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Official Journal of the American College of Sports Medicine 1406 May 30, 2:00 PM - 2:20 PM Medial Elbow Pain - softball athlete Mary Lloyd Ireland, FACSM, D. Jeff Covell. University of Kentucky Healthcare, Lexington, KY. (No relationships reported) hIsTOry: 17YO female, right hand dominant softball athlete fell on outstretched right arm when she dived back to base to avoid being thrown out. She had immediate pain in the medial aspect of her right elbow. No previous injuries. She went to an urgent treatment center and radiographs showed a medial epicondyle avulsion fracture, joint was reduced. Neurocirculatory status was intact and she was seen the following day. PhysICaL EXaMINaTION: Right elbow: Active range of motion was 45-110. Ecchymosis medially. Tenderness over the medial epicondyle. 2+ opening on valgus stress testing at maximal extension of 45°. No tenderness over the radial head. Negative Tinel’s over the ulnar nerve. Pulses present. No firmness of the forearm compartments. Normal wrist and shoulder exam. PhysICaL EXaMINaTION: 1. Elbow dislocation, reduced. 2. Medial epicondyle fracture. 3. Ulnar collateral ligament partial vs complete tear. 4. Radial head fracture, distal humeral fracture, coronoid fracture. TEsT aNd rEsuLTs: RADIOGRAPHS: AP lateral, oblique views showed medial epicondyle fracture in two pieces which measure 8 mm and 3 mm. Stress views showed opening medially. Epiphyseal plates closed. MRI scan showed disruption of ulnar collateral ligament proximally, comminuted medial epicondyle fracture, bone edema of the posterior aspect of the radial head consistent with valgus axial loading mechanism. FINaL WOrKING dIaGNOsIs: 1. Medial humeral epicondyle comminuted fracture. 2. Proximal ulnar collateral ligament proximal tear. TrEaTMENT aNd OuTCOMEs: The patient was placed in a hinged elbow brace. She began active and passive ROM. Two weeks after her injury, her ROM was 30-120°. Patient underwent right elbow internal fixation of the medial humeral epicondyle fracture with repair proximally of the ulnar collateral ligament. Ulnar nerve was inspected but was left in its anatomic position. Postoperatively she was immobilized for a couple of weeks to allow for healing of the incision and then range of motion emphasizing extension more than flexion was done. At 6 months followup, range of motion was 2-140°. Her elbow was stable. She returned to full activity. The interesting message about this case is that surgery is indicated to manage medial epicondyle fracture/UCL sprain from an elbow dislocation on the dominant arm of a throwing athlete. 1407 May 30, 2:20 PM - 2:40 PM Wrist Injury In Collegiate Basketball Player Abigail K. DeBusk, Robert G. Hosey, FACSM, Wade M. Rankin, Scott D. Mair. University of Kentucky, Lexington, KY. (No relationships reported) hIsTOry: 23-year-old collegiate women’s basketball player complaining of left wrist pain presented to clinic with a three week history of intermittent pain after falling on an outstretched hand during off season workouts. She described pain with dorsiflexion of the wrist and especially with weight-bearing activity. She denied radiation of pain into her hand or elbow. She had been taping the wrist and continuing to play with some pain. She also had taken an anti-inflammatory in the past which helped as well. Initial xrays were interpreted as negative. PhysICaL EXaM: She had full range of motion in dorsiflexsion, pronation, and supination of the wrist. She had pain with active and resisted dorsiflexion over dorsum of her wrist. Radial pulses 2+ bilaterally. She was neurologically intact. Negative Watson’s test. No TFCC tenderness. No pain over carpal bones. 8-10 weeks later patient presented and still had recurrent and worsening symptoms with weight lifting and playing basketball. Physical exam at this time showed decreased dorsiflexion of approximately ten degrees with continued pain. Xrays now showed widening of scapholunate ligament and flattening of lunate with mild sclerosis. PhysICaL EXaMINaTION: 1. Carpal fracture 2. Extensor Carpi Ulnaris tendinitis 3. Osteochondrosis of the lunate (Kienbock’s Disease) 4. Carpal Tunnel Syndrome 5. Ganglion Cyst 6. Scapholunate ligament disruption TEsT aNd rEsuLTs: L wrist xrays: -July:No acute bony injury or significant degenerative changes -December: Widening of scapholunate ligament and flattening of lunate with mild sclerosis MR Arthrogram Left Wrist with corticosteroid injection: -Disruption of scapholunate ligament Vol. 45 No. 5 Supplement S267 -AVN with fragmentation of the lunate -Joint effusion and synovitis -Volar ganglion on the radioscaphoid articulation FINaL/WOrKING dIaGNOsIs: Kienbock’s Disease (avascular necrosis of the lunate) TrEaTMENT/OuTCOME: 1. Initial treatmenta. She had good relief of symptoms with