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Caine D, Patel V, Nguyen JC. Overuse Injury of the Epiphyseal Primary Physis. Semin Musculoskelet Radiol 2024; 28:375-383. [PMID: 39074721 DOI: 10.1055/s-0044-1785207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
Year-round participation in youth sport that involves high levels of repetitive movement fosters an environment in which overuse injuries are likely to occur. Epiphyseal primary physeal stress injuries (PSIs), unique to skeletally immature athletes, are a particular concern, given their potential for growth disturbance. Initially observed in Little League baseball players, these injuries are now known to affect the long bones around the shoulder, elbow, wrist, hand, knee, ankle, and foot of skeletally immature athletes involved in a variety of sport activities.This article offers an epidemiological and radiologic perspective on the extent and distribution of epiphyseal PSIs in youth sport. We also review a novel framework for understanding the pathophysiologic mechanisms causing these injuries. This information is essential for the early identification of epiphyseal PSIs and devising preventive measures that can reduce a delayed diagnosis and long-term morbidity. Preventing and reducing injury to the epiphyseal growth plates is essential because impairment and dysfunction can result in lifelong morbidity and a risk of premature osteoarthritis.
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Affiliation(s)
- Dennis Caine
- Division of Education, Health and Behavior Studies, Kinesiology and Public Health Education, University of North Dakota, Grand Forks, North Dakota
| | - Vandan Patel
- Department of Radiology, Section of Musculoskeletal Imaging, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jie C Nguyen
- Department of Radiology, Section of Musculoskeletal Imaging, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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2
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Sjöman AE, Grønhaug G, Julin MV. A Finger in the Game: Sport-Specific Finger Strength Training and Onset of Injury. Wilderness Environ Med 2023; 34:435-441. [PMID: 37550103 DOI: 10.1016/j.wem.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 06/11/2023] [Accepted: 06/20/2023] [Indexed: 08/09/2023]
Abstract
INTRODUCTION Strength training has proved to be an effective way to prevent injuries, but the evidence of the impact of strength training on finger injuries is lacking. A fingerboard is a sport-specific tool used by climbers for strength training of fingers. In this study, we searched for associations between fingerboard training and finger injuries in climbers with different lengths of climbing experience and levels of performance. METHODS A web-based survey was used to collect information on self-perceived pain or injury in fingers (SPIIF) and regular fingerboard training (RFT). The survey was administered to the Finnish climbing community. Data were analyzed using contingency tables; chi-square was used to evaluate statistical significance. RESULTS No significant correlations between SPIIF and RFT were found when analyzing all the participants (n=434) together. In climbers with 6 y or more in the sport, SPIIF was not common and RFT was negatively associated with SPIIF (χ2 [1, n=200]=4.57; P=0.03). In contrast to this, in male climbers who had been climbing for less than 6 y and had advanced to 7a level or higher (French lead/Font bouldering), SPIIF was common and RFT was positively associated with SPIIF (χ2 [1, n=75]=4.61; P=0.03). CONCLUSIONS We suggest that doing RFT may prevent SPIIF in climbers with a long background in the sport as fingerboard training can help build stronger fingers and thereby stronger tendons and ligaments. Climbers with fewer years in the sport and less adaptation to the fingers should be cautious with their training loads and RFT to avoid finger injuries and pain.
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Affiliation(s)
- Anna E Sjöman
- LAUREA University of Applied Science, Espoo, Finland.
| | - Gudmund Grønhaug
- Department of Sport, Food and Natural Sciences, Faculty of Education, Western Norway University of Applied Sciences, Campus Sogndal, Norway Arts and Sports, Sogndal, Norway
| | - Mikko V Julin
- LAUREA University of Applied Science, Espoo, Finland
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3
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Zbojniewicz AM. MRI anatomy and injuries of the fingers. Pediatr Radiol 2023; 53:1562-1575. [PMID: 36808525 DOI: 10.1007/s00247-023-05624-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/29/2023] [Accepted: 01/30/2023] [Indexed: 02/20/2023]
Abstract
Magnetic resonance imaging (MRI) diagnosis of underlying finger pathology can be intimidating due to the presence of unique anatomy. The small size of the fingers and the unique orientation of the thumb compared to the fingers also introduce unique demands on the MRI system and the technologists performing the study. This article will review the anatomy pertinent to injuries at the fingers, provide protocol guidance, and discuss pathology encountered at the fingers. Although much of the encountered pathology in the fingers overlaps with adults, unique pathology to children will be highlighted when applicable.
