Trends in the Sports Medicine Match: An Analysis of the National Resident Matching Program Data from 2010 to 2021.

ABSTRACT: Sports medicine (SM) fellowship training has become popular among residents. Thus, an analysis was undertaken to assess data on matching rates from 2010 to 2021. The purpose of this study is to analyze trends in SM fellowship applications using National Resident Matching Program data. Retrospective study with analysis of applicants applying into accredited SM fellowships between 2010 and 2021. The number of accredited programs and fellowship positions have more than doubled from 2010 to 2021. There was a significant increase in match rates over time (P < 0.001); match rates were at 70% or below prior to 2015 and above 70% after 2015. The average number of applicants per position stayed consistent. The number of Doctor of Osteopathic Medicine applicants increased 110% whereas the number of U.S. born foreign and non-U.S. citizen applicants decreased 20.8%. SM fellowship training has increased since 2010. Acceptance rates and number of applicants have increased over time because of the growth in fellowship programs and accredited positions.

Training and Practice Settings of Physicians Dual-Certified in Emergency and Sports Medicine.

ABSTRACT: Survey study of training and practice paradigms and job satisfaction of dual-boarded emergency medicine (EM) and sports medicine (SM) physicians. The REDCap survey was sent to 193 American Board of EM members who hold a Certificate of Added Qualification in SM. A total of 124 EM/SM physicians responded (67.5% male). More than 70% completed three-year residencies while only 28.5% had an EM/SM residency faculty. One-quarter delayed fellowship after residency 6.45 years on average. Regarding their first job after fellowship, 27.6% practiced only EM, 54.5% practiced both EM and SM, and 12.2% practiced only SM. Regarding their current job, 29.1% practice only EM. 47.3% practice both EM and SM, and 20.9% practice only SM. Only 13.9% and 9.9% indicated they are unhappy with their first job and current job, respectively. There is significant variability in practice settings for EM/SM physicians with the overwhelming majority being happy with their career choices.

Recommended Musculoskeletal and Sports Medicine Model Curriculum for Emergency Medicine Residency Training.

ABSTRACT: Musculoskeletal and sports medicine conditions are common in the emergency department (ED). Emergency physicians may not be receiving adequate education to achieve clinical competency in musculoskeletal medicine during residency training. This article aims to provide a standardized musculoskeletal and sports medicine curriculum for emergency medicine training. Broad curriculum goals include proficiency in evaluating and managing patients presenting to the ED with acute and chronic musculoskeletal complaints and other medical conditions related to or affected by physical exertion, sports participation, or environmental exposure. Specific objectives focus on knowledge of these disorders, physical examination skills, procedural skills including musculoskeletal ultrasound, appropriate consultation and referral, and patient education for these conditions. Educational methods will consist of didactics; online self-directed learning modules; simulation; and supervised clinical experiences in the ED, primary care sports medicine clinics, and orthopedic clinics if available. Curriculum implementation is expected to vary across programs due to differences in residency program structure and resources.

Advice on stroke provided by pharmacies in the United States: implications for treatment and care.

OBJECTIVES: Studies have found that some health lines and physician's offices have provided treatment advice other than "call 9-1-1 for an ambulance" to patients who present with a stroke scenario. We assessed the treatment advice given by selected pharmacies in the United States regarding stroke. METHODS: The investigators called 73 randomly selected pharmacies and informed respondents that the caller's mother had experienced stroke-like symptoms several days earlier. Respondents were asked what should be done if the symptoms returned in the future and then debriefed on the deception afterward. RESULTS: Seventy-one of the 73 pharmacies participated and only 20% (95% confidence interval 12-30) of respondents gave the ideal advice "call 9-1-1 for an ambulance." CONCLUSIONS: One out of every five pharmacy respondents across the United States recommended advice other than calling emergency medical services for a potential stroke scenario.

Image Timing After COVID-19 Infection in Athletes.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has significantly impacted National Collegiate Athletic Association (NCAA) athletics, with specific concerns for cardiac involvement after infection. Pericardial abnormalities have been seen in up to 39.5% of athletes after COVID-19 infection, while myocardial involvement has been reported at a lower rate of 2.7%. To date, myocardial injury has been seen in 0.6% to 0.7% of athletes when using symptom screening and imaging as clinically indicated, which increases to 2.3% to 3.0% when all athletes with COVID-19 undergo cardiac magnetic resonance (CMR) imaging. PURPOSE: This study will examine whether there exists an ideal time from positive COVID-19 results to obtaining imaging to increase the likelihood of finding abnormalities. STUDY DESIGN: Prospective cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: NCAA athletes at West Virginia University who were found to be COVID-19 positive on routine screening were required to undergo echocardiography (ECG) and CMR. These data were reviewed by cardiology and determined to be normal or abnormal. Statistical analysis with logistic regression and descriptive statistics was performed to evaluate whether a time existed where abnormalities on imaging were most likely to be found. RESULTS: A total of 41 athletes were included in this study. ECG was performed earlier on average than CMR imaging, at 18.2 days versus 27.5 days. No significant difference was found in timing from COVID-19 infection diagnosis and abnormalities seen on imaging for either ECG or CMR imaging. CONCLUSION: The risk of cardiac involvement in athletes in the setting of COVID-19 has already been documented. This study suggests that imaging timing is independent of cardiac involvement with no correlation to specific time periods where more abnormalities may be found. However, CMR imaging showing changes at day 54 after infection suggests cardiac findings can be seen months after imaging. CLINICAL RELEVANCE: Cardiac imaging for athletes after contracting COVID-19 does not show a significant relationship to time of imaging. However, given the cardiac involvement seen months after diagnosis, further examination of prolonged cardiac effects must be carried out.

