Aruba Sports Medicine

Shoulder Dislocation. Bankart and Hill Sachs lesions

The shoulder is the most complex and mobile joint in the human body. As a result, it can suffer from a variety of problems. Many of the ailments are caused by inflammation or tearing of the tendon, as well as problems in the rotator cuff or the bone system.

Among the most frequent injuries we can highlight rotator cuff tear, dislocation, frozen shoulder, bursitis, tendonitis and fractures.

Today we want to focus on two of the most common shoulder injuries, especially in sports: the Bankart injury and the Hill Sachs injury.

Bankart lesion involves the rupture of the glenoid labrum which is a fibrous capsule that is located where the head of the humerus sits. It surrounds the base of the shoulder joint and is responsible for giving it greater stability. This usually results from an anterior dislocation of the shoulder, in other words, when the shoulder moves forward, usually due to trauma, the head of the humerus takes the labrum with it, it tears it off.

 

Hill Sachs injury Hill Sachs fracture is a depression of the posterolateral part of the head of the humerus. It is caused by the impaction of the head of the humerus against the glenoid rim. anteroinferior following a traumatic event that causes a dislocation of the shoulder. During shoulder dislocation, the head of the humerus is crushed against the glenoid, depressed, and deformed.

 

Symptoms

Patients suffering from Bankart and Hill Sachs lesions experience acute pain and a feeling of shoulder instability. If the lesion is small it may not cause any symptoms, but we will generally find the following symptoms:

  • Persistent shoulder pain.
  • Instability.
  • The patient describes how he feels that “his shoulder is coming out.”
  • After the first dislocation, it is common for further episodes of shoulder dislocation to occur.

Treatment

Conservative treatment includes anti-inflammatory drugs, rest, cold application and physical therapy. If this is not sufficient, surgery will be necessary. The patient usually wears a sling for the first week, although it may be necessary for longer.

In most cases, physiotherapy is recommended to help with pain and postoperative sequelae. Physiotherapy treatment will be based on:

  • Mobilization of the glenohumeral and scapulothoracic joints mainly in all their ranges of motion.
  • Myofascial Treatment.
  • Therapeutic massage.
  • Analgesic and anti-inflammatory treatment through physical agents such as:
  • Shortwave
  • Ultrasounds
  • Laser
  • Analgesic Currents
  • Exercise to strengthen the rotator cuff, all the stabilizing muscles of the shoulder and the scapula.
  • Scapular control and stabilization exercise.
  • Stretching of the shoulder and upper limb muscles.
  • Proprioception exercise and conditioning for normal activity.

Utility of Musculoskeletal Ultrasound in Sports Medicine

Nowadays, musculoskeletal ultrasound has become a necessary and very useful tool for the diagnosis and prognosis of sports injuries, its use is increasingly established in the world of sports and has multiple advantages over other modalities.

It is fast, cheap and, in addition, it allows interaction with the patient, which has led to an exponential growth in their employment.

Therefore, in the field of Sports Medicine and Traumatology, in the event of an injury it is necessary to reach an exact diagnosis in the shortest possible time, to be able to establish an immediate treatment, which allows to shorten the recovery. This is where ultrasound is a basic tool for the study of all injuries, which limit the athlete’s performance so much. In addition, ultrasound allows a rigorous and detailed evolutionary control to be carried out, assessing the day-to-day of the injury.

Among the many advantages that this diagnostic technique provides over other study techniques, especially in the assessment of tissues such as muscle, ligament and tendon, the following should be noted:

– It allows dynamic studies to be carried out, which accurately determine the diagnosis of small lesions, which may go unnoticed, when the structures remain at rest. In the case of complex joint unions such as the scapulo-humeral joint, from dynamic maneuvers, the existence of entrapment syndromes can be demonstrated.

– It allows the carrying out of repeated studies that facilitate an evolutionary control in the day-to-day of the injured athlete. As there are no contraindications, this rapid technique allows a comparative examination with the healthy side to determine the extent and characteristics of the lesion area.

