Sports Medicine

Definitions & Anatomy

All sports and exercises, even walking, carry a risk of sprains. The areas of the body most at risk for a sprain depend on the specific activities involved. For example, basketball, volleyball, soccer, and other jumping sports share a risk for foot, leg, and ankle sprains. Soccer, football, hockey, boxing, wrestling, and other contact sports put athletes at risk for strains. So do sports that feature quick starts, such as hurdling, long jump, and sprinting. Gymnastics, tennis, rowing, golf, and other sports that need extensive gripping put participants at higher risk for hand strains. Elbow strains often happen in racquet, throwing, and contact sports. Here are some facts on musculoskeletal injuries:

  • Sprains are a stretch and/or tear of a ligament, the tissue connecting 2 bones. Ligaments stabilize and support the body’s joints. For example, ligaments in the knee connect the upper leg with the lower leg. This allows you to walk and run.
  • Strains are a twist, pull and/or tear of a muscle and/or tendon. Tendons are cords of tissue that connect muscles to bones.
  • Breaks are a fracture, chip, or complete break in bone, often caused by accidents, sports injuries or bone weakness.

Sprains

A sprain is caused by an injury that stresses a joint and over stretch or even ruptures the supporting ligaments. This can happen from a fall, twist, or blow to the body. Sprains can be categorized from mild to severe. In a mild sprain, a ligament is stretched, but the joint remains stable and is not loosened. A moderate sprain partially tears the ligament, causing the joint to be unstable. With a severe sprain, ligaments tear completely or separate from the bone. This loosening interferes with how the joint functions. You may feel a tear or pop in the joint. Although the intensity varies, all sprains commonly cause pain, swelling, bruising, and inflammation.

The ankle is the most commonly sprained joint. And a sprained ankle is more likely if you’ve had a previous sprain there. Repeated sprains can lead to ankle arthritis, a loose ankle or tendon injury.

Strains

Acute strains are caused by stretching or pulling a muscle or tendon. Chronic strains are the result of overuse of muscles and tendons, through prolonged, repetitive movement. Not getting enough rest during intense training can cause a strain. Typical symptoms of a strain include:

  • Pain
  • Muscle spasm
  • Muscle weakness
  • Swelling
  • Inflammation
  • Cramping

Fracture or “Broken Bone”

Bone breaks, unlike sprains and strains, should always be looked at by a healthcare provider to make sure of proper healing. Call your healthcare provider if the pain does not lessen or if the bone appears to be deformed. Seek urgent medical care if you have numbness, weakness, or poor circulation in the injured limb.

Conditions

Ankle

Muscle Strains

Usually occur when an already stretched muscle is suddenly forced to contract and shorten. This sudden contraction, causes the muscle fibers to tear and injure. The possibility of a muscle strain increases significantly if there has been a previous injury to the same area. Therefore, it is important to warm up properly before exercising and to gradually increase your workload as doing too much too soon can cause a muscle strain too. Muscle strains are categorized as mild, moderate, or severe depending on the extent of the injury.

Strains and Sprains

  • A sprain is stretching or tearing of a ligament, the tissues that connect bones to other bones. Sprains will cause pain at or around the joint involved.
  • A strain is a stretching or tearing of a muscle or tendon. Tendons connect muscles to bones. Strains will cause pain and stiffness in the involved muscle or tendon.

Elbow

Biceps Tendon Rupture

Normally, a biceps tendon is connected to the arm bone and helps to move your arm in a flexing position. When the bicep tendon ruptures, the tendon tears and the muscle cannot pull on the bone. It becomes detached from the bone causing pain and weakness.

Golfer’s Elbow & Tennis Elbow

Medial epicondylitis or golfer’s elbow, is similar to its counterpart, tennis elbow, except for the location of the pain located on the elbow as well as the activity leading up to the injury caused this pain. Both conditions are caused by overuse of the muscles and tendons of the forearm, leading to inflammation and pain around the elbow joint. The pain of golfer’s elbow is usually at the elbow joint on the inside of the arm; a shooting sensation down the forearm is also common while gripping objects. Golfer’s elbow and tennis elbow, are both forms of tendonitis. Due to the force of the muscle, the points of insertion of the tendon on the bone, are often on pointed prominences.

