Ligament Sprains Research Articles

Effects of soft bracing or taping on a lateral ankle sprain: a non-randomised controlled trial evaluating recurrence rates and residual symptoms at one year.

BackgroundAfter sustaining an ankle sprain, taping is often the standard treatment in primary care. Ankle braces are sometimes used as an alternative. This study aimed to compare the effects of four weeks of soft bracing or taping following acute lateral ankle ligamentous sprain (ALALS) on sprain recurrence rates and residual symptoms at one year.MethodsIn this pragmatic, non-randomised controlled trial, 157 adult participants with an ALALS caused by an inversion trauma were alternately allocated to a four week treatment with a soft brace (intervention group) or a four week treatment with ankle tape (control group) in order of presentation. The primary outcome was the 1-year incidence of the self-reported recurrence of ALALS. The secondary outcome was the occurrence of residual symptoms.ResultsBaseline characteristics did not differ appreciably between the treatment groups. Thirteen patients (17%) in the brace group reported a re-injury versus 11 patients (14%) treated with tape, corresponding to a risk difference of 3.1% (relative risk 1.2, 95% CI 0.6 to 2.6). Cox regression analysis showed a hazard ratio of self-reported ankle sprain recurrence within 52 weeks in the brace group compared to the tape group of 0.9 (95% CI 0.4 to 1.9). After one year, patients in the brace group had poorer scores on the manual anterior ankle test, corresponding to a risk difference of 15.4% (RR 2.4, 95% CI 1.1 to 5.0).ConclusionALALS recurrences and residual symptoms appear to be similar at one year when an ALALS is treated with four weeks of soft bracing or taping.Trial registrationISRCTN92030205

Ultrasound-guided musculoskeletal interventions in American football: 18 years of experience.

Myotendinous strains, contusions, and hematomas are common injuries in American football. Along with ligament sprains and inflammatory disorders, musculoskeletal injuries often result in lost participation time. This article summarizes 18 years of experience with 128 ultrasound-guided drainages and injections in 69 football players with 88 injuries. When performed by an operator with sufficient expertise in diagnostic and procedural skills, ultrasound-guided musculoskeletal interventions are minimally invasive, are safe, and can play an integral role in injury management.

Acute non-specific low back pain in primary care

Acute non-specific low back pain, usually a result of muscle strains and ligament sprains from lifting, exercising or moving unexpectedly, is commonly encountered in primary care. At any given time, approximately one in five adults will report low back pain. Although non-specific low back pain is usually self-limiting and improves with time, there is an array of treatment options to facilitate this process and to minimise potential suffering, disability and absenteeism from work. This article will provide a review of such treatment options.

The Diagnosis of Knee Pain

The knee is open to injury because it is designed for rapid action, not simply during its large excursion from extension to full flexion, but also lesser accommodative movements of rotation, tilt and glide. As if that were not enough, that highly developed but sometimes temperamental sesamoid, the patella, adds its own unique problems. The complexities of these movements are reflected in the subtleties of the structure of the knee. Regrettably they have also led to a proliferation of clinical tests and surgical repairs whose sophistication confuses rather than enlightens.Before enquiring about the characteristics of the painful knee the general characteristics of the patient should be assessed quickly. In children problems usually relate to patellar malalignment syndromes, possibly a discoid meniscus, and the aching discomfort produced by traction apophysitis such as Osgood-Schlatter's disease of the tibial tuberosity. After puberty girls are particularly likely to develop patellar pain, which may be associated with lateral subluxation of that bone. In the young woman the sources of such pain may be so prolix that the surgeon may do more harm than good if he operates. During adolescence and early adult life males are most likely to suffer from meniscal and ligamentous tears, often brought on by exertion or accidents during sport. A patient with an endomorphic physique usually has associated genu valgum and may present with medial ligament sprains and patello-femoral pain. Those with ligamentous laxity are also prone to sprains and patellar subluxation. The mesomorphic athlete is likely to injure the menisci, or may come in with significant tears of the ligaments and synovium.

Cochrane in CORR ®: surgical versus conservative treatment for acute injuries of the lateral ligament complex of the ankle in adults (review).

