Clinical and Diagnostic Characteristics of Calcaneal Apophysitis: A Systematic Review and Thematic Analysis.

BACKGROUND: Calcaneal apophysitis is an overuse injury in pediatric patients that causes heel pain and reduction in function. The aim of this study is to explore this condition and offer medical insight into its presentation and symptomatology, along with current treatment options. METHODS: We explored PubMed/Medline for studies involving calcaneal apophysitis in pediatric patients. The search included all articles published from database inception until June 1, 2021. We only included articles published in English. Clinical information and demographics extracted from the reported studies were analyzed and assessed. RESULTS: Only 28 studies met our criteria, with a total of 1,362 cases. Of the cases reported, 973 affected boys (71.4%). Presentation was bilateral in 589 cases (43.2%) and unilateral in 433 cases (31.8%). Radiographic imaging was used for the diagnosis of 358 cases (26.3%). All reported treatment modalities were conservative, and these included physical therapy and rest, kinesiotherapy and taping, and orthotic devices. A total of 733 cases (53.7%) reported improved outcomes,32 cases (2.3%) reported no improvement, and the remainder of cases did not report prognostic outcomes (44%). CONCLUSIONS: Calcaneal apophysitis is an overuse disease commonly found in the pediatric population. Educating parents and coaches with regard to its symptomatology, etiology, and treatment is essential to diagnose the condition earlier and provide better outcomes.

Intraoperative periprosthetic humeral fracture during reverse shoulder arthroplasty: a sequelae of prior biceps tenodesis.

Intraoperative periprosthetic humeral fractures are a rare but debilitating complication of reverse shoulder arthroplasty and can occur during multiple stages of the procedure. Prior biceps tenodesis has been found to reduce cortical humeral strength and predispose the patient to humeral fracture. We present a case of a 68-year-old female with a previous history of biceps tenodesis due to an irreparable rotator cuff tear. Months later, and after symptoms persisted, a reverse shoulder arthroplasty was performed. During the surgery and while performing final reduction, a fracture line was observed involving the hole used for the previous tenodesis procedure. The fracture was repaired, and the patient reported favorable outcomes. We report several factors that might have contributed to sustenance of this intraoperative fracture including prior biceps tenodesis, use of a press fit humeral stem, and the sex of the patient.

Upper limb injuries in mixed martial arts.

OBJECTIVE: Mixed-Martial-Arts(MMA) is a worldwide growing sport that incorporates different fighting styles and disciplines and is often associated with the Ultimate Fighting Championship(UFC) . The aim of this study is to explore the patterns and trends of upper limb injuries in MMA. METHODS: Ringside physician reports of the UFC fights between 2016 and 2019(inclusive) were extracted and screened from the Nevada State Athletic Commission(NSAC). The following variables were included: sex, weight division, injury mechanism, injury type, injury location, and type of finish. Injury rates were calculated and expressed per 100 athletic exposures (AE). An independent t-test, a one way analysis of variance(ANOVA), and a Joinpoint regression analysis were conducted to explore any significant differences or trends among variables. P-values<0.05 were considered significant(95% CI). RESULTS: A total of 81 upper limb injuries in 408 fights were recorded between 2016 and 2019. The injury rate was 9.9 injuries per 100 athletic-exposures(AE). Striking opponents was the most common mechanism of injury(p < 0.001). The hand was the most commonly injured location with an injury rate of 6.61 per 100AE(p < 0.001). Females had a higher upper limb injury rate than their male counterparts, but the difference failed to reach significance(p = 0.454). Similarly, no significant differences existed between rates of different types of injures. Matches ending with decision had the highest number of upper limb injuries with a rate of 12.6 per 100AE; however, no significant difference was determined between the rates of different ways of finish(p = 0.115). The strawweight(20.5 per 100AE), female flyweight(19.2 per 100AE), and male flyweight(13.8 per 100AE) divisions had the highest upper limb injury rates. CONCLUSION: The hand was the most commonly injured upper limb location in MMA, and 'striking opponent' was the most common injury mechanism. Increasing padding in gloves and implementing medical examinations during bouts can help reduce injury rates.

Predictors of postoperative pain, opioid consumption, and functionality after arthroscopic shoulder surgery: A prospective observational study.

