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Family Health Magazine - Fall/Winter 2000

The 5 Most Common, Undetected Sports Injuries 

That nagging little pain in your ankle that never quite goes away may indicate something more serious than a sprain.

"There are a variety of sporting injuries that are frequently overlooked or misidentified," reports John Z. Shumko, M.D., Ph.D., Medical Director for the Sports Medicine Institute and Comprehensive Rehabilitation Center at the Saint Barnabas Ambulatory Care Center. "When trying to diagnose an injury, it is important that the physician and patient are willing to look beyond the obvious to identify some commonly missed conditions."

Following are descriptions of the five most common, undetected sports injuries and comments from Dr. Shumko and Edward Decter, M.D., Leonard Jaffe, M.D., and Frederick Gordon, M.D., orthopaedic surgeons and members of the Executive Council of the Saint Barnabas Sports Medicine Institute. H. Mahmood Cheema, M.D., Section Chief of orthopaedic surgery at Saint Barnabas Medical Center, is also a member of the Executive Council.

1. Achilles Tendon Rupture:
This injury occurs when the tendon is partially or completely separated. Misdiagnosed up to 25 percent of the time as a strain, sprain or lesser injury, an Achilles tendon partial rupture can initially manifest with little pain or pain so severe that the patient has difficulty walking. This injury occurs frequently in those who play racket sports requiring quick turns.

Typically, a patient will remember a sudden pain in the heel or calf, and possibly a "popping" sound in the area. The hallmark of this injury, says Frederick Gordon, M.D., orthopaedic consultant for The New Jersey Ballet Company, is that it does not heal on its own over time and may even worsen. To properly diagnose an Achilles tendon rupture, a physician must do a physical examination to check for gaps or painful areas in the Achilles tendon and the ability for the injured person to plantar flex (point the foot downward). In doubtful cases, an MRI may be required to confirm the diagnosis. To heal, this injury may require surgical repair and casting, followed by extensive rehabilitation.

2. Concussion:
A jarring of the brain, called a concussion, may result in loss of or altered consciousness. Many athletes suffering from a concussion may refuse to leave the game or not report the injury, while others may continue to play because they do not realize the injury has occurred. An undiagnosed concussion can lead to a slow brain bleed, especially if the player has a previous history of concussion. Because of the higher potential for this injury in sports such as football and hockey, health professionals must perform Sideline Evaluations with standardized concussion assessment.

After a collision with another player or a surface, a physical exam should be done to check basic reflexes and coordination and to look for dilation of pupils or eyes that cannot follow light. A cognitive exam would require the player to repeat a variety of information, such as numbers in a series. A memory task would check for loss of short-term memory by having the player repeat something back over a short period of time. The assessment should be repeated in 30 minutes and compared. Players suspected of having a concussion need to see a physician immediately.

3. Anterior Cruciate Ligament Tear (ACL):
The most common knee injury, an ACL tear occurs when the ligament is stretched beyond its limit and creates a hazardous situation where the ligament can be torn. ACLs are commonly misdiagnosed as sprains or collateral ligament knee strains, says Leonard Jaffe, M.D., a team physician for a professional New Jersey hockey team, especially if swelling of the surrounding knee muscle occurs, which makes diagnosis more difficult.

This injury occurs most frequently among soccer, football and lacrosse players because of the hard turns and fast stops these sports require.

After the initial swelling has gone down, a Lachman Test may be performed to determine if an ACL tear has occurred. This test, done by a physician, flexes the injured knee to check for looseness. If an athlete with an ACL tear continues to play, he or she risks tearing the cartilage and/or complete dislocation of the knee. This injury most often requires surgical repair and extensive rehabilitation, says Dr. Jaffe.

4. Scaphoid Fracture:
The scaphoid, a wrist bone, can be found in the triangular groove between the base of the thumb and the index finger. Fractures to this area, which are often incorrectly identified as sprains, can occur from a fall onto an outstretched hand during a sport such as skiing or basketball. This injury mimics the symptoms of a sprained ligament or tendon -- pain and sensitivity -- but unlike a sprain, this injury does not heal over time or with rest.

Persistent pain may signal a scaphoid fracture. If this injury is left untreated, the fracture may not heal and the patient may experience loss of function at the wrist, says Edward Decter, M.D., team physician for the NY/NJ MetroStars. Through the use of a bone scan, the injury can be determined and if a scaphoid fracture is found, surgery may be required.

5. Femoral Neck Stress Fracture:
The head of the bone in the thigh or hip region, called the femoral neck, is prone to stress fractures that are sometimes difficult to diagnose. This injury is commonly found in runners who have recently increased the speed, length or intensity of their exercise. Women are more susceptible to these stress fractures, possibly due to the angle of the femoral neck, Dr. Shumko says.

People with a femoral stress fracture may notice a vague pain in the groin or thigh region that increases during a workout and grows in intensity over time. Initially, it may mimic a strain or tendinitis. This injury does not go away with the use of anti-inflammatory medication, hot or cold compresses or stretching. A bone scan may be required to determine if a fracture has occurred. If left untreated, joint destruction can result. Treatment includes a modified training program that includes aquatic therapy and also eliminates weight-bearing exercise.

"All of these injuries can produce varying degrees of pain and disability and the sooner they are diagnosed, the better the outcome," says Dr. Shumko.

For an appointment at the Sports Medicine Institute and Comprehensive Rehabilitation Center at the Saint Barnabas Ambulatory Care Center, call (973) 322-7330.

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