What are the Factors that Impact the Outcomes of Arthroscopic Rotator Cuff Repair?

BACKGROUND

The cuff is a complex structure with many factors affecting it. How much it is affected after repair is still being investigated.

AIM

The aim of this study was to analyze the functional results of individuals who received arthroscopic rotator cuff repair and assess the various factors that could impact these outcomes.

METHODS

The study included 57 patients with a mean age of 58.8 years (range: 39-71) who underwent arthroscopic rotator cuff repair between 2013 and 2020, with a minimum of 6 months after the operation. Functional and clinical outcomes of the patients were evaluated using preoperative and postoperative scores (QDASH, ASES, and VAS). The study also analyzed how demographic factors, type and duration of the tear, comorbidities such as diabetes mellitus (DM) and hypertension (HT), and other pathologies may have affected the patients' scores.

RESULTS

The effect of the operation on the scores in rotator cuff tears was highly significant (P < 0.05). Age, gender, tear size, fatty degeneration, anchor configuration, comorbidities, and additional procedures presented variable values on postoperative scores, but were not statistically significant. The effect of DM and HT on VAS scores was statistically significant (P < 0.05).

CONCLUSION

The results of rotator cuff repair appear to be influenced by several factors, including the sex of the patient, type and duration of tear, comorbidities, and surgical procedures used. Although these factors had an effect on the scores, they were not statistically significant.

Association between platelet indices and the severity of the disease and mortality in patients with COVID-19

OBJECTIVE

The aim of the study was to determine the association between platelet indices and disease severity, and outcomes of the patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a secondary hospital.

PATIENTS AND METHODS

722 hospitalized patients who had positive rRT-PCR for SARS-CoV-2 and/or typical findings of COVID-19 at chest computed tomography (CT) were enrolled in this study. Initial platelet count (PLT) and indices, including mean platelet volume (MPV), platelet distribution width (PDW), plateletcrit (PCT), MPV/PCT, MPV/PLT, PDW/PLT, PDW/PCT on admission and the third day of hospitalization, and their relationship with disease severity and outcomes were evaluated retrospectively.

RESULTS

The mean age of the patients was 57.2±15.6 years (range: 16-94) and male/female ratio was 1.22. 81.9% of the patients had moderate and 11.8% had severe disease. 1.8% of the patients had thrombocytopenia at admission. The patients transferred to the intensive care unit (ICU) had significantly lower baseline lymphocyte counts, PLT, PCT, and 3rd day lymphocyte counts when compared with the patients in wards. ICU patients also had higher baseline CRP, LDH, ferritin, MPV/PCT, MPV/PLT, PDW/PLT, PDW/PCT ratios, and 3rd day PDW, CRP, LDH, and ferritin levels than the patients in wards. Mortality was associated with lower baseline lymphocyte counts, PLT, PCT, 3rd day lymphocyte counts and PCT. Higher baseline CRP, LDH, ferritin, MPV/PCT, PDW/PLT, PDW/PCT and 3rd day CRP, LDH, ferritin, procalcitonin, PDW, MPV/PCT, PDW/PLT, and PDW/PCT ratios were also associated with poor prognosis.

CONCLUSIONS

Platelet count and ratios were significantly associated with mortality in patients with COVID-19.

Review of Anterior Submuscular Transposition of Ulnar Nerve for Cubital Tunnel Syndrome

Objective

In this study, we report the results of patients who underwent ulnar nerve submuscular anterior transposition surgery due to cubital tunnel syndrome.

Methods

Data of 46 patients who underwent anterior submuscular transposition surgery due to cubital tunnel syndrome between January 2010 and December 2014 were retrospectively reviewed. Twenty-seven patients with preoperative and postoperative complete medical records available and who had completed at least 24 months follow-up were included in the study.

Results

According to preoperative McGovan staging system, 1 patient was classified as stage 1, 8 were stage 2A, 3 were stage 2B, and 15 were stage 3. The mean follow-up time was 61.4 (35-88) months. The mean DASH score of the patients was calculated as 19 (0-81.81). Mayo elbow performance score was excellent in 13 patients, good in 7, fair in 6, and poor in 1.

