Sports Medicine Update

Am J Sports Med 2004Mar: 32(2): 301–7 An evaluation of the apprehension, relocation, and surprise tests for anterior shoulder instability I. K. Lo, B. Nonweiler, M. Woolfrey, R. Litchfield, A. Kirkley University of Calgary Sport Medicine Centre, Calgary, Alberta, Canada BACKGROUND: Although there are many studies describing tests for shoulder instability, there are few assessing the validity of these tests in diagnosing anterior shoulder instability. PURPOSE: To assess the validity of the apprehension, relocation, and surprise tests as predictors of anterior shoulder instability. STUDY DESIGN: Retrospective review of prospectively collected data. METHODS: Forty-six patients with a clear diagnosis of one of the following shoulder disorders were evaluated by four independent, blinded examiners: traumatic anterior instability (18), rotator cuff tendinosis (17), posterior instability (2), glenohumeral osteoarthritis (4), or multidirectional instability (5). Interobserver reliability was also determined. RESULTS: In subjects who felt apprehensive on all three tests, the mean positive and negative predictive values were 93.6% and 71.9%, respectively. The surprise test was the single most accurate test (sensitivity5 63.89%; specificity5 98.91%). An improvement in the feeling of apprehension or pain with the relocation test added little to the value of the tests. Interobserver reliability was determined to be 0.83. CONCLUSIONS AND CLINICAL RELEVANCE: The results of this study suggest that a positive instability exam on all three tests is highly specific and predictive of traumatic anterior glenohumeral instability. Eur J Appl Physiol 2004 Mar: 91(2–3): 140–6. Epub 2003 Oct 02 Hormonal responses in athletes: the use of a two bout exercise protocol to detect subtle differences in (over)training status R. Meeusen, M. F. Piacentini, B. Busschaert, L. Buyse, G. De Schutter, J. Stray-Gundersen Department of Human Physiology and Sportsmedicine, Free University of Brussels, Pleinlaan, Brussels, Belgium In overtrained athletes, several signs and symptoms have been associated with the imbalance between training and recovery. However, reliable diagnostic markers for distinguishing between well-trained, overreached (OR) and overtrained (OT) athletes are lacking. A hallmark feature of overtraining syndrome (OTS) is the inability to sustain intense exercise and recover for the next training or competition session. We therefore devised a test protocol utilizing two bouts of maximal work. With this test protocol, we tried to establish a difference in hormonal responses between the training status of T and OR athletes. Seven well-trained cyclists participated in this study and were tested before and after a training camp. We also present the data of one OT motocross athlete who was clinically diagnosed as overtrained. All athletes performed two maximal exercise tests separated by 4 h. Blood was analyzed for cortisol, adrenocorticotrophic hormone (ACTH), growth hormone and prolactin (PRL). Performance decreased by 6% between the first and the second exercise test in the OR group, and by 11% in the OT subject. Moreover, during the second exercise test there were more marked differences between the T and OR athletes; in particular, the OT subject did not show an increase in some of the hormonal responses. PRL increased only by 14% in the OT subject’s second test and there was a 7% decrease in ACTH. The two-exercise approach enables us to detect subtle performance decrements that will not be identified by one exercise trigger. The hormonal responses to the second exercise test were different between the T and OR athletes (the increase in the T group was higher than in the OR, which was in turn higher than in the OT). The results of the case presentation of an overtrained athlete provide evidence of an altered and dysfunctional hypothalamic– pituitary axis response to two bouts of maximal exercise. These findings can be used to develop markers for diagnosis of OTS and address the pathologic mechanism operative in the syndrome, as well as to provide an outcome measure to evaluate possible therapeutic regimes. J Appl Physiol 2004 Feb: 96(2): 814–21. Epub 2003 Oct 10 Arm-cranking muscle power and arm isometric muscle strength are independent predictors of all-cause