Acute Obturator Externus Injury in Professional Soccer Players: A Case Series.

When patients present with hip or groin pain, proximal quadriceps or adductor injuries are often initially suspected. In this case report, however, we present three cases of professional soccer players who were found to have obturator externus injury. A 30-year-old player and a 24-year-old player complained of pain in the left side after long distance shooting during an in-season training session and a match, respectively. Another 24-year-old player complained of pain in the right side after long distance passing during a preseason training session. On physical examination, active hip external rotation and passive hip internal rotation and extension elicited pain in all three players. All three players underwent magnetic resonance imaging (MRI) which found obturator externus grade II injuries for two players and grade I injury for one player. Rehabilitation protocols included relative rest, cryotherapy, and electrotherapy over a period of one week. All patients were able to return to play after 10 days. Correct identification of obturator externus injury afforded our players a favorable prognosis and a relatively quick return-to-sport compared with quadricep or adductor injury.

Characteristics and Future Direction of Tibialis Posterior Tendinopathy Research: A Scoping Review.

Background and Objectives: Tibialis posterior tendon pathologies have been traditionally categorized into different stages of posterior tibial tendon dysfunction (PTTD), or adult acquired flatfoot deformity (AAFD), and more recently to progressive collapsing foot deformity (PCFD). The purpose of this scoping review is to synthesize and characterize literature on early stages of PTTD (previously known as Stage I and II), which we will describe as tibialis posterior tendinopathy (TPT). We aim to identify what is known about TPT, identify gaps in knowledge on the topics of TPT, and propose future research direction. Materials and Methods: We included 44 studies and categorized them into epidemiology, diagnosis, evaluation, biomechanics outcome measure, imaging, and nonsurgical treatment. Results: A majority of studies (86.4%, 38 of 44 studies) recruited patients with mean or median ages greater than 40. For studies that reported body mass index (BMI) of the patients, 81.5% had mean or median BMI meeting criteria for being overweight. All but two papers described study populations as predominantly or entirely female gender. Biomechanical studies characterized findings associated with TPT to include increased forefoot abduction and rearfoot eversion during gait cycle, weak hip and ankle performance, and poor balance. Research on non-surgical treatment focused on orthotics with evidence mostly limited to observational studies. The optimal exercise regimen for the management of TPT remains unclear due to the limited number of high-quality studies. Conclusions: More epidemiological studies from diverse patient populations are necessary to better understand prevalence, incidence, and risk factors for TPT. The lack of high-quality studies investigating nonsurgical treatment options is concerning because, regardless of coexisting foot deformity, the initial treatment for TPT is typically conservative. Additional studies comparing various exercise programs may help identify optimal exercise therapy, and investigation into further nonsurgical treatments is needed to optimize the management for TPT.

Patient-reported outcomes during telehealth versus in-person follow-up visits for patients treated with extracorporeal shockwave therapy.

BACKGROUND: The limited research describing clinical outcomes using telehealth for management of musculoskeletal conditions is primarily within orthopedic surgery care. OBJECTIVE: To characterize differences in patient reported outcomes using telehealth compared with in-person follow-up visits in patients with Achilles tendinopathy (AT) or plantar fasciitis (PF) treated using extracorporeal shockwave therapy (ESWT). DESIGN: Retrospective chart review. SETTING: Outpatient sports medicine clinic. PATIENTS: 82 patients with AT and 46 patients with PF. INTERVENTIONS: In-person (n = 76) and telehealth (n = 52) follow-up visits. MAIN OUTCOME MEASUREMENTS: Victorian Institute of Sports Assessment-Achilles (VISA-A) for AT and Foot and Ankle Ability Measure (FAAM) for PF as well as billing level. RESULTS: There was significant improvement from baseline to final VISA-A (p < .01) and FAAM (p < .01) following ESWT. No significant difference existed in the proportion of patients who met the minimal clinically important difference based on in-person (71.1%) versus telehealth (71.2%) follow-up (p = .99). The in-person group demonstrated higher billing levels compared to the telehealth group (Level: 3.5 ± 0.6 vs. 2.8 ± 0.7, p < .01). CONCLUSIONS: Given no significant differences in outcomes between two modes of follow-ups, telehealth may serve as an alternative method to guide management of musculoskeletal injuries with ESWT and other procedures.

