Ocular injuries in sports

Eye injuries are common in sports. Team physicians need to be able to recognize and treat common injuries and know when to refer other problems. This article highlights the current treatment of common sports-related eye injuries and reviews some of the new literature. Nearly 90% of all sports-related eye injuries can be prevented with adequate eye protection and will be discussed in some detail in the article.     

Children's sports injuries

Sports injuries in children are common. They range from very serious and even, occasionally, fatal accidents, to trivial sprains and bruises. Sports medicine is a burgeoning field. Parallel with this there has been an increased understanding of the radiology of these lesions. Lesions in the immature skeleton differ greatly to those in the mature skeleton. This review describes the most frequent sports injuries in children.     

Extreme sports: injuries and medical coverage

Extreme sports (including in-line skating, snowboarding, mountain bicycling, extreme skiing, rock climbing, indoor tackle football, kickboxing, skateboarding, and ultra-endurance racing) are growing in popularity. Often these sports are designed to expose athletes to greater thrills and risks than are found in traditional sporting activities. Despite this increased risk of injury, athletes competing in these sports often have little or no formal medical coverage. This article reviews what is known about this emerging area of sports medicine to assist physicians in preparing for medical coverage of these athletes and their competitions.     

Imaging pediatric sports injuries: lower extremity

Injuries to pediatric athletes, which are becoming increasingly common, take the form of acute injuries and chronic overuse injuries. Acute injuries of the lower extremity include avulsions of the pelvic apophyses, muscle-tendon injuries, transient dislocation of the patella, ankle sprains, and acute tears of the anterior cruciate ligament and menisci. Magnetic resonance (MR) imaging of the latter 2 injuries should approach the accuracy of MR imaging of the adult knee. Chronic overuse injuries of the lower extremity in this age group include stress fractures, which are most common in the tibia; ankle impingement syndromes; osteochondritis dissecans of the knee and osteochondral lesions of the talus; and traction apophysitis, most commonly presenting as Osgood-Schlatter disease and Sinding-Larsen-Johannson disease, affecting the patellar tendon. Imaging findings of all these lesions are characteristic, and allow radiologists to assist their clinical colleagues in diagnosing and treating pediatric athletic injuries.     

Imaging pediatric sports injuries: upper extremity

With increasing youth participation in organized sports, more injuries in this age group are being treated by primary care and sports medicine physicians. Overuse injuries are much more common now than in past decades, with Little League shoulder, Little League elbow, and gymnast wrist being particular concerns. Rotator cuff tears and glenoid labral injuries, once thought to be rare in this age group, are also more common now. Osteochondritis dissecans of the elbow is relatively common and typically fares poorly without surgery. Wrist abnormalities that occur nowadays include triangular fibrocartilage tears. Tendonitis, which is now observed frequently in clinical practice in this age group, rarely requires imaging.     

Dental injuries in sports

The expanding arena of sports and vigorous recreational activities is associated with an increased risk for sportsrelated injuries, including trauma to the teeth. Because dental professionals may not be present on site, in the best interest of athletes, it is suggested that sports medicine professionals who are present be provided with current evaluative, emergent, and referral protocols for proper management of sports-related dental injuries to address the immediate needs of the athlete and to enhance the long-term prognosis of the traumatized tooth. This article provides information related to some of the more common dental injuries encountered in sports, including crown fractures, root fractures, and traumatic tooth displacements. Use of properly fitted, custom-fabricated athletic mouth guards for the prevention of dental injuries is recommended strongly, as is the inclusion of a dentist on the sports medicine team roster.     

Eye injuries in sports

In a retrospective study from 1988 to 1998, eye injuries were found in 553 patients. Seventy-six (13.7%) of these injuries were associated with sport. The mechanism of trauma was for the most part a ball (71.1%) or a club (13.2%). Most eye injuries occurred in soccer (35.5%), which is, by far, the most widespread sport in this region of Norway. A disproportionately high number of the injuries occurred in floorball (17.1%), bandy (13.2%), and squash (10.5%). The rules in these sports may, in theory, be strict enough to prevent eye injuries in most cases. However, these rules are often neglected in informal activities. Strategies for educating the general public about the potentially serious effect of eye injuries in sports exposed to such risk are of great importance.     

Pediatric sports elbow injuries

Elbow injuries in the pediatric and adolescent population represent a spectrum of pathology that can be categorized as medial tension injuries, lateral compression injuries, and posterior shear injuries. Early and accurate diagnosis can improve outcomes for both nonoperative and operative treatments. Prevention strategies are important to help reduce the increasing incidence of elbow injuries in youth athletes.     

