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Cirque du Soleil's "Mystere" was the focus of this epidemiological investigation into the nature and rate of injury occuffence in the members of the cast. Sixty-two athletes comprised the subject group involved inthe 12-month data collection period. Injury report forms and daily exposure sheets were used to collect data, and data was analyzed using the Microsoft Access relational database program. The rate of injury was found to be 531 injuries per 100 athletes, and 10 injuries per 1000 exposures. Females sustained a higher number of injuries (6.a) than the males (5.0) over the data collection period. The highest number of injuries per performner (6.2) was sustained in the trapeze act, while the lowest number of injuries per performer (2.4) was sustained in the Chinese poles act. Fifty-one percent of the injuries occurred during show performance, 9.7% were sustained during training, and 33 % occurred over a period of time (gradual onset). The act affected most by injury during show performance was the teeterboard act, followed by the trapeze act, while the act affected least by injury was the manipulation act. The body part affected most by acute injury was the ankle, followed by the low back, neck, shoulder, and the knee. The body part affected most by overuse injuries was the shoulder, followed by the low back, knee, lower leg and hip/buttock. The most common injury types were sprains, strains, tendinitis, and contusions respectively. The act that resulted in the highest number of injuries was the teeterboard act (101). Mechanism of injury was considered to be an important factor in analyzing the causes of injuries and suggesting preventative measures, despite the absence of a biomechanical analysis of the various aspects of the show. Insufficient warm-up, previous injury, and return to participation too soon following an injury were considered to be contributing factors associated with injury. Acute injuries were attributed to poor conditioning, poor biomechanical technique, lack of skill, fear of injury, lack of concentration while performing skills, equipment failure, poor communication between two performers, poor spotting, inadequate safety equipment, and interference from props or apparatus. Overuse injuries were attributed to increased training time, over-training, muscle imbalances, inflexibility, postural problems, poor skill biomechanics, previous injury, fatigue, effects from costumes, and effects from apparatus. Use of this database for ongoing tracking of injury and exposure data was determined to be helpful for injury projection/prediction, development of conditioning and rehabilitation programs that are activity specific, Establishment of the necessity of a full-time coaching staff, long term injury tracking, and screening athletes for potential employment. [author summary]

We report the case of a 28-year-old transgender (male-to-female) patient that had a partial tear of the rhomboid major tendon, scapulothoracic bursitis, and glenohumeral instability on the same side. These conditions resulted from traumatic events during circus acrobatic maneuvers. Additional aspects of this case that make it unique include (1) the main traumatic event occurred during a flagpole exercise, where the patient’s trunk was suspended horizontally while a vertical pole was grasped with both hands, (2) headaches were associated with the periscapular injury and they improved after scapulothoracic bursectomy and rhomboid tendon repair, (3) surgical correction was done during the same operation with an open anterior capsular-labral reconstruction, open scapulothoracic bursectomy without bone resection, and rhomboid tendon repair, (4) a postoperative complication of tearing of the serratus anterior and rhomboid muscle attachments with recurrent scapulothoracic pain occurred from patient noncompliance, and (5) the postoperative complication was surgically corrected and ultimately resulted in an excellent outcome at the one-year final follow-up.