scholarly journals Clavicular Fracture in a Collegiate Football Player: A Case Report of Rapid Return to Play

2011 ◽  
Vol 46 (1) ◽  
pp. 107-111 ◽  
Author(s):  
Sarah B. Rabe ◽  
Gretchen D. Oliver
Keyword(s):  
Surgical Treatment ◽  
Sports Medicine ◽  
National Collegiate Athletic Association ◽  
Health And Safety ◽  
Field Evaluation ◽  
Football Player ◽  
Return To Play ◽  
Clavicular Fracture ◽  
Rehabilitation Protocols ◽  
Division I Football

Abstract Objective: To present the case of surgical treatment and rehabilitation of a midshaft clavicular fracture in a National Collegiate Athletic Association Division I football athlete. Background: While attempting to catch a pass during practice, the athlete jumped up and then landed on the tip of his shoulder. On-the-field evaluation was inconclusive, with a sideline evaluation diagnosis of clavicular fracture. Postinjury radiographs revealed a midshaft clavicular fracture. Differential Diagnosis: Spiral oblique midshaft clavicular fracture. Treatment: The sports medicine staff discussed surgical and nonsurgical options. A surgical procedure of internal fixation with an 8-hole plate was performed. Uniqueness: Surgical treatment for clavicular fractures is becoming increasingly common. This is the first report of an advanced rehabilitation protocol for surgical repair. We suggest that new rehabilitation protocols for clavicular repairs be investigated now that surgical treatment is being pursued more frequently. Conclusions: More aggressive treatment procedures and rehabilitation protocols for clavicular fractures have evolved in recent years. With these medical advancements, athletes are able to return to play much more quickly without compromising their health and safety.

scholarly journals Return to Play After Exertional Rhabdomyolysis

2016 ◽  
Vol 51 (5) ◽  
pp. 406-409 ◽  
Author(s):  
Kevin Schleich ◽  
Tyler Slayman ◽  
Douglas West ◽  
Kyle Smoot
Keyword(s):  
Sports Medicine ◽  
National Collegiate Athletic Association ◽  
Medical Literature ◽  
Athletic Trainers ◽  
Return To Sport ◽  
Division I ◽  
Return To Play ◽  
Actual Process ◽  
Exertional Rhabdomyolysis ◽  
Division I Football

Objective: To outline a 4-phase progressive program that safely and successfully enabled athletes to return to sport without recurrence of exertional rhabdomyolysis symptoms. Background: In January 2011, a large cluster of National Collegiate Athletic Association Division I football athletes were evaluated and treated for exertional rhabdomyolysis. After the athletes were treated, the athletic trainers and sports medicine providers were challenged to develop a safe return-to-play program because of the lack of specific reports in the medical literature to direct such activities. Treatment: A progressive 4-phase program based on existing recommendations, including guidelines for continued clinical and laboratory monitoring. Conclusions: Although the actual process of reintegrating players will differ based on each athlete's unique circumstances, this program provides a safe and effective foundation that can be modified based on the response to activity and sport.

Assessment of Mild Head Injury Using Measures of Balance and Cognition: A Case Study

1997 ◽  
Vol 6 (3) ◽  
pp. 283-289 ◽  
Author(s):  
Bryan L. Riemann ◽  
Kevin M. Guskiewicz
Keyword(s):  
Head Injury ◽  
Sports Medicine ◽  
Athletic Trainers ◽  
Head Injuries ◽  
Football Player ◽  
Athletic Participation ◽  
Return To Play ◽  
Mild Head Injury ◽  
Collegiate Football

Mild head injury (MHI) represents one of the most challenging neurological pathologies occurring during athletic participation. Athletic trainers and sports medicine personnel are often faced with decisions about the severity of head injury and the timing of an athlete's return to play following MHI. Returning an athlete to competition following MHI too early can be a catastrophic mistake. This case study involves a 20-year-old collegiate football player who sustained three mild head injuries during one season. The case study demonstrates how objective measures of balance and cognition can be used when making decisions about returning an athlete to play following MHI. These measures can be used to supplement the subjective guidelines proposed by many physicians.

scholarly journals Current Practices in the Treatment of Syndesmotic Injuries: A Global Perspective

