Common Pickle Ball Wrist Injuries

Do you experience a dull and aching pain or soreness in your wrist during or after playing racket or paddle sports? Does your wrist feel stiff when reaching for low balls or flicking your wrist for those difficult and awkward shots? If you answered yes and your symptoms are located on the “pinky” side of your paddle wrist, then you have ulnar-sided wrist pain. Pain in this region can be anything from wrist arthritis, tendon irritation, joint instability, or triangular fibrocartilage (TFCC) injury. Ulnar-sided wrist pain can be uncomfortable and persist if left untreated, but early treatment can significantly reduce pain and discomfort. Common athlete complaints include:

  • stiffness
  • clicking or snapping sensation
  • local swelling
  • pain.

Typically, symptoms increase when gripping a racket/paddle, twisting your wrist, and rotating your forearm. There are several structures, including ligaments, nerves, and tendons, especially on the small finger side of your wrist that can be injured from repetitive use in awkward positions, or from direct trauma, such as a fall onto the hand. Early diagnosis is critical to assess which structures are involved to provide athletes with the optimal course of treatment. Your physician will assess your pain symptoms, joints/ligaments and stability via clinical exam, X-rays and/or MRI. Medical management varies depending on severity, structures injured and other medical history concerns.

Often, with recreational and novice tennis and Pickle ball athletes, there is evidence of muscular weakness in the shoulder blade, shoulder rotator cuff, upper arm muscles, and forearm. Weakness in these areas often lead to using your wrist and hand in less stable positions causing increased force through the ulnar side of the wrist.

I have these symptoms, now what?

If you find you have wrist pain while playing sports or completing daily activities, an evaluation by a physician is necessary to rule out any underlying medical conditions. From there, a proper course of treatment could help to address your symptoms.

How will hand therapy help me?

Referral to a Certified Hand Therapist (CHT) can assist in the assessment of your core strength/posture, shoulder/elbow/forearm/wrist flexibility and strength. Using a variety of special tests and assessment techniques, your hand therapist can prescribe neuromuscular exercises, proper splints to support your wrist, core strengthening, flexibility exercises, and joint protection strategies to reduce pain and get you back on the court safely and efficiently.


New Mexico Orthopaedics is a multi-disciplinary orthopedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Preventing Injuries While Golfing

Golf is a popular sport and offers a range of health benefits. Regular golf can help improve stamina, cardiovascular fitness and muscular endurance. For example, the average golfer playing an 18-hole game walks about seven kilometers. While the risk of injury from playing golf is low compared to other sports, common golf injuries include injuries to the lower back, shoulder, elbow, wrist, head and eye.

Risk factors for golfing injuries

Some of the factors that can increase your risk of a golfing injury include:

  • Time spent playing – generally, the more often you play, the higher your risk of injury. Golfers who spend more than six hours per week in competitive play are at increased risk of overuse injuries, as are professional golfers.
  • Unsupervised children – injuries to children under the age of 10 years are often the result of inadequate adult supervision (for example, children getting hit in the face by swinging clubs).
  • Incorrect technique – examples include poor swing style and hitting the ground instead of the ball. Incorrect technique dramatically increases the risk of injury. Golfers who perform correct technique are less likely to injure themselves.
  • Failure to warm up and cool down – warming up and cooling down are extremely important to reduce the risk of muscle and joint injuries.
  • Previous injury – golf can aggravate existing injuries.

Health and safety suggestions for golf

Suggestions include:

  • Make sure equipment, such as clubs and shoes, are professionally fitted.
  • Be SunSmart. Wear sun protective clothing, use SPF30+ (or higher) sunscreen and lip balm, wear an appropriate hat, seek shade where possible and wear sunglasses.
  • Insect repellent should be carried in your golf bag at all times.
  • Drink non-alcoholic fluids before, during and after the game. Take drinks with you in your golf bag to avoid dehydration during play.
  • Practice the rules and etiquette of the game. For example, make sure that no one is standing too close when you’re about to swing, and always call out ‘fore’ to warn others if your shot appears to be heading in their direction.
  • Obey all safety instructions when driving a motorized golf cart.
  • Postpone play if lightning strikes are possible.
  • Avoid placing hands in holes or areas where spiders or snakes might inhabit.
  • Supervise young children on the golf course at all times. For example, make sure they don’t stand too close when someone is teeing off and don’t allow them to fool around with golf clubs.
  • Get adequate rest between games.
  • Carry a mobile phone, wherever possible, in case of emergency.

Warming up before playing golf

Muscle strains and sprains are more likely to occur if you fail to warm up properly before play. A study of golfers undertaken by the Sports Injury Prevention Unit at Deakin University in Victoria found that less than three per cent of Victorian golfers warm up properly, while nearly half don’t warm up at all.

