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Upper Body Injuries

Upper Body Injuries

Upper Body Injuries

Upper body injuries are common in athletes but happen in non-athletes as well.

We will consider any injury that begins above the level of the lumbar spine (low back) as an upper body injury.

Some examples of injuries that affect the upper body are muscle, tendon, ligament, cartilage, joint and bone injuries.  These injuries can be acute or chronic as well as traumatic or non-traumatic.  Acute injuries are recent injuries that have occurred within the past few days.  A chronic injury is one that has been present for a period of time.

Examples of traumatic injury would be falling off your bike or a collision with the ground while snowboarding.  An example of non-traumatic injury would be a pain that develops in your shoulder while lifting weights or a pain that develops in your neck while sitting at your desk.

Below are the most common upper body injuries that we diagnose and treat successfully at San Diego Sports Injury & Running Institute.

Cervical/Neck Injuries

  1. Cervical Disc Bulge/Swelling – Stage 1 disc injury is easily treated and can be reversed.  The most common cervical discs to bulge are C5-C6 and C6-C7.  Bulging of these discs can cause shooting/radicular pain to travel down the arm into the hand in a very specific and predictable pattern.  Other symptoms include numbness, tingling and possible weakness into the shoulder, arms or hands.  Both X-rays and MRI’s are appropriate tests to help diagnose the severity of the condition.  Disc bulges will usually respond to conservative treatment which may include manipulation, ultrasound, electrical stimulation and cervical traction.
  2. Cervical Disc Protrusion – Stage 2 disc injury is treatable conservatively and will typically not require surgery.  A disc bulge can turn into a disc protrusion if left unchecked.  .  The most common cervical discs to protrude are C5-C6 and C6-C7.  Protrusion of these discs can cause shooting/radicular pain to travel down the arm into the hand in a very specific and predictable pattern.  Other symptoms include numbness, tingling and possible weakness into the shoulder, arms or hands.  Both X-rays and MRI’s are appropriate tests to help diagnose the severity of the condition.  Disc protrusions will usually respond to conservative treatment which may include manipulation, ultrasound, electrical stimulation and cervical traction.
  3. Cervical Disc Herniation – Stage 3 disc injury that is treatable with conservative methods but may require extended treatment.  A disc protrusion can turn into a disc herniation if allowed to progress.  .  The most common cervical discs to herniate are C5-C6 and C6-C7.  Herniation of these discs can cause shooting/radicular pain to travel down the arm into the hand in a very specific and predictable pattern.  Other symptoms include numbness, tingling and possible weakness into the shoulder, arms or hands.  Both X-rays and MRI’s are appropriate tests to help diagnose the severity of the condition.  Disc herniations will usually respond to conservative treatment which may include manipulation, ultrasound, electrical stimulation and cervical traction.  If symptoms related to a cervical disc herniation do not resolve within a reasonable amount of time a surgical consultation is recommended.
  4. Cervical Disc Extrusion – A cervical disc extrusion typically will require surgery to correct.  Cervical disc herniations can progress to a disc extrusion if allowed to go unchecked.  The most common discs to extrude are C5-C6 and C6-C7.  Extrusion of these discs cause shooting pain down the arm into the hand in a very specific and predictable pattern.  X-rays and MRI’s are both appropriate tests in the case of cervical spinal stenosis.
  5. Cervical Stenosis – Stenosis simply means narrowing, in this case it is either narrowing of the small holes (Intervertebral Foramen or IVF) where the nerves exit on either side of your spinal cord to travel down your arm or narrowing of the spinal canal itself.  Narrowing of an IVF will result in symptoms on the narrowed side and result in irritation of the nerve as it travels through your neck and down your arm.  Narrowing of the spinal canal will usually result in symptoms on both sides (bilateral).  Symptoms can include pain in the neck, shoulders, arms or hands or legs.  Balance and coordination issues and in severe cases loss of bladder control.  X-rays and MRI’s are both appropriate tests in the case of cervical spinal stenosis.  Other symptoms include numbness, tingling and possible weakness into the shoulder, arms, hands or legs.  Cervical Stenosis will usually respond to conservative treatment which may include manipulation, ultrasound, electrical stimulation and cervical traction.
