RESUMEN
ABSTRACT: Achilles tendinopathy is a common overuse injury that is traditionally managed with activity modification and a progressive eccentric strengthening program. This narrative review describes the available evidence for adjunctive procedural interventions in the management of midportion and insertional AT, specifically in the athletic population. Safety and efficacy data from available literature on extracorporeal shockwave therapy, platelet-rich plasma, high-volume injectate with or without tendon scraping, and percutaneous needle tenotomy are used to propose an algorithm for treatment of Achilles tendinopathy for the in-season athlete.
Asunto(s)
Tendón Calcáneo , Traumatismos en Atletas , Plasma Rico en Plaquetas , Tendinopatía , Humanos , Tendinopatía/terapia , Tendón Calcáneo/lesiones , Traumatismos en Atletas/terapia , Tratamiento con Ondas de Choque Extracorpóreas , Tenotomía/métodos , Atletas , AlgoritmosRESUMEN
OBJECTIVE: The purpose of the current study is to synthesize the outcomes of investigations reporting the odds of lumbar degenerative disc disease (DDD) in competitive swimmers compared to controls. LITERATURE SURVEY: PubMed, Embase, and Web of Science databases were searched according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines from inception until March 2023 to identify relevant studies evaluating the risk for lumbar DDD associated with swimming. METHODS: Data in the current literature were synthesized for positive imaging findings of DDD at one or more lumbar level in swimmers compared to nonswimmers. Additionally, data regarding prevalence of lumbar disc degeneration and back pain in competitive swimmers were synthesized. SYNTHESIS: Four studies were included in the final analysis. Study quality and risk of bias were deemed adequate. There was significant heterogeneity among studies (I2 = 0.74) regarding data collected, population of swimmers, sample size, and methods. Therefore, a meta-analysis was not conducted. The majority of the studies included in this study (three of four) reported that swimmers have increased odds of developing lumbar DDD. Additionally, secondary outcome analysis indicated that swimmers have a higher probability of developing moderate-to-severe back pain. CONCLUSION: Competitive swimming appears to be associated with the presence of DDD on advanced imaging and moderate-to-severe back pain. These findings are limited by significant differences in study methodology in the included studies. Although swimming is conventionally considered a low-impact sport, elite swimmers risk developing lower back pain and disc pathology, possibly because training involves unique biomechanics with repetitive rotational and hyperextension/flexion of the spine. Further research investigating risk factors involving biomechanics of swimming on the spine may have important implications for stroke technique, injury prevention, and rehabilitation for swimmers.
RESUMEN
BACKGROUND: Anterior knee pain is a common symptom many females experience during pregnancy. There are several musculoskeletal changes that occur in anatomy and physiology throughout the course of pregnancy that impact the lower extremity kinetic chain. Pregnant athletes, recreational through competitive, who attempt to maintain a high activity level through each trimester may be at increased risk for anterior knee pain due to a greater demand for lumbopelvic and hip stabilization. CLINICAL QUESTION: What are the evidence-driven rehabilitation guidelines and specific modifications needed to treat anterior knee pain in the female athlete during each trimester of pregnancy? KEY RESULTS: We aim to provide an overview of rehabilitation treatment guidelines for pregnant females with anterior knee pain, presenting specific physiological changes and rationale for modifications, discussed by trimester. We recommend our program be conducted under the supervision of a physical therapist working closely with the athlete's obstetrics and sports medicine team. CLINICAL APPLICATION: The number of women who are active during pregnancy is increasing. We provide an overview of the guidelines and considerations for treating women with anterior knee pain during a healthy and uneventful pregnancy.
Asunto(s)
Articulación de la Rodilla , Rodilla , Embarazo , Humanos , Femenino , Atletas , Extremidad Inferior , DolorRESUMEN
Pitching is a complex kinetic chain activity requiring the transfer of energy from the lower body, through the core and trunk, and finally through the arm to generate explosive acceleration of the baseball. As a result, large forces are generated in the trunk musculature and rib attachments from the late cocking phase of pitching through deceleration. The repetitive cumulative load and high pitch velocities put professional pitchers at risk of rib stress fracture. Given the potential for a prolonged recovery course and high rate of recurrence, early recognition of rib bone stress injury is critical to optimize care. Identifying torso strength imbalances, suboptimal pitching biomechanics (such as late or inadequate pelvic rotation), as well as metabolic deficiencies that may adversely affect bone health are essential to expedite safe return to play and prevent future injury. In this review, we discuss risk factors, mechanism of injury, typical clinical presentation, diagnostic imaging findings, and propose treatment and prevention strategies for rib stress fractures in overhand pitchers.
