SPORTS-RELATED INJURIES
Patellofemoral syndrome is a knee injury caused by the kneecap repeatedly moving against the leg bone — damaging tissue and causing pain. This could also occur as the result of an acute trauma to the knee, such as a sharp blow sustained through a fall.
Symptoms of patellar instability may include:
• Buckling of the knee
• Knee slips off to one side
• Stiffness of the joint
• Pain when sitting
• Swelling of the joint
It can take up to six weeks for this type of injury to heal, while following our combination of special exercises, proper footwear and anti-inflammatory treatments to speed the process.
Nonsurgical treatments such as exercise and a brace are recommended when the kneecap is only partially dislocated. This will help to strengthen the muscles of the thigh to help hold the knee in place.
The hip joint is the connection of the “ball” (head of the femur bone) with the “socket” (acetabulum of the pelvis). It supports the weight of the body in static and dynamic postures, and allows for a wide range of movements. The hip is composed of several bones, as well as three key ligaments which reinforce the joint. The hip joint also includes the labrum, which is a ring of cartilage that surrounds the “socket” and holds the “ball” in place, making the joint harder to dislocate.
The hip joint is susceptible to many musculoskeletal injuries, which include arthritis, dislocation, impingement, labral tears and damage to the surrounding muscles, tendons and ligaments.
Symptoms of a hip injury may include:
• Pain while walking or pivoting
• Pain at night
• Decreased mobility or flexibility
• Catching, popping or grinding of the joint
Injuries to the hip may result from acute trauma, such as a fall or motor vehicle accident, or chronic wear and tear. Diagnosis will include a comprehensive physical examination to determine range of motion, stability and pain, as well as an X-ray, MR arthrogram to determine the nature of the injury and an intra-articular injection.
Some other hip conditions include:
• Hip impingement or femoroacetabular impingement (FAI): Encompasses conditions of the hip in which the shape of your hip bones do not permit normal movement of the hip and may cause pain. Abnormal bone shape can be on the femur (CAM impingement), on the rim of the acetabulum (Pincer impingement), or both. The rubbing of the bones in an abnormal fashion can cause pain and lead to damage of other structures in the hip, including the cartilage and acetabular labrum.
• Labral tear: The fibrous cartilage lining of the acetabulum (socket), the labrum, may be torn through various mechanisms including impingement and trauma. Many individuals have labral tears, and labral tears may or may not cause an individual to experience symptoms in their groin and hip. The injection you have or may get into your hip helps determine if the labral tear is contributing to your hip pain. Some symptoms of labral tears are locking, catching, and/or pain in the groin.
• Loose bodies: A loose body is one or multiple pieces of tissue or bone that have fragmented from their normal position in the joint and are no longer attached properly. These fragments become free to move about the joint and may damage normal tissue and cause pain and/or a catching sensation. These fragments can result from trauma, such as a fall, motor vehicle accident, or sport injury.
• Hip cartilage injuries: The surface of the head of the femur and corresponding surface on the acetabulum are lined by a surface known as articular cartilage. This surface allows smooth motion within the hip joint and can be found in various other joints including the shoulder, knee, and ankle. The concern about articular cartilage injury lies in the lack of potential for this type of cartilage to regenerate and heal when significantly damaged.
Patients that sustain trauma to the hip joint and/or have chronic impingement may damage this cartilage. Usually, the cartilage begins degeneration by undergoing softening. When associated with impingement, the second stage of cartilage injury usually involves the detachment of the cartilage from the underlying bone. This can be thought of as a bubble of cartilage. The next stage of cartilage injury is generally detachment of the bubble to the point where it becomes a cartilage flap. This cartilage flap will not heal back to the bone on its own. Untreated flaps encourage further cartilage degeneration and the progression of osteoarthritis within the hip joint.
For some patients, hip arthroscopy surgery will be necessary to treat their condition, find long-term pain relief, and achieve their full recovery goals. Arthroscopic hip surgery involves making 2 or 3 small incisions around your hip and looking inside the joint with a camera that is around the same diameter as a pencil. While the camera is inserted in one small incision, the other incision(s) will be used to place various instruments in the joint in order to treat the cause of your hip discomfort.
Frequently Asked Questions
Q: Will surgery always be necessary to treat hip pain?
