Note from Editor-in-Chief William O. Roberts
The summer has passed all too quickly and fall sports are underway at high schools and colleges around the country. I continued my love affair with the Montana mountains and had to call on my medical skills for a couple of situations. It reminded me that one can never really get away from medicine, and the skills we learn in training and in sports medicine have many applications.
The first occurred at the family camp we stay in each summer. A college senior to be (pre-med) stood up too quickly on the trail while crossing under a downed tree and lacerated his scalp. The wound was full thickness and a little over a centimeter in length. I did not have suture materials or a staple gun with me. The nearest medical facility was 3+ hours away; so a 7to 8 hour round trip with treatment time included and it was 6:30 p.m. I remembered my old trick for kids who were afraid of needles and braided his hair to close the wound. Another “camper” had his fly tying kit and used it along with some superglue to secure the braid. A follow up report from his mother indicated he had healed well. That was the easy one.
The second problem occurred at Sperry Chalet in Glacier National Park. The temperatures had peaked in the mid-90s and the trail up to the chalet was in the sun for most of the day. There is a long exposed traverse across “The Oven” as the large bowl is referred to by the chalet staff. A woman from South Carolina was not doing well. An EMT hiking the trail recognized she was in trouble and helped with cool towels and extra water. She was still vomiting at dinner time when I became involved. Although from a “hot” part of the country, she was new to the altitude and had not been hiking with a pack. Her companions said she drank twice as much water during the hike as they had and they were on the trail for about 9 hours. It was hot in the dining hall so we moved her outside in the shade. Her skin was dry and cool. She had a headache and did not feel well. She had not passed urine for many hours. Her top was salt stained from sweat. She answered questions coherently and seemed to be “with it.” Was this heat exhaustion, acute mountain sickness, dehydration, hyponatremia, or some combination? I had her stop drinking water. After some time passed she felt better and I gave her some lemonade with added salt to sip slowly. Eventually she kept fluids down, urinated, and felt better. She did not hike with her group the next day and was well when she hiked down two days later. It was clear to me during this encounter why the medical response teams in the Grand Canyon carry point of care sodium analyzers and hypertonic saline, as this woman presented a difficult diagnostic dilemma. Fortunately all turned out well in this instance.
Again, it is interesting when you are called to help in wilderness situations and you never know when you will need to apply your knowledge and skills.
This issue of Current Sports Medicine Reports (CSMR) addresses Extremity and Joint Conditions and Sport-Specific Illness and Injury with a wide array of topics that should pique the interest of every reader.
The journal’s new Extremity and Joint Conditions Section Editor Chad A. Asplund, MD, MPH, FACSM, has assembled a set of articles that will prove useful in your care of athletes. Check out this section to learn more about popliteal artery entrapment syndrome, anatomic factors that may predispose female athletes to ACL injury, hip pain in athletes, and chronic exertional compartment syndrome testing. In this section, you’ll also want to read the two interesting case reports about heterotopic ossification after acromioclavicular separation in an adolescent athlete and snapping pes syndrome in a pediatric athlete.
When exploring the Sport-Specific Illness and Injury segment recruited by Section Editor Craig C. Young, MD, FACSM, you will learn more about the medical care needs of aquatics athletes, climbers, and wrestlers along with common shoulder injuries in American football players. You won’t want to miss the case report about a subchondral fracture of the femoral head in a high school badminton player in this section.
Pearls & Pitfalls looks at death in athletes, news on hyponatremia, and nuances in sickle cell trait. Scanning Sports Medicine covers the latest clinical research published by ACSM, and Web Alerts reviews several interesting Web sites. CAQ Review covers peripheral nerve injury and Clinical Pearls offers five key characteristics to consider when purchasing a running shoe. Our Clinician Profile features John C. Hill, DO, FACSM, the journal’s new Competitive Sports section editor, an active member of ACSM since 1995, and a holder of the coveted Leadville Race Series Belt Buckle (completed all the Leadville races including the 100 mile bike and 100 mile running races in the same year).
I hope the topics covered in this edition will help you help your athletes and active patients perform at their peak, return to competition safely, and reduce their risk of injury.
Lastly, please note that articles from Current Sports Medicine Reports, Medicine & Science in Sports & Exercise®, Exercise and Sport Sciences Reviews, ACSM’s Health & Fitness Journal®, and the soon-to-be launched Translational Journal of the American College of Sports Medicine, are now available to the public 12 months after the publication date of the article. In May, ACSM’s Board of Trustees voted to grant free online access to the journals to increase ACSM’s worldwide influence and make ACSM’s important research and content more widely available. To access this content visit the journal sites:
• Current Sports Medicine Reports: www.acsm-csmr.org
• Medicine & Science in Sports & Exercise®: www.acsm-msse.org
• Exercise and Sport Sciences Reviews: www.acsm-essr.org
• ACSM’s Health & Fitness Journal®: www.acsm-healthfitness.org
William O. Roberts, MD, MS, FACSM