Foot & Ankle
The foot and ankle can be at risk of injury due to impact when accidents occur or playing sports. Fractures of the foot are common and can be easily treated by our foot and ankle team. Our consultants are extremely experienced in sporting and traumatic injuries using non-surgical and surgical intervention, to get you back on your feet enjoying life.
Achilles Tendon Injury
The Achilles Tendon is the large tendon that connects your heel bone to your calf muscle. Problems with the Achilles is associated with sports and can range from pain when training which may be inflammation of the tendon or to a more significant injury which is a torn or ruptured Achilles. Symptoms apart from pain or stiffness when training is swelling at the area. When rupture occurs, a sudden sharp pain is sometimes felt along with a loud snapping noise, followed by difficulty in walking with significant swelling and bruising appearing. Diagnosis consists of consultation, examination with diagnostic tests such as an ultrasound or MRI. If rupture has occurred a simple examination is enough to diagnose.
- For Achilles Tendonitis, conservative treatment is recommended. A combination of physiotherapy, change or reduction in training, anti-inflammatory medication, ultrasound guided injection and/or shockwave therapy to the tendon. Recovery period can range between 4-12 weeks.
- Surgery is the more preferred option for Achilles rupture. The reasons are that a surgical repair gives a better functional outcome with less risk of re-rupturing the tendon and a shorter recovery period. Surgery involves connecting the two torn ends together and recovery usually involves a plaster cast or boot in the initial post-operative period. Physiotherapy is important in the recovery phase to strengthen the surrounding muscles and tendon and you should be back to walking and jogging at 3 months.
- Treating an Achilles Tendon rupture non-operatively involves elevating the heel and fixing the position in a plaster cast or boot to allow the tendon to heal naturally. Recovery takes longer with conservative treatment and there is an increased risk of re-rupture and weakness when playing sport. Physiotherapy is also needed in the recovery period and this can range between 3 and 6 months.
Ankle fractures are common in contact sports, when a severe twisting motion occurs in the ankle to break the bones along with jumping or landing incorrectly. Instant pain is felt from the fracture and significant swelling and bruising occurs almost instantly.
- Urgent diagnosis and treatment of an ankle fracture is important. X-rays are needed to aid diagnosis and a treatment plan.
- Conservative treatment such as plaster cast initially followed by physiotherapy and bracing is the usual treatment for a nondisplaced ankle facture.
- Surgery is only needed when the fracture is complex and displaced. Therefore, internal fixing with plates, screws or wires is necessary. Recovery period with a plaster cast initially for up to 6 weeks plus physiotherapy regime can range between 3- 6 months to get back to normal activity.
The ankle joint is supported by many ligaments on both sides that attach the foot and ankle to the leg. The cause of an ankle sprain is usually from a twisting motion or incorrect placement of the foot when playing sports, e.g. running or jumping. The ankle rolls either inward or outwardly and the ligaments supporting the ankle are stretched and/or torn. Symptoms include immediate pain, inability to weight bear and a popping or tearing sensation. In some severe cases, small pieces of bone can be torn off with the ligament or bones are dislocated and fractured. Some patients are at risk of having an unstable ankle joint from repetitive sprains.
- Non-surgical treatment is typically the usual management of a sprain. Rest, ice, compression and elevation should be the first phase immediately after the injury. Minor sprains should recover within a few days. However severe sprains should be examined by a specialist. X-ray and MRI are diagnostic tests that will enable the team to treat the affected ligaments and formulate a plan. A boot will be needed in the early stages to support the joint, along with physiotherapy management. Recovery period can range from 6-12 weeks.
- Surgical treatment is only needed if the joint is unstable and painful 6 months after injury. Following further diagnostic tests our foot and ankle team may advise arthroscopy of the joint or ligament repair surgery. The surgery involves repairing the affected ligaments and the recovery period involves wearing a plaster cast in the initial phase moving to a boot with physiotherapy. This period or recovery can take 6 weeks to weight bear and up to 3-6 months to return to normal sporting activity.
