Medical services at the 2017 Sapporo Asian winter games: injury and illness epidemiology at a 34-nation multisport event.

OBJECTIVES: We describe the medical services provided and report the injuries and illnesses that occurred at the eighth Asian Winter Games 2017. METHODS: A total of 2010 athletes and team officials from 32 National Olympic Committees and 2 guest countries attended this event; medical services were provided for 16 days. Medical data (medical care and physiotherapy) were collected for the same period by the organising committee for athletes and non-athletes (team officials, workforce, media and spectators) and recorded on the electronic medical record system at the medical rooms in the venues and the team residences. RESULTS: We recorded 745 medical encounters (medical care, 443; physiotherapy, 302), of which 549 (74%) were among athletes. There were 214 injuries as well as 144 illnesses and other medical conditions. Of the 1164 athletes, 549 (47%) utilised the services. Ice hockey, snowboarding and alpine skiing had high rate of medical encounters. More than half of the delegations were not accompanied by team doctor, and rate of medical encounters was high in these teams. The vast majority of patients transferred to hospital for further care were mostly athletes (n=36 out of 41), mostly alpine skiers and ice hockey players. CONCLUSION: Injuries and illnesses varied depending on NOC medical staffing and sport events. These data will serve organisers of medical and physiotherapy services in the Asian Winter Games and similar large events.

Epidemiological patterns of traumatic musculoskeletal injuries and non-traumatic disorders in Japan Self-Defense Forces.

BACKGROUND: The epidemiological patterns of musculoskeletal injuries or disorders in military personnel have not been well documented and a better understanding is required for proper preventative measures and treatment. Here, we investigated musculoskeletal injuries or disorders among members of the Japan Self-Defense Forces. METHODS: All orthopedic patients (n = 22,340) who consulted to Japan Self-Defense Forces Hospitals were investigated for their type of injury or disorder, the injured body part, the mechanism, and the cause of injuries. RESULTS: Thirty-nine percent of the cases were classified as traumatic injuries, and 61% were classified as non-traumatic disorders. Of the traumatic injury patients, the injured body part was the upper extremity in 32%, the trunk in 23%, and the lower extremities in 45% of the cases. The most common injured body location was the knee followed by the hand/finger and ankle. Exercise was the most common cause of injury, followed by traffic accident and military training. Contusions were the most common traumatic injuries, followed by sprains and fractures. Of non-traumatic disorders, the lower extremities were reported as the injured part in 43% of the disorders. Lumbar spine disorders were the most common non-traumatic disorders, followed by tendon and joint disorders. CONCLUSIONS: Over one-third of orthopedic cases among members of the Japan Self-Defense Forces are traumatic injuries, with the knee being the body part most commonly injured and exercise being the leading cause of injury.

Effect of distal radius volar plate position on contact pressure between the flexor pollicis longus tendon and the distal plate edge.

PURPOSE: Some clinical studies have suggested that distal radius plates placed distal to the watershed line have the potential to impinge on the traversing flexor tendons. However, the validity of this theory remains unclear. The purpose of this study was to evaluate the quantitative effect of volar plate position on flexor pollicis longus (FPL) tendon friction by measuring the contact pressure between the FPL tendon and the distal edge of the locking plate. METHODS: We used 7 fresh cadaveric upper extremities without wrist osteoarthritis or any deformity. External loads of 1.5 and 3.0 kgf were applied to the FPL tendon to simulate the pinch function of the thumb. A distal radius volar plate was applied to these cadaveric specimens in various positions relative to the watershed line. We measured contact pressure between the distal plate edge and the FPL tendon using a thin flexible pressure sensor and compared it among various positions of the volar plate for wrist extension angles of 0°, 30°, and 60° and ulnar deviation angles of 0° and 20°. RESULTS: Under the 30° or 60° wrist extension condition, contact pressure significantly increased when the distal plate edge was placed distal to the watershed line, compared with when it was placed proximal to or at the watershed line. CONCLUSIONS: Our quantitative results support the theory that plates placed distal to the watershed line have the potential to impinge on the traversing FPL tendon, even when a radius fracture heals anatomically. CLINICAL RELEVANCE: This study clarifies a mechanism of FPL tendon irritation after volar plate fixation for distal radius fractures.

Effectiveness of external rotation immobilization in highly active young men with traumatic primary anterior shoulder dislocation or subluxation.

We treated 15 highly active young men (16 shoulders) with traumatic primary anterior shoulder dislocation or subluxation using 3-week external rotation immobilization. Fourteen patients (14 shoulders) were members of the Self-Defense Force and the other patient (2 shoulders) was a high school student who played club-level rugby. Average patient age at the time of the primary injury was 21.3 years (range, 17-26 years). Magnetic resonance imaging (MRI) was performed on 14 of 16 shoulders after the 3-week external rotation immobilization and showed that the anteroinferior labrum was reduced on the glenoid rim in 11 shoulders but remained medially displaced on the glenoid neck in 3 shoulders. Five shoulders, including these 3 shoulders, underwent arthroscopic Bankart repair after 3-week external rotation immobilization. Eleven shoulders continued nonoperative treatment after the immobilization. Four of 11 shoulders had no recurrence of symptoms for >2 years, and these patients were able to return to their preinjury activities. However, 7 shoulders experienced recurrence within 2 years. We concluded that external rotation immobilization may not be as effective as mentioned previously in highly active young men with primary traumatic anterior shoulder dislocation or subluxation. Whether a patient has instability symptom recurrence after external rotation immobilization depends on more than the fact that the anteroinferior labrum is not reduced on MRI.

