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Dancer Injuries

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181. Female Athlete Triad (Diagnosis)

history, dietary concerns/restrictions, and a bone health history. [ ] Simple inquiries such as these may reveal the first warning signs of an athlete at risk or suffering from the female athlete triad. A study that categorized athletes into low-, moderate-, and high-risk groups for bone stress injuries using the Female Athlete Triad Cumulative Risk Assessment score found that moderate-risk athletes were twice as likely to sustain a bone stress injury when compared to the low-risk group and high-risk (...) were 4 times as likely. The study also found that bone stress injuries were most common in cross-country runners. [ ] Previous Next: Prognosis For many athletes, the long-term prognosis is good. Few athletes with the female athlete triad are admitted to the hospital for inpatient treatment, and few die from their disease. However, significant long-term morbidity may affect these women later in life. The diagnosis of the female athlete triad was established in the early 1990s, although this set

2014 eMedicine.com

182. Stress Fracture (Treatment)

=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMzA5MTA2LXRyZWF0bWVudA== processing > Physical Medicine and Rehabilitation for Stress Fractures Treatment & Management Updated: Nov 29, 2017 Author: Stephen Kishner, MD, MHA; Chief Editor: Consuelo T Lorenzo, MD Share Email Print Feedback Close Sections Sections Physical Medicine and Rehabilitation for Stress Fractures Treatment Rehabilitation Program Physical therapy See Deterrence. The foundation of treatment for symptomatic stress injury is activity modification. To create an environment conducive to healing (...) the stress injury, interrupting the cycle of repetitive overload is essential. For athletes, this typically results in time lost from competition and intensive training. For most stress fractures, the period of relative rest may be expected to last from 4-12 weeks. Factors influencing the duration of the activity restriction include the anatomic site of the stress injury, the extent of the stress injury, and the anticipated demands on the athlete upon return to play. During the period of restricted

2014 eMedicine.com

183. Snapping Hip Syndrome (Treatment)

at least twice a week to assist with lumbopelvic and lower extremity stability. Patients are typically started on a home program during the later stages of the recovery phase. The same home program can be modified for the maintenance phase of rehabilitation. Previous References Johnston CA, Wiley JP, Lindsay DM, Wiseman DA. Iliopsoas bursitis and tendinitis. A review. Sports Med . 1998 Apr. 25(4):271-83. . Reid DC. Prevention of hip and knee injuries in ballet dancers. Sports Med . 1988 Nov. 6(5):295 (...) -307. . Jacobsen JS, Thorborg K, Soballe K, Ulrich-Vinther M. Eccentric hip abductor weakness in patients with symptomatic external snapping hip. Scand J Med & Sci in Sports . 2012. 22:e140-e146. Tatu L, Parratte B, Vuillier F, Diop M, Monnier G. Descriptive anatomy of the femoral portion of the iliopsoas muscle. Anatomical basis of anterior snapping of the hip. Surg Radiol Anat . 2001. 23(6):371-4. . Jacobs M, Young R. Snapping hip phenomenon among dancers. Am Correct Ther J . 1978 May-Jun. 32(3

2014 eMedicine.com

184. Corns (Treatment)

in General Medicine . 7th ed. New York, NY: McGraw-Hill; 2008. 97. Kennedy CTC, Burd DAR. Mechanical and Thermal Injury. Burns T, Breathnach SM, Cox N, Griffiths CE, eds. Rook's Textbook of Dermatology . 7th ed. London, England: Blackwell Science; 2004. 22. Viegas SF, Torres FG. Cherry pitter's thumb. Case report and review of the literature. Orthop Rev . 1989 Mar. 18 (3):336-8. . Villano PA, Ruocco V, Pisani M. The cameo engraver's corn. Int J Dermatol . 1990 Jul-Aug. 29 (6):424-5. . Scott MJ Jr, Scott (...) arterial disease. A case report. J Am Podiatr Med Assoc . 1985 Nov. 75 (11):616-8. . Coughlin MJ. Common causes of pain in the forefoot in adults. J Bone Joint Surg Br . 2000 Aug. 82(6):781-90. . Verbov JL, Monk CJ. Talar callosity--a little-recognized common entity. Clin Exp Dermatol . 1991 Mar. 16 (2):118-20. . Oztekin HH, Boya H, Nalcakan M, Ozcan O. Second-toe length and forefoot disorders in ballet and folk dancers. J Am Podiatr Med Assoc . 2007 Sep-Oct. 97 (5):385-8. . Baccouche D, Mokni M, Ben

