Treatment of the ulnar nerve for overhead throwing athletes undergoing ulnar collateral ligament reconstruction

Ulnar nerve(UN) injuries are a common complaint amongst overhead athletes. The UN is strained during periods of extreme valgus stress at the elbow, especially in the late-cocking and early acceleration phases of throwing. Although early ulnar collateral ligament(UCL) reconstruction techniques frequently included routine submuscular UN transposition, this is becoming less common with more modern techniques. We review the recent literature on the sites of UN compression, techniques to evaluate the UN nerve, and treatment of UN pathology in the overhead athlete. We also discuss our preferred techniques for selective decompression and anterior transposition of the UN when indicated. More recent studies support the use of UN transpositions only when there are specific preoperative symptoms. Athletes with isolated ulnar neuropathy are increasingly being treated with subcutaneous anterior transposition of the nerve rather than submuscular transposition. When ulnar neuropathy occurs with UCL insufficiency, adoption of the muscle-splitting approach for UCL reconstructions, as well as using a subcutaneous UN transposition have led to fewer postoperative complications and improved outcomes. Prudent handling of the UN in addition to appropriate surgical technique can lead to a high percentage of athletes who return to competitive sports following surgery for ulnar neuropathy.     

Use of the Menstrual Cycle to Enhance Female Sports Performance and Decrease Sports-Related Injury

The impact of the menstrual cycle on female sports performance is a growing interest area in sports and athletics. In March 2017, the British Journal of Sports Medicine, published the article, “Sport, Exercise and the Menstrual Cycle: Where is the Research?”, highlighting the significant under-representation of women included in sport and exercise medicine research studies. Dr. Georgie Bruinvels, a research scientist, is focused primarily on menstruation in female athletes and use of the menstrual cycle to optimize training and performance, while decreasing injury. Bruinvels, states, “There is a body of research emerging that highlights that strength training is more advantageous in the first half of the menstrual cycle because the body adapts and recovers better. Pediatric and Adolescent Gynecology has a place in this emerging interest area, given our level of expertise in menstruation, female physiology and the often-avoided female pubertal physiology.     

The effects of visual cognitive tasks on landing stability and lower extremity injury risk in high-level soccer players

BackgroundVisual cognition plays a pivotal role in sports. It is widely recognized that there is an intriguing coupling that they could affect each other through interaction between visual cognition and motor control, but few studies linked the effects of visual cognitive tasks on landing stability to postural control and injury risk.Research questionWhether visual cognitive tasks affect the landing stability and lower limb injury risk of professional soccer players?MethodsThe current study used a three-dimensional Multiple Object Tracking (MOT) task to simulate visual cognitive difficulties experienced in soccer matches. Fifteen male high-level soccer athletes (height: 181.43 ± 7.36 cm, weight: 75.37 ± 10.67 kg, training years: 10.07 ± 2.98 yr) from our school team were recruited and completed a landing action from a high platform with and without MOT tasks. Vicon infrared high-speed motion capture system and three-dimensional force measuring platform were used to collect various outcomes simultaneously.ResultsThe Time to Stabilization (TTS) during landing was significantly prolonged, while the Medial-Lateral Stability Index (MLSI), Anterior-Posterior Stability (APSI), Dynamic Postural Index Stability Index (DPSI), the trajectory lengths, and envelope area of COP during landing were also increased during MOT dual-task.DiscussionThe decline of these indicators reflected the deterioration in postural stability and greater requirements for maintaining balance which could increase the risk of injury in soccer athletes. We advocate that adequate visual attention and visual information processing might play critical roles in maintaining dynamic balance through the supraspinal neural network.     

Reliability of a portable fixed frame dynamometry system used to test lower limb strength in elite Australian Football League players

ObjectivesDeficits in strength of lower limb musculature have been associated with increased injury risk in a variety of athletic populations. As medical and performance staff seek to better understand the association between hip and knee strength measures and injury risk, measurement tools with high reliability and utility are required to profile and manage athletes effectively. The purpose of this study was to investigate the test-retest reliability of a portable fixed frame dynamometry system used to assess hip and knee strength of an elite Australian Football League team.DesignCase series.MethodsMaximum voluntary isometric strength of the hip abductors, hip adductors and knee flexors of 41 elite male Australian Football League footballers (mean age = 23.7 ± 4.1 years, height = 189.2 ± 7.0 cm, weight = 88.6 ± 8.4 kg) were tested during preseason training. Tests were performed one week apart on the same training day of a standard preseason week.ResultsTest-retest reliability was very high for left hip adduction (ICC 0.958), right hip adduction (ICC 0.955), left hip abduction (ICC 0.957), right hip abduction (ICC 0.945), left knee flexion (ICC 0.927) and right knee flexion (ICC 0.923). Furthermore, standard errors of measurement in per cent (SEM%) ranged from 3.21 to 5.03%, and minimal detectable change (MDC) from 3.93 to 6.65 kg for the different hip and thigh strength measures, making it possible to determine small changes in strength at the individual level.ConclusionsThis study demonstrated very high reliability when testing maximal voluntary isometric hip and knee strength using a portable fixed dynamometry system (KangaTech) in an elite male Australian Football League setting.     

