Hypermobility Syndrome

Ankle Posterior Impingement

Ms Ann (not her real name) is an elite level badminton athlete who came with complaints of pain in the back of both ankles with net-play and jumping smashes since 3 months duration. To her dismay, she still had the pain despite taking a month off from training. These symptoms are also common in gymnasts and dancers who do repeated jumps and en-pointe. Soccer players have been reported to have similar symptoms in literature.

I examined her ankles and found that she had tenderness and bogginess (oedema) of the posterior aspect (back) of her ankle joint (between the Achilles tendon insertion and the calcaneal and talus bones). She had pain when I compressed her hindfoot with her foot plantarflexed (Impingement test). If he jumped repeatedly on the spot, it would give her the same pain. She also had tenderness of her Achilles tendon insertion (Insertional tendinopathy) and associated hindfoot varus.

I have advised her to do some calf stretching with the knees bent slightly and knees straightened. She was also taught to tape her ankle to prevent full plantarflexion. She was planned for an X-ray to rule out Os Trigonum or fracture of the lateral tubercle of Talus. An MRI of the ankle would identify bone bruising, tendon and joint capsule inflammation.

Ultrasound guided corticosteroid has been shown to benefit most athletes with capsule or tendon inflammation. Most of these athletes are symptom free after 2 weeks and return to play within 4 weeks rehabilitation. A selected few with persistent symptoms, os trigonum or a possible nerve entrapment may require arthroscopic surgical intervention.

Find out more about the injury here:-
Posterior Ankle Impingement in Professional Soccer Players: Effectiveness of Sonographically Guided Therapy
MRI features of foot and ankle injuries in ballet dancers

Knee pain after swimming breaststroke

Ms Lim is a lady is her twenties who walked in limping this morning with complaints of left knee pain after swimming breaststroke for an hour the previous day. She does 'gym-workout' for 2 sessions per week, dance lessons for 3 sessions per week and swimming for 2 sessions a week. She has never had any previous falls or similar episode.

She had tenderness on the femoral attachment of the medial collateral ligament. She had no laxity of the ligament. I taped her knee to give her some pain relief while putting on a knee sleeve. She was given several strengthening exercises for her quadriceps, hamstrings and gluteal muscles. I will review her condition in 2 weeks duration to decide on return to play.

Rugby World Cup 2007 (France 7th Sept - 20th Oct 2007)

20 world class teams will be engaging in a sport which requires agility, power and strategy in the IRB Rugby World Cup 2007 from the 7th September 2007 to 20th October 2007. 3 teams (USA, Canada, Argentina) represent the Americas, 9 teams (England, France, Georgia,Ireland, Italy, Portugal, Romania, Scotland, Wales)represent Europe, 2 teams (Namibia, South Africa) represent Africa and 6 teams (Australia, Japan, Fiji, New Zealand, Samoa and Tonga)represent Asia-Oceania divided into 4 pools (A-D).

The Pool Stages will be held from 7th September 2007 to 30th September 2007 and the Knockout Stages will be held from the 6th October 2007 to 20th October 2007 after a 5 day break. Matches will be played in 12 different venues in France (Bordeaux, Lens, Lyon, Marseille, Montpellier, Nantes, Paris, St Denis, St Etienne and Toulouse) and UK (Cardiff, Edinburg).

Which team will make it to the finals on the 20th October 2007 in St-Denis?

Find out more at the links below:-
World Rugby Cup 2007 Official Website
Fixtures
Destination France
Ticketing
Player Statistics
FanZone
RWC Video
Official Store
Total Rugby Radio

Osgood Schlatter's Disease

Matt is a 23 years old store-keeper who doubles up as a forklift driver. He recently developed a left knee painful swelling during work and prolonged walking. He used to have knee pain during his teens when he was actively playing sports.

I examined his knee and found that he had a prominent tibial tuberosity which was tender and inflammed. I applied a patella knee brace for him but he refused to wear it. We ended up taping his knee (see photo) and it seemed to offer him some pain relief. I sent him off with some NSAIDS and advised him about RICE treatment.

Since it was quite mild, I would expect his pain to subside in 2 weeks but he should strengthen his core muscles, hamstring and quadriceps. He would only be fit to lift heavy weights after at least 4 weeks.

Sudden Deaths in Soccer: Are we doing anything about it?

There is an interesting write up of the series of sudden deaths in soccer by The Star (Malaysia) on Thursday August 30, 2007.

