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Achilles tendinopathy has been reported as the most common overuse injury in sports medicine clinics (Clement et al. Am J Sports Med 12: 179-184, 1984). Standard treatment regimens include activity modification, heel lifts, arch supports, stretching exercises, nonsteroidal anti-inflammatories, and eccentric loading. There is a lack of consensus regarding treatment. Even so, most athletes will respond to this regimen. However, conservative management will prove to be inadequate for a subset of patients. When conservative therapy fails, other noninvasive treatment measures may be considered. Extracorporeal shock wave therapy (ESWT) has been used in soft-tissue disorders including lateral epicondylitis, plantar fasciitis, and calcific tendonitis of the shoulder. Conclusive evidence recommending ESWT as a treatment for Achilles tendinopathy is lacking. This article explores the role of shock wave therapy in the management of recalcitrant Achilles tendinopathy in patients attempting to avoid an invasive intervention.

Twenty-one fourth-year medical students were given a brief lecture on ultrasound of the knee and fifteen minutes of supervised ultrasound scanning of three cadavers which had been injected with saline to give varying degrees of knee effusions. Each student was then individually observed and required to scan both knees of a cadaver different from the practice cadavers and identify the patella, the femur, the quadriceps tendon and if a suprapatellar effusion was present, and which knee had the larger effusion. All twenty-one students correctly identified all anatomical structures, suprapatellar effusions, and which knee had the larger effusion. Identifying a knee effusion can be an important clinical finding in diagnosing and managing a patient with knee complaints. Fourth-year medical students can learn to identify knee effusions with ultrasound following a brief introductory lecture and hands-on scanning practice session.

Nutritional supplements are widely used by patients and athletes around the world for many different reasons. Many companies are thriving on this billion-dollar industry with little proof that these substances do what they are reported or suggested to do. Beta-hydroxy-beta-methylbutyrate (HMB) is a relatively new supplement on the ergogenic landscape. Studies of HMB supplementation have shown minimal gains in strength and lean body mass in specific populations, mainly untrained athletes and patients with wasting syndromes. HMB use in those athletes involved in regular high-intensity exercise has not been proven to be beneficial when multiple variables are evaluated. Unlike other ergogenics, with HMB no adverse events have been reported in association with short-term use. Despite these findings, HMB cannot be recommended as an ergogenic until further studies in larger groups reproduce early data. This review summarizes current literature on HMB, and provides the reader with information to better educate and treat patients and athletes.

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