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Sprains/Strains

Sprain is an injury or tear of the ligaments and strain is injury to the muscle or tendons. Sprains and strains are common in ankle, spine, knee, thigh, hip, elbow, and wrist joints.

Sprain is caused by trauma, overstretching of the joints during sports activities such as basketball and swimming. Strain is caused due to overuse of the muscles, inadequate rest during breaks while playing sports. Some sports such as gymnastics, basketball, football, hockey, and running causes the muscles and ligament tear.

The muscles injured during sports include hamstring and quadriceps muscles of the thigh, calf and knee muscles, and flexor muscles of the joints. The commonly observed symptom is pain and inflammation. In addition to these symptoms muscle spasm, muscle weakness, and cramping may be observed.

Immediately following an injury and before being evaluated by a medical doctor, you should initiate the R.I.C.E. method of treatment

  • Rest: Rest the knee as more damage could result from putting pressure on the injury.
  • Ice: Ice packs applied to the injury will help diminish swelling and pain. Ice should be applied over a towel to the affected area for 15-20 minutes four times a day for several days. Never place ice directly over the skin.
  • Compression: Wrapping the knee with an elastic bandage or compression stocking can help to minimize the swelling and support your knee.
  • Elevation: Elevating the knee above heart level will also help with swelling and pain.

Your doctor may prescribe nonsteroidal anti-inflammatory drugs to reduce the pain and inflammation. Rehabilitation program is recommended for people injured by sports which help to regain strength and allow fast recovery. Rehabilitation program includes massages and various strengthening, stability, and stretching exercises which should be carried out on a regular basis.

Hip Dislocation

The hip joint is a ball and socket joint. The “ball” is the head of the femur, or thigh bone, and the “socket” is the cup shaped acetabulum. The joint is surrounded by muscles, ligaments, and tendons that support and hold the bones of the joint in place. Hip dislocation occurs when the head of the femur moves out of the socket. The femoral head can dislocate either backward (posterior dislocation) or forward (anterior dislocation).

Hip dislocation can be caused by injuries from motor vehicle accidents or severe falls. The common symptoms of hip dislocation include pain, inability to move your legs and numbness along the foot or ankle. A dislocation may also be associated with a fracture in the hip, back or knee bones. When you present to the clinic with these symptoms, your doctor performs a thorough physical examination and may order imaging studies such as X-rays to confirm the diagnosis.

Treatment involves reduction, in which your doctor repositions the bones to their normal position under anesthesia. Surgery may be performed to remove fragments of bone or torn tissues that block and prevent reduction. During your recovery, you are advised to limit movement and placing weight on the injured hip with the use of crutches. Physical therapy is vital in regaining the strength and mobility in your hip joint after treatment.

Shoulder Dislocation

Playing more overhead sports activities and repeated use of shoulder at workplace may lead to sliding of the upper arm bone, the ball portion, from the glenoid–the socket portion of the shoulder. The dislocation might be a partial dislocation (subluxation) or a complete dislocation causing pain and shoulder joint instability. Shoulder joint often dislocates in the forward direction (anterior instability) and it may also dislocate in backward or downward direction.

Most common symptoms of shoulder dislocation are pain and shoulder joint instability. Other symptoms such as swelling, numbness and bruising may occur. At times, it may cause tear in the ligaments or tendons of the shoulder and nerve damage. Your doctor will examine your shoulder and may order an X-ray to confirm the diagnosis.

The condition is treated by a process called closed reduction which involves placing the ball of the upper arm back into the socket. Following this, the shoulder will be immobilized using a sling for several weeks. Ice may be applied over the area for 3-4 times a day. Rehabilitation exercises may be started to restore range of motion, once the pain and swelling decrease.

Patellar Dislocation

Patella (knee cap) is a protective bone attached to the quadriceps muscles of the thigh by quadriceps tendon. The Patella is attached to the femur bone and forms a patellofemoral joint. Patella is protected by a ligament which secures the kneecap from gliding out and is called as medial patellofemoral ligament (MPFL).