Little League Elbow

Medial epicondyle apophysiitis or Little League Elbow (LLE), is a pain at the inner growth plate of the elbow in the young throwing athlete. Little League Elbow often is caused by excessive throwing and poor throwing technique in a young athlete. Usually seen in adolescents athletes that participate in throwing sports. The repetitive motion of throwing, especially with poor technique, can cause stress on the inside part of the elbow leading to damage. The prevalence of LLE has become more frequent with children participating in year round leagues.

Muscle Strains

Usually occur when an already stretched muscle is suddenly forced to contract and shorten. This sudden contraction, causes the muscle fibers to tear and injure. The possibility of a muscle strain increases significantly if there has been a previous injury to the same area. Therefore, it is important to warm up properly before exercising and to gradually increase your workload as doing too much too soon can cause a muscle strain too. Muscle strains are categorized as mild, moderate, or severe depending on the extent of the injury.

Patellar Tendonitis

Strains and Sprains

  • A sprain is stretching or tearing of a ligament, the tissues that connect bones to other bones. Sprains will cause pain at or around the joint involved.
  • A strain is a stretching or tearing of a muscle or tendon. Tendons connect muscles to bones. Strains will cause pain and stiffness in the involved muscle or tendon.

Tennis Elbow

Similar to Golfer’s elbow, Lateral Epicondylitis, or Tennis Elbow, is one of the most common elbow injury sports. Exactly what causes tennis elbow is unknown, but it is thought to be due to small tears of the tendons that attach the muscles of the forearm to the arm bone at the elbow joint. The lateral epicondylitis usually involves the wrist extensors, a muscle group involved in the function to cock back your wrist and stabilization as in gripping a racquet, baseball bat, or club.

Throwing Injuries

UCL Tear

The ulnar collateral ligament or UCL, is the main ligament stabilizing the inner aspect of the elbow joint during the act of throwing. It provides the stability which is necessary to throw a ball or to work and lift overhead. When an injury to the ulnar collateral ligament occurs, this instability can cause severe disruption. Sometimes an UCL tear can be from chronic repetitive overhead throwing motions or from a one single traumatic event such as falling on an outstretched arm. If the UCL tear occurs gradually, there may be a progressive ache or soreness along the inner aspect of the elbow and a throwing athlete may notice decreased velocity and control with throwing. If it occurs quickly, there is often a “pop” followed immediately by swelling and pain. Sometimes the nerves that surround the UCL can be injured too. In the occurrence, a patient may develop a numbness or tingling sensation in the middle and ring fingers.

Shoulder

Bankart Lesion

Bankart lesion(s) of the shoulder is a tear of the labrum that causes gross instability and a recurrence of shoulder dislocations. This type of injury often occurs when the shoulder pops out of joint, thereby tearing the labrum and is quite common in younger patients.

Biceps Tendon Rupture

A biceps tendon rupture usually occurs from an injury where the attachment separates from the bone or the tendon to tear. Normally, biceps tendons are connected strongly to the bone and usually do not tear spontaneously. However, when the biceps tendon tears and ruptures, this tendon is detached. Following a biceps tendon rupture, the muscle cannot pull on the bone, and certain movements may be weakened and painful.

Labral Tear

The shoulder socket itself is extremely shallow and unstable. The bones of the shoulder are not held in place adequately, thereby requiring extra support. To help compensate for this instability, the shoulder joint has a cuff of cartilage (labrum) that forms a cup for the end of the arm bone to move within. The labrum in the shoulder joint wraps around the shallow shoulder socket, thus making the socket deeper, thus providing more stability. When a labral tear occurs, the cartilage rim that attaches to arm and shoulder becomes unstable. This usually occurs from sports-related activities like throwing or where a shoulder or arm injury has occurred. The labrum itself may simply become brittle with age and may fray and tear as part of the aging process.