Importance of the Topic More than 650,000 ankle sprains present to emergency departments in the United States for treatment every year [14]. The vast majority of these sprains are injuries to the lateral ligament complex resulting from a forceful inversion of the ankle joint during physical activity [7]. The impact of a lateral ligament complex sprain is experienced through acute pain and swelling, several weeks of acute disability resulting in time lost from work or other activities, and in as many as 20% of patients, chronic instability of the ankle joint [1, 7]. Anatomically, lateral ligament sprains are almost always localized to the anterior talofibular ligament. The calcaneofibular ligament is also involved in 50% to 75% of sprains [2]. The third ligament of the lateral ligament complex - the posterior talofibular ligament - is rarely involved. In cases of chronic instability, anatomic reconstructive procedures (as originally described by Brostrom [4] and subsequently modified) frequently are used to correct a deficient lateral ligament complex and restore stability of the ankle joint [4]. It is plausible that primary repair of acute lateral ligament complex tears may facilitate ligament healing, shorten time off work and/or athletic activities, and reduce the incidence of chronic instability. However, surgical intervention also has inherent disadvantages, such as wound infection, iatrogenic nerve injury, and other postsurgical complications. The primary objective of this Cochrane Review is to determine whether surgical management is superior to conservative management of acute lateral ligament complex injuries [6]. Upon Closer Inspection The lack of a standardized patient-oriented outcome instrument provided unique challenges to this meta-analysis, and led to the need to independently evaluate 11 outcomes (four primary outcomes and seven secondary outcomes). A maximum of 12 of 20 trials reported data on a common outcome to allow for a meta-analysis. A validated, reliable, and universally accepted ankle outcome instrument would have facilitated a rigorous and informative meta-analysis of outcome data from all trials [5], but such an outcome instrument does not presently exist [3, 9]. A single trial published by Prins [10] in 1978 demonstrated several benefits of surgical management - results that differed substantially from other published trials, including several more-recent and better-designed efforts [8, 11-13] - and greatly influenced the pooled estimate for many outcomes. The pronounced and, occasionally differing, direction of Prins’ results may be attributable to the trial being only quasi-randomized, resulting in no concealment of treatment allocation or blinding. In order to test the robustness of the results, the authors of this review performed several sensitivity analyses both with and without Prins’ trial data. Excluding this trial reduced the variability of results between trials, and eliminated all significant benefits in applicable primary outcomes for surgical intervention. When interpreting the results, it is also important to explicitly recognize characteristics of patients enrolled in the included trials. Both adults with chronic ankle instability and children were deliberately excluded. The majority of patients in these trials were young active adult males suffering from ankle injuries that were painful and/or swollen enough for them to present to an acute care setting. In other words, these are patients who had relatively severe injuries, and theoretically are most likely to have benefited from surgical intervention. In general, one would expect a patient presenting to an ambulatory or primary care clinic to have an even more diminished benefit from surgical intervention. This is an important consideration when determining the clinical relevance of the results. Take-Home Messages Overall, this Cochrane Review (which is current to January 2006) failed to demonstrate a benefit of surgery compared with conservative management for acute lateral ligament complex injuries. Since this review was conducted, at least two more randomized controlled trials have been published comparing conservative and surgical management for acute lateral ligament complex injuries [8, 11]. Both of these trials failed to demonstrate significant differences between surgery and conservative management in their primary outcomes, further corroborating the findings of this Cochrane review. Because studies have failed to consistently demonstrate evidence of benefit for surgical repair, along with the additional complications inherent with an invasive surgical procedure, surgery for acute lateral ligament complex injuries is not recommended, regardless of severity. The optimal method of conservative management (rigid immobilization versus early mobilization) remains a topic of ongoing investigation. The development of a standardized outcome instrument that is validated, reliable, and universally accepted will facilitate analysis of future trials in foot and ankle surgery.

Sonography of sports injuries of the hip.