PURPOSE: This study aims to identify predictors of postoperative pain and opioid consumption after shoulder surgery to help optimize postoperative pain protocols. STUDY DESIGN: Observational cohort study. METHODS: One thirty-four patients undergoing arthroscopic shoulder repair were included. Variables related to the patient, surgery and anesthesia were collected and correlated with postoperative pain intensity, analgesic consumption, and functionality up to 1-month post-surgery. We used mixed-effect linear models to estimate the association of gender, interscalene block (ISB), preoperative shoulder pain, non-steroidal anti-inflammatory drugs (NSAIDs) consumption before surgery, and type of surgery with each of the following outcomes: postoperative pain scores, opioid consumption, and functionality. We further analyzed the data for pain scores and opioid consumption per body weight using the multiple linear regression analysis to demonstrate the aforementioned associations specifically at 1 h, 6 h, 12 h, 24 h, 72 h, 1 week and 1 month after surgery. RESULTS: Omitting the ISB was associated with higher postoperative pain and cumulative opioid consumption over the first 24 h after surgery. Rotator cuff repair and stabilization surgeries were found to be predictive of higher postoperative pain at 24 h, 72 h, and 1 week and lower functionality at 1 week after surgery. Preoperative shoulder pain and NSAIDs consumption were also predictive of postoperative pain and cumulative opioid consumption. CONCLUSION: Omitting a single shot ISB is a strong predictor of postoperative pain and opioid consumption in the early postoperative phase, beyond which the type of surgery, particularly rotator cuff repair and stabilization surgery, emerges as the most important predictor of postoperative pain and functionality.

Physical Testing in Sports Rehabilitation: Implications on a Potential Return to Sport.

Strength and power constitute vital predictors for an individual's quality of life and athletic performance. Measurement of these two parameters is very important in the world of sports science and medicine and necessitates a high level of accuracy and reliability. Several tests are used to measure strength and power, including the isometric maximal voluntary contraction test, the 1-repetition maximum test, and the Wingate test, as well as other tests that target upper and lower limbs. The unique characteristics present in each of these tests entail a subsequently unique mode of application during the process of rehabilitation. This helps athletic trainers and medical personnel evaluate recovery and decide on a potential return to sport. A comprehensive holistic approach that includes multiple testing, psychosocial assessment, and a gradual return to activity is best to achieve promising outcomes and preinjury athletic levels. LEVEL OF EVIDENCE: V, expert opinion.

Stacked Biocomposite Screws in a Single-Stage Revision Anterior Cruciate Ligament Reconstruction Has Acceptable Fixation Strength in a Porcine Cadaveric Model.

BACKGROUND: Stacked screws is a commonly used technique in single-stage revision anterior cruciate ligament (ACL) reconstruction in the setting of bone loss, but there are limited data to support its use. HYPOTHESIS: Two configurations of a biocomposite stacked screws construct have similar fixation strength and linear stiffness as a primary ACL reconstruction construct in a biomechanical model. STUDY DESIGN: Controlled laboratory study. METHODS: A total of 30 porcine legs were divided into 3 groups. Group 1 underwent primary ACL reconstruction with a patellar tendon graft fixed into the femur, with an 8-mm biocomposite interference screw of beta-tricalcium phosphate and poly lactide-co-glycolide. For a revision ACL reconstruction model, groups 2 and 3 had bone tunnels created and subsequently filled with 12-mm biocomposite screws. New bone tunnels were drilled through the filler screw and the surrounding bone, and the patellar bone plug was inserted. Group 2 was fixed with 8-mm biocomposite screws on the side of the graft opposite the filler screw, while group 3 had the interference screw interposed between the graft and the filler screw. The construct was loaded at 1.5 mm/s in line with the tunnel until failure. Load to failure, linear stiffness, and mode of failure were recorded. RESULTS: The mean pullout strength for groups 1, 2, and 3 was 626 ± 145 N, 653 ± 152 N, and 720 ± 125 N, respectively (P = .328). The mean linear stiffness of the construct in groups 1, 2, and 3 was 71.4 ± 9.9 N/mm, 84.1 ± 11.1 N/mm, and 82.0 ± 10.8 N/mm, respectively. Group 2 was significantly stiffer than group 1 (P = .037). CONCLUSION: Two configurations of a biocomposite stacked screws construct for a single-stage revision ACL reconstruction in the setting of bone loss show a similar fixation strength and linear stiffness to a primary ACL reconstruction at time zero in a porcine model. CLINICAL RELEVANCE: In the setting of bone loss from tunnel malpositioning, a single-stage revision ACL reconstruction using a stacked screws construct may provide adequate fixation strength and linear stiffness.

