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Injuries, Symptoms & Treatments
Sports Medicine
We love treating athletes because we are athletes
Sports medicine is a subspecialty of orthopedics that deals with the prevention, diagnosis, treatment and rehabilitation of injuries suffered during athletic activity. The goal of treatment is to heal and rehabilitate the injury so patients can return to their favorite activities quickly, whether it's Little League, recreational play or a high school, college or professional sport.
Due to frequent use, wear-and-tear and risk of a fall or accident associated with sports activities, athletes are often susceptible to orthopedic injuries, including a stress fracture, chronic pain, or a tearing or stretching or internal structures. Different activities place different parts of the body at a higher risk for damage. It is therefore important to take necessary precautions to protect yourself while playing sports. Treatment for these conditions may involve surgery, orthotics, physical therapy and rest.
As with a sports team, there are many physicians who work together to help the patient regain maximum use of the injured limb or joint. "Players" on the team are typically the physician, orthopedic surgeon, rehabilitation specialist, athletic trainer and physical therapist - and the patient as well. Dr. Bellapianta has specialized training in the diagnosis, treatment and prevention of sports injuries, and can help athletes return to their favorite activities as quickly as possible through the most advanced, minimally invasive treatments available.
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Diseases/Conditions of Sports Medicine
Anterior Cruciate Ligament (ACL) Injuries
One of the most common knee injuries is an anterior cruciate ligament sprain or tear.
Athletes who participate in high demand sports like soccer, football, and basketball are more likely to injure their anterior cruciate ligaments.
If you have injured your anterior cruciate ligament, you may require surgery to regain full function of your knee. This will depend on several factors, such as the severity of your injury and your activity level.
Anatomy
Three bones meet to form your knee joint: your thighbone (femur), shinbone (tibia), and kneecap (patella). Your kneecap sits in front of the joint to provide some protection.
Bones are connected to other bones by ligaments. There are four primary ligaments in your knee. They act like strong ropes to hold the bones together and keep your knee stable.
Collateral Ligaments
These are found on the sides of your knee. The medial collateral ligament is on the inside and the lateral collateral ligament is on the outside. They control the sideways motion of your knee and brace it against unusual movement.
Cruciate Ligaments
These are found inside your knee joint. They cross each other to form an "X" with the anterior cruciate ligament in front and the posterior cruciate ligament in back. The cruciate ligaments control the back and forth motion of your knee.
The anterior cruciate ligament runs diagonally in the middle of the knee. It prevents the tibia from sliding out in front of the femur, as well as provides rotational stability to the knee.
Description
About half of all injuries to the anterior cruciate ligament occur along with damage to other structures in the knee, such as articular cartilage, meniscus, or other ligaments.
Injured ligaments are considered "sprains" and are graded on a severity scale:
Partial tears of the anterior cruciate ligament are rare; most ACL injuries are complete or near complete tears.
Cause
The anterior cruciate ligament can be injured in several ways:
Several studies have shown that female athletes have a higher incidence of ACL injury than male athletes in certain sports. It has been proposed that this is due to differences in physical conditioning, muscular strength, and neuromuscular control. Other suggested causes include differences in pelvis and lower extremity (leg) alignment, increased looseness in ligaments, and the effects of estrogen on ligament properties.
Symptoms
When you injure your anterior cruciate ligament, you might hear a "popping" noise and you may feel your knee give out from under you. Other typical symptoms include:
Compartment Syndrome
Compartment syndrome is a painful condition that occurs when pressure within the muscles builds to dangerous levels. This pressure can decrease blood flow, which prevents nourishment and oxygen from reaching nerve and muscle cells.
Compartment syndrome can be either acute or chronic.
Acute compartment syndrome is a medical emergency. It is usually caused by a severe injury. Without treatment, it can lead to permanent muscle damage.
Chronic compartment syndrome, also known as exertional compartment syndrome, is usually not a medical emergency. It is most often caused by athletic exertion.
Anatomy
Compartments are groupings of muscles, nerves, and blood vessels in your arms and legs. Covering these tissues is a tough membrane called a fascia. The role of the fascia is to keep the tissues in place, and, therefore, the fascia does not stretch or expand easily.
Description
Compartment syndrome develops when swelling or bleeding occurs within a compartment. Because the fascia does not stretch, this can cause increased pressure on the capillaries, nerves, and muscles in the compartment. Blood flow to muscle and nerve cells is disrupted. Without a steady supply of oxygen and nutrients, nerve and muscle cells can be damaged.
In acute compartment syndrome, unless the pressure is relieved quickly, permanent disability and tissue death may result. This does not usually happen in chronic (exertional) compartment syndrome.
Compartment syndrome most often occurs in the anterior (front) compartment of the lower leg (calf). It can also occur in other compartments in the leg, as well as in the arms, hands, feet, and buttocks.
Cause
Acute Compartment Syndrome
Acute compartment syndrome usually develops after a severe injury, such as a car accident or a broken bone. Rarely, it develops after a relatively minor injury.
Conditions that may bring on acute compartment syndrome include:
Chronic (Exertional) Compartment Syndrome
The pain and swelling of chronic compartment syndrome is caused by exercise. Athletes who participate in activities with repetitive motions, such as running, biking, or swimming, are more likely to develop chronic compartment syndrome. This is usually relieved by discontinuing the exercise, and is usually not dangerous.
Symptoms
Acute Compartment Syndrome
The classic sign of acute compartment syndrome is pain, especially when the muscle within the compartment is stretched.
The pain is more intense than what would be expected from the injury itself. Using or stretching the involved muscles increases the pain.
