SPORTS INJURIES: CHALLENGES AS ATHLETES AGE

1. SPORTS INJURIES:CHALLENGES AS ATHLETES AGE Amy B. Harris, MSN, RN, OCNS-C Nurse Coordinator CNHS Washington, D.C. aharris@childrensnational.org

2. CONFLICT OF INTEREST I hereby certify that, to the best of my knowledge, no aspect of my current personal or professional situation might reasonably be expected to affect significantly my views on the subject on which I am presenting.

3. OBJECTIVES Discuss the various overuse conditions common in aging athletes Evaluate common sports injuries and recommended treatment options appropriate for the mature athlete Develop a treatment plan for the mature athlete which focuses on enhancing function and reducing pain

4. OUR AGING POPULACE U.S Census Bureau, Population Estimates and Projections; from www.silverbook.org

5. OUR AGING NATION • 10,000 Americans celebrate their 65th birthday every day • LONGEVITY REVOLUTION • Our aging nation is triggering a SILVER TSUNAMI OF CHRONIC AGE-RELATED DISEASES RESULT: Increased national health care spending, high rates of morbidity and mortality, and decline in quality of life www.cdc.gov/nchs/data

7. SPORTS INJURIES – Challenges as Athletes Age

8. Stuart H. Walker, MD – Sailing Hall of Famer Soling Skipper Won the Ice Bowl on 1/1/16 at age 92

9. The Aging Athlete • Musculoskeletal Aging • Due to: • Diminished flexibility • Reduced endurance • Decreased blood supply to musculoskeletal structures • Osteopenia • Osteoarthritis • Hormonal changes • Multiple other factors Mature athletes are more susceptible to injury

10. FITNESS ASSESSMENT • Functional Fitness Test (previously called the Senior Fitness Test) • A simple, easy-to-use battery of test items uses to assess the functional fitness of older adults • Safe and enjoyable • Meets scientific standards for reliability and validity • Has accompanying performance scores of over 7,000 men and women between the ages of 60 and 94

11. FITNESS ASSESSMENT • Functional Fitness Tests (FFT’s) • Chair Stand – Measures lower body strength Equipment: Chair without arms, Stopwatch 2. Arm Curl – Measures upper body strength Equipment: 5 lb weight, 8 lb weight, stopwatch, straight-back chair with no arms • Two Minute Step Test – Measures endurance Equipment: Stop Watch, Measuring tape, Blue painter’s tape • Chair Sit and Reach – Measures lower body flexibility (hamstrings) Equipment: Chair and Ruler • Up and Go – Measures speed, agility, and balance Equipment: Chair, Cone, Stopwatch • Back Scratch Test – Measures flexibility in the upper body Equipment: Ruler

12. Tao Porchon-Lynch DOB 8/13/18 97 y/o Former Model, and Dance Instructor Continues to Teach Yoga

13. EXERCISE IS MEDICINE • EXERCISE: • Enhances- • Muscle mass • Tendon and ligament strength • Bone health • Reverses many of the physiological consequences of aging • Promotes coping and time management • Provides a social support structure

14. Types of Athletic Injuries • Overuse or Chronic Injury • Bursitis • Tendonitis • Stress Fracture Acute Traumatic Injuries • Lacerations • Abrasions • Sprains / Strains • Ligamentous injuries • Cartilage tears • Dislocations / Subluxations • Fractures

15. Head and Facial Injury • Blunt/Penetrating Eye Injury • Lacerations • Fractures • Concussions • Spinal Cord Injury FOCUS ON PREVENTION!

17. Sports Injuriesof theUpper Extremity

18. Shoulder InjuriesImpingement Syndrome  Rotator Cuff Injury • Mechanism of injury – multiple factors • Overuse syndrome Clinical Presentation • Pain over the lateral and anterior shoulder radiating into deltoid • Initially pain occurs with activity especially overhead motions – progressing to pain at rest • Decreased and painful range of motion • May feel shoulder catch

19. Shoulder Anatomy

20. Shoulder Injuries • Rotator Cuff Musculature • Four Distinct Muscles • Supraspinatus Muscle Is the First Damaged

22. Impingement sign • With hand on unaffected shoulder, forward flex the arm • Positive impingement sign if pain occurs at 90 degrees of forward flexion

23. Hawkin’s Test Passively Abduct the shoulder to 90 degrees Flex Shoulder to 30 degrees Flex Elbow to 90 degrees Internally Rotate the Shoulder PAIN indicates a positive test Test for Supraspinatous Tendon Impingement (Subacromial Impingement)

24. Drop Arm Test • Assessment for Rotator Cuff Tear • Specifically Tear of the Supraspinatous Muscle

25. Rotator Cuff Tear

26. Shoulder Injuries Diagnostic Testing X-rays to Rule Out Fracture MRI scan to Rule Out Impingement Vs. Tendinopathy Vs. Tear

27. Conservative Treatment • Conservative Treatment • P-RICE-MM • NSAIDs • Cortisone Injections

30. Rotator Cuff Tears • Surgical Intervention • Arthroscopic Repair • Mini-Open Technique

31. Epicondylitis • Location • Medial - Golfers Elbow • Lateral – Tennis Elbow Pitchers and Swimmers Little League Pitchers Mechanism of Injury • Overuse Syndrome Differential Diagnosis • Obtain X-Rays to Rule Out: Loose Bodies Fracture Occult Injury Exostosis • Radial Nerve Entrapment • Radiocapitellar Degeneration

32. Epicondylitis • Clinical Presentation • Well Localized Pain & Swelling • Difficulty / Pain with Supination & Pronation • Conservative Treatment • P-RICE-MM • Brace

33. Lateral Epicondylitis (Tennis Elbow)

34. Platelet-Rich Plasma (PRP) • Platelets contain proteins – growth factors – which are important in the healing of injuries • PRP is plasma which an increased concentration of growth factors • PRP is prepared by drawing blood, separating the platelets, centrifugation is done and then the increased concentration of platelets is combined with the remaining blood

35. Treatment with PRP • PRP can be injected into the injured area along with a local anesthetic (in achilles tendonitis for example the heel cord can be injected) • PRP can also be used during surgery – PRP can be stitched into torn tissues • PRP has not been shown to be effective in the treatment of arthritis of the knee • PRP has also been studied in the treatment of fractures and yet no significant benefit was shown • PRP has been used successfully to treat Epicondylitis

36. Hand Injuries • Most Commonly Injured Body Site • Least Protected / Padded Area Mechanism of Injury • Direct Trauma Most Common

39. MALLET FINGER Extensor Tendon Injury at DIP Joint Extensor Lag Sudden Forced Flexion Conservative Treatment Surgical Intervention K-Wire Fixation -

40. Skier’s Thumb Ulnar Collateral Ligament (UCL tear) Possible Avulsion Fracture Symptoms: Pain, Swelling, Ecchymosis around the Thenar Eminence / MCP joint Physical Exam: Instability of the MCP joint

41. UCL injuries –Gamekeeper’s Thumb, Skier’s Thumb • Incomplete Tear / Sprain • - Conservative Treatment • P-RICE-MM • Thumb Spica Cast / Splint Complete Tear • Surgical Intervention • UCL Reconstruction • Avulsion Fracture fixation

42. CASE STUDY • 55 y/o female • Keel Boat Race – Assigned to PIT on J-105 • Upon Spinnaker take-down, Thumb and 2nd finger hyperextended ? Physical Exam X-Rays Treatment Reassessment Plan

44. Sports Injuriesof theLower Extremity

46. Knee: Normal A & P

47. ANTERIOR CRUCIATE LIGAMENT

48. The Lachman Test