Sport participation and injuries among undergraduate students of a Nigerian University

Backgroud: Sports participation is a healthy behaviour but it is not without the risk of injuries. Information on the extent of sport participation and sport injuries among Nigerian Unversity students is sparse. Objeclive: To determine the prevalence and types of sport participation and injuries among university.students in Nigeria. Factors associated with sport participation among students were also examined.

METHODS

A cross-sectional survey was conducted using a self-administered questionnaire to collect information on the frequcncy and types of sport participation and sport-related injuries among a representative sample of undergraduate students of the University of Lagos, Nigeria. Resuts: A sport participation prevalence of 64.2% (95%CI: 59.5 - 68.7) was recorded among students. Football (soccer) (53.2%) had the highest participation rate. Male students (78.4% vs.41.2%) participated more frequently in sports (p <0.001). Overall injury rate was 52.5 injuries/100 students/ year (95%CI: 46.5 - 58.5). The prevalence of injury was 45.7% in male and 12.7% in female students. About half (49.3%) of reported injuries resulted in time loss. The leg and ankle were the most frequently injured body parts for all injuries and most serious injuries. Football recorded the highest prevalence of injury (73.8%).

CONCLUSION

Sport participation among students was fair and injury rate was considerably high, mostly affecting the lower extremity and most injuries resulting from football participation. This study suggests the need for improved sport participation support among students and the need for the initiation of injury prevention initiatives by stakeholders.

Performance success or failure is influenced by weeks lost to injury and illness in elite Australian track and field athletes: A 5-year prospective study

OBJECTIVES

To investigate the impact of training modification on achieving performance goals. Previous research demonstrates an inverse relationship between injury burden and success in team sports. It is unknown whether this relationship exists within individual sport such as athletics.

DESIGN

A prospective, cohort study (n=33 International Track and Field Athletes; 76 athlete seasons) across five international competition seasons.

METHODS

Athlete training status was recorded weekly over a 5-year period. Over the 6-month preparation season, relationships between training weeks completed, the number of injury/illness events and the success or failure of a performance goal at major championships was investigated. Two-by-two table were constructed and attributable risks in the exposed (AFE) calculated. A mixed-model, logistic regression was used to determine the relationship between failure and burden per injury/illness. Receiver Operator Curve (ROC) analysis was performed to ascertain the optimal threshold of training week completion to maximise the chance of success.

RESULTS

Likelihood of achieving a performance goal increased by 7-times in those that completed >80% of planned training weeks (AUC, 0.72; 95%CI 0.64-0.81). Training availability accounted for 86% of successful seasons (AFE=0.86, 95%CI, 0.46 to 0.96). The majority of new injuries occurred within the first month of the preparation season (30%) and most illnesses occurred within 2-months of the event (50%). For every modified training week the chance of success significantly reduced (OR=0.74, 95%CI 0.58 to 0.94).

CONCLUSIONS

Injuries and illnesses, and their influence on training availability, during preparation are major determinants of an athlete's chance of performance goal success or failure at the international level.

Ankylosing spondylitis in an athlete with chronic sacroiliac joint pain

Ankylosing spondylitis is a disease in which inflammation of joints, most often in the axial skeleton, can lead to reactive fibrosis and eventual joint fusion with associated immobility and kyphosis. The disease often involves extra-articular features, such as uveitis and aortic regurgitation, as well as associated inflammatory conditions of the intestines. Its etiology is unknown. Ankylosing spondylitis most commonly presents in young males (15-30 years old) as persistent low back pain and stiffness that is worse in the morning and at night and improves with activity. The authors report the case of a young male athlete whose symptoms were initially incorrectly diagnosed as sacroiliac joint instability and dysfunction and later as a sacroiliac stress fracture before further workup revealed a seronegative spondyloarthropathy and the diagnosis of ankylosing spondylitis. The patient was prescribed oral indomethacin daily by the attending rheumatologist and started on a slow progression of return to running, jumping, and weight lifting. Within 4 weeks of beginning this treatment, the patient had complete cessation of pain with the medication. At follow-up 1 year after graduation from his university, the patient was nearly symptom free and working in a non-heavy labor job. The purpose of this case report is to remind sports medicine physicians of the prevalence of rheumatologic diseases in general and ankylosing spondylitis in particular and of the various ways in which spondyloarthropathies may present in athletes. Increased suspicion may lead to earlier diagnosis and treatment, potentially reducing illness severity and duration and improving the performance of athletes with this condition.

