Hoffa Syndrome: Impingement of the Fat Pad of the Knee

Here is a great illustration of the amount of pressure tennis pro Rafael Nadal places on his knee during play.  Impingement of the fatpad behind the kneecap is known as Hoffa Syndrome.

Symptoms & findings include:

• Pain and/or swelling behind or below the kneecap
• Possible history of knee hyper-extension (called genu recurvatum)
• Positive finding on "Hoffa’s test" physical exam manuever by a sports medicine physician

Treatment should start with non-surgical:

• Rest and avoiding aggravating activities
• Ice or cryotherapy
• Anti-inflammatory (pills or injection)
• Physiotherapy modalities such as ultrasound or TENS.
• Muscle strengthening
• Kinesio-Taping

If conservative treatment does not work then surgery may be advised. This may involve the complete or partial removal of the fat pad itself.  See a sports medicine specialist if you think you have Hoffa Syndrome.

You Don't Have to be a Golfer to get Golfer's Elbow

I was recently asked to comment on Cincinnati Reds middle reliever Jonathan Broxton being placed on the Disabled List due to a flexor mass strain in his elbow. This ailment is a type of "Golfer's Elbow" (a.k.a. medial epicondylitis) that occurs in recreational athletes or people who participate in work that requires repetitive and vigorous use of the forearm muscles (for example: painters, plumbers, carpenters, auto workers, cooks, and even butchers). It is thought that the repetition and power grip required in these occupations leads to injury.

Most people who get medial epicondylitis are between the ages of 30 and 50, although anyone can get it if they have the risk factors. In sports like golf, improper stroke technique, poor flexibility, and improper equipment may be risk factors.

Almost always the condition gets better without surgery, but treatment is necessary. Treatment programs include a temporary rest from the offending activity (for example, lay off sports or light duty at work), anti-inflammatories (preferably pills but possibly an injection), checking the equipment you're using for proper size and weight, physical therapy for stretching and pain-relieving modalities, and possible use of a special brace that takes pressure off of the medial epicondyle muscles.

Images from the American Academy of Orthopaedic Surgeons


The condition will usually wax and wane before it goes away with treatment.

Have you ever had Golfer's Elbow? What caused it and what did it take for you to get better?

Why all the Hamstring Injuries in Major League Baseball?

It looks like Los Angeles Dodgers All-Star outfielder Matt Kemp is headed back to the Disable List with a right hamstring injury this year (last year he injured his left hamstring and missed 51 days). Of the 189 players currently on the MLB DL, 19 are for hamstring injuries, greater than 10%.  A study published in the American Journal of Sports Medicine in 2011 noted that hamstring injuries comprised 13.5% of injuries for position players and 8% overall.
So why all the hamstring injuries in baseball? Traditional thinking had blamed tightness, poor warm-up and poor conditioning of the posterior chain of the body (i.e., hamstrings, gluteals, piriformis). However current thinking takes it a step further. Tightness and poor warm-up cannot be overcome with static stretching (like reach-and-hold type of stretching). Only dynamic stretching (flexibility through movement) will condition the muscles to handle the sudden start and stop movements of baseball. Also, single line strengthening, such as hamstring curls and squats, do not adequately prepare the muscles for the twisting/turning/cutting/pivoting movements that frequently cause injury during sports. Therefore, diagonal and multi-directional strengthening is needed to condition the muscles to handle these complex movements. These contemporary approaches are already being incorporated into MLB conditioning programs, and we hope they will result in a decrease in hamstring injuries.

Have you ever had a hamstring injury? What did it take for you to get better?