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Sports Medicine

Sports injuries occur when playing indoor or outdoor sports or while exercising. Sports injuries can result from accidents, inadequate training, improper use of protective devices, or insufficient stretching or warm-up exercises. The most common sports injuries are sprains and strains, fractures, and dislocations.

The most common treatment recommended for injury is rest, ice, compression and elevation (RICE).

  • Rest: Avoid activities that may cause injury
  • Ice: Ice packs can be applied to the injured area which will help to diminish swelling and pain. Ice should be applied over a towel to the affected area for 15-20 minutes four times a day for several days. Never place ice directly over the skin
  • Compression: Compression of the injured area helps to reduce swelling. Elastic wraps, air casts, and splints can accomplish this
  • Elevation: Elevate the injured part above heart level to reduce swelling and pain.

Some of the measures that are followed to prevent sports related injuries include:

Follow an exercise program to strengthen the muscles

  • Gradually increase your exercise level and avoid overdoing the exercise
  • Ensure that you wear properly-fitted protective gear such as elbow guards, eye gear, facemasks, mouthguards, and pads, comfortable clothes, and athletic shoes before playing any sports activity which will help to reduce the chances of injury
  • Make sure that you follow warm up and cool down exercises before and after sports activity. Exercises will help to stretch the muscles, increase flexibility, and reduce soft tissue injuries
  • Avoid exercising immediately after eating a large meal
  • Maintain a healthy diet which will nourish the muscles
  • Avoid playing when you are injured or tired. Take a break for some time after playing
  • Learn all the rules of the game you are participating in
  • Ensure that you are physically fit to play the sport

Some of the common sports injuries include:

Shoulder Injuries

Severe pain in shoulders while playing your favorite sports such as tennis, basketball and gymnastics may be because of torn ligament in shoulder or shoulder dislocation. These may be caused by overuse of shoulder while playing sports. Simple pain or acute injuries may be treated with conservative treatment and chronic injuries may require surgical treatment.

Knee Injuries

Anterior cruciate ligament (ACL) is major stabilizing ligament in the knee which may tear with over use of knee for playing sports. The ACL has poor ability to heal and may cause instability. Other common sports injuries in knee are cartilage damage and meniscal tear. Knee injuries of sports may require surgical intervention that can be performed using open surgical or minimally invasive technique. Your surgeon will recommend you for physical therapy to strengthen your muscles, improve elasticity and improve the movements of the bones and joints.

Sports-related Elbow injuries

Some of the common sports-related elbow injuries include:

Elbow Fractures:

Fracture is a common injury to the elbow. Elbow fractures may result from a fall onto an outstretched wrist, a direct impact to the elbow or a twisting injury. Elbow fractures may cause severe pain, swelling, tenderness and painful movements. If a fracture is suspected, immediate intervention by your doctor is necessary. Surgery is often required if a bony displacement is observed.

Throwing Injuries

An athlete uses an overhand throw to achieve greater speed and distance. Repeated throwing in sports such as baseball and basketball can place a lot of stress on the joints of the arm, and lead to weakening and ultimately, injury to the structures in the elbow. These overuse injuries may include:

Inflammation or tears of the ulnar collateral ligaments (supportive tissue that support the elbow joint)

Inflammation of the flexor tendons (tissue connecting muscles of the forearm to the upper arm bone) at the inner side of the elbow

Wearing of cartilage (spongy protective tissue lining bones in a joint) over the olecranon (pointed elbow bone) and development of abnormal bony growths (bone spurs)

Tiny cracks (stress fractures) of the olecranon

Irritation of the ulnar nerve

Throwing injuries can produce pain, numbness, tingling and reduction in the throwing velocity. When you present with symptoms of a throwing injury, your doctor will review your medical history, discuss your athletic activities and perform a thorough physical examination to examine the strength, range of motion, and stability of your elbow. Imaging tests (X-ray, MRI and CT scans) may be ordered to confirm the diagnosis.

Your doctor may suggest a conservative approach to treatment such as rest, ice application, physical therapy, anti-inflammatory medications, and a modification of activity and throwing technique. If symptoms remain uncontrolled surgery may be performed to repair the injured tissues either through an open surgery or a less invasive technique (arthroscopy) where a camera and instruments are inserted through a narrow tube. Surgery may be performed to reconstruct the ulnar collateral ligament and relocate the ulnar nerve to the front of the elbow. Four to six weeks of rehabilitation is recommended following surgery to prevent stiffness, and improve strength and range of motion. Your doctor will discuss when it safe for you to return to your activities based on the injury and how well you recover.

Distal Bicep Rupture

The biceps muscle is located in front of your upper arm. It helps in bending your elbow as well as in rotational movements of your forearm. Also, it helps to maintain stability in the shoulder joint. The biceps muscle has two tendons, one of which attaches it to the bone in the shoulder and the other attaches at the elbow. The biceps tendon at the elbow is called the distal biceps tendon and if there is a tear in this tendon, you will be unable to move your arm from the palm-down to palm-up position. Once the distal biceps tendon is torn, it cannot regrow back to the bone and heal by itself. Permanent weakness during rotatory movements of the forearm may occur if the tendon is not repaired surgically.

Biceps tendon tear can be complete or partial. In partial biceps tendon tear, the tendon does not break up completely. Complete tendon tears will break the tendon into two parts. Tears of the distal biceps tendon are usually complete tears and the muscle gets separated from the bone. They most often result from a sudden injury or lifting a heavy object. Additional risk factors such as advancing age, smoking, and use of corticosteroid medications can also result in increased muscle and tendon weakness.