Context:Sports-related injuries of the hip are a common complaint of both competitive and recreational athletes of all ages. The anatomic and biomechanical complexity of the hip region often cause diagnostic uncertainty for the clinicians evaluating these injuries. Therefore, obtaining additional diagnostic information is often crucial for providing injured athletes with a prompt and accurate diagnosis so they can return to activity as soon as possible. Musculoskeletal ultrasound is becoming increasingly important in evaluating and treating sports-related injuries of the hip.Evidence Acquisition:The PubMed database was searched in May of 2013 for English-language articles pertaining to sonography of sports injuries of the hip using the following keywords in various combinations: musculoskeletal, ultrasound, hip, hip sonography, and sports.Study Design:Clinical review.Level of Evidence:Level 4.Results:Musculoskeletal ultrasound is currently being used for both diagnosis and treatment in a wide range of acute and chronic conditions affecting the hip, including tendinosis, tendon/muscle strains, ligamentous sprains, enthesopathies, growth plate injuries, fractures, bursitis, effusions, synovitis, labral tears, and snapping hip. Therapeutically, it is used to guide injections, aspirations, and biopsies.Conclusion:Musculoskeletal ultrasound use is expanding and will likely continue to do so as more clinicians realize its capabilities. Characteristics, including accessibility, portability, noninvasiveness, dynamic examination, power Doppler examination, and low cost highlight the potential of ultrasound.

Treatment of Lateral Knee Pain Using Soft Tissue Mobilization in Four Female Triathletes

Prospective case series. These case reports present results of the treatment of lateral knee pain in four female amateur triathletes. The athletes were referred to the author's clinic with either a diagnosis of iliotibial band friction syndrome or patellofemoral pain syndrome, all four having symptoms for longer than seven months. Changes in training routines were identified as the possible cause of the overuse injuries that eventually developed into chronic conditions. Treatment involved soft tissue mobilization of the musculotendinous structures on the lateral aspect of the knee. At four weeks, three of the athletes improved 9 to 19 points on the Lower Extremity Functional Scale, 3 to 5 points on the Global Rating of Change Scale, and demonstrated improvement in hamstring and iliotibial band flexibility. At eight weeks the Global Rating of Change for these three athletes was a 7 ("a very great deal better") and they had returned to triathlon training with no complaints of lateral knee pain. One athlete did not respond to treatment and eventually underwent arthroscopic surgery for debridement of a lateral meniscus tear. After ruling out common causes for lateral knee pain such as lateral meniscus tear, lateral collateral ligament sprain, patellofemoral dysfunction, osteochondral injury, biceps femoris tendonitis, iliotibial band friction syndrome or osteoarthritis, soft tissue restriction should be considered a potential source of dysfunction. In some cases soft tissue restriction is overlooked; athletes go undiagnosed and are limited from sports participation.

Evidenced-based clinical review: Laterally-based ankle and hindfoot pain

The diagnosis of laterally-based ankle and hindfoot pain is comprehensive and the possibilities of injury origin can be easily overlooked. Injury misdiagnosis can result in improper treatment and can lead to exacerbated injuries, persistent pain, and chronic problems. Successful diagnosis of laterally-based ankle and hindfoot injuries requires knowledge of the differential diagnosis. This differential can be classified into fractures, ligamentous injuries, tendon injuries, osteochondral lesions, and nerve lesions. Narrowing the differential to arrive at an accurate diagnosis necessitates a detailed patient history, an understanding of the injury mechanism, the selective use of diagnostic imaging modalities, and a thorough clinical examination that incorporates palpation, range of motion (ROM), and provocative maneuvers. The initial treatment of minor lateral ligament and syndesmotic sprains should include protection, rest, ice, compression, and elevation (PRICE), weight bearing to tolerance, and pain control with non-steroidal anti-inflammatory drugs (NSAIDs). Early mobilization and functional rehabilitation including osteopathic manipulative therapies (OMT) should also be incorporated to reduce pain and swelling and improve range of motion. The initial treatment of fractures, ligament and tendon injuries, osteochondral lesions, and nerve injuries should include PRICE treatment with non-weight bearing and the referral to an orthopedic or sports medicine specialist should be considered.