  6. Cervical Sprains – A sprain is defined as an injured ligament.  You can injure your cervical spine ligaments during a flexion-extension (whiplash) type of trauma.  This can happen with any impact directly to your body that causes your head to “snap” back and forth.  With enough force ligaments in the neck can be torn resulting in the diagnosis of a cervical sprain.  It is also possible to have “double-crush” syndrome.  This would occur if a patient was to have a sprain accompanied by a cervical disc bulge.  This is actually quite common and can result in much confusion to the patient as well as the doctor due to the patient’s multiple and confusing set of symptoms. Symptoms can include pain in the neck, shoulders, arms and headaches.   Cervical sprains (whiplash) will usually respond to conservative treatment which may include manipulation, ultrasound, electrical stimulation and strengthening.
  7. Cervical Muscle Strains – A Strain is defined as a torn muscle.  You can injure your cervical spine muscles during a flexion-extension (whiplash) type of trauma.  This can happen with any impact directly to your body that causes your head to “snap” back and forth.  With enough force ligaments in the neck can be torn resulting in the diagnosis of a cervical sprain.  It is also possible to have “double-crush” syndrome.  This would occur if a patient was to have a sprain accompanied by a cervical disc bulge.  This is actually quite common and can result in much confusion to the patient as well as the doctor due to the patient’s multiple and confusing set of symptoms. Symptoms can include pain in the neck, shoulders, arms and headaches.   Cervical sprains (whiplash) will usually respond to conservative treatment which may include manipulation, ultrasound, electrical stimulation and strengthening.
  8. Whiplash – Whiplash is an injury that affects your neck following an event that causes your head to snap back and forth.  The violent, rapid motion will cause your neck muscles to contract in an effort to stop the motion of your head.  This can lead to muscular strain and ligament sprain in your cervical spine.  Symptoms can include pain in the neck, shoulders, arms and headaches.   Cervical sprains (whiplash) will usually respond to conservative treatment which may include manipulation, ultrasound, electrical stimulation and strengthening.
  9. Torticollis – Torticollis is also known as “wry-neck”.  This condition causes limited motion in your neck and will result in your head being turned to one side.  Symptoms include limited range of motion and cervical pain.  Torticollis will usually respond to conservative treatment which may include manipulation, ultrasound, electrical stimulation, moist heat and stretching.
  10. Temporomandibular Joint Syndrome/TMJ – Injury directly to the jaw, whiplash like trauma, grinding your teeth, stress or arthritis are all common causes of pain in the TMJ.  Symptoms include pain in your jaw, problems opening or closing your jaw, pain during eating or yawning, clicking, popping or catching of the jaw and pain or swelling in the side of your face.  This condition is often confused with dental conditions so an accurate diagnosis is primary.  Secondly, it is important to know why you are having TMJ pain.  If you are grinding your teeth at night then a night splint is appropriate.  Pain in the TMJ due to mechanical or structural reasons will normally respond well to conservative treatment such as manipulation, ultrasound, moist heat and stretching.
  11. Cervical Arthritis/Osteoarthritis/Degenerative Joint Disease/Cervical Spondylosis – All of these are pseudonyms for degenerations of the cervical bones, discs and joints.  Neck stiffness, pain, headaches and joint “crackling” when moving are all common symptoms of cervical arthritis.  Cervical arthritis is common in patients over 50 (common and normal ARE NOT the same) and may be responsible for their symptoms but it is paramount to ensure a proper diagnosis as many times arthritis is present but IS NOT responsible for their symptoms.  Cervical arthritis will normally respond well to conservative treatment such as manipulation, ultrasound, moist heat and stretching.