Chronic (Exertional) Compartment Syndrome
Chronic compartment syndrome causes pain or cramping during exercise. This pain subsides when activity stops. It most often occurs in the leg.
Symptoms may also include:
Fractures (Broken Bones)
A fracture is a broken bone, the same as a crack or a break. A bone may be completely fractured or partially fractured in any number of ways (crosswise, lengthwise, in multiple pieces).
Types of Fractures
Althouh bones are rigid, they do bend, or give, somewhat when an outside force is applied. However, if the force is too great, bones will break, just as a plastic ruler breaks when it is bent too far.
The severity of a fracture usually depends on the force that caused the break. If the bone's breaking point has been exceeded only slightly, the bone may crack rather than break all the way through. If the force is extreme, such as that caused by an automobile crash or gunshot, the bone may shatter.
If the bone breaks in such a way that bone fragments stick out through the skin, or a wound penetrates down to the broken bone, the fracture is called an open fracture. This type of fracture is particularly serious because once the skin is broken, infection in both the wound and the bone can occur.
Common types of fractures include:
Cause
The most common causes of fractures are:
Symptoms
Many fractures are very painful and may prevent you from moving the injured area. Other common symptoms include:
Heat Injury and Heat Exhaustion
There are many types of heat injury, ranging from mild heat cramps to life-threatening heat stroke. A growing number of children and young adults are playing sports during late summer and early fall.
According to the Centers for Disease Control and Prevention, heat illness during practice or competition is a leading cause of deathx and disability among U.S. high school athletes. As more people exercise in warm conditions, it's essential to take proper precautions.
Heat-related illnesses are preventable. Prevention begins with understanding the causes of heat illness, and making sure to stay cool and hydrated during hot weather. In addition, knowing the signs of heat injury and being able to treat it immediately will reduce the number of severe cases.
Cause
When we exercise, our bodies cool off by sweating. As we perspire, we lose necessary body fluids. If we do not replace these fluids, we become dehydrated. This makes it difficult to sweat and cool down, which can result in a heat injury.
During regular exercise, 70 to 90% of the energy our bodies produce is released by heat. Many factors can hinder heat release and perspiration. These include:
Mild Heat Injury
Heat Cramps
Heat cramps are painful cramps in the stomach, arm, and leg muscles. These cramps are caused by not replacing salt and fluids during intense, prolonged exercise in the heat.
Treatment for Heat Cramps
Moderate Heat Injury
Heat Syncope
Weakness, fatigue, and fainting are the chief symptoms of heat syncope. They are typically brought on by exercising hard in the heat. Too much salt and water are lost through perspiration and are not replaced.
Heat syncope often occurs during the first 5 days of adjusting to a new activity. It also can occur in people taking diuretic medicines or those with pre-existing heat illness. Young athletes returning to play after time off for injury are also at greater risk for heat syncope. Without treatment, heat syncope can put you at risk for heat stroke.
Heat Exhaustion (Water Depletion)
Heat exhaustion is brought on by heavy sweating and results in extreme weight loss. As heat exhaustion sets in, perspiration decreases, and skin and body temperatures rise. Core body temperature typically rises to 104° F.
Additional signs of heat exhaustion include excessive thirst, weakness, headache, and sometimes loss of consciousness.
Heat Exhaustion (Salt Depletion)
Common signs of heat exhaustion due to salt depletion are nausea and vomiting, frequent muscle cramps, and dizziness. Core body temperature is typically up to 104° F.
You are at risk for this type of heat exhaustion when you do not sufficiently replace normal body salts and minerals. This can sometimes happen during prolonged exercise if water alone is used to replenish fluids. Body minerals, such as those found in sports drinks, must also be replaced.
Severe Heat Injury
Heat Stroke
Heat stroke is the most severe form of heat injury. When suffering from heat stroke, your body cannot cool itself. This is an acute medical emergency.
Heat stroke is medically defined as core body temperature greater than 104° F. Organ system failure can result from this high of a body temperature.
Treatment of Heat Stroke
Prevention
There are many ways to reduce your risk for heat injury.
General Guidelines
See a doctor before starting a new exercise activity. Discuss recent illnesses or medications that could cause dehydration. Cardiac or pulmonary conditions can also contribute to heat injury.
Take time to adapt to a new activity or climate. Coaches should plan pre-season conditioning programs. These should be held during weather conditions similar to a typical practice.
Increase the intensity and duration of your exercise program gradually. If you participate in sports that require protective equipment, avoid wearing it at the start of training.
Recommendations
Muscle Contusion (Bruise)
Athletes in contact sports have many opportunities to get a muscle contusion (bruise). Contusions are second only to strains as a leading cause of sports injuries.
Most contusions are minor and heal quickly, without taking the athlete away from the game. Severe contusions, however, can cause deep tissue damage and lead to complications that may prevent an athlete from being able to play sports for months.
Cause
Contusions occur when a direct blow or repeated blows by a blunt object strike part of the body, crushing underlying muscle fibers and connective tissue without breaking the skin. A contusion can result from falling or jamming the body against a hard surface.
A contusion may result from a direct blow to a muscle when players collide during sports.
Symptoms
Contusions cause swelling and pain and can limit joint range of motion near the injury. Torn blood vessels may cause bluish discoloration. The injured muscle may feel weak and stiff.
Sometimes a pool of blood collects within damaged tissue, forming a lump over the injury (hematoma). If tissue damage is extensive, you may also have a broken bone, dislocated joint, sprain, torn muscle, or other injuries.
Contusions to the abdomen may damage internal organs.
Muscle Cramps
A muscle cramp is an involuntary contraction of a muscle that occurs suddenly and does not relax. If you have ever experienced a charley horse, you probably still remember the sudden, tight and intense pain caused by a muscle locked in spasm.
