Kategoriarkiv: Adults injuries

Complications: If steady progress is not experienced, you should be medically (re)examined to ensure that the diagnosis is correct or whether complications for muscle ruptures have arisen.

Stress fracture

STRESS FRACTURE

Diagnosis:

(Stress fracture)

Anatomy: The femur is the only bone in the thigh. Innumerable muscles are attached to the bone.

Caput femoris
Collum femoris
Trochanter minor
Trochanter major

THIGH BONE FROM THE FRONT

Cause: Repeated loads, particularly when walking or running, can cause such great stress that cracks (stress fractures) appear in the shaft of the femur (article).

Symptoms: Pain and tired sensation in the thigh. The pain is aggravated upon applying pressure (direct and indirect tenderness) and applying load (walking, running).

Examination: X-ray. Since many stress fractures are not visible early in the course, x-ray examination can be repeated after a few weeks, if stress fractures are still suspected. Scintigraphy, CT, MRI and ultrasound scans can often diagnose stress fractures far earlier than x-rays (Ultrasonic image). The frequency of stress fractures in the femur is probably more often than presumed (article). It is crucial for the result of the treatment that the diagnosis is made as early as possible (article).

Treatment: The treatment primarily comprises relief. Only in special cases is surgery necessary (article).

Rehabilitation: The rehabilitation is completely dependant on the type of fracture and the treatment (relief or surgical). A rehabilitation period of 2-4 months must be expected before maximum participation in sports activity can be resumed (article).

Complications: If progress is not smooth, you should be medically re-evaluated to ensure that the fracture is healing according to plan. In some cases a false joint is formed (pseudoarthrosis), which requires surgical treatment.

Chronic compartment syndrome in the posterior thigh

CHRONIC COMPARTMENT SYNDROME IN THE POSTERIOR THIGH

Diagnosis:

(Chronic compartment syndrome in the posterior thigh)

Anatomy: The thigh muscles are divided into three groups (muscle compartments) of powerful, partially unyielding, muscle membranes (fascias); a front, an inner and a rear muscle compartment (Drawing).

Cause: The muscles can increase so quickly following intensive training that the muscle membranes surrounding the muscles cannot keep up, causing the pressure in the muscle compartment to increase. The pressure can in some cases increase so greatly that impingement of blood vessels and nerves can occur. In other cases, chronic muscle compartment syndrome can arise as a complication to earlier muscle ruptures.

Symptoms: With chronic compartment syndrome there is slowly insetting pain in the posterior muscles after a few minutes activity. There is a sensation that the muscle is “tightened” and becomes hard, which is accompanied by discomfort. If the activity is stopped the discomfort diminishes, but returns after a short period of resuming the sports activity once again.

Examination: The diagnosis is made on the basis of the characteristic history and possibly with a pressure measurement in the muscle compartment (article).

Treatment: With chronic muscle compartment syndrome the treatment primarily comprises relief and slowly increasing training intensity, rheumatic medicine (NSAID), and massage (article 1). If there is scar tissue in the muscle, ultrasound guided injection of corticosteroid around the scar tissue formation can be attempted. In cases where there is a lack of progress a surgical splitting of the muscle membranes can be performed, which is usually a minor procedure with good results (article-1) (article-2).

Rehabilitation: INSTRUCTION

Rehabilitation: Once the pain has diminished, the sports activity can generally be slowly resumed according to the principles mentioned under rehabilitation, general.

Complications: In cases of lack of progress with relief and slow rehabilitation, an ultrasound scan should be performed before possible surgery to rule out complications to (previous) muscle ruptures. If scar tissue is in evidence in the muscles, ultrasound guided injection of corticosteroid can be attempted in the area surrounding the scar tissue.

Acute compartment syndrome

ACUTE COMPARTMENT SYNDROME

Diagnosis:

(Acute compartment syndrome)

Cause: The pressure in a muscle compartment can rise so fast (due to bleeding or fluid extraction) that the muscle membranes cannot keep up. The pressure in the muscle compartment can therefore increase so greatly that impingement of blood vessels and nerves can occur.

