Winter Sports Injuries: A Slippery Slope

Jay Rapley, M.D.- Board Certified in Orthopaedics & Sports Medicine,

Every year during the winter we all get excited to hit the ski slopes, frozen ponds and skating rinks to enjoy a few hours of outdoor exercise. Participating in winter sports such as skating, skiing or ice hockey you can suffer common injuries that can be prevented with the right safety precautions.
Almost 200,000 people were treated at hospitals, doctors’ offices, and emergency rooms for injuries related to winter sports in 2018, according to the U.S. Consumer Product Safety Commission. This figure includes:
• 76,000 injuries from snow skiing
• 53,000 injuries from snowboarding
• 48,000 injuries from ice skating
• 22,000 injuries from sledding and tobogganing


Winter sports injuries include sprains, strains, dislocations, and fractures. These injuries usually happen at the end of the day, when people overexert themselves on the last run before the day’s end. Most injuries can easily be prevented if participants prepare for their sport by keeping in good physical condition, staying alert, and stopping when they are tired or in pain.

COMMON INJURIES
CONCUSSION
More than 23,500 concussions result from playing winter sports every year. Most occur while skiing or snowboarding, anyone who falls while skating or playing hockey could be at risk of a brain injury.

Concussions are the leading cause of death and disability among skiers and snowboarders. Symptoms of concussion are blurred vision, dizziness, confusion, swelling at the site of the injury and vomiting. Dr. Jay Rapley of Rockhill Orthopaedic Specialists said, “Although there are no laws or regulations regarding the use of helmets, their use can reduce the risk of a head injury up to 30% in some studies.”

DISLOCATED SHOULDER
When you hit a hard surface like ice, you run the risk of dislocating your shoulder. This joint is more mobile than other joints and is less stable. Skiers are at greater risk of dislocating a shoulder, but other winter activities can be just as risky. Not only is a dislocated shoulder extremely painful but putting off medical care for too long could lead to a chronically unstable shoulder causing functional limitations. Chronic shoulder instability can not only impact your daily life but can lead to degenerative changes in your shoulder at an earlier age.

SPINAL INJURIES
Dr. Rapley stated, “These injuries to the back and spinal cord are the most devastating of all the injuries. Currently there is no cure for a spinal cord injury and every aspect of a patient’s life is affected in some way.” A fracture or dislocation could damage the spinal cord and lead to either partial or full paralysis.
Skiers are especially prone to spinal injuries in the wintertime. Snowboarding and other high-intensity sports could cause you to hurt your back, so it’s important to adhere to skiing injury prevention tips.


ELBOW INJURIES
If you stretch out your hands to break a fall or keep from crashing into something a serious elbow injury can occur from winter sports. Dr. Rapley commented, “The most common result of an elbow injury is loss of elbow extension, or the ability to straighten your arm fully. This can happen with or without a fracture. Wrist and elbow injuries can be more common in snowboarders than skiers, but these injuries do not always discriminate.”

SKIER’S THUMB
Skiing is the only winter sport in which you’re regularly using your hands and wrists. That’s why the most common hand injury – a torn ligament in the thumb – is known as skier’s thumb. It’s the second-most common injury among skiers, second only to knee sprains.


KNEE INJURIES
The most common winter sports injuries are knee injuries. “The main stabilizing ligament of the knee, the ACL, is commonly torn during skiing accidents,” Dr. Rapley says. “These injuries can be treated with or without surgery but require a long recovery time. Tearing the ACL can increase the risk of future arthritis four-fold if the ACL is the only structure damaged and a six-fold increase in arthritis if there is associated damage to the cartilage.”

Knee Pain

ANKLE SPRAINS
Every day, 25,000 Americans sprain or fracture their ankles. Tripping, twisting or rolling ankles – all things that can happen when playing winter sports. A fracture of the Talus bone – located above the heel bone on the outside of the ankle – is known as snowboarder’s ankle. “Some of these ankle injuries commonly seen with snowboarding can lead to chronic ankle pain and dysfunction,” Says Dr. Rapley. “Sometimes surgery is performed to fix a fracture with plates and screws or excision of bony fragments.”

WINTER SPORTS SAFETY TIPS
Following these injury prevention guidelines is the key to avoiding common injuries whether you’re on the ice or on the slopes.
Take Regular Breaks: While enjoying the winter fun, take frequent breaks to hydrate, refuel and recover. This will give overworked muscles a break and allow them to keep going.
Watch the Weather: Winter weather can be quite unpredictable, check the forecast before you head out. Inclement conditions increase the likelihood of a sports injury.
Don’t Go Alone: When playing winter sports, minimize the risk by bringing someone with you. Stay close enough to one another so you can react quickly if there’s an accident.
Do Warmup Exercises: Your muscles and heart need to be in good shape before any type of physical activity. Do warmups for intense wintertime activities such as skiing, skating or snowboarding. Warm up cold muscles with some light exercise or stretching.
Use Protective Equipment: Winter sports injuries can be minimized or prevented by wearing reliable protective equipment. The most essential pieces are a helmet, goggles and UV sunglasses for skiing and snowboarding.


