As sports participation increases so too does the incidence of injuries, both acute and overuse. The growing skeleton is particularly susceptible due to the presence of growth cartilage at 3 locations; the epiphyseal plate, the joint surface and the apophysis. The risk of injury is most pronounced during the rapid growth spurt of adolescence when other factors, such as muscle tightness across joints, also become important in the aetiology of sporting injury. Overuse injuries seen in this age group may reflect the growth characteristics of the immature skeleton or may be of the type seen in adult athletes undergoing rigorous training schedules. Recent developments in organised competitive sport have seen growing individuals undertake prolonged and intensive training programmes when they are particularly at risk of sustaining an overuse injury. The training programme is one of a number of risk factors important in the generation of injury, many of which can be modified or controlled to an extent. Other factors such as growth deformities or malalignments are peculiar to the individual and preparticipation evaluation of the young athlete helps to identify those at risk. Whilst long term disability rarely eventuates, the loss of enjoyment and temporary incapacity resulting from this type of injury is significant. It is apparent that many of these injuries are preventable, and given the information available concerning the factors involved in their aetiology, it is the responsibility of coaches and health professionals alike to become involved in their early diagnosis, treatment and prevention.

Sixty-four survivors from a prospective study of early rheumatoid disease were assessed again at a mean of 15.2 years from presentation and their status compared with 29 patients who had died. Eleven of the dead and only two of the survivors had been treated with steroids. There was a small increase in mortality due to the disease itself but only one death was directly caused by it. As might be expected, those who died were older. In the first year of disease, they had lower haemoglobin levels, a lower body mass, higher sedimentation rates and higher levels of blood urea. One-fifth at entry to the study and two-fifths by the time of death, had poor functional capacity. Of 64 survivors, six had poor functional capacity at entry and nine after 15 years. Discriminant analysis was performed to identify the most powerful combination of early features predicting a poor functional outcome. A combination including early erosive change, seropositivity, poor grip strength and cervical subluxation predicted the outcome correctly in 73% of survivors. Almost 60% of survivors remained with or improved to normal function at 15 years suggesting that morbidity is not as bad as has been suggested in the past.

Objective-To investigate the production of the matrix metalloproteinase (MMP), collagenase (MMP-1), and its natural inhibitor, the tissue inhibitor of metalloproteinases (TIMP) by diseased human tendon samples in organ culture.

A process of progressive tendon failure leads to rotator cuff rupture in a significant percentage of the ageing population but many individuals remain asymptomatic. Aetiological factors are varied and not completely understood but greater knowledge of shoulder function and mechanics allows for improved non-operative and operative management. There is a definite role for comprehensive conservative treatment of rotator cuff disorders in those cases where surgery is not clearly indicated. Successful rehabilitation depends largely on proper clinical assessment and individualized treatment. This requires a good understanding of the biomechanics of shoulder, and especially rotator cuff, function. Few recent studies have properly evaluated the results of such non-operative treatment.

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