CHAPTER 23 SPECIAL CONCERNS OF THE ATHLETE SHOULDER TULSA BONE & JOINT CHAPTER 23 SPECIAL CONCERNS OF THE ATHLETE SHOULDER Dislocations Subluxations Cuff tears Osteolysis of distal clavicle (power lifters) Fractures TONY JABBOUR, MD SPORTS MEDICINE

ELBOW/FOREARM Elbow – high stress during throwing. TULSA BONE & JOINT ELBOW/FOREARM Elbow – high stress during throwing. MCL stretching leads to valgus instability. Radial head osteochondritis dissecans (younger pitchers). Lateral epicondylitis (tennis elbow, injury to extensor tendons of the wrist). TONY JABBOUR, MD SPORTS MEDICINE

TULSA BONE & JOINT WRIST/HAND Mallet finger – extensor tendon rupture from the distal phalanx, splinting usually. Jersey finger – Football. Flexor digitorum profundus (FDP) of tackling player. Flexor tendon avulses from distal phalanx. Surgery is usual treatment. Skiers thumb – ulnar collateral ligament sprain of the thumb. TONY JABBOUR, MD SPORTS MEDICINE

TULSA BONE & JOINT HIP/THIGH Avulsion injuries from anterior superior iliac spine or ischial tuberosity. Younger athletes, usually around 14 years of age. Hamstring strains – usually older athletes. Femoral neck stress fractures (rare but require pinning). TONY JABBOUR, MD SPORTS MEDICINE

KNEE Second most frequently injured in regard to soft tissue injuries. TULSA BONE & JOINT KNEE Second most frequently injured in regard to soft tissue injuries. Overuse injuries lead to tendinitis. Traumatic – Patellar dislocations, ACL tear, cartilage damage (articular cartilage or meniscus). MCL – Soccer, hockey. ACL – Non-contact, high speed, change of direction. Tibia subluxes onto femur. TONY JABBOUR, MD SPORTS MEDICINE

LEG Shin splints – Non-specific term, should be avoided. TULSA BONE & JOINT LEG Shin splints – Non-specific term, should be avoided. Stress fracture of tibia. Exertional compartment syndrome – different from post-traumatic compartment syndrome in that pressure never gets high enough to cause permanent damage. Increased pressure leads to increased lactic acid, which leads to increased pain which leads to athlete having to stop activity. TONY JABBOUR, MD SPORTS MEDICINE

ANKLE Most common of all soft tissue athletic injuries. TULSA BONE & JOINT ANKLE Most common of all soft tissue athletic injuries. Ligaments prone to injury. Complete ligament tears can heal non-operatively. Achilles rupture – middle-aged athletes. Thompson test. TONY JABBOUR, MD SPORTS MEDICINE

TULSA BONE & JOINT FOOT Plantar fasciitis and stress fracture of calcaneus, common causes of heel pain. Stress fracture of metatarsals and sesamoid bone. TONY JABBOUR, MD SPORTS MEDICINE

TULSA BONE & JOINT SPINE Cervical injuries – spearing in football is illegal which can lead to quadriplegia. TONY JABBOUR, MD SPORTS MEDICINE

SPORTS SPECIFIC INJURIES FOOTBALL TULSA BONE & JOINT SPORTS SPECIFIC INJURIES FOOTBALL Keep helmet and shoulder pads on during transport to ER by ambulance. Stingers/Burners – painful sensations radiating down arm and possibly numbness and weakness secondary to forceful shoulder depression or lateral bending of neck during tackling. Low back pain common with gymnastics and football. TONY JABBOUR, MD SPORTS MEDICINE

Stress fracture of pars interarticularis (spondylolysis). TULSA BONE & JOINT Stress fracture of pars interarticularis (spondylolysis). Axial loads on spine in extension. MRI/bone scan. Treatment – Rest and bracing. Spondylolisthesis – progressive instability of one vertebral body onto the one below – “rare complication in athletes”. Contusions. Fractures. Sprains. Dislocations. Turf toe hyperextension injury. TONY JABBOUR, MD SPORTS MEDICINE

BASEBALL Shoulder instability with secondary impingement. TULSA BONE & JOINT BASEBALL Especially pitchers: Shoulder instability with secondary impingement. Valgus overload of elbow (younger athletes). Osteochondritis dissecans of elbow. Hook of hamate fracture, batting. TONY JABBOUR, MD SPORTS MEDICINE

LACROSSE High risk of knee and ankle injuries. TULSA BONE & JOINT TONY JABBOUR, MD SPORTS MEDICINE

