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1.
BMJ Case Rep ; 14(2)2021 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-33558381

RESUMO

Guillain-Barré syndrome (GBS) is an acute, monophasic, polyradiculoneuropathy usually provoked by a preceding infection. The cardinal features are progressive weakness in the upper and lower limbs accompanied by loss of deep tendon reflexes. The diagnosis is made on the basis of the clinical history and examination findings, supported by typical cerebrospinal fluid and electrophysiology findings. Trauma and surgery are well understood but rare precipitants of GBS, which clinicians should be aware of, in order not to miss an opportunity to use immunomodulatory therapies. Furthermore, the presence of postsurgical or post-traumatic GBS should prompt careful assessment for underlying malignancy or autoimmune disease associated with an acute demyelinating polyradiculoneuropathy. Here, we present a case of post-traumatic GBS and discuss the potential mechanisms that might underlie this, as well as the investigations and treatment that should be considered.


Assuntos
Traumatismos em Atletas/complicações , Síndrome de Guillain-Barré/diagnóstico , Síndrome de Guillain-Barré/etiologia , Dor nas Costas/complicações , Diagnóstico Diferencial , Fraturas Ósseas/complicações , Síndrome de Guillain-Barré/tratamento farmacológico , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Masculino , Pessoa de Meia-Idade
3.
Clin Sports Med ; 40(1): 147-158, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33187605

RESUMO

Pediatric patients with concussions have different needs than adults throughout the recovery process. Adolescents, in particular, may take longer to recover from concussion than adults. Initially, relative rest from academic and physical activities is recommended for 24 to 48 hours to allow symptoms to abate. After this time period, physicians should guide the return to activity and return to school process in a staged fashion using published guidelines. Further concussion research in pediatric patients, particularly those younger than high-school age, is needed to advance the management of this special population.


Assuntos
Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/terapia , Concussão Encefálica/diagnóstico , Concussão Encefálica/terapia , Esportes Juvenis/lesões , Adolescente , Adulto , Traumatismos em Atletas/complicações , Concussão Encefálica/complicações , Criança , Terapia por Exercício , Humanos , Aprendizagem , Síndrome Pós-Concussão/diagnóstico , Síndrome Pós-Concussão/terapia , Volta ao Esporte , Fatores de Tempo
4.
Sports Health ; 13(1): 65-70, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32639180

RESUMO

CONTEXT: Malnutrition is well-studied in various aspects of the orthopaedic literature, most commonly in relation to arthroplasty, spine surgery, and trauma. However, the management of nutritional deficiencies is commonly overlooked among orthopaedic sports medicine providers. The purpose of this article is to analyze the available sports medicine literature to review the associations between malnutrition and the management of orthopaedic sports medicine patients from a treatment and performance standpoint. EVIDENCE ACQUISITION: PubMed was searched for relevant articles published from 1979 to 2019. STUDY DESIGN: Clinical review. LEVEL OF EVIDENCE: Level 4. RESULTS: Few studies exist on the implications of macronutrient deficiencies specific to orthopaedic sports medicine procedures. Interestingly, micronutrient disorders-namely, hypovitaminosis D and iron deficiency-have been well studied and may lead to worse postoperative outcomes, injury rates, and athletic performance. Nutritional supplementation to correct such deficiencies has been shown to mitigate these effects, though further study is required. CONCLUSION: Nutritional deficiencies are highly prevalent in orthopaedic sports medicine patients, and practitioners should be aware of their potential effects on treatment and performance outcomes. Management of such deficiencies and their effect on surgical patients remain an area of potential future research. Future studies are warranted in order to explore the potential therapeutic role of nutritional supplementation to prevent complications after common orthopaedic sports medicine procedures, improve athletic performance, and reduce injury rates.


