Olympic Class Sailing Injuries and Illness: A 15-Year Study of a World Cup Regatta Venue

INTRODUCTION

Olympic class sailing injuries are a minimally researched topic. Our study includes 15 y of data from medical coverage of the Miami venue during the Sailing World Cup. The objective was to examine the nature of Olympic class sailing injuries and illnesses during competition.

METHODS

The records of the medical clinic encounters of a World Cup Sailing regatta were reviewed. Summary statistics and nominal categorized data regarding demographics, onset, mechanism, nature of condition, and referral were collected.

RESULTS

There were 740 clinic encounters, ranging from 20 to 70 annually. Five hundred fifty-five (75%) were musculoskeletal in nature, and 184 (25%) were related to medical concerns. Twelve athletes were referred to the emergency department (ED), averaging <1 per year. However, 6 (50%) of the ED referrals came from NACRA 17, 49er, and 49er F-X classes, representing a 16% ED referral rate by fleet per year. In contrast, the remainder of the classes had a 0.04% ED referral rate. The lumbar spine, cervical spine, and foot/ankle were the most common body regions treated. Laser Radial sailors had 71(10%) visits, the most per class. Coaches and staff represented 59 (8%) visits.

CONCLUSIONS

Olympic class sailing venue medical coverage should be equipped to treat a variety of acute and chronic injuries and illnesses among athletes as well as coaches and staff. Overall, rates of ED or other off-site referrals are low but higher for 49er, 49er F-X, and North American Catamaran Racing Association (NACRA)-17 classes.

Injuries in Male and Female Elite Aquatic Sports Athletes: An 8-Year Prospective, Epidemiological Study

This study aimed to determine the injury patterns associated with training activities in elite South Korean aquatic sports athletes training for the Olympic Games. From 2012 to 2019, we prospectively collected data on elite aquatic sports athletes at the Korea National Training Center. The athletes were assessed by four sports medicine doctors, and data were stratified according to sex, aquatic style, injury body location, and injury severity. Chi-square tests were used to compare groups. Injury rates was expressed as rate ratios with 95% confidence intervals. Annually, the center hosts an average of 42 elite aquatic athletes spread over four aquatic styles. We recorded 797 injuries in total (annual average: 2.37 injuries/athlete), during training sessions, 57.1% of which were mild injuries. For all athletes, most injuries occurred in the upper limb (35.9%), followed by the lower limb (31.0%), the trunk (24.5%), and the head and neck (8.7%). Aquatic style significantly influenced injury body location and severity for both male and female athletes (injury body location: p < 0.001 and p < 0.010, respectively; injury severity: p = 0.027 and p < 0.001, respectively). In general, male and female athletes experienced a comparable risk of injury (rate ratio: 1.15; 95% confidence intervals: 0.53-2.46). Among the male and female South Korean elite aquatic athletes training for the Olympic Games, most injuries were mild and occurred in the upper limb, and aquatic style influenced injury body location and severity.

Reduced shoulder strength and change in range of motion are risk factors for shoulder injury in water polo players

OBJECTIVE

To determine whether pre-season shoulder ROM and strength can be used to identify athletes at risk of future shoulder injury.

DESIGN

Prospective cohort.

SETTING

High performance sports institute.

PARTICIPANTS

76 sub-elite water polo players.

MAIN OUTCOME MEASURES

Mean pre-season shoulder internal (IR) and external rotation (ER) ROM and strength values compared by gender, dominance and prospective injury status.

RESULTS

14-dominant shoulder injuries were recorded. There was a significant difference (p = 0.05) in total ROM difference (TROM) between the prospectively injured and no injury groups (-17.2°(30.4);-0.8°(13.3)), and dominant side ER strength (11.7%(2.4) vs 14.5%(2.8), p = 0.03) and IR strength (16.5%(3.0) vs 21.6%(4.9) as a percentage body weight (PBW) were also significantly different (p ≤ 0.03). Separate significant associations were found between future episodes of shoulder injury and; dominant shoulder TROM difference of ≥7.5°(OR 3.6,95%CI 0.8-16.0), ER strength as a PBW≤12.5%(OR 5.2,95%CI 1.0-27.9), and IR strength as a PBW≤16.8%(OR 13.8,95%CI 2.2-88.0).

