Sports Medicine

The Achilles tendon is the largest tendon in your body. It is used pretty much whenever you move your leg, but perhaps most notably during jumping. This is when it is most vulnerable to injury.

A rupture of the tendon typically happens when there is an acute action or event that stresses the tendon on top of prolonged overuse. A rupture is when the tendon fibers are so torn that the tendon can no longer support running, jumping or even walking sometimes.

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It’s relatively common for athletes of sports that include sudden acceleration and deceleration, pivoting, direct contact and other quick movements, to experience an ACL (anterior cruciate ligament) injury. Unfortunately, a full tear is more common than any other type of injury, and that requires a surgical repair to regain proper knee function.

You may have an ACL injury if you are experiencing these signs or symptoms:

• “Popping” noise at the time of the injury
• Pain with swelling
• Loss of full range of motion
• Tenderness along the joint line
• Discomfort while walking

Treatment for an ACL injury varies by a patient’s needs. Sometimes, older or non-active people can attempt a non-surgical recovery, with might include bracing and physical therapy.

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How surgery is performed using a patellar graft

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How surgery is performed using a hamstring graft

A broken ankle can be a simple break of one bone or several bones that make up your ankle. The more bones that break, the more difficult it is to walk or put any pressure on the joint.

Ankle fractures occur most often from:

• twisting or rotating your ankle,
• rolling your ankle
• tripping or falling
• from impact during a car accident

You might have an ankle fracture if you’re experiencing any of the following symptoms:

• Immediate and severe pain
• Swelling
• Bruising
• Tender to the touch
• Unable to put weight on the injured foot
• Appears a bone is out of place (dislocated or a deformity)

Your treatment plan will vary by the type(s) of bones that are broken and the severity of the injury. If the broken bone is not out of place, nonsurgical treatment may be an option. These range from wearing a high-top tennis shoe for added stability to a short leg cast.

If the ankle fracture is more complex, surgery may be recommended. The OrthoNebraska team will work collaboratively with you to determine your needs, risks and the appropriate treatment plan.

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Ankle sprains are common injuries that range from mild to severe. They are the result of tiny tears in the fibers that make up the ligaments of your ankle or can be complete tears through the tissue.

The causes of sprained ankles can include:

• Walking or exercising on an uneven surface
• Falling down
• Sports that require cutting actions (trail running, basketball, tennis, football)
• Any activity where someone could step on your foot while you’re running

You may have a sprained ankle if any of the following symptoms are present:

• Swelling
• Bruising
• Tenderness to the touch
• Instability of the ankle

Ankle sprains are graded by severity but nearly all are treated without surgery. Nonsurgical treatment may include:

• The RICE method (rest, ice, compression and elevate)
• Protecting the ankle (brace, wrap, etc.)
• Physical therapy to improve range of motion and strength
• Anti-inflammatory medications
• Crutches and/or cast-boot or other immobilization devices

Repeated or severe ankle sprains may lead to chronic ankle instability. While somewhat unusual, surgery may be recommended if your injury does not improve. The OrthoNebraska team will work collaboratively with you to determine your needs, risks and the appropriate treatment plan.

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A spinal cord injury results when a fall or traumatic injury such as a car accident fractures or dislocates the vertebrae bones in your spine.

Symptoms resulting from damage to the spinal cord might include pain when moving your back or spine, partial or complete loss of feeling and muscle control (paralysis) and problems with bowel or bladder control.

A detailed diagnosis is really important, even if your symptoms are minor, because damaged nerves tend to recover quickly or not at all. Seeing a specialist in treating spinal cord injuries who will put together a detailed treatment plan for your situation can make a big difference when it comes to the final outcome and recovery from a spinal cord injury.

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When the bursa (fluid-filled sacs) in your elbow (or more specifically, the olecranon, or bony tip of the elbow) becomes irritated or inflamed, elbow bursitis may be diagnosed. Traumatic injury or prolonged pressure on the elbow are the most common causes. Activities often associated with elbow bursitis include any occupation or activity that requires you to crawl on your knees and lean on your elbows in tight places, and holding different positions, such as a plank, for longer periods of time.

Elbow bursitis may be present if you’re experiencing the following symptoms:

• Excessive swelling
• Pain and possible restricted movement
• Skin that’s red and warm to the touch

Nonsurgical treatment may include draining the fluid from the bursa, followed by an antibiotic. Your physician may also recommend the use of elbow pads, adjusting your activities to minimize pressure on your elbow and anti-inflammatory medications to reduce swelling and pain.

If the elbow bursitis does not improve from removing the fluid and/or antibiotics, outpatient surgery may be recommended.

