Pediatric and Adolescent Figure Skating Injuries: A 15-Year Retrospective Review.

OBJECTIVE: To analyze the characteristics of injuries sustained by young figure skaters who were evaluated at regional pediatric sports medicine clinics. DESIGN: Retrospective chart review (2003-2017). SETTING: Sports medicine clinics at a tertiary-level pediatric medical center. PATIENTS: Two hundred ninety-four figure skaters (271 female and 23 male). Age rage: 9 to 19 years. Mean age: 14.2 ± 2.3 years. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Mechanism of injury (acute vs overuse), injured body areas, diagnoses for most commonly injured body areas, and distribution of bone stress injuries. RESULTS: Eight hundred sixty-four figure skating-related injuries were identified. Approximately 68.9% were overuse and 31.1% were acute. In female figure skaters, the most frequently injured body areas were foot/ankle (29.6%), knee (19.3%), and back (15.8%). In male figure skaters, they were foot/ankle (25.4%), hip (16.4%), and knee (14.9%). Most common diagnoses at these body areas were tendinopathy (foot/ankle), extensor mechanism (knee), and posterior column bone stress injuries (back). All injuries to anterior knee structures, excluding bone contusions, were categorized as extensor mechanism injuries. About 11.8% of all injuries were bone stress reactions/fractures with the majority occurring at the back (42.2%), foot/ankle (32.4%), and lower leg (15.7%). CONCLUSION: Most injuries sustained by figure skaters were overuse and occurred most commonly at the foot/ankle (29.6%), knee (19.3%), and back (15.8%). Approximately 1 in 10 injuries were bone stress reactions/fractures, and nearly 1 in every 3 skaters who presented with back pain was diagnosed with a posterior column bone stress injury. Health care providers who take care of young figure skaters need to maintain a high index of suspicion for overuse injuries, especially bone stress reactions/fractures.

Improved reporting of overuse injuries and health problems in sport: an update of the Oslo Sport Trauma Research Center questionnaires.

In 2013, the Oslo Sports Trauma Research Center Overuse Injury Questionnaire (OSTRC-O) was developed to record the magnitude, symptoms and consequences of overuse injuries in sport. Shortly afterwards, a modified version of the OSTRC-O was developed to capture all types of injuries and illnesses-The Oslo Sports Trauma Research Center Questionnaire on Health Problems (OSTRC-H). Since then, users from a range of research and clinical environments have identified areas in which these questionnaires may be improved. Therefore, the structure and content of the questionnaires was reviewed by an international panel consisting of the original developers, other user groups and experts in sports epidemiology and applied statistical methodology. Following a review panel meeting in October 2017, several changes were made to the questionnaires, including minor wording alterations, changes to the content of one question and the addition of questionnaire logic. In this paper, we present the updated versions of the questionnaires (OSTRC-O2 and OSTRC-H2), assess the likely impact of the updates on future data collection and discuss practical issues related to application of the questionnaires. We believe this update will improve respondent adherence and improve the quality of collected data.

Overuse injuries in Swedish elite athletics- a study protocol for a prospective multifactorial cohort study.

BACKGROUND: Overuse injuries (OI) are common in elite athletics. Previous studies have had athletes self-report injuries rather than having a medical professional provide a clear diagnosis. This might be a major reason for the inconsistencies in reported incident proportions of OI in elite athletics, in addition to the varying definitions of OI in current literature. Risk factors or combinations of risk factors (biomechanical, clinical, and training-related) have been shown to be important in the developmental process of OI. However, no studies have examined these relationships using a multifactorial and prospective approach in elite athletics. The purpose of this study protocol is to describe OI incidence proportion, injury severity, location, and occurrence during a complete athletics season. Moreover, possible discipline specific and injury specific risk factors that might be associated with OI will be examined. METHODS: This study will be an explorative prospective cohort study including approximately 120 elite athletes. All athletes will be screened twice during one complete athletics season. The screening will consist of a body composition scan to measure muscle mass, fat free mass, lean mass, bone density, and bone mineral content. In addition, clinical examination will measure range of motion for the lower back, hip, knee, shoulder, and elbow and ankle joints. A running analysis will measure the 3D motions of the hip, knee, and ankle joints. Finally, maximal isometric strength tests of the main core and lower extremity muscles will be carried out. To record injuries, each athlete will consult a physiotherapist or sports medicine doctor affiliated with the study to get a clear diagnosis. Injury data will be recorded according to the previously published athletics consensus statement. DISCUSSION: Results from this study protocol will contribute more insight and detailed knowledge regarding the extent of OI occurrence among elite athletes during a complete athletics season. It will also provide further insights into which risk factors are associated with the development of OI in elite athletics.

