Peter K. Kriz

Effect of air travel on exercise-induced coagulatory and fibrinolytic activation in marathon runners.

Objective:Air travel and exercise change hemostatic parameters. This study investigated the effect of air travel on exercise-induced coagulation and fibrinolysis in endurance athletes. Design:A prospective longitudinal study. Setting:The 114th Boston Marathon (April 19, 2010). Participants:Forty-one adults were divided into travel (T: 23 participants, living >4-hour plane flight from Boston) and nontravel (C: 18 participants, living <2-hour car trip from Boston) groups. Independent Variables:Age, anthropometrics, vital signs, training mileage, and finishing time were collected. Main Outcome Measures:Subjects provided venous blood samples the day before (PRE), immediately after (FINISH), and the day following the marathon after returning home (POST). Blood was analyzed for thrombin–antithrombin complex (TAT), tissue plasminogen activator (t-PA), hematocrit (Hct), and the presence of Factor V Leiden R506Q mutation. Results:Thrombin–antithrombin complex increased more in T subjects in PRE to FINISH samples (5.0 ± 4.0 to 12.9 ± 15.6 μg/L) than in C subjects (4.0 ± 1.2 to 6.1 ± 1.2 μg/L; P = 0.02 for comparison). The t-PA increased in both the T (5.4 ± 2.3 to 25.1 ± 12.2 ng/mL) and C (5.6 ± 2.0 to 27.7 ± 11.3 ng/mL) groups in PRE to FINISH samples, and this response did not differ between groups (P = 0.23 for comparison). Both groups exhibited similar t-PA and TAT values at POST that were not different than PRE (all P > 0.35). Age was related to the FINISH TAT values in T (r2 = 0.19; P = 0.04) but not in C (r2 = 0.03; P = 0.53) subjects. Conclusions:Results suggest that the combination of air travel and marathon running induces an acute hypercoaguable state; this hemostatic imbalance is exaggerated with increasing age.

Effectiveness of Protective Eyewear in Reducing Eye Injuries Among High School Field Hockey Players

OBJECTIVE: To determine if injury rates differ among high school field hockey players in states that mandated protective eyewear (MPE) versus states with no protective eyewear mandate (no MPE). METHODS: We analyzed field hockey exposure and injury data collected over the 2009–2010 and 2010–2011 scholastic seasons from national and regional databases. RESULTS: Incidence of all head and face injuries (including eye injuries, concussion) was significantly higher in no-MPE states compared with MPE states, 0.69 vs 0.47 injuries per 1000 athletic exposures (incidence rate ratio [IRR] 1.47; 95% confidence interval [CI]: 1.04–2.15, P = .048). Players in the no-MPE group had a 5.33-fold higher risk of eye injury than players in the MPE group (IRR 5.33; 95% CI: 0.71–39.25, P = .104). There was no significant difference in concussion rates for the 2 groups (IRR 1.04; 95% CI: 0.63–1.75, P = .857). A larger percentage of injuries sustained by athletes in the no-MPE group required >10 days to return to activity (32%) compared with athletes in the MPE group (17%), but this difference did not reach statistical significance (P = .060). CONCLUSIONS: Among high school field hockey players, playing in a no-MPE state results in a statistically significant higher incidence of head and face injuries versus playing in an MPE state. Concussion rates among players in MPE and no-MPE states were similar, indicating that addition of protective eyewear did not result in more player-player contact injuries, challenging a perception in contact/collision sports that increased protective equipment yields increased injury rates.

Risk Stratification for Ulnar Collateral Ligament Injury in Major League Baseball Players A Retrospective Study From 2007 to 2014

Background: Ulnar collateral ligament (UCL) injury has become increasingly common in Major League Baseball (MLB) players in recent years. Hypothesis: There is a significant difference in preinjury fastball velocity between MLB pitchers with tears and matched controls without UCL injury. Pitchers with injuries are throwing harder and getting injured earlier in their MLB careers. Study Design: Cohort study; Level of evidence, 3. Methods: From 2007 to 2014, a total of 170 documented UCL injuries (156 pitchers, 14 position players) occurred in MLB. Inclusion criteria for this study consisted of any player who tore his UCL in MLB during this time frame. There were 130 regular-season tears (April-September). From this group, 118 players who pitched more than 100 innings prior to tear were matched to subjects with no tear and were compared using a logistic regression analysis. A subgroup of “early tear” players who threw less than 100 career innings (n = 37) was also identified and compared with the larger tear group using a logistic regression analysis. Results: Of the 130 tears that occurred during the regular season, a significantly larger number (62%) occurred in the first 3 months (P = .011). The rate of UCL tears per MLB player (P = .001) was statistically significant. In the group of 118 matched tears, the mean fastball velocity was greater in the tear group (91.7 mph) compared with the control group (91.0 mph; P = .014). Furthermore, relief pitchers made up a greater percentage of the early tear group (<100 innings) compared with the later tear group (P = .011). Sixteen of the 170 UCL tears (9.4%) were recurrent tears, with 5 of 16 experiencing both tear and retear within the past 4 years. Conclusion: There is a statistically significant difference in the mean fastball velocity of pitchers who injure their UCL. Small increases in pitcher fastball velocity are a main contribution to the increased rate of tear in MLB. In addition, there has been an increased incidence of injury in the first 3 months of the season. Finally, early tears are more likely to occur in relief pitchers than starters.

