Diagnostic Accuracy of Musculoskeletal Ultrasound on Long Head Biceps Tendon Pathologies.

Clinical Scenario: Pathologies of the long head of the biceps brachii (LHB) tendon are a source of shoulder pain in many people. It is important to have a reliable assessment of the LHB tendon to make an accurate diagnosis and provide the correct treatment or referral if necessary. Shoulder ultrasound is very accurate in the diagnosis of rotator cuff tears. However, its ability to detect pathologies of the LHB tendon is still unclear. Clinical Question: In patients with shoulder pain, can musculoskeletal ultrasound accurately diagnose LHB tendon pathologies? Summary of Key Findings: Four high-quality cohort studies met inclusion criteria and were included in the critical appraisal. The STrengthening the Reporting of OBservational studies in Epidemiology checklist was used to score the articles on methodology and consistency. Three studies evaluated accuracy in diagnosis of full-thickness tears and found high sensitivity (SN) and specificity (SP). Three studies evaluated accuracy in diagnosis of partial-thickness tears and found low SN and negative predictive value, but high SP and positive predictive value. Two studies evaluated tendon subluxation/dislocation and found high SN and SP. Two studies evaluated tendinitis and found moderate SN and high SP. Clinical Bottom Line: There is moderate to strong evidence to support the use of musculoskeletal ultrasound in diagnosis of LHB tendon pathology. Strength of Recommendation: There is grade B evidence that musculoskeletal ultrasound can accurately diagnose full-thickness tears and tendon subluxation/dislocation; can rule in partial-thickness tears (based on SP and positive predictive value), but not rule out partial-thickness tears; and can rule in tendinitis (based on SP and positive predictive value), but not rule out tendinitis.

Fourth cranial nerve palsy in a collegiate lacrosse player: a case report.

OBJECTIVE: To present the case of a National Collegiate Athletic Association Division I men's lacrosse athlete with fourth cranial nerve injury as the result of a minor traumatic blow. BACKGROUND: The athlete was struck on the right side of his head during a lacrosse game. On-field evaluation revealed no cervical spine involvement or loss of consciousness. He complained of headache and dizziness, with delayed reports of visual disturbance. Sideline visual acuity and cranial nerve screenings appeared within normal limits. Consultation with the team physician indicated that immediate referral to the emergency department was unnecessary. DIFFERENTIAL DIAGNOSIS: Concussion, third cranial nerve palsy, fourth cranial nerve palsy. TREATMENT: The certified athletic trainer safely removed the athlete from the playing field and monitored him on the sideline. After being seen by the team physician, the patient was referred to a neurologist, ophthalmologist, and finally a neuro-ophthalmologist before a definitive diagnosis was made. The palsy did not necessitate surgical intervention, resolving with conservative treatment. The athlete was able to return to full athletic ability at his preinjury level by 8 months postinjury. UNIQUENESS: Superior oblique palsy as the result of fourth cranial nerve injury is the most frequent isolated cranial nerve palsy; however, these palsies are often underdiagnosed by health professionals. Such palsies are uncommon within the athletic realm, making timely diagnosis even less likely. CONCLUSIONS: Cranial nerve palsy may present very subtly in patients. Therefore, on-field health care providers should be aware of the descriptions and types of compensations that signal nerve injury.

Immediate post-concussion assessment and cognitive testing (ImPACT) practices of sports medicine professionals.

CONTEXT: Computerized neurocognitive testing is becoming popular among clinicians evaluating sport-related concussions across all levels of sport. Baseline neurocognitive testing has been recommended to provide more accurate representation of the preconcussion cognitive status of individual athletes. However, little is known about the use of baseline neurocognitive testing in concussion assessment and management. OBJECTIVE: To examine implementation and practice trends of sports medicine professionals using baseline neurocognitive testing at the high school and collegiate levels. DESIGN: Quantitative survey research. SETTING: Online survey. PATIENTS OR OTHER PARTICIPANTS: Certified athletic trainers (ATs) from approximately 1209 US institutions listed on the ImPACT Web site were recruited. A total of 399 ATs completed the survey, for a response return rate of 32.7%. MAIN OUTCOME MEASURE(S): Survey questions addressed educational level, years of certification, employment setting, percentage of athletes baseline tested, and accuracy of baseline tests. Other items addressed postconcussive neurocognitive testing protocols and scenarios for return-to-play decisions based on neurocognitive testing. RESULTS: Nearly all ATs (94.7%) administered baseline computerized neurocognitive testing to their athletes. However, only 51.9% examined these baseline tests for validity. The majority of ATs indicated that they administer baseline neurocognitive tests most frequently to football players (88.4%), followed by women's soccer players (78.8%) and men's soccer players (71.2%). Nearly all respondents (95.5%) stated that they would not return a symptomatic athlete to play if the athlete's neurocognitive scores were back to baseline. However, when asked if they would return an athlete who is symptom free but who scores below his or her baseline, 86.5% responded no, 9.8% responded yes, and 3.8% indicated that it depended on the importance of the competition. CONCLUSIONS: The use of baseline testing, baseline testing readministration, and postconcussion protocols among ATs is increasing. However, the ATs in this study reported that they relied more on symptoms than on neurocognitive test scores when making return-to-play decisions.

