Epidemiology of Injuries in Olympic Sports.

Injuries effect the performance of athletes. Severity of injuries is determined by time loss and sporting performance reduction. To treat injuries adequately, it is necessary to get an overview of varied injuries types in different sports disciplines. In a retrospective study 7.809 athletes from Germany, Switzerland and Austria competing in competitive or recreational levels of sports were included. Injury prevalence was highest in team sports (75 %), followed by combat (64 %), racquet (54 %) and track and field (51 %). Knee (28 %) and shoulder (14 %) were the most at risk joints. Time loss in sporting activity after injury was longest in the region of knee (26 weeks). Of all reported injuries, 48 % were accompanied by a reduced level of performance. The highest injury prevalence occurred in the year 2016 (45 %). More injuries occurred during training (58 %) compared to competition (42 %). Across Olympic disciplines, a large number of injuries occurred during training sessions. Injury frequency increased as the Olympic games drew closer. Knee and shoulder injuries were the most severe injuries with respect to time loss and reduction sporting performance.

The Surgical Management of NCAA Division 1 College Football Injuries Post COVID-19: A Single Institution Retrospective Review.

ABSTRACT: Cohen, JL, Cade, WH, Harrah, TC, Costello II, JP, and Kaplan, LD. The surgical management of NCAA Division 1 college football injuries post COVID-19: A single institution retrospective review. J Strength Cond Res 38(5): 906-911, 2024-The unprecedented COVID-19 pandemic had a significant impact on college football operations, including athletes' training regimens. As a result of these changes, concern for increased injury susceptibility post COVID-19 regulations has become a point of discussion. The current study sought to evaluate the incidence of surgical injury among NCAA Division 1 college football players at the authors' institution during the first full season after start of the COVID-19 pandemic compared with previous years. Retrospective chart review was performed for all players who sustained injuries requiring surgery while a member of the NCAA Division 1 football program during the 2009-2021 seasons. A p -value of ≤0.05 was used to determine significance. A total of 23 surgical injuries occurred in 22 players during the 2021 season compared with 121 in 118 players in the 12 previous seasons combined ( p = 0.0178; RR = 1.47). There was a significant increase in shoulder injuries ( n = 13 vs. n = 31; p = <0.0001; RR = 3.05) and specifically a significant increase in labral tears ( n = 10 vs. n = 30; p = 0.0003; RR = 2.74). No difference was seen in knee injuries ( n = 10 vs. n = 77; p = 0.27; RR = 1.35) and specifically no difference in anterior cruciate ligament injuries ( n = 3 vs. n = 31; p = 0.77; RR = 1.17). This phenomenon is multifactorial in nature, but alterations to players' training and preparations because of the COVID-19 pandemic likely resulted in suboptimal conditioning, leading to the increased incidence of surgical injuries emphasizing the importance of adequate strength training and conditioning.

Knee, Low Back, and Shoulder Problems Among University and Professional Volleyball Players: Playing With Pain.

CONTEXT: The knee, low back, and shoulder account for most overuse injuries in volleyball. Previous researchers have used methodology that did not examine the extent of injury burden and effect on performance. OBJECTIVE: To develop a more accurate and complete understanding regarding the weekly prevalence and burden of knee, low back, and shoulder problems within the highest levels of men's volleyball, including the role that preseason complaints, match participation, player position, team, and age have on complaints. DESIGN: Descriptive epidemiology study. SETTING: Professional volleyball clubs and the National Collegiate Athletic Association Division I program. PATIENTS OR OTHER PARTICIPANTS: A total of 75 male volleyball players, representing 4 teams playing in their country's respective premier league (Japan, Qatar, Turkey, and the United States), participated over a 3-season period. MAIN OUTCOME MEASURE(S): Players completed a weekly questionnaire (Oslo Sports Trauma Research Centre Overuse Injury Questionnaire) reporting pain related to their sport and the extent to which knee, low back, and shoulder problems affected participation, training volume, and performance. Problems leading to moderate or severe reductions in training volume or performance or the inability to participate were considered substantial problems. RESULTS: The mean weekly prevalence of knee, low back, and shoulder problems based on 102 player-seasons was 31% (95% CI = 28%, 34%), 21% (95% CI = 18%, 23%), and 19% (95% CI = 18%, 21%), respectively. Most players (93%, 95/102 player-seasons) reported some level of knee (79%, n = 81/102 player-seasons), low back (71%, n = 72/102 player-seasons), or shoulder (67%, n = 68/102 player-seasons) complaints during the season. Most players (58%, n = 59/102 player-seasons) experienced at least 1 episode of substantial problems affecting the knee (33%, n = 34/102 player-seasons), low back (27%, n = 28/102 player-seasons), or shoulder (27%, n = 28/102 player-seasons). Players with preseason complaints had more in-season complaints than teammates without preseason problems (mean weekly prevalence: knee, 42% versus 8%, t49 = -18.726, P < .001; low back, 34% versus 6%, t32 = -12.025, P < .001; shoulder, 38% versus 8%, t30 = -10.650, P < .001). CONCLUSION: Nearly all included elite male volleyball players experienced knee, low back, or shoulder problems, and most had at least 1 bout that substantially reduced training participation or sport performance. These findings suggest that knee, low back, and shoulder problems result in greater injury burden than previously reported.

