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Because of the unique demands of a pitch, baseball players have the greatest percentage of injuries resulting in surgery among high school athletes, with a majority of these injuries affecting the shoulder and elbow due to overuse from throwing. These injuries are believed to occur because of repeated microtrauma to soft tissues caused by the repetitive mechanical strain of throwing. Researchers and practitioners have suggested that baseball pitchers' workloads are a significant risk factor for injury in adolescent players, resulting in lost time and slowing of performance development. The purpose of our review was to investigate the current research relative to monitoring workload in baseball throwers and discuss techniques for managing and regulating cumulative stress on the arm, with a focus on preventing injury and optimizing performance in adolescent baseball pitchers.

Kienbock's disease was initially considered as lunate osteomalacia due to lesions of its nutrient arteries during carpal ligament tears. It has also been suggested following primary fractures, or because of repeated microtrauma. It is only in the past 20 or 30 years that it has appeared as aseptic necrosis. Based on Hulten's hypothesis that a negative radioulnar index was the cause of Kienbock's disease, equalization osteotomies (shortening of the radius or lengthening of the ulna) were developed. The observation of Kienbock's disease in subjects with a positive index and the risk of ulnar abutment after osteotomy led to the introduction of new osteotomies to get around these difficulties, still in the hope of treating the cause of Kienbock's disease. While it has been confirmed that a negative radioulnar index promotes lunate fracture, it clearly does not induce the pathology in the form of necrosis. In this scenario, perilunar osteotomies produce durable decompression, limiting the risk of lunate fracture in case of necrosis by removing the compressive constraints. After comparing the different osteotomies used to treat Kienbock's disease, it seems that the Camembert osteotomy for radius shortening, combined with selective shortening of the ulnar head as described by Sennwald, decompresses the lunate maximally, and protects it long enough for potential natural revascularization to occur.

Diabetic foot ulcers (DFUs) are among the most consequential and costly complications faced by patients with diabetes and the global healthcare system. Acknowledged risk factors for DFUs include diabetic peripheral neuropathy (DPN), peripheral arterial disease (PAD), microtrauma and foot deformities. Research on additional risk factors for DFUs has recently focused on dysregulated, autonomic vasomotor control in the skin of patients with DPN. In particular, impaired dermal microvascular reactivity (IDMR) with its attendant reduction in nutritive capillary blood flow has been identified as an emerging risk factor. This especially relates to refractory wounds noted in patients without overt PAD signs. In this paper, evidence will be reviewed supporting the evolving understanding of IDMR and its impact on DFU formation and healing. Advances in diagnostic instrumentation driving this research along with the most promising potential therapies aimed at improving microvascular function in the diabetic foot will be discussed in brief.

Posterior glenohumeral instability in overhead athletes presents a unique set of challenges for both diagnosis and treatment. Although a great deal of attention has been focused on the management of injuries to the biceps-labrum complex and rotator cuff in throwers, comparatively less has been written about posterior glenohumeral instability within this unique cohort. Historically, posterior instability has been observed secondary to either acute trauma or repetitive microtrauma, usually among collision athletes, weight lifters, and rowers. However, posterior glenohumeral instability resulting from pathology of the posterior capsulolabral tissues in throwers is a different entity, and the clinical assessment begins with an accurate differentiation between adaptive capsular laxity and labral injury with pathologic instability. Some posterior capsule labrum tears confirmed on arthroscopy will require nothing more than debridement. However, for more extensive lesions, surgical treatment must balance the necessity to repair torn capsulolabral tissues with the tendency to over constrain the shoulder. The literature provides mixed results regarding the likelihood of overhead athletes with posterior glenohumeral instability and labral injury treated surgically returning to their preinjury level of sport performance.

AIM Intra-operative enteroscopy (IE) is a valid diagnostic tool which can be adopted in order to identify the precise location of bleeding gastrointestinal angiodysplasias (GIADs) of the small bowel. We describe a novel IE technique that may increase the diagnostic yield by maintaining a steady distension of the bowel and that prevents microtrauma to the intestinal mucosa and spillage of enteric content into the operative field. METHODS After laparotomy, a centimetric transverse enterotomy is performed approximately at the middle of the small bowel. A 12-mm trocar with balloon is then introduced and insufflated. The small bowel is gently distended by carbon dioxide insufflation. Through the trocar, a paediatric colonscope is then inserted and the enteroscopy is performed either retrogradely to the duodenum or anterogradely to the caecum. Once located, surgery is tailored to the precise site of bleeding, with a consequent sparing of intestinal resection. RESULTS IE with 12-mm trocar with balloon was adopted in four elderly patients undergoing surgery for bleeding GIADs. The length of small bowel resection ranged from 10 to 200 cm, depending on the number of GIADs. Operating time ranged from 210 to 275 min. Intra-operative blood loss was nil. No patient developed organ-space or wound infections. There was no recurrence of bleeding from the midgut. CONCLUSION Performing IE through a balloon trocar may increase the diagnostic accuracy of the procedure with the benefit of reducing the risk of traumatic injury to the bowel and the risk of surgical site infection.

Dysfunction of the suprascapular nerve (SSN) is closely related to rotator cuff pathology; nerve dysfunction can lead to cuff disease and vice versa. Owing to repetitive microtrauma during overhead sports or massive cuff tears with significant tendon retraction, the SSN may suffer compression or traction neuropathy at the suprascapular notch. The SSN release technique has already been described. However, on the basis of the many hands-on cadaveric laboratories in which we have participated in the past 20 years, only a few instructors and almost none of the attendants have shown the experience and skill set needed to release the SSN at the suprascapular notch. Therefore, a review of the surgical technique following the anatomic descriptions of an expert anatomist (P.G.) of the shoulder girdle is quite valuable., Technique Video Video 1 Left shoulder in a young athlete with suprascapular nerve compression syndrome. Physical examination and magnetic resonance imaging findings are presented, and the step-by-step surgical technique of arthroscopic suprascapular nerve release is described.

Background: Posterior shoulder instability (PSI) is a relatively uncommon condition that occurs in about 10% of patients with shoulder instability. PSI is usually associated with dislocations due to acute trauma and multidirectional instability, but it can also occur with or without recognizable recurrent microtrauma. The infrequency of atraumatic or microtraumatic PSI and the lack of a full understanding of the pathoanatomy and the knowledge of management can lead to misdiagnosis or delayed diagnosis. Purpose: To evaluate the morphologic factors of the glenoid that are associated with atraumatic or microtraumatic PSI. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Enrolled in this study were patients who underwent arthroscopic posterior labral repair between January 2013 and March 2017 and were diagnosed with posterior glenohumeral instability by means of preoperative computed tomography arthrography (CTA) (n = 39; PSI group). These patients did not have any significant dislocation or subluxation episodes. The morphologic factors of the glenoid as revealed using CTA were compared with the CTA images from a sex-matched control group (n = 117) of patients without PSI who had been diagnosed with adhesive capsulitis in an outpatient clinic. The glenoid version and shape were evaluated between the 2 groups using the CTA findings, and the degree of centricity of the humeral head to the glenoid was assessed in the PSI group. Multivariate logistic regression analysis was performed to identify factors associated with PSI. Results: The results of the multivariate logistic regression analysis indicated no statistically significant difference between the PSI and control groups regarding glenoid version or a flat-shaped glenoid. However, statistically significant between-group differences were found regarding convex glenoid shape, with an odds ratio of 5.39 (95% CI, 1.31-23.35; P = .0207). The proportion of eccentricity was significantly higher in the PSI group (21/39; 54%) versus the control group (47/117; 40%) ( P = .031). Conclusion: The presence of convex glenoid shape was significantly associated with atraumatic or microtraumatic PSI. Humeral head eccentricity accounted for a high percentage of convex glenoid shape. However, there was no significant correlation between PSI and glenoid retroversion.

