Sleep in the Athlete
Sleep is important for not only general health but also for lowering injury risk and maintaining athletic performance. Sleep disorders are prevalent in athletes, and taking a sleep history, evaluating sleep quality, and addressing other related factors including mental health are essential in diagnosing and understanding sleep disorders. Other methods such as polysomnography, actigraphy, and sheet sensors can also be used. Treatment options for sleep disorders include sleep hygiene, cognitive behavioral therapy, medication, and addressing contributing factors. For athletes, sleep can also be affected by factors such as tra...
Source: Clinics in Sports Medicine - July 18, 2023 Category: Sports Medicine Authors: Carly Day, Naoya Nishino, Yuka Tsukahara Source Type: research
Substance Misuse in Elite Athletes
Sports medicine physicians and athletic trainers regularly encounter athletes who misuse substances that put them at risk for adverse health, social, interpersonal, academic, psychological, and performance effects. The three most encountered substances are alcohol (binge drinking), cannabis (marijuana), and tobacco/nicotine vaping. Early detection using self-report screening instruments, adverse consequences questionnaires, and urine testing are reviewed. Brief interventions that involve personalized feedback, goal setting, support system involvement, psychoeducation, contingency management, and/or motivational interviewin...
Source: Clinics in Sports Medicine - July 18, 2023 Category: Sports Medicine Authors: David R. McDuff, Michelle Garvin, Joy Chang, Donald Thompson Source Type: research
Of Sound Mind and Body
Those of us in the specialty of “sports medicine” have an intrinsic understanding that we do not simply take care of an athlete’s knee meniscal tear. We do not “just” diagnose a concussion and place an athlete on hold until asymptomatic. No. From the moment we pledge the Hippocratic Oath to care for the entire individual without doing harm, we consistently strive to identify and diagnose the obvious, all the while considering and anticipating the more obscure. But complete care extends beyond the physical. (Source: Clinics in Sports Medicine)
Source: Clinics in Sports Medicine - July 18, 2023 Category: Sports Medicine Authors: Siobh án M. Statuta Tags: Preface Source Type: research
Clavicle Nonunion and Malunion
Clavicle nonunion and malunion are relatively uncommon but, when symptomatic, can result in pain and dysfunction that requires surgical intervention. Various reconstructive and grafting techniques are available to achieve stable fixation and union. In the setting of persistent nonunion, vascularized bone grafting may be necessary. A thorough understanding of the patient ’s type of nonunion and potential for healing is crucial for achieving satisfactory results because is thoughtful preoperative planning and surgical fixation. (Source: Clinics in Sports Medicine)
Source: Clinics in Sports Medicine - July 11, 2023 Category: Sports Medicine Authors: Alirio J. deMeireles, Natalia Czerwonka, William N. Levine Source Type: research
Anxiety Disorders in Athletes
Athletes and non-athletes experience many anxiety-related symptoms and disorders at comparable rates. Contributory factors may include pressure to perform, public scrutiny, sporting career dissatisfaction, injury, and harassment and abuse in sport. Anxiety may negatively impact sport performance. Specific types of anxiety may have unique presentations in athletes. It is important to rule out general medical and substance-related causes of anxiety symptoms. Psychotherapy and pharmacology treatment options should be considered, bearing in mind athletes ’ environmental circumstances and physiologies. (Source: Clinics in Sports Medicine)
Source: Clinics in Sports Medicine - July 11, 2023 Category: Sports Medicine Authors: Claudia L. Reardon, Paul Gorczynski, Brian Hainline, Mary Hitchcock, Simon Rice Source Type: research
Mental Health in the Youth Athlete
Though research is inconclusive in being able to determine if young athletes are more or less likely to suffer from mental health disorders compared with their non-athlete peers, there are important psychological considerations that are unique to the athletic population. This includes depression in the context of overtraining and burnout, performance anxiety, perfectionism, psychological sequalae of concussion, and injury as an independent risk factor for depression, anxiety, post-traumatic stress, and high-risk behaviors. Optimization of mental health care in youth athletes requires continued efforts to improve mental hea...
Source: Clinics in Sports Medicine - July 11, 2023 Category: Sports Medicine Authors: Mary M. Daley, Claudia L. Reardon Source Type: research
Management of Acromioclavicular Joint Injuries
There has been a rapid evolution in best practice management of acromioclavicular (AC) joint injuries. AP, Zanca, scapular Y, and dynamic axillary radiographic views provide optimal visualization of the joint and may assess for the presence of horizontal AC instability. Severity of AC joint pathology is classified according to the 6-tier Rockwood scoring system. Over 160 surgical techniques have been described for AC joint repair and reconstruction in the last decade; as a result, determining the optimal treatment algorithm has become increasingly challenging secondary to the lack of consistently excellent clinical outcome...
Source: Clinics in Sports Medicine - July 6, 2023 Category: Sports Medicine Authors: Liam A. Peebles, Ramesses A. Akamefula, Matthew J. Kraeutler, Mary K. Mulcahey Source Type: research
Open Anatomic Coracoclavicular Ligament Reconstruction for Acromioclavicular Joint Injuries
Open reconstruction of the coracoclavicular (CC) and acromioclavicular (AC) ligaments results in excellent reduction of severely displaced AC dislocations, most commonly Grades III and V. Anatomic CC reconstruction through clavicular bone tunnels can prevent vertical instability, whereas the addition of an acromial limb of the graft can increase horizontal stability. Autograft tendon is preferred in the young athletic group of collision sports participants, although allograft has had acceptable results. Accessory fixation may be placed to protect the graft during healing, or for severe instability, especially for athletes ...
