Prevalence of Cardiovascular Disease and Risk Factors Among Former National Football League Players.

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death worldwide, but prevalence estimates in former professional athletes are limited. OBJECTIVES: HUDDLE (Heart Health: Understanding and Diagnosing Disease by Leveraging Echocardiograms) aimed to raise awareness and estimate the prevalence of CVD and associated risk factors among members of the National Football League (NFL) Alumni Association and their families through education and screening events. METHODS: HUDDLE was a multicity, cross-sectional study of NFL alumni and family members aged 50 years and older. Subjects reported their health history and participated in CVD education and screening (blood pressure, electrocardiogram, and transthoracic echocardiogram [TTE] assessments). Phone follow-up by investigators occurred 30 days postscreening to review results and recommendations. This analysis focuses on former NFL athletes. RESULTS: Of 498 participants screened, 57.2% (N = 285) were former NFL players, the majority of whom were African American (67.6%). The prevalence of hypertension among NFL alumni was estimated to be 89.8%, though only 37.5% reported a history of hypertension. Of 285 evaluable participants, 61.8% had structural cardiac abnormalities by TTE. Multivariable analysis showed that hypertension was a significant predictor of clinically relevant structural abnormalities on TTE. CONCLUSIONS: HUDDLE identified a large discrepancy between participant self-awareness and actual prevalence of CVD and risk factors, highlighting a significant opportunity for population health interventions. Structural cardiac abnormalities were observed in most participants and were independently predicted by hypertension, affirming the role of TTE for CVD screening in this population aged older than 50 years. (Heart Health: Understanding and Diagnosing Disease by Leveraging Echocardiograms [HUDDLE]; NCT05009589).

External Iliac Artery Endofibrosis: A Discussion on Two Unique Cases.

Iliac artery endofibrosis (IAE), as the name suggests, involves subintimal fibrosis of the iliac artery. IAE is most commonly associated with competitive athletics, particularly cycling, and remains a rather underappreciated diagnosis in the clinical setting. We present two unique and distinct presentations of IAE in competitive athletes. The first case involves a 38-year-old male cyclist who initially presented with complaints of a bulge at the right groin and acute onset monoplegia and paresthesia associated with exertion of the right lower extremity. This patient was referred to vascular surgery and underwent right common iliac artery and proximal common femoral artery endarterectomy with patch angioplasty and Fogarty embolectomy. Case 2 involves a 50-year-old female triathlete who presented with left lower extremity claudication of a more chronic course, with symptoms beginning approximately four years prior. The pain radiated to her upper thigh and was associated with exertion, restricting her exercise tolerance and return to training. After a diagnosis of IAE was made, she was referred to vascular surgery for a left iliofemoral bypass.

Elbow Evaluation Via Telephone and Video Visit.

Background Elbow conditions and pathology are commonly seen in the outpatient clinic. Telephone and video visits can allow for expeditious assessment of elbow complaints, without the added challenges of commuting for a clinic-based evaluation. In the setting of a pandemic, the benefits of telemedicine are apparent, but the time and effort saved from being able to remotely evaluate musculoskeletal conditions are also useful in a non-pandemic situation. In this modern era of telemedicine, protocols need to be developed to provide guidance for a remote elbow evaluation. As with all musculoskeletal conditions, the history about the elbow complaint allows the clinician to develop a differential diagnosis, which is either supported or refuted based on physical examination and diagnostic studies. Appropriate questions asked over a telephone call can provide answers that lead the clinician to a specific diagnosis and treatment plan. Furthermore, responses to these same questions can be further supported by a video assessment of the affected elbow, which may provide additional evidence to support a diagnosis and plan of care. Aims To outline possible questions, responses, and video examination techniques to aid the clinician in elbow examinations conducted via telemedicine. Methods We have created a pathway for step-by-step evaluation to help physicians direct their patients through the typical elements of a thorough elbow examination via telehealth. Results We have created tables of questions, answers, and instructions to help guide the physician through different aspects of a telehealth elbow examination. We have also included a glossary of descriptive images that demonstrate each maneuver.  Conclusion This article provides a structured guide to efficiently extracting clinically relevant information during telemedicine examinations of the elbow.

Overtraining syndrome in the athlete: current clinical practice.

Competitive athletes are pushed routinely to the limits of their physical abilities. When tempered with periods of rest and recovery, a highly demanding training schedule can have tremendous benefits. However when an athlete is pushed too far, overtraining syndrome (OTS) can develop and result in career-ending damage. Overreaching and overtraining are part of the same spectrum that can lead to OTS. The pressure to perform placed on elite athletes is a real danger. Athletes and coaches understand the importance of rest days, but the insidious onset of OTS slowly saps the efficacy of recovery times so the athlete is no longer able to reach previously attainable goals. Identifying markers that correlate with overreaching and overtraining can arrest progression of a potentially negative cycle. We will examine the current literature and discuss possible screening tests and red flags that will assist in preventing OTS from occurring.

Metabolic testing in the office.

The three most commonly used metabolic tests are the Resting Metabolic Rate, Anaerobic Threshold Testing, and V.O2max. For several decades, these metabolic tests have been confined to the setting of university-based physiology laboratories and cardiopulmonary environments, i.e., metabolic carts in the intensive care units. The information gathered is used as a research and clinical tool in evaluating metabolic activity in a variety of physiological states from a body at rest, to exercise (aerobic and anaerobic), in certain medical states like illness, fed/starvation, and medicinal or supplementation affective states. Over the last decade, as technology has improved, so have the metabolic testing carts. They have become widely available for mainstream use by a variety of health care professionals. The purpose of this article is to review these three tests and how they may be useful in a medical practice.

Intrarater and interrater reliability of a manual technique to assess anterior humeral head translation of the glenohumeral joint.

The purpose of this study was to determine the intrarater and interrater reliability of a manual anterior humeral head translation test. Fifteen subjects were positioned lying in a supine position with their identity shielded from examiners. A standard manual anterior humeral head translation test was performed and repeated with the glenohumeral joint in 90 degrees of elevation in the scapular plane, with use of the grading method proposed by Altchek and Dines in 1993. Reliability was assessed with the coefficient of agreement and kappa statistic. Intrarater reliability was 81.4% comparing grade I and II translation. This decreased to 54% when examiners distinguished between grades I, I+, II, and II+. Interrater reliability for the same comparisons was 70.4%, decreasing to 37.3%. On the basis of these data, the technique of manually assessing anterior humeral head translation studied has poor overall interrater reliability and only fair intrarater reliability. The test-retest accuracy of humeral head translation is enhanced when examiners only determine the relationship of the humeral head relative to the glenoid rim.

Osteoarthritis of the glenohumeral joint: nonsurgical treatment options.

Glenohumeral osteoarthritis is a relatively uncommon type of osteoarthritis characterized by loss of anterior or forward flexion. Assessing range of motion, impingement, and strength, combined with radiologic imaging, can help determine the extent of damage. Published studies focus primarily on surgical treatment, but commonly used nonsurgical approaches include anti-inflammatory medications, oral and injectable viscosupplementation, and physical therapy. These conservative measures can be very effective for active patients and also appeal to their physicians who consider shoulder surgery as a last resort.