Baseball Finger, also known as Mallet Finger, is a condition that occurs when one of the tendons that assist in straightening out the finger is damaged. This damage can occur from the jamming or forceful bending down of the fingertip. Symptoms include swelling and tenderness around the fingertip.

Those at Risk
Though it is called Baseball Finger, the injury can also occur while playing football and basketball as well.

Diagnosis
A Baseball Finger is diagnosed once the manner in which the injury was incurred is discussed and the last knuckle and extension of the finger are physically examined. An X-ray may also be indicated in order to determine if the finger bone was damaged during the force.

Treatment
Baseball Finger is not a serious injury and generally only requires a splint that holds the finger out straight. Occasionally surgery is required if the bone sustained serious damage.

Common in sports, finger sprains occur when the ligaments of the fingers or thumb are stretched and unusually bent - generally during a fall onto the hand. And a finger dislocation occurs when the ligaments and joint capsule surrounding the joint are actually torn and forced out of alignment.

Sprain
The bones of the finger joints are connected by joint capsules, in which the ligaments are located. When the ligament is stretched beyond its capacity, it tears or sprains. In sports, this is often referred to as a jammed finger. The classification of ligament sprains includes: Grade I, which is a 25 percent tearing of the ligament; Grade II, which is a 25 to 75 percent tearing of the ligament; and a Grade III, which is a complete tearing of the ligament.

Dislocation
When the strong force placed on the ligament does not tear the ligament, but rather pulls a small piece of bone off the finger at the end of the ligament, it is called an avulsion fracture, or a third-degree sprain - representing a complete ligamentous disruption. A dislocation is the most severe form of a third-degree sprain, because the ligament must be torn completely to dislocate the joint.

All types of sprains will prompt joint swelling, stiffness, and loss of joint motion. Bruising may also be present.

Diagnosis
Following patient history and physical examination, an X-ray will help diagnose the severity of the injury and determine the type of treatment required.

Treatment
When a finger or thumb injury occurs, there should be an immediate refrain from activity involving the injured hand while cold compression and elevation help reduce swelling. It is important to reduce swelling, as it can cause stiffness and make recovery and resumption of normal range of motion more difficult.

For minor sprains, treatment includes a brief period of immobilization and splinting in conjunction with anti-inflammatory medication and cold compression - followed by a series of range of motion rehabilitative exercises. More serious sprains involving a dislocation or fracture may require surgery in order to properly repair and realign the joint.

Also called "Skier's Thumb" and "Gamekeepers Thumb," injury to the Ulnar Collateral Ligament (UCL) of the thumb jeopardizes the strength of the ligament and its ability to secure the bones at the base of the thumb (metacarpophalangeal or MCP joint) and prevent the thumb from extending out too far away from the hand.

This type of injury is defined as an acute injury when it occurs as the result of stress placed on the ulnar collateral ligament from an extreme force (valgus force) - such as that experienced when the thumb is caught in a ski pole during a fall. In this situation the ligament undergoes an exaggerated stretch and often tears as a result.

Those at Risk
When a repetitive activity or sport eventually leads to the loosening of the ulnar collateral ligament over time, it is referred to as a chronic injury. Often times tennis players and baseball players will experience this.

Diagnosis
Those suffering from this type of injury generally experience some instability and difficulty griping things tightly. Though those with an acute tear of the UCL report pain and swelling directly over the torn ligament at the base of the thumb.

Both a physical examination and X-ray are done to confirm diagnosis and determine the extent of the injury. A valgus stress test is also performed in order to check the strength of the ligament and corresponding stability of the joint.

Treatment
Depending on the extent of the injury and other patient factors, either a thumb spica cast will be used to stabilize and encourage healing for approximately four to six weeks - followed by range of motion exercises to strengthen grip - or surgery is recommended.

Surgery is considered in the case of a complete tear (rupture) of the ligament and evidence of significant instability. It is usually done several weeks following the injury and is considered an outpatient procedure. Patients generally see results within four weeks following the surgery and regain thumb strength. Occasionally the MCP joint continues to be unstable and causes pain during pinching or grasping activities. Since chronic instability and looseness of the thumb eventually results in the development of arthritis, other procedures may be considered - including grafting in new tissue to reconstruct the ligaments, or arthrodesis in order to fuse the joint.

A scaphoid fracture is a break in the small bone in the wrist joint called the scaphoid. It is also known as the navicular bone (though this name is most commonly used today to describe a bone in the foot).

