Douglas B Mckeag

Oregon Health and Science University | OHSU · Department of Family Medicine, Sports Medicine

Background/aim To evaluate the association of genetic polymorphisms APOE, APOE G-219T promoter, microtubule associated protein(MAPT)/tau exon 6 Ser⁵³Pro, MAPT/tau Hist⁴⁷Tyr, IL-6572 G/C and IL-6RAsp358Ala with the risk of concussion in college athletes. Methods A 23-centre prospective cohort study of 1056 college athletes with genotyping was compl...

Background: Approximately 3.8 million sports related TBIs occur per year. Genetic variation may affect both TBI risk and post-TBI clinical outcome. Limited research has focused on genetic risk for concussion among athletes. We describe the design, methods, and baseline characteristics of this prospective cohort study designed to investigate a pote...

Objective: To update the 1997 American Academy of Neurology (AAN) practice parameter regarding sports concussion, focusing on 4 questions: 1) What factors increase/decrease concussion risk? 2) What diagnostic tools identify those with concussion and those at increased risk for severe/prolonged early impairments, neurologic catastrophe, or chronic...

Objective To investigate associations of APOE and Tau gene polymorphisms with sports-related acute concussions and baseline to post-concussion neuropsychological test score changes. Design Multi-center prospective cohort study. Setting Scholarship athletes at 21 universities and 4 high schools Participants: 3218 athletes playing football (70%) or s...

Attention deficit hyperactivity disorder (ADHD) is an important issue for the physician taking care of athletes since ADHD is common in the athletic population, and comorbid issues affect athletes of all ages. The health care provider taking care of athletes should be familiar with making the diagnosis of ADHD, the management of ADHD, and how treat...

Maintaining performance levels in athletes remains challenging when metabolic disturbances may be suspected clinically. In athletes there are reported deviations from normal range lab values and multiple factors that may lead to clinical suspicion of thyroid disease, including hypothyroidism, hyperthyroidism, and thyroiditis. Reports of exogenous t...

Epiphyseal Injuries and ApophysitisFluid Balance and Heat InjuriesBack ProblemsGenitourinary and Abdominal InjuriesFurther Reading

Basketball covers the epidemiology of basketball injury, the physiological demands of basketball, preventive medicine, pre-participation examination and special considerations to be given to the young basketball player, and finally looks at the 'special' basketball player -- diabetics, asthmatics, epileptics, etc.

Diabetes MellitusAsthma and Exercise-Induced AsthmaSeizure DisorderMentally and Physically Challenged AthletesConclusion Further Reading

Infectious diseases among athletic teams commonly present challenges for team physicians and primary care doctors. There is some evidence to suggest that athletes are more susceptible to infection during an outbreak of the general population. The frequent physical contact and close travel arrangements associated with many team sports may put athlet...

Ankle sprains are a common and potentially disabling injury. Successful prediction of susceptibility to ankle sprain injury with a simple test could allow ankle sprain prevention protocols to be initiated and help prevent disability in the athletic population. To investigate the ability of the single leg balance (SLB) test, carried out at preseason...

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To assess predictive value of concussion signs and symptoms based on return-to-play timelines. Physician practice study without diagnosis that includes presentation, initial and subsequent treatment, and management of concussion. National multisite primary care sports medicine provider locations. Twenty-two providers at 18 sites; 101 athletes (91 m...

Maxillofacial injuries occur in contact and noncontact sports. Despite advancements in protective equipment and rule changes, there is still an unacceptably high rate of maxillofacial injuries. These injuries are clinically challenging. The significant morbidity, deformity, and disability associated with these injuries can be avoided by their promp...

A 42 year-old male former semi-professional soccer player sustained a right lower extremity popliteal contusion during a soccer game. He was clinically diagnosed with a possible traumatic deep vein thrombosis (DVT), and sent for confirmatory tests. A duplex doppler ultrasound was positive for DVT, and the patient was admitted to hospital for antico...

