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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…

Renal and Genitourinary Problems

Anatomy Genitourinary system: Composed of internal and external organs of the urinary system and genital/reproductive system. Both systems are contained in the abdomen and pelvic region. Urinary system: Composed of kidneys, ureters, bladder, and urethra Reproductive system: Male (penis, testicles), female (ovaries, Fallopian tubes, uterus, vagina, vulva) Female genitourinary system: Situated within the pelvis, except for the vulva, which is external ( Fig. 32.1 ) Male…

Hematologic Problems in the Athlete

Red Blood Cell Disorders And Inherited Hemoglobinopathies Sickle Cell Syndromes Description: Sickle cell warrants special consideration for athletes. Inheritance of a gene from one parent results in sickle cell trait (SCT), and inheritance from both results in sickle cell disease (SCD). Other allele formations that lead to sickling include hemoglobin SC and sickle cell beta-thalassemia. Whereas SCD is a contraindication for competitive sports because of the…

Gastrointestinal Problems

General Principles The gastrointestinal (GI) system and its processes are a secondary priority for the body during exercise. As a result, GI dysfunction and disease can often impede maximal athletic potential. During exercise, blood flow is diverted from the splanchnic circulation and preferentially distributed to demanding peripheral muscles. Additionally, sustained movement created during athletic activity can cause disruption to physiologic GI functioning. These factors are thought…

Infections in Athletes

General Principles Athletes may be immunosuppressed due to a variety of psychological, environmental, and physiologic stressors, especially when combined with inadequate diet and sleep. Infectious outbreaks affect sports participation and performance and can easily spread to team staff, spectators, and other contacts. Appropriate diagnosis may help decrease sports disruption, return the patient to health, foster sports success, and quell a regional epidemic. An athlete’s increased risk…

Overtraining

Introduction Overtraining syndrome (OTS) is among the most challenging medical disorders that confronts the sports medicine provider. OTS, although most commonly associated with endurance athletes (e.g., runners, swimmers), can also be identified in strength athletes. At present, OTS is complicated by multiple diagnostic and therapeutic challenges, as current research in this area is limited by a small number of studies and inconsistent results. Researchers have concluded…