Conclusion

Anterior submuscular transposition of ulnar nerve had resolved symptoms 89% of our patients. The technique is a successful method with a low recurrence and complication rate.

Effects of beta-blockers on archery performance, body sway and aiming behaviour

Objectives

This study aimed to determine the effect of selective (bisoprolol-5 mg) and non-selective (propranolol-40 mg) beta-blockers on archery performance, body sway and aiming behaviour.

Methods

Fifteen male archers participated in a randomised, double-blind, placebo-controlled, cross-over study and competed four times (control, placebo, selective (bisoprolol) and non-selective (propranolol) beta-blocker trials). Mechanical data related to the changes in the centre of pressure during body sway and aim point fluctuation and when shooting was collected. During the shots, heart rate was recorded continuously.

Results

Results indicated that, in beta-blocker trials, although shooting heart rates were lowered by 12.8% and 8.6%, respectively, for bisoprolol and propranolol, no positive effect of beta-blockers was observed on shooting scores. Also, the use of beta-blockers did not affect shooting behaviour and body sway.

Conclusion

The use of either selective or non-selective single dose beta-blockers had no positive effect on shooting performance in archery during simulated match conditions.

Delphi developed syllabus for the medical specialty of sport and exercise medicine: part 2

Training in the medical specialty of sport and exercise medicine (SEM) is available in many, but not all countries. In 2015, an independent Delphi group, the International Syllabus in Sport and Exercise Medicine Group (ISSEMG), was formed to create a basic syllabus for this medical specialty. The group provided the first part of this syllabus, by identifying 11 domains and a total of 80 general learning areas for the specialty, in December 2017. The next step in this process, and the aim of this paper was to determine the specific learning areas for each of the 80 general learning areas. A group of 26 physicians with a range of primary medical specialty qualifications including, Sport and Exercise Medicine, Family Medicine, Internal Medicine, Cardiology, Rheumatology and Anaesthetics were invited to participate in a multiple round online Delphi study to develop specific learning areas for each of the previously published general learning areas. All invitees have extensive clinical experience in the broader sports medicine field, and in one or more components of sports medicine governance at national and/or international level. SEM, Family Medicine, Internal Medicine, Cardiology, Rheumatology and Anaesthetics were invited to participate in a multiple round online Delphi study to develop specific learning areas for each of the previously published general learning areas. All invitees have extensive clinical experience in the broader sports medicine field, and in one or more components of sports medicine governance at national and/or international level. The hierarchical syllabus developed by the ISSEMG provides a useful resource in the planning, development and delivery of specialist training programmes in the medical specialty of SEM.

Remote assessment in sport and exercise medicine (SEM): a narrative review and teleSEM solutions for and beyond the COVID-19 pandemic

Background

The COVID-19 pandemic forces sport and exercise medicine (SEM) physicians to think differently about the clinical care of patients. Many rapidly implement eHealth and telemedicine solutions specific to SEM without guidance on how best to provide these services.

Aim

The aim of this paper is to present some guiding principles on how to plan for and perform an SEM consultation remotely (teleSEM) based on a narrative review of the literature. A secondary aim is to develop a generic teleSEM injury template.

Results

eHealth and telemedicine are essential solutions to effective remote patient care, also in SEM. This paper provides guidance for wise planning and delivery of teleSEM. It is crucial for SEM physicians, technology providers and organisations to codesign teleSEM services, ideally involving athletes, coaches and other clinicians involved in the clinical care of athletes, and to gradually implement these services with appropriate support and education.

Conclusion

teleSEM provides solutions for remote athlete clinical care during and after the COVID-19 pandemic. We define two new terms—eSEM and teleSEM and discuss guiding principles on how to plan for and perform SEM consultations remotely (teleSEM). We provide an example of a generic teleSEM injury assessment guide.

Effects of benzodiazepine on neuromuscular activity performance in archers

AIM

The aim of the study was to investigate the effects of benzodiazepine on shooting performance and its components in archers. In order to evaluate the possible effects of benzodiazepine, performance related parameters of body sway, mechanical clicker reaction time, aiming behavior and heart rate values were measured.

