Orthopaedic & Sports

Dear @Ian 

I am sorry to hear of your injury. Injuries to the biceps femoris have indeed been reported in isolation or with concomitant injuries to the adjacent ligaments within the knee. You seem to describe a Grade 4 injury - Complete muscle injury with discontinuity and retraction. While surgical repair is generally advocated to restore the native anatomic features to minimize loss of function and strength, there is still no consensus on optimal management with regard to successful return to sport. This is perhaps why you had been advised against surgery.

Hamstring injuries are the most common injury in sports. Unfortunately, they are associated with long rehabilitations and have a tendency to recur. In isolated injuries, he treatment is conservative, with the use of anti-inflammatory drugs in the acute phase followed by a muscle rehabilitation program. Proximal avulsions have shown better results with surgical repair. 

In general, conservative therapy is indicated for single-tendon acute proximal tendon avulsions or multiple tendon lesions with less than 2 cm of retraction. 

Surgical treatment is the best option for ischial apophysis avulsions in skeletally immature patients, avulsions with the HS bone fragment, and proximal avulsions of the entire HS complex. Surgery is also indicated in patients with avulsions in one or two tendons and retractions greater than 2cm. In recreational athletes or inactive patients, surgery is indicated only if the patient is symptomatic.

With the information you have given, you have mentioned a retraction of 70mm = 7cm. You also mention that you are not an elite athlete. Decision for surgery or primary rehabilitation in your case is a difficult and challenging one that needs to be made in a shared and mutual manner with your physician. I hope this helps with some clarification at least.

Hello, sorry to hear about your injury! Inversion injuries (rolling the ankle) are very common injuries. If you felt a pop, then the most frequent issue would be a tear in the lateral ankle ligaments (ATFL). Generally if you can weight bear and the X-rays don’t show any fractures then it should be reasonably safe to continue to rehab and Physiotherapy for now. You may want to return to your physician for a check up in another few weeks to see if things are recovering as planned. Further tests and imaging might be needed if the ankle doesn’t sort itself out by then. 

One other small thing - if the pain on the top of the foot is quite significant then you probably want to get that assessed separately from the ankle as well. This is because sometimes when we roll our ankle we may also injure ligaments or bones in the foot. 

Hi @sickboiboi although muscle aches are part and parcel of exercise, pain is also the first sign an injury may be developing, some of which could permanently impair your ability to exercise. As a general rule of thumb, one should rest during aches like these. If pain persists despite a period of rest, then a consultation and examination with your doctor may be required.
 
It is also best to adapt your fitness regime to your own needs as everyone's body is different. If you find a lot of aching in a certain muscle group with your current regimen, you may want to explore focusing on other unrelated muscle groups and/or cycling between them to facilitate rest (e.g. cardio-legs training, and upper body-strength training). Hope this helps!

Dear @angella ,

I am sorry to hear of your accident. You indeed have a fractured clavicle (collarbone). I am not quite sure what they meant by a 'fissured scapula'. Clavicle fractures can be treated conservatively - by an arm sling if there no open wounds, skin is not tented and/or if you have no injuries to the blood vessels and nerves in the area. Having said that, there are studies that show that collarbone fractures with significant displacement and shortening will result in some functional deficit (i.e. weakness in shoulder movement etc) if left to heal on their own. I would suggest a repeat X-ray within 2 weeks of the initial injury and a review by an Orthopaedic Surgeon to discuss the progress and the options available to you. I hope this helps!

Dear @joheet 

Thank you for your question. Indeed, sitting for long hours and working is one of the common causes why people develop a stiff and sore back. From the symptoms that you have described, it appears like that pain is limited to the lower back without any radiation of pain or an 'electric' sensation running through the legs, which is good. That means that it is less likely that there is any form of nerve impingement. The fact that you get temporary relief from standing, walking and foam rolling also clues in to the fact that a large component of your pain is muscular in origin.

While it is going to be the new norm that a significant number of people will be working from home, I think it is good to consider augmenting our home environment and our practices to suit this 'new norm'. First of all, I would advise you to take breaks every 1-2 hours or so of sitting to do gentle stretching to 'loosen' your back muscles. Injuries to the back usually happen when the spine is stiff. Sudden movement of a stiff spine often causes injury which results in pain. Pain that leads to even more stiffness. Therefore, in order to break this vicious cycle, regular stretching is useful. You can find some simple stretching exercises on the Internet. Regular yoga  or pilates classes may be useful to improve flexibility too, if you can afford the time. Once you have incorporated the regular stretching to your routine, you can then transit to adding further exercises to strengthen your back muscles. 

