Shoulder and elbow symptoms in talented Dutch baseball pitchers: results of a two-season prospective study.

CONTEXT: Baseball pitching requires fast and coordinated motions of the whole body to reach high ball speeds, putting considerable strain on the musculoskeletal system, particularly the shoulder and elbow. DESIGN: Descriptive epidemiology study. OBJECTIVE: To describe musculoskeletal symptoms and the functional status of the shoulder and elbow in male high school baseball pitchers. SETTING: Dutch baseball talent academies. PATIENTS OR OTHER PARTICIPANTS: 125 male high school baseball pitchers aged 12 to 18 years, who participated in one of the six Dutch baseball talent academies and the Dutch National U-18 team were recruited and enrolled. MAIN OUTCOME MEASURE(S): Musculoskeletal symptoms, functional status of the shoulder and elbow were registered for each player every six months over two consecutive baseball seasons through self-assessment questionnaires, including the Kerlan-Jobe Orthopaedic Clinic (KJOC) and the Western Ontario Shoulder Instability Index (WOSI) questionnaires. RESULTS: 570 musculoskeletal (MSS) symptoms in 93 of the 125 players were reported. The average six-month prevalence for symptoms of the throwing shoulder was 37% (95% CI: 33% - 41%), and for the elbow 37% (95% CI: 31% - 42%), followed by the lower back with 36% (95% CI: 26% - 45%). The baseball pitchers who experienced only shoulder symptoms had an average KJOC score of 80.0 (95% CI: 75.3-84.7) points, while those with only elbow symptoms reported a score of 90.2 (95% CI: 89.2-95.3). On the WOSI questionnaire, baseball pitchers scored an average of 421.2 (95% CI: 200.1 - 642.4) points. CONCLUSION: In a cohort of Dutch high school baseball pitchers, one-third reported shoulder and elbow symptoms on the throwing side, with reduced functional status and lower back symptoms. Future efforts should focus on developing preventive strategies through early symptom detection, aiming to prevent symptom progression and, ultimately, the development of severe injuries.

Injuries in Dutch elite field hockey players: A prospective cohort study.

This study describes the prevalence, incidence density, severity, and nature of injuries in elite field hockey players over the Dutch 2015-2016 season. Eighty players answered a baseline questionnaire and were subsequently followed up every 2 weeks to report the hours spent on training/competition and experienced injuries, which were registered using the Oslo Sports Trauma Research Centre Questionnaire on Health Problems. Of the 74 players included in the analysis, 52 (70%) reported 112 injuries. Eighty-seven injuries (78%) received medical attention, and 56 (50%) led to training/competition time-loss. Thirty-four injuries (30%) hampered players' availability to train and compete. Most of the injuries (74%) were not caused by any contact. The mean prevalence of injury was 29% (95% confidence interval [CI] 3-55) for all, 9% (95% CI 0-20) for acute, and 14% (95% CI 0-36) for overuse injuries. Players sustained 3.5 (95% CI 2.5-4.5) new acute injuries per 1000 hours of training and 12.3 (95% CI 7.6-17.0) per 1000 hours of competition. The median of the severity score was 28 from 100 (25%-75% interquartile range [IQR] 16-42) for all, 35 (IQR 23-53) for acute, and 21 (IQR 16-31) for overuse injuries. On average, 1 in 4 elite field hockey players experiences an injury within a 2-week period during the season. Although acute injuries are common, overuse injuries pose a comparable problem in elite field hockey. As injuries are a burden on players' health and may hamper performance and availability to train and compete, prevention is of great importance.

Preventing recurrent ankle sprains: Is the use of an App more cost-effective than a printed Booklet? Results of a RCT.

