Prevalence and Factors Associated with Pain and History of Musculoskeletal Injuries in Skateboarders.

Objective (a) To identify the prevalence of current musculoskeletal pain and injury in the last year and (b) to verify the association of the presence of current pain and the history of injury with demographic, sports, and health characteristics in skateboarders. Method A cross-sectional observational study was conducted with 64 skateboarders who answered a questionnaire addressing demographic, sports practice, and health characteristics. The Fisher exact test verified the association of these characteristics with the presence of current pain and with the report of injury in the last year. The chi-squared test verified whether there was a difference between the observed and expected distribution for the body segment reported with pain and history of injury, and with the type of injury. Results The prevalence of pain was of 82.8%, and the observed frequency was higher than expected ( p < 0.01) in the knee, the ankle, the lumbosacral region, and the foot. The presence of pain was associated with age ( p = 0.05) and with whether the patient had already undergone physical therapy treatment ( p < 0.01). The prevalence of injury in the last year was of 68.8%, and the frequency observed was higher than expected ( p < 0.01) in the knee, the ankle, the wrist, the hand, the foot, and the shoulder. Sprain and fracture showed a higher frequency than expected ( p < 0.01). The history of injury was associated with the use of protective equipment ( p = 0.01), having already undergone surgery ( p = 0.02), and physical therapy treatment ( p = 0.03). Conclusion The practice of skateboarding presents a high prevalence of pain and injuries in the last year. The findings may contribute to the planning of preventive strategies.

The impact of direct access physiotherapy compared to primary care physician led usual care for patients with musculoskeletal disorders: a systematic review of the literature.

PURPOSE: To update and appraise the available evidence with respect to the impact of direct access physiotherapy compared to primary care physician-led usual medical care for patients with musculoskeletal disorders in terms of efficacy, health care utilization and processes, health care costs, patient satisfaction, and compliance. MATERIALS AND METHODS: Systematic searches were conducted in five bibliographic databases up to June 2019. Studies presenting quantitative data of any research related to direct access physiotherapy for patients with musculoskeletal disorders were included. Two independent raters reviewed the studies, conducted the methodological quality assessment and a data extraction regarding patient outcomes, adverse events, health care utilization and processes, patient satisfaction, and health care costs. RESULTS: Eighteen studies of weak to moderate quality were included. Five studies found no significant differences in pain reduction between usual primary care physician-led medical care and direct access physiotherapy. Four studies reported better clinical outcomes in patients with direct access in terms of function and quality of life. In terms of health care costs, four studies demonstrated that costs were lower with direct access and one study reported similar costs between both types of care. CONCLUSION: Emerging evidence of weak to moderate quality suggest that direct access physiotherapy could provide better outcomes in terms of disability, quality of life, and healthcare costs compared to primary physician-led medical care for patients with musculoskeletal disorders but not for pain outcomes. These conclusions could be modified when higher quality trials are published. CLINICAL RELEVANCE: Direct access physiotherapy for patients with musculoskeletal disorders appears as a promising model to improve efficiency of care and reduce health care costs, but more methodologically sound studies are required to formally conclude. TRIAL REGISTRATION PROSPERO: #CRD42018095604IMPLICATIONS FOR REHABILITATIONEmerging evidence of weak to moderate quality indicates that direct access physiotherapy could provide better outcomes in terms of disability, quality of life and healthcare costs compared to primary physician led usual medical care for musculoskeletal disorders patients.Direct access physiotherapy may lead to increased access to care and a more efficient use of health care resources.Direct access physiotherapy does not appear to improve pain outcomes compared to primary care physician-led usual medical care.

Musculoskeletal trauma imaging in the era of novel molecular methods and artificial intelligence.