Archers are known to be exposed to the risk of developing various injuries, including less described microvascular damages, which can however heavily affect the performance of athletes. Nailfold videocapillaroscopy is a safe, proven and non-invasive method that allows us to examine the nail capillaries and diagnose vascular anomalies in athletes suffering from the consequences of microtrauma caused by repeated use of fingertips. The detection of defined capillaroscopic pictures is the basis for the follow-up and suggests carrying out further clinical investigations to exclude underlying pathologies. In women this aspect is even more important since they are more frequently affected by autoimmune diseases such as scleroderma which can cause microcirculation alterations. We report the case of a 16-year-old woman who has been practicing archery for five years. She had been complaining for two years about painful fingertips, worsening in the last year. Through videocapillaroscopy, carried out by using a ×200 optical probe-equipped videocapillaroscope connected to image analyzer software (VideoCap software 3.0; DS Medica, Milan, Italy), we detected changes in the microvasculature compatible with a non-specific pattern. The findings of these anomalies suggest a diagnostic analysis aimed at excluding the presence of systemic diseases such as scleroderma. Once these conditions are excluded, and assuming that the documented alterations are due to the particular muscular effort and vibrations to which the fingers are subjected in shooting, we suggest follow-up to keep under control possible further developments and clinical changes. As far as we know, this is the first report that documents and describes the condition of microvascular changes in an archer. Archers, similar to other athletes who mainly use fingertips such as volleyball players, are more exposed to the development of digital traumas that can induce alterations in the microcirculation. We suggest that a periodic capillaroscopy should be included in the health surveillance program of these athletes, in fact this simple, reliable, non-invasive and inexpensive diagnostic tool is able to recognize early signs of microvascular damage and then suggest indications for further investigations and or follow-up.

Olecranon bursitis is a disease characterized by inflammation of the olecranon bursa, most often due to microtrauma. Although it is a common condition, there is a lack of evidence-based recommendations for the management of nonseptic olecranon bursitis. The condition is often self-limited and resolves with conservative methods such as rest, ice, compression, orthosis wear, and nonsteroidal anti-inflammatory medications. Older studies have shown resolution of symptoms with intrabursal corticosteroid injections and surgical bursectomy. More recent literature has demonstrated adverse effects of intrabursal injections and surgery compared with noninvasive management for initial treatment of nonseptic olecranon bursitis. In order to better tailor decision-making, it is important that hand surgeons understand the comparative efficacies of each option for management of nonseptic olecranon bursitis.

Pachydermodactyly is a rare, benign fibromatosis located around the proximal interphalangeal joints. It is often misdiagnosed as juvenile idiopathic arthritis and may cause unnecessary treatments and anxiety in patients. The goal of this paper is to describe this condition through all the existing information in the scientific literature. A systematic review and a descriptive study have been conducted. A systematic research was performed in PubMed, Embase, Cochrane Library and WOS. Pachydermodactyly was four times more frequent in male subjects and usually started in adolescence. Bilateral presentation was more frequent. History of microtrauma in both hands due to digital manipulation was found in almost half of the patients, many of them showed some neuropsychiatric disorder. In women, the onset happened later, unilateral involvement and family history were more frequent. Swelling of soft tissue without joint implication was found in imaging tests. The progression was usually positive and the treatment included stopping the microtrauma, administrating intralesional corticoids and/or surgery. Diagnosis can be established in asymptomatic young patients through a congruent physical exam, regular analytic results and imaging tests that simply show swelling of soft tissue—a biopsy is generally not required for diagnosis. As pachydermodactyly’s course is asymptomatic and benign, knowledge about this condition is limited, which increases the likelihood of its underdiagnosis—it is important that clinicians know of pachydermodactyly in order to avoid misdiagnosis.

We present the rare case of a young adult who developed late recurrence of Kasabach-Merritt phenomenon in a congenital kaposiform hemangioendothelioma that had been quiescent since infancy. We postulate that the extensive and infiltrative nature of our patient's tumor, combined with a recent history of direct microtrauma from acupuncture, contributed to the development of this late complication.

Closed ruptures of the flexor digitorum profundus (FDP) tendon cause a loss of active flexion at the distal interphalangeal joint. Commonly referred to as a ‘jersey finger’ because of its association with tackling sports, the distal aspect of FDP is avulsed from its insertion on the distal phalanx in zone I, with or without a fragment of bone. Because of this classic injury mechanism and pattern, providers may not seek advanced imaging beyond plain radiographs. Although rare, injury to FDP more proximally may occur. More often this injury is associated with a weak underlying tendon because of repetitive microtrauma or anomalous anatomy, for example. We present a case of a closed rupture of the FDP in zone III, and stress the importance of maintaining a high clinical suspicion and the potential use of adjunct ultrasound imaging to localise the site of injury.

Osteochondroses is a well-known entity and typically affecting immature skeleton with few common locations involved are femoral head epiphysis, tibial tubercle apophysis, calcaneal apophysis, humeral capitellum and anterior vertebral end plates. We report a rare case of osteochondroses showing avascular necrosis involving metacarpal heads known as Dieterich disease, involving the head of the third metacarpal and probably the first case with a history of rock climbing as an etiology. Chronic repetitive microtrauma plays a significant role in the disease, as is seen in our patient. Imaging plays a crucial role in diagnosing, as well as monitoring progress, with MRI being a critical modality. The fact that this entity is rare does not necessarily make it difficult to detect. It may be clinical underdiagnosed due to lack of familiarity with this entity and radiographic findings may be subtle or inapparent. Bone scan is likely sensitive but not specific. MRI also likely has a role for early detection. This article is written with educational intent for the reader for the benefit of the patients with this rare disease.

Tinea nigra is an uncommon superficial dermatomycosis precipitated by Hortaea werneckii, a halophilic and halothermic yeast-like fungus capable of producing a melanin-like substance. This pathogen infiltrates the stratum corneum in the setting of microtrauma and produces an asymptomatic brown to black macule or patch that appears similarly to melanocytic nevi or melanoma. We present a case of a 52-year-old woman who presented to clinic several months after developing a painless, nonpruritic dark brown patch in her left foot inside the fourth toe web. The coloration and location of this lesion would typically prompt biopsy; however, Wood’s lamp examination and potassium hydroxide (KOH) preparation were pursued first and demonstrated evidence of infection by H. werneckii. The patient was treated with topical clotrimazole cream and miconazole powder for one month, and her lesions cleared completely. Her lesions did not recur at her three-month follow-up appointment.

