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1.
J Ultrasound Med ; 2021 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-34927276

RESUMO

OBJECTIVES: To investigate ultrasound (US) femoroacetabular translation measurements in female athlete patients. METHODS: A prospective cross-sectional study was conducted in female athlete patients <50 years. Demographic data, Beighton score/hypermobility status, and sport participation were collected. Hip dysplasia was determined using radiographic measurements (lateral center edge angle, anterior center edge angle, Tönnis angle); femoral version angles were measured with CT or MR. Femoroacetabular translation US measures included neutral (N), neutral flexed (NF), extension external rotation/apprehension (EER) positions. Maximal difference (delta) between US measures was calculated. RESULTS: 206/349 female hips were analyzed (median age 21.2 years [range, 12-49.5]). The primary sport group was performing arts (45%, 92/206). Mean Beighton score was 5.2 (SD, 2.5) with 61% (129/206) of hips exhibiting hypermobility (Beighton score ≥5). For each additional unit of Beighton score, N US measurement increased by 0.7 mm (ß = 0.7; 95% confidence interval [CI] = 0.22-1.25; P < .001), NF by 1 mm ( ß = 0.9; 95% CI = 0.3-1.43; P = .002) and EER by 0.8 mm ( ß = 0.8; 95% CI = 0.27-1.37; P < .001) when adjusting for age and dysplasia status. A positive correlation was detected between NF (r = 0.19; 95% CI = 0.05-0.33; P = .007) and EER (r = 0.19; 95% CI = 0.05-0.32; P = .01) with Tönnis angle and a negative correlation between the delta and femoral version (r = -0.20; 95% CI = -0.35 to 0.03; P = .02). No difference in US measures was detected across sport groups (N [P = .24], NF [P = .51], EER [P = .20], delta [P = .07]). CONCLUSION: Beighton score was independently associated with dynamic US measures in female athlete patients who are not hypermobile when controlling for other factors.

2.
BMJ Open Sport Exerc Med ; 7(4): e001169, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34987860

RESUMO

Objective: To compare femoroacetabular (FA) translation between dancers and athletes with hip pain and between dancers with and without hip pain. Methods: In this cross-sectional study, 171 female athletes and dancers with hip pain underwent dynamic hip ultrasound (DHUS) of FA translation in three positions: neutral (N), neutral with contralateral hip flexion (NF), apprehension position with contralateral hip flexion (EER-F). Multivariable linear regression analysis was used to assess variation in FA translation between dancers and athletes in the presence of age, Beighton score/hypermobility, BMI, radiographic markers of acetabular dysplasia and femoral version angles. Symptomatic dancers were matched to asymptomatic dancer controls on age, height and BMI, and comparison analyses of FA translation were conducted controlling for matched propensity score and Beighton score. Results: In the symptomatic cohort, dancers were younger, had higher Beighton scores and were more hypermobile than non-dancers. Dancers also showed greater NF, EER-F and max US-min US (delta) compared with non-dancers (mean 5.4 mm vs 4.4 mm, p=0.02; mean 6.3 mm vs 5.2 mm, p=0.01; 4.2 mm vs 3.6 mm, p=0.03, respectively). Symptomatic dancers showed greater NF and EER-F compared with asymptomatic dancers (mean 5.5 mm vs 2.9 mm, p<0.001; mean 6.3 mm vs 4.2 mm, p<0.001, respectively). Comparison of symptomatic dancers with and without hip dysplasia showed no difference in DHUS measurements. Conclusion: DHUS measurements of FA translation are greater in female dancers with hip pain relative to female non-dancer athletes with hip pain and asymptomatic female dancers.

3.
J Dance Med Sci ; 24(3): 99-104, 2020 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-32867911

RESUMO

Femoroacetabular impingement (FAI) is a common anatomical variant in ballet dancers. Cam morphology (a subtype of FAI) and increased alpha angles have been identified as risk factors for hip pain. Ultrasound has recently been used to measure alpha angles in the diagnosis of cam morphology, but its utility remains understudied. The purpose of this study was to investigate the effect of ultrasound measured alpha angles on hip pain and function scores in elite female adolescent ballet dancers. The alpha angles of 25 dancers (mean age: 15.9 years) were measured using ultrasound and calculated with ImageJ Software. Cam morphology was defined by alpha angles of 60° or greater. Participants rated their hip pain and function using the International Hip Outcome Tool 12 (iHOT-12) survey. For normally distributed variables, the independent t-test was performed, and for abnormally distributed variables, the Mann-Whitney U Test. Along with mean and standard deviation (SD) values, median score, interquartile range (IQR), and 95% confidence intervals (95% CIs) were also analyzed. Significantly lower iHOT-12 scores were found in dancers with alpha angles ≥ 60° (mean ± SD, 74.34 ± 13.01; 95% CIs, 58.18, 90.50, median 67.20; IQR, 18.55), compared to dancers with alpha angles < 60° (mean ± SD, 80.22 ± 15.65; 95% CIs, 72.90, 87.54; median, 81.60; IQR, 16.35; p = 0.001). It is concluded that: 1. elite female adolescent ballet dancers with alpha angles higher than 60° experienced worse hip pain and function; 2. alpha angles may impact hip pain and function in these dancers; and 3. further studies should use a prospective design to investigate the predictive ability of their findings.


