Sports Medicine

There are two cruciate ligaments that crisscross like an “X” in the center of your knee. They connect your thighbone (femur) to your shinbone (tibia) and help stabilize the knee when in motion. The ligament on top is the anterior cruciate ligament or ACL. It is often torn from abrupt twisting or pivoting, as when you suddenly change direction; from the impact of landing a jump; or from a fall. ACL tears are especially common in sports like football, soccer (especially in females), and girls’/women’s basketball.

When you tear your ACL, you might hear a popping sound and your knee will give out. As it begins to swell the pain sets in. A torn ACL cannot heal on its own. Treatment will depend on the severity of the tear. A partial tear without knee instability may respond to conservative treatments. A complete tear or knee instability may require surgery. Fortunately, ACL reconstruction can help most athletes recover their full function after an ACL tear.

During an ACL reconstruction, your surgeon will replace the damaged ACL with a strip of tendon from under your kneecap or your hamstring, securing the ends to your thighbone and shinbone. The procedure is typically performed using arthroscopy, a minimally invasive surgery.

The goal of ACL reconstruction is to restore function and stability, and avoid further injury when you return to your sport. After surgery, you’ll go through physical therapy to facilitate your recovery. The therapeutic exercises prescribed will help you strengthen the muscles surrounding the knee and maximize your range of motion.

The other cruciate ligament, the PCL (posterior cruciate ligament), criss-crosses behind the ACL, on the back side of the knee. Like the ACL, it connects the thighbone to the shinbone, stabilizes the knee, and prevents the shinbone from moving too far backward.

While PCL tears are less common than ACL tears, this ligament is also often injured during football or soccer, and it is a common injury during car accidents as well. It may occur from a direct impact when the knee is bent (such as falling on a bent knee or hitting the dashboard during a wreck) or from a hit on the side of the knee or just below the kneecap.

Minor PCL tears usually heal with rest, medication, and physical therapy while more severe or complete tears may require reconstruction through arthroscopic surgery, followed by physical therapy.

The rotator cuff is a group of muscles and tendons in the shoulder that form a “cuff” over the upper end of the arm bone (humerus). It helps to lift and rotate the arm and to stabilize the ball of the shoulder within the joint.

The rotator cuff is commonly injured during sports that involve repetitive throwing, lifting, or reaching, such as baseball, tennis, weight lifting, and rowing. Symptoms may arise gradually, including pain, weakness, or stiffness when lifting, lowering, or rotating your arm. You might also hear a crackling sound when moving your shoulder.

In many cases, a rotator cuff tear can heal with nonsurgical treatment such as rest, anti-inflammatory medication, or steroid injection. You might also need to use a sling to immobilize the shoulder for a period of time, and go through physical therapy to strengthen the shoulder and restore mobility.

If you need surgery, there are different surgical techniques your orthopedic surgeon may use, depending on the severity of your injury. During rotator cuff surgery, the doctor will repair the tendon, reattach it to the bone, and remove any bone spurs present. Your doctor may be able to perform the procedure arthroscopically (a minimally invasive approach), or he may have to perform an open repair with a large incision to fully access the joint.

After surgery, you will need physical therapy to regain your strength and function.

The biceps muscle runs from your shoulder to your forearm. At the top of your arm, two tendons (a long head and short head, also called the proximal biceps tendons) attach the muscle to the shoulder. They help stabilize the shoulder and assist in overhead motions. At the other end of the muscle, a tendon attaches it to the smaller bone (radius) in the forearm. This distal biceps tendon helps bend the elbow and rotate the lower arm.

The most common biceps tendon tear occurs in the long head. When it happens, you may feel a sharp pain or hear a snap at the shoulder. You may lose strength in your arm and notice a large bulge in the upper arm. This type of biceps tendon tear often occurs from years of overuse, such as repetitive overhead motions.

The biceps tendon below the elbow can also tear, although it’s much less common. When this happens, you will feel a sharp pain or hear a snap at the elbow, and you may be unable to lift items or bend your elbow. This type of biceps tendon tear often occurs when an unexpected force is applied to a bent arm, as when trying to break a fall.

