Sports Medicine Physicians Research Articles

Understanding the Cheerleader as an Orthopaedic Patient: An Evidence-Based Review of the Literature.

Cheerleading is a highly popular youth sport in the United States and has been increasingly recognized in recent years for its athleticism and competitive nature. The sport has changed dramatically since its inception. When the sport of cheerleading was first developed, its primary purpose was to entertain crowds and support other athletes. Today, cheerleaders are competitive athletes themselves. Cheerleaders, most of whom are in the pediatric age group, and their parents commonly approach orthopaedic surgeons and sports medicine physicians with questions regarding the risks associated with participation in the sport. Appropriate clinical guidance is especially important for athletes returning to the sport after an injury. However, unlike other popular sports (eg, football, basketball, and volleyball), the intricacies of cheerleading are not well-known to those outside the sport, including many health care providers. Previous studies have reported on the epidemiological patterns of injuries associated with cheerleading and how such aesthetic sports affect the body, finding that fractures and concussions are prevalent and that catastrophic injuries are more common than in most other sports. Here, we provide an evidence-based discussion of 10 pertinent topics regarding cheerleading and its risks to the musculoskeletal system. The purpose of this review is to provide a comprehensive resource for orthopaedic surgeons and sports medicine physicians who care for these athletes.

Ultrasound Stress-Imaging is a Promising Tool to Detect Achilles Tendon Damage

Category:Sports; Basic Sciences/BiologicsIntroduction/Purpose:Achilles tendon disorders are among the most common conditions observed by sports medicine physicians and among the most difficult to diagnose using current clinical tools. While qualitative imaging is a validated method to grade the severity of tendinopathy, predicting the risk of these patients progressing or suffering tendon ruptures remains a major clinical need. Therefore, the purpose of this study was to determine the efficacy of quantitative ultrasound imaging to explain in vitro fatigue-induced degradation of Achilles tendon mechanical properties. We hypothesized that decreases in mean echogenicity would be linked to in vitro tendon fatigue characterized by decreased mechanical properties.Methods:In this cadaveric tendon study, we cyclically fatigued 10 cadaveric Achilles tendons (7 donors; sex: 4M, 3F; age: 60+-15 years) and acquired b-mode ultrasound images to determine if stress-imaging biomarkers provide new insight into tendon status. We cut dog-bone shapes to concentrate tendon damage at the mid-substance where we acquired ultrasound images. In a custom- built testing bath, we cyclically applied 10-20 MPa of tendon stress at 1 Hz for 150,00 or until the specimen failed. Every 500th cycle, we applied 2 slow (0.25 Hz) tendon stresses of 10-20 MPa while acquiring ultrasound images using an 18MHz transducer.We calculated the change in tendon echogenicity caused by the applied stress to determine if this stress-imaging biomarker was associated with tendon failure. We compared these stress-imaging biomarkers from the tendons that failed (N=6) and the tendons that survived (N=4) cyclic fatigue damage using an unpaired t-test (p < 0.05).Results:Quantitative analysis of the ultrasound images indicated 2 key differences between tendons that failed during the cyclic loading protocol and those that did not (Figure 1 shows representative data of tendons with similar demographics but one tendon exhibited increased change in echogenicity before failing while the other tendon exhibited smaller changes in echogenicity and did not rupture). First, mean echogenicity decreased before failure. Second, the average change in mean echogenicity was significantly greater in tendons that failed (p = 0.031). For most tendons that did fail, mean echogenicity decreased during the third phase of fatigue life. For the tendons that did not fail, mean echogenicity plateaued along with strain during the second phase of fatigue.Conclusion:This study found detectable differences in image echogenicity during a stress test between tendons that fail during cyclic loading and those that do not. While preliminary, our findings indicate that B-mode ultrasound has potential as a clinically viable tool to predict severe tendon injuries. Our future work is focused on developing computer-based predictive tools to assess Achilles tendon fatigue in patients with tendinopathy following prolonged tendon loading to establish quantitative imaging thresholds that can serve as clinical benchmarks.

