American Football 101
Are you looking for a way to increase the capabilities of your football team? Is your football team leaving something to be desired? Are you looking to skyrocket your team's effectiveness with the most effective drills and plays?
JOHN KIRKLIN, WHO WAS more interested in football than medicine in his undergraduate days, remembers clearly the moment he became a cardiac surgeon. He was enrolled in the medical school at Harvard University when Dr. Robert Gross, a Boston surgeon, visited to give a lecture. It was the 1930s, and heart
Certain sports require intraoral devices that can cause malocclusion or TMJ stress. Ice hockey, football, and boxing, for example, use oral mouthguards that protect the teeth. These devices should be examined to ensure that they do not alter occlusion or load the temporomandibular joints. Chin straps should also be examined to ensure that they are not too tight and do not compress the temporomandibular joints.
Second-impact syndrome is a rare but potentially fatal cumulative injury that occurs when an athlete, having not yet recovered from an acute brain injury, sustains a second injury before the symptoms associated with the first injury have resolved. This syndrome dramatizes the extreme vulnerability of the mildly injured brain. The true incidence of SIS is actually unknown. The National Center for Catastrophic Sports Injury Research reported 35 probable cases during the time period of 1980 through 1993 and 17 of these were confirmed with necropsy or surgery and MRI findings. The SIS has been reported in football, boxing, ice hockey, and downhill skiing.
CTBI has been a disorder more commonly reported among boxers however, this condition can also be encountered in football, ice hockey, soccer, rugby, and potentially any sport associated with recurrent concussion. The frequency of CTBI in sports is largely unknown. It has been estimated that the prevalence of CTBI among retired professional boxers is 17 however, the incidence or prevalence in football, ice hockey, soccer, rugby and other contact collision sports is unknown. Cumulative injury is an extremely important concept in athletic concussion. There can be significant morbidity associated with more than one concussive episode. After a second concussion, the postconcussion syndrome is more pronounced. Multiple concussions may affect personality, academic performance, and the ability to return to competition. However, long-term effects can be even more devastating.
The aim of rehabilitation is to restore a sport-specific function to, or above, pre-injury levels. In cricket it could be the perfect bowling action, in tennis the serve, in baseball the throw, in football ball control or in gymnastics landing. This type of training requires knowledge and understanding of the sport's specific demands and is usually prescribed and supervised by a sports therapist in close collaboration with a coach. After surgery or long immobilisation, this final stage of rehabilitation training is the most time-consuming and risky. In the final stage of rehabilitation after healing of an injury, functional training back to full performance level must be gradual, over a period of time that corresponds to the functional requirements of the muscles and the healing process of the underlying injury. This period could vary from a few weeks after a simple ankle sprain to a year after complicated knee surgery. The training has to be specific and, preferably, performed in a...
Excessive cervical forward bending (hyperflexion) can cause a sprain, strain, subluxation, dislocation, or fracture. Protective muscle spasm and associated pain make it difficult to determine which of the cervical structures is injured. The mechanism is not actually a pure hyperflexion but a combination of compression and flexion or flexion and rotation. Major stress occurs at C5-C6 level where the mobile cervical vertebrae join the less mobile vertebrae of C7 and Tl. This forward bending mechanism of injury occurs frequently in sports such as diving (into shallow water), trampolining, rugby, football, and ice hockey.
The worst injuries to the cervical spine occur with forced forward bending and compression. The head makes contact with an object (hockey boards or football opponent) with the cervical spine in a full forward bent position. The neck can stand less force in this position than in an extended position. Most of these injuries cause damage to the middle or lower cervical region and involve C4-C7. According to Kapandji, during forward bending the upper vertebral body tilts and slides anteriorly, the disc nucleus pulposus moves posteriorly, and the movement is checked mainly by the ligaments.
Facet and nerve root injuries are more common with a rotational overstretch of the cervical spine. Wrestling, football, and rugby cause vigorous rotational forces to the neck. Rarely is the rotational force a pure movement. It is often associated with a forward bending, back bending, or side bending component as well. The cervical over-rotation is coupled with lateral flexion to the same side as the rotation.
Burners or stingers are common causes of pain and burning dysesthesias in the upper extremity. These injuries are most commonly the result of a violent stretch31 of the brachial plexus. These injuries are usually transient, lasting only a few seconds. As these often occur in game situations, especially in football, the athlete should be kept out of competition until symptoms resolve. The diagnosis of this condition is made almost on history alone, although a player might run off the field with a characteristic dead arm at his or her side. Symptoms should be unilateral, extremely painful with burning and paresthesias down the extremity, and transient. They may also be accompanied by weakness of the deltoid, biceps, spinatii, and brachioradialis. It is very important to distinguish a burner from cervical radicu-lopathy caused by compression of a nerve root. The former is usually self-limiting, while the latter is of more concern. Most patients with findings attributable to cervical...
Spinous process fractures most often occur at the lower cervical and upper thoracic levels and are often an isolated bony finding. When it affects C7, it is called clay shoveler's fracture. Three mechanisms of injury have been described avulsion of the spinous process following strong contraction of trapezius and rhomboid, direct hit to the spinous process, and spinous process avulsion by intraspinous and supraspinous ligaments during forced c-spine hyperextension or hyperflexion. This latter mechanism occurs only with high-velocity trauma such as in football or MVA.
The discovery of mirror neurons is one of the most intriguing neuroscientific findings, especially when applied to our growing understanding about how dance engages others. These specialized neurons, located in major cortical regions of the brain, allow us to mimic an action that is performed in front of us. They rapidly link perception, action, and intention in order to facilitate the acquisition of new motor behaviors. Not only do these mirror neurons help us learn new skills but they also form strong neural circuits as we practice and witness these skills. Perhaps this is why members of an audience who have danced gain greater pleasure when watching others dance and why they are less kinesthetically involved when they watch football players. Mirror neurons help us learn and they improve with practice. Along with mirror neurons we are also neurobiologically biased to empathically sense the emotional state of others. Even in newborn infants this ability is evident. When one baby...
Transient tetraplegia most often results after an impact forcing the cervical spine into hyperextension, hyperflexion, or axial loading. Affected athletes experience tetraplegic symptoms of relatively short duration that include dysesthesias, and or weakness in both arms, both legs, or all four extremities. Individuals do not generally complain of neck pain. The clinical symptoms last for as short as 10-15 minutes and as long as 48 hours. The patient regains full function and ROM and radiographs show no evidence of fracture, but these players often have cervical canal stenosis. In individuals with a narrowed canal in the AP diameter, the pathophysiology is thought to be as follows. Hyperextension or hyperflexion of the cervical spine causes further narrowing of the canal with compression of the cord against adjacent bony or ligamentous structures. Torg et al. found the incidence of transient cervical cord neurapraxia with transient tetraplegia to be 7 per 10,000 football athletes.