As a patient of OrthoNebraska, your treatment plan for elbow bursitis will be developed collaboratively between you and your care team, while discussing the risks and benefits as they pertain to you individually.

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Flexor tendons help control movement in your hand. When they’re damaged, it can become hard or impossible to bend your fingers or thumb. A torn or cut tendon in your forearm, wrist, palm or along a finger is considered a flexor tendon injury.

Common causes of flexor tendon injuries include:

• Sports activities (football, wrestling, rugby)
• Deep cut
• Health conditions (rheumatoid arthritis)

You may have a flexor tendon injury if the following symptoms are present, usually as a result of trauma like a fall:

• Open injury such as a cut
• Inability to bend one or more joints of your finger
• Pain when your finger is bent
• Tenderness along our finger on the palm side of your hand
• Numbness in your fingertip

A splint may be used to give your arm or finger more protection as it heals, however, if your tendon is cut surgery will likely be recommended. The OrthoNebraska team will work collaboratively with you to determine the best treatment plan for your individual needs.

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Fractures of your toes and forefoot are relatively common and often the result of a direct blow to the foot or overuse and repetitive stress from high-impact sports like running and basketball.

Symptoms of a toe or forefoot fracture include:

• Bruising or discoloration that extends to nearby parts of the foot
• Pain when walking or putting weight on that foot

If you feel you may have a foot fracture, apply ice immediately, elevate your foot, do not put weight on that foot and add light compression by wrapping your foot. Seek medicare care right away, or at the least after a couple days if you symptoms do not improve.

If a fracture is confirmed, treatment will depend on the location of the injury and the type of fracture. For broken toes, “buddy taping” might be recommended. When the fracture is in the forefoot, elevation and limited weight-bearing are likely treatments with the possibility of a cast or walking boot. Surgery is not often recommended for foot fractures, but may be if it is complex or at risk for improper healing.

The OrthoNebraska team will work collaboratively with you to determine your needs, risks and the appropriate treatment plan.

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Elbow fractures and dislocations come in many shapes and sizes. Mostly caused by traumatic injury, they are more common in women and those between the ages of 30 and 40.

The most common elbow fractures are radial head fractures, which symptoms including:

• Outside elbow pain or swelling
• Pain and difficulty when straightening the arm
• Inability to turn the arm, such as turning a doorknob.

Disclocations have similar symptoms, but are typically very painful, especially full dislocations, which are often confirmed by X-ray.

Doctors classify fractures according to displacement, or how far out of the normal position they are. Less severe fractures with small cracks and/or minimal bone movements may be treatable without surgery. In these cases, a splint or sling will be used to ensure proper healing, with a gradual return to normal. More severe fractures may require surgery to avoid creating long-term problems or movement restrictions. The surgery typically involves resetting the bones in place using screws and plates, along with any necessary repairs to the surrounding ligaments.

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While knee ligament sprains or tears are common, they are most often found in athletes who participate in direct contact sports such as football or soccer. A knee ligament injury is often caused by some force that pushes the knee sideways (either to the outside or the inside of the knee).

You may have a knee ligament injury if you are experiencing any or several of these signs or symptoms:

• Pain at the sides of your knee (either inside or outside)
• Swelling near the site of the injury
• Instability/feeling as though your knee is giving out)

Depending on the overall damage to the ligaments and surrounding tissues, surgery may or may not be needed. Whether the fix is surgical or not, with appropriate treatment, you should regain full range of motion and stability of your knee.

Nonsurgical treatment could include:

• Ice and rest
• Bracing
• Physical therapy

If surgical treatment is needed, the OrthoNebraska team will work with you to determine your needs, risks and the appropriate treatment plan.

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A tear in the ring of cartilage surrounding the socket of the shoulder joint is called a labrum tear or SLAP tear (superior labrum anterior and posterior). The location of the tear can also impact the bicep tendon and cause additional challenges. Throwing athletes and weightlifters have a higher risk of a labrum tear.

Acute trauma and repetitive shoulder motion are the primary causes of labrum tears. This includes:

• Motor vehicle accidents
• Fall onto an outstretched arm
• Forced pulling of the arm
• Forced movement of the arm when it’s raised above shoulder level
• Shoulder dislocation

Labrum tear symptoms include:

• A sensation of locking, popping, catching or grinding in your shoulder
• Pain with shoulder movement or holding your arm in specific positions
• Pain when lifting an object
• Reduced shoulder strength
• Feeling as though your shoulder might pop out of joint
• Reduced range of motion

It’s not uncommon for labrum tears to be treated without surgery. Nonsurgical treatment options include anti-inflammatory medication and physical therapy. If your symptoms and pain do not improve with medication and therapy, surgery may be recommended. OrthoNebraska’s specialists will work closely with you to develop a treatment plan that fits your individual needs and goals.