Apart from these exercises, having good back care habits are important. For example, bending the knees to lift objects from the floor rather than bending the back. Sitting with a good posture while typing. Having a good back support on your chair.

I hope these tips will be useful for you!

Dear @Aiden 

Thank you for your question and I am sorry to hear of your plight. Am I correct to say that you had made an uneventful recovery since your hip replacement and this pain that you are feeling is something new that you are experiencing in the last 2 months? There can be several causes for the symptoms that you are describing. These can be broadly classified as intra-articular (from inside the prosthetic joint) and extra-articular (from outside the joint i.e. muscles, tendons,  bone spurs etc.). Sometimes while the pain is felt at the hip, the problem can be somewhere else, most commonly the spine. This is what we call 'referred pain'. However, from what you have described in your post it does not see like this pain is of spinal origin. You have not mentioned any redness in the area or fever which is great because we can rule out infection. A physical examination by a doctor and some basic imaging like an X-ray of the joint may be useful as a starting point to evaluate your pain. However, further imaging such as MRI (excellent for soft tissues like muscles and tendons) or CT (excellent for bone and to assess alignment of the hip joint) may be needed if the X-ray do not reveal anything. My advice would be to take a break from the long walks and get the physio to do a basic assessment of the movements of your hip as well as the strengths of the major muscles around the hip joint. It would be best to get the surgeon who did your hip replacement to have a look at you if at all possible. 

Hi Jess,

Sorry to hear about your compression fracture! I presume this is a compression fracture of your spine. These fractures usually are healing at 2 months so it would not be usual to be having cold sweats and symptoms at 2 months. It could be because the fracture is not healing well, or complications such as an infection or nerve compression have developed. Would suggest getting it checked by your specialist or a specialist to assess if any of these issues have developed.

Dear @Joseph ,

Thank you for your question. I am sorry to hear that you have been troubled by low back pain for a few years. Low back pain is a very prevalent problem across the world. There are may causes of low back pain. We would need more information about your symptoms. This coupled with the signs that we find on physical examination would then allow us to make an informed diagnosis. Since you have been troubled by the pain for a few years now, I would encourage you to see a doctor. Details on the following will be very useful for the attending doctor:

1. How did the pain start?

2. Was there any trauma/injury?

3. Is it a sharp pain or dull ache?

4. Where in the back is it located?

5. Has it always been there or does it ‘come and go’?

6. At its worst, how bad is the pain from a scale of 0-10?

7. At its best, how bad is the pain from a scale of 0-10?

9. Does the pain shoot down either leg?

10. Do you have any numbness or weaknenss in either leg?

11. Do you have any trouble passing urine or motion?

12. Is your walking affected?

13. Is your sleep affected?

The most common cause of low back pain is usually an injury to muscles or ligaments of the back which usually recovers with rest and physiotherapy. With age, the spine undergoes degeneration (lumbar spondylosis) and this can cause pain too. 

 

I hope the above information is helpful. For a start, avoid lifting heavy weights and observe good posture and back care habits. You can do some core strengthening exercises (easily found off the web) as well as stretching exercises for the back while waiting to see your doctor. Take care!

Hi @Steve sorry to hear about your predicament! Sesamoiditis is inflammation of sesamoid bones at their attachments. Sesamoids are unique in that they connect with muscles via tendons, unlike most other bones that connect with each other at joints. Sesamoiditis is more common at the knee (patella/knee cap which is technically a Sesamoid, but sometimes also called tendinitis) and the bottom of the foot, although the hand has sesamoids in the region called the "Volar plate".

There are several possible causes of pain in the region you describe, apart from bony disorders like Sesamoiditis, there can also be soft tissue disorders (e.g. affecting muscle tendons or their protective layer/"tendon sheath") in the area. Common examples for the latter include trigger finger and De Quervains tenosynovitis, although one would expect the shots to have at least provided some temporary relief. You can read more about them here: https://www.health.harvard.edu/diseases-and-conditions/tendon-trouble-in-the-hands-de-quervains-tenosynovitis-and-trigger-finger

Unfortunately, it would not be possible to distinguish between them without first finding out more about your lifestyle, circumstances surrounding the start of your symptoms, aggravating factors, as well as performing an examination in-person of the affected area. However, these are fairly standard assessments and I trust your provider would already have done them, and likely came to the conclusion of sesmoiditis based on these and has offered surgery due to the lack of response to the shots.

