MRI bone marrow oedema precedes lumbar bone stress injury diagnosis in junior elite cricket fast bowlers.

OBJECTIVES: Lumbar bone stress injury ('bone stress injury') is common in junior fast bowlers. The repetitive loading of cricket fast bowling may cause bone marrow oedema (BMO), detectable on MRI, before the bowler suffers from symptomatic bone stress injury. We investigated the temporal relationship between BMO, bone stress injury, along with bowling workload correlates, in elite junior fast bowlers throughout a cricket season. METHODS: 65 junior fast bowlers were prospectively monitored for one 8-month cricket season. For research purposes, participants had up to six MRI scans at set times in the season; findings were withheld from them and their clinicians. Standard practices for bowling workload monitoring and injury diagnosis were followed. RESULTS: 15 (23%) participants developed bone stress injury during the study. All 15 of these participants had BMO detected on at least one of the preceding MRI scans, including the scan immediately prior to diagnosis. The risk of BMO progressing to bone stress injury during the season was greatest for participants with BMO present 2 weeks prior to the national championship tournament (period of high load) (RR=18.9, OR=44.8). Both bone stress injury and BMO were associated with bowling a higher percentage of days in training and having a shorter bowling break during the season. The number of balls bowled and acute-to-chronic workload were not associated with imaging abnormalities or injury. CONCLUSION: The presence of BMO on MRI in asymptomatic junior cricket fast bowlers confers a very high risk for bone stress injury. The risk may be managed by MRI screening and monitoring bowling frequency.

Common Ice Hockey Injuries and Treatment: A Current Concepts Review.

Injuries are common in ice hockey, a contact sport where players skate at high speeds on a sheet of ice and shoot a vulcanized rubber puck in excess of one hundred miles per hour. This article reviews the diagnoses and treatment of concussions, injuries to the cervical spine, and lower and upper extremities as they pertain to hockey players. Soft tissue injury of the shoulder, acromioclavicular joint separation, glenohumeral joint dislocation, clavicle fractures, metacarpal fractures, and olecranon bursitis are discussed in the upper-extremity section of the article. Lower-extremity injuries reviewed in this article include adductor strain, athletic pubalgia, femoroacetabular impingement, sports hernia, medial collateral and anterior cruciate ligament tears, skate bite, and ankle sprains. This review is intended to aid the sports medicine physician in providing optimal sports-specific care to allow their athlete to return to their preinjury level of performance.

Frequency and cost of claims by injury type from a state workers' compensation fund from 1998 through 2008.

OBJECTIVE: To determine which work-related injuries are the most frequent and costly. DESIGN: Secondary analysis of workers' compensation claims data. SETTING: Data were provided by a large, Maryland workers' compensation insurer from 1998 through 2008. PARTICIPANTS: Not applicable. INTERVENTIONS: None. MAIN OUTCOMES MEASURES: For 45 injury types, the number of claims and compensation amount was calculated for total compensation and for medical and indemnity compensation separately. RESULTS: Back and knee injuries were the most frequently occurring single injury types, whereas heart attack and occupational disease were the most expensive in terms of mean compensation. When taking into account both the frequency and cost of injury (mean cost × number occurrences), back, knee, and shoulder injuries were the most expensive single injury types. CONCLUSIONS: Successful prevention and management of back, knee, and shoulder injuries could lead to a substantial reduction in the burden associated with work-related injuries.

Common injuries and medical problems in singles figure skaters.

Figure skating continues to increase in popularity as both a recreational and competitive sport. Skaters continue to "push the envelope" in perfecting more technically difficult skills. With their strenuous training programs, skaters are at risk from chronic overuse injuries, which tend to plague singles skaters more often than acute injuries. The majority of injuries occur in the lower extremities or low back. Figure skaters also are at risk for particular medical problems, such as exercise-induced bronchospasm and disordered eating. Sports Medicine physicians are sure to encounter figure skaters and their "Sports-specific problems" in their practice and should be knowledgeable about the common maladies that can plague figure skaters. This article reviews the most common injuries and medical problems in singles figure skaters.

An unusual case of firearm injury: bullet lodged in the tongue.

