BACKGROUND: Archery is one of the oldest human skills that survived to the present day. At first, it was used for hunting and war and later became a sport. The interest in archery has grown annually. Each type of sport has specific injuries. Information about archery-related injuries will allow us to develop preventive measures and help make this sport safer. The article will be useful for coaches, sports doctors, physiotherapists, and orthopedic surgeons.
 AIM: To present modern information about frequency, types of archery-related injuries, and preventive methods.
 MATERIALS AND METHODS: The publication search was performed in the PubMed/MEDLINE databases from 1978 to 2023 using combinations of OR, AND operators, and keywords: archery, archery injuries, rotator cuff injuries, arrow injuries, and overuse. Consequently, we extracted 49 foreign and domestic scientific sources.
 RESULTS: Archery injuries occur in 4.4 per 10,000 people involved in this sport. Acute injuries in archers are rare, mainly due to shooting errors and most often lead to soft tissue damage because of a fracture of a bow, arrow, or bowstring during a shot (83.3%) or as a result of touching the bowstring with a bow. Chronic injuries occur in 83.9% of archery athletes. The main risk factors for their occurrence include overuse, high repetitions during training, lack of strength of the athlete, and incorrect technique. Overuse (67.9%) is the most common cause of chronic tendon, ligament, and joint injuries. Injuries occurred in 30%–53% of cases in the shoulders (rotator cuff tear, scapular dyskinesia, and shoulder impingement syndrome), 12.8% in the elbow (medial and lateral epicondylitis and traumatic bursitis), 8.9%–19.9% in the spine and forearm (chronic tendovaginitis and tunnel syndromes).
 CONCLUSIONS: Proper training and safety measures help prevent acute injuries. Practicing archery techniques and strength training are the main measures of preventing muscle overuse and reducing the incidence of chronic injuries.

History: A 39-year-old softball player injured his right elbow playing softball. The injury occurred secondary to a fall with impact of his posterior elbow onto a hard object. He had immediate pain and swelling. He was seen in the emergency room one week later due to continued pain with increasing swelling over the back of his elbow as well as forearm and hand. A Doppler study was negative for a DVT. No x-rays were done. He was seen in out-patient follow-up one week later with primary complaints of pain, swelling, and weakness. He was unable to play softball, but otherwise was not limited by the injury. He denied any significant numbness or tingling. ROS negative for neck, shoulder or wrist pain. Physical Exam: generally well developed and muscular male in no distress. Right arm with swelling noted to involve upper arm, elbow, forearm and wrist. There was swelling of the olecranon bursa. There was a 2 × 3 cm mass present 3–4 cm proximal to the olecranon. There was associated tenderness over the bursa and mass. No increased skin temperature or errythema. ROM 0–140 degrees flexion, 90 degrees pronation and supination. (+) Pain with passive and active elbow flexion and extension. Strength 5/5 with flexion, 4/5 extension. Neurologic and vascular status intact with 2+ radial pulses. DIFFERENTIAL DIAGNOSIS: Traumatic bursitis with myositis ossificans Olecranon or occult fracture DVT Triceps tendon tear TEST AND RESULTS: Radigraphs Small area of calcification in triceps just proximal to the olecranon. No fracture or bony abnormalities present. DRAINAGE OF HEMATOMA: Sixty milliliters of serosanguineous fluid was removed with an 18 gauge needle. A palpable defect was present over the posterior olecranon with a palpable firm mass over distal/posterior arm. MRI: Sagital T1, T2, short tau inversion recovery (STIR) and axial images were performed. Pattern consistent with post-traumatic olecranon bursitis associated with edema and fluid within and adjacent to the triceps tendon and lateral triceps head suggesting of partial tear of the muscle fibers, and myositis. No fracture or bony abnormalities. FINAL/WORKING DIAGNOSIS: Triceps tendon tear TREATMENT AND OUTCOMES: Orthopedic referral Surgical repair of the triceps tendon with drill holes and suturing Cast Immobilization post-operatively for 3 weeks Early motion followed by strengthening Return to sports 4–6 months after repair

