When it sees you but you don’t see it

Do Not Miss!!!

All of us who practice clinical care — who actively treat athletes and other patients — are keenly aware of the perils of a medical missed diagnosis.  The issues of concern can range from the relatively obvious — an Achilles tendon rupture for instance — to the more subtle.  In the case of an Achilles tendon rupture [or a scaphoid fracture or slipped capital femoral epiphysis (SCFE)], the outcomes from a medical misdiagnosis can be severe for both the patient and clinician:  significant morbidity for the former, and a possible medical malpractice suit (most especially in our litigious United States) for the latter.

Early in my training it was hammered home to me that if I let a patient with an Achilles tendon rupture walk out of my room with some bland assurance that one should give his or her acute posterior ankle pain a couple of weeks of rest and ice, and a message of ‘come back and see me if you’re not feeling better in a few weeks,” well….I could say hello to a suit which I would most certainly have to settle out of court.

Don’t want to be ‘that guy’ who doesn’t see the Achilles tendon rupture when it sees me.

Cassidy Foley, D.O., lead author

But what of some relatively common issues that may have more benign consequences, even if not initially ‘seen?’  What of the issues where missed or delayed diagnosis can result in weeks to months to years of frustration and, perhaps, unnecessary workup and/or misguided and ineffective treatments?

With those thoughts in mind, I was delighted to read an excellent study on the “Diagnosis and Treatment of Slipping Rib Syndrome” in the January 2019 CJSM.  Read more of this post

SportsKongres 2019 — An Overview Courtesy of Dr. Sheree Bekker

SportsKongres 2019, Copenhagen Denmark

Readers of this blog may be familiar with one of CJSM’s recurring collaborators, Dr. Sheree Bekker.  Dr. Bekker is a researcher in injury prevention at the University of Bath, UK,. She is, as well, an outspoken advocate raising awareness of the challenges faced by women in the field of sport medicine.  Finally, Sheree is a friend, and someone who is very active on Twitter:  a definite follow if you are in sport & exercise medicine and are reading this post!

I was following closely her tweets from the recent sportskongres in Copenhagen — what sounds like a fantastic conference just wrapped, and the buzz is on already for #SportsKongres2020.  Dr. Bekker graciously accepted my invitation to share her thoughts on the recent conference.  Enjoy, and hope to see you in Copenhagen in 2020!

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Dr. Sheree Bekker

Sheree Bekker, PhD

The 2019 edition of the Scandinavian Sports Medicine Congress has wrapped. Colloquially known by just a single name (as all the most famous people are, see: Serena, LeBron), sportskongres has, time and again, been billed by the British Journal of Sports Medicine as one of the Big 5.

This was my first sportskongres (full disclosure: I was an invited speaker), and from afar my biggest impressions of this conference were that the social program is legendary (spoiler: this is true), and that the focus is on clinically-relevant presentations and workshops (also true). Knowing that the majority of delegates at sportskongres are clinicians, I found an audience eager to learn from different disciplines and areas, an audience hungry for new insights and understandings as to what they are seeing and experiencing in everyday practice, and – most of all – an audience highly engaged in doing better. Read more of this post

The 2019 AMSSM Position Statement on Concussion — a Podcast with Dr. Kim Harmon

How to manage concussion in sport in 2019: The AMSSM Position Statement, and the new CJSM podcast

As one of our partner societies, the American Medical Society for Sports Medicine (AMSSM) contributes significantly and regularly to the global sports medicine discussion.  When the AMSSM authors a position statement, it’s a document that should be read by the active sports medicine clinician

Prof. Kim Harmon, past-president of the AMSSM

Hence, the publication of the AMSSM Position Statement on Concussion in Sport is news we want to make sure you all know about.  And if you haven’t had the chance to read it yet, you can now take the opportunity to hear about it from the publication’s lead author, Dr. Kimberly Harmon of the University of Washington.

For the new statement, Dr. Harmon notes that she and a panel of expert authors adopted a very specific focus: what does the practicing clinician need to be current when diagnosing and managing a concussion in 2019. This is a document for the sideline, the training room, the clinic.  A document for ‘now.’

It is evidence-based, but also ready to assist clinicians in the areas of concussion where evidence is currently limited.  That is, the statement makes suggestions for needed future research directions, but also reports current best practices informed by consensus or expert opinion.

After reading it, I found myself immediately referencing the statement when conversing with patients and families, whose questions might range from whether their child should take fish oil after their concussion (no, unless your child is a rat, as Dr Harmon may say….) to whether they are ready to drive (well, that depends….).

Take a listen to all of our podcasts on our main website or on iTunes.

If you want especially to hear interviews we’ve had with authors of previous AMSSM Position Statements, check out as well our podcasts with Dr. Jonathan Drezner (cardiovascular screening) and this one with Dr. Irfan Asif  (best practices for a sports medicine fellowship).

As ever give us feedback on these podcasts at the iTunes page, or in the comment section here!

Super Bowl Blues

The 2018 – 19 NFL season has ended with a familiar conclusion:  the New England Patriots having won (their sixth such championship).

Are you among the people who watched the game and found it boring (‘worst ever’)*?  Did you forego viewing entirely? Are you among the majority (reportedly) of fans disappointed because those Patriots won?  Sad simply because the season is over?

February can be a slog for all of us in the Northern Hemisphere — sports like the NFL can keep us going, and so perhaps you, my dear reader, are a bit blue for any number of reasons?

Well, I do not have something to cheer you up per se — rather I have something, perhaps, that will make you more blue….but it is an issue of vital importance to our profession.  And we can’t turn our eyes askance.

Recently published ‘ahead of print’ is headline-making original research: Reasons for Prescription Opioid Use While Playing in the National Football League as Risk Factors for Current Use and Misuse Among Former Players.

Headlines indeed. Over the Super Bowl weekend the New York Times published an article profiling former NFL players and their struggle with chronic pain and opioid addiction. It referenced the CJSM study authored by Dr. Eugene Dunne of Brown University and his team of authors.  Some of the more important findings reported are that among “….retired NFL players with exposure to prescribed pain medication during their playing career 26.2% reported recent use of prescription opioids (past 30 days).”  Moreover, the authors found that the past may be midwife to the future: use of opioids to manage pain during their career was associated with a 30% increased risk of present-day use of opioids in retired NFL Players.

Opioid use and abuse is a public health crisis of unprecedented scale in the USA according to JAMA.  Sports are not untouched by this epidemic.  CJSM has always striven to publish important and relevant research which can be translated into practical use — we provide this platform for clinicians helping individual patient-athletes, and we provide this platform for public health advocates as well.  We devoted an entire issue (Sept 2018) recently to the oft-neglected subject of pain management in athletes.  Guest Editor Prof. Wayne Derman of Stellenbosch Univ., South Africa emphasized in our podcast with him that it is imperative that clinicians seek holistic methods of pain control and that researchers look more intentionally at the issue of analgesia in athletics. An over-reliance on pharmacology, most especially opioids, is a potential recipe for problems (to wit, the experience of former NFL players in this new CJSM study).

Join us in this work and the global conversation on issues of importance to athletes, clinicians, researchers and public health advocates by checking out some of these references and following us on Twitter. We’ll always keep you abreast of what’s new and breaking in our world of sport and exercise medicine.

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*P.S. I really enjoyed the Super Bowl. Though low scoring, I loved watching Pats’ defense flummox such a great Rams’ offense, and I thought the game was tense until the very end. How about you?

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