Aim & Research Question Davis et al. 2019 proposed six visible signs (VS) of concussion. Our study evaluated frequency of VS after head impacts, how often individuals with VS underwent a diagnostic evaluation, and correlated head impact magnitudes with appearance of VS. Design Retrospective Observational Cohort/Setting Military service members in training and athletics, as well as and civilian athletes. Participants 542 military service members and 1502 civilians. Independent Variables On-site report from Commander or video confirmation rated by an expert. Outcome Measures VS of concussion, concussion assessment/removal from activity, impact monitoring mouthguard data. Main Results 177,800 impacts across 10900 subject-days of participation were collected. Most impacts (64%) were in daily living ranges (e.g. <10g acceleration and <1J workload). VS were seen in a small number of impacts (n=426, 0.2%). In VS impacts, 82% were not assessed and 86% continued participation. The median VS impact magnitudes (55g, 30J) versus non-VS impacts (8g, 1J) were significantly different (p<0.001 for both parameters). Conclusions This work supports the importance of identification of visible signs of suspected concussion, triggering appropriate diagnostic evaluation advocated by the 5th International Conference on Concussion. It appears that while potentially concussive events are uncommon, VS are often unseen. When VS did occur in our cohort they were frequently not assessed. Impacts with VS of concussion had significantly greater measured force than those without. These data suggest a well-calibrated impact monitoring system may help capture high magnitude impacts that could lead to VS.

Importance Myocarditis is a leading cause of sudden death in competitive athletes. Myocardial inflammation is known to occur with SARS-CoV-2. Different screening approaches for detection of myocarditis have been reported. The Big Ten Conference requires comprehensive cardiac testing including cardiac magnetic resonance (CMR) imaging for all athletes with COVID-19, allowing comparison of screening approaches. Objective To determine the prevalence of myocarditis in athletes with COVID-19 and compare screening strategies for safe return to play. Design, Setting, and Participants Big Ten COVID-19 Cardiac Registry principal investigators were surveyed for aggregate observational data from March 1, 2020, through December 15, 2020, on athletes with COVID-19. For athletes with myocarditis, presence of cardiac symptoms and details of cardiac testing were recorded. Myocarditis was categorized as clinical or subclinical based on the presence of cardiac symptoms and CMR findings. Subclinical myocarditis classified as probable or possible myocarditis based on other testing abnormalities. Myocarditis prevalence across universities was determined. The utility of different screening strategies was evaluated. Exposures SARS-CoV-2 by polymerase chain reaction testing. Main Outcome and Measure Myocarditis via cardiovascular diagnostic testing. Results Representing 13 universities, cardiovascular testing was performed in 1597 athletes (964 men [60.4%]). Thirty-seven (including 27 men) were diagnosed with COVID-19 myocarditis (overall 2.3%; range per program, 0%-7.6%); 9 had clinical myocarditis and 28 had subclinical myocarditis. If cardiac testing was based on cardiac symptoms alone, only 5 athletes would have been detected (detected prevalence, 0.31%). Cardiac magnetic resonance imaging for all athletes yielded a 7.4-fold increase in detection of myocarditis (clinical and subclinical). Follow-up CMR imaging performed in 27 (73.0%) demonstrated resolution of T2 elevation in all (100%) and late gadolinium enhancement in 11 (40.7%). Conclusions and Relevance In this cohort study of 1597 US competitive athletes with CMR screening after COVID-19 infection, 37 athletes (2.3%) were diagnosed with clinical and subclinical myocarditis. Variability was observed in prevalence across universities, and testing protocols were closely tied to the detection of myocarditis. Variable ascertainment and unknown implications of CMR findings underscore the need for standardized timing and interpretation of cardiac testing. These unique CMR imaging data provide a more complete understanding of the prevalence of clinical and subclinical myocarditis in college athletes after COVID-19 infection. The role of CMR in routine screening for athletes safe return to play should be explored further.

