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Fencing is a sport in which two people attempt to score points by making their weapon (epee, foil, or saber) contact their opponent. The most common types of injury seen in fencing are weapon injuries; strains, sprains, and trauma; and nontraumatic injuries, the pathologic findings of which are discussed in this article.
OBJECTIVE: To report the soft tissue injuries sustained by the members of four disabled sports organizations (DSOs) who competed as the USA Team at the 1996 Paralympic Games. SETTING: 1996 Paralympic Games, Atlanta, Georgia. METHODS: Soft tissue (strain, sprain, tendonitis, bursitis, or contusion) injury frequencies sustained by Disabled Sports USA (DSUSA, n = 66), the United States Association for Blind Athletes (USABA, n = 53), the United States Cerebral Palsy Athletic Association (USCPAA, n = 56), and Wheelchair Sports USA (WSUSA, n = 129) athletes were compared by body region with chi-square tests (p<.05) and standardized residual assessment. RESULTS: A total of 254 soft tissue injuries (67% acute onset, 170/254) were sustained by the participant DSO members. Statistical design limitations and poor USCPAA athlete homogeneity prompted their exclusion from group comparisons (descriptive results are reported). The most common injury regions for specific DSOs were shoulder (26%), hip-thigh (14%), and ankle (12%) for DSUSA; hip-thigh (21%), cervicothoracic region (19%), and shoulder (17%) for USABA; lumbar region (14%), foot-toe (13%), and ankle (9%) for USCPAA; and shoulder (18%), arm-elbow (12%), forearm-wrist (12%), and lumbar region (9%) for USUSA. Chi-square residual analysis showed that the USABA athletes contributed more to cervicothoracic and lower leg region injury frequencies than DSUSA or WSUSA athletes. The WSUSA athletes contributed more to elbow-arm and forearm-wrist region injury frequencies than DSUSA or USABA athletes. The DSUSA athletes contributed more to ankle region injury frequencies than USABA or WSUSA athletes. CONCLUSIONS: Differences in soft tissue injury frequency among athletes of differing DSOs suggest that the competitive use of adaptive or assistive devices, in combination with sport-specific stressors and the athletes' disabilities, is related to the development of predictable soft tissue injury patterns. The decreased incidence of shoulder injury among WSUSA athletes suggests that the injury prevention advice provided by previous studies is being implemented among athletes at this competitive level. The increased incidence of ankle injuries among DSUSA athletes suggests lower extremity load imbalances (prosthetic vs. uninvolved) during running. The increased incidence of lower leg injuries among USABA athletes suggests "overuse" injury patterns typical of nondisabled runners, or inadvertent contacts (contused shins), whereas the increased incidence of cervicothoracic injuries suggests injuries related to falls, "near falls," or sudden directional changes prompted by guidance aids.
Sports-related soft tissue injuries, such as sprains, strains, and contusions, are a common painful condition. Current treatment includes oral nonsteroidal anti-inflammatory drugs (NSAIDs), which have a high incidence of intolerable gastrointestinal side effects. Topically applied drugs have the potential to act locally in the soft tissues without systemic effects. This study assessed the efficacy and safety of topical diclofenac (NSAID) patch applied directly to the painful injury site for the treatment of acute minor sports injury pain. Adult subjects (N = 222) were recruited from two communities for a multicenter, randomized, placebo-controlled, parallel design study. All subjects had suffered a painful minor sports injury within the prior 72 hours of study entry. Either a diclofenac epolamine or placebo topical patch was applied directly to the skin overlying the painful injured site twice daily for 2 weeks. Measures of pain intensity were performed in a daily diary and at clinic visits on days 3, 7, and 14. Diclofenac patch was superior to placebo patch in relieving pain. Statistical significance was seen on clinic days 3 (P = 0.036) and 14 (P = 0. 048), as well as the daily diary pain ratings at days 3, 7, and 14 (P < or =0.044). No statistically significant differences were seen in any safety or side-effect measures with the diclofenac patch as compared to the placebo patch. Diclofenac epolamine patch is an effective and safe pain reliever for treatment of minor sports injury pain. The advantages of this novel therapy include its ease of use and lack of systemic side effects.
