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Top 10 Sports Injuries

The most common sports-related injuries primarily are overuse injuries. As the name implies, an overuse injury results from wear and tear on the body, particularly on joints subjected to repeated activity.

Certain types of injuries plague sports participants. Most of them, however, are minor. Knowing the early signs and what to do can help prevent them from becoming nagging problems.

Here’s a look, from head to toe, at the Top Ten sports injuries you’re most likely to face:

Muscle Pull
Probably the most common sports injury is a muscle pull, which can happen to almost any muscle in the body. No matter how diligently you warm up and stretch, or cool down and stretch, you may pull a muscle from overuse, fatigue or taking a fall. There is little you can be done to prevent a muscle pull except to stay limber and work your muscles regularly.

A muscle pulls when a sudden, severe force is applied to the muscle and the fibers are stretched beyond their capacity. If only some of the fibers tear, that is a muscle pull. If most of the fibers tear, that is a muscle tear.

Neck Pain

A pulled muscle or a muscle spasm in the neck can happen when a tennis player looks up to serve or hit an overhead smash. The pain is on one side of the neck, and the neck may be pulled over slightly to that side. It is particularly painful to turn the head in the direction of the pain. That is, if the pain is on the left side of the neck, the player can turn to the right, but not to the left.

Cyclists who use racing handlebars may also feel neck stiffness. With your back bent low over the handlebars, you have to tilt your neck up to see ahead. After a long ride, the neck muscles may tighten up and go into spasm from this awkward position.

Shoulder Impingement
The shoulder bones are held together by a group of muscles known as the rotator cuff muscles. These muscles (supraspinatus, infraspinatus, subscapularis and teres minor) are responsible for the shoulder’s fine movements, such as throwing a ball. Because of the shoulder’s shallow socket and lack of ligament strength, any weakness of the small, rotator cuff muscles makes it easy for the head of the shoulder to slide around in the joint.

If the shoulder joint is continually stressed with the arm in an overhead position, as it is in softball, tennis, volleyball, swimming and weight training, the small rotator cuff muscles begin to stretch out. This allows the head of the joint to become loose within the shoulder socket. If the head of the shoulder is loose, when the arm is extended backwards over the shoulder the head will slide forward, catching the tendon of short head of the biceps between the ball and the socket. The same thing happens when the arm is raised to the side above parallel to the ground. The head will drop in the socket and the tendon of the long head of the biceps or the supraspinatus becomes impinged.

This impingement causes the tendons to become inflamed and painful. Tennis players feel the pain when they try to hit an overhead or serve. The same thing can happen to golfers in both the backswing and the follow-through when their shoulders are above parallel to the ground.

Lower Back Strain
Almost everyone who participates in sports experiences lower back strain at one time or another, usually from twisting awkwardly, lifting a heavy weight or doing some unpracticed activity. Virtually all lower back injuries are due to weak or tense muscles or muscle strain. Suddenly overloading muscles may pull or tear muscle fibers, sending the back muscles into spasm and causing pain.

Weightlifters, golfers, martial artists and tennis players are prone to back injuries because these sports involve unilateral motions. A golfer rotates the lumbar spine in only one direction, which is the equivalent of lifting weights with only one side of body. Martial artists generally have one dominant leg and kick with that one more than the other.

Tennis Elbow
Tennis elbow is really an inflammation of the muscles of the forearm and the tendon that connects the muscles to the bones in the elbow. These muscles bend the wrist backward and cause the wrist to turn the palm face up. When the muscles and tendon become inflamed from overuse, the pain is felt on the outside of the elbow (lateral epicondylitis).

A tennis player most often aggravates the elbow by hitting the ball late on the backhand side, straining the forearm muscles and tendon. Constantly turning the wrist to put more spin on the serve also can cause pain.

Golfers also suffer from tennis elbow, but on the non-dominant side, that is, a right-handed golfer will feel the pain in the left elbow. Pulling the club through the swing with the left wrist causes irritation in the left elbow.

A second type of tennis elbow is known as medial epicondylitis. This causes pain on the inside of the elbow. It is most often seen among golfers, baseball pitchers, tennis players who hit topspin forehands and weight lifters.

Runner’s Knee
The most common cause of knee pain is runner’s knee, known medically as chondromalacia patella. This is due to misalignment of the kneecap in its groove. The kneecap normally goes up or down in the groove as the knee flexes or straightens out. If the kneecap is misaligned, the kneecap pulls off to one side and rubs on the side of the groove. This causes both the cartilage on the side of the groove and the cartilage on the back of the kneecap to wear out. On occasion, fluid will build up and cause swelling in the knee.

