5 Common Hockey Injuries

Hockey photo

The regular NHL season is well underway and the Seattle Thunderbirds are respectively improving their stats with their recent win over the Vancouver Giants at ShoWare Center.

In the regular season as well as the off season, players experience a variety of sports-related injuries as a result. Ice hockey is a contact sport where the players and the puck move at high speeds, so when players run into each other or objects, great force is used. This is why hockey is considered a collision sport. Injuries are fairly common, but efforts can be made to avoid them with training and proper equipment. Listed below are five common injuries that can occur while playing hockey.

AC Joint Injury

The acromioclavicular joint, or AC joint, is one of the joints in the shoulder responsible for motion and stability. The ligaments that hold the AC joint together can be torn through sudden impact to the shoulder, which can cause separation to occur in the AC joint. This sudden impact can happen in hockey when players skating at high speeds collide with one another or into a rigid surface. Swelling, bruising, pain, and motion range loss are all symptoms of AC joint separation. There may also be visible bumps on the shoulder if the bones separate.

Shoulder Dislocation

Shoulder dislocation generally refers to a dislocation in the glenohumeral joint in the shoulder. This happens when the top of the humerus, or upper arm bone, is forced out of the glenoid, the socket in the shoulder joint it usually nestles in. If a player falls or receives a heavy blow or sudden impact on the shoulder, it can cause dislocation if the upper arm is forced to move in an abnormal way. Symptoms of shoulder dislocation include pain, weakness, and mobility issues. The arm may also appear to hang incorrectly off the shoulder.

Muscle Strain

Muscle strain occurs when a muscle is pushed past its limit. This can happen if a player’s muscle is suddenly presented with a heavy load or stretched beyond its normal ability. If a player’s muscles are tight but not warmed up or not conditioned well, tearing or straining is a risk. Symptoms of a muscle tear include pain at rest or when the muscle is used, and weakness or inability to use the muscle.

Meniscus Injury

The meniscus is a C-shaped piece of cartilage in the knee. There are two menisci in each knee joint, and if they are torn they can affect stability in the knee. This tearing can happen if the cartilage is worn down or through the quick movements and stress put on the knees by ice skating. Symptoms vary depending on how and where the meniscus is torn, but symptoms can include pain, instability or feeling the knee “giving,” stiffness, swelling, and an impaired range of motion. Sliding, popping, or locking may occur if the tear is left untreated because loose fragments from the meniscus tear will drift into the joint.

Gamekeeper’s Thumb

The ulnar collateral ligament, or UCL, connects the bones at the base of the thumb, which prevents the thumb from moving too far from the hand. When an acute sprain or tear of the UCL occurs, it is called a UCL injury. When the injury is chronic and develops over time from repeated UCL stretching, it’s called gamekeeper’s thumb. UCL injuries are commonly caused by injury or trauma in which the thumb is bent away from the hand at the MCP joint. This can happen in sports hockey, or in any situation in which a fall is landed on an outstretched hand.

This injury might also be sustained when a person is gripping something that is suddenly moving, like a hockey stick during a fall. Swelling, pain, and tenderness on the ulnar side of the thumb are all symptoms of UCL injury. You may also have difficulty pinching and gripping with the thumb, and you may have limitations in your range of movement. In severe cases, a bump under the skin, called a Stener lesion, may form due to the ends of the torn ligament being held apart by a nearby tendon.

If you believe you are suffering from a sports injury and need specialized orthopedic care, Orthopedic Specialists of Seattle has excellent treatment options available for you. Please feel free to contact Orthopedic Specialists of Seattle at (206) 633-8100 to schedule an appointment.

