Common spinal injuries in athletes

Special needs of athletes with spine injuries must be considered when planning for treatment of these patients. The patients wish to return to competition safely but rapidly. Nurses must understand the patients'/athletes' need but put them into perspective with respect to the diagnosis, treatment, and degree of disability. Support, encouragement, and understanding from a knowledgeable health professional are invaluable.     

Athletes returning to play after cervical spine or neurobrachial injury

The treatment algorithms for athletes with spine injuries follow similar guidelines as those for non-athletes in terms of deciding between surgical intervention and non-operative management. However, the athlete has unique postoperative demands and the decision to “allow” an athlete to return to competitive sports after a spinal or plexus injury can be difficult. This article reviews the several studies, available guidelines and peer-reviewed publications to aid in the decisions to allow athletes to return to sports. A set of recommendations concerning return to play after a spinal injury is provided.     

Sex Differences in Common Sports Injuries

Common sports injuries include bone stress injuries (BSIs), anterior cruciate ligament (ACL) injuries, and concussions. Less commonly recognized are the specific sex differences in epidemiology, risk factors, and outcomes of these conditions by sex. An understanding of these factors can improve their clinical management, from prescribing appropriate prehabilitation to guiding postinjury rehabilitation and return to play. This narrative review summarizes the sex differences in the diagnosis and management of BSIs, ACL injuries, and concussions. Although BSIs are more common in female athletes, risk factors for both sexes include prior injury and relative energy deficiency in sport (RED-S). Risk factors in female athletes include smaller calf girth, femoral adduction, and higher rates of loading. Female athletes are also at greater risk for developing ACL injuries in high school and college, but their injury rate is similar in professional sports. Increased lateral tibial slope, smaller ACL size, and suboptimal landing mechanics are additional risk factors more often present in female athletes. Male athletes are more likely to have ACL surgery and have a higher rate of return to sport. Concussions occur more commonly in female athletes; however, female athletes are also more likely to report concussions. Male athletes more commonly sustain concussion through contact with another player. Female athletes more commonly sustain injury from contact with playing equipment. Managing post-concussion symptoms is important, and female athletes may have prolonged symptoms. An understanding of the sex-specific differences in these common sports injuries can help optimize their prehabilitation and rehabilitation.

Traumatic amputation. Mechanisms of injury, treatment, and rehabilitation

Traumatic amputations are one of many injuries that can occur to the body's musculoskeletal systems. Degloving, partial and total amputations are common types of traumatic injuries. Since traumatic amputations are very life threatening, emergency treatment must be initiated quickly and directed toward profuse blood loss and potential hypovolemia. Not only do traumatic amputees undergo extreme physiological changes, but they must also encounter the psychological trauma of an amputation. Due to a loss of body part(s) and alteration in body image, the amputee often experiences the stages of grieving which may take months and years to resolve. Extensive rehabilitation with the use of an interdisciplinary team approach is one of the most successful ways to return the amputee to the work place. A combination of occupational therapy, physical therapy, vocational rehabilitation and psychological support generally promote a sense of well being and return the traumatic amputee to a level of independence.     

Social adjustment and rehabilitation in international competitors with spinal injuries sustained in military service

One hundred and eighteen competitors, with spinal injuries, attending the First International Ex-Service Wheelchair Games, held in July 1993, were interviewed. Athletes from 17 countries attended. Sixteen competitors were tetraplegic and 102 paraplegic, their injuries are detailed below. The injuries had occurred on average 14.0 years previously; 35 injuries were war injuries, a further 10 due to combat training. The paraplegic athletes had spent 9.6 months and the tetraplegic 12.3 months in hospital. Fifty-five spinal stabilizations had been performed, and this was associated with a reduced inpatient stay for the paraplegic athletes (7.7 months vs 11.3 months). Spinal fixation did not affect later employment. Thirty-one athletes worked, and the amount of pension had no significant bearing on the numbers working. There was a mean delay of 38.3 months from injury until return to sport, and only 11.8% of competitors took up sport in the initial rehabilitation period. The differences between operative treatment, inpatient stay and numbers working from the different countries are compared. Financing of attendance and training seemed to be informal, with just over half of the athletes financed by their governments. The role of sport in rehabilitation of those patients with spinal injuries, and specifically those injured whilst serving in the armed forces, is discussed.     

