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Deep Venous Thrombosis and Pulmonary Embolism

Bleeding in the athlete can result from injury or after orthopedic surgery. Hemostasis—the body's process to stop bleeding—prevents what can be a life-threatening hemorrhage. Immobilization and hypercoagulable states can also induce clotting at improper sites (thrombosis). If the resultant clot dislodges and migrates (thromboembolism), it can lead to devastating tissue damage and organ failure. The most feared complication of that cascade is a fatal pulmonary embolism…

Exercise-Induced Bronchoconstriction

Definition and Prevalence Exercise-induced bronchoconstriction (EIB) describes acute, transient airway narrowing that occurs during and after exercise. EIB is characterized by symptoms of cough, wheezing, or chest tightness during or after exercise. Exercise is one of the most common triggers of bronchoconstriction in asthmatic patients. Approximately 80% of individuals with chronic asthma have exercise-induced respiratory symptoms. However, EIB can also occur in up to 10% of…

Comprehensive Cardiovascular Care and Evaluation of the Elite Athlete

Historical Perspective The elite athlete has enjoyed a celebrated status within our culture since ancient times. The Olympic Games solidified that status as early as 776 BC, and it was amplified by Pheidippedes, who was a legendary Greek Olympic champion in 500 BC. Ten years later when the Persians arrived at the plains of Marathon and threatened to conquer Athens, Pheidippedes was dispatched from Athens to…

Team Medical Coverage

The roots of peak athletic performance are embedded in the optimal health of athletes. It is the responsibility of every member of the sports medicine team to provide consistent, thorough, evidence-based, and comprehensive care for each athlete. Team medical coverage has evolved rapidly and has become a pivotal component of athletics at all levels of competition. The ultimate responsibility for medical decisions regarding both prevention and…

Commonly Encountered Fractures in Sports Medicine

Almost any type of fracture can occur during athletic activities. This is because of the many different types of sports and the corresponding situations in which athletes are found. All athletes undertake various fracture risks with participation. Many of these specific fractures are covered in detail in other chapters. This chapter focuses on certain specific fractures and their management, particularly on stress fractures in various bones…

Overview of Sport-Specific Injuries

The intricacies of many sports result in patterns of injury that are different compared with those of the general athletic population. It is important that health care providers caring for professional and nonprofessional athletes are familiar with their specific needs to afford accurate recognition and swift treatment. Sports injuries have been well documented in high school and collegiate settings. Overall, injury rates appear to be higher…

Basic Arthroscopic Principles

The first arthroscope was developed in 1920 with an optical cannula diameter of 7.3 mm by Dr. Kenji Takagi from Tokyo. His idea to look inside a closed knee with an instrument, a cystoscope, in 1918 came from his interest in the early diagnosis of tuberculous knees in Japan, which was a problematic disease at the time. Dr. Takagi is credited with being the first innovator and…

Imaging Overview

Imaging is important in the diagnosis and management of orthopedic disorders and sports-related injuries. Athletic injuries are common among all age groups. Patients are becoming more knowledgeable with respect to their injuries and the imaging modalities available to diagnose them. Meanwhile, physicians have become more adept at combining their clinical skills with imaging findings to affect better patient care. Subspecialization in the fields of sports medicine…

Exercise Physiology

Exercise physiology is the identification and study of the physiologic mechanisms underlying physical activity and the body's response and adaptation to exercise. Most training programs used by athletes, whether they are for strength or endurance, aim to change the underlying physiology for the benefit of sport competition or fitness. This chapter discusses the major concepts of exercise physiology to provide a background that sports medicine practitioners…

Orthobiologics: Clinical Application of Platelet-Rich Plasma and Stem Cell Therapy

The human body possesses a tremendous healing potential. However, despite its innate restorative capacity, in many instances the body's ability to heal is limited. Musculoskeletal tissues such as tendon, ligament, and cartilage present challenges to clinicians because these tissues tend to heal slowly because of their limited blood supply and slow cell turnover. Furthermore, conservative management or surgical intervention alone may not reliably recapitulate the normal…

