Matthew Silvis

High Prevalence of Pelvic and Hip Magnetic Resonance Imaging Findings in Asymptomatic Collegiate and Professional Hockey Players

Background: Prior retrospective studies have reported magnetic resonance imaging (MRI) findings of common adductor–abdominal rectus enthesopathy and acetabular labral tear in athletes treated for athletic pubalgia and hip pain. The true prevalence of these findings and association with symptoms in this population is unknown. Purpose: This study was undertaken to determine the prevalence of pelvic and hip MRI findings and association with clinical symptoms in professional and collegiate hockey players. Study Design: Cross-sectional study; Level of evidence, 3. Methods: The study included 21 professional and 18 collegiate hockey players. Self-reported symptoms were measured using a modified Oswestry Disability Questionnaire. Participants underwent 3-T MRI evaluation of the pelvis and hips. The MRI scans were interpreted independently by 3 musculoskeletal radiologists in 2 sessions separated by 3 months using a 5-point Likert scale to assess for features associated with common adductor–abdominal rectus dysfunction and hip pathology. To estimate prevalence, MRI findings rated 4 or higher on 4 of the 6 interpretations were considered positive. A variance component analysis was applied to determine intrareader and interreader reliability and the lower 95% confidence limits (CLs). Results: No participants reported symptoms related to pelvic or hip disorders. The MRI findings of common adductor–abdominal rectus dysfunction were observed in 14 of 39 participants (36%) and hip pathologic changes in 25 of 39 (64%). There was moderate agreement between readings, with intrareader and interreader reliabilities ranging from 0.37 to 1.00. The interreader reliability was less for evaluation of hip pathologic abnormalities than for groin pathologic abnormalities, with the lowest reliability observed in reporting of hip osteochondral lesions (0.37 with lower 95% CL of 0.22) and fluid in the primary cleft (0.45 with lower 95% CL of 0.29) and perfect reliability in the absence of effusion and abdominal rectus tendon tears. Overall, 30 of 39 (77%) asymptomatic hockey players demonstrated MRI findings of hip or groin pathologic abnormalities. Conclusion: Given the high prevalence of MRI findings in asymptomatic hockey players, it is necessary to cautiously interpret the significance of these findings in association with clinical presentation. Future investigations will determine whether these asymptomatic findings predict future disabilities.

High School Soccer Players With Concussion Education Are More Likely to Notify Their Coach of a Suspected Concussion

Previously published studies have found that concussion symptoms are underreported in youth athletics. This study evaluated the likelihood high school soccer players would identify themselves as having concussion related symptoms during game situations. A questionnaire inquiring about past concussion education and the likelihood of notifying their coach of concussion symptoms was administered to 183 high school soccer players. Of the 60 (33%) who completed the survey, 18 (72%) athletes who had acknowledged receiving concussion training responded that they would always notify their coach of concussion symptoms, as compared with 12 (36%) of the players who reported having no such training (P = .01). The results of this study suggest that athletes with past concussion training are more likely to notify their coach of concussion symptoms, potentially reducing their risk for further injury. Concussion education should be considered for all high school soccer players.

The Barefoot Debate: Can Minimalist Shoes Reduce Running-Related Injuries?

Abstract Running has evolved throughout history from a necessary form of locomotion to an athletic and recreational pursuit. During this transition, our barefoot ancestors developed footwear. By the late 1970s, running popularity surged, and footwear manufacturers developed the running shoe. Despite new shoe technology and expert advice, runners still face high injury rates, which have yet to decline. Recently, “minimalist” running, marked by a soft forefoot strike and shorter, quicker strides, has become increasingly popular within the running community. Biomechanical studies have suggested that these features of barefoot-style running may lead to a reduction in injury rates. After conducting more outcomes-based research, minimalist footwear and gait retraining may serve as new methods to reduce injuries within the running population.

