Sport Injuries

28 October 2013

Sport Injuries
Mohammad Alsofyani
Teaching Assistant – Orthopedic Department

6th MBBS - Surgery Module

1

2

Syllabus
Sport Injuries

Upper Limb

Lower Limb

Impingement
Syndrome

Frozen Shoulder

PCL Injury

Tennis Elbow

Meniscal Injury

Golfer’s Elbow


ACL Injury

Ankle Sprain

28 October 2013

3

Upper Limb
1.
2.
3.
4.


Impingement Syndrome.
Frozen Shoulder.
Tennis Elbow
Golfer‟s Elbow.

28 October 2013

4

1. Impingement Syndrome
 Anatomy:
 The shoulder consists of three
bones (humerus, scapula and
clavicle).
 2 joints
(glenohumeral, acromioclavicular
).
 2 articulations
(scapulothoracic, acromiohumer
al) that are joined by several
interconnecting ligaments and
layers of muscles.


28 October 2013

5

 Anatomy:
 Rotator cuff is a group of muscles and their tendons
that act to stabilize the shoulder.


28 October 2013

6

Muscle

Origin

Insertion

Action

Nerve Supply

Supraspinatus

Supraspinous
fossa of scapula

Greater
tubercle of
humerus

Abduct the
arm

Suprascapular nerve

Infraspinatus

Infracspinous
fossa of scapula

Greater
tubercle of
humerus

External
rotation

Suprascapular nerve

Teres Minor

Lateral border of
scapula

Greater
tubercle of
humerus

External
rotation

Axillary nerve

Subscapularis

Subscapular
fossa

Lesser tubercle

Internal
rotation

Upper and lower
subscapular nerves


28 October 2013

7

 Definition: Is a painful disorder which is thought to
arise from repetitive compression or rubbing of
the rotator cuff.


28 October 2013

8

 Pathophysiology:

Degeneration

Trauma


Vascular
Reaction

Swelling

Impingement

Rotator Cuff
Disruption

28 October 2013

9

 Grades:
Grade

Age

Cause

Mechanism

Grade I

18 – 30 years

Supraspinatus
tendinitis –
subacromial bursitis

overuse

Grade II

40 – 45 years

Supraspinatus
tendinitis –
subacromial bursitis –
partial tear - fibrosis

Overuse –
degeneration
(Osteoarthritis)

Grade III

Over 45 years

Supraspinatus
tendinitis –
subacromial bursitis –
progressive fibrosis –
disruption of the cuff

Overuse – Fall –
atrophic
degeneration in
the cuff


28 October 2013

10

 Clinical Features:
 Pain.
 Swelling.
 Limitation of shoulder movement.
 Muscle atrophy.
 Tenderness over greater tuberosity.


28 October 2013

11

 Diagnosis:

Arthroscopy
Radiological
Examinations
Clinical Examinations

28 October 2013

12

 Diagnosis:
 Clinical tests:
1. The painful arc: on active abduction, the
pain is aggravated as the arm transverses
an arc between 60° and 120°.

2. The impingement sign: The scapula is
stabilized with one hand while the other
raises the affected arm in flexion,
abduction and internal rotation. The test is
positive when the pain is elicited.


28 October 2013

13

 Diagnosis:
 Non-invasive:
1. X-ray.
2. MRI.


28 October 2013

14

 Diagnosis:
 Invasive:
1. Arthrography: Dye is injected into
the glenohumeral joint and
postinjection radiographs are filmed
to assess the integrity of the
glenohumeral joint. If dye escapes
out of the joint and into the
subacromial space, it is diagnostic
of a full-thickness rotator cuff tear.


28 October 2013

15

 Diagnosis:
 Invasive:
1. Arthroscopy: Minimally invasive visual surgical
procedure to assess shoulder pathology.


28 October 2013

16

 Management:
 Conservative:
1. It consists of rest, heat, massage, NSAIDs, local
infiltration of hydrocortisone.
2. Exercises both active and passive.
3. Temporary immobilization.


28 October 2013

17

 Management:
 Operative:
1. Failure of conservative treatment for three months.
2. Patients are young and active.
3. Increase loss of shoulder function.
 Methods:
1. Excision of calcium deposits.
2. Repair of incomplete tear.
3. Acromioplasty.


28 October 2013

18

2. Frozen Shoulder
(Adhesive Capsulitis)
 Definition: it is a disorder characterized by progressive

pain and stiffness of the shoulder which usually resolves
spontaneously after about 18 months.


