Clinical and ultrasound findings of 'swimmer's shoulder' and its association with training history in elite Portuguese swimmers: a cross-sectional study

OBJECTIVES

To assess the prevalence of shoulder injuries and ultrasound findings in elite Portuguese swimmers and their association with symptoms and personal or training-related factors.

METHODS

This cross-sectional study was conducted at the Portuguese Open and Youth Swimming National Championships between 27 and 30th July 2022. Each athlete entered details regarding personal and training history into a questionnaire and underwent a physical and ultrasound shoulder examination.

RESULTS

A total of 102 swimmers out of 662 Portuguese athletes were included in the study. Shoulder pain experienced during the previous season was reported by 42% of the athletes. A high prevalence of shoulder structural abnormalities was noted, specifically supraspinatus tendinosis (91%), tears (29%), and subacromial bursitis (29%). Specific training for injury prevention was associated with higher rates of infraspinatus tendinosis (p = 0.047), and supraspinatus tears were linked to greater swimming distances per week (p < 0.001) and practice (p < 0.001), more years of practice (p = 0.018), shoulder pain at the time of evaluation (p = 0.023), a higher number of missed competitions (p = 0.041), and shoulder injections (p = 0.009). Subacromial bursitis was associated with shoulder pain at the time of evaluation (p = 0.002) and during the previous season (p < 0.001), missed competitions (p < 0.001), and requirement for physical therapy (p = 0.006).

CONCLUSIONS

A high prevalence of shoulder morphological changes was found in surveyed swimmers and there were several associations with training load, regardless of individual characteristics of each athlete. It is essential to understand the true impact of current injury prevention programs and to develop effective measures to protect swimmers' health.

[Ice Swimming]

Ice Swimming Abstract: Just a few years ago, no one could imagine that ice swimming could evolve into a competitive sport. In the past, people swimming in ice-cold water were called madmen and, at best, were studied as scientific objects. Today regular competitions in ice swimming over different distances (ice mile, ice km, and shorter distances such as 50m, 100m, and 200m), and different disciplines are organized (freestyle, breaststroke, backstroke, butterfly). National championships, as well as continental and world championships, are also held, with new records set regularly. In this overview, we summarize the historical development of ice swimming up to a competitive sport and explore the risks in this nascent sports discipline.

Intrinsic Risk Factors for Noncontact Musculoskeletal Injury in Collegiate Swimmers: A Prospective Cohort Study

CONTEXT

Shoulder pain is pervasive in swimmers of all ages. However, given the limited number of prospective studies, injury risk factors in swimmers remain uncertain.

OBJECTIVE

To determine the extent to which the risk factors of previous injury, poor movement competency, erroneous freestyle swimming technique, and low perceived susceptibility to sport injury were associated with noncontact musculoskeletal injury in collegiate swimmers.

DESIGN

Prospective cohort study.

SETTING

College natatorium.

PATIENTS OR OTHER PARTICIPANTS

Thirty-seven National College Athletic Association Division III swimmers (21 females, 16 males; median age = 19 years [interquartile range = 3 years], height = 175 ± 10 cm; mass = 70.0 ± 10.9 kg).

MAIN OUTCOME MEASURE(S)

Participants completed preseason questionnaires on their previous injuries and perceived susceptibility to sport injury. At the beginning of the season, they completed the Movement System Screening Tool and the Freestyle Swimming Technique Assessment. Logistic regression was used to calculate odds ratios (ORs) with 95% CIs for the association between each risk factor and injury.

RESULTS

Eleven of the 37 participants (29.7%) sustained an injury. Univariate analyses identified 2 risk factors: previous injury (OR = 8.89 [95% CI = 1.78, 44.48]) and crossover hand positions during the freestyle entry phase (OR = 8.50 [95% CI = 1.50, 48.05]). After adjusting for previous injury, we found that a higher perceived percentage chance of injury (1 item from the Perceived Susceptibility to Sport Injury) decreased the injury odds (adjusted OR = 0.11 [95% CI = 0.02, 0.82]). Poor movement competency was not associated with injury (P > .05).

CONCLUSIONS

Previous injury, a crossover hand-entry position in freestyle, and a low perceived percentage chance of injury were associated with increased injury odds. Ascertaining injury histories and assessing for crossover positions may help identify swimmers with an elevated injury risk and inform injury-prevention strategies.

Non-shoulder Injuries in Swimming: A Systematic Review

OBJECTIVE

The shoulder is the most common injury in swimming, followed by the knee and spine. The repetitive nature of swimming training may predispose a swimmer to injury. Several risk factors have been previously identified, but the level of evidence and level of certainty that these risk factors predispose a swimmer to injury risk has yet to be evaluated critically in a systematic review.

DESIGN

Systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

DATA SOURCES

Data were obtained through PubMed, Cochrane, and Google Scholar. The database search was limited to articles that were published between January 1980 and December 2019.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Level I, II, and III studies were included in this review. All studies must have been conducted in swimmers or swimming, a description of the specific pathology and provide at least one identified risk factor with an association (P < 0.05).

RESULTS

A total of 19 critically appraised articles identified 28 potential risk factors for musculoskeletal injuries in swimmers. The risk factors were grouped by the anatomical region: neck and back, pelvis and hip, and the knee. Only 2 risk factors were appraised at a moderate level of certainty, both occurring in the knee. The remaining 26 identified risk factors were appraised at a low level of certainty. There is a clear lack of research surrounding nonshoulder injuries in swimmers.

