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Romero-Morales C, López-López D, Almazán-Polo J, Mogedano-Cruz S, Sosa-Reina MD, García-Pérez-de-Sevilla G, Martín-Pérez S, González-de-la-Flor Á. Prevalence, diagnosis and management of musculoskeletal disorders in elite athletes: A mini-review. Dis Mon 2024; 70:101629. [PMID: 37716840 DOI: 10.1016/j.disamonth.2023.101629] [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] [Indexed: 09/18/2023]
Abstract
Musculoskeletal injuries in elite sports are ones of the most impact issue because their remarkable impact on performance caused by drastic absence of training and competition and a progressive deterioration in physical health, emotional and social athletes' dimensions. Also, the prevalence of epidemiologic research found an incidence of musculoskeletal disorders vary within sports and in elite athletes which is even higher as a consequence of higher demand physical performance. This way, the loss of physical performance due to an sport injury impacts not only the individual economic sphere of the professional but also that ofsports entities, reaching, according to some studies, a loss estimated in the range of 74.7 million pounds. Thus, the purpose of this article is to review and to provide an overview of the most common musculoskeletal injuries in elite sports precipitating factors, clinical presentation, evidence-based diagnostic evaluation, and treatment recommendations with a view to preventing medical conditions or musculoskeletal injuries that may alter performance and general health in the elite athletes.
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Affiliation(s)
- Carlos Romero-Morales
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - Daniel López-López
- Research, Health and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Industrial Campus of Ferrol , Universidade da Coruña, 15403 Ferrol, Spain.
| | - Jaime Almazán-Polo
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - Sara Mogedano-Cruz
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - María Dolores Sosa-Reina
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | | | - Sebastián Martín-Pérez
- Faculty of Health Sciences, Universidad Europea de Canarias, La Orotava, Santa Cruz de Tenerife 38300, Spain
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Arora S, Popkin CA, Wong TT. Trends in MR Arthrogram Utilization at a Tertiary Care Academic Center. Curr Probl Diagn Radiol 2023; 52:346-352. [PMID: 36842885 DOI: 10.1067/j.cpradiol.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 02/01/2023] [Indexed: 02/11/2023]
Abstract
The purpose is to evaluate the trends in MR arthrogram utilization at a tertiary care academic institution and to determine if there are factors that can be implicated in the utilization trends. Number of MR arthrograms of the shoulder, hip, and elbow from 2013-2020 at our institution were identified (n = 1882). Patient demographics including age, sex, sports participation, history of prior surgery, and physician referral were obtained. Descriptive statistics were performed to determine the prevalence of MR arthrograms. Linear regression analyses were performed to determine the relationship of time with prevalence of arthrograms. Chi-square tests and posthoc analyses with Bonferroni correction were used to assess if categorical variables were different between the years. There was overall decrease in the prevalence of MR arthrograms of the shoulder, hip, and elbow despite an increase in the overall MR volume during the study period. Linear regression models significantly predicated decrease in arthrogram prevalence with each passing year (P < 0.001). The percentage of orthopedic referrals for arthrograms in the hip (P = 0.002) and shoulder (P = < 0.001) decreased significantly towards the end of the study period. None of the other variables assessed were significant. At our tertiary care academic institution, arthrogram utilization has been drastically decreasing over the past 8 years. The percentage of orthopedic referrals for shoulder and hip arthrograms significantly decreased at the end of the study period.
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Affiliation(s)
- Silvia Arora
- Department of Radiology, Division of Musculoskeletal Radiology, New York-Presbyterian Hospital Columbia University Medical Center, 622 West 168th Street, MC-28, New York, NY 10032
| | - Charles A Popkin
- Department of Orthopedic Surgery, The Center for Shoulder, Elbow, and Sports Medicine, New York-Presbyterian Hospital Columbia University Medical Center, 622 West 168th Street, PH-11, New York, NY 10032
| | - Tony T Wong
- Department of Radiology, Division of Musculoskeletal Radiology, New York-Presbyterian Hospital Columbia University Medical Center, 622 West 168th Street, MC-28, New York, NY 10032.