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Affiliation(s)
- Andrew M Zbojniewicz
- Advanced Radiology Services, Michigan State University, Grand Rapids, MI, 49525, USA.
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4
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Pastor T, Schweizer A, Andronic O, Dietrich LG, Berk T, Gueorguiev B, Pastor T. A Life Dedicated to Climbing and Its Sequelae in the Fingers-A Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:17050. [PMID: 36554928 PMCID: PMC9778768 DOI: 10.3390/ijerph192417050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/07/2022] [Accepted: 12/16/2022] [Indexed: 06/17/2023]
Abstract
Fingers of sport climbers are exposed to high mechanical loads. This work focuses on the fingers of a 52-year-old active elite climber who was the first in mankind to master 8B (V13), 8B+ (V14) and 8C (V15) graded boulders, bringing lifelong high-intensity loads to his hands. It is therefore hypothesized that he belongs to a small group of people with the highest accumulative loads to their fingers in the climbing scene. Fingers were analyzed by means of ultrasonography, X-rays and physical examination. Soft tissue and bone adaptations, as well as the onset of osteoarthritis and finger stiffness, were found, especially in digit III, the longest and therefore most loaded digit. Finally, this article aims to provide an overview of the current literature in this field. In conclusion, elite sport climbing results in soft tissue and bone adaptations in the fingers, and the literature provides evidence that these adaptations increase over one's career. However, at later stages, radiographic and clinical signs of osteoarthritis, especially in the middle finger, seem to occur, although they may not be symptomatic.
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Affiliation(s)
- Tatjana Pastor
- Department of Plastic and Hand Surgery, Inselspital University Hospital Bern, University of Bern, 3012 Bern, Switzerland
- AO Research Institute Davos, 7270 Davos, Switzerland
| | - Andreas Schweizer
- Division of Hand Surgery, Department of Orthopaedics and Trauma Surgery, Balgrist University Hospital, University of Zurich, 8006 Zurich, Switzerland
| | - Octavian Andronic
- Division of Hand Surgery, Department of Orthopaedics and Trauma Surgery, Balgrist University Hospital, University of Zurich, 8006 Zurich, Switzerland
| | - Léna G. Dietrich
- Department of Plastic and Hand Surgery, Inselspital University Hospital Bern, University of Bern, 3012 Bern, Switzerland
| | - Till Berk
- AO Research Institute Davos, 7270 Davos, Switzerland
- Department of Trauma, University Hospital Zurich, 8091 Zurich, Switzerland
| | | | - Torsten Pastor
- Division of Hand Surgery, Department of Orthopaedics and Trauma Surgery, Balgrist University Hospital, University of Zurich, 8006 Zurich, Switzerland
- Department of Orthopaedic and Trauma Surgery, Cantonal Hospital Lucerne, 6002 Lucerne, Switzerland
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Jones G, Johnson R, Schöffl V, Schöffl I, Lutter C, Johnson MI, Halsey T. Primary Periphyseal Stress Injuries of the Fingers in Adolescent Climbers: A Critical Review. Curr Sports Med Rep 2022; 21:436-442. [PMID: 36508599 DOI: 10.1249/jsr.0000000000001016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
ABSTRACT The worldwide rise in popularity of climbing and development of climbing as a competitive sport is reflected by its debut at the 2021 Summer Olympic Games in Tokyo. Digital primary periphyseal stress injuries in adolescent climbers may pose a significant risk to long-term skeletal health. The aim of this article is to critically review research on the diagnosis and management of primary periphyseal stress injuries of the fingers in adolescent climbers. We adopted a systematic approach to searching for relevant literature. Articles were identified after searches of the following electronic databases: Discover, Academic Search Complete, PubMed, Embase, SPORTDiscus, and ScienceDirect. Conclusive evidence suggests digital primary periphyseal stress injuries are a consequence of repetitive microtrauma. Pain reported by adolescent climbers on the dorsal aspect of the proximal interphalangeal joint should be investigated promptly to avoid serious negative consequences. Clinicians should be aware of the efficacy of imaging techniques to inform a clinical diagnosis. A conservative management approach is preferred but in rare cases surgical intervention may be necessary. A diagnostic and therapeutic algorithm for digital primary periphyseal stress injuries is presented.
