Clinical Journal of Sport Medicine最新文献

Objectives: Social determinants of health (SDOH) are a major driver of health care outcomes in the United States. This study sought to assess the prevalence of SDOH in varsity collegiate student-athletes as this has not been an area of study in the sports medicine literature.

Design: This cross-sectional cohort study included varsity student-athletes presenting for a preparticipation physical examination (PPE) for the 2024-2025 academic year.

Setting: This study was conducted within the athletic department at an NCAA Division I University.

Patients: All incoming and returning varsity student-athletes (n = 673) completing an annual PPE were included in the study.

Interventions: Student-athletes were asked to answer 8 SDOH questions on the PPE form.

Main outcome measures: Data were analyzed for the entire student-athlete group, by sex, and by self-reported academic year.

Results: Approximately 7.5% of student-athletes in this study reported at least 1 SDOH concern. Food insecurity and social isolation were the most frequently reported issues. Upper-year students were more likely to have SDOH concerns when compared with first-year or graduate students.

Conclusions: The SDOH are a concern for varsity student-athletes even at a well-resourced NCAA Division I university. Athletic departments can leverage this information as they work to support the health and well-being of their student-athletes. Attention to SDOH can not only affect the health of a student-athlete but also their performance on the field of play.

Objectives: (1) To radiographically examine morphologies consistent with femoroacetabular impingement (FAI) syndrome in youth ice hockey and ringette athletes aged 14 to 24 years; (2) to examine FAI syndrome diagnosis because it relates to positive findings on special tests.

Design: Cross-sectional.

Setting: University, Sport Medicine Center.

Participants: Male and female ice hockey/ringette athletes at 14 to 24 years with no history of traumatic hip/pelvic injuries/surgeries.

Interventions: Examination of a novel screening protocol, using a cluster of tests, for FAI syndrome.

Main outcome measures: Clinical hip findings (hip passive range of motion [p-ROM]; hip muscle strength testing; hip impingement special tests [ST]), radiographic evidence of FAI syndrome (α angle; lateral center edge angle [LCEA]; crossover sign).

Results: A convenience sample of 28 males and 30 females consented from a larger cohort to undergo radiographs. FAI syndrome was present in 61% of males and 67% of females. Males demonstrated higher odds of cam morphologies unilaterally relative to females (OR = 4.29, 95% CI, 1.52-12.23), and based on point estimates, females displayed higher odds of pincer morphologies, both unilaterally (OR = 2.68, 95% CI, 0.95-7.73) and bilaterally (OR = 2.41, 95% CI, 0.73-8.12). Males displayed higher α angle than females (b 2 = 6.05, 95% CI, -9.75 to -2.34). No other covariates were associated with α angle/LCEA. With each additional positive ST, the odds of having evidence of FAI syndrome increased 3-fold (OR = 3.34, 95% CI, 1.91-5.83).

Conclusions: Youth male and female ice hockey and ringette athletes display similar prevalence of FAI syndrome; however, specific morphologies differ by sex. This study provides evidence that a cluster of tests may increase the certainty with which suspected FAI syndrome can be assessed through screening.

Objectives: This study aimed to investigate the prevalence of hip-related groin pain (HRGP), and femoroacetabular impingement (FAI) syndrome-related signs and symptoms, in ice hockey and ringette athletes, considering important covariables (eg, age, sex).

Design: Intra and interrater reliability and cross-sectional.

Setting: University, Sport Medicine Centre.

Participants: Male and female ice hockey/ringette athletes at 14 to 24 without a history of traumatic hip/pelvic injuries/surgeries.

Interventions: Novel screening for the assessment of HRGP and signs and symptoms associated with FAI syndrome.

Main outcome measures: HGRP-focused hip history questionnaire, International Hip Outcome tool, clinical hip screen (hip passive range of motion (ROM), p-ROM; hip muscle strength testing; hip impingement special tests).

Results: HRGP was reported by 61% of participants [105/166 (63%) male, 60/104 (57%) female]. Men with HRGP had reduced ROM in flexion (with = 124 degrees, 95% CI, 122-125 degrees; without = 126 degrees, 95% CI, 124-127 degrees, t = 1.81, P = 0.04), adduction (with = 26 degrees, 95% CI, 25-27 degrees; without = 28 degrees, 95% CI, 27-29 degrees; t = 0.21, P = 0.01), and internal rotation (with = 31 degrees, 95% CI, 30-33 degrees; without = 34 degrees, 95% CI, 33-35 degrees; t = 2.86, P = 0.002) compared with male without HRGP. Both male and female with HRGP reported up to 5-fold increased odds of positive findings on impingement tests compared with those without HRGP [flexion-adduction-internal rotation (FADIR): male, odds ratio (OR = 2.84, 95% CI, 1.73-4.69; female OR = 5.37, 95% CI, 2.21-14.87)]. When modelled and fit with other covariates, FADIR (OR = 0.76, 95% CI, 0.51-1.12) and maximal squat distance (OR = 1.69, 95% CI, 1.30-3.60) increased odds of having HRGP. International Hip Outcome scores (OR = 0.96, 95% CI, 0.95-0.98) displayed an inverse relationship with HRGP.

