Emily Kraus

Bone Stress Injuries in Runners

Bone stress injuries (BSIs) are common running injuries and may occur at a rate of 20% annually. Both biological and biomechanical risk factors contribute to BSI. Evaluation of a runner with suspected BSI includes completing an appropriate history and physical examination. MRI grading classification for BSI has been proposed and may guide return to play. Management includes activity modification, optimizing nutrition, and addressing risk factors, including the female athlete triad. BSI prevention strategies include screening for risk factors during preparticipation evaluations, optimizing nutrition (including adequate caloric intake, calcium, and vitamin D), and promoting ball sports during childhood and adolescence.

Piriformis Syndrome With Variant Sciatic Nerve Anatomy: A Case Report

A 68‐year‐old male long distance runner presented with low back and left buttock pain, which eventually progressed to severe and debilitating pain, intermittently radiating to the posterior thigh and foot. A comprehensive workup ruled out possible spine or hip causes of his symptoms. A pelvic magnetic resonance imaging neurogram with complex oblique planes through the piriformis demonstrated variant anatomy of the left sciatic nerve consistent with the clinical diagnosis of piriformis syndrome. The patient ultimately underwent neurolysis with release of the sciatic nerve and partial resection of the piriformis muscle. After surgery the patient reported significant pain reduction and resumed running 3 months later. Piriformis syndrome is uncommon but should be considered in the differential diagnosis for buttock pain. Advanced imaging was essential to guide management.

Poster 155 Higher Cumulative Risk Assessment Scores Are Associated with Delayed Return to Play in Division I Collegiate Distance Runners

Disclosures: Adam Lewno: I Have No Relevant Financial Relationships To Disclose Case/Program Description: A 20-year-old collegiate male swimmer presented with 1-month history of left shoulder pain and progressive weakness that originally awoke him from sleep several hours after completing the first practice of a training trip notable for rapid increase in practice intensity and volume. Physical examination was significant for left infraspinatus fossa atrophy, no active external shoulder rotation, supraspinatus and teres minor strength of 4/5, and medial scapular winging. Magnetic resonance imaging (MRI) of the left shoulder and scapula demonstrated partial tear of the posterior fibers of the infraspinatus tendon, infraspinatus and supraspinatus edema, atrophy and edema of the teres minor suggestive of acute on chronic denervation. There was no pathology noted in the rotator cuff, labrum, articular cartilage, suprascapular or spinoglenoid notch. Electrodiagnostic studies were significant for severe left suprascapular neuropathy of axonal nature with active denervation to the supraspinatus and infraspinatus. There was no evidence of denervation within the teres minor despite MRI findings and clinical exam correlation. Setting: Electrodiagnostic lab, Tertiary Care Hospital. Results: Electrodiagnostic study with ultrasound localization of the teres minor confirmed normal motor units and muscle fiber appearance while the infraspinatus and supraspinatus demonstrated significant denervation. There was no entrapment of the suprascapular nerve noted during static and stroke specific ultrasound examination. Discussion: Neuralgic amyotrophy is most commonly seen in volleyball players, pitchers, and wrestlers after sustained high intensity practice and competitions. Rarely does it develop solely in the suprascapular nerve after a single intense practice within swimmers. Ultrasound localization during electrodiagnostic evaluation improved needle examination while allowing for dynamic assessment of both muscular function and possible nerve entrapment during sport specific motions. Conclusions: Rapidly developing shoulder pain with lasting weakness after practice intensity changes in swimming should be concerning for neuralgic amyotrophy. Ultrasound correlated electrodiagnostic studies significantly improved diagnostic capabilities in clinically divergent cases. Level of Evidence: Level V

A Review and Proposed Rationale for the use of Ultrasonography as a Diagnostic Modality in the Identification of Bone Stress Injuries

Bone stress injuries are common in military personnel and athletes. The delayed diagnosis of a bone stress injury can lead to a more severe injury that requires a longer period of treatment. The early detection of bone stress injuries is a central part of management. Currently, the reference standard for detecting bone stress injuries is magnetic resonance imaging. However, the expanding use of point‐of‐care ultrasonography (US) may enable the early detection of bone stress injuries in the clinical setting. In this article, we review the US detection of bone stress injuries, as well as discuss the rationale for the use of US in the diagnosis of these injuries.

Integrating Musculoskeletal Education and Patient Care at Medical Student−Run Free Clinics

Student‐run free clinics (SRFCs) have emerged as an important educational component of United States (U.S.) medical schools. Despite the prevalence of musculoskeletal (MSK) problems presenting to SRFCs, students and clinics are often unprepared to diagnose and to treat common MSK complaints.

Use Of Dietary Supplements, Energy and Protein Bars, Gels and Drinks Among Elite Collegiate Endurance Runners: 2692 Board #215 June 3, 9: 30 AM - 11: 00 AM.

Having the physical capabilities to fight fires and protect lives is very important to all firefighters. They often use nutritional supplements for disease prevention and health promotion. In different areas of field firefighters, their workloads and the choice to use nutritional supplements maybe different. PURPOSE:This study was to investigate the nutritional supplements use, nutrition knowledge and physical work capacity tests in different areas of field firefighters of Kaohsiung City Fire Department, Taiwan. METHODS:The final sample of 356 field firefighters were obtained from 25 branches in urban, suburban, and exurban areas. All participants completed a self-administered questionnaire in which they were asked about the types of nutritional supplements use (vitamins/minerals, carbohydrate/protein supplements, energy regulatory products, and Health food), the resources of nutrition information, the reasons for use, and nutrition knowledge test. The physical work capacity test score (includes 3000-meter run, shuttle run, heavy load and run, horizontal bar, weight lifting, push-up, and sit-up) was offered by Training and Education Division in Kaohsiung City Fire Department. RESULTS:The prevalence of nutritional supplements use was 50.8% (urban 54.9 %, suburban 43.2%, and exurban 39.9%). The most commonly-used nutritional supplements were Health food (68.2%) and vitamin/mineral (19.0%). The decision to use nutritional supplements was mostly driven by their friends (18.7%). Two major reasons for using nutritional supplements were to eliminated the fatigue (19.1%) and enhance immune function (15.5%). Overall, supplement users have significantly higher scores of nutrition knowledge test than non-users (72.4 ± 19.9 vs. 65.2 ± 26.5, p<0.001). There were no significant differences between three areas in total physical work capacity test score (urban 91.1 ± 8.25, suburban 89.3 ± 9.05, and exurban 90.2 ± 8.04, p=0.39). However, the urban and suburban field firefighters have significantly higher heavy load and run, push-up, sit-up and weight lifting scores than exurban field firefighters. CONCLUSIONS:These results can provide information for their senior officers and can be a reference of nutrition education for dietitians and health educators.