Check Your Gear: Wear multiple layers that can insulate your body and be removed as needed. Make sure all of your equipment is in good condition without any obvious defects. This includes your skis, snowboard, ice skates, sled and anything else you’re relying on to work properly.
Follow Proper Techniques: Many injuries occur because the skier, skater or snowboarder didn’t have the right form. Spend time learning from a qualified instructor before participating or research online to learn techniques for winter sports safety.
Experience Level: Know your abilities and stick to the trails that are suited for them, it’s important to recognize your own limitations. Learn the rules of the sport, whether it be an ice-skating rink or on the ski slopes.
Wear Appropriate Clothing: For winter sports wear heavy coats and apparel to stay warm. Clothing does more than just keep you warm, it has to be flexible enough to allow you to move freely, because constrictive clothing can actually increase the risk of injury.


Know Your Surroundings: Many winter sports injuries occur because someone didn’t anticipate a big tree or rock on the ski slope or didn’t notice a thin patch of ice during a hockey game. Knowing what’s around you helps you figure out where to go – and which areas to avoid.


Limitations: Even after following every skiing, skating or snowboarding injury prevention guideline, you could end up feeling exhausted or experience pain. In either case, it’s time to stop. Don’t push yourself during “one last run” when you’re already tired. This is when accidents can easily happen.


WINTER IS COMING
Don’t let an injury put your winter plans on ice. Winter means fun and the possibility of canceled school days for the young and young-at-heart, it also means serious complications and risks for people of all walks of life. Taking extra caution and using these injury prevention tips can help reduce the risk of serious injuries during your winter sports activities.

Sources: www.orthoinfo.aaos.org, www.sports-health.com, www.gebauer.com, www.cpsc.com

Jay Rapley, Board Certified in Orthopaedic Surgeon, Board Certified in Sports Medicine, www.rockhillortho.com

Baseball Injury Prevention

The most common baseball injuries include mild soft tissue injuries, such as muscle pulls (strains), ligament injuries (sprains), cuts, and contusions (bruises).

Although baseball is a non-contact sport, most serious injuries are due to contact — either with a ball, bat, or another player.

The repetitive nature of the sport can also cause overuse injuries such as damage to the rotator cuff in the shoulder, or ulnar collateral ligament tears in the elbow.

Proper Preparation for Play

For Coaches

  • First aid. Familiarity with first aid, including recognizing and treating the most common injuries, is especially important for coaches. Be able to administer basic first aid for minor injuries, such as facial cuts, bruises, strains, sprains, and tendonitis.
  • Field knowledge. Be familiar with your baseball field, including its telephone and cardiac defibrillator.
  • Emergency situations. Be prepared for emergencies. Have a plan to reach medical personnel for help with more significant injuries like concussions, breathing problems like wheezing, heat illness, and orthopaedic emergencies, such as fractures and dislocations.
  • Follow the rules. Know the rules and encourage safe and appropriate play.

For Players

  • Physical exam. A pre-season physical exam is important for both younger and older players. The goal is to prevent injuries and illnesses by identifying any potential medical problems. These may include asthma, allergies, heart, or orthopaedic conditions.
  • Warm up. Always take time to warm up. Warm up with some easy calisthenics, such as jumping jacks. Continue with walking or light running, such as running the bases. Many warm-ups also include position-specific stretches. Gentle stretching, in particular your back, hamstrings, and shoulders, can be helpful. Your team coach or athletic trainer may provide a stretching program.
  • Cool down and stretch. Stretching at the end of practice is too often neglected because of busy schedules. Stretching can help reduce muscle soreness and keep muscles long and flexible. Slowly and gently stretch after activity, holding each stretch for 30 seconds.
  • Hydrate. Even mild levels of dehydration can hurt athletic performance. If you have not had enough fluids, your body will not be able to effectively cool itself through sweat and evaporation. A general recommendation is to drink 24 ounces of non-caffeinated fluid 2 hours before exercise. Drinking an additional 8 ounces of water or sports drink right before exercise is also helpful. While you are exercising, break for an 8 oz. cup of water every 20 minutes.

