Common Conditions
Ankle
Ankle sprain
An ankle sprain is an extremely common injury, occurring approximately 25,000 times per day. When the ankle is subjected to abnormal movements, the ligaments can become torn or stretched, causing pain and swelling. Depending on the extent of the injury, strains can be mild, moderate, or severe. They are usually treated with protected weight bearing until pain and swelling decrease, and occasionally require physical therapy to return to athletics. If sprains keep recurring, surgery may be required to repair the ankle ligaments.
Useful Links: Ankle Sprain (AAOS)
Achilles Rupture
The Achilles tendon is the largest tendon in the body and connects your calf muscles to the heel bone. Occasionally, the tendon can become injured and its fibers can separate, causing pain and the inability to push off with the foot. Both nonsurgical and surgical treatments are available for Achilles Rupture. If you are concerned that your Achilles tendon may be torn, we would recommend scheduling an appointment immediately for evaluation by a specialist.
Useful Links: Achilles Tendon Rupture (AAOS)
Turf Toe
“Turf toe” is a sprain of the big toe when it is hyperextended, such as pushing off when starting to sprint. It is a common injury on surfaces such as artificial turf, which does not have as much “give” as natural grass surfaces. Often the injury can be treated with rest, ice, elevation, and orthotics. Surgery is usually not needed for this injury, but severe sprains can occasional require operative intervention.
Elbow
Biceps Tendon Rupture
A biceps tendon rupture is an injury that occurs to the biceps tendon causing the attachment to separate from the bone or the tendon to tear. A normal biceps tendon is connected strongly to the bone. When the biceps tendon ruptures, this tendon is detached. Following a biceps tendon rupture, the muscle cannot pull on the bone, and certain movements may be weakened and painful. When the rupture occurs at the distal biceps tendon on the elbow, where there is only one attachment, then surgical repair is often recommended.
Golfer's Elbow (Medial Epicondylitis)
Golfer’s elbow, or medial epicondylitis, is similar to its counterpart, tennis elbow. The primary differences between these conditions are the location of the pain and the activity that leads to injury. However, both conditions are caused by overuse of the muscles and tendons of the forearm, leading to inflammation and pain around the elbow joint.
Tennis elbow and golfer’s elbow, are both forms of tendonitis. Tendons are the ends of muscles that attach to bone. Due to the force of the muscle, the points of insertion of the tendon on the bone, are often pointed prominences. The medical names of tennis elbow (lateral epicondylitis) and golfer’s elbow (medial epicondylitis) come from the names of these bony prominences where the tendons insert, and where the inflammation causes the pain.
The pain of golfer’s elbow is usually at the elbow joint on the inside of the arm; a shooting sensation down the forearm is also common while gripping objects. Treatment can involve injections, physical therapy, bracing, or a small surgery.
Little Leaguer's Elbow
Little Leaguer’s Elbow is also known as apophysitis of the medial epicondyle. It is seen in young pitchers and is due to excessive throwing or poor throwing technique. Overthrowing with poor technique causes stress on the medial epicondyle, which is a growth center. It is especially a problem in athletes who do not take a break from participating in baseball.
Most athletes start to notice increasing pain in the inner elbow, longer recovery time and decreased velocity with throwing. A Sports Medicine physician can diagnose this problem by getting a detailed throwing history and a physical exam. X-rays are often taken to look for more severe injuries.
Tennis Elbow (Lateral Epicondylitis)
Tennis elbow, or lateral epicondylitis, is one of the most common elbow injury seen. Exactly what causes tennis elbow is unknown, but it is thought to be due to small tears of the tendons that attach the muscles of the forearm to the arm bone at the elbow joint.
Tennis elbow often involves a tendon that inserts on the lateral epicondyle known as the extensor carpi radialis brevis. Pain is often elicited with wrist or finger extension, and it can radiate down the forearm. There are several treatments for tennis elbow, and it can be a difficult problem to treat.
Initial treatments include anti-inflammatories and avoiding causative activities. Braces or physical therapy can also be helpful. Injections, such as cortisone or platelet rich plasma can also be used. Percutaneous or open surgery can be done if tennis elbow persists despite conservative treatment.
Throwing Injuries
There are several injuries that only occur in the shoulder and elbow of throwing athletes. Throwing is a specific motion that puts abnormal strain on the shoulder and elbow and injuries can result in problems that other patients do not experience.