METHODS

Subjects were 24 (10 females and 14 males) archers competing at international events and trained at least 4 years. Each archer was requested to perform under normal, placebo, and the influence of benzodiazepine (diazepam 5 mg, oral). Thus, each archer competed as control, placebo and benzodiazepine under double blind crossover design. The competition was especially designed to simulate competition environment by having archers shooting in doubles each time, on a specifically designed platforms. One platform was mounted on two force plates, where all the data related to shooting and body swaying was collected. The second platform was a dummy platform, to provide the second subject with similar feelings as the subject on the first platform. With this set of data collection, the archers were asked to compete 6 times each in changing rounds, where they had 24 shots in each competition. Repeated measure of ANOVA was used to compare the differences between control, placebo and benzodiazepine shots.

RESULTS

Results showed that there was no difference in shooting scores, resting heart rate, shooting heart rate, aiming behavior (aiming displacement in x and y axis on the target), the amount of changes in the center of pressure both in terms of displacement and velocity (front and rear foot), clicker reaction time between control, placebo and 5 mg diazepam administration shots.

CONCLUSION

It can be concluded that the use of 5 mg diazepam has no effect on shooting performance and related parameters on archers in an artificially conducted competition environment.

Acute traumatic tear of latissimus dorsi muscle in an elite track athlete

Soft tissue injuries constitute 30-50% of all sports related injuries; however, injury to the latissimus dorsi muscle is quite rare with only a few cases reported in the literature. Herein, we describe an acute traumatic tear of the latissimus dorsi muscle in an elite track athlete, which has not been reported in the track and field sports before. The injury was caused by forceful resisted arm adduction that took place at hurdling and starting from the block. A pseudotumor appearance in the axillary region was misdiagnosed as a mass. The diagnosis was made by ultrasound alone and the patient was managed conservatively.

Report of a serious reportable communicable disease at a major sporting event

A European Youth Olympic Sports Festival (EYOF), in Jaca, Northern Aragon, Spain, involving 1500 athletes, from 43 countries was held in January for 7 days. The event was marred by a case of type B Neisseria meningitidis. The usual care of the patient was performed in a local hospital. He eventually made a full recovery. The case was reported to the Local Health Authority and the National Public Health authority of the patient's country. Their advice was to treat the core case, give prophylactic therapy to the inner circle (28 athletes and officials) and surveillance of the other close contacts (84 total) with temperature and symptom review daily. They advised against further information being given to the rest of the athletes and officials, in case it might give rise to a panic situation. The dilemma of the responsible physicians was that 1500 athletes were traveling back to 43 countries within the incubation period of the bacterial meningitis. It was decided that informing each country was appropriate. This was done at the event by informing the Chef of the Missions and writing to the Secretary Generals of each National Olympic Committee attending. This was the first serious contagious disease at a major sporting event. The way in which the wider dispersing attendees were informed at the event should form the basis of management at sporting events in the likelihood of a serious communicable disease.

Running velocities and heart rates at fixed blood lactate concentrations in elite soccer players

This study was undertaken to examine the endurance performance of elite soccer players, according to age and playing position. A total of 197 male soccer players participated in this study. Each player performed exercise tests on the treadmill that included 3-minute runs and 30-second blood sampling intervals. During these tests, running speeds at the first and second stages were 10 km/hr -1 and 12 km/hr -1, respectively. When these tests were completed, running speed was increased by 1 km/hr every 3 minutes until the runner reached exhaustion. Blood samples were analyzed immediately by means of an automated lactate analyzer. Heart rate was monitored continuously at 5-second intervals. Running velocities and heart rates at 2-mmol/L -1, 2.5-mmol/L -1, 3-mmol/L -1, and 4-mmol/L -1 blood lactate concentrations were calculated with use of the spline function. Analysis of variance was used to analyze data to determine the differences between playing positions (goalkeepers, defenders, midfielders, and forwards) and age groups (older than 30 years of age, between 25 and 29 years old, between 20 and 24 years old, and 19 years old and younger). Statistical significance was set at P<.01. No significant differences were revealed between defenders, midfielders, and forwards regarding running velocities and heart rates and their correlation with specified lactate concentrations. Goalkeepers demonstrated lower endurance performance than players in the other playing positions (P<.001). Running velocities corresponding to all lactate concentrations showed no significant differences in all age groups, but heart rates in soccer players older than 30 years of age were significantly lower than those of players in other age groups (P<.01). Results of this study suggest that the endurance performance level of professional players is similar for players in all positions, except for goalkeepers, and that endurance performance is not adversely affected when a person's age increases beyond 30 years of age.

