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The physician has an important role in identifying unhealthy lifestyles, offering counselling and, if necessary, referring the patient to another profession or care unit. Therefore, knowledge and skills related to lifestyle habits are included in the goal description for residents in all clinical specialities.  SK courses in lifestyle habits should be based on National Guidelines for Prevention and Treatment - Support for Governance and Management (2018), issued by the Swedish National Board of Health and Welfare. Preferably, the course should include training sessions where the participants can practice the counselling techniques. The ethical principles provide the foundation for work related to lifestyle habits. The course should include evidence-based knowledge on how lifestyle habits affect symptoms, risk factors, and diseases, as well as the effect of changing lifestyle habits. Also, discussions about local routines and the physician's role in addressing lifestyle habits are valuable components of the course.

This review aims to enlighten the existing research about Achilles tendon ruptures (ATR) in racket sports. Further, this review will also include the acute management, rehabilitation, treatment and prognosis of an ATR. ATR is a common injury among individuals playing racket sports. However, the literature is limited and not up to date. Previous research claims that up to 70 percent of all ATR is related to sports activities where racket sports dominate. A large number of patients sustaining an ATR return to sport within a year from injury. 

Background: Pain from the lateral aspect of the elbow is a common symptom in racket sports, both in recreational and competitive players. In Tennis elbow (TE), the pain is elicited from the lateral epicondyle and the common extensor origin just distal of the epicondyle. The symptoms are aggravated by gripping activity and might be related to activity level, in work as well as in recreational or elite racket sports. TE is considered to be an overuse injury of degenerative nature and the diagnose is easily made, based on a typical history and clinical findings.

Objective: To present current knowledge concerning management of TE in racket sports by a review of the literature.

Methods: Narrative literature review.

Results: An overview of TE in racket sports with highlight on the clinical features, alternative diagnoses and suggested treatments in the literature. Since TE is considered to be an overuse injury, the paper also provides advises for training plan besides management until resolution of symptoms.

Conclusions: This painful condition is self-limiting with a good prognosis. No treatment has convincingly evidence, besides methods for reducing pain symptoms. When the pain symptoms are under control, it is important that the return to racket sports is gradual.

Antecedentes: El dolor en la parte lateral del codo es un síntoma común en los deportes de raqueta, tanto en jugadores recreacionales como de competición. En el codo de tenista (CT), el dolor se produce en el epicóndilo lateral y en el origen del extensor común justo distal al epicóndilo. Los síntomas se agravan con actividades de agarre y pueden estar relacionados con el nivel de actividad, ya sea en el trabajo o en los deportes de raqueta recreacionales o de élite. Se considera que el CT es una lesión por sobreuso de naturaleza degenerativa y el diagnóstico se realiza fácilmente basado en la historia y los hallazgos clínicos.

Objetivo: Presentar el conocimiento actual sobre el tratamiento del CT en los deportes de raqueta a través de una revisión de la literatura.

Métodos: Revisión de la literatura narrativa.

Resultados: Un resumen del CT en los deportes de raqueta con énfasis en las características clínicas, los diagnósticos alternativos y los tratamientos sugeridos en la literatura. Dado que el CT se considera una lesión por sobreuso, el artículo también hace sugerencias para un plan de entrenamiento adicional al tratamiento hasta que se resuelvan los síntomas.

Conclusiones: Esta condición dolorosa es autolimitada y tiene un buen pronóstico. No hay tratamiento con evidencia determinante, además de los métodos para reducir los síntomas de dolor. Cuando los síntomas de dolor están bajo control, es importante que el regreso a los deportes de raqueta sea gradual

Background: While metabolic health is acknowledged to affect connective tissue structure and function, the mechanisms are unclear. Glucocorticoids are present in almost every cell type throughout the body and control key physiological processes such as energy homeostasis, stress response, inflammatory and immune processes, and cardiovascular function. Glucocorticoid excess manifests as visceral adiposity, dyslipidemia, insulin resistance, and type 2 diabetes. As these metabolic states are also associated with tendinopathy and tendon rupture, it may be that glucocorticoids excess is the link between metabolic health and tendinopathy. Objective: To synthesise current knowledge linking glucocorticoid exposure to tendon structure and function. Methods: Narrative literature review. Results: We provide an overview of endogenous glucocorticoid production, regulation, and signalling. Next we review the impact that oral glucocorticoid has on risk of tendon rupture and the effect that injected glucocorticoid has on resolution of symptoms. Then we highlight the clinical and mechanistic overlap between tendinopathy and glucocorticoid excess in the areas of visceral adiposity, dyslipidemia, insulin resistance and type 2 diabetes. In these areas, we highlight the role of glucocorticoids and how these hormones might underpin the connection between metabolic health and tendon dysfunction. Conclusions: There are several plausible pathways through which glucocorticoids might mediate the connection between metabolic health and tendinopathy.

Pain from the lateral and the medial aspect of the elbow is a common symptom in sports, other recreational activities, or work. In tennis elbow, the pain is elicited from the common extensor origin just distal of the lateral epicondyle, while in golfer's elbow, the pain is elicited from the flexor-pronator mass just distal to the medial epicondyle. The main symptoms are pain from the epicondyles of the elbow and are related to activity level. The pathogenesis is not known, but these conditions are considered to be overuse injuries of degenerative nature. The diagnoses are verified by clinical examination. Further investigation is not necessary with typical history and clinical findings, and the conditions are self-limiting with good prognosis. In the literature, the golden standard for treatment is conservative treatment although the support in the literature is not conclusive. No treatment has convincing evidence for a faster recovery even though there are, of course, methods for reducing pain symptoms. When the pain is under control, it is important that the return to activity is gradual.