An evaluation of an educational intervention in psychology of injury for athletic training students.

CONTEXT: "Psychosocial Intervention and Referral" is 1 of the 12 content areas in athletic training education programs, but knowledge gained and skill usage after an educational intervention in this area have never been evaluated. OBJECTIVE: To evaluate the effectiveness of an educational intervention in increasing psychology-of-injury knowledge and skill usage in athletic training students (ATSs). DESIGN: Observational study. SETTING: An accredited athletic training education program at a large Midwestern university. PATIENTS OR OTHER PARTICIPANTS: Participants included 26 ATSs divided into 2 groups: intervention group (4 men, 7 women; age = 21.4 +/- 0.67 years, grade point average = 3.37) and control group (7 men, 8 women; age = 21.5 +/- 3.8 years, grade point average = 3.27). DATA COLLECTION AND ANALYSIS: All participants completed the Applied Sport Psychology for Athletic Trainers educational intervention. Psychology-of-injury knowledge tests and skill usage surveys were administered to all participants at the following intervals: baseline, intervention week 3, and intervention week 6. Retention tests were administered to intervention-group participants at 7 and 14 weeks after intervention. Analysis techniques included mixed-model analysis of variance (ANOVA) and repeated-measures ANOVA. RESULTS: The Applied Sport Psychology for Athletic Trainers educational intervention effectively increased psychology-of-injury knowledge (29-point increase from baseline to intervention week 6; F(2,23) = 29.358, P < .001, eta(p) (2) = 0.719) and skill usage (50-point increase from baseline to intervention week 6; F(2,23) = 5.999, P = .008, eta(p) (2) = 0.343) in undergraduate ATSs. These increases were maintained at the 7-week and 14-week retention testing (P < .001 for both). CONCLUSIONS: This first attempt at evaluating an educational intervention designed to improve ATSs' knowledge and skill usage revealed that the intervention was effective. Although both knowledge and skill usage scores decreased by the end of the retention period, the scores were still higher than baseline scores, indicating that the intervention was effective.

Current sport-related concussion teaching and clinical practices of sports medicine professionals.

CONTEXT: Various consensus and position statements recommend a multifaceted approach when diagnosing a possible concussion. The effectiveness of these materials depends largely on their content being disseminated to educators and to those in the clinical setting. OBJECTIVE: To identify the concussion management methods and guidelines currently taught in the athletic training classroom and clinical settings and to track the dissemination of the Vienna guidelines throughout the educational curriculum. DESIGN: A 17-question Internet survey. SETTING: A Web link was e-mailed to the program directors and certified athletic trainers holding educational positions in athletic training at 300 accredited programs in the United States. PATIENTS OR OTHER PARTICIPANTS: 513 program directors and athletic trainers. MAIN OUTCOME MEASURE(S): Survey questions addressed education level, years of certification, employment setting, concussion assessment and return-to-play guidelines used in the clinical setting and the classroom, and clinical and teaching preferences for existing position statements and concussion grading systems. The Vienna guidelines' "simple" and "complex" definitions of concussions were provided with the return-to-play stepwise approach. RESULTS: The National Athletic Trainers' Association position statement was the most widely used method of assessing, managing (61%), and making return-to-play decisions (47%) among participants. More than half of participants (66%) had never heard of the Vienna guidelines. After reading the Vienna guidelines' definitions and return-to-play criteria, nearly three-fourths of participants agreed with them. In addition, 68% said that they would use them, and 84% reported that they would teach them to students. CONCLUSIONS: The majority of program directors and certified athletic trainers used a multidimensional approach to assess and manage a concussion. The National Athletic Trainers' Association position statement and Vienna guidelines were underused in both the classroom and clinical settings.