Source: Clinics in Sports Medicine - July 6, 2023 Category: Sports Medicine Authors: E. Lyle Cain, David Parker Source Type: research
Surgical Pearls and Pitfalls for Anatomic Acromioclavicular/Coracoclavicular Ligament Reconstruction
Injuries to the acromioclavicular (AC) joint are common shoulder injuries in contact/collision athletes. There are a number of different surgical options that can be used to treat these injuries. The majority of these injuries can be treated nonoperatively with an early return to play for type I and II injuries. Surgical intervention and AC/CC (coracoclavicular) ligament reconstruction have excellent postoperative outcomes if complications can be avoided. This review will focus on the pearls and pitfalls for anatomic AC and CC ligament reconstruction for high-grade AC joint injuries. (Source: Clinics in Sports Medicine)
Source: Clinics in Sports Medicine - July 6, 2023 Category: Sports Medicine Authors: Peter S. Chang, Colin P. Murphy, Ryan J. Whalen, John M. Apostolakos, Matthew T. Provencher Source Type: research
Risk for Fracture with Acromioclavicular Joint Reconstruction and Strategies for Mitigation
Acromioclavicular (AC) joint injuries are a common cause of shoulder pain, especially among athletes. Surgical reconstruction of the AC joint can lead to complications such as fracture of the coracoid process, clavicle or acromion, which can negatively affect the patient's outcome. The purpose of this review is to discuss the risk factors for fractures associated with AC joint reconstruction, as well as the strategies that can be used to mitigate this risk. Risk factors for fractures include low mineral density, coracoid/clavicle drilling, larger holes in the coracoid, and the number of tunnels used for reconstruction. (So...
Source: Clinics in Sports Medicine - July 5, 2023 Category: Sports Medicine Authors: Nikolaos Platon Sachinis, Knut Beitzel Source Type: research
Acromioclavicular Joint Anatomy and Biomechanics
The shoulder girdle extends from the sternoclavicular joint to the scapular stabilizing muscles posteriorly. It consists of 3 joints and 2 mobile regions. The shoulder girdle is statically stabilized by the acromioclavicular and coracoclavicular capsuloligamentous structures and dynamically stabilized by the trapezius, deltoid, and deltotrapezial fascia. During humerothoracic elevation, the clavicle elevates, protracts, and rotates posteriorly through the sternoclavicular joint while the scapula tilts posteriorly and rotates upward. The purpose of this article is to review the anatomy and biomechanics of the acromioclavicu...
Source: Clinics in Sports Medicine - July 1, 2023 Category: Sports Medicine Authors: Nicholas P.J. Perry, Nozimakhon K. Omonullaeva, Blake M. Bacevich, Robert J. Nascimento, Evan A. O ’Donnell, Mark D. Price, Augustus D. Mazzocca Source Type: research
Diagnosis and Nonoperative Treatment of Acromioclavicular Joint Injuries in Athletes and Guide for Return to Play
This article will focus on the diagnosis and nonoperative treatment of AC joint injuries in athletes. We will also comment on return-to-play guidelines after this nonoperative treatment. (Source: Clinics in Sports Medicine)
Source: Clinics in Sports Medicine - July 1, 2023 Category: Sports Medicine Authors: Brittany Olsen, Bonnie Gregory Source Type: research
Arthroscopic Repair and Reconstruction of Coracoclavicular Ligament
Acromioclavicular joint separations are common shoulder injuries that require prompt recognition, diagnosis, and treatment. Deciding on a treatment algorithm relies on a detailed knowledge of anatomy and a thorough understanding of the specific functional demands of the patient in question. When a repair or reconstruction is indicated, arthroscopic assistance can be a helpful tool to ensure a safe, anatomic reconstruction that minimizes morbidity and maximizes the potential return to high-level function. (Source: Clinics in Sports Medicine)
Source: Clinics in Sports Medicine - July 1, 2023 Category: Sports Medicine Authors: Jeffrey D. Hassebrock, Daniel J. Stokes, Tyler R. Cram, Rachel M. Frank Source Type: research
Midshaft Clavicle Fractures
For displaced midshaft clavicle fractures, operative treatment either with open reduction and plate fixation or with intramedullary fixation has been shown to provide earlier return to work and sport, improved functional outcomes, greater patient-reported satisfaction with appearance, and significantly decreased incidence of nonunion and malunion when compared with conservative treatment. Operative intervention is not without risks associated with surgery. Shared decision-making with the patient and understanding patient goals allows surgeons to recommend a management option that the patient will be comfortable with and wi...
Source: Clinics in Sports Medicine - June 27, 2023 Category: Sports Medicine Authors: Myra Trivellas, Jocelyn Wittstein Source Type: research
Classification of Distal Clavicle Fractures and Indications for Conservative Treatment
Management of distal clavicle fractures depends on a clear understanding of the injury ’s proximity to the ligamentous attachments joining the clavicle and scapula. Various classification systems have been proposed to guide treatment. Despite this, controversy between operative and nonoperative management remains for certain fracture patterns. Patient-specific factors, concomitant i njuries, fracture characteristics (displacement, shortening, and rotation) should all be considered when deciding on treatment. When nonoperative management is indicated, patients should be immobilized in a sling for 2 weeks, followed by gra...
Source: Clinics in Sports Medicine - June 26, 2023 Category: Sports Medicine Authors: Jayson Lian, Ferdinand J. Chan, Benjamin J. Levy Source Type: research
