Sports Medicine

The Carrell Clinic™ provides the most comprehensive sports medicine to include diagnosis, treatment, and rehabilitation of sports injuries. Our sports medicine program treats recreational, high school, college, and professional athletes. As a testament to the outstanding level of sports medicine provided, The Carrell Clinic™ is proud to be the official team physicians for the Dallas Cowboys, Dallas Mavericks, and the SMU Mustangs. In addition to these great sports teams, our physicians treat and return professional athletes from all different sports back to peak performance.

The Carrell Clinic™ physicians are board certified, fellowship-trained specialists in sports medicine. Our physicians take a conservative and comprehensive approach to treating sports injuries, which include diagnostics, physical therapy, pain management, and as a last resort, surgical intervention.

 

Sports Medicine Conditions

Sprains/Strains

Sprain is an injury or tear of the ligaments and strain is injury to the muscle or tendons. Sprains and strains are common in ankle, spine, knee, thigh, hip, elbow, and wrist joints.

Sprain is caused by trauma, overstretching of the joints during sports activities such as basketball and swimming. Strain is caused due to overuse of the muscles, inadequate rest during breaks while playing sports. Some sports such as gymnastics, basketball, football, hockey, and running causes the muscles and ligament tear.

The muscles injured during sports include hamstring and quadriceps muscles of the thigh, calf and knee muscles, and flexor muscles of the joints. The commonly observed symptom is pain and inflammation. In addition to these symptoms muscle spasm, muscle weakness, and cramping may be observed.

Immediately following an injury and before being evaluated by a medical doctor, you should initiate the R.I.C.E. method of treatment

  • Rest: Rest the knee as more damage could result from putting pressure on the injury.
  • Ice: Ice packs applied to the injury will help diminish swelling and pain. Ice should be applied over a towel to the affected area for 15-20 minutes four times a day for several days. Never place ice directly over the skin.
  • Compression: Wrapping the knee with an elastic bandage or compression stocking can help to minimize the swelling and support your knee.
  • Elevation: Elevating the knee above heart level will also help with swelling and pain.

Your doctor may prescribe nonsteroidal anti-inflammatory drugs to reduce the pain and inflammation. Rehabilitation program is recommended for people injured by sports which help to regain strength and allow fast recovery. Rehabilitation program includes massages and various strengthening, stability, and stretching exercises which should be carried out on a regular basis.

 

Hip Dislocation

The hip joint is a ball and socket joint. The “ball” is the head of the femur, or thigh bone, and the “socket” is the cup shaped acetabulum. The joint is surrounded by muscles, ligaments, and tendons that support and hold the bones of the joint in place. Hip dislocation occurs when the head of the femur moves out of the socket. The femoral head can dislocate either backward (posterior dislocation) or forward (anterior dislocation).

Hip dislocation can be caused by injuries from motor vehicle accidents or severe falls. The common symptoms of hip dislocation include pain, inability to move your legs and numbness along the foot or ankle. A dislocation may also be associated with a fracture in the hip, back or knee bones. When you present to the clinic with these symptoms, your doctor performs a thorough physical examination and may order imaging studies such as X-rays to confirm the diagnosis.

Treatment involves reduction, in which your doctor repositions the bones to their normal position under anesthesia. Surgery may be performed to remove fragments of bone or torn tissues that block and prevent reduction. During your recovery, you are advised to limit movement and placing weight on the injured hip with the use of crutches. Physical therapy is vital in regaining the strength and mobility in your hip joint after treatment.

 

Shoulder Dislocation

Playing more overhead sports activities and repeated use of shoulder at workplace may lead to sliding of the upper arm bone, the ball portion, from the glenoid–the socket portion of the shoulder. The dislocation might be a partial dislocation (subluxation) or a complete dislocation causing pain and shoulder joint instability. Shoulder joint often dislocates in the forward direction (anterior instability) and it may also dislocate in backward or downward direction.
Most common symptoms of shoulder dislocation are pain and shoulder joint instability. Other symptoms such as swelling, numbness and bruising may occur. At times, it may cause tear in the ligaments or tendons of the shoulder and nerve damage. Your doctor will examine your shoulder and may order an X-ray to confirm the diagnosis.

