The risks and benefits of local injection therapy of overuse sports injuries with cortisteroids are reviewed here. Injection of corticosteroid inside the tendon has a deleterious effect on the tendon tissue and should be unanimously condemned. No reliable proof exists of the deleterious effects of peritendinous injections. Too many conclusions in the literature are based on poor scientific evidence and it is just the reiteration of a dogma if all steroid injections are abandoned. The corticosteroids represent an adjuvant treatment in the overall management of sports injuries: basic treatment is ‘active’ rest and graduated rehabilitation within the limits of pain. With proper indications there are only few and trivial complications that may occur with corticosteroid injections. Guidelines for proper local injection therapy with corticosteroids are given.
This review is based on the results of 308 operations for unexplained, chronic groin pain suspected to be caused by an imminent, but not demonstrable, inguinal hernia: the 'sportsman's hernia' (SH). No differences in perioperative findings between cured and non-cured athletes were found. However, there was a remarkable difference between the various perioperative findings in the studies. It was characteristic that further clinical investigation of the noncured, operated athletes gave an alternative and treatable diagnosis in more than 80% of cases. Herniography was used consistently in the diagnostic process in all the studies on SH. However, in 49% of cases hernias were also demonstrated on the opposite, asymptomatic groin side. In conclusion, the final diagnosis (and treatment) often reflects the speciality of the doctor and the present literature does not supply proper evidence to the theory that SH con-1 stitutes a credible explanation for chronic groin pain.Groin pain is a common problem among athletes in general and among soccer players in particular. Diagnoses to be considered in cases of groin pain include tendinitis or partial rupture of groin muscles or tendons (the adductor groups, m. rectus femoris, m. rectus abdominous, the hamstring group, m. sartorius and m. iliopsoas), bursitis (the iliopectineal bursa), periostitis, symphysitis, stress fracture (the ramus pubis suphf), avulsion (trochanter minor), neuralgia (the n. ilioinguinalis), diseases of the columna and the sacroiliac joints, adenitis, prostatitis, projecting abdominal pain and hernias.Palpable hernias are often asymptomatic, but have been reported to cause chronic groin pain (1, 2). It has recently been recommended by several abdominal surgeons that routine inguinal hernia repair in athletes with chronic groin pain, and in cases where no hernia is found by physical examination, should be performed. This recommendation is based on the condition termed 'the sportsman's hernia' (SH).We have conducted a review of the available literature in order to present and discuss the scientific basis for SH, for which an increasing number of athletes have received and currently are receiving surgical treatment. Literature reviewThe review was based on the results reported in six articles on SH. The number of operations for SH, the perioperative findings, and the follow-up periods are shown in Table l .A total of 323 surgical inguinal hernia repairs were performed in 295 athletes. At least 39 athletes (1 3%) had bilateral symptoms and 29 athletes (10%) were operated on bilaterally. Bilateral groin pain was found in 8% (3), 13% (4), 21% (5) and 32% (6) of the total numbers of athletes operated.In 15 cases there was clinical evidence of an inguinal hernia evaluated by palpation pre-operatively. In the remaining 308 cases the pre-operative examination was normal. The indication for these 308 operations was unexplained chronic groin pain suspected to be caused by an imminent, but not demonstrable, inguinal hernia -'the sportsman's hernia'.Polglase et al. oper...
Jumper's knee is an overuse disease. The initial subjective complaints are well‐localized pain, usually occurring after physical activities and often at the lower pole of the patella. The diagnosis of jumper's knee is usually easily established after acquiring a detailed history and a carefully performed physical examination, but the lesion can be mistaken for other disorders or injuries, such as bursitis, meniscal injuries or chondromalacia (1) or other causes of the patellofemoral pain syndrome. Today ultrasonography is the method of choice for the evaluation of jumper's knee as it is both time and cost saving, non‐invasive, repeatable, accurate and allows a dynamic image of the tendon, guided injections and control of treatment. Conservative therapy is the treatment of choice in the early stages and includes adequate warm‐up, stretching of the quadriceps muscle and physical activity with respect to the pain, and ice pack application after activity. When the pain disappears, the training intensity can be increased. NSAID (Non‐Steroidal Anti‐Inflammatory Drugs) and local peritendinous injections with long‐acting steroids can be a helpful and safe adjuvant to the conservative treatment and should be tried before surgery. Surgical treatment is indicated only if a prolonged and well‐supervised conservative treatment program fails in chronic jumper's knee (including local injection with steroid) or in acute total rupture. Review papers concerning jumper's knee are already published (2–5), but in this review the importance of ultrasonography to make the diagnosis, to plan therapy and control the treatment and the safety of peritendinous injection with steroid is pointed out. The scientific documentation for the recommanded treatment (conservative, steroid injection and operation) is, however, insufficient. Many more controlled studies are needed. Ultrasonography and placebo‐controlled, double–blinded, cross‐over studies for treatment with local injection of steroid are ongoing (6, 7).
Ultrasound examination is a recognized advanced tool in the diagnosis of many sport-related overuse injuries. This article illustrates a new indication for ultrasound examination: the diagnosis of iliopsoas tendinitis and its treatment by ultrasound-guided local injection of long-acting corticosteroid.
'Handball goalie's elbow' has been defined as pain in the elbow region due to repetitive forced hyperextensions of the elbow. Goalkeepers are the players most often suffering from hyperextension trauma to the elbow in European team handball. They may complain of radiating pain or numbness in the ulnar aspect of the forearm in addition to local pain in the elbow region. To detect any injury to the ulnar nerve that could explain the symptoms, we performed a neurological and neurophysiological study in goalkeepers with elbow pain. Nine goalkeepers, with a total of 15 'handball goalie's elbow', were included in this study. Neurological examination revealed a probable ulnar nerve lesion in one player. Neurophysiological and electromyographic examinations (10 examinations) were, however, normal in all players. Handball goalkeepers with elbow problems may suffer from symptoms suggestive of ulnar nerve affection, but serious or permanent injury to the ulnar nerve with wasting or paresis is unusual.
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