2014 eMedicine.com

185. Ankle Impingement Syndrome (Treatment)

. Electrotherapeutic modalities may also be helpful. In ballet dancers, technique assessment is helpful and essential to prevent further pain and injury. Next: Recovery Phase Rehabilitation Program Physical Therapy Postoperatively, advise posterior splinting for 1 week, as well as a supportive brace and elastic compression stocking. Physical therapy is initiated at 2-3 weeks for strengthening, range of motion, proprioception, and sport-specific rehabilitation. Previous References Ferkel RD. Soft tissue pathology (...) of the ankle. McGinty JB, Caspari RB, Jackson RW, Poehling GG, eds. Operative Arthroscopy . 2nd ed. Philadelphia, Pa: Lippincott Raven; 1996. 1141-55. Ferkel RD. Ankle and foot injuries. Fu FH, Stone DA, eds. Sports Injuries . Baltimore, Md: Lippincott Williams & Wilkins; 1994. Umans HR, Cerezal L. Anterior ankle impingement syndromes. Semin Musculoskelet Radiol . 2008 Jun. 12(2):146-53. . Sanders TG, Rathur SK. Impingement syndromes of the ankle. Magn Reson Imaging Clin N Am . 2008 Feb. 16(1):29-38, v

2014 eMedicine.com

186. Iliopsoas Tendinitis (Treatment)

of the hip, pelvis, and thigh. Kibler WB, Herring SA, Press JM, eds. Functional Rehabilitation of Sports and Musculoskeletal Injuries . Philadelphia, Pa: Lippincott Williams & Wilkins; 1998. 226-243. Jacobs M, Young R. Snapping hip phenomenon among dancers. Am Correct Ther J . 1978 May-Jun. 32(3):92-8. . Jacobson T, Allen WC. Surgical correction of the snapping iliopsoas tendon. Am J Sports Med . 1990 Sep-Oct. 18(5):470-4. . Janzen DL, Partridge E, Logan PM, Connell DG, Duncan CP. The snapping hip (...) arthroplasty. J Am Acad Orthop Surg . 2009 Jun. 17(6):337-44. . Reid DC. Prevention of hip and knee injuries in ballet dancers. Sports Med . 1988 Nov. 6(5):295-307. . Renström P, Peterson L. Groin injuries in athletes. Br J Sports Med . 1980 Mar. 14(1):30-6. . Shin AY, Morin WD, Gorman JD, Jones SB, Lapinsky AS. The superiority of magnetic resonance imaging in differentiating the causeof hip pain in endurance athletes. Am J Sports Med . 1996 Mar-Apr. 24(2):168-76. . Tatu L, Parratte B, Vuillier F, Diop M

2014 eMedicine.com

187. Peroneal Mononeuropathy (Treatment)

. A group from Turkey has reported good results after tibialis posterior tendon transfer for persistent foot drop after peroneal nerve repair. [ ] Another group has reported good results from patients with deep peroneal nerve injuries resulting in foot drop undergoing nerve transfer of functional fascicles of either the superficial peroneal nerve or of the tibial nerve as donor for deep peroneal-innervated muscle groups. [ ] A group from Italy has reported good motor improvement with a double tendon (...) transfer method from the tibialis posterior to tibialis anterior, and flexor digitorum longus transfer to the extensor digitorum longus and extensor hallucis longus tendons. [ ] Previous References Hobson-Webb LD, Juel VC. Common Entrapment Neuropathies. Continuum (Minneap Minn) . 2017 Apr. 23 (2, Selected Topics in Outpatient Neurology):487-511. . Bregman PJ, Schuenke M. Current Diagnosis and Treatment of Superficial Fibular Nerve Injuries and Entrapment. Clin Podiatr Med Surg . 2016 Apr. 33 (2):243