Runners are not the only ones who develop runner’s knee. Pain can develop around the back of the kneecap or in the back of the knee after participating in any running sport.

Shin Splints
Shin splints are pains in the muscles near the shin bones. They can be caused by running or jumping on hard surfaces or simply overuse. They occur most often in people unaccustomed to training, although they can also plague experienced athletes who switch to lighter shoes, harder surfaces or more concentrated speed work.

The pain occurs on the inner side of the middle third of the shin bone. The muscle responsible for raising the arch of the foot attaches to the shin bone at that spot. When the arch collapses with each foot strike, it pulls on the tendon that comes from this muscle. With repeated stress, the arch begins to pull some of its muscle fibers loose from the shin bone. This causes small areas of bleeding around the lining of the bone, and pain.

If the irritated area is about the size of a 50-cent piece or smaller, or shin pain suddenly increases, you may have a stress fracture. The twisting of the tibia can cause the bone to crack. A stress fracture may not show up on an x-ray, and therefore a bone scan is indicated.

Ankle Sprain
The most common ankle sprain happens when the foot rolls to the outside and sprains the ligaments on the outside of the ankle. The outside of the ankle swells up and throbs, and may turn black and blue around the injury.

When a jogger steps gently off a curb and “twists” an ankle, this simply stretches the ligaments, with no real tearing, and is considered a mild sprain. When a tennis player lunges out over a poorly planted foot, partially tearing the fibers of the ligament, that is considered a moderate sprain. When a volleyball player jumps and lands on another player’s foot, twisting and forcing the ankle violently to the court, most or all of the fibers tear, and this is a severe sprain.

If weight-bearing is possible on the ankle after a sprain, the ankle probably is not broken. If you feel pain on the inside of the ankle, then it should be x-rayed to rule out a hair-line fracture.

Achilles Tendinitis
The Achilles tendon in the back of the ankle is the largest tendon in the body. It transfers the force of muscle contractions to lift the heel. Achilles tendinitis is an inflammation of the tendon, usually due to overuse, such as frequent jumping in basketball or volleyball. The most common cause is excessive pronation of the ankle and foot, which causes the Achilles tendon to pull off center.

The pain of a torn Achilles tendon feels like a gunshot in the leg. A partial tear is harder to spot. If the width of the injured Achilles tendon is smaller than the healthy one, or you feel intense pain when standing on your toes, see a doctor for treatment, and possibly surgery.

Arch Pain
The elastic covering on the sole of the foot–the plantar fascia–runs the length of the foot and holds up the arch. When this shock-absorbing pad becomes inflamed, this is called plantar fasciitis, causing a dull ache along the length of the arch.

The ache is due to over-stretching or partially tearing the arch pad. This happens most often to people with rigid, high arches. They feel the pain when they put weight on their foot or when pushing off for the next stride. Pain is particularly intense upon arising or after sitting for a long while.

Plantar fasciitis is particularly common among middle-aged people who have been sedentary and who suddenly increase their level of physical activity. Runners are most susceptible, but almost any sport that keeps the athlete standing can lead to arch pain. Inappropriately fitting shoes or a weight gain of 10 to 20 pounds can also contribute to the condition.

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A Patient’s Guide to Cuff (Rotator) Tear Arthropathy

The rotator cuff is a unique structure in the shoulder that is formed by four tendons. These four tendons attach to four muscles that help keep the shoulder stabilized in the socket (or glenoid) and help rotate the upper arm inward and outward. If the rotator cuff is torn and is not repaired, a type of wear and tear arthritis of the shoulder can develop over time. This condition is sometimes called arthropathy and the term cuff tear arthropathy is used to describe this type of arthritis of the shoulder that develops when the rotator cuff is damaged. If you develop this condition, your shoulder will be painful. Movement and strength of the shoulder will be decreased. Moving the arm away from the body and raising it over your head can be especially difficult.

This guide will help you understand

  • what parts of the shoulder are involved
  • what causes this condition
  • how doctors diagnose the condition
  • what treatment options are available

Anatomy

What parts of the shoulder are involved?

The bones of the shoulder are the humerus (the upper arm bone), the scapula (the shoulder blade), and the clavicle (the collar bone). The roof of the shoulder is formed by a part of the scapula called the acromion. The shoulder joint is also called the glenohumeral joint. One of the bones of the glenohumeral joint is the humerus (the long bone of the upper arm). It has a ball, called the humeral head on the top end. The humeral head fits into a small, shallow cup called the glenoid fossa. It makes up the other part of the glenohumeral joint. The glenoid fossa is part of the shoulder blade. A large ligament runs from the front of the acromion to another part of the shoulder blade called the coracoid process. This ligament is called thecoracoacromial ligament. It adds stability to the front of the shoulder.

