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Running injuries and how to prevent them: BJSM article (by Irene S. Davis et al.) featured in the NY-Times

13 Feb, 16 | by BJSM

 

Running is a low barrier activity with ongoing popular appeal. Running injury prevention is therefore an (unfortunately) important related area of study, with practical – day to day- training implications for many individuals. Therefore it is no surprise that Irene S. Davis et al.’s BJSM publication Greater vertical impact loading in female runners with medically diagnosed injuries: a prospective investigation” sparked public interest. The authors’ work was recently featured, by author Gretchen Reynolds, in The New York Times:

Athlete running at sunset on beach

“…Running injuries are extremely common, with some statistics estimating that as many as 90 percent of runners miss training time every year due to injury.

But the underlying cause of many of these injuries remains in question. Past studies and popular opinion have blamed increased mileage, excess body weight, over-striding, modern running shoes, going barefoot, weak hips, diet, and rough pavement or trails. But most often, studies have found that the best indicator of a future injury is a past one, which, frankly, is not a helpful conclusion for runners hoping not to get hurt.

So for the new study, which was published in December in the British Journal of Sports Medicine, researchers at Harvard Medical School and other universities decided to look at running injuries, one of the more obvious but surprisingly understudied aspects of running, and to focus their attention, in part, on those rare long-time runners who have never been hurt.

Specifically, they set out to look at pounding, or impact loading, which means the amount of force that we create when we strike the ground. Pounding is, of course, inevitable during a run. But runners with similar body types and running styles can experience wildly different amounts of impact loading, and it hasn’t been clear to what extent these differences directly contribute to injuries…

During that time, more than 100 of the runners reported sustaining an injury that was serious enough to require medical attention. Another 40 or so reported minor injuries, while the rest remained uninjured.

More remarkably, in the minds of the researchers, 21 of the runners not only did not become injured during the two-year study but also had not had a prior injury. They remained long-term running-injury virgins, the athletic equivalent of unicorns…

…The never-injured runners, as a group, landed far more lightly than those who had been seriously hurt, the scientists found, even when the researchers controlled for running mileage, body weight and other variables.

That finding refutes the widely held belief that a runner cannot land lightly on her heels.

“One of the runners we studied, a woman who has run multiple marathons and never been hurt, had some of the lowest rates of loading that we’ve ever seen,” said Irene Davis, a Harvard professor who led the study. She pounded far less than many runners who land near the front of their feet, Dr. Davis said. “When you watched her run, it was like seeing an insect running across water. It was beautiful…”

Read the full NY-Times article HERE

Congrats to ECOSEP, MuscleTech Network, and FC Barcelona – the 2015 cover competition winners!

12 Feb, 16 | by BJSM

December 49(24)Congratulations to all of the collaborators and supporters of the ECOSEP/FC Barcelona, December 2015 BJSM issue (#24) for winning the 2015 cover competition by a landslide (honorable runner up goes to Sports Physiotherapy New Zealand 49(issue #14) Strong debut performance!).

We had the pleasure of sharing the news with two of the major contributors: Nikos Malliaropoylos (founding member of ECOSEP), and Gil Rodas (FC Barcelona Doctor):

BJSM: Congratulations! How do you feel about winning “BJSM best cover” for 2015?

We are really impressed with this award. It’s a great example of team work between ECOSEP -MuscleTech -FC Barcelona and BJSM – a genuine collaboration between the scientific community and a football club. The front cover was the tip of the iceberg: a great global sport & exercise medicine event, in the biggest football stadium in Europe (capacity of 99,354 seats that hosted more than 400 international delegates). The stadium was a real feature of the conference of course as the podium was on the hallowed turf and our listners sat in the stadium seats. The big screen hosted the shots! Winning the Best Cover rewarded all our efforts to make this venture successful for the attendees.

BJSM: What in this 24th issue of 2015, stands out for you as exemplary work?

Not easy to answer this as there are so many good articles in this issue – which is usual for the BJSM now. The Exercise-induced leg pain in sport editorial is a very good update regarding this issue in sports. Exercise for osteoarthritis of the knee: a Cochrane systematic review and MRI, does not add value over and above patient history and clinical examination in predicting time to return to sport after acute hamstring injuries: A prospective cohort of 180 male athletes, are papers that can really affect practice and benefit patients who attend physiotherapists, doctors and other sports clinicians.

BJSM: In your opinion, where do we head from here?

FC Barcelona knows that a winning team always carries on maintaining the cornerstone partners. Muscle Tech and ECOSEP with BJSM support can add more value to Sports and Exercise Medicine both in Europe and globally. We are dedicated to this exciting field so let’s spread the word of the great evidence we have now and please look out for our conference in Barcelona, October 2016!

BJSM: Thanks Nikos and Gil! 

We will select and contact our 2 individual prize winners within the next two weeks. Stay tuned.

