Sport concussion assessment tool: baseline values for varsity collision sport athletes

OBJECTIVE

To determine baseline symptom and neurocognitive norms for non-concussed and previously concussed varsity athletes using the sport concussion assessment tool (SCAT).

STUDY DESIGN

Descriptive cohort study.

SETTING

University of Calgary.

SUBJECTS

260 male and female university football, ice hockey and wrestling athletes over three seasons (2005-7).

METHODS

A baseline SCAT was completed during preseason medical evaluation. Subjects were grouped as follows: all participants, men, women, never concussed (NC) and previously concussed (PC).

MAIN RESULTS

The mean age of participants was 20.5 years (range 17-32). In total, 41.2% of all athletes had a total post-concussion symptom scale (PCSS) score of 0. The mean baseline PCSS scores were as follows: all participants 4.29; men 3.52; women 6.39; NC 3.75 and PC 5.25. The five most frequently reported symptoms for all athletes were fatigue/low energy (37% of subjects), drowsiness (23%), neck pain (20%), difficulty concentrating (18%) and difficulty remembering (18%). The median immediate recall score was 5/5 for all groups. Women scored a median of 5/5 on delayed recall, whereas all remaining groups scored a median of 4/5. Months in reverse order were successfully completed by 91.6% of subjects. All participants, women and PC scored a median of 6 on reverse digits, whereas men and NC scored a median of 5.

CONCLUSIONS

The mean SCAT baseline PCSS score was approximately 5, although just under half of the athletes scored 0. Female athletes scored better on tests of neurocognitive function. PC athletes scored better than NC athletes on all neurocognitive tests except delayed five-word recall.

Injuries during the 2006 Women's Rugby World Cup

BACKGROUND

Although there have been reports of injury rates in men's World Cup rugby, there has been no research into injury rates in women's international rugby.

OBJECTIVE

To determine the rate of injury at the 2006 Women's Rugby World Cup (WRWC).

METHODS

All participating teams in the 2006 WRWC were enrolled prospectively in this study. Healthcare workers for each team collected data on training and game exposure and information on injuries.

RESULTS

55 players (16%) sustained at least one injury (10.0/1000 player hours); 4 players (1%) sustained two injuries. 45 injuries occurred during games (37.5/1000 player hours) and 14 injuries occurred during practice (12.5/1000 player hours), a statistically significant difference (RR = 12.5, 95% CI 6.9 to 22.8). The injury rate was 39.3/1000 player hours for the forwards and 42.2/1000 player hours for the backs (RR = 1.3, 95% CI 0.7 to 2.3). The front row had the highest injury rate (62.5/1000 player hours). 63.6% of injuries occurred during the tackle. Most injuries occurred to the neck, knee and head/face. The majority of injuries were sprains, muscle injuries and contusions. There were five fractures during the event and four reported concussions.

CONCLUSION

Female players sustained a considerable rate of injury during the 2006 WRWC. Backs had a slightly higher rate of injury than forwards, but the players most often injured were in the front row. The neck/cervical spine and knee were the most commonly injured regions, followed by the head and face. This is the first study to examine injury rates in female rugby players at a World Cup and reports valuable data in this population.

Achilles tendon pain intensity and level of neovascularization in athletes as determined by color Doppler ultrasound

The cause of pain in Achilles tendinopathy is thought to be related to the presence of neovascularization in the tendon as seen on color Doppler ultrasound. Asymptomatic pathology has been observed in patellar tendons of elite athletes. The purpose of this study was to examine the prevalence of Achilles tendon pain and the characteristics of Achilles tendons in a young athletic population. Sixty-four varsity athletes underwent color Doppler ultrasound imaging to determine tendon thickness, presence of degeneration and neovascularization. The presence of swelling and tenderness was determined, and Achilles tendon pain was rated on three visual analogue scales (VAS) (pain during exercise, pain at rest, pain during daily activities) as well as on the VISA-A scale. Tendon symptoms were not related to the presence of neovascularization. There was a low prevalence of Achilles tendinopathy, tenderness, and neovascularization in this population. Neovascularization was seen in both a painful and a non-painful tendon.