Ensure Appropriate Equipment and Its Use

  • Equipment should fit properly and be worn correctly.
  • Wear a batting helmet at the plate, in the “on deck” circle waiting your turn at bat, and during base running.
  • Protective face shields attached to batting helmets can reduce the risk of facial injury if hit by a ball.
  • Position-specific equipment should be used.
    • Catchers should always use a catcher’s mitt, helmet, face mask, throat guard, long-model chest protector, protective supporter, and shin guards.
    • Batters should consider wearing protective jackets to avoid injury from being hit by ball.
  • Players should always wear shoes with a snug heel, roomy toe box, good traction, flexibility in the sole, and plenty of ankle support and coverage. Shoes also should breather so as not to encourage bacteria or fungus growth.
  • Always break in a new pair of cleats before wearing them during a game, and check shoes periodically for signs of wear and tear. Children often outgrow their shoes before they wear them out.
  • Gender-specific equipment may be of value, including athletic supports for boys/men and padded bras for girls/women.
  • In youth leagues, softer baseballs decrease the risk of injury from being hit by a pitched ball.
  • Players should be instructed in how to avoid getting hit by a ball.

protective baseball equipment

Examples of appropriate safety equipment include a batting helmet with face shield and catcher’s protective gear.

Ensure a Safe Environment

  • Inspect the playing field for uneven terrain (holes, divots), glass, and other debris.
  • Use a field with breakaway bases. Many injuries occur while sliding into bases. The traditional stationary base is a rigid obstacle for an athlete to encounter while sliding. In contrast, a breakaway base is snapped onto grommets attached to an anchored rubber mat, which holds it in place during normal play. Although a sliding runner can dislodge it, the breakaway base is stable and will not detach during normal base running. Installing breakaway bases on all playing fields could significantly decrease sliding injuries.
  • Assess weather conditions and be prepared to delay/cancel the game, especially in cases of particularly hot weather or thunderstorms with lightning.

Focus on Technique

Base Running

The American Academy of Orthopaedic Surgeons recommends the following tips for those individuals sliding into, as well as protecting, the bases while playing baseball and softball:

  • Players under age 10 should not be taught to slide.
  • Proper instruction in sliding technique must be provided and players must practice sliding, beginning with a sliding bag, before being allowed to slide during a game.
  • The “obstruction” rule (the fielding player cannot obstruct the path of the runner) must be taught and observed. Getting in the way of the runner or blocking the base without possession of the ball is dangerous to both the runner and fielder.
  • To prevent foot and ankle injuries between the runner and fielder on first base, a “double bag” (a separate bag for each team — one white, one orange) should be used so both the runner and first baseman have their own base.

Pitching and Throwing

Follow established guidelines for youth baseball, which include limiting the number of pitches thrown and type of pitches thrown, according to age. The following guidelines are recommended by Pitch Smart, a Major League Baseball and USA Baseball initiative that provides guidelines to help parents, players, and coaches to avoid overuse.

Table of pitch count limits

Both coaches and parents should be responsive to young pitchers who complain of arm or shoulder pain. Be sure to seek out medical care for arm pain that does not go away or that comes back every time a child resumes pitching.

Prevent Overuse Injuries

Because many young athletes are focusing on just one sport and are training year-round, doctors are seeing an increase in overuse injuries. The American Academy of Orthopaedic Surgeons has partnered with STOP Sports Injuries to help educate parents, coaches, and athletes about how to prevent overuse injuries. Specific tips to prevent overuse injuries in baseball include:

  • Limit the number of teams in which your child is playing in one season. Kids who play on more than one team are especially at risk for overuse injuries.
  • Do not allow your child to play one sport year round — taking regular breaks and playing other sports is essential to skill development and injury prevention.
  • Do not allow your child to pitch on consecutive days and avoid pitching on multiple teams with overlapping seasons.

Injury Diagnosis

Good communication between doctors, players, parents, and coaches is key to diagnosing and treating more significant baseball injuries.

Young players may not be able to recall exactly how an injury happened or describe their symptoms in detail. They may even hide injuries because of concern about being removed from play.

Coaches and parents must pay close attention to changes in a player’s participation or performance. Should there be an injury, doctors may need their help to provide accurate details and a medical history.

Safe Return to Play

An injured player’s symptoms must be completely gone before returning to play. For example:

  • In case of a joint problem, the player must have no pain, no swelling, full range of motion, and normal strength.
  • In case of concussion, the player must have no symptoms at rest or with exercise, and should be cleared by the appropriate medical provider.
  • In case of a shoulder or elbow overuse injury, the player should gradually return to a throwing program, increasing the number of throws depending on the length of time away from play, and their specific team position

Arthritis of the Knee

Arthritis is inflammation of one or more of your joints. Pain, swelling, and stiffness are the primary symptoms of arthritis. Any joint in the body may be affected by the disease, but it is particularly common in the knee.

Knee arthritis can make it hard to do many everyday activities, such as walking or climbing stairs. It is a major cause of lost work time and a serious disability for many people.