MCL Tears and Repairs By Dr. Charlie Peterson, MD

MCL Tears and Repairs

The medial collateral ligament (MCL), located on the inside portion of the knee, is one of the more common sporting injuries to the lower extremity. It is usually an “acute” injury, meaning that it happens suddenly due to trauma. In sports, the athlete may take a sudden blow to the outside of the knee, creating excessive tensile force to the MCL, such as being tackled in football. This injury also occurs commonly in sports where the ankle is immobilized such as hockey and downhill skiing, where the ankle is stabilized in a skate or boot. This immobilization leaves the knee to absorb the full impact of a collision or fall and increases the risk of knee injury.

Functional Anatomy

The skeletal anatomy of the knee consists of three bones. The thigh bone, medically termed the femur connects with the shin bone, called the tibia. In the front of the knee is the knee cap, or the patella. Holding these bones together are the four major knee ligaments. Two are located deep within the joint and are called cruciate ligaments. They prevent excessive forward and backward motion, as well as rotation. The remaining two are the collateral ligaments, and are located on the sides of the knee. Their job is to prevent lateral, or sideways, motion of the knee. The MCL is located on the inside of the knee joint and prevents the knee from collapsing inward. In addition to the bones and ligaments, the knee has two cartilage pads called the medial meniscus and lateral meniscus. These pads act as shock absorbers within the knee.

Types of MCL Injury

Tears to the MCL are usually a result of direct trauma, either from a blow to the outside of the knee, such as with a football tackle, or a fall that pushes the lower leg sideways. Partial tears will cause varying degrees of instability within the knee, and are often treated successfully with conservative interventions including bracing and physical therapy to strengthen the surrounding musculature. Complete tears may cause significant instability in the knee, especially if in combination with other ligament injuries such as the ACL.

If isolated, even high-grade MCL tears can still often be treated with bracing alone. However, such tears often occur in conjunction with other structures such as the medial meniscus or the anterior cruciate ligament (ACL). The medial meniscus has a direct connection to the MCL, making it particularly susceptible to injury during an acute MCL sprain. Should this be the case, surgical intervention may be required to restore full function due to the degree of instability caused by multiple injuries.

Non-operative Treatment

MCL tears are most often treated successfully without surgery. With significant tears there may be an initial degree if instability following injury. A hinged knee brace may be prescribed to limit control of this aberrant movement. As the ligament heals, your orthopedic surgeon may refer you to physical therapy to strengthen the leg musculature surrounding the knee, and also to restore normal movement patterns that may have been disrupted following injury and immobilization. Patients are able to perform most of their normal daily activities during this process, with the possible exception of high intensity athletics, and generally have very good outcomes following four to eight weeks of rehabilitation.

Surgical Treatment

In cases where non-operative treatment has failed or in some multiple ligament injuries, the surgeon will recommend repair or reconstruction surgery. This means that the damaged MCL will be repaired with sutures if possible. If that is not possible, then a new ligament can be fashioned from a soft-tissue “graft,” a piece of tendon taken from either the patient or a cadaver. A small incision is made to gain access to the area, and the repair made, or the tendon graft is anchored in place with surgical screws.

Following surgery, there will be a period of immobilization, followed by physical therapy. The duration and intensity of the rehabilitation process is dependent on the type of MCL repair or reconstruction, and the other injuries present. In most cases, patients can return to full function including athletics at the conclusion of treatment.

Pumpkin Carving Safety Tips

Every October, carved pumpkins peer out from porches and doorsteps in the United States and other parts of the world. Gourd-like orange fruits inscribed with ghoulish faces and illuminated by candles are a sure sign that Halloween and the holiday season is upon us. The practice of decorating “jack-o’-lanterns” – the name comes from an Irish folktale about a man named Stingy Jack – originated in Ireland, where large turnips and potatoes served as an early canvas.

Irish immigrants brought the tradition to America, home of the pumpkin, and it became an integral part of Halloween festivities. Click Here and find pumpkin carving safety tips for you and your loved ones!

