The Evaluation and Management of Concussion to Optimize Safe Recovery.

Concussion is a mild traumatic brain injury causing temporary neurologic dysfunction. Symptoms following concussion are variable and generally are expected to resolve within about 1 month, but some patients experience persistent and prolonged symptoms. An early return to safe, symptom-limited activity is now favored, using targeted rehabilitation and treatments. Accommodations may be needed to facilitate return-to-school and work following concussion. Athletes should not be cleared for a full return to sport until they have recovered from a concussion and completed a return-to-play progression, in addition to returning to work/school fully.

The Delayed Presentation and Diagnosis of Youth Wrestling Injuries: A 20-Year Analysis of National Injury Data.

INTRODUCTION: The nature of wrestling may lead athletes to mask injuries with the delayed presentations of youth wrestling-related injuries not being well characterized. METHODS: This descriptive epidemiological study queried the National Electronic Injury Surveillance System database to characterize delayed presentations of wrestling-related injuries in middle and high-school athletes. Data collection consisted of national estimates, demographics, and injury characteristics of patients with delayed (D) presentations (≥1 day) and same-day (S) presentations to US emergency departments after sustaining a wrestling-related injury during the scholastic wrestling season (December to February, 2000 to 2019). RESULTS: Of middle and high-school wrestlers presenting to US emergency departments, 5.6% (95% confidence interval [CI] 4.3% to 7.1%) reported delayed presentations for a total of 1,110 patients (CI, 591 to 1,630) annually. Most commonly (P < 0.001), injuries were sustained on Saturdays in both cohorts (D, 28.2%; CI, 22.4% to 34.8%; S, 29.6%; CI, 24.3% to 35.5%). Patients reporting delayed presentations were less likely to sustain fractures (D, 11.5%; CI, 8.3% to 15.6%; S, 18.9%; CI, 15.0% to 23.5%; P = 0.019) and injuries of the head/neck (D, 20.0%; CI, 16.5 to 24.1%; S, 26.2%; CI, 21.4% to 31.7%; P = 0.011). DISCUSSION: A substantial proportion of adolescent wrestlers report delayed presentations of injuries. This emphasizes the need for vigilance in detecting subtle signs of injury.

'It's just my knee': a qualitative study investigating the process of reframing and young athletes' perceived quality of life between anterior cruciate ligament injury and surgery.

OBJECTIVES: To understand the factors influencing young athletes' perceptions of quality of life (QOL) following an anterior cruciate ligament (ACL) rupture, prior to reconstructive surgery. DESIGN: Qualitative descriptive study using semi-structured interviews and thematic analysis of data. SETTING: Tertiary sports medicine clinic with patients recruited from the practices of three specialist orthopaedic surgeons. PARTICIPANTS: Twenty athletes aged 14-25 provided consent to participate in the study and completed interviews prior to their ACL reconstruction surgery. Participants were eligible to participate if they were scheduled to undergo ACL reconstruction, were 25 years of age or younger, identified as athletes (participated in any level of organised sport), could communicate in English and agreed to be audio recorded. Participants were not eligible if they had experienced a multiligament injury or fracture. RESULTS: Young athletes shared common factors that made up their QOL; social connections and support, sport, health, and independence. However, participants' perceptions of their current QOL were quite variable (13-95/100 on a Visual Analogue Scale). Participants who were able to reframe their injury experience by shifting focus to the positive or unaffected aspects of their lives tended to have more favourable perceptions of their QOL than participants who shifted focus to the losses associated with injury. CONCLUSIONS: Young athletes who have experienced an ACL injury define their QOL based on social support, sport, health and independence. Individual processes of adaptation and cognitive reframing in response to an ACL injury may exert a greater influence on postinjury QOL than the physical ramifications of the injury itself. Understanding individual perceptions may help target potential interventions or supports to enhance athletes' adaptation to injury.

Distal Abdominal Oblique Avulsion Injuries in Two Collegiate Hockey Players: A Case Report.

ABSTRACT: While injuries to the abdominal oblique muscles near their origin at the lower ribs are commonly seen in sports that require explosive trunk rotational movements such as baseball and tennis, there are few reports in the literature of avulsion injuries to these muscles from their distal attachments at the iliac crest. We present the case of two collegiate male hockey players who suffered such injuries as a result of a direct impact mechanism while rotated at the waist. These injuries should be suspected when patients have significant pain in the lower abdominal region worsened by flexion and rotation of the trunk and can be accurately characterized by musculoskeletal ultrasound or MRI. With a conservative rehabilitation program focused on core, hip adductor, and hip flexor strengthening, our athletes were able to return to game participation within 6 wk of the initial injury.

