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Hand skin temperature measurements have previously been performed on either dorsal or palmar sides and it is possible to find arguments for the advantage of both locations. Therefore, the aim of this study was to use dynamic infrared (IR) imaging to examine the relationship between dorsal and palmar hand skin temperature. The palmar and dorsal hand skin temperature before and after a cold stress test was measured with IR thermography in 112 healthy participants. Calculation of surface average temperature was made from nine regions of interest on each hand's dorsal and palmar side. Temperature values were recorded at baseline, directly after immersion of hands in vinyl gloves for one minute in water at 20 ±0.5 °C (gloves removed), and after eight minutes rewarming. Results showed that: a) the skin temperatures on the dorsal and palmar sides of the hand are strongly correlated; b) the correlation is stronger on the fingers than on the carpometacarpal (CMC) area; c) the palmar side of the CMC area is warmer than the dorsal side, but this is reversed in the fingers so that the nail bed is warmer than the finger pad; and d) the temperature difference ∆T between the dorsal and palmar sides of the fingers is independent of the skin temperature, though ∆T on the CMC area of the hand is temperature dependent. Such differences can be important in detailed investigations of thermal phenomena in the hand. In conclusion, results showed a strong correlation between the dorsal and palmar temperatures. If both sides cannot be measured, the purpose of the investigation should determine which side of the hand should be measured.

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Little is known about physical activity level and knee function including jump capacity and fear of movement/reinjury more than 20 years after injury of the anterior cruciate ligament (ACL). Seventy persons with unilateral ACL injury participated (23 ± 2 years post-injury): 33 treated with physiotherapy in combination with surgical reconstruction (ACLR ), and 37 treated with physiotherapy alone (ACLPT ). These were compared with 33 age- and gender-matched controls. Assessment included knee-specific and general physical activity level [Tegner activity scale, International Physical Activity Questionnaire (IPAQ)], knee function [Lysholm score, Knee injury and Osteoarthritis Outcome Score (KOOS)], jump capacity (one-leg hop, vertical jump, side hops), and fear of movement/reinjury [Tampa Scale for Kinesiophobia (TSK)]. Outcomes were related to degree of osteoarthritis (OA). ACL-injured had lower Lysholm, KOOS, and Tegner scores than controls (P < 0.001), while IPAQ score was similar. ACL-injured demonstrated inferior jump capacity in injured compared with noninjured leg (6-25%, P < 0.001-P = 0.010 in the different jumps), while noninjured leg had equal jump capacity as controls. ACL groups scored 33 ± 7 and 32 ± 7 of 68 on TSK. Lower scores on Lysholm and KOOS symptom were seen for persons with moderate-to-high OA than for no-or-low OA, while there were no differences for physical activity and jump capacity. Regardless of treatment, there are still negative knee-related effects of ACL injury more than 20 years later.

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OBJECTIVE: Familial osteochondritis dissecans (OCD) is a rare disorder characterised by disturbed chondro-skeletal development, disproportionate growth and deformation of the skeleton. DESIGN: We identified a five-generation family with 15 living affected members from Northern Sweden. The disorder was diagnosed with a case definition of OCD in at least one joint. RESULTS: Main clinical findings consisted of OCD in knees and/or hips and/or elbows, disproportionate short stature and early osteoarthritis (OA). There were no radiological indications of epiphyseal dysplasia. Anthropometric measurements of affected individuals showed short stature, a high ratio between sitting height and total height, a relatively normal arm span and head circumference. In 12 of 15 cases, onset was during late childhood or adolescence and OA had developed in seven of those patients. CONCLUSIONS: Our observation suggests that OA is a frequent complication in familial OCD even though the lesions appear before closure of physis.