Background: Rotator cuff tendinopathy (RCT), subacromial impingement (SAIS), and medial (MEP) and lateral (LEP) epicondylitis are the most common causes of upper limb pain caused by microtrauma and degeneration. There are several therapeutic choices to manage these disorders: extracorporeal shockwave therapy (ESWT) has become a valuable option. Methods: A systematic review of two electronic medical databases was performed by two independent authors, using the following inclusion criteria: RCT, SAIS, MEP, and LEP, ESWT therapy without surgical treatment, with symptoms duration more than 2 months, and at least 6 months of follow-up. Studies of any level of evidence, reporting clinical results, and dealing with ESWT therapy and RCT, SAIS, MEP, and LEP were included. Results: A total of 822 articles were found. At the end of the first screening, following the previously described selection criteria, we selected 186 articles eligible for full-text reading. Ultimately, after full-text reading, and reference list check, we selected 26 articles following previously written criteria. Conclusions: ESWT is a safe and effective treatment of soft tissue diseases of the upper limbs. Even in the minority cases when unsatisfied results were recorded, high energy shockwaves were nevertheless suggested in prevision of surgical treatment.

Paget-Schroetter Syndrome is a rare condition in the spectrum of deep vein thromboses involving spontaneous upper extremity venous thrombosis in the axillary-subclavian vein. The syndrome usually occurs in young, healthy individuals and is a progressive, anatomic manifestation of venous thoracic outlet syndrome. Thrombosis is secondary to repetitive overuse of the arm, leading to compression, microtrauma, and local inflammation of the particularly vulnerable subclavian vein in the thoracic outlet at the junction of the first rib and clavicle. The condition is often misdiagnosed because of its rarity and can lead to significant disability and morbidity if treatment is delayed. In this case report, Paget-Schroetter Syndrome, causing significant pain and dysfunction, is presented in an 18 year-old female freestyle-swimmer that was successfully treated with anticoagulation, thrombolysis, thoracic outlet decompression and first rib resection, scalenectomy, venolysis, and venoplasty. Early suspicion of this condition can lead to prompt diagnosis, and subsequent aggressive interventional treatment with catheter-directed thrombolysis and thoracic outlet decompression, in addition to anticoagulation, demonstrated success in achieving complete resolution of symptoms in this case.

Athletes, depending on the specific moving pattern or force of acute trauma, sustain a wide variety of injuries of the elbow and forearm. The incidence of acute traumatic events in athletes is rather rare compared to overuse injuries. The former is associated with high impact sports or a fall on the outstretched arm. Direct trauma can lead to tendon ruptures, ligament tears, fractures or dislocation of the elbow. The latter is very common in any athlete with repetitive elbow flexion and extension or pronation and supination wrist motion. Overuse injuries may cause tendinopathies of the triceps- and biceps tendon or medial and lateral epicondylitis. Osteochondral lesions in the elbow also go back to repetitive microtrauma and altered biomechanics of the joint and concern adolescent throwing athletes. Entrapment syndromes such as the pronator- or cubital tunnel syndrome are part of the nerval entity and have to be differentiated to acute nerve lesions. The aforementioned injuries have a big impact on overhead athletes, especially on those in throwing, catching and swinging sports.

Anterolateralni mekotkivni sindrom sraza gležnja je stanje kod kojeg dolazi do uklještenja kronično upalno promijenjenih hipertrofiranih mekih tkiva unutar zgloba između prednjega ruba tibije i vrata talusa pri dorzalnoj fleksiji stopala. Predstavlja jedan od češćih uzroka kroničnog bola u gležnju zaostalih nakon ozljede. Javlja se kao komplikacija uganuća gležnja u 1 do 2 % slučajeva. Ozljeda ligamenata i prednje zglobne kapsule, kao i okolnog masnog tkiva, dovodi do lokalne upalne reakcije tkiva te zbog ponavljajuće mikrotraume do kroničnog sinovitisa uz hiperplaziju i fibrozu mekih tkiva. Dijagnoza se temelji na anamnezi i kliničkom pregledu te rendgenološkoj obradi, upotpunjenima ultrazvučnom pretragom i magnetskom rezonancijom (MR). U većini slučajeva anterolateralni mekotkivni sraz zahtijeva operacijsko liječenje. Artroskopija gležnja predstavlja zlatni standard u operacijskom liječenju., Anterolateral ankle impingement is a condition in which chronically inflammatory hypertrophied soft tissues are trapped inside the joint between the anterior edge of the tibia and the neck of the talus in dorsal flexion of the foot. It represents one of the most common causes of residual chronic ankle pain after injury. It occurs as a complication of ankle sprains in 1 to 2% of cases. Injury to the ligaments and anterior articular capsule, as well as the surrounding adipose tissue, results in local inflammatory tissue reaction and, due to the recurrent microtrauma, leads to chronic synovitis with hyperplasia and soft tissue fibrosis. Diagnosis is based on medical history, clinical examination and x-ray, completed with ultrasound and magnetic resonance imaging. In most cases, anterolateral ankle impingement requires surgical treatment. Ankle arthroscopy is the gold standard in surgical treatment.

Background Medial epicondylitis is a common orthopedic condition that typically results from overuse or previous microtrauma of the flexor-pronator mass. Repetitive eccentric loading of the muscles leads to subsequent degeneration of the flexor tendons. Diagnosis Patients present with a painful elbow. In the case of concomitant elbow pathologies, including ulnar neuritis and ulnar collateral ligament injury, there should be a detailed examination. Generally, the diagnosis is based on the clinical examination. T2-weighted magnetic resonance imaging can be useful for chronic courses, over 6 months. Treatment Nonsurgical management is the mainstay of treatment. Hence, surgical treatment may be indicated for patients with persistent symptoms after conservative treatment. In the case of a surgical treatment, arthroscopy can be useful to capture concomitant elbow pathologies.

Background. Plantar fasciopathy is a frequent source of foot pain in athletes, and it is caused by the degeneration of the proximal insertion of the plantar fascia, usually triggered by repetitive microtrauma. Type I porcine collagen was shown to enhance tendon repair in vitro, and collagen injections are currently used to treat different tendinopathies. The aim of this study is to verify the effectiveness of collagen injections on pain and function in runners with plantar fasciopathy. Methods. Runners, who have been suffering from plantar fasciopathy for at least 6 months, were treated with a series of 4 ultrasound-guided type I porcine collagen injections, at weekly intervals. The Visual Analogue Scale, American Orthopedic Foot and Ankle Society-Ankle Hindfoot score and pressure algometry were used to verify the effects of collagen injections at 1-month and 3-month follow-up. Results. Compared to baseline, minor (p ≥ .05) and major (p ≤ .001) improvements on pain and function were registered at 1-month and 3-month follow-up, respectively. Conclusion. This is the first study that evaluates the effectiveness of collagen injections in the treatment of plantar fasciopathy in runners. Despite the limitations of this study, the positive findings could represent the starting point for further clinical trials.

