Athlete ECG T-wave abnormality interpretation patterns by non-experts.

Background: The presence of T-wave abnormalities (TWA) on an athlete's electrocardiogram (ECG) presents as a diagnostic challenge for physicians. Types of TWA patterns classified as abnormal by inexperienced readers have not been systematically analyzed. Methods: ECGs from the 2011-2015 National Football League Scouting Combine (initially interpreted by general cardiologists) were retrospectively reviewed by expert sports cardiologists with strict application of the 2017 International Criteria. Patterns of TWA that were altered from the original interpretation were analyzed. Results: The study included 1643 athletes (mean age 22 years). There was a 67 % reduction in the number of athletes with any TWA (p < 0.001) with 111 ECGs changed to normal. Inferior TWA was the most common interpreted initial ECG abnormality altered followed by anterior and lateral. Discussion: This analysis revealed an initial high rate of TWA by non-expert readers. Tailored education programs to physicians who interpret athlete ECGs should highlight these specific T-wave patterns. We see this as an opportunity to make more clinicians aware of ECG interpretation guidelines as sports trained cardiologists are mostly self-taught.

The Effects of Headgear in High School Girls' Lacrosse.

BACKGROUND: Girls' lacrosse headgear that met the ASTM International performance standard (ASTM F3137) became available in 2017. However, the effects of headgear use on impact forces during game play are unknown. PURPOSE: To evaluate potential differences in rates, magnitudes, and game-play characteristics associated with verified impacts among players with and without headgear during competition. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A total of 49 female high school participants (mean age, 16.2 ± 1.2 years; mean height, 1.66 ± 0.05 m; mean weight, 61.2 ± 6.4 kg) volunteered for this study, which took place during the 2016 (no headgear; 18 games) and 2017 (headgear; 15 games) seasons. Wearable sensors synchronized with video verification were used. Descriptive statistics, impact rates, and chi-square analyses described impacts and game-play characteristics among players with and without headgear. Differences in mean peak linear acceleration (PLA) and peak rotational velocity (PRV) between the no headgear and headgear conditions were evaluated using a linear generalized estimating equation regression model to control for repeated within-player measurements. RESULTS: Overall, 649 sensor-instrumented player-games were recorded. A total of 204 impacts ≥20g recorded by the wearable sensors were verified with video analysis (102 no headgear; 102 headgear). Most impacts were imparted to the player's body (n = 152; 74.5%) rather than to the player's head (n = 52; 25.5%). Impact rates per player-game did not vary between the no headgear and headgear conditions (0.30 vs 0.34, respectively; impact rate ratio, 0.88 [95% CI, 0.37-2.08]). There was no association between impact frequency by mechanism or penalties administered between the no headgear and headgear conditions for overall or direct head impacts. The generalized estimating equation model estimated a significant reduction in mean impact magnitudes overall (PLA: -7.9g [95% CI, -13.3 to -2.5]; PRV: -212 deg/s [95% CI, -359 to -64]) with headgear relative to no headgear. No game-related concussions were reported during this study. CONCLUSION: Lacrosse headgear use was associated with a reduction in the magnitude of overall impacts but not a significant change in the rate of impacts, how they occur, or how penalties were administered for impacts sustained during competition. Further research is needed with a larger sample and different levels of play to evaluate the consequences of headgear use in girls' lacrosse.

Arrhythmias and Adaptations of the Cardiac Conduction System in Former National Football League Players.

Background Habitual high-intensity endurance exercise is associated with increased atrial fibrillation (AF) risk and impaired cardiac conduction. It is unknown whether these observations extend to prior strength-type sports exposure. The primary aim of this study was to compare AF prevalence in former National Football League (NFL) athletes to population-based controls. The secondary aim was to characterize other conduction system parameters. Methods and Results This cross-sectional study compared former NFL athletes (n=460, age 56±12 years, black 47%) with population-based controls of similar age and racial composition from the cardiovascular cohort Dallas Heart Study-2 (n=925, age 54±9 years, black 53%). AF was present in 28 individuals (n=23 [5%] in the NFL group; n=5 [0.5%] in the control group). After controlling for other cardiovascular risk factors in multivariable regression analysis, former NFL participation remained associated with a 5.7 (95% CI: 2.1-15.9, P<0.001) higher odds ratio of AF. Older age, higher body mass index, and nonblack race were also independently associated with higher odds ratio of AF, while hypertension and diabetes mellitus were not. AF was previously undiagnosed in 15/23 of the former NFL players. Previously undiagnosed NFL players were rate controlled and asymptomatic, but 80% had a CHA2DS2-VASc score ≥1. Former NFL players also had an 8-fold higher prevalence of paced cardiac rhythms (2.0% versus 0.25%, P<0.01), compared with controls. Furthermore, former athletes had lower resting heart rates (62±11 versus 66±11 beats per minute, P<0.001), and a higher prevalence of first-degree atrioventricular block (18% versus 9%, P<0.001). Conclusions Former NFL participation was associated with an increased AF prevalence and slowed cardiac conduction when compared with a population-based control group. Former NFL athletes who screened positive for AF were generally rate controlled and asymptomatic, but 80% should have been considered for anticoagulation based on their stroke risk.