– At present, the use of compact equipment facilitates the use of this technique in the field, thanks to the ease of application, safety, its non-radiant character and its accessibility.

– New technological advances such as three-dimensional study, elastography, high-resolution Doppler or Doppler quantification, are making it possible to complete the examination of the musculoskeletal lesion so that small lesions are now easily diagnosed.

On the other hand, some drawbacks of ultrasound must be considered in comparison with other diagnostic techniques, such as the limited independence of the explorer, interobservative variability, poor visualization of the bone, and intra-articular structures as well as that of certain muscles.

Ecografía - Ángel Troncoso Fisioterapia Ecografía musculoesquelética: ¿es una herramienta válida en el razonamiento clínico en fisioterapia?

Usefulness of Ultrasound in injuries that appear as a result of sports activity :

  • Epicondylitis or “tennis elbow”
  • Epitrocleitis or “golfer’s elbow”
  • Painful shoulder from rotator cuff tendon injuries, bursitis, etc.
  • Biceps brachii tendinitis
  • Wrist sprain
  • Finger tendonitis
  • Painful hip from injury to the adductors or pubalgia
  • Bruising on the thigh from contusions or ruptured rectum
  • Hamstring muscle rupture with posterior thigh pain
  • Knee sprain with involvement of lateral ligaments
  • Quadriceps or patellar tendinopathy (“jumper’s knee”)
  • “Goose foot” tendinopathy (pain on the inside of the knee)
  • Tennis leg
  • Ankle sprains or strains
  • Achilles tendon tendinopathies
  • Plantar fasciitis or pain in the sole of the foot
  • Tears or strains of the rectus abdominis

 

Laser Therapy

What are the effects of using lasers?

The use of laser in physiotherapy, if it has these characteristics, increases metabolic activity by acting on the mitochondria, which can reduce healing times. In addition, it produces an increase in vasodilation, improves lymphatic drainage, reduces inflammation and increases the pain threshold. Photomechanical stimulation inhibits pain sensation and provides immediate relief.

Toral points out that laser therapy “has no absolute contraindications.” Laser therapy is painless, and although it increases the temperature of the treated area, it is not invasive. The laser acts on the cell membrane generating a photochemical effect, which facilitates tissue regeneration, pain reduction and remodeling of inflammatory effects.

All these characteristics allow to obtain a series of effects that were not achieved with the low-power laser.

  • The biostimulant effect accelerates the production of fibroblasts with the consequent production of collagen in order to rebalance the extracellular matrix and to remodel the tissues. This is only achieved by long pulse continuous or pulsed emission.
  • The anti-inflammatory effect is the result of biological stimulation of the tissues, which triggers vasodilation.
  • Stimulation also produces a neoangiogenesis phenomenon that has an anti- edema effect .
  • High-powered laser therapy also has relaxation effects by modulating the release of oxygen.
  • Finally, the analgesic effect allows to reduce pain without collateral effects, optimizing the interaction with the peripheral nervous system.

 

What can laser be used for in physiotherapy?

With these functionalities, the laser covers a wide spectrum of applications.

  • In traumatology it is used for post-trauma recovery , because it allows the possibility of modeling the emission according to the desired physiological effect.
  • In pain therapy, because it is capable of generating a rapid decrease in joint and muscle pain through the stochastic emission patented by Mectronic, which acts on the peripheral nervous system.
  • In the prevention of accidents, because if they undergo laser therapy treatments before the sporting event, the musculoskeletal structures will be vascularized and perfectly oxygenated, reducing the risk of micro-injuries.
  • To speed up recovery , because the multi-modal emission allows the therapy to be personalized according to the need.
  • To quickly eliminate edema, because it allows you to customize the therapy according to the somatic characteristics of the patient and their pathological state.
  • To heal muscle injuries, because it allows the metabolic activation of all microbiological processes that return the intracellular and extracellular balance to the cell, in order to rapidly rebuild muscle tissue.
  • To treat acute pathologies, because it modulates, in the water phase of the pathology, the inflammatory effects through a stimulating action of the deep tissues.
  • To treat tendinopathies, because it exerts a biostimulant action and rebalances the correct balance of muscle forces through deep and complete oxygenation of the muscle fasciae.
  • As a physiological accelerator , because it allows the correct biostimulant therapy to be applied by defining the energy dose and the mode of emission depending on the pathological condition of the patient.