Assuntos
Traumatismos em Atletas/cirurgia , Desempenho Atlético/fisiologia , Desnutrição/complicações , Procedimentos Ortopédicos , Anemia Ferropriva/complicações , Anemia Ferropriva/terapia , Traumatismos em Atletas/complicações , Suplementos Nutricionais , Humanos , Desnutrição/terapia , Nutrientes/deficiência , Procedimentos Ortopédicos/efeitos adversos , Complicações Pós-Operatórias , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/terapia
6.
Sports Health ; 12(6): 540-546, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32936058

RESUMO

CONTEXT: With increased use of cannabis-based products by the public for both recreational and medical use, sports medicine clinicians should be informed of historical context, current legal considerations, and existing evidence with regard to efficacy, safety, and risks in the athletic community. EVIDENCE ACQUISITION: A review of ClinicalTrials.gov, MEDLINE, and CINAHL from 2015 to present was conducted with emphasis on the most recent literature using search terms, cannabis, nabiximols, cannabinoids, pain management, THC, CBD, and marijuana. Bibliographies based on original search were utilized to pursue further literature search. STUDY DESIGN: Clinical review. LEVEL OF EVIDENCE: Level 3. RESULTS: At present, limited high-quality studies exist for use of cannabinoids for acute pain, chronic pain, or concussion. None of the trials involving cannabinoids included the athletic population. Thus, results from this clinical review are extrapolated to conditions of the sports medicine population. For acute pain, 2 small-randomized double-blinded crossover trials concluded no immediate effect of cannabinoid therapy. More robust evidence exists for treatment of chronic pain conditions through meta-analysis and systemic reviews. Cannabinoid therapy exhibits moderate efficacy as a treatment for some chronic pain conditions. Investigations included a broad spectrum of chronic pain conditions, including neuropathic, musculoskeletal, inflammatory, and central pain conditions, and reveal reduction in pain and improvement of quality of life with limited adverse effects. For concussion, evidence is based on preclinical in vitro and animal models revealing possible neuroprotective effects as well as 2 clinical studies involving the presence of cannabinoids for concussion (some sports-related), but there are no high-quality trials evaluating efficacy for treatment with cannabinoids at this time. CONCLUSION: Although various biochemical explanations exist on the use of cannabinoid therapy through modulation of the endocannabinoid system for several medical issues affecting athletes, recommendations from clinicians must be extrapolated from a majority of research done in the nonathletic population. Lack of strong-quality clinical evidence, coupled with inconsistent federal and state law as well as purity issues with cannabis-based products, make it difficult for the sports medicine clinician to widely recommend cannabinoid therapeutics at present. Future larger, higher quality clinical research studies with standardized pure extracts will better guide appropriate medical use going forward. At present, evidence for a multitude of therapeutic applications is emerging for cannabinoid treatment approaches. With emphasis placed on patient-centered clinical decisions, cannabinoids hold promise of treatment for athletes with chronic pain conditions. Clinicians who treat the athletic community must consider legal and ethical issues when discussing and recommending the use of cannabinoids, with acknowledgment of inconsistencies in purity of various formulations and concerns of drug testing.


Assuntos
Traumatismos em Atletas/complicações , Canabinoides/uso terapêutico , Maconha Medicinal/uso terapêutico , Manejo da Dor/métodos , Dor Aguda/tratamento farmacológico , Traumatismos em Atletas/tratamento farmacológico , Concussão Encefálica/tratamento farmacológico , Canabinoides/efeitos adversos , Dor Crônica/tratamento farmacológico , Medicina Baseada em Evidências/normas , Humanos , Uso da Maconha/legislação & jurisprudência , Maconha Medicinal/efeitos adversos , Estados Unidos
7.
Rev Med Suisse ; 16(701): 1421-1427, 2020 Aug 05.
Artigo em Francês | MEDLINE | ID: mdl-32833357

RESUMO

The elbow joint is highly congruent and subject to less stress than other joints. This contributes to a rather low incidence of pathologies in the general population. However, in athletes who perform repeated movements with supraphysiological forces, diverse pathologies may appear. The objective of this article is to develop an anatomopathological approach to elbow pain in order to identify its origin. A rapid and precise diagnosis allows initiating an adequate treatment and minimizing time of sporting activity arrest.


