Center for Orthopedic Rehabilitation :: Common Injuries

If you suspect you have any of these injuries, CORE can help!

Shoulder Injuries

Rotator Cuff Tendonitis
This condition is often associated with repetitive, abnormal stress to the tendons of the rotator cuff (four small muscles that surround and steer shoulder movement) resulting in inflammation and pain. Resultant cuff tendonitis may cause sharp, acute pain in the shoulder or upper arm aggravated after periods of activity such as overhead throwing or lifting. Pain may also be experienced when dressing, grooming, sleeping on the affected shoulder, reaching high over head, or behind the back. Functional weakness is usually present with lifting during everyday activities. If the condition is left untreated, the tendonitis may progress to a partial thickness tear of the rotator cuff, often requiring surgery. Physical therapy can be beneficial to regain lost shoulder motion and functional strength while decreasing pain and facilitating the healing process to the injured tissues.

SLAP (Superior Labrum Anterior and Posterior) Lesion
This condition involves injury to the superior (top) portion of the labrum of the shoulder joint. The labrum is a cartilaginous ring that serves to deepen the socket of the joint providing both stability and a site for muscular attachment for the biceps brachii. Common causes of a SLAP lesion include falling onto an outstretched hand, overhead lifting, and overhead throwing. Common patient reports include instability within the shoulder causing a vague ache. In addition, some patients may report catching, popping, or clicking within the joint during functional activities.

Rotator Cuff Impingement
This condition involves a progressive, mechanical impingement of the rotator cuff tendons beneath the bony architecture (coracoacromial arch) of the shoulder joint. The resultant impingement of the cuff tendons results in significant shoulder pain increased with the performance of overhead and functional activities. Common causes of cuff impingement include bony abnormalities and rotator cuff tendon thickening. Conservative treatment is typically geared towards decreasing the initial pain and inflammation, restoring pain free range of motion within the shoulder, and rebuilding functional strength to the rotator cuff and scapular musculature.

Rotator Cuff Tear (Partial Thickness and Full Thickness)
This condition involves complete (full thickness) or incomplete (partial thickness) disruption of the tendons of the rotator cuff muscle group. Common causes of injury include direct trauma to the shoulder, repetitive overhead lifting, and participation in sports that require overhead throwing. In addition to these causes, some patients experience a cuff tear simply as a direct result of a degenerative process with no specific trauma or activity associated with the injury. A common presentation for a patient with a rotator cuff tear includes an individual 40 years of age or older with reports of constant, lateral shoulder pain affecting the ability to sleep accompanied with functional weakness limiting his or her ability to lift the arm against gravity.

Adhesive Capsulitis (Frozen Shoulder)
This condition involves stiffening (freezing) and inflammation of the soft tissues (joint capsule and ligaments) that surround the shoulder joint. The stiffening of these structures creates severe loss of functional shoulder movement, pain surrounding the joint, and an inability to sleep on the affected side. The incidence for this condition is approximately 2% within the general population and from 10-35% within the diabetic patient population. Other common factors related to an increase in the prevalence of this condition include cervical spine (neck) disorders, hypothyroidism, and prolonged post-surgical or post-traumatic immobilization of the shoulder. Physical therapy can help restore ROM and reduce recovery time.

ELBOW FOREARM INJURIES

Tennis Elbow
Also known as lateral epicondylitis. Tennis elbow stems from overuse, improper muscle strength, and repetitive movement of the wrist or elbow where the tendons at the elbow become stressed due to poor mechanics (i.e. typing, racquetball, tennis, golf). Localized pain at the lateral (outside) elbow is present with wrist and elbow movement. Pain can become so intense that lifting a glass of water may be a chore! Tennis elbow can be difficult to relieve if mechanics and flexibility/strength issues are not addressed.

Golfer’s Elbow
Also known as medial epicondylitis. Similar to tennis elbow with associated pain and decreased movement, but golfer’s elbow occurs on the inside of the elbow. Golfer’s elbow presents similar signs and symptoms as tennis elbow and is also difficult to heal if not handled properly. Therapeutic management of golfer’s elbow is very similar to that of tennis elbow. Splinting may be used to decrease strain on the muscles, and the use of anti-inflammatories will help with tissue swelling and pain. Therapy focuses on restoration of muscle balances (flexibility and strengthening), education on causative factors and prevention, and thermal and electrical modalities to decrease inflammation and facilitate healing.