Figure 19-4 Shoulder of 20-year-old football player (from Fig. 19-1). A, Posterior labral detachment viewed arthroscopically. B, With two inferior sutures already placed and tied, final anchor has been placed and suture passed through labrum and capsule to be used as shuttle suture. C, Suture from anchor after being passed through labrum and capsule. D, Final posterior repair. Figure 19-4 Shoulder of 20-year-old football player (from Fig. 19-1). A, Posterior labral detachment viewed arthroscopically. B, With two inferior sutures already placed and tied, final anchor has been placed and suture passed through labrum and capsule to be used as shuttle suture. C, Suture from anchor after being passed through labrum and capsule. D, Final posterior repair.
An object whose appearance was deceptive (a sponge that looked like a football, a torch that looked like a fish, a frog pencil sharpener, and a cat-shaped salt cellar). The experimenter (E) showed the object to the child, saying, 'When you look at this with your eyes right now, what does it look like ' After the child answered, E demonstrated what the object really was. The child was then asked two test questions (a) 'What is this really and truly and (b) 'When you look at it with your eyes right now, does it look like a football or does it look like a sponge ' The order of presentation of the four objects, and that of the 'look' versus 'really and truly' questions, was fully randomised and counterbalanced. Children received one mark if they answered both the reality and appearance questions correctly for each of the four objects, giving a score out of 4 for their overall performance on the appearance-reality task.
SYMPTOMS There is a severe sharp pain around the anterior tibio fibula junction, haemarthrosis and sense of ankle instability after a severe hyperflexion-inversion or eversion ankle sprain. A player cannot continue and will limp off the pitch. This injury is well-known in association with a fracture but occurs frequently in isolation in contact sports such as football and rugby.
A relationship between OA of the hip and knee, and heavy work or sports activities has been postulated. Sports activities with intense high impact and tor-sional loading are associated with an increased prevalence of OA 27 . Examples of such sports are soccer, American football, rugby, team handball, basketball, competitive running and water skiing 28 .
An estimated 300,000 concussions occur each year from sports-related activity (Centers for Disease Control and Prevention CDC , 1997). In high school football, there are 40,000 concussions per year, for a 3 to 5 incidence (Powell and Barber-Foss, 1999). High-risk sports include contact and collision sports such as football, ice hockey, rugby, wrestling, and to a lesser extent, soccer and basketball. Women may be more prone to concussion in some sports (Tierney et al., 2005), for unclear reasons, with further research needed. Younger players also may be more prone to concussion because of less developed neck muscles and the higher relative weight of the head compared with the rest of the body. In addition, children may sustain more serious concussions because of their immature nervous system.
Injury to the spinal cord resulting in temporary or permanent neurologic injury is a rare but potentially catastrophic event during sports competition. Cervical spine trauma is most common in contact and collision sports such as American football, rugby, ice hockey, gymnastics, skiing, wrestling, and diving (Cantu and Mueller, 1999 Carvell et al., 1983 Tator and Edmonds, 1984 Wu and Lewis, 1985). Cervical spinal cord injuries are the most common catastrophic injury in American football and the second leading cause of death attributable to football. The National Center for Catastrophic Sports Injury Research reported that the incidence of cervical spinal cord injury in American football between 1977 and 2001 was 0.52, 1.55, and 14 per 100,000 participants in high school, college, and professional football, respectively (Cantu and Mueller, 2003). Recognition of the axial load mechanism as the major cause of catastrophic cervical spine injury in American football resulted in rule changes...
A typical patient will complain of pain radiating down the buttock into the lower extremity. For example, a 26-year-old football player felt a sudden dull pain in his left buttock that radiated down the outside of his leg following a tackle. The pain subsided but after the game he noticed it returned. Over the last 8 days, he says the pain has gotten much worse. He says the pain has become a sharp pain in his lower back that radiates into his buttock and down the lateral thigh into the lateral calf, foot, and big toe. He complains of mild numbness in his lateral calf but says the rest of the pain feels more electric and shooting in nature. Leaning forward and sitting for a prolonged period of time makes the symptoms worse.
The typical patient will relate a history of trauma. For example, the patient may be a young skateboarder who fell from a height while twisting in the air and suffered immediate back pain. Or, the patient may be a football player who got tackled by a helmet in the back (spearing, which is a penalty). Although a transverse process fracture is not considered to be serious in long-term considerations, they are exquisitely painful in the short term (similar to a broken rib).
An agenda is set, where the problem that is being solved is identified. Tackle one issue at a time. People feel competent when they can solve one problem and not be overwhelmed by several all at once. You might identify the problem as a question, such as, How can we balance my desire to watch football with our need for time together The problem-solving model follows these steps
How does a teenager acquire a coherent self-identity In Erikson's view, his self-identity gains real strength only from wholehearted and consistent recognition of real accomplishments. These he described as achievements that have meaning in their culture. They might include high grades, making the football team, building a home as a volunteer for Habitat for Humanity, or all of the above.
During a sudden change of direction while running, and quick starts and stops. Factors such as weakness or tightness of the adductor muscles can predispose an athlete to a groin strain. This injury is commonly seen in soccer players as well as football, ice hockey, basketball, tennis, and baseball players.
Is metaphoric creativity unlimited or does it emerge from certain personal (including bodily) and cultural constraints The study of metaphoric variation offers some challenges to prominent theories of creative metaphoric use. Consider the following examples of newspaper headlines used to talk about the outcome of sporting events, in this case, American college football games Cougars drown Beavers, Cowboys corral Buffaloes, Clemson cooks Rice, and Army torpedoes Navy (Kovecses, 2009). The nicknames of the college teams (e.g., 'Cougars' are the mascot for Washington State University, 'Beavers' are the mascot for Oregon State University, 'Buffaloes' the mascot for University of Colorado, etc.) are paired with verbs that metaphorically refer to defeat. Thus, beavers live in water and can be defeated when drowned, cowboys corral cattle, and therefore would defeat an opponent like buffaloes by corralling them, rice is considered 'done' or defeated when cooked, and a Navy ship is defeated...
Anterior cruciate ligament (ACL) injuries are common in sports. The incidence of ACL injury is greater in athletes who participate in contact sports such as football or rugby. The mechanism of injury is usually hyperextension, deceleration, or cutting. Frequently, the ACL is injured in combination with other structures, such as the medial collateral ligament and medial meniscus ( terrible triad ). In non-contact sports such as skiing, the ACL is prone to injury when there is a force that drives the tibia anteriorly while the knee is flexed at 90 degrees.
Medial meniscal injuries usually occur when an athlete is attempting to cut with a fixed foot. Damage results when rotational forces are applied to the knee while it is partially flexed with the foot on the ground. Medial meniscal injuries are commonly seen in sports such as soccer and football. Unfortunately, the medial meniscus is often damaged in conjunction with ligamentous injuries.