Sports and Exercise Medicine in India: Looking Beyond Injury

Sports Medicine (SM) is a new specialty in India which has been often projected, dealing only with treating musculoskeletal (MSK) sports injuries. With adequate training in medical and clinical physiology, SM physicians have an important role to play as an essential part of the multidisciplinary and multispecialty team in the fight against the rise of physical inactivity, sedentary lifestyle and non-communicable diseases. Dope-free sports performance enhancement is another important aspect, which needs beyond the MSK centric approach of sports medicine. There is need for awareness and overall development of this unique specialty, with contribution from government side and non-government organizations.

Development of a Telehealth Examination for Sport-Related Concussion in the Outpatient Setting

To develop a brief, focused telehealth physical examination for use in the outpatient setting by sports medicine physicians, pediatricians, neurologists, and primary care physicians. Telemedicine has become a key resource for addressing healthcare access limitations for individuals living in rural communities. The COVID-19 pandemic has forced physicians and other healthcare providers to adopt telemedicine practices. Published literature guiding the evaluation of patients with concussion via telemedicine is sparse. The Buffalo Concussion Physical Examination (BCPE) is a practical and pertinent clinical assessment that helps to diagnose concussion and that has prognostic value when repeated over the first weeks after injury. An interdisciplinary team with experience in telemedicine services utilized a modified-Glaser approach to consensus to translate elements of the BCPE into virtual methods enabling clinicians to provide care to patients over the internet. The Telehealth version of the BCPE (Tele-BCPE) includes an orthostatic intolerance screen, examination of the cranial nerves, and tests of the oculomotor, vestibular and cervical systems. History and examination templates as well as detailed instructions for performance are included. The Tele-BCPE is meant to be used at initial and follow-up visits for patients acutely after concussion as well as in those with prolonged symptoms. We developed a telehealth physical examination to help direct treatment to patients at any stage after concussion and reduce barriers to healthcare access posed by the COVID-19 pandemic and for patients living in rural or underserved areas. Prospective evaluation of the validity and reliability of the Tele-BCPE for the diagnosis and management of patients with concussion is warranted.

Acute Concussion vs Post-Concussion Syndrome (PCS): How Can We Prevent Progression?

To contrast the presentation and recovery of acute concussion and post-concussion syndrome (PCS) in order to identify factors for PCS prevention. Concussions are classified as acute (<90 days to resolution) or post-concussion syndrome (PCS, = 90 days to resolution). PCS poses a great burden to the individual and to public health. Further investigation is warranted for understanding the progression of acute concussion to PCS and potential mitigating strategies. Retrospective chart review of concussion patients seen by Sports Medicine and Exercise Physicians over a five-year period. Outcome measures included demographics, wait-times, injury mechanisms, Sport Concussion Assessment Tool (SCAT) scores, management plans, and recovery timelines. Four hundred ninety-six patients (289 male/207 female, 19.7 ± 9.4 years) presented with 561 concussions in 1,471 visits. Acute concussions accounted for 88% of injuries and 12% were PCS. Females (RR = 1.4) and adults = 25 years (RR = 3.6) were more likely to be diagnosed with PCS. In both, injuries occurred most commonly in hockey, football, and soccer. Family physicians were the most frequent referral provider (58% acute, 76% PCS). Median injury-appointment time was 11.0 days (acute) compared to 182.0 days (PCS). Initial total SCAT symptom score was significantly greater (p < 0.001) in PCS (56.0 ± 33.0) compared to acute concussion (39.8 ± 31.9). Therapies (i.e., referral, medication, intervention) were prescribed in 44% of acute injury visits compared to 73% of PCS visits. Recovery timelines for return to work, school, and sport were significantly longer in PCS patients than in those with acute concussions (p < 0.05). Our findings of the incidence/presentation of PCS agree with previous literature. Athletes who are female and/or = 25 years may be at greater risk for PCS progression, requiring close monitoring and further injury prevention efforts. Considering the number of referrals from family physicians, further concussion education may better optimize initial management and shorten delays in seeking necessary sports medicine consultation.

Impact of bio-bubble on the mental health of elite cricketers during the COVID-19 pandemic: The bio-bubble fatigue

Ever since the resumption of cricket during COVID-19 pandemic, players and support staff have to stay in an isolated environment during the tournaments to prevent the risk of contracting COVID-19 from the external environment. This can have an adverse effect on the mental health of the players as they have to spend a lot of alone time, which can lead to introspection and rumination consisting of constant negative feelings. The authors evaluated media reports published between 1st July, 2020 and 31st May, 2021, on players withdrawing from a tournament midway or players who pulled out of an entire tournament citing bio-bubble fatigue (mental fatigue due to the bio-bubble environment) and found eight such cases. Mental fatigue builds in a cumulative manner, and therefore, more players are likely to suffer from bio-bubble fatigue during the next couple of months if this issue is not addressed. The authors recommend that every team must have a sports medicine physician/ sports psychologist at all times during the tournaments to make sure that the players remain mentally fit during this phase of COVID-19 pandemic.