Navicular stress fracture in high-performing twin brothers: a case report

Navicular stress fractures mainly occur in sprinting and push-off athletes. Numerous predisposing factors have been implicated in their development. Within a six-week interval in the summer of 2009, twin brothers, both elite track and field athletes, presented to us with medial foot pain. Plain radiographs were negative but a radioisotope bone scan and CT scan revealed an incomplete navicular fracture in both of them. The fracture was typically located in the proximal dorsal cortex of the central portion of the navicular bone. The presence of such a stress fracture in high performing, monozygotic twins, has never been described. As extrinsic and intrinsic risk factors, their comparability of mechanical stresses and kinematics as well as a genetic predisposition can be put forward. This case report suggests that a complex interaction between mechanical and genetic risk factors exists in the development of navicular stress fractures.

Retrospective case evaluation of gender differences in sports injuries in a Japanese sports medicine clinic

BACKGROUND

Although both gender- and sports-specific injuries exist among athletes, gender differences in the types of injuries caused by sports activities, except for anterior cruciate ligament (ACL) injury and anterior knee pain, are not well established.

OBJECTIVE

An observational study with a retrospective case-series design was conducted to investigate gender-specific differences in the types of injuries sustained while engaging in sports activities common to both males and females.

METHODS

We analyzed injuries sustained during sports activities including basketball, volleyball, tennis, skiing, track and field, and swimming, using data on age, sex, sports activities, activity levels, and sports injuries that had been computerized at our sports medicine (orthopedics) clinic. Inclusion criteria were sports activities that had a record of >100 injuries in total and athletes aged <50 years who were engaging in only 1 sports activity. We determined the absolute number of patients in each category and their percentage (proportion) of our cohort. The proportions of common injuries caused by sports activities were investigated, and gender-specific differences in the types of common injuries caused by sports activities were clarified. The Fisher exact test was used to determine the significance (P < 0.01) of the gender-specific differences in the types of sports injuries.

RESULTS

According to our database, during the 14-year period between October 1992 and December 2006, a total of 2,989 athletes (1,624 males and 1,365 females) aged <50 years who engaged in 1 of the 6 sports activities described consulted our sports medicine clinic. The most common sports injuries were ACL injury (14.3%) and knee pain (13.7%), followed by ankle sprain (9.4%), lumbar disc disease (7.0%), meniscus injury (5.1%), stress fracture (2.9%), low back pain (2.5%), patellar tendinitis (2.1%), injury of the medial collateral ligament of the knee (2.0%), lumbar spondylolysis (1.7%), and muscle strain (1.5%). Among these 11 types of sports injuries, a significantly higher proportion of females who engaged in basketball (24.4% vs 10.5%), volleyball (20.5% vs 4.5%), or skiing (41.4% vs 26.5%) presented with an ACL injury, compared with their male counterparts (all, P < 0.001). There was also a significantly higher proportion of females than of males among the track and field athletes who presented with stress fractures (18.7% vs 3.9%; P < 0.001).

CONCLUSION

The findings of this retrospective study suggest that there are gender-specific differences in the types of injuries sustained during sports activities.

[Epiphyseal fracture of the proximal tibia: review of the literature and report of simultaneous bilateral fractures in a 13-year-old boy]

Proximal tibial epiphyseal injury is a rare finding in adolescents. We report the case of a 13-year-old boy with simultaneous epiphyseal fractures of both proximal tibiae to illustrate appropriate diagnosis and treatment of this condition. The injury occurred while performing a long jump: a Salter-Harris type II fracture of the right proximal tibia was sustained at take-off and a Salter-Harris type III avulsion fracture of the left tibial tuberosity upon landing. Closed reduction and internal fixation using K-wires were performed on the right side, whereas open reduction and internal fixation were done on the left side, using a lag screw and additional McLaughlin wiring.

Simultaneous bilateral tibial tubercle avulsion fracture in an adolescent: a case report and review of the literature

Avulsion fractures of the tibial tubercle are uncommon. Bilateral tibial tubercle avulsion fractures are extremely rare. In this article, we describe Watson-Jones type III simultaneous bilateral tibial tubercle avulsion fractures in a 17-year-old boy who fell on the ground while taking off in high jump in sport. An open anatomic reduction and internal fixation was performed. We report here on the successful surgical treatment of a simultaneous bilateral fracture of the tibial tuberosity in an adolescent. These types of fractures involve a growth plate, extend through the articular surface and appear to do well with open reduction and secure internal fixation despite their bilateral nature, with recovery and functional outcome comparable to results from unilateral tibial tubercle avulsion fractures.

