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1.
J Safety Res ; 76: 262-268, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33653558

RESUMO

INTRODUCTION: Concussion is traumatic brain injury with associated tissue damage commonly produced by an indirect or direct head or facial trauma that can negatively impact an athletes' career and personal life. In this context, the importance on how to deal with a concussion has received attention from worldwide literature and has become a topic of enormous interest in the sports medicine arena. OBJECTIVE: This systematic review aimed to investigate how sports-related concussion is being managed regarding athletic injuries, athletes' age, clinical signs of concussion, adopted questionnaires, as well as decision making in sports medicine. METHODS: A systematic review of the literature was performed searching 10 electronic databases with no limitations for year of publication up to December 2019. The search terms used were: Brain Concussion, Athletes, Sports Medicine, Athletic Injuries, Clinical Decision-Making, and Decision Making. The articles were considered eligible when the studies related to populations of regular sports practitioners, professional or recreational, of any age; sports injury; articles reporting concussion evaluation in at least 30 athletes; and articles published in English, French, Portuguese, Italian. We excluded systematic review articles, reviews, editorials, sport-unrelated concussion, no questionnaire application, approaching retired athletes, consensus statement letters, author's reply to editorials, synopsis, and abstracts. RESULTS: The parameters adopted for decision-making and management were broadly variable and were based on a variety of clinical signs or scoring outcomes from a myriad of questionnaires with little consistency in protocol or management guidelines, which could guide the average clinician. CONCLUSION: This systematic review provides current evidence that post-concussion management in sports medicine has yet to accomplish a standardized protocol that clinicians could use to optimally care for athletes. The extensive number of manuscripts and studies addressing the topic confirms that sports-related concussion in the pediatric and adolescent population has come to the forefront in the sports medicine field.


Assuntos
Atletas/estatística & dados numéricos , Traumatismos em Atletas/terapia , Concussão Encefálica/terapia , Medicina Esportiva/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/etiologia , Concussão Encefálica/diagnóstico , Concussão Encefálica/etiologia , Criança , Feminino , Humanos , Masculino , Adulto Jovem
2.
Clin Sports Med ; 40(2): 301-310, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33673888

RESUMO

Athletic injuries to the hip flexors and iliopsoas have been described in populations across all levels of competitive sports. Overall estimates of hip flexor pathology have ranged from 5% to 28% of injuries among high-risk sport specific groups. Although most of these injuries are successfully treated with conservative management, and high rates of return to play are observed, significant rehabilitation time can be involved. As the understanding of hip pathology with imaging modalities such as MRI has advanced, greater importance has been placed on accurately diagnosing hip flexor injuries and initiating rehabilitation protocols early to minimize time loss from sport.


Assuntos
Atletas , Traumatismos em Atletas/diagnóstico , Lesões do Quadril/diagnóstico , Traumatismos em Atletas/terapia , Quadril , Humanos , Imagem por Ressonância Magnética
3.
Clin Sports Med ; 40(2): 375-384, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33673893

RESUMO

Pelvic avulsion fractures are common in youth athletes; many of these injuries can be treated conservatively. This article reviews the etiology, presentation, and management of the more common pelvic avulsion fractures, including anterior superior iliac spine, anterior inferior iliac spine, ischial tuberosity, and iliac crest avulsions. Adolescent pelvic avulsion fractures rely on the amount of fracture displacement to guide treatment. Conservative management includes rest and avoiding use of the muscle(s) that attach to the avulsed fragment. Operative treatment is reserved for widely displaced fractures or symptomatic nonunions. With appropriate treatment, young athletes frequently return to their same level of sport.


Assuntos
Traumatismos em Atletas/diagnóstico , Fratura Avulsão/diagnóstico , Pelve/lesões , Adolescente , Atletas , Traumatismos em Atletas/terapia , Tratamento Conservador/efeitos adversos , Fixação Interna de Fraturas/efeitos adversos , Fraturas Ósseas/terapia , Humanos , Ílio/lesões , Ílio/cirurgia , Ísquio/lesões , Ísquio/cirurgia
4.
Clin Sports Med ; 40(2): 385-398, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33673894

RESUMO

This article provides concise and up-to-date information on the most common hip pathologies that affect adolescent athletes. We cover the evaluation and treatment of avulsion injuries, stress fractures, slipped capital femoral epiphysis (SCFE), femoroacetabular impingement, developmental dysplasia of the hip, Legg-Calve-Perthes disease, and coxa saltans focusing on minimizing advanced imaging and using conservative therapy when applicable. Although this is not an all-encompassing list of disorders, it is key to understand these hip pathologies because these injuries occur commonly and can also have detrimental complications if not diagnosed and addressed early, especially SCFE and femoral neck stress fractures.