STUDY DESIGN: Cost data were gathered from computerized records of the Liberty Mutual Insurance Company for low back pain workers' compensation claims (N = 119,107) and for all claims (N = 731,087) initiated from 45 jurisdictions (states) during 1989. OBJECTIVE: This study provided more current, accurate, and additional information to estimate the costs and incidence associated with compensable low back pain compared with all compensation claims. METHODS: The first group of data included all compensable low back claims selected by specific codes: body part codes consisted of low back area, sacrum and coccyx, disc, and multiple trunk; injury codes consisted of strain, sprain, inflammation, rupture, hernia, fracture, and contusion. The second sample included all compensable claims, including both occupational injuries and illnesses. RESULTS: Low back pain cases represented 16% of all claims but 33% of all claims costs; 55.4% of the low back pain cases received medical payments only (i.e., did not receive indemnity payments for lost time). The mean cost per case for low back pain was $8321; median cost per case was $396. Medical costs represented 32.4% of the total costs; indemnity costs (i.e., payment for lost time) represented 65.8%. CONCLUSIONS: Since indemnity costs represent the greatest percentage of workers' compensation expenditure, the primary goal of low back pain management should be the prevention or reduction of prolonged disability.
Injuries are a common occurrence in young, active civilian and military populations. This study examined injury incidence and the association of musculoskeletal injuries with age and physical fitness in soldiers. Subjects were a cohort of 298 male soldiers assigned to an infantry battalion in Alaska. The soldiers' ages were obtained from the battalion records and their physical fitness was assessed from 2-mile run times, sit-ups, and push-ups. Injuries were documented from a retrospective review of the soldiers' medical records for a 6-month period (October to March) before the fitness testing. Fifty-one percent of the soldiers suffered one or more injuries. The most common injury diagnosis was musculoskeletal pain, followed by strains, sprains, and cold-related injuries. Soldiers experienced a total of 212 separate injuries, which resulted in 1764 days of limited duty. The crude annualized injury rate was 142 injuries per 100 soldiers (one soldier could experience more than one type of injury). The proportion of soldiers injured decreased as age increased. Slower 2-mile run times and fewer sit-ups were associated with a higher incidence of musculoskeletal injuries. This study documents the injury incidence in infantry soldiers and identifies younger age and low physical fitness as potential risk factors for these injuries.
This study examined the traumatic-injury characteristics associated with one of the high-risk occupations in the construction industry--drywall installers--through an analysis of the traumatic-injury data obtained from the Bureau of Labor Statistics. An additional objective was to demonstrate a feasible and economic approach to identify risk factors associated with a specific occupation by using an existing database. An analysis of nonfatal traumatic injuries with days away from work among wage-and-salary drywall installers was performed for 1992 through 1995 using the Occupational Injury and Illness Survey conducted by the Bureau of Labor Statistics. Results from this study indicate that drywall installers are at a high risk of overexertion and falls to a lower level. More than 40% of the injured drywall installers suffered sprains, strains, and/or tears. The most frequently injured body part was the trunk. More than one-third of the trunk injuries occurred while handling solid building materials, mainly drywall. In addition, the database analysis used in this study is valid in identifying overall risk factors for specific occupations.
From a sample of 849 adolescents studied at age 15, 429 had been involved in 657 separate incidents, which resulted in 705 acute injuries requiring medical attention during their 14th and 15th years of life. The most common injuries were sprains, strains, fractures and lacerations, and the most common body site was the finger. The majority of injuries were of minor severity. Striking against an object or person was the most common incident resulting in injury, followed by being struck by an object or person, and overexertion or strenuous movement. Approximately half of the injuries were incurred during sport or a similar physical activity. Sporting injuries are examined in detail and preventive measures discussed.