Basic Science of Implants in Sports Medicine

Sports injuries in athletes are commonly associated with injury to soft tissues, specifically tendons, ligaments, menisci, and cartilage. Common tendon and ligament injuries in the physically active population include rotator cuff tears, Achilles tendinopathy, anterior cruciate ligament (ACL) tears, and lateral epicondylitis (“tennis elbow”). These injuries can be classified as either repetitive microtrauma, which is caused by overuse, or macrotrauma, which typically results from external physical…

Basic Science of Graft Tissue in Sports Medicine

Graft tissue is widely used in sports medicine for soft tissue reconstruction and augmentation of ligaments and tendons. Understanding the physiology of fixation and incorporation of tendon and/or bone within the tunnels is important for the surgeon, because this knowledge can help guide postoperative rehabilitation and educate patients when they return to play. Many options exist for graft tissue, both as autografts and allografts, and for…

Basic Concepts in Biomechanics

Biomechanics is an interdisciplinary field that uses the principles of mechanics to improve the human body through design, development, and analysis of equipment, systems, and therapies. This biomechanical knowledge can help in understanding the loading of the musculoskeletal system and its mechanical responses, which can be used to determine normal function, predict changes, and propose interventions. More specifically, basic biomechanics explores forces and moments required for…

Physiology and Pathophysiology of Musculoskeletal Tissues

Tendon and Ligament Structure Tendons and ligaments are both dense, regularly arranged connective tissues. The surface of the tendon is enveloped in a white, glistening, synovial-like membrane, called the epitenon , which is continuous on its inner surface with the endotenon , a thin layer of connective tissue that binds collagen fibers and contains lymphatics, blood vessels, and nerves. In some tendons, the epitenon is surrounded…

Fractures and Dislocations of the Midfoot and Forefoot

The Tarsal Navicular Anatomy The tarsal navicular lies in the uppermost portion of the medial longitudinal arch of the foot between the head of the talus and the three cuneiforms. The proximal concave articular surface and convex distal articular surface makes the navicular uniquely shaped as the keystone of the arch by connecting the talus of hindfoot to the cuneiforms of the midfoot and allowing for…

Talus Fractures and Peritalar Dislocations

The talus’s multiple articulations facilitate complex motion of the ankle and hindfoot critical to the biomechanics of gait, earning its title “the universal joint of the foot.” While fractures of the talus are uncommon, accounting for approximately 1% of all fractures, they are frequently the result of high-energy trauma, such as motor vehicle collisions and falls from height, and frequently lead to considerable morbidity. Injuries to…

Fractures of the Calcaneus

Calcaneal fractures usually result from high-energy mechanisms and can be devastating injuries. Early complications and long-term sequelae are common. The optimal treatment for displaced intraarticular fractures remains controversial. Surgical treatment with the extensile lateral approach has reliable radiographic and functional outcomes but is associated with a high rate of wound complications. Less invasive approaches, such as the limited open sinus tarsi approach, are associated with lower…

Ankle Fractures and Dislocations

Ankle fractures are a commonly encountered injury to the lower extremity and account for approximately 9% of all fractures. The incidence of ankle fractures has been increasing among all age groups, and the mechanism of injury is most commonly a fall (35.68%), sports injury (35.26%), exercise injury (19.29%), jumping (5.38%), or a generalized trauma (4.06%). Most ankle fracture patients can be provisionally treated in the emergency…

Pilon Fractures

Fractures that involve the weight-bearing articular surface of the distal tibia are known as pilon or plafond fractures. They were first described by Destot in 1911 and by Bonin in 1950. In 1968, Rüedi et al were the first to describe the fracture, its treatment, and a prognostic classification. These injuries are rare and comprise less than 1% of all lower extremity fractures and between 5%…