Assuntos
Traumatismos em Atletas/diagnóstico , Lesões do Quadril/diagnóstico , Adolescente , Atletas , Impacto Femoroacetabular/diagnóstico , Fraturas de Estresse , Quadril , Articulação do Quadril , Humanos , Doença de Legg-Calve-Perthes/complicações , Doença de Legg-Calve-Perthes/diagnóstico , Doença de Legg-Calve-Perthes/terapia , Escorregamento das Epífises Proximais do Fêmur/complicações
5.
J Athl Train ; 56(2): 157-163, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33596598

RESUMO

CONTEXT: Mandated concussion education has aimed to improve student-athlete knowledge; however, some collegiate student-athletes continue to not disclose concussion. Concussion knowledge may not be the only factor influencing reporting, as student-athlete sex, sport, and pressure from external stakeholders (eg, coaches, teammates, fans, parents or family) have all been documented as influencing collegiate concussion-reporting behavior. OBJECTIVE: To examine factors associated with concussion nondisclosure in collegiate student-athletes. DESIGN: Cross-sectional study. SETTING: Four National Collegiate Athletic Association Division I and two Division II universities. PATIENTS OR OTHER PARTICIPANTS: A total of 1125 collegiate student-athletes completed the survey, and 741 provided viable responses and were included for data analysis. MAIN OUTCOME MEASURE(S): We used a 10- to 15-minute electronic or paper-and-pencil survey that asked about personal and sport demographics, diagnosed concussions and nondisclosed concussion history, concussion knowledge, and level of agreement regarding pressure to play after a head impact experienced during collegiate sport participation. Significant univariable factors were entered into a multivariable logistic regression analysis. RESULTS: Sex (P = .005), sport-risk type (P < .001), diagnosed concussion history (P < .001), concussion knowledge (P = .017), and pressure from coaches (P < .001), teammates (P < .001), fans (P = .024), and parents or family (P = .003) were factors associated with concussion nondisclosure in individual univariable logistic regressions. After we conducted multivariable analyses, male sex (P = .001), high concussion-risk sport participation (P = .048), diagnosed concussion history (P < .001), increased concussion knowledge (P = .013), and experiencing pressure from coaches to continue playing after sustaining a hit to the head (P = .002) were factors associated with concussion nondisclosure in collegiate student-athletes. CONCLUSIONS: Our results suggest that concussion-education programs should go beyond the identification of signs and symptoms to include the dangers of continuing to play, long-term consequences, and transparency about concussion protocols. Comprehensive concussion-education programs should involve coaches and athletes to improve the reporting culture.


Assuntos
Atletas/estatística & dados numéricos , Traumatismos em Atletas/diagnóstico , Concussão Encefálica/diagnóstico , Revelação , Adolescente , Estudos Transversais , Feminino , Humanos , Masculino , Michigan , Ohio , Pennsylvania , South Carolina , Esportes , Estudantes/estatística & dados numéricos , Inquéritos e Questionários , Universidades , Adulto Jovem
6.
Am J Sports Med ; 49(4): 1040-1048, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33600216

