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Ankle Sprained Clinic

We are specialized in treating Acute and Chronic Ankle Injury. Cure your Ankle Sprained Today! Call us at +65 64712744 or SMS +65 92357641 for Appointment.

A sprained ankle is an injury that occurs when you roll, twist or turn your ankle in an awkward way. This can stretch or tear the tough bands of tissue (ligaments) that help hold your ankle bones together.

Ligaments help stabilize joints, preventing excessive movement. A sprained ankle occurs when the ligaments are forced beyond their normal range of motion. Most sprained ankles involve injuries to the ligaments on the outer side of the ankle.

Treatment for a sprained ankle depends on the severity of the injury. Although self-care measures and over-the-counter pain medications may be all you need, a medical evaluation might be necessary to reveal how badly you’ve sprained your ankle and to put you on the right path to recovery.

Symptoms:

Signs and symptoms of a sprained ankle include:

  • Pain, especially when you bear weight on the affected foot
  • Swelling and, sometimes, bruising
  • Restricted range of motion

Some people hear or feel a “pop” at the time of injury.

When to see a doctor

Call your doctor if you have pain and swelling in your ankle and you suspect a sprain. Self-care measures may be all you need, but talk to your doctor to discuss whether you should have your ankle evaluated. If your signs and symptoms are severe, it’s possible you may have broken a bone in your ankle or lower leg.

Ankle Sprain

Ankle Sprain

Causes Sprained Ankle

A sprain occurs when your ankle is forced to move out of its normal position, which can cause one or more of the ankle’s ligaments to stretch or tear.

Examples of situations that can result in an ankle sprain include:

  • A fall that causes your ankle to twist
  • Landing awkwardly on your foot after jumping or pivoting
  • Walking or exercising on an uneven surface

Risk Factors:

Factors that increase your risk of a sprained ankle include:

  • Sports participation. Ankle sprains are a common sports injury. Sports that require rolling or twisting your foot, such as basketball, tennis, football, soccer and trail running, can make you vulnerable to spraining your ankle, particularly if you’re overweight. Playing sports on an uneven surface also can increase your risk.
  • Prior ankle injury. Once you’ve sprained your ankle, or had another type of ankle injury, you’re more likely to sprain it again.

Complications:

If a sprained ankle is left untreated, if you engage in activities too soon after spraining your ankle or if you sprain your ankle repeatedly, you may experience the following complications:

  • Chronic pain
  • Chronic ankle joint instability
  • Early-onset arthritis in that joint

Many people don’t seek medical attention for mild ankle sprains. If your sprain is severe, however, your family doctor may refer you to a doctor who specializes in sports medicine or orthopedic surgery.

What you can do

You may want to write a list that includes:

  • Detailed descriptions of your symptoms
  • Information about medical problems you’ve had, especially past ankle injuries
  • Information about the medical problems of your parents or siblings
  • All the medications and dietary supplements you take
  • Questions you want to ask the doctor

Diagnosis:

During the physical exam, your doctor will check for points of tenderness. He or she will move the joint in a variety of ways to check your range of motion and to see if any particular position or movement causes pain.

If the injury is severe, your doctor may recommend one or more of the following imaging scans to rule out a broken bone or to more precisely evaluate the soft tissue damage:

  • X-ray. During an X-ray, a small amount of radiation passes through your body to produce images of your internal structures. This test is good for evaluating bones, but is less effective at visualizing soft tissues. Tiny cracks or stress fractures in bones may not show up, especially at first, on regular X-rays.
  • Bone scan. For a bone scan, a technician will inject a small amount of radioactive material into an intravenous line. The radioactive material is attracted to your bones, especially the parts of your bones that have been damaged. Damaged areas show up as bright spots on an image taken by a scanner. Bone scans are good at detecting stress fractures.
  • Computerized tomography (CT). CT scans are useful because they can reveal more detail about the bones of the joint. CT scans take X-rays from many different angles and combine them to make cross-sectional images of internal structures of your body.
  • Magnetic resonance imaging (MRI). MRIs use radio waves and a strong magnetic field to produce detailed images of internal structures. This technology is exceptionally good at visualizing soft tissue injuries.

 Get treatment on your Sprained Ankle Today! Call us at +65 64712744 or SMS +65 92357641 for Appointment.

Patient Guide to Wrist Pain

Wrist pain is a common complaint. Many types of wrist pain are caused by sudden injuries that result in sprains or fractures. But wrist pain also can be caused by more long-term problems such as repetitive stress, arthritis and carpal tunnel syndrome.

Because so many factors can lead to wrist pain, diagnosing the exact cause of long-standing wrist pain sometimes can be difficult. An accurate diagnosis is crucial, however, because proper treatment depends on the cause and severity of your wrist pain.

DeQuervain's Tenosynovitis

DeQuervain’s Tenosynovitis

Symptoms of Wrist Pain:

Wrist pain may vary, depending on what’s causing it. For example, osteoarthritis pain is often described as being similar to a dull toothache, while tendinitis usually causes a sharp, stabbing type of pain. The precise location of your wrist pain also can give clues to what might be causing your symptoms.

When to see a doctor
Not all wrist pain requires medical care. Minor sprains and strains, for instance, usually respond to ice, rest and over-the-counter pain medications. But if pain and swelling last longer than a few days or become worse, see your doctor. Delays in diagnosis and treatment can lead to poor healing, reduced range of motion and long-term disability.

Causes of Wrist Pain:

Your wrist is a complex joint made up of eight small bones arranged in two rows between the bones in your forearm and the bones in your hand. Tough bands of ligament connect your wrist bones to each other and to your forearm bones and hand bones. Tendons attach muscles to bone. Damage to any of the parts of your wrist can cause pain and affect your ability to use your wrist and hand.

Injuries

  • Sudden impacts. Wrist injuries often occur when you fall forward onto your outstretched hand. This can cause sprains, strains and even fractures. A scaphoid fracture involves a bone on the thumb side of the wrist. This type of fracture may not show up on X-rays immediately following the injury.
  • Repetitive stress. Any activity that involves repetitive wrist motion — from hitting a tennis ball or bowing a cello to driving cross-country — can inflame the tissues around joints or cause stress fractures, especially when you perform the movement for hours on end without a break. De Quervain’s disease is a repetitive stress injury that causes pain at the base of the thumb.