Elastofibroma dorsi (ED) is a relatively common, albeit rarely diagnosed, benign soft tissue tumor, often with a sub- or infrascapular localization. ED is most common in females >50 years of age, and is unilateral in 67-90% of cases [1]. The pathogenesis is unclear, but it is hypothesized that repeated microtrauma stemming from friction between the scapula and the posterior thoracic wall induces an abnormal proliferation of fibroelastic tissue. Studies have also shown considerable heritability [2]. The condition is often asymptomatic, but can result in pain and decrease in upper extremity function. The diagnosis is made from MRI or pathology examination of a biopsy or tissue post excision. The present paper discusses a case of bilateral ED in a 76 year old female with a history of several years of manual labor as a hairdresser.

Posterior shoulder instability in athletes and the sports-active population can be an important factor for disability and lesser performance than expected. Two main groups of patients with different injury etiology and different pathomechanics should be differentiated. They also differ each from other in their participating sport. Contact athletes are exposed to traumatic events and repetitive microtrauma with overload to the posterior part of the glenohumeral joint. Traumatic posterior shoulder dislocation or subluxation can be result of the force applied in the posterior direction. On the other hand, repetitive microtrauma to the posterior shoulder complex, which is the most frequent cause of posterior shoulder instability, is the result of the continuous loading to the posterior glenohumeral restraints. The second group are overhead athletes, where the origin of posterior shoulder instability is mainly atraumatic, with gradually developed pain and a sensation of unstable shoulder. In these cases, concomitant injuries and pathological findings in addition to posterior shoulder instability are common. The connection between labral lesion, dynamic shoulder dysfunction, and capsular laxity can be described as a vicious circle. Microinstability events in a decompensated shoulder with excessive laxity leads to progression of labral lesions. Adaptive mechanisms in the glenohumeral joint specific for overhead athletes may challenge the diagnosis as the examiner must differentiate between adaptive capsular laxity and pathological instability. Prevention and conservative approach should be the first treatment option, especially in overhead athletes. Good indications for surgical treatment are structural pathological changes to the posterior capsulolabral complex in cases of traumatic posterior shoulder instability.

Posterior shoulder instability is a relatively rare clinical condition, with an incidence approximately 20 times lower than that of anterior shoulder instability in initial reports [1, 2]. It occurs in less than 10% of the patients with shoulder instability [3], is more frequent in athletes participating in contact or overhead sports, and is more common in the military population [4]. Typically, posterior instability is the result of repetitive microtrauma in flexion, adduction, and internal rotation of the humerus [5]. Respectively, an acute episode in the same position can lead to a traumatic posterior dislocation.

Contains fulltext : 220959.pdf (Publisher’s version ) (Open Access) BACKGROUND: The majority of sports-related injuries involve skeletal muscle. Unlike acute trauma, which is often caused by a single traumatic event leading to acute symptoms, exercise-induced microtrauma may remain subclinical and difficult to detect. Therefore, novel methods to detect and localize subclinical exercise-induced muscle microtrauma are desirable. PURPOSE: To assess acute and delayed microstructural changes in upper leg muscles with multiparametric quantitative MRI after running a marathon. STUDY TYPE: Longitudinal; 1-week prior, 24-48 hours postmarathon and 2-week follow-up POPULATION: Eleven men participants (age: 47-68 years). FIELD STRENGTH/SEQUENCE: Spin-echo echo planar imaging (SE-EPI) with diffusion weighting, multispin echo, Dixon, and fat-suppressed turbo spin-echo (TSE) sequences at 3T. MR datasets and creatine kinase (CK) concentrations were obtained at three timepoints. ASSESSMENT: Diffusion parameters, perfusion fractions, and quantitative (q)T(2) values were determined for hamstring and quadriceps muscles, TSE images were scored for acute injury. The vastus medialis and biceps femoris long head muscles were divided and analyzed in five segments to assess local damage. STATISTICAL TESTS: Differences between timepoints in MR parameters were assessed with a multilevel linear mixed model and in CK concentrations with a Friedman test. Mean diffusivity (MD) and qT(2) for whole muscle and muscle segments were compared using a multivariate analysis of covariance (MANCOVA). RESULTS: CK concentrations were elevated (1194 U/L [166-3906], P

Purpose The craniocervical junction (CCJ) is a complex of bony and ligamentous structure stabilizing CCJ. Nearly one-third of all traumatic injuries to the cervical spine involve the CCJ. Only little literature is available on this topic, and most of the studies are focused on anatomy, biomechanics or ligamentous injury in whiplash-associated disorders. We conducted a prospective study to investigate age-related changes in the craniocervical ligaments. Methods We included asymptomatic volunteers between 16 and 99 years old who had no history of whiplash or other cervical trauma. Volunteers underwent a three-dimensional turbo spin-echo proton density-weighted sequence with variable flip-angle distribution focused on the craniocervical ligaments. The six main ligaments of the craniocervical junction were evaluated for grade of degeneration on a four-point scale by two independent readers, blinded for age and sex. Results We included 102 volunteers. The mean age was 50.03 (16-94). Fifty-nine (58%) patients showed degeneration of at least one ligament of the CCJ. High-grade anomalous changes and multiligamentous involvement had a positive correlation with age (p < 0.001). The inter-rater agreement was fair to moderate, and the intra-rater agreement was moderate to substantial. Conclusion The craniocervical ligaments show a variable degree of signal intensity and thickness in asymptomatic adults. We postulate that these changes can be due to normal aging or due to repetitive microtrauma. We propose a new grading system to evaluate changes to the craniocervical ligaments in asymptomatic volunteers. Graphic abstract These slides can be retrieved under Electronic Supplementary Material. [GRAPHICS] .

Тема выпускной квалификационной работы: «Разработка мероприятий по снижению уровня производственного травматизма при внедрении основ бережливого производства в цехе металлообработки ЗАО «НПО СМ». Данная работа посвящена внедрению мероприятий из стандарта «Бережливое производство» в цехе металлообработки ЗАО «НПО СМ» с целью снижения уровня производственного травматизма, проведению сравнительного анализа уровня травматизма до внедрения мероприятий из стандарта и после. Задачи, которые решались в ходе исследования: 1. Изучение деятельности предприятия ЗАО «НПО СМ» 2. Анализ мероприятий, содержащихся в стандарте «Бережливое производство», направленных на снижение уровня производственного травматизма. 3. Внедрение разработанных мероприятий, оценка их эффективности. Работа проведена на базе ЗАО «НПО СМ», где были внедрены мероприятия, направленные на снижение уровня производственного травматизма. Были проведены расчеты, наглядно отражающие состояние производственного травматизма до внедрения мероприятий и после. В результате был проанализирован стандарт ИСМ «Бережливое производство», выявлены мероприятия, способствующие снижению уровня производственного травматизма, разработан регламент о ведении «Журнала учета полученных микротравм на производстве», произведен расчет коэффициентов частоты и тяжести производственного травматизма до и после внедрения мероприятий. На основании проведенных исследований, внедренные мероприятия оценены как эффективные., The subject of the graduate qualification work is «Development of measures to reduce the level of industrial injuries when implementing the principles of lean production in the metalworking shop of JSC “NPO SM” ». The work was fulfilled on the premises of devoted to introduction of measures of standard Lean manufacturing in the metal working shop of JSC "NPO SM" to reduce the level of injury, the comparative analysis of the level of injuries prior to the implementation of measures from the standard and after. Tasks that were solved in the course of the study: 1. Analysis of the legal framework and standards of the ISM "Lean production". 2. Identification of measures contained in the "Lean manufacturing" standard aimed at reducing the level of industrial injuries. 3. Calculation of coefficients of frequency and severity of industrial injuries before the introduction of measures from the standard and after. 4. Evaluating the effectiveness of implemented measures. The work was carried out on the basis of JSC "NPO SM", where measures were introduced to reduce the level of industrial injuries. Calculations were made that clearly reflect the state of industrial injuries before the introduction of measures and after. As a result, the ISM standard "Lean manufacturing" was analyzed, measures were identified that contribute to reducing the level of industrial injuries, regulations were developed on maintaining a "Log of microtraumas received at work", and coefficients of frequency and severity of industrial injuries were calculated before and after the implementation of measures. Based on the conducted research, the implemented measures were evaluated as effective.