Concussion is the most common head injury in sports. Historically, concussion was described as traumatic paralysis of nervous function with a tendency to recover without deficit and revealing no anatomic abnormality. There are many definitions of concussion in the literature. Most recently, the American Orthopaedic Society for Sports Medicine Concussion Workshop Group has defined cerebral concussions as any alteration in cerebral function caused by a direct or indirect force transmitted to the head resulting in one or more of the following acute signs or symptoms a brief loss of consciousness, light-headedness, vertigo, cognitive and memory dysfunction, blurred vision, difficulty concentrating, amnesia, headache, nausea, vomiting, photophobia or a balance disturbance. In 1983, Gerberich et al. surveyed the head coaches and players of 103 secondary school football teams in Minnesota. The incidence of cerebral concussion in foot ball was 19 per 100 participants, and 24 of all football...
Recently, one of the classifications of such brain injury, Standardized Assessment of Concussion (SAC), has been developed by the Quality Standards Subcommittee of the American Academy of Neurology (Table 6.4.1). It is used on the sideline to assess the orientation, memory and concentration as a mental status examination of athletes who are suspected of having suffered concussion 19 . The SAC is used by the American football league and the National Hockey League (NHL) to manage concussion on the field. In 1973, Schneider 20 described two young athletes who experienced initial concussive syndromes and subsequently died after relatively minor second impacts. Since then 19 deaths from second impact syndrome (SIS) have been documented in the US. Furthermore, successive concussive impacts may also lead to milder but still significant impairment of cognitive processes (attention, memory), personality, language functioning and somatic concerns (sensitivity to light, dizziness), commonly...
Frequently reported in contact sports like American football and rugby 22 . nique or associated collisions with an opponent may result in long-term complaints. Soccer seems to include more close contact, and it is reasonable to enforce standing rules and increased severity of penalty for dangerous play. The mass of the football is about 400 g and it may hit the head at speeds exceeding 100 km h. Based on various assumptions, the calculated force against the head may exceed 2000 N. The forces that have to be counteracted by the neck muscles can thus be far beyond the forces occurring in common car collisions.
SYMPTOMS The symptoms are immediate haemarthrosis and pain in the medial part of the knee. If only the external portion is ruptured there will be superficial bruising rather than haemarthrosis. This is an injury common in contact sports such as football, rugby and other high-intensity sports. The MCL ruptures during an excessive valgus sprain and usually causes the inability to continue sport. AETIOLOGY In many cases this is a non-contact injury, where the player loses their balance and twists the knee. The ligament can rupture partially (Grade I-II) or completely (Grade III-IV), externally from its origin on the femur to its insertion on the tibia or internally at the insertion into the medial meniscus. This injury is, consequently, frequently associated with other injuries to cartilage, menisci, capsule or other ligaments. CLINICAL FINDINGS There is haemarthrosis and or medial bruising and swelling. If there is an isolated rupture of the insertion to the meniscus, there is a capsule...
Brachial plexus neuropathy (plexopathy) can result from blunt or penetrating trauma. The typical injury is directed into the axilla or violently increases the angle between the shoulder and head. In the latter case, stingers or burners, which frequently occur in football players, result in temporary
SYMPTOMS Effusion and exercise-induced pain often combined with mechanical problems of locking, clicking, clunking or discomfort on impact (compression and rotation). This injury is common in sports such as football, rugby and other high-intensity contact sports but is also common, with no major trauma, as degenerative tears in older athletes or sedentary individuals. AETIOLOGY In many cases this injury occurs from direct or indirect trauma or in association with other ligament injuries. It can occur from around 10 years of age and throughout life. Note There are numerous ways the meniscus can rupture horizontal, vertical, bucket handle or complex tears. The tear can be localised posteriorly, centrally or anteriorly, causing different symptoms and signs. CLINICAL FINDINGS There is effusion in most cases. The compression rotation test is positive. There is often tenderness on palpation of the affected joint
Many years ago, Swallin suggested another idea as a model for transport in molten metals and molten salts.22 In his view, the free space that occurs when a liquid melts does not play a part in the mechanism of transport, diffusion, conductance, and viscous flow. This occurs, he suggested, by means of microjumps, a movement not unlike the gyrations of a person in a large football crowd trying to get out to his seat in the front row. Gaps in the crowd are too small to aid his motion, so that the only way is to shuffle slowly forward, pushing and being pushed. Swallin's23 suggestion did not sit well with researchers studying molten salt at the time of its publication, however, because it was accompanied by the following equation
Some patients will be taking coumadin (warfarin), an anticoagulant or blood thinner. As long as coumadin is being taken, patients should avoid all vigorous contact sports such as rugby, soccer, and football. Dangerous sports like skydiving, in which one might receive blows to the head or begin bleeding, should also be avoided.
Athletes are preoccupied with body image, composition, and total mass. In weight-dependent sports such as running, weight loss may aid performance. Other sports such as boxing, football, or wrestling may require healthy weight gain. Athletes expect physicians to know the effects of nutrition on performance measures such as endurance, speed, or strength.
Chronic groin injuries are in some cases preceded by an acute episode, but more frequently the athlete has no recollection of this. A pattern of a sudden increase in training, including the intensity, the training methods or the total amount, in the period before the appearance of injury is typical. For example, an iliopsoas-related overuse problem can typically be sustained by increased repetitive hip flexion as when running uphill or by intensive kicking exercises in soccer or football.
Finally, before leaving the clinical course section of the history, it is important to note the current status of the complaint. This current status should be understood in light of the athlete's current level of activity, where he or she is in relation to the season, and how long he or she has until the shoulder has to be in playing condition. A college football quarterback who dislocates his shoulder for the first time early in his senior year might pursue a different treatment course from that of the same player who dislocates in the first week of the off-season after his junior year. Such an understanding requires thorough communication with the athlete and an understanding of his or her goals and guides the patient and the physician to the best choice for their desired outcome.
Ankle braces may also lead to a reduction in the incidence and severity of acute ankle sprains in competition (Bahr 2001), such as basketball (Sitler et al 1994), men's football (soccer) (Surve et al 1994, Tropp et al 1985) and women's football (Sharpe et al 1997). Although the studies reviewed provide important information regarding efficacy of tape or a brace, criticisms have been made regarding study design, external validity, confounding variables and sample size (Sitler et al 1994). These should also be considered before selecting the appropriate technique or device.
The organized sports with the highest risk for head and neck injuries are football, gymnastics, wrestling, and ice hockey. Football is the sport associated with the highest risk of such injuries. Head and neck injuries also occur in a variety of nonorganized sports activities including diving, skiing, surfing, and trampoline use. The clinical presentation of a traumatic cervical disc herniation is variable. Patients may present with isolated neck pain, radiculopathy, or an anterior cord syndrome with paralysis of the upper and lower extremities. In contrast to adults, immature athletes most commonly develop disc herniations at C3-C4 and C4-C5. Disc injury is associated with axial loading and hyperflexion during activities such as wrestling, diving, and football. 7. What biomechanical force is the primary cause of fracture dislocations involving the cervical spine during football The National Football Head and Neck Injury Registry demonstrated that most cervical fracture dislocations...