- Sinus Tarsi Syndrome, is associated with prior sprain injuries. Symptoms vary from typical sprain injuries and as instability/swelling is usually absent. X-rays are usually normal and the role of MRI is questionable. Diagnosis is confirmed with medical examination to find tenderness over the sinus Tarsi. Local anaesthetic and steroid injections offer relief and typically up to 3 injections over a period relieves the symptoms. Surgical management is only necessary if the injection treatment is not successful. Arthroscopy of the ankle would be advised in this case.
Stress Fractures are small cracks in the bone of the foot or ankle and are usually caused by overuse. Women are more at risk then men due to contributing factors such as osteoporosis or low oestrogen production which aids bone heeling. Risk factors contributing to stress fracture are;
- Increase in training
- High impact sports which are performed on hard surfaces e.g. tennis, football, running.
- Incorrect footwear or poor foot positioning when performing the sport.
- Osteoporosis or hormone imbalance that contributes to poor bone strengthening.
Most bones in the foot and ankle can be affected and symptoms are usually pain in the affected area when training or playing sports.
- To treat effectively a diagnosis is important. Recent stress fracture tends not to show up on x-ray until after 3 weeks of initial injury. Therefore, an experience consultant can diagnose from experience or with MRI.
- Rest is the best treatment for stress fractures. Therefore, a break from training for 6-12 weeks is recommended. A boot may also be prescribed to cushion the foot and ankle in the initial recovery period.
- Most stress fractures heal from rest; however some may need surgical intervention if the fracture has worsened but this is rare. Our foot and ankle team would advise the best surgical intervention depending on the location of the stress fracture.
Hip & Knee
The Hip and Knee joint are vulnerable to damage during sport, accidents or injuries from wear and tear. Our highly skilled hip and knee team combine their skills to ensure we offer the best treatment with non-surgical treatment and surgical management to get you back to enjoying life quickly.
Fracture of the Hip/Shin(Tibia)/Thigh(Femur)
Fractures can occur in the hip, shin (tibia) and thigh (femur). When accidents happen e.g. a fall from a height, or impact or sudden movement is made during contact sport e.g. skiing/cycling, then fractures in these areas can be the result. Osteoporosis is another condition that can factor into bone strength and density, therefore bones can be brittle and more at risk of fracture. Symptoms are immediate pain in the fractured area, swelling, inability to weight bear, leg deformity and in the severe cases the bone may have pierced the skin. Diagnosis includes x-ray along with medical examination.
- Conservative treatment, is possible for certain fractures. Depending on the location and alignment of the fracture the hip and knee team would advise non-weight bearing activities, plaster cast for tibia fractures or bracing for femur fractures. Physiotherapy will also be included in the recovery period which may range between 6-12 weeks to get back to normal duties.
- Surgery is advised when the fracture is severe and alignment of the bone will need surgical intervention. Internal and external fixation methods can be applied depending on the fracture. Some hip fractures may lead to a total hip replacement to ensure recovery and mobility for the patient. The recovery period can vary depending on the fracture and patient’s age and fitness level. Physiotherapy will also include in the rehabilitation phase and fractures that include surgical intervention will normally take 6 weeks for the patient to weight bear and 3-6 months to return to normal daily activities. All fractures are different and our hip and knee team are highly experienced in treating all trauma to the tibia, femur, hip and knee.
Ligament Injuries of the Knee
Anterior Cruciate Ligament(ACL)/ Posterior Cruciate Ligament(PCL)/ Medial Collateral Ligament(MCL)/Lateral Collateral Ligament(LCL)/Multiple Ligament Injury.
The Knee has many supporting ligaments surrounding the joint that is important for movement and is at risk of injury when playing sports. Twisting, jumping, leg rotation using poor techniques or where contact is made can cause partial or full thickness tears in the surrounding ligaments. Depending on the movement when the injury occurred will signify the location of the ligament injury. Symptoms range from a noise heard from the knee when injured, pain, inability to weight bear and instability in the joint, swelling and bruising. Consultation, X-rays and MRI will also be needed for a diagnosis.