HISTORY: 23-year-old NFL athlete being evaluated for post COVID physical and pre-participation entrance examination. Athlete had mild sick symptoms and tested positive for COVID in the summer prior to beginning training camp. He was asymptomatic at the time of the entrance examination. However, protocol from the NFL required him to have an EKG, Echocardiogram, Cardiac MRI, and a Troponin level. PHYSICAL EXAMINATION: Age-appropriate male in no acute distress. No evidence of JVD. Grade 2/6 holodiastolic murmur heard during auscultation. Regular rate and rhythm. No evidence of heaves or thrills. Lungs were clear to auscultation without wheezing, rales, or rhonchi. No evidence of respiratory distress or accessory muscle use visualized. DIFFERENTIAL DIAGNOSIS: 1. Post-Infectious Myocarditis 2. Dilated Cardiomyopathy 3. Restrictive Cardiomyopathy 4. Infective Endocarditis 5. Valvular pathology 6. ASD TEST AND RESULTS: EKG- Overall normal. Did not meet full criteria for LVH. ECHO- Increased LV size at 6.2 cm. Low normal EF at 55-60%. Holodiastolic flow reversal in the descending thoracic aorta, consistent with severe aortic regurgitation. Cardiac MRI- Bicuspid aortic valve without stenosis but with severe aortic regurgitation. Low/Normal EF at 55% and a severely enlarged left ventricle. Mild aortic root dilation. CBC, BMP, and Troponin were all within normal ranges. FINAL WORKING DIAGNOSIS: Bicuspid aortic valve with aortic insufficiency TREATMENT AND OUTCOMES: Athlete was seen by two different cardiologists, the second one was sought after by the athlete for a second opinion. The final decision was made that he would proceed with a valvular repair. Repair was successful on the valve and he was instructed that heavy lifting would need to be avoided for 12 weeks. He was able to resume aerobic exercise as tolerated, without limits. After surgery, athlete was started on metoprolol er 25 mg once daily, and, lisinopril 2.5 mg once daily. Athlete did not return to play this season. Planning on returning for the 2021 season, pending further discussion on valvular replacement type.

Objectives: This study examined whether an online course would lead to increased knowledge about the medical issues volunteers encounter during a marathon. Materials and Methods: Health care professionals who volunteered to provide medical coverage for an annual marathon were eligible for the study. Demographic information about medical volunteers including profession, specialty, education level and number of marathons they had volunteered for was collected. A 15-question test about the most commonly encountered medical issues was created by the authors and administered before and after the volunteers took the online educational course and compared to a pilot study the previous year. Results: Seventy-four subjects completed the pre-test. Those who participated in the pilot study last year (N = 15) had pre-test scores that were an average of 2.4 points higher than those who did not (mean ranks: pilot study = 51.6 vs. non-pilot = 33.9, p = 0.004). Of the 74 subjects who completed the pre-test, 54 also completed the post-test. The overall post-pre mean score difference was 3.8 +/- 2.7 (t = 10.5 df = 53 p < 0.001). While subjects with all levels of volunteer experience demonstrated improvement, only change among first time marathon volunteers was significantly different from the others. Subjects reporting all degree/certification levels demonstrated improvement, but no difference in improvement was found between degree/certification levels. Conclusion: In this follow-up to the previous year's pilot study, online education demonstrated a long-term (one-year) increase in test scores. Testing also continued to show short-term improvement in post-course test scores, compared to pre-course test scores. In general, marathon medical volunteers who had no volunteer experience demonstrated greater improvement than those who had prior volunteer experience.

Despite growing health and safety concerns, American football remains a vastly popular sport in the United States. Unfortunately, even with increased efforts in promoting education and hydration, the incidence of death from exertional heat stroke continues to rise. General risk factors such as hydration status, obesity, fitness level, and football-specific risk factors such as timing of training camp and equipment all contribute to the development of heat illness. At the professional level, changes have been made to effectively reduce mortality from heat stroke with no deaths since August 2001. However, there have been at least 33 total deaths at the high school and collegiate levels since this time. More efforts need to be focused at these levels to mandate exertional heat illness prevention guidelines in order to reverse this trend of mortality in our younger athletes.

Despite growing health and safety concerns, American football remains a vastly popular sport in the United States. Unfortunately, even with increased efforts in promoting education and hydration, the incidence of death from exertional heat stroke continues to rise. General risk factors such as hydration status, obesity, fitness level, and football-specific risk factors such as timing of training camp and equipment all contribute to the development of heat illness. At the professional level, changes have been made to effectively reduce mortality from heat stroke with no deaths since August 2001. However, there have been at least 33 total deaths at the high school and collegiate levels since this time. More efforts need to be focused at these levels to mandate exertional heat illness prevention guidelines in order to reverse this trend of mortality in our younger athletes.

Physicians, nurses physician assistants, certified athletic trainers and physical therapists who volunteer to provide medical care for race participants during a marathon may be unfamiliar with the types of injuries and diseases they will encounter. Although pre-race lectures are offered, these may be poorly attended. This study examined whether an online course might be better received and lead to increased knowledge about the medical issues clinicians might encounter during a marathon.

