SPORTS INJURIES DIAGNOSIS & TREATMENT

With increasing attempts to get people to exercise more, to aid weight loss and reduce the prevalence of life-threatening illness, GPs and other health professionals as well as students entering primary care will be faced with increasing numbers of patients with exercise-induced injury. We have to improve our ability to help these patients. And as they usually turn to their GPs as their first port of call now, it makes sense to help those GPs so they can make good diagnoses, give sensible advice on treatment and rehabilitation and make appropriate referrals. The purpose of this series of articles is to help GPs and students to identify physical injuries of the joints and their surrounding tissues. Designed to be used in a general practice situation, these articles are targeted at sports people from club level to elite, as well as “casual” exercisers. With this information, treatment and referral should be more specific, resulting in happier patients, appropriate and cost-effective referrals, and a satisfied doctor. The content of these articles won’t always reflect cutting-edge sports medicine. They will deliver back-to-basics revision of anatomy and instruct on diagnosis and treatment, including background theory and evidence- based medicine where appropriate. They are designed for doctors and students who need the information but haven’t got the time to invest wholeheartedly in a sports medicine degree. The first in the series is a general outline of the theory and basics of injury, diagnosis and rehabilitation. Subsequent articles will look at different major joints, their structure (including surface anatomy and internal structures) and function, as well as how they are affected by injury and the sort of rehabilitation required. The joints will include the knee, shoulder, ankle, wrist, hip, elbow, cervical spine, sacroiliac joint and lumbar spine.

Later articles in the series will compare different pairs of joints (e.g. the cervical spine and the shoulder; the elbow and the wrist; the lower back and the hip; the knee and the ankle) and outline their similarities as well as reviewing the symptoms of each and how to differentiate them. The final article will cover miscellaneous conditions like carpal tunnel syndrome, de Quervain’s and trigger finger. Although these articles will use evidence- based medicine where appropriate, many treatments have moved into “sports folklore”. We should always assess new treatments that have been shown to improve recovery with good evidence, but we should also remember the old axiom: “If it isn’t broken, why fix it?”

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DIAGNOSIS AND TREATMENT OF SPORTS INJURIES

This is the first of several articles on sporting injuries. It provides a comprehensive overview of the different types of injury and looks at specific issues relating to their diagnosis, treatment and rehabilitation, while recommending some more general approaches to both diagnosis and treatment.

BY DR SIMON KAY, GP

INTRODUCTION Musculoskeletal injuries can broadly be divided into three categories: n Acute injuries n Overuse injuries n Dysbalance injuries.

These injuries can affect all the major joints in the body, in the short term or in the long term.

ACUTE INJURY This occurs as a result of excessive forces overcoming the structures involved. The physics of injury is not within the scope of this article. It can involve any single structure or multiple structures as the force increases.

For example, a twist to a knee could range from a sprained or torn cruciate ligament or meniscal damage to complete joint disruption. What defines the level of injury is multifactorial and often consistent with the force behind the injury. If the severity of the injury seems inappropriate for the circumstances, use the “surgical sieve” (Box 1) to check for precipitating factors or other illnesses; for example, severe pain after an injury in a child’s bone could be because of brittle bone disease or the early presentation of osteosarcoma. Always try to match the diagnosis to the description of the injury and the forces involved. Diagnosis depends on the triad of history, examination and special

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