Some common problems encountered in the elbows of throwing athletes include ulnar collateral ligament tears, flexor-pronator muscle strain or tendonitis, valgus extension overload syndrome with olecranon osteophytes, medial epicondyle apophysitis or avulsion, olecranon stress fractures, osteochondritis dissecans of the capitellum, and loose bodies. These conditions often respond to rest and physical therapy, but can involve surgical treatment as well.
Shoulder problems can manifest as tendonitis, labral tears, bursitis, capsular contractures, and scapular (shoulder blade) abnormalities. GIRD, or glenohumeral internal rotation deficit is a common problem in pitchers that results from scarring of the joint capsule.
The first step in treatment of throwing injuries involves proper diagnosis with an experienced sports medicine physician. The MFA offers physicians who have worked with throwing athletes at the college and professional levels and would be happy to take part in your care.
UCL Tear (Ulnar Collatera Ligament / Tommy John)
The ulnar collateral ligament is often injured in baseball pitchers, and can be the result of one traumatic injury, or repeated stress over time. Sometimes, the athlete may even hear a pop, which is followed by bruising and swelling on the inner aspect of the elbow. Numbness and tingling in the 4th and 5th fingers is not uncommon.
There are several specialized tests that can be done in the office if a UCL injury is suspected. Plain x-rays can occasionally show a small fracture, and an MRI is often done to better evaluate the ligament. If the studies are inconclusive, a dynamic ultrasound can be done to determine whether there is significant laxity (looseness) in the elbow.
Treatment of complete UCL tears in baseball pitchers often involves a ligament reconstruction, where a tendon is taken from the athlete or from a cadaver and used to recreate the torn ligament. Partial tears, as well as complete tears in non-baseball pitchers, can often be treated with a directed rehabilitation program.
Hip
Femoroacetabular Impingement
Evidence is emerging that subtle abnormalities around the hip, resulting in femoroacetabular impingement (FAI), may be a contributing factor in some instances to osteoarthritis in the young patient. FAI is the abnormal contact or friction between the femoral neck/head (ball) and the acetabular margin (socket), causing tearing of the labrum and avulsion of the underlying cartilage region, continued deterioration, and eventual onset of arthritis.
Nonsurgical treatment involves changes in activity, anti-inflammatories, and physical therapy. Sometimes, an arthroscopic surgery can be done to repair damage to the hip labrum and remove the areas of friction between the ball and socket of the hip joint.
Hip Labral Tear
The labrum is a pad of fibrocartilage deep in the hip joint. The hip is a ball-in-socket joint with the ball from the thigh bone (femur) and the socket from the pelvis (acetabulum). The labrum is a pad of cartilage that lies between the femoral head (ball) and the acetabulum (socket). It acts as a stabilizer and a shock absorber in the hip. Labral tears are common in athletes. When tears in the labrum occur, patients can experience pain deep in the hip joint. There are many different causes for tears. When a labral tear is symptomatic and patients have failed non-surgical measures such as physical therapy, activity modification and medication, it may be repaired arthroscopically.
Snapping Hip
There are three types of snapping hip: internal (iliopsoas tendon or hip flexor), intra-articular (loose bodies), and external (IT band). In most patients the snapping is merely an annoyance, but it can lead to pain and dysfunction, especially with athletic activities. When non-surgical measures have failed, these conditions can be treated arthroscopically.
Knee
ACL (Anterior Cruciate Ligament) Injury
The ACL is one of the most commonly injured ligaments in the knee. It helps provide stability to the knee joint, and is especially useful with cutting and pivoting activities. It can be injured without direct contact to the knee, and is often torn when the body is rotating and the foot is planted. When the ligament tears, patients often feel a “pop” in the knee and have swelling. It may be difficult to put weight on the affected leg for several days. Initial treatment includes ice, compression, and elevation.
ACL tears can often be diagnosed on physical examination. An MRI is often used to confirm a tear of the ligament, as well as to identify whether additional structures have been injured. A high percentage of patients with ACL tears have continued instability in the knee during sporting or work-related activities.
The majority of patients who are active with sports or at work may require anterior cruciate ligament reconstruction. Surgical treatment then requires reconstruction of the ligament using a graft taken from either your own body (autograft) or a donor (allograft). The most appropriate type of graft for any individual patient is determined through an evaluation and discussion with your sports medicine physician. The appropriate graft is then threaded through the knee joint with the help of arthroscopic tools and placed where the normal anterior cruciate ligament was. The graft is secured to both the thigh bone and the lower leg bone and then biologically heals in to become the anterior cruciate ligament over the following months. Any other injuries to the knee joint are also arthroscopically evaluated and treated at the same time. This outpatient procedure often requires a period of bracing followed by a structured physical therapy program.