Cramps can affect any muscle under your voluntary control (skeletal muscle). They can involve part or all of a muscle, or several muscles in a group.
The most commonly affected muscle groups are:
Cause
Although the exact cause of muscle cramps is unknown (idiopathic), some researchers believe inadequate stretching and muscle fatigue leads to abnormalities in the mechanisms that control muscle contraction. Other factors may also be involved, including poor conditioning, exercising or working in intense heat, dehydration and depletion of salt and minerals (electrolytes).
Inadequate Stretching and Muscle Fatigue
Muscles are bundles of fibers that contract and expand to produce movement. A regular program of stretching lengthens muscle fibers so they can contract and tighten more vigorously when you exercise. When your body is poorly conditioned, you are more likely to experience muscle fatigue, which can alter spinal neural reflex activity. Overexertion depletes a muscle's oxygen supply, leading to build up of waste product and spasm. When a cramp begins, the spinal cord stimulates the muscle to keep contracting.
Heat, Dehydration, and Electrolyte Depletion
Muscle cramps are more likely when you exercise in hot weather because sweat drains your body's fluids, salt and minerals (i.e., potassium, magnesium and calcium). Loss of these nutrients may also cause a muscle to spasm.
Risk Factors
Some people are predisposed to muscle cramps and get them regularly with any physical exertion.
Those at greatest risk for cramps and other ailments related to excess heat include infants and young children, and people over age 65. Other factors that put people at greater risk for muscle cramp include:
Muscle cramps are very common among endurance athletes, such as marathon runners and triathletes, and older people who perform strenuous physical activities.
Symptoms
Muscle cramps range in intensity from a slight tic to agonizing pain. A cramping muscle may feel hard to the touch and/or appear visibly distorted or twitch beneath the skin. A cramp can last a few seconds to 15 minutes or longer. It might recur multiple times before it goes away.
Home Remedies
Cramps usually go away on their own without seeing a doctor.
Prevention
To avoid future cramps, work toward better overall fitness. Do regular flexibility exercises before and after you work out to stretch muscle groups most prone to cramping.
Warm Up
Always warm up before stretching. Good examples of warm-up activities are slowly running in place or walking briskly for a few minutes.
Calf Muscle Stretch
Lean forward against a wall with one leg in front of the other. Straighten your back leg and press your heel into the floor. Your front knee is bent. Hold for 15 to 30 seconds.
Do: Keep both heels flat on the floor. Point the toes of your back foot toward the heel of your front foot.
Hamstring Muscle Stretch
Sit up tall with both legs extended straight in front of you. Your feet are neutral — not pointed or flexed. Place your palms on the floor and slide your hands toward your ankles. Hold for 30 seconds.
Do: Keep your chest open and back long. Reach from your hips. Stop sliding your palms forward when you feel the stretch.
Do not: Round your back or try to bring your nose to your knees. Do not lock your knees.
Hamstring muscle stretch. You should feel this stretch at the back of your thighs and behind your knees.
Quadriceps Muscle Stretch
Hold on to a wall or the back of a chair for balance. Lift one foot and bring your heel up toward your buttocks. Grasp your ankle with your hand and pull your heel closer to your body. Hold the stretch for 30 seconds.
Do: Keep your knees close together. Stop bringing your heel closer when you feel the stretch.
Do not: Arch or twist your back.
Hold each stretch briefly, then release. Never stretch to the point of pain.
When To See Your Doctor
Although most muscle cramps are benign, sometimes they can indicate a serious medical condition.
See your doctor if cramps are severe, happen frequently, respond poorly to simple treatments, or are not related to obvious causes like strenuous exercise. You could have problems with circulation, nerves, metabolism, hormones, medications, or nutrition.
Muscle cramps may be a part of many conditions that range from minor to severe, such as Lou Gehrig's disease (amyotrophic lateral sclerosis), spinal nerve irritation or compression (radiculopathy), hardening of the arteries, narrowing of the spinal canal (stenosis), thyroid disease, chronic infections, and cirrhosis of the liver.
Shin Splints
Shin splints are a common exercise-related problem. The term "shin splints" refers to pain along the inner edge of the shinbone (tibia).
Shin splints typically develop after physical activity. They are often associated with running. Any vigorous sports activity can bring on shin splints, especially if you are just starting a fitness program.
Simple measures can relieve the pain of shin splints. Rest, ice, and stretching often help. Taking care not to overdo your exercise routine will help prevent shin splints from coming back.
Description
Shin splints (medial tibial stress syndrome) is an inflammation of the muscles, tendons, and bone tissue around your tibia. Pain typically occurs along the inner border of the tibia, where muscles attach to the bone.
Cause
In general, shin splints develop when the muscle and bone tissue (periosteum) in the leg become overworked by repetitive activity.
Shin splints often occur after sudden changes in physical activity. These can be changes in frequency, such as increasing the number of days you exercise each week. Changes in duration and intensity, such as running longer distances or on hills, can also cause shin splints.
Other factors that contribute to shin splints include:
Symptoms
The most common symptom of shin splints is pain along the border of the tibia. Mild swelling in the area may also occur.
Shin splint pain may:
Sprains, Strains and Other Soft-Tissue Injuries
The most common soft tissues injured are muscles, tendons, and ligaments. These injuries often occur during sports and exercise activities, but sometimes simple everyday activities can cause an injury.
Sprains, strains, and contusions, as well as tendinitis and bursitis, are common soft-tissue injuries. Even with appropriate treatment, these injuries may require a prolonged amount of time to heal.
Cause
Soft-tissue injuries fall into two basic categories: acute injuries and overuse injuries.
