Musculoskeletal problems of the chest wall in athletes.

Chest pain in the athlete has a wide differential diagnosis. Pain may originate from structures within the thorax, such as the heart, lungs or oesophagus. However, musculoskeletal causes of chest pain must be considered. The aim of this review is to help the clinician to diagnose chest wall pain in athletes by identifying the possible causes, as reported in the literature. Musculoskeletal problems of the chest wall can occur in the ribs, sternum, articulations or myofascial structures. The cause is usually evident in the case of direct trauma. Additionally, athletes' bodies may be subjected to sudden large indirect forces or overuse, and stress fractures of the ribs caused by sporting activity have been extensively reported. These have been associated with golf, rowing and baseball pitching in particular. Stress fractures of the sternum reported in wrestlers cause pain and tenderness of the sternum, as expected. Diagnosis is by bone scan and limitation of activity usually allows healing to occur. The slipping rib syndrome causes intermittent costal margin pain related to posture or movement, and may be diagnosed by the 'hooking manoeuvre', which reproduces pain and sometimes a click. If reassurance and postural advice fail, good results are possible with resection of the mobile rib. The painful xiphoid syndrome is a rare condition that causes pain and tenderness of the xiphoid and is self-limiting. Costochondritis is a self-limiting condition of unknown aetiology that typically presents with pain around the second to fifth costochondral joints. It can be differentiated from Tietze's syndrome in which there is swelling and pain of the articulation. Both conditions eventually settle spontaneously although a corticosteroid injection may be useful in particularly troublesome cases. The intercostal muscles may be injured causing tenderness between the ribs. Other conditions that should be considered include epidemic myalgia, precordial catch syndrome and referred pain from the thoracic spine.

Shoulder injury in professional cricketers.

OBJECTIVE: To describe the impact of shoulder injuries on professional cricketers during the 2005 England and Wales first class cricket season. DESIGN: Professional cricketers in England were asked to complete two questionnaires relating to shoulder injuries. Players who returned both questionnaires were included in this study. MAIN OUTCOME MEASUREMENTS: The impact of any shoulder pain whilst playing cricket, impaired cricketing performance and shoulder injury related problems during training and activities of daily living. RESULTS: One hundred and fifty eight of a total of 378 players (42%) returned both questionnaires. Twenty-three per cent of the participants described shoulder injury during the 2005 season. Injury prevalence (the percentage of players not available for selection in a match due to shoulder injury) was 1.7%. Sixty-four per cent of shoulder injured players often or always had associated problems when fielding, and 58% of shoulder injured players fielded in a specific position to avoid shoulder injury related problems. Eighteen per cent of all study participants felt pain on throwing at some stage during the survey period. CONCLUSIONS: Professional cricketers generally play on with shoulder injuries without missing matches, though their performance, especially during fielding, is often compromised. Research into the diagnoses, aetiology, appropriate treatment and prevention of shoulder injuries in cricket is required.

Single photon emission computerized tomography and reverse gantry computerized tomography findings in patients with back pain investigated for spondylolysis.

BACKGROUND: Athletes with low back pain may have sustained a bone stress injury in the lumbar neural arch, including spondylolysis. Single photon emission computerized tomography (SPECT) and reverse gantry computerized tomography (rg-CT) help localize bone stress response and spondylolyses. OBJECTIVES: To describe the SPECT and rg-CT findings in those patients suspected of suffering from a spondylolysis. STUDY DESIGN: Large retrospective case series. SETTING: Secondary and tertiary care center in England. PATIENTS: A total of 213 patients presenting to the Spinal Unit and Sports Medicine Clinics between 1995 and 2000 with low back pain and subsequently investigated for spondylolysis by SPECT and rg-CT. METHODS: An experienced consultant musculoskeletal radiologist reported the SPECT and rg-CT, and these results along with data from the patient's medical records were analyzed. MAIN OUTCOME MEASURES: Sites and sides of increased scintigraphic activity in the lumbar neural arch seen on SPECT and complete and incomplete spondylolyses were recorded. RESULTS: Single photon emission computerized tomography scan showed increased scintigraphic uptake in 145 patients, mostly (42.3%) at L5. Marked increase in scintigraphic uptake was noted on the left side of the neural arch in 31 patients and on the right in 17 (chi; P < 0.05). Spondylolysis was identified on rg-CT in 81 patients. Spondylolyses were bilateral on 44 occasions, but unilateral lesions occurred in the left pars 36 times and on the right 16 times (chi; P < 0.01) CONCLUSIONS: Spondylolyses were a frequent finding on rg-CT in young athletes with low back pain. The sports most commonly associated with this stress response in the pars interarticularis were cricket and soccer. The lower lumbar levels are more likely to show abnormalities on SPECT and computerized tomography. Among those investigated for spondylolysis, left-sided lower lumbar pain was more common than right, and a marked increase in scintigraphic uptake was noted on the left more often than the right. Although bilateral spondylolyses were common, left-sided spondylolyses were more common than right. The asymmetric repetitive movements of certain sports may be responsible. In particular, fast bowlers developed spondylolysis on the opposite side of the body to their bowling arm.

Comparing injuries of spin bowling with fast bowling in young cricketers.

OBJECTIVE: To compare the incidence and anatomic distribution of injuries sustained in spin and fast bowling in young cricketers. DESIGN: A prospective cohort study. Physical characteristics and retrospective data (sporting involvement and previous injuries) from young cricketers were recorded. The cohort of young cricketers was divided according to style of bowling into a group of spin bowlers and a group of fast bowlers. Data from the spin bowler group was compared with the data from the fast bowler group to assess whether these groups were matched. A prospective study of injuries sustained by the bowlers was then undertaken. Data regarding cricket played and injuries sustained were collected by telephone questionnaire every 6 weeks for 6 months from each bowler. SETTING: Bowlers were recruited from young cricketers training at Centers of Excellence of 3 "First Class" Counties in England in January 1998. PARTICIPANTS: There were 42 spin bowlers and 70 fast bowlers. The mean age was 14.9 years (range 9 to 21 years). MAIN OUTCOME MEASURES: Injuries caused by bowling and interfering with bowling are included in incidence data. The number of deliveries bowled in matches and practice is used as the denominator for the reported incidence. RESULTS: Telephone follow-up was achieved when planned on 98.2% of occasions. There were 29 injuries meeting the criteria above. The incidence of injury in spin bowlers was 0.066 per 1,000 balls and 0.165 per 1,000 balls in fast bowlers (p = 0.097 Wilcoxon rank sum test). The incidence of injury (per 1,000 balls) at various anatomic sites in fast bowling was knee 0.057, ankle 0.043, low back 0.029, and shoulder 0.007. In spin bowlers, the site incidence was shoulder 0.055 and low back 0.011. The percentage with injuries at ankle, knee, and shoulder was significantly different (95% confidence intervals) for fast and spin bowlers. A significant difference was not found for lower back injuries. CONCLUSIONS: Incidence of injuries in fast bowling is greater than in spin bowling (but this was not a significant difference within the limits of this study). Low back injuries in fast bowlers have been the subject of published research. However, injuries in spin bowling have not previously been described, and this study indicates that shoulder injuries in wrist spinners merit further study.