CONCLUSION

Pre-season dominant TROM difference, and reduced shoulder IR and ER strength relative to body weight were significant predictors for future shoulder injury. Although further investigation with a larger sample size is required, achieving optimal values on these measures may reduce future episodes of shoulder injury in water polo players.

Epidemiology of shoulder injury in sub-elite level water polo players

OBJECTIVE

Investigate the patterns and circumstances of shoulder injury, in both male and female sub-elite water polo players, through evaluating the injury incidence, mechanism and subsequent training time lost.

DESIGN

Retrospective cohort.

SETTING

Sports institute.

PARTICIPANTS

80 sub-elite water polo players.

MAIN OUTCOME MEASURES

Total injury number and incidence, mechanism of injury, lost training time and time from injury onset to seeking treatment.

RESULTS

For the athlete self-report data set (2009-2013), 218 total injuries were reported with 54 (25%) being shoulder injuries. From 2014 to 2016, 133 physiotherapist-report injuries were recorded, the shoulder accounting for 21 (16%) of total injuries. The shoulder was the most frequently injured site and accounted for 25% of lost training days. Two thirds of shoulder injuries were due to overuse (67%). The average time between sustaining a shoulder injury and presenting to the team physiotherapist was 10 days.

CONCLUSION

Irrespective of data collection method, shoulder injuries were the most common injury for both male and female sub-elite water polo players. Future injury prevention strategies could address overuse through optimising throwing volumes, and include athlete education about injury management to determine whether reducing time delay between injury occurrence and seeking treatment improves outcomes.

Atypical presentation of acute aortic dissection in a young competitive rower

A 27-year-old man (who is also the lead author) presented with dull pain deep to the suprasternal notch, following a period of intense exercise (rowing). He was initially sent home with no diagnosis, but 24 hours later returned to a different Accident & Emergency (A&E), due to continued discomfort and an increasingly altered mental state, and was diagnosed with an extensive type A aortic dissection extending from the aortic root to the iliac bifurcation of the aorta, with an ~8 cm aneurysm on the ascending aorta and a diseased aortic valve. Following emergency surgery to replace the aortic valve and the aorta from the aortic root to the middle of the aortic arch (hemiarch), the patient recovered well.

Water-Related Vaginal Injury: A Case Report and Review of the Literature

BACKGROUND

Vaginal injury can result from entry of water into the vagina under high pressure. Previously reported cases describe water-jet vaginal injuries in women participating in water-related activities, including: water skiing, personal watercraft use, waterslides, water hose and fountains, with and without foreign body in situ.

CASE

We describe the case of a severe vaginal laceration and hemorrhage in a 44-year-old female from a high-pressure water-jet generated during a water-ski fall requiring operative repair. Timely management resulted in excellent patient outcome.

CONCLUSION

A literature review demonstrated that, although uncommon, watersport-related gynaecologic injuries can be life-threatening, and women who regularly engage in watersports can be counselled regarding potential preventative measures. Physicians encountering patients with these injuries should rule out intraperitoneal injury and consider benefits of antibiotics.

Knowledge and attitudes about sports-related dental injuries and mouthguard use in young athletes in four different contact sports-water polo, karate, taekwondo and handball

BACKGROUND/AIMS

The increasing popularity of participating in sports activities among children and adolescents has increased the risk of sports-related orofacial and dental injuries. Therefore, it is important to establish efficient preventive strategies regarding sports-related dental trauma. The aim of this study was to evaluate the occurrence of sports-related dental injuries in young athletes and to compare the frequency of such injuries between high-risk and medium-risk sports, along with assessing athletes' attitudes and habits regarding mouthguard use.

METHODS

A total of 229 young athletes from four different sports (water polo (n = 59), karate (n = 58), taekwondo (n = 57) and handball (n = 55)) participated in this study. A standardized questionnaire about the frequency of orofacial and dental injuries was used. Questions were also asked about athletes' habits related to mouthguard use.

RESULTS

Mean age of the participants was 12.9 ± 3.2 years, and the average time of playing experience was 4.8 ± 3.1 years. Orofacial injury had been experienced by 58 athletes (25.3%), while 31 athletes (13.5%) suffered dental injury. Higher rate of dental injuries was observed in water polo (18.6%), karate (17.2%) and handball (21.8%) than in taekwondo (3.5%) (P = .035). Most participants were aware of mouthguards for dental trauma prevention and considered them efficient for preventing dental injuries during sports activities, but only 94 (41%) used them. There was a statistically significant difference in the use of mouthguards between taekwondo (73.7%) and karate (70.7%) players compared to handball (14.5%) and water polo players (5.1%) (P < .001).