Improving the clinical practice for athletes and military service people with Exercise Induced Leg Pain: my path from MD to PhD

9 Feb, 16 | by BJSM

Sport and Exercise Medicine: The UK trainee perspective – A BJSM blog series

By Dr. Dave Roscoe

I am a Sport and Exercise Medicine (SEM) and Rehabilitation Medicine trainee currently posted at the Defence Medical Rehabilitation Centre (DMRC), Headley Court. I am also a qualified GP and have recently had the privilege of completing a PhD in SEM under the supervision of the University of Surrey (UoS) Department of Biomedical Engineering. I focused on the diagnosis and management of Exercise Induced Leg Pain (EILP) and Chronic Exertional Compartment Syndrome (CECS).

Before transferring to the Army in 2014, I spent most of my career as a Royal Navy Commando Medical Officer working alongside the Royal Marines (RM). EILP, in all of its guises: shin pain, anterior knee pain, stress fractures, CECS and to a lesser extent Popliteal Artery Entrapment, is a well-documented problem blighting careers in military populations. As part of the medical team at the Commando Training Centre, home of the longest and most arduous initial infantry-training programme in the world, we saw a high volume of these overuse lower limb injuries on a daily basis. Consequently, this is a topic I have been interested in for many years. I wanted to improve the overall clinical service that can be offered to athletes and servicemen with EILP by trying to clarify the nature of the underlying pathology in CECS and identify the risk factors that might predispose to the condition. I wanted to investigate the effectiveness of the different treatment modalities and try to define, once and for all, the criteria by which a diagnosis of CECS should be made.

legs

I first had to identify the most suitable host institution for this type of project so prior to commencing my PhD in 2012, I scoped several universities to establish which could provide the most relevant expertise and supervision. I decided on the UoS as it offered the perfect mix of research experience (UoS has one of the longest established biomechanics laboratories in the country), relevant ongoing research and quality of facilities with access to excellent academic supervision. I then had to successfully navigate the Defence Deanery Higher Degree Board, Ministry of Defence Ethics Committee and the UoS Higher Degree Panel. This required presenting a detailed background and rationale including assessments of potential clinical and financial benefits of both the work and myself. The whole application process took a year to complete after which I spent 3 years working in the gait laboratory at DMRC. I worked with a great team whilst learning a range of techniques including dynamic invasive intramuscular compartment pressure (IMCP) measurement, gait analysis with 3-dimensional kinematics, plantar pressure measurement and EMG as well as study design and statistical analysis. No mean feat for a mere GP!

All of these experiences informed my thesis, the abstract of which is below:

The Diagnosis and Management of Chronic Exertional Compartment Syndrome in the UK Military Population.

Background

CECS presents as EILP in the lower limb is presumed to be a result of elevated IMCP although this has never been proven. Doubt exists regarding the validity of the diagnostic criteria for CECS, the role of IMCP and the outcomes from surgical management[1]. An alternative biomechanical condition, Anterior Biomechanical Overload Syndrome (ABOS)[2], was proposed to account for the symptoms of CECS and a programme of gait re-education (GRE) was introduced although no primary research has been carried out to investigate the predisposing biomechanical and anthropometric factors for CECS or ABOS.

Methods

Case-control studies investigated the anthropometric, biomechanical and IMCP differences between CECS cases and asymptomatic controls. A post-surgical study evaluated the role of IMCP and a longitudinal study investigated the effectiveness of GRE and the nature of resultant biomechanical changes.

Results

Cases were significantly shorter than controls with specific biomechanical changes not akin to ABOS[3]. IMCP levels were significantly higher in cases than controls allowing for the extraction of diagnostic criteria for CECS[4]. Surgical responders had similar IMCP to controls but significantly lower than non-responders3. The biomechanical components of ABOS were not replicated. GRE made changes to gait but these did not correspond to those identified in the CECS case-control study3.

Conclusions

The intrinsic role of IMCP in CECS has been confirmed allowing for improved diagnostic criteria1. Use of these criteria should allow for improved patient selection for surgery and improved outcomes. Novel insights to the biomechanical and anthropometric differences are provided allowing for the proposal of a new pathophysiological model whereby extrinsic training conditions impact upon intrinsic risk factors leading to CECS. These studies do not support the existence of ABOS or the use of GRE in the management of CECS.

Having completed my thesis, I have had time to reflect. From the outset of the application process to getting completed works published4, a PhD is an endurance challenge like no other. At times, it can seem like a near impossible and ill-defined mountain to climb; along the way there are setbacks, false-summits and hidden crevasses to traverse. You must tread carefully and determinedly, breaking it down into smaller, more manageable questions but never lose sight of the overall goal. A PhD teaches skills in every professional domain not just the specific area of interest. Learning how to formulate and investigate research questions and critically interrogate evidence and data is as challenging as it is rewarding.