Suggestions include:

  • Walk briskly for a couple of minutes to raise your heart rate.
  • Warm up your neck and upper back by dropping your chin to your chest, gently rolling your head from side to side in slow half-circles.
  • Warm up your shoulders. Hold a golf club horizontal to the ground, keeping your hands about shoulder width apart. Slowly raise the club overhead, hold for a few moments and then lower. Hold the golf club in a similar way, but this time behind your back. Raise as high as you can, hold for a few moments, then lower.
  • Warm up your torso with side bends. Slide your hand down your leg to support the weight of your torso.
  • Twist through the waist – gently and slowly turn from one side to the other.
  • Go through the motions of swinging the club without actually hitting a ball. Begin with gentle half swings and work up to full swings over the course of a few minutes.

Cool down after the activity. Use the same range of stretches suggested above.

Take care of your back

Suggestions include:

  • Consider using a buggy to transport your clubs, or carry clubs using a supportive carry brace.
  • Carry out a general strength and fitness program that includes weight training or aerobic activities, such as walking or jogging, to improve muscle strength, flexibility and endurance.
  • Strengthen abdominal muscles to support your lower back. A Canadian study found that golfers with strong side abdominal muscles (obliques) have a reduced incidence of back pain.
  • Consider taking lessons with a PGA qualified coach to improve your technique to prevent injury and improve performance.

Suggestions include:

  • Don’t engage in long practice sessions, particularly if you are practicing the one shot over and over.
  • If you are practicing your putting, make sure you straighten up and stretch regularly.
  • Remember to bend your knees when picking up balls. Lift one leg off the ground as you lean over to counterbalance your weight.
  • Try not to use more force than is necessary for the swing, especially in the ‘follow through’ motion after the ball has been hit.

Treat a golfing injury promptly

Suggestions on what to do if you are injured include:

  • Stop immediately if injury occurs. Playing on will only exacerbate the injury.
  • All injured players, regardless of how severe the injury is, should seek first aid or prompt medical treatment of their injury.
  • Treat all soft tissue injures (ligament sprains, muscle strains, bumps and bruises) with rest, ice, compression, elevation (raise the injured limb above your heart) and referral to a health professional.
  • Injured golfers should not resume play until they have completely recovered from their injury.

Where to get help

  • Your doctor
  • Professional Golf Association coach
  • Physiotherapist

Things to remember

  • Common golf injuries include injury to the lower back, shoulder, elbow, wrist, head and eye.
  • Warm up thoroughly before play to reduce your risk of muscle and joint injuries.
  • Remember to bend your knees when picking up balls. Lift one leg off the ground as you lean over to counterbalance your weight.
  • Take golf lessons to improve your technique.

New Mexico Orthopaedics is a multi-disciplinary orthopedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Acute vs. Chronic Sports Injuries

Article featured on Summit Orthopedics

You may have heard the terms acute sports injury and chronic sports injury. But what is the difference between acute vs chronic sports injuries?

What is an acute sports injury?

Acute injuries happen in a single moment. In sports, they could be the result of a collision, abnormal twisting, landing wrong after a jump, or some other kind of traumatic injury.

In short, when you experience an acute injury during sports, you’ll know it. You may hear a “pop” or feel a tearing sensation, and it will generally be painful, with swelling, bruising, or deformity after the injury.

How do you diagnose and treat an acute sports injury?

Acute injuries should get evaluated urgently, within a week if not on the day of injury itself. Treatment depends on the severity of the injury, but getting an X-ray and an evaluation right away is always a good idea. When the injury is acute, it’s important to get it treated quickly to make sure it heals properly.

If surgery is needed, we should do it quickly, so the bones and ligaments can be lined up right away. That gives the athlete the best chance of getting back to sports as soon as possible. Planning for a return to sports should be part of an athlete’s discussion with a sports medicine provider after an acute injury.

What about chronic sports injuries?

Many active and athletic people can relate to a long-term, nagging soreness or stiffness in the body whether it’s a baseball pitcher’s aching shoulder or a runner’s sore knees. These are the kinds of symptoms associated with chronic sports injuries.

Chronic injuries happen over time, generally with overuse. They happen when a joint, tendon, or other structure wears out over time. Examples include tendinitis and rotator cuff injuries with microtears that build up over years.

In sports, loading a joint or other structure the wrong way or with too much force for too long can lead to that structure getting too thin and eventually giving out. Our bodies are designed to withstand force, but if an athlete goes above and beyond that force threshold repetitively, it can set the stage for a chronic sports injury.

How are chronic sports injuries treated?