Patients may complain of a history of mild lower back pain that has become worse and progressive to the point that participating in activities that require lumbar extension is not tolerated. Often, the patient may report participation in gymnastics, swimming, football, or soccer. The pain may refer to the buttocks and posterior thighs.
Boys participating in soccer, basketball and football seem to be at greatest risk for acute injuries. Sprains (injury to ligaments) or strains (injuries to muscles or tendons) are common, whereas fractures are less frequent. First aid in acute injuries includes immobilization, cooling and, if required, pain relief. The subsequent treatment depends on the type, severity and location of the injury. The approach to acute injuries in children is similar to that in adults unless the growth plate is injured. The reader is therefore referred to the chapters on injuries in this textbook. Children with growth plate injuries should be seen by an experienced pediatric orthopedic surgeon.
In 1953, Evans36 described a biotenodesis procedure in which the peroneus brevis tendon is released at the musculotendinous junction, rerouted through the fibula, and then reattached to its proximal stump. This procedure was later modified by suturing the tendon back to itself instead of reattaching it to the proximal stump.37 In 1999, Girard et al38 reported on their results of the modified Brostrom-Evans procedure, a procedure that augments the Brostrom reconstruction with the addition of the anterior third of the peroneus brevis (Figs. 66-3 and 66-4). This procedure adds static restraint without a significant sacrifice of dynamic peroneal restraint. The authors believe that the modified Brostrom-split Evans has a role in revision surgery, obese individuals, heavy athletes (e.g., football lineman), laborers, and in patients with generalized ligamentous laxity. It is also our procedure of choice in patients with suspected combined instability patterns. Girard et al38 reported results...
SYMPTOMS The symptoms are immediate haemarthrosis and pain in the lateral part of the knee. This injury is common in contact sports such as football, rugby and other high-intensity sports. LCL ruptures occur during a varus sprain and cause an inability to continue sport. The forces involved are high since the lateral knee structures are stronger than the medial, these injuries are rare.
Figure 41-19 Stress examination of the ring finger proximal interphalangeal joint in a 25-year-old recreational flag football player demonstrates significant laxity (30 degrees) of the radial collateral ligament. This examination finding is suggestive of a grade III radial collateral ligament injury. Figure 41-19 Stress examination of the ring finger proximal interphalangeal joint in a 25-year-old recreational flag football player demonstrates significant laxity (30 degrees) of the radial collateral ligament. This examination finding is suggestive of a grade III radial collateral ligament injury.
The term tennis leg arose because many patients suffering this injury were playing tennis at the time of injury. To understand why tennis leg is an injury of the middle-aged tennis player, one needs to consider the factors that may cause the gastrocnemius muscle to stretch and rupture. The flat-heeled tennis shoe allows excessive ankle dorsiflexion, which tightens the heel cord distally, while sudden knee extension increases the tension on the muscle belly proximally.6 Tennis is an active cutting sport that requires players to perform sudden movements that place the gastrocnemius in a position of risk. Of sports in which this age group generally participates, golf, swimming, walking, and jogging are not cutting sports. Other sports that do require cutting, such as football, basketball, and soccer, usually do not have much participation by individuals in their 40s and 50s in the United States.
Avulsion of the flexor digitorum profundus at its insertion on the distal phalanx is known as jersey finger. This is commonly seen in football, rugby, or flag football and usually results from grasping the pants or jersey of an opposing player. As the player pulls away, the finger is forcibly extended while the profundus continues to contract and avulsion may result. McMaster,91 in 1933, showed experimentally that a normal tendon ruptures most commonly at its insertion, less commonly at the musculo-tendinous junction, and rarely in the substance of the tendon. Although quite rare, Schnebel et al99 reported a case of isolated traumatic avulsion of the flexor digitorum sublimis in a college football player. Several previous cases were reported in the literature that were treated without surgical intervention, although in one case presenting with pain and loss of extension at the PIP joint, the sublimis was excised and synovectomy performed.
SYMPTOMS Gradual or acute onset of localised exercise-induced pain at the lateral posterior aspect of the knee with or without preceding trauma. It is most common in pivoting sports like football or rugby or in cross-country running. AETIOLOGY This is an inflammatory response around the popliteus tendon in the posterior lateral intra-articular part of the knee. This condition typically occurs as a result of sudden changes in training habits, such as an increase in intensity or amount of impact, or after a direct impact, such as a kick. SYMPTOMS Immediate haemarthrosis and pain in the knee after a sudden hyper-flexion or hyperextension sprain or direct tackle. It is common in contact sports such as football and rugby and other high-intensity sports. AETIOLOGY The typical athlete suffers a hyperextension or valgus rotation sprain during sport or after a direct impact to the anterior proximal tibia while the knee is flexed ('dashboard' injury). The thick ligament can rupture partially or...
SYMPTOMS There is a sharp localised exercise-induced pain over a metatarsal bone. Most commonly, MT IV or V are affected, often after a previous sprain or after a direct impact injury. AETIOLOGY The injury is either caused by direct impact, for example from football boot studs, or by excessive repetitive stress from forefoot running or jumping, sometimes due to faulty shoes or inlays with the breaking point of the sole over the mid-part of a metatarsal. SYMPTOMS There is increasing stiffness and exercise-induced pain around MTP I without preceding trauma, usually affecting adult athletes. This condition can be mistaken for 'turf toe', which is common in young footballers. AETIOLOGY The aetiology is unclear but there is a possible genetic predisposition. CLINICAL FINDINGS There is decreased active and passive range of motion, most notably in extension and flexion of the MTP I to the degree that the joint freezes. There is localised swelling, effusion and tenderness on palpation over...
The journey through the birth canal is a slow process. To your baby (and you) it may seem endless. Since the head of a newborn baby is very large compared to its body size, the head is molded during the delivery. Newborns often appear with heads in the shape of a football. It's remarkable to see how quickly head shape returns to normal within one or two weeks. This molding of the head does not have any adverse effect on the brain or other aspects of your baby's health. Less commonly, a swelling on the back of the head, usually on only one side, may persist for a few weeks after birth. This happens when a small blood clot fonns beneath the scalp skin during delivery. Similar to
Transient brachial plexopathies and radiculopathies, commonly referred to as stingers or burners result from trauma to the brachial plexus or nerve roots. The mechanism of injury is traction to these neurological structures that occur when the head is forcibly laterally tilted and extended as the contralateral shoulder is depressed. They often occur at the time of a block or tackle in football. As many as 65 of collegiate football players are diagnosed with at least one career stinger most of these players are defensive linemen. Other etiologies include compression of nerve roots in their foramina during forced lateral neck bending or a direct blow to the brachial plexus at Erb's point. Most transient brachial plexopathies affect the
Closed lesions usually resulting from traction are the most common causes of traumatic brachial plexopathy. Stretch injuries are responsible for about 70 percent of serious brachial plexus injuries. High-velocity closed injuries, which usually involve the supraclavicular plexus, are primarily due to motor vehicle accidents, occupational injuries, and falls. Falls, which result in scapular and proximal humeral fractures and humeral head dislocations, are the most common causes of infraclavicular injuries. Brachial plexus injury, usually involving the lower trunk or medial cord, occurs in 5 percent of patients undergoing coronary artery bypass surgery. Brachial plexus injury is probably due to traction associated with sternal retraction. Most brachial plexus avulsion injuries are due to motor vehicle accidents, especially motorcycle accidents, industrial accidents, or to obstetrical injury, falls, objects falling on the shoulder, and sports injuries (most...
