The hormonal profile in women using combined monophasic oral contraceptive pills varies across the pill cycle: a temporal analysis of serum endogenous and exogenous hormones using liquid chromatography with tandem mass spectroscopy.

Oral contraceptive pills, of all types, are used by approximately 151 million women worldwide; however, a clear understanding of the concentrations of endogenous and exogenous hormones across a 28-day combination monophasic oral contraceptive pill pack is not well described. In our study of 14 female participants taking various combination monophasic oral contraceptive pills, we found significant fluctuations in endogenous and exogenous hormone levels throughout the pill cycle. Our analysis revealed significantly greater levels of ethinyl estradiol on the 20th and 21st days of active pill ingestion, compared with days 1-2 (active) and days 27-28 (inactive pill ingestion). Conversely, estradiol concentrations decreased during active pill consumption, while progestin and progesterone levels remained stable. During the 7 days of inactive pill ingestion, estradiol levels rose sharply and were significantly higher at days 27-28 compared with the mid and late active phase time points, while ethinyl estradiol declined and progestin did not change. These findings challenge the previous assumption that endogenous and exogenous hormones are stable throughout the 28-day pill cycle.NEW & NOTEWORTHY The results from this study have wide-ranging implications for research and treatment in women's health including considerations in research design and interpretation for studies including women taking oral contraceptives, the potential for more precise and personalized methods of dosing to reduce unwanted side effects and adverse events, and the potential treatment of a variety of disorders ranging from musculoskeletal to neurological with exogenous hormones.

Link Between the Female Athlete Triad and Gymnastics-Related Injury in Retired Collegiate Gymnasts.

OBJECTIVES: To compare gymnastics-related injuries between former collegiate gymnasts who did and did not report components of the female athlete triad (Triad) during college, including disordered eating or menstrual irregularity. We hypothesized that athletes reporting these 2 triad symptoms would have higher rates of time loss injury and injuries requiring surgery. DESIGN: Retrospective case-control. SETTING: Online survey. PATIENTS: Four hundred seventy former collegiate gymnasts. INTERVENTIONS: Athletes completed online survey distributed through social media. MAIN OUTCOME MEASURES: Participants were grouped based on self-reported menstrual irregularity and disordered eating during college. We compared time loss injuries, injuries resulting in surgery, and injury locations between the groups using χ2 analyses. RESULTS: Seventy percent (n = 328) of participants in this study reported a time loss college injury without surgery, and 42% (n = 199) reported an injury during college that required surgical treatment. A significantly greater proportion of gymnasts with only disordered eating reported a time loss gymnastics injury (without surgery) compared with those who reported only menstrual irregularity during college (79% vs 64%; P =0 .03). A significantly greater proportion of the disordered eating-only group reported a spine injury compared with the menstrual irregularity-only group (P = 0.007) and the group who reported neither menstrual irregularity nor disordered eating (P = 0.006). CONCLUSIONS: College gymnasts who experienced disordered eating were more likely to experience a nonsurgical time loss injury while in college, as well as spine injury compared with those with menstrual irregularity. Sports medicine providers should be aware of the association between injuries and individual components of Triad in gymnasts beyond bone stress injuries.

A Research and Clinical Framework for Understanding Achilles Injury in Female Collegiate Gymnasts.

ABSTRACT: Gymnastics is a popular sport with a high injury rate, particularly at the collegiate level. Achilles tendon rupture is a catastrophic injury with career-changing impact. Over the last decade, there has been a growing incidence of Achilles tendon ruptures, especially in female gymnasts. Currently, neither the effects of contributing risk factors on Achilles tendon rupture nor the research frameworks to guide future intervention strategies have been well described. This article reviews the functional anatomy and mechanical properties of the Achilles tendon, provides precollegiate and collegiate intrinsic and extrinsic risk factors for Achilles tendon rupture, and proposes a research framework to address this injury from a systemic perspective. Potential clinical interventions to mitigate Achilles tendon injury are proposed based on currently available peer-reviewed evidence.