An American Experience with a New Olympic Collision Sport: Rugby Sevens

Objectives:Rugby Sevens is a future Olympic collision sport that is played globally with a high incidence of injury. The sport is growing exponentially in the U.S. There is limited injury data on Rugby Sevens. Currently, there is no study evaluating incidence of injury in the National Rugby Sevens population in the U.S. The objective of this study was to characterize the injury rates among amateur Rugby Sevens players in the U.S.Methods:This was a prospective descriptive injury epidemiology study involving American Rugby Sevens tournaments from 2010-2013. The injury data were collected from both male and female Rugby Sevens players (13, 524 players) and conformed to the international consensus statement on rugby injury definitions. The study included a total of 1,127 teams competing in under-15 to national candidate level tournaments (USA Rugby Local Area, Territorial Union, National and All-Star Sevens Series, USA Sevens Invitational and Collegiate Rugby Championships). A total of 2746 matches were played, 2734 lasting 14-minutes (0.23 hours) in length and 12 lasting 20-minutes (0.33 hours) in length. The overall injury exposure for all players was 8858.9 playing hours (7 players per side * 2 teams per match * 0.23 hours per match * 2734 matches + 7 players per side * 2 teams per match * 0.33 hours per match * 12 matches). Player injury data were reported as proportion (%), mean (SD), and rate of injury as injuries per 1000 playing hours.Results:Incidence of combined medical attention and time-loss injuries was 97.7/1000 playing hours (n=875 injuries) (23.6±5 years old). Time-loss injuries alone were encountered at 43.1/1000 playing hours (n=380 injuries) (forwards, 14.3/1000, n=127; backs 25.7/1000, n=228) (RR: 1.8; 1.53-2.11, P < 0.001). Elite/national male competitors (242.6/1000) were injured more often than lower playing levels (147.6/1000) (P < 0.001). Most injuries were acute injuries (96%) that occurred during the tackling phase of play (97%), and it resulted mainly from contact with an opposing player (67%). The main injuries seen were ligament sprain in lower extremities (43%). Upper extremity injuries were seen more often among male players (76%) than female players (24%) (RR: 0.31, CI: 0.25-0.40, P < 0.001). Knee injuries were seen more often in women’s elite players than men’s elite players (P = 0.014). Head/neck injuries (backs, 58%; forwards, 42%) occurred more often in male players (74%) (RR: 0.34; CI: 0.26-0.44, P < 0.001).Conclusion:Injury prevention in American Rugby Sevens should focus on proper tackling technique as most injuries in our series occurred during tackling. We also saw a significant number of head/neck injuries in our U.S. playing population, which may reinforce the importance of proper tackling technique in this collision sport. The rate of head/neck injuries (23%) in our U.S. cohort (National candidates, 25%; lower competitors, 23%) was higher than the rate reported among international male Rugby Sevens players (5%) (Table 1). Overall, our National candidates had higher rates of time loss injuries than lower American amateur playing levels. Our observed injury rate among U.S. elite players is also higher than that reported for international male Rugby Sevens population. Understanding the injury profile of American Rugby Sevens is important to healthcare providers and would direct the growth and safety of this growing collision sport, allowing safe return-to-play decisions and formulation of prevention protocols.

Corticosteroid and Anesthetic Injections for Muscle Strains and Ligament Sprains in the NFL.

Administering local anesthetic or corticosteroid injections in professional athletes to allow return to play is common but has traditionally been viewed as suspect and taboo. The skepticism surrounding therapeutic injections stems predominantly from anecdotal experience as opposed to scientific data. The purpose of this paper is to evaluate the current use of corticosteroid injections for muscle strains and ligaments sprains in the National Football League to document player's ability to return to play and possible adverse effects. Athletes from a single National Football League team who received at least one corticosteroid or anesthetic injection for either a muscle strain or ligament sprain during three consecutive seasons were retrospectively reviewed. Thirty-seven injections were given over the three seasons. Injections were either performed blindly or by using ultrasound guidance. Twice as many defensive players were injected than offensive players. The average number of days of conservative treatment before injection was 6.5days. All players returned to play after injection. There were no complications from any of the injections. Seventeen (55%) players did not miss a single game, and nine (30%) did not miss a single day. Quadriceps strains were associated with the most missed games (four) and the most missed days (36.5). Proximal hamstring strains were second with an average of three missed games and 28 missed days. Corticosteroid injections are a safe and effective therapeutic intervention for treating muscle strains and ligament sprains in order to enable athletes to return to competition earlier.

Changes in Health-Related Quality of Life and Knee Function After Knee Injury in Young Female Athletes.