Injuries in Medium to Long-Distance Triathlon: A Retrospective Analysis of Medical Conditions Treated in Three Editions of the Ironman Competition

Triathlon's popularity is rapidly increasing, and epidemiological data relating to its related medical conditions is crucial to the development of proper medical plans and safety guidelines for it. This study examined the data from the medical reports collected during three consecutive editions of Ironman Italy, from 2017 to 2019. Out of 10,653 race-starters, 3.3% required medical attention sustaining 472 medical conditions. A significantly higher injury risk was found for females versus males (χ2 = 9.78, p = 0.02) and in long-distance (IR: 4.09/1,000hours) rather than in Olympic/middle distance races (IR: 1.75/1,000hours). Most (68.4%) conditions (including muscular exhaustion, hypothermia, and dehydration) were systemic, whilst only 10.2% were acute traumatic injuries. Of a total of 357 triathletes requiring medical assistance, 8.1% were a candidate for hospitalisation. The equipment and personnel that are required for the medical assistance in future triathlon events were estimated based on Maurer's algorithm, and ten practical recommendations for triathlon medical support were formulated.

Heat Injury in Open-Water Swimming: A Narrative Review

ABSTRACT

Swimming is one of the most popular sports in the world with open-water swimming (OWS) gaining more and more prominence since being featured in the Federation Internationale De Natation World Aquatics Championships in 1992 and the Olympic Games in 2000. The aim of this review is to analyze the existing literature on heat injury in OWS. Relevant literature was located via computer-generated citations during November of 2020 through online computer searches of multiple major databases. Athletes participating in OWS are exposed to environmental conditions that place them at risk for unique medical conditions such as heat injury. Clinicians providing care for OWS athletes should be educated and trained to recognize these conditions and minimize risks to optimize athlete safety. This article identifies medical challenges related to heat injury in OWS while investigating water temperature recommendations, physiological effects of hyperthermia, risk mitigation strategies, and treatment measures.

Training, Injury, and Lifestyle Characteristics of Recreational Triathletes

ABSTRACT

Triathlon is a popular sport among recreational and competitive athletes. As triathletes compete in races ranging from 16 to 140.6 miles and train in three disciplines simultaneously, it is difficult to identify injury risk factors. The aim of this study was to evaluate characteristics of a group of recreational triathletes regarding their medical history, training regimen, and injuries. Thirty-four triathletes completed this survey. We found a wide range of body types, training habits, and lifestyle characteristics. As in previous studies, we found a high rate of injuries in our surveyed triathletes. Injury rates were higher in athletes who had completed a longer race and those who reported higher training times per week. Additionally, many individuals have medical problems, use a variety of supplements, and follow specific dietary restrictions, which need to be considered in addition to training when assessing injury risk and recovery from injury.

Training Regimes and Recovery Monitoring Practices of Elite British Swimmers

Consistent prescriptions for event-specific training of swimmers are lacking, which points to likely differences in training practices and a potential gap between practice and scientific knowledge. This study aimed to analyze the distance-specific training load of elite swimmers, derive a consistent training sessions' description and reflect on the current recommendations for training and recovery. The individual training regimes of 18 elite British swimmers were documented by surveying four swim and two strength and conditioning (S&C) coaches. The annual and weekly training load and content were compared between swimmers competing in sprint, middle and long-distance events. Thematic analysis of the surveys was conducted to identify key codes and general dimensions and to define a unified classification of the swimming and S&C training sessions. Weekly training loads and content of the swim (ƞ² - effect size; p = 0.016, ƞ² = 0.423) and S&C (p = 0.028, ƞ² = 0.38) sessions significantly differed between the groups. Long-distance swimmers swam significantly longer distances (mean ± SD; 58.1 ± 10.2 km vs. 43.2 ± 5.3 km; p = 0.018) weekly but completed similar number of S&C sessions compared to sprinters. The annual swimming load distribution of middle-distance specialists did not differ from that of long-distance swimmers but consisted of more S&C sessions per week (4.7 ± 0.5 vs. 2.3 ± 2.3; p = 0.04). Sprinters and middle-distance swimmers swam similar distances per week and completed similar number of S&C sessions but with different proportional content. Whereas all coaches reported monitoring fatigue, only 51% indicated implementing individualized recovery protocols. We propose a consistent terminology for the description of training sessions in elite swimming to facilitate good practice exchanges. While the training prescription of elite British swimmers conforms to the scientific training principles, recommendations for recovery protocols to reduce the risk of injury and overtraining are warranted.

Creatine Supplementation Supports the Rehabilitation of Adolescent Fin Swimmers in Tendon Overuse Injury Cases

Our purpose was to investigate the effect of creatine (Cr) supplementation on regeneration periods in tendon overuse injury rehabilitation of adolescent fin swimmers. The participants of this study were injured adolescent competitive fin swimmers (n = 18). The subjects were randomly assigned the creatine (CR) or placebo (PL) groups with a double-blind research design. The subjects were given Cr supplementation or received the placebo as part of the conservative treatment of the tendinopathy. We measured the segmental lean mass (SLM;kg), the ankle plantar flexion peak torque (PFT;N·m), the pain intensity (NRS;values), prior to immobilization, after immobilization (R2) and after the 2nd (R4) and 4th (R6) weeks of the rehabilitation period of the injured limb. The creatine kinase (CK; U/L) enzyme levels were measured before immobilization, and then every 24 hours for four days. There was a significant decrease in SLM (CR by 5.6% vs. PL by 8.9%; p < 0.03) after two weeks of immobilization in both groups (p < 0.001). After four weeks rehabilitation the SLM significantly increased in both groups (CR by 5.5% vs. PL by 3.8%; p < 0.01). The percent changes in PFT after supplementation in R4 (p < 0.001) and R6 (p < 0.03) were significantly different between groups. There was a significant percent increase measured in the CR group (R4 by 10.4%; p < 0.001; R6 by 16.8%; p < 0.001), whereas significant, but lower growth found in the PL group also took place (R4 by 7.1%; p < 0.001; R6 by 14.7%; p < 0.001) after four weeks of rehabilitation. Significantly faster decrease were found in NRS of CR versus PL group during treatment (p < 0.02). We detected significantly lower CK levels increase at the CR group compared to the PL group. The results of this study indicate that Cr supplementation combined with therapeutic strategy effectively supports the rehabilitation of tendon overuse injury of adolescent fin swimmers.