Doping in the Ultimate Fighting Championship (UFC): A 4-year epidemiological analysis.

BACKGROUND: Doping is a practice that is present in many sports and organizations, including mixed martial arts and the Ultimate Fighting Championship (UFC). The aim of this study is to explore the epidemiological patterns of doping among UFC athletes. METHODS: We screened the official United-States-Anti-Doping-Agency® (USADA) website, the annual USADA reports and the official UFC website for information on fighters and anti-doping rule violations (ADRVs). Our dataset included gender, age, weight class, testing numbers, date of ADRV, type of ADRV, and duration of suspension. Appropriate statistical tests were conducted to assess for statistical significance. RESULTS: USADA tested 1070 UFC athletes 2624 times as of late 2015 up till the end of 2019 (N = 1070). A total of 209 adverse findings were recorded; out of which, 102 ADRVs were committed by 93 athletes (8.7%) from all weight divisions. This constituted an adverse finding rate of 16.55 per 1000 test and an ADRV rate of 8.08 per1000 test. Mean age of sanctioned athletes was 32 years. Use of anabolic steroids was significantly the most common ADRV recorded (p = 0.018). The men's heavyweight division had an ADRV rate of 19.3 per 1000 tests, significantly higher than that of women's bantamweight division at 2 per 1000 tests (p = 0.03), women's featherweight division at 0 per 1000 tests (p = 0.009), and men's flyweight division at 3 per 1000 tests (p = 0.035). ADRV rate showed a significantly increasing trend among men's weight divisions (p < 0.001). CONCLUSION: Doping is present in mixed martial arts. Increasing testing numbers, raising awareness and education on the risks of doping, and conducting further research on the issue is key to help resolve this problem.

Craniofacial and traumatic brain injuries in mixed martial arts.

Objective: Mixed-Martial-Arts (MMA) has witnessed a rapid growth over the recent years. This study aims to explore the patterns and trends of head injuries in MMA.Design: Descriptive epidemiological study.Setting: Ringside physician reports of the Ultimate Fighting Championship (UFC) fights between 2016 and 2019 (inclusive) were screened. Data were extracted from the Nevada State Athletic Commission (NSAC) database. Play-by-play video analysis was also conducted.Participants: UFC fighters involved in fights sanctioned by the NSAC, between 2016 and the end of 2019 (N = 816).Independent variables: Sex, location of head injury, type of head injury, injury mechanism, number of significant head strikes, type of finish, and weight division.Main outcome measures: Head injury rates were calculated. A one-way analysis of variance (ANOVA) was used to explore any statistically significant differences between injury rates of different locations, types, and types of finishes. An independent t-test was used to determine whether any significant differences existed between the two sexes, and a Joinpoint regression analysis was used to determine the statistical significance of the trends of head injury rates across different weight divisions. P-values <0.05 were considered significant (95% CI).Results: A total of 288 head injuries in 408 fights were recorded during our study period. Head injury rate constituted 35 injuries per 100 athletic-exposures (AE) in sanctioned fights. Traumatic brain injuries (TBI) were the most common type of injury, with a rate of 16 per 100AE, significantly greater than that of fractures (p = 0.003). Males had a head injury rate of 37 per 100AE, higher than that of females which was 23 per 100AE. Technical Knockout (TKO)/ Knockout(KO) was the type of finish with the highest rate of head injuries, significantly greater than that of decision or submission (p < 0.001). In general, head injury rates were higher as weight divisions increased.Conclusion: Head injuries are prevalent in MMA. Preventive measures need to be implemented to ensure fighter safety and limit injury risk.

Prevalence and patterns of shoulder injuries in Major League Baseball.