Assuntos
Atletas , Traumatismos em Atletas/diagnóstico , Articulação do Cotovelo/lesões , Cotovelo/lesões , Traumatismos em Atletas/complicações , Humanos , Dor/diagnóstico , Dor/etiologia , Dor/prevenção & controle
8.
Clin J Sport Med ; 30(4): 412-415, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32644320

RESUMO

OBJECTIVE: Report the clinical findings and outcomes among pediatric patients diagnosed with benign paroxysmal positional vertigo (BPPV) after sports-related concussion (SRC). DESIGN: Retrospective case series. SETTING: Multidisciplinary pediatric concussion program. PATIENTS: Patients younger than 19 years with a sport or recreation activity-related concussion referred for comprehensive vestibular physiotherapy assessment. MAIN OUTCOME MEASURE: Symptom resolution after targeted particle repositioning (PR). RESULTS: During the study period, 115 pediatric SRC patients underwent vestibular physiotherapy assessment including 12 (10.4%) who were diagnosed with BPPV. Unilateral posterior semicircular canal (SCC) BPPV was diagnosed in 8/12 (75%) patients, and unilateral anterior SCC BPPV diagnosed in 4/12 (25%) patients. Benign paroxysmal positional vertigo was successfully treated in all patients with a mean of 1.58 targeted PR maneuvers (range = 1-4). CONCLUSIONS: Comprehensive management of pediatric SRC requires a multidisciplinary approach to address the heterogeneous pathophysiology of persistent postconcussion symptoms. Pediatric SRC patients with coexisting BPPV should be considered for targeted PR.


Assuntos
Vertigem Posicional Paroxística Benigna/etiologia , Concussão Encefálica/complicações , Esportes Juvenis/lesões , Adolescente , Traumatismos em Atletas/complicações , Traumatismos em Atletas/fisiopatologia , Vertigem Posicional Paroxística Benigna/terapia , Concussão Encefálica/fisiopatologia , Feminino , Humanos , Masculino , Modalidades de Fisioterapia , Estudos Retrospectivos
9.
Dev Neuropsychol ; 45(3): 110-117, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32419513

RESUMO

Increased focus on sports-related concussion (SRC) in football in the media, and mandatory concussion education for parents of youth sport athletes, may result in parental concern that youth athletes will experience long-term effects from concussion. We sought to identify beliefs about long-term effects of concussion in parents of youth soccer athletes. Four hundred and eleven parents from soccer leagues in three states completed a survey assessing parents' perceptions and knowledge of long-term effects of SRC. Nearly all youth soccer parents surveyed (96.5%) believe there are long-term effects from SRCs, 76% reported concern their child would sustain a concussion, and 71% had talked with their child about concussion symptoms/reporting. Parents ranked tackle football as having the highest risk for concussion, followed by soccer, ice hockey, cheerleading, and lacrosse. Parents of children that had previously sustained a concussion were 8.3x more likely to be concerned their child would sustain a concussion, and parents with a personal history of concussion were 2x more likely to consider not allowing their child to participate in youth sports. There are wide-spread beliefs among youth soccer parents regarding long-term effects of SRCs, and concerns their children will sustain concussions while participating in youth sports.