Firearm-related injuries are a major problem worldwide, in forensic medicine practice. and unusual presentation of bullet trajectory can create surgical or medico-legal diagnostic problems. A 23-year-old man suffered two gunshot wounds, was taken to emergency department immediately after the incident. Physical examination revealed two entrance gunshot wounds on the left lumbar region under the lower margin of left scapulae and right gluteal region. An exit wound was defined on the lateral side of the right gluteal region which was located 5 cm distance of entrance wound. Radiological investigation showed a bullet in the tongue without any life threatening impairment. A thoracic CT scan and abdominal USG were normal. Following the initial examinations he was hospitalized and the bullet removed from the tongue by a simple surgical operation. An interesting case of gunshot injury where the passage route of bullet extending along from upper posterior part of the left lumbar region to the tongue without vital organ injury or serious disability has been reported.

Evaluation of the athlete with buttock pain.

Buttock (gluteal) pain is commonly experienced by athletes of all ages and activity levels. Evaluation of buttock pain can be challenging because the differential diagnoses are extensive. Symptoms may originate from the pelvis or hip or be referred from the lumbosacral spine or neurovascular structures. Few articles in the literature are dedicated to the primary complaint of buttock pain. The purpose of this article is to provide a clinical algorithm to assist the sports clinician in reaching an accurate diagnosis and initiating the appropriate treatment.

Lower preseason reactive strength index scores are associated with injury in female collegiate volleyball players but not male collegiate basketball players.

OBJECTIVES: Functional tests are used by sports medicine professionals to discriminate injury risk in athletes. One test that has shown promise is the drop vertical jump (DVJ); however, it is primarily used to evaluate measures associated with anterior cruciate ligament injury. The DVJ test can also be used to calculate the reactive strength index (RSI); a measure used to assess an athlete's power. The ability of the RSI to discriminate injury risk is unknown. The purpose of this study was to prospectively evaluate the ability of preseason RSI scores to identify athletes at risk for a noncontact time-loss injury to the low back or lower extremities. DESIGN: Prospective cohort. METHODS: One hundred and fifty-five male collegiate basketball (BB) players and 117 female collegiate volleyball (VB) players were recruited for this study. DVJ tests were performed in a motion capture lab. RESULTS: Female VB players with a RSI 0.9125m/s or less (30.48cm box) were 4 times (relative risk=4.2 [95% CI: 1.0, 17.7]; p-value=0.024) more likely to be injured. There was no association between preseason scores and injury in the male BB athletes. CONCLUSION: RSI scores should be collected for female collegiate VB players as part of a preseason screen.

Coati (Nasua nasua) attacks on humans: case report.

Coatis [including Nasua nasua, the ring-tailed coati], are medium-sized mammals widely distributed in the Americas. They are social animals, whose normal diet includes insects, fruits, and small vertebrates, and rarely prey on larger sized animals. There are, to our knowledge, no reports in the medical literature of attacks on humans. This report describes a coati attack on 2 children in their home. The children sustained deep scratches and bites. The animal may have injured the humans in a defensive strike, but motivation for attack was uncertain. Coati attacks may occur in places where there is interaction between these mammals and humans.

Back Injuries.

When searching for evidence-based answers about treating athletes with low back injury/pain, there are some difficulties. The first is defining who is an athlete. The second problem is that the lifetime prevalence of low back pain in the general population in our country approaches 100. Last, most studies published only deal with a narrow population of athletes, often performing very different types of physical activity. We searched the literature for studies that specifically evaluated athletes longitudinally. This article reviews the demographics, diagnostic challenges, history and physical examination, imaging choices, treatment, and controversies encountered when treating this population.

Course, diagnosis, and treatment of depressive symptomatology in workers following a workplace injury: a prospective cohort study.

OBJECTIVES: To estimate prevalence, incidence, and course of depressive symptoms and prevalence of mental health treatment following a workplace injury, and to estimate the association between depressive symptoms and return-to-work (RTW) trajectories. METHOD: In a prospective cohort study, workers filing a lost-time compensation claim for a work-related musculoskeletal disorder of the back or upper extremity were interviewed 1 month (n = 599) and 6 months (n = 430) postinjury. A high level of depressive symptoms was defined as 16 or more on the self-reported Center for Epidemiologic Studies-Depression (CES-D) Scale. The following estimates are reported: prevalence of high depressive symptom levels at 1 and 6 months postinjury; incidence, resolution, and persistence of high depressive symptom levels between 1 and 6 months; and prevalence of self-reported mental health treatment and depression diagnosis at 6 months postinjury. RESULTS: Prevalence of high depressive symptom levels at 1 month and 6 months postinjury were 42.9% (95% CI 38.9% to 46.9%) and 26.5% (95% CI 22.3% to 30.7%), respectively. Among participants reporting high depressive symptom levels at 1 month postinjury, 47.2% (95% CI 39.9% to 54.5%) experienced a persistence of symptoms 6 months postinjury. By 6 months, 38.6% of workers who never returned to work or had work disability recurrences had high depressive symptom levels, compared with 17.7% of those with a sustained RTW trajectory. At 6-month follow-up, 12.9% (95% CI 5.8% to 20.1%) of participants with persistently high depressive symptom levels self-reported a depression diagnosis since injury and 23.8% (95% CI 14.7% to 32.9%) were receiving depression treatment. CONCLUSIONS: Depressive symptoms are pervasive in workers with musculoskeletal injuries, but transient for some, and seldom diagnosed as depression or treated.