The rotator cuff is made up of tough, fibrous tissue. It forms a cuff (or capsule) covering the shoulder joint. There are four tendons that help form the rotator cuff. The muscles that form the tendons are the supraspinatusinfraspinatusteres minor, and subscapularis. These muscles rotate the shoulder outward and inward. Along with another muscle, the deltoid, they also help lift the arm away from the body.

The rotator cuff slides between the humeral head and the acromion as we raise our arm. As this sliding occurs over and over, the rotator cuff tendons will often be pinched as you use the shoulder everyday. This pinching is called impingement. Over time this pinching can lead to damage and weakening of the rotator cuff tendons.

Causes

What causes this condition?

Dr. Charles Neer actually described rotator cuff tear arthropathy (RCTA) in 1977. Today, doctors generally refer to this as simply cuff tear arthropathy. Cuff tear arthropathy is actually a type of wear and tear, or degenerative arthritis of the shoulder that develops over time after the rotator cuff is damaged.

Normally, when the rotator cuff muscles contract, they pull the head of the humerus tightly into the socket of the shoulder. This stabilizes the shoulder and allows the the large deltoid muscle to raise the arm over the head as it rotates the humeral head like a pulley. This motion needs the rotator cuff and deltoid muscles to work together – in balance. When the rotator cuff is torn, the shoulder becomes unbalanced. The deltoid muscle pulls the head of the humerus up into the acromion in a sliding motion. When the top of the humerus hits the underside of the acromion, the deltoid may be able to pull the arm part way up as it levers against the underside of the acromion. But, over time this abnormal sliding motion causes wear and tear on the joint surfaces. Arthritis develops and any motion becomes painful. The shoulder becomes weaker and weaker until you can no longer raise the arm above the head.

Rotator cuff tears are very common. Trauma, such as falls, lifting, and pulling forcefully can also cause a rotator cuff tear. When this happens, it is called an acute tear. Although the rotator cuff can be damaged from a single traumatic injury, damage to the rotator cuff usually occurs gradually. Age can be a factor. As we age, the tendons of the rotator cuff become weaker and more likely to be injured. The blood supply to the tendons diminishes with age. Rotator cuff tears are much more likely to occur after the age of 40.

Certain activities can increase the wear and tear on the rotator cuff. Repetitive overhead activity such as painting, plastering, racquetball, weightlifting, and swimming can cause wear and tear of the rotator cuff.

Surgeons generally will recommend surgery to repair a rotator cuff tear when it occurs. A successful surgical repair of a torn rotator cuff tear can make the development of cuff tear arthropathy much less likely. But, sometimes a rotator cuff tear cannot be repaired. The tissue is simply too damaged and cannot fixed. This is not an uncommon situation in older patients with rotator cuff tears. In other cases, the patient simply elects not to have surgery to repair a rotator cuff tear and chooses to simply live with the discomfort. Over several years, both of these situations can result in the later development of rotator cuff arthropathy.

Symptoms

What does this condition feel like?

The most common symptom of rotator cuff tear arthropathy is pain in and around the shoulder. The pain can also radiate into your neck, arm, even into your wrist or hand. The shoulder can be especially painful when trying to lift the arm, or rotate it outward. The pain is usually worse at night. It can interrupt your sleep, especially if you try to sleep on the affected shoulder. If untreated, the pain can be nearly continuous and can be severe.

Weakness of the shoulder makes it difficult, if not impossible to lift the arm overhead. Often, even starting this motion can be difficult. The tendency is to shrug the shoulder in order to lift the arm part of the way. With time, weakness of the rotator cuff muscles will worsen. Range of motion can be quite limited. You will often find it difficult to do routine things, like reaching behind your back, reaching into a cabinet, or combing your hair. You may notice a crackling or popping sensation. When there is arthritis of the glenohumeral joint, there is often a creaking or grating sound.

Diagnosis

How do doctors diagnose this condition?

Your doctor will want to do a history and physical examination. He will ask you about activities or trauma that could have injured your shoulder. He will want to know the level of your pain, and what limitations you have. A physical examination is done. Range of motion and strength of the shoulder muscles will be evaluated. Your doctor will want to look at your shoulder to see if there is bony deformity, or atrophy (shrinkage) of the muscles. With a complete rotator cuff tear, moving the arm away from the body can be nearly impossible. If your doctor lifts your arm for you, and you cannot hold it up, this is called a positive Drop Arm Test. This usually means the rotator cuff is torn.

