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MEDICINE
MEDIA GUIDE
AN ILLUSTRATED RESOURCE ON THE MOST COMMON
INJURIES AND TREATMENTS IN SPORTS FALL 2011
If at any time, you need additional information, a quote for a story, or to speak with one of our
sports medicine experts, please dont hesitate to contact media relations staff at AOSSM or AAOS.
AOSSM: lisa@aossm.org or 847-292-4900
AAOS: media@aaos.org or 847-823-7186
About AOSSM
Formed primarily as a forum for education and research, AOSSM has increased its membership
from its modest start of less than 100 to nearly 3,000 today. AOSSM members are physicians
and allied health professionals who demonstrate scientific leadership, involvement and dedication
in the daily practice of sports medicine.
The unifying interest of the membership is their concern with the effects of exercise and the
monitoring of its impact on active individuals of all ages, abilities and levels of fitness. While many
members treat high profile athletes who play on professional teams, many devote their practices
to helping out their community and treating players on the local high school or junior college team.
About AAOS
The American Academy of Orthopaedic Surgeons serves orthopaedic surgeons who are medical
doctors with training in the diagnosis and non-surgical as well as surgical treatment of the
musculoskeletal system, including bones, joints, ligaments, tendons, muscles and nerves.
With more than 36,000 members, AAOS (www.aaos.org) is the premier not-for-profit organization
that provides education programs for orthopaedic surgeons and allied health professionals, champions
the interests of patients and advances the highest quality musculoskeletal health. Orthopaedic
surgeons and the Academy are the authoritative sources of information for patients and the general
public on musculoskeletal conditions, treatments and related issues. An advocate for improved
patient care, AAOS is participating in the Bone and Joint Initiative (www.usbjd.org) the global
initiative established in 2002 to raise awareness of musculoskeletal health, stimulate research
and improve peoples quality of life.
This information is brought to you by the American Orthopaedic Society for Sports Medicine and the American Academy of Orthopaedic
Surgeons. They provide general information only and are not a substitute for your own good judgement or consultation with a physician.
For more information on sports injuries, please visit www.sportsmed.org and www.orthoinfo.org.
SPORTS MEDICINE 2
SPORTS MEDICINE
MEDIA GUIDE
AC Joint Injuries 4
Ankle Sprains 6
Anterior Cruciate Ligament Injuries 7
Articular Cartilage Injuries 9
Concussion 11
Heat Illness 13
The Mature Athlete 15
Meniscal Tears 16
MRSA Infections 17
Overuse Injuries 19
Rotator Cuff Tears 21
Shoulder Impingement 23
Shoulder Instability/Dislocations 24
SLAP Tears 26
Steroids 27
Stress Fractures 28
Sudden Cardiac Death in Athletes 30
Throwing Injuries in Children 31
Treatment of Tendon/Ligament
Disorders with Platelet-Rich Plasma 32
Sources 33
Copyright 2011. American Orthopaedic Society for Sports Medicine. All rights reserved. SPORTS MEDICINE 3
AC JOINT
INJURIES
EXPERT CONSULTA NT | Edward McFarland, MD
Additional Information
www.sportsmed.org
www.orthoinfo.org
www.STOPSportsInjuries.org
Recovery time for lateral ankle sprains How can an ankle sprain
is typically one to three weeks. Recovery be prevented?
time for high ankle sprains is typically Taping the ankle or using a brace
three to six weeks. for support can help prevent re-injury.
There are many different types of braces:
Rehabilitation can begin a few days
some made of neoprene, some made
after the injury, when the swelling starts
of elastic material, and some that have
to go down. There are three goals to
extra straps or ties for support. Braces
aim for in rehabilitation:
with straps or ties generally provide
1. Restore motion greater support.
and flexibility.
2. Restore Additional Information
strength. www.sportsmed.org
3. Restore www.orthoinfo.org
balance. www.STOPSportsInjuries.org
How can ACL injuries be prevented? or from an organ donor. This tissue is passed through
Several prevention programs have been developed in drill holes in the thigh bone and shin bone and then
an attempt to decrease the incidence of noncontact anchored in place to create a new ACL. Over time
ACL injuries. The focus of current prevention programs this graft matures and becomes a new, living
is on proper nerve/muscle control of the knee. ligament in your knee.
