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Thorax and Abdominal Injuries

General Principles Overview Injuries to the thorax and abdomen are more often seen in sports involving sudden deceleration and impact (e.g., football, ice hockey, skiing, and snowboarding). Early recognition and management of these potentially life-threatening injuries are imperative. Serial assessments and a high index of suspicion are essential for accurate evaluation. Once severe injury is recognized, emergency medicine fundamentals and stabilization should be initiated until transfer…

Hand and Wrist Injuries

General Principles Overview Fortunately, most sports-related hand and wrist injuries, when addressed in a timely manner, do not represent a significant threat to limb viability, long-term function, or eventual return to sports. Perhaps the greatest morbidity from these injuries results from delayed presentations or missed injuries, a common feature in athletes motivated to compete. Hand function is closely linked to full flexion of the ulnar three…

Elbow Injuries

General Principles History and Physical Examination History Hand dominance Location: medial, lateral, anterior, or posterior Type of pain: radiating, numbness/tingling, stiffness, mechanical symptoms (locking/catching) Duration of symptoms Mechanism of injury Pain modifiers Activity related: gripping, lifting, pushing, throwing, punching History of previous injuries Recent changes in technique or training regimen Treatments rendered and response Physical Examination Inspection Compare with uninjured side Skin changes Swelling Ecchymosis Muscle…

Shoulder Injuries

Acknowledgment The authors would like to acknowledge the work of Charles T. Crellin, MD, and Kevin M. Honig, MD, for their contribution to the previous edition. History A careful history will help establish the diagnosis and formulate a treatment plan. Important factors include the chief complaint, mechanism of injury, hand dominance, what sport the athlete plays, and prior treatments. Common complaints are “pain with overhead activities,”…

Maxillofacial Injuries

General Principles Epidemiology Three to twenty-nine percent of facial injuries are a result of sporting activities. Sixty to ninety percent of facial injuries in sports occur in males aged 10–29 years. Approximately 75% of facial fractures involve the zygoma, mandible, or nose. Most commonly injured teeth are maxillary central incisors, followed by lateral incisors and mandibular incisors. Initiation of Care of the Head-Injured Athlete Airway Injury…

Eye Injuries

General Principles A 2013 study estimated over 30,000 emergency department visits annually for sports- and recreation-related eye injuries. The majority of these injuries occurred in individuals younger than 25 years, with a peak during adolescence, and 80% occurred in males. Approximately 1.5% of all sports-related injuries involve the eye or ocular adnexa. These injuries have a high morbidity rate, and long-term visual impairment can lead to…

Neck Injuries

General Principles Cervical spine injuries are most often seen in football and hockey but have occurred in wrestling, rugby, baseball, lacrosse, skiing, snowboarding, equestrian sports, and mountain biking. Anatomy There are seven cervical vertebrae and eight cervical nerves. Spinal nerves exit above the vertebral body for which they are named; for example, the sixth cervical nerve exits at the C5–C6 disc space. The cervical spine is…

Head Injuries

General Principles Head injuries in sports are comparatively mild compared with those in high-velocity motor vehicle accidents (MVAs), yet they remain significant and important injuries for team physicians to evaluate and manage. Concussion is the most common head injury in sports. Information is evolving regarding pathophysiology, diagnosis, natural history, and treatment of concussion in sports. Consider focal, vascular, and associated injuries (e.g., cervical spine, skull fractures,…

Physical Modalities in Sports Medicine

General Principles A modality is the application of a therapeutic treatment in order to elicit an adaptive response within the body. The aim of modalities is to create an optimal healing environment. They are external treatments best thought of as an adjunct to the body’s own recovery process. Although they should not be the only treatment, they show value in the sports medicine realm by speeding…

Comprehensive Rehabilitation of the Athlete

General Principles The overall goal of rehabilitation is to enhance the recovery of injured tissues and avoid stresses that may prove deleterious to the healing process. This is accomplished by understanding normal function, pathomechanics, and the healing processes of specific tissues. Current research and scientific evidence must establish guidelines for rehabilitation. Rehabilitation specialists must integrate the medical team’s diagnosis and conduct a functional examination of the…

