In this week’s column, our panel of experts answers your queries on issues like joint pains and muscle tears sustained during action.

Q: I’m a regular cricketer and specialise as an off-spinner. Recently, I’ve developed a pain and swelling in my index finger and middle finger joints. This hampers my bowling. Somebody said it is fingers arthritis. Please advise. –Usman Khalid.

A: With the short history you gave and keeping in mind your profession, there are some likely causes. What you need to do is to have an appointment with our hand surgeon, who will have a look and examine your hand, and advise you some temporary treatment to relieve your pain, while the workup is done to confirm the diagnosis.

Probably you are having partial ligament injury or some form of arthritis, which involves small joints of the hand. Once our hand surgeon has a look at your fingers you will likely to have some investigations to confirm the diagnosis, which may include CBC, ESR-CRP, RA factor, X-ray of the hand and probably an MRI to rule out ligament tear.

It is a walk-in clinic, so you don’t need a prior appointment or booking. Please let us know your queries and hope you get well soon.

Dr. Shahab Ghani

Q: I play cricket regularly. A fast bowler, I am 25 years old. While bowling in a match, I fell on the ground during my run-up and ended up with a number of bruises. My right knee was injured badly, and since then, a severe pain bothers me whenever I try to bowl. I need your help to suggest what to do? –Jameel Khan.

A: Dear reader, you have suffered a knee injury while bowling which commonly happens due to sudden twisting and turning of the knee. Injury during sports can damage bone as well as soft tissue structures inside the knee joint. There are many soft tissues in the joint in the form of ligaments and cartilage which usually gets injured. You are having pain during bowling which strongly suggests that there is an injury in your knee. It is advised that you hold extreme activity and get proper evaluation of your knee by a sports medicine specialist which includes complete examination of your joint and some radiological investigations.

Dr. Muhammad Sufyan

FCPS (Ortho) AO Fellow (Germany), Sports Medicine Fellowship (Singapore)

Assistant Professor | Department of Orthopaedic Surgery

Liaquat National Hospital &  Medical College

Q: While playing hockey, the opponent's hockey stick rammed into my right thigh. I was unable to continue the game, because of a sharp pain. I have been told by the doctor that my thigh muscle was ruptured. Is it a permanent injury? Shall I quit the game for good? I am 27 years old. –Anwer Ahmed.

A: Looking at the history and incident described it seems like a Quadriceps muscle tear.

The quadriceps muscle is a large and strong located just above the kneecap. It straightens the knee and can withstand tremendous force.

The main cause of a quad tendon tear is a direct blow during sports activities or a forced flexion of the knee.

There are several symptoms that indicate a partial or complete tear of the quadriceps tendon. These include:

• Inability to straighten the knee without assistance

• Inability to raise the leg and keep it elevated

• A visible gap or divot where the tear has occurred

• Acute pain

Diagnosis

MRI is the best modality to diagnose the severity of tear. Quadricep tendon measures 10 to 20 cm in length.

Grade 1: Strain, no tendon or muscle fibers are disrupted.

Grade 2: Partial tear or discontinuity of some muscle fibers and variable tearing/thinning of tendon

Grade 3: A complete tear of the tendon on MRI, is characterized by discontinuity of all fibers.

Treatment:

For partial/complete tears (grade 2/3) in the quadriceps tendon, the treatment may require surgical processes depending on severity.

In grade 1 the tear can be encouraged to heal naturally with the use of anti-inflammatory medication, knee braces, physical therapy and avoiding any athletic activities in acute phase that comprise of 3-5 days.

Strengthening exercises can begin gradually, preferably after 4 to 6 weeks of injury and should progress sequentially through isometric, isotonic, isokinetic, and functional exercises.

The usual goal for return to play is optimal fitness with a relatively low likelihood of recurrence of injury. Recommendations for return to play typically are based only on expert opinion.

Dr. Nasir Ahmed

MCPS (Surg), FCPS (Tr&Orth)

Consultant | Department of Orthopaedic Surgery

Liaquat National Hospital &  Medical College

Q: I play volleyball. I am 29 years. Last year while playing, I had an injury in my right thumb joint. The doctor dressed it with a bandage, and after six weeks I was told that all is ok with me. But, lately when I resumed playing the game, the severe pain in my thumb joint recurred, and a swelling is visible. Please suggest how to get rid of this situation. –Naseer Hassan.

A: Thank you for your query. From the history you provided it seems like an ulnar collateral ligament injury of the thumb. This ligament functions to keep the bone and muscle in perfect coordination for smooth functioning. It can be damaged due to unusual aggressive activities or over stretching. For the diagnosis we need history and physical examination of the patient in clinic and if that is non conclusive, we may need a simple xray or in some cases an MRI. But the problem has established treatment and can be dealt once diagnosed. For the time being avoid playing volley ball or other sports activities.

Dr. Shahab Afzal Beg

FRCS (UK), FRCS PLAST (UK), DIP PLAST (UK), CERT PLAST (UK), Fellow in Hand Surgery (UK)

(All the specialists on our experts’ panel are associated with Liaquat
National Hospital. Please send your queries at khalidhraj@gmail.com or Anjum.Rizvi@lnh.edu.pk.)

– Khalid Hussain