The fact that sport, as the most important secondary matter in the world, is closely linked to the world of medicine is something that pharmaceutical advertising in particular likes to emphasize. Sporting activity is dramatically staged to illustrate the hoped-for efficacy of certain drugs. Likewise, we find close references to sports in the designation of various health disorders. Part 1 was published in issue 11/2016.
Endofibrosis of the iliac artery in the cyclist.
If a cyclist complains to the doctor about loss of power while riding, lack of strength, debilitating pain, and feels that his racing shorts are too tight at the level of the distal thigh, then it is probably endofibrosis of the iliac artery (mostly externa). This inner wall change of the artery results from supranormal hemodynamic conditions and the constant angulation of the vessel in the inguinal region. The clinical examination is bland, so to speak. In the performance test on the bicycle, one finds an altered index of pulses both on the upper arm and in the ankle area. Arteriography can definitively determine this endofibrosis. The treatment is exclusively surgical. It should be mentioned that the first description of this syndrome took place in Lausanne in 1982.
“Artère Poplitée Capturée du Joggeur”
This is a narrowing of the popliteal artery in the popliteal area, either due to calf muscles with anatomical variations in shape, or due to similar changes in the artery, or due to functional muscle hypertrophy during sports such as running and cycling. This clinical picture affects men under 30 years of age in 90% of cases. In 20% of cases, the problem is bilateral. Symptoms are often nonspecific and variable, usually exertional pain, often on inclines. They resemble intermittent claudications, are spasmodic, and can sometimes be very painful. Clinical examination is poor, diagnosis is made by echo-Doppler, with functional studies of plantar flexion of the ankle against resistance as well as passive dorsiflexion. MRI or angio-CT have become established as a means of clarification before surgery, which is usually necessary. In surgical measures, depending on the form, tenotomy or arterial correction is chosen.
Several terms have also become established in the field of the musculoskeletal system. Let’s consider the following:
The thrower shoulder
Anyone who is a little interested in the biomechanics of the throwing motion will have no problem understanding that the shoulder joint is almost inevitably damaged by this strong supraphysiological load. The angular velocities are extremely high. The compression forces (up to 650 N) and the max. reached 1200 N are also very high. This results in permanent overloads of the capsular as well as the muscular structures; furthermore, imbalances of the force pairs as well as disturbances of the coordination between arm and trunk etc. arise. These structural and functional changes are summarized in the term throwing shoulder. They are also found in overhead sports (swimming, tennis). These changes provoke instabilities with “impingement” symptoms (mostly poster superior). Lesions of the rotator cuff, labrum and biceps tendon anchor (SLAP) may also occur. This complex clinical picture is not easy to diagnose and runs through a complete examination and with the help of imaging measures. Depending on the balance, treatment will be conservative – with careful rehabilitation – but often surgical.
The tennis elbow
The first description of this clinical picture is found in Germany in 1873. The typical elbow pain was initially referred to as “writer’s cramp.” Then they received the name “Washer Woman’s Elbow” and about 1883 finally “Lawn Tennis Elbow”, shortened known as “Tennis Elbow”. From a purely medical point of view, tennis elbow is a symptom of overuse (and therefore not an acute condition such as an accident) in the attachment area of the wrist extensors, i.e. an enthesopathy or tendinopathy of the lateral epicondyle of the humerus. (Epicondylopathy humero-radialis). The diagnosis is mainly made clinically, by means of provocation tests, and possibly by imaging means. Treatment itself is primarily conservative, but “validated” surgical measures exist for refractory cases. It is interesting that a change of tennis racket, an adjustment of the grip thickness or an improved stroke technique are the most effective “treatment methods”.