2014 eMedicine.com

188. Corns (Overview)

a normal physiological response—proliferation of the stratum corneum. One of the primary roles of the stratum corneum is to provide a barrier to mechanical injury. Any insult compromising this barrier causes homeostatic changes and the release of cytokines into the epidermis, stimulating an increase in synthesis of the stratum corneum. When the insult is chronic and the mechanical defect is not repaired, hyperplasia and inflammation are common. [ ] With corns, external mechanical forces are focused (...) Tethered spinal cord syndrome [ ] Vascular occlusion syndromes [ ] (ie, verruca vulgaris) [ ] Faulty mechanics play a role. Irregular distribution of pressure and repetitive motion injury (especially in athletes) are believed to be the main inciting causes; however, inappropriately shaped or constrictive footwear in the presence of bony prominences (eg, talar bone prominences [ ] ) may exacerbate corn formation. Furthermore, some disorders may alter the shape or sensation of the soles of the feet. Bony

2014 eMedicine.com

189. Clavus (Overview)

a normal physiological response—proliferation of the stratum corneum. One of the primary roles of the stratum corneum is to provide a barrier to mechanical injury. Any insult compromising this barrier causes homeostatic changes and the release of cytokines into the epidermis, stimulating an increase in synthesis of the stratum corneum. When the insult is chronic and the mechanical defect is not repaired, hyperplasia and inflammation are common. [ ] With corns, external mechanical forces are focused (...) Tethered spinal cord syndrome [ ] Vascular occlusion syndromes [ ] (ie, verruca vulgaris) [ ] Faulty mechanics play a role. Irregular distribution of pressure and repetitive motion injury (especially in athletes) are believed to be the main inciting causes; however, inappropriately shaped or constrictive footwear in the presence of bony prominences (eg, talar bone prominences [ ] ) may exacerbate corn formation. Furthermore, some disorders may alter the shape or sensation of the soles of the feet. Bony

2014 eMedicine.com

190. Stress Fracture (Overview)

> Physical Medicine and Rehabilitation for Stress Fractures Updated: Nov 29, 2017 Author: Stephen Kishner, MD, MHA; Chief Editor: Consuelo T Lorenzo, MD Share Email Print Feedback Close Sections Sections Physical Medicine and Rehabilitation for Stress Fractures Overview Background There are 2 common stress injuries to bone: (1) insufficiency fractures, which occur typically when osteoporotic bone is subjected to normal stress, and (2) stress fractures, which can occur when normal bone is subjected (...) to abnormal activity. [ ] Stress fractures are overuse injuries of bone. These fractures, which may be nascent or complete, result from repetitive subthreshold loading that, over time, exceeds the bone's intrinsic ability to repair itself. Briefhaupt originally described stress fractures in military recruits in 1855. Our present understanding of the pathophysiology of stress fractures and of bone's response to loading has been advanced by numerous studies investigating the epidemiology of stress fractures

2014 eMedicine.com

191. Snapping Hip Syndrome (Overview)

DM, Wiseman DA. Iliopsoas bursitis and tendinitis. A review. Sports Med . 1998 Apr. 25(4):271-83. . Reid DC. Prevention of hip and knee injuries in ballet dancers. Sports Med . 1988 Nov. 6(5):295-307. . Jacobsen JS, Thorborg K, Soballe K, Ulrich-Vinther M. Eccentric hip abductor weakness in patients with symptomatic external snapping hip. Scand J Med & Sci in Sports . 2012. 22:e140-e146. Tatu L, Parratte B, Vuillier F, Diop M, Monnier G. Descriptive anatomy of the femoral portion of the iliopsoas (...) No data are available on the prevalence or incidence of snapping hip syndrome. The syndrome occurs most often in individuals aged 15-40 years and affects females slightly more often than males. [ ] In one clinic, the rate of some form of snapping hip syndrome in female ballet dancers with hip complaints was 43.8%, and approximately 30% noted pain with this condition. [ ] Previous Next: Functional Anatomy The pelvis is the link between the trunk and the lower extremities. The ball-and-socket joint