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0011
Author(s):  
Jonathan Bartolomei ◽  
Shanthan C. Challa ◽  
Kenneth J. Hunt ◽  
Daniel K. Moon
Keyword(s):  
North American ◽  
Sports Medicine ◽  
Return To Sport ◽  
High Impact ◽  
Optimal Treatment ◽  
Return To Play ◽  
Considerable Variability ◽  
Flexible Devices ◽  
Fixation Devices ◽  
Rehabilitation Protocols

Category: Ankle; Sports Introduction/Purpose: There exists little consensus regarding optimal treatment protocols for syndesmotic injuries. Orthopedic clinicians have implemented a variety of treatment strategies, ranging from immobilization to screw fixation to new flexible fixation devices. While the body of literature is growing with regard to both the biomechanics and clinical outcomes for various constructs and rehabilitation protocols, there is little consensus on the optimal treatment and return to sport strategy for these injuries. We endeavored to assess current approaches to syndesmotic injuries by orthopedic foot and ankle specialists around the world in six athlete scenarios with increasing degrees of injury. Commensurate with the lack of available data to guide treatments, we hypothesize that there will be great variability in the treatment and management of syndesmotic injuries. Methods: A REDcap survey was created with 27 questions, including respondent demographics, indications for treatment of syndesmotic injuries, preferred treatment, preferred technique for repairing the syndesmosis, and post-operative management. Respondents were asked to choose their preferred fixation device and post-operative return to play protocols in six different athlete scenarios (moderate impact, high impact, and very high impact and each with/without complete deltoid injury). The survey was disseminated among the memberships of 18 North American and International medical societies. Society members were surveyed via three emails distributed two weeks apart. Frequencies and percentages were calculated for all categorical responses. Results: A total of 596 providers responded to the survey, including 337 American surgeons and 259 members of various international societies. There was a 70% survey completion rate with a wide geographic distribution among respondents. Flexible devices were the preferred fixation construct (48%), followed by screws (27%), hybrid fixation (19%) and other (6%). There was a higher preference for flexible devices among sports medicine trained providers (58%) relative to non-sports medicine trained providers (44%). 62% of respondents noted that their rehabilitation protocols would not change for each athlete scenario. Considerable variability was present in anticipated full return to sport, ranging from immediately following injury to six months post-op. 33% stated that they would repair the deltoid ‘greater than 50%’ of the time if injured. Conclusion: There is a wide variety of indications and treatment constructs employed by orthopedic surgeons for athletes with ligamentous syndesmotic injuries requiring fixation. Although flexible fixation devices are the preferred choice among all respondents, there was considerable variability in device choices. Fellowship training also appears to affect the preferred fixation method. There was no overall difference between device preference between North American and International respondents (Fig1). There also exists substantial variability in expected return to play for every athlete scenario. The diversity in approaches and post-operative recommendations underscores the need for evidence-based guidelines regarding the management of syndesmotic injuries.

scholarly journals The Evolving Approach to Treating Syndesmotic Injuries in the Elite Athlete: An International Perspective

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0040
Author(s):  
Jonathan Bartolomei ◽  
Kenneth Hunt ◽  
Shanthan Challa
Keyword(s):  
Sports Medicine ◽  
Return To Sport ◽  
High Impact ◽  
Optimal Treatment ◽  
Return To Play ◽  
Considerable Variability ◽  
Fixation Device ◽  
Flexible Devices ◽  
Fixation Devices ◽  
Rehabilitation Protocols

