Marwan Al-Dawoud
@DrMarwanAl_D
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Sports Medicine Doctor | Dad | @northernballet | @Connect_Health_ | @EastLancsHosp | @bmj_latest | @leedsbeckett | IG: doc_marwan
Halifax, West Yorks, England
Joined August 2017
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Pinned Tweet
Outstanding support from the rugby league and sporting community to get behind
@Rob7Burrow
and his family.
The atmosphere tonight was incredible, filled with emotion and love which was a real privilege to be part of.
Iconic.
❤
#OneRobBurrow
@leedsrhinos
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🏵SEM case🏵
With consent...🧵
71 yr old cyclist who fell off his bike & landed hard onto his left hip on the road
He was left heavily bruised but carried on
A week later he noticed a large soft lump appear on the outside of his hip
8 years later he was referred to MSK
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49
301
Interesting medical case presenting to MSK
Consent✅️
20♀️
3 months bruising & swelling right shin
No trigger
This is what it looks like 👇🏽
What could it be?
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47
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🏵Indirect signs of a Frozen Shoulder on Ultrasound🏵
1. Long head of biceps effusion (most common)
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With patient consent...🧵
46♀️
Very competitive runner (London Marathon, Great North Run, local club etc)
Presented to MSK in 2014 with lateral foot pain -> XR: 5th met base stress # -> ortho: conservative management
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6 months ago I could barely walk, was in the worst pain I've experienced in my life, was down & worst of all...completely lost my right arse cheek 🍑😱
After microdiscectomy, amazing physio & persistence I'm now dead lifting 130kg, doing 20k on the bike living a normal life 🙌🏽
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🏵A thread for cyclists & clinicians who manage them🏵
Flow limitations in the iliac arteries (FLIA)
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🧠The 6th Consensus statement on Concussion has been published today🧠
Here's a thread summarising the main points of difference from the 5th
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👍🏽 Ultrasound guided peri-median nerve injection for carpal tunnel syndrome 👍🏽
I inject the saline/steroid superior to and inferior to the nerve / "hydrodissect"
One of my fav injections to do 😁
Consent ✔️
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Delighted to take on this role with a club steeped in such great history, a dedicated set of players and staff, a loyal and dependable fan-base and an inspirational DNA that feeds through its fabric
#LeedsLeedsLeeds
#Leeds
#Yorkshire
#Rhinos
#SportsMedicine
#Doctor
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A patient in an NHS MSK clinic this week: "you're the first doctor I've met who actually looks like he exercises".
We need to be and do better 🏋🏻♂️
Be the change....
#Practicewhatyoupreach
#Sport
#Exercise
#Medicine
#RoleModels
#DrHench
@movingmedicine
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Delighted to have our COVID-19 MSK Risk Stratification Tool published
@BMJOpenSEM
And to make the tool publicly available for MSK clinicians to use:
Thanks to
@AndrewVCuff
@AndreaRavindra
Dr Ian Bernstein and
@Connect_Health_
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🩺A great case for Doctors working in MSK services, but also for GPs 🩺
🙏🏽This is not a dig at any profession. Below are the facts of this case which make good learning🙏🏽
Consent ✅️
86 ♂️
June 22- twisted getting out of a car and felt some pain in the left groin area
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A message to my esteemed physio colleagues: if ur going to focus on one area to dust off the old knowledge cobwebs off; make it on minor injuries, fractures, wound care, applying a POP&the like.
If you're going to be redeployed anywhere, it's most likely to be urgent care
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Consent ✔️
The value of clinical and sonographic correlation
Professional rugby player 🏉
Felt pain in the right plantar fascia during a game, played on, the next match felt it ping, carried on playing, got MoTM 🙌🏽
Clinically:
- loss of medial arch
- reduced tension Windlass
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GPs & physios
Pls stop recommending, advising/doing steroid injectns for patients w lateral hip pain
They only give short term relief&the deterimental impacts of steroid to soft tissues is well documented
There's so much to explore with these patients
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I was born in Scotland
Raised in Edinburgh/ Glasgow / Burnley
Been a doctor for over 17 yrs
Represented England as
@England_RL
Dr
I am & feel very much British & am proud to be
Me, my family & friends are all scared for our safety & question whether we're welcome anymore
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🏵Clinical pearl🏵
If you read "long head of biceps tenosynovitis" on an ultrasound report.
