Etiology of knee pain in elite cyclists: A 14-month consecutive case series.

Overuse injuries of the knee are a common cause of missed training and competition days in elite cyclists, however the underlying conditions causing this knee pain are not well defined. We conducted a diagnostic study, investigating a consecutive series of 53 high level cyclists with non-traumatic knee pain over a 14 month period. Demographic data on the participants' cycling specialty and training level was noted. Clinical information concerning knee pain intensity, location and occurrence were collected using a questionnaire. Our results show 7 different overuse injuries were identified. The prepatellar friction syndrome accounted for the majority of these overuse injuries (46%), while medial plica syndrome (15%), biceps femoris tendinopathy (7.5%), patellar tendinopathy (9.4%), infrapatellar plica friction syndrome (7.5%), infrapatellar fat pad impingement (5.7%) and iliotibial band syndrome (3.7%) were other causes of knee pain in these athletes. In contrast to current belief, our results show that instead of patellofemoral cartilage overload, friction related overuse injuries are the most frequent and underestimated cause of knee pain in high level cyclists.

Categorising sports injuries in epidemiological studies: the subsequent injury categorisation (SIC) model to address multiple, recurrent and exacerbation of injuries.

OBJECTIVE: Sports injuries are often recurrent and there is wide recognition that a subsequent injury (of either the same or a different type) can be strongly influenced by a previous injury. Correctly categorising subsequent injuries (multiple, recurrent, exacerbation or new) requires substantial clinical expertise, but there is also considerable value in combining this expertise with more objective statistical criteria. This paper presents a new model, the subsequent injury categorisation (SIC) model, for categorising subsequent sports injuries that takes into account the need to include both acute and overuse injuries and ten different dependency structures between injury types. METHODS: The suitability of the SIC model was demonstrated with date ordered sports injury data from a large injury database from community Australian football players over one playing season. A subsequent injury was defined to have occurred in the subset of players with two or more reported injuries. RESULTS: 282 players sustained 469 subsequent injuries of which 15.6% were coded to categories representing injuries that were directly related to previous index injuries. This demonstrates that players can sustain a number of injuries over one playing season. Many of these will be unrelated to previous injuries but subsequent injuries that are related to previous injury occurrences are not uncommon. CONCLUSION: The handling of subsequent sports injuries is a substantial challenge for the sports medicine field-both in terms of injury treatment and in epidemiological research to quantify them. Application of the SIC model allows for multiple different injury types and relationships within players, as well as different index injuries.

Discrepancies in clinical definitions of stress fractures: implications for the United States Army.

ABSTRACT In the United States Army initial entry training (IET) environment, stress fractures are common musculoskeletal injuries. Due to the repetitive physical demands placed on soldiers, stress fractures are particularly common in individuals matriculating through basic combat training (BCT) and advanced individual training (AIT). Within the Army medical department, the clinical definitions of stress fractures vary widely among providers who are directly responsible for diagnosing these injuries. The use of diversified definitions of stress fractures in patient evaluations, treatment, communication measures, and injury data collection negatively affect patient dispositions and soldier training outcomes. This report identifies discrepancies in clinical definitions of stress fractures and the implications for the Army regarding the lack of a standardized definition for stress fractures.

An update of the Japanese Oslo Sports Trauma Research Center questionnaires on overuse injuries and health problems.