Pitch Counts in Youth Baseball and Softball: A Historical Review.

OBJECTIVE: Pitching injuries are getting increased attention in the mass media. Many references are made to pitch counts and the role they play in injury prevention. The original purpose of regulating the pitch count in youth baseball was to reduce injury and fatigue to pitchers. This article reviews the history and development of the pitch count limit in baseball, the effect it has had on injury, and the evidence regarding injury rates on softball windmill pitching. DATA SOURCE: Literature search through PubMed, mass media, and organizational Web sites through June 2015. RESULTS: Pitch count limits and rest recommendations were introduced in 1996 after a survey of 28 orthopedic surgeons and baseball coaches showed injuries to baseball pitchers' arms were believed to be from the number of pitches thrown. Follow-up research led to revised recommendations with more detailed guidelines in 2006. Since that time, data show a relationship between innings pitched and upper extremity injury, but pitch type has not clearly been shown to affect injury rates. Current surveys of coaches and players show that coaches, parents, and athletes often do not adhere to these guidelines. There are no pitch count guidelines currently available in softball. CONCLUSIONS: The increase in participation in youth baseball and softball with an emphasis on early sport specialization in youth sports activities suggests that there will continue to be a rise in injury rates to young throwers. The published pitch counts are likely to positively affect injury rates but must be adhered to by athletes, coaches, and parents.

Review of musculoskeletal injuries and prevention in the endoscopy practitioner.

Practitioners of endoscopy often experience musculoskeletal pain and injury (most often in the back, neck, shoulders, hands, wrists, and thumbs) that are associated with the minute and repetitive strain that is placed on these areas during endoscopic procedures. This review of the current documentation of endoscopy-related pain and injuries among practitioners finds that such problems are widespread and specific in kind as well as strongly correlated with high procedure volume and procedure duration. Research on the nature and impact of cumulative trauma and overuse syndromes in other professions such as dentistry, pianists, production labor, and athletics is brought to bear on the work of the endoscopist. A more thorough understanding of the nature and prevalence of work-related pain and injury sustained by endoscopists should inform further development of ergonomic practices and equipment design. This article reviews current recommendations for ergonomic design in the endoscopy procedure space and finds that reported compliance with those recommendations is quite low. Strategies for the management of the risk of musculoskeletal injuries related to the practice of endoscopy include compliance with currently recommended ergonomic practices, education of trainees in ergonomic technique when practicing endoscopy, and research toward the modification and development of more ergonomic endoscopes and procedure spaces.

The Oslo Sports Trauma Research Center questionnaire on health problems: a new approach to prospective monitoring of illness and injury in elite athletes.

BACKGROUND: Little information exists on the illness and injury patterns of athletes preparing for the Olympic and Paralympic Games. Among the possible explanations for the current lack of knowledge are the methodological challenges faced in conducting prospective studies of large, heterogeneous groups of athletes, particularly when overuse injuries and illnesses are of concern. OBJECTIVE: To describe a new surveillance method that is capable of recording all types of health problems and to use it to study the illness and injury patterns of Norwegian athletes preparing for the 2012 Olympic and Paralympic Games. METHODS: A total of 142 athletes were monitored over a 40-week period using a weekly online questionnaire on health problems. Team medical personnel were used to classify and diagnose all reported complaints. RESULTS: A total of 617 health problems were registered during the project, including 329 illnesses and 288 injuries. At any given time, 36% of athletes had health problems (95% CI 34% to 38%) and 15% of athletes (95% CI 14% to 16%) had substantial problems, defined as those leading to moderate or severe reductions in sports performance or participation, or time loss. Overuse injuries represented 49% of the total burden of health problems, measured as the cumulative severity score, compared to illness (36%) and acute injuries (13%). CONCLUSIONS: The new method was sensitive and valid in documenting the pattern of acute injuries, overuse injuries and illnesses in a large, heterogeneous group of athletes preparing for the Olympic and Paralympic Games.