Diagnosis and Treatment of Injuries to the Biceps and Superior Labral Complex in Overhead Athletes

Purpose of Review

This review discusses the diagnostic and treatment challenges presented by injuries to the biceps and superior labral complex.

Recent Findings

A focused patient history, numerous physical examination maneuvers, and appropriate advanced imaging studies must be utilized to reach an accurate diagnosis. Nonoperative management, even in overhead athletes, has demonstrated relatively good outcomes, while operative outcomes have yielded mixed results. The surgeon must take into account a number of variables when choosing the appropriate surgical procedure: labral repair versus biceps tenodesis. Rehabilitation, either as nonoperative management or as a postoperative protocol, should focus on restoring glenohumeral and scapulothoracic strength, endurance, and full, pain-free range of motion, while correcting any deficiencies in balance or rhythm throughout the overhead motion.

Summary

Despite the operative treatment challenges that SLAP tears present, with new techniques and proper patient selection, overhead athletes with injuries to the biceps and superior labrum complex can return to sport at a high level.

     

Expert opinion and controversies in sports and musculoskeletal medicine: concussion in the young athlete

Concussion is a common injury in young athletes and can be very challenging for clinicians to diagnose and manage. Debate exists over not only the incidence of long-term risks of multiple concussions but also the potential for catastrophic outcomes after sports-related head injury. Decisions on returning athletes to competition can be difficult, and there are limited prospective data on which to make these decisions. This has resulted in the existence of a number of published guidelines and consensus statements on the management of concussion in athletes. Athletes sustaining a concussion need appropriate on-field care and structured follow-up. Baseline cognitive assessments can be helpful, but clinicians must be aware that head trauma may result in a wide array of clinical signs and symptoms. Delivery of care and decisions on return to play need to be based on an individual assessment of the affected athlete.     

Stress fractures and knee injuries in runners

Running often can cause injuries to the knee as a result of kinetic chain dysfunctions. Addressing these dysfunctions in rehabilitation can prevent future injury. Stress fractures often occur in runners who engage in training errors. Female runners are particularly susceptible to stress fractures, especially in the setting of the female athlete triad. Proper identification and prevention of these injuries allows for athletes to return to running expeditiously.     

Hockey

Hockey players as a whole do not suffer from the same degree of overuse injuries that many athletes experience. However, they do sustain a large number of contact injuries. A few minutes explanation as to the immediate treatment required may well reduce the number of times the player has to return to the surgery in the future.     

专业运动员脊柱脊髓损伤后重返赛场的研究进展

专业运动员的脊柱伤病是损伤预防和运动康复领域中的重要临床研究课题。本文根据疾病分类回顾目前运动员脊柱脊髓损伤后重返赛场的相关情况,包括颈椎(颈部软组织损伤、颈椎骨折和脱位、颈椎管狭窄症、颈椎间盘突出症、刺痛和烧灼痛)、胸椎(胸椎骨折)、腰椎(腰肌劳损、腰椎峡部裂、腰椎滑脱、腰椎间盘突出症)和脊髓震荡与脊髓损伤。本文还分析了运动员颈、胸、腰段脊柱脊髓损伤后重返赛场的标准,以期为未来临床管理和建立共识/指南提供参考。     

Stress fractures in athletes

Most stress fractures are preventable. Proper conditioning and preseason training is essential. Selection of the appropriate age-related sport must be taken into consideration. Adequate warm-up and cool-down is important to prevent muscle injuries that may contribute to stress fractures later on. The athlete should be aware of not "over-doing it" because fatigue is a contributing factor to the stress injury rate. Proper dress and equipment are necessary. Using the basic methods of prevention, along with good sportsmanship, safe participation in any sport may be anticipated. Because the demands and expectations of our high-performance athletes are more prevalent, education and rehabilitation of the sports-injured patient have become ever important. With the emergence of sports medicine as a discipline, injured athletes are returned to the playing arenas much more rapidly with newer protocols and techniques. We must be ready rapidly to assess, diagnose, and treat all sports injuries; however, we must be aware and alert to the possibility that it is an injury of "wear and tear" when making any diagnosis and prescribing any treatment regime.     