BACKGROUND: The design of childhood injury prevention programmes is hindered by a dearth of valid and reliable information on injury frequency, cause, and outcome. A number of local injury surveillance systems have been developed to address this issue. One example is CHIRPP (Canadian Hospitals Injury Reporting and Prevention Program), which has been imported into the accident and emergency department at the Royal Hospital for Sick Children, Glasgow. This paper examines a year of CHIRPP data. METHODS: A CHIRPP questionnaire was completed for 7940 children presenting in 1996 to the accident and emergency department with an injury or poisoning. The first part of the questionnaire was completed by the parent or accompanying adult, the second part by the clinician. These data were computerised and analysed using SPSSPC for Windows. RESULTS: Injuries commonly occurred in the child's own home, particularly in children aged 0-4 years. These children commonly presented with bruising, ingestions, and foreign bodies. With increasing age, higher proportions of children presented with injuries occurring outside the home. These were most commonly fractures, sprains, strains, and inflammation/oedema. Seasonal variations were evident, with presentations peaking in the summer. CONCLUSIONS: There are several limitations to the current CHIRPP system in Glasgow: it is not population based, only injuries presented to the accident and emergency department are included, and injury severity is not recorded. Nevertheless, CHIRPP is a valuable source of information on patterns of childhood injury. It offers local professionals a comprehensive dataset that may be used to develop, implement, and evaluate child injury prevention activities.
OBJECTIVE: To compare the ketoprofen TDS patch with diclofenac gel in the treatment of traumatic acute pain in benign sport-related soft-tissue injuries. DESIGN: 7-14 treatment days, prospective, randomised, open study. PATIENTS: Outpatients aged 18-70 years diagnosed for painful benign sport-related soft-tissue injury (sprains, strains and contusions within the prior 48 h), randomised to either ketoprofen patch 100 mg once daily (n = 114) or diclofenac gel 2-4 g three times daily (n = 109). INTERVENTION: 7-14 days of topical non-steroidal anti-inflammatory drugs treatment to assess the pain intensity changes (daily activities and spontaneous at rest) in a daily diary (100-mm Visual Analogue Scale (VAS)). MAIN OUTCOME MEASUREMENT: Pain intensity (VAS). RESULTS: The ketoprofen patch was not inferior to diclofenac gel in reducing the baseline pain during daily activities (difference of -1.17 mm in favour of ketoprofen patch, 95% CI (-5.86 to 3.52), reducing to the baseline VAS 79%. Ketoprofen patch presented also a higher cure rate (64%) than diclofenac gel (46%) at day 7 (p = 0.004). Patient opinions about the treatment comfort (pharmaceutical shape, application and dosage) were also statistically higher for the ketoprofen patch (>80% of the patients rated as good or excellent the patch removal and skin adherence). CONCLUSION: Ketoprofen patches are effective and safe pain relievers for the treatment of sports injury pain with advantages compared with diclofenac gel.
OBJECTIVES: The goal of this study was to determine the occupational hazards experienced by children harvesting cocoa in western Ghana in order to design a vocational literacy life skills curriculum and radio social messaging campaign with a safety component to decrease hazardous work exposures in child agricultural work. METHODS: An observational analysis was conducted of children aged 9 through 17 based upon personal interviews of agricultural workers, focus groups, and direct observation of work practices and activities. Job site analysis incorporated task mapping, job hazard review, and a review of equipment and use of protective gear. RESULTS: Children and young people aged 9 through 17 are exposed to hazardous occupational exposures including strenuous work, sharp tools, and pesticides. Lack of training in proper safety practices and inadequate personal protective equipment were commonly noted. Injuries and illnesses included musculoskeletal disorders, sprains, strains, lacerations to the head, fractures, eye injuries, rashes, and coughing. CONCLUSION: Children working in cocoa harvesting are exposed to physical and chemical hazards without proper training or personal protective equipment. Unless safety interventions occur, there are potential long-term adverse health consequences.
