The Sports Medicine Resource Manual

664 Pages·2008·27.51 MB·English

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THESPORTSMEDICINERESOURCEMANUAL ISBN:978-1-4160-3197-0
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Knowledgeandbestpracticeinthisfieldareconstantlychanging.Asnewresearchandexperience
broadenourknowledge,changesinpractice,treatment,anddrugtherapymaybecomenecessaryor
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responsibilityofthepractitioner,relyingontheirownexperienceandknowledgeofthepatient,to
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ThePublisher
LibraryofCongressCataloging-in-PublicationData
Seidenberg,PeterH.
Thesportsmedicineresourcemanual /PeterH.Seidenberg,AnthonyI.
Beutler.—1sted.
p. ;cm.
Includesbibliographicalreferences.
ISBN978-1-4160-3197-0
1. Sportsmedicine. 2. Sportsinjuries. I.Beutler,AnthonyI.II.
Title.
[DNLM: 1. AthleticInjuries—diagnosis. 2. Athletic
Injuries—therapy. 3. Physician’sRole. 4. SportsMedicine—methods.
QT261S458s2008]
RC1210.S432008
617.10027—dc22
2007041856
AcquisitionsEditor:RollaCouchman
DevelopmentalEditor:PamelaHetherington
PublishingServicesManager:JoanSinclair
DesignDirection:KarenO’KeefeOwens
PrintedintheUnitedStatesofAmerica
Lastdigitistheprintnumber: 9 8 7 6 5 4 3 2 1
Dedication
We would like to thank our many teachers—those wonderful men and women who cared and took
time from their busy lives to explain complex things to simple minds.
This book is dedicated to our families—our parents; our children; but most of all to our patient and
wonderful wives, Jen and Angie.
(
Contributors
MAJChadAsplund,MD MichaelCannon,MD,MS
Sports Medicine Coordinator; Department of Family and Assistant Professor; Department of Community and Family
Community Medicine; Eisenhower Army Medical Center; Medicine; Saint Louis University School of Medicine; St. Louis,
Fort Gordon, Georgia Missouri
MichaelBarron,MD DennisA.Cardone,DO
Family Physician; Department of Family Medicine; Southern Children’sSportsCenter;PediatricOrthopedicsofSouthFlorida;
Illinois Healthcare Foundation; Belleville, Illinois Fort Myers, Florida
AnthonyI.Beutler,MD ElizabethJ.Caschetta,MS,ATC
Chief; Injury Prevention Research Laboratory; Assistant Certified Athletic Trainer; Illini Sports Medicine; Belleville,
Professor; Department of Family Medicine; Uniformed Services Illinois
University of the Health Sciences; Bethesda, Maryland
MarcA.Childress,MD
BarryP.Boden,MD AssistantProfessor;DepartmentofFamilyMedicine;Uniformed
Adjunct Associate Professor in Surgery; Department of ServicesUniversityoftheHealthSciences;Bethesda,Maryland;
Orthopaedic Surgery; F. Edward Herbert School of Medicine; Teaching Physician; Deparment of Family Medicine; Malcolm
UniformedServicesUniversityoftheHealthSciences;Bethesda, Grow Medical Center; Andrews Air Force Base, Maryland
Maryland; Orthopaedic Surgeon; The Orthopaedic Center;
Rockville, Maryland
RaymondD.Chronister,ATC
Assistant Athletic Trainer; Department of Physical Education;
JimmyD.Bowen,MD,FAAPMR,CSCS
United States Naval Academy; Annapolis, Maryland
Assistant Professor; Departments of Surgery and Physical
Medicine; Uniformed Services University of the Health
GregDammann,MD
Sciences; Bethesda, Maryland; Clinical Instructor; Southeast
Resident; Department of Orthopaedic Surgery; Tripler Army
Missouri State University; Medical Director; Department of
Medical Center; Honolulu, Hawaii