Symptoms: With the acute muscle compartment syndrome there is increasing pain, which is often more powerful than expected from the primary evaluation of the extent of the injury. At the same time sensory disturbances can occur.

Examination: The diagnosis is made on the basis of the characteristic history, increased circumference of the thigh, tight and hard posterior thigh muscle and by a pressure measurement in the muscle compartment (article).

Treatment: With acute muscle compartment syndrome the treatment in severe cases comprises acute splitting of the muscle membrane. It is imperative for the continuing function of the muscle that this operation be acute, which is, of course, only possible if the athlete seeks acute medical attention (article-1) (article-2). In mild cases, surgery can be omitted under close hospital observation. (article-3).

Rehabilitation: The rehabilitation is completely dependant on which muscle groups are affected, the provoking cause (blow to the muscle, muscle rupture or over-training) and which treatment that has been performed (relief, surgical splitting). Once the pain has decreased, the sports activity can generally be slowly resumed according to the principles as mentioned under rehabilitation, general.

Complications: Muscles and nerves can suffer permanent damage if the treatment is not started as soon as possible.

Special: Since there is a chance of permanent disability, the injury should be reported to your insurance company.

Muscle rupture in the posterior thigh

MUSCLE RUPTURE IN THE POSTERIOR THIGH

Diagnosis:

(Ruptura musculi)

Anatomy: A rupture can in principle occur to all muscles in the rear of the thigh, however, ruptures most often happen in the large posterior muscles in the centre of the thigh (M biceps femoris, M semitendinosus, M semimembranosus) which have the function of stretching the hip and flexing the knee.

M. biceps femoris (caput longum)
M. semitendinosus
Caput breve m. bicipitis femoris
M. plantaris
Tendo m. bicipitis femoris
M. gastrocnemius
M. sartorius
M. gracilis
M. semimembranosus

THIGH FROM THE REAR

Cause: When one of the posterior thigh muscles is subjected to a load beyond the strength of the muscle (typically sprinting), a rupture occurs. The vast majority of ruptures are partial muscle ruptures.

Symptoms: In slight cases a local tenderness is felt after being subjected to load (“sprained muscle”, “imminent pulled muscle”). In severe cases sudden shooting pains are felt in the muscle (“partial muscle rupture”, “pulled muscle”) and in the worst case a sudden snap is felt rendering the muscle unusable (“total muscle rupture”). The following three symptoms are characteristic in connection with muscle injuries: pain upon applying pressure, stretching and activation of the muscle (flexing knee) against resistance. With total ruptures a defect can often be seen and felt in the muscle, and above and below the rupture a swelling can be felt (the contracted muscle belly and bleeding). The most frequent place for partial ruptures on the posterior thigh is the large posterior muscles in the centre of the thigh (M biceps femoris, M semitendinosus, M semimembranosus) which have the function of stretching the hip and flexing the knee.

Acute treatment: Click here.

Examination: In very slight cases with only minimal tenderness and no discomfort when walking normally, medical examination is not necessarily required. The severity of the tenderness is however, not always a measure of the extent of the injury. In cases of more pronounced tenderness or pain, medical examination is required to ensure the diagnosis and treatment. The diagnosis is usually made following normal medical examination, however, if there is any doubt concerning the diagnosis, ultrasound scanning (or MRI scanning) can be performed, as these are the most suitable examinations to ensure the diagnosis (Ultrasonic image). The larger the bleeding as assessed by ultrasound scanning, the longer the period needed to heal the injury. MR imaging in the prognostication of hamstring injury. Work in progress (article).

Treatment: The treatment of the vast majority of muscle injuries today involves relief and rehabilitation. It is only in very rare cases that surgery is indicated Even large ruptures in the thigh muscles will usually be able to be healed and rehabilitated without giving functional disorder (but often cosmetic disfigurement with an irregular thigh muscle).