Feasibility and impact of a musculoskeletal health for musicians (MHM) program for musician students: A randomized controlled pilot study.

BACKGROUND: There is a high incidence of performance-related musculoskeletal disorders in musicians that may be reduced via education programs. However, the efficacy of formalized injury prevention programs has not been rigorously studied. PURPOSE: To assess the feasibility and effect of a formalized injury prevention education workshop on incidence and severity of musculoskeletal pain in a cohort of musician-students attending an intensive summer music festival compared to controls. STUDY DESIGN: Randomized-controlled-pilot trial. METHODS: Musicians at an 8-week long intensive summer festival were randomized to an intervention (workshop) or control group. Workshop attendees participated in a 90-minute session of injury prevention strategies. Musculoskeletal outcome data were collected at the start and end of the festival. Outcomes included presence of musculoskeletal pain, adherence level, and sub-scales of the Musculoskeletal Pain Intensity and Interference Questionnaire for Musicians. RESULTS: A total of 57 musician-students (ages 17-30, 23 females) participated in the study, and 48(84%) completed the study. Seventy-five percent of workshop participants reported adherence over 8 weeks. At baseline, 84% of participants reported a history of playing-related pain, and 47% recent or current pain. Participants played a range of instruments (50% string, 34% piano, 16% woodwind/brass). At baseline, average weekly reported playing time was 39 hours (±11). At follow-up, reported pain decreased by 32% in the intervention group and increased by 8% in controls (P < .01). Pain interference scores were lower (Post - Pre = -4.58, 95% CI -9.26 to 0.11, P = .055). There was no statistically significant difference between groups for pain intensity. CONCLUSIONS: The high compliance and willingness to participate suggests that injury prevention education implementation is feasible. Our preliminary findings suggest a positive effect on pain incidence and pain interference in the intervention group. Future studies will examine the relationship between adherence levels and injury rates in a larger cohort and identify obstacles to implementation.

Women Are at Higher Risk for Concussions Due to Ball or Equipment Contact in Soccer and Lacrosse.

BACKGROUND: There is ample evidence to suggest sex- and gender-based differences in the incidence of sports-related concussions. The mechanisms of concussion may vary between male and female athletes and contribute to this observed difference. Understanding the underlying etiology by pooling data from primary studies across different settings and sport types will inform interventions that can reduce concussion rates. QUESTIONS/PURPOSES: Specifically, we asked: (1) In which sports are female athletes less likely to experience concussions from player contact? (2) In which sports are female athletes more likely to experience concussions because of ball or equipment contact? METHODS: PubMed, EMBASE, and Cochrane Library databases were searched to identify articles published from January 2000 to December 2018. Ten studies met the inclusion criteria, which were studies that reported concussion incidence by mechanism for both male and female athletes. Exclusion criteria included non-English studies, conference abstracts, and studies on non-sports related concussions. The sports represented by the 10 studies included ice hockey (n = 4), soccer (n = 5), basketball (n = 4), baseball/softball (n = 4), and lacrosse (n = 5). The rate ratio was calculated as the incidence rate in female athletes/male athletes for each concussion mechanism or activity. Data were pooled using the DerSimonian-Laird random-effects model. Study quality was assessed with the Newcastle-Ottawa Scale. RESULTS: Female athletes were at lower risk of player-contact-induced concussions in lacrosse (pooled rate ratio 0.33 [95% CI 0.25 to 0.43]; p < 0.001), basketball (pooled rate ratio 0.86 [95% CI 0.76 to 0.97]; p = 0.01), ice hockey (pooled rate ratio 0.64 [95% CI 0.56 to 0.73]; p < 0.001), soccer (pooled rate ratio 0.70 [95% CI 0.66 to 0.75]; p < 0.001), and soccer heading (pooled rate ratio 0.80 [95% CI 0.72 to 0.90]; p < 0.001); in these sports, men were at higher risk of concussions from player contact. Female athletes were more likely to experience concussions because of ball or equipment contact in lacrosse (pooled rate ratio 3.24 [95% CI 2.10 to 4.99]; p < 0.001), soccer (pooled rate ratio 2.04 [95% CI 1.67 to 2.49]; p < 0.001), and soccer heading (pooled rate ratio 2.63 [95% CI 1.84 to 3.77]; p < 0.001). CONCLUSIONS: The mechanism or activity underlying concussions differs between male and female athletes across different sports. This finding remains the same regardless of whether there are rule differences between the men's and women's games. The implementation of other interventions are required to further ensure player safety, including protective head equipment, concussion prevention training, or rules limiting player contact in the men's game. LEVEL OF EVIDENCE: Level III, retrospective study.