Sports Medicine; St. Francis Medical Center; Staff Psychiatrist;
Orthopedic Associates of Southeast Missouri; Cape Girardeau,
W.ScottDeitche,MD
Missouri
DirectorofSportsMedicine;FamilyMedicineResidencyCenter;
Carl R. Darnall Army Medical Center; Fort Hood, Texas
LoriA.Boyajian-O’Neill,DO
AssociateProfessorandChair;DepartmentofFamilyMedicine;
Kansas City University of Medicine and Biosciences; Kansas PatriciaA.Deuster,PhD,MPH
City, Missouri Professor; Department of Military and Emergency
Medicine;UniformedServicesUniversityoftheHealthSciences
FredH.Brennan,Jr,DO,FAOASM,FAAFP School of Medicine; Scientific Director; Consortium for Health
Director; National Capital Consortium Tri-Service Primary Care and Human Performance; Bethesda, Maryland
Sports Medicine Fellowship Program; Bethesda, Maryland;
Assistant Team Physician; George Mason University; Fairfax, LTCKevindeWeber,MD,FAAFP
Virginia Director; Military Primary Care Sports Medicine Fellowship;
Assistant Professor of Family Medicine; Uniformed Services
JorgeCabrera,MD,PhD University of the Health Sciences; Bethesda, Maryland
Resident; Department of Family Practice; Womack Army
Medical Center; Fort Bragg, North Carolina PierreA.d’Hemecourt,MD
Director of Primary Care Sports Medicine; Division of Sports
GreggCalhoon,ATC Medicine; Boston Children’s Hospital; Harvard Medical School;
Athletic Trainer; Department of Physical Education; United Boston, Massachusetts; Team Physician; Department of Health
States Naval Academy; Annapolis, Maryland Services; Boston College; Chestnut Hill, Massachusetts
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viii Contributors
DavidA.Djuric,MD PhilipHam,DO
Resident; Department of Family Medicine; Dewitt Army Director;BoardCertifiedFamilyPracticePhysician;Department
Community Hospital; Fort Belvoir, Virginia of Family Practice; United States Air Force; Cannon Air Force
Base, New Mexico
TimothyDwyer,MD
YuvalHeled,PhD
Senior Medical Officer; Ray Hall Branch Medical Clinic; The
Assistant Professor; Department of Military and Emergency
Basic School; Quantico, Virginia
Medicine;UniformedServicesUniversityoftheHealthSciences
School of Medicine; Bethesda, Maryland; Researcher; Heller
AdamJ.Farber,MD Institute of Medical Research; Sheba Medical Center; Tel
Chief Resident; Department of Orthopaedic Surgery; Johns Hashomer; Ramat Gan, Israel
Hopkins Hospital; Baltimore, Maryland
MAJDuaneR.Hennion,MD
DepartmentofFamilyMedicine;UniformedServicesUniversity
CPTDavidD.Farnsworth,MD
of the Health Sciences; Bethesda, Maryland
Resident; Saint Louis University Family Medicine
Residency; Cardinal Glennon Children’s Hospital; St. Louis, ThomasM.Howard,MD
Missouri; Department of Family Medicine; St. Elizabeth’s Assistant Clinical Professor; Department of Family Medicine;
Hospital; Belleville, Illinois Virginia Commonwealth University School of Medicine;
Richmond,Virginia;ProgramDirector;VirginiaCommonwealth
KarlB.Fields,MD
University; Fairfax Family Practice Sports Medicine Fellowship;
Professor and Associate Chairman; Department of Family
Fairfax, Virginia
Medicine;UniversityofNorthCarolina;Director;FamilyPractice
Residency and Sports Medicine Fellowship; Moses H. Cone AllysonS.Howe,MD
Health System; Greensboro, North Carolina Director of Sports Medicine; Department of Family Medicine;
Malcolm Grow Medical Center; Andrews Air Force Base,
ScottD.Flinn,MD
Maryland