For chronic injuries, time is less of a component, because the injury is long term. With a chronic injury, we can try nonoperative treatments like physical therapy, RICE, and anti-inflammatories. Even if surgery is recommended, it doesn’t have to happen right away.


New Mexico Orthopaedics is a multi-disciplinary orthopedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Sports-Related Meniscus Tears and Surgical Treatment

Article featured on NY Orthopedics

A torn meniscus tear is one of the most common knee injuries found in athletes. These types of injuries commonly occur when the athlete twists their knee. Most meniscus tears are primarily found in athletes who perform in contact sports like football and rugby. However, active basketball players, skiers, and volleyball players are also at risk.

Below you’ll find some common symptoms of a torn meniscus, how to treat it, and the best and quickest ways to recover.

What Are the Common Symptoms of a Torn Meniscus

Your meniscus is a C-shaped piece of cartilage that sits between your shinbone and thighbone. It’s often referred to as the knee’s shock absorber, reducing the impact on your joint every time your foot makes contact with the surface.

Patients With a Torn Meniscus Report Experiencing:

  • A popping sensation in their knee
  • Swelling
  • Stiffness
  • Discomfort turning their knee
  • Knees locking into place
  • Difficulty straightening the knee
  • Instability

Meniscus Tears in Athletes

In many cases, a torn meniscus will heal over time. Rest, medication, and physical therapy can speed recovery times in those cases where surgery is not necessary. In more severe cases, arthroscopic surgery may be required to repair the meniscus. This is more common in cases where the knee has locked into place.

Can You Play Sports With a Torn Meniscus

You should not continue to play sports if you are experiencing any torn meniscus symptoms. In fact, you should avoid any activity that may cause the knee to twist. If you’re experiencing any of the symptoms we’ve listed above, contact one of our qualified knee specialists for an examination as soon as possible to determine if they are related to a meniscus tear.

What Natural Methods Can I Perform to Heal a Torn Meniscus?

If your doctor chooses a non-surgical approach to heal your meniscus tear, they will likely recommend a combination of rest, ice, compression, and elevation, otherwise known as R.I.C.E.

  1. Rest – Keep off your knee as much as possible for the next couple of days. Putting pressure on your knee could aggravate your symptoms and limit your recovery time.
  2. Ice – Place an ice pack on your knee for 10 to 15 minutes a few times a day to reduce any swelling.
  3. Compression – Your doctor may recommend a wrap or brace to stabilize your knee until it fully heals.
  4. Elevation – Try to sit or lay back and elevate your knee above your heart. This will promote blood flow toward your heart which will aid in recovery.

What is the Recovery Time for Non-Surgical Torn Meniscus Treatments?

With any treatments, recovery can last around six to eight weeks; however, even minor tears may take longer to heal.

Torn Meniscus Surgery

In more severe cases, a doctor may recommend surgery. There are three main procedures a specialist may perform.

  • Meniscus Repair – Your surgeon will perform an arthroscopy to determine the extent of the tear. From there, the surgeon will sew the torn pieces of the menisci back together.
  • Trimming the Meniscus – Through an arthroscopy, a surgeon will trim back and remove any damaged cartilage, leaving the healthy cartilage intact.
  • Meniscus Transplant – In some cases, a surgeon may choose to replace the meniscus with a healthy one from a donor. A patient must often meet several criteria to qualify for this type of treatment.

What is the Recovery Time For Torn Meniscus Surgery?

Recovery times can vary depending on the extent of the surgery. However, a healthy estimate is anywhere from six weeks to three months.

What are the Best Exercises After Meniscus Tear Surgery?

Your doctor will likely recommend light exercises to promote healing and improve your range of motion as you fully heal from your meniscus surgery. Here is just a sample of the types of torn meniscus exercises your doctor may recommend:

Hamstring Contractions:

Lie on your back with your knees bent and pull your heels in, tightening the muscles behind your thigh. Hold for five seconds and repeat ten times.

Straight Leg Raises:

Lying on your back, lift your outstretched leg about six inches off the ground. Hold for five seconds before lowering. Repeat ten times.

Standing Leg Raises:

Stand up using a railing or table for support. Slowly lift your leg forward, raising it about four to six inches off the ground. Gently lower your leg. Repeat ten times.

Can I Still Play Sports After Meniscus Surgery?

While each meniscus tear is different, the vast majority of patients who receive treatment will experience full mobility after treatment is complete. Athletes can continue playing the sports they love and stay competitive.


New Mexico Orthopaedics is a multi-disciplinary orthopedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Getting Back Into Sports After a Knee Surgery

Article featured on Cone Health

While the time it can take to return to sports after knee surgery varies, it is important to follow doctor’s orders, according to Stephen Lucey, MD, an orthopedic surgeon in Greensboro and member of the Cone Health Medical and Dental Staff.