While the scaphoid is the most frequently injured carpal bone - accounting for nearly 60 percent of all wrist (carpal) fractures - it is a difficult bone to break and is therefore most often the result of a strong force as in sports (football, basketball, motorcycle racing), or an automobile accident. Twice as much force is required to break the scaphoid bone than one of the bigger forearm bones.

The scaphoid bone is shaped like a cashew and is located on the thumb side of the wrist, near the lower arm bones. Eighty percent of the surface is covered by articular cartilage, and it functions much like a ball bearing in the wrist joint. The unique thing about the scaphoid bone is its blood supply. The blood supply for a scaphoid bone enters from the top, though most fractures occur in the middle or lower portion of the bone. This creates a problem, because the blood supply cannot reach the injury in order to facilitate adequate healing. Sometimes when a scaphoid bone breaks and loses connection with its blood supply, it experiences avascular necrosis - which may cause the bone to crumble and the wrist joint to be destroyed.

Generally injury occurs when the wrist joint of an outstretched hand hyperextends. Men are much more likely to fracture this bone than a woman, because of the forceful activities in which they are often involved and weight ultimately falling or pushing against joint.

Often times those sustaining a scaphoid fracture mistake it for a simple wrist sprain, because the bone is located entirely inside the joint and these fractures rarely result in an obvious deformity - as evidenced in the fracture of a forearm, hand or finger bone. And while there may be swelling, that can subside after a few days. The diagnosis of a scaphoid fracture can be delayed for weeks and sometimes months as a result.

When a fracture occurs, pain and tenderness is experienced on the thumb side of the wrist, motion is painful, swelling may be evident on the back and thumb side of the wrist and dull ache my occur periodically. An x-ray of the wrist will detect the fracture - though not always immediately after the break. A bone scan can assist in determining diagnosis just days following the injury.

Often times injuries incurred as a result of high speed or force, such as in football, a fall at high speed or auto accident will result in a complex injury. A complex injury involves companion fractures and ligament injuries as well. A thorough examination will determine whether or not the injury is complex.

Risk Factors
Scaphoid fractures generally occur in men between the ages of 20 and 40 years. It is a common injury in traditional as well as extreme sports. It is also common in motor vehicle accidents.

Treatment
Initially ice should be applied and the limb elevated in order to reduce swelling. Most scaphoid fractures are treated with immobilization - with either a splint or short arm cast from six weeks to three months depending on the severity of the break and associated injuries. Though, casting alone does not always promote healing and in the case of some athletes may impede the rapid return to their sport by restricting the ability to strengthen the area and perform range of motion exercises.

Cast treatment works best for "incomplete" fractures, or those that do not extend across the entire bone. Nondisplaced fractures also have a good prognosis from casting.

Those scaphoid fractures that are "complete" may require a bit more than casting. In some cases either an arthroscopic or open surgical procedure is required in order to stabilize the bone with a scaphoid bone screw, Kirshner wire or other fixation device. Fractures with a severe ligament injury as well require surgery in order to stabilize the wrist and prevent the collapse of the wrist bones - which could cause deterioration and permanent stiffness of the wrist joint.

A fresh fracture (a fracture that is less than two to four weeks old) that is displaced or unstable requires surgery and the use of a fixation device for stabilization. A fracture that is not first stabilized is unlikely to heal in a cast.

Nonunions and Old Fractures
An untreated scaphoid fracture can result in severe arthritis and eventually require surgery to fuse or replace the joint. A nonunion of the bone, or a bone that has failed to heal, and old fractures, require special treatment.

Sometimes a bone graft is necessary to prompt the healing of an old scaphoid bone fracture that has never healed. A small piece of bone is taken from the iliac portion of the pelvic bone in order to stimulate healing of the old fracture. A Herbert scaphoid screw is used to stabilize the bone graft and the patient is put in a cast for approximately four weeks. Occasionally a fresh fracture will also require a bone graft when there are a number of pieces, or it is "comminuted."

Rehabilitation

Following Immobilization
If a wrist was immobilized with casting, the patient will begin a series of range of motion exercises upon the removal of the cast. These exercises are very important for limbs that have been immobilized for any length of time - as joints become stiff and muscles weakened. A thumb spic splint may be used for protection until range of motion and strength of the wrist flexors and extensors improve. Supination, pronation, and grip exercises are progressively added.