Over the past decade rapid advancements in molecular imaging (MI) and artificial intelligence (AI) have revolutionized traditional musculoskeletal radiology. Molecular imaging refers to the ability of various methods to in vivo characterize and quantify biological processes, at a molecular level. The extracted information provides the tools to understand the pathophysiology of diseases and thus to early detect, to accurately evaluate the extend and to apply and evaluate targeted treatments. At present, molecular imaging mainly involves CT, MRI, radionuclide, US, and optical imaging and has been reported in many clinical and preclinical studies. Although originally MI techniques targeted at central nervous system disorders, later on their value on musculoskeletal disorders was also studied in depth. Meaningful exploitation of the large volume of imaging data generated by molecular and conventional imaging techniques, requires state-of-the-art computational methods that enable rapid handling of large volumes of information. AI allows end-to-end training of computer algorithms to perform tasks encountered in everyday clinical practice including diagnosis, disease severity classification and image optimization. Notably, the development of deep learning algorithms has offered novel methods that enable intelligent processing of large imaging datasets in an attempt to automate decision-making in a wide variety of settings related to musculoskeletal trauma. Current applications of AI include the diagnosis of bone and soft tissue injuries, monitoring of the healing process and prediction of injuries in the professional sports setting. This review presents the current applications of novel MI techniques and methods and the emerging role of AI regarding the diagnosis and evaluation of musculoskeletal trauma.

Firearm-Related Musculoskeletal Injuries in Brazilian Children and Teenagers.

Objective To evaluate and describe musculoskeletal injuries by firearms in children and adolescents attended in a major trauma center. Methods This was a retrospective study that evaluated the medical records of < 18 years old patients who were victims of injuries by firearms and who presented to the emergency department of our hospital, from January 2014 to December 2016. A total of 51 patients were excluded for not showing musculoskeletal injures or for other reasons, while 126 were included. The collected data were: gender; age; way of admission; body site hit; fractures; complications and sequelae; associated injures; hospitalization time; surgeries; deaths. Results Out of 126 patients included, 107 were male (84.9%) and 19 were female (15.1%). The mean age was 15 years and 5 months old (range: 2y + 8 months to 17y + 11 months years old). A total of 70 patients were hospitalized (55.6%), with a mean hospital stay of 9.6 days, and 21 patients were hospitalized in the intensive care unit (ICU) for a mean of 14.7 days. A total of 37 patients needed orthopedic surgery (29.4%). There were 6 deaths (4.8%). The thigh was the most hit region, in 43 injuries (24.7%). Six patients had spinal cord sequelae, and eight patients had peripheral nerves injuries. A total of 58 patients (46%) had 71 fractures, and the femur was the most hit (15.5%). A total of 52 (41.3%) patients presented with associated injuries. In the 71 fractures, the treatment was conservative in 45 (63.4%), surgical in 23 (32.4%). Three injuries resulted in death (4.2%). Conclusion Adolescents and males are at-risk groups for firearms injuries, and the lesions are mainly on the lower limbs. Less than half of the patients had fractures, but many had complex lesions with potential for severe sequelae.

Firearm-Related Musculoskeletal Injuries in Brazilian Children and Teenagers / Lesões musculoesqueléticas por armas de fogo em crianças e adolescentes brasileiros

Abstract Objective To evaluate and describe musculoskeletal injuries by firearms in children and adolescents attended in a major trauma center. Methods This was a retrospective study that evaluated the medical records of < 18 years old patients who were victims of injuries by firearms and who presented to the emergency department of our hospital, from January 2014 to December 2016. A total of 51 patients were excluded for not showing musculoskeletal injures or for other reasons, while 126 were included. The collected data were: gender; age; way of admission; body site hit; fractures; complications and sequelae; associated injures; hospitalization time; surgeries; deaths. Results Out of 126 patients included, 107 were male (84.9%) and 19 were female (15.1%). The mean age was 15 years and 5 months old (range: 2y + 8 months to 17y + 11 months years old). A total of 70 patients were hospitalized (55.6%), with a mean hospital stay of 9.6 days, and 21 patients were hospitalized in the intensive care unit (ICU) for a mean of 14.7 days. A total of 37 patients needed orthopedic surgery (29.4%). There were 6 deaths (4.8%). The thigh was the most hit region, in 43 injuries (24.7%). Six patients had spinal cord sequelae, and eight patients had peripheral nerves injuries. A total of 58 patients (46%) had 71 fractures, and the femur was the most hit (15.5%). A total of 52 (41.3%) patients presented with associated injuries. In the 71 fractures, the treatment was conservative in 45 (63.4%), surgical in 23 (32.4%). Three injuries resulted in death (4.2%). Conclusion Adolescents and males are at-risk groups for firearms injuries, and the lesions are mainly on the lower limbs. Less than half of the patients had fractures, but many had complex lesions with potential for severe sequelae.

