All of our specialists deal with sports and trauma conditions. To find out about them click here
Total Orthopaedics offers a multispecialty service, six days a week to ensure we diagnose and treat urgent sports injuries and accidents that lead to unfortunate fractures of any bone in the body, dislocation of joints, torn ligaments, muscles and tendons. Sports such as cycling, tennis, golf, running, football and rugby can cause injuries or fractures and our team of specialists are skilled in treating them all to get you back to enjoying life and sport again.
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 fracture.
- 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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.