Comparison of outcomes of untreated carpal tunnel syndrome and asymptomatic controls in meat packers

Our objectives were to determine the reporting of symptoms, the medical outcome and the work status of meat plant workers diagnosed with clinical carpal tunnel syndrome (CTS). Forty-seven cases of CTS were identified from a previously reported study, and were matched by age, gender and hand use. Cases and controls were followed up for 24 months. The Provincial Workers' Compensation Board and company health records were used to determine the reporting of symptoms, interventions and work status. Thirty-one study cases and all control cases were followed for the full 24 months (16 study cases were lost to follow-up). In total, 12 cases reported symptoms of CTS during the 24 months (eight study cases and four controls). Of the eight study cases, one required surgical release of the carpal tunnel. After a period of work modification, five of the eight study cases returned to regular duty and the remainder were placed on permanent job restrictions. Of the four controls, one subject had a surgical release and returned to regular work, two subjects' jobs were permanently modified, and the fourth returned to regular duty. Occupation-related CTS in meat packers appears to be transient and responsive to conservative measures, with a surgical rate comparable to other occupations.

Phenylboronic acid-salicylhydroxamic acid bioconjugates. 2. Polyvalent immobilization of protein ligands for affinity chromatography

Phenylboronic acid bioconjugates prepared from alkaline phosphatase by reaction with either 2,5-dioxopyrrolidinyl 3-[N-[3-(1,3,2-dioxaboran-2-yl)phenyl]carbamoyl]propanoate (PBA-XX-NHS) or 2,5-dioxopyrrolidinyl 6-[[3,5-di-(1,3,2-dioxaboran-2-yl)phenyl]carbonylamino]hexanoate (PDBA-X-NHS) were compared with respect to the efficiency with which they were immobilized on salicylhydroxamic acid-modified Sepharose (SHA-X-Sepharose) by boronic acid complex formation. When immobilized on moderate capacity SHA-X-Sepharose (5.4 micromol of SHA/mL of gel), PDBA-alkaline phosphatase conjugates were shown to be stable with respect to both the alkaline (pH 11.0) and acidic (pH 2.5) buffers utilized to recover anti-alkaline phosphatase during affinity chromatography. Boronic acid complex formation was compared to covalent immobilization of alkaline phosphatase on Affi-Gel 10 and Affi-Gel 15. PDBA-AP.SHA-X-Sepharose was shown to afford superior performance to both Affi-Gel 10 and Affi-Gel 15 with respect to immobilization of alkaline phosphatase, retention of anti-alkaline phosphatase and recovery of anti-alkaline phosphatase under alkaline conditions. High capacity SHA-X-Sepharose (> or = 7 micromol of SHA/mL of gel) was shown to afford superior performance to moderate capacity SHA-X-Sepharose (4.5 micromol of SHA/mL of gel) with respect to stability at pH 11.0 and pH 2.5 when a PDBA-alphaHuman IgG conjugate with a low incorporation ratio of only 1.5:1 was immobilized on SHA-X-Sepharose and subsequently utilized for affinity chromatography of Human IgG. The results are interpreted in terms of either a bivalent or trivalent interaction involving boronic acid complex formation.

Phenylboronic acid-salicylhydroxamic acid bioconjugates. 1. A novel boronic acid complex for protein immobilization