RESUMEN
There remains a paucity of literature addressing adhesive capsulitis of the hip (ACH), making the diagnosis and treatment a continued challenge for healthcare providers. ACH encompasses restricted hip range-of-motion and pain that progresses through analogous Stages (1-4) to adhesive capsulitis of the shoulder. We report a case presentation of a middle-aged man that illustrates the significance of certain patient factors and provide a review of current literature to aid in the diagnostic evaluation and treatment for addressing ACH. Initial conservative treatment of ACH includes the appropriate management of associated comorbidities, oral and/or injectable pharmacologics, and physical therapy. While frequently resolving with time, refractory cases of ACH may require more aggressive approaches including pressure dilation, manipulation under anesthesia, synovectomy, capsular release and, for select patients, total hip arthroplasty. Given the limited available literature addressing ACH, healthcare providers may be forced to rely on a small number of published case reports and outdated review articles to guide their diagnostic evaluation and treatment approaches. Thus, this case presentation and review provides an updated approach to better diagnose and manage patients with ACH.
RESUMEN
ABSTRACT: Knee extensor mechanism tendinopathy, including patellar and quadriceps tendinopathy, is common among athletes and those involved in jumping sports. It is largely a clinical diagnosis that presents as anterior knee pain and stiffness with associated tenderness over the affected tendon. Imaging modalities, including ultrasound and/or magnetic resonance imaging, may be helpful with the diagnosis of difficult cases or in the planning of interventional procedures. Focused and structured rehabilitation using eccentric or heavy slow resistance exercise in conjunction with load management is important for recovery. Adjuvant therapies (e.g., injections or surgery) may be necessary in recalcitrant cases or those with insufficient response to rehabilitation efforts. Prevention strategies focus on improving biomechanics, landing mechanism and lower-extremity balance, flexibility, and strength.
Asunto(s)
Ligamento Rotuliano , Tendinopatía , Humanos , Rodilla , Articulación de la Rodilla , Extremidad Inferior , Tendinopatía/diagnóstico , Tendinopatía/prevención & controlRESUMEN
Calcific tendinopathy (CT) is an important musculoskeletal condition most commonly seen in the shoulder girdle, accounting for 10-42% of all shoulder pain. Despite the high prevalence within the shoulder region, CT has been demonstrated in many tendons throughout the axial and appendicular skeleton. Unlike degenerative tendinopathies, CT appears to be a self-limiting condition that affects otherwise-healthy tendon with deposition of calcium hydroxyapatite crystals between healthy tenocytes. In patients with functionally limiting symptoms or pain, the clinical course may be accelerated through a multitude of treatments including physical therapy and pain management, extracorporeal shock wave therapy, ultrasound-guided percutaneous lavage (UGPL), and operative debridement. Currently, the most efficacious and frequently utilized treatment for shoulder CT is UGPL due to its ability to effectively reduce calcium burden and pain while limiting soft-tissue damage. However, more evidence regarding the treatment and course of CT is needed before determining the most appropriate treatment at all potential sites of CT.
