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There has been explosive growth of intensive, year-round sports for children of both sexes, with a resulting high degree of family involvement and commitment. Consequently, a diagnosis of juvenile osteochondritis dissecans (JOCD) impacts parent and child on many different levels. Compliance is the key element when a conservative treatment plan for JOCD is appropriate. An informed physician understands the dynamics between the "compliance triad" of physician, parent, and child, and recognizes that compliance is a process with foreseeable stages and characteristic behaviors.

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The anaerobic energy system is involved in providing energy for all forms of physical activity. The relevance of this system to human performance and physical fitness throughout the age spectrum is underscored here and contrasted with the aerobic energy system. The anaerobic system responds to high-intensity training with biochemical, neural, and anatomic adaptations. Unlike the aerobic system, this response tends to be primarily a local phenomenon with little systemic adaptation. An important factor distinguishing anaerobic training from aerobic training is the intensity of the exercise dose. For anaerobic training to occur, the dose must be of high intensity and performed to near-exhaustion. The anaerobic system can be indirectly assessed by performance tests, such as a vertical jump or stair climb, or more directly by supramaximal bicycle tests. The impact of recent research regarding the trainability of the anaerobic system, particularly in the elderly population, is encouraging. The elderly respond to anaerobic training and, as a result, their independence, quality of life, and safety from falls can be improved. While little is known about anaerobic rehabilitation after injury, it is known that isokinetic and performance tests may be considered normal after rehabilitation, despite incomplete rehabilitation of the anaerobic system. Thus, appropriate application of the anaerobic system assessments and training principles is an important aspect of sports medicine practice.

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This study was conducted to quantify anabolic steroid use in Illinois, investigate student knowledge and perception of anabolic steroid use, and identify characteristics of the anabolic steroid user. We surveyed 3047 freshman and senior high school students from 38 high schools, randomly selected from three school enrollment sizes and five geographic locations, using a six-page anonymous questionnaire. Anabolic steroid use was reported by 58 (1.9%) of the participants, 44 of 1477 (3%) males and 14 of 1562 (0.9%) females. Thirty-four of 1679 (2%) freshman and 24 of 1366 (1.8%) seniors reported use. Anabolic steroids were used in all possible school enrollment sizes and geographic locations (matrix cells). Four (7%) of the users reported starting at age 10 or younger. A teacher/coach was reported as a primary source by 8 (14%) of the users, as well as identified by 11 (19%) of the users as the individual they knew using anabolic steroids. It appears that anabolic steroids are being introduced to students in elementary and junior high schools, and that teachers/coaches are actively involved in their use.

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A group of 14 patients underwent 17 consecutive open surgical excisions of the distal clavicle for atraumatic osteolysis after having failed conservative treatment. All patients were men involved in weight training or heavy-lifting occupations. The diagnosis was based on no history of shoulder trauma, positive plain radiographs, and positive joint scintigraphy. All 14 patients were available for followup at an average of 25 months postoperatively. The UCLA Shoulder Rating Scale was used for evaluation. All patients reported full return to sports and employment at a satisfactory level. All results were rated as excellent (8) or good (9). Eleven of the 14 patients had bilateral involvement to some extent. One patient had undergone open excision of the contralateral distal clavicle before the study and 3 patients presented with bilateral symptoms and underwent staged bilateral excisions during the study. Seven patients presented with contralateral symptoms and radiographic involvement at latest followup after return to weight-lifting activities.

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Atraumatic osteolysis of the distal clavicle (AODC) in athletes is a stress failure syndrome of the distal clavicle. It is related to intolerable exercise doses. For some athletes, the acromioclavicular joint is the weak link in the musculoskeletal system. There is never a history of a major injury to the acromioclavicular joint. It occurs principally in young athletes who have a long history of training and performance. It is further characterised by athletes who generally have an associated intense strength training programme. The condition will inexorably progress to decrease the level of performance and later interfere with activities of daily living. If the athlete is unwilling to alter his or her exercise training and performance regimen, she or he will eventually become surgical candidates. The results of excision of the distal clavicle for AODC are good or excellent in virtually all cases. The diagnosis of AODC is confirmed by the history of accumulative exercise doses and the key historical feature of intensive participation in strength training. Local tenderness will be found at the acromioclavicular joint, plain radiographs will show degenerative changes in the vast majority of cases and joint scintigraphy must be positive to confirm the diagnosis.

