Transcript Sporting injuries - Southampton Hand Course

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
Sporting injuries
Impact Sports
Handle sports
Racquet
Ball
Fighting Sports
Repetitive Loading
Impact Sports
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Rugby
American Football
Ice Hockey
Soccer
Impact Sports
• Tackle Elbow :
– Biceps Tendon Rupture
– MCL Rupture
Impact - Wrists
• Distal Radius Fracture
• Scaphoid fracture
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• Sc-Lunate Lig Rupture
Impact - Hands
• 5th most common
Rugby injury
• Thumb :
– UCL rupture
– CMC: Bennetts Fracture
Scaphoid Fractures
• FOOSH
• Wrist Extension Injury
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• Ball hitting hand
• Punch Injury
Percutaneous Fixation
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Percutaneous screw fixation versus
conservative treatment for fractures
of the waist of the scaphoid - A
Prosp Randomised study
M. M. McQueen
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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
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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
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Mallett Finger
PIP dislocation: ?Fracture ?Central slip
Crush : Phalangeal / MC fracture
Wrist : Scaphoid / ScLun Lig
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
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
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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