Citations

» Lateral epicondylitis (LE) or tennis elbow is a common cause of elbow pain in the general population, especially women in the fourth and fifth decades of life who participate in repetitive forceful movements involving the wrist and forearm. » The pathogenesis of this overuse injury is believed to start from an overload event leading to a microtear in or near the origin of the extensor carpi radialis brevis that is subsequently prone to additional injury and structural weakness over time. » Treatment of LE often begins with a wide variety of nonoperative modalities including rest, nonsteroidal anti-inflammatory drugs, bracing, and physical therapy. For recalcitrant symptoms, additional nonoperative therapies are implemented; however, there remains a lack of comparative efficacy between these adjunct treatments. » In this article, we examine the available literature regarding nonoperative management of LE and provide supplementary insight into the effectiveness of current modalities.

Background: Epidemiological studies of lateral ankle sprains in NCAA sports are important in appraising the burden of this injury and informing prevention efforts. Purpose: To describe the epidemiology of lateral ankle sprains in NCAA sports during the 2014-15 through 2018-19 seasons. Study Design: Descriptive epidemiology study. Methods: Injury and exposure information collected within the NCAA Injury Surveillance Program (ISP) were examined. Counts, rates, and proportions of lateral ankle sprains were used to describe injury incidence by sport, event type (practices, competitions), season segment (preseason, regular season, postseason), injury mechanism (player contact, noncontact, and surface contact, injury history (new, recurrent), and time loss (time loss [≥1 day], non–time loss). Injury rate ratios (IRRs) were used to examine differential injury rates, and injury proportion ratios (IPRs) were used to examine differential distributions. Results: A total of 3910 lateral ankle sprains were reported (4.61 per 10,000 athlete exposures) during the study period, and the overall rate was highest in men’s basketball (11.82 per 10,000 athlete exposures). The competition-related injury rate was higher than the practice-related rate (IRR, 3.24; 95% CI, 3.04-3.45), and across season segments, the overall rate was highest in preseason (4.99 per 10,000 athlete exposures). Lateral ankle sprains were most often attributed to player-contact mechanisms in men’s (43.2%) and women’s sports (35.1%), although injuries were more prevalently attributed to player contact in men’s than in women’s sports (IPR, 1.23; 95% CI, 1.13-1.34). Overall, 49.7% of all lateral ankle sprains were time loss injuries. Conclusions: The findings of this study are consistent with previous epidemiological investigations of lateral ankle sprains among NCAA athletes. Results offer additional context on differential injury mechanisms between men’s and women’s sports and on injury risk across the competitive season. Future research may examine the effectiveness of deploying injury prevention programs before the start of a season.

We have previously shown that, similar to the severe‐intensity power duration relationship (i.e., W’ sev ), there exists a separate, smaller power‐duration relationship for the extreme‐intensity domain (W’­ ext ) in men. We have also shown that there may be differences in contributions of central and peripheral fatigue between men and women during and immediately following extreme‐intensity exercise. The current study tested the hypotheses that 1) the W’ ext would be significantly less than W’ sev in both sexes, but not different between men and women, 2) absolute Maximum Voluntary Contractions (MVC) would be reduced to greater extent at end‐exercise following severe‐ and extreme‐intensity exercise in men compared to women but not when scaled relative to baseline, and 3) peripheral fatigue would be greater at task failure (T lim ) in men compared to women following severe‐intensity exercise, with no sex difference following extreme‐intensity exercise. Following familiarization, 7 men and 7 women completed three severe‐ (T lim : 2‐4 min, S3; 5‐7 min, S2; 8‐12 min, S1) and three extreme‐intensity (70, 80, 90% MVC) isometric knee‐extension bouts to task failure. MVC and potentiated twitch force (Q pot ) were measured and compared at baseline, task failure, and 150 s of recovery. W’ ext was significantly smaller compared to W’ sev in men (2.4 ± 1.2 kJ vs 3.9 ± 1.3 kJ; p = 0.03) and in women (1.6 ± 0.8 kJ vs 2.9 ± 1.7 kJ; p = 0.05), however there were no sex differences in either W’ ext or W’­ sev . There were no sex differences in MVC at task failure following severe‐intensity exercise. However, MVC was lower in women following extreme‐intensity exercise compared to men, although there were no sex differences in MVC relative to baseline. Further, there were no differences in MVC by the end of recovery compared to baseline in men or women following extreme‐intensity exercise. Q pot was not different at task failure following severe‐ and extreme‐intensity exercise between men and women. However, men showed lower Q pot relative to baseline, suggesting greater peripheral fatigue development, with the exception of exercise at 90% MVC. These data provide evidence that important sex differences exist in the contributions of peripheral fatigue to task failure and in recovery from exercise which depend on exercise intensity. Therefore, practitioners need to consider exercise intensity and the time course of recovery when prescribing exercise to men and women.

Abstract A 49-year-old woman with a history of daily inhaled corticosteroid use for asthma presented to a concussion clinic 7 wk after sport-related head injury with headache, visual blurring, dizziness, nausea, fatigue, polydipsia, and polyuria. Examination revealed difficulty with vestibulo-occulomotor testing due to nausea and visual straining. Cranial CT/MR imaging was unremarkable. Laboratory testing revealed critically low serum cortisol, hypernatremia, and urine studies suggesting diabetes insipidus. The patient was referred to the emergency department. Intravenous fluid resuscitation, corticosteroids, and desmopressin led to significant symptomatic relief. She was maintained on oral hydrocortisone after cosyntropin test revealed adrenal insufficiency. Her clinical picture suggested chronic subclinical adrenal suppression from inhaled corticosteroids, which was exacerbated by hypopituitarism possibly from concussion combined with diabetes insipidus. Adrenal insufficiency should be considered in athletes with history of corticosteroid use and endocrine-related symptoms after concussion, because this can create significant morbidity and can mimic traditional symptoms of concussion.