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Shoulder Surgery
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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, mouth guards, 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

Tennis Elbow

Tennis elbow is the common name for the elbow condition lateral epicondylitis. It is an overuse injury that causes inflammation of the tendons that attach to the bony prominence on the outside of the elbow. It is a painful condition occurring from repeated muscle contractions in the forearm that leads to inflammation and micro tears in the tendons that attach to the lateral epicondyle. The lateral epicondyle is the bony prominence that is felt on the outside of the elbow and the condition is more common in sports individuals playing tennis.

ACL Reconstruction

The anterior cruciate ligament is one of the major stabilizing ligaments in the knee. It is a strong rope like structure located in the center of the knee running from the femur to the tibia. When this ligament tears unfortunately it doesn’t heal and often leads to the feeling of instability in the knee.

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Patellar Instability

Patellar (knee cap) instability results from one or more dislocations or partial dislocations (subluxations). Patella is the small piece of bone in front of the knee that slides up and down the femoral groove (groove in the femur bone) during bending and stretching movements. The ligaments on the inner and outer sides of patella hold it in the femoral groove and avoid dislocation of patella from the groove.
Any damage to these ligaments may cause patella to slip out of the groove either partially (subluxation) or completely (dislocation). This misalignment can damage the underlying soft structures such as muscles and ligaments that hold the knee cap in place. Once damaged, these soft structures are unable to keep the patella (knee cap) in position. Repeated subluxation or dislocation makes the knee unstable and the condition is called as knee instability.
Patients with knee instability experience different signs and symptoms such as:

  • Pain, especially when standing up from a sitting position
  • Feeling of unsteadiness or tendency of the knee to “give way” or “buckle”
  • Recurrent subluxation
  • Recurrent Dislocation
  • Severe pain, swelling and bruising of the knee immediately following subluxation or dislocation
  • Visible deformity and loss of function of the knee often occurs after subluxation or dislocation
  • Sensation changes such as numbness or even partial paralysis can occur below the dislocation as a result of pressure on nerves and blood vessels

Various factors and conditions may cause patellar instability. Often a combination of factors can cause this abnormal tracking and include the following:

    • Anatomical defect: Flat feet or fallen arches and congenital abnormalities in the shape of the patella bone can cause misalignment of the knee joint.
    • Abnormal “Q” Angle: The “Q” angle is a medical term used to describe the angle between the hips and knees. The higher the “Q” angle, such as in patients with Knock Knees, the more the quadriceps pull on the patella causing misalignment.
    • Patellofemoral Arthritis: Patellar misalignment causes uneven wear and tear and can eventually lead to arthritic changes to the joint.
    • Improper Muscle Balance: Quadriceps, the anterior thigh muscles, function to help hold the kneecap in place during movement. Weak thigh muscles can lead to abnormal tracking of the patella, causing it subluxate or dislocate.

Your surgeon diagnoses the condition by collecting your medical history and physical findings. He may also order certain tests such as X-rays, MRI or CT scans to confirm the diagnosis.

Treatment for instability depends on the severity of condition and based on the diagnostic reports. Initially your surgeon may recommend conservative treatments such as physical therapy, use of braces and orthotics. Pain relieving medications may be prescribed for symptomatic relief. However when these conservative treatments yield unsatisfactory response surgical correction may be recommended.

Considering the type and severity of injury surgeon decides on the surgical correction. A lateral retinacular release may be performed where your surgeon releases, or cuts, the tight ligaments on the lateral side (outside) of the patella enabling the patella to slide more easily in the femoral groove.

Your surgeon may also perform a procedure to realign the quadriceps mechanism by tightening the tendons on the inside or medial side of the knee.

If the misalignment is severe tibial tubercle transfer (TTT) will be performed. This procedure involves the surgeon removing a section of bone where the patellar tendon attaches on the tibia. The bony section is then shifted and properly realigned with the patella and reattached to the tibia with two screws.

Following the surgery rehabilitation program may be recommended for better outcomes and quicker recovery.