The most common symptom is a sudden, severe pain in the upper arm or at the elbow. You may feel a “pop” at the elbow when the tendon tears. Other symptoms include swelling, visible bruising, weakness in the elbow, trouble turning your arm from a palm up to a palm down position, and a gap in the front of the elbow caused by absence of the tendon. A bulge may also appear in your arm caused by the recoiled, shortened biceps muscle.

Distal biceps tendon rupture is usually diagnosed based on your symptoms, medical history, and physical examination. During the physical examination, your doctor will look for a gap in the tendon by palpating the front part of your elbow. Your doctor will diagnose a partial tear by asking you to bend your arm and tighten the biceps muscle. You may have pain if there is a partial tear. X-rays may be taken to rule out other conditions causing elbow pain. Using an MRI scan your doctor can know whether tear is partial or complete.

There are several procedures to accomplish reattachment of the distal biceps tendon to the forearm bone. Some techniques require two incisions while in others one incision may be sufficient. In some cases, the tendon is reattached using stitches passed through holes drilled in the bone. Sometimes, a small metal implant may be used to attach the tendon.

Surgical technique

During distal biceps tendon repair, your surgeon makes a small incision over the upper forearm, where the biceps muscle attaches to the radius bone. The torn biceps tendon is brought up through the incision. Then, the radius bone is prepared for tendon reattachment and to promote healing. Two suture anchors will be inserted into the bone. These serve as anchorage for the tendon. The sutures from the suture anchors are passed through the tendon in a particular interlocking manner so as to ensure a strong tendon repair.

After the repair is complete, a hinged elbow brace will be applied with your elbow bent at 90 degrees. The brace will be removed after 6 weeks and it may take up to 6months -1 year to regain full strength.

Tommy John Surgery

Ulnar collateral ligament (UCL) Reconstruction surgery involves replacing a torn ulnar collateral ligament with a tendon from elsewhere in the body. It is also referred to as Tommy John Surgery.

The UCL, also called medial collateral ligament, is located on the inside of the elbow and connects the ulna bone to the humerus bone. It is one of the main stabilizing ligaments in the elbow especially with overhead activities such as throwing and pitching. When this ligament is injured, it can end a professional athlete’s career unless surgery is performed.

Symptoms

The common symptoms associated with a UCL injury are as follows:

  • Pain on inner side of the elbow
  • Unstable elbow joint
  • Numbness in the little finger or ring finger
  • Decreased performance in activities such as throwing baseballs or other objects

Causes

Ulnar collateral ligament injury is usually caused by repetitive overhead throwing such as in baseball. The stress of repeated throwing on the elbow causes microscopic tissue tears and inflammation. With continued repetition, eventually the UCL can tear preventing the athlete from throwing with significant speed. If untreated, it can end an athlete’s professional career. UCL injury may also be caused by direct trauma such as with a fall, car accident, or work injury. Other causes include any activity that requires repetitive overhead motion of the arm such as tennis, pitching sports, fencing, and painting.

Diagnosis

UCL injury should be evaluated by an orthopedic specialist for proper diagnosis and treatment. Your physician will perform the following:

  • Medical history
  • Physical examination including a valgus stress test to assess for elbow instability

Other tests such as X-rays and MRI scans may be ordered to confirm the diagnosis.

Treatment

Your physician will recommend conservative treatment options to treat the symptoms associated with UCL injury unless you are a professional or collegiate athlete. In these cases, if the patient wants to continue in their sport, surgical reconstruction is performed.

Conservative treatment options that are commonly recommended for non-athletes include the following:

  • Activity restrictions
  • Orthotics
  • Ice compression
  • Medications
  • Physical therapy
  • Pulsed ultrasound to increase blood flow to the injured ligament and promote healing
  • Professional instruction

Procedure

If conservative treatment options fail to resolve the condition and symptoms persist for 6-12 months, your surgeon may recommend ulnar collateral ligament reconstruction surgery. UCL reconstruction surgery repairs the UCL by reconstructing it with a tendon from the patient’s own body (autograft) or from a cadaver (allograft). The most frequently used tissue is the palmaris longus tendon in the forearm. The basic steps for UCL reconstruction surgery includes the following:

  • The surgery is performed in an operating room under regional or general anesthesia
  • Your surgeon will make an incision over the medial epicondyle area
  • Care is taken to move muscles, tendons, and nerves out of the way
  • The donor tendon is harvested from either the forearm or below the knee
  • Your surgeon drills holes into the ulna and humerus bones
  • The donor tendon is then inserted through the drilled holes in a figure 8 pattern
  • The tendon is attached to the bone surfaces with special sutures
  • The incision is closed and covered with sterile dressings

Finally, a splint is applied with the elbow flexed at 90 degrees.

Post-operative care

After surgery your surgeon will give you guidelines to follow, depending on the type of repair performed and the surgeon’s preference. Common post-operative guidelines include:

  • Elevate your arm above heart level to reduce swelling
  • Wear an immobilizing splint or cast for 1-3 weeks
  • Apply ice packs to the surgical area to reduce swelling
  • Keep the surgical incision clean and dry. Cover the area with plastic wrap when bathing or showering
  • Physical therapy will be ordered for strengthening and stretching exercises after the removal of the splint or cast
  • Professional athletes can expect a strenuous strengthening and range of motion rehabilitation program for 6-12 months before returning to their sport
  • Eating a healthy diet and not smoking will promote healing

Risks and complications

As with any major surgery there are potential risks involved.

The majority of patients suffer from no complications following UCL Reconstruction surgery, however, complications can occur following elbow surgery and include:

  • Infection
  • Limited range of motion
  • Nerve damage causing numbness, tingling, burning or loss of feeling in the hand and forearm area
  • Cubital Tunnel Syndrome
  • Elbow instability
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