I have been very fortunate to lead research projects that have provided significantly improved and more accurate diagnostic criteria for CECS as well as delineating many previously unknown risk factors for the condition. We have analysed the different treatment options using the same criteria for success and used this to inform the commissioning of services. Our results have allowed us to be more certain in our selection of patients for intervention and to better identify those treatment modalities that offer a good chance of success. However, only time will show if this translates into a meaningful change in wider practices and clinical effect. Overall, I would recommend getting involved in research to all in SEM as I think there are a host of clinical domains that could benefit from well structured research and the casting of light into the dark places in order to further improve and standardise care for our athletes and populations.

 ********************************

David Roscoe is a Sport and Exercise Medicine (SEM) and Rehabilitation Medicine trainee currently posted at the Defence Medical Rehabilitation Centre (DMRC), Headley Court, Surrey.

Farrah Jawad is a Sport and Exercise Medicine registrar and co-ordinates the BJSM Trainee Perspective blog.

References

[1] Aweid et al., “Systematic Review and Recommendations for Intracompartmental Pressure Monitoring in Diagnosing Chronic Exertional Compartment Syndrome of the Leg.,” Clinical Journal of Sport Medicine : Official Journal of the Canadian Academy of Sport Medicine 22, no. 4 (July 2012): 356–70, doi:10.1097/JSM.0b013e3182580e1d.

[2] Andrew Franklyn-Miller et al., “Biomechanical Overload Syndrome: Defining a New Diagnosis,” British Journal of Sports Medicine 0, no. 2012 (September 14, 2012): 201209124, doi:10.1136/bjsports-2012-091241.

[3] Papers in submission.

[4] David Roscoe, Andrew J Roberts, and David Hulse, “Intramuscular Compartment Pressure Measurement in Chronic Exertional Compartment Syndrome: New and Improved Diagnostic Criteria.,” The American Journal of Sports Medicine 43, no. 2 (November 18, 2014): 392–98, doi:10.1177/0363546514555970. http://ajs.sagepub.com/content/early/2014/11/17/0363546514555970.abstract

Muscle Injury Virtual Conference: Summary of papers and podcasts that address key issues and debates

5 Feb, 16 | by BJSM

A monthly round-up of podcasts and articles

By Steffan Griffin (@lifestylemedic) &

Dr Markus Laupheimer (@swisssportscare)

Welcome to the first virtual conference of 2016, where we focus on an important yet polarising topic for all SEM practitioners– muscle injuries. There is a lot of discussion as to the best muscle injury classification to guide diagnosis and treatment. Below is a collection of BJSM papers and podcasts so you can decide which one you think is most useful!


muscle injuryAn Overview of muscle injury classification systems
http://bit.ly/23BCPwH

This paper provides a great overview and a good insight into the development of muscle injury classification systems. It also provides a framework from which to understand the historical progression of the classification and grading of muscle injuries and delve into the strengths and weaknesses of various systems.

Munich Consensus Statement

Inconsistent terminology among SEM practitioners led to the formulation of the Munich muscle injuries consensus statement, where some of the biggest names in sports medicine gathered to define and establish practical and systematic terms. In addition, a new comprehensive classification system was developed, which differentiates between four types… but you’ll have to read/listen to find out more!

PODCAST: The Munich muscle classification – Using it for more accurate diagnosis and treatment http://bit.ly/23BCrhT

Dr Peter Ueblacker is an internationally renowned orthopaedic surgeon and sports medicine doctor who had a long and very successful career with Bayern Munich from 2009 – 2015. He gives us an overview of the development of the Munich classification and how it is used in practice, with a particular focus on the spine.

PODCAST: Managing muscle injuries – Does the Munich Consensus Statement help? http://bit.ly/1Vz0qZ9

Grading of muscle injuries should have a big influence on time to return to sport but it’s not so easy! Babette Pluim asks Prof Gino Kerkhoffs how the Munich Consensus Statement of terminology and classification of muscle injuries in sport was developed. And what are the practical implications for clinicians?

PAPER: Terminology and classification of muscle injuries in sport – The Munich consensus statement http://bit.ly/23BDKxl #OpenAccess

Not convinced it works in practice? Ekstrand, Askling and others applied the classification to thigh muscle injuries in elite football and documented the results… http://bit.ly/23BDZbC

British Athletics Muscle Injury Classification

The British Athletics model, constructed by Noel Pollock and others, argue that commonly used muscle injury grading systems lack diagnostic accuracy and provide limited prognostic information to the clinician. Whilst there is recent evidence regarding the prognostic features of muscle injuries, this evidence has not often been incorporated into the grading proposals. The British Athletics Muscle Injury Classification proposes a new system, based on the available evidence, which they hope will provide a sound diagnostic base for therapeutic decision-making and prognostication.