Upper limb musculoskeletal disorders in healthcare personnel.

The literature on upper limb musculoskeletal disorders (UL-MSD) in different groups of healthcare workers was reviewed: 65 relevant studies were collected. In dentists, the neck was the most frequently affected segment, with prevalences up to 73% and exceeding 50% in 7 out of 12 studies. In dental hygienists and in laboratory technicians, the hand/wrist had the highest prevalence in the majority of the studies. In nurses, the most seriously affected anatomic sites were the neck and shoulders. Physiotherapists had the lowest prevalence of UL-MSD. A high prevalence of upper limb disease, mainly carpal tunnel syndrome, was reported in dentists, dental hygienists, anesthesia nurses and endoscopists. The high prevalence of upper limb disorders/diseases reported in health personnel supports the hypothesis of a significant risk in these workers. However, the possible role of biomechanical overload, as much as that of stress or other personal factors, cannot be currently assessed. Practitioner Summary: Published studies support the hypothesis of a significant risk of upper limb musculoskeletal disorders in healthcare activities. The neck was the most frequently affected segment in dentists, the hand/wrist in dental hygienists and in laboratory technicians, and the neck and shoulders in nurses. Lower prevalence was reported in physiotherapists. A high prevalence of carpal tunnel syndrome was also observed in various healthcare activities.

High prevalence of overuse injury among iron-distance triathletes.

BACKGROUND: Triathlon is an increasingly popular sport at both the elite and the recreational level. However, there have been few high-quality studies of injuries and illnesses among triathletes. OBJECTIVE: To register overuse problems and acute injuries among iron-distance triathletes throughout a training season leading up to a major event. METHODS: A 26-week prospective cohort study was conducted including 174 participants of the 2011 Norseman Xtreme Triathlon. Data on overuse injuries located in the shoulder, lower back, thigh, knee and lower leg were collected every second week using the Oslo Sports Trauma Research Center Overuse Injury Questionnaire. Illnesses, acute injuries and overuse problems affecting other anatomical areas were also recorded using standard injury surveillance methods. RESULTS: The average prevalence of overuse problems was 56% (95% CI 51 to 61) (490 cases). The average prevalence of substantial overuse problems was 20% (95% CI 18 to 21) (165 cases). The most prevalent sites of overuse problems were the knee (25%), lower leg (23%) and lower back (23%). The acute injury incidence was 0.97 injuries per 1000 h of training (36 cases) and 1.02 injuries per 1000 h of competition (5 cases). A majority of moderate and severe acute injuries were located at the knee, shoulder/clavicle and sternum/ribs. The predominant types of acute injuries were contusions, fractures and sprains. The incidence of illness was 5.3/1000 athlete-days (156 cases). CONCLUSIONS: Overuse problems constitute the majority of injury cases among iron-distance triathletes, and are far more common than acute injuries and illnesses. The most prevalent sites of injury in the present study were the knee, lower leg, lower back and shoulder. Future injury prevention studies in iron-distance triathletes should focus on these areas.

Orofacial problems in musicians: a review of the literature.

OBJECTIVE: The objective of our study was to review the different pathologies of the stomatognathic system that can present in musicians as a result of playing their instruments. DESIGN: The National Library of Medicine's PubMed database was searched to identify all peer-reviewed articles in the English literature dealing with orofacial problems in musicians, using both subject headings such as MeSH terms (PubMed) and free text words in combination (oral, musician, violin, wind instruments, vocalists, orthodontic, tooth, temporomandibular disorders [TMD]). The identified studies were assessed independently by two authors. We included any instruments that involved the orofacial area: i.e., wind and brass instruments, vocalists, and violins and violas. RESULTS: Thirty-two articles were selected that were of many different types (clinical reviews, longitudinal and transverse studies of therapeutic procedures, case-control studies). Among orofacial problems, the most common disorders that affect musicians are TMDs, herpes simplex virus infections, orthodontic problems, and problems with perioral musculature. CONCLUSIONS: Musicians may suffer from pathological conditions that are worsened by their occupation due to excessive practice and stress. These conditions can cause permanent injuries that subsequently prevent the musicians from playing. Depending on the characteristics of the musical instrument and the way it is played, professional musicians generally show a propensity for buccodental problems.