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A prospective clinical study used joint scintigraphy to investigate conservative treatment of juvenile osteochondritis dissecans (JOCD) of the femoral condyle. The predictive value of scintigraphic evaluation and various parameters (age at onset, sex, location and size of lesion) were analyzed. Over a 10 year period, the senior author followed 92 knees in 76 patients, 60 of whom were male and 16 female (11 and 5 bilaterals, respectively). All patients were participants in athletics or exercise programs. All patients had orthopaedic assessment, roentgenographic studies (AP, lateral, and tunnel views), 99m-Technetium phosphate compound joint scintigraphy, and instruction in a symptom-free existence (with all athletic activity proscribed). Patients were reevaluated and scanned every 8 weeks. No casts or braces were used, although crutches were sometimes necessary to maintain symptom-free levels. Based on specific indications for failure of conservative treatment, 50% of these patients failed and underwent surgery. Of the 92 knees, 52 were successfully treated conservatively, while 40 failed. Average followup was 4.2 years. Average age at onset was 12.5 years; the success group averaged 12.1 years and the failure group 13.0 years. The average lesion size was 363.2 mm2, with 309.5 mm2 in the success group and 436.0 mm2 in the failure group. Parameters of location, sex, and scan classification were not statistically significant as predictive factors. This study found no predictors for the success or failure of treatment beyond a moderate correlation of larger lesion size with failed conservative treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

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A 4 year prospective study (1982 to 1985) of high school varsity football injuries from the four Peoria high school football teams was undertaken. Two hundred fifty-one injuries were recorded among a player population of 598, resulting in an injury rate of 42.1% per 100 players. All of the players followed a prescribed preseason summer conditioning program that was endorsed by the Illinois High School Athletic Association. The injuries were recorded on an athletic injury profile and entered into a computer for data analysis and retrieval. The injury distribution by player position showed that halfbacks, tackles, linebackers, and guards had a higher risk of injury than other positions. The knee was the body part injured most frequently (20.3%). A matrix of injuries to halfbacks was set up to examine the relationship of body part injured to type of play, time of injury, and activity during injury. An anthropometric study using the Quetelet index did not reveal any correlation between injury and body size when the injured players were compared with the non-injured players. Experience since 1969 has taught us many of the errors and pitfalls involved in injury surveillance. Strict adherence to recording of data will ensure an accurate and useful injury surveillance program.

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* Supported in part by a grant from Hydra-Fitness Industries, Belton, TX. Twenty-nine prepubertal males ( age = 8.2 +/- 1.3 years) were evaluated for concentric isokinetic strength at the knee, shoulder, and elbow joints, [at the dominant (D) and nondominant (ND) sides]. At each joint, flexion (F) was compared with extension (E) at two speeds of 30 degrees /sec (30) versus 90 degrees /sec (90) over each 10% of the range of motion (ROM). Reliability was estimated between identical motions at the D versus ND side. Results for work at the knee joint indicated slightly higher work output at the ND side (23.5 versus 25.0 joules for D versus ND), significantly higher work output for extension compared to flexion (19.0 versus 29.2 joules for F versus E) and for the slower compared to the faster speed (26.2 versus 21.9 joules for 30 versus 90). At the shoulder joint, extension resulted in significantly greater work compared to flexion (14.2 versus 22.0 joules for F versus E) and the slower speed was associated with significantly greater work (1 9.7 versus 16.7 joules for 30 versus 90). At the elbow joint, the only significant difference observed for work occurred for speed, with the faster speed resulting in greater work (10.8 versus 9.5 joules for 30 versus 90). Analysis for torque scores at each of the three joints revealed that extension resulted in greater torque than flexion, 30 degrees /sec resulted in greater torque than 90 O/sec and that peak torque scores occurred during the first 50% of ROM. Correlations to estimate reliability exceeded r = 0.70 for comparisons of torque and work scores for D versus ND. Age, height, and weight correlated r = 0.50 < r < 0.90 with peak torque during each of the motions. It was concluded that prepubertal males have similar patterns of concentric isokinetic strength measured at the knee, shoulder, and elbow joints compared to adults, because strength was greater during E versus F, for slower versus faster speeds, and during the initial phase of ROM.J Ortho Sports Phys Ther 1988;9(10):345-351.

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This study examined the safety of one type of strength training for prepubescent males. Eighteen males (average age, 8.3 +/- 1.2 years) participated in a 45 min/session, three session/week, 14 week supervised strength training program with an attendance rate of 91.5%. Concentric work was done almost exclusively. KinCom analysis showed significant strength gain in this group (P less than 0.05), while an age, sex, and activity matched control group did not gain strength. Safety was evaluated by injury surveillance, blood pressure and heart rate monitoring, scintigraphy, and creatine phosphokinase measurement. Effects on growth and development, flexibility, and motor performance were also investigated, as these are factors with an impact on sports injury occurrence. Results showed that in the short term, supervised concentric strength training results in a low injury rate and does not adversely affect bone, muscle, or epiphyses; nor does it adversely affect growth, development, flexibility, or motor performance. As the safety question is multifaceted, this should not lead to the conclusion that strength training for prepubescents is uniformly safe. Further research is needed.