Shoulder Check: Investigating Shoulder Injury Rates, Types, Severity, Mechanisms, and Risk Factors in Canadian Youth Ice Hockey.

OBJECTIVE: To describe shoulder-related injury rates (IRs), types, severity, mechanisms, and risk factors in youth ice hockey players during games and practices. DESIGN: Secondary analysis of data from a 5-year prospective cohort study, Safe-to-Play (2013-2018). SETTING: Canadian youth ice hockey. PARTICIPANTS: Overall, 6584 player-seasons (representing 4417 individual players) participated. During this period, 118 shoulder-related games and 12 practice injuries were reported. ASSESSMENT OF RISK FACTORS: An exploratory multivariable mixed-effects Poisson regression model examined the risk factors of body checking policy, weight, biological sex, history of injury in the past 12 months, and level of play. MAIN OUTCOME MEASURES: Injury surveillance data were collected from 2013 to 2018. Injury rates with 95% confidence interval (CI) were estimated using Poisson regression. RESULTS: The shoulder IR was 0.35 injuries/1000 game-hours (95% CI, 0.24-0.49). Two-thirds of game injuries (n = 80, 70%) resulted in >8 days of time-loss, and more than one-third (n = 44, 39%) resulted in >28 days of time-loss. An 83% lower rate of shoulder injury was associated with policy prohibiting body checking compared with leagues allowing body checking (incidence rate ratio [IRR], 0.17; 95% CI, 0.09-0.33). A higher shoulder IR was observed for those who reported any injury in the last 12-months compared with those with no history (IRR, 2.00; 95% CI, 1.33-3.01). CONCLUSIONS: Most shoulder injuries resulted in more than 1 week of time-loss. Risk factors for shoulder injury included participation in a body-checking league and recent history of injury. Further study of prevention strategies specific to the shoulder may merit further consideration in ice hockey.

Throwing Shoulder Adaptations Are Not Related to Shoulder Injury or Pain: A Preliminary Report.

BACKGROUND: Overhead throwing in baseball and softball athletes induces shoulder adaptations theorized to increase risk of shoulder musculoskeletal injury (MSI) and/or pain due to range of motion (ROM) deficits. HYPOTHESIS: Shoulder ROM adaptations are associated with a higher risk for developing shoulder MSI and pain. STUDY DESIGN: Prospective cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: A total of 60 National Collegiate Athletic Association Division I athletes cleared for full athletic participation and free from upper extremity MSI in the last 4 weeks (age, 19.0 ± 1.2 years; weight, 82.1 ± 13.7 kg; height, 178.6 ± 11.2 cm; softball, n = 23; baseball, n = 37). Passive glenohumeral internal rotation (IR), external rotation (ER), and horizontal adduction (HA) ROM were measured with the scapula stabilized and used to categorize participants with/without external rotation gain (ERG), external rotation insufficiency (ERI), glenohumeral internal rotation deficit (GIRD), pathological GIRD, and posterior shoulder tightness (PST) before the competitive season. Groups were then compared to assess the incidence of shoulder MSI prospectively and prevalence of shoulder pain at the initial evaluation. RESULTS: Baseball and softball athletes demonstrated significantly less IR ROM in the dominant shoulder (50.6° ± 9.4°) compared with the nondominant shoulder (59.1° ± 8.6°; P < 0.01) and significantly more ER ROM (dominant, 104.6° ± 12.1°; nondominant, 97.7° ± 12.0°; P < 0.01). Incidence of shoulder MSI was 15% but was not significantly related to any shoulder adaptations. No significant relationship was found between prevalence of pain and any shoulder adaptations in the 27% of athletes with pain. CONCLUSION: Increased ER and decreased IR ROM adaptations in intercollegiate overhead throwing athletes do not appear to be correlated to risk of shoulder MSI or pain. CLINICAL RELEVANCE: The findings of this level 3 prospective study provide clinicians working with overhead athletes information regarding shoulder MSI risk and pain. It is recommended that clinicians should not use ROM adaptations exclusively to determine increased risk of shoulder MSI.

