Head injuries in athletes

Head injury is a common consequence of athletic participation. Athletes, parents, coaches, trainers, and tem physicians must remain aware that there are potentially significant immediate and long-term effects from both serious and minor head injuries. The recognition of severe and minor head injuries, their immediate management, and guidelines for allowing athletes to return to competition provide the focus for this article.     

Hip injuries in athletes

Hip injuries are common in athletes, and there is an extensive differential diagnosis of potential causes. This article reviews the anatomy of the hip, and discusses the imaging findings of hip pathology in athletes including skeletal, intraarticular, and extra-articular abnormalities. The role of radiography, computed tomography (CT), magnetic resonance (MR) imaging, MR arthrography, CT arthrography, and sonography in evaluating each condition is discussed.     

Overuse injuries in equestrian athletes

Some 30 million Americans are involved in equestrian sports. Although there is significant literature regarding catastrophic injury, there is very little literature that addresses overuse injury and its effect on rider and horse. As the horse and rider function as a unit, overuse injuries to the rider can affect the horse's training and responsiveness. Sports physicians treating riders should understand correct posture in the saddle and its alteration by muscular imbalance and injury. This review discusses common equestrian events, and common overuse injuries in recreational and competitive riders.     

Acute hand injuries in athletes

Hand and wrist injuries in athletes are common, representing between 3 and 25% of all sports injuries. As many as a quarter of all sports injuries involve the hand or wrist. We review the recent literature regarding acute hand injuries in athletes based on the structures involved – bone, muscle/tendon, ligament, and neurovascular – including diagnosis and pathophysiology of these injuries, focusing on athlete-specific facets of treatment, and when available, opinions on return to play.     

Overuse injuries in equestrian athletes

Some 30 million Americans are involved in equestrian sports. Although there is significant literature regarding catastrophic injury, there is very little literature that addresses overuse injury and its effect on rider and horse. As the horse and rider function as a unit, overuse injuries to the rider can affect the horse’s training and responsiveness. Sports physicians treating riders should understand correct posture in the saddle and its alteration by muscular imbalance and injury. This review discusses common equestrian events, and common overuse injuries in recreational and competitive riders.     

Exertion injuries in female athletes

Because sports injuries in men form most of the available statistics, the reportage of injuries in female athletes is sparse. We describe exertion injuries and disorders in 281 women athletes, all of which hampered athletic training or performances. Sixty per cent of the injuries occurred to girls ages between 12-19 years, and about forty-eight per cent were track and field athletes. The most common sites of injury were the ankle, foot, heel and leg. Osteochondritic disorders were the most typical injuries in the series, and the chronic medical tibial syndrome was the injury that needed surgical treatment most frequently. Overuse injuries seem to differ very little from each other in the events included in this survey.     

Lower leg overuse injuries in athletes

Achilles paratenonitis and medial tibial syndrome are the most common specific overuse injuries among athletes in Finland, and they are a problem especially in endurance sports, such as long-distance running and jogging. Conservative treatment is often successful, but if it fails operative treatment is necessary. The surgical methods developed in Finland, which are widely used in the treatment of Achilles paratenonitis and medial tibial syndrome, are presented with clinical follow-up results in this paper. The patients operated on for Achilles paratenonitis were some years older than the patients operated on for retrocalcaneal bursitis (mean 38.4 versus 32.3 years). Results after operation were excellent or good in 92.4% of 291 patients operated on for Achilles paratenonitis, 84.2% of the 63 operated on for retrocalcaneal bursitis and 79% of the 47 operated on for medial tibial syndrome. All the patients treated operatively were patients in whom conservative treatment had failed. In conclusion, operative treatment of Achilles paratenonitis or medial tibial syndrome in athletes is indicated when these complaints do not respond to any type of conservative treatment.     