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Injury occurrence in all 12 female elite senior football teams in premiere league was registered during 1 year. Of 269 players, 129 (48%) sustained 237 injuries. The total injury incidence was 4.6/1000 h of football. The injury incidence during practice was 2.7 and during the game time was 13.9/1000 h. The highest injury incidence during practice was to the knee (0.8/1000 h) and thigh (0.5/1000 h), and during game time was to the knee (4.4/1000 h) and head (2.2/1000 h). In total, the location for the highest injury incidence was the knee with 1.5 injuries/1000 h of football. The majority of injuries (82%) were localized to the lower extremities. Sixty-six injuries (28%) were re-occurring injuries (re-injuries). The incidence of traumatic injuries was 3.3/1000 h of football and for overuse injuries 1.3/1000 h. Overuse injuries occurred mainly during the preseason and at the beginning of the spring season. Thirty-nine percent of the injuries were slight or minor causing absence from practice or game time of less than 1 week, 39% were moderate (absence 7-28 days) and 22% were major (absence more than 28 days). The major injuries occurred often owing to trauma and were mainly to the knee.

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BACKGROUND: It is a matter of debate whether or not ordinary heading of the ball in soccer causes injury to brain tissue. OBJECTIVE: To analyse concentrations of the biochemical markers of brain tissue damage S-100B and neurone specific enolase (NSE) in serum of female elite soccer players in association with a competitive game. METHODS: Venous blood samples were obtained from 44 female soccer players before and after a competitive game for analysis. The number of headers and trauma events (falls, collisions, etc) was assessed from videotape recordings for each player. RESULTS: Concentrations of both brain damage markers were increased after the game (S-100B, 0.18 (0.11) v 0.11 (0.05) microg/l (p = 0.000); NSE, 10.14 (1.74) v 9.05 (1.59) microg/l (p = 0.001)). There was a significant correlation between changes in S-100B concentrations and both the number of headers (r = 0.430, p = 0.004) and the number of other trauma events (r = 0.517, p < 0.001). CONCLUSION: The concentrations of both S-100B and NSE were increased by game associated activities and events. The increases in S-100B concentration were significantly related to the number of headers and other trauma events, which indicates that both these factors may have contributed to these increases.

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The number of minor traumatic brain injury (mTBI), cerebral concussions, is increasing and cannot be eliminated by any kind of equipment. Prevention strategies, such as the introduction of "checking from behind" rules have become effective in decreasing the number of severe spinal injuries. A new "head checking" rule should reduce mTBI in the same way in the following years. Mouthguards should be mandatory as an effective device for the prevention of dental and orofacial injuries, as well as reducing the incidence and severity of mTBI. A new internet database system, the International Sports Injury System (ISIS) should improve epidemiological analysis of head, face, and spinal injuries worldwide. ISIS should provide an internationally compatible system for continuous monitoring of risk factors, protective effects of equipment, and protective effects of equipment and effects of changes in rules through the years.

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Head injuries in sports have received increased attention during the past decade. As explained in this article, the most recent guidelines for the management of head injuries in sports adopted by the American Academy of Neurology (AAN) have been adapted for the Swedish sports society. The guidelines include a grading scale of head injuries in sports, a sideline evaluation to aid physicians, coaches and athletes in the acute situation, and a management strategy for safe return to play after a head injury. The use of these guidelines will facilitate appropriate acute and subacute management and thereby prevent repeated head injuries that could lead to potentially catastrophic outcome or long-term cognitive sequelae.

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Traumatic spinal cord injury (SCI) in the cervical or thoracic region is one of the most catastrophic types of sport injuries. This study was designed to determine incidence and mechanisms of major SCI in ice hockey in Finland and Sweden from 1980 to 1996 in order to find possibilities for prevention. Retrospective analysis of injury occurrence were carried out. Medical case records were reviewed and injured players were interviewed to complete the data. From 1980 to 1996, there were 16 accidents involving spinal cord injury with permanent disability. All players were male. The mean age was 21.1 years (range = 14 to 33 yr). In 50% of the cases the mechanism was body checking from behind and a blow to the head from the boards. In 69% of the cases the vertebral injury was fracture or/and luxation between C5 and C7. The neurological endstate was tetraplegia/paresis in 10 cases and paraplegia/paresis of the lower extremities in 6 cases. Ice hockey is one of the most popular sports in Europe, and the number of participants is still increasing. The typical mechanism in SCI is body checking from behind, falling down and a head-first blow from the boards. These serious injuries may be prevented by changing the rules (banning body checking near the boards) with strict refereeing and education of trainers and players.

