The elbow is a frequently underestimated and commonly misunderstood joint, leading to a considerable amount of clinical problems. A large part of this due to the largely overlapping and often unspecific symptoms of various diseases and injuries. A better understanding of elbow symptoms and the clinical exam of the elbow is the key to unlocking elbow pathology. This paper reviews a comprehensive and concise exam of the elbow that can easily be employed in a primary care sports medicine setting.
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The shoulder is the second most commonly injured joint in Sports Traumatology. A thorough clinical examination is mandatory for a strategic therapy regime. A standardized and, importantly, gentle and pain sparing, physical examination not only builts the basis for above mentioned, yet also provides a base in the doctor-patient relationship. The following guideline is meant to aid in these regards. Nonetheless, clinical experience is of utmost importance in combination with a correct physical examination. Hence, if hesitation is present about the diagnosis or treatment, there should be no hesitation in consulting an expert.
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Back pain has become one of the most frequent sports-related health problems. Up to 80% of the Swiss population experience at least one episode per year up to several times per week. It affects athletes of all age groups and all levels of activity equally. The causes of acute and chronic back pain are plentiful, but can be easily appreciated with a thorough and comprehensive history, concise clinical examination, and adequate imaging.
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Young competitive athletes are particularly at risk during puberty. Growth plates and apophyses are reduced in their stability by hormone influence. Epiphyses can slip, apophyses can tear out. Therefore, a regular examination of those athletes is important. The examination should focus on muscular asymmetries, or reduced range of motion of a joint. Shortened muscles have to be recon as a risk factor for apophysitis. Dysbalances of the musculature are mainly found in the trunk area. Training plans should be adapted to the increased vulnerability.
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There seems to be a lack of consensus among medical associations, professional sports bodies and medical professionals about when pre-participation evaluations (PPE) are indicated and how they should be designed. Although it is generally accepted that the primary purpose of the PPE is the identification of cardiovascular disease and risk factors for sudden cardiac death in competitive athletes, there is an ongoing debate on which methods are most apt in the screening process. Furthermore, the need of PPE has been questioned all together in leisure or hobby athletes.
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Until now, there have been no studies in Switzerland that investigate differences in the motor performance disposition of children in urban and rural as well as in traditional and physical education kindergartens. A newly developed test instrument (MOBAK-KG) was therefore used in a supra-­cantonal research project in school year 2017/18 to test the motor skills of 4- to 6-year-old children (n = 403, Ø 5,7 years, SD = .56) in the areas of “self-movement” and «object-movement».
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The actual significance and definition of hypertensive response to exercise (HRE) is still debated. Up to now, there is consensus in defining it as a systolic blood pressure value of either ≥ 210 mmHg in men and ≥ 190 mmHg in women or a diastolic blood pressure ≥ 110 mmHg during maximal exercise stress test. The mechanisms underlying an exaggerated blood pressure response to exercise are poorly understood; however, there are studies suggesting that HRE may represent a preclinical stadium of essential hypertension, which shares several common pathological mechanisms mostly related to an endothelial dysfunction and vascular stiffness.
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Cardiopulmonary exercise testing (CPET) is recommended in pre-participation evaluation of athletes to measure their cardiorespiratory fitness and maximal exercise tolerance. It is used for the diagnosis of probable cardiovascular and pulmonary disease and for the investigation of possible risks in sports. In case of non-specific symptoms during exercise, which are frequent in athletes, CPET is useful in the evaluation of physiological responses of body organ systems to exercise. This case-based review demonstrate the potential of CPET in the assessment of fatigue and loss of performance in a competitive professional athlete.
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Myocarditis is defined as an inflammation of the heart muscle and its presentation, especially in athletes, is heterogeneous. Underlying causes include in most of the cases viruses, and less often bacteria, toxins, vasculitic diseases or pharmaceutical agents. Cardiac magnetic resonance (CMR) imaging is the primary imaging tool to diagnose myocarditis following laboratory test, electrocardiogram and echocardiography. In certain cases, endomyocardial biopsy is required, especially in unclear cases with reduced systolic left ventricular ejection fraction.
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Sudden death of an athlete is the most devastating medical event in sports. While accidents account for more than 50% of these cases, sudden cardiac deaths (SCD) are less frequent (approx. 15%), but the leading medical cause of deaths. The risk depends on age, sex, ethnicity, type of sport and sport level. There are large variations in the methods of registration of SCD in recreational and competitive sports. This must be taken into account when interpreting reported incidences and causes. High data quality in registries is a prerequisite for meaningful preventive strategies (e.g. ECG screening and safety at sports facilities).
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Through continuous improvement of diagnostic accuracy of ECG criteria for athletes sensitivity as well as specificity have grown so much that foregoing this screening tool is not feasible anymore. The most updated guidelines, the so-called “International (Seattle) Criteria” globally exhibit the most important reference publication, currently. The criteria were created with the purpose that particularly “non-cardiologists” should be able to use them before clearly pathological findings lead to further follow-up examinations at a specialist. On the other hand, physiologic ECG findings should not prompt expensive further evaluations, as it used to happen quite frequently.
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Traditionally, cardiovascular screening has been recommended mostly for competitive athletes younger than 35 years. The perception that only young competitive athletes at top level are at increased risk, has changed in the last years. Theoretically, we advocate a voluntary cardiovascular screening for all athletes who exercise vigorously, independent of their competitive status, and age. Although, this should be based on an individual estimation of the athlete’s risk. Physical examination, medical history and an ECG should be the baseline investigations for all athletes.
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Objective: To determine differences between male and female subjects in the thigh muscles characteristics, separated into architectural (pennation, thickness, and/or fascicle length), mechanical (mass, strength, power, and/or stiffness), neuromuscular (activity) and fatigue aspects, in order to better understand the sex-related differences in the risk of muscle injuries. Methods: A systematic literature search on Pubmed was performed with different keywords: skeletal muscle AND sex characteristics AND muscle contraction, with the following limits: humans and adults (19–44 years old).
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Back pain is common among elite cyclists. Experiences of athletes and observations of coaches show that it may influence training quality and sometimes even limit performance during competition. Therefore the following study questions were investigated: 1) How many athletes of the Swiss cycling national teams suffer back pain during training or competition? 2) How good is athletes’ core strength? 3) What correlation exists between back pain and core strength? 4) Does an intensified core strength training reduce back pain? A total of 111 elite cyclists, 45 athletes (38 m, 7f; 19.6 ± 3.5y) of technical disciplines (BMX, Trial, Downhill, 4X) and 66 athletes (39 m, 27f; 19.5 ± 5.8y) of endurance disciplines (road, MTB, Cyclo-cross) all members of Swiss cycling national teams, took part in in the study.
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In cardiopulmonary exercise testing with children and adolescents, age specific protocols are used together with tools adjustable to their body dimension and development. Assessing weight, height und pubertal stage is a prerequisite for the interpretation of every test. Indications for exercise testing are airway symptoms and findings limited performance, chronic diseases, planning of trainings and scientific studies. The more tests are standardized and used on a large scale, the more normal values are available to compare individual results. However, the interindividual variability of measured values is high, depending as much from the developmental stage of the individual as from protocols, tools and the performing laboratory.
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