Sacral stress fracture: an unusual cause of low back pain in an amateur tennis player.

Stress fractures are common in athletes, and their incidence in sport is estimated at 2-4%. A case is reported of a stress fracture of the sacrum in an amateur tennis player. The patient was treated with rest and physiotherapy, focusing on stretching programmes and analgesic treatments, followed by an educational programme of tennis training and muscle strengthening. This appears to be the first report of this pathology in a tennis player.

Interventions for tears of the rotator cuff in adults.

BACKGROUND: Tears of the rotator cuff tendons, which surround the joints of the shoulder, are one of the most common causes of pain and disability in the upper extremity. OBJECTIVES: To review the efficacy and safety of common interventions for tears of the rotator cuff in adults. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group specialised trail register (July 2002), the Cochrane Controlled Trials Register (The Cochrane Library issue 2, 2002), MEDLINE (1966 to December 2001), EMBASE (1974 to December 2001), Biological Abstracts (1980 to December 2001), LILACS (1982 to December 2001), CINAHL (November 1982 to December 2001), Science Citation Index and reference lists of articles. We also contacted authors and handsearched conference proceedings focusing on shoulder conditions. SELECTION CRITERIA: Randomised or quasi-randomised clinical trials involving tears of the rotator cuff were the focus of this review. All trials involving conservative interventions or surgery were included (non-steroidal anti-inflammatory drugs, intra-articular or subacromial glucocorticosteroid injection, oral glucocorticosteroid treatment, physiotherapy, and open or arthroscopic surgery). DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed suitability for inclusion, methodological quality and extracted data. Dichotomous data were presented as relative risks (RR) and 95% confidence intervals (CI), using the fixed effects model. MAIN RESULTS: Eight trials involving 455 people were included and 393 patients analysed. Trials were grouped in eight categories of conservative or surgical treatment. The median quality score of all trials combined was 16 out of a possible 24 points, with a range of 12-18. In general, included trials differed on diagnostic criteria for rotator cuff tear, there was no uniformity in reported outcome measures, and data which could be summarised were rarely reported. Only results from two studies comparing open repair to arthroscopic debridement could be pooled. There is weak evidence for the superiority of open repair of rotator cuff tears compared with arthroscopic debridement. REVIEWER'S CONCLUSIONS: There is little evidence to support or refute the efficacy of common interventions for tears of rotator cuff in adults. As well as the need for further well designed clinical trials, uniform methods of defining interventions for rotator cuff tears and validated outcome measures are also essential.

Evoluçäo clínica e radiológica da meniscectomia lateral parcial artroscópica / Arthroscopic lateral partial meniscectomy: clinical and radiographic evolution

Os autores estudaram retrospectivamente 89 pacientes submetidos a meniscectomia lateral parcial artroscópica, entre 1984 e 1993, selecionados segundo critérios de ausência de lesao ligamentar associada, ausência de sinais de degeneraçao articular confirmados quando realizada artroscopia, sem queixas anteriores relacionadas com a patologia meniscal lateral. Dos pacientes, 37 (41,57 por cento) foram avaliados segundo questionário e os 52 (58,43 por cento) restantes, analisados também clínica e radiograficamente. Foi realizada associaçao entre o tipo de lesao e evoluçao clínica. Encontraram pior evoluçao desde o início para volta às atividades pregressas nos casos em que a meniscectomia era mais abrangente, princippalmente da regiao do tendao poplíteo até o corno posterior, nas lesoes longitudinais com ressecçao de mais de 1/3 do menisco. Observaram clara piora de evoluçao clínica com o tempo de seguimento. O estudo radiográfico mostrou sinais incipientes de artrose lateral principalmente nos pacientes com maior seguimento e maior atividade física. O outro achado relacionado com pior evoluçao foi o aparecimento de amolecimento ou fissura cartilagínea no compartimento lateral, no momento da meniscectomia parcial artroscópica. Os autores concluíram que a meniscectomia lateral parcial pode apresentar evoluçao precocemente sintomática, principalmente nas lesoes longitudinais posteriores e extensas, em atletas de grande atividade, podendo piorar ao longo do tempo.