Arm & Elbow Conditions

Sprains, Strains, and Other Soft-Tissue Injuries

Sprains, Strains, and Other Soft-Tissue Injuries

When you participate in sports and physical fitness activities, you can injure the soft tissues of your body. Even simple everyday activities can damage these ligaments, tendons, and muscles.

Some of the soft-tissue injuries you are most likely to experience include:

  • sprains
  • strains
  • contusions
  • tendonitis
  • bursitis
  • stress injuries

Any of these can be the result of a single episode, such as a fall, a sudden twist, or a blow to the body. You might also sustain one or more of these injuries because of repeated overuse, such as in ongoing athletic activities. In this case, small amounts of body stress accumulate slowly but steadily. The result can be damage and pain.

Here are some of the injuries you are most likely to experience, along with suggested ways of treating them.

Sprains

The joints of your body are supported by ligaments. Ligaments are strong bands of connective tissue that connect one bone to another. A sprain is a simple stretch or tear of the ligaments.

The areas of your body that are most vulnerable to sprains are your ankles, knees, and wrists.

A sprained ankle can occur when your foot turns inward. This can put extreme tension on the ligaments of your outer ankle and cause a sprain.

A sprained knee can be the result of a sudden twist.

A wrist sprain most often occurs when you fall on an outstretched hand.

Most mild sprains heal with “R.I.C.E.” (rest, ice, compression, and elevation) and exercise. Moderate sprains may also require a period of bracing. The most severe sprains may require surgery to repair torn ligaments.

Sprains and strains are usually treated first with RICE (rest, ice, compression using a bandage, and elevation.)
Strains

Your bones are supported by a combination of muscles and tendons. Tendons connect muscles to bones.

A strain is the result of an injury to either a muscle or a tendon, usually in your foot or leg. The strain may be a simple stretch in your muscle or tendon, or it may be a partial or complete tear in the muscle-and-tendon combination.

The recommended treatment for a strain is the same as for a sprain: rest, ice, compression, and elevation. This should be followed by simple exercises to relieve pain and restore mobility.

For a serious tear, the soft tissues may need to be repaired surgically.

Contusions

A contusion is a bruise caused by a blow to your muscle, tendon, or ligament. The bruise is caused when blood pools around the injury and discolors the skin.

Most contusions are mild and respond well when you rest, apply ice and compression, and elevate the injured area.

If symptoms persist, medical care should be sought to prevent permanent damage to the soft tissues.

Tendonitis

Inflammation is a healing response to injury. It is usually accompanied by swelling, heat, redness, and pain. An inflammation in a tendon or in the covering of the tendon is called tendonitis.

Tendonitis is caused by a series of small stresses that repeatedly aggravate the tendon.

Professional baseball players, swimmers, tennis players, and golfers are susceptible to tendonitis in their shoulders and arms.

Soccer and basketball players, runners, and aerobic dancers are prone to tendon inflammation in their legs and feet.

Tendonitis may be treated by rest to eliminate stress, anti-inflammatory medication, steroid injections, splinting, and exercises to correct muscle imbalance and improve flexibility.

Persistent inflammation may cause damage to the tendon, which may necessitate surgical correction.

Bursitis

A bursa is a sac filled with fluid that is located between a bone and a tendon or muscle. A bursa allows the tendon to slide smoothly over the bone.

Repeated small stresses and overuse can cause the bursa in the shoulder, elbow, hip, knee, or ankle to swell. This swelling and irritation is called bursitis.

Many people experience bursitis in association with tendonitis.

Bursitis can usually be relieved by rest and possibly with anti-inflammatory medication. Some orthopaedic surgeons also inject the bursa with additional medication to reduce the inflammation.

Stress Fractures

When one of your bones is stressed by overuse, tiny breaks in the bone can occur. The injury is termed a stress fracture.

Early symptoms may be pain and swelling in the region of the stress fracture. The bones of the lower leg and foot are particularly prone to stress fractures.