Visual status of Nepalese national football and cricket players

This study was undertaken to assess the visual acuity, refractive status, stereopsis, colour vision and ocular morbidity of Nepalese national footballers and cricketers. Ninety-five national football and cricket players of different age group, who had at least played one international tournament representing Nepal, were included in the study. A thorough ocular examination of the players was done in the study period of six months, which revealed that higher-level professional players have significant visual problems. Among the players 70.0% had never had complete ocular examination, 8.0% were found with refractive error, 60.0% with stereo acuity equal or less than 40" of arc and 65.0% with ocular complaints.

Acute lateral ankle sprains in track and field athletes: an expanded classification

We present a longitudinal observational study on classification of acute lateral ankle ligament injuries in track and field athletes, based on objective criteria. These very common and sometimes troublesome sports injuries are treated functionally, but there is a lack in international literature on predicting the time needed for full recovery. Taking into consideration (1) active range of motion, (2) edema, (3) stress radiographs findings, and (4) full rehabilitation time, we divided grade III sprains in IIIA and IIIB, proposing that these injuries can be classified in four categories (I, II, IIA, IIIB). The range of motion-edema-stress radiographs classification that we propose evaluates the severity of lateral ankle injuries, is an easy and practical method, and predicts full return in athletic activities without residual complaints, if the proper rehabilitation program is executed.

Medical coverage for track and field events

Providing medical coverage at a track and field event is similar to other spectator events, but there are some important differences. With simultaneous events occurring over a large area, reliable communication with quick access to all event sites is mandatory. Preparation needs to include a prearranged emergency response plan for each event. Because field events involve throwing heavy and sometimes sharp objects (discus, hammer, shot put, and javelin) or landing in a cushioned pit (high jump, pole vault), sites need well-demarcated, constantly monitored boundaries with properly installed, well-maintained safety equipment. All personnel involved in monitoring these events should be educated on proper procedure in managing potential head or neck injuries. Event officials must also remained focused on their tasks, avoiding the distractions that simultaneous events can cause. Because most events are outdoors, appropriate protection and recovery sites for heat, cold, and sun exposure should be arranged.

Evolution of the treatment options of ulnar collateral ligament injuries of the elbow

Ulnar collateral ligament (UCL) insufficiency is potentially a career threatening, or even a career ending, injury, particularly in overhead throwing athletes. The evolution of treating modalities provides afflicted athletes with the opportunity to avoid premature retirement. There have been several clinical and basic science research efforts which have investigated the pathophysiology of UCL disruption, the biomechanics specific to overhead throwing, and the various types of treatment modalities. UCL reconstruction is currently the most commonly performed surgical treatment option. An in depth analysis of the present treatment options, both non-operative and operative, as well as their respective results and biomechanical evaluation, is lacking in the literature to date. This article provides a comprehensive current review and comparative analysis of these modalities. Over the last 30 years there has been an evolution of the original UCL reconstruction. Yet, despite the variability in modifications, such as the docking technique, interference screw fixation, and use of suture anchors, the unifying concepts of UCL reconstruction are that decreased dissection of the flexor-pronator mass and decreased handling of the ulnar nerve leads to improved outcomes.

Forced shoulder abduction and elbow flexion test: a new simple clinical test to detect superior labral injury in the throwing shoulder

PURPOSE

Although several clinical tests for detecting superior labral injury of the shoulder have been reported, some of the maneuvers involved are complicated and diagnosis is still inaccurate. The purpose of this report is to introduce our forced shoulder abduction and elbow flexion test (forced abduction test) along with an assessment of its efficacy in the throwing shoulder in comparison with other clinical tests.

TYPE OF STUDY

Prospective nonrandomized clinical trial.

METHODS

Fifty-four throwing athletes who underwent arthroscopic surgery were prospectively studied. Superior labral injury was present in 24 cases (Snyder's classification was type 2 in 22, and type 3 in 2). Several clinical tests were performed preoperatively and the results were recorded on our original chart. The condition of the superior labrum was then examined during arthroscopic surgery. The results of these tests were compared with the arthroscopic findings as a standard. The forced abduction test was defined as positive when pain at the posterosuperior aspect of the shoulder on forced maximal abduction was relieved or diminished by elbow flexion.

RESULTS

The sensitivity, specificity, and accuracy of the forced abduction test were 67%, 67%, and 67%, respectively. It was one of the most useful tests, along with the crank test and O'Brien's test (crank test, 58%, 72%, 66%; O'Brien's test, 54%, 60%, 57%; respectively). Furthermore, the results of the forced abduction test showed a significant correlation with the presence of superior labral injury (P = .0275, chi-square test).

CONCLUSIONS

The forced abduction test was technically simple and its usefulness was comparable to the O'Brien's and crank tests for diagnosing superior labral injury in throwing shoulders.

LEVEL OF EVIDENCE

Level II.