Acute injuries are caused by a sudden trauma, such as a fall, twist, or blow to the body. Examples include sprains, strains, and contusions.
Overuse injuries occur gradually over time when an athletic or other activity is repeated so often that areas of the body do not have enough time to heal between occurrences. Tendinitis and bursitis are common soft-tissue overuse injuries.
Common Acute Soft-Tissue Injuries
Acute soft-tissue injuries vary in type and severity. When an acute injury occurs, initial treatment with the RICE protocol is usually very effective. RICE stands for Rest, Ice, Compression, and Elevation.
Rest. Take a break from the activity that caused the injury. If the injury is to your leg, your doctor may also recommend that you use crutches to avoid bearing weight.
Ice. Use cold packs for 20 minutes at a time, several times a day. Do not apply ice directly to the skin.
Compression. To prevent additional swelling and blood loss, wear an elastic compression bandage.
Elevation. To reduce swelling, elevate the injury higher than your heart while resting.
Sprains
A sprain is a stretch and/or tear of a ligament, a strong band of connective tissue that connects the end of one bone with another. Ligaments stabilize and support the body's joints. For example, ligaments in the knee connect your thighbone (femur) with your shinbone (tibia), enabling you to walk.
The areas of the body that are most vulnerable to sprains are the ankles, knees, and wrists. A sprained ankle can occur when your foot turns inward, placing extreme tension on the ligaments of your outer ankle. A sprained knee can result from a sudden twist, and a wrist sprain can occur if you fall onto an outstretched hand.
Sprains are classified by severity:
While the intensity varies, pain, bruising, swelling, and inflammation are common to all three categories of sprains. Treatment for sprains begins with the RICE protocol and physical therapy. Moderate sprains often require a period of bracing (for example, a CAM walking boot can be worn to help support and immobilize a sprained ankle). The most severe sprains may require surgery to repair torn ligaments.
Strains
A strain is an injury to a muscle and/or tendon. Tendons are fibrous cords of tissue that attach muscles to bone. Strains often occur in the back or leg (typically, the hamstring).
Similar to a sprain, a strain may be a simple stretch of your muscle or tendon, or it may involve a partial or complete tear of the muscle and tendon. Symptoms of a strain may include pain, muscle spasm, muscle weakness, swelling, inflammation, and cramping.
Soccer, football, hockey, boxing, wrestling and other contact sports put athletes at risk for hamstring strains, as do sports that feature quick starts, such as hurdling, long jumping, and running races. Gymnastics, tennis, rowing, golf and other sports that require extensive gripping have a high incidence of hand sprains. Elbow strains frequently occur in racquet, throwing, and contact sports.
The recommended treatment for a strain is the same as for a sprain: rest, ice, compression and elevation. This should be followed by simple exercises to relieve pain and restore mobility. Surgery may be required for a more severe tear.
Contusions (Bruises)
Contusions occur when a direct blow (or repeated blows) by a blunt object strikes part of the body, crushing underlying muscle fibers and connective tissue without breaking the skin. A contusion can result from falling or jamming the body against a hard surface. Discoloration of the skin is caused by blood pooling around the injury.
Most contusions are mild and respond well to the RICE protocol. If symptoms persist, medical care should be sought to prevent permanent damage to the soft tissues.
Common Overuse Soft-Tissue Injuries
Tendinitis
Tendinitis is an inflammation or irritation of a tendon or the covering of a tendon (called a sheath). It is caused by a series of small stresses that repeatedly aggravate the tendon. Symptoms typically include swelling and pain that worsens with activity.
Tiny tears in the Achilles tendon cause it to swell and thicken.
Professional baseball players, swimmers, tennis players, and golfers are susceptible to tendinitis in their shoulders and elbows. Soccer and basketball players, runners, and aerobic dancers are prone to tendon inflammation in their knees and ankles.
Tendinitis may be treated by rest to eliminate stress, anti-inflammatory medication, steroid injections, splinting, and exercises to correct muscle imbalance and improve flexibility. Persistent inflammation may cause significant damage to the tendon, which may require surgery.
Bursitis
Bursae, are small, jelly-like sacs that are located throughout the body, including around the shoulder, elbow, hip, knee, and heel. They contain a small amount of fluid, and are positioned between bones and soft tissues, acting as cushions to help reduce friction.
Bursitis is inflammation of a bursa. Repeated small stresses and overuse can cause the bursa to swell. Many people experience bursitis in association with tendinitis.
Bursitis can usually be relieved with changes in activity and anti-inflammatory medications, such as ibuprofen. If swelling and pain do not respond to these measures, your doctor may recommend removing fluid from the bursa and injecting a corticosteroid medication. The steroid medication is an anti-inflammatory drug that is stronger than the medication that can be taken by mouth. Corticosteroid injections usually help relieve pain and swelling.
Although surgery is rarely necessary for bursitis, if the bursa becomes infected, an operation to drain the fluid from the bursa may be necessary. In addition, if the bursa remains infected or the bursitis returns after all nonsurgical treatments have been tried, your doctor may recommend removal of the bursa.
Removal (excision) of the bursa can be done using a standard incision (open procedure), or as an arthroscopic procedure with small incisions and miniature surgical instruments. Your doctor will talk with you about which procedure is appropriate for your situation.
Prevention
Injuries often occur when people suddenly increase the duration, intensity, or frequency of their activities. Many soft-tissue injuries can be prevented through proper conditioning and training. Other prevention tips include:
Stress Fractures
One of the most common injuries in sports is a stress fracture. Overcoming an injury like a stress fracture can be difficult, but it can be done.
What is a stress fracture?
