Monday, 28 April 2008

14th Paralympiad Malaysia Kuala Lumpur 2008

The 14th Paralympiad Malaysia Kuala Lumpur 2008 will be held at National Sports Complex and University Putra Malaysia (UPM) from the 3-9 May 2008. More than 1500 athletes from the 15 states will be competing in this games. The official opening ceremony will be held at the National Stadium, Bukit Jalil, Kuala Lumpur at 7.45pm 3rd May 2008 and the closing ceremony will be held at 7.45pm on the 9th May 2008 at Putra Stadium, Bukit Jalil, Kuala Lumpur. Entrance is free!

Doctors and physiotherapists will be involved in medical coverage and Classification of athletes according to the various disabilities. Classification will be held from 1-2 May 2008 at the Engineering College, UPM just adjacent to the Games Village. The athletes who do not have valid classification would need to be classified. However, athletes who are unsure of their status should get their classification status confirmed at the classification station before 3pm of 2nd May 2008.

Athletes are reminded that there would be doping control testing during the competition. Hence, caution should be taken to avoid medication which are on the WADA Prohibited list 2008.

Enjoy the games!

Friday, 25 April 2008

Extensor Retinaculum Injury and Extensor Digitorum Longus tenosynovitis

A male artistic gymnast was seen a few days ago with complaints of pain in the dorsum of the left foot after intensive training involving runs and jumps since 2 weeks earlier. He had difficulty standing on-toes, taking-off from jumps and landing.

After examining his ankle, I found that he had slightly reduced range of plantarflexion in the left ankle due to pain. There was tenderness and mild oedema of the extensor retinaculum and mild tenosynovitis of the Extensor Digitorum Longus tendons. However, resisted extension was pain free.

I did a simple taping to prevent extreme plantarflexion while enabling him to point his toes during his routine(Two figure of 6, and a double medial and lateral ankle locks and closed up the 'holes'). That seemed to do the trick and he should be back doing some training. However, he was told to refrain from sprinting or jumping to his maximal height as it may aggravate the injury. He was advised to undergo physiotherapy to reduce the symptoms and strengthen his lower limb.

Friday, 18 April 2008

Hallux Valgus

A fencing athlete was seen with her big toes (hallux) turned outwards (valgus), hence crowding into her second toe. She was lucky as she did not have any symptoms of pain usually seen in the prominent bunions. Gymnasts and dance athletes often suffered from painful bunions. She could consider using nights splints for the big toe, taping during training and some icing after training to assist her. If she wanted something off-training, she could buy a broad forefoot footwear and use a silicone gel spacing device between the toes.

Just don't wear the toe spreader to run or play badminton or table-tennis. You might get really bad blisters.

Tuesday, 15 April 2008

Bilateral Peroneal Subluxation

The videos of a fencing athlete showing both feet plantarflexed and going into eversion to initiate subluxation of the peroneal tendons.

The left peroneal subluxation (suffered after a game of futsal) causes pain with sprinting and quick lunges hence limiting his performance in his sport. His rehabilitation may take up to 8 weeks before return to sport.

The right preoneal tendon partially subluxes but doesn't seem to give the athlete any problems as he is still able to plantarflex comfortably without pain.

Also see a previous post on peroneal subluxation here.

Thursday, 10 April 2008

Calf Cramps (with Medial Gastrocnemius strain)

A young lady in her 20s came this morning complaining of right calf residual pain after having a cramp while waking up this morning. Her mother gave her a hot traditional oil which she massaged on her calf but the pain persisted. She walked into my room with a limp and supported her weight on her forefoot.

She had several localised areas of tenderness along the medial gastrocnemius muscle but no apparent swelling. She also had an almost full ankle dorsiflexion and plantarflexion. She is likely to have suffered from a Right medial gastrocnemius Grade II strain. She was advised to undergo rice treatment and her calf was support with a crepe bandage to partially restrict movement and reduce pain. She would require an ultrasound scan to determine extent of the muscle injury if she wants to participate in sports.

Isometric exercises and hydrotherapy could be instituted to start her rehabilitation process along with electrotherapy. The duration of the rehabilitation will depend on the severity of the strain and her response to treatment (evaluate weekly).

Tuesday, 1 April 2008

Right Hamstring Partial Tear in Badminton Player

A 37 yrs old male badminton recreational athlete came in last week after injuring his right thigh doing a 'split' while reaching for a net shot from the baseline 2 days earlier. He felt something snap and had pain lifting his thigh. He found it difficult to bend forward to reach for things due to the pain.

He hobbled onto the examination couch in pain. He was only able to flex his hip up to 40 degrees (Straight Leg Raising) and had a defect in the proximal attachment (see photos) of the semitendinosus muscle with a bulge distally. There was tenderness at the distal bulge of the semitendinosus muscle.

I sent him for an X-ray to rule out avulsion fracture and an MRI to assess the extent of the tear and hematoma. He was given Cox-2 Selective NSAIDS for pain and inflammation and advised to undergo RICE treatment regularly. (awaiting MRI films... )

Clinically, he has at least a grade II strain of the Right semitendinosus which would require at least 12 weeks rehabilitation before return to play. He may have difficulty regaining his full agility and power if he is an elite athlete vying for a place to represent the country in international competition.