Dr.RAJAT JANGIR Professor & Head Senior Consultant Arthroscopy and Joint Replacement (Specialist in Shoulder Knee Hip Surgery) 67/34 Mansarovar Jaipur Appointment: +91 8104855900 Email: ligamentsurgeon@gmail.com https://www.shoulderkneejaipur.com/ Professor Department of Sports Medicine MG Hospital, Jaipur ============================================================ * Vast experience and specialisation in the field of Arthroscopy and sports surgery. * M.S. orthopaedics from BJ Medical College, Civil hospital, Ahmedabad * Fellowship in Arthroscopy and Sports injury with Prof Joon Ho Wang at Samsung Medical Center, South Korea * Shoulder Surgery (Madrid, Spain) * Diploma in Sports Medicine from InternationaI Olympic Committee * Invited as Athlete Medical Doctor at Rio Olympic 2016 * Done Rajasthan's first "All Inside Physeal Preserving ACL reconstruction" in 13 year old Athlete Rated as one of best orthopedic surgeon with excellence in Knee Shoulder Arthroscopy & Joint replacements'

1. SPORTS INJURIES :
CURRENT DIMENSIONS
Dr.RAJAT JANGIR
SHOULDER KNEE SPECIALIST ORTHOPAEDIC SURGEON
CONSULTANT AND DIRECTOR
SHOULDER & KNEE SURGERY CLINIC
JAIPUR

2. SPORTS FOR HEALTH

3. But for some people—particularly those who overdo or who
don’t properly train or warm up—these benefits can come at
a price: sports injuries.

4. SPORTS INJURIES
ATHLETIC ACTIVITIES EXERCISING TRAINING

5. EPIDEMOLOGY
Age 5-14 Age 15-24 After age 25
playground or engaged in
"general exercise,”
high school and college,
team sports become
common-basketball-soccer,
and football injuries
less common and people
become more likely to hurt
themselves generally
working out, running,
biking

6. Knee injuries (55%) > Shoulder > Ankle
The most common injuries are
— strains or sprains (41%),
— broken bones (20%),
— bruises or superficial injuries (19%)

7. India: Data Sparse
Journal of Athletic Enhancement: Prevalence of Sports Injuries in Adolescent Athletes Ieleni Sreekaarini, KMC Manipal

8. SPORTS INJURY PATTERN IN SCHOOL GOING CHILDREN CHANDIGARH

9. ACUTE SPORTS INJURIES
The ‘immediate’ cause may seem obvious
ü but sports medicine clinicians think beyond the ‘immediate cause’

10. ACUTE SPORTS INJURIES
▪ Acute ankle sprain
▪ Acute knee injury (ACL)
▪ Acute hamstring strain
▪ Acute low back injury

11. ACUTE INJURIES
— The key is to think about the cause…but not just the immediate cause
OVERTRAINING
SUBOPTIMAL PROPRIOCEPTION/NEUROMUSCULAR CONTROL
REGIONAL MUSCLE IMBALANCE
PREVIOUS INJURY NOT FULL REHABILITATED
LACK OF SKILL!
IMPAIRED EYESIGHT OR POOR VISION

12. CHRONIC SPORTS INJURIES
Chronic’ injuries may be ‘recurrences’ or ‘overuse’ type injuries
They provide an even larger array of ‘upstream causes’

13. CHRONIC SPORTS INJURIES
— Stress fracture (of the tibia)
— Achilles tendinopathy
— Osteoarthritis

14. CHRONIC SPORTS INJURIES
STRESS FRACTURE
Biomechanics (technique)
Overtraining
Nutrition
Footwear

15. CHRONIC SPORTS INJURIES
TENDINOPATHY
Biomechanics (technique)
Overtraining
Genetics

16. CHRONIC SPORTS INJURIES
Osteoarthritis
Previous ACL injury
Obesity
Meniscal surgery
Genetics

17. FRENCH GYMNAST SAMIR AIT SAID SNAPPED HIS LEG DURING A
POMMEL HORSE

18. AUSTRALIAN JAVELIN THROWER KIM MICKLE DISLOCATED HER RIGHT SHOULDER

19. ANKLE SPRAIN

20. GERMAN GYMNAST ADREAS TOBA

21. ROLE OF PHYSICIAN
— Diagnosis and Treatment
— Team Leader
— Decision Maker Return to Play
— Educator, Advisor
— Advocate & Confidant

22. PREVENTION
Primary
• Avoidance of
injury ( eg-
safety
helmets)
Secondary
• Early
diagnosis and
treatment
once the
injury has
occurred
Tertiary
• Rehabilitation-
to reduce and
correct any
deformity

23. PRIMARY PREVENTION-

24. — >100,000 ACL Injuries/Year
— NonModifiable: Anatomical Environmental Hormonal
— No single risk factor
Mandelbaum, B.R., et. al. Effectiveness of neuromuscular and proprioceptive training programin
preventing the incidence of ACL injuries in females athletes. AJSM 2005
Griffin, L.Y. et al. Non-contact anterior ligament injuries:risk factors and preventative strategies.
J Amer Acad Orthop Surg 2000
ACL INJURY

25. — 70% ACL injuries are non-contact
— Most common biomechanical factor straight hips and knees, as well
as flat feet during landing.

