SPORTS INJURIES HAMSTRING ACL OVERHEAD ATHELTE I Dr.RAJAT JANGIR JAIPUR
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Dr.RAJAT JANGIR(Asso Prof.)
Senior Consultant Arthroscopy and Joint Replacement
(Specialist in Shoulder Knee Hip Surgery)
Ligament and Joints Clinic
67/34 Mansarovar Jaipur
Whatsapp: shorturl.at/gnAEP
Appointment: +91 8104855900
Email: ligamentsurgeon@gmail.com
Google Page: https://g.page/KNEE-Shoulder-SURGERY?...
Facebook: https://www.facebook.com/Ligamentandj...
* Vast experience and specialisation in the field of Arthroscopy and sports surgery.
* M.S. orthopaedics from BJ Medical College, Civil hospital, Ahmedabad
* Fellowship in Arthroscopy and Sports injury with Prof Joon Ho Wang at Samsung Medical Center, South Korea
* Diploma in Sports Medicine from InternationaI Olympic Committee
* Invited as Athlete Medical Doctor at Rio Olympic 2016
* Done Rajasthan's first "All Inside Physeal Preserving ACL reconstruction" in 13 year old Athlete
Dr.Rajat is rated as one of the best orthopedic surgeon with with excellence in Knee Shoulder Arthroscopy surgeries as replacements'
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SPORTS INJURY JAIPUR TALK I Dr.RAJAT JANGIR JAIPUR
1. SPORTS INJURIES
Dr.RAJAT JANGIR
Consultant Arthroscopy and Sports Injury
Ligament and Joints Clinic, Mansarovar, Jaipur
MS Ortho (Ahmedabad)
Fellow Arthroscopy(S.Korea)
Dip Sports Med IOC
3. But for some people—particularly those who overdo or who don’t
properly train or warm up—these benefits can come at a price:
sports injuries.
4. Knee injuries (55%) >Shoulder> Ankle
The most common injuries are
strains or sprains (41%),
broken bones (20%),
bruises or superficial injuries (19%)
5. India: Data Sparse
Journal of Athletic Enhancement: Prevalence of Sports Injuries in
Adolescent Athletes Ieleni Sreekaarini, KMC Manipal
15. Rest
Remove player from field
Rest injured area
Immobilize area
Why?
Reduces further tissue damage
Reduces blood flow
Allows for full assessment of injury
16. Ice
Ice bag, pack
Ice water bath
15 mins/ 5 times a day
Why?
Cool the area which constricts blood vessels, reduces blood flow and fluid
leakage, less swelling, pressures and pain
17. Compression
Compress injured area with
Elastic bandage
Move distal to proximal
Why?
External pressure reduces fluid leakage and bleeding into tissues
Provide support the area
18. Elevation
Elevate area above height
Why?
Reduces bleeding as blood has to flow up hill
Gravity helps swelling to move towards lymph nodes
19. No HEAT
Includes
Hot packs
Spas
Saunas
Why?
Increases blood flow to area therefore increases swelling
20. No ALCOHOL
Includes most things adults enjoy after a game of sports
Why?
Thins blood which increases swelling
Adds toxins to already injured area
21. No RUNNING
Includes running as well as any exercise that is painful
Why?
Increases in tissue damage
Overload to other area as compensation
22. No MASSAGE
Rub down
Massage
Mobilizations
Why?
May increases tissue damage
Increases blood circulation to the injured area
26. Lesions
• Specific to the overhead athlete
- Internal impingement
- UPS (Unstable Painful Shoulder)
• Not specific to the overhead athlete
- SLAP tears
- Anterior Instability
- Sub-acromial impingement
- Fractures/ dislocations
28. Pathology
• Cardinal lesions
• Articular sided rotator cuff tears
• Postero-superior labral lesions
• Landmark article: Walch G, Boileau P, Noel E, et al. Impingement of the deep surface of the
supraspinatus tendon on the posterosuperior glenoid rim: an arthroscopic study. J Shoulder Elbow
Surg. 1992;1:238-245.
29. Symptoms
ation
• Pain during maximal abduction/ external rot
• Posterior joint line / shoulder girdle pain
• Progressive decrease in velocity. Loss of control /
performance.
• Symptoms of anterior instability (?)
30. Signs
• Posterior glenohumeral joint-line tenderness
• Loss of Internal Rotation
• Excessive External rotation
• Special tests
- for SLAP, biceps, Cuff and instability
31. Specific test
• Internal impingement test
• Place arm in Abduction 90-110, Max ER, Ext 10-15.
• Deep posterior shoulder pain
• In non contact injuries; 95% sensitivity, 100%
specificity
Meister K, Buckley B, Batts J. The posterior impingement sign: diagnosis of rotator cuff and posterior labral tears
secondary to internal impingement in overhand athletes. Am J Orthop. 2004;33:412-415.
32. Specific test
• Jobe’s Relocation test
• Abduction and external rotation causes posterior joint
line pain.
• relieved by anterior pressure
34. UPS: Unstable Painful shoulder
• Symptoms of pain
• No symptoms of instability.
• Imaging / Arthroscopy suggestive of instability
• Apprehension test caused pain
Retrospective Mean 38 months FU
• 95% satisfied 75% return to sports.
The unstable painful shoulder (UPS) as a cause of pain from Unrecognized Anteroinferior
instability in the young athlete.
J Shoulder Elbow Surg. 2011 Jan;20(1):98-106.
Boileau P, Zumstein M, Balg F, Penington S, Bicknell RT. Hôpital de L'Archet, Nice,
France.