Dislocation of the patella occurs when the patella moves out of the patellofemoral groove, (called as trochlea) onto a bony head of the femur. If the knee cap partially comes out of the groove, it is called as subluxation and if the kneecap completely comes out, it is called as dislocation (luxation). Patella dislocation is commonly observed in young athletes between 15 and 20 years. It commonly affects women because of their wider pelvis which creates lateral pull on the patella.

Some of the causes for patellar dislocation include direct blow or trauma, twisting of the knee while changing the direction, muscle contraction, and congenital defects. It also occurs when the MPFL is torn. The common symptoms include pain, tenderness, swelling around the knee joint, restricted movement of the knee, numbness below the knee, and discoloration of the area where the injury has occurred.

Your doctor will examine your knee and suggests diagnostic tests such as X-ray, CT scan, and MRI scan to confirm condition and provide treatment. There are non-surgical and surgical ways of treating patellofemoral dislocation.

Non surgical or conservative treatment includes:

  1. PRICE (protection, rest, ice, compression, and elevation)
  2. Nonsteroidal anti-inflammatory drugs and analgesics to treat pain and swelling
  3. Braces or casts which will immobilize the knee and allows the MPF ligament to heal
  4. Footwear to control gait while walking or running and also decreases the pressure on the kneecap.
  5. Physical therapy is recommended which helps to control pain and swelling, prevent formation of scar of soft tissue, and also helps in collagen formation. Physiotherapist will extend your knee and applies direct lateral to medial pressure to the knee which helps in relocation. It includes straightening and strengthening exercises of the hip muscles and other exercises which will improve a range of motions.

Surgical treatment is recommended for those individuals who have recurrent patella dislocation. Some of the surgical options include:

  1. Lateral-release– It is done to loosen or release the tight lateral ligaments that pull the kneecap from its groove which increases pressure on the cartilage and causes dislocation. In this procedure, the ligaments that tightly hold the kneecap are cut using an arthroscope.
  2. Medial patellofemoral ligament reconstruction – In this procedure, the torn MPF ligament is removed and reconstructed using grafting technique. Grafts are usually harvested from the hamstring tendons, located at the back of the knee and are fixed to the patella tendon using screws. The grafts are either taken from the same individuals (autograft) or from a donor (allograft). This procedure is also performed using an arthroscope.
  3. Tibia tubercle realignment or transfer– Tibia tubercle is abony attachment below the patella tendon which sits on the tibia. In this procedure the tibia tubercle is moved towards the center which is then held by two screws. The screws hold the bone in place and allow faster healing and prevent the patella to slide out of the groove. This procedure is also performed using an arthroscope.

After the surgery, your doctor will suggest you to use crutches for few weeks, prescribe medications to control pain and swelling, and recommend physical therapy which will help you to return to your sports activities at the earliest.

Fracture care

The word “fracture” implies to broken bone. A bone may get fractured completely or partially and it is caused commonly from trauma due to fall, motor vehicle accident or sports. Thinning of the bone due to osteoporosis in the elderly can cause the bone to break easily. Overuse injuries are common cause of stress fractures in athletes.

Fracture Healing

Our body reacts to a fracture by protecting the injured area with a blood clot and callus or fibrous tissue. Bone cells begin forming on the either side of the fracture line. These cells grow towards each other and thus close the fracture.

Medical Therapy

The objective of early fracture management is to control bleeding, prevent ischemic injury (bone death) and to remove sources of infection such as foreign bodies and dead tissues. The next step in fracture management is the reduction of the fracture and its maintenance. It is important to ensure that the involved part of the body returns to its function after fracture heals. To achieve this, maintenance of fracture reduction with immobilization technique is done by either non-operative or surgical method.

Non-operative (closed) therapy comprises of casting and traction (skin and skeletal traction).

Casting

Closed reduction is done for any fracture that is displaced, shortened, or angulated. Splints and casts made up of fiberglass or plaster of Paris material are used to immobilize the limb.

Traction

Traction method is used for the management of fractures and dislocations that cannot be treated by casting. There are two methods of traction namely, skin traction and skeletal traction.

Skin traction involves attachment of traction tapes to the skin of the limb segment below the fracture. In skeletal traction, a pin is inserted through the bone distal to the fracture. Weights will be applied to this pin, and the patient is placed in an apparatus that facilitates traction. This method is most commonly used for fractures of the thighbone.

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