PODCAST: Managing muscle injuries better – tips from Dr Noel Pollock http://bit.ly/23BCyd9

Dr Noel Pollock explains to Dr Markus Laupheimer how and why the Classification developed, as well as why the (older) Munich classification was not ideal. Listen for tips on how this classification adds something special and is of practical value for treating your athletes with muscle injuries.

PAPER: British athletics muscle injury classification: a new grading system http://bit.ly/1Vz0Y13

Again, the authors also put the system to the test in hamstring injuries, and found that time to return to full training is delayed and recurrence rate is higher in intratendinous (‘c’) acute hamstring injury – one of the grades that form the British Athletics classification system http://bit.ly/1Vz1ood

We hope you have found these articles and podcasts useful. If you have any thoughts on the issue, why not let us know on twitter (@BJSM_BMJ) or on Google+, we may even be able to set-up a forum with some of the experts.

FIFA launches new initiative to disseminate latest SEM knowledge and improve care for football players

3 Feb, 16 | by BJSM

Many sports medicine doctors and physios received the following email today. We share it further here. Read on…

fifa logoZurich, 02 February 2016
JDV/awe
FIFA Diploma in Football Medicine

(http://f-marc.com/footballdiploma/)

Dear friends and colleagues,
With the support of some of the most recognised international experts in sports medicine, FIFA is launching a new initiative to help disseminate the latest knowledge in sports science and improve care for football players around the globe. The “FIFA Diploma in Football Medicine” is a free online course, accessible to all and also designed to help clinicians learn how to diagnose and manage common football-related injuries and illnesses.
Each module is written by international experts in their respective fields, sharing written content, podcasts and video examinations as well as providing links to journal articles and other resources. High-profile players also share their experiences of injury and what they learned through recovery. For further information, check the diploma webpage.
The diploma acts as an easily accessible platform for disseminating the knowledge that the FIFA Medical Assessment and Research Centre (F-MARC) has gained over the past 22 years. For instance, by raising the awareness of the FIFA 11+ programme alone, we may be able to reduce the incidence of football-related injuries by up to 50 percent.
While the diploma is designed to be completed in its entirety, it can be used in a variety of ways. For example, participants might want to learn about one area in particular and complete a single lesson or module only. In completing the “FIFA Diploma in Football Medicine”, medical staff will improve the standard of care they provide to athletes all over the world.
It is an outstanding resource for all health practitioners involved in the care of football players. A unique, contemporary, comprehensive and superbly educational tool which should not be missed. Please pass on the word – education is key to prevention!
Should you have any questions, please do not hesitate to contact FIFA’s Medicine and Science Office (medical@fifa.org). We are at your disposal.

 

Yours faithfully,

jiri signature

 

 

 

FIFA
Prof Jiří Dvořák, MD
FIFA Chief Medical Officer

 

Football Medicine Strategies: Return to Play Conference, major value for both seasoned SEM pros and students

31 Jan, 16 | by BJSM

Undergraduate perspective on Sports & Exercise Medicine – a BJSM blog

By Sean Carmody (@seancarmody1)

When will they be able to get back playing?”

..That is the question that the medical staff of football clubs attempt to answer most days of their working lives. The question may come from coaches, journalists, agents, supporters, club owners and most importantly, the affected players themselves.

The theme of this year’s Football Medicine Strategies Conference  is centered on identifying the factors determining a footballer’s successful Return to Play following injury. As such, the conference will benefit sports medicine personnel who want to give more accurate responses to the perennial question regarding the readiness of a player to return to competition.

RTP

The Queen Elizabeth II Conference Centre in London will once again play host to the Conference on the 9th to 11th of April. Last year over 2000 delegates attended from all over the world, representing some of the most famous clubs and influential organisations in football. The Conference is set to grow once again in 2016, maintaining its position as one of the world’s leading sports medicine events.

What can we expect from this year’s conference?

Since its first international event in 1992, Isokinetic have developed a reputation for presenting innovative and cutting-edge research at their annual conferences. Dr Alicia Tomkinson, a Clinical Fellow in Sports Medicine, believes one of the strengths of the Conference is “the opportunity to gain a snapshot of how multidisciplinary management works in elite sport”. This was particularly true of 2015’s event which saw the medical departments of Europe’s top clubs; Bayern Munich, Real Madrid, AC Milan, Juventus, Chelsea and Arsenal, describe in detail how they organise their sports medicine provision. Ted Caplan, a fourth year medical student at Bristol University singled that stream out for praise; “It was extremely inspiring to hear and learn from some of the world leaders in sport and exercise medicine”. Another particular highlight from last year’s conference was the constructive debate that took place between clinicians and researchers on the use of PRP during the rehabilitation process.

Isokinetic’s commitment to innovation and pushing the boundaries is set to continue this year with the programme featuring topics such as the role of regenerative medicine in RTP and psychological considerations in RTP. The Science of Football Summit on the third day of the conference will focus on athletic development in youth footballers, an important, but often overlooked population. Once more, there are world class speakers scheduled for each day of the conference.

