Search

Hip injuries in the overhead athlete have attracted little attention in the past; however, hip and groin injuries make up 5.5% of all professional baseball injuries and continue to increase in prevalence. Hip and groin injuries are exacerbated by the repetitive extremes of motion required for throwing, serving, and spiking a ball as well as the rapid acceleration and deceleration involved in overhead athletics. The diagnosis and management of these injuries in overhead athletes can be challenging, and often involves multiple pain sources. These athletes commonly experience adductor strains and athletic pubalgia/core muscle injuries which often occur concurrently with underlying bony pathology such as femoroacetabular impingement, which leads to limitations in hip range-of-motion. Hip and groin injuries in the overhead athlete can be debilitating and recurring; therefore, accurate and prompt diagnosis and management of these injuries are critical.

Objectives: Shoulder instability is a common injury among contact- and collision-sport athletes that encompasses a spectrum of glenohumeral pathology ranging from subluxation to dislocation. While glenohumeral dislocation frequently leads to removal from play, athletes are often able to play through glenohumeral subluxation. Previous research on glenohumeral instability among athletes has largely focused on missed-time injuries only, which has likely disproportionately excluded subluxation injuries and underestimated the overall incidence of shoulder instability. The objective of this study is to describe the epidemiology of shoulder instability injuries not resulting in missed time among professional athletes in the National Football League (NFL) during the 2015 through 2019 seasons. Methods: The NFL’s Electronic Medical Record was retrospectively reviewed to identify shoulder instability injuries that did not result in missed time during the 2015 through 2019 seasons. For each injury, player age, player position, shoulder laterality, instability type, instability direction, injury timing, injury setting, and injury mechanism were recorded. For injuries that occurred during games, incidence rates were calculated based on timing during the season as well as player position. The influence of player position on instability direction was also investigated. Results: During the 2015 through 2019 seasons, 546 shoulder instability injuries were documented in the NFL’s Electronic Medical Record. Of these, 162 (29.7%) did not result in missed time beyond the date of injury. The majority of non-missed-time injuries were subluxations (97.4%), occurred during games (70.7%), and resulted from a contact mechanism (91.2%). The overall incidence rate of game-related instability was 1.6 injuries per 100,000 player-plays and was highest during the postseason (3.5 per 100,000 player-plays). With respect to player position, the greatest number of non-missed-time instability injuries occurred in defensive secondary (28.4%) and offensive linemen (19.8%), while kickers/punters and defensive secondary had the highest game incidence rates (5.5 and 2.1 per 100,000 player-plays, respectively). In terms of direction, 54.3% of instability events were posterior, 31.9% anterior, 8.5% multidirectional, and 5.3% inferior. Instability events were most often anterior among linebackers and wide receivers (50% and 100%, respectively), while posterior instability was most common for defensive linemen (66.7%), defensive secondary (58.6%), quarterbacks (100.0%), running backs (55.6%), and tight ends (75.0%). Conclusions: Shoulder instability injuries that do not result in missed time beyond the date of injury are much more common among collision-sport athletes than previously thought, accounting for approximately 30% of all instability events in the NFL. The majority of these injuries are posterior subluxations, though instability direction appears to vary by player position. This study highlights the diverse nature of shoulder instability injuries and underscores the need for increased surveillance among collision-sport athletes, as even subluxations can result in significant damage to the capsulolabral complex. [Table: see text][Table: see text][Table: see text][Figure: see text]

The purpose of this study is to examine the 30-day postoperative complications after hip arthroscopy as a function of patient age. The American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2016 was used to identify all patients undergoing hip arthroscopy using Current Procedural Terminology and International Classification of Disease codes. Patient characteristics and postoperative complications were compared in a retrospective cohort study with a level of evidence 3 across patient age cohorts using bivariate and multivariate analysis that corrected for differences in baseline patient characteristics. In total, 2,427 patients undergoing hip arthroscopy were identified. Of all identified patients, 667 (27.5%) were under 30 years of age, 596 (24.5%) were between 31 and 40, 599 (24.6%) were between 41 and 50, and 566 (23.3%) were older than 50. Chondroplasty, abrasion arthroplasty, and/or resection of the labrum were the most commonly performed procedures in all age groups. As age increased, patients were more likely to be female and have a higher body mass index, more medical comorbidities, a shorter operative duration, and a higher American Society of Anesthesiologists class. The rate of any 30-day postoperative complication was 1.35% in patients under 30 years of age, 1.68% in patients between 31 and 40, 2.67% in patients between 41 and 50, and 5.12% in patients older than 50 (p