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Sudah SY, Menendez ME, Garrigues GE. Nonoperative Treatment of the Biceps-Labral Complex. Phys Med Rehabil Clin N Am 2023; 34:365-375. [PMID: 37003658 DOI: 10.1016/j.pmr.2022.12.004] [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: 03/06/2023]
Abstract
The long head of the biceps and superior labrum should be evaluated as an interdependent functional unit. A focused patient history and physical examination including multiple provocative tests should be performed alongside advanced imaging studies to obtain an accurate diagnosis. Nonoperative treatment modalities including nonsteroidal anti-inflammatory drugs, glucocorticoid injections, and a standardized physical therapy regimen should be exhausted before operative intervention. Significant improvements in pain, functional outcomes, and quality of life are achieved in patients treated nonoperatively. Although these outcomes are less consistent for overhead athletes, return to play and performance metrics seem comparable to those who undergo surgery.
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Affiliation(s)
- Suleiman Y Sudah
- Department of Orthopedics, Monmouth Medical Center, 300 2nd Avenue, Long Branch, NJ 07740, USA
| | - Mariano E Menendez
- Oregon Shoulder Institute at Southern Oregon Orthopedics, 2780 East Barnett Road, 200, Medford, OR 97504, USA
| | - Grant E Garrigues
- Department of Orthopaedic Surgery, Rush University Medical Center, Midwest Orthopaedics at Rush, 1611 West Harrison Street, Orthopedic Building, Suite 400, Chicago, IL 60612, USA.
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Blaeser AM, Markus DH, Hurley ET, Gonzalez-Lomas G, Strauss EJ, Jazrawi LM. Current Controversies and Decision-Making in the Management of Biceps Pathologies. JBJS Rev 2021; 9:01874474-202112000-00008. [PMID: 34962898 DOI: 10.2106/jbjs.rvw.21.00096] [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: 11/14/2022]
Abstract
» Biceps tendon pathologies include a spectrum of injuries that range from mild tendinosis to complete tendon rupture. » Tendinosis, the most common pathology, occurs more frequently with age and is likely related to chronic degeneration. On the other side of the spectrum of severity lies a rupture of the long head of the biceps tendon (LHBT), which may be accompanied by injury to the glenoid labrum. » Superior labral anterior-posterior (SLAP) tears are frequently associated with biceps pathology. Surgical management for injuries of the bicipital-labral complex includes biceps tenodesis or tenotomy and SLAP repair. A consensus as to which of these procedures is the optimal choice has not been reached, and management may ultimately depend on patient-specific characteristics. » Due to the relatively low incidence of distal biceps tendon rupture, agreement on the optimal management strategy has not been reached. Surgical repair, or reconstruction in the case of a chronic rupture, is often chosen. However, nonoperative management has also been utilized in older, less-active patients.
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Affiliation(s)
- Anna M Blaeser
- Department of Sports Medicine, New York University Langone Health, New York, NY
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Hodgetts C, Walker B. Epidemiology, common diagnoses, treatments and prognosis of shoulder pain: A narrative review. INT J OSTEOPATH MED 2021. [DOI: 10.1016/j.ijosm.2021.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Weick JW, Workman WB, Bush CJ, McCollum KA, Sugaya H, Freehill MT. Reported Technical Aspects of Type II SLAP Lesion Repairs in Athletes. Arthrosc Sports Med Rehabil 2021; 3:e289-e296. [PMID: 34027434 PMCID: PMC8128993 DOI: 10.1016/j.asmr.2020.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 09/01/2020] [Indexed: 12/14/2022] Open
Abstract
Purpose To systematically review the available literature to further describe and report the available data on SLAP repair techniques and the association with outcomes. Methods A systematic review of literature was performed on manuscripts describing type II SLAP repairs in athletes. Selection criteria included studies reporting exclusively type II SLAP tears without concomitant pathology, minimum 2-year postoperative follow-up, use of anchor fixation, and return to previous level of play data available. We extracted patient outcome as well as surgical construct details from each article. Average outcomes and return to play rates were calculated and substratified further by athlete type. Return to play rates were compared by repair constructs with the Student t test. Results Initial search resulted in 107 articles. After exclusion criteria were applied, 17 articles were included in the final analysis. Overall, 84% of patients had good-to-excellent results. Of all athletes, 66% returned to previous level of play. There was significant variation in reported technique in terms of anchor number, location, material, suture type, and knotless versus knotted constructs. No significant difference was reported in outcomes in comparison of suture type (P-value .96) or knotted versus knotless constructs (P-value .91). Given the significant variability in reporting, no statistical analysis was felt able to be performed on anchor location and number. Conclusions Repair of type II SLAP tears in athletes is a difficult problem to treat with overall low return to play despite a high rate of “good” outcomes when assessed by outcome measures. Significant variability exists in surgical technique, as well as reporting of surgical technique, potentially limiting the ability to define the best or most effective technique for SLAP repair. Level of Evidence IV, systematic review of level III and level IV studies.
