Gardening Injuries.

Golfers elbow is a similar problem but affecting the origin of the long wrist flexors. Again a simple stretching and strengthening regime will aid recovery, with local steroid injections being reserved for the more resistant cases.

Olecranon bursitis

This can occur in the gardening scenario as a type of overuse injury and with repetitive minor trauma. The function of the olecranon bursa is to allow the skin to glide freely over the bony prominence of the olecranon. It is a closed sac lined by synovium that is interposed between the skin and triceps tendon and the olecranon process. With bursitis the walls of the bursa become thickened and oedematous and the bursal cells produce excess fluid. With significant trauma the bursal sac can contain frank blood. Repeated episodes of lesser trauma give rise to a chronic inflammatory process with a persistent effusion.

Management involves identifying and remedying any precipitating factors where possible. Symptomatic treatment with rest, ice and compression possibly with oral anti-inflammatories is the initial treatment. Fluid in the bursa can be aspirated aseptically to improve comfort followed by the application of a pressure dressing. More chronic cases can be treated with aspiration and injection of steroid often with good results. Surgery can be used to remove the bursal sac if symptomatic despite maximal conservative treatment. Occasionally a septic bursitis can occur but prompt treatment with antibiotics is usually curative.

Prevention is better than cure, so consideration for the use of elbow pads in those with symptoms is recommended.

Ankle sprains

As in everyday life, gardeners can sustain such injuries often associated with uneven ground, inappropriate footwear, obstacles and slippery surfaces. Being aware of such risks and taking care in the garden can help reduce ankle injuries.

• Most sprains involve the lateral ligament complex and most are managed conservatively. Initial assessment involves appropriate examination of the ankle joint and deciding whether an x-ray is needed. The Ottowa rules for ankle injury recommend an ankle x-ray if there is bony tenderness of either malleoli and/or inability to weight bear. This seems an obvious suggestion but if followed appropriately will reduce the number of unnecessary x-rays performed. The majority will involve damage to the anterior talo-fibula ligament, with more significant injuries the calcaneo-fibula ligament is involved and with severe injuries the posterior talo-fibula ligament is damaged. Most injuries can be conservatively managed as follows 

• Protection with ankle bracing to prevent reinjury while ligament heals
• Rest for injured ankle until normal heel-toe gait is restored
• Ice on ankle to decrease swelling and relieve pain
• Compression as soon as possible to decrease swelling
• Elevation: the initial step for reducing swelling
• Medication: NSAIDs for pain relief
• Mobilization early on when pain free to expedite return to activities
• Modalities: exercise and proprioception training to prevent reinjury

Plantar fascitis

This inflammatory condition affecting the origin of the plantar fascia on the calcaneum can be caused by excessive digging especially in unsuitable footwear. The plantar fascia originates on the medial calcaneal tuberosity and inserts on the proximal phalanx of each to. It helps to support the medial longitudinal arch and as such is important in weight redistribution during the gait cycle. condition. The condition usually presents with localised heal pain which is often bilateral and can be very debilitating. Avoidance of long periods of digging and ensuring the use of good solid soled footwear can help avoid this. The following important pointers should be noted;

• X-rays generally unhelpful
• Ignore ‘plantar spur’
• Rest/stretching/orthotics 1st line
• No evidence to say heel cups beneficial
• Reserve injection for chronic cases
• Only consider surgery after 12m conservative treatment

(Jerry Ryan, Evidence-based Sports Medicine 2002)

Patella bursitis

Bursae are synovial-lined cavities that normally contain a thin film of fluid that overlie bony prominences around the knee. They serve to reduce friction during knee motion. Repetitive trauma from overuse, or more commonly, chronic irritation results in local inflammation and fluid collection within the bursa. The prepatellar bursa is the most commonly affected and is known also as “housemaid’s knee”, this is often caused by excessive kneeling, especially on hard grounds. Such activity can result in tissue damage and inflammation of the various bursa associated with the patella. Patients present with swelling, pain and tenderness well localised to the inflamed bursa. Swelling can be dramatic, but it is always confined to the general area of the inflamed bursa. With prepatellar bursitis, the bony contours of the patella are obscured, unlike an intra-articular effusion. Weight-bearing or gentle range of motion does not significantly increase pain, although the patient will notice tightness and secondary pain as flexion is increased. This helps to distinguish bursitis from septic arthritis which is markedly painful to any range of motion or weight bearing. Avoiding long periods of kneeling and the use of knee pads or other kneeling aids now available will help to reduce the pressure on the patella and reduce the risk of bursitis developing. Established bursitis may need relative rest from precipitating activities, non-steroidal anti-inflammatory drugs and occasionally aspiration of the bursa (sometimes with injection of steroid). Tools with specially developed extended handles can allow the user to carry out tasks such as weeding without kneeling or bending.

Cuts and wounds

All gardeners will sustain minor cuts and grazes the majority of which are minor and self-limiting. Evan small thorns can cause significant problems and can lead to infection. Tetanus is also a rare but theoretical risk from wounds in the garden so attention to tetanus immunisation must be considered in active gardeners. Gardeners should be encouraged to use gloves to prevent cuts and reduce the risk of soft tissue infection.

Poisons

There are hundreds of chemical preparations on the market to aid the gardener in his war against pests and diseases and it is vital to remember that most of them are extremely toxic, for this reason containers must be appropriately labelled and kept away from children.

Power tools / machinery

Equipment used in gardening can be potentially dangerous and sometimes lethal. Appropriate protective clothing and equipment must be used as per the manufacturers’ instructions. Most advice needed in this area is common sense but each spring casualty departments are awash with gardening injuries. Examples include trauma to feet due to inappropriate footwear whilst using lawnmowers, eye injuries due to absence of goggles whilst cutting hedges, electric shocks from faulty electric cables. Vigilance is needed by all gardeners using such powerful equipment to avoid serious injuries or even a fatality.

Injury Prevention

Checklist to help prevent injury and accidents in the garden

1. Do not do too much too soon (particularly for novice gardeners).
2. Take regular breaks whilst working in the garden.
3. Avoid excessive bending and twisting at the knees. Lift items carefully by bending the knees.
4. Make use of labour saving tools which can help reduce overuse injuries.
5. Use appropriate protective equipment e.g. gloves and goggles.

Dr Geoff Davies     Dip SEM

GP, Barry, Vale of Glamorgan.