Overuse Elbow Injuries in Youth Gymnasts

2021 ◽  
pp. 036354652110007
Author(s):  
Nicholas A. Bonazza ◽  
Eliana B. Saltzman ◽  
Jocelyn R. Wittstein ◽  
Marc J. Richard ◽  
Whitney Kramer ◽  
...  
Keyword(s):  
Osteochondritis Dissecans ◽  
Radial Head ◽  
Nonoperative Treatment ◽  
Rehabilitation Program ◽  
Overuse Injuries ◽  
Lateral Side ◽  
Clinical Expertise ◽  
Pubmed Database ◽  
Elbow Injuries ◽  
Early Specialization

Background: Gymnastics is a unique sport that places significant loads across the growing elbow, resulting in unique overuse injuries, some of which are poorly described in the current literature. Purpose: To provide a comprehensive review of the unique overuse elbow injuries seen in youth gymnasts and to provide an up-to-date synthesis of the available literature and clinical expertise guiding treatment decisions in this population. Study Design: Narrative review. Methods: A review of the PubMed database was performed to include all studies describing elbow biomechanics during gymnastics, clinical entities of the elbow in gymnasts, and outcomes of operative and/or nonoperative treatment of elbow pathology in gymnasts. Results: Participation in gymnastics among youth athletes is high, being the sixth most common sport in children. Early specialization is the norm in this sport, and gymnastics also has the highest number of participation hours of all youth sports. As a result, unique overuse elbow injuries are common, primarily on the lateral side of the elbow. Beyond common diagnoses of radiocapitellar plica and osteochondritis dissecans of the capitellum, we describe a pathology unique to gymnasts involving stress fracture of the radial head. Additionally, we synthesized our clinical experience and expertise in gymnastics to provide a sport-specific rehabilitation program that can be used by providers treating surgical and nonsurgical conditions of the elbow and wishing to provide detailed activity instructions to their athletes. Conclusion: Overuse injuries of the elbow are common in gymnastics and include osteochondritis dissecans of the capitellum, radiocapitellar plica syndrome, and newly described radial head stress fractures. A thorough understanding of the psychological, cultural, and biomechanical aspects of gymnastics are necessary to care for these athletes.

scholarly journals Osteochondritis Dissecans of the Tibial Plateau in Children and Adolescents: A Case Series

2020 ◽  
Vol 8 (8) ◽  
pp. 232596712094138
Author(s):  
Millicent Croman ◽  
Dennis E. Kramer ◽  
Benton E. Heyworth ◽  
Mininder S. Kocher ◽  
Lyle J. Micheli ◽  
...  
Keyword(s):  
Osteochondritis Dissecans ◽  
Tibial Plateau ◽  
Femoral Condyle ◽  
Young Patients ◽  
Case Series ◽  
Lateral Compartment ◽  
Nonoperative Treatment ◽  
Lateral Side ◽  
Level Of Evidence ◽  
Presenting Symptoms