[Periostal avulsion of m. vastus medialis in a triathlete during competition]

Periostal avulsion of m. vastus medialis is a very rare injury. To our knowledge, it has not previously been described, and there is no treatment algorithm. A 32-year-old male professional triathlete experienced this type of injury during a final sprint in a competition. He achieved a good functional result after treatment with an optimal rehabilitation regimen, and approximately four months after the injury he won a medal in a major international event.

High School Football and Late-Life Risk of Neurodegenerative Syndromes, 1956-1970

OBJECTIVE

To assess whether athletes who played American varsity high school football between 1956 and 1970 have an increased risk of neurodegenerative diseases later in life.

PATIENTS AND METHODS

We identified all male varsity football players between 1956 and 1970 in the public high schools of Rochester, Minnesota, and non-football-playing male varsity swimmers, wrestlers, and basketball players. Using the medical records linkage system of the Rochester Epidemiology Project, we ascertained the incidence of late-life neurodegenerative diseases: dementia, parkinsonism, and amyotrophic lateral sclerosis. We also recorded medical record-documented head trauma during high school years.

RESULTS

We identified 296 varsity football players and 190 athletes engaging in other sports. Football players had an increased risk of medically documented head trauma, especially if they played football for more than 1 year. Compared with nonfootball athletes, football players did not have an increased risk of neurodegenerative disease overall or of the individual conditions of dementia, parkinsonism, and amyotrophic lateral sclerosis.

CONCLUSION

In this community-based study, varsity high school football players from 1956 to 1970 did not have an increased risk of neurodegenerative diseases compared with athletes engaged in other varsity sports. This was from an era when there was a generally nihilistic view of concussion dangers, less protective equipment, and no prohibition of spearing (head-first tackling). However, the size and strength of players from previous eras may not be comparable with that of current high school athletes.

When Is It Too Early for Single Sport Specialization?

Over the past 15 years, there has been an increase in youth sports participation with a concomitant increase in early year-round training in a single sport. Many factors contribute to the desire of parents and coaches to encourage early single sport specialization, including the desire to give the young athlete an edge in competition, pursuit of scholarships, and potential professional status, and the ability to label a young athlete as elite at an early age. Despite these perceived advantages, some data suggest that early sport specialization does not lead to a competitive advantage over athletes who participate in multiple sports. Although the data are limited, there is some evidence that early sport specialization may put the young athlete at risk for overuse injuries. The focus of this review is to highlight the evidence regarding early sport specialization and risk for injury; discuss the risk factors for overuse injury in high-risk sports including ice hockey, swimming, gymnastics, and baseball; and discuss future potential research that would help define the risk of injury for young athletes who participate in early sport specialization.

The epidemiology of injury in canoeing, kayaking and rafting

The aquatic environment is a complex mix of waterways with varying uses and hazards. It is the intersection of the use of the water and the hazards which provides enjoyment to those who use them as well as risk to a person's health. Canoeing, kayaking and rafting have and continue to be popular recreation sports in aquatic environments. This chapter explores participation in, risks associated with and prevention strategies for keeping canoeists, kayakers and rafters safe and healthy. There is a dearth of good quality descriptive studies exploring these issues, particularly around the risks involved and the effectiveness of proposed prevention strategies. According to Outdoor Foundation, there are 23.9 million people in the USA who undertake paddling activities per annum, with canoeing (10.1 million) being the most popular activity followed by recreational kayaking (6.2 million). There were 141 deaths of canoeists (89) and kayakers (52) identified by the US Coast Guard in their recreational boating statistics data for 2009. The crude rate of death per 100,000 participants for canoeing ranges between 0.72 and 0.92 and for kayaking between 0.37 and 0.41 per annum. Although death is the most severe consequence of a misadventure while paddling, there are a range of other hazards faced such as hitting objects, waterborne diseases, hypothermia from unintended submersion, blisters, muscle strain, cuts and abrasions. There are a range of prevention strategies which have been proposed and provided in this chapter. However, there is very little evidence of their effectiveness. Further research is required in understanding the risk associated with paddling activities, the effectiveness of prevention strategies and how these strategies might be delivered.

Cervical spinal cord injury associated with near-drowning does not increase pneumonia risk or mortality