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Affiliation(s)
| | - Rowena Johnson
- Carnegie School of Sport, Leeds Beckett University, Leeds, UNITED KINGDOM
| | | | | | | | - Mark I Johnson
- Centre for Pain Research, Leeds Beckett University, Leeds, UNITED KINGDOM
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6
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Crum RP, Cervantes L, Berger AJ. Pediatric hand ultrasound: common indications, injury, inflammation and masses. Pediatr Radiol 2022; 52:1671-1686. [PMID: 35368212 DOI: 10.1007/s00247-022-05286-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 12/01/2021] [Accepted: 01/14/2022] [Indexed: 11/29/2022]
Abstract
Ultrasound is a uniquely valuable tool for evaluating musculoskeletal problems in the pediatric hand. Acute and chronic injuries involving tendons and ligaments of the hand can be quickly assessed and can guide surgical decision-making. Using ultrasound, palpable lesions and masses can be evaluated for cystic and solid components aiding in differential diagnosis. Additionally, ultrasound provides evaluation of acute versus chronic changes of inflammatory arthritis, assessing disease severity and subclinical synovitis and serving as an adjunct to medical management. This review will cover common indications and ultrasound findings of the pediatric hand, focusing on common injuries, inflammatory arthritis and masses. Important anatomical features of the hand will be discussed as well as imaging technique and evaluation in the pediatric patient.
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Affiliation(s)
- Rachel Pevsner Crum
- Department of Pediatric Radiology, Nicklaus Children's Hospital, 3100 SW 62 Ave., Miami, FL, 33155, USA.
| | - Luisa Cervantes
- Department of Pediatric Radiology, Nicklaus Children's Hospital, 3100 SW 62 Ave., Miami, FL, 33155, USA
| | - Aaron J Berger
- Division of Pediatric Plastic Surgery, Nicklaus Children's Hospital, Miami, FL, USA
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Pastor T, Fröhlich S, Pastor T, Spörri J, Schweizer A. Cortical Bone Thickness, Base Osteophyte Occurrence and Radiological Signs of Osteoarthritis in the Fingers of Male Elite Sport Climbers: A Cross-Sectional 10-Year Follow-Up Study. Front Physiol 2022; 13:893369. [PMID: 35721555 PMCID: PMC9203125 DOI: 10.3389/fphys.2022.893369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/16/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Sport climbing places high mechanical loads on fingers. In 2012, our research group demonstrated adaptations of climbers’ cortical bones with the presence of osteophytes compared to non-climbing controls. Objectives: 1) To investigate 10-year changes in cortical bone thickness, base osteophyte occurrence and radiological signs of osteoarthritis in the fingers of elite male sport climbers with more than 25 years of climbing history and 2) to compare cortical bone thickness, base osteophyte occurrence and radiological signs of osteoarthritis between male sport climbers and age-matched controls at the 10-year follow-up. Methods: All 31 elite sport climbers who participated in both the baseline and 10-year follow-up assessments (follow-up rate 100%) were examined by means of X-rays. Cortical bone thickness, presence of osteophytes and signs of osteoarthritis according to Kellgren-Lawrence were obtained and compared to the baseline values 10 years earlier and to age-matched controls at the follow-up (n = 15). Results: Significantly increased cortical bone thickness over the past 10 years was observed in climbers (mean absolute difference with 95% CI:0.98 mm (0.77 mm, 1.19 mm); p <0.001). Moreover, compared to age-matched controls, climbers had significantly thicker cortical bone at the 10-year follow-up (mean absolute difference with 95% CI:0.86 mm (0.61 mm, 1.12 mm); p <0.001). In climbers, osteophytes and clear signs of osteoarthritis were mainly seen in DIP joints. Signs of osteoarthritis according to Kellgren-Lawrence were more prevalent than 10 years before in most joints. In lateral radiographs, base osteophytes were not significantly more prevalent than 10 years before in most of the joints. The percentage of climbers who had osteophytes in any DIP (PIP) joint increased from 93.5% (67.7%) at baseline to 100% (74.2%) at the 10-year follow-up. The percentage of climbers who had clear signs of osteoarthritis according to Kellgren-Lawrence in any DIP (PIP) joint increased from 12.9% (9.7%) at baseline to 74.2% (64.5%) at 10-year follow-up. Only a few such degenerative changes were found in age-matched controls. Conclusion: An accumulation of repetitive climbing-related stress to the fingers of elite sport climbers over the career may induce lifelong mechano-adaptation of the cortical bone thickness of all phalanges. At the 10-year follow-up, a further significant increase in radiographic signs of osteoarthritic changes was observed.