Background: The increase in ulnar collateral ligament (UCL) elbow reconstructions over the past 20 years has affected younger athletes more than any other age group. Although return to play and postoperative performance have been extensively studied in professional baseball players, outcomes in collegiate baseball players are less known. Purpose/Hypothesis: The purpose of this study was to characterize return to play and changes in performance after UCL reconstruction (UCLR) in collegiate baseball players. We hypothesized that collegiate baseball players would have similar return-to-play rates compared with professional athletes and no significant differences in performance compared with matched controls. Study Design: Cohort study; Level of evidence, 3. Methods: Collegiate athletes undergoing UCLR by a single surgeon were identified. Postoperatively, individual collegiate career paths were analyzed through use of publicly available data from team websites, injury reports, and press releases. Data obtained included time to return to competition, number of collegiate seasons played after surgery, total games started and played, seasonal wins, losses, saves, innings played, hits, earned run average (ERA), home runs, shutouts, strikeouts, walks, and walks plus hit per inning pitched (WHIP). The UCLR group was compared with a matched control group of collegiate pitchers without elbow injury. Results: Of the 58 collegiate baseball players analyzed (mean ± SD age, 19.95 ± 1.19 years), 84.5% returned to play at the collegiate level. Players returned to competition at 16.98 ± 6.16 months postoperatively and competed for 1.60 ± 0.84 seasons postoperatively. In terms of career longevity, 81.0% of collegiate pitchers either completed their collegiate eligibility or remained on active rosters, and 2 players (4.1%) ultimately played at the professional level after UCLR. Compared with a matched cohort, the UCLR group had no significant differences in collegiate pitching performance statistics after surgery. Conclusion: College baseball players returned to play at a rate comparable with the rate published in prior literature on professional pitchers and often completed their collegiate playing eligibility postoperatively. Compared with controls, the UCLR group had no statistically significant differences in pitching performance postoperatively. Further studies are needed to determine the exact reasons why college players retire despite having endured extensive surgical and postoperative rehabilitation processes related to UCLR. Younger populations are experiencing elbow injuries at an increasing rate secondary to increased workloads at the amateur level. As these athletes matriculate into the collegiate ranks, they are at continued risk of sustaining UCL injury, and little explicit information is available on their prospects of return to play and career longevity after UCLR.

Background: Single-sport athletes who specialize in baseball at a young age may have a greater predisposition to overuse injury, burnout, and decreased career longevity when compared with multiple-sport athletes. The effect of sport specialization has not been studied in professional baseball players. Hypothesis: Major League Baseball (MLB) players who played multiple sports in high school would experience fewer injuries, spend less time on the disabled list, play more games, and have a longer career than athletes who played only baseball in high school. Study Design: Descriptive epidemiology study. Methods: First- and second-round MLB draft picks from 2008 to 2016 who played in at least 1 professional game were included in this study. Athletes who participated in 1 or more sports in addition to baseball during high school were considered multisport athletes, and athletes who participated in only baseball were considered single-sport athletes. For each athlete, participation in high school sports, injuries sustained in MLB and Minor League Baseball, number of days on the disabled list for each injury, number of games played in both leagues, and whether the athlete was still active were collected from publicly available records. Results: A total of 746 athletes were included in this study: 240 (32%) multisport and 506 (68%) single sport. Multisport athletes played in significantly more mean total games (362.8 vs 300.8; P < .01) as well as more mean MLB games (95.9 vs 71.6; P = .04) than single-sport athletes. There was no difference in the mean number of seasons played in the major leagues (1.8 vs 1.6; P = .15) or minor league (5.25 vs 5.20; P = .23) between multisport and single-sport athletes. Single-sport athletes had a significantly higher prevalence of upper extremity injuries compared with multisport athletes (136 [63%] vs 55 [50%]; P = .009). Single-sport pitchers also had a higher prevalence of shoulder and elbow injuries (86 vs 27; P = .008) and were more likely to have recurrent elbow injuries (33% vs 17% recurrence; P = .002) compared with multisport pitchers. Conclusion: Professional baseball players who participated in multiple sports in high school played in more major league games and experienced lower rates of upper and lower extremity injuries than players who played only baseball in high school.

