Seattle Seahawks WR, Percy Harvin and His Hip Labral Tear

Percy Harvin, Seattle Seahawk’s Wide Receiver is waiting out another week before he can return to the football playing field. NFL Spinzone reports, “Harvin was able to return to practice a couple of weeks ago, but the Seahawks have prudently decided to rest him. He has recovered quickly and well from off-season hip surgery, but Pete Carroll is 100% correct in being as cautious as possible with their new star receiver. The last thing they need is for the oft-injured Harvin to have a setback, especially since the 8-1 Seahawks clearly have their eyes set on a Super Bowl-winning season.”

The labrum is a unique structure found in the hip. The labrum is a specialized structure that lines the edge or rim of the hip socket. The shape and function of the labrum can be most easily understood as being similar to a bumper cushion on a pool table. The shape of the labrum is triangular in cross-section. The labrum acts as a cushion between the ball and socket of the hip joint during flexion of the hip.

The labrum is filled with nerve fibers that make tears in the labrum very painful.

What causes a labral tear?hip-labral-tear

Labral tears typically occur from:

  • Repetitive motion. Physical activity that requires one to repeatedly pivot the body can lead to joint wear and tear. This is common in athletes such as golfers and baseball players, who must repeatedly twist their bodies to hit a ball.
  • Osteoarthritis. Increased friction from osteoarthritis symptoms inside the hip joint may lead to labral tear.
  • Trauma. Dislocation or violent, direct impact to the hip joint may cause labral tears. This is common in athletes and victims of car accidents.
  • Birth defects. Some people are born with abnormal hip structures, which increase the progression of wear and tear on the hip joint. These problems may lead to labral tears.

What does it feel like?

Some labral tears cause no signs or symptoms; however, when symptoms are present, they include:

  • Radiating pain in the hip and groin
  • A catching or locking sensation in the hip joint
  • Stiffness in the joint
  • A limited range of motion

How do I know if I have a labral tear?

A physical examination by your doctor will help diagnose the cause of your symptoms. X-rays will allow your physician to take a closer look at the bone and rule out other possible underlying conditions. Magnetic resonance imaging (MRI) may also be used to further examine the soft tissues.

How are labral tears treated?

The level of treatment depends upon the severity of the condition. Some patients recover in only a few weeks using conservative treatments. However, patients with severe labral tearing may require surgery. One or a combination of these treatments may be used:

  • Rest and activity modification. By resting and allowing the inflammation of the joint to settle down, symptoms may be alleviated.
  • Medication. Anti-inflammatory medicines may help alleviate the pain and inflammation associated with labral tears. Your doctor may also recommend cortisone injections.
  • Physical therapy. Learning new exercises can help maximize hip range of motion, strength, and stability.
  • Surgery. In general, labral tears can be either repaired or trimmed during an arthroscopic procedure. Depending on the severity of the tear, the surgeon may cut out and remove the torn piece of labrum or repair the torn tissue by sewing it back together.

According to Dr. Watt, “Hopefully Percy will continue his recovery and return to the field soon. If you think you have labral tear or hip condition that is not getting better, I would be happy to evaluate your hip and devise an appropriate treatment plan.”

 

In the words of Russell Wilson, “Go Hawks!”

 

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.

Rotator Cuff Tears and Repairs

Rotator Cuff Tears and Repairs

In the world of orthopedic surgery, there are few body parts as notorious as the rotator cuff. It’s one of those medical terms that has become a household name, and usually comes with a wince and a sympathetic nod when we hear it. Most people know of someone, a friend or family member, who has injured this particular part of the shoulder. We also see it in the sports news quite often.

In fact, now that football season is in full swing, we may hear more about Seattle Seahawks defensive lineman Michael Bennett who was diagnosed with a rotator cuff tear earlier this year. He played through the injury last season and plans to do it again this year, although he will likely need surgery in the off-season.

The rotator cuff is a group of four small muscles and tendons that surround the head of the shoulder. Their job is not so much to move the arm through space, but to provide dynamic stability to the shoulder. This means that as the larger muscles of the chest and shoulder create arm movement, the smaller rotator cuff muscles pull the upper arm into the shoulder socket. This design allows the ligaments of the shoulder to be relatively loose so that we can enjoy a vast degree of mobility, being able to reach in a near three hundred and sixty degree range of motion.

Tearing of the rotator cuff can happen in two ways. An acute tear happens suddenly, such as when you fall on an outstretched hand, or lifting a heavy object. There is generally the sudden onset of pain and a corresponding loss of function of the arm, to varying degrees.Tears can also happen slowly over time. As we age, the tendons of the rotator cuff become weaker and gradually fray. This is particularly so with the supraspinatous tendon, located on the top of the shoulder blade.

This muscle and tendon tends to get pinched between the shoulder blade and the arm bone, especially if theother rotator cuff muscles are weak. The supraspinatous also has poor blood supply, sotears often do not heal on their own, making surgical repair necessary to restore function.-1

Symptoms of a Rotator Cuff Tear

Symptoms of a rotator cuff tear include pain with movement of the shoulder and tenderness to touch. Inability to lift even household objects out to the side or overhead is also typical. Sometimes a person will not be able to actively lift the arm overhead due to abnormal movement within the joint itself.

Another indicator is a prior history of shoulder tendonitis or bursitis as this would point to excessive stress on the rotator cuff over time.

Treatment can be conservative for some tears, including physical therapy to improve shoulder mobility and progressively strengthen the cuff muscles. However, the majority of tears will likely require surgery if function of the shoulder is to be restored. Rotator cuff surgery has come a long ways in recent years, with many surgeries being arthroscopic.

This is a minimally invasive technique where the surgeon inserts a camera and surgical tools through small incisions in the shoulder. The instruments are only about a centimeter in diameter and can burrow through layers of muscle on top of the rotator cuff, whereas in past years these muscles had to be cut, making for longer recovery times.

During thesurgery, the torn rotator cuff tendon will be sutured together. The surgeon will also clean away any bone spurs that may have contributed to a degenerative tear.

If the tear is complex or involves additional procedures such as tendon transfers due to excessive degeneration of the rotator cuff tendon, then the surgeon may need to open the shoulder with a slightly longer incision. It involves more cutting of shoulder musculature and may slightly lengthen recovery time; however, from time to time it is necessary.

Fortunately, most repairs will not require this technique.Recovery is generally a four to six month process, involving four phases:

  • Phase 1 (protection): Lasting from day one to four weeks, this stage of healing involves protecting the surgery. You will be required to wear a sling during most parts of the day. Gentle mobility exercises may be prescribed.
  • Phase 2 (passive motion): Lasting until the sixth week, you will be prescribed physical therapy and begin moving the shoulder with assistance within a prescribed range of motion.
  • Phase 3 (active motion): From weeks six through twelve, the focus will be on moving the arm and shoulder on your own, increasing the active range of motion.
  • Phase 4 (strengthening): You should have improved mobility at this time, allowing you to focus on building full strength and function of the arm.

Undergoing a rotator cuff repair can be a lengthy process. The amount of time that you will be required to be away from work will vary depending on the physical demands of your job. This will all be discussed in depth during pre-operative visits so that you may plan accordingly.

However, if surgery is recommended, you should not delay for long, as the torn tissue becomes weak and shortened over time, making a successful repair more difficult.If you are experiencing persistent shoulder pain, please feel free to contact my office to arrange a consultation.

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.