Stop 🛑and think
The biceps is rarely the primary problem, rather secondary to a glenohumeral joint issue, as demonstrated very well in this case
Consent
72 F. Gradual onset left shoulder pain with restriction in ROM. Weak cuff
USS shows fluid surrounding LHB, likely decompressed from joint, juxta-articular osteophytes and posterior GHJ effusion
MRI confirms significant GHJ OA with effusion and synovitis
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Consent ✅️
77yr old ♀️
2 years shoulder pain and worsening visible swelling
USS shows huge subacromial bursitis & long head of biceps effusion
Otherwise completely fit and well
What do you think could be the possible cause of such a big bursitis?
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Thanks to
@tanyaarnold
@BBCLookNorth
for giving me some airtime yesterday to talk about all we're doing
@leedsrhinos
to beat
#COVID19
@LeedsCC_News
@PHE_YorksHumber
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@EmilyDudgeon
has created a great infographic which breaks it down into easy to digest chunks 🖍
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Consent ✅️
Professional rugby player 🏉
History of a degenerative wrist, had steroid injections into the wrist j
Holding his child and felt a snap in his wrist followed by a dull ache in the forearm
The next day unable to extend thumb
Picture & ultrasound below Diagnosis?
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Consent ✅️
🌼Rare care🌼
27 Yr old nurse
A year ago tripped over her ankle wearing high heels on a night out
Since troubled with lateral ankle pain
Been having physio by way of ankle stability and strengthening exercises but not getting better
-> referred into SEM
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Honoured to have a photo with this legend at the Denver test over the weekend. Having
@russellcrowe
there too was a bonus 😝
@England_RL
#maximusmeridius
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💡A really interesting case which I wanted to share which will spark those who like to go deeper into consultation history💡
38♀️
She had a long history of chronic widespread pain, weakness and complex mental health problems
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An interesting SEM case (with permission)...🧵
60 year old lady with a 9/52 history of lateral ankle pain of insidious onset, initially painful to touch around the ankle
History of breast cancer on Anastrozole along with Bisphosphonate & Calcium/ Vit D with normal Vit D levels
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After 7 amazing years&2 world cup finals with this special
@England
partially sighted squad, I've decided to hang my boots up
What an absolute privilege&honour2represent the nation with these outstanding individuals 🏴🦁🦁🦁🏴
@Adamlione
@JoshPughComic
@CathGilby
@TomThePhysio
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Me: "are you otherwise fit & well?"
Every patient: "yes"
Me: "On your records it's says you're diabetic, is that right?"
..."Yes"
"And had a coronary artery bypass graft done last year?
..."Yes"
"And you're on inhalers for COPD?"
..."Yes"
🤦🏻♂️
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With patient consent...🧵
63♂️
Brick layer 🧱, presented w 18 months of L medial knee pain which started following a fall where his knee twisted & was forced into deep flexion
Symptoms localised to med prox femoral condyl & med joint line
Pain on valgus stress but no laxity
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Consent ✔️
⚡️Suprascapular nerve block⚡️
A useful injection to have in your repertoire
▪️GH joint OA not for surgery
▪️Pain relief for cuff tears w risk of rupture
▪️Pre painful injections eg hydrodistension,barbotage
I use:
5-10ml Lidocaine &
10mg triamcinilone
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53 year old male presents with a 3 month history of shoulder pain after a fall
Pain and weakness clinically
What's the diagnosis?
👀 Answer down below
Consent ✔️
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Concussion talk to players and staff
@leedsrhinos
Recognise
Remove
Recover
Rise to the challenge
#concussion
#rugbyleague
#leeds
#sportsmedicine
#education
#rhinos
#rugby
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Consent ✅️
54yr old ♂️
18 months lateral heel pain, not responding to decent loading programme and shockwave
X ray reported normal
Booked in for injection
Initial scan looks like barn door plantar fasciopathy, with thickening and mixed echogenicity at the PF origin...
