Common sports injuries.2560

1. Common Sports Injuries Ukris Gunadham, MD, FRCOST Department of Orthopaedics Trang Hospital Lecture for 5th year medical student

2. Objectives • Acute / Chronic Injury • Terminology • Common injuries - Hand and Wrist - Elbow - Shoulder - Knee - Ankle - Foot

3. Terminology • Stress Fracture • Sprain • Strain • Contusion • Tendinitis / Tendonitis • Bursitis

4. Acute Injury  contact sports  sudden swelling  should be examined immediately ✤ Bone and Joint; fracture, subluxation, dislocation ✤ Ligament ; torn, sprain ✤ Muscle; strain, contusion, soreness, cramp

5. Sprains • “ligament injury” • Severity; • grade 1 - stretching / minor torn • grade 2 - partial torn (<90% fiber) • grade 3 - complete torn • Symptoms; pain, swelling, bruise, limit ROM • Treatments; RICE

6. RICE ✤ Rest : avoid activity, gait aids ✤ Ice : vasoconstriction; (20min/session - q.2-3 hr) ✤ Compression : pressure effect ✤ Elevation : reduce swelling

7. ✤ hemorrhage phase: hematoma ✤ Inflammatory phase: inflammatory cell  granulation tissue ( 2 weeks) ✤ Reparative phase: extracellular matrix (5-7days to weeks) ✤ Remodelling phase:collagen fiber formation( weeks to year) Ligament healing

8. Sprains ✤ 1+ instability: < 5mm ✤ 2+ instabiliy: 5-10 mm ✤ 3+ instability: > 10 mm

9. Strains • “muscle injury” • caused by a sudden stretching force or a very forceful contraction of the muscle • Severity; • grade 1 - <10% muscle fiber damaged • grade 2 - 10-90% fiber damaged • grade 3 - complete rupture of muscle

10. Strains Degree of Muscle Injury First : some fiber torn Second : pain, swollen, decrease power and range of motion (ROM) Third : complete tear, no contraction, gapping or palpable muscle

11. Strains SYMPTOMS • Sudden pain or feeling that the muscle has tightened • Pain on contraction • Tenderness • Pain on stretching • Swelling and bruising • Decrease ROM TREATMENTS Initial : RICE stretching exercises can usually begin within 48 hours / pain free More severe injuries need longer rest

12. Contusions • “direct impact to muscle” • causes local muscular damage and bleeding as the muscle is crushed against the underlying bone. • Pain, bruising, swelling are common. • There may be a decrease in motion. • Contracting the muscle will be painful.

13. Muscle Cramp ✤ Brisk muscle contraction ✤ Common : thigh and calf ✤ Exercise in extremely hot or cool environment ✤ Dehydration ✤ Decrease potassium, calcium, magnesium  Rx: Massage, stretching, hydration

14. Chronic Overuse Injury  trivial , repetitive microtrauma  factors : intensity & frequency  predisposed : malalignment & muscular imbalance ✤ Bone and Joint; stress fracture, apophysitis ✤ Ligament; tendonitis ✤ Muscle; chronic exertional compartment syndrome ✤ Bursae; bursitis

15. Stress Fractures • incomplete fracture, hairline fracture, fatigue fracture • femur, tibia, fibula, metatarsals, navicular, calcaneus, talus, ribs  Low velocity, repetitive  Track athletes, dancers  Pain on exertion, night pain, point of tenderness  Sub acute to chronic cases : radiographic changes( 2-3 weeks)

16. Stress Fractures Treatments: • Modified rest for six to eight weeks • NSAIDs • Cryotherapy • Stretching and flexibility exercises • Non weight-bearing with crutches

17. Tendon : Overuse Injury Repetitive mechanical loading of the tendon Cellular/matrix response adequate inadequate Transient weakness in tendonadaptation Continued loading exceeding the tendon’s healing capability

18. Tendonitis • Overuse injury which gradually develops over time. • ‘Tendonitis’ literally means inflamed tendon.

19. Tendonitis SYMPTOMS • Pain gradually over a period of time • Worse when start and then ease off • Morning stiff? • Thicker, tender tendon • Lumps /nodules within the tendon TREATMENT • Initial treatments; reduce pain, stiffness and swelling • Electrotherapeutic • Acupuncture • Stretching exercise • Eccentric strengthening exercise

20. Bursitis ✤ Inflammation of ‘bursa’ ✤ Overuse condition occurs due to repeated rubbing of the overlying soft tissue ✤ Impact bursitis is due to bleeding into the bursa

21. Common Bursitis

22. Common problems

23. Carpal Tunnel Syndrome • Median nerve compression at wrist • Causes; – Traumatic – Repetitive use – Pregnancy – Use of vibrating machinery – Congenital – Arthritis

24. Carpal Tunnel

25. Carpal Tunnel Syndrome SYMPTOMS • Dull ache pain in the wrist and forearm may radiate to elbow and shoulder • Tingling or burning sensation • Pain which is worse at night • Weakness in the fingers and hands. SIGNS • Tinel’s sign • Phalen’s test • Two-point discrimination test • Durkan’s compression test *

26. De Quervain's Tenosynovitis • Tenosynovitis of 1st extensor compartment [ APL & EPB ] • Radial side wrist pain • Swelling • Catching or snapping • Numbness • Finkelstein’s test