Resumo Objetivo Avaliar e descrever lesões musculoesqueléticas por armas de fogo em crianças e adolescentes atendidas em um pronto-socorro de grande porte. Métodos Estudo retrospectivo avaliando os prontuários de pacientes, vítimas de armas de fogo e menores de 18 anos de idade que deram entrada ao pronto socorro do nosso hospital, de janeiro de 2014 a dezembro de 2016. Um total de 51 pacientes foi excluído por não apresentar lesões musculoesqueléticas ou outras razões, enquanto 126 foram incluídos. Os dados colhidos foram: sexo; idade; via de entrada; tipo de lesão; balas alojadas e removidas; local do corpo atingido; fraturas; complicações e sequelas; lesões associadas; tempo de internamento e de UTI; cirurgias; e óbitos. Resultados Dos 177 pacientes menores de 18 anos que deram entrada no pronto socorro por ferimento por armas de fogo, 126 pacientes (71,2%) atenderam aos critérios de inclusão. Foram excluídos 51 (43 por não apresentaram lesões musculoesqueléticas). Cento e sete (84,9%) eram do sexo masculino e 19 (15,1%) do feminino. A média de idade foi 15,5 anos (limites, 2 anos + 8 meses a 17 anos + 11 meses). Setenta pacientes foram internados por tempo médio de 9,6 dias, e 21 pacientes foram hospitalizados na unidade de tratamento intensivo (UTI) por 14,7 dias em média. Um total de 37 pacientes (29,4%) foi submetido a cirurgias ortopédicas. Houve um total de 6 óbitos (4,8%). A coxa foi a principal região atingida, em um total de 43 vezes (24,7%). Seis pacientes tiveram lesões da medula espinhal, e oito pacientes tiveram lesões de nervos periféricos. Um total de 58 pacientes (46%) teve 71 fraturas, e o fêmur foi o principal osso fraturado (11 pacientes; 15,5%). Um total de 52 pacientes (41,3%) tiveram lesões associadas. Das 71 fraturas, o tratamento foi conservador em 45 (63,4%) e cirúrgico em 23 (32,4%). Três evoluíram para óbito (4,2%). Conclusão Os adolescentes e o sexo masculino são grupo de risco para lesões de armas de fogo, e as lesões são principalmente em membros inferiores. Menos da metade dos pacientes apresentaram fraturas, mas muitos apresentaram lesões complexas com potencial de graves sequelas.

Accuracy of recall of musculoskeletal injuries in elite military personnel: a cross-sectional study.

BACKGROUND: Self-reported data are often used in research studies among military populations. OBJECTIVE: The accuracy of self-reported musculoskeletal injury data among elite military personnel was assessed for issues with recall. DESIGN: Cross-sectional study. SETTING: Applied research laboratory at a military installation. PARTICIPANTS: A total of 101 subjects participated (age 28.5±5.6 years). Study participants were active duty military personnel, with no conditions that precluded them from full duty. PRIMARY AND SECONDARY OUTCOME MEASURES: Self-reported and medical record reviewed injuries that occurred during a 1-year period were matched by anatomic location, injury side (for extremity injuries), and injury year and type. The accuracy of recall was estimated as the per cent of medical record reviewed injuries correctly recalled in the self-report. The effect of injury anatomic location, injury type and severity and time since injury, on recall, was also assessed. Injuries were classified as recent (≤4 years since injury) or old injuries (>4 years since injury). Recall proportions were compared using Fisher's exact tests. RESULTS: A total of 374 injuries were extracted from the subjects' medical records. Recall was generally low (12.0%) and was not different between recent and old injuries (P=0.206). Injury location did not affect recall (P=0.418). Recall was higher for traumatic fractures as compared with less severe non-fracture injuries (P values 0.001 to <0.001). Recall for non-fracture injuries was higher for recent as compared with old injuries (P=0.033). This effect of time since injury on recall was not observed for fractures (P=0.522). CONCLUSIONS: The results of this study highlight the importance of weighing the advantages and disadvantages of self-reported injury data before their use in research studies in military populations and the need for future research to identify modifiable factors that influence recall.