the injection at the time of MR arthrogram. b. She continued to play basketball. c. Repeat corticosteroid injection in February, again with good results of symptom relief 2. Surgery May 2012 a. Radial shortening with plate fixation b. Graduated and was lost to follow up c. Currently playing basketball in European leagues 1408 May 30, 2:40 PM - 3:00 PM shoulder Injury in soccer player Zarinah Hud. LECOM Medical Fitness & Wellness Center, Erie, PA. (Sponsor: Patrick Leary and Gregory Coppola, FACSM) (No relationships reported) hIsTOry: A right hand dominant, 19 year old male college soccer player is seen 21 days post right shoulder injury in the clinic. He reported that he fell directly onto right side of his neck and abducted shoulder. He denied numbness, weakness or pain at the time of impact, but did report immediate dysesthesia in right shoulder that worsened throughout the game. He was evaluated after the game by an ATC. The athlete denied headache, cervical, elbow and wrist pain. No prior history of upper extremity injuries. Review of systems, social history, and past medical history was otherwise unremarkable. PhysIaL EXaMINaTION: Athlete in no acute distress. Right upper limb inspection revealed atrophy in the deltoid, rhomboid, upper/middle trapezius, supraspinatus and infraspinatus; elevated shoulder and upward, internally rotated scapula at rest. There was generalized tenderness over the superior and anterolateral right shoulder. The cervical spine exam revealed full AROM/PROM without restriction in all planes and no tenderness over midline or paraspinal musculature. Spurling’s test was negative bilateral. The manual muscle test revealed maximum resistance against AROM (5/5) throughout the upper extremity on the left and right except for: shoulder abduction, flexion, and external rotation on the right, which exhibited incomplete range of motion against gravity (3-/5). DTR’s: +1/4 over bicep, brachioradialis and triceps tendons bilateral. Sensation was intact to light touch and pinprick C5-T1 bilateral. PhysICaL EXaMINaTION: 1.Mononeuropathy vs plexopathy 2. Adhesive Capsulitis 3. Rotator cuff Tear 4. Parsonage-Turner Syndrome 5. Occult fracture TEsT aNd rEsuLTs: I. Shoulder X-ray Findings (AP/Lateral) - Non displaced greater tuberosity fracture II.MRI Shoulder w/o Contrast -Fracture of greater tuberosity of humerus and bony contusion; tendinosis of supraspinatus and infraspinatus tendons without tear III. EMG Evaluation -No evidence for a right upper extremity radiculopathy, plexopathy or mononeuropathy FINaL WOrKING dIaGNOsIs: Neer’s II Classification Humeral head fracture TrEaTMENT aNd OuTCOMEs: 1. Greater Tuberosity ORIF 2. Shoulder Immobilization 3. Repeat X-rays 4. Rehabilitation: Throwers Ten, Scapulo-thoracic strengthening exercises 5. Will RTP once he has full painless ROM and normal strength Abstracts were prepared by the authors and printed as submitted. Thursday, May 30, 2013
Thursday, May 30, 2013 S268 Vol. 45 No. 5 Supplement D-21 Free Communication/Poster - Assessment of Physical Activity and Energy Expenditure May 30, 2013, 1:00 PM - 6:00 PM Room: Hall C 1409 Board #1 May 30, 2:00 PM - 3:30 PM Estimating Food Energy requirements and average daily Metabolic rate For The us Population: 2005-2006 Edward Archer, Greg A. Hand, FACSM, James R. Hebert, Erica Lau, Xuewen Wang, Robin Shook, Raja Fayad, Steven N. Blair, FACSM. Univeristy of South Carolina, Columbia, SC. (No relationships reported) PurPOsE:To estimate population-level food energy requirements (FER), total daily energy expenditure (TDEE), and average daily metabolic rate (ADMR) in a nationally representative sample of US adults. METhOds:FER, TDEE, and ADMR were estimated via a factorial equation in a nationally representative, cross-sectional, stratified sample of 2597 adults, aged 20 to 74 years (US National Health and Nutrition Examination Survey; NHANES 2005-2006). TDEE was calculated using estimated resting energy expenditure (REE), ADMR, and thermic effect of food (TEF). REE was derived from validated equations using demographic (i.e., age and sex) and anthropometric (i.e., height and weight) data. ADMR was calculated from objectively measured PA via accelerometry-based activity monitors and self-reported sleep duration. TEF was assigned a value of 7.5% of TDEE based on previous calorimetric research. rEsuLTs:The 2005-2006 estimated FER for the US population were 2940 kcal/day for men and 2275 kcal/day for women. FER ranged from 3230 kcal/day in obese (i.e., BMI ≥30kg/m2) men to 2026 kcal/day in normal weight (BMI < 25kg/m2) women. There were significant inverse relationships between ADMR and obesity and age. For men and women, the ADMR values were 1.53 and 1.52, respectively. Obese men and women had lower ADMR values than normal weight (p
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