- Conservative management is considered when the ligaments have been injured however will heal without surgery. Our knee team will assess with medical examination to identify the range of movement to consider non-operative treatment. Initial recovery phase advised is rest, ice, compression and elevation to help reduce the swelling and pain. Physiotherapy will be needed to improve movement and strength of the knee. Recovery period can range between 6-12 weeks.
- Surgery. All knee ligament repairs are usually performed as a knee arthroscopy. This procedure involves small incisions to insert a telescope and long instruments into the knee joint which reduces risk of infection and recovery time. During a knee arthroscopy, the torn ligaments are assessed, repaired and damaged tissue or debris is removed from the joint. Recovery period ranges between patients and complexity of the surgery, however most arthroscopic surgery can be a day case procedure. Physiotherapy is also part of the recovery and patients are usually weight bearing at 6 weeks, 12 weeks back to usual activity and at 6 months playing sports again.
- ACL reconstruction involves arthroscopic techniques and a graft to reconstruct the torn ligament. This graft may be taken from the patient’s tendon either from the hamstring or kneecap (autograft) or donated from another person’s tissue (allograft). Small incisions are made to access, remove and replace the torn ligament with the graft. Recovery with this procedure is gradual for those wishing to play sport again. Physiotherapy rehabilitation plays and important role to assess and improve range of motion for the joint and strengthen the surrounding muscles to support the knee. Patients should be weight bearing from 2-4 weeks, returning to normal daily duties and light exercise between 3-6 months. For contact sports recovery may take longer, however our knee team and allied physiotherapists will advise on your progress.
The Meniscus is a cartilage layer like shock absorber in the middle of the knee joint between the heads of the femur and tibia. Tears can occur during sport where a jumping action or sudden change of direction, knee twists. The older generation can also suffer from Meniscal Tears due to degeneration of the cartilage and an accident or fall can contribute to further injury. Symptoms include immediate pain from injury, swelling and the knee may lock due to the torn meniscus blocking flexion of the joint. Diagnosis includes consultation and MRI scan.
- Conservative management is recommended if the Meniscus Tears can heal without surgical intervention. Rest, anti-inflammatory medication, physiotherapy and injection therapy. Ultrasound guided steroid injection, Platelet Rich Plasmainjections are alternative therapies that can induce healing and prevent surgery. Please contact our team for more information on alternative treatment therapies
Surgery is needed when the Meniscal Tears are large or unstable. Repairing the Meniscus surgically involves a knee arthroscopy. This procedure involves small incisions to insert a telescope and long instruments into the knee joint which reduces risk of infection and recovery time. During the knee arthroscopy, the torn Meniscus is assessed, repaired and damaged tissue or debris is removed from the joint. Recovery period ranges between patients and complexity of the damage. Physiotherapy is also part of the recovery and patients are usually weight bearing at 2-4 weeks, 6-8 weeks back to usual activity and at 3-6 months playing sports.
Neck Strain (Back pain)
The spine is supported with muscled, tendons and ligaments. This supporting tissue can be injured or strained during sporting activities or caused by twisting/lifting and aggravated by poor posture and long periods working sitting at our desks. Back pain usually resolves after days/weeks with anti-inflammatory medication and only a small percentage of patients will need support from our spinal specialists. Back pain can signify a muscle/ligament strain and in some cases the muscle may spasm and cause intense pain and immobility for patients. Diagnosis includes medical examination, x-ray, ultrasound and/or MRI/CT.
- Conservative treatment includes physiotherapy, anti-inflammatory and muscle relaxation medication. Spinal injection(s) to control pain for other conditions such as arthritis e.g. nerve block, epidural, facet joint injections. Recovery period can range between 4-6 weeks.
- Surgery is only necessary if the back/neck pain/strain is related to Spondylosis or Fracture of the Spine.
Disc Herniation (Slipped disc)
The Vertebrae of the spine has 33 interlocking bones that form the spinal column. Each individual vertebra has a cushion of cartilage that allows the spine to bend and absorb impact. A disc herniation occurs when the inner part of the disc herniates through a split in the outer surface. Most disc herniations occur in the lumbar area, the lower part of the back. The cause of a slipped disc can be from a lifting or twisting injury, high impact sports or degenerative disease. Because the disc is herniating out of its outer layer and puts pressure on spinal nerve(s), the symptoms include pain in the area, nerve pain that continues through the buttocks and down the leg and in some cases leg weakness. This pain is referred to as lumbar nerve root pain (sciatica). Diagnosis includes consultation, medical examination, x-ray and/or MRI or CT.