Recurrent ankle sprains can be reduced by following a neuromuscular training (NMT) program via a printed Booklet or a mobile application. Regarding the high incidence of ankle sprains, cost-effectiveness regarding implementation can have a large effect on total societal costs. In this economic analysis, we evaluated whether the method of implementing a proven effective NMT program using an App or a Booklet resulted in differences in injury incidence rates leading to costs and hence to differences in cost-effectiveness. In total, 220 athletes with a previous ankle sprain were recruited for this randomized controlled trial with a follow-up of 12 months. Half of the athletes used the freely available "Strengthen your ankle" App and the other half received a printed Booklet. After the 8-week program, athletes were questioned monthly on their recurrent injuries. Primary outcome measures were incidence density of ankle injury and incremental cost-effectiveness ratio (ICER). During follow-up, 31 athletes suffered from a recurrent ankle sprain that led to costs resulting in a hazard ratio of 1.13 (95% CI: 0.56-2.27). The incremental cost-effectiveness ratio of the App group in comparison with the Booklet group was €361.52. The CE plane shows that there was neither a difference in effects nor in costs between both intervention methods. This study showed that the method of implementing the NMT program using an App or a Booklet led to similar cost-effectiveness ratios and the same occurrence of recurrent injuries leading to costs. Both the App and the Booklet can be used to prevent recurrent ankle injuries, showing no differences in (cost-) effectiveness at 12-month follow-up.

High prevalence of self-reported injuries and illnesses in talented female athletes.

BACKGROUND: A thorough knowledge of the epidemiology and severity of injuries and illness in youth female elite sports is lacking due to the methodological challenges involved in recording them. In this study, the prevalence and incidence of injuries and illness are assessed among youth female elite athletes. Instead of solely focusing on time-loss injuries, our study included all substantial and non-substantial health problems (ie, injuries, mental problems and illnesses). METHODS: Sixty young elite Dutch female athletes (age: 16.6 years (SD: 2.3), weight: 58.3 kg (SD: 15.1), height: 154.1 cm (SD: 44.2)) participating in soccer (n=23), basketball (n=22) and gymnastic (n=15) talent development programmes were prospectively followed during one season (September 2014 to April 2015). To collect health problem data, all athletes completed the Oslo Sports Trauma Research Center Questionnaire on Health Problems every other week. Main outcome measures were average prevalence of injury and incidence density of injury. RESULTS: At any given time, 47.9% of the athletes reported an injury (95% CI 43.6% to 52.6%) and 9.1% reported an illness (95% CI 5.1 to 19.0). The average injury incidence density was 8.6 per 1000 hours of athlete exposure. The average number of self-reported injuries per athlete per season was significantly higher in soccer athletes (4.3±2.7) than in basketball athletes (2.6±2.0) (p=0.03) and not significantly higher than in the gymnastic squad. The knee and the ankle were two of the most common injury locations for all squads. Knee injuries in basketball and soccer and heel injuries in the gymnastic squad had the highest impact on sports participation. CONCLUSION: High prevalence of self-reported injuries among talented female athletes suggests that future efforts towards their prevention are warranted.

The "Strengthen your ankle" program to prevent recurrent injuries: A randomized controlled trial aimed at long-term effectiveness.

OBJECTIVES: Recurrent ankle sprains can be reduced by a neuromuscular training program (NMT). The way NMT is delivered may influence the incidence of long term recurrent injuries, residual pain and disability. DESIGN: This RCT with a follow-up of twelve months, evaluated whether the implementation method of a proven effective NMT program delivered by a mobile application or a written instruction booklet, resulted in differences in injury incidence rates, functional ankle disability/pain in the long term, assuming equal compliance - as is shown in previous research - with the 8-week intervention. METHODS: 220 athletes with a history of ankle sprain were recruited for this RCT. 110 athletes were offered the freely available "Strengthen your ankle App" and the other 110 received a printed Booklet. Primary outcome measure was incidence density of ankle sprains. Secondary outcome measures were residual pain/disability and the individual cumulative number of ankle sprains during follow-up. RESULTS: The incidence densities of self-reported ankle sprain recurrences were not significantly different between both groups (HR 1.06; 95% CI 0.76-1.49). Median FADI (Functional Ankle and Disability Index) scores increased equally over time in both groups, indicating a lower rate of limitation and pain in both groups at follow-up. Neither FADI scores nor cumulative recurrent injuries were significantly different between groups. CONCLUSIONS: This study showed that the implementation method of a NMT program by using an App or a Booklet did neither lead to different injury incidence rates in the long term nor did it influence residual functional disability/pain. Assuming equal compliance during the 8-week intervention, both methods show similar effectiveness in twelve-month follow-up.