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A type of reconstructive surgery, SLAP repairs are a common surgery to fix a torn labrum, a piece of fibrocartilage lining the rim of the shoulder socket

Pressure or stretching injuries can cause fibers within the nerves to break. When a nerve is broken, it can interfere with the nerve’s ability to send or receive signals from the brain.

A nerve injury can occur almost anywhere in the body, so many factors will be considered when developing your treatment plan.

While it depends on the location and severity of the nerve injury, surgery is often recommended to repair the nerves. More than likely physical therapy will be needed after surgery, which includes retraining your brain to send signals to those nerves and preventing any joints from becoming stuff.

The OrthoNebraska team will work collaboratively with you to determine your needs, risks and the appropriate treatment plan.

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When a child’s kneecap is in place, it moves up and down within a groove at the end of their thighbone. However, during a fall or with forceful, direct contact it can be forced partially or completely out of the groove and become dislocated. While it is possible for the kneecap to slip back into place on its own, medical attention is still recommended to help with pain and to determine if other damage to the knee exists.

Common causes of patellar dislocation include:

• Shallow or uneven groove in the femur
• “Looser” ligaments (mostly in children)
• Children with cerebral palsy and Down syndrome due to imbalance and muscle weakness
• Direct blow or hard fall

Patellar dislocation is a possible culprit with any of the following symptoms:

• Pain or swelling in the kneecap
• Feeling like the kneecap is shifting or sliding out of the groove
• Feeling like the knee is buckling or giving out
• Hearing a “popping” sound when the kneecap dislocates
• Change in the knee’s appearance
• Fear of running or changing direction

Seek medical attention immediately if your child’s knee seems to be dislocated. Nonsurgical treatment options include: bracing for stabilization, crutches, and physical therapy. If additional damage is done to other areas of the knee surgery may be recommended.

OrthoNebraska’s team will work with you to develop the right treatment plan to help prevent future dislocations.

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A rotator cuff tear occurs when one or more of the tendons in your rotator cuff is no longer fully attached to your humerus bone (arm). As with tears in other parts of the body, rotator cuff tears are most often caused by an acute injury such as a fall or from long-term wear and tear.

Additional risk factors for rotator cuff tears include repetitive lifting and overhead activities. Because of this, athletes and certain occupations are often impacted:

• Tennis players
• Baseball pitchers
• Painters
• Carpenters

You might have a rotator cuff tear if you have any of the following symptoms:

• Pain at rest and night
• Pain when lifting or lowering your arm
• Weakness when lifting or rotating your arm
• Feeling of a cracking sensation when moving your shoulder in certain ways

It is important to reduce activity and seek medical attention if you might have a rotator cuff tear. Continuing to lift or participate in sports can cause further damage. Your OrthoNebraska team will work with you to create a treatment plan that meets your individual needs, whether that involves nonsurgical or surgical treatment.

Nonsurgical treatment for rotator cuff tears includes:

• Rest
• Limited activity
• Anti-inflammatory medication
• Physical therapy
• Injections

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One of the most common knee injuries, meniscus tears can happen to athletes participating in contact sports or anyone engaging in significant physical activity. This c-shaped cartilage in your knee can tear from trauma or from degenerative changes that occur over time. It’s not uncommon for a meniscus tear to occur along with other knee injuries such as an ACL tear.

Meniscus tears often occur while pivoting or cutting, making quick start-stop movements. In older adults, these tears can occur simply by twisting the wrong way.

You could have a meniscus tear if you have the following symptoms:

• Knee pain
• Stiffness and swelling
• “Catching” or locking of the knee
• Feeling like your knee is giving out
• Limited range of motion

Treatment for a torn meniscus depends on a wide range of factors such as your age, symptoms and activity level. Your treatment will also vary by where the tear is located within the meniscus. Nonsurgical treatment typically begins with rest, ice, compression and elevation (RICE). Additionally, anti-inflammatory medications or injections may be recommended.

If surgery is recommended, the OrthoNebraska’s team will work with you and your primary physician to develop a treatment plan that supports your goals and activity level.

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Your rotator cuff is used during many daily activities, which makes it more susceptible to injury or wear and tear. Pain can stem from tendinitis (irritated tendons), bursitis (inflamed bursae) or impingement (acromion rubs against the tendon and bursae in your shoulder).

Shoulder impingement can affect athletes who participate in activities that involve them swinging their arms overhead such as swimming, baseball and tennis. It can also affect those whose occupation involves repetitive lifting or overhead activities like construction or painting. Lastly, shoulder impingement can be the result of a minor injury.

