Sports Medicine

What is Tendonitis and How can it Be Managed?

TendonitisThe tendons are thick, fibrous cords that attach muscles to bones and they can become inflamed and cause pain similar to that experienced by muscle injury and inflammation. This is them referred to as tendinitis and the causes of this condition may be due to:

  • Sudden injury sustained to the affected limb or joint.
  • Repetitive movements over a period of time that results in increased stress being placed on the affected tendons.
  • Occupations that involve the individual being placed into awkward positions to perform duties in, frequent overhead reaching, forceful exertion, and being exposed to repetitive vibrations.
  • Using improper techniques to perform certain jobs or sport-related movements.

Types of tendinitis

Some common names of tendonitis pathologies include:

  • Golfer’s elbow – involvement of the medial (inside) tendon of the elbow.
  • Tennis elbow – involvement of the lateral (outside) tendon of the elbow.
  • Swimmer’s shoulder – impingement of the rotator cuff tendon between the acromion of the shoulder blade and the greater tuberosity of the humerus (bone of the upper arm). This is seen in swimmers who specialize in freestyle and front crawling swimming strokes.
  • Pitcher’s shoulder – inflammation of the long head of the biceps muscle that attaches to the shoulder which is called bicep tendonitis and may occur in baseball and softball pitchers. This condition may also occur in swimmers where the bicep muscle is involved as well as in any other sports where throwing activities are performed such as javelin and cricket, and where contact occurs such as in wrestling, gridiron football, and martial arts.
  • Jumper’s knee – inflammation of the tendon of the patella (knee-cap) or even the quadriceps tendons caused by repetitive straining from too much running and/or jumping.

Signs and symptoms

Patients may present with the following clinical signs and symptoms when dealing with tendinitis:

  • Pain that is often described as a dull pain that is felt over the affected area.
  • Increased pain when moving the affected limb or joint.
  • Tenderness and swelling over the affected area.
  • Decreased range of motion of the affected limb which is restricted due to pain.


Tendonitis is managed conservatively with the following therapies:

  • Resting the affected limb and not performing movements that cause pain.
  • Using pain medication such as acetaminophen and anti-inflammatory medications such as ibuprofen or naproxen.
  • Applying ice packs or cold compresses over the affected areas to help reduce swelling and inflammation.
  • Physical therapy to help incorporate exercises and to learn correct techniques that will help prevent inflammation of the tendons.
  • Steroid and local anesthetic medications can be injected into an affected joint or around an involved tendon to also help reduce inflammation and pain.
  • Regenerative medicine in the form of platelet-rich plasma (PRP) can be administered where the platelet cells help to repair damage to a tendon caused by chronic inflammation.

If these therapies are ineffective, then surgical intervention may be warranted. Procedures may include:

  • Focused aspiration of scar tissue (FAST) which is performed to remove scar tissue on tendons caused by chronic inflammation of the tissue.
  • Arthroscopic tendon repair using small instruments if the inflamed tendon has torn or ruptured.

Overview of Common Knee Sports Injuries

In 2014, there were 10.4 million visits to a doctor’s office because of knee injuries. The knee is a complex joint with multiple components. This complexity makes it vulnerable to a variety of injuries. Knee injuries can be successfully treated using simple measures, such as physical therapy rehabilitation exercises and bracing.

Knee Components

The structures and components of the knee joint include:

  • Bones – Three bones meet to form the knee joint: femur (thighbone), tibia (shinbone), and patella (kneecap).Knee anatomy picture
  • Articular cartilage – The ends of the tibia and fibula, and back portion of the patella, are covered with a slippery articular cartilage. This allows the bones to glide smoothly across each other as you bend or extend the leg.
  • Meniscus – Two wedge-shaped pieces of cartilage that act as shock absorbers are the menisci (singular – meniscus). This tough, rubbery material stabilizes the joint.
  • Ligaments – Bones are connected to other bones via ligaments, and the knee contains four main ligament structures.
  • Tendons – These fibrous structures connect bones to muscles.

Knee Sprains and Strains

A sprain is a tear or stretch of a ligament, which holds bone to bone. A strain is injury of a tendon and/or muscle. You are at increased risk for knee injury if you have a history of strains and sprains, are overweight, or are in poor physical condition. Sprains and strains are categorized according to severity:

  • Mild – Tendon or ligament is stretched slightly, but there is no joint loosening.
  • Moderate – There are partial tears of the tendon or ligament, producing joint instability and some swelling.
  • Severe – Produces excruciating pain during movement, and the tear is complete.