The fracture may not be seen on initial routine X-rays, requiring a bone scan to obtain the diagnosis.

These injuries are treated by rest, activity modification, cast immobilization, and, rarely, by surgery.

Good Care

If you are an athlete or a fitness enthusiast, you should pay close attention to your body’s warning signs.

Recreational athletes can help prevent injuries by a brief warm up, then stretching, before exercise.

Fatigue and pain are usually a signal that you are pressing too hard. Be sure to stretch thoroughly before your work-out, and stop before you are exhausted.

Stress injuries can also result from poor muscle balance, lack of flexibility, or weakness in soft tissues caused by previous injuries. These injuries to the muscle, bone ligaments, and tendons may require a prolonged amount of time to heal, in spite of appropriate care.

Consult your orthopaedic surgeon for treatment of these injuries to the soft tissue and bone. Besides treating the problem, he or she can develop a program of exercise or rehabilitation to restore function.

Last reviewed: July 2007
AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS “Find an Orthopaedist” program on this website

High School Sports Injuries

High School Sports Injuries

Every year, millions of teenagers participate in high school sports. An injury to a high school athlete can be a significant disappointment for the teen, the family, and the coaches. The pressure to play can lead to decisions that may lead to additional injury with long-term effects. High school sports injuries can cause problems that require surgery as an adult, and may lead to arthritis later in life.

When a sports injury occurs, it is important to quickly seek proper treatment. To ensure the best possible recovery, athletes, coaches, and parents must follow safe guidelines for returning to the game.

The Adolescent Athlete

Teenage athletes are injured at about the same rate as professional athletes, but injuries that affect high school athletes are often different from those that affect adult athletes. This is largely because high school athletes are often still growing.

Growth is generally uneven: Bones grow first, which pulls at tight muscles and tendons. This uneven growth pattern makes younger athletes more susceptible to muscle, tendon, and growth plate injuries.

Types of High School Sports Injuries

Injuries among young athletes fall into two basic categories: overuse injuries and acute injuries. Both types include injuries to the soft tissues (muscles and ligaments) and bones.

Acute Injuries

Acute injuries are caused by a sudden trauma. Examples of trauma include collisions with obstacles on the field or between players. Common acute injuries among young athletes include contusions (bruises), sprains (a partial or complete tear of a ligament), strains (a partial or complete tear of a muscle or tendon), and fractures.

A twisting force to the lower leg or foot is a common cause of ankle fractures, as well as ligament injuries (sprains).
Reproduced and modified with permission from The Body Almanac. © American Academy of Orthopaedic Surgeons, 2003.

Overuse Injuries

Not all injuries are caused by a single, sudden twist, fall, or collision. Overuse injuries occur gradually over time, when an athletic activity is repeated so often, parts of the body do not have enough time to heal between playing.

Overuse injuries can affect muscles, ligaments, tendons, bones, and growth plates. For example, overhand pitching in baseball can be associated with injuries to the elbow. Swimming is often associated with injuries to the shoulder. Gymnastics and cheerleading are two common activities associated with injuries to the wrist and elbow.

Stress fractures are another common overuse injury in young athletes. Bone is in a constant state of turnover—a process called remodeling. New bone develops and replaces older bone. If an athlete’s activity is too great, the breakdown of older bone occurs rapidly, and the body cannot make new bone fast enough to replace it. As a result, the bone is weakened and stress fractures can occur—most often in the shinbone and bones of the feet.

Catastrophic Sports Injuries

Many sports, especially contact sports, have inherent dangers that put young athletes at special risk for severe injuries. Even with rigorous training and proper safety equipment, children are at risk for severe injuries to the head and neck with damage to the brain or spinal cord.

Catastrophic injuries have been reported in a wide range of sports, including ice hockey, wrestling, football, swimming, soccer, pole vaulting, cheerleading, and gymnastics. It is important for coaches, parents, and athletes to be aware of the guidelines and regulations developed for each sport to prevent head and neck injury.