The most common types of arthritis are osteoarthritis and rheumatoid arthritis, but there are more than 100 different forms. While arthritis is mainly an adult disease, some forms affect children.

Although there is no cure for arthritis, there are many treatment options available to help manage pain and keep people staying active.

Anatomy

The knee is the largest and strongest joint in your body. It is made up of the lower end of the femur (thighbone), the upper end of the tibia (shinbone), and the patella (kneecap). The ends of the three bones where they touch are covered with articular cartilage, a smooth, slippery substance that protects and cushions the bones as you bend and straighten your knee.

Two wedge-shaped pieces of cartilage called meniscus act as “shock absorbers” between your thighbone and shinbone. They are tough and rubbery to help cushion the joint and keep it stable.

The knee joint is surrounded by a thin lining called the synovial membrane. This membrane releases a fluid that lubricates the cartilage and reduces friction.

normal knee anatomy

Description

The major types of arthritis that affect the knee are osteoarthritis, rheumatoid arthritis, and posttraumatic arthritis.

Osteoarthritis

Osteoarthritis is the most common form of arthritis in the knee. It is a degenerative,”wear-and-tear” type of arthritis that occurs most often in people 50 years of age and older, but may occur in younger people, too.

In osteoarthritis, the cartilage in the knee joint gradually wears away. As the cartilage wears away, it becomes frayed and rough, and the protective space between the bones decreases. This can result in bone rubbing on bone, and produce painful bone spurs.

Osteoarthritis develops slowly and the pain it causes worsens over time

osteoarthritis and bone spurs

 

Rheumatoid Arthritis

Rheumatoid arthritis is a chronic disease that attacks multiple joints throughout the body, including the knee joint. It is symmetrical, meaning that it usually affects the same joint on both sides of the body.

In rheumatoid arthritis the synovial membrane that covers the knee joint begins to swell, This results in knee pain and stiffness.

Rheumatoid arthritis is an autoimmune disease. This means that the immune system attacks its own tissues. The immune system damages normal tissue (such as cartilage and ligaments) and softens the bone.

Posttraumatic Arthritis

Posttraumatic arthritis is form of arthritis that develops after an injury to the knee. For example, a broken bone may damage the joint surface and lead to arthritis years after the injury. Meniscal tears and ligament injuries can cause instability and additional wear on the knee joint, which over time can result in arthritis.

Symptoms

A knee joint affected by arthritis may be painful and inflamed. Generally, the pain develops gradually over time, although sudden onset is also possible. There are other symptoms, as well:

  • The joint may become stiff and swollen, making it difficult to bend and straighten the knee.
  • Pain and swelling may be worse in the morning, or after sitting or resting.
  • Vigorous activity may cause pain to flare up.
  • Loose fragments of cartilage and other tissue can interfere with the smooth motion of joints. The knee may “lock” or “stick” during movement. It may creak, click, snap or make a grinding noise (crepitus).
  • Pain may cause a feeling of weakness or buckling in the knee.
  • Many people with arthritis note increased joint pain with rainy weather.

Doctor Examination

During your appointment, your doctor will talk with you about your symptoms and medical history, conduct a physical examination, and possibly order diagnostic tests, such as x-rays or blood tests.

Physical Examination

During the physical examination, your doctor will look for:

  • Joint swelling, warmth, or redness
  • Tenderness about the knee
  • Range of passive (assisted) and active (self-directed) motion
  • Instability of the joint
  • Crepitus (a grating sensation inside the joint) with movement
  • Pain when weight is placed on the knee
  • Problems with your gait (the way you walk)
  • Any signs of injury to the muscles, tendons, and ligaments surrounding the knee
  • Involvement of other joints (an indication of rheumatoid arthritis)

Imaging Tests

  • X-rays. These imaging tests create detailed pictures of dense structures, like bone. They can help distinguish among various forms of arthritis. X-rays of an arthritic knee may show a narrowing of the joint space, changes in the bone and the formation of bone spurs (osteophytes).
  • Other tests. Occasionally, a magnetic resonance imaging (MRI) scan, a computed tomography (CT) scan, or a bone scan may be needed to determine the condition of the bone and soft tissues of your knee.

x-rays of normal knee and knee with osteoarthritis

Laboratory Tests

Your doctor may also recommend blood tests to determine which type of arthritis you have. With some types of arthritis, including rheumatoid arthritis, blood tests will help with a proper diagnosis.

Treatment

There is no cure for arthritis but there are a number of treatments that may help relieve the pain and disability it can cause.

Nonsurgical Treatment

As with other arthritic conditions, initial treatment of arthritis of the knee is nonsurgical. Your doctor may recommend a range of treatment options.

Lifestyle modifications. Some changes in your daily life can protect your knee joint and slow the progress of arthritis.