Pediatric sports-related injuries are becoming more prevalent with the increase in participation in high volume, frequency, and intensity training and competitions that place a great amount of stress on an immature musculoskeletal system. Little league elbow is characterized as repetitive valgus stress to the medial epicondyle physis during overhead-throwing sports, causing microtrauma to the open growth plate and putting the child at risk for an avulsion fracture and the adolescent at risk for a ligamentous injury. Osteochondritis dissecans of the capitellum is commonly seen in baseball players and gymnasts due to the unnatural biomechanical demands placed on the elbow during throwing and upper extremity weight-bearing activities. If left untreated, this condition can lead to substantial pain and can put the child at risk for developing premature arthritis and limited range of motion about the elbow. Distal radial epiphysitis, also known as gymnast wrist, is a chronic wrist condition commonly observed in gymnasts due to the excessive upper extremity weight-bearing demands on a vulnerable region of the wrist. Often these sports-related injuries can initially be successfully managed with conservative treatment, with therapy and sport-specific rehabilitation protocols being instrumental components to recovery and the ultimate transition to return to full sport participation.

Posterior instability of glenohumeral joint represents 3% of all shoulder dislocations [1]. Posterior instability can be classified according to the grade, direction, mechanism of displacement and timing of the trauma (acute, chronic, locked or non-locked and recurrent posterior subluxation). McLaughlin described two main types of posterior instability: chronic posterior displacement and recurrent posterior subluxation [2]. Posterior dislocation is to be considered chronic after 3 weeks from the traumatic event; the recurrent form can be caused by a single traumatic posterior displacement, but usually less than 10% of such dislocations have a recurrence. Possible causes of recurrence include microtrauma due to repeated shoulder movements in a risky position, like in some athletes (rugby, bench press, swimming, etc.) or professionals. An enhanced laxity, generalized or localized to the shoulder girdle, has to be investigated in all cases of posterior shoulder dislocations.

Benign joint hypermobility syndrome (BJHS), which occurs in approximately 3% of the general population, is defined as the presence of musculoskeletal symptoms in individuals with hypermobility in the absence of systemic rheumatic disease. The symptoms appear either after intense physical activity or with repetitive microtrauma. The Brighton criteria are most commonly used for diagnosing of BJHS. Typically pain associated with BJHS is described as dull; it can be either constant or self-limited, usually diffuse, and very often associated with fatigue. BJHS is a diagnosis of exclusion; thus, the most important issue is to identify other symptoms of potential systemic connective tissue disease. There is no specific treatment of BJHS. One of the most important issues is modification of lifestyle to avoid excessive joint movements and exercises that may aggravate the symptoms.

Тема выпускной квалификационной работы: Совершенствование системы управления охраной труда на малом предприятии (на примере сквозной лесозаготовительной бригады). Объект исследования: комплексная безопасность и охрана труда на предприятиях малого бизнеса. Предмет исследования: разработка мероприятий по совершенствованию системы управления охраной труда в лесозаготовительной бригаде. Данная работа посвящена проведению анализа системы управления охраной труда на малом предприятии и разработке путей её совершенствования. Задачи, которые решались в ходе исследования: 1. Изучение нормативно-правовой базы, ознакомление с отечественной и зарубежной литературой по проблеме исследования. 2. Проведение анализа системы управления охраной труда на предприятии малого бизнеса на примере сквозной лесозаготовительной бригады. 3. Анализ возможных опасностей и рисков, возникающих при работе сквозной лесозаготовительной бригады. 4. Разработка путей развития и улучшения системы управления охраной труда, расчёт экономического эффекта от внедряемых мероприятий. Работа проведена на базе сквозной лесозаготовительной бригады индивидуального предпринимателя в Новгородской области. Произведен анализ нормативной документации по охране труда. Проведен аудит внутренней документации по охране труда. Выполнено усовершенствование и разработка дополнительных механизмов контроля системы управления охраной труда. Произведен расчет экономического эффекта от планируемых мероприятий по охране труда. Для решения поставленных задач использовался системный подход, статистические данные, положения теорий управления риском, классификации и идентификации, опросы, метод сравнения. Результаты ВКР могут быть использованы в организациях лесозаготовительного комплекса в области совершенствования СУОТ., Theme of final qualification work: Improving the OSH management system in a small enterprise (using the example of a through logging team). Object of study: integrated safety and labor protection in small businesses. Subject of research: development of measures to improve the OSH management system in the logging team. This work is devoted to the analysis of the OSH management system in a small enterprise and the development of ways to improve it. Tasks that were solved during the study: 1. The study of the regulatory framework, familiarization with domestic and foreign literature on the research problem. 2. An analysis of the OSH management system at a small business using the example of a through logging team. 3. Analysis of the possible dangers and risks arising from the work of the through logging team. 4. Development of ways to develop and improve the OSH management system, calculation of the economic effect of the implemented measures. The work was carried out on the basis of a through logging team of an individual entrepreneur in the Novgorod region. The analysis of regulatory documents on labor protection. An audit of internal labor protection documentation was conducted. Improvement and development of additional control mechanisms for the OSH management system has been completed. The economic effect of the planned labor protection measures has been calculated. To solve the set tasks, a systematic approach was used, statistics, theories of risk management theories, classification and identification, surveys, and a comparison method. The results of the WRC can be used in organizations of the logging complex in the field of improving OSH management.used in organizations of the logging complex in the field of improving OSH management.

Overuse injuries result from the combination of repetitive microtrauma and inadequate healing time. Repetitive loading of biological tissues illustrates damage accumulation and failure consistent with a mechanical fatigue process. Overuse injuries may involve the muscle-tendon unit bone, articular cartilage, epiphysis, or bursa. This chapter reviews the most relevant injuries for doctors and coaches who accompany their athletes. The following conditions are covered specially, knee pain, patellar tendinopathy, iliotibial band syndrome, medial tibial stress syndrome, stress fractures, compartment syndrome, plantar fasciitis, and Achilles tendinitis. Injury is caused by a combination of inadequate preparation, inappropriate equipment, poor technique, and overuse. Nonsurgical management may include rest, nonsteroidal anti-inflammatory drugs, corticosteroid injection, application of ice, reduction in training intensity, orthotics, night splints, physical therapy, and surgery. Injury prevention should be the focus, with particular attention to alignment, appropriate equipment, and appropriate training.