A chemical affinity system exhibiting antibody-like properties is described. The system exploits bioconjugates with appended phenylboronic acid (PBA) moieties and a support-bound phenylboronic acid complexing reagent derived from salicylhydroxamic acid (SHA) for protein immobilization on a chromatographic support. The structure of the PBA.SHA complex was characterized by 11B NMR and mass spectrometry and compared with complexes derived from model compounds. Protein modification reagents were synthesized from 3-aminophenylboronic acid and utilized to prepare bioconjugates from alkaline phosphatase (AP) and horseradish peroxidase (HRP). AP obtained from one source afforded PBA bioconjugates exhibiting significant loss of enzymatic activity, whereas AP obtained from a second source afforded PBA bioconjugates exhibiting only a modest loss of enzymatic activity. Conversely, HRP afforded PBA bioconjugates exhibiting no loss of enzymatic activity. SHA-modified Sepharose was prepared by reaction of methyl 4-[(6-aminohexanoylamino)methyl]salicylate with CNBr-activated Sepharose 4B, followed by treatment with aqueous alkaline hydroxylamine. PBA-AP and PBA-HRP conjugates were efficiently immobilized on SHA-Sepharose at pH 8.3. PBA-AP conjugates were retained after washing with acidic buffers at pH 6.7, 4.2, and 2.5, whereas PBA-HRP conjugates were retained after washing with buffer at pH 6.7, but were eluted to some extent at and below pH 4.2. The results are interpreted in terms of multivalent interactions involving boronic acid complex formation between the enzyme bioconjugates and immobilized complexing reagent.

Small molecule-based chemical affinity system for the purification of proteins

A new chemical affinity system is described for the purification of proteins. The Linx Affinity Purification System enables researchers to quickly and easily bind a protein ligand to a chromatographic matrix and use the resulting affinity resin to purify a second protein from crude mixtures. The entire process takes approximately 2 h.

Evaluation of outcomes in patients following surgical treatment of chronic exertional compartment syndrome in the leg

OBJECTIVE

To evaluate outcomes in patients who had a fasciotomy performed on their leg(s) for chronic exertional compartment syndrome (CECS).

DESIGN

A retrospective descriptive cohort study.

SETTING

Tertiary care sport medicine referral practice.

PATIENTS

A consecutive series of 62 patients surgically treated for CECS from January 1991 to December 1997.

MAIN OUTCOME MEASURES

A questionnaire was designed and developed to assess pain (using a 100 mm visual analogue scale), level of improvement, level of maximum activity, satisfaction level, and the occurrence of reoperations.

RESULTS

Fifty patients had anterior/lateral compartment involvement, 8 patients had deep posterior compartment involvement, and 4 patients had anterior/lateral/deep posterior compartment involvement. The demographics of the 39 respondents and 23 nonrespondents were similar. The mean percent pain relief of respondents was 68% (95% CI [confidence interval] = 54% to 82%). There was no relationship between percent pain relief and the documented immediate post exercise compartment pressures. A clinically significant improvement was reported by 26 of 32 (81%) anterior/lateral compartment patients and 3 of 6 (50%) patients with deep posterior compartment involvement. Patient level of activity after fasciotomy was classified as equal to or higher than before the operation with a lesser degree of pain by 28 of 36 (78%) patients, while 8 of 36 (22%) patients reported lower activity levels than before the operation. Of the patients reporting lower activity, seven were due to exercise related pain in the post operative leg(s) and one was due to lifestyle changes. Thirty of 38 patients (79%) were satisfied with the outcome of the operation. Four of 62 patients (6%) failed the initial surgical procedure and required revision surgery for exercise-induced pain. In addition, one of these individuals also had a sympathectomy and another had a neurolysis performed at the time of revision surgery. Three of the 62 (5%) patients had subsequent operations for exercise-induced pain on different compartments than the initial surgical procedure. One individual had an unsuccessful operative repair of a posttraumatic neuroma. Postoperative complications were reported by 5 of 39 (13%) patients in the additional comments section of the questionnaire.

CONCLUSIONS

The majority of patients surgically treated for CECS experience a high level of pain relief and are satisfied with the results of their operation. The level of pain relief experienced by patients is not related to the magnitude of the immediate post exercise compartment pressures. Despite the possibility that some patients have less favorable outcomes, experience complications, or need subsequent operations, fasciotomy is recommended for patients with CECS as there is no other treatment for this condition.

Prevalence and incidence of carpal tunnel syndrome in a meat packing plant

OBJECTIVES

To determine prevalence and incidence of carpal tunnel syndrome (CTS) in a modern meat packing plant. The secondary objective was to explore the relation between ethnicity and CTS.

