We report a rare case of high-volume training-related myopericarditis. A male, 18 years old, elite road bicycle racing cyclist with high-volume training of 1,000 km per week for >7 years, presented with progressively worsening exertional breathlessness, reduced effort tolerance, and one episode of cardiac syncope. The symptoms were present prior to the coronavirus disease 2019 pandemic but made worse with the sudden increase in the volume of training after lockdown periods in preparation for competition. He exhibited multiple premature ventricular ectopic beats during his resting electrocardiogram, with a normal echocardiogram and non-elevated cardiac enzyme. The exercise stress test revealed similar multiple premature ventricular beats, warranting further investigation using cardiac magnetic resonance imaging (MRI). The findings of the cardiac MRI were suggestive of myopericarditis. He was instructed to refrain from training and initially started with a short course of colchicine. However, his symptoms deteriorated, and cardiac MRI revealed a decrease in the left ventricular ejection fraction from 59% to 50%. His treatment was escalated to a short course of tapered dose steroid, anti-failure medication and gradual, supervised, return to sports program. This case report highlights the discussion of return to play in athletes with myopericarditis.

A REVIEW OF TWO CASE REPORTS OF SAPHENOUS NERVE NEURALGIA IN HOSPITAL KUALA LUMPUR, MALAYSIA Saphenous nerve neuralgia is often underdiagnosed as medial-sided knee pain, resulting in a delay in treatment and increased risk of developing chronic neuropathic pain. The development of saphenous nerve neuralgia can be attributed to direct trauma to the medial side or entrapment of the nerve post-operative knee surgeries. Due to delay in diagnosis, the treatment options are limited, and outcomes vary. We presented two complicated cases of saphenous nerve neuralgia in our sports medicine clinic, Hospital Kuala Lumpur, Malaysia, and outlined the management options available for such cases from sports physician perspectives.

A SUCCESSFUL TREATMENT OF TARSAL TUNNEL SYNDROME USING HYDRO-DISSECTION TECHNIQUE: A CASE REPORT Tarsal tunnel syndrome (TTS) is an uncommon musculoskeletal ankle disorder caused by compression of the posterior tibial nerve at the tarsal tunnel level. Our objective is to describe the first case report of tarsal tunnel syndrome successfully treated with the hydro-dissection technique. This is a case of 41 years old lady who suffered from severe ankle sprain. She was prescribed an ankle brace to treat her ankle sprain. After 1-year post-injury, she complained of moderate to severe medial ankle pain, neuropathic, radiating to the big toe. Clinical assessments revealed tenderness at the tarsal tunnel area, accompanied by a positive Tinel sign, reproducing similar symptoms. Ultrasound examination confirmed an enlarged posterior tibial nerve at the level of the tarsal tunnel, with tenderness during sono-palpation and reproducing symptoms on sono-Tinel sign. She underwent hydro-dissection of the posterior tibial nerve with a marked reduction in pain and improvement in daily function.

Background: Most international bodies recommended against musculoskeletal steroid injection during the COVID-19 pandemic, fearing that the immunosuppressive effects of the steroid could worsen COVID-19 infection, thus prolonging the suffering of patients with severe musculoskeletal disease. The authors’ aim is to analyze the risk of COVID-19 infection after musculoskeletal injections. Methods: This is a retrospective study of patients who visited a sports medicine clinic and received musculoskeletal steroid injections between January 1, 2020 and February 28, 2021. The collected data was compared with the national COVID-19 registry to identify positive COVID-19 patients. The patients were only considered positive for COVID-19 following corticosteroid injection within 3 months after injection. Results: Out of 502 steroid injections; 79.7% (n = 400) received a single injection in one day, 19.1% (n = 96) received steroid injections at 2 sites in one day, and 1.2% (n = 6) received steroid injections at 3 sites in one day. Using the Fisherʼs exact test, there was no statistically significant association of COVID-19 infection between the steroid group and control group (relative risk, 1.44; 95% confidence interval, 0.9–23.1, P = 0.654). Only one patient contracted mild COVID-19 with no post COVID complications. Conclusions The authors recommend the use of musculoskeletal steroid injections in clinically indicated situation without having increased risk of COVID-19.