Assuntos
Traumatismos em Atletas/complicações , Concussão Encefálica/complicações , Pais/psicologia , Futebol/fisiologia , Criança , Feminino , Humanos , Masculino , Inquéritos e Questionários
10.
Am J Sports Med ; 48(7): 1657-1664, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32401542

RESUMO

BACKGROUND: Anterior cruciate ligament (ACL) tears can either be treated nonoperatively with physical therapy and then treated operatively if persistent instability is present, or be directly treated operatively. Advantages of early ACL reconstruction surgery include shorter time from injury to surgery and potentially fewer meniscal injuries, but performing early ACL reconstruction in all patients results in surgery in patients who might not need ACL reconstruction. It is important to assess in which patients nonoperative treatment is successful and which patients will require ACL reconstruction and thus might be better treated surgically in an earlier phase. PURPOSE: To identify patient characteristics that predict the success of nonoperative treatment. STUDY DESIGN: Cohort study (Prognosis); Level of evidence, 2. METHODS: All patients with complete ACL injuries who were evaluated between 2014 and 2017 at our clinic were included. The minimum follow-up was 2 years. The initial treatment and ultimate ACL reconstruction were reviewed. Univariate analysis was performed using Mann-Whitney U tests and chi-square tests and multivariate analysis using binary logistic regression. RESULTS: A total of 448 patients were included with a median age of 26 years and median Tegner level of 7 and mean Tegner level of 6.4. At initial consultation, 210 patients (47%) were treated nonoperatively with physical therapy and 126 of these patients (60%) ultimately required ACL reconstruction. Nonoperative treatment failed in 88.9% of patients <25 years of age, 56.0% of patients 25 to 40 years, and 32.9% of patients >40 years (P < .001); and 41.9% of patients with Tegner level 3 to 6, and 82.8% of patients with Tegner level 7 to 10. Age <25 years (odds ratio [OR], 7.4; P < .001) and higher Tegner levels (OR, 4.2; P < .001) were predictive of failing nonoperative treatment in multivariate analysis. Patients in the failed nonoperative group had longer time from diagnosis to surgery than the direct reconstruction group (6.2 vs 2.2 months; P < .001), and more frequently had new meniscal injuries (17.4% vs 3.1%; P < .001) at surgery. CONCLUSION: Nonoperative treatment of ACL injuries failed in 60% of patients and was highly correlated with age and activity level. In patients aged 25 years or younger or participating in higher-impact sports, early ACL reconstruction should be considered to prevent longer delay between injury and surgery, as well as new meniscal injuries.


Assuntos
Lesões do Ligamento Cruzado Anterior/terapia , Modalidades de Fisioterapia , Adolescente , Adulto , Lesões do Ligamento Cruzado Anterior/complicações , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior , Traumatismos em Atletas/complicações , Traumatismos em Atletas/terapia , Feminino , Seguimentos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Retrospectivos , Lesões do Menisco Tibial/complicações , Tempo para o Tratamento , Resultado do Tratamento , Adulto Jovem
11.
J Orthop Sports Phys Ther ; 50(4): CPG1-CPG73, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32241234

RESUMO

Over the last decade, numerous concussion evidence-based clinical practice guidelines (CPGs), consensus statements, and clinical guidance documents have been published. These documents have typically focused on the diagnosis of concussion and medical management of individuals post concussion, but provide little specific guidance for physical therapy management of concussion and its associated impairments. Further, many of these guidance documents have targeted specific populations in specific care contexts. The primary purpose of this CPG is to provide a set of evidence-based recommendations for physical therapist management of the wide spectrum of patients who have experienced a concussive event. J Orthop Sports Phys Ther 2020;50(4):CPG1-CPG73. doi:10.2519/jospt.2020.0301.


Assuntos
Traumatismos em Atletas/terapia , Concussão Encefálica/terapia , Modalidades de Fisioterapia , Traumatismos em Atletas/complicações , Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/psicologia , Concussão Encefálica/complicações , Concussão Encefálica/diagnóstico , Concussão Encefálica/psicologia , Medicina Baseada em Evidências , Humanos , Educação de Pacientes como Assunto
12.
Arch Clin Neuropsychol ; 35(5): 469-481, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32186667