APTIDÃO FÍSICA E LESÕES: 54 SEMANAS DE TREINAMENTO FÍSICO COM POLICIAIS MILITARES / PHYSICAL FITNESS AND INJURIES: 54 WEEKS OF PHYSICAL TRAINING AMONG MILITARY POLICE OFFICERS / APTITUD FÍSICA Y LESIONES: 54 SEMANAS DE ENTRENAMIENTO FÍSICO CON LA POLICÍA MILITAR

RESUMO Introdução: A aptidão física é imprescindível para policiais militares. Entretanto, apesar de a finalidade do treinamento militar ser o aperfeiçoamento de diferentes componentes da aptidão física, sua execução de forma não adequada pode associar-se ao desenvolvimento de lesões musculoesqueléticas. Objetivo: Verificar o efeito do treinamento físico militar sobre indicadores de aptidão física e incidência de lesões musculoesqueléticas em participantes do Curso de Formação de Soldados da Polícia Militar do Estado de São Paulo. Método: A amostra foi composta por 86 homens que foram submetidos ao Teste de Aptidão Física no início e depois de 54 semanas de treinamento. As informações sobre lesões foram obtidas com questionário específico. Resultados: Houve melhora significativa do volume máximo de oxigênio (VO2máx), resistência muscular localizada, força e velocidade ao final do treinamento. Entretanto, 45,3% dos policiais sofreram uma ou mais lesões, sendo 65,6% delas concentradas nos membros inferiores, 18% nos membros superiores e 16,4% no tronco e na cabeça. O nível osteoarticular concentrou 50,8% das lesões, o nível músculo-ligamentar, 26,3% e o tegumentar, 22,9%. Conclusão: Apesar do resultado satisfatório em relação à aptidão física, a incidência de lesões entre os policiais foi elevada.

ABSTRACT Introduction: Physical fitness is imperative for military police officers. However, although the purpose of military training is to improve different components of physical fitness, its inadequate performance may be associated with the development of musculoskeletal injuries. Objective: To verify the effect of military physical training on indicators of physical fitness and incidence of musculoskeletal injuries in participants of the Training Course of Military Police Officers in the State of São Paulo. Methods: The sample consisted of 86 men who were submitted to the Physical Fitness Test at the beginning and after 54 weeks of training. Information on injuries was obtained with a specific questionnaire. Results: There was significant improvement in maximum oxygen uptake (VO2max), localized muscle endurance, strength and velocity at the end of training. However, 45.3% of the officers suffered one or more injuries, 65.6% of which were concentrated in the lower limbs, 18% in the upper limbs, and 16.4% in the torso and head. The osteoarticular level concentrated 50.8% of the injuries, the musculoligamentous level, 26.3%, and the tegumentary level, 22.9%. Conclusion: Despite the satisfactory results regarding physical fitness, the incidence of injuries among military police officers was high.

RESUMEN Introducción: La buena aptitud física es indispensable para la policía militar. Si embargo, aunque el propósito del entrenamiento militar sea la mejora de los diferentes componentes de condición física, su ejecución inadecuada puede estar asociada con el desarrollo de lesiones musculoesqueléticas. Objetivo: Verificar el efecto del entrenamiento físico militar sobre los indicadores de aptitud física y la incidencia de lesiones musculoesqueléticas en los participantes del Curso de Entrenamiento de Soldados de la Policía Militar del Estado de São Paulo. Método: La muestra consistió en 86 hombres que fueron sometidos a la Prueba de Aptitud Física al inicio y después de 54 semanas de entrenamiento. La información sobre lesiones se obtuvo con cuestionario específico. Resultados: Hubo una mejora significativa del consumo máximo de oxígeno (VO2máx), la resistencia muscular localizada, fuerza y velocidad al final del entrenamiento. Sin embargo, el 45,3% de los policías sufrieron una o más lesiones, siendo el 65,6% concentrado en las extremidades inferiores, el 18% en las extremidades superiores y el 16,4% en el torso y la cabeza. El nivel osteoarticular concentra el 50,8% de las lesiones, el nivel musculoligamentoso, 26,3% y el tegumentario, 22,9%. Conclusión: A pesar de los resultados satisfactorios en términos de aptitud física, la incidencia de las lesiones entre los policías fue alto.

Common injuries in athletes' knee: experience of a specialized center.

