Thursday, 29 March 2007

Josiah fractures his clavicle?

Josiah Ng, who currently ranks 7th in the world suffered a hip contusion after hitting the training motor-pace bike on the 22nd March 2007. Just a week later he had a terrible mishap after an illegal technique used by an Italian rider caused him to loose control and crash. It was reported by the Star newspaper that he suffered a 'broken collar-bone.

Tuesday, 27 March 2007

Wrist injury in Badminton player (Scapho-lunate Subluxation)

Chris is a 16 years old club badminton player who fell on his right palm 6 weeks ago while playing singles competition. He tried to play in the doubles soon after but couldn't as the wrist started to swell and the pain was unbearable. He was seen by a doctor and his pain was on the ulna styloid. He could not do any lobs and smashing after that as he had pain on the back of the wrist (dorsum).

He did not have any problems with wrist range of movement. "Ouch!", he squealled when I palpated the lunate bone. There seemed to be more mobility of the bone adjacent to the scaphoid bone (see picture). After discussing with him, we decided to do an X-ray to rule out fracture of the lunate bone followed by an Ultrasound or MRI of the Right wrist to rule out scapholunate ligament tear.

Meanwhile, I told him to start pain-free strengthening exercises for his wrist and suggested he tape his wrist during play. He was not to do any 'lobs' and 'smashing' until we obtained the results from his X-rays and MRI.

Tibialis Posterior Tendinopathy

Ms Wang, a young lady executive shuffled slowly into my clinic. "I think I sprained my right ankle on the treadmill 2 days ago", she said. I was expecting a large swollen ankle but it was not that swollen. Then she pointed at the spot on the navicular tubercle (marked 'o' on the picture). She had a previous 'twist' of the same ankle several years earlier.

It sounded like a foot injury seen in my gymnasts, diving and dance sports athletes. She had mild pain when asked to flex and extend her ankle but she could not twist her foot outwards (eversion). She also had pain twisting her foot inwards (inversion) against the resistance of my palm. I palpated (felt with my fingers) the tibialis posterior tendon insertion on the navicular tubercle and she had severe tenderness.

Informed her that her tendon was strained but the deltoid ligament was spared. She needed to ice every 4 hourly (15 minutes/session), avoid high heeled shoes, possibly tape her ankle if she wanted to do more vigorous walking or running, have another look at her walking gait with her shoes, start some isometric exercises and progress to some theraband exercises. "I will see you after a week and expect the injury to heal within 3 to 4 weeks if you do your exercises"

Thursday, 22 March 2007

Glucosamine for knee osteoarthritis

Athletes with osteoarthritis of the knee joint often suffer from recurrent pain and swelling of the joints after intensive running and jumping. Current research provides good evidence to support the use of glucosamine sulfate in the treatment of mild-to-moderate knee osteoarthritis. Most studies have used crystalline glucosamine sulfate supplied by one European manufacturer (Rotta Research Laboratorium). Results of a recent large clinical trial (GAIT) comparing the effects of glucosamine / chondroitin sulphate for treatment of knee osteoarthritis did not show any additional benefit except in the patients with moderate to severe pain from osteoarthritis. A more recent study (GUIDE) shows in a 6 months random placebo controlled trial that oral glucosamine sulphate (1500mg/day)is more effective that placebo or acetamenophen (3gm/day). ARTHRITIS & RHEUMATISM Vol. 56, No. 2, February 2007, pp 555–567

Most of my athletes with mild to moderate Osteoarthritis have had symptom relief and functional improvement after taking Glucosamine for a tleast 1 to 3 months. Those with recurrent swelling and pain would also benefit from a course of three to five Intra-articular Hyaluronic Acid weekly injections. Athletes who undergo this injection are advised not to continue with vigorous running and jumping during the course of treatment. These athletes would also be given other forms of exercises to improve strength and stability.

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F1 Malaysian Grand Prix

Read that the organisers are giving attractive offers for the F1 Malaysian Grand Prix in Sepang. Offers are valid until 31st March 2007. Let the wheels roar!!! Visit the website at Sepang International Circuit.