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Affiliation(s)
- Jack W Weick
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Will B Workman
- Walnut Creek Orthopedics & Sports Medicine, Team Orthopedic Surgeon, Oakland Athletics, Walnut Creek, California
| | - Christopher J Bush
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Katherine A McCollum
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A
| | | | - Michael T Freehill
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, U.S.A
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Lin BJ, Ling DI, Calcei JG, Altchek DW, O'Brien SJ, Dines JS. Return to Play After Biceps Tenodesis and Transfer in a Young, Athletic Population. Orthopedics 2021; 44:e13-e18. [PMID: 33141232 DOI: 10.3928/01477447-20201009-03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 11/17/2019] [Indexed: 02/03/2023]
Abstract
The goal of this study was to investigate the level of play that can be expected in a young, athletic population after biceps tenodesis and transfer. The authors hypothesized that both return to play rates and clinical improvement would be high after biceps tenodesis and transfer among young athletes. They conducted a retrospective review of patients who underwent biceps tenodesis and transfer procedures with a minimum follow-up of 24 months. Eligible patients were contacted for consent and asked to complete a questionnaire on patient-reported, shoulder-specific outcome measure scores, level of postoperative play, and other relevant information. The study included 41 patients with a mean age of 21.3 years. Patients reported a mean Kerlan-Jobe Orthopaedic Clinic (KJOC) score of 71.7, Disabilities of the Arm, Shoulder and Hand (DASH)-Sports score of 21.3, Single Assessment Numeric Evaluation (SANE) score of 79.4, and Numeric Rating Scale (NRS) pain score of 1.8. Scores for all patient-reported outcome measures were statistically better (P<.05) for patients who underwent biceps transfer (n=24) compared with biceps tenodesis (n=17). Of the participants, 26 (63%) played a primary overhead throwing sport. Most of the patients (95%) returned to play, and of those who returned to play, 67% returned to their preoperative level or higher. Although biceps tenodesis and transfer procedures have been designated primarily for older patients with biceps-labral complex injuries, the high return to play rates and outcome scores of patients in this case series show that biceps tenodesis and transfer can provide effective surgical treatment for a younger athletic population with biceps-labral complex injuries. [Orthopedics. 2021;44(1):e13-e18.].
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Lamplot JD, Ward BE, O'Brien SJ, Gulotta LV, Taylor SA. Physiologic Long Head Biceps Tendon Excursion Throughout Shoulder Range of Motion: A Cadaveric Study. Orthop J Sports Med 2020; 8:2325967120957417. [PMID: 33110926 PMCID: PMC7557685 DOI: 10.1177/2325967120957417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 04/27/2020] [Indexed: 01/02/2023] Open
Abstract
Background: Restoration of the long head of the biceps tendon (LHBT) length-tension
relationship is critical in preserving muscle strength and efficiency when
performing biceps tenodesis. While static anatomic landmarks such as the
inferior border of the pectoralis major may be used intraoperatively to
achieve this, shoulder position may affect the excursion of the biceps
tendon and represents another variable to consider. Purpose/Hypothesis: The purpose of this study was to quantitatively evaluate the normal excursion
of LHBT that occurs through a glenohumeral range of motion. We also sought
to determine whether elbow position affects LHBT excursion. We hypothesized
that LHBT excursion will be affected by glenohumeral flexion and extension,
and elbow extension will result in increased excursion at each glenohumeral
position compared with a neutral position. Study Design: Controlled laboratory study. Methods: A total of 10 fresh-frozen specimens underwent a standard approach for
subpectoral biceps tenodesis. The LHBT was identified and tagged with a
radiopaque marker within zone 3 of the bicipital tunnel. A total of 3
K-wires were then drilled into the osseous floor: one at the level of the
marker in the LHBT, one at 1 cm proximal, and a third 1 cm distal. All 3
K-wires were then cut flush with the anterior humeral cortex. The specimens
were next placed into 8 different positions, and the excursion of the LHBT
was measured by referencing the K-wires using static fluoroscopic imaging.
