The most common disorders seen by sports orthopaedists as well as the general orthopedic are the overuse injuries. All active persons, from the elite athlete to the “weekend warrior,” are subject to these injuries that typically become chronic because they do not cause enough discomfort to cause the athlete to stop participating in their sport. The athlete will usually consult a trainer or coach initially, and if symptoms continue or worsen will look for medical advice. Many of these injuries are brought on by insufficient recovery time. Some are nagging injuries following an acute event, which never is allowed to heal. There are many overuse injuries of both the upper and lower extremities that can cause an athlete to perform at a lower level.
Chronic injuries of the upper extremity include: rotator cuff tendonitis, tennis elbow (lateral epicondylitis), golfer's elbow (medial epicondylitis), DeQuervain's tenosynovitis, cubital tunnel syndrome, and carpal tunnel syndrome. Although there are many more disorders, these are some of the more commonly seen problems. Rotator cuff tendonitis is associated with overhead activity- especially with throwing athletes. The rotator cuff is a broad flat tendon comprised of four muscles. Together, they keep the head of the humerus centrally located throughout the range of motion of the shoulder joint. Overlying the tendon is a bursa, or a fluid-making sac, which can become inflamed as well. Patients will commonly complain of pain with overhead activity, problems sleeping on the shoulder, and possibly weakness of the shoulder, secondary to the pain while using the shoulder. The initial treatment for this type of chronic shoulder pain is activity modification (stop performing exercises that cause the shoulder to hurt), anti-inflammatory medicines (if no contraindications), icing and other modalities, and a physical therapy program designed to first achieve painless motion, followed by strengthening of the arm. Once these have been accomplished, a gradual return to normal activity is allowed.
Tennis and golfer's elbow are basically the same entity on opposite sides of the elbow. During a golfer's downswing, the lag arm has stress placed on the inside, or medial aspect, of the elbow. Likewise, during a backhand, the tennis player will stress the lateral or outside of the elbow. This repetitive stress can cause multiple micro-traumatic events that can cause the origin of the forearm flexor muscles (golfer's elbow) or wrist extensors (tennis elbow) to develop tears and degenerate. This degeneration can cause pain and loss of strength. Normally, symptoms will abate time by combining rest, stretching, anti-inflammatory medicines, and occasionally a strap used to offload the area. However, like the name implies, these can cause long-term pain and dysfunction. If all non-operative treatment fails, there are some procedures that can alleviate symptoms.
DeQuervain's tenosynovitis is a problem in the first extensor compartment of the wrist, caused by repetitive lifting or extending the wrist. The initial treatment starts with icing; anti-inflammatories, stretching, and can include an injection and splinting. The lower extremities are also frequently involved. These injuries can range from “nagging” problems with tendonitis and bursitis to the more serious stress fracture. Most of the lower extremity problems are caused by the repetitive nature of running, jumping or dancing. There are multiple sites in the lower extremities that can be involved with a bursitis or tendonitis. The most common sites are: the lateral aspect of the hip (greater trochanteric bursitis), the front portion of the knee (patellar tendonitis or pes anserine bursitis), and the posterior ankle (Achilles tendonitis). The treatment for all of these is activity modification, icing regimens, stretching, anti-inflammatories, and physical therapy.
While overuse injuries can cause months of distress and lost playing time, they are not as serious as a stress fracture. Stress fractures are commonly seen in the foot, lower leg and the hip. These injuries require diagnosis and treatment by an orthopaedic surgeon. Often this diagnosis can be made with a combination of a history, physical exam and x-rays. Sometimes an additional test, such as a bone scan, is needed to secure the diagnosis. Stress fractures of the metatarsals are treated with modified weightbearing, casting, and sometimes surgery. These same treatments are needed in the treatment of the lower leg stress fractures. Stress fractures of the hip are serious, and can be an emergency. Patients commonly complain of groin and knee pain. This injury is rare, but is usually seen in people who log many miles, such as long distance runners and military recruits. When suspected clinically, X-rays along with a MRI or bone scan, are used to confirm the diagnosis. These fractures commonly need to be “pinned” or secured with internal devices such as screws. If not caught early, they may go on to move apart and can have a poor outcome, with hip arthritis being the result.
Keeping all of this in mind, overuse or chronic injuries are commonly diagnosed and usually require a period of rest, combined with therapy and medications. They may need a longer time to heal than the athlete would like, but most will resolve with little or no long-term problems. Occasionally, a seemingly innocuous injury can be serious. If an athlete has tried treating the injury and the problem persists, he or she should consult a physician.
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