CONCLUSIONS

Handball and water polo had similarly high occurrence of dental trauma as karate, a high-risk martial art sport. Therefore, the classification of sports according to the risk of dental trauma should be reconsidered. It would be beneficial to make wearing a mouthguard mandatory in all high-risk sports, as well as in those with medium-risk for dental injuries.

Orthopedic injuries associated with jet-skis (personal watercrafts): A review of 127 inpatients

BACKGROUND

Personal watercrafts (PWC) account for a disproportionate amount of water based injuries. Current literature suggests those with less PWC experience are more at risk for injury. Previous studies have not specifically evaluated the orthopedic implications of PWC usage or how various mechanisms of injury (MOI) contribute to different injury patterns.

HYPOTHESIS

PWC injuries will frequently require orthopedic intervention. The presence of an orthopedic injury will result in increased injury severity score (ISS), hospital and intensive care unit (ICU) length of stay (LOS). Patients visiting our region will have less PWC experience and so are more prone to serious injuries.

MATERIALS AND METHODS

Retrospective cohort study at a single Level 1 trauma center of admitted patients sustaining PWC injuries from 02/2004-03/2017. The following were studied: demographics, mechanism, season, ISS, hospital and ICU LOS, follow-up, fracture characteristics and management.

RESULTS

Hundred and twenty-seven patients were admitted due to PWC injury, 66 (52.0%) sustained an orthopedic injury, totaling 103 fractures (48 [46.6%] lower extremity, 26 [25.2%] upper extremity, 14 [13.6%] vertebral, 11 [10.7%] pelvic ring and 4 [3.9%] acetabulum). The mean age of orthopedic patients was 29 years (range 8-62). Handle bar injuries were significantly associated with open fractures, (13 of 25 open fractures, 3 of which became infected). Injuries occurring during the winter were associated with a higher ISS, yet more injuries occurred in the summer. A patient being a "visitor" to the region did not influence ISS. The mean LOS was 12.6 days for orthopedic patients. Eighteen orthopedic patients (27.3%) required ICU admission and 36 (54.5%) patients required orthopedic surgery (mean 2.11 operations).

DISCUSSION

A majority of PWC injuries resulted in extremity fractures with a moderate percentage requiring orthopedic surgery. Correlations between PWC experience and injury incidence can provide information for increased safety.

LEVEL OF EVIDENCE

IV; retrospective.

Kite surfing: epidemiology of trauma

Kite surfing has become an increasingly popular recreational activity worldwide. Thrill seekers can span the water at high speeds and reach great heights risking injury and death. We report the case of a young kite surfer who sustained a fracture dislocation of the right acetabulum that required specialised surgical management. We present this case with a review of the literature outlining the incidence of pelvic and acetabular fractures in the kitesurfing community. Overall, there is a low incidence of pelvic fractures in comparison with other orthopaedic traumas reported among kite surfers, and the most commonly injured sites are the foot and ankle. Emergency departments should be alert to this activity and its associated injury patterns due to its ever-increasing popularity.

A case report: Paediatric surfer's myelopathy

Surfer's myelopathy was first described by Thompson et al., in 2004.¹ It is a rare cause of sudden spinal cord injury that occurs in the absence of direct trauma to the spinal area in novice healthy surfers. We present the case of the youngest patient we are aware of to be diagnosed with surfer's myelopathy following actual surfing. A clear aetiology for surfer's myelopathy has not previous been described. However, the hypothesis that there is ischaemia to the lower spinal cord is supported by our case, where we present the first clear angiographic evidence of the occlusion of the great anterior radicular artery of Adamkiewicz in a patient diagnosed with surfer's myelopathy.