 

Shoulder Injuries

  1. Impingement Syndrome – A condition that affects the shoulder and causes pain during overhead movements, reaching behind your back or lifting something with the involved side. Specifically the rotator cuff tendon(s), most commonly the Supraspinatus and/or the subacromial bursa are what is getting pinched and damaged.  If it is allowed to be pinched long enough it can result in a significant rotator cuff tear.  In my opinion it is irresponsible for a physician to prescribe anti-inflammatory drugs to a patient with this condition without fully understanding WHY the person has developed the condition.  It is imperative that the cause of impingement be removed in order for it to resolve.  At San Diego Sports and Running Institute we specialize in accurate diagnosis as well as identifying causes then providing modifications to the activity which allows you body to heal.  Slightly torn tendons can also respond favorably to conservative treatment such as manipulation, ultrasound, electrical stimulation, Kinesiotaping moist heat and strengthening.
  2. Rotator Cuff Syndrome – The rotator cuff is a group of four muscles commonly remembered by medical students at the SITS muscles. That stands for Supraspinatus, Infraspinatus, Teres Minor and Subscapularis.  The most common condition to affect the rotator cuff is impingement of the Supraspinatus tendon.  Repetitive, long term pinching of the Supraspinatus will lead to a tear.  The second most common rotator cuff tendon to be pinched and possibly torn is the infraspinatus.  The pain is usually felt in the front and/or side of the shoulder and pain will increase with overhead movements.  It is imperative that the cause of impingement be removed in order for it to resolve.  At San Diego Sports and Running Institute we specialize in accurate diagnosis as well as identifying causes then providing modifications to the activity which allows you body to heal.  Slightly torn tendons can also respond favorably to conservative treatment such as manipulation, ultrasound, electrical stimulation, Kinesiotaping moist heat and strengthening.
  3. Swimmers Shoulder – Is another name for impingement syndrome. Because swimmers do repetitive, overhead movements they can develop impingement syndrome.  This is also true of weightlifters.  In fact, any sport or activity that requires repetitive, overhead type movements will place a person at risk for developing impingement syndrome.  .  The pain is usually felt in the front and/or side of the shoulder and pain will increase with overhead movements.  It is imperative that the cause of impingement be removed in order for it to resolve.  At San Diego Sports and Running Institute we specialize in accurate diagnosis as well as identifying causes then providing modifications to the activity which allows you body to heal.  Slightly torn tendons can also respond favorably to conservative treatment such as manipulation, ultrasound, electrical stimulation, Kinesiotaping moist heat and strengthening.
  4. Instability – Instability of the shoulder is due to loose or torn ligaments that can no longer hold the shoulder in correct alignment. The pain associated with shoulder or glenohumeral instability is neck pain, upper back pain and shoulder pain.  The person may also have noticeable “clunking and popping” and in severe cases numbness and weakness down their arm.  Shoulder instability can lead to and cause shoulder impingement syndrome.  At San Diego Sports and Running Institute we address the instability by stabilizing it.  We do this through a unique but common sense approach using waterproof athletic tape to tape your shoulder and provide support.  The most important thing about taping is that it helps hold the joint in place so that when you are performing the strengthening exercises you are having less pain and better form.
  5. Chronic Dislocation Syndrome – If the person had ever suffered a dislocated shoulder chances are that they tore some ligaments that provide structural support to the shoulder. Without them your body can not maintain alignment and your shoulder will either dislocate or subluxate out of joint.  Besides causing pain in the shoulder it can also cause pain, numbness and weakness in the shoulder and arm.  San Diego Sports and Running Institute we first move the shoulder back into alignment (relocate) and then we use waterproof sports tape (Kinesiotape or Rocktape) to tape the shoulder and provide the necessary support so that it will not dislocate again.  There are also strengthening exercises that can be helpful in reducing future dislocation occurrences.
  6. Shoulder Subluxation – Is a partial dislocation of your Glenohumeral joint. Symptoms may include pain in the shoulder, numbness, weakness and/or pain in the arm.  At San Diego Running Institute we can relocate your shoulder into proper alignment and then stabilize it by using waterproof, athletic tape (Rocktape of Kinesiotape).  We will also instruct you on proper strengthening exercises to help prevent future occurrences.
