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EFFECTIVENESS OF CORTICOSTEROID INJECTIONS COMPARED WITH PHYSIOTHERAPEUTIC INTERVENTIONS FOR LATERAL EPICONDYLITIS: A SYSTEMATIC REVIEW. Barr S, Cerisola FL, Blanchard V. Physiotherapy

2009:95:251–265.

The main databases were searched up to March 2009 for all English-language randomised controlled trials (RCTs) that included participants with a clinical diagnosis of lateral epicondylitis, in whom corticosteroid injections were compared with physiotherapeutic interventions, and in which at least one clinically relevant outcome measure was included. The data were extracted and analysed independently, and the PEDro scale was used to assess the methodological quality of each eligible study. Five RCTs were identified and included in the review. Four of them included the measurement of pain-free grip strength. Standardised mean differences (effect sizes) were calculated for this outcome measure and assessors’ ratings of severity at 3, 6, 12, 26 and 52 weeks were given for two of the RCTs. Large effect sizes were demonstrated in favour of corticosteroid injections at short-term follow-up compared with physiotherapeutic interventions. At intermediate- and long-term follow-up, medium to large effect sizes were demonstrated in favour of physiotherapeutic interventions compared with corticosteroid injections. However, at long-term follow-up, the analysis suggests that there is a small benefit of physiotherapeutic interventions compared with a “wait and see” policy.

sportEX comment As often happens in systematic reviews it is difficult to find a decent number of high- quality trials with comparable outcome measures, so these results should be treated with a degree of caution. The phrase “wait and see” is a euphemism for doing nothing. It seems that it is being used more and more in research as a control group. Is it really ethical for members of a health profession to not give treatments they are trained to give?

INCIDENCE, RISK, AND PROTECTIVE FACTORS OF MILD TRAUMATIC BRAIN INJURY IN A COHORT OF AUSTRALIAN NON- PROFESSIONAL MALE

RUGBY PLAYERS. Hollis SJ,

Stevenson MR et al. American Journal of Sports Medicine 2009;Sep 29 (e-Pub ahead of print).

This study examines what the authors consider to be an emerging public health issue in high-contact sports like rugby. It shows that non-professional rugby players have a high incidence of concussion and that players who had sustained a recent concussion prior to the rugby season were almost twice as likely to sustain a subsequent concussion during the rugby season.

sportEX comment There is little evidence about the long-term effects of concussion, which can occur in any contact sport – not just rugby. The reoccurrence rate mentioned here is a particular worry and all sports should have a protocol in place to minimise this risk.

A REVIEW OF 130 CONSECUTIVE MEDICAL NEGLIGENCE REPORTS. Gidwani S, Zaidi SMR, Bircher MD. Journal of Bone and Joint Surgery – British Volume 2009;91-

SPORTS ACTIVITIES AFTER LOWER LIMB OSTEOTOMY. GOUGOULIAS N, KHANNA A, MAFFULLI N. BRITISH MEDICAL BULLETIN 2009;91(1):111-121

A search of the main databases including Google Scholar© using the keywords “osteotomy and sports” produced 11 studies (all

for level IV evidence) of lower limb osteotomy. Of these, nine reported on high tibial osteotomies, one on periacetabular osteotomies, and one on distal tibial osteotomies. All studies generally agreed that post-operative participation in recreational sports is possible for most patients who were active in sports before their surgery. However, no patients were able to participate in competitive sports. There was some suggestion that intensive participation in sports after osteotomy may adversely affect outcome and may lead to failures requiring re-operation. Patients may be able to remain active in selected sports activities after a lower limb osteotomy for osteoarthritis, but more rapid progression of arthritis is a possibility.

sportEX comment A positive paper for this group of patients. If they did sport before the

operation, they should be able to participate afterwards, although not at a competitive level.

B(2):151–156.

This review examined 130 consecutive cases of alleged clinical negligence in which the senior author had been requested to act as an expert witness between 2004 and 2006. He received information on the outcome of 97 concluded cases from the relevant solicitors. None of the 97 cases proceeded to a court hearing; 55% of cases were abandoned by the claimants’ solicitors; and the remaining 45% were settled out of court. The cases were settled for sums ranging between £4,500 and £2.7 million (median settlement of £45,000). The cases settled out of court usually involved delays in treatment or diagnosis, or because of substandard surgical techniques.

sportEX comment Between this review and the paper on the dangers of medical students at the beginning of term, one wonders how safe it is to go into hospital at all!!

4 sportEX medicine 2010;43(Jan):4-6