No Pain and No Gain: Kommerell's Diverticulum with a Right-Sided Aortic Arch, and an Aberrant Left Subclavian Artery Presenting in a Body Builder with Muscle Bulk Imbalance.

A 22-year-old right-handed male presented to the Sports Medicine clinic with concerns of upper extremity muscle asymmetry. Physical examination showed gross muscular asymmetry when comparing the left upper extremity to the right. Radial pulses were 2 + on the right and 1 + on the left. Due to concern for vascular anomaly, computed tomography angiography was performed which revealed a right-sided aortic arch with Kommerell's diverticulum and aberrant left subclavian artery. The patient underwent a left carotid subclavian bypass successfully, but his recovery was complicated by an upper extremity deep venous thrombosis. He is currently on novel anticoagulant but has been released to normal activities and doing well. Kommerell's Diverticulum (KD) is a rare congenital anomaly caused by a persistent remnant of the fourth primitive dorsal arch during embryological development. Although the prevalence of KD is rare, it is important to identify and diagnose this condition to provide definitive care.

Initially concealed concussion lowers in-game performance of NCAA Division I football players: a case series.

Objectives: Many athletes conceal concussion symptoms to continue to play. If athletes and coaches knew that performance drops significantly after a concussion, in turn hurting the team, athletes may be more prone to report concussion symptoms. The objective of our research was to report three cases that support this performance decline after an undisclosed concussion. Methods: This is a case series of three NCAA Division I football players who did not immediately report their concussions. The play in which the concussion occurred was identified via video review then the players' pre and post-injury performance grades, as scored by their position coaches, were recorded. Additional data regarding their performance in other games and their concussion assessments were also recorded. Results: Three injuries were identified and reviewed. Player 1 had a pre-injury performance score of 76/100 with a post-injury score of 47/100. This was a drop of 29 points for a decrease in his in-game performance by 38%. Player 2 had a pre-injury score of 100/100 with a post-injury score of 60/100. This was a drop of 40 points or a 40% decrease in his in-game performance. Player 3 had a pre-injury score of 67/100 and a post-injury score of 43/100 for a drop of 24 points or a 36% decrease in his in-game performance. Conclusions: We reported three college football players who suffered concussions but did not immediately disclose their symptoms. Each had a marked decrease in performance grades after their concussion. If the performance effect of a concussion can be quantified, athletes and coaches may begin to change their mind-set that a concussion can be 'played through.' This case series should serve as a first step in quantifying concussion effects on performance.

Status of US Emergency Medical Service Protocols Regarding Pre-Transfer Cooling for Exertional Heat Stroke.

OBJECTIVE:  Exertional heat stroke (EHS) is a significant cause of morbidity and mortality in athletes and active individuals. In the field, initial management of exertional heat illness is based on rapid whole-body cooling. Cold-water immersion (CWI) is considered the superior cooling modality for EHS treatment. However, there often is a disconnect between the sports medicine community and the emergency medical service (EMS) community. Well-written emergency action plans may fail if EMS protocols do not allow for CWI in initial management. This is the first study to look at the current national EMS protocols regarding prehospital management of EHS. The purpose of our study was to assess the status of heat illness protocols regarding CWI for EHS in all 50 states plus Washington, DC.  Methods: An internet search was performed to find EHS protocols. Statewide protocols were preferred. Several parameters were recorded for each protocol including whether: 1) CWI was the recommended cooling treatment for EHS and 2) CWI was explicitly permitted to be completed prior to transportation. RESULTS:  We found nine of the 51 protocols, or 17.6%, explicitly recommended CWI and 11 of the 51, or 21.6%, specifically instructed EMS personnel to complete CWI or cooling methods prior to transport. However, six protocols, or 11.8%, provided the recommendation instructing some variation of the phrase "do not delay transport to cool the patient." CONCLUSION:  Despite the medical literature endorsing CWI as the most effective treatment modality in a prehospital setting for exertional heat illness, EMS protocols largely fail to reflect this which leads to mismanagement and inadequate care of EHS patients. While CWI is not always available, all EMS protocols should include a systematic practical guideline for a heat illness patient when employing cooling treatment with an emphasis on CWI when available as the preferred treatment technique for EHS and the concept of "cool first, transport second."

High Prevalence of Pericardial Involvement in College Student Athletes Recovering From COVID-19.