For athletes, weightlifters or those involved in contact sports such as football are most susceptible to biceps tendon tears.

Proximal biceps tendon ruptures (those at the shoulder) typically heal with conservative treatments, although active athletes benefit from surgery to reattach the tendon in order to return to their sport.

For athletes, a distal biceps tendon tear almost always requires surgery to reattach the tendon to the bone. Surgery for either type of tear will require physical therapy to restore range of motion.

Pitcher’s elbow, or Little League elbow, is a common complaint among young baseball players who pitch and throw repetitively. It is a form of tendonitis that results from overuse of the elbow tendons and ligaments. An athlete will feel pain on the inside of the elbow and may notice a limited range of motion or a locking of the elbow joint.

This injury requires ice to control inflammation and several days of rest. If the athlete ignores the problem and continues throwing, he can experience serious complications, require surgery, and jeopardize his ability to continue playing his sport.

Tennis elbow, or lateral epicondylitis, is a type of tendonitis that causes pain on the outside of the elbow, where the tendons of your forearm muscles attach to a bony bump called the lateral epicondyle. The pain can also spread into your forearm and wrist.

Tennis elbow occurs from overuse of the elbow tendons, such as during certain sports or occupations that involve repetitive motions, such as painters, plumbers, and carpenters. The condition requires rest and anti-inflammatory medication to heal. If the condition becomes chronic or the pain becomes disabling, your orthopedist might suggest surgery.

The Achilles tendon connects your calf muscle to your heel bone. It can tear suddenly from being overstretched during sports such as basketball, football, or tennis. It may also tear gradually as a result of Achilles tendonitis, an overuse injury that weakens the tendon.

The Achilles tendon can tear partially or completely. When this happens, you’ll hear a pop and feel a sharp pain in the back of your ankle and lower leg. It will be difficult to point your toes, walk, and climb stairs.

For athletes, surgery is typically recommended to repair the tear and reattach the tendon. You will wear a splint or cast for several weeks after surgery and participate in physical therapy when healing is complete.

Burners and stingers are a nerve injury that frequently occurs at the shoulder during contact or collision sports such as football. Players who tackle or block are most susceptible to this type of injury.

The injury is so named because of the stinging or burning pain that radiates from the shoulder to the hand. The pain can feel like an electric shock that travels down the arm, accompanied by weakness or numbness and a warm sensation.

Burners and stingers are caused by damage to the group of nerves called the brachial plexus, which extends from the spinal cord in the neck across the upper chest to the armpit. This network of nerves controls movement and feeling in the arm and hand. Brachial plexus nerve damage can prevent the muscles of the arm and hand from working properly, and cause loss of feeling in the area.

Most burners and stingers are temporary and resolve fairly quickly. They require rest to heal, and an athlete should never be allowed to return to sport until his or her symptoms have completely disappeared.

If symptoms last for several days, the athlete may need to work with a trainer or therapist to regain strength and motion.

Arthroscopy is one of the most commonly performed orthopedic procedures.  This minimally invasive procedure allows an orthopedic surgeon to evaluate, diagnose, and treat joint disorders by providing a clear view of the inside of the joint.

Many sports injuries can be treated through arthroscopic surgery, including:

• ACL and PCL tears
• Torn meniscus (knee cartilage)
• Rotator cuff tears
• Dislocated shoulder
• Shoulder impingement syndrome
• Chondromalacia patellae (runner’s knee, in which the cartilage under the kneecap is damaged due to abnormal alignment or instability of the kneecap)
• Loose bone or cartilage in the knee, shoulder, elbow, ankle, or wrist

Using small incisions, the surgeon inserts a tiny instrument called an arthroscope, which includes a camera that displays images of the inside of the joint on a monitor. If treatment is necessary, the surgeon will make additional incisions to insert surgical instruments and remove or repair damaged tissues.

Arthroscopy is the preferred method of surgery whenever possible. Benefits include decreased tissue trauma, less pain and scarring, and faster recovery time.