Before surgery, you may do specific exercises to aid in recovery. “Recommended exercises can be done at home or with a physical therapist to improve strength and range of motion,” says Dr. Lucey.

Then, you can expect to follow a 3-step process to get back to the sports you enjoy.

After surgery, you should use the RICE method: Rest the knee, ice it, compress or wrap the injured area and elevate it to prevent swelling. “At first, you should take it easy,” adds. Dr. Lucey. “You may benefit from pain relievers as directed by your surgeon.” Second, you can expect to begin mobilization or therapy techniques that improve range of motion and begin to strengthen your knee. Once you have sufficiently recovered, the focus shifts to the final phase of recovery – strengthening exercises. “For runners, strengthening might include biking or running on a treadmill,” shares Dr. Lucey. “For soccer players, juggling, kicking or passing the ball are options.”

The timeline for returning to sports depends on your knee issue and extent of surgery. “After arthroscopic knee surgery requiring a small incision, you may be able to return to sports in a month while it could take 6 months or more after tearing an ACL, a ligament that helps stabilize your knee joint,” concludes Dr. Lucey. “The key is following your doctor’s instructions on your road to recovery.”


New Mexico Orthopaedics is a multi-disciplinary orthopedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Are You Ready for a Marathon?

Article featured on Summit Orthopedics
If you are a runner, running a marathon may be on your bucket list. We share some advice for you to consider before you commit to your first marathon.
In the summertime race events are plentiful. Runners can include the whole family in a day of fitness fun by signing up for a family run, race to raise money for worthy causes, or set their sites on the race that tests their endurance as a runner: the marathon. It is important for aspiring marathoners to understand that it is one thing to run a 5-mile course, and quite another to complete a 26.2 mile race.
The decision to run a marathon should be given serious consideration. To run a marathon safely means making a significant time commitment to months of planning and training.
We suggest that runners consider three factors before they commit to their first marathon.

Schedule

Training for a marathon means dedicated time to training; but that’s not where your time commitment ends. You’ll also need time for proper recovery between training sessions, and should also factor in a higher-than-normal level of fatigue. If you are at a point where demands on your time are high, or you may not have the support you need, you might want to consider a half marathon instead. This shorter race still requires training, and will give you more first hand experience about whether you are ready for the demands of a longer race.

Pre-Existing Injuries

If you have any knee, hip, or back issues, marathon training is going to increase the stress on problem areas. This is a factor you should discuss with a physical therapist before you commit to training for a big race.

Nutrition

Marathon training increases your body’s nutrition needs. If you aren’t a healthy eater, are you ready to make significant changes in your diet to protect your body’s performance?
Running is a wonderful way to stay fit and healthy, and every runner talks about the emotional satisfaction that goes hand-in-hand with their sport. We applaud ambitious goals like checking that first marathon off the bucket list, and we want you to be ready and able to commit the time and discipline you’ll need to safely train to achieve your goal.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.
New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.
Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.
If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

5 Expert Tips for Preventing Winter Sports Accidents

5 Expert Tips for Preventing Winter Sports Accidents

BY KAYLA MCKISKI | Article Featured on US News

Hitting the slopes or the skating rink as the winter of 2020 winds down? Don’t let an accident or injury spoil your fun.

“Winter sports and recreational activities have great health and cardiovascular benefits,” said Dr. Joseph Bosco, vice president of the American Academy of Orthopaedic Surgeons (AAOS). “However, it’s important not to underestimate the risks that cold weather can bring.”

He noted that hospitals and health care clinics see a surge of bone and joint injuries during the winter months and many could be prevented with the right preparation.

Sprains, strains, dislocations, fractures and more traumatic injuries can happen to anyone. Here, Bosco and the AAOS offer suggestions on how to protect yourself:

  • Be prepared: Before you tackle a winter sport, make sure your muscles are warmed up and in good condition. Cold muscles, tendons and ligaments are more prone to injury. Make sure to have water and other supplies on standby.
  • Wear appropriate gear: Well-fitting protective equipment like goggles, helmets, gloves and padding is crucial. Your clothes should be layered, light, loose and wind-resistant. Footwear should be warm, provide ankle support and keep your feet dry.
  • Follow the rules: If you’re unsure of the rules of your sport, it’s time to take a lesson with a qualified instructor, especially with sports like skiing and snowboarding. Knowing how to fall correctly and safely can drastically reduce your risk of injury.
  • Keep an eye on the weather: Warnings about storms and extremely low temperatures are red flags. If you’re experiencing hypothermia or frostbite, seek immediate shelter and medical attention.
  • Use common sense: Always have a buddy when participating in an outdoor sport or activity. If you feel pain or fatigue, don’t push yourself and stop the activity.

