Sporting injuries

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Sporting injuries

• David Hargreaves
• Consultant Hand, Wrist and Elbow Surgeon
• Southampton

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Sporting Injuries

• Leisure Time
• Sports Interest
• Sports Industry
• UK Sporting legacy
• Soccer
• Americas Cup

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Impact Sports

• Rugby
• American Football
• Ice Hockey
• Soccer

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Impact Sports

• Tackle Elbow
• Biceps Tendon Rupture
• MCL Rupture

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Impact - Wrists

• Distal Radius Fracture
• Scaphoid fracture
• Sc-Lunate Lig Rupture

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Impact - Hands

• 5th most common Rugby injury
• Thumb
• UCL rupture
• CMC Bennetts Fracture

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Scaphoid Fractures

• FOOSH
• Wrist Extension Injury
• Ball hitting hand
• Punch Injury

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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 200866-71
• Quicker time to union
• Earlier return to sport function.
• No stat diff in nonunion

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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-B1403.
• No significant difference

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Factors affecting Union

• Delay in Treatment
• Displacement (gt1mm)
• Smoking

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Handle Sports

• Racquet vs Hand Ball vs Hand

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Ball vs Hand

• Mallett Finger
• PIP dislocation ?Fracture ?Central slip
• Crush Phalangeal / MC fracture
• Wrist Scaphoid / ScLun Lig

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Racquet Type Injuries

• Elbow
• Tendonitis
• Chronic MCL
• PostMed Impingement

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Racquet

• Wrist Injury
• Tendonitis
• FCR
• ECU
• Ligament
• TFCC tear
• CMC 4 5

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Racquet

• Hook of Hamate
• Golf
• Tennis
• Mechanism
• Direct Trauma
• ?

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Hook of Hamate

• Clinical signs
• Tenderness
• Resisted LF flexion in ulnar deviation
• Ulnar nerve irritation

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Treatment

• Non Op
• Operation
• Excise
• Fixation

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Fighting Sports

• Boxing
• Martial Arts
• Judo

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Fighting

• Elbow
• Hypertrophic osteophytosis
• Impingement
• Instability
• PLRI
• MCL

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Punch

• Wrist
• Scaphoid
• CMC Subluxation
• Sagittal Band tears

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Loading Sports

• Sudden
• Weight Lifting
• Chronic
• Cycling

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Biceps Tendon Rupture

• Avulsion from Bicipital tub.
• Clinical Signs
• Bruising
• Hook Test
• Popeye sign

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Biceps Treatments

• Non Op Rx
• Fatigability
• Supn Flexion
• Muscle cramp
• Not an option for most Sportsmen

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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

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Late Repair

• Reattachment
• Tight Biceps
• lt60deg
• Graft
• Hamstring
• Allograft Achilles
• Transfer
• Brachialis insertion

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Biceps Tendonitis

• Diff Diag Bursitis
• Degeneration
• Partial Avulsion
• PRP
• Reattachment

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Conclusions

• Diagnosis -over investigate
• Prognosis -dont underestimate
• Communication -Rehab team