METHODS

Six hundred and sixty five workers were interviewed and examined to find the prevalence of CTS. Subsequently, 421 workers without CTS were followed up and examined at a median interval of 253 days; of those, 333 remained without CTS and were again examined at a median interval of 148 days.

RESULTS

The prevalence and incidence of CTS was 21% and 11/100 person-years, respectively. The incidence for Asian mixed, white, and other ethnicities was 12.0, 12.2, and 7.2 cases/100 person-years, respectively. The observed incidence for men and women was 9.7 and 18.4 cases/100 person-years, respectively. This difference was not quite significant (p = 0.068) with an estimated relative risk (women v men) of 1.9 (95% confidence interval (95% CI) 0.9 to 3.8). The interaction between sex and use of tools was significant (p = 0.04), however, although the relative risk for CTS in women who used tools was 4.2 the numbers were small and not significant. The relative risk for men who used tools was 0.64 and not significant. The percentage of incident cases with comorbid disease was only 6.3% (3/47).

CONCLUSIONS

The prevalence and incidence of CTS in this workforce were higher than in the general population. However, the prevalence of CTS in this modern, mechanised plant was not significantly different from that reported in older plants. No relation was found between ethnicity, age, body mass index, and CTS for either prevalence or incidence. Comorbid disease among the cases of CTS is significantly less than that found in other industry.

Treatment of iliopsoas syndrome with a hip rotation strengthening program: a retrospective case series

STUDY DESIGN

Retrospective case series.

OBJECTIVE

To review the effectiveness of a home-based rehabilitation program in the treatment of iliopsoas syndrome.

BACKGROUND

Conservative management strategies for iliopsoas bursitis (syndrome) have not been well documented in the literature. This study relates the outcome of an exercise program (hip rotation exercises and stretching) to address clinical deficiencies observed in iliopsoas syndrome.

METHODS AND MEASURES

A retrospective chart review and phone follow-up were done to determine pain and activity limitation for 9 patients (mean age, 35.6 +/- 12.7 years; 8 women, 1 man) before and after application of the rehabilitation program. As a group, symptoms of iliopsoas syndrome were present for a mean of 12.6 (+/- 18.4) months prior to diagnosis and rehabilitation. Activity restrictions related to presenting symptoms were measured using a 4-point ordinal scale (from a score of 1 [pain and unable to do sport] to a score of 4 [pain-free, full activity]).

RESULTS

Pain and function improvement occurred in 7 of 9 (77%) patients. Five patients improved by at least 2 pain/activity levels at the time of follow-up (13.2 +/- 9.8 months following diagnosis); all but 2 patients were able to return to full activity.

CONCLUSIONS

This study gives preliminary evidence that a specific exercise regimen incorporating hip rotation might improve function and reduce pain for patients with iliopsoas syndrome.

Can sonography predict the outcome in patients with achillodynia?

PURPOSE

We evaluated whether the grade assigned to the Achilles tendon's appearance on sonograms can be used to predict the outcome of achillodynia.

METHODS

A retrospective evaluation was done of a case series of patients with Achilles tendon pain seen at a sports medicine clinic. The study consisted of chart reviews, telephone follow-up interviews, and grading of ultrasound images of the tendon obtained during the initial visit. The grading scheme was as follows: grade 1, normal tendon; grade 2, enlarged tendon; and grade 3, tendon containing a hypoechoic area, regardless of size. The time needed to recover from symptoms was compared between grades using survival analysis.

RESULTS

The group consisted of 33 patients, with a mean age of 35.8 years and a mean follow-up time of 24.3 months. There was a statistically significant difference in the time to full recovery between grades (p = 0.02). Patients with grade 1 tendons had a prompter resolution of symptoms than did patients with grade 2 or 3 tendons.

CONCLUSIONS

This retrospective study of the outcome of achillodynia demonstrates the possible use of tendon sonography as a prognostic tool to supplement physical examination.

