Sport-related differences in biomarkers of bone resorption and cartilage degradation in endurance athletes.

OBJECTIVE: By measuring urinary cross-linked N-telopeptide (NTx) as a bone resorption marker and urinary C-telopeptide of type II collagen (CTx-II) as a cartilage degradation marker, we asked whether differences in skeletal stresses in college athletes undergoing high-intensity training for diverse types of aerobic sports affect their skeletal metabolism and, if so, differentially or in unison. METHODS: The study was cross-sectional at a Division 1 college campus with 60 student athletes representing crew, cross-country running and swimming. Controls were 16 non-athlete undergraduates. Urine samples were collected for NTx and CTx-II analysis by enzyme-linked immunosorbent assay, normalizing results to creatinine. Two-way analysis of variance models and pair-wise comparisons were used to test whether biomarker levels differed by sport and the significance when adjusted for body mass index (BMI). RESULTS: NTx and CTx-II showed significant differences between groups before and after adjusting for BMI. NTx was highest in the rowers, and higher in rowers and runners than in swimmers or controls. CTx-II was significantly higher in runners than in crew, swimmers or controls, when unadjusted for BMI. After adjusting for BMI, these group differences remained significant except for runners over crew. CONCLUSION: Athletes in-training in the three sports show significant differences in these markers of bone resorption and cartilage collagen degradation. The results suggest that crew undergo the highest bone remodeling and runners the highest cartilage degradation. The results also show how these markers can vary physiologically between individuals, at extremes of skeletal exercise.

Syncope following neck trauma in a football player.

A college football player sustained a contusion to his anterior neck, over the carotid artery. Less than a minute later he fainted, then experienced episodes of postural dizziness with bradycardia and hypotension. He completely recovered within 3 hours from the time of injury. An unusual but possible cause of this patient's syncopal episode is posttraumatic carotid sinus syncope. This case illustrates the importance of checking vital signs in any athlete who experiences loss of consciousness, and that its occurrence in a collision sport is not always caused by a concussion.

Tunnel expansion after hamstring anterior cruciate ligament reconstruction with 1-incision EndoButton femoral fixation.

In this study, we compared a study group of 20 patients who underwent anterior cruciate ligament (ACL) reconstruction with hamstring autografts using a 1-incision endoscopic technique verses a control group of 20 patients using a 2-incision technique. The patient groups were compared based on increase of bone tunnel diameter seen radiographically, physical examination, and arthrometer measurements. The 1-incision technique differed from the 2-incision technique in 2 ways: an EndoButton femoral fixation system and drilling of the femoral tunnel through the tibial tunnel (transtibial). This study shows that the majority of tunnel diameter measurements for the 1-incision ACL reconstruction technique were greater than those of the 2-incision ACL reconstruction technique using autologous hamstring tendons, at both 3 and 12 months of follow-up. Between 3 and 12 months follow-up, there was no statistical differences in tunnel enlargement between the 2 groups of patients. The measured tunnel enlargement, therefore, would have occurred before the 3-month follow-up. There was no significant difference in the Lachman or arthrometer testing in either group of patients at the termination of this study. This indicates that, although tunnel expansion is significant, the increased expansion is not related to increased knee laxity in the first year.

Anterior hip pain.

Anterior hip pain is a common complaint with many possible causes. Apophyseal avulsion and slipped capital femoral epiphysis should not be overlooked in adolescents. Muscle and tendon strains are common in adults. Subsequent to accurate diagnosis, strains should improve with rest and directed conservative treatment. Osteoarthritis, which is diagnosed radiographically, generally occurs in middle-aged and older adults. Arthritis in younger adults should prompt consideration of an inflammatory cause. A possible femoral neck stress fracture should be evaluated urgently to prevent the potentially significant complications associated with displacement. Patients with osteitis pubis should be educated about the natural history of the condition and should undergo physical therapy to correct abnormal pelvic mechanics. "Sports hernias," nerve entrapments and labral pathologic conditions should be considered in athletic adults with characteristic presentations and chronic symptoms. Surgical intervention may allow resumption of pain-free athletic activity.

Simple home program for frozen shoulder to improve patients' assessment of shoulder function and health status.

BACKGROUND: The purpose of this investigation was to test the hypothesis that a simple home program can improve the self-assessed shoulder function and health status of a group of patients with frozen shoulders. METHODS: A case series using a one-group pretest, posttest design analyzing 41 patients from a single orthopedic practice who had a frozen shoulder were included in this study. The patients completed the Simple Shoulder Test (SST) and the Medical Outcomes Study Short-Form Health Survey (SF-36) questionnaire at the time of initial consultation, had treatment consisting of education regarding frozen shoulder and home stretching instructions, and were asked to complete the same questionnaires mailed every 6 months. Initial results were compared with previously published control values to establish level of impairment, and follow-up results were compared with the initial results to determine the extent of improvement. RESULTS: Patients initially had serious deficits in the 12 shoulder functions inventoried by the SST and were also compromised in their general health status as reflected by the SF-36 scores. At follow-up, 4 of 10 SST functions were improved (P < 0.001). The SF-36 health status scores of physical function, comfort, and physical role function were also improved (P < 0.001). CONCLUSION: These data suggest that this home program for frozen shoulder can lead to improved self-assessed shoulder function and health status in patients similar to those in the study population.

Allergen-mediated disease: keeping patients active.

A nasal corticosteroid is the most effective treatment for allergic rhinitis, but delayed improvement can reduce compliance. Topical vasoconstrictors, cromolyn, and NSAIDs are recommended for allergic conjunctivitis. Some athletes who have exercise-induced or exercise-exacerbated asthma may have a refractory period, which, along with short- and long-term beta-2 agonists, inhaled corticosteroids, and leukotriene antagonists, may be used to manage symptoms. Topical steroids are the main treatment for atopic dermatitis. Drug restrictions by sports governing bodies can limit therapies for competitive athletes.