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Background: A validated clinical risk tool has been developed to identify pediatric and adolescent patients at risk of developing persisting symptoms after concussion, but has not been prospectively investigated within a sample of athletes seen after concussion by primary care sports medicine physicians and/or athletic trainers. Purpose: To determine whether a validated clinical risk prediction tool for persistent postconcussive symptoms (PPCSs) predicted which patients would develop PPCSs when obtained within 14 days of concussion among a multicenter sample of adolescent athletes. Study Design: Cohort study; Level of evidence, 2. Methods: Pediatric and adolescent patients (8-18 years of age) from 7 pediatric medical centers and 6 secondary school athletic training facilities who were diagnosed with a concussion and presented ≤14 days after concussion were enrolled as part of the Sport Concussion Outcomes in Pediatrics (SCOPE) study during their initial visit and were followed until symptom resolution. Clinical risk scores (Predicting and Preventing Post-concussive Problems in Pediatrics [5P]) and total symptom severity were obtained using the Post-Concussion Symptom Inventory at the initial visit (mean, 4.9 ± 2.9 days after concussion). Participants were then compared based on symptom resolution time: PPCS group (≥28 days to symptom resolution) and no-PPCS group (<28 days). The authors assessed the odds of developing PPCSs based on the 5P risk score using a binary logistic regression model and the utility of the clinical risk prediction tool to identify total time to symptom resolution using a Cox proportional hazards model. Results: A total of 184 participants enrolled, underwent initial evaluation, and were followed until symptom resolution (mean age, 15.2 ± 2.1 years; 35% female). The mean time to symptom resolution across the entire sample was 17.6 ± 3.7 days; 16% (n = 30) of participants developed PPCS. Those in the PPCS group had significantly greater mean initial total 5P risk scores than those in the no-PPCS group (7.9 ± 1.7 vs 5.9 ± 2.3, respectively; P <.001). After adjustment for initial symptom severity, time to assessment, and assessment setting, a higher initial total 5P risk score was associated with a significantly greater odds of developing PPCSs (adjusted odds ratio, 1.49; 95% CI, 1.07-2.08; P =.019). Furthermore, a higher 5P risk score was significantly associated with longer total symptom resolution time (hazard ratio, 0.80; 95% CI, 0.74-0.88; P <.001). Conclusion: In a multicenter sample of youth athletes seen in different outpatient health care settings, the 5P risk score accurately predicted which athletes may be at risk for developing PPCSs. [ABSTRACT FROM AUTHOR]

This study compared three-dimensional (3-D) hip and knee kinematics and kinetics between lateral shuffle and side-step cutting movements to determine whether the simpler lateral shuffle movement can be used in place of cutting to assess knee injury risk. A total of 78 patients (52 female) and 34 controls (16 female) aged 8-19 years performed lateral shuffle and 45° side-step cutting movements. Hip and knee kinematics and kinetics between initial contact and peak knee flexion were calculated using the Plug-in-Gait model and compared between activities using Pearson's correlation and paired t-tests. Peak knee valgus angle correlated strongly (r=0.86, p<0.0001), while minimum (r=0.25, p=0.0001) and peak hip abduction (r=0.24, p=0.0003), and peak hip internal rotation (r=0.33, p<0.0001) correlated only weakly between the two activities. Peak external knee valgus moment (r=0.32, p<0.0001) and average external knee (r=0.42, p<0.0001) and hip (r=0.37, p<0.0001) flexion moments correlated weakly to moderately between activities. Subjects were more internally rotated (3.6°, p<0.0001) and less abducted (16.7° and 17.3° for minimum and maximum, p<0.0001) at the hip during cutting, with higher hip (0.12, p<0.0001) and lower knee (-0.02, p=0.0001) non-dimensional flexion moments. These results suggest that the lateral shuffle movement may be useful for evaluating knee valgus, particularly during initial visual assessment. However, the lateral shuffle may not be challenging enough to reveal poor neuromuscular control over hip ab/adduction and rotation, necessitating follow-up assessment of cutting, ideally using 3-D motion analysis. [ABSTRACT FROM AUTHOR]

The article presents recommendations for proper in-office test for injuries in baseball players and other throwing athletes. It suggests to ask the location of the pain, evaluate the severity of the pain and locate the timing of the pain to collect a detailed history of a patient having shoulder pain. It advises the probable consideration of several diagnoses, such as internal or external impingement syndromes and shoulder labrum pathology, based on the response of the patient to the questions.