Background:Recent literature has called for greater attention to evidence-based practice in sports medicine with the documentation of overall status and impairments following injury. The prospective documentation of impairments associated with knee injuries in female athletes regarding their health-related quality of life (HRQoL) and knee function (KF) of high school and collegiate athletes is limited. Assessing the effect knee injuries have on young female athletes may allow clinicians to better understand the perspectives of the athletes who sustain these injuries.Purpose:To document the changes over 12 months in self-reported HRQoL and KF in young females who have sustained a knee injury.Study Design:Case series; Level of evidence, 4.Methods:A convenience sample of 242 females (mean age, 17.4 ± 2.4 years) who injured their knee participating in sport or recreational activities was utilized. Injuries were categorized as anterior cruciate ligament tears (ACL), anterior knee pain (AKP), patellar instability (PAT), meniscus tear (MNT), iliotibial band syndrome (ITB), collateral ligament sprain (COL), and other (OTH). HRQoL was assessed with the Short Form–12 v 2.0 survey (SF-12) physical component summary (PCS) and mental component summary (MCS). KF was assessed with the 2000 International Knee Documentation Committee survey (IKDC). Dependent variables included the paired differences in the 2000 IKDC as well as SF-12 composite scores from preinjury through 12 months postdiagnosis. Paired differences were assessed with repeated-measures analyses of variance (P ≤ .05).Results:IKDC scores were lower through 12 months for ACL, AKP, and PAT; through 6 months for MNT; and through 3 months for COL and OTH. HRQoL PCS and MCS scores were lower through 3 to 12 months depending on the type of injury classification.Conclusion:Knee injuries can negatively affect KF and HRQoL for up to 12 months in young females. Sports medicine providers need to be aware of these impacts as they work to effectively treat individuals with these injuries.

Neuromechanical coupling in the regulation of muscle tone and joint stiffness.

The ability of the nervous system to accommodate changes to joint mechanics is crucial in the maintenance of joint stability and the prevention of injury. This neuromechanical coupling is achieved through several mechanisms such as the central and peripheral regulation of muscle tone and subsequent alterations to joint stiffness. Following joint injury, such as a ligamentous sprains, some patients develop functional instability or require surgery to stabilize the joint, while others are able to cope and display limited impairments. Several researchers have attempted to explain these divergent outcomes, although research using proprioceptive tasks and quantifying reaction times has led to equivocal results. Recent innovations have allowed for the simultaneous measurement of mechanical and nervous system function among these subsets. The intent of this review was to explore the relationships between joint stiffness and nervous system function, and how it changes following injury. By better understanding these mechanisms, researchers and clinicians may better develop and implement rehabilitation protocols to target individual deficits among injured populations.

Validity and Reliability of the Standardized Orthopedic Assessment Tool (SOAT): A Variation of the Traditional Objective Structured Clinical Examination

Health care professions have replaced traditional multiple choice tests or essays with structured and practical, performance-based examinations with the hope of eliminating rater bias and measuring clinical competence. To establish the validity and reliability of the Standardized Orthopedic Assessment Tool (SOAT) as a measure of clinical competence of orthopaedic injury evaluation. Descriptive laboratory study. University. A total of 60 undergraduate students and 11 raters from 3 Canadian universities and 1 standardized patient. Students were required to complete a 30-minute musculoskeletal evaluation in 1 of 2 randomly assigned mock scenarios involving the knee (second-degree medial collateral ligament sprain) or the shoulder (third-degree supraspinatus muscle strain). We measured interreliability with an intraclass correlation coefficient (ICC) (2,k) and stability of the tool with standard error of measurement and confidence intervals. Agreement was measured using Bland-Altman plots. Concurrent validity was measured using a Pearson product moment correlation coefficient whereby the raters' global rating of a student was matched to the cumulative mean grade score. The ICCs were 0.75 and 0.82 for the shoulder and knee cases, respectively. Bland-Altman plots indicated no systematic bias between raters. In addition, Pearson product moment correlation analysis demonstrated a strong relationship between the overall cumulative mean grade score and the global rating score of the examinees' performances. This study demonstrated good interrater reliability of the SOAT with a standard error of measurement that indicated very modest stability, strong agreement between raters, and correlation indicative of concurrent validity.

