William W. Dexter

American Medical Society for Sports Medicine (AMSSM) position statement: interventional musculoskeletal ultrasound in sports medicine

Background The use of diagnostic and interventional ultrasound has significantly increased over the past decade. A majority of the increased utilisation is by non-radiologists. In sports medicine, ultrasound is often used to guide interventions such as aspirations, diagnostic or therapeutic injections, tenotomies, releases and hydrodissections. Objective Critically review the literature related to the accuracy, efficacy and cost-effectiveness of ultrasound-guided injections (USGIs) in major, intermediate and small joints; and soft tissues. Design Systematic review of the literature. Results USGIs are more accurate than landmark-guided injections (LMGIs; strength of recommendation taxonomy (SORT) Evidence Rating=A). USGIs are more efficacious than LMGIs (SORT Evidence Rating=B). USGIs are more cost-effective than LMGIs (SORT Evidence Rating=B). Ultrasound guidance is required to perform many new procedures (SORT Evidence Rating=C). Conclusions The findings of this position statement indicate there is strong evidence that USGIs are more accurate than LMGI, moderate evidence that they are more efficacious and preliminary evidence that they are more cost-effective. Furthermore, ultrasound-guided (USG) is required to perform many new, advanced procedures and will likely enable the development of innovative USG surgical techniques in the future.

Athletic Skin Injuries Combating Pressure and Friction

Because the skin is the athletes first line of defense, it is exposed to friction and pressure in nearly every athletic setting. Whether applied acutely or chronically, friction and pressure often cause skin trauma, such as abrasions, chafing, calluses, blisters, talon noir (black heel), and acne medianica. Sports medicine clinicians, who regularly see skin injuries, can speed healing by making a timely diagnosis, recommending effective treatment, and discussing prevention strategies.

American Medical Society for Sports Medicine (AMSSM) Position Statement: Interventional Musculoskeletal Ultrasound in Sports Medicine

The use of diagnostic and interventional ultrasound has significantly increased over the past decade. A majority of the increased utilization is by nonradiologists. In sports medicine, ultrasound is often used to guide interventions such as aspirations, diagnostic or therapeutic injections, tenotomies, releases, and hydrodissections. This American Medical Society for Sports Medicine (AMSSM) position statement critically reviews the literature and evaluates the accuracy, efficacy, and cost‐effectiveness of ultrasound‐guided injections in major, intermediate, and small joints, and soft tissues, all of which are commonly performed in sports medicine. New ultrasound‐guided procedures and future trends are also briefly discussed. Based upon the evidence, the official AMSSM position relevant to each subject is made.

Barriers to Outdoor Physical Activity in Wintertime Among Somali Youth

To identify barriers to outdoor physical activity in winter among Somali youth in Maine. Despite the many proven health benefits of physical activity among children, such as cardiovascular fitness and health status as an adult, there has been a decrease in physical activity among children in recent years. Specifically, children who are of low socio-economic status or are from communities where many immigrants are at increased risk for developing obesity. Immigrants are also less likely to be physically active. There are many potential barriers to wintertime physical activity among Somali youth in Maine, such as lack of financial resources, transportation, proper winter clothing, and appropriate knowledge of winter safety, and language and cultural barriers. For females, different attire required for outdoor activity may be a barrier. Somali parents and children were recruited from Portland, Maine to participate in focus groups led by a trained facilitator with a Somali translator and cultural broker. Transcripts were coded using NVIVO software to identify barriers to physical activity among Somali youth outside in winter. Eight focus groups were conducted. Sixty-one Somali community members were recruited. Participants felt outdoor physical activity is important, but note that it is decreased in winter. Barriers to outdoor activity in winter cited by focus group participants were lack of resources, health concerns, gender barriers for females, and knowledge barriers. Concern over lack of supervision while children play outside was also cited. This study revealed many of the underlying beliefs, barriers and cultural issues that impact Somali families’ intention to be active and ability to be active outdoors in winter. These findings can be used to generate research hypotheses and public health interventions regarding outdoor physical activity among Somali youth.

Injury trends and prevention in rugby union football.