A: No, some hip injuries can be treated without the need for surgery. Nonsurgical treatments for a hip injury typically include a modification of activities, physical therapy exercises to stretch and strengthen the joint, and non-steroidal anti-inflammatory medications to relieve pain. Nonsurgical means are often prescribed before any surgical options are recommended.
Q: What can be treated using hip arthroscopy?
A: Arthroscopic hip surgery is a treatment option for various hip conditions, including:
• Labral tears
• Impingement
• Cartilage injuries
• Removal of loose bodies
Arthroscopic surgery will be recommended for injuries that do not respond to non-surgical methods and involve weakness, loss of function, and/or pain.
Q: Why is arthroscopy a superior method of hip surgery?
A: The advantage of arthroscopy to traditional open surgery is that the joint does not need to be completely opened up, and no muscles are cut or displaced. This reduces the recovery time and may increase the success rate due to reduced trauma to the joint.
Dislocations, sprains/strains and tears make up to 20% of all sports injuries. Most shoulder injuries are caused by overuse — particularly with sports that require overhead movement, such as tennis, swimming, basketball and volleyball. Ask us about our preventative exercise programs for the off-season. Shoulder injuries can be treated with non-surgical, orthobiologic, or minimally-invasive arthroscopic surgery.
Frequently Asked Questions
Q: Will I need physical therapy following shoulder instability treatment?
A: PT is an important part of your recovery from shoulder instability, especially if you received shoulder instability surgery. You must see a physical therapist 3 times a week, beginning after your first postoperative visit for suture removal. In addition, you will perform your exercises at home 3 times a day. These exercises will consist of hand, wrist and elbow range of motion as well as specific exercises to prevent your shoulder from becoming stiff. We will write a prescription for you to take to your therapist. If you need help finding a therapist, please let our office know.
Q: How long will it take to recover from an orthopedic shoulder injury?
A: Every patient is unique, and your recovery period will depend on a wide range of personalized factors. We will advise you on your length of recovery during your consultations, and our team will be with you at each step of your rehabilitative process.
Q: How does an arthroscopic rotator cuff surgery work?
A: When an orthopedic shoulder surgeon performs arthroscopic shoulder surgery, we make two tiny, minimally-invasive incisions in your affected shoulder. We then insert a tiny tool with a camera attached called an arthroscope, which allows us to view the inside of your joint without opening the entire shoulder. Partial tears will involve a trimming or smoothing procedure called “debridement,” while full tears will involve suturing the two sides of the tendon back together. Tendons torn away from their insertion onto the upper arm bone (humerus) will need to be reattached.
Often athletes will pull or strain one of the three muscles behind the knee, in the back of the leg — known as a hamstring strain. Pain results from small tears in the muscles or tendons, which is often the result of overuse or over-stretching. Hamstring injuries generally take a long time to heal and require rest, icing and anti-inflammatories. Be sure to inquire about exercise plans that can help prevent injury and/or speed recovery.
Repetitive use of the elbow in sports such as tennis and golf cause an injury called epicondylitis (or tennis elbow), which make up about 7% of all sports injuries. Repetitive movements cause tears in the elbow ligaments, resulting in pain on the inside or outside of the elbow. To properly heal, you may need a break from the sport — however, we also can provide an exercise plan to strengthen the arm to prevent elbow injuries.
This lower back pain can send pain down into the legs and is often caused by activities such as baseball, golf, biking and track/field. Sciatica is often caused by a lack of stretching prior to activity. With any back pain, immediate attention should be sought at our office.
Shin splints are often identified as shooting pains that travel down the front of the legs — often found with runners or those that increase intensity of activity too quickly. In some cases, shin splints may be the result of a stress fracture — so it’s important to be seen by one of our doctors for proper diagnosis. Be sure to ask for our preventative/recovery exercises to help eliminate pain and keep you in play.
The muscles in the inner thigh form your groin muscles, and when they are overused, over-extended or not properly stretched can result in a groin pull. Most sports that require a side extension of the leg can cause this type of injury – but with proper warm-up stretching, groin pulls can be prevented.
Athletes put the anterior cruciate ligament of the knee under a tremendous amount of stress. If left untreated, ACL injuries can lead to cartilage damage.
ACL ruptures can be caused by these factors:
• Environmental: Sports that include running, jumping, and landing pose the most potential for injury to the athlete. Interestingly, the risk for rupture of the anterior cruciate ligament does not increase in contact sports (as opposed to non-contact sports). About 70% of ACL tears are noncontact injuries.
