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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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Beletsky A, Okoroha KR, Cabarcas B, Garcia GH, Gowd AK, Meyer J, Vadhera AS, Singh H, Gursoy S, White GM, Davidson J, Nicholson GP, Chahla J, Verma NN. Magnetic Resonance Imaging Findings of the Asymptomatic Shoulder May Impact Performance, Not Future Injury List Placement in Major League Baseball Pitchers. Arthrosc Sports Med Rehabil 2022; 4:e487-e493. [PMID: 35494266 PMCID: PMC9042760 DOI: 10.1016/j.asmr.2021.10.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 10/11/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate preseason shoulder magnetic resonance images (MRIs) obtained from pitchers entering either major or minor league baseball (MLB) and correlate findings with subsequent injury, operative repair, and placement on the injured list (IL). Methods Preseason-MRI of the throwing shoulders of professional-level baseball pitchers, taken during routine evaluations at a single organization (2004-2017) were retrospectively reviewed. Publicly available databases were queried to exclude pitchers with known injuries prior to pre-signing imaging. Three blinded reviewers reviewed all MRI scans independently to evaluate for the presence of abnormalities in the rotator cuff (RTC), labrum, capsule, long-head of the biceps tendon (LHBT), and humeral head. Binary imaging findings were correlated to future placement on the IL for subsequent shoulder complaints. Bivariate statistics using Student’s t-tests and Fisher exact tests (both α = .05) were used in this study. Results A total of 38 asymptomatic pitchers with shoulder MRIs were included. Pitchers had a mean (±SD) age of 28.2 ± 4.9 and had pitched an average of 119.6 ± 143.8 career games. Pitchers with partial articular-sided RTC tears (P = .04) or intra-articular BT hyperintensity (P = .04) on preseason MRI demonstrated an association with the need for future surgery. Pitchers with evidence of labral heterogeneity demonstrated greater total career pitch counts (10,034.1 vs 2,465.3; P = .04). Evidence of a posterior-superior humeral cyst was associated with decreased strikeouts per 9 innings (6.1 vs 8.0; P = .039) and total strikeout percentage (16.1% vs 23.2%; P = .04). Conclusion Although there was a significant difference in the percent of various radiographic findings between the injured and healthy cohort, no MRI findings were predictive of future IL placement or duration of placement. The presence of a posterior superior humeral cyst was associated with decreased strikeout rates at 2 and 3 years, the presence of a labral tear was associated with decreased earned run average (ERA) at 3 years and decreased career strikeout percentages, and increased capsular signal was associated with decreased 5-year ERA. Level of Evidence Level IV, retrospective study.
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Internal Derangement of the Shoulder Joint in Asymptomatic Professional Baseball Players. Acad Radiol 2020; 27:582-590. [PMID: 31300356 DOI: 10.1016/j.acra.2019.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 06/15/2019] [Accepted: 06/16/2019] [Indexed: 11/23/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate the influence of throwing activity on shoulder morphology and the difference in shoulder morphology on MRI between asymptomatic professional baseball players and volunteers who play baseball as a recreational activity. MATERIALS AND METHODS This retrospective case-control study included 68 asymptomatic professional baseball players (32 pitchers, 36 batters) and 30 male volunteers. Morphologic changes in the following shoulder structures were assessed on MRI: rotator cuff, glenoid labrum, humeral head, subacromial-subdeltoid bursa, subcoracoid bursa, long head of the biceps tendon, deltoid muscle, acromion, and clavicle. RESULTS Partially torn supraspinatus, posterior glenoid or labral lesions, bone marrow edema, intraosseous cysts of the humeral head, and edematous subacromial-subdeltoid bursa were significantly more commonly observed in players (p = 0.01, p < 0.001, p = 0.03, p< 0.001, and p < 0.001). Players with more than 10 years of experience had a significantly higher incidence of patchy intermediate signal abnormality (odds ratio: 3.73, p = 0.03), partial tear in the supraspinatus tendon (odds ratio: 6.20, p = 0.03), and edematous change in the subacromial-subdeltoid bursa (odds ratio: 2.96, p = 0.03). CONCLUSION The results from our study showed that repetitive throwing activities cause macroscopic structural lesions of the shoulder joints in asymptomatic baseball players. Significance of these lesions is to be determined.