The quantification of training loads provides valuable information to reduce overtraining and detecting the risk of injury. The present study looks into the evolution of the training load using the RPE and s-RPE method and describes the injuries observed. It is an observational study based on 9 subjects of the Pardinyes basketball team (Leb Plata category) who, in each practice and match, recorded their RPE. This value, together with the volume (in minutes), provides the s-RPE. All injuries and their typology were also recorded during the first round of the competition. A total of 124 sessions were registered and 14 injuries were described in the period that went from 09/19/2019 to 02/15/2020. The load evolution of each player has been compared to the team average and to the one perceived by the coach. The lower extremity was, by far, the most injured one (13/14 injury events). The highest percentage of injuries was registered during the last part of the training sessions and matches, coinciding with the highest physical and psychological fatigue, and 64% of them were due to microtrauma. These inexpensive and easy-to-use methods (RPE and s-RPE) provide valuable data for planning, in order to adjust loads and prevent overtraining and injuries. It is necessary to manage workload to provide the player with the ideal stimulus, minimizing the risk of injury and, at the same time, maximizing their performance.

While athletes are often considered the epitome of health due to their physique and lowered potential for metabolic and cardiovascular diseases, they may also be at risk for the onset and development of venous thromboembolism (VTE). In an attempt to achieve and remain competitive, athletes are frequently exposed to numerous athlete-specific risk factors, which may predispose them to VTE through the disruption of factors associated with Virchow's triad (i.e., hypercoagulability, venous stasis, and vessel wall injury). Indeed, hypercoagulability within an athletic population has been well documented to occur due to a combination of multiple factors including exercise, dehydration, and polycythemia. Furthermore, venous stasis within an athletic population may occur as a direct result of prolonged periods of immobilization experienced when undertaking long-distance travels for training and competition, recovery from injury, and overdevelopment of musculature. While all components of Virchow's triad are disrupted, injury to the vessel wall has emerged as the most important factor contributing to thrombosis formation within an athletic population, due to its ability to influence multiple hemostatic mechanisms. Vessel wall injury within an athletic population is often related to repetitive microtrauma to the venous and arterial walls as a direct result of sport-dependent trauma, in addition to high metabolic rates and repetitive blood monitoring. Although disturbances to Virchow's triad may not be detrimental to most individuals, approximately 1 in 1,000 athletes will experience a potentially fatal post-exercise thrombotic incidence. When acquired factors are considered in conjunction with genetic predispositions to hypercoagulability present in some athletes, an overall increased risk for VTE is present.

Background Abdominal wall tumors are rare and include heterogeneous diseases. Among them, desmoid tumors are the most frequent and are often diagnosed in young women during or early after pregnancy; inflammatory response after trauma or microtrauma, such as after cesarean section, may favor their growth. Results A 37-year-old woman presented with a progressive mass in the abdominal wall after a cesarean section. Positron emission tomography imaging confirmed a positive mass with a high maximum standardized uptake value; a biopsy suggested a myofibroblastic tumor. With continued tumor growth and worsening symptoms, the mass resembled a desmoid tumor; therefore, we proceed with its resection. The final diagnosis was foreign body granuloma as a reaction to the spillage of meconium and keratinous material in the amniotic fluid during cesarean section. Conclusions The present case provides information on an abdominal wall foreign body granuloma arisen from meconium and vernix caseosa after cesarean section, which presented an atypical clinical picture, mimicking a desmoid, thus requiring a careful diagnostic and treatment approach.

Medial epicondylitis, also known as "golfer's elbow," is a common orthopaedic condition that typically results from overuse of the flexor pronator mass. Repetitive eccentric loading of the muscles responsible for wrist flexion and forearm pronation leads to microtrauma and subsequent degeneration of the flexor pronator tendon. Patients with medial epicondylitis typically present in the fourth to sixth decade of life and have an insidious onset of medial elbow pain. Occasionally, medial epicondylitis may result from an acute traumatic event, such as an acute avulsion of the common flexor tendon. Patients should be examined for concomitant elbow pathologies, including ulnar neuritis and ulnar collateral ligament injury. T2-weighted magnetic resonance imaging can show increased signal intensity in the common flexor tendon or a complete rupture. Nonsurgical management is the mainstay of treatment; however, surgical treatment may be indicated in elite athletes and patients with persistent symptoms after conservative treatment. This technique article with accompanying video describes open debridement and repair of the flexor pronator tendon, with an emphasis on restoration of the anatomic footprint and compression across the repair site to promote biological healing.

BackgroundThe lateral epicondyle is a common site for chronic tendinosis (i.e. lateral epicondylitis), a condition characterized by overuse and degeneration of a tendon due to repeated microtrauma. This leads to pain and functional limitations. There is a growing interest in non-surgical forms of treatment for this condition including provision of corticosteroid injections and regenerative injection therapy (provision of autologous blood and platelet rich plasma injections).ObjectiveWe compared the effectiveness of corticosteroids with regenerative injection therapy for the treatment of lateral epicondylitis.MethodsWe systematically reviewed randomized controlled trials published in English language from 2008 to 2018. Databases used included PEDro, Scopus, PubMed, and CINAHL. Nine articles met our selection criteria. The PEDRo scale scores helped assess study quality. Cochrane risk of bias criteria helped assess bias. We analyzed results focusing on pain and function using meta-analyses.ResultsSix out of 9 studies had low risk of bias. There were no short-term (1 and 2 month) differences in pain scores between the corticosteroid and regenerative injection groups. Participants receiving regenerative injections demonstrated greater long-term improvements lasting for a period of≈2 years.ConclusionRegenerative injections provision results in greater long–term pain relief and improved function for people with lateral epicondylitis.

Patellar tendon ruptures are rare, but debilitating injuries are typically seen in young active males in the third and fourth decades of life. They can occur as a single acute injury or from repetitive microtrauma weakening the tendon. Patients typically present complaining of knee pain, swelling, and an inability to perform a straight leg raise. Most conventionally, these injuries are classified as acute (less than two weeks) or chronic (greater than two weeks) based upon the timing of presentation. In patients with patellar tendon ruptures and inability to perform a straight leg raise, patellar tendon repair is most often recommended. A subset of patients with chronic patellar tendon ruptures, however, presents several months after their initial injuries. These neglected patella tendon ruptures present a particularly challenging clinical scenario in which primary repair is often difficult or not possible. This case report describes a modification to an existing surgical technique for reconstructing the patellar tendon using an ipsilateral semitendinosus tendon autograft with suture tape augmentation.

