This study supports the need for a concussed athlete to have access to a provider trained in concussion management in a timely fashion in order to prevent delayed recovery and return to play.

No abstract

Infectious dermatoses represent a significant source of morbidity and missed athletic participation among athletes. Close quarters and skin trauma from contact sports can lead to outbreaks among teams and athletic staff. The National Collegiate Athletic Association and National Federation of State High School Associations have published guidance with recommended management and return-to-play criteria for common fungal, bacterial, viral, and parasitic rashes. In addition to rapidly diagnosing and treating infectious dermatoses, team physicians should counsel athletes and athletic staff on proper equipment care and personal hygiene to reduce infection transmission. Clinicians should always consult sport and athlete governing bodies for sport-specific recommendations.

This case of soleus canal syndrome highlights the use of ultrasound for both diagnosis and treatment via hydrodissection and myotomy.

Platelet-rich plasma (PRP) is a biologic agent commonly used in sports medicine practice for a variety of injuries (1). The mechanism of PRP is based on the principle that inflammation is integral to healing activation and autologous activated platelets and their contents have an active role in this process (2). PRP injected directly at a site of joint injury (which may include tendinopathies and tears of muscles, ligaments, and tendons) induces a cascade of cytokines and chemokines that signal cellular proliferation, differentiation, and proteosynthesis (2,3). Platelets also upregulate receptors that mediate the inflammatory response by preventing excess leukocyte recruitment from anti-inflammatory cytokines (2).Since the PRP-induced healing process starts with inflammation, patients frequently experience pain during injection and in the days following the procedure. When considering the additional mechanical effects of targeted percutaneous tissue fenestration during concomitant PRP delivery, patient discomfort is a common, but undesired short-term effect. Procedural pain can be a source of distress for the patient and may even lead to temporal functional decline, despite the potential for longer-term therapeutic improvements in outcomes. While the astute sports medicine clinician will provide informed consent, patient-centered shared decision making,

Objective: To assess the consistency of return to sport and occupation recommendations following EHI provided in published clinical practice guidelines, consensus statements, position statements, and practice alerts. A secondary aim was to evaluate the consistency of medical policies governing the return to duty following EHI between the branches of the United States Armed Forces and the agreement with published recommendations. Methods: Ovid MEDLINE, Web of Science, and CINAHL databases were searched for clinical practice guidelines and position statements published at any time that guided return to activity in individuals with EHI. Methodological quality was assessed and the specific recommendations for clinical management were extracted. Consistency of recommendations was evaluated. Agreement between published guidelines and the policies governing return to activity in military tactical athletes with heat injury were also evaluated. Results: Two professional societal guidelines provided recommendations pertaining to return to function following EHI. There was consistency between guidelines regarding recommendations that addressed abstinence from activity; medical follow-up; graded resumption of activity; and return to function. Pertaining to military policy, contemporary regulations published in recent years reflected the best evidence provided in the professional guidelines. The greatest incongruence was noted in older military policies. Conclusions: This systematic review highlights the need for consistent recommendation across all branches of the military when it comes to returning service members to duty after EHI.

No abstract

Saphenous entrapment neuropathy in the distal thigh most commonly occurs at Hunter's canal and is characterized by neurologic symptoms distal to the midthigh in the saphenous nerve distribution. Presented is a 23-year-old active duty female service member with left medial knee pain worse with knee flexion and extension. Evaluation raised suspicion for saphenous nerve entrapment at Hunter's canal, and ultrasound-guided subsartorius fascial plane hydrodissection was performed in addition to focused rehabilitation of the adductor and core musculature. No reports of this treatment have been published to date. This case introduces ultrasound-guided subsartorius fascial plane hydrodissection as novel treatment in Hunter's canal syndrome.