Showing papers in "The Physician and Sportsmedicine in 1996"
TL;DR: Detective Winnie arrived at the scene of a fight at a restaurant to find everything in disarray, and found the proprietor, Mr. Sully, thinking he had been robbed and the so‐called fight was nothing more than a red herring.
Abstract: DIRECTIONS: Read the story below. Then answer the questions. When Detective Winnie arrived at the scene, everything was in disarray. Tables were overturned, chairs were splintered, broken dishes and food were scattered everywhere. “It looks like there was a fight,” said the restaurant’s proprietor, Mr. Sully. “Heck of a fight, too, from what I can tell.” “Maybe,” said Mr. Winnie. He walked slowly around the floor, looking closely down at the mess. He was deliberating. “Fifteen years I have owned this restaurant,” Mr. Sully said. “Fifteen years I have trusted the same general manager. But it was after hours. Why were so many people here, eating, after hours? It’s like the place was open, when it wasn’t.” “Maybe,” said Mr. Winnie. “And I guess no one even paid their check,” Mr. Sully went on, dismally. Mr. Winnie looked up. “Mr. Sully,” he announced. “This so‐called ‘fight’ is nothing more than a red herring.” Mr. Sully looked at him in confusion. “I suggest you check your safe,” Mr. Winnie went on. I think you have been robbed. And the longer we stand here wondering about this mysterious dinner and ‘fight’, the more time the thief―I suspect your general manager―has to abscond with your hard‐earned money.” “But...how do you know that the fight was a fake?” Mr. Sully demanded. “Because there are no footprints in the food,” Mr. Winnie said, simply. Mr. Sully looked around, flabbergasted. “So there aren’t!” “It’s as if someone tiptoed through here, knocking over tables and breaking chairs, but stepping around the mess carefully, so they wouldn’t get food on their shoes. If this had been a real fight, the food would have all been smeared everywhere!” 1. Which word is a synonym for disarray?
80 citations
TL;DR: Performance on the neuropsychological tests was not associated with age, boxing record, length of career, or history of knockout or technical knockout, but the amount of sparring the boxers did was inversely associated with their performance on several of the tests.
Abstract: A volunteer group of 42 professional boxers provided information about their careers and training practices and underwent neuropsychological testing. Performance on the neuropsychological tests was not associated with age, boxing record (wins, losses, or total number of bouts), length of career, or history of knockout or technical knockout. However, the amount of sparring the boxers did was inversely associated with their performance on several of the tests. Impairments revealed by the tests were in the areas of attention, concentration, and memory.
62 citations
TL;DR: Although activity modification may alleviate symptoms, fasciotomy may be required and patients typically experience pain and swelling and may also have sensory deficits or paresthesias, and motor loss or weakness.
Abstract: The pain and swelling associated with exertional compartment syndrome is caused by raised intracompartmental pressures possibly induced by muscle swelling or increased osmotic pressure. Although ei...
44 citations
TL;DR: Anti-inflammatory medications such as inhaled cromolyn sodium, nedocromil sodium, and corticosteroids are used to control underlying asthma as well as EIA.
Abstract: Exercise-induced asthma (EIA) brief affects 12% to 15% of the general population. Its symptoms include chest tightness, shortness of breath, coughing, wheezing, fatigue, and prolonged recovery times after exercise. Diagnosis depends on accurate history, physical examination, and lung function testing. Nonpharmacologic management includes modification of both activity and ambient conditions, along with rigorous patient education. Short-acting inhaled beta2 agonists are the pharmacologic treatment of choice for isolated and breakthrough EIA. Anti-inflammatory medications such as inhaled cromolyn sodium, nedocromil sodium, and corticosteroids are used to control underlying asthma as well as EIA. Other agents such as oral theophylline or long-acting beta agonists may be important but their roles aren't clearly defined.
43 citations
TL;DR: Osteochondritis dissecans (OCD) is a common pathological condition of the knee currently recognized as an acquired, usually idiopathic, focal lesion of the subchondral bone as mentioned in this paper.