Bassett III (right center with hat ), in his familiar surroundings on the sidelines of a Duke football game. He is standing by Dr. William E. Garrett, Jr., at the time a Duke orthopedic resident. Dr. Garrett is immediate past president of the American Orthopaedic Society for Sports Medicine and has a career in the care of collegiate, Olympic, and professional soccer athletes. Figure 1-5 Dr. Frank H. Bassett III (right center with hat ), in his familiar surroundings on the sidelines of a Duke football game. He is standing by Dr. William E. Garrett, Jr., at the time a Duke orthopedic resident. Dr. Garrett is immediate past president of the American Orthopaedic Society for Sports Medicine and has a career in the care of collegiate, Olympic, and professional soccer athletes.
The prevailing view is that light or moderate, or at times even strenuous, physical exercise is beneficial to articular cartilage and joint structures (Fig. 1.7.5). This kind of activity strengthens joint structures, articular cartilage included, having also the capacity to prevent degenerative ailments of the musculoskeletal system, such as osteoarthritis. The high prevalence of knee osteoarthritis in former soccer players and American football players has been attributed to the high incidence of ligament, meniscal and joint injuries. There is some data showing that long-distance runners are prone to acquiring radiographic signs of knee or hip osteoarthritis. Radiographs of athletes may show signs of 'penarthropathie sportive', i.e. periarticular bone changes and calcification of ligament and tendon insertions, while at the same time the joint space may be normal in weight-bearing radiographic studies. The marginal lips or 'osteophytes' in the radiographs have been considered as...
Direct blows to the anterior, posterior, or lateral aspect of the neck can be serious, depending on the force of the blow, the object involved, and the cervical spine position. For example, contact with a puck, softball, or baseball moving at full speed can be serious. Contact with an opposing player's stick, arm, knee, or elbow is fairly common in contact sports and results in mild to moderate injury. In football, piling on, late hits, and hitting on the numbers can cause serious head and neck injuries.
The normal mechanism of injury occurs when a player's body is tackled form one side and the head and neck are quickly side bent toward that side. This occurs frequently in hockey, wrestling, and football. There is compression of the structures on one side and tension on the opposite side. Damage to the brachial plexus or cervical plexus can occur if the cervical region is side bent and rotated in one direction while the other arm is pulled in the opposite direction (Fig. 212). This commonly occurs in football when the player holds the head side bent away from the side of injury and the involved shoulder is driven downward or backward while tackling or blocking an opposing player. Burners occur more frequently in defensive players than offensive players and more in the game than practice situations. Players often describe the resulting sensation as a burner or stinger with the sharp pain radiating from the shoulder into the arm and hand. The brachial plexus usually suffers only a mild...
Acute cervical disc herniation usually occurs in older athletes. However, highperformance wrestlers and football players are at especially high risk. Compression of a particular nerve root by a herniated nucleus pulposus (HNP) or chemical irritation of that nerve by this material may cause radicular symptoms with localized cervical pain. Such patients are often most comfortable with the neck in a neutral or slightly hyperextended posture symptoms are often relieved by gentle traction. Symptoms are often reproduced by a positive Spurling's test. In this test, the patient's head is passively extended and laterally rotated to the side of symptoms. Gentle axial compression is then applied by the examiner. Reproduction of symptoms indicates a positive test.
For persons with osteogenesis imperfecta contact sports like football (tackle), ice hockey, sledge hockey and soccer should be discouraged due to the risk of fractures. Similarly it is not recommended that individuals with hemophilia take part in football (tackle) or ice hockey 58 .
NSAIDs make up a popular class of over-the-counter and prescription pain relievers. Advertisements for NSAIDs are often targeted at athletes of all levels for their anti-inflammatory effects, which differentiate this class from other pain relievers such as acetaminophen. Such directed marketing is apparently effective, as one study found that at least 20 of high school football players surveyed used NSAIDs on a daily basis in season. These athletes used NSAIDs with expectations of improved athletic performance and prevention of pain that might occur during practice or competition.48 NSAIDs are not thought to have stand-alone ergogenic properties. Their analgesic effect may allow increased training and or performance, but the masking of pain by use of NSAIDs interrupts a natural defense mechanism for preventing further injury. Additionally, as inflammation is a part of the healing process for most injuries, the antiinflammatory effect of NSAIDs may be detrimental to recovery from...
The metacarpophalangeal joint of the thumb is vulnerable when the thumb is abducted because, in abduction, the MP joint is locked, allowing forces to the distal thumb to be transmitted to the MP joint. Lateral stress with the thumb in abduction stresses the ulnar collateral ligament (UCL).30 Commonly referred to as gamekeeper's thumb or skier's thumb, injuries to the ulnar collateral ligament of the thumb MP joint precipitate MP joint instability. Causative factors include falling with the thumb entangled in a ski pole strap, creating torque, and forceful abduction of the thumb.26 It is estimated that 15-25 of all skiing injuries involve the thumb.34,35 Ski poles without grip restraints, which in a fall are discarded cleanly, seem to be the safest for avoiding thumb MP joint UCL injuries. Other sports where this injury occurs include basketball, gymnastics, rugby, volleyball, and hockey. Football-related UCL injuries are also reported when players' abducted thumbs strike other...
A 32-year-old man presents with left ankle pain. He was playing football with friends earlier today and twisted his ankle. The pain occurs at rest and is worsened by movement and weight-bearing activities. There is moderate swelling and mild bruising of the left ankle. He states I don't like to take pills and asks for a recommendation to cool the affected area.
Figure 41-18 A clinical picture of a complex dorsal dislocation of the thumb middle phalanx joint in an 18-year-old football player who sustained a significant hyperextension load. There is noted hyperextension of the middle phalanx joint and adduction of the thumb metacarpal. Figure 41-18 A clinical picture of a complex dorsal dislocation of the thumb middle phalanx joint in an 18-year-old football player who sustained a significant hyperextension load. There is noted hyperextension of the middle phalanx joint and adduction of the thumb metacarpal.
Most patients with isolated ACL injury do well with activities of daily living. They typically can participate in limited sporting activities, but will have difficulty with vigorous activity. Daniel et al4 divided various sports and occupations into tiered levels based on the intensity of the activity. Sports that require jumping, pivoting, and hard cutting such as basketball, football, and soccer are considered level I sports. Sports such as baseball, racket sports, and skiing require lateral motion but less jumping and hard cutting than level I sports and are considered level II. Sporting activities that do not require cutting, pivoting or lateral motion such as jogging, running, and swimming are considered level III. Additionally, Daniel et al4 expanded this classification to include occupations that similarly require cutting and pivoting type maneuvers. The challenge to the surgeon is to decide which patients will benefit from operative or nonoperative management....