A young athlete collides with an opponent. The play ends. The athlete walks from the field of play in an unsteady fashion. The medical staff begins the process of assessment. And the questions begin: Are you OK? What's wrong? How many fingers? What do you remember?"After the assessment is complete, decisions are made. Initially, the question is, sh...

Investigate the relationship between on-field markers of concussion severity and postinjury neuropsychological and symptom presentation in an athlete-specific population. Case control study. Multicenter analysis of high school and college athletes. A total of 78 athletes sustaining sports-related concussion were selected from a larger sample of 139...

I'm a dad and proud of it! I'll defend my kids against all comers-opponents, coaches, refs, and sometimes even teammates. Anything wrong with that?

Many US medical schools require a family medicine clerkship, yet little is known about the quantity and diversity of the diagnoses the students experience. This study examines patients encountered with musculoskeletal diagnoses using quantitative data collected by family practice clerkship students. Over a two-year period, 445 students completed 7,...

The rate and pattern of injuries is similar in both physically-challenged and able-bodied athletic participation. However, understanding of the unique medical issues faced by physically-challenged athletes is necessary in conducting appropriate pre-participation evaluations and developing strategies for injury prevention and medical management. Rev...

The rate and pattern of injuries is similar in both physically-challenged and able-bodied athletic participation. However, understanding of the unique medical issues faced by physically-challenged athletes is necessary in conducting appropriate pre-participation evaluations and developing strategies for injury prevention and medical management. Rev...

Methods of preventing and treating knee injuries have changed with the rapid development and refinement of knee braces. Prophylactic knee braces are designed to protect uninjured knees from valgus stresses that could damage the medial collateral ligaments. However, no conclusive evidence supports their effectiveness, and they are not recommended fo...

An 11-year-old male football player had a 3-month history of persistent right thigh pain. He had continued to play regularly despite intermittent pain and cramping, but symptoms had worsened significantly and he had lately had occasional flulike symptoms and mild fever. X-rays and an ultrasound vascular study were normal, but an MRI revealed a poss...

A "burner" is a common nerve injury resulting from trauma to the neck and shoulder, usually during sports participation. The injury is most often caused by traction or compression of the upper trunk of the brachial plexus or the fifth or sixth cervical nerve roots. Burners are typically transient, but they can cause prolonged weakness resulting in...

To investigate the importance of loss of consciousness (LOC) in predicting neuropsychological test performance in a large sample of patients with head injury. Retrospective comparison of neuropsychological test results for patients who suffered traumatic LOC, no LOC, or uncertain LOC. Allegheny General Hospital, Pittsburgh, Pennsylvania. The total...

Spontaneous pneumomediastinum is usually a benign, self-limiting condition in which retrosternal chest pain is the most common complaint and subcutaneous emphysema is the most prevalent physical finding. Chest radiographs confirm the diagnosis. A case report of a 19-year-old college swimmer who initially reported anterior neck pain demonstrates the...

Spontaneous pneumomediastinum is usually a benign, self-limiting condition in which retrosternal chest pain is the most common complaint and subcutaneous emphysema is the most prevalent physical finding. Chest radiographs confirm the diagnosis. A case report of a 19-year-old college swimmer who initially reported anterior neck pain demonstrates the...

Functional knee braces (FKBs) have become a popular adjunct to managing ACL injuries (1). Since their introduction, functional braces have gained wide acceptance for use on ACL-deficient knees and for graft protection during rehabilitation after ACL reconstruction (2).

Despite the high prevalence and potentially serious outcomes associated with concussion in athletes, there is little systematic research examining risk factors and short- and long-term outcomes. To assess the relationship between concussion history and learning disability (LD) and the association of these variables with neuropsychological performan...

Disorders of the patellofemoral joint are common in recreational and competitive athletes. The pathophysiology of these disorders is unclear but may be related to malalignment of the patella and femoral trochlea, which may produce the characteristic anterior knee symptoms (1). Diagnosing and treating patellofemoral pain syndrome is challenging but...

