Musculoskeletal Sports Injuries – Treatments

Dr Jannoun is a UK certified Musculoskeletal Ultrasonographer and trained for two years at the University of Bournemouth before attaining a Diploma in Musculoskeletal Ultrasound with merit in 2008. Ultrasound guided injections are free from radiation and Xray and ultrasound is a quick, efficient, and accurate evaluation of soft tissue. Painful areas can be easily located and confirmed with the patient during examination. It allows side to side dual comparison of symptomatic/asymptomatic limb and increases the success rate of procedures (British Journal of Sports Medicine. November 2008; 42(11):572-576). It also helps to minimise the risk of damage to nearby structures and can capture real-time- structure movement and relationships in the shoulder, knee, and ankle. Ultrasound is useful for guiding injections and allows replication of procedures requiring accuracy of needle placement and infiltration of drugs into a focused target area. It causes no health problems and may be repeated as often as is necessary if medically indicated and unlike the strong magnetic field of MRI, ultrasound is not affected by cardiac pacemakers.

photo of Dr. Jannoun carrying out an ultrasound to a patient's shoulder.

Joint pain is often due to overloading of the joints during sport or work related activities or due to osteoarthritis. Local Infiltration with corticosteroid is the traditional method that works but causes temporary weakening and 50% tend to relapse. An alternative to using corticosteroids is the use of a drug called Ostenil. This a solution containing hyaluronic acid. It works by restoring the normal balance between the breakdown and production of hyaluronic acid. This effect of Ostenil means that it can decrease pain and stiffness and improve the other symptoms of osteoarthritis. It contains no animal proteins, which means it is very unlikely to cause an allergic reaction. Ostenil has been given to thousands of patients and has not been found to cause any serious side effects. The exact make-up of hyaluronic acid in Ostenil has been carefully chosen so that it is as effective as possible in treating osteoarthritis. Joint Lubricants (click to download patient information leaflet) 

(In lumber and sacroiliac instability, discogenic pain, whiplash injury, and recurrent ankle sprain) Ligaments help to provide stability in the joints. Sometimes ligaments can be overstretched, or even torn. The ligament may then not control the joint adequately – thus leading to ‘instability’ which may put abnormal stresses on the joints. Sclerosant injections (Prolotherapy) work by stimulating the body to make new fibres which are laid down within the substance of the ligaments, thickening and strengthening them. Each ligament has to be stimulated 3 or 4 times at intervals of a week, in order to produce sound fibrous development. Hence the injections are given as a course of treatment. Prolotherapy Patient Leaflet (click to download)

Traumeel is a homeopathic blend of numerous plant and mineral extracts with known healing properties and is a popular treatment for soft tissue injuries including muscle, ligament, and tendon injuries. In professional athletic circles, there is great demand and respect for this therapy. The treatment is appealing because of its immediate effects combined with a low side effect profile compared to steroid injections and anti-inflammatory medications. In the bodies attempt to repair itself, the inflammation phase can be excessive and prolonged, which delays and disrupts healing. By neutralizing the balance of inflamed cells called “cytokines”, Traumeel restores a balance of inflammation to facilitate healing. Injected into tendons, ligaments, muscle, and joints, under ultrasound guidance to ensure precise placement. The frequency of treatment is dependent on the extent of the patient’s condition, and ranges from 1-2 injection sessions on a weekly to bimonthly basis. Most patients notice an immediate response after the first injection, though sustaining this improvement may require repeated injections.

Nitrate patches containing glyceryl Trinitrate (Minitran 5®,1.25-2.5mg/24hrs) have found its use in tendon injury treatment. The application of the patch over the affected painful tendon increases the level of nitrous oxide (NO donor) found in healing tendons. Tendon healing is reduced when nitrous oxide is blocked. These patches are applied daily for at least 4-6 weeks and are helpful in treating tennis and golfers elbow as well as Achilles tendon pain.

High Volume image guided Injections (HVIGI) for chronic Achilles tendinopathy. In the case of ongoing Achilles and Patellar tendon pain, ultrasound imaging often highlights abnormal vessels that have grown into the tendon in response to repetitive strain and abnormal healing of tendon injury. The procedure involves injecting a large (40-50mls) volume of solution containing local anaesthetic, normal saline, and a small dose of hydrocortisone (hence the term high volume distension) around the tendon in the area of new vessel development (neovascularisation). These vessels are surrounded by nerves that cause ongoing local pain. Studies have shown that by injecting the high volume solution around the vessels and surrounding nerves, HVIGI significantly reduces pain and improves function in patients with resistant Achilles tendinopathy in the short- and long-term.

A Western scientific approach de-activating painful trigger points in shortened, tense muscles responsible for myofascial pain. It involves the insertion of acupuncture needles into the tight bands and knots of muscle, releasing energy and reducing the local spasm. Beneficial following whiplash injury, back pain, calf pain, and tennis elbow.

Among the many causes of groin pain is the hip joint and all of the conditions that can affect it. Often the clinical presentation in patients with groin pain is mixed. If a patient’s groin pain is entirely relieved by a hip joint injection (diagnostic block), even temporarily, then an anatomical diagnosis is made. The patient will then need further investigation to make an accurate assessment of the hip joint pathology. Hip pain can however also be due to traumatic or degenerative arthritis. Injection into the hip joint under X-ray guidance with a corticosteroid solution or a course of Ostenil can help relieve the pain and improve joint mobility.