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Affiliation(s)
- Torsten Pastor
- Department of Orthopaedic and Trauma Surgery, Cantonal Hospital Lucerne, Lucerne, Switzerland
- Division of Hand Surgery, Department of Orthopaedics and Trauma Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- *Correspondence: Torsten Pastor,
| | - Stefan Fröhlich
- University Center for Prevention and Sports Medicine, Department of Orthopaedics, Balgrist University Hospital, University Zurich, Zurich, Switzerland
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Tatjana Pastor
- Division of Hand Surgery, Department of Orthopaedics and Trauma Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Department of Plastic and Hand Surgery, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland
| | - Jörg Spörri
- University Center for Prevention and Sports Medicine, Department of Orthopaedics, Balgrist University Hospital, University Zurich, Zurich, Switzerland
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Andreas Schweizer
- Division of Hand Surgery, Department of Orthopaedics and Trauma Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Caine D, Maffulli N, Meyers R, Schöffl V, Nguyen J. Inconsistencies and Imprecision in the Nomenclature Used to Describe Primary Periphyseal Stress Injuries: Towards a Better Understanding. Sports Med 2022; 52:685-707. [PMID: 35247201 DOI: 10.1007/s40279-022-01648-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2022] [Indexed: 11/26/2022]
Abstract
Stress injuries involving the epiphyseal-physeal-metaphyseal complex affecting the extremities of child and adolescent athletes were first described in the early 1950s. Initially observed in Little League baseball players, these injuries are now known to affect skeletally immature athletes in a variety of sports that involve high-impact repetitive overuse activities. Collectively known as primary periphyseal stress injuries, they may affect the long bones around the shoulder, elbow, wrist, hand, hip, knee, ankle, and foot of young athletes. These injuries respond well to timely treatment and relative rest, while non-compliance with non-operative treatment can produce skeletal growth disruption and resultant limb deformity. A major concern raised from the existing literature on primary periphyseal stress injuries is the long history of inconsistent and imprecise terminology used to describe these injuries. A variety of terms have been used to describe primary periphyseal stress injuries, including those which potentially misinform regarding who may be affected by these injuries and the true nature and pathophysiologic mechanisms involved. These imprecisions and inconsistencies arise, at least in part, from a misunderstanding or incomplete understanding of the nature and mechanism of primary periphyseal stress injuries. In this article, we examine the inconsistent and imprecise nomenclature historically used to describe primary periphyseal stress injuries. We also offer a novel framework for understanding the pathophysiologic mechanisms behind these injuries, and provide suggestions for more standard use of terminology and further research moving forward.
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Affiliation(s)
- Dennis Caine
- Kinesiology and Public Health Education, Division of Education, Health and Behavior Studies, University of North Dakota, Hyslop Sport Center, 2721 2nd Ave N Stop 8235, Grand Forks, ND, 58202-8235, USA.
