Latissimus Dorsi and Teres Major Tendon Avulsions in Cricketers: A Case Series and Literature Review.

INTRODUCTION: Acute latissimus dorsi tendon injuries are uncommon, having not previously been described in cricketers. The leg spinner's stock ball bowling technique and the fast bowler's back-of-the-hand slow ball, which is used much more widely in T20 cricket, produce a significant eccentric contraction load on the latissimus dorsi muscle. METHODOLOGY: A retrospective review of a case series of acute latissimus dorsi tendon injuries in 3 elite cricketers (2 fast bowlers and a leg-spin bowler). We compare the outcomes using patient-rated scales and objective strength testing. Two patients underwent operative repair and had excellent outcomes. One of the nonoperatively managed patients had mild ongoing symptoms at 7 months. DISCUSSION: An associated injury to teres major did not affect the outcome of this injury. Operative repair is a viable alternative and may produce better outcomes in cricketers. CONCLUSION: The short T20 form of cricket has lead to an increase in the number of back-of-the-hand slow balls, a risk factor for Latissimus injury, whereas leg-spin bowling is another risk.

Radiological healing of lumbar spine stress fractures in elite cricket fast bowlers.

OBJECTIVES: Review magnetic resonance imaging (MRI) of elite adult fast bowlers with a history of lumbar spine stress fracture for evidence of bone healing. The findings will determine whether bone healing can occur in this population, and whether MRI may be used as a tool to assess bone healing and inform clinical decision making. DESIGN: Retrospective cohort. METHODS: Participants were elite Australian fast bowlers who sustained a lumbar spine stress fracture confirmed on MRI and had at least one subsequent MRI. Two radiologists independently reviewed all images. RESULTS: Thirty-one fractures from 20 male fast bowlers were reviewed. Median maximum fracture size was 6mm (range 2-25mm). Twenty-five fractures achieved bone healing, with a median 203 (IQR 141-301) days between the initial MRI (to confirm diagnosis) and the MRI when bone healing was observed. Fracture size and signal intensity of bone marrow oedema were positively associated with the number of days to the MRI when bone healing was observed (r2=0.245, p<0.001 and r2=0.292, p<0.001 respectively). Fractures which occurred at the same site as a previously united fracture took longer to heal than the first fracture (median 276 days to the MRI when bone healing was observed compared to 114 days for first fracture; p=0.036). CONCLUSIONS: Lumbar spine stress fractures in elite adult fast bowlers are capable of achieving complete bone healing, as demonstrated in the majority of bowlers in this study. Larger fractures, greater bone marrow oedema, and history of previous injury at the same site may require longer healing time which may be monitored with MRI.

Injuries to elite male cricketers in Australia over a 10-year period.

This study analyses injuries occurring to Australian male cricketers at the state and national levels over 10 years using recently published international definitions of injury. Data was collected retrospectively for 3 years and then prospectively over the final 7 years. Injury incidence has stayed at a fairly constant level over the 10 years. Injury prevalence has gradually increased over the 10-year period but fell in season 2004-2005. Increasing match scheduling over the 10-year period has probably contributed to the increasing injury prevalence. Fast bowlers miss, through injury, about 16% of all potential playing time, whereas the prevalence rate for all other positions is less than 5%. Some match and schedule-related risks for bowling injury have been noted, including a greater risk of injury in the second innings of first class matches (compared to the first innings), a greater risk of injury in the second game of back-to-back matches and an increased risk of injury in the rare situation of enforcing the follow-on in a test match. The introduction of a boundary rope at all grounds has successfully eliminated the mechanism of injury from collision with fences whilst fielding. Cricket is a much safer sport to play at the elite level for batsmen, fieldsmen, wicketkeepers, and spin bowlers than the football codes, which are the other most popular professional sports in Australia.

Changes to injury profile (and recommended cricket injury definitions) based on the increased frequency of Twenty20 cricket matches.

