Clinical Journal of Sport Medicine最新文献

Abstract: We present 3 cases of Ethiopian endurance athletes with electrocardiographic patterns resembling the historically described "Black athlete" ECG phenotype. Two athletes presented with symptoms-palpitations and presyncope-and were evaluated in emergency settings. Their ECGs showed T-wave inversions and ST-segment elevation in right precordial leads. Comprehensive workup, including imaging and stress testing, excluded structural or arrhythmic pathology. The third case involved an asymptomatic female marathon runner undergoing routine screening, with similar ECG findings. Longitudinal follow-up confirmed a physiological basis. These cases illustrate the phenotypic overlap between Ethiopian athletes and ECG patterns historically attributed to athletes of African descent, despite limited data validating such patterns in specific subpopulations. The findings underscore limitations of race-based ECG interpretation and highlight the need for more inclusive, phenotype-driven research in sports cardiology to improve accuracy and reduce misclassification. This case series supports the consideration of broader population diversity in developing athlete ECG criteria.

Objective: Evaluating sports-related concussion (SRC) knowledge, awareness of evaluation tools and management protocols, and access to educational resources within the French-speaking sports community in Canada and Europe.

Design: Cross-sectional, anonymous online survey.

Participants: French-speaking athletes, coaches, and health care professionals (HCPs).

Intervention: The electronic survey consisted of 33 questions that can be grouped into the following 3 categories: (1) SRC knowledge assessment through self-report and general knowledge questions, (2) awareness of internationally recommended detection tools and managements protocols, and (3) access to educational resources. The survey was codeveloped with athletes, coaches, and HCP and validated by and expert panel.

Main outcome measures: A SRC knowledge score was built based on answers to 4 questions on SRC mechanisms, symptoms, and management. Awareness of the Sport Concussion Assessment Tool 5, the Concussion Recognition Tool 5, and the 6-step return to sport protocol were collected with coaches and HCPs.

Results: Overall, 2073 participants responded to the survey, comprising 48% athletes, 33% coaches and 19% HCP. Knowledge scores (/100, median [IQR]) were highest among HCPs [98.1 (96.2, 100)], followed by coaches [96.2 (73.1, 98.1)], and athletes [90.4 (67.3, 92.3)] with significant differences between the groups (P < 0.001). Participants from Canada demonstrated higher knowledge scores [92.3 (75.0, 98.1)] than those from Europe [75.0 (67.3, 96.2); P < 0.001]. Similar differences were observed for the awareness of recommended tools and the access to educational resources.

Conclusions: Knowledge translation strategies should be adapted to better reach the French-speaking sports community in Europe and further individualized according to professional role.

Objective: To assess platelet-rich plasma (PRP) preinjection protocols of American Medical Society for Sports Medicine (AMSSM) physicians.

Design: Prospective cohort study distributed by the AMSSM through their email list-serv through REDCap.

Setting: Virtual survey distribution.

Interventions: N/A.

Main outcome measures: Demographic information, number of injections, conditions treated, and average cost were assessed. Outcomes were centrifuge kits, leukocyte preparation, complete blood count ordered, and nonsteroidal anti-inflammatory drugs restriction. The preferred classification systems of PRP researchers were also assessed.

Results: Of the 246 survey participants, 214 providers treated patients with PRP injections, averaging 7.21 (±8.80 SD) injections per month. A single PRP injection was approximately $685 (±316 SD). Nearly three-quarters of participants (73.7%) were family medicine trained. The most common pathologies treated were for degenerative joint disease of the knee (85.7%) and lateral epicondylitis (72.4%). One-hundred ninety (90.5%) responders used commercial kits, with significant variability in types. Using both leukocyte-rich and leukocyte-poor preparations (63.0%) was favored. CBCs were not ordered in 93.3% of cases, and NSAIDs were discontinued in 92.4% of encounters with a mean restriction duration of 8.68 days. Platelet-rich plasma researchers comprised 15.2% (n = 32) of participants. Single classification systems were favored by 81.3%, with the most common classifications being PAW, MARSPILL, or Other.

Conclusions: Although PRP protocol differences still exist, there may be more homogeneity than previously considered. However, significant variability in kit types and PRP preparations is present, which makes comparing outcome measures across institutions challenging.

Objective: To describe and predict patient-reported outcomes (PROs) and to investigate differences between individuals with a rotator cuff tear who were and were not successfully treated with a 12-week exercise therapy program.

Design: Prospective observational cohort.

Setting: Orthopedic sports medicine clinical practice settings and departments of orthopedic surgery, physical therapy, and bioengineering at the University of Pittsburgh.