Most patients present with a characteristic history. The leg pain is of insidious onset, associated with repetitive activities, and relieved by rest. Running and jumping sports are most often affected, including track, basketball, volleyball, dance, and football. While the cause is not completely clear, there is an obvious association with overuse. Thus, the athlete may describe an increase in training frequency or intensity, a change of shoes or practice surface, or another variation that could lead to excess biomechanical stresses. At the time of presentation, most often the pain has been present for weeks to months and sometimes even years. The pain may initially occur only after strenuous exercise, later becoming present even with simple walking. It may fluctuate with athletic seasons or gradually worsen with time until the athlete can no longer participate in sports. The examiner should obtain a history regarding amenorrhea in the female, thyroid disease, nutritional deficits, or...
Until recently, sports medicine has been primarily focused on the treatment of acute injuries or those injuries that occur in a single episode or event. These injuries most often occur during full-contact sports like football, soccer, and hockey. However, the focus on acute injuries is not as relevant as it once was. The recreational athlete of today is typically involved in repetitive sports such as running, aerobics, swimming, and or overhead sports. Athletes involved in these sports are less likely to experience an acute injury, yet are more susceptible to injury secondary to repetitive microtrauma. Younger athletes continue to involve themselves in organized year-round sports and are predisposed to similar overuse injuries.
In low-energy athletic injuries, the injury is primarily liga-mentous and instability affects only the second metatarsal. However, more extensive injury may occur the amount and direction of applied energy determine the extent and direction of the Lisfranc disruption. Football-related injuries are not uncommon, especially in linemen. Snowboarding- and windsurfing-related injuries may result as one falls away from the forefoot, which is secured by a foot sling.
The most frequent cause of an AC separation is the application of a direct force, which frequently occurs during a fall onto the shoulder when the arm is adducted (Fig. 26-2). This commonly occurs in contact sports such as football and hockey or in recreational sports such as cycling when an individual goes over the handlebars of a bike. In these situations, the energy from the fall forces the acromion downward and medially, causing the AC ligaments to be damaged first, followed by a sequential disruption of CC ligaments in higher energy injuries.
Cervical disk injuries occur with higher frequency in highperformance athletes playing football or wrestling than the general population.3 Cervical disk disease is generally categorized into soft versus hard disk disease. Acute disk herniations in sports are thought to occur from uncontrolled lateral bending3 (Fig. 15-4). Hard disk disease (disco-osteophytic disease) can become symptomatic through various mechanisms (Fig. 15-5). Both entities can cause varying amounts of neck and arm pain. Athletes with radicular symptoms or long tract signs should undergo MRI examination.17 It can be difficult to differentiate
An apophyseal avulsion fracture of the pelvis is a fracture through the physis of a secondary center of ossification. These commonly involve the anterior superior iliac spine, anterior inferior iliac spine, and ischial tuberosity apophysis. These fractures occur almost exclusively in 11- to 17-year-old patients. They are most commonly seen in soccer, track, football, and baseball. In most cases, these fractures occur during fast running, hurdling, pitching, or sprinting.15 These injuries usually do not occur due to direct trauma. They may occur as a consequence to a hip dislocation. Fractures of the anterior superior iliac spine result from the pull of the sartorius and the tensor fascia lata muscles. Fractures through the anterior inferior iliac spine result from pull of the straight head of the rectus femoris muscle. A forceful sprint or a swing of a baseball bat will typically avulse the anterior superior iliac spine.
Generally, athletes with HIV infection should be allowed to participate in sports just like any others. Physicians of HIV patients who are engaged in sports associated with a risk of exposure of blood, such as wrestling, boxing, football and so on, should inform the patients concerned of the theoretical risk that the infection can be transmitted further and strongly advise against their continuing to take part in sports of that kind. It is important to consider the anonymity aspects and to ensure that the infection status of the person concerned does not come to the knowledge of leaders or team-mates unless the individual has given his her consent.
Athletic activities can result in a wide variety of joint injuries through either direct trauma or repetitive stress 61 . Although the predilection for specific injuries varies with the sport (e.g. elbow instability in baseball players, shoulder dislocations in football players and wrestlers, knee injuries in basketball players), all injuries can be debilitating and often involve ligamentous structures. Ligaments are structures that are known to play an important role in mediating normal joint mechanics. These parallel-fibered, dense connective tissues share the transmission of forces with other periarticular tissues to provide joint stability 62 .
The etiology of effort-induced venous thrombosis is unknown, but it has been described in connection with the 'tennis leg', repetitive muscular use during jogging and kick boxing, in which intimal venous damage may occur as a result of knee hyperextension. There are also case reports of this syndrome occurring in American football and skiing 1 . Anatomic variations of the popliteal fossa veins may be an etiologic factor.
Avulsion of the flexor digitorum profundus tendon is similar to a mallet deformity and is diagnosed as inability to actively flex the distal interphalangeal joint, associated with pain and swelling. Radiographs may show avulsion of the volar base of the distal phalanx. The ring finger is most often involved and is seen in football injuries as the finger is caught in the opponent's jersey. Surgical treatment of the tendon should be performed within 7-10 days to avoid retraction of the flexor tendon.
Medial collateral ligament (MCL) injuries are the most common among the liga-mentous injuries. Injuries to the MCL result from a force directed to the lateral aspect of the knee. MCL injuries are common in contact sports such as football during a block against the lateral knee. Injuries to the MCL may also occur in non-contact sports such as skiing or swimming. Any sudden change in momentum or sustained valgus force at the knee can damage the MCL. Severe injury may also involve detachment of the medial meniscus or ACL.
Individuals in many fields have taken advantage of these factors to boost their creative production. For example, humor writers use a strategy incorporating the making of remote associations as a means of generating ideas for cartoons, gag lines, and jokes. In 1990, Gene Perret, who named his version of this strategy Random Associations, (p. 75) suggests that a writer make a list of about 50 words, phrases, people, places, or things - anything at all related to a topic under consideration. Perret recommends including atypical items on the list to increase the likelihood of uncommon or unexpected associations. After creating the list, the writer should peruse it, at first trying consciously to make unusual connections between some of the items and then letting the mind work unconsciously to make unusual connections. Writers can take a more focused approach by making specific categories within the overall topic and forcing unusual connections between random associations in the different...
How could I forget the influence of my Spanish teacher, Miss Weir, my football coach, Coach Defee, or my speech teacher, Mr Flathers, at Amarillo High School So many classmates at Texas Tech, University of Texas Dental Branch, and the orthodontic department and colleagues have touched my life in so many positive ways. Without Dr A.P. Westfall's support and encouragement in the orthodontic department, none of this would have ever happened.