These programs focus on plyometrics, balance,
and strengthening/stability exercises. What does ACL injury recovery entail?
Rehabilitation of the knee after ACL reconstruction
Plyometrics is a rapid, powerful movement which first
requires time and hard work. Return to full function
lengthens a muscle (eccentric phase) then shortens
can vary from 6 weeks to 6 months depending on
it (concentric phase). The length-shortening cycle
severity and activity levels. The rate of rehabilitation
increases muscular power. An example would be
may take longer, depending on the specific
an athlete jumping off a small box and immediately
requirements of the individuals sport/activity.
jumping back into the air after contact with the floor.
The overall success rate for ACL surgery is very good.
Balance training commonly involves use of wobble
Many studies have shown that more than 90 percent
or balance boards. On-field balance exercises
of patients are able to return to sports without
may include throwing a ball with a partner while
symptoms of knee instability. Although some patients
balancing on one leg.
do complain of stiffness and pain after surgery, these
To improve single-leg core strength and stability, problems have been minimized by current surgical
athletes perform exercises such as jumping and techniques and aggressive rehabilitation.
landing on one leg with the knee flexed and then
momentarily holding that position. Additional Information
www.sportsmed.org
How are ACL tears treated surgically? www.orthoinfo.org
Many different surgical approaches have been www.STOPSportsInjuries.org
developed for the ACL injured knee. Years of
experience have shown that simply stitching the
ligament together is rarely successful. Therefore,
current techniques involve reconstructing the ACL
by building a new ligament out of tissue harvested
from one of the other tendons around the knee
Plain X-rays are not usually good in diagnosing For patients with osteoarthritis, non-surgical treatment
articular cartilage problems but are usually taken consists of physical therapy, lifestyle modification
to rule out other abnormalities. (e.g., reducing activity), bracing, supportive devices,
oral and injection drugs (i.e., non-steroidal anti-
How is an injury treated? inflammatory drugs, cartilage protective drugs),
Injuries to the cartilage that do not extend to the and medical management. Surgical options are
bone will generally not heal on their own. Injuries very specific to osteoarthritis severity and can provide
that penetrate to the bone may heal, but the type of a reduction in symptoms that are generally only short
cartilage that is laid down is structurally unorganized lived. Total joint replacement can provide relief for
and does not function as well as the original articular the symptom of advanced osteoarthritis, but generally
cartilage. Defects smaller than 2 cm have the best requires a change in a patients lifestyle and/or
prognosis and treatment options. Those options activity level.
include arthroscopic surgery using techniques to
remove damaged cartilage and increase blood flow
from the underlying bone (e.g. drilling, pick procedure,
or microfracture). For smaller articular cartilage
defects which are asymptomatic, surgery may not
be required. For larger defects, it may be necessary Additional Information
to transplant cartilage from other areas of the knee www.sportsmed.org
(joint). Consult your specialist for further information www.orthoinfo.org
on the decision to have surgery. www.STOPSportsInjuries.org
be at increased risk of second impact syndrome. Baseline testing is important for assessing concussion
Neurocognitive testing may help doctors determine symptoms after an incident. The baseline testing
when it is safe to return to competition. often includes neurocognitive tests, symptom
checklists, sideline assessment tools such as
What is neurocognitive testing? the Sideline Concussion Assessment Tool (SCAT),
Neurocognitive testing is a questionnaire the athlete and balance testing.
takes (usually by computer) that tests multiple areas
of brain function including memory, problem solving, Additional Information
reaction times, brain processing speeds, and post www.sportsmed.org
concussion symptoms. It is most valid if the athlete www.orthoinfo.org
has a pre-injury baseline test on file to compare the www.STOPSportsInjuries.org
post concussion test. This information can be very
helpful to the physician in determining return to play.