A stress fracture is an overuse injury. It occurs when muscles become fatigued and are unable to absorb added shock. Eventually, the fatigued muscle transfers the overload of stress to the bone causing a tiny crack called a stress fracture.
What causes a stress fracture?
Stress fractures often are the result of increasing the amount or intensity of an activity too rapidly. They also can be caused by the impact of an unfamiliar surface (a tennis player who has switched surfaces from a soft clay court to a hard court); improper equipment (a runner using worn or less flexible shoes); and increased physical stress (a basketball player who has had a substantial increase in playing time).
Where do stress fractures occur?
Most stress fractures occur in the weightbearing bones of the lower leg and the foot. More than 50 percent of all stress fractures occur in the lower leg.
What activities make athletes most susceptible to stress fractures?
Studies have shown that athletes participating in tennis, track and field, gymnastics, and basketball are very susceptible to stress fractures. In all of these sports, the repetitive stress of the foot striking the ground can cause trauma. Without sufficient rest between workouts or competitions, an athlete is at risk for developing a stress fracture.
Are women more susceptible to stress fractures than men?
Stress fractures affect people of all ages who participate in repetitive sporting activities, like running. Medical studies have shown that female athletes seem to experience more stress fractures than their male counterparts. Many orthopaedic surgeons attribute this to a condition referred to as "the female athlete triad": eating disorders (bulimia or anorexia), amenorrhea (infrequent menstrual cycle), and osteoporosis. As a female's bone mass decreases, her chances of getting a stress fracture increase.
What are the symptoms of a stress fracture?
Pain with activity is the most common complaint with a stress fracture. This pain subsides with rest.
How are stress fractures diagnosed?
It is very important that during the medical examination the doctor evaluates the patient's risk factors for stress fracture.
X-rays are commonly used to determine stress fracture. Sometimes, the stress fracture cannot be seen on regular x-rays or will not show up for several weeks after the pain starts. Occasionally, a computed topography (CT) scan or magnetic resonance imaging (MRI) will be necessary.
How are stress fractures treated?
The most important treatment is rest. Individuals need to rest from the activity that caused the stress fracture, and engage in a pain-free activity during the six to eight weeks it takes most stress fractures to heal.
If the activity that caused the stress fracture is resumed too quickly, larger, harder-to-heal stress fractures can develop. Re-injury also could lead to chronic problems where the stress fracture might never heal properly.
In addition to rest, shoe inserts or braces may be used to help these injuries heal.
Prevention
Here are some tips developed by the American Academy of Orthopaedic Surgeons to help prevent stress fractures:
It is important to remember that if you recognize the symptoms early and treat them appropriately, you can return to sports at your normal playing level.
Rotator Cuff Tears
A rotator cuff tear is a common cause of pain and disability among adults. Each year, almost 2 million people in the United States visit their doctors because of a rotator cuff problem.
A torn rotator cuff will weaken your shoulder. This means that many daily activities, like combing your hair or getting dressed, may become painful and difficult to do.
Anatomy
Your shoulder is made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle). The shoulder is a ball-and-socket joint: the ball, or head, of your upper arm bone fits into a shallow socket in your shoulder blade.
Your arm is kept in your shoulder socket by your rotator cuff. The rotator cuff is a group of four muscles that come together as tendons to form a covering around the head of the humerus. The rotator cuff attaches the humerus to the shoulder blade and helps to lift and rotate your arm.
There is a lubricating sac called a bursa between the rotator cuff and the bone on top of your shoulder (acromion). The bursa allows the rotator cuff tendons to glide freely when you move your arm. When the rotator cuff tendons are injured or damaged, this bursa can also become inflamed and painful.
Description
When one or more of the rotator cuff tendons is torn, the tendon no longer fully attaches to the head of the humerus.
Most tears occur in the supraspinatus tendon, but other parts of the rotator cuff may also be involved.
In many cases, torn tendons begin by fraying. As the damage progresses, the tendon can completely tear, sometimes with lifting a heavy object.
There are different types of tears.
Cause
There are two main causes of rotator cuff tears: injury and degeneration.
Acute Tear
If you fall down on your outstretched arm or lift something too heavy with a jerking motion, you can tear your rotator cuff. This type of tear can occur with other shoulder injuries, such as a broken collarbone or dislocated shoulder.
Degenerative Tear
Most tears are the result of a wearing down of the tendon that occurs slowly over time. This degeneration naturally occurs as we age. Rotator cuff tears are more common in the dominant arm. If you have a degenerative tear in one shoulder, there is a greater likelihood of a rotator cuff tear in the opposite shoulder -- even if you have no pain in that shoulder.
Several factors contribute to degenerative, or chronic, rotator cuff tears.
Risk Factors
Because most rotator cuff tears are largely caused by the normal wear and tear that goes along with aging, people over 40 are at greater risk.
People who do repetitive lifting or overhead activities are also at risk for rotator cuff tears. Athletes are especially vulnerable to overuse tears, particularly tennis players and baseball pitchers. Painters, carpenters, and others who do overhead work also have a greater chance for tears.
Although overuse tears caused by sports activity or overhead work also occur in younger people, most tears in young adults are caused by a traumatic injury, like a fall.
Symptoms
The most common symptoms of a rotator cuff tear include:
Tears that happen suddenly, such as from a fall, usually cause intense pain. There may be a snapping sensation and immediate weakness in your upper arm.
Tears that develop slowly due to overuse also cause pain and arm weakness. You may have pain in the shoulder when you lift your arm, or pain that moves down your arm. At first, the pain may be mild and only present when lifting your arm over your head, such as reaching into a cupboard. Over-the-counter medication, such as aspirin or ibuprofen, may relieve the pain at first.
