Ultrasound-Guided Electroacupuncture Treatment for Rotator Cuff Tendinopathy: Proposing an Effective Alternative to Nonoperative Medical Treatments.

Background: Rotator cuff (RTC) tendinopathy is a common painful condition of the shoulder that impairs function and quality of life. Nonoperative treatments when physical therapy and oral medications have not resolved the issue often consist of different strategies to improve blood flow and promote growth factors, thereby creating regeneration and healing of injured tissue in the RTC tendons. Acupuncture could serve in a similar role when needles are strategically targeted into injured tissue utilizing ultrasound visualization. Case: A 58-year-old male presented with over 1 year of symptomatic RTC tendinopathy involving the supraspinatus and infraspinatus tendons. He had not gotten sustained pain relief with physical therapy or a corticosteroid injection to the subacromial bursa and was not a surgical candidate for RTC repair due to only having small partial tearing of the tendons. He wanted to consider alternative treatment options and it was decided that he could pursue ultrasound-guided electroacupuncture. Results: Treatment was successful and completed within 4 weekly sessions. He reported 85% improvement in symptoms two months after starting treatment and is now over 1 year out from treatment, with what the patient states as "minimal" residual discomfort with one stretching movement. Conclusions: Ultrasound guidance of acupuncture needles into areas of RTC tendon injury simulates many of the current nonoperative treatment modalities sports medicine has to offer for RTC tendinopathy. This short- and long-term successful case report provides a steppingstone for future research into this area.

Attention Deficit Hyperactivity Disorder: Unique Considerations in Athletes.

CONTEXT: Attention deficit hyperactivity disorder (ADHD) is a common psychiatric condition in the general population, with evidence suggesting that it may be more common among athletes. EVIDENCE ACQUISITION: Literature searches were performed on PubMed, MEDLINE, and Cochrane databases for the years 2000 to 2016 utilizing the following key search terms: ADHD, ADD, guidelines, diagnosis, athlete, sports, treatment, pharmacotherapy, stimulants, risk, cardiovascular effects, concussion, and traumatic brain injury (TBI). STUDY DESIGN: Clinical review. LEVEL OF EVIDENCE: Level 4. RESULTS: ADHD exists among athletes at all levels of play, and symptomatology overlaps significantly with that of concussion. Treatment with stimulants has cardiovascular effects and may not be permitted by the athlete's governing body. An athlete's level of competition and individual cardiovascular risk factors may therefore affect medication choices. CONCLUSION: ADHD diagnosis and treatment are paramount to optimal quality of life and functioning in affected individuals. Pharmacologic treatment options should not specifically be avoided in athletes; however, stimulant use is an independent risk factor for heat illness. Concussion, a common athletic injury, may have an altered course in those affected by ADHD, specifically with regard to neurocognitive testing and recovery.