Clinical Journal of Sport Medicine最新文献

Objective: The exertional compartment syndrome (ECS) is often a delayed diagnosis. Compartment pressure measurements (CPM) confirm the diagnosis. Herein we present our algorithm for the evaluation and management (E&M) of ECS. It avoids multiple CPM and shows the importance of the history and examination for E&M of the ECS.

Design: A literature review showed that limb abnormalities are hardly ever mentioned. Subsequently we show how the history, examination (for recognizing abnormalities), and CPM integrate with our algorithm for E&M of the ECS.

Setting: Our algorithm evolved for a 32-year interval and approximately 150 ECS evaluations.

Patients: Our E&M method was used for the above complement of patients.

Interventions: The symptomatic muscle compartment(s) and the severity of pain during the inciting activity are ascertained. The examination detects abnormalities and tautness of muscle compartments. This information integrated into our ECS algorithm establishes which compartments need CPM.

Main outcome measures: Pain severity is quantified on a 0- to 10-point scale. This information is integrated with history, examination findings, and CPMs to guide E&M for a range of ECS presentations.

Results: Abnormalities detected on the examination often explain why ECS occurs. This information is valued by the patient, minimizes CPM, and offers sound advice for E&M.

Conclusions: Our article heightens awareness of the ECS diagnosis for all levels of care providers. It objectifies pain severity, shows the importance of the examination, and minimizes ECM in giving advice to the referral sources.

Objective: The purpose of this systematic review is to evaluate the original peer-reviewed studies on athletes who developed myocarditis after coronavirus disease (COVID-19) infection or after COVID-19 mRNA vaccination. Both entities likely have an immunologic component. We discuss elite, professional, college, and adolescent athletes. The athletes are generally young and healthy, representing a distinctive population group that differs from the general population. This review includes diagnosis of myocarditis, incidence, complications, prognosis, and return-to-play guidance for sports medicine clinicians and coaches.

Data sources: We surveyed the PUBMED, Embase, and Web of Science databases for the relevant peer-reviewed articles in the English language published from the onset of the pandemic until April 2023. Included were original observational studies and case series. Excluded were individual case reports and a small series with incomplete data. The resulting search yielded 30 original articles.

Main results: Reported myocardial abnormalities in athletes were rare after COVID-19 infection and even less frequent after COVID-19 mRNA vaccination. True incidence, however, may be higher because of under-reporting and frequent asymptomatic presentation. Male gender was prevalent for both manifestations; postvaccination myocarditis occurrence was the highest after the second vaccine dose. Diagnostic and return-to-play algorithms were developed and should be adopted and followed.

Conclusions: The risk of myocarditis from COVID-19 infection and COVID-19 mRNA vaccination is very low. The long-term prognosis and evolution of the observed cardiac magnetic resonance abnormalities are currently unknown. Although inferences can be made from the published data, COVID-19 and postvaccine myocarditis in athletes may represent only a small fraction of the true incidence of those who have been affected worldwide and not evaluated.

Objective: This study investigated the role of specialty concussion care on the clinical course of recovery in adolescent patients who initiated care beyond 3 weeks from their injury.

Design: Retrospective analysis of protracted recovery groups was based on the number of days in which a patient presented for care postinjury: early (22-35 days), middle (36-49 days), and late (50+ days).

Setting: Sports medicine and orthopedics clinic.

Patients: 101 patients aged 12 to 18 years.

Independent variables: Age, race/ethnicity, sex, concussion or migraine history, neurodevelopmental or psychiatric diagnosis, King-Devick, Trails Making, Vestibular Ocular Motor Screening (VOMS), and Postconcussion Symptom Scale (PCSS).

Main outcome measures: Days since injury to evaluation, recovery days from evaluation, and total recovery days.

Results: There were no significant differences between groups for PCSS, average K-D scores, and Trails B-A. Vestibular Ocular Motor Screening change score was significantly different between groups such that the late group had less change in VOMS score compared with the early group (F = 3.81, P = 0.03). There were significant differences between groups in terms of days since injury to evaluation (F = 399.74, P < 0.001) and total recovery days (F = 19.06, <0.001). The middle (25.83 ± 34.95) and late group (30.42 ± 33.54) took approximately 1 week and 12 days longer to recover compared with the early group, respectively. Recovery days from evaluation were not significantly different between the 3 groups (F = 1.30; P = 0.28).

Conclusions: Protracted recovery patients evaluated in a specialty concussion clinic received medical clearance to complete the return-to-play process with an athletic trainer within 1 month from the initial visit. The findings are consistent with previous research suggesting that earlier concussion care can expedite recovery.

Objective: To report injury epidemiology in youth male academy-level athletes in the United States.