Prevalence and incidence of stenosing flexor tenosynovitis (trigger finger) in a meat-packing plant

The purpose of this study was to determine the prevalence and incidence of trigger finger (TF) in a meat-packing plant and explore the relationship between hand-tool use and the development of TF. A cross-sectional study was competed wherein 665 workers were interviewed and examined to determine the point prevalence. Subsequently, 454 TF-negative workers were followed up and examined twice at a median interval of 225 days. The point prevalence of TF was 14%. The person-year incidence rate was 12.4% and 2.6% for tool use and non-tool use workers, respectively. Forty-three cases of TF (75.2%) in the incidence arm of the study used a hand tool, for a relative risk of 4.7 (P < 0.002; 95% confidence interval, 1.5-23.9). Although a significant relationship was found between ethnicity and the presence of TF in the prevalence data, this was not confirmed in the incidence study. There is an increased prevalence of TF in this meat-packing plant and high worker turnover may underestimate the true prevalence rates. Hand-tool use increases the risk of developing TF.

Iliopsoas bursitis and tendinitis. A review

This review examines the diagnosis and management of iliopsoas bursitis and/or tendinitis. It is a relatively uncommon and unrecognised cause of anterior hip pain and anterior snapping hip. In view of its pathology, iliopsoas bursitis might be better referred to as iliopsoas syndrome. It can usually be diagnosed by history and physical examination, though real time ultrasound may be useful in confirming the diagnosis. Magnetic resonance and computerised tomography imaging have limited roles in its diagnosis, but may identify other pathology or surgical lesions. Nonoperative management has not been well established. Surgical management does not guarantee treatment success. There is a need for further research into both diagnostic and treatment options for those patients with iliopsoas bursitis/tendinitis.

Serial ultrasonographic imaging evaluation of the patellar tendon after harvesting its central one third for anterior cruciate ligament reconstruction

The purpose of this study was to assess ultrasonographic image changes in the patellar tendon after removal of its central one third for anterior cruciate ligament reconstruction. Fourteen patellar tendons in 14 patients were assessed preoperatively and at 2 weeks, 4 weeks, 2 months, 6 months, and 12 months postoperatively. With time, the entire donor tendon became enlarged, hypoechoic, and inhomogeneous compared with the presurgical state. Tendons enlarged maximally in anteroposterior thickness by 2 months and then began to diminish, remaining two times their original anteroposterior thickness by 12 months and never returning to their preoperative appearance. The margins of the defect became indistinct over time. In the donor patellar tendon, abnormal echogenicity was profound and persisted up to 1 year after surgery. Ultrasonographic imaging has the ability to evaluate the postoperative patellar tendon over time and to monitor the normal changes seen with healing.

Knee joint dynamics predict patellar tendinitis in elite volleyball players

We quantified the lower extremity dynamics developed during the volleyball spike and block jumps to find out if predictive relations exist between jump dynamics and patellar tendinitis. Lower extremity movement biomechanics were analyzed for 10 members of the 1994 Canadian Men's National Volleyball Team (all right-handed hitters). Based on physical examination, 3 of the 10 players had patellar tendon pain associated with patellar tendinitis at the time of testing. In masked biomechanical and logistic regression analyses, we discovered that the vertical ground-reaction force during the take-off phase of both spike and block jumps was a significant predictor of patellar tendinitis-correctly predicting the presence or absence of patellar tendinitis in 8 of 10 players. Deepest knee flexion angle (during landing from the spike jump) predicted 10 of 10 cases correctly for the left knee. The external tibial torsional moment (during the takeoff for the right knee with the spike jump and for the left knee with the block jump) was also a significant predictor of tendinitis. In these players, the likelihood of patellar tendon pain was significantly related to high forces and rates of loading in the knee extensor mechanism, combined with large external tibial torsional moments and deep knee flexion angles.