The condition is treated by a process called closed reduction which involves placing the ball of the upper arm back into the socket. Following this, the shoulder will be immobilized using a sling for several weeks. Ice may be applied over the area for 3-4 times a day. Rehabilitation exercises may be started to restore range of motion, once the pain and swelling decrease.

 

Elbow Dislocation

The elbow is a hinge joint made up of 3 bones – humerus, radius and ulna. The bones are held together by ligaments to provide stability to the joint. Muscles and tendons move the bones around each other and help in performing various activities. Elbow dislocation occurs when the bones that make up the joint are forced out of alignment.

Elbow dislocations usually occur when a person falls onto an outstretched hand. Elbow dislocations can also occur from any traumatic injury such as motor vehicle accidents. When the elbow is dislocated you may have severe pain, swelling, and lack of ability to bend your arm. Sometimes you cannot feel your hand, or may have no pulse in your wrist because arteries and nerves run along your elbow may be injured.

To diagnose elbow dislocation your doctor will examine your arm. Your doctor will check the pulses at the wrist and will evaluate the circulation to the arm. An X-ray is necessary to determine if there is a break in the bone. An arteriogram, an x-ray of your artery can be helpful to know if the artery is injured.

An elbow dislocation is a serious injury and therefore requires immediate medical attention. At home, you may apply an ice pack to the elbow to ease pain and swelling. However it is important to see your doctor for help. You can also check if the arteries and nerves are injured or remain intact. You can feel your pulse by pressing tips of your fingers at the base of your wrist. They should turn white or blanch and a pink colour should come back in 3 seconds. To check for nerves, first bend your wrist up and move your fingers apart and then touch your thumb to your little finger. You can also check for numbness all over your hand and arm. If you have problem with any of these tests you need to see your doctor right away.

You doctor will put your dislocated elbow back in place by pulling down your wrist and levering your elbow. This procedure is known as reduction. As it is a painful procedure you may be given medications to relieve your pain before the procedure. After the reduction you may have to wear a splint to immobilize your arm at the elbow. After few days you may also need to do gentle motion exercises to improve the range of motion and strength.

Elbow dislocations may be prevented if you avoid falling on outstretched arm or avoid situations that may cause falls such as walking at night or walking on slippery floors.

 

Patellar Dislocation

Patella (knee cap) is a protective bone attached to the quadriceps muscles of the thigh by quadriceps tendon. The Patella is attached to the femur bone and forms a patellofemoral joint. Patella is protected by a ligament which secures the kneecap from gliding out and is called as medial patellofemoral ligament (MPFL).

Dislocation of the patella occurs when the patella moves out of the patellofemoral groove, (called as trochlea) onto a bony head of the femur. If the knee cap partially comes out of the groove, it is called as subluxation and if the kneecap completely comes out, it is called as dislocation (luxation). Patella dislocation is commonly observed in young athletes between 15 and 20 years. It commonly affects women because of their wider pelvis which creates lateral pull on the patella.

Some of the causes for patellar dislocation include direct blow or trauma, twisting of the knee while changing the direction, muscle contraction, and congenital defects. It also occurs when the MPFL is torn. The common symptoms include pain, tenderness, swelling around the knee joint, restricted movement of the knee, numbness below the knee, and discoloration of the area where the injury has occurred.

Your doctor will examine your knee and suggests diagnostic tests such as X-ray, CT scan, and MRI scan to confirm condition and provide treatment. There are non-surgical and surgical ways of treating patellofemoral dislocation.