27. Tennis elbow • Pain just below the lateral epicondyle • Weakness in the wrist • Pain with resisted wrist extension • Pain with passive terminal wrist flexion with the elbow in full extension usually involves a microtear of ECRB, but may also extend into ECRL and ECU

30. Golfers / Throwers Elbow • Pain on medial epicondyle at origin of PT and FCR • Weakness in the wrist • Pain on the inside of the elbow when hard grip • Pain when resisted wrist flexion • Pain on resisted wrist pronation

34. Rotator Cuff Injury • Dynamic stability of GH joint • 4 muscles; Supraspinatus .. abduct Infraspinatus .... ER Teres minor ....... ER Subscapularis ... IR

35. Rotator Cuff Tear

36. Rotator Cuff Tendinopathy ✤ Pain on rotation of the shoulder, especially against resistance ✤ Pain on abduction ✤ Tenderness when pressing on the affected tendon ✤ The tendon may feel thickened ✤ creaking feeling (crepitus) when moving the tendon

37. Knee Injuries

38. Anterior Cruciate Ligament ✤ Primary restrain of excessive anterior translation of tibia ✤ Prevent extreme hyperextension ✤ ‘twisting’ injury ✤ chronic symptom : ‘giving way’ and Quadriceps atrophy

39. Anterior Cruciate Ligament

40. Anterior Cruciate Ligament ✤ Lachman test ; most sensitive ✤ Anterior drawer test ✤ Lateral pivot shift test ; most specific

43. Anterior Cruciate Ligament Treatments ✤ Conservative in low demand, elderly -> Quadriceps exercise ✤ Surgery in young, active patients -> ACL reconstruction

44. Posterior Cruciate Ligament ✤ Primary restrain of excessive posterior translation of tibia ✤ chronic; PF arthritis ✤ pathognomonic; drop back sign ✤ posterior drawer test ✤ quadricep active test

45. Posterior Cruciate Ligament

48. Posterior Cruciate Ligament Treatments ✤ Mostly conservative in gr.I-II -> Quadriceps exercise ✤ Surgery in gr.III -> PCL reconstruction

49. Ankle Sprain

50. Ottawa Ankle Rule Need ankle series x-ray if; Pain exists near one or both of the malleoli PLUS one or more of the following: ✤ Age >55 years old ✤ Inability to bear weight ✤ Bone tenderness over the posterior edge or the tip of either malleolus

51. Ankle series film AP, Lateral , Mortise (15-degrees IR)

52. Ankle series film AP, Lateral , Mortise (15-degrees IR)

53. Ankle Special Test ✤ Squeeze Test ✤ External Rotation Test ✤ Anterior Drawer Test ✤ Talar Tilt Test

57. Ankle Sprain Initial Treatments ✤advice ✤RICE ✤NSAIDs Immobilizations ✤ankle support / wrapping ✤taping (Gibney splint) ✤slab ✤cast ✤protected weight

59. Ankle Sprain ; Rehabilitation

60. Osgood-Schlatter disease ✤ Apophysitis of tibial tuberosity ✤ onset :10-20 years of age ✤ bilateral 20-30% ✤ Adolescent athletes : M > F ✤ Pain at a proximal tibia, prominent mass

61. Osgood-Schlatter disease ✤ Conservative Treatment; ✤ rest ✤ knee brace ✤ analgesic / NSAIDs ✤ protected weight in severe case ✤ avoid contact sports ✤ improve with age

62. Jumpers Knee ‘Patellar Tendonitis’ ✤ chronic overuse injury of patellar tendon ✤ jumping sport; basketball, gymnastic ✤ Pain at inferior and anterior patella ✤ Aching and stiffness after exertion ✤ Pain when quadriceps contraction ✤ The affected tendon may appear larger ✤ May be associated with poor Vastus medialis obliquus (VMO) function ✤ Calf weakness may be present

63. Runners Knee ‘ITB syndrome’ ✤ Pain on the outside of the knee (at or around the lateral epicondyle of the femur) ✤ Tightness in the iliotibial band (Ober Test) ✤ Pain normally aggravated by running, particularly downhill ✤ Pain during flexion or extension of the knee, made worse by pressing in at the side of the knee over the sore part ✤ Weakness in hip abduction ✤ Tender trigger points in the gluteal area may also be present

64. Runners Knee ‘ITB syndrome’ Ober Test

65. Runners Knee ‘ITB syndrome’ Treatment ✤ Proper shoes ✤ NSAIDS ✤ Stretching tensor fascia lata and iliotibial band ✤ Strengthening hip abductor

66. Plantar Fasciitis ✤ Heel pain, under the heel and usually on the inside, at the origin of the attachment of the fascia: medial calcaneal tubercle ✤ Pain when pressing on the inside of the heel and sometimes along the arch ✤ Pain is usually worse first thing in the morning as the fascia tightens up overnight ✤ If more severe  the pain can get worse throughout the day if activity continue ✤ Stretching the plantar fascia may be painful ✤ Sometimes there may also be pain along the outside border of the heel

67. Plantar Fasciitis

68. Plantar Fasciitis Treatment ✤Rest, Ice ✤NSAIDs, analgesic ✤Achilles stretching ✤Plantar fascia massage ✤Heel cushion / cup ✤Steroid injection

Common sports injuries.2560

Common sports injuries.2560

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