The primary care sports medicine fellowship: American Medical Society for Sports Medicine proposed standards of excellence.

The American Medical Society for Sports Medicine recognises a need to provide direction and continually enhance the quality of sports medicine fellowship training programmes. This document was developed to be an educational resource for sports medicine physicians who teach in a 1-year primary care sports medicine fellowship training programme. It is meant to provide high standards and targets for fellowship training programmes that choose to re-assess their curriculum and seek to make improvements.

Primary Care Sports Medicine Fellowship: AMSSM Proposed Standards of Excellence.

The American Medical Society for Sports Medicine (AMSSM) recognizes a need to provide direction and continually enhance the quality of sports medicine fellowship training programs. This document was developed to be an educational resource for sports medicine physicians who teach in a 1-year primary care sports medicine fellowship training program. It is meant to provide high standards and targets for fellowship training programs that choose to reassess their curriculum and seek to make improvements.

Elbow Injuries in the Young Throwing Athlete.

Baseball pitchers and other throwing athletes place their elbows under tremendous stresses, making them vulnerable to a number of unique injuries. Skeletally immature throwers in particular are at a greater risk for growth plate and other bony injuries, due to the relative strengths of these tissues and the kinematics involved in throwing. Care should be taken to fully evaluate these injuries based on the particular history and presentation to properly direct treatment and rehabilitation. Patients, as well as other athletes, coaches, and families, also should be made aware of the significant risk factors for these injuries, especially those regarding pitch limits, proper mechanics, and sufficient rest.

Medical management of youth baseball and softball tournaments.

The medical management of youth baseball and softball tournaments requires both proper planning and a basic awareness of commonly seen sport-specific injuries. While youth sporting events are designed to be a fun experience for all, injuries and emergencies will occur. With proper planning, and supplies, the impact of these issues can be minimized. This article will outline some basic principles for the medical personnel that may be involved in youth baseball and softball events.

Using viscosupplementation to treat knee osteoarthritis.

This article provides physicians specializing in nonsurgical sports medicine with an overview of viscosupplementation as a treatment for osteoarthritis (OA) pain. Osteoarthritis is a painful, disabling condition that is becoming more prevalent in patients and is generally treated using conservative nonpharmacologic measures. If conservative measures are unsuccessful at alleviating pain, current recommendations include prescribing acetaminophen and nonsteroidal anti-inflammatory drugs to patients. However, long-term use of these agents increases the risk for liver, cardiovascular, gastrointestinal, and/or renal complications in patients. Viscosupplementation is the term used for intra-articular injection of hyaluronic acid/hylans. Intra-articular injections of these agents have good safety profiles and have shown efficacy for treating knee OA pain. Viscosupplementation injections relieve pain for ≤ 26 weeks, which is longer than the short-term pain relief derived from nonsteroidal anti-inflammatory drugs and corticosteroid injections. Additionally, viscosupplementation administered to patients in earlier stages of OA may be more beneficial than when given later in the treatment of OA. As part of a multimodal algorithm, viscosupplementation combined with conventional therapy or other pharmacologic agents has been shown to be more effective at managing OA than conventional care alone. This article reviews the evidence for using viscosupplementation as part of a comprehensive program for managing OA in patients.

Effect of Concussion on Reaction Time and Neurocognitive Factors: Implications for Subsequent Lower Extremity Injury.

Background: Recent evidence has demonstrated that athletes are at greater risk for a lower extremity injury following a return-to-sport (RTS) after sport-related concussion (SRC). The reason for this is not completely clear, but it has been hypothesized that persistent deficits in neurocognitive factors may be a contributing factor. Hypothesis/Purpose: This study assessed simple reaction time, processing speed, attention, and concentration in a group of athletes, post-concussion upon clearance for RTS for potential deficits that may result in slower reaction time, processing speed, attention, and concentration. The researchers hypothesized that the concussion group would demonstrate worse scores on both assessments compared to a sex-, age-, and sport-matched cohort. Study Design: Case-controlled study. Methods: Twelve participants who had suffered a SRC and eight healthy individuals who were matched to the concussed group by age, sex, and sport were evaluated. Those with a concussion had been cleared for RTS by a licensed healthcare provider. Each participant underwent neurocognitive tests that included a simple reaction time test (SRT) and the King-Devick Test (K-D). Independent t-tests were performed to compare the groups with significance set a priori at p<0.05. Results: There was a significant difference (p =0.024) between groups for SRT with the concussed group demonstrating a better SRT than the control group. There were no significant differences (p =0.939) between the groups for the K-D. Conclusion: With no significant differences between groups in the K-D assessment and, surprisingly, the concussed group having a better SRT compared to the healthy group, our hypothesis was not supported. Clinical Relevance: These specific measures, compounded with extensive post-concussion time lapse until RTS clearance, may have limited capacity in revealing potential persistent deficits in relevant neurocognitive characteristics. Level of Evidence: Level of Evidence 3.

Youth baseball injuries: recognition, treatment, and prevention.

Baseball is a very popular and safe sport for children and adolescents. Understanding bone maturation and risk factors for overuse will guide the practitioner to manage these athletes properly. Overuse injury risk can be minimized by limiting pitch counts, ensuring adequate recovery, developing proper mechanics, and allowing for early evaluation and intervention. Rest, albeit difficult for the athlete, is the mainstay of treatment for many of the maladies affecting this age group of throwers. Individualized approaches to treatment for this population are advised. Structural damage that may lead to surgery is rare but may need consideration if there is no response to conservative measures. Several resources are available to educate players, coaches, and parents regarding safe play.

Neck Injuries.

Neck injuries are relatively uncommon but have the potential to cause serious and permanent disability. In athletes, injuries are most common in contact sports, and occur with direct axial loading with a forward-flexed neck. Soft tissue and peripheral nerve injuries are typically minor and self-limiting, with excellent recovery potential and return to activities based on symptoms. Concern for devastating spinal cord injuries has led to routine immobilization using spine boards and hard cervical collars. This approach may provide more harm than benefit when applied universally, and a more commonsense protocol can be used to better address potential neck injuries.

Prevention of overuse injuries in young baseball pitchers.

With millions of athletes participating in baseball in the United States annually, overuse injuries are common occurrences. Epidemiological studies, including surveys of orthopaedic surgeons, coaches, and athletes, indicate that injuries such as those to the ulnar collateral ligament are increasing in incidence. Many risk factors for throwing injuries have been proposed-including the immature skeleton, throwing mechanics, glenohumeral internal rotation deficit, pitch type, velocity, and counts-but little evidence is available to support the majority of these factors. Recent studies have shown that pitch volume and overuse are central factors that lead to shoulder and elbow injuries in the young throwing athlete. Pitching while fatigued and in spite of arm pain has also been implicated.