Exercise Dependency and Overuse Injuries in Attention Deficit Hyperactivity Disorder.

ABSTRACT: Attention deficit hyperactivity disorder (ADHD) is a common condition, but current medications have limitations, pushing a drive for alternative approaches. Different exercise-focused approaches have shown promise, but concern has also been raised about individuals with ADHD showing greater risk of addiction, including exercise dependency. Using an online survey, we examined current exercise practices, including exercise dependency and the presence of overuse injury, which could result from overexercising, in 114 adults with ADHD. We found that most were regularly exercising. None were classified as exercise dependent, but 38.9% were deemed symptomatic nondependent. Hyperactive-impulsive symptoms were a predictor of the level of exercise withdrawal experienced, and the co-occurrence of autism spectrum disorder was associated with greater risk of overuse injuries. The data indicate that ADHD may confer some greater risk of exercise dependency, aligning with previous studies investigating other addictions and suggesting further research is critical.

[Accident-related and workplace-related vascular disorders of the hand]. / Unfall- und arbeitsplatzbezogene Erkrankungen der Hand mit gefäßmedizinischem Hintergrund.

BACKGROUND: Limited hand function as the result of occupational exposure or accidental injury could primarily be of vascular origin. Since it is quite rarely seen in the course of routine traumatology, special awareness of this is needed. AIM OF THE PAPER: The occupational diseases hypothenar/thenar hammer syndrome (occupational disease 2114) and vibration-induced vasospastic syndrome (occupational disease 2104) are presented on the basis of their etiological and pathogenetic characteristics, taking aspects of occupational medicine and expert opinion into consideration. DISCUSSION: Blunt force trauma to vascular structures of the hand can damage the tunica intima of the affected thenar or hypothenar arteries. Chronic exposure of the arms, hands and fingers to vibration can lead to the injury of nerve and vascular structures. Thermometry and pallesthesiometry are used in the diagnostics alongside methods of vascular medicine. CONCLUSION: Vascular entities can also play a role in the surgical assessment of the impact of an accident or of an occupational disease after exposure to vibration. Awareness of them can shorten the latency between the onset of symptoms and a definitive diagnosis.

Blocking CTGF/CCN2 reduces established skeletal muscle fibrosis in a rat model of overuse injury.

Tissue fibrosis is a hallmark of overuse musculoskeletal injuries and contributes to functional declines. We tested whether inhibition of CCN2 (cellular communication network factor 2, previously known as connective tissue growth factor, CTGF) using a specific antibody (termed FG-3019 or pamrevlumab) reduces established overuse-induced muscle fibrosis in a clinically relevant rodent model of upper extremity overuse injury. Young adult rats performed a high repetition high force (HRHF) reaching and lever-pulling task for 18 weeks, after first being shaped for 6 weeks to learn this operant task. Rats were then euthanized (HRHF-Untreated), or rested and treated for 6 weeks with FG-3019 (HRHF-Rest/FG-3019) or a human IgG as a vehicle control (HRHF-Rest/IgG). HRHF-Untreated and HRHF-Rest/IgG rats had higher muscle levels of several fibrosis-related proteins (TGFß1, CCN2, collagen types I and III, and FGF2), and higher muscle numbers of alpha SMA and pERK immunopositive cells, compared to control rats. Each of these fibrogenic changes was restored to control levels by the blocking of CCN2 signaling in HRHF-Rest/FG-3019 rats, as were HRHF task-induced increases in serum CCN2 and pro-collagen I intact N-terminal protein. Levels of cleaved CCN3, an antifibrotic protein, were lowered in HRHF-Untreated and HRHF-Rest/IgG rats, compared to control rats, yet elevated back to control levels in HRHF-Rest/FG-3019 rats. Significant grip strength declines observed in HRHF-Untreated and HRHF-Rest/IgG rats, were restored to control levels in HRHF-Rest/FG-3019 rats. These results are highly encouraging for use of FG-3019 for therapeutic treatment of persistent skeletal muscle fibrosis, such as those induced with chronic overuse.

Sport specialization is associated with upper-extremity overuse injury in high school baseball players.

