Care of the Esports Athlete.

ABSTRACT: The growth of electronic sports (esports), or competitive video gaming, in recent years has led to an increasing number of players seeking care for injuries and injury prevention associated with esports. In addition, the increase of esports players seeking care from health care professionals leads to a heightened awareness about the role of health and lifestyle in esports performance.Unfortunately, few health care professionals are familiar with the physical and mental demands of this sport or are comfortable addressing the needs of this athletic population and the issues that they encounter affecting their health and their sport. This article offers an overview of common esports health issues and considerations specific to esports athletic care for the sports medicine physician in support of optimizing the care of these patients.

Achilles Tendinopathy, A Brief Review and Update of Current Literature.

ABSTRACT: Chronic pain in the Achilles tendon is a common problem in both athletes and nonathletes alike. The etiology for the development of Achilles tendinopathy has not been fully elucidated, and there remains multiple theories to explain the pain and dysfunction accompanying this condition. The diagnosis of Achilles tendon problems continues to rely on the clinical history and physical examination. The optimal management of pain, restoration of function, and return-to-sports participation with Achilles tendinopathy are evolving because of the advancement in technologies and research regarding its pathophysiology. This article aims to provide a brief review of the relevant anatomy, differential diagnosis, imaging findings, and an update of the literature on conservative and minimally invasive managements of chronic Achilles tendinopathy.

Deep Gluteal Syndrome: A Pain in the Buttock.

ABSTRACT: While buttock pain is a common complaint in sports medicine, deep gluteal syndrome (DGS) is a rare entity. DGS has been proposed as a unifying term referring to symptoms attributed to the various pain generators located in this region. While not all-inclusive, the diagnosis of DGS allows for focus on pathology of regionally associated muscles, tendons, and nerves in the clinical evaluation and management of posterior hip and buttock complaints. An understanding of the anatomic structures and their kinematic and topographic relationships in the deep gluteal space is pivotal in making accurate diagnoses and providing effective treatment. Because presenting clinical features may be unrevealing while imaging studies and diagnostic procedures lack supportive evidence, precise physical examination is essential in obtaining accurate diagnoses. Management of DGS involves focused rehabilitation with consideration of still clinically unproven adjunctive therapies, image-guided injections, and surgical intervention in refractory cases.

Sports Medicine: Sports Event Care and Return to Play.

In 2008, approximately 60 million children, adolescents, and young adults were involved in organized sports, which account for more than 3.5 million injuries each year. Family physicians often create and implement return to play (RTP) protocols for athletes. If a concussion is suspected in an athlete, the athlete should be withdrawn immediately from participation in sports and monitored with serial assessments. There is no same-day RTP for athletes with concussion. A brief period of physical and cognitive rest is suggested, with a gradual return to activity. Transient brachial neuropraxia, also known as a burner or stinger, results from injury to the brachial plexus and typically resolves within days. Strict protocols exist for college and high school athletes with bacterial, viral, and fungal skin infections. Athletes may RTP when no new active lesions are present, healing lesions are covered, and the athlete is receiving treatment. Provision of care at a mass participation event requires extensive preparation. Emergency action plans are an invaluable tool for large sports events. These should be jointly developed by all involved parties and rehearsed regularly. Legal, liability, and privacy considerations may affect the physician's decision to provide care at a sports or mass participation event.

Postoperative Lyme Arthritis in the Orthopaedic Patient.

CONTEXT: Lyme disease is the most common tick-borne illness in North America and Europe, and Lyme arthritis is a frequent late-stage manifestation in the United States. However, Lyme arthritis has rarely been reported as a postoperative complication. EVIDENCE ACQUISITION: The PubMed database was queried through June 2018, and restricted to the English language, in search of relevant articles. STUDY DESIGN: Clinical review. LEVEL OF EVIDENCE: Level 3. RESULTS: A total of 5 cases of Lyme arthritis as a postoperative complication have been reported in the literature. CONCLUSION: These cases highlight the importance for providers practicing in Lyme-endemic regions to keep such an infection in mind when evaluating postoperative joint pain and swelling. We propose herein an algorithm for the workup of potential postoperative Lyme arthritis. STRENGTH OF RECOMMENDATION TAXONOMY (SORT): C.

Myositis Ossificans in Sport: A Review.

Myositis ossificans is a benign, solitary, frequently self-limiting, ossifying soft-tissue mass encountered often in the active sporting population. Typically occurring within skeletal muscle - most often the brachialis, quadriceps and adductor muscle groups - lesions may arise with or without a traumatic history. The exact pathophysiology of these ossifying lesions is still poorly understood. Patients present with localized pain and swelling with loss of range of motion. Plain radiographs may not be able to detect early lesions, which allows for an expanded role of ultrasonography as an early screening modality, despite magnetic resonance imaging remaining the gold standard for imaging of soft tissue masses. Conservative treatment is implemented for most patients with excellent outcomes, with surgical excision being an option for persistent symptoms or progressive disease. Typically, athletes are able to progress to light activity at 2 to 3 months, full activity by 6 months, and back to their preinjury level by 1 year.

Medical Issues in American Football: Eyes, Teeth, and Skin.

Providing care to football players often involves recognizing and treating nonorthopedic conditions. We report on common ophthalmologic, dental, and dermatologic conditions seen by the football team physician.

Greater trochanteric pain syndrome: more than bursitis and iliotibial tract friction.

Disorders causing lateral hip pain are encountered frequently by physicians. Evaluating these problems can be challenging because of the myriad of potential causes, the complex anatomy of the peritrochanteric structures, and the inconsistently described etiologic factors. Misconceptions about the causes of lateral hip pain and tenderness are common, frequently leading to approaches that only provide temporary solutions rather than address the underlying pathology. Trochanteric bursitis is implicated frequently but is seldom the primary cause of pain in chronic cases. It is important to address hip rotator cuff tendinopathy and pelvic core instability. Treatment options include therapeutic exercise, physical modalities, corticosteroid injections, extracorporeal shock wave therapy, and regenerative injection therapies. For recalcitrant cases, surgery may be appropriate. By understanding the anatomy of the peritrochanteric structures, and the pathologic processes most likely responsible for symptomatology and dysfunction, the physician will be prepared to provide effective long-term solutions for this common problem.

Lower gastrointestinal distress in endurance athletes.

Training regimens and race days place significant demands upon both the competitive endurance athlete and the frequent-recreational runner. Lower gastrointestinal derangements, especially those involving diarrhea and rectal bleeding, are common and can impact adversely both the performance and the health of the athlete. While most cases are relatively benign, more significant and severe symptoms may not only impair sports performance, but also signify more serious disease. The sports medicine clinician should be familiar with the management of these problems in order to optimize treatment, facilitate return to play, and maximize the athlete's potential.