Single leg balance test to identify risk of ankle sprains.

BACKGROUND: Ankle sprains are a common and potentially disabling injury. Successful prediction of susceptibility to ankle sprain injury with a simple test could allow ankle sprain prevention protocols to be initiated and help prevent disability in the athletic population. OBJECTIVE: To investigate the ability of the single leg balance (SLB) test, carried out at preseason physical examination, to predict an ankle sprain during the autumn sports season. DESIGN: Prospective cohort study SETTING: High school varsity athletics and intercollegiate athletics. MAIN OUTCOME MEASURE: Ankle sprains in athletes with positive SLB tests. RESULTS: The association between a positive SLB test and future ankle sprains was significant. Controlling for confounding variables, the relative risk for an ankle sprain with a positive SLB test was 2.54 (95% confidence interval, 1.02 to 6.03). Athletes with a positive SLB test who did not tape their ankles had an increased likelihood of developing ankle sprains. The relative risk for ankle sprain for a positive SLB test and negative taping was 8.82 (1.07 to 72.70). A history of previous ankle injury was not associated with future ankle sprains in this study. The kappa value for interrater reliability for the SLB test was 0.898 (p<0.001). CONCLUSIONS: An association was demonstrated between a positive SLB test and ankle sprain. In athletes with a positive SLB test, not taping the ankle imposed an increased risk of sprain. The SLB test is a reliable and valid test for predicting ankle sprains.

The physically-challenged athlete: medical issues and assessment.

The rate and pattern of injuries is similar in both physically-challenged and able-bodied athletic participation. However, understanding of the unique medical issues faced by physically-challenged athletes is necessary in conducting appropriate pre-participation evaluations and developing strategies for injury prevention and medical management. Review of the literature provides insight for choosing relevant tests and interpreting components of the physical examination for this population. More research is needed in the management of medical problems specific to the physically-challenged athlete.

Knee braces: current evidence and clinical recommendations for their use.

Methods of preventing and treating knee injuries have changed with the rapid development and refinement of knee braces. Prophylactic knee braces are designed to protect uninjured knees from valgus stresses that could damage the medial collateral ligaments. However, no conclusive evidence supports their effectiveness, and they are not recommended for regular use. Functional knee braces are intended to stabilize knees during rotational and anteroposterior forces. They offer a useful adjunct to the treatment and rehabilitation of ligamentous knee injuries. Patellofemoral knee braces have been used to treat anterior knee disorders and offer moderate subjective improvement without significant disadvantages. Additional well-designed studies are needed to demonstrate objectively the benefits of all knee braces. Knee braces should be used in conjunction with a rehabilitation program that incorporates strength training, flexibility, activity modification and technique refinement.

Progressive knee pain in a young football player.

An 11-year-old male football player had a 3-month history of persistent right thigh pain. He had continued to play regularly despite intermittent pain and cramping, but symptoms had worsened significantly and he had lately had occasional flulike symptoms and mild fever. X-rays and an ultrasound vascular study were normal, but an MRI revealed a possible femoral sarcoma. A biopsy demonstrated osteomyelitis of the right femur with an adjacent abscess. After a course of parenteral antibiotics, he recovered fully and returned to competitive football. Osteomyelitis in adolescents can lead to a variety of nonspecific symptoms, and heightened awareness is important for accurate diagnosis and treatment.

The "burner": a common nerve injury in contact sports.

A "burner" is a common nerve injury resulting from trauma to the neck and shoulder, usually during sports participation. The injury is most often caused by traction or compression of the upper trunk of the brachial plexus or the fifth or sixth cervical nerve roots. Burners are typically transient, but they can cause prolonged weakness resulting in time loss from athletic participation. Furthermore, they often recur. Treatment consists of restoring range of motion, improving strength and providing protective equipment. Return to sports participation depends primarily on reestablishment of pain-free motion and full recovery of strength and functional status.

Relationship between concussion and neuropsychological performance in college football players.