Assuntos
Dança/lesões , Impacto Femoroacetabular/diagnóstico por imagem , Articulação do Quadril/diagnóstico por imagem , Amplitude de Movimento Articular , Adolescente , Estudos Transversais , Dança/fisiologia , Feminino , Quadril/diagnóstico por imagem , Humanos , Estudos Prospectivos , Ultrassonografia
4.
Sports (Basel) ; 7(9)2019 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-31547307

RESUMO

The current study aims to compare the mechanical propensities between healthy runners and runners with hamstring injuries. Retrospective case-control video analysis was used. A total of 35 (12 male and 23 female) videos of runners with hamstring injuries were compared with videos of sex-, age-, mass-, and height-matched healthy control runners. The main outcome variables were trunk posture angles, overstride angles, and foot strike patterns. An independent t-test and chi-squared tests were employed to analyze the main outcome variables between the runners with hamstring injuries and the healthy control runners. The statistical significance of less than 0.05 (p < 0.05) was used. The runners with hamstring injuries had a 1.6° less forward-trunk posture angles compared with the healthy control runners (p = 0.043). Also, the runners with hamstring injuries demonstrated a 4.9° greater overstride angles compared with the healthy control runners (p = 0.001). Finally, the runners with hamstring injuries had a tendency of rearfoot strike, while the healthy control runners showed a forefoot strike pattern (p = 0.004). In conclusion, the runners with hamstring injuries demonstrated different running mechanical propensities compared with the healthy runners.

5.
Clin Pediatr (Phila) ; 58(6): 671-676, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30813766

RESUMO

The objective of this study was to determine diagnostic accuracy of magnetic resonance imaging (MRI) and computed tomography (CT) scans in young athletes diagnosed with spondylolysis. A cross-sectional study was used. Twenty-two young athletes (14.7 ± 1.5 years) were diagnosed as spondylolysis based on a single-photon emission CT. Following the diagnosis, participants underwent MRI and CT scan imaging tests on the same day. The sensitivity and false-negative rate of the MRI and CT scans were analyzed. MRI test confirmed 13 (+) and 9 (-) results while CT test showed 17 (+) and 5 (-) results. The sensitivity and false-negative rate of MRI were, respectively, 59.1% (95% confidence interval [CI] = 36.7% to 78.5%) and 40.9% (95% CI = 21.5% to 63.3%). Furthermore, the sensitivity and false-negative rate of CT scan were 77.3% (95% CI = 54.2% to 91.3%) and 22.7% (95% CI = 0.09% to 45.8%). Our results indicated that CT scan is a more accurate imaging modality to diagnose spondylolysis compared with MRI in young athletes.


Assuntos
Imageamento por Ressonância Magnética/métodos , Espondilólise/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adolescente , Atletas/estatística & dados numéricos , Estudos Transversais , Reações Falso-Negativas , Feminino , Humanos , Masculino , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Espondilólise/fisiopatologia
6.
Clin Orthop Relat Res ; 477(5): 1086-1098, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30531425

RESUMO

BACKGROUND: Hip microinstability has gained attention recently as a potential cause of hip pain. Currently there is a lack of evidence-based objective diagnostic criteria surrounding this diagnosis. Previous studies have shown translation of the femoral head during extreme hip positions. However, reliable assessment of femoral head translation is lacking. QUESTIONS/PURPOSES: (1) How precise is musculoskeletal ultrasound for measuring anterior femoral head translation during the hip anterior apprehension test? (2) What is the intra- and interrater reliability of dynamic ultrasonography in assessing anterior femoral head translation? METHODS: We recruited 10 study participants (20 hips) between the ages of 22 and 50 years with no history of hip pain or functional limitations. Test-retest methodology was used. Seven females and three males were enrolled. The mean age of study participants was 27 years (SD 8.7 years); mean body mass index was 22.6 kg/m (SD 2.2 kg/m). All study participants underwent dynamic hip ultrasonography by three different physicians 1 week apart. Each hip was visualized in two neutral positions (neutral and neutral with the contralateral hip flexed [NF]) and two dynamic positions, which sought to replicate the apprehension test, although notably study participants had no known hip pathology and therefore no apprehension. The first maintained the hip in extension and external rotation off to the side of the examination table (EER1), and the second held the hip off of the bottom of the examination table (EER2). One hundred twenty ultrasound scans (480 images) were performed. Mean and SD were calculated using absolute values of the difference in ultrasound measurements (mm) between positions NF and EER1 and NF and EER2 calculated for each physician as well as an average of all three physicians. Intraclass correlation coefficient (ICC) analysis was used to examine intra- and interrater reliability. RESULTS: The mean absolute difference for NF and EER1 was 0.84 mm (SD 0.93 mm) and for NF and EER2 0.62 mm (SD 0.40 mm) on Study Day 1. Similarly, on Study Day 2, the mean absolute difference for NF and EER1 position was 0.90 mm (SD 0.74 mm) and for NF and EER2 1.03 mm (SD 1.18 mm). Cumulative values of ICC analysis indicated excellent intrarater reliability in all four positions: neutral 0.794 (95% confidence interval [CI], 0.494-0.918), NF 0.927 (95% CI, 0.814-0.971), EER1 0.929 (95% CI, 0.825-0.972), and EER2 0.945 (95% CI, 0.864-0.978). Similarly, interrater ICC analysis cumulative values were excellent for NF, EER1, and EER2 and fair to good for the neutral position: neutral 0.725 (95% CI, 0.526-0.846), NF 0.846 (95% CI, 0.741-0.913), EER1 0.812 (95% CI, 0.674-0.895), and EER2 0.794 (95% CI, 0.652-0.884). CONCLUSIONS: This study offers the first ultrasound protocol of which we are aware for measuring anterior femoral head translation. Hip dynamic ultrasound may assist in providing precise objective clinical-based diagnostic evidence when evaluating complex hip pain and suspected microinstability. Musculoskeletal ultrasound is a reliable office-based method of measuring anterior femoral head translation that can be utilized by physicians with varying experience levels. Future studies are needed to investigate ultrasound anterior femoral head translation taking into account sex, prior hip surgery, hip osseous morphology, and ligamentous laxity. LEVEL OF EVIDENCE: Level III, diagnostic study.