  • Minimize activities that aggravate the condition, such as climbing stairs.
  • Switching from high impact activities (like jogging or tennis) to lower impact activities (like swimming or cycling) will put less stress on your knee.
  • Losing weight can reduce stress on the knee joint, resulting in less pain and increased function.

Physical therapy. Specific exercises can help increase range of motion and flexibility, as well as help strengthen the muscles in your leg. Your doctor or a physical therapist can help develop an individualized exercise program that meets your needs and lifestyle.

Assistive devices. Using devices such as a cane, wearing shock-absorbing shoes or inserts, or wearing a brace or knee sleeve can be helpful. A brace assists with stability and function, and may be especially helpful if the arthritis is centered on one side of the knee. There are two types of braces that are often used for knee arthritis: An “unloader” brace shifts weight away from the affected portion of the knee, while a “support” brace helps support the entire knee load.

Other remedies. Applying heat or ice, using pain-relieving ointments or creams, or wearing elastic bandages to provide support to the knee may provide some relief from pain.

Medications. Several types of drugs are useful in treating arthritis of the knee. Because people respond differently to medications, your doctor will work closely with you to determine the medications and dosages that are safe and effective for you.

  • Over-the-counter, non-narcotic pain relievers and anti-inflammatory medications are usually the first choice of therapy for arthritis of the knee. Acetaminophen is a simple, over-the-counter pain reliever that can be effective in reducing arthritis pain.

    Like all medications, over-the-counter pain relievers can cause side effects and interact with other medications you are taking. Be sure to discuss potential side effects with your doctor.

  • Another type of pain reliever is a nonsteroidal anti-inflammatory drug, or NSAID (pronounced “en-said”). NSAIDs, such as ibuprofen and naproxen, are available both over-the-counter and by prescription.
  • A COX-2 inhibitor is a special type of NSAID that may cause fewer gastrointestinal side effects. Common brand names of COX-2 inhibitors include Celebrex (celecoxib) and Mobic (meloxicam, which is a partial COX-2 inhibitor). A COX-2 inhibitor reduces pain and inflammation so that you can function better. If you are taking a COX-2 inhibitor, you should not use a traditional NSAID (prescription or over-the-counter). Be sure to tell your doctor if you have had a heart attack, stroke, angina, blood clot, hypertension, or if you are sensitive to aspirin, sulfa drugs or other NSAIDs.
  • Corticosteroids (also known as cortisone) are powerful anti-inflammatory agents that can be injected into the joint These injections provide pain relief and reduce inflammation; however, the effects do not last indefinitely. Your doctor may recommend limiting the number of injections to three or four per year, per joint, due to possible side effects.

    In some cases, pain and swelling may “flare” immediately after the injection, and the potential exists for long-term joint damage or infection. With frequent repeated injections, or injections over an extended period of time, joint damage can actually increase rather than decrease.

  • Disease-modifying anti-rheumatic drugs (DMARDs) are used to slow the progression of rheumatoid arthritis. Drugs like methotrexate, sulfasalazine, and hydroxychloroquine are commonly prescribed.

    In addition, biologic DMARDs like etanercept (Embril) and adalimumab (Humira) may reduce the body’s overactive immune response. Because there are many different drugs today for rheumatoid arthritis, a rheumatology specialist is often required to effectively manage medications.

  • Viscosupplementation involves injecting substances into the joint to improve the quality of the joint fluid.
  • Glucosamine and chondroitin sulfate, substances found naturally in joint cartilage, can be taken as dietary supplements. Although patient reports indicate that these supplements may relieve pain, there is no evidence to support the use of glucosamine and chondroitin sulfate to decrease or reverse the progression of arthritis.

    In addition, the U.S. Food and Drug Administration does not test dietary supplements before they are sold to consumers. These compounds may cause side effects, as well as negative interactions with other medications. Always consult your doctor before taking dietary supplements.

Alternative therapies. Many alternative forms of therapy are unproven, but may be helpful to try, provided you find a qualified practitioner and keep your doctor informed of your decision. Alternative therapies to treat pain include the use of acupuncture and magnetic pulse therapy.

Acupuncture uses fine needles to stimulate specific body areas to relieve pain or temporarily numb an area. Although it is used in many parts of the world and evidence suggests that it can help ease the pain of arthritis, there are few scientific studies of its effectiveness. Be sure your acupuncturist is certified, and do not hesitate to ask about his or her sterilization practices.

Magnetic pulse therapy is painless and works by applying a pulsed signal to the knee, which is placed in an electromagnetic field. Like many alternative therapies, magnetic pulse therapy has yet to be proven.

Surgical Treatment

Your doctor may recommend surgery if your pain from arthritis causes disability and is not relieved with nonsurgical treatment. As with all surgeries, there are some risks and possible complications with different knee procedures. Your doctor will discuss the possible complications with you before your operation.