Non surgical or conservative treatment includes:

  • PRICE (protection, rest, ice, compression, and elevation)
  • Nonsteroidal anti-inflammatory drugs and analgesics to treat pain and swelling
  • Braces or casts which will immobilize the knee and allows the MPF ligament to heal
  • Footwear to control gait while walking or running and also decreases the pressure on the kneecap.
  • Physical therapy is recommended which helps to control pain and swelling, prevent formation of scar of soft tissue, and also helps in collagen formation. Physiotherapist will extend your knee and applies direct lateral to medial pressure to the knee which helps in relocation. It includes straightening and strengthening exercises of the hip muscles and other exercises which will improve a range of motions.

Surgical treatment is recommended for those individuals who have recurrent patella dislocation. Some of the surgical options include:

  • Lateral-release– ­It is done to loosen or release the tight lateral ligaments that pull the kneecap from its groove which increases pressure on the cartilage and causes dislocation. In this procedure, the ligaments that tightly hold the kneecap are cut using an arthroscope.
  • Medial patellofemoral ligament reconstruction – In this procedure, the torn MPF ligament is removed and reconstructed using grafting technique. Grafts are usually harvested from the hamstring tendons, located at the back of the knee and are fixed to the patella tendon using screws. The grafts are either taken from the same individuals (autograft) or from a donor (allograft). This procedure is also performed using an arthroscope.
  • Tibia tubercle realignment or transfer– Tibia tubercle is abony attachment below the patella tendon which sits on the tibia. In this procedure the tibia tubercle is moved towards the center which is then held by two screws. The screws hold the bone in place and allow faster healing and prevent the patella to slide out of the groove. This procedure is also performed using an arthroscope.

After the surgery, your doctor will suggest you to use crutches for few weeks, prescribe medications to control pain and swelling, and recommend physical therapy which will help you to return to your sports activities at the earliest.

 

Acromioclavicular joint (AC joint) dislocation

Acromioclavicular joint (AC joint) dislocation or shoulder separation is one of the most common injuries of the upper arm. It involves separation of the AC joint and injury to the ligaments that support the joint. The AC joint forms where the clavicle (collarbone) meets the shoulder blade (acromion).

Causes

It commonly occurs in athletic young patients and results from a fall directly onto the point of the shoulder. A mild shoulder separation is said to have occurred when there is AC ligament sprain that does not displace the collarbone.  In more serious injury, the AC ligament tears and the coracoclavicular (CC) ligament sprains or tears slightly causing misalignment in the collarbone. In the most severe shoulder separation injury, both the AC and CC ligaments get torn and the AC joint is completely out of its position.

Symptoms

Symptoms of a separated shoulder may include shoulder pain, bruising or swelling, and limited shoulder movement.

Diagnosis

The diagnosis of shoulder separation is made through a medical history, a physical exam, and an X-ray.

Conservative treatment options

Conservative treatment options include rest, cold packs, medications, and physical therapy.

Surgery

Surgery may be an option if pain persists or if you have a severe separation.

Anatomic reconstruction

Of late, research has been focused on improving surgical techniques used to reconstruct the severely separated AC joint. The novel reconstruction technique that has been designed to reconstruct the AC joint in an anatomic manner is known as anatomic reconstruction. Anatomic reconstruction of the AC joint ensures static and safe fixation and stable joint functions. Nevertheless, a functional reconstruction is attempted through reconstruction of the ligaments. This technique is done through an arthroscopically assisted procedure. A small open incision will be made to place the graft.

This surgery involves replacement of the torn CC ligaments by utilizing allograft tissue. The graft tissue is placed at the precise location where the ligaments have torn and fixed using bio-compatible screws. The new ligaments gradually heal and help restore the normal anatomy of the shoulder.

Postoperative rehabilitation includes use of shoulder sling for 6 weeks followed by which physical therapy exercises should be done for 3 months. This helps restore movements and improve strength. You may return to sports only after 5-6 months after surgery.

Fracture care

The word “fracture” implies to broken bone. A bone may get fractured completely or partially and it is caused commonly from trauma due to fall, motor vehicle accident or sports. Thinning of the bone due to osteoporosis in the elderly can cause the bone to break easily. Overuse injuries are common cause of stress fractures in athletes.

