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Sporting injuries. David Hargreaves Consultant Hand, Wrist and Elbow Surgeon Southampton. Sporting Injuries. Leisure Time Sports Interest Sports Industry UK Sporting legacy Soccer America`s Cup. Impact Sports. Rugby American Football Ice Hockey Soccer. Impact Sports. - PowerPoint PPT Presentation
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Sporting injuries
David HargreavesConsultant Hand, Wrist and Elbow Surgeon
Southampton
Sporting Injuries
• Leisure Time • Sports Interest • Sports Industry
• UK Sporting legacy– Soccer– America`s Cup
Impact Sports
Racquet Ball
Handle sports Fighting Sports Repetitive Loading
Sporting injuries
Impact Sports
• Rugby• American Football• Ice Hockey• Soccer
Impact Sports
• Tackle Elbow :– Biceps Tendon Rupture– MCL Rupture
Impact - Wrists
• Distal Radius Fracture
• Scaphoid fracture
• Sc-Lunate Lig Rupture
QuickTime™ and a decompressor
are needed to see this picture.
Impact - Hands • 5th most common
Rugby injury
• Thumb : – UCL rupture
– CMC: Bennetts Fracture
Scaphoid Fractures
• FOOSH
• Wrist Extension Injury
• Ball hitting hand
• Punch Injury
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are needed to see this picture.
Percutaneous Fixation • Percutaneous screw fixation versus
conservative treatment for fractures of the waist of the scaphoid - A Prosp Randomised study
• M. M. McQueen• J Bone Joint Surg Br; Jan 2008:66-71
• Quicker time to union • Earlier return to sport & function. • No stat diff in nonunion
Electro-magnetic Stimulation• The clinical and radiological outcome of
pulsed electromagnetic field treatment for acute scaphoid fractures: A randomised double-blind placebo-controlled multicentre trial
• Hanneman (Maastrich)• Bone Joint J Oct 2012 94-B:1403.
• No significant difference
Factors affecting Union
• Delay in Treatment
• Displacement (>1mm)
• Smoking
Handle Sports
• Racquet vs Hand Ball vs Hand
Ball vs Hand
• Mallett Finger• PIP dislocation: ?Fracture ?Central slip• Crush : Phalangeal / MC fracture• Wrist : Scaphoid / ScLun Lig
Racquet Type Injuries• Elbow
– Tendonitis– Chronic MCL
• PostMed ImpingementQuickTime™ and a
decompressorare needed to see this picture.
Racquet
• Wrist Injury– Tendonitis
• FCR• ECU
– Ligament
– TFCC tear
– CMC 4 &5
Racquet
• Hook of Hamate– Golf – Tennis
– Mechanism : • Direct Trauma• ?
Hook of Hamate
• Clinical signs:
– Tenderness
– Resisted LF flexion in ulnar deviation
– Ulnar nerve irritation
Treatment
• Non Op
• Operation: – Excise– Fixation
Fighting Sports
• Boxing • Martial Arts
• Judo
Fighting:
• Elbow : – Hypertrophic osteophytosis
• Impingement
– Instability • PLRI• MCL
Punch
• Wrist : – Scaphoid
• CMC Subluxation
• Sagittal Band tears
Loading Sports
• Sudden :– Weight Lifting
• Chronic :– Cycling
Biceps Tendon Rupture
• Avulsion from Bicipital tub.• Clinical Signs :
– Bruising – Hook Test– Popeye sign
Biceps Treatments
• Non Op Rx: – Fatigability – Supn & Flexion– Muscle cramp
– Not an option for most Sportsmen
Acute Surgical Repair• 2 Incision Technique
– Posterior aspect of BT
• 1 Incision Technique– Endobutton / ToggleLoc– Tendon not easily inserted
into bone – Anterior part of BT
Late Repair • Reattachment :
– Tight Biceps– <60deg
• Graft : – Hamstring– Allograft : Achilles
• Transfer – Brachialis insertion
Biceps Tendonitis
• Diff Diag: Bursitis
• Degeneration • Partial Avulsion
• PRP • Reattachment
Conclusions• Diagnosis: -over investigate • Prognosis: -don’t underestimate• Communication: -Rehab team