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Sports Medicine Infections

Sports Medicine  -50% of primary care sports medicine is due to infection Infections & Exercise mild to moderate exercise lower rates of infection Hight Intensity Exercise 70-80% Max Heart Rate or longer duration increased risk of infections symptoms usually seen 3-4 days after inoculation decreased strength, decreased stroke volume, increased fatigue, etc Fever multistep response to infection increased metabolic rate…

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Cartilage Lesions

Cartilage Lesions Incidence ICRS Grading Scale Concomitant Pathologies malalignment varus valgus patellofemoral Ligamentous Instability Patellar Instability Osteochondritis Dissecans juvenile form (open physes) adult pathophysiology Indication for Surgery impending physical closure instability  fluid behind lesion expanding lesion on imaging failed nonoperative management Fixation >85% healing rate for juvenile OCD

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Posterior Cruciate Ligament Injuries (PCL)

Mechanisms dashboard hyper flexion hyper-extension Physical Exam can present with PF pain beware of false anterior drawer, because baseline tibia is subluxed due to PCL injury quad active test positive with 2mm shift reverse pivot shift moderately specific but also can be present in uninjured knee so check other side Radiographs alignment look for tibial spine avulsion fibular head avulsion…

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Dislocation of the Acromioclavicular Joint (JBJS 1987)

Screenshot-2015-05-20-00.12.34-e1432095302195-73x98 Dislocation of the Acromioclavicular Joint (JBJS 1987) Journal Club Shoulder | JC Sports Medicine | JC Upper Extremity | JC
Taft, T. N., Wilson, F. C., & Oglesby, J. W. (1987). Dislocation of the acromioclavicular joint. An end-result study. The Journal of Bone & Joint Surgery, 69(7), 1045. https://doi.org/3654696


In this classic article from JBJS, Taft et al. retrospectively analyzed 127 patients who had been treated both operatively and nonoperatively for acute dislocation of the acromioclavicular joint. Average follow-up was approximately 10 years. Fifty-two of the patients were managed with surgery and 75 were management without surgery.

Screenshot-2015-05-20-00.12.34-e1432095302195-73x98 Dislocation of the Acromioclavicular Joint (JBJS 1987) Journal Club Shoulder | JC Sports Medicine | JC Upper Extremity | JC   DC-Joint-Classification-300x238 Dislocation of the Acromioclavicular Joint (JBJS 1987) Journal Club Shoulder | JC Sports Medicine | JC Upper Extremity | JC

 

Classification system for acromioclavicular injury.

Key findings of operative versus nonoperative management of dislocation of the acromioclavicular joint
  • reduction of the AC joint was not necessary for good results
  • Operative management resulted in more complications than nonoperative management
  • 4 weeks of sling use led to good results (after gradual exercises)
  • In patients with persistent pain and symptoms, distal clavice resection was usually successful
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Running Injury Risk Using Minimalist Shoes is Influenced by Training Distance and Body Mass

Fuller, J. T., Thewlis, D., Buckley, J. D., Brown, N. A. T., Hamill, J., & Tsiros, M. D. (2017). Body Mass and Weekly Training Distance Influence the Pain and Injuries Experienced by Runners Using Minimalist Shoes. The American Journal of Sports Medicine, 363546516682497. https://doi.org/10.1177/0363546516682497


This randomized clinical trial performed in Australia investigated running injury risk in 61 male runners with a mean age of 27 years old. All participants had a rearfoot strike at the beginning of the trial and met minimum training and performance requirements. Participants were randomized to a minimalist shoe or conventional shoe group for the remainder of the study. The minimalist shoe runners were then transitioned from their conventional shoes to minimalist shoes gradually over a 26 week period. Ultimately, 31 runners were allocated to the minimalist shoe group and 30 runners were allocated to the conventional shoe group. Runners completed a visual analog scale (VAS) weekly to assess their pain levels.
home_cover-73x98 Running Injury Risk Using Minimalist Shoes is Influenced by Training Distance and Body Mass Journal Club Sports Medicine | JC   home_cover-1x1 Running Injury Risk Using Minimalist Shoes is Influenced by Training Distance and Body Mass Journal Club Sports Medicine | JC

home_cover-73x98 Running Injury Risk Using Minimalist Shoes is Influenced by Training Distance and Body Mass Journal Club Sports Medicine | JC   home_cover-1x1 Running Injury Risk Using Minimalist Shoes is Influenced by Training Distance and Body Mass Journal Club Sports Medicine | JC   Screenshot-2017-02-04-14.12.35-300x264 Running Injury Risk Using Minimalist Shoes is Influenced by Training Distance and Body Mass Journal Club Sports Medicine | JC

Linear fixed-effects model predicted differences in weekly pain between minimalist and conventional shoes relative to weekly training distance.

Key findings of minimalist vs. conventional shoes include:
  • Knee, calf, shin, and ankle pain scores were significantly higher (more self-reported pain) in the minimalist shoe group than the conventional shoe group
  • There were no differences in foot, thigh, or lower back pain scores between groups
  • For runners using minimalist shoes, the risk of injury increased with increasing body mass and with increasing training distance
  • For runners using minimalist shoes, a body mass of 85kg or more correlated with a 68% chance of injury by the end of the 26 week training period
  • For runners using minimalist shoes, a weekly training distance of more than 21.7 miles resulted in a clinically significant increase in calf pain compared to conventional shoes
  • A weekly training distance of more than 24.9 miles resulted in clinically significant increases in shin and ankle pain compared to conventional shoes
  • Runners over 187 lbs were more than 3x as likely to sustain a running injury
  • The study authors concluded that heavier runners should avoid running in minimalist shoes
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Degenerative Cervical Spine

Cervical Spondylosis degenerative changes facet arthropathy begins @ 40 years of age, by 60-70 years most men and women have it symptoms can be discogenic neck pain, radiculopathy, and/or myelopathy As disc ages decrease in disk hydration decreased chondroitin sulfate increased keratin sulfate Inflammatory mediators IL-1 TNF-alpha Most common at C5-6, next at C4-5 How to Classify Stenosis acquired or…

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Tibial Shaft Fractures | Lower Extremity Trauma

  Usually classified by location (proximal, middle, distal) AO/OTA Classification of Shaft Fractures (see Figure) proximal, middle, or distal Types A, B, and C Oestern & Tscherne Classification of Soft Tissue Injury (Closed) C-0: little or no soft tissue injury C-I: superficial abrasion C-II: deep, contaminated abrasion with local contusion damage to skin or muscle C-III: extensive skin contusion or crushing…

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Tibial Plateau Fractures | Lower Extremity Trauma

Tibial Plateau Fractures Schatzker Classification I - Lateral plateau split young people with good bone lateral meniscus tear trapped in fracture II- Lateral plateau split-depression valgus blow with axial loading age > 40 III - Lateral plateau depression (tend to be stable) IV - Medial plateau fracture (15% of plateau fractures) less common associated with LCL injury pattern most commonly…

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NCAA Football Injuries – Most Surgeries are Arthroscopic

2459519 TSUTWFM8 items 1 default ASC http://www.orthoconsult.com/wp-content/plugins/zotpress/ Epidemiologic study of NCAA (collegiate) football injuries across 60 teams over 5 seasons. Most common orthopaedic injuries were lower extremity. This 2016 study utilized information from the NCAA injury surveillance system over 5 seasons. Key findings include: Over 18,000 football injuries 39% were in competition, 56% were in regular practices The highest injury…

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