Objectives: There exists little consensus regarding optimal treatment protocols for syndesmotic injuries. Orthopaedic clinicians have implemented a variety of treatment strategies, ranging from immobilization to screw fixation to new flexible fixation devices. While the body of literature is growing with regard to both the biomechanics and clinical outcomes for various constructs and rehabilitation protocols, there is little consensus on the optimal treatment and return to sport strategy for these injuries. We endeavored to assess current approaches to syndesmotic injures by orthopedic foot and ankle specialists around the world in 6 athlete scenarios with increasing degree of injury. Commensurate with the lack of available data to guide treatments, we hypothesize that there will be great variability in the treatment and management of syndesmotic injuries. Methods: A REDcap survey was created with 27 questions, including respondent demographics, indications for treatment of syndesmotic injuries, preferred treatment, preferred technique for repairing the syndesmosis and post-operative management. Respondents were asked to choose their preferred fixation device and post-operative return to play protocols in six different athlete scenarios (moderate impact, high impact and very high impact and each with/without complete deltoid injury). The survey was disseminated among the memberships of 18 North American and International medical societies. Society members were surveyed via three emails disseminated 2 weeks apart. Frequencies and percentages were calculated for all categorical responses. Results: A total of 596 providers responded to the survey, including 337 American surgeons and 259 members of various international societies. There was a 70% survey completion rate with a wide geographic distribution among respondents. Flexible devices were the preferred fixation construct (48%), followed by screws (27%), hybrid fixation (19%) and other (6%). There was a higher preference for flexible devices among sports medicine trained providers (58%) relative to non-sports medicine trained providers (44%). 62% of respondents noted that their rehabilitation protocols would not change for each athlete scenario. Considerable variability was present in anticipated full return to sport, ranging from immediately following injury to 6 months post-op (Fig 1). 33% stated that they would repair the deltoid ‘greater than 50%’ of the time if injured. Conclusion: There is a wide variety of indications and treatment constructs employed by orthopaedic surgeons for athletes with ligamentous syndesmotic injuries requiring fixation. Although, flexible fixation devices are the preferred among all respondents but there was a considerable variability in device choices. Fellowship training also appears to affect the preferred fixation device choice. There also exists substantial variability in expected return to play for every athlete scenario (Fig 1). The diversity in approaches and post-operative recommendations underscores the need for evidence-based guidelines regarding management of syndesmotic injuries.

scholarly journals Collegiate Athletic Trainers' Experiences With External Pressures Faced During Decision Making

2020 ◽  
Vol 55 (4) ◽  
pp. 409-415
Author(s):  
Alicia M. Pike Lacy ◽  
Stephanie Mazerolle Singe ◽  
Thomas G. Bowman
Keyword(s):  
Ncaa Division I ◽  
Sports Medicine ◽  
National Collegiate Athletic Association ◽  
Athletic Trainers ◽  
External Pressure ◽  
Division I ◽  
Return To Play ◽  
Major Theme ◽  
Patient Centered ◽  
Medical Decisions

Context Conflict is prevalent between sports medicine professionals and coaching staffs regarding return-to-play decisions for athletes after injury in the National Collegiate Athletic Association (NCAA) Division I setting. The firsthand experiences of athletic trainers (ATs) regarding such conflict have not been fully investigated. Objective To better understand the outside pressures ATs face when making medical decisions regarding patient care and return to play after injury in the NCAA Division I Football Bowl Subdivision (FBS) setting. Design Qualitative study. Setting Semistructured one-on-one telephone interviews. Patients or Other Participants Nine ATs (4 men, 5 women; age = 31 ± 8 years [range = 24–48 years]; years certified = 9 ± 8). Data Collection and Analysis Interviews were audio recorded and later transcribed. Thematic analysis was completed phenomenologically. Researcher triangulation, peer review, and member checks were used to establish trustworthiness. Results Two major themes emerged from the qualitative analysis: (1) pressure is an expected component of the Division I FBS AT role, and (2) strategies can be implemented to mitigate the negative effects of pressure. Three subthemes supported the second major theme: (1) ensuring ongoing and frequent communication with stakeholders about an injured athlete's status and anticipated timeline for return to play, (2) providing a rationale to coaches or administrations to foster an understanding of why specific medical decisions are being made, and (3) establishing positive relationships with coaches, athletes, and administrations. Conclusions External pressure regarding medical decisions was an anticipated occurrence for our sample. Such pressure was described as a natural part of the position, not negative but rather a product of the culture and environment of the Division I FBS setting. Athletic trainers who frequently face pressure from coaches and administration should use the aforementioned strategies to improve the workplace dynamic and foster an environment that focuses on patient-centered care.