Risk and Causes of Death among Former National Football League Players (1986-2012).

PURPOSE: Previous research identified decreased overall and cardiovascular mortality for National Football League (NFL) players from the 1959-1988 era. The present study explored the mortality risk among recent NFL players who played in an era of heavier linemen and nearly year-round physical conditioning. METHODS: This cohort study included 9778 former NFL players with at least 1 yr in the NFL whose last season was between 1986 and 2012. Players' pension fund records were matched to the National Death Index to determine vital status, date of death, and cause of death. Standardized mortality ratios (SMR) compared player mortality through 2014 with US men of the same age, race, and calendar year. Cox proportional hazards models assessed the effect of player characteristics on overall and cardiovascular mortality. RESULTS: Two percent (n = 227) of players were deceased, with a median age at death of 38 yr (range, 23-61 yr). The most common major causes of death were diseases of the heart (n = 47; 21%), violence (n = 39; 17%), and transportation injuries (n = 34; 15%). Risk of death was significantly lower than the general population for overall mortality (SMR, 0.46, 95% confidence interval (CI), 0.40-0.52), cardiovascular disease (SMR, 0.65; 95% CI, 0.50-0.84), and other major causes. Players with playing-time body mass index (BMI) of >35 kg·m had significantly higher cardiovascular disease mortality (SMR, 2.20; 95% CI, 1.32-3.44) than did the general population and higher overall mortality risk (standardized rate ratio, 3.84; 95% CI, 2.66-5.54) than did players with a BMI of <30 kg·m. CONCLUSIONS: Consistent with an earlier NFL cohort and other elite athlete populations, the overall and cardiovascular mortality risk of this NFL cohort was significantly lower than that of the general US male population, likely attributable to a healthy worker effect and less smoking.However, players with the highest playing-time BMI exhibited elevated cardiovascular mortality risk.

Ascending Aortic Dimensions in Former National Football League Athletes.

BACKGROUND: Ascending aortic dimensions are slightly larger in young competitive athletes compared with sedentary controls, but rarely >40 mm. Whether this finding translates to aortic enlargement in older, former athletes is unknown. METHODS AND RESULTS: This cross-sectional study involved a sample of 206 former National Football League (NFL) athletes compared with 759 male subjects from the DHS-2 (Dallas Heart Study-2; mean age of 57.1 and 53.6 years, respectively, P<0.0001; body surface area of 2.4 and 2.1 m2, respectively, P<0.0001). Midascending aortic dimensions were obtained from computed tomographic scans performed as part of a NFL screening protocol or as part of the DHS. Compared with a population-based control group, former NFL athletes had significantly larger ascending aortic diameters (38±5 versus 34±4 mm; P<0.0001). A significantly higher proportion of former NFL athletes had an aorta of >40 mm (29.6% versus 8.6%; P<0.0001). After adjusting for age, race, body surface area, systolic blood pressure, history of hypertension, current smoking, diabetes mellitus, and lipid profile, the former NFL athletes still had significantly larger ascending aortas (P<0.0001). Former NFL athletes were twice as likely to have an aorta >40 mm after adjusting for the same parameters. CONCLUSIONS: Ascending aortic dimensions were significantly larger in a sample of former NFL athletes after adjusting for their size, age, race, and cardiac risk factors. Whether this translates to an increased risk is unknown and requires further evaluation.

Sleep-apnea risk and subclinical atherosclerosis in early-middle-aged retired National Football League players.

