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What's new in sports medicine (primary care)

What's new in sports medicine (primary care)
Literature review current through: Jan 2024.
This topic last updated: Jan 18, 2024.

The following represent additions to UpToDate from the past six months that were considered by the editors and authors to be of particular interest. The most recent What's New entries are at the top of each subsection.

ADOLESCENT AND PEDIATRIC SPORTS MEDICINE

Avulsion fractures of hip and pelvis in children (October 2023)

There are few large-scale studies of pelvic avulsion fractures in children. A retrospective review of over 700 children with pelvic or hip avulsion fractures from a single tertiary care hospital reported the average patient age was just over 14 years and nearly 80 percent were sustained by males [1]. The anterior-superior and inferior iliac spines and ischial tuberosity were the most common sites, accounting for over 80 percent of fractures. Most injuries were sustained while the patient was running or kicking during sport, most often football (soccer). The incidence of avulsion fracture rose substantially during the study period, 2005 to 2020. (See "Pelvic trauma: Initial evaluation and management", section on 'Epidemiology and mechanism'.)

MANAGEMENT AND REHABILITATION OF MUSCULOSKELETAL INJURIES

Barbotage procedure for calcific tendinopathy of shoulder (January 2024)

To date, few high-quality studies have assessed the effectiveness of barbotage, an ultrasound-guided procedure to remove deposits in patients with calcific tendinopathy of the shoulder. In a recent, multicenter trial, 220 adults with calcific tendinopathy of at least three months duration were randomly assigned to one of three treatment arms: barbotage plus injection with glucocorticoid and analgesic; sham barbotage plus injection with glucocorticoid and analgesic; or, sham barbotage plus injection of analgesic alone [2]. At four months, patients in all three groups experienced moderate improvement in shoulder symptoms and function, but no significant differences were noted among treatment groups. At 24 months, neither barbotage with glucocorticoid injection nor glucocorticoid injection alone was superior to sham treatment (ie, analgesic injection alone). While barbotage is likely less effective than previously thought, we believe it remains a useful therapy for some patients. (See "Calcific tendinopathy of the shoulder", section on 'Barbotage'.)

Return to sport following stress fracture (November 2023)

Evidence is limited regarding return to sport (RTS) following stress fracture. A new systematic review of 76 studies involving nearly 3000 cases,provides some guidance; most of the studies were retrospective and involved predominately male athletes [3]. The lowest overall rates for RTS were reported for injuries of the femoral neck (55 percent), talus (69 percent), anterior tibial shaft (76 percent), and tarsal navicular (83 percent). The longest average times for RTS were reported for stress fractures of the tarsal navicular (127 days), femoral neck (107 days), and medial malleolus (106 days). These figures are averages, and healing for individuals may vary substantially given the many factors involved, including location within the bone, radiologic grade, duration of symptoms, compliance with treatment, and underlying bone health. Nevertheless, these findings inform treatment decisions and anticipatory guidance for athletes. (See "Overview of stress fractures", section on 'Return to activity'.)

Heavy load resistance exercise for tendinopathy (November 2023)

Evidence supporting the effectiveness of resistance exercise for the treatment of chronic (overuse) tendinopathy is growing. A recent systematic review and meta-analysis of 110 studies with just under 4000 subjects assessed research primarily involving the rotator cuff, Achilles, lateral elbow, and patellar tendons [4]. While noting that resistance dose was not well documented in many studies, researchers found consistent evidence that rehabilitation programs using resistance loads in excess of body weight and performed less frequently (ie, less than daily) demonstrated greater efficacy. These findings are consistent with our approach to treatment. (See "Overview of the management of overuse (persistent) tendinopathy", section on 'Heavy-load resistance training'.)

MEDICAL ISSUES RELATED TO SPORTS AND EXERCISE

Sport participation among athletes with increased risk of fatal arrhythmias (October 2023)

In patients who participate in competitive athletics and have a diagnosis that increases the risk of fatal arrhythmias, return to sport participation may provoke an arrhythmia or risk damage to an internal cardioverter-defibrillator (ICD). In a recent single-center report of 76 patients with a genetic cardiomyopathy that increased the risk of sudden death (32 percent with an ICD) who underwent tailored treatment and a shared decision-making process before returning to elite sport participation, there were four arrhythmic events and no fatalities during 200 patient-years of observation [5]. The small study size and nonstandardized approach to risk assessment and counseling limit the generalizability of these findings. In patients with an increased risk of fatal arrhythmias, we advise against participation in competitive sports, but some athletes may choose to participate based on their values and preferences following a shared decision-making process. (See "Athletes with arrhythmias: Treatment and returning to athletic participation", section on 'Athletes with ICDs'.)

6th International Conference on Concussion in Sport (August 2023)

Recently, a consensus statement and multiple systematic reviews and other studies were published based on work completed at the 6th International Conference on Concussion in Sport held in Amsterdam in late 2022 [6]. Highlights from the conference include evidence summaries emphasizing the effectiveness of policies to reduce the risk for sports-related concussion (SRC), including mouthguard use in ice hockey and limiting contact drills in American football, and updated clinical assessment tools. These tools include the sixth edition of the Sport Concussion Assessment Tool for adults and children (SCAT6 and Child SCAT6), designed for acute evaluations, and the new Sports Concussion Office Assessment Tool 6 for adults and children (SCOAT6 and Child SCOAT6). The conference affirmed the importance of physical activity and aerobic exercise that does not exacerbate symptoms as an early intervention. The conference consensus statement is consistent with our approach to the assessment and management of SRC. (See "Clinic-based evaluation of sports-related concussion in adolescents and adults", section on 'Introduction'.)

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