Do You Know the Three Most Common Athletic Injuries?
Orthopedic Surgeons who specialize in sports medicine commonly see and treat injuries of the knee and the shoulder. In fact, these two areas of the body are some of the most frequently injured. There are three injuries that orthopedic surgeons see and treat regularly.
When the knee gets injured, many times it is just a sprain, often caused by twisting injuries. In some sports pivoting quickly or twisting and getting struck on the side of the knee from another player can be the cause of more serious injuries to the meniscus or knee ligaments. Twisting and bending injuries can also injure the ACL. Sports that require running and pivoting and contact sports such as, basketball, soccer and football tend to cause traumatic injuries to the knee, whereas, endurance athletes who run or play tennis, usually experience less serious injuries – meniscus tears or degenerative wear and tear.
The meniscus acts as a shock absorber between the tibia and the femur and has an important role in keeping the knee healthy and pain-free. Meniscus tears, if small and in an area with good blood supply, can often resolve without surgery. If the patient is older or there is poor blood supply to the area, a meniscus tear can leave persistent pain and swelling. If that is the case, it produces excessive fluid in the knee, which leads to joint swelling. We often times try to treat this conservatively and try physical therapy first. If patients continue to have pain and swelling, surgery is often recommended to remove the part of the meniscus that is torn. MCL tears can also be treated non-surgically and will sometimes heal with limited motion, a knee brace and a course of therapy. On the other hand, a torn ACL in an active patient, almost always requires surgery for a full recovery. When the ACL is torn the blood supply to the ligament is severed. A knee without an intact ACL is unstable and the knee will not be strong to maintain an active lifestyle and play sports with pivoting or twisting motions.
The prognosis and course of treatment for knee injuries varies, based on the injury, but knee injuries don’t mean surgery is inevitable. Over-the-counter anti-inflammatories and a knee brace may be enough for the injury to heal on its own. Sometimes physical therapy is recommended and the importance of strengthening the area should not be underestimated.
Shoulder – Labral Tears
Another area of the body that is susceptible to injury is the shoulder and within the shoulder lies the labrum. The labrum is a ring of cartilage that covers the ball and socket joint of the shoulder. It’s acts as a cushion around the rim of the shoulder socket and is one of the major stabilizers to keep the ball of the shoulder in the socket. Labral tears can happen from overhead throwing, lifting, twisting or falling on an outstretched arm.
There are different two types of labral tears – A SLAP tear and a Bankart tear. This signifies which area of the labrum is injured or torn. A SLAP tear refers to a tear on the top of the socket where the biceps tendon attaches. These types of tears cause discomfort and pain but are not associated with dislocations of the shoulder. Fortunately, many SLAP tears will heal on their own with rest, physical therapy and strengthening and eventually they become asymptomatic. We usually treat labral tears with conservative care unless there is a need for surgical intervention. When a SLAP tear is more serious, the biceps tendon can sometimes pull on the labrum and sometimes it detaches from the glenoid. These types of tears have a very poor healing potential without surgery.
A Bankart tear is a second type of labral tear that can affect the shoulder. With this type of tear, an individual runs the risk of shoulder instability and dislocation. That’s because the tear is located on the anterior side of the shoulder and the ball can be forced out and out and over the rim of the socket. These types of tears usually require a surgical repair to regain stability, especially if the individual plays contact sports. Without repairing it there is a 90% chance of dislocating the shoulder again. The good news is that for individuals who need surgery to repair the labrum, the outcomes are good, and people generally are able to get back to all of the activities that they enjoy.
Shoulder – Rotator Cuff Injuries
Another common shoulder injury is a rotator cuff tear, and these happen more often in patients over 40 years old. A rotator cuff tear is often the result of wear and tear over time versus a traumatic injury. It is important to get a proper diagnose for shoulder pain because often the pain of tendonitis or bursitis can mimic a rotator cuff tear. An MRI is needed to confirm a rotator cuff tear. Contact sports, overhead activities, heavy lifting, repetitive motion are all risk factors for a rotator cuff tear. Impingement syndrome also puts people at risk. In this case, individuals may experience pain or even get bursitis from shoulder impingement. Over time it can lead to the development of a bone spur which furthers the impingement, increases the pain in the shoulder and the likelihood of a rotator cuff tear.
There are four tendons that make up the rotator cuff. Of those tendons, the supraspinatus tendon is the most susceptible to a tear. It is possible to have a partial tear, and these have a better chance at healing with conservative care, which is a combination of injections, anti-inflammatories and physical therapy. If there is a complete tear, it often will continue to get larger, and individuals complain of worsening pain with activity. Complete tears usually need to be surgically repaired; however, some patients pursue physical therapy, do get better and can live with the injury without a lot of pain.
With any of these common injuries, individuals may worry that they need surgery. It’s important to see the doctor and get the proper diagnosis. Fortunately, these injuries don’t necessarily mean you will need surgery. We encourage people to try conservative care first and GIVE PHYSICAL THERAPY A CHANCE –it may relieve the symptoms and pain and you may not need surgery after all.
Dr. Kouyoumjian is an orthopedic surgeon and sports medicine specialist at OrthoTexas. He treats many young athletes in addition to older patients with shoulder injuries and arthritis in the joints.