Sports Injuries -- September 20, 2010 -- Dr. David R. Moore - NewsChannel5.com | Nashville News, Weather & Sports

Sports Injuries -- September 20, 2010 -- Dr. David R. Moore

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MEDICAL MONDAYS: News Notes
David R. Moore, MD: orthopaedic surgeon
BAPTIST HOSPITAL
TOPIC: Sports Injuries: Athletes of All Ages
Monday, September 20, 2010

news notes via www.webmd.com

Stress Fractures

What Is a Stress Fracture?

Stress fractures are some of the most common sports injuries. They are tiny breaks in the bone, usually caused by repetitive stress from activities like running. Although they can be quite painful, they usually heal themselves if rested for a few months.

Many different sports raise the risk of stress fractures. Activities that require running and jumping may cause fractures in the legs or feet. More than half of all adult and adolescent stress fractures occur in the lower leg bones. 25% of adult fractures are in the metatarsal bones of the feet (the bones of the instep).

Other sports that require repetitive movements -- like pitching or rowing -- can result in stress fractures in other parts of the body.

Stress fractures are much more likely to develop in people who have just started a new exercise or abruptly stepped up the intensity of their work out. When the muscles aren't conditioned, they tire easily and can't support and cushion the bones as well. Increased pressure is exerted directly on the bones, which can lead to a fracture.

Stress fractures seem to be more common in women, especially in women who do not have regular menstrual cycles. A reduction in estrogen can cause osteoporosis, or weakening of the bones. Teenagers may also be at higher risk, since their bones aren't fully hardened.

Any anatomical abnormalities -- like fallen arches -- can distribute stress unequally through the feet and legs. This raises the risk of stress fractures. So can poor-quality equipment, like worn-out running shoes.

Unfortunately, stress fractures tend to recur. About 60% of people who have a stress fracture have also had one previously.

 

Knee Ligament Injuries: PCL, LCL, MCL, and ACL Injury

Ligament injuries in the knee - such as an anterior cruciate ligament (ACL) -- are dreaded by professional and amateur athletes alike. They can be painful and debilitating. They can even permanently change your lifestyle.

But there's good news. While an ACL injury or other ligament damage once ended the career of many an athlete, treatment is much more successful now.

So what's behind these feared injuries? Ligaments are tough bands of tissue that connect the bones in your body. Two important ligaments in the knee, the ACL and posterior cruciate ligament (PCL),  connect the thigh bone with the bones of the lower leg. But too much stress on these ligaments can cause them to stretch too far -- or even snap.

ACL injury and other ligament injuries can be caused by:

  • Twisting your knee with the planted.
  • Getting hit on the knee.
  • Extending the knee too far.
  • Jumping and landing on a flexed knee.
  • Stopping suddenly when running.
  • Suddenly shifting weight from one leg to the other.

These injuries are common in soccer players, football players, basketball players, skiers, gymnasts, and other athletes.

There are four ligaments in the knee that are prone to injury.

  • Mentioned above, the anterior cruciate ligament (ACL) is one of the two major ligaments in the knee. It connects the thigh bone to the shin bone. ACL injuries are a common cause of disability in the knee. In the U.S., 95,000 people get them every year. They are more common in women than men.
  • The posterior cruciate ligament (PCL) is the second major ligament in the knee connecting the thigh bone to the shin bone.
  • The lateral collateral ligament (LCL) connects the thigh bone to the fibula, the smaller bone of the lower leg.
  • The medial collateral ligament (MCL) also connects the thigh bone to the shin bone.

 

What Does a Knee Ligament Injury Feel Like?

An ACL injury -- or other ligament injury -- is sometimes hard to diagnose. Symptoms of a knee ligament injury are:

  • Pain, often sudden and severe.
  • A loud pop or snap during the injury.
  • Swelling.
  • A feeling of looseness in the joint.
  • Inability to put weight on the point without pain.

If they're not treated at the time, ACL injuries and other types of ligament injuries may act up months or years later. They can make your knee give out when you twist or pivot.

To diagnose an ACL or other ligament injury, your doctor will give you a thorough exam. If your knee is swollen with blood, your doctor may use a needle to drain it. You may need X-rays, MRI (Magnetic Resonance Imaging) scans, or other tests.

What's the Treatment for a Knee Ligament Injury?

