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The five minute sports medicine consult
  1. C Milne

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    Edited by Mark D Bracker. Published by Lippincott Williams & Wilkins, 2001, £53.00 (hardcover), pp 631. ISBN 0781730457

    The idea for this book grew out of a weekly didactic lecture series on the Fellowship programme at the University of California, San Diego. Mark Bracker is the director of the programme, and he has assembled some 200 contributing authors to provide a potted summary of virtually all the common conditions seen in sports medicine practice.

    Each chapter is in a stereotyped format; most occupy a two page spread. The entry includes basic definitions, epidemiological data, and mechanism of injury. Diagnostic aspects are logically divided into history, examination, and imaging. Then follows a brief description of acute and long term treatment, plus commonly asked questions. Each chapter concludes with a listing of the ICD-9 code plus a brief bibliography.

    What about the content? I chose several common topics to check on this. Patellofemoral pain is the most common clinical problem in most sports medicine practices. The entry in this book tends to overemphasise imaging (most cases require absolutely none and this should be stated). It mentions McConnell taping and exercises, but also mentions surgery. Most experts in this part of the world would only consider surgery if there was an associated patellar instability problem. The entry on concussion still mentions grading, which reflects the fact that it was compiled before the 2001 Vienna consensus conference, which abandoned this concept. There is no mention of the specific Maddock’s questions that have been well validated in evaluation of acute concussion. Adductor strains are common in many sports. There is no mention of ultrasound or MRI scans in the evaluation of complex groin problems, in which adductor tendinopathy may be only part of the problem. Navicular stress fractures are covered in a succinct and accurate manager, incorporating standard management guidelines. Plantar fascia problems are generally well covered, but there is no mention of associated seronegative arthropathy in cases of bilateral plantar fasciitis.

    The final section of the book includes about 10 clinical algorithms for evaluation of musculoskeletal problems, based on different body parts. These are then subdivided into acute and chronic. There are accompanying clinical photographs and in some cases radiographs with line diagrams to help on-cut the inexperienced user to the underlying bony anatomy. The algorithms are generally well done, but the clinical photographs would be easier to correlate with pathology if they had arrows to specific painful body sites with common diagnostic entities, rather than the coding that is used.

    The principal strength of this book is its consistent format, with subdivisions that make for easy searching of critical information. The two pages per topic are easy to photocopy as patient information sheets. Its shortcomings relate to its heavy North American bias (but then this is its principal market), and the absence of some important clinical entities—for example, I could not find any reference to triangular fibrocartilage tears of the wrist. Also, the list of differential diagnoses is often quite long, without any further indication as to their importance. In this respect, the tables in Brukner and Kahan’s textbook indicating “common”, “less common”, and “not to be missed” pathologies are very helpful. READ codes would be worth adding to the ICD codes.

    Who could benefit from reading it? Doctors sitting diploma or fellowship exams will find some value in not missing the key basic points on various clinical entities. However, they will need to look further for a full perspective on various problems. The material is useful as patient handouts, and is a good alternative to their trawling the internet. Senior clinicians wanting a snappy update on a problem they may not have seen recently may also find it of benefit.

    Overall, this is an excellent idea that has been competently brought to print. Future editions have the task of providing a more comprehensive world view, plus updating entries based on the continued advances in clinical knowledge.

    Evidence basis17/20


    Edited by Mark D Bracker. Published by Lippincott Williams & Wilkins, 2001, £53.00 (hardcover), pp 631. ISBN 0781730457

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