BACKGROUND AND HYPOTHESIS: Sport specialization is increasingly common in youth sports and is a risk factor for lower-extremity overuse injuries. However, limited data exist on whether specialization is associated with upper-extremity (UE) overuse injuries, specifically in youth baseball players. We hypothesized that specialization in baseball and being a pitcher would be associated with poorer arm health and UE overuse injury history in the previous year. METHODS: During the 2019 spring baseball season, 551 high school baseball athletes (aged 15.9 ± 1.3 years) from 3 states (Alabama, n = 200; California, n = 188; and Michigan, n = 163) completed an anonymous questionnaire. Athletes were recruited from 5 high schools in each state, with schools matched based on factors that influence specialization rates. The questionnaire consisted of (1) demographic characteristics, (2) baseball participation information (including sport specialization status), and (3) throwing-arm health and UE injury history in the previous 12 months. Throwing-arm health was assessed using the Youth Throwing Score (YTS), a validated and reliable outcome measure for youth baseball players. Multivariate regression analyses were used to examine the association between variables of interest and the YTS or UE overuse injury history, adjusting for covariates. RESULTS: After adjustment for covariates, highly specialized athletes were more likely to report a UE overuse injury in the previous year compared with low-specialization athletes (odds ratio [OR], 3.77; 95% confidence interval [CI], 1.39-10.2, P = .009). Both athletes who reported playing baseball for more than 8 months per year (OR, 2.03; 95% CI, 1.12-3.65; P = .019) and athletes who reported being a pitcher (OR, 2.11; 95% CI, 1.20-3.72; P = .010) were more likely to report a history of UE overuse injury. Highly specialized players reported lower (worse) YTS values compared with low-specialization players (least-squares mean estimate ± standard error, 56.5 ± 1.1 vs. 53.3 ± 0.7; P = .034). Players who reported pitching as one of their positions scored worse on the YTS than non-pitchers (least-squares mean estimate ± standard error, 51.6 ± 0.8 vs. 57.2 ± 0.6; P < .001). CONCLUSION: Although baseball recommendations that discourage sport specialization are widely available for parents, athletes, and coaches, high rates of sport specialization were reported in our sample. We found that being highly specialized in baseball was associated with UE overuse injury history and worse throwing-arm health in high school baseball athletes. Continued education for baseball parents, athletes, and coaches is necessary to raise awareness of the risks associated with high specialization.

Joint contribution of rotation of the back and repetitive movements to disability pension using job exposure matrix data.

BACKGROUND: Heavy physical effort at work has been linked with disability pension, but the contribution of other ergonomic job exposures is less studied. We studied the independent and joint contributions of long-term exposure to (i) rotation of the back and (ii) repetitive movements to disability pension, particularly due to musculoskeletal disorders. METHODS: Exposures were measured with the Helsinki Health Study Job Exposure Matrix during 1996-2005 and linked to register data on employees of the City of Helsinki, Finland (n = 18 585). Outcomes were followed up during 2006-2015. Competing risk survival analyses were performed and synergy indices computed, adjusting for sociodemographic factors. RESULTS: Long-term exposure to rotation of the back was associated with disability pension due to any cause [age and sex-adjusted subhazard ratio (SHR) 2.39, 95% confidence interval (CI) 1.73-3.30], and specifically disability pension due to musculoskeletal disorders (SHR = 3.39, 95% CI 1.52-7.56) when compared to employees exposed to neither of the two exposures. Repetitive movements alone did not increase the risk of disability pension (all-cause SHR = 1.08, 95% CI 0.84-1.38, musculoskeletal SHR = 1.65, 95% CI 0.91-2.97). Employees with exposure to both rotation of the back and repetitive movements had the highest risk of disability pension due to musculoskeletal disorders (SHR = 5.98, 95% CI 3.85-9.28), but the interaction between exposures was additive rather than synergistic. Adjustment for education diluted the associations by 42-108%. CONCLUSION: Long-term exposure to awkward work postures increased the risk of disability pension. Educational inequalities largely account for differences in occupational exposures.

Fasciotomy for chronic exertional compartment syndrome of the leg: clinical outcome in a large retrospective cohort.