RESUMO

OBJECTIVE: Although research shows that abnormal scores are common in adults, fewer studies examine the frequency of abnormal scores within children. The present study assessed how specific tests, cognitive domains, and patient factors affect the likelihood of abnormally low scores among healthy youth athletes. METHODS: Youth athletes (n = 85, Mage = 11.72, SD = 2.23) completed a comprehensive neuropsychological battery (N = 23 tests) during baseline testing for a sport-related concussion clinical research program. "Abnormal" scores were defined using cutoffs at 1, 1.5, and 2 standard deviations (SDs) below the population mean. Univariate and multivariate Poisson regression models examined abnormal test scores as a function of age, sex, ethnicity, and Full-Scale Intelligence Quotient (FSIQ). RESULTS: Using cutoffs of 1, 1.5, and 2 SDs, the percent of healthy participants with at least one abnormal test score was 61.2, 36.5, and 22.4%, respectively, indicating a high proportion of healthy participants with abnormal scores and low specificity for tests using these cutoffs. In univariate Poisson regression analyses, FSIQ and abnormal score were negatively correlated (p < .001), wherein lower FSIQ was associated with more abnormal scores. In multivariate regression analyses, lower performance on executive function, memory, and processing speed tests was significantly associated with an increased frequency of abnormal scores. CONCLUSIONS: Abnormally low scores in healthy youth occur frequently and do not necessarily represent functional deficits. Cutoffs of 2 SDs should be considered for many tests to increase specificity and reduce the risk of false positive errors that could lead to negative clinical outcomes.


Assuntos
Atletas , Traumatismos em Atletas , Concussão Encefálica , Esportes , Adolescente , Adulto , Atletas/psicologia , Traumatismos em Atletas/complicações , Traumatismos em Atletas/diagnóstico , Concussão Encefálica/diagnóstico , Criança , Humanos , Memória , Testes Neuropsicológicos
13.
Phys Ther Sport ; 43: 143-150, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32200259

RESUMO

OBJECTIVES: To gain insight into perceived factors related to bone health and stress fracture (SF) prevention for female runners and to understand their experiences within the medical community. DESIGN: Cohort qualitative study. SETTING: University health system. PARTICIPANTS: Forty female runners, 20 who had SF histories and 20 age-and-running-distance matched women without SF. MAIN OUTCOME MEASURES: Women participated in audiotaped qualitative semi-structured interviews. For women with a SF history, questions sought their perspectives on factors that they felt contributed to SF, experiences with the medical community, and changes made post SF. For women without a SF history, questions sought perspectives on factors felt important to perceived running-related bone health. RESULTS: Six themes emerged; 1) Previous/Recurrent Musculoskeletal Injuries, 2) Activity Patterns and Training Regimens, 3) Nutrition, 4) Prevention and Intervention, 5) Pain, and 6) Mindset. Within these themes, between group differences are characterized by differences in knowledge and/or application of knowledge for health and wellness. Compared to women without SF, women with SF histories increased training load more quickly, had poorer nutrition, performed less cross-training, and kept running despite pain. CONCLUSIONS: More education is needed for female runners to decrease risks for SF.


Assuntos
Traumatismos em Atletas/complicações , Fraturas de Estresse/etiologia , Educação de Pacientes como Assunto/métodos , Percepção/fisiologia , Pesquisa Qualitativa , Corrida/lesões , Traumatismos em Atletas/prevenção & controle , Traumatismos em Atletas/psicologia , Estudos de Coortes , Feminino , Fraturas de Estresse/prevenção & controle , Fraturas de Estresse/psicologia , Humanos , Inquéritos e Questionários , Adulto Jovem
14.
J Athl Train ; 55(4): 329-335, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32160058

