A Mansingh

Methods for injury surveillance in international cricket

Background: The varying methods of cricket injury surveillance have made direct comparison of published studies in this field impossible. Methods: A consensus regarding definitions and methods to calculate injury rates in cricket was sought between researchers in this field. This was arrived at through a variety of face to face meetings, email communication, and draft reviews between researchers from six of the major cricket playing nations. Results: It is recommended that a cricket injury is defined as any injury or other medical condition that either (a) prevents a player from being fully available for selection for a major match or (b) during a major match, causes a player to be unable to bat, bowl, or keep wicket when required by either the rules or the team’s captain. Recommended definitions for injury incidence (for matches, training sessions, and seasons) and injury prevalence are also provided. It is proposed that match injury incidence is calculated using a denominator based on a standard time estimated for player exposure in matches, for the purposes of simplicity. This will allow all injury surveillance systems, including those with limited resources, to make calculations according to a standard definition. Conclusion: The consensus statement presented provides a standard which, if followed, allows meaningful comparison of injury surveillance data from different countries and time periods, which will assist in the possible identification of risk factors for injury in cricket.

Injuries in West Indies cricket 2003–2004

Objective: To analyse injuries in West Indies Cricket and compare them with those of other cricket playing nations. Methods: Injuries between June 2003 and December 2004 were surveyed prospectively in all major matches of the West Indies Cricket Board. Results: Most injuries occurred in the West Indies Test and one day international teams. Mean match injury incidence was 48.7 per 10 000 player-hours in Test cricket, and 40.6 per 10 000 player-hours in one day international cricket, with injury prevalence of 11.3% and 8.1% respectively. In domestic cricket, the match injury incidence was 13.9 per 10 000 player-hours for first class cricket, and 25.4 per 10 000 player-hours in one day domestic competitions. There were more injuries on tour for the West Indies team than at home. The batsmen and fast bowlers sustained 80% of injuries, with many leading to long absence from the game, although many of these injuries were sustained while fielding. Most injuries were of the phalanges (22%) and the lumbar spine (20%) sustained mainly while fielding (including catching) and fast bowling respectively. Conclusions: Injuries in West Indies cricket may be reduced by (a) early detection and management of injuries on tour, (b) attention to fielding and catching techniques, and (c) monitoring of young fast bowlers.

Knowledge and Attitudes towards Fluid Hydration of Athletes by Jamaican Track and Field High School Coaches

Objective: To determine whether or not Jamaican coaches’ knowledge and practices of fluid replacement is on par with that of the National Athletic Association’s and the American College of Sports Medicine Standards. Methods: A descriptive survey of 90 high school track and field coaches in Jamaica was conducted. Coaches were given a 29 item survey questionnaire which adapted the content from previous surveys and also based on the National Athletic Training Associations’ guidelines for fluid replacement and information sources of fluid replacement. A pass score of 80% was employed. Results: 26.6% of participants passed the knowledge based assessment with the minimum requirement of 80%. Approximately 73.4% of participants had an unacceptable level of knowledge about fluid replacement and hydration. Only 26 (28.9%) received training in fluid replacement therapy. Most therefore relied on reading material ranging from magazines to journals, or learnt it on the job from other coaches. Conclusion: Findings suggest that the level of knowledge in Jamaican track and field high school coaches about fluid replacement and hydration is very poor. However their attitudes towards fluid replacement and hydration are very good and this will facilitate their acceptance and adoption of correct fluid replacement guidelines. Tapping into this positive attitude and implementing workshops, seminars and on-site promotion should improve the coaches’ knowledge significantly.

An Unusual Cause of Locking of the Knee: Pedunculated Pigmented Villo-nodular Synovitis.

The Editor, Sir, Locking of the knee is an acute traumatic extension deficit with an inability to achieve full active or passive extension (1, 2). True locking indicates a mechanical block while pseudo-locking indicates a functional block (1). Most cases of locking of the knee are due to meniscal and ligamentous injuries and loose bodies (1). Pigmented villo-nodular synovitis (PVNS) represents a rare but important cause of locking of the knee (3, 4). Recognition of this cause will lead to early and definitive management. A 22-year old female was removing her boots when she developed sudden onset pain to her right knee and inability to fully extend the joint. She had no swelling of the knee joint and had no previous trauma to the knee. There was no history of any previous problems with that knee or any other joint. Over the next four weeks, she ambulated with a limp and reported that at times the knee seemed to be able to extend better than other times. She subsequently sought medical attention. On examination, she had an antalgic gait with swelling of the right knee. Her range of motion was 10– 110 degrees and she had mild lateral joint line tenderness. She had no ligament laxity and no masses were palpable. Magnetic resonance imaging (MRI) of the knee was reported as normal except for a joint effusion. Based on the clinical features, arthroscopy of the knee was performed. At surgery, a pedunculated brown lesion was noted in the lateral gutter arising from the synovium. The entire joint was evaluated for additional lesions but this was the only lesion found. It was excised in total and sent for histology. The patient had two months of postoperative physiotherapy after which she had full range of motion of the knee and no residual joint effusion. Histology of the lesion showed nodules of synovial-lined fibro-cartilagenous tissue infiltrated by a chronic inflammatory cell infiltrate composed of sheets of foamy histiocytes, siderocytes and occasional langerhans and cells mixed with mononuclear cells. These histological features are consistent with PVNS. Pigmented villo-nodular synovitis presents clinically as two different entities, a localized form and a diffuse form (5). In cases in which none of the common causes is identified, it is prudent that the clinician consider other rare but important diseases including PVNS and intra-articular tumours. A diagnosis of PVNS may be suggestive from the history of the patient, as these patients usually have an insidious onset with diffuse discomfort as opposed to focal pain seen in meniscal disorders. The joint effusion is often out of proportion with the degree of discomfort and joint aspirate often reveals a brown coloured to haemorrhagic fluid. A significant number of patients may also have a palpable mass. Plain radiography often offers no diagnostic help and features suggestive of PVNS are seen in less than thirty per cent of patients with PVNS of the knee (6). Figure Pigmented villo-nodular synovitis localized in the lateral gutter at arthroscopic surgery. Magnetic resonance imaging is the imaging investigation of choice with the classic low signal lesion on both T1 and T2 weighted images. In fat suppressed images, the mass is high signal and may enhance with thallium Tl-201 scintigraphy (7). However, the MRI can be negative as in the present case. Parikh et al reported experience of similar circumstances of a negative MRI and positive arthroscopic findings in two cases (8). Clinicians need to be aware that intra-articular tumours are an important cause of locking of the knee.