RESUMO

BACKGROUND: Vestibular and ocular symptoms in sport-related concussions are common. The Vestibular/Ocular-Motor Screening (VOMS) tool is a rapid, free, pen-and-paper tool that directly assesses these symptoms and shows consistent utility in concussion identification, prognosis, and management. However, a VOMS validation study in the acute concussion period of a large sample is lacking. PURPOSE: To examine VOMS validity among collegiate student-athletes, concussed and nonconcussed, from the multisite National Collegiate Athletic Association-Department of Defense Concussion Assessment, Research and Education (CARE) Consortium. A secondary aim was to utilize multidimensional machine learning pattern classifiers to deduce the additive power of the VOMS in relation to components of the Sport Concussion Assessment Tool 3 (SCAT3). STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 3. METHODS: Preseason and acute concussion assessments were analyzed for 419 student-athletes. Variables in the analysis included the VOMS, Balance Error Scoring System, Standardized Assessment of Concussion, and SCAT3 symptom evaluation score. Descriptive statistics were calculated for all tools, including Kolmogorov-Smirnov significance and Cohen d effect size. Correlations between tools were analyzed with Spearman r, and predictive accuracy was evaluated through an Ada Boosted Tree machine learning model's generated receiver operating characteristic curves. RESULTS: Total VOMS scores and SCAT3 symptom scores demonstrated significant increases in the acute concussion time frame (Cohen d = 1.23 and 1.06; P < .0001), whereas the Balance Error Scoring System lacked clinical significance (Cohen d = 0.17). Incorporation of VOMS into the full SCAT3 significantly boosted overall diagnostic ability by 4.4% to an area under the curve of 0.848 (P < .0001) and produced a 9% improvement in test sensitivity over the existing SCAT3 battery. CONCLUSION: The results from this study highlight the relevance of the vestibular and oculomotor systems to concussion and the utility of the VOMS tool. Given the 3.8 million sports-related and 45,121 military-related concussions per year, the addition of VOMS to the SCAT3 is poised to identify up to an additional 304,000 athletes and 3610 servicemembers annually who are concussed, thereby improving concussion assessment and diagnostic rates. Health care providers should consider the addition of VOMS to their concussion assessment toolkits, as its use can positively affect assessment and management of concussions, which may ultimately improve outcomes for this complex and common injury.


Assuntos
Traumatismos em Atletas , Concussão Encefálica , Esportes , Atletas , Traumatismos em Atletas/diagnóstico , Concussão Encefálica/diagnóstico , Estudos de Coortes , Humanos , Testes Neuropsicológicos , Universidades
7.
Neurology ; 96(15): 705-715, 2021 04 13.
Artigo em Inglês | MEDLINE | ID: mdl-33637627

RESUMO

OBJECTIVE: To evaluate whether participating in physical contact sports is associated with a release of neurofilaments and whether such release is related to future clinical neurologic and/or psychiatric impairment. METHODS: We performed a systematic review of the PubMed, MEDLINE, and Cochrane Library databases using a combination of the search terms neurofilament(s)/intermediate filament and sport(s)/athletes. Original studies, written in English, reporting on neurofilaments in CSF and/or serum/plasma of contact sport athletes were included. This review was conducted following the Preferred Reporting Items for Systematic Review and Analyses guidelines. RESULTS: Eighteen studies in 8 different contact sports (i.e., boxing, American football, ice hockey, soccer, mixed martial arts, lacrosse, rugby, and wrestling) matched our criteria. Elevated light chain neurofilament (NfL) levels were described in 13/18 cohorts. Most compelling evidence was present in boxing and American football, where exposure-related increases were appreciable at the intraindividual level (up to 4.1- and 2.0-fold, respectively) in well-defined groups. Differences in exposure severity (including previous cumulative effects), sampling/measurement time points (with regard to expected peak values), and definitions of the baseline setting are considered as main contributors to the variability in findings. No studies were encountered that have investigated the relationship with the targeted clinical end points; therefore no NfL cutoffs exist that are associated with a poor outcome. CONCLUSION: NfL release can be seen, as a potential marker of neuronal brain damage, in participants of physical contact sports, particularly boxing and American football. The exact significance regarding the risk for future clinical impairment remains to be elucidated.


Assuntos
Traumatismos em Atletas/diagnóstico , Biomarcadores/sangue , Biomarcadores/líquido cefalorraquidiano , Concussão Encefálica/etiologia , Filamentos Intermediários/metabolismo , Traumatismos em Atletas/sangue , Traumatismos em Atletas/líquido cefalorraquidiano , Boxe/lesões , Concussão Encefálica/diagnóstico , Futebol Americano/lesões , Hóquei/lesões , Humanos , Artes Marciais/lesões , Esportes com Raquete/lesões , Futebol/lesões , Luta Romana/lesões
8.
J Strength Cond Res ; 35(4): 910-919, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33555832