28 October 2013

19

2. Frozen Shoulder
 Etiology: Idiopathic
 Risk Factors:
 Diabetes.
 Dupuytren‟s disease.

 Hyperlipidemia.
 Hyperthyroidism.
 Cardiac disease.
 Hemiplegia.
 After recovery from neurosurgery.


28 October 2013

20

2. Frozen Shoulder
 Age 40 – 60 years.
 70% of patients are women.
 Pain gradually increases in severity and
often prevents sleeping on the
affected side.
 After several months it begins to
subside.
 Stiffness becomes an increasing
problem, continuing for another 6-12
months after pain has disappeared.


28 October 2013

21

2. Frozen Shoulder


•Duration 9-15
months.
•Minimal pain
except at end of
ROM.
•Significant
limitation of ROM
with rigid end
feel.

Stage 3 (Thawing or Recovery)

•Duration 1-9
months.
•Pain with active
and passive
ROM.
•Significant
limitation with
flexion, abductio
n, external and
internal rotation.

Stage 2 (Frozen)

Stage 1 (Freezing)

 Stages:

•Duration 15-24
months.
•Minimal pain.
•Progressive
improvement in
ROM

28 October 2013

22

2. Frozen Shoulder
 Diagnosis:

“Not every stiff or painful shoulder is a frozen shoulder. And
indeed there is some controversy over the criteria for
diagnosing frozen shoulder” (Zuckerman et al., 1994)


28 October 2013

23

2. Frozen Shoulder
 Diagnosis:
 The diagnosis of frozen shoulder is clinical resting on
two characteristic features:
1. Painful restriction of the movement in the presence
of normal x-rays.

2. A natural progression through three successive
stages.


28 October 2013

24

2. Frozen Shoulder
 Management:
 Conservative:
1. To relieve pain and prevent further stiffness.
2. Analgesics and anti-inflammatory drugs.
3. Reassure the patient that recovery is certain.
4. Pendulum exercises are encouraged.
5. Once the acute pain has subsided, manipulation
under general anesthesia may improve the range
of movement.


28 October 2013

25

2. Frozen Shoulder
 Management:
 Operative:
1. Surgery doesn‟t have a well-defined role.
2. The main indication is prolonged and disabling
restriction of movement which fails to respond to
conservative treatment.
3. The rotator interval and coracohumeral ligament
are released and the coracoacromial ligament is
excised.


28 October 2013

26

3. Tennis Elbow (Lateral
Epicondylitis)
 Definition: Pain and tenderness over the lateral

epicondyle of the elbow (The bony insertion of the
common extensor tendons).


28 October 2013

27

Epicondylitis)
 Mechanisms: Forceful repetitive wrist extension.


28 October 2013

28

Epicondylitis)
 Active individual of 30 or 40 years.
 Gradual pain and localized to the lateral
epicondyle.
 The elbow looks normal, and flexion and extension
are full and painless.
 Pain can be elicited by:
1. Extending the elbow.
2. Pronating the forearm.

3. Passively flexing the wrist.


28 October 2013

29

Epicondylitis)
 Management:
 Conservative:
1. Rest and physiotherapy.
2. Injection of the tender area with
corticosteroid and local anesthetic
relieves pain.
3. Using a brace centered over the
back of your forearm may also help
relieve symptoms of tennis elbow.


28 October 2013

30

Epicondylitis)
 Management:
 Operative:
1. Persistent of symptoms for 6 to 12 months.
2. A few cases are sufficiently persistent or recurrent.
3. Release of lateral epicondylar muscles.


28 October 2013

31

4. Golfer‟s Elbow (Medial
Epicondylitis)
 Definition: Is very similar to Tennis Elbow but occurs on
the medial side of the elbow where the flexor origins
are effected.


28 October 2013

32

Epicondylitis)
 Mechanisms: overuse flingers flexion.


28 October 2013

33

Epicondylitis)
 Resisted wrist and finger flexion in pronation will
provoke the pain


28 October 2013

34

Lower Limb
1.
2.
3.
4.


ACL Injury.
PCL Injury.
Meniscal Injury.
Ankle Sprain.

28 October 2013

35

1. ACL Injury
 Anatomy:
 Origin:
1. Medial and anterior aspect of the
tibial plateau.
 Insertion:
1. Lateral femoral condyle.
 Function:
1. provide approximately 85% of total
restraining force of anterior
translation.
2. Prevents excessive tibial medial
and lateral rotation.