Clinical Professor; University of California, San Diego; Force
Surgeon;CommanderNavalSurfaceForces;UnitedStatesNavy; WesleyR.Ibazebo,MD
San Diego, California Resident; Department of Physical Medicine and Rehabilitation;
University of North Carolina at Chapel Hill; Chapel Hill, North
BradleyD.Fullerton,MD,FAAPMR
Carolina
Physical Medicine and Rehabilitation Preceptor; University of
Texas Medical Branch; Galveston, Texas; Consulting Physiatrist MAJChristopherG.Jarvis,MD,FAAFP
in Ultrasound Research; Human Engineering Research SeniorSportsMedicineFellow;DepartmentofFamilyMedicine;
Laboratory; University of Pittsburgh; Pittsburgh, Pennsylvania; UniformedServicesUniversityoftheHealthSciences;Bethesda,
Medical Director of Spasticity Clinic; Dell Children’s Hospital; Maryland
Austin, Texas
ShawnF.Kane,MD
CPTRichardGeshel,DO
Family Physician; Primary Care Sports Medicine; Blanchfield
StaffPhysician;DepartmentofFamilyMedicine;ReynoldsArmy
Army Community Hospital; Fort Campbell, Kentucky
Community Hospital; Fort Sill, Oklahoma
BrandonD.Larkin,MD
MAJRodneyGonzales,MD
Primary Care Sports Medicine Fellow; Department of
Family Medicine Residency Program; Martin Army Community
Community and Family Medicine; Saint Louis University; St.
Hospital; Fort Benning, Georgia
Louis, Missouri
NormanW.GillIII,PT,DSc,CertMPT,OCS,FAAOMPT
LTCJeffC.Leggitt,MD
Department of Orthopaedics and Rehabilitation; Walter Reed
LTS US Army
Army Medical Center; Washington, DC
JamesD.Leiber,DO
EliseT.Gordon,MD
Assistant Professor; Department of Family Medicine;
Physician; Department of Family Medicine/Sports
Department of Osteopathic Principles and Practice; Lake Erie
Medicine; Naval Hospital of Pensacola; Pensacola, Florida
College of Osteopathic Medicine; Bradenton, Florida
LyndonB.Gross,MD,PhD
Assistant Professor; Department of Orthopedic Surgery; Saint ChristopherJ.Lettieri,MD
Louis University; Active Provisional Staff; Department of Associate Professor of Medicine; Department of Medicine;
Orthopedic Surgery; Des Peres Hospital; Active Provisional UniformedServicesUniversityoftheHealthSciences;Bethesda,
Staff; Department of Orthopedic Surgery; St. Joseph’s Hospital; Maryland;MedicalDirector;SleepDisorders Clinic;Pulmonary,
Courtesy Staff Physician; Department of Orthopedic Surgery; Critical Care, and Sleep Medicine; Walter Reed Army Medical
Missouri Baptist Medical Center; St. Louis, Missouri Center; Washington, DC
(
Contributors ix
JeffreyL.Levy,DO MelissaNebzydoski,DO
Director; Primary Care Sports Medicine; Family Medicine Resident; Department of Family Medicine; Dewitt Army
Residency Clinic; Womack Army Medical Center; Fort Bragg, Community Hospital; Fort Belvoir, Virginia
NorthCarolina;TeamPhysician;MethodistCollege;Fayetteville,
North Carolina JayE.Noffsinger,MD
Professor of Pediatrics; Saint Louis University School of
MAJGuyR.Majkowski,PT,DSc,OCS,FAAOMPT Medicine; Director of Medical Student Education; Pediatric
Director of Rehabilitation Services; Malcolm Grow Medical Sports Medicine; Cardinal Glennon Children’s Medical Center;
Center; Andrews Air Force Base, Maryland St. Louis, Missouri
GeofD.Manzo,MS,ATC
RochelleM.Nolte,MD
Approved Offsite Clinical Instructor; Athletic Training;
Sports Medicine Physician; Aviation Medical Officer; US Coast
McKendreeCollege;Lebanon,Illinois;CertifiedAthleticTrainer;
Guard; San Diego, California
Illini Sports Medicine/Professional Therapy Services; St.