Assuntos
Fêmur/diagnóstico por imagem , Articulação do Quadril/diagnóstico por imagem , Quadril/diagnóstico por imagem , Instabilidade Articular/diagnóstico por imagem , Ultrassonografia/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
7.
J Ultrasound Med ; 38(6): 1527-1536, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30380165

RESUMO

OBJECTIVES: Treatment for iliopsoas tendinopathy includes ultrasound (US)-guided iliopsoas peritendinous corticosteroid injection. Evidence is lacking regarding US-guided iliopsoas injection efficacy in patients with iliopsoas tendinopathy and intra-articular (IA) hip abnormalities. The purpose of this study was to examine the efficacy of US-guided iliopsoas corticosteroid injection for iliopsoas tendinopathy in patients with and without IA hip abnormalities. METHODS: This work was a prospective study evaluating patients aged 12 to 50 years with iliopsoas tendinopathy. Participants completed a Hip Disability and Osteoarthritis Outcome Score (HOOS) questionnaire before and 6 weeks after injection. The main outcome measure was the change in HOOS subcategory scores. Independent variables included time and hip status. Normal hips were compared to abnormal hips with IA abnormalities. A 2-way repeated measures analysis of covariance with effect size (η2 ) was used to determine injection effects on HOOS scores before and 6 weeks after injection. RESULTS: A total of 178 patients (154 female and 24 male) were analyzed. Time effects were found for both normal and abnormal hips in all HOOS subcategories: symptoms (P = .041; η2 = 0.050), pain (P = .001; η2 = 0.184), activities of daily living (P = .011; η2 = 0.076), function in sports and recreation (P = .001; η2 = 0.151), and quality of life (QOL; P = .001; η2 = 0.193). Significant differences between normal versus abnormal hips were found in the sports and recreation (P = .032; η2 = 0.056) and QOL scores (P = .001; η2 = 0.135). CONCLUSIONS: In patients with iliopsoas tendinopathy, US-guided iliopsoas corticosteroid injection improved outcomes regardless of coexisting IA hip abnormalities. Patients without IA hip abnormalities showed greater improvement in sports and recreation and QOL scores compared to patients with IA hip abnormalities. Ultrasound-guided iliopsoas injection for iliopsoas tendinopathy may advance short-term care and help continue with nonsurgical treatment regimens.


Assuntos
Corticosteroides/uso terapêutico , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/fisiopatologia , Dor/tratamento farmacológico , Tendinopatia/diagnóstico por imagem , Ultrassonografia de Intervenção/métodos , Adolescente , Corticosteroides/administração & dosagem , Adulto , Criança , Feminino , Humanos , Injeções Intra-Articulares , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Dor/fisiopatologia , Estudos Prospectivos , Tendinopatia/complicações , Tendinopatia/fisiopatologia , Resultado do Tratamento , Adulto Jovem
8.
J Phys Ther Sci ; 30(8): 1056-1062, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30154600

RESUMO

[Purpose] Primary purpose was to compare running mechanics between healthy runners and runners with chronic exertional compartment syndrome (CECS) including overstride angles, ankle dorsiflexion (DF) angles, and foot strike patterns. The secondary purpose was to analyze the association between the overstride angles and ankle DF angles. [Participants and Methods] Running images of 7 female runners with bilateral CECS patients were captured at a time of the medical examination. Their running images were compared with gender, age, and body mass index matched 31 healthy control runners. [Results] The bilateral CECS female runners have a propensity of running with significantly greater overstride and ankle DF angles than the healthy female runners. There were no foot strike differences between the two cohorts. There were a non-significant, poor relationship between overstride and ankle DF angles in the healthy female runners while a significant, strong association was found between overstride and ankle DF angles in the bilateral CECS female runners. [Conclusion] Compared to healthy female runners, bilateral CECS female runners demonstrated different running mechanics including greater overstride and ankle DF angles. The two variables were strongly associated with each other in bilateral CECS female runners, but not in healthy female runners. This may potentially contribute to the mechanism of CECS development.