What will students gain from attending?

Students can often feel intimidated by conference programmes, deeming that they lack the requisite knowledge to participate fully in the occasion. This certainly isn’t the case with FMSC, where 27% of the delegates in 2015 were students.

One of the key factors that attracts undergraduates to the Conference is the ability to meet potential mentors, as Liam Newton, a recent graduate in physiotherapy reflected; “The most valuable aspect of the conference was to network with the biggest and best names in sports medicine. Everyone was extremely approachable and encouraging of students”. Dr Liam West, who founded the Undergraduate Sport and Exercise Medicine Society (USEMS), agreed with that sentiment,  and emphasised how a chance meeting at the Football Medicine Strategies Confrence “may help students take their first step into working within football medicine either on a medical elective or more permanent basis”. Additionally, Dr West cites the unique learning opportunities, stating “the educational programme is unrivalled in terms of expertise and breadth of topics”.

Student Discount

After the impressive undergraduate turnout at last year’s conference, USEMS have again teamed up with Isokinetic to provide a significant discount to students looking to attend. The discount includes both days (Saturday and Sunday) plus FREE Monday SUMMIT for £150 (instead of the full price of £390). To register at this discounted price email Alexia Sotiropoulou – a.sotiropoulou@isokinetic.com referencing ‘USEMS’.

To learn more about the conference and to register:

See you in London!

************************************************

Dr. Sean Carmody is a junior doctor working in the South Thames deanery. He has built on his passion for SEM and is now one of the key players in the Undergraduate movement in SEM alongside the advocating of physical activity education for students.

Dr. Liam West  (@Liam_West) coordinates the “Undergraduate Perspective on Sports & Exercise Medicine” Blog Series.

If you would like to contribute to the “Undergraduate Perspective on Sports & Exercise Medicine” Blog Series please email LIAMWESTSEM@HOTMAIL.CO.UK for further information.

February 10th Re-launch of hugely popular: BodyMatters, Massive Open Online Course

27 Jan, 16 | by BJSM

BodyMatters, Dr. Ian Shrier’s free Massive Open Online Course (MOOC) in Sport and Exercise Medicine is re-launching for the 2nd time on Feb 10, 2016 (registration open now).

Last year, over 30,000 students from 185 different countries participated. This relaunch provides an opportunity for those who were unable to see it the first time around. Based on past experiences of other MOOCs, Dr. Shrier expects to have 8-10,000 students in this session.

Extremelearningglobal

Image from: http://www.theguardian.com/education/

The MOOC is divided into three parts:

  1. Why physical activity is important,
  2.  How to train without getting injured, and;
  3. What to do if you do get injured.

The guest lecturer roster includes leading experts from around the world: Paul McCrory, Kerry Gordon, and Steven Blair, to name a few. Although many past students were from health and fitness industries, the content is accessible to a broad audience, and designed for the lay public.

Dr. Shrier has learned a lot himself, “I had never heard of physical literacy before [I listened to the talk by Patrice Aubertin], and the history of the anti-doping movement by Andrew Pipe was fascinating”.

The innovative format, along with guest lecturers that all have something unique to offer, is sure to make MOOC #2 a lot more valuable than the free registration suggests!

For more information and to register follow THIS LINK.

 

Parsonage-Turner Syndrome: A Case Study to illustrate the need for more SEM Departments within the NHS

25 Jan, 16 | by BJSM

Sport and Exercise Medicine: The UK trainee perspective – A BJSM blog series

By Robin ChatterjeeAbosede Ajayi, and Fey Probst

Email for correspondence: robin.chatterjee@imperial.nhs.uk

Competing interests: none declared

Introduction

Sports & Exercise Medicine (SEM) is a relatively new and sometimes misunderstood specialty. There is a general preconception that it is solely to do with the medical management of the elite sports person. It is however much more than that and has a vital role to play in the future of a cost-effective, streamlined NHS. There is a paucity of NHS SEM departments in the UK. This case is just one example of how the involvement of SEM physicians can improve the efficacy of patient management.

Case Report

A 44 year old male bus driver presented to the Soft Tissue Injury Management (STIM) Clinic at Charing Cross Hospital. This is a daily clinic, within the Emergency Department, where individuals with acute and chronic musculoskeletal ailments, acute soft tissue injuries or medical problems related to participation in physical activity, exercise or sport are seen by an SEM doctor.

The patient had a 2 year history of worsening acute intermittent left upper limb neuropathic pain with associated multifocal pareses. The pain initially occurred at the shoulder only, but over a period of months had started to radiate down the limb and cause weakness. The pain was not positional in nature but was worse at night and often awoke him when asleep. Each episode was self-limiting with pain ceasing after 2-3 weeks but then recurring again 3-4 months later. The severity of his symptoms had prevented him from working for several months. This consequently induced depression.