Participants: Eighty-two individuals, age ≥40 years with a symptomatic isolated supraspinatus tear.

Interventions: Individualized 12-week exercise therapy program and longitudinal follow-ups at 3, 6, 12, and 24 months.

Main outcome measures: (1) PROs: Western Ontario Rotator Cuff (WORC) index (WORC) & Numeric Pain Rating Scale (NPRS), (2) shoulder range of motion (ROM) and strength, (3) rotator cuff tear size and location, (4) glenohumeral kinematics.

Results: Significant improvements in both PROs were observed at all time points when compared with baseline. At the 24-month follow-up, improvement greater than the minimally clinically important difference was noted for 78% of individuals for the WORC and 55% for the NPRS. Baseline predictors for 24-month change in WORC and an overall successful outcome were identified and included the baseline WORC score and the side-to-side difference in ROM for external rotation at 90 degrees abduction.

Conclusions: Individuals with symptomatic, isolated supraspinatus tears, managed with exercise therapy, experienced clinically important improvements in self-reported disability and more than half experienced a similar improvement in pain, at a 2-year follow-up. Baseline patient-reported outcomes measures and side-to-side differences passive ROM predicted 24-month success after exercise therapy. These findings may be useful in plan-of-care decision making.

Objectives: To examine the long-term neuropsychological outcome in retired, predominantly equestrian, athletes with a history of concussion and determine whether there is a protective role of cognitive reserve in the expression of cognitive impairment.

Design: The neuropsychological functioning of retired athletes with a history of concussion was compared with controls.

Setting: Private research clinic as part of the ICHIRF study.

Participants: Male and female retired athletes and controls.

Interventions: Participants were administered a battery of standardized neuropsychological tests.

Main outcome measure: A principal components analysis regression was conducted, adjusted for participant characteristics. Premorbid function was used as an index of cognitive reserve.

Results: Three components were identified that explained >95% of the variance in 14 neuropsychology tests; the first component (PC1) explained 87% of the variance. A regression model on PC1 identified an association between concussion and PC1, with lower scores in concussed participants with lower premorbid function.

Conclusions: A history of concussion is associated with lower neuropsychological performance, and this is more pronounced in individuals with lower premorbid functioning, an indicator of cognitive reserve.

Abstract: Parsonage-Turner syndrome (PTS), also known as neuralgic amyotrophy, presents with unilateral shoulder pain, followed by weakness. Associated sensory symptoms such as numbness may also occur. Contrary to the traditional thought that the condition typically self-resolves within weeks or gradually reaches full recovery with conservative management, more recent reports have revealed that a large portion of affected individuals experience persistent symptoms. We present an unusual case in which the patient developed PTS associated with streptococcal pharyngitis as a child, and his shoulder symptoms did not recover despite ongoing physical therapy. By young adulthood, he developed high-grade glenohumeral joint subluxation on the verge of full dislocation. Furthermore, imaging demonstrated the possibility of a reverse Hill-Sachs deformity. In addition to resumption of physical therapy, the patient has been referred to a tertiary care center to determine whether tendon transfer is a viable treatment option.

Objective: To analyze QT characteristics in children and adolescent athletes (11-16 years) using the Bazett and Fridericia formulas and compare the results by age, sex, and heart rate (HR).

Design: Cross-sectional study.

Setting: Sports federations in the Spanish autonomous community of La Rioja.

Participants: 3672 federated athletes aged 11 to 16 years.

Interventions: None.

Main outcome measures: We analyzed the 12-lead resting ECGs performed as part of the baseline screening program of sports federations. Mean corrected QT (QTc) values and percentiles were calculated using the Bazett (QTcB = QT/RR1/2) and Fridericia formulas (QTcF = QT/RR1/3). These values were compared according to age, sex, and HR.

Results: Most athletes (99%) showed a normal QTc. Only four adolescent boys had values above 460 ms (with Bazett >455 ms) using the Fridericia formula. One athlete had a significantly prolonged QTc with both formulas. Using the Bazett formula, significant differences in QTc were observed by sex (longer in adolescent girls), age (longer in 11-12 year olds), and HR (increases with higher HR). Still, with the Fridericia formula, no significant differences were observed in this age group, but differences were observed by sex. For HR, substantial differences were observed when comparing the 60 to 90 bpm range with the low and high intervals, with no differences found between bradycardia and tachycardia subgroups.

Conclusions: Our study shows that using the Bazett and Fridericia formula to measure QTc is recommended for cardiovascular screening in young athletic populations. The values obtained can serve as a reference for the early detection of long QT syndrome in ECGs performed in this population.