Concussion

Concussions are mild traumatic brain injuries. They are caused by a blow to the head or body that results in the brain moving rapidly back and forth inside the skull.

Although some sports have higher instances of concussion—such as football, ice hockey, and soccer—concussions can happen in any sport or recreational activity.

In 2010, the American Academy of Pediatrics recommended that young athletes with concussions be evaluated and cleared by a doctor before returning to sports. The American Academy of Neurology issued a similar statement, and stressed that doctors who clear athletes for return to sports should be trained in managing and assessing sports concussions.

Growth Plate Injuries

Growth plates are areas of developing cartilage tissue near the ends of long bones. When a child becomes full-grown, the growth plates harden into solid bone.

Because growth plates are the last portion of bones to harden (ossify), they are vulnerable to fracture. Growth plates regulate and help determine the length and shape of adult bone, therefore, injuries to the growth plate can result in disturbances to bone growth and bone deformity.

Growth plate injuries occur most often in contact sports like football or basketball and in high impact sports like gymnastics.

Prompt Medical Attention

Whether an injury is acute or due to overuse, a high school athlete who develops a symptom that persists or that affects his or her athletic performance should be examined by a doctor. Untreated injuries could lead to permanent damage or disability.

Some athletes may downplay their symptoms in order to continue playing. Coaches and parents should be aware of the more common signs of injury, such as pain with activity, changes in form or technique, pain at night, and decreased interest in practice.

Doctor Examination

During the examination, the doctor will ask about how the injury occurred, the symptoms, and will discuss the athlete’s medical history. During the physician examination, the doctor will look for points of tenderness, as well as range of motion.

If necessary, the doctor may recommend imaging tests, such as x-rays or other tests, to evaluate the bones and soft tissues.

Treatment

Treatment will depend upon the severity of the injury, and may include a combination of physical therapy, strengthening exercises, and bracing. More serious injuries may require surgery.

Return to Play

A player’s injury must be completely healed before he or she returns to sports activity.

  • In case of a joint problem, the player must have no pain, no swelling, full range of motion, and normal strength.
  • In case of concussion, the player must have no symptoms at rest or with exercise, and should be cleared by the appropriate medical provider.

Media stories about the early return to competition by professional athletes following injury create the impression that any athlete with proper treatment can return to play at the same ability level, or even better.

It is important for players, parents, and coaches to understand that depending on the type of injury and treatment required, the young athlete may not be able to return to the game at the same level of play—no matter how much effort is put into injury rehabilitation.

Prevention

Many high school sports injuries can be prevented through proper conditioning, training, and equipment.

High school athletes require sport specific training to prevent injury. Many injuries can be prevented with regular conditioning that begins prior to the formal sports season. Injuries often occur when athletes suddenly increase the duration, intensity, or frequency of their activity. Young athletes who are out of shape at the start of the season should gradually increase activity levels and slowly build back up to a higher fitness level.

Using proper technique for the position being played is also key to preventing injury. Proper equipment—from the right shoes to safety gear—is essential. In addition, injuries can be prevented when athletes understand and follow the rules of the game, and display good sportsmanship.

Because many young athletes are focusing on just one sport and are training year-round, doctors are seeing an increase in overuse injuries. The American Academy of Orthopaedic Surgeons has partnered with STOP Sports Injuries to help educate parents, coaches, and athletes about how to prevent overuse injuries. Specific tips to prevent overuse injuries include:

  • Limit the number of teams in which your child is playing in one season. Athletes who play on more than one team are especially at risk for overuse injuries.
  • Do not allow your child to play one sport year-round—taking regular breaks and playing other sports is essential to skill development and injury prevention.
Last reviewed: August 2012
Reviewed by members of POSNA (Pediatric Orthopaedic Society of North America)

The Pediatric Orthopaedic Society of North America (POSNA) is a group of board eligible/board certified orthopaedic surgeons who have specialized training in the care of children’s musculoskeletal health. One of our goals is to continue to be the authoritative source for patients and families on children’s orthopaedic conditions. Our Public Education and Media Relations Committee works with the AAOS to develop, review, and update the pediatric topics within OrthoInfo, so we ensure that patients, families and other healthcare professionals have the latest information and practice guidelines at the click of a link.
AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS “Find an Orthopaedist” program on this website.