Objective: The aim of this study was to identify the accuracy of the McMurray test in the adolescent and pediatric population. Design: Retrospective case series. Setting: Tertiary care, institutional. Patients: Inclusion criteria included patients who presented with unilateral knee pain and were seen by pediatric sports medicine physicians. Patients were excluded if their knee pain was related to any underlying conditions. Three hundred patient charts were reviewed, and 183 patients (age range: 8-18 years, mean: 14 years; 74 male) met the inclusion criteria. Interventions: Symptoms at initial visit (knee pain). Main Outcome Measures: Presence of a meniscal tear using the McMurray test. Results: Eighty-four percent (160/191) of patients had a McMurray test documented as performed by the physician, and 17% (27/160) elucidated a positive response. Of 26 patients who had a positive McMurray and underwent magnetic resonance imaging (MRI), 16 (62%) showed a meniscal tear on their MRI. However, of the 87 patients who had a negative McMurray and still underwent MRI, 25 (29%) had a positive meniscal tear. The sensitivity, specificity, positive predictive value, and negative predictive value were 39%, 86%, 62%, and 71%, respectively. Conclusion: In a pediatric and adolescent population, the McMurray test was negative for 61% (23/38) of meniscal tears identified on MRI. Clinical Relevance: Although the test can be a useful tool as a part of a thorough evaluation, combining it with mechanical symptoms, patient history and imaging may be more helpful to diagnose a meniscus tear. [ABSTRACT FROM AUTHOR]

Motion analysis offers objective insight into biomechanics, rehabilitation progress and return to sport readiness. This study examined changes in three-dimensional movement patterns during drop jump landing between early and late stages of rehabilitation in adolescent athletes following anterior cruciate ligament reconstruction (ACLR). Twenty-four athletes (58% female; mean age 15.4 years, SD 1.2) with unilateral ACLR underwent motion analysis testing 3–6 months and again 6–10 months post-operatively. Kinematics and kinetics were compared between visits and between limbs using repeated measures ANOVA. The operative side exhibited lower vertical ground reaction force, less energy absorption and lower sagittal external moments at the knee and ankle, and lower peak dorsiflexion angles compared with the non-operative side regardless of visit. Between visits, hip and knee flexion increased bilaterally, as well as hip flexion moments and energy absorption. During early rehabilitation following ACLR, adolescent athletes reduced flexion and loading of the knee and ankle on their operative limb. Motion and loading increased over time, particularly at the hip, but remained reduced at the knee and ankle 6–10 months post-operatively. [ABSTRACT FROM AUTHOR]

Background: Understanding movement variability is important to guide biomechanical assessment. Variability may change with age, and more repetitions of a movement need to be assessed when variability is high.Research Question: This study quantified the trial-to-trial (within subject) variability of three tasks commonly assessed during sports biomechanical testing: vertical drop jump, heel touch (single leg squat from step), and single leg hop. We hypothesized that pre-teen athletes would exhibit greater variability than more mature teenage athletes when performing all of these movements.Methods: Fifty-five uninjured pediatric athletes ages 7-15 years performed 3 repetitions of vertical drop jump, heel touch, and single leg hop for distance tasks during 3D motion analysis testing. Trial-to-trial variability was assessed using the standard deviation (SD) and range (maximum-minimum) of clinically relevant kinematic and kinetic metrics among the multiple repetitions of each task performed by each participant. Variability was compared between age groups using 2-sided t-tests. Standard error of measurement (SEM) and minimum detectable difference (MDD) were also calculated for each variable of interest.Results: For drop jump and heel touch, kinetic variability was similar between groups, but the younger group had greater kinematic variability. However, the older group was much more variable than the younger group during single leg hop landing, particularly in terms of kinetics and sagittal plane kinematics. Overall, kinematic variability had a median within-subject SD of 1-9°, median range of 2-17°, and 95th percentile for range of >15-20° for many of the variables examined. MDD was >10° for many kinematic variables, >0.2 Nm/kg for all frontal plane moments, >0.4 Nm/kg for most sagittal plane moments, and >0.5 W/kg for most energy absorption variables.Significance: The high within-subject trial-to-trial variability in performing sports tasks suggests that multiple trials should be analyzed for a more complete and representative evaluation. [ABSTRACT FROM AUTHOR]