Seahawks DE Michael Bennett taken off field on stretcher

On Sunday, September 29, seattlepi.com reported that Seahawks defensive end Michael Bennett, who has been a big story this season as Seattle’s sack leader, was taken off the field Sunday on a stretcher after he was injured on a play against the Texans in Houston. The article reported, “Late in the second quarter, Bennett was rushing Texans quarterback Matt Schaub when he was pushed from behind by a Houston defender into Schaub’s leg. Bennett’s head appeared to snap back, and his helmet flew off as he hit the ground. Bennett laid face-down on the turf for several minutes as trainers tended to him.”

According to the news article, “Bennett suffered a strained muscle in his back that was close to his vertebrae. The location of the injury was why medical personnel were extra-careful and carted Bennett off the field on a stretcher.” Head coach, Pete Carroll said that he was “fine” and a tweet was sent out the next day stating that Bennet was practicing and that he may be able to play in their upcoming game against Indianapolis.

Treatment of a lumbar muscle strain is important to understand. Once you know the cause of your symptoms, you can proceed with treatment. It is important that if you are not sure of the cause of low back pain, that you are evaluated by a physician. According to Dr. Charlie Peterson, “Back injuries can be painful, frustrating and even scary, but are also common. As such, the vast majority can be managed with a few simple techniques. However, if you have unusual symptoms or your pain persists, it’s time to seek advice from a specialist.”

If you are experiencing pain in your lower back or it has been injured as a result of physical activity, below is a list to help you treat your injury:

Step 1: Rest

The first step in the treatment of a lumbar muscle strain is to rest the back. This will allow the inflammation to subside and control the symptoms of muscle spasm. Bed rest should begin soon after injury, but should not continue beyond about 48 hours. While it is important to rest the injured muscles, it is just as important to not allow the muscle to become weak and stiff. Once the acute inflammation has subsided, some simple stretches and exercises should begin.

Step 2: Medications

Two groups of medications are especially helpful in treating the acute symptoms of a lumbar back strain. The first of these are anti-inflammatory medications. These medications help control the inflammation caused by the injury, and also help to reduce pain. There are many anti-inflammatory options, talk to your doctor about what medication is appropriate for you.

The second group of medications commonly prescribed for the treatment of lumbar strains is muscle relaxing medications. Again, there are several options that you may discuss with your doctor. These medications are often sedating, so they need to be used with care. For patients who have back spasm symptoms, these muscle relaxing mediations can be a very useful aspect of treatment.

Step 3: Physical Therapy/Exercises

Proper conditioning is important to both avoid this type of problem and recover from this injury. By stretching and strengthening the back muscles, you will help control the inflammation and better condition the lumbar back muscles. The exercises should not be painful. Without some simple exercises, the low back muscles can become “deconditioned,” or weak. When the low back muscles are “deconditioned”, it is very difficult to fully recover from low back injuries.

It is also important to understand that even if you are “in good shape,” you may have weak low back muscles. When you have a low back muscle injury, you should perform specific exercises that stretch and strengthen the muscles of the low back, hips and abdomen. These exercises are relatively simple, do not require special equipment, and can be performed at home.

Step 4: Further Evaluation

If your symptoms continue to persist despite treatment, it is appropriate to return to your doctor for further evaluation. Other causes of back pain should be considered, and perhaps x-rays or other studies (MRI, CT scan, bone scan, laboratory studies) may be needed to make an accurate diagnosis.

If you believe you are suffering from a back injury and need specialized orthopedic care, Orthopedic Specialists of Seattle has excellent treatment options available for you.

Shoulder Ligament Injuries

Things tend to wear out and break at the moving parts. It’s just one of those principles of engineering that we cannot shake. It is one of the reasons that we see so many people with shoulder injuries.

The shoulder is the most mobile joint in the body and we ask it to do a lot for us. Every day, we reach forward, overhead and behind the back, sometimes repetitively or with heavy loads.

Other times, the shoulder absorbs more force than it should as we use the arm to break a fall in sports. This activity can lead to either traumatic or repetitive use injury. Today, we will focus on those injuries specific to the ligaments of the shoulder complex.

