Cindy J. Chang

Herpes and tinea in wrestling: managing outbreaks, knowing when to disqualify.

The two most troublesome skin infections in wrestlers are herpes gladiatorum and tinea gladiatorum. Determining whether athletes should or should not be disqualified from practice or competition because of these infections requires some expertise. Recommendations are presented to assist the practitioner in the care of these conditions in wrestlers and other athletes who have frequent skin-to-skin contact.

Wolff-Parkinson-White syndrome in athletes.

Introduction Wolff-Parkinson-White (WPW) syndrome is a congenital abnormality that involves an accessory pathway between the atria and the ventricles in addition to the normal atrioventricular node–His pathway. This extra pathway can conduct electrical impulses to the ventricles more quickly and can cause pre-excitation arrhythmias to occur [1]. Three percent to 4% of WPW cases are familial and inherited as an autosomal dominant trait. WPW syndrome has a frequency of 1.5 to 3.1 per 1000 persons in Western countries [2]. The incidence of WPW is higher in men than in women, and it can occur at any age [3]. Therefore, it is inevitable that WPW syndrome can pose a major risk to the small fraction of athletes that have inherited the condition. The following two case reports describe the evaluation of possible WPW syndrome in two Division I collegiate athletes, a female softball player and a female water polo player. Quick detection of the syndrome is vital, and this should be followed by risk stratification and treatment according to the guidelines established by the 36th Bethesda Conference.

Subtalar dislocation in a female gymnast.

Introduction: Medial subtalar dislocations appear to be relatively infrequent, but can result from low-impact trauma due to sports participation. Although this injury is often associated with young, male basketball players [1], other athletes may also be at risk. This case report describes a medial subtalar dislocation that occurred in an intercollegiate female gymnast. With no cast immobilization and daily rehabilitation starting 10 days after injury, she fully recovered and successfully returned to competition.

Two unusual cases of acetabular fractures sustained during sports.

Fractures of the acetabulum are severe injuries that usually accompany mechanisms of high-energy impact such as motor vehicle accidents and falls. Although this injury is now also recognized as being associated with athletic activities that entail high-energy impact (e.g., skiing, gymnastics), a MEDLINE literature search produced no published reports to date of acetabular fractures occurring due to relatively low-impact, noncontact injuries in otherwise healthy individuals. This case report describes two similar fractures of the acetabulum that occurred in intercollegiate football and lacrosse.

Sideline evaluation and management of acute hip trauma in a collegiate athlete.

Traumatic injuries of the femoroacetabular joint and labrum are relatively infrequent in contact sports, including football. Extra-articular injuries to the hip region are reported more frequently, such as bone and soft tissue contusions to the iliac crest and fossa, and sprains and strains of the soft tissues of the hip and pelvic girdle. A study of injury patterns in Big 10 Conference Football reports that injuries to the hip, thigh, and leg (excluding the knee, foot, and ankle) comprise 1.0/1000 incidents (1). Another study, which analyzes 16 years of data from the NCAA Injury Surveillance System for men’s collegiate football, reports that soft tissue injuries to the hip and pelvis have an infrequent but significant incidence, with muscletendon strains and pelvis-hip contusions (1.9% and 1.8%, respectively) being most common. Any injury type that does not comprise at least 1% of total injuries is not included; thus the exclusion of pelvic and acetabular injuries highlights their infrequency (2). However, a 14-year study of elite collegiate football players at the annual National Football League (NFL) Combine finds that soft tissue hip injuries are among the top five diagnoses and are among those with the largest reported increase in frequency during the study period (3). Similarly, a report by two prominent hip surgeons estimates that injury to the hip involves 6% of adult and 24% of pediatric athletic-related injuries (4). This low incidence does not excuse an understanding of proper management of hip injuries such as dislocation, subluxation, and joint capsule sprain. It is of great importance that the athletic training staff and sports physicians distinguish between intra-articular and extraarticular injury at initial evaluation because management decisions, particularly weight-bearing and return to play status, may vary significantly.

Cardiovascular screening of Paralympic athletes reported by chief medical officers of the PyeongChang 2018 Paralympic Winter Games

The 2009 IOC Consensus Statement on Periodic Health Evaluation (PHE) of Elite Athletes recommends a 12-lead ECG, but the frequency of the PHE elements is not defined.1 In 2011, the International Paralympic Committee (IPC) approved the IPC Medical Code, which describes the need for routine PHE based on the latest medical knowledge.2 However, the components and frequency of screening are also not delineated. Recent research has evaluated the cardiovascular (CV) screening practices of Olympic athletes, but there are limited data regarding CV screening of Paralympic athletes.3 4 This study aimed to investigate current practices for CV screening of Paralympic athletes. Chief medical officers (CMOs) for National Paralympic Committees of the PyeongChang 2018 Paralympic Winter Games were identified by the IPC and surveyed regarding the CV screening practices of their respective teams. The primary outcome was the utilisation of CV screening components as part of the PHE. The secondary outcomes were the frequency of performing the CV screening components. A total of 35 of the 49 (71.4%) countries …

Cardiovascular screening of Olympic athletes reported by chief medical officers of the Rio 2016 Olympic Games

Objective The IOC recommends periodic cardiovascular screening of athletes, but the adoption of these recommendations is unknown. The purpose of this investigation was to evaluate and compare cardiovascular screening practices of countries participating in the Rio 2016 Olympic Games. Methods A list of chief medical officers (CMOs) was compiled by the IOC during the 2016 Olympic Games. CMOs were requested to complete an online survey about cardiovascular screening of their countries’ Olympic athletes. Comparisons of screening practices were made by categorising countries by continent, gross domestic product (GDP) per capita and size of athlete delegation. Results CMOs for 117/207 (56.5%) countries participating in the 2016 Olympic Games were identified. 94/117 countries (80.3%) completed the survey, representing 45.4% of all countries and 8805/11 358 (77.5%) of all 2016 Olympic athletes. Most of the countries surveyed (70.2%) perform annual cardiovascular screening. Among the survey respondents, all or most athletes from each country were screened at least once with the following components: personal history (86.2% of countries), family history (85.1%), physical examination (87.2%), resting ECG (74.5%), echocardiogram (31.9%) and stress test (30.8%). Athletes were more likely to be screened with ECG in countries with relatively larger athlete delegation (OR 2.05, 95% CI 1.10 to 3.80, p=0.023) and with higher GDP per capita (OR 1.69, 95% CI 1.11 to 2.57, p=0.014). Conclusion Most of the responding countries perform annual cardiovascular screening of Olympic athletes, but there are differences in the components used. Athletes from countries with larger athlete delegations and higher GDP per capita were more likely to be screened with ECG.