Introduction Sports physiotherapists will regularly (I’m talking every day) rehabilitate knees that have undergone ACL reconstruction. As the vast majority of you will know, it is a common injury with a relatively long rehabilitation timeframe (generally 6 – 12 months depending on surgeon’s preference). This long rehabilitation and progression through to return to play (RTP) […]
What if I were to tell you that I was going to discuss the second most common foot injury in athletes, that is missed or misdiagnosed in 1 in every 5 cases? Is that something you might be interested in? Well that is what happening… Lisfranc joint injuries are a challenging presentation in an athletic population. As stated above, they are relatively common and regularly misdiagnosed. However, unfortunately they have the potential to develop into a CAREER-ENDING injury! Undoubtedly, this makes prompt and accurate diagnosis and evidence based management exceptionally important.
As sports physiotherapists we regularly assess and treat patients and athletes with shoulder instability. It has been suggested that glenohumeral instabllity affects up to 2% of the general population (Ahlgren et al., 1978). However, we know that posterior instability is much less common accounting for somewhere between 2 and 10% of these cases (Tannenbaum & Sekiya, 2011). The reason why it is important for use is that these presentations are most common in athletes, secondary to either overuse or a traumatic episode. This makes knowledge of evidence based management and diagnosis of posterior shoulder instability particularly pertinent.
Patellar dislocation accounts for 2 – 3% of all knee injuries, however, is the second most common cause of knee haemarthrosis (Aglietti et al., 2001). Patellar dislocation is most commonly associated with sports injuries, and therefore, is encountered commonly by the sports physiotherapist. In recent times there has been controversy on the most appropriate forms of management following primary (or first time) patellar dislocation. This post discusses evidence based management of primary patellar dislocations.
Cyclops lesions are an unfortunate sequelae of anterior cruciate ligament injury, and are most commonly seen following ACL reconstructions. The cyclops lesion is a consequence of a localised form of anterior arthrofibrosis. This results in the formation of a nodule of fibrous tissue in the anterior portion of the ACL graft (Tonin et al., 2001). The cyclops lesion sits in the anterior margin of the intercondylar notch, just above the tibial tunnel, which can become impinged between the tibia and femur upon knee extension (Bradley et al., 2000).
INTRODUCTION Mid-portion (or non-insertional) Achilles tendinopathy has been reported as one of the most common overuse injuries (Maffulli et al., 2003). It is common in those who engage in regular physical activity, which means athletes are particularly susceptible to this condition. Sports physiotherapists who treat regularly treat runners will be aware of its high incidence […]
Cervical radiculopathy is a pathology of the cervical nerve root (Dox et al 1979), frequently associated with cervical disc herniation or another space occupying lesion (such as osteophytes), which can cause nerve root impingement and inflammation. As many of you will be aware, this can be a very painful and often debilitating condition. Although the natural history of the condition is favourable, it has been suggested that if the condition becomes chronic it can be recurring and impact negatively on physical and mental health. Therefore, it is essential that as physiotherapists we are aware of the most evidence informed diagnosis and treatment techniques for cervical radiculopathy.
Acromioclavicular injuries are common in a variety of sports, particularly those which involve heavy contact or tackling. For example, Flik et al (2005) reported the incidence of AC injuries was the third most common in men’s ice hockey. Thus, this is a common injury. Whilst in many injury cases, such as acute presentations and the higher grade AC separations, the diagnosis can be quite obvious. However, many conditions of the shoulder present with very similar clinical presentations, and thus differential diagnosis can be challenging (Meyer et al 1990). Thus, this article examines the diagnostic accuracy for clinical examination tests for acromioclavicular joint pain.
When I say optimal shoulder function what do you think? My guess for many of you it is likely ‘rotator cuff function’ (yeah, for some it may be scapulohumeral rhythm). However, you would undoubtedly agree that optimal function of the rotator cuff musculature is essential in the successful rehabilitation of the majority of shoulder pathologies. It is common in clinical practice to utilise shoulder adduction movements to guide clinical decision making, particular in subacromial impingement syndrome patients. However, a recent EMG study has challenged the validity of both these assessment and treatment decisions.
How do you make a diagnosis? I assume that you perform a subjective examination and develop competing hypotheses, and then work to support or negate these via your objective examination. Can you, however, following your physical examination tell the patient the percentage chance of them having a particular diagnosis? Is that something you might be interested in? If your answer is a resounding yes, Bayes’ Theorem and a Fagan’s Nomogram can give you the ability to do so. This post will give you the easily implementable basics of using the Fagan’s Nomogram to improve your diagnostic accuracy!