Purpose To examine whether rest intervals of different durations (“High Rest, Low Frequency” v. “Low Rest, High Frequency”), and load at different force exertion levels with different repetition frequencies (“High Load, Low Repetition” v. “Low Load, High Repetition”) have an impact on muscle micro-trauma, as such micro-trauma over repetitive loading and long-term muscle overuse can lead to musculoskeletal disorders (MSDs). Method Twenty-four adult males (mean age: 24.1 years; 3.6 SD) were randomly assigned to one of 4 bicep muscle eccentric exercise treatment groups (n = 6; “High Load, Low Repetition; High Rest, Low Frequency”, “High Load, Low Repetition; Low Rest, High Frequency”, “Low Load, High Repetition; High Rest, Low Frequency”, or “Low Load, High Repetition; Low Rest, High Frequency”) with non-dominant arm to induce muscle micro-trauma reactions in serum. Subjects in all treatment groups had equivalent total work volume, total rest duration and total work duration for comparison of muscle micro-trauma between and within the treatment groups. Muscle micro-trauma biomarker serum Creatine Kinase (CK) level was measured pre-exercise (Day 0) and post-exercise on Days 1, 2, 4, and 8. ANOVA with repeated measures was used to examine significance of rest and load-repetition combination over pre and post experiment days, as well as possible interactions. Result CK levels fluctuated significantly across different “Day” (P = 0.0115). Interaction was disordinal and significant between “Day” and “Rest” (P = 0.0000), and “Load” and “Rest” (P = 0.0322). Under “High Load, Low Repetition” condition, CK levels on Day 4 were significantly higher than on Days 0 and 2; CK levels on Day 8 were significantly higher than Day 0. CK level peaked on Day 4. Under “Low Rest” Condition, CK level on Days 4 and 8 are significantly higher than Day 0. Conclusion Shorter but more frequent rest intervals led to more extreme muscle micro-traumatic responses than the longer but less frequent ones, especially under “High Load, Low Repetition” condition when non-dominant bicep brachii was subscribed with eccentric exercise regimen. Relevance to industry The exploration of how rest scheduling affects progression of microtrauma from a biomechanical and molecular level in this study furthers current understanding of the early stage development of WMSDs. With future studies’ further research and confirmation, the findings of this study may be able to serve as a first attempt to guide shift scheduling and job design at manufacturing facilities.

La osteocondritis disecante (OCD) es una patología que afecta el cartílago articular y el hueso subcondral en las epífisis articulares de humanos y otros mamíferos. A pesar de que su etiología es multifactorial, la presencia de esta lesión ha sido frecuentemente atribuida a microtraumatismos reiterados por los efectos de la actividad física sobre las articulaciones afectadas. Este trabajo involucra un primer paso en el estudio de esta patología en restos humanos de Patagonia Austral, la cual no fue analizada en forma sistemática. El objetivo es analizar la variabilidad de la OCD en un conjunto de restos humanos de 26 individuos adultos pertenecientes a sociedades de cazadores-recolectores de esta región durante el Holoceno medio-tardío (ca. 5200-70 años AP) y su posible relación con la edad, el sexo, la dieta, la cronología y el área geográfica de procedencia. Se discute si su expresión está vinculada con los patrones de actividad física desarrollados por los grupos, en función de las prácticas económicas llevadas a cabo. La prevalencia general observada en esta muestra (42,3%), mayor a la reportada para poblaciones actuales, sugiere que la actividad física habría desempeñado un rol importante en el desarrollo de la OCD en al menos parte de las personas afectadas. Osteochondritis dissecans (OCD) is a pathology that affects the articular cartilage and the subchondral bone in the articular epiphyses of humans and other mammals. Although its etiology is multifactorial, its presence has been frequently attributed to repetitive microtrauma because of physical activity on the affected joints. This paper is a first step in the study of this pathology in human remains from Patagonia Austral, as it has not been systematically studied. The objective is to analyze the variability of the OCD in a sample of 26 hunter-gatherer adult individuals that lived in this region during the Middle-Late Holocene (ca. 5200-70 years BP) and its possible relationship with age, sex, diet, chronology and region of origin. The association between its expression and the patterns of physical activity developed in accordance with the economic practices, is discussed. The overall prevalence observed in this sample (42,3%), higher than that reported for current populations, suggests that physical activity would have played an important role in the development of OCD in at least part of the affected individuals. Fil: Zuñiga Thayer, Rodrigo. Universidad Nacional del Centro de la Provincia de Buenos Aires; Argentina Fil: Suby, Jorge Alejandro. Incuapa-conicet; Argentina Fil: Flensborg, Gustavo Ariel. Incuapa-conicet; Argentina Fil: Luna, Leandro Hernan. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina

Background Myositis ossificans traumatica (MOT) involves the heterotopic development of lamellar bone after a traumatic injury. Despite being termed “myositis,” MOT is not limited to muscle but rather can involve tendons, fat, and fascia. “Traumatica” reflects that lesions are usually associated with a history of significant trauma, that is, fractures or surgery; however, many reports suggest they can also be linked to repetitive low-energy insults. In both cases, the inflammatory response secondary to tissue injury generates a proliferative osteoblastic cascade. Case Description We present a case of persistent wrist pain in a 43-year-old woman associated with yoga activities. Her radiographic studies demonstrated partial scapholunate (SL) ligament tear and an associated mass lesion. Surgical pathology revealed MOT involving the SL ligament. Literature Review MOT lesions in the upper extremity are usually localized around the elbow, and cases in the hand are relatively rare. There are no prior reports of occurrences within the wrist joint or in association with the SL ligament. However, biomechanical studies have quantified significant mechanical strains across the SL interval during various yoga poses. This pattern of microtrauma is capable of generating MOT. Clinical Relevance Upper extremity weight-bearing positions are common in yoga and subject the wrist, especially the SL interval, to high mechanical strains. This pattern of microtrauma should lead the clinician to suspect MOT when encountering a mass in the wrist, but malignancy and infection must be ruled out.

Background: it has been well established that chronic ankle pain negatively affects the lives of patients. Surgical techniques for ankle pain have evolved dramatically over the past decade, as arthroscopic equipment has improved to allow excellent exposure to the ankle joint and surrounding anatomic areas. Soft- tissue and osseous impingement syndromes are now increasingly recognized as a significant cause of chronic ankle pain, The exact cause of this condition is debated but seems to involve osteophyte formation due to either repetitive microtrauma or macrotrauma associated with major injuries. Careful analyses of patient history and signs and symptoms at physical examination can suggest a specific diagnosis in most patients. Aim of the work: this systematic review aimed to assess the outcome of ankle arthroscopy versus conservative modalities in management of ankle impingement syndrome. Methods: a systematic literature search of the PubMed, Embase (classic), and Chochrane library databases, for articles that published from January 1990 to June 2017 was performed using the following inclusion criteria English language puplications, human clinical trials, studies that reported on at least one of the chosen outcome measures which are patient satisfaction, time to return to full activity, AOFAS score, visual analog scale (VAS) score for pain, and complications, we found 9 studies met our inclusion criteria, data extraction was done which is consisted of population characteristics, in addition to the outcome measures. Results: nine articles were included in this systematic review. Overall, good results were found for arthroscopic treatment in patients with ankle impingement syndrome, patient satisfaction rates was reported in 5 studies, we reported high percentages of good to excellent satisfaction rates, ranging 74% to 94%, especially in patients treated with arthroscopy, Complication rates were 14.1%, as regard to patients treated with arthroscopy the rate was 13.2%, on the other hand the rate was 17.6% in those patients treated with injection therapy technique, conventional conservative modalities reported to be ineffective in treating ankle impingement except injection therapy technique in case of ankle soft tissue impingement. Conclusion: our systematic review showed that Patients may respond to conservative treatment modalities, especially ultra-sound guided injection mainly in soft tissue impingement type, arthroscopic debridement is the treatment of choice for patients of ankle impingement syndrome of both osseous and soft tissue nature with least morbidity and early return to function, and also it is noted to be superior to conservative modalities.