Over time, the pain may become more noticeable at rest, and no longer goes away with medications. You may have pain when you lie on the painful side at night. The pain and weakness in the shoulder may make routine activities such as combing your hair or reaching behind your back more difficult.
It should be noted that some rotator cuff tears are not painful. These tears, however, may still result in arm weakness and other symptoms.
ACL Tear
This injury is a tearing of the ACL ligament in the knee joint. The ACL ligament is one of the bands of tissue that connects the femur to the tibia. An ACL tear can be painful. It can cause the knee to become unstable.
Shin Splints
This is pain you feel in the front of one or both of your lower legs. It can be a problem for runners, dancers, gymnasts and other active people.
Stress Fractures
Stress fractures are one or more tiny cracks in a bone. These fractures are common in the legs and feet.
Rotator Cuff
Injury
The rotator cuff muscles and tendons hold your upper arm bone in your shoulder socket. A hard fall, repetitive arm motions or problems with the structure of your shoulder can injure the rotator cuff.
Common Treatments of Sports Medicine
Medications
Over-the-counter medications can be used to control pain and inflammation. These medications, called non-steroidal anti-inflammatory drugs (NSAIDs), include aspirin, ibuprofen, and naproxen. Acetaminophen can also be effective in controlling pain.
Prescription medications also are available. A doctor will take account the type of condition/injury, its severity, and the patient's general physical health before prescribing a medication. Patients with stomach ulcers, asthma, kidney disease, or liver disease, for example, may not be able to safely take anti-inflammatory medications. For patients with inflammatory conditions, the doctor (typically a rheumatoligist) may prescribe medications that modify the body's immune response.
Diagnostic Imaging
Diagnostic imaging techniques help narrow the causes of an injury or illness and ensure that the diagnosis is accurate. These techniques include x-rays, computed tomography (CT) scans, and magnetic resonance imaging (MRI).
These imaging tools let your doctor "see" inside your body to get a "picture" of your bones, organs, muscles, tendons, nerves, and cartilage. This is a way the doctor can determine if there are any abnormalities.
X-rays
X-rays (radiographs) are the most common and widely available diagnostic imaging technique. Even if you also need more sophisticated tests, you will probably get an x-ray first.
The part of your body being pictured is positioned between the x-ray machine and photographic film or digital x-ray sensor. You have to hold still while the machine briefly sends electromagnetic waves (radiation) through your body, exposing the film to reflect your internal structure. The level of radiation exposure from x-rays is not harmful, but your doctor will take special precautions if you are pregnant.
Bones, calcifications, some tumors, and other dense matter appear white or light because they absorb the radiation. Less dense soft tissues and breaks in bone let radiation pass through, making these parts look darker on the x-ray film.
You will probably be x-rayed from several angles. If you have a fracture in one limb, your doctor may want a comparison x-ray of your uninjured limb. Your x-ray session will probably be finished in about 10 minutes. The images are ready quickly. They are either developed from the x-ray film or written to a CD to be viewed on a computer screen.
In some circumstances, a contrast material or dye may be injected into a joint while x-rays are taken. This procedure, which is called an "arthrogram," helps to outline soft tissue structures in the joint. It may also confirm needle placement in the joint when fluid is removed or medication is injected into the joint.
X-rays may not show as much detail as an image produced with more sophisticated techniques. They are, however, the most common imaging tool used to evaluate an orthpaedic problem and are available in our offices.
Computed Tomography (CT)
Computed tomography (CT) is an imaging tool that combines x-rays with computer technology to produce a more detailed, cross-sectional image of your body. A CT scan lets your doctor see the size, shape, and position of structures that are deep inside your body, such as organs, tissues, or tumors. Tell your doctor if you are pregnant before undergoing a CT scan.
You lie as motionless as possible on a table that slides into the center of the cylinder-like CT scanner. The process is painless. An x-ray tube slowly rotates around you, taking many pictures from all directions. A computer combines the images to produce a clear, two-dimensional view on a television screen.
You may need a CT scan if you have a problem with a small, bony structure or if you have severe trauma to the brain, spinal cord, chest, abdomen, or pelvis. Sometimes, you may be given a dye or contrast material to make certain parts of your body show up better.
A CT scan costs more and takes more time than a regular x-ray. It can be done in either a hospital setting or an outpatient imaging center.
Magnetic Resonance Imaging (MRI)
Magnetic resonance imaging (MRI) is another diagnostic imaging technique that produces cross-sectional images of your body. Unlike CT scans, MRI works without radiation. The MRI tool uses magnetic fields and a sophisticated computer to take high-resolution pictures of your bones and soft tissues. Tell your doctor if you have a pacemaker, implants, metal clips, or other metal objects in your body before you undergo an MRI scan.
You lie as motionless as possible on a table that slides into the tube-shaped MRI scanner. The MRI creates a magnetic field around you and then pulses radio waves to the area of your body to be pictured. The radio waves cause your tissues to resonate.
A computer records the rate at which your body's various parts (tendons, ligaments, nerves, etc.) give off these vibrations, and translates the data into a detailed, two-dimensional picture. You will not feel any pain while undergoing an MRI, but the machine may be noisy.
An MRI may be used to help diagnose torn knee ligaments and cartilage, torn rotator cuffs, herniated disks, osteonecrosis, bone tumors, and other problems. It may take from 30 to 60 minutes to do the study. Like a CT scan, an MRI scan may be done in a hospital or at an outpatient imaging center.
Other Imaging Studies
Other orthopaedic imaging studies include ultrasound and bone scan (nuclear imaging).