Is risk-taking in talented junior tennis players related to overuse injuries?

Overuse injuries are a serious problem in junior tennis. Gaining insight in age-specific risk factors can contribute to prevention. The developmental cognitive processes that take place during adolescence make talented players more inclined to take risks. This may be even more pronounced in the high performance culture in which they move. Therefore, this study focuses on the relationship between risk-taking and overuse injuries in talented tennis players. Seventy-three talented tennis players (45 boys and 28 girls, age 11-14 years) were monitored for 32 weeks, using the Oslo Sports Trauma Research Centre Questionnaire on Health Problems. Risk-taking was measured at the start of the season with the Iowa Gambling Task. Linear regression analyses were executed to predict (a) overuse injuries, (b) time loss overuse injuries and (c) overuse severity, by risk-taking, exposure time, and injury history. In boys, risk-taking contributed significantly to time loss overuse injuries [F(1,39) = 7.764, P = 0.008, R2  = 0.15] and to overuse severity [F(1,39) = 5.683, P = 0.022, with an R2 of 0.13] In girls, time loss overuse injuries [F(1,23) = 6.889, P = 0.018, R2  = 0.20] and overuse severity [F(1,23) = 7.287, P = 0.013, R2  = 0.24] were predicted by exposure time. Coaches and trainers should be aware that talented male tennis players who are inclined to take risks, are more likely to maintain risky behavioral patterns related to overuse injuries.

Increasing compliance with neuromuscular training to prevent ankle sprain in sport: does the 'Strengthen your ankle' mobile App make a difference? A randomised controlled trial.

BACKGROUND: E-health has the potential to facilitate implementation of effective measures to prevent sports injuries. AIM: We evaluated whether an interactive mobile application containing a proven effective exercise programme to prevent recurrent ankle sprains resulted in higher compliance as compared with regular written exercise materials. METHODS: 220 athletes participated in this randomised controlled trial with a follow-up of 8 weeks; 110 athletes received a booklet explaining an 8-week neuromuscular training programme; 110 athletes participated in the same programme in an interactive mobile App (Strengthen your ankle). The primary outcome was compliance with the exercise programme. Secondary outcome measure was the incidence density of self-reported recurrent ankle sprains. RESULTS: The mean compliance to the exercise scheme was 73.3% (95% CI 67.7% to 78.1%) in the App group, compared with 76.7% (95% CI 71.9% to 82.3%) in the Booklet group. No significant difference in compliance was found between groups. The incidence densities of self-reported time-loss recurrences were not significantly different between both groups (HR 3.07; 95% CI 0.62 to 15.20). SUMMARY: This study shows that the method of implementing the exercises by using an App or a Booklet does not lead to different compliance rates. NEW FINDINGS: The use of a mobile App or a Booklet lead to similar compliance and injury rates in the short term. TRIAL REGISTRATION NUMBER: The Netherlands National Trial Register NTR 4027. The NTR is part of the WHO Primary Registries.

Positional OSA part 2: retrospective cohort analysis with a new classification system (APOC).

