Injury surveillance in elite Paralympic athletes with limb deficiency: a retrospective analysis of upper quadrant injuries

Acute and Chronic Injury Patterns in Competitive Paraclimbing Sports

OBJECTIVE

This is the first study to evaluate sport-related injuries in competitive Paraclimbing athletes with the aim of creating a medical database for future research on injury prevention.

DESIGN

This was a descriptive epidemiology study. Data collection took place in two parts. In the first part, an online survey ( n = 81) was conducted. The second part was undertaken during three competitions ( n = 273) of the 2021 International Federation of Sport Climbing Paraclimbing competitions. Injury severity grading was determined using the Climbing Injury Score of the International Federation of Sport Climbing.

RESULTS

In the online survey, 76 injuries were reported: 62% acute and 38% chronic injuries. Injury severity was as follows: 21 scored 1, 34 scored 2a, 19 scored 2b, and 2 scored 3. The most injured body regions were the upper extremity (66%) with shoulder injuries (29%) most common; 53% reported regular pain/discomfort during training/competition and 16% used nonsteroidal anti-inflammatory drugs regularly to prevent pain/discomfort when training. In the 2021 International Federation of Sport Climbing Paraclimbing competitions, eight injuries were recorded. Injury severity was as follows: seven scored 1 and one scored 2a. The most injured body region was the upper extremity (47%). Overall, the calculated climbing time was 975 hrs, and injury incidence risk was 8.21 per 1000 hrs.

CONCLUSION

Compared with nondisabled climbers, the injury pattern seems to be sport dependent but influenced by the unique impairments of the athletes. In Paraclimbing competitions, the injury severity is mostly mild, with an overall low injury incidence. A concern is the number of athletes with pain/discomfort during training/competition with regular nonsteroidal anti-inflammatory drug intake.

Novel Use of a Shoulder Spica: Treatment for Midshaft Humerus Fracture in the Presence of Limb Deficiency

Pediatric midshaft humerus fractures are typically managed with a hanging arm cast, Sarmiento bracing, coaptation splint, or a combination of these treatment options. Here we report a novel use of a shoulder spica cast in the treatment of a midshaft humerus fracture in the presence of limb deficiency. Current treatments proved unsuccessful in maintaining adequate alignment, specifically the varus deformity of the fracture. A shoulder spica was able to successfully maintain acceptable alignment throughout the duration of the patient's healing process. This nontraditional use of a shoulder spica cast shows the practicality of its ability to be utilized for the treatment of unique upper extremity orthopedic obstacles.

Parasport: Effects on Musculoskeletal Function and Injury Patterns

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Sports participation can improve gait, muscle strength, and functional abilities in patients with a wide variety of disabilities. Para athletes are also at substantial risk for injury during sports participation.

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Ambulant athletes with cerebral palsy are at risk for soft-tissue injuries about the knee as well as foot and ankle injuries. Wheelchair athletes are at risk for osteoporotic fractures and shoulder girdle injuries. Limb-deficient athletes are prone to low back pain and overuse injuries of the contralateral extremity.

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Para athletes are vulnerable to abuse during sports participation, and physicians should promptly report any possible abuse or mistreatment.

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Orthopaedic surgeons should understand disability and sport-specific risk factors for injury in para athletes in order to initiate early management and injury prevention protocols.

Psychosocial aspects of sports medicine in pediatric athletes: Current concepts in the 21st century

Behavioral aspects of organized sports activity for pediatric athletes are considered in a world consumed with winning at all costs. In the first part of this treatise, we deal with a number of themes faced by our children in their sports play. These concepts include the lure of sports, sports attrition, the mental health of pediatric athletes (i.e., effects of stress, anxiety, depression, suicide in athletes, ADHD and stimulants, coping with injuries, drug use, and eating disorders), violence in sports (i.e., concepts of the abused athlete including sexual abuse), dealing with supervisors (i.e., coaches, parents), peers, the talented athlete, early sports specialization and sports clubs. In the second part of this discussion, we cover ergolytic agents consumed by young athletes in attempts to win at all costs. Sports doping agents covered include anabolic steroids (anabolic-androgenic steroids or AAS), androstenedione, dehydroepiandrostenedione (DHEA), human growth hormone (hGH; also its human recombinant homologue: rhGH), clenbuterol, creatine, gamma hydroxybutyrate (GHB), amphetamines, caffeine and ephedrine. Also considered are blood doping that includes erythropoietin (EPO) and concepts of gene doping. In the last section of this discussion, we look at disabled pediatric athletes that include such concepts as athletes with spinal cord injuries (SCIs), myelomeningocele, cerebral palsy, wheelchair athletes, and amputee athletes; also covered are pediatric athletes with visual impairment, deafness, and those with intellectual disability including Down syndrome. In addition, concepts of autonomic dysreflexia, boosting and atlantoaxial instability are emphasized. We conclude that clinicians and society should protect our precious pediatric athletes who face many challenges in their involvement with organized sports in a world obsessed with winning. There is much we can do to help our young athletes find benefit from sports play while avoiding or blunting negative consequences of organized sport activities.

Lumbosacral injuries in elite Paralympic athletes with limb deficiency: a retrospective analysis of patient records

Background

Compared to injury data in able-bodied athletes, relatively little literature exists for Paralympic athletes. Injury data underpins the design and evaluation of injury prevention strategies in elite sport. The aim of this study was to investigate frequency, characteristics and management of lumbosacral injuries in elite athletes with limb deficiency.

Methods

A retrospective analysis of injuries in elite athletes with limb deficiency (2008 to 2017) was conducted using available data extracted from The English Institute of Sport (EIS) clinical records. Eligibility criteria: funded athletes, eligible for EIS physiotherapy support with full or partial limb deficiency. Data were analysed descriptively using frequencies.

Results

A total of 107 injuries from 32 athletes were included. Participants comprised 18 men (59%), from 9 sports, with mean age for index injuries of 27 years (range 18 to 38 years) and 15 with congenital limb deficiency (47%). Average number of index injuries for congenital and traumatic limb deficient groups were 13 and 19, respectively. Where injury onset was recorded (n=79), half of injuries occurred during training (40%, n=43). Arthrogenic structures accounted for 32.7% of injuries, myogenic 26.2%, with neurogenic, discogenic and osteogenic each <5%. The number of treatments delivered in each injury episode ranged from 1 to 43, with symptom resolution taking 2 to 439 days.

Conclusion

Elite athletes with limb deficiency experience lumbosacral injuries predominantly involving muscles and joints. While consistency and accuracy of data recording limits definitive conclusions, findings highlight the importance of precision in recording injury data as part of surveillance to enable implementation of effective injury prevention strategies.