Most common applications

  • Deep tissue penetration with power up to 12 W in continuous mode
  • Pulsating mode for immediate pain relief
  • Painful shoulder
  • Hip arthrosis
  • Epicondylitis
  • Carpal tunnel syndrome
  • Patellar tendonitis
  • Lumbar pain
  • Achilles tendonitis
  • Back pain

 

Core Concept and Assessment Training

The core is based on a set of clinical biomechanical osteoarticular muscle groups, especially the central part of the body, including dorsal lumbar rachis, pelvis, and hips, which allows us stability in the spine coordinated by the motor control system; when it is subjected to external and internal forces for its training it is of useful importance since the trunk and the extremities participate

The assessment of the Core applies different kinematic and dynamometric techniques, it is important to highlight that its operation depends on maximum strength, resistance strength, intra and intermuscular coordination, motor control, and proprioceptive control.

The objective is to prevent lumbopelvic injuries, optimization of performance in order to improve the stability of the athlete with precision and agility, the ideal is to perform exercises that exercise the flexors, extensors, lateralizers and rotators, the most effective safe are sample dog, bug Dead and planks, taking into account the frequency, intensity and equal volume through the iliolumbar proprioceptive exercise program and waist dissociation, the upper and lower limbs are necessary for coordination of the Core stability of the same in the sports field.

Pointer Dead bugIron

Bibliography

Borghuis, J; Hof, A and Lemmink, K. (2008) The importance of sensory motor control in provide stability core stability. Sports medicine, 38, 11, 893-916.

McGill SM (2007) Low back disorders: evidence-based prevention and rehabilitation, 2nd.ed. champaing: Human Kinetic.

Van Dieen, JH; Luger, T and Van der Eb, J. (2012) Effects of fatigue on trunk stability in elite gymnasts. Eur J Appl Physiol. 112 (4): 1307–13 .:

Vera-García, FJ; Elvira, JL; Brown, SH and McGill, SM. (2007) Effects of abdominal stabilization maneuvers on the control of spine motion and stability against sudden trunk perturbations. J Electromyogr Kinesiol. 17 (5): 556–67

Vera-García, FJ; Barbado, D; Moreno-Pérez, V; Hernández-Sánchez, S; Juan-Recio, C and Elvira, JLL. (2015) Core stability: Evaluation and training criteria. Rev Andal Med Sport, 8 (2): 79-85.

Seven Myth about Physical Therapy is only for accidents and injuries

Physical therapists are specialists in the movement who assist people in reducing pain, improving or restoring mobility, and remaining active throughout life. However, there are a few myths that frequently discourage patients from seeking treatment. It’s time to dispel 7 common myths about physical therapy:

Read More

Carpal Tunnel Syndrome: Therapy is effective

What you might be experiencing

Classically, Carpal Tunnel Syndrome (CTS) is characterized by needles or pins, numbness burning, or pain in the thumb and index fingers. The swelling, the difficulty in distinguishing between temperatures that are hot and cold, and a decrease in coordination can all be symptoms. Patients with this disorder often wake up at night with serious symptoms. They may be required to hold their hands in order to relieve themselves.

Read More

Physical Therapy can provide Relief for Lower Back Pain

What type of work is most appropriate depends on the cause

If you’re suffering from low back pain that lasts longer than a few weeks Your doctor may recommend you to a physical therapist. While simple methods like applying heat or cold or using pain relief pills available over the counter might help, the best treatment for back pain is to exercise and other treatments under the direction of physical therapy.

“First and foremost, we attempt to figure out the kind of back pain we’re experiencing,”  Are you dealing with chronic or acute pain, and what’s the root of the problem? “We perform tests to determine the type of treatment that will perform best,”.

Read More