Relative Energy Deficit (Female Triad)

ABSTRACT CLINICAL PRESENTATION & EXAM: The relative energy deficit also known as RED-S or the Female Triad, is a common occurrence with females. RED-S occurs due to many factors such as increased energy output, decreased energy intake, or can sometimes be caused by both. RED-S in females is diagnosed by three symptoms: abnormal eating habits, osteoporosis, and functional hypothalamic amenorrhea. The patient does not need to experience all three symptoms to be diagnosed with RED-S. The energy deficit affects physiological functions such as cardiovascular health, immunity, protein synthesis, along with menstrual functions in females. ANATOMY & PATHOLOGY: Osteoporosis is a condition in which the bone becomes weak due to low bone production. Functional hypothalamic amenorrhea is a reversible disorder in which the pulsatile release of gonadotropin-releasing hormone from the hypothalamus is impaired. Gonadotropin-releasing hormone is a hypothalamic decapeptide that helps to maintain reproductive functions. The hypothalamus is a region in the lower-part of the brain that plays a major role in helping to release hormones. DIAGNOSTIC TESTING & CONSIDERATIONS: Some common signs that an athlete might have RED-S are irritability, gradual weight loss, or irregular menses. When testing for RED-S, there is not a single test to diagnose it. A patient may take multiple diagnostics tests such as a pregnancy test, MRI, pelvic ultrasonography, endometrial biopsy, electrocardiography, radiography, and many other tests. Along with these tests, it is recommended to test for the individual symptoms of RED-S. Testing for the amount of energy a patient has is vital. Testing options include but are not limited to, a thorough physical exam, assessments of energy intake and output and an examination of the patient\u27s body mass index. It is important to remember that body mass index is not always accurate due to the unrepresented energy level of a patient. When testing for functional hypothalamic amenorrhea, a patient must undergo a series of tests to evaluate if they are pregnant, have a tract obstruction, or are experiencing primary ovarian insufficiency. The use of tests such as a pregnancy test, serum luteinizing hormone test, a pelvic ultrasound, are recommended for diagnosing functional hypothalamic amenorrhea. Screening yearly for this syndrome is recommended. TREATMENT & RETURN TO ACTIVITY: In order to treat RED-S, a patient usually needs to consult with a group of medical professionals. A patient must undergo a physical examination to find out which parts of the body have been affected. Treatment options should be equipped to fit each symptom of the energy deficit and the patient. It is recommended to try treating the syndrome without the use of pharmaceutical drugs by maintaining sufficient energy, calorie, and calcium intakes. Treating balanced energy levels in a patient who restricts their energy intake requires an examination by a mental health professional. If a patient did not intentionally limit their energy intakes, then she would be referred to a dietician to help manage her energy levels and/or have restrictions placed on her activities. Any patient with hormone deficiency is recommended to use pharmaceutical treatments. In order to recover bone loss and prevent it, the physician must help the female patient recover her normal menses. The recovery of menses is vital. If left untreated, the patient could continue to lose bone mass. Healthy weight gain in a patient has also been proven to help recover bone mass. The athletic trainer of an athlete is well equppied to help provide a treatment option for an athlete and tailor her recovery exercises

Jones Fracture

CLINICAL PRESENTATION & EXAM: The Jones typically manifests in the patient’s history in one of two ways: the fracture occurs at a specific point in time or the pain appears due to repetitive stress on the fifth metatarsal in a region known as the metaphyseal-diaphyseal junction. Sudden pain at the base of the fifth metatarsal will have appeared within 1.5 cm of the tuberosity. Patients will have trouble bearing weight on the foot with possible ecchymosis and/or edema present and will start to notice gradual pain on the opposite side of the foot as well as noticeable swelling. Patients are usually able to correlate the pain back to an incident where laterally directed force on the forefoot has occurred during plantar flexion of the ankle (typically this occurs during basketball or football). ANATOMY & PATHOLOGY: The fifth metatarsal(s) are the long bones in the middle of the foot, each having a neck, base, and shaft. The last bone on the foot is where most fractures of the fifth metatarsal occur usually by the base. The metaphyseal-diaphyseal region is the portion of developing long bone between the shaft (diaphysis) and the growing portion of the bone (epiphysis). DIAGNOSTIC TESTING & CONSIDERATIONS: After receiving the jones fracture, the patient will have to undergo a physical exam. Usually the fracture can be picked up on an x-ray but sometimes the patient might need to do an MRI/bone scan. TREATMENT & RETURN TO ACTIVITY: Depending on the severity of the fracture and an individual’s athleticism, there are many ways to treat the Jones Fracture. Jones Fractures heal with rest, but because these fractures occur due in the part of the bone that receives low blood supply, healing takes a long time. Surgery is recommended, particularly to athletic individuals, because the fracture may reoccur. The surgical option includes placing a plate, rod, or intramedullary screw in the fifth metatarsal of the foot. If surgery is not chosen, there are other ways to treat the Jones Fracture. Crutches and protective boots can be worn to reduce the weight and stress on the foot since Jones Fractures occur due to a repetitive stress to the injured area. While a patient can walk in a WBAT boot for 4-6 weeks, patients may need to lean towards surgery. X-rays should be taken every week or biweekly to confirm that the fracture is healing and ensure there was no nonunion. Surgery is the fastest way to return to normal activity; if the boot is used recovery will take a couple months. The fracture can reoccur so light activity is recommended if the patient wears the boot

Patellofemoral Syndrome

CLINICAL PRESENTATION & EXAM: Patellofemoral syndrome is an aching pain at the front of the knee and is common in athletes. Patellofemoral syndrome occurs due to many factors such as overuse (repetitive stress on the knee), trauma to the knee, surgery, and weak muscles. Surgery to the knee using the patellar tendon as a graft to fix the anterior cruciate ligament greatly increases the risk of pain. Many factors play a role in increasing the risk of developing patellofemoral syndrome such as sports, age, and gender. Most people who develop patellofemoral syndrome tend to be adolescents or young adults. Older people can develop patellofemoral syndrome but it is less common. Instead, most older people have knee problems due to arthritis. Sports that include jumping and running such as basketball and track greatly increases the risk of developing the syndrome. Both men and women can develop patellofemoral syndrome but it is more common in females. Common symptoms of patellofemoral syndrome include pain when bending the knee such as squatting. ANATOMY & PATHOLOGY: The patellar tendon connects the tibia to the patella. The anterior cruciate ligament is a ligament in the kneecap that crosses the posterior cruciate ligament. The anterior cruciate ligament is located in the middle of the knee and helps to hold the tibia in place. DIAGNOSTIC TESTING & CONSIDERATIONS: A physician will start by moving the knee and pushing down on certain areas to eliminate conditions similar to patellofemoral syndrome. After this, a physician will also run other diagnostic tests such as x-rays, CT scans, and an MRI. TREATMENT & RETURN TO ACTIVITY: There are both non surgical and surgical treatment options. One can begin with simple treatment options such as resting the knee and avoiding strenuous activities. If that does not work, then a physician may recommend physical therapy. Physical therapy includes icing the knee after exercise/training, taping the knee, braces and rehabilitation. Rehabilitation exercises that correct the movement of the knee are recommended. A physical therapist may recommend a break from sports that involve stress on the knee. If rest and physical therapy do not work, then surgery is recommended. The most common surgeries for patellofemoral syndrome are realignment and arthroscopy. Realignment surgery involves relieving kneecap pressure and/or correcting the angle of the kneecap. Arthroscopy involves inserting an arthroscope through a small incision and removing damaged cartilage