This study analyzes injuries occurring prospectively in Australian men's cricket at the state and national levels over 11 seasons (concluding in season 2008-09). In the last four of these seasons, there was more cricket played, with most of the growth being a new form of the game - Twenty20 cricket. Since the introduction of a regular Twenty20 program, injury incidence rates in each form of cricket have been fairly steady. Because of the short match duration, Twenty20 cricket exhibits a high match injury incidence, expressed as injuries per 10,000 hours of play. Expressed as injuries per days of play, Twenty20 cricket injury rates compare more favorably to other forms of cricket. Domestic level Twenty20 cricket resulted in 145 injuries per 1000 days of play (compared to 219 injuries per 1000 days of domestic one day cricket, and 112 injuries per 1000 days of play in first class domestic cricket). It is therefore recommended that match injury incidence measures be expressed in units of injuries per 1000 days of play. Given the high numbers of injuries which are of gradual onset, seasonal injury incidence rates (which typically range from 15-20 injuries per team per defined 'season') are probably a superior incidence measure. Thigh and hamstring strains have become clearly the most common injury in the past two years (greater than four injuries per team per season), perhaps associated with the increased amount of Twenty20 cricket. Injury prevalence rates have risen in conjunction with an increase in the density of the cricket calendar. Annual injury prevalence rates (average proportion of players missing through injury) have exceeded 10% in the last three years, with the injury prevalence rates for fast bowlers exceeding 18%. As the amount of scheduled cricket is unlikely to be reduced in future years, teams may need to develop a squad rotation for fast bowlers, similar to pitching staff in baseball, to reduce the injury rates for fast bowlers. Consideration should be given to rule changes which may reduce the impact of injury. In particular, allowing the 12th man to play as a full substitute in first class cricket (and therefore take some of the bowling workload in the second innings) would probably reduce bowling injury prevalence in cricket.

Pace bowlers in cricket with history of lumbar stress fracture have increased risk of lower limb muscle strains, particularly calf strains.

OBJECTIVE: To assess whether a history of lumbar stress fracture in pace bowlers in cricket is a risk factor for lower limb muscle strains. METHODS: This was a prospective cohort risk factor study, conducted using injury data from contracted first class pace bowlers in Australia during seasons 1998-1999 to 2008-2009 inclusive. There were 205 pace bowlers, 33 of whom suffered a lumbar stress fracture when playing first class cricket. Risk ratios ([RR] with 95% confidence intervals[CI]) were calculated to compare the seasonal incidence of various injuries between bowlers with a prior history of lumbar stress fracture and those with no history of lumbar stress fracture. RESULTS: Risk of calf strain was strongly associated with prior lumbar stress fracture injury history (RR = 4.1; 95% CI: 2.4-7.1). Risks of both hamstring strain (RR = 1.5; 95% CI: 1.03-2.1) and quadriceps strain (RR = 2.0; 95% CI: 1.1-3.5) were somewhat associated with history of lumbar stress fracture. Risk of groin strain was not associated with history of lumbar stress fracture (RR = 0.7; 95% CI: 0.4-1.1). Other injuries showed little association with prior lumbar stress fracture, although knee cartilage injuries were more likely in the non-stress fracture group. CONCLUSION: Bony hypertrophy associated with lumbar stress fracture healing may lead to subsequent lumbar nerve root impingement, making lower limb muscle strains more likely to occur. Confounders may be responsible for some of the findings. In particular, bowling speed is likely to be independently correlated with risk of lumbar stress fracture and risk of muscle strain. However, as the relationship between lumbar stress fracture history and calf strain was very strong, and that there is a strong theoretical basis for the connection, it is likely that this is a true association.

Fast bowlers in cricket demonstrate up to 3- to 4-week delay between high workloads and increased risk of injury.

BACKGROUND: Limited research in cricket bowlers and baseball pitchers has shown a correlation between workload and injury risk. HYPOTHESIS: Acute high bowling workload in cricket leads to increased risk of bowling injury in future matches. STUDY DESIGN: Cohort study (prognosis); Level of evidence, 2. METHODS: One hundred twenty-nine pace (fast) bowlers who bowled in 2715 player matches over a period of 10 seasons were followed to compare overs bowled in each match and injury risk subsequent to the match. RESULTS: Bowlers who bowled more than 50 overs in a match had an injury incidence in the next 21 days of 3.37 injuries per 1000 overs bowled, a significantly increased risk compared with those bowlers who bowled less than 50 overs (relative risk [RR], 1.77; 95% confidence interval [CI]: 1.05-2.98). Bowlers who bowled more than 30 overs in the second inning of a match had a significantly increased injury risk per over bowled in the next 28 days (RR, 2.42; 95% CI: 1.38-4.26). Time periods of less than 21 days or more than 28 days after the match in question did not yield significant differences in injury risk per over bowled between high and low workload bowlers. CONCLUSION: High acute workload in cricket fast bowlers may lead to a somewhat delayed increased risk of injury up to 3 to 4 weeks after the acute overload, possibly via a mechanism of damaging immature (repair) tissue. CLINICAL RELEVANCE: Cricket fast bowling and possibly baseball pitching workloads require scrutiny not just for acute injuries but also for injury prevention in the subsequent month.

Side strain: a tear of internal oblique musculature.

OBJECTIVE: Our objective was to describe the normal MRI anatomy of the musculature of the lateral abdominal wall and the findings in athletes with side strain injury. CONCLUSION: MRI can delineate the sheets of musculature that make up the lateral abdominal wall. Side strain injury is caused by tearing of the internal oblique muscle from the undersurface of one of the lower four ribs or costal cartilages. MRI can document the site of a muscle tear, characterize the severity of injury, and monitor healing.