[Risks of repetitive movements in health personnel]. / Rischi da movimenti ripetitivi nel personale sanitario.

To date, scant attention has been devoted to the occupational risk related to repetitive movements in health personnel. Using three database, PubMed, Scopus, and EMBASE, we found 57 papers on this topic, and on possibly related upper limb symptoms and diseases. In these studies, evaluation of the risk, e.g. using the methods currently applied in industry, are lacking. Although in several studies data on the prevalence of upper limb symptoms and disorders are presented, a comparison of results is difficult as different methods were applied. Furthermore, a comparison with adequate controls is frequently lacking, and/or correlation with the risk was not studied. Despite these limitations, an overall evaluation of the results shows that in health personnel the prevalence of upper limb symptoms/disorders is generally high. Highest prevalences were observed for the neck, shoulder, wrist/hand symptoms and for Carpal Tunnel Syndrome (CTS) in dental personnel, for symptoms to the neck, shoulder and wrist/hand in sonographers, and to the neck, shoulder, elbow, and, especially, wrist/hand in laboratory technicians using manual pipettes. In the nursing personnel highly variable prevalences were observed; this is possibly due to the variability of the tasks performed by this occupational group. Repetitive movements of upper limb are a known risk factor for symptoms to the neck, shoulder, elbow, and wrist/hand, and some disorders, as CTS: the high prevalences observed in health workers may be related to this risk. Nevertheless, other factors such as effort, posture and precision work may play an important role too. As a conclusion, available data are insufficient for an adequate evaluation of the occupational risk related to repetitive movements in health workers.

COL2A1 gene polymorphisms and susceptibility to osteoarthritis of the hand in Finnish women.

OBJECTIVES: To study the role of two COL2A1 single nucleotide polymorphisms (rs3737548 and rs2276455) and their haplotypes in individual susceptibility to osteoarthritis (OA) of the hand in Finnish women. METHODS: Bilateral hand radiographs of 543 Finnish female dentists and teachers aged 45-63 years were examined and classified for the presence of OA by using reference images. The COL2A1 genotypes were determined by PCR-based methods. Data regarding other risk factors were collected by questionnaire. The haplotypes were statistically reconstructed from the genotype data by the PHASE program. Associations between the genotypes/diplotypes and hand OA were studied by logistic regression. RESULTS: Allowing for age and occupation, the carriage of at least one COL2A1 intron 33 minor allele was associated with an increased risk of hand OA (odds ratio (OR) 1.58, 95% CI 1.05 to 2.36) and the number of affected joints. When stratified by occupation, the increased risk associated with the intron 33 minor allele carriage appeared to be mainly attributable to the dentists (OR 2.18, 95% CI 1.18 to 4.06). The 2-1 haplotype (exon 5B minor allele-intron 33 major allele) posed a significantly higher risk of hand OA (OR 3.21, 95% CI 1.08 to 9.55) compared with non-carriers. Moreover, an interaction was observed between intron 33 minor allele carriage and low task variation history in dental work (OR 2.87, 95% CI 1.05 to 7.89 for their joint effect). CONCLUSIONS: The results suggest that the studied COL2A1 gene polymorphisms may play a role in the aetiology of hand OA and that this effect may be enhanced by repetitive loading work tasks.

Musculoskeletal disorders amongst practising South African oral hygienists.

OBJECTIVES: The study sought to determine the level of musculoskeletal disorders among working oral hygienists in South Africa and potential determinants that are associated with these disorders. METHODS: Oral hygienists registered with the HPCSA were requested to complete an anonymous questionnaire. Apart from demographic information they were asked to report on any musculoskeletal symptoms experienced in the hands, neck, shoulders and lower back as well as details of workload, types of scaling procedures, size of instruments, the mobility of the operator's chair and the adjustability of patient chairs. RESULTS: Of the 362 respondents, 61.3%, 66.5%, 56.6% and 59.6%, experienced hand, neck, shoulder and lower back symptoms respectively. Twenty-eight percent of the respondents performed hand-scaling for more than four hours per day. Twenty-six percent reported immobile operator chairs, while 12.6% reported patient chairs that were difficult to adjust. Employing multivariate analysis, excessive hand scaling was associated with hand and shoulder symptoms, while immobile operator's chairs and poorly adjustable patient chairs were respectively associated with neck and lower back problems. CONCLUSIONS: The prevalence of work-related musculoskeletal disorders in practising oral hygienists in South Africa appears to be similar to that in developed countries. Significant determinants of musculoskeletal disorders may be immobile operator stools, poorly adjustable patient chairs and excessive hand-scaling daily.

