This book on sports medicine is one of eight in a series of
subspecialty-based "first reads" for students, orthopaedic
residents, and fellows in both orthopaedics and primarycare sports medicine.
The stated goals are to provide readable essential information for general
understanding in an approximately three-month rotation. The text is also
written for physician assistants and nurse practitioners as well as physical
therapists and athletic trainers interested in the care of athletes. The
volume is divided into five sections: Special Issues, Medical Issues, Upper
Extremity, Lower Extremity, and Rehabilitation. The chapters are commonly
formatted according to the topics of pathogenesis (classification,
pathophysiology, etiology, and epidemiology), diagnosis (history, physical
examination, imaging), and treatment (medical decision-making, nonoperative
and operative treatment, and postoperative management). The text itself is not
referenced, but a few selected references are included at the end of each
chapter for further reading. In general, there are ample figures, important
tables on key information, and excellent algorithms that primarily detail the
decision-making process as it relates to treatment.
This fundamental knowledge textbook is appropriate for a learner's
"first read" in sports medicine. The common practice observed
today is for students to use a review monograph since the large reference
textbooks are not readable in a three-month rotation. Thus, this textbook
appropriately fits in this early reading niche. Furthermore, the reader will
gain a much clearer understanding of etiology and medical decision-making in
sports medicine by reading this text than by memorizing the answers in a
monograph designed for test review. The strengths of this textbook include a
common format, clearly outlined sections, comprehensive coverage, clear
writing style, and well-illustrated figures, tables, and algorithms.
Several chapters are especially noteworthy. These include "Female
Athletes" (Chapter 4), "Medical Concerns of the Team
Physician" (Chapter 12), "Anatomy and Biomechanics of the
Shoulder" (Chapter 14), "Anterior Instability of the
Shoulder" (Chapter 17), and "Upper Extremity Nerve Injuries"
(Chapter 21). Curiously, the section on the upper extremity (Section III) and
the section on the lower extremity (Section IV) both have a slightly different
approach to anatomy and biomechanics and to physical examination. The section
on the upper extremity extensively covers these topics in the first two
chapters, whereas the section on the lower extremity incorporates this
information in the first few pages of each chapter. In my opinion, inclusion
of this information in specific anatomic chapters is preferable not only to
facilitate the process of learning but also to shorten the length of each
chapter and avoid redundancy.
There are several areas for improvement in this textbook. First, 485 pages
of text is a little too long for three months of reading. Thus, I would
recommend that students of sports medicine first read the sections titled
"Upper Extremity" and "Lower Extremity," then
"Rehabilitation." If time permits, they should choose the most
important chapters in "Special Issues" and "Medical
Issues." Several of the chapters in these two sections are quite long
and contain information that is already discussed in the chapters on adult
athletes. Perhaps these two sections should be combined in future editions of
the book. The approach to references could be changed to advance a reader's
knowledge of the evidence behind the subject matter. Publishing the level of
evidence that was assigned to each study would reinforce the concept of
evidence-based medicine. For example, the reader could be led to understand
that a treatment decision that was originally based on the results of a case
series study (Level IV) is subject to change when the results of a cohort
study (Level II) or a randomized control trial (Level I) are available in the
future. Perhaps a second edition of this book could clearly state whether
references are current concepts reviews, expert opinions (instructional course
lectures), or research-based studies (Levels I through IV). In the algorithmic
presentations of the percentage of patients who underwent nonoperative
compared with operative treatment, information could be offered to aid the
reader in seeing each condition in an appropriate clinical context. For
example, the final end point in the patellofemoral pain algorithm is surgery,
yet surgery should be offered to only a very small percentage of patients.
Finally, several of the chapters offer suggested references that were
published before 2000, and these references should be appropriately
updated.
In conclusion, I congratulate the editors and authors on providing a
clearly written, excellent "first read" for learners in sports
medicine. This book will enhance the sports-medicine knowledge of all who read
it and will hopefully stimulate further evidence-based inquiry in sports
medicine. I hope that the authors accept my comments as constructive
criticism, as I enjoyed reading this textbook and look forward to future
editions.