Special Diagnostic Procedures in Sports Medicine

Sports Diagnostics-Maximizing the Results or Preventing Injuries

Sports diagnostics is a comprehensive scientific concept and comprises an aspect of training monitoring and/or sports medicine [...].

Detection of acromioclavicular joint pathology in asymptomatic shoulders with magnetic resonance imaging

The purpose of this study was to determine the prevalence of acromioclavicular joint (ACJ) arthritis with magnetic resonance imaging (MRI) evaluation in asymptomatic patients. Fifty shoulders in 42 patients were evaluated with the use of standard MRI techniques. There were 18 men and 24 women with an average age of 35 years (range, 19 to 72). ACJ arthritic changes were graded on a scale from 1 to 4 (none, mild, moderate, and severe), based on the amount of subacromial fat effacement, joint space narrowing, irregularity, capsular distension, and osteophyte formation. Forty-one (82%) of 50 shoulders had abnormalities consistent with arthritis on MRI. Patients were divided into two groups according to age: those older than 30 years and those 30 years old or younger. In the 30-and-under age group, 68% of the shoulders had arthritic changes, whereas in the over-30 age group, 93% had arthritic changes. Furthermore, in a comparison of the two groups, more advanced arthritic changes were found in the over-30 age group (P <.05). Clinical decisions to resect the ACJ should correlate the physical examination with the MRI findings because many patients may be clinically asymptomatic.

The wrist of the formula 1 driver

OBJECTIVES

During formula 1 driving, repetitive cumulative trauma may provoke nerve disorders such as nerve compression syndrome as well as osteoligament injuries. A study based on interrogatory and clinical examination of 22 drivers was carried out during the 1998 formula 1 World Championship in order to better define the type and frequency of these lesions.

METHODS

The questions investigated nervous symptoms, such as paraesthesia and diminishment of sensitivity, and osteoligamentous symptoms, such as pain, specifying the localisation (ulnar side, dorsal aspect of the wrist, snuff box) and the effect of the wrist position on the intensity of the pain. Clinical examination was carried out bilaterally and symmetrically.

RESULTS

Fourteen of the 22 drivers reported symptoms. One suffered cramp in his hands at the end of each race and one described a typical forearm effort compartment syndrome. Six drivers had effort "osteoligamentous" symptoms: three scapholunate pain; one medial hypercompression of the wrist; two sequellae of a distal radius fracture. Seven reported nerve disorders: two effort carpal tunnel syndromes; one typical carpal tunnel syndrome; one effort cubital tunnel syndrome; three paraesthesia in all fingers at the end of a race, without any objective signs.

CONCLUSIONS

This appears to be the first report of upper extremity disorders in competition drivers. The use of a wrist pad to reduce the effects of vibration may help to prevent trauma to the wrist in formula 1 drivers.

The effect of shoulder magnetic resonance imaging on clinical decision making

One hundred cases were prospectively evaluated to determine the impact of magnetic resonance imaging on clinical decision making in an orthopaedic practice devoted to the treatment of disorders about the shoulder. Each was analyzed for changes in the clinical diagnosis or treatment. A change that either changed the primary diagnosis or type of treatment (operative versus nonoperative) was classified as category one. If additional clinically relevant findings were noted on the imaging studies without altering the primary diagnosis, or if the form of treatment was modified but not changed from operative or nonoperative, it was considered category two. Among the 100 imaging studies reviewed, category one and two changes were observed in 11 and 7 cases, respectively. Magnetic resonance imaging was particularly helpful in diagnosing ganglion cysts about the shoulder, a category one change in three out of three cases. For specific diagnoses a category one or two change was observed in 17% (10 of 59), 29% (4 of 14), 8% (1 of 13),and 100% (2 of 2) for rotator cuff disease, glenohumeral instability, adhesive capsulitis, and biceps disease, respectively. In 35 cases magnetic resonance imaging was considered to be unnecessary for the diagnosis or treatment of the patient. For the 65 patients who underwent magnetic resonance imaging, category one and two changes were noted in 10 and 5 patients, respectively. Statistical significance was demonstrated for category one changes in the entire group (100 cases) and the in subgroup recommended for magnetic resonance imaging (65 cases) (p < 0.05), indicating that the judicious use of magnetic resonance imaging can have a significant increase its impact on clinical decision making. Magnetic resonance imaging was found to be of limited diagnostic value in patients with an isolated primary clinical diagnosis of adhesive capsulitis, glenohumeral or acromioclavicular arthritis, brachial plexopathy, and cervical degenerative disk disease.