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    Sports Injuries 31.08.11

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    Amicable Vanu
    A 40-year-old male presents with right heel pain after playing in a football match for the first time in years. He was kicked in the heel during the game and now has difficulty walking. The provisional diagnosis is Achilles tendinopathy. Tests that would be performed include examination of the Achilles tendon for swelling, nodularity, heat and crepitus to rule out rupture. Management includes rest, NSAIDs, stretching exercises, and referral to physiotherapy if not improved in 3-6 months.

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    Sports Injuries 31.08.11

    Uploaded by

    Amicable Vanu
    12 views31 pages
    A 40-year-old male presents with right heel pain after playing in a football match for the first time in years. He was kicked in the heel during the game and now has difficulty walking. The provisional diagnosis is Achilles tendinopathy. Tests that would be performed include examination of the Achilles tendon for swelling, nodularity, heat and crepitus to rule out rupture. Management includes rest, NSAIDs, stretching exercises, and referral to physiotherapy if not improved in 3-6 months.

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    sports injurises

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    A 40-year-old male presents with right heel pain after playing in a football match for the first time in years. He was kicked in the heel during the game and now has difficulty walking. The provisional diagnosis is Achilles tendinopathy. Tests that would be performed include examination of the Achilles tendon for swelling, nodularity, heat and crepitus to rule out rupture. Management includes rest, NSAIDs, stretching exercises, and referral to physiotherapy if not improved in 3-6 months.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    12 views31 pages

    Sports Injuries 31.08.11

    Uploaded by

    Amicable Vanu
    A 40-year-old male presents with right heel pain after playing in a football match for the first time in years. He was kicked in the heel during the game and now has difficulty walking. The provisional diagnosis is Achilles tendinopathy. Tests that would be performed include examination of the Achilles tendon for swelling, nodularity, heat and crepitus to rule out rupture. Management includes rest, NSAIDs, stretching exercises, and referral to physiotherapy if not improved in 3-6 months.

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    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 31

    Sports Injuries

    Andrew OBrien
    Tom Milligan

    Scenario
    A 40 year old male is asked to play in a work 5 a-side
    football match. He hasnt played for a number of
    years but used to play regular 5 a side in his twenties.
    3 minutes into the game he felt he was kicked in the
    right heel and had to stop playing. The other players
    denied making any contact at the time. He comes to
    see you the next day as he has had difficulty walking
    since.
    What is your provisional diagnosis?
    What tests would you perform?

    Achilles Tendinopathy
    Previously termed Achilles tendinitis but studies
    suggest no prostaglandin mediated inflammation
    Term encompasses pain, swelling, weakness and
    stiffness of the Achilles
    Repeated overloading causes degeneration &
    disorganized collagen fibre laydown
    Thought to occur when imbalance between
    degeneration & repair leading to tearing & pain
    Usually occurs at mid-portion of tendon (site of AT
    rupture)
    Can have associated inflammation of
    retrocalcaneal bursa

    Diagnosis
    History
    Pain in mid portion of tendon
    Pain related to exercise (often at start and after
    exercise with diminished discomfort during exercise)
    Stiffness of tendon in morning
    Often unaccustomed to or increased intensity of
    exercise
    Can interfere with daily living activity
    Examination
    Look for deformity & swelling
    Palpate swelling, nodularity, heat and creps.
    Exclude rupture

    Management

    Expectation 3-6 months to resolve


    Discontinue quinolones/consider steroid use
    Initial period rest until pain subsides
    NSAIDS should be limited to 14 days use
    AT stretching exercises
    DO NOT Inject tendon
    Consider referral to physio for biomechanical
    assessment
    Consider referral to MSK or orthos if not settled
    at 3-6 months

    Stretches

    AT stretches: hold for


    30 secs, rpt x3, twice
    daily

    Wall Push Ups: try


    and hold lean for 30
    secs, x 10, Twice daily

    Stair stretch: 30
    seconds x 6, twice
    daily

    Spiderman Rehab

    Management In
    Secondary Care
    Extracorporeal shock wave therapy
    Iontophoresis, phonophoresis, sclerosant, GTN
    patch, growth factor injections all have weak
    evidence.
    Surgery includes nodule & adhesion excision,
    longitudinal incision.