PURPOSE: To describe the incidence and injury distribution of knee injuries in the general population of a European setting. METHODS: Retrospective study of all knee injuries registered at the Emergency Department at Umeå University Hospital, Sweden, during 1995-2009 in relation to age, sex, diagnosis, location and activity at the time of injury, mechanism of injury, and treatment and/or follow-up plan. RESULTS: During 1995-2009, 12,663 knee injuries were registered, 8 % of all injuries. The incidence of knee injuries resulting in a visit to the Emergency Department was six cases per 1,000 person years. One-third of all injuries occurred during sports. And 30 % were 15-24 years. More men than women were injured during sporting activities and women were mostly injured during transportation. CONCLUSION: Knee injuries in a general population are common and the injury distribution varies with age and sex. Sports activities and young age were prominent features of the injured population. LEVEL OF EVIDENCE: IV.

Tennis elbow is a common and difficult-to-treat condition largely because of lack of evidence. The natural history is unknown, but the condition is described as self-limiting. The objective of this case report is to describe the natural course of two control participants (pain free), who later developed tennis elbow, patient history, clinical findings, and ultrasound and colour Doppler examination before, during and after a period of tennis elbow.

Background Tennis elbow is a tendinopathy affecting the upper extremity. Recent studies have shown high sensitivity for ultrasound (US) examination and high specificity for colour Doppler (CD) examination. There are no mid- or long-term follow-up investigations of the tendon structure and blood flow using these techniques.

Objective To use US and CD to study structure and blood flow in the extensor origin in patients with tennis elbow treated with intratendinous injections.

Design Follow-up study

Setting Sports Medicine Unit, Umeå University.

Patients 25 patients (28 elbows), mean age 46 years (range 27–66), treated with intratendinous injections due to chronic pain from tennis elbow.

Method US and CD examination of the extensor origin was carried out at inclusion and at follow-up two years after intratendinous injection treatment with polidocanol and/or a local anaesthetic.

Main outcome measurements US (structure) and CD (blood flow) findings.

Results All patients had structural tendon changes and high blood flow at inclusion when given the injection treatment. At the two-year follow-up, structural tendon changes were seen in 20/28 elbows and high blood flow was seen in 4/28 elbows. The majority of patients with a good clinical result after treatment had no visible blood flow (17/20), but the structural changes showed no relation to a good result (13/20 remaining changes).

Conclusions Doppler findings, but not structure, might be related to the clinical result after intratendinous injection treatment of tennis elbow.

OBJECTIVE: To appraise existing evidence for prolotherapy, polidocanol, autologous whole blood and platelet-rich plasma injection therapies for lateral epicondylosis (LE). DESIGN: Systematic review. DATA SOURCES: Medline, Embase, CINAHL, Cochrane Central Register of Controlled Trials, Allied and Complementary Medicine. Search strategy: names and descriptors of the therapies and LE. STUDY SELECTION: All human studies assessing the four therapies for LE. MAIN RESULTS: Results of five prospective case series and four controlled trials (three prolotherapy, two polidocanol, three autologous whole blood and one platelet-rich plasma) suggest each of the four therapies is effective for LE. In follow-up periods ranging from 9 to 108 weeks, studies reported sustained, statistically significant (p<0.05) improvement in visual analogue scale primary outcome pain score measures and disease-specific questionnaires; relative effect sizes ranged from 51% to 94%; Cohen's d ranged from 0.68 to 6.68. Secondary outcomes also improved, including biomechanical elbow function assessment (polidocanol and prolotherapy), presence of abnormalities and increased vascularity on ultrasound (autologous whole blood and polidocanol). Subjects reported satisfaction with therapies on single-item assessments. All studies were limited by small sample size. CONCLUSIONS: There is strong pilot-level evidence supporting the use of prolotherapy, polidocanol, autologous whole blood and platelet-rich plasma injections in the treatment of LE. Rigorous studies of sufficient sample size, assessing these injection therapies using validated clinical, radiological and biomechanical measures, and tissue injury/healing-responsive biomarkers, are needed to determine long-term effectiveness and safety, and whether these techniques can play a definitive role in the management of LE and other tendinopathies.

BACKGROUND: Tennis elbow (TE) is a painful condition affecting the common extensor origin at the lateral humeral epicondyle. Colour Doppler examination has shown increased blood flow at this site and the sensory, and sympathetic innervation patterns have been delineated. However, it is not known whether there is local production of catecholamines and/or acetylcholine in this tissue, which is the case in patellar and Achilles tendinopathies. OBJECTIVE: To investigate the possible presence of local production of catecholamines and acetylcholine in non-neuronal cells (fibroblasts) in connective tissue at the muscle origin at the lateral humeral epicondyle in patients with TE. DESIGN: Immunohistochemical studies were performed on biopsies taken from the extensor origin in patients with TE and in pain-free controls. For reference purpose, biopsies from the flexor origin in patients with golfer's elbow (GE) were also studied. PATIENTS: Seven patients with TE and four patients with GE. Six healthy asymptomatic individuals served as controls. Method: Immunohistochemistry, using antibodies detecting synthesising enzymes for catecholamines (tyrosine hydroxylase; TH) and acetylcholine (choline acetyltransferase; ChAT). RESULTS: TH-like immunohistochemical reactions were seen in fibroblasts in four of the seven patients with TE and two of the four patients with GE. No such reactions were detected in controls (0/6). No ChAT reactions were seen in any of the investigated specimens. CONCLUSIONS: There is evidence of local, non-neuronal production of catecholamines, but not acetylcholine, in fibroblasts in the tissue at the muscle origin at the lateral and medial epicondyles in patients with TE and GE, respectively, which might have an influence on blood vessel regulation and pain mechanisms in these conditions.