Conditions & treatments covered

The Unit is here to keep you on your feet, fit and active at any time of life, whether you compete in sports at the highest level or just want to stay active, mobile and free of pain.

Anterior Knee Pain

Location

As the patella (kneecap) tilts and rotates, its underside makes contact with the femur producing pain in this anterior region. Amongst many causes, repetitive contact that leads to anterior knee pain may result from anatomical misalignment or biomechanical, muscular and overuse trauma.

Symptoms

The pain that results from a pressure overload between the patella and its various contact points with the femur may affect both inactive patients and the more athletic. Repetitive impact, for example running up steps, hills, hard and uneven surfaces, may initiate the condition but once developed even prolonged sitting may be painful.

Diagnosis

Detailed discussion with the patient should identify possible causes, many of which relate to some triggering event, particularly for athletes. Imaging with CT or MRI scans should help to identify unusual conditions such as osteochondritis dissecans if the pain fails to respond to several weeks of treatment. Physical examination may highlight poor hip alignment or deficiencies in, commonly, the "quads" that allow too much lateral movement of the patella. Aspects of the patient's training may also point towards aggravating factors.

Treatment

This will depend upon the symptoms experienced, the age and lifestyle of the patient. For benign knee disorders, a combination of analgesics, heat or ice treatment, strength and flexibility exercises, bracing and taping, or orthotics (suitable shoe support). Surgery may be considered as a last resort. For example, fraying of the retropatellar cartridge (chondromalacia) may be treatable with 'keyhole' surgery to smooth out the under surface of the patella.

Further help:

Knee anatomy
www.thewellingtonhospital.com/patient-services/orthopaedics/knee/

 

 

 

Achilles Tendinopathy

Location

The Achilles tendon transmits the muscular force of the calf to the foot, moving the body forward in running, jumping, skipping etc. Excessive and repetitive overload of the Achilles tendon leads to tendinopathy, typically as a result of intense and sustained running in training, recreational or competitive sports such as football in which running is a major element.

Symptoms

There will typically be a gradual increase in pain and stiffness, particularly after sleep, which may reduce with walking or applying heat. The pain may subside during training only to reoccur at rest. Left untreated the problem will progress, becoming persistent and affect everyday living.

Diagnosis

Physical examination will identify palpable tenderness with thickening and sometimes palpable nodules at the Achilles tendon. Diagnosis may be confirmed using Ultrasound or MRI scan. Diagnosis will also involve pain measurement and management.

Treatment

Initially, conservative treatment may be recommended, using a combination of strategies which may control inflammation, identify and help correct limb malalignment, tackle injurious training methods and poor equipment, and strengthen contributory muscle weakness. Orthotics combined with a programme of stretching exercises, for example, can reduce the strain on the Achilles tendon, improving mobility. Corticosteroid and other anti-inflammatory injections may also be helpful but there is a risk of tendon rupture. Cryotherapy may also be useful for short-term pain relief. 

If the patient does not respond to conservative management, surgery may be considered. For chronic Achilles tendon injuries, surgery involves incision of the paratenon sheath around the tendon, release of adhesions, removal of any degenerative tissue and repair of partial tears, followed by an individualised rehabilitation programme over several months.

Further help:

Achilles tendon treatments
/patient-services/orthopaedics/foot-and-ankle/

Ankle Sprains

Location

The lateral ankle ligaments and ankle joint capsule is most often affected.

Symptoms

During any weight-bearing activity, it may feel like the ankle is going to collapse, with pain and constant swelling.

Diagnosis

Medical attention should be sought as soon after injury as possible as bleeding into the ankle joint is common, leading to chronic inflammation.

Treatment

There are four ways available to manage an ankle ligament sprain/rupture:

  • Nothing and simply wait for the ankle to settle.
  • Immobilise the injured ankle in a plaster cast for a period of 4-6 weeks.
  • Functional rehabilitation to treat the sprained ankle (a graded physiotherapy programme, often combined with a removable ankle brace).
  • Surgery, persisting ankle pain or instability may indicate the need of surgery to remove loose cartilage, inflamed tissue or scar tissue from the joint or to repair injured ligaments.