Bicycle Safety

Bicycle Safety

Cycling is a good form of exercise, so it is not surprising that more than 80 million people in the United States have taken up bicycling for fun and as a mode of transportation.

According to the Consumer Product Safety Commission (CPSC), more than 1.4 million cycling injuries were reported in 2012.

Common Bicycle Injuries

In 2010, bruises and minor cuts were the leading types of injuries involving bicycles, followed by fractures, muscle strains, and sprains. However, serious injuries, including death, do occur. Some of the most common cycling injuries that orthopaedic surgeons treat include broken collar bones and wrists.

Tips for Preventing Injuries

To minimize your risk of injury while riding a bicycle:

  • Wear a helmet. Wearing a bike helmet reduces the risk of serious head and brain injury by 85%. Always wear a helmet approved by the American National Standards Institute (ANSI).
    • Make sure it fits snugly but comfortably, and does not obstruct your vision.
    • It should have a chin strap and buckles that stay securely fastened.
    • Studies have shown that wearing a bicycle helmet can reduce head injuries.
  • Follow the rules of the road. Familiarize yourself with all of the bicycle rules of the road in your city or state. Ride in the direction of traffic. Follow traffic signs and lights. Signal your turns or your intentions so that drivers can anticipate your actions. If you are riding with others, ride single file.
  • Ride defensively. Understand that drivers often do not see cyclists, so you must be fully aware of your surroundings and ready to act to avoid a collision. Intersections are especially dangerous because drivers making turns are not looking for cyclists. Be careful when riding next to parked cars to avoid being hit by an opening door.
  • Choose bike routes wisely. Avoid riding on high traffic roads. The most direct route to your destination is often not the safest because more vehicles will also take that route. Select streets with fewer and slower cars.

    Whenever possible, choose streets with designated bicycle lanes. If there is not a bicycle lane, ride on the right shoulder of the road.

    Choose wide streets. When a street lane is too narrow for a vehicle and bicycle to safely ride side-by-side, or if there are several parked cars on the street, you will need to join traffic and ride toward the center of the road. If this causes traffic behind you to jam, or if cars are switching lanes trying to pass you, it is safest to find a different, quieter street.

  • Avoid distracted cycling. Do not listen to music with head phones, talk on your phone, text, or do anything else that can obstruct your hearing and/or vision while riding.
  • Take extra precautions while bicycling at night. Wear bright fluorescent colors and make sure to have rear reflectors. Both a working tail light and headlight should be visible from 500 feet away.
  • No drugs or alcohol. Never ride a bicycle while under the influence of drugs or alcohol.
  • Never underestimate road conditions. Be cautious of uneven or slippery surfaces.
  • Maintain your bicycle. Check your bicycle’s mechanical components on a regular basis (brakes, tires, gears, etc.), just like you would for a car. If your bike is not in good condition, do not ride it.
  • Adjust your bicycle to fit. Make certain the bicycle is the proper size for the rider. Appropriately sized frames, handlebar and seat heights will improve your ability to control the bike, and reduce the risk for overuse injuries. If you ride regularly, consider a professional fit from a bike shop.
  • Dress appropriately. Avoid loose clothing and wear appropriate footwear. Never wear flip flops. Wear padded gloves. Use appropriately padded cycling shorts for longer rides. If you commute on your bike, carry your belongings in a proper bag with close fitting straps. Wear sunscreen, when appropriate.
  • Pace yourself: Cycling can be vigorous exercise. Make sure you are fit enough to participate before you start pedaling. In addition, make sure you understand how to use the gear systems on your bike to help control your physical exertion level. See your doctor before you begin any exercise program.
  • Change riding positions. Slight variations in your position can reduce stress on pressure points on your body and avoid overstressing muscles.
  • Hydrate. Be sure to carry water and food on longer rides. Drink a full water bottle each hour you spend on the bike.
  • Supervise younger riders at all times. It is recommended that younger children ride only in enclosed areas.
Last reviewed: June 2013
AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS “Find an Orthopaedist” program on this website.

