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Cricket Sports Injuries HASSAN M Y, HELEN

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Cricket Sports Injuries HASSAN M Y, HELEN Cricket Sports Injuries HASSAN M Y, HELEN Introduction: Sports medicine is a broad and complex branch of the health care profession. It is a demanding field in medicine providing the health care professional with challenges both on and off the field. The principles of treatment include the maintenance of euphysiological benefits of exercise while attending to the injury with specificity. It is important to treat to the biological as well as the psychological component of the injured athlete. Successful management include early and correct diagnosis, rehabilitation and compliance of the athlete and sports administrators. Despite the advent of technology, a small percentage of athletes are unable to return to sports medicine and it is for this reason that primary prevention is imperative to reduce the incidence of injuries where possible. INJURY PREVENTION Injury prevention can be caused by intrinsic or extrinsic causes. Intrinsic causes include anatomical dysfunction while extrinsic causes are environment factors. Addressing both factors is imperative in reducing injury rates in sports medicine. Categorization of prevention into primary, secondary and tertiary structures is possible. Primary prevention: Primary prevention deals with direct or indirect prevention on an individual basis. An example would be correction of muscle imbalances of the shoulder structure of a bowler in an attempt to prevent shoulder dysfunction. Secondary prevention: Secondary prevention deals with preventing injury on a group basis. An example would be educating cricketers to the benefits of warm up, stretching and cooling down in an attempt to reduce musculotendinous injuries. Tertiary prevention: Tertiary prevention is efforts undertaken by the sports governing bodies in the field of cricket with initiation and implementation of strategies to reduce injuries at a club, provincial and national level. An example include the United Cricket Board of South Africa initiating the production of a proactive guideline policy on educating cricketers, coaches and governing bodies on injury prevention. Preventing Cricket Injuries: Medical screening Attention to biomechanics Footwear Orthotics Conditioning Training Technique Training Hydration Nutrition Playing environment Warm up/Cool down/stretching UV protection Game rules Coach education Environmental factors Protective equipment: visors, padding, helmets SCREENING OF THE ATHLETE MUSCULOSKELETAL EVALUATION: General Health Previous injuries Postural and biomechanical assessment Spinal movements Strength/flexibility Muscle imbalances Proprioception Neurodynamic tests Special sport/position tests Level of fitness Other activities: gym ISOKINETIC TEST EXAMPLE OF A NATIONAL CRICKETER: INTERPRETATION: SHOULDER VALUE INTERPRETATION EXTERNAL ROTATION Bilateral differences 11.9 R weakness – Slight imbalance concentric (%) Bilateral differences 18.2 L weakness – Slight imbalances eccentric (%) Concentric/eccentric L: -13.0 Severe eccentric weakness (Nm) R: 16.6 Moderate eccentric weakness INTERNAL ROTATION Bilateral differences 7.1 L weakness – Slight weakness concentric (%) Bilateral differences 16.7 L weakness – moderate imbalance Eccentric (%) Concentric/Eccentric L: 1.4 Severe eccentric weakness (Nm) R: -10.0 Severe eccentric weakness LOWER LIMB INJURIES HIP AND PELVIS INJURIES (1) FEMORAL NECK STRESS FRACTURES Overuse injuries of the femoral bone may occur at the neck of the femoral bone. The SA fast bowler NGAM was diagnosed with stress fracture of femoral neck. Risk factors include muscle fatigue, training errors, and poor training surfaces or poor shock absorption. Symptoms Anterior thigh or groin pain. Pain becoming progressively worse nocturnal pain relieved by rest. Examination Antalgic gait with pain produced with axial compression. X-rays may be normal. Diagnosis with bone scan / G / MRI. Management Depends on site of fracture and severity. Compression fracture Non-displaced: Bed rest, progressive WB Displaced: ORIF Tension fracture Non-displaced: Bed rest, progressive WB. Consideration of ORIF Displaced: ORIF OSTEITIS PUBIS Osteitis pubis is an inflammatory condition of the symphysis pubis resulting from activities that cause acute or continuous shearing forces across the pubic symphysis. Repetitive micro trauma evokes an inflammatory response. Symptoms Insidious pain becoming progressively worse in the inguinal or groin area. The pain is sharp, stabbing or burning and twisting movements aggravates it. A click if present represents assign of instability. Resting relieves the pain. Signs: Tenderness localized to pubic symphysis with palpation. Painful passive hip abduction Resisted adduction painful. Positive lateral