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PubMed1990

Intrinsic risk factors and athletic injuries.

The benefits of physical activity are widely known. However, the risk of a musculoskeletal injury is an unfavourable consequence in physical training. Age, gender, injury history, body size, local anatomy and biomechanics, aerobic fitness, muscle strength, imbalance and tightness, ligamentous laxity, central motor control, psychological and psychosocial factors as well as general mental ability are factors in the predisposition to injury. Junior (15 to 16 years) and senior athletes seem to be at a higher risk of injury in many types of sport. However, the relationship between age and injuries apparently depends on both the type and intensity of activity practiced. The majority of injured athletes in many studies have been males. Men are, however, more likely to participate in vigorous exercise and sport and it is not known if men are at a generally higher risk of injury when the exposure is taken into account. Certain lesions, such as sprains, strains and dislocations, tend to recur. Previous injuries may necessarily not cause a repetition of injury if treated adequately, but certain individuals may be at a higher risk of injury due to injury-prone biological characteristics. Excessive height and weight have been shown to predispose to stress injuries in physical training. Idiopathic or acquired abnormalities in the anatomy or biomechanics in any joint may lead to a local injury. However, physical requirements vary widely between different types of activity and predisposition to injury due to anatomical or biomechanical factors seems to be characteristic for each type of exercise. Lack of fitness, muscle weakness, joint looseness and poor general flexibility have been suggested as factors in the outcome of athletic injuries but no definite conclusions can be made on the basis of the existing literature. Long simple reaction times to visual stimuli and long choice reaction times to visual stimuli have recently been related to musculoskeletal injuries. No exceptional personality dimension in injury proneness as a whole has been found and the results from specific groups cannot be extrapolated generally. Accumulation of life stress apparently predisposes to an athletic injury. Musculoskeletal injuries seem to be more common in subjects with lower scores in intelligence tests but no causation has been shown yet. Altogether, a complex network of risk factors for athletic injuries has been found. However, no prospective study including all the recognised injury risk factors has been presented in the literature.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗

PubMed1995

In-line skating injuries. Epidemiology and recommendations for prevention.

In 1993 there was an estimated 12.6 million in-line skaters in the US. In-line skating is popular because of its affordability and its exercise and recreational value. The main risk factors for injury include speed, obstacles and hard surfaces. Using the National Electronic Injury Surveillance System in US hospitals, 31,000 skaters were reported injured over a 12 month period. Fractures, dislocations, sprains, strains and avulsion made up 67% of all injuries. It is recommended that skaters wear protection equipment including, helmet, wrist guards, knee-pads and elbow-pads. Although head injuries from skating appear low in numbers, helmet protection is also recommended. Further studies are required that assess risk factors for injury and environmental and behavioural aspects.

Adolescent↗

PubMed2000

Injuries to athletes with disabilities: identifying injury patterns.

Participation in sport activities for people with disabilities continues to gain in popularity. With participation in sports, there is an inherent risk of injury. A review of current sport epidemiological studies was used and we concluded that injury patterns for this population are similar to those for athletes without disabilities. Injury data from Paralympic competitions dating back to 1976 indicate that most elite athletes with disabilities seek medical care for illness and musculo-skeletal injuries. However, there are very limited injury data regarding Winter Paralympic events or skiing injuries. For those athletes who participate in Summer Paralympic events, abrasions, strains, sprains and contusions are more common than fractures and dislocations. However, location of injuries appears to be disability and sport dependent. Lower extremity injuries are more common in ambulatory athletes (visually impaired, amputee, cerebral palsy) and upper extremity injuries are more frequent in athletes who use a wheelchair. While it appears that the majority of the injuries occurring in this population are minor in nature, inconsistencies in the definition of injury in the literature make this conclusion tenuous. When injuries are expressed as time lost in participation, 52% of injuries resulted in 7 days lost or less, 29% in 8 to 21 days lost and 19% in greater than 22 days lost. The only prospective study addressing injury rates of athletes with disabilities in a manner consistent with other sport epidemiological studies found an injury rate of 9.3 injuries per 1000 athlete-exposures (AE). This injury rate is less than American football (10.1 to 15/1000 AE) and soccer (9.8/1000 AE), and greater than basketball (7.0/1000 AE). It is unclear whether comparative statistics such as these take into consideration the number of illness and injury episodes that resulted from the disability. Further complicating epidemiological studies for athletes with disabilities is the definition of the population and samples of convenience which are frequently used. These samples are often not representative of the multiplicity of disability conditions, levels of competition and range of sport activities available. Prospective studies comparing athletes to sedentary control individuals to measure differences in injury rates, type and frequency between and within disability groups, sports and levels of competition are desperately needed to further the knowledge of injury trends and develop and establish accurate injury prevention programmes.