Asunto(s)
Calcinosis , Tendinopatía , Calcinosis/cirugía , Calcinosis/terapia , Humanos , Tendinopatía/cirugía , Tendinopatía/terapia , Irrigación TerapéuticaRESUMEN
ABSTRACT: A 61-yr-old female equestrian presented after 2 wks of left medial thigh pain, which developed suddenly while exiting a car. She denied any history of recent trauma or falls. On examination, she was found to have tenderness at the left distal medial thigh with a palpable region of decreased tissue volume at the gracilis myotendinous junction. Point-of-care ultrasound and magnetic resonance imaging confirmed a high-grade partial thickness tear of the left distal gracilis at the myotendinous junction, as well as pes anserine bursal distention. She received physical therapy and underwent a 1-time ultrasound-guided corticosteroid injection to the left pes anserine bursa. At follow-up, her symptoms had significantly improved, and she had returned to horseback riding after 12 wks. Isolated gracilis myotendinous tear is a rare condition, and this is a unique case with an atypical mechanism of injury as gracilis injuries have only been reported during vigorous exercise-related activities rather than transitional movements. This case illustrates the potential increased risk of distal gracilis injury after repetitive corticosteroid injections (genicular nerve blocks and radiofrequency lesioning) in a patient who was also likely predisposed to gracilis microtrauma due to her equestrian activities. Gracilis injury should be considered in the differential diagnosis of distal medial thigh pain, especially in cases with similar interventional and recreational profiles.
Asunto(s)
Traumatismos en Atletas/diagnóstico , Músculo Grácil/lesiones , Dolor Musculoesquelético/diagnóstico , Traumatismos de los Tendones/diagnóstico , Muslo/lesiones , Animales , Traumatismos en Atletas/complicaciones , Diagnóstico Diferencial , Femenino , Caballos , Humanos , Persona de Mediana Edad , Dolor Musculoesquelético/etiología , Traumatismos de los Tendones/etiologíaRESUMEN
OBJECTIVE: In this narrative review, we highlight sex-specific anatomic and biomechanical features of the hip region in female athletes, as well as the potential impact of these characteristics on observed disparities in both intra-articular and extra-articular injury patterns between female and male athletes. It is our goal to broaden the scope of knowledge related to hip pathology in active female athletes among sports medicine providers with the hope of better optimizing sport participation and performance in female athletes. DATA SOURCES: A literature review was conducted using PubMed database and Google Scholar search engine. Search terms included sport, female, athlete, sex differences, injury, hip, and all diagnoses discussed in this review. Cross-reference of these articles identified additional resources. MAIN RESULTS: Sex-specific differences in both static design and dynamic function contribute to disparities in hip injury patterns between female and male athletes. Intra-articular injuries, including labral and ligamentum teres pathology, as well as extra-articular injuries, including iliopsoas tendon dysfunction, gluteal and proximal hamstring tendinopathy, ischiofemoral impingement, bone stress injuries, and certain nerve entrapment syndromes, seem to affect female athletes more commonly than male counterparts. CONCLUSIONS: Given unique anatomic and functional considerations, the growing population of female athletes worldwide warrants specialized care and consideration. Potential predisposition to specific hip injuries should be taken into consideration during diagnostic evaluation of hip pain in the female athlete.
Asunto(s)
Traumatismos en Atletas , Lesiones de la Cadera , Medicina Deportiva , Atletas , Traumatismos en Atletas/diagnóstico , Traumatismos en Atletas/epidemiología , Femenino , Lesiones de la Cadera/diagnóstico , Lesiones de la Cadera/epidemiología , Articulación de la Cadera , Humanos , MasculinoRESUMEN
ABSTRACT: Achilles tendinopathy is a common overuse condition that is characterized by degenerative, cumulative tissue microtrauma. It is largely a clinical diagnosis in which the patient typically presents with localized pain that is worse with tendon-loading activities. Imaging modalities may be helpful with the diagnosis of difficult cases or in the planning of interventional procedures. Midportion (noninsertional) and insertional tendinopathy have distinct features and differences for therapeutic paradigms. Overall, Achilles tendinopathy has a good clinical prognosis with most patients improving with activity modification and rehabilitation, with a focus on progressive tendon-loading. Recalcitrant cases may require adjuvant treatment with procedures (e.g., injections, shockwave therapy) and rarely surgical intervention.
