Mental health symptoms and disorders are common among elite athletes, may have sport related manifestations within this population and impair performance. Mental health cannot be separated from physical health, as evidenced by mental health symptoms and disorders increasing the risk of physical injury and delaying subsequent recovery. There are no evidence or consensus based guidelines for diagnosis and management of mental health symptoms and disorders in elite athletes. Diagnosis must differentiate character traits particular to elite athletes from psychosocial maladaptations.Management strategies should address all contributors to mental health symptoms and consider biopsychosocial factors relevant to athletes to maximise benefit and minimise harm. Management must involve both treatment of affected individual athletes and optimising environments in which all elite athletes train and compete. To advance a more standardised, evidence based approach to mental health symptoms and disorders in elite athletes, an International Olympic Committee Consensus Work Group critically evaluated the current state of science and provided recommendations.

/pdf/mental-health-in-elite-athletes-international-olympic-2thfae2q5f.pdf

Mental health in elite athletes: International Olympic Committee consensus statement (2019).

Subacromial impingement syndrome (SIS) represents a spectrum of pathology ranging from subacromial bursitis to rotator cuff tendinopathy and full-thickness rotator cuff tears. The relationship between subacromial impingement and rotator cuff disease in the etiology of rotator cuff injury is a matter of debate. Both extrinsic compression and intrinsic degeneration may play a role. Management includes physical therapy, injections, and, for some patients, surgery. There remains a need for high-quality studies of the pathology, etiology, and management of SIS.

https://www.uhasselt.be/Documents/UHasselt/initiatieven/2012/schouderklachten/1-Overzichtsartikel-All%20in%20one/1-A2-Shoulder-Flatow-Subacromial%20impingement-JAOOS-2011.pdf

Subacromial impingement syndrome.

Background: Joint injections and aspirations are used to reduce joint pain and decrease inflammation. The efficacy of these injections is diminished when they are placed inadvertently in the wrong location or compartment. The purpose of this study was to determine whether the use of varying sites or imaging techniques affects the rate of accurate needle placement in aspiration and injection in the shoulder, elbow, and knee. Hypotheses: (1) Accuracy rates of different joint injection sites will demonstrate variability. (2) Injection accuracy rates will be improved when performed with concomitant imaging. Study Design: Systematic review of the literature. Methods: Studies reporting injection accuracy based on image verification were identified through a systematic search of the English literature. Accuracy rates were compared for currently accepted injection sites in the shoulder, elbow, and knee. In addition, accuracy rates with and without imaging of these joints were compared. Results: In the glenohumeral joint, there is a statistically higher accuracy rate with the posterior approach when compared with the anterior approach (85% vs 45%). Injection site selection did not affect accuracy for the subacromial space, acromioclavicular joint, elbow, or knee. The use of imaging improved injection accuracy in the glenohumeral joint (95% vs 79%), subacromial space (100% vs 63%), acromioclavicular joint (100% vs 45%), and knee (99% vs 79%). Conclusion: Injection accuracy rates are significantly higher for the posterior approach compared with the anterior approach for the glenohumeral joint. Similarly, the accuracy rates are also higher when imaging is used in conjunction with injection of the glenohumeral joint, subacromial space, acromioclavicular joint, and knee.

Improving injection accuracy of the elbow, knee, and shoulder: does injection site and imaging make a difference? A systematic review.

Expert and exceptional performance are shown to be mediated by cognitive and perceptual-motor skills and by domain-specific physiological and anatomical adaptations. The highest levels of human performance in different domains can only be attained after around ten years of extended, daily amounts of deliberate practice activities. Laboratory analyses of expert performance in many domains such as chess, medicine, auditing, computer programming, bridge, physics, sports, typing, juggling, dance, and music reveal maximal adaptations of experts to domain-specific constraints. For example, acquired anticipatory skills circumvent general limits on reaction time, and distinctive memory skills allow a domain-specific expansion of working memory capacity to support planning, reasoning, and evaluation. Many of the mechanisms of superior expert performance serve the dual purpose of mediating experts' current performance and of allowing continued improvement of this performance in response to informative feedback during practice activities.

/pdf/theories-and-research-in-clinical-decision-making-and-skill-3yaggixgq1.pdf

Theories and Research in Clinical Decision Making and Skill Acquisition in Nursing Practice : Skill Acquisition ; Expert and exceptional performance: evidence of maximal adaptation to task constraints