Arthritis

  • Osteoarthritis. In general, osteoarthritis in the wrist is uncommon, usually occurring only in people who have injured that wrist in the past. Osteoarthritis is caused by wear and tear on the cartilage that cushions the ends of your bones. Pain that occurs at the base of the thumb may be caused by osteoarthritis.
  • Rheumatoid arthritis. A disorder in which the body’s immune system attacks its own tissues, rheumatoid arthritis is common in the wrist. If one wrist is affected, the other one usually is, too.

Other diseases and conditions

  • Carpal tunnel syndrome. Carpal tunnel syndrome develops when there’s increased pressure on the median nerve as it passes through the carpal tunnel, a passageway in the palm side of your wrist.
  • Ganglion cysts. These soft tissue cysts occur most often on the top of your wrist opposite your palm. Smaller ganglion cysts seem to cause more pain than do larger ones.
  • Kienbock’s disease. This disorder typically affects young adults and involves the progressive collapse of one of the small bones in the wrist. Kienbock’s disease occurs when the blood supply to this bone is compromised.

Risk Factors of Wrist Pain:

Wrist pain can happen to anyone — whether you’re very sedentary, very active or somewhere in between. But your risk may be increased by:

  • Sports participation. Wrist injuries are common in many sports, including bowling, golf, gymnastics, snowboarding and tennis.
  • Repetitive work. Almost any activity that involves your hands and wrists — even knitting and cutting hair — if performed forcefully enough and often enough can lead to disabling wrist pain.
  • Diseases and conditions. Your risk of developing wrist pain is increased if you have diabetes, leukemia, scleroderma, lupus or an underactive thyroid gland.

Diagnosis of Wrist Pain:

During the physical exam, your doctor may:

  • Check your wrist for points of tenderness and swelling
  • Ask you to move your wrist to see if your range of motion has been decreased
  • Assess your grip strength and forearm strength

In some cases, your doctor may suggest imaging tests, arthroscopy or nerve tests to help pinpoint the cause of your wrist pain.

Imaging tests

  • X-rays. Using a small amount of radiation, simple X-rays can reveal bone fractures, as well as evidence of osteoarthritis.
  • Computerized tomography (CT) scan. CT scans can provide more-detailed views of the bones in your wrist. A CT scan takes X-rays from several directions and then combines them to make a two-dimensional image.
  • Bone scan. In a bone scan, a small amount of radioactive material is injected into your bloodstream. This makes injured parts of your bones brighter on the resulting scan images.
  • Magnetic resonance imaging (MRI). MRIs use radio waves and a strong magnetic field to produce detailed images of your bones and soft tissues. For a wrist MRI, you may be able to insert your arm into a smaller device rather than have your entire body slide into a full-size MRI machine.

Arthroscopy
If imaging test results are inconclusive, your doctor may perform an arthroscopy, a procedure in which a pencil-sized instrument is inserted into your wrist via a small incision in your skin. The instrument contains a light and a tiny camera. Images are projected onto a television monitor.

Nerve tests
If your doctor thinks you have carpal tunnel syndrome, he or she might order an electromyogram (EMG). This test measures the tiny electrical discharges produced in your muscles. A needle-thin electrode is inserted into the muscle, and its electrical activity is recorded when the muscle is at rest and when it’s contracted. Nerve conduction tests also are performed as part of an EMG to assess if the electrical impulses are slowed in the region of the carpal tunnel.

CURE YOUR WRIST PAIN TODAY. CALL US AT +65 6471 2744 OR SMS to +65 92357641 FOR APPOINTMENT.

Patient Guide to Shoulder Pain

Shoulder pain should not be ignored. Early treatment can prevent further injury and chronic shoulder problems. Pain in the shoulder may also be referred from other areas of the body, e.g. disc problems the neck.

The Shoulder Joint

The structure of the shoulder joint allows more range of motion than any other joint in the body.

The shoulder actually has several joints that work together to allow a wide range of motion. Most injuries occur at the “main” shoulder joint, where the head of the upper arm meets the shoulder blade; the term “shoulder joint” refers to this joint. The other smaller shoulder joints are referred to by their specific names.

The head of the upper arm bone sits on a very small and shallow socket in the shoulder blade. This allows for the shoulder’s wide range of motion but makes it susceptible to injury. Because there is little bony stability, the shoulder relies greatly on connective tissue (e.g. ligaments, tendons, muscles) to hold the bones of the joint together and to stabilize the joint.

Causes of Shoulder Pain

The Most Common Cause of shoulder joint pain is rotator cuff tendonitis – injury and inflammation of the tendons (rotator cuff tendons) that envelope the shoulder joint. The most common cause of rotator cuff tendonitis is overuse of the shoulder, though the rotator cuff tendons may be injured suddenly as a result of a fall or accident.

Muscle strain is common in the muscles that run over the shoulders to the neck . It is often the result of holding the shoulders in a raised position for long periods of time. The muscles between the shoulder blades are often strained from slouching from long periods of time. Muscle strain varies in severity.

Other painful shoulder conditions, such as frozen shoulder, may occur for no apparent reason. (The risk of frozen shoulder increases when the shoulder is not used enough after a painful injury). The cause of calcium deposits in the shoulder, which may trigger episodes of acute inflammation of the tendons, is also unclear. Arthritis sometimes occurs in a previously injured shoulder joint.

Slap Lesion

Slap Lesion

Risk Factors

WEAK ROTATOR CUFF MUSCLES

Weak or fatigued rotator cuff muscles can lead to soft tissue injury. If the muscles that stabilize the shoulder joint (mainly the rotator cuff muscles) are weak or fatigued, the muscles fail to fully stabilize the joint. If the head of the upper arm bone is not kept in place in its socket, abnormal force is placed upon tissue surrounding the shoulder joint and can lead to injury. Shoulder tendonitis and bursitis are common.

OVERUSE

Shoulder pain is frequently caused by chronic overuse of the shoulder. The shoulder may become injured suddenly from a blow or fall, but gradual injury from chronic overuse of the shoulder is more common. Repetitive lifting, pushing, pulling, throwing, and especially overhead activities may lead to injury. Pain may be mild and intermittent in the beginning and worsen over time. Combining repetitive overhead activities with force increases the risk of injury further (e.g. stacking heavy objects on a high shelf).