Injuries in elite motorcycle racing in Japan

OBJECTIVES

To investigate the incidence and pattern of injuries, relative risks, and factors affecting incidence among elite motorcycle competitors in Japan.

METHODS

A total of 117 elite motorcycle competitors including 36 road racers, 60 motocross racers, and 21 trial bike riders completed a questionnaire about injuries.

RESULTS

Sixty major injuries (25 in road racing, 32 in motocross, and three in trial bike riding) were reported. The most common injuries were fractures (45), followed by ligament injuries (8), dislocations (5), and soft tissue injuries (2). The overall injury rate was 22.4 per 1000 hours, and the death rate was zero. There was no significant correlation between risk of injury and age, experience, or accumulated competition points.

CONCLUSIONS

Injury rates in competitions such as road racing and motocross are high, and therefore additional safety measures are needed to protect competitors from injury.

Sequential avulsion of the anterior inferior iliac spine in an adolescent long jumper

We present here an unusual case of a sequential avulsion fracture of the anterior inferior iliac spine (AIIS), occurring first in the right and then the left AIIS, during long jump attempts. The case of a 17 year old boy with pain around his right groin, which first occurred during a long jump attempt, is presented. Radiographic examination revealed an avulsion fracture of the right AIIS. After conservative treatment, full athletic activity was allowed 2 months after the injury. However, 4 months later the patient returned with a similar pain in the opposite side of his groin. Radiographs revealed another fracture of the left AIIS. The boy underwent the same treatment protocol; he was examined with isokinetic dynamometry. No complication or re-injury occurred during the 2 year follow up period. In the present study, we introduce the first case of a sequential bilateral AIIS avulsion fracture caused by a long jump.

[Chronic knee joint discomfort]

Chronic pain in the knee joint is frequently a sign of arthrosis in adults. This must be clearly differentiated from other knee problems. Patellofemoral stress syndrome (occurs mostly in young people) and arthritis with effusion in the knee joint after long and mostly unusual stress also allow only a reduced function of the knee joint. However, even when the knee joint is still fully functional, chronic problems could already exist: For example, for joggers, iliotibial band friction syndrome (runner's knee) or after high unphysiological stress, patellar tendinopathy (jumper's knee). These must be differentiated from pes anserinus syndrome and a plica mediopatellaris.

Track and field injuries

OBJECTIVE

A review of the existing literature on injuries to youth (< or =18 years old) in track and field or athletics.

DATA SOURCES

Searches of the Medline and SPORT Discus databases for English language articles through the end of 2003, using the search terms (adolescent or youth) and (track or field or running) and injuries.

MAIN RESULTS

Only nine prospective or retrospective studies were found dealing with track and field injuries in children and that stated injury rates or provided enough information to allow the estimation of injury rates. Differences in study design and inconsistencies in the definition of a reportable injury provided major hindrances to making comparisons or combining data across studies. Among the few conclusions that can be drawn are that the lower extremities account for the majority of injuries, and muscle strains and ligament sprains are the predominant types of injury. While a majority of injuries may occur during training, since there is much more exposure during training than during competitions, the risk of injury is about four times higher during competitions.

CONCLUSIONS

Informed decisions with regard to preventing injuries in youth track and field are dependent upon the quality of the basic epidemiological data available, and at this time such data are, for the most part, nonexistent. Because of the large numbers of participants and the large number and variety of activities involved in track and field, adequately designed epidemiological research is difficult, but opportunities for research in this sport are available for anyone willing to take on the challenge.

Equipment Innovations and Rules Changes in Sports

Participation in competitive athletics carries an inherent risk for injury. The acceptable level of risk in certain sports is often a topic of considerable debate. The National Collegiate Athletic Association, and other sports governing bodies, use injury surveillance and input from coaches, administrators, officials, athletes, and sports medicine experts in considering rules and equipment changes. Equipment innovations and/or equipment rules changes may decrease the risk of injury. However, equipment and rules changes can alter the essence or style of play of a particular sport, thus possibly increasing the risk of injury. This article discusses recent changes in equipment in various sports. The reasons for change, controversy, and relevant research related to those changes are also reviewed.

Isolated dislocation of the proximal tibiofibular joint in a long jumper

Acute traumatic proximal tibiofibular joint dislocation is an exceedingly rare injury. This is a case report in a rare horizontal type joint variant, following a long jump injury. The diagnostic approach when this injury is suspected is described.

Athletic injuries of the first metatarsophalangeal joint

Turf-toe injuries can occur in many athletic endeavors. This article describes the different injuries that occur to the first metatarsophalangeal joint that may be termed "turf toe." These injuries may result in significant morbidity. Thus proper diagnosis is paramount for instituting appropriate treatment to facilitate an athlete's prompt return to the playing field. Two case studies are presented to illustrate injuries of the first metatarsophalangeal joint in the athletic population.