Body surfing accidents (BSA) can cause cervical spinal cord injuries (CSCIs) that are associated with near-drowning (ND). The submersion injury from a ND can result in aspiration and predispose to pulmonary complications. We predicted a worse outcome (particularly the development of pneumonia) in patients with CSCIs associated with ND. A retrospective review was performed of patients who were treated at Eastern Virginia Medical School for a CSCI resulting from a blunt mechanism. Data collected included basic demographic data, data regarding injury and in-hospital outcomes, and discharge data, including discharge disposition. Statistics were performed using χ(2) and Student t test. In 2003 to 2008, 141 patients were treated for CSCIs with inclusion criteria. Thirty patients (21%) had an associated ND (BSA) and 111 patients (79%) did not (BLT). The cohorts were similar in mean age (BSA, 45 years; BLT, 50 years; P = 0.16) and male gender distribution (BSA, 93%; BLT, 79%; P = 0.13). The cohorts were similar in injury severity using Injury Severity Score (BSA, 22; BLT, 24; P = 0.65). The cohorts were similar in rates of developing pneumonia (BSA, 3%; BLT, 12%; P = 0.31). The rate of infection was significantly higher in the cohort without an associated near-drowning (BSA, 10%; BLT, 32%; P = 0.033). The mean intensive care unit stay (BSA, 3.5 days; BLT, 11.3 days; P = 0.057) and the rate of mortality were similar (BSA, 10%; BLT, 10% P = 0.99). Those patients with an associated ND had a shorter hospital stay (BSA, 5.7 days; BLT, 22.2 days; P = 0.007) and a better chance of being discharged home (BSA, 57%; BLT, 27%; P = 0.004). CSCIs after a BSA do better than their counterparts without an associated ND. CSCIs associated with ND appear to be isolated injuries with minimal pulmonary involvement despite submersion injuries.

Imaging of triathlon injuries

Injuries in triathletes are common and are mostly overuse injuries. Rotator cuff tendinitis is the most common complaint from swimming, but the incidence of tendinopathy and rotator cuff tears on magnetic resonance imaging is comparable in triathletes without and with shoulder pain. Cycling injuries are mainly to the knee, including patellar tendinosis, iliotibial band syndrome, and patellofemoral stress syndrome, and to the Achilles tendon and the cervical and lumbar spine. Running is associated with most injuries in triathletes, during both training and racing, causing the athlete to discontinue the triathlon. In addition to knee injuries from running, triathletes may also develop foot and ankle, lower leg, and hip injuries similar to single-sport distance runners. Some injuries in triathletes may be mainly symptomatic during one of the three sports but are exacerbated by one or both of the other disciplines.

A survey of Swiss swimming pool attendants' knowledge of first-aid treatment after lip and dental injuries

Although dental injuries are common occurrences at swimming pools, there are very few publications about them. The purpose of this study was to interview pool attendants at public swimming pools/bathing resorts in Switzerland on lip and dental injuries in 2007. The questions focussed on their knowledge of first aid, the frequency and accident site of lip and tooth trauma, as well as the storage medium for avulsed teeth. Questions were also asked about the presence of a "dental first-aid kit" and the poster on dental first aid. 606 public pools were contacted, and one pool attendant per pool was interviewed by telephone. 553 individuals participated; 53 declined to take part. The results show that in 2007, 40% of the interviewed pool attendants (n = 221) had witnessed at least one lip injury, and 36.9% (n = 204) at least one tooth trauma. At pools with slides, accidents were more frequent (p<0.001), and the waterslide was the most common accident site. The pool attendants provided satisfactory answers on their actions after lip and dental injuries. However, 68.7% could not adequately answer the questions on storage of avulsed teeth. Only 74 pool attendants had a dental first-aid kit. Of these, only 68 used the kits as the storage medium for avulsed teeth. 59 pool attendants were in possession of the poster on dental first aid. Overall, it was shown that pool attendants who had a dental first-aid kit and a dental first aid poster gave better answers on how to handle tooth trauma.

ACC claims for sports-related dental trauma from 1999 to 2008: a retrospective analysis

OBJECTIVE

To describe trends in sports-related dental injuries reported to ACC in the past 10 years.

DESIGN

Retrospective case series.

METHODS

De-identified data on orofacial injuries were obtained from ACC for the financial years 1999-2008, and new claims were identified for each year (with recurring claims omitted from the analysis). Patterns in new-claim data were identified by age, sex, region and the sport involved. Trends in claims for the sport categories were also identified

RESULTS

The annual number of claims ranged from 24,998 to 31,257; overall, 38.7% of claims were made by females and 61.3% by males, and these proportions remained largely unchanged during the observation period. For sports-related claims, those aged 11-20 years had the highest percentage of claims (with between 41.7% and 44.4%, depending on year) while those older than 60 had the smallest percentage of claims, with 0.5% to 1.1%. Sport was involved in 20.6% to 26.2% of new claims. The highest percentage of injuries was attributable to rugby (between 22.2% and 33.1%, depending on the year). Water sports contributed to between 14.2% and 20.8% of claims. Cycling increased from 1.5% in 1999 to 15.3% in 2006, and then decreased to 10.6% in 2008. Hockey, basketball, soccer, cricket and netball had 4.4%, 4.8%, 6.9%, 4.7% and 3.9% respectively.

CONCLUSIONS

Although its share has decreased in recent years, rugby remained the greatest contributor to sport-related orofacial injuries, with water sports consistently second (cycling had the largest change, with a rapid increase in the past 3 years). There is a need to re-examine mouthguard (and other injury prevention) policies for particular sports.

[Surf and Seymour's fractures]

The authors present four cases of Seymour-like juxtaepiphyseal fractures related to surf accidents. All four patients were novices at the sport, had the same fractures in identical circumstances. In all cases, reduction was achieved using an 'in-and-out' 1.2 K-wire serving as a 'joystick' which was then also used for fixation. The nail was fixed at the end.

A purpuric rash

Kelly is 28 years of age and a recreational sea swimmer and surfer. He presented with a rash on both arms of 6 months duration. Kelly said a similar eruption occurred 12 months previously and resolved in a few weeks with 1% hydrocortisone cream. He has no significant past history, is not on any medication, and there is no recent history of trauma or contact with insects or animals. Physical examination revealed multiple, flat, nonblanching dark red lesions on the medial aspect of both arms (Figure 1, 2). The rest of the physical examination was unremarkable. Full blood examination revealed normal levels of haemoglobin, white cells and platelets, and coagulation studies are normal.