Fracture Healing

Our body reacts to a fracture by protecting the injured area with a blood clot and callus or fibrous tissue. Bone cells begin forming on the either side of the fracture line. These cells grow towards each other and thus close the fracture.

Medical Therapy

The objective of early fracture management is to control bleeding, prevent ischemic injury (bone death) and to remove sources of infection such as foreign bodies and dead tissues. The next step in fracture management is the reduction of the fracture and its maintenance. It is important to ensure that the involved part of the body returns to its function after fracture heals. To achieve this, maintenance of fracture reduction with immobilization technique is done by either non-operative or surgical method.

Non-operative (closed) therapy comprises of casting and traction (skin and skeletal traction).

Casting

Closed reduction is done for any fracture that is displaced, shortened, or angulated. Splints and casts made up of fiberglass or plaster of Paris material are used to immobilize the limb.

Traction

Traction method is used for the management of fractures and dislocations that cannot be treated by casting. There are two methods of traction namely, skin traction and skeletal traction.

Skin traction involves attachment of traction tapes to the skin of the limb segment below the fracture. In skeletal traction, a pin is inserted through the bone distal to the fracture. Weights will be applied to this pin, and the patient is placed in an apparatus that facilitates traction. This method is most commonly used for fractures of the thighbone.

Surgical Therapy

Open Reduction and Internal Fixation (ORIF)

This is a surgical procedure in which the fracture site is adequately exposed and reduction of fracture is done. Internal fixation is done with devices such as Kirschner’s wires, plates and screws, and intramedullary nails.

External fixation

External fixation is a procedure in which the fracture stabilization is done at a distance from the site of fracture. It helps to maintain bone length and alignment without casting.

External fixation is performed in the following conditions:

  • Open fractures with soft-tissue involvement
  • Burns and soft tissue injuries
  • Pelvic fractures
  • Comminuted and unstable fractures
  • Fractures having bony deficits
  • Limb-lengthening procedures
  • Fractures with infection or nonunion

Rehabilitation

Fractures may take several weeks to months to heal completely. You should limit your activities even after the removal of cast or brace so that the bone become solid enough to bear the stress. Rehabilitation program involves exercises and gradual increase in activity levels until the process of healing is complete.

Sports Medicine Treatment Options

Sports medicine involves diagnosing, treating and preventing injuries during sports activity and exercises. Sports injuries can result from accidents, inadequate training, improper use of protective devices, or insufficient stretching or warm-up exercises. The most common sports injuries are sprains and strains, fractures and dislocations.

Early evaluation and diagnosis of sports injuries provide better treatment outcomes and prevention of complications. Treatments utilized in sports medicine include:

  • Medication to relieve pain and inflammation
  • Rest, ice, compression and elevation (R.I.C.E) of the affected region of the body
  • Immobilization with splints, casts, braces and special shoes
  • Physical therapy: exercises and physical manipulation to strengthen muscles and joints, and improve range of motion. Physical therapy can be indicated individually or following surgical treatment.
  • Training to improve specific sports techniques
  • Surgery to correct or repair tears, lacerations, fractures and dislocations

Some of the measures that are followed to prevent sports related injuries include:

  • Follow an exercise program to strengthen the muscles
  • Gradually increase your exercise level and avoid overdoing the exercises
  • Ensure that you wear properly-fitted protective gear such as elbow guards, eye gear, facemasks, mouth guards, pads, comfortable clothes and athletic shoes before playing any sports activity to help reduce the chances of injury
  • Make sure that you follow warm up and cool down exercises before and after sports activities. Exercises will help to stretch the muscles, increase flexibility, and reduce soft tissue injuries.
  • Avoid exercising immediately after eating a large meal.
  • Maintain a healthy diet to nourish the muscles.
  • Avoid playing when you are injured or tired. Take a break for some time after playing.
  • Learn all the rules of the game you are participating in.
  • Ensure that you are physically fit to play the sport.

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