Design: An observational study on injury occurrences and playing time over the 2019 to 2020, 2020 to 2021, and 2021 to 2022 soccer seasons.

Setting: Data collected from a single midwestern soccer academy in the United States in partnership with a tertiary care level I pediatric heath institution.

Patients: All male youth athletes to have enrolled and participated in the developmental academy during any of the 3 studied seasons.

Interventions: None. This was an observational study.

Main outcome measures: Injury rate (incidence per 1000 playing hours), type, location, mechanism (noncontact vs contact), severity, and mode of play (match vs training) in which the injury was sustained.

Results: Overall rate of injury was 3.64 per 1000 h exposure. Injuries of moderate severity (8-28 days of missed playing time) were most common. When stratified by team, injury rates were highest in the U15 (5.15/1000 h) and lowest in the U12 (0.87/1000 h). Most injuries involved muscles of the lower extremities.

Conclusions: Among male youth academy-level soccer athletes in the United States, older players tended to sustain injuries at a higher rate than younger. The lower extremity was the most common injury location, and muscle injuries and most common type. Concussions remain common in this population, accounting for nearly a 10th of all athletic injuries.

Clinical relevance: Injury epidemiology data from this study add to the growing worldwide pool of data from youth, male, academy-level soccer athletes that will augment development of injury prevention interventions.

Objective: Describe how sports medicine clinicians support decision making about sport participation after concussion recovery with adolescent patients and their parents. Specific areas of inquiry related to how clinicians framed the decision, what factors they considered in how they approached the decision process, and how they navigated discordance within families.

Design: Qualitative study.

Setting: Tertiary care sports medicine clinics at 4 children's hospitals in the United States.

Participants: Individual interviews were conducted with 17 clinicians practicing in sports medicine settings.

Interventions: N/A.

Main outcome measures: Semi-structured interviews explored clinician approaches to supporting decision making, with the question guide informed by components of the Ottawa Decision Support Framework.

Results: Clinicians routinely incorporated aspects of shared decision making (SDM) into their conversations with families. This included ensuring all parties were informed about risk and aligned behind a shared value of adolescent well-being. Mediation strategies were used to manage discordance between adolescents and their parents, and between parents. These strategies aimed to facilitate a decision that was adolescent centered. When clinicians believed that there was a medical benefit to modifying the adolescent's sport participation practices, or when they did not believe the athlete was psychologically ready to return to the sport in which they were injured, they initiated conversations about alternative activities. In such situations, they used persuasive communication practices to encourage families to strongly consider this option.

Conclusion: The strengths and strategies used by sports medicine clinicians in this study provide a foundation for guidance or intervention development aimed at supporting SDM after concussion with adolescents and their families.

Objective: Approximately 20% of students with sport-related concussion (SRC) report new symptoms of anxiety and depression which may be associated with delayed recovery and increased risk for developing a mood disorder. Early prescribed aerobic exercise facilitates recovery in athletes with concussion-related exercise intolerance. We studied the effect of aerobic exercise treatment on new mood symptoms early after SRC.

Design: Exploratory secondary analysis of 2 randomized controlled trials (RCT).

Setting: Sports medicine clinics associated with UB (Buffalo, NY), CHOP (Philadelphia, PA), and Boston Children's Hospital (Boston, MA).

Participants: Male and female adolescents (aged 13-18 years) diagnosed with SRC (2-10 days since injury).

Interventions: Participants were randomized to individualized targeted heart rate aerobic exercise (n = 102) or to a placebo intervention designed to mimic relative rest (n = 96).

Main outcome measures: Incidence of Persisting Post-Concussive Symptoms (PPCS, symptoms ≥28 days).

Results: First RCT recruited from 2016 to 2018 and the second from 2018 to 2020. Of 198 adolescents, 156 (79%) reported a low burden (mean 1.2 ± 1.65/24) while 42 (21%) reported a high burden (mean 9.74 ± 3.70/24) of emotional symptoms before randomization. Intervention hazard ratio for developing PPCS for low burden was 0.767 (95% CI, 0.546-1.079; P = 0.128; β = 0.085) and for high burden was 0.290 (95% CI, 0.123-0.683; P = 0.005; β = 0.732).

Conclusions: High burden of mood symptoms early after injury increases risk for PPCS, but the sports medicine model of providing early targeted aerobic exercise treatment reduces it. Nonsports medicine clinicians who treat patients with a high burden of new mood symptoms after concussion should consider prescribing aerobic exercise treatment to reduce the risk of PPCS and a mood disorder.

Objective: Cervical spine proprioception may be impaired after concussion. Our objective was to determine the diagnostic utility of cervical spine proprioception for adolescent concussion.

Design: Cross-sectional.

