Validation of Panoramic Ultrasound Measurement of the Cross-Sectional Area of the Vastus Medialis.

ABSTRACT: Minnehan, KS, Dexter, WW, Holt, CT, Scharnetzki, L, Alex, JP, Chin, KE, and Kokmeyer, DJ. Validation of panoramic ultrasound measurement of the cross-sectional area of the vastus medialis. J Strength Cond Res 37(1): 41-45, 2023-The cross-sectional area (CSA) of the vastus medialis (VM) is an independent predictor of important clinical outcomes in musculoskeletal conditions of the knee, such as pain and long-term function. Previous studies validated ultrasound (US) to measure larger muscles of the thigh, but this approach has limited accuracy in measuring smaller muscles, such as the VM. In this study, we aimed to validate panoramic US measurements of the CSA of the VM and compare the results with those from the gold standard of magnetic resonance imaging (MRI) (significance set p ≤ 0.05). In this retrospective, single-center study, we compared pairs of US and MRIs taken of 25 adults who participated in a 10-week study of non-weight-bearing activity at a National Aeronautics and Space Administration facility. Images were acquired from various locations on the right thigh at multiple time points. Two researchers independently analyzed the US and MRI pairs by outlining the intermuscular border of the VM in the most distal image. We found excellent agreement between the US and MRI measurements of the CSA of the VM analyzed by researcher 1 (interclass correlation coefficient [ICC]: 0.997) and researcher 2 (ICC: 0.980). We also found excellent agreement for interrater reliability for MRI (ICC: 0.988) and US (ICC: 0.982) and intrarater reliability for US for researcher 1 (ICC: 0.999) and researcher 2 (ICC: 0.996). Our findings demonstrate that US is a valid and reliable tool for measuring the CSA of the VM compared with MRI.

Unverifiable Academic Work by Applicants to Primary Care Sports Medicine Fellowship Programs in the United States.

BACKGROUND: In 2008, it was shown that 11% of applications to a primary care sports medicine program contained unverifiable citations for publications. In 2009, the American Medical Society for Sports Medicine changed the application requirements, requiring proof that all claimed citations (publications and presentations) be included with the fellowship application. OBJECTIVE: We determined the rate of unverifiable academic citations in applications to primary care sports medicine fellowship programs after proof of citations was required. METHODS: We retrospectively examined all applications submitted to 5 primary care sports medicine fellowship programs across the country for 3 academic years (2010-2013), out of 108 to 131 programs per year. For claimed citations that did not include proof of publication or presentation, we attempted to verify them using PubMed and Google Scholar searches, a medical librarian search, and finally directly contacting the publisher or sponsoring conference organization for verification. RESULTS: Fifteen of 311 applications contained at least 1 unverifiable citation. The total unverifiable rate was 4.8% (15 of 311) for publications and 11% (9 of 85) for presentations. These rates were lower than previously published within the same medical subspecialty. CONCLUSIONS: After requiring proof of publication and presentation citations within applications to primary care sports medicine fellowship programs, unverifiable citations persisted but were less than previously reported.

General Medical Considerations for the Wilderness Adventurer: Medical Conditions That May Worsen With or Present Challenges to Coping With Wilderness Exposure.

Participation in wilderness and adventure sports is on the rise, and as such, practitioners will see more athletes seeking clearance to participate in these events. The purpose of this article is to describe specific medical conditions that may worsen or present challenges to the athlete in a wilderness environment.

Tolerability and Efficacy of 3 Approaches to Intra-articular Corticosteroid Injections of the Knee for Osteoarthritis: A Randomized Controlled Trial.

BACKGROUND: Several studies have been performed suggesting that a superolateral approach to cortisone injections for symptomatic osteoarthritis of the knee is more accurate than anteromedial or anterolateral approaches, but there are little data to correlate clinical outcomes with these results. Additionally, there are minimal data to evaluate the pain of such procedures, and this consideration may impact physician preferences for a preferred approach to knee injection. PURPOSE: To determine the comparative efficacy and tolerability (patient comfort) of landmark-guided cortisone injections at 3 commonly used portals into the arthritic knee without effusion. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: Adult, English-speaking patients presenting to a sports medicine clinic with knee pain attributed to radiographically proven grades I through III knee osteoarthritis were randomized to receive a cortisone injection via superolateral, anteromedial, or anterolateral approaches. Patients used a visual analog scale (VAS) to self-report comfort with the procedure. Western Ontario and McMaster Universities Arthritis Index (WOMAC) 3.1 VAS scores were used to establish baseline pain and dysfunction prior to the injection and at 1 and 4 weeks follow-up via mail. RESULTS: A total of 55 knees from 53 patients were randomized for injection using a superolateral approach (17 knees), an anteromedial approach (20 knees), and an anterolateral approach (18 knees). The mean VAS scores for procedural discomfort showed no significant differences between groups (superolateral, 39.1 ± 28.5; anteromedial, 32.9 ± 31.5; anterolateral, 33.1 ± 26.6; P = .78). WOMAC scores at baseline were similar between groups as well (superolateral, 1051 ± 686; anteromedial, 1450 ± 573; anterolateral, 1378 ± 673; P = .18). The WOMAC scores decreased at 1 and 4 weeks for all groups, with no significant differences in reduction between the 3 groups. CONCLUSION: Other studies have shown that the superolateral portal is the most accurate. This study did not assess accuracy, but it showed that all 3 knee injection sites studied have similar overall clinical benefit at 4-week follow-up. Procedural pain was not significantly different between groups.