• Anatomical: ACL injuries are especially common in female athletes, due to many possible contributing factors. The most prevalent explanation proposes that female athletes tend to land more straight-legged than men, removing the quadriceps muscles’ shock-absorbing action on the knee. Often, the knee on a straight leg can’t withstand this and bends sideways.
• Hormonal: High levels of hormones including estrogen have been associated with an increased risk of ACL rupture.We’ll recommend the best approach — surgical or non-surgical based on your injuries and condition — to return you the full range of motion and stability to the knee.
A meniscus tear can sometimes be treated without a need for meniscus surgery. Non-surgical treatments can include orthobiologic therapies, rest, ice, compression and elevation combined with anti- inflammatory medications for pain. These treatments have proven effective, since the blood vessels feeding the outer edges of the meniscus allow your body to heal itself on its own. However, if your knee does not heal on its own and remains painful, stiff or locked, our team may recommend arthroscopic knee surgery.
Frequently Asked Questions
Q: What can I expect from arthroscopic knee surgery?
A: Arthroscopic knee surgery involves making two tiny, minimally-invasive incisions in your knee, then insert a tiny tool with a camera attached called an arthroscope. This allows us to view the inside of your joint without opening the entire knee. We then trim away pieces of damaged cartilage, leaving only healthy cartilage to strengthen and grow.
Q: Will I need physical therapy following my knee treatment?
A: Yes. Whether you require surgery or not, physical therapy is an important part of ensuring that your knee returns to its peak performance following your injury and treatment. Be sure to follow all of our instructions when it comes to physical therapy.
Q: How long will it take to recover from an orthopedic knee injury?
A: Every patient is unique, and your recovery period will depend on a wide range of personalized factors. Our team will advise you on your length of recovery during your consultations and your rehabilitative process.
The muscles that mobilize your leg or knee in an upward motion are a group of muscles called your hip flexor. Injuries may occur when these muscles are weak, stiff or injured in a fall — and can be torn or overstretched. Be sure to ask for our exercise plan, designed to increase flexibility and hip flexor strength for all sports and activities at any age.
Rotator cuff muscles are important in shoulder movements and in maintaining shoulder joint stability. The rotator cuff, also called the rotor cuff, identifies the group of muscles and tendons that stabilize the shoulder. The rotator cuff muscles undergo a tremendous amount of stress under normal circumstances. Add the stress and strain of tennis or baseball, and the risk of suffering sports injuries increases dramatically.
Rotator cuff tears may result from a single traumatic injury or repetitive motion in the joint. The majority of these injuries involve the overuse of these muscles and tendons over a period of several years.
Diagnosis of a rotator cuff tear involves a physical examination to check range of motion, tenderness and strength, as well as an X-ray or MRI. Tears of the rotator cuff are sometimes correlated with fracture or shoulder dislocation. Non-surgical treatments typically include strengthening exercises to increase range of motion, anti-inflammatory medication, steroid injections, rest, and activity modification.
Signs of rotator cuff injury include:
• Pain when attempting over-the-head activities.
• Pain in the shoulder that is often worse at night.
• Joint stiffness.
• Pain when bending the arm and rotating it outward.Rotator cuff surgery is recommended for injuries to the rotator cuff that do not respond to non-surgical methods and involve weakness, loss of function, and pain. The nature of the injury will determine the type of surgery, although most tears can be repaired using arthroscopic shoulder surgery.
Shoulder dislocation occurs when the top of the arm bone (humerus) detaches from the shoulder blade (scapula). Dislocation must be reduced quickly and at times requires anesthesia. Long term treatment may require Physical Therapy or surgical repair to reduce subsequent dislocation. Once the area has been repositioned, you may be discharged with a mobilizer sling and a prescription for anti-inflammatory medication.
If you’re experiencing the following symptoms, it may be time for shoulder instability treatment:
• Your shoulder chronically becomes dislocated
• Your shoulder “gives out” on a regular basis
• You experience persistent shoulder pain
• Your shoulder constantly feels loose in its joint
When determining how to treat shoulder instability, we will take your personal goals, injury and medical history into account. Some patients can recover from shoulder instability nonsurgically, using physical therapy techniques to strengthen the shoulder muscles and build stability.
Patients who struggle with frequent dislocations and have sustained damage to the surrounding ligaments may require shoulder instability surgery. The goal of this procedure is to repair those damaged ligaments, allowing them to become strong enough to support the shoulder and restore its stability.