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Sports Medicine

Sports Medicine at Oregon Shoulder Institute

Sports Medicine, also known as sports and exercise medicine (SEM), is a branch of medicine that deals with the treatment and prevention of sports and exercise-related injuries and improving fitness and performance. The main objective of sports medicine is to help individuals engage in sports and exercise safely and effectively to accomplish their training goals.

What are Sports Injuries?

Sports injuries are injuries sustained while playing indoor or outdoor sports such as football, basketball, hockey, baseball, and tennis, or while exercising. Sports injuries can result from sports accidents, inadequate training, improper use of protective devices, or insufficient stretching or warm-up exercises.

Shoulder Injuries in Overhead Athletes

An overhead athlete is at increased risk of injury due to the mechanism associated with rapid shoulder elevation, external rotation, and abduction. An overhead throwing motion is an intricate and skillful movement that presents a special challenge of needing the glenohumeral joint to surpass its physiologic limits during overhead sports activities.

Athletes involved in overhead sports such as baseball, American football, tennis, volleyball, swimming, and other repetitive throwing sports apply immense force across their shoulders during hitting and throwing actions and are at increased risk of developing overhead shoulder injuries. An overhead injury may occur due to improper techniques, training errors, shoulder instability, shoulder imbalance, and overuse of muscles surrounding the shoulder.

Causes of Overhead Athlete’s Shoulder Injuries
Most problems in the shoulder involve ligaments, muscles, tendons, and joints. Some of the common causes that can be attributed to overhead athlete’s shoulder injuries include:Inflammation of the jointsTorn cartilage or torn rotator cuffInflammation of the tendons or rotator cuff tendinitisBursitis or swelling of the bursa sacsFractures and dislocationsStiffening of the ligaments, muscles, and tendonsShoulder instability (a condition where a shoulder joint is forced out or moves out of its normal position) Shoulder impingement (inflammation from repetitive shoulder activities)

Symptoms of Overhead Athlete’s Shoulder Injuries
Some of the common symptoms of overhead athlete’s shoulder injuries include:

- Persistent pain and tenderness
- Referred or radiating pain
- Loss of range of motion
- Pain with overhead action

Reduction in throwing velocityTightness of the chest musclesSnapping or popping sensationWeaknessScapular winging (a painful condition of the shoulder blades)

Types of Overhead Athlete’s Shoulder Injuries

Athletes in sports such as baseball, tennis, and American football are more susceptible to overhead athlete’s shoulder injuries that include:

SLAP Tears: In a slap injury, the superior part of the shoulder labrum is injured. The labrum is a rim of tough fibrous tissue that stabilizes the shoulder joint. This type of injury commonly occurs in sports with overhead motions such as baseball.

Tendon Tears and Biceps Tendinitis: Repetitive throwing movement leads to irritation and inflammation of the biceps tendon known as biceps tendinitis. Damage to the tendon may also result in a tear leading to a torn biceps tendon.

Rotator Cuff Tears and Tendinitis: Overuse of the rotator cuff muscles or tendons results in a rotator cuff tear and tendinitis. This is most commonly observed in baseball throwers due to repeated high-speed throwing activity that adds significant stress on the ligaments and rotator cuff tendons of the shoulder.

Impingement: During an overhand throwing action as in baseball, the rotator cuff tendons at the back of the shoulder get pinched between the humeral head and the glenoid socket. This is known as internal impingement that leads to partial tearing of the rotator cuff tendon and may also damage the shoulder labrum.

Instability: Shoulder instability happens when the humeral head slips out of the shoulder socket resulting in dislocation. This is seen in throwers where the instability occurs due to repetitive throwing motions that stretch the ligaments causing increased laxity (looseness).

Scapular Rotation Dysfunction: This type of injury is mostly noted in throwers where the repeated use of scapular muscles leads to changes in the muscles that affect the position of the scapula resulting in drooping of the affected shoulder.

Glenohumeral Internal Rotation Deficit (GIRD): In this type of injury, soft tissues in the back of the shoulder tighten leading to loss of internal rotation due to high-speed repetitive throwing action noted in throwers. This puts throwers at a greater risk of rotator cuff and labral tears.

Diagnosis of Overhead Athlete’s Shoulder Injuries
Your doctor will review your symptoms and medical history and perform a physical examination to check for range of motion, stability, and strength of your shoulder. If necessary, your doctor will order certain imaging tests such as X-rays, MRI, CT scan, or ultrasound to confirm the source of pain and narrow down any associated problems.

Treatment for Overhead Athlete’s Shoulder Injuries
Treatments for overhead athlete’s shoulder injuries include both surgical as well as non-surgical options. Your doctor will decide the best option for you based on the condition of your shoulder.