Joint aspiration/injection and synovial fluid (SF) analysis are both invaluable procedures for the diagnosis and treatment of joint disease. This chapter addresses: (1) the indications, the technical principles and the expected benefits and risks of aspiration and injection of intra-articular corticosteroid; and (2) practical aspects relating to SF analysis, especially in relation to crystal identification. Intra-articular injection of long-acting insoluble corticosteroids is a well-established procedure that produces rapid pain relief and resolution of inflammation in most injected joints. The knee is the most common site to require aspiration, although any non-axial joint is accessible for obtaining SF. The technique requires a knowledge of basic anatomy and should not be unduly painful for the patient. Provided sterile equipment and a sensible, aseptic approach are used, it is very safe. Analysis of aspirated SF is helpful in the differential diagnosis of arthritis and is the definitive method for diagnosis of septic arthritis and crystal arthritis. The gross appearance of SF can provide useful diagnostic information in terms of the degree of joint inflammation and presence of haemarthrosis. Microbiological studies of SF are the key to the confirmation of infectious conditions. Increasing joint inflammation is associated with increased SF volume, reduced viscosity, increasing turbidity and cell count, and increasing ratio of polymorphonuclear: mononuclear cells, but such changes are non-specific and must be interpreted in the clinical setting. However, detection of SF monosodium urate and calcium pyrophosphate dihydrate crystals, even from un-inflamed joints during intercritical periods, allow a precise diagnosis of gout and of calcium pyrophosphate crystal-related arthritis.

Joint aspiration and injection and synovial fluid analysis

OBJECTIVE: To determine whether grade point average, hours of clinical education, or both are significant predictors of performance on the National Athletic Trainers' Association Board of Certification examination and whether curriculum and internship candidates' scores on the certification examination can be differentially predicted. DESIGN AND SETTING: Data collection forms and consent forms were mailed to the subjects to collect data for predictor variables. Subject scores on the certification examination were obtained from Columbia Assessment Services. SUBJECTS: A total of 270 first-time candidates for the April and June 1998 certification examinations. MEASUREMENTS: Grade point average, number of clinical hours completed, sex, route to certification eligibility (curriculum or internship), scores on each section of the certification examination, and pass/fail criteria for each section. RESULTS: We found no significant difference between the scores of men and women on any section of the examination. Scores for curriculum and internship candidates differed significantly on the written and practical sections of the examination but not on the simulation section. Grade point average was a significant predictor of scores on each section of the examination and the examination as a whole. Clinical hours completed did not add a significant increment for any section but did add a significant increment for the examination overall. Although no significant difference was noted between curriculum and internship candidates in predicting scores on sections of the examination, a significant difference by route was found in predicting whether candidates would pass the examination as a whole (P =.047). Proportion of variance accounted for was less than R(2) = 0.0723 for any section of the examination and R(2) = 0.057 for the examination as a whole. CONCLUSIONS: Potential predictors of performance on the certification examination can be useful to athletic training educators in assisting students. These findings must be used cautiously because of the low proportion of explained variance. Low R(2) values suggest that the largest contributors to performance on the examination were not identified in this study. Although the results of this study support the decision to discontinue the internship route to certification, continued research focusing on identification and investigation of the constructs that contribute to examination success is needed.

Predicting Performance on the National Athletic Trainers' Association Board of Certification Examination From Grade Point Average and Number of Clinical Hours.

Incorporating Gaming Technology into Athletic Injury Rehabilitation: A Review of the Literature

Objectives: To examine methods used to evaluate the clinical competence and proficiency of students in medicine and allied health professions. To identify factors that would be valuable to educators in athletic training and other medical and allied health professions in the development and use of clinical assessment methods. Data Sources: We searched EBSCO Academic, InfoTrac, MEDLINE and PubMed for literature from professional journals related to clinical education, assessing clinical competence, clinical competence, clinical proficiency assessment. Data Synthesis: Assessment of competence in the clinical setting is an issue for medicine and allied health education programs, including athletic training. Methods used to assess clinical competence included written, objective tests, checklists, oral examinations, patient management problems, simulated patients, observed clinical situations, the Observed Structured Clinical Exam and observation of students. Each method has its advantages and concerns. Psychom...

Issues in Selecting Methods of Evaluating Clinical Competence in the Health Professions: Implications for Athletic Training Education.

Context: Navicular drop is widely believed to be an indicator of elevated susceptibility to pronation-related injuries, which may be increased by fatigue in the muscles that dynamically support the medial longitudinal arch. Objective: The purpose of this study was to evaluate navicular drop before and after fatigue of the ankle invertor muscles among individuals with different foot types. Participants: 20 male and 16 female recreationally active, college-age volunteers (20.03 ± 1.48 years of age). Methods: Navicular drop was measured before and after inducing fatigue in the ankle invertor muscles. Participants’ foot types were classified as high-arch, neutral, or low-arch. Results: There was no interaction between foot type and trial, and no main effect for trial. A main effect for foot type was significant (p = .001). Intra-class correlation coefficients for prefatigue and postfatigue measurements indicated good internal consistency. Conclusion: Our fndings failed to provide any evidence to support the e...

Navicular Drop Before and After Fatigue of the Ankle Invertor Muscles

Teaching High-Risk Clinical Competencies: Simulations to Protect Students and Models

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