CONTEXT: Despite the high prevalence and potentially serious outcomes associated with concussion in athletes, there is little systematic research examining risk factors and short- and long-term outcomes. OBJECTIVES: To assess the relationship between concussion history and learning disability (LD) and the association of these variables with neuropsychological performance and to evaluate postconcussion recovery in a sample of college football players. DESIGN, SETTING, AND PARTICIPANTS: A total of 393 athletes from 4 university football programs across the United States received preseason baseline evaluations between May 1997 and February 1999. Subjects who had subsequent football-related acute concussions (n = 16) underwent neuropsychological comparison with matched control athletes from within the sample (n = 10). MAIN OUTCOME MEASURES: Clinical interview, 8 neuropsychological measures, and concussion symptom scale ratings at baseline and after concussion. RESULTS: Of the 393 players, 129 (34%) had experienced 1 previous concussion and 79 (20%) had experienced 2 or more concussions. Multivariate analysis of variance yielded significant main effects for both LD (P<.001) and concussion history (P=.009), resulting in lowered baseline neuropsychological performance. A significant interaction was found between LD and history of multiple concussions and LD on 2 neuropsychological measures (Trail-Making Test, Form B [P=.007] and Symbol Digit Modalities Test [P=.009]), indicating poorer performance for the group with LD and multiple concussions compared with other groups. A discriminant function analysis using neuropsychological testing of athletes 24 hours after acute in-season concussion compared with controls resulted in an overall 89.5% correct classification rate. CONCLUSIONS: Our study suggests that neuropsychological assessment is a useful indicator of cognitive functioning in athletes and that both history of multiple concussions and LD are associated with reduced cognitive performance. These variables may be detrimentally synergistic and should receive further study.

Neck Pain and Dyspnea in a Swimmer: Spontaneous Pneumomediastinum Presentation and Return-to-Play Considerations.

Spontaneous pneumomediastinum is usually a benign, self-limiting condition in which retrosternal chest pain is the most common complaint and subcutaneous emphysema is the most prevalent physical finding. Chest radiographs confirm the diagnosis. A case report of a 19-year-old college swimmer who initially reported anterior neck pain demonstrates the importance of avoiding complications such as pneumothorax with careful monitoring, outpatient management, and cessation of athletic activities. After 7 to 10 days patients can slowly resume sports if symptoms do not recur.

Prescribing functional braces for knee instability.

Functional knee braces (FKBs) have become a popular adjunct to managing ACL injuries (1). Since their introduction, functional braces have gained wide acceptance for use on ACL-deficient knees and for graft protection during rehabilitation after ACL reconstruction (2).

Using patellofemoral braces for anterior knee pain.

Disorders of the patellofemoral joint are common in recreational and competitive athletes. The pathophysiology of these disorders is unclear but may be related to malalignment of the patella and femoral trochlea, which may produce the characteristic anterior knee symptoms (1). Diagnosing and treating patellofemoral pain syndrome is challenging but important, since patellofemoral abnormalities can result in substantial discomfort and disability.

Ankle sprains expedient assessment and management.

Most ankle injuries occur from excessive inversion, but it is important to be able to differentiate a simple inversion sprain from a potentially disabling injury. Expedient diagnosis includes first screening for deformities and then performing specific tests like the anterior drawer and side-to-side test. To optimize assessment, the examiner needs to take advantage of the preswelling period on the sidelines. Physicians can treat most ankle injuries nonoperatively, taking steps to ensure a quick return to play. Fracture signs and treatment are covered in a comprehensive table.

Medicine in motion.

When C. Everett Koop exclaimed that exercise is the "most potent modifier of health" in medicine today ((1)), he was merely echoing what most of us have known for the past 25 years. Exercise is not only recreation and work, it is also therapy, prevention, and treatment. Primary care physicians inherently practice "sports medicine" with each patient they treat because they know the inherent health benefits of physical activity. As a result, society now has a greater consciousness about sports medicine and the benefits of exercise than ever before.

Cryotherapy-induced common peroneal nerve palsy.