RESUMO

ABSTRACT: Karuc, J, Misigoj-Durakovic, M, Sarlija, M, Markovic, G, Hadzic, V, Trost-Bobic, T, and Soric, M. Can injuries be predicted by functional movement screen in adolescents? The application of machine learning. J Strength Cond Res 35(4): 910-919, 2021-This study used machine learning (ML) to predict injuries among adolescents by functional movement testing. This research is a part of the CRO-PALS study conducted in a representative sample of adolescents and analyses for this study are based on nonathletic (n = 364) and athletic (n = 192) subgroups of the cohort (16-17 years). Sex, age, body mass index (BMI), body fatness, moderate-to-vigorous physical activity (MVPA), training hours per week, Functional Movement Screen (FMS), and socioeconomic status were assessed at baseline. A year later, data on injury occurrence were collected. The optimal cut-point of the total FMS score for predicting injury was calculated using receiver operating characteristic curve. These predictors were included in ML analyses with calculated metrics: area under the curve (AUC), sensitivity, specificity, and odds ratio (95% confidence interval [CI]). Receiver operating characteristic curve analyses with associated criterium of total FMS score >12 showed AUC of 0.54 (95% CI: 0.48-0.59) and 0.56 (95% CI: 0.47-0.63), for the nonathletic and athletic youth, respectively. However, in the nonathletic subgroup, ML showed that the Naïve Bayes exhibited highest AUC (0.58), whereas in the athletic group, logistic regression was demonstrated as the model with the best predictive accuracy (AUC: 0.62). In both subgroups, with given predictors: sex, age, BMI, body fat percentage, MVPA, training hours per week, socioeconomic status, and total FMS score, ML can give a more accurate prediction then FMS alone. Results indicate that nonathletic boys who have lower-body fat could be more prone to suffer from injury incidence, whereas among athletic subjects, boys who spend more time training are at a higher risk of being injured. Conclusively, total FMS cut-off scores for each subgroup did not successfully discriminate those who suffered from those who did not suffer from injury, and, therefore, our research does not support FMS as an injury prediction tool.


Assuntos
Traumatismos em Atletas , Adolescente , Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/epidemiologia , Teorema de Bayes , Humanos , Aprendizado de Máquina , Masculino , Movimento , Curva ROC
9.
J Athl Train ; 56(1): 92-100, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33534900

RESUMO

CONTEXT: Many survey-based methods have been used to explore concussion-reporting behavior. However, because the decision to report or conceal a concussion is likely multifactorial, this may narrow the findings, as the surveys were largely designed by the researchers. OBJECTIVE: To explore student-athletes' perspectives regarding factors that may influence the reporting of sport-related concussion. DESIGN: Qualitative study. SETTING: National Collegiate Athletic Association Division I athletics. PATIENTS OR OTHER PARTICIPANTS: We conducted 17 semistructured interviews with student-athletes who had sustained 1 or more concussions while attending a large university (men = 4, women = 13, age = 20.9 ± 1.3 years). DATA COLLECTION AND ANALYSIS: After data saturation and member checks, a 5-cycle analytic process was completed: topical review, literature review, data collection and summarizing using a codebook developed by a 3-person research team, linking of findings to current research, and final interpretations. RESULTS: We discovered 3 themes. Participants discussed concussion perceptions by describing their understanding of a concussion, their own injury experiences, and their perceptions of symptom severity and duration. Regarding reporting behavior, participants described an order of individuals with whom they would speak, symptoms present in order to report (eg, feeling different from normal), immediate reactions, and influential factors for mitigating short- and long-term consequences. Lastly, participants discussed the value of support systems, such as how coaches can both positively and negatively influence reporting and athletic trainer involvement. CONCLUSIONS: Participants often drew from their own concussion experiences in naming common concussion signs and symptoms. Additionally, they indicated that both short- and long-term health consequences influenced and deterred their seeking care and that their support systems, including coaches and athletic trainers, played a role in their concussion experience. Research is needed to determine if using student-athletes' own words to describe a concussion and incorporating student-athletes' support systems, especially coaches and athletic trainers, is effective in increasing concussion reporting.


Assuntos
Traumatismos em Atletas/diagnóstico , Concussão Encefálica/diagnóstico , Revelação , Autorrelato , Atletas/estatística & dados numéricos , Feminino , Humanos , Masculino , Pesquisa Qualitativa , Esportes , Estudantes/estatística & dados numéricos , Inquéritos e Questionários , Universidades , Adulto Jovem
10.
J Athl Train ; 56(1): 85-91, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33534901