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Via Salvador Allende, 43, Baronissi SA, 84081, Salerno, Italy
- Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, Largo Città di Ippocrate, 84131, Salerno, Italy
- Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary University of London, 275 Bancroft Road, London, E14DG, England
- School of Pharmacy and Bioengineering, Faculty of Medicine, Guy Hilton Research Centre, Keele University, Thornburrow Drive, Hartshill, Stoke-on-Trent, ST4 7QB, England, UK
| | - Rachel Meyers
- Department of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnatti, OH, 45229, USA
| | - Volker Schöffl
- Klinik Für Orthopädie Und Unfallchirurgie, Sozialstiftung Bamberg, Buger Straße 80, 96049, Bamberg, Germany
- Klinik für Unfallchirurgie und Orthopädische Chirurgie, Freidrich Alexander Universität Erlangen-Nürnberg, FRG, Erlangen, Germany
- School of Clinical and Applied Sciences, Leeds Becket University, Leeds, UK
- Section of Wilderness Medicine, Department of Emergency Medicine, School of Medicine, University of Colorado, Denver, USA
| | - Jie Nguyen
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Long term evolution of soft tissue response in the fingers of high-level sport climbers: A cross-sectional 10 Year follow-up study. Phys Ther Sport 2021; 52:173-179. [PMID: 34547601 DOI: 10.1016/j.ptsp.2021.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/10/2021] [Accepted: 09/12/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Sport climbing induces physiological changes in the body of high-level climbers. In 2012, our study group demonstrated adaptions of elite climbers' soft tissues with thicker A2/A4-pulleys, flexor tendons and palmar plates compared to non-climbers. OBJECTIVES To assess these adaptations over time we examined all 31 (follow up 100%) climbers that participated in that baseline study again using ultrasonography after a follow-up of 10 years. MAIN FINDINGS (1) In climbers, a significant increase in A2 and A4-pulley and flexor tendon thickness over the last 10 years was observed (p < 0.001), while PIP&DIP palmar plate thickness remained unchanged (p > 0.05); (2) at 10-years follow-up, all soft tissue thickness parameters (incl. palmar plates) were still significantly larger in climbers than in age-matched controls (p < 0.05); (3) as for the association with anthropometrics and climbing performance/experience, a significant association of the current climber's soft tissue thickness could only be found between palmar plate and reached climbing level(p = 0.032) as well as climber's body weight(p = 0.004). CONCLUSION An accumulation of repetitive climbing-related stress to the fingers of elite sport climbers over the career induces mechano-adaptation of the A2/A4-pulleys, flexor tendons and palmar plates. At later stages, there is a further significant increase in flexor tendon and pulley thickness, but not for palmar plate thickness.
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Iruretagoiena X, De la Fuente J, Rodríguez-López ES, Davila F, Dorronsoro A, Goenaga L, Blasi M. Longer Tendon-Bone Distances of the A2 and A4 Annular Pulleys in Experienced High-Level Sport Climbers: Injury or Adaptation? Wilderness Environ Med 2021; 32:450-456. [PMID: 34538713 DOI: 10.1016/j.wem.2021.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 07/02/2021] [Accepted: 07/27/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Experienced high-level climbers are subject to a number of bone and soft tissue changes over the years and are also among the most exposed to pulley injuries. One of the main consequences of pulley rupture is the separation of the flexor tendons from the subjacent phalanges, also known as bowstringing. The purpose of this study was to determine whether this population has asymptomatic bowstringing of the A2 and/or A4 pulleys as determined by tendon-bone distance (TBD) values when compared to nonclimbers. METHODS High-resolution ultrasound TBD measurements in active forced flexion were made for the A2 and A4 pulley of the ring finger bilaterally. Participants were 21 asymptomatic sport climbers who had 21 consecutive years of climbing at a level above 9.66 in the International Mountaineering and Climbing Federation difficulty metric scale. Control subjects were 21 age-matched nonclimbers. RESULTS A significantly longer TBD-25% (0.3 mm) and 35% (0.4 mm) for the A2 and A4 pulleys, respectively-was found in the experienced climbers group (experienced climbers group: A2 1.6±0.5 mm and A4 1.6±0.4 mm; nonclimbers group: A2 1.2±0.1 mm and A4 1.2±0.2 mm). CONCLUSIONS Our results suggest that bowstringing of A2 and A4 pulleys occurs in asymptomatic experienced high-level climbers, which could be interpreted as either an adaptive mechanism to workloads endured over years of climbing or a consequence of underdiagnosed pulley ruptures.
