Usefulness of echocardiography in preparticipation screening of competitive athletes.

INTRODUCTION AND OBJECTIVES: Despite the established diagnostic value of the electrocardiogram in preparticipation screening of athletes, some cardiac structural changes can be missed, particularly in early disease stages. The aim of this study was to evaluate the prevalence of cardiac structural changes via the systematic use of echocardiography in preparticipation screening of competitive athletes. METHODS: Professional athletes or participants in a competitive athletic program underwent a screening that included family and personal medical history, physical examination, electrocardiography, exercise testing, and Doppler echocardiography. RESULTS: A total of 2688 athletes (67% men; mean age [standard deviation], 21 [10] years) were included. Most of the echocardiographic evaluations (92.5%) were normal and only 203 (7.5%) showed changes; the most frequent change was left ventricular hypertrophy, seen in 50 athletes (1.8%). Cessation of athletic activity was indicated in 4 athletes (0.14%): 2 for hypertrophic cardiomyopathy (electrocardiography had shown changes that did not meet diagnostic criteria), 1 pectus excavatum with compression of the right ventricle, and 1 significant pulmonary valve stenosis; the rest of the changes did not entail cessation of athletic activity and only indicated periodic monitoring. CONCLUSIONS: Although rare, some cardiac structural changes can be missed on physical examination and electrocardiography; in contrast, they are easily recognized with echocardiography. These findings suggest the use of echocardiography in at least the first preparticipation screening of competitive athletes to improve the effectiveness of programs aimed at preventing sudden death in athletes.

Rectus abdominis muscle injuries in elite handball players: management and rehabilitation.

Muscle injuries generally occur in two-joint muscles with a high percentage of type II fibers during the performance of eccentric activity. Some muscle injuries, such as those located in the adductor longus, a monoarticular muscle, as well as rectus abdominis do not fully comply with these requirements. This study examines five cases of elite handball players with ruptured rectus abdominals. Sonographically, lesions in rectus abdominis are shown as a disruption of the fibrillar pattern with a hematic suffusion that invades the entire lesion. In some of the cases, the ultrasound study was complemented with a MRI. A unified rehabilitation protocol was applied and the return to play time of each handball player ranged between 16 and 22 days, with an average of 18.2 days. Follow-up at 15 months showed no evidence of re-injury or residual discomfort and all of them are playing at their highest level. The aim of this study was to illustrate a feature of handball injury that, as in tennis and volleyball, is uncommon and so far has not been specifically reported. The phenomenon of contralateral abdominal hypertrophy in handball appears in the dominant arm as in tennis and volleyball.

Utilidad del ecocardiograma en la revisión preparticipativa de deportistas de competición / Usefulness of Echocardiography in Preparticipation Screening of Competitive Athletes

Introducción y objetivos A pesar del establecido valor diagnóstico del electrocardiograma en la revisión preparticipativa de sujetos deportistas, algunas alteraciones estructurales cardiacas podrían pasar inadvertidas, en especial en fases precoces de la enfermedad. El objetivo de este estudio es valorar la prevalencia de alteraciones estructurales cardiacas mediante el uso sistemático de la ecocardiografía en la revisión preparticipativa de deportistas de competición. Métodos Se estudió a los deportistas incluidos en un programa de competición o profesionales. Se realizó a todos los deportistas una revisión que incluyó historia familiar y personal, examen físico, electrocardiograma, prueba de esfuerzo y ecocardiograma Doppler. Resultados Se incluyó a 2.688 deportistas (el 67% varones; media de edad, 21 ± 10 años). La mayoría de los estudios ecocardiográficos (92,5%) fueron estrictamente normales y solo 203 (7,5%) tenían alteraciones; la más frecuente de ellas fue la hipertrofia ventricular izquierda, en 50 deportistas (1,8%). En 4 casos (0,14%) se indicó el cese de la práctica deportiva: 2 por miocardiopatía hipertrófica (el electrocardiograma mostraba alteraciones pero no cumplía criterios diagnósticos), 1 pectus excavatum con compresión del ventrículo derecho y 1 estenosis valvular pulmonar significativa; el resto de las alteraciones no implicaron el cese de la práctica deportiva y solo requirieron seguimiento periódico. Conclusiones: Algunas alteraciones estructurales cardiacas, aunque poco frecuentes, pueden pasar inadvertidas al examen físico y en el electrocardiograma; en cambio, son fácilmente reconocibles con un ecocardiograma. Estas observaciones indican introducir el ecocardiograma al menos en la primera valoración preparticipativa de deportistas de competición para mejorar la eficacia de los programas de prevención de la muerte súbita del deportista (AU)