Characteristics of subscapularis muscle strain in professional baseball players: a case series.

BACKGROUND: Subscapularis muscle strains can develop in professional baseball players, rendering the players unable to continue playing for a certain period. However, the characteristics of this injury are not well known. The purpose of the present study was to investigate the details of the injury and the postinjury course of subscapularis muscle strain in professional baseball players. METHODS: Of 191 players (83 fielders and 108 pitchers) who were members of a single Japanese professional baseball team between January 2013 and December 2022, 8 players (4.2%) had subscapularis muscle strain and were enrolled in this study. The diagnosis of muscle strain was made on the basis of shoulder pain and magnetic resonance imaging findings. The incidence of subscapularis muscle strain, the details of the site of the injury, and the time to return to play were examined. RESULTS: Subscapularis muscle strain occurred in 3 (3.6%) of 83 fielders and 5 (4.6%) of 108 pitchers, with no significant difference between fielders and pitchers. All players had injuries on the dominant side. Most injuries were located at the myotendinous junction and in the inferior half of the subscapularis muscle. The mean time to return to play was 55.3 ± 40.0 (range, 7-120) days. At a mean 22.7 months after the injury, there were no reinjured players. CONCLUSION: A subscapularis muscle strain is a rare injury among baseball players, but in players whose shoulder pain cannot be given a definite diagnosis, subscapularis muscle strain should be considered as a possible etiology.

Prevention of shoulder injuries in volleyball players: The usefulness and efficiency of a warm-up routine.

OBJECTIVES: The objective of this study was to assess the efficiency of a warm-up routine focused on shoulder injury prevention in volleyball players. DESIGN: Prospective study. SETTING: University. PARTICIPANTS: Eight recreational volleyball teams (44 males, 49 females) were included in the study and assigned to two different groups (prevention or control) in a blinded way. In the prevention group, the players had to perform specific exercises at the beginning of each training session twice a week. MAIN OUTCOME MEASURES: Injuries were recorded monthly in both groups with an online questionnaire. RESULTS: A significant decrease in the total number of injuries as well as in the severity of the injuries was observed in the prevention group in comparison to the control group (p = 0.0001-0.013). For the shoulder, a decrease in injury incidence was also observed in the prevention group. This decrease reached significance in male players (p = 0.045). CONCLUSIONS: The program appears to be efficient to reduce the risk of shoulder injuries in recreational volleyball players. Adjustments in the duration and in the contents of the program will have to be made to further improve compliance and better meet the requirements of both players and trainers.

Shoulder pain and injury risk factors in competitive swimmers: A systematic review.

AIM: To synthesize and assess the literature for shoulder pain and injury risk factors in competitive swimmers. DESIGN: Systematic review with best-evidence synthesis. DATA SOURCES: CINHAL, SportDiscus, Scorpus, PubMed, and Embase databases from 1966 to April 30 2022. SEARCH AND INCLUSION: Cohort, cross-sectional, and case-control studies investigating shoulder pain or injury risk factors in competitive swimmers were included. Quality of eligible studies were assessed using a modified Newcastle-Ottawa scale. Risk factors were divided into four categories: modifiable-intrinsic, modifiable-extrinsic, non-modifiable, and other/secondary. RESULTS: Of 1356 studies identified, 24 full texts were evaluated for methodological quality, 22 met the criteria and were included in best evidence synthesis. There was no strong evidence supporting or refuting the association between 80 assessed variables and shoulder injury or pain. The swimmers' competitive level (nondirectional), and shoulder muscle recruitment profiles (e.g., increased activity of serratus anterior) exhibited moderate evidence supporting an association. Conversely, internal and external range of motion, middle finger back scratch test, training frequency, specialty stroke, height/weight, sex, and age all had moderate evidence opposing an association. Limited evidence was found for 58 variables, and conflicting for 8. The highest quality study (n = 201) suggested high acute-to-chronic workload ratio and reduced posterior shoulder strength endurance are associated with injury. CONCLUSIONS: Due to the paucity of high-quality studies, future prospective studies are needed to reevaluate known risk factor associations over exploring additional potential risk factors. Swimming practitioners should be aware of the nondirectional association of a swimmer's competitive level and pain, as squad changes could impact injury incidence. Moreover, swimmers experiencing shoulder pain may show increased activity in shoulder stabilizers during specific movements. Importantly, shoulder strength-endurance may be the most clinically relevant modifiable intrinsic risk factor.