BACKGROUND: Chronic exertional compartment syndrome (CECS) is an overuse disorder typically affecting an athletic population. CECS is a diagnosis based on history and intracompartmental pressure (ICP) testing. CECS patients can be treated surgically by fasciotomy; however, research on the relationship between ICP and patient symptoms and also between ICP and patient-reported outcome post-fasciotomy is limited. This study aims to (1) assess functional outcome and patient satisfaction post-fasciotomy and (2) identify any potential correlation between ICP and reported levels of pain. METHODS: 138 CECS patients who had ICP measurements and subsequently underwent fasciotomy were identified from our regional service for exercise-induced lower limb extremity pain between January 2000 and March 2017. Clinical outcomes were recorded at the time of ICP testing and in the post-operative follow-up clinic. Pain was reported using a verbal rating scale (VRS) ('low', 'moderate' or 'high') or as a visual analogue score (VAS) 0-10 (0 = least painful, 10 = most painful). Spearman's ranked correlation test was used to calculate correlation between ICP and reported pain. RESULTS: A total of 138 patients were eligible for inclusion in this study (mean age 29.7 ± 9.7 years, 110 M, 28 F) of which 109 patients (VRS n = 61, VAS n = 48) reported pain level at pre- and post-operative stages. Mean pre-operative VAS score was 8.52 ± 0.71, and decreased to 0.77 ± 0.69 post-operatively. An insignificant positive correlation (r = 0.046, two-tailed p = 0.76) was found between VAS pain and ICP. A significant moderate positive correlation (r = 0.497, two-tailed p = 0.01) was found between VRS pain and ICP. CONCLUSION: Fasciotomy significantly reduces pain and increases activity levels in CECS patients. ICP was found to positively correlate with patient-reported pain.

A Review and Proposed Rationale for the use of Ultrasonography as a Diagnostic Modality in the Identification of Bone Stress Injuries.

Bone stress injuries are common in military personnel and athletes. The delayed diagnosis of a bone stress injury can lead to a more severe injury that requires a longer period of treatment. The early detection of bone stress injuries is a central part of management. Currently, the reference standard for detecting bone stress injuries is magnetic resonance imaging. However, the expanding use of point-of-care ultrasonography (US) may enable the early detection of bone stress injuries in the clinical setting. In this article, we review the US detection of bone stress injuries, as well as discuss the rationale for the use of US in the diagnosis of these injuries.

Surgery for subacromial impingement syndrome in relation to occupational exposures, lifestyle factors and diabetes mellitus: a nationwide nested case-control study.

OBJECTIVES: To estimate the risk of surgery for subacromial impingement syndrome (SIS) in relation to occupational exposures, lifestyle factors and diabetes mellitus. METHODS: We conducted a case-control study nested in a register-based cohort study of the Danish working population. For each of 3000 first-time cases of surgery for SIS, two age-matched and sex-matched controls were drawn. Cases and controls received a questionnaire on job history and other factors. Job histories were combined with a psychosocial job exposure matrix (JEM) and the updated Shoulder JEM, which provided exposure intensities on measurement scales. Ten-year cumulative exposures to upper arm elevation >90°, repetitive shoulder movements, forceful shoulder exertions and hand-arm vibrations (HAVs) were estimated. We used conditional logistic regression. RESULTS: There were 5396 persons (60%) who answered the questionnaire. For occupational mechanical exposures, the adjusted OR (ORadj) ranged from 1.9 (95% CI 1.5 to 2.5 for HAVs) to 2.5 (95% CI 1.9 to 3.5 for force) among men and 1.7 (95% CI 1.2 to 2.5 for HAVs) to 2.0 (95% CI 1.3 to 2.9 for force) among women. No statistically significant associations were found for occupational psychosocial factors. Body mass index (BMI) and pack-years of smoking showed ORadj up to 2.0. Diabetes mellitus showed ORadj of 1.5 (95% CI 1.1 to 2.2) for men and 2.2 (95% CI 1.4 to 3.4) for women. CONCLUSIONS: Our findings add to the evidence of an increased risk of surgery for SIS in relation to occupational cumulative mechanical exposures, even when an increased risk in relation to BMI, smoking and diabetes mellitus is taken into account.

Posterior interosseous nerve syndrome after pneumatic hammer use: An uncommon condition.

