Sports Medicine

The Division of Sports Medicine’s orthopaedic surgeons are board-certified musculoskeletal specialists, skilled in both surgical and non-surgical management of sports injuries. An overall philosophy of early intervention, treatment, and rehabilitation enables the patient to return to a physically active lifestyle.

Soft Tissue Injuries
Shoulder Injuries
Knee Injuries
Anterior Cruciate Ligament Tear
Medial Collateral Ligament Tear
Meniscus Tear
Elbow Injuries
Treatments

Soft Tissue Injuries    back to top

Bursitis
Chronic inflammation of a bursa (synovial fluid filled sac) located between skin and bone. Bursae act as cushions and ease the movement of one part of the body over another. Bursitis is characterized by pain, swelling tenderness, and limitation of any motion that involves the inflamed bursa.

Sprain
A sprain is a partial or complete tear of a ligament.

Strain
A strain is a partial or complete tear of a muscle or tendon.

Tendinitis
An inflammation of a tendon, a tough band of tissue that connects muscle to bone.


Shoulder Injuries    back to top

The shoulder girdle attaches the humeral bone of the upper extremities to the axial skeleton. Each shoulder girdle consists of two bones: a clavicle and a scapula. The shoulder joint allows movement in many directions. It is surrounded by four muscles and supported by tendons. The tendons are jointly referred to as the rotator cuff.

Frozen Shoulder
Frozen shoulder is the common term for adhesive capsulitis, an inflammatory condition that restricts motion in the shoulder. The capsule of a shoulder joint includes the ligaments that attach the shoulder bones to each other. When inflammation occurs within the capsule, the shoulder bones are unable to freely move within the joint. Diabetes, shoulder trauma (including surgery), a history of open heart surgery, hyperthyroidism, and a history of cervical disk disease are all associated with an increased risk for this problem. Often, there is no known cause.

Rotator Cuff Tendinitis/Tear
Rotator cuff tendinitis is an inflammation (irritation and swelling) of the tendons of the shoulder. The shoulder joint is a ball and socket type joint where the top part of the arm bone (humerus) forms a joint with the shoulder blade (scapula). The rotator cuff holds the head of the humerus into the scapula. Inflammation of the tendons of the shoulder muscles can occur in sports requiring the arm to be moved over the head repeatedly as in tennis, baseball (particularly pitching), swimming, and lifting weights over the head. Chronic inflammation or injury can cause the tendons of the rotator cuff to tear. The risk factors are being over age 40 and participation in sports or exercise that involves repetitive arm motion over the head (such as baseball).

Knee Injuries    back to top

The knee is the largest joint in the body. It is composed of the lower femur (thigh bone), the upper tibia (shin bone), and the patella (knee cap). Large ligaments attached to the femur and tibia provide stability, and the quadriceps (thigh muscle) provides strength. The ends of the bones are cushioned by cartilage.

Anterior Cruciate Ligament Tear   back to top
An anterior cruciate ligament injury is extreme stretching or tearing of the anterior cruciate ligament (ACL) in the knee. A tear may be partial or complete. The knee is essentially a modified hinge joint located where the end of the femur (thigh bone) meets the top of the tibia (shin bone). There are four main ligaments connecting these two bones:

• medial collateral ligament (MCL) -- runs along the inner part of the knee and prevents the knee from bending inward
• lateral collateral ligament (LCL) -- runs along the outer part of the knee and prevents the knee from bending outward
• anterior cruciate ligament (ACL) -- lies in the middle of the knee. It prevents the tibia from sliding out in front of the femur, and provides rotational stability to the knee
• posterior cruciate ligament (PCL) -- works in concert with the ACL. It prevents the tibia from sliding backwards under the femur

The ACL and PCL cross each other inside the knee forming an "X." This is why they are called the “cruciate” (cross-like) ligaments.

ACL injuries are often associated with other injuries. The "unhappy triad" is a classic example, in which the ACL is torn at the same time as the MCL and the medial meniscus (one of the shock-absorbing cartilages in the knee). This type of injury is most often seen in football players and skiers. Women are more likely to suffer an ACL tear than men. The cause for this is not completely understood, but may have to do with differences in anatomy as well as muscular functioning.

Adults who tear their ACL usually do so in the middle of the ligament or pull the ligament off the femur bone. These injuries do not heal by themselves. Children are more likely to pull off their ACL with a piece of bone still attached -- these may heal on their own or may require the bone to be fixed. In cases of suspected ACL tear, an MRI may help to confirm the diagnosis, and to evaluate other injuries to the knee, such as to the other ligaments or cartilage.

Some people are able to live and function normally with a torn ACL. However, most people complain that their knee is unstable and may "give out" with attempted physical activity. Unrepaired ACL tears may also lead to early arthritis in the affected knee.

ACL tears may be due to contact or non-contact injuries. A blow to the side of the knee, such as may occur during a football tackle, may result in an ACL tear. Alternatively, coming to a quick stop, combined with a direction change while running, pivoting, landing from a jump, or overextending the knee joint, can cause injury to the ACL. Basketball, football, soccer and skiing are common causes of ACL tears.