Eye Protection and Risk of Eye Injuries in High School Field Hockey

OBJECTIVE: To determine if injury rates among female field hockey players differ before and after implementation of a national mandate for protective eyewear (MPE). METHODS: We analyzed girls’ field hockey exposure and injury data collected from national (High School Reporting Information Online [RIO]) and regional (Fairfax County Public Schools) high school sports injury databases in 2 seasons before (2009/10 and 2010/11) and 2 seasons after (2011/12 and 2012/13) a national MPE. RESULTS: The incidence of eye/orbital injuries was significantly higher in states without MPE (0.080 injuries per 1000 athletic exposures [AEs]) than in states with MPE (before the 2011/12 mandate) and the postmandate group (0.025 injuries per 1000 AEs) (odds ratio 3.20, 95% confidence interval 1.47–6.99, P = .003). There was no significant difference in concussion rates for the 2 groups (odds ratio 0.77, 95% confidence interval 0.58–1.02, P = .068). After the 2011/12 MPE, severe eye/orbital injuries (time loss >21 days) were reduced by 67%, and severe/medical disqualification head/face injuries were reduced by 70%. Concussion rates for field hockey (0.335 per 1000 AEs) rank third among girls’ sports included in the High School RIO surveillance program. CONCLUSIONS: Among female high school field hockey players, MPE is associated with a reduced incidence of eye/orbital injuries and fewer severe eye/orbital and head/face injuries. Concussion rates did not change as a result of the national MPE. Concussion remains the most common injury involving the head and face among female field hockey players, prompting further inquiry into potential effects of adopting protective headgear/helmets.

Stress fracture of the second metatarsal and sprain of lisfranc joint in a pre-professional ballet dancer.

We present the case of a 14-year-old pre-professional ballerina that demonstrates common features of two conditions affecting the midfoot that are often missed or subject to delay in diagnosis in such young athletes: 1. stress fractures at the base of the second metatarsal, and 2. sprain of the Lisfranc joint complex. While these represent potentially career-altering injuries in the professional dancer, this case demonstrates that a high index of clinical suspicion, careful physical exam, appropriate radiographic assessment, and prompt treatment are essential to achieving the best possible outcome.

Neurocognitive Deficits of Concussed Adolescent Athletes at Self-reported Symptom Resolution in the Zurich Guidelines Era:

Background: Previous studies have evaluated high school and collegiate athletes in the pre–Zurich guidelines era; whether adolescent athletes demonstrate similar neurocognitive decrements in the current concussion management era remains unclear. Purpose: To assess for the presence of neurocognitive deficits in adolescents with a sport-related concussion at the time of self-reported symptom resolution. Study Design: Cross-sectional study; Level of evidence, 3. Methods: We conducted a prospective cohort study of 32 patients, aged 13 to 18 years, who sustained concussions during ice hockey and who were referred to 3 sports medicine clinics between September 1, 2012, and March 31, 2015. Demographic, anthropometric, and injury data were collected at the time of the initial postconcussion evaluation. To document symptoms, patients completed the Post-Concussion Symptom Scale (PCSS) at initial and follow-up visits. Baseline and postinjury neurocognitive function were assessed using computerized neurocognitive testing (Immediate Post-Concussion Assessment and Cognitive Test [ImPACT]), and a reliable change index was used to determine significant changes in composite scores. Statistical comparisons were conducted using the Student t test and Mann-Whitney U test. Results: A total of 9 of 32 athletes (28.1%; 95% CI, 14.8%-46.9%) demonstrated continued neurocognitive impairment on ≥1 composite score when no longer reporting concussion-related symptoms, while only 2 of 32 athletes (6.3%; 95% CI, 1.4%-23.2%) demonstrated continued neurocognitive impairment on ≥2 composite scores. Conclusion: Neurocognitive deficits persist in adolescent athletes who no longer report concussion-related symptoms, at rates similar to those of collegiate athletes but at longer time intervals. This finding provides further evidence that adolescent athletes with a sport-related concussion demonstrate a protracted recovery and resolution of neurocognitive deficits compared with collegiate and professional athletes. Computer-based neurocognitive testing as part of a multifaceted approach continues to play an important role in return-to-play decision making after a sport-related concussion in adolescent athletes. Test-taking strategies may erroneously identify asymptomatic athletes as exhibiting neurocognitive impairment.