Bipolar Disorder and Athletes: A Narrative Review.

Bipolar disorder is a diagnosis with immense lifelong implications that affects 1% to 2% of the general population. It typically presents during late adolescence and early adulthood, which often coincides with the age of peak athletic performance and a limited window of opportunity to compete at the highest levels of sport. Understanding the nature and course of the illness, as well as the effects that pharmacological treatment can have on an athlete, can be extremely beneficial for sports medicine physicians, particularly as many young athletes may not yet be diagnosed and/or adequately treated. Bipolar disorder is an incredibly complex and challenging diagnosis, but the ability to identify symptoms and intervene early is invaluable. The aim of this review is to summarize the available evidence and to highlight relevant risk factors, diagnostic features, management, and potential complications pertaining to the athletic population.

L’ostéotomie tibiale antérieure de déflection avec préservation de la TTA ne modifie pas la hauteur rotulienne

Anterior-closing wedge high tibial osteotomy (ACW-HTO) in ACL reconstruction (ACLR) can prevent graft rupture in patients with posterior tibial slope (PTS) > 12°. Management of patellar height is of concern when performing HTO. The objective was to evaluate the effect of tibial tubercle-sparing ACW-HTO on patellar height in revision ACLR. A retrospective analysis of prospectively collected data from 2 centers was performed. All patients who underwent tibial tubercle-sparing ACW-HTO in revision ACLR were identified and included. Data regarding age, gender and body mass index were collected. Patellar height was measured on full weightbearing pre- and postoperative x-rays. The tibial-referenced indexes of Insall–Salvati (ISI), Caton–Deschamps (CDI) and Blackburne–Peel (BPI) were assessed on lateral x-rays. The Femoral Patellar Height Index (FPHI), femur-referenced, was calculated on frontal x-rays. Pre- and postoperative PTS were assessed using the proximal anatomic axis of the tibia and the tangent line to the medial tibial plateau. All radiological measurements were performed by two trained sports medicine physicians, twice at three-month intervals. Mean values were retained for statistical analysis. Inter- and intra-observer reliability were assessed for each parameter. Forty-seven tibial tubercule-sparing ACW-HTO were retained for analysis. Most patients were male (n = 32, 68.1%) with a mean age of 28.9 ± 9.2 years old (range 17–58). Good to excellent intra- and inter-observer reliability were reported for all parameters. The mean decrease in PTS was 8.60° ± 2.95 (range 3–13.6). No significant difference in patellar height was found between pre- and postoperative x-rays regardless of the index (P > .05). Linear regression investigated the influence of change in slope (delta PTS) on change in patellar height (delta and ratio). No influence of delta PTS was found on all parameters except on the CDI ratio (ratio = preoperative/postoperative, P = .0088). Multivariate analysis showed a significant influence of delta PTS on the CDI ratio (P = .0335), but none on the ISI (P = .7037), BPI (P = .6324), and FPHI (P = 5709) ratios. A change in PTS appeared to influence the Caton–Deschamps Index, but this tibial plateau-referenced method may be biased after HTO. No change in patellar height was observed with others index after tibial tubercle-sparing ACW-HTO.

Incidence Rates of Surgery After Knee MRI: Association According to Referring Physician Type and Patient's Age and Sex.

