Scanning sports

The following information was presented in July at the Family Physician in Sports Medicine meeting in Minneapolis sponsored by the American Academy of Family Physicians.     

Scanning sports

Complex tests and procedures brief are not usually needed to identify shoulder injuries that are common in clinical practice: rotator cuff injuries, shoulder instability, and impingement syndrome, among others. The history can differentiate causes of pain or instability with questions about symptom patterns. Performing targeted physical tests such as the drop-arm test and the apprehension test establishes presence and degree of impingement or instability. A standard radiographic series that includes rotation, axillary, and supraspinatus outlet views can identify presence of associated fractures, calcification, and lesions.     

Wheelchair sports medicine

Wheelchair sports medicine involves the assessment of recreational and competitive sport capacities of physically disabled individuals, medical classification to allow fair competition among athletes with various types and degrees of disability, the prevention, diagnosis, and treatment of athletic injuries, and research into the biomechanics and physiology of wheelchair athletics. Involvement in wheelchair sports medicine activities increases professional awareness and provides a valuable referral source for organized sports activities.     

Acupuncture in sports medicine

Conclusions Acupuncture is a minimally invasive, relatively safe medical procedure that appears to have complex effects on the central and peripheral nervous system, immune system, and pain perception. Although acupuncture should not supplant the role of conventional therapies such as rehabilitation to treat these conditions, it is a useful adjunct to treat pain, which can inhibit muscular contraction, interfering with rehabilitation and athletic performance. It is also useful for treatment of chronic conditions that fail to respond to more conventional therapies. Although recent studies are of higher quality, problems remain in the design and interpretation of acupuncture research. Larger, better-controlled studies are needed to determine the effectiveness of acupuncture compared with more conventional treatments.     

Ethics in sports medicine

Physicians have struggled with the medical ramifications of athletic competition since ancient Greece, where rational medicine and organized athletics originated. Historically, the relationship between sport and medicine was adversarial because of conflicts between health and sport. However, modern sports medicine has emerged with the goal of improving performance and preventing injury, and the concept of the "team physician" has become an integral part of athletic culture. With this distinction come unique ethical challenges because the customary ethical norms for most forms of clinical practice, such as confidentiality and patient autonomy, cannot be translated easily into sports medicine. The particular areas of medical ethics that present unique challenges in sports medicine are informed consent, third parties, advertising, confidentiality, drug use, and innovative technology. Unfortunately, there is no widely accepted code of sports medicine ethics that adequately addresses these issues.     

Ultrasound in sports medicine

The accuracy of sonography in evaluating various conditions of the musculoskeletal system has been demonstrated and its utility as a primary diagnostic imaging modality in the musculoskeletal system in the United States has been increasing in frequency. Sonography is universally tolerated across a broad patient population, including pediatric and pregnant patients and those in whom traditional magnetic resonance (MR) imaging is not an option, due either to absolute or relative contraindications. Sonographic examinations are relatively quick compared with an MR or computed tomographic study, and delays in scheduling are therefore minimal, an advantage for those patients who have traveled a long distance or who are in a considerable amount of discomfort at the time of their visit to the orthopedic surgeon. With portable ultrasound units, examinations can be performed on the playing field, immediately at the time of the acute injury, for rapid diagnosis. Lastly, ultrasound can be used to guide for therapeutic procedures at the same time the diagnostic exam is performed.     

Reticulocytes in sports medicine

Reticulocytes are the transitional cells from erythroblasts to mature erythrocytes. Reticulocytes are present in blood for a period of 1-4 days and can be recognized by staining with supravital dyes, such as new methylene blue, or fluorescent markers, which couple residual nucleic acid molecules, a hallmark of the immature forms of erythrocytes. Although reticulocytes could be counted through a microscope (there is a standard of International Committee for Standardisation in Haematology for manual counting), this method is reported to be time consuming, inaccurate and imprecise. The integration of the reticulocyte count in automated haematology systems allowed the widespread use of these parameters, although the lack of calibration material and different markers, technologies and software used in automated systems could engender discrepancies among data obtained from different analytical systems.The importance of reticulocytes in sports medicine derives from their sensitivity, the highest among haematology parameters, in identifying the bone marrow stimulation, especially when recombinant human erythropoietin is fraudulently used. Automated systems are also able to supply information on volume, density and the haemoglobin content of reticulocytes.Some of the related parameters are also used in algorithms for identifying abnormal stimulation of bone marrow as reticulocytes haematocrit. The pre-analytical variability of reticulocytes (transportation, storage, biological variability) should be taken into account in sports medicine also. Reticulocytes remain stable for almost 24 hours at 4 degrees C from blood drawing, they are affected by transportation, and biological variability is not high in general. It could be remarked, however, that the intra-individual variability is high when compared with other haematological parameters such as haemoglobin and haematocrit. The intervals of data reported in athletes are very similar to reference intervals characterizing the general population.The reticulocyte count shows some modifications after training and during the competition season. The variability induced by exercise cannot be overlooked since the so-called haematological passport, a personal athlete's document in which haemoglobin and other parameters are registered, may be introduced by sports federations. Exposure to naturally high altitude and 'living high-training low' programmes determined contentious results on reticulocytes. Simulated high altitude induced by intermittent hypobaric hypoxia does not modify reticulocytes, despite an increase in erythropoietin serum concentration. The variability among athletes competing in different sport disciplines is apparently limited. The knowledge of the behaviour of reticulocytes in training and competitions is crucial for defining their role in an antidoping control context. It is important for sport physicians and clinical pathologists to know the reticulocyte variability in the general population and in athletes, the pre-analytical warnings, the different methodologies for counting reticulocytes and the derived parameters automatically available, and, finally, the possible influence of training, competitions, type of sport and altitude.     

Misdiagnosis in sports medicine

With the increase in participation sports comes an increased prevalence of sports injuries. Injuries of the shoulder and knee present the sports medicine practitioner with the challenge of obtaining a proper diagnosis and providing appropriate treatment. Commonly misdiagnosed injuries to the shoulder and knee include anterior cruciate ligament injuries, patella subluxation/dislocation, and labral injuries. This article provides insight into obtaining a detailed history, performing a focused physical examination, and understanding the pathoanatomy of the affected joints in order to help avoid misdiagnosis of these complex injuries. These skills can aid practitioners to better meet the needs of the high school, college, professional, and recreational athlete.