Monitoring the health of athletes is important for their protection, and questionnaires such as those produced by the Oslo Sports Trauma Research Center (OSTRC) are a valuable tool in this process. In 2020, several changes were made to the OSTRC questionnaires (OSTRC-O, OSTRC-H), including changes to the wording, structure, and logic of the original questionnaires. In the present study, the Japanese versions of the OSTRC questionnaires (OSTRC-O.JP, OSTRC-H.JP) were revised to meet the requirements of the updated versions and to analyse new and previously collected data to illustrate the impact of the changes on Japanese athletes. Proposed changes were categorized as minor or more substantial; minor changes were effected to the questionnaire instructions and to the wording of all four questions, and more substantial changes were made to the wording of question 2. The updated questionnaires also included changes to questionnaire logic and answer categories. To assess the consequences of the changes to the wording of question 2, 101 athletes were asked to complete the OSTRC-H.JP, which included both the original and updated versions of question 2, over 10 consecutive weeks. We calculated the number of health problems identified when new gatekeeper logic was and was not applied, using 1585 OSTRC-H.JP responses to assess the consequences of the changes to the questionnaire logic. The kappa coefficient, which measures the level of agreement between the responses to question 2 of the original and updated versions, was high. By applying gatekeeper logic, there was a remarkable reduction in the number of injuries and illnesses among all health problems but less reduction in substantial health problems and time loss health problems. These changes will make it easier for Japanese athletes to complete the questionnaires and improve the quality of collected data.

Cluster analysis of symptoms among patients with upper extremity musculoskeletal disorders.

INTRODUCTION: Some musculoskeletal disorders of the upper extremity are not readily classified. The study objective was to determine if there were symptom patterns in self-identified repetitive strain injury (RSI) patients. METHODS: Members (n = 700) of the Dutch RSI Patients Association filled out a detailed symptom questionnaire. Factor analysis followed by cluster analysis grouped correlated symptoms. RESULTS: Eight clusters, based largely on symptom severity and quality were formulated. All but one cluster showed diffuse symptoms; the exception was characterized by bilateral symptoms of stiffness and aching pain in the shoulder/neck. CONCLUSIONS: Case definitions which localize upper extremity musculoskeletal disorders to a specific anatomical area may be incomplete. Future clustering studies should rely on both signs and symptoms. Data could be collected from health care providers prospectively to determine the possible prognostic value of the identified clusters with respect to natural history, chronicity, and return to work.

Rethinking Patellar Tendinopathy and Partial Patellar Tendon Tears: A Novel Classification System.

BACKGROUND: Patellar tendinopathy is an overuse injury of the patellar tendon frequently affecting athletes involved in jumping sports. The tendinopathy may progress to partial patellar tendon tears (PPTTs). Current classifications of patellar tendinopathy are based on symptoms and do not provide satisfactory evidence-based treatment guidelines. PURPOSE: To define the relationship between PPTT characteristics and treatment guidelines, as well as to develop a magnetic resonance imaging (MRI)-based classification system for partial patellar tendon injuries. STUDY DESIGN: Cohort study (prognosis); Level of evidence, 2. METHODS: MRI characteristics and clinical treatment outcomes were retrospectively reviewed for 85 patients with patellar tendinopathy, as well as 86 physically active control participants who underwent MRI of the knee for other conditions. A total of 56 patients had a PPTT and underwent further evaluation for tear size and location. The relationship between tear characteristics and clinical outcome was defined with use of statistical comparisons and univariate and logistic regression models. RESULTS: Of the 85 patients, 56 had partial-thickness patellar tendon tears. Of these tears, 91% involved the posterior and posteromedial regions of the proximal tendon. On axial MRI views, patients with a partial tear had a mean tendon thickness of 10 mm, as compared with 6.2 mm for those without (P < .001). Eleven patients underwent surgery for their partial-thickness tear. All of these patients had a tear >50% of tendon thickness (median thickness of tear, 10.3 mm) on axial views. Logistic regression showed that tendon thickness >8.8 mm correlated with the presence of a partial tear, while tendon thickness >11.45 mm and tear thickness >55.7% predicted surgical management. CONCLUSION: Partial-thickness tears are located posterior or posteromedially in the proximal patellar tendon. The most sensitive predictor for detecting the presence of a partial tear was patellar tendon thickness, in which thickness >8.8 mm was strongly correlated with a tear of the tendon. Tracking thickness changes on axial MRI may predict the effectiveness of nonoperative therapy: athletes with patellar tendon thickness >11.5 mm and/or >50% tear thickness on axial MRI were less likely to improve with nonoperative treatment. A novel proposed classification system for partial tears, the Popkin-Golman classification, can be used to guide treatment decisions for these patients.