If a long-arm cast is used and flexion contractures are evident, physical therapy will be recommended and a program specific to the patient will be developed.

Following Surgery
Following surgery with internal fixation, patients are instructed to keep their wrist elevated for the first couple of days and to keep clean, dry bandages on the surgical area. Swelling is reduced with cold compressions. And analgesic medications may be prescribed to help minimize postoperative pain.

Following an arthroscopic procedure and period of immobilization, range of motion exercises begin, but may vary on the patient and condition of the wrist following certain surgeries. Patients are then given progressive strengthening exercises for the wrist flexors and extensors - with supination, pronation and grip exercises gradually added.

Generally, once a fresh fracture is stabilized with fixation, the patient may return to sports in approximately eight weeks. Though following a nonunion and bone grafting, the recovery process may last up to three months.

A small meniscus located on the ulnar side of the wrist (the side opposite the thumb), the triangular fibrocartilage complex (TFCC) serves as a connective site for ligaments, as well as a cushion between the carpal wrist bones and the end of the forearm. It is damaged when a strong compression and shearing force is applied to it. Since the wrist is not a weight-bearing joint, the pain and functional discomfort are minimal.

Those at Risk
While a fall on an outstretched arm could result in such an injury, athletes involved in activities requiring a large amount of wrist motion such as swinging a baseball bat, throwing a ball or other object, as well as gymnastics and other events requiring wrists to balance weight are most at risk.

Diagnosis
Patients experiencing TFCC damage may experience discomfort on the ulnar side (little finger) of the wrist, increased pain when the hand is rotated away from the thumb and a popping sound. While a physical examination and description of the accident that resulted in the injury will indicate the possibility of TFCC damage, an MRI will confirm the diagnosis.

Treatment
Depending on the severity of the damage either conservative treatment, arthroscopy or a surgical procedure to repair a tear is recommended.

Conservative treatment consists of rest and change in activity in order to reduce stress to the affected hand. It may also include casting of the wrist and the use of non-steroidal anti-inflammatory medications (NSAIDs).

If pain persists following conservative treatment, or if there was a severe tear, wrist arthroscopy may be performed. Chronic tears may require an excision of the tear.

A wrist sprain occurs when ligaments that support the wrist and connect the bones to each other are stretched or torn. This often happens when an outstretched hand is used to break a fall. Individuals suffering from a wrist sprain may experience pain and swelling around the wrist. The area may be sensitive and warm, with visible redness or bruising. Those suffering from a wrist sprain have limited ability to move the wrist.

An x-ray is generally taken to ensure that no bones are broken. While not frequently performed for this type of injury, occasionally a magnetic resonance imaging (MRI) scan may be done in order to determine if a more severe ligament injury exists.

Risk Factors
Those individuals involved in sports, as well as those experiencing poor coordination, balance, flexibility and strength in muscles and ligaments, are at greater risk for wrist sprains.

Treatment
Treatment options for wrist sprains are generally non-invasive and may include a period of rest from rigorous hand activities. Cold compression is used to reduce pain and swelling - and elevation helps drain fluid and reduce swelling. Inflammation reducing medication such as Ibuprofen, Naproxen, Acetaminophen (Tylenol) and aspirin, may also be prescribed.

Occasionally a brace or cast may be placed on the wrist to ensure immobilization. Surgery, though rare in such cases, is sometimes necessary to repair a ligament that has completely torn - or address an associated fracture.

Rehabilitation
Following a period of rest, patients then begin a series of exercises, in order to restore flexibility, range of motion and wrist strength. While some of the exercises focus on strengthening all muscles surrounding the area of vulnerability, others are developed specific to the patient's lifestyle and can fit easily into daily activities.

Wrist synovitis is the inflammation of the synovial membrane lining the joints in the wrist and often coincides with carpal tunnel syndrome at the wrist - with compression of the median nerve as it travels through the carpal tunnel.

It is often found in patients suffering from Rheumatoid Arthritis, and may also present itself in the form of a Ganglion cyst. Patients suffering from the condition suffer from pain and discomfort when moving the wrist.

Those at Risk
While wrist synovitis most often affects those suffering from Rheumatoid Arthritis, it has also been diagnosed in young patients involved in sports demanding on the wrist joint such as gymnastics and tennis.

Diagnosis
Patient history and the type of pain experienced will provide some insight for diagnosis. Magnetic resonance imaging (MRI) will help identify the areas of vulnerability and confirm wrist synovitis.