Repetitive overhead activities can be particularly damaging. When the arm is raised overhead, the head of the upper arm bone migrates upward on the shoulder socket somewhat and rotator cuff tendons come into contact with the roof of the shoulder blade. Repeated contact and friction of the rotator cuff tendons often leads to irritation and inflammation of the tendons (tendonitis).

A strong rotator cuff helps keep the head of the upper arm bone from riding up excessively but some contact between the rotator cuff and bones in the joint still occurs with overhead activity. The bursa that lies under the roof of the shoulder blade may also be affected and become inflamed (bursitis). Shoulder bursitis often occurs along with shoulder tendonitis.

AGING

Aging is a major factor in rotator cuff injuries Tendons lose elasticity with aging and they become more susceptible to injury. Muscle mass also decreases with age. Both the rotator cuff muscles and tendons can be strengthened with resistance exercises.

Prevention of Shoulder Pain

Overuse shoulder injuries often can be prevented.

Weak rotator cuff muscles may be unable to adequately stabilize the shoulder joint. Rotator Cuff Exercises can help. Building up strength of the rotator cuff through exercise helps to stabilize the shoulder joint to prevent abnormal pressure on the soft tissues surrounding the joint. The muscles that control the shoulder blade also play a role in stabilizing the shoulder joint.

Avoid repetitive overhead activities. If you are involved in activities that involve repetitive overhead movements, take frequent breaks. Fatigued rotator cuff muscles lose the ability to keep the shoulder stabilized.

Avoid doing too much too soon. If you are going to engage in any overhead activity you haven’t done for a long time, such as getting back into playing tennis, endurance must be built up slowly. Exercises to strengthen the muscles you will be using in an activity reduce the chance of injury.

Warm up before engaging in sports such as swimming, tennis or throwing sports that require overhead movement.

Proper form for your sport should be learned and practiced to prevent injury.

Maintain proper posture. Muscles over the shoulders become strained from holding the shoulders in a raised position for long periods of time. Muscles in the upper back, between the shoulder blades, become strained as a result of slouching.

Treatment of Shoulder Pain

Prevent major problems by treating minor problems early. If a minor injury is not given a chance to heal before it is subjected to the same activity, pain and inflammation may become chronic.

Treatment of shoulder pain depends on the cause – seek a proper diagnosis from a qualified physician. Most shoulder injuries heal with conservative treatment. Healing takes time. The time it takes to recover depends upon several factors, e.g. the severity of injury, the type of injury, how quickly one heals, how early one begins treatment.

Typical treatment of shoulder pain (for most conditions) involves a combination of rest (not complete rest), exercise, anti-inflammatory medication, applying cold or heat to the shoulder joint and, in some cases, an injection of steroids into the shoulder joint.

Doing activities that aggravate shoulder pain often cause further damage, delay healing, and may lead to long-term problems. However, not using the shoulder at all weakens the shoulder and leaves it more vulnerable to injury. Immobilizing the shoulder may also lead to frozen shoulder. Stretching exercises help prevent this condition.

Strengthening exercises for the muscles that support the shoulder, particularly the rotator cuff (the muscles and tendons that dynamically stabilize the main shoulder joint) are a major part of treatment for most shoulder injuries, but strength training before adequate healing has taken place may cause further pain and injury. A physician or physical therapist can determine when the shoulder is ready for strengthening exercises. Shoulder Exercises can prevent injury from recurring.

Massage therapy is also used to treat many soft tissue injuries. From muscle strain to tendonitis to frozen shoulder, massage therapy increases circulation, speeds healing, improves range of motion and relieves pain.

Most shoulder pain improves with conservative treatment; however, surgery may occasionally be required (depending upon the type of and severity of the injury). Surgery may be performed to tighten loose ligaments, repair a torn tendon, remove a calcium deposit, trim a damaged tendon, etc. when conservative treatment doesn’t adequately resolve symptoms.

Diagnosis of Shoulder Pain

Many shoulder conditions have similar symptoms and it may be difficult to diagnose the problem from symptoms alone. A physician, often an orthopedist, diagnoses the cause of shoulder pain by taking into consideration the patient’s symptoms and medical history, findings of a physical examination and sometimes diagnostic testing, such as x-rays, a CT scan, or an MRI.


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Rotator Cuff Injuries

Suspect Rotator Cuff Injury? You are at the right place. Cure your Rotator Cuff Injury today. Call us +65 64712744 or SMS to +65 92357641 to schedule for an appointment.

Your rotator cuff is made up of the muscles and tendons in your shoulder. These muscles and tendons connect your upper arm bone with your shoulder blade. They also help hold the ball of your upper arm bone firmly in your shoulder socket. The combination results in the greatest range of motion of any joint in your body.

A rotator cuff injury includes any type of irritation or damage to your rotator cuff muscles or tendons. Causes of a rotator cuff injury may include falling, lifting and repetitive arm activities especially those done overhead, such as throwing a baseball or placing items on overhead shelves.

About half of the time, a rotator cuff injury can heal with self-care measures or exercise therapy.

Rotator Cuff Tear

Rotator Cuff Tear

SYMPTOMS OF ROTATOR CUFF INJURIES:

Rotator cuff injury signs and symptoms may include:

  • Pain and tenderness in your shoulder, especially when reaching overhead, reaching behind your back, lifting, pulling or sleeping on the affected side
  • Shoulder weakness
  • Loss of shoulder range of motion
  • Inclination to keep your shoulder inactive

The most common symptom is pain. You may experience it when you reach up to comb your hair, bend your arm back to put on a jacket or carry something heavy. Lying on the affected shoulder also can be painful. If you have a severe injury, such as a large tear, you may experience continuous pain and muscle weakness.

