstrated decreased knee flexion and increased frontal plane knee loading compared to better performing athletes. Most studies determined an association between NP and LE injury risk. Visual motor reaction time, processing speed, and working memory appear to be useful NP measures for identifying athletes at risk for LE injury. Various brain regions including the precuneus and lingual gyrus may be implicated as neural signatures for LE injury. While recently developed technology offer promise, far-transfer effects to LE injury risk reduction have yet to be substantially investigated. ConclusionsNP should be considered an important component for identifying LE injury risk. Sports scientists and clinicians may consider a variety of assessments and interventions to quantify and train NP in conjunction with previously established protocols.

Feasibility and Validity of Wearable Sensors for Monitoring Temporal Parameters in Manual Wheelchair Propulsion.

Upper extremity pain and injury are among the most common musculoskeletal complications manual wheelchair users face. Assessing the temporal parameters of manual wheelchair propulsion, such as propulsion duration, cadence, push duration, and recovery duration, is essential for providing a deep insight into the mobility, level of activity, energy expenditure, and cumulative exposure to repetitive tasks and thus providing personalized feedback. The purpose of this paper is to investigate the use of inertial measurement units (IMUs) to estimate these temporal parameters by identifying the start and end time of hand contact with the push-rim during each propulsion cycle. We presented a model based on data collected from 23 participants (14 males and 9 females, including 9 experienced manual wheelchair users) to guarantee the reliability and generalizability of our method. The obtained outcomes from our IMU-based model were then compared against an instrumented wheelchair (SMARTWheel) as a reference criterion. The results illustrated that our model was able to accurately detect hand contact and hand release and predict temporal parameters, including the push duration and recovery duration in manual wheelchair users, with the mean error ± standard deviation of 10 ± 60 milliseconds and -20 ± 80 milliseconds, respectively. The findings of this study demonstrate the potential of hand-mounted IMUs as a reliable and objective tool for analyzing temporal parameters in manual wheelchair propulsion. IMUs offer significant strides towards inclusivity and accessibility due to their portability and user-friendliness and can democratize health monitoring of manual wheelchair users by making it accessible to a broader range of users compared to traditional technologies.