BACKGROUND: In Part 1 of this two-part article, the Amsterdam Positional Obstructive Sleep Apnoea Classification (APOC) was recently introduced, a classification system aimed at facilitating the identification of suitable candidates for positional therapy (PT): patients who will benefit from a clinically significant improvement of their obstructive sleep apnoea (OSA) with PT. APOC was developed with new generation PT devices in mind rather than conventional PT (tennis ball technique). New generation PT can be defined as a well-tolerated device which prevents a patient from adopting the worst sleeping position (WSP) without negatively influencing sleep efficiency, as objectified by a full night polysomnography (PSG). PT is rapidly gaining momentum in the scope of OSA treatment. The objective of this manuscript is to measure the prevalence of position-dependent obstructive sleep apnoea (POSA) according to the APOC, in a consecutive series of patients referred for PSG as well as an investigation of associations between POSA and certain patient characteristics. METHODS: We performed a retrospective, single-centre cohort study including a consecutive series of patients who underwent a PSG during the period of April 2010 until October 2010. RESULTS: Within this OSA-cohort (n = 253), a prevalence of POSA of 69 % when applying APOC is measured, compared to 64 % when applying Cartwright's classification. An inverse relation between POSA and BMI was observed, likewise between POSA and apnoea hypopnoea index (AHI). CONCLUSION: We are of opinion that APOC is a suitable tool to identify patients who will or will not benefit from PT, thus resulting in more cost-efficient treatment.

A one-season prospective study of injuries and illness in elite junior tennis.

The objective of this study was to estimate the incidence and prevalence of injury and illness among elite junior tennis players. A cohort of 73 players (11-14 years) in the 2012-2013 Dutch national high-performance program was followed for 32 weeks; all participants completed the study. The OSTRC Questionnaire on Health Problems was used to record self-reported injuries and illnesses and to record training and match exposure. Main outcome measures were average prevalence of overuse injury and illness and incidence density of acute injury. On average, players practiced 9.1 h/week (SD 0.6; range 2.3-12.0) and had 2.2 h of match play (SD 0.6; range 2.3-12.0). During the course of the study, 67 players reported a total of 187 health problems. The average weekly prevalence of all health problems was 21.3% (95% CI: 19.2-22.9), of which 12.1% (95% CI: 10.9-13.3) constituted overuse injuries and 5.8% (95% CI: 4.6-6.9) illnesses. The incidence of acute injuries was 1.2/1000 h of tennis play (95% CI: 0.7-1.7). The high occurrence of overuse injuries among elite junior tennis players suggests that an early focus on preventative measures is warranted, with a particular focus on the monitoring and management of workload.

Placental pathology and neurological morbidity in preterm infants during the first two weeks after birth.

BACKGROUND: The placenta plays a crucial role during pregnancy and dysfunction causes long-term neurological problems. Identifying placenta-related risks for neurological problems shortly after birth may provide clues for early interventions aiming to improve neurological outcome. OBJECTIVE: To determine the association between placental pathology and neurological morbidity in preterm infants during the first two weeks after birth. STUDY DESIGN: Placentas of 52 singleton, preterm infants (GA: 25-31weeks, BW: 560-2250 grammes) were examined for histopathology. The infants' neurological condition shortly after birth was determined by assessing the quality of their general movements (GMs): normal, abnormal, or hypokinetic, on days 5, 8, and 15. A motor optimality score (MOS) was also assigned. RESULTS: Examination of the placentas revealed maternal vascular underperfusion (n=29), ascending intrauterine infection (AIUI) (n=19), villitis of unknown aetiology (n=6), chronic deciduitis (n=11), foetal thrombotic vasculopathy (FTV) (n=9), and elevated nucleated red blood cells (NRBCs) as a marker for foetal hypoxia (n=7). None of the placental lesions were significantly associated with the quality of GMs or MOS. CONCLUSIONS: This study indicated that placental lesions were not associated with infants' neurological condition as measured by the quality of their general movements during the first two weeks after birth.

A qualitative study on overuse injuries: the beliefs of athletes and coaches.