Sunday, 18 March 2007

Champions Youth Cup Malaysia 2007

16th March 2007 – 14 of the world’s greatest football clubs will play in a single tournament and all in one place – when Malaysia hosts the Champions Youth Cup Malaysia 2007 from 5th to 19th, August 2007. The inaugural event is supported by the Ministry of Youth and Sports, the Ministry of Tourism and is backed by the FA of Malaysia (FAM).

Four groups of four teams will play round robin matches in Alor Star, Kuantan, Melaka and Kuching with the knockout stages and the final to be held in Kuala Lumpur.

“The tournament shows that Malaysia matters to these clubs – a two weeks football festival of the world’s greatest clubs, the world’s finest young players and 34 matches across seven venues,” said Jonatan Price, chairman of UK-based Gifted Group Limited.

“The clubs make a huge investment in these players through their academy structures and Malaysians will enjoy a very special privilege because for the first ever, these clubs will be introducing their next generation of stars to a world wide television audience as a prelude to them playing in the Champions League and the Copa Libertadores.”

Among the more notable players to have matured from the various development programmes of these clubs are Franz Beckenbauer (Bayern Munich), Johan Cruyff (Ajax Amsterdam), Zico (Flamengo) and Lionel Messi (Barcelona).

In the meantime Datuk Azalina Othman Said, the Minister for Youth and Sports said that the organisation of the Champions Youth Cup Malaysia 2007 is subjected to the approval from FIFA as well as the Asian Football Confederation (AFC).

The official draw for the tournament will be held in Malaysia on 19th April, 2007.


AC Milan (Italy),Ajax Amsterdam (Holland),Arsenal (England),Boca Juniors (Argentina),Barcelona (Spain),Bayern Munich (Germany),Chelsea (England),Flamengo (Brazil),Juventus (Italy),Inter Milan (Italy),MALAYSIA,Manchester United (England),Paris St. Germain (France),PSV Eindhoven (Holland),Porto (Portugal),Qatar,(adapted from FAM website);

We want to hear your comments and your support for this affair! I have enclosed the official website for further information. You may also find more information about tourism in Malaysia at Tourism Malaysia. Join us to make this championship a success.

Friday, 16 March 2007

Ingrown Toenail

Anthony is a 10 year old basketball player and cyclist who weighs 60 kgs. He came this afternoon with a recurrent left big toe painful swelling since 1 year duration. He has seen several doctors but he said, "Nothing they did worked!".

I examined his toe and found that the swelling was already resolving. There were signs that probably it was oozing pus over the past few days. Somehow he came in as he felt it was "too much of a hassle".

I got him to agree not to trim his toenails so deep. I was also concerned whether he was diabetic as he had a strong family history of diabetes in his family. I gave him a course of oral antibiotics and an antiseptic for dressing. Told him to bring his footwear for examination and stay off playing games until it healed. I thought, who would stay with this for a whole year?!!

Ulna Neuritis in Cyclist

Mark is a 45 years old road cyclist with a mileage of 200 km per week. He came to see me 2 months ago with complaints of numbness and tingling sensation of his little finger and adjacent side of the hand. He mentioned that he was 'riding harder' than usual and had occasional wrist pain 2 weeks earlier as he 'felt good' and wanted to do more.

He was quite happy to lay off riding for 2 weeks and was given some isometric and resistance exercises with theraband. Subsequently, when I reviewed him again last month, he was slightly better. I gave him some neurotonics (vitamin B12) and allowed him to ride but advised against putting excessive pressure on the handlebars.

He came back last week without any symptoms and he said that he was riding better now that his wrists were stronger.

Tuesday, 13 March 2007

Plantar Fasciitis (Ouch!)

Brian is a 'recreational' badminton player who just returned to play after a 1 month celebration of Chinese New Year. For obvious reasons he wanted to get rid of some of the 'excess' weight that he gained. 2 days after play he started having severe hindfoot pain in the mornings. The pain subsides after walking for half and hour. He seemed to feel better walking in his leather shoes but playing badminton was a painful affair.