The most common knee bone that is broken is the patella. Many patellar fractures are caused by high energy trauma, such as in a motor vehicle collision or a fall from a high structure. The patella is injured during sports by falling directly on it, or when there is a high impact collision with another player.


During sports play, a dislocation can occur when the bones of the knee go out of place. Dislocations are either partial or complete. The tibia and femur can be forced out of alignment, or the patella can slip out of position. A dislocation occurs as a result of sports-related contact.

Anterior Cruciate Ligament (ACL) Tears

The anterior cruciate ligament is often injured with sports play, such as football, basketball, and soccer. This ligament is torn when the athlete changes direction rapidly, or when he/she lands from a jump incorrectly. About 50% of ACL tears occur along with damage to another knee structure, such as meniscus, other ligaments, or articular cartilage.

Posterior Cruciate Ligament (PCL) Injuries

Tearing of the posterior cruciate ligament occurs from a direct blow to the front of the knee when the knee is in a bent position. PCL tears are usually partial tears and can heal without surgery.

Collateral Ligament Injuries

The collateral ligaments are torn or injured by a force that pushes the knee sideways, as with contact sports. Injury to the medial collateral ligament (MCL) often occurs from a direct blow outside of the knee, whereas the lateral collateral ligament (LCL) is injured from a blow to the inside of the knee.

Meniscal Tears

Tears to the meniscus occur when cutting, twisting, pivoting, or being tackled. These injuries also occur from arthritis or aging. A meniscal tear to a weakened meniscus can occur from an awkward twist when rising from a chair.

Tendon Tears

The patellar and quadriceps tendons can be torn or stretched easily during sports activities. These occur from falls, landing awkwardly from a jump, or from a direct force to the front aspect of the knee.

OSPI offers the top sports medicine specialists in Arizona serving Gilbert, Chandler, Mesa, Queen Creek and Maricopa AZ. All types of tendon and ligament injuries are treated with regenerative medicine procedures, bracing, physical therapy and operative procedures when necessary.

Most insurance is accepted, and the Board Certified orthopedic surgeons in Gilbert are experts at getting athletes back to activity quickly, call today!


What Exactly is a Sports Hernia?

Hernia (Athletic Pubalgia)

A sports hernia is a soft tissue injury of the groin region. This painful hernia is also called athletic pubalgia. It occurs most often in athletes who play sports requiring sudden direction changes and intense twisting movements.

Is a sports hernia the same as an abdominal hernia?

A sports hernia can lead to a traditional abdominal hernia, but it is a different type of injury. Athletic pubalgia is a strain or tear of a ligament, tendon, canstockphoto31482997and/or muscle in the groin or lower abdomen area.

What body structures are affected from sports hernia?

The soft tissues most often affected by sports hernia are the lower abdomen oblique muscles and the tendons that attach the obliques to the pubic bone. For many people, the abductor tendons (attach thigh muscles to the pubic bone) can be torn or stretched.

What is the cause of sports hernia?

Sports hernia occurs from vigorous sports, such as soccer, football, ice hockey, and wrestling. Any activity that involves planting the feet and twisting the body with maximum exertion can cause stretching or tearing of the groin area.

What are the symptoms of a sports hernia?

A sports hernia causes severe pain of the groin or lower abdomen at the time of the injury. The pain is relieved with rest, but can return with activity, particularly twisting movements. This type of hernia does not cause a visible groin bulge as seen with an inguinal hernia. However, over time, a sports hernia can lead to an inguinal hernia, with abdominal organs pressing against the weak soft tissues to form a noticeable bulge.

How is a sports hernia diagnosed?

If you or your trainer suspects you have a sports hernia, you should see a doctor. The doctor will ask questions about your symptoms, inquire about how the injury occurred, and perform a physical examination. The doctor will look for tenderness of the groin region. In addition, the doctor will examine you for an inguinal hernia.

Will I need testing?

The doctor may choose to perform radiographs (x-rays) and/or a magnetic resonance imaging (MRI) scan to help determine if or not you have a hernia.

How is sports hernia treated?

Treatment for sports hernia includes:

  • Nonsurgical treatment – This involves resting the area for 7-10 days and using ice packs periodically to take down swelling. If you have a bulge of[ File # csp4036800, License # 2145984 ] Licensed through in accordance with the End User License Agreement ( (c) Can Stock Photo Inc. / 4774344sean

    the groin, the doctor will show you how to use a compression wrap (Ace bandage) to relieve pain.

