Career hazards for the dancer.

Most dance injuries are of the overuse variety. Their gradual onset, coupled with the intense competition for professional positions, often results in injuries being ignored and thus seen late in their course. While treatment of the specific injury is of paramount concern, maintenance of the extremes of flexibility, strength, and conditioning necessary to dance professionally is an equally important treatment element.

Disability days in major league baseball.

We have examined the injury experience in Major League Baseball as reflected by the disabled list, based on data presented by American Specialty Companies in their publications, to examine any changes in injury rates over the past 11 years. It is reasonable to expect that improvements in training and conditioning, diagnostic methods, and surgical treatment over the last 11 years would have reduced injuries and resulted in fewer players on the disabled list. Yet, such does not appear to be the case. There is no evidence that the number of injuries in Major League Baseball has declined over the last decade; on the contrary, it appears that both the number of players and player days on the disabled list have increased. Team membership, injury location, and position do not appear to be related to the increase. Nor does it appear that the increase in injuries is a result of more sensitive diagnostic tests allowing the diagnoses of previously unrecognized injuries. Whatever the reason, it is significant that publicly available data, when viewed over an 11-year period, reveal a gradual and consistent increase in reported injuries--suggesting a problem that deserves attention.

Noncontact anterior cruciate ligament injuries: risk factors and prevention strategies.

An estimated 80,000 anterior cruciate ligament (ACL) tears occur annually in the United States. The highest incidence is in individuals 15 to 25 years old who participate in pivoting sports. With an estimated cost for these injuries of almost a billion dollars per year, the ability to identify risk factors and develop prevention strategies has widespread health and fiscal importance. Seventy percent of ACL injuries occur in noncontact situations. The risk factors for non-contact ACL injuries fall into four distinct categories: environmental, anatomic, hormonal, and biomechanical. Early data on existing neuromuscular training programs suggest that enhancing body control may decrease ACL injuries in women. Further investigation is needed prior to instituting prevention programs related to the other risk factors.

Sports-induced inflammation in the lower extremities.

Inflammations of the patellar and Achilles tendons, knee and ankle apophyses, and plantar fascia are common among professional and amateur athletes. The tendency to favor a sore leg and delay seeking medical attention often results in muscle atrophy. Many patients thus require physical as well as pharmacologic therapy to prevent further injury and regain full use of the leg.

Managing ankle sprains: keys to preserving motion and strength.

The vast majority of ankle injuries involve one or more of the lateral supporting ligaments and can usually be managed successfully in the primary care setting. Important diagnostic variables include the mechanism of injury, the level of weight-bearing ability, and the presence or absence of bony tenderness. Early application of a focal compression device is the paramount measure for preserving range of motion and strength. Other important measures include early mobilization, contrast baths, strength exercise, and, on return to activity, prophylactic bracing.

Ballet injuries. An analysis of epidemiology and financial outcome.

The financial outcome and epidemiology of ballet dancers' injuries were studied by examining workers' compensation insurance records covering 3 seasons (3 years) of activity for a large professional ballet company. One hundred four dancers sustained 309 injuries that resulted in insurance payouts for medical costs of $398,396. The average cost per injury was $1289. Although only 4.2% of the injuries resulted in medical costs exceeding $5000, these represented 60.0% of the total medical costs. Nine injuries resulted in medical costs in excess of $10,000 each. Overall, there were 2.97 injuries per injured dancer. Twenty-four dancers (23.0% of the injured) sustained 5 or more injuries each and thus were responsible for 51.9% (161) of all injuries. The foot (74 injuries, 23.9%), lumbar spine (71, 23.0%), and ankle (41, 13.3%) were the most frequently injured anatomic regions. The experience of this ballet company is similar to that of a college athletic department or a professional sports team. All could employ similar strategies to reduce injuries and associated costs.

Injuries in recreational adult fitness activities.

Volunteers (986) from fitness clubs and studios were recruited and followed for a 3-month period to document the injury consequences of adult recreational fitness participation. Participants were telephoned each week and their activities as well as any injuries that occurred were recorded. Of the 525 injuries and complaints reported during 60,629 hours of activity, 475 occurred as a result of sports participation for an overall rate of 7.83 per 1000 hours of participation. Seventy-six percent of these episodes caused the patient to alter or miss 1 or more activities, while 9.5% involved a physician visit. The rate for time-loss injuries was less than 2 per person per year (1.76 per 298 hours) or 5.92 per 1000 hours. Running had a higher risk of injury compared with most other individual sports. Cardiovascular fitness activities had low to medium rates, as did weight work; competitive sports were higher. For 6 of the most commonly injured areas, the reinjury rate was about twice that reported for those with no history of previous injury. The risks of injury from most recreational fitness activities were relatively modest, particularly if the activities were not competitive. Physicians might help patients reduce their risks of injury by encouraging suitable activities and by reducing the risks of reinjury by implementing appropriate rehabilitation programs.

Lasers in orthopedic surgery.

Among surgical specialities; orthopedics has been the slowest to embrace the laser as a surgical tool. Although lasers have been used in ophthalmology for over two decades, and laser usage has become commonplace in gynecology, otorhinolaryngology, dermatology, plastic surgery, and general surgery, it is only within the past four years that lasers have attracted appreciable attention in orthopedics. The fact that much of the surgery in the majority of specialities is ablative in nature makes use of the laser particularly appealing, as lasers are the ultimate of ablative tools. Much of orthopedic surgery, on the other hand, is primarily reparative or reconstructive in nature. The re-establishment of continuity or the replacement of tissues such as bone, tendon, and ligament are the goals of the majority of orthopedic surgical procedures. While lasers may ultimately play some role in tissue repair, that role is currently viewed as one of providing precision (for example, nerve and small vessel "welding") rather than strength, the latter being crucial in orthopedics. It is, thus, not surprising that the interest in "orthopedic lasers" centers around the relatively few procedures that are ablative in nature - intervetebral disc removal, the removal of polymethylmethacrylate, and the majority of arthroscopic procedures.

