Professional sportsmen and women rely on rapid, accurate assessment and treatment of injuries to allow them to regain match fitness and return to the field at the earliest opportunity.
At Harlequin FC rugby club, point-of-care ultrasound complements physical examination as an aid to diagnosis, as team doctor Courtney Kipps explained. Harlequins is an English Premiership rugby union team based in Twickenham. The club’s medical team needs to ensure that the pool of players available for selection on match days is as large as possible. This not only involves maintaining the current health and fitness of the players, but also their treatment and rehabilitation after injury. Dr Courtney Kipps, Harlequins team doctor since 2011, explained:
“An important part of sports and exercise medicine is the diagnosis and monitoring of musculoskeletal injuries, and ultrasound technology provides valuable information to help a more rapid recovery.”
Harlequins has invested in point-of-care ultrasound systems for use in the clinic and at the pitch side, which gives the medical team the flexibility to use ultrasound imaging wherever and whenever it is needed. This helps them to establish the true extent of an injury more rapidly, allowing medical advice to be tailored to that specific injury, and enables reassurance to be offered when the problem is not as bad as first thought. Courtney continued:
“I am part of a large medical team comprising of doctors, physiotherapists, osteopaths and other soft tissue therapists that attend matches to look after any acute injuries that occur. Rugby is a hard-hitting contact sport, and players suffer a lot of interesting and challenging injuries that need to be assessed quickly. A few years ago, we invested in a portable ultrasound machine – a Sonosite Edge – that we can take to matches for use at the pitch side. We also have a Sonosite X-Porte in the clinic, which is available for use whenever we need it during the week, when we have more time on our side. These systems are a valuable addition to the clinical examination tool box. Ultrasound provides a different perspective on the assessment of an injury, giving doctors and physios an insight into the player’s anatomy and any tissue damage, while patients benefit from a visual explanation of their injury. Ultrasound imaging is extremely useful for the assessment of swollen joints, as well as acute injuries such as haematomas, and tendon and ligament tears, and chronic injuries such as tendinopathies.”
Real-time imaging not only allows the extent of an injury to be more accurately identified, but also offers some prognostic information of the likely rehabilitation period. Professional rugby players, like other professional sportsmen and women, are always keen to continue training, and it can be very useful to be able to show the patient the exact nature of the injury. Ultrasound can also provide assurance that an injury has fully healed following rehabilitation.
“Players typically want to return to full sporting activity as soon as possible – whether it's good for them or not! Our role as a medical team is to ensure that players who have been sidelined are as strong and fit as possible before they return to the pitch, reducing the chance of secondary or recurrent injuries. During the recovery phase, ultrasound imaging may be used to monitor the progress of an injury or to evaluate why an injury is not improving as quickly as we would like it to. It is extremely useful to be able to show the injury to the player, as it gives them an appreciation of the potential severity of the situation and helps generate an understanding of their physical limitations.”
Another area of sports and exercise medicine where ultrasound is particularly beneficial is the injection of anti-inflammatory medications to reduce swelling and inflammation. Historically, these injections have been performed blind, relying on physical examination and an understanding of anatomy. However, there is always some risk of incorrect needle placement with this technique, and the use of ultrasound guidance is standard practice today. Courtney continued:
“Ultrasound guidance allows injections to be performed confidently and effectively. The position of the needle can be seen, giving complete confidence in the precise placement of the injection. We chose our first system, an Edge, for its portability, image quality and robustness. In a rough and ready environment at the side of a rugby pitch, you need to know that your system will withstand unintentional knocks and the Sonosite systems, including the transducers, are drop tested to demonstrate their robustness. The X-Porte is ideal for the clinic, offering extremely detailed images. It is also very user friendly, which has the benefit of allowing me to focus on the patient, rather than the ultrasound system."
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