Abstract: Osteochondritis dissecans (OCD) is a common pathological condition of the knee currently recognized as an acquired, usually idiopathic, focal lesion of the subchondral bone. With disease progression, the overlying articular cartilage may develop softening, edema, early separation from the surrounding cartilage, partial detachment, or complete osteochondral separation with loose body formation. Despite a long-standing awareness of this condition, the pathogenesis and ideal management of OCD remains poorly understood. OCD of the knee requires a timely diagnosis to prevent compromise of the articular cartilage and to maximize the opportunity to perform a restorative procedure. Children and adolescents are more commonly affected by OCD lesions, better known as juvenile OCD. In juvenile, stable forms of OCD, the majority of patients can achieve a good outcome with non-operative management. Indications for surgical treatment are based on lesion stability, physeal closure, and clinical symptoms. Reconstitution of the articular surface, improved vascularity, rigid fixation, and early motion are primary tenets for osteochondral fragment preservation. If the fragment cannot be preserved, then cartilage restoration techniques may be attempted, including marrow stimulation, autologous chondrocyte implantation, and osteochondral autograft or fresh allograft transplantation, depending on the lesion size and individual patient’s demands. The overall goal for the treatment of adult OCD lesions is to relieve pain, restore function, and prevent development of secondary osteoarthritis.
42 citations
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TL;DR: Physicians can successfully encourage activity by giving patients a written exercise prescription along with printed advice on how to design a safe, enjoyable routine.
Abstract: Exercise is becoming more widely used prevent and treat the diseases that are most prevalent in the United States: coronary artery disease, stroke, hypertension, diabetes, arthritis, osteoporosis, dysllpi-demia, obesity, depression, cancer, and chronic obstructive pulmonary disease. However, physicians need more training in how to make best use of this powerful therapy. Physicians can successfully encourage activity by giving patients a written exercise prescription along with printed advice on how to design a safe, enjoyable routine.
25 citations
TL;DR: Signs and symptoms of the female athlete triad may include fatigue, anemia, depression, cold intolerance, lanugo, and eroded tooth enamel from frequent vomiting.
Abstract: The female athlete triad of disordered eating, amenorrhea, and osteoporosis affects women and girls in many sports, but the messages conveyed to those in "appearance" sports like gymnastics may play a role. Because the triad may result in irreversible bone loss and death, early detection is imperative. Friends, parents, coaches, and physicians can be alert to behaviors like eating alone, trips to the bathroom during or after meals, and the use of laxatives. Other signs and symptoms of the female athlete triad may include fatigue, anemia, depression, cold intolerance, lanugo, and eroded tooth enamel from frequent vomiting. Multidisciplinary treatment typically involves education, determining contributing factors, restoring adequate nutrition, and prescribing estrogen therapy when appropriate.
23 citations
TL;DR: In their approach to managing athletes who sustain concussions, sports physicians differ at least as widely as do the many published guidelines on the subject.
Abstract: In their approach to managing athletes who sustain concussions, sports physicians differ at least as widely as do the many published guidelines on the subject. The scarcity of scientific evidence makes practical decisions about when an athlete can safely return to the field difficult. Efforts to forge a consensus are underway, but controversy persists around such questions as whether a brief loss of consciousness should be classified as a severe concussion.
19 citations
TL;DR: There is no consensus on optimal rehabilitation, but functional exercises with stretching and strengthening have been emphasized.
Abstract: Strains to the hamstring muscle group are prevalent and, unfortunately, often recurrent, with prolonged rehabilitation and persistent disability. Most hamstring injuries are of a single muscle near the muscle-tendon junction. Rarely, the hamstring muscle group may avulse from the ischial tuberosity. The diagnosis can usually be made by history and physical exam, but MRI can be used to help pinpoint the extent and location of the injury. Initial treatment typically consists of rest, ice, compression, elevation, and pain relief. There is no consensus on optimal rehabilitation, but functional exercises with stretching and strengthening have been emphasized.
19 citations
TL;DR: A two-step infection by the Epstein-Barr virus accounts for the characteristic features of infectious mononucleosis (IM), and it may take 3 to 6 months for an elite athlete to regain top form.
Abstract: A two-step infection by the Epstein-Barr virus accounts for the characteristic features of infectious mononucleosis (IM). New serologic tests for viral antigens exist, but a rapid kit test for heterophil antibody usually suffices to confirm the diagnosis. General management is supportive only. Splenic rupture is very rare, almost never fatal if diagnosed early, and, in most cases, is probably best treated by splenectomy. Athletes tend to recover from IM faster than nonathletes. When the spleen returns to normal size, the athlete can return to contact sports, though it may take 3 to 6 months for an elite athlete to regain top form.
