Rotator cuff contusions of the shoulder in professional football players: Epidemiology and magnetic resonance imaging findings

BACKGROUND: No published reports have studied the epidemiology and magnetic resonance imaging findings associated with rotator cuff contusions of the shoulder in professional football players. PURPOSE: To determine a single professional football team\u27s incidence, treatment, and magnetic resonance imaging appearance of players sustaining rotator cuff contusions of the shoulder. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: From 1999 to 2005, a North American professional football team\u27s injury records were retrospectively reviewed for athletes who had sustained a rotator cuff contusion of the shoulder during in-season participation. Those patients who had magnetic resonance imaging of the shoulder with a 1.5-Tesla magnet were reviewed by a musculoskeletal radiologist and graded according to the appearance and severity of clinical injury. RESULTS: Twenty-six players had a rotator cuff contusion. There was an average of 5.5 rotator cuff contusions per season (47% of all shoulder injuries). The predominant mechanism of injury was a direct blow in 70.3%. Magnetic resonance imaging findings included peritendon edema at the myotendinous junction, critical zone tendon edema, and subentheseal bone bruises. Treatment consisted of a protocol involving modalities and cuff rehabilitation in all patients. Six patients had persistent pain and weakness for a minimum of 3 days and were given a subacromial corticosteroid injection. Overall, 3 patients (11.4%) required later surgical treatment on the shoulder. CONCLUSION: Rotator cuff contusions accounted for nearly half of all shoulder injuries in the football players in this study. Magnetic resonance imaging is an extremely useful tool in determining severity of injury and integrity of the rotator cuff. The majority of athletes are able to return to sports with conservative treatment; a minority of shoulders might progress to more severe injuries such as rotator cuff tears

Decreased Anal Sphincter Lacerations Associated with Restrictive Episiotomy Use

Objective To determine whether restrictive episiotomy use was associated with decreases in anal sphincter lacerations and the risk of anal sphincter laceration attributable to episiotomy. Study design This was a retrospective database study. Rates of episiotomy, anal sphincter laceration (third- or fourth-degree tear), and other confounding variables were compared among vaginal deliveries before (1999) and after (2002) restrictive episiotomy use was implemented at our institution. Logistic regression was used to estimate the odds ratio of anal sphincter laceration that was due to episiotomy and other variables. Results The episiotomy rate decreased 56% (37% to 17%, P \u3c .001) between 1999 and 2002, whereas the anal sphincter laceration rate decreased 44% (9.7% to 5.4%, P \u3c .001). There were no changes in age, race, nulliparity, prolonged second stage of labor, operative vaginal deliveries, birth weight, or macrosomia, although oxytocin use and epidural use decreased slightly (37% to 31%, P \u3c .001, and 80% to 76%, P = .02, respectively). The adjusted odds ratio of anal sphincter laceration attributable to episiotomy decreased 55%, from 6.5 (95% CI: 3.8, 11.1) to 2.9 (95% CI: 1.7, 5.0), between 1999 and 2002. Conversely, the adjusted odds ratios of anal sphincter laceration attributable to the other independent risk factors all increased or remained the same: operative vaginal delivery, which increased from 4.4 (95% CI: 2.7, 6.9) to 6.3 (95% CI: 3.6 11.1); nulliparity, from 2.9 (95% CI: 1.8, 4.8) to 2.9 (95% CI: 1.4, 5.9); macrosomia, from 1.9 (95% CI: 1.1, 3.4) to 2.6 (95% CI: 1.3, 5.4); and prolonged second stage, from 2.0 (95% CI: 1.3, 3.0) to 2.1 (95% CI: 1.2, 3.7). Conclusion With restrictive episiotomy use, the episiotomy rate, anal sphincter laceration rate, and risk of anal sphincter laceration attributable to episiotomy were all reduced by approximately 50%