9.
Phys Sportsmed ; 46(4): 477-484, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30122090

RESUMO

OBJECTIVE: To investigate the prevalence of hypoechoic areas by US and its' association with VISA-P scores among asymptomatic jumpers while highlighting sex comparisons. DESIGN: Cross-sectional study. SETTING: Pre-participation exam at a National Collegiate Athletic Association (NCAA) division I college. PARTICIPANTS: Thirty-one college athletes who engage in jumping sports. MAIN OUTCOME MEASURES: Hypoechoic images of patellar tendon captured by ultrasound examination were compared to a self-reported knee functional survey, the Victorian Institute of Sport Assessment for patellar tendinopathy (VISA-P) scale (0-100). RESULTS: With a total of 31 athletes (13 males and 18 females), prevalence rate of the hypoechoic areas of patellar tendon was 19.4% (6/31) in the right knee and 29.0% (9/31) in the left knee. There was no proportional difference in a comparison of prevalence rate of hypoechoic area [(+) or (-)] by sex in either right or left knee. The VISA-P scores were significantly lower in US (+) than US (-) in the right knee (p = 0.003, Cohen's d = 1.675), but not the left knee (p = 0.250, Cohen's d = 0.512). The receiver operating characteristics curve analysis indicated the most sensitive and specific VISA-P values based on status [(+) or (-)] of hypoechoic area was 89.5 with 86.4% and 77.7% of sensitivity and specificity. CONCLUSION: In short, hypoechoic areas were detected by US examination among self-reported asymptomatic jumpers. There was an association between hypoechoic areas and VISA-P scores in the right knee, but not in left knee. VISA-P scores may be used as a screening tool for the presence of hypoechoic areas.


Assuntos
Ligamento Patelar/diagnóstico por imagem , Tendinopatia/diagnóstico por imagem , Atletas , Basquetebol , Estudos Transversais , Feminino , Humanos , Articulação do Joelho/diagnóstico por imagem , Masculino , Ligamento Patelar/patologia , Prevalência , Atletismo , Ultrassonografia , Voleibol , Adulto Jovem
10.
Phys Sportsmed ; 46(3): 385-392, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29301454

RESUMO

OBJECTIVES: The purpose of this study was to investigate the relationship between coping skills and current hip pain and function scores in ballet dancers. Secondly, we examined the relationship between coping skills and past injuries. Thirdly, we investigated the association between past injuries and current pain and function scores. METHODS: This was a cross-sectional observational study. Twenty-six young elite female dancers (mean age 15.9 years, range 14-17 years) participated. Participants completed surveys indicating past injury history, rating pain and function on the short International Hip Outcome Tool (iHOT-12), and assessing coping skills on the Athletic Coping Skills Inventory Score (ACSI-28). Independent t-tests, Cohen's d, effect size, chi-square and correlation coefficient and determination analyses were conducted. RESULTS: There was no significant relationship between iHOT-12 scores and ACSI-28 scores (r = -0.250, p = 0.087). There was no significant difference (p = 0.289) in past injuries comparing those with ACSI-28 scores above and below the mean ACSI-28. A significant moderate negative correlation was detected between both iHOT-12 scores and total past injuries (r = -0.609, p < 0.001), and iHOT-12 scores and past non-hip injuries (r = -0.628, p < 0.001). CONCLUSION: Past injuries may influence current hip pain and function in young female dancers. Correlation determination (r2) indicated that 37% of current pain and function scores were explained by total past injuries in a small group of young high-level ballet dancers. Further research should engage a prospective design to investigate the predictive ability of findings.


Assuntos
Adaptação Psicológica , Dança/lesões , Lesões do Quadril/psicologia , Articulação do Quadril/fisiopatologia , Dor/psicologia , Adolescente , Estudos Transversais , Feminino , Humanos , Dor/fisiopatologia , Esportes , Inquéritos e Questionários
11.
Orthop J Sports Med ; 5(8): 2325967117723108, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28840149