Prevalence of the anterosuperior capsulolabral anatomical variations and their association with pathologies of the glenoid labrum: a systematic review and meta-analysis.

PURPOSE: Differentiating the anatomical variations of the anterosuperior portion of the glenoid labrum from pathologies is important to avoid unnecessary iatrogenic complications resulting from inaccurate diagnosis. Additionally, the presence of several variations was reported to be conductive to lesions involving the glenoid labrum. Thus, the aim of this study was to state the prevalence rates of the sublabral recess, sublabral foramen, and the Buford complex, and to verify their association with labral lesions. METHODS: Systematic search of electronic databases was conducted to gain potentially eligible literature. Suitable studies were selected in a two-round screening, and relevant data were subsequently extracted. Calculation of the pooled prevalence estimates, including sub-analyses on cohort size, study type, and geographical variance, was conducted. Pooled analysis of risk ratios (RR) was used to assess the conductive nature of the discussed variants to superior labrum anterior to posterior (SLAP) lesions. RESULTS: The screening resulted in selection of 20 studies investigating the morphological features of the glenoid labrum, consisting of 7601 upper limbs. On the bases of random-effects meta-analysis the sublabral recess, sublabral foramen and Buford complex occur with a pooled prevalence of 57.2% (95% CI 30.0-84.4%), 13.5% (95% CI 8.2-18.9%), and 3.0% (95% CI 1.5-4.5), respectively. Moreover, individuals with Buford complex have RR 2.4 (95% CI 1.3-4.7) of developing SLAP lesions, especially type II (95.5%; 95% CI 86.1-100%), whereas such risk for sublabral recess and sublabral foramen was not statistically significant. CONCLUSION: Morphological variants of the glenoid labrum posing diagnostic confusion are frequently observed. Gradually, the Buford complex may be a predisposing factor for sustaining a SLAP lesion.

Changes in Shoulder Trauma during the COVID-19 Pandemic: A South Korean Survey.

Background: This study aimed to investigate the changes in the incidence of shoulder trauma and surgery 1 year after the outbreak of coronavirus disease 2019 (COVID-19) with social restriction compared with 1 year before the pandemic. Methods: Patients managed in our orthopedic trauma center between February 18, 2020, and February 17, 2021 (COVID-19 period) for shoulder trauma were compared with patients managed for the same duration a year ago (non-COVID-19 period; February 18, 2019, to February 17, 2020). The incidence of shoulder trauma, surgery, and mechanism of injury were compared between these periods. Results: The total number of shoulder trauma cases was lower in the COVID-19 period than in the non-COVID-19 period, although the difference was not significant (160 vs. 180 cases, p = 0.278). In addition, traumatic shoulder surgeries decreased during the COVID-19 period (57 vs. 69 cases, p = 0.285). The incidence of shoulder trauma according to four diagnostic classifications (contusion, sprain/subluxation, fracture, and dislocation) and fracture/dislocation types did not differ between the periods. During the COVID-19 period, accidental falls outdoors (45 vs. 67, p = 0.038) and sports-related injuries (15 vs. 29, p = 0.035) significantly decreased, but accidental falls at home (52 vs. 37, p = 0.112) increased compared with those during the non-COVID-19 period, although the difference was not significant. The monthly incidence of shoulder trauma decreased 2 months after the first outbreak (significant in March, p = 0.019), then steadily increased and significantly decreased during the second outbreak (August, p = 0.012). However, the third outbreak (December, p = 0.077) had little effect on the incidence of shoulder trauma. The number of monthly traumatic shoulder surgeries showed a similar pattern to the monthly incidence of shoulder trauma. Conclusions: During the COVID-19 pandemic, annual shoulder trauma cases and surgeries decreased compared to those in the non-COVID-19 period, even though the difference was insignificant. The incidence of shoulder trauma and surgery was significantly reduced in the early COVID-19 period; however, the effect of the pandemic on orthopedic trauma practice was minimal after approximately half a year. Decreases in falls outdoors and sports-related injuries, but an increase in falls at home, were observed during the COVID-19 pandemic.

