Game Schedules and Rate of Concussions in the National Football League.

BACKGROUND: Concussion prevention in the National Football League (NFL) is an important priority for player safety. The NFL now has modified game schedules, and one concern is that unconventional game schedules, such as a shortened rest period due to playing on a Thursday rather than during the weekend, may lead to an increased risk of injuries. HYPOTHESIS: Unconventional game schedules in the NFL are associated with an increased rate of concussion. STUDY DESIGN: Descriptive epidemiological study. METHODS: This study analyzed concussions and game schedules over the NFL regular seasons from 2012 to 2015 (4 years). Documented numbers of concussions, identified by use of the online database PBS Frontline Concussion Watch, were summarized by regular-season weeks. Association of days of rest and game location (home, away, or overseas) with the rate of concussion was examined by use of the χ2 test. Logistic regression analysis was performed to examine the relationships of days of rest and home/away games to the risk of repeated concussions, with adjustment for player position. RESULTS: A total of 582 concussions were analyzed in this study. A significantly greater number of concussions occurred in the second half of the season (P < .01). No significant association was found between the rate of concussion and the days of rest, game location, or timing of the bye week by the team or the opponent (P > .05). Game schedules were not significantly associated with the occurrence of repeat concussions (P > .05). CONCLUSION: Unconventional game schedules in the NFL, including playing on Thursday and playing overseas, do not seem to put players at increased risk of concussions.

A Scaphoid Stress Fracture in a Female Collegiate-Level Shot-Putter and Review of the Literature.

Scaphoid stress fractures are rare injuries that have been described in young, high-level athletes who exhibit repetitive loading with the wrist in extension. We present a case of an occult scaphoid stress fracture in a 22-year-old female Division I collegiate shot-putter. She was successfully treated with immobilization in a thumb spica splint for 6 weeks. Loaded wrist extension activities can predispose certain high-level athletes to sustain scaphoid stress fractures, and a high index of suspicion in this patient population may aid prompt diagnosis and management of this rare injury.

The accuracy of ultrasound-guided and palpation-guided peroneal tendon sheath injections.

OBJECTIVE: The aim of this study was to describe and to validate an ultrasound-guided peroneal tendon sheath (PTS) injection technique and to compare the accuracy of ultrasound-guided vs. palpation-guided PTS injections in a cadaveric model. DESIGN: Twenty cadaveric lower limbs were injected with and without ultrasound guidance, using a different color of liquid latex for each injection technique. The injections were performed by a single investigator in a randomized order. Cadaveric specimens were dissected 1 wk later by a blinded investigator who graded injection accuracy on a 3-point scale (1, accurate; 2, partially accurate; 3, inaccurate). RESULTS: Ultrasound-guided injections were 100% (20 of 20) accurate whereas palpation-guided injections were 60% (12 of 20) accurate (P = 0.008). Six palpation-guided injections were partially accurate, and two were inaccurate. Two of the partially accurate and both of the inaccurate injections were intratendinous. CONCLUSIONS: In a cadaveric model, ultrasound-guided PTS injections are significantly more accurate than palpation-guided injections. When performing PTS injections, clinicians should consider ultrasound guidance to improve injection accuracy and minimize potential complications such as intratendinous injection.

Accuracy of ultrasound-guided and palpation-guided knee injections by an experienced and less-experienced injector using a superolateral approach: a cadaveric study.

OBJECTIVES: To evaluate the accuracy of ultrasound (US)-guided and palpation-guided knee injections by an experienced and a less-experienced clinician with use of a superolateral approach. DESIGN: Single-blinded, prospective study. SETTING: Academic institution procedural skills laboratory. PARTICIPANTS: Twenty cadaveric knee specimens without trauma, surgery, or major deformity. INTERVENTION: US-guided and palpation-guided knee injections of colored liquid latex were performed in each specimen by an experienced and a less-experienced clinician with use of a superolateral approach. The order of injections was randomized. The specimens were subsequently dissected by a blinded investigator and assessed for accuracy. MAIN OUTCOMES: Accuracy was divided into 3 categories: (1) accurate (all of the injectate was within the joint), (2) partially accurate (some of the injectate was within the joint and some was within the periarticular tissues), and (3) inaccurate (none of the injectate was within the joint). The accuracy rates were calculated for each clinician and guidance method. RESULTS: US-guided knee injections that used a superolateral approach were 100% accurate for both clinicians. Palpation-guided knee injections that used a superolateral approach were significantly influenced by experience, with the less-experienced investigator demonstrating an accuracy rate of 55% (95% confidence interval = 34%-74%) and the more experienced investigator demonstrating an accuracy rate of 100% (95% confidence interval = 81%-100%). CONCLUSIONS: US-guided knee injections that use a superolateral approach are very accurate in a cadaveric model, whereas the accuracy of palpation-guided knee injections that use the same approach is variable and appears to be significantly influenced by clinician experience. These findings suggest that US guidance should be considered when one performs knee injections with a superolateral approach that require a high degree of accuracy.