A Scoping Review of the Epidemiology, Management, and Outcomes of Golf-Related Fractures.

ABSTRACT: Golf is a popular sport; however, there is a paucity of data in relation to golf-associated fractures, and the rate and timing of returning to golf. The aim of this review is to describe golf-associated fractures, including epidemiology, management, and timing of returning to golf following treatment. A literature search was performed using MEDLINE/PubMed, Embase, and Web of Science. Data were extracted and summarized in a narrative synthesis. A total of 436 articles were identified with an initial search of which 58 met the inclusion criteria. Twelve anatomical sites of golf swing-related fractures were identified, of which 10 sites were specific for stress fractures. The most common sites of golf swing-related stress fractures were the ribs followed by the hook of hamate. There was a common theme of delay to diagnosis, being initially assigned to a soft tissue injury. Most golfers with swing-related stress fractures were able to return to golf with the exception of osteoporotic associated vertebral stress fractures. Timing of returning to golf was between 4 and 12 months for most of the golfers with stress fractures following conservative management. Operative intervention was an option of hook of hamate nonunion, following a stress fracture, and tibial shaft stress fractures. Golf equipment-related fractures were not rare and were associated with major trauma and in some cases associated with significant persistent morbidity. Golf-related stress fractures commonly involve the ribs and hook of hamate; knowledge of this may aid in early diagnosis and appropriate treatment when symptomatic golfers are encountered. Although golf is a noncontact sport, fractures associated with golf equipment can be life changing, and safety training guidelines should be established.

Sport Psychology: Principles and Practices for Sports Medicine Physicians.

ABSTRACT: Sport psychology is the scientific study and application of psychological principles to enhance performance and well-being in sport, exercise, and physical activity. It has numerous applications to sports medicine, as psychological factors are associated with sport injury risk, recovery, successful return to play, and overall health. This article addresses how sport psychology is important to sports medicine and what applied sport psychologists do. We discuss several psychological principles and practices relevant to individual performance and well-being, including goal setting, communication, arousal and performance, imagery/mental rehearsal, attention management, managing psychological distress, and behavioral health. We also discuss principles and practices of sport psychology relevant to team performance, including stages of team development, goal setting, communication, arousal and performance, and behavioral health. Sport psychology and applied sport psychology practitioners can be valued assets to sports medicine teams in supporting individual and team performance and injury recovery.

Criteria, Timing, and Factors Associated With Return to Competitive Sport After Rotator Cuff Surgery.

Rotator cuff pathology in competitive athletes is common and may produce chronic symptoms and joint disability, impairing sports participation and leading to premature retirement. Athletes are a high-functioning patient population with unique characteristics. Decision-making for return to sport is a complex and multifactorial process. Literature is sparse and does not provide precise guidelines to assist physicians to make the right decision. This review aimed to highlight factors affecting outcome, timing, and criteria for return to competitive sport after rotator cuff surgery to help physicians to clearly counsel athletes and make high-quality decisions for return to sport.

Diagnosis and management of thoracic outlet syndrome in athletes.

The physical demands of sports can place patients at elevated risk of use-related pathologies, including thoracic outlet syndrome (TOS). Overhead athletes in particular (eg, baseball and football players, swimmers, divers, and weightlifters) often subject their subclavian vessels and brachial plexuses to repetitive trauma, resulting in venous effort thrombosis, arterial occlusions, brachial plexopathy, and more. This patient population is at higher risk for Paget-Schroetter syndrome, or effort thrombosis, although neurogenic TOS (nTOS) is still the predominant form of the disease among all groups. First-rib resection is almost always recommended for vascular TOS in a young, active population, although a surgical benefit for patients with nTOS is less clear. Practitioners specializing in upper extremity disorders should take care to differentiate TOS from other repetitive use-related disorders, including shoulder orthopedic injuries and nerve entrapments at other areas of the neck and arm, as TOS is usually a diagnosis of exclusion. For nTOS, physical therapy is a cornerstone of diagnosis, along with response to injections. Most patients first undergo some period of nonoperative management with intense physical therapy and training before proceeding with rib resection. It is particularly essential for ensuring that athletes can return to their baselines of flexibility, strength, and stamina in the upper extremity. Botulinum toxin and lidocaine injections in the anterior scalene muscle might predict which patients will likely benefit from first-rib resection. Athletes are usually satisfied with their decisions to undergo first-rib resection, although the risk of rare but potentially career- or life-threatening complications, such as brachial plexus injury or subclavian vessel injury, must be considered. Frequently, they are able to return to the same or a higher level of play after full recovery.