Arthroscopy. During arthroscopy, doctors use small incisions and thin instruments to diagnose and treat joint problems.

Arthroscopic surgery is not often used to treat arthritis of the knee. In cases where osteoarthritis is accompanied by a degenerative meniscal tear, arthroscopic surgery may be recommended to treat the torn meniscus.

Cartilage grafting. Normal, healthy cartilage tissue may be taken from another part of the knee or from a tissue bank to fill a hole in the articular cartilage. This procedure is typically considered only for younger patients who have small areas of cartilage damage.

Synovectomy. The joint lining damaged by rheumatoid arthritis is removed to reduce pain and swelling.

Osteotomy. In a knee osteotomy, either the tibia (shinbone) or femur (thighbone) is cut and then reshaped to relieve pressure on the knee joint. Knee osteotomy is used when you have early-stage osteoarthritis that has damaged just one side of the knee joint. By shifting your weight off the damaged side of the joint, an osteotomy can relieve pain and significantly improve function in your arthritic knee.

Total or partial knee replacement (arthroplasty). Your doctor will remove the damaged cartilage and bone, and then position new metal or plastic joint surfaces to restore the function of your knee.

uni knee replacement implant and total knee replacement implant

(Left) A partial knee replacement is an option when damage is limited to just one part of the knee. (Right) A total knee replacement prosthesis.

Recovery

After any type of surgery for arthritis of the knee, there is a period of recovery. Recovery time and rehabilitation depends on the type of surgery performed.

Your doctor may recommend physical therapy to help you regain strength in your knee and to restore range of motion. Depending upon your procedure, you may need to wear a knee brace, or use crutches or a cane for a time.

In most cases, surgery relieves pain and makes it possible to perform daily activities more easily.

Source: Department of Research & Scientific Affairs, American Academy of Orthopaedic Surgeons. Rosemont, IL: AAOS; April 2014. Based on data from the National Health Interview Survey, 2012; U.S. Department of Health and Human Services; Centers for Disease Control and Prevention; National Center for Health Statistics.

Shoulder Pain and Common Shoulder Problems

What most people call the shoulder is really several joints that combine with tendons and muscles to allow a wide range of motion in the arm — from scratching your back to throwing the perfect pitch.

Mobility has its price, however. It may lead to increasing problems with instability or impingement of the soft tissue or bony structures in your shoulder, resulting in pain. You may feel pain only when you move your shoulder, or all of the time. The pain may be temporary or it may continue and require medical diagnosis and treatment.

This article explains some of the common causes of shoulder pain, as well as some general treatment options. Your doctor can give you more detailed information about your sho

Anatomy

Your shoulder is made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle).

The head of your upper arm bone fits into a rounded socket in your shoulder blade. This socket is called the glenoid. A combination of muscles and tendons keeps your arm bone centered in your shoulder socket. These tissues are called the rotator cuff. They cover the head of your upper arm bone and attach it to your shoulder blade.

 

Cause

Most shoulder problems fall into four major categories:

  • Tendon inflammation (bursitis or tendinitis) or tendon tear
  • Instability
  • Arthritis
  • Fracture (broken bone)

Other much less common causes of shoulder pain are tumors, infection, and nerve-related problems.

Bursitis

Bursae are small, fluid-filled sacs that are located in joints throughout the body, including the shoulder. They act as cushions between bones and the overlying soft tissues, and help reduce friction between the gliding muscles and the bone.

Sometimes, excessive use of the shoulder leads to inflammation and swelling of the bursa between the rotator cuff and part of the shoulder blade known as the acromion. The result is a condition known as subacromial bursitis.

Bursitis often occurs in association with rotator cuff tendinitis. The many tissues in the shoulder can become inflamed and painful. Many daily activities, such as combing your hair or getting dressed, may become difficult.

Tendinitis

A tendon is a cord that connects muscle to bone. Most tendinitis is a result of inflammation in the tendon.

Generally, tendinitis is one of two types:

  • Acute. Excessive ball throwing or other overhead activities during work or sport can lead to acute tendinitis.
  • Chronic. Degenerative diseases like arthritis or repetitive wear and tear due to age, can lead to chronic tendinitis.

The most commonly affected tendons in the shoulder are the four rotator cuff tendons and one of the biceps tendons. The rotator cuff is made up of four small muscles and their tendons that cover the head of your upper arm bone and keep it in the shoulder socket. Your rotator cuff helps provide shoulder motion and stability.

Learn more: Biceps TendinitisShoulder Impingement/Rotator Cuff Tendinitis

Tendon Tears

Splitting and tearing of tendons may result from acute injury or degenerative changes in the tendons due to advancing age, long-term overuse and wear and tear, or a sudden injury. These tears may be partial or may completely separate the tendon from its attachment to bone. In most cases of complete tears, the tendon is pulled away from its attachment to the bone. Rotator cuff and biceps tendon injuries are among the most common of these injuries.