“Don’t let winter sports injuries freeze your fun,” Bosco said in an AAOS news release. “By keeping in good physical condition, staying alert and stopping when you’re tired or in pain, you can enjoy the best of winter and reduce your risk of injury.”


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Shoulder Injuries in the Throwing Athlete

Shoulder Injuries in the Throwing Athlete

Article Featured on AAOS

Overhand throwing places extremely high stresses on the shoulder, specifically to the anatomy that keeps the shoulder stable. In throwing athletes, these high stresses are repeated many times and can lead to a wide range of overuse injuries.

Although throwing injuries in the shoulder most commonly occur in baseball pitchers, they can be seen in any athlete who participates in sports that require repetitive overhand motions, such as volleyball, tennis, and some track and field events.

Anatomy of the Shoulder

Your shoulder is a ball-and-socket joint 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. Surrounding the outside edge of the glenoid is a rim of strong, fibrous tissue called the labrum. The labrum helps to deepen the socket and stabilize the shoulder joint. It also serves as an attachment point for many of the ligaments of the shoulder, as well as one of the tendons from the biceps muscle in the arm.

Strong connective tissue, called the shoulder capsule, is the ligament system of the shoulder and keeps the head of the upper arm bone centered in the glenoid socket. This tissue covers the shoulder joint and attaches the upper end of the arm bone to the shoulder blade.

The bones of the shoulder

The bones of the shoulder. Reproduced with permission from J Bernstein, ed: Musculoskeletal Medicine. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2003.

The ligaments of the shoulder

The ligaments of the shoulder. Reproduced with permission from J Bernstein, ed: Musculoskeletal Medicine. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2003.

Your shoulder also relies on strong tendons and muscles to keep your shoulder stable. Some of these muscles are called the rotator cuff. The rotator cuff is made up of four muscles that come together as tendons to form a covering or cuff of tissue around the head of the humerus.

The biceps muscle in the upper arm has two tendons that attach it to the shoulder blade. The long head attaches to the top of the shoulder socket (glenoid). The short head attaches to a bump on the shoulder blade called the coracoid process. These attachments help to center the humeral head in the glenoid socket.

rotator cuff anatomy

This illustration shows the biceps tendons and the four muscles and their tendons that form the rotator cuff and stabilize the shoulder joint. Reproduced and adapted with permission from The Body Almanac. (c) American Academy of Orthopaedic Surgeons, 2003.

In addition to the ligaments and rotator cuff, muscles in the upper back play an important role in keeping the shoulder stable. These muscles include the trapezius, levator scapulae, rhomboids, and serratus anterior, and they are referred to as the scapular stabilizers. They control the scapula and clavicle bones — called the shoulder girdle — which functions as the foundation for the shoulder joint.

Muscles in the upper back

Muscles in the upper back help to keep the shoulder stable, particularly during overhead motions, like throwing. (Note: this illustration has been drawn in such a way to show the many layers of muscle in the back.) Reproduced with permission from JF Sarwark, ed: Essentials of Musculoskeletal Care, ed 4. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010.

Cause

When athletes throw repeatedly at high speed, significant stresses are placed on the anatomical structures that keep the humeral head centered in the glenoid socket.

baseball pitching phases

The phases of pitching a baseball. Reproduced and adapted with permission from Poss R (ed): Orthopaedic Knowledge Update 3. Rosemont, IL. American Academy of Orthopaedic Surgeons, 1990, pp 293-302.

Of the five phases that make up the pitching motion, the late cocking and follow-through phases place the greatest forces on the shoulder.

  • Late-cocking phase. In order to generate maximum pitch speed, the thrower must bring the arm and hand up and behind the body during the late cocking phase. This arm position of extreme external rotation helps the thrower put speed on the ball, however, it also forces the head of the humerus forward which places significant stress on the ligaments in the front of the shoulder. Over time, the ligaments loosen, resulting in greater external rotation and greater pitching speed, but less shoulder stability.
  • Follow-through phase. During acceleration, the arm rapidly rotates internally. Once the ball is released, follow-through begins and the ligaments and rotator cuff tendons at the back of the shoulder must handle significant stresses to decelerate the arm and control the humeral head.

When one structure — such as the ligament system — becomes weakened due to repetitive stresses, other structures must handle the overload. As a result, a wide range of shoulder injuries can occur in the throwing athlete.

The rotator cuff and labrum are the shoulder structures most vulnerable to throwing injuries.

Common Throwing Injuries In the Shoulder

SLAP Tears (Superior Labrum Anterior to Posterior)

In a SLAP injury, the top (superior) part of the labrum is injured. This top area is also where the long head of the biceps tendon attaches to the labrum. A SLAP tear occurs both in front (anterior) and in back (posterior) of this attachment point.