Following ACL reconstruction, a patient’s return to such activities as biking may occur within the first 3 to 6 weeks, treadmill running by 10 to 12 weeks, outdoor running by 3 to 4 months, and full unlimited pivoting type sports by 6 to 8 months.
Cartilage Injuries
Injury to the knee can cause damage to the articular lining cartilage in the knee joint, or sometimes to both the cartilage and the bone. Symptoms may include swelling and pain when bending the knee.
If the injury is restricted to the cartilage, it will not show up in a plain X-ray; it may be noted on an MRI. An arthroscopy (using a special instrument to look inside the joint) can thoroughly identify it.
If a piece of cartilage or bone has become detached in the knee and the injury is not treated immediately, the loose part can ‘swim around’ in the joint. This means that it may occasionally get stuck, causing pain and a feeling that the knee is locked. The knee may also click and swell up. Such a condition is called a loose body in the knee.
As cartilage does not show up on an X-ray, the loose body will only be visible if it consists of bone. An MRI is often done to assess for cartilage injury.
In some cases arthroscopy can be used to ‘smooth’ the cartilage. Although new cartilage cannot grow to take its place, scar tissue appears.
It is also possible to transplant some cartilage from an uninjured part of the knee. Another option is to remove some normal cartilage cells, reproduce them in a lab and then later reimplant them into the damaged area so that new cartilage will grow.
LCL/PLC (Posterolateral Corner Injury)
The lateral collateral ligament is one of the four knee ligaments, spanning from the femur to the top of the fibula. Complete tears of the LCL often require knee surgery to restore stability to the knee. The LCL is often injured in combination with other ligaments of the knee.
Patients with LCL injuries have pain on the outside of their knees and often have a sense of “giving way.” Mild injuries of the LCL can often heal in a brace. Severe injuries involve reconstruction or repair of the ligament, using either tendons from a cadaver or from the patient. Following surgery, the knee is often maintained in a brace for 6-8 weeks, with return to sports at 6-9 months following reconstruction. Physical therapy is an integral part of recovery from LCL surgery.
MCL (Medial Collateral Ligament) Injury
The medial collateral ligament (MCL) is one of four ligaments that are critical to the stability of the knee joint. A ligament is made of tough fibrous material and functions to control excessive motion by limiting joint mobility. The four major stabilizing ligaments of the knee are the anterior and posterior cruciate ligaments (ACL and PCL, respectively), and the medial and lateral collateral ligaments (MCL and LCL, respectively).
The MCL spans the distance from the end of the femur (thigh bone) to the top of the tibia (shin bone) and is on the inside of the knee joint. The medial collateral ligament resists widening of the inside of the joint, or prevents “opening-up” of the knee.
Symptoms of a MCL injury tend to correlate with the extent of the injury. MCL injuries are graded on a scale of I to III.
Grade I MCL Tear
This is an incomplete tear of the MCL. The tendon is still in continuity, and the symptoms are usually minimal. Patients usually complain of pain with pressure on the MCL, and may be able to return to their sport very quickly. Most athletes miss 2-4 weeks of play.
Grade II MCL Tear
Grade II injuries are also considered incomplete tears of the MCL. These patients may complain of instability when attempting to cut or pivot. The pain and swelling is more significant, and usually a period of 4-6 weeks of rest is necessary.
Grade III MCL Tear
A grade III injury is a complete tear of the MCL. Patients have significant pain and swelling, and often have difficulty bending the knee. Instability, or giving out, is a common finding with grade III MCL tears. A knee brace or a knee immobilizer is usually needed for comfort, and healing may take 6 weeks or longer.
Because the MCL resists widening of the inside of the knee joint, the MCL is usually injured when the outside of the knee joint is struck. This action causes the outside of the knee to buckle, and the inside to widen. When the MCL is stretched too far, it is susceptible to tearing and injury. This is the injury seen by the action of “clipping” in a football game. An injury to the MCL may occur as an isolated injury, or it may be part of a complex injury to the knee. Other ligaments, most commonly the ACL, or the meniscus (cartilage), may be torn along with a MCL injury.