Two case reports of complicated permanent crown fractures treated with partial pulpotomies

The partial pulpotomy can offer a superb outcome for the treatment of traumatic complicated crown fractures. The procedure is often used for dental trauma in children when the major aim of treatment is to preserve tooth vitality while providing a favorable environment for continued root development. The purpose of this paper was to review scientific evidence supporting partial pulpotomy and its high success rate and illustrate the clinical technique by presenting 2 challenging cases of complicated crown fractures with long-term follow-up.

Retrospective case evaluation of gender differences in sports injuries in a Japanese sports medicine clinic

BACKGROUND

Although both gender- and sports-specific injuries exist among athletes, gender differences in the types of injuries caused by sports activities, except for anterior cruciate ligament (ACL) injury and anterior knee pain, are not well established.

OBJECTIVE

An observational study with a retrospective case-series design was conducted to investigate gender-specific differences in the types of injuries sustained while engaging in sports activities common to both males and females.

METHODS

We analyzed injuries sustained during sports activities including basketball, volleyball, tennis, skiing, track and field, and swimming, using data on age, sex, sports activities, activity levels, and sports injuries that had been computerized at our sports medicine (orthopedics) clinic. Inclusion criteria were sports activities that had a record of >100 injuries in total and athletes aged <50 years who were engaging in only 1 sports activity. We determined the absolute number of patients in each category and their percentage (proportion) of our cohort. The proportions of common injuries caused by sports activities were investigated, and gender-specific differences in the types of common injuries caused by sports activities were clarified. The Fisher exact test was used to determine the significance (P < 0.01) of the gender-specific differences in the types of sports injuries.

RESULTS

According to our database, during the 14-year period between October 1992 and December 2006, a total of 2,989 athletes (1,624 males and 1,365 females) aged <50 years who engaged in 1 of the 6 sports activities described consulted our sports medicine clinic. The most common sports injuries were ACL injury (14.3%) and knee pain (13.7%), followed by ankle sprain (9.4%), lumbar disc disease (7.0%), meniscus injury (5.1%), stress fracture (2.9%), low back pain (2.5%), patellar tendinitis (2.1%), injury of the medial collateral ligament of the knee (2.0%), lumbar spondylolysis (1.7%), and muscle strain (1.5%). Among these 11 types of sports injuries, a significantly higher proportion of females who engaged in basketball (24.4% vs 10.5%), volleyball (20.5% vs 4.5%), or skiing (41.4% vs 26.5%) presented with an ACL injury, compared with their male counterparts (all, P < 0.001). There was also a significantly higher proportion of females than of males among the track and field athletes who presented with stress fractures (18.7% vs 3.9%; P < 0.001).

CONCLUSION

The findings of this retrospective study suggest that there are gender-specific differences in the types of injuries sustained during sports activities.

[Poisoning with weever fish venom: a case report]

Poland's access to the EU causes that there is the risk of poisoning from sources outside Poland. This is confirmed by the case reported below. The Weeverfish Trachinus draco lives in the coastal waters of West Africa and Europe (including those of the Mediterranean Sea) and belongs to the most poisonous fish species. The venom of Trachinus draco contains proteins that cause cellular membrane depolarisation, and haemolysis. A 35-yr. man was admitted to the Toxicological Department of the Nofer Institute of Occupational Medicine for symptoms, such as: a strong pain, swelling and reddening of the left leg, that had appeared after contact with an unidentified fish when he had been enjoying a bath in the Mediterranean Sea. In the additional examinations, slight abnormalities were detected only in the results of blood agglutination test. The patient was discharged from the hospital 7 days later in good condition.

Shoulder pain in water polo: A systematic review of the literature

The main aim of this systematic review is to synthesize and critically evaluate literature on the incidence and clinical presentation of shoulder pain in water polo. A secondary aim is to examine the contributing factors to shoulder pain in water polo. Medline, Cinahl, Embase, Ausport, Ovid, Sports Discus, Pubmed and Google Scholar data bases were electronically searched. Data were extracted regarding research design, injuries, pain, incidence, interventions and therapy outcomes. Of an initial yield of 23 papers, 11 fulfilled the inclusion criteria and were categorized into studies on incidence, shoulder pain, shoulder mobility, strength and throwing injuries. Methodological limitations included sampling and measurement biases, inadequate internal validity of measurement tools, poor specification of testing protocols and limitations in statistical analysis. The review found a high incidence of shoulder pain in water polo. Although there was limited evidence regarding causation, the repeated action of throwing was identified as a contributing factor to shoulder pain. Future studies need to explore the relative contributions of hyper-mobility and muscle strength imbalance to shoulder pain in water polo.

Triathlon related musculoskeletal injuries: The status of injury prevention knowledge

Triathlon is a popular participation sport that combines swimming, cycling and running into a single event. A number of studies have investigated the incidence of injury, profile of injuries sustained and factors contributing to triathlon injury. This paper summarises the published literature in the context of the evidence base for the prevention of triathlon related injuries. Relevant articles on triathlon injuries were sourced from peer-reviewed English language journals and assessed using the Translating Research into Injury Prevention Practice (TRIPP) framework. This review highlights the significant knowledge gap that exists in the published literature describing the incidence of injury, the profile of injuries sustained and evidence for the prevention of injury in triathlon. Despite the number of studies undertaken to address TRIPP Stages 1 and 2 (injury surveillance, aetiology and mechanism of injury), most triathlon studies have been limited by retrospective designs with substantial, and unvalidated, recall periods, inconsistency in the definitions used for a reportable injury and exposure to injury, or a failure to capture exposure data at all. Overall, the paucity of quality, prospective studies investigating the incidence of injury in triathlon and factors contributing to their occurrence has led to an inability to adequately inform the development of injury prevention strategies (TRIPP Stages 3-6) for this sport, a situation that must be rectified if gains are to be made in reducing the burden of triathlon related injury.