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OBJECTIVE: To evaluate the frequency of concussion in Swedish ice hockey and to establish a uniform grading and treatment model for concussions of different severity. METHODS: Frequency of concussion was investigated in two studies, one retrospective and one prospective. In the retrospective study, all Swedish elite ice hockey players (n = 265) were asked to answer a questionnaire on the number and treatment of previous concussions. Only concussions diagnosed by a doctor were recorded. The questionnaire was completed by 227 players (86%). In the prospective study, all injuries including concussions occurring during game and practice in the Swedish Elite League (n = 12 teams) were recorded during four years. The causes of injury, referees judgements, diagnosis, treatment, and time absent from ice hockey were registered on special cards. RESULTS: In the retrospective study, 51 out of 227 players (22%) in the Swedish Elite League reported at least one concussion. In the prospective study, 52 concussions were reported. The incidence of a concussion is at least one concussion every year/team or a yearly risk of about 5% for a player to sustain a concussion. Most concussions occurred during league play (81%). Body contact (checking or boarding) was the most common cause of concussions. The players were absent from full training and play on a mean of 6 d. CONCLUSIONS: As this injury is potentially dangerous it must be treated seriously according to a simple treatment model presented. In cases of repeated concussions during the same season, a longer period of time away from play is suggested. In players who have sustained several concussions over the years a thorough medical examination including EEG, CT/MRI, and neuropsychological tests should be performed. If any of these is pathological the player should be advised to give up ice hockey.

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We report a review of 54 patients with chronic anterior cruciate ligament rupture treated by patellar-quadriceps tendon graft augmented with polypropylene braid (Kennedy-LAD). The femoral placement of the graft was randomised to either a modified over-the-top (OTT) or a tunnel position obtained by an isometric drill guide (ISO). At the two-year follow-up both procedures had resulted in improvement of subjective knee function and activity level. Stereoradiographic measurements showed reduction of anteroposterior laxity to near normal in about one-third of the patients, but muscle strength and objective functional performance showed little or no changes. The OTT group had better subjective knee function. We were unable to confirm the theoretical advantages of the use of the drill guide, partly because it provided a tibial tunnel which was too anterior.

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In this retrospective investigation we have determined the rate and types of knee injuries among Swedish ice hockey players, and related these data to the use of knee braces. Thirty-seven of the originally selected 50 hockey teams (74%) of elite or first division calibre took part in the study, and 600 players answered a questionnaire. A total of 254 previous knee injuries sustained while playing hockey were reported by 243 players; tears of the medical collateral ligament (60%), meniscus (15%) or anterior cruciate ligament (12%) were the most commonly reported injuries. Prophylactic knee braces were worn by 138 (23%) of the players. Of these, 122 (88%) had earlier sustained a knee injury, and 16 had not. A total of 17 knee injuries had occurred while the players were wearing a brace. Six of these players had previously uninjured knees while 11 had repeat injury in a brace despite earlier successful rehabilitation or operation. The most common injury in braced knees was a tear of the medial collateral ligament. We conclude that the number of knee injuries is high among Swedish ice hockey players, and that the efficacy of functional knee braces to reduce knee injuries is questionable.