2014 eMedicine.com

192. Achilles Tendon Rupture (Overview)

Achilles Tendon Rupture (Overview) Achilles Tendon Injuries: Practice Essentials, Background, Anatomy Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMzA5MzkzLW92ZXJ2aWV3 processing > Achilles Tendon Injuries (...) Updated: Sep 12, 2018 Author: Anthony J Saglimbeni, MD; Chief Editor: Dean H Hommer, MD Share Email Print Feedback Close Sections Sections Achilles Tendon Injuries Overview Practice Essentials Achilles tendon pathologies include rupture and tendonitis. Many experts now believe, however, that tendonitis is a misleading term that should no longer be used, because signs of true inflammation are almost never present on histologic examination. Instead, the following histopathologically determined

2014 eMedicine.com

193. Peroneal Mononeuropathy (Overview)

Peroneal mononeuropathy is uncommon in children but has been reported in all age groups. Profession Dancers are also prone to superficial and deep peroneal nerve entrapments. [ ] Previous Next: Prognosis Common peroneal nerve decompression is a useful procedure to improve sensation and strength as well as to decrease pain. [ ] A retrospective study evaluated electrodiagnostic prognostic factors after peroneal nerve injury in 39 subjects. Outcome was associated with compound muscle action potential (...) , Selected Topics in Outpatient Neurology):487-511. . Bregman PJ, Schuenke M. Current Diagnosis and Treatment of Superficial Fibular Nerve Injuries and Entrapment. Clin Podiatr Med Surg . 2016 Apr. 33 (2):243-54. . Tzika M, Paraskevas G, Natsis K. Entrapment of the superficial peroneal nerve: an anatomical insight. J Am Podiatr Med Assoc . 2015 Mar. 105 (2):150-9. . Kennedy JG, Baxter DE. Nerve disorders in dancers. Clin Sports Med . 2008 Apr. 27 (2):329-34. . Humphreys DB, Novak CB, Mackinnon SE

2014 eMedicine.com

194. Lumbosacral Radiculopathy (Overview)

at multiple levels. Herniation of the intervertebral disc can cause impingement of the above neuronal structures, thus causing pain. The presence of disc material in the epidural space is thought to initially result in direct toxic injury to the nerve root by chemical mediation and then exacerbation of the ensuing intraneural and extraneural swelling, which results in venous congestion and conduction block. Notably, the size of the disc herniation has not been found to be related to the severity (...) with the upright position. Because each intervertebral disc is a fluid system, hydraulic pressure is generated whenever a load is placed on the axial skeleton. The hydraulic pressure mechanisms then multiply the force on the annulus fibrosus of the intervertebral disc to make it 3-5 times that which is exerted on the axial skeleton. Previous Next: Sport-Specific Biomechanics Dancers are prone to both acute and chronic back problems, including lumbosacral radiculopathy, which develop secondary

2014 eMedicine.com

195. Iliopsoas Tendinitis (Overview)

(4):271-83. . Khan K, Cook JL, Maffulli N. Tendinopathy in the active person: Separating fact from fiction to improve clinical management. Am J Med Sports . 2000. 2(2):89-99. Lachiewicz PF, Kauk JR. Anterior iliopsoas impingement and tendinitis after total hip arthroplasty. J Am Acad Orthop Surg . 2009 Jun. 17(6):337-44. . Reid DC. Prevention of hip and knee injuries in ballet dancers. Sports Med . 1988 Nov. 6(5):295-307. . Renström P, Peterson L. Groin injuries in athletes. Br J Sports Med (...) 16, 2019 Author: Joseph P Garry, MD, FACSM, FAAFP; Chief Editor: Sherwin SW Ho, MD Share Email Print Feedback Close Sections Sections Iliopsoas Tendinitis Overview Background Hip and pelvis injuries represent 2-5% of all sports injuries. Among these injuries, groin pain is the most common finding. The most common sports-related injuries in the hip, pelvis, and thigh area are musculotendinous, (eg, quadriceps strain, adductor tendinitis) and, less commonly, iliopsoas tendinitis. Iliopsoas

