Morphological study on the origin of the semitendinosus muscle in the long head of biceps femoris.

Hamstring muscle injuries are the most prevalent among athletes who engage in sprinting activities. Their most frequent location is where the long head of the biceps femoris joins with the semitendinosus muscle to form the conjoint hamstring tendon. Just distal to this area, an additional group of fibers of the semitendinosus originate from medial aspect of biceps femoris. The objective of this study was to analyze the morphological characteristics of this union and to discuss its potential role in hamstring tears. Anatomical dissection was performed on 35 thighs. Samples obtained from this region were sectioned and stained with Masson's trichrome for further histological evaluation. A group of fibers from the semitendinosus muscle originating from the long head of the biceps femoris were observed in all 35 specimens. This origin was located 67 ± 12 mm from the ischial tuberosity and was 32 ± 14 mm in length. This group of muscle fibers had a width of 10.9 ± 5.3 mm and a thickness in the anteroposterior axis of 3.2 ± 1.4 mm. Its pennation angle was 9.2 ± 1.5 degrees. Microscopic examination showed muscle cells from both muscles contacting interposed tendinous tissue. In conclusion, fibers of the semitendinosus muscle consistently arise from the proximal aspect of the long head of biceps femoris. The morphological characteristics of this junction have functional implications. The horizontal component of the semitendinosus vector could pull the long head of the biceps femoris medially during its shortening-lengthening cycle, rendering it an intrinsic risk factor for hamstring injuries.

Lesiones musculares deportivas: correlación entre anatomía y estudio por imágenes / Muscle injuries in sports: imaging study

Un gran segmento de la población participa en actividades deportivas. Las lesiones musculares corresponden a aproximadamente un tercio de las lesiones deportivas. Las demandas recreacionales y profesionales de la sociedad moderna exigen un diagnóstico precoz y preciso, para un adecuado tratamiento y seguimiento, dadas las implicancias económicas y mediáticas, especialmente en deportistas de elite. La imagenología tiene un rol fundamental en la evaluación de estas lesiones. Permite evaluar localización, extensión, severidad y estimar pronóstico, así como también el seguimiento para determinar el retorno deportivo. En este artículo se revisa la anatomía microscópica y macroscópica muscular, la fisiología, los tipos de lesiones y su representación en imágenes, tanto en ultrasonido (US), como en resonancia magnética (RM). Se mencionan distintas clasificaciones descritas en la literatura y se propone una nueva nomenclatura y descripción, basada principalmente en la anatomía muscular, la localización y cuantificación de las lesiones.

A large segment of the population participates in sporting activities. Muscle injuries account for approximately one-third of the injuries. The recreational and professional demands of modern society require an early and precise diagnosis of these, for an adequate treatment and follow-up, given the economic and media implications, especially in elite athletes1. Imaging plays a fundamental role in the evaluation of these lesions. It allows evaluation location, extent, severity and estimations of prognosis, as well as the follow-up to determine the return to sport. This article reviews the microscopic and macroscopic muscle anatomy, the physiology, types of lesions and their representation in images, both in ultrasound (US) and magnetic resonance (MRI). Different classifications described in the literature are mentioned and a nomenclature and description is proposed, based mainly on the muscle anatomy, localization and type of injury.

Hamstring Injuries in Professional Soccer Players: Extent of MRI-Detected Edema and the Time to Return to Play.

BACKGROUND: Discrepancies exist in the literature regarding the association of the extent of injuries assessed on magnetic resonance imaging (MRI) with recovery times. HYPOTHESIS: MRI-detected edema in grade 1 hamstring injuries does not affect the return to play (RTP). STUDY DESIGN: Retrospective cohort study. LEVEL OF EVIDENCE: Level 4. METHODS: Grade 1 hamstring injuries from 22 professional soccer players were retrospectively reviewed. The extent of edema-like changes on fluid-sensitive sequences from 1.5-T MRI were evaluated using craniocaudal length, percentage of cross-sectional area, and volume. The time needed to RTP was the outcome. Negative binomial regression analysis tested the measurements of MRI-detected edema-like changes as prognostic factors. RESULTS: The mean craniocaudal length was 7.6 cm (SD, 4.9 cm; range, 0.9-19.1 cm), the mean percentage of cross-sectional area was 23.6% (SD, 20%; range, 4.4%-89.6%), and the mean volume was 33.1 cm3 (SD, 42.6 cm3; range, 1.1-161.3 cm3). The mean time needed to RTP was 13.6 days (SD, 8.9 days; range, 3-32 days). None of the parameters of extent was associated with RTP. CONCLUSION: The extent of MRI edema in hamstring injuries does not have prognostic value. CLINICAL RELEVANCE: Measuring the extent of edema in hamstring injuries using MRI does not add prognostic value in clinical practice.