Athletic Injuries↗

PubMed2005

Costs of occupational injury and illness within the health services sector.

Knowledge of costs is essential to allocate medical resources efficiently. The authors' goal was to estimate and compare costs across occupations, industries, gender, race, and types of nonfatal injuries and illnesses. This is an incidence study of nationwide data, 1993. Nonfatal incidence data were drawn from the Bureau of Labor Statistics Annual Survey. Medical costs were from the Detailed Claims Information data set. Productivity (wage) costs were calculated using the Current Population Survey. Pain and suffering costs were estimated from data on jury verdicts. Injuries and illnesses to nursing aides and orderlies cost 2,200 million dollars; costs were 900 million dollars for registered nurses and 40 million dollars for licensed practical nurses. The ranking of health services industries in terms of costs was: hospitals (52 percent of all costs), nursing care facilities (38 percent), home care services (6 percent), physicians' offices (4 percent), and laboratories (<1 percent). Types of injuries (sprains, strains, fractures) were similar across occupations and industries, but types of illness (carpal tunnel syndrome, respiratory diseases) varied. The most costly injured body parts were: back, shoulder, knee, wrist, and neck. Injuries and illnesses comprised roughly 90 percent and 10 percent, respectively, of total costs. The hospital industry was the third most expensive of 313 U.S. industries. Costs of occupational injury and illness in the health services industry were high and varied across occupation, industry, disease, race, and gender.

Accidents, Occupational↗

PubMed1999

The costs of work-related musculoskeletal disorders in automotive manufacturing.

Inadequate application of ergonomic principles to the design of workplaces and individual jobs has adverse consequences for worker health and safety, especially in terms of strains, sprains, and other musculoskeletal disorders. In addition to the human pain and suffering, other losses are externalized to workers, with adverse financial and psychosocial impacts. There are also costs to employers through workers' compensation claims, scrap, and decreased production quality, medical insurance premiums, labor turnover, and adverse impacts on labor relations, although many of these are not linked by traditional accounting methods to ergonomic problems per se. Data collected in five plants of two major U.S. automotive manufacturing companies in the last decade have been used to estimate some of the costs associated with work-related musculoskeletal disorders (MSDs), only some of which resulted in workers compensation claims. In one plant in 1984-85, the payroll cost of all back and shoulder disorders was at least $320 per year per worker, not including workers' compensation premiums or claims paid. A large proportion of these costs were accrued by "unreported" cases, that is, cases that either had never been reported to the plant clinic or had been reported in the past and were considered administratively to have recovered. In the other four plants, annual costs associated with in-plant medical visits for MSDs in 1989-93 were almost as high as those resulting from compensation claims. At least one-half of these disorders were estimated to be attributable to physical ergonomic exposures in the workplace and thus preventable. These data are consistent with estimates by others that the real costs to employers are at least two to three times the amount paid in workers' compensation cases, and that at least 50 percent of all work-related musculoskeletal disorders among the working population could be prevented by appropriate ergonomic job design. Furthermore, recent experience with ergonomics programs in various manufacturing and service settings shows that they are cost-effective in reducing morbidity, work absenteeism, and workers' compensation claims; payback periods for workplace modifications can be as short as a few months. Further investigations should explore the reasons that monetary costs and other impacts on profitability do not always motivate employers to improve working conditions.

Journal Article↗

PubMed1993

Common elbow problems in the athlete.

