Slipping Rib Syndrome (12th Rib Syndrome)

This basketballer suffered from loin pain at the tip of the Right 12th rib and along the 11th intercostal space after feeling at 'pull' during competition. The pain persisted despite taking oral NSAIDS but reduced slightly with ice application. Similar injuries have been seen previously in martial arts, dancers, boxers and swimmers.

We ruled out fracture by clinical examination and X-rays and progressed to do some PNF stretching and strengthening exercises. An ultrasound scan was not done as we did not suspect a torn muscle. His symptoms subsided significantly after the first visit and was resolved within the next 2 weeks. He was told to strengthen his intercostal muscles and oblique abdominal muscles with rotary torso and stomach crunch exercises. Kinesiotaping was applied to provide a controlled lateral rotation and back extension while reducing pain.

Read articles in swimmers and non-athletes.

National Basketball League 2010

Here are some photos of basketball injuries taken by the press (Lim Chee Sen) during the National Basketball league 2010. Most of the tournament was covered by St John's Ambulance or Red Crescent volunteers with ambulances on standby for emergencies.

Another player twisted his ankle after accidentally tripping over another player's foot. He was back to play the semifinals after vigorous physiotherapy and rehabilitation exercises.

This player suffered from a scalp laceration after jumping over another player and suffered from a scalp laceration from the elbow of the player. He had a 2.5 cm scalp laceration which had to be sutured at a local hospital. The coach ensured that untrained personnel were not allowed to intervene until the doctor arrived to ensure that there were no cervical spine (neck) injuries.

Laceration wounds seen just adjacent to the eyebrows due to accidental elbow defensive manouvre. Apply pressure to the wound immediately with sterile gauze to control bleeding of the wound. Once the wound stops bleeding apply an adhesive plaster to hold the edges of the laceration and send the player to the doctor.



Player caught in an awkward position during a challenge by opposing player. He suffered from a lateral ligament complex ankle sprain and was duly iced to prevent swelling and reduce pain. Keep ankle elevated while icing it and ensure that he is examined by his team doctor as soon as possible.


You can read more about the event here.

Finger Dislocation

This is the photo of a basketball player who dislocated left 5th finger. The finger was immediately rediced easily by the coach. He subsequently used RICE treatment which reduced the symptoms. He taped the finger to prevent a recurrence but refused further examination.

2nd Malaysian International Basketball Championships 7-10 October 2009

The 2nd Malaysian International Basketball Championships would be held at MABA from the 7-11 October 2009. This competition involves men (Korea, Hongkong, Philipines, Chinese Taipei, Malaysia, China) and women (Chinese Taipei, Singapore, Malaysia, China) teams from 7 Asian nations.



More details may be obtained from the MABA website or the official MIBC website.

Non-dsplaced fracture neck of radius and avulsion fracture of olecranon

John (not his real name) is a 28 yrs old recreational basketball player who slipped while playing and landed on his outstretched arm (on his left palm). He got up and felt a sharp pain in his left forearm and could not straighten or bend his elbows fully. He also could not twist his wrists (supinate and pronate).

He immediately came over to see me yesterday evening and I examined him and found that he had a very tender common extensor tendon suggesting that he might have partially torn his tendon. He could not do the extensor muscle testing (resisted extension) due to the pain. There was no crepitus but I suspected a possible greenstick fracture of his left radius bone. His pain was still quite unbearable despite getting an injection for pain.

I sent him off for an X-ray of his ulna and radius along with an Orthopaedic consultation as he may need further intervention if there was a fracture. His report from the surgeon shown a non-displaced fracture of the neck of radius with minimal avulsion of his triceps insertion into the >olecranon. He was treated conservatively with Plaster of Paris cast and was due for a review in 3 weeks. This may be followed by support with a functional brace to expedite his rehabilitation process.

Links to articles of interest:-
Radial Head Fractures
The Use of Ultrasonography in the Diagnosis of Occult Fracture of the Radial Neck
Olecranon Fracture

Tibialis Posterior Tendinopathy (Traction apophysitis)

Ms Chia is an 11 years old child who played basketball barefooted last week. She came with Right midfoot pain since a few days duration. She particularly mentioned that she had pain jumping and doing brisk walking. Her mother was worried as she thought it could be cancerous.

I examined her feet and found out that she was flat footed and had a prominent navicular tuberosity(insertion of Tibialis Posterior tendon) on both feet. She had tenderness at that spot but there were no obvious signs except that she had pain standing on her toes and resisting inversion (pushing her forefoot inward against my hand).

I explained to her mother that she would benefit by having good medial longitudinal arch support with orthoses. She could have taping of her foot to provide additional arch support. If symptoms persisted, an X-ray could be done to rule out avulsion fracture (tendon pulls off the tubercle from the bone) or other pathology.

She should recover swiftly with proper footwear, modified activity, isometric and theraband resistance exercises within 2-4 weeks.

Navicular Stress Fracture

Crystal is an elite basketball player who landed on her right foot after doing a jump shoot and suffered from severe foot pain a week ago. She was taken off the court as she could not continue weight-bearing. Subsequently, she was seen by another colleague and found to be having tenderness and fullness (oedema) over the inner portion of the dorsum of her right foot. Her X-rays showed a Type III Navicular Fracture.

Anatomy:

The navicular bone, located in the midfoot, articulates with the head of the talus, cuboid, and the three cuneiform bones that are involved in the acetabulum pedis. It gives attachment to the spring ligament (superomedial and inferior calcaneonavicular ligament)that can be injured in a failure of the posterior tibialis tendon and cause an adult acquired flatfoot deformity. The navicular bone provides insertion for the posterior tibialis tendon. Some pathologies can be related to the presence of an accessory navicular bone.Osteonecrosis or stress fractures can affect the navicular bone because of its poor vascularization, especially in its central portion.

Radiological classification of Navicular Fracture: dorsal cortical break (type I), fracture propagation into the navicular body (type II), and fracture propagation into another cortex (type III). It includes modifiers "A" (avascular necrosis of a portion of the navicular); "C" (cystic changes of the fracture), and "S" (sclerosis of the margins of the fracture).


She was placed in a non-weight bearing cast for 4 weeks (as she wanted play if there was no pain!). I saw her at 4 weeks post-injury and her repeat X-ray did not show much callous formation. She was placed in a functional walking brace (Donjoy) and advised minimal weight bearing for another 2-4 weeks. She was told that such fractures may take a longer period to heal and some studies suggest that surgery (ORIF) may be an option. I prescribed her low frequency ultrasound treatment (Exogen) to encourage bone healing. Most studies suggest that conservative (non-surgical) management provide good results for non-displaced navicular fracture but a few small studies suggest that elite athletes may benefit from surgery in type II or III fractures. Return to sporting activity varies from 3.0 months (Type I), 3.6 months (Type II) and 6.8 months (Type III) according to Saxena et al*.

*J Foot Ankle Surg. 2000;39(2):96-103