Craig C. Young

Use of protective equipment by adolescents in inline skating, skateboarding, and snowboarding.

Objectives:Determine the frequency of personal protective equipment (PPE) use in adolescent inline skaters, skateboarders, and snowboarders; explore factors influencing PPE use; identify factors that would influence use; and examine the association of high-risk behaviors and PPE use. Design:Cross-sectional survey. Setting:Central/southeast Wisconsin. Participants:Participants 13-18 years-old. Interventions:None. Independent variables = age, gender, sport. Main Outcome Measurements:None. Dependent variables = PPE use, factors influencing use, and frequency of other high-risk behaviors. Results:The mean age of 333 participiants was 14.9 years. Adolescents wore considerably less PPE than recommended. Inline skaters wore the most; snowboarders the least. The most common reasons adolescents wore PPE were parents, peers, and rule/requirement. Younger adolescents cited parents more often than older adolescents as a factor for PPE use. Discomfort and lack of perceived need were the most common reasons for nonuse. Sustaining/witnessing an accident was the most common reason that would convince adolescents to wear PPE. Almost half of adolescents reported nothing would convince them to wear PPE. Younger adolescents wore more PPE than older adolescents. An association was seen between PPE use in all sports and bicycle helmets. An inverse relationship was found for tobacco and helmet use among skaters, as well as alcohol and helmet use in skateboarders. Conclusions:Adolescents underuse PPE. PPE reinforcement by parents/peers, encouraging bike helmets, manufacturing more comfortable gear, educating adolescents, and instituting PPE requirements in public areas may increase compliance. This could lead to decreased injuries. Physicians should discuss PPE with their patients/families. There may be an association between PPE use in extreme sports and decreased high-risk health behaviors.

Mass Participation Event Management for the Team Physician: A Consensus Statement

DEFINITION Mass participation event management is medical administration and participant care at these sporting events. Medical management provides safety advice and care at the event that accounts for large numbers of participants, anticipated injury and illness, variable environment, repeated games or matches, and mixed age groups of varying athletic ability. This document does not pertain to the care of the spectator. GOAL The goal is to assist the team/event physician in providing medical care during mass participation events. The physician’s role is to organize a medical team that facilitates event safety, provides medical care, makes return-to-participation decisions, and acts as the event medical spokesperson. To accomplish this goal, the team physician should have knowledge of and be involved with • Administrative matters concerning the event • Medical care and protocols • Hydration and fluid replacement SUMMARY This document provides an overview of select medical issues that are important to team physicians who are responsible for mass participation event management. It is not intended as a standard of care, and should not be interpreted as such. This document is only a guide, and as such, is of a general nature, consistent with the reasonable, objective practice of the healthcare professional. Individual treatment will turn on the specific facts and circumstances presented to the physician. Adequate insurance should be in place to help protect the physician, the athlete, and the sponsoring organization. This statement was developed by a collaboration of six major professional associations concerned about clinical sports medicine issues; they have committed to forming an ongoing project-based alliance to bring together sports medicine organizations to best serve active people and athletes. The organizations are American Academy of Family Physicians,

Ulnar stress fracture of the nondominant arm in a tennis player using a two-handed backhand.

Stress fractures are infrequently seen in non-weight-bearing bones. However, stress fractures may be present in any bone that undergoes repetitive stress. We report an unusual case of stress fracture in the nondominant arm of a tennis player who uses a two-handed backhand stroke.

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.

In-line skating: use of protective equipment, falling patterns, and injuries

ObjectiveTo determine the use of protective equipment, reasons for nonuse of protective equipment, and patterns of injury, falls, and stopping techniques of recreational in-line skaters. DesignSurvey. Participants313 in-line recreational skaters observed skating in the parks, on bicycle trails, and on parkways in Milwaukee, Wisconsin and Columbus, Ohio were asked to participate in a short survey in 1995. Main Outcome MeasurementsThe frequency of in-line skater use of protective equipment, reasons for nonuse, patterns of injury, and patterns of falls. ResultsProtective equipment was worn most of the time in the following proportions of skaters [95% confidence interval in brackets]: wrist guards (51%) [44.7%–58.1%]; knee pads (36%) [29.3%–42.5%]; elbow pads (15%) [8.4%–22.8%]; and helmets (15%) [8.0%–22.0%]. Reasons cited for not using protective equipment included lack of perceived need (47.3%), discomfort (37.5%), cost (15.9%), and undesirable appearance (15.2%). Stopping techniques included skating off into the grass (14.6%) [11.8%–17.4%] and voluntarily falling (3.5%) [2.1%–4.9%]. Causes of involuntary falls included spontaneous loss of balance (32.9%) [28.9%–36.9%], hitting rocks or other small objects (17.3%) [14.4%–20.2%], uneven pavement (17%) [14.2%–19.8%], and failure to stop (11.3%) [8.4%–14.2%]. Site of initial impact after falling included the hands and wrists (44.6%) [38.3%–50.9%], the knees (19.6%) [16.4%–22.8%], and the buttocks region (17.2%) [14.3%–20.1%]. Injuries had occurred in 26% of the skaters; 14% of injuries were fractures. ConclusionsIn-line skaters often do not wear protective equipment because they believe it is not necessary. Recent studies have suggested, however, that protective equipment does prevent injuries. Physicians should counsel their patients who are in-line skaters to use protective equipment.