Diagnosis and treatment of shoulder injuries in the athlete

The goal of the treatment team dealing with patients who have sports-related shoulder injuries is to return them to their previous activity. There is no substitute for knowledge of anatomy, diagnosis modalities, or current treatments. Realistically, some of the athletes are not able to return to the level of competition they performed originally. For those patients, recommendations and suggestions for alternatives based on a sound knowledge of arthroscopic principles need to be considered. One of the greatest roles for the nurse treating these patients may be the temporary loan of her shoulder for them to lean on.     

Non-operative Care of the Patient with an ACL-Deficient Knee

Purpose of Review

The purpose of this review is to provide an update to the most objective, evidence-based path through a non-operative course of rehabilitation after anterior cruciate ligament injury for those hoping to return to pivoting and cutting sports.

Recent Findings

Anterior cruciate ligament (ACL) injuries are prevalent in pivoting and cutting athletes with many of these patients electing to pursue surgical reconstruction in hopes of returning to prior levels of function. Despite many athletes pursing ACL reconstruction, some may elect to pursue a non-operative course of care. Success with this treatment plan should be defined as the ability to return to sport without subsequent giving way episodes.

Summary

Identification of those most likely to successfully return to sport with a non-operative course begins with completion of an evidence-based screening tool. If the patient has no concomitant injury and successfully passes the screening, they may proceed to a systematic, evidence-based progression through rehabilitation. Finally, the patient must complete a return to sport program and meet appropriate objective criteria, prior to return to sport.

     

The Non-injured Leg Can Be Used as a Reference for the Injured Leg in Single-legged Hop Tests

BackgroundSingle-legged hop tests are frequently used in substantiating return to sport decisions following lower extremity injury. Evidence for using the non-injured leg as a reference for the injured leg in the return to sport decision-making at the criterion-based point of return to sport following lower extremity injury is lacking.PurposeTo compare absolute values in single-legged hop tests between the non-injured leg of athletes returning to high-impact sports after lower extremity injury and the matched leg of healthy athletes.Study DesignCross-sectional study.MethodsOne hundred and sixty-nine athletes returning to high-impact sports after lower extremity injury and 169 matched healthy athletes executed five single-legged hop tests. Differences between athletes returning to high-impact sports after lower extremity injury and matched healthy athletes on five single-legged hop tests were analyzed using paired t-tests.ResultsThere were no statistically significant differences between the non-injured leg of athletes returning to sport and the matched leg of healthy athletes. Effect sizes ranged from 0.05 to 0.14 indicating negligible effects.ConclusionClinicians can use the non-injured leg as a reference for the injured leg in single-legged hop tests for deciding on return to high-impact sports after lower extremity injuries.Level of Evidence3b     

Ultrasound Appearances of Complications After Arthroscopic Anterior Cruciate Ligament Reconstruction

Anterior cruciate ligament tears are among the most frequent knee injuries. Surgical treatment is mandatory in active athletes to prevent meniscal tears and early joint degenerative changes. Anterior cruciate ligament arthroscopic reconstruction (ACLAR) is considered the preferred procedure, allowing a successful functional restoration and a prompt return to sports practice. Postsurgical complications are infrequent and are mainly assessed clinically and by magnetic resonance imaging. Although ultrasound can only evaluate the outer aspect of the knee, it can detect several ACLAR complications. The aim of this pictorial essay is to present the ultrasound appearances of a wide spectrum of ACLAR complications.     

