Sports Medicine

WHAT IS SPORTS MEDICINE?

Sports Medicine is a branch of medicine that deals both with physical fitness, as well as the treatment and prevention of acute injuries and chronic conditions that are related to sports activities.

Physicians within this field specialize in restoring and maintaining the health of the musculoskeletal system including joints, bones, muscles, tendons, and ligaments. Sports Medicine Doctors are typically Orthopedic Surgeons. All Sports Medicine physicians complete an undergraduate bachelors degree, receive their Medical Degree from an accredited four year graduate program, and then complete a five year Orthopedic Surgery Residency. Some also obtain additional training with a Sports Medicine Fellowship.

Sports Medicine physicians specialize not only in the care of the highly trained athlete, but also in taking care of injuries or conditions that may occur in the general athletic population. While many of the injuries sustained by athletes and the general public are similar, often the specific treatment and rehabilitation may differ, depending on the patient's unique needs.

COMMON SPORTS INJURIES

Almost any joint can be injured during sport. The following is a list of some of the more common Sports Medicine injuries:

SHOULDER

• Dislocation/Instability
• Superior Labral tear (SLAP lesion)
• Rotator Cuff tear
• Acromioclavicular (AC) joint sprain/dislocation
• Tendonitis (Rotator cuff tendonitis, Impingement Syndrome)
• Biceps Instability/tendonitis

ELBOW

• Collateral ligament tears/Instability
• Loose bodies
• Epicondylitis (tennis elbow, golfer’s elbow)
• Osteochondritis dissecans (OCD, little leaguers elbow)

HAND & WRIST

• Dislocations, ligament tears
• Carpal Instability
• Scaphoid fracture
• Tendonitis
• Mallet finger
• Boxer’s fractures
• Gamekeeper’s thumb (skier’s thumb)
• Tendon ruptures (jersey finger)

KNEE

• Meniscus tears
• Ligament injuries (ACL, PCL, MCL, LCL)
• Patellar dislocation/instability
• Cartilage injuries
• Loose bodies

FOOT & ANKLE

• Ankle sprains/instability
• Achilles tendon rupture
• Achilles tendonitis
• Plantar fasciitis
• Turf toe
• Metatarsal fractures (Jones fracture)

ACUTE VS CHRONIC INJURIES

Sports injuries may be Acute or Chronic.

Acute injuries occur suddenly, like a dislocation, ligament tear, fracture, or muscle tear. These require immediate treatment at the time of injury, and may require ongoing care by a Sports Medicine specialist.

Chronic injuries are those injuries that occur over time, frequently caused by overuse or repetitive stress. These conditions include tendonitis, Carpal Tunnel syndrome, progressive arthritis, ligament tears, and muscle strains.

Acute

• Occurs suddenly
• Specific injury recalled
• Rapid swelling, bruising
• Examples
  • Shoulder Dislocation
  • ACL Ligament tears
  • Fractures
  • Ankle Sprain

Chronic

• Gradual onset, occurs over time
• May not recall a specific injury
• Slow onset of swelling, increases with activity
• Dull aches while resting
• Examples
  • Carpal Tunnel Syndrome
  • Tennis elbow
  • Arthritis
  • Medial collateral ligament tear

MAKING A DIAGNOSIS

Sports Medicine Orthopedic Surgeons may utilize a variety of tools to diagnose a condition. The most important part of making a diagnosis is in taking a thorough history of the injury, and performing a thorough physical examination. Often additional diagnostic studies are needed. These may include x-rays, ultrasound, MR and CT imaging, as well as diagnostic and/or therapeutic injections.

TREATMENT

Non-operative treatment of sports injuries is successful in the majority of patients. This may include simple rest, immobilization of an injured joint, possible injections, and physical therapy.

Some injuries may require surgery for a full recovery. Advances in Orthopedic Surgery have led to the development of arthroscopic surgery as a way to treat a large variety of conditions, as compared to an open surgery.