Rugby union football has long been one of the most popular sports in the world. Its popularity and number of participants continue to increase in the United States. Until 1995, rugby union primarily was an amateur sport. Worldwide there are now flourishing professional leagues in many countries, and after a long absence, rugby union will be returning to the Olympic games in 2016. In the United States, rugby participation continues to increase, particularly at the collegiate and high school levels. With the increase in rugby professional athletes and the reported increase in aggressive play, there have been changes to the injury patterns in the sport. There is still significant need for further epidemiologic data as there is evidence that injury prevention programs and rule changes have been successful in decreasing the number of catastrophic injuries in rugby union.

Misrepresentation of Research Citations by Applicants to a Primary Care Sports Medicine Fellowship Program in the United States

Objective:To determine the prevalence of misrepresentation of publications and national presentations claimed in applications to the Maine Medical Center (MMC) Primary Care Sports Medicine Fellowship Program from 2001 through 2004. Design:A retrospective chart review study. Setting:The Maine Medical Center Primary Care Sports Medicine Fellowship Program. Methods:Presentations were confirmed in the program of the cited meeting or by contacting the sponsoring organization. Publications were verified by performing a MEDLINE search or by cross-referencing in Ulrichs International Periodicals Directory. If the title was listed, the citation was verified by contacting the publisher. Results:Fifty applicants reported research publications. Of those, 14 applications had publications that could not be verified. The overall misrepresentation rate was 11.3%; among applicants claiming publications it was 28%. There was no difference in misrepresentation rate between specialties. Eighteen applicants reported giving national presentations, and nine presentations could not be verified, corresponding to an overall misrepresentation rate of 5.6%. Of applicants claiming presentations, 38.9% had at least one misrepresentation. Conclusion:Applicants to the Maine Medical Center Sports Medicine Fellowship Program were found to have high rates of misrepresentation in their citations of both publications and presentations.

American Medical Society for Sports Medicine position statement: interventional musculoskeletal ultrasound in sports medicine.

Abstract:The use of diagnostic and interventional ultrasound has significantly increased over the past decade. A majority of the increased utilization is by nonradiologists. In sports medicine, ultrasound is often used to guide interventions such as aspirations, diagnostic or therapeutic injections, tenotomies, releases, and hydrodissections. This American Medical Society for Sports Medicine (AMSSM) position statement critically reviews the literature and evaluates the accuracy, efficacy, and cost-effectiveness of ultrasound-guided injections in major, intermediate, and small joints, and soft tissues, all of which are commonly performed in sports medicine. New ultrasound-guided procedures and future trends are also briefly discussed. Based on the evidence, the official AMSSM position relevant to each subject is made.

Fungal Infections and Parasitic Infestations in Sports: Expedient Identification and Treatment

Common fungal infections include tinea corporis, capitis, cruris, versicolor, and pedis, as well as onychomycosis. Prevention of spread is important and involves frequent skin surveillance, avoidance of shared equipment, and regular equipment cleaning. The NCAA recommends treatment of tinea corporis and capitis infections and covering any exposed infection before return to play. Parasitic infestations occur because of the close physical contact of team members and athletes in contact sports. Both scabies and pediculosis should be treated before return to play, according to NCAA guidelines. Cutaneous larva migrans, a chronic parasitic infection caused by a hookworm, may be seen in beach volleyball players.

Hypothermia. Safe and efficient methods of rewarming the patient.

Hypothermia, a relatively common problem in the winter months, can cause significant morbidity. It presents in a variety of situations and affects a wide age range. Diagnosis requires a high index of suspicion, because the symptoms, which are primarily related to the central nervous system, are not distinctive. Appropriate management requires accurate measurement of core body temperature. Treatment is centered on rewarming the patient safely and efficiently while providing other supportive measures. Care should be taken to avoid arrhythmias. Simple precautions greatly reduce the risk of hypothermia.

Cholinergic urticaria in a jogger: Ruling out exercise-induced anaphylaxis

Cholinergic urticaria is a systemic response to a rise in core temperature that can be brought on by exercise, as in this case of a 24-year-old jogger. Many cases, however, are mild. The exact pathophysiology for the release of histamines is unknown, but the resulting rash can be distressing for patients. The challenge for physicians is to differentiate exercise-induced urticaria from exercise-induced anaphylaxis, a potentially life-threatening condition. Effective management includes patient education, antihistamine use, if needed, and avoidance of precipitating triggers, such as strenuous exercise or hot showers.