- Conservative treatment is successful in many patients. Movement and light exercise is encouraged, along with physiotherapy rehabilitation and anti-inflammatory medication. Additionally, a spinal injection called a nerve root block may help relieve pain and assist with rehabilitation. Recovery period is up to 6 weeks.
- Surgery is necessary when conservative management has not improved symptoms. The primary surgical procedure is known as a Discectomy. This operation can be performed as an open procedure, however depending on the disc herniation our spinal team are skilled in key-hole surgery and will perform a Microdiscectomy. In these procedures, the bulging disc is removed carefully. Recovery time can vary depending on whether this procedure is key-hole or open. Patients who have a microsdiscectomy will recover more quickly. Initial recovery period starts as an inpatient in hospital and will vary between 1-2 days. Patients will be assisted on the ward with physiotherapy to be able to weight bear and walk. The wound will be checked at 2 weeks. Ongoing recovery includes physiotherapy for 4-6 weeks and returning to normal duties varies between patients however most patients are back to normal duties between 1-2 months. Spinal surgery does have risk and complications; therefore, our surgeons will guide you every step of the way to ensure you have all the information and support.
- Additional procedures may also need to be performed along with a discectomy. Specifically, a disc herniation in the neck our spinal team will perform an Anterior Cervical Discectomy and therefore will need to fuse two vertebrae together- Spinal Fusion. This procedure includes either using a bone graft either from the patient, a donor or artificial bone with plates/screws/cage to fuse in place. Disc replacement surgery may be another option for patients with a disc herniation. This is the same procedure as a discectomy however a disc prosthesis is inserted to support the vertebrae and replace the herniated disc. Recovery period with these additional procedures may take longer a little longer than advised above, however our spinal team will guide you to getting back to enjoying life.
Fractures of the Spine
Fractures of the spine can unfortunately occur from a sporting injury or accident such as falling from a height or vehicle accident. The cause is usually from direct impact and/or be related to degenerative disease e.g. Osteoporosis. Fractures can range between the front/back and either side of the spine and occur in any area from the neck down. Symptoms include pain at the site of the fracture, swelling and inability to weight bear or move the spine. Swelling around the site can cause pressure on the spinal cord and therefore fractures are needed to be diagnosed and treated urgently. Diagnosis includes medical examination, x-rays, CT/MRI.
- Conservative treatment- is dependent on the location of the fracture and if the vertebra(e) is stable and no risk of injury to the spinal cord. Many fractures of the spine can heal and the usual course of treatment is either a back brace or plaster cast for a period. Recovery can range between 6-12 weeks and physiotherapy is recommended once the fracture is stable.
- Surgery is necessary when the vertebrae is not stable and there is risk of injury to the spinal cord. In some cases, spinal fusion will be performed. This procedure includes joining two or more vertebrae together by either using a bone graft either from the patient, a donor or artificial bone with plates/screws/cage to fuse in place. Initial recovery period starts as an inpatient in hospital and will vary between 1-4 days. Patients will be assisted on the ward with physiotherapy to be able to weight bear and walk. The wound will be checked at 2 weeks. Ongoing recovery includes physiotherapy for 6-12 weeks and returning to normal duties varies between patients however most patients are back to enjoying life between 3-6 months
- Our spinal team are also highly skilled in other minimal invasive surgical procedures to treat spinal fractures. Vertebroplasty or Kyphoplasty are procedures performed under x-ray guidance and through a long needle. Bone cement is injected into fracture site (vertebroplasty) or a balloon is inserted (kyphoplasty) and inflated to create a space for injected bone cement to support the fracture. These procedures are low risk and very successful to treat certain spinal fractures. Recovery period is minimal and most patients are weight bearing and mobile the next day. Patients are encouraged to return to normal duties as soon as possible and limit contact sports and lifting for a period.