Treatment
Depending on the severity of the condition and other vulnerabilities that may exist, wrist synovitis may be treated with glucocorticoid injections into the joint. When wrist synovitis presents with a wrist ganglion and deteriorating conditions following the use of antirheumatic drugs (DMARDs) and other conservative treatment, a Synovetomy may be recommended.

A Synovetomy is done to remove the inflamed joint tissue (synovium) that is causing the pain, irritation and swelling. It may be done arthroscopically or surgically.

Physical therapy begins one to two weeks following a procedure and focuses on restoring range of motion.

Among the most common type of fracture, the distal radius fracture affects the distal end (end towards the wrist) of the radius bone in the forearm - generally when the arm is used to break a fall.

A distal radius fracture is also called Colles Fracture - named after the surgeon who initially described it, Abraham Colles.

The radius is a forearm bone that runs between the wrist and the elbow. It becomes rigid when it is extended in order to break a sudden fall and subjected to extreme compression and twisting force that generally results in a fracture at the wrist. This type of injury can also result from a direct trauma.

A fracture may be either displaced (out of proper alignment) or non displaced.

When it occurs, the pain is immediate and there is an obvious deformity of the wrist. This may be followed by pain, stiffness, swelling and loss motion in the affected area. Bruising may also be present.

Those at Risk
While distal radius fractures can happen to anyone involved in a trauma such as a car accident, as well as the weekend roller bladder or skater boarder, it most frequently occurs in athletes involved in action sports such as motocross racing and cycling.

Distal radius fractures are also common in patients over the age of 60 as a result of osteoporosis. A relatively minor fall in these patients can result in a fracture because of the decreased bone density.

Diagnosis
Patient history, nature of the incident that resulted in the fracture, and a physical examination will assist in the diagnosis. The outward appearance, while varied depending on severity, is also a strong indicator of this type of fracture. An X-ray will confirm the diagnosis.

Treatment
The primary goal of treatment is to ensure that the bones heal in the correct alignment. For fractures that are not displaced a simple brace and anti-inflammatory medication may be all that is necessary. For fractures that are displaced, or not properly aligned, surgery may be indicated in order to ensure that the dislocated bones are replaced in their normal anatomic positions. This is called reduction. Reduction may be done either closed (without making an incision) or open (with an incision). The type of fixation used to hold the bone in the correct position is determined based on the condition of the patient, lifestyle, and severity of the injury.

Common injuries among athletes, contusions often involve the muscles of the forearm and portion of the bony prominence of the elbow. In athletes, the forearm often absorbs the greatest portion of the impact - particularly in contact sports. This repeated force to the muscles can result in bruising and possibly bleeding, which produces stiffness during active range of motion activities. Occasionally a contusion is accompanied by a fracture, depending on the severity of the force.

Depending on the area impacted by the force, a contusion can also produce an actute hemorrhagic bursitis or a common chronic olecranon bursitis. A contusion to the ulnar nerve (an area often referred to as the "funny bone") can be very painful and send burning sensations down the ulnar side of the forearm to the ring and little fingers.

Those at Risk
Athletes involved in high impact contact sports such as football, baseball and basketball are most likely to be affected by this condition, though contusions can also result from an accident or fall.

Diagnosis
Patient history, combined with a thorough physical examination that includes range of motion tests, are used in diagnosing elbow trauma. An X-ray may be taken to identify a possible fracture, which sometimes accompanies a trauma resulting in a contusion.

Treatment
Once any accompanying fracture is addressed, a period of rest followed by a series of range of motion exercises may be all that is necessary in the treatment of contusions to the elbow or forearm.

Elbow Instability
Elbow instability is the detachment or thinning of an elbow ligament often caused by throwing activities or sports, or a trauma that resulted in a dislocation. Instability can affect either the outer (lateral) or inner (medial) portion of the elbow.

Elbow instability is classified according to five criteria, which help in identifying the severity of the condition - acute, chronic, or recurrent, as well as the area of irritation, the direction of displacement, the degree of displacement, and any associated fractures.

This condition is symptomatically similar and sometimes confused with arthritis and tendonitis.

Those at Risk
Athletes involved in throwing sports generally develop medial elbow instability. And those experiencing trauma or earlier surgery to repair a dislocated elbow most often develop lateral elbow instability.