RESUMO

CONTEXT: Among sports-recovery methods, cold-water immersion (CWI), contrast-water therapy (CWT), and whole-body cryotherapy (WBC) have been applied widely to enhance recovery after strenuous exercise. However, the different timing effects in exercise-induced muscle damage (EIMD) after these recovery protocols remain unknown. OBJECTIVE: To compare the effects of CWI, CWT, and WBC on the timing-sequence recovery of EIMD through different indicator responses. DESIGN: Crossover study. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: Twelve male middle- and long-distance runners from the Beijing Sport University (age = 21.00 ± 0.95 years). INTERVENTION(S): Participants were treated with different recovery methods (control [CON], CWI, CWT, WBC) immediately postexercise and at 24, 48, and 72 hours postexercise. MAIN OUTCOME MEASURE(S): We measured perceived sensation using a visual analog scale (VAS), plasma creatine kinase (CK) activity, plasma C-reactive protein (CRP) activity, and vertical-jump height (VJH) pre-exercise, immediately postexercise, and at 1, 24, 48, 72, and 96 hours postexercise. RESULTS: For the VAS score and CK activity, WBC exhibited better timing-sequence recovery effects than CON and CWI (P < .05), but the CWT demonstrated better effects than CON (P < .05). The CRP activity was lower after WBC than after the other interventions (P < .05). The VJH was lower after WBC than after CON and CWI (P < .05). CONCLUSIONS: The WBC positively affected VAS, CK, CRP, and VJH associated with EIMD. The CWT and CWI also showed positive effects. However, for the activity and timing-sequence effect, CWT had weaker effects than WBC.


Assuntos
Traumatismos em Atletas , Crioterapia/métodos , Hidroterapia/métodos , Mialgia , Corrida , Traumatismos em Atletas/complicações , Traumatismos em Atletas/fisiopatologia , Estudos Cross-Over , Humanos , Imersão , Masculino , Músculo Esquelético/lesões , Músculo Esquelético/fisiopatologia , Mialgia/diagnóstico , Mialgia/etiologia , Mialgia/terapia , Medição da Dor , Resultado do Tratamento , Adulto Jovem
15.
Arch Clin Neuropsychol ; 35(5): 482-490, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32161939

RESUMO

OBJECTIVE: Jockeys have high rates of concussion, with 5% of jockeys receiving at least one concussion annually. The impact of acute concussion upon cognition is well understood, but less is known about the long-term effects of concussion upon cognition. Our aim was to assess the impact of concussion upon jockeys who had provided pre-concussion assessments of cognition using a prospective design. METHOD: In this study, over a 5-year period, we assessed the cognitive performance of jockeys with ≥1 medically diagnosed concussion (MDC; n = 17, months since concussion, M = 29.18), against those who had not been concussed (NC; n = 41). Jockeys who had not been concussed in the preceding 6 months completed four computer-based cognitive assessments from the CogSport battery. RESULTS: Unlike the majority of the small existing literature, there was no difference (p ≥ .05) between the MDC and NC groups after controlling for age and baseline performance. Additionally, we used a measure of reliable change to assess for clinically meaningful decrements from baseline in each test and composite score 5 years later. None of the jockeys in the MDC group recorded significant decrements on any CogSport measure from baseline (z > -1.65). CONCLUSIONS: The findings suggest that the presence of concussion does not result in persistent decrements in cognitive performance and that when findings are considered collectively, assessing factors beyond medically diagnosed concussion (e.g., chronic stress, undiagnosed concussion) may improve the interpretation of our current findings.


Assuntos
Traumatismos em Atletas , Concussão Encefálica , Traumatismos em Atletas/complicações , Concussão Encefálica/complicações , Cognição , Humanos , Testes Neuropsicológicos , Estudos Prospectivos
16.
Orthop Clin North Am ; 51(2): 227-233, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32138860

RESUMO

Ulnar abutment (ulnocarpal impaction) syndrome may be a source of ulnar-sided wrist pain in the athlete. This condition results from excessive load transfer across the triangular fibrocartilage complex and ulnocarpal joints with characteristic degenerative changes. It frequently occurs in patients with either static or dynamic ulnar positive variance. Treatment is tailored to the athlete and their sporting demands. Surgical treatment focuses on addressing ulnar variance to unload the ulnocarpal joint, with multiple surgical options, including the metaphyseal closing wedge osteotomy achieving this goal. This review focuses on the presentation, biomechanics, and treatment options for ulnar abutment syndrome in the athlete.


