Sports-specific concerns in the young athlete: football

Imaging of football injuries to the upper extremity

Imaging of football players is unique in many ways. Familiarity with mechanisms of injury, position of the player, and the need for rapid diagnosis and reporting will help radiologists when dealing with these athletes. Although plain radiographs are typically the first imaging modality used, MR imaging has become the cornerstone on which diagnoses and treatment decisions are based. As these athletes become stronger, faster, and more skilled, the ability to accurately assess their injuries becomes even more important, and understanding of the challenges that these patients present becomes critical.

Thermoregulatory responses and hydration practices in heat-acclimatized adolescents during preseason high school football

CONTEXT

Previous researchers have not investigated the thermoregulatory responses to multiple consecutive days of American football in adolescents.

OBJECTIVE

To examine the thermoregulatory and hydration responses of high school players during formal preseason football practices.

DESIGN

Observational study.

SETTING

Players practiced outdoors in late August once per day on days 1 through 5, twice per day on days 6 and 7, and once per day on days 8 through 10. Maximum wet bulb globe temperature averaged 23 +/- 4 degrees C.

PATIENTS OR OTHER PARTICIPANTS

Twenty-five heat-acclimatized adolescent boys (age = 15 +/- 1 years, height = 180 +/- 8 cm, mass = 81.4 +/- 15.8 kg, body fat = 12 +/- 5%, Tanner stage = 4 +/- 1).

MAIN OUTCOME MEASURE(S)

We observed participants within and across preseason practices of football. Measures included gastrointestinal temperature (T(GI)), urine osmolality, sweat rate, forearm sweat composition, fluid consumption, testosterone to cortisol ratio, perceptual measures of thirst, perceptual measures of thermal sensation, a modified Environmental Symptoms Questionnaire, and knowledge questionnaires assessing the participants' understanding of heat illnesses and hydration. Results were analyzed for differences across time and were compared between younger (14-15 years, n = 13) and older (16-17 years, n = 12) participants.

RESULTS

Maximum daily T(GI) values remained less than 40 degrees C and were correlated with maximum wet bulb globe temperature (r = 0.59, P = .009). Average urine osmolality indicated that participants generally experienced minimal to moderate hypohydration before (881 +/- 285 mOsmol/kg) and after (856 +/- 259 mOsmol/kg) each practice as a result of replacing approximately two-thirds of their sweat losses during exercise but inadequately rehydrating between practices. Age did not affect most variables; however, sweat rate was lower in younger participants (0.6 +/- 0.2 L/h) than in older participants (0.8 +/- 0.1 L/h) (F(1,18) = 8.774, P = .008).

CONCLUSIONS

Previously heat-acclimatized adolescent boys (T(GI) < 40 degrees C) can safely complete the initial days of preseason football practice in moderate environmental conditions using well-designed practice guidelines. Adolescent boys replaced most sweat lost during practice but remained mildly hypohydrated throughout data collection, indicating inadequate hydration habits when they were not at practice.

Imaging of American football injuries in children

It is estimated that 3.2 million children ages 6 to 14 years participated in organized youth football in the United States in 2007. Approximately 240,000 children play football in the nation's largest youth football organization, with tackle divisions starting at age 5 years. The number of children playing unsupervised football is much higher, and the overall number of children participating in American football is increasing. Sports are the leading cause of injury-related emergency room visits for teenagers, and football is a leading precipitating athletic activity for these visits. Football is also the most hazardous organized sports in the United States. Though most pediatric football-related injuries are minor, such as abrasions, sprains, and strains of the extremities, football accounts for more major and catastrophic injuries than any other sport. Given football's popularity with children in the United States, combined with the high rate of injury associated with participation in this activity, radiologists should be familiar with the imaging features and injury patterns seen in this patient population.

Occupational and Sport Related Traumatic Neuropathy

BACKGROUND

Sport and occupation related traumatic nerve injury is a common problem in the United States. While the physical requirements of each pursuit place participants at risk for injury to certain peripheral nervous system structures, the vast numbers of professional and recreational pursuits limits the ability to become familiar with nerve injuries specific to each. A more pragmatic approach is to apply knowledge of mechanisms of injury, physiology of nerve injury, regional anatomy, and at-risk peripheral nervous system structures to the routine neurologic history and physical assessment to arrive at a localizing and etiologic diagnosis.

REVIEW SUMMARY

The authors discuss potential mechanisms of nerve injury, the role of electrodiagnostic testing, regional peripheral nervous system anatomic considerations and lesion localization.

CONCLUSIONS

Despite the wide variety of professionally and recreationally induced peripheral nerve injuries, application of anatomic, physiologic and mechanistic considerations allow the neurologist to make an etiologic and localizing diagnosis.