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Münch L, Beitzel K, Willinger L, Imhoff AB. [Shoulder pain in athletes - 5 steps from diagnosis to successful treatment]. MMW Fortschr Med 2018; 160:44-47. [PMID: 29943010 DOI: 10.1007/s15006-018-0706-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Lukas Münch
- Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Knut Beitzel
- Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland.
- Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar TU München, Ismaninger Str. 22, D-81675, München, Deutschland.
| | - Lukas Willinger
- Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Andreas B Imhoff
- Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
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Johnson JE, Fullmer JA, Nielsen CM, Johnson JK, Moorman CT. Glenohumeral Internal Rotation Deficit and Injuries: A Systematic Review and Meta-analysis. Orthop J Sports Med 2018; 6:2325967118773322. [PMID: 29845083 PMCID: PMC5967160 DOI: 10.1177/2325967118773322] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background: There is an association between throwing activity and glenohumeral internal rotation deficit (GIRD). An 18° to 20° deficit has been adopted as the standard definition of pathological GIRD, but specific findings as to how GIRD relates to an injury are inconsistent. Purpose: To systematically review the literature to clarify the definition of GIRD diagnosis for adolescent and adult overhead athletes and to examine the association between GIRD and an increased risk of injuries in these athletes. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of the literature was performed. Observational studies comparing glenohumeral internal rotation range of motion (ROM) in injured and uninjured overhead athletes were included for the meta-analysis. Studies of adolescent and adult athletes were analyzed separately. ROM was compared for the injured and uninjured groups, and a weighted mean GIRD was estimated. To account for potential heterogeneity across studies, both fixed- and random-effects models were used to calculate a standardized mean difference (SMD). Results: Nine studies of level 3 or 4 evidence were included. From these, 12 study groups (4 adolescent, 8 adult) comprising 819 overhead athletes (226 injured, 593 uninjured) were included in the meta-analysis. The estimated SMD in GIRD between the injured and uninjured groups was 0.46 (95% CI, 0.15-0.77; P < .01) for the overall sample. The between-group effect was larger for adults (SMD, 0.60 [95% CI, 0.18 to 1.02]; P < .01) than adolescents (SMD, 0.20 [95% CI, –0.24 to 0.63]; P = .13). The weighted mean GIRD for the injured and uninjured groups was 13.8° ± 5.6° and 9.6° ± 3.0°, respectively, which also differed by age group. Moderate study heterogeneity was observed (I2 = 69.0%). Conclusion: Based on this systematic review, the current definition of pathological GIRD may be too conservative, and a distinct definition may be required for adolescent and adult athletes. While the results indicate a link between internal rotation deficits and upper extremity injuries in the overhead athlete, higher quality prospective research is needed to clarify the role that GIRD plays in future injuries to overhead athletes of various ages.
