Sports Medicine: Just the Facts

CHAPTER 81 • BICYCLING INJURIES 483

• First degree, second degree, and third degree are
  treated with hydroactive dressings (adaptic) and sil-
  vadene or mupuricin ointments


• Larger third degree: Silvadene cream tid or wet to dry
  dressings
  •Tetanus prophylaxis for all abrasions

PELVIC

• Fractures of the superior and inferior rami are the
  most common pelvic fractures (Baker, 1998).
  
  
  1. Stable fractures need pain relief and rest, most heal
     within 2–3 weeks
  
  
  2. Unstable fractures need surgical intervention
  
  
  
  

VISCERAL

• Mostly caused by handlebars
  1.Abdominal wall—hernia (Holmes, Hall, and
  Schaller, 2002)
  2. Liver—hematomas (Nehoda et al, 2001)
  3. Spleen—hematoma
  4. Pancreas—hematoma, tears
  5. Bowel—perforation

VASCULAR

• External iliac artery endofibrosis (Abraham, Saumet,
  and Chevalier, 1997; Morelli and Stone, 2001)
  1.Progressive stenotic intimal thickening of the
  external iliac artery
  2. Presentation—pain or cramps in buttocks, thighs,
  or calves; may also present with sensation of the
  swollen leg with maximal effort or strenuous
  cycling
  3. Must be seen by physician as soon as possible
  4. Diagnosis
  a. Ultrasound and continuous-wave Doppler of the
  lower limb

b.Systolic humeral and posterior tibial arterial

pressures with an oscillometer

c. Arteriorgraphy with femoral Seldinger tech-

nique

5. Treatment
   a. Professional athletes—surgical endarterectomy
   b.Recreational athletes—decrease or switch activity

OVERUSE (FIG. 81-2) (Wilber et al, 1995)

KNEE

Anterior

•Patellar pain syndrome, quadriceps tendinitis, chon-

dromalacia patellae, and patella tendinitits

• Causes:Training errors (rapid increase in mileage,
  high gearing, excessive hills), bicycle fit problems
  (seat too low or too far forward, malpositioned cleats,
  crank arm too long), anatomic issues (genu valgus,
  genu varum, hyperpronation)


• Treatment:(1) Review and adjust training plan. (2)
  Improve bike fit—move seat higher, move saddle pos-
  terior; reposition cleats. (3) Correct for lower extremity
  anatomic abnormalities–consider bicycling orthotics.
  (4) Rehabilitation and knee strengthening.

Medial

• Irritation of medial patellofemoral ligament, plica, or
  pes anserine bursitis


• Causes:Training errors, cleats with toes pointed out,
  feet too far apart


• Treatment:(1) Review and adjust training plan. (2)
  Adjust cleats or shorten bottom bracket axle. (3)
  Possible surgical plica excision or medial patell-
  ofemoral ligament release. (4) Rehabilitation and knee
  strengthening.

FIG 81-2 Common overuse

injuries in Recreational Cyclists.

SOURCE: Adapted from Wilber CA,

Holland GJ, Madison RE, et al. An

epidemiologic analysis of overuse

injuries among recreational cyclists.

Int J Sports Med 1995:16:201–6.