Discrepancies in describing pain: is there agreement between numeric rating scale scores and pain reduction percentage reported by patients with musculoskeletal pain after corticosteroid injection?

OBJECTIVE: Pain intensity is commonly rated on an 11-point Numerical Pain Rating Scale which can be expressed as a calculated percentage pain reduction (CPPR), or by patient-reported percentage pain reduction (PRPPR). We aimed to determine the agreement between CPPR and PRPPR in quantifying musculoskeletal pain improvement at short-term follow-up after a corticosteroid injection. DESIGN: Retrospective cohort study. SETTING: Urban, academic, physical medicine, and rehabilitation outpatient interventional musculoskeletal and spine center. METHODS: The agreement between CPPR and PRPPR was determined by concordance correlation coefficient (CCC) in subjects who had experienced improvement in musculoskeletal or radicular pain 3 weeks after a first-time injection at our clinic. Subjects who experienced unchanged pain (PRPPR = 0) were compared to CPPR with paired t-test. RESULTS: We examined 197 subjects with greater than 3/10 pain who underwent first-time fluoroscopic-guided corticosteroid injections. Ninety-three subjects reported higher PRPPR than CPPR values, and 41 subjects reported higher CPPR values. The CCC between CPPR and PRPPR was 0.44 (95% CI 0.35-0.54), with a precision of 0.54 and an accuracy of 0.81, and 95% limits of agreement ranging between -41% and +73%. Values for CCC, precision, and accuracy were higher for males compared to females and were highest in the youngest age group (18-40) and lowest in the middle age group (41-60). CONCLUSIONS: PRPPR may not agree with CPPR at 3 week follow-up, as these individuals tend to report a higher estimated percentage improvement compared to the value calculated from their pain scores.

Comparative effectiveness of lumbar transforaminal epidural steroid injections with particulate versus nonparticulate corticosteroids for lumbar radicular pain due to intervertebral disc herniation: a prospective, randomized, double-blind trial.

BACKGROUND: Lumbar transforaminal epidural injections are commonly utilized to treat radicular pain due to intervertebral disc herniation. OBJECTIVE: This study aims to determine if there was a major difference in effectiveness between particulate and nonparticulate corticosteroids for acute radicular pain due to lumbar disc herniation. DESIGN: A multicenter, double blind, prospective, randomized trial on 78 consecutive subjects with acute uni-level disc herniation resulting in unilateral radicular pain. All subjects received a single level transforaminal epidural steroid injection with either dexamethasone or triamcinolone. Repeat injections were allowed as determined by the blinded physician and subjects. Primary outcomes included: number of injections received, surgical rates, and categorical pain scores at 2 weeks, 3 months, and 6 months. Secondary outcomes included mean Oswestry Disability Index. RESULTS: Both triamcinolone and dexamethasone resulted in statically significant improvements in pain and function at 2 weeks, 3 months, and 6 months, without clear differences between groups. The surgical rates were comparable with 14.6% of the dexamethasone group and 18.9% of the triamcinolone group receiving surgery. There was a statistically significant difference in the number of injections received, with 17.1% of the dexamethasone group receiving three injections vs only 2.7% of the triamcinolone group. CONCLUSIONS: Transforaminal epidural corticosteroid injections are an effective treatment for acute radicular pain due to disc herniation, and frequently only require 1 or 2 injections for symptomatic relief. Dexamethasone appears to possess reasonably similar effectiveness when compared with triamcinolone. However, the dexamethasone group received slightly more injections than the triamcinolone group to achieve the same outcomes.

