Thursday, December 13, 2012
The near constant overhead motion involved in volleyball places the shoulder at the forefront of volleyball injuries. Overuse injuries such as tendonitis, bursitis, and impingement are amongst the most common conditions faced by these athletes. Inadequate rest and recovery, poor mechanics, and muscle imbalances can predispose athletes for these conditions. More advanced conditions such as labral tears, specifically Superior Labrum Anterior Posterior, or SLAP, are also common in this sport. Similar to baseball pitchers, extreme rotation and torque from serving and spiking places strain on this structure’s attachment site. Over time it can become detached, causing pain, loss of power, and often requiring surgery to heal completely. Stretching and scapular strengthening can be very helpful in preventing and even treating these tears.
Lastly, atrophy and injury to a specific rotator cuff muscle, the infraspinatus, has been documented in surprisingly high numbers in elite volleyball players. Stretch on a specific nerve to this muscle is the likely cause. While generally asymptomatic, this condition which can be quite striking visually may warrant attention if it interferes with players’ ability to compete.
Knee injuries are also seen quite frequently in this population. Similar to basketball players, repetitive jumping, crouching, and landing on hard surfaces place these athletes at risk for patellar tendonitis, or “jumpers knee.” This condition will often cause pain in the front of the knee below the knee cap. It is also an overuse injury similar to shoulder tendonitis. Similarly, rest, proper stretching, and strengthening can help prevent this condition. Patellar straps, icing, and anti-inflammatory medication can provide relief when this condition is present.
Lastly, the low back, or lumbar spine, can take a tremendous amount of stress as athletes use their core to generate power in their swing. A condition known as spondylolysis is felt to be related to repetitive extension, or bending backward, of the lumbar spine. This condition affects a portion of the spinal column and can cause low back pain, and occasionally pain can radiate to the buttock or even leg. If present, aggressive treatment is indicated, including rest from sports, physical therapy, anti-inflammatories, and sometimes bracing. Most patients will be successfully treated without surgery but recovery can be prolonged. Very rarely surgery will be required to heal this condition.
These are just a few, but the most commonly seen, conditions faced by all levels of athletes participating in volleyball. Proper rest, mechanics, equipment, and coaching can prevent many of them. If your athlete is experiencing pain in these areas, the best course of action is to notify your coach and training staff they can get the attention they deserve.
Wednesday, December 12, 2012
The rotator cuff is a group of four muscles connecting the shoulder blade to the arm bone, the humerus. They function as a group to stabilize the shoulder joint and assist in lifting and rotation of the arm. When injured, patients will often notice pain, weakness, and often mechanical complaints like grinding or catching of the joint, especially with overhead activities.
Rotator cuff injuries can affect patients of any age. Typically in patients younger than 40 years old, the tissue is rarely torn and more often suffers from conditions such as impingement, bursitis, or tendonitis. In these situations, the structure of the rotator cuff is often sound, however weakness in the shoulder blade, inflammation in the surrounding bursa, or early changes in the quality of the rotator cuff tendon are the source of pain.
Because of this, rotator cuff conditions in this age group can often be managed conservatively through combinations of medications, injections, and physical therapy.
In older patients or younger ones suffering from significant injuries sometimes seen in falls and at work, the rotator cuff tissue can begin to tear. When this occurs, pain can become more constant. It will often be felt on the top or front of the shoulder. It can radiate to the upper arm as well. Pain shooting to the hand is less often caused by rotator cuff tears and more so by issues affecting the spine. Pain often manifests worse at night. In these situations, in addition to a thorough physical exam and x-rays, patients will often undergo an MRI. Shoulder injuries are easier to see when there is fluid within the joint, so your physician will often order an arthrogram, whereby a special dye is injected into the joint, just prior to the MRI.
Even if an MRI shows a full thickness tear, there can be some benefit seen with further conservative treatment such as physical therapy, even though the tear will unlikely heal in this situation. However, in patients suffering persistent pain and weakness, or when there is a fear that the tear will enlarge over time, surgery is often recommended. Traditional open and arthroscopic options exist to fix the torn tendon to the bone. The small incisions and lower blood loss of arthroscopic surgery offers the chance to have decreased pain, less stiffness, and a faster recovery. Healing rates are likely similar between the two options.
After surgery most repairs will require the use of a sling for 4-6 weeks. Complete healing of repairs can take three months, and full recover is often anywhere from 4-6 months. Physical therapy and home exercise play a key role in preventing stiffness and regaining strength in the shoulder muscles.
As you can see, rotator cuff tears present multiple options in their treatment. It is important to talk to your physician about which is the best treatment for your situation.
Friday, December 7, 2012
ACL Prevention
Thursday, November 29, 2012
Hip pain and arthroscopy
When injured, patients will typically suffer from mechanical symptoms of the hip such as clicking and catching as well as limited range of motion. Other times the symptoms are less obvious, and only manifest with a dull groin pain with certain activities. At the time of arthroscopy, some labrum tears will need to be repaired with suture, and others will need to be trimmed to prevent continued symptoms.
Labrum tear
Coexistent with labrum tears, many surgeons are increasingly recognizing a condition termed femoroacetabular Impingement, or FAI. This condition refers to a mismatch in the shape of the two bones, the femur and acetabulum, which compose the hip joint. Deformity can be present in the femur, the acetabulum, or more commonly both. When on the femur it is termed a cam type impingement and if on the acetabulum, a pincer type impingement.
At a minimum FAI is felt to be the primary causative factor for labrum tears, and there are some who feel this condition is a significant contributor to osteoarthritis of the hip due the articular cartilage damage often seen when this condition exists. Treatment of this condition at the time of hip arthroscopy requires contouring the bone to recreate the natural shape of both bones, to minimize future trauma to the labrum and articular cartilage. In addition to these conditions, hip arthroscopy can successfully treat conditions such as loose bodies, cartilage defects, snapping hip, synovitis, tendon and ligament tears, and in certain cases osteoarthritis. Prior to hip arthroscopy, most patient will require specialized x-rays and MRI where dye is injected into the hip. Most patients will be on crutches approximately two weeks after their arthroscopy, and perform a combination of physical therapy and a home program for their rehabilitation. Return to athletic competition can take anywhere from four to six months.