Elizabeth’s Hospital; Belleville, Illinois; Head Athletic Trainer; FrancisG.O’Connor,MD,MPH
Gateway Grizzlies Independent Minor League Baseball Club; Medical Director; Human Performance Lab; Military and
Sauget, Illinois Emergency Medicine; Associate Professor of Family
Medicine; Department of Military and Emergency Medicine;
TimothyJ.Mazzola,MD
UniformedServicesUniversityoftheHealthSciences;Bethesda,
TeamPhysician(Former);USAirForceAcademy;UnitedStates
Maryland
Air Force Academy, Colorado; Chief; Pagosa Springs Sports
Medicine; Pagosa Springs, Colorado
CPTJessicaA.Pesce,MS,PT
Assistant Chief; Physical Therapy; Womack Army Medical
AndrewT.McDonald,MD
Center; Fort Bragg, North Carolina
Team Physician; Primary Care and Sports Medicine; Rose-
Hulman Institute of Technology; Sports Medicine Physician;
JamesPhillips,MD
Bone & Joint Center; AP&S Clinic; Terre Haute, Indiana
Captain; United States Army Medical Corps; Darmstadt Health
MAJHowardJ.McGowan,MD Clinic; Darmstadt, Germany
AssistantProfessor;DepartmentofFamilyMedicine;Uniformed
NicholasA.Piantanida,MD
ServicesUniversityoftheHealthSciences;Bethesda,Maryland;
Teaching Physician; Department of Family Medicine; Malcolm AssistantProfessor;DepartmentofFamilyMedicine;Uniformed
Grow Medical Center; Andrews Air Force Base, Maryland ServicesUniversityoftheHealthSciences;Bethesda,Maryland;
Director; Primary Care Sports Medicine; Primary Care
MAJChristopherD.Meyering,DO Department; Keller Army Community Hospital; West Point,
Sports Medicine Fellow; Primary Care Sports Medicine; DeWitt New York
Army Community Hospital; Fort Belvoir, Virginia; Sports
Medicine Fellow; Tri-Service Primary Care Sports Medicine ScottA.Playford,MD
Fellowship; Uniformed Services University of the Health SportsMedicinePhysician;CampGeigerSportsMedicine;Naval
Sciences; Bethesda, Maryland Hospital Camp Lejeune; Jacksonville, North Carolina
WilliamA.MitchellIII,MD MAJChristopherM.Prior,DO,FAAFP
Fellow; Primary Care Sports Medicine Fellowship; Saint Louis Assistant Professor; Department of Family Practice; Uniformed
University; St. Louis, Missouri; Fellow; Department of Family ServicesUniversityoftheHealthSciences;Bethesda,Maryland;
and Community Medicine; St. Elizabeth’s Hospital; Director of Sports Medicine; Family Medicine; Columbine
Belleville, Illinois Medical Center; Family Physician; Department of Family
Practice; Littleton Adventist Hospital; Littleton, Colorado;
RyanE.Modlinski,MD
President; Rocky Mountain Sports Medicine Association; Castle
Fellow; Primary Care Sports Medicine; Moses H. Cone Family
Rock, Colorado
Medicine Residency; Greensboro, North Carolina
BernardPurcell,MS
SeanT.Mullendore,MD Manager;InjuryPreventionResearchLaboratory;Departmentof
Adjunct Assistant Professor; Department of Family Medicine; Family Medicine; Uniformed Services University of the Health
University of Nebraska Medical Center; Staff Family/Sports Sciences; Bethesda, Maryland
Physician; 55 MDOS/SGOPR; Ehrling Bergquist USAF Clinic;
Offutt AFB; Omaha, Nebraska ScottW.Pyne,MD,FAAFP,FACSM
AssistantProfessor;DepartmentofFamilyMedicine;Uniformed
DanielL.Munton,MD ServicesUniversityoftheHealthSciences;Bethesda,Maryland;
Staff Physician; Physical Medicine and Rehabilitation; Director of Health Services; Chief of the Medical Staff; Team
Department of Sports Medicine; Abilene Sports Medicine and Physician; United States Naval Academy; Naval Health Clinic
Orthopedics; Abilene, Texas Annapolis; Annapolis, Maryland
(
x Contributors
AhmedA.Radwan,MD TimothyL.Switaj,MD
Family Medicine Attending/Sports Medicine Fellowship Staff Resident; Department of Family Medicine; Dewitt Army