It is not a substitution for an evaluation by a physician.
bouts of exercise in the same day, the replacement Treatment tips include:
fluid should contain carbohydrates, sodium,
Getting the athlete to a shaded area.
and potassium, which are standard components
of commercial sports drinks. If it is heat stroke, cool the athlete rapidly
using cold water immersion. If immersion
Weighing oneself before and after activity provides is not available you may use spray from
good feedback on the level of hydration. If the athlete a hose, cold water sponging, or placing
is lighter after an activity, then it is likely a fluid cold towels over the entire body.
deficit has occurred and it is necessary to replace
Monitoring body temperature.
the weight loss by drinking more during the next
practice to approximate sweat losses. An athlete Providing cool beverages if possible (i.e., if the
who loses more than two percent to three percent athlete does not have altered consciousness).
of body weight during exercise may be at a point Getting medical assistance as soon as possible.
of compromising performance and physiological
Heat exhaustion is a form of heat illness that can
function. If the athlete gains weight after an activity,
develop after several days of exposure to high
then the quantity of rehydration fluid during activity
temperatures and inadequate or unbalanced
should be reduced.
replacement of fluids.
Exercise is not only for the young, but for minutes, three to four days per week. significant deformity, such as flat feet
the mature population as well. Exercise If there are physical conditions that (fallen arches), the use of foot orthotics
can be a good way for older adults need correction, a cardiac, pulmonary, can decrease stress on the entire lower
to maintain independence and remain or physical therapy rehabilitative program extremity. Symptoms from arthritic
healthy in body and mind. Major health may be helpful before beginning an changes in the knee may be decreased
problems the mature population often exercise program. These rehabilitation through the use of specialized braces.
faces can include arthritis, high blood programs should instruct the mature
pressure, heart disease, lung disease, athlete to a fitness level where they How can the mature athlete
depression, and hearing and sight loss. may then pursue their own program. prevent injury or discomfort
during exercise?
With the exception of hearing and sight
loss, all of these problems can potentially What type of exercises should Any discomfort during or after
a program include? exercise should be investigated to
improve in the mature athlete with
a controlled exercise program. The types of exercises an individual prevent reoccurrence or worsening.
takes on should be based on the Over-the-counter pain relievers and
All mature athletes should have athletes desires, pre-existing conditions, anti-inflammatory medications can
a comprehensive medical and and the ability to exercise pain-free. be used short-term if there are no
musculoskeletal evaluation prior to For individuals with lower extremity joint adverse interactions with other medical
beginning any exercise program. These issues, such as arthritis or instability, it is conditions. Additionally, the use of ice,
examinations and subsequent medical best to avoid repetitive impact activities heat, massage, and flexibility programs
and exercise counseling may prevent like running. Athletes with shoulder can relieve many exercise-induced
catastrophic health events and injuries. disabilities should avoid repetitive symptoms. More aggressive treatments
The evaluation should satisfy the overhead activities, such as military with narcotic analgesics and/or
mature athletes needs for disease presses and pull-ups. Using multiple cortisone injections should be reserved
prevention, endurance, strength, types of activities to enhance strength to treat a specific injury and not simply
body image, and competitiveness. can allow for even better muscle and to allow for short-term competition.
tendon tissue recovery. If the mature
How can exercise benefit adult desires to play a sport which may Summary
the mature athlete? aggravate pre-existing muscle, tendon, By working together with a medical
Creating a specialized program with or bone problems, they should be in and/or exercise professional to create
a qualified personal trainer can improve good condition prior to performing the a tailored program, the mature athlete
flexibility, balance, endurance, and sport. A decrease in the frequency of the can maintain independence, increase
strength. If the exercise program sport may decrease painful symptoms. physical capabilities, prevent injury and
includes sports, such as golf or tennis, add significantly to ones quality of life.
technique education by qualified What types of equipment will
instructors may also be useful for the mature athlete need? Additional Information
performance and injury prevention. Wearing shoes that match the specific www.sportsmed.org
To achieve results, any program must exercise and/or sport program can be www.orthoinfo.org
be done consistently for at least 3045 beneficial. If the individuals foot has www.STOPSportsInjuries.org
Using ice after an activity for minor aches and pain Always remember to warm up and cool down
properly before and after activity. Incorporating
Using anti-inflammatory medications as necessary
strength training, increasing flexibility, and improving
If symptoms persist, a sports medicine specialist will core stability will also help minimize overuse injuries.
be able to create a more detailed treatment plan for
Seek the advice of a sports medicine specialist or
your specific condition. This may include a thorough
athletic trainer when beginning an exercise program
review of your training program and an evaluation
or sport to prevent chronic or recurrent problems.
for any predisposing factors. Physical therapy and
Your program can also be modified to maintain overall
athletic training services may also be helpful.
fitness levels in a safe manner while you recover
from your injury. You should return to play only when
Can overuse injuries be prevented?
clearance is granted by a health care professional.
