Sports injuries and adults

Extrinsic

Torn cartilage (meniscus)

Cause

This is caused twisting injury.

Symptoms

Pain with or without swelling, locking or a feeling of instability.

Investigations

X-ray and MRI scan.

Treatment

If symptoms are causing disability then key hole surgery may be indicated.

Torn anterior cruciate ligament (ACL)

Cause

This is caused by a twisting injury.

Symptoms

The usual presentation is with pain, a popping noise may be heard as the ligament ruptures. When the problem is chronic pain and instability develop.

Investigations

An MRI scan will confirm the diagnosis and reveal any associated problems.

Treatment

Surgical reconstruction has been possible for more than 20 years; however surgery may not be indicated in some individuals.

Ankle instability

Cause

Usually due to repeated damage to the ligament on the outside of the ankle.

Symptoms

The ankle gives way, is unstable and usually swells.

Investigations

An X-ray may reveal associated problems, however a stress X-ray will confirm the extent of the ligament damage. An MRI scan is also useful to define the damage.

Treatment

Most unstable ankles do not require treatment, however if the instability is persistent and associated with other ankle problems a reconstruction is indicated.

Rotator cuff syndromes of the shoulder

Cause

With age the rotator cuff (a sheath of muscles around the shoulder) will become thin. Eventually it may fail; this failure may extrinsic or intrinsic.

Symptoms

Acute or chronic pain as the shoulder is elevated. Inability to lift the arm.

Investigations

An MRI scan is the investigation of choice although a plain X-ray may show evidence of problems with the cuff.

Treatment

This depends on the severity of the problem and ranges from the use of physiotherapy, steroid injections and, in resistant cases, surgery.

Dislocated shoulder

Cause

This follows a fall onto the arm.

Symptoms

There is pain in the shoulder, and there may be pain and tingling in the arm.

Investigations

An X-ray will confirm the diagnosis. MRI will be helpful if the problem is recurrent.

Treatment

The dislocation must be reduced under sedation or anaesthetic. Surgery may be required to deal with further dislocations.

Long bone fractures

Cause

These are caused by a direct blow or twisting injury.

Symptoms

They are usually obvious because of pain, swelling and deformity.

Investigations

They require hospitalisation; X-rays confirm the diagnosis and allow for classification of the fracture type with a view to planning treatment.

Treatment

This depends on the nature of the fracture. Although fixation of the fracture is very common, some more simple fractures may be treated in more traditional ways with plaster of Paris or one of the more modern substitutes.

Small bone fractures

Cause

These are also caused by a direct blow or twisting injury.

Symptoms

They may be neglected and treated as a sprain. Persistent pain at the site of an injury when associated with swelling requires medical advice.

Investigations

An X-ray is usually performed.

Treatment

This depends on the type of fracture.

Torn achilles tendon

Cause

Pushing off or jumping from the foot.

Symptoms

Pain in the Achilles area (back of the heel). There may be a snapping noise or sensation.

Investigations

If the diagnosis is in doubt ultrasound examination will confirm the problem.

Treatment

Most surgeons recommend surgical repair and treatment with a brace.

Intrinsic

Knee pain

Cause

Knee pain is common in recreational sportsmen and women. It may be part of the ageing process (which is unlikely to be accelerated by sport), or what used to be called an internal derangement of the knee (IDK). There are numerous causes for the pain.

Symptoms

Classic knee symptoms include pain, swelling, stiffness, and instability or a combination of these.

Investigations

An X-ray is helpful but an MR scan will give more information.

Treatment

This depends on the diagnosis made after imaging. As a general rule, if symptoms are intrusive and do not respond to non-operative treatment, arthroscopic surgery can be helpful.

Low back pain

Cause

There are multiple causes if this which include degenerative disc disease and spondylolysis (a small defect at the back of the vertebra).

Symptoms

Back pain alone is best managed without surgery, however should there be pain referred to the leg with neurological symptoms (numbness, weakness or tingling) the problem should be investigated further.

Investigations

Investigation such as MRI scanning or CT radiographs will help to define the cause of the pain.

Treatment

Treatment depends on the underlying cause. Whilst some conditions require urgent surgery to relieve pressure on the spinal cord, most patients respond to conservative treatment.

Shin splints

Cause

There are several causes of this "syndrome".

Symptoms

The symptom is pain in the shin that is brought on by exercise and relieved by rest, however there are variations on this.

Investigations

X-rays are helpful to exclude a stress fracture, but MRI scanning may be required. Direct measurement of leg compartment pressures may also be required.

Treatment

This depends on the cause of the pain. Most cases of shin splints respond to non-operative treatment. Sometimes surgery is required to release the leg compartments.

Groin pain

Cause

There are also a multitude of causes for this problem. These include an arthritic hip, deep and superficial hernias, strain of the adductor muscles or an inflammation of the pubic symphysis.

Symptoms

The presenting symptom is pain in the groin that usually develops during or after sport.

Investigations

The investigations depend very much on the history and may include plain X-rays, isotope scanning, dynamic ultrasound or MRI scanning.

Treatment

This depends on the underlying cause. Most causes of groin pain do not require surgery and will respond to physiotherapy.

Achilles tendon pain

Cause

Problems with the Achilles tendon may occur in the tendon itself (tendinopathy), at it's insertion into the heel bone (insertional tendinopathy) or just behind the tendon (retrocalcaneal bursitis).

Symptoms

The predominant symptom is pain and there may also be swelling of the tendon itself or around it.

Investigations

Both MR scanning and ultrasound studies are helpful in defining the problem.

Treatment

Treatment should always be non-surgical in the first instance. Failure to respond may be an indication for surgery.

Ankle pain

Cause

This may be caused by problems within the joint, at the front (anterior impingement) or back (posterior impingement) of the joint.

Symptoms

Pain is the main symptom and it may be possible to localise it to a specific area of the joint. There may also be swelling and to a lesser extent instability.

Investigations

X-rays are helpful as is an MRI scan.

Treatment

This depends on the cause of the pain. Should non-operative treatment fail then arthroscopic surgery allows an assessment of the inside of the joint and a debridement (removal) of any abnormal tissue.

Tennis elbow

Cause

This may be caused by unaccustomed exercise, but may also develop insidiously.

Symptoms

Pain over the outside of the elbow. A similar type of condition occurs on the inside of the elbow (golfer's elbow).

Investigations

This is usually a diagnosis that can be made without investigations, however in cases that do not respond to treatment ultrasound and MRI scanning may be useful.

Treatment

Most cases of tennis elbow are self limiting and require supportive (pain killers and physiotherapy) treatment. Occasionally surgery is required.

Hallux rigidus

Cause

Arthritis of the joint at the base of the great toe.

Symptoms

Pain, swelling and stiffness of the joint.

Investigations

X-ray will confirm the diagnosis.

Treatment

Drugs and splints may be helpful, however surgery is indicated when quality of life is affected.

Metatarsalgia

Cause

This is pain in the forefoot around the knuckles of the lesser toes. There are several causes, but only rarely is there a serious cause.

Symptoms

Pain under the base of the toes, occasionally with tingling in the toes and deformity of the toes.

Investigations

An X-ray may be helpful; ultrasound or MR scanning can be very useful.

Treatment

This depends on the cause. As a rule non-operative treatment is initially used. However, if this fails surgery may be possible.

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