Physician; Family Medicine/Sports Medicine; Saint Louis Community Hospital; Fort Belvoir, Virginia
University; St. Louis, Missouri; Family Medicine Attending/
Sports Medicine Fellowship Staff Physician; Family Medicine/ SeanThomas,MD
Sports Medicine; St. Elizabeth’s Hospital; Belleville, Illinois Family Medicine Residency Faculty; Womack Army Medical
Center; Fort Bragg, North Carolina
LCDRLeslieH.Rassner,MD
AssistantProfessor;DepartmentofFamilyMedicine;Uniformed StephenJ.Titus,MD
ServicesUniversityoftheHealthSciences;Bethesda,Maryland; AssistantProfessor;DepartmentofFamilyMedicine;Uniformed
Head;DivisionofSportsMedicine;DepartmentofOrthopedics; ServicesUniversityoftheHealthSciences;Bethesda,Maryland;
Residency Staff Physician; Department of Family Medicine; Teaching Faculty; Family Medicine Residency; Malcolm Grow
Naval Hospital Camp Lejeune; Camp Lejeune, North Carolina Medical Center; Andrews Air Force Base, Maryland
JenniferReed,MD,FAAPMR GastonTopol,MD
Professor; Eastern Virginia Medical School; Norfolk, Virginia; Team Physiatrist; Rosario Rugby Union; Rosario, Argentina
Attending Physician; Bone & Joint/Sports Medicine Institute;
Naval Medical Center; Portsmouth, Virginia
BrianK.Unwin,MD
K.DeanReeves,MD ViceChairforEducation;AssistantProfessorofFamilyMedicine
Clinical Associate Professor; Physical Medicine and and Geriatrics; Department of Family Medicine; Uniformed
Rehabilitation; University of Kansas Medical Center; Lawrence, Services University of the Health Sciences School of Medicine;
Kansas; Rehabilitation Medical Director; Meadowbrook Faculty Physician; National Naval Medical Center; Bethesda,
Maryland;FacultyPhysician;DewittArmyCommunityHospital;
Rehabilitation Hospital; Gardner, Kansas
Fort Belvoir, Virginia; Faculty Physician; Walter Reed Army
PeterH.Seidenberg,MD,FAAFP Medical Center; Washington, DC
President and Co-Founder; King Medical Care, Inc.;
Bloomsburg, Pennsylvania CharlesW.Webb,DO,FAAFP
Assistant Professor; Department of Family Medicine; Oregon
JoelL.Shaw,MD
Health and Science University; Portland, Oregon; Director;
AssistantProfessor;DepartmentofFamilyMedicine;Uniformed
PrimaryCareSportsMedicine;DepartmentofFamilyMedicine;
ServicesUniversityoftheHealthSciences;Bethesda,Maryland;
Madigan Army Medical Center; Tacoma, Washington
Assistant Fellowship Director; Tri-Service Primary Care Sports
Medicine Fellowship; Dewitt Army Community Hospital; Fort
Belvoir, Virginia JohnH.Wilckens,MD
Associate Professor; Orthopaedic Surgery; Johns Hopkins
MarkA.Slabaugh,MD UniversitySchoolofMedicine;AttendingOrthopaedicSurgeon,
AssociateProfessor;DepartmentofSurgery;UniformedServices Chairman; Orthopaedic Surgery; Johns Hopkins Bayview
UniversityoftheHealthSciences;Bethesda,Maryland;Chiefof Medical Center; Team Physician; Baltimore Orioles; Baltimore,
Orthopaedics; Department of Orthopaedics; Malcolm Grow Maryland; Orthopaedic Consultant; Naval Academy Athletic
Medical Center; Andrews Air Force Base, Maryland Association; Annapolis, Maryland
MarkB.Stephens,MD,MS PamelaM.Williams,MD
Associate Professor; Family Medicine; Uniformed Services AssistantProfessor;DepartmentofFamilyMedicine;Uniformed
University of the Health Sciences; Bethesda, Maryland Services University of the Health Sciences; Bethesda, Maryland
JanieceN.Stewart,MD DerekA.Woessner,MD
Fellow;PrimaryCareSportsMedicine;SaintLouisUniversity;St. StaffPhysician;MartinArmyCommunityHospital;FortBenning,
Louis, Missouri; Assistant Professor; Illini Sports Medicine; St. Georgia
Elizabeth’s Hospital; Belleville, Illinois
NicoleT.Yedlinsky,MD