[Sports injuries in children and adolescents: etiology, epidemiology, and risk factors]

Growing participation of children in sports has resulted in an increased incidence of sports injuries. Although methodological differences in epidemiologic studies largely prevent precise comparisons, it appears that young athletes participating in combat and contact sports seem to be more prone to injuries. Knee and ankle injuries are the most commonly encountered problems and chronic events are more prevalent than acute ones. The occurrence of athletic injuries is multifactorial and may present differences with respect to sex and the sports branch involved. An analytical approach of all relevant groups (parents, coaches, physical education teachers, health personnel) is necessary to understand, treat, and prevent athletic injuries in children.

Changes in blood haemorheological parameters after submaximal exercise in trained and untrained subjects

The blood stream is affected by viscosity and many other haemorheological factors such as lipid peroxidation in the plasma and red blood cells. The aim of this study was to investigate the changes of haemorheological parameters after submaximal exercise in trained and untrained subjects. The results indicated that heart rate, lymphocyte count, erythrocyte deformability, plasma lipid peroxide levels and erythrocyte glutathione peroxidase activity are increased after submaximal exercise.

Changes in serum creatine kinase, lactate dehydrogenase and aldolase activities following supramaximal exercise in athletes

While it is well known that prolonged intense exercise raises serum enzyme activities, the effects of short duration intense exercise on enzyme activity changes have not been clearly described. Three successive standard 30 s Wingate anaerobic cycle ergometer tests separated by 6-8 min rest intervals were performed by competitive male middle- and long-distance runners or cyclists (no. = 33), and matched healthy control subjects (no. = 30). Immediately before and 6 h after the tests, blood samples were before and 6 h after the tests, blood samples were taken to assess the effects of exercise on serum creatine kinase (CK), lactate dehydrogenase (LD) and aldolase (ALS) enzyme activities. Serum CK activities were found to be significantly higher in athletes than in the controls, both before and 6 hours after the test (p < 0.001), as were ALS activities (p < 0.01 before and p < 0.05 after the test), whereas LD activities were significantly higher (p < 0.05) in the athletes only after the test. Following the test, increases in LD activities (p < 0.01) were observed in athletes and rises in CK activities (p < 0.05) were seen in the controls. Significant correlations between pre- and post-exercise serum enzyme activities were established for both groups. In conclusion, following a supramaximal exercise test, increases in serum LD activities of athletes and in CK activities of controls appear to be more pronounced, and increases in serum CK, LD and ALS activities seem to depend more on the duration of exercise than on its intensity.

The relationship of maximal alactacid anaerobic power to somatotype in trained subjects

The purpose of the present study was to investigate the relationship between somatotype components and maximal alactacid anaerobic power (MAAP) in trained subjects. The somatotype components (endomorphy: means = 2.66, S.D. = +/- 0.78; mesomorphy: means = 5.45, S.D. = +/- 1.12; ectomorphy: means = 2.46, S.D. = +/- 0.88) and total MAAP were measured in 40 male fencers (aged, means 21.79, S.D. = +/- 3.97) in order to determine the correlations. The results did not show any correlations between the parameters. It can be concluded that the MAAP of an individual does not depend on the somatotype; but it may also be assumed that MAAP show changes with the percentage of fibre type, enzymatic activity in these fibres involved by large muscle groups which are relatively related to musculo-skeletal development (second component of somatotype) and neuro-muscular properties of the subjects, all having a genetic basis.