JOURNAL WATCH THE VALIDITY AND

ACCURACY OF CLINICAL TESTS USED TO DETECT LABRAL PATHOLOGY OF THE SHOULDER: A

SYSTEMATIC REVIEW. Munro

W. Healy R. Manual Therapy 8 November 2008

This review systematically evaluates the evidence for the accuracy of these tests with reference to study quality and key biases. Databases were searched to identify 15 studies evaluating 15 clinical tests for labral pathology against magnetic resonance imaging (MRI) or surgery. Results: Six accurate tests – biceps load I, biceps load II, internal rotation resistance, Crank, Kim and Jerk tests – were identified from high-quality single studies in selected populations. Subgroup analysis identified varying results of accuracy in the Crank test and the active compression (AC) test when evaluated in more than one study.

sportEX comment Labral tears frequently require repair

and physiotherapists need confidence in clinical tests used to detect labral pathology in order to identify this condition accurately. As is often the case with research, the authors draw the conclusion that further evaluation is needed before these tests can be used with confidence. There appears to be no definitive test that works every time, but a combination of tests might allow the tester to come to a conclusion with greater certainty.

THE EPIDEMIOLOGY OF ROCK-CLIMBING INJURIES. Jones G, Asghar A, Llewellyn DJ. British Journal of Sports Medicine 2008;42:773–778

A total of 201 active rock climbers (163 males, 38 females) aged 16–62 years were recruited at five outdoor and six indoor climbing venues in the UK. The climbers were asked to report on injuries requiring medical attention or withdrawal from participation for one day or longer. Results: Around 50% of climbers had sustained at least one injury in the past 12 months, causing a total of 275 distinct anatomical injuries. Twenty-one climbers (10%) had sustained acute climbing injuries as a result of a fall, 67 climbers (33%) had chronic overuse injuries, and 57 climbers (28%) had acute injuries caused by strenuous climbing moves. Dedicated climbers participating in different forms of rock climbing more often and at a higher level of technical difficulty may be more prone to injury, particularly overuse injuries of the finger and shoulder. The principal sources of treatment or advice sought by climbers were physiotherapists (18%), other climbers (14%) and doctors (11%).

sportEX comment This says a lot about rock climbers. The vast majority of injuries come from either the

climbers overextending themselves during the climb or from overuse, rather than falling off. The real eye-opener is that 14% of participants sought advice from their peers rather than medical professionals. There is a big market here for therapists.

THE USE OF MEDICATION AND NUTRITIONAL

SUPPLEMENTS DURING FIFA WORLD CUPS 2002 AND 2006.

Tscholl P, Junge A, Dvorak

J. British Journal of Sports Medicine 2008;42:725–730

Team physicians were asked to document all medication and nutritional supplements taken in the 72 hours before each match. A total of 2,944 team physicians’ reports were received. Results: A total of 10,384 substances were reported (1.8 substances/player/match); 4,450 (42.9%) of these were medicinal and 5,934 (57.1%) were nutritional supplements. The medications prescribed most frequently

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were non-steroidal anti-inflammatory agents. More than half of the players took these at least once during a tournament, and more than 10% of players (156/1472) took them before every match. b2-agonists were reported for 1.4% of participating players and inhaled corticosteroids for 1.6% of participating players. Injected corticosteroids were reported for 73 players.

sportEX comment This is a serious amount of

medications and supplements. The report describes it as “alarming”. The question is: are these substances taken for therapeutic reasons or as a ritual by players believing they will give them an edge? Is it time for the medical practitioners to say “No”?

sportEX medicine 2009;39(Jan):4-6