Elbow & Shoulder
Fractures of the Elbow (Humerus/Ulna/Radius)
Fractures of and around the elbow occur in the ulna and radius (bones in the forearm), radial head (end of radius just below the elbow), and in the lower or middle section of the humerus (bone which connects elbow to shoulder). These fractures are caused usually from a direct blow or impact when arms are outstretched to break a fall, e.g. cycling. Symptoms include pain, swelling, deformity of the arm, perhaps some numbness and inability to move or bend the arm. Diagnosis involves consultation and x-ray.
- Conservative treatment- some fractures may be treated without surgery and will need either splinting or to place the arm in a brace/sling. Conservative treatment is only recommended if the fracture has not caused the bone(s) to move out of alignment and will heal correctly from making the arm immobile. Recovery period can range between 4-6 weeks.
- Surgery- Is necessary if both forearm bones have been fractured, the bones are out of alignment/unstable or have been forced through skin. Surgery involves realigning the fractured bones with either plates/screws/pins or radial head replacement. Recovery period depending on the fracture(s) can take up to 6 weeks with the arm immobile in a sling/brace. Physiotherapy will be needed once the fracture has healed and the arm can be manipulated.
Elbow Tendon injuries/conditions (Tennis Elbow/Golfers Elbow/Flexor Tendinitis)
The tendons surrounding the elbow are susceptible to inflammatory conditions or what is known as elbow tendinopathy. Tennis elbow and golfers elbow are conditions relating to the tendons on the outside(tennis) and inside (golf) of the elbow, Flexor Tendinitis relates to the tendon in the forearm that continues down the arm through to the hand. The cause for all conditions is due to repetitive stress on the tendons surrounding the elbow and/or arthritis in the elbow joint. Symptoms include pain, tenderness on examination and the progression to weakness in grip strength of racquet or club. Diagnosis involves medical examination, x-ray and/or MRI.
- Conservative treatment- most elbow tendinopathies improve with rest and physiotherapy. In severe cases that do not improve with rest and prescribed exercises our elbow team would consider ultrasound guided steroid injection(s), extracorporeal shockwave therapy and other alternative remedies. Tendinopathies can be painful and not all patients respond in the same way, therefore a combination of treatment may be needed. Recovery period can be anything from 4 weeks- 3 months.
- Surgery- in the most severe cases our elbow team would only consider surgical intervention if conservative treatment has not resolved the symptoms. Surgery would include excision around the affected tendon and suturing any damage to the tendon. Recovery time can range between 4 weeks to 3 months and would include brace/sling and physiotherapy.
Fracture of the Shoulder (Collar bone/upper arm/shoulder blade)
Fractures occur in the collar bone (clavicle), upper arm (proximal humerus) and shoulder blade (scapula). The cause and location of the fracture would depend on the injury, whether relating to a sport e.g. cycling, rugby or high impact e.g. a vehicle accident. Symptoms include immediate pain over the fracture site, swelling, bruising and limited movement in the arm. Diagnosis includes physical examination, x-rays.
- Conservative treatment- is possible for fractures that are aligned. Therefore, the shoulder will be placed in a sling to ensure it is supported. Pain and anti-inflammatory is prescribed along with physiotherapy after the fracture has healed. Recovery period can range between 4-6 weeks.
- Surgery – is necessary if the fracture is not aligned and ‘displaced’ or there are fragments along with multiple fracture in surrounding bones. The surgery will involve plates and screws to fix the fracture and realign the bones. The shoulder will need to be in a sling for up to 6 weeks and physiotherapy will be needed once the fracture has healed. Recovery period can range between 6-12 weeks.
Glenoid Labrum Tear
The Labrum is tissue surrounding the socket part of the shoulder joint (Glenoid). A tear is caused by an injury such as dislocation, impact during sport/accident to an outstretched arm or repetitive shoulder movement in sports. Symptoms include pain when the arm is stretched over the head, catching or instability when the shoulder moves or an increase in immobility of the joint. Diagnosis includes consultation, x-ray and MRI.