Typically, an MCL injury alone can heal with a hinged knee brace for several weeks. When the MCL is torn in conjunction with other structures in the knee, surgery may be required to repair or reconstruct the ligament.
Meniscus Tear
The meniscus is a very important shock absorber of the knee made of a very strong substance called fibrocartilage. It protects the cartilage of the joint, keeping it from wearing out and causing early arthritis. A large percentage of our body weight is distributed through the meniscus as we walk, run, and jump. The meniscus adds to the stability of the knee joint by helping the shape of the femur or thigh bone conform to the tibia or leg bone. The meniscus also plays a role in the nourishment of the joint cartilage that covers the bones in the joint.
An acute meniscal tear may be heard as a “pop” and felt as a tear or rip in the knee. Many are followed within a few minutes to hours by swelling of the knee as a result of blood accumulation. Some do not result in much swelling and some present themselves in a less acute fashion. Patients with meniscal tears often describe a popping or catching in their knee. Some actually can feel something out of place. In the most dramatic situations the knee will actually lock, preventing the patient from fully extending or straightening the knee — or occasionally from flexing or bending it. The pain or discomfort is usually along the joint line or where the femur and tibia bone come together. It often starts out relatively painful; then with time, much (if not all) of the pain disappears except with certain activities. Some patients will have the tear become asymptomatic (no symptoms) for a time, especially if their activity level decreases significantly.
Tenderness is elicited by deep palpation (examination using the hands) along the joint line. Twisting the knee while flexing it will occasionally cause or reproduce the patient’s symptoms.
Meniscal tears do not show up on plain X-rays because the meniscus does not contain calcium the way bones do. There are some specialized tests such as the MRI scan which are helpful in further evaluating the meniscus.
Several events can cause the meniscus to become damaged. It can tear or rip from force, pinching it between the femur and the tibia. Most frequently this is a twisting-type force and is relatively common in sports-related knee injuries. Occasionally it is associated with a ligament rupture. It does not always require a major fall or twist to cause a meniscal tear. Some occur with nothing more than getting up from a squatting position. Certain meniscal tears occur gradually over a long period of time. In older patients these may represent so-called degenerative meniscal tears and may not be symptomatic. The location of the tear within the meniscus may determine the type of treatment which is most appropriate.
There is no known medicine or therapy that will heal or fix a torn meniscus. It is a mechanical problem that often requires a mechanical solution. This usually means either partial excision (removal) or repair of the tear. Excision versus repair is often decided at the time of arthroscopic surgery and will depend upon several factors. The patient’s age, the age of the tear, the size and location, as well as the patient’s activity level all play a role in deciding whether a tear can be repaired or must be excised. In general, due to the essential role of the meniscus in protecting the knee from early arthritis, repair is always preferable to removal.
Patellar Tendonitis
Patellar tendonitis, also called jumper’s knee, is pain in the front of the knee along the band of tissue (the patellar tendon) that connects the kneecap (patella) to the shin bone (tibia).
Symptoms:
Pain and tenderness around the patellar tendon
Swelling in your knee joint, or swelling where the patellar tendon attaches to the shin bone
Pain with jumping, running or walking, especially downhill or downstairs
Pain with bending or straightening the leg
Tenderness behind the kneecap
Causes:
The most common activity causing patellar tendonitis is too much jumping. Other repeated activities, such as running, walking, or bicycling may also lead to patellar tendonitis. All of these activities put repeated stress on the patellar tendon, causing it to become inflamed.
Patellar tendonitis can also happen to people who have problems with the way their hips, legs, knees, or feet are aligned. This alignment problem can result from having wide hips, being knock-kneed, or having feet with arches that collapse when you walk or run, a condition called overpronation.
Treatment:
Patellar tendonitis is most often treated without surgery. Physical therapy and anti-inflammatories can be helpful, and a special type of brace can be worn that offloads the tendon. If these treatments are not successful, occasionally a small surgery can be done to remove the portion of the tendon that is not healing well.
PCL (Posterior Cruciate Ligament) Injury
The PCL has been described as one of the main stabilizers of the knee. It is broader and stronger than the ACL. It connects the femur (thigh bone) to the tibia (shin bone). Its function is to prevent the posterior translation of the tibia relative to the femur.