General Medical Considerations for the Wilderness Adventurer: Medical Conditions That May Worsen With or Present Challenges to Coping With Wilderness Exposure.

Participation in wilderness and adventure sports is on the rise, and as such, practitioners will see more athletes seeking clearance to participate in these events. The purpose of this article is to describe specific medical conditions that may worsen or present challenges to the athlete in a wilderness environment.

Injury trends and prevention in rugby union football.

Rugby union football has long been one of the most popular sports in the world. Its popularity and number of participants continue to increase in the United States. Until 1995, rugby union primarily was an amateur sport. Worldwide there are now flourishing professional leagues in many countries, and after a long absence, rugby union will be returning to the Olympic games in 2016. In the United States, rugby participation continues to increase, particularly at the collegiate and high school levels. With the increase in rugby professional athletes and the reported increase in aggressive play, there have been changes to the injury patterns in the sport. There is still significant need for further epidemiologic data as there is evidence that injury prevention programs and rule changes have been successful in decreasing the number of catastrophic injuries in rugby union.

Misrepresentation of research citations by applicants to a primary care sports medicine fellowship program in the United States.

OBJECTIVE: To determine the prevalence of misrepresentation of publications and national presentations claimed in applications to the Maine Medical Center (MMC) Primary Care Sports Medicine Fellowship Program from 2001 through 2004. DESIGN: A retrospective chart review study. SETTING: The Maine Medical Center Primary Care Sports Medicine Fellowship Program. METHODS: Presentations were confirmed in the program of the cited meeting or by contacting the sponsoring organization. Publications were verified by performing a MEDLINE search or by cross-referencing in Ulrich's International Periodicals Directory. If the title was listed, the citation was verified by contacting the publisher. RESULTS: Fifty applicants reported research publications. Of those, 14 applications had publications that could not be verified. The overall misrepresentation rate was 11.3%; among applicants claiming publications it was 28%. There was no difference in misrepresentation rate between specialties. Eighteen applicants reported giving national presentations, and nine presentations could not be verified, corresponding to an overall misrepresentation rate of 5.6%. Of applicants claiming presentations, 38.9% had at least one misrepresentation. CONCLUSION: Applicants to the Maine Medical Center Sports Medicine Fellowship Program were found to have high rates of misrepresentation in their citations of both publications and presentations.

Bacterial dermatoses in sports.

Bacterial skin dermatoses are common in athletes, and it is the role of team physicians to be able to recognize and treat such problems. Despite the skin's role as an efficient barrier, a moist environment coupled with frequent skin trauma and contact by athletes with equipment and other players predispose to acquiring infections. In the past 10 years, there has been a dramatic rise in methicillin-resistant Staphylococcus aureus (MRSA) infections. This article discusses community-acquired MRSA infections among athletes and focuses on the recognition of, management of, and return-to-play guidelines for common bacterial skin infections in athletes. Some of the more unusual bacterial infections that may present in this population are also reviewed.

Cutaneous fungal and viral infections in athletes.

Fungal and viral cutaneous infections are common among athletes and can develop quickly into widespread outbreaks. To prevent such outbreaks, the team physician must be familiar with common cutaneous infections including tinea corporis, tinea capitis, tinea pedis, herpes simplex, molluscum contagiosum, and human papillomaviruses. Appropriate treatment and management of these infections allows the athlete to safely return to play and safeguards teammates and opponents against the spread of these diseases.

Inguinal hernias: value of preparticipation examination, activity restriction decisions, and timing of surgery.

Though groin pain is common, the differential diagnosis is broad, and narrowing down the diagnosis of an inguinal hernia can be challenging. Once a hernia is diagnosed, play becomes limited based on severity of symptoms and physician and patient comfort, and the athlete should be closely monitored for worsening symptoms. Several surgical approaches are available for the repair of inguinal hernias, but without knowing the true natural history of this disorder, it is difficult to know when it is appropriate to have a hernia repaired.

Acne and active patients: improving more than superficial appearances.

Acne vulgaris is a common skin condition that affects many athletes. Accurate diagnosis of the type and severity of acne lesions will help direct appropriate therapeutic interventions. Medications, including topical retinoids, topical antibiotics, oral antibiotics, and oral retinoids, are effective in treating acne. Side effects of acne therapy are common and generally mild, but athletes may require special counseling to minimize adverse effects of acne therapy. Treating acne may be challenging for both patient and physician, but with patience and perseverance, an appropriate treatment plan can provide dramatic improvements in the skin, emotional well-being, and social and athletic functioning.