Sports medicine is a medical speciality that focuses on the prevention, diagnosis and treatment of injuries related to physical activity and sport.
Traumatology is the branch of medicine that deals with injuries and trauma caused by accidents, falls or impacts.
Treatment varies according to severity, from immobilisation to surgery.
consultation
The biceps is a muscle that allows the elbow to flex and supinate (used to turn a key in a lock, for example).
A rupture of this tendon can occur when the elbow is flexed against too much resistance (eccentric flexion). This injury may be partial or complete. It mainly affects men in their forties.
Clinically, during this movement against resistance, a snapping sound may be felt, associated with a sharp pain in the biceps. Visually, the biceps muscle retracts and an asymmetry is visible in relation to the shape of the biceps of the other arm (known as the Popeye sign). A haematoma may also appear.
Complete rupture of the distal biceps results in a 40-50% loss of strength in supination and a 30% loss of strength in flexion.
The diagnosis is mainly clinical. An MRI is also prescribed to assess the % of tendon rupture (in the case of partial injury), to evaluate tendon quality and to document the degree of retraction. In order to optimise analysis of the biceps tendon, this MRI must be performed in a specific elbow position (flexion and supination).
Treatment depends on the patient's age and functional requirements. Partial injuries are usually treated conservatively. In the case of a complete rupture in a young patient, surgical treatment is necessary, preferably within 2-3 weeks of the trauma. The longer the delay between the trauma and surgery, the more the tendon will retract. This will prolong recovery time and reduce the potential for healing. Postoperatively, in the case of a rupture with a highly retracted tendon, it is possible to retain residual stiffness with a slight extension deficit of the elbow.
A rupture of this tendon can occur when the elbow is flexed against too much resistance (eccentric flexion). This injury may be partial or complete. It mainly affects men in their forties.
Clinically, during this movement against resistance, a snapping sound may be felt, associated with a sharp pain in the biceps. Visually, the biceps muscle retracts and an asymmetry is visible in relation to the shape of the biceps of the other arm (known as the Popeye sign). A haematoma may also appear.
Complete rupture of the distal biceps results in a 40-50% loss of strength in supination and a 30% loss of strength in flexion.
The diagnosis is mainly clinical. An MRI is also prescribed to assess the % of tendon rupture (in the case of partial injury), to evaluate tendon quality and to document the degree of retraction. In order to optimise analysis of the biceps tendon, this MRI must be performed in a specific elbow position (flexion and supination).
Treatment depends on the patient's age and functional requirements. Partial injuries are usually treated conservatively. In the case of a complete rupture in a young patient, surgical treatment is necessary, preferably within 2-3 weeks of the trauma. The longer the delay between the trauma and surgery, the more the tendon will retract. This will prolong recovery time and reduce the potential for healing. Postoperatively, in the case of a rupture with a highly retracted tendon, it is possible to retain residual stiffness with a slight extension deficit of the elbow.
DISTAL BICEPS RUPTURE
TRICEPS RUPTURE
The biceps is a muscle that allows the elbow to flex and supinate (used to turn a key in a lock, for example).
A rupture of this tendon can occur when the elbow is flexed against too much resistance (eccentric flexion). This injury may be partial or complete. It mainly affects men in their forties.
A rupture of this tendon can occur when the elbow is flexed against too much resistance (eccentric flexion). This injury may be partial or complete. It mainly affects men in their forties.
© Arthrex
FRACTURED CLAVICLE
The clavicle is the only bone that connects the thorax to the upper limb. It acts as a real ‘suspension bar’ and thus withstands a great deal of stress. The scapula and humerus (the arm bone) are held together mainly by muscles.
Fractures of the clavicle are common and, in most cases, can be treated conservatively (immobilisation in an orthopaedic waistcoat followed by gradual rehabilitation).
However, surgical treatment becomes necessary when the fracture shows significant displacement or multiple fragmentation.
The choice of surgical technique depends on the location of the fracture:
- Diaphyseal fracture (in the central part of the clavicle): This type of fracture generally has an excellent prognosis and recovery is faster.
- Distal fracture (in the lateral part of the clavicle, which articulates with the scapula): When the fracture affects this area, the ligaments stabilising the clavicle may be damaged. In these cases, the surgical technique and rehabilitation programme must be adapted.
This type of fracture can also lead to long-term complications, such as osteoarthritis.
Bone healing takes an average of three months, but may take slightly longer for a distal clavicle fracture. During this period, it is advisable not to carry heavy loads.
The removal of osteosynthesis material (plates, screws, etc.) is not systematically necessary and should only be considered at least 1.5 years after the operation, in order to reduce the risk of a new fracture.
© Arthrex
Fractures of the proximal humerus are very common. It is the 3rd most common fracture in patients ≥ 65 years of age. This type of fracture is more common in women, as they are more prone to osteoporosis.
The fracture may be associated with dislocation of the glenohumeral joint and, more rarely, with neurological damage to the axillary nerve (traction injury linked to dislocation).