RESUMO

CONTEXT: Collegiate student-athletes continue competing after experiencing symptoms of a concussion. Self-report of concussion symptoms is a critical element of the recovery process. Identifying factors related to concussion disclosure can aid in encouraging self-reporting. OBJECTIVE: To use latent profile analysis to categorize and describe athletes based on factors related to concussion disclosure. DESIGN: Cross-sectional study. SETTING: Web-based survey. PATIENTS OR OTHER PARTICIPANTS: A total of 2 881 (52.4% female; 65.3% in-season; 40% collision sport) student-athletes from 16 National Collegiate Athletic Association member institutions. MAIN OUTCOME MEASURE(S): Student-athlete concussion expectations, attitudes, and norms were the profile variables and reporting intentions served as the distal outcome variable. We conducted latent profile analysis using select profile variables to determine the optimal number of classes. Differences in concussion-reporting intentions by profile assignment were then examined. Lastly, the extent to which a student-athlete's sex, season status, and level of contact predicted his or her intentions to report a concussion within each profile was investigated. RESULTS: Five unique student-athlete profiles emerged, including 1 profile that was most risky and another that was least risky. Females had significantly higher odds of being in the least risky profile. Those participating in collision sports had significantly higher odds of being in the top 2 most risky profiles. Contact-sport and in-season athletes were less likely to be in the least risky profile. CONCLUSIONS: With a better understanding of student-athlete profiles, athletic trainers have an opportunity to encourage concussion disclosure. Prompt disclosure would allow student-athletes to begin the return-to-play protocol in a more timely manner.


Assuntos
Traumatismos em Atletas/diagnóstico , Concussão Encefálica/diagnóstico , Revelação , Autorrelato , Atletas/estatística & dados numéricos , Estudos Transversais , Feminino , Humanos , Intenção , Masculino , Esportes , Estudantes/estatística & dados numéricos , Inquéritos e Questionários , Universidades
11.
JAMA Netw Open ; 4(2): e2037349, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33587137

RESUMO

Importance: An objective, reliable indicator of the presence and severity of concussive brain injury and of the readiness for the return to activity has the potential to reduce concussion-related disability. Objective: To validate the classification accuracy of a previously derived, machine learning, multimodal, brain electrical activity-based Concussion Index in an independent cohort of athletes with concussion. Design, Setting, and Participants: This prospective diagnostic cohort study was conducted at 10 clinical sites (ie, US universities and high schools) between February 4, 2017, and March 20, 2019. A cohort comprising a consecutive sample of 207 athletes aged 13 to 25 years with concussion and 373 matched athlete controls without concussion were assessed with electroencephalography, cognitive testing, and symptom inventories within 72 hours of injury, at return to play, and 45 days after return to play. Variables from the multimodal assessment were used to generate a Concussion Index at each time point. Athletes with concussion had experienced a witnessed head impact, were removed from play for 5 days or more, and had an initial Glasgow Coma Scale score of 13 to 15. Participants were excluded for known neurologic disease or history within the last year of traumatic brain injury. Athlete controls were matched to athletes with concussion for age, sex, and type of sport played. Main Outcomes and Measures: Classification accuracy of the Concussion Index at time of injury using a prespecified cutoff of 70 or less (total range, 0-100, where ≤70 indicates it is likely the individual has a concussion and >70 indicates it is likely the individual does not have a concussion). Results: Of 580 eligible participants with analyzable data, 207 had concussion (124 male participants [59.9%]; mean [SD] age, 19.4 [2.5] years), and 373 were athlete controls (187 male participants [50.1%]; mean [SD] age, 19.6 [2.2] years). The Concussion Index had a sensitivity of 86.0% (95% CI, 80.5%-90.4%), specificity of 70.8% (95% CI, 65.9%-75.4%), negative predictive value of 90.1% (95% CI, 86.1%-93.3%), positive predictive value of 62.0% (95% CI, 56.1%-67.7%), and area under receiver operator characteristic curve of 0.89. At day 0, the mean (SD) Concussion Index among athletes with concussion was significantly lower than among athletes without concussion (75.0 [14.0] vs 32.7 [27.2]; P < .001). Among athletes with concussion, there was a significant increase in the Concussion Index between day 0 and return to play, with a mean (SD) paired difference between these time points of -41.2 (27.0) (P < .001). Conclusions and Relevance: These results suggest that the multimodal brain activity-based Concussion Index has high classification accuracy for identification of the likelihood of concussion at time of injury and may be associated with the return to control values at the time of recovery. The Concussion Index has the potential to aid in the clinical diagnosis of concussion and in the assessment of athletes' readiness to return to play.