Stress fractures of the medial great toe sesamoids in athletes

The purpose of this study was to determine whether specific symptoms and findings are present in patients with symptomatic stress fractures of the sesamoids of the great toe and, if so, whether partial sesamoidectomy is sufficient for successful treatment. Five consecutive athletes (five females; mean age 16.8 years [range, 13 to 22 years]) with six feet that were treated for symptomatic stress fractures of the sesamoids of the great toe were included in this study. Four athletes (five feet) performed rhythmic sports gymnastics; the fifth athlete was a long jumper. Some swelling to the forefoot and activity-related pain that increased in forced dorsiflexion, but disappeared at rest was found in all patients. While plain X-rays evidenced fragmentation of the medial sesamoid, MRI (n=2) and frontal plane CT scan (n=3) did not always confirm the diagnosis, but bone scan (n=3) and axial as well as sagittal CT scan were useful to detect the pathology. After failure of conservative treatment measures, surgical excision of the proximal fragment was successful in all patients, and there were no complications. All patients were pain free and regained full sports activity within six months (range, 2.5 to six months). At final follow-up which averaged 50.6 months (range, 20 to 110 months), the overall clinical results were graded as good/excellent in all patients, and there was only one patient with of restriction sports activities. The obtained AOFAS-Hallux-Score was 95.3 (75 to 100) points. Apparently, stress fractures occur more often at the medial sesamoid, and females are mainly involved. When a stress fracture is suspected, bone scan and CT scan are suggested as more reliable in confirming the diagnosis than other imaging methods. When conservative treatment has failed, surgical excision of the proximal fragment is recommended.

Long-term prognosis for jumper's knee in male athletes. A prospective follow-up study

BACKGROUND

Little information is available on the long-term outcome of jumper's knee, a common problem among athletes.

PURPOSE

Our aim was to determine the 15-year prognosis of jumper's knee.

STUDY DESIGN

Prospective case control.

METHODS

The prognosis for jumper's knee was studied using two groups: athletes with jumper's knee and nonsymptomatic control athletes. At baseline, all subjects participated in standardized clinical examinations and measurements, and 15 years later they were asked to respond to a questionnaire.

RESULTS

Twenty athletes with jumper's knee and 16 athlete control subjects responded (response rate 74% and 84%, respectively). The jumper's knee group reported significantly more knee symptoms according to their Kujala score and more knee pain after repeated squatting. Fifty-three percent of the subjects in the jumper's knee group (9 of 17) reported that they had quit their sports career because of their knee problem, compared with 7% of the control athletes (1 of 14). Patellar height was associated with knee symptoms at follow-up.

CONCLUSION

Jumper's knee causes mild but long-lasting symptoms after an athletic career.

Potential complication of bioabsorbable screw fixation for osteochondritis dissecans of the knee

The 3 cases presented describe loosening or failure of bioabsorbable screws in the treatment of osteochondritis dissecans (OCD). In case 1, a 17-year-old boy with OCD of the medial femoral condyle was treated with bioabsorbable screw fixation. Six months after surgery, the patient had an acute episode of pain with effusion. Arthroscopic examination revealed 2 of the 4 screws backed out, causing cartilage damage to the corresponding tibial plateau. The shafts of the remaining 2 screws had completely absorbed, leaving the unabsorbed screw heads as intra-articular loose bodies in the knee. Unpredictable and inconsistent degradation of the screws is believed to be the mechanism for screw back-out and cartilage damage.

Late sciatic nerve palsy following avulsion of the biceps femoris muscle from the ischial tuberosity

A case of late sciatic nerve palsy following avulsion of the biceps femoris muscle from the ischial tuberosity in a 27-year-old athlete is reported.

Sand pits and bucket handles: A case of bilateral traumatic bucket-handle tears of the medial menisci

Bucket-handle tears of the medial menisci are a common injury in young adult athletes. The incidence of acute bilateral tears occurring simultaneously is anecdotally very small and its occurrence has not been reported. We present the case of an 18-year-old man who sustained bilateral bucket-handle tears of the medial menisci while long jumping. We propose that the mechanism of injury may be analogous to that in footballers. This case report raises awareness of the occurrence of bilateral bucket-handle tears.

