Neonatal microstructural development in the posterior limbs of the internal capsule (PLIC) was assessed using diffusion tensor imaging (DTI) fractional anisotropy (FA) in 24 verylow-birthweight preterm infants at 37 weeks' gestational age and compared with the children's gait and motor deficits at 4 years of age. There were 14 participants with normal neonatal FA values (seven females, seven males; born at 27.6 weeks [SD 2.3] gestational age; birthweight 1027g [SD 229]) and 10 participants with low FA values in the PLIC (four females, six males; born at 28.4 weeks [SD 2.0] gestational age; birthweight 1041g [SD 322]). Seven of the 10 children with low FA and none of the children with normal FA had been diagnosed with CP by the time of gait testing. Among children with low neonatal FA, there was a strong negative correlation between FA of the combined left and right side PLIC and log NI (r=-0.89, p=0.001) and between FA and GMFCS (r=-0.65, p=0.04) at 4 years of age. There was no correlation between FA and gait NI or GMFCS at 4 years of age among children with normal neonatal FA. This preliminary study suggests neonatal DTI may be an important predictor of the severity of future gait and motor deficits.Cerebral palsy (CP) is the most common motor disorder in children born preterm, affecting over 15% of very-low-birthweight (VLBW) preterm infants (less than 1500g, less than 32wks gestation). Currently, most children with CP do not receive a specific prognosis or treatment plan until they present with gait deficits. Treatment depends on the severity of gait deficits, which range from toe walking in the mildly impaired, to a crouched, rotated gait in the more severely impaired. 4 Among children with CP who are not walking by age 2 years, only 10% walk independently by age 7 years. 25 This indicates a need for early and accurate prognosis, at an age when there is optimal neuronal plasticity and treatment may improve motor control, prevent growth related deformities, and reduce the need for orthopaedic surgery.The brain structure-function relations that influence motor control development in preterm children are not well understood. Previous studies have reported a global association between damage to neonatal white matter (WM), such as periventricular leukomalacia (PVL), in the region of the posterior limbs of the internal capsule (PLIC) on MRI and the risk of developing CP. 5,6 Selective vulnerability of the internal capsule (IC) to hypoxia-ischemia is thought to result from insufficient vascularization of the developing blood supply in the periventricular region in preterm infants. 5 Damage to WM, including PVL, is thought to be the major cause of motor dysfunction in preterm children with spastic CP. 3,6,7,8,17 A recent study of brain MRI in adolescents with CP found that motor dysfunction was more strongly correlated with the severity of damage in the IC and precentral gyrus than with the total WM volume loss. 22 These findings are consistent with the neuroanatomy. The descending motor axons of the corticospinal t...

Treatment of plantar fasciitis with ACP or ESWT plus conventional treatments resulted in improved pain and functional outcomes compared with conventional treatment alone. There was no significant difference between ACP and ESWT in terms of VAS and AOFAS ankle-hindfoot scale improvements, although the ACP group demonstrated greater reductions in plantar fascia thickness.

Common sports injuries include bone stress injuries (BSIs), anterior cruciate ligament (ACL) injuries, and concussions. Less commonly recognized are the specific sex differences in epidemiology, risk factors, and outcomes of these conditions by sex. An understanding of these factors can improve their clinical management, from prescribing appropriate prehabilitation to guiding postinjury rehabilitation and return to play. This narrative review summarizes the sex differences in the diagnosis and management of BSIs, ACL injuries, and concussions. Although BSIs are more common in female athletes, risk factors for both sexes include prior injury and relative energy deficiency in sport (RED-S). Risk factors in female athletes include smaller calf girth, femoral adduction, and higher rates of loading. Female athletes are also at greater risk for developing ACL injuries in high school and college, but their injury rate is similar in professional sports. Increased lateral tibial slope, smaller ACL size, and suboptimal landing mechanics are additional risk factors more often present in female athletes. Male athletes are more likely to have ACL surgery and have a higher rate of return to sport. Concussions occur more commonly in female athletes; however, female athletes are also more likely to report concussions. Male athletes more commonly sustain concussion through contact with another player. Female athletes more commonly sustain injury from contact with playing equipment. Managing post-concussion symptoms is important, and female athletes may have prolonged symptoms. An understanding of the sex-specific differences in these common sports injuries can help optimize their prehabilitation and rehabilitation. LEVEL OF EVIDENCE: IV.

Residents in this study demonstrate poor accuracy of AC joint and lateral knee joint line identification by palpation, using US as the criterion standard for verification. There were no statistically significant differences in the accuracy rates of joint line palpation based on resident level of education. US may be a useful tool to use to advance the current methods of teaching the physical examination in medical education.

Objectives Few studies have investigated overweight trajectories and psychosocial adjustment among adolescents. We conducted analyses with data from the multisite Study of Early Child Care and Youth Development (SECCYD). Methods Sample included 1,350 youth born in 1991. Data consisted of repeated measures of weight, height, and multiple subscales of internalizing and externalizing behavioral problems measured by the Child Behavior Checklist (CBCL) from age nine to age 15. Results Three trajectory patterns were identified: never/rarely overweight/obese (59.5%), late start/light overweight/obese (12.1%), and chronically/heavy overweight/obese (28.4%). Youths with chronically/heavy overweight/obese trajectory pattern had significantly higher scores of internalizing problems over time, as well as syndrome subscales of somatic complaints, social problems and social withdrawal over time than youths with the never/rare overweight/obese trajectory pattern. There was no significant difference in either broad-band behavioral problems or narrow-band syndrome subscales between youths with the never/rare overweight/obese trajectory pattern and those with the late start/light overweight/obesity trajectory pattern. Conclusions Study findings may advance knowledge on the distinct developmental trajectory patterns of overweight youth and their linkages to the psychosocial adjustment during the period of pubertal transition. The results highlight the need for future prevention research to improve the physical development and mental well-being of adolescents.