Introduction and objectives Despite the established diagnostic value of the electrocardiogram in preparticipation screening of athletes, some cardiac structural changes can be missed, particularly in early disease stages. The aim of this study was to evaluate the prevalence of cardiac structural changes via the systematic use of echocardiography in preparticipation screening of competitive athletes. Methods Professional athletes or participants in a competitive athletic program underwent a screening that included family and personal medical history, physical examination, electrocardiography, exercise testing, and Doppler echocardiography. Results A total of 2688 athletes (67% men; mean age [standard deviation], 21 [10] years) were included. Most of the echocardiographic evaluations (92.5%) were normal and only 203 (7.5%) showed changes; the most frequent change was left ventricular hypertrophy, seen in 50 athletes (1.8%). Cessation of athletic activity was indicated in 4 athletes (0.14%): 2 for hypertrophic cardiomyopathy (electrocardiography had shown changes that did not meet diagnostic criteria), 1 pectus excavatum with compression of the right ventricle, and 1 significant pulmonary valve stenosis; the rest of the changes did not entail cessation of athletic activity and only indicated periodic monitoring. Conclusions Although rare, some cardiac structural changes can be missed on physical examination and electrocardiography; in contrast, they are easily recognized with echocardiography. These findings suggest the use of echocardiography in at least the first preparticipation screening of competitive athletes to improve the effectiveness of programs aimed at preventing sudden death in athletes (AU)

Prevención de lesiones en el deportista (aspectos generales y aspectos podológicos) / No disponible

Uno de los principales problemas que tienen los deportistas,tanto si son del mundo profesional comoamateur, son las lesiones deportivas. Estas puedenser tanto agudas como crónicas. En la actualidad seobserva que los entrenamientos son cada vez másexigentes tanto en el número de horas de entrenocomo en la intensidad de las cargas. Esto, junto aunos periodos de descanso entre competición insuficientesha hecho que aparezcan de forma fácillas lesiones deportivas y dentro de estas las lesionespor sobrecarga. Estas lesiones, son muy antipáticasy si no se actúa sobre su etiología es muy fácil que secronifiquen. El presente trabajo clasifica de formasistemática y didáctica los distintos factores que ala larga, si incidimos en ellos, pueden disminuir laprobabilidad de que aparezca una lesión deportiva.Seguro que nos dejamos unos cuantos, ya que eltema de prevención de lesiones es un tema abiertoy permanentemente en revisión. Los avancestecnológicos de la actualidad han hecho que enlos últimos años haya cambiado el diagnóstico, eltratamiento y la prevención de éstas(AU)

One of the main problems that sportsmen haveis sport injuries, independently of if they areprofessional or amateur sportsmen. Theseinjuries can be acute as well as chronic. Atpresent, trainings are increasingly demandingboth in the number of hours of training and theintensity of loads. This, beside insufficient periodsof rest between competitions, is the causethat sports injuries, and more specifically injuriesdue to overloads, have increased recently.These injuries are very unpleaseant and onemust act upon their etiology or otherwise theywill get chronic. The present work classifiesin a systematical and didactic way the differentfactors that can reduce the probabilityof appearance of sport injuries if we act uponthem. Most probably we are forgeting someof the factors, since the subject of injuriesprevention is an open topic permanently inreview. Actual technological advances havechanged the diagnosis, the treatment and theprevention of sport injuries(AU)