Risk factors associated with throwing injuries in young baseball players.

BACKGROUND: Few studies have retrospectively analyzed the relationship between joint range of motion (ROM) and muscle flexibility and shoulder and elbow throwing injuries in a large number of elementary school baseball players. The purpose of this study was to retrospectively identify the physical factors related to shoulder and elbow throwing injuries in younger baseball players. METHODS: A total of 2466 younger baseball players belonging to our Prefecture Rubber Baseball Federation who participated in medical check-ups from 2016 to 2019 were analyzed. Players completed a questionnaire and had a medical check-up that included a physical examination and ultrasonography. ROM (internal rotation [IR] angle and external rotation angle) of the shoulder and hip and the finger-to-floor distance and heel-to-buttock distance were measured. The straight leg raise was also performed. The results of two groups (normal group and injury group) were compared using the χ2 test, Mann-Whitney U test, and Student t test. Stepwise forward logistic regression models were developed to identify risk factors. RESULTS: On univariate analysis, nine of the 13 evaluated items showed significant decreases in ROM and muscle flexibility in the injury group. On multiple logistic regression analysis, grade, finger-to-floor distance, IR angle of the dominant side shoulder, and IR angle of the nondominant side hip were significantly associated with the occurrence of throwing injuries. Decreased total shoulder angle was observed not only on the dominant side but also on the nondominant side in the injury group. CONCLUSION: Decreased ROM and muscle flexibility were risk factors for baseball-related throwing injuries in elementary school baseball players. To prevent shoulder and elbow throwing injuries, players, coaches, medical staff, and parents need to be aware of these findings.

Arm injury in youth baseball players: a 10-year cohort study.

BACKGROUND: Arm injuries are commonly encountered in baseball as young athletes play into adulthood. The purpose of this study was to examine the incidence of arm injury and risk for surgery in adolescent baseball players followed over a 10-year period from scholastic, age-group, and travel baseball leagues through their highest level of competition. METHODS: A prospective study was conducted enrolling middle and high school baseball players in 2010-2012, then followed for 10 years or until retirement from competitive baseball. Players were included if fully participating in team activities at the time of preseason study enrollment. Players with prior arm (shoulder or elbow) surgery or those diagnosed with time loss arm injury within the past year were excluded. Only shoulder and elbow overuse problems resulting in time-loss from sport and medical attention from a sports medicine physician or orthopedic surgeon were documented as injuries in this study. Musculoskeletal overuse injuries were classified based on the orchard injury classification system. Incidence proportion and risk ratio (RR) and 95% confidence intervals (CIs) for initial injury and injuries requiring surgery were calculated. RESULTS: A total of 261 pitchers (age: 14.2 ± 2.6 years; follow-up: 4.2 ± 2.7 years) were enrolled. Twenty percent of the cohort was followed for ≥7 years. The overall injury incidence was 25.6/100 athletes (95% CI 21-31) with a cumulative surgical incidence of 5.4/100 athletes (95% CI 3.2-8.8). The risk of experiencing shoulder injury (n = 25) and elbow injury (n = 38) were similar (n = 38) (RR 0.7, 95% CI 0.4-1.1). The athletes also presented with a similar frequency of requiring surgery regardless of the injured body part. However, the risk of surgery in those playing beyond the high school level was 4.3 times greater (95% CI 1.2-15.0) than those only playing high school. CONCLUSION: This is the first study to follow a large cohort of youth baseball players as they progress, showing a relatively high arm injury incidence. Shoulder and elbow injury incidence was similar but surgical risk increased playing beyond high school, specifically for the elbow. The high injury frequency and burden of care required by young baseball players as reported in this study is concerning, and strategies to reduce injury should be investigated.

Aiming too high: Shoulder injury related to vaccine administration (SIRVA): A case series.