Rehabilitation: INSTRUCTION

Complications: If steady progress is not experienced, you should be medically (re)examined to ensure that the diagnosis is correct or whether complications for muscle ruptures have arisen.

Muscle ruptures aroud the knee

MUSCLE RUPTURES AROUND THE KNEE

Diagnosis:

Anatomy: The majority of the muscle tendons running from the thigh to the shin bone pass the knee joint to the rear of the knee. The majority of “over-load” symptoms emanate therefore from the muscles in the hollow of the knee (popliteal space).

M. biceps femoris (caput longum)
M. semitendinosus
Caput breve m. bicipitis femoris
M. plantaris
Tendo m. bicipitis femoris
M. gastrocnemius
M. sartorius
M. gracilis
M. semimembranosus

KNEE FROM THE REAR

Cause: Muscle ruptures occur following sudden, violent loads, causing a total or partial rupture in the muscle or the muscle fastening. Many muscle ruptures are preceded by tenderness in the muscle or muscle tendon. Ruptures in the anterior thigh muscle fastening (tendo m bicipitis femoris) on the head of the calf bone (caput fibulae), and the calf muscle fastenings in the popliteal space are commonly seen. The vast majority of ruptures are partial ruptures.

Symptoms: Pain when applying pressure along the muscle tendon, aggravated by stretching and activation against resistance (flexing of knee). In light cases, a local tenderness can be felt after subjecting to load (“sprained muscle” “imminent pulled muscle”). In more severe cases, a sudden shooting pain can be felt in the muscle (“partial muscle rupture”, “pulled muscle”) and in the worst cases a violent “snap” can be felt, after which it is impossible to use the muscle (“total muscle rupture”). The following three symptoms are characteristic of muscle injuries: pain when applying pressure, stretching and activation against resistance (flexing of knee). A defect in the muscle can often be seen and felt in cases of a total muscle rupture, as well as swelling in the muscle (the contracted muscle belly and muscular bleeding).

Acute treatment: Click here.

Examination: A medical examination is not necessarily required in light cases. More severe cases, or cases where the treatment has not brought any improvement should be evaluated by a doctor to make a precise diagnosis. The diagnosis is usually made on the basis of a normal medical examination. Ultrasound scanning (and MR scanning) is often necessary in cases of a severe rupture in order to evaluate the extent of the rupture and bleeding (Ultrasonic image).

Treatment: Treatment comprises rest and relief, stretching and increasing loads within the pain threshold. Muscle ruptures are usually treated with a rehabilitation program, and surgery can only be considered in very rare cases with total muscle ruptures.

Rehabilitation: INSTRUCTION

Complications: In case of lack of progress it should be considered whether the diagnosis is correct. Special consideration should be given to:

Luxation of the knee cap

LUXATION OF THE KNEE CAP

Diagnosis:

((Sub)luxation patellae)

Anatomy: The large anterior thigh muscle (musculus quadriceps femoris) consists of four muscles (m vastus lateralis, m vastus medialis, m vastus intermedius & m rectus femoris). All the muscles fasten on the upper edge of the knee cap. The knee cap ligament (ligamentum patellae) connects the lower edge of the knee cap with the front part of the shin bone (tuberositas tibiae). The knee cap is held in place by the structures that fasten on the knee cap, especially the anterior thigh muscle, joint capsule and several ligaments (retiaculum patellae mediale & retiaculum patellae laterale) as well as the knee cap ligament.

Tendo m. adductoris magni
Retinaculum patellae mediale
Meniscus medialis
Ligamentum collaterale mediale/tibiale
Bursa anserina
Bursa subtendinea m. sartori
Ligamentum patellae
Patella

KNEE JOINT

Cause: Luxation of the knee cap can occur following a blow on the knee, but more often after a sudden and violent knee movement, where the knee is twisted and stretched at the same time. This can cause the knee cap to be displaced to the external side of the knee, whereby the ligaments holding the knee cap will rupture. The knee cap will often impact with the thigh bone, producing the risk of cartilage damage in the knee: cartilage damage in the joint (osteokondrale lesion), cartilage damage on the knee cap (chondromalacia patellae).