Little League Shoulder

Proximal Humeral Epiphyseolysis or Little League Shoulder (LLS), is also known as pain at the upper arm growth plate in the young throwing athlete. Little League Shoulder is caused by repetitive force across the growth plate (or physis) in the upper arm causing it to become irritated and sometimes widen. LLS usually occurs in adolescents aged 11-16 years of age and is very common in baseball players. However, LLS can also occur in other athletes that do repetitive overhead motion (lacrosse, tennis, volleyball, etc.)

Muscle Strains

Usually occur when an already stretched muscle is suddenly forced to contract and shorten. This sudden contraction, causes the muscle fibers to tear and injure. The possibility of a muscle strain increases significantly if there has been a previous injury to the same area. Therefore, it is important to warm up properly before exercising and to gradually increase your workload as doing too much too soon can cause a muscle strain too. Muscle strains are categorized as mild, moderate, or severe depending on the extent of the injury.

Rotator Cuff Tear

Shoulder Dislocation

A shoulder dislocation is an injury that occurs when the top of the arm bone (humerus) loses contact with the socket of the shoulder (scapula). This is also similar to an acromioclavicular (AC) joint separation.

Shoulder Instability

Shoulder Separation

A shoulder separation or acromioclavicular (AC Joint) separation is an injury to the area or junction between the shoulder and collar bone. It involves a ligament or soft-tissue injury to that area but may also include a fracture. Although this injury is usually sports related, it can happen in trauma such as falls or car accidents. A shoulder separation occurs after a fall or a sharp blow to the top of the shoulder. This is not the same as a shoulder dislocation, which occurs at the large joint where the arm attaches to the shoulder, although the two may appear to be the same.

Strains and Sprains

  • A sprain is stretching or tearing of a ligament, the tissues that connect bones to other bones. Sprains will cause pain at or around the joint involved.
  • A strain is a stretching or tearing of a muscle or tendon. Tendons connect muscles to bones. Strains will cause pain and stiffness in the involved muscle or tendon.

SLAP Lesion

Superior Labral Anterior to Posterior or SLAP lesion can occur from a variety of injuries that cause damage to the superior portion of the labrum where the bicep tendon inserts. This usually occurs from repetitive over arm motion such as throwing a ball, falling on an outstretched arm or lifting a heavy object. When the superior labrum is detached or torn at the site of the biceps tendon insertion, it is termed a superior labrum anterior to posterior tear (SLAP).

Throwing Injuries

There are many common throwing shoulder injuries include labral tears, bursitis, tendonitis, rotator cuff tears,biceps tendon injuries, capsular contractures, and shoulder blade (scapula) dyskinesis (abnormal movement) or true winging. A common condition in which throwing athletes develop is from the loss of internal rotation from scarring of the joint capsule, scapula dyskinesis, labral tears, and rotator cuff tears is known as GIRD or glenohumeral internal rotation deficit. It is the most common condition affecting the throwing shoulder. The constant, repetitive overhead throwing motion imparts high, outward, extension loads to the athlete’s shoulder and elbow. This can lead to either a progressive structural change, or a chronic or acute injury. Although of note, the elbow does not discriminate between sportsrelated injuries and non-sports injuries, it is the continuation of overhead throwing most often results in subsequent injury and symptom recurrence.

Hand

Wrist

Foot

Muscle Strains

Usually occur when an already stretched muscle is suddenly forced to contract and shorten. This sudden contraction, causes the muscle fibers to tear and injure. The possibility of a muscle strain increases significantly if there has been a previous injury to the same area. Therefore, it is important to warm up properly before exercising and to gradually increase your workload as doing too much too soon can cause a muscle strain too. Muscle strains are categorized as mild, moderate, or severe depending on the extent of the injury.

Strains and Sprains

  • A sprain is stretching or tearing of a ligament, the tissues that connect bones to other bones. Sprains will cause pain at or around the joint involved.

  • A strain is a stretching or tearing of a muscle or tendon. Tendons connect muscles to bones. Strains will cause pain and stiffness in the involved muscle or tendon.