  7. Acromioclavicular Joint Syndrome – The acromioclavicular joint (ac joint) is the area where the rotator cuff passes and is commonly pinched. What is not commonly known is that there are 3 variations of acromion processes.  Type 1 acromion is flat and poses the least risk to the rotator cuff tendons.  A type 2 acromion is hooked and poses a high risk to the rotator cuff tendons as they pass beneath the ac joint.  A type 3 acromion is severely hooked and poses a significant threat to the rotator cuff tendon as it passes beneath it.  A type 2 and type 3 acromion are common variables in impingement syndrome and can only be diagnosed with X-rays or MRI.
  8. Frozen Shoulder – Results in stiffness, pain and lack of motion in your glenohumeral joint (shoulder). This painful and limiting condition can result from any shoulder condition that becomes chronic.  Scar tissue develops causing extreme pain and severe decrease in the ability to move the joint.  Sadly most frozen shoulder cases could be avoided if the reason for it was remedied.  It is curious to us why so many people go to physical therapy with a frozen shoulder only to get worse.  The reason for this is due to fact that while at physical therapy their shoulder is often being traumatized leaving the min more pain than when they got there!  At San Diego Sports and Running Institute great care is taken to not worsen the patients shoulder in the process of trying to help…imagine that!  Over the years we have developed a highly specialized treatment protocol that will speed up the healing and get your shoulder back to normal.
  9. Adhesive Capsulitis – Is another name for frozen shoulder. All cases of Adhesive Capsulitis should be treated the same as Frozen Shoulder.  San Diego Sports and Running Institute has been rehabilitating Adhesive Capsulitis/Frozen Shoulder conditions without drugs or surgery for 15 years.  Our approach is fast and gentle and will help restore your shoulder to normal.
  10. Subacromial Bursitis – A bursa is a fluid filled sac found between bone and tendon. The bursa’s job is to help prevent friction between the tendon and the bone.  With repetitive motions or impacts the bursa can become swollen and inflamed.  Pain is felt in the front and outside (lateral) portion of the shoulder.  Pain will typically increase if trying to sleep on that shoulder or trying to lift something with that involved arm.  San Diego Sports and Running Institute has developed a protocol that is both quick and effective in relieving pain associated with shoulder bursitis.
  11. Subdeltoid Bursitis – Is the same as subacromial bursitis. Pain will be felt if trying to lift something overhead, lying on that side, trying to support your body weight with that side, throwing with the bad side and various other movements such as trying to touch your back.  This painful condition can lead to frozen shoulder/adhesive Capsulitis if not addressed quickly and effectively.  San Diego Sports and Running Institute will diagnose your condition accurately and provide simple, safe and effective solutions to help you eliminate your shoulder bursitis.
  12. Bicipital Tendonitis – Inflammation to the long head of the Biceps tendon where it is located in the upper arm is a common condition that is usually secondary to other shoulder conditions such as impingement, arthritis and instability. The pain is felt in the upper arm near the front of the shoulder and is made worse with repetitive overhead activities or lifting. This painful and limiting condition can lead to frozen shoulder if not addressed properly.  San Diego Sports and Running Institute addresses the problem in a multi-pronged approach.  We identify what is causing your bicipital tendonitis and help you remove the cause or modify it.  Second we use healing modalities that you might find in a professional sports teams locker room to help heal the damaged tendon.  These modalities include ultrasound, electrical stimulation, Myofascial release and therapeutic sports taping for support.  Last we teach the patient corrective muscle strengthening and balancing exercises to strengthen the injured area and prevent future recurrences.
  13. Bicep tendon Subluxation – The Bicep tendon can partially dislocate in the upper arm as it pass underneath the transverse ligament. Patients will often report hearing a cracking noise followed by pain in the front (anterior) portion of the shoulder that may be accompanied by numbness into the arm and hand and weakness of the shoulder muscles. Range of motion will also be decreased as patients will usually not be able to reach behind their back without significant discomfort and lack of motion compared to the non-symptomatic side.  This condition cannot be seen on X-ray and is often missed by MRI.  Proper orthopedic/provocative testing can differentiate bicep tendon Subluxation from similarly presenting shoulder conditions such as rotator cuff syndrome.  Once an accurate diagnosis is made the bicep tendon can be reduced/relocated with a very specific technique which will then allow the injury to begin to heal.  Following relocation of the tendon proper rehabilitation must be done to strengthen the surrounding muscles and repair the transverse ligament.