Diagnosis
In order to accurately diagnose elbow instability, a physical examination with patient history is obtained - along with X-rays and magnetic resonance imaging (MRI) enhanced with an arthrogram. An arthrogram is the process of injecting the elbow with a small amount of dye in order to enhance the clarity of the MRI, which aids in the capturing of ligament disruption.

Treatment
The conservative treatment plan indicated for elbow instability includes anti-inflammatory medication - possibly combined with a period of immobilization.

In cases nonresponsive to conservative treatment, surgery is performed to reconstruct the biomechanics of the joint and repair the ligaments. Surgery is indicated only when the risk of long-term arthritis from prolonged friction is present.

Medial collateral ligament (MCL) injuries most often occur when the elbow is subjected to the high velocity pitches attained by amateur and professional pitchers, who may throw balls reaching speeds between 70 and 100 miles an hour. This level of throwing places a significant amount of force on the elbow joint that over time can lead to irritation, inflammation, cartilage tears, formation of bone spurs and eventually tearing of the MCL.

The MCL is part of a network of ligaments and tendons that attach and help stabilize at the elbow the bones of the lower (ulna and radius) and upper (humerus) arm.

When the MCL is torn, athletes usually maintain full range of motion and the ability to throw, but with significantly reduced force. While often times a "pop" is reported with the ligament tears, it can also be a gradual process and go undetected for a period of time.

Those at Risk
Baseball players, particularly pitchers, are most often diagnosed with this injury as a result of the frequent and irregular force exerted on their elbow joint.

Diagnosis
Patient history and physical examination are followed by a radiologic exam. Those patients experiencing extended periods of performance disruption may have an X-ray, while those experiencing a sharp "pop" - particularly during a throw - may require magnetic resonance imaging (MRI).

Treatment
A change in activity is recommended initially in order to remove the stress from the elbow. This may mean a temporary change in field position for an athlete, while the damage is assessed. A course of conservative treatment followed by rehabilitation is generally the first phase of addressing an injury or condition.

When a tear requires surgery, an exploratory arthroscopy is generally performed to confirm no other damage. And a surgery popularized by a former major league pitcher, Tommy John, called the Tommy John surgery may be indicated. The procedure - known to doctors as medial collateral ligament reconstruction - takes only an hour and returns full strength to the elbow by replacing a ligament in the medial elbow with a tendon from another area of the body (generally taken from the forearm, hamstring or foot).

Also known as Golfer's Elbow, medial epicondylitis is similar in nature to lateral epicondylitis or Tennis Elbow - though one affects the outer (lateral) portion of the elbow and the other affects the inner (medial) portion.

Medial epicondylitis affects the inner portion of the elbow and is caused by the excessive and repeated force used to bend the wrist toward the palm. This occurs in such activity as pitching a baseball, swinging a golf club or serving a tennis ball. The force causes damage to the tendons responsible for this bending action and causes a pain that generates from the elbow to the wrist, on the palmar side of the forearm.

While the condition may also result from a number of other activities such as carrying a heavy suitcase, chopping wood with an ax, throwing a javelin and frequently using other hand tools, it has become popularized by golfers and is most often referred to as Golfer's Elbow.

Those at Risk
Those adults subjecting repeated force on the wrist are likely to experience medial epicondylitis. It is often diagnosed in those actively involved in a sporting activity or manual labor - generally between the ages of 20 and 40.

Diagnosis
Diagnosis of medial epicondylitis usually consists of patient history and a physical examination of the arm and wrist in various positions of resistance.

Treatment
Unless chronic and severe, most cases are treated with conservative nonsurgical treatment plans that may include: cold compression, anti-inflammatory medications, and strengthening exercises.

When the condition is nonresponsive to conservative treatment, surgery is indicated to repair the ligament.

Known by physicians as lateral epicondylitis, Tennis Elbow affects the lateral, or outer, portion of the elbow and results when the elbow is overstressed or repetitively overused.

The forearm muscles that bend the wrist back (the extensors) attach at the lateral epicondyle (bony bump at the outer portion of the elbow) and are connected by a single tendon. Lateral epicondylitis is the irritation and subsequent inflammation of the tendon around the lateral epicondyle, or bony elbow bump, thought to be the result of tissue degeneration within the tendon.