- Conservative treatment- some Labrum tears can heal with initial rest from physical activity involving the shoulder joint, anti-inflammatory medication. Physiotherapy will be required to help rehabilitate the joint. Recovery period can range between 4-6 weeks
- Surgery- the surgical procedure(s) will depend on the extent of the labrum tear. Shoulder Arthroscopy is the procedure using a telescope inserted into the shoulder joint along with thin instruments that are used to improve the shoulder joint. The torn piece will be removed and any other structure repaired, e,g tendon, ligament to tighten the shoulder joint. Recovery period includes wearing a sling for 6 weeks and physiotherapy. From 6-12 weeks patients can resume normal daily activities and between 3-6 months back to enjoying life and playing sports
Rotator Cuff Tendonitis (Shoulder Impingement/Rotator Cuff Tear)
The Rotator Cuff refers to the tendons and muscles that holds the shoulder joint in place with the upper arm and shoulder blade. Other structures affect the rotator cuff and these include a bursa which is a sac that lubricates the rotator cuff and is positioned under the end of the shoulder blade (acromion). Inflammation of the tendons and bursa can occur, additionally the acromion can rub on the rotator cuff due to the narrowing caused by the inflammation of the surrounding tissues, bony lumps that may have formed or caused by degenerative disease. The rotator cuff tendons due to wear and tear and repetitive stress can be torn either partially or completely ruptured. Sports such as tennis and rowing, degeneration of the joint and age are contributing factors of these conditions. Symptoms include pain, weakness in the arm, difficulty with full range of movement of the arm. Diagnosis includes consultation by an experienced shoulder consultant with extensive physical examination. Diagnostic tests such as x-ray, ultrasound and MRI may also be needed.
- Conservative treatment is encouraged. This includes initial rest from sporting activity, anti-inflammatory medication, ultrasound guided steroid injection and physiotherapy to help strengthen and improve movement in the shoulder. Recovery period can range from 6-12 weeks depending on the condition.
- Surgery is necessary when symptoms have not improved with conservative treatment and it is difficult to carry out normal daily activities. Shoulder arthroscopy is a common procedure to treat many shoulder problems. Like arthroscopy of the knee and hip, a telescope is inserted into the shoulder joint and thin instruments are used to improve the shoulder joint. Rotator Cuff Repair will be necessary to join the torn tendons. Subacromial Decompression may be another procedure performed to treat shoulder impingement and this includes creating space around the rotator cuff. Removal of inflamed tissue, bony lumps/spurs and debridement of the shoulder joint may also be included. Recovery period can vary between patients and injury sustained. Patients will need to wear a sling to protect the shoulder when discharged from hospital. The wound will need to be checked in clinic after 2 weeks. Physiotherapy is necessary for the recovery and patients are usually back at work between 2-6 weeks and enjoying life and playing sports between 3-6 months.
The shoulder is the most commonly dislocated joint in the body. The cause of the ball and socket joint being dislocated is usually from an accident or sports injury when impact has occurred. The dislocation can additionally cause stretching and damage to the ligaments, tendons and muscles that stabilise the joint. Previous dislocation of the shoulder may cause ongoing instability of the shoulder joint due to damage to the surrounding tissues. Diagnosis includes consultation, physical examination, X-ray, MRI.
- Conservative treatment- initially the shoulder dislocation will need to be stabilised by manipulation and moved back into place. Anti-inflammatory/pain medication and a sling to protect the shoulder will be prescribed. Physiotherapy will also be necessary to help strengthen the joint. Ongoing instability may be difficult to manage conservatively and therefore surgery may be advised to prevent ongoing dislocations.
- Surgery that is needed is called shoulder stabilisation and is performed as a shoulder arthroscopy. This procedure uses a telescope is inserted into the shoulder joint along with thin instruments that are used to improve the shoulder joint. Shoulder stabilisation involves fixing the rim of the joint with absorbable tacks and ligament repair with tightening should this be necessary. There are some cases whereby the procedure may need to move to open surgery, however our shoulder specialist will advise on the likelihood of this. Recovery period includes wearing a sling for 6 weeks and physiotherapy. From 6-12 weeks patients can resume normal daily activities and between 3-6 months back to enjoying life and playing sports.