Professional football is one of the most popular sports in the United States. There is a common constellation of injuries that are seen frequently. Much attention has been focused on concussions and their long-term outcomes in this population. Other common causes of morbidity include cervical spine injuries, knee injuries including anterior cruciate ligament and other ligamentous injuries, ankle sprains, and medical issues including cardiac and sickle trait. Several recent studies have focused on hip impingement and hamstring injuries, among others, as sources of missed playing time as well. This review describes some of the frequently seen injuries and medical issues in professional football players. Proper management of both medical disease and on-field injuries can reduce morbidity and may lead to faster return to play and reduced risk of future injury.

Professional football is one of the most popular sports in the United States. There is a common constellation of injuries that are seen frequently. Much attention has been focused on concussions and their long-term outcomes in this population. Other common causes of morbidity include cervical spine injuries, knee injuries including anterior cruciate ligament and other ligamentous injuries, ankle sprains, and medical issues including cardiac and sickle trait. Several recent studies have focused on hip impingement and hamstring injuries, among others, as sources of missed playing time as well. This review describes some of the frequently seen injuries and medical issues in professional football players. Proper management of both medical disease and on-field injuries can reduce morbidity and may lead to faster return to play and reduced risk of future injury.

In the modern world it is imperative to understand the social and legal aspects of caring for the athlete. Two recent BJSM articles1 ,2 highlight important aspects of team physician practice. Confidentiality and protection of athletes medical information is increasingly challenging in the era of social media, which allows rapid dissemination of individuals’ personal details from a variety of sources.1 Additionally, as physicians travel both domestically and internationally to cover events, it is important to consider legal and social aspects of caring for the athlete. These may include: licensing issues, malpractice coverage, access to care at outside institutions and prescribing medications, including narcotics. As healthcare evolves in the USA and across the world, it is important for the team physician to be updated on the latest policies and factors, which may prevent them from providing necessary care in a timely fashion. Thus, these two articles1 ,2 are both timely, and should serve as a discussion point for further examination of these topics in other …

Football is one of the most popular sports in the United States and is the leading cause of sports-related injury. A large focus in recent years has been on concussions, sudden cardiac death, and heat illness, all thought to be largely preventable health issues in the young athlete. Injury prevention through better understanding of injury mechanisms, education, proper equipment, and practice techniques and preseason screening may aid in reducing the number of injuries. Proper management of on-field injuries and health emergencies can reduce the morbidity associated with these injuries and may lead to faster return to play and reduced risk of future injury. This article reviews current concepts surrounding frequently seen football-related injuries.

Football is one of the most popular sports in the United States and is the leading cause of sports-related injury. A large focus in recent years has been on concussions, sudden cardiac death, and heat illness, all thought to be largely preventable health issues in the young athlete. Injury prevention through better understanding of injury mechanisms, education, proper equipment, and practice techniques and preseason screening may aid in reducing the number of injuries. Proper management of on-field injuries and health emergencies can reduce the morbidity associated with these injuries and may lead to faster return to play and reduced risk of future injury. This article reviews current concepts surrounding frequently seen football-related injuries.

Brachial plexus injuries are frequently encountered in sports. Classically, the symptoms include transient burning, pain, and occasionally weakness of an isolated upper extremity resulting from a peripheral nerve injury of varying degrees. Persistent symptoms or recurrent injuries may necessitate imaging such as electromyography. Medical personnel should be familiar with brachial plexus anatomy and the common nerve injury mechanisms of compression or traction. On-field assessment includes evaluation for potentially more serious neurologic injuries and possible return to play when symptoms have resolved and the athlete has good range of motion and strength. Evidence-based guidelines are largely lacking, resulting in challenging evaluation and return-to-play decisions. Management focuses on improving neck range of motion and strength in addition to assessing for proper sport-specific technique. Additionally, enhancing protective equipment may prevent brachial plexus injuries. Currently, global screening via imaging of athletes is not recommended.

Brachial plexus injuries are frequently encountered in sports. Classically, the symptoms include transient burning, pain, and occasionally weakness of an isolated upper extremity resulting from a peripheral nerve injury of varying degrees. Persistent symptoms or recurrent injuries may necessitate imaging such as electromyography. Medical personnel should be familiar with brachial plexus anatomy and the common nerve injury mechanisms of compression or traction. On-field assessment includes evaluation for potentially more serious neurologic injuries and possible return to play when symptoms have resolved and the athlete has good range of motion and strength. Evidence-based guidelines are largely lacking, resulting in challenging evaluation and return-to-play decisions. Management focuses on improving neck range of motion and strength in addition to assessing for proper sport-specific technique. Additionally, enhancing protective equipment may prevent brachial plexus injuries. Currently, global screening via imaging of athletes is not recommended.