Symptoms likely start out as being fairly mild but can quickly escalate to any of the following:

• Pain during activity and rest
• Radiating pain from the front of the shoulder to the side of the arm
• Sudden pain with lifting and reaching
• Pain when throwing

Without treatment, these symptoms will likely worsen over time to include night pain, loss of strength and motion, difficulty with activities such as buttoning or zipping.

Nonsurgical treatments can typically provide relief from shoulder impingement:

• Anti-inflammatory medications
• Physical therapy
• Injections

If relief is not achieved through nonsurgical methods, surgery may be recommended, typically a minimally invasive shoulder scope.

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There are many different types of shoulder injuries, many of which are caused by athletic activities that require repetitive, overhead motion. However, the same can be true for any activity that involves repeated overhead movements such as washing walls and gardening.

You might have a shoulder injury if you answer “yes” to the following questions:

• Is your shoulder stiff?
• Do you have trouble moving your arm or shoulder into certain positions?
• Does your shoulder feel like it could “pop out” of the socket?
• Do you feel like you’ve lost shoulder strength during typical tasks?

Because the shoulder is comprised of bones, tendons, ligaments and muscles, the exact cause and solution to your injury should be diagnosed by an orthopedic specialist.

Treatment of your shoulder injury depends on the severity of your injury. More than likely shoulder strengthening exercises will be recommended, along with anti-inflammatory medication.

If relief is not achieved through nonsurgical methods, surgery may be recommended, typically a minimally invasive shoulder scope.

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A shoulder joint tear appears in the tissue rim that surrounds the shoulder socket. This type of injury can be the result of trauma such as falling, a direct blow or sudden pull or from repetitive shoulder movement like throwing.

You may have a shoulder joint tear if any of the following symptoms are present:

• Feeling of instability in your shoulder
• Dislocation
• Pain with overhead activities
• Sounds of catching, locking, popping or grinding
• Night pain
• Reduced range of motion
• Loss of strength

Initial treatment for a shoulder joint tear could include anti-inflammatory medication and rest followed by rehabilitation exercises. However, if your injury does not appear to heal, surgery may be recommended, typically a minimally invasive shoulder scope.  Your OrthoNebraska team will work with you to create a treatment plan that meets your individual needs.

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Sprains and strains are often caused during sports activities or daily tasks. Sprains are ligament injuries and strains are muscle or tendon injuries.

Most acute (sudden) injuries of this type can be treated using the RICE method:

• Rest
• Ice the injury site for 20 minutes at a time, several times a day
• Compression bandage
• Elevate the injury site above your heart

However, moderate sprains usually result in a pretty loose joint. While rarely requiring significant treatment, bracing or other equipment may be helpful. Severe sprains are torn ligaments, which typically require medical attention. They may be treated by home exercises or physical therapy or in the case of tears, surgery would sometimes be recommended. At OrthoNebraska, we believe in working together to arrive at a treatment plan that balances the risks and benefits.

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Overuse of a joint is often the cause of pain or inflammation. Tennis elbow is common among athletes and those who spend long periods of time making the same motion repeatedly. This condition results when forearm muscles and tendons become damaged causing pain and tenderness on the outside of the elbow. Tennis elbow is most common in your dominant hand but can affect both arms.

Those most at risk for developing tennis elbow include:

• Tennis and other racquet-based sports
• Painters
• Plumbers
• Carpenters
• Auto Workers
• Cooks/Butchers

You may be experiencing tennis elbow if you have any one or more of these symptoms:

• Pain or burning on the outside of your elbow
• Weak grip strength
• Pain at night

Nearly all patients with tennis elbow see results without needing surgery. Nonsurgical treatment could include:

• Rest
• Anti-inflammatory medications
• Physical therapy
• Brace
• Injections
• Shock wave therapy
• Sports equipment check

If surgery is needed, your OrthoNebraska team will work collaboratively with you to create the right treatment plan for your individual needs.

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Stretching for Golfer’s or Tennis Elbow

Perform only as instructed by your surgeon or other healthcare provider.

Throwing athletes typically put a lot of stress their elbows and shoulders. Over time, without a proper rest and training regimen, the ulnar collaterial ligament (UCL) can become strained or tear. It’s a common point of failure for youth and professional athletes.

This injury will lead to pain on the inside of the elbow and the inability to achieve proper throwing velocity.

Treatment for UCL tears depends on the extent of the damage. A minor tear or strain may heal with only rest and ice. From there, treatment may progress to:

• Physical therapy
• Changes to throwing mechanics
• Anti-inflammatory medications like ibuprofen
• Injections such as Platelet Rich Plasma (PRP)
• Surgery, typically a minimally invasive elbow scope

At OrthoNebraska, we believe listening and crafting a treatment plan that works for each patient and their needs is important.

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How Tommy John surgery is performed