Sports Injuries and Arthroscopic (Keyhole) Surgery

This is partial or complete tearing of muscle fibres during sudden stretching or acceleration. It most often affects the hamstrings, calf or groin muscles. Athletes commonly describe 'something snapped, like a whip striking', followed by pain and weakness when contracting the muscle.

Tears are graded: partial fibre damage usually improves with rest, controlled loading and gradual strengthening; complete ruptures and avulsions from the tendon-bone junction may require surgery. Reinjury risk rises markedly with an early return, so the decision is based on examination and strength testing rather than the calendar.

A sprain stretches the ligaments holding a joint together beyond their tolerance. It most often affects the outer ankle ligaments, followed by the medial knee ligament and the fingers and toes. Swelling, bruising and tenderness around the joint are typical.

Mild and moderate sprains are usually treated without surgery: brief protection, swelling reduction and then balance and strength work. However, giving way, continued inability to bear weight after the first day or recurrent sprains warrant assessment for ligament damage and accompanying cartilage or bone injury. For knee ligament injuries, see anterior cruciate ligament (ACL) injury.

A tendon is a strong structure connecting muscle to bone. Repeated loading can disrupt its structure (tendinopathy); pain initially improves after warming up, then may persist throughout training. Achilles, patellar and shoulder tendons are commonly affected in athletes.

The foundation of treatment is not simply reducing load but reorganising it appropriately: eccentric strengthening, reviewing technique and equipment, and gradual progression. Painkillers and physiotherapy are supportive. For foot and ankle tendons, see foot and ankle conditions; for shoulder tendons, see shoulder conditions.

A direct blow causes bruising of muscle and subcutaneous tissues; vessel damage causes blood to collect within tissue (haematoma). Swelling, warmth and subsequent colour change occur. Most blunt injuries settle on their own.

Rapidly increasing swelling, pain worsening out of proportion to the impact, a tense area and numb or cold fingers may indicate an emergency (compartment syndrome). Attend the nearest emergency department without delay.

It is fluid accumulation and an inflammatory response within bone, detected by MRI rather than X-rays. It often signals excessive loading, repetitive microtrauma or joint-surface damage and causes deep, persistent pain worse with weight-bearing.

Treatment prioritises temporarily reducing load, investigating causes such as alignment, training errors, cartilage damage and vitamin D or calcium status, and returning gradually. Bone marrow oedema is a finding, not a diagnosis; planning depends on its underlying cause.

Tissue deteriorates when it lacks time to repair the effects of loading. Rapid increases in training volume, changes in surface or footwear, technique errors, inadequate sleep and poor nutrition are common triggers. Pain develops gradually, initially only after exercise, then begins to limit performance.

Treatment for this group is almost entirely non-surgical: managing load, improving movement quality and addressing strength and flexibility deficits. Continuing through pain is the most common reason these injuries become chronic.

These are fine cracks in bone caused by repeated loading rather than one impact. They most often affect the tibia, metatarsals and heel bone. Pain is localised, tender to finger pressure and worsened by running.

X-rays may be normal in the first weeks; MRI is requested if suspicion remains. Treatment generally involves unloading and a gradual return to activity; surgery may be needed in certain areas, such as around the hip or the fifth metatarsal, because of non-union risk. Menstrual irregularity, low energy intake and bone density are assessed together in female athletes; the osteoporosis page provides further information on bone health.

This is pain around the kneecap, particularly downhill, on stairs and after prolonged sitting. Usually several factors contribute rather than one structure: hip and thigh muscle imbalance, foot alignment, sudden distance increases and technique.

Treatment is non-surgical: strengthening the hip external rotators and quadriceps, adjusting running volume and reviewing footwear and surfaces. If pain is accompanied by locking or giving way inside the knee, meniscal and ligament injuries must be distinguished; see meniscal tear for details.

PRP and similar biological procedures may be considered for selected tendon and joint problems in athletes as part of a non-surgical plan. The level of evidence varies by injury type; some applications remain under investigation and are not suitable for every patient. For competitive athletes, the product must also be assessed for compliance with anti-doping regulations. For a comparison of methods, see regenerative and non-surgical treatments and PRP treatment.

Arthroscopy is surgery performed through small incisions using a camera and fine instruments inside a joint. It is planned for conditions such as meniscal tears, anterior cruciate ligament rupture, rotator cuff tears and shoulder impingement when non-surgical treatment has not helped or the type of tear requires surgery from the outset. The procedures performed in each joint are described on the relevant condition pages: meniscal tear, anterior cruciate ligament, rotator cuff tear and shoulder impingement syndrome.