18 citations
TL;DR: An analysis of the most common problems active women face suggests effective strategies for diagnosis, treatment, rehabilitation, and prevention.
Abstract: The causes of women's sports injuries are currently a topic of vigorous speculation in sports medicine. Research has yet to clearly link gender to any injury etiology. Meanwhile, physicians are analyzing gender differences to find ways that women can better condition themselves for sports, avoid injuries, and recover quickly from the injuries that do occur. An analysis of the most common problems active women face—anterior cruciate ligament, patellofemoral, shoulder, and foot injuries—suggests effective strategies for diagnosis, treatment, rehabilitation, and prevention.
TL;DR: Patients typically experience pain and swelling and may also have sensory deficits or paresthesias, and motor loss or weakness.
Abstract: In brief The pain and swelling associated with exertional compartment syndrome is caused by raised intracompartmental pressures possibly induced by muscle swelling or increased osmotic pressure. Although either the acute or chronic form of exertional compartment syndrome may occur, chronic is more common. Patients typically experience pain and swelling and may also have sensory deficits or paresthesias, and motor loss or weakness. Diagnosis is confirmed by intracompartmental pressure measurements before and after exercise. Although activity modification may alleviate symptoms, fasciotomy may be required.
TL;DR: Acetaminophen and certain modalities such as icing the area are the basis of acute treatment in conjunction with ergonomic adaptation and a good low-back exercise program to help decrease stress on the low back, making back pain less likely.
Abstract: For about half of all pregnant brief women, low-back pain is inevitable. Physicians who can specify what type of back pain the patient has—lumbar, sacroiliac, or nocturnal—can institute targeted treatment that addresses the relevant pathophysiology. Acetaminophen and certain modalities such as icing the area are the basis of acute treatment in conjunction with ergonomic adaptation and a good low-back exercise program. This will help decrease stress on the low back, making back pain less likely. Before a woman becomes pregnant, encouraging her to become fit and resolving existing back problems is the key to back pain prevention.
TL;DR: This case report describes a female college basketball player who experienced brief loss of consciousness with hemiparesis after being struck in the jaw during a game, which resulted in persistent headache, cognitive difficulties, and reversal in hand dominance when she returned to play a month later.
Abstract: This case report describes a female college basketball player who experienced brief loss of consciousness with hemiparesis after being struck in the jaw during a game. When she returned to play a month later, she sustained a second mild head injury, which resulted in persistent headache, cognitive difficulties, and reversal in hand dominance. She has since recovered fully. This case addresses return-to-play issues for the head-injured athlete, especially the risk of recurrent injury. It also illustrates the utility of neuropsychological testing when standard medical tests fail to detect any abnormalities.
TL;DR: The Physician and Sportsmedicine: Vol. 24, No. 12, pp. 99-100 as discussed by the authors, was the first publication of this article, and was published in 1996.
Abstract: (1996). Sports Bras and Briefs. The Physician and Sportsmedicine: Vol. 24, No. 12, pp. 99-100.
TL;DR: A 15-year-old football player who suffered burner symptoms that resolved quickly but led to shoulder weakness and neck pain a few days later is described.
Abstract: Burner syndrome (brachial plexus injury) is common in contact sports, especially on the football field, but not always benign. Our case report describes a 15-year-old football player who suffered burner symptoms that resolved quickly but led to shoulder weakness and neck pain a few days later. Detailed serial clinical examinations are imperative for proper classification of burner injuries. Cervical root lesions, shoulder injuries, and other plexus or nerve involvement must be excluded. Rehabilitation includes physical modalities and range-of-motion, stretching, and strengthening exercises for cervical, shoulder, and elbow muscles. Prevention measures include preseason strengthening exercises and protective devices.
TL;DR: Assessment, focusing on the physical exam, requires a high degree of suspicion for associated cruciate ligament, meniscus, and posterolateral or posteromedial corner injuries.