  • Physical therapy – After 10-14 days, the doctor may recommend physical therapy exercises to improve flexibility and strength of the inner thigh and abdominal muscles.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) – These include naproxen, ibuprofen, and ketoprofen, which are used to reduce pain and swelling.
  • Surgery – The surgical procedure to repair torn groin tissues involves making one incision (open procedure), or a few tiny incisions (endoscopic procedure). With endoscopy, the surgeon uses a small tube and camera to make necessary repairs inside the abdomen region.

Is treatment effective?

According to statistics, more than 90% of patients who have surgery or use nonsurgical treatment are able to return to sports activity. For some patients, however, the tissues tear again requiring surgical repair.

How common is sports hernia?

The incidence of groin injuries is around 15% for the general population. However, many athletes report groin pain but never see a healthcare professional for treatment.

Orthopedic and Sports Performance Institute is the top sports medicine practice in Arizona, with a location in the East Valley serving Mesa, Gilbert, Chandler, Tempe, Queen Creek, Maricopa and surrounding areas. Call us today for comprehensive options!


Holmich P & Thorborg K (2014). Epidemiology of Groin Injuries in Athletes. In D.R. Diduch and L.M. Brunt (eds.), Sports Hernia and Athletic Pubalgia: Diagnosis and Treatment, 13. DOI 10.1007/978-1-4899-7421-1_2, © Springer Science+Business Media New York.

Overview of Muscle Contusions and Cramps from a top East Valley Orthopedic

Muscle Contusions and Cramps

What are bruises?

Also called contusions, bruises occur when small blood vessels under the skin’s surface are broken. When blunt trauma occurs, it causes tissue and cell damage as well as bleeding within the muscle. Blood escapes from damaged capillaries and seeps into the tissues. Inflammation initiates canstockphoto23422208macrophage action and phagocytosis of debris, which helps with muscle regeneration.

What causes bruises?

Bruising can occur to the skin, muscle, and bone. Bruises result from vigorous exercise, trauma to the body, or from medications. A nutritional deficiency of iron or vitamin B12 can lead to anemia, which makes bruising more likely.

How common are bruises?

Contusions comprise around 65% of all sports-related injuries. Most bruises go unreported and untreated. The gastrocnemius (calf) muscles and the quadriceps (thigh) muscles are most often bruised. Direct blows are less frequent than indirect ones (strain), and many athletes can return to full activity soon after a strain.

Which muscles are more susceptible to bruising?

Skeletal muscle comprises 45% of the total body weight. Muscles that cross a single joint are close to the bone, and are at most risk for contusions. The larger muscles that go between two joints are more susceptible to stretch-induced strains.

How are contusions treated?

Following the initial bruising, the goal of therapy is to decrease hemorrhage, reduce inflammation, and control pain. This involves the “RICE” formula: limb immobilization and rest (R), use of ice packs (I), wearing a compression (C) bandage (Ace wrap), and elevating (E) the extremity. RICE is done for the first 24 hours for minor bruises, and for 48 hours for more severe contusions.

Once the bruise is stable, heat is used to break up the blood from the tissue and to get it back into circulation. For serious thigh contusions, the client may use crutches, as weight-bearing can be extremely painful. A contusion will generally stabilize after 2-3 days.

What are muscle spasms?

Muscle spasms (cramps) are involuntary contracting of the muscle. Spasms can be mildly annoying or excruciatingly painful. They can only last a few seconds, or they may persist for hours. Some muscle cramps are so severe that they cause tissue bruising of the surrounding area.

What causes muscle cramps?

During exercise, the muscles require the proper amounts of hydration, nutrients, and electrolytes to function. Without these elements, cramping can occur. The causes of muscle cramps include:

  • Nutritional deficiencycanstockphoto10163991
  • Dehydration
  • Strenuous exercise
  • Electrolyte depletion

What does a muscle cramp feel like?

Often called a “charley horse,” a muscle cramp is a sudden intense pain causes by spasming muscle tissue. The cramp results from a forcibly contracted muscle that will not relax.

What muscles are prone to cramps?

Cramps affect any muscle that is under voluntary control (the skeletal muscles). The muscles that lie between two joints are most prone to cramps. Muscle spasms can involve a group of muscles or only a portion of the muscle. The most commonly affected muscle groups include:

  • Back of the thigh (the hamstrings)
  • Back of the lower leg (the gastrocnemius)
  • Front of the thigh (the quadriceps)
  • Foot muscles
  • Abdominal region

Who is at risk for muscle cramps?