Background:The utility of magnetic resonance imaging (MRI) in the primary care setting is uncertain, with a perception that there is less likelihood for surgery after MRI ordered by general practitioners (GPs) when compared with orthopaedic surgeons and sports medicine physicians. Additionally, the influence of patient age and sex on subsequent surgical intervention is currently unknown.Purpose/Hypothesis:The purpose of this study was to compare surgical incidence after MRI referrals by orthopaedic surgeons, GPs, and sports medicine physicians, including a subset analysis for GP patients based on type of approval given by the radiologist. The authors also wanted to explore the association of age and sex on subsequent surgical intervention. They hypothesized that surgical incidence after MRI ordered by orthopaedic surgeons and sports medicine physicians would be higher than after MRI ordered by GPs.Study Design:Cohort study; Level of evidence, 3.Methods:Knee MRI referrals by the 3 physician cohorts during May to December 2017 were assessed. For GP patients, the types of approval or recommendation from a radiologist were categorized. Subsequent surgical intervention status was then compared among referral groups up to 2 years after MRI. Associations of age and sex with surgical occurrence were also assessed. Chi-square test, analysis of variance, and univariate/multivariable logistic regression were used for statistical analysis.Results:Overall, 407 referrals were evaluated (GP, n = 173; orthopaedic, n = 176; sports medicine, n = 58). Surgical incidence was not significantly higher for orthopaedic and sports medicine than GP referrals at 3 months (10%, 3%, and 6%, respectively; P = .23), 6 months (20%, 17%, and 15%; P = .49), and 2 years (30%, 35%, and 24%; P = .25). Surgical incidence for GP patients was higher after discussion with a radiologist or when evaluating specific pathology on prior imaging versus less defined reasons (30.4% vs 15.7%, respectively; P = .03). Surgical incidence was lower for older patients (11% vs 31% for >60 years vs all other age groups combined; P = .002), and women were less likely to undergo surgery than men (22% vs 35%, respectively; P = .008).Conclusion:Surgical incidence after MRI was likely appropriately lower for older patients. Lower incidence for female patients is of uncertain cause and warrants further study.

American Medical Society for Sports Medicine Position Statement: Principles for the Responsible Use of Regenerative Medicine in Sports Medicine.

Many sports medicine physicians are currently considering introducing regenerative medicine into their practice. Regenerative medicine and the subclassification of orthobiologics are a complicated topic and have produced widely varying opinions. Although there is concern by government regulators, clinicians, scientists, patient advocacy organizations, and the media regarding the use of regenerative medicine products, there is also excitement about the potential benefits with growing evidence that certain regenerative medicine products are safe and potentially efficacious in treating musculoskeletal conditions. Sports medicine physicians would benefit from decision-making guidance about whether to introduce orthobiologics into their practice and how to do it responsibly. The purpose of this position statement is to provide sports medicine physicians with information regarding regenerative medicine terminology, a brief review of basic science and clinical studies within the subclassification of orthobiologics, regulatory considerations, and best practices for introducing regenerative medicine into clinical practice. This information will help sports medicine physicians make informed and responsible decisions about the role of regenerative medicine and orthobiologics in their practice.

Stress Fracture of the Sternum

A 15-year-old sprinter consulted with a physical therapist due to a 1-week history of mechanical chest pain. Following physical therapy examination, the patient was referred to a sports medicine physician for further diagnostic evaluation by ultrasound, which was suggestive of a fracture. Magnetic resonance imaging then identified the stress fracture. JOSPT Cases 2021;1(4):240–241. doi:10.2519/josptcases.2021.10323