Three Key Findings When Diagnosing Shoulder Multidirectional Instability: Patient Report of Instability, Hypermobility, and Specific Shoulder Tests.

Shoulder instability has varying mechanisms of injury, direction, and severity. Classification systems based on clustering signs and symptoms have been developed to define subgroups of shoulder instability. Despite this attempt at homogeneity, multidirectional instability (MDI) suffers from the same lack of diagnostic clarity as low back pain. In this Viewpoint, the authors outline 3 key areas to address when diagnosing MDI: patient interview, medical comorbidities, and specific shoulder tests and measures. J Orthop Sports Phys Ther 2020;50(2):52-54. doi:10.2519/jospt.2020.0602.

Using causal energy categories to report the distribution of injuries in an active population: An approach used by the U.S. Army.

OBJECTIVES: To describe the etiologic distribution of all injuries among U.S. Army Active Duty soldiers by causal energy categories. DESIGN: Retrospective cohort, descriptive analysis. METHODS: Injury was defined as the interruption of tissue function caused by an external energy transfer (mechanical, thermal, radiant, nuclear, chemical, or electrical energy). A comprehensive injury matrix standardized categories by causal energies, body locations, and injury types. Categories differentiated acute (ACT) from cumulative micro-traumatic (CMT) overuse injuries, and musculoskeletal injuries (MSKI) from those affecting other or multiple body systems (non-MSKI). International Classification of Diseases (ICD) diagnoses codes were organized into established categories. The matrix was applied to electronic health records for U.S. Army soldiers in 2017. RESULTS: Mechanical energy transfers caused most injuries (97%, n = 809,914): 76% were CMT overuse and the remaining were ACT (<21%). The majority (83%) were MSKI (71% CMT, 12% ACT). While almost one-half (47%) were to lower extremities (38% CMT, 9% ACT) the most frequently injured anatomical sites were the knee and lower back (16% each, primarily CMT). CONCLUSIONS: For the first time all soldiers' injuries have been presented in the same context for consistent comparisons. Findings confirm the vast majority of injuries in this physically-active population are MSKI, and most are CMT MSKI. A very small portion are non-MSKI or injuries caused by non-mechanical energy (e.g., heat- or cold-weather). Most Army injuries are to the lower extremities as a grouped body region, but additional matrix specificity indicates the most injured anatomical locations are the knee, lower back, and shoulder.

Repetitive strain injury.

Repetitive strain injury remains a controversial topic. The term repetitive strain injury includes specific disorders such as carpal tunnel syndrome, cubital tunnel syndrome, Guyon canal syndrome, lateral epicondylitis, and tendonitis of the wrist or hand. The diagnosis is usually made on the basis of history and clinical examination. Large high-quality studies using newer imaging techniques, such as MRI and ultrasonography are few. Consequently, the role of such imaging in diagnosis of upper limb disorders remains unclear. In many cases, no specific diagnosis can be established and complaints are labelled as non-specific. Little is known about the effectiveness of treatment options for upper limb disorders. Strong evidence for any intervention is scarce and the effect, if any, is mainly short-term pain relief. Exercise is beneficial for non-specific upper limb disorders. Immobilising hand braces and open carpal tunnel surgery release are beneficial for carpal tunnel syndrome, and topical and oral non-steroidal anti-inflammatory drugs, and corticosteroid injections are helpful for lateral epicondylitis. Exercise is probably beneficial for neck pain, as are corticosteroid injections and exercise for shoulder pain. Although upper limb disorders occur frequently in the working population, most trials have not exclusively included a working population or assessed effects on work-related outcomes. Further high-quality trials should aim to include sufficient sample sizes, working populations, and work-related outcomes.

Musicians' health: applying the ICF framework in research.