36. Decision making
• Level of participation
• Sport
• Motivation
• Season
Surgeon
Therapist Coach
Patient
37. Beware!
!• Cuff tears in asymptomatic individuals
• Labral tears in asymptomatic athletes !
• Pathologies which do not corelate with clinical
picture !
• Low sensitivity of scans to pick PT cuff tears
Avoid Excessive reliance on scans
38. Role of surgery
• After exhausting rehab options.
• “Trial of Therapy” vs “early surgery” = overuse vs
acute trauma
41. Hamstring strain
Lateral:
Biceps femoris (BF) lh – sh
Medial:
Semimembranosus (SM)
Semitendinosus (ST)
Tendon insertion
Proximal conjoined of ST and BF(A)
SM long prox tendon (B)
• Distal insertions
Lateral lh-BF
• Fibular head
Medial
SM: deep, flat, wide
ST: superficial
42. Injury types
Direct injury – Contusion – Laceration
Indirect injury (muscle strain)
Most common in sports
High recurrence rate
43. Indirect injury
High speed(1) – Eccentric
Combination?
Slowstretch(2)
Passive outer range stretch – Prolonged recovery time
44. Diagnosis
Inspection
Pain on:
– Stretch
– Contraction
– Palpation (83% BF LH, 12% SM, 5% ST*)
Additional imaging may guide diagnosis and prognosis#
45. MRI or US?
Ultrasound
Low costs
Dynamic imaging
MRI
More sensitive small/deep lesions
Less rater dependent
46. MRI indication and timing: experts opinion
< 3 days trauma MRI preferred
‘by experts and literature for acute hamstring injuries in elite athletes based
on its greater sensitivity for minor injuries’
Kerkhoffs et al. 2012
47. History Positive parameters
Moderate evidence:
• Shorter self predicted time to RTP
Limited evidence:
• Shorter time to RTP predicted by the clinician
48. Negative history parameters
Limited evidence:
• Type of sport (dancers vs sprinters)
• Higher VAS score at injury
Conflicting evidence:
• Stretching type of injury mechanism (vs. sprinting type)
• ≥ 1 day to walk pain free
49. Advise for daily practice, reporting MRI
Absence of edema (Grade 0 quicker RTP),
Grade 3 delayed RTP
Involvement of proximal tendon (and describe the central tendon)
57. Return to play
Decision affects:
Athlete’s availability
Performance
Re-injury rate
Clinician reputation
58. Return to play
• No consensus about safely RTP
• No single test as the gold standard.
Orchard J, Best TM, Verrall GM. Return to play following muscle strains. Clin J Sport Med Off
J Can Acad Sport Med 2005;15:436–41.
Heiderscheit BC, Sherry MA, Silder A, et al. Hamstring strain injuries: recommendations for
diagnosis, rehabilitation, and injury prevention. J Orthop Sports Phys Ther 2010;40:67–81.
Mendiguchia J, Brughelli M. A return-to-sport algorithm for acute hamstring injuries. Phys Ther
Sport 2011;12:2–14.
59.
60.
61. Can we use MRI for RTP decision making ?
Follow-up MRI has been suggested to support decisions
62.
63. Plantar Fasciitis
Gradual onset of deep, aching heel pain localized to the plantar medial heel
AM pain on arising & after getting up from sitting
Start-up pain improves after ambulation but may worsen w/ prolonged
activity
64. Plantar Fasciitis
Risk Factors
Repetitive stress in athletes
Obesity
Cavus foot – accommodates poorly to stresses
Over-pronated pes planus – excessive laxity stresses the PF
Tight heel cord
Heel spur: Often coincidental
NOT itself the etiologic factor Occurs in FDB, not the PF
65.
66. Plantar Fasciitis Non-op Treatment
Successful in more than 90% of patients
Complete relief of symptoms may take months to > 1 yr
Achilles tendon & PF stretching (latter more effective)
Heel cushions/ Shoe inserts / orthoses
Activity modification Oral NSAIDs
67. Plantar Fasciitis
Non-op Treatment
If no improvement after 6 – 8 weeks
Night splints
Casting
Steroid injection
After weeks to months w/o improvement
Limit to2 or 3as may weaken PF & resulting rupture
Avoid injecting the fat pad as atrophy may result
Consider w/u for rheumatologist
68. Plantar Fasciitis
OPERATIVE Treatment
AOFAS position statement recommends min 6 mo and preferably 12 mo
nonoperative treatment
Subtotal PF release ± decompression of first branch of lateral plantar nerve
Complete release → iatrogenic flat foot w/ lateral midfoot pain
Endoscopic release limited
79. Advantages- Anatomic Reconstruction
Supplementing both AM & PL
Controlling both AP & Rotatory Instability
Drilling femoral Tunnel Independently of tibial tunnel
81. ADVANTAGES
LESS PAIN
QUICKER RECOVERY
INSTRUMENTATION SPECIFICALLY DESIGNED FACILITATE A MORE
PREDICTABLY ANATOMIC ACL RECONSTRUCTION
Disadvantages
INCREASED COSTS DUE TO THE SPECIAL INSTRUMENTS
TECHNICALLY DEMANDING WITH LEARNING CURVE FOR SUGEON
Notas do Editor
In recent years, increasing numbers of people of all ages have been heeding their health professionals’ advice tIn recent years, increasing numbers of people of all ages have been heeding their health professionals’ advice to get active for all of the health benefits exercise has to offer.
The power is gained from the Trunk and the upper thighs
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