Background: Osteochondritis dissecans (OCD) of the knee is a relatively well-known condition, most commonly arising in the femoral condyle. Lesions arising in the tibial plateau are rarely described. Purpose: To present a case series of OCD lesions of the tibial plateau. Study Design: Case series; Level of evidence, 4. Methods: Medical records and diagnostic imaging of patients <20 years of age with confirmed diagnosis of OCD of the tibial plateau from a single institution were retrospectively reviewed. Characteristic and radiographic features as well as details of both nonoperative and surgical management were investigated. Lesion characteristics and treatment outcomes were also analyzed. Results: A total of 9 lesions were identified in 9 patients (5 females, 4 males) who fit the inclusion criteria. The mean age at diagnosis was 14.2 years (range, 9-17 years). Knee pain (8/9) of longer than 1 year in duration was the most common presenting symptom. All 9 lesions were located on the lateral tibial plateau, and concomitant lateral compartment pathology was present in 5 of 9 patients (4 lateral femoral condyle OCDs, 3 lateral meniscal tears [1 discoid], and 1 discoid meniscus). Only 2 lesions were visible on initial radiographs; all 9 were visible on magnetic resonance imaging. All patients underwent initial nonoperative treatment; 2 patients demonstrated resolution of symptoms. Two patients underwent surgery for concomitant pathology, and the OCD was not addressed surgically. A total of 5 patients continued to be symptomatic after nonoperative treatment, prompting surgical intervention, which consisted of microfracture and chondroplasty in all 5 cases. A total of 2 of the 5 microfracture patients had resolution of symptoms, while another 2 patients had continued symptoms ultimately responsive to steroid injection treatment. One patient had revision microfracture, followed by autologous chondrocyte implantation and an arthroscopic lysis of adhesions. At final follow-up, ranging from 7 months to 10 years, 8 patients were asymptomatic, while 1 patient had developed early osteoarthritis. Conclusion: OCD of the tibial plateau in young patients is rare, usually involves the lateral side, and may have significant long-term implications for knee function. Presenting symptoms are often vague, and lesions may not always be visible on initial radiographs, which may lead to delayed treatment and adversely affect outcomes.

scholarly journals Age-Specific Prevalence and Clinical Characteristics of Humeral Medial Epicondyle Apophysitis and Osteochondritis Dissecans: Ultrasonographic Assessment of 4249 Players

2017 ◽  
Vol 5 (5) ◽  
pp. 232596711770770 ◽  
Author(s):  
Kenichi Otoshi ◽  
Shinichi Kikuchi ◽  
Kinshi Kato ◽  
Ryohei Sato ◽  
Takahiro Igari ◽  
...  
Keyword(s):  
Osteochondritis Dissecans ◽  
Morphological Changes ◽  
Medial Epicondyle ◽  
Baseball Players ◽  
Elbow Pain ◽  
Elbow Injuries ◽  
Bony Healing ◽  
History Of ◽  
Study Participants ◽  
Ultrasonographic Assessment

Background: Traction apophysitis of medial epicondyle (MEC) lesions and osteochondritis dissecans (OCD) of the capitellum are common elbow injuries in adolescent baseball players. However, the age-specific prevalence of these pathologies and their influence on elbow pain remain unknown. Purpose: To investigate the age-specific prevalence of each MEC lesion and capitellar OCD and to identify the incidence of elbow pain in each condition. Study Design: Descriptive epidemiology study. Methods: Study participants consisted of 4249 baseball players aged 6 to 17 years. A questionnaire was used to assess history of elbow pain, and morphological changes of the elbow joint were assessed using ultrasonography. Results: Regarding MEC lesions, fragmented (FG) and irregular (IR) lesions both reached their greatest respective prevalence at 11 to 12 years of age. After 14 years of age, IR decreased sharply, whereas FG was maintained at approximately 10%. Hypertrophic (HT) lesions increased sharply, reaching over 50% at 16 years of age, while there was a decrease in IR and FG lesions in the same age group. The prevalence of capitellar OCD remained the same (approximately 2%) throughout all ages except for in players aged 7 to 8 years (>7%). Players with MEC lesions had significantly greater prevalence of a history of elbow pain compared with those without (68.0% vs 39.1%) and were at a significantly greater risk for FG lesions (odds ratio [OR], 4.04; 95% CI, 3.16-5.22) compared with IR (OR, 3.22; 95% CI, 2.44-4.27) and HT lesions (OR, 2.03; 95% CI, 1.75-2.36). Players with capitellar OCD also had a significantly greater risk of a history of elbow pain (OR, 2.34; 95% CI, 1.40-4.11). Conclusion: Controlling the amount of practice and its intensity according to the condition of each player in the preadolescent and adolescent periods may be important in accelerating bony healing and decreasing preventable elbow pain in adulthood.

scholarly journals Clinical Utility of an MRI-Based Classification System for Operative Versus Nonoperative Management of Ulnar Collateral Ligament Tears: A 2-Year Follow-up Study