Most ankle injuries occur from excessive inversion, but it is important to be able to differentiate a simple inversion sprain from a potentially disabling injury. Expedient diagnosis includes first screening for deformities and then performing specific tests like the anterior drawer and side-to-side test. To optimize assessment, the examiner needs...

When C. Everett Koop exclaimed that exercise is the "most potent modifier of health" in medicine today ((1)), he was merely echoing what most of us have known for the past 25 years. Exercise is not only recreation and work, it is also therapy, prevention, and treatment. Primary care physicians inherently practice "sports medicine" with each patient...

To report an uncommon complication of distal hamstring icing, cryotherapy-induced common peroneal nerve palsy. A 22-year-old football player applied ice to his distal hamstring for 20 min because of soreness. This application of ice resulted in foot drop and sensory changes in the anterior lower leg and dorsum of the foot. Over the next year, full...

For the most part, physicians who take care of athletes tend to view the preparticipation physical exam (PPE) as a necessary but time-consuming and somewhat bothersome evil. It is not fun. It usually occurs at the hottest, most uncomfortable time of the year, and is often sandwiched between regular work responsibilities and family plans. ("I'd love...

Each year ankle sprains account for a significant degree of disability and expense. Thus, it is important that family physicians become familiar with methods of preventing ankle sprains. Both internal and external methods prevent ankle injuries. Internal methods include improving flexibility, strength and proprioception; effective external methods...

THE PURPOSE OF THIS PAPER IS TO: 1) describe the seasonal affective disorder syndrome using a case illustration, 2) provide a simple and reliable method for identifying seasonal affective disorder, and 3) provide data as to the prevalence of the syndrome in a subset of collegiate hockey players. Collegiate hockey players were selected, because thei...

Knee ligamentous injuries occur during sport, and when there is extensive injury, they can be associated with subluxation or dislocation. We present the case of a female basketball player who sustained a knee dislocation during noncontact play. An immediate angiogram confirmed vascular integrity, and surgical treatment with ligamentous reconstructi...

As more primary care physicians enter the field of Sports Medicine, they will inevitably encounter more injured young athletes than what they may have experienced in their private practices. Recognizing the differences that exist between the young athlete and adult is essential in properly diagnosing and rehabilitating these athletes. As mentioned...

The breakdown of skeletal muscle cells, rhabdomyolysis, is often caused by physical exercise. The exact mechanism of muscle injury is poorly understood. When injured, muscle cells release enzymes into the bloodstream, which can be detected on laboratory examination. In most cases, the amount of breakdown is minimal and patients suffer no ill effect...

Younger athletes are participating in more activities today than ever before. The primary care physician needs to fulfill the role of guiding these athletes into their activities safely with recommendations to help prevent injuries and other health conditions that may occur during their training and participation. Knowledge covering preparticipatio...

Disability-related conditions such as bladder problems or pressure sores need not keep people from activity. Although active individuals with disabilities require some specialized management, they mainly need medical care for sports-related cuts, sprains, and strains. Physicians can help remove medical barriers to participation for active individua...

More than 20 million children between the ages of four and nineteen participate in organized sports in the U.S. today. That's a lot of sprains, spills, bumps, and strains. Dr. John Duff, an expert in sports medicine, details a complete program for treating injuries when they occur and tells when it is necessary to go to the doctor or hospital.

Exercise-induced asthma has long been associated with athletics. There continues to be a plethora of explanations concerning the etiology of this sometimes misunderstood syndrome. With the advocation of exercise for the asthmatic and additions to the pharmacologic armamentarium for treating this problem, there is a need to review and outline curren...

We have discussed the epidemiology of osteoarthritis as well as its physiology and pathophysiology. Most important, we have looked at exercise as a potential cause of this chronic disease and have offered information concerning the possibility of SROA. Finally, we have looked at exercise as a possible treatment and how it may become an intervention...