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Affiliation(s)
- Xeber Iruretagoiena
- Department of Physical Therapy, Universidad Camilo José Cela, Madrid, Spain; Eskura Osasun Zentroa, Beasain, Spain; Department of Physical Therapy, Universidad of Deusto, San Sebastian, Spain
| | | | | | - Fernando Davila
- Orthopedics Department, Clínica Pakea-Mutualia, San Sebastián, Spain
| | | | | | - Marc Blasi
- Plastic Surgery Department, Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona), Spain
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Primary Periphyseal Stress Injuries in Young Athletes: A Systematic Review. Sports Med 2021; 52:741-772. [PMID: 34370212 DOI: 10.1007/s40279-021-01511-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Overuse injuries are common in sporting children and adolescents. These injuries are a particular concern when they involve the epiphyseal-physeal-metaphyseal (EPM) complex given their potential to disturb skeletal growth. Specifically, the limits of mechanical tolerance of the EPM complex to repetitive stress may be exceeded by the intense and continuous training characteristic of many youth sports today. OBJECTIVE This article describes the present status of knowledge on the occurrence and outcome of primary periphyseal stress injuries (PPSIs) affecting the EPM complex in the extremities of children and adolescents involved in youth sports. METHODS A comprehensive review of the sports medicine literature was conducted to determine the nature and extent of PPSIs affecting the EPM complex of the extremities among youth sports participants and the potential for consequent skeletal growth disturbance and resultant limb deformity associated with these injuries. RESULTS Our initial search uncovered 128 original published scientific articles reporting relevant data on PPSIs. There were 101 case reports/series, 19 cross-sectional, 1 case-control, and 7 cohort studies with relevant data. The case reports/series studies reported 448 patients with PPSIs involving the extremities. Children and adolescents representing a variety of high impact repetitive youth sports activities-including baseball, badminton, climbing, cricket, dance, gymnastics, rugby, soccer, swimming, tennis, and volleyball-may sustain PPSIs involving the shoulder, elbow, hand and wrist, knee, and ankle and foot. Although incidence data from prospective cohort studies are lacking, data arising from cross-sectional studies suggest that PPSIs may be common in select groups of youth athletes-including the shoulder in baseball players (0-36.6%), wrist in gymnasts (10-83%) and platform divers (52.6%), and fingers in rock climbers (5-58%). Notably, not all stress-related skeletal changes detected on imaging were symptomatic in these studies. When diagnosed and treated with an appropriate period of rest and rehabilitation, most patients studied were able to return to their sport activities. However, our data also show that 57/448 PPSIs (12.7%) produced growth disturbance, and that 28/448 patients (6.2%) underwent surgery for their injuries. Absence of treatment, delayed presentation and diagnosis, and non-compliance with a rest regimen were common in cases that produced growth disturbance. CONCLUSIONS PPSIs may affect the extremities of children and adolescents engaged in a variety of youth sports, especially at advanced levels of training and competition. Most skeletally immature patients with PPSIs respond well to timely treatment; however, in extreme cases, PPSIs can progress to produce skeletal growth disruption which may necessitate surgical intervention. Clearly, establishing the early diagnosis of PPSIs and providing timely treatment of these injuries are needed to ensure the skeletal health of youth sports participants. Rigorous prospective longitudinal epidemiological and imaging studies designed to provide incidence rates of PPSIs and to determine the effect of PPSIs on long-term skeletal health are also necessary.
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Abstract
Increasing numbers of people are participating in the sport of rock climbing, and its growth is expected to continue with the sport's Olympic debut in 2020. Extreme loading of the upper extremities, contorted positioning of the lower extremities, rockfall, and falling from height create an elevated and diverse injury potential that is affected by experience level and quantity of participation. Injuries vary from acute traumatic injuries to chronic overuse injuries. Unique sport-specific injuries to the flexor tendon pulley system exist, but the remaining musculoskeletal system is not exempt from injury. Orthopaedic evaluation and surgery is frequently required. Understanding the sport of rock climbing and its injury patterns, treatments, and prevention is necessary to diagnose, manage, and counsel the rock-climbing athlete.
