Category Archives: Injuries

The Throwing Arm of a Baseball Pitcher – Understanding Shoulder Pain

Shoulder pain, particularly related to throwing sports such as baseball, involves the rotator cuff. You may have heard a variety of medical terms related to the shoulder, like rotator cuff tendinitis, rotator cuff tear, or impingement syndrome. But what does this mean  to a baseball athlete?

The first piece of good news is tha shoulder pain, like most other Pitcher at Mound, Throwing the Ballsports-related injuries, rarely requires surgery. Now that we are hopeful that surgery will not likely be required, what can we do to alleviate the shoulder pain and prevent it from coming back?

Before discussing treatments for shoulder pain, a basic understanding of the anatomy of the shoulder may be helpful. The shoulder is a complex joint. There are three bones and two joints that contribute to shoulder function– the humerus, clavicle, and scapula are the bones. The ball and socket joint of the shoulder is between the humerus and the scapula. The acromial clavicular joint between the scapula and clavicle moves with forward elevation of the arm and helps stabilize the shoulder on the chest wall. The shoulder is the most mobile joint in the body and because of this it is easily injured.

Causes of Rotator Cuff Injuries

The shoulder joint is often injured in the throwing sports, such as baseball, because it has a greater range of movement than any other joint in the body. Shoulder muscles and ligaments bare a tremendous amount of stress throughout the throwing motion.

When you raise your arm up above your head, as occurs during the cocking and acceleration phases of the pitching motion, the rotator cuff muscles can be pinched under the acromion, causing irritation and occasionally sharp pain felt on the front or top of the shoulder. This situation is referred to as “shoulder impingement’ or “impingement syndrome”.

Deceleration

 A good throwing technique requires the athlete to use his body weight and the large muscle groups of the legs, back and trunk to generate kinetic energy across the shoulder in the direction of the thrown object. After the ball is released, the retained energy in the throwing arm needs to be dissipated back to the large muscles which then absorb it. Stated more simply, after a ball is thrown, the arm must decelerate. The large muscles of the back and trunk, as well as the triceps and the rotator cuff all assist in deceleration of the arm. A tremendous amount of stress can be placed on the rotator cuff muscles as they assist in decelerating the arm after the ball is released. This is particularly true in pitchers who don’t follow through all the way. By not following through, deceleration must occur abruptly, increasing the amount of stress that is placed on the smaller and more easily injured rotator cuff muscles.

Biomechanics

As stated above, when a pitcher has poor biomechanics, undue stress can be placed on the soft tissue structures of the shoulder. Different biomechanical flaws place stress on different structures. Volumes have been written on the subject. What is important to remember here is that pitchers with poor throwing biomechanics place undue stress on the smaller rotator cuff muscles, compared to the stronger muscles of the back and trunk.  Ensuring that an athlete learns proper throwing technique is a worthy investment in the health of their arm.

 Overuse 

Overuse is the most common source of throwing related injuries. Most importantly, it is avoidable. Paying close attention to pitch counts and giving athletes ample rest is the best way to prevent overuse injuries. It is important that athletes are allowed to come out of a game at the first sign of shoulder discomfort or soreness, even if it is not convenient to the goal of winning the game that day.

Treatment and Prevention

Reduce Inflammation – Using the RICE method: 1) Rest; 2) Ice; 3) Compression; and 4) Elevation

Myofascial Release – When muscle tissue is injured, scar is formed. Scar formation (also called myofascial adhesion) is the body’s way of patching an injured area. The problem with scar is that it is tough and fibrous, whereas healthy muscle is supple and elastic, like a rubber band. Myofascial Release Technique is used to break up scar formation and restore the muscle’s elasticity, or rubberband-like characteristics. Once the rotator cuff muscles are painfree and myofascial adhesions are broken, therapeutic exercises are essential to a complete recovery. It should also be noted that myofascial release technique can increase throwing velocity by optimizing the elasticity of the throwing muscles.