PURPOSE: Injuries described as 'playing-related' in musicians have a prevalence rate of up to 87%. Nevertheless, healthcare consultation rates among this population remain low. Using the theoretical framework of the World Health Organization's International Classification of Functioning, Disability and Health (ICF), the author examined the musicians' health literature to determine potential causes for the shortcomings in the provision of evidence-based treatment for injured musicians. METHOD: A review of the literature on musicians' health was performed from 1998 to December 2005. In total, 131 papers were reviewed. RESULTS: Much of the literature on musicians' health is related to the domain of Body Structure and Function within the ICF framework. However, even in these relatively well-defined areas, clinicians appear to agree that the 'best treatment' depends enormously on the interplay of biopsychosocial factors and on the musician's context. Underrepresented areas in the literature include Environmental Factors, Personal Factors, and the domain of Participation. CONCLUSIONS: This review demonstrates a lack of research in some health and health-related domains in the musicians' health literature. The author suggests that these underrepresented areas within the ICF framework may explain shortcomings in the availability of effective, evidence-based treatment for musicians. The use of a framework to shape future research in this field is advocated.

Common lower limb sport-related overuse injuries in young athletes.

INTRODUCTION: Sports injuries in children and adolescent present a unique challenge to the physician. They are often seen for clinical conditions unique to their age group. This paper highlights the epidemiological aspect of sports-related overuse injuries in this age group. MATERIALS AND METHODS: This retrospective study reviewed all the paediatric patients diagnosed with overuses injuries during a 5 years and 7 months period. The overuse injuries were anterior superior iliac spine avulsion fracture, Osgood-Schlatter disease, Sinding-Larson-Johansson disease, osteochondritis dissecan and Sever's disease. We reviewed the literature and attempted to give an overview for each condition and the anatomical differences that contributed to their occurrence in this age group. RESULTS: A total of 506 cases of the overuse injuries were seen during the study period. Seventy-three per cent were male patients. The knee joint was the commonest affected joint while the hip was the least affected joint. The mean age at diagnosis was younger in female compared to male for all conditions except in Sinding-Larson Johansson syndrome. Female was diagnosed at a mean age of 11.7 years while male at 10.8 years. Osgood-Schlatter disease was the commonest among the overuse injuries. There was no discernible racial predilection for these conditions except in the patients with anterior superior iliac spine avulsion. CONCLUSIONS: Overuse injuries are not uncommon in children and adolescent. An adequate understanding of the anatomy of the sports the children participated in as well as the anatomical differences between adult and children may assist the primary care providers better meet parents' and coaches' expectations.

Factor associated with self-reported work-related musculoskeletal disorders in Brazilian adults.

OBJECTIVE: To describe the prevalence of work-related musculoskeletal disorder (WMSD) and analyze the factors associated with this outcome in the Brazilian population. METHODS: In this cross-sectional, population-based study, we use data from the National Survey on Health (PNS) of 2013. The sample was composed of 60,202 Brazilians aged 18 years or older. The outcome variable was the occurrence of self-reported WMSD. Sociodemographic and occupational characteristics, personal resources, and health conditions were investigated as explanatory variables. Analyses were performed with the software Stata 12.0 and considered the weighting imposed by the sampling design of the study. Then, univariate and multivariate binary logistic models were carried out, considering a significance level of 5%. RESULTS: The results obtained indicated that the prevalence of WMSD in the Brazilian population was of 2.5%, ranging from 0.2% (Acre) to 4.2% (Santa Catarina). The factors associated with a greater chance of occurrence of WMSD were: female sex (OR = 2.33; 95%CI 1.72-3.15); be temporarily away from work (OR = 2.44; 95%CI 1.41-4.23); be exposed to noise at the workplace (OR = 2.16; 95%CI 1.68-2.77); seniority equal to or greater than 4.5 years at the current job (OR = 1.37; 95%CI 1.09-1.72); participate in volunteer work (OR = 1.65; 95%CI 1.25-2.17); report medical diagnosis of arthritis or rheumatism (OR = 2.40; 95%CI 1.68-3.44); and depression (OR = 2.48; 95%CI 1.86-3.31). On the other hand, factors associated with less chance of WMSD were: not having a partner (OR = 0.73; 95%CI 0.37-0.71) and working in an open environment (OR = 0.51; 95%CI 0.37-0.71). CONCLUSIONS: The associated factors and the prevalence found indicate regional and gender differences. Special attention to comorbidities and environmental noise monitoring would benefit the health of workers in the Country.