Because of the popularity of sports participation, sports physical therapists must recognize in the athlete the many clinical conditions that occur about the elbow. The purpose of this paper is to present the most common elbow problems that an athlete may encounter and to provide information to facilitate recognition of elbow pathology. This information is essential before initiating treatment. An attempt is made to include sprains, strains, neuropathies, dislocations, fractures, contusions, vascular insults, and skin problems in the distal humerus, elbow, and proximal forearm of both the immature and mature athlete. Comprehension of the mechanism of injury aids clinical evaluation and rehabilitation and enhances early return to activity.

Athletic Injuries↗

PubMed1996

Pain dysfunction syndrome of the knee.

Pain dysfunction syndrome is a descriptive term recommended by Amadio to describe patients whose pain is excessive, nonanatomic, and out of proportion to their injury. This retrospective review reports the effectiveness of a differential epidural block in the evaluation of these patients. Four patterns of response were identified with the block: 1) reflex sympathetic dystrophy (RSD) (14%), 2) somatic (9%), 3) mixed sympathetic and somatic (27%), and 4) central (50%). The inciting injury in 70% of the patients was a minor strain, sprain, or contusion. Despite accurate diagnosis, the results in compensation cases with pain dysfunction syndrome are exceedingly poor.

Adolescent↗

PubMed2000

A comparative study of subsyde-CR versus meloxicam in rheumatic disorders.

A prospective, randomised comparative clinical study was conducted in adult patients of either sex presenting with articular and non-articular rheumatic conditions commonly encountered in clinical practice Rheumatoid arthritis, osteo-arthritis, cervical spondylosis, and lumbago/sciatica were the most frequent conditions encountered in both the groups, followed by others like tenosynovitis, frozen shoulder, prolapsed disc, fibrositis, myositis, sprains, strains and so on. The drugs that were employed for therapy were diclofenac in a controlled release formulation employing the DRCM technology (subsyde-CR) and meloxicam in a standard formulation marketed in our country. Both drugs were well tolerated and found to be effective in reducing the signs and symptoms of the disease entities throughout the study period, but subsyde-CR was observed to produce a somewhat greater reduction in signs and symptoms scores that meloxicam, a difference that could be possibly attributed to the greater efficacy of subsyde-CR in non-articular rheumatic conditions. On the basis of the available literature on diclofenac and meloxicam as well as the DRCM technology in formulating subsyde-CR, it is reasonable to conclude that a controlled release formulation of diclofenac based on the DRCM technology offers a safe and effective alternative to other non-steroidal anti-inflammatory drugs such as meloxicam.

Anti-Inflammatory Agents, Non-Steroidal↗

PubMed2000

Change in diagnosis among orthopedists compared to non-orthopedists in the management of acute knee injuries.

OBJECTIVE: Uncertainty regarding diagnosis is associated with lower patient satisfaction and can lead to delays in definitive treatment and to inappropriate use of resources. We sought to compare change in diagnosis among orthopedists and non-orthopedists caring for a community based cohort of individuals with incident acute knee injuries. METHODS: We conducted a longitudinal investigation of a population based cohort of Olmsted County residents with their first episode of acute knee injury occurring between January 1, 1993, and December 31, 1995. We reviewed the entire (inpatient and outpatient) medical records for these patients and collected extensive clinical data on all diagnoses made (including possible and probable) and the specialty of the attending physician(s) making them. Diagnoses were categorized as: (1) meniscus injury, cruciate injury, or osteochondral fracture; (2) ligament injury, patellar instability, patellar injury; or (3) sprain, strain, injury (unspecified). Diagnostic switches were defined as changes from one diagnostic category to another, or the addition or subtraction of a diagnostic category. We then examined the quality of the documented evidence supporting meniscal, ligamentous, and cruciate diagnoses (at initial evaluation) by comparing the clinical evidence to the recommendations outlined by the American Academy of Orthopaedic Surgeons clinical algorithm on acute knee injury. Analyses were conducted comparing (1) the number of diagnostic switches and (2) the quality of the documented evidence among those cases initially cared for by orthopedists and those cared for by non-orthopedists, using logistic regression analysis adjusting for age, sex, and injury severity. The influence of these variables on costs of care was also examined. RESULTS: There were 664 patients (361 men and 303 women) in our study population, with an average age of 36.0 years (minimum 17, maximum 87). Of these, 324 were excluded because they only had one clinical encounter for their acute knee injury. Of the remaining 340, 59 (17.4%) were initially cared for by an orthopedist and 211 (62.1%) were cared for by an orthopedist at some time during their care. Diagnostic switches were significantly less frequent in the group who were cared for by orthopedists (55% vs 74%, p < 0.001). This result persisted after adjusting for age, sex, and severity (p = 0.003). The proportion of cases whose diagnoses were supported by evidence was significantly higher among the group whose first attending physician was an orthopedist (63.0% vs 37.6%, p = 0.002). Both change in diagnosis (p < 0.001) and physician specialty (p < 0.001) were statistically significant predictors of costs of care. CONCLUSION: Compared to non-orthopedic care, orthopedic care for acute knee injury was associated with fewer changes in diagnosis, and diagnoses made by orthopedists were more likely to be supported by evidence. However, even after adjusting for severity, orthopedic care remained significantly more costly than non-orthopedic care.