Stretching and Strengthening Exercise – Stretching and strengthening of the rotator cuff is crucial to completing shoulder rehab and remaining pain free. A few simple rotator cuff exercises will strengthen the muscles, resulting in injury resistance and optimal performance. You’ll notice that college and major league pitchers perform rotator cuff exercises on a regular basis, even when they are not injured. This speaks volumes to the importance of a healthy rotator cuff in pitchers, as well as other athletes whose sport involves repetitive stress on the shoulder.

If you are shoulder pain due to a sports injury, please call me at 425-823-400 or email me at ProOrthoAppointment@proliancesurgeons.com to schedule an appointment.

Common Weightlifting Injuries

Weight lifting is a sport as well as part of someone’s exercise regimen.  Experienced weight lifters rarely suffer serious injuries but newcomers to the sport or exercise are more prone to musculoskeletal injuries.

 

Distal biceps rupture:

This is a rupture of the biceps tendon that attaches the biceps muscle in the arm to a bone of the upper forearm. A weightlifter can rupture this tendon at the elbow with a sudden force that extends the elbow while trying to contract the biceps. Performing a biceps curl and then losing control of the weight is an example. Surgery to reattach the tendon is usually needed. Choosing a weight that a person can lift and control can help prevent a distal biceps rupture.

 

Labral tear:

The labrum is a cartilage bumper in the shoulder that surrounds the glenoid (socket). With repetitive compression of the labrum or possibly an acute motion that injures the shoulder, the weightlifter can feel discomfort or a clicking sensation deep within the shoulder. An orthopedic surgeon can perform a physical exam and tests that suggest a labral tear. An MRI with contrast injected (MR arthrogram) can demonstrate a tear. Surgery is often required to treat a shoulder labral tear if it limits activity. Proper technique and having shoulder pain evaluated early if it is not improving can be helpful.

 

Shouldering impingement:

This is more of a cause of chronic shoulder pain in a weightlifter rather than an acute injury. Avoiding exercises that cause pain can help the problem. Working with a physical therapist to improve shoulder mechanics and strengthen the muscles around the shoulder can often speed recovery. Seeing an orthopedic surgeon or a physical therapist when this problem develops and starting a treatment program can often accelerate return to overhead lifting.

 

Lower back muscle strain:

A strain of the muscles of the lumbar spine can occur from using improper technique with exercises or picking up or putting down weights awkwardly. Fortunately most don’t require more aggressive treatment than rest and activity modification. Proper lifting technique is key.

 

Quadriceps or hamstring muscle strain:

Acute strains of the quadriceps and hamstring muscles from squats, leg presses, lunges and other lower extremity exercises can occur. Most heal without surgery and require only rest and short-term exercise modification. Proper exercise techniques and choosing an appropriate amount of weight can help prevent injuries.

 

 

Patellar or quadriceps tendonitis:

These are also more chronic issues with the tendons around the knee than acute injuries. Pain in the tendons above or below the kneecap with lower extremity exercises can develop and worsen over time. Often short-term avoidance of exercises that reproduce the pain, anti-inflammatory medication, and ice can resolve the problem.

 

Many of the injuries listed above can be prevented by using proper technique. Often simply rest and short-term activity modification can prevent a minor pain from turning into a more serious injury.

 

If any musculoskeletal pain continues to limit your ability to work out the way you want, consider visiting Dr. Stickney to learn and understand possible treatments by calling 425-823-400 to schedule an appointment or email him at ProOrthoAppointment@proliancesurgeons.com.

 

 

Housemaid’s Knee (Prepatellar Bursitis) – Know the Signs and Symptoms

Housemaid’s knee is also known as prepatellar bursitis. It is caused by inflammation of the bursa (a small fluid-filled sac) in front of the kneecap. It more commonly occurs in people who spend long periods of time kneeling. Housemaid’s knee is more common in tradesmen who spend long periods of time kneeling -for example, carpet fitters, concrete finishers and roofers.