Foot Drop in a Marathon Runner from Chronic Complete Hamstring Tear

Physicians who care for athletes easily recognize the hamstring muscle strain or partial rupture as a common injury. Conversely, complete ruptures of the hamstring musculature or the proximal hamstring tendon are more difficult to identify and are relatively rare injuries. In a series of 1,014 musculotendinous injuries studied at the Mayo Clinic, Anzel et al found only 2 complete hamstring ruptures resulting from “indirect stress” (ie, not resulting from a direct blow or laceration). Most complete ruptures reported in the literature have occurred in waterskiing or motorcycle accidents, but also occasionally have resulted from power weightlifting, martial arts, rugby, and dancing. Etiologic factors associated with hamstring injuries include lack of flexibility, increased muscle fatigue, hamstring strength imbalances, and insufficient warm-up before activity. Known sequelae of chronic, complete ruptures include pain, lack of strength and flexibility, and loss of control of the affected leg during downhill walking and running. A lesser known complication is dysfunction of the sciatic nerve, often a result of direct compression from hematoma formation and scar tissue. Sensory dysfunction of the sciatic nerve as a result of a chronic, complete hamstring rupture has been described by many authors; motor dysfunction was first described in the literature by Street and Burks in 2000. We present a second case of motor dysfunction of the sciatic nerve from a chronic, complete hamstring rupture. CASE REPORT

Spine injuries in dancers.

Care of a dancer calls for a unique balance between athlete and artist. The physician must familiarize himself or herself with dance terminology, common moves, correct technique, and dancers mentality. The goal is to work intimately with the dancer to care for the injury and, if possible, continue to participate in portions of dance class to limit anxiety and increase compliance to treatment. The spine is the second most injured area of the body in dancers, and many issues stem from poor technique and muscle imbalance. This often leads to hyperlordosis, spondylolysis, spondylolisthesis, lumbar facet sprain, discogenic back pain, and muscle spasm and piriformis syndrome. This article reviews these causes of low back pain with a focus on dance-related presentation and treatment issues.

Serial sevens: not the most effective test of mental status in high school athletes

ObjectiveTo evaluate the ability of uninjured high school athletes to pass three mental status tests that are commonly used on the sidelines for the evaluation of concussions: the serial sevens test, the serial threes test, and recitation of months of year in reverse order (MOYR). ParticipantsHigh school student athletes in grades 9, 10, 11, and 12 having sports preparticipation physical examinations. The initial study tested 522 consecutive athletes. The follow-up study tested 109 consecutive athletes. InterventionThe athletes of the initial group were asked to perform a serial sevens test, followed by a serial threes test, and finally to recite the MOYR. The second group was asked to perform the same tests in a random order. Main Outcome MeasuresParticipants were given 1-min time limits for each test, with passing defined as either 7 consecutive correct iterations or 11 correct with one mistake. ResultsFor the initial group, 51.3% successfully performed serial sevens, 78.7% successfully performed serial threes, and 89.5% successfully recited the MOYR. For the second group, 52.7% successfully performed serial sevens, 78.1% success-fully performed serial threes, and 88.9% successfully recited the MOYR. The pass rates were significantly different for both groups. The pass rates were similar for both sexes, all grade levels, and all sports in both test groups. Participants, both overall and in all subgroups, failed serial sevens more often than serial threes and MOYR (p < 0.001 for the initial group; p < 0.0001 for the second group). They failed serial threes more often than MOYR (p < 0.001 for the initial group; p < 0.01 for the second group). ConclusionsThe percentage of uninjured high school athletes successfully completing serial sevens is too low to make the test useful for evaluation of concussion; the test lacks specificity. The percentage of athletes passing the MOYR was greatest, perhaps making this a better sideline test than the traditional serial sevens test. However, testing needs to be done in injured athletes before clinical application can be recommended.

Effect of education and language on baseline concussion screening tests in professional baseball players.

Objective:The purpose of the present study was to investigate the possible effects of sociocultural influences, specifically pertaining to language and education, on baseline neuropsychological concussion testing as obtained via immediate postconcussion assessment and cognitive testing (ImPACT) of players from a professional baseball team. Design:A retrospective chart review. Setting:Baseline testing of a professional baseball organization. Participants:Four hundred five professional baseball players. Independent Variables:Age, languages spoken, hometown country location (United States/Canada vs overseas), and years of education. Main Outcome Measures:The 5 ImPACT composite scores (verbal memory, visual memory, visual motor speed, reaction time, impulse control) and ImPACT total symptom score from the initial baseline testing. Results:The result of t tests revealed significant differences (P < 0.05) when comparing native English to native Spanish speakers in many scores. Even when corrected for education, the significant differences (P < 0.05) remained in some scores. Conclusions:Sociocultural differences may result in differences in computer-based neuropsychological testing scores.

Acute mallet toe.

INTRODUCTION Extensor tendon injuries are common in the finger, where they are variably referred to as a mallet, baseball, or drop finger, but similar injuries can also occur in the toe. The acute presentation of a mallet toe is rare because most cases are idiopathic. Mallet toe is often underdiagnosed, and early treatment is important because it leads to better functional outcomes and less pain.