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My approach regarding the steroid injections in MSK.... At present we do not know whether there is any association between steroid injections and risk of developing or worsening COVID-19, but there have been some hypothesised concerns, albeit small /1
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Outstanding talk by
@enda_king
☘ on return to play following ACL-R. Key points:
-6 times more likely to rupture contralateral side
-Fear of injury & knee pain negatively affect return
-Set milestones with the player early
-Integrate rehab & performance
@sscsportsmed
@TheRFL
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🦶🏽Superficial calcaneal bursitis 🦶🏽
The forgotten cause of heel pain
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Don't forget you're breathing wrong too
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🏵Ultrasound guided acromioclavicular joint injections🏵
There are two [three] main techniques for injecting, in plane and out of plane
Make sure you know how to do them both, and here's how:
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Delighted to work with
@LeedsHospitals
in setting up a COVID vaccination session for
@leedsrhinos
and
@RhinosNetballSL
players and staff today at
@EllandRoad
@James_Donaldson
@briegrierson
#COVIDVaccination
#NHS
😷💉 👏🏽👏🏽
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CYBY✅️
Professional rugby player
Pushed into the back with force during a game -> hyperextension
Presents with tendernes over L4/5 on palpation, pain on extension of lumbar spine. No neurology or radiculopathy
What's going on here ?
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@Janetbirdope
I really like your other content but this video demonstrates poor practice and also poor injection technique
The far majority who have "failed physio" for tennis elbow, haven't had a proper loading programme or education in my experience
@Physio_lab
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Polite request: please can Radiographers/ Radiologists stop reporting x rays like this as "calcific tendinitis" ?
Calcifications are often coincidental and not the cause of a presenting shoulder complaint
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Great performance and win yesterday. Always an honour to represent 🏴
@England_RL
#EnglandRL
#DenverTest
#RugbyLeagueChallenge
#SportsMedicine
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Reflection:
1. Paramedics are definitely the most under-rated and this poll just proves it
#Heros
2. There's alot of love for nurses who are highly rated and valued 💚
3. Physios need to learn some humility!
Who are the most under-rated health care professionals?
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Glad to have got all the moving parts in place for a safe and welcomed return to training for players and staff
@leedsrhinos
#RugbyLeague
#Covid19UK
#sportsmedicine
#returntowork
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Delighted to welcome
@MRheumy
as our new Head of Rheumatology
@Connect_Health_
He joins
@AndrewVCuff
as Head of MSK &
@GailSowden
as Head of Pain. And with
@stevenawoor
&
@wilksey49
we've got a stellar line up managing all our clinical services nationally
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So happy to have received this in the post today
@CambridgeUP
@DrAMistryPsych
@DrAllanJohnston
@CyrusRamone
🙌🏽 Great book, but I am biased of course ☺🥊🥊🥊
#sportspsychiatry
#sportsmedicine
#boxing
#mentalhealth
5
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A dip in the subacromial bursa is a tell tale sign that the tendon has lost its contours and tension, in that portion and should lead you to look closely at the underlying tendon
You can see directly underneath the full thickness tendon tear and associated subacromial bursitis
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The RED-S CAT tool is very useful in assessing the relative risk and categorising into red | amber | green
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What a lovely early Christmas pressie from
@Giantsrl
🎅
What a class club 🏉
It's been a privilege 👊🏽
Best of luck in the 2023 season 🏆
@ashtongolding1
@J_mcGillvary
@Chrishilly1987
@TFages
@m_lawrence90
@Jdjones26
@McQueen1070
@Joey12g
@Elroy_cudj
@PhysioPatRob
0
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Loving my new toy
@Connect_Health_
@AlpinionMedical
E Cube8 Diamond 💎
Thank you
@physiquipe
🙏🏽
#POCUS
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Lovely case yesterday of a 48 year old lady suffering MS with a debilitating painful and stiff frozen shoulder for 12 months. ROM 90 in abduc and flexion, ext rot 1/4. Immediately after performing a hydrodistension she had full rom. She was so happy she cried
#lovemyjob
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A pt I saw today with advanced OA of the knee came with the expectation of monthly steroid injections, having had no physio input or basic self Mx advice
On exploring this, she said she saw an Orthopaedic surgeon who said it's a myth injections can only be done 2-3 times a year
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Thanks to
@hummel1923
for the new
@England_RL
kit. Looking forward to getting out to Denver and beating the Kiwis 🏴🇦🇺🇱🇷👊🏼
#rugbyleague
#bronchos
#visa
#sportsmedicine
#states
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A few reflections from doing some GP work after being away from it for a while:
- Admin/ reception staff trying to put on a brave face but totally overwhelmed. Constant calls and fed up patients
- GPs stretched beyond safe limits. I've often found myself the only doctor 1/
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With consent...