OBJECTIVES: Preventive approaches for overuse injuries in sports will be more successful when synchronised with athletes' and coaches' beliefs. We interviewed athletes and coaches in order to better characterize their beliefs about the definition of an overuse injury, as well as the intrinsic and extrinsic risk factors that underlie overuse injuries. DESIGN: Qualitative study using in-depth interviews in athletes and coaches of different sports. METHODS: Athletes who had experienced overuse injuries and coaches who trained athletes who had sustained overuse injuries from sports clubs were invited to participate through interview. We explored each participant's individual definition of an overuse injury and the beliefs concerning the intrinsic and extrinsic risk factors concerning overuse injuries were explored. RESULTS: After nine athletes and nine coaches, sample size saturation was confirmed. Athletes and coaches integrate somatic as well as psychological and sociological factors into the definition of and risk factors for overuse injuries. Intrinsic factors for an overuse injury were related to physical factors, technique, psychological factors and heredity. The extrinsic factors were related to situational, social and training factors, as well as the individual coach. CONCLUSIONS: Athletes and coaches have a holistic view on the definition of overuse injuries, and the intrinsic and extrinsic risk factors for overuse injuries. If preventive approaches for overuse injuries are developed and implemented, they should incorporate physical factors, as well as incorporate psychological and social factors. Based on the input of coaches and athletes, the latter are important risk factors for overuse injuries.

Placental pathology is associated with illness severity in preterm infants in the first twenty-four hours after birth.

BACKGROUND: Placental pathology is associated with long-term neurological morbidity. Little is known about the association of placental pathology and illness severity directly after birth in preterm infants. OBJECTIVE: To determine the association between placental pathology and illness severity in preterm infants during the first 24 h after birth. STUDY DESIGN: Placentas of 40 preterm infants, born after singleton pregnancies (gestational age 25.4-31.7 weeks, birth weight 560-2250 g) were assessed for histopathology. Illness severity was measured using the Score of Neonatal Acute Physiology Perinatal Extension (SNAPPE). A high SNAPPE reflects high illness severity. RESULTS: Examination of the 40 placentas revealed: pathology consistent with maternal vascular underperfusion (MVU) (n=24), ascending intrauterine infection (AIUI) (n=17), villitis of unknown aetiology (VUE) (n=6), foetal thrombotic vasculopathy (FTV) (n=6), elevated nucleated red blood cells (NRBCs) (n=6), and chronic deciduitis (n=10). SNAPPE ranged from 1 to 53 (median 10). Infants with elevated NRBCs had a higher SNAPPE than infants without elevated NRBCs (median 30 vs. 10, p=0.014). The same was found for the presence of FTV (median 30 vs. 10, p=0.019). No relation existed between SNAPPE and the other placental pathologies. CONCLUSIONS: Elevated NRBCs and FTV were associated with higher illness severity during the first 24 h after birth in preterm infants. Ascending intrauterine infection was not associated with high illness severity.

Optimising ankle sprain prevention: a critical review and practical appraisal of the literature.

OBJECTIVES: To establish the effect of preventive measures and assert the optimal prevention strategy for acute lateral ligament injury to the ankle. METHODS: An electronic literature search was employed to look for published randomised controlled trials, a controlled trials or time interventions containing research questions regarding the prevention of lateral ankle ligament injuries. Two reviewers reviewed relevant studies for strengths and weaknesses in design and methodology, according to a standardised set of predefined criteria. A total of 24 relevant studies met the criteria for inclusion and were analysed. RESULTS: Overall taping, bracing and neuromuscular training were all effective for the prevention of ankle-sprain recurrences. The RRs of these prophylactic measures are of similar magnitude, ranging from 0.2 to 0.5 when compared with control groups. Although preventive effects have been reported in a general athletic population, evidence suggests this overall effect is due to a strong preventive effect in previously injured athletes and that any effect on fresh ankle sprains is either non-existent or very low. CONCLUSIONS: Based on these outcomes, a combination of an external prophylactic measure (tape or brace) with neuromuscular training will achieve the best preventive outcomes with minimal burden for the athlete.