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In this prospective study, we have investigated incidence of injuries of different severity, types of injury, and mechanisms of injury during ice hockey games. All twelve Swedish elite hockey teams were observed during the season 1988-1989 when a total number of 664 games were played. There was a total number of 285 injuries, of which the majority were minor (61%) and only 9% were classified as major. Seventy-four per cent of the injuries occurred during games and 26% during practice. The overall incidence of injury was 53.0 per 1000 player-game hours. Eighty-five per cent of injuries were caused by trauma and 15% by over-use. Injuries were most often localized to the head/face (39%) or the lower limb (32%). Most injuries resulted from stick contact or player contact including checking. A reduction of minor and moderate injuries should be possible by stricter enforcement of the hockey rules, and more widespread use of visors.

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Between 1973 and 1981, 101 patients had a Putti-Platt repair for recurrent dislocation of the shoulder; 89 of them were followed up and 43 underwent a clinical examination, 23 being assessed with the Cybex dynamometer. The 46 who did not attend were interviewed by telephone. The mean follow up time was 8 +/- 2 years (range 5-14 years). Redislocation occurred in 18 patients (20%), but this was twice as high in patients who were aged under 26 years at the time of operation compared with those who were older (29% versus 13%). The time of recurrence was between 1 and 11 years after operation. A decrease in strength and power of abduction, internal and external rotation, was found in the affected shoulder. Restriction of all measured movements, particularly external rotation, was also found in all patients. Nevertheless most had a high functional score and relatively few symptoms. We conclude that the Putti-Platt procedure has a high recurrence rate in younger patients, and we hesitate to recommend it for young active individuals.

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Pure strength training will result in good functional results in most patients with anterior or posterior cruciate ligament injuries. In a randomised study it was shown that functional training without specific strength training will result in at least comparable results to isokinetic training. In order to increase compliance and to improve the results of training a new rehabilitation programme combines pure strength training and functional training. The aim of this treatment is to restore the dynamic stability of the knee.

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Fifteen patients with isolated old rupture of the anterior cruciate ligament (ACL) were examined to judge their functional disability. The following basic factors were used for evaluation: thigh muscle strength testing, stabilometry in a one-leg stance with straight and flexed knee, gait analysis, performance tests, knee function score, activity grading scale, and clinical joint laxity tests. We found that these rehabilitated patients mainly had impaired performance in those tests which greatly stressed the knee joint's sagittal stability. One-leg hop length was impaired for the injured limb. This group of patients had bilateral impairment of postural control compared with a reference group. This dysfunction was not revealed when comparing limbs. A derotation brace (ECKO) had neither a positive nor a negative effect in the tests. Different aspects of knee function evaluation are emphasized. Some of the altered functions are suggested to be due to central adjustments of motor control.

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Four different types of derotation braces and an elastic knee support were tested on ice-hockey players. The elastic support did not noticeably affect rotation and abduction-adduction of the knee. All four braces reduced rotation and abduction-adduction in test actions simulating sports situations. Flexion-extension was slightly affected by two of the individually made braces in one action. Running a figure eight was slower with two of the individually made braces. The best braces, one individually made and one ready-made, limited rotation and abduction-adduction effectively, but did not affect performance. Minor differences in design may account for differences in effect and may alter the protection afforded by a brace.

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A good system for evaluating the degree of impairment, disability, and handicap of the patient with a cruciate ligament injury includes functional score, activity grading, stability testing, and measurements of performance and strength, all of which are relevant to different aspects of knee function. The symptom-related knee score gives a more differentiated picture of the disability than does a binomial rating of symptoms. A way of grading the disability in an objective way is to use a performance test. This test could also be used for monitoring rehabilitation before full activity has been resumed. The activity grading scale is very useful for grading the handicap.

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Fifty-three consecutive patients with troublesome old cruciate ligament lesions underwent a 3-month thigh and calf muscle training program. Before training, the diagnosis was established by arthroscopy and clinical examination under anesthesia. Significant improvement in strength, performance, knee score, and activity level took place; the majority were improved and declined surgery. A period of strength training is recommended before the decision to undertake surgery for cruciate ligament injury.

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