When to see a doctor
You should see your doctor if:

  • You’re experiencing severe shoulder pain
  • You’re unable to use your arm or feel weak in the arm
  • You have shoulder pain that’s lasted more than a week

CAUSES OF ROTATOR CUFF TEAR:

Four major muscles (subscapularis, supraspinatus, infraspinatus and teres minor) and their tendons connect your upper arm bone (humerus) with your shoulder blade (scapula). A rotator cuff injury, which is fairly common, involves any type of irritation or damage to your rotator cuff muscles or tendons, including:

  • Tendinitis. Tendons in your rotator cuff can become inflamed due to overuse or overload, especially if you’re an athlete who performs a lot of overhead activities, such as in tennis or racquetball.
  • Bursitis. The fluid-filled sac (bursa) between your shoulder joint and rotator cuff tendons can become irritated and inflamed.
  • Strain or tear. Left untreated, tendinitis can weaken a tendon and lead to chronic tendon degeneration or to a tendon tear. Stress from overuse also can cause a shoulder tendon or muscle to tear.

Common causes of rotator cuff injuries include:

  • Normal wear and tear. Increasingly after age 40, normal wear and tear on your rotator cuff can cause a breakdown of fibrous protein (collagen) in the cuff’s tendons and muscles. This makes them more prone to degeneration and injury. With age, you may also develop calcium deposits within the cuff or arthritic bone spurs that can pinch or irritate your rotator cuff.
  • Poor posture. When you slouch your neck and shoulders forward, the space where the rotator cuff muscles reside can become smaller. This can allow a muscle or tendon to become pinched under your shoulder bones (including your collarbone), especially during overhead activities, such as throwing.
  • Falling. Using your arm to break a fall or falling on your arm can bruise or tear a rotator cuff tendon or muscle.
  • Lifting or pulling. Lifting an object that’s too heavy or doing so improperly — especially overhead — can strain or tear your tendons or muscles. Likewise, pulling something, such as a high-poundage archery bow, may cause an injury.
  • Repetitive stress. Repetitive overhead movement of your arms can stress your rotator cuff muscles and tendons, causing inflammation and eventually tearing. This occurs often in athletes, especially baseball pitchers, swimmers and tennis players. It’s also common among people in the building trades, such as painters and carpenters.

RISK FACTORS OF ROTATOR CUFF INJURIES:

The following factors may increase your risk of having a rotator cuff injury:

  • Age. As you get older, your risk of a rotator cuff injury increases. Rotator cuff tears are most common in people older than 40.
  • Being an athlete. Athletes who regularly use repetitive motions, such as baseball pitchers, archers and tennis players, have a greater risk of having a rotator cuff injury.
  • Working in the construction trades. Carpenters and painters, who also use repetitive motions, have an increased risk of injury.
  • Having poor posture. A forward-shoulder posture can cause a muscle or tendon to become irritated and inflamed when you throw or perform overhead activities.
  • Having weak shoulder muscles. This risk factor can be decreased or eliminated with shoulder-strengthening exercises, especially for the less commonly strengthened muscles on the back of the shoulder and around the shoulder blades.

DIAGNOSIS OF ROTATOR CUFF INJURIES:

If your injury appears to be severe or your doctor can’t determine the cause of your pain through physical examination, he or she may recommend diagnostic imaging tests to better delineate your shoulder joint, muscles and tendons. These may include:

  • X-rays
  • A magnetic resonance imaging (MRI) scan
  • An ultrasound scan

TREATMENT OF ROTATOR CUFF INJURIES:

Most of the time, treatment for rotator cuff injuries involves exercise therapy. Your doctor or a physical therapist will talk with you about specific exercises designed to help heal your injury, improve the flexibility of your rotator cuff and shoulder muscles, and provide balanced shoulder muscle strength. Depending on the severity of your injury, physical therapy may take from several weeks to several months to reach maximum effectiveness.

Other rotator cuff injury treatments may include:

  • Steroid injections. Depending on the severity of your pain, your doctor may use a corticosteroid injection to relieve inflammation and pain.
  • Surgery. If you have a large tear in your rotator cuff, you may need surgery to repair the tear. Sometimes during this kind of surgery doctors may remove a bone spur or calcium deposits. The surgery may be performed as an open repair through a 2 1/2- to 4-inch (6- to 10-centimeter) incision, as a mini-open repair through a 1 1/4- to 2-inch (3- to 5-centimeter) incision, or as an arthroscopic repair with the aid of a small camera inserted through a smaller incision.
  • Arthroplasty. Some long-standing rotator cuff tears over time may contribute to the development of rotator cuff arthropathy, which can include severe arthritis. In such cases, your doctor may discuss with you more extensive surgical options, including partial shoulder replacement (hemiarthroplasty) or total shoulder replacement (prosthetic arthroplasty).

A unique treatment option now available involves the use of a reverse ball-and-socket prosthesis. This reverse shoulder prosthesis is most appropriate for people who have very difficult shoulder problems. These include having arthritis in the joint, along with extensive tears of multiple muscles and tendons (rotator cuff) that support the shoulder, or having extensive rotator cuff tears and a failed previous shoulder joint replacement.

CURE YOUR ROTATOR CUFF INJURY TODAY. CALL +65 6471 2744 OR SMS to +65 92357641 FOR APPOINTMENT TODAY!

Hamtring Injury / Pulled Hamstring

A hamstring strain is a common injury involving a tear in one or more of the hamstring muscles.  A pulled hamstring can range from mild to very severe involving a complete tear of the muscle.

Pulled hamstring symptoms

One of the most obvious symptoms of a hamstring strain is a sudden sharp pain at the back of the leg during exercise, most probably during sprinting or high speed movements. Depending on how bad the injury is the athlete will usually have to stop immediately and further participation in training or sport difficult or impossible. Often the athlete will try to play on with a pulled hamstring but this is one injury where it just isn’t possible.

Pulled hamstrings are graded 1, 2 or 3 depending on severity.  Grade 1 consists of minor tears within the muscle. A grade 2 is a partial tear in the muscle and grade 3 is a severe or complete rupture of the muscle.

Grade 1 Hamstring strain

With a grade 1 hamstring strain the athlete may have tightness in back of the thigh but will be able to walk normally. They will be aware of some discomfort and unable to operate at full speed. There will be little swelling and trying to bend the knee against resistance is unlikely to reproduce much pain.