An economic evaluation of a proprioceptive balance board training programme for the prevention of ankle sprains in volleyball.

OBJECTIVES: To evaluate the cost effectiveness of a proprioceptive balance board training programme for the prevention of ankle sprains in volleyball. METHODS: A total of 116 volleyball teams participated in this study which was carried out during the 2001-2002 volleyball season. Teams were randomly allotted to an intervention group (66 teams, 628 players) or a control group (52 teams, 494 players). Intervention teams followed a prescribed balance board training programme as part of their warm up. Control teams followed their normal training routine. An ankle sprain was recorded if it occurred as a result of volleyball and caused the subject to stop volleyball activity. The injured player completed a cost diary for the duration of the ankle sprain. Analyses were performed according to the intention to treat principle. Mean direct, indirect, and total costs were calculated and were compared between the two groups. RESULTS: The total costs per player (including the intervention material) were significantly higher in the intervention group (36.99 (93.87)) than in the control group (18.94 (147.09)). The cost of preventing one ankle sprain was approximately 444.03. Sensitivity analysis showed that a proprioceptive balance board training programme aimed only at players with previous ankle sprains could be cost effective over a longer period of time. CONCLUSIONS: Positive effects of the balance board programme could only be achieved at certain costs. However, if broadly implemented, costs associated with the balance board programme would probably be lower.

A one season prospective cohort study of volleyball injuries.

OBJECTIVE: To estimate the overall incidence of acute and overuse volleyball injuries, and to describe factors associated with ankle sprains. METHODS: 486 players from the second and third Dutch national volleyball divisions participated in the study and were followed prospectively during a whole season. Three measurements were made during the season (baseline, follow up 1, and follow up 2), where all players completed a questionnaire on demographic variables (only at baseline), sports participation, use of preventive measures, and previous injuries. Volleyball exposure during training and matches was recorded for each individual player by the coach on a weekly exposure form. In case of injury the coach provided the injured player with an injury registration form, which had to be completed within one week after the onset of injury. RESULTS: 100 injuries were reported, resulting in an overall injury incidence of 2.6 injuries/1000 hours. The incidence of acute injuries was 2.0/1000 hours. Ankle sprains (n = 41) accounted for most of the acute injuries, and 31 (75%) of all players with an ankle sprain reported a previous ankle sprain. Twenty five overuse injuries were reported. The overall incidence of overuse injuries was 0.6/1000 hours; the back and the shoulder were the most common sites. CONCLUSIONS: Ankle sprain is the most common injury in volleyball, accounting for 41% of all volleyball related injuries. Previous injury seems to be an important risk factor for an ankle sprain. Injury prevention programmes should focus on ankle sprains and concentrate on players with previous ankle sprains.

Effects of health information in youth on adult physical activity: 20-year study results from the Amsterdam growth and health longitudinal study.

In the Amsterdam Growth and Health Longitudinal Study (AGAHLS), a group of apparently healthy males and females (n = 200) were interviewed about their physical activities on eight separate occasions over a period of 20 years between 13 and 33 years of age (multi-measured group: MM). Information about their health was given based on their personally measured lifestyle (activity, diet, smoking) and biological risk characteristics for chronic diseases (medical check-ups). A comparable group of boys and girls (n = 200) was only measured on two occasions (bi-measured group: BM): at 13 and 33 years. Physical activity was estimated with a structured interview. Total physical activity and sports activity were estimated in three intensity levels (light, moderate, and heavy). It was hypothesized that the eight repeated medical check-ups with health information in the MM group would result in a healthier lifestyle with respect to the determinants and levels of habitual physical activity compared to the BM group. Contrary to the hypothesis, males and females in the BM group showed a significantly higher increase or a lower decrease in physical activities compared to the MM group. This negative effect on the physical activity pattern at 33 years in the MM group may have been caused by more underreporting of physical activities than in the BM group. In conclusion, there does not appear to be a significant effect of long-term (multi-measured) health information with medical check-ups during adolescence and young adulthood on level of physical activity in males and females at 33 years of age.