REHABILITATION STRATEGIES ADDRESSING NEUROCOGNITIVE AND BALANCE DEFICITS FOLLOWING A CONCUSSION IN A FEMALE SNOWBOARD ATHLETE: A CASE REPORT

Head injuries, including concussions, in athletes can account for an extended period of time lost from sports competition. Neurocognitive and balance deficits which may linger following a concussion affect an athlete''s ability to return to sport safely. If these deficits are not specifically addressed in a rehabilitation program then the athlete may be at risk for not only additional concussions but possible musculoskeletal injury. ImPACT testing is a reliable method for identifying neurocognitive deficits and assists in the development of a neurocognitive training program. The information gathered from ImPACT may also indicate risk for musculoskeletal injuries. Research evidence suggesting specific rehabilitation strategies and interventions addressing neurocognitive deficits following a concussion is lacking. Progressions in a neurocognitive training program may include the integration of balance, reaction training, and activities that address memory deficits. The purpose of this case report is to discuss the evaluation and treatment plan for a female snowboard athlete following a concussion.

Level of Evidence:

5     

Second-impact syndrome.

Sports-related injuries are among the more common causes of injury in adolescents that can result in concussion and its sequelae, postconcussion syndrome and second-impact syndrome (SIS). Students who experience multiple brain injuries within a short period of time (hours, days, or weeks) may suffer catastrophic or fatal reactions related to SIS. Adolescents are particularly susceptible to the dangers of SIS, and current return-to-play guidelines may be too lenient to protect a student from SIS. Any student with signs of a concussion should receive medical evaluation and not be allowed to return to play in the current game or practice. The role of the school nurse includes being knowledgeable about management of head injuries and return-to-play guidelines, providing follow-up for athletes who have concussions, and providing education on prevention and management of head injuries.     

Ankle injuries in athletes: A review of the literature

Ankle injuries are commonplace in the athletic population, with lateral ligament sprains accounting for the majority of them. The medial ligament complex, the distal tibiofibular syndesmosis as well as any of the bones that constitute the ankle joint can also be injured. Typical mechanisms of injury include inversion-plantarflexion and external rotation on a supinated, dorsiflexed or pronated foot. Lesions of the ankle present with similar symptoms of pain, swelling and tenderness. Therefore, a thorough history and physical examination must be obtained to make the correct diagnosis. This is especially critical for athletes as certain injuries can lead to termination of their career if not treated accurately on time. Imaging may be useful in some cases to confirm or rule out differential diagnoses. Most injuries can be managed conservatively using the Protection, Rest, Ice, Compression and Elevation protocol followed by a comprehensive rehabilitation programme. Surgery is reserved for grade III ligament tears that are refractory to initial non-operative treatment and displaced fractures that are unlikely to unite without surgical intervention. The objective of this review is to discuss the common ankle injuries encountered in the athletic population and the approaches to their diagnosis and management.     

Sports-related knee injuries in female athletes: what gives?

Knee injuries occur commonly in sports, limiting field and practice time and performance level. Although injury etiology relates primarily to sports specific activity, female athletes are at higher risk of knee injury than their male counterparts in jumping and cutting sports. Particular pain syndromes such as anterior knee pain and injuries such as noncontact anterior cruciate ligament (ACL) injuries occur at a higher rate in female than male athletes at a similar level of competition. Anterior cruciate ligament injuries can be season or career ending, at times requiring costly surgery and rehabilitation. Beyond real-time pain and functional limitations, previous injury is implicated in knee osteoarthritis occurring later in life. Although anatomical parameters differ between and within the sexes, it is not likely this is the single reason for knee injury rate disparities. Clinicians and researchers have also studied the role of sex hormones and dynamic neuromuscular imbalances in female compared with male athletes in hopes of finding the causes for the increased rate of ACL injury. Understanding gender differences in knee injuries will lead to more effective prevention strategies for women athletes who currently suffer thousands of ACL tears annually. To meet the goal in sports medicine of safely returning an athlete to her sport, our evaluation, assessment, treatments and prevention strategies must reflect not only our knowledge of the structure and innervations of the knee but neuromuscular control in multiple planes and with multiple forces while at play.