Author: Michael Ranger

Rhabdomyolysis

Rhabdomyolysis
Rhabdomyolysis is a serious condition characterized by breakdown of skeletal muscle. In young
athletes it is most commonly caused due to overexerting the muscles. Extreme muscle overuse
can damage the muscle tissue, breaking it down, which causes the release of a muscle protein
called myoglobin into the bloodstream. A big influx of myoglobin is toxic to the kidneys which
can block it’s filtration system leading to kidney complications. The severe muscle damage can
also cause an extremely high level of electrolytes to accumulate into the bloodstream which can
cause serious complications to vital organs including the heart.
Common causes:
● Trauma or crush injuries eg car accident
● Extreme muscle exertion
● Prolonged immobility
● Infections
● Muscle hypoxia
● Genetic disorders
● Body-temperature changes
● Drug or alcohol abuse
● Metabolic and electrolyte disorders
Common signs and symptoms:
● Muscle pain – the most common muscle groups affected are the calves and lower back
● Muscle weakness or stiffness
● Dark coloured urine due to excessive myoglobin levels
● Flu-like symptoms
● Elevated creatine-kinase level
Management:
● Urgent medical management is recommended initially which may include treatment to
manage electrolyte imbalances and intravenous fluids to help maintain urine production
and prevent organ damage.
● It is important to adequately hydrate, retain range of motion and avoid overexertion to
prevent creating more muscle breakdown.
● Physiotherapy management will often include rehabilitation to regain range of motion,
muscle strength, and full function to assist in progressing back to physical activity.

 

Staff Profile – Matilda Wayte

Matilda Wayte

 

Matilda is a qualified Exercise Physiologist, who is passionate about improving people’s lives through movement and physical activity. Graduating from QUT in 2018, Matilda initially plied her trade in Brisbane before joining the Mackay team in Sep 2021.
Matilda’s love for human movement came from 15 years as a Gymnast where she competed at a national level on a twice. Nowadays Matilda stays active by playing team sports or exploring the beautiful local Queensland mountains and beaches.
Believing that everyone should be able to enjoy the benefits of physical activity no matter their age, gender, or condition, Matilda works with all her patients to tailor an exercise program specific to their goals. Matilda is also currently studying Neurological rehabilitation at ECU and has a particular interest in Clinical Pilates, Hydrotherapy, Mental health, Women’s health, and Chronic disease management.

Exercise Physiologist Matilda Wayte

Wrist injury series – Scapholunate dissociation

Scapholunate dissociation

What is it

An injury involving a stretch or tear of the scapholunate ligament which can affect the way the
scaphoid and lunate bones interact.

Mechanism

Often occurs when a person experiences a fall onto an outstretched hand where the wrist is
forced into a position of hyperextension and ulnar deviation which causes a stretching or tearing
of the ligaments between the scaphoid and lunate. Distal radius fractures are often associated
with scapholunate dissociation.

Clinical presentation

● History of a fall onto an outstretched hand
● Pain/clicking on the dorso-radial aspect of the wrist
● Reduced grip strength
● Tenderness 2cm distal to Lister’s tubercle on the radial side of the lunate
● Tenderness in the proximal end of the anatomical snuffbox
● Watson test: either painful or reveals dorsal movement of the scaphoid
● X-ray while gripping an object is useful for diagnosis

Management

● For incomplete tears where there is no instability of the scapholunate joint,
splinting/casting to immobilise the joint may be required
● Taping to improve stability
● Avoiding aggravating activities
● Regaining pain-free movement and strength through joint mobilisation and strengthening
exercises
● For complete tears specialist opinion is recommended as surgical intervention may be
required

Wrist injury series – TFCC injury

TFCC irritation

What is it?

Triangular Fibrocartilage Complex (TFCC) is a cartilage structure that lies between the ulna and
carpus. The function of the TFCC is to act as the main stabiliser of the distal radioulnar joint.

TFCC anatomy

Mechanism

Often injured in forced ulnar deviation or falling on an outstretched hand. Common in racquet or
stick sports and those that create repetitive ulnar and compressive loading including
gymnastics, weight lifting, boxing and surfing. TFCC injury should be investigated following a
distal radius fracture and wherever distal radioulnar joint (DRUJ) instability exists.

