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James Geiselman, Rachel Gillespie and Andrew Miller

brachialis strain and was advised to follow up with his athletic trainer (AT) for co-management of his injury. Differential diagnosis included: brachialis strain, biceps brachii strain, medial epicondylitis, lateral epicondylitis, and UCL sprain. Radiographs and magnetic resonance imaging (MRI) were not

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Emily Kroshus, Sara P.D. Chrisman, Jeffrey J. Milroy and Christine M. Baugh

, these studies did not differentiate between athletes by history of concussion diagnosis. A possible SCT-based conceptual framework that encompasses the athlete’s history of concussion diagnosis is useful to better model concussion-reporting behavior (Figure  1 ). Figure 1 —Conceptual framework related

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Nancy D. Groh and Greggory M. Hundt

-specific competencies related to the clinical evaluation and diagnosis of general medical conditions across body systems not related to musculoskeletal injury, 3 self-efficacy in this area of assessment may not be as high in comparison with musculoskeletal evaluation due to a lower incidence of exposure to medical

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Katherine Craig, Shannon L. Jordan, Daniel R. Chilek, Doug Boatwright and Julio Morales

exhibited compression of the subclavian artery and the presence of an accessory rib. Reprinted from Seminars in Thoracic and Cardiovascular Surgery , 28(1), Hussain MA, Aljabri B, Al-Omran M, Vascular thoracic outlet syndrome, 151–157, 2016, with permission from Elsevier. Diagnosis of TOS should begin with

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Abbey C. Thomas, Janet E. Simon, Rachel Evans, Michael J. Turner, Luzita I. Vela and Phillip A. Gribble

time of original diagnosis. 17 Equally, variable knee OA prevalence rates have been reported following intraarticular fractures at the knee, ranging from 17% to 58%, depending on injury severity and time to follow-up. 18 – 22 In a study of OA prevalence 2 to 9 years following injury in a group of

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Denis H. Stott, Sheila E. Henderson and Fred A. Moyes

The lack of a system for the analysis and diagnosis of handwriting incompetence has led to the neglect of this area of learning failure. This article describes a new instrument, the Diagnosis and Remediation of Handwriting Problems (DRHP) (Stott, Moyes, & Henderson, 1984b), that has been designed to fill this hiatus. Handwriting problems are divided into (a) faults of concept and style, which reflect failures of learning or teaching, and (b) faults of motor control, which suggest fine-motor or perceptual dysfunction and may have a neurological origin. Specimens of children’s handwriting illustrate this categorization. The methodology of the remedial programs proposed by the DRHP is based on empirical findings about the nature of handwriting movements. These programs are briefly described. There is a need for handwriting specialists to advise teachers and help in the diagnosis of problems. It is suggested that physical education teachers be trained to develop these skills.

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Victor E.D. Pinheiro and Herbert A. Simon

The ability to diagnose motor skills is one of the most important competences of a teacher of physical education and sport. Teacher education programs fall short of providing prospective teachers with courses in motor skill diagnosis. To be successful, any effort to teach it must rest on a sound conceptual framework or model. This article provides the theoretical framework for adapting information-processing theory, a widely accepted theory of human thinking, to modeling diagnostic thought processes. It describes specifically the three components of the model: acquisition, cue interpretation, and diagnostic decision. The findings from the model provide a foundation upon which to build instructional strategies for developing diagnostic competence.

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Shannon David, Kim Gray, Jeffrey A. Russell and Chad Starkey

The original and modified Ottawa Ankle Rules (OARs) were developed as clinical decision rules for use in emergency departments. However, the OARs have not been evaluated as an acute clinical evaluation tool.

Objective:

To evaluate the measures of diagnostic accuracy of the OARs in the acute setting.

Methods:

The OARs were applied to all appropriate ankle injuries at 2 colleges (athletics and club sports) and 21 high schools. The outcomes of OARs, diagnosis, and decision for referral were collected by the athletic trainers (ATs) at each of the locations. Contingency tables were created for evaluations completed within 1 h for which radiographs were obtained. From these data the sensitivity, specificity, positive and negative likelihood ratios, and positive and negative predictive values were calculated.

Results:

The OARs met the criteria for radiographs in 100 of the 124 cases, of which 38 were actually referred for imaging. Based on radiographic findings in an acute setting, the OARs (n = 38) had a high sensitivity (.88) and are good predictors to rule out the presence of a fracture. Low specificity (0.00) results led to a high number of false positives and low positive predictive values (.18).

Conclusion:

When applied during the first hour after injury the OARs significantly overestimate the need for radiographs. However, a negative finding rules out the need to obtain radiographs. It appears the AT’s decision making based on the totality of the examination findings is the best filter in determining referral for radiographs.

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I-Min Lee, Kathleen Y. Wolin, Sarah E. Freeman, Jacob Sattlemair and Howard D. Sesso

Background:

The number of cancer survivors is increasing rapidly; however, little is known about whether engaging in physical activity after a cancer diagnosis is associated with lower mortality rates in men.

Methods:

We conducted a prospective cohort study of 1021 men (mean age, 71.3 years) who were diagnosed with cancer (other than nonmelanoma skin cancer). Men reported their physical activities (walking, stair climbing, and participation in sports and recreational activities) on questionnaires in 1988, a median of 6 years after their cancer diagnosis. Physical activity was updated in 1993 and men were followed until 2008, with mortality follow-up > 99% complete, during which 777 men died (337 from cancer, 190 from cardiovascular disease).

Results:

In multivariate analyses, the relative risks for all-cause mortality associated with expending < 2100, 2100–4199, 4200–8399, 8400–12,599, and ≥ 12,600 kJ/week in physical activity were 1.00 (referent), 0.77, 0.74, 0.76, and 0.52, respectively (P-trend < 0.0001). Higher levels of physical activity also were associated with lower rates of death from cancer and cardiovascular disease (P-trend = 0.01 and 0.002, respectively).

Conclusions:

Engaging in physical activity after cancer diagnosis is associated with better survival among men.

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Megan P. Brady and Windee Weiss

Clinical Scenario:

Common injuries in high-level and recreational athletes, nonathletes, and the elderly are medial and lateral meniscus tears. Diagnosis of meniscus tears is done with clinical exam, magnetic resonance imaging (MRI), and arthroscopy. The gold standard is arthroscopy, but accuracy of a clinical exam versus MRI diagnosis of meniscus tears is in question. A clinician’s ability to detect a meniscus tear is beneficial to the patient from a timing standpoint. The process of obtaining an MRI and results could be lengthy, but if the meniscus tear is accurately diagnosed clinically, the patient could be suspended from athletics or specific job duties to prevent further injury. In addition, rehabilitation could be initiated immediately, resulting in better outcomes for the patient. The ability to diagnose a meniscus tear clinically could initiate the rehabilitation process much sooner than waiting for MRI testing and results. Beginning the rehabilitation phase earlier may lead to faster postoperative rehabilitation and better patient outcomes. Clinical detection of a meniscus tear will facilitate possible suspension, early treatment, and rehabilitation recommendations, but the MRI will provide more specific information about the injury, including type and location of tear. Thus, surgical decisions such as operative versus nonoperative or meniscectomy versus repair would be based on MRI results.

Focused Clinical Question:

Is a clinical exam as accurate as an MRI scan for diagnosing meniscus tears?