A history of sudden deaths in football

# Aug 28, 2007: Spain and Sevilla defender Antonio Puerta (pic) died on Tuesday following a heart attack, becoming the latest footballer to die suddenly while playing.

# April 11, 2006: Colombian teenager Victor Alfonso Guerrero, 17, died during a training session for the reserve side of Colombian First Division club Envigado FC. He collapsed and lost consciousness, and died on the way to hospital.

# June 25, 2005: Hugo Cunha, a 28-year-old midfielder with Portuguese top flight side Uniao Leiria, died while playing a match with friends. Cunha suffered a heart attack and was unable to be resuscitated by the emergency services.

# Oct 27, 2004: Brazilian Serginho, 30, collapsed during a Brazilian First Division match between his club Sao Caetano and Sao Paulo and later died. His death caused a huge controversy after the autopsy revealed that his heart weighed 600 grams, twice the normal size. Sao Caetano, the club’s president and the doctor were sanctioned by Brazil’s sporting authorities.

# Jan 25, 2004: Benfica’s Hungarian international striker Miklos Feher, 24, collapsed during a Portuguese Premier League match against Vitoria Guimaraes and never regained consciousness. The autopsy revealed he had suffered from a heart malformation.

# June 26, 2003: Cameroon international Marc-Vivien Foe died while playing against Colombia in the semi-final of the Confederations Cup. The Manchester City player collapsed in the centre circle and all efforts to save him failed. An autopsy revealed he had a disorder of his heart’s electrical system.

# December 2002: Macedonian defender Stefan Toleski died of a suspected heart attack. He collapsed halfway through the first half of his side FK Napredok’s league match against Kumanovo and later died in hospital.

# February 2000: John Ikoroma, a 17-year-old Nigerian youth international, suffered a heart attack during a friendly in the United Arab Emirates. He was in a trial match for Al-Wahda against Kazakh club Astona when he collapsed 20 minutes before the final whistle. He died in hospital.

# 1997: Emmanuel Awanegbo, a Nigerian playing in Germany, died after only 12 minutes of play. The death was attributed to cardiac arrest.

# 1995: Amir Angwe, 29, a striker for the Julius Berger Club of Nigeria, collapsed a minute before the end of an African Cup Winners’ Cup semi-final match with Maxaquene of Mozambique. Doctors believe he died of a heart attack.

# 1989: Nigerian international Samuel Okwaraji, who had signed as a professional for AS Roma in Italy after stopping his university studies in Rome, died during a World Cup qualifier between the Super Eagles and Angola.

This is a reminder to all who conduct sporting competition that efforts are needed to prevent the occurence of sudden deaths in elite athletes. Although elite athletes are routinely screened for medical conditions, some are done without exercise stress test. Some have in the past linked such deaths to fatigue, severe dehydration, doping, alcohol and illicit drugs. In some parts of the world, soccer and field hockey tournaments are still held without cardiac resuscitation equipment to give some hope of saving the athlete in the event of sudden cardiac arrest.

What are we doing to prevent sudden cardiac deaths in our sport?

Medical Coverage for Karatedo

Every time I am asked to assist in medical coverage of a martial event, I would ask for the assistance of hospital teams to ensure that the whole mechanism for emergency care is activated. During the 8th AKF, the organisers had the commitment of the Negeri Sembilan Health Department to ensure that the medical services offered during the 3 day competition was adequate and did not endanger the participants' lives.

The most important factors responsible for keeping the injury risks low were:-
1. The high standards of referreeing
2. The high fitness and skill levels of participants
3. Adequate rehydration in between bouts

Despite having a team for each 'tatami', we were busy with minor lacerations, bruises, contusions, muscle strains and mild joint sprains. We only had one participant who injured her neck, was immobilised using the hard cervical collar and long spinal board and transferred safely to the hospital. Two participants had mild concussion and were sent to hospital for further evaluation and observation for 24 hours. We only had to stitch up a bad laceration on an official who had fallen before the second day's competition. The Atomated External Defibrillator (AED) was available on stand-by in the event of patient collapse due to cardiac arrhythmias.

This is definitely a competition involving the whole team of referrees (rules and regulations), officials (traffic), doctors and paramedics, ambulance driver, registar-on-call and surgeon-on-call (immediate hospital care).

We still need qualified volunteers to provide a safer medical coverage during such sports events. You may contact me at draston@gmail.com.

Malaysian Male Kata 8th AKF 2007

Japan Male Kata 8th AKF 2007