Measurement of subclavicular pressure on the subclavian artery and brachial plexus in the costoclavicular space during provocative positioning for thoracic outlet syndrome.

BACKGROUND: Thoracic outlet syndrome is thought to be caused by compression of the brachial plexus or subclavian artery in the interscalene, costoclavicular, or subcoracoid space. Some provocative tests are widely used for diagnosing thoracic outlet syndrome. However, whether provocative positions actually compress the neurovascular bundle in these spaces remains unclear. The purpose of this study was to investigate the possibility of neurovascular bundle compression in the costoclavicular space by measuring the pressure applied to the brachial plexus and subclavian artery in provocative positions. METHODS: Bilateral shoulders of eight fresh-frozen transthoracic human cadavers with no obvious anatomical abnormalities were used in this study. There were three female and five male cadavers with a mean age of 81.7 years (range 72-90 years). The pressure on the brachial plexus and subclavian artery between the clavicle and first rib were measured using a 0.13-mm thin pressure sensor in each of four provocative positions (depressed position, alternative Eden position, throwing position, Wright position). RESULTS: Nerve contact pressure was increased in seven shoulders in the Wright position (2.87 +/- 3.13 N/cm(2); range 0.81-9.76 N/cm(2)). The frequency of nerve compression in the Wright position was significantly higher when compared to that in the other three limb positions (P = 0.018). Artery contact pressure was increased in three shoulders in the Wright position (mean 0.59 +/- 0.13 N/cm(2); range 0.45-0.7 N/cm(2)). As was the case with nerve compression, the frequency of compression tended to be higher for the Wright position, but no significant difference was seen. CONCLUSIONS: In four of eight specimens with no obvious anatomical abnormalities, the brachial plexus was compressed in the costoclavicular space in the Wright position. The Wright position thus may be a useful position for inducing nerve compression in the costoclavicular space.

Recovery of shoulder rotational muscle strength after a combined Bankart and modified Bristow procedure.

The objective of this study was to determine the influence of rotational muscle strength on shoulder function after a combined open Bankart and modified Bristow procedure and to determine the time of recovery for shoulder rotational strength. Fourteen patients were investigated by use of the relationship between the Rowe score and isokinetic concentric muscle strength. Forty patients were measured regarding the time course of muscle strength preoperatively and at 1.5, 3, 4.5, 6, 9, and 12 months postoperatively. There was a positive correlation coefficient between the Rowe score and muscle strength. The mean peak torque was significantly lower than the preoperative level at 1.5 and 3 months after surgery (P < .01) and recovered by 4.5 months after surgery. The contralateral peak torque ratio continued to increase until 12 months after surgery. These results indicate that high-level sports activities should be delayed until 9 to 12 months after a Bankart and modified Bristow procedure.

Effect of weight loss on T-cell receptor-mediated T-cell function in elite athletes.

PURPOSE: Long-term intensive exercise by athletes may sometimes lead to a susceptibility to infections. In the present study, we examined the differences in immune function between amateur wrestlers experiencing weight loss (WL) and those without WL who underwent similar intensive exercise training. METHODS: Eighteen elite amateur wrestlers who attended the Japanese national championship were classified into two groups. One group consisted of those with either slight or no WL (without WL) (<4%; mean, 1%) (N = 9), and the other group consisted of those who needed a significant WL (with WL) (> or = 4%; mean, 7%) (N = 9) during a 1-month period of intensive training. The leukocyte counts as well as the leukocyte subsets in the peripheral blood were examined. The proliferation and cytokine production in T lymphocytes in response to bacterial superantigens (staphylococcal enterotoxin B, streptococcal pyrogenic exotoxin A) and anti-CD3 antibody (Ab) were also examined. RESULTS: The total leukocyte counts and leukocyte subsets did not differ substantially between the groups and were also not different from the findings before starting the intensive exercise training. Natural killer cells and T cells among the lymphocytes significantly increased in both groups, whereas the increase in each group was not different. Although the T-cell responses to bacterial superantigens were not different, the anti-CD3 Ab-stimulated proliferation and interferon-gamma production of lymphocytes from the wrestlers with WL were significantly lower than those of the wrestlers without WL. This hyporesponsiveness to CD3 stimulation recovered 2 months after the tournament when the wrestlers reverted to their normal weight. CONCLUSION: Intensive exercise in athletes accompanied by a rapid WL was found to compromise the CD3/T-cell receptor-mediated T-cell function in athletes.