2019 ◽  
Vol 7 (4) ◽  
pp. 232596711983978 ◽  
Author(s):  
Prem N. Ramkumar ◽  
Heather S. Haeberle ◽  
Sergio M. Navarro ◽  
Salvatore J. Frangiamore ◽  
Lutul D. Farrow ◽  
...  
Keyword(s):  
Classification System ◽  
Odds Ratio ◽  
Clinical Utility ◽  
Nonoperative Management ◽  
Ulnar Collateral Ligament ◽  
Nonoperative Treatment ◽  
Rehabilitation Program ◽  
Collateral Ligament ◽  
Baseball Players

Background: A recently introduced classification system of medial ulnar collateral ligament (UCL) tears accounting for location and severity has demonstrated high interobserver and intraobserver reliability, but little is known about its clinical utility. Purpose: The primary purpose of this study was to assess the relationship of the magnetic resonance imaging (MRI)–based classification system in predicting which athletes had success with nonoperative versus operative treatment after completing a standardized rehabilitation program. A secondary objective included return to play (RTP) and return to prior performance (RPP) analyses of baseball players. Study Design: Cohort study; Level of evidence, 3. Methods: After an a priori power analysis, 58 consecutive patients with UCL tears and a minimum of 2-year follow-up were retrospectively divided into 2 groups: those who successfully completed operative treatment and those who completed nonoperative treatment. The MRI-based classification stages accounting for UCL tear location and severity were compared between the nonoperative and operative groups. A subanalysis for baseball players, including RTP and RPP, was performed. Results: A total of 58 patients (40 baseball players [34 pitchers]) met inclusion criteria. Of these patients 35 (32 baseball players [27 pitchers]) underwent surgery, and 23 (8 baseball players [7 pitchers]) underwent nonoperative management. No patients in the nonoperative arm crossed over to surgery after completing the rehabilitation program. Patients with distal tears (odds ratio, 48.0; P = .0004) and complete tears (odds ratio, 5.4; P = .004) were more likely to undergo surgery. Baseball players, regardless of position, were confounding determinants of operative management, although there was no difference in RTP and RPP between treatment arms. Conclusion: A 6-stage MRI-based classification system addressing UCL tear location and severity may help early decision making, as patients likely to fail nonoperative treatment have complete, distal tears, whereas those with proximal, partial tears may be more amenable to nonoperative management.

scholarly journals Rehabilitation of discourse impairments after acquired brain injury

2014 ◽  
Vol 8 (1) ◽  
pp. 58-65 ◽  
Author(s):  
Gigiane Gindri ◽  
Karina Carlesso Pagliarin ◽  
Fabíola Schwengber Casarin ◽  
Perrine Ferré ◽  
Yves Joanette ◽  
...  
Keyword(s):  
Brain Injury ◽  
Social Life ◽  
Negative Impact ◽  
Acquired Brain Injury ◽  
Rehabilitation Program ◽  
Neurological Injury ◽  
Diagnostic Tools ◽  
Cognitive Domains ◽  
Pubmed Database ◽  
Patient Performance

ABSTRACT Language impairments in patients with acquired brain injury can have a negative impact on social life as well as on other cognitive domains. Discourse impairments are among the most commonly reported communication deficits among patients with acquired brain damage. Despite advances in the development of diagnostic tools for detecting such impairments, few studies have investigated interventions to rehabilitate patients presenting with these conditions. Objective: The aim of this study was to present a systematic review of the methods used in the rehabilitation of discourse following acquired brain injury. Methods: The PubMed database was searched for articles using the following keywords: "rehabilitation", "neurological injury", "communication" and "discursive abilities". Results: A total of 162 abstracts were found, but only seven of these met criteria for inclusion in the review. Four studies involved samples of individuals with aphasia whereas three studies recruited samples of individuals with traumatic brain injury. Conclusion: All but one article found that patient performance improved following participation in a discourse rehabilitation program.