This case report presents a 27 year-old manual worker with right wrist extension deficit after pneumatic hammer handling. MRI and electromyographic studies revealed partial compromise of the posterior interosseous nerve (PIN) proximal to the branch for the extensor digitorum communis. The patient enrolled a 6-week rehabilitation period and recovered without remaing symptoms. PIN syndrome has mostly been associated with compressive neuropathies of the upper limb, but has seldom been reported in labor contexts. This case exemplifies an unusual presentation of PIN compression without a definite imaging diagnosis, where clinical presentation and electrodiagnostic studies are paramount for an accurate approach and understanding of the underlying condition.

Non-surgical treatment of pubic overload and groin pain in amateur football players: a prospective double-blinded randomised controlled study.

PURPOSE: The incidence of groin pain in athletes is steadily increasing. Symptomatic pubic overload with groin pain and aseptic osteitis pubis represent well-known and frequently misdiagnosed overuse injuries in athletes. This study investigated the benefits of standardised non-surgical treatment for swift return-to-football. METHODS: In a prospective double-blinded controlled study, 143 amateur football players with groin pain as well as radiological signs and clinical symptoms of pubic overload were analysed for 1 year. Two randomised study groups participated in an intensive physical rehabilitation programme, either with or without shock wave therapy. The control group did not participate in any standardised rehabilitation programme but only stopped participating in sports activity. Follow-up examinations took place 1, 3 months and 1 year after the beginning of therapy. Endpoints were visual analogue scale (VAS), functional tests, the time of return-to-football, recurrent complaints and changes in the MR image. RESULTS: Forty-four football players with groin pain and aseptic osteitis pubis were randomised into two study groups; 26 received shock wave therapy, 18 did not. Clinical examination showed pubic overload as a multi-located disease. Players receiving shock wave therapy showed earlier pain relief in the VAS (p < 0.001) and returned to football significantly earlier (p = 0.048) than players without this therapy. Forty-two of 44 players of both study groups returned to football within 4 months after the beginning of therapy and had no recurrent groin pain within 1 year after trauma. Fifty-one players of the control group returned to football after 240 days (p < 0.001), of whom 26 (51%) experienced recurrent groin pain. Follow-up MRI scans did not show any effect of shock wave therapy. CONCLUSION: Non-surgical therapy is successful in treating pubic overload and osteitis pubis in athletes. Shock wave therapy as a local treatment significantly reduced pain, thus enabling return-to-football within 3 months after trauma. Early and correct diagnosis is essential for successful intensive physiotherapy. LEVEL OF EVIDENCE: I.

Chronic Exertional Compartment Syndrome in Athletes.

Chronic exertional compartment syndrome (CECS) refers to exercise-induced, reversible increases in pressure within well-defined inelastic fascial compartments leading to compromised tissue perfusion followed by functional loss, ischemic pain, and neurologic symptoms. Symptoms typically resolve when the activity ceases and there are usually no permanent sequelae. In the upper extremity, this condition most commonly affects athletes during sports requiring repetitive and vigorous gripping, such as rowers. In addition to clinical history and examination, a number of methods aid diagnosis, including compartment pressure measurements, magnetic resonance imaging, and near infrared spectroscopy. When symptoms persist despite conservative treatment, multiple operative techniques have been described to treat CECS including open, mini-open, and endoscopic release of involved compartments. We review the pathophysiology, diagnostic modalities, treatment strategies, and outcomes data for CECS of the upper extremity while highlighting areas of residual controversy.

Proliferative myositis of the latissimus dorsi presenting in a 20-year-old male athlete.

We describe the case of a 20-year-old rower presenting with an uncommon condition of Proliferative Myositis (PM) affecting the Latissimus Dorsi (LD). PM is a rare, benign tumour infrequently developing in the upper back. Its rapid growth and firm consistency may mistake it for sarcoma at presentation. Therefore, careful multidisciplinary work-up is crucial, and should involve appropriate radiological and histopathological investigations. Here, we propose the aetiology of LD PM to be persistent myotrauma induced by repetitive rowing motions. Symptoms and rate of progression ultimately determine the management which includes surveillance and/or conservative resection. There have been no documented cases of recurrence or malignant transformation.

Prevalence and proposed mechanisms of chronic low back pain in baseball: part i.

