Ultra Sports Wimbledon Latest - November

Our Ultra Sports Clinic in Wimbledon remains a busy hub of activity, and we're dedicated to staying at the forefront of patient care. Part of that commitment involves tracking the trends we see and digging deep into complex cases. Here’s a look at what’s been happening at our Wimbledon clinic this month.

Key Takeaways:

• Industry Trends & Local Insights: What We’ve Noticed This Month

• Case Study: Unravelling Complex Upper Limb Weakness

Industry Trends & Local Insights

What We’ve Noticed This Month

We're proud that our strongest relationships continue to be with our local partners. A majority of our new appointments are still coming from referrals within Third Space and from trusted Personal Trainers. This collaborative approach is key to achieving the best outcomes for our patients. We are also actively working on strengthening our relationships with local consultants, ensuring a seamless and rapid referral pathway when a patient's care requires it.

In terms of injury patterns, two main themes have emerged:

1. Overuse and Training Errors: As always, we are treating a significant number of injuries related to training errors. This often happens when enthusiastic individuals increase their training load too quickly or push for new goals without perfecting their form. Our team is here to help diagnose the issue, manage the recovery, and refine your technique to prevent recurrence.

2. Meniscal and OA Flare-ups: We've seen a consistent number of active middle-aged and older individuals presenting with flare-ups of meniscal (knee cartilage) irritations or osteoarthritis (OA). Our primary goal is always to find effective management strategies that control symptoms and keep you moving, empowering you to continue the activities you love.

Case Study

Unravelling Complex Upper Limb Weakness

Sometimes, a case presents a complex puzzle. This recent patient highlights the importance of a thorough diagnostic process.

Patient: 30-year-old male rugby player.

History: The patient came to our Osteopath following a challenging few months. He had sustained several neck hyperflexion injuries from rugby and had also suffered a fall onto his posterior shoulder two months prior, though it initially seemed to have no lasting symptoms.

Subjective Symptoms: His primary complaint was restricted and painful neck movement, specifically into extension (looking up) and left rotation. More concerningly, he reported progressive weakness in his shoulder (flexion and abduction) and elbow (flexion) on the left side.

The puzzling part? This weakness was present despite a lack of pain, mechanical symptoms (like catching or clicking), pins and needles, or typical radicular (nerve) pain shooting down the arm.

Objective Findings:

• Cervical (Neck): His neck extension was reduced by about 30% and was painful at the end range. Left rotation was also mildly limited.

• Neurological: We found a clear myotomal pattern of weakness (graded 4/5) in the C5-C6 nerve root distribution, affecting his deltoid and biceps muscles. His biceps reflex was mildly decreased. Critically, sensory tests (dermatomes) were all intact. Spurling's test and the Upper Limb Tension Test (ULTT) for the median nerve were both positive, suggesting nerve irritation.

• Shoulder: His shoulder's active range of motion was full, and all special tests for impingement, rotator cuff, and instability were negative. However, we noted rapid fatigability of his deltoids, biceps, and external rotators.

Imaging & Diagnosis: An MRI helped confirm the clinical picture. It revealed a C5/6 disc bulge that was making mild contact with the nerve root. Separately, it also showed a small posterior-inferior labral tear in his shoulder.

Our working diagnosis was twofold:

1. Cervical facet/disc irritation at C5/6 was contributing to motor inhibition (the weakness) without the classic radicular pain.

2. A coexisting, and likely contributing, posterior-inferior labral injury in the shoulder.

Management & Progress: Our initial management plan focused on addressing both the neck and shoulder components:

• Cervical: We used manual therapy, including mobilisations of the restricted joints in the neck and upper back, along with neurodynamic (nerve gliding) exercises and mobility drills.

• Shoulder: We began a loading programme for the posterior cuff and scapular stabilisers, carefully keeping exercises below shoulder height to respect the labral injury.

After five weeks, the patient had made excellent progress in one area: he had complete restoration of pain-free cervical range of motion.

However, the primary issue remained. Despite the neck being pain-free and his nerve tension tests improving, the 4/5 weakness in his elbow flexion, shoulder flexion, and external rotation persisted.

Current Plan: This persistent, pain-free weakness is a key clinical finding that warrants further investigation. While we continue his progressive strengthening programme, we have referred the patient to a specialist shoulder consultant and a neurophysiologist. This will allow for further diagnostics (such as nerve conduction studies) to precisely identify the cause of the motor deficit and guide the next phase of his recovery.

This case is a perfect example of why a thorough assessment is crucial. It's not always straightforward, and our team at Wimbledon is dedicated to digging deep to find the root cause of your problem.

Contact Ultra Sports Clinic Today

We are proud to serve the Wimbledon community and are committed to continuously improving our services. Whether you're an elite athlete, a weekend warrior, or dealing with persistent pain like in our case study, our team is here to help you get back to your best.

If you're experiencing pain, weakness, or reduced function, book an appointment at our Ultra Sports Wimbledon Clinic today.