Just about everyone has muscle cramps at some point during life. Sometimes, the slightest movement will trigger a muscle cramp. They also can happen during exercise, such as playing tennis or golf, bowling, or swimming. Those at most risk for muscle cramps include:

  • People over the age of 65 years
  • Young children
  • Overweight individuals
  • People on diuretics (water pills)
  • Endurance athletes (runners and triathletes)

How are muscle cramps treated?

The first thing to do is stop what activity you are doing that triggered the cramping. Gently massage and stretch the cramping muscle, holding it in a stretched position until the pain eases. Apply heat to a tight, tense muscle, and apply ice packs to a sore muscle. Whirlpool therapy can be used to recover from cramps and contusions.

OSPI offers top sports medicine treatment for all types of contusions, sprains, strains and full ligament tears. Options include stem cell therapy, orthopedic surgery, pain management, physical therapy and more. Most insurance is accepted, call us today!

Overview of Knee Collateral Ligament Injuries and Treatment

The lateral collateral ligament (LCL) and medial collateral ligament (MCL) are important for avoiding rotational instability of the knee joint, as well as preventing cartilage damage. A collateral ligament injury often requires reconstruction using the patient’s own tissue or donor tissue.

What is the purpose of the collateral ligaments?

The LCL is on the outer portion of the knee, and it connects the thigh bone (femur) to the leg bone (fibula). This

[ File # csp11032144, License # 2179054 ] Licensed through in accordance with the End User License Agreement ( (c) Can Stock Photo Inc. / pixologic

ligament’s purpose is to avoid stress across the knee where it buckles outward. Along with other ligaments, the LCL forms a complex that provides external rotation stability. The MCL connects the thigh bone (femur) to the shin bone (tibia). It keeps the knee from buckling inward.

What are the symptoms of lateral collateral ligament injuries?

Injury to the LCL can lead to buckling of the knee. A direct blow on the inside of the knee can cause hyperextension stress on the LCL. This ligament often is torn along with the anterior cruciate ligament, which occurs from high-force sporting injuries. Symptoms include instability of the knee joint, mild knee pain, tenderness and swelling on the outer region of the knee, as well as weakness and/or numbness of the foot.

What are the symptoms of medial collateral ligament injuries?

With MCL injuries, you can have pain, tenderness, and swelling. Several hours after the initial injury, the pain may increase. You may also notice some bruising on the inner aspect of the knee.

How are collateral ligament injuries diagnosed?

The doctor diagnoses collateral ligament injuries based on symptoms, history of injury, physical examination, and magnetic resonance imaging (MRI) scans. X-rays can be normal, but MRI has a 90% accuracy rate for showing ligament tears. Ligament injuries are graded using a scale as follows:

  • Grade 1 injuries – Mild and usually gets better within 1-3 weeks. Only requires non-surgical treatment and use of crutches for a short while.
  • Grade 2 injuries – Moderate and usually gets better in 4-6 weeks. May require wearing a hinged knee brace and limited weight-bearing.
  • Grade 3 injuries – Severe and require wearing a hinged brace for several months. Weight-bearing is limited for 4-6 weeks. Often requires surgery.

What is the treatment for collateral ligament injuries?canstockphoto7107950

The LCL does not heal as well as the MCL. For minor tears, the doctor will recommend rest for a few weeks, use of ice to decrease swelling, elevation of the leg, and a compression bandage (ACE wrap). Physical therapy is used to restore strength and range of knee motion.

For high-grade tears, surgery is necessary. The doctor will reattach the ligament using large stitches or a suture anchor. If the ligament is torn into two pieces, the pieces can be sewed together. When a graft is used, the new structure is attached to replace the torn ligament.

How common are collateral ligament injuries?

According to statistics, the incidence of acute knee injury in the U.S. is 300 cases per 100,000 persons per year. Collateral ligament injuries make up 25% of all acute knee emergency room visits. These injuries are more common in adults aged 20 to 34 years. The NCAA reports 2 collateral injuries per 1,000 player exposures in a year.

OSPI has been the top sports medicine orthopedic doctors in the East Valley for years, with sports medicine physicians providing comprehensive operative and nonoperative care for all types of knee injuries. Call us today!


National Collegiate Athletic Association. NCAA Injury Surveillance System. 1999-2000.