Lightning injuries in sports: situations to avoid

There is no absolute protection against lightning because of its random and capricious nature. However, the risk of being struck by lightning can be substantially reduced. There are general safety rules that apply to all athletic and recreational events. The athlete should have a proactive plan that can be instituted when storms approach. He/she should go to a safe shelter before the storm arrives and stay there until the danger is gone. Because the location, climate, terrain and playing site vary with different sporting activities, safety plans may have distinct elements for different recreational activities. Mountain climbers should know the weather patterns of their locale. The highest frequency of lightning strikes in the Rocky Mountains occurs between 11 am and 9 pm during the months of April to September. There is less chance of a hiker encountering lightning during the early morning hours. Many tourists are unaware of this pattern, which may possibly explain the finding that most lightning victims are visitors from other states. The bicyclist is as vulnerable as anyone in the open. In the event of lightning he/she should seek safe shelter and get off the bike. Rubber tires do not provide protection from lightning. Golfers continue to make the same mistakes year after year. Golfers should know to seek safe shelter (clubhouse or closed metal vehicle) before the storm arrives and not return prematurely to the golf course. They should avoid isolated trees, open fields, unsafe sheds and metal poles. They should separate from each other rather than gather together. Swimmers should get out of the pool and find a safe shelter. Safe areas do not include poolsides, under awnings or under trees. A nearby closed automobile may be the safest place until the danger is gone. Applying precautions when engaging in these sporting or recreational activities will help to minimise the risk of casualties or fatalities caused by lightning.     

Overuse injuries in youth sports: biomechanical considerations

Many children today participate in highly organized sports programs that involve regimented year-round repetitive training. This type of training has led to an increased incidence of overuse musculoskeletal injuries. Sports physicians have dealt with sports injuries in children for many years and, on the basis of their clinical experience, have developed guidelines to treat and to try and prevent these injuries. The purpose of this article is to provide a biomechanical perspective of sports injuries in young athletes and blend ideas from this perspective with more traditional clinical perspectives that dominate the literature relative to this topic. Basic tissue and gross movement mechanics principles are used to identify growth, morphological, and movement factors that may predispose a child to an overuse injury. Several biomechanical analyses of simple movement tasks are presented to quantify the forces developed in various tissues and to illustrate the effects that growth can have on these forces. Guidelines are given for developing injury prediction models that may be used in the future to establish safe and effective training guidelines for children.     

Golf and racquet sports injuries

There are specific injuries that are common in golf and racquet sports. These abnormalities have a predilection for specific structures as well and can be divided into two categories on the basis of etiology as either chronic repetitive injury or acute trauma. With golf injuries, upper extremity abnormalities prevail and include rotator cuff disease, epicondylitis, wrist tenosynovitis, and hamate hook fracture. Thoracolumbar spine pain can also occur. The order of frequency of these ailments is different for professional and recreational athletes. With racquet injuries, as in tennis, lower extremity injuries are more common and include medial gastrocnemius and Achilles tendon abnormalities, although shoulder, elbow, and wrist abnormalities may also occur. Knowledge of the biomechanics behind each sport is also helpful in understanding the pathophysiology of injury and in part explains the findings seen at imaging.     

Imaging of sports injuries in the foot

OBJECTIVE: This article selectively reviews several areas in which imaging can play a major role in the diagnosis and treatment of sports injuries of the foot. CONCLUSION: Diagnostic imaging provides useful evaluation of capsuloligamentous sports injuries and Morton neuroma in the foot and facilitates appropriate treatment. An understanding of the relevant anatomy, normal imaging appearance, and the spectrum of imaging findings in the setting of injury is important for the practicing radiologist.     

Osteoarthritis after sports knee injuries

Recent advances in the knowledge of tissue homeostasis, including the tissue homeostasis theory and the envelope of function theory as proposed by Dye, have greatly increased our knowledge of the pathophysiology of osteoarthrosis after sports knee injuries. The development of these two theories has not only advanced our understanding of the treatment and prevention of osteoarthrosis after acute injuries to the knee, but has also given us guidance as to directions for future research.     

Spinal injuries in contact sports

Contact and collision sports such as American football expose the athlete to a wide array of potential injuries. Knee injuries garner much of the attention, but spinal injuries are potentially catastrophic and all levels of medical coverage of football must be knowledgeable and prepared to attend to an athlete with a neck injury. Of the other possible spinal conditions, some resolve on their own, others might require conservative therapy, and still others might require surgical intervention. The spectrum of potential injury is wide, yet the medical team must practice and prepare to treat the possible catastrophic neck injury.