The results were analyzed using 1-way analysis of variance testing followed
by Tukey honestly significant difference testing for pairwise comparison
between each individual position and the reference position. Results: The average total LHBT excursion was 24.4 ± 5.2 mm between the neutral
shoulder position and the other shoulder positions tested. The position of
the LHBT was significantly different in the reference position compared with
each of the other 7 shoulder positions (P < .001).
Additionally, the 2 positions of shoulder extension had different LHBT
excursions when compared with each position of shoulder flexion
(P < .0001). For each shoulder position tested, the
position of the LHBT was not significantly different in elbow flexion
compared with extension. Conclusion: There is approximately 24 mm of LHBT excursion throughout the glenohumeral
range of motion, with significantly different amounts of excursion in
glenohumeral flexion and extension. Elbow position does not significantly
affect LHBT excursion. Positioning the shoulder in extension during biceps
tenodesis may overtension the biceps, while positioning the shoulder in
flexion may undertension the biceps relative to the neutral position.
Further research is needed to identify the optimal shoulder position for
biceps tenodesis. Clinical Relevance: Shoulder positioning is an important consideration in establishing a normal
length-tension relationship during biceps tenodesis. When compared with
flexed shoulder positions, LHBT excursion significantly differs in positions
of extension and in a neutral position.
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Affiliation(s)
- Joseph D Lamplot
- Emory University, Department of Orthopaedics, Atlanta, Georgia, USA
| | - Brian E Ward
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Stephen J O'Brien
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Lawrence V Gulotta
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Samuel A Taylor
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
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Altahawi F, Polster JM. Thrower's Shoulder: An Approach to MR Imaging Interpretation. Magn Reson Imaging Clin N Am 2020; 28:243-255. [PMID: 32241661 DOI: 10.1016/j.mric.2019.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In this article, the authors aim to focus on the challenges of interpreting shoulder MR imaging in the throwing athlete with an approach formed by evidence-based literature and clinical experience, with a particular focus on superior labrum tears.
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Affiliation(s)
- Faysal Altahawi
- Cleveland Clinic Foundation, 9500 Euclid Avenue, A21, Cleveland, OH 44195, USA
| | - Joshua M Polster
- Cleveland Clinic Foundation, 9500 Euclid Avenue, A21, Cleveland, OH 44195, USA.
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Abstract
Most first-time anterior glenohumeral dislocations occur as the result of trauma. Many patients suffer recurrent episodes of anterior shoulder instability (ASI). The anatomy and biomechanics of ASI is addressed, as is the pathophysiology of capsulolabral injury. The roles of imaging modalities are described, including computed tomography (CT) and MR imaging with the additional value of arthrography and specialized imaging positions. Advances in 3D CT and MR imaging particularly with respect to the quantification of humeral and glenoid bone loss is discussed. The concepts of engaging and nonengaging lesions as well as on-track and off-track lesions are examined.
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Affiliation(s)
- Christopher J Burke
- Department of Radiology, NYU Langone Health, NYU Langone Orthopedic Center, 333 East 38th Street, New York, NY 10016, USA.
| | - Tatiane Cantarelli Rodrigues
- Department of Radiology, NYU Langone Health, NYU Langone Orthopedic Center, 333 East 38th Street, New York, NY 10016, USA
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