Factors associated with pain reduction after transforaminal epidural steroid injection for lumbosacral radicular pain.

OBJECTIVE: To identify demographic and clinical factors associated with pain improvement after a lumbosacral transforaminal epidural steroid injection (TFESI) for the treatment of radicular pain. DESIGN: Retrospective cohort study. SETTING: Outpatient center. PARTICIPANTS: Adults (N=188) who underwent a fluoroscopically guided TFESI for lumbosacral radicular pain. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Pain reduction from preinjection to 2-week follow-up was measured by visual analog scale (VAS). Patients were grouped by those who experienced no pain relief or worsened pain (≤0%), pain relief but <50% relief (>0%-<50%), or significant pain relief (≥50%) on the VAS. RESULTS: The mean duration of pain prior to injection was 45.8±81 weeks. The mean time to follow-up after TFESI was 20±14.2 days. Significantly more patients who experienced ≥50% pain relief at follow-up reported higher preinjection pain on the VAS (P=.0001) and McGill Pain Inventory Questionnaire (P=.0358), reported no worsening of their pain with walking (P=.0161), or had a positive femoral stretch test (P=.0477). No significant differences were found between VAS pain reduction and all other demographic and clinical factors, including a radiologic diagnosis of disk herniation versus stenosis or other neural tension signs on physical examination. CONCLUSIONS: Greater baseline pain on the VAS and McGill Pain Inventory, a history of a lack of worsening pain with walking, and a positive femoral stretch test predict a greater likelihood of pain reduction after TFESI for lumbosacral radicular pain at short-term follow-up. Greater baseline pain on the McGill Pain Inventory and a lack of worsening pain with walking predict a magnitude of >50% pain reduction.

Validity of SC-StepRx pedometer-derived moderate and vigorous physical activity during treadmill walking and running in a heterogeneous sample of children and youth.

BACKGROUND: The purpose of this study was to determine the validity of the SC-StepRx pedometer to assess moderate and vigorous physical activity during treadmill walking and running in a heterogeneous sample of children and youth aged 10-17 years. METHODS: Physical activity intensity assessed via indirect calorimetry served as the criterion standard. A convenience sample of 40 participants (20 boys, 20 girls) wore 6 SC-StepRx pedometers, 2 ActiGraph GT3X accelerometers, 2 Actical accelerometers, 1 Walk4Life MVP pedometer and 1 NL-1000 pedometer while walking/running at speeds approximating 2, 3, 4, 6 and 7 METs. Associations between indirect calorimetry and each activity monitor were assessed using linear regression analyses in SAS 9.2. RESULTS: Estimates of moderate and vigorous physical activity from all monitors were significantly associated with the criterion standard of indirect calorimetry. The strongest associations with the criterion measure were observed for the SC-StepRx with moderate/vigorous thresholds of 110/130 steps•minute(-1), and the NL-1000 (R2 = 0.82, p <0.05). The SC-StepRx with moderate/vigorous thresholds of 110/130 steps•minute(-1) also exhibited the highest combined sensitivity (92.9%) and specificity (96.5%) for correctly identifying a bout of moderate-to-vigorous physical activity. CONCLUSIONS: This study demonstrates that the SC-StepRx pedometer is a valid tool for the measurement of moderate and vigorous physical activity in children and youth.

Achilles tendon rupture preceded by normal asymptomatic imaging in a collegiate gymnast: A case report.