PURPOSE: Shoulder injury directly related to vaccination (SIRVA) occurs when a vaccine is administered too high in the shoulder. The primary aim of this study was to accurately detail the occurrence, symptoms, diagnosis, management and long-term outcomes of SIRVA cases in Victoria, Australia. PRINCIPAL RESULTS: The study identified 102 SIRVA cases from 2007 to 2020 from the Surveillance of Adverse Events Following Vaccination in the Community (SAEFVIC) database. The majority [73/85; (86 %)] of cases resolved completely with a median time to resolution of 8 weeks and no statistically significant difference in recovery by immunisation provider type or baseline imaging. MAJOR CONCLUSIONS: This large case series includes long-term clinical progress in SIRVA, allowing accurate evaluation and analysis. Further evaluation is required to establish if other risk factors contribute to SIRVA, which may help with targeted, tailored education for providers on correct vaccine administration technique, including in large and rapid vaccine rollouts.

[Injuries of the shoulder in winter sports]. / Wintersportverletzungen am Schultergelenk.

Skiing as a sport has come a long way from the first competitive event in Norway in 1767 to about 200 million skiers today worldwide. With Germany alone recording around 8000 injuries annually, there is an increased need for awareness for winter-sport-related injuries and their management. According to the latest report by "Auswertungsstelle für Skiunfälle" (ASU, evaluation center for ski accidents), shoulder injuries alone account for more than 20% of injuries to all body regions (men 26.1% and women 13%). The most common injuries affecting the shoulder girdle are rotator cuff strains, glenohumeral dislocations, acromioclavicular dislocations and clavicle fractures. These injuries are primarily the result of four mechanisms: direct impact, axial load on an extended arm, resisted forced abduction of the arm, and external rotation forces resulting from a firmly planted ski pole in the grasp of a skier during a fall. In this article, we describe the three most common shoulder girdle injuries in winter sports along with their management and answer the most important questions for the athlete.

Number of Months of Baseball in the Previous Year and Preseason Olecranon Tenderness: Risk Factors for Shoulder and Elbow Injuries in High-School Baseball Players.

OBJECTIVE: To identify risk factors for shoulder and elbow injuries in high-school baseball position players and pitchers in the preseason history and physical examination. DESIGN: Retrospective cohort study. SETTING: Community high-school baseball. PARTICIPANTS: Three hundred seventy-one male baseball players' mean age 15.0 ± 1.8 years. OUTCOME MEASURES: A preseason history and physical examination was performed on all athletes. Injury information was collected by weekly self-report and athletic trainer injury logs throughout the season. Comparisons between injured and noninjured players were performed using t tests and χ 2 analyses. Binary logistic regression models were developed to identify risk factors for injury. RESULTS: Seventy-six injuries were recorded over the season. In univariate analysis, the injured group had greater months of baseball participation ( P = 0.007) and shoulder visual analog scale for the past year ( P = 0.003). The injured group also had more olecranon tenderness ( P < 0.0001, odds ratio [OR] 2.9) and decreased elbow arc of motion. All other factors were not significantly different ( P > 0.05). In multivariable logistic regression, months per year of baseball participation was the only factor significantly associated with injuries ( P = 0.010, OR = 1.21). CONCLUSIONS: Baseball players who developed arm injuries during a season were more likely to play more months of baseball and report shoulder pain in the previous year. The presence of preseason olecranon tenderness was associated with nearly triple the risk of injury during the season. Every additional month of baseball participation in the previous year was associated with a 1.2× increased odds of injury. The presence of glenohumeral internal rotation deficit was not a predictor of injury.

The Prevalence of Shoulder Disorders among Professional Bullfighters: A Cross-Sectional Ultrasonography Study.

We aimed to investigate clinical and ultrasound signs of shoulder overuse injuries in professional bullfighters; side-to-side differences (dominant vs. non-dominant); and to determine potential differences according to bullfighters' categories. An observational cross-sectional study was conducted. Thirty professional and active bullfighters were assessed. A bilateral ultrasound assessment of the subacromial bursa, long biceps head tendon (LHBT), and rotator cuff was performed to determine the presence of bursitis, subluxation, partial or total tendon rupture, tenosynovitis, or calcification. Supraspinatus tendon thickness was measured. Finally, a battery of clinical orthopedic tests (Yergason, Jobe, infraspinatus, Gerber, and bursa tests) were also performed. Most identified ultrasound findings were located in the dominant side, being the presence of bursitis (n = 9; 30%), LHBT tenosynovitis (n = 8; 26.7%), and subscapularis tendon calcification (n = 5; 16.7%) the most prevalent. No side-to-side or between-categories differences were found for supraspinatus tendon thickness (all, p > 0.05). The most frequent positive signs were the infraspinatus test (40.0%), Gerber lift-off test (33.3%), and bursitis, Jobe, and Yergason tests (all, 26.7%). Ultrasound signs were commonly found at LHBT, subacromial bursa, and rotator cuff in professional bullfighters without difference between categories and sides. No side-to-side or between-categories differences were found. Positive clinical test signs suggestive of bursitis, LHBT, and rotator cuff tendinopathy were frequently observed.