2014 eMedicine.com

196. Low Energy Availability in the Female Athlete (Overview)

meals that are less energy dense may be an important means of avoiding low energy availability conditions and thus preventing the female athlete triad [ ] Musculoskeletal history A careful review of past and current musculoskeletal injuries in the female athlete should be conducted. There should be a focus on all stress fractures, as well as on other fractures. There is an increase in risk of stress fractures in females with a chronic energy deficit. Any injury that results in loss of training (...) should be considered if a patient's reproductive function is not restored with a trial of increased energy intake or if the findings on history and physical exam suggest other causes of . If the patient has signs of hyperandrogenism ( ), free and total testosterone can be tested to assess for androgen excess. [ ] In a 2016 study by Łagowska et al, nutritional status and dietary habits were analyzed in relation to testosterone levels in female athletes and ballet dancers with menstrual disorders

2014 eMedicine.com

197. Phobic Disorders (Overview)

disorder) If another medical condition (eg, Parkinson disease, obesity, or disfigurement caused by a burn or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive Performance-only subtype is specified when fear is restricted to speaking or performing in public. Individuals with performance-only social phobia do not fear or avoid nonperformance in generic social situations; their phobic reaction is typically restricted to professional performance (eg, musicians (...) , dancers, performers, or athletes or public speaking). Specific phobia The specific DSM-5 criteria for specific phobia are as follows [ ] : Marked fear or anxiety about a specific object or situation (eg, flying, heights, animals, receiving an injection, or seeing blood); in children, this fear or anxiety may be expressed by crying, tantrums, freezing or clinging The phobic object or situation almost always provokes immediate fear or anxiety The phobic object or situation is actively avoided or endured

2014 eMedicine.com

198. Metatarsal Stress Fracture (Overview)

. This type of injury is seen in runners of all levels, as well as ballet dancers and gymnasts and patients with rheumatoid arthritis (RA), metabolic bone disease, and neuropathic conditions. [ , , ] Metatarsal stress fractures are also seen with increasing frequency in patients who engage in aerobics activities, particularly high-impact aerobics. Next: Epidemiology Frequency United States The incidence of stress fractures in the general population is unknown, as virtually all literature on the subject (...) is derived from a military population or advanced-level athletes. Stress fractures are estimated to constitute up to 16% of all injuries that are related to athletic participation; running is the cause in most of these cases. Most stress fractures (95%) involve the lower extremities, particularly the metatarsals. A study by Waterman et al reported the incidence rate for lower extremity stress fractures in the US military (not adjusted for sex, race, age, rank, and service branch), including

2014 eMedicine.com

199. Metatarsal Stress Fracture (Treatment)

and a return to dancing without pain. [ ] However, further study is warranted given the small study size and that all but one of the young dancers received ESWT. Smith et al identify the prevalence of vitamin D deficiency in patients with a low energy fracture of the foot or ankle. The study concluded that hypovitaminosis D was common among patients with a foot or ankle injury. Patients with a low energy fracture of the foot or ankle were at particular risk for low vitamin D, especially if they smoked (...) bearing as tolerated, initially in a wooden-soled shoe, and then in a comfortable shoe. Recreational Therapy Aqua-running, swimming, or bicycling may be continued to maintain physical fitness. Other Treatment (Injection, manipulation, etc.) Albisetti et al reported their experience with diagnosing and treating stress fractures at the base of the second and third metatarsals in young ballet dancers from 2005-2007. [ ] Of 150 trainee ballet dancers, 19 had stress fractures of the metatarsal bone bases

2014 eMedicine.com

200. Female Athlete Triad (Treatment)

for a fracture or stress fracture, depending on the type of injury. Unless a fracture or stress fracture requires surgical intervention, surgery is usually not indicated. Many initial laboratory and radiologic studies can be ordered at this time to aid in clinical decision-making. For some tests, the patient may need to be referred to regional facilities or larger laboratories, and this time should be used to begin forming a relationship with the athlete. Special concerns Because the female athlete triad (...) at the earliest sign of a cardiac abnormality. Few patients with anorexia complain of the classic chest pain or shortness of breath until late in the course of the disease. If the athlete develops a fracture or stress fracture that requires surgical intervention, referral to an orthopedist is needed. Many such injuries can be managed nonoperatively; however, femoral neck stress fractures or compression vertebral fractures may require consultation with a specialist. If casts or braces are needed, they may have

2014 eMedicine.com

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