Regional Anesthesia in the Elite Athlete.

Elite athletes are exposed to an elevated risk of musculoskeletal injury which may present a significant threat to an athlete's livelihood. The perioperative anesthetic plan of care for these injuries in the general population often incorporates regional anesthesia procedures due to several benefits. However, some concern exists regarding the potential for regional anesthesia to adversely impact functional recovery in an elite athlete who may have a lower tolerance for this risk. This article aims to review the data behind this concern, discuss strategies to improve the safety of these procedures and explore the features of consent in this patient population.

Regenerative Medicine Solutions for Rotator Cuff Injuries in Athletes: Indications and Outcomes.

Rotator cuff (RC) injuries include a wide range of pathologic states. Athletes are perhaps the most susceptible to RC injuries ranging from tendinopathy to partial or full-thickness tears, due to functional overload and repetitive movements, causing abstention from sports for long periods. Regenerative medicine keeps giving us multiple choices to fight the disability caused by these pathologies. A literature search was performed, and findings related to the structure-function of rotator cuff units, pathophysiology of injuries, regenerative medicine treatments, and future strategies were outlined. Platelet-rich plasma (PRP) has a greater number of articles and clinical trials, accompanied by stem cells progenitor, prolotherapy, and new approaches such as microfragmented adipose tissue and exosomes. RC injuries in athletes can cause pain, functional impotence, and the risk of recurrence, and can lead them to stop playing sports. Regenerative medicine offers a range of treatments, but some of them need further studies to underline their actual validity.

The diagnosing and treatment of concussions.

Mild traumatic brain injury, such as concussion, was once considered self-resolving. However, over the past decade, increased understanding of the short- and long-term impact has led to new guidelines for active management. In this review, we summarise recent findings, covering diagnostic criteria, and management for early and persistent symptoms. Many of the postconcussive symptoms can be treated and an individualised approach from a biopsychosocial perspective is recommended. Overall, the new knowledge will significantly impact patient care and future research.

Arthroscopically Assisted Treatment of Isolated Comminuted Trapezium Fracture: A Report of Two Cases.

CASES: Two competitive athletes with isolated comminuted trapezium fractures, sustained during American football and rugby, presented with pain and swelling of the first metacarpal base. Computed tomography confirmed isolated comminuted trapezium fractures. Arthroscopic reduction of displacement with screw fixation below the articular surface was performed through a small incision. Both patients returned to their preinjury sports levels within 2 months postoperatively. CONCLUSION: Arthroscopic treatment of isolated comminuted trapezium fractures achieved accurate reduction of articular surface displacement and preserved trapeziometacarpal joint stability with minimal soft-tissue invasion. This facilitated an early return to contact sports for the affected athletes.

Essential elements of physical fitness analysis in male adolescent athletes using machine learning.

Physical fitness (PF) includes various factors that significantly impacts athletic performance. Analyzing PF is critical in developing customized training methods for athletes based on the sports in which they compete. Previous approaches to analyzing PF have relied on statistical or machine learning algorithms that focus on predicting athlete injury or performance. In this study, six machine learning algorithms were used to analyze the PF of 1,489 male adolescent athletes across five sports, including track & field, football, baseball, swimming, and badminton. Furthermore, the machine learning models were utilized to analyze the essential elements of PF using feature importance of XGBoost, and SHAP values. As a result, XGBoost represents the highest performance, with an average accuracy of 90.14, an area under the curve of 0.86, and F1-score of 0.87, demonstrating the similarity between the sports. Feature importance of XGBoost, and SHAP value provided a quantitative assessment of the relative importance of PF in sports by comparing two sports within each of the five sports. This analysis is expected to be useful in analyzing the essential PF elements of athletes in various sports and recommending personalized exercise methods accordingly.