Most overuse injuries can be prevented with proper
training and common sense. Learn to listen to your
body. Remember that no pain, no gain does not
apply here. The 10 percent rule is very helpful in Additional Information
determining how to take things to the next level. www.sportsmed.org
In general, you should not increase your training www.orthoinfo.org
program or activity more than 10 percent per week. www.STOPSportsInjuries.org
This allows your body adequate time for recovery and
response. This rule also applies to increasing pace
or mileage for walkers and runners, as well as to the
amount of weight added in strength training programs.
Three techniques are used for rotator cuff repair: Additional Information
open repair (through a traditional incision) www.sportsmed.org
www.orthoinfo.org
mini-open repair (partially assisted by a camera
www.STOPSportsInjuries.org
view, with a smaller incision)
arthroscopic (performed with only a small camera
inserted through multiple small puncture wounds)
What is shoulder How does shoulder This may mean temporarily avoiding
impingement? impingement occur? activities like tennis, pitching or
Impingement refers to mechanical Any process which compromises this swimming. A nonsteroidal anti-
compression and/or wear of the rotator normal gliding function may lead to inflammatory medication may also
cuff tendons. The rotator cuff is actually impingement. Common causes include be recommended by your doctor.
a series of four muscles connecting the weakening and degeneration within the The mainstay of treatment involves
scapula (shoulder blade) to the humeral tendon due to aging, the formation of exercises to restore normal flexibility
head (upper part of the shoulder joint). bone spurs and/or inflammatory tissue and strength to the shoulder girdle,
The rotator cuff is important in within the space above the rotator cuff including strengthening both the
maintaining the humeral head within and overuse injuries. Overuse activities rotator cuff muscles and the muscles
the glenoid (socket) during normal that can lead to impingement are most responsible for normal movement
shoulder function and also contributes commonly seen in tennis players, of the shoulder blade. This program of
to shoulder strength during activity. pitchers and swimmers. instruction and exercise demonstration
Normally, the rotator cuff glides smoothly may be initiated and carried out either
between the undersurface of the How is shoulder impingement by the doctor, certified athletic trainer or
acromion, the bone at the point of diagnosed? a skilled physical therapist. Occasionally,
the shoulder and the humeral head. an injection of cortisone may be helpful
The diagnosis of shoulder impingement
in treating this condition.
can usually be made with a careful
history and physical exam. Patients with
impingement most commonly complain
Is surgery necessary?
of pain in the shoulder, which is worse Surgery is not necessary in most
with overhead activity and sometimes cases of shoulder impingement. But
severe enough to cause awakening in if symptoms persist despite adequate
the night. Manipulation of the shoulder nonsurgical treatment, surgical
in a specific way by your doctor will intervention may be beneficial.
usually reproduce the symptoms and Surgery involves debriding, or surgically
confirm the diagnosis. X-rays are also removing, tissue that is irritating the
helpful in evaluating the presence rotator cuff. This may be done with
of bone spurs and/or the narrowing either open or arthroscopic techniques.
of the subacromial space. Outcome is favorable in about
90 percent of the cases.
How is shoulder
impingement treated? Additional Information
The first step in treating shoulder www.sportsmed.org
impingement is eliminating any www.orthoinfo.org
identifiable cause or contributing factor. www.STOPSportsInjuries.org
The shoulder is the most mobile joint The shoulder is made up of three
in the body. It allows one to lift the arm, bones: humerus (upper arm bone), Statistics
rotate it, and reach up over head. It is scapula (shoulder blade), and 70,000 shoulder dislocations
occur each year.
able to turn in many directions. This clavicle (collarbone).
greater range of motion, however, Athletes who have suffered
Shoulder dislocations can be partial,
results in less stability. a shoulder dislocation:
with the ball of the upper arm coming
just partially out of the socket. This Lance Armstrong,
How do shoulder dislocations Professional Cyclist
is called a subluxation. A complete
happen? Drew Brees, New Orleans Saints
dislocation means the ball comes Quarterback
Shoulder instability occurs when the all the way out of the socket.
head of humerus (the upper arm bone)
is forced out of the shoulder socket. What are the symptoms
This usually occurs as a result of of shoulder instability?
a sudden traumatic injury.
