Prevalence of Inadequate Immunity to Measles, Mumps, Rubella, and Varicella in MLB and NBA Athletes.

BACKGROUND: Multiple outbreaks of vaccine-preventable viral diseases have occurred in professional sports in recent years. Currently, there is no established protocol for vaccination or immunity screening for professional athletes. HYPOTHESIS: There are significant differences in the prevalence of inadequate immunity dependent on age, sport, country of birth, and participation in collegiate sports. STUDY DESIGN: Cross-sectional cohort study. LEVEL OF EVIDENCE: Level 4. METHODS: A sample of Major League Baseball (MLB) and National Basketball Association (NBA) players were screened for serologic evidence of immunity to measles, mumps, rubella, and varicella prior to the 2015 and 2016 seasons. The results were designated as adequate (immune) or inadequate (equivocal or nonimmune) based on laboratory criteria. Comparison with an age-matched control group was performed using data from the National Health and Nutrition Examination Survey (NHANES). RESULTS: A total of 98 athletes (62 MLB, 36 NBA) were screened. The prevalence of inadequate immunity for any virus was 35.5% in MLB players and 33.3% in NBA players. There was a significantly greater risk of inadequate immunity to rubella (risk ratio, 6.38; P < 0.01) and varicella (risk ratio, 4.21; P < 0.01) in athletes compared with the age-matched NHANES population. Our analysis did not reveal differences in rates of immunity based on sport, country of birth (US born vs international), or participation in college athletics. There was a lower rate of inadequate immunity to varicella with increasing age (odds ratio, 0.72; P = 0.05). CONCLUSION: One-third of athletes studied had inadequate immunity to 1 of the 4 viruses tested. Younger players had a significantly greater risk of inadequate immunity to varicella. Birth outside the US and lack of participation in college athletics were not found to influence immunity rates. CLINICAL RELEVANCE: These results can inform the development of future screening programs to prevent outbreaks of viral infections in professional athletes.

Bone Health in Athletes.

CONTEXT: The health of the skeletal system is important for athletes young and old. From the early benefits of exercise on bones to the importance of osteoporosis prevention and treatment, bone health affects the ability to be active throughout life. EVIDENCE ACQUISITION: PubMed articles dating from 1986 to 2016 were used for the review. Relevant terms such as keywords and section titles of the article were searched and articles identified were reviewed for relevance to this article. STUDY DESIGN: Clinical review. LEVEL OF EVIDENCE: Levels 1 through 4 evidence included. RESULTS: There is strong evidence that exercise benefits bone health at every age and is a critical factor in osteoporosis prevention and treatment. Vitamin D, calcium, and hormones play vital roles in ensuring optimal bone health. When there is an imbalance between exercise and nutrition, as seen in the female athlete triad, bone health is compromised and can lead to bone stress injuries and early osteoporosis. Both of these can lead to morbidity and lost time from training and competition. Thus, early recognition and appropriate treatment of the female athlete triad and other stress fracture risk factors are vital to preventing long-term bone health problems. CONCLUSION: To optimize bone health, adequate nutrition, appropriate weightbearing exercise, strength training, and adequate calcium and vitamin D are necessary throughout life.

Outcomes of arthroscopic rotator cuff repair in patients aged 70 years or older.

PURPOSE: To evaluate outcomes of arthroscopic rotator cuff repair in patients aged 70 years or older. METHODS: We identified 44 consecutive patients aged 70 years or older undergoing primary all-arthroscopic repair of symptomatic full-thickness tears of the rotator cuff. A minimum 2-year follow-up was performed by an independent examiner including range of motion and dynamometer strength testing, and shoulder functional outcome scores including the American Shoulder and Elbow Surgeons score, Simple Shoulder Test score, and pain score on a visual analog scale were determined. Paired t tests were performed to compare preoperative and postoperative measures. Postoperative Constant-Murley scores were normalized with scores from age- and sex-matched healthy individuals. RESULTS: Of the patients, 39 (88.6%) were available for follow-up evaluation, with a mean age of 75.3 ± 4.2 years (range, 70.1 to 89.8 years) and a mean follow-up of 36.1 ± 9.9 months (range, 24.3 to 59.4 months). The American Shoulder and Elbow Surgeons score improved from 45.8 ± 16.6 (mean ± SD) to 87.5 ± 14.4 at final follow-up (P < .0001). The Simple Shoulder Test score improved from 3.9 ± 2.3 to 9.8 ± 2.5 (P < .0001). The pain score on the visual analog scale improved from 4.6 ± 2.2 to 0.5 ± 0.9 (P < .0001), and forward elevation increased from 114.8° ± 42.0° to 146.2° ± 33.2° (P = .0012). Mean age- and sex-matched normalized Constant-Murley scores ranged from 88.3% to 97.2% of normal in men and 81.7% to 88.8% of normal in women. CONCLUSIONS: Arthroscopic rotator cuff repair provides significant improvement in pain and function in carefully selected patients aged 70 years or older with symptomatic full-thickness rotator cuff tears and has a low complication rate. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Early return to work in workers' compensation patients after arthroscopic full-thickness rotator cuff repair.