The Effects of Bariatric Surgery Weight Loss on Knee Pain in Patients with Osteoarthritis of the Knee

Studies have shown that osteoarthritis (OA) is highly associated with obesity, and individuals clinically defined as obese (BMI > 30.0 kg/m2) are four times more likely to have knee OA over the general population. The purpose of this research was to examine if isolated weight loss improved knee symptoms in patients with osteoarthritis. Adult patients (n = 24; age 18–70; BMI > 35 kg/m2) with clinical and radiographic evidence of knee OA participated in a one-year trial in which WOMAC and KOOS surveys were administered at a presurgery baseline and six and twelve months postsurgery. Statistical analysis was performed using Students t and Wilcoxon Signed Rank tests. Weight loss six and twelve months following bariatric surgery was statistically significant (P < 0.05) compared to presurgery measurements. All variables from both KOOS and WOMAC assessments were significantly improved (P < 0.05) when compared to baseline. Isolated weight loss occurring via bariatric surgery resulted in statistically significant improvement in patients knee arthritis symptoms at both six and twelve months. Further research will need to be done to determine if symptom relief continues over time, and if the benefits are also applicable to individuals with symptomatic knee arthritis that are overweight but not obese.

Common Leg Injuries of Long-Distance Runners: Anatomical and Biomechanical Approach

Context Long-distance running (greater than 3000 m) is often recommended to maintain a healthy lifestyle. Running injury rates increase significantly when weekly mileage extends beyond 40 miles cumulatively. With the development of running analysis and other diagnostic tests, injuries to the leg secondary to bone, musculotendinous, and vascular causes can be diagnosed and successfully managed. Evidence Acquisition Searches used the terms running, injuries, lower extremity, leg, medial tibial stress syndrome, compartment syndrome, stress fractures, popliteal artery entrapment, gastrocnemius soleus tears, and Achilles tendinopathy. Sources included Medline, Google Scholar, and Ovid from 1970 through January 2012. Results Tibial stress fractures and medial tibial stress syndrome can sometimes be prevented and/or treated by correcting biomechanical abnormalities. Exertional compartment syndrome and popliteal artery entrapment syndrome are caused by anatomic abnormalities and are difficult to treat without surgical correction. Conclusion Leg pain due to bone, musculotendinous, and vascular causes is common among long-distance runners. Knowledge of the underlying biomechanical and/or anatomic abnormality is necessary to successfully treat these conditions.

Reliability, Validity, and Injury Predictive Value of the Functional Movement Screen A Systematic Review and Meta-analysis

Background: The Functional Movement Screen (FMS) is utilized by professional and collegiate sports teams and the military for the prevention of musculoskeletal injuries. Hypothesis: The FMS demonstrates good interrater and intrarater reliability and validity and has predictive value for musculoskeletal injuries. Study Design: Systematic review and meta-analysis. Methods: A systematic review and meta-analysis were conducted using a computerized search of the electronic databases MEDLINE and ScienceDirect in adherence with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Extracted relevant data from each included study were recorded on a standardized form. The Cochran Q statistic was utilized to evaluate study heterogeneity. Pooled quantitative synthesis was performed to measure the intraclass correlation coefficient (ICC) for interrater and intrarater reliability, along with 95% CIs, and odds ratios with 95% CIs for the injury predictive value for a score of ≤14. Results: Eleven studies for reliability, 5 studies for validity, and 9 studies for the injury predictive value were identified that met inclusion and exclusion criteria; of these, 6 studies for reliability and 9 studies for the injury predictive value were pooled for quantitative synthesis. The ICC for intrarater reliability was 0.81 (95% CI, 0.69-0.92) and for interrater reliability was 0.81 (95% CI, 0.70-0.92). The odds of sustaining an injury were 2.74 times with an FMS score of ≤14 (95% CI, 1.70-4.43). Studies for validity demonstrated flaws in both internal and external validity of the FMS. Conclusion: The FMS has excellent interrater and intrarater reliability. Participants with composite scores of ≤14 had a significantly higher likelihood of an injury compared with those with higher scores, demonstrating the injury predictive value of the test. Significant concerns remain regarding the validity of the FMS.