The patient had sought the advice of his GP several times and had also at various stages of his illness, had consultations with orthopaedic surgeons, physiotherapists, rheumatologists and a neurologist. He had had many blood tests, x-rays, an MRI scan of his shoulder and MRI brachial plexus, all of which were unremarkable.

When examined in STIM clinic, the patient had pain in the left shoulder and axilla with decreased sensation both in the regimental badge sign area and in the distribution of C6 and C7, together with difficulty in abducting the shoulder (grade 2/5). Ultrasonography of the shoulder was performed during the consultation which demonstrated wasting of the supraspinatus and deltoid muscles.

Nerve conduction studies were subsequently performed which confirmed the diagnosis of Parsonage-Turner Syndrome (PTS). The patient was then referred to an SEM Physician in the private sector for further management.

Overview of Parsonage-Turner Syndrome

PTS (also known as idiopathic brachial plexopathy, brachial neuritis or neuralgic amyotrophy) was first described in the Lancet in 19481 and is classically described as a sudden onset, episodic and acute unilateral shoulder girdle pain2 that may extend to the upper arm, forearm and the hand3 with night pain and associated neurological weakness, numbness, muscle atrophy and dysesthesia2.

It has both an idiopathic and autosomal dominant hereditary form4. The current hypothesis is that PTS is secondary to an underlying pre-disposition and a susceptibility to mechanical injury of the brachial plexus; the episodes are then caused by an immune-mediated response to the brachial plexus 4, 5.

PTS affects men more than women6 and most patients present between the ages of 30 and 60 years7 though it has been reported from 3 months to 75 years8. It has an overall reported incidence of 1.64 cases per 100,000 people9.

Once preliminary tests such as MRI scan have ruled out alternate pathologies that may be causing the symptoms, electromyography (EMG) and nerve conduction studies (NCS) are the investigations of choice that can positively support the diagnosis of PTS10, 11.

Treatment is composed of pain management, physical therapy and rehabilitation.

PTS has a good prognosis with 80% of patients functionally recovering within 2 years and 90% recovering within 3 years12. The rate of recurrence in the idiopathic form is 5-26% and 75% in the inherited form13. 

Conclusion

In theory the delivery of services and teaching of sport and exercise medicine has been a key concept of the medical profession in the UK since 1912. In practice, only since the formation of the Faculty of Sport & Exercise Medicine (FSEM) in 2006 has a formal SEM training programme been established and NHS SEM departments encouraged14, 15. In light of the specialty being in its infancy, there remains a dearth of SEM clinics available in the public health system. With an ageing, progressively overweight and ever-increasing population, chronic non-operative musculoskeletal morbidity is becoming more and more prevalent. SEM can and should become an integral cog in the wheel of health service delivery in the modern British population were more departments and clinics to become available. The case discussed in this report is one of many examples where early consultation with an SEM specialist can lead to a ‘one-stop-shop’ service where the patient is reviewed in a holistic manner, a diagnosis is reached in a shorter time frame and where unwarranted investigations are avoided. The unique nature of SEM training allows the specialist to have an insight into orthopaedics and rheumatology as well as emergency medicine, public health and exercise physiology too. The end result of this is a two-fold effect of improved efficiency of service delivered to the patient and also reduction of cost within the NHS. The former is achieved, as the SEM physician is skilled in diagnostic techniques such as ultrasonography, interventional procedures such as nerve root blocks and long-term management in the form of exercise prescription and psychological therapies. The NHS can benefit financially as an SEM physician can provide expert triage of both GP and A&E musculoskeletal referrals and thus reduce inappropriate referral to surgical specialties and instead utilise alternate services such as physiotherapy or podiatry.

Although PTS is a rare disorder, there are many common ailments such as atraumatic chronic low back pain, plantar fasciitis, chronic groin pain and obesity, where early consultation with an SEM physician can result in improved patient management (by achieving an early diagnosis and formulation of a definitive management plan) and therefore a reduction in subsequent visits to other healthcare professionals. Ultimately this will result in efficient healthcare management of the individual as well as being cost effective for the NHS as a whole.