Acute Disease↗

PubMed1992

Analyses of battle casualties by weapon type aboard U.S. Navy warships.

The number of casualties was determined for 513 incidents involving U.S. Navy warships sunk or damaged during World War II. Ship type and weapon were significant factors in determining the numbers of wounded and killed. Multiple weapon attacks and kamikazes yielded more wounded in action than other weapon types. Multiple weapons and torpedos resulted in a higher incidence of killed in action than other weapons. Penetrating wounds and burns were the most prominent injury types. Kamikaze attacks yielded significantly more burns than incidents involving bombs, gunfire, torpedos, mines, and multiple weapons. Mine explosions were responsible for more strains, sprains, and dislocations than the other weapon types.

History, 20th Century↗

PubMed1977

A five-year study of mortality in a busy ski population.

A 5-year study of a busy ski population in Utah revealed a total at-risk period of approximately 3.5 million skier-days. While the morbidity (fractures, strains, sprains, and occasionally more severe injuries) associated with skiing is well recognized and considered by most physicians concerned to be distributed somewhat unevenly within the various skills of skiing, the authors have identified an exceedingly low mortality among the same population. Six individuals died as a result of injuries directly attributable to skiing. Three of these were considered to be advanced skiers and three were of intermediate skill. In three instances the environment was considered to play a role in the accident. Two of these victims were skiing out of control, one as a result of ice-covered snow and one as a result of speed in combination with a small jump. The third victim was crushed in an avalanche. One accident was completely unexplained, the skier having skied without apparent attempt at checking or change of course into a nonrecreational area. The two remaining skiers of intermediate skill both suffered injuries incident to falling forward with considerable force onto a relatively flat, hard snow surface. Notwithstanding the intense and sometimes prolonged exertion at relatively high altitudes (9,400 to 11,000 ft or 2.9 to 3.3 km), only one skier with a previous history of atherosclerotic heart disease died while skiing. One additional middle-aged skier with similar history died at the conclusion of the day.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1987

Epidemiology of school injuries: a 2-year experience in a municipal health department.

School injuries occurring in a municipal school system during a 2-year period were reviewed to identify epidemiologic features of school injuries, to determine data requirements for ongoing injury surveillance, and to identify potential preventive strategies. Overall, 3,009 injuries were reported (2.82/100 students per year). Elementary school students had only a slightly higher rate (2.85) than secondary school students (2.78). However, the cause, nature, school location of injury, and body area injured formed distinct patterns in these two groups. Playgrounds were responsible for the highest overall and elementary school rates, whereas sports areas and classrooms had the highest rates among secondary school students. Falls were the most frequent cause of injury in elementary schools whereas, as expected, sports injuries were the most frequent cause among secondary school students. Contusions and abrasions of the head were the most frequent type of injury for both groups, although more common among elementary school students, whereas fractures, sprains, strains, and dislocations were more frequent among secondary school students. Although the proportion of severe injuries to secondary school students was slightly higher (39 v 35%), the rate of referral of students to a hospital or physicians among secondary school students (1.21 per 100 student-hours) was almost twice the rate of elementary school students (0.65 per 100 student-hours). Problems with definition of injury severity and the need to explore the social aspects of schools as a factor in injuries emerged as important considerations for future research.