The prevalence of low back pain (LBP) among active baseball players ranges between 3 and 15%. The execution of baseball-specific manoeuvres, such as pitching or batting, may be related to the onset of LBP. These baseball motions are complex and require appropriate activation of the core musculature to produce a well-timed motion with forces minimized at the extremities. The spine, core and back musculature are involved with acceleration and deceleration of rotational motions. This narrative review synopsizes the available evidence of the prevalence of and mechanical factors underlying LBP in the baseball population. Possible mechanical mechanisms linking baseball play to LBP include aberrant motion, improper timing, high lumbar stress due to mechanical loading and lumbopelvic strength deficits. Potential clinical implications relating to these possible mechanical mechanisms will also be highlighted. The state of the evidence suggests that there are deficits in understanding the role of baseball motion and playing history in the development of spine conditions.

Effectiveness of dry needling and high-volume image-guided injection in the management of chronic mid-portion Achilles tendinopathy in adult population: a literature review.

Achilles tendinopathy is a common overuse condition affecting the adult population. The incidence is on the rise because of greater participation of people in recreational or competitive sporting activities. There are several treatment options available both non-operative and operative. Ultrasound-guided dry needling and high-volume image-guided injection is relatively a new procedure. The aim of this study was to find out the effectiveness of dry needling and HVIGI in the management of mid-portion chronic Achilles tendinopathy by performing a literature review. Search strategy was devised to find the suitable articles for critical appraisal using the electronic databases. Four articles were selected for critical appraisal, and these papers showed good short- to long-term results of image-guided high-volume injection in the management of Achilles tendinopathy. We conclude that high-volume image-guided injection is effective in the management of Achilles tendinopathy. It provides good short- and medium-term relief of symptoms. It should be considered as one of the many options available for this condition.

Inability to perform because of pain/injury in elite adult Irish dance: A prospective investigation of contributing factors.

Previous research in Irish dancing (ID) has recorded high levels of pain/injury. Screening protocols in other genres have been developed to identify at-risk dancers. The aims of the study were to examine the factors that relate to absence from dancing because of musculo-skeletal pain/injury in ID, and to inform guidelines for the development of an evidence-based screening protocol. Baseline subjective data (n = 85) and physical data (n = 84) were gathered. Subjects completed a monthly online questionnaire for 1 year providing data on general physical and psychological health and rates of pain/injury. Subjects were allocated to a "More Time Absent (MTA)" or "Less Time Absent (LTA)" category depending on their duration of absence from performance over the year. Eighty-four subjects completed the year-long follow-up (MTA: n = 32; LTA: n = 52). Two hundred seventy-eight complaints of pain/injury were recorded. Factors significantly associated with membership of the MTA group included greater anger-hostility (P = 0.003), more subjective health complaints (P = 0.026), more severe previous pain/injury (P = 0.017), more general everyday pain (P = 0.020), more body parts affected by pain/injury (P = 0.028), always/often dancing in pain (P = 0.028), and insufficient sleep (P = 0.043). Several biopsychosocial factors appear to be associated with absence from ID because of pain/injury. Biopsychosocial screening protocols and prevention strategies may best identify at-risk dancers.

[Pachydermodactyly : A rare but benign consequence of repetitive movement patterns]. / Pachydermodaktylie : Eine seltene und benigne Folge repetitiver Bewegungsabläufe.

Pachydermodactyly is an acquired swelling of the lateral aspects of the fingers and is thought to be a reactive pattern due to exogenous factors, such as repetitive mechanical friction. We describe the clinical case of a 17-year-old male patient who presented with the typical symptoms of pachydermodactyly.

The Application of Tensegrity Massage in a Professionally Active Musician - Case Report.

PURPOSE: The purpose of our study was to present options for the application of tensegrity massage to manage pain caused by the overload of soft tissues in musicians. DESIGN: Tensegrity massage was applied to a 34-year-old male violinist. METHODS: The methodology included a correct positioning and tensegrity massage with individually designed procedure. FINDINGS: After therapy, the patient achieved complete pain relief, and relaxation of muscles in the shoulder girdle and free part of the upper arm. The analgesic effect lasted for 6 months after the end of therapy. CONCLUSIONS: Massage is an effective method in eliminating pain caused by the overload of soft tissues. If used regularly before physical effort, it can prevent muscle overload. CLINICAL RELEVANCE: The presented massage procedure is an effective therapy in pain caused by the overload of soft tissues in musicians and it can be one of the elements of complex physiotherapy in active musicians.