Background: This study aims to explore the epidemiological patterns of shoulder injuries in professional baseball.Methods: The transaction lists of the 'Major League Baseball' website were screened for injuries from 2011 to 2016, inclusive. Only players that were placed on the 'Disabled List' were included in the study. Our database included the player's position, injury location, injury cause, and time spent on the Disabled List.Results: A total of 3090 injuries were recorded; 511 (17%) were shoulder injuries, making it the most vulnerable anatomic location in baseball (N = 511). Of the 511 shoulder injuries, 132 (25.8%) were due to inflammation, making it the most common cited cause of shoulder injury. Most shoulder injuries occurred in April with 125 (24%) injuries, while June and May came in second and third with 89 (17%) and 81 (16%) injuries, respectively. The pitcher was the player most prone to injury, as it constituted 78% of the injuries. The average time spent off by a shoulder injury was 69 days, which implicated substantial economic losses for the injured athlete's club.Conclusion: Shoulder injuries are prevalent in professional baseball. The overhead pitching motion puts the shoulder at risk and accounts for the high incidence of its injuries.

Case report: Broad insertion of a large subscapularis tendon in association with congenital absence of the long head of the biceps tendon.

Congenital absence of the long head of the biceps (LHB) tendon is a rare variation in shoulder anatomy. The authors present a case of congenital absence of the long head of the biceps tendon associated with a large insertion of the subscapularis muscle. The patient initially presented with shoulder pain on overhead activity. Shoulder examination was negative for signs of a torn biceps tendon. MRI revealed congenital absence of the LHB tendon, a rim rent tear of the supraspinatus, and a large insertion of the subscapularis muscle. This is the first reported case describing a large insertion of the subscapularis muscle associated with absence of the LHB tendon.5.

Slipping Rib Syndrome: Solving the Mystery of the Shooting Pain.

Slipping rib syndrome is an often unrecognized and underdiagnosed condition caused by the increased mobility of the anterior ends of the costal cartilages of the false ribs. Patients usually present with severe intermittent abdominal pain that is exacerbated by various physical movements. Diagnosis of slipping rib syndrome is mainly clinical and can be confirmed by a physical examination technique termed the "Hooking Maneuver." Treatment includes conservative therapy, intercostal nerve block and surgical operation. Hence, the management and care plan of each patient must be individualized as per the presenting symptoms and medical history. Early recognition and prompt intervention necessitate that physicians be more aware of the symptomatology and prognosis of this condition. This study presents a rare case of a patient with slipping rib syndrome and offers medical insight to the clinical diagnosis and therapeutic modalities of this condition, in light of the current existing literature.

Biomechanics of the Acute Boutonniere Deformity.

PURPOSE: To demonstrate which structures of the extensor mechanism create a boutonniere deformity, when damaged, in a cadaver model. An analysis of how damage to these anatomical structures affects the biomechanical performance of the extensor mechanism was also performed. METHODS: We secured 18 fresh cadaveric hands onto an apparatus consisting of a computer-controlled motor and tensiometer attached in series to the extensor communis tendon of the ring and middle digits. The central slip, transverse, and oblique fibers of the interosseous hood and the triangular ligament were sequentially divided. After each structure was divided, the motors were activated to provide a constant tendon displacement force. The angular displacement at the proximal interphalangeal (PIP) and distal interphalangeal joints was recorded. RESULTS: In all digits, detachment of the central slip from the middle phalanx produced a decrease in extension of the PIP joint. When the transverse and oblique fibers of the interosseous hood were also divided, extension at the PIP joint was further decreased. A boutonniere deformity occurred only when all 3 structures were damaged. CONCLUSIONS: The boutonniere deformity requires subluxation of the lateral bands volar to the axis of rotation of the PIP joint. This study demonstrates that damage to the central slip alone does not cause the deformity. Combined injury of the central slip, triangular ligament, and transverse and oblique fibers of the interosseous hood causes a boutonniere deformity. CLINICAL RELEVANCE: Division of the central slip leads to loss of extension at the PIP joint. A more substantial loss of extension after injury or development of a boutonniere deformity should alert clinicians that other structures of the extensor mechanism are also damaged.

Sport and exercise medicine research activity in the Arab world: a 15-year bibliometric analysis.