Symptoms: Sudden insetting severe pain that renders continued sports activity impossible. The knee cap can become completely displaced to the external side of the knee in some cases, and the knee will consequently be locked in a flexed position (total luxation) until the knee cap suddenly slips into place again allowing the knee to be stretched once more. In other cases, the knee cap will only be partially displaced to the external side of the knee (subluxatio patellae).

Acute treatment: Click here.

Examination: The diagnosis can be difficult if the knee cap is in its correct position, and anyone with suspicions of displacement of the knee cap should always seek medical attention to ensure the diagnosis and correct treatment. The examination will typically provoke severe pain when the knee cap is pressed outwards (lateral) whilst the knee is flexed (Apprehension test). The knee cap will often be able to be pressed further out on an injured knee than a healthy one. An MR scan will be able to reveal more information regarding the cartilage condition in the knee after a partial or total luxation of the knee cap (article).

Treatment: Partial luxation should primarily be treated with relief and rehabilitation. There is no general consensus of opinion regarding treatment of total luxation of the knee cap, some recommend surgery whilst others advocate relief and rehabilitation (article 1) (article 2). Surgery should however be considered with repeated (total or partial) luxation.

Rehabilitation: INSTRUCTION

Rehabilitation of non-operated, partial luxation of the knee cap (subluxatio patellae).

Bandage: Tape and bandaging has no documented preventive effect subsequent to previous total or partial luxation of the knee cap (article), however experience has shown that this is utilised to a large degree (tape-instruction).

Complications: In case of lack of progress it should be considered whether the diagnosis is correct. Special consideration should be given to:

Special: Since there is a risk that the injury can cause permanent disability, the injury should be reported to your insurance company. A running style analysis can be considered to evaluate whether a correction to the running style can be recommended.

Degerative arthritis

DEGERATIVE ARTHRITIS

Diagnosis:

(Osteoarthritis)

Anatomy: The bones in the knee joint comprise the thigh bone (femur), shin-bone (tibia) and the knee cap (patella). The articular surfaces of the thigh bone, shin-bone and knee cap are lined with a cartilage covering of a few millimetre’s thickness which serves to reduce the load or strain on the joint surfaces.

Patella
Tibiae
Meniscus lateralis
Femur

KNEE JOINT

Cause: Repeated and uniform loads can cause damage to the cartilage, and subsequently the bone beneath the cartilage (degenerative arthritis). of the synovial membrane (synovitis), which will cause formation of fluid, swelling, reduction in mobility and pain in the knee joint. Degenerative arthritis in the knee joint is often seen after a previous rupture of the anterior cruciate ligament, rupture of the posterior cruciate ligament eller meniscus lesion, where it has been necessary to remove the whole or part of the meniscus.

Symptoms: Pain in the joint with movement under load or strain. Difficulties in the start up phase are often experienced, alleviated after warm-up, but with pain again after a prolonged period under load. Swelling of the joint (synovitis) in occasional cases. With pronounced swelling, a fluid filled bursa can develop in the hollow (popliteal space) of the knee (Baker cyst).

Examination: Normal medical examination is usually sufficient to make the diagnosis, however, it is also often necessary to perform an x-ray (or ultrasound scan or MR scan) to make the diagnosis.

Treatment: Treatment comprises relief from the pain inducing activities until the swelling has gone down, after which training can commence with the primary aim to strengthen the muscles surrounding the joint and retain joint mobility (article). There is no treatment which can restore the damaged cartilage (and bone). Cartilage transplants are, as yet, not suitable for general degenerative arthritis. In cases of swelling in the joint (and popliteal space), inflammation of the synovial membrane (synovitis) can be attempted subdued by using rheumatic medicine (NSAID), or by draining the fluid and injecting corticosteroid. The injections can be performed to advantage by utilising an ultrasound guided method (Ultrasonic image). Pain without swelling of the joints is best treated with paracetamol. In severe cases of degenerative arthritis where there is pain when resting (at night), it may be necessary to replace the joint.