RESUMO

BACKGROUND: Femoroacetabular impingement (FAI) is a painful and limiting condition of the hip that is often seen in young athletes. Previous studies have reported a higher prevalence of this disorder in male athletes, but data on the structural morphology of adolescent and young adult female athletes, specifically those involved in dance, are lacking. PURPOSE: (1) To investigate the radiographic morphology of FAI deformities in adolescent and young adult female single-sport dance and nondance athletes and (2) to examine the differences in the radiographic findings between these 2 groups. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: A retrospective chart review of 56 female single-sport athletes 10 to 21 years of age with a diagnosis of FAI within a single-sports medicine division of a pediatric academic medical center was performed. Acetabular index (AI), lateral center-edge angle (LCEA), crossover sign, and ischial spine sign were measured bilaterally on anteroposterior radiographs; alpha angle (AA) was measured on lateral films, and anterior center-edge angle (ACEA) was measured on false-profile films. Independent t tests and Mann-Whitney U tests were used to compare mean angle measurements between dance and nondance athletes. Dichotomized categorical variables and crossover and ischial spine signs were analyzed between dance and nondance athletes by applying a chi-square test. Statistical significance was set as P < .05 a priori. RESULTS: Significant differences in angle measurements were noted. AA was significantly lower in the dancers compared with the nondance athlete group (49.5° ± 6.0° vs 53.9° ± 7.3°, P = .001). The LCEA and ACEA of dance athletes were significantly greater compared with nondance athletes (33.8° ± 6.7° vs 30.9° ± 5.8° [P = .016] and 36.0° ± 8.1° vs 32.3° ± 7.0° [P = .035], respectively). No significant difference in AI was seen between the 2 cohorts (5.0° ± 4.0° for dancers vs 5.9° ± 3.4° for nondancers, P = .195). CONCLUSION: Significant differences existed in the radiographic bony morphology of young female single-sport dance athletes compared with nondance athletes with FAI. In dance athletes, symptoms were seen in the setting of normal bony morphology.

12.
Spine (Phila Pa 1976) ; 42(18): E1087-E1091, 2017 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-28542108

RESUMO

STUDY DESIGN: Clinical case report of unilateral pedicular stress fracture with a contralateral spondylolysis in a male high-school athlete presenting with low back pain. OBJECTIVE: To report this uncommon cause of low back pain in an adolescent athlete, and review the relevant literature. SUMMARY OF BACKGROUND DATA: The incidence of spondylolysis in the Caucasian population was found to be about 3% to 6%. This number is probably higher in the athletic adolescent age group, with reports ranging from 8% to 15%. Spondylolysis may be associated with pedicle fracture, usually on the contralateral side. This is an uncommon phenomenon that is not well described in the adolescent age group. METHODS: A 16-year-old male athlete presents with low back pain and limitation in sports as well as in daily activities. Clinical evaluation was suspicious for, and radiographic evaluation revealed left-sided L5 spondylolysis as well as contralateral L5 pedicle fracture. Conservative management included Boston Overlapping brace, external electrical stimulation, modification of activities, and a comprehensive physical therapy program. RESULTS: Radiological evaluation revealed persistent left L5 pars defect and advanced healing of the contralateral pedicle fracture. The patient achieved complete pain relief and returned to varsity level sporting activity. CONCLUSION: Complete radiographic and clinical healing of the pedicle defect was observed, with return competitive varsity-level football without symptoms. LEVEL OF EVIDENCE: 5.


Assuntos
Dor Lombar/etiologia , Vértebras Lombares/cirurgia , Fraturas da Coluna Vertebral , Espondilólise , Adolescente , Atletas , Humanos , Masculino , Radiografia , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Espondilólise/complicações , Espondilólise/diagnóstico por imagem , Espondilólise/cirurgia
13.
J Pediatr Orthop B ; 25(4): 315-21, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27058819

RESUMO

UNLABELLED: To compare sports-related hip injuries on the basis of sex and age in a cohort of young athletes. A 5% random probability sample of all new patients' charts over a 10-year time period was selected for investigation. The most common hip injury diagnoses, sport at time of injury, mechanism (acute/traumatic vs. overuse), and types (bony vs. soft tissue) were compared by sex and age (preadolescent vs. adolescent). Descriptive and χ-analyses were carried out. The interaction of sex and age with respect to hip injury over time was examined by two-way (sex, age) analysis of variance. A total of 2133 charts were reviewed; N=87 hip injuries. The main diagnoses for males included labral tear (23.1%), avulsion fracture (11.5%), slipped capital femoral epiphysis (11.5%), dislocation (7.7%), and tendonitis (7.7%). The main diagnoses for females were labral tear (59.0%), tendonitis (14.8%), snapping hip syndrome (6.6%), strain (4.9%), and bursitis (4.9%). The five most common sports/activities at the time of hip injury were dancing/ballet (23.0%), soccer (18.4%), gymnastics (9.2%), ice hockey (8.1%), and track and field (6.9%). Age by sex comparisons showed a greater proportion of the total hip injuries (38.5%) in males compared with females (8.2%) during preadolescence (5-12 years). However, in adolescence (13-17 years), the hip injury proportion was significantly higher in females (91.8%) compared with males (61.5%; P<0.001). Injury mechanism and type differed by sex, with females sustaining more chronic/overuse (95.1%) and soft tissue type injuries (93.4%) compared with males (50.0 and 53.8%, respectively; P<0.001). Females were found to have a sharper increase in hip injury proportion as they progressed through puberty compared with males (analysis of variance sex-by-age interaction; P<0.001). Hip injury mechanism and type differed significantly between males and females during growth. Notably, the proportion of hip injuries in the young female athletes showed a significantly greater increase with advancing age compared with males. Hip injuries in children and the interplay with growth, as it relates to injury predisposition, require further investigation to facilitate efforts aimed at prevention. LEVEL OF EVIDENCE III: Cross-sectional epidemiological study.