The effect of an ankle orthosis on ankle range of motion and performance

Ankle joint orthoses are used for rehabilitation and/or prevention of ankle sprains. The purpose of this study was to determine the effect of the Malleoloc ankle joint orthosis on active and passive range of motion reduction and on a jumping and a figure-eight running test. Twelve subjects with a history of inversion ankle sprain and documented increased anterior translation in a drawer test participated in the study. Active and passive range of motion for inversion was determined with and without the orthosis and pre- and post-exercise. Additionally, performance tests for figure-eight running and jumping were administered. The results showed that the tested orthosis 1) restricted the active range of motion and passive inversion substantially, 2) reduced the other movement degrees of freedom only minimally, 3) provided the same movement restriction before and after exercise, and 4) did not affect performance. The Malleoloc ankle joint orthoses can, therefore, restrict ankle joint motion without affecting performance negatively.

Patellar tendinitis: MR imaging features, with suggested pathogenesis and proposed classification

PURPOSE

To characterize the magnetic resonance (MR) imaging features of patellar tendinitis.

MATERIALS AND METHODS

Fifteen patients with a clinical diagnosis of patellar tendinitis underwent gadolinium-enhanced MR imaging of the knee.

RESULTS

Grades of patellar abnormality, based on findings in the enthesial region at MR imaging, correlated with signs of increasing fibrovascular repair: grade 1 (n = 4), enhancing area adjacent to patellar apex, with marginal zone of intermediate signal intensity, and a patellar apical chondral-bone avulsion; grade 2 (n = 5), same signs as grade 1 damage but without avulsion; grade 3 (n = 6), homogeneous, nonenhancing area of intermediate signal intensity adjacent to the patellar apex seen on all images. Changes were most obvious posteriorly and involved the central and medial thirds of the tendon. Chronic injury to the medial retinaculum was a common associated finding.

CONCLUSION

Patellar tendinitis demonstrates a consistent spectrum of changes at MR imaging that can aid understanding of the origin and treatment of damage.

Exercise loading of tendons and the development of overuse injuries. A review of current literature

This review examines recent studies on the effects of exercise on tendons in animal models. Although tendon adaptation to exercise has been described using histology, morphometry, ultrasonography and molecular biology, precise measurements of excess tendon loading during exercise protocols have not been reported. Only a few studies have attempted to evaluate the mechanical strength of exercised tendons. The long term effect of exercise on tendons appears to be positive, but researchers have suggested that periods of mechanical weakness occur in tendons during adaptation to loading conditions. Studies documenting changes associated with the terminal state of pathological tendons are also summarised. Unfortunately, there are no descriptions of tendon tissue in the early stages of overuse injury. Since blood flow is commonly implicated in the emergence of tendinitis, the final section covers recent work on blood flow and tendon physiology. Related research identifying cellular mediators (hyperthermia, hypoxia, and oxidative stress) involved in the development of tendinitis is also presented. Suggestions for further research into exercise loading and the development of tendon overuse injuries are made.

Human skeletal muscle fibre types and force: velocity properties

It has been reported that there is a relationship between power output and fibre type distribution in mixed muscle. The strength of this relationship is greater in the range of 3-8 rad.s-1 during knee extension compared to slower or faster angular knee extensor speeds. A mathematical model of the force: velocity properties of muscle with various combinations of fast- and slow-twitch fibres may provide insight into why specific velocities may give better predictions of fibre type distribution. In this paper, a mathematical model of the force:velocity relationship for mixed muscle is presented. This model demonstrates that peak power and optimal velocity should be predictive of fibre distribution and that the greatest fibre type discrimination in human knee extensor muscles should occur with measurement of power output at an angular velocity just greater than 7 rad.s-1. Measurements of torque:angular velocity relationships for knee extension on an isokinetic dynamometer and fibre type distribution in biopsies of vastus lateralis muscles were made on 31 subjects. Peak power and optimal velocity were determined in three ways: (1) direct measurement, (2) linear regression, and (3) fitting to the Hill equation. Estimation of peak power and optimal velocity using the Hill equation gave the best correlation with fibre type distribution (r < 0.5 for peak power or optimal velocity and percentage of fast-twitch fibres). The results of this study confirm that prediction of fibre type distribution is facilitated by measurement of peak power at optimal velocity and that fitting of the data to the Hill equation is a suitable method for evaluation of these parameters.