Sports-related Concussion in Children and Adolescents.

Concussions are becoming increasingly important to manage properly as sports participation continues to rise. Repeated injuries occurring before the brain has had a chance to recover from an initial insult are particularly dangerous and must be prevented. Although much national media attention has been devoted to concussions in professional sports, it is important to appreciate that athletes in any age group, children and adolescents in particular, are at risk of sports-related concussion. It is crucial to remove an athlete from play any time concussion is suspected. Once removed from play, recovery then begins with a period of cognitive and physical rest, followed by a gradual return to cognitive and athletic activities as symptoms resolve. Children and adolescents pose a unique challenge to the clinician managing their recovery, as the physical and cognitive rest periods required often involve time away from school and sports, which can be academically detrimental and socially isolating. Recently developed sideline assessment tools have greatly aided the urgent sideline assessment of an athlete suspected of having a concussion. In this article, a brief review of current guidelines is presented in tandem with the authors' preferred treatment of concussion.

Factors associated with the presence of patellar tendon abnormalities in male athletes.

OBJECTIVES: To investigate the association between lower limb alignment, range of motion/flexibility and muscle strength with the presence of patellar tendon abnormalities in male athletes. DESIGN: This was a cross-sectional study. METHODS: Thirty-one male basketball and volleyball athletes were assessed for ankle dorsiflexion range of motion, shank-forefoot alignment, iliotibial band flexibility, hip external rotators and abductors isometric torque, passive hip internal rotation range of motion and frontal plane knee and patellar alignment (McConnell and Arno angles). Ultrasonographic evaluations of hypoechoic areas of the patellar tendons were performed in longitudinal and transverse planes. A receiver operating characteristic curve was used to determine clinically relevant cut-off point for each variable. When the area under the curve was statistically significant, Prevalence Ratio (PR) and 95% confidence intervals were calculated to indicate the strength of the association between the independent variable and the presence of patellar tendon abnormalities. RESULTS: Receiver operating characteristic curve showed that iliotibial band flexibility (p=0.006), shank-forefoot alignment (p=0.013) and Arno angle (p=0.046) were associated with patellar tendon abnormalities. Cut-off points were established and only the Prevalence Ratio of iliotibial band flexibility (cut-off point=-0.02°/kg; PR=5.26) and shank-forefoot alignment (cut-off point=24°; PR=4.42) were statistically significant. CONCLUSIONS: Athletes with iliotibial band or shank-forefoot alignment above the clinically relevant cut-off point had more chance to have patellar tendon abnormalities compared to athletes under the cut-off point values. These results suggest that such factors could contribute to patellar tendon overload, since patellar tendon abnormalities indicate some level of tissue damage. Both factors might be considered in future prospective studies.

The Role of Magnetic Resonance Imaging in Athletic Pubalgia and Core Muscle Injury.

Magnetic resonance imaging (MRI) has become the standard of care imaging modality for a difficult, often misunderstood spectrum of musculoskeletal injury termed athletic pubalgia or core muscle injury. Armed with a dedicated noncontrast athletic pubalgia protocol and a late model phased array receiver coil, the musculoskeletal imager can play a great role in effective diagnosis and treatment planning for lesions, including osteitis pubis, midline pubic plate lesions, and rectus abdominis/adductor aponeurosis injury. Beyond these established patterns of MRI findings, there are many confounders and contributing pathologies about the pelvis in patients with activity related groin pain, including internal and periarticular derangements of the hip. The MRI is ideally suited to delineate the extent of expected injury and to identify the unexpected visceral and musculoskeletal lesions.

Magnetic Resonance Imaging of Sports Injuries Involving the Ankle.

Understanding of ankle injuries has evolved for the past few decades, influenced by capability to visualize ligaments, tendons, and bone marrow on magnetic resonance imaging (MRI). Natural history of injury progression, complications, and healing has also been characterized using MRI. Stress injury is particularly common at the ankle in athletes and "weekend warriors" alike. This article will discuss manifestations of ankle injury on MRI as well as associated findings that should be addressed.

Is sport practice a risk factor for shoulder injuries in tetraplegic individuals?

