1. 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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

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

10. 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

11. 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

12. 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

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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

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

21. 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

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

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

24. 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

25. 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

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

27. 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

28. 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 year olds.
TONY JABBOUR, MD SPORTS MEDICINE

29. 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