Grade 2 Hamstring strain

With a grade 2 hamstring strain the athletes gait will be affected and they will most likely be limping. Sudden twinges of pain during activity will be present. They may notice some swelling and pain will be reproduced when pressing in on the hamstring muscle as well as trying to bend the knee against resistance.

Grade 3 Hamstring strain

A grade 3 hamstring strain is a severe injury involving a tear to half or all of the muscle. The athlete may need crutches to walk and will feel severe pain and weakness in the muscle. Swelling will be noticeable immediately and bruising will usually appear within 24 hours.

Hamstring strain causes

The hamstring muscle group consists of three separate muscles; the Semitendinosus, Semimembranosus and Biceps Femoris. During sprinting the hamstring muscles work extremely hard to decelerate the tibia (shin bone) as it swings out. It is in this phase just before the foot strikes the ground that the hamstrings become injured as the muscles are working hardest and approaching their maximum length.

A pulled hamstring rarely manifests as a result of contact. If you have taken an impact to the back of the leg it should be treated as a contusion until found to be otherwise. A strained or pulled hamstring as it is sometimes called is a tear in one or more of the hamstring muscles. Strictly speaking there are three hamstring muscles, the Semitendinosus, Semimembranosus and Biceps Femoris.

Problems with the lower back and pelvis may increase the likelyhood of suffering a hamstrings strain and should always be considered, particularly for recurrent hamstring injuries.

Pulled hamstring treatment

It is vitally important that treatment for a hamstring strain starts immediately following injury.

What can the athlete do?

The most important phase for treatment is the first 48 hours post-injury. In this time the following can be carried out by the athlete themselves:

  • Apply Cold Therapy immediately for 10-15 minutes and repeat this every hour for the first day. After this, every 2-3 hours is sufficient.
  • Use a compression bandage to minimize intra muscular bleeding and swelling.
  • Rest as much as possible with the leg elevated.
  • Stretching exercises should be done but only when pain allows. It is likely that strengthening exercises will be possible before the leg is ready for stretching.
  • Strengthening exercises should be done as soon as pain allows. Mobility exercises can help with decreasing the swelling in the area. Strengthening exercises will gradually increase the load through the muscle.

What can a Sports Injury Specialist do?

  • Advise on a full hamstring strain rehab program such as that developed for us by Premiership Football Physiotherapist Neal Reynolds.
  • Use sports massage for hamstrings to speed up recovery. Sports massage is important in the treatment and rehab of hamstring muscle injuries as massage helps correct new muscle fiber realignment and minimizes scar tissue. In addition massage can increase the blood flow to the injured area.
  • Use ultrasound and other forms of electrotherapy are often used as part of pulled hamstring treatment to aid the healing process and reduce swelling.
  • Provide mobility aids such as crutches particularly if the hamstring strain is severe. Resting it is important.
  • Provide an MRI scan to ascertain the amount of damage sustained.
  • In severe ruptures surgery may be needed to repair the muscle damage.

CURE YOUR HAMSTRING INJURY TODAY. CALL US +65 6471 2744 OR SMS to +65 92357641 FOR APPOINTMENT TODAY.

Groin Strain (Groin Pulled)

A groin pull is an injury to the muscles of the inner thigh. The groin muscles, called the adductor muscle group, consists of six muscles that span the distance from the inner pelvis to the inner part of the femur (thigh bone). These muscles pull the legs together, and also help with other movements of the hip joint. The adductor muscles are important to many types of athletes including sprinters, swimmers, soccer players, and football players.

A groin pull is an injury to the adductor muscles called a muscle strain. When a muscle is strained, the muscle is stretched too far. Less severe strains pull the muscle beyond their normal excursion. More severe strains tear the muscle fibers, and can even cause a complete tear of the muscle. Most commonly, groin pulls are minor tears of some muscle fibers, but the bulk of the muscle tissue remains intact.

Symptoms of a Groin Strain

An acute groin pull can be quite painful, depending on the severity of the injury. Groin pulls are usually graded as follows:

  • Grade I Groin Strain: Mild discomfort, often no disability. Usually does not limit activity.
  • Grade II Groin Strain: Moderate discomfort, can limit ability to perform activities such as running and jumping. May have moderate swelling and bruising associated.
  • Grade III Groin Strain: Severe injury that can cause pain with walking. Often patients complain of muscle spasm, swelling, and significant bruising.

Groin pulls are often seen in athletics who participate in sports such as ice hockey and soccer. The injury appears to be related to factors including hip muscle strength, preseason conditioning, and previous injury. Because of this, proper conditioning is of utmost importance to prevent the occurrence of a groin strain injury. Athletes, especially hockey and soccer players, should incorporate adductor strengthening, pelvic stabilization, and core strengthening exercises into their workouts to prevent the occurrence of a pulled groin.

A pulled groin is usually a clear diagnosis. Most athletes know what the injury is before they seek medical attention. However, other conditions can mimic the symptoms of a groin strain. One condition that was previously not well recognized is called a sports hernia. Sports hernias have been found in patients who were diagnosed with chronic groin strains. The sports hernia is a condition similar to a regular inguinal hernia, and is due to a weakening of the muscles that form the abdominal wall. The symptoms of a sports hernia are often nearly identical to those of a groin strain.

Other conditions that may mimic the symptoms of a groin strain include osteitis pubis(inflammation of the pubic bone), hip joint problems (including early arthritis, labral tears, and other conditions), and low back problems (pinched nerves).

When do I need to see a doctor for a groin pull?
If you have symptoms of a severe groin pull, you should be evaluated for proper treatment. Some signs of a severe groin strain include:

  • Difficulty walking
  • Pain while sitting or at rest
  • Pain at night

Severe groin pulls should be evaluated because in some very rare situations of complete muscle rupture, surgery may be necessary to reattach the torn ends of the muscle. This is rarely needed, even in patients with Grade III groin strain injuries, as these patients can usually undergo successful non-operative treatment.

If you are unsure if you have a groin pull or the symptoms do not quickly resolve, then you should be seen by your doctor. As described above, other conditions can be confused with a groin pull, and these should be considered if your symptoms do not resolve. Once a strain is diagnosed, you can begin treatment for your groin pull.