PURPOSE: To report an uncommon complication of distal hamstring icing, cryotherapy-induced common peroneal nerve palsy. CASE SUMMARY: A 22-year-old football player applied ice to his distal hamstring for 20 min because of soreness. This application of ice resulted in foot drop and sensory changes in the anterior lower leg and dorsum of the foot. Over the next year, full clinical neurologic function returned. DISCUSSION: Previously reported cases of cryotherapy-induced common peroneal nerve palsy involved lateral knee or circumferential thigh icing with nerve injury at the fibular neck. This case involved distal hamstring icing, and nerve injury occurred more proximally. RELEVANCE: This case demonstrates that caution should be used even when using a modality as common as ice. Ice exposure should be limited in patients with low body fat or in areas where a nerve is not well protected by subcutaneous tissue.

Seasonal mood disturbances in collegiate hockey players.

OBJECTIVE: THE PURPOSE OF THIS PAPER IS TO: 1) describe the seasonal affective disorder syndrome using a case illustration, 2) provide a simple and reliable method for identifying seasonal affective disorder, and 3) provide data as to the prevalence of the syndrome in a subset of collegiate hockey players. DESIGN AND SETTING: Collegiate hockey players were selected, because their practices begin in the fall and play is completed in the spring. The teams selected for participation were from the far Northwest and the upper Midwest regions. SUBJECTS: Sixty-eight Division I hockey players volunteered for the study. The three teams from which the subjects were chosen were located above latitude 42 degrees /45' north. Subjects were from the northern latitudes. MEASUREMENTS: The Seasonal Pattern Assessment Questionnaire was used to screen for seasonality. A sample of the athletes was also examined using the Hamilton Rating Scale for Depression together with the Diagnostic and Statistical Manual of Mental Disorders (4th ed) criteria for Seasonal Pattern Specifier. RESULTS: Thirty-three (51%) were asymptomatic, 7 (11%) met the criteria for seasonal affective disorder, and 25 (39%) hockey players scored in the range that could classify them as candidates for subsyndromal seasonal affective disorder. CONCLUSIONS: The prevalence of seasonal affective disorder among our sample approximated the national norm for the northern latitudes. However, the prevalence of subsyndromal seasonal affective disorder in our population was 25% compared to 13% reported nationally. Light therapy has been shown to reverse the effects of the disorders; however, further research needs to be conducted to determine its acceptance and effectiveness by the athletic population.

Practical methods of preventing ankle injuries.

Each year ankle sprains account for a significant degree of disability and expense. Thus, it is important that family physicians become familiar with methods of preventing ankle sprains. Both internal and external methods prevent ankle injuries. Internal methods include improving flexibility, strength and proprioception; effective external methods of ankle protection include using athletic tape, lace-up stabilizers and semirigid orthoses.

Ugh! Sports physicals!

For the most part, physicians who take care of athletes tend to view the preparticipation physical exam (PPE) as a necessary but time-consuming and somewhat bothersome evil. It is not fun. It usually occurs at the hottest, most uncomfortable time of the year, and is often sandwiched between regular work responsibilities and family plans. ("I'd love to see you pitch tonight, Ian, but I've got to do sports physicals for 3 hours after work.").

Noncontact knee dislocation in a female basketball player: a case report.

Knee ligamentous injuries occur during sport, and when there is extensive injury, they can be associated with subluxation or dislocation. We present the case of a female basketball player who sustained a knee dislocation during noncontact play. An immediate angiogram confirmed vascular integrity, and surgical treatment with ligamentous reconstruction was performed. Peroneal nerve injury was present but resolved in 42 weeks. A review of the literature discussing knee dislocation is presented.

Common injuries in the child or adolescent athlete.

As more primary care physicians enter the field of Sports Medicine, they will inevitably encounter more injured young athletes than what they may have experienced in their private practices. Recognizing the differences that exist between the young athlete and adult is essential in properly diagnosing and rehabilitating these athletes. As mentioned in our previous article (Caring for the School-Aged Athlete, Primary Care, December 1994), comprehensive care of the young athlete can be quite involved and somewhat different from care of the adult population. This article focuses on some specific injuries unique to younger, skeletally immature athletes, while mentioning the differential diagnosis of some of the other common sports injuries shared by both younger and older athletes.