 

Elbow Injuries

  1. Medial Epicondylitis – Also known as “Golfer’s Elbow” medial epicondylitis results in pain and inflammation on the inner side of the persons elbow. Long term pain and inflammation will lead to medial epicondyle tendonosis and is considered a chronic condition.  This condition is common is sports that require gripping like golf and weight lifting as well as throwing sports such as baseball.  It is important to differentiate this injury from a pinched nerve in the neck, “little league elbow” and Ulnar collateral ligament and/or Ulnar nerve injury.  Medial Epicondylitis is easily treated most of the time with conservative therapy.  At San Diego Sports and Running Institute we utilize therapeutic ultrasound, electrical stimulation, Myofascial release, Kinesiotaping and bracing in addition to stretching and strengthening exercises to help you repair this injury and return to sport.
  2. Lateral Epicondylitis – Also known as “Tennis Elbow” lateral epicondylitis results in pain and inflammation on the outside/lateral side of the elbow. Long term pain and inflammation can lead to a condition called lateral epicondyle tendonosis.  This condition is common in sports that require gripping such as tennis or from jobs that require repetitive movement while gripping such as painting, plumbing or contracting.  Once an accurate diagnosis is made it is extremely important to examine what is actually causing this condition because often the activity can me changed or modified allowing the condition to improve instantly.  When therapy is needed San Diego Sports and Running Institute we utilize therapeutic ultrasound, electrical stimulation, Myofascial release, Kinesiotaping and bracing in addition to stretching and strengthening exercises to help you repair this injury and return to sport.
  3. Bicep Insertion Bursitis/Tendonitis – Inflammation of the long head of the biceps tendon is a common condition that causes pain in the front/anterior portion of the shoulder. Repetitive overhead motions can cause micro tearing of the tendon overtime as well as certain sports such as weight lifting or swimming.  Biceps tendonitis is often misdiagnosed with the patient actually having shoulder impingement syndrome and shoulder instability.  Other conditions to rule out would be a labrum tear or rotator cuff tear.  While X-rays only show the bone architecture MRI will show the cartilage, ligaments, muscles, tendons and bone.  An MRI may be necessary to find out the true underlying cause.  When therapy is needed San Diego Sports and Running Institute we utilize therapeutic ultrasound, electrical stimulation, Myofascial release, Kinesiotaping and bracing in addition to stretching and strengthening exercises to help you repair this injury and return to sport.
  4. Tricep Tendonitis – Inflammation of the Triceps tendon can occur due to repetitive pushing activity such as in push-ups. While the condition is not that common it does occur commonly in weight lifters.  I have personally diagnosed Tricep tears that were misdiagnosed as Triceps tendonitis in two different weight lifters.  Pain for a Tricep tear of inflammation will cause pain in the back of the elbow and possible weakness.  A tear will definitely result in weakness if trying to extend the elbow against resistance.  When therapy is needed San Diego Sports and Running Institute we utilize therapeutic ultrasound, electrical stimulation, Myofascial release, Kinesiotaping and bracing in addition to stretching and strengthening exercises to help you repair this injury and return to sport.
  5. Olecranon Bursitis – Results in pain and swelling behind the elbow and is usually due to blunt force trauma to the elbow such as landing on it during a fall. This condition typically requires the bursa to be drained at least once, sometimes twice.  When the fluid is drained it should be checked to rule out infection.
  6. Ulnar Subluxation – A luxation is a complete dislocation while a Subluxation is a partial dislocation. It is common for the elbow joints to subluxate.  When the joint angle is changed due to Subluxation secondary conditions can occur such as medial Epicondylitis and lateral Epicondylitis.  At the San Diego Sports and Running Institute we are highly skilled in reducing subluxations at the elbow and then taping the area for stability.  If the Subluxation becomes a chronic problem instead of a onetime event we will teach you elbow stabilization exercises to prevent future recurrences.
  7. Radial Subluxation – Radius subluxations are common and can result in pain, sticking and catching on the outside of the elbow. This condition commonly occurs if someone is suffering from lateral epicondylitis and can complicate the condition.  It is important to differentiate this condition from a problem with the Tricep tendon and to reduce the radial subluxation as quickly as possible.  At the San Diego Sports and Running Institute we can quickly and safely reduce you Radius subluxation and if necessary provide stability taping to prevent it from subluxating again. If the subluxation is chronic specific strengthening exercises will be necessary in order to prevent future problems.

Wrist Injuries

  1. Wrist Sprain – You have 8 little bones that make up your wrist. The most common two bones/joints to sprain are the Scaphoid and Lunate.  These bones/joints can sprain during falling on an outstretched hand or being in a prolonged position that stresses them such as the Yoga pose known as “Crow Pose”.  A sprain by definition is a slightly or severely torn ligament.  The ligaments job is to hold bones together at the joint.  If the ligament is compromised the joint will become unstable and will hurt during particular movements.  It is very important to differentiate a sprain from a broken bone and this can easily be done with a simple X-ray.  Once a fracture is ruled out the sprained joint should be immobilized for a period of time to ensure proper healing.  Sports medicine techniques such as therapeutic ultrasound and Kinesiotaping are used commonly by San Diego Sports and Running Institute to help ensure proper healing and reduce pain.  It is common for the wrist bones to subluxate with a wrist sprain.  For this reason we will also check the wrist alignment and reduce any wrist subluxations that accompany the sprain.
  2. Wrist Strain
  3. Wrist Subluxation
  4. Carpal Tunnel Syndrome
  5. Scaphoid Syndrome/Kienbock’s Disease/Avascular necrosis
  6. Ganglion Cyst
  7. Wrist Arthritis
  8. De Quervains Tenosynovitis

 

Hand Injuries

  1. Trigger Finger
  2. Tendonitis
  3. Arthritis