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Sporting injuries David Hargreaves Consultant Hand, Wrist and Elbow Surgeon Southampton.

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Presentation on theme: "Sporting injuries David Hargreaves Consultant Hand, Wrist and Elbow Surgeon Southampton."— Presentation transcript:

1 Sporting injuries David Hargreaves Consultant Hand, Wrist and Elbow Surgeon Southampton

2 Sporting Injuries Leisure Time Sports Interest Sports Industry UK Sporting legacy –Soccer –America`s Cup

3

4 Impact Sports Rugby American Football Ice Hockey Soccer

5 Impact Sports Tackle Elbow : –Biceps Tendon Rupture –MCL Rupture

6 Impact - Wrists Distal Radius Fracture Scaphoid fracture Sc-Lunate Lig Rupture

7 Impact - Hands 5th most common Rugby injury Thumb : –UCL rupture –CMC: Bennetts Fracture

8 Scaphoid Fractures FOOSH Wrist Extension Injury Ball hitting hand Punch Injury

9 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

10 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

11 Factors affecting Union Delay in Treatment Displacement (>1mm) Smoking

12 Handle Sports Racquet vs Hand Ball vs Hand

13 Ball vs Hand Mallett Finger PIP dislocation: ?Fracture ?Central slip Crush : Phalangeal / MC fracture Wrist : Scaphoid / ScLun Lig

14 Racquet Type Injuries Elbow –Tendonitis –Chronic MCL PostMed Impingement

15 Racquet Wrist Injury –Tendonitis FCR ECU –Ligament –TFCC tear –CMC 4 &5

16 Racquet Hook of Hamate –Golf –Tennis –Mechanism : Direct Trauma ?

17 Hook of Hamate Clinical signs: –Tenderness –Resisted LF flexion in ulnar deviation –Ulnar nerve irritation

18 Treatment Non Op Operation: –Excise –Fixation

19 Fighting Sports Boxing Martial Arts Judo

20 Fighting: Elbow : –Hypertrophic osteophytosis Impingement –Instability PLRI MCL

21 Punch Wrist : –Scaphoid CMC Subluxation Sagittal Band tears

22 Loading Sports Sudden : –Weight Lifting Chronic : –Cycling

23 Biceps Tendon Rupture Avulsion from Bicipital tub. Clinical Signs : –Bruising –Hook Test –Popeye sign

24 Biceps Treatments Non Op Rx: –Fatigability –Supn & Flexion –Muscle cramp –Not an option for most Sportsmen

25 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

26 Late Repair Reattachment : –Tight Biceps –<60deg Graft : –Hamstring –Allograft : Achilles Transfer –Brachialis insertion

27 Biceps Tendonitis Diff Diag: Bursitis Degeneration Partial Avulsion PRP Reattachment

28 Conclusions Diagnosis: -over investigate Prognosis: -don’t underestimate Communication: -Rehab team


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