Shoulder pain in elite swimmers: primarily due to swim-volume-induced supraspinatus tendinopathy

BACKGROUND/HYPOTHESIS

Shoulder pain in elite swimmers is common, and its pathogenesis is uncertain. HYPOTHESIS/STUDY DESIGN: The authors used a cross-sectional study design to test Jobe's hypothesis that repetitive forceful swimming leads to shoulder laxity, which in turn leads to impingement pain.

METHODS

Eighty young elite swimmers (13-25 years of age) completed questionnaires on their swimming training, pain and shoulder function. They were given a standardised clinical shoulder examination, and tested for glenohumeral joint laxity using a non-invasive electronic laxometer. 52/80 swimmers also attended for shoulder MRI.

RESULTS

73/80 (91%) swimmers reported shoulder pain. Most (84%) had a positive impingement sign, and 69% of those examined with MRI had supraspinatus tendinopathy. The impingement sign and MRI-determined supraspinatus tendinopathy correlated strongly (r(s)=0.49, p<0.00001). Increased tendon thickness correlated with supraspinatus tendinopathy (r(s)=0.37, p<0.01). Laxity correlated weakly with impingement pain (r(s)=0.23, p<0.05) and was not associated with supraspinatus tendinopathy (r(s)=0.14, p=0.32). The number of hours swum/week (r(s)=0.39, p<0.005) and weekly mileage (r(s)=0.34, p=0.01) both correlated significantly with supraspinatus tendinopathy. Swimming stroke preference did not.

CONCLUSIONS

These data indicate: (1) supraspinatus tendinopathy is the major cause of shoulder pain in elite swimmers; (2) this tendinopathy is induced by large amounts of swimming training; and (3) shoulder laxity per se has only a minimal association with shoulder impingement in elite swimmers. These findings are consistent with animal and tissue culture findings which support an alternate hypothesis: the intensity and duration of load to tendon fibres and cells cause tendinopathy, impingement and shoulder pain.

Risk factors and prevention for spinal cord injury from diving in swimming pools and natural sites in Quebec, Canada: a 44-year study

BACKGROUND

Diving is the most frequent cause of spinal cord injury (SCI) from recreation and sport in Canada. This study was done to identify risk factors for SCI from diving in the province of Quebec.

METHODS

An interview survey was done for a target population of 203 subjects with a SCI from diving treated in the two specialized rehabilitation centers in Quebec during 1961-2004. Telephone interviews of consenting individuals were used to collect pertinent personal, equipment, and environmental factors for each incident.

RESULTS

Response was 44% (89/203); 92% were male and 85% <35 years old. Only 37% were aware prior to injury of the risk of SCI from diving, and only 33% had received water safety training. Swimming pools were the site of 51% (n=45) and natural bodies of water for 49% (n=44). 87% (n=39) of pools were single-unit home pools and 57% (n=26) above-ground. Depth indicators were absent for 100% of above-ground and 74% of in-ground pools. For SCI in in-ground pools, 63% resulted from striking the up-slope between deep and shallow ends. For dives at natural sites, a dock or wharf was the most frequent location, 36% (n=16). In 52% of pools and 79% of natural sites, depth was <1.4m (4.6ft). Signs prohibiting diving were absent in 96% of above-ground and 89% of in-ground pools. Alcohol was reported in 47% of SCIs.

INTERPRETATION

The target for prevention of diving SCI is male youths and young adults. Above-ground pools are too shallow and small for diving. Deep ends of many in-ground pools are excessively shallow and short since many SCIs resulted from striking the up-slope. Prevention of SCI from diving needs to focus on education of potential victims, pool vendors and manufacturers, and regulations for safety norms in private pools. Water safety should highlight diving as a high-risk activity, and emphasize that most home pools and natural sites are unsafe. Safer evidence-based pool designs and more effective warnings need to be implemented.

Reliability of MRI assessment of supraspinatus tendinopathy

OBJECTIVE

To determine the interobserver and intraobserver reliability of the interpretation of MRIs for supraspinatus tendinosis.

METHODS

In the interobserver trial, the MRIs of 52 athletes' shoulders were observed by 3 observers on one occasion within a 2-month period. All 52 images were read by the most experienced musculoskeletal radiologist on 3 different occasions on separate days without access to the previous readings for the intraobserver trial. Supraspinatus tendinosis was graded using a modified 4-point scale from grades 0 to grade 3.

RESULTS

The grading of MRI-determined supraspinatus tendinosis was reliable, having an intraclass correlation (ICC) of 0.85 when assessed by the single well-trained observer. Interobserver reliability was only fair to good (ICC = 0.55).

CONCLUSIONS

Supraspinatus tendinosis can be accurately identified on MRI with little variation by a single well-trained observer. Interobserver reliability was only fair to good. Our data indicated that the reliability of the assessment was much greater in more experienced radiologists than in those with less experience.

Prevention of catastrophic injuries in sports

Catastrophic sports injuries are rare but severely debilitating events. Catastrophic injuries are divided into two etiologic categories: direct and indirect. Direct injuries are those resulting directly from participation in a sport, such as a collision in football. Football is associated with the greatest number of direct catastrophic injuries for all major team sports in the United States, whereas ice hockey, pole vaulting, gymnastics, and football have the highest incidence of direct catastrophic injuries per 100,000 male participants. Cheerleading is associated with the highest number of direct catastrophic injuries for all sports in which females participate. Indirect or nontraumatic injuries are caused by systemic failure resulting from exertion while participating in a sport and include cardiovascular conditions, heat illness, exertional hyponatremia, and dehydration. Indirect deaths in athletes are predominantly caused by cardiovascular conditions such as hypertrophic cardiomyopathy and coronary artery disease.