Hip and groin injuries in athletes

Although athletic injuries about the hip and groin occur less commonly than injuries in the extremities, they can result in extensive rehabilitation time. Thus, an accurate diagnosis and well-organized treatment plan are critical. Because loads of up to eight times body weight have been demonstrated in the hip joint during jogging, presumably even greater loads can occur during vigorous athletic competition. The available imaging modalities are effective diagnostic tools when selected on the basis of a thorough history and physical examination. Considerable controversy exists as to the cause and optimal treatment of groin pain in athletes, or the so-called "sports hernia." There has also been significant recent attention focused on intraarticular lesions that may be amenable to hip arthroscopy. This article briefly reviews several common hip and groin conditions affecting athletic patients and highlights some newer topics.     

Exertion injuries in adolescent athletes.

A series of 147 cases of exertion injuries in less than or equal to 15 years old athletes is presented. All injuries occurred during training or athletic performances without trauma and caused symptoms that prevented athletic exercises. There were 67 girls (46%) and 80 boys (54%) in the material. About 90% of them had been training for more than one year before the onset of the symptoms; 65% were interested in track and field athletics, 13% in ball games, 11% in skiing, 4% in swimming, and 3% in orienteering. The rest were interested in other sports. About 33% of the injuries were growth disturbances or osteochondroses seen also in other children. About 15% were anomalies, deformities or earlier osteochondritic changes, which caused first symptoms during the physical exercise; 50% were typical overuse injuries that may bother adult athletes, too; 43% of the injuries were localized in ankle, foot and heel, 31% in knee, 8% in back and trunk, 7% in pelvic and hip region, and the rest in other parts of the body. The injuries were generally slight, no permanent disability was noticed. Rest and conservation therapy cured most cases; operative treatment was used in only eight cases.     

Rehabilitation of hand injuries in athletes

This article outlines and stresses the importance of proper rehabilitation of hand injuries in athletes. Rationale for guidelines in splinting, modalities, and appropriate progression of various types of exercise is discussed.     

Management of lumbar injuries in athletes

Lumbar spine pain is a common and disabling condition affecting an athlete's ability to train and compete. The athletic management team must take a cooperative approach to diagnosis and treatment. The presentation pattern and injury history may provide an early cue to diagnosis; information gained by the trainer or therapist at the time of injury is particularly important. The unique anatomy and biomechanics of the lumbar segments leads to certain injury patterns. Knowledge of the potential motion, muscle effectors of motion and mechanisms of injury allows for a highly specific diagnosis. A meticulous physical examination with particular attention to neurological findings should be used to confirm suspicions from the athlete's symptom pattern. Early conservative treatment should be initiated for all patients except those who are mechanically unstable or neurologically impaired. Aerobic and nonpainful sports-specific training may be continued under the care of the trainer or physical therapist. This will limit the loss of skill and endurance when normal activity is resumed. Diagnosis-specific medical and physical therapy should supplement this training activity. A care team that carefully analyses the pain presentation, injury history and symptoms, and directs a diagnosis-specific treatment programme, should manage lumbar spine conditions in the athlete.     

Overuse injuries in adolescent athletes.

As sports participation increases so too does the incidence of injuries, both acute and overuse. The growing skeleton is particularly susceptible due to the presence of growth cartilage at 3 locations; the epiphyseal plate, the joint surface and the apophysis. The risk of injury is most pronounced during the rapid growth spurt of adolescence when other factors, such as muscle tightness across joints, also become important in the aetiology of sporting injury. Overuse injuries seen in this age group may reflect the growth characteristics of the immature skeleton or may be of the type seen in adult athletes undergoing rigorous training schedules. Recent developments in organised competitive sport have seen growing individuals undertake prolonged and intensive training programmes when they are particularly at risk of sustaining an overuse injury. The training programme is one of a number of risk factors important in the generation of injury, many of which can be modified or controlled to an extent. Other factors such as growth deformities or malalignments are peculiar to the individual and preparticipation evaluation of the young athlete helps to identify those at risk. Whilst long term disability rarely eventuates, the loss of enjoyment and temporary incapacity resulting from this type of injury is significant. It is apparent that many of these injuries are preventable, and given the information available concerning the factors involved in their aetiology, it is the responsibility of coaches and health professionals alike to become involved in their early diagnosis, treatment and prevention.