PURPOSE: Limited data from former National Football League (NFL) players suggest that obstructive sleep apnea (OSA) may be highly prevalent after retirement. It remains unclear whether the high prevalence of OSA in retired players is comparable to nonathletes. This retrospective analysis compared sleep apnea (SA) risk in retired NFL players to a community cohort (CARDIA Sleep study), and examined associations between SA risk and cardiovascular risk factors, including subclinical atherosclerosis. MATERIALS AND METHODS: Retired NFL players (n=122) were matched to CARDIA Sleep participants by age ±2 years (range 37-55 years), body mass index ±2 kg/m2, race, and male sex. Participants underwent electron-beam computed tomography to measure coronary artery calcium (CAC) and completed the Berlin Questionnaire to determine SA risk. The presence of CAC was defined as an Agatston score >0. RESULTS: Retired NFL players had a greater prevalence of high SA risk than the matched CARDIA Sleep participants (27% vs 11.5%, P=0.002). Compared to the CARDIA Sleep participants, retired players were less likely to smoke, and had higher blood pressure, lower fasting glucose levels, and higher cholesterol levels. However, there was no difference in the prevalence of detectable CAC (30% vs 30%, P=1). In both players and the community cohort, SA risk was not significantly associated with CAC after controlling for age, race, and body mass index. CONCLUSION: Retired NFL players have a greater prevalence of high SA risk but similar prevalence of CAC compared with a well-matched community cohort.

Lack of blood pressure difference by race in professional American football players.

Previous findings suggest that professional American football players have higher blood pressures (BP) and a higher prevalence of pre-hypertension and hypertension than the general population. We sought to determine whether race is associated with differences in BP and prevalence of pre-hypertension and hypertension among a large sample of professional football players. BP was measured at 2009 team mini-camps for 1484 black (n = 1007) and white (n = 477) players from 27 National Football League (NFL) teams. Players were categorized into three position groups based on body mass index (BMI). There was no racial difference in mean systolic or diastolic BP in any of the three position groups. There were no racial differences in prevalence of hypertension (99 [9.8%] black players vs. 39 [8.2%] white players; P = .353) or pre-hypertension (557 [55.3%] black players vs. 264 [55.3%] white players; P = 1.0). Contrary to findings in the general population, BP and prevalence of pre-hypertension/hypertension did not vary with race in a large population of active NFL players.

Rate of injury among youth lacrosse players.

OBJECTIVE: This study describes the rate of injury and the types and mechanisms of injuries incurred by girls and boys during youth recreational lacrosse. DESIGN: Prospective cohort study. SETTING: Games were played at a large turf community athletic complex. PARTICIPANTS: Participants included male and female lacrosse players aged 9-15 years. A total of 143 games were played, resulting in 4603 athlete-exposures (AEs). ASSESSMENT OF RISK FACTORS: Youth players were grouped based on sex and 3 age categories: under 11 (U11; 9-10 years), under 13 (U13; 11-12 years), and under 15 (U15; 13-14 years). MAIN OUTCOME MEASURES: Certified athletic trainers collected data on type of injury and injury mechanism. RESULTS: There were 6.3 injuries per 1000 AEs for boys and girls combined. Girls had 7 injuries (3.4 per 1000 AEs) and boys had 22 injuries (8.7 per 1000 AEs). Contusions and lacerations were the most frequent injury (n = 13), and body-to-body contact (n = 10) was the most common injury mechanism. There were 4 concussions among boys (U13 and U15) and none among girls. CONCLUSIONS: Most injuries evaluated in youth lacrosse were contusions/lacerations; however, serious injuries were observed, including concussions in boys in the age group where body contact is allowed.

Video incident analysis of concussions in boys' high school lacrosse.

BACKGROUND: Boys' lacrosse has one of the highest rates of concussion among boys' high school sports. A thorough understanding of injury mechanisms and game situations associated with concussions in boys' high school lacrosse is necessary to target injury prevention efforts. PURPOSE: To characterize common game-play scenarios and mechanisms of injury associated with concussions in boys' high school lacrosse using game video. STUDY DESIGN: Descriptive epidemiological study. METHODS: In 25 public high schools of a single school system, 518 boys' lacrosse games were videotaped by trained videographers during the 2008 and 2009 seasons. Video of concussion incidents was examined to identify game characteristics and injury mechanisms using a lacrosse-specific coding instrument. RESULTS: A total of 34 concussions were captured on video. All concussions resulted from player-to-player bodily contact. Players were most often injured when contact was unanticipated or players were defenseless (n = 19; 56%), attempting to pick up a loose ball (n = 16; 47%), and/or ball handling (n = 14; 41%). Most frequently, the striking player's head (n = 27; 79%) was involved in the collision, and the struck player's head was the initial point of impact in 20 incidents (59%). In 68% (n = 23) of cases, a subsequent impact with the playing surface occurred immediately after the initial impact. A penalty was called in 26% (n = 9) of collisions. CONCLUSION: Player-to-player contact was the mechanism for all concussions. Most commonly, injured players were unaware of the pending contact, and the striking player used his head to initiate contact. Further investigation of preventive measures such as education of coaches and officials and enforcement of rules designed to prevent intentional head-to-head contact is warranted to reduce the incidence of concussions in boys' lacrosse.