PatrickSt.Pierre,MD Family Practice Physician;Departmentof Primary Care;Bayne-
Assistant Professor; Orthopaedic Surgery; Uniformed Services Jones Army Community Hospital; Fort Polk, Louisiana
University of the Health Sciences; Bethesda, Maryland;
Associate Director; Nirschl Orthopaedic Sports Medicine
Fellowship; Virginia Hospital Center; Arlington, Virginia
TheviewsexpressedinthistextbookarethoseoftheauthorsandshouldnotbeconstruedasofficialpolicyoftheDepartmentof
the Air Force, the Department of the Army, the Department of the Navy, or the Department of Defense.
(
Foreword
Francis G. O’Connor, MD, MPH
‘‘You find what you look for, and diagnose what you dedicated,competent,primarycaresportsmedicinephysiciansas
know.’’ they seek to improve their individual expertise and raise, with
—Dr. Jack Houston integrity,thegenerallevelofsportsmedicinepractice.6Inaddition,
the American College of Sports Medicine, which was founded
The late Dr. Jack Houston, founder of the Houston Sports in 1954, inaugurated its first family physician, William O.
Medicine Clinic and educator of many of today’s leaders in Roberts, MD,asCollege Presidentin 2004.7
sports medicine, is credited with the above quote, which invites Accordingly,thewrittenfieldhasalsochanged.Thediscipline
all clinicians to ‘‘think outside the box.’’ As a clinical educator, I now has several leading journals, as well as clinical sections in
haveinvokedthisquoteforyearsinanattempttoinspireprimary othersportsmedicinejournals.Inadditiontothejournalliterature,
care sports medicine fellows and family medicine residents. My textbooksthatwererarein1993aboundasleadersandfellowship
goal is to remind them that they are limited only by their own graduates have been quick to define the discipline. Books cur-
imagination and that, in many respects, they are their patients’ rently available for primary care sports medicine physicians
mostimportant riskfactor. range in scope, from definitive texts addressing defined areas to
Primarycaresportsmedicinehasbeenadisciplinepracticedby broad-based, evidence-based review texts to books devoted to
primary care providers for many years. In 1988, Tucker and exploring the idiosyncrasies of field-side coverage and mono-
O’Bryan published that the great majority of physicians who graphs comprehensively detailing physical examination techni-
were field side on Friday night in New York state for high- ques. Missing in this picture, however, has been a definitive text
school football games were family physicians.1 Many of us with that seeks to identify and describe in detail the core procedures
a little gray hair have fond memories of that first preparticipation that define the sports medicine practitioner, both in the office as
examinationinhighschoolbeingperformedinabusygymnasium well asatthe field side.
by the community family physician—the sports doc—who may Peter Seidenberg and Anthony Beutler, both of whom are fel-
wellalso havedelivered us. lowship-trained primary care sports medicine physicians and
About the same time as Tucker and O’Bryan’s study, a steady accomplished clinical educators and researchers, recognized this
sentiment was growing in the primary care community that addi- missingpiece.Theyhaveidentifiedtheskillset,assembledahost
tionaltraining(fellowship)inprimarycaresportsmedicinewould of talented authors, and produced a textbook that defines the
beofgreatservicetofamilyphysicians,internists,physicalmedicine integrated cognitive and procedural approach necessary to suc-
andrehabilitationphysicians,pediatricians,andemergencymedi- ceed asasports medicineclinician.