Accidental Falls↗

PubMed1979

[The influence of sports injuries on sport participation and work].

The incidence and complications of sport injuries in athletics, basketball, gymnastics, hockey, netball, cricket, tennis and soccer were analysed from questionnaire responses of 239 sport participants in Pretoria. Lower limb injuries were most common (73%). Torn tendomuscular organs represented 29,3% of the total number of injuries; sprains, strains and dislocations 35,9%; and fractures 20,5%. Medical treatment was sought by 62,8% of the patients. A total of 60,7% of the subjects was advised to suspend further participation in sport, but 30,6% failed to do so and more than half of these again sustained injuries. Those who were booked off from work totalled 18,0%, but a further 4,5% stayed away from work voluntarily.

Absenteeism↗

PubMed1994

Occupational musculoskeletal disorders.

Musculoskeletal disorders of the workplace include the acute, cumulative and chronic injuries or illnesses of the soft tissues which are caused by mechanical stress, strain, sprain, vibration, inflammation, or irritation. The successful management of occupational musculoskeletal disorders must account for workplace conditions (ergonomics and work practices), psychosocial factors, diagnostic uncertainties, and the need for active modalities (exercises and a progressive increase in activities of daily living), rather than passive (bed rest and traction). Although most occupational musculoskeletal disorders respond to conservative measures such as ice or heat, protective devices such as, neutral splints for carpal tunnel syndrome, nonsteroidal anti-inflammatory drugs, and progressive strengthening, resolution may take months. Prevention is often more important than treatment, and may entail workplace revisions and special worker training. Worker selection programs--strength testing, pre-placement radiographs, and inquiries about prior low back pain--have poor predictive value.

Chronic Disease↗

PubMed1993

Epidemiology of injuries associated with physical training among young men in the army.

It is widely acknowledged that musculoskeletal injuries occur as a result of vigorous physical activity and exercise, but little quantitative documentation exists on the incidence of or risk factors for these injuries. This study was conducted to assess the incidence, types, and risk factors for training-related injuries among young men undergoing Army infantry basic training. Prior to training we evaluated 303 men (median age 19 yr), utilizing questionnaires and measurements of physical fitness. Subjects were followed over 12 wk of training. Physical training was documented on a daily basis, and injuries were ascertained by review of medical records for every trainee. We performed univariate and multivariate analyses of the data. Cumulative incidence of subjects with one or more lower extremity training-related injury was 37% (80% of all injuries). The most common injuries were muscle strains, sprains, and overuse knee conditions. A number of risk factors were identified, including: older age, smoking, previous injury (sprained ankles), low levels of previous occupational and physical activity, low frequency of running before entry into the Army, flexibility (both high and low), low physical fitness on entry, and unit training (high running mileage).

Adult↗

PubMed1996

Physical injuries and fatalities resulting from the Oklahoma City bombing.

OBJECTIVE: To provide an epidemiologic description of physical injuries and fatalities resulting from the April 19, 1995, bombing of the Alfred P. Murrah Federal Building in Oklahoma City. DESIGN AND SETTING: Descriptive epidemiologic study of all persons injured by the bombing and of all at-risk occupants of the federal building and 4 adjacent buildings. Data were gathered from hospital emergency and medical records departments, medical examiner records, and surveys of area physicians, building occupants, and survivors. STUDY POPULATION: All persons known to have been exposed to the blast. MAIN OUTCOME MEASURES: Characteristics of fatalities and injuries, injury maps, and injury rates by building location. RESULTS: A total of 759 persons sustained injuries, 167 persons died, 83 survivors were hospitalized, and 509 persons were treated as outpatients. Of the 361 persons who were in the federal building, 319 (88%) were injured, of whom 163 (45%) died, including 19 children. Persons in the collapsed part of the federal building were significantly more likely to die (153/175, 87%) than those in other parts of the building (10/186, 5%) (risk ratio [RR], 16.3; 95% confidence interval [CI], 8.9-29.8). In 4 adjacent buildings, injury rates varied from 38% to 100%; 3 persons in these buildings and 1 person in an outdoor location died. The most frequent cause of death was multiple injuries. Among survivors, soft tissue injuries, fractures, sprains, strains, and head injuries were most common; these injuries were most often caused by flying glass and other debris and collapsed ceilings. CONCLUSIONS: The Oklahoma City bombing resulted in the largest number of fatalities of any terrorist act in the United States, and there were 4 times as many nonfatal injuries as fatalities. Disaster management plans should include the possibility of terrorist bombing, and medical preparedness should anticipate that most injuries will be nonfatal. The role of building collapse in fatal injuries should be considered in the design of buildings at high risk of being bombed so as to reduce injuries.

