Artroscopia y reconstrucción articular

martes, 28 de enero de 2014

The shoulders of giants

Br J Sports Med 47:873 doi:10.1136/bjsports-2013-092852
  • Warm up

The shoulders of giants

  1. Johannes Zwerver2
+Author Affiliations
  1. 1Department of Sports Medicine, Aspetar, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  2. 2University of Groningen, University Medical Center Groningen, Center for Sports Medicine, Groningen, the Netherlands
  1. Correspondence toDr Adam Weir, Department of Sports Medicine, Aspetar, Qatar Orthopaedic and Sports Medicine Hospital, Doha 29222, Qatar;
  • Accepted 5 July 2013
As far back as 1159 John of Salisbury realised, and later Newton acknowledged that advances in science were made by building on previous knowledge. They likened themselves to dwarves who were only able to discover distant wonders because they sat on the shoulders of giants. Although we have moved on nearly an entire millennium since this phrase was coined, the principle still holds up. Kentucky, while famous for fried chicken, also has some more healthy exports to its credit. The Second Scapular Summit, held in Lexington, lead to this month's consensus paper ( which summarises the current state of affairs, allows us to elevate our knowledge and broadens our vision on this subject.
In his editorial, Dr Ben Kibler (, who is recognised as one of the giants in the field, glances back over his own shoulder and explains the origins of the article. Dr Babette Pluim reflects on the practical application of some of the recommendations made during the scapular summit in her editorial on page 875. There is also a podcast with Dr Kibler (
As we wing our way through this Dutch Association of Sports Medicine issue of the BJSM, we encounter a wealth of great publications. A thorough clinical examination, an art as old as medicine itself, remains the corner stone of diagnostics in sports medicine. The shoulder and hip are all areas commonly injured in athletes presenting for advice and treatment. This issue contains a series of articles that give insight and help us refine our evidence-based physical examination techniques (, Our honed examination skills will enable us to diagnose injuries in patients more accurately and hopefully lead to improved treatment.

Some exercises are more equal than others

We once again rub shoulders with the BMJ in our highlighted paper on the treatment of subacromial impingement syndrome. In many studies exercise programmes are not well reported or not specified for the condition being studied. Holmgren et al's study on page 908which includes a clear description of the physical tests used and of the programme followed, demonstrates that some exercises are more equal than others. The use of a scapula and cuff-specific programme gave significantly better outcomes than unspecific movement exercises for the neck and shoulder, and was successful in decreasing the need for surgery. We hope that future studies on exercise programmes as interventions will continue to include an accurate description of the intervention used. The PEDro for this month also covers the topic of exercise therapy for shoulder impingement syndrome and gives us a great summary of the literature on this subject (see page 927).

Falling this fall

As we approach the cooling down of this fall warm up we include a Dutch paper on falling. While falling itself could not be easier, landing is the hard part. This study examined whether school children could be taught to land more safely and with improved technique in order to prevent getting themselves injured. If you are curious about whether it worked check out the paper on page ( To finish off on a Dutch note we also have a podcast with Professor Ron Dierks from the University of Groningen on the latest sports medical news from Holland (


  • Competing interests None.
  • Provenance and peer review Not commissioned; internally peer reviewed.

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