Sailing Injuries: A Review of the Literature.

Sailors are at risk for acute injuries, overuse injuries, environmental injuries, and sailing-related illnesses. Sailing-related injury rates vary from 0.29 to 5.7 per 1,000 hours which is lower than many other land-based sports. However, the fatality rate of 1.19 per million sailing-days is relatively high. The most common injuries are contusions and lacerations predominantly to the upper and lower extremities. Falls and impacts from various parts of the sailboat are the most common mechanisms of traumatic injury. High winds, operator inexperience, and operator inattention are the most common contributing factors for injury. Among Olympic-class sailors, overuse injuries to the back (29-45%) and knees (13-22%) are commonly reported. As many as seventy-three percent of sailing-related deaths are due to drowning as a result of falls overboard (39-44%) or capsizing the vessel (20-40%). Eighty-two percent of sailing-related drowning victims in US waters were not wearing a lifejacket. Leading contributing factors to fatal sailing accidents are high winds (12-27%), alcohol use (10-15%), and operator inexperience (8%). [Full article available at http://rimed.org/rimedicaljournal-2019-02.asp].

Health Consequences of Youth Sport Specialization.

Sport specialization is a training method now commonly used by young athletes who hope to achieve elite-level success. This may be defined as (1) choosing a main sport, (2) quitting all other sports to focus on 1 sport, and (3) year-round training (greater than 8 months per year). A number of sports medicine organizations have published recommendations based on the limited evidence available on this topic. The objective of this article was to perform a narrative review of the currently available evidence and sports medicine organizational recommendations regarding sport specialization and its effects on health to guide athletic trainers and sports medicine providers. To accomplish this goal, we conducted a narrative review of articles and position statements on sport specialization published from 1990 through 2018. Injury, overuse injury, serious overuse injury, and lower extremity injury were likely associated with higher degrees of sport specialization in various populations. Sports medicine organizations in general recommended against sport specialization in young athletes and instead promoted multisport participation for physical and psychological benefits. Few long-term data suggest that sport specialization has negative health-related quality-of-life consequences. Higher degrees of sport specialization likely pose risks of overuse injury; however, the age of specialization at which this risk occurs is not known. Because different populations and sports activities may put children at risk for certain injuries, future researchers should monitor large populations with sport-specific prospective active surveillance.

Musculoskeletal symptoms in New Zealand dental therapists: prevalence and associated disability.

OBJECTIVE: To determine the prevalence and associations of disability due to musculoskeletal symptoms among practising New Zealand dental therapists. DESIGN: Cross-sectional survey of a random sample of dental therapists. METHOD: A postal questionnaire was sent out to all 483 registered dental therapists who were New Zealand Dental Therapists' Association (NZDTA) members in 2005. RESULTS: Usable responses were obtained from 323 therapists (98.8% female; mean age 49.2; age range 23 to 72). The most commonly reported problems in the previous year were neck (56.8%), lower back (54.0%) or shoulder symptoms (52.4%). Fewer of those working regularly with a dental assistant reported shoulder symptoms, but they had a higher prevalence of hip/thigh symptoms. Overall, the prevalence of disability ranged from approximately one in five (neck) to one in three (elbows or lower back) of those reporting symptoms. CONCLUSIONS: The prevalence of musculoskeletal symptoms among New Zealand dental therapists is high, with neck, shoulder and lower back symptoms being particularly common. The impact of those symptoms on sufferers' daily lives is considerable. Both therapists and employers need to examine ways of minimising musculoskeletal stress in order to minimise the incidence of new cases, and to support sufferers so that they are not lost prematurely from a workforce group which is already struggling to maintain sufficient practising numbers.

[Orofacial and hearing specific problems among 340 wind instrumentalists in Lebanon]. / Problèmes spécifiques de la sphère oro-maxillo-faciale et de l'ouïe chez 340 musiciens libanais pratiquant les instruments à vent.