Like self-serving bias at the individual level, groups can also take credit for their successes, and attribute failures to external causes. This is called 'group-serving bias.' Especially in the environments where teamwork is more important than individual effort, the locus of attribution shifts from individuals to groups. In other words, people try to explain success and failures of the group instead of their own success and failures. For instance, when a football team wins a game, they attribute success to their group cohesiveness, but if they lose, they attribute failure to external causes such as an unfair referee.
Instead there are abrupt changes in head movement resulting in acceleration and deceleration of the brain. Impact injuries typically produce focal injuries. The primary mechanism of traumatic brain injury in sports is the rapid acceleration and deceleration of the head by mechanical forces. There are three types of acceleration including rotational (angular), linear (translational), and impact deceleration. Among these, rotational acceleration is considered the primary culprit in producing brain injury. The sports that rank highest in brain injury (e.g., football, boxing, and
Head-on type collision with the top or crown of a football or hockey helmet. Epidemiological study as well as biomechanical and cinematographic analysis, have determined that cervical spine quad-riplegia in football results from direct compression in head-on collisions. Force is not absorbed or dissipated by the surrounding musculature and goes directly through the spine. Axial loading of the cervical spine occurs when the neck is slightly flexed (approximately 30 ) so that the cervical lordosis is straightened. The impact can damage This injury occurs most often in recreational diving, gymnastics, rugby, wrestling, tackle football, trampolining, and hockey. Axial compression of this sort can occur with a direct blow that compresses the cervical spine, or when the head is fixed and the trunk is still moving so that the cervical spine is compressed between the head and trunk. This occurs in hockey when the athlete is pushed from behind into the boards. Tator sites this as one of the...
Participation in contact sports such as hockey, boxing, soccer, baseball, football, and wrestling can result in dental trauma. In the United States, the National Youth Sports Foundation estimates that more than 5 million teeth will be avulsed in sporting events each year. The Centers for Disease Control and Prevention in 2001 estimated that approximately one third of all dental injuries in the United States are sports related. After trauma, the dentition should be examined for fractures and mobility. Injuries to the teeth and supporting structures should be treated emergently.
Studies published in both the USA and UK show how protective devices have decreased the number of dental injuries. Mouth protectors have proved to be an effective means of reducing the degree and incidence of dental trauma associated with contact sports. Mouth guards are commonly used in boxing but other sports have been reluctant to adopt them. The incidence of dental and oral soft tissue injuries decreases to less than 1 when mouthguards are mandatory for football players. Conversely, when basketball players do not wear mouthguards, more than one fourth of the injuries involve the teeth, tongue, and lips. Mouthguards protect
A 21-year-old collegiate football player felt an acute pop in his right lower extremity during practice. Physical examination was consistent with an acute midsubstance Achilles tendon rupture. To decrease the risk of wound complications in a high-level athlete and to decrease the risk of reruptures, operative intervention was performed with the Achillon system. A 1-cm transverse incision at the level of the rupture was utilized along with No. 1 nonabsorb-able polyfilament for fixation. Postoperatively, the patient was placed in a splint in 20 degrees of plantarflexion in order to maximize skin perfusion over the Achilles.31 The patient underwent functional rehabilitation as outlined for patients who have undergone open repair however, the splint was discontinued at 1 week, and earlier range-of-motion therapy begun, because of a minimal
Shoulder dislocation is the complete separation of the humeral head from the articular surface of the glenoid. The glenohumeral joint is the most commonly dislocated joint in the body. Approximately 95 of shoulder dislocations occur in the anterior direction, but dislocation can also occur inferiorly, superiorly, and posteriorly. There is a high incidence of dislocation in full contact sports such as football and rugby, or sports in which violent falls may occur such as downhill skiing, mountain climbing, and cycling.
Football, baseball, basketball, and other sports are national passions and players often are obsessed with playing regardless of whether they are grade schoolers or professionals The third example, a professional football player with a stable long finger metacarpal fracture, wants to return to playing football as soon as possible. The splinting goal for this football player is to maintain the hand in a position that facilitates safe healing of his metacarpal fracture. The referring physician deems the fracture stable and recommends a protective playing cast. The therapist fabricates an adapted fiberglass cast for the patient to wear during
Nick Greene, a member of the school's winning football team, made an appointment with the school psychologist, Sam Foster. He confided that he had been taking supervitamins to build up his muscles over the past year. A fellow high school student bought the vitamins at a local health club and sold them in the locker room to football team members. Nick had seen some TV news stories about steroids, and he thinks maybe the supervitamins have some of that in it. He was worried because he also heard that steroids could make a guy act queer, and he wanted to know if that could happen to him.
Spondylolysis, a stress fracture of the pars interarticularis, is a common cause of low back pain (LBP) in athletes and is the most common cause of athletic LBP in adolescents (Standaert and Herring, 2000 Standaert et al., 2000). Athletes who participate in sports involving repeated and forceful hyperextension of the spine (e.g., gymnastics, American football) are more likely to develop spondylolysis from the cumulative effect of repetitive loading of the bone imposed by physical activity. Athletes generally have an insidious history of increasing focal back pain reproduced by lumbar extension.
The basal ganglia control the background activity on which a conscious movement is made. They are like the backing music to the lead vocal, or the rest of the team to the football player with the ball. They are not where the action is, but unless they are working properly the action is not what it should be. When we are sitting having a cup of tea, we may be thinking about lifting the cup to our lips, but the rest of our body is in a position and state that is appropriate to drinking tea. If we stand up, our body needs to change the muscular background, so that it is now appropriate for standing, and then if we walk, it needs to change again into a walking mode. When the basal ganglia do not work properly, the muscular background becomes disordered. If they are underactive, it becomes difficult to change quickly from sitting to standing or from standing to walking. The state of relative relaxation and contraction of different muscle groups is also disordered, so that rather than...
The relationship between asthma and sports appears to be dual in nature. It has long been recognized that asthmatics participating in sporting activities experience EIB. However, recent studies have highlighted high prevalences of chest tightness, cough, wheezing or prolonged shortness of breath and asthma in highly trained athletes, especially American football players, swimmers and cross-country skiers (Table 4.5.1), suggesting that exercise per se may cause normal individuals to develop asthma. In non-asthmatic subjects, inhalation of large volumes of cold air can cause a decrease in lung function 52 . Moreover, in a recent study, Langdeau et al. reported that 49 of elite athletes had bronchial hyperresponsiveness to metha-choline, defined as PC2Q 16 mg mL (provocative concentration causing 20 fall in FEVI), with a greater prevalence in those athletes exposed to cold air and humid air 53 . In a case control study, Heir and Oseid observed that cross-country skiers with a diagnosis...
The patient will usually recall the traumatic event that involved significant axial loading on the spine. Typically this occurs during landing following a high jump in gymnastics, or a head on tackle in football. The patient will complain of stiffness of the trunk and localized pain.
SYMPTOMS The symptoms are pain and immediate haemarthrosis, caused by bleeding from the ruptured ligament. This is an injury common in contact sports such as football, rugby and other high-intensity sports such as downhill skiing. There is often a 'pop' sound from the knee and an inability to continue.
