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

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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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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

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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

• 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