INTRODUCTION: The aim of this study is to detect the problems related to wind instruments in order to determine the contributing factors. MATERIAL AND METHOD: This study is a prospective study of a sample of Lebanese wind-instruments musicians. Questionnaire of 17 items about personal data, musical activities in general and specific problems related to wind instruments. RESULTS: 340 response out of 400 (85%). Gender: male 100%. Age: 28.5 +/- 6.5 years (13-50). Practice of any physical activity: 57.5%. Smokers: 40.5% Data about musical practice - Years of practice: 6.5 +/- 5.5. Daily practice: 2.5 +/- 1.5 hours with 3.5 +/- 2 rest periods of 16.5 +/- 15 minutes. Weekly practice: 5 +/- 2 days. Data about medical problems - Hear loss 34%; respiratory difficulties: 19.5%; wound of lips muscles: 5%; gums and tongue lesions: 7.8%; myospasms of the cheeks and lips: 34.5%; dental problems: 30.7%; temporo-mandibular disorders (TMD): 22.5%. There is a high association between risk factors and pathology. Risks related to the instrument's use : hear loss (p = 0.001), traumas to lips muscles (p = 0.065), myospasms (p = 0.064), TMD (p = 0.000). Other factors: physical activity is beneficial; smoking is harmful (breathing difficulties, spasms, headaches). Factors influencing the different problems: age (31 +/- 7 years); years of practice (9 +/- 6); hours of practice per day (2 +/- 1.5); days of practice per week (4.5 +/- 2.5). CONCLUSION: Wind instruments are related to problems of mouth, facial muscles and hearing. This may lead musicians to stop their activities or to irreversible professional disabilities. A medical follow-up during the musicians training is needed to prevent these problems.

Defining the Term "Overuse": An Evidence-Based Review of Sports Epidemiology Literature.

Reference/Citation: Roos KG, Marshall SW. Definition and usage of the term "overuse injury" in the US high school and collegiate sport epidemiology literature: a systematic review. Sports Med. 2014;44(3):405-421. CLINICAL QUESTION: What is the current context of the term overuse in the epidemiologic sports injury literature? DATA SOURCES: The authors performed a database search of PubMed and SPORTDiscus. The Boolean phrases athletics AND injury and overuse OR epidemiology were searched. STUDY SELECTION: Studies were included in the review based on the following criteria: (1) epidemiologic in nature, (2) involved US high school or collegiate athletes, and (3) published in English between 1996 and 2012. In addition, a study was classified as epidemiologic in nature if appropriate exposure data were collected in order to calculate injury incidence rates. One reviewer initially read the titles or abstracts of the studies to determine their relevance for the systematic review. Studies were excluded if they (1) were biomechanical or anatomical in nature, (2) were clinical in nature, or (3) assessed the effectiveness of an intervention. DATA EXTRACTION: The reviewer extracted statistics and definitions of the word and phrase overuse and no contact. The reviewer adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines as much as possible. MAIN RESULTS: A total of 5182 titles of articles were initially identified in the databases searched. Then 232 studies were read to determine if they included overuse statistics. A total of 35 articles were included in the final review. Two main surveillance programs were used in these studies, with the authors of 12 articles (n = 12/35, 34.3%) using data from the High School Reporting Information Online (RIO) and the authors of 13 articles (n = 13/35, 37.1%) using data from the National Collegiate Athletic Association's Injury Surveillance System (ISS). One group (n = 1/35, 2.9%) used both surveillance systems, whereas 9 groups (n = 9/35, 25.7%) used other surveillance systems. Articles were categorized as (1) high school or collegiate studies using neither ISS nor RIO data, (2) high school studies using RIO data, or (3) collegiate studies using ISS data. The authors of only 1 article of the 35 (2.9%) provided a comprehensive definition of the word overuse. Collectively, 14 groups classified overuse as a mechanism of injury, 7 classified it as a category of diagnosis, and 8 classified it as both a mechanism of injury and a category of diagnosis. Specifically, 12 of the 35 articles combined overuse with other terms such as chronic, gradual onset, and repetitive stress, whereas 4 of the 35 articles defined overuse in the context of no-contact injuries. CONCLUSIONS: A great deal of inconsistency exists within the sports injury epidemiological literature regarding the term overuse. The authors of the systematic review recommended using the term overuse when referencing the mechanism of injury. A working definition of the term overuse should be used in injury surveillance such that injuries due to overuse are characterized by a mechanism of gradual onset and an underlying pathogenesis of repetitive microtrauma.