    Achilles Tendon Rupture


    Predisposing Factors
    Age 30 50
    Steroids
    Fluoroquinolones
    Tendinopathy
    Haglunds Deformity
    Running Sports

    History
    Abrupt change of direction
    Often Patient unaccustomed to sport
    Often patient thinks struck at back of
    ankle

    Diagnosis
    Simmonds/Thompsons
    /Squeeze Test
    Palpation - Rupture at
    3 to 6cm

    Treatment
    All Cases Referred to
    Orthopaedics
    Treatment Equinus
    casting vs Surgical
    repair
    Decision depends on
    patient choice and
    activity level

    Scenario 2
    A 17 year old girl comes to see you c/o pain in her
    lower legs. She has been in the school athletics
    team for 4 years and has recently started training
    for the london marathon. She says she has pain in
    her lower legs and points to the middle 1/3 of her
    tibias. It comes on if she runs any more than 4 or 5
    miles and can last for days after the run
    You note she is tender on the medial border of her
    tibias in the mid/upper 1/3
    What advice would you give and what is your
    management plan?

    Shin Splints
    Medial Tibial Stress Syndrome/Shin Splints
    Not Specific Diagnosis - Refers to pain along the
    course of the tibia
    Cause is thought to be related to overloading
    muscles of the lower limb and biomechanical
    irregularities
    Encompasses 3 main entities:
    1. Medial Tibial Stress Syndrome
    2. Chronic compartment syndrome
    3. Tibial stress fracture

    MTSS
    Most Common Running injury accounts 15%
    Inflammation of tendon insertions to tibial
    periosteum
    Pain is in distribution of Sharpey Fibres that
    connect Soleus fascia through periosteum of tibia
    Increased foot pronation, varus tendancy of
    forefoot, increased strength of plantar flexors,
    inadequate Ca intake, hard or inclined running
    surfaces, inadequate shoes and previous injury all
    implicated

    MTSS Risk Factors


    Repetitive trauma sports e.g. running &
    gymnastics
    Female
    Low aerobic fitness
    Over Pronation Feet
    Tight calf muscles
    Sudden Increases activity level

    MTSS
    MTSS consequence of repetitive stress
    by impact forces that fatigue soleus
    Causes bending or bowing of Tibia
    overloading bone remodeling
    capabilities of Tibia
    Stress microfractures can be created
    which arent seen on XRAY

    Diagnosis
    History
    Examnation tenderness of
    tibia
    XRAY
    CT/MRI

    Management

    Shock Absorbent insoles


    Control overpronation
    Training Error Avoidance
    Rest (up to 3/12)
    Crutches
    NSAIDS
    Physio for lower limb muscle strengthening and
    graduated training programs.

    Knee Sports injuries

    Aims
    o To have a working knowledge of knee anatomy to explain common injuries
    to patients
    o To appropriately refer knee meniscal injuries
    o Be aware of patella tendonitis

    Objectives
    o Be able to draw a schematic diagram of a knee
    o To be able to diagnose meniscal injuries and know the difference between
    sports injuries and fragility tears
    o Know Diagnosis and treatment for patella tendonitis.

    Anatomy

    Case 1
    A 23 year old footballer has had a twisting injury
    to the knee which has now locked and become
    swollen. He can weight-bare with pain. You see
    him a week after the injury.
    What do you want to know?
    What treatments are available?
    Are the treatment different if he were 60?

    Meniscus Injuries
    Are there mechanical symptoms
    Fragility tear or not
    Referral Options:
    o Haemarthrosis
    o Arthroscopy without imaging
    o Imaging

    Case 2
    An 13 year old boy has persistent pain in his knee
    following a minor trauma two weeks ago. You can
    find no locking, effusion, instability. He can walk
    with minor discomfort. Would you:
    A. Wait and see
    B. Refer to physio
    C. X-ray

    Case 3
    25 year old man with anterior knee pain. When
    you examine him he can straight leg raise, has no
    effusion or locking or crepitus but has point
    tenderness on the distal pole of the patella.
    What is wrong?
    How do we treat this?

    http://www.youtube.com/watch?v=hqNC3sXzJII&fe
    ature=relmfu
    http://www.youtube.com/watch?v=ul09qA4hJQg&f
    eature=related

    Patella tendinitis
    One of the commonest tendinopathies
    Rest, Ice, NSAIDS, Stretches before future
    exercise
    Eccentric loading exercises
    Refer to physio.

    Question Session

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