Epidemiology of injuries in U.S. high school track and field throwing events from 2008 to 2019.

BACKGROUND: Injury characteristics of high school track and field throwing athletes in the United States are not well studied. Understanding epidemiology of injuries is important to identify treatment and prevention strategies. OBJECTIVE: To describe injury rates and patterns in U.S. high school track and field throwing events from a longitudinal national sports injury surveillance system. DESIGN: Descriptive epidemiology study. SETTING: Data were provided by the National High School Sports Related Injury Surveillance System, High School RIO (Reporting Information Online). METHODS: Athletic trainers reported injury and exposure data through the High School RIO website on a weekly basis. An athlete exposure (AE) was defined as one athlete participating in one school-sanctioned practice or competition. Throwing events of discus, shot put, and javelin were analyzed in this study. MAIN OUTCOME MEASURES: Injury rate, rate ratios (RR), injury proportion ratios (IPR). PARTICIPANTS: U.S. high school athletes. RESULTS: A total of 267 track and field throwing injuries occurred during 5,486,279 AEs. Overall, the rate of injuries in competition was higher than in practice (RR 1.35, 95% confidence interval [CI] 1.01-1.80). In practice, the rate of injuries was higher for girls than boys (RR 1.53, 95% CI 1.12-2.08). The most frequently injured body part was the shoulder (21.7%), followed by the ankle (16.5%) and knee (12.0%). The most common types of injury were muscle strains (26.14%) and ligament sprains (25%). Recurrent injuries accounted for a higher proportion of chronic injuries compared to new injuries (IPR 1.85, 95% CI 1.16-2.97). CONCLUSION: This study described injury characteristics of high school track and field throwing athletes from 2008 to 2019. Based on our results, injury prevention may be particularly important for female throwers with prior injury.

An update on technical and safety practice patterns of interlaminar epidural steroid injections.

Introduction: Interlaminar epidural steroid injections (ILESIs) are mainstay in the management of low back, neck and radicular pain and are a commonly performed pain management procedure in the United States. Our survey aims to provide an update in practice patterns of ILESIs among interventional pain physicians. Methods: We distributed a 91-item survey nationwide to private and academic interventional pain physicians who perform epidural steroid injections (ESIs). The survey was distributed via REDCap with a series of questions inquiring about current practices in epidural steroid injections from March 2021 to March 2022. Cross sectional data from survey responses specific to ILESI-related practices were captured and synthesized. Results: Of 103 complete survey responses, 96 physicians perform ILESIs (cervical, 87.5 %; thoracic, 82.3 %; lumbar 99 %). Nearly all surveyed physicians utilize fluoroscopy (98.1 %) over other modalities like MRI and ultrasound. For CIESIs, dexamethasone was the preferred steroid (52.4 %) over methylprednisolone (23.7 %); the converse was true for LIESIs in which methylprednisolone (44.2 %) was preferred over dexamethasone (32.6 %). The majority of providers performing ILESI's (91.7 %) preferred a Tuohy/Weiss needle while only a small fraction preferred the Quincke needle (7.2 %). Sedation practices were more varied with only about half of providers (47.6 %) offering medications. Furthermore, a great fraction of providers continue to use contrast for LIESIs (97.9 %) and CIESIs (89.6 %). Discussion: Our survey suggests that despite updated consensus recommendations, variability continues to exist in procedural practice patterns. Highlighting areas of variable adherence to current safety guidelines can assist with what is emphasized in the generation of future evidence-based guidelines. Though our survey was conducted in the context of the COVID-19 pandemic with resultant supply chain shortages, more research is needed to elucidate what variables may factor into why proceduralists may stray from guideline concordant care.

An update on technical and safety practice patterns in transforaminal epidural steroid injections.