28 October 2013

36

1. ACL Injury
 Definition: One of the most common knee injuries is
an anterior cruciate ligament sprain or tear.

 Mechanisms:
 Hyperextension force.
 Twisting force on a semiflexed knee.


28 October 2013

37

1. ACL Injury
 Mechanisms:
 Hyperextension force.


28 October 2013

38

1. ACL Injury
 Mechanisms:
 Twisting force on a semiflexed knee.


28 October 2013

39

1. ACL Injury
 Immediately collapse and is painful.
 Popping sensation felt or heard.
 Swelling.
 Giving away.


28 October 2013

40

1. ACL Injury
 Classification:
 Ligaments sprain are classified in three degrees:
1. 1st Degree: Tear of only a few fibers of the ligament.
Minimal swelling, localized tenderness but little
functional disability.

2. 2nd Degree: Almost all the fibers of a ligament are
disrupted. Pain, swelling and inability to use the
limb. Joint movements are normal.
3. 3rd Degree: complete tear of the ligament


28 October 2013

41

1. ACL Injury
 Diagnosis:

Arthroscopy
Radiological
Examinations
Clinical Examinations

28 October 2013

42

1. ACL Injury
 Diagnosis:
 Clinical Examinations:
1. Lachman‟s test.
2. Anterior drawer test.
3. Pivot shift test.


28 October 2013

43

1. ACL Injury
 Diagnosis:
 Radiological Examinations:
1. Plain X-ray: to demonstrate bone avulsed or
associated fracture.
2. MRI


28 October 2013

44

1. ACL Injury
 Diagnosis:
 Arthroscopy:
1. May be needed in cases where doubt
persists.


28 October 2013

45

1. ACL Injury
 Management:
 Conservative:
1. Most cases of grades I and II.
2. The hematoma is aspirated and the knee is
immobilized in a commercially available knee
immobilizer.
3. After a few weeks, the adequate strength can be
regained by physiotherapy.


28 October 2013

46

1. ACL Injury
 Management:
 Operative:
1. Indicated in multiple ligaments injured
knee, especially in young athletes.
2. Performed 2-3 weeks after injury after acute phase
subsided.
3. Methods:
a) Repair of the ligament: performed for fresh. Additional
reinforcement is provided by a fascial or tendon graft
(Tendon of Hamstring).

b) Reconstruction: in cases of ligament injuries presenting
late.


28 October 2013

47

2. PCL Injury
 Anatomy:
 Origin:
1. The posterior intercondylar area of
the tibia.
 Insertion:
1. Medial condyle of the femur.
 Function:
1. keeps the tibia from moving
backwards too far.


28 October 2013

48

2. PCL Injury
 Definition: It is less common than ACL tears.

 Mechanisms:
 Backward force on tibia.


28 October 2013

49

2. PCL Injury
 Pain with swelling that occurs steadily and quickly
after the injury.
 Swelling that makes the knee stiff and may cause a
limp.

 Difficulty walking.
 The knee feels unstable, like it may "give out”.


28 October 2013

50

3. Meniscal Injury
 Anatomy:
 The semilunar cartilages are two crescentshaped plates of fibrocartilage placed on
condylar surface of the tibia
 Functions:

1. Increase the stability of the knee.
2. Controlling the complex rolling and
gliding actions of the joint.
3. Distributing load during movement.


28 October 2013

51

3. Meniscal Injury
 Definition: Medial meniscus is more commonly injured
than the lateral and is usually associated with other
ligament injuries of the knee.

 Mechanisms:
 Medial meniscal:
1. In young: twisting force with the knee bent and
taking weight.
2. In middle age: fibrosis has decreased the mobility
of meniscus and hence tear occurs with less force.


28 October 2013

52

3. Meniscal Injury
 Mechanisms:


28 October 2013

53

3. Meniscal Injury
 Classifications


28 October 2013

54

3. Meniscal Injury
 Usually a young person.
 Pain (usually on the medial side).
 Knee is „locked‟ in partial flexion.
 Sometimes the knee gives way spontaneously.