Female gymnasts are the athletes that are most likely to experience Achilles tendon rupture, due to the high energy and eccentric load place on their Achilles tendon related to their sport. It is postulated that degenerative changes, watershed vascular supply, calcifications, and high amounts of inflammatory cells may play a role. This case report highlights an athlete with an asymptomatic Achilles tendon that was visualized to be normal utilizing ultrasound. She was found to have no evidence of underlying tendon pathology. The athlete then ruptured her Achilles tendon 8 months later during a gymnastic meet with no proceeding symptoms. This case report challenges the accepted theory that preexisting tendinosis or pathology proceeds Achilles tendon rupture. In this case, it is postulated that tendon rupture may be secondary to significant mechanical force even without underlying pathology. Level of evidence: Level 4.

Sex and gender differences in lower limb chronic exertional compartment syndrome: a systematic review.

OBJECTIVES: Chronic exertional compartment syndrome (CECS) is a cause of exertional leg pain and has been reported in varying frequencies in males and females. Currently, it is unclear whether there are significant sex and gender differences in lower-limb CECS. Delineating sex and gender differences is vital in determining the causes of CECS and best treatments. This systematic review aimed to determine the sex/gender distribution of CECS and to assess for sex and gender differences in CECS diagnosis and outcomes. METHODS: PubMed (Medline), Cochrane Library, and EMBASE databases were searched for studies that were published from January 2000-March 2022 and reported lower-limb CECS data in males and/or females. Data on CECS diagnosis (intracompartmental pressures) and outcomes (e.g. post-surgical return-to-sport, need for re-operation) with sex/gender breakdowns were extracted. The sex/gender distribution of CECS and prevalence of CECS by sex/gender were calculated. RESULTS: Forty-one studies were included in the systematic review; there were 27 retrospective reviews, 8 prospective studies, and 6 retrospective studies with prospective follow-ups. Thirty studies involved surgical populations. Sex/gender distribution of CECS was calculated using data from 24 studies; 51% were female. Prevalence of CECS was available in five studies and ranged widely for males (54%-73%) and females (43%-65%). Intracompartmental pressure data varied by sex/gender. Male athletes were more likely than female athletes to return to sport following surgery for CECS, but variations in all other post-surgical outcomes were observed between sexes and genders in the general population. CONCLUSION: Females represented 51% of the patients who were diagnosed with CECS among studies. Most CECS diagnosis and outcomes data varied by sex/gender, except for post-surgical outcomes data in athletes, which demonstrated that males had higher rates of return to sport than females. Future studies are needed to examine factors contributing to sex and gender differences in CECS diagnosis and outcomes.

Vasovagal rates in flouroscopically guided interventional procedures: a study of over 8,000 injections.

OBJECTIVE: To determine the rate of vasovagal (vv) complications in fluoroscopically guided interventional procedures. DESIGN: Retrospective case series analysis of prospectively collected data from March 8, 2004 to January 30, 2009. SETTING: A single academic medical center. SUBJECTS: Four thousand one hundred eighty-three subjects undergoing 8,010 consecutive injections. OUTCOME MEASURES: Pearson's chi-square test was used to determine the relationship between categorical variables. RESULTS: A total of 8,010 injections, including epidural steroid injections, radiofrequency nerve ablations, medial branch blocks, hip injections, knee injections, and glenohumeral injections were performed. Overall vv reaction rate was 2.6%, with 0.8% of procedures resulting in early terminated due to vv reaction. Peripheral joint injections had a vv rate of 0.2%, all occurring in hip injections. Transforaminal epidural steroid injections had a vv rate of 3.5%. Diagnostic blocks of the medial branches had the highest rate of vv (5.1%). Other predictors of vv reactions were identified including preprocedure pain score visual analog scale <5 (P = 0.004), male gender (P < 0.001), and age less than 65 years old (P < 0.001). CONCLUSIONS: vv reactions have an overall low occurrence rate (2.6%) in interventional procedures ranging from 0% in peripheral knee and shoulder injections to 5.1% in medial branch blocks. Conservative treatment of vv reaction and willingness to terminate procedures resulted in no serious adverse events related to vv reaction in 8,010 procedures.