Impingement

Shoulder impingement occurs when the top of the shoulder blade (acromion) puts pressure on the underlying soft tissues when the arm is lifted away from the body. As the arm is lifted, the acromion rubs, or “impinges” on, the rotator cuff tendons and bursa. This can lead to bursitis and tendinitis, causing pain and limiting movement.

Learn more: Shoulder Impingement/Rotator Cuff Tendinitis

Instability

Shoulder instability occurs when the head of the upper arm bone is forced out of the shoulder socket. This can happen as a result of a sudden injury or from overuse.

Shoulder dislocations can be partial, with the ball of the upper arm coming just partially out of the socket. This is called a subluxation. A complete dislocation means the ball comes all the way out of the socket.

Once the ligaments, tendons, and muscles around the shoulder become loose or torn, dislocations can occur repeatedly. Recurring dislocations, which may be partial or complete, cause pain and unsteadiness when you raise your arm or move it away from your body. Repeated episodes of subluxations or dislocations lead to an increased risk of developing arthritis in the joint.

Learn more: Chronic Shoulder Instability

Arthritis

Shoulder pain can also result from arthritis. There are many types of arthritis. The most common type of arthritis in the shoulder is osteoarthritis, also known as “wear and tear” arthritis. Symptoms such as swelling, pain, and stiffness, typically begin during middle age. Osteoarthritis develops slowly and the pain it causes worsens over time.

Osteoarthritis, may be related to sports or work injuries or chronic wear and tear. Other types of arthritis can be related to rotator cuff tears, infection, or an inflammation of the joint lining.

Often people will avoid shoulder movements in an attempt to lessen arthritis pain. This sometimes leads to a tightening or stiffening of the soft tissue parts of the joint, resulting in a painful restriction of motion.

Learn more: Arthritis of the Shoulder

Fracture

Fractures are broken bones. Shoulder fractures commonly involve the clavicle (collarbone), humerus (upper arm bone), and scapula (shoulder blade).

Shoulder fractures in older patients are often the result of a fall from standing height. In younger patients, shoulder fractures are often caused by a high energy injury, such as a motor vehicle accident or contact sports injury.

Fractures often cause severe pain, swelling, and bruising about the shoulder.

Learn more: Shoulder Trauma (Fractures and Dislocations)

Link to full article:

https://www.orthoinfo.org/en/diseases–conditions/shoulder-pain-and-common-shoulder-problems/

 

 

Athletic Shoes-How to select the right ones.

Foot, Ankle, Heel

How to Select the Right Athletic Shoes

FootcareMD.com-This material was codeveloped with the American Academy of Orthopaedic Surgeons.

Proper-fitting sports shoes can enhance performance and prevent injuries. Follow these fitting facts when purchasing a new pair of athletic shoes.

  • If possible, purchase athletic shoes from a specialty store. The staff will provide valuable input on the type of shoe needed for your sport as well as help with proper fitting. This may cost a premium in price but is worthwhile, particularly for shoes that are used often.
  • Try on athletic shoes after a workout or run and at the end of the day. Your feet will be at their largest.
  • Wear the same type of sock that you will wear for that sport.
  • When the shoe is on your foot, you should be able to freely wiggle all of your toes.
  • The shoes should be comfortable as soon as you try them on. There is no break-in period.
  • Walk or run a few steps in your shoes. They should be comfortable.
  • Always re-lace the shoes you are trying on. You should begin at the farthest eyelets and apply even pressure as you create a crisscross lacing pattern to the top of the shoe.
  • There should be a firm grip of the shoe to your heel. Your heel should not slip as you walk or run.
  • If you participate in a sport three or more times a week, you need a sport-specific shoe.
  • It can be hard to choose from the many different types of athletic shoes available. There are differences in design and variations in material and weight. These differences have been developed to protect the areas of the feet that encounter the most stress in a particular athletic activity.

Athletic shoes are grouped into categories: Running, training and walking. This includes shoes for hiking, jogging and exercise walking. For a walking shoe, look for a comfortable soft upper, good shock absorption, smooth tread, and a rocker sole design that encourages the natural roll of the foot during the walking motion. The features of a good jogging shoe include cushioning, flexibility, control and stability in the heel counter area, as well as lightness and good traction.

Court sports. Includes shoes for tennis, basketball and volleyball. Most court sports require the body to move forward, backward and side-to-side. As a result, most athletic shoes used for court sports are subjected to heavy abuse. The key to finding a good court shoe is its sole.