OBJETIVO: Descrever a prevalência de distúrbio osteomuscular relacionado ao trabalho (Dort) e analisar os fatores associados com esse desfecho na população brasileira. MÉTODOS: Neste estudo transversal, de base populacional, utilizamos dados da Pesquisa Nacional de Saúde (PNS) de 2013. A amostra foi composta por 60.202 brasileiros com 18 anos ou mais de idade. A variável desfecho foi a ocorrência de Dort autorreferida. Como variáveis explicativas, foram investigadas características sociodemográficas, ocupacionais, recursos pessoais e condições de saúde. As análises foram realizadas com o software Stata 12.0 e levaram em consideração as ponderações impostas pelo delineamento amostral do estudo. Foi realizado, então, um modelo logístico binário uni e multivariado, considerando o nível de significância de 5%. RESULTADOS: Os resultados obtidos indicaram que a prevalência de Dort na população brasileira foi de 2,5%, variando de 0,2% (Acre) a 4,2% (Santa Catarina). Os fatores associados à maior chance de ocorrência de Dort foram: sexo feminino (OR = 2,33; IC95% 1,72-3,15); estar afastado temporariamente do trabalho (OR = 2,44; IC95% 1,41-4,23); estar exposto a ruído no local de trabalho (OR = 2,16; IC95% 1,68-2,77); antiguidade igual ou superior a 4,5 anos no trabalho atual (OR = 1,37; IC95% 1,09-1,72); participar de trabalho voluntário (OR = 1,65; IC95% 1,25-2,17); relatar diagnóstico médico de artrite ou reumatismo (OR = 2,40; IC95% 1,68-3,44) e de depressão (OR = 2,48; IC95% 1,86-3,31). Por outro lado, foram associados à menor chance de diagnóstico de Dort: não ter parceiro (OR = 0,73; IC95% 0,37-0,71) e trabalhar em ambiente aberto (OR = 0,51; IC95% 0,37-0,71). CONCLUSÕES: Os fatores associados e a prevalência encontrada indicam diferenças regionais e de gênero. Especial atenção às comorbidades e monitoramento do ruído ambiental beneficiariam a saúde dos trabalhadores no país.

Working hand syndrome: A new definition of non-classified polyneuropathy condition.

The aim of this paper was to define an unexplained non-classified polyneuropathy condition as a new neurological disease. This new diagnosis of occupation related polyneuropathy has been named as "WORKING HAND SYNDROME (WHS)."This study collected and compared clinic and electrophysiological analyze data from healthy controls, WHS patients, carpal tunnel syndrome (CTS) patients and polyneuropathy patients. The WHS patients presented to the clinic with pain, numbness, tingling, and burning sensations in their hands that increased significantly during rest and nighttime. However, there was no weakness in the muscles, and the deep tendon reflexes were normal in this disease. The patients had all been working in physically demanding jobs requiring the use of their hands/arms for at least 1 year, but no vibrating tools were used by the patients. All of the cases were men. I supposed that overload caused by an action repeated chronically by the hand/arm may impair the sensory nerves in mentioned hand/arm. In patients with these complaints, for a definitive diagnosis, similar diseases must be excluded. Nonetheless, the specific electrophysiological finding that the sural nerves are normal on the lower sides, as well as the occurrence of sensory axonal polyneuropathy in the sensory nerves without a significant effect on velocity and latency in the work-ups of the upper extremity are enough to make a diagnosis.In conclusion, WHS has been defined as a polyneuropathy and occupational disease. Patients with WHS present with pain, numbness, tingling, and burning sensations in their hands that increases significantly during rest and nighttime. They also use their arms/hands for jobs that require heavy labor. The neurological examinations of patients with WHS are normal. Only the sensory nerves in the upper extremities are affected. This article is suggested to serve as a resource for patients, health care professionals, and members of the neurology community at large.