Assuntos
Traumatismos em Atletas/diagnóstico , Lesões do Quadril/diagnóstico , Pediatria/métodos , Adolescente , Antropometria , Atletas , Traumatismos em Atletas/reabilitação , Índice de Massa Corporal , Criança , Pré-Escolar , Estudos de Coortes , Estudos Transversais , Dança/lesões , Feminino , Ginástica , Lesões do Quadril/reabilitação , Humanos , Masculino , Fatores de Risco , Fatores Sexuais , Lesões dos Tecidos Moles , Esportes , Medicina Esportiva , Centros de Atenção Terciária
14.
Pediatrics ; 136(3): 521-7, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26283783

RESUMO

OBJECTIVE: To determine if injury rates among female field hockey players differ before and after implementation of a national mandate for protective eyewear (MPE). METHODS: We analyzed girls' field hockey exposure and injury data collected from national (High School Reporting Information Online [RIO]) and regional (Fairfax County Public Schools) high school sports injury databases in 2 seasons before (2009/10 and 2010/11) and 2 seasons after (2011/12 and 2012/13) a national MPE. RESULTS: The incidence of eye/orbital injuries was significantly higher in states without MPE (0.080 injuries per 1000 athletic exposures [AEs]) than in states with MPE (before the 2011/12 mandate) and the postmandate group (0.025 injuries per 1000 AEs) (odds ratio 3.20, 95% confidence interval 1.47-6.99, P = .003). There was no significant difference in concussion rates for the 2 groups (odds ratio 0.77, 95% confidence interval 0.58-1.02, P = .068). After the 2011/12 MPE, severe eye/orbital injuries (time loss >21 days) were reduced by 67%, and severe/medical disqualification head/face injuries were reduced by 70%. Concussion rates for field hockey (0.335 per 1000 AEs) rank third among girls' sports included in the High School RIO surveillance program. CONCLUSIONS: Among female high school field hockey players, MPE is associated with a reduced incidence of eye/orbital injuries and fewer severe eye/orbital and head/face injuries. Concussion rates did not change as a result of the national MPE. Concussion remains the most common injury involving the head and face among female field hockey players, prompting further inquiry into potential effects of adopting protective headgear/helmets.


Assuntos
Traumatismos Oculares/prevenção & controle , Dispositivos de Proteção dos Olhos , Hóquei/lesões , Concussão Encefálica/epidemiologia , Concussão Encefálica/prevenção & controle , Traumatismos Craniocerebrais/epidemiologia , Traumatismos Craniocerebrais/prevenção & controle , Traumatismos Oculares/epidemiologia , Traumatismos Faciais/epidemiologia , Traumatismos Faciais/prevenção & controle , Feminino , Humanos , Incidência , Órbita/lesões , Estudos Prospectivos , Virginia/epidemiologia
15.
Circ Cardiovasc Imaging ; 8(2): e002487, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25673646

RESUMO

BACKGROUND: Myocardial adaptations to exercise have been well documented among competitive athletes. To what degree cardiac remodeling occurs among recreational exercisers is unknown. We sought to evaluate the effect of recreational marathon training on myocardial structure and function comprehensively. METHODS AND RESULTS: Male runners (n=45; age, 48±7 years; 64% with ≥1 cardiovascular risk factor) participated in a structured marathon-training program. Echocardiography, cardiopulmonary exercise testing, and laboratory evaluation were performed pre and post training to quantify changes in myocardial structure and function, cardiorespiratory fitness, and traditional cardiac risk parameters. Completion of an 18-week running program (25±9 miles/wk) led to increased cardiorespiratory fitness (peak oxygen consumption, 44.6±5.2 versus 46.3±5.4 mL/kg per minute; P<0.001). In this setting, there was a significant structural cardiac remodeling characterized by dilation of the left ventricle (end-diastolic volume, 156±26 versus 172±28 mL, P<0.001), right ventricle (end-diastolic area=27.0±4.8 versus 28.6±4.3 cm(2); P=0.02), and left atrium (end-diastolic volume, 65±19 versus 72±19; P=0.02). Functional adaptations included increases in both early (E'=12.4±2.5 versus 13.2±2.0 cm/s; P=0.007) and late (A'=11.5±1.9 versus 12.2±2.1 cm/s; P=0.02) left ventricular diastolic velocities. Myocardial remodeling was accompanied by beneficial changes in cardiovascular risk factors, including body mass index (27.0±2.7 versus 26.7±2.6 kg/m(2); P<0.001), total cholesterol (199±33 versus 192±29 mg/dL; P=0.01), low-density lipoprotein (120±29 versus 114±26 mg/dL; P=0.01), and triglycerides (100±52 versus 85±36 mg/dL; P=0.02). CONCLUSIONS: Among middle-aged men, recreational marathon training is associated with biventricular dilation, enhanced left ventricular diastolic function, and favorable changes in nonmyocardial determinants of cardiovascular risk. Recreational marathon training may, therefore, serve as an effective strategy for decreasing incident cardiovascular disease.