Happily, a mild to moderate knee ligament injury may heal on its own given time. To speed the healing, you can:

  • Rest the knee. Avoid putting excess weight on your knee. You may need to use crutches for a time.
  • Ice your knee to reduce pain and swelling. Do it for 20-30 minutes every 3-4 hours for 2-3 days, or until the pain and swelling is gone.
  • Compress your knee. Use an elastic bandage, straps, or sleeves on your knee to control swelling.
  • Elevate your knee on a pillow when you're sitting or lying down.
  • Wear a knee brace to stabilize the knee and protect it from further injury.
  • Take anti-inflammatory painkillers. Non-steroidal anti-inflammatory drugs (NSAIDs), like Advil, Aleve, or Motrin, will help with pain and swelling. However, these drugs can have side effects and they should be used only occasionally, unless your doctor specifically says otherwise.
  • Practice stretching and strengthening exercises if your doctor recommends them.

For severe collateral ligament tears, you may need surgery to attach the ligament back to the bone if it was pulled away or to the other part of the ligament if it was torn in the middle.

Unfortunately, the cruciate ligaments -- the ACL and PCL -- cannot be repaired. Once they are completely torn or stretched beyond their limits, that's it. The only option is a reconstruction. In this procedure, tendons are taken from other parts of your leg or a cadaver to replace the torn ligament.

A ligament reconstruction for an ACL or PCL injury is complicated and involved. It's not the right choice for everyone. Some people who have pain or severe instability in their knees may choose to have it. So might professional athletes -- or devoted amateurs -- who really want to return to their previous level of activity.

But if the pain is not a problem, you may choose to skip the surgery and accept the risk of some permanent weakness and instability in your leg. You may also opt for a custom-made brace. Talk over the treatment options with your doctor.

When Will I Feel Better After a Knee Ligament Injury?

Recovery time depends on how severe your knee ligament injury is. People also heal at different rates. While you recover -- If your doctor agrees -- you could take up a new activity that won't hurt your knee. For instance, runners could try swimming.

Whatever you do, don't rush things. Don't try to return to your old level of physical activity until:

  • You feel no pain when you bend or straighten your knee.
  • You feel no pain in your knee when you walk, jog, sprint, or jump.
  • Your knee is no longer swollen.
  • Your knee feels as strong as your uninjured knee.

If you start using your knee before it's healed, you could cause permanent damage.

How Can I Prevent a Knee Ligament Injury?

Knee ligament injuries are hard to prevent, since they're usually the result of an accident. But taking some precautions might lower your risks. You should:

  • Keep your thigh muscles strong with regular stretching and strengthening.
  • Stretch before and after physical activity.
  • Never abruptly increase the intensity of your workout. Make changes slowly.

 

Rotator Cuff Injury

The rotator cuff is a group of tendons and muscles in the shoulder, connecting the upper arm (humerus) to the shoulder blade (scapula). The rotator cuff tendons provide stability to the shoulder; the muscles allow the shoulder to rotate.

The muscles in the rotator cuff include:

  • Teres minor
  • Infraspinatus
  • Supraspinatus
  • Subscapularis

Each muscle of the rotator cuff inserts at the scapula, and has a tendon that attaches to the humerus. Together, the tendons and other tissues form a cuff around the humerus.

Rotator Cuff Conditions

  • Rotator cuff tear: An injury tears a rotator cuff tendon that's been weakened by age or wear and tear. Weakness in the arm (and usually pain) are the symptoms.
  • Rotator cuff tendinitis (tendonitis): Repetitive overhead use of the arms (such as painting or throwing) causes a painful strain injury. Rest, ice, and pain relievers are usually effective treatments.
  • Rotator cuff impingement: The tendons of the rotator cuff are squeezed between the humerus and a nearby bone called the acromion. Symptoms and treatment of impingement are similar to tendinitis.
  • Frozen shoulder (adhesive capsulitis): The humerus adheres to the shoulder blade, causing shoulder pain and stiffness. Symptoms usually resolve with time and exercise, or steroid injections.
  • Subacromial bursitis: Inflammation of the small sac of fluid (bursa) that cushions the rotator cuff tendons from a nearby bone (the acromion).

Rotator Cuff Tests

  • Magnetic resonance imaging (MRI): Magnetic waves create highly detailed images of the muscles, bones, and tendons in the shoulder.
  • Computed tomography (CT): A machine takes multiple X-ray pictures of the shoulder, and a computer reconstructs them into detailed images. CT is not as effective as MRI at detecting rotator cuff problems.
  • Plain films (X-rays): X-ray films don't show rotator cuff problems, but may show fractures, bone spurs, or other bone abnormalities.
  • Physical examination: Limitations in different movements suggest different problems. If a doctor can move your arm fully, but you can't (because of weakness), a rotator cuff tear is possible.
  • Ultrasound: An ultrasound probe directs painless high-frequency sound waves at the shoulder, creating images of the muscles and tendons.
  • Arthrogram: Dye is injected into the shoulder joint and X-ray films are taken. If dye leaks out of the shoulder joint on the films, there may be a rotator cuff tear.
  • Painful Arc test: Pain that is elicited when raising the arm beyond 90 degrees. The arm moves away from the body and toward the side.