Return to Activity Considerations in a Football Player Predisposed to Exertional Heat Illness: A Case Study

2007 ◽  
Vol 16 (3) ◽  
pp. 260-270 ◽  
Author(s):  
Eric Emmanuel Coris ◽  
Stephen Walz ◽  
Jeff Konin ◽  
Michele Pescasio
Keyword(s):  
Sports Medicine ◽  
Football Player ◽  
Return To Play ◽  
Heat Illness ◽  
Competitive Sport ◽  
Exertional Heat Illness ◽  
The Third ◽  
Return To Activity ◽  
Medicine Team

Context:Heat illness is the third leading cause of death in athletics and a leading cause of morbidity and mortality in exercising athletes. Once faced with a case of heat related illness, severe or mild, the health care professional is often faced with the question of when to reactivate the athlete for competitive sport. Resuming activity without modifying risk factors could lead to recurrence of heat related illness of similar or greater severity. Also, having had heat illness in and of itself may be a risk factor for future heat related illness. The decision to return the athlete and the process of risk reduction is complex and requires input from all of the components of the team. Involving the entire sports medicine team often allows for the safest, most successful return to play strategy. Care must be taken once the athlete does begin to return to activity to allow for re-acclimatization to exercise in the heat prior to resumption particularly following a long convalescent period after more severe heat related illness.

scholarly journals Talocrural Dislocation With Associated Weber Type C Fibular Fracture in a Collegiate Football Player: A Case Report

2008 ◽  
Vol 43 (3) ◽  
pp. 319-325 ◽  
Author(s):  
R. Daniel Ricci ◽  
James Cerullo ◽  
Robert O. Blanc ◽  
Patrick J. McMahon ◽  
Anthony M. Buoncritiani ◽  
...  
Keyword(s):  
Athletic Training ◽  
Ankle Joint ◽  
Sports Medicine ◽  
Football Player ◽  
Division I ◽  
Rehabilitation Protocol ◽  
Fibular Fracture ◽  
Weber Type ◽  
Type C ◽  
Division I Football

Abstract Objective: To present the case of a talocrural dislocation with a Weber type C fibular fracture in a National Collegiate Athletic Association Division I football athlete. Background: The athlete, while attempting to make a tackle during a game, collided with an opponent, who in turn stepped on the lateral aspect of the athlete's ankle, resulting in forced ankle eversion and external rotation. On-field evaluation showed a laterally displaced talocrural dislocation. Immediate reduction was performed in the athletic training room to maintain skin integrity. Post-reduction radiographs revealed a Weber type C fibular fracture and increased medial joint clear space. A below-knee, fiberglass splint was applied to stabilize the ankle joint complex. Differential Diagnosis: Subtalar dislocation, Maisonneuve fracture, malleolar fracture, deltoid ligament rupture, syndesmosis disruption. Treatment: The sports medicine staff immediately splinted and transported the athlete to the athletic training room to reduce the dislocation. The athlete then underwent an open reduction and internal fixation procedure to stabilize the injury: 2 syndesmosis screws and a fibular plate were placed to keep the ankle joint in an anatomically reduced position. With the guidance of the athletic training staff, the athlete underwent an accelerated physical rehabilitation protocol in an effort to return to sport as quickly and safely as possible. Uniqueness: Most talocrural dislocations and associated Weber type C fibular fractures are due to motor vehicle accidents or falls. We are the first to describe this injury in a Division I football player and to present a general rehabilitation protocol for a high-level athlete. Conclusions: Sports medicine practitioners must recognize that this injury can occur in the athletic environment. Prompt reduction, early surgical intervention, sufficient resources, and an accelerated rehabilitation protocol all contributed to a successful outcome in the patient.

scholarly journals A Comparison of Physical Therapy Protocols Between Open Latarjet Coracoid Transfer and Arthroscopic Bankart Repair

2020 ◽  
Vol 12 (2) ◽  
pp. 124-131
Author(s):  
Alexander Beletsky ◽  
Jourdan M. Cancienne ◽  
Brandon J. Manderle ◽  
Nabil Mehta ◽  
Kevin E. Wilk ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Sports Medicine ◽  
Return To Sport ◽  
Return To Play ◽  
Bankart Repair ◽  
Level Of Evidence ◽  
Arthroscopic Bankart Repair ◽  
Rehabilitation Protocols ◽  
Level 3 ◽  
Tissue Stabilization