Asunto(s)
Tendón Calcáneo , Tendinopatía/terapia , Tendón Calcáneo/anatomía & histología , Humanos , Examen Físico , Pronóstico , Volver al Deporte , Tendinopatía/diagnóstico , Tendinopatía/diagnóstico por imagen , Tendinopatía/etiologíaRESUMEN
ABSTRACT: Trunk pain is a common cause of performance limitation and time away from sport in athletes. However, atraumatic trunk injuries are underrepresented in medical literature and underrecognized clinically. Delays in diagnosis and initiation of appropriate treatment can increase injury morbidity and return-to-play time. Currently, evidence-based guidelines for diagnosis and treatment of trunk pain in athletes are limited. Thus, we provide an overview of atraumatic sport-related injuries to the thoracic spine (disc herniation, scoliosis, kyphosis), ribcage (bone stress injury, costochondritis, Tietze syndrome, slipping rib syndrome, costovertebral or costotransverse joint dysfunction), and chest and abdominal wall musculature (intercostal, serratus anterior, oblique strains, regional myofascial pain), highlighting sport-specific biomechanical considerations. We aim to increase awareness of these causes of trunk pain among sports medicine providers in an effort to guide diagnostic and treatment recommendations that will ultimately improve overall musculoskeletal health in athletes.
Asunto(s)
Traumatismos en Atletas , Torso/lesiones , Traumatismos en Atletas/diagnóstico , Traumatismos en Atletas/etiología , Traumatismos en Atletas/fisiopatología , Traumatismos en Atletas/terapia , Fenómenos Biomecánicos , Humanos , Músculo Esquelético/lesiones , Dolor/etiología , Costillas/anatomía & histología , Costillas/lesiones , Curvaturas de la Columna Vertebral/diagnóstico , Curvaturas de la Columna Vertebral/etiología , Curvaturas de la Columna Vertebral/terapia , Esguinces y Distensiones/diagnóstico , Esguinces y Distensiones/etiología , Esguinces y Distensiones/terapia , Vértebras Torácicas/anatomía & histología , Vértebras Torácicas/lesiones , Torso/fisiopatologíaRESUMEN
Aim: To determine whether platelet-rich plasma (PRP) can successfully treat symptoms associated with proximal hamstring tendinopathy. Materials & methods: Charts were retrospectively reviewed of patients with a diagnosis of chronic proximal hamstring tendinopathy who underwent an ultrasound-guided leukocyte-rich PRP injection to assess reported outcomes at baseline and final follow-up post-intervention. Results: In 22 patients with a mean age of 48.7 years and mean symptom duration of 26.5 months, mean Numeric Pain Rating Scale and Victorian Institute of Sport Assessment Scale for Proximal Hamstring Tendinopathy subscores demonstrated statistically significant improvements (p < 0.05) at a mean of 7.91 months follow-up. Sixty-eight percent of patients demonstrated ≥50% reduction of pain. Conclusion: Pain and functional outcomes improved following injection of PRP.
Asunto(s)
Dolor Musculoesquelético/prevención & control , Transfusión de Plaquetas/métodos , Plasma Rico en Plaquetas , Tendinopatía/terapia , Adulto , Anciano , Enfermedad Crónica , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tendinopatía/diagnóstico por imagen , Ultrasonografía/métodos , Adulto JovenRESUMEN
INTRODUCTION: The global pandemic due to SARS-CoV-2 has resulted in an expansion of telemedicine. Measures of quality and barriers for rapid use by patients and physicians are not well described. OBJECTIVE: To describe results from a quality improvement initiative during a rapid adoptive phase of telemedicine during the pandemic. DESIGN: Patient and physician satisfaction with synchronous audiovisual telemedicine visits was measured during the early adoptive phase (6 April 2020-17 April 2020) within the division of sports medicine in an academic Physical Medicine and Rehabilitation (PM&R) department. Patients were invited to participate in a quality improvement initiative by completing an online survey at the end of a telemedicine visit. Physicians completed a separate survey. PRIMARY OUTCOME MEASURES: Patient measures included visit type, duration of encounter, quality, and satisfaction. Physicians reported on experiences performed telemedicine. RESULTS: Surveys were completed by 119 patients (293 telemedicine encounters, response rate 40.6%) and 14 physiatrists. Telemedicine was utilized primarily for follow-up visits (n = 74, 70.6%), and the most common duration was 15 to 29 minutes. Patients rated their telemedicine visit as "excellent" or "very good" across measures (91.6%-95.0%) including addressing concerns, communication, developing a treatment plan, convenience, and satisfaction. Value of completing a future telemedicine visit was measured at 84.9%. Most reported estimated travel time saved was in excess of 30 minutes. Rate of no-show was 2.7%. Most physicians (57.1%) had no prior experience with telemedicine visits, and most were comfortable performing these visits after completing 1 to 4 sessions (71%). Nearly all physicians (92.9%) rated their telemedicine experience as very good or excellent. The key barrier identified for telemedicine was technical issues. All physicians reported plans to perform telemedicine visits if reimbursement continues. CONCLUSIONS: In summary, rapid expansion of telemedicine during the COVID-19 pandemic was well-received by a majority of patients and physicians. This suggests feasibility in rapid expansion of telemedicine for other outpatient sports medicine practices.
Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/rehabilitación , Pandemias , Satisfacción del Paciente/estadística & datos numéricos , Medicina Física y Rehabilitación/métodos , Médicos/normas , Neumonía Viral/rehabilitación , Telemedicina/métodos , Adolescente , Adulto , Anciano , COVID-19 , Niño , Infecciones por Coronavirus/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pacientes Ambulatorios , Neumonía Viral/epidemiología , SARS-CoV-2 , Adulto JovenRESUMEN
Management of hip region disorders is challenging. Orthobiologic treatments including platelet rich plasma (PRP), mesenchymal stem cells, and amniotic injectables have gained popularity as promising treatments despite a lack of robust evidence for their effectiveness. We review rationale and current evidence for orthobiologics for three common hip region conditions: hip osteoarthritis, gluteal tendinopathy, and proximal hamstring tendinopathy. Overall, the current state of evidence is extremely limited for orthobiologic treatments and is predominantly relevant to PRP injections. There is currently a lack of data to support the use of mesenchymal stem cells or amniotic injectables in these conditions of the hip.
Asunto(s)
Enfermedades Musculoesqueléticas , Osteoartritis de la Cadera , Plasma Rico en Plaquetas , Tendinopatía , Humanos , InyeccionesRESUMEN
Ankle sprains affect athletic populations at high rates. Athletes who suffer an ankle sprain frequently go on to develop persistent symptoms, resulting in significant resources spent toward treatment, rehabilitation, and prevention. A thorough clinical evaluation is necessary to ensure an accurate diagnosis and appropriate treatment prescription. This narrative review aims to present an approach to evaluation of high and low ankle sprains for athletes of all levels. The authors review the current evidence for ankle sprain treatment and rehabilitation. Strategies for prevention of recurrent sprains and return to play considerations also are discussed.
Asunto(s)
Traumatismos del Tobillo/rehabilitación , Traumatismos en Atletas/rehabilitación , Esguinces y Distensiones/rehabilitación , Traumatismos del Tobillo/diagnóstico , Atletas , Traumatismos en Atletas/diagnóstico , Humanos , Esguinces y Distensiones/diagnósticoRESUMEN
BACKGROUND: Softball pitching is a ballistic, complex movement that requires an underhand windmill motion to create force and ball velocity. In addition to proper pitch biomechanics, upper and lower extremity strength and joint motion likely contribute to ball location accuracy and velocity. Yet, the number of studies reporting muscle strength and joint range of motion among softball pitchers is scarce. OBJECTIVE: To assess differences between throwing and nonthrowing shoulder, elbow, and hip (lead and trail leg) strength and range of motion (ROM) in high school and collegiate level softball windmill pitchers. DESIGN: Cross-sectional study. PARTICIPANTS: Thirty-three female softball pitchers (24 high school, 9 collegiate) were recruited from local teams. METHODS: Goniometric joint ROM and handheld dynamometer strength measurements of the bilateral shoulders, elbows, and hips were measured. MAIN OUTCOME MEASUREMENTS: Goniometric joint ROM of the bilateral elbows (flexion, extension), shoulders, and hips (flexion, extension, internal rotation [IR], external rotation [ER]). Handheld dynamometer strength measurements of the bilateral shoulders (flexion, extension, abduction, IR, ER), elbows (flexion, extension), and hips (flexion, extension, IR, ER, abduction). RESULTS: Across all pitchers, there was greater shoulder flexion ROM in the nonthrowing limb than in the throwing limb (P = .004). There was greater hip extension in the lead leg than trail leg. Among high school pitchers, there was greater shoulder ER (x = 105.792 ± 7.11) than collegiate pitchers (x = 100.1 ± 6.92), P = .05. There was no difference in total arc of shoulder rotational motion (ER+ IR) between throwing and nonthrowing limbs across all pitchers, nor between high school and collegiate pitchers. Strength measures demonstrated greater throwing limb shoulder abduction (P = .006) and IR strength (P = .001) than the nonthrowing shoulder across all pitchers. Elbow flexion strength was significantly greater than the nonthrowing side (P = .001). No difference was noted in hip strength between lead and trail lower extremities. CONCLUSIONS: Developing normative data for softball pitchers upper and lower extremity strength and range of motion may allow providers to assess players more comprehensively and identify athletes out of the expected value range. This information may help in guiding strength and conditioning programs for softball pitchers. LEVEL OF EVIDENCE: III.