Typical symptoms are a catching or locking sensation, and pain with certain shoulder movements. Pain deep within the shoulder or with certain arm positions is also common.

shoulder labrum and SLAP tear

(Left) The labrum helps to deepen the shoulder socket.

(Right) This cross-section view of the shoulder socket shows a typical SLAP tear.

Bicep Tendinitis and Tendon Tears

Repetitive throwing can inflame and irritate the upper biceps tendon. This is called biceps tendinitis. Pain in the front of the shoulder and weakness are common symptoms of biceps tendinitis.

Occasionally, the damage to the tendon caused by tendinitis can result in a tear. A torn biceps tendon may cause a sudden, sharp pain in the upper arm. Some people will hear a popping or snapping noise when the tendon tears.

biceps tendinitis

(Left) The biceps tendon helps to keep the head of the humerus centered in the glenoid socket. (Right) Tendinitis causes the tendon to become red and swollen.

Rotator Cuff Tendinitis and Tears

When a muscle or tendon is overworked, it can become inflamed. The rotator cuff is frequently irritated in throwers, resulting in tendinitis.

Early symptoms include pain that radiates from the front of the shoulder to the side of the arm. Pain may be present during throwing, other activities, and at rest. As the problem progresses, pain may occur at night, and the athlete may experience a loss of strength and motion.

Rotator cuff tears often begin by fraying. As the damage worsens, the tendon can tear. When one or more of the rotator cuff tendons is torn, the tendon no longer fully attaches to the head of the humerus. Most tears in throwing athletes occur in the supraspinatus tendon.

rotator cuff tear

Rotator cuff tendon tears in throwers most often occur within the tendon. In some cases, the tendon can tear away from where it attaches to the humerus.

Problems with the rotator cuff often lead to shoulder bursitis. There is a lubricating sac called a bursa between the rotator cuff and the bone on top of your shoulder (acromion). The bursa allows the rotator cuff tendons to glide freely when you move your arm. When the rotator cuff tendons are injured or damaged, this bursa can also become inflamed and painful.

Internal Impingement

During the cocking phase of an overhand throw, the rotator cuff tendons at the back of the shoulder can get pinched between the humeral head and the glenoid. This is called internal impingement and may result in a partial tearing of the rotator cuff tendon. Internal impingement may also damage the labrum, causing part of it to peel off from the glenoid.

Internal impingement may be due to some looseness in the structures at the front of the joint, as well as tightness in the back of the shoulder.

The muscles and tendons of the rotator cuff

The muscles and tendons of the rotator cuff. Reproduced with permission from JF Sarwark, ed: Essentials of Musculoskeletal Care, ed 4. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010.

shoulder impingement

This illustration shows the infraspinatus tendon caught between the humeral head and the glenoid. Reproduced with permission from JF Sarwark, ed: Essentials of Musculoskeletal Care, ed 4. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010.

Instability

Shoulder instability occurs when the head of the humerus slips out of the shoulder socket (dislocation). When the shoulder is loose and moves out of place repeatedly, it is called chronic shoulder instability.

In throwers, instability develops gradually over years from repetitive throwing that stretches the ligaments and creates increased laxity (looseness). If the rotator cuff structures are not able to control the laxity, then the shoulder will slip slightly off-center (subluxation) during the throwing motion.

Pain and loss of throwing velocity will be the initial symptoms, rather than a sensation of the shoulder “slipping out of place.” Occasionally, the thrower may feel the arm “go dead.” A common term for instability many years ago was “dead arm syndrome.”

Glenohumeral Internal Rotation Deficit (GIRD)

As mentioned above, the extreme external rotation required to throw at high speeds typically causes the ligaments at the front of the shoulder to stretch and loosen. A natural and common result is that the soft tissues in the back of the shoulder tighten, leading to loss of internal rotation.

This loss of internal rotation puts throwers at greater risk for labral and rotator cuff tears.

Scapular Rotation Dysfunction (SICK Scapula)

abnormal positioning of the scapula

This photograph shows abnormal positioning of the scapula on the right side. Reproduced with permission from Kibler B, Sciascia A, Wilkes T: Scapular Dyskinesis and Its Relation to Shoulder Injury. J Am Acad Orthop Surg 2012; 20:364-372.

Proper movement and rotation of the scapula over the chest wall is important during the throwing motion. The scapula (shoulder blade) connects to only one other bone: the clavicle. As a result, the scapula relies on several muscles in the upper back to keep it in position to support healthy shoulder movement.

During throwing, repetitive use of scapular muscles creates changes in the muscles that affect the position of the scapula and increase the risk of shoulder injury.