Introduction: Stress fractures have continued to plague competitive athletes and military recruits, especially at the beginning of military service. The underlying pathophysiology of stress fractures occurs when the rate of repetitive microtrauma exceeds that of osseous remodeling. The prevention of lower extremity stress fractures remains a long-standing problem in the military, and it represents a significant socioeconomic burden. Treatment strategies include early identification of the symptoms, early diagnosis, a sufficiently long training pause. The present study aimed at determining the incidence and type of Stress Fractures in Border Security Force cadets (BSF) recruited in Indore through clinical and radiological diagnosis. Material and Methods: In a prospective study of Stress Fractures, a group of 1000 BSF cadets training in Indore was selected and those presenting with symptoms were evaluated clinically and radiologically. The SF was graded in to 4 groups based on the suggested clinicoradiological classification by Agarwal. Results: One hundred and seventy four (174) out of 1000 consecutive recruits had symptoms of SFs. Out of 150 diagnosed with SF 60 (40%) were Grade I, 54 (36%) was Grade II, 29 (19.33%) were Grade III and 7 (4.67%) were Grade IV. The significant higher incidence of SFs has been attributed to training with maximum stress on running, jumping, parade on hard ground, and gymnastics. The maximum occurrence of Stress fracture in our study was found at 10 weeks of training. Conclusion: There is a high incidence of SF in military cadets which tends to remain unreported otherwise. Proper education of trainees, trainers and instructors, modification in training procedures, use of better equipments can reduce occurrence of these fractures. Early reporting to hospital and treatment is also necessary as it can help in early return to full activity.

Osteochondral injuries in pediatric patients may occur as a result of a traumatic injury or secondary to an osteochondritis dissecans (OCD) lesion. Lateral patella dislocation is a common traumatic cause of osteochondral injury that typically occurs at the medial facet of the patella or at the lateral aspect of the distal femur. Multiple theories have been proposed for the cause of an OCD lesion in the knee, including trauma or repetitive microtrauma, local vascular insufficiency, and family history. The most “classic” location for OCD lesions of the knee is the lateral aspect of the medial femoral condyle of the distal femur. Multiple treatment options are available for both traumatic osteochondral injuries and OCD lesions, with important determining factors of treatment being skeletal maturity of the patient, instability of the fragment, lesion location, and size of the lesion. Nonsurgical management is appropriate in some situations. Surgical options range from simple fragment excision to internal fixation of the fracture fragment to more complex cartilage restoration or replacement procedures. This special focus section will discuss the diagnosis and treatment options for traumatic osteochondral knee injuries, including the subset secondary to juvenile OCD lesions.

Noninsertional Achilles tendinosis is differentiated from insertional Achilles tendinosis based on anatomic location. Tendinosis, as opposed to tendonitis, is primarily a degenerative process and the role of inflammation is believed limited. The etiology of Achilles tendinopathy may include overuse leading to repetitive microtrauma, poor vascularity of the tissue, mechanical imbalances of the extremity, or combination of these elements. There is evidence to support eccentric exercise nonoperative management for patients with noninsertional Achilles tendinopathy. Operative treatment options include percutaneous longitudinal tenotomies, minimally invasive tendon scraping, open débridement and tubularization, and tendon augmentation with flexor hallucis longus.

Ankle impingement syndromes are a commonly encountered clinical entity seen in athletes, secondary to repetitive forceful microtrauma. Symptoms are related to impingement of osseous or soft tissue abnormalities in the ankle joint, in particular the tibiotalar joint, which may result in painful limitation of ankle movements. Imaging modalities, such as radiographs and magnetic resonance imaging, are very useful in diagnosing osseous and soft tissue abnormalities seen in different types of ankle impingement syndromes. This article reviews the classification of ankle impingement syndromes, their etiology, and clinical and radiological findings.

Here, we present a rare case of a preadolescent boy with a prominent bony bump on the femoral neck. The main histological feature was concordant with a reactive osteochondromatous lesion possibly induced by repetitive microtrauma, probably because of overtraining as a soccer goalkeeper. The nature of this pathological change is consistent with the growth of a cam deformity. Especially in the preadolescent age group, we should note that repetitive use of the same joint kinematics may induce a prominent cam deformity.

Stroke (i.e., cerebrovascular accident) affects one in 10,000 people between the ages of 14 and 45, however, very little is known about the frequency and type of stroke that occurs in athletes. The risk of injury to the neurovascular structures may depend on the type of sport involvement, although, sport-specific incidence rates are not known. Therefore, the goal of our scoping review was to provide some guidance to better inform the development of a context-fit stroke model by summarizing studies on a broad research topic related to stroke or cerebrovascular accident in sport based on a strict athlete definition. We used the guidance of Arksey and O’Malley’s five-stage-process for a scoping review. Databases included MEDLINE(R) Epub Ahead of Print, In-Process &amp, Other Non- Indexed Citations, Ovid MEDLINE(R) Daily and Ovid MEDLINE(R), and Embase (OVID databases), CINAHL Plus with Full Text, SportDiscus with Full Text (Ebsco databases), and Scopus. Publication dates were from 1979–2020 across nine different countries resulting in 39 individual cases of stroke with an athlete age range of 14–56 years (95% male). The major inciting event(s) prior to stroke onset were headaches (38.4%), head trauma (30.7%), and neck injury and/or vertebral artery dissection (20.5%). Several sporting activities were represented with American football as the most prevalent (30.7%). In summary, we found that sports with an aspect of impact, collision, or microtrauma can lead to subsequent stroke. These sport-related traumatic events were often difficult to diagnose because of the longer interval before ischemia occurred. Therefore, health care providers should be particularly attuned to the possibility of stroke when evaluating athletes presenting with or without neurological deficit.

Introduction and importance Trochlear AVN is a very rare entity with only a limited number of cases being reported. Case presentation Our case is interesting as it presents a case of an incidentally found bilateral trochlear AVN in a 12 year-old child when he presented with an undisplaced right supracondylar fracture. Clinical discussion It is highly likely that an unknown underlying predisposing factor, possibly recurrent microtrauma, was responsible for the bilateral occurrence. Conclusion We recommend further research to identify other etiological and predisposing factors, as the etiological factors still remain unclear, despite the available literature., Highlights • Trochlear AVN is a very rare entity with only a limited number of cases being reported • Incidentally found bilateral trochlear AVN in a 12 year-old child, presented with an undisplaced supracondylar fracture. • The possibility of repetitive microtrauma occurring with contact sports is highlighted, which may predispose to trochlear AVN