The HELP System as a Tool for Monitoring Physician Prescribing Patterns

Conference PaperBiomedical Informatic

Idiopathic Obturator Internus Strain in a Collegiate Tennis Player: A Case Report

Objective: Present a clinical case detailing the evaluation and treatment of an idiopathic obturator internus strain in a collegiate tennis player. Background: Isolated injury to the obturator internus muscle is uncommon. In cases that do present, patients often report often report a mechanism for injury involving falling or kicking. In previously reported cases, diagnosis is confirmed by magnetic resonance imaging. Treatment: Patient presented to the athletic training clinic complaining of left hip external rotator tightness and pain, and was unable to recall a mechanism of injury. Following the failure of conservative treatment, final diagnosis of a grade II obturator internus strain was made via magnetic resonance imaging. Using the confirmed diagnosis, the athletic training staff was able to progress strengthening and range of motion exercises until the patient returned to competition six weeks post injury. Conclusion: Obturator internus strains are possible causes of posterior hip pain and tightness. Currently, there are no reliable evaluation techniques for the obturator internus that do not involve diagnostic imaging. Further research needs to be conducted to determine if there are any signs and symptoms specific to obturator internus injuries

Effect of Cupping Therapy on Skin Surface Temperature in Healthy Individuals

Purpose: The purpose of this study was to examine the effect of cupping therapy on skin surface temperature, and therefore local blood flow, at the medial forearm. Methods: 32 healthy subjects [13 females (age = 21.14 ± 1.70, height = 168.00 ± 9.70 cm, mass = 67.07 ± 16.93) and 16 males (age = 21.78 ± 1.90, height = 180.62 ± 6.09, mass = 88.35 ± 14.66) participated in this study. A mark was made with a permanent marker 7 cm distal to the medial forearm. Cupping therapy was performed over this mark with the use of a plastic pump cup for 15 minutes. Every 5 minutes the cup was removed in order for skin surface temperature to be taken. Skin surface temperature was taken with the use of an infrared thermometer at base line, 5 minutes into treatment, 10 minutes into treatment, 15 minutes into treatment, and 5 minutes after treatment. A one way repeated measures ANOVA was performed to analyze the difference in skin surface temperature over time. Significance was set at an alpha level p \u3c 0.05. Results: Significant differences were found between all conditions (baseline = 89.37 ± 2.09, 5 minutes into treatment = 90.49 ± 2.08, 10 minutes into treatment = 91.65 ± 2.18, 15 minutes into treatment = 91.62 ± 2.26, 5 minutes after treatment = 92.40 ± 2.03, p \u3c 0.001). Conclusion: A single cupping therapy treatment appears to significantly increase skin surface temperature at the treatment site. Increases in skin surface temperature have been suggested as a representation of increases in local blood flow. These findings suggest that a single cupping therapy treatment may increase local blood flow at the medial forearm

Fracture of a Heterotopic Ossification of the Syndesmosis in a Collegiate Football Player: A Case Report.

Objective: Present a clinical case detailing the assessment and management of a collegiate football player suffering from the fracturing of a heterotopic ossification of the syndesmosis. Background: Heterotopic ossifications are not uncommon following surgical fixation of the tibiofibular syndesmosis. Typically, properly healed fibular fractures do not result in further complications associated with heterotopic ossification. Treatment: A 21-year-old collegiate football player (1.8 m, 77.1 kg) reported to the athletic training staff complaining of acute lateral ankle pain following a plant and twist mechanism while running receiving routes. Initial evaluation led to a diagnosis of a syndesmotic ankle sprain, with a plan to pursue conservative management. When patient was unable to participate in the following practice due to intensity of pain, the patient was referred for x-rays a revealed poorly healed Weber Type C fracture that had been mislabeled as a Maisonneuve fracture at the patient’s previous university. This previous injury led to a heterotopic ossification of the syndesmosis that had fractured during the more recent injury. With this new diagnosis, the patient consented to conservative treatment that allowed the patient to return to football activities the following offseason. Uniqueness: While heterotopic ossification of the ankle syndesmosis has been reported in literature, there has yet to be extensive research on the condition. Generally, when these ossifications become symptomatic best practices involve surgical removal. In spite of presenting with symptoms, the patient was able to return to full participation following conservative treatment. Conclusion: When providing patient care, accurate diagnosis is crucial to optimal outcomes. Caring for patients in a collegiate setting presents a unique number of instances of patient care transfer, which may make previous misdiagnosis hard to recognize. Diligent health care practitioners should always ensure that a comprehensive medical history is obtained in order to make an accurate assessment. Keywords: Heterotopic ossification, syndesmosis, ankl

Utilization of Cupping Therapy in the Treatment of Vascular Thoracic Outlet Syndrome in a Collegiate Pitcher: A Case Study

Objective: Present a clinical case detailing the effectiveness of dry cupping therapy in treating thoracic outlet syndrome. The utilization of dry cupping therapy on a 20-year-old collegiate baseball pitcher with diagnosed thoracic outlet syndrome is presented. Background: Thoracic outlet syndrome is a relatively rare musculoskeletal condition affecting 1/100,000 patients annually. Dry cupping therapy is an ancient therapeutic modality that utilizes various means of suction with the goal of decompressing myofascial layers. Treatment: Following diagnosis, patient was successfully treated in two weeks using dry cupping therapy. The patient experienced no further incidence of thoracic outlet syndrome symptoms and was able to complete the remainder of his competitive season. Uniqueness: The patient’s thoracic outlet syndrome was diagnosed at an early stage, leading to the need of clearance from a vascular specialist before returning to competition. To the author’s knowledge, there are currently no published case reports detailing the use of cupping therapy to treat thoracic outlet syndrome. Conclusion: Cupping therapy may be a viable treatment option when seeking to address tight musculature. Further research needs to be conducted to determine optimal parameters for cupping therapy as a therapeutic modality