Association between traditional cholesterol parameters, lipoprotein particle concentration, novel biomarkers and carotid plaques in retired National Football League players.

OBJECTIVES: We assessed whether low-density lipoprotein particle concentration (LDL-P) and high-sensitivity C-reactive protein [hs-CRP] can identify subclinical atherosclerosis better than traditional cholesterol parameters in retired National Football League (NFL) players. BACKGROUND: It is not known whether LDL-P and the biomarker hs-CRP can identify subclinical atherosclerosis better than low-density lipoprotein cholesterol (LDL-C) or non-high-density-lipoprotein cholesterol (non-HDL-C) in retired NFL players, given high prevalence of metabolic syndrome in these players. METHODS: Carotid artery plaque screening was performed with traditional lipids, LDL-P, and hs-CRP in 996 retired players. Logistic regression analyses comparing highest with the lowest quartile were performed. RESULTS: Carotid artery plaques were seen in 41%. LDL-C (odds ratio [OR] 1.66, 95% confidence interval [CI] 1.06-2.59), non-HDL-C (OR 1.67, 95% CI 1.04-2.67), and LDL-P (OR 2.21, 95% CI 1.35-3.62) were associated with plaques in adjusted models. Among 187 retired players with metabolic syndrome, LDL-C (OR 1.40, 95% CI 0.53-3.72) was not associated with carotid plaques, whereas LDL-P (OR 3.71, 95% CI 1.16-11.84) and non-HDL-C (OR 2.63, 95% CI 0.91-7.63, p=0.07; borderline significant) were associated with carotid plaques. hs-CRP (OR 1.13, 95% CI 0.71-1.79) was not associated with carotid plaques. CONCLUSION: Carotid artery plaques were common in retired NFL players and were strongly associated with LDL-P, especially among those with metabolic syndrome. hs-CRP was not associated with carotid plaques in this cohort.

Video incident analysis of head injuries in high school girls' lacrosse.

BACKGROUND: Knowledge of injury mechanisms and game situations associated with head injuries in girls' high school lacrosse is necessary to target prevention efforts. PURPOSE: To use video analysis and injury data to provide an objective and comprehensive visual record to identify mechanisms of injury, game characteristics, and penalties associated with head injury in girls' high school lacrosse. STUDY DESIGN: Descriptive epidemiology study. METHODS: In the 25 public high schools of 1 school system, 529 varsity and junior varsity girls' lacrosse games were videotaped by trained videographers during the 2008 and 2009 seasons. Video of head injury incidents was examined to identify associated mechanisms and game characteristics using a lacrosse-specific coding instrument. RESULTS: Of the 25 head injuries (21 concussions and 4 contusions) recorded as game-related incidents by athletic trainers during the 2 seasons, 20 head injuries were captured on video, and 14 incidents had sufficient image quality for analysis. All 14 incidents of head injury (11 concussions, 3 contusions) involved varsity-level athletes. Most head injuries resulted from stick-to-head contact (n = 8), followed by body-to-head contact (n = 4). The most frequent player activities were defending a shot (n = 4) and competing for a loose ball (n = 4). Ten of the 14 head injuries occurred inside the 12-m arc and in front of the goal, and no penalty was called in 12 injury incidents. All injuries involved 2 players, and most resulted from unintentional actions. Turf versus grass did not appear to influence number of head injuries. CONCLUSION: Comprehensive video analysis suggests that play near the goal at the varsity high school level is associated with head injuries. Absence of penalty calls on most of these plays suggests an area for exploration, such as the extent to which current rules are enforced and the effectiveness of existing rules for the prevention of head injury.

Effectiveness of the women's lacrosse protective eyewear mandate in the reduction of eye injuries.