Yawn BP, Amadio P, Harmsen WS, et al. Isolated acute knee injuries in the general population. J Trauma. 2000 Apr. 48(4):716-23.

What is Turf Toe and How is it Treated?

A turf toe is a sprain of the big toe’s main joint. This injury occurs when the big toe is forcibly bent upward, which is referred to as hyperextension. This can occur when pushing off into a sprint from the turf and having the toe get stuck flat on the ground.

Who gets turf toe?

Sprains of the big toe are prevalent among football players who play on artificial turf. Artificial turf is a harder surface than grass, and there is no “give” when force is placed upon it.canstockphoto12027384

Which toe structures are affected with turf toe?

The big toe has two joints. The largest joint of the toe is called the metatarsophalangeal joint (MTP). The MTP is where the first long bone of the foot (metatarsal) meets the bone of the toe (phalanx). With turf toe, the MTP joint is injured. The joint has many structures that form the plantar complex. These include:

  • Plantar plate – Thick fibrous tissue lying beneath the MTP joint. This prevents the big toe from bending too much.
  • Flexor hallucis brevis – Attaching to the toe bone, this is the tendon that runs under the first metatarsal bone. This structure provides stability and strength of the big toe.
  • Collateral ligaments – These are located on each side of the toe, and they connect to the metatarsal bone to the phalanx bone. These structures prevent the toe from going too far to either side.
  • Sesamoid bones – These two small bones are surrounded by the flexor hallucis tendon, and they help the toe move easily, provide stability to the MTP joint, and assist with weight-bearing on the forefoot.

How common is turf toe?

In a study of NCAA football players, the incidence of turf toe injuries was 0.062 per 1,000 athlete exposures. Football players were 14 times more likely to sustain a turf toe injury during games than during practice. Less than 2% of these injuries require surgical intervention.

How is turf toe diagnosed?

Turf toe is diagnosed based on symptoms, physical examination, and x-rays. To help the doctor devise a canstockphoto7107950treatment plan, the injury is graded from 1 to 3.

  • Grade 1 – The plantar complex is stretched causing slight swelling and tenderness.
  • Grade 2 – There is partial tearing of the plantar complex causing tenderness, swelling, and bruising.
  • Grade 3 – There is complete tearing of the plantar complex causing severe tenderness, swelling, and bruising.

During the exam, the doctor checks for range of motion, as well as swelling and bruising. The doctor will order x-rays to visualize the bones, and magnetic resonance imaging (MRI) scans for viewing soft tissues and cartilage.

What causes turf toe?

Turf toe occurs when the forefoot is fixed on the grown with the heel raised, and a force pushes the big toe into a hyperextended state. This injury can also occur during a forceful tackle.

How is grade 1 turf toe treated?

The RICE protocol is first-line treatment for grade 1 turf toe injuries. This includes:

  • Rest – Taking a break from sporting activities, avoiding walking, and not bearing weight on the affected toe.
  • Ice – Use of ice packs for 20-minute intervals several times each day.
  • Compression – Wearing an elastic compression bandage.
  • Elevation – Elevating the affected toe to decrease swelling.

In addition, taping the big toe to other toes (buddy taping) will restrict motion and improve healing. Nonsteroidal integrity-fracture-walkeranti-inflammatory drugs (NSAIDs) are used to reduce swelling and relieve pain. The athlete should use orthotics when returning to activity, such as a phraphite shoe insert with a stiff forefoot component.

How are grade 2 turf toe injuries treated?

For grade 2 injuries, the MTP joint is kept immobilized, and a walking boot is used for 7-14 days. For most athletes, a full 2 weeks of rest is recommended before returning to activity.

How is grade 3 turf toe treated?

For severe MTP joint injuries, the toe is immobilized for 3-4 weeks. The athlete uses a walking boot or cast that keeps the big toe in a downward position. Physical therapy is used to stretch and strengthen the big toe and to prevent joint stiffness.

Is surgery required for turf toe?

Surgery is required for:

  • Severe tearing of the plantar complex
  • Vertical instability of the MTP joint
  • Loose bone chips of the joint
  • Fracture of the sesamoid bone
  • Damage to the joint cartilage
  • New or worsening bunion

OSPI offers the top sports medicine orthopedic treatment in Arizona. The Gilbert orthopedic surgeons are experts in both the nonoperative and operative treatment of injuries such as turf toe. Most insurance is accepted, call today!


George E, Harris AH, Dragoo JL, & Hunt KJ (2014). Incidence and risk factors for turf toe injuries in intercollegiate football: data from the national collegiate athletic association injury surveillance system. Foot Ankle Int, 35(2):108-15. doi: 10.1177/1071100713514038.