Perhaps if there is still uncertainty surrounding this, you may want to discuss with your physician the option of performing an imaging scan such as an MRI to evaluate further. Hope this helps!

Dear @igotz99problemz ,

Thank you for your query. Was there any trauma or injury involved prior to you feeling this soreness and hearing the clicking sounds? How is your shoulder movement? Is it restricted? Some aches and pains can be a result of repetitive strains on the shoulder. Clicking without pain can usually be observed first but if you truly feel that the shoulder does not feel right and this problem has been going on for a while, then you should get a medical professional to examine your shoulder.

Dear @Jlynita_86 ,

Thank you for your query and I am sorry to hear that you are currently experiencing  these symptoms.

Intermittent numbness in both arms and hands can be caused by a few conditions. These can be anywhere in the course of the nerves traveling from the brain, to the spinal cord, to the major nerves and then to the smaller nerves in the hand. I would advise you to seek a medical professional for a full history and examination to exclude important causes. Once these have been excluded, you can then be referred to a specialist to be worked up for the rest of the conditions like cervical spondylosis (wear and tear of the neck spine which can result in compression of nerves) or other nerve compression syndromes like carpal tunnel syndrome. Please take care.

Hi ladymouse 

Sorry to hear about your injury! The small joints of the finger can be quite prone to develop stiffness after an injury and tendon repair. It’s quite common not to be able to regain full function/motion after such an injury.

Nonetheless, if the result is not satisfactory, it might be worth getting an ultrasound scan done to look at how the tendon repair is doing and also how much excursion (sliding) of the tendon is possible. Options for adhesions can include more therapy, a steroid injection and manipulation of the joint and surgery for adhesiolysis. As for shockwave, I’m not aware of data that it’s useful though I don’t see how it can be harmful. 

Hope that helps!

Hi Lunarorbit,

Thanks for your detailed description! Whether an ankle ligament reconstruction (Brostrom) would benefit you or not, boils down to the assessment of whether your symptoms are due to ankle ligament laxity. 

A lot of times, we expect a torn ligament to manifest as a “loose” ankle that rolls over or gives way easily. 

However, that’s not always true and there are many people who instead have symptoms of an achy and sore ankle with activity instead. This is because the ankle joint mechanics is off due to the loss of ligament function. 

If you’ve had an MRI done already which shows the ankle is healthy except for the ligament tear and bone  avulsion, then there’s a pretty good chance your symptoms are due to the laxity and altered mechanics from the incompetent ligament. Another soft sign is if your ankle feels better or more secure when you wear a brace - this can also be an indicator that the symptoms are due to loss of ligament function. 

Hello oldancer,,

Sorry to hear about the sudden pain. Sharp upper thigh pain can have a few different causes. Nerve related issues either from the spine and lower back, or around the pelvis could be responsible. You may want to check out a condition called meralgia parasthetica which comes from nerve compression around the pelvis. Also, even though it feels like soft tissue, it’s still a possibility it could be  coming from the hip joint too. Either way, if it doesn’t go away would be good to get it checked out by a medical professional.

Hi @Iamking oh dear Im sorry to hear this! I am afraid there is quite a bit of swelling in the image, you may have a fracture and your condition requires a physical examination with a doctor for them to make that determination and create a management plan tailored to your needs accordingly. Given the severity of the pain and your being unable to bear weight on the foot, depending on the doctor’s findings on examination he may need to arrange an X-Ray for you to check if there is a fracture. 

Some may go to an emergency department for a condition like this, however I would not recommend that as the waiting time may be considerable. There are a few GP clinics that have X-Ray capabilities which you can consider to save time in case you end up needing a scan, these include the Raffles Medical Clinic at level 2 in Raffles Medical Hospital (RMH). In the mean time, try to avoid bearing weight on your foot and if the pain is severe, get help or use crutches/wheelchair (if you have any) as you make your way to the clinic. Hope this helps!

Hi @melvin, what you are describing sounds like a radiating pain from an impinged nerve root in the spine. The action that you describe that precipitates the pain is what we call a “bowstringing” effect. I think it is prudent for you to see your general practitioner/ family physician for a physical examination and potentially a referral to see an orthopedic surgeon. I hope this helps!