Assuntos
Atletas , Traumatismos em Atletas/diagnóstico , Concussão Encefálica/diagnóstico , Encéfalo/fisiopatologia , Eletroencefalografia , Aprendizado de Máquina , Adolescente , Traumatismos em Atletas/fisiopatologia , Concussão Encefálica/fisiopatologia , Estudos de Casos e Controles , Feminino , Escala de Coma de Glasgow , Humanos , Masculino , Testes de Estado Mental e Demência , Estudos Prospectivos , Reprodutibilidade dos Testes , Volta ao Esporte , Instituições Acadêmicas , Universidades , Adulto Jovem
12.
Artigo em Inglês | MEDLINE | ID: mdl-33467702

RESUMO

The functional movement screen (FMS) is commonly used to evaluate sports injury risks, but no study has been reported for Wushu athletes. The aim of this study was to identify optimal FMS cut-off points for previously injured Wushu athletes and to examine the associations with other possible factors. In this study, a total of 84 Chinese Wushu athletes (15.1 ± 4.5 years old, 51% male) with a minimum of two years of professional training background in either Taiji, Changquan, or Nanquan were assessed by the FMS. Video recordings were used to confirm the scoring criteria, and previous injuries were assessed based on face-to-face interviews. An optimal cut-off of the FMS score was investigated by receiver operating characteristic curves with sensitivity and specificity. We found that FMS score of less than 16 (sensitivity = 80%, specificity = 56%) was related to an increased occurrence of injuries (odds ratio = 5.096, 95%CI: 1.679-15.465) for the current study sample. The training type and training levels were related with FMS scores. More than half of the athletes (58%) had FMS asymmetry and 21% of athletes reported pain while performing the FMS protocol. Future prospective studies are recommended to use FMS with cut-off of 16 points in Wushu athletes.


Assuntos
Traumatismos em Atletas , Artes Marciais , Adolescente , Adulto , Atletas , Traumatismos em Atletas/diagnóstico , Criança , Teste de Esforço , Feminino , Humanos , Masculino , Movimento , Estudos Prospectivos , Adulto Jovem
14.
Sports Med Arthrosc Rev ; 29(1): 9-14, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33395224

RESUMO

Athletic hip injuries account for a substantial portion of missed time from sports in high-level athletes. For both femoroacetabular impingement (FAI) and core muscles injuries, a thorough history and physical examination are paramount to guide the treatment. While advanced imaging including computed tomography and magnetic resonance imaging are frequently obtained, a wealth of information can be ascertained from standard radiographs alone. For patients with isolated or combined FAI and core muscle injuries (CMIs), the initial treatment is often nonoperative and consists of rest, activity modification, and physical therapy of the hips, core, and trunk. Injections may then aid in both confirming diagnosis and temporary symptom abatement. Arthroscopic procedures for refractory FAI in experienced hands have been shown to be both safe and efficacious. While surgical repair options for CMIs are significantly more variable, long-term studies have demonstrated the rapid resolution of symptoms and high return to play rates. More recently, anatomic and clinical correlations between FAI and CMIs have been identified. Special attention must be paid to elite athletes as the incidence of concurrent FAI with CMI is extremely high yet with significant symptom variability. Predictable return to play in athletes with coexisting symptomatic intra-articular and extra-articular symptomatology is incumbent upon the treatment of both pathologies.


Assuntos
Traumatismos em Atletas/diagnóstico , Impacto Femoroacetabular/diagnóstico , Músculo Esquelético/lesões , Algoritmos , Artroscopia , Traumatismos em Atletas/diagnóstico por imagem , Traumatismos em Atletas/cirurgia , Traumatismos em Atletas/terapia , Tratamento Conservador , Impacto Femoroacetabular/diagnóstico por imagem , Impacto Femoroacetabular/cirurgia , Impacto Femoroacetabular/terapia , Humanos , Injeções Intra-Articulares , Imagem por Ressonância Magnética , Anamnese , Músculo Esquelético/cirurgia , Exame Físico , Radiografia , Volta ao Esporte , Tomografia Computadorizada por Raios X , Tronco
15.
Instr Course Lect ; 70: 259-272, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33438915

RESUMO

Given that sports medicine covers a broad spectrum of orthopaedic injuries, the team physician is often required to face challenging decisions when treating injured athletes. Injuries of the upper and lower extremities can lead to clinical dilemmas for the team physician, who needs to ensure appropriate treatment and interventions to prevent subsequent injuries. The athlete's personal goals and athletic career must also be respected throughout this process. It is important to discuss the most common athletic injuries that pose clinical dilemmas for the sports physician and useful tips to address them based on the existing evidence.