An Overview of Stress Fractures and Treatment

A stress fracture is a small crack in a bone. This common injury occurs in high impact sports, such as basketball and long distance running. Stress fractures are painful, but they usually heal with rest.

How common are stress fractures?

Stress fractures comprise about 10% of all athletic injuries. The incidence of stress fractures is around 10-20% of the general population.

Which bones are more likely to incur a stress fracture?

The most common injured bones include the metatarsals (foot), as well as the lower leg bones (tibia and fibula). Stress fractureMore than 50% of stress fractures occur in the lower leg bones, with 25% of these injuries occurring in the metatarsal bones of the feet.

What increases the risk for stress fractures?

Certain factors increase the incidence of stress fracture, either directly or indirectly. Risk factors include:

  • Muscle weakness
  • Muscle inflexibility
  • Inappropriate footwear
  • Training changes (shoes, terrain, intensity, and activity)
  • Excessive muscle strength
  • Poor running technique
  • Lower extremity alignment anomalies
  • Previous history of injury

What sports activities are likely to lead to stress fractures?

There is a higher incidence of stress fractures in sports that require repetitive movements. These include:

  • Cricket (bowling the ball)
  • Rowing
  • Aerobics
  • Running
  • Basketball

What bones are affected by stress fractures?

  • Tibia (lower leg) stress fractures – These are associated with running, jumping, walking, and dancing, and are stress fracture3more common in females.
  • Metatarsal (foot) – These are linked to dancing, running, marching, and walking.
  • Femur (thigh) stress fractures – These are seen mostly in female athletes who engage in running and walking.

What causes a stress fracture?

Stress fractures are more likely to develop in persons who have just begun a new activity, or those who have increased the intensity of their workout routines. Stress fractures occur when the muscles are not conditions, causing them to tire easily so they do not support and cushion the bones. In addition, stress fractures are more common in women than men.

What are the symptoms of a stress fracture?

A stress fracture causes a dull, intense pain at the affected site. The pain is worsened with walking, standing, or exercising. Swelling is likely to occur, and some patients have mild bruising.

How is a stress fracture diagnosed?

To diagnose stress fracture, the doctor will conduct a thorough physical examination of the painful area. X-rays may not detect a stress fracture, so the doctor may order another imaging scan, such as a nuclear bone scan or magnetic resonance imaging (MRI) scan.

What is the treatment for stress fractures?

Initial treatment involves the RICE protocol. This involves rest, ice, compression, and elevation. The extremity is rested for a few days, and ice packs are applied to reduce pain and swelling. A compression bandage will reduce the likelihood of re-injury, and elevation helps take down swelling. For pain, nonsteroidal anti-inflammatory drugs integrity-fracture-walkerare used, such as naproxen or ibuprofen.

In addition, a walking boot may help prevent excess pressure on the fracture, provide pain relief and accelerate healing. There is some evidence for electrical impulse treatment of stress fractures as well.

Surgery for a stress fracture may become necessary if conservative treatment fails. In addition, athletes who desire to get back into sports activities faster may desire surgery for a speedier recovery. One example may be a 5th metatarsal fracture that is keeping a person out of competition.

Can stress fractures be prevented?

Prevention is important for any athlete wishing to avoid stress fractures. This involves:

  • Modifying training – To reduce the incidence of stress fractures, training regimens should be individualized.
  • Stretching – During warm-up, the athlete should perform leg muscle stretching.
  • Use of orthotics – This includes shock-absorbing shoe inserts, which reduce the occurrence of leg stress fractures.
  • Supplements – Taking calcium with vitamin D is helpful for preventing stress fractures.


American College of Sports Medicine (2015). Stress Fractures. Retrieved from:

Patel DS, Roth M, & Kapil N (2011). Stress Fractures: Diagnosis, Treatment, and Prevention. Am Fam Physician, 1;83(1):39-46.

What You Need to Know About Rotator Cuff Tears

A rotator cuff tear is a common cause of disability and pain among adults. According to 2008 statistics, around 2 million people in the United States visited a doctor with a rotator cuff problem. A rotator cuff tear can weaken the shoulder, and it limits ability to perform simple daily activities, such as brushing teeth or dressing.

What structures are affected by a rotator cuff tear?