Hip

Arthritis

  • Osteoarthritis or “wear and tear arthritis” is very common in the hip joint since the cartilage tends to wear out over time. When this cartilage wears away, the ball begins rubbing on the socket or acetabulum and ultimately causes severe pain and hip disability. The most frequent reason for osteoarthritis is genetic. If your parents have arthritis, you may also be at risk of suffering from degenerative joint disease.
  • Inflammatory Arthritis. Swelling and heat (inflammation) of the synovium or joint lining causes a release of enzymes which ultimately soften and eventually destroy the hip cartilage. Some of the most common inflammatory conditions of the hip are Rheumatoid arthritis, Lupus and Psoriatic Arthritis.

Femoroacetabular Impingment

The abnormal friction or contact between the ball (femoral head/neck) and the socket (acetabulum) is called Femoroacetabular Impingment. This friction causes the cartilage (labrum) surrounding the hip joint to deteriorate leading to the underlying cartilage to tear off (avulsion). This continued deterioration eventually leads to arthritis. Typically, nonsurgical treatment fails to control these symptoms.

Labral Tear (Hip)

The labrum is a pad of cartilage that lies between the femoral head (ball) and the acetabulum (socket). It acts as a shock absorber and stabilizes the hip. This type of injury is very common in athletes. When labral tears occur, patients usually experience pain deep in the hip joint. There are also many different causes for labral tears.

Loose Bodies

Usually occurs following a sports injury or trauma may move the ball too much one way or another causing small pieces of bone or cartilage to shear off. These small pieces are called “loose bodies.”, and it is appropriate to think of these bodies as debris in the joint. These loose bodies may also be caused by degeneration to the hip joint as happens in many forms of arthritis. These loose bodies often cause increasing pain and stiffness when they get caught between the smooth surfaces of the hip joint. Loose bodies can stay in one place or can move around the hip joint. Loose bodies can also spontaneously move within the hip joint and temporarily allowing for some relief from the pain.

Muscle Strains

Usually occur when an already stretched muscle is suddenly forced to contract and shorten. This sudden contraction, causes the muscle fibers to tear and injure. The possibility of a muscle strain increases significantly if there has been a previous injury to the same area. Therefore, it is important to warm up properly before exercising and to gradually increase your workload as doing too much too soon can cause a muscle strain too. Muscle strains are categorized as mild, moderate, or severe depending on the extent of the injury.

Strains and Sprains

  • A sprain is stretching or tearing of a ligament, the tissues that connect bones to other bones. Sprains will cause pain at or around the joint involved.
  • A strain is a stretching or tearing of a muscle or tendon. Tendons connect muscles to bones. Strains will cause pain and stiffness in the involved muscle or tendon.
  • Hamstring Muscle Strain
    This is when a major muscle in the back of the thigh tears or stretches. The injury can sideline a person for up to 6 months. The likely cause is muscle strength imbalance between the hamstrings and the quadriceps, the muscles in the front of the thigh. Kicking a football, running, or leaping to make a basket can pull a hamstring. Hamstring injuries tend to happen again.

Synovitis

An inflammation of the synovium or lining of our joints. When this lining gets irritated, the synovium can become inflamed, which may cause or contribute to your hip pain. Synovitis is typically caused by another underlying hip problem (labral tear, femoroacetabular impingement, or osteoarthritis) but can also due to a primary disease of the synovium or inflammatory arthritis.

Knee

ACL Injury

Anterior Cruciate Ligament (ACL) Injury Ligaments are tough, non-stretchable rope-like structures that stabilize our bones where they meet at our joints. The anterior cruciate ligament (ACL) is one of the four ligaments that provide stability and centering to our knee joint. The ACL is particularly important in providing rotational stability and is often damaged during sports related activities that require pivoting. An injury to the ACL can also result from either direct contact to the knee which causes excessive angulation of the knee joint or non-contact planting and pivoting with bending of the knee. When the ACL is torn, patients may feel or hear a “pop” in the knee joint. The knee most often gives out and may quickly swell preventing movement and weight bearing.