LOW BACK PAIN

The spine is the most dynamic structure in our body as it allows for optimal stability and movement and maintains our posture. This highly integrated and dynamic structure is involved in all movement and is undergoing constant stress 24/7, so it should not be surprising to us when it starts to show wear and tear. Contributing factors to low back pain include poor body mechanics and work ergonomics, decreased strength, and muscular/structural imbalances. As the low back is subject to repetitive stresses of daily life and occasional injury, it may respond by showing signs and symptoms of wear and tear. These symptoms may manifest themselves as pain located around the waistline and/or lower extremities, and possibly, numbness and tingling to the lower extremities. If any of these symptoms persist or worsen, seek immediate medical attention.

Herniated Disc
Discs are located between the vertebrae of the spine to help minimize shock and help optimize movement. As we age, the discs lose their elasticity and may tear or bulge onto the spinal nerves. This can produce extreme muscle spasms and pain to low back and legs and/or numbness and tingling to legs and toes. Physical therapy may be indicated to decrease the odds of surgical intervention.

WRIST/HAND INJURIES

Tendonitis
Tendonitis, simply put, is inflammation of the tendon. A tendon is what connects muscles to bone, and it typically crosses a joint. Overuse of the joint or muscle causes inflammation of the tendon. Tendonitis is very common in the wrist and hand. Tendonitis of specific tendon(s) can have different names (i.e. DeQuervain’s tenosynovitis, Intersection syndrome, finger tendonitis), but treatment is generally the same. Occupational therapy may be prescribed to use thermal or electrical modalities to decrease pain and inflammation, for custom splint fabrication, to learn exercises and stretches to restore muscle and tendon flexibility, and to strengthen the wrist and hand to resume normal use. Your workstation and daily activities may need to be modified to prevent further injury and overuse.

Arthritis
There are many forms of arthritis with most forms being categorized as either Osteoarthritis or Rheumatoid arthritis. Osteoarthritis generally occurs from “wear and tear” on the joints, while Rheumatoid arthritis is actually an autoimmune disorder that attacks the lining of the joints. Both forms of arthritis frequently occur in the wrist and hand. In addition to medical management, occupational therapy may be prescribed. Therapy goals are to decrease joint inflammation, improve joint range of motion, and provide education on joint protection techniques as well as to provide equipment to relieve strain on the affected joints during daily activities. Therapists may also fabricate rigid splints to rest and immobilize joints during a “flare-up” and recommend a variety of soft splints that support joints during hand use

Fractures to Hand or Wrist
A common mechanism of injury is falling on an outstretched arm with the wrist hyper-extended. Proper alignment of the bone(s) is essential for normal healing and restoration of motion. In addition, because of important vessels and nerves surrounding these structures, it is very important to follow-up with an orthopedic surgeon or a hand specialist. Treatment generally consists of casting or surgery to stabilize the fracture, followed by therapy to regain range of motion of the joints.

Carpal Tunnel Syndrome
The carpal tunnel is a narrow passageway in your wrist that allows nine tendons in the fingers and thumb, as well as the median nerve, to travel into the hand. Pressure inside the carpal tunnel may be increased by repetitive wrist motions, gripping, or sustained wrist and finger positions. This increased pressure on the nerve may cause wrist pain, numbness and tingling in the thumb and first two fingers, and eventual hand weakness. Carpal Tunnel Syndrome may be managed with anti-inflammatories and with splinting to immobilize the wrist and decrease pressure in the carpal canal. A patient may be referred to an occupational therapist for splinting, nerve and tendon exercises, thermal or electrical modalities to decrease inflammation, and education on prevention of symptoms and activity modification. If conservative management is unsuccessful, surgery may be required to decompress the nerve.

Tendon/Ligament Injuries to Fingers
These types of injuries usually occur with direct contact to the fingers (“jammed finger”) or forceful gripping of an object that is moving. Pain may occur with movement, or in some cases, finger movement may not occur at all if a tendon is ruptured. Proper medical attention is necessary to avoid permanent deformity to the finger involved. Immobilization is usually done as required by the physician to allow proper healing of the damaged tissues. Once the splint is removed, occupational therapy will help restore proper motion to the fingers and facilitate the return to full function.