This study examines year-to-year (1965, 1976 to 1977) and state-to-state (six western United States) cost variations in relation to injury site, severity, and repetition of high school football injuries. Data were collected from the files of the largest single insurer of secondary school students in these states. Analysis was made through a specially programmed Qantel 1300 computer. The average claim cost in 1965 was $34.72 in 1976 was $149.93, and, in 1977, it was $177.95. The average cost was lowest in Utah and highest in California. In the 1976 to 1977 season, 3,501 claims from 15,252 players were reported. Over 25% of the claims filed were from players who had more than come claim per season. Relatively minor injuries (sprains, strains, contusions, and abrasions) accounted for 72.3% of all injuries but only 42.4% of medical costs. Lower extremity injuries accounted for one-third of the injuries and one-half of the costs. Knee injuries alone accounted for 12.7% of all injuries and 31.8% of all medical costs paid by the insurance company. It is proposed that trainers and coaches not only know how to care for minor injuries but also that they are more rigid in their criteria for fitness, agility, stamina, and psychologic factors so that players predisposed to injury and repeated injuries will not contribute to the escalating medical costs of high school football injuries.
This study examines the cost of high school soccer injuries. Data was collected from the files of the largest single insurer of secondary school students in six western states. Analysis was made through a specially programmed Qantel 1300 computer (Empire Computer Systems, Seattle, Washington). The average claim cost was $127.29 for injuries in 1976 to 1977, ranging from the lowest in Washington to the highest in California. During this period 436 claims from 10,634 players were reported. Relatively minor injuries (sprains, strains, contusions, and abrasions) accounted for 75.9% of all injuries but only 49.4% of all costs; lower extremity injuries accounted for more than one-half of all injuries and costs. Knee injuries alone represented 11.7% of all injuries--28.2% of all medical costs paid by the insurance companies. Injuries occur only one-fifth as frequently in soccer, compared with football. It is anticipated that medical expenses for soccer players will be less than 16% of expenses incurred by an equal number of football players.
Injuries sustained by male and female professional basketball teams were compared. Injuries from two consecutive seasons were coded, and computer-based cross-tabulations comparing sex, body part, and type of injury were performed. The women's injury frequency was 1.6 times that of men. The body part most frequently injured on both teams was the ankle. Women sustained significantly more knee and thigh injuries as well as sprains, strains, and contusions. Men had significantly more muscle spasms. Other injuries occurred in similar patterns in both sexes. Alterations in training programs are suggested with emphasis on women's strengthening and men's flexibility.
The purpose of this retrospective study was to describe the magnitude, nature, and costs of assault injuries among teachers, a high-risk group. Review of assault cases (N = 341) was based on internal and case management vendor records. The 3-year assault rate was 3.24 per 1,000 teachers. Assaults were predominately physical, occurring during classroom disputes and while restraining students. Assaults accounted for 2,480 lost workdays and more than dollars 714,000 in lost wages and case management fees. The most costly injuries on a per-case basis were strain-sprain injuries resulting in lost workdays and fractures not resulting in lost workdays. Less than 20% of the assaults accounted for all of the lost workdays and most of the case costs. Study variables accounted for 13% of case costs. Occupational health nurses should collaborate with school personnel, administrators, and parents to develop prevention programs, which may include de-escalation techniques for teachers as well as case management strategies.
An open, multi-centre study was carried out in patients with various moderate to severe painful conditions to assess the effectiveness of zomepirac in relieving pain. Patients were treated with 300 mg to 600 mg zomepirac daily for 7 days. Data from 15,484 patients have been analyzed. Most of the patients (75%) were already being treated with an analgesic on entry and more than half of them had been prescribed this by their doctor. Almost half, however, had still been in pain for more than 4 weeks before receiving zomepirac. An analysis of pain severity assessments showed a reduction from an initial score of 2.4 to 1.3 (on a 4-point rating scale). Global responses were recorded and 71.7% of the patients were considered to have improved according to the opinion of both doctors and patients, with the best response (84.1%) being observed in those with acute painful states such as sprains, strains and fractures and with pain of short duration. Pain frequently disrupts sleep, and 46.2% of patients reported their sleep as 'bad' or 'very bad' on entry to the study. After treatment, this figure was reduced to 15.1%. The side-effects reported, which were mainly gastro-intestinal, were mild in general and led to withdrawal of only 7.2% of the patients before completion of treatment.