Context: Recent studies examining return to sport after traumatic shoulder instability suggest faster return-to-sport time lines after bony stabilization when compared with soft tissue stabilization. The purpose of the current study was to define variability across online Latarjet rehabilitation protocols and to compare Latarjet with Bankart repair rehabilitation time lines. Evidence Acquisition: Online searches were utilized to identify publicly available rehabilitation protocols from Accreditation Council for Graduate Medical Education (ACGME)–accredited academic orthopaedic surgery programs. Study Design: Descriptive epidemiology study. Level of Evidence: Level 3. Results: Of the 183 ACGME-accredited orthopaedic programs reviewed, 14 institutions (7.65%) had publicly available rehabilitation protocols. A web-based search yielded 17 additional protocols from private sports medicine practices. Of the 31 protocols included, 31 (100%) recommended postoperative sling use and 26 (84%) recommended elbow, wrist, and hand range of motion exercises. Full passive forward flexion goals averaged 3.22 ± 2.38 weeks postoperatively, active range of motion began on average at 5.22 ± 1.28 weeks, and normal scapulothoracic motion by 9.26 ± 4.8 weeks postoperatively. Twenty (65%) protocols provided specific recommendations for return to nonoverhead sport–specific activities, beginning at an average of 17 ± 2.8 weeks postoperatively. This was compared with overhead sports or throwing activities, for which 18 (58%) of protocols recommended beginning at a similar average of 17.1 ± 3.3 weeks. Conclusion: Similar to Bankart repair protocols, Latarjet rehabilitation protocols contain a high degree of variability with regard to exercises and motion goal recommendations. However, many milestones and start dates occur earlier in Latarjet protocols when compared with Bankart-specific protocols. Consequently, variability in the timing of rehabilitation goals may contribute to earlier return to play metrics identified in the broader literature for the Latarjet procedure when compared with arthroscopic Bankart repair. Strength of Recommendation Taxonomy (SORT): Level C.

scholarly journals Systematic Review of Orthopaedic and Sports Medicine Injuries and Treatment Outcomes in Women's National Basketball Association and National Basketball Association Players

2021 ◽  
Vol 9 (2) ◽  
pp. 232596712098207
Author(s):  
Sachin Allahabadi ◽  
Favian Su ◽  
Drew A. Lansdown
Keyword(s):  
Systematic Review ◽  
Lower Extremity ◽  
Achilles Tendon ◽  
Sports Medicine ◽  
Direct Consequence ◽  
National Basketball Association ◽  
Return To Play ◽  
Level Of Evidence ◽  
Cartilage Injuries ◽  
Women's National Basketball Association

Background: Athletes in the Women’s National Basketball Association (WNBA) and National Basketball Association (NBA) are subject to high injury rates given the physical demands of the sport. Comprehensive data regarding injury patterns and rates in these athletes are limited. Purpose: To summarize available data on orthopaedic and sports medicine–related injuries through 2020 in professional female and male basketball players. Study Design: Systematic review; Level of evidence, 4. Methods: A search was conducted using PubMed and Embase through April 5, 2020, to identify injury studies regarding WNBA and NBA players. Studies were included if the injury or surgery was considered a direct consequence of game play including musculoskeletal/orthopaedic, concussion, ophthalmologic, and craniomaxillofacial injuries. Systematic reviews, screening studies, or studies without sufficient WNBA or NBA player subgroup analysis were excluded. Results: A total of 49 studies met inclusion criteria, 43 (87.8%) of which detailed musculoskeletal injuries. The lower extremity represented 63.3% of studies. A majority (59.2%) of studies were level 4 evidence. The source of data was primarily comprehensive online search (n = 33; 67.3%), followed by official databases (n = 11; 22.4%). Only 3 studies concerned WNBA athletes compared with 47 that concerned NBA athletes. The lowest return-to-play rates were cited for Achilles tendon repairs (61.0%-79.5%). Variability in return-to-play rates existed among studies even with similar seasons studied. Conclusion: The majority of literature available on orthopaedic and sports medicine–related injuries of NBA and WNBA athletes is on the lower extremity. The injuries that had the greatest effect on return to play and performance were Achilles tendon ruptures and knee cartilage injuries treated using microfracture. The reported outcomes are limited by heterogeneity and overlapping injury studies. There are limited available data on WNBA injuries specifically.

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