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Introduction

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This is a wise maxim, “to take warning from others of what may be to your own advantage.”

Terence. Heautontimoroumenos, Act i. Sc. 2, 36 (210), circa 185 BC

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Not every patient who presents to the sports and exercise medicine clinician has a sports-related condition. Sports and exercise medicine has its share of conditions that must not be missed—“red flag” conditions that may appear at first to be rather benign. The patient with the minor “calf strain” may have a deep venous thrombosis; the young basketball player who has been labeled as having Osgood-Schlatter disease may actually have an osteosarcoma. In this chapter we:

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  • outline a clinical approach that should maximize your chances of recognizing a condition that is “masquerading” as a sports-related condition

  • describe some of these conditions and illustrate how they can present.

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How to recognize a condition masquerading as a sports injury

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As always, the key to recognizing that everything is not as the first impression might suggest is a thorough history and a detailed physical examination. If you do not recognize a masquerading condition from the history and examination, it is unlikely you will order the appropriate investigations to make the diagnosis. For example, if a patient presents with tibial pain and it is, in fact, due to hypercalcemia secondary to lung cancer, a bone scan of the tibia looking for stress fracture will usually not help with the diagnosis, but a history of weight loss, occasional hemoptysis, and associated abdominal pain may. In a basketball player with shoulder pain, the history of associated arm tightness and the physical finding of prominent superficial veins are more important clues to axillary vein thrombosis than would be a gray-scale ultrasound scan looking for rotator cuff tendinopathy.

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If there is something about the history and examination that does not fit the pattern of the common conditions, then consider alternative, less common conditions. You must ask yourself, “Could this be a rare condition or unusual manifestation?” Then other options are entertained, and the appropriate diagnosis can be conceived. Thus, successful diagnosis of masquerading conditions requires recognition of a discrepancy between the patient’s clinical features and the typical clinical pattern.

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Conditions masquerading as sports injuries

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Table 7.1 lists some of the conditions that may masquerade as sports and exercise medicine conditions. These are outlined below.

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Table 7.1

Conditions that may masquerade as sports and exercise medicine conditions

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