BACKGROUND: The role of sports in decreasing the prevalence of many diseases has led to a growing interest in the field of sport and exercise medicine. But sport and exercise medicine still remains new to the Arab world, waiting to be explored. The aim of this study is to describe and characterise sport and exercise medicine research activity in the Arab world between 2002 and 2016. METHODS: The PubMed database was used to search for publications related to sport and exercise medicine. Publications were classified according to the country of origin and filtered to include publications between 2002 and 2016. Research output was analysed with respect to gross domestic product (GDP) and population of each country. RESULTS: A total of 1148 papers related to sport and exercise medicine were found to be published in the Arab countries between 2002 and 2016. Sport-and-exercise-medicine-related publications constituted 0.86% of the total biomedical research papers published in the Arab world and 0.49% of the world's sport and exercise medicine literature. The number of sport-and-exercise-medicine-related publications per country ranged from zero to 352, with Qatar occupying the top spot. Tunisia ranked first with respect to publications per average GDP, while Qatar ranked first with respect to publications per average population. Comoros, Mauritania, Somalia, Sudan and Yemen were found to have no publications related to sport and exercise medicine. CONCLUSION: Sport and exercise medicine is a novel field in the Arab world. Recognising the barriers facing sport and exercise medicine research and exploring them meticulously remains an essential part of the plan to improve the Arab world's output and contribution in this field.

Is intraarticular pathology common in patients with hip dysplasia undergoing periacetabular osteotomy?

BACKGROUND: Periacetabular osteotomy (PAO) enables correction of bony acetabular deficiency in the setting of hip dysplasia. Patients with insufficient acetabular coverage often have intraarticular pathology, but the degree of this pathology has been incompletely characterized. We have used arthroscopy as an adjunct to PAO to further delineate intraarticular pathology in patients with hip dysplasia with mechanical symptoms. QUESTIONS/PURPOSES: We documented the arthroscopic incidence of (1) femoral and acetabular chondral pathology, (2) femoral neck cam lesions, and (3) internal snapping or ligamentum teres pathology among patients having arthroscopy before PAO. METHODS: We reviewed all 16 patients (17 hips; mean age at surgery, 21 years; range, 12-33 years) with hip dysplasia who underwent PAOs and concomitant hip arthroscopy at our institutions from October 2010 to March 2012. During this period, 80 patients underwent PAOs, making the arthroscopic cohort 21% of the total cohort. Indications for concomitant hip arthroscopy were mechanical symptoms consistent with labral pathology identified on MRI. We documented pathology involving the labrum, chondral surface, ligamentum teres, cam deformity, and psoas tendon. RESULTS: Arthroscopy revealed significant intraarticular pathology in all patients. Fourteen hips had anterosuperior labral tears, and three hips had preoperative findings of internal snapping hip. Eleven hips had femoral cam-type lesions in addition to dysplasia, and 16 hips had articular chondral injury. Two hips had full-thickness ligamentum tears, and 13 hips had partial-thickness tears. CONCLUSIONS: Intraarticular pathology at the time of PAO is common. Future studies are needed to rigorously address the use of arthroscopic intervention during PAO and the impact on clinical outcome compared to PAO alone.

Dysfunctional expansion of hematopoietic stem cells and block of myeloid differentiation in lethal sepsis.

Severe sepsis is one of the leading causes of death worldwide. High mortality rates in sepsis are frequently associated with neutropenia. Despite the central role of neutrophils in innate immunity, the mechanisms causing neutropenia during sepsis remain elusive. Here, we show that neutropenia is caused in part by apoptosis and is sustained by a block of hematopoietic stem cell (HSC) differentiation. Using a sepsis murine model, we found that the human opportunistic bacterial pathogen Pseudomonas aeruginosa caused neutrophil depletion and expansion of the HSC pool in the bone marrow. "Septic" HSCs were significantly impaired in competitive repopulation assays and defective in generating common myeloid progenitors and granulocyte-monocyte progenitors, resulting in lower rates of myeloid differentiation in vitro and in vivo. Delayed myeloid-neutrophil differentiation was further mapped using a lysozyme-green fluorescent protein (GFP) reporter mouse. Pseudomonas's lipopolysaccharide was necessary and sufficient to induce myelosuppresion and required intact TLR4 signaling. Our results establish a previously unrecognized link between HSC regulation and host response in severe sepsis and demonstrate a novel role for TLR4.