Objective: The purpose of this study was to explore the perceived ability of sports medicine physicians to effectively treat and manage the preventative and rehabilitative care of adaptive athletes.

Design: Exploratory mixed-methods, survey-based study.

Setting: Online, United States.

Participants: The survey was conducted using a sample of 2728 physicians. A total of 286 responded to the invitation and the response rate was 10% (286 of 2728). One hundred thirty (45.5%) of 286 physicians completed the survey.

Interventions: Survey.

Main outcome measures: Knowledge of adaptive athlete care and perceived confidence.

Results: Most respondents were willing to accept adaptive athletes into their clinical practice, and there were no significant associations between their willingness and if (χ 2 = 5.487, P = 0.139) or at what point (χ 2 = 4.463, P = 0.878) they received education about adaptive athletes. Those who received education about adaptive athletes during training reported feeling moderately to very confident in caring for adaptive athletes in an outpatient setting (χ 2 = 36.906, P < 0.001). When considering the areas of knowledge lacking to appropriately manage a competitive adaptive athlete, multiple areas named as deficits were identified. Themes centered on increasing hands-on experience, understanding of the adaptive athlete's disability and its impact on participation in adaptive sports, the physical demand of adaptive sports, and equipment.

Conclusions: Our results indicate that most physicians are willing to accept adaptive athletes into their practice; however, they acknowledge more education and training is needed to feel comfortable and confident when working with this population. Further educational interventions are needed to ensure equitable care for adaptive athletes.

Objective: To determine the inter- and intrarater reliability of physical therapists and athletic trainers to rate the subjective biomechanical and motor control risk factors exhibited by patients undergoing a structured postoperative anterior cruciate ligament (ACL) return-to-sport (RTS) assessment.

Design: Interrater and intrarater reliability.

Setting: University sports medicine clinic.

Patients: Thirty adult patients with ACL reconstruction who underwent a standardized ACL RTS assessment.

Intervention: Video data demonstrating the performance of the ACL RTS assessments were distributed to 4 skilled raters. The limb performance of each test was evaluated for hip/pelvic stability, knee flexion, varus/valgus, shock absorption, trunk stability, power, and body control on a 3-point scale. For each patient, the scores (1-3) for each subjective component were added to attain a total subjective score for each of the 17 tests.

Main outcome measures: Total scores for each of the tests were used to calculate interrater and intrarater reliability for all 4 raters.

Results: Most of the tests demonstrated substantial agreement across the 4 raters with interclass coefficients ranging from 0.61 to 0.77. The posteromedial and posterolateral components of the Y Balance test had lower coefficients (0.57-0.61). Although the leg press had near perfect agreement (0.81-0.86), hamstrings and hip abduction strength had moderate agreement (0.33-0.68).

Conclusions: This study has demonstrated the substantial agreement of a subjective rating system to evaluate the biomechanical and motor control risk patterns of patients after ACL reconstruction undergoing a standardized return-to-sport assessment. Multiple raters were able to substantially agree on the patients' risk profile across 14 of the 17 different tests of physical function. Further work is required to improve the interrater reliability of the Y balance test and hamstrings/hip strength evaluations.

Objective: To identify strength and flexibility measures that are associated with the risk of running-related overuse injuries.

Design: Prospective observational study.

Setting: Secondary analysis of a previously reported cohort of runners.

Participants: Runners registered for the 2019 New York City Marathon.

Independent variables: Participants were asked to complete a baseline strength and flexibility self-assessment 16 weeks before the marathon date.

Main outcome measure: Participants were asked to respond to surveys on running-related injuries occurring within 4-week "training quarters" at 16, 8, 4, and 1 week(s) before the marathon date.

Results: Of the n = 867 runners included in our final analytic sample, 36.1% sustained a running-related overuse injury while preparing for the marathon. The only significant difference in odds and/or hazard of injury was found in the single-leg glute bridge test. Participants who reported that they could hold a single-leg glute bridge on their weaker side for 20 to 29 seconds had 64% lower risk of running-related overuse injury (aHR: 0.36; 95% CI, 0.18-0.72; P = 0.0036) than those who could only hold for 0 to 9 seconds on their weaker side. In addition, participants who reported that they could hold a single-leg glute bridge on their weaker side for 30 seconds or more had 49% lower risk of running-related overuse injury (aHR: 0.51; 95% CI, 0.29-0.92; P = 0.0245).

Conclusions: Strength training programs, particularly targeting hip abductors and related muscle groups, may provide benefits for distance runners, though more rigorous research is needed.