Functional scores and subjective responses of injured workers with back or neck pain treated with chiropractic care in an integrative program: a retrospective analysis of 100 cases.

OBJECTIVE: The purpose of this study is to report on integrative care for the treatment of injured workers with neck or back pain referred to a doctor of chiropractic from a medical or osteopathic provider. METHODS: This retrospective case series study evaluated data on 100 patients referred for chiropractic care of work-related spinal injuries involving workers' compensation claims. Deidentified data included age, sex, visual analog scale scores for pain, pre- and posttreatment Functional Rating Index (FRI) scores, and subjective response to chiropractic care. Based on date of injury to first chiropractic treatment, patients were subdivided as acute, subacute, or chronic injured workers. Cases were analyzed for differences in pretreatment FRI scores, posttreatment FRI scores, FRI change scores (posttreatment FRI minus pretreatment FRI score), and subjective percentage improvement using a 1-way analysis of variance. Treatment included manual therapy techniques and exercise. RESULTS: Injured workers with either an acute or subacute injury had significantly lower posttreatment FRI scores compared with individuals with a chronic injury. The FRI change scores were significantly greater in the acute group compared with either the subacute or chronic injured workers. Workers in all categories showed improved posttreatment tolerance for work-related activities and significantly lower posttreatment subjective pain scores. CONCLUSIONS: The study identified positive effects of chiropractic management included in integrative care when treating work-related neck or back pain. Improvement in both functional scores and subjective response was noted in all 3 time-based phases of patient status (acute, subacute, and chronic).

[Diagnostic image (357). A man with a knife in his back]. / Diagnose in beeld (357). Een man met een mes in de rug.

A 28-year-old man walked into the emergency room with two stab wounds and a kitchen knife still in his back of which the point was located in L11.

Overuse Injuries Among Female Combat Warriors in the Israeli Defense Forces: A Cross-sectional Study.

Introduction: Integration of females in combat units poses a unique challenge for army commanders around the world. The purpose of this study is to provide a detailed up-to-date situation report regarding overuse injuries among combat female warriors in the IDF (Israeli Defense Forces) in order to enable evidence-based decision-making, prevention policy, and further research of this highly significant military public health issue. Methods: A cross-sectional descriptive study was conducted including 2,519 females recruited to combat duties during the year of 2013. The main data source was the IDF's computerized medical consultation records package (CPR). Descriptive statistics was performed and some results were compared with males using data from other reports and studies of the IDF. Results: The overall injury rate was 28.3%. Of all injuries, 86% were in the ankle and calf (41%), the lower back (23%), and the knee (22%) regions. The average lost training days was 11 d for females as compared with 8 d for males. The overall rates of stress fractures and the rates of femur and femoral neck stress fractures were significantly higher among females as compared with males (11.2% vs. 2.5%, p = 0.0032, and 7.8% vs. 1.6% p = 0.00001, respectively). Conclusions: The overuse injury rates among females in the IDF are high and may be considered a significant military public health problem. In order to reduce the numbers of overuse injuries, which is expected to significantly increase after the IDF's policy change regarding to combat duties open for females, we recommend planning and implementation of policies and intervention programs and further research regarding to overuse injuries among female combat warriors with special focus on the calf and ankle, lower back, and knee regions and femoral stress fractures.

What is the optimal observation time for a penetrating wound to the flank?