Common symptoms of chronic shoulder A persistent sensation of the shoulder
Once a shoulder has dislocated, it is instability include: feeling loose, slipping in and out
vulnerable to repeat episodes. When of the joint, or just hanging there
Pain caused by shoulder injury
the shoulder is loose and slips out of
place repeatedly, it is called chronic Repeated shoulder dislocations How is shoulder instability
shoulder instability. Repeated instances of the shoulder
diagnosed?
giving out There are specific tests that help assess
instability in the shoulder, including
general looseness in ligaments. A doctor
may order imaging tests, including
Clavicle
(Collarbone) X-rays, CT Scan or MRI to help
Rotator
confirm a diagnosis and identify
Cuff Tendon
any other problems.
The newspapers are full of articles are likelier to engage in risky behavior,
revealing the use of anabolic steroids, such as taking other illegal drugs, or Statistics
a performance enhancing drug, in the engaging in dangerous sexual practices. As many as four million American
children and teens are using
Olympics and professional sports, but
Signs of anabolic steroid use include: performance enhancing drugs
these dangerous drugs are also being such as anabolic steroids.
used by children in college, high school, Acne, often severe, and seen
and even middle school! on the back and face
Severe mood swings, extreme
What are anabolic steroids? aggression, and even suicidal behavior drugs on a daily basis. Get involved.
Anabolic steroids are synthetic derivatives Ask kids about what they know about
Premature balding, irreversible
of the male sex hormone testosterone. breast enlargement, and smaller these drugs. Ask them if they know if
The steroids help with the construction testicles in boys any of their classmates are using these
of new proteins and increase muscle drugs. Ask them if they know the
Deeper voice, shrinking breasts,
size and strength. This is something potential dangers of performance
and clitoral enlargement in girls
that already takes place in the body, enhancing drugs.
but the steroids simulate or increase this Dangerous enlargement of the heart,
If you think your child may be
normal biologic activity. Performance that may increase bad cholesterol
and blood pressure experimenting with these drugs,
enhancing drugs are easily available talk to your doctor.
in communities, weight rooms, or even Often irreversible liver damage
via the Internet. It is also important to talk with the
In children, premature closure
coaches and ask if yearly physicals
Steroids can either be taken orally or of the growth plates, stopping
are required by the league or school for
by an injection. Anabolic steroids in and normal growth of bones.
athletic participants. A pre-participation
of themselves are not effective. However, physical by a physician is an invaluable
when used in conjunction with strength Is there ever a reason to take
way to screen for potential performance
training they may cause gains in size anabolic steroids?
enhancing drug use in athletes. Ask
and strength, along with dangerous Anabolic steroids are invaluable to people the coaches if they know if any of their
side effects. who have lost testicular function, such athletes have experimented with
as men with testicular tumors. Anabolic performance enhancing drugs.
What are the side effects steroids are also used in some types of
of anabolic steroids? anemia to stimulate the bone marrow.
Performance enhancing drugs do have
the ability to make athletes bigger and How can we prevent children
stronger but users face potentially deadly from using anabolic steroids? Additional Information
health risks. Many of the side effects of Do not think that performance enhancing www.sportsmed.org
performance enhancing drugs continue drugs are only a problem of the elite www.orthoinfo.org
even after stopping the drugs. Users also athletes. Children are exposed to these www.STOPSportsInjuries.org
stress fractures infrequently require expensive imaging Maintain a healthy diet. Make sure to incorporate
modalities such as bone scans or MRIs. A rest period calcium and vitamin D rich foods in your meals.
of one to six weeks of limited weight bearing activity Use the proper equipment. Do not wear old
progressing to full weight bearing may be necessary. or worn running shoes.
Return to activity should be a gradual process.