Designing a study on footballers' injuries in the 2024 African cup of nations competition (Ivory Coast).

INTRODUCTION: To enhance players' performance and implement effective injury prevention protocols and surveillance programs in football, it is essential to conduct epidemiological studies. Since significant disparities in injury rates across various football competitions were reported, it is important to characterize injuries in the context of the African cup of nation (AFCON) competition. AIM: To determine the incidence and factors associated with injuries among African footballers during the 2024 AFCON competition, which will be held in Ivory Coast from January 13 to February 11, 2024. METHODS: Two expert physician in sports medicine will perform an analytical study (i.e.; a video-based analysis) of the 52 matches that will be played during the 2024 AFCON. The following parameters will be noted: i) Injury incidence, ii) Characteristics of injured players such as age, on-field position, and player league continent, iii) Characteristics ofinjuries such as mechanism, body location, moment of injury in terms of the minute of play and the round of the match, place of the injury in term of stadium zone, replacement consequent to the injury, absence next match, re-injury, recurrence of the injury with the same location during the competition, referee decision, and stoppage time for on-field injury, and iv) Characteristics of matches such as the match' schedule, ambient temperature, humidity, and wind speed. CONCLUSION: This study will allow enriching the existing literature with additional data regarding the injuries and the players' characteristics in the African context.

An examination of changes in psychological status across four phases of injury recovery and return to sport: A prospective weekly study of competitive athletes from acute care to return to sport.

While ample research has shown that sport injuries are associated with poor psychological status, scant attention has been given to changes in injured athletes' psychological status over the full course of recovery and return to sport. The aim of the present study was to prospectively investigate potential changes in injured athletes' psychological status across four phases of recovery and return to sport. A total of 38 severely injured adult competitive athletes (58% female; mean age 24.1 ± 7.18 years) participated in this prospective weekly investigation (n = 319 observations). Athletes' were asked to indicate their current phase of recovery or return to sport (acute care, rehabilitation, adapted training, or full return to sport) after which they responded to visual analog scales assessing post-injury psychological status, including: perceived pain (frequency and intensity), emotions (positive and negative), anxiety (cognitive and physiological), motivation, self-efficacy, and satisfaction. During the acute care phase, participants showed higher scores of perceived pain, and physiological anxiety compared to the other phases. During the adapted training phase, amotivation was higher than in the acute care phase, and self-efficacy was lower than in other phases. At full return to sport, athletes showed less perceived pain, cognitive anxiety, and more satisfaction than during other phases. The present study provides a deeper prospective understanding of changes in athlete's psychological status over the course of injury recovery and return to sport and highlight the importance of monitoring psychological status.

Assessing the COVID-19 pandemic's impact on pediatric baseball and basketball-related craniofacial and neck injuries treated in United States emergency departments, 2003-2022.

BACKGROUND: A large proportion of United States (U.S.) youth play basketball, baseball, softball, or T-ball. Each of the activities poses a documented risk of craniofacial and neck injuries. However, few studies have assessed the national prevalence of pediatric craniofacial and neck injuries in this population, particularly following the COVID-19 pandemic. METHODS: The National Electronic Injury Surveillance System (NEISS) dataset was used to identify pediatric craniofacial and neck injuries associated with basketball, baseball, softball, or T-ball from 2003-2022 in a cross-sectional study. The annual number of injuries before and after the onset of the COVID-19 pandemic with 95% confidence intervals were calculated. Interrupted time series analysis (ITSA) was used to estimate the pandemic's impact on the monthly number of injuries incurred nationally. RESULTS: Both overall and stratified by sport involvement, the annual number and rate of injuries identified in NEISS decreased significantly after the COVID-19 pandemic. ITSA demonstrated that the monthly number of injuries decreased -4094.4 (95% CI = -5100, -3088.7) immediately after the beginning of the pandemic. The number of injuries began increasing towards pre-pandemic levels at a rate of 110.6 (95% CI = 64, 157.2) injuries per month after the initial plunge. CONCLUSION: Prior to the-pandemic, there was a steady decline in craniofacial and neck injuries due to basketball, baseball, softball and T-ball among children, aged <18 years. The shutdown during the initial months of the COVID-19 pandemic resulted in a precipitous drop in such injuries. Current rates are approaching pre-pandemic levels and may exceed them. Continued efforts are needed to keep the pre-pandemic progress.