SYMPTOMS There is a gradual or acute on set of effusion and exercise-induced pain often combined with mechanical problems of locking, clicking, clunking or discomfort on impact (compression and rotation). This injury is common in sports such as football, rugby and other high-intensity contact sports but can also occur gradually in sports where hypermobility is important, such as ballet, gymnastics and martial arts. AETIOLOGY In many cases this injury occurs from direct or indirect trauma or in association with other ligament injuries.
Repeated direct blows to the hand can cause vascular damage. Contusions often occur to the dorsum of the hand where the blood vessels, nerves, tendons, and bones are relatively superficial and there is little fat or muscle padding. Such injuries occur often in contact sports like football and rugby where the hand is unprotected. Contusions to the metacarpophalangeal joints are common in contact sports where fights occur or if a fist is used as part of the sport (i.e., boxing, football).
Mild TBI accounts for approximately 5 of injuries in high school athletes. Two-thirds occur in football players.253 Approximately 300,000 cases of mild TBI during sports and recreation are reported by American hospitals yearly. Many more occur. A variety of reasonable guidelines have been made about when to allow an athlete to return to play.254 Most athletes recover by 10 days after the concussion. The combination of a learning disability and concussion in college football players appears to synergistically lower subsequent cognitive performance.255 Amateur soccer players are also at greater risk compared to other athletes for impaired memory and plannning performance, especially after known concussion and probably associated with frequent headers to move the soccer ball.
Now consider how two different patients cope with a sprained ankle. Let us suppose that each has a severe sprain with marked swelling and a lot of pain but no fracture or ligament instability. One patient will be completely unable to bear weight and will need crutches for a week or so. The other will laugh or be insulted at the very suggestion of crutches. Instead, he will insist on having the ankle strapped up so that he can try to get ready for an important game of football next weekend. They each have a similar physical injury, but what they do about it is very different.
Among athletes, primary osteitis pubis is thought to be caused by repetitive microtrauma, chronic overuse injury, and muscle imbalance. The abdominal and adductor muscles have a central point of attachment on the symphysis pubis or the pivot point, but these muscles act antagonistically to each other, predisposing the pubic symphysis to opposing forces. These forces become critical in the kicking activities associated with sports such as soccer, Australian rules football, and North American football (Fig. 44-3). When an athlete kicks, the kicking limb is hyperextended at the hip while the trunk is rotated laterally in the opposite direction. Greater than 2 mm of vertical motion is seen in cases that are associated with pubic symphysis instability.
Figure 30-42 Normal anteroposterior radiograph of the ankle revealing a normal tibiofibular clear space (i), normal tibiofibular overlap (2), and normal medial clear space (3). Significant mortise widening is noted with widening of all three of these parameters. Note the distal fibula fracture. This injury is best treated with internal fixation of the fracture and stabilization of the ankle mortise with a syndesmosis screw. B, Football eversion injury shows widening medial mortise with associated deltoid tear, widening distal tibiofibular syndesmosis, high fibular fracture, and small posterior malleolus fracture (not seen here). (A courtesy James L. Moeller, MD B from Nicholas J, Hershman E. The Lower Extremity and Spine in Sports Medicine, vol i, 2nd ed. St Louis, Mosby, 1995, p 465.) Figure 30-42 Normal anteroposterior radiograph of the ankle revealing a normal tibiofibular clear space (i), normal tibiofibular overlap (2), and normal medial clear space (3). Significant mortise...
Other evidence that disgust is a basic emotion comes from studies of the development of disgust. The reaction of distaste, from which it is proposed that the reaction of disgust derives, can be observed in the newborn infant within 2 hours of birth (Rosenstein & Oster, 1988). Indeed, the facial expression for distaste in the newborn is identical to that for disgust in adults, and this facial expression is shown during development by congenitally blind children, so that the facial expression cannot simply be a learned one (Galati, Miceli, & Sini, 2001). The first item to acquire disgust properties is typically faeces, which occurs at about 2 years of age. The importance of this point was not lost on Freud (1910) who argued that the primary role of disgust was to prevent childhood coprophagia. Of course, from the age of 2 onwards the range of potential items that may become associated with disgust depends on a complex interaction of personal, familial, and cultural factors. For example,...
The average return to sports is approximately 14 days in football for metacarpal injuries and is independent of nonoperative or operative fixation. This time frame is very sport specific and position dependent. For example, a football lineman will be able to return more quickly than a receiver. However, the receiver will return sooner than a person involved in a racquet sport.
Figure 45-23 A 16-year-old high school football player develops acute onset of right hip pain doing squats. A, Sagittal view magnetic resonance arthrogram demonstrates a macerated anterior labrum (arrows). B, Viewing from the anterolateral portal, a macerated tear of the anterior labrum is probed along with articular delamination at its junction with the labrum. C, The damaged anterior labrum has been excised, revealing an overhanging lip (arrows) of impinging bone from the anterior acetabulum. D, Excision of the impinging portion of the acetabulum (acetabuloplasty) is performed with a bur. (Courtesy of J.W. Thomas Byrd, MD, Nashville, TN.) Figure 45-23 A 16-year-old high school football player develops acute onset of right hip pain doing squats. A, Sagittal view magnetic resonance arthrogram demonstrates a macerated anterior labrum (arrows). B, Viewing from the anterolateral portal, a macerated tear of the anterior labrum is probed along with articular delamination at its junction...
Disruption of the terminal extensor tendon at its insertion on the distal phalanx is one of the most common tendon injuries in sports. It is known as mallet finger, drop finger, or baseball finger. This is especially common in softball, baseball, and basketball and in football receivers.1 The injury usually occurs when a ball or other object hits the tip of the finger resulting in a flexion force while the extensor is actively contracting. The mallet deformity also may result from a direct blow to the dorsum of the DIP joint or secondary to a hyperextension force at this joint.69 In certain cases in which wearing a splint is not practical, such as in the health care professional, a single longitudinal K wire may be placed percutaneously across the DIP joint to maintain extension and allow continued function. This technique has limited application and is not usually recommended in the athlete. Continued participation in most sports is allowed during treatment of mallet finger as long...
Clinically, the athlete with a forefoot stress fracture will complain of pain and swelling in the midfoot just behind the metatarsal heads. The swelling and pain increase with activity and improve with rest. They are better in the morning after a night's sleep. Initial radiographs may not demonstrate the early stress reaction, but if the athlete continues to participate in her sport despite pain, the increased insult to the bone results in a fracture line, which can be seen radiographically. If rest is instituted early when pain first begins, radiographs may never show a fracture line but instead may reveal an area of increased bone density indicative of healing. Because foot mobility is needed for performance by many female athletes (e.g., the gymnast, runner, and dancer), these athletes cannot perform in a hard-soled shoe, as might a football lineman, and will lose from 4 to 10 weeks from sport until their fracture heals. Preventing stress fractures by proper conditioning, adequate...