The non-surgical treatment options may include:

Ice: Application of ice packs on the shoulder to decrease swelling and pain

Activity Modification:  Avoiding activities that trigger symptoms and changing your lifestyle

Physical Therapy:  Regular exercise regimen to improve range of motion and strengthen shoulder muscles

Anti-inflammatory Medication:  Meds like naproxen and ibuprofen can relieve inflammation and pain.

Cortisone Injection: If physical therapy, medications, rest, and activity modification do not yield the desired results, then a cortisone injection may be helpful. Cortisone is a very effective anti-inflammatory medicine for bursitis and long-term pain reliever for tears and structural damage.

The surgical treatment options may include:

Arthroscopy: Most throwing injuries can be treated with arthroscopic surgery. Your doctor will be able to repair damage to soft tissues, such as ligaments, labrum, or rotator cuff tears by using this technique. Arthroscopy is a minimally invasive surgical procedure that involves making small keyhole incisions to pass a fiberoptic tube with a tiny camera called an arthroscope and miniature instruments into the shoulder joint. The camera displays pictures of the affected region on a television screen and the doctor uses these images to carry out the surgery.

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Common Shoulder Conditions

Glenohumeral Arthritis

Shoulder arthritis causes pain and stiffness in the shoulder and typically occurs in people over the age of 50. The hallmark is pain and reduced range of motion. Arthritis can result in painful which may be constant or increase with activity. The diagnosis is typically obvious on X-rays which show reduced joint space and bone spurs.

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Frozen Shoulder

Frozen shoulder, also called adhesive capsulitis, causes pain and stiffness in the shoulder. The condition affects the glenohumeral joint (ball and socket joint) and occurs in about 2% of the population and most commonly affects mid-aged people. The hallmark is a normal joint with inability move the shoulder due to adhesions.

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Calcific Tendonitis

Calcific tendonitis is a build-up of calcium within the rotator cuff tendon. When calcium builds up in the tendon it causes a chemical irritation and pressure between the rotator cuff and overlying acromion bone. The pain from calcific tendonitis can be extreme.

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Shoulder Impingement

Shoulder impingement is the condition of inflammation of the tendons of the shoulder joint. It is one of the most common causes of pain in the adult shoulder. The shoulder is a ‘ball-and-socket’ joint.

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Shoulder Instability

A dislocation occurs when the end of the humerus (the ball portion) partially or completely dislocates from the glenoid (the socket portion) of the shoulder.

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Rotator Cuff Tear

Rotator cuff tears are one of the most common causes of shoulder pain. Pain typically occurs in the front or side of the shoulder. The pain may radiate to the elbow. Symptoms are worse with overhead activity and often cause difficulty sleeping which can significantly affect quality of life.

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Platelet Rich Plasma – Shoulder Info

What is it?

More and more patients are asking about biologic options such as Platelet Rich Plasma (PRP) to improve healing.  PRP is essentially concentrated growth factors obtained from peripheral blood. Although blood is mainly a liquid(called plasma), it also contains small solid components (red cells, white cells, and platelets.) Platelets are best known for their importance in clotting blood. However, platelets also contain hundreds of proteins called growth factors which are very important in the healing of injuries.

PRP is plasma with many more platelets than what is typically found in blood. The concentration of platelets — and, thereby, the concentration of growth factors — can be 5 to 10 times greater (or richer) than usual.

What are the potential uses/benefits?

These technologies are safe and potentially beneficial, but the clinical evidence is unclear. Although it is not exactly clear how PRP works, laboratory studies have shown that the increased concentration of growth factors in PRP can potentially speed up the healing process and reduce pain.

Rotator Cuff
The greatest benefit for healing appears to be in small to medium sized tears where studies have suggested that healing is improved with PRP. The use of PRP for rotator cuff tears is primarily for after surgical repair (at the time of surgery). PRP can’t make the tendon move back to the bone. The only way to do that is to repair the tendon. However, several studies have suggested that PRP can improve healing once the tendon is repaired.

Clinical evidence from knees has demonstrated that PRP injection decrease pain compared to injection of hyaluronic acid. At this time there are no studies in the shoulder. However, we have used PRP for shoulder arthritis in many cases with success.

What is the process?

PRP is obtained from peripheral blood. In this technique 15 ml (3 teaspoons) of the patient’s own blood is drawn is obtained in the clinic. This blood is then processed in a special centrifuge which separates the blood into different layers. The goal here is to obtain 2-4 ml of PRP. This layer is specifically chosen because PRP has a high concentrate of growth factors that may aid in healing. This process takes about 15 mins. Then, the PRP concentrate is injected back into the shoulder under ultrasound guidance to ensure that it is placed properly. For shoulder arthritis, the general recommendation is do a series of 3 treatments, spaced 1-2 weeks apart.

What is the cost?

Currently, PRP is not covered by insurance. Therefore, it is an “out-of-pocket” expense. The cost for PRP is  $500 for one treatment or $1,000 for three treatments.