References

  1. Parsonage MJ, Turner JWA. The Shoulder Girdle Syndrome. Lancet. 1948 Jun 26; 1 (6513): 973-978
  2. Feinberg JH, Radecki J. Parsonage-Turner syndrome. HSS J. 2010 Sep; 6(2): 199-205
  3. Crooks RJ, Jones DA, Fiddian AP. Zoster-associated chronic pain: an overview of clinical trials associated with acyclovir. Scand J Infect Dis Suppl. 1991; 80: 62-68
  4. van Alfen N, van Engelen BGM, Hughes RAC. Treatment for idiopathic and hereditary neuralgic amyotrophy (brachial neuritis). Cochrane Database Syst Rev. 2009 Jul 8; (3): CD006976
  5. van Alfen N. clinical and pathophysiological concepts of neuralgic amyotrophy. Nat Rev Neurol. 2011 May 10; 7(6): 315-22
  6. Aymond JK, Goldner JL, Hardaker WT. Neuralgic Amyotrophy. Orthop Rev. 1989 dec; 18(12): 1275-9
  7. Darby MJ, Wass AR, Fodden DI. Neuralgic amyotrophy presenting to an accident and emergency department. J Accid Emerg Med. 1997 Jan; 14(1): 41-3
  8. Cumming WJK, Thrush DC, Kenwood DH. Bilateral neuralgic amyotrophy complicating Weil’s disease. Postgrad Med J. 1978 Oct; 54 (636): 680-1
  9. Beghi E, Kurland LT, Mulder DW, Nicolosi A. Brachial plexus neuropathy in the population of Rochester, Minnesota, 1970-1981. Ann Neurol. 1985 Sep; 18 (3): 320-323
  10. Suarez GA. Immune brachial plexus neuropathy. In: Dyck PJ, Thomas PK, (eds). Peripheral neuropathy. Elsevier Saunders, Philadelphia. 2299-2308
  11. van Elfen N. The neuralgic amyotrophy consultation. J Neurol. 2007 Jun; 254 (6): 695- 704
  12. Conway RR. Neuralgic amyotrophy: uncommon but not rare. Mo Med. 2008 Mar-Apr; 105 (2): 168-9
  13. van Alfen N, van Engelen BG. The clinical spectrum of neuralgic amyotrophy in 246 cases. Brain. 2006 Feb; 129 (Pt. 2): 438-50
  14. McLatchie GR. Sport and exercise medicine- the state of play. Scott Med J. 2010; 55(2): 3-4
  15. Chatterjee R. A lasting legacy: clinical commissioning groups and sport medicine. Br J Gen Pract. 2014 Mar; 64(620): 141

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Robin Chatterjee is a Specialist Registrar in Sports & Exercise Medicine at Charing Cross & Hammersmith Hospitals and also a General Practitioner with a Special Interest in Sports & Exercise Medicine. With a background in anaesthetics he has practised in an eclectic range of fields including Altitude & Hyperbaric medicine, Intensive Care in the Australian Outback, being a trauma physician in Thailand during the 2008 uprising, as well elite sporting events such as the Virgin London Marathon and Dextro Energy ITU Triathlon World Championship Finals.

Dr Abosede Ajayi, known as GB, is an Emergency Medicine Consultant at Charing Cross Hospital, London with a passion for sport and in particular rugby. She is an experienced Sports Physician having worked in international sport for over a decade with a wide array of sports & teams including Chelsea FC Academy, London Harlequins and latterly as Chief Medical Officer to British Diving & Great Britain Wheelchair Rugby. When not next to a rugby pitch or diving pool, in what remains of her spare time, she enjoys listening to, writing & singing gospel music.

Dr Probst trained at St. Mary’s Hospital in Paddington. She undertook rotations in Surgery, Medicine and Emergency Medicine prior to becoming an Emergency Department consultant. She is a BASICS doctor and has been a doctor at several prehospital and sporting events, including Tough Mudder, the London Marathon and triathlons both mass participation and elite. She is best known for a MacGyver approach to life, carrying with her anything which might be needed for any conceivable opportunity.

Dr Farrah Jawad coordinates the BJSM Trainee Perspective blog.

Vote now for your chance to win: BJSM cover competition grand finale

21 Jan, 16 | by BJSM

Welcome to our final round in the 2015 BJSM cover competition, where the winners from each preliminary round compete for ‘Top cover of 2015’. Beyond the excitement of reviewing our favourite issues, you can enter in a draw for a chance to win one of two prizes. We also feature the winners on the BJSM blog. Voting closes midday Friday 29th London time.

Here are this year’s prizes:

  1. Be entered in a draw for FREE REGISTRATION to the ‘Return to Play’ Football Medicine Strategies Conference, London, April 9-11 2016 (£590 / £350 cash value, educational value: priceless). You have a 1 in 10 chance of winning!

OR

  1.  A sports medicine/sports physio textbook of your choice to a price not exceeding Grieve’s Modern Musculoskeletal Physiotherapy (4th edition, 2015).

Simple!! Here’s how to qualify for the prize:

1. Vote below for your favourite BJSM 2015 cover.

2. Include your email address for us to contact you if you win – we delete them all after the competition. Your email will not be used for list serve or promotional purposes.

3. Tweet this blog post: mention @BJSM_BMJ and hashtag #BJSMBestCover

AND/OR

4. Like our Facebook page, like the link to this blog, share the link on your own Facebook wall, and hashtag #BJSMBestCover

If you share this post on both Twitter and Facebook you double your chances of winning. But just one prize per person. Fast, fun, and the rewards are big!

