Sports Medicine

MULTIPROFISSIONAL TEAM

• Physiatry;
• Orthopedics;
• General Practice;
• Musculoskeletal Radiology;
• Physiotherapy;
• Strenght Coach;
• Psychology / Coaching;
• Nutrition.

METHODOLOGICAL BASIS

• Locomotor System signs and symptoms;
• Biomechanics and Kinesiology;
• Therapeutic Exercise;
• Movement Analysis;
• Minimally Invasive Techniques.

1st Phase

• Diagnosis;
• Functional Assessment;
• Planning Intervention,

2nd Phase

• Rehabilitation;
• Performance;
• Prevention;
• Conservative Medical Treatment;
• Surgical Treatment.

DIAGNOSIS

MEDICAL ASSESSMENT

CARDIOVASCULAR RISK ASSESSMENT
 

IMAGIOLOGIC DIAGNOSIS

Imagiologic evaluation has impact on diagnosis and treatment of sports injuries.

• X-ray;
• High resolution ultrasound;
• CT;
• Arthro-CT;
• MRI;
• Arthro-MRI.

WHAT TO ORDER? 

1. Basic exam: Radiography;
2. Soft tissue injuries: Ultrasound or MRI; 
3. Fractures (diagnosis and follow-up), biometric studies: CT;
4. Stress injuries (diagnosis and follow-up): MRI;
5. Internal derangements of joints: MRI (or arthro-CT / MRI-arthrography);
6. Negative Radiography and Ultrasound: MRI.

ULTRASOUND (US)

• Superficial structures;
• Muscle and tendon - 30% of sports injuries;
• Muscle injury: diagnosis, follow-up and detection of complications;
• Dynamic study, sonopalpation;
• Contralateral comparison;
• No ionizing radiation.

ARTHRO-MR 

• MR after intra-articular contrast injection;
• Capsular distension;
• Main indications: 
  • Shoulder and hip labral pathology;
  • Rotator cuff;
  • Osteochondral lesions and intra-articular loose bodies;
  • Intrinsic wrist ligaments and triangular fibrocartilage;
  • Post-operative meniscus evaluation.

GFI FUNCTIONAL ASSESSMENT

20 Functional tests

• 10 Mobility & Stability;
• 10 Strenght & Coordination.

Physical Limitations

• Functional Deficits;
• Lost of Joint Mobility.

WHEN TO ORDER?

1. Diagnostic doubt; 
2. Temporal pressure - correct diagnosis and prompt initiation of appropriate treatment;
3. Provide the athlete visual evidence of the injury - improve treatment adherence;
4. Decision: Conservative vs. Surgical treatment;
5. Failure of conservative treatment.

RADIOGRAPHY (CR

• Basic examination (two perpendicular planes), special incidences;
• Bone fractures, degenerative changes.

COMPUTED TOMOGRAPHY (CT)

• Excelente resolução para estruturas ósseas;
• Caracterização de fracturas complexas e complicações de fracturas;
• Reconstrução 3D;
• Alterações discais e ósseas da coluna vertebral;

ARTHRO-CT 

• CT after intra-articular contrast injection;
• Evaluation of articular cartilage surface, meniscus, labrum;
• Alternative to MR;
  • Higher spatial resolution and anatomical detail;
  • Less tissue resolution.

MAGNETIC RESONANCE (MR)

• Excellent tissue resolution;
• Good spatial resolution;
• Most complete technique - bone, cartilage, ligament, tendon, meniscus, muscle, synovial...

TREATMENT

PAIN MANAGEMENT

Minimally invasive techniques

• Through interest and progressive investment in Image Guided Techniques, namely Ultrasound and Fluroscopy Guided Techniques, which allow for a greater cohesion between clinical and image analysis. This in turn leads to a greater  precision in the injection, which translates into an increase in the effectiveness, profitability and doctor - patient - treatment compliance.

FLUOROSCOPY GUIDED TECNHIQUES

Anesthetics Blocks / Corticoanesthetics

• Lumbar Facet Joints;
• Lumbar Transforaminal Epidural;
• Hip.

Viscossuplementation

• Joints.

REHAB AND PERFORMANCE

• Therapeutic Exercise;
• Joint Mobility;
• Functional Training;
• Strenght Training;
• Isoinercial Training.

ULTRASOUND GUIDED TECNHIQUES

Anesthetics Blocks / Corticoanesthetics 

• Joints;
• Peri-articular;
• Soft Tissues;
• Trigger Points / Miofascial Syndrome.

Platelet Rich Plasma (PRP)

• Tendon and Ligament ; Muscle and Joint.

Viscosuplementation

• Joints.

Dry Needling / Mesotherapy / Prolotherapy 

• Soft Tissues.

Botulinic Toxin 

• Miofascial Syndrome;
• Peripheral Nerve Block.

Barbotage

• Calcificant Tendinopathy.

High Volume Injection

• Adhesive Capsulitis:
• Mid Portion Aquilles Tendinopathy.

INJURIES PREVENTION

• Injury Prevention Program (including pre-competion).

SURGICAL TREATMENT

Treatment of sports trauma and overuse injuries through arthroscopic, mini-invasive and classical approach.

FOOT AND ANKLE:

• Insertional and not insertional Achilles tendinopathy;
• Haglund disease;
• Lateral ligament instability;
• Tibiofibular syndesmosis instability;
• Peroneal tendinopathy and instability; 
• Anterior and posterior impingement;
• Osteochondral lesions.

SHOULDER:

• Glenohumeral instability and lesions of the long head of the biceps brachiallis;
• Subacromial conflict;
• Rotator cuff tendinopathy and ruptures.

KNEE:

• Patellofemoral instability;
• Anterior cruciate ligament rupture;
• Meniscal tears;
• Cartilage injury.

FUNCTIONAL PACKAGES

1 - MEDICAL EVALUATION

• Medical Appointment;
• GFI Functional Assessment;
• Cardiovascular Risk Assessment.

3 - SPORTS PERFORMANCE OR PREVENTION

• Medical Appointment;
• GFI Functional assessment;
• Performance program:
  • 24 sessions (3 months);
  • 48 sessIons (6 months);
• Follow-up.

2 - FUNCTIONAL REHABILITATION PACKAGE

• Medical Appointment;
• GFI Functional Assessment;
• Therapeutic exercise program:
  • 4 sessions (2 weeks);
  • 8 sessions (4 weeks);
  • 12 sessions (6 weeks);
• Follow-up - Appointment.

4 - JUNIOR PERFORMANCE PACKAGE (<18y.)

• Medical Appointment;
• GFI Functional assessment;
• Strenght and stretching program:
  • 8 sessions (1 month);
  • 24 sessions (3 months);
• Follow-up - Appointment.