Common Orthopaedic Injuries

Ankle Sprains

Ankle sprains are a common injury of the lower extremity that occur during various athletic activities as a result of inversion of the foot. About 90 percent are lateral sprains involving strain or tears of the weaker lateral ligaments of the ankle.

Symptoms: Pain, swelling and discoloration of the involved side of the foot/ankle.

Initial Treatment: The application of the "RICE" protocol: Rest from involved activity, ice pack, compression, and elevation of the affected extremity.

Rehabilitation: Length of needed treatment is determined by the amount of pain. In the first week, crutches may be required.

To strengthen the muscles that support the ankle, sit on a chair and lift the affected leg; then with the foot circle the ankle 10 to 20 times. Follow with wider circles in a clockwise direction and counter-clockwise direction.

Swimming or cycling for 15 to 30 minutes at a time will also improve healing and overall fitness.

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Osgood Schlatter Disease

The tibial tubercle is the attachment point for the patellar tendon. This vulnerable area, when subjected to continuous pulling of the quadriceps muscle group, can result in an overuse injury called Osgood Schlatter's disease. This disease is most frequently observed in adolescent athletes and is more common in boys.

Symptoms: Symptoms include a painful bump below the knee accompanied with warmth and swelling.

Initial Treatment: Apply an ice pack wrapped in a towel to the affected area several times a day for 10 to 15 minutes. Rest and load reduction promotes healing. Avoid ultrasound as a therapy, which could affect the growth plate. Adults presenting with symptoms may require the surgical removal of bone fragments.

Rehabilitation: Upon return to activity, regular stretching of the hamstring and quadriceps will decrease the muscle tension and the pulling force on the patellar tendon. This should be a painless stretch.

Quadriceps Stretch: Using one hand for support, stand up straight and bend one leg - grasping at the ankle. Pull heel toward buttocks to stretch the thigh. Hold the stretch for 10-15 seconds, then rest 10-20 seconds. Repeat three times. Extending the thigh backwards can increase the stretch.

Hamstring Stretch: Elevate one leg on a bench or step and bend forward. Keep the back straight and flex the toes toward your body. Hold 10-15 seconds followed by a 10-20 second rest. Repeat three times.

Co-ordination: Stand on the injured leg with arms spread for balance. Try to maintain balance for 20 seconds with eyes closed. Try 10-20 small knee bends. Use of a patellar strap or brace spreads the load at the insertion point of the patellar tendon and decreases the point pressure. When cycling, use a bike with gears using the lightest gear. Higher pedal frequency spares the stress on the knees.

Avoid prolonged sitting with knees pulled up or in the same position.

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Tennis Elbow

Tennis elbow is, perhaps, the best known of sport overuse injuries. It is estimated that more than 50 percent of all tennis players will suffer the severe pain and tenderness of tennis elbow in the course of their career, with increasing risk over the age of 35.

Symptoms: Pain and tenderness on the outer side of the elbow that may radiate down the forearm to the wrist and fingers. Wrist movements, like lifting/grasping/door opening, can be very painful.

Initial Treatment: Initial therapy should include rest, icing, and stretching. Rest may mean either a complete cessation of activity, or activity modification. Physiotherapy, involving friction massage, ultrasound, and a standardized exercise program may be helpful. Steroid injections have been proven to be effective in the short term.

Rehabilitation: The muscles of the extensor compartment of the forearm should be stretched and exercised daily.

To strengthen the extensor compartment muscles extend the arm forward away from the shoulders with palm down and elbow straight. Grab the fingers and wrist with the opposite hand and bend the wrist till tension is felt at the outside of the elbow. Squeezing a stress ball can increase grip strength.

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Tennis Leg

Tennis leg, also referred to as calf muscle strain, is a disorder involving a partial tear of the calf muscles. It is seen commonly in athletes in their middle ages. It occurs due to a sudden contraction of the calf muscle.

Symptoms: Symptoms of this disorder include a sharp pain of the calf muscle, sometimes accompanied by an audible sound. The pain can last from a few days to as long as six weeks.

Initial Treatment: This should involve rest from activity and the application of an ice pack to the calf for 10 to 15 minutes several times a day. The application of a compression bandage also helps apply pressure to small blood vessels and limit bleeding into the muscle.

Rehabilitation: After the worst pain has subsided, progress to building muscle strength by gradually increasing the applied load. Placing a heel lift in both shoes helps with reducing the load applied. Swimming every day is helpful for circulation and the healing process. When returning to the activity, one must perform stretching exercises of the long and short calf muscles prior to initiating planned activity.

One such stretch includes stepping forward with the unaffected leg, then with the affected knee held straight, transfer body weight to the unaffected leg by leaning forward.

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Wrist Tendinopathy

Wrist tendinopathy is the overuse syndrome resulting in inflammation of the tendons in the wrist resulting in pain. It is seen often in the non-dominant wrist of tennis players who use a double-handed backhand swing. This injury results from heavy loads applied to the wrist, overstretching and tearing of the tendons in the wrist.

Symptoms: Pain, redness, heat and swelling of the affected wrist.

Initial Treatment: Modification of activity involving rest from the sport regarding the use of the affected wrist. Apply an ice pack for 10 to 15 minutes to the involved wrist several times a day. Applying a wrist band or tape will help to stabilize the tendon and accelerate healing.

Rehabilitation: The goal of recovery is to strengthen the muscles that stabilize the wrist. To increase strength in the wrist flexors, start with a light weight (i.e. 1 lb.).

With the forearm on the knee, elbow flexed and palm facing up, move the wrist up and down 10 to 20 times for 2-3 sets. Exercise for the wrist extensors is the same as that for flexors with the palm facing down.

Once these exercises are tolerated, pronation (palm down) and supination (palm up) exercises can be practiced:

With elbow flexed and supported by the knee, the forearm is rotated clockwise and counterclockwise. Grip strength is improved by squeezing on a soft ball for a few seconds (10-20 repetitions).

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Wright State University Boonshoft School of Medicine