Evaluation of sex differences in rodent anterior cruciate ligament injury.

The relative contributions of sex differences in anatomy, biomechanics, and hormones to the increased risk of anterior cruciate ligament (ACL) injury in female athletes remains unknown. The purpose of this study is to investigate sex differences in anatomy and biomechanics of the native and reconstructed ACL using our established murine model. A total of 140 12-week-old wild-type C57Bl/6 (70 male vs. 70 female) mice were used for this study. ACL reconstruction was performed on 120 mice who were split into four groups: Group 1 (30 males sacrificed at 14 days), Group 2 (30 females sacrificed at 14 days), Group 3 (30 males sacrificed at 28 days), and Group 4 (30 females sacrificed at 28 days). Tendon graft-to-bone healing was assessed by biomechanical, histological, and micro-CT analysis. Twenty mice were used for baseline testing. Females showed significantly higher anterior (p < 0.05) and total displacement (p < 0.05). Males demonstrated a significantly higher load-to-failure force of native ACLs compared to females (p < 0.05). There was no significant difference in load-to-failure force in the ACL autograft. There were no significant sex differences in histological analysis of graft integration or tibial slope. The increased knee laxity and reduced load-to-failure of the native ACL observed in the female mice are consistent with some of the proposed risk factors driving the increased risk of ACL injury in females. Understanding the relative contributions of factors driving sex differences in material properties of the ACL will provide insight into the sex differences in ACL injury and future prevention strategies.

Return to sport in elite gymnastics: Unprecedented training interruptions provide lessons for the future.

INTRODUCTION: Year-round training is standard for elite gymnasts in the United States, but the coronavirus disease 2019 (COVID-19) pandemic led to unprecedented training interruptions. The effect of these training disruptions is unknown. OBJECTIVE: This study aimed to describe and compare training interruptions in elite gymnasts before and during the pandemic, the time it took to return to the prior level of gymnastics training, the development of injuries during return to gymnastics training, and gymnast-reported difficulty in and nervousness about returning to prior level of gymnastics training. DESIGN: Retrospective study. SETTING: Anonymous online surveys distributed to elite gymnasts in the United States. PARTICIPANTS: A total of 184 current elite gymnasts who completed the surveys were included. This represented an overall response rate of 52.3% (184/352). INTERVENTIONS: None. MAIN OUTCOME MEASURES: Information was collected about training interruptions and time, nervousness, difficulty, and injury during return to gymnastics. RESULTS: Gymnasts reported significantly longer training interruptions due to COVID-19 than before the pandemic (8.7 ± 4.4 vs. 4.4 ± 7.9 weeks, p < .001), but duration of return to prior gymnastics level was similar (4.6 ± 2.7 vs. 3.7 ± 4.8 weeks, p = .106). Of the 137 gymnasts who had returned to training by the time of the survey, 46 (33.6%) reported an injury during their return to gymnastics. A high degree of nervousness to return to gymnastics was significantly associated with greater risks of injury upon return (risk ratio [RR] 2.7, 95% confidence interval [CI]: 1.6-4.7; p < .001) and difficulty returning to prior level (RR 3.4, 95% CI: 1.7-6.6; p < .001). CONCLUSION: Pandemic-related training interruption was significantly greater in duration than prior interruptions, but time required for return to gymnastics was similar. Gymnasts may be at increased risk of injury during return to gymnastics if experiencing nervousness about returning following a break in training. These findings provide guidance for gymnasts' return from training interruptions and may refute the long-held belief that gymnasts should not take time away from training due to fear of injury or difficulty regaining skills.

Variability in Patient-Incurred Costs and Protocols of Regenerative Medicine Procedures for Musculoskeletal Conditions in the United States.