Ligaments hold one bone to another bone and limit the amount of motion available in the joint. This prevents excess movement or motion in directions not intended for a particular joint.

The tighter the ligaments are, the less motion available. Because the shoulder is a highly mobile joint, the ligaments must be loose to allow motion in all directions. This creates some inherent instability in the joint, and an avenue to potential injury.

Anterior Ligament Sprain/Dislocation

This injury usually occurs when we raise the arm overhead or out to the side and apply a force, such as with retrieving a heavy object from an overhead shelf. If the load is too great, then the ligaments in the front of the shoulder become overloaded and can tear, causing a sprain. If the ligaments tear enough, then the bones can separate and cause a dislocated shoulder.

Dislocations should get immediate medical attention in the emergency room. Treatment involves applying traction to the joint, which allows the shoulder to return to its normal position and then a period of immobilization to allow the ligaments to heal.

Unfortunately, the ligaments do not heal quite as tightly as they once were. The shoulder becomes increasingly unstable, disposing it to another dislocation. Conservative treatment following a dislocation involves strengthening of the rotator cuff, a group of four muscles that provide additional stability to the shoulder.

As you move your arm through space, the rotator cuff sucks the head of the arm bone, medically termed the humerus, into the socket. After a dislocation, it is even more important to keep the rotator cuff working properly. You may be referred to a physical therapist, who can provide instruction in the proper exercises.

Should the shoulder continue to dislocate, surgical intervention may be required. This entails tightening the shoulder capsule by “pulling up the slack” in the loose ligaments and stitching them back in place. This surgery is highly successful at stopping future dislocations, but there is a period of immobilization and rehabilitation for several weeks following the surgery.

Shoulder Separation

This is a common traumatic injury caused by falling on an outstretched hand. With this injury, the force of landing on the hand is transmitted through the shoulder, causing a tear in the ligament that holds the collarbone in place. The result is a dislocation of the joint where the collarbone meets the shoulder blade, located at the bony area on top of the shoulder.

This joint is called your acromioclavicular, or AC joint, and because this is the pivot point where the shoulder blade rotates, an injury here can cause significant loss of function in the arm, especially in the overhead range of motion.

Minor sprains in the ligament may heal, but active individuals who have difficulty or pain with arm use may need to undergo surgical correction, as conservative treatment usually will not restore proper mechanics and movement patterns.

Surgery involves harvesting a tendon from elsewhere in the body and using is as a replacement for the broken ligament. This effectively anchors the collarbone back in its correct position.

Frozen Shoulder

Medically termed adhesive capsulitis, this condition may be a result of injury to the shoulder, but just as often occurs without any type of trauma. It is an inflammation of the shoulder joint capsule, which contains the shoulder ligaments.

As the capsule becomes inflamed and thickened, the shoulder becomes painful and loses significant mobility. Frozen shoulder may persist from several months to a year or longer and usually follows a predictable pattern of presentation that includes three stages.

  1. The acute stage is marked by sharp pain in the shoulder throughout the range of motion, but especially with reaching overhead and out to the side. Shoulder mobility becomes limited.
  2. During the frozen stage, acute pain starts to subside, but mobility of the shoulder continues to be limited.
  3. The final phase is the thawing phase, where the joint mobility of the shoulder begins to improve, and functional use returns.

Although frozen shoulder can afflict a wide range of people, there are certain risk factors that may dispose someone to getting this condition including diabetes, cardiac disease, and hypo or hyperthyroid issues. Treatment is usually non surgical, as the condition usually gets better with time.

During the acute and frozen phases, anti-inflammatory medications may be prescribed, as well as a steroid injection directly into the joint capsule, which significantly limits the degree of inflammation.

Physical therapy may be ordered in order to learn some gentle mobility exercises, followed by more aggressive stretching and mobilization of the shoulder as the condition progresses into the thawing phase.