Sports Medicine

KNEE

SHOULDER

ANTERIOR CRUCIATE LIGAMENT (ACL) TEARS

A ligament is a tough band of tissue that connects bones. The anterior cruciate ligament (ACL) is a strong ligament located in the center of your knee, that connects the thigh bone (femur) to the shin bone (tibia). It is one of the four major ligaments that help stabilize the knee joint.

What is an ACL injury (or tear)? How does it happen?

An ACL tear is damage to the anterior cruciate ligament (ACL). The tear may be partial (the ligament is torn a little) or complete (the ligament is torn into two pieces). A mild injury may stretch the ligament but leave it intact.

The ACL can be injured in several ways. However, an ACL injury commonly occurs during sports involving twisting or overextending your knee. This can happen when you are changing direction rapidly, slowing down when running, or landing from a jump.

What can I do about my ACL tear?

The treatment can be surgical or non-surgical and the decision will depend more on your lifestyle than your age. The presence of other knee injuries should also be considered.  (see SurgeriesArthroscopic ACL reconstruction).

 

Physical therapy is extremely important in rehabilitation, either after surgery or with conservative treatment. And it must be remembered that the recovery time is long. Talk with your Orthopaedic surgeon, he will guide you through this decision-making process.

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MENISCUS TEARS

The meniscus is a fibrocartilaginous structure in the knee joint between your thighbone (femur) and shinbone (tibia). Each knee has two menisci (plural of meniscus). They act as shock absorbers and help stabilize the joint.

What is a meniscus tear?

It is damage to the meniscus that can be traumatic or degenerative (atraumatic).

Traumatic tears are common among players in sports such as football, basketball, and soccer. The tear frequently occurs during activities involving knee twisting.

Degenerative Meniscal tears are closely related to tissue aging and, in most cases, do not require surgery.

What can I do about my meniscus tear?

The treatment can be surgical or non-surgical. It will depend on your age, activity level, type of tear, and symptoms. A non-operative treatment program will often focus first on reducing pain and maintaining the full motion of the knee.

Your doctor might recommend rest, ice, and knee elevation.

You may need physiotherapy.

If surgery is required, a knee arthroscopy is most common. (see Surgeries – Meniscus tears)

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ROTATOR CUFF TEARS

The rotator cuff connects your upper arm bone (humerus) with your shoulder blade (scapula) and is made up of four tendons that help hold the shoulder in place. Your rotator cuff allows you to lift your arms and reach upward.

What is a rotator cuff tear?

A rotator cuff tear occurs when a tendon is torn and is partially or completely detached from the humerus bone. The most common symptoms are pain and weakness when lifting or rotating your arm.

What is the treatment for a rotator cuff tear?

For small tears, your surgeon might recommend rest and activity modifications for a variable amount of time. The doctor may also suggest physiotherapy, which can reduce pain and help make your shoulder stronger and more flexible.
You can take anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen to relieve pain and reduce inflammation, but only for short periods of time. Steroid injections may be effective; however, it is not possible to predict how long the effects will last.
Surgery might be indicated for larger tears or if you have continued pain after conservative treatment.

How long does it take to recover after a rotator cuff repair surgery?

Recovery time may vary for each individual. The most important factors that determine the recovery time are the size of the tear and the patient’s commitment to rehabilitation.
Full recovery time is about 4 to 6 months for small tears, however, for larger tears, a complete recovery may take anywhere from 6 to 12 months.

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SHOULDER LABRAL TEARS

The shoulder is a ball and socket joint that connects the bone of the upper arm (humerus) with the shoulder blade (scapula) and is the most moveable in the body. The head (ball) of the upper arm bone rests in a shallow socket in the shoulder blade called the glenoid.
The shoulder labrum is a type of rubbery cartilage attached to the socket’s rim (glenoid) and helps stabilize the joint.

What is a labral tear?

Labral tears occur when you damage the labrum and are usually caused by trauma or repetitive shoulder motion. When the shoulder dislocates, the labrum in the front of the shoulder almost always tears. You may feel shoulder pain or experience shoulder instability (the feeling that your shoulder is slipping out of place). Some types of labral tears can increase the risk of dislocation.

How is a labral shoulder tear treated?

This will depend on the type of tear and its severity. In many cases, nonsurgical methods are effective in relieving pain. Rest, icing, anti-inflammatory drugs, and physiotherapy are common treatment options.
Surgery may be recommended if conservative treatment is ineffective, or your tear is severe.

How is the recovery from labrum surgery?

Your recovery may take a few months. Your arm and shoulder will be in a sling for approximately 4 weeks. Predicting how soon someone can return to sports after the operation is difficult. Most of the time, people can return after 4 to 6 months. However, for overhead and contact sports it is recommended to wait about 8 to 10 months.

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BICEPS TENDON TEAR AT THE SHOULDER

A tendon is a cord of strong fibrous tissue that connects muscles to bones. Tendons work as levers to move your bones as your muscles contract. The biceps muscle is located at the front of your upper arm and has tendons that attach it to the shoulder and elbow bones.
Biceps tendon tears at the shoulder (also known as proximal biceps tendon tears) are far more common than elbow (distal biceps tendon).

What is a proximal biceps tendon tear?

A tear can be partial or complete. Complete tears mean the tendon has torn away from the bone. 

It happens most often in middle-aged people and is usually due to years of wear and tear on the shoulder. Overuse and injury are other common causes.

What is the treatment for a proximal biceps tendon tear?

The treatment can be surgical or conservative (nonsurgical).

Doctors usually treat a ruptured proximal biceps tendon without surgery. For most people, pain from a biceps tendon tear resolves over time.

A feeling of mild weakness in the forearm and a change in the contour (a deformity) of the front of your upper arm (called “Popeye muscle”) are common, but usually well tolerated by patients.

Surgery is reserved for patients who have persistent pain, severe loss of strength or are very concerned with the cosmetic appearance of the “Popeye muscle”.

How is the recovery from a biceps tendon tear surgery?

Your shoulder will be in a sling for about 4 weeks. Physical therapy may be recommended after two or three weeks to regain range of motion and shoulder strength.

Patients can resume daily activities in 3 to 6 weeks, but it usually takes four to six months to recover from a proximal biceps tendon surgery.

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