The number of primary care sports medicine fellowships increases each year. Presently, there is little information concerning the content of these programs. This article presents a profile of the injuries and illnesses seen in an 8-month period at one such fellowship program. This training program included a community-based clinic, a student health...

This study explores the possibility of estimating the severity of osteoarthritis in the elderly through magnetic resonance measurements of proton relaxation times in articular cartilage. Twenty-five paired samples were cut from eight cartilage specimens. The specimens had been taken in the normal course of knee surgery from patients aged 60 years o...

One aspect of the current drug-testing controversy that has gone relatively unexamined concerns the extent to which student-athletes are fully informed of the testing procedures employed by their institution. College athletes (N = 2,282) participating at 11 NCAA-affiliated institutions nationwide were surveyed as to their awareness of their school'...

Overuse injuries are caused by intrinsic and extrinsic factors. Exercise exposes even the most subtle anatomic imperfections and extrinsic influences. Overuse that is not musculoskeletal in nature and new information pertaining to the role of bursae are discussed. Treatment philosophy is approached with an emphasis on history taking.

The role of exercise in children and adolescents has been discussed, including consideration of conditioning and training guidelines for this age group. Training should be sport-specific, with any conditioning program specifically emphasizing the energy systems used by the particular sport. The effect of exercise on growth and development and subse...

In brief This investigation replicated a 1985 study of alcohol and drug use among college athletes. A written questionnaire was administered to 2,282 varsity athletes participating in five men's and five women's sports at 11 institutions. Fewer athletes reported using cocaine, marijuana, or amphetamines in 1989 than in 1985, but increases were repo...

There has been recent interest in the development of problem-based human genetics curricula in U.S. medical schools. The College of Human Medicine at Michigan State University has had a problem-based curriculum since 1974. The vertical integration of genetics within the problem-based curriculum, called "Track II," has recently been revised. On firs...

The unavailability of a team physician for contact/collision sports such as football can sometimes mean that an injured player will continue in a game. By doing so, the player may risk greater, perhaps even permanent disabling injury.

The importance of the preparticipation physical examination (PPPE) is highlighted because it constitutes one of the few occasions in which the physician can actively prevent sports injuries. An understanding of the goals and objectives of the PPPE is discussed. The need is not for a standard evaluation form, but rather for a consistent understandin...

In brief: With sports and exercise participation increasing, there is a growing need for physicians with training in sports medicine. At Michigan State University in East Lansing, several programs have been established to give physicians, residents, and medical students training opportunities in sports medicine. As part of the sports medicine progr...

Overuse injuries of the lower extremity represent a frequent, significant problem. This article discusses management of the most common overuse disorders: anterior tibialis strain, medial tibial stress syndrome, compartment syndrome, stress fractures, and Achilles tendinitis. These injuries often are the culmination of a process (repetitive stress)...

In brief: Teaching sports medicine to family practice residents as a formal clinical rotation is relatively new. However, there has been considerable activity in this important area. Educational objectives for family practice residents have been well defined. Less well defined are the community and institutional resources and relationships necessar...

Many of the injuries seen in the office setting are acute in nature. Generally, they are the common sprains, strains, fractures, and dislocations of various joints and soft tissues. Most are injuries of movement, and so the dynamics of the injury (biomechanics) become an important part of the history-taking. Most common acute injuries can be diagno...

In brief: Primary care physicians provide most of the sports medicine care rendered in the United States through their office practices and through their roles as team physicians for local schools. With appropriate training and experience, their breadth of medical expertise probably makes them the physicians most qualified to function as “sports ph...

Patellofemoral dysfunction is a common orthopedic condition. It can be successfully treated by primary care physicians who are familiar with the risk factors, clinical presentation, therapy, and indications for orthopedic referral. Use of a well-tested treatment program can help return most patients to normal function.

A group of experts met to discuss a case from the Cleveland Clinic Foundation. This case conference is part of a series featuring a variety of sports medicine topics.