HIP INJURIES

Iliotibial Band Syndrome
Inflammation of the thick, fibrous tissue that runs from the top of the hip to just below the knee. This injury commonly occurs in runners and can be very debilitating. Physical therapy has been shown to reduce pain and inflammation and restore proper muscle balances throughout the pelvic region. Once the pain diminishes, a thorough running analysis may be completed to prevent recurrence of the injury.

Piriformis Syndrome
This condition refers to irritation of the piriformis muscle which lies underneath the gluteus muscle, or buttock. Because the sciatic nerve passes underneath or through the piriformis muscle, burning or numbness/tingling may occur due to nerve irritation. Pain may start in the buttock and radiate down the affected leg. It is important to seek proper medical attention to rule out referred pain from the spine. In most cases, piriformis syndrome may be alleviated through anti-inflammatories, and lower extremity flexibility program, if spine problems are ruled out.

KNEE INJURIES

Osteoarthritis (OA)
General degeneration of the knee joint that stems from wear and tear. This is accompanied by gradual increase in pain with activities (walking, stairs, prolonged sitting or standing). Physical therapy will help alleviate the pain by focusing on proper strengthening and stretching.

ACL Injury
The ACL injury is a very common injury to the knee. This ligament prevents the lower leg from moving forward on the upper leg. The mechanism of injury is from a twisting motion when the foot is firmly planted. The degree of severity ranges from a mild stretch of the fibers (Grade I) to complete rupture of the ligament (Grade III). The individual may feel or hear a “pop” with associated swelling. The individual may also report a feeling of “giving out” to the knee, limiting the function of the knee. An orthopedic specialist will be able to help diagnose and recommend treatment options for the individual. Physical therapy is commonly utilized before and after surgery to maximize recovery.

Meniscus Injuries
Commonly called torn cartilage, this is an injury to one of the two circular pads between the upper and lower legs. They function to decrease shock to the knees and distribute weight bearing forces through the legs. The mechanism of injury is a compression force associated with a twisting motion. A “pop” may be heard, but there is usually increased pain along the joint line of the knee. Signs and symptoms include pain, swelling, knee “locking up” or the feeling that the knee is stuck, and difficulty with walking and stairs.

LOWER LEG INJURIES

Achilles’ Tendonitis:
Inflammation of the Achilles’ tendon caused by overuse injuries (running, jumping), as well as decreased calf strength and flexibility. Tenderness and swelling are present over the tendon along with pain with walking, stairs, and running. Treatment includes ice, anti-inflammatories, flexibility training, and lower extremity strengthening. Foot biomechanics and proper footwear should be addressed as well.

ANKLE/FOOT INJURIES

Lateral Ankle Inversion Sprain
This injury is typically found in athletics when an individual “rolls” their ankle. Often times, this injury is characterized by swelling at the outside ankle bone (lateral malleolus) with possible bruising if the injury is severe enough. An ankle sprain results in damage to the ligaments of the outer ankle, although a small fracture can occur at the outer ankle bone. Initial management of this injury should include rest, ice with compression, and elevation of the leg to decrease swelling. Physical therapy is utilized to accelerate recovery time and reduce the risk of re-injury.

Posterior Tibialis Tendonitis
The posterior tibialis muscle is found at the inner aspect of the lower leg with the tendon extending down the leg and along the inner aspect of the foot. The function of this muscle and tendon is to support the arch of the foot. This tendon can become injured with running and also if the foot pronates or collapses too much. In this instance, the muscle and tendon become overworked resulting in swelling and irritation of the tendon. Often, this injury requires a biomechanical assessment by a medical professional to resolve aggravating factors and resolve the injury. Physical therapy can help eliminate the pain and restore function.

Plantar Fasciitis
The plantar fascia is a thick band of tissue along the arch and the bottom of the foot that is needed to support the arch. This band of fascia attaches the underside of the heel. This diagnosis is usually used to describe pain that occurs at the inside arch and the heel. Typically, this is characterized by pain occurring at the heel with the first step in the morning and made worse with prolonged walking and running. Physical therapy can help eliminate the pain and restore function.