BACKGROUND: In an effort to minimize the risk of catastrophic eye injury, US Lacrosse initiated mandatory use of protective eyewear in women's lacrosse in the 2004-2005 season. PURPOSE: The authors compared eye injury rates in girls' scholastic lacrosse before and after implementation of protective eyewear. They also compared head/face injury rates, concussion rates, and overall injury rates before and after the rule change to assess possible unintended consequences of the change. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: The study group included female scholastic lacrosse players in the 25 public high schools in Fairfax County, Virginia, during the 2004-2009 spring seasons. Injury rates were compared with those from the same data source for the 2000-2003 seasons. Premandate versus postmandate injury rates were adjusted for athlete exposures, or total opportunities for injury throughout the season. RESULTS: The rate of eye injuries was reduced from 0.10 injuries per 1000 athlete exposures (AEs) in 2000 through 2003 before the use of protective eyewear to 0.016 injuries per 1000 AEs in 2004 through 2009 (incident rate ratio [IRR], 0.16; 95% confidence interval [CI], 0.06-0.42). The rate ratio of head/face injuries excluding concussion also decreased (IRR, 0.44; 95% CI, 0.26-0.76). There was no change in the rate ratio of total injuries involving all body parts (IRR, 0.93; 95% CI, 0.82-1.1) after introduction of protective eyewear. However, the rate ratio of concussion increased (IRR, 1.6; 95% CI, 1.1-2.3). CONCLUSION: The use of protective eyewear in women's lacrosse was associated with a reduction in the number of eye injuries. The number of head/face injuries decreased in this study group after introduction of protective eyewear, and there was no change in overall injury rates. The reason for the increase in concussion rate cannot be determined conclusively based on this study, but the authors speculate that this increase resulted largely from increased recognition and diagnosis because overall injury rates do not indicate rougher play with introduction of protective equipment.

Prevention of anastomotic thrombosis by botulinum toxin B after acute injury in a rat model.

PURPOSE: Revascularized or replanted digits may fail because of vessel thrombosis. Off-label use of botulinum toxin type A injected subcutaneously has been used successfully in limited case series to treat vasospastic disorders. Botulinum toxin type B (BTX-B) is thought to have an earlier onset of action than type A in certain settings. We used a rat model to determine the ability of BTX-B to decrease vasospasm and prevent thrombosis after acute vessel division and anastomotic repair. METHODS: We transected and immediately repaired the bilateral femoral arteries and veins of 25 rats via microscopic technique. We measured each vessel's diameter before transection. Each rat had 1 leg randomly assigned to receive BTX-B; the contralateral side received normal saline. We separated the animals into 5 groups. Each group underwent vasospastic stress at a different time point (12, 24, 48, 72, and 120 h) after the anastomoses and treatment with BTX-B or saline. Vasospastic stress included a lower extremity cold temperature challenge and systemic treatment with phenylephrine. After vasospastic stress, we reopened the wounds and recorded vessel thrombosis and diameter. RESULTS: Vessel thrombosis rate was lower in the BTX-B-treated group of vessels compared with those receiving placebo. Thrombosis rate was 8% for BTX-B-treated arteries versus 68% for saline-treated arteries. Thrombosis rate was 20% for BTX-B-treated veins versus 76% for saline-treated veins. Overall vessel thrombosis rate was significantly lower for BTX-B at all time points except at 120 hours when no thrombotic events occurred for either group. Average increase in diameter for BTX-B-treated vessels was significantly greater than that for the controls regardless of patency. CONCLUSIONS: BTX-B prevented or reduced the incidence of thrombosis after acute vessel anastomosis in this rat model at all time points less than 120 hours compared with placebo. The average final vessel diameter throughout the series of BTX-B-treated vessels was significantly larger than in the control group. CLINICAL RELEVANCE: The use of BTX-B may improve the success rate of microvascular anastomoses by being protective against vasospastic stress and subsequent thrombosis.

Trends in concussion incidence in high school sports: a prospective 11-year study.

