Clinics in sports medicine
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Stress fractures of the medial malleolus and distal fibula are rarely encountered. They typically affect the athletic and running population and manifest the usual signs and symptoms of stress fractures. Axial and torsional forces, muscular contractions, and alignment are believed to play a role in their development. ⋯ The diagnosis can be confirmed with radionuclide bone scanning or MRI. Most injuries are amenable to nonsurgical management. An operative intervention for athletes with medial malleolar stress fractures has been advocated under certain circumstances.
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Since the stress fracture of the tarsal navicular was first described in 1970, awareness of the injury has increased, and navicular stress fractures have represented up to 35% of stress fractures in recent series. However, these injuries remain difficult to diagnose and treat because of their often vague clinical presentation and the poor correlation between radiographic and clinical findings.
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For the athlete, not only can pulmonary disorders cause significant alterations in training schedules or even prolonged stoppages, they can be life-threatening. Infectious diseases such as acute bronchitis, influenza, and pneumonia conspire to disrupt exercise regimens. ⋯ Obstructive sleep apnea not only causes disruptive symptoms but can be associated with significant cardiovascular morbidity and even mortality. This article addresses the most common pulmonary conditions athletes face and provides a framework for the diagnosis and treatment of these conditions.
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Gastrointestinal (GI) illnesses are common in athletes. Various causes include adverse physiologic adaptations of the gut during exercise; excess ingestion of carbohydrate drinks, alcohol, and anti-inflammatory medications; emotional stressors; exposure to pathogens in closed environments and during travel; trauma; and abdominal wall pressure overload. Unfortunately, evidence-based management of GI illnesses in athletes is limited because most studies have compared various GI illnesses between different sports, rather than comparing athletes to nonathletes. This article reviews the evidence that is available specifically relating to etiology, pathophysiology, clinical presentation, relevant differential diagnoses, acute management, and recommendations for specialist consultation of various GI illnesses in the training-room setting.
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Neurological conditions are common in athletes. Trauma can cause direct central (eg, concussion or hemorrhage) or peripheral (eg, stinger) injury. ⋯ This article reviews assessment and initial management of head injury, stingers, seizures, and headaches. Return-to-play criteria are also discussed.