Platelet-Rich Plasma (PRP)
During the past several years, much has been written about a preparation called platelet-rich plasma (PRP) and its potential effectiveness in the treatment of injuries.
Many famous athletes — golfer Tiger Woods, tennis star Rafael Nadal, and several others — have received PRP for various problems, such as sprained knees and chronic tendon injuries. These types of conditions have typically been treated with medications, physical therapy, or even surgery. Some athletes have credited PRP with their being able to return more quickly to competition.
What Is Platelet-rich Plasma (PRP)?
Although blood is mainly a liquid (called plasma), it also contains small solid components (red cells, white cells, and platelets). The platelets are best known for their importance in clotting blood. However, platelets also contain hundreds of proteins called growth factors that are very important in the healing of injuries.
PRP is plasma with many more platelets than what is typically found in blood. The concentration of platelets — and, thereby, the concentration of growth factors — can be 5 to 10 times greater (or richer) than usual.
To develop a PRP preparation, blood must first be drawn from a patient. The platelets are separated from other blood cells and their concentration is increased during a process called centrifugation. These platelets are then injected into the injured site.
How Does PRP Work?
Although it is not exactly clear how PRP works, laboratory studies have shown that the increased concentration of growth factors in PRP can potentially speed up the healing process.
To speed healing, the injury site is treated with the PRP preparation. This can be done in one of two ways:
What Conditions are Treated with PRP? Is It Effective?
Research studies are currently being conducted to evaluate the effectiveness of PRP treatment. Recent research has shown that certain tendon problems can have improved outcomes with PRP injections. Additionally, more and more literature is showing the significant effectiveness of PRP in the treatment of mild to moderate knee osteoarthritis. Factors that can influence the effectiveness of PRP treatment include:
Chronic Tendon Injuries
According to the research studies currently reported, PRP is effective in the treatment of chronic tendon injuries, especially tennis elbow, a very common injury of the tendons on the outside of the elbow.
The use of PRP for other chronic tendon injuries — such as chronic Achilles tendinitis or inflammation of the patellar tendon at the knee (jumper's knee) is promising. However, it is difficult to say at this time that PRP therapy is any more effective than traditional treatment of these problems.
Acute Ligament and Muscle Injuries
Much of the publicity PRP therapy has received has been about the treatment of acute sports injuries, such as ligament and muscle injuries. PRP has been used to treat professional athletes with common sports injuries like pulled hamstring muscles in the thigh and knee sprains.
Surgery
More recently, PRP has been used during certain types of surgery to help tissues heal. It was first thought to be beneficial in shoulder surgery to repair torn rotator cuff tendons. However, the results so far show little or no benefit when PRP is used in these types of surgical procedures. Recent research has been dedicated to the benefit of PRP in meniscus healing after meniscus repair; however, these studies are only in their infancy.
Surgery to repair torn knee ligaments, especially the anterior cruciate ligament (ACL) is another area where PRP has been applied. At this time, there appears to be little or no benefit from using PRP in this instance.
Knee Arthritis
More and more literature is showing the effectiveness of low-leukocyte PRP in treating low- to moderate-grade knee osteoarthritis. Some studies have shown that these results can last up to two years.
Fractures
PRP has been used in a very limited way to speed the healing of broken bones. So far, it has shown no significant benefit.
Conclusion
Treatment with PRP could hold promise, however, current research studies to back up the claims in the media are lacking. Although PRP does appear to be effective in the treatment of certain chronic tendon injuries and low- to moderate-grade knee osteoarthritis, the medical community needs more scientific evidence before it can determine whether PRP therapy is truly effective in other conditions
Even though the success of PRP therapy is still questionable, the risks associated with it are minimal: There may be increased pain at the injection site, but the incidence of other problems — infection, tissue damage, nerve injuries — appears to be no different from that associated with cortisone injections.
If you are considering treatment with PRP, be sure to check your eligibility with your health insurance carrier. Few insurance plans, including workers' compensation plans, provide even partial reimbursement.
Soft Tissue Injections
Soft tissue injections are shots into an area of the body that is not a bone or a joint. They may be used in areas such as a tendon, a muscle, or a bursa. (A bursa is a sac of fluid that cushions and lubricates areas where tendons, ligaments, skin, muscles, or bones rub against each other.) These injections are often used to treat problems such as inflamed tendons (tendinitis) and bursas (bursitis).
These shots may be used to put in one or more medicines. Examples are local anesthetics that can help with short-term pain relief or steroid medicines that can give longer-term relief. Steroids don't always relieve pain. And when they do, it can take a few days to work. But when they work, the pain relief can last for several days to a few months.
Physical Therapy
Orthopedic physical therapy can be life-changing. A skilled physical therapist (PT) can get you back on track with your daily activities after surgery, an injury, accident, or illness.
That’s because an orthopedic PT specializes in diagnosing and treating conditions that affect any part of your musculoskeletal system.
An orthopedic PT works to integrate all your other bodily systems — especially your neurological and cardiovascular systems — with your musculoskeletal system to treat your injury or condition appropriately.
In this article, we’ll take a closer look at what orthopedic physical therapy is, when you may need it, and the types of treatments it includes.
What’s orthopedic physical therapy?
Orthopedic physical therapy involves the care of your entire musculoskeletal system, which includes your:
A PT who specializes in orthopedics can evaluate your condition and diagnose the issue or condition you have. This will include:
Orthopedic physical therapy is provided in outpatient clinics, hospitals, skilled nursing facilities, sports facilities, and even in your home. The entry-level degree for a PT these days is a clinical doctorate. So when you go to work with a PT, you’re working with a doctor of physical therapy, who has completed three years of graduate school studies.