Field sports.
 Includes shoes for soccer football, and baseball. These shoes are cleated, studded or spiked. The spike and stud formations vary from sport to sport, but generally there are replaceable or detachable cleats, spikes or studs affixed onto nylon soles.

Track and field sport shoes. Because of the specific needs of individual runners, athletic shoe companies produce many models for various foot types, gait patterns and training styles.

Specialty sports. Includes shoes for golf, aerobic dancing and bicycling.

Outdoor sports. Includes shoes used for recreational activities such as hunting, fishing and boating.

Learn more about about sport shoes:

 

 

 

 

 

 

Fall Proof Your Home

November 17, 2017

‘Tis the season to fall-proof your home

Orthopaedic surgeons offer fall prevention safety tips

AAOS-ROSEMONT, Ill. (Nov. 17, 2017)—The holidays are about spending time with family and friends. And while many people focus on fulfilling holiday traditions like decorating their homes, shopping for presents, and hosting parties, they often forget to fall-proof their homes.

Falls are dangerous and can cause serious fractures that could impact one’s ability to move and carry-out daily functions. According to the Centers for Disease Control and Prevention (CDC), more than 300,000 adults age 65 years and older, are hospitalized for hip fractures each year, and more than 95 percent of hip fractures are caused by falling.

“While older people are at an increased risk for falls due to the normal effects of aging such as decreased quality of vision, balance and strength, a popular misconception is that they’re the only ones at risk,” said orthopaedic trauma surgeon and the American Academy of Orthopaedic Surgeon spokesperson Lisa Cannada, MD. “The reality is people of all ages are at risk for falls due to environmental and health factors. The first step to reducing your risk is making necessary changes in your home.”

Fall-proofing is not only beneficial for new house guests who are visiting this season. It’s also helpful to people who are familiar with their home surroundings. The AAOS and the Orthopaedic Trauma Association (OTA), whose members treat patients who sustain fractures and injuries from a fall, encourage everyone to consider the following tips to enjoy a fall-free holiday:

  • Reduce clutter. It’s easy to accumulate clutter, such as boxes of decor and stacks of gifts from holiday shopping. Take the time to declutter your home, especially the hallways and stairs.
  • Designate a play area. Children may receive lots of new toys for the holidays and scatter them around the house. It’s important to contain those toys in a dedicated play area and clean up the toys after kids are done playing to avoid tripping.
  • Keep walkways clear. Keep the path between your front door, driveway and mailbox well-lit and clear of debris.
  • Install nightlights. Keep the halls/walkways in your home well-lit and consider a nightlight in your bathroom. A clear path is especially helpful for family members or guests who are trying to get to the restroom in the middle of the night.
  • Secure all loose area rugs. Place double-sided carpet tape or slip-resistant backing on all loose rugs around your home including the bathroom.
  • Rearrange furniture. Ensure no furniture is blocking pathways between rooms.
  • Consider stair gates. If you have young kids who will be visiting for the holidays, or who live in your home, consider installing child-proof gates at the top and bottom of your stairs to prevent children from accessing them without adult supervision.
  • If a fall happens, do not panic. Take several deep breaths, assess the situation and determine if you are hurt. If you are badly injured do not try to get up, instead, call for help from a family member or a neighbor. If you are alone when a fall happens, slowly crawl to the telephone and call 911 or relatives.

For more fall-proofing safety tips visit the AAOS and OTA Falls Awareness and Prevention Guide.

Prevent Overuse Injuries

Overuse injuries in youth can be caused by training errors, improper technique, excessive sports training, inadequate rest, muscle weakness and imbalances and early specialization. Learn more about general stress, inflammation, tendinitis and other overuse injuries.

Learn more about Overuse Injuries (PDF – 70KB)

Source: National Athletic Trainers’ Association, Journal of Athletic Training, American Academy of Pediatrics

Achilles Tendon Rupture (Tear)

The Achilles tendon is the largest tendon in the body. It connects your calf muscles to your heel bone and is used when you walk, run, and jump.

Although the Achilles tendon can withstand great stresses from running and jumping, it is vulnerable to injury. A rupture of the tendon is a tearing and separation of the tendon fibers so that the tendon can no longer perform its normal function.

This video animation provides information about the Achilles tendon, how it can be injured, and how injuries are treated — both non-surgically and surgically.

https://www.orthoinfo.org/en/diseases–conditions/achilles-tendon-rupture-tear-video/

Source:   www.orthoinfo.org

Shy Away from Shin Splints and Fractures

Shin splints and stress fractures: both are overuse injuries caused by rapid increase in the amount or intensity of an activity. Despite this similarity, they are not the same and affect the body in different ways.

Learn what you need to know about shin splints and fractures. (PDF – 75KB)

Source: National Athletic Trainers’ Association, American Academy of Orthopedic Surgeons