The effects on sports performance of technologic advances in sports prostheses and wheelchairs.

The field of medicine continues to advance as new technologies emerge. These technological advancements include the science of sports prostheses and wheelchairs, in which there have been significant advancements over the past decades. The world of adaptive sports continues to expand, largely due to a combination of the increase in awareness, inclusion, and technology. As participation in sports for people with impairments increases, there has been an associated demand for new, innovative adaptive sporting equipment designs that help accommodate the physical deficits of the individual. Controversy has risen as persons with disabilities advance their skills with adaptive sports equipment to compete with individuals without disabilities. The controversy leads to the question: is the adaptive equipment allowing athletes with disability to regain the lost function from their baseline or does it allow them to exceed prior ability level? This narrative review provides information regarding the performance effects of advances in technology and biomechanics of adaptive sports equipment to help answer these questions.

Golf in the Paralympic Games.

ABSTRACT: The Paralympic Games offer exciting opportunities for athletes with an impairment to compete at the highest level with other athletes from around the globe, fostering international goodwill, inclusivity, and diversity. Golf returned to the Olympic Games in 2016; despite a significant growth in popularity for persons with physical and mental impairments, it has not been a Paralympic Games sport. The inaugural US Adaptive Open may provide a model for future Paralympic Games golf competitions.

Special Populations in Orthobiologics: Athletic, Elderly, and Pediatrics Populations.

This section is devoted to a review of the literature regarding the usage of orthobiologics in the special populations of elite athletes, the elderly, and pediatrics. The prospect of these regenerative options is encouraging to help provide alternative options that may enhance recovery and healing of acute and degenerative pathologic conditions. The goal is to provide the readers an overview of the existing literature highlighting areas with growing research and others that are still lacking.

Adaptive Cycling.

Adaptive athletes have globally embraced the sport of adaptive cycling, and participation is expanding rapidly on local, national, and international levels. With a diverse array of events supporting adaptive cyclist participation, there is a need to create more awareness about the history and classes of adaptive cycling, adaptive cycle technology, and injuries and medical concerns specific to this group of adaptive athletes. This communication aims to review the major aspects of adaptive cycling, from the technological aspects of both the cycles and adaptations of the athlete to injuries and medical concerns specific to adaptive cyclists.

Assessing the Accuracy of Ultrasound-Guided Needle Placement in Sacroiliac Joint Injections.

OBJECTIVE: The aim of the study was to assess the accuracy of ultrasound-guided needle placement for sacroiliac joint injections. DESIGN: Institutional review board approval was gained for a prospective cohort study of 50 patients (N = 50). Study patients who were referred for sacroiliac joint injections for sacroiliac joint mediate pain and met inclusion/exclusion criteria were enrolled in the study. Each patient underwent needle placement with ultrasound guidance in the procedure suite. After the needle was placed with the ultrasound guidance, fluoroscopy was used to confirm correct placement via contrast injection confirming a sacroiliac joint arthrogram. The arthrogram was confirmed via the performing physician and radiologist. RESULTS: The placement of the needle with ultrasound guidance into the sacroiliac joint was confirmed successful in 96% (48/50) patients by fluoroscopic arthrogram. The two patients with unsuccessful arthrograms after initial placement of the needle with ultrasound were morbidly obese. There was intravascular uptake during the arthrogram of one patient who had a successful arthrogram. CONCLUSIONS: Ultrasound-guided injection of the sacroiliac joint is successful and accurate upon confirmation of fluoroscopic arthrogram and should be used as an imaging modality for needle guidance.

Use of Platelet-Rich Plasma for the Treatment of Acetabular Labral Tear of the Hip: A Pilot Study.

OBJECTIVE: This study aims to assess whether ultrasound-guided injection of platelet-rich plasma can safely and effectively treat symptoms associated with acetabular hip labral tears. DESIGN: Institutional review board approval was gained for a prospective study of eight patients (N = 8), who have previously failed conservative management, to receive ultrasound-guided injection of platelet-rich plasma at the site of hip labrum tear. We assessed pain reduction and functional ability at baseline and then 2, 6, and 8 wks after injection, using the visual analog scale and Harris Hip Score, respectively. RESULTS: Statistically significant differences in Harris Hip Score were seen 2 wks (86.5 ± 10.8, P < 0.01), 6 wks (88.0 ± 10.7) P < 0.01), and 8 wks (92.1 ± 11.6, P < 0.01) after injection as compared with baseline (76.0 ± 13.4). Corresponding improvements were seen in visual analog scale 2 wks (1.0, P < 0.01 at rest, 2.5, P < 0.01 with activity), 6 (0.9, P < 0.01 at rest, 2.3, P < 0.01 with activity), and 8 wks (0.5, P < 0.01 at rest, 1.3, P < 0.01 with activity) compared with baseline (3.8 at rest, 5.4 with activity). CONCLUSIONS: Ultrasound-guided injection of platelet-rich plasma holds promise as an emerging, minimally invasive technique toward symptom relief, reducing pain, and improving function in patients with hip labral tears.