Clinical presentation

● Ulnar sided pain that worsens with grip, rotation and weight bearing
● Clicking sensation on wrist movement
● Point tenderness between the pisiform and the ulnar head
● Reduced grip strength
● Pain on resisted wrist extension and ulnar deviation
● Positive foveal sign = sharp pain with deep palpation
● Positive press test = reproduction of pain when lifting own weight up off a chair using the
affected wrist
● MRI imaging is useful for diagnosis of these injuries

Management

● Avoiding aggravating activities
● Avoiding repetitive wrist movements and trying to keep wrist in a neutral position where
possible
● Short period of splinting
● Tape to offload the TFCC
● Stabilisation exercises particularly involving ECU and pronator quadratus instability as a result of a complete ligamentous rupture often requires surgery as soon as possible.

Jersey Day 2021

Jersey Day is all about raising awareness – there is no requirement to raise funds. Jersey Day is fun, it’s free and by registering to become an organ and tissue donor you could be helping to save a life.

WEAR YOUR FAVOURITE JERSEY, HAVE SOME FUN AND START A CONVERSATION ABOUT ORGAN DONATION

Each Jersey Day we ask schools and workplaces across Australia to allow students and employees to wear their favourite sporting jersey to school or work and begin the conversation with their family and friends about the importance of becoming an organ and tissue donor. Jersey Day was inspired by the gift of life that Nathan Gremmo (pictured) gave to six people when he became an organ donor at age 13.

#donatelife #jerseydayau

Jessica, Max and Tom wearing their jerseys with pride.

Finger injury series – Trigger finger

Trigger finger

What is it:

A condition where a finger or thumb becomes painful and difficult to straighten. In severe cases the finger may get stuck in a bent position.

 

 

Mechanism:

The precise cause of trigger finger is still unknown however repetitive finger movements such as occupations requiring extensive gripping, prolonged writing or grasping of small tools or objects are possibilities. This can cause thickening and narrowing of the space the tendon responsible for bending the finger travels through. This can cause the tendon to get caught in the space when straightening or bending the finger.

 

Clinical presentation:

  • Finger stiffness and swelling especially in the morning
  • Pain and poor movement in the finger
  • A clicking or catching feeling in the finger
  • Finger locking or clicking in a bent position, which suddenly pops straight
  • Finger locking in a bent position and inability to straighten.

 

Management:

  • Activity modification
  • Custom thermoplastic splinting to prevent the friction caused by the tendon movement most commonly at the metacarpophalangeal joint (joint between the palm and finger)
  • Home exercises to improve strength and range of motion.

Finger injury series – Swan-neck deformity

Swan-neck deformity

What is it:

Deformity of the finger characterised by hyperextension of the middle finger joint and flexion of the fingertip.

 

Mechanism:

Initially caused by damage to the attachment of the finger extensor tendon which may be due to a traumatic laceration, avulsion fracture from a direct blow to the fingertip while finger is straight or due to weakening of the tendon caused by inflammatory disease e.g. rheumatoid arthritis.

 

Clinical presentation:

  • Swelling and stiffness of finger joints
  • A difficulty in flexion at the middle finger joint
  • A snapping sensation may also occur during flexion.

 

Management:

Non surgical:

  • A custom thermoplastic extension block splints to correct hyperextension at the middle finger joint.
  • A progressive thermoplastic extension splint can help improve the fingertip flexion deformity.
  • Passive stretching.

Surgical:

May be indicated for severe or long-standing deformities as these will not likely achieve true correction without surgery.

 

Prognosis:

Some degree of deformity or limitations in range of motion are common.

Finger injury series – Boutonniere deformity

Boutonniere deformity

What is it:

Deformity of the finger characterised by hyperextension of the fingertip and flexion of the proximal interphalangeal joint.

 

Mechanism:

Can be caused by the extensor tendon of the finger being severed due to trauma or tearing/weaning of the extensor tendon due to an injury or condition e.g. rheumatoid arthritis.

Most often it is due to a forceful blow to the top side of a bent middle finger joint.

 

Clinical presentation:

  • Loss of extension at the middle finger joint and hyperextension at the fingertip.
  • A weak grip
  • Inability to grasp and manipulate small objects with the top of the finger.
  • Swelling and pain.

 

Management:

Non surgical:

  • The creation of a custom thermoplastic splint that will hold middle finger joint into extension full time for around 6-8 weeks. When full extension of the joint can be maintained throughout the day progress to night splinting.
  • Thermoplastic splinting of the fingertip into slight flexion may be indicated.
  • Exercises can be gradually incorporated after splinting to improve range of motion and strength.

 

Surgical:

May be indicated when the deformity results from rheumatoid arthritis, the tendon is severed, a large bone fragment is displaced from its normal position or the condition does not improve with splinting.