Assuntos
Remodelamento Atrial , Cardiomegalia Induzida por Exercícios , Coração/fisiologia , Resistência Física , Corrida , Remodelação Ventricular , Adaptação Fisiológica , Adulto , Fatores Etários , Função do Átrio Esquerdo , Biomarcadores/sangue , Ecocardiografia Doppler , Teste de Esforço , Humanos , Lipídeos/sangue , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio , Estudos Prospectivos , Fatores Sexuais , Fatores de Tempo , Função Ventricular Esquerda , Função Ventricular Direita
17.
BMJ Open ; 4(2): e004498, 2014 Feb 14.
Artigo em Inglês | MEDLINE | ID: mdl-24531453

RESUMO

OBJECTIVES: The effect of habitual, high-intensity exercise training on the progression of atherosclerosis is unclear. We assessed indices of vascular health (central systolic blood pressure (SBP) and arterial stiffness as well as carotid intima-medial thickness (cIMT)) in addition to cardiovascular risk factors of trained runners versus their untrained spouses or partners to evaluate the impact of exercise on the development of carotid atherosclerosis. SETTING: field study at Boston Marathon. PARTICIPANTS: 42 qualifiers (mean age±SD: 46±13 years, 21 women) for the 2012 Boston Marathon and their sedentary domestic controls (46±12 years, n=21 women). OUTCOMES: We measured medical and running history, vital signs, anthropometrics, blood lipids, C reactive protein (CRP), 10 years Framingham risk, central arterial stiffness and SBP and cIMT. RESULTS: Multiple cardiovascular risk factors, including CRP, non-high-density lipoprotein cholesterol, triglycerides, heart rate, body weight and body mass index (all p<0.05), were reduced in the runners. The left and right cIMT, as well as central SBP, were not different between the two groups (all p>0.31) and were associated with age (all r≥0.41; p<0.01) and Framingham risk score (all r≥0.44; p<0.01) independent of exercise group (all p>0.08 for interactions). The amplification of the central pressure waveform (augmentation pressure at heart rate 75 bpm) was also not different between the two groups (p=0.07) but was related to age (p<0.01) and group (p=0.02) in a multiple linear regression model. CONCLUSIONS: Habitual endurance exercise improves the cardiovascular risk profile, but does not reduce the magnitude of carotid atherosclerosis associated with age and cardiovascular risk factors.


Assuntos
Aterosclerose/fisiopatologia , Doenças das Artérias Carótidas/fisiopatologia , Corrida/fisiologia , Adulto , Fatores Etários , Aterosclerose/diagnóstico por imagem , Pressão Sanguínea , Índice de Massa Corporal , Peso Corporal , Proteína C-Reativa/metabolismo , Artérias Carótidas/diagnóstico por imagem , Artérias Carótidas/fisiopatologia , Doenças das Artérias Carótidas/diagnóstico por imagem , Espessura Intima-Media Carotídea , HDL-Colesterol/sangue , Feminino , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco , Triglicerídeos/sangue , Rigidez Vascular
18.
J Pediatr Orthop ; 33(4): 383-8, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23653026

RESUMO

BACKGROUND: Evaluation of extension-based low back pain in young athletes with suspected pars injury may include a referral for skeletal single photon emission computed tomography (SPECT). However, the diagnostic yield of this technique in children with low back pain before the age of 10 years remains uncertain. We examined a series of consecutive SPECT scans to address this question. MATERIALS AND METHODS: A retrospective review of department databases revealed 107 consecutive skeletal Tc-99m MDP SPECT scans performed between January 1, 2007 and December 31, 2009 in children less than 10 years of age. Of these, 72 studies were performed for a referral diagnosis of back pain. There were 43 girls (44 studies) and 28 boys (28 studies). The mean age was 7.2 years (range, 1.9 to 9.9 y). All SPECT scans were reviewed and positive findings documented. In addition, all available anatomic imaging, imaging reports (computed tomography, magnetic resonance, and x-ray) and clinical notes were reviewed, and results were compared with those of SPECT studies. RESULTS: Of the 72 SPECT studies, 35 (49%) identified a focal area in the spine of abnormal increased uptake, with 17 in the region of the pars interarticularis. With additional imaging, 1 case was demonstrated not to be a pars injury (computed tomography showed a transverse process fracture) and 2 patients with negative SPECT scans were shown to have pars injuries that SPECT scan had not detected, for a total of 18 pars injuries (25%) in this cohort. Reported participation in gymnastics or football was related to pars injury (odds ratio 4.3, P=0.04). CONCLUSIONS: Pars injury was found in 25% of children referred for SPECT scan with back pain below 10 years of age. SPECT scan was highly sensitive for this injury as well as in identifying other potential sites of pathology, and should be considered in the workup of persistent low back pain in young children. LEVEL OF EVIDENCE: Level II, diagnostic study.