Further help:

www.thewellingtonhospital.com/patient-services/orthopaedics/foot-and-ankle/

Groin Pain

Location

Groin pain is a common injury in people doing weight-bearing sport. There are a large number of causes for groin pain and it is therefore important that the injury is carefully assessed by a specialist so that the correct diagnosis can be made. Groin pain can be caused by bruising, stretching or tearing the muscle fibres that extend between the pelvis and inner thigh. These adductor muscles or the tendons that attach them to the pelvis are stretched and inflamed as the thigh moves beyond its normal limits from the body's centre. Strenuous workouts, with inadequate warm up and without sufficient rest time being allowed to restore normal function, are inclined to severely stress the adductor muscles. Otherwise, muscles and tendons in the area may become more prone to irritation and injury.

Symptoms

Sudden sharp pain in the groin area during exercise will usually be accompanied by pain and tenderness in the hip/groin region, followed within 24 hours by swelling and inflammation spreading downward, with the skin being discoloured as bruising appears within 48 hours. Walking and especially running will be painful.

Diagnosis

If the pain is anything other than newly onset (acute), rather than long standing, physical examination will involve careful movement of the leg and hip joint to evaluate the extent of damage. If a more serious condition is suspected, imaging with x-ray, CT or MRI scan may be recommended. For example, long standing pain in the groin area may be an inguinal hernia which may need surgical attention.

Treatment

A groin strain may be first- second- or third-degree in severity and treatment will be geared to this. The degree of damage to be treated can range from simple bruising of the adductor muscles, pulled tendon or muscle fibers, the symptoms of which typically last a week, or a severely stretched or separated tendon which may take some months to heal. Early examination will help confirm whether the groin pain will respond to rest, compression and other conservative treatment or needs further investigation.

Further help:

Groin anatomy
www.physioroom.com/injuries/groin_and_pelvis/groin_strain_full.php

Pain management
/patient-services/pain-management/

Low Back Pain (LBP)

Location

Patients may experience a sudden, sharp, persistent, or dull pain felt below the waist usually as a result of strain of the muscles that attach to, and surround, the bones of the spine (vertebrae) and the 'discs' between each bone. As this spinal cord protects the nerves that come from the brain, damage and pain in the lower back may mean nerves arising from the spinal cord are being compressed. Low back pain is either acute or chronic. Acute LBP may begin suddenly with intense pain usually lasting less than 3 months. Chronic pain is persistent long-term pain, sometimes lasting throughout life. Even chronic pain may present episodes of acute pain.

Symptoms

Although the pain may be immediately obvious both as to cause and effect, other symptoms can include localized pain in a specific area of the low back, general aching, and/or pain that radiates into the low back, buttocks, and leg(s). Sometimes pain is accompanied by neurologic symptoms such as numbness, tingling, or muscle weakness in a leg or foot. However, long term pain in the lower back can also indicate spinal stenosis, arthritis (osteoarthritis), spinal infection (osteomyelitis), spinal tumours (benign and malignant), spondylolisthesis, and vertebral fractures (e.g. burst fracture).

Diagnosis

Details of your age and general health, any recent history of trauma or injury, your training regime or indications of other symptoms will guide diagnosis and treatment. Physical examination and blood tests may lead to imaging with MRI or CT scan of the suspected seat of the pain. Problems with your bladder or bowels or weight loss and feeling generally unwell may also indicate further diagnostic testing.

Treatment

For simple back pain, rest and medication with painkillers and muscle relaxants may resolve the problem. If pain persists for some weeks, physiotherapy or other physical treatment could follow, taking account of your training regime to make sure this is not aggravating the pain. Osteopathy and chiropractic treatments to manipulate the spine may provide short term pain relief and some find acupuncture helps. If tests indicate longer term causes of the pain, such as spinal stenosis, you may need to consider surgery.

Examination may show that the lower back pain is arising from the facet joints which link and stabilise the vertebrae, allowing the spine to bend and twist. To determine whether there is wear or damage to the facet joints, an anaesthetic injection may be used to diagnose the source of pain and, with a higher dose, to treat the pain to allow exercise therapy to strengthen the back muscles.