Cardiovascular screening in athletes has been a source of controversy within the sports medicine community. Annual screening inclusive of ECG is currently required by all major professional sports leagues in the USA and recommended by the IOC.1 In 2016, the American Medical Society for Sports Medicine (AMSSM) published a statement on cardiovascular screening, recognising knowledge gaps and advocating for medical providers caring for competitive athletes to consider important factors when determining an individualised cardiovascular screening strategy. These include the risk of sudden cardiac arrest (SCA) in the specific athlete population, the available resources and cardiology infrastructure for screening and secondary evaluations.2 The purpose of this investigation was to determine the cardiovascular screening practices of the US National Governing Bodies (NGBs) and National Paralympic Committees (NPCs). This study was approved by the Institutional Review Board from the …

Although psychosis often occurs during adolescence, there has been little research on how the ubiquitously used Internet and social media could impact pathways to care. We examined how youth with psychotic spectrum disorders (PSD) versus non-psychotic mood disorders (NPMD) use online resources in the early illness stages.Social media use and pathways to care data were collected using a semi-structured interview from 80 youth (PSD = 40 and NPMD = 40) aged 12-21 years within 2 years of symptom onset.A total of 97.5% of participants (mean age = 18.3 years) regularly used social media, spending approximately 2.6 ± 2.5 h per day online. There were 22.4% of our sample (PSD = 19.4%, NPMD = 25.0%, P = 0.56) who reported waiting to reach out for help believing that symptoms would disappear. A total of 76.5% (PSD = 67.5%, NPMD = 85.0%, P = 0.06) noticed social media habit changes during symptom emergence. Thirty per cent reported discussing their symptoms on social media (PSD = 22.5%, NPMD = 37.5%, P = 0.14). NPMD patients sought information most on how to stop symptoms (40.0% vs. 13.5%, P = 0.01), while PSD youth were more commonly interested in what caused their symptoms (21.6% vs. 15.0%, P = 0.45). More PSD patients (42.9% vs. 25.0%, P = 0.10) would prefer to receive mental health information via the Internet. Altogether, 63.6% (PSD = 64.9%, NPMD = 62.5%, P = 0.83) were amenable to clinicians proactively approaching them via social media during symptom emergence. A total of 74.3% (PSD = 78.4%, NPMD = 70.0%, P = 0.40) liked the idea of obtaining help/advice from professionals via social media.The Internet and social media provide an unparalleled opportunity to supplement and potentially transform early intervention services, and acceptance of this approach appears to be high.

Background Cardiac screening in athletes has recently been a focus of investigation and debate among the sports medicine community. Athletic associations and organizations, including the International Olympic Committee, have issued recommendations regarding screening practices in an effort to prevent sudden cardiac death in sport. Objective To examine cardiovascular screening strategies among Olympic-level athletic teams. Design Cross-sectional survey. Setting United States National Governing Bodies (NGBs) and National Paralympic Committees (NPCs). Participants Medical team members for US NGBs and NPCs. Interventions Medical team members were surveyed regarding the cardiovascular screening practices of their respective teams. Main Outcome Measurements The screening components and screening frequency performed by US NGBs and NPCs. Results Medical team members for 49/72 (68%) of the US NGBs and NPCs were identified and contact information was obtained through various sources. 42/49 teams (86%) completed the assessment (34 from NGBs and 8 from NPCs). Twenty-one of 42 teams (50%) reported that there was a periodic health evaluation requirement that directed the cardiovascular screening components, frequency, and/or provider. The following screening components were reported as being performed at least once in all or most athletes: personal history (91% of teams), family history (86%), physical exam (81%), electrocardiogram (33%), echocardiogram (5%), and stress test (2%). For teams who did not screen athletes with ECG, the most frequently cited reasons were lack of ECG equipment (40%), lack of evidence (33%), and lack of consensus regarding follow-up testing (20%). Conclusion The US NGBs and NPCs are a heterogeneous collection of athletic teams that have varying approaches to cardiovascular screening. Lack of infrastructure appears to be the biggest barrier to implementing advanced screening protocols. Results from this investigation can be used to support efforts to provide consistent cardiovascular screening practices to NGB and NPC athletes with the goal of preventing tragedy from sudden cardiac death.