Chronic ankle instability alters eccentric eversion/inversion and dorsiflexion/plantarflexion ratio

To determine if the eccentric evertor/invertor and dorsiflexor/plantar-flexor ratio are altered in subjects with chronic ankle instability. Twenty chronic ankle instability (CAI) subjects as an experimental group, and twenty healthy subjects as a control group, were matched in age, gender, and activity level. CAI subjects have a history of at least one ankle sprain and repeated episodes of giving way were included in CAI group. Subjects with no prior history of ankle injury were included in the control group. Ankle evertor/invertor and dorsiflexor/plantar-flexor muscles eccentric torque ratios were measured using the eccentric muscle contraction at angular velocities 60 and 120°/s. Analysis of variance revealed that the eccentric contraction eversion/inversion ratio of CAI group was significantly lower than normal group ratio at angular velocities 60 and 120°/s (p=0.041 and 0.012) respectively. The eccentric contraction dorsiflexion/plantarflexion ratio of CAI group was significantly higher than normal group ratio at both angular velocities (p=0.036 and 0.013) respectively. Moreover, at angular velocities of 60°/s and 120°/s a deficit in inversion and eversion eccentric torques were identified in CAI group (p=0.000), plantarflexion torque deficit of CAI group (p=0.034 and 0.028), respectively, and no deficit was identified for dorsiflexion torque of CAI group (p=0.595 and 0.696) respectively. Chronic ankle instability increases the dorsiflexion/plantarflexion muscles torque ratio and decreases the eversion/inversion ratio at angular velocities 60 and 120°/s. Therefore, the restoration of a normal eccentric inversion, eversion, and plantarflexion strength may prevent recurrent lateral ankle ligament sprain.

A Comparative, Prospective, and Randomized Study of Two Conservative Treatment Protocols for First-episode Lateral Ankle Ligament Injuries

The objective of this study was to investigate functional results, the amount of time that patients missed from regular working activities, and the incidence of residual mechanical ankle instability following conservative treatment of a first episode of severe lateral ankle ligament sprain (with articular instability). This prospective and randomized study included 186 patients with severe lateral ankle ligament injuries, who were randomly assigned into 2 conservative treatment groups. In group A, participants were treated with a walking boot with weight-bearing allowed, pain management, ice, and elevation with restricted joint mobilization for 3 weeks. In group B, patients were treated with a functional brace for 3 weeks. After this period, patients from both groups were placed in a short, functional brace for an additional 3 weeks, during which they also started a rehabilitation program. No statistically significant difference was found in pain intensity score between the 2 groups; however, functional evaluations based on the AOFAS ankle and hindfoot score system showed a statistically significant improvement in the group treated with the functional brace. In addition, the average recovery period necessary for patients of group B to resume their duties was shorter than that for patients in group A. No significant difference was detected in residual mechanical ankle instability between the 2 groups. Patients with severe lateral ankle ligament lesions treated with a functional brace were shown to exhibit somewhat better results than those treated with a walking boot, and both methods presented a very low incidence of residual chronic instability. We found adequate conservative treatment was sufficient to reestablish ankle stability and that functional treatment had a marginally better clinical short-term outcome with a shorter average recovery period. Level I, prospective randomized study.

Epidemiology of musculoskeletal upper extremity ambulatory surgery in the United States

BackgroundMusculoskeletal disorders of the upper extremity are common reasons for patients to seek care and undergo ambulatory surgery. The objective of our study was to assess the overall and age-adjusted utilization rates of rotator cuff repair, shoulder arthroscopy performed for indications other than rotator cuff repair, carpal tunnel release, and wrist arthroscopy performed for indications other than carpal tunnel release in the United States. We also compared demographics, indications, and operating room time for these procedures.MethodsWe used the 2006 National Survey of Ambulatory Surgery to estimate the number of procedures of interest performed in the United States in 2006. We combined these data with population size estimates from the 2006 U.S. Census Bureau to calculate rates per 10,000 persons.ResultsAn estimated 272,148 (95% confidence intervals (CI) = 218,994, 325,302) rotator cuff repairs, 257,541 (95% CI = 185,268, 329,814) shoulder arthroscopies excluding those for cuff repairs, 576,924 (95% CI = 459,239, 694,609) carpal tunnel releases, and 25,250 (95% CI = 17,304, 33,196) wrist arthroscopies excluding those for carpal tunnel release were performed. Overall, carpal tunnel release had the highest utilization rate (37.3 per 10,000 persons in persons of age 45–64 years; 38.7 per 10,000 persons in 65–74 year olds, and; 44.2 per 10,000 persons in the age-group 75 years and older). Among those undergoing rotator cuff repairs, those in the age-group 65–74 had the highest utilization (28.3 per 10,000 persons). The most common indications for non-cuff repair related shoulder arthroscopy were impingement syndrome, periarthritis, bursitis, and instability/SLAP tears. Non-carpal tunnel release related wrist arthroscopy was most commonly performed for ligament sprains and diagnostic arthroscopies for pain and articular cartilage disorders.ConclusionsOur data shows substantial age and demographic differences in the utilization of these commonly performed upper extremity ambulatory procedures. While over one million upper extremity procedures of interest were performed, evidence-based clinical indications for these procedures remain poorly defined.