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Affiliation(s)
- Jordan E Johnson
- Jerry M. Wallace School of Osteopathic Medicine, Campbell University, Lillington, North Carolina, USA
| | - Joshua A Fullmer
- Jerry M. Wallace School of Osteopathic Medicine, Campbell University, Lillington, North Carolina, USA
| | - Chaseton M Nielsen
- Jerry M. Wallace School of Osteopathic Medicine, Campbell University, Lillington, North Carolina, USA
| | - Joshua K Johnson
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah, USA
| | - Claude T Moorman
- Department of Orthopedic Surgery, Carolinas Medical Center, Charlotte, North Carolina, USA
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Lin DJ, Wong TT, Kazam JK. Shoulder Injuries in the Overhead-Throwing Athlete: Epidemiology, Mechanisms of Injury, and Imaging Findings. Radiology 2018; 286:370-387. [PMID: 29356641 DOI: 10.1148/radiol.2017170481] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The unparalleled velocity achieved by overhead throwers subjects the shoulder to extreme forces, resulting in both adaptive changes and pathologic findings that can be detected at imaging. A key biomechanical principle of throwing is achieving maximum external rotation, which initially leads to adaptive changes that may result in a pathologic cascade of injuries. In addition to the well-established concepts of glenohumeral internal rotation deficit and internal impingement, osseous and soft-tissue injuries of the shoulder unique to overhead athletes are illustrated. The epidemiology and biomechanics of throwing injuries are reviewed, and examples from the authors' institutional experience with competitive, collegiate, and professional baseball players are provided to demonstrate the constellation of unique imaging findings seen in overhead throwing athletes. Given the widespread popularity of baseball, and other sports relying on overhead throwing motions at all playing levels from recreational to professional, it is important for radiologists in various practice settings to be familiar with the special mechanisms, locations, and types of shoulder injuries seen in the overhead throwing population. © RSNA, 2018.
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Affiliation(s)
- Dana J Lin
- From the Department of Radiology, New York-Presbyterian Hospital, Columbia University Medical Center, 622 W 168th St, MC-28, New York, NY 10032
| | - Tony T Wong
- From the Department of Radiology, New York-Presbyterian Hospital, Columbia University Medical Center, 622 W 168th St, MC-28, New York, NY 10032
| | - Jonathan K Kazam
- From the Department of Radiology, New York-Presbyterian Hospital, Columbia University Medical Center, 622 W 168th St, MC-28, New York, NY 10032
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Wang HK, Yu CW, Hsu CY, Chen BB, Chen HC, Chen CY, Lee YH, Shih TTF. Microcirculation at the supraspinatus tendon and shoulder external rotation explosive strength and fatigue are correlated. ISOKINET EXERC SCI 2017. [DOI: 10.3233/ies-160639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Hsing-Kuo Wang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taiwan
- Center of Physical Therapy, National Taiwan University Hospital, Taiwan
| | - Chih-Wei Yu
- Department of Radiology and Medical Imaging, National Taiwan University College of Medicine and Hospital, Taiwan
| | - Chao-Yu Hsu
- Department of Radiology and Medical Imaging, National Taiwan University College of Medicine and Hospital, Taiwan
- Department of Radiology, Taipei Hospital, Ministry of Health and Welfare, New Taipei, Taiwan
| | - Bang-Bin Chen
- Department of Radiology and Medical Imaging, National Taiwan University College of Medicine and Hospital, Taiwan
| | - Hsin-Chia Chen
- Department of Radiology and Medical Imaging, National Taiwan University College of Medicine and Hospital, Taiwan
| | - Chin-Yi Chen
- Department of Athletics, National Taiwan University, Taipei, Taiwan
| | - Yong-Hsiang Lee
- Physical Education Office, National Taiwan University of Science and Technology, Taipei, Taiwan
| | - Tiffany Ting-Fang Shih
- Department of Radiology and Medical Imaging, National Taiwan University College of Medicine and Hospital, Taiwan
- Department of Radiology and Medical Imaging, Taipei City Hospital, Taiwan
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Seltenes Krankheitsbild. ARTHROSKOPIE 2017. [DOI: 10.1007/s00142-016-0106-x] [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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Beirer M, Sandmann GH, Imhoff AB, Buchmann S. [Surgical treatment of posterosuperior impingement (PSI)]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2016; 28:430-437. [PMID: 27469476 DOI: 10.1007/s00064-016-0465-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 04/06/2016] [Accepted: 04/06/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To restore the physiologic anterior and posterior capsular volume to achieve an anatomic central contact point of the glenohumeral articulation and treatment of concomitant glenohumeral injuries due to posterosuperior impingement (PSI). INDICATIONS Plateauing of clinical improvement despite adequate nonsurgical treatment (for at least 6-12 months). CONTRAINDICATIONS General contraindications for elective arthroscopic surgery. SURGICAL TECHNIQUE Diagnostic arthroscopy of the glenohumeral joint through the posterior portal to assess stability of the biceps-labral complex even in the Abduction and External Rotation (ABER) position to confirm the diagnosis of PSI and to detect concomitant glenohumeral injuries. In most cases posterosuperior SLAP (superior labrum anterior posterior) repair or tenodesis of the long head of the biceps. POSTOPERATIVE MANAGEMENT Arm sling for 6 weeks with limited range of motion. Free active range of motion of elbow and wrist. Limited shoulder external rotation for 6 weeks. Free shoulder range of motion from week 7, full daily life activities after 12 weeks. Modification of the postoperative management according to intraoperative findings. RESULTS At our hospital 18 overhead athletes (6 women, 12 men, mean age 31 years) with PSI without SLAP lesion or rotator cuff tear underwent isolated plication of the anteroinferior capsule after primary nonsurgical treatment. At a mean period of 9 months, 16 patients returned to their pre-injury sports activity level, 2 patients had to give up their sports due to persisting shoulder problems. At a mean follow-up of 27 months (range 12-55 months) the Walch Duplay score was on average 82.9 ± 8.3 for men and 73.8 ± 5.9 for women.