cinephysicians whowereinterested in gainingmoreexpertise in For those of us who have seen the birth and growth of the
thisarea.Sportsmedicinefellowshipssoonbecamequitepopular discipline of primary care sports medicine, we remember pivotal
and were sponsored throughout the country in academic family moments that helped to shape the specialty: board certification,
medicinedepartments,orthopedicsdepartments,andprivateprac- accredited fellowships, the founding of the American Medical
ticegroups.ThejournalThePhysicianandSportsmedicinebecame Society of Sports Medicine, the first family physician to lead the
amusthave,withitsannualissueupdatingfellowshipsacrossthe American College of Sports Medicine, and key advancements
country.2 in sports medicine literature that have shaped our specialty.
In April 1993, the first board examination in sports medicine, Just as a Strauss or Birrer text was instrumental for the first
which was a certificate of added qualification, was offered to Certificate of Added Qualifications and a Mellion handbook was
familyphysicians,internists,andpediatricians.Atthattime,avari- anecessarycompanionforallsportsphysiciansattendingatrain-
etyoffellowshipswereoffered,therewasnoformalaccreditation ing room, I have no doubt that this Seidenberg/Beutler Sports
process, and physicians who could demonstrate practical experi- Medicine Resource Manual will become a ‘‘must have’’ for every
ence were ‘‘grandfathered’’ into the board examination. In addi- graduating family medicine resident and beginning sports medi-
tion, there was a fair amount of anxiety among the growing cinefellowaswellasacornerstoneteachingtextfortheirattend-
number of primary care sports physicians because the discipline ing physicians.
had not yet been clearly defined, and there were few if any core Returning to Dr. Houston’s quotation, Drs. Seidenberg and
textbooksor publishedcurricula.3-5 Beutler have been out-of-the-box thinkers, and they have truly
Since that time the field of primary care sports medicine has edited a unique manuscript that will assume a fundamental
dramatically changed. Fellowships are now accredited by the position for sports medicine providers. I’m proud to have had a
Accreditation Council for Graduate Medical Education by strict role in their education, and I’m sure that Dr. Houston would
criteria. An examinee who desires to sit for the Certificate of haveadmired theircontribution to the fieldofsports medicine.
AddedQualificationsexaminationmustbeagraduateofanaccre-
dited fellowship. Physiatrists will sit for the board examination in REFERENCES
sportsmedicinefor the first timein 2007.
Hundreds of graduates abound from many fine fellowships,
1. TuckerJB,O’BryanJJ,etal:MedicalcoverageofhighschoolfootballinNewYork
and they have found excellent clinical opportunities as academic
state.PhysSportsmed1988;16(9):120-128.
leaders and private-practice clinicians. The American Medical 2. The Physician and Sportsmedicine home page (Web site). Available at www.
SocietyofSportsMedicinewasfoundedin1991,withthemission physsportsmed.com.AccessedMarch27,2007.
being to offer a forum that fosters a collegial relationship among 3. StraussRB:SportsMedicine,2nded.Philadelphia,WBSaunders,1991.
(
xii Foreword
4. BirrerRB:SportsMedicineforthePrimaryCarePhysician.Philadelphia,Appleton& 6. AmericanMedicalSocietyforSportsMedicinehomepage(Website).Availableat
Lange,1984. www.amssm.org.AccessedMarch27,2007.
5. Mellion MB, Walsh WM, Shelton GL (eds): The Team Physician’s Handbook. 7. AmericanCollegeofSportsMedicinehomepage(Website).Availableatwww.acsm.
Philadelphia,Hanley&Belfus,1990. org.AccessedMarch27,2007.