26. Injury prevention program focus on
ü Balance
ü Eccentric Strength
ü Proper Mechanics
ü Flexibility
overall reduction of severe ACL injuries from 72 –89%.

27. uAssessment of injuries
ØABC
ØTOTAPS
uTreatment of injuries
ØPRICER
ØNo HARM
Treatment

28. ABC
— Airway
— Breathing
— Circulation

29. TOTAPS
u Talk
u Observe
u Touch
u Active
u Passive
u Skills

30. Initial treatment of injuries
PRICER
— Protection
— Rest
— Ice
— Compression
— Elevation
— Referral

31. Protection
— Take player away from field to avoid further injury as soon as possible

32. Rest
— Remove player from field
— Rest injured area
— Immobilize area
— Why?
Ø Reduces further tissue damage
Ø Reduces blood flow
Ø Allows for full assessment of injury

33. Ice
— Ice bag, pack
— Ice water bath
— 15 mins/ 5 times a day
— Why?
Ø Cool the area which constricts blood vessels, reduces blood flow and
fluid leakage, less swelling, pressures and pain

34. Compression
u Compress injured area with
u Elastic bandage
u Cohesive bandage
u Move distal to proximal
u Why?
ØExternal pressure reduces fluid leakage and bleeding into tissues
ØProvide support the area

35. Elevation
— Elevate area above height
— Why?
Ø Reduces bleeding as blood has to flow up hill
Ø Gravity helps swelling to move towards lymph nodes

36. No HEAT
— Includes
— Hot packs
— Spas
— Saunas
— Why?
Ø Increases blood flow to area therefore increases swelling

37. No ALCOHOL
— Includes most things adults enjoy after a game of sports
— Why?
Ø Thins blood which increases swelling
Ø Less pain felt therefore more damage caused
Ø Adds toxins to already injured area

38. No RUNNING
— Includes running as well as any exercise that is painful
— Why?
Ø Increases in tissue damage
Ø Overload to other area as compensation

39. No MASSAGE
— Rub down
— Massage
— Mobilizations
— Why?
Ø May increases tissue damage
Ø Increases blood circulation to the injured area

40. Summary
ü Diverse range of ‘causes’
ü Understanding ‘cause’ may influence treatment and prevention
ü No simple way to identify what the relative ‘mix’ of causes is for one
particular injury
ü In clinical practice, think about the range of options and treat

41. COMMON SHOULDER PROBLEMS
YOUNG PATIENT
SHOULDER DISLOCATION
SLAP tear
IMPINGEMENT
BICEPS TENDINITIS
FRACTURE

42. SHOULDER DISLOCATION
• MOST MOBILE
• ANTERIOR
INFERIOR
• YONGER THE AGE

43. SHOULDER DISLOCATION

44. RECURRENT DISLOCATION
POSITION PORTALS 3

45. SHOULDER DISLOCATION
BANKART LESION BANKART REPAIR

46. ARTHROSCOPIC BANKART REPAIR
3 MONTHS RESULTS

47. Posterior
Shoulder
Dislocation

50. SLAP TEAR Thrower’s Shoulder

51. SLAP tear
BICEPS TENODESIS
3 MONTHS REHAB

52. BICEPS TENDONITIS
• Pain in the front of the shoulder and weakness are common
• Sports — particularly those that require repetitive
overhead motion, such as swimming, tennis, and baseball
• MRI USG
• Rest Ice NSAIDS
• USG guised steroids
• Physical therapy

53. BICEPS TENDONITIS
— Refractory: Bicipital Tenodesis

54. ADVANTAGE OF ARTROSCOPIC
SURGERY
— SMALLER INCISIONS
— MINIMAL SOFT TISSUE TRAUMA
— LESS POST-OPERATIVE PAIN
— FASTER HEALING TIME
— LOWER INFECTION RATE

55. ROTATOR CUFF DYSFUCTION

56. RC TEAR SYMPTOMS
• WEAKNESS IN SHOULDER
• PAIN IN SHOULDER
• SEVERE NIGHT PAIN

57. ROTATOR CUFF TEAR
RAJ
AT

59. ROTATOR CUFF REPAIR
RAJ
AT

61. TEAM EFFORT

70. CONTACT
WEBSITE
WWW.SHOULDERKNEEJAIPUR.COM
BLOGS
WWW.MYSHOULDERKNEEEXPERT.IN
HELPLINE
8104855900