Muscle function in chronic compartment syndrome of the leg

Chronic compartment syndrome (CCS) is a recognized cause of recurrent leg pain in the exercising patient. Decreased muscle function has been implied in this condition. This study compared the ankle dorsiflexion torque of 10 CCS patients with that of 18 control subjects during 20 repeated, maximal, isokinetic contractions at 60 degrees/sec. Peak torque, relative peak torque, and endurance data were collected. Results showed significantly lower peak torque and relative peak torque in the CCS group (p < or = 0.05), supporting the implication of muscle weakness in CCS. Paradoxically, endurance was significantly higher in the CCS group (p < or = 0.01), and there was a significant (p < or = 0.01), negative correlation (r = -0.50) between peak torque and endurance. The relationship between the findings and CCS is discussed. Strengthening may be useful in very mild cases or in postfasciotomy patients.

Sports medicine electives. Are they available in Canadian family medicine programs?

Sports medicine is becoming a larger part of a family physicians' practice. We surveyed all family medicine teaching programs in Canada to determine how many offer sports medicine experiences and who teaches them. The study found that few residents have clinical training in sports medicine, though most have attended seminars. Primary care physicians, orthopedic surgeons, physiotherapists, and rheumatologists teach sports medicine.

Muscle fiber type distribution as estimated by Cybex testing and by muscle biopsy

The purpose of the present study was to derive a regression equation relating variables obtained from a series of noninvasive functional tests in a normal subject population to the fiber type distribution of vastus lateralis muscle (VL) determined using muscle biopsy. All functional tests were designed to distinguish between basic properties of Type II fibers (fast twitch fibers) and Type I fibers (slow twitch fibers) and included assessment of peak torque, power output at nine different angular velocities (60 degrees.s-1 to 300 degrees.s-1), as well as a fatigue test consisting of 60 consecutive contractions at 90 degrees.s-1 to establish fatigue resistance of the knee extensor muscles. Using a stepwise multiple regression procedure, relative torque after 53-55 contractions (T55) in the fatigue test and power output at an angular velocity of 280 degrees.s-1 normalized for fat free mass of the thigh (FFMT) were the best predictors for fiber type distribution, explaining 51.8% of the variance in the proportion of Type II fibers in VL. No other measured variable met entering criteria. Subgroup analyses revealed a higher peak torque/FFMT, higher power/FFMT values at angular velocities of 200 degrees.s-1 and higher, and lower relative torque beyond 30 contractions in the fatigue test for the fast twitch group, FTG (subjects with > 60% Type II fibers, N = 8) as compared with the STG (subjects with < 45% Type II fibers, N = 9). Results from the present study suggest that two simple functional tests on a Cybex dynamometer yield reasonable estimates of the fiber type distribution in VL.

Anterior compartment pressures in cross-country skiers. A comparison of classic and skating skis

This paper compares the pressure changes in the anterior compartment of the leg when cross-country skiing using the skating method on either skating skis or classic skis. Intracompartmental pressures of the right leg were recorded from the tibialis anterior muscle of 10 subjects at rest and 15 seconds after 10 to 12 minutes of cross-country skiing on a designated course. All subjects completed two trials on different days. In one trial, subjects used skating skis and for the other trial, classic skis were used for the skating technique. Although the average pressure increase was higher for the classic ski trials than for the skating ski trials, the difference was not significant. This finding indicates that cross-country skiers who skate on a classic ski as opposed to a shorter skating ski do not experience a significantly greater increase in their anterior compartment pressure. Thus, it appears that the type of ski used is not the most significant factor contributing to chronic compartment syndrome.