Epidemiology of snow skiing- versus snowboarding-related concussions presenting to the emergency department in the United States from 2010 to 2014

Objectives: To examine the trend of concussions in skiers and snowboarders from 2010 to 2014; and to quantify and compare the incidence of concussions injuries in skiers and snowboarders who presented to emergency departments in the United States in 2014. Design: Cross-sectional study of concussions in skiers and snowboarders who were evaluated in emergency departments in the United States. Main Outcomes Measure: Incidence of concussions. Results: The trend of the annual incidence of concussions for skiers and snowboarders remained stable from 2010 to 2014. An estimated total of 5388 skiing-related concussions and 5558 snowboarding-related concussions presented to emergency departments in the United States between January 1st, 2014, and December 31st, 2014. This represented an incidence of 16.9 concussions per 1 000 000 person-years for skiers and 17.4 concussions per 1 000 000 person-years for snowboarders. The incidence of concussions in the pediatric and young adult population of skiers was significantly higher than the incidence in the adult population. Similarly, the incidence of concussions in the pediatric and young adult population of snowboarders was significantly higher than the incidence in the adult population. The incidence of concussions was significantly higher in males compared with females in both skiing and snowboarding. Conclusions: The incidence of concussions from 2010 to 2014 plateaued in both skiers and snowboarders. Pediatric and young adult skiers and snowboarders had significantly higher incidences of concussion than the adult population. In contrast to the higher incidence of concussions in females in several sports including ice hockey, soccer, and basketball, the incidence of concussions was higher in males compared with females in both skiing and snowboarding.

Two-Dimensional Video Analysis of Youth and Adolescent Pitching Biomechanics: A Tool For the Common Athlete.

Three-dimensional (3D) motion analysis is the gold standard for analyzing the biomechanics of the baseball pitching motion. Historically, 3D analysis has been available primarily to elite athletes, requiring advanced cameras, and sophisticated facilities with expensive software. The advent of newer technology, and increased affordability of video recording devices, and smartphone/tablet-based applications has led to increased access to this technology for youth/amateur athletes and sports medicine professionals. Two-dimensional (2D) video analysis is an emerging tool for the kinematic assessment and observational measurement of pitching biomechanics. It is important for providers, coaches, and players to be aware of this technology, its application in identifying causes of arm pain and preventing injury, as well as its limitations. This review provides an in-depth assessment of 2D video analysis studies for pitching, a direct comparison of 2D video versus 3D motion analysis, and a practical introduction to assessing pitching biomechanics using 2D video analysis.

Traumatic Superficial Temporal Artery Pseudoaneurysm in a Helmeted Lacrosse Player.

Introduction Superficial temporal artery pseudoaneurysms (STAP) are uncommon vascular lesions typically coinciding with blunt head trauma. Although hundreds of cases have been described (5,10), few have been reported in sports medicine journals. Diagnosis of STAP can be made clinically, presenting as painless masses at the site of injury. STAP can be confused with cysts, abscesses, hematomas, lipomas, and other dermal lesions (2) but can be primarily identified using duplex ultrasound (US) or computed tomography angiography (CTA). Point-of-care musculoskeletal US, a modality becoming more widely available in sports medicine clinics, provides safe and accurate diagnosis of STAP and can facilitate referral, treatment, and ultimately return to play for athletes (10). Timely diagnosis is critical as pseudoaneurysm rupture is the main cause of morbidity. We present the case of a 16-year-old high school lacrosse player who developed STAP after being struck by a lacrosse ball.

Current Controversies Regarding Body Checking and Tackling in Youth Sports

Opinion statementHead and spinal injuries in collision sports such as American football, ice hockey, and lacrosse affect millions of youth and adolescent athletes in the USA. Strategies to reduce sport-related concussion and catastrophic spinal cord injuries have increased over the past few decades, with rule changes limiting body checking at younger levels of youth ice hockey and bans on spear tackling in American football. Until recently, sports medicine communities have focused their efforts on providing consensus statements and guidelines pertaining to the detection, evaluation, and management of sport-related concussion. Many of these recommendations have extrapolated data from adult studies as limited research is available on youth athletes. There is a movement among sports medicine clinicians and researchers to collaborate with youth sports organizations to provide scientific data and answers to questions pertaining to youth collision sport injury. Changes and advances in protective equipment have not resulted in a dramatic decline in collision sport head injuries. But several strategies hold promise, such as teaching proper body checking and tackling technique; establishing and enforcing rules that limit head contact and intent-to-harm hits to vulnerable players; implementing participation strategies determined by age, size, and physical maturity level; and introducing injury prevention strategies to reduce head injuries. By administering these interventions collectively, a safer environment for our youth and adolescent collision sport athletes to engage in healthy competition can be provided. In addition, evaluation of our collective intense sport culture is needed as societal pressures are also likely contributing to injuries and unintended consequences. Pediatricians play a vital role in advocating for the safety of youth collision sport athletes as medical providers, parents, coaches, and as board members and in advisory positions of youth sports organizations.