28 October 2013

55

3. Meniscal Injury
 Diagnosis:
 Clinical Examinations:
1. McMurray‟s Test.
2. Apley Compression Test.


28 October 2013

56

3. Meniscal Injury
 Diagnosis:
1. Plain X-ray
2. MRI


28 October 2013

57

3. Meniscal Injury
 Diagnosis:
 Arthroscopy:
1. May be needed in cases
where doubt persists.


28 October 2013

58

3. Meniscal Injury
 Management:
 Conservative:
1. Indicated in patients soon after injury with no
locking.
2. If knee is locked, it is manipulated under general
anesthesia.
3. The is immobilized for 2-3 weeks followed by
physiotherapy.


28 October 2013

59

3. Meniscal Injury
 Management:
 Operative:
1. Indicated if the joint can‟t be unlocked and if
symptoms are recurrent.
2. Closed partial meniscectomy via an arthroscope is
better than total removal of the menisci by open
surgery.


28 October 2013

60

4. Ankle Sprain
 Anatomy:
 Ligaments of the ankle:
1. Anterior talofibular ligament.
2. Calcaneofibular ligament.
3. Posterior talofibular ligament.


28 October 2013

61

4. Ankle Sprain
 Definition: Common injury in sport. If
improperly treated it may result in
chronic laxity, pain or delayed
recovery.

 Mechanisms:
 Inversion of supinated planter flexed
foot.


28 October 2013

62

4. Ankle Sprain
 Anterior talofibular ligament commonly injured
followed by Calcaneofibular ligament.
 The posterior talofibular ligament is rarely sprained.
 Pain, swelling and tenderness over the affected
ligament.


28 October 2013

63

4. Ankle Sprain
 Diagnosis:
 Clinical:
1. Anterior Drawer Test: If the displacement of talus is
more than 8 mm anterior, it suggests laxity of the
anterior talofibular ligament.


28 October 2013

64

4. Ankle Sprain
 Diagnosis:
1. X-ray : AP of the ankle to assess talar tilt.
2. Talar tilt test:
 Examiner stabilizes the leg with one hand while inverting
plantar flexed heel with the other hand.
 Alternatively, place the patient's leg in the lateral
position, hanging off the table.
 A strap is applied around the ankle which courses
around the lateral side of the ankle.

 A 4 kg wt is then applied which forces the ankle into
inversion and plantar flexion.


28 October 2013

65

4. Ankle Sprain
 Diagnosis:
1. Talar tilt test: If the tilt is
more than 5°, it suggests
laxity of anterior talofibular
and calcaneofibular
ligaments


28 October 2013

66

4. Ankle Sprain
 Management:
 Grade I:
1. Ice therapy, compression bandage, foot
elevation, NSAIDs, are the recommended
treatment.

 Grade II:
1. Long leg cast, range of motion
exercises, strengthening exercises are helpful.
 Grade III:
1. Same lines as mentioned above and sometimes
may require surgical repair.


28 October 2013

67

Case Study


28 October 2013

68

History
A 25-year-old man was playing football for his local
team. While going in for a tackle he sustained a
twisting injury to his knee. There was no immediate
swelling. He continued to play for about ten
minutes to the end of the game but then
complained of some pain in the medial aspect of
his knee. He awoke the next day with a painful
swelling in the knee and so consults his general
practitioner.


28 October 2013

69

Examination
This young man has some mild
swelling,
associated
with
marked tenderness to palpation
over the medial joint line. He has
normal varus/valgus stability of
the knee and a negative
anterior draw and Lachman‟s
test. The range of motion is full. A
plain x ray shows good
preservation
of
the
joint
space, and MRI film is shown.


28 October 2013

70

Questions
 What is the diagnosis?
 What are the common clinical features of this injury?
 How would you manage this injury?


28 October 2013

71

References
Textbook of Orthopedics (John Ebnezar).
Aply‟s System of Orthopedics and Fractures.
Essential of Orthopedics (RM Shenoy).
Essential Orthopedics (J.Maheshwari).
Field Guide to Fracture Management (Richard B.
Birrer).
 Current Diagnosis and Treatment of Orthopedic
(Harry B. Skinner).
 Essential Orthopedic and Trauma (David J. Dandy)
 Pocket of Orthopedics and Fractures. (Ronald
McRae).







28 October 2013

Sport Injuries

Empfohlen

Empfohlen

Weitere ähnliche Inhalte

Was ist angesagt?

Was ist angesagt? (20)

Andere mochten auch

Andere mochten auch (20)

Ähnlich wie Sport Injuries

Ähnlich wie Sport Injuries (20)

Kürzlich hochgeladen

Kürzlich hochgeladen (20)

Sport Injuries