Setting: Research laboratory.

Participants: Adolescents ≤18 days of concussion and uninjured controls.

Interventions: N/A.

Main outcomes: Head repositioning accuracy (HRA) testing, a measure of cervical spine proprioception. The HRA test involved patients relocating their head back to a neutral starting position with eyes closed after maximal cervical spine flexion, extension, and right and left rotations. The overall HRA error score was the mean error (distance from the starting point to self-reported return to neutral) across 12 trials: 3 trials in each direction. We used t -tests to compare group means and logistic regression (outcome = group, predictor = HRA, covariates) to calculate odds ratios. We used a receiver operator characteristic curve to evaluate area under the curve (AUC) and calculate the optimal HRA cutpoint to distinguish concussion from controls.

Results: We enrolled and tested 46 participants with concussion (age = 15.8 ± 1.3 years, 59% female, mean = 11.3 ± 3.3 days postconcussion) and 83 uninjured controls (age = 16.1 ± 1.4 years, 88% female). The concussion group had significantly worse HRA than controls (4.3 ± 1.6 vs 2.9 ± 0.7 degrees, P < 0.001, Cohen d = 1.19). The univariable HRA model AUC was 0.81 (95% CI = 0.73, 0.90). After adjusting for age, sex, and concussion history, the multivariable model AUC improved to 0.85 (95% CI = 0.77, 0.92). The model correctly classified 80% of participants as concussion/control at a 3.5-degree cutpoint.

Conclusions: Adolescents with concussion demonstrated worse cervical spine proprioception than uninjured controls. Head repositioning accuracy may offer diagnostic utility for subacute concussion.

Objectives: This study explored the link between early sports specialization and injury rates in youth divers, a relationship that remains largely unexplored within diving.

Design: Cross-sectional survey.

Setting: Members of the USA Diving Organization and collegiate male and female divers participated in an online survey, reporting their sports involvement and injury history.

Participants: One hundred eighty-two male and female divers aged 8 to 25 years were recruited through USA Diving or US collegiate team databases.

Independent variables: Early/late specialization (based on age <12 or 12 years or older), gender (M/F), springboard and/or platform divers, experience (junior/senior, regional/zone/national/international), hours of dryland/water training, and prior sport exposure.

Main outcome measures: Injury history obtained on questionnaire.

Results: One hundred eighty-two divers were surveyed; 70% female. Age to start diving and age to concentrate solely on diving were significantly associated with certain injuries ( P < 0.05). Beginning diving before age 13 years of age was significantly associated with lower odds of injuries in the shoulder and wrist ( P = 0.013 and 0.018, respectively), after adjusting for select covariates. Age of specialization was not significantly associated with injuries in any body part ( P > 0.05), after adjusting for covariates. Greater years of diving experience was significantly associated with diving injuries in all 11 body parts ( P < 0.05).

Conclusions: This study indicates that early sports specialization is associated with decreased injury rates in elite youth divers who specialized before age 13 years, particularly for head/neck, shoulder, and wrist injuries. Moreover, we observed a positive correlation between experience and injury rate. Further investigation should focus on distinguishing between acute and overuse injuries.

Objective: This study summarizes findings from a cross-sectional survey conducted among National Collegiate Athletic Association (NCAA) Division 1 football programs, focusing on sport-related concussion (SRC) protocols for the 2018 season.

Design: Cross-sectional survey study.

Setting: 65 football programs within the Autonomy Five (A5) NCAA conferences.

Participants: Athletic trainers and team physicians who attended a football safety meeting at the NCAA offices June 17 to 18, 2019, representing their respective institutions.

Intervention: Electronic surveys were distributed on June 14, 2019, before the football safety meeting.

Main outcome measures: Results for 16 unique questions involving SRC protocols and resources were summarized and evaluated.

Results: The survey garnered responses from 46 of 65 programs (response rate = 71%). For baseline testing , 98% measured baseline postural stability and balance, 87% used baseline neurocognitive testing, while only 61% assessed baseline vestibular and/or ocular function. Regarding concussion prevention , 51% did not recommend additional measures, while 4% and 24% recommended cervical compression collars and omega-3 supplementation, respectively. In postconcussion treatment , 26% initiated aerobic exercise 1 day postconcussion if symptoms were stable, 24% waited at least 48 hours, 4% waited for the athlete to return to baseline, 11% waited until the athlete became asymptomatic, and 35% determined procedures on a case-by-case basis.

Conclusions: Most institutions assessed postural stability/balance and neurocognitive functioning at baseline and introduced light aerobic exercise within 48 h postconcussion. There was variation in baseline assessment methods and concussion prevention recommendations. These survey findings deepen our understanding of diverse SRC protocols in NCAA football programs.