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Joint Mobility Protection during the Developmental Age among Free Climbing Practitioners: A Pilot Study. J Funct Morphol Kinesiol 2020; 5:jfmk5010014. [PMID: 33467230 PMCID: PMC7739414 DOI: 10.3390/jfmk5010014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 01/03/2020] [Accepted: 02/10/2020] [Indexed: 11/17/2022] Open
Abstract
Sport-climbing popularity increased intensely over the past years. Particularly, children's and adolescents' interest therein is constantly growing. Despite a large effort in preventing injuries and muscle overloads, a fine-tuned training for each sensitive phase of child development is still needed. The objective of the study was to evaluate an innovative training program aimed at the preservation of joint mobility during the developmental age. This article relies on the results of a steady training program allowing to retain joints integrity among the practice of sport climbing in children. Joint mobility changes have been monitored before and after a one-year training program in fifteen subjects aged between 8 and 18 years. Subjects were divided into three groups depending on age (Turgor Secundus, Proceritas Secunda and Turgor Tertius). The motor tests administered were the sit-and-reach test, coxo-femoral mobility test and scapula-humeral mobility test. Our results showed that one-year training improved joint mobility at each analyzed phase, suggesting that this training program could improve mobility and flexibility. Given the importance of joint mobility preservation for discipline-related injuries prevention and eventually recovering, it is essential to provide a specific training program as a route to approach sport climbing, and even more importantly, at an early age. This work represents a preliminary study in order to demonstrate both efficacy on the joint mobility and the requirement of our playful work to support the global sport-climbing workout.
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Steffen K, Soligard T, Mountjoy M, Dallo I, Gessara AM, Giuria H, Perez Alamino L, Rodriguez J, Salmina N, Veloz D, Budgett R, Engebretsen L. How do the new Olympic sports compare with the traditional Olympic sports? Injury and illness at the 2018 Youth Olympic Summer Games in Buenos Aires, Argentina. Br J Sports Med 2019; 54:168-175. [PMID: 31796464 DOI: 10.1136/bjsports-2019-101040] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To describe injuries and illnesses across traditional and new sports among the participating athletes of the Buenos Aires 2018 Youth Olympic Summer Games (BA YOG) (6-18 October 2018). METHODS We recorded the daily number of athlete injuries and illnesses (1) through the reporting of all National Olympic Committee (NOC) medical teams and (2) in the polyclinic and medical venues manned by the BA YOG 2018 medical staff. RESULTS In total, 3.984 athletes from 206 NOCs were observed. NOCs and BA YOG 2018 medical staff reported 619 injuries and 334 illnesses, equalling 15.5 injuries and 8.4 illnesses per 100 athletes over the 13-day period. The eight new sports on the Youth Olympic programme (futsal, beach handball, karate, roller speed skating, kitesurfing, BMX freestyle, climbing and break dancing) fell in between the other sports with respect to injury and illness risk. Injury incidence was highest in rugby (43% of all rugby players), followed by boxing (33%) and badminton (24%), and lowest in swimming, archery, roller speed skating, equestrian, climbing and rowing (<5%). The highest incidences of illness were recorded in golf (20%), followed by triathlon (16%), beach volleyball and diving (both 14%). Of the illnesses, 50% affected the respiratory system and 15% the gastrointestinal system. Injury and illness incidences varied between continents with athletes representing Europe having significantly fewer injuries and illnesses compared with other continents, apart from a similar illness incidence to Asian athletes. CONCLUSION The overall injury incidence of 15.5 injuries per 100 athletes was higher, while the overall illness incidence of 8.4 illnesses per 100 athletes was similar to previous youth and Olympic Games. The new sports did not differ significantly compared with the other sports with respect to injury and illness risk.
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Affiliation(s)
- Kathrin Steffen
- Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo Sports Trauma Research Center, Oslo, Norway .,Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
| | - Torbjørn Soligard
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland.,Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Margo Mountjoy
- Family Medicine, McMaster University Michael G DeGroote School of Medicine, Waterloo, Ontario, Canada.,Sports Medicine, FINA Bureau, Lausanne, Switzerland
| | | | | | | | | | | | | | - Daniel Veloz
- British Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Richard Budgett
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
| | - Lars Engebretsen
- Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo Sports Trauma Research Center, Oslo, Norway.,Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland.,Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
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Pastor T, Fröhlich S, Spörri J, Schreiber T, Schweizer A. Cartilage abnormalities and osteophytes in the fingers of elite sport climbers: An ultrasonography-based cross-sectional study. Eur J Sport Sci 2019; 20:269-276. [DOI: 10.1080/17461391.2019.1631389] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Torsten Pastor
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Stefan Fröhlich
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Jörg Spörri
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Tonja Schreiber
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Andreas Schweizer
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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