(
Preface
‘‘Youneverknowhowbigthefieldis,untilyoutryand Attheturnofthetwenty-firstcentury,evidence-basedmedicine
walk across it...’’ is fast becoming a cliche´. However, the need to assess the
evidencethatunderliestreatmentrecommendationsremainscriti-
When we sat down to design ‘‘the one sports medicine text- cal.Itisessentialtounderstandnotonlywhattheevidenceshows,
book’’ for graduating family medicine residents and all sports butalsowhatitdoesnotshoworwhatithasnotshownyet.The
fellows, we really did not imagine creating something 650 pages evidencebaseofsportsmedicinecanperhapsbestbedescribedas
long. Sports medicine seemed a relatively simple thing, just ‘‘growing.’’Applyingamatureevidencescaletothegrowingbody
muscles and bones and people hurting themselves. But as we ofsportsmedicineevidencewouldresultinhavingnearlyallevi-
triedtocompileasingletextdescribingthephilosophy,examina- denceratedaCora3.Ratherthandothat,wehavetriedtocreate
tions,treatments, procedures, andspecialconsiderations inherent ascalethatallowsforanddistinguishesthesmallstudysizestypi-
in our daily practice, we soon gained a firsthand appreciation for calofthecurrentsportsmedicineevidencebase.Thistextusesthe
howbigthe fieldis andhow longittakes to walk acrossit. following evidence scale:
Thisisauniquetext.Itislargelywrittenbyprimarycaresports
medicine physicians for primary care sports medicine physicians. Levelof evidence(LOE):
The orthopedists, athletic trainers, physical therapists, and A—Double-blind study
other professionals who we invited to participate were chosen B—Clinical trialmorethan 20subjects
because of their knowledge and also because of their proven C—Clinical trialfewer than 20subjects
track records in training primary care sports medicine profes- D—Series 5or moresubjects
sionals. The authors in this book are not only experts in their E—Anecdotal case reports
subjectmatter,buttheyalsounderstandhowtoteachtheirsubject
mattertoprimarycarephysicians.Theyunderstanditbecausethey Other levels of evidence (meta-analysis, consensus opinion,
doiteveryday.Aseditors,weexpressoursincereappreciationto etc.) arenoted assuchin the text.
these dedicated professionals who have poured their souls into Theageoftextbooksmaybedrawingtoaclose.Withsomany
thesechapters. online sources boasting up-to-date treatment recommendations
The text is organized into sections that parallel the process of and the push to make all things digital, one might wonder how
sports medicine diagnosis. The opening section contains the thisbookwillcompete.Longafterleechesarenolongerfashion-
philosophy of sports medicine: the essential duties to consider able for treating patellofemoral pain (that is a joke, at least in
before even stepping foot on a sideline or seeing athletes in a 2007!), we hope that the well-worn pages of your Sports
training room. Section 2 presents the history and physical exam: MedicineResourceManualwillstillbeavaluablephysicalexam-
how to examine and diagnose the injured athlete. After proper inationreview,afamiliarprocedurereference,andatrustedaffir-
examination, diagnosis and treatment are presented in Section 3. mation ofsports medicineandteam physician philosophy.
In this section we have provided the basics of casting, splinting, So,whetheryouareafamilymedicinedoctortryingtoreview
andfracturecare,aswellasthetreatmentoftraditionalsoft-tissue and learnmoreabout musculoskeletal medicine or a sportsmed-
injuries. Section 4 outlines rehabilitation and bracing: the art and icinefellowpreparingtodiveintoyourfast-pacedfellowship,we
science of augmenting and allowing the body to heal itself. An hopeyoufindthisbookvaluable.Itwaslotsoffuntocreate,andit
overview of the myriad procedures and special tests in sports was written for you.
medicinefollowsinSection5.Finally,asanoverarchingcapstone,
the appendices outline the role of exercise in maintaining health Peter H.Seidenberg,MD, FAAFP
andfitnessin the pediatric, pregnant, andgeriatric populations. AnthonyI. Beutler,MD