Vibrio alginolyticus infections in the Netherlands after swimming in the North Sea

During the summer of 2006, wound infections in bathers caused by Vibrio species were reported from several European countries. In Germany, three people were reported to have developed Vibrio vulnificus infections

Back and neck pain in triathletes

OBJECT

As the sport of triathlon has continued to grow, increasing numbers of triathletes have presented in the neurosurgery clinics with various spinal disorders. This epidemiological study was undertaken to establish the lifetime incidence of neck and back pain, to gauge the prevalence of discogenic pain, and to identify risk factors among triathletes in the Boulder, Colorado, area.

METHODS

A live online questionnaire was developed that was used to collect information about physical characteristics, training habits, athletic status, number of races completed, and back pain among triathletes. The incidence of cervical and/or lumbar discogenic back pain was defined according to the duration of symptoms for the most recent pain episode. The lifetime incidence of low-back pain was 67.8%, with 23.7% of cases possibly being discogenic in origin. The number of triathlons in which the respondents had participated and the presence of previous sports-related injuries were predictive of low-back pain (p = 0.02 and p < 0.00001, respectively). The lifetime incidence of neck pain was 48.3%, with 21.4% of cases being consistent with intervertebral disc involvement. The number of previous sports-related injuries was predictive of neck pain (p < 0.00001), and a strong tendency toward neck pain was observed for athletes with more total years of participation in sports (p = 0.06).

CONCLUSIONS

The two main risk factors for long-term spinal problems include sports-related injuries and overuse. The study results definitely support the influence of both mechanisms for low-back pain. Neck pain was associated with an injury event, and a strong (although not statistically significant) tendency toward neck pain was observed in respondents with overuse injuries.

Epilepsy-related Injuries

Only one prospective, controlled study has compared the risk of accidental injury in persons with epilepsy to controls without seizures. A mildly increased risk in the epilepsy group was found, predominantly due to injuries that result directly from a seizure. With regard to injury type, this study found significantly higher rates of only head and soft tissue injury; however, most injuries were minor. Several retrospective, population-based studies have suggested increased rates of more serious injury types. Submersion injury has a high mortality; the risk of submersion in children with epilepsy is 7.5-13.9 fold higher than in the general population. The risk of fracture is elevated approximately twofold, either resulting directly from seizure-induced injury or predisposed by drug-induced reduction in bone mineral density. Burns due to seizures account for between 1.6% and 3.7% of burn unit admissions. The risk of motor vehicle accidents in drivers with epilepsy also appears increased, albeit marginally. Several factors predispose to a higher risk of injury among those with epilepsy. Seizures resulting in falls increase the risk of concussion and other injuries. Higher seizure frequency, lack of a prolonged seizure-free interval, comorbid attention deficit disorder, or cognitive handicap may also increase the risk of injury. While some restrictions are necessary to protect the safety of the person with epilepsy, undue limitations may further limit achievement of independence. Given the high morbidity and mortality of submersion injury, those with active epilepsy should bathe or swim only with supervision; however, showering is a reasonable option. Appropriate vitamin D and calcium supplementation and periodic measurement of bone mineral density in those at risk for osteopenia are recommended.

Water incident related hospital activity across England between 1997/8 and 2003/4: a retrospective descriptive study

Background

No one has ever reported or investigated the number of people who have been admitted to hospital for a water related incident. The purpose of this paper is to examine, the hospital activity resulting from such incidents including to length of stay, gender, age and cause.

Methods

The data was extracted from the Hospital Episode Statistics (HES) for episodes with a mention of ICD 10 (V90–94, W15–16, W65–74, X38, X92, Y21) for the years 1997/8 to 2003/4. Population based rates and relative risk were calculated using the most recent Census data for England (2001).

Results

The 6,793 episodes resulted in a total of 32,520 bed days with an average of length of stay of 5.0 days. Males made up 73.7% (n = 5,006) of episodes and females 26.1% (n = 1,787). Annual trends peaked in 1999–2000 at a rate of 2.4 per 100,000 and have fluctuated on alternate years there after. In terms of relative risk males are at a 2.3 to 3.0 increased annual risk of being admitted compared to females, relating to a water event. The highest annual rates were observed within the 0 – 14 age group, ranging from 3.1 to 4.2 episodes per 100,000.

Conclusion

Based on these findings, for every one drowning that occurs per year there are three hospital episodes. Each of the age groups identified within the study reported an increase in hospital episodes between 2002 – 2003 and 2003 – 2004, when considering the fatality information available it would appear that although fatalities are decreasing in the similar time period, hospital episodes are increasing.

For the 0–14 age group, the cause of the injury had changed over the years, moving away from bath tub and swimming pool, to watercraft incidents (V91 – 93). For the 15 – 59 age group there had been a decline in the frequency of watercraft and water transport episodes, however, an increase in diving and jumping injury and incidents. In the over 60 age group water transport episodes remained the most frequent, with swimming pool related episodes declining and other specified drowning and submersion increasing.

More work needs to be undertaken in regard to who is admitted to hospital, when where, and how to fill gaps in knowledge and highlight information that is critical to prevention strategies.