Including Modifiable and Nonmodifiable Factors Improves Injury Risk Assessment in Professional Baseball Pitchers.

OBJECTIVES: To (1) evaluate an injury risk model that included modifiable and nonmodifiable factors into an arm injury risk prediction model in Minor League Baseball (MiLB) pitchers and (2) compare model performance separately for predicting the incidence of elbow and shoulder injuries. DESIGN: Prospective cohort. METHODS: A 10-year MiLB injury risk study was conducted. Pitchers were evaluated during preseason, and pitches and arm injuries were documented prospectively. Nonmodifiable variables included arm injury history, professional experience, arm dominance, year, and humeral torsion. Modifiable variables included BMI, pitch count, total range of motion, and horizontal adduction. We compared modifiable, nonmodifiable, and combined model performance by R2, calibration (best = 1.00), and discrimination (area under the curve [AUC]; higher number is better). Sensitivity analysis included only arm injuries sustained in the first 90 days. RESULTS: In this study, 407 MiLB pitchers (141 arm injuries) were included. Arm injury incidence was 0.27 injuries per 1000 pitches. The arm injury model (calibration 1.05 [0.81-1.30]; AUC: 0.74 [0.69-0.80]) had improved performance compared to only using modifiable predictors (calibration: 0.91 [0.68-1.14]; AUC: 0.67 [0.62-0.73]) and only shoulder range of motion (calibration: 0.52 [0.29, 0.75]; AUC: 0.52 [0.46, 58]). Elbow injury model demonstrated improved performance (calibration: 1.03 [0.76-1.33]; AUC: 0.76 [0.69-0.83]) compared to the shoulder injury model (calibration: 0.46 [0.22-0.69]; AUC: 0.62 [95% CI: 0.55, 0.69]). The sensitivity analysis demonstrated improved model performance compared to the arm injury model. CONCLUSION: Arm injury risk is influenced by modifiable and nonmodifiable risk factors. The most accurate way to identify professional pitchers who are at risk for arm injury is to use a model that includes modifiable and nonmodifiable risk factors. J Orthop Sports Phys Ther 2022;52(9):630-640. Epub: 9 July 2022. doi:10.2519/jospt.2022.11072.

Identifying Cases of Shoulder Injury Related to Vaccine Administration (SIRVA) in the United States: Development and Validation of a Natural Language Processing Method.

BACKGROUND: Shoulder injury related to vaccine administration (SIRVA) accounts for more than half of all claims received by the National Vaccine Injury Compensation Program. However, due to the difficulty of finding SIRVA cases in large health care databases, population-based studies are scarce. OBJECTIVE: The goal of the research was to develop a natural language processing (NLP) method to identify SIRVA cases from clinical notes. METHODS: We conducted the study among members of a large integrated health care organization who were vaccinated between April 1, 2016, and December 31, 2017, and had subsequent diagnosis codes indicative of shoulder injury. Based on a training data set with a chart review reference standard of 164 cases, we developed an NLP algorithm to extract shoulder disorder information, including prior vaccination, anatomic location, temporality and causality. The algorithm identified 3 groups of positive SIRVA cases (definite, probable, and possible) based on the strength of evidence. We compared NLP results to a chart review reference standard of 100 vaccinated cases. We then applied the final automated NLP algorithm to a broader cohort of vaccinated persons with a shoulder injury diagnosis code and performed manual chart confirmation on a random sample of NLP-identified definite cases and all NLP-identified probable and possible cases. RESULTS: In the validation sample, the NLP algorithm had 100% accuracy for identifying 4 SIRVA cases and 96 cases without SIRVA. In the broader cohort of 53,585 vaccinations, the NLP algorithm identified 291 definite, 124 probable, and 52 possible SIRVA cases. The chart-confirmation rates for these groups were 95.5% (278/291), 67.7% (84/124), and 17.3% (9/52), respectively. CONCLUSIONS: The algorithm performed with high sensitivity and reasonable specificity in identifying positive SIRVA cases. The NLP algorithm can potentially be used in future population-based studies to identify this rare adverse event, avoiding labor-intensive chart review validation.