STUDY DESIGN: A retrospective cohort. OBJECTIVES: To report the incidence rates of shoulder injuries diagnosed with magnetic resonance imaging (MRI) in tetraplegic athletes and sedentary tetraplegic individuals. To evaluate whether sport practice increases the risk of shoulder injuries in tetraplegic individuals. SETTING: Campinas, Sao Paulo, Brazil. METHODS: Ten tetraplegic athletes with traumatic spinal cord injury were selected among quad rugby athletes and had both the shoulders evaluated by MRI. They were compared with 10 sedentary tetraplegic individuals who were submitted to the same radiological protocol. RESULTS: All athletes were male with a mean age of 32.1 years (range 25-44 years, s.d.=6.44). Time since injury ranged from 6 to 17 years, with a mean value of 9.7 years and s.d. of 3.1 years. All sedentary individuals were male with a mean age of 35.9 years (range 22-47 years, s.d.=8.36). Statistical analysis showed a protective effect of sport in the development of shoulder injuries, with a weak correlation for infraspinatus and subscapularis tendinopathy (P=0.09 and P=0.08, respectively) and muscle atrophy (P=0.08). There was a strong correlation for acromioclavicular joint (ACJ) and labrum injuries (P=0.04), with sedentary individuals at a higher risk for these injuries. CONCLUSION: Tetraplegic athletes and sedentary individuals have a high incidence of supraspinatus tendinosis, bursitis and ACJ degeneration. Statistical analysis showed that there is a possible protective effect of sport in the development of shoulder injuries. Weak evidence was encountered for infraspinatus and subscapularis tendinopathy and muscle atrophy (P=0.09, P=0.08 and P=0.08, respectively). Strong evidence with P=0.04 suggests that sedentary tetraplegic individuals are at a greater risk for ACJ and labrum injuries.

Isolated lateral collateral ligament complex injury in rock climbing and Brazilian Jiu-jitsu.

We report two occurrences of high-grade tears of the lateral collateral ligament complex (LCLC), consisting of the anterolateral ligament (ALL) and fibular collateral ligament (FCL). One injury occurred in a rock climber and the other in a martial artist. Increasing awareness of isolated injuries of the LCLC will allow for appropriate diagnosis and management. We review and discuss the anatomy of the LCLC, the unique mechanism of isolated injury, as well as physical and imaging examination findings.

Ruptura del ligamento cruzado anterior asociada con tumor de rodilla / Anterior cruciate ligament rupture associated with knee tumor

Se ha descripto que los tumores de la rodilla pueden ser inicialmente mal diagnosticados como lesiones deportivas o viceversa, con consecuencias dramáticas potenciales. Otro diagnóstico aún más conflictivo puede suceder cuando ambas patologías ocurren en forma simultánea. La ruptura del ligamento cruzado anterior está dentro de las lesiones deportivas más frecuentes, con una incidencia en EEUU de 150.000 a 200.000 por año. En contraste, los tumores musculo-esqueléticos de rodilla son relativamente infrecuentes. A pesar de esto, las lesiones deportivas y las lesiones tumorales presentan una estricta relación ya que exhiben un mismo grupo etario con similar sintomatología y localización anatómica, pudiendo generar problemas en el diagnóstico. El objetivo del trabajo fue describir tres pacientes con lesiones simultáneas en la rodilla: una ruptura traumática del ligamento cruzado anterior (LCA) y un tumor musculo-esquelético que puede ser particularmente confuso para el cirujano tratante. Nivel de evidencia: IV...

It has been reported that tumors about the knee may be initially misdiagnosed as athletic injuries or vice versa, with potentially dramatic consequences. An even more conflicting diagnostic situation might happen when both pathologies occur simultaneously. Anterior cruciate ligament ruptures are among the most frequent athletic injuries, with an incidence of 150.000-200.000 per year in the USA. On the other side, musculoskeletal tumors about the knee are much less common. However, they frequently occur in the same age group with symptoms that overlap, making it difficult to have a precise diagnosis. We report three patients with simultaneous lesions about the knee: A traumatic anterior cruciate ligament (ACL) rupture and a musculoskeletal tumor, which may be confusing for the treating surgeon. Level of evidence: IV...