Any age group can be affected by housemaid’s knee. It is generally more common in males than in females. Housemaid’s knee in children is more likely to be caused by infection. Infection is also a common cause of housemaid’s knee in people whose immune systems are not working normally; people include those receiving steroid treatment or those on chemotherapy treatment for cancer.

What is bursitis?

Bursitis means inflammation within a bursa. A bursa is a small sac of fluid with a thin lining. There are a number of bursae in the body. Bursae are normally found around joints and in places where ligaments and tendons pass over bones. They can also be found in other places if there has been unusual pressure or friction placed on that area.

Generally, the function of a bursa is to help reduce friction and allow maximum range of motion around joints. When there is inflammation within a bursa (bursitis), the bursa swells due to an increase in the amount of fluid within the bursa sac.

 

What is housemaid’s knee?

There are four bursae located around the knee joint. They are all prone to inflammation, or bursitis. However, the prepatellar bursa (the bursa in between the skin and the kneecap) is most commonly affected. Its position is shown in the diagram. Housemaid’s knee is the name given to inflammation of the prepatellar bursa.

What causes housemaid’s knee?

There are a number of different things that can cause housemaid’s knee:

·      A sudden, one-off, injury to the knee – For example, a fall or direct blow on to the knee

·      Recurrent minor injury to the knee – This usually happens after spending long periods of time kneeling down, putting pressure on the kneecap (patella). Historically, this was typical of housemaids who spent long periods of time on their knees scrubbing floors; hence, the term housemaid’s knee.

·      Infection – The fluid in the prepatellar bursa sac can become infected and cause inflammation within a bursa (bursitis). This is particularly common in children with housemaid’s knee. This usually follows a cut, scratch or injury to the skin on the surface of the knee. This injury allows germs (bacteria) to spread infection into the bursa.

·      Another inflammatory disease – If you already have an inflammatory disease such as rheumatoid arthritis, you have an increased risk of developing a bursitis. Rheumatoid arthritis is a form of arthritis that causes inflammation, pain and swelling of joints.

·      Gout – If you have gout or pseudogout, you have an increased risk of developing a bursitis. Gout is caused by a build-up of uric acid crystals. Uric acid is a chemical in the blood that is usually harmless and passed out with the urine. In gout, it builds up and collects within a joint, causing pain, inflammation and joint swelling.

 

How is housemaid’s knee diagnosed?

Dr. Stickney is usually able to diagnose housemaid’s knee simply by examining your knee. He may ask you questions about your occupation or if you have had any recent knee injury and if you have any history of other joint problems.

If Dr. Stickney suspects that housemaid’s knee is caused by infection, he may suggest that they draw some fluid from the bursa. This is a straightforward procedure. The skin on the front of your knee is sterilized with some fluid and the procedure is carried out in a clean environment. A small needle is used to take a sample of the fluid from your prepatellar bursa, which is directly underneath the skin in front of your kneecap. This fluid is sent off to the laboratory to look for signs of infection. If infection is confirmed, the laboratory may be able to suggest which antibiotic medicines will treat it.

Treatment options for Housmaid’s Knee

Episodes’ of housemaid’s knee will settle with medical or supportive treatment unless infected, in which case, your Dr. Stickney may draw fluid, send for lab tests and prescribe some form of antibiotics. Drug or surgical treatment is determined in the treatment plan if the injury is recurring and/or infection is extreme.

If you are suffering from housemaid’s knee, call Dr. Stickney and schedule an appointment at 425-823-400 or email him at ProOrthoAppointment@proliancesurgeons.com.

ACL Prevention and Treatment

Spring is the perfect time to get outdoors to play tennis, basketball, soccer or even take up running.  Being active requires our bodies to adjust to the season once again and the providers at ProOrtho want to make sure that you are not sidelined from enjoying your favorite outdoor activity this season!

