Sports injuries
Conditions and treatment
Achilles Tendon Disorders
Who does this affect? This is the heel cord. It is a crucial tendon at the back of the ankle that allows the patient to “toe-off” when walking or running. The blood supply comes from above and below and so the portion in the middle becomes vulnerable as you get older.
Symptoms It can become inflamed (tendonitis) or even rupture during activity, especially sports involving rapid acceleration such as tennis or squash.
Investigations A careful examination is essential. Scans can be used in order to diagnose this condition.
Non-surgical Treatment Initially, physiotherapy and orthotics (insoles) are used for tendonitis. Specialised splints, which can avoid the necessity for an operation, can treat ruptures but recovery is slower than with surgery, and the re-rupture rates are higher.
Surgical Treatment In some patients, early surgical repair of ruptured achilles tendon, with functional aftercare, has the lowest rates of re-rupture. Surgery is also undertaken for chronic tendonitis.
Anterior Cruciate Ligament Reconstruction
Who does this affect? Sportsmen and women are at risk of this injury. It is usually due to a twist or change of direction whilst running. The patient often hears or feels a “pop” and their knee swells within minutes becoming very painful.
Symptoms The anterior cruciate ligament is one of two main ligaments within the knee joint. It can lead to feelings of knee instability, “giving way” pain and long-term knee problems
Investigations Often a careful assessment by the surgeon is all that is required. MRI Scans are undertaken if there is any doubt.
Non-surgical Treatment Initially, physiotherapy is helpful to stop the knee stiffness and muscle wasting i.e. rehabilitation starts before surgery. If the patient wishes to maintain their pre-injury lifestyle, surgery is recommended. Also, avoiding surgery can result in long-term knee problems of cartilage tears, instability and early arthritis.
Surgical Treatment It cannot be repaired and so is replaced using either hamstring tendons or part of the patellar tendon. Increasingly, this is undertaken with “keyhole” techniques. Surgery is undertaken in combination with a supervised rehabilitation program designed to return the knee and patient to a high level of activity.
Cartilage tears
Who does this affect? The knee is a complex joint and is commonly injured during activity. It can happen in both sportsmen and women, and in less active patients especially in association with early arthritis.
Symptoms Within the knee are ligaments (ACL) and semi-circular pieces of soft cartilage (meniscus). These can be torn and this can cause persistent pain as well as mechanical symptoms such as clicking or locking.
Investigations X-ray of the knee is usual. MRI scan is often used to help confirm the diagnosis.
Non-surgical Treatment Rest and physiotherapy may help settle symptoms. Injections are used occasionally.
Surgical Treatment This condition can be relieved by a day case “keyhole” operation known as arthroscopy. Here the knee joint is inspected via small incisions using a camera. Suitable tears are repaired and those that are not are removed.
Dislocation of the Shoulder
Who does this affect? There are two main groups, young athletes, and older patients often following a fall.
Symptoms In young patients, the lining of the shoulder joint becomes torn. This is the Bankart lesion. It often does not heal back correctly and is a weak spot, resulting in easier and easier dislocations. In older patients, it is more usual for the rotator cuff to tear, again often making the shoulder weak.
Investigations Specific scans e.g. MRI or CT are sometimes used in younger patients. In older patients it is more likely that an MRI or ultrasound scan would be undertaken to assess the tear.
Non Surgical Treatment First-time young dislocators are treated with a special (Itoi) brace and physiotherapy in order to reduce the chances of further dislocations.
Surgical Treatment Should dislocation occur twice or more, surgery is then recommended to re-attach the torn lining. If there is a repairable tear to the cuff, then early surgery is recommended.
Elbow Pain
Who does this affect? This includes tendon problems such as tennis and golfer’s elbow, which benefit from early diagnosis and treatment. This approach reduces the need for surgery for chronic problems. These conditions are not always due to sporting activity and usually affect those aged between 35-60.
Symptoms It is an over-use disorder, with micro-tears and a chronic healing process in the affected tendon. This causes pain and loss of function in the elbow. Symptoms are usually felt on activity, but can even occur at rest.
Investigations A focused clinical examination is usually sufficient to make the diagnosis.
Non-surgical Treatment The earlier the condition is treated, the better the outcome. Treatment starts with a cortisone injection, rest and physiotherapy. Forearm clasps can also be used.
Surgical Treatment For resistant cases day case surgery is offered.
Groin Strain and Pain
Who does this affect? Athletes are the group of people most commonly affected.
Symptoms Aching groin pain on physical activity.
Investigations X-rays, ultrasound or MRI scans may be necessary. Diagnoses include problems outside the joint such as tendon problems and problems inside the joint such as cartilage injury; ligament injury and labral tear which is similar to a cartilage tear in the knee.
Non-surgical Treatment If identified early the condition will usually respond to a specific program of physiotherapy.
Surgical Treatment Long-term symptoms that do not settle with physiotherapy and injection may require surgery such as arthroscopy.
Pain of the Hand & Wrist
Who does this affect? This condition can affect any age group.
Symptoms Symptoms can occur following a specific incident e.g. a fall or from over-use. Ligament ruptures, sprains and tendon injuries are often seen with this condition. We will provide an expert opinion and treatment plan.
Investigations A careful clinical examination is critical. X-rays and scans are often required.
Non-surgical Treatment Treatment depends on the diagnosis. Non-surgical treatment can include splints and physiotherapy.
Surgical Treatment Surgery is undertaken to correct any underlying damage.
Rotator Cuff Problems & Shoulder Pain
Who does this affect? Any age group, particularly, in middle years. It can occur either from repetitive activity or a “one-off” movement, such as a fall. It can also be due to a shoulder dislocation.
Symptoms Shoulder pain - muscle strains, particularly of the rotator cuff are common. This is often known as “impingement” pain. Early assessment and treatment is crucial to avoid chronic symptoms. Rotator cuff tendon tears are often not identified for a long time. These can cause shoulder pain often with muscle weakness. Prompt diagnosis and repair (surgery) gives the best chance of successful outcome and return to full activity.
Investigations A clinical exam and plain X-rays are essential. After this, usually an MRI scan is used to confirm the diagnosis.
Non-surgical Treatment If the tendons are strained, then a cortisone injection and physiotherapy is the first line of treatment. This is successful for over 50% of patients.
Surgical Treatment “Keyhole” surgery known as, Arthroscopic Subacromial Decompression, is used for patients whose pain persists. If the rotator cuff tendon is torn, then prompt surgery to reattach the tendon gives the best outcome. Increasingly, this is done by keyhole methods too. Cuff repair does mean a period of recovery to regain full use, with physiotherapy.
Shin Splints
Who does this affect? This condition can affect athletes at all levels.
Symptoms Aching shin pain on activity, which can become pain on just standing, or even at rest
Investigations X-rays. Occasionally MRI scans are needed.
Non-surgical Treatment Early detection, rest and treatment (podiatry, physiotherapy) is optimum
Surgical Treatment Prolonged symptoms may require special investigations and prolonged rehabilitation.
Upper Limb Fractures
Who does this affect? This condition can affect any age group.
Symptoms Symptoms can occur following a fall or other injury. Upper limb fractures are common injuries and include collarbone (clavicle), wrist and hand. Early assessment, prompt treatment including surgery if required and focused physiotherapy, is essential to keep recovery time to a minimum, and prevent stiffness or other complications.
Investigations X-rays are the most common. Sometimes scans are needed to help plan treatment.
Non-surgical Treatment Often a splint is all that is needed. Increasingly, surgery is used to restore the anatomy and permit early rehabilitation and return to full activity.