Abstract: Medial collateral ligament and lateral collateral ligament (LCL) tears are common sequelae of varus or valgus knee injuries. Assessment, focusing on the physical exam, requires a high degree of suspicion for associated cruciate ligament, meniscus, and posterolateral or posteromedial corner injuries. Nonoperative treatment consisting of RICE, pain modalities, activity modification, and protection with a hinged brace is standard for most injuries. Grade 3 LCL tears usually require surgery. Functional rehabilitation begins immediately. Return to play is generally allowed when the player has regained 90% of usual strength.
TL;DR: The cardiac, respiratory, and central nervous system conditions that warrant activity disqualification are examined and guidelines about when it's safe for patients to participate are provided.
Abstract: Sports activities promote health and fitness for most participants, but for some, activity can complicate an illness or even be fatal. This article, the first of a two- part series on contraindications to activity, examines the cardiac, respiratory, and central nervous system conditions that warrant activity disqualification and provides guidelines about when it's safe for patients to participate.
TL;DR: A detailed history and physical exam are essential in pinpointing the injury process and making a specific diagnosis of acute elbow injuries.
Abstract: Acute elbow injuries are often collision related; chronic elbow injuries typically stem from overuse and valgus stress. What seems a purely traumatic injury, though, may actually represent an acute-on-chronic process, so a detailed history and physical exam are essential in pinpointing the injury process and making a specific diagnosis. Important details in the history are the quality, intensity, and onset of pain and the location of symptoms and their effect on function. The exam should include visual inspection, palpation, range of motion, and key tests such as applying valgus stress. Treatment can often be conservative, with emphasis on strength-building rehabilitation.
TL;DR: Primary care physicians should ask patients about urologic problems at each yearly gynecologic exam to help determine the nature of the condition and recommend conservative treatment, which often restores continence.
Abstract: Almost half of all women who exercise regularly experience some degree of urinary stress incontinence The cause is often multifactorial, but physical activity often aggravates it Because denial is commonplace, at each yearly gynecologic exam primary care physicians should ask patients about urologic problems If a problem exists, a urinary questionnaire and voiding diary can help determine the nature of the condition In addition, a thorough medical, urologic, and gynecologic history can help pinpoint the cause Physical exam can reveal such conditions as neurologic deficits and pelvic floor weakness, and other tests can rule out infection and other disorders Conservative treatment, which may involve drugs, pelvic floor strengthening, and mechanical devices, often restores continence
TL;DR: Treatment focuses on icing, relative rest, physical therapy, and modifying the swimming workout to reduce overuse and impingement.
Abstract: Shoulder pain caused by impingement of subacromial tissues is a common overuse injury in swimming, especially among adolescents who may have rigorous training schedules and be skeletally immature. A case of a 14-year-old girl with swimmer's shoulder demonstrates the diagnostic work-up, which involves pertinent history, inspection, palpation, and assessment of strength, impingement, and instability. Treatment focuses on icing, relative rest, physical therapy, and modifying the swimming workout to reduce overuse and impingement.
TL;DR: A careful neurologic examination can help identify most carotid artery injuries, but because the symptoms of injury may not appear immediately, follow-up may be necessary.
Abstract: Injury to the carotid artery can occur in athletes by direct blow to the neck or by hyperextension of the neck. After such injury, symptoms may be mild or transient. Catastrophic complications such as stroke can occur if the injury is not recognized and treated. Neurologic changes such as transient weakness or transient unilateral blurred vision that occur after a hyperextension injury or a direct blow to the neck may indicate a carotid artery injury. A careful neurologic examination can help identify most carotid artery injuries, but because the symptoms of injury may not appear immediately, follow-up may be necessary. Treatment may consist of anticoagulation therapy or operative repair.
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TL;DR: Meanwhile, everyone's talking about outcomes management tools, which are totally irrelevant in the absence of an electronic medical record.
Abstract: Meanwhile, everyone's talking about outcomes management tools. These are totally irrelevant in the absence of an electronic medical record.
TL;DR: Physicians need to be familiar with the anatomy of the region and the most common mechanisms of injury to be able to expediently diagnose and treat such injuries.