Initial kinematic chain injuries increase hazard of subsequent arm injuries in professional baseball pitchers.

BACKGROUND: Currently, there are few studies that have evaluated the relationship between a lower extremity or trunk injury (kinematic chain) and subsequent arm injury. The purpose of this study was (1) to investigate the relationship between initial kinematic chain (lower extremity or trunk) injury and subsequent arm injury; and (2) to investigate the relationship between initial shoulder or elbow injury and subsequent arm injury. METHODS: A 7-year prospective injury risk study was conducted with Minor League Baseball pitchers. Pitches, pitching appearances, athlete exposures (AEs), and arm injuries (≥1-day time loss) were documented throughout the season. Cox survival analyses with 95% confidence intervals (95% CIs) were performed. Confounders controlled for included age, body mass index, arm dominance, pitching role, previous arm injury, number of pitching appearances, and seasonal pitch load. RESULTS: A total of 297 pitchers participated (total player days = 85,270). Arm injury incidence was 11.4 arm injuries/10,000 AEs, and kinematic chain incidence was 5.2 injuries/10,000 AEs. Pitchers who sustained a kinematic chain injury demonstrated a greater hazard (2.6 [95% CI: 1.2, 5.6], P = .019) of sustaining an arm injury. Pitchers who sustained an initial shoulder injury demonstrated a greater hazard (9.3 [95% CI: 1.1, 83], P = .047) of sustaining a subsequent shoulder or elbow injury compared with pitchers who sustained an initial elbow injury. CONCLUSIONS: Pitchers who sustained an initial lower extremity or trunk injury demonstrated an increased subsequent arm injury hazard compared with pitchers who did not. Pitchers who sustained an initial shoulder injury demonstrated a greater hazard of sustaining a subsequent arm injury compared with pitchers who sustained an initial elbow injury. However, this secondary analysis should be interpreted with caution. Clinicians should monitor risk with workload accumulation, which may be related to pitching compensatory strategies in a fatigued state. Pitchers who sustain a shoulder injury should be evaluated and perform both shoulder and elbow rehabilitation strategies before return to sport.

High Incidence of Combined and Posterior Labral Tears in Military Patients With Operative Shoulder Instability.

BACKGROUND: Anterior shoulder instability is the pattern most commonly reported in the civilian population, but military servicemembers may represent a unique population. At 1.7 per 1000 person-years, servicemembers not only have a higher incidence of instability events compared with civilians (reported rate of 0.2-0.8), but the distribution of labral tears in the military may differ significantly as well. HYPOTHESIS: The incidence of combined and posterior labral tears in the military population will be greater than numbers previously reported. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: The Wounded, Ill, and Injured Registry, a Department of Defense patient reported outcomes data collection platform that includes all military branches, was queried retrospectively for all patients who had undergone a primary arthroscopic or open shoulder stabilization procedure (Current Procedural Terminology codes 29806, 23455, 23462) between October 2016 and January 2019. Demographic information was obtained through intake forms completed by patients at the time of enrollment into the Military Orthopaedics Tracking Injuries and Outcomes Network. Tear location was determined arthroscopically and labeled as anterior, inferior, posterior, superior, or any combination thereof. Chi-square analysis was used to compare the percentage of patients with isolated anterior, isolated posterior, isolated inferior, or combined labral tears in the current study cohort with those in a previously reported cohort of patients with operative shoulder instability at a single military treatment facility. RESULTS: A total of 311 patients were included who had undergone primary shoulder stabilization during the study period. Of these patients, 94 (30.2%) had isolated anterior tears, 76 (24.4%) had isolated posterior tears, and 136 (43.7%) had combined tears. We observed a higher percentage of combined tears in our data set than in a data set from a single military treatment facility (χ2(2) = 48.2; P < .00001). Chi-square analysis demonstrated that significantly more female patients had an isolated anterior labral tear (51.2%) compared with male patients (27.1%; χ2(2) = 9.4; P = .009). CONCLUSION: The incidence of combined and posterior labral tears in the military population is greater than numbers previously reported in both military and civilian populations.