Diagnosis is made on the basis of X-rays. In cases where it is difficult to accurately assess the degree of displacement of the various fracture fragments, a CT scan may be necessary. However, this is not always recommended.
In most cases, treatment is conservative with 4-6 weeks of orthopaedic waistcoat (depending on the type of fracture) and progressive physiotherapy. Initially, physiotherapy is used to restore mobility. Only then is muscle strengthening introduced.
Bone consolidation (healing of the fracture) takes 3 months. It is therefore advisable not to carry any weight during this period.
In the case of significant displacement, surgical treatment is indicated. The type of surgery depends on the type of fracture, the patient's age and bone quality. When bone quality is sufficient, fixation of the fracture (called osteosynthesis) using a centromedullary nail or plate is indicated (the implant is chosen according to the type of fracture). In the case of advanced osteoporosis, an inverted total shoulder prosthesis may be indicated.
The complications, whether the treatment is conservative or surgical, are: joint stiffness (which is systematically transient at the start of treatment. However, 100% mobility of the shoulder cannot always be regained, and a slight loss of mobility may persist), callus (meaning that the fracture is consolidated but with a deformity in relation to the normal anatomy of the shoulder), and failure of the fracture to consolidate (also known as pseudarthrosis).
In the case of surgery, the additional risks are: infection; and in the case of osteosynthesis-type surgery, discomfort from the material (which can be removed 1.5 years after surgery, but only in the event of significant discomfort) and avascular necrosis of the humeral head (in the event of very significant displacement of the fracture, the blood vessels in the bone may be damaged and cause sequelae despite fixation of the fracture).
In cases of avascular necrosis, radiological monitoring is required for 2 years postoperatively and may necessitate removal of the osteosynthesis material. In the most severe cases, a 2nd stage prosthesis is required.
fracture of the proximal humerus
© Arthrex
This is the most common fracture of the elbow. It usually occurs when the hand is dropped with the arm outstretched.
When the fracture is not too badly displaced, it requires only a very short period of immobilisation. To avoid long-term stiffness of the joint, mobilisation of the elbow (by the patient and physiotherapy) is started very soon after the trauma. Conservative treatment is possible in the majority of cases.
When the fracture is significantly displaced, surgery is indicated. The type of surgery will depend on the severity of the fracture and any associated lesions (30% of cases).
It should be noted that whatever the type of treatment, there is a risk of osteoarthritis in the long term.
When the fracture is not too badly displaced, it requires only a very short period of immobilisation. To avoid long-term stiffness of the joint, mobilisation of the elbow (by the patient and physiotherapy) is started very soon after the trauma. Conservative treatment is possible in the majority of cases.
When the fracture is significantly displaced, surgery is indicated. The type of surgery will depend on the severity of the fracture and any associated lesions (30% of cases).
It should be noted that whatever the type of treatment, there is a risk of osteoarthritis in the long term.
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radial head fracture
Olecranon fracture
This type of fracture is less common than radial head fractures, but more disabling, and usually requires surgery.
It generally occurs when the elbow is bent after a fall. The patient experiences severe pain and difficulty in extending the elbow. Clinically, the tip of the elbow is displaced upwards
(because it is pulled by the triceps muscle) and active extension is limited or impossible.
Different types of osteosynthesis exist depending on the type of fracture (number and size of fragments). Post-operatively, the elbow is immobilised in a plaster cast with progressive mobilisation. The osteosynthesis material may be removed after 1 year post-operatively, if the patient is uncomfortable (as the material lies just under the skin in this anatomical area and may cause irritation or discomfort).
In patients aged ≥ 75 years, clinical studies have shown that surgery (osteosynthesis) has poor results (secondary displacement of the osteosynthesis material due to reduced bone quality, non-union, skin pain linked to the presence of osteosynthesis material in an area where the skin is more fragile, infection). This is why, after a certain age, conservative treatment using a cast can be instituted.
This type of fracture is associated with a long-term risk of osteoarthritis.
It generally occurs when the elbow is bent after a fall. The patient experiences severe pain and difficulty in extending the elbow. Clinically, the tip of the elbow is displaced upwards
(because it is pulled by the triceps muscle) and active extension is limited or impossible.
Different types of osteosynthesis exist depending on the type of fracture (number and size of fragments). Post-operatively, the elbow is immobilised in a plaster cast with progressive mobilisation. The osteosynthesis material may be removed after 1 year post-operatively, if the patient is uncomfortable (as the material lies just under the skin in this anatomical area and may cause irritation or discomfort).
In patients aged ≥ 75 years, clinical studies have shown that surgery (osteosynthesis) has poor results (secondary displacement of the osteosynthesis material due to reduced bone quality, non-union, skin pain linked to the presence of osteosynthesis material in an area where the skin is more fragile, infection). This is why, after a certain age, conservative treatment using a cast can be instituted.
This type of fracture is associated with a long-term risk of osteoarthritis.
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