Introduction: Previous studies have suggested variability in practice patterns for transforaminal epidural steroid injections (TFESIs) despite published safety guidance. The purpose of this study was to understand recent trends in periprocedural safety practices in TFESIs and how some aspects of interventional pain practice may have been influenced by the coronavirus disease 2019 (COVID-19) pandemic and related supply chain shortages. Methods: A 91-item survey was distributed to 111 program directors of Accreditation Council for Graduate Medical Education accredited Pain Management fellowships, 42 North American Spine Society and Interventional Spine and Musculoskeletal Medicine recognized fellowship directors, and 100 private practice interventional pain physicians to capture current practices in epidural steroid injections from March 2021 to March 2022. Additional responses were obtained through advertising on social media platforms consisting of interventional pain physicians. Cross sectional data from survey responses specific to TFESI-related practices were gathered and analyzed. Results: Of 103 complete survey responses, 102 physicians perform TFESIs (cervical, 33.3%; thoracic, 40.2%; lumbar, 100%; sacral, 89.2%). There was variability in preprocedural imaging review, sedation practices, contrast and fluoroscopy techniques, and type and dose of steroid preferred. Many physicians saw a decrease in number of procedures performed weekly as a result of the COVID-19 pandemic. Conclusions: There remains practice variability in various periprocedural aspects of TFESIs despite existing safety recommendations. Further research is needed to identify ongoing barriers to adherence to established guidelines. Recent practice trends may have been affected by unique challenges posed by the COVID-19 pandemic, and these trends should be considered in the event of future supply chain limitations and/or need for disaster response.

Do Differences Exist in Impact Test Domains between Youth Athletes with and without an Anterior Cruciate Ligament Injury?

Poor baseline reaction time, as measured via the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT), has been associated with anterior cruciate ligament (ACL) injury risk in adult athletes. Our study sought to determine whether the reaction time and impulse control ImPACT test domains differed between ACL injured and uninjured pediatric athletes. A total of 140 high-school aged athletes comprising 70 athletes who went on to sustain an ACL injury between 2012 and 2018 and 70 age- and sex-matched uninjured controls were included in the study. Mean reaction times were similar for the injured (0.67 s) and uninjured (0.66 s) athletes (p = 0.432), and the impulse control scores were also similar for those with (5.67) and without (6.07) an ACL injury (p = 0.611). Therefore, neurocognitive risk factors for sustaining an ACL injury in adults cannot necessarily be extrapolated to adolescent athletes. Further research is needed to understand why differences exist between injury risk in youth and adult athletes.

Deep Brain Stimulation associated gliosis: A post-mortem study.

BACKGROUND: DBS is a well-established therapy for patients with PD and is an emerging therapy for other neuropsychiatric disorders. Despite the rise in DBS usage, relatively little is known about the tissue and cellular responses to DBS. PURPOSE: To examine post-mortem effects of DBS leads by objectively quantifying gliosis around the distal DBS lead tip. METHODS: The UF DBS Brain Bank repository currently has 64 brains, of which 18 cases met criteria for this study. RESULTS: The average patient age was 54.88 ±â€¯13.43 years (mean ±â€¯SD), male:female ratio was 3:1, average disease duration was 20.70 ±â€¯6.36 years and average DBS duration was 7.26 ±â€¯6.36 years. Microscopic evaluation revealed tissue reaction and astrocytic responses to the lead. Significant fibrosis was seen in n = 2 brains and prominent microglial response in n = 1. Mean gliotic collar measured from H&E and GFAP staining was 122.5 µm and 162.5 µm, respectively. Mean gliotic thickness at the DBS electrode lead tip was 119.13 ±â€¯64.29 µm for patients receiving DBS for 0-5 years, 127.85 ±â€¯94.34 µm for 5-10 years and 111.73 ±â€¯114.18 µm for patients with DBS >10 years. Kruskal-Wallis one-way analysis of variance (ANOVA) revealed no statistically significant differences between DBS duration and amount of gliosis. CONCLUSIONS: This study revealed that approximately three out of four post-mortem DBS cases exhibited pathological evidence of a glial collar or scar present at the ventral DBS lead tip. The amount of gliosis was not significantly associated with duration of DBS. Future studies should include serial sectioning across all DBS contacts with correlation to the volume of tissue activation and to the clinical outcome.