Initially moderate pain is felt at the outer portion of the elbow. Over time pain increases and may spread down the forearm and to the back of the middle and ring fingers - eventually causing debilitating pain and weakness in arm function. Reaching and grasping activities may become painful, and a nagging discomfort may be present while resting after activities.

Those at Risk
While it got its name because five in 10 recreational and professional tennis players suffers from the condition, the average man and woman between the ages of 40 and 60 is far more likely to suffer from the condition doing everyday activities - painting with a brush or roller, using a chain saw or hand tools, pruning shrubs, lifting children up and down. The overuse of the muscles and tendons of the forearm and elbow is likely to prompt the condition.

Diagnosis
In diagnosing tennis elbow, patient history and a pain analysis are generally followed by a physical exam that places the arm and wrist in various positions that require the forearm muscles and tendons to stretch. An X-ray may be indicated in order to eliminate other causes of elbow pain. A magnetic resonance image (MRI) or ultrasound test may also be used in establishing and confirming diagnosis.

Treatment
Beginning always with conservative nonsurgical treatment for such conditions, a plan to prevent further degeneration and promote an environment conducive to tendon healing is established. This may entail a course of anti-inflammatory medications if acute inflammation is determined. A physical or occupational therapy program helps instruct patients on ways to perform activities without placing strain on the elbow. And recently available to patients suffering from chronic tennis elbow nonresponsive to traditional conservative treatment options is a new noninvasive high-energy shockwave therapy. This nonsurgical procedure is called the OssaTron Treatment and is performed as an outpatient procedure that takes less than 20 minutes.

When the condition is nonresponsive to conservative treatment and not conducive to shockwave therapy, surgery may be indicated, in order to relieve the tension from the extensor tendon. This procedure is called lateral epicondyle release and can also be done as outpatient.

Ulnar Collateral Ligament (UCL) Tears, often referred to as a Tommy John injury, were once devastating injuries to an athlete involved in overhead and throwing sports such as swimmers, volleyball players, pitchers and ice hockey players. But today early diagnosis and treatment keeps players in the game without skipping a beat.

The UCL of the elbow is critical for valgus stability and serves as the primary elbow stabilizer. It consists of three bands - the anterior, posterior and transverse. The anterior band contributes the greatest in valgus stability.

The acceleration phase of an overhead throw causes the greatest amount of valgus stress on the elbow - while the forearm lags behind the upper arm and creates valgus stress. This leaves the elbow primarily dependent on the anterior band of the UCL for stability. The extreme acceleration can cause the valgus force to overcome the tensile strength of the UCL and result in either chronic microscopic tears or an acute rupture.

Tearing of the ligament generally occurs after a period of localized internal soreness around the elbow. When the tear occurs, patients report feeling a "pop" followed by weakness and inability to function properly.

Those at Risk
Athletes regularly subjecting their elbow to high acceleration activities in flexion and extension are likely to incur this type of injury.

Diagnosis
Patient history and physical examination are followed by a radiologic exam. Those patients experiencing extended periods of pain may have an X-ray performed, while those experiencing deep sharp pains - particularly during a sport activity - may require magnetic resonance imaging (MRI).

Treatment
A change in activity is recommended initially in order to remove the stress from the elbow. This may mean a temporary change in position for an athlete, while the damage is assessed. A course of conservative treatment followed by rehabilitation is generally the first phase of addressing an injury or condition.

When a tear or rupture requires surgery, an exploratory arthroscopy is generally performed to confirm no other damage. And a surgery popularized by a former major league pitcher, Tommy John, called the Tommy John surgery may be necessary. The procedure - known to doctors as ulnar collateral ligament reconstruction - takes only an hour and returns full strength to the elbow and forearm by replacing the damaged ligament with a tendon from another area of the body (generally taken from the forearm, hamstring or foot).

The biceps muscle is found in the front of the upper arm and is attached to the shoulder and lower arm bone by tendons. It helps control lower arm movement and is particularly instrumental in the follow through of forceful throwing movements such as those in football or baseball. When the tendons are overused or overstressed, they become irritated and inflamed. This condition is called Biceps Tendonitis. It is often secondary to rotator cuff instability.

Biceps tendonitis may cause pain along the front of the shoulder during arm and shoulder movement - particularly forward and upward movements. Pain may intensify at night and become increasingly prevalent during daily activity such as lifting or carrying groceries or garbage bags.

Those at Risk
While athletes in throwing sports are often diagnosed with this condition, it can affect any active male or female who repetitively overuses the biceps muscle