Decreased Anal Sphincter Lacerations Associated with Restrictive Episiotomy Use

Objective To determine whether restrictive episiotomy use was associated with decreases in anal sphincter lacerations and the risk of anal sphincter laceration attributable to episiotomy. Study design This was a retrospective database study. Rates of episiotomy, anal sphincter laceration (third- or fourth-degree tear), and other confounding variables were compared among vaginal deliveries before (1999) and after (2002) restrictive episiotomy use was implemented at our institution. Logistic regression was used to estimate the odds ratio of anal sphincter laceration that was due to episiotomy and other variables. Results The episiotomy rate decreased 56% (37% to 17%, P \u3c .001) between 1999 and 2002, whereas the anal sphincter laceration rate decreased 44% (9.7% to 5.4%, P \u3c .001). There were no changes in age, race, nulliparity, prolonged second stage of labor, operative vaginal deliveries, birth weight, or macrosomia, although oxytocin use and epidural use decreased slightly (37% to 31%, P \u3c .001, and 80% to 76%, P = .02, respectively). The adjusted odds ratio of anal sphincter laceration attributable to episiotomy decreased 55%, from 6.5 (95% CI: 3.8, 11.1) to 2.9 (95% CI: 1.7, 5.0), between 1999 and 2002. Conversely, the adjusted odds ratios of anal sphincter laceration attributable to the other independent risk factors all increased or remained the same: operative vaginal delivery, which increased from 4.4 (95% CI: 2.7, 6.9) to 6.3 (95% CI: 3.6 11.1); nulliparity, from 2.9 (95% CI: 1.8, 4.8) to 2.9 (95% CI: 1.4, 5.9); macrosomia, from 1.9 (95% CI: 1.1, 3.4) to 2.6 (95% CI: 1.3, 5.4); and prolonged second stage, from 2.0 (95% CI: 1.3, 3.0) to 2.1 (95% CI: 1.2, 3.7). Conclusion With restrictive episiotomy use, the episiotomy rate, anal sphincter laceration rate, and risk of anal sphincter laceration attributable to episiotomy were all reduced by approximately 50%

Internal impingement: Findings on magnetic resonance imaging and arthroscopic evaluation

Purpose: The purpose of this study was to examine preoperative shoulder magnetic resonance imaging (MRI) and intraoperative arthroscopic findings in throwing athletes with a clinical diagnosis of internal impingement. Type of Study: Retrospective review. Methods: A retrospective review of the surgical indications for 769 shoulder arthroscopic procedures performed from 1997 to 2000 revealed 9 throwing athletes with a diagnosis of severe internal impingement. Each had failed treatment that included a minimum of 3 months of rehabilitation. Preoperative MRIs in all 9 were read by a fellowship-trained musculoskeletal radiologist blinded to the operative findings. Findings at arthroscopy were culled from the operative reports. Results: On both MRI and at arthroscopy, all 9 athletes had posterosuperior labral lesions, 1 had a humeral head articular cartilage lesion, and 1 had a SLAP lesion. Additional findings on MRI included humeral head edema, subchondral cystic changes, posterosuperior glenoid sclerosis, and rotator cuff tendonopathy predominately in the infraspinatus. At arthroscopy, there were additional findings of articular-sided partial rotator cuff tears not shown on MRI. Conclusions: Both MRI and arthroscopic findings described labral and humeral head articular cartilage lesions. These findings may be indicative of internal impingement in throwing athletes. Level of Evidence: Level III, diagnostic

Hamstring injuries in professional football players: magnetic resonance imaging correlation with return to play.

BACKGROUND: Magnetic resonance imaging (MRI) allows for detailed evaluation of hamstring injuries; however, there is no classification that allows prediction of return to play. PURPOSE: To correlate time for return to play in professional football players with MRI findings after acute hamstring strains and to create an MRI scoring scale predictive of return to sports. STUDY DESIGN: Descriptive epidemiologic study. METHODS: Thirty-eight professional football players (43 cases) sustained acute hamstring strains with MRI evaluation. Records were retrospectively reviewed, and MRIs were evaluated by 2 musculoskeletal radiologists, graded with a traditional radiologic grade, and scored with a new MRI score. Results were correlated with games missed. RESULTS: Players missed 2.6 ± 3.1 games. Based on MRI, the hamstring injury involved the biceps femoris long head in 34 cases and the proximal and distal hamstrings in 25 and 22 cases, respectively. When \u3c 50% of the muscle was involved, the average number of games missed was 1.8; if \u3e 75%, then 3.2. Ten players had retraction, missing 5.5 games. By MRI, grade I injuries yielded an average of 1.1 missed games; grade II, 1.7; and grade III, 6.4. Players who missed 0 or 1 game had an MRI score of 8.2; 2 or 3 games, 11.1; and 4 or more games, 13.9. CONCLUSIONS: Rapid return to play (\u3c 1 week) occurred with isolated long head of biceps femoris injures with \u3c 50% of involvement and minimal perimuscular edema, correlating to grade I radiologic strain (MRI score \u3c 10). Prolonged recovery (missing \u3e 2 or 3 games) occurs with multiple muscle injury, injuries distal to musculotendinous junction, short head of biceps injury, \u3e 75% involvement, retraction, circumferential edema, and grade III radiologic strain (MRI score \u3e 15). CLINICAL RELEVANCE: MRI grade and this new MRI score are useful in determining severity of injury and games missed-and, ideally, predicting time missed from sports