Asunto(s)
Béisbol/fisiología , Articulación del Codo/fisiología , Articulación de la Cadera/fisiología , Fuerza Muscular/fisiología , Rango del Movimiento Articular/fisiología , Articulación del Hombro/fisiología , Adolescente , Fenómenos Biomecánicos , Estudios Transversales , Femenino , Humanos , Adulto JovenRESUMEN
This case presentation describes a 50-year-old healthy woman who developed left-sided hip pain while training for the Boston Marathon. Magnetic resonance imaging demonstrated a stress fracture of the left iliac body. This injury was unique in that it did not occur in the setting of low bone mineral density and it did not fall into the current published radiographic categorization based on location of injury. This case illustrates an uncommon and atypical bone stress injury in an endurance athlete. It should be considered in the differential diagnosis of runners presenting with hip or lumbopelvic pain. LEVEL OF EVIDENCE: V.
Asunto(s)
Fracturas por Estrés/diagnóstico , Ilion/lesiones , Imagen por Resonancia Magnética/métodos , Carrera , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Humanos , Ilion/diagnóstico por imagen , Persona de Mediana EdadRESUMEN
BACKGROUND: Limited research is available regarding return-to-running (RTR) time after femoral neck stress fractures. While studies have shown the prognostic value of image-based grading scales for stress fractures at other sites, few have included femoral neck stress fractures. PURPOSE: To determine if the grade of femoral neck stress fractures based on magnetic resonance imaging (MRI) characteristics correlates with RTR time. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: This study included 24 patients (mean age, 32.9 years; range, 18-51 years) who were diagnosed with 27 femoral neck stress fractures by MRI from 2009 to 2015 at a single sports medicine clinic. All fractures were compression sided and were treated nonoperatively. Charts were reviewed for patient demographics and RTR time. Images were graded from 1 to 4 using the Arendt stress fracture severity scale. Statistical analysis was performed using survival analysis and Cox proportional hazard model to compare the RTR time between grades. Cox regression was repeated, adjusted for age, bone mineral density (BMD), and body mass index (BMI). RESULTS: The mean (±standard error of the mean) RTR time in weeks for patients with fractures graded 1 to 4 was 7.4 ± 2.7 (range, 4-11), 13.8 ± 3.8 (range, 6-21), 14.7 ± 3.5 (range, 8.5-24), and 17.5 ± 3.4 (range, 10-32), respectively. Survival analysis indicated that there was a statistically significant effect of fracture grade on RTR time (P = .0065). The Cox model indicated a statistically significant difference in RTR time between grades 1 and 2 (P = .036), 1 and 3 (P = .014), and 1 and 4 (P = .002). The unadjusted hazard ratio was significant (P = .037). There were no statistically significant differences between the remaining grades (P = .82 for grades 2 and 3, P = .37 for grades 2 and 4, and P = .31 for grades 3 and 4). Age (P = .71) and BMD (P = .81) did not have an effect on RTR time. The hazard ratio remained significant (P = .05) after adjusting for age and BMD. BMI tended to have an effect on RTR time (P = .09). After adding BMI to the adjustment, the hazard ratio decreased in significance (P = .13), although sample size also decreased. CONCLUSION: Grade 2 to 4 femoral neck stress fractures require longer RTR time than do grade 1 injuries. Patients with lower BMI tend to require a longer RTR time.