Medial Collateral Ligament Tear   back to top
The medial collateral ligament (MCL) is a ligament extending from the upper-inside surface of the tibia (the shin bone) to the bottom-inside surface of the femur (the thigh bone). The ligament stabilizes the joint on the inside of the knee. An MCL injury is a stretch, partial tear, or complete tear of the medial collateral ligament of the knee. (The term "medial" means the ligament is on the inside of the knee.) The MCL is usually injured by pressure placed on the knee-joint from the outside, resulting in stress on the inside of the knee joint (valgus stress). It is often injured at the same time as an anterior cruciate ligament (ACL) injury.

During physical examination with a medial collateral ligament test, the doctor can detect looseness of the ligament. This test involves bending the knee to 25 degrees and putting pressure on the outside surface of the knee.

Other tests may include:

• a knee MRI
• a knee joint X-ray
• a knee joint X-ray with stress applied

Meniscus Tear
The meniscus is a C-shaped fibrous piece of cartilage that is found in certain joints and forms a buffer between the bones to protect the joint. The meniscus also serves as a shock-absorption system, assists in lubricating the joint, and limits the joint flexion and extension.

A meniscus tear is a tear in the shock-absorbing cartilage (meniscus) of the knee. Meniscal tears are most commonly caused by twisting or hyperflexion of the joint. A physical examination will usually show signs of a torn meniscus. This includes various manipulations of the joint. The following are used to diagnose meniscal tears:

• Pain on the joint line in the area of the meniscus tear.
• In the McMurray's test, the health care practitioner will have you lie on your back while holding the heel of your injured leg with your leg bent. Pressure is placed on the outside of the knee with the practitioner's other hand, and the leg is straightened with the foot turned in (internally rotated). Pain and/or a click over the inner part the joint indicate an inner (medial) meniscal tear.
• For an Apley's compression test, the health care practitioner will have you lie on your back with your knee bent at a 90 degree angle. The practitioner will grab your foot with both hands and rotate it to the outside (lateral rotation) while a downward force is applied to the foot. The practitioner's knee and thigh may be used to stabilize your thigh. Pain in the inner part of the joint may indicate an inner (medial) meniscal tear.
• A ballottement test for synovial effusions (excess joint fluid) is positive in meniscal tears, indicating swelling with fluid around the joint. This test is a physical examination test that allows the practitioner to detect the presence of fluid in a body space.
• Other tests that are used to diagnose meniscus tears may include:
• a knee MRI
• a knee joint X-ray

Elbow Injuries    back to top

The elbow is a complex hinge joint that is capable of bending, straightening, and twisting movements. It is composed of three bones, which are attached by muscles and ligaments. The distal humerus (upper arm bone) connects with the upper ends of the ulna and radius (the forearm bones). The ends of the bones are cushioned by cartilage. The ulnar collateral ligament grouping (UCL) is composed of three bands of ligaments. The UCL holds the bones forming the elbow in place, and helps to control joint movement.

Golfer’s Elbow
Golfer's elbow or medial epicondylitis refers to pain and inflammation of the epicondyle (bony prominence) on the inside of the elbow closest to the body.

Tennis Elbow
Tennis elbow or lateral epidondylitis refers to pain and inflammation of the epicondyle (bony prominence) on the outside of the elbow.

Sports Medicine Treatments   back to top

Medical Evaluation
Your physician will complete the following evaluations:

• History: The physician will ask how the injury occurred, what type of pain (stabbing, dull, throbbing) is present, and the location of pain, as well as what sport was involved.

• Physical Examination: The affected area will be examined and palpated for obvious skeletal abnormalities and limitations in mobility.

• Diagnostic Imaging: X-rays, CT scanning, or MRI studies may be necessary in order to assess the extent of injury.

First Treatment
The initial treatment for minor soft tissue injuries can be remembered by the acronym RICE: rest, ice, compression, elevation.

Conservative Treatment
Well-established non-surgical treatments include rest, medication, physical therapy, immobilization (casting), and support (bracing).

Surgical Treatment

Arthrodesis
The joining or fusing together of two joint bones. The new fused joint sacrifices flexibility for increased stability.

Arthroplasty
A surgical procedure performed to restore function to a joint or to correct a deformity by reconstructing or replacing the diseased joint.

Arthroscopy
A surgical procedure that utilizes an arthroscope (a thin tube with a light source), which is inserted into a joint through a small incision, allowing the surgeon to view the inside of the joint. Instruments are then inserted through other small incisions to repair the joint. The utilization of small instruments reduces swelling and trauma to the surrounding tissue structures. Arthroscopic procedures include:

• Irrigation: the removal and cleansing of debris from the joint, as well as any free-floating pieces of bone or cartilage
• Synovectomy: limited removal of inflamed tissues in larger joints
• Resurfacing: smoothing out rough or irregular joint surfaces

Ligament and Tendon Repair
Some ligament tears may require surgical repair through either arthroscopy or open reconstructive surgery. The torn ligament is replaced with another tendon from around the associated joint or muscle group. The tendon is secured to the bone through the use of sutures or anchors.

Osteotomy