I’ve written recently about shoulder dislocation, a serious condition in which the ball portion of the shoulder (humerus) becomes completely dislodged from the socket. This week we’ll discuss a shoulder separation, another common shoulder injury. But first let’s clear up some terminology to avoid confusion.
A separated shoulder refers to an injury to the ligaments of the acromioclavicular joint (commonly known as the AC joint), which is the joint between the end of your collarbone and the upper part of your shoulder blade. It’s located near the point of the shoulder.
Over the last several years there’s been a growing consensus that some sport behaviors place a young athlete at risk for overuse injury: single sport specialization before age 14, playing that sport in training and competition more hours per week than your age in years, and playing more than eight months out of the year. Sport specific recommendations such as PitchSmart have also emerged.
What was previously unknown was whether following these recommendations actually leads to reduced injury rates. Recently published research indicates that parents who are knowledgeable of the PitchSmart recommendations and follow them with their young pitchers show significantly reduced injury rates compared to parents who were unaware of those recommendations.
It’s estimated that a substantial number of athletes in all age groups use performance enhancing substances (PES). Some surveys of high school age athletes have shown anabolic steroid use reported by 3%, and other types of PES use as high as 30% by male professional cyclists. It seems that PES use affects all age groups, many sports, males, and females.
It turns out that one effective means of reducing PES use could be completely non-technical: athletes who have a strong moral compass are far less likely to use PES, regardless of the pressure felt in their sport.
By now, most athletes understand that a concussion leads to changes in brain function. After a concussion an athlete may have symptoms such as headache and light sensitivity. Students may have difficulties with concentration in the classroom.
But what most athletes don’t know about is that a concussion also leads to changes in balance and peripheral vision. It turns out that those associated changes create an increased risk of injuries to the lower extremity, such as knee injuries or ankle sprains. In a recently published analysis, athletes with a concussion were 2x more likely to have a lower extremity injury in the weeks and months after a concussion.
A “sports hernia” is an injury to the soft tissue around the groin, typically involving the abdominal muscles and the adductor muscles of the inner thigh. This injury is most commonly a number of partial tears in the area where the tendons insert on to the bones of the pelvis. The injury can go by other names such as “athletic pubalgia” and “core muscle injury”.
In an athlete, this is an injury that will frequently go on to need surgery. Some of the keys to successful return to sport after surgery are:
Finding a doctor skilled in the diagnosis and surgery for a sports hernia
Working with a physical therapist after surgery with experience in core muscle rehabilitation
Following return to sport protocols carefully, and also making sure you’re mentally confident about your return to sport
Most people should aim for a return to sport at about the start of the 13thweek after surgery, although some elite athletes will follow an aggressive protocol that might allow a return in the 4thto 6thweeks after surgery.
We’ve come a long way from the earliest versions of artificial turf, which were essentially large pieces of green plastic laid down over cement. The newest generations of artificial turf are radically better than the very first versions, yet the debate over which type of surface is best from a safety standpoint continues.
We’ll highlight this week some of the latest published research in this debate. In a large series specifically studying collegiate tackle football, it was determined that playing on artificial turf was an increased risk for PCL injuries in Division I players and for ACL injuries in Division II and Division III players.
While there are many strengths in this study, I would caution that the results are specific to American collegiate tackle football and may not be similar in other sports or in youth age groups.
Our current best ways to treat a torn ACL is a surgical procedure called a “reconstruction”, where a substitute tissue (a “graft”) is used to replace the torn ACL. Tunnels or sockets are drilled in the bone, so the bone essentially grows into the new tissue and makes a new ACL.
ACL surgery has improved substantially over the last 30 years, with generally excellent results. But there can be issues related to the bone tunnels potentially causing growth disturbance in young athletes, and issues related to the removal of the graft. A new type of ACL repair using stitches and a biologic scaffold to enhance healing is showing very exciting early results. If this ACL repair technique proves itself in larger clinical studies, we can expect it to be an excellent option to avoid tunnels and grafts for some ACL tear types.
The kneecap (“patella”) can sometimes come completely out of its normal alignment. This is called a “dislocation” and if you’ve ever had one you know how incredibly painful this can be. If you have a single dislocation, we’ll typically recommend rehab without surgery. If you go on to have multiple dislocations, surgery is often recommended to stabilize the kneecap.
Results from surgery are reliable as far as stabilizing the kneecap, but return to sports results are widely variable. Some published medical data show return to sports at about 55% and others as high as 85%. Some of the key factors in successful return to sports are normalized function as measured on specific tests, and near-normal strength when compared to the normal knee. It may take more than 8 months after surgery to achieve these milestones.
In today’s article I’d like to provide some general guidelines about return to play after surgery for a shoulder dislocation. Your individual situation will be unique, based upon multiple factors so for specific guidelines you’ll need to discuss this carefully with your orthopedic surgeon. It’s also important to note that surgeons will have considerable variability in their personal preferences for return to play.
Here are the targets I will typically aim for:
Noncontact overhead sports, full swing golf, racket sports: four months
Pitcher throwing from the mound: six months
Full contact and collision sports: 6 to 9 months
When you’ve got an important event coming up, or when you’re in the midst of your season, it can be tempting to overwork yourself and ignore recovery. The problem with this is that you can increase injury risk over the course of a season. And if you go into your important competition overworked or tired it’ll definitely affect your performance. The key is to find a way to include recovery during your season, and especially before events. Doing so will reduce injury risk and give you the best chance of peak performance.