Musculoskeletal Injuries in Sports

Acknowledgment The authors would like to acknowledge the contributions of previous edition authors W. Michael Walsh, MD; Ronnie D. Hald, PT, ATC; Laura E. Peter, MD; and Morris B. Mellion, MD . General Classification of Musculoskeletal Sports Injuries Musculoskeletal sports injuries can be classified as traumatic or overuse injuries. Traumatic Injuries Description: Result from specific episode(s) of trauma, whether recent (acute) or in the more distant…

Connective Tissue Diseases and Rheumatologic Problems in Athletes

Connective Tissue Disorders Marfan Syndrome Overview: Inheritable autosomal-dominant genetic condition that affects the processing of fibrillin; it is caused by >1800 mutations in the gene encoding fibrillin-1 (FBN-1), located on chromosome 15 at the q21 loci. Approximately 10% of patients with Marfan phenotype have no identifiable mutation in the FBN1 gene; mutations in TGF-beta receptor 2 and TGF-beta receptor 1 genes have been linked to these…

Skin Problems in the Athlete

General Principles Skin infections account for 21% of illnesses and injuries reported in collegiate sports and 8.5% in high school sports. In collegiate sports, skin infections account for 1%–2% of all time-loss injuries. Twenty percent of National Collegiate Athletic Association (NCAA) wrestlers lose practice or competition time because of skin problems annually. Common dermatologic lesions and examples are listed in Table 40.1 . Table 40.1 Description of…

Headache in the Athlete

General Principles Headache is one of the most common disorders and symptoms reported to primary care, the emergency department, and team physicians. Complaints of headache account for 1%–4% of primary care office and emergency department visits. In the general population, the prevalence of headache in a 1-year period is >90% and the lifetime prevalence is 93%–99%. Headaches are one of the most commonly reported pain complaints…

Neurologic Problems in the Athlete

Epilepsy and Seizure Activity in Athletes Definition Seizure: A transient disruption of brain function from abnormal, excessive, synchronous neuronal activity in the brain; its clinical manifestation depends on the specific region and extent of the brain involved, which may include altered motor function, sensation, alertness, perception, and autonomic function. Epilepsy: An enduring predisposition to generate recurrent, unprovoked epileptic seizures; worldwide prevalence is approximately 8.2 per 1000…

Exercise-Induced Bronchoconstriction, Urticaria, And Anaphylaxis

Exercise-Induced Bronchoconstriction Definitions: Exercise-induced bronchoconstriction (EIB) is defined as a transient narrowing of airways in response to exercise and can be classified as with asthma (EIBa) or without asthma (EIBwa). EIB can present with classic asthma symptoms or with more subtle fatigue or effects on performance. EIB was previously defined as exercise-induced bronchospasm, as opposed to bronchoconstriction, and exercise-induced asthma (EIA) described symptoms brought on by…

The Hypertensive Athlete

General Principles An estimated 108 million Americans over the age of 18 years have hypertension (HTN). HTN is the most common cardiovascular condition observed in competitive athletes. Athletes are usually considered to be free from cardiovascular disease because of their apparent high level of fitness. The overall incidence of HTN in athletes is approximately 50% less than that in the general population. HTN begins in young…

Cardiac Disease in Athletes

The Athlete’s Heart Definition Intense regular physical exercise can induce physiologic and morphologic cardiac changes known as “athlete’s heart.” These adaptations are a normal response to repetitive exercise and training. Physiologic Changes Increased vagal tone Morphologic changes, including left ventricular (LV) enlargement, increases in LV wall thickness, and LV mass Pathologic vs. Physiologic Hypertrophy Physiologic changes that occur in response to training can be difficult to…

Ecg Interpretation in Athletes

Introduction Sudden death related to cardiovascular disorders is the most common cause of death among athletes during sports and exercise. Genetic cardiovascular disorders, such as cardiomyopathies and ion channelopathies, are the primary causes of sudden cardiac death (SCD) in athletes. Acquired cardiac conditions, such as myocarditis, also represent an important cause of SCD in young athletes. Most of these disorders can be identified through characteristic changes…

The Athlete with Diabetes

General Principles Diabetes mellitus (DM) is a chronic group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion leading to an absolute insulin deficiency due to beta-cell destruction (type 1), by defects in insulin action because of progressive insulin secretory loss along with increasing insulin resistance (type 2), or by other causes such as pregnancy (gestational), neonatal diabetes or maturity-onset diabetes of the…