Hip Dislocation and Subluxation in Athletes: A Systematic Review

Background: Hip dislocation is a rare occurrence during sports but carries serious implications for athletes. Purpose: To systematically review treatment strategies and outcomes for hip dislocation in athletes, with the ultimate goal of providing sports medicine physicians with the information necessary to appropriately treat and counsel patients sustaining this injury. Study Design: Systematic review; Level of evidence, 4. Methods: PubMed, MEDLINE, and Embase were searched for studies relating to hip instability and athletics from January 1, 1989 to October 1, 2019. s and articles were evaluated on the basis of predefined inclusion and exclusion criteria. Inclusion criteria were the following: (1) data from ≥1 patients, (2) native hip dislocation or subluxation occurring during sports, (3) patients aged at least 10 years, and (4) written in English. Exclusion criteria were (1) patients younger than 10 years; (2) nonnative or postoperative hip dislocation or subluxation; (3) a native hip injury without dislocation or subluxation; (4) patients with dislocation or subluxation secondary to neuromuscular, developmental, or syndromic causes; (5) dislocation or subluxation not occurring during sports; (6) patients with physeal fractures; or (7) review articles or meta-analyses. Data were recorded on patient demographics, injury mechanism, treatment strategies, and clinical and radiographic outcomes. Where possible, pooled analysis was performed. Studies were grouped based on reported outcomes. Meta-analysis was then performed on these pooled subsets. Results: A total of 602 articles were initially identified, and after screening by 2 reviewers, 27 articles reporting on 145 patients were included in the final review. There were 2 studies that identified morphological differences between patients with posterior dislocation and controls, including decreased acetabular anteversion (P = .015 and .068, respectively), increased prevalence of a cam deformity (P < .0035), higher alpha angles (P≤ .0213), and decreased posterior acetabular coverage (P < .001). No differences were identified for the lateral center edge angle or Tonnis angle. Protected postreduction weightbearing was most commonly prescribed for 2 to 6 weeks, with 65% of reporting authors recommending touchdown, toe-touch, or crutch-assisted weightbearing. Recurrence was reported in 3% of cases. Overall, 4 studies reported on findings at hip arthroscopic surgery, including a 100% incidence of labral tears (n = 27; 4 studies), 92% incidence of chondral injuries, 20% incidence of capsular tears, and 84% incidence of ligamentum teres tears (n = 25; 2 studies). At final follow-up, 86% of patients reported no pain (n = 14; 12 studies), 87% reported a successful return to play (n = 39; 10 studies), and 11% had radiographic evidence of osteonecrosis (n = 38; 10 studies). Conclusion: Various treatment strategies have been described in the literature, and multiple methods have yielded promising clinical and radiographic outcomes in patients with native hip dislocation sustained during sporting activity. Data support nonoperative treatment with protected weightbearing for hips with concentric reduction and without significant fractures and an operative intervention to obtain concentric reduction if unachievable by closed means alone. Imaging for osteonecrosis is recommended, with evidence suggesting 4- to 6-week magnetic resonance imaging and follow-up at 3 months for those with suspicious findings in the femoral head.

Medial Epicondyle Apophyseal Avulsion Fractures in Youth Throwers: A Severe Variant of Little League Elbow (132)

Objectives:Medial epicondyle apophyseal avulsion fractures sustained during throwing represent an understudied, severe variant of medial epicondyle apophysitis, or ‘Little League elbow’. The current study sought to characterize presenting features, treatment options, and clinical results of a large cohort of pre-adolescent and adolescent patients who presented with these fractures.Methods:Skeletally immature athletes with medial epicondyle apophyseal avulsion fractures sustained during throwing from 2003-2017 at a tertiary-care pediatric referral center were identified. Exclusion criteria were fractures sustained during non-throwing activity or prior elbow fracture. Medical records and radiographic images were reviewed for study variables. Treatment decisions were made independently by fellowship-trained pediatric orthopaedic surgeons or sports medicine physicians on a case-by-case basis. Patients treated with open reduction and internal fixation (ORIF) were compared to those treated non-operatively, and all fracture patients were compared to a larger control group of patients diagnosed with medial epicondyle apophysitis/Little League elbow with no fracture.Results:During the study period, a total of 317 patients were diagnosed with Little League elbow due to medial epicondyle apophyseal overuse injury, 50 of whom (16%) sustained a discreet, radiographically confirmed epicondyle fracture sustained during a single throw. Median age of the fracture cohort at presentation was 13.1 years (range 8 years – 16 years). Forty-nine fracture patients (98%) were male baseball pitchers and one (2%) was a male football quarterback. Fracture patients had significantly higher median BMI (21.3 kg/m2 vs. 19.2kg/m2, p=0.004) than the apophysitis control group, but there was no significant difference in age. Of the 37 patients with documentation regarding pre-injury symptoms, 31 patients (84%) described pre-existing medical elbow pain prior to their acute injury, while 6 (16%) denied pain prior to the inciting throw. Of the 12 patients (24%) with documented shoulder exams at presentation, 5 (42%) demonstrated glenohumeral internal rotation deficit (GIRD). Twenty-three patients (46%) were treated with ORIF (22 single screw fixation; 1 suture anchor fixation), while 27 (54%) were treated non-operatively. Median fracture displacement was significantly greater in operative patients than non-operative patients (5.0mm vs. 3.0mm, p=<.001), with all ‘minimally displaced’ (<4mm) fractures undergoing non-operative treatment (Figure 1). Multivariable analysis determined that for each additional mm of displacement, the odds of surgical intervention increased by 6.4 times (OR=6.36; 95% CI=1.83-22.07; p=.004), when controlling for age and BMI. All patients returned to their throwing sport (RTS) at a median of 12.8 weeks post-diagnosis, but 13 (26%) developed recurrent elbow pain, with no significant difference in in RTS time or recurrence rate between treatment cohorts. Nine of twenty-two (41%) screw ORIF patients underwent secondary implant removal, with no significant difference in this rate between those with or without a washer.Conclusions:Medial epicondyle apophyseal avulsion fractures in youth throwers represent a severe variant of Little League elbow, constituting approximately 16% of cases within the condition’s spectrum. These fractures may be effectively treated with either non-operative measures, particularly minimally displaced fractures <4mm, or ORIF, though >40% of operative patients may require implant removal. A large majority of patients reported medial elbow pain prior to fracture, suggesting this severe presentation of Little League elbow may be preventable.