Scapular rotation dysfunction is characterized by drooping of the affected shoulder. The most common symptom is pain at the front of the shoulder, near the collarbone.

In many throwing athletes with SICK scapula, the chest muscles tighten in response to changes in the upper back muscles. Lifting weights and chest strengthening exercises can aggravate this condition.

Doctor Examination

Medical History and Physical Examination

The medical history portion of the initial doctor visit includes discussion about your general medical health, symptoms and when they first began, and the nature and frequency of athletic participation

During the physicial examination, your doctor will check the range of motion, strength, and stability of your shoulder. He or she may perform specific tests by placing your arm in different positions to reproduce your symptoms.

The results of these tests help the doctor decide if additional testing or imaging of the shoulder is necessary.

Imaging Tests

Your doctor may order tests to confirm your diagnosis and identify any associated problems.

X-rays. This imaging test creates clear pictures of dense structures, like bone. X-rays will show any problems within the bones of your shoulder, such as arthritis or fractures.

Magnetic resonance imaging (MRI). This imaging study shows better images of soft tissues. It may help your doctor identify injuries to the labrum, ligaments, and tendons surrounding your shoulder joint.

Computed tomography (CT) scan. This test combines x-rays with computer technology to produce a very detailed view of the bones in the shoulder area.

Ultrasound. Real time images of muscles, tendons, ligaments, joints, and soft tissues can be produced using ultrasound. This test is typically used to diagnose rotator cuff tears in individuals who are not able to have MRI scans.

Treatment

Left untreated, throwing injuries in the shoulder can become complicated conditions.

Nonsurgical Treatment

In many cases, the initial treatment for a throwing injury in the shoulder is nonsurgical. Treatment options may include:

  • Activity modification. Your doctor may first recommend simply changing your daily routine and avoiding activities that cause symptoms.
  • Ice. Applying icepacks to the shoulder can reduce any swelling.
  • Anti-inflammatory medication. Drugs like ibuprofen and naproxen can relieve pain and inflammation. They can also be provided in prescription-strength form.
  • Physical therapy. In order to improve the range of motion in your shoulder and strengthen the muscles that support the joint, your doctor may recommend specific exercises. Physical therapy can focus on muscles and ligament tightness in the back of the shoulder and help to strengthen the structures in the front of the shoulder. This can relieve some stress on any injured structures, such as the labrum or rotator cuff tendon.
  • Change of position. Throwing mechanics can be evaluated in order to correct body positioning that puts excessive stress on injured shoulder structures. Although a change of position or even a change in sport can eliminate repetitive stresses on the shoulder and provide lasting relief, this is often undesirable, especially in high level athletes.
  • Cortisone injection— If rest, medications, and physical therapy do not relieve your pain, an injection of a local anesthetic and a cortisone preparation may be helpful. Cortisone is a very effective anti-inflammatory medicine. Injecting it into the bursa beneath the acromion can provide long-term pain relief for tears or other structural damage.

cortisone injection in shoulder

A cortisone injection may relieve painful symptoms. Reproduced with permission from JF Sarwark, ed: Essentials of Musculoskeletal Care, ed 4. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010.
Your doctor may recommend surgery based on your history, physical examination, and imaging studies, or if your symptoms are not relieved by nonsurgical treatment.The type of surgery performed will depend on several factors, such as your injury, age, and anatomy. Your orthopaedic surgeon will discuss with you the best procedure to meet your individual health needs.

Arthroscopy. Most throwing injuries can be treated with arthroscopic surgery. During arthroscopy, the surgeon inserts a small camera, called an arthroscope, into the shoulder joint. The camera displays pictures on a television screen, and the surgeon uses these images to guide miniature surgical instruments.

Because the arthroscope and surgical instruments are thin, the surgeon can use very small incisions (cuts), rather than the larger incision needed for standard, open surgery.

During arthroscopy, your doctor can repair damage to soft tissues, such as the labrum, ligaments, or rotator cuff.

shoulder arthroscopy

During arthroscopy, your surgeon inserts the arthroscope and small instruments into your shoulder joint.

Open surgery. A traditional open surgical incision (several centimeters long) is often required if the injury is large or complex.

Rehabilitation. After surgery, the repair needs to be protected while the injury heals. To keep your arm from moving, you will most likely use a sling for for a short period of time. How long you require a sling depends upon the severity of your injury.

As soon as your comfort allows, your doctor may remove the sling to begin a physical therapy program.

In general, a therapy program focuses first on flexibility. Gentle stretches will improve your range of motion and prevent stiffness in your shoulder. As healing progresses, exercises to strengthen the shoulder muscles and the rotator cuff will gradually be added to your program. This typically occurs 4 to 6 weeks after surgery.