Risk factors for overuse injuries in runners.

There are many suspected risk factors for running-related overuse injuries; however, this remains a difficult area to adequately study. Numerous studies concerning factors that contribute to running injuries now exist in the literature, but inconsistent and sometimes conflicting results are found. This is likely due to different methodologies, definitions, outcome measures, and studied populations. This article reviews and summarizes several relevant studies on this topic, focusing on anatomic (intrinsic) risk factors as well as risk factors related to training (extrinsic). Due to the likely multifactorial nature of running injuries, very few firm conclusions can be made based on the existing studies. Training volume (mileage) and the occurrence of previous injuries seem to be the two most consistent risk factors across epidemiologic studies.

Finger osteoarthritis and differences in dental work tasks.

Mechanical load has been proposed as a risk factor for hand osteoarthritis. Dentists produce high manual forces in their work tasks. We studied whether the pattern of dental work tasks was associated with finger osteoarthritis. Radiographs of both hands of 291 middle-aged female dentists were examined for the presence of osteoarthritis. Patterns of dental work tasks during work history were empirically defined by cluster analysis. Three patterns emerged reflecting high, moderate, and mild task variation. Age, specialization, years in clinical work, various activities requiring hand use, family history of Heberden's nodes, body mass index, and smoking were accounted for in logistic regression analyses. The dentists with a history of low task variation had a greater prevalence of osteoarthritis in the thumb, index, and middle fingers compared with dentists with high variation (OR 2.22; 95%CI 1.04-4.91). The pattern of dental work task history is associated with the localization of osteoarthritis in the fingers.

Sports-specialized intensive training and the risk of injury in young athletes: a clinical case-control study.

BACKGROUND: Data are lacking regarding the independent risk of injury related to intense single-sport training or growth rate in young athletes. PURPOSE: To determine whether sports specialization, weekly training volumes, and growth rates are associated with increased risk for injury and serious overuse injury in young athletes. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: Injured athletes aged 7 to 18 years were recruited from 2 hospital-based sports medicine clinics and compared with healthy controls from affiliated primary care clinics undergoing sports physicals (2010-2013). Participants completed surveys reporting hours per week spent in organized sports, physical education class, and free play, as well as degree of sports specialization and Tanner stage. Heights and weights were measured. Injury details were obtained from athlete surveys and electronic medical records. RESULTS: Of 1214 athletes enrolled, 1190 (50.7% male) had data satisfactory for analysis. There were 822 injured participants (49.5% male; unique injuries, n = 846) and 368 uninjured participants (55% male). Injured athletes were older than uninjured athletes (14.1 ± 2.1 vs. 12.9 ± 2.6 years; P < .001) and reported more total hours of physical activity (19.6 ± 9.2 vs. 17.6 ± 8.9 h/wk; P < .001) and organized sports activity (11.2 ± 2.6 vs. 9.1 ± 6.3 h/wk; P < .01). After accounting for age and hours in sports activity spent per week, sports-specialized training was an independent risk for injury (odds ratio [OR], 1.27; 95% CI, 1.07-1.52; P < .01) and serious overuse injury (OR, 1.36; 95% CI, 1.08-1.72; P < .01). Young athletes participating in more hours of sports per week than number of age in years (OR, 2.07; 95% CI, 1.40-3.05; P < .001) or whose ratio of organized sports to free play time was >2:1 hours/week had increased odds of having a serious overuse injury (OR, 1.87; 95% CI, 1.26-2.76; P < .01). Growth rates were similar between injured and uninjured athletes (4.8 cm/y for both groups; P = .96). CONCLUSION: Injured young athletes were older and spent more hours per week in organized sports. There is an independent risk of injury and serious overuse injury in young athletes who specialize in a single sport. Growth rate was not related to injury risk. The study data provide guidance for clinicians counseling young athletes and their parents regarding injury risks associated with sports specialization.