HISTORY - A 28-year old, right-handed male was hit in the right triceps during a pick up game of basketball. He felt his forearm was forcibly extended beyond its usual range and felt a sudden sharp pain. He continued to play with elbow soreness. Two hours later, he experienced increased pain with decreased range of motion and joint swelling. Prior to this injury, he recalled having a long standing decreased elbow range of motion since the age of 11, when he was a little league pitcher. At age 14, he experienced lateral elbow pain, had x-rays taken and was told he had “compressed cartilage.” He received ultrasound and some physical therapy. Through his 20's he found it increasingly difficult to complete a full round of golf and experienced elbow soreness and numbness with pitching, lifting and throwing a football. PHYSICAL EXAMINATION - Examination was done one day post injury. There was diffuse joint swelling and erythema. No ecchymosis was noted. He had tenderness to palpation over the medial and lateral epicondyles, and distal triceps. Passive elbow range of motion was restricted between minus 45° of extension and 95° of flexion. No valgus or varus instability. The right shoulder lacked 30° of internal rotation and a positive lateral scapular slide in positions 2 and 3 on the right. There was crepitus with supination and pronation. Wrist flexion and extension were within normal limits. Sensation was intact DIFFERENTIAL DIAGNOSIS - Loose body Traumatic bursitis Osteochondritis dissecans Humeral/supracondylar fracture Dislocation of the humeral-ulnar joint TESTS AND RESULTS - AP and lateral radiographs of the right elbow: Large joint effusion; decreased radial humeral joint space; small osteophyte seen on the articular margin of the coranoid process of the ulna; osteopenia of the radius and ulna; no fracture; no loose body. MRI elbow: Joint effusion, a 1.2 cm loose body noted in the olecranon fossa; possible additional loose body within the ventral aspect of the joint and measures only a few mm in size. Degenerative changes are noted within the capitellum with evidence of subchondral sclerosis and cystic changes, as well as osteophytosis. No other abnormalities noted. WORKING DIAGNOSIS - Loose body TREATMENT - NSAIDS, ice and rest initiated day after injury. Resolution of swelling led to a “fixed” range of motion between minus 20° extension and 120° flexion, he underwent an arthroscopic procedure to remove the loose body. Started range of motion and strengthening exercises two weeks post surgery. Returned to sports one month after surgery.

Although microscopic studies have shown similarities between bursal and joint membranes, little is known about bursae and their response to disease states. Eighty-six cases of superficial bursitis due to trauma, bacterial infection, or gout were reviewed and compared with cases of joint inflammation due to the same etiologies. In traumatic bursitis the bursal fluid mucin test was more abnormal and the viscosity lower than that of joint fluid in traumatic arthritis. The bursal fluid total leukocyte count of septic bursitis was less than 20,000/mm3 in 8 of 13 cases but in only 1 of 21 synovial fluids from cases of septic arthritis (P = 0.005). In gouty bursitis the mean total leukocyte count of bursal fluid was 2800/mm3, compared with a mean synovial fluid total leukocyte count of 28,700 in gouty arthritis (P less than 0.02). These findings indicate that superficial bursae react less intensely than diarthrodial joints to specific disease stimuli and that a relatively low bursal fluid leukocyte count is often present in cases of septic and gouty bursitis.

In a series of 25 patients (predominantly women) with Morton's metatarsalgia, the most likely site for a neuroma is the third cleft of the left foot. If a swelling is present or if radiographic examination shows toe divergence then the diagnosis in unlikely to be a simple digital neuroma. A review of the literature suggests that there are other causes of pain in the forefoot. Usually the pain is diffuse by when it is localized, Morton's metatarsalgia is diagnosed. However, causes other than a digital neuroma, e.g. traumatic bursitis and rheumatoid arthritis, epithelial cyst, and foreign body should be borne in mind.

Traumatic bursitis and artificial turf.

A study has been made of the results after local injections of hydrocortisone acetate (compound F acetate) in the treatment of some common orthopaedic conditions. In the treatment of rheumatoid arthritis, marked improvement was noted in the condition of 49 per cent. of the injected joints, whereas improvemenst was moderate in 35 per cent. and mild in 13 per cent.; no relief was obtained in 3 per cent. of the joints into which this material was injected. The relief of symptoms persisted for two to eight days in most cases. When improvement was more prolonged, some additional factor usually was present; among the more important of these was general improvement in the status of the rheumatoid arthritis, either sponstaneous or induced by other forms of treatment. Brief systemic effects were noted in 21 per cent. of the patients who had rheumatoid arthritis and who received injections of hydrocortisone acetate. Intra-articular injection of hydrocortisone acetate appears to be a helpful adjunct in the treatment of rheumatoid arthritis, especially in patients who have involvement of only a few joints or in whom other measures of treatment are generally adequate except in a few joints. Marked improvement occurred in 38 per cent. of the injected joints in patients who had osteo-arthritis; moderate improvement was noted in 34 per cent., mild in 7 per cent., and insignificant in 21 per cent. The improvement usually lasted for one to eight days; when more prolonged improvement was noticed, other factors, such as increased rest ansd limitations of weight-bearing activities, appeared to play a role. This form of treatment apparently is helpful as an adjunct in the management of osteo-arthritic patients, particularly those suffering from acute or subacute flare-ups or those in whom maximal applications of other conservative measures has failed to relieve discomfort. Limited experience with intra-articular injections of hydrocortisone acetate in the treatment of traumatic synovitis, psoriatic arthritis, and acute gouty arthritis suggests that its temporary antirheumatic effect might be helpful in the management of these conditions. Use of hydrocortisone acetate in the treatment of epicondylitis (tennis elbow) has proved discouraging to date. The most favorable response to local treatment by injection of hydrocortisone acetate apparently occurs in self-limited conditions, such as traumatic bursitis. Injection of hydrocortisone acetate appears to hasten the recovery and shorten the period of convalescence.

The treatment of traumatic bursitis by internal paracentesis