Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

Featured on Channel NewsAsia

Self Diagnosis of Sports Injuries

The principles of injury management rely on the premise that we know what we are treating. Diagnosis is the key to success. We must differentiate injuries such as ‘knee sprain’, ‘muscle strain’ and ‘bruises’ from the corresponding pathoanatomical diagnoses: ‘rupture of the anterior cruciate ligament’, ‘grade II muscle rupture’ or ‘intra-muscular haematoma’. In some cases, the diagnosis is obvious from the person’s history, symptoms, signs and clinical tests; in others an X-ray, MRI scan or second opinion from a general surgeon, rheumatologist or other specialist will be required. Even when the diagnosis is clear, opinions may vary as to the most appropriate treatment. There are consensuses and controversies that change over time and depend on routines, skills and resources. For example, an anterior cruciate ligament rupture of the knee can be treated with physiotherapy, with or without surgery, depending on the patient and other factors. With the rapid and improved access to information offered by the Internet, many patients like yourselves do your homework before they arrive at the sports clinic, although the material they find may need careful interpretation. The results of studies may be interpreted in different ways, depending on the quality of the study and the patients studied. For example, non-active patients who sprain their knee and rupture their anterior cruciate ligament do very well without surgical reconstruction, while a professional footballer’s career would be ended
without surgery. We need to know how best to read and understand the literature to reach an informed decision to the benefit of the injured athlete. Whilst researching beforehand on symptoms and their treatments seeks to aid the patient on their knowledge of the subject, it is still advisable to seek a specialist who can properly diagnose you.

With the technical wizardry available to healthcare professionals today, it is easy to forget the importance of hands-on skills. Clinical symptoms and signs, combined with a thorough history of the patient can, in the majority of cases, give a clear lead to the correct diagnosis, providing the professional knows how to test and what to ask. Leading questions are usually unsuccessful: simply asking the injured athlete to describe that happened and their symptoms is usually more fruitful. Diagnoses can then be confirmed with a clinical test, or perhaps an X-ray or scan, before treatment. Thorough inspection and palpation and passive and active mobility and resistance tests of dynamic muscle function, comparing the healthy and injured sides is also very important.

In a general clinical practice, examination of a knee or shoulder injury cannot, for practical reasons, take more than ten to fifteen minutes, which is sometimes inadequate. In a sports injury clinic like mine, we usually allow 30 to 45 minutes for the initial consultation, including the clinical examination. For most acute limb injuries, this is adequate but for chronic problems arising from over-use, two or more sessions may be required before a diagnosis can be reached.

The main, and most crucial, question to ask any injured person is: can you please demonstrate and describe, in your own way, what happened? Many athletes will be able to demonstrate and explain in such detail that they provide the diagnosis as if from the text book. Before rushing to carry out detailed specific tests, the doctor should evaluate posture and gait, look for signs of pain or discomfort and remember that most musculo-skeletal injuries to a limb or joint will reduce the athlete’s range of motion and control, which could cause muscle atrophy. Ask if the athlete has taken painkillers, which may blur your findings, and perform basic functional tests on the relevant part of the body.

Inspection and palpation of the injured area can identify signs of inflammation, such as oedema (swelling around the joint), effusion (fluid within the joint), tenderness, increased temperature, redness, impairment of function or bruising. Let the injured athlete demonstrate the movements that cause the problem. Muscle resistance tests can identify weakness or pain and should be done manually on all the relevant muscles, comparing the injured and non-injured sides. Joint laxity tests and specific injury tests are crucial for the diagnosis of many of the most common injuries. They are not always easy to perform and require years of training.

To make an appointment to have a diagnosis with us, please call us at +65 9724 1219 (24 hrs)

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