The shoulder is made of three bones: the humerus (upper arm bone), the scapula (shoulder rotator cuffblade), and the clavicle (collarbone). The shoulder is a ball-and-socket joint that is kept stable by the rotator cuff. The rotator cuff is composed of four muscles that come together with tendons to cover the head of the humerus (ball of the joint). The rotator cuff helps you lift and rotate your arm. Between the rotator cuff and the shoulder bone (acromion) is a lubricating sac known as a bursa. This structure allows the arm bone to move freely in the socket.

What are the different types of rotator cuff tears?

When one or more rotator cuff tendons are torn, the structures no longer attach to the ball (head of the humerus). Tears can begin as partial frayed areas that progress to complete tears as the damage worsens. The types of rotator cuff tears are:

  • Partial tear – A slight tearing of the soft tissue, but it is not severed into two pieces.
  • Full-thickness tear – Also called a complete tear, this is where the structure is torn into two separate pieces.

What causes a rotator cuff tear?

There are two primary causes for tearing of the rotator cuff: acute injury and degeneration.

  • Acute injury – This occurs if you fall onto an outstretched arm, or when you lift something that is too heavy. An acute tear often occurs along with other shoulder injuries, such as a Rotator Cuff Teardislocated shoulder or broken collarbone.
  • Degeneration – A tear related to degeneration occurs from wearing down of the tendon over time. This type of tear occurs more in older adults. Rotator cuff tears are more common in the dominant arm, and you have an increased risk for tearing the opposite shoulder structure when you have a tear in the dominant arm rotator cuff.

What are the risk factors for a rotator cuff tear?

Several factors can contribute to chronic rotator cuff tears. These are:

  • Repetitive stress – Repeating the same shoulder movements over and over can put stress on your rotator cuff tendons and muscles. This occurs with certain sporting activities like baseball (throwing) rowing, tennis, and weight lifting.
  • Lack of adequate blood supply – As you age, the blood flow to the rotator cuff lessens. Without an adequate blood supply, the body’s ability to heal and repair damaged tendon and muscle decreases.
  • Bone spurs – Bony overgrowths develop on the lower aspect of the acromion bone. When you lift your arms, the spurs rub on the rotator cuff structures, which are called shoulder impingement. Over time, this rubbing weakens the tendon are makes it tear.
  • Being older – Because most rotator cuff tears are caused by wear-and-tear, aging and being over age 40 years is a risk factor.

How common are rotator cuff tears?

The frequency of full-thickness rotator cuff tears is 5-30%, with increasing incidence with advanced age.

What are the symptoms of a rotator cuff tear?

The most common symptoms of a rotator cuff tear are:Shoulder pain

  • Intense pain after an injury
  • Snapping sensation and immediate upper arm weakness
  • Pain when lifting or lowering the arm
  • Pain at rest, particularly when lying on the injured shoulder
  • Weakness when rotating the arm or lifting
  • Cracking sensation (crepitus) when moving the shoulder

How is a rotator cuff diagnosed?

The orthopedic doctor in Chandler and Gilbert will ask you questions about your injury, inquire about your usual activates, ask about your symptoms, and take a medical history. In addition, a thorough examination is done. The doctor will measure range of shoulder motion and test your arm strength.

X-rays are often done to assess for a dislocation, fracture, or bony deformity. X-rays do not show the soft tissue structures, so a magnetic resonance imaging (MRI) scan is done. This test confirms the tear and alerts the doctor to the significance of the injury.

How are rotator cuff tears treated?

The goal of treatment is to reduce pain and to restore full function. Treatment options vary, depending on the severity of the tear, the age of the patient, and the level of activities. Around 50% of people will not need surgery. Nonsurgical treatment options include:

  • Rest – The East Valley orthopedic doctor may suggest you rest the shoulder and limit Shoulder Arthroscopyoverhead activities. A sling can be worn to protect your shoulder while you rest it.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) – This includes drugs such as naproxen and ibuprofen, which decrease pain and swelling.
  • Physical therapy – Specific exercises will improve strength and restore movement of the shoulder. Your exercise program involves stretches for range of motion and flexibility, as well as strengthening the muscles that support the shoulder. This will prevent future injury and relieve pain. The therapist can also use various pain relief measures, such as heat therapy, ultrasound, electrical stimulation, and massage.
  • Corticosteroid injection – If rest, NSAIDs, and physical therapy do not reduce pain and improve mobility, the doctor may recommend a corticosteroid injection. This medication is instilled into the joint to decrease inflammation.

How will the Gilbert orthopedic doctor determine if I need surgery?