Conclusion: Findings from this study provide evidence to support the use of hip screening in athletes at risk of FAI syndrome. Challenges to the assessment of the hip joint continue to limit the reliability of screening tools.

Objective: Describe central nervous system (CNS) function using the Glasgow Coma Scale (GCS) and a description of signs and symptoms in patients with exertional heat stroke (EHS) during the course of treatment at a warm-weather road race. Determine whether a relationship exists between rectal temperature (T re ) and the GCS in patients with EHS during treatment.

Design: Cross-sectional research design retrospectively using medical charts.

Setting: Eleven-kilometer road race medical tent.

Patients: Patients (n = 25) with EHS receiving treatment.

Interventions: Dedicated scribes recorded patient vitals on a medical chart. The deidentified medical charts were provided by the medical director after the race. A Spearman rank correlation was used to determine whether a relationship existed between Tre and GCS (subscales and cumulative).

Main outcome measures: Rectal temperature was measured using an in-dwelling flexible probe with temperatures recorded approximately every 3 minutes. GCS was recorded by subscales on the medical chart by scribes according to existing word anchors.

Results: Average initial T re was 41.0 ± 0.6°C (105.8 ± 1.1°F) and cumulative GCS score was 14 ± 3 (4-15). No single CNS dysfunction predominated across most observations. Confusion had the highest recorded percentage (19.8%). There was a significant but weak correlation between T re and GCS [r s (124) = -0.255, P = 0.004; Ρ 2 = 0.06]. For time points in which Tre was >40°C, there was no correlation between Tre and GCS [r s (60) = -0.209, P = 0.108; Ρ 2 = 0.04], and GCS subscales Eye [r s (60) = -0.230, P = 0.077; Ρ 2 = 0.05], Verbal [r s (60) = -0.183, P = 0.161; Ρ 2 = 0.03], and Motor [r s (60) = -0.214, P = 0.100; Ρ 2 = 0.05].

Conclusions: Although GCS is a good global measure, it may not be appropriate in capturing how CNS dysfunction presents in patients with EHS. Clinicians should continue to use clinical CNS dysfunction and T re to initially recognize EHS, however, T re should be used to guide prehospital cooling of patients with EHS.

Abstract: A 33-year-old woman participating in a physically high-intensity event experienced a heat injury and was incidentally found to be pregnant. Other contributing factors to the heat injury were the event taking place during the hottest month of the year, consumption of creatine and preworkout supplements, and abstaining from breakfast on the day of the event. She suffered heat stroke with AST and ALTs reaching 8k and CK peak of 36k. The concern for acute liver failure prompted discussions for a possible liver transplant, ultimately not required. Viability of the pregnancy was indeterminable during admission. Follow-up after discharge revealed quadriceps soreness with light activity, CK levels peaking to 5k, and ALT/AST increased to 1062/234 roughly a month after her admission. BUN and Cr were slightly elevated on presentation to ED (23 and 1.8), normalizing with 3L of IVF before admission. UA unremarkable. With continued rest, the patient's symptoms resolved; CK, AST, and ALT normalized; and her pregnancy is proceeding normally. The patient is considered high risk for dehydration, shock liver, and repeat heat injury during her first delivery. This is due to increased CK/AST/ALT levels with moderate walking for 1 h. In addition, the patient meets criteria for heat tolerance testing to determine risk of future heat injuries.

Objective: To determine the role of player self-report in concussion evaluation and diagnosis.

Design: Retrospective; cross-sectional.

Setting: National Football League (NFL).

Participants: National Football League players between 2018 and 2023.

Interventions: Unaffiliated Neurotrauma Consultant gameday reports; Electronic Medical Records; Game Statistics and Information System.

Main outcome measures: Concussion evaluations and diagnoses; concussion evaluation trigger; player demographics and characteristics (eg, age, injury history).

Results: From 2018 to 2023, player self-report occurred in 24% (preseason) and 30% (regular season) of all concussion evaluations and 32% (preseason) and 39% (regular season) of diagnosed concussions. The proportion of self-report was largest among individuals with 6 to 10 years of NFL experience, offensive and defensive linemen, and those with 2 or more previous concussions.

Conclusions: This study found that NFL players self-report concussion-like symptoms to initiate evaluation approximately one-third of the time, which increased to almost 40% in concussed players. This may indicate enhanced improvement in player understanding of the injury and motivation to report to improve their symptoms, which is supported by the finding that players with more experience in the NFL and those with multiple previous concussions showed a higher percentage of triggering the evaluation by self-report. These findings help inform future educational efforts to promote timely reporting and improve postinjury recovery.