Long term evolution of soft tissue response in the fingers of high-level sport climbers: A cross-sectional 10 Year follow-up study

BackgroundSport climbing induces physiological changes in the body of high-level climbers. In 2012, our study group demonstrated adaptions of elite climbers’ soft tissues with thicker A2/A4-pulleys, flexor tendons and palmar plates compared to non-climbers.ObjectivesTo assess these adaptations over time we examined all 31 (follow up 100%) climbers that participated in that baseline study again using ultrasonography after a follow-up of 10 years.Main findings(1) In climbers, a significant increase in A2 and A4-pulley and flexor tendon thickness over the last 10 years was observed (p < 0.001), while PIP&DIP palmar plate thickness remained unchanged (p > 0.05); (2) at 10-years follow-up, all soft tissue thickness parameters (incl. palmar plates) were still significantly larger in climbers than in age-matched controls (p < 0.05); (3) as for the association with anthropometrics and climbing performance/experience, a significant association of the current climber's soft tissue thickness could only be found between palmar plate and reached climbing level(p = 0.032) as well as climber's body weight(p = 0.004).ConclusionAn accumulation of repetitive climbing-related stress to the fingers of elite sport climbers over the career induces mechano-adaptation of the A2/A4-pulleys, flexor tendons and palmar plates. At later stages, there is a further significant increase in flexor tendon and pulley thickness, but not for palmar plate thickness.     

Interrogating cortical representations in elite athletes with persistent posterior thigh pain – New targets for intervention?

ObjectivesHamstring injuries in athletes can lead to significant time away from competition as a result of persistent posterior thigh pain. These cases are often difficult to treat as the state of the tissues alone cannot explain symptoms. In non-athletic populations with persistent pain, disruptions to tactile, proprioceptive, and spatial cortical representations exist, which has led to promising brain-based treatments. Here, we explored whether athletes with persistent posterior thigh pain also display impairments in these cortical representations.DesignCross-sectional study.MethodsFourteen male professional athletes with persistent posterior thigh pain (‘Patients’) and 14 pain-free age, sport, body mass index and level-matched controls (‘Controls’) participated. The tactile cortical representation was assessed using two-point discrimination (TPD) threshold and accuracy of tactile localisation; the proprioceptive cortical representation was assessed using a left/right judgement task; spatial processing was assessed using an auditory detection task.ResultsTPD thresholds were similar for Patients and Controls (p = 0.70). Patients were less accurate at localising tactile stimuli delivered to their affected leg, slower to make left/right judgements when the lower limb image corresponded to the side of their affected leg, and less accurate at detecting auditory stimuli delivered near their affected leg, when compared to their healthy leg or to the leg of Controls (p < 0.01 for all).ConclusionsLeg-specific tactile, proprioceptive, and spatial processing deficits exist in athletes with persistent posterior thigh pain. That these processing deficits exist despite rehabilitation and normal tissue healing time suggests they may play a role in the persistence of posterior thigh pain.     

Factors predisposing to patellar chondropathy and patellar apicitis in athletes

Summary Factors predisposing to patellar chondropathy (the PC group) and inferior patellar apicitis (jumper's knee — the PA group) were sought by means of a questionnaire, detailed quantitative physical measurements and radiological examination in male athletes. There were 20 athletes in the two groups who had typical symptoms and signs of each disorder. A group of 20 high-level athletes without knee symptoms served as a control group.The factors found in the PC group which differed significantly from those in the control group included increased anterior drawer sign (p<0.05), increased passive mediolateral patellar range of movement (p<0.001) and increased hyperextension (p<0.05). More leg length inequality (p<0.001) and patella alta (p<0.05) was observed in the PA group than in the controls.There was statistically significant positive correlation between the different measurements of knee laxity (anterior drawer sign, passive mediolateral patellar movement and hyperextension) in the 60 cases. The correlation coefficient between the length of the patellar tendon and passive mediolateral patellar movement was 0.82 (p<0.001).

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Résumé On a recherché, chez des athlètes de sexe masculin, à l'aide d'un questionnaire détaillant les mensurations physiques quantitatives et les résultats des examens radiologiques, les facteurs prédisposants à la chondropathie de la rotule (groupe CR) et à l'apexite patellaire inférieure (groupe AP). Dans chacun de ces 2 groupes il y avait 20 athlètes qui présentaient des symptômes typiques de l'une de ces 2 affections. Un groupe de 20 athlètes de haut niveau, asymptomatiques, a servi de groupe de contrôle (groupe C).Les facteurs trouvés dans le groupe CR qui différaient significativement de ceux du groupe C, étaient l'augmentation du tiroir antérieur (p<0.05), de la mobilité transversale de la rotule (p<0.001) et de l'hyperextension du genou (p<0.05). Dans le groupe AP, il y avait plus d'inégalités de longueur des membres inférieurs (p<0.001) et de patella alta (p<0.05) que dans le groupe C.Statistiquement, il y avait dans les 60 cas une corrélation positive significative entre les différents tests de laxité du genou. Le coefficient de corrélation entre la longueur du tendon rotulien et la mobilité transversale de la rotule était de 0.82 (p<0.001).