42 ♀️ personal trainer and marathon runner
Background of graves disease, subtotal thyroidectomy on carbimazole
Left buttock pain whilst running the London marathon->A&E X ray normal-> Half marathon in June-> MSK-> MRI: shows left sacral stress fracture
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What an absolute pleasure it's been working with these fine gents looking after the lads
@England_RL
#medicalteam
#sportsmedicine
#sportsphysio
#dreamteam
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Enjoyed my birthday bike ride treat day off courtesy of
@Connect_Health_
Thanks for the card
@AWalton_Connect
and all the staff at head office
#birthdayleave
#valued
#birthdayboy
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🚨This is a calcaneal stress fracture until proven otherwise 🚨
Alternative diagnoses include simple degenerative change due to running biomechanics
However, can't do a csi until know for sure
-> I've sent him for an MRI
-- I will update the case when the MRI is back
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CYBY ✅️
High volume saline injection for recalcitrant mid portion achilles tendinopathy
Transverse view, needle in plane
Followed by long view, needle out of plane
Injectate seen stripping the fat pad from the tendon > disruption of neovessels > pain relief --> rehab
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3
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Inspiring being with the
@EnglandFootball
para squads- Blind Men's, Deaf Women's and Men's, Partially Sighted and Cerebral Palsy- all training together on the warm weather camp
#culture
#parasport
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RIP Rob 💔
You were an inspiration and a warrior till the end 😥
Outstanding support from the rugby league and sporting community to get behind
@Rob7Burrow
and his family.
The atmosphere tonight was incredible, filled with emotion and love which was a real privilege to be part of.
Iconic.
❤
#OneRobBurrow
@leedsrhinos
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📢Erythema Nodosum📢
- Inflammation of subcut fat (panniculitis)
- Most commonly affects the shins
- Most common in ♀️ aged 25-40
- Over 1/2 of cases the cause is unknown
Other causes:
- Throat infections (Strep, EBV)
- Chlamydia
- Herpes
- Drugs: SSRIs, NSAIDs, OCP
- IBD
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💉 Ultrasound guided hip joint injection 💉
Consent ✅️
Indication: osteoarthritis
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And just for interest, this is what came out...350ml of brown old haematoma and serosanguinous fluid (I wish I had larger syringes to hand!)
With the size of the MLL, reaccumulation is a possibility, and if happens, the above management approach will be considered
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Great news for
@Connect_Health_
winning the poster prize
@TherapyExpo
for our poster celebrating all the hard work in establishing SEM services nationally through substantive Consultant roles and high quality Registrar training posts
@FSEM_UK
@Rosh_C_G
👏🏽
@AndrewVCuff
@wilksey49
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Update on this case 💥
Ultrasound showed it to be varicose veins!!
Consent ✅️
#MedTwitter
need your expertise please!
31♂️
2 yr history of lumps down the arm, getting more of them
Painful during exercise, not at rest
Clinically soft but firm, under the skin, mobile, in a track
I'm thinking schwannoma, needs biopsy, v likely benign
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🌼Cuff arthropathy🌼
Some lovely signs here in this 72 year old lady who was referred as ? Frozen shoulder ?RCRSP
Consent ✔️
1. Full thickness degenerate supraspinatus tear with tendonopathy of the remaining tendon
Note the humeral head degeneration at the tendon attachment
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Fantastic opportunity to join what's setting up to become one of the best medical & performance teams I've part of in a long time
@RichHunwicks
@23Benjones
Advanced facilities✅
Multi-discplinary team✅
Research opportunities✅
#Physiotherapy
0
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What an amazing couple of days learning percutaneous ultrasound guided trigger finger and carpal tunnel release
Getting to observe a world first theatre list using the product was a privilege
This innovation will help patients with incisionless surgery and care closer to home
4
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So good to have information and a whole host of validated questionnaires (MSKHQ, EQ5D, PSFS, Start MSK) filled out electronically by the patient available before seeing them for their first appointment. Great work
@AndrewVCuff
👏🏽
@Connect_Health_
2
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Really productive meeting with the Orthopaedic Directorate this week agreeing a Frozen Shoulder pathway that spans across 1° & 2° care.