Assuntos
Traumatismos em Atletas/diagnóstico , Dor Lombar/etiologia , Traumatismos da Coluna Vertebral/diagnóstico , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Fatores Etários , Traumatismos em Atletas/patologia , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Masculino , Encaminhamento e Consulta , Estudos Retrospectivos , Sensibilidade e Especificidade , Traumatismos da Coluna Vertebral/patologia
19.
J Dance Med Sci ; 17(4): 159-64, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24565331

RESUMO

Irish dance is growing in popularity and competitiveness; however, very little research has focused specifically on this genre of dance. The purpose of this study was to analyze the types of dance injuries incurred by Irish dancers. A chart review was performed to identify all injuries associated with Irish dance seen in the sports medicine or orthopaedic clinics at the investigators' hospital over an 11-year period. "Injury" was defined as any dance-related pain or disorder that led to evaluation in the clinics. Survey data were also collected from study participants. Ultimately, 255 patients from over 30 different schools of dance were seen with injuries directly related (726 clinic visits) or partially related (199 visits) to Irish dance. Participants ranged in age from 4 to 47, with 95% (243/255) under the age of 19. These 255 patients received 437 diagnoses. Almost 80% of the injuries (348/437) were attributable to overuse, and 20.4% were acute and traumatic injuries (89/437). Ninety-five percent (95.9%) of injuries involved the hip or lower extremity. The most common sites were the foot (33.2%), ankle (22.7%), knee (19.7%), and hip (14.4%). Typical diagnoses were tendon injury (13.3%), apophysitis (11.4%), patellofemoral pain and instability (10.8%), stress injury (10.1%), and muscle injury (7.8%). The majority of traumatic injuries were seen in clinic within 3 weeks, but less than a quarter of overuse injuries were seen that quickly. The most common treatment, prescribed to 84.3% of patients, was physical therapy and home exercises, and the majority of dancers (64.3%) were able to return to full dance activity after injury.


Assuntos
Dança/lesões , Adolescente , Adulto , Traumatismos do Tornozelo/epidemiologia , Traumatismos do Tornozelo/reabilitação , Criança , Pré-Escolar , Transtornos Traumáticos Cumulativos/epidemiologia , Transtornos Traumáticos Cumulativos/reabilitação , Feminino , Traumatismos do Pé/epidemiologia , Traumatismos do Pé/reabilitação , Lesões do Quadril/epidemiologia , Lesões do Quadril/reabilitação , Humanos , Traumatismos do Joelho/epidemiologia , Traumatismos do Joelho/reabilitação , Masculino , Pessoa de Meia-Idade , Modalidades de Fisioterapia , Adulto Jovem
20.
Pediatrics ; 130(6): 1069-75, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23147982

RESUMO

OBJECTIVE: To determine if injury rates differ among high school field hockey players in states that mandated protective eyewear (MPE) versus states with no protective eyewear mandate (no MPE). METHODS: We analyzed field hockey exposure and injury data collected over the 2009-2010 and 2010-2011 scholastic seasons from national and regional databases. RESULTS: Incidence of all head and face injuries (including eye injuries, concussion) was significantly higher in no-MPE states compared with MPE states, 0.69 vs 0.47 injuries per 1000 athletic exposures (incidence rate ratio [IRR] 1.47; 95% confidence interval [CI]: 1.04-2.15, P = .048). Players in the no-MPE group had a 5.33-fold higher risk of eye injury than players in the MPE group (IRR 5.33; 95% CI: 0.71-39.25, P = .104). There was no significant difference in concussion rates for the 2 groups (IRR 1.04; 95% CI: 0.63-1.75, P = .857). A larger percentage of injuries sustained by athletes in the no-MPE group required >10 days to return to activity (32%) compared with athletes in the MPE group (17%), but this difference did not reach statistical significance (P = .060). CONCLUSIONS: Among high school field hockey players, playing in a no-MPE state results in a statistically significant higher incidence of head and face injuries versus playing in an MPE state. Concussion rates among players in MPE and no-MPE states were similar, indicating that addition of protective eyewear did not result in more player-player contact injuries, challenging a perception in contact/collision sports that increased protective equipment yields increased injury rates.


Assuntos
Traumatismos em Atletas/prevenção & controle , Traumatismos Oculares/prevenção & controle , Dispositivos de Proteção dos Olhos , Hóquei/lesões , Adolescente , Traumatismos em Atletas/epidemiologia , Concussão Encefálica/epidemiologia , Concussão Encefálica/etiologia , Estudos Transversais , Traumatismos Oculares/epidemiologia , Feminino , Humanos , Incidência , Masculino , Vigilância da População , Fatores de Risco , Estados Unidos , Percepção Visual , Cicatrização
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