scholarly journals Stress Fracture and Nonunion of Coronoid Process in a Gymnast

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
T. Hetling ◽  
P. Bourban ◽  
B. Gojanovic
Keyword(s):  
Body Weight ◽  
Literature Review ◽  
Mechanical Loading ◽  
Stress Fracture ◽  
Return To Sport ◽  
Rehabilitation Program ◽  
Coronoid Process ◽  
Overuse Injuries ◽  
Case Description ◽  
Return To Competition

Background. Gymnasts have high mechanical loading forces of up to 14 times body weight. Overuse lesions are typical in wrists and stress fractures in the olecranon, while isolated fractures of the coronoid process are uncommon. We present a case of retraumatized nonunion stress fracture of the ulnar coronoid process.Case Description. A 19-year-old gymnast presented with elbow pain after training. Imaging confirmed an old fracture of the coronoid process. We describe a 6-month multiphase return to competition rehabilitation program, which allowed him to compete pain-freely.Literature Review. Acute and overuse injuries in gymnasts are known but no nonunion of the coronoid process has been described before. Only one case of stress fracture of coronoid process in a gymnast was reported.Purpose and Clinical Relevance. We could successfully and conservatively return to sport a reactivated nonunion of a stress fracture of the coronoid process.

Nonoperative Treatment of Osteochondritis Dissecans of the Knee

2014 ◽  
Vol 33 (2) ◽  
pp. 295-304 ◽  
Author(s):  
Justin S. Yang ◽  
Ljiljana Bogunovic ◽  
Rick W. Wright
Keyword(s):  
Osteochondritis Dissecans ◽  
Nonoperative Treatment

Intraoperative Acoustic Evaluation of Living Human Cartilage of the Elbow and Knee during Mosaicplasty for Osteochondritis Dissecans of the Elbow

2008 ◽  
Vol 36 (12) ◽  
pp. 2345-2353 ◽  
Author(s):  
Kohei Nishitani ◽  
Yasuaki Nakagawa ◽  
Tadashi Gotoh ◽  
Masahiko Kobayashi ◽  
Takashi Nakamura
Keyword(s):  
Osteochondritis Dissecans ◽  
Radial Head ◽  
Material Properties ◽  
Signal Intensity ◽  
Early Stage ◽  
Young Male ◽  
Signal Duration ◽  
Transform Method ◽  
Human Cartilage ◽  
Intensity Index

Background Autologous osteochondral mosaicplasty for osteochondritis dissecans of the capitellum is being used increasingly In adolescent patients. Little research has been published on the material properties of living human cartilage of the elbow and knee. Hypothesis The cartilage of the osteochondritis dissecans lesion is detected as degenerated by ultrasound. The material properties of the cartilage of the intact part of the elbow are not different from those of the intact knee except in thickness. Study Design Descriptive laboratory study. Methods The authors studied 10 young male athletes with osteochondritis dissecans of the capitellum who underwent mosaicplasty. An acoustic probe was used for measurement, and the wavelet transform method was used. Three parameters were used: signal intensity (Index of cartilage stiffness), signal duration (index of roughness), and signal interval (index of thickness). Results The cartilage of the osteochondritis dissecans lesion had lower signal intensity than did the intact part of the capitellum. The cartilage of the radial head opposite the capitellum had significantly lower signal intensity and higher signal duration than did other sites. The signal intensity of the radial head was significantly higher in early-stage patients than in late-stage Patients, although the macroscopic view was almost all intact. The signal intensity of the plug was decreased significantly after 9rafting. Conclusion The osteochondritis dissecans lesion had lower signal intensity than did the intact part of the capitellum. Although the macroscopic view looked intact, the radial head cartilage was degenerated as measured acoustically. Clinical Relevance Not only the cartilage of the capitellum but the cartilage of the radial head are acoustically degenerated in osteochondritis dissecans patients. Plugs might be damaged in the transplanting procedure, and further follow-up is necessary.

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