Sports medicine

Question 1

Ddx of hip pain in adult

Answer 1

1. Extra-articular vs intra-articular
2. Extra-articular:
   
   1. Muscles -
   2. Nerves
   3. Ligaments
   4. Tendons
   5. Referred pain
3. Intra-articular
   
   1. Bones
   2. Soft tissue

Question 2

Red flag diagnosis for hip pain:

Answer 2

1. Stress fracture
2. Development dysplasia of the hip
3. Juvenile idiopathic arthritis
4. Septic arthritis
5. Rheumatoid arthritis
6. Malignancy
7. Slipped upper femoral epiphysis

Question 3

What is severs disease? or severed apophysitis

Answer 3

1. Traction injury from repetitive activity where the Achilles tendon pulls on the growth plate at the heel (traction apophysitis).
2. The pain is localised to the heel, aggravated by physical activity
3. The condition is self- limiting (when the growth plate in the heel closes), but may cause intermittent symptoms during times of high growth and activity

Question 4

Investigations for severs apophysitis?

Answer 4

Nil required. clinical diagnosis by the history and presence of tenderness when examining the back of the heel.

Question 5

Management of apophysitis?

Answer 5

conservative:

1. Activity modification
2. decrease stress on heel via taping and heel cupping
3. ice
4. Topical antiinflammatories
5. oral nsaids paracetamol

Question 6

What is the N” spot? And its importance?

Answer 6

The N spot is located between the extensor hallucis longus and tibialis anterior tendons on the dorsum of the foot

A navicular stress fracture is relatively common and accounts for 35% of stress fractures

Question 7

Investigations for stress fracture (navicular)

Answer 7

1. Plain x-ray - poor sensitivity for stress fractures

2. MRI or bone scan most reliable

Question 8

Management for navicular stress fracture?

Answer 8

1. High risk of non-union
2. strict non-weight bearing (NWB) immobilisation in a cast or controlled ankle movement (CAM) boot for six to eight weeks.
3. However, if the N spot is tender, the patient needs to have a further two weeks of NWB immobilisation.

Question 9

What are the recommendations to return to sport after a navicular fracture?

Answer 9

Option 1
• Weeks 6–8: Activities of daily living, deep water running, swimming
• Weeks 8–10: Alternate day running for 5 minutes (week 1) and 10 minutes (from week 2)
• Weeks 10–12: Running at 50% full effort
• Weeks 12–16: Return to play

Question 10

Features that may suggest a high grade muscle strain or tear?

Answer 10

• immediately clutching the thigh
• not being able to continue play
• subsequent pain
• difficulty with flexing the knee (eg when dressing and undressing).