Adolescent Pitcher Recovery from Partial Ulnar Collateral Ligament Tear after Platelet-Rich Plasma.

Platelet-rich plasma (PRP), as a regenerative treatment for partial ulnar collateral ligament (UCL) tears, is validated to lead to faster clinical recovery and return to play in adult athletes. However, studies examining such a role of PRP in younger pediatric and adolescent athletes are scarce. A 14-year-old adolescent throwing athlete, a right-handed pitcher, presented with chronic right medial elbow pain discovered to be secondary to a partial UCL tear, as identified on both ultrasound and magnetic resonance imaging. A single ultrasound-guided injection of PRP to the pathologic site of the partial UCL tear, in concert with our standardized rehabilitation protocol for throwing athletes after UCL injuries, enabled the boy to heal and return to throwing at full pitching distance without pain and without complications. This emphasizes the utility of PRP as a regenerative treatment option in an adolescent throwing athlete.

Low back pain in the adolescent athlete.

Clinicians must have knowledge of the growth and development of the adolescent spine and the subsequent injury patterns and other spinal conditions common in the adolescent athlete. The management and treatment of spinal injuries in adolescent athletes require a coordinated effort between the clinician, patients, parents/guardians, coaches, therapists, and athletic trainers. Treatment should not only help alleviate the current symptoms but also address flexibility and muscle imbalances to prevent future injuries by recognizing and addressing risk factors. Return to sport should be a gradual process once the pain has resolved and the athlete has regained full strength.

Adaptive sports technology and biomechanics: wheelchairs.

Wheelchair sports are an important tool in the rehabilitation of people with severe chronic disabilities and have been a driving force for innovation in technology and practice. In this paper, we will present an overview of the adaptive technology used in Paralympic sports with a special focus on wheeled technology and the impact of design on performance (defined as achieving the greatest level of athletic ability and minimizing the risk of injury). Many advances in manual wheelchairs trace their origins to wheelchair sports. Features of wheelchairs that were used for racing and basketball 25 or more years ago have become integral to the manual wheelchairs that people now use every day; moreover, the current components used on ultralight wheelchairs also have benefitted from technological advances developed for sports wheelchairs. For example, the wheels now used on chairs for daily mobility incorporate many of the components first developed for sports chairs. Also, advances in manufacturing and the availability of aerospace materials have driven current wheelchair design and manufacture. Basic principles of sports wheelchair design are universal across sports and include fit; minimizing weight while maintaining high stiffness; minimizing rolling resistance; and optimizing the sports-specific design of the chair. However, a well-designed and fitted wheelchair is not sufficient for optimal sports performance: the athlete must be well trained, skilled, and use effective biomechanics because wheelchair athletes face some unique biomechanical challenges.

Adaptive sports technology and biomechanics: prosthetics.

With the technologic advances in medicine and an emphasis on maintaining physical fitness, the population of athletes with impairments is growing. It is incumbent upon health care practitioners to make every effort to inform these individuals of growing and diverse opportunities and to encourage safe exercise and athletic participation through counseling and education. Given the opportunities for participation in sports for persons with a limb deficiency, the demand for new, innovative prosthetic designs is challenging the clinical and technical expertise of the physician and prosthetist. When generating a prosthetic prescription, physicians and prosthetists should consider the needs and preferences of the athlete with limb deficiency, as well as the functional demands of the chosen sporting activity. The intent of this article is to provide information regarding the current advancements in the adaptive sports technology and biomechanics in the field of prosthetics, and to assist clinicians and their patients in facilitating participation in sporting activities.

Complementary and alternative medicine in osteoarthritis.

The intent of this focused clinical review is to assess the current literature on a variety of complementary and alternative medicine treatments for osteoarthritis. This review assesses acupuncture techniques, moxibustion, transcutaneous electrical nerve stimulation, low-level laser therapy, and massage. These treatment methods are growing in popularity among the general public. It is important that providers become aware of the existing literature regarding the efficacy of these alternative methods for the treatment of osteoarthritis to adequately respond to the inquiries of our patients.

Rucksack-induced plexopathy mimicking a lateral antebrachial cutaneous neuropathy.

A 20-yr-old active duty soldier complained of right lateral forearm numbness that began shortly after carrying 100 lbs of equipment (20-lb load-bearing equipment, 20-lb individual body armor, and 60-lb rucksack) while deployed during Operation Iraqi Freedom. Physical examination revealed normal strength but decreased sensation over the right lateral forearm, thumb, and index finger. Imaging studies were normal. Electrodiagnostic studies revealed an absent right lateral antebrachial cutaneous nerve conduction study with abnormal electromyography findings in the right deltoid and biceps brachii. He was diagnosed with an upper trunk brachial plexopathy. The patient's symptoms gradually resolved with conservative treatment. Although rucksack palsies have been previously reported, this relatively rare cause of brachial plexus injury has been generally declining with the reengineering of more ergonomically favorable rucksacks. It is possible that the additional body armor may have contributed.