The golfer’s elbow
Like tennis elbow, golfer’s elbow affects the medial epicondyle. That is, in this case we are also dealing with an attachment tendinopathy, this time it is the wrist flexors and pronators and the finger flexors, all of which are fixed with a common attachment at the medial elbow; these are highly stressed structures in golf, as in many other activities. Grip technique seems to play a role here. Often, athletes with golfer’s elbow have never held a golf club in their hands. For example, we also find this condition in climbers (“Climber’s Elbow”) and in baseball players (“Pitcher’s Elbow”, in children so-called “Little League Elbow”). Diagnosis is largely clinical, e.g., palpatory and with movements against resistance of the examiner such as wrist flexion or wrist pronation. Treatment is conservative for the time being, by refraining from pain-producing loads, or is carried out with physiotherapy – first pain-relieving, then building up with training of the affected muscles. The infiltrations (corticosteroids, PRP) are frequently used. Surgical debridement with possible decompression of the adjacent ulnar nerve should be chosen only as ultima ratio.
The ski thumb
In the case of a ski fall with an open hand, the ski pole and its loop can cause a brusque movement in the metacarpophalangeal joint of the thumb, with an outward (radial) bending. The result is an injury to the inner ligament (lig. collaterale ulnare), which can tear partially or completely. An initial complication occurs when the torn ligament gets under the aponeurosis of the m. adductor pollicis (so-called stener lesion). This circumstance is an indication for surgery. In certain cases, bony avulsion occurs at the base of the first phalanx. The diagnosis is clinical, not always very easy, even with the help of sonography. Treatment may well be conservative, but consistent: immobilization in splint for four to six weeks. In cases of clear instability, surgery is appropriate.
The runner’s knee
The incidence of running-related health disorders is high, with figures ranging from 20% to 85% reported in the literature. In other words, 2.5 to 5.8 faults per 1000 running hours must be expected. The fact that the knee joint is frequently affected is not surprising. The term “Runner’s Knee” actually refers to all overuse symptoms related to the knee, i.e. femoro-patellar syndrome including. chondropathia patellae, plica syndrome (irritation of a plica synovialis, usually medial = plica medio-patellaris) and “ilio-tibial band friction syndrome” (tractus ilio tibialis, so-called rubbing syndrome). In the German-speaking world, runner’s knee predominantly refers to tractus syndrome.
“Jumper’s Knee”
Whether it is during the jump or the landing, the knee extensor apparatus is generally heavily stressed, especially the four attachments: Pina iliaca antero inferior, proximal patellar pole, patellar apex and tuberositas tibiae. While in the growing age mainly the first and the fourth enthesis react, in the adult it is primarily the patellar tip that is affected by these heavy loads. In German-speaking countries, this is referred to as patellar tendinitis. Diagnosis is simple (patient’s information, local findings), but treatment is persistent. It is mostly conservative, surgical solutions are described.
“Tennis Leg”
During a tennis match, running onto a stop ball perfidiously played by an opponent can result in a knife-like pain below the back of the knee in the inner calf area: a strain, or in scientific terms, a muscle tear. The muscle most commonly affected is the caput mediale of the m. gastrocnemius. The muscle tear is a serious injury, which is not very difficult to diagnose, but must be treated with system: Classic first aid measures (ice, compression, the vein compression stocking has proven very effective), relief with sticks, as well as physiotherapy – first passive, then increasingly active (muscle building). Of course, this injury can occur in other sports with a similar mechanism. The term tennis leg is also used.
“Footballer’s Ankle”
The plantar and dorsal flexions of the upper ankle joint, which are always repeated during football play, can lead to morphological changes in the ventral part of the joint, a so-called talus nose and osteophyte-like protrusions on the tibia. These bony structures, in turn, promote entrapment symptoms in this anterior joint segment with corresponding pain and dysfunction. Therapy ranges from conservative to surgical, the latter with removal of the bone tracks and capsular thickening.
Those who study sports medicine more closely and follow the Anglo-Saxon literature will discover a few more similar terms such as “biker’s knee,” “swimmer’s knee,” “gymnast’s wrist,” “boxer’s knuckle,” or “turf toe,” possibly others related to sports with which we are less familiar. But be careful: these terms are only collective terms and require a precise diagnosis.
HAUSARZT PRAXIS 2016; 11(12): 3-4