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In order to examine the effectiveness and safety of hydraulic resistance strength training in young males, 26 pre-pubertal males (mean age = 8.2 +/- 1.3 yr) completed a 14-wk strength training study. Subjects were evaluated before and after the 14-wk experimental period for pubertal state (Tanner's sexual maturity rating, serum testosterone, and serum dihydroepiandrosterone sulfate). Effectiveness of the strength training program was determined by measuring pre-post differences in: isokinetic strength for flexion and extension at the knee and elbow joints at two speeds (30 degrees and 90 degrees X s-1) (KIN COM, Chattecx, Inc., Chattanooga, TN), flexibility, standing long jump, vertical jump, body composition parameters, maximal oxygen consumption, and creatinine phosphokinase. Safety of strength training was assessed by biphasic musculoskeletal scintigraphy before and after the program and by physician evaluation of complaints by subjects. Strength training subjects (N = 16) participated in a 45 min/session, 3 session/wk, 14-wk supervised strength training program with an attendance rate of 91.5%. Participants performed concentric work using hydraulic resistance equipment (Hydra-Fitness Industries, Belton, TX). Eccentric work was not performed. Control subjects (N = 10) did not strength train but did participate in sport activities and activities of daily living. Results indicated that strength training subjects increased isokinetic strength as a result of strength training (average concentric work/repetition increases by 18.5 to 36.6% for the eight motions tested; torque scores over the first 90% of the range of motion increases by 13.1 to 45.1% for the eight motions tested). These changes were significantly greater than changes seen in the control group (P less than 0.05). Strength training subjects also demonstrated significant improvements (as compared to control subjects) in vertical jump (+10.4%), flexibility (+8.4%), and maximal oxygen consumption [+19.4% (l X min-1), +13.8% (ml X kg X min-1)] after the experimental period. Musculoskeletal scintigraphy revealed no evidence of damage to epiphyses, bone, or muscle as a result of strength training. Only one strength training-related injury was reported (left shoulder pain, 3 strength training sessions missed). In contrast, six strength training subjects sustained injuries during activities of daily living, resulting in 47 missed strength training sessions. It was concluded that, in the short term, supervised concentric strength training using hydraulic resistance equipment is safe and effective in pre-pubertal boys.

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The impingement syndrome is a frequent occurrence in the throwing athlete. Sports medicine physicians have not yet attained the diagnostic quality in the shoulder they possess about the knee. The success of treatment of the impingement syndrome is directly proportional to the accuracy of diagnosis. This improved diagnostic ability will occur when the mechanism of injury is correlated to the tissue involved and the differential diagnosis of shoulder pain in the athlete is complete.

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The known sensitivity of joint scintigraphy in following the course of fracture healing caused the authors to believe that this radiologic technique might be valuable in the management of osteochondritis dissecans (OCD). Accordingly, 99mTc-diphosphonate joint scintigraphy was used on 18 patients with OCD of the knee. The average age was 13 1/2 years. The scintigrams were repeated at 6-week intervals until healing had occurred. When the diagnosis of OCD was established by standard roentgenograms and joint scintigraphy, the patients were placed on an activity restriction program, attempting to reach a symptom-free level. The patients were followed for an average of 18 months. Ninety-five scans were categorized according to their level of scintigraphic activity. This led to a discrete four-part scintigraphic classification that is indicative of the extent of healing or progression of this condition, and precedes changes seen on standard x-rays by months. Joint scintigraphy also rules out anomalies of ossification in the diagnosis of OCD since an anomaly should have a normal scintigraphic appearance. We have concluded that joint scintigraphy is valuable in the management of OCD because of its superior sensitivity to changes in the activity of the lesion. As experience is gained with this technique, those cases that should be prophylactically surgically stabilized may be indicated.

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This uncommon syndrome is caused by compression of the posterior humeral circumflex artery and axillary nerve or one of its major branches in the quadrilateral space. Forward flexion and/or abduction and external rotation of the humerus aggravate the symptoms. Discrete point tenderness is always found posteriorly in the quadrilateral space. Patients with appropriate history and physical findings should have a subclavian arteriogram done by the Seldinger technique. A positive arteriogram reveals occlusion of the posterior humeral circumflex artery with the arm in abduction and external rotation. Patients with sufficient symptoms not responding to conservative treatment and having a positive subclavian arteriogram and local tenderness over the quadrilateral space should be considered for surgical decompression. A posterior approach is recommended. Of the 18 patients operated on, eight have had dramatic and complete relief, eight have been improved, and two have shown no improvement.

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An outbreak of Staphylococcus aureus furuncles (boils) occurred among 26 members of a central Illinois high school football team. A total of 55 boils were reported with a diameter of induration ranging from 0.25 to 6 inches (mean = 1.25 inches). Eighty-nine percent of the boils were located on the extremities, and 70% were known to have developed following a bruise or break in the skin. The development of boils was associated with prior bruises and open wounds. Use of skin lubricant, elbow and forearm pads, whirlpool bath, and athletic tape were also associated with the development of boils, but were not judged to be causal. Rather, these factors most likely reflected attempts to protect areas of compromised skin which were at high risk of developing boils. Lack of hot water and soap for showering may have facilitated the occurrence of the outbreak by discouraging players from showering. Other variables examined, but excluded as important factors, were the sharing of football pads, the sharing of towels, the laundering of athletic clothes, and the position played on the football team.

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