BACKGROUND: Understanding the risk and trends of sports-related concussion among 12 scholastic sports may contribute to concussion detection, treatment, and prevention. PURPOSE: To examine the incidence and relative risk of concussion in 12 high school boys' and girls' sports between academic years 1997-1998 and 2007-2008. STUDY DESIGN: Descriptive epidemiology study. METHODS: Data were prospectively gathered for 25 schools in a large public high school system. All schools used an electronic medical record-keeping program. A certified athletic trainer was on-site for games and practices and electronically recorded all injuries daily. RESULTS: In sum, 2651 concussions were observed in 10 926 892 athlete-exposures, with an incidence rate of 0.24 per 1000. Boys' sports accounted for 53% of athlete-exposures and 75% of all concussions. Football accounted for more than half of all concussions, and it had the highest incidence rate (0.60). Girls' soccer had the most concussions among the girls' sports and the second-highest incidence rate of all 12 sports (0.35). Concussion rate increased 4.2-fold (95% confidence interval, 3.4-5.2) over the 11 years (15.5% annual increase). In similar boys' and girls' sports (baseball/softball, basketball, and soccer), girls had roughly twice the concussion risk of boys. Concussion rate increased over time in all 12 sports. CONCLUSION: Although the collision sports of football and boys' lacrosse had the highest number of concussions and football the highest concussion rate, concussion occurred in all other sports and was observed in girls' sports at rates similar to or higher than those of boys' sports. The increase over time in all sports may reflect actual increased occurrence or greater coding sensitivity with widely disseminated guidance on concussion detection and treatment. The high-participation collision sports of football and boys' lacrosse warrant continued vigilance, but the findings suggest that focus on concussion detection, treatment, and prevention should not be limited to those sports traditionally associated with concussion risk.

Sleep-disordered breathing in the National Football League.

STUDY OBJECTIVES: Prior studies have suggested that the prevalence of sleep disordered breathing (SDB) among players in the National Football League (NFL) is disproportionately high. SDB can increase cardiovascular disease risk and is correlated with hypertension. NFL players have a higher prevalence of hypertension, and we sought to determine the prevalence of SDB among players the NFL and the associations of SDB with anthropometric measures and cardiovascular risk factors. DESIGN: Cross-sectional cohort study. SETTING: NFL athletic training facilities from April to July 2007. PARTICIPANTS: A total of 137 active veteran players from 6 NFL teams. MEASUREMENTS: This evaluation of SDB among players in the NFL used a single-channel, home-based, unattended, portable, sleep apnea monitor. Multiple domains of self-reported sleep were assessed. Weight, body mass index, body fat percentage, neck circumference, waist circumference, and waist-to-hip ratio, as well as blood pressure, cholesterol, and fasting glucose concentrations were measured. RESULTS: The mean respiratory disturbance index was 4.7 (+/- 12), with a median (interquartile range) of 2 (1,4). The prevalence of at least mild SDB (RDI > or = 5) was 19% (95% confidence interval, 12.8%-26.6%). Only 4.4% (95% confidence interval, 1.6%-9.2%) of participants had respiratory disturbance index of 15 or greater. Linemen and non-linemen were not different in their prevalence or severity of SDB. No single anthropometric measure was highly associated with SDB, and SDB was not well correlated with cardiovascular risk factors. CONCLUSIONS: The prevalence of SDB in active NFL players was modest, predominately mild, and positively associated with several measures of adiposity. SDB did not account for excess cardiovascular risk factors.

Body size, body composition, and cardiovascular disease risk factors in NFL players.

AIMS: We characterized the size of active National Football League (NFL) players by multiple criteria and analyzed their relation to traditional cardiovascular disease (CVD) risk factors with the objective of further clarifying the occurrence of cardiovascular risk factors in different player positions. METHODS: This cross-sectional study was conducted in professional athletic training facilities. The participants were 504 active veteran players from a convenience sample of 12 NFL teams, grouped as interior linemen (IL) or all others (AO). Comparisons were made between the NFL groups and an age-equivalent general population database. RESULTS: The IL group was significantly larger than AO by all size measures. Both groups were significantly larger than the Coronary Artery Risk Development in Young Adults (CARDIA) group. Mean percent body fat measurements in AO (mean, 13.4%; 95% confidence interval [CI], 12.9%-14%) and IL (mean, 25.2%; 95% CI, 24.4%-26%) groups were lower than estimates for the general population. Systolic blood pressure (BP) was higher in IL (mean, 131 mm Hg; 95% CI, 129-133 mm Hg) than AO (mean, 126 mm Hg; 95% CI, 125-127 mm Hg) and greater in both groups compared with the CARDIA group (mean, 112 mm Hg; 95% CI, 111-112 mm Hg). Mean low-density lipoprotein cholesterol and high-density lipoprotein cholesterol (HDL-C), total cholesterol, triglycerides, and glucose were within the normal range for both IL and AO. Interior linemen had significantly lower HDL-C than AO and the CARDIA group. Both NFL groups had significantly lower fasting glucose than CARDIA. CONCLUSION: Body fat in active NFL players was lower than predicted by standard measures of obesity. Although the players were large, they were in the normal range for most CVD risk factors. Mean BP in the prehypertensive range was found in both NFL position groups, but was significantly higher in IL than in AO. Prehypertension in these athletes warrants vigilance.