The pain was spot on the calcaneal attachment of the plantar fascia (see the mark 'X' on the photo). He also had tightness in the calf muscles and was flat footed. He had difficulty doing calf stretching. "I never did this before", he said.

We got him to wear a slipper with raised heel support (1/4"), a pair of preformed insoles for his flat foot, daily calf stretching when he got back from work, and ice-massage over the spot. He also saw a physiotherapist for myofascial release for his calf. Within 2 weeks he was back playing. Obviously, he was told to avoid playing to vigorously!

Monday, 12 March 2007

Low Backache

Ms Lim, a lady in her twenties came to see me this morning with complaints of low backache after waking up from sleep. She told me that she did not do any physical activity except the washing the corridor the previous day. However, she was able to sit with mild pain and did not have 'shooting' pain to her legs. She was previously seen by my colleague 1 month ago for the same problem but it resolved with some vitamin B12 supplementation and an analgesic.

She bent her back backward and forward and had moderate pain on the left side but her range of movement was full. She had some tenderness of the left quadratus lumborum muscle and the posterior superior iliac spine on both sides.

She was not keen on doing exercises or investigating further as she felt it was not a serious injury. I left her with a muscle relaxant, 5 days of moderate analgesics and advice to remain 'active'. She was told she could return to see me again if symptoms did not resolve as 50% of non-specific low back pain tends to resolve on their own within a week. I informed her that she probably should not use the corset (see picture attached) for longer than 2 weeks duration.

Friday, 2 March 2007

Diet only is as effective for weight loss?

A randomized controlled trial (CALERIE) done by Redman et al to test the effect of a 25% energy deficit by diet alone,CR or diet (12.5% Energy deficit) plus exercise (12.5% increase in exercise energy expenditure),CR+EX for 6 months on body composition and fat distribution. Thirty-five out of 36 healthy overweight (16M/19F) subjects completed the study. Participants lost 10% of body weight (CR:-8.3±0.8, CR+EX:-8.1±0.8kg, p=1.00), 24% of fat mass (CR:-5.8±0.6, CR+EX:-6.4±0.6kg, p=0.99), and 27% of abdominal visceral fat (CR:0.9±0.2, CR+EX:0.8±0.2kg, p=1.00). This study suggests that diet restriction may be equivalent to diet restriction and exercise.
Journal of Clinical Endocrinology & Metabolism, doi:10.1210/jc.2006-2184
Blog Authors comment: This study does not rule out the additional benefits of doing physical exercise which has cardiovascular and metabolic implications. However, it is encouraging as a weight loss of 10% has additional benefits on cardiovascular risk reductions for obese or overweight patients.

Check out this site for weight loss strategies

Thursday, 1 March 2007

Rotator-Cuff Injury

Ahmad has been playing for several weeks in preparation for a major badminton competition in 2 months time. His coach wanted him to perfect his skills with multi-shuttle drills involving lobs and smashes. He would be sore in the right shoulder tip after each training session. Moreso after repetitive smashing. His coach asked him to ice after training but yesterday despite icing his shoulder he had persistent pain and his smashes were getting weaker.

I saw him and found out that if he abducts his shoulder (brings his shoulder up on the sides) more than 90 degrees and rotates it backwards, he has some pain. He also has pain in front of his shoulder lifting his arm behing his back. He was able to do the empty can test (where he pushes his abducted shoulder upwards with the thumb pointing downwards)with some pain. Between 1 and 10, the painscore was 5-6.

Our radiology colleague did an ultrasound scan for him showing some inflammation of the rotator cuff and grade I strain of the supraspinatus tendon. He was lucky not to have any impingement demonstrated clinically or on X-rays.

We talked with the player and his coach and decided that he was going to concentrate on his footwork and aerobic fitness for 3 to 4 weeks. He was allowed to do skills without 'overhead' work. Part of his training programme would involve work with theraband and core stability. THe physiotherapist got him to do some 'car-wash' wiping movements diagonally to improve his shoulder proprioception (sense of position and balance).

Within 2 weeks his shoulder was feeling much better and he was able to swing his shoulders without pain. At 4 weeks he regained most of his strength and was able to smash even harder without pain.