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Sports Injuries

Overuse injuries can occur in any of the soft tissues, or even hard tissues of the body with sports injuries. About 30 to 50% of all sports practices are related to overuse injuries from repetitive trauma. The injury just overwhelms the soft tissue and failure occurs, so we see all types of athletes whether they are recreational or professional and it happens at all levels. Muscle and tendon injuries, it’s age dependent. Adolescents, their weakest structure in the muscular tendinous extent tends to be at the growth plate. As we become young adults, it’s the ligaments and the soft tissues, muscles and tendons. In older adults it tends to be the bone, and we see more fractures.

Tears can happen within the substance of the tendon, where the tendon attaches to the bone, where the ligaments attach to the bone, or at the muscular tendinous junction. Most common mechanism of injury is excessive amount of stretch. It is usually failure of the musculotendinous junction or the muscle tendon units, it can be an intrasubstance degeneration. Normal physiology, there is a crimp or a wavy pattern to the tendon. Once you exceed approximately 4% of strain on t hat tendon.

Symptoms. Patient’s usually present with pain, swelling, pseudoparalysis, lack of motion, it could be acute, sharp or inability to actively move the joint. The picture on the right, it’s sort of hard to see but you start noticing some swelling just above the knee on the new leg, but it’s hard to determine it.

Patellar tendinitis is a common tendon issue that we see, happens at the level of the patella, also called jumper’s knee from repetitive jumping. Usually they have pain at the tendon insertion. Treatment once again, physical therapy, ice, rest anti-inflammatory medicines, patellar tendon straps.

Most patellar tendonitis happens at the inferior pole of the patella, in adolescence they get Osgood Schlatter’s disease which is a traction epiphysitis at the insertion site. These immature patient’s get these traction injuries because of the issue of what’s strongest in their bodies, tendons and ligaments tend to be stronger than bone, so they pull off the tendon from the bone.

Bursitis, multiple bursas throughout the knee, the prepatellar bursa, the infrapatellar bursa, you have bursas around the ITB pes tendons on the medial side, they are gastroc and semi-tendinosis. Bursas are fluid filled sacs, they are there to minimize friction, they can get inflamed, they can get septic, more commonly, the reason for sepsis is usually that there has been intervention, either with a needle or a puncture wound from an abrasion. Patient’s usually present with swelling, erythema, tenderness.

The other issue that we get into with these sports related activities is lower leg pain, the classic triad of lower leg pain that becomes a diagnostic dilemma sometimes has a differential between compartment syndrome, shin splints and stress fractures. They happen in healthy, middle aged active people. 

Compartment syndromes are the most devastating, they are the ones that can cause most of the damage. Most runners will have them, shin splints is a periostitis, it’s where the periosteum is being pulled off the bone. They usually have pain posterior medial of the tibia, they describe it as a dull, achiness or a soreness. It can be sharp or severe later on. It is usually diffuse, it’s not point specific, that’s how this sort of differentiates itself from stress fractures, in that it is diffuse.

Stress fractures, these tend to be related to multifactorial. You see them a lot more in women, especially now that women are becoming more athletically active, the level of intensity of their activity is increased, their bone size tends to be a little bit less than men, it’s related to hormonal variances and dietary habits. Be concerned about foot wear, excessive amount or pronation.

Treatment: Compression side stress fractures heal pretty well. You can treat them symptomatically with nonweight bearing, sometimes a cast is necessary, the high risk and nonunion types can require surgical intervention, specifically as an orthopaedist, and that gets them back to their activities faster. Fibula, we usually can treat these without surgery, rest, splinting. An air splint is very beneficial. You can get air splints that are higher than the typical ankle air splint that you are used to seeing, they can return to activities when they are pain-free. The big concern we have, especially in runners, the stress fractures.