pelvic compression or cross-leg tests. Associated abnormal biomechanics such as weak abductor muscle may be present. X- rays: Radiographic imaging may lag behind by as much as 4 weeks in confirming the diagnosis. Radiographic findings include: Unilateral or bilateral fraying of the periosteum, bone resorption of adjacent pubic bones and widening of the symphysis joint space. Residual osteophyes with sclerosis and cystic changes may occur. Pubic symphysis shifting of greater than 2mm indicates instability. Bone scan: Increased isotope with symmetric involvement of the pubic symphysis in the area. Treatment: Rest, NSAIDs. Oral corticosteroids recommended by some authors. Physical therapy includes therapeutic ultrasound. Localized injection using steroid is controversial. Progressive strengthening program and return to competition. Duration varies 3 to 6 months. Surgery is considered as a last resort and only after nonoperative measures have deemed to fail. Arthrodesis of the pubic symphysis has a definite role to play in patients with proven osteitis pubis recalcitrant to nonoperative management and in whom instability is clearly demonstrated. SPORTS HERNIA A sports hernia is result of disruption of the posterior inguinal wall structures. It occurs in twisting sports and results from injury to the inguinal wall structures viz. transverses abdominus, conjoint tendon, internal oblique muscle and external oblique aponeurosis. Symptoms Unlike the classical hernia it does not present with a bulge representing a hernia. It presents with pain in the groin. On examination localized tenderness and increased sensitivity of related structure with straining. Investigation Ultrasound useful for diagnosis however user dependent MRI useful. Treatment Surgery for repair and stabilization. MUSCLE STRAINS Thigh muscle strains Acute muscle injuries in the thigh area include injuries to flexor, abductor and adductor compartments. (i) Adductor muscle strain The adductor longus muscle is the commonest adductor muscle to be involved. Pain and swelling localized to injured site. Painful passive abduction with resisted, adduction causing pain. Ultrasound useful in grading injury. (i) Rectus femoris muscle strain Localized or pain at injured site with painful resisted hip flexion and knee extension. (iii) Iliopsoas muscle strain Pain on resisted hip flexion with hip 90° flexion as starting point. Lower abdominal wall injuries Pain in proximity of pubic bone. Resisted leg eleration or resisted sit up will reproduce the pain. Lateral abdominal strain muscle injury seen with fast bowlers. LOWER LIMB INJURIES Acute injuries KNEE ANATOMY OVERVIEW OF ACUTE KNEE INJURIES Acute injuries include injuries to the muscles and ligaments crossing the knee joint. Intra articular injuries include cruiate ligament sprains and meniscal injuries. Acute medial knee injuries: The anatomical structures that may be injured on the medial side include the medial collateral ligament, medial meniscus, and proximal tibialfibular joint and medial plica. Medial collateral ligament sprains: The medial collateral ligament sprain is the result of a vulgas force to the knee joint. Injury is graded according to the severity of the injury. Isolated Grade 1 is treated conservatively with early mobilization and strengthening exercises. Medial knee strapping is recommended for support and for proprioception. Isolated grade 2 sprains requires some degree of immobilization with the aid of a knee brace limiting knee flexion to 20 to 30 degrees of flexion for 4 to 6 weeks depending on the severity of the injury. Grade 3 degree injury is usually associated with associated cruciate or meniscal tears. Management depends on the nature and severity of the associated injuries. Medial plica syndrome: The medial plica is a medial synovial fold that may become symptomatic. The management is conservative with pain control and surgery is indicated if symptomatic after failed conservative treatment. Meniscal tears: Meniscal tears will present with knee swelling. Associated knee locking and giving way may be present. Diagnosis is confirmed with MRI or at arthroscopy. Ultrasound of the knee is an inexpensive, non-invasive modality that is user dependent and is useful for diagnosis of meniscal tears and also for the staging of concomitant ligament sprains. Meniscal staging by identifying location from the meniscosynovial junction allows preoperative assessment to definite intra- operative management. The management depends on the location from the meniscosynovial junction. The tears located in the vascular peripheral area may heal spontaneous or with suturing while tears in the avascular zone requires partial meniscectomy. ULTRASOUND IMAGE OF MENISCUS: Longitudinal view of meniscus, demonstrating possible staging of meniscus tear from the meniscosynovial
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