Triathlon

From its roots in San Diego to its Olympic debut in Sydney in 2000, triathlon has emerged as a popular sport with a wide variety of participants. Because of the nature of the sport, excessive training resulting in overuse injuries is common. Triathlon injuries can also be unique from the individual sports involved in that they are attributed to a cumulative effect of multi-sport training. Because many triathletes have not grown up participating in the individual sports, biomechanics in each of the disciplines must also be considered as a source of injury. Nutrition and environmental factors and the role that they play in the endurance athlete should also not be overlooked. The sport of triathlon is rapidly growing, and the ability to recognize the unique aspects of these injuries can help the multisport athlete to train properly and be healthier and more successful.

Acute os styloideum injury in an elite athlete

The os styloideum, an accessory carpal bone, may suffer injury during traumatic wrist flexion. The case described corresponds to an acute os styloideum injury in an elite athlete; a diagnosis made using high-resolution computed tomography and magnetic resonance imaging permitted not only the identification of the anomaly and associated abnormalities but also ruled out more significant injury to the extensor carpi radialis brevis.

Adolescent butterfly swimmer with bilateral subluxing sternoclavicular joints

Sternoclavicular joint subluxation/dislocation injuries in the athlete are uncommon. They can be organised by degree (subluxation, dislocation), timing (acute, chronic, recurrent, congenital), direction (anterior, posterior), and cause (traumatic, atraumatic). The unusual case reported is an adolescent butterfly swimmer with recurrent bilateral sternoclavicular subluxation associated with pain and discomfort. The condition was treated and resolved with conservative management. The diagnosis, investigations, and treatment options are discussed.

Cervical Spine Injuries in Ocean Bathers: Wave-related Accidents

OBJECTIVE:

Spine injuries can occur secondary to several aquatic recreational activities. A series of cases of patients who experienced cervical spine injuries secondary to ocean waves accidents is presented. A description and analysis of this kind of injury is performed.

METHODS:

Sixteen patients were treated from January 1999 to May 2005. The mechanism of accident, mechanism of injury, neurological status, radiographic findings, associated injuries, and treatment were analyzed.

RESULTS:

These injuries are common among older patients. More severe and devastating injuries occurred in young patients. The most common mechanism of injury is hyperextension associated to spondylosis, which usually caused central cord syndrome.

CONCLUSION:

Wave-related accidents in ocean bathers are secondary to lack of experience of swimming in the ocean and underestimating the danger of waves. Although different types of mechanism of injury occurred, hyperextension was the most common. High-risk patients are older people with preexisting cervical spondylosis.

Risk Factors for Water Sports???Related Cervical Spine Injuries

BACKGROUND

To examine risk factors associated with water sports-related cervical spine injuries (WSCSI).

METHODS

A retrospective analysis of all patients admitted for WSCSI from 1993 to 1997 was performed. The severity of cervical spine injury was assessed by review of medical records and imaging studies. Mechanisms of injury and activities at the time of injury were noted to determine risk factors for cervical spine injuries caused by wave forced impacts (WFI) from activities such as bodysurfing and body boarding. These risks were compared with injuries incurred by shallow water dives (SWD).

RESULTS

One hundred patients were analyzed (mean age, 36 years old); 89% were male, 62% were nonresidents of Hawaii, and 75% had a large build. Patients without radiographic evidence of fractures, subluxations, and/or dislocations (n = 26) were significantly older (48 versus 32 years old, p < 0.0001) with a higher rate of pre-existing cervical spine abnormalities (65% versus 15%, p < 0.0001) compared with the remainder of patients (n = 74). Seventy-seven percent of WFI involved nonresidents. The mean age of WFI patients was significantly older than patients involved in SWD (42 versus 25 years). Ninety-six percent of wave-related accidents occurred at moderately to severely rated shorebreak beaches.

CONCLUSIONS

Wave forced impacts of the head with the ocean bottom typically occurred at moderate to severe shorebreaks, and involved inexperienced, large-build males in their 40s. Spinal stenosis and degenerative spondylosis may increase the risk of cervical spine injury associated with WFI due to the increased risk of neck hyperextension and hyperflexion impacts inherent to this activity.

Chlorine-related inhalation injury from a swimming pool disinfectant in a 9-year-old girl

Chlorine is a potential respiratory hazard in both occupational and household settings. The clinical sequelae of inhalation are variable in severity and timing, and subacute presentation is a concern. We report the case of a 9-year-old girl who developed dyspnea, hypoxemia, and pneumonitis approximately 12 hours after exposure to chlorine released from aerosolized swimming pool purification tablets. Her course was characterized by improvement with supplemental oxygen and bronchodilator therapy. Follow-up pulmonary testing at 4 months after the episode revealed the presence of mild obstructive reactivity of the airways, but she was able to perform normal activities without requiring medications. We discuss the pathophysiology, symptoms, therapy, and long-term follow-up of chlorine inhalation injuries.

Training patterns and sports injuries in triathletes

Sports-related injuries are a significant health problem within Australia, and constitute a national health priority. There is limited Australian research data available on factors that contribute to triathlon injuries, and in particular on how training patterns relate to injury risk. This study examined the association between training patterns and injury in mostly non-elite triathletes. A cross-sectional survey of 258 triathletes completed a questionnaire that focused on injuries they had sustained during the previous three triathlon seasons. Statistical associations were found between hours of training and sustaining an injury. These associations were U shaped, with those triathletes training at low levels and at high levels more likely to sustain an injury. The results suggest that, for non-elite triathletes, the likelihood of sustaining an injury is least when training for a total of 8 to 10 hrs per week, specifically cycling for five to six hrs and running for three to four hrs weekly. Time spent on swimming training does not appear to affect injury risk. This research is seen as a contribution towards assisting triathletes in the planning of training programs aimed at reducing the risk of injury.