Welcome to our November 2022 issue of the Clinical Journal of Sport Medicine.
We are pleased to close out the year by bringing you another bumper issue full of original research offerings and interesting content of relevance to practising sport and exercise medicine clinicians.
This issue kicks off with an Editorial by Wang and Colleagues on the topic of Post-COVID-19 Neurological Syndrome and Concussion, the authors drawing interesting parallels between neurological symptoms associated with COVID-19 and those well-known to practitioners in managing patients with concussion.
Although the etiologies and pathophysiologies of these syndromes are distinct, the authors argue that symptoms common to both conditions are similar in many respects, and that those caring for athletes with post-COVID-19 neurological syndromes may wish to adopt different approaches for returning their patients to training and play depending on symptomatology and length of symptoms. They propose a Sports COVID Neurologic Algorithm in order to assist clinicians with return to activity decision making for patients with post-covid-19 neurological symptoms. We would be interested to hear readers' views concerning this approach, and on the challenges you have faced in managing your patients with these conditions when they have occurred concurrently.
In a retrospective cohort study involving 524 patients, Hou and Colleagues investigate the factors associated with additional clinic visits in the treatment of sports-related concussion over a 3-year period amongst athletes presenting to a regional multidisciplinary sports concussion center.
Of 524 patients aged between 12 and 23 years, 236 were discharged to an athletic trainer following an initial clinic visit with 288 requiring additional appointments. Several associations were noted for those requiring additional clinic visits, including higher initial symptom scores, family history of psychiatric conditions and / or migraines, prior concussions, and younger age. Interestingly, a family history of psychiatric disorders was the most important predictor of further clinic visits amongst this cohort. The authors conclude that identifying these associations may help to influence concussion care pathways, assist in the management of patient and family expectations, and to optimise clinic visit attendances. Although it may be challenging to ask questions relating to family psychiatric history when seeing a patient for an initial consultation, perhaps this information should be requested more often. We'd be interested to hear your views.
Glenohumeral osteoarthritis (OA) offers several challenges when deciding on conservative treatment strategies. Kirschner and colleagues present a prospective, randomized-controlled trial of ultrasound-guided glenohumeral joint injections of leukocyte-poor platelet-rich plasma (LP-PRP) versus hyaluronic acid (HA) in the treatment of glenohumeral OA. Seventy patients over age=18 were recruited who had over 3 months' symptoms of pain failing conservative measures, together with transient relief of symptoms with an ultrasound-guided intra-articular injection of local anaesthetic, and confirmation of glenohumeral OA on imaging. A single injection of either LP-PRP or HA was used, and patients were followed-up for 12 months post-injection. Significant improvements in pain and function were observed with both treatments although there were no significant differences in outcomes between either patient groups, regardless of the severity of osteoarthritis. The authors concluded that further similar studies should investigate the effects of different PRP preparations, differing injection volumes, and should include a placebo group for comparison.
Creuze and Colleagues present a novel case series using botulinum toxin injections for the treatment of longstanding adductor-related groin pain (diagnosed according to Doha criteria). In a retrospective study with 50 subjects recruited over a 4 year period, Hip and Groin Outcome Score (HAGOS), pain scores (visual-analog scale assessment) and Blazina classification (symptom severity scores) were assessed at different time periods post-treatment up to one year (days 30, 90, 180 and 365). All patients underwent a period of rehabilitation with a physiotherapist from day 7 until their planned return to sport. Second injections were proposed at day 90, 180 and 365 in the event of recurrences or in thge event of no improvement in symptoms post-first injection. The Authors found that HAGOS scores improved at day 30 post-treatment, with improvements sustained at day 90, day 180 and day 365 compared with baseline). The authors recommend a prospective randomized-controlled study should be conducted to further investigate the role of botulinum toxin for treatment-resistant adductor-related groin pain.
Uddin and Colleagues report on the practice of rapid weight loss adopted by many combat athletes and the relationship of this strategy with concussion symptom recall. The incidence of concussion amongst combat athletes is understandably significant, and factors influencing the presentation of concussion symptomatology amongst these individuals are important to consider. In an online survey of 132 combat sport athletes, strong associations were identified between rapid weight loss symptomatology and concussion symptoms, highlighting the difficulties for clinicians in intrepreting concussion assessments when athletes are adopting rapid weight loss strategies. The authors recommend monitoring of hydration status when performing baseline and recovery neurocognitive testing amongst this athlete group.
Other interesting Original Research articles this issue include a study on the association of posterior ankle impingement syndrome clinical features with imaging findings in elite ballet dancers, a systematic review and meta-analysis of arthroscopic treatment for femoroacetabular impingement syndrome amongst adolescents, and a study of the incidence of concussion and time to return-to-play in the National Rugby League.
We bring you three General Review articles on the diagnostic accuracy of clinical tests and imaging examination for femoroacetabular impingement, selective signs of meniscus tears as visualized by magnetic resonance imaging, and a systematic review and meta-analysis on the effectiveness of whole-body vibration training on postural stability and lower limb strength during anterior cruciate ligament reconstruction rehabilitation.
We also present three Brief Reports, and three interesting Case Reports on subsartorius fascial plane hydrodissection for Hunter's Canal syndrome, endoscopic ischial tuberosity osteophyte resection for ischiofemoral impingement, and incidental os-odontoideum in an adolescent athlete with sports-related concussion.
Don't forget to check out CJSM on Instagram as well as on our other social media outlets including Twitter and Facebook, and don't forget to keep an eye on the CJSM Blog to keep up to date with what's going on in the world of Sports Medicine.
Also, it's always worthwhile checking out our CME articles on the Lippincott CME Connection website with new topics being added regularly, and don't forget to test your clinical reasoning skills with our clinical case studies, produced in association with AMSSM and AOASM and available for free on our website.
Hoping you enjoy our final issue of 2022, and wishing you in advance a very happy Christmas and New Year,
Christopher Hughes MBBS MSc