[Criteria for classification of upper limb work-related musculo-skeletal disorders due to biomechanical overload in occupational health. Consensus document by an Italian Working Group]. / Criteri per la trattazione e la classificazione di casi di malattia da sovraccarico biomeccanico degli arti superiori nell'ambito della medicina del lavoro. Documento di consenso di un gruppo di lavoro nazionale.

BACKGROUND AND OBJECTIVE: In a preliminary consensus document the authors proposed criteria and methods to identify upper limb work-related MSDs due to biomechanical overload. With this document they intend to define severity according to shared models and procedures so as to fit behaviours to diagnostic procedures and their medical-legal assessment. This becomes especially important in view of Ministerial Decree of April 27 2004 fixing the new lists of diseases having a possible work-related origin that must be reported by law in accordance with art. 139 of law n. 1124, and also on account of the impact of such diseases which, for the first time in Italy, are regulated by law. CONTENTS: The working group, which included INAIL and ISPESL experts and was fully supported by SIMFER (Italian Society of Physical Medicine and Rehabilitation) and SINC (Italian Society of Clinical Neurophysiology), defined a general clinical procedure (anamnesis, objective examination and instrumental assessment) regarding each portion of the concerned upper limb (shoulder, elbow and wrist/hand). Once the presence and characteristics of anatomic and functional damages are established, the results allow a classification scheme to be proposed of upper limb diseases (tendon disorders and entrapment neuropathy) divided into 6 increasing severity stages: initial, medium, medium-severe, severe and extremely severe. Special attention was paid to two instrumental examinations that proved to be of great clinical interest, at least in occupational health: echography of soft tissues (in appendix) and electroneurography for entrapment neuropathy. The limitations of this proposal are discussed but the main goal was achieved: to standardize terms and provide homogeneous criteria to achieve classification of upper limb damage due to biomechanical overload for increasing severity levels. The working group research activity is part of a research project funded by ISPESL.

An 8-year longitudinal study of overreaching in 114 elite female Chinese wrestlers.

CONTEXT: Successful training involves structured overload but must avoid the combination of excessive overload and inadequate recovery. OBJECTIVE: The aim of this study was to determine the incidence of functional overreaching (FOR), nonfunctional overreaching (NFOR), and overtraining syndrome in elite female wrestlers during their normal training and competition schedules and to explore the utility of blood markers for the early detection of overreaching. Classification of FOR, NFOR, and overtraining syndrome was based on the European Congress of Sports Medicine position statement. DESIGN: Case series. SETTING: China Institute of Sport Science. PATIENTS OR OTHER PARTICIPANTS: Over an 8-year period, 114 wrestlers from the women's Asian wrestling team were monitored to help identify if and when they experienced FOR, NFOR, or overtraining syndrome. MAIN OUTCOME MEASURE(S): Creatine kinase, hemoglobin, testosterone, and cortisol were measured throughout the period to identify whether wrestlers were outside the reference intervals (constructed from normal recovery data) during periods of overreaching and not overreaching. RESULTS: Among the 114 athletes, there were 13 (3.6%) instances of FOR, 23 (6.4%) instances of NFOR, and 2 (0.6%) instances of overtraining syndrome. The diagnostic sensitivity for FOR was 38%, 15%, 45%, and 18% for creatine kinase, hemoglobin, testosterone, and cortisol, respectively. The diagnostic sensitivity for NFOR was 29%, 33%, 26%, and 35% for creatine kinase, hemoglobin, testosterone, and cortisol, respectively. Specificity was 79%, 88%, 90%, and 82% for creatine kinase, hemoglobin, testosterone, and cortisol, respectively. Post hoc analysis showed no mean differences in creatine kinase (F = 0.5, P = .47), hemoglobin (F = 3.8, P = .052), testosterone (F = 0.2, P = .62), or cortisol (F = 0.04, P = .85) between monitoring periods when wrestlers were and were not diagnosed with FOR and NFOR. CONCLUSIONS: Coaches and sports scientists should not use single blood variables as markers of overreaching in elite female wrestlers.

