Managing Ear Trauma

In brief Sports in which the ear may sustain blows or experience changes in ambient pressure can pose dangers to the ear. Possible injuries include “cauliflower ear”— classic to wrestlers— auricular lacerations, auricular avulsions, and barotrauma. Prompt treatment can preserve ear structure and function. Properly protecting the ear is the best defense against trauma.     

Managing triathlon competition

Medical coverage of endurance events requires knowledge of conditions that are specific to, or present differently in, endurance athletes. Serious conditions such as hyponatremia and rhabdomyolysis, and heat illnesses such as hypo- and hyperthermia, need to be accurately and quickly separated from more benign conditions such as exerciseassociated collapse.     

Managing Ankle Sprains

The vast majority of ankle injuries involve one or more of the lateral supporting ligaments and can usually be managed successfully in the primary care setting. Important diagnostic variables include the mechanism of injury, the level of weight-bearing ability, and the presence or absence of bony tenderness. Early application of a focal compression device is the paramount measure for preserving range of motion and strength. Other important measures include early mobilization, contrast baths, strength exercise, and, on return to activity, prophylactic bracing.     

Managing Posterior Shoulder Instability

Posterior shoulder instability, a recently recognized source of pain in throwing, overhand, and contact sports, usually results from repetitive microtrauma or a single traumatic episode. Physical signs often are not obvious, so targeted physical tests, provocative maneuvers, and radiographic studies are needed to identify abnormal humeral head translation. Examination under anesthesia or arthroscopy may be required. The first line of treatment focuses on an intensive physical therapy protocol that strengthens the infraspinatus, teres minor, and posterior deltoid muscles. Surgery may be indicated, but ideal technique is a matter of debate.     

Managing Tibial Stress Fractures

In brief Tibial stress fractures often occur in Patients who participate in running and jumping sports. With rest, most stress fractures heal without incident, though midshaft fractures are more resistant to healing. Bone scans are usually required to confirm the diagnosis. Relative rest, strength training, proper footwear, and treating underlying risk factors are the mainstays of treatment. A new treatment option is a pneumatic brace that the patient can wear when he or she returns to play. Physicians should be prepared to counsel competitive athletes about the risks of returning to play too soon.     

Managing Fibromyalgia With Exercise

Although its cause remains obscure and no laboratory test confirms its diagnosis, fibromyalgia is a well-defined condition, more common than rheumatoid arthritis. Exercise is an essential component of treatment, helping patients cope with this painful disease.     

Managing blisters in competitive athletes

Friction blisters can have a negative effect on an individual’s ability to perform his or her sport or duties. In a recent study, 69% of soldiers participating in a 20-km road march were found to have blisters, 10% of whom required medical intervention. Blistering of the feet is one of the most common injuries sustained by runners while training and racing. Although most blisters are minor and can be treated conservatively, others can lead to intense pain, cellulitis, and even sepsis. The best way to treat friction blisters is to prevent them; however, if they do occur, timely and effective treatment will help prevent the complications that can impede athletic performance.