General population job exposure matrix applied to a pooled study of prevalent carpal tunnel syndrome.

A job exposure matrix may be useful for the study of biomechanical workplace risk factors when individual-level exposure data are unavailable. We used job title-based exposure data from a public data source to construct a job exposure matrix and test exposure-response relationships with prevalent carpal tunnel syndrome (CTS). Exposures of repetitive motion and force from the Occupational Information Network were assigned to 3,452 active workers from several industries, enrolled between 2001 and 2008 from 6 studies. Repetitive motion and force exposures were combined into high/high, high/low, and low/low exposure groupings in each of 4 multivariable logistic regression models, adjusted for personal factors. Although force measures alone were not independent predictors of CTS in these data, strong associations between combined physical exposures of force and repetition and CTS were observed in all models. Consistent with previous literature, this report shows that workers with high force/high repetition jobs had the highest prevalence of CTS (odds ratio = 2.14-2.95) followed by intermediate values (odds ratio = 1.09-2.27) in mixed exposed jobs relative to the lowest exposed workers. This study supports the use of a general population job exposure matrix to estimate workplace physical exposures in epidemiologic studies of musculoskeletal disorders when measures of individual exposures are unavailable.

Rotator cuff tears in young patients: a different disease than rotator cuff tears in elderly patients.

BACKGROUND: The purpose of this study was to conduct a systematic review of the literature to evaluate the characteristics of injury and treatment outcomes of rotator cuff tears in young patients. METHODS: A systematic electronic search was performed for clinical studies evaluating rotator cuff tears in patients younger than 40 years with special emphasis on reporting of injury characteristics and treatment outcomes with a minimum 1-year follow-up. RESULTS: Twelve studies (involving 336 patients) met inclusion criteria. The mean age of the patients was 28 years (range, 16-40 years), with a mean follow-up of 39 months. There were 2 distinct subgroups. The majority of studies (7 of 10) showed that patients typically had a full-thickness tear with an acute traumatic etiology. However, within the subgroup of elite throwers, 5 of 6 studies demonstrated a majority of tears that were partial thickness stemming from chronic overuse. Rotator cuff repair improved pain and strength in almost all studies reporting on these parameters. Eighty-seven percent of patients reported they were satisfied. However, all studies examining elite throwers showed significant difficulty in returning to play (25%-97%). CONCLUSIONS: In young patients with rotator cuff tears, there are 2 primary groups. (1) A majority group with rotator cuff tears of traumatic origin responded well to both arthroscopic and open rotator cuff repair in terms of pain relief and self-reported outcomes postoperatively. These patients reported high levels of satisfaction and return to preinjury level of play. (2) A unique subpopulation composed of elite throwers had improved outcomes but suboptimal return to play.

Peripheral Neuropathies in Nonparetic Upper Extremities of Stroke Patients Induced by Excessive Use of a Walking Device.

BACKGROUND: Poststroke patients reportedly experience entrapment neuropathies in the nonparetic upper extremities, and the use of an assistive device for long periods may increase this risk. We examined nerve conduction velocities in hemiparetic patients and investigated the relationship between abnormal measurements and duration of walking. METHODS: Twenty-eight male hemiparetic outpatients who used a cane or a crutch participated in this study. Clinical characteristics such as age, period of time from stroke onset, side and severity of paresis, activities of daily living, and basic ability to walk, as well as each patient's approximate number of hours walking per day, were collected. Electrophysiological evaluation was performed via nerve conduction studies of the median, ulnar, and radial nerves. The clinical features were compared between patients with and without peripheral neuropathies. RESULTS: Twelve patients (43%) had peripheral neuropathies involving a total of 15 nerves. There was no difference in age, duration of hemiparesis, side and severity of paresis, Barthel index, and Functional Ambulation Classification between the 2 groups. Abnormalities were absent in the patients who walked at or less than an hour but were present in 50% and 63.4% of patients with walking times of 1-2 hours and more than 2 hours, respectively. CONCLUSIONS: Excessive use of a T-cane or a Lofstrand crutch was hypothesized to induce entrapment neuropathies in the nonparetic upper extremity. To prevent these injuries, a well-balanced gait should be established to reduce the load on the walking device.