Clinical Examination, Spondylolysis and Adolescent Athletes

Sundell, C-G; Jonsson, Håkan; Ådin, Lars; Larsén, Karin

doi:10.1055/s-0032-1321723

Cited by 21 publications

(36 citation statements)

References 17 publications

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“…Results of the search are presented in Additional file 8. Three studies from the systematic review [87–89] and five studies from our updated search [90–94] were included (Table 2). …”

Section: Resultsmentioning

confidence: 99%

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Clinical classification in low back pain: best-evidence diagnostic rules based on systematic reviews

Petersen¹,

Laslett²,

Juhl

2017

BMC Musculoskelet Disord

142

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BackgroundClinical examination findings are used in primary care to give an initial diagnosis to patients with low back pain and related leg symptoms. The purpose of this study was to develop best evidence Clinical Diagnostic Rules (CDR] for the identification of the most common patho-anatomical disorders in the lumbar spine; i.e. intervertebral discs, sacroiliac joints, facet joints, bone, muscles, nerve roots, muscles, peripheral nerve tissue, and central nervous system sensitization.MethodsA sensitive electronic search strategy using MEDLINE, EMBASE and CINAHL databases was combined with hand searching and citation tracking to identify eligible studies. Criteria for inclusion were: persons with low back pain with or without related leg symptoms, history or physical examination findings suitable for use in primary care, comparison with acceptable reference standards, and statistical reporting permitting calculation of diagnostic value. Quality assessments were made independently by two reviewers using the Quality Assessment of Diagnostic Accuracy Studies tool. Clinical examination findings that were investigated by at least two studies were included and results that met our predefined threshold of positive likelihood ratio ≥ 2 or negative likelihood ratio ≤ 0.5 were considered for the CDR.ResultsSixty-four studies satisfied our eligible criteria. We were able to construct promising CDRs for symptomatic intervertebral disc, sacroiliac joint, spondylolisthesis, disc herniation with nerve root involvement, and spinal stenosis. Single clinical test appear not to be as useful as clusters of tests that are more closely in line with clinical decision making.ConclusionsThis is the first comprehensive systematic review of diagnostic accuracy studies that evaluate clinical examination findings for their ability to identify the most common patho-anatomical disorders in the lumbar spine. In some diagnostic categories we have sufficient evidence to recommend a CDR. In others, we have only preliminary evidence that needs testing in future studies. Most findings were tested in secondary or tertiary care. Thus, the accuracy of the findings in a primary care setting has yet to be confirmed.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-017-1549-6) contains supplementary material, which is available to authorized users.

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“…Results of the search are presented in Additional file 8. Three studies from the systematic review [87–89] and five studies from our updated search [90–94] were included (Table 2). …”

Section: Resultsmentioning

confidence: 99%

“…Although several of the studies displayed risk of disease progression bias and poor description of index tests, the quality items reveal serious risks of bias in few cases [90, 94]. …”

Section: Discussionmentioning

confidence: 99%

Clinical classification in low back pain: best-evidence diagnostic rules based on systematic reviews

Petersen¹,

Laslett²,

Juhl

2017

BMC Musculoskelet Disord

142

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“…These symptoms include localized tenderness, muscle spasms, hamstrings tightness, decreased lumbar lordosis, functional scoliosis, palpable step off and gait abnormalities. Radicular symptoms are rare but when present L 5 radiculopathy most commonly occurs [4,16,31]. A complaint of low back pain in a competitive fine athlete requires in-depth investigation, specific diagnosis and finally an appropriate treatment [32].…”

Section: Clinical Presentationmentioning

confidence: 99%

Management of spondylolysis and low-grade spondylolisthesis in fine athletes. A comprehensive review

Bouras

Korovessis

2014

Eur J Orthop Surg Traumatol

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Conservative treatment including physiotherapy and bracing is the mainstay in the treatment of symptomatic spondylolysis and low-grade isthmic spondylolisthesis in fine athletes. If consequent treatment fails, the operative treatment (pars repair and short fusion) is decided. Return to play following surgery varies from 6 to 12 months with prohibition in collision sports. Return to play is mostly depended on specific sport activity.

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“…17 The incidence is significantly higher in the athletic population, with studies showing as many as 52% of athletes with low back pain suffering spondylolysis and 60% with low back pain suffering a pars interarticularis defect of any grade. 7 Other studies show that spondylolysis and spondylolisthesis constitute 47% of low back pain in adolescent athletes. 22 Athletic participation is indeed a well-known risk factor for the development of pars interarticularis defects, but studies on the incidence of pars interarticularis defects often have 1 of 3 limitations: (a) small sample sizes; (b) the athletes being studied are from the same sporting institutions, the sporting styles of which may independently contribute to pars interarticularis defects; or (c) the studies measure incidence in a small number of sports.…”

Section: Introductionmentioning

confidence: 97%

The Incidence of Pars Interarticularis Defects in Athletes

Tawfik

Phan

Mobbs

et al. 2019

Global Spine Journal

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Study Design: Literature review. Objective: To conduct a literature review of studies reporting the incidence of pars interarticularis defects in athletes of specific sports, in order to allow more targeted prevention and treatment strategies to be implemented for the groups at highest risk. Methods: Electronic searches were performed using PubMed, Ovid Medline, EMBASE, Google Scholar, Cochrane Database of Systematic Reviews, and Cochrane Database of Controlled Trials from their dates of inception to September 2017, with the following keywords: “spondylolysis,” “sports,” “low back pain,” and “pars defects.” Results: A total of 509 total articles were retrieved, of which 114 were used in the final review. The incidence of pars interarticularis defects was found to be highest in diving (35.38%), cricket (31.97%), baseball/softball (26.91%), rugby (22.22%), weightlifting (19.49%), sailing (17.18%), table tennis (15.63%), and wrestling (14.74%). Only 5 studies reported the management instituted for their participants, and these were all case reports. Of 74 players with spondylolysis in these studies, 70 (94.59%) underwent conservative treatment and 4 (5.41%) underwent surgical treatment. 61 (82.43%) returned to their previous level of play, 6 (8.11%) retired, and the disposition of the final 7 was not reported. Conclusion: The current medical literature provides good evidence that the incidence of pars interarticularis defects is higher in the athletic population, with the highest incidence in diving. There remains no gold standard protocol for the management of pars interarticularis defects. Further research is required to compare conservative therapy to surgical therapy and to compare the various surgical techniques to each other.

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Clinical Examination, Spondylolysis and Adolescent Athletes

Cited by 21 publications

References 17 publications

Clinical classification in low back pain: best-evidence diagnostic rules based on systematic reviews

Clinical classification in low back pain: best-evidence diagnostic rules based on systematic reviews

Management of spondylolysis and low-grade spondylolisthesis in fine athletes. A comprehensive review

The Incidence of Pars Interarticularis Defects in Athletes

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