Further help:

Anatomy of the spine
/patient-services/orthopaedics/spinal/

Pain management
/patient-services/pain-management/

Rehabilitation for lower back pain
www.sportsmedicineuk.co.uk/lower_back.html

Shoulder Pain

Location

Although the shoulder is the most mobile joint, the range of motion that the shoulder is capable of also means it is prone to injury, being the most frequently dislocated joint in the body. The ball and socket joint of the shoulder is anchored by its muscles, tendons and ligaments, each of which may be disrupted by injury or over-use, whether from excessive or poorly managed training, or trauma. The joint and surrounding tissue also may be affected by degenerative damage.

Symptoms

Shoulder pain may be localised or may be referred to areas around the shoulder or down the arm. Disease within the body (such as gallbladder, liver, or heart disease, or disease of the cervical spine of the neck) also may generate pain that travels along nerves to the shoulder.

Diagnosis

Medical history and physical examination should identify causes of the pain, which may include:

  • Dislocation - which may be accompanied by swelling, numbness and bruising of the surrounding ligaments or tendons, possibly with nerve damage.
  • Separation - the ligaments that secure the collarbone (clavicle) to the shoulder blade (scapula) tear allowing the clavicle to dislocate.
  • Tendinitis and bursitis - overuse and aging may wear down the tendons, muscles, and structures surrounding the shoulder. Pain and discomfort in the upper shoulder or upper third of the arm may be slow to develop but can also affect the biceps tendon, with pain travelling down to the elbow and forearm.
  • Torn Rotator Cuff - common in sports involving repeated overhead arm motion (like tennis). The pain is felt over the deltoid muscle at the top and outer side of the shoulder, especially when the arm is raised or extended out from the side of the body. The shoulder may feel weak, especially when trying to lift the arm into a horizontal position.
  • Frozen shoulder - the joint becomes so tight and stiff that it is nearly impossible to carry out simple movements, such as raising the arm. Pain and stiffness tend to be worse at night. The condition is unusual in people under age 40 but if there is limited shoulder movement, an arthrogram may confirm diagnosis.
  • Fracture - a fall or blow to the shoulder may cause a partial or total crack, usually of the clavicle or neck of the humerus. There will be severe pain, redness and bruising around the area and the bones may appear out of position.
  • Arthritis - this degenerative disease is caused by wear and tear of the cartilage (osteoarthritis) or inflammation of one or more joints (rheumatoid arthritis). This can affect the shoulder joint and surrounding muscles, tendons, and ligaments.

Diagnostic tests may include arthrogram (x-ray after injection of a contrast fluid), MRI or CT scan.

Treatment

As examination can show a wide range of possible causes of shoulder pain, treatment will likewise extend from simple rest and rehabilitation through to surgery to replace the shoulder joint. As mentioned above, shoulder pain can also indicate other health issues which may need early attention.

Further information can be found by visiting The Wellington Shoulder Unit.

Tennis Elbow

Location

Pain and tenderness is localised in the elbow and the back of the forearm and is aggravated by lifting, bending or twisting the arm.

Symptoms

The pain experienced can range from mild discomfort for a few weeks to severe pain lasting several weeks. Some may have a painful elbow joint for some years, as stiffness and tendon damage accumulates. Without treatment, a weak elbow may lead to pain in the rest of the affected arm, shoulder or neck as the body tries to compensate.

Diagnosis

This is an overuse injury, arising from small tears to tendons and muscle coverings which are not allowed to heal fully, gradually causing more serious inflammation of the tendon such that it constricts blood flow to the radial nerve that controls muscles in the arm and hand. It is common in racquet sports, swimming, golf, and any sport involving repeated throwing. Physical examination and discussion of your symptoms are usual although x-ray may be used to rule out possible injury inside the elbow joint, and an MRI or Ultrasound of the soft tissues around the elbow may become necessary if pain is severe.