OBJECTIVE: The present cross-sectional study aims to identify the most common knee injuries in athletes cared at a Specialized Outpatient Clinics. METHOD: Analysis of patients cared at the Knee Outpatient Clinics of a Sports Trauma Center, divided by gender, age and diagnosed injury. RESULTS: Initially 440 patients were divided into 33 types of sports; after excluding the less statistically significant practices, nine sports remained. The most frequently performed sports were football with almost 50% of total patients presenting anterior cruciate ligament (ACL) injury, and road runs with great frequency of meniscal injury. There was no correlation of the disorder with the type of sports performed but a correlation was found with patient's age/gender. CONCLUSION: The complete ACL rupture was the most common injury found in football, basketball and volleyball players, followed by meniscal injury in street runners.

Common injuries in athletes' knee: experience of a specialized center

OBJECTIVE: The present cross-sectional study aims to identify the most common knee injuries in athletes cared at a Specialized Outpatient Clinics. METHOD: Analysis of patients cared at the Knee Outpatient Clinics of a Sports Trauma Center, divided by gender, age and diagnosed injury. RESULTS: Initially 440 patients were divided into 33 types of sports; after excluding the less statistically significant practices, nine sports remained. The most frequently performed sports were football with almost 50% of total patients presenting anterior cruciate ligament (ACL) injury, and road runs with great frequency of meniscal injury. There was no correlation of the disorder with the type of sports performed but a correlation was found with patient's age/gender. CONCLUSION: The complete ACL rupture was the most common injury found in football, basketball and volleyball players, followed by meniscal injury in street runners. Level of Evidence IV, Study Transversal. .

MUSCLE INJURIES IN ATHLETES.

This article had the aim of demonstrating the physiology, diagnosis and treatment of muscle injuries, focusing on athletes and their demands and expectations. Muscle injuries are among the most common complaints in orthopedic practice, occurring both among athletes and among non-athletes. These injuries present a challenge for specialists, due to the slow recovery, during which time athletes are unable to take part in training and competitions, and due to frequent sequelae and recurrences of the injuries. Most muscle injuries (between 10% and 55% of all injuries) occur during sports activities. The muscles most commonly affected are the ischiotibial, quadriceps and gastrocnemius. These muscles go across two joints and are more subject to acceleration and deceleration forces. The treatment for muscle injuries varies from conservative treatment to surgery. New procedures are being used, like the hyperbaric chamber and the use of growth factors. However, there is still a high rate of injury recurrence. Muscle injury continues to be a topic of much controversy. New treatments are being researched and developed, but prevention through muscle strengthening, stretching exercises and muscle balance continues to be the best "treatment".

Importância do treinamento da propriocepção e do controle motor na reabilitação após lesões músculo-esqueléticas / The importance of training the proprioception and motor control in rehabilitation following musculoskeletal injuries

A propriocepção e o controle muscular possuem um papel fundamental na estabilidade articular dinâmica. Após lesões ortopédicas algumas características sensório-motoras são alteradas e devem ser focadas em programas de reabilitação, para que haja sucesso no retorno às atividades realizadas previamente a lesão. Desta forma, devem ser realizados exercícios proprioceptivos específicos desde início do período pós operatório ou após a fase aguda de lesões tratadas conservadoramente, com o objetivo de melhorar a acuidade proprioceptiva e a resposta muscular antecipatória e reativa, restabelecendo a estabilidade articular dinâmica. Neste artigo abordaremos o conceito original de propriocepção, a contribuição para a manutenção da estabilidade articular dinâmica, a influência da lesão na acuidade proprioceptiva e o treinamento da propriocepção e do controle neuromuscular.

Proprioception and muscular control play a fundamental role in dynamic joint stability. After orthopedic injuries, some motor-sensory characteristics are effected and must be focused on in rehabilitation programs in order to successfully return to pre-injury activities. Certain specific proprioceptive exercises should be initiated immediately after surgery, or after the proper treatment of the acute phase of injuries in order to improve the proprioceptive acuity and the anticipatory and reactive muscular response, reestablishing dynamic joint stability. In this article we focus on the original concept of proprioception, its contribution to the maintenance of dynamic joint stability, the influence of injuries on the proprioceptive acuity, proprioceptive and neuromuscular control training.