CSM 2014 Orthopaedic Section Poster Presentations (OPO1106–OPO1165, OPO2218–OPO2298, OPO3106–OPO3183)

CSM 2014 Orthopaedic Section Poster Presentations (OPO1106–OPO1165, OPO2218–OPO2298, OPO3106–OPO3183)

Return to Run: Lateral Ankle Sprain with Sural Nerve Involvement - A Case Study

Lateral ankle sprains are the most common injuries sustained by athletes. The sprains not only cause ligamentous damage, but also affects the musculotendinous and nervous tissue around the lateral ankle complex. In order to render appropriate rehabilitation, a proper evaluation is required. Injury to the sural nerve in association with lateral ankle sprain is rarely mentioned in the literatures. However, sural nerve injury can occur more frequently than commonly expected, leading to misdiagnosis and mistreated component of ankle sprains. There is a lack of literature relating the whole scenario of lateral ankle injury involving ligament sprain, joint dysfunction, peroneal muscle strains, sural nerve involvement and physiotherapy management. Thus, the present study is conducted to highlight the outcomes of a patient with lateral ankle sprain involving sural nerve pathology as well as describes the physiotherapy management including mobilisation of the joint, neural mobilisation and balance exercise training. This case study demonstrates an ankle inversion injury of 22 year old male while playing football. Detailed examination and physiotherapy management were carried out for 5 visits over 4-weeks period. Outcome measures were compared between the baseline and final visit. The patient exhibited significant improvement and back to run. Thus, suggesting the need of neural tissue examination on patients with lateral ankle sprains.

A computational biomechanics study to investigate the effect of myoelectric stimulation on peroneal muscles in preventing inversion‐type ankle ligamentous sprain injury

The aim of this study was to develop a three-dimensional (3D) computational model to justify the effect of myoelectric stimulation in preventing ankle inversion ligamentous sprain injury.

Injuries Among Spanish Male Amateur Soccer Players

Background: Soccer is the most popular sport worldwide, with about 265 million players, both professionals and amateurs. Most research investigating soccer injuries has focused on professional players because they have greater exposure time, but most soccer players are at the recreational level. Purpose: To undertake a retrospective epidemiological study of the injuries sustained in Spanish amateur soccer during the 2010-2011 season. Study Design: Descriptive epidemiological study. Methods: Any injuries incurred by the 134,570 recreational soccer players (aged 18-55 years) registered with the Spanish Football Federation were reported to the federation’s medical staff. A standardized medical questionnaire, based on the Fédération International de Football Association (FIFA) Medical and Research Centre (F-MARC) consensus for collection procedures in studies of soccer injuries, was used to classify the injury according to type, severity, location, and treatment. Results: A total of 15,243 injuries were reported, with an average of 0.11 injuries per player and per year. From the total number of injuries, 67.2% were classified as injuries that resulted in time loss, while the remaining 32.7% were injuries that required medical attention. Most injuries led to a minimum of 1 competitive match being missed (87%), and only 2.5% were recurrent injuries. The rate of injuries per 1000 hours of play was double during games (1.15/1000 hours) compared with during training (0.49/1000 hours). From the total number of injuries reported, 7.7% corresponded to goalkeepers, 24.2% to forwards, 33.8% to defenders, and 34.3% to midfielders. The knee (29.9%) and ankle joints (12.4%) were the most common body locations injured, while ligament sprains and ruptures accounted for 32.1% of the total injuries attended. Older amateur players (age ≥30 years) had a greater number of injuries per year and per 1000 hours of play than their younger counterparts. Conclusion: The risk of injury in amateur soccer is lower than that previously reported in professional players. The most common complaints in amateur players are knee ligament injuries. Further research is needed to investigate ways of reducing the incidence of injuries in amateur soccer.