Your doctor will discuss with you when it is safe to return to sports activity. If your goal is to return to overhead sports activities, your doctor or physical therapist will direct a therapy program that includes a gradual return to throwing.

It typically takes 2 to 4 months to achieve complete relief of pain, but it may take up to a year to return to your sports activities.

Prevention

In recent years, there has been a great deal of attention on preventing throwing injuries of the shoulder.

Proper conditioning, technique, and recovery time can help to prevent throwing injuries. Throwers should strive to maintain good shoulder girdle function with proper stretches and upper back and torso strengthening.

In the case of younger athletes, pitching guidelines regarding number of pitches per game and week, as well as type of pitches thrown, have been developed to protect children from injury.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Hip Pointers in Contact Sports

Hip Pointers in Contact Sports

Article Featured on Nationwide Children’s Hospital

Hip Pointers

Bumps and falls are all a part of everyday life as an athlete, and can often result in bruising and injury. The majority of these types of injuries are seen in contact sports. The term “hip pointer” is often used as a catch all phrase for any injury resulting in pain to the front of the hip. However, this is not always the case.

What is a Hip Pointer?

A hip pointer is bruising caused by a fall or a direct blow to the iliac crest, or front and top of the pelvis. This bruising is not always visible and may actually occur deep below the skin. Bruising may also occur in the abdominal muscles which attach to the pelvis. Most often hip pointers are seen in contact sports such as football and soccer. Hip pointers are extremely painful and may be aggravated by walking, running, laughing, coughing, or deep breathing.

Treatment

Hip pointers are treated immediately with rest and ice. Resting the injured hip from extremely painful movements will help to reduce swelling and speed the healing process. It may take 1 to 2 weeks before the injured hip is pain free with movement. During this time the athlete should be allowed to stretch the hip in all directions to avoid stiffness. The rule here is to stretch in the pain free range. Any pain will only slow the healing process and delay their return to sport.

It is important to consult your physician if your pain last more than two weeks or worsens overtime. This may be a sign of a more severe injury. Ice should be applied directly to the hip for 30 minutes of every 1-2 hours for the first 72 hours. A regimen of gentle stretching for 20-30 seconds can help to loosen the muscles around the injured hip and reduce pain. For more information on strains please see the article “The Sprains and Strains of Sporting Injuries” located on the Nationwide Children’s Hospital website.

Prevention

Hip pointers can be prevented by wearing appropriate protective equipment. For example, football and hockey wear protective hip pads to help prevent this injury. In other sports where padding is not worn, such as soccer, certain skills and techniques can be taught to avoid this injury. Padding can also be worn to prevent further injury to the hip.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Water Polo Study Highlights Head Injury Risk

Water Polo Study Highlights Head Injury Risk

Water polo players appear to face similar head injury risks as athletes in better-known sports, a new study finds. “For years, water polo’s head trauma risks have been downplayed or overshadowed by football-related brain injuries,” said study co-author James Hicks.

“Our data quantifies the extent of the problem and sets the stage for additional research and possible rule changes or protective gear to improve water polo safety,” Hicks added. He is chairman of the department of ecology and evolutionary biology at the University of California, Irvine.

“People who’ve never seen a game may not realize how physical it is,” Hicks said in a university news release. “Head-butts and elbows. Balls flying up to 50 miles per hour.”

And while no concussions were diagnosed among players in the study, the force of the head blows was “similar to those observed in collegiate soccer, another sport that is commonly studied for the risks associated with repeated head impact exposure,” he added.

For the study, Hicks and his colleagues tracked several dozen players in Division 1 NCAA Men’s Water Polo over three seasons. The players wore caps embedded with electronic sensors.

Overall, the researchers counted an average of 18 head hits per game. Offensive players were far more likely to get hit in the head than players in defensive and transition positions (60%, 23% and 17%, respectively), the findings showed. Players attacking from the left side of the goal suffered more head hits than players on the right, possibly because right-handed athletes commonly throw shots from the left zone, the researchers noted.

Offensive center was the most dangerous position in terms of hits to the head. On average, those players took nearly seven blows to the head per game, which amounted to 37% of all head impacts recorded in the study. The second-most vulnerable position, defensive center, averaged two head hits per game, according to the report.

The study authors concluded that “intercollegiate water polo athletes may represent a valuable cohort for studying the acute and chronic effects of repeated head impacts in sport to extend our knowledge of athlete physiology and neurology and to inform evidence-based policies to promote the safety of athletes and the benefits of sport.”

The study was published online May 2 in the journal PLOS ONE. In a previous study, Hicks and a colleague found that 36% of 1,500 USA Water Polo players recalled at least one concussion during their playing career.

More information

The American Academy of Pediatrics has more on water polo injury risk and safety.