Chad A. Asplund
Basketball has been an organized sport since the 1890s and is considered a limited contact sport. It involves a tremendous amount of running with explosive movements and rapid changes in direction and pace. Extreme stresses on the body during play result in many acute musculoskeletal injuries, whereas the ability to play year round and at most ages leads to many overuse injuries.
With the great popularity of basketball, most teams at the high school level and beyond have associated physicians or certified athletic trainers who are responsible for injury prevention and medical care; however, care for the athlete falls to the hands of many health care providers because many injuries occur outside of organized play (21,35).
Nearly one million people are involved in basketball injuries each year in the United States. Population-based injury rates are 3.9 per 1,000, but player injury rates are seen as high as 50% in some European professional leagues (16).
An epidemiologic study of 100 representative U.S. high schools over the 2005-2006 and 2006-2007 seasons reported an injury rate of 1.94 per 1,000 athlete exposures (AEs) (8).
Several studies demonstrate no significant difference in the risk for injury between males and females (20,32); others have shown that females are more frequently injured than males (2.08/1,000 AEs vs. 1.83/1,000 AEs) (8).
College injury rates are 5.7 per 1,000 athlete exposures for males and 5.6 for females (32).
High school players are more likely to be injured during competition than college players (3.27/1,000 AEs vs. 1.4/1,000 AEs) (8). Between 62% and 64% of injuries in college basketball occur during practice (32), whereas 53%-58% of high school basketball injuries occur during practice (34). In the National Basketball Association (NBA), 49.9% of reported injuries over 17 years were sustained during games (12).
Basketball has the highest per capita injury rate for all sports in the age group 14-25 years, ranks second in ages 5-14 years, and third in ages 25 years and up (11).
Approximately 17.5% of sports-related emergency room visits and 13.5% of sports-related visits to primary care physicians are basketball related (11).
Sprains are the most common type of injury in basketball. Sprains account for 32%-34% of injuries at the collegiate level (32) and 44% at the high school level (8).
Children are more susceptible to overuse injuries due to open physes, especially at the elbow, knee, and ankle (9).
Fungal infections are prevalent in athletes, and tinea pedis is the most common dermatophytosis. High-top shoes, perspiration, friction, and poor foot care contribute to recurrent problems. Drying feet, changing socks, absorbent powders (without corn starch), and over-the-counter (OTC) and prescription antifungals are effective treatment measures. Similar measures should be taken to treat tinea cruris or “jock itch,” which is also common in athletes.
Blisters are another common problem that can cause significant problems for the basketball athlete. Rigid footwear and significant movement inside of the shoe cause this to occur as the shear stresses between epidermal layers cause fluid to build up. These can be safely drained under sterile conditions if full and tense, and these areas should be protected with Vaseline, moleskin, etc., and treated with topical antibiotics if there are open lesions. Proper footwear, including cushion socks, and conditioning can prevent blisters.
Concussion or mild traumatic brain injury (MTBI) occurs in basketball from two mechanisms — player-to-player contact or contact with the floor (8).
Table 83.1 Common Location of Basketball Injuries (8)
Frequency of Injury
MTBI comprises 3.3% of injuries in male basketball players < 20 years old and 5.2% in females < 20 years old, which represents a twofold increase in males and a threefold increase in girls over a 10-year period (35) and reflects the higher incidence of MTBI in females of all age groups. Player collisions are the most likely etiology, and most of these occur in the open court, not under the basket (33).
Basketball involves significant physiologic stress as reflected in findings from professional players. Heart rates average 169 bpm and are above 85% predicted maximum for 75% of competitive playing time (26).
Hypertension is seen in basketball, even though many players are young. Blood pressure elevation over 140 mm Hg systolic and 90 mm Hg diastolic on two separate readings should be investigated. Family history, supplement and medication use, and substance abuse should be considered while investigating other secondary causes.
Blood pressure should be controlled before allowing exercise. In mild and moderate hypertension, exercise is often part of a treatment plan, but in severe hypertension, it is contraindicated. When choosing treatment options, medications with negative performance side effects such as diuretics and nonselective β-blockers should be a last resort (4).
Sudden cardiac death is a rare but serious threat, with an incidence of one in 11,394 in National Collegiate Athletic Association (NCAA) basketball players. Incidence is significantly higher in males and in black athletes, with a prevalence of one in 3,000 Division I male basketball players based on a study from 2004-2008 (15). This represents a significantly higher incidence than previously estimated, and basketball players have been found to be at higher risk for sudden cardiac death than any other athletes (15,25). This could be linked to a predisposition for basketball players to be tall and thin, or Marfanoid, or to a predisposition for a higher prevalence of hypertrophic cardiomyopathy in young African American athletes (24).
Preparticipation examination with a focus on history taking is the best method to prevent sudden death but has not been proven to improve morbidity or mortality.
High-risk individuals with a family history of premature or sudden death, history of exercise-related syncope, or findings of Marfan syndrome should be identified for further testing.
Marfan syndrome is a disorder that affects multiple organ systems, including disproportionate overgrowth of the long bones in the musculoskeletal system and valve dysfunction, dilated cardiomyopathy, and predisposition to aortic aneurysm and dissection in the cardiovascular system (18).
Because people affected with Marfan syndrome tend to be tall with longer extremities, a higher proportion of them are found among basketball players. Family history is important because Marfan syndrome is passed on as a dominant trait, but about 25% of cases are sporadic.
Marfan Syndrome Diagnostic Criteria is a list of features doctors use to diagnose (or decide if someone has) Marfan syndrome. The diagnostic criteria are sometimes called the “Ghent Criteria,” named after the city in Belgium where doctors decided which features to include on the list (Table 83.2).
In the 2010 revised Ghent nosology, aortic root aneurysm and ectopia lentis are now cardinal features. In absence of any family history, the presence of these two manifestations is sufficient for the unequivocal diagnosis of Marfan syndrome.
In patients who die from Marfan syndrome, the etiology is cardiovascular (aortic dissection, congestive heart failure, or cardiac valve disease) in over 90% of cases (18).
Hypertrophic cardiomyopathy (HCM) accounts for 36% of sudden cardiac death in young athletes and has been noted to occur more commonly in male athletes and approximately twice as often in nonwhites, predominantly blacks (24,25).
HCM is a relatively common disorder, with an incidence of about 1:500, and can lead to cardiac death by fatal arrhythmias, so thorough evaluation is indicated in those diagnosed with HCM to risk stratify and determine treatment (24).
Clinical diagnosis of HCM is established most easily and reliably with two-dimensional echocardiography by imaging the hypertrophied but nondilated left ventricular (LV) chamber, in the absence of another cardiac or systemic disease (e.g., hypertension or aortic stenosis) (24).
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