Some patients with rotator cuff tears require surgery for repair. The East Valley shoulder specialist may suggest surgery if:

  • You are active and use your arms for sports and overhead work.
  • You have continued pain after conservative measures.
  • You have a large tear (greater than 3 cm).
  • You have symptoms that persist for more than 6 months.
  • You have significant loss of function and weakness in the shoulder.
  • Your tear was caused by a recent injury.

How is rotator cuff tear surgery done?

Repair of a torn rotator cuff with a Gilbert or Chandler shoulder specialist involves reattaching the torn tendon to the humeral head. If the tendon is destroyed, a graft may be used to make the repair. The arthroscopic surgery involves making a few incisions around the shoulder capsule and using a camera and small instruments to make the repair.

OSPI offers the top sports medicine treatment in the Valley, including nonoperative and operative therapies. This may include NSAIDS, PT, injections or surgical repair. Call today!


Baker CL, ed. Shoulder impingement and rotator cuff lesions. The Hughston Clinic Sports Medicine Book. Baltimore, Md: Lippincott Williams and Wilkins; 1995. 272-9.

What You Need to Know About Shoulder Separation

A shoulder separation involves separation of the clavicle (collarbone) and the acromion (end of the shoulder blade). This injury can be partial or complete, painless or painful, and mild or severe.

What body structures are involved in a shoulder separation?

The clavicle and scapula (shoulder blade) are connected by the acromioclavicular (AC) joint. Shoulder painThis joint is held together by the coraclavicular (CC) and acromioclavicular ligaments. With an acromioclavicular joint injury (shoulder separation), these ligaments are partially or completely torn.

How are shoulder separations classified?

A shoulder separation is classified by how severely the ligaments are injured. The classes are:

  • Type I injury – The AC ligament is partially torn, but the CC ligament remains intact.
  • Type II injury – The AC ligament is completely torn, and the CC ligament is partially torn or not injured.
  • Type III injury – Both the CC and AC ligaments are completely torn. The acromion and clavicle are separated.
  • Type IV – Involves tearing of deltoid and trapezius muscles as well as CC and AC ligament tearing.

What causes a shoulder separation?

Traumatic acromioclavicular joint dislocations can occur during athletic events. A direct blow to the shoulder or a fall onto the shoulder can cause shoulder separation. The injury requires excessive force. Shoulder separations are common injuries in sporting activities.

How common are shoulder separations?

According to a recent study of shoulder problems, intra-articular injuries were found in 18% of patients, and co-occuring injuries to the shoulder girdle occur frequently.

What are the symptoms of shoulder separation?

The symptoms and signs of a separated shoulder include:

Pain at the time of injuryAC Joint Injuries

  • Limited shoulder movement related to pain
  • Swelling
  • Bruising
  • Tenderness over the AC joint
  • Possible deformity with the clavicle appearing out of place

How is a shoulder separation diagnosed?

The doctor will inquire about your injury, take a medical history, and conduct a clinical examination. The doctor will check for a bump or deformity, the shoulder range of motion, blood flow, and muscle strength. In addition, he will perform certain test to assess nerve function. X-rays are taken to assess fractures and dislocation.

How is a shoulder separation treated?

Treatment of a shoulder separation depends on the extent of injury. For type II and II injuries, AC Joint Injurythe shoulder is rested and supported with a sling, and the patient must undergo physical therapy. The therapist helps the patient strengthen the shoulder and regain range of motion. This is important for prevention of frozen shoulder syndrome.

Surgery is reserved for patients with type III and IV injuries. Surgery is performed on type I and II injuries that do not respond to non-surgical treatment, or when pain continues after 2-3 months. Surgery involves reconstruction of the CC and AC ligaments using screws or sutures to stabilize the joint. The procedure may be performed using the arthroscopic technique, where the surgeon makes several small incisions around the joint, and inserts a tiny camera to view the structures. Small instruments are also inserted to make necessary repairs.

OSPI offers top orthopedic surgeons in the East Valley serving Gilbert, Chandler, Mesa, Queen Creek and surrounding areas. All types of sports injuries such as shoulder separations are treated, including all levels of AC joint injury. For the top Arizona sports medicine surgeons, call OSPI today!


Tischer T1, Salzmann GM, El-Azab H, Vogt S, & Imhoff AB (2009). Incidence of associated injuries with acute acromioclavicular joint dislocations types III through V. Am J Sports Med, 37(1):136-9. doi: 10.1177/0363546508322891.