Clinical considerations for the assessment, management, and treatment of concussion in females

: This review paper describes an individualized, targeted clinical care approach for the assessment, management, and treatment of sport-related concussions (SRC), and also highlights important clinical considerations for providing care to females with a SRC. Ideally, SRCs should be managed by an interdisciplinary medical team including but not limited to neuropsychologists, primary care sports medicine physicians, and physical therapists. The clinician that coordinates care should employ a multi-modal assessment approach (e.g., neurocognitive, vestibular/ocular motor, symptoms, balance, clinical exam/interview) to capture the heterogeneity of symptoms and impairments that are associated with SRC. Clinicians must also be aware of certain factors, specific to females that may complicate SRC recovery such as female preferences for clinical care, their greater risk for established risk factors (e.g., concussion history and migraine) and female sex hormone cycles that may influence multiple concussion outcomes (e.g., symptom reports and neurocognitive scores). Concussion management has moved away from a one-size-fits-all approach and clinicians must be willing to provide a comprehensive assessment that caters to the needs of females in order to individualize the treatment recommendations and avoid a prolonged recovery.

Static and Dynamic Balance Assessment in Healthy and Concussed Adolescent Athletes.

The purpose of this study was to explore the utilization of the Y Balance Test (YBT) alongside the Balance Error Scoring System (BESS) during examination of healthy adolescent athletes (14-18 year old) as well as those with acute and chronic concussion. A repeated-measures study of balance in a cross-sectional convenience sample of adolescents participating in high-school athletics. Data were collected on healthy athletes in their school setting for comparison purposes and on concussed athletes in the physical therapy rehabilitation center at the hospital. Participants were a convenience sample of male and female athletes between the ages of 14 to 18 year old [180 healthy (111 male, 69 female) and 44 (28 male, 16 female) with concussion]. All participants were cleared for participation by preparticipation examination or by the treating sport medicine physician. Healthy athletes performed the YBT, a dynamic assessment of balance. Athletes with concussion also performed the BESS, a static assessment of balance. Means for each YBT reach direction were statistically different for both healthy males and females ( P < 0.05). Within both the acute and chronic subsets of the concussed sample, some participants performed over the median value for the BESS but not the YBT. These data may suggest that dynamic balance testing in conjunction with static balance testing could be valuable in both the acute and chronic phases of concussion to ensure a comprehensive assessment of the necessary balance skills for athletic play.

Practical Management: Telehealth Examination for Sport-Related Concussion in the Outpatient Setting.

This article presents the telehealth version of the Buffalo Concussion Physical Examination (BCPE) (Tele-BCPE). It is a brief, focused telehealth PE for use in the outpatient setting by sports medicine physicians, pediatricians, neurologists, and primary care physicians. It is derived from the BCPE and includes general considerations for providers performing telehealth services and instructions for adapting traditional clinical tests for virtual use. The Tele-BCPE includes an orthostatic intolerance screen, examination of the cranial nerves, and tests of the oculomotor, vestibular, and cervical systems. It is meant to be used at initial and follow-up outpatient visits for patients acutely after concussion and in those with prolonged symptoms. This telehealth PE, when combined with other assessments, can help provide direct treatment to patients at any stage after concussion and reduce barriers to healthcare access posed by the COVID-19 pandemic and for patients living in rural or underserved areas.