Stress fractures and bone health in track and field athletes

The effect of exercise on bone health has received much attention in recent years. The problems of the female athlete triad: disordered eating, amenorrhea and osteoporosis have helped us to better understand and appreciate the important interaction of mechanical, hormonal, nutritional as well as genetic factors on bone health in the young female athlete. The relatively high stress fracture incidence of young track and field athletes can be quite disabling for the athlete's present and future running career. A number of risk factors including low bone mineral density (BMD), menstrual irregularities, dietary factors and prior history of stress fractures have been associated with an increased risk for stress fractures in the female athlete. Few studies have found risk factors for stress fractures in the male athlete. Female gender has been found to be a risk factor for stress fractures in the military population, but this finding is less apparent in athlete studies. Caucasians have been found to have a higher risk for stress fractures than African-American military recruits, but there is very limited data assessing stress fracture risk in athletes of varying ethnicity. Prevention of stress injury to bone involves maximizing peak bone mass in the pediatric and young adult age groups. Maintaining adequate calcium nutrition, caloric intake as well as hormonal and energy balance are important preventive measures, as are ensuring appropriate amounts of weight bearing exercise for optimizing bone health and preventing fractures. More research is needed to determine factors leading to improvements in bone density and fracture reduction in athletes at risk.

Musculoskeletal injuries in a six-day track race: ultramarathoner's ankle

OBJECTIVE

To document injuries during a 6-day track race (in which direction was reversed every 2 hours) and compare these injuries with those incurred during other ultra-marathon track and road races, and to investigate a characteristic ultra-marathon injury, tendonitis of the ankle dorsiflexors.

DESIGN

A prospective, cohort study of competitors during a 6-day race.

SETTING

400-m grass track in Colac, Victoria.

PARTICIPANTS

All 17 competitors (16 men and 1 woman).

MAIN OUTCOME MEASURES

Total numbers and percentages of specific musculoskeletal injuries.

RESULTS

A total of 36 injuries were recorded in 11 competitors. The ankle (36%) and the knee (22%) were the regions most frequently injured. The four most common diagnoses were: Achilles tendonitis (19%); extensor digitorum longus tendonitis (14%); retropatellar pain syndrome (14%); and anterior compartment pain (11%).

CONCLUSION

Achilles tendonitis, patellofemoral pain, and tendonitis of the foot dorsiflexors are the three most common injuries in ultra-marathons of 6 days or more. Ankle injuries predominate in track races, whereas knee injuries are more common in road races. Road races are associated with higher frequency of injury to the leg on the downside of the camber. Track races have an even distribution of injury. Confirmation is presented that the characteristic ultra-marathon injury is tendonitis of the foot dorsiflexors.

Glenohumeral joint: internal and external rotation range of motion in javelin throwers

OBJECTIVE

To assess differences in glenohumeral joint rotatory range of movement in javelin throwers between the throwing and non-throwing arm.

METHOD

A universal 360 degrees goniometer was used to assess glenohumeral joint external and internal rotation range in 90 degrees of shoulder abduction in a group of ten senior international javelin throwers.

RESULTS

Both arms had significantly greater degrees of external than internal rotation (p < 0.01), and the throwing arm had significantly greater range of external rotation than the non-throwing arm (p < 0.01).

CONCLUSIONS

The presence of an excessive range of external rotation in the throwing shoulder has the potential to increase eccentric load on the rotator cuff muscles and strain on the passive restraints of the glenohumeral joint. Both of these factors have been implicated in the pathological processes leading to injury in the overhead throwing athlete.

[One hundred years of orthopedics in the Netherlands. X. Sports injuries]

Sports injuries result from frequently repeated similar movements performed with submaximal force. In practice the term is also used, incorrectly, for many other injuries sustained during, or even outside, the practising of sports. Running may lead to injuries of muscles (rupture, chronic compartment syndrome), of tendons (peritendinitis, tendinosis, partial rupture, insertion tendinitis), of bone (stress fracture) and of cartilage (athrosis). Jumping mostly puts the ankle at risk, especially of development of an anterior or posterior impingement syndrome. Throwing puts much strain on the shoulder muscles; possible problems are microruptures in the rotator cuff, avulsion of the glenoid rim, chronic tendinitis of the biceps tendon and entrapment of the suprascapular nerve. The main element of the treatment is rest. If symptoms persist, surgery may be considered. Previous diagnostic imaging may then be of value.

A cross sectional study of 100 athletes with jumper's knee managed conservatively and surgically. The Victorian Institute of Sport Tendon Study Group

OBJECTIVES

Jumper's knee causes significant morbidity in athletes of all standards. However, there are few reference data on the clinical course of this condition in a large number of patients, and the aim of this study was to rectify this.