If pain or swelling occurs, immediately stop the
Low-impact activities, such as swimming or biking,
activity and rest for a few days. If continued pain
can be performed to maintain cardiovascular
persists, see an orthopaedic surgeon.
conditioning once the pain subsides. When the
patient can comfortably perform low-impact activities It is important to recognize the symptoms early
for prolonged periods without pain, high-impact and treat them appropriately to return to sports
exercises may be initiated. Typically, the athlete at a normal playing level.
gradually increases jogging mileage and eventually
returns to sport-specific activities. Additional Information
www.sportsmed.org
High-risk stress fractures, involving areas such as the
www.orthoinfo.org
hip, have a predilection for progressing to complete
www.STOPSportsInjuries.org
fracture; therefore, they require a more aggressive
approach. In athletes who have chronic pain and
normal findings on initial X-rays, a bone scan or MRI
is recommended. Because of the high complication
rate, high-risk stress fractures should be treated like
traumatic fractures often with a cast and
occasionally with surgery when necessary.
Concussion Solomon DJ, Levine WN. SLAP tears: pearls and pitfalls in
American Orthopaedic Society of Sports Medicine Concussion diagnosis and management. Sports Medicine Update. 2011;
Workshop Chicago 1997 Jan/Feb:2-6.
Collins, Gioia, Langlios 2007 Concussion Management
Stress Fractures
Guidelines CDC Physician ToolKit
eMedicine Stress Fracture: Article by Jonathan C Reeser, MD,
International Conference on Concussion in Sport Vienna 2001, PhD. Retrieved 2007-12-23.
Prague, 2004, Zurich 2008
Sudden Cardiac Death in Athletes
Heat Illness
PPE Preparticipation Physical Evaluation published by the
Wexler, RK. Evaluation and treatment of heat-related illnesses. American Academy of Pediatrics
American Family Physician. 2002. 65:11.
Bope. Connw Current Therapy 2011, 1st edition
Inter-Association Task Force on Exertional Heat Illnesses.
Maron BJ. Hypertrophic Cardiomyopathy and other Causes
Exertional Heat Illnesses Consensus Statement. Available at
of Sudden Cardiac Death in Young Competitive Athletes, with
http://www.sportsmed.org/downloads/pdf/CS_heatillness.pdf.
Considerations for Preparticipation Screening and Criteria for
Anderson, SJ, et al. Climatic heat stress and the exercising Disqualification, Cardiol Clin. 25 (2007) 399-414
child and adolescent. Pediatrics. 2000. 106:1.
Nessa WT. Cardiovascular Disease in Athletes, Am J Sports Med.
MRSA Infections 1999 27:108.
www.cdc.gov/mrsa/groups/advice-for-athletes.html Rakel. Textbook of Family Medicine, 7th ed. 2007, Saunders
www.doh.state.fl.us/disease_ctrl/epi/fleis/mrsashapiro.pdf Boden B. J Am Acad Orthop Surg. 2005;13:445-454, Direct
Catastrophic Injury in Sports
www.emedicinehealth.com/mrsa_infection/article_em.htm
Marx. Rosens Emergency Medicine, 7th ed. 2009 Mosby
www.medicinenet.com/mrsa_infection/article.htm
DeLee. DeLee and Drezs Orthopaedic Sports Medicine, 3rd ed.
www.mayoclinic.com/health/mrsa/DS00735
2009 Saunders
www.nlm.nih.gov/medlineplus/ency/article/007261.htm
Drezner J. Br J Sports Med. 2009: 43:625-626
www.staph-infection-resources.com/mrsa-pictures.html
Treatment of Tendon/Ligament Disorders
Slap Tears with Platelet-Rich Plasma
Andrews JR, Carson EG, McLeod WD. Glenoid labrum tears Foster TE, Puskas BL, Mendelbaum BR, Gerhardt MB, Rodeo SA.
related to the long head of the biceps. Am J Sports Med. Platelet-rich plasma: from basic science to clinical applications.
1985;13(5):337-341. Am J Sports Med. 2009. 37:2259-2270.
Burkhart SS, Morgan CD. The peel-back mechanism: its role in Mishra A, Pavelko T. Treatment of chronic elbow tendinosis
producing and extending posterior type II SLAP lesions and its effect with buffered platelet-rich plasma. Am J Sports Med. 2006.
on SLAP repair rehabilitation. Arthroscopy. 1998;14(6):637-640. 34:1774-1778.
Edwards SL, et al. Nonoperative treatment of superior labrum
anterior posterior tears: improvements in pain, function, and
quality of life. Am J Sports Med. 2010;38(7):1456-1451.
SPORTS MEDICINE 33
www.sportsmed.org www.orthoinfo.org