Abstract: The most common injuries to the clavicle and its associated articulations are acromioclavicular and sternoclavicular dislocations, clavicle fractures, and osteolysis and degeneration of the clavicle. Physicians need to be familiar with the anatomy of the region and the most common mechanisms of injury to be able to expediently diagnose and treat such injuries. Diagnosis is often straightforward, and conservative measures such as a figure-of-eight harness, icing, and nonsteroidal anti-inflammatory drugs usually produce satisfactory results.
TL;DR: The next line of treatment involves the use of topical agents such as erythromycin 2% solution.
Abstract: Pitted keratolysis usually presents no diagnostic difficulties because of its distinctive clinical appearance and odor. Participating in a sport that makes the feet hot and sweaty often contributes to this dermatologic condition. Sometimes simple measures such as proper foot drying and ventilating procedures are enough to clear the infection. The next line of treatment involves the use of topical agents such as erythromycin 2% solution.
TL;DR: A dull, deep pain in the wrist after a fall on an outstretched hand is the hallmark of a scaphoid fracture and range ofmotion and strengthening exercises are prescribed to restore hand function after cast removal.
Abstract: A dull, deep pain in the wrist after a fall on an outstretched hand is the hallmark of a scaphoid fracture. Pain with maneuvers that stress the scaphoid can suggest fracture on physical exam. Radiographs are crucial: Determining the location, stability, and orientation of the fracture guides treatment and predicts outcome. Distal fractures and horizontally oriented fractures generally heal well and can be managed by immobilization in a short-arm thumb spica cast. Proximal fractures and vertically oriented fractures have the most morbidity, and open reduction should be considered. When prolonged immobilization is required, range-of-motion and strengthening exercises are prescribed to restore hand function after cast removal.
TL;DR: Though distal biceps rupture is far less common than its proximal counterpart, primary care physicians should be aware of the diagnostic criteria.
Abstract: As in this case study of a snowboarder, the typical history for distal biceps brachii rupture involves a single traumatic event, an audible popping sound, and intense pain. The physical exam will reveal ecchymosis in the antecubital area and weakness with both supination and elbow flexion; the distal biceps brachii tendon will not be palpable. Though distal biceps rupture is far less common than its proximal counterpart, primary care physicians should be aware of the diagnostic criteria. Referral for surgical treatment is necessary to preserve elbow flexion and supination strength.
TL;DR: Although fit, active women may tolerate more strenuous exercise, relatively sedentary women may benefit most from non-weight-bearing exercises, moderate workouts appear to be safe for most women who have gestational diabetes.
Abstract: Exercise can play a significant role in managing blood glucose levels in women who develop gestational diabetes and in women with type II diabetes who become pregnant. Because contracting muscles help stimulate glucose transport, exercise can help women control gestational diabetes without insulin. After constraints typical of pregnancy are taken into account-such as soft-tissue laxity and fetal status-an exercise program can be tailored to the individual needs of patients. Although fit, active women may tolerate more strenuous exercise, relatively sedentary women may benefit most from non-weight-bearing exercises. Moderate workouts appear to be safe for most women who have gestational diabetes.
TL;DR: Clinicians need to understand both the sport and the illness to know what level of activity to recommend, and solo exercise at a reduced intensity is generally safe for patients whose symptoms are above the neck.
Abstract: Active people who suffer acute brief infectious illness may have questions concerning participation in exercise or sports during their illness. Many patients are reluctant to “get behind” on their training or “let down the team.” Physical activity, however, may worsen the condition, result in impaired performance, or infect others. On the other hand, some contagious diseases are relatively benign, and some activities don't affect others. Therefore, clinicians need to understand both the sport and the illness to know what level of activity to recommend. For example, solo exercise at a reduced intensity is generally safe for patients whose symptoms are above the neck.
TL;DR: Treatment of Graves' disease in young athletes consists of symptom management and antithyroid medication, radioactive iodine thyroid ablation, or, rarely, thyroidectomy.
Abstract: Graves' disease has a multitude of presentations, and certain symptoms can mimic sports-related concerns such as overtraining. A review of three cases of Graves' disease in young athletes illustrates the spectrum of symptoms and the pathophysiology. Diagnosis involves a detailed patient history, physical exam, and appropriate lab studies, including a thyroid radioactive iodine uptake scan. Treatment consists of symptom management and antithyroid medication, radioactive iodine thyroid ablation, or, rarely, thyroidectomy.