Ruptura del ligamento cruzado anterior asociada con tumor de rodilla / Anterior cruciate ligament rupture associated with knee tumor

Se ha descripto que los tumores de la rodilla pueden ser inicialmente mal diagnosticados como lesiones deportivas o viceversa, con consecuencias dramáticas potenciales. Otro diagnóstico aún más conflictivo puede suceder cuando ambas patologías ocurren en forma simultánea. La ruptura del ligamento cruzado anterior está dentro de las lesiones deportivas más frecuentes, con una incidencia en EEUU de 150.000 a 200.000 por año. En contraste, los tumores musculo-esqueléticos de rodilla son relativamente infrecuentes. A pesar de esto, las lesiones deportivas y las lesiones tumorales presentan una estricta relación ya que exhiben un mismo grupo etario con similar sintomatología y localización anatómica, pudiendo generar problemas en el diagnóstico. El objetivo del trabajo fue describir tres pacientes con lesiones simultáneas en la rodilla: una ruptura traumática del ligamento cruzado anterior (LCA) y un tumor musculo-esquelético que puede ser particularmente confuso para el cirujano tratante. Nivel de evidencia: IV...(AU)

It has been reported that tumors about the knee may be initially misdiagnosed as athletic injuries or vice versa, with potentially dramatic consequences. An even more conflicting diagnostic situation might happen when both pathologies occur simultaneously. Anterior cruciate ligament ruptures are among the most frequent athletic injuries, with an incidence of 150.000-200.000 per year in the USA. On the other side, musculoskeletal tumors about the knee are much less common. However, they frequently occur in the same age group with symptoms that overlap, making it difficult to have a precise diagnosis. We report three patients with simultaneous lesions about the knee: A traumatic anterior cruciate ligament (ACL) rupture and a musculoskeletal tumor, which may be confusing for the treating surgeon. Level of evidence: IV...(AU)

Arthroscopic treatment of glenohumeral instability in soccer goalkeepers.

The aim of this study was to report epidemiologic data and results of arthroscopic treatment of glenohumeral instability in soccer goalkeepers. We included 12 soccer goalkeepers with a mean age of 28.9 years (range 18-45 years) with acute or recurrent traumatic anterior instability who underwent an arthroscopic anatomic capsulolabral repair with bone anchors. Patients who underwent surgery within 4 weeks of the first episode of dislocation were classified as acute instability. The results were evaluated using the Rowe Scale and analyzed according to stability, range of motion and function. The mean follow-up was 3.8 years. The most common mechanism of injury (90% of the cases) was abduction, external rotation and extension. Associated injuries were present in 57.2% of recurrent cases and 20% of acute cases (p<0.293). Excellent or good results were observed in 80% of the cases of acute instability and in 57.2% of cases in the group with recurrent instability (p<0.586). From a total of 12 soccer goalkeepers who underwent the arthroscopic capsulolabral repair, good or excellent results were obtained in 66.6% of cases of glenohumeral instability. Surgical arthroscopic repair was possible in all cases of acute or recurrent instability based on well-established inclusion criteria, i. e., with well-defined exclusion criteria, such as HAGL lesion and significant glenohumeral bone loss, the arthroscopic capsulolabral repair can be carried out in soccer goalkeepers.

Distribución de las lesiones en un equipo profesional de fútbol colombiano / Distribution of lesions in a colombian professional soccer team

El fútbol es uno de los deportes con mayor riesgo y frecuencia de lesiones. Para determinar la distribución de las lesiones de un equipo profesional de fútbol durante una temporada; se realizó un estudio de cohorte prospectivo incluyó a los 29 jugadores de la categoria A del Deportivo Independiente Medellín que participaron en la primera temporada de 2009 de la copa Mustang. Cada uno de los jugadores diligenció una encuesta inicial que incluía la edad, posición de juego, lesiones previas incapacitantes en los últimos dos años y dominancia del miembro inferior. Diariamente se llenaba el formato de lesión para cada jugador, en entrenamiento y competencia, que incluía sitio anatómico lesionado, tipo de lesión, diagnóstico inicial, diagnóstico definitivo, lesión recurrente, mecanismo de lesión, causa de la lesión e incapacidad. La edad promedio fue de 23,55 ± 4,65. El 44,8% de los jugadores reportaron antecendentes de les¡ón en los últimos 2 años. El 64,3% de las lesiones ocurrieron durante la competencia. El sitio anatómico más afectado fue el muslo. El primer diagnóstico fue el desgarro muscular y siempre ocurrio en competencia. La mayoría de las lesiones fueron musculares (35,7%) y de no contacto (85,7%). Las lesiones por sobreuso y trauma presentaron la misma frecuencia en todo el grupo. El 50% de las lesiones fueron leves. No se presentaron lesiones recurrentes. Se presentaron más lesiones durante la competencia, principalmente desgarros musculares del muslo, de no contacto, por sobreuso y trauma, leves en severidad y primordialmenteen jugadores con lesiones previas.