It has been reported that there is only a 2% incidence of isolated PCL tears. PCL injury commonly occurs in sports such as football, soccer, basketball, and skiing. A forceful hyperextension of the knee or a direct blow just below the knee cap will disrupt the PCL and cause knee pain and PCL Injury.
The physical examination of the knee by a sports medicine specialist will determine the ligamentous structures involved and determine if it is a PCL Injury or another ligament causing the knee pain. Plain x-rays will be taken to ensure that no fracture has occurred. An MRI will be ordered to identify the extent of the ligamentous and cartilaginous injuries. There is usually swelling as well as significant tenderness to palpation of the back of the knee causing considerable knee pain. Knee surgery will usually take place after the swelling has gone down. The posterior draw test done with the knee at 90 degrees of flexion, will demonstrate a posterior shift of the tibia relative to the femur.
Severe PCL laxity, which results in a knee with significant posterior translation is quite unsettling to the patient, especially athletes due to the shifting of the tibia during running. These patients benefit from a PCL reconstruction, which re-establishes stability to the knee. As noted in the treatment of ACL injuries, the ruptured ligament cannot be repaired. It must be reconstructed using a graft. This can be from the injured patients’ own body or from a donor. The graft is attached through drill holes in the tibia and femur, using arthroscopic techniques, to re-establish the posterior cruciate attachment.
This is an outpatient procedure allowing the patient to walk with crutches and a brace in their home. Return to sports is restricted for 10 to 12 months, allowing the knee to rebuild strength and function.
Runner's Knee (Patellofemoral Syndrome)
Patellofemoral syndrome is a term used to describe pain related to the kneecap. It is often related to overuse in repetitive activities, such as running. Patients often have difficulty with stairs, hills, kneeling, and other every day activities. It can be related to the alignment of the kneecap, previous injury, or wear and tear of the cartilage under the kneecap.
Runner’s knee is often treated with physical therapy, which helps offload the kneecap by strengthening certain muscle groups of the hip and knee.
Shoulder
Biceps Tendon Rupture (Shoulder)
The biceps tendon in the shoulder can rupture from wear and tear on the tendon, or with certain injuries. Patients often feel a pop in the front of the shoulder which is accompanied by bruising and swelling. Often, a “popeye” deformity is noticed when flexing the injured arm.
Biceps tendon ruptures in the shoulder often cause no functional problems. The pain following a biceps tendon rupture can be treated with rest, followed by physical therapy. If patients are unsatisfied with the cosmetic appearance of the arm after a biceps tendon rupture, surgery can be done to reattach the tendon.
Labral Tear (Shoulder Instability)
A labral tear of the shoulder often results from a dislocation or subluxation of the shoulder joint. The labrum is like a bumper that goes around the socket of the shoulder. It provides added stability to the shoulder joint.
When the shoulder has been dislocated or subluxed (partially dislocated), there is excessive pressure on the labrum, causing it to tear. Patients often feel pain and have limited range of motion of the shoulder following such an injury. Once the initial pain has resolved, some patients may have recurrent episodes of instability of the shoulder because of the labral tear.
The initial treatment following an instability event of the shoulder often involves rest, anti-inflammatories, and rehabilitation of the shoulder muscles. If the instability recurs, surgery is often recommended to fix the labrum and restore stability to the shoulder joint.
Surgery to repair the torn labrum is sometimes necessary. The purpose of the surgery is to reattach the torn labrum to the socket of the shoulder. Large labral tears that are the result of trauma generally need to be fixed in surgery. The success rate of this surgery is quite good, with over 90 percent of patients returning to their normal activities without any further dislocations.
Rotator Cuff Tears
The rotator cuff is a group of four tendons that wrap around the shoulder joint to assist in elevation and rotation of the shoulder. They help keep the shoulder stable as well. When one or more of these tendons are torn, patients often have difficulty lifting up the arm or performing tasks with the arm above shoulder level. Many patients complain of pain at night that keeps them from sleeping.
It is often difficult to distinguish rotator cuff tendonitis, or inflammation of the tendons, from a rotator cuff tear. Most patients with tendonitis will benefit from physical therapy directed at the rotator cuff and other shoulder muscles. If a tear is present, surgery may be required to repair the torn tendon, which restores function to the shoulder and keeps the tear from becoming larger.
Based on a physical examination of the shoulder, the sports medicine specialist may recommend either physical therapy occasionally an MRI of the shoulder to look for a torn rotator cuff. Surgery is usually done arthroscopically and requires the use of a sling and physical therapy to regain shoulder function.