Demographics and Treatment of Adolescent Posttraumatic Headache in a Regional Concussion Clinic

OBJECTIVE Mild traumatic brain injury affects over one million pediatric patients annually. Minimal data and no guidelines exist regarding treatment of posttraumatic headache (PTH). The current study investigated treatment and outcomes in patients with posttraumatic headache. METHODS Medical records of all patients (age 13-18 years of age) seen at a regional concussion program from 2006 to 2011 were reviewed. Statistical analysis using SAS 9.2 was conducted to determine the effectiveness of treatment as well as the association of gender, concussion history, and football participation on the duration of posttraumatic headache. RESULTS Four hundred subjects met the inclusion criteria. Females were more likely to report posttraumatic headache than males (90% vs. 79%, P = 0.004), more likely to be prescribed amitriptyline (24% vs. 13%, P = 0.004), and had a significantly longer recovery time (median, 80 days versus 34 days, P < 0.001). Seventeen percent of subjects were prescribed amitriptyline for treatment of posttraumatic headache, of which 82% reported a beneficial effect. There was no difference in the percentage of posttraumatic headache or recovery time in football players versus other male athletes from other sport mechanisms. CONCLUSION Females are more likely to report posttraumatic headache than males and also take longer to recover. Amitriptyline appears to be well-tolerated and an effective treatment strategy for patients with posttraumatic headache. Among pediatric patients evaluated in a concussion clinic, there is no difference in the proportion of football players reporting headaches compared with male players of other sports.

Sacral stress fracture in a professional hockey player: a case report.

Lumbosacral pain is common in the general population and among athletes. Many athletes are diagnosed with low back strain and treated with nonsteroidal anti-inflammatories, rest, and muscle relaxers. However, the differential for low back pain in athletes is broad and includes many potential etiologies such as: lumbar disk disease, facet arthropathy, spondylolysis, sacroiliitis, tendinopathies, ligament sprains, hip pathology, bursitis, intraabdominal processes, and neoplasm. Sacral stress fractures are included among the many possibilities. Stress fractures are rare in the general population, with a <1% incidence over a lifetime, but up to 20% of runners may experience a stress fracture while participating in their sport. Athletes are unique as they engage in prolonged strenuous activities, both in practice and competition. Sports activities have the potential of placing extreme amounts of repetitive loading on bones, articular surfaces, and soft tissues throughout the body, including the sacrum. Hockey players place considerable demands on their pelvis during training and competition given the physical demands of the sport. This article presents a case of a delayed diagnosis of a sacral stress fracture in a professional hockey player. This is the first known report of a hockey-related sacral stress fracture.

Do Youth Hockey Coaches Allow Players With a Known Concussion to Participate in a Game

Ice hockey is a high-risk sport for concussion. It is important that coaches have an understanding of concussion, although previous studies have demonstrated poor knowledge of concussion recognition and management by youth coaches. A cross-sectional survey with 7 case scenarios was completed by 314 youth hockey coaches. Each case scenario described a player with a concussion during a game, and scores reflected how the coach would respond to each scenario. Although most coaches would not allow a player to continue participating in a game after suffering a concussion, there was a small percentage that would. Statistical analysis found an inverse relationship between the coaches’ age and consideration of continued participation. This places athletes at significant risk for further injury and is not consistent with current concussion guidelines. USA Hockey should provide additional concussion training for their coaches as well as mandatory health care clearance following a concussion.

The dilemma of genotype positive-phenotype negative hypertrophic cardiomyopathy.

Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiovascular disease and the leading cause of sudden death in athletes. An autosomal dominant disorder affecting approximately 1 in 500 individuals, HCM has been linked to multiple mutations and exhibits variable phenotypic expression. The utility of cardiovascular screening in diagnosing risk factors for sudden cardiac death continues to be debated intensely. Genetic testing has been employed increasingly in diagnosing HCM, resulting in a subset of patients with genotype positive-phenotype negative disease; these patients carry the mutation for HCM but lack pathologic evidence of disease. These individuals pose a dilemma in the clinical management of HCM: should treatment guidelines for phenotypically normal HCM patients be the same as that of symptomatic patients? Governing bodies continue to disagree, providing conflicting guidelines for sports participation. This review examines the current fund of knowledge regarding HCM and the debate regarding screening.