Стратегии управления сахарным диабетом у спортсменов

Glycemic control is the biggest challenge for athletes with diabetes mellitus (DM) on insulin therapy. Done well, it can keep glycogen metabolism normal and allow performance improvement through adjustment of the insulin doses to the specifics of nutrition and exercising. In DM Type 1 and Type 2 patients, intense physical activity and resistance exercising, as well as interval training, enable optimal physiological adaptation during the training period and prove to be beneficial when the athlete does one-time exercise sets. But for athletes with DM on insulin therapy, keeping blood glucose at the optimal level is not the only important issue. It is also necessary to factor in the potential body temperature regulation disturbances that increase the risk of heat stress during training/competition, learn the effects the drugs used by athletes may have on the glycemic status, control electrolyte balance and dehydration, know how to execute the application for permission to use insulin for therapeutic purposes submitted to the anti-doping organization. The purpose of this review was to draw attention of sports medicine physicians and coaches to the above problems and to the need for wider use of the new DM control technology; help athletes with DM on insulin therapy continuously perform well and ensure their athletic longevity.

Potential role of an athlete-focused echocardiogram in sports eligibility.

Sudden cardiac death (SCD) of an athlete is a rare but tragic event and sport activity might play a trigger role in athletes with underlying structural or electrical heart diseases. Preparticipation screenings (PPs) have been conceived for the potential to prevent SCD in young athletes by early identification of cardiac diseases. The European Society of Cardiology protocol for PPs includes history collection, physical examination and baseline electrocardiogram, while further examinations are reserved to individuals with abnormalities at first-line evaluation. Nevertheless, transthoracic echocardiography has been hypothesized to have a primary role in the PPs. This review aims to describe how to approach an athlete-focused echocardiogram, highlighting what is crucial to focus on for the different diseases (cardiomyopathies, valvulopathies, congenital heart disease, myocarditis and pericarditis) and when is needed to pay attention to overlap diagnostic zone (“grey zone”) with the athlete's heart. Once properly tested, focused echocardiography by sports medicine physicians may become standard practice in larger screening practices, potentially available during first-line evaluation.

Ultrasound-guided microinvasive trigger finger release technique using an 18-gauge needle with a blade at the tip: A prospective study.

Open surgical trigger finger release has limited success and the risk of complications; however, percutaneous techniques offer a successful alternative. There is limited understanding of the success of percutaneous trigger finger release. To prospectively evaluate the functional outcomes of patients with Green classification Grade 2 to 4 trigger finger treated with an ultrasound-guided microinvasive trigger finger release using a special 18-gauge needle with a blade at the tip. Prospective, case-series study. This study took place at an academic institution by one sports medicine physician (R.E.C.) with subspecialty training and certification in musculoskeletal ultrasound. Sixty patients (79 cases) met criteria and agreed to participate in this study; 19 patients had multiple fingers treated. Average patient age was 62.8 years (SD 10.2). Average trigger finger severity diagnosis was Grade 3. Patients were treated with an ultrasound-guided microinvasive trigger finger release using a special 18-gauge needle with a blade at the tip. Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), numerical rating scale (NRS), and Nirschl scores were captured preprocedure, at various time points, and at final follow-up. Changes between preprocedure and final follow-up were analyzed by paired t test (p < .05). Differences were also analyzed between finger, grade level, and gender by repeated measures analyses of variance (p < .05). No adverse events were documented perioperatively or postoperatively. Average follow-up time was 18.4months (SD 4.6). At final follow-up, 100% of patients reported no recurrence of catching/locking, 97% had complete resolution of symptoms and significant improvement in QuickDASH scores, and 99% required no further treatment. All measurements showed a decrease in pain and symptoms over time. The improvements in QuickDASH score, NRS, and Nirschl scale and the resolution of mechanical symptoms were all statistically significant. Ultrasound-guided release using the 18-gauge needle with a blade provides significant functional improvement and full resolution of mechanical symptoms with minimal adverse events.

Reevaluation of Diagnostic Criteria for Exertional Rhabdomyolysis in Collegiate Wrestlers: A Case Series and Review

Rhabdomyolysis is a common and potentially fatal condition encountered by athletic trainers, coaches, primary care physicians and sports medicine physicians. Benign, or physiological, Exertional Rhabdomyolysis (ER) may resemble Delayed Onset Muscle Soreness (DOMS) and becomes clinically significant when accompanied by other morphologies including severe muscle pain and swelling, and myoglobinuria. ER is often characterized by a triad of symptoms.