Rehabilitation: INSTRUCTION

Rehabilitation: Rehabilitation is primarily aimed at strengthening the thigh muscles, whereby the joint can be stabilised and relieved to a certain extent.

Complications: Degenerative arthritis which is positioned on the weight-bearing parts of the joint surfaces represents one of the most serious sports injuries, and often results in an end to the sporting career. It is usually possible to participate in sports with lesser knee straining activity (i.e. swimming), whereas sports with great knee straining activity (i.e. running, football) should be treated with reservation.

Special: Shock absorbing shoes or inlays will reduce the load on the knee.

Cartilage damage in the joint

CARTILAGE DAMAGE IN THE JOINT

Diagnosis:

(Osteochondral lesion)

Cause: Twists in the knee joint causing the thigh bone and shin bone to collide can cause damage to the cartilage in the knee. In some cases a piece of cartilage can be shed which can wander in the joint (joint-mouse) and become inflamed and increase the production of synovial fluid.

Symptoms: Pain in the joint when under load or strain. Often, periodic swelling of the joint (synovitis).

Examination: Normal medical examination is often not sufficient. To make the diagnosis correctly it is therefore necessary to perform an arthroscopic examination (telescopic examination of the joint (Photo) or an MR-scanning (Ultrasonic image).

Treatment: Treatment comprises relief from the painful activities until the pain is no longer experienced, after which gradual re-training can be commenced. There is no treatment that can restore the damaged cartilage, which has itself poor restorative ability. Different procedures to enhance the healing can be attempted using arthroscopy, however, the results are generally unsatisfactory. Results from experimental cartilage transplants are still not successful enough to warrant introduction as a routine treatment in the near future (article). Joint-mouse that provokes the symptoms must be surgically removed. Injection of corticosteroid in the knee joint, performed under ultrasound guidance, can be attempted to combat prolonged and pronounced cases of fluid accumulation in the knee joint (synovitis).

Rehabilitation: Rehabilitation is completely dependent upon the type of cartilage damage (size and position in the joint) and treatment (conservative or surgical). It is generally attempted to strengthen the musculature around the knee joint.
Also read rehabilitation, general.

Complications: Large cartilage damage which is positioned on the weight-bearing parts of the joint represents one of the most serious sports injuries, and often results in an end to the sporting career.

Special: As there is a risk that the injury can cause permanent disability, all cases should be reported to your insurance company.

Cartilage damage on the knee cap

BRUSKBESKADIGELSE BAGPÅ KNÆSKALLEN

Diagnosis:

(Chondromalacia patellae)

Patella
Tibiae
Meniscus lateralis
Femur

KNEE JOINT

Cause: Repeated and uniform loads can cause damage to the cartilage, and subsequently the bone beneath the cartilage (degenerative arthritis). Degenerative arthritis changes (osteoarthrosis) on the rear of the knee cap occur often after a fall on the knee and with many smaller over-loads, however, in many cases the cause is unknown. A weak thigh muscle and increased outward turning of the foot (pronation) have been suspected of being a contributory factor to the disease.

Symptoms: Pain in the joint when under load or strain, especially with bent knee (for example stairway steps). A sensation of stiffness in the knee after a prolonged period of sitting. Swelling of the joint (synovitis) in occasional cases.

Examination: Normal medical examination is often sufficient. A characteristic of the condition is that the pain occurs when the knee cap presses against the thigh bone, producing a rough, grating sensation. If there are any doubts regarding the diagnosis the examination can be supplemented by X-rays, arthroscopic examination or an MR-scan.

Treatment: Treatment comprises relief from the painful activities until the pain is no longer experienced, after which gradual re-training can be commenced primarily aimed at strengthening the thigh muscles. There is no treatment that can restore the damaged cartilage on the knee cap. Several different surgical treatments have been attempted with unsatisfactory results (article).

Rehabilitation: INSTRUCTION