OVERUSE INJURIES

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OVERUSE INJURIES

• PANOS THOMAS

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OVERUSE INJURIES

• -Repetitive or cyclical forces that result in
  microtrauma to the muscles, tendons and bones.
  The inability of the body to repair itself
  because the on-going stress leads to pain and
  dysfunction.
• -Epidemiology 30-50 of all sports injuries !

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TENDINITIS

• -Age 1) Younger patient Osgood Schlatter,
  Severs
• 2) Older patient Rotator cuff and Achilles
  Tendinitis
• -Others 71 men with Achilles tendon ruptures
• 0 blood group

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TENDINITIS

• Anatomy flattened tendons (abdominal wall)
• Associated with sesamoid bone (patella)
• Cylindrical tendons (post.tibialis, peroneus
  longus)
• Achilles tendon spiral structure

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TENDINITIS

• Physiology relative avascular (white appearance)
• 30 collagen type 1, 2 elastine
• Linear stress over 4 of tendons length results
  in plastic deformation and over 8 to a rupture

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SWIMMERS SHOULDER

• 13-26 of all swimmers
• Many causes, predominant instability from the
  sport specific demands
• 1) increased shoulder ROM
• 2) increased IR and adduction strength
• 3) Prolonged, fatigue shoulder intensive training
• Reduced stability will lead to subluxation which
  with repetition leads to inflammation and pain

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SWIMMERS SHOULDER

• Treatment - Objectives increase stability,
  reduced inflammation before scarring, return
  athlete to full activity
• Plan 1)Avoid all painful activities, NSAIDS
• 2)Decrease anterior capsule stretching and
  increase posterior capsule
• 3)Increase rotator cuff exercise, ER
• 4)Scapular-positioning muscle exercises

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SWIMMERS SHOULDER

• Prevention 1)Avoid all painful activities and
  notify Coach of shoulder pain immediately
• 2)Dont use ice or NSAIDS on a chronic base
• 3)Equal time spent stretching posterior and
  anterior capsules
• 4)Perform general rotator cuff exercises
• 5)Perform scapular-positioning muscle exercises

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WEIGHT LIFTERS SHOULDER

• - Localized discomfort at ACJ, present at night
  time (first noticed after bench press exercise)
• -X-rays osteolysis of distal clavicle
• -Treatment 1)Narrower grip and control descent
  phase
• 2)Avoid bench press, push up
• 3)NSAIDS, ice, local infiltrations
• 4)Arthroscopic or open excision surgery

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IMPINGEMENT SYNDROME

• -Throwing athletes, racket sports, gymnasts,
  volleyball, swimmers
• -Acromion shape important (types 2,3)
• -It affects supraspinatus tendon (tendinitis,
  rupture)
• -Increased discomfort with shoulder in abduction
  and IR
• -Part of painful athletes shoulder

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IMPINGEMENT SYNDROME

• -Gradual onset of symptoms, worse with overhead
  activities. Pain at rest or at night
• -Difficult to abduct in early stages, provocative
  tests, tendon tests
• -MRI scan, Arthrogram, x-rays, U/S

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IMPINGEMENT SYNDROME

• Treatment rest, NSAIDS, physiotherapy 2-3 weeks
• One local infiltration (injection test)
• Arthroscopic/ open acromioplasty with 80
  excellent results
• Residual pain syndrome (?
  Instability, other)

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OTHER SHOULDER OVERUSE

• -Biceps tendinitis and subluxation
• -SLAP lesion
• -Repair and preservation of the biceps-labrum
  complex

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ELBOW OVERUSE INJURIES

• 1) Pronator syndrome entrapment neuropathy of
  the medial nerve
• -EMG studies often normal
• -Cricket, rowing, racket sports, weight lifting,
  archery
• -Pain over volar aspect of elbow and forearm
• -Numbness over thenar eminence (palmer cutaneus
  branch), absence of night symptoms
• -Tinels test, provocative tests
• - Modify activity, rest, NSAIDS, surgery

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ELBOW OVERUSE INJURIES

• 2)Medial epicondylitis, cubital tunnel syndrome
• 3)Lateral epicondylitis (tennis elbow)
• - Pathology within ECRB tendon
• -Age over 35, high activity level of wrist
  extensors
• -Localized pain, difficulty to lift small objects
  (cups) reduced hand grip
• -Rest, NSAIDS, infiltrations, physiotherapy,heat
  sleevers, surgery

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WRIST AND HAND OVERUSE INJURIES

• De Quervain syndrome
• -APL, EPB inflammation into the fibrous sheath
• -Pain medially, Finkelstein tests
• -Treatment rest, splinting, NSAIDS,
  infiltrations, physiotherapy, surgery

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ACHILLES TENDINITIS

• -Prevelence 6-11 amongst runners
• -Training errors 75, hyperpronation 56, poor
  gastrocnemius-soleus flexibility 40, improper
  shoes 10
• -16 of runners are retiring from the sport

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ACHILLES TENDINITIS

• -Paratenonitis inflammation proximal to the
  tendon (thickening, scarring)
• -Tendinitis middle third of the tendon
  (spiraling configuration, less blood perfusion)
• -Biomechanical factors subtalar pronation etc

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ACHILLES TENDINITIS

• Management 1)Decrease inflammation and pain
  (ice, NSAIDS, heel wedge)
• 2)Correction limb and foot abnormalaties
• 3)Footwear modification
• 4)Improve strength-flexibility
• 5)Later on physiotherapy (US, electrotherapy)
• 6)Injection into retrocalcaneal bursa
• 7)Surgery after 3-6 months

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PLANTAR FASCIITIS

• -7 of all lower limb injuries in running
• -Stabilizer from midstance to toe-off
• -Over pronation or cavus foot
• -Periosteum bleeding produces a spur

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PLANTAR FASCIITIS

• Management
• 1) Control pain and inflammation
• 2) Modification of mechanical factors