METHODS

A retrospective study of the course of jumper's knee in 100 athletes who presented to a sports medicine clinic over a nine year period was carried out. Subjects completed a questionnaire designed to collect details of sport participation, symptoms, and time out of sport. Ultrasonographic results were recorded from the radiologists' reports. Histopathological results were obtained for patients who had surgery.

RESULTS

Forty eight subjects recalled that symptoms of jumper's knee began before the age of 20 years. Symptoms prevented 33 from participating in sport for more than six months, and 18 of these were sidelined for more than 12 months. Forty nine of the subjects had two or more separate episodes of symptoms. Ultrasonography showed a characteristics hypoechoic region at the junction of the inferior pole of the patella and the deep surface of the patellar tendon. Histopathological examination showed separation and disruption of collagen fibres on polarisation light microscopy and an increase in mucoid ground substance consistent with damage of tendon collagen without inflammation.

CONCLUSIONS

Jumper's knee has the potential to be a debilitating condition for a sports person. About 33% of athletes presenting to a sports medicine clinic with jumper's knee were unable to return to sport for more than six months.

Risk factors for stress fractures in track and field athletes. A twelve-month prospective study

The aim of this 12-month prospective study was to investigate risk factors for stress fractures in a cohort of 53 female and 58 male track and field athletes, aged 17 to 26 years. Total bone mineral content, regional bone density, and soft tissue composition were measured using dual-energy x-ray absorptiometry and anthropometric techniques. Menstrual characteristics, current dietary intake, and training were assessed using questionnaires. A clinical biomechanical assessment was performed by a physical therapist. The incidence of stress fractures during the study was 21.1% with most injuries located in the tibia. Of the risk factors evaluated, none was able to predict the occurrence of stress fractures in men. However, in female athletes, significant risk factors included lower bone density, a history of menstrual disturbance, less lean mass in the lower limb, a discrepancy in leg length, and a lower fat diet. Multiple logistic regression revealed that age of menarche and calf girth were the best independent predictors of stress fractures in women. This bivariate model correctly assigned 80% of the female athletes into their respective stress fracture or nonstress fracture groups. These results suggest that it may be possible to identify female athletes most at risk for this overuse bone injury.

Paediatric sports injuries in Hong Kong: a seven year survey

OBJECTIVE

To ascertain the epidemiological characteristics of sports injuries in children in Hong Kong.

METHODS

Retrospective review of all cases seen in the Sports Injury Clinic of the Prince of Wales Hospital, Shatin, Hong Kong, in the period May 1984 to December 1990. The variables studied were age at presentation, gender, side of the body injured, anatomical location of the injury, type and severity of injury, sport played, level (school, recreational, amateur and professional) and frequency of sports participation, length in years of sports practice, and initial management of the injury.

RESULTS

Of the 2293 patients seen, 238 were youngsters (54% boys) 16 years old or younger. Ball games accounted for the greatest number of injuries, with 37 children taking part in basketball, 28 in soccer, 12 in volleyball, and 31 children taking part in a variety of other ball games. Of the remaining children, the single largest group was practising track and field, with sprinting and middle distance running accounting for 42 injuries, and 28 children were injured while cycling. Most of the injuries (85%) were classified as non-serious, but 15% of children presented with a total of 21 fractures, two joint dislocations, five concussions, and seven torn knee ligaments.

CONCLUSIONS

Children sports participation in Hong Kong, although not at high level and not as widespread as in the West, accounts for significant morbidity. These injuries should be carefully monitored to ascertain whether they result in any detrimental long term effects.

Musculoskeletal injuries in track and field: incidence, distribution and risk factors

This study evaluated the incidence, distribution and types of musculoskeletal injuries sustained by 95 track and field athletes in a 12 month period using a retrospective cohort design, and analysed selected training, anthropometric, menstrual and clinical biomechanical risk factors. Overall, 72 athletes sustained 130 injuries giving an athlete incidence rate of 76% and an injury exposure rate of 3.9 per 1000 training hours. The majority of injuries were overuse in nature and approximately one-third of all injuries were recurrent. The risk of injury was not influenced by gender or event group. The most common sites of injury were the leg (28%), thigh (22%) and knee (16%) with the most common diagnoses being stress fractures (21%) and hamstring strains (14%). Injury patterns varied between event groups with middle-distance and distance runners sustaining more overuse injuries, and sprinters, hurdlers, jumpers and multi event athletes more acute injuries (p < 0.05). Increasing age, greater overall flexibility and a greater prevalence of menstrual disturbances were associated with a greater likelihood of injury. The results of this study show that track and field athletes are at high risk for musculoskeletal injury and that it may be possible to identify those who are more likely to sustain an injury.