PURPOSE: The purpose of this study was to investigate the ability of patients to return to their preoperative work level and to identify functional prognostic factors in a group of Workers' Compensation (WC) patients after arthroscopic repair of full-thickness rotator cuff tears at a minimum follow-up of 1 year. METHODS: Seventy-eight consecutive WC patients underwent arthroscopic rotator cuff repair (ARCR) and were retrospectively reviewed. Potential predictors of occupational outcomes were recorded. The primary outcomes included work level at the time of discharge, time to maximum medical improvement (MMI), and failures requiring revision rotator cuff repair. Secondary outcomes including physical examination and subjective scoring scales were also recorded. RESULTS: Overall, 88.5% of patients (n = 69) returned to their preoperative level of work at a mean time to MMI of 7.6 +/- 2.6 months. Of the WC patients, 55 (70.5%) were followed up for purposes of assessing shoulder function, with a mean follow-up of 33.6 +/- 13.9 months. The mean American Shoulder and Elbow Surgeons score at this time was 82.3 +/- 20.9, and the mean score on a visual analog scale was 1.7 +/- 2.3. An association was found between patients who underwent ARCR with open biceps tenodesis and delay in MMI (P = .01). CONCLUSIONS: WC patients undergoing ARCR may expect a high likelihood of return to full duty at a mean time to MMI of 7.6 months. At the time of follow-up, patients reported good outcomes using validated scoring scales, but subjective outcomes remained inferior to non-WC patients based on historical controls. Alcohol use was the only prognostic factor to show a significant association with return to restricted-duty employment and repair failure. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Injuries to the pectoralis major muscle: diagnosis and management.

Injuries to the pectoralis major muscle are relatively infrequent but result in pain, weakness, and deformity of the upper extremity. The usual injury mechanism is during eccentric shortening of the pectoralis major under heavy load, such as when performing a bench press exercise. The ability to detect and treat a pectoralis major rupture is important for both the clinician and the patient and is aided with knowledge of the anatomy, the clinical findings, and results of nonoperative and operative care. It is important to understand the physical demands and desires of the patient as well as to understand the outcomes of both nonoperative and operative care to make an informed decision regarding optimal treatment. This article highlights the importance of the clinical examination in identifying the injury, examines various surgical techniques to repair the rupture, and reports on potential complication and reinjury rates.

Outcomes after arthroscopic revision rotator cuff repair.

BACKGROUND: Although a number of reports have documented outcomes after open revision rotator cuff repair, there are few studies reporting results after arthroscopic revision. HYPOTHESIS: Arthroscopic repair of failed rotator cuff results in significant improvement in shoulder functional outcome and pain relief. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Multiple variables including demographic data, the number of prior ipsilateral shoulder surgeries, and tear size were recorded from chart review. An independent examiner then measured shoulder strength, range of motion, and shoulder functional outcome scores including American Shoulder and Elbow Surgeons score, Simple Shoulder Test, and visual analog pain scale. Paired t tests were performed to compare preoperative and postoperative measures. Additionally, contingency table analysis was performed to identify prognostic factors for failure of repair requiring further surgery and American Shoulder and Elbow Surgeons score less than 50. RESULTS: Fifty-four patients (88.5%) were available for follow-up evaluation with a mean age of 54.9 +/- 10.1 years (range, 22.7-82.5 years) and a mean follow-up of 31.1 +/- 11.9 months. American Shoulder and Elbow Surgeons scores improved from 43.8 +/- 5.7 (mean +/- 95% confidence interval) before revision to 68.1 +/- 7.2 at final follow-up (P = .0039). The Simple Shoulder Test improved significantly from 3.56 +/- 0.8 before surgery to 7.5 +/- 1.1 at most recent follow-up (P < .0001). Visual analog pain scale scores improved from 5.17 +/- 0.8 to 2.75 +/- 0.8 (P = .03), and forward elevation increased from 121.0 degrees +/- 12.3 degrees to 136 degrees +/- 11.8 degrees postoperatively (P = .025). Greater than 1 prior shoulder surgery was associated with cases that required additional surgery (P = .031). Female gender (P = .007) and preoperative abduction less than 90 masculine (P = .009) were associated with American Shoulder and Elbow Surgeons scores less than 50. CONCLUSION: Arthroscopic revision rotator cuff repair may be a reasonable treatment option even after prior open repairs and provides both improved pain relief and shoulder function. Nonetheless, results are not completely optimal. Female patients and those who have undergone more than 1 ipsilateral shoulder surgery are at increased risk for poorer results.

The snapping scapula: diagnosis and treatment.

As a largely under-recognized problem, snapping scapula stems from the disruption of normal mechanics in scapulothoracic articulation. It is especially common in the young, active patient population, and symptoms are frequently seen with overhead and throwing motions. Understanding the anatomy of the scapula and surrounding neurovascular structures is crucial in making a differential diagnosis and providing both nonoperative and surgical treatments. Common causes of snapping scapula include bursitis, muscle abnormality, and bony or soft-tissue abnormalities. Anatomic variations, such as excessive forward curvature of the superomedial border of the scapula, may also be a cause for snapping. Benign tumor conditions of the scapula can also predispose one to snapping scapula syndrome and should be thoroughly investigated during the course of treatment. Patients with snapping scapula syndrome typically present with a history of pain with overhead activities. Snapping scapula is associated with audible and palpable crepitus near the superomedial border of the scapula. Various imaging studies may be used to rule out soft-tissue and bony masses, which may cause impingement at the scapulothoracic articulation. In most cases nonoperative treatment is curative and includes physical therapy for scapular muscle strengthening and nonsteroidal anti-inflammatory medications. Corticosteroid injections may also be used for therapeutic and diagnostic purposes. In most cases overuse injuries and repetitive strains respond well to nonoperative treatments. When nonoperative measures fail, surgery is a proven modality, especially if a soft-tissue or bony mass is implicated. Both open and arthroscopic techniques have been described with predictable results.