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The following represent additions to UpToDate from the past six months that were considered by the editors and authors to be of particular interest. The most recent What's New entries are at the top of each subsection.
ADOLESCENT AND PEDIATRIC SPORTS MEDICINE
Prevention of concussion in children playing hockey (April 2017)
Evidence is limited regarding specific interventions to prevent sport-related concussion. In a prospective study of the effect of a Canadian rule change on age eligibility for body checking in youth hockey, the rate of concussions decreased by 64 percent among 11- and 12-year-old hockey players after the eligible age for checking was raised to 13 years . Thus, limiting types of contact until an older age appears to be an effective strategy to reduce the risk of concussion in younger players, although prior studies suggest that the risk of injuries other than concussion may be increased when players are introduced to body checking in subsequent seasons. (See "Concussion in children and adolescents: Management", section on 'Prevention'.)
MANAGEMENT AND REHABILITATION OF MUSCULOSKELETAL INJURIES
Nonsurgical treatment for shoulder impingement (October 2017)
Impingement is a common cause of shoulder pain and dysfunction, but evidence pertaining to the effectiveness of treatment options is limited. A recent systematic review of randomized trials of nonsurgical interventions for shoulder impingement identified the overall quality of the studies as very low, but found that physical therapy programs that emphasize specific exercises for the rotator cuff and scapular muscles to be among the most effective interventions for improving shoulder function and pain . These findings support our approach to the treatment of this condition. (See "Shoulder impingement syndrome", section on 'Physical therapy'.)
MEDICAL ISSUES RELATED TO SPORTS AND EXERCISE
Home use of topical anesthesia to control pain from corneal abrasions (August 2017)
In a retrospective study of 444 patients with corneal abrasions given a 24-hour supply of topical tetracaine at the initial emergency department visit, there were no documented serious complications or uncommon adverse events . However, definitive outcomes were only known for 120 patients who returned for rechecks. Patients receiving topical tetracaine were more likely to return for emergency department reevaluation compared with patients who did not receive tetracaine. Topical analgesia was prescribed inappropriately in one-third of patients, for lesions other than simple corneal abrasion (eg, large corneal abrasions, retained rust rings, herpes keratitis, anterior uveitis, and corneal erosions). Because of the possibility of overuse (ie, use beyond 24 hours) and the risk of inappropriate administration, we favor other means of pain control and discourage the prescribing of topical anesthetic agents. More evidence is needed to establish the safety of this practice in patients with simple corneal abrasions. (See "Corneal abrasions and corneal foreign bodies: Management", section on 'Pain control'.)
Consensus statement from 5th International Conference on Concussion in Sport (July 2017)
Recently, the 5th International Conference on Concussion in Sport published a consensus statement . Concussion remains a clinical diagnosis that is best approached through multidimensional testing. The consensus statement endorses the new 5th edition of the Sport Concussion Assessment Tool (SCAT5) for sideline assessment of athletes 13 and older, and the Child SCAT5 for athletes 5 to 12 years old. Consistent with prior iterations, the statement emphasizes immediate removal from play followed by a careful systematic evaluation whenever concussion is suspected. Athletes diagnosed with a concussion should rest, but strict absolute rest is not necessary, and patients can be encouraged to become more active in a gradual manner as their symptoms permit. (See "Sideline evaluation of concussion" and "Concussion in children and adolescents: Clinical manifestations and diagnosis" and "Concussion and mild traumatic brain injury" and "Sideline evaluation of concussion", section on 'Assessment instruments'.)
PREVENTION AND BIOMECHANICS OF MUSCULOSKELETAL INJURIES
Warmup program and risk of shoulder injuries in team handball (September 2017)
Although it is widely accepted that a proper warmup reduces the risk of injury among overhead throwing athletes, little high-quality evidence is available to inform the design of warmup programs. In a cluster-randomized trial involving 45 elite handball teams and 660 players (a population of throwing athletes with a shoulder injury profile similar to baseball pitchers), a preparticipation warmup consisting of five exercises reduced shoulder injuries (28 percent lower risk) in the intervention group compared with controls over the course of the seven-month season . We suggest that all throwing athletes perform injury prevention exercises regularly, including an appropriate warmup. (See "Throwing injuries of the upper extremity: Treatment, follow-up care, and prevention", section on 'Exercise and throwing programs for treatment and injury prevention'.)
Minimalist running shoes and injury risk (June 2017)
Although running shoes with minimal padding (minimalist shoes) have gained popularity in recent years, few studies of the effects of training in such shoes have been performed. In a recent randomized trial, 61 trained runners with a habitual rearfoot strike were randomly assigned to minimalist or standard running shoes, and then gradually increased the time spent running in the designated shoes over 26 weeks . Of 27 injuries sustained by participants, 16 occurred in runners using minimalist shoes and 11 in runners using conventional running shoes. The risk of injury was increased twofold among runners with increased body mass using minimalist shoes. We suggest that runners over 85 kg (187 pounds) not use minimalist shoes, and that other runners avoid excessive training in such shoes. (See "Overview of running injuries of the lower extremity", section on 'Running barefoot or with minimalist shoes'.)
- Black AM, Hagel BE, Palacios-Derflingher L, et al. The risk of injury associated with body checking among Pee Wee ice hockey players: an evaluation of Hockey Canada's national body checking policy change. Br J Sports Med 2017.
- Steuri R, Sattelmayer M, Elsig S, et al. Effectiveness of conservative interventions including exercise, manual therapy and medical management in adults with shoulder impingement: a systematic review and meta-analysis of RCTs. Br J Sports Med 2017; 51:1340.
- Waldman N, Winrow B, Densie I, et al. An Observational Study to Determine Whether Routinely Sending Patients Home With a 24-Hour Supply of Topical Tetracaine From the Emergency Department for Simple Corneal Abrasion Pain Is Potentially Safe. Ann Emerg Med 2017.
- McCrory P, Meeuwisse W, Dvorak J, et al. Consensus statement on concussion in sport-the 5(th) international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med 2017.
- Andersson SH, Bahr R, Clarsen B, Myklebust G. Preventing overuse shoulder injuries among throwing athletes: a cluster-randomised controlled trial in 660 elite handball players. Br J Sports Med 2017; 51:1073.
- Fuller JT, Thewlis D, Buckley JD, et al. Body Mass and Weekly Training Distance Influence the Pain and Injuries Experienced by Runners Using Minimalist Shoes: A Randomized Controlled Trial. Am J Sports Med 2017; 45:1162.