Rehabilitation after surgery
After you have surgery, orthopedic physical therapy may help reduce pain, normalize your walking, improve your range of motion, and prevent excessive scar tissue buildup. Additionally, it may also help you regain your balance, strength, and mobility. Patients often work with orthopedic PTs after surgeries such as:
Rehabilitation after acute injury
An acute injury is one that happens as a result of a single trauma to the body. If you sprain an ankle, tear your meniscus, or herniate a disc in your back, an orthopedic PT can help you:
Rehabilitation after chronic injury
A chronic injury is damage to your body that occurs over time, usually because your movement patterns have caused small, repetitive injuries to your tendons, bones, or joints. Examples of chronic injuries include:
An orthopedic PT can analyze your movement patterns to isolate the source of the injury. They can also help you manage symptoms like pain and swelling, and can educate you about how to move safely to avoid injuries in the future.
What types of treatments are used?
Orthopedic PTs use a wide range of therapeutic modalities, exercises, assistive devices, and patient education methods to help you. Depending on how your therapist uses these treatments, they may be:
Here are some examples of treatments that may be used with orthopedic physical therapy.
Hot/cold therapy
Orthopedic PTs use both cryotherapy (cold therapy) and thermotherapy (heat therapy) to treat musculoskeletal pain and swelling.
In a 2015 studyTrusted Source involving 100 patients, both heat and ice helped prevent muscle damage, but cold used immediately after intense exercise was more effective at preventing muscle soreness.
Exercise therapy
Your therapist will create an exercise plan that will likely include strengthening, mobility, or balance-building exercises. It’s a good idea to practice the exercises with your therapist at first so you know you’re doing them correctly. Once you know how to do the exercises properly, you will be encouraged to do them at home on a regular basis to help boost your strength and mobility.
E-stim (TENS or NMES)
There is some evidenceTrusted Source that electrical stimulation has the ability to cut down on pain. When a PT uses this treatment modality, the therapist attaches an e-stim device to the injured area of your body.
There are two main types of e-stim devices. They include:
Traction
Traction takes the pressure off compressed or damaged joints. It can be conducted with a piece of equipment or with the therapist’s hands, and is considered helpful for people with:
Hydrotherapy
Your therapist may incorporate water therapy into your treatment plan. You may perform exercises in a pool or whirlpool as part of your rehabilitation.
This type of therapy can be especially helpful if you have joint issues or injuries because water provides gentle resistance. The buoyancy that water provides helps support you while you exercise, which reduces the impact you place on your joints.
Soft tissue manipulation
A soft tissue manipulation is a form of manual physical therapy in which the PT uses hands-on techniques on your muscles, ligaments, and fascia. This is done to break adhesions and to optimize your muscle function.
Although more research is needed to verify the specific effects of soft tissue manipulation, it is generally recommended as a way to reduce painTrusted Source and decrease muscle tension.
Joint mobilization
This technique involves a therapist moving your joint firmly and carefully in the desired direction. Like soft tissue manipulation, it is a manual technique.
Dry needling
In some states, PTs are permitted to use dry needling, a technique that’s similar to acupuncture.
With this technique, the therapist inserts a thin needle into a specifically targeted muscle with a trigger point — usually one that is the source of tension or pain.
Laser or light therapy
Orthopedic PTs may use low-level laserTrusted Source or light therapies to boost muscle performance, reduce muscle fatigue, and enable muscle repair after an injury.
Kinesiology taping
Kinesiology tape is an extremely flexible band of tape made of stretchy fabric. This therapeutic tape, which often comes in bright colors or snappy patterns, is applied to specific areas of the body. Although there is little research to support its effectiveness, anecdotal evidence suggests that kinesiology tape may help:
How can you get the best results from orthopedic physical therapy?
To get the most out of each physical therapy session, it’s important to:
Patient Guide to Safe Surgery
When we go for surgery we turn over our care to highly trained doctors, nurses, and hospital staff. However, we also know that patients who understand their treatment are going to get the most out of their hospital visit.
Talk to your caregivers, understand what is happening to you, and never be afraid to ask questions. Bring a friend or family member as your healthcare advocate. Ask new and unfamiliar caregivers to identify themselves and explain their role in your treatment. Be involved, and help to make your care go well.
Preoperative Consultation with Your Surgeon
When you visit your surgeon, use the following checklist to provide your surgeon and surgical team with necessary information about you and your orthopaedic problem.
Before Surgery
Bring to the hospital:
After Surgery
Pay attention to the health care you receive. If something does not seem right — such as the type of medication you are receiving-tell your doctor, nurse, or another healthcare professional.
Prevent falls.
Know your treatment plans.
At Discharge
You usually receive a lot of instructions just prior to leaving. The nurse will give you the highlights in writing, including a list of the medications you will need to take. It is hard to remember everything. As always, ask questions if you do not understand the instructions.
Conclusion
Research shows that patients who take part in decisions about their health care are more likely to have better outcomes. Ask questions, understand treatment, and follow instructions, and you will be on the road to recovery.
ACL Repair
This procedure repairs your knee after a tear of the anterior cruciate ligament This ligament is in the center of the knee. It helps anchor the femur to the tibia.
Physical Therapy
Physical therapy can help control pain, recover from injury or disease and help you get better after surgery. It can also help keep you healthy as you get older.
Ankle Fracture Surgery
This surgery fixes an unstable break in your ankle. The break could be in the small bone of your lower leg, called the "fibula" or the larger bone, called the "tibia." Sometimes, they're both broken.
Rotator Cuff Repair
This surgery repairs a tear of the rotator cuff in your shoulder. The rotator cuff is group of muscles and tendons. It holds the head of the humerus in the shoulder socket.
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