Ultrasound catheter placement for deep posterior compartment pressure measurements in chronic compartment syndrome

Medial shin pain, often referred to as shin splints, is a common but difficult to diagnose entity in many athletes. Chronic deep posterior compartment syndrome as a cause of medial leg pain is still controversial. The problems of deep posterior compartment pressure measurement contribute to this controversy. These problems include safety of catheter insertion and the possibility that the patient has more than one deep posterior compartment. In this paper, we present a new technique for catheter placement in which continuous ultrasound guidance is used. This technique allows for the safe placement of the catheter into the deep posterior compartment and for documentation of catheter tip location.

Sports injuries in the emergency department: controversies and management guidelines

Sport-related injury is a common problem seen in the emergency department of Canadian hospitals. The mechanism of injury is essential information in making an accurate diagnosis. The motivation of the athlete is an important factor in arranging appropriate follow-up and counselling for return to activity. This article addresses diagnostic and management considerations for shoulder injury, acute knee injury, concussion, compartment syndrome, and stress fracture.

A Primary Care Perspective of Chronic Compartment Syndrome of the Leg

In brief: Chronic compartment syndrome (CCS) of the leg is a recently recognized cause of recurrent leg pain in the exercising patient. Apart from rest, the only effective treatment is fasciotomy. This study reviews 39 fasciotomies that were performed on 16 patients with clinically determined CSS. Fourteen (88%) of the patients returned to full activity with few or no residual complaints. These results indicate that clinically identified features can distinguish CCS from other forms of recurrent leg pain. Compartment pressure measurements taken during exercise can confirm the diagnosis of CCS and determine the need for fasciotomy.

The relationship of individual anaerobic thresholds to total, alactic and lactic oxygen debts after a set treadmill run

This study investigated the relationship of individual anaerobic thresholds to oxygen debt. Anaerobic threshold speed (VTAM) was determined for 21 male university students using a continuous ramp treadmill protocol. The onset of anaerobiosis was determined by visual inspection of excess CO2 elimination. The following week, all subjects ran at the treadmill speed 3.3 m.sec-1 for 10 minutes (this speed split the group into two halves). Recovery oxygen consumption was monitored after this run. Application of double exponential equations by computer and subsequent integration was used to calculate total, alactic, and lactic oxygen debts. Subjects who ran above their VTAM (group L-VTAM) had significantly (p less than .05) higher total, lactic and alactic debts compared to subjects who ran below their VTAM (group H-VTAM). The total debt demonstrated a significant (p less than .05) negative correlation (r = .77) to VTAM in group L-VTAM. This appears to be due to increasing lactic debt, that was also significantly (p less than .05) negatively correlated (r = -.73) to VTAM. Group H-VTAM did not exhibit this characteristic. This study demonstrates that VTAM, as determined by excess CO2 elimination, is a critical factor in determining oxygen debt and therefore, work above this point (which results in the onset of metabolic acidosis) may limit the optimal running speed for a given distance.

A triplanar electrogoniometer investigation of running mechanics in runners with compensatory overpronation

Selected temporal events and associated kinematic parameters were studied about the knee and ankle during running using the C.A.R.S. -U.B.C. Triplanar Electrogoniometer, with and without corrective running orthotic devices (CRODs), in ten male runners who displayed compensatory overpronation. Extension and flexion, internal and external rotation plus varus and valgus displacement were recorded at the knee joint, while plantar and dorsi flexion, adduction and abduction plus inversion and eversion were recorded at the foot. CRODs produced a significant decrease (p less than 0.03) in the total amount of foot eversion during the support phase of running. The maximum amounts of support phase foot dorsiflexion and abduction were not altered significantly by CRODs. CRODs produced a significant increase (p less than 0.03) in the amount of plantar flexion occurring after foot strike. The knee was not fully extended at foot strike and up to ten degrees of additional knee extension took place after foot strike, before knee flexion began. None of the absolute time intervals between the achievement of the maximum of the three components of pronation (ankle abduction, eversion and dorsiflexion) and maximum knee flexion or maximum knee internal rotation were significantly altered by CRODs: Significant differences were detected between the left and right legs for several parameters at both the knee and ankle, which the authors believe warrants the separate examination and treatment of each leg when CRODs are to be used to control compensatory overpronation.