Arthroscopic Surgery allows the surgeon to perform the procedure with specialized instruments, inserted inside a joint though tiny puncture wounds, while visualizing the procedure with a fiberoptic camera, on a television monitor. Arthroscopic Surgery now allows us to diagnose and repair injuries to many joints. This may result in less tissue damage, less pain and scarring, and a faster rehabilitation. Dr. Weiss is a Master Instructor in Arthroscopy for the Arthroscopy Association of North America. A partial list of procedures that are now performed arthroscopically is listed below:

COMMON ARTHROSCOPIC SURGERY PROCEDURES:

SHOULDER

• Rotator cuff repair
• Ligament/Instability repair
• Arthritis
• Nerve decompression
• Frozen shoulder
• Biceps Tenodesis
• Distal clavicle resection (Mumford procedure)
• Subacromial decompression

ELBOW

• Tennis Elbow (Epicondylitis)
• Loose bodies
• Arthritis
• Stiffness
• Osteochondritis dissecans (OCD)
• Ulnar nerve release

WRIST

• Ligament repair
• Ganglion (cyst) excision
• Instability repair
• Proximal row carpectomy
• Carpal tunnel release
• Trigger finger release

HIP

• Ligament repair
• Loose bodies
• Debridement

KNEE

• Ligament reconstruction (ACL and PCL)
• Menisectomy
• Meniscus repair
• Meniscus Transplantation
• Cartilage repair/transplant
• Patellar (kneecap) realignment
• Loose bodies

ANKLE

• Loose bodies
• Instability
• Arthritis

PREVENTION

Many Sports Medicine injuries can be avoided or reduced with a few simple steps:

• Pre-season physical exams can help identify potential risks and issues before an injury occurs
• Stretching and a gradual warm-up before full activity can minimize the chance of strained muscles
• Make sure all gear and equipment fit properly to avoid accidents. Something as simple as a loose shoe could cause a major injury!
• Sport specific training can strengthen muscle groups, improve balance, and reduce incidence of more serious injuries (i.e. ACL tears)

NEW RESEARCH AND ADVANCES IN SPORTS MEDICINE

ARTHROSCOPY:

Surgeons can now use a small fiberoptic camera fed through tiny incisions in the skin to visualize joints and repair many injuries.

TISSUE ENGINEERING:

With Autologous Chondrocyte Implantation (ACI) cartilage cells (chrondrocytes) are harvested from the patient, grown in a tissue lab, and reinserted back into the patient’s knee to repair a cartilage defect.

In a Platelet Rich Plasma (PRP) procedure, whole blood is drawn from the patient, and the plasma with concentrated platelets is extracted. Growth factors can be injected back into a patient and may stimulate repair of injured tissues.

While still relatively experimental, stem cell therapy promises to be another option to regenerate or repair damaged tissue.

TISSUE TRANSPLANTATION

For patients who have lost their meniscus, a replacement cadaver meniscus can be transplanted through a Meniscus Transplantation.

With the OATS (Osteochondral Autograft Transplantation) procedure, a dowel-shaped piece of bone and cartilage is harvested from a healthy part of the knee, and then transplanted into a defect in the cartilage (think hair transplant).

Many ligaments in the shoulder, elbow, wrist, knee, and ankle can be reconstructed using cadaver tissue with a ligament reconstruction procedure. Some of these include:

• Shoulder: AC joint reconstruction
• Elbow: Ulnar Collateral Ligament reconstruction (“Tommy John”)
• Wrist: Distal radioulnar joint reconstruction
• Knee: Anterior Cruciate Ligament (ACL), Posterior Cruciate Ligament (PCL), Patella (MPFL) stabilization, Posterolateral corner reconstruction

TISSUE REPAIR/REGENERATION

With the TENEX procedure you can recieve ultrasound guided percutaneous treatment of many conditions, including Epicondylitis (tennis elbow), Achilles tendonitis, Patellar tendonitis, and Plantar fasciitis, all without any incisions.