Treatment of a groin pull is usually guided by the severity of the injury. Resting a groin pull is the key to successful treatment. As a general rule of thumb, if you have a groin pull, you can do activities that don’t aggravate your injury. You should rest until you are pain free to allow the injured muscle to heal. Resting inadequately may prolong your recovery.

The following are the common treatments used for groin strains:

  • Rest
    It is important to rest following the injury to allowed the injured muscle to properly heal. Allow pain to guide your level of activity; this means that activities which cause symptoms should be avoided.
  • Stretching
    Gentle stretching is helpful, but it should not be painful. Stretching excessively can be harmful and slow the healing process.

    • Adductor stretches
  • Ice the Injury
    Apply ice to the injured area in the acute phase (first 48 hours after injury), and then after activities. Ice will help calm the inflammatory response and stimulate blood flow to the area.
  • Heat Applications
    Before activities, gentle heating can help loosen the muscle. Apply a heat pack to the groin prior to stretching or exercising. As a general rule of thumb, remember to heat before, and ice after.

    • Know when to ice and when to heat an injury
  • Anti-inflammatory Medications
    Oral anti-inflammatory medications (such as Ibuprofen, Aleve, or Motrin) can help relieve symptoms of pain and also calm the inflammation.
  • Physical Therapy
    Physical therapists can be helpful in guiding treatment that may speed your recovery. Some people find modalities such as ultrasound, therapeutic massage, and specific exercises particularly helpful. You should see your physician to determine if these would be appropriate for your condition.

What can be done to prevent groin strains?
New research is shedding light on factors that can be helpful in preventing groin injuries. Competitive athletes who participate in soccer, ice hockey, or similar sports that are prone to groin injuries should focus some energy on groin injury prevention. Exactly what exercises and stretches are most important in still being worked out, but some suggestions for groin injury prevention include:

  • Adductor stretching
  • Hip adductor and abductor strengthening
  • Pelvic stabilization exercises
  • Core stability, including abdominal and lumbar strengthening

Together, these exercises and stretches can help control the movements of the hip and pelvis, and hopefully prevent many groin strains.

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Patella Injuries

The patella, or kneecap, is one of three bones, along with the tibia (shin bone) and femur (thigh bone), that make up the knee joint. All of these bones are covered with a layer of cartilage at points where their surfaces come into contact. Furthermore, the patella is wrapped within a tendon. This tendon connects the quadriceps muscle of the thigh to the shin bone (tibia) below the knee joint.

Condromalacia Patella

Condromalacia Patella

The patella is important functionally because it increases the leverage of the knee joint. From a mechanical perspective, the patella allows for an increase of about 30% in strength of extension (kicking) of the leg at the knee joint.

Symptoms of Kneecap Problems

Problems with the kneecap typically cause pain felt directly around the kneecap. Often these symptoms are noticed doing specific activities:

  • Walking stairs (particularly down)
  • Prolonged sitting
  • Kneeling

There are several common problems associated with the kneecap that can cause problems and pain in the knee

Chondromalacia Patellae (Runner’s Knee)
The most common disorder is known as chondromalacia, often called Runner’s Knee. Chondromalacia occurs because of irritation of the cartilage on the undersurface of the kneecap.

Prepatellar Bursitis (Housemaid’s Knee)
Prepatellar bursitis, or Housemaid’s Knee Syndrome, is a condition of swelling and inflammation over the front of the knee. This is commonly seen in patients who kneel for extended periods, such as carpet layers and gardeners.

Patellar Subluxation
Also called an unstable kneecap, patients who experience this painful knee condition have a patella that does not track evenly within its groove on the femur.

Kneecap Dislocation
When the kneecap comes completely out of its groove, the condition is called a patella dislocation. When the kneecap dislocates, it must be put back into its groove.

Treatment of Kneecap Problems

Treatment of these various kneecap conditions depends on the diagnosis, however there are some general guidelines that can be followed. For more information, and for a diagnosis of your knee pain, it is important to see your doctor.

  • Rest
    Resting the injured knee to allow time for inflammation to subside is very important. Cross-training will allow you to keep in shape. When you do return to activity, do so gradually.
  • Physical Therapy
    Physical therapy is very important to balance the strength of the muscles around the knee joint. Most importantly, the quad and hamstring muscle groups should be flexible and balanced.
  • Ice the Injury
    Apply ice to the knee to cool down inflammation in stimulate blood flow to the area. Be careful not to ice too much!
  • Anti-Inflammatory Medications
    Anti-inflammatory medications may help with inflammation and will also help alleviate some of the pain associated with patella conditions.
  • Arthroscopic Surgery
    While surgery is seldom needed because of a kneecap problem, arthroscopy is a treatment option if the problem is not getting any better with conservative treatment.

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Distal Radius Fractures (Broken Wrist)

The radius is the larger of the two bones of the forearm. The end toward the wrist is called the distal end. A fracture of the distal radius occurs when the area of the radius near the wrist breaks.

Distal radius fractures are very common. In fact, the radius is the most commonly broken bone in the arm.

A distal radius fracture almost always occurs about 1 inch from the end of the bone. The break can occur in many different ways, however.

One of the most common distal radius fractures is a Colles fracture, in which the broken fragment of the radius tilts upward. This fracture was first described in 1814 by an Irish surgeon and anatomist, Abraham Colles — hence the name “Colles” fracture.

A Colles fracture occurs when the broken end of the radius tilts upward.
 

Other ways the distal radius can break include:

  • Intra-articular fracture. A fracture that extends into the wrist joint. (“Articular” means “joint.”)
  • Extra-articular fracture. A fracture that does not extend into the joint is called an extra-articular fracture.
  • Open fracture. When a fractured bone breaks the skin, it is called an open fracture. These types of fractures require immediate medical attention because of the risk for infection.
  • Comminuted fracture. When a bone is broken into more than two pieces, it is called a comminuted fracture.

It is important to classify the type of fracture, because some fractures are more difficult to treat than others. Intra-articular fractures, open fractures, comminuted fractures, and displaced fractures (when the broken pieces of bone do not line up straight).are more difficult to treat, for example.

Sometimes, the other bone of the forearm (the ulna) is also broken. This is called a distal ulna fracture.

This illustration shows some of the types of distal radius fractures.
Causes of Distal Radius Fracture:

The most common cause of a distal radius fracture is a fall onto an outstretched arm.

