Injury Rate and Patterns in Group Strength-Endurance Training Classes.

OBJECTIVE: To identify the injury rate during high-intensity functional training. PARTICIPANTS AND METHODS: Adults (N=100; 82 [82%] female) in group strength-endurance training at the Dan Abraham Healthy Living Center from January 9, 2017, through April 19, 2018, were recruited for the study. Participants were recruited before the class start date. Those who consented received a preclass survey and another survey 6 weeks after the class started to obtain data on demographic characteristics, baseline joint problems or pain, injuries in the preceding 6 weeks, class satisfaction, and exercise habits. Classes lasted 6 weeks and were led by a trainer for 60 minutes, once weekly. Participants were encouraged to perform similar exercise on 2 additional nonconsecutive days throughout the week. Injury was self-reported and defined as experiencing new pain or sustaining injury while exercising during the 6-week time frame. The primary outcome measure was the number of injuries per 1000 training hours. RESULTS: The injury rate was 9.0 injuries per 1000 training hours (95% CI, 5.8-13.4 injuries per 1000 training hours) during the 6-week training and 5.0 injuries per 1000 training hours (95% CI, 2.8-8.2 injuries per 1000 training hours) during the 6 weeks preceding enrollment (P=.08). Injury occurred in 18 (18%) of participants during the 6-week training, and 9 of 24 injuries (37.5%) occurred during a training class. The most commonly injured regions were knees (n=7) and back (n=6). Burpees and squats were the most common movements causing injury. CONCLUSION: The increased injury rate during the study was not statistically significant. It was higher than rates reported in previous retrospective studies of high-intensity functional training, weight lifting, or power lifting but comparable with rates reported in prospective studies of novice and recreational runners.

Fibrocartilaginous embolic myelopathy: demographics, clinical presentation, and functional outcomes.

STUDY DESIGN: Retrospective cohort study. OBJECTIVES: To describe the demographics, clinical presentation, and functional outcomes of fibrocartilaginous embolic myelopathy (FCEM). SETTING: Academic inpatient rehabilitation unit in the midwestern United States. METHODS: We retrospectively searched our database to identify patients admitted between January 1, 1995 and March 31, 2016, with a high probability of FCEM. Demographic, clinical, and functional outcome measures, including Functional Independence Measure (FIM) information was obtained by chart review. RESULTS: We identified 31 patients with findings suggestive of FCEM (52% male), which was 2% of the nontraumatic spinal cord injury population admitted to inpatient rehabilitation. The age distribution was bimodal, with peaks in the second and sixth-to-seventh decades. The most common clinical presentation was acute pain and rapid progression of neurologic deficits consistent with a vascular myelopathy. Only three patients (10%) had FCEM documented as a diagnostic possibility. Most patients had paraplegia and neurologically incomplete injuries and were discharged to home. Nearly half of the patients required no assistive device for bladder management at discharge, but most were discharged with medications for bowel management. Median FIM walking locomotion score for all patients was 5, but most patients were discharged using a wheelchair for primary mobility. Median motor FIM subscale score was 36 at admission and 69 at discharge, with a median motor efficiency of 1.41. CONCLUSIONS: FCEM may be underdiagnosed and should be considered in those with the appropriate clinical presentation, because their functional outcomes may be more favorable than those with other causes of spinal cord infarction.

Hodgkin's Lymphoma Presenting as a Cavitary Lung Lesion.

Hodgkin lymphoma (HL) typically presents in the nodal regions at an early stage of the disease. Occasionally, patients can present with disease in extranodal regions. We report a case of HL in a 25-year-old female who presented to the emergency department following a motor vehicle accident with incidental findings of pulmonary cavitary lesions, fever, tachycardia, anemia, leukocytosis and thrombocytosis. This case illustrates the difficulty in diagnosis when the disease presents in extranodal regions with nonspecific systemic symptoms. Complete workup for infectious and autoimmune etiology was performed and found to be negative. CT guided biopsy and bronchoscopy failed to yield the diagnosis; a video-assisted thoracoscopic surgery was necessary to obtain the diagnosis of advanced-stage HL in this patient.