Assuntos
Artralgia/terapia , Traumatismos em Atletas/terapia , Mau Alinhamento Ósseo/terapia , Ulna/lesões , Traumatismos do Punho/terapia , Artralgia/complicações , Artralgia/cirurgia , Traumatismos em Atletas/complicações , Traumatismos em Atletas/cirurgia , Mau Alinhamento Ósseo/complicações , Mau Alinhamento Ósseo/cirurgia , Humanos , Osteotomia , Ulna/cirurgia , Traumatismos do Punho/complicações , Traumatismos do Punho/cirurgia
17.
BMJ Case Rep ; 13(3)2020 Mar 03.
Artigo em Inglês | MEDLINE | ID: mdl-32132101

RESUMO

A football player was diagnosed with myositis ossificans of his right adductor longus muscle after an acute injury. Conservative treatment failed and 1 year after the initial trauma the patient underwent surgical excision of a large ossification. Seven months postoperatively, the patient was fully recovered and returned to his preinjury activity levels. We present our approach to this case and discuss our considerations, referring to background information about this rare disease.


Assuntos
Traumatismos em Atletas/complicações , Miosite Ossificante/cirurgia , Futebol/lesões , Coxa da Perna/lesões , Coxa da Perna/cirurgia , Diagnóstico Diferencial , Humanos , Masculino , Miosite Ossificante/etiologia , Adulto Jovem
18.
NeuroRehabilitation ; 46(2): 167-180, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32083597

RESUMO

BACKGROUND: Persistent Sport-Related Post-Concussion Syndrome is often diagnosed with any type of prolonged PCS symptoms. However, there are not specific diagnostic criteria for PPCS such that misdiagnosis often occurs. Further, the signs and symptoms of PCS overlap with other common illnesses such as depression, anxiety, migraines, ADHD and others. Misdiagnosis may lead to less than efficacious treatment, resulting in prolonged symptoms. OBJECTIVE: This article will review relevant evidence-based literature on PCS, pointing out the lack of a systemic diagnostic framework. It will also provide evidence that highlights the multiple conflicting findings in the literature. This article will posit the BioPsychoSocial framework as the best diagnostic framework for understanding the impact of concussions on the person and to generate individualized and personal interventions. METHODS: A narrative review of sport concussion-related articles was conducted, after extensive searches of relevant and non-relevant literature by each author, as well as articles recommended by colleagues. Articles varied from American Academy of Neurology Class I to IV for evaluation and critique. Class IV articles were reviewed, as there is much public misconception regarding sport and other concussion treatment that needed identification and discussion. RESULTS: Articles reviewed varied by quality of research design and methodology. Multiple symptoms, recovery patterns and rehabilitation treatment approaches are purported in the sport-related concussion literature. Current consensus data as well as the mixed and contradictory findings were explored. CONCLUSIONS: Persistent Sport-Related Post-Concussion Syndrome is a topic of great interest to both professionals and the general public. There is much misunderstanding about the etiology, causation, diagnostic formulations, symptom presentation, prolonging factors and treatment involved in this syndrome. This article posits an individualized multi-system diagnostic formulation, examining all relevant factors, as generating the best interventions for neurorehabilitation of Persistent Sport-Related Post-Concussion Syndrome.