Osteoporosis (a disorder in which bones become very fragile and more likely to break) can make a relatively minor fall result in a broken wrist. Many distal radius fractures in people older than 60 years of age are caused by a fall from a standing position.

A broken wrist can happen even in healthy bones, if the force of the trauma is severe enough. For example, a car accident or a fall off a bike may generate enough force to break a wrist.

Good bone health remains an important prevention option. Wrist guards may help to prevent some fractures, but they will not prevent them all.

Symptoms of Distal Radius Fracture:

A broken wrist usually causes immediate pain, tenderness, bruising, and swelling. In many cases, the wrist hangs in an odd or bent way (deformity).

Doctor Examination:

If the injury is not very painful and the wrist is not deformed, it may be possible to wait until the next day to see a doctor. The wrist may be protected with a splint. An ice pack can be applied to the wrist and the wrist can be elevated until a doctor is able to examine it.

If the injury is very painful, if the wrist is deformed or numb, or the fingers are not pink, it is necessary to go to the emergency room.

To confirm the diagnosis, the doctor will order x-rays of the wrist. X-rays are the most common and widely available diagnostic imaging technique. X-rays can show if the bone is broken and whether there is displacement (a gap between broken bones). They can also show how many pieces of broken bone there are.

(Left) An x-ray of a normal wrist. (Right) The white arrows point to a distal radius fracture.
 

Treatment

Treatment of broken bones follows one basic rule: the broken pieces must be put back into position and prevented from moving out of place until they are healed.

There are many treatment options for a distal radius fracture. The choice depends on many factors, such as the nature of the fracture, your age and activity level, and the surgeon’s personal preferences.

Nonsurgical Treatment

If the broken bone is in a good position, a plaster cast may be applied until the bone heals.

If the position (alignment) of your bone is out of place and likely to limit the future use of your arm, it may be necessary to re-align the broken bone fragments. “Reduction” is the technical term for this process in which the doctor moves the broken pieces into place. When a bone is straightened without having to open the skin (incision), it is called a closed reduction.

After the bone is properly aligned, a splint or cast may be placed on your arm. A splint is usually used for the first few days to allow for a small amount of normal swelling. A cast is usually added a few days to a week or so later, after the swelling goes down. The cast is changed 2 or 3 weeks later as the swelling goes down more, causing the cast to loosen.

Depending on the nature of the fracture, your doctor may closely monitor the healing by taking regular x-rays . If the fracture was reduced or thought to be unstable, x-rays may be taken at weekly intervals for 3 weeks and then at 6 weeks. X-rays may be taken less often if the fracture was not reduced and thought to be stable.

The cast is removed about 6 weeks after the fracture happened. At that point, physical therapy is often started to help improve the motion and function of the injured wrist.

Surgical Treatment

Sometimes, the position of the bone is so much out of place that it cannot be corrected or kept corrected in a cast. This has the potential of interfering with the future functioning of your arm. In this case, surgery may be required.

Procedure. Surgery typically involves making an incision to directly access the broken bones to improve alignment (open reduction).

A plate and screws hold the broken fragments in position while they heal.

Depending on the fracture, there are a number of options for holding the bone in the correct position while it heals:

  • Cast
  • Metal pins (usually stainless steel or titanium)
  • Plate and screws
  • External fixator (a a stabilizing frame outside the body that holds the bones in the proper position so they can heal)
  • Any combination of these techniques

An external fixator.

Open fractures. Surgery is required as soon as possible (within 8 hours after injury) in all open fractures. The exposed soft tissue and bone must be thoroughly cleaned (debrided) and antibiotics may be given to prevent infection. Either external or internal fixation methods will be used to hold the bones in place. If the soft tissues around the fracture are badly damaged, your doctor may apply a temporary external fixator. Internal fixation with plates or screws may be utilized at a second procedure several days later.

Recovery

Because the kinds of distal radius fractures are so varied and the treatment options are so broad, recovery is different for each individual. Talk to your doctor for specific information about your recovery program and return to daily activities.

Pain Management

Most fractures hurt moderately for a few days to a couple of weeks. Many patients find that using ice, elevation (holding their arm up above their heart), and simple, non-prescription medications for pain relief are all that are needed to relieve pain.

Your doctor may recommend combining ibuprofen and acetaminophen to relieve pain and inflammation. The combination of both medications is much more effective than either one alone. If pain is severe, patients may need to take a prescription-strength medication, often a narcotic, for a few days.

Cast and Wound Care

In some cases, original casts will be replaced because swelling has gone down so much that the cast becomes loose. The last cast is usually removed after about 6 weeks.

During healing, casts and splints must be kept dry. A plastic bag over the arm while showering should help. If the cast does become wet, it will not dry very easily. A hair dryer on the cool setting may be helpful.

Most surgical incisions must be kept clean and dry for 5 days or until the sutures (stitches) are removed, whichever occurs later.

Potential Complications

After surgery or casting, it is important that you achieve full motion of your fingers as soon as possible. If you are not able to fully move your fingers within 24 hours due to pain and/or swelling, contact your doctor for evaluation.

Your doctor may loosen your cast or surgical dressing. In some cases, working with a physical or occupational therapist will be required to regain full motion.

Unrelenting pain may be a sign of Complex Regional Pain Syndrome (Reflex Sympathetic Dystrophy) which must be treated aggressively with medication or nerve blocks.

Rehabilitation and Return to Activity

Most people do return to all their former activities after a distal radius fracture. The nature of the injury, the kind of treatment received, and the body’s response to the treatment all have an impact, so the answer is different for each individual.

Almost all patients will have some stiffness in the wrist. This will generally lessen in the month or two after the cast is taken off or after surgery, and continue to improve for at least 2 years. If your doctor thinks it is needed, you will start physical therapy within a few days to weeks after surgery, or right after the last cast is taken off.

Most patients will be able to resume light activities, such as swimming or exercising the lower body in the gym, within 1 to 2 months after the cast is removed or within 1 to 2 months after surgery. Vigorous activities, such as skiing or football, may be resumed between 3 and 6 months after the injury.

Long-Term Outcomes

Recovery should be expected to take at least a year.