OBJECTIVES: This study sought to explore the spectrum of cardiac abnormalities in student athletes who returned to university campus in July 2020 with uncomplicated coronavirus disease 2019 (COVID-19). BACKGROUND: There is limited information on cardiovascular involvement in young individuals with mild or asymptomatic COVID-19. METHODS: Screening echocardiograms were performed in 54 consecutive student athletes (mean age 19 years; 85% male) who had positive results of reverse transcription polymerase chain reaction nasal swab testing of the upper respiratory tract or immunoglobulin G antibodies against severe acute respiratory syndrome coronavirus type 2. Sequential cardiac magnetic resonance imaging was performed in 48 (89%) subjects. RESULTS: A total of 16 (30%) athletes were asymptomatic, whereas 36 (66%) and 2 (4%) athletes reported mild and moderate COVID-19 related symptoms, respectively. For the 48 athletes completing both imaging studies, abnormal findings were identified in 27 (56.3%) individuals. This included 19 (39.5%) athletes with pericardial late enhancements with associated pericardial effusion. Of the individuals with pericardial enhancements, 6 (12.5%) had reduced global longitudinal strain and/or an increased native T1. One patient showed myocardial enhancement, and reduced left ventricular ejection fraction or reduced global longitudinal strain with or without increased native T1 values was also identified in an additional 7 (14.6%) individuals. Native T2 findings were normal in all subjects, and no specific imaging features of myocardial inflammation were identified. Hierarchical clustering of left ventricular regional strain identified 3 unique myopericardial phenotypes that showed significant association with the cardiac magnetic resonance findings (p = 0.03). CONCLUSIONS: More than 1 in 3 previously healthy college athletes recovering from COVID-19 infection showed imaging features of a resolving pericardial inflammation. Although subtle changes in myocardial structure and function were identified, no athlete showed specific imaging features to suggest an ongoing myocarditis. Further studies are needed to understand the clinical implications and long-term evolution of these abnormalities in uncomplicated COVID-19.

Case Report: A Near Miss of Pulmonary Embolism in a Division 1 Collegiate Basketball Player.

INTRODUCTION: The clinical presentation of pulmonary embolism (PE) is often associated with classic vital instability such as tachycardia, hypoxia, and tachypnea. This critical diagnosis is often less likely if a patient is negative by Pulmonary Embolism Rule-Out Criteria (PERC) standards with a low pre-test probability of disease. Caution must be used when evaluating elite athletes with the PERC rule due to low resting heart rate and certain risk factors, which are inherent to athletics. CASE REPORT: We report the case of a 20-year-old male Division 1 collegiate athlete with pleuritic chest pain diagnosed with PE despite being PERC negative. His presenting heart rate (HR) of 79 beats per minute was correctly determined to be tachycardic relative to his resting HR of 47-60 beats per minute. Despite his PERC negative status, PE was found after an elevated D-dimer and subsequent computed tomography angiography. CONCLUSION: Special consideration should be used when evaluating elite athletes for PE, as their resting physiology may differ from the general population. Additionally, certain risk factors for thromboembolic disease are inherent in competitive athletics and should be considered during an initial risk assessment. The presented patient was successfully treated with oral anticoagulation for three months and was able to return to play.

Point-of-care Ultrasound Diagnosis of Tennis Leg.

A 38-year-old male presented with left calf pain after a fall while skiing. Physical examination revealed tenderness over the gastrocnemius with a palpable mass and pain with resisted plantar flexion. Point-of care-ultrasound (POCUS) of the gastrocnemius was consistent with a muscle rupture, and we made a diagnosis of tennis leg. The patient was instructed to rest for two weeks, followed by a home rehabilitation program, and he was able to return to his normal activities. Here we present a case of tennis leg quickly and accurately diagnosed with POCUS, negating the need for additional advanced imaging.

Sunburn, Thermal, and Chemical Injuries to the Skin.

Sunburn, thermal, and chemical injuries to the skin are common in the United States and worldwide. Initial management is determined by type and extent of injury with special care to early management of airway, breathing, and circulation. Fluid management has typically been guided by the Parkland formula, whereas some experts now question this. Each type of skin injury has its own pathophysiology and resultant complications. All primary care physicians should have at least a basic knowledge of management of acute and chronic skin injuries.

Common injections in musculoskeletal medicine.

Musculoskeletal injections are a common procedure in primary care and sports medicine but can be intimidating for some clinicians. This article addresses current evidence for corticosteroid injections, and common injection indications and techniques, namely knee, subacromial bursa, glenohumeral joint, lateral epicondyle, de Quervain tenosynovitis, and greater trochanteric bursa injections. Preparation for injections and some evidence for ultrasound guidance are also reviewed.

Evaluation and treatment of sternoclavicular, clavicular, and acromioclavicular injuries.

Injuries to the clavicle and associated structures may involve fractures of the clavicle or injuries to the surrounding joints, usually from a blow to the shoulder. They present with variable signs and symptoms, requiring a thorough history and physical examination. Diagnosis typically involves plain radiographs but more advanced imaging may be required, especially in the case of sternoclavicular joint dislocations. Often, nonoperative management is indicated but, occasionally, surgical intervention is required. Due to the high incidence of clavicle injuries, it is paramount that the primary care physician be able to recognize, diagnose, and manage these injuries.