Shoulder Separation (AC Dislocation)

Acromioclavicular joint (AC joint) dislocation or shoulder separation is one of the most common injuries of the upper arm. It involves separation of the AC joint and injury to the ligaments that support the joint. The AC joint forms where the clavicle (collarbone) meets the shoulder blade (acromion).

Causes

It commonly occurs in athletic young patients and results from a fall directly onto the point of the shoulder. A mild shoulder separation is said to have occurred when there is AC ligament sprain that does not displace the collarbone. In more serious injury, the AC ligament tears and the coracoclavicular (CC) ligament sprains or tears slightly causing misalignment in the collarbone. In the most severe shoulder separation injury, both the AC and CC ligaments get torn and the AC joint is completely out of its position.

Symptoms

Symptoms of a separated shoulder may include shoulder pain, bruising or swelling, and limited shoulder movement.

Diagnosis

The diagnosis of shoulder separation is made through a medical history, a physical exam, and an X-ray.

Conservative treatment options

Conservative treatment options include rest, cold packs, medications, and physical therapy.

Surgery

Surgery may be an option if pain persists or if you have a severe separation.

Anatomic reconstruction

Of late, research has been focused on improving surgical techniques used to reconstruct the severely separated AC joint. The novel reconstruction technique that has been designed to reconstruct the AC joint in an anatomic manner is known as anatomic reconstruction. Anatomic reconstruction of the AC joint ensures static and safe fixation and stable joint functions. Nevertheless, a functional reconstruction is attempted through reconstruction of the ligaments. This technique is done through an arthroscopically assisted procedure. A small open incision will be made to place the graft.

This surgery involves replacement of the torn CC ligaments by utilizing allograft tissue. The graft tissue is placed at the precise location where the ligaments have torn and fixed using bio-compatible screws. The new ligaments gradually heal and help restore the normal anatomy of the shoulder.

Postoperative rehabilitation includes use of shoulder sling for 6 weeks followed by which physical therapy exercises should be done for 3 months. This helps restore movements and improve strength. You may return to sports only after 5-6 months after surgery.

Clavicle Fracture

The clavicle is the bone that connects your sternum or breastbone to your shoulder. Clavicle fracture, also called broken collarbone is a very common sports injury seen in people who are involved in contact sports such as football and martial arts as well as impact sports such as motor racing.

Causes

A broken collarbone normally occurs after a fall onto the shoulder or a motor vehicle accident. The most common sports associated with clavicle fractures include football, hockey, and skiing.

Symptoms

A broken collarbone most often causes pain, swelling and bruising over the collarbone. Pain increases with shoulder movement. Your shoulder may be slumped downward and forward. You may also have a bump around the area of the break. You may hear a grinding sound when you try to raise your arm.

Diagnosis

To diagnose a broken collarbone, your doctor will take a brief history, about the injury, and perform a physical examination of your shoulder. An X-ray of the clavicle is taken to identify the location of the fracture. Your doctor may also recommend a computerized tomography (CT) scan in some cases.

Conservative Treatment Options

Most broken collarbones heal without a surgery. An arm sling may support the arm and hold the bones in their normal position. You may also be given pain medications to relieve the pain. After your pain reduces your doctor may recommend gentle shoulder and elbow exercises to minimize stiffness and weakness in your shoulder. Follow up with your doctor until your fracture heals.

Surgery

Surgery may be required in case of displaced fractures. Surgery is performed to re-align the fractured ends and stabilize them during healing. Surgery often involves use of pins or plates and screws to maintain proper position of the bone during healing.

Plates & Screws fixation

During this surgical procedure, your surgeon will reposition the broken bone ends into normal position and then uses special screws or metal plates to hold the bone fragments in place. These plates and screws are usually left in the bone. If they cause any irritation, they can be removed after fracture healing is complete.
Pins

Placement of pins may also be considered to hold the fracture in position and the incision required is also smaller. They often cause irritation in the skin at the site of insertion and have to be removed once the fracture heals.

  • American Academy of Orthopaedic Surgeons
  • Arthroscopy Association of North America
  • American Orthopaedic Society for Sports Medicine
  • Dignity Health