Some pain with vigorous activities may be expected for the first year. Some residual stiffness or ache is to be expected for 2 years or possibly permanently, especially for high-energy injuries (such as motorcycle crashes), in patients older than 50 years of age, or in patients who have some osteoarthritis. However, the stiffness is usually minor and may not affect the overall function of the arm.

Finally, osteoporosis is a factor in many wrist fractures. It has been suggested that people who have a wrist fracture should be tested for bone weakness, especially if they have other risk factors for osteoporosis. Ask your doctor about osteoporosis testing.

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Preventing ACL Injuries

ACL (anterior cruciate ligament) knee injuries can cause many problems for kids who play sports. Besides the chance of having to sit out an entire season, they might face loss of scholarship funding, lowered academic performance,1 and long-term disability from osteoarthritis (a painful joint condition). More than 50,000 debilitating ACL injuries occur in female athletes at the high school and intercollegiate varsity levels in an average year.

Knee Bursitis

Knee Bursitis

Why do ACL Injuries occur in kids?

Most ACL tears do not occur from player-to-player contact. The most common causes of noncontact ACL injury include: change of direction or cutting maneuvers combined with sudden stopping, landing awkwardly from a jump, or pivoting with the knee nearly fully extended when the foot is planted on the ground.

Who is at Risk for An ACL Injury?

There is no definitive link between age and gender, and the rising rates of ACL injuries. However, landing, cutting, and pivoting maneuvers have been shown to differ between male and female athletes. For example, some female soccer players may perform playing actions with more of a knock-kneed position, or a reduced hip and knee joint range of motion, or decreased hamstring strength, any of which may underlie their increased risk for an ACL injury.

How can an ACL Injury be prevented?

It is difficult to assess how athletes can best modify their movements to prevent noncontact ACL injuries. Speaking with an athletic trainer, physical therapist, or sports medicine specialist is a good place to start. Recent research has allowed therapists and clinicians to easily identify and target weak muscle areas (e.g., weak hips, which leads to knock-kneed landing positions) and identify ways to improve strength and thus help prevent injury. In addition, other risk factors such as reduced hamstring strength and increased joint range of motion can be further assessed by a physical therapist or athletic trainer to improve performance—or rehabilitation efforts after an injury has occurred.

Current studies also demonstrate that specific types of training, such as jump routines and learning to pivot properly, help athletes prevent ACL injuries. These types of exercises and training programs are more beneficial if athletes start when they are young. It may be optimal to integrate prevention programs during early adolescence, prior to when young athletes develop certain habits that increase the risk of an ACL injury.

Summary

There are several factors that determine whether or not a young athlete will get an ACL injury. Preseason screening programs that monitor important risk factors and identify young “high-risk” athletes who would benefit from targeted neuromuscular training interventions may be the most beneficial way to reduce the risk of ACL injuries in young athletes.

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Shoulder Tendonitis

What is shoulder tendonitis/bursitis?

Shoulder bursitis and tendonitis are common causes of shoulder pain and stiffness. They indicate swelling (inflammation) of a particular area within the shoulder joint.

The shoulder joint is kept stable by a group of muscles called the rotator cuff as well as the bicipital tendon (the tendon that keeps the upper arm bone within the shoulder socket). When the rotator cuff tendon or the bicipital tendon becomes inflamed and irritated it is called rotator cuff tendonitis or bicipital tendonitis.

An area called the subacromial bursa lies in the space between the shoulder tendons. The bursa is what protects these tendons. Subacromial bursitis occurs when the bursa becomes inflamed.

Both conditions (shoulder bursitis and tendonitis) can cause pain and stiffness around the shoulder and may exist together.

What causes shoulder tendonitis/bursitis?

Tendonitis occurs as a result of sports injuries, by repetitive minor impact on the affected area, or from a sudden, more serious injury. For instance, professional baseball players, swimmers, tennis players, and golfers are susceptible to tendonitis in their shoulders, arms, and elbows. Improper technique in any sport is one of the primary causes of overload on tissues including tendons, which can contribute to tendonitis. But you don’t have to be a professional athlete to develop this condition. Anyone can get tendonitis, but it is more common in adults, especially those over 40 years of age. As tendons age, they tolerate less stress, are less elastic, and tear more easily.

Shoulder tendonitis/bursitis typically results from one or more of these factors:

  • Age: 40 and over
  • Frequent use of the arm in an overhead position or throwing motion, as in:
    • tennis or other racquet sports
    • swimming
    • baseball
  • Jobs such as overhead assembly work, butchering, or using an overhead pressing machine, heavy lifting
  • Direct blow to the shoulder area or falling on an outstretched arm
  • Other diseases or conditions that weaken shoulder muscles, such as rheumatoid arthritis, gout, psoriasis, or an unusual drug reaction
  • Infection (rare)

How is shoulder tendonitis/bursitis treated?

Treatment goals include reduction in pain and inflammation, as well as preserving mobility and preventing disability and recurrence.

The treatment recommendations may include a combination of rest, splints, heat and cold application. You may need more advanced treatments including:

  • Corticosteroid injections from your health care provider. They work quickly to decrease the inflammation and pain.
  • Physical therapy that includes range of motion exercises and splinting. This can be very beneficial.
  • Surgery, if you are not responding to other treatments.

When should you seek medical advice?

Most cases of tendonitis go away on their own over time. It may take weeks to months to recover, depending on the severity. See your doctor if you experience pain that interferes with your normal day-to-day activities, have soreness that doesn’t improve despite self-care measures, if you have recurrence, or if you have a fever and the area affected by tendonitis appears red or inflamed (swollen, warm). These signs and symptoms may indicate that you have an infection.

In addition, see your doctor if you have other medical conditions that may increase your risk of an infection, or if you take medications that increase your risk of infection, such as corticosteroids or immunosuppressants.

How can you prevent shoulder tendonitis/bursitis?

Because most cases of tendonitis are caused by overuse, the best treatment is prevention. It is important to avoid or modify the activities that cause the problem. Underlying conditions such as improper posture or poor technique in sports or work must be corrected.

Apply these basic rules when performing activities:

  • Take it slow at first and gradually build up your activity level.
  • Use limited force and limited repetitions.
  • Stop if unusual pain occurs.

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