Cause of Death↗

PubMed1997

Medical coverage analysis for Wisconsin's Olympics: the Badger State Games.

The objective of this analysis is to determine the prevalence and severity of injuries encountered during the 1994-96 Badger State Summer Games Finals. Allocation of available medical personnel can be determined with this information. Medical contact with an athlete required an evaluation form to be completed by the health care professional covering the event. Information was compiled and analyzed to determine injury frequency and severity. Of the 31,580 athletes competing over the three year period in the 11 sports provided with medical personnel, 285 suffered a reportable injury. Soccer and basketball had the highest number of reported injuries with 68 and 65 injuries respectively. Basketball (2.00%), cycling (1.59%), wrestling (1.50%) and roller hockey (1.24%) had the highest injury rates. Severity of injury determined by the number of injuries transported to a medical facility found wrestling (23), soccer (22), basketball (11), and cycling (6) with the highest numbers of severe injuries. Wrestling (1.27%), basketball (.34%), soccer (.32%), and cycling (.21%) had the highest rate of severe injury. The most common sustained injuries were found to be sprains, strains, skin wounds, and contusions. These four types of injuries made up 70.18% of the injuries sustained. In conclusion, non-physician medical presence may be adequate coverage in most venues at multi-sport athletic competitions like the Badger State Games because of the relatively low frequency of severe injuries.

Athletic Injuries↗

PubMed1999

Parachuting injuries during Operation Royal Dragon, Big Drop III, Fort Bragg, North Carolina, May 15/16, 1996.

On the night of May 15/16, 1996, the largest parachute assault of United States (US) and United Kingdom (UK) airborne forces in 52 years occurred at Fort Bragg, North Carolina. This paper describes the injuries sustained in that operation. A total of 4,754 (US, N = 3,066; UK, N = 1,688) aircraft exits were made, causing a total of 137 (US, N = 73; UK, N = 64) injuries in 117 personnel (US = 68; UK = 49). There were 15 hospital admissions (US = 8; UK = 7; p = 0.37) and no fatalities. The combined exit injury incidence was 24.6 injured soldiers per 1,000 exits. The US exit injury rate was 22 injured per 1,000 aircraft exits and the UK rate was 29 injured soldiers per 1,000 aircraft exits. This difference was not statistically significant (p = 0.25). Lower extremity sprains, strains, and fractures accounted for the majority of injuries in US and UK forces. UK soldiers sustained significantly more of these potentially incapacitating injuries than US troops, 16.1 per 1,000 exits versus 9.1 per 1,000 exits, respectively (chi 2 = 4.07; p = 0.043; relative risk [RR] = 1.70; 95% confidence interval [CI] = 1.01, 2.86). The UK forces sustained significantly more closed head injuries than US forces, 7.1 per 1,000 exits versus 2.3 per 1,000 exits, respectively (chi 2 = 6.4; p = 0.011; RR = 3.13; 95% CI = 1.23, 7.93). The UK forces also had significantly more soldiers with multiple injuries than US forces (RR = 9.15; 95% CI = 2.5, 39.7). Factors that may have influenced differences in injury incidence include differences in weight of personal equipment and possible differences between the drop zones.

Adolescent↗