To determine the distribution of injuries to professional football team during a season, a prospective cohort study included the 29 players from Class A Deportivo Independiente Medellín who participated in the first season of 2009 Mustang Cup was done. Each player fills out an initial survery that included age, playing position, previous disabling injuries in the past two years and lower limb dominance. Every day was filled format for each player injury in training and competition, which included anatomical site injured, type of injury, initial diagnosis, final diagnosis, recurrent injury, mechanism of injury, cause of injury and disability. The average age was 23,55 ± 4,65. The 44,8% of players reported a history of injury in the last 2 years. 64,3% of injuries occurred during competition. The most affected anatomical site was the thigh. The first diagnosis was a muscle tear and always occurred in competition. Most of the injuries were muscle (35,7%) and no contact (85,7%). Overuse injuries and trauma showed the same frequency in the group. 50% of the injuries were minor. There were no recurrent lesions. There were more injuries during competition, particularly the thigh nuscle tears, no contact, overuse and trauma, mild in severity and primarily players with previous injuries.

Comparison of magnetic resonance imaging findings in anterior cruciate ligament grafts with and without autologous platelet-derived growth factors.

PURPOSE: To determine whether the use of platelet-rich plasma gel (PRPG) affects magnetic resonance imaging (MRI) findings in the anterior cruciate ligament (ACL) graft during the first year after reconstruction. METHODS: A prospective single-blinded study of 50 ACL reconstructions in 50 patients was performed. In group A (study group) PRPG was added to the graft with a standardized technique, and in group B (control group) no PRPG was added. An MRI study was performed postoperatively between 3 and 9 months in group A and between 3 and 12 months in group B. The imaging analysis was performed in a blind protocol by the same radiologist. RESULTS: The mean heterogeneity score value at the time of MRI, assigned by the radiologist, was 1.14 in group A and 3.25 in group B. Both groups were comparable in terms of sex and age (P < .05). The mean time to obtain a completely homogeneous intra-articular segment in group A (PRPG added) was 177 days after surgery, and it was 369 days in group B. Using the quadratic predictive model, these findings show that group A (PRPG added) needed only 48% of the time group B required to achieve the same MRI image (P < .001). CONCLUSIONS: ACL reconstruction with the use of PRPG achieves complete homogeneous grafts assessed by MRI, in 179 days compared with 369 days for ACL reconstruction without PRPG. This represents a time shortening of 48% with respect to ACL reconstruction without PRPG.

Dermatosis del deporte / Skin disease of sports

Durante la mayoría de los ejercicios deportivos la piel y sus anexos están sometidos a constantes factores traumáticos, infecciosos, alergenos, químicos y otras variables ambientales potencialmente dañinos. La primera causa de injuria cutánea traumática es el equipamiento deportivo. En este artículo se revisan algunas de las manifestaciones dermatológicas mas comunes relacionadas con la participación en los deportes. Se plantea su diagnóstico, tratamiento y prevención.

Etodolac: analgesic effects in musculoskeletal and postoperative pain.

Numerous clinical trials have shown etodolac to be an effective analgesic. The purpose of the present report is to review results of 14 studies that demonstrate the effectiveness of etodolac in a variety of painful conditions. Presented are the results of four postsurgical pain studies, one study of acute gouty arthritis and nine studies of acute musculoskeletal disorders: acute low back pain, acute painful shoulder, tendinitis and bursitis, and acute sports injuries. A single oral dose of etodolac (25, 50, 100, 200, or 400 mg) was compared with aspirin (650 mg) or a combination of acetaminophen (600 mg) plus codeine (60 mg) for the relief of pain up to 12 h following oral, urogenital or orthopedic surgery. In multiple dose studies of acute gouty arthritis and musculoskeletal conditions, etodolac 200 or 300 mg twice a day (b.i.d.) or 200 mg three times a day (t.i.d.) was compared with naproxen 500 mg b.i.d. or t.i.d., diclofenac 50 mg b.i.d. or t.i.d., and piroxicam 20 or 40 mg once a day (o.d.) administered over 5 to 14 days. The efficacy of etodolac was at least equal and in some ways superior to aspirin and acetaminophen plus codeine in the relief of postsurgical pain. In studies of acute gouty arthritis, significant improvement from baseline were seen for all efficacy parameters evaluated for both the etodolac- and naproxen-treated patients. All the present studies of musculoskeletal conditions have shown etodolac to be effective and comparable in analgesic efficacy to naproxen, diclofenac or piroxicam. In summary, etodolac therapy for pain following surgery, in acute gouty arthritis and in acute musculoskeletal conditions resulted in analgesia comparable to that provided by several well-established analgesic or anti-inflammatory agents.