Other areas such as the neck may also need evaluation. A pinched nerve in the neck can mimic a rotator cuff tear. A neurological examination to include checking reflexes and sensation may be included. Your doctor may want you to have anelectromyogram (EMG). This checks the function of the muscles of the shoulder. An EMG uses a small needle in the muscle being tested. It measures the electrical activity of the muscle at rest, and when tightened.

Your doctor will request X-rays of your shoulder. X-rays show the shape of the bones and joints. When the rotator cuff is torn, the shoulder will often ride high, meaning that it sits higher in the joint than it should. It can also show how much damage ahs occurred to the joint surfaces.

Magnetic resonance imaging (MRI) allows your doctor to look at slices of the area in question. The MRI machine uses magnetic waves, not X-rays to show the muscle, tendons, and ligaments of the shoulder. MRIs will show tears of the rotator cuff tendons. Atrophy of the muscles can also be evaluated with MRI. A computerized tomography (CT) scan shows slices of bone. Like X-rays, it uses radiation. A CT scan can help to more accurately determine the degree of damage of the glenohumeral joint. A CT scan is especially useful to plan surgery if an artificial shoulder replacement is considered for treatment.

Treatment

What treatment options are available?

Nonsurgical Treatment

Conservative care that includes physical therapy, ice, heat, and anti-inflammatories is tried first. The goal of treatment is to reduce pain, and increase range of motion and function. Corticosteroid injection into the shoulder joint is also sometimes helpful. Steroids are very powerful anti-inflammatory medications that can reduce pain temporarily. These injections will not heal the tear but may give pain relief for several weeks to months. If arthritis of the shoulder is advanced, and pain is continuous and severe, surgery may be the best option available.

Surgery

Cuff tear arthropathy is the result of long standing lack of rotator cuff function. In almost all cases, repair of the rotator cuff tear is no longer an option. Surgery for cuff tear arthropathy is done when pain and decreased motion continue after conservative care. The simplest surgical procedure to try and improve the situation is a debridement. During a debridement, the surgeon will surgically remove (debride) any inflammed tissue, bones spurs and loose flaps of tendon tissue that may be catching in the joint and causing pain. This procedure may reduce pain, however, it does not always improve range of motion, strength, or function of the shoulder.

Patients with this type of arthritis would seem to be good candidates for a shoulder replacement, but replacing the shoulder in the typical fashion has not been successful. Replacing the shoulder with a special type of artficial shoulder joint is becoming more popular. This procedure is called a reverse shoulder replacement.

The “normal” artificial shoulder was designed to copy our real shoulder. The glenoid component (the socket) was designed to replace our normal shoulder socket with a thin, shallow plastic cup. The humeral head component was designed to replace the ball of the humerus with a metal ball that sits on top of the glenoid. This situation has been compared to placing a ball on a shallow saucer. Without something to hold it in place, the metal ball simply slides around on the saucer. In the shoulder that something is the rotator cuff and the muscles that attach to the tendons. Without a rotator cuff to hold the metal ball centered in the plastic socket, the metal quickly wore out the plastic socket and the joint became painful once again. The answer to this dilemma was to rethink the mechanics of the shoulder joint and design an artificial shoulder that worked differently than the real shoulder joint. The solution was to reverse the socket and the ball, placing the ball portion of the shoulder where the socket use to be and the socket where the ball or humeral head use to be. This new design led to a much more stable shoulder joint that could function without a rotator cuff. The artificial joint itself provided more stability by creating a deeper socket that prevented the ball from sliding up and down as the shoulder was raised. The large deltoid muscle that covers the shoulder could be used to more effectively lift the arm, providing better function of the shoulder. The final result is a shoulder that functions better, is less painful and can last for years without loosening.

Rehabilitation

What should I expect after treatment?

Nonsurgical Rehabilitation

Your physical therapist will show you how to use ice or heat to help with pain. You will also be instructed in exercises to strengthen your shoulder girdle as much as possible. Showing you joint protection tips, or motion that you can expect to do safely without causing more harm to your shoulder is also important. The goal is to reduce pain, increase range of motion and function, and prevent further arthritis.

After Surgery

A physical or occupational therapist will see you the day after surgery to begin your rehabilitation program. Therapy treatments will gradually improve the movement in your shoulder. Your therapist will go over your exercises and make sure you are safe getting in and out of bed and moving about in your room.