Assuntos
Traumatismos em Atletas/psicologia , Traumatismos em Atletas/reabilitação , Reabilitação Neurológica/métodos , Reabilitação Neurológica/psicologia , Síndrome Pós-Concussão/psicologia , Síndrome Pós-Concussão/reabilitação , Ansiedade/etiologia , Ansiedade/psicologia , Ansiedade/reabilitação , Traumatismos em Atletas/complicações , Biorretroalimentação Psicológica/métodos , Concussão Encefálica/diagnóstico , Terapia Cognitivo-Comportamental/métodos , Humanos , Transtornos de Enxaqueca/etiologia , Transtornos de Enxaqueca/psicologia , Transtornos de Enxaqueca/reabilitação , Educação de Pacientes como Assunto/métodos , Síndrome Pós-Concussão/etiologia
19.
J Neurol Neurosurg Psychiatry ; 91(5): 455-468, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32107272

RESUMO

INTRODUCTION: Understanding whether concussion in sport is associated with worsening cognitive function in later life will likely have immediate repercussion on sports concussion prevention and management policy and sporting rules and regulations. This systematic review aims to summarise the evidence on the association between concussion sustained by professional/elite athletes and long-term cognitive impairment. METHODS: Embase, PubMed and Web of Science were used to search for eligible studies. Studies including professional/elite athletes from any sport were considered. Three comparison groups were considered: internal comparison (concussed vs non-concussed athletes within the same sample); between-sport comparison (contact sport athletes vs non-contact sports ones); external comparison (athletes vs samples of the general population or population norms). RESULTS: 14 studies were included (rugby, American football, ice hockey players, boxers and marital art fighters). The general quality of the evidence was poor. The overall evidence, weighted for type of comparison and study quality, points towards an association between sustaining a sport-related concussion and poorer cognitive function later in life in rugby, American football and boxing, although it is unclear to what extent this is clinically relevant. Data on ice hockey and martial arts were too sparse to allow conclusions to be drawn. CONCLUSION: High-quality, appropriately designed and powered epidemiological studies are urgently needed to assess the association between sustaining a sport-related concussion and cognitive impairment later in life. Particular emphasis should be put on the clinical translational value of findings.


Assuntos
Atletas/psicologia , Traumatismos em Atletas/complicações , Concussão Encefálica/complicações , Disfunção Cognitiva/etiologia , Atletas/estatística & dados numéricos , Humanos
20.
Phys Ther Sport ; 42: 68-74, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31935640

RESUMO

OBJECTIVE: To examine differences between male and female adolescents on measures of balance, vestibular and oculomotor function within 3 weeks of concussion among a group of pediatric patients presenting to a sports medicine clinic. DESIGN: Medical record review. SETTING: Sports medicine clinic. PARTICIPANTS: 197 female (median age = 15.2 years) and 381 male (median age = 14.6 years) pediatric patients seen for a concussion, evaluated 9.3 ± 5.2 (mean ± SD) days post-concussion. MAIN OUTCOME MEASURES: Patients completed Balance Error Scoring System (BESS), tandem gait, gaze stability, and near point of convergence (NPC) tests. RESULTS: A higher proportion of female patients exhibited abnormal NPC (22% vs. 14%; p = 0.017), gaze stability (53% vs. 43%; p = 0.028), and tandem gait tests (20% vs. 13%; p = 0.026) compared to male patients. Multivariable analysis indicated an independent association between female sex and increased odds of abnormal NPC (adjusted odds ratio [aOR] = 1.79, 95% CI = 1.07-3.00), and tandem gait tests (aOR = 1.96, 95% CI = 1.12-3.41) following concussion. CONCLUSIONS: Our results indicate that within the first three weeks of a concussion, female pediatric patients demonstrated increased odds of exhibiting abnormal near point of convergence, and tandem gait test performance compared to male patients.


Assuntos
Traumatismos em Atletas/fisiopatologia , Concussão Encefálica/fisiopatologia , Movimentos Oculares/fisiologia , Músculos Oculomotores/fisiopatologia , Equilíbrio Postural/fisiologia , Doenças Vestibulares/fisiopatologia , Vestíbulo do Labirinto/fisiopatologia , Adolescente , Traumatismos em Atletas/complicações , Concussão Encefálica/complicações , Feminino , Marcha/fisiologia , Humanos , Masculino , Doenças Vestibulares/etiologia , Testes de Função Vestibular
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