A Guide to Safety for Young Athletes

 

A Guide to Safety for Young Athletes

For young athletes, sports activities are more than play. Participation in athletics improves physical fitness, coordination, and self-discipline, and gives children valuable opportunities to learn teamwork

Because young athletes are still growing, they are at a greater risk for injury than adults. The consequences of overdoing a sport can include injuries that impair growth, and may lead to long-term health problems.

Fortunately, many youth sports injuries can be prevented. Some of the more effective ways to prevent these injuries include age-specific coaching, appropriate physical conditioning, and proper use of equipment.

In addition, coaches and parents can prevent injuries by fostering an atmosphere of healthy competition that emphasizes confidence, cooperation, and a positive self-image, rather than just winning.

Differences Between Child and Adult Athletes

Children Are Still Growing

The young athlete is not a smaller version of an adult. Children’s bones, muscles, tendons, and ligaments are still growing, making them more susceptible to injury. In addition, there are significant differences in coordination, strength, and stamina between children and adults.

Children Vary in Size and Maturity

Young athletes of the same age can differ greatly in size and physical maturity. Grade school students are less likely to experience severe injuries during athletic activities because they are smaller and slower than older athletes. High school athletes, however, are bigger, faster, stronger, and capable of delivering tremendous forces in contact sports.

Children Can Injure Growth Plates

Growth plates are the areas of developing cartilage at the ends of long bones where bone growth occurs in children. The growth plates are weaker than the nearby ligaments and tendons. A twisted ankle that might result in a sprain in an adult, could result in a more serious growth plate fracture in a young athlete. Growth plate injuries have the potential to disrupt the normal growth of bone.

Common Youth Sports Injurie

Acute Injuries

Acute sports injuries are caused by a sudden trauma, such as a twist, fall, or collision. Common acute injuries include broken bones, sprains (ligament injuries), strains (muscle and tendon injuries), and cuts or bruises.

Most acute injuries should be evaluated by a doctor. Prompt first aid treatment should be provided by coaches and parents when the injury occurs. This usually consists of the RICE method: rest, applying ice, wrapping with elastic bandages (compression), and elevating the injured arm, hand, leg, or foot. This usually limits discomfort and reduces healing time. Proper first aid will minimize swelling and help the doctor establish an accurate diagnosis.

Overuse Injuries

Overuse injuries occur gradually over time, when an athletic activity is repeated so often, parts of the body do not have enough time to heal between playing. Examples of overuse injuries include throwing injuries in the elbow, Achilles tendinitis, and shin splints.

Coaches may have more difficulty spotting less severe problems, however, because the pain is low grade and the athlete often ignores it. Repeat injuries may turn into overuse conditions, which can put the athlete on the sidelines for the rest of the season.

To keep athletes in the game long-term, overuse injuries need to be diagnosed and treated by a physician as soon as possible. Parents and coaches should be aware of the more common signs of overuse injury. These include:

  • Pain. This pain cannot be tied to an acute injury, such as from a fall. The pain often increases with activity
  • Swelling
  • Changes in form or technique
  • Decreased interest in practice

In the growing athlete’s musculoskeletal system, pain from repetitive motion may appear somewhere besides the actual site of the injury. For instance, a knee ache in a child or adolescent may actually be pain caused by an injury to the hip.

Whether an injury is acute or due to overuse, a child who develops a symptom that persists or that affects his or her athletic performance should be examined by a doctor. A child should never be allowed to “work through the pain.”