Idiopathic Proximal Tibiofibular Joint Laxity in a Collegiate Baseball Player: A Case Report

Objective: Present a clinical case detailing the assessment and management of a collegiate baseball player suffering from symptomatic laxity of the proximal tibiofibular joint. Background: Injuries to the proximal tibiofibular joint are rare, and generally accompanied by some form of trauma. Typically, dislocations of the proximal tibiofibular joint occur in an anterior direction, and require reduction and possible fixation as a first course of treatment. Treatment: A 20-year-old collegiate baseball player reported to the athletic training clinic complaining of idiopathic lateral right knee pain. The patient could not recall a mechanism, but recalled an insidious onset of pain that had begun two months prior to reporting to the athletic training staff. There has been some documentation of patients presenting with congenitally lax proximal tibiofibular ligaments, but at this time there is no demographic information on this patient population. Uniqueness: Most cases of proximal tibiofibular laxity occur as a result of trauma. In this patient’s case, there was no specific mechanism of injury or site morbidity to suggest an injury had occurred. Additionally, the patient was able to develop dynamic, and functional stability before regaining static stability. Conclusion: Anatomical abnormalities offer clinicians a unique opportunity to explore multiple levels of problem solving and patient assessment. Further research needs to be conducted to provide demographic data and treatment options for patients suffering from proximal tibiofibular joint laxity

Comparison of Pitching from Flat Ground vs. 10-Inch Mound Regarding Elbow Varus Torque and Arm Speed

Purpose: The purpose of this study was to examine the effect of throwing surface and distance on varus elbow torque and arm speed. Methods: 11 male collegiate baseball pitchers (age = 20.73 ± 1.56 years, height = 175.26 ± 9.03 cm, mass = 70.31 ± 9.03 kg) participated in this study. Varus elbow torque and distance were measured using a 3D motion sensor housed in a spandex sleeve at the medial joint line of the elbow. Participants were instructed to complete their normal warmup routine as if they were about to pitch in a bullpen session or a game. Participants were then fitted with the sleeve and 3D motion sensor and then instructed to throw 5 maximum effort fastballs at both 60 feet 6 inches and 50 feet 6 inches from a 10-inch mound and 5 maximum effort fastballs at both 60 feet 6 inches and 50 feet 6 inches from flat ground. A two-way ANOVA with repeated measures was used to analyze the differences in elbow varus torque and arm speed when pitching from 60 feet 6 inches and 50 feet 6 inches from a 10-inch mound and from flat ground. Tests of significance were carried out at an alpha level p \u3c 0.05. Results: Significant differences in elbow varus torque were found when throwing from a 10-inch mound compared to flat ground (10-inch mound = 46.99 ± 2.36, Flat ground = 42.67 ± 3.14). No significant differences in elbow varus torque were found when throwing from 60 feet 6 inches compared to 50 feet 6 inches regardless of surface (60 feet 6 inches = 45.38 ± 2.96, 50 feet 6 inches = 44.28 ± 2.59). No significant differences in arm speed were found regardless of surface or distance. Conclusions: Throwing from a 10-inch mound appears to place more torque on the elbow than throwing from flat ground. Clinicians should be mindful of this fact when progressing patients through throwing programs

Athletic Trainers’ Perceived and Actual Knowledge of Cupping Therapy Concepts

Purpose: To date, there does not appear to be a study published that has examined the prevalence of clinical use and the perceived and actual knowledge of cupping therapy that clinicians possess. The purpose of this study was to determine the perceived and actual knowledge of cupping therapy among athletic trainers. Methods: 113 certified athletic trainers completed the study (age = 35 ± 10 years, years of certified experience = 12 ± 10 years). Participants were sent an electronic survey via email that assessed frequency of usage, perceived knowledge, and actual knowledge of cupping therapy. Data were downloaded and analyzed using a commercially-available statistics package (SPSS Version 25, IBM, Armonk, NY). Measures of central tendency (means, standard deviations, frequencies) were calculated for all survey items. A Pearson correlation was calculated for the perceived knowledge and actual knowledge items to identify a knowledge gap between what one believes they know and actually what they do know. Finally, an independent samples t-test was used to explore differences on the actual knowledge assessment based on prior education. Significance was set at P \u3c .05 a priori. Results: The majority of certified athletic trainers reported not viewing the use of cupping therapy as necessary to their clinical practice. However, the majority also reported using cupping therapy at least once in the past week when treating patients. Regarding perceived knowledge, the majority of respondents were in the mid-range of agreement/disagreement, indicating at least some level of uncertainty. Average scores on actual knowledge were 8.90±1.34 out of 12 questions. A poor positive relationship was found between perceived and actual knowledge (r = 0.125, P = 0.259). We also identified a poor positive relationship (r = 0.079, P = 0.439) between the actual knowledge assessment score and the likelihood to pursue continuing education item from the perceived knowledge assessment. Conclusions: While the majority of athletic trainers did not view cupping therapy as necessary to their clinical practice, the majority did use the tool in their weekly practice. The relationship between actual knowledge and pursuit of continuing education suggestion that continuing education may improve knowledge of cupping therapy