Objectives We sought to explore the spectrum of cardiac abnormalities in student-athletes who returned to university campus in July 2020 with an uncomplicated Coronavirus disease 2019 (COVID-19). Background There is limited information regarding cardiovascular involvement in young individuals with mild or asymptomatic COVID-19. Methods Screening echocardiograms were performed in 54 consecutive student-athletes (mean age: 19 years, 85% males) who tested positive on reverse transcription–polymerase chain reaction nasal swab testing of the upper respiratory tract or IgG antibodies against SARS-CoV-2. A sequential cardiac magnetic resonance (CMR) imaging was performed in 48 (89%) subjects. Results A total of 16 (30%) athletes were asymptomatic while 36 (66%) and 2 (4%) reported mild and moderate COVID-19 related symptoms, respectively. For the 48 athletes completing both imaging studies, abnormal findings were identified in 27 (56.3%) individuals. This included 19 (39.5%) showing pericardial late enhancements with associated pericardial effusion. Of the individuals with pericardial enhancements, 6 (12.5%) had reduced global longitudinal strain (GLS) and/or an increased native T1. One patient showed myocardial enhancement and reduced left ventricular ejection fraction or reduced GLS with or without increased native T1 were also identified in additional 7 (14.6%) individuals. Native T2 were normal in all subjects and no specific imaging features of myocardial inflammation were identified. Hierarchical clustering of LV regional strain identified three unique myopericardial phenotypes that showed significant association with the CMR findings (P=0.03). Conclusion Over one in three previously healthy college-athletes recovering from COVID-19 infection showed imaging features of a resolving pericardial inflammation. Although subtle changes in myocardial structure and function were identified, no athlete showed specific imaging features to suggest an ongoing myocarditis. Further studies are needed to understand the clinical implications and long-term evolution of these abnormalities in uncomplicated COVID-19.

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Background Initial protocols for return to play cardiac testing in young competitive athletes following SARS‐CoV‐2 infection recommended cardiac troponin (cTn) to screen for cardiac involvement. This study aimed to define the diagnostic yield of cTn in athletes undergoing cardiovascular testing following SARS‐CoV‐2 infection. Methods and Results This prospective, observational cohort study from ORCCA (Outcomes Registry for Cardiac Conditions in Athletes) included collegiate athletes who underwent cTn testing as a component of return to play protocols following SARS‐CoV‐2 infection. The cTn values were stratified as undetectable, detectable but within normal limits, and abnormal (>99% percentile). The presence of probable or definite SARS‐CoV‐2 myocardial involvement was compared between those with normal versus abnormal cTn levels. A total of 3184/3685 (86%) athletes in the ORCCA database met the inclusion criteria for this study (age 20±1 years, 32% female athletes, 28% Black race). The median time from SARS‐CoV‐2 diagnosis to cTn testing was 13 days (interquartile range, 11, 18 days). The cTn levels were undetectable in 2942 athletes (92%), detectable but within normal limits in 210 athletes (7%), and abnormal in 32 athletes (1%). Of the 32 athletes with abnormal cTn testing, 19/32 (59%) underwent cardiac magnetic resonance imaging, 30/32 (94%) underwent transthoracic echocardiography, and 1/32 (3%) did not have cardiac imaging. One athlete with abnormal troponin met the criteria for definite or probable SARS‐CoV‐2 myocardial involvement. In the total cohort, 21/3184 (0.7%) had SARS‐CoV‐2 myocardial involvement, among whom 20/21 (95%) had normal troponin testing. Conclusions Abnormal cTn during routine return to play cardiac screening among competitive athletes following SARS‐CoV‐2 infection appears to have limited diagnostic utility.

Objective: To provide certified athletic trainers, team physicians, emergency responders, and other health care professionals with recommendations on how to best manage a catastrophic cervical spine injury in the athlete.Background: The relative incidence of catastrophic cervical spine injury in sports is low compared with other injuries. However, cervical spine injuries necessitate delicate and precise management, often involving the combined efforts of a variety of health care providers. The outcome of a catastrophic cervical spine injury depends on the efficiency of this management process and the timeliness of transfer to a controlled environment for diagnosis and treatment.Recommendations: Recommendations are based on current evidence pertaining to prevention strategies to reduce the incidence of cervical spine injuries in sport; emergency planning and preparation to increase management efficiency; maintaining or creating neutral alignment in the cervical spine; accessing and maintaining the airway; stabilizing and transferring the athlete with a suspected cervical spine injury; managing the athlete participating in an equipment-laden sport, such as football, hockey, or lacrosse; and considerations in the emergency department.

Wrestling is a popular high school and college sport with an injury and illness rate second only to football. It is important that the physician providing medical care for wrestlers be familiar with the unique characteristics of wrestling and the associated common injuries and medical problems. Common orthopedic injuries include shoulder, elbow, and finger dislocation; prepatellar bursitis; knee medial collateral ligament sprains; and cervical strains. Skin infections are the most common cause of missed mat time for wrestlers. Physicians need to be able to identify and treat these infections, and know the rules regarding return to wrestling once an infection has been identified. Other conditions that are common include auricular hematomas, epistaxis, and brow lacerations. Physicians also need to be familiar with the medical issues involved with rapid weight loss and weight cycling, and understand the high school and college weight certification rules.

The Union Cycliste Internationale (UCI) Mountain Bike World Cup in 2019 provided unique challenges for effective prehospital care. While on-site medical care has demonstrated improved outcomes along with reduced emergency department and emergency medical services (EMS) utilization, this aspect has not been well documented in the literature with respect to rural mass gathering events (MGEs). Conducted at a large mass gathering event in a geographically isolated area, this study aimed to assess the medical needs at this specific event and will hopefully assist in future coordination of similar events. All patients who were treated at the event clinic were included in the analysis. Primary investigators collected and recorded data while providing care. We believe the on-site clinic was successful in reducing barriers to healthcare by improving access, streamlining the treatment process, and optimizing resource utilization. This benefit extended to race participants, support staff, spectators, and the local EMS system.

A 38-year-old male presented with left calf pain after a fall while skiing. Physical examination revealed tenderness over the gastrocnemius with a palpable mass and pain with resisted plantar flexion. Point-of care-ultrasound (POCUS) of the gastrocnemius was consistent with a muscle rupture, and we made a diagnosis of tennis leg. The patient was instructed to rest for two weeks, followed by a home rehabilitation program, and he was able to return to his normal activities. Here we present a case of tennis leg quickly and accurately diagnosed with POCUS, negating the need for additional advanced imaging.