With over 30 million children participating in sports each year across the United States, a number of significant injuries are to be expected. Although mild injuries such as strains, sprains, and contusions predominate, catastrophic injuries do occur. Young athletes are at an increased risk for growth plate and apophyseal injuries, overuse injuries, and heat illness. Many of these sports injuries can be prevented. Prevention strategies include protective equipment, rule changes, preseason and season prevention interventions, safety measures, better coaching, education, and a societal awareness of injury and prevention. This article discusses current injury prevention for children participating in baseball, football, soccer, and ice hockey.
OBJECTIVE: Backpacking is a popular recreational activity, yet the differential experiences of women are unknown. The objective was to compare women with men backpackers to determine the extent to which injuries and illnesses limit endurance outdoor recreational activities. METHODS: This was a prospective cohort surveillance survey of 334 persons who hiked the Appalachian Trail for > or =7 days. At the end of their hike, 280 subjects completed a questionnaire. Male hikers served as controls for injury and illness. RESULTS: Women comprised 26% (72 of 280) of the sample. The mean (+/-SD) duration of hiking was 144 +/- 66 days covering 1570 +/- 680 miles. Fifty-seven percent (41 of 72) of women and 72% (150 of 208) of men attained their goal (P = .02). The occurrence of individual musculoskeletal problems, such as strains, sprains, arthralgias, tendonitis, and fractures, were similar (P = .9) between sexes. The occurrence of diarrhea (56%) was also similar (relative risk [RR] 1.0; P = .9) between sexes. Of regularly menstruating women, 87% (43 of 49) had menstrual changes while hiking, such as change in frequency (45%) or character (43%) (RR 3.1; 95% CI, 2.0-4.8; P < .001). Shortened duration of menses was most common (41%). Amenorrhea occurred in 22% (11 of 49) of women, including 5 of 25 taking oral contraceptive pills (OCPs). Breakthrough, midcycle bleeding occurred in 20% (10 of 49) of women. CONCLUSIONS: Women had similar experiences as compared with men when backpacking. Menstrual changes were very common including amenorrhea. Prolonged amenorrhea raises concern for potential bone mineral density loss, and OCPs should be considered to prevent such loss.
OBJECTIVES: The objectives of this study were to identify the number and types of recreational injuries sustained by visitors to Mount Rainier National Park and Olympic National Park in Washington State and to compare the nature of injuries sustained by children compared with adults. METHODS: We retrospectively reviewed case incident reports obtained by rangers in Mount Rainer National Park and Olympic National Park between 1997 and 2001. Data collected included victim age, gender, date of injury, activity preinjury, type of injury, and mechanism of injury. RESULTS: There were 535 cases of recreational wilderness injuries (including 19 total deaths), yielding a rate of 22.4 injuries per million visits. The mean age of injury victims was 34 years. Males were more likely to sustain injury than were females (59% vs 41%). Most injuries occurred during summer months between noon and 6:00 PM, and 90% occurred during daylight hours. The most common preinjury activities included hiking (55%), winter sports (15%), and mountaineering (12%), and the most common types of injuries included sprains, strains and soft tissue injuries (28%), fractures or dislocations (26%), and lacerations (15%). A total of 121 (23%) of the injuries occurred in children (<18 years of age). There were 19 deaths in the 2 national parks (18 men, 1 woman); all victims were adults. Hiking (58%) and mountaineering (26%) were the most common activities at the time of death. Mechanism of death included falls (37%), medical (eg, myocardial infarction) (21%), drowning (5%), and suicide (5%). CONCLUSIONS: The most common type of injury was soft tissue injury, and injuries occurred most commonly while hiking, during daylight hours, and in the summer. Preinjury activities and types of injuries were different in children compared with adults. Knowledge of how and when injuries occur in national parks can assist in determining what resources are needed to help provide a safer environment for park visitors. This study may also aid prevention strategies in the national parks, guide training of rangers, aid in the preparation of first aid kits, and further the education of people who participate in wilderness activities.