GYMNASTICS Eating disorder Abnormal menses Stress Fracture TULSA BONE & JOINT GYMNASTICS ACL injuries Ankle injuries with landing. Hyperextension of spine leads to spondylolysis. Eating disorders – Female triad: Eating disorder Abnormal menses Stress Fracture TONY JABBOUR, MD SPORTS MEDICINE

TENNIS Shoulder instability (younger athletes). TULSA BONE & JOINT TENNIS Shoulder instability (younger athletes). Rotator cuff tears (older athletes). Low back pain. Lateral epicondylitis (older athletes). TONY JABBOUR, MD SPORTS MEDICINE

BASKETBALL Finger injuries. TULSA BONE & JOINT BASKETBALL Finger injuries. Jumper’s knee (chronic tendinosis of patellar tendon, usually at distal pole of patella. Treatment – hamstring stretches and quadriceps strengthening. Knee/ankle injuries most common. TONY JABBOUR, MD SPORTS MEDICINE

CHEERLEADING Year-round Sport. Overuse injuries. Low back pain. TULSA BONE & JOINT CHEERLEADING Year-round Sport. Overuse injuries. Low back pain. High number of catastrophic injuries (neck and head injuries) secondary to basket tosses and pyramids. TONY JABBOUR, MD SPORTS MEDICINE

SOCCER Knee/ankle injuries most common. TULSA BONE & JOINT SOCCER Knee/ankle injuries most common. Osteitis pubis – Repetitive stress on symphysis pubis from high kicking. TONY JABBOUR, MD SPORTS MEDICINE

HOCKEY Lacerations from skates and fighting. TULSA BONE & JOINT HOCKEY Lacerations from skates and fighting. AC joint clavicle fracture because of body checking. Catastrophic neck injuries. MCL injuries. TONY JABBOUR, MD SPORTS MEDICINE

TULSA BONE & JOINT MARTIAL ARTS AC joint injuries secondary to landing on point of shoulder. TONY JABBOUR, MD SPORTS MEDICINE

VOLLEYBALL Jumper’s knee. ACL meniscal injury. TULSA BONE & JOINT VOLLEYBALL Jumper’s knee. ACL meniscal injury. Shoulder instability in younger patients. Finger tip injuries. TONY JABBOUR, MD SPORTS MEDICINE

SWIMMING Shoulder injuries. Breaststroker’s knee ( MCL strain). TULSA BONE & JOINT SWIMMING Shoulder injuries. Breaststroker’s knee ( MCL strain). TONY JABBOUR, MD SPORTS MEDICINE

DIVING Inferior shoulder instability. TULSA BONE & JOINT TONY JABBOUR, MD SPORTS MEDICINE

RUNNING Stress fractures of metatarsals and tibia. TULSA BONE & JOINT RUNNING Stress fractures of metatarsals and tibia. Exertional compartment syndrome. TONY JABBOUR, MD SPORTS MEDICINE

FEMALE ATHLETE Lower center of gravity. TULSA BONE & JOINT FEMALE ATHLETE Lower center of gravity. Wider pelvis which leads to high valgus angle at knee (knock-kneed). Wider pelvis also leads to high patellofemoral tracking problems. Smaller notch in knee leads to high ACL tears. Monthly fluctuation of Estrogen levels. If Estrogen is down, this leads to osteoporosis which leads to decreased repair of stress fractures. TONY JABBOUR, MD SPORTS MEDICINE

FEMALE TRIAD: Eating disorders Osteoporosis Abnormal menses TULSA BONE & JOINT FEMALE TRIAD: Eating disorders Osteoporosis Abnormal menses TONY JABBOUR, MD SPORTS MEDICINE

AGING ATHLETE Definition of aging? More sprains and strains. TULSA BONE & JOINT AGING ATHLETE Definition of aging? More sprains and strains. Increased risk of stress fractures. Vascular claudication (peripheral vascular disease). Neurogenic claudication (spinal stenosis). TONY JABBOUR, MD SPORTS MEDICINE

PEDIATRIC ATHLETE Open physes (growth plates). TULSA BONE & JOINT PEDIATRIC ATHLETE Open physes (growth plates). Physis tends to fail before ligament fails. All sprains in children/adolescents – think physis fracture. Apophysitis – inflammation at attachment of tendons. (Osgood-Schlatter’s disease). Avulsion fracture (ischial tuberosity). Osteochondritis dissecans (elbows of pitchers). Tarsal coalition in 11-15 year olds. TONY JABBOUR, MD SPORTS MEDICINE

ATHLETES WITH DISABILITIES TULSA BONE & JOINT ATHLETES WITH DISABILITIES Special Olympics. Down’s Syndrome – Cervical spine C1-2 instability. Wheelchair athletes – rotator cuff tears. TONY JABBOUR, MD SPORTS MEDICINE