Abstract: Platelet-rich plasma (PRP) is increasingly used for the treatment of knee osteoarthritis (OA), especially in younger patients. Adverse effects are rare but can include synovitis and effusions. In this case, we present a 43-year-old woman with no history of calcium pyrophosphate deposition disease (CPPD) developed acute swelling and stiffness of the knee within 1 h after a leukocyte-poor PRP injection. Synovial fluid analysis revealed positively birefringent rhomboid-shaped crystals, confirming pseudogout. She was treated conservatively with NSAIDs and physical therapy, with complete symptom resolution in 2 weeks. This case highlights a rare complication of PRP injection, underscoring the importance of considering subclinical CPPD in patients with early onset OA. Pseudogout should be discussed as a potential, though uncommon, risk when counseling patients about PRP therapy.

Objective: To assess the effect of environmental distractions on the cognitive subcomponents of the Sport Concussion Assessment Tool 6 (SCAT6).

Design: Retrospective chart review.

Setting: Baseline testing completed during preseason physical examinations (PPEs) in an athletic training room.

Participants: Ninety male youth ice hockey players (13-18 years).

Independent variables: Noise, distractions, and observed participant attention recorded by the certified athletic trainer (AT).

Main outcome measures: Total cognitive score; subcomponent SCAT6 scores, including orientation, immediate memory, digits backwards, and the months backward scores; total concentration score; and delayed recall score.

Results: The months in reverse order score was significantly associated with whether the testing environment was quiet, that is, louder environments were associated with greater time to complete the task ( P = 0.040). The concentration score was significantly associated with whether the participant was observed to have paid attention ( P = 0.005). The total cognitive score correlated significantly with whether the participant was observed to be paying attention, that is, lower scores were associated with lower reported attention ( P = 0.017).

Conclusions: Preseason SCAT6 testing ideally should be administered in a quiet, distraction-free environment whenever possible.

Objective: A subset of patients with concussion report neck pain that may increase the likelihood of persistent postconcussive symptoms, but the prevalence of comorbid neck pain with concussion has not been well studied. Hence, the primary objective of this study was to define the prevalence of comorbid neck pain and disability in patients after concussion.

Design: A cross-sectional electronic survey.

Setting: Two different academic medical center concussion clinics.

Participants: A convenience sample of adult (age ≥18 years) concussion patients with a Glasgow Coma Score of 13 to 15 and presenting at the concussion clinic. No other specific exclusion criteria.

Interventions: Not applicable.

Main outcome measures: Survey questions on demographics, concussion-related clinical history, neck pain, neck-related disability, and headache.

Resultsintotal,: 299 adults completed the one-time anonymous survey. In total, 183 respondents (61%) reported having comorbid neck pain, with a mean numeric pain score of 5.0 ± 2 (0-10 range) and a mean neck disability index score of 38%. In total, 68% of respondents with neck pain reported the upper cervical region as the most frequent location of pain. The subset of respondents reporting neck pain with headache were more likely to report their headache radiating forward (40%; OR 4.58, CI, 2.39-8.77) and getting worse with pushing the neck (19%; OR 11.62, CI 2.73-49.55) or with movements of the head and neck (39%; OR 3.71, CI, 1.99-6.90).

Conclusions: The findings of this study reveal a high prevalence of comorbid neck pain with moderate levels of pain and disability in patients with concussion.

Objectives: To determine population values of femoroacetabular translation using dynamic hip ultrasonography (DHUS) in professional ballet dancers.

Design: Cross-sectional cohort.

Setting: Three ballet companies.

Participants: Ninety professional ballet dancers.

Interventions: Dynamic hip ultrasonography was performed (12 images/dancer, 1080 images). Biometrics included Trochanteric Prominence Angle Test and Beighton Score.

Main outcome measures: Anterior and posterior DHUS measures were documented, and femoroacetabular translation was calculated.

Results: Anterior exam mean values for female dancers in neutral (N), neutral flexed (NF), and extension external rotation (EER) positions were 4.3 ± 2.05, 9.4 ± 2.61, and 11.4 ± 2.83, respectively, and anterior translation 2.1 ± 2.08; for posterior exam, posterior neutral, posterior flexion adduction internal rotation, and posterior stand positions showed a median value (interquartile range [IQR]) 0 (0-2) and mean values of 11.7 ± 4.89 and 8.8 ± 4.63, respectively, and posterior femoroacetabular translation 10.4 ± 4.62. Ultrasound measures for male dancers' anterior exam showed 5.5 ± 2.86, 10.9 ± 2.82, and 12.9 ± 2.78 and anterior translation 1.9 ± 1.62, and posterior exam measures showed median (IQR) 0 (0-3) and mean 11.3 ± 4.69 and 10.1 ± 5.36 and posterior femoroacetabular translation 9.6 ± 3.82. Differences by sex were found in N and NF positions: male dancers had greater translation versus female dancers in the left ( P = 0.03 and P = 0.03, respectively) and right hips ( P = 0.02 and P = 0.004, respectively). Males had greater EER in the right hip compared with females ( P < 0.001).

Conclusions: Dynamic hip ultrasonography determined population values in professional ballet dancers. Sex-based differences among dancers were found.