The incidence and distribution of stress fractures in competitive track and field athletes. A twelve-month prospective study

The incidence and distribution of stress fractures were evaluated prospectively over 12 months in 53 female and 58 male competitive track and field athletes (age range, 17 to 26 years). Twenty athletes sustained 26 stress fractures for an overall incidence rate of 21.1%. The incidence was 0.70 for the number of stress fractures per 1000 hours of training. No differences were observed between male and female rates (P > 0.05). Twenty-six stress fractures composed 20% of the 130 musculoskeletal injuries sustained during the study. Although there was no difference in stress fracture incidence among athletes competing in different events (P > 0.05), sprints, hurdles, and jumps were associated with a significantly greater number of foot fractures; middle- and long-distance running were associated with a greater number of long bone and pelvic fractures (P < 0.05). Overall, the most common sites of bone injuries were the tibia with 12 injuries (46%), followed by the navicular with 4 injuries (15%), and the fibula with 3 injuries (12%). The high incidence of stress fractures in our study suggests that risk factors in track and field athletes should be identified.

Ultrasound for diagnosis of apophyseal injuries

Avulsion injuries of the apophysis is a problem in young athletes. A correct diagnosis is necessary for establishing the appropriate treatment and the rehabilitation program. However, it is often difficult to distinguish between a simple muscle strain and an avulsion fracture. The X-ray examination is helpful only when an ossification center of the apophysis exists. Ultrasonography is considered the suitable diagnostic tool for these cases. From June 1988 to June 1993, 243 young athletes were seen with an anamnestic and clinically suspected apophyseal injury of the lower extremity. In all cases X-ray examination and ultrasound examination were performed. In 80 cases the diagnosis was confirmed by X-ray examination and in 97 by ultrasonography. Four criteria were defined for the sonographic examination: (a) a hypoechogenic zone, (b) increased distance to the apophysis, (c) dislocation of the apophysis, and (d) mobility of the apophysis on dynamic examination. These criteria are correlated to (a) edema, (b) lysis, (c) avulsion, and (d) unstable avulsion of the apophysis. Ultrasonography is a proven technique for the detection of apophyseal injuries. In comparison to X-ray examination, it has the advantages of no radiation exposure, early detection even without ossification center, and dynamic examination.

Risk factors for stress fractures in female track-and-field athletes: a retrospective analysis

The incidence and nature of stress fractures and the relationship of potential risk factors to stress-fracture history were investigated retrospectively in a group of 53 female competitive track-and-field athletes. Forty-five stress fractures, diagnosed by clinical findings and bone scan, radiograph, or CT scan, were reported in 22 women. Tibial fractures were the most common (33%). There was no significant difference in bone mineral density at the lumbar spine and tibia/fibula or in percentage body fat and total lean mass when comparing the groups with and without a stress-fracture history. Athletes with a past stress fracture were significantly older at menarche and were more likely to have experienced a history of menstrual disturbance (p < 0.05). Analysis of dietary behavior found that athletes with stress fractures scored significantly higher on the EAT-40 test and were more likely to engage in restrictive eating patterns and dieting. Multiple logistic regression showed that athletes with a history of oligomenorrhea were six times more likely to have sustained a stress fracture in the past, while those who were careful about their weight were eight times more likely. Prevention and treatment of stress fractures in female athletes should include a thorough assessment of menstrual characteristics and dietary patterns.

[Bilateral apophyseal rupture of the tibial tuberosity in the athlete]

The fracture through the apophysis underlining the tibial tuberosity remains an infrequent traumatic lesion. The simultaneous bilateral occurrence of this injury is rare. A 16-year old athlete suffered an Ogden type 1B fracture on the left and a type 1B injury combined with a Salter II lesion on the right side during the acceleration phase of a high jump. Open reduction and internal fixation were carried out bilaterally on the day of the injury. Hardware removal was performed after 12 weeks. Full range of motion and return to athletic activity was obtained 20 weeks after the injury. A modification of the Ogden classification is suggested.

Track and field athletics injuries--a one-year survey

The training programmes and competitive performances of 147 track and field athletes, from many different clubs within the UK, were analysed retrospectively in order to study the incidence, severity and types of injuries which they had suffered during the year September 1989-September 1990. This information was then related to the particular event in which they specialized as well as a number of hypothetical risk factors proposed for making them more prone to injury. Of the athletes 96 (65.3%) were male and 51 (34.7%) were female, and their ages ranged from 14 to 32 years, with their levels of competition ranging from 'competitive spectators' to UK internationals. A marked correlation was noted between their age, level of competition, number of supervised training sessions which they attended, and their incidence of injuries. However, certain other factors which were studied, such as their sex, the hours they trained, and the particular event in which they specialized appeared to provide no obvious relationship.