The effect of tape, braces and shoes on ankle range of motion.

Sport injuries are unwanted adverse effects accompanying participation in sports. In a wide variety of sports the most common location of injury is the ankle, frequently resulting from a forced plantar flexed inversion of the foot exceeding the physiological range of motion (ROM). Historically the purpose of external support systems is to prevent acute ankle injuries by restricting abnormal ankle ROM. It is believed that a superior restrictive effect also implies a superior preventive effect. The purpose of this review was to examine the literature regarding the restricting effect of adhesive taping, prophylactic ankle stabilisers (PAS) and high-top shoes on ankle ROM. It has been found that tape restricts ankle eversion and inversion ROM significantly following application. However, tape loosens significantly following standardised exercise and sports activities. Studies regarding PAS reported that both semi-rigid and nonrigid stabilisers give a significant post-application restriction of ankle inversion motion. The nonrigid stabilisers show loosening over time during exercise, while the semi-rigid stabilisers maintain their restrictive effect over the same time span. High-top shoes in comparison to low-top shoes are more effective in restricting mechanically imposed ankle inversion ROM. Low-top shoes, however, also limit mechanically imposed ankle inversion stress with the ankle in the position in which ankle injury occurs most frequently. One must keep in mind, however, that a superior mechanical restriction of ankle ROM does not necessarily imply a superior preventive effect. Only well-controlled randomised studies can show such an effect, and these studies have shown a reduction of ankle injury incidence for all 3 prophylactic measures reviewed.

The effect of preventive measures on the incidence of ankle sprains.

OBJECTIVE: To critically review the current data concerning the efficacy of preventive measures described in the literature, on the incidence of lateral ankle ligament injuries. DATA SOURCES: MEDLINE, Sportdiscus, and EMBASE were searched for papers published between 1980 and December 1998. Keywords used in the search were "prevention" in combination with "ankle," "ankle taping," "ankle bracing," "orthosis," "shoes," and "proprioception." Additional references were reviewed from the bibliographies of the retrieved articles. STUDY SELECTION: A study was included if: 1) the study contained research questions regarding the prevention of lateral ankle ligament injuries; 2) the study was a randomized controlled trial, a controlled trail, or a time intervention; 3) the results of the study contained incidence rates of lateral ankle ligament injuries as study outcome; and 4) the study met the cut-off score set for quality. DATA EXTRACTION AND SYNTHESIS: Two reviewers reviewed relevant studies for strengths and weaknesses in design and methodology, according to a standardized set of predefined criteria. Eight relevant studies met the criteria for inclusion and were analyzed. MAIN RESULTS: Overall, all studies reported a significant decrease in incidence of ankle sprains using the studied preventive measure. There was a great variety in methodology and study design between the eight analyzed studies, and every study had one or more drawbacks. Therefore, between studies only general results could be compared. CONCLUSIONS: The use of either tape or braces reduces the incidence of ankle sprains. Next to this preventive effect, the use of tape or braces results in less severe ankle sprains. However, braces seem to be more effective in preventing ankle sprains than tape. It is not clear which athletes are to benefit more from the use of preventive measures: those with or those without previous ankle sprains. The efficacy of shoes in preventing ankle sprains is unclear. It is likely the newness of the footwear plays a more important role than shoe height in preventing ankle sprains. Proprioceptive training reduces the incidence of ankle sprains in athletes with recurrent ankle sprains to the same level as subjects without any history of ankle sprains.

DNA-analysis is mandatory in case of an uncommon malignancy.

In a child a diagnosis of sweat gland carcinoma was made on basis of a surgical specimen presumed to be taken from an occipital lymph node. DNA analysis confirmed mixing of specimens in the referring hospital.