Skip to Main Content

++

INTRODUCTION

++

Wherever the art of medicine is loved, there is also a love of humanity.

Hippocrates (c.460–370 BCE)

++

This chapter should be read in conjunction with Chapter 14. These chapters are very different from their fourth edition predecessors. In earlier editions of Clinical Sports Medicine, we argued for the importance of accurate pathological diagnosis. At times, this is realistic. A player falls on his or her wrist and sustains an acute scaphoid fracture. You can make a clinical diagnosis and confirm it with imaging. So far, so good. Accurate tissue diagnosis remains a foundation where appropriate.

++

In this fifth edition, we recognise that we previously overestimated the proportion of settings where accurate, very specific tissue diagnosis is possible. Consider patients who present with low back pain. Is the tissue diagnosis the facet joint, vertebra, fascia, muscle or disc? In these cases, can investigation, such as magnetic resonance imaging (MRI) provide the holy grail of tissue diagnosis? No, MRI cannot.

++

This chapter reinforces Chapter 14’s key message—the art of diagnosis takes place against a backdrop of patient-based probabilities. Honest teachers will explain that the clinician is narrowing the odds from the ‘pre-test probability’ to a new ‘post-test probability’. (See Likelihood ratios and Fagan’s Nomogram, Chapter 14.)

++

DOES ‘DIAGNOSIS’ MEAN ‘TISSUE DIAGNOSIS’?

++

Is there a difference between a diagnosis of: 1. ‘swimmer’s shoulder’; 2. ‘rotator cuff tendinopathy’; and 3. ‘shoulder pain related to training load errors and suboptimal biomechanics’? The first of these (‘swimmer’s shoulder’) represents a 1970s advance in sports medicine. Alongside labels such as tennis elbow, goalie’s elbow, hockey player’s groin and footballer’s ankle, ‘diagnosis’ consisted of the name of a sport paired with a commonly injured body part. This was an advance at the time, as many doctors were not aware of sports medicine conditions and sports physiotherapy had not yet emerged in many countries.

++

The major limitation of this type of label is lack of precision. Each of those labels (e.g. hockey groin) could apply to a number of pathological entities which may benefit from distinct treatment. Such labels have no place in 21st-century sports medicine.

++

What about ‘rotator cuff tendinopathy’? Is that a valid diagnosis? The fourth edition of Clinical Sports Medicine asserted that accurate pathological diagnosis was essential for the following reasons.

++

  • It enabled the clinician to explain the problem and the natural history of the condition to the athlete, who will want to know precisely for how long he or she will be affected. A patient may present with an acute knee injury but the diagnosis of anterior cruciate ligament (ACL) tear has markedly different implications to the diagnosis of minor meniscal injury.

  • It enabled optimum treatment. Numerous conditions have similar presentations but markedly different treatments. For example, consider the differences in treatment between: lateral ligament sprain ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

Clinical Sports Medicine Collection Full Site: One-Year Subscription

Connect to one of the most renowned references in sports medicine and explore all aspects of diagnosis and management of sports-related injuries and physical activity. Subscription includes access to a library of sports medicine videos.

$65 USD
Buy Now

Pay Per View: Timed Access to all of Clinical Sports Medicine Collection

48 Hour Subscription $34.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.