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Affiliation(s)
- M Beirer
- Abteilung für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675, München, Deutschland
| | - G H Sandmann
- Abteilung für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675, München, Deutschland
| | - A B Imhoff
- Abteilung für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675, München, Deutschland.
| | - S Buchmann
- Abteilung für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675, München, Deutschland
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Structural and biomechanical changes in shoulders of junior javelin throwers: a comprehensive evaluation as a proof of concept for a preventive exercise protocol. Knee Surg Sports Traumatol Arthrosc 2016; 24:1931-42. [PMID: 25152936 DOI: 10.1007/s00167-014-3223-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 07/28/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE The purpose of this study was to develop a preventive exercise protocol based on structural and functional changes present in shoulder joints of young throwing athletes. As a proof of concept, these changes were previously evaluated in a cross-section of high-performance junior javelin throwers. METHODS Thirteen members of the German and Bavarian junior javelin squad (mean age 17.5 ± 0.8 years) completed a systematic clinical examination, shoulder range of motion (ROM) measurement, and were scored with standardized clinical tools. 3.0 tesla magnetic resonance imaging (MRI) was conducted on both shoulders. Bilateral three-dimensional analysis of the scapulothoracic motion during multiplanar humeral elevation and isokinetic strength testing of the shoulder internal and external rotators was accomplished. Based on the findings, a preventive exercise protocol was confirmed. RESULTS Dominant internal ROM was significantly decreased (dominant 48° ± 20° vs. non-dominant 57° ± 19°; P = 0.006) and dominant external ROM increased (dominant 117° ± 15° vs. non-dominant 107° ± 10°; P = 0.008). MRI revealed posterosuperior intraosseous cysts of the humeral head with a size larger than >3 mm in 69 % of the dominant shoulders and only in 15 % in the non-dominant shoulders. Motion analysis of the static scapular resting position was significantly different between dominant and non-dominant sides regarding anterior tilt (dominant > non-dominant, mean difference 4.2°, P = 0.010) and retraction (dominant > non-dominant, mean difference 2.4°, P = 0.038). Dominant scapular anterior tilt during flexion and abduction was significantly increased (-4.3°, P = 0.006; -3.4°, P = 0.046). Dominant retraction was significantly increased during abduction (-2.3°, P = 0.040). Isokinetic outcome parameters presented nonsignificant bilateral differences. CONCLUSIONS Elite junior javelin throwers already present structural (humeral intraosseous cysts) and biomechanical changes (ROM deficits and asymmetric scapulothoracic motion patterns), even if they have no history of major shoulder pain or injury. A novel exercise protocol was developed in order to address the complex of alterations in a comprehensive way. Preventive diagnostics in combination with a systematic all-year preventive exercise intervention might be one option to detect and control risk factors of a symptomatic throwing shoulder at an early stage. LEVEL OF EVIDENCE IV.
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