Source: The Vancouver Sun
Nearly a decade has passed since Lynne Robson’s first encounter with frozen shoulder. But she remembers in exquisite detail the limitations it imposed and the pain it caused her.
Frozen shoulder — also known as adhesive capsulitis — is a condition in which the capsule of connective tissue that encases the shoulder thickens and tightens around the joint. The process is extremely painful and results in a virtual immobilization of the joint, leaving the sufferer with an arm that barely functions. On average, about two-to-three per cent of people will develop frozen shoulder at some point in their lives, says orthopedic surgeon Dr. Stephen Thompson.
A positive painful arc test and a positive external rotation resistance test in a patient with shoulder pain has a high likelihood of being rotator cuff disease (RCD). And a positive lag test (external or internal rotation) likely means a full-thickness rotator cuff tear.
That’s according to a meta-analytic review of relevant studies. Dr. Job Hermans from Erasmus Medical Center, Rotterdam, the Netherlands and colleagues say they did the analysis to identify the most accurate clinical examination findings for RCD.
The studies they included involved patients referred to a specialist (orthopedist, rheumatologist, or sports medicine physician) for evaluation of shoulder pain. As a result, the prevalence of RCD was high – 33% to 81%, compared to a general population prevalence of 2.8% to 15%, they noted in JAMA August 28. Among five studies with level 1-2 quality scores, a positive painful arc test result was the only finding with a positive likelihood ratio (LR) greater than 2.0 for RCD (LR 3.7). A normal painful arc test result had the lowest negative LR (0.36).
Among strength tests, a positive external rotation lag test and internal rotation lag test had the highest positive LRs (7.2 and 5.6) for full-thickness tears.
With an LR of 3.3, a positive drop arm test result “might help identify patients with RCD,” the investigators say, whereas a normal internal rotation lag test result was most accurate for identifying patients without a full-thickness tear (LR 0.04).
There is a lack of data from primary care settings for findings that could be used to diagnose RCD among patients with shoulder pain,” Dr. Hermans and colleagues say.
And they caution, “Because specialists performed all the clinical maneuvers for RCD in each of the included studies with no finding evaluated in more than three studies, the generalizability of the results to a nonreferred population is unknown.”
Also, they say, it’s unclear whether examinations performed by generalist physicians would have the same results as those performed by specialists, because differences may be attributable to the skill of the examiner as well as to the patient populations. Yet, they believe the tests “could be mastered with practice by the generalist physician.”
“The approach we present of pain provocation tests, strength tests, and composite tests provides a framework for thinking about the physical examination findings and for interpreting the results,” the researchers conclude.
For a patient with shoulder pain, they suggest the physician could perform a single pain provocation test (painful arc test), three strength tests (internal rotation lag test, external rotation lag test, and drop arm test), and one composite test (external rotation resistance test).
Using the general population prevalence of RCD, which increases with age, the posterior probability of disease would be 9.6% (for patients older than 30 years) to more than 40% (for patients 70 years and older), the investigators say. Among patients referred to shoulder specialists, the presence of pain during the painful arc test confers a more than 60% probability of disease.
On the other hand, general medical patients with no pain during the painful arc test would have a low probability of RCD (1%-6%). Because of the high probability of disease among patients referred to shoulder specialists, the absence of pain during a painful arc test in a referred patient does not rule out RCD, because the probability could still be as high as 13%, the investigators say. They did not respond to request for comment by press time.
Source: PR Newswire
Breg Inc., a premier provider of sports medicine products and services, announced today the introduction of an innovative new T Scope® Hip Brace that delivers enhanced comfort, support and protection during post-operative hip rehabilitation. Hip arthroscopy is fast growing, with an estimated 70,000 procedures performed in the United States each year1. This new brace positions Breg to become a valued partner to medical professionals in this growing category.
American Academy of Orthopedic Surgeons issues list of unnecessary treatments. Knowing which medical treatments are needed and which aren’t plays an important role in personal wellness and in creating an efficient healthcare system. Now, individuals with arthritis and other difficulties getting around have a shortlist of procedures many of them can do without.
Athletes seeking a healthy performance weight should eat high fiber, low-fat food balanced with their training regimen in order to maintain muscle while still burning fat, according to a report by an Oregon State University researcher.
“Depending on the sport, athletes sometime want to either lose weight without losing lean tissue, or gain weight, mostly lean tissue,” she said. “This is very difficult to do if you restrict caloric intake too dramatically or try to lose the weight too fast. Doing that also means they don’t have the energy to exercise or they feel tired and put themselves at risk of injury.”
The incidence rate for stress fracture injuries among females was nearly three times greater when compared to males. Knee rotation and abduction angles when landing were both associated with the rates of lower-extremity stress fractures, as were reduced knee and hip flexion angles, and increased vertical and medial ground reaction forces.
“Lower extremity movement patterns and strength have previously been associated with stress fractures and overuse injuries; however, our study is one of the first to identify dynamic knee rotation and frontal plane angles as important prospective risk factors for lower extremity stress fractures.
UC Irvine researchers have demonstrated that basketballs and volleyballs can spread potentially dangerous germs among players. Their findings may bring a new awareness to athletes, coaches, trainers and parents regarding safe sanitation practices for athletes.
Staphylococcus aureus, a germ known for causing staph infections in athletes, was selected for the study. Methicillin-resistant Staphylococcus aureus, commonly referred to as MRSA, is a kind of staph that is particularly worrisome because of its resistance to many antibiotics. Athletes with MRSA infections often must endure emergency room visits, costly outpatient follow-ups, and time away from games and practice.
Source: The NY Times
Almost everyone who runs (or has shopped for running shoes) has heard that how your foot pronates, or rolls inward, as you land affects your injury risk. Pronate too much or too little, conventional wisdom tells us, and you’ll wind up hurt. But a provocative new study shows that this deeply entrenched belief is probably wrong and that there is still a great deal we don’t understand about pronation and why the foot rolls as it does.
“Vegetarian athletes can meet their dietary needs from predominantly or exclusively plant-based sources when a variety of these foods are consumed daily and energy intake is adequate,” Ghosh wrote in his presentation.
Vegetarians should find non-meat sources of iron, creatine, zinc, vitamin B12, vitamin D and calcium because the main sources of these typically are animal products and could be lacking in their diets. Vegetarian women, in particular, are at increased risk for non-anemic iron deficiency, which may limit endurance performance. In addition, vegetarians as a group have lower mean muscle creatine concentrations, which may affect high-level exercise performance.
A lot of hardcore runners have proper running form on the mind. Another concern they may have is foot posture. Does foot posture make a difference in staying injury-free?
A recent study found that runners with pronated feet, or feet that fall slightly inward towards the middle of the body, were less likely to get injured while running than people with other kinds of feet.