Injuries to pitchers in women's collegiate fast-pitch softball.

An injury survey of eight college softball teams ranked among the top 15 during the 1989 women's NCAA tournament championship by their athletic trainers found 26 injuries and complaints in 20 of 24 players. There were 15 grade I (nontime-loss) injuries, all musculotendinous except for a leg contusion and an ankle sprain. The 6 grade II injuries (altered play) were also musculotendinous except for 2 sprains to the hand and wrist. The 5 grade III (stopped play) injuries were somewhat more varied in type and resulted in an average of almost 7 weeks of time lost per injured player. Eighty-two percent of the time-loss injuries (grades II and III) involved the upper extremity. This survey suggests that there are likely to be a significant number of injuries involving loss of time from practice or games among elite women's fast-pitch softball pitchers.

The CO2 laser in arthroscopy: potential problems and solutions.

The CO2 laser is the most commonly used laser in arthroscopic surgery. This device offers enhanced precision in both cutting and ablation, as well as improved accessibility of difficult to reach structures. However, the use of energy rather than mechanical devices, the lack of tactile feedback, and the necessary use of a gaseous environment can result in problems not encountered in conventional arthroscopic surgery. This article presents these problems and suggests solutions.

Injuries in the 1987 national amateur volleyball tournament.

In a prospective study of injuries in the 1987 United States Volleyball Association's national tournament, we found 154 injuries in 1520 participants during 7812 hours of play. The injury rate in this study was 1.97/100 hours of play. Before the tournament, the participants' history was taken, and during the week of participation, records were kept of every player who presented with an injury. Players ranged in age from 17 to 60 and competed in five age/gender groups. Females had an injury rate of 2.3 and males had an injury rate of 1.7. The highest injury rate was seen in the men's open division, ages 17 to 35 (2.7), and the lowest rate was seen in the men's Golden Masters, ages 46 and up (1.5). Seventy-nine percent of the injuries occurred during the tournament and 21% were considered to be chronic injuries with an acute exacerbation. The upper extremities accounted for 20% of the injuries. The ankle (17.6%), low back (14.2%), and knee (11%) were the most common injury sites. Strains (36%) and sprains (28%) were the most frequent types of injury. Only eight (5.2%) injuries resulted in more than 5 days of time loss. Two of these injuries involved the knee and two others required surgery. It is likely that in studies relying upon retrospective methods, fewer of the less severe injuries are found, thereby leading to an overestimation of the percentages of knee and ankle injuries and the proportion of severe injuries. The clinician contemplating providing care for a high-level tournament should expect a preponderance of minor injuries occurring in a variety of anatomical locations.(ABSTRACT TRUNCATED AT 250 WORDS)

Orthopedic preparticipation screening examination.

The primary care physician is often called upon to perform a medical examination before the patient may participate in athletic activities. The examination should identify congenital and acquired musculoskeletal problems and the residuals of previous musculoskeletal injuries. This article and its illustrations show the steps of an orthopedic preparticipation screening examination and indicate how some problems may be identified.

A review of the use of prophylactic knee braces in football.

A review of nine studies of prophylactic knee braces worn by players in American tackle football lends some support for the use of double-hinged braces at the high-school level. Evidence for their use at the college level seems less persuasive. Caution should be exercised in interpreting these studies owing to the probable presence of bias and confounding variables and to difficulty in generalizing results beyond the study populations. The two studies that assigned braces randomly found lower injury rates for knees and knee ligaments among high-school and high-school size players. Conversely, a large, multiteam collegiate study found a significantly higher rate of knee injuries among brace users, a difference that remained when controlled for position, skill, and previous injury.

Clinical significance and evaluation of prophylactic knee brace studies in football.

A review of nine studies of prophylactic knee braces in American tackle football found some support for the use of double-hinge braces in high school but little support for their use at the collegiate level. Problems with bias and confounding make it necessary that caution be exercised in the interpretation of the results of these studies, however,. To which groups these results might apply must also be considered. The two studies that assigned braces randomly found lower injury rates among high school and high-school-sized players for knee injuries and knee ligament injuries. Conversely a large, multiteam collegiate study found a significantly higher rate of knee injuries among brace users, a difference that remained when controlled for position, skill, and previous injury.

The epidemiology of foot and ankle injuries in sports.

A 6 1/2-year review of 16,754 injuries seen in a multispecialty sports medicine clinic found that 25 per cent of the 12,681 injuries in the top 19 sports occurred at the ankle and foot. The percentages of foot and ankle injuries varied substantially from sport to sport, as did the proportion of sprains versus overuse injuries at each location. An appreciation of the patterns and numbers of injuries presenting can be helpful in patient management and can aid the planning of both clinical investigations and educational programs.

Overuse Syndromes of the Lower Extremity.

In brief: Overuse injuries of the lower extremity represent a frequent, significant problem. This article discusses management of the most common overuse disorders: anterior tibialis strain, medial tibial stress syndrome, compartment syndrome, stress fractures, and Achilles tendinitis. These injuries often are the culmination of a process (repetitive stress) rather than the result of a single event. Grading injuries on a scale of 1 to 4 according to severity can help determine the correct treatment. The primary treatment goal is to reduce inflammation through icing, rest, and appropriate use of nonsteroidal anti-inflammatory agents. For a safe return to pain-free activity, additional measures are required to correct biomechanical problems, educate the athlete on training techniques, and begin a gradual reconditioning program.