Options for a hemodynamically stable patient with a penetrating wound to the flank or back but no peritonitis, includes serial physical examinations versus a triple-contrast CT scan. There is, however, little consensus on the minimum time for serial examinations to exclude an injury that requires an operation. Therefore, a retrospective review of patients who sustained a penetrating wound to the flank or back and were admitted to a Level I trauma center was performed. Patients were identified through the trauma registry, patient charts, and morbidity/mortality records. From 1995 to 2003, 93 patients undergoing observation for a penetrating flank/back wound subsequently required a therapeutic laparotomy. The time from admission to operation was less than 3 hours for 84 per cent of the patients requiring therapeutic intervention. A further 10 per cent presented with symptoms between 4 to 6 hours, and 6 per cent between 7 to 18 hours. All the injuries caused symptoms within 18 hours of the injury event. The majority of patients (94%) who require a laparotomy after a period of observation for a penetrating flank/back wound will develop signs and symptoms within 6 hours of admission. A period of hospitalization longer than 18 hours did not detect further injuries in the asymptomatic patient.

When golf hurts: musculoskeletal problems common to golfers.

Golfers most frequently report injuries to the low back, nondominant shoulder, and elbow. Injury patterns differ between elite and recreational golfers; professional and elite golfers tend to experience golf injury related to overuse while amateur golfers may experience injury related to adverse swing technique and overuse. Therapeutic interventions should include assessment and treatment of deficiencies in the kinetic chain and professional instruction to modify swing technique. Changes in the swing may include instruction in a more efficient technique or shortening the swing to decrease biomechanical forces affecting the injured area.

Primary identification of an abused child in dental office: a case report.

Although the injuries of child abuse are many and varied, several types of injuries are common to abuse. Many of these injuries are within the scope of dentistry or easily observed by the dental professional in the course of routine dental treatment. The authors present a case of child abuse with multiple bruises. The child had been spanked in the previous night and the morning of the attendance by his mother. This case emphasized that all practitioners should be vigilant when patients present with abnormal injuries which may be the result of abuse and further investigation should be instigated.

Spine Conditions: Mechanical and Inflammatory Low Back Pain.

Mechanical low back pain (LBP) is an injury or derangement of an anatomic structure in the low back. When evaluating patients with LBP, clinicians should maintain clinical suspicion for vertebral fracture, cancer, and cauda equina syndrome. Management includes patient education focused on exercise, massage, and behavioral approaches such as cognitive behavioral therapy. Acupuncture can be an effective alternative and specific herbal supplements may provide short-term pain relief. The prognosis for patients with mechanical LBP is good. Inflammatory LBP is pain resulting from a systemic inflammatory condition, often referred to as axial spondyloarthritis. Ankylosing spondylitis is chronic inflammatory LBP characterized by early onset (mean age 24 years), with a higher prevalence in men. Five clinical parameters can help identify inflammatory LBP: improvement with exercise, pain at night, insidious onset, onset at younger than 40 years, and no improvement with rest. Management of inflammatory LBP typically includes nonsteroidal anti-inflammatory drugs and structured exercise programs, with emphasis on the involvement of a rheumatology subspecialist. Spondyloarthritis is associated with other rheumatic or autoimmune conditions, including rheumatoid arthritis, inflammatory bowel disease, and psoriasis. These should be considered when evaluating patients with inflammatory LBP.

Use of Physical Therapists to Identify and Treat Musculoskeletal Injuries at "The Tip of the Trident".

Musculoskeletal injuries continue to be the most common cause of decreased readiness and loss of productivity in all military environments. In commands with smaller footprints, such as Naval Special Warfare (NSW), every asset is critical for mission success. Studies have shown that early intervention by a medical provider can enhance healing and maintain unit readiness by preventing medical evacuations. Reports are limited with regard to Special Forces commands, especially during deployment. This article describes the injury characteristics and treatment of injuries seen by a physical therapist while deployed at forward operation commands embedded with NSW Group 2 Team 4. Over 4 months, 282 patients were evaluated and treated in southeast Afghanistan. In descending order, the three most common injured body regions were the lumbar/sacral spine (n = 82), shoulder (n = 59), and knee (n = 28). Therapy exercises (n = 461) were the most frequently performed treatment modality, followed by mobilization/manipulation (n = 394) and dry needling (n = 176). No patient evaluated was medically evacuated from the area or sent to an advanced medical site. Our data are similar to other published data reported on deployed units in terms of mechanisms and locations of injuries; thus, Special Forces commands do not appear to have unique injury patterns. These results support continued use of physical therapists in forward operations because of their ability to evaluate injuries and provide treatment modalities that help maintain the integrity of small commands at the site of injury.