When you go home, you may get home therapy visits. By visiting your home, your therapist can check to see that you are safe getting around in your home. Treatments will also be done to help improve your range of motion and strength. In some cases, you may require up to three visits at home before beginning outpatient therapy.

Out patient therapy at a facility can often more effective and is often preferred over home physical therapy. The first few outpatient treatments will focus on controlling pain and swelling. Ice and electrical stimulation treatments may help. Your therapist may also use massage and other types of hands-on treatments to ease muscle spasm and pain. Continue to use your shoulder sling as prescribed.

As the rehabilitation program evolves, more challenging exercises are chosen to safely advance the shoulder’s strength and function. Finally, a select group of exercises can be used to simulate day-to-day activities, like grooming your hair or getting dressed.

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Shoulder Impingement Syndrome

Impingement Syndrome, which is sometimes called Swimmer’s shoulder or Thrower’s shoulder, is caused by the tendons of the rotator cuff becoming impinged as they pass through the shoulder joint.

Symptoms of impingement syndrome:

  • Shoulder pain comes on gradually over a long period.
  • Pain at the front and/or side of the shoulder joint with overhead activity such as throwing, front crawl swimming – most common in external impingements.
  • Pain at the back and/or front of the shoulder when the arm is held out to the side (abducted) and turned outwards (external rotation) – most common in internal impingements.
  • Pain when lifting the arm above 90 degrees.
  • Pain on internal (medial rotation) movements – for example reaching up behind your back.
  • Positive shoulder impingement tests.

What is Impingement Syndrome?

Impingement Syndrome, which is sometimes called Swimmer’s shoulder or Thrower’s shoulder, is caused by the tendons of therotator cuff (supraspinatus, infraspinatus, teres minor andsubscapularis muscles) becoming ‘impinged’ as they pass through a narrow bony space called the Subacromial space – so called because it is under the arch of the acromion. With repetitive pinching, the tendon(s) become irritated and inflamed.

This can lead to thickening of the tendon which may cause further problems because there is very little free space, so as the tendons become larger, they are impinged further by the structures of the shoulder joint and the muscles themselves.

Impingement Syndrome in itself is not a diagnosis, it is a clinical sign. There are at least NINE different diagnoses which can cause impingement syndrome. These include:

  • Bone spurs
  • Rotator cuff disease/injury
  • Labral injury
  • Shoulder instability
  • Biceps tendinopathy
  • Scapula (shoulder blade) movement dysfunctions

If left untreated, shoulder impingements can result in a rotator cuff tear.

Impingement Syndrome can be classified as External or Internal:

1. External impingement, which can be either primary or secondary:

Primary

  • Is usually due to bony abnormalities in the shape of the acromial arch.
  • Can sometimes be due to congenital abnormalities (known as os acromial), or due to degenerative changes, where small spurs of bone grow out from the arch with age, and impinge on the tendons.

Secondary

  • Usually due to poor scapular (shoulder blade) stabilisation which alters the physical position of the acromion, hence causing impingement on the tendons.
  • Is often due to weak serratus anterior and tight pectoralis minor muscles
  • Other causes can include weakening of the rotator cuff tendons due to overuse (e.g. throwing and swimming) or muscular imbalance with the deltoid muscle and rotator cuff muscles.

2. Internal impingement

  • Occurs predominantly in athletes where throwing is the main part of the sport (e.g. pitches in baseball)
  • The under side of the rotator cuff tendons are impinged against the glenoid labrum – this tends to cause pain at the back of the shoulder joint as well as sometimes at the front.

Treatment of impingement syndrome

What can the athlete do?

  • Rest
  • Apply ice or cold therapy to the painful area for 10-15 minutes per 2 hour period. Remember to use an ice bag or a towel wrapped around the ice to protect against ice burn.
  • Seek advice from a sports injury professional who can develop an appropriate rehabilitation programme
  • Return to sport gradually once the pain has eased

What can the sports injury professional or doctor do?

  • Carry out specific tests and/or order X-Rays to determine what is causing the impingement
  • Prescribe anti-inflammatory medication such as Ibuprofen or other NSAID’s (non steroidal anti inflammatory drugs).
  • Advise on rehabilitation programme’s to improve function and decrease pain.
  • Discuss the option of directly injected steroids into the subacromial space to reduce inflammation and reduce inflammation in the local area (this is not usually an early option).
  • Discuss the option of surgery in cases which have failed conservative rehabilitation efforts – this is usually after a period of at least 6-12 months.

Stop the pain and get your Shoulder checked. Call +65 6471 2744 (24 Hours) / Email: info@boneclinic.com.sg