Histopathology of common tendinopathies. Update and implications for clinical management.

Tendon disorders are a major problem for participants in competitive and recreational sports. To try to determine whether the histopathology underlying these conditions explains why they often prove recalcitrant to treatment, we reviewed studies of the histopathology of sports-related, symptomatic Achilles, patellar, extensor carpi radialis brevis and rotator cuff tendons. The literature indicates that healthy tendons appear glistening white to the naked eye and microscopy reveals a hierarchical arrangement of tightly packed, parallel bundles of collagen fibres that have a characteristic reflectivity under polarised light. Stainable ground substance (extracellular matrix) is absent and vasculature is inconspicuous. Tenocytes are generally inconspicuous and fibroblasts and myofibroblasts absent. In stark contrast, symptomatic tendons in athletes appear grey and amorphous to the naked eye and microscopy reveals discontinuous and disorganised collagen fibres that lack reflectivity under polarised light. This is associated with an increase in the amount of mucoid ground substance, which is confirmed with Alcian blue stain. At sites of maximal mucoid change, tenocytes, when present, are plump and chondroid in appearance (exaggerated fibrocartilaginous metaplasia). These changes are accompanied by the increasingly conspicuous presence of cells within the tendon tissue, most of which have a fibroblastic or myofibroblastic appearance (smooth muscle actin is demonstrated using an avidin biotin technique). Maximal cellular proliferation is accompanied by prominent capillary proliferation and a tendency for discontinuity of collagen fibres in this area. Often, there is an abrupt discontinuity of both vascular and myofibroblastic proliferation immediately adjacent to the area of greatest abnormality. The most significant feature is the absence of inflammatory cells. These observations confirm that the histopathological findings in athletes with overuse tendinopathies are consistent with those in tendinosis--a degenerative condition of unknown aetiology. This may have implications for the prognosis and timing of a return to sport after experiencing tendon symptoms. As the common overuse tendon conditions are rarely, if ever, caused by 'tendinitis', we suggest the term 'tendinopathy' be used to describe the common overuse tendon conditions. We conclude that effective treatment of athletes with tendinopathies must target the most common underlying histopathology, tendinosis, a noninflammatory condition.

Musculoskeletal colloquialisms: how did we come up with these names?

Eponyms and colloquial terms are labels that provide two kinds of information: the pattern of a complex injury or pathologic problem and, in the case of an eponym, the name of an individual who has been closely identified with the pathologic problem. Such terms remind us that the medicine of today is not entirely the work of our contemporaries. The article illustrates many of the common colloquial terms applied to fractures and musculoskeletal injuries seen in everyday practice. Wherever possible, the illustrations and definitions are based on the original descriptions of the injuries.

Femoral neck stress fractures.

Fifty-four femoral neck stress fractures were studied prospectively to evaluate treatment methods. Fifty-four fractures in 49 patients were identified in a 4 year prospective study that included 1,049 stress fractures of all types. From our evaluation of treatment methods, a modification of existing classification systems was developed based on radiographic findings and treatment. Differences from earlier studies were noted in racial diversity, in nonprogression of tension-side fractures, and in return to function.

Occupational musculoskeletal disorders.

Musculoskeletal disorders of the workplace include the acute, cumulative and chronic injuries or illnesses of the soft tissues which are caused by mechanical stress, strain, sprain, vibration, inflammation, or irritation. The successful management of occupational musculoskeletal disorders must account for workplace conditions (ergonomics and work practices), psychosocial factors, diagnostic uncertainties, and the need for active modalities (exercises and a progressive increase in activities of daily living), rather than passive (bed rest and traction). Although most occupational musculoskeletal disorders respond to conservative measures such as ice or heat, protective devices such as, neutral splints for carpal tunnel syndrome, nonsteroidal anti-inflammatory drugs, and progressive strengthening, resolution may take months. Prevention is often more important than treatment, and may entail workplace revisions and special worker training. Worker selection programs--strength testing, pre-placement radiographs, and inquiries about prior low back pain--have poor predictive value.