Outline of the SPIKE study
In volleyball, spiking is the act of scoring a point by slamming the ball over the net into the opposing court effectively. In this thesis, the first steps of elucidating the unexplored entity of Shoulder PCHA pathology and digital Ischemia in Known Elite volleyball players are made in order to provide an effective contribution to knowledge.
Hence the PhD thesis title: SPIKE the PCHA.
The thesis is divided into three parts: the first part covers symptomatology and associated risk factors, the second part focuses on imaging, and the third part concerns clinical management.
PART I – Symptomatology and associated risk factors
Chapter 2 describes which symptoms are most likely to be associated with PCHA pathology with distal embolization in volleyball players, and assesses the prevalence of these symptoms in the dominant limb among elite male indoor volleyball players in the Netherlands.
In Chapter 3 we assess which risk factors are associated with self-reported symptoms of digital ischemia among elite male indoor volleyball players in the Netherlands.
The test-retest reliability of the Shoulder PCHA pathology and digital Ischemia – Questionnaire (SPI-Q), which can be used for the detection of self-reported symptoms of digital ischemia in elite volleyball players, is determined in Chapter 4.
In Chapter 5 we assess the prevalence of self-reported symptoms of digital ischemia in the spiking hand, and associated risk factors, among international world-class beach volleyball players.
PART II – Imaging
In Chapter 6, we present a 4-step standardized vascular ultrasound (US) protocol for the assessment of the proximal PCHA: the SPI-US protocol (Shoulder PCHA pathology and digital Ischemia – UltraSound protocol).
The inter-observer reliability of the SPI-US protocol for the diameter assessment of proximal PCHA and DBA is assessed in Chapter 7.
In Chapter 8 the prevalence of PCHA aneurysms in the dominant shoulder of elite volleyball players is determined, and PCHA and DBA characteristics are described that can be used to accurately identify and assess the PCHA using the SPI-US protocol.
PART III – Clinical management
In Chapter 9 four risk profiles among elite volleyball players are presented based on the presence of US-detected PCHA pathology in the dominant shoulder, reporting of symptoms of digital ischemia in the spiking hand, and identified risk factors. Per profile, guidelines for clinical management are proposed to optimize care.
Chapter 10 describes the effect of conservative management for a PCHA aneurysm with symptomatic embolization in the spiking arm in a professional volleyball player with the use of novel Magnetic Resonance Angiography.