Strategies for Preventing Youth Sports Injuries

There are several strategies that coaches, parents, and athletes can follow to help prevent sports injuries. Most importantly, athletes should:

Proper protective gear for a baseball catcher.

  • Be in proper physical condition to play a sport (a pre-participation sports physical examinations can be very useful in screening for potential problems)
  • Know and abide by the rules of a sport
  • Wear appropriate protective gear (for example, shin guards for soccer, a hard-shell helmet when facing a baseball pitcher, a helmet and body padding for ice hockey)
  • Know how to correctly use athletic equipment (for example, correctly adjusting the bindings on snow skis)
  • Always warm up before playing
  • Stay hydrated
  • Avoid playing when very tired or in pain

Proper Training

Young athletes need proper training for sports. They should be encouraged to train for the sport rather than expecting the sport itself to get them in shape.

Young athletes also should follow a regular conditioning program (in conjunction with their coach) with incorporated exercises designed specifically for their chosen sport. In addition, a well-structured, closely supervised weight-training regimen may modestly help youngsters prepare for athletic activities.

STOP Sports Injuries

Many sports injuries in young athletes — particularly elbow and knee injuries — are caused by excessive, repetitive stress on immature muscle-bone units. Doctors are seeing an increase in overuse injuries because many young athletes are focusing on just one sport and are training year-round. The American Academy of Orthopaedic Surgeons has partnered with STOP Sports Injuries to help educate parents, coaches, and athletes about how to prevent overuse injuries. Specific tips to prevent overuse injuries include:

  • Limit the number of teams in which your child is playing in one season. Kids who play on more than one team are especially at risk for overuse injuries.
  • Do not allow your child to play one sport year round – taking regular breaks and playing other sports is essential to skill development and injury prevention.

Atmosphere of Healthy Competition

Coaches and parents are also responsible for creating an atmosphere that promotes teamwork and sportsmanship.

Youth sports should always be fun. The “win at all costs” attitude of many parents, coaches, professional athletes and peers can lead to injuries. A young athlete striving to meet the unrealistic expectations of others may ignore warning signs of injury and continue to play with pain.

Young athletes must learn to deal with success and defeat in order to place events in a proper perspective. The promotion of the “win at all costs” ethic can have both short-term and long-term detrimental effects on impressionable young athletes.

Special Considerations

Female Athletes

Sports and exercise are healthy activities for girls and women of all ages. The participation of girls and young women in sports has increased significantly since the passage of Title IX. Occasionally, a female athlete who focuses on being thin or lightweight may eat too little or exercise too much. Doing this can cause long-term health damage.

Three interrelated illnesses may develop when a girl or young woman goes to extremes in dieting or exercise. Together, these conditions are known as the “female athlete triad.”

The three conditions are:

  • Disordered eating
  • Menstrual dysfunction
  • Premature osteoporosis (low bone density for age)

Treatment for female athlete triad often requires help from a team of medical professionals including your doctor, your athletic trainer, a nutritionist, and a psychological counselor.

Steroid Use

Many young athletes — boys and girls — use black-market anabolic steroids to improve their athletic performance. Steroids have been shown to increase muscle mass, but they can cause serious and potentially life-threatening complications and should be avoided. Most steroids are illegal and are banned by sports organizations.

Sports Supplements

Many athletes of all ages take sports supplements, such as creatine, because they think it will increase strength and improve sports performance.

The U.S. Food and Drug Administration does not regulate nutritional supplements. This means that the supplement products available in stores may vary in amount and quality, and there is no guarantee of safety or purity.

There is also not enough research on the long-term health effects of taking sports supplements, especially in adolescents and children who are still growing.

No matter what your age or health condition, always see your doctor for advice before taking nutritional supplements.

Benefits of Sports Participation

Athletic activity by young people is generally safe with low risks and high benefits. The major goal should be enjoyable participation. Exposure to competitive and noncompetitive sports encourages the development of fitness, motor skills, social skills, and a life-long appreciation for sports.