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Zusammenfassung. Ein 70-jähriger Patient wurde nach einem Bootsunfall mit verminderter Körpertemperatur (Hypothermie Stadium II) in die Notaufnahme eingeliefert. Aufgrund des vorliegenden Verwirrtheitszustandes war keine klare Anamnese zu erheben, weswegen eine sekundäre Hypothermie zu Beginn nicht ausgeschlossen werden konnte. Die arterielle BGA wies eine schwere metabolische Laktatazidose auf. Ausserdem zeigte das EKG J-Wellen, positive Ausschläge am Ende des QRS-Komplexes, welche typisch für eine Hypothermie sind. Nach Erwärmung mittels warmer Infusionslösungen und konvektiver Wärmeleitsysteme normalisierten sich sowohl der EKG-Befund als auch der Säure-Basen-Haushalt.

Spontaneous Recanalization After Carotid Artery Dissection: The Case for an Ultrasound-Only Monitoring Strategy

Dissection of the internal carotid artery (ICA) accounts for 5% to 25% of ischemic strokes in young adults. We report a case of spontaneous recanalization of a traumatic ICA dissection in which carotid duplex (CDU) and transcranial color-coded duplex ultrasound (TCCD) were used. A 47-year-old male presented with intermittent episodes of headache, blurry vision, anisocoria, and loss of taste sensation following a whiplash injury while body surfing. Magnetic resonance angiogram (MRA) of the neck revealed absent flow in the cavernous ICA and a clot at the skull base. Carotid duplex, used to further evaluate flow, demonstrated reverberating color Doppler and spectrum signal. A TCCD showed ICA occlusion and smaller-caliber intracranial ICA. The patient reported for follow-up after 1 month on anticoagulation therapy. Upon his return, CDU and TCCD were normal and the ICA showed normal color and spectrum signals. Computed tomography angiogram confirmed ultrasound findings of a dramatic improvement of ICA patency. Additionally, the patient reported that his headaches had resolved. Extracranial CDU and TCCD are useful for monitoring patient progress in cases of spontaneous recanalization following carotid artery dissection. These inexpensive and noninvasive imaging modalities proved to be critical in the initial and follow-up evaluations of the extracranial and intracranial vascular system, providing a strong alternative to expensive magnetic resonance imaging and invasive angiograms and offering more hemodynamic information than "static" MRA.

Shoulder injury in water polo: A systematic review of incidence and intrinsic risk factors

OBJECTIVES

Water polo is a popular water-based contact sport that involves swimming, throwing and defending. Cumulatively, these repetitive overhead activities are thought to increase the risk of shoulder injury and, subsequently to affect players' physical conditioning as well as team performance. The purpose of this review was to examine available evidence relating to shoulder injury rates and risk factors for shoulder injury in water polo.

DESIGN

Systematic review METHODS: CINAHL, AUSPORT, Pubmed, Pedro and SPORTDiscus databases were searched for original research papers using the predefined terms ("water polo") AND (shoulder OR glenohumeral* OR arm OR "upper limb").

RESULTS

Twenty papers were identified as suitable for inclusion. Reported shoulder injury rates varied from 24% - 51%. Shoulder injuries were more likely to become chronic compared to all other reported injuries. Injury data during the last three World Championships indicates an increasing rate of shoulder injuries-per-year with participation in aquatic sports. Risk for shoulder injury in water polo is multi-factorial. Volume of shooting, range of motion, scapular dyskinesis, strength imbalance, proprioceptive deficit and altered throwing kinematics have been proposed to be associated with an increased risk of injury.

CONCLUSIONS

Although this review showed water polo to have a high propensity for shoulder injury, the descriptive nature of the included papers limited the inferences that could be drawn from the pooled literature. Future directions for research include collecting normative data for shoulder range of motion, strength ratio and proprioception with prospective analysis of these attributes in relation to injury rates and time lost.

Proliferative myositis of the latissimus dorsi presenting in a 20-year-old male athlete

We describe the case of a 20-year-old rower presenting with an uncommon condition of Proliferative Myositis (PM) affecting the Latissimus Dorsi (LD). PM is a rare, benign tumour infrequently developing in the upper back. Its rapid growth and firm consistency may mistake it for sarcoma at presentation. Therefore, careful multidisciplinary work-up is crucial, and should involve appropriate radiological and histopathological investigations. Here, we propose the aetiology of LD PM to be persistent myotrauma induced by repetitive rowing motions. Symptoms and rate of progression ultimately determine the management which includes surveillance and/or conservative resection. There have been no documented cases of recurrence or malignant transformation.