Hypertrophic Cardiomyopathy in Youth Athletes: Successful Screening With Point-of-Care Ultrasound by Medical Students.

OBJECTIVES: Hypertrophic cardiomyopathy (HCM) is a life-threatening genetic cardiovascular disease that often goes undetected in young athletes. Neither history nor physical examination are reliable to identify those at risk. The objective of this study is to determine whether minimally trained medical student volunteers can use ultrasound to screen for HCM. METHODS: This was a prospective enrollment of young athletes performed at 12 area high schools and three area colleges, between May 2012 and August 2013. All participants underwent point-of-care ultrasound performed screening for HCM by trained medical students and reviewed by a pediatric cardiologist. An interventricular septum to left ventricular posterior wall ratio greater than 1.25 was considered to be abnormal (positive screen). RESULTS: A total of 2332 participants were enrolled. There were 137 (5.8%) with a positive screening for HCM, of which 7 (5.1%) were confirmed to have HCM by a pediatric cardiologist. In a small cohort with positive screen for HCM, there was a 100% sensitivity (95% confidence interval, 59.04 to 100%) and 4.86% (95% confidence interval, 1.98 to 9.76%) positive predictive value of for having HCM. CONCLUSIONS: Volunteer medical students, using point-of-care ultrasound, were able to effectively screen for HCM in young athletes.

Wrist pain, distal radial physeal injury, and ulnar variance in young gymnasts: does a relationship exist?

BACKGROUND: Chronic wrist pain affects up to 79% of young gymnasts. Distal radial growth plate injury and positive ulnar variance have also been reported in this population. HYPOTHESIS: There is a relationship between wrist pain, radiographic findings of distal radial growth plate injury, and ulnar variance in skeletally immature young gymnasts. STUDY DESIGN: Cross-sectional study. METHODS: Fifty-nine gymnasts (28 girls and 31 boys; average age, 9.3 years) completed a questionnaire detailing training and wrist pain symptoms. Each received a wrist examination, grip strength measurement, and bilateral wrist radiographs. RESULTS: Wrist pain was reported by 56% of the gymnasts (33 of 59), with 45% (15 of 33) describing pain of at least 6 months' duration. Factors significantly associated with wrist pain included higher skill level, older age, and more years of training. For those between 10 and 14 years of age, 83% had wrist pain, compared with 44% for those outside of that age range. Fifty-one percent of the gymnasts (30 of 59) had findings of stress injury to the distal radial physis of at least a grade 2; 7% (4) had frank widening of the growth plate. Wrist pain prevalence was significantly related to the grade of radiographic injury. Mean ulnar variance was significantly more positive than established norms. Ulnar variance was not associated with wrist pain or radiographic injury of the distal radial physis. CONCLUSIONS: Radiographic findings of distal radial physeal injury are associated with wrist pain among young nonelite gymnasts.

Wrist pain in young gymnasts: frequency and effects upon training over 1 year.

OBJECTIVE: To determine the frequency and characteristics of wrist pain in young, nonelite gymnasts over a 1-year training period, and to describe the effects of chronic wrist upon gymnastics training. DESIGN: Prospective cohort study. SETTING: Los Angeles-based gymnastics club. PARTICIPANTS: Forty-seven nonelite female and male gymnasts between 5 and 16 years of age. ASSESSMENTS: Each subject completed an interview-based questionnaire and received a physical exam at the study onset and at the end of 1 year of training. The questionnaire detailed training habits and elicited a history and description of wrist pain. MAIN OUTCOME MEASURES: The frequency of wrist pain and several measures of training were reported at the study onset and at 1 year. Gymnasts with wrist pain were compared with those who were pain-free. MAIN RESULTS: Wrist pain was reported by 57% (27 of 47) of subjects at the study onset. Eighty-nine percent (24 of 27) reported wrist pain both at the study onset and 1 year later. Nineteen gymnasts (40%) were pain-free at each collection. The floor exercise, the pommel horse, and the balance beam were most frequently associated with wrist pain symptoms. Multivariate analysis revealed that adolescent gymnasts between 10 and 14 years of age were significantly more likely to report wrist pain at each survey than those who were either above or below this age range (p = 0.03). Forty-two percent of subjects with wrist pain at each survey reported that the symptoms interfered with training. Only five gymnasts with wrist pain were seen by physicians. Training intensity increased in gymnasts with and without wrist pain. The relative increase within each group was statistically significant among pain-free gymnasts (p = 0.003), but was not for those with wrist pain (p = 0.08). CONCLUSIONS: Wrist pain among young, nonelite gymnasts is common, and appears to persist with continued training in the vast majority of those who report symptoms. Adolescent gymnasts between 10 and 14 years of age training at this level are significantly more likely to have wrist pain. Wrist pain appears to have a negative effect upon training, based upon both self-report and training intensity measures; however, more study is needed with respect to this issue.