Background: The use of regenerative medicine as an "off label" treatment for musculoskeletal conditions has increased in recent years. However, the literature is sparse regarding the costs of these treatments to patients. Purposes: We sought to determine the patient-incurred costs for regenerative medicine treatments performed by physicians for musculoskeletal conditions in the United States, according to primary specialty, geographic region, practice setting, and years in practice. We also sought to characterize pre- and posttreatment protocols and image guidance use. Methods: We performed a cross-sectional study with data collection occurring between April 2020 and April 2021. It began with the distribution of an online survey through an email campaign by the American College of Sports Medicine to its members. Approximately 90 emails were sent by our research team as well. Throughout the year, various participant recruitment methods were used (through Twitter, for example). Survey data included physician demographics, practice/training information, types/costs of regenerative medicine treatments performed, and pre-/postprocedure protocols. Results: One hundred physicians who self-reported performing standalone regenerative medicine procedures participated in this online survey. According to the responses, the most common treatments performed were platelet-rich plasma (PRP; 100%), bone marrow concentrate (BMC; 41%), microfragmented adipose grafting (36%), prolotherapy (33%), and bone marrow aspirate (BMA; 21%) administered to the peripheral joints, tendons/muscles, ligaments, and/or spine. Overall, the respondents reported large variations in treatment costs to patients; BMA and BMC were the most expensive and had the largest ranges in costs for all anatomical locations. Costs for PRP were lower than those for BMA and BMC, with less variation. Physicians in private practice reported higher PRP, BMC, and BMA costs in the peripheral joints than those in academic settings. Most physicians recommended avoiding non-steroidal anti-inflammatory drugs pre- and postprocedure, and 74% recommended physical therapy postprocedure. Conclusions: Findings from a survey of physicians who provide regenerative medicine procedures as off-label treatment for musculoskeletal conditions suggest that there is variation in related patient-incurred costs. Future studies should explore associations between treatment costs and outcomes.

Sex hormone-mediated change on muscle activation deactivation dynamics in young eumenorrheic women.

The goal of the study was to characterize muscle activation/deactivation dynamics across the menstrual cycle in healthy young women. Twenty-two healthy eumenorrheic women (age: 27.0 ± 4.4 years; mean ± SD) were tested every other day for one menstrual cycle. Serum estradiol and progesterone were quantified at the time of testing. Peak torque (PT), time to peak torque (TPT), and half relaxation time (HRT) of soleus muscle twitch were measured. Muscle twitch was elicited by delivering 1 ms width electrical pulses to the tibial nerve at an intensity that generated a maximum motor response (S-100) and at supramaximal intensity (S-120; 1.2 × S-100). The analyses were performed for each menstrual cycle phase: 1) the follicular phase to analyze the effect of estradiol while the progesterone concentrations remained at low concentrations; 2) the luteal phase to analyze the effect of progesterone with background estradiol concentrations. In the follicular phase, there was no association of estradiol for PT, TPT, and HRT. In the luteal phase, while estradiol had no association on PT, TPT, and HRT, progesterone expressed a significant association with HRT reduction but no association on PT or TPT. Also, there was a significant estradiol and progesterone interaction for HRT. However, the regression parameters are nearly zero, suggesting that the change in HRT may not have an impact on muscle performance across the menstrual cycle but implications on other women's health conditions with elevated sex hormone concentrations, such as pregnancy, may prove critical.

Disparities in concussion diagnoses compared to ankle injuries.