The ACL (anterior cruciate ligament (ACL) is one of four major ligaments that provide stability to the knee joint. It is located in the center of the knee and prevents the tibia (or shin bone) from sliding forward in relation to the femur (or thigh bone) and also prevents abnormal rotation of the knee. ACL injuries most commonly occur in sports that require cutting, pivoting, and quick stops like soccer and basketball.  Often the injury occurs without contact.

Immediately after an ACL injury, your knee may swell, feel unstable and may become painful when weightbearing. Many people hear or feel a “pop” in their knee when an ACL injury occurs.

Depending on the severity of your ACL injury, treatment may include surgery to replace the torn ligament followed by rehabilitation exercises to help you regain strength and stability.   When ACL injuries are left untreated your knee may feel unstable and if you continue to play cutting and pivoting sports it can casue further damage to your knee like meniscus tears and cartilage damage.

If your favorite sport involves pivoting or jumping, a proper training program can help reduce your chances of an ACL injury.   ACL prevention programs have been shown to decrease the risk of ACL injuries in female athletes.

ProOrtho offers the following tips on how to prevent an ACL injury:

  • Learn how to move with good alignment so you protect your knees.
  • Develop body awareness, strength, and balance to support your knees and ankles. Always jump, land, stop, and move with your knees directly over your feet.
  • Do NOT let your knees collapse inward.
  • Cut, pivot, and land from jumps with your knees more bent
  • Develop strength in your hips and thighs.
  • Warm up and stretch before games and practice.
  • Perform a variety of drills until the movement patterns are second nature and you don’t have to think about it.

By improving your flexibility, strength (particularly of the core, hips, and legs), balance, agility, and your ability to jump and land safely, you have less a chance of being injured.

According to Dr. Clinton, “all athletes in at risk sports, especially girls and women, should participate in an ACL prevention program.  This is the one thing that you can do that has been proven to prevent ACL injuries. “

If you are suffering from an ACL injury, call ProOrtho and schedule an appointment with one of their physicians at 425-823-400 or email them at ProOrthoAppointment@proliancesurgeons.com.

Orthopedic Injuries Related to Spring and Tips to Avoid Injury

When the rain showers subside here in the Pacific Northwest, we all love to take advantage of the great outdoors.  Cleaning the rain gutters, mowing the lawn, moving furniture or gardening may present injuries.  Let’s face it, when the sun comes out, we want to do everything outside!

Consider these statistics:

  • According to the U.S. Consumer Product Safety Commission, more than 35,500 people injured themselves while using a stepladder.
  • More than 41,000 Americans injured themselves while gardening or using gardening equipment
  • More than 127,000 people were injured while operating a lawn mower

Many common injuries, including tendonitis, sprains, strains or breaks, can be prevented with proper technique.  ProOrtho providers offer helpful tips for tackling all your spring plans:

  • Stretch – Stretch your arms, back and legs for several minutes before heading out to the garden or before cleaning out your basement or garage.
  • Squat – Avoid bending!  Make sure you are lifting with your legs. It’s important to squat when making a bed or shoveling dirt or mulch.
  • Lighten your load – When you are shoveling, try not to lift more than you can manage – This is when people tend to hurt themselves.  By using proper body mechanics, you may prevent an injury from occurring – Use your entire body to shovel; your hip and thigh muscles are some of the largest and strongest in the body, so put them to work.
  • Take a break –To avoid repetitive stress injury, rotate tasks that involve doing the same motions again and again (raking, digging) every 15 to 20 minutes and briefly rest or stretch in between.
  • Slide and push heavy or awkward objects.
  • Secure and stabilize a ladder before climbing.

According to Dr. Gregush, “The majority of injuries we see are preventable.  Take a few extra minutes to secure ladders before climbing on them and avoid repetitive activities.”

If you are suffering from a spring-related injury, call ProOrtho and schedule an appointment with one of our physicians at 425-823-400 or email us at ProOrthoAppointment@proliancesurgeons.com.