4 minute read
Polodoc: Double Impact, Triple Trouble
from Polo Times
by Edit
Dr.med. Andreas Krü ger is a Swiss board orthopaedic and trauma surgeon in Zurich, who specialises in knee and shoulder surgery. Andi is a second generation of tournament doctors for equine sports, known as Polodoc since 2013 and affiliated with Polo Park Zurich
Double Impact, Triple Trouble
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Restarting riding and playing polo after a minor injury can be fateful when the initial injury is underestimated, and diagnostics tools are used too late. In professional sport teams, mostly maximal diagnostics are used on the injury day or within 24 hours to fully assess all dimensions of morphological damages. The precise identification of potential failure points can be crucial for the sport and can prevent on-going impairment and delayed recovery, to full function or secondary chronic disability.
Injury Mechanism
Relatively minor medical injuries like a tendinitis or partial rupture of the insertion of the adductors (riding muscle) can majorly limit your polo performance when the stable A-frame is at risk and movements out of the middle of the saddle are painful. Not being able to hold that powerhouse in a stable position can lead to non-stoppable imbalance with an increased risk of leaving the horse unintentionally. With that increased risk, the chance of injuring the upper extremity while landing is immensly increased.
Diagnostics
Most polo clubs have some kind of medical staff, which provides basic medical care for tournaments or club events when a fall occurs. Due to the fact this basic care is trained for treating life-threating emergencies, initial minor injuries can be under-estimated or stay undiagnosed. In some cases a medical therapist like the physiotherapist or chiropractor recommends diagnostics after an unsatisfactory or delayed result due to conservative treatment. Initial body checks
by the general practitioner or family doctor who is unaware of critical polo injuries can mean that the impact of these relatively small injuries can be under-estimated. Secondary assessments of bone and soft tissue after a physical examination need more and more cumbersome referral to a radiological department when ultrasound or x-ray diagnostics are outsourced. In case of dissonance of clinical symptoms and basic radiological results, early cross-sectional diagnostics can be key for correct evaluation and interpretation of the underlying injury.
Case Study
In this case, the initial injury was an adductor injury on the left leg with a partial tear of the insertion. This is a very painful injury to the most important muscle for the polo player when stability in the saddle is needed. Initial diagnostics were done with conventional X-ray where no relevant injury of the bone was stated by the radiologist. Secondary cross-sectional imaging with MRI was recommended but refused by the player. While recreational riding a secondary fall happened with a hard impact to the ground and landing in the ‘superman position’ with impact to the left shoulder and side of the
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Pelvis MRI: The MRI reveals any fractures of the pelvic ring (Pic 1/2) and a injury of the adductors left (Pic 3) 2
pelvis. MRI diagnostics of the shoulder and the pelvis revealed a high-grade partial muscle and tendon injury of the rotator cuff and a pelvic ring fracture with involvement of the hip joint.
Recommendation
Primary minor injuries can open the door to tremendous impairment and a delayed return to play when initially under-diagnosed or evaluated with basic examinations by general care providers. Early cross-sectional imaging will help to improve a tailor made recovery plan. Continuous follow up with a specialised medical team and maybe the help of wearables can be a turbo speed step in full recovery to play polo.
For more information on Polodoc contact Andreas Krü ger at drmedkrueger@gmail.com or www.polodoc.ch
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Expert Opinion for Musculoskeletal Imaging PD Dr.med. Nadia Mamisch-Saupe
Swiss medical board certified radioligist Radiology Klinik Hirslanden Zü rich Switzerland
Musculoskeletal imaging is widely available and primarily used in sport trauma to detect injuries of bone fractures as well as ligament or muscle injuries. The widespread use of radiological departments makes conventional X-rays easy to obtain but the interpretation can be tricky due to technical or intellectual restriction. In the case of non-displaced fractures (fracture lines) of the bone or minor injuries like bone bruises only a sensitive crosssectional imaging (CT or MRI) can deliverer the required information on the radiological picture. In particular, the MRI is powerful in detecting acute soft tissue or tendon injuries like avulsions on the bony insertion. The MRI is the gold standard when damages are in a combination with under-diagnosed bone injuries in conventional X-rays. Delayed cross-sectional imagining in musculoskeletal trauma can be cumbersome and misleading when secondary posttraumatic arthritic joints are examined. In complicated polytraumatised or pre-injured/operated cases a musculoskeletal expertise is recommended to minimise misleading diagnosis.
Tel: +41 44 387 26 31 Fax: +41 44 387 26 35 Clinic Email: radiologie.hirslanden@hirslanden.ch Direct Email: nadja.mamisch@hirslanden.ch Radiologie Klinik Hirslanden, Klinik Hirslanden. Witellikerstrasse 40, 8032 Zü rich Schweiz
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