- See a senior clinician early to get diagnosis right
- Early iA steroid
- Escalate promptly if not responding
@MrSaifHadi
@EastLancsHosp
1
2
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Consent✅️
25yr old metal worker & amateur footballer
1 yr pain & swelling back of the knee
Insidious onset. No clear trauma or mechanism. Interfering with daily life & work
MRI (done due to age to check nil internal) confirms Bakers cyst, nil else
4
2
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This kind of rhetoric is irresponsible and breaks down best practice principles and guidance in the management of knee OA
I showed the patient some basic strengthening exercises to start which she was open to
We can do better than this
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Proud to be part of this which has the potential to be a real game changer in the way we manage concussions in sport
@23Benjones
@gjtierney
@DanWeaving
@leedsrhinos
#concussion
#rugby
#sportsmedicine
🤝 Rugby League to link with
@leedsbeckett
University in major new research project to quantify the risk of head impact in the sport, with the aim of increasing understanding and reducing future risk.
👉 More:
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0
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Ultrasound:
The left (normal) side, the plantar fascia can be visualised along its length & clearly becomes taught on Windlass
On the right side, there is a 3cm gap with fluid over the distally visualised PF & loss of tension when passive big toe dorsiflexion is applied=rupture
1
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Who says barbotage doesn't work for calcification?
Patient presented in August 2018.
Barbotage performed in January 2019 (after maximising self management and rehab).
Resolution of symptoms and calcification on review in June 2019 💉💪🏽
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Nearly forgot, this is what the scan looked like after aspiration:
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Feedback like this from patients makes it all worthwhile and superchargers me to keep doing what I love doing!
Humbled 🙏🏽
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Consent ✔️
Percutaneous ultrasound guided trigger finger release
MSK ultrasound just reached a whole new level 🌟
4
7
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If your tendinopathy patient isn't responding then think wider : metabolic health linked with tendinopathy
@CampbellMurdoch
@basem_uk
#UpHillDownDale
1
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Consent? YBY✅️
65 yr retired nurse
4/12 med knee pain relatively quick onset
->GP -> naproxen -> physio -> not improving -> x ray: early degen med comp -> MSK -> iA CSI -> no better -> SEM: POCUS -> para meniscal cyst -> aspirated -> 😁
Common things aren't always common
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One of the best foot and ankle case threads I've seen in a long while. Definitely worth a read. Plenty of golden nuggets 👇🏽
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@MSmith_DPT
Physios: please stop putting your recommendations for steroid injections in the referral. Thanks
5
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Case in point
GP referral
"shoulder pain, USS reports calcific tendinosis, refer ortho consider steroid injection"
Assessed: very fit, gyms regularly, full range of movement, no arc pain, empty can painful, excellent power, doesn't even want an injection
-> refer physio
Polite request: please can Radiographers/ Radiologists stop reporting x rays like this as "calcific tendinitis" ?
Calcifications are often coincidental and not the cause of a presenting shoulder complaint
8
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Well done to
@DrAllanJohnston
and
@ProperSport
but most of all
@Minnsie1
for making this game changing interview. Best of luck on your return Thomas 👍🏼
#rugbyleague
#mentalhealth
1
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.
@England_RL
players and staff witnessing an amazing Fiji victory over New Zealand
#RLWC2017
1
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Consent ✅️
39 Yr old female with recurrent plantar fasciopathy with partial tear
PRP into the tear defect 💉🩸
In plane, long axis, into the fascia (tear)
With steroid I do out of plane, long axis, deep to the fascia
3
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Consent? You bet ya ✅️
Professional athlete
6/12 of medial ankle pain radiating distally to medial mid foot region
Clinically📍point tenderness between FHL & TP
Ultrasound shows bony fragment, close to NV bundle. Confirmed on MRI
-> removal by Ortho
-> happy athlete 😁
4
1
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Some people who really know their stuff in this field:
@rjprobinson
@jpmrogers
@sportex_dr_amal
@nickyKfitness
@DrAllanJohnston
Plus many others
🍲🏃♀️🦴🥞💪🏽🏅
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