Rotator Cuff Treatments

  • Pain medicines: Nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, or other medicines can be used to relieve the pain of rotator cuff injuries.
  • Corticosteroid injections: Cortisone or another anti-inflammatory steroid medicine is injected into the shoulder. The reduction in inflammation helps relieve pain.
  • Physical therapy: Various exercises can improve flexibility and strength of the other muscles in the rotator cuff. This increased strength can help compensate for a rotator cuff problem.
  • Occupational therapy: Similar to physical therapy, occupational therapy for rotator cuff injuries focuses on daily tasks that require shoulder movements.
  • Arthroscopic surgery: A surgeon operates through small incisions, using an arthroscope (a tube with a camera and tools on its end). The torn rotator cuff tendon is reattached to the bone.

 

Strains, Sprains, and Other Sports Injuries: 3 Questions

If you engage in sports or a favorite workout at the gym, you have probably twisted an ankle or pulled a muscle at some point.

In many cases, injuries are due to overuse of a part of the body when participating in a certain sport -- runner's knee or tennis elbow, for example. Other types of injuries are caused by trauma -- hard contact with something, perhaps resulting in a broken bone or torn ligament or tendon.

At a recent meeting of the American College of Sports in Medicine in Austin, Texas, Edward G. McFarland, MD, spoke with WebMD about sprains, strains, tears, and other types of sports injuries: What they are, how to avoid them, and how to treat them.

McFarland is the Wayne H. Lewis Professor of Orthopedics and Shoulder Surgery at Johns Hopkins Medicine in Baltimore and a team physician for the Baltimore Orioles baseball team.

What are the most common types of sports injuries?

We usually divide them into two groups: traumatic injuries and overuse injuries.

First, traumatic [injuries]. In the lower extremities, the most common would be knee ligament injuries and fractures. In the upper extremities it would be fractures, rotator cuff injuries, and instability of the shoulder.

Overuse in lower extremities would be patellar [knee cap area] tendinitis or Achilles [heel area] tendinitis. In the upper extremities, it would be ... biceps and rotator cuff [shoulder muscle and tendon] problems.

With either type of injury, any type of musculoskeletal tissue can be involved: bone, ligament, tendon, muscle, or nerve.

What are the most common causes of these injuries and how can you prevent them?

Traumatic injuries are, of course, very unpredictable. Sometimes they're due to poor conditioning, poor surfaces, or poor equipment. Oftentimes, they are just bad luck.

Overuse injuries are almost always due to increasing the stress on the tissues too rapidly. So we see them very often in people who are out of shape and do things they are not used to doing or not conditioned for doing.

The other place we see them is in people who are fairly well-conditioned and try to bump up their level of fitness or level of expertise too rapidly.

I think that as you get more mature, you realize that it takes less and less to get your tissues aggravated.

I always tell people when you are starting out, do about one tenth of what you think you can do and try not to overdo it. We often see people who haven't done a sport in months or years and try to go out full-gun or full-bore. Suddenly they are hurting all over, or get tendinitis, or irritation of their tendons or ligaments or knees or their joints. The biggest issue is a large increase in [physical] stress too rapidly.

But still, it is very unpredictable, which is what makes it so frustrating.

What are the treatments for these different injuries?

With traumatic injuries, if you have bruising or swelling or can't move something, you of course need to see a health provider to make sure that you didn't break something.

For overuse injuries, there is a litany of things you can do. We usually recommend relative rest. In other words, you don't have to completely stop your sport, but you should back off a little bit. Maybe not exercise five days a week but go to three, or maybe don't exercise for two hours, but for 45 minutes.

You may want to do some cross training, exercising joints other than those that are irritated.

Also, use ice on places that hurt.  Ice, not heat -- the old adage about ice for 24 hours followed by heat is really not believed anymore. Ice is better for pain and swelling and for getting range of motion back. You can ice after any exercise; you can even ice at night in bed. Heat is good for stretching and before exercise, but ice is always better afterward.

You can also take some acetaminophen in a low dose if you are so inclined, but it's a little trickier if you try to use anti-inflammatories [such as aspirin, ibuprofen or naproxen] because there are lots of side effects associated with them. But if you don't have trouble with those, then small doses are probably OK.

 

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