Shoulder Separation (Acromioclavicular Joint Injury)
A shoulder separation occurs after a fall or a sharp blow to the top of the shoulder. This injury is usually sports related. Some separations happen in car accidents or falls. This is not the same as a shoulder dislocation, which occurs at the large joint where the arm attaches to the shoulder, although the two may appear to be the same.
The shoulder separation, or acromioclavicular (AC) dislocation, is an injury to the junction between the collarbone and the shoulder. It is usually a soft-tissue or ligament injury but may include a fracture (broken bone).
Nonoperative Treatment:
Ice -Is an important treatment of most acute soft tissue injuries.
Sling -Frequently, a sling is needed and helpful for the first few days after an injury. This helps to support the weight of the arm and to restrict motion. It is usually advised, however, to begin some motion exercises within a few days once the immediate pain has stopped.
Pain relievers and anti-inflammatory medications-May be advised, either over-the-counter or by prescription.
Physical Therapy -You may require physical therapy, particularly once the immediate pain has stopped within a few days. The decision for this often is made during a follow-up visit.
Surgery:
Some surgeons prefer to repair severe AC separations, especially in high-level throwing athletes. The surgery is usually done through a small incision over the AC joint, and can sometimes be done arthroscopically to reduce pain and improve cosmetic appearance.
SLAP Tears (Superior Labrum Anterior to Posterior)
The labrum is a fibrous bumper that helps to stabilize the shoulder joint. It provides an attachment site for a variety of other shoulder structures including the capsule, ligaments and biceps tendon. When the superior labrum is detached or torn at the site of the biceps tendon insertion, it is termed a superior labrum anterior to posterior tear (SLAP). A variety of injuries may cause damage to the superior part of the labrum where the biceps tendon inserts. The most common type of injuries are repetitive over arm motion such as throwing a ball, falling on an outstretched arm or lifting a heavy object.
Overhead athletes or patients involved in repetitive overhead work can damage the superior labrum. This often generates a deep or posterior pain in the shoulder joint accompanied by a clicking, catching or popping sensation. There may be weakness with overhead activity. The throwing athlete often notices diminished velocity and control with throwing a ball. A thorough evaluation by your sports medicine physician is most appropriate to confirm this diagnosis. Plain x-rays may be obtained in order to rule out any type of bony damage. An MRI may also be obtained in order to determine the degree of superior labral injury as well as the existence of any injury in the adjacent capsule, ligaments or biceps tendon.
Non-operative treatment may help a large percentage of patients with a superior labral tear. This non-operative treatment requires avoiding the offending sport or activity for 3 to 6 weeks in combination with ice and a non-steroidal anti-inflammatory (if your medical history allows it). A structured physical therapy program is also initiated to restore range of motion as well as strength. In addition rehabilitation of the leg, hip, abdominal and back musculature enhances recovery. When the athlete is pain free and has near full range of motion and strength, a sport or work simulation is carried out. If an athlete has persistent pain, weakness, clicking and catching which prevent return to sport, work or sleep then surgical treatment may be necessary.
Surgical treatment of a SLAP tear is arthroscopic, and involves a repair of the labrum using small anchors that are placed in the socket of the shoulder. Patients are typically in a sling for 4-6 weeks, followed by physical therapy for several months.
Throwing Injuries
There are several injuries that only occur in the shoulder and elbow of throwing athletes. Throwing is a specific motion that puts abnormal strain on the shoulder and elbow and injuries can result in problems that other patients do not experience.
Some common problems encountered in the elbows of throwing athletes include ulnar collateral ligament tears, flexor-pronator muscle strain or tendonitis, valgus extension overload syndrome with olecranon osteophytes, medial epicondyle apophysitis or avulsion, olecranon stress fractures, osteochondritis dissecans of the capitellum, and loose bodies. These conditions often respond to rest and physical therapy, but can involve surgical treatment as well.
Shoulder problems can manifest as tendonitis, labral tears, bursitis, capsular contractures, and scapular (shoulder blade) abnormalities. GIRD, or glenohumeral internal rotation deficit is a common problem in pitchers that results from scarring of the joint capsule.
The first step in treatment of throwing injuries involves proper diagnosis with an experienced sports medicine physician. The MFA offers physicians who have worked with throwing athletes at the college and professional levels and would be happy to take part in your care.