Cartilage Injuries

Loose Bodies/Spurs

LCL Injury

Ligaments are tough, non-stretchable rope-like structures that stabilize our bones where they meet at our joints. The lateral collateral ligament (LCL) is one of the four ligaments that provide stability and centering to our knee joint. The LCL is particularly important in providing rotational stability and helps to prevent widening of the outside of the knee. It spans the distance from the end of the femur (thigh bone) to the top of the fibula (thin, outer, lower leg bone) and is on the outside of the knee. Most LCL injuries happen from a direct force from the side of the knee, causing moderate to severe knee pain and ligament injury which often leads to knee surgery. It is much less frequent ligament injury than the medial collateral ligament (MCL) but commonly occurs with other ligament injury to the knee.

MCL Injury

The medial collateral ligament (MCL) is one of the four ligaments that provide stability and centering to our knee joint. The MCL helps to provide rotational stability and helps to prevent widening of the outside of the knee. The MCL spans the distance from the end of the femur (thigh bone) to the top of the tibia (shin bone) and is on the inside of the knee joint. The medial collateral ligament resists widening of the inside of the joint, or prevents “opening-up” of the knee. Most MCL injuries happen from a direct force from the side of the knee, causing moderate to severe knee pain and ligament injury which often leads to knee surgery. It is the more common ligament injury than the lateral collateral ligament (LCL) but commonly occurs with other ligament injury to the knee.

Meniscal Tear

The meniscus works like a shock absorber in the knee joint and made of a very strong substance called fibrocartilage. It helps to prevent and protect the knee from early arthritis and wearing out by this shock absorptive property. A large percentage of our body weight is distributed through the meniscus as we walk, run, and jump. The meniscus adds to the stability of the knee joint by helping the shape of the femur or thigh bone conform to the tibia or leg bone. The meniscus also plays a role in the nourishment of the joint cartilage that covers the bones in the joint.

Muscle Strains

Usually occur when an already stretched muscle is suddenly forced to contract and shorten. This sudden contraction, causes the muscle fibers to tear and injure. The possibility of a muscle strain increases significantly if there has been a previous injury to the same area. Therefore, it is important to warm up properly before exercising and to gradually increase your workload as doing too much too soon can cause a muscle strain too. Muscle strains are categorized as mild, moderate, or severe depending on the extent of the injury.

Patellar Tendonitis

PCL Injury

Similar to the ACL in nature, the PCL is broader and stronger than the ACL. It connects the femur (thigh bone) to the tibia (shin bone). Its function is to prevent the posterior translation of the tibia relative to the femur and is important in providing rotational stability and is often damaged during sports-related activities that require pivoting. A forceful hyperextention of the knee or a direct blow just below the knee cap will disrupt the PCL and cause knee pain and PCL Injury. It has been reported that there is only a 2% incidence of isolated PCL tears.

Runner’s Knee

Strains and Sprains

  • A sprain is stretching or tearing of a ligament, the tissues that connect bones to other bones. Sprains will cause pain at or around the joint involved.

  • A strain is a stretching or tearing of a muscle or tendon. Tendons connect muscles to bones. Strains will cause pain and stiffness in the involved muscle or tendon.

Spine

Muscle Strains

Usually occur when an already stretched muscle is suddenly forced to contract and shorten. This sudden contraction, causes the muscle fibers to tear and injure. The possibility of a muscle strain increases significantly if there has been a previous injury to the same area. Therefore, it is important to warm up properly before exercising and to gradually increase your workload as doing too much too soon can cause a muscle strain too. Muscle strains are categorized as mild, moderate, or severe depending on the extent of the injury.

Strains and Sprains

  • A sprain is stretching or tearing of a ligament, the tissues that connect bones to other bones. Sprains will cause pain at or around the joint involved.

  • A strain is a stretching or tearing of a muscle or tendon. Tendons connect muscles to bones. Strains will cause pain and stiffness in the involved muscle or tendon.

  • Back Strain
    One of the most common injuries – when the muscles that support the spine are twisted, pulled, or torn. Athletes who engage in excessive jumping or twisting—during basketball, diving, or volleyball, for example—are at risk for this injury.

Treatments

We offer both surgical and non-surgical options for all of these conditions:

Ankle
Elbow
Shoulder
Hand
Wrist
Foot
Hip
Knee
Spine