Assuntos
Traumatismos em Atletas , Médicos , Esportes , Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/terapia , Humanos , Volta ao Esporte , Estações do Ano
16.
Instr Course Lect ; 70: 337-354, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33438920

RESUMO

Spinal injuries are common and are a significant burden in the professional athlete population. From single-level disk herniation to career-ending fractures, the consequences of these conditions vary widely. Both contact and noncontact injuries can substantially affect the health and performance of elite athletes competing in a variety of sports. The nature and severity of these injuries have great influence on the prospects for full recovery and successful return to play. Common spinal injuries, management decisions, and return to play prospects are important considerations in the professional athlete population.


Assuntos
Traumatismos em Atletas , Deslocamento do Disco Intervertebral , Doenças da Coluna Vertebral , Traumatismos da Coluna Vertebral , Esportes , Atletas , Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/terapia , Humanos , Traumatismos da Coluna Vertebral/diagnóstico , Traumatismos da Coluna Vertebral/terapia
17.
Clin Sports Med ; 40(1): 123-131, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33187603

RESUMO

The medications used in postconcussion syndrome are typically used to help manage or minimize disruptive symptoms while recovery proceeds. These medications are not routinely used in most concussions that recover within days to weeks. However, it is beneficial to be aware of medication options that may be used in athletes with prolonged concussion symptoms or for those that have symptom burdens that preclude entry into basic concussion protocols. Medications and supplements remain a small part of the concussion treatment plan, which may include temporary academic adjustments, physical therapy, vestibular and ocular therapy, psychological support, and graded noncontact exercise.


Assuntos
Traumatismos em Atletas/terapia , Concussão Encefálica/terapia , Síndrome Pós-Concussão/terapia , Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/tratamento farmacológico , Concussão Encefálica/diagnóstico , Concussão Encefálica/tratamento farmacológico , Suplementos Nutricionais , Ácidos Docosa-Hexaenoicos/uso terapêutico , Humanos , Modalidades de Fisioterapia , Síndrome Pós-Concussão/diagnóstico , Síndrome Pós-Concussão/tratamento farmacológico , Psicoterapia
18.
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
19.
Clin Sports Med ; 40(1): 187-197, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33187608

RESUMO

The recommendation to retire from sport after concussion has evolved with the understanding of concussion. Age, sport, position, level of play, relevant medical and concussion history, severity and duration of symptoms, neuroimaging and neuropsychological testing should all be considered. Susceptibility to injury, persistence of symptoms, psychological distress, and personal values and support may also play a role. Pediatric athletes may require a more conservative approach, given ongoing growth and development. For professional and/or elite athletes, financial or career implications may be considerations. When possible, retirement should be a shared decision among the athlete, the family, and the health care team.


Assuntos
Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/psicologia , Concussão Encefálica/diagnóstico , Concussão Encefálica/psicologia , Tomada de Decisão Compartilhada , Aposentadoria , Traumatismos em Atletas/diagnóstico por imagem , Traumatismos em Atletas/terapia , Concussão Encefálica/diagnóstico por imagem , Concussão Encefálica/terapia , Família , Humanos , Neuroimagem , Testes Neuropsicológicos , Equipe de Assistência ao Paciente , Volta ao Esporte
20.
Clin Sports Med ; 40(1): 199-211, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33187610

RESUMO

This article focuses on 3 concepts that continue to be investigated in the search for the holy grail of concussion-a valid diagnostic test. Imaging advances are discussed with optimism that functional MRI and diffusion tensor imaging may be available clinically. Biomarkers and the use of genetic tests are covered. Sideline accelerometer use may help steer discussions of head trauma risk once technology exists to accurately estimate acceleration of the brain. In the meantime, strategies including allowing athletes to be substituted out of games for an evaluation and video review in elite sports can improve recognition of sports-related concussion.


Assuntos
Traumatismos em Atletas/diagnóstico , Concussão Encefálica/diagnóstico , Medicina Esportiva/tendências , Acelerometria , Traumatismos em Atletas/diagnóstico por imagem , Traumatismos em Atletas/terapia , Biomarcadores , Concussão Encefálica/diagnóstico por imagem , Concussão Encefálica/terapia , Imagem de Tensor de Difusão , Testes Genéticos , Humanos , Imagem por Ressonância Magnética
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