BACKGROUND: Health disparities related to concussions have been reported in the literature for certain minority populations. Given the significant impact of concussions on long- and short-term function, the mitigation of barriers to accessing care is an important public health objective. OBJECTIVE: To determine if racial and ethnic disparities exist in patients who seek care for concussions compared to a control group with orthopedic ankle injuries (sprains and fractures) to minimize confounding factors that predispose to injury. DESIGN: Cohort study. SETTING: Single institution between February 2016 and December 2020. PATIENTS: A retrospective review of electronic medical records was completed for patients with International Classification of Diseases, Tenth Revision (ICD-10) diagnosis codes for concussion, ankle sprain, and ankle fracture. A total of 10,312 patients were identified: 1568 (15.2%) with concussion, 4871 (47.3%) with ankle sprain, and 3863 (37.5%) with ankle fracture. INTERVENTIONS: Patients were stratified by demographic factors, including sex, ethnicity, race, and insurance type. MAIN OUTCOME MEASURES: Diagnosis of concussion. RESULTS: The concussion group was the youngest (28.3 years ± 18.0) and had the fewest females (53.1%) compared to the ankle sprain (35.1 years ± 19.7; 58.7%) and fracture groups (44.1 years ± 21.3; 57.3%). The concussion group had a smaller proportion of Hispanic patients than the ankle sprain group (odds ratio [OR] 0.71, 95% confidence interval [CI] 0.55-0.92, p = .010) and fracture group (OR 0.58, 95% CI 0.44-0.75, p = <.001). In addition, the concussion group was less likely to be Asian (OR 0.70, CI 0.52-0.95, p = .023) than the sprain group and less likely to be Black/African American than both sprain (OR 0.65, 95% CI 0.46-0.93, p = .017) and fracture groups (OR 0.62, 95% CI 0.43-0.89, p = .010). There were no differences across racial groups between ankle sprains and fractures. Patients with Medicaid/Medicare and self-pay had a higher likelihood of being in the concussion group than those with private insurance. CONCLUSION: Differences in concussion diagnosis may exist between certain demographic groups compared to those with ankle injuries. Efforts to mitigate disparities in concussion care are worthwhile with a focus on patient and caregiver education.

Prevalence of rapidly progressive osteoarthritis of the hip following intra-articular steroid injections.

INTRODUCTION: Numerous studies have indicated that intra-articular steroid injections to the hip are beneficial for short-term pain relief. However, recent studies have drawn concerns of rapidly progressive osteoarthritis of the hip (RPOH) following intra-articular steroid injections. The prevalence of RPOH following intra-articular steroid injections varies widely in the literature. OBJECTIVE: To identify the prevalence of RPOH following intra-articular steroid injections, and to compare baseline characteristics between patients with and without RPOH. DESIGN: Case series. SETTING: Tertiary academic hospital. PATIENTS: A total of 924 patients (median [interquartile range; IQR] age: 59 [45-70] years; 579 female) who received an intra-articular hip steroid/anesthetic injection from January 2016 to March 2018 and had available pre- and post-injection imaging (prior to surgical intervention) were included in the study. INTERVENTIONS: Baseline and injection-related data-including demographics, age, body mass index, medical history, laterality, and steroid type-were collected from electronic medical records. MAIN OUTCOME MEASURES: Post-injection RPOH was determined via imaging review by a physiatry fellow, followed by an attending physiatrist and a musculoskeletal radiologist to confirm findings. RESULTS: The majority of patients received unilateral injections into the hip, and the most common steroids used were triamcinolone and methylprednisolone. Review of pre- and post-injection imaging revealed 26 cases of RPOH, for an overall prevalence of 2.8% (95% confidence interval [CI] 1.9%-4.1%). Compared to those without RPOH, patients with RPOH were significantly older (median age [IQR]: 64 [60-73] vs. 59 [44-70] years, p = .003) and had a shorter duration of symptoms prior to their injections (median [IQR]: 3 vs. 12 [6-36] months, p < .001). Adjusted regression analyses showed that age was associated with greater odds of RPOH (odds ratio [OR], 95% CI: 1.04, 1.01 to 1.07; p = .003). CONCLUSIONS: The prevalence of RPOH following intra-articular steroid injections into the hip was lower than previously reported but still clinically relevant. This should be considered when counseling patients prior to intra-articular hip steroid injections.