Treatment

If your lifestyle allows for adequate recovery time, simple rest and avoiding whatever caused the condition may suffice. For sports people, professional guidance will help avoid further damage. Otherwise, treatment may include medication with anti-inflammatory painkillers and/or steroid injections. If symptoms last more than a month or so, other specialist help may be recommended, such as physiotherapy or, in a few cases, surgery.

Further information can be found by visiting The Wellington Shoulder Unit.

Stress Fractures

Location

One of the most common sports injuries, a stress fracture is an overuse injury that occurs when the muscles fail to absorb repeated shocks and overload the bone causing small cracks, most usually in the lower leg and foot. Running or jumping on hard surfaces and using unsuitable equipment are common contributory factors. Lack of rest between vigorous exercise risks a stress fracture, particularly in sports such as tennis, gymnastics, dance, basketball, track and field.

Symptoms

Pain that is experienced with activity and eases with rest is the most common symptom, with women more likely to suffer than men, possibly linked with menstrual or dietary problems leading to decreased bone mass.

Diagnosis

Stress fractures do not always show up on x-rays but detailed physical examination and discussion of your medical history and lifestyle will help confirm your risk factors, because these overuse injuries have a typical course and common physical findings. Imaging may include an MRI or CT scan particularly if x-rays show evidence of partial healing of the bone around the stress fracture. Early diagnosis is important to avoid the risk of more long term damage.

Treatment

Adequate rest and pain-free activity for up to 2 months following diagnosis will most often be effective. If there is a risk of displacement of the fracture, a cast and use of crutches may be recommended. Occasionally drug therapy can enhance healing. Returning too early to the activity that caused the fracture may trigger more serious, longer term injury and fractures that may never heal properly. Orthotics and modified training regimes may also help healing and prevent further damage.

Further help:

Orthotics
/patient-services/orthopaedics/foot-and-ankle/

Shin Splints

Location

Generalised pain occurs in the front of the lower leg along the front or back inside area of the shin bone (tibia), most usually resulting from repetitive stress or jarring of the bones, muscles and joints of the leg with inadequate rest to allow recovery between workouts.

Symptoms

Shin pain will be aggravated with running, jumping or any weight bearing exercise, particularly if on hard or inclined surfaces. The calf muscles may also become tight and inflexible.

Diagnosis

Physical examination allied to medical history should identify the cause, which is most usually related to overtraining that over exerts muscles, particularly in beginner or occasional runners not used to the stress that running puts on the muscles, bones and joints of the leg and foot. More experienced athletes may also develop biomechanical problems through poor technique such as excessive pronation of the foot that increases the risk of shin splints.

Treatment

Like other stress injuries, adequate rest is the best treatment, combined with ice, compression and elevation to relieve and reduce pain and swelling. If the injury does not respond to this combination within 48 hours and continues for three or more weeks you should seek a more detailed examination, treatment and rehabilitation programme.

Hamstring Injuries

Location

Injuries to the hamstring - actually a group of powerful muscles connecting the lower pelvis to the back of the shin bone - are common in sports involving sudden acceleration such as soccer, basketball, track and field. Injury can also result from impact to the muscle, such as a kick or fall on the back of the thigh. A hamstring contusion differs from a pulled hamstring, which is a tear in the muscle fibres, which can range in size and severity.

Symptoms

Hamstring injury is invariably sudden and painful but has a wide range of severity. Small tears to the muscle result in bleeding and subsequent bruising that spreads from the back of the thigh down below the knee and into the foot. The thigh will swell affecting a wider area of muscle pain and tightness. Muscle spasm is common and may be severe. Flexing the knee is often painful and with a severe hamstring strain the muscle tear may need surgery to repair it.

Diagnosis

Strains and tears to the hamstring muscle usually result when an external and opposing force is applied when the muscle is trying to contract. Physical examination and discussing how the injury happened will help clarify the likely level of damage suffered.

Treatment

Whatever the severity of the injury, immediate rest is vital to avoid further damage. The application of ice, compressive bandage and elevation of the leg will provide short term relief and crutches may be necessary if walking is painful. Physical examination and any necessary diagnostic imaging (ultrasound or MRI) will then help confirm how much muscle damage has occurred and what medication, physical therapy or, in severe cases, what surgical procedure may be needed.