Epidemiology of Common Injuries in the Volleyball Athlete.

PURPOSE OF REVIEW: To review the recent literature regarding the epidemiology of injuries in the volleyball athlete across all levels of play and to discuss areas where further studies are needed. RECENT FINDINGS: Injury epidemiology for volleyball at the collegiate and high school level has been supported by a longitudinal injury surveillance program through the NCAA Injury Surveillance System (NCAA ISS) and High School Reporting Information Online (HS RIO) for the past 30 years. The creation of the FIVB Injury Surveillance System (FIVB ISS) in 2010 shows promise in advancing the literature on the injury at the professional level, and further studies on beach volleyball injuries are needed. Overall, injury patterns in volleyball in the past decade showed similar distribution to prior studies, but the rate of injury may be decreasing. Common injuries in volleyball include ankle sprains, patellar tendinopathy, finger and thumb sprains, overuse injuries of the shoulder, and concussions. Injury surveillance from the NCAA has demonstrated injury trends at the collegiate level, but further longitudinal studies are needed to evaluate injury at the professional level and for beach volleyball to help develop injury prevention strategy.

Foot and ankle injuries in the barefoot sports.

Playing sports barefoot has been contested since the very beginnings of athletic competition. Even today, some data suggest that shoes may limit the adaptive pronation that occurs after footstrike during running gait. This pronation likely protects runners from injury. Boardsport participants who perform their sports barefoot on the water seem to be at risk for foot and ankle injuries. The high-impact forces in gymnastics place participants at risk for foot and ankle injuries, as well. Swimming and diving have a low rate of foot and ankle injuries. The risk of ankle sprain in beach volleyball, which is played barefoot, seems to be lower than that for indoor volleyball, played wearing shoes. Martial arts place competitors at risk for injuries to the foot and ankle from torsional and impact mechanisms. Athletes who hope to return to barefoot competition after injury should perform their rehabilitation in their bare feet.

Palpitations in athletes.

In an athletic population, the incidence of palpitations varies from 0.3% to as high as 70%, depending on age and type of sport being studied. Palpitations, or an awareness of an increased or abnormal heart beat, are rare in the school-age athlete, but much more common in older endurance athletes. The majority are felt to be benign, with prognosis relating to type of specific rhythm disturbance and presence or absence of underlying heart disease. Atrial fibrillation can account for up to 9% of rhythm disturbances in elite athletes, and up to 40% in those with long-standing symptoms. In athletes with premature ventricular beats (PVCs), underlying heart disease is more likely to be present in those with a high PVC burden, defined as >/=2000 PVCs/24 hours. Choice of monitoring device is crucial in making a proper diagnosis of the specific rhythm disturbance. For symptoms occurring within a 24-hour period, simple Holter monitoring is adequate to make a diagnosis. However, if symptoms occur less frequently, clinicians must choose one of the other available monitoring devices. Most importantly, choice of device should depend on which device is most likely to detect the rhythm disturbance. Other cardiac testing such as echocardiography, stress testing, endomyocardial biopsy, genetic testing, electrophysiologic testing, or cardiac magnetic resonance imaging may be indicated as well. The majority of palpitations in athletes will be first identified by screening examination, or by a complaint from the athlete. The third and most current pre-participation examination monograph recommends asking the athlete if he/she has palpitations with exercise. The assumption has been made that palpitations occurring at rest in athletes are benign, but this theory has not been validated prospectively in a large cohort of the athletic population. Specific rhythms can often be treated with radiofrequency ablation, with return to sports provided there is no significant high risk underlying heart disease present. Athletes with known malignant ventricular rhythm disturbances, or underlying substrate for such, who have undergone implantation of an automatic implanted cardioverter-defibrillator are not recommended to return to sport because there is no data on the safety and efficacy of defibrillators in this clinical setting, and certain athletic activities may result in damage to the device.

Primary care of the sports hernia: recognizing an often-overlooked cause of pain.

Groin injury is common in sports that involve high-speed torsion of the trunk, especially soccer, as in this case of a 28-year-old goalie. The sports hernia, a syndrome of pain caused by disruption of the inguinal canal without a clinically detectable hernia, is often initially overlooked. Examination reveals maximal tenderness over the pubic tubercle and posterior inguinal canal. The diagnosis is clinical, but x-rays and bone scanning may help rule out a concurrent injury. The pain may be multifactorial, with coexisting hip or adductor muscle pathology complicating the clinical picture. Rehabilitation, particularly core strengthening with emphasis on the abdominal obliques, is the first line of treatment. If this is ineffective, surgery is usually successful, and most athletes return to a high level of sports participation 6 to 8 weeks postsurgery.

Corticosteroid injection for treatment of de Quervain's tenosynovitis: a pooled quantitative literature evaluation.

BACKGROUND: There have been many approaches described to treat de Quervain's tenosynovitis, but no definite consensus emerges in the literature. We conducted a pooled quantitative literature evaluation to review the therapeutic studies in the English language to determine the various reported cure rates. METHODS: All citations in the MEDLINE and Ovid databases that addressed de Quervain's tenosynovitis were independently reviewed. Appropriate studies from the bibliographies of these articles were then obtained. Of the 35 articles on de Quervain's temosynovitis that were found in the modern literature, only seven allowed for comparison among potentially effective treatments. Studies were included if they evaluated or compared treatment options among patients and had defined criteria for diagnosis and successful treatment. These seven studies were descriptive, not comparative. In other words, each study reported the proportion of successful outcomes with different treatments, without a comparison to a specified control group. Four hundred fifty-nine wrists were subjected to one of several therapeutic modalities. RESULTS: There was an 83% cure rate with injection alone. This rate was much higher than any other therapeutic modality (61% for injection and splint, 14% for splint alone, 0% for rest or nonsteroidal anti-inflammatory drugs). CONCLUSION: It seems that injection alone is the best therapeutic approach to de Quervain's tenosynovitis.

Neck Injuries.

In brief When a neck injury is suspected, the on-site physician must first provide basic trauma care, which includes establishing an airway as necessary, assessing breathing, and checking circulation and neurologic compromise. A few targeted questions during history taking and a directed physical exam will help rule out serious cervical injuries, which are uncommon. More common are minor injuries, such as "burners." Team physicians must also be well-versed in immobilizing and transporting the patient, administering a thorough neurologic exam, and establishing when the athlete can return to competition.