Intra- and inter-examiner variability in performing Tinel's test.

PURPOSE: The Tinel sign was adopted in the early 1950s to detect sites of nerve compression. There have been few attempts to standardize how one elicits Tinel's sign. The goal of this study was to evaluate intra- and inter-examiner variability in the force generated using different techniques to elicit Tinel's sign. METHODS: Nine clinicians, consisting of 3 experienced hand and peripheral nerve surgeons, 3 junior hand and peripheral nerve surgeons, and 3 surgeons in training were included in the study. Three different Tinel-type maneuvers were evaluated: (1) striking the load cell using the dominant middle finger only ("single-finger strike"), (2) using the dominant index and middle finger together ("double-finger strike"), and (3) preloading with the nondominant thumb and then striking the thumb with the dominant middle finger ("preload"). Test subjects were instructed to use their customary range of force during the testing. Each subject performed 3 sets of 5 strikes per technique. RESULTS: There was a significant difference in nearly all subjects between the range of force generated with single- or double-finger techniques and preload technique. There was also a difference in nearly all subjects when comparing the range of forces using the single-and double-finger techniques. In addition, there were large differences in the range of forces produced by the examiners for each technique. CONCLUSIONS: There is no standardization for eliciting the Tinel sign. This study demonstrates considerable intra- and inter-examiner differences in the range of forces generated by the different Tinel's techniques that are used in clinical practice. This variability might explain clinical differences between examiners in the ability to obtain a Tinel sign in a patient and might explain the inconsistency of sensitivity and specificity reported for Tinel's sign. Further research on standardization is needed, and future study protocols using Tinel's sign should take these findings into account.

Prevalence of cardiovascular disease risk factors among National Football League players.

CONTEXT: Concern exists about the cardiovascular health implications of large size among professional football players and those players who aspire to professional status. OBJECTIVES: To assess cardiovascular disease (CVD) risk factors in active National Football League (NFL) players and to compare these findings with data from the Coronary Artery Risk Development in Young Adults (CARDIA) study. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional study of 504 active, veteran football players from a convenience sample of 12 NFL teams at professional athletic training facilities between April and July 2007. Data were compared with men of the same age in the general US population (CARDIA study, a population-based observational study of 1959 participants aged 23 to 35 years recruited in 1985-1986). MAIN OUTCOME MEASURES: Prevalence of CVD risk factors (hypertension, dyslipidemia, glucose intolerance, and smoking). RESULTS: The NFL players were less likely to smoke when compared with the CARDIA group (0.1% [n = 1]; 95% confidence interval [CI], 0%-1.4%; vs 30.5% [n = 597]; 95% CI, 28.5%-32.5%; P < .001). Despite being taller and heavier, NFL players had significantly lower prevalence of impaired fasting glucose (6.7% [n = 24]; 95% CI, 4.6%-8.7%; vs 15.5% [n = 267]; 95% CI, 13.8%-17.3%; P < .001). The groups did not differ in prevalence of high total cholesterol and low-density lipoprotein cholesterol (LDL-C), low high-density lipoprotein cholesterol (HDL-C), or high triglycerides. Hypertension (13.8% [n = 67]; 95% CI, 11.0%-16.7%; vs 5.5% [n = 108]; 95% CI, 4.6%-6.6%) and prehypertension (64.5% [n = 310]; 95% CI, 58.3%-70.7%; vs 24.2% [n = 473]; 95% CI, 22.3%-26.1%) were significantly more common in NFL players than in the CARDIA group (both P < .001). Large size measured by body mass index (BMI) was associated with increased blood pressure, LDL-C, triglycerides, and fasting glucose, and decreased HDL-C. CONCLUSIONS: Compared with a sample of healthy young-adult men, a sample of substantially larger NFL players had a lower prevalence of impaired fasting glucose, less reported smoking, a similar prevalence of dyslipidemia, and a higher prevalence of hypertension. Increased size measured by BMI was associated with increased CVD risk factors in this combined population.