2015 covers finalists:

 

49.4

49 (4) Physical activity issue (thanks Professors Trost & Blair)

BJSM Journal Cover

49 (6): Road to Recovery: Return to Sport (#RTP2015) (aka, “Time Travel”)

 

July 49 (14)

July 49 (14) @SportsPhysioNZ

October 49 (19)

October 49 (19) – @YLMSportsScience infographic

 

December 49 (24)

December 49 (24) ECOSEP and FC Barcelona

Recap

49 (4): Physical Activity Issue with Profs Trost & Blair

49 (6): Road to Recovery: Return to Sport (#RTP2015)

49 (14): Sports Physiotherapy New Zealand (@SportsPhysioNZ)

49 (19): Shoe surface interaction & injury risk (ACSP, @ACSP_SportsDocs)

49 (24): 8th MuscleTech Network Workshop (@ECOSEPinfo)

VOTE NOW!

Top 3 most popular BJSM podcasts of ALL TIME

18 Jan, 16 | by BJSM

The year in BJSM podcasts is off to a good start. “Knowledge translation in sports physiotherapy: moving research into practical use” (with Dr Michael Skovdal Rathleff, Dr Dylan Morrissey and Dr. Christian Barton) had 1000 listens in just 24 hours.

We have lots more to look forward to in 2016. Stay tuned – new podcasts will be posted every Friday. Only time will tell if any of these will beat the ‘reigning champions’ of the most popular podcasts of all time:

podcast listening

  1. Diagnosing and treating acute hamstring injuries

This is a podcast by Dr Robert-Jan de Vos, sports physician in the Erasmus Medical Centre in the Netherlands, with Guustaaf Reurink, who is a registrar in Sports Medicine in the Netherlands and is currently finishing his thesis on diagnosis and treatment of acute hamstring injuries. Recently, he published a paper in the New England Journal of Medicine about the role of Platelet-rich Plasma (PRP) treatment for acute hamstring injuries (www.nejm.org/doi/full/10.1056/NEJMc1402340).

We start with discussing this interesting study, which did not show a benefit of PRP injections in acute hamstring injuries. Dr Reurink expresses the methods and results of this study and possible explanations for these findings are debated.

Dr Reurink also performed a number of studies on the value of clinical tests and Magnetic Resonance Imaging (MRI) in acute hamstring injuries. Previously, he already showed that most MRIs are still abnormal when the athlete already returned to gameplay (bjsm.bmj.com/content/early/2013…92450.abstract?eaf).

We close by discussing the role of MRI and standardised clinical tests as a predictor of time to return to play and re-injury.

  1. Professor Peter O’Sullivan (@PeteOSullivanPT) on Tiger Woods’ back and ‘core strength’

Peter O’Sullivan has two recent BJSM podcasts (see below). In this podcast he shares his thoughts on the recent media attention around Tiger Woods’ obvious back pain while playing in the US PGA.

He discusses what the pathology might be, why the media suggested that Mr Woods’ ‘sacrum went out’. He contends that ‘core strengthening’ may not be the panacea.

The lessons apply to the management of low back pain, and other pain, in a myriad of settings.

See also
Read Professor O’Sullivan’s blog on Tiger Wood’s back pain: bit.ly/1zaISGz

Listen to his podcast on lower back pain: goo.gl/jrQxSe

Listen to his podcast on overtreatment and overdiagnosis in sports medicine: goo.gl/vPZ3g8

  1. Dr Alison Grimaldi with practical physiotherapy tips on treating lateral hip pain

With over twenty years’ experience, accreditation in Sports Physiotherapy, and a recent PhD in the topic of lateral hip pain, Alison Grimaldi (@AlisonGrimaldi) was invited to this podcast by BJSM’s Twitter community.

She is a popular conference speaker internationally. Here she walks you through each step of the assessment and treatment of an older patient with right hip pain. She then shares how to assess and treat a younger sportsperson.

In both cases, Dr Grimaldi emphasizes that compression is bad for tendons that run over bony prominences (trochanter in this case) and indicates how this can be addressed.

Enjoy one of our most practical podcasts. Recorded at the Physiotherapy New Zealand Conference, Auckland (September 2014) with thanks to the NZ Sports Physiotherapy Interest Group (@SportsPhysioNZ).

Links:
1) JL Cook, C Purdam Is compressive load a factor in the development of tendinopathy? Br J Sports Med 46(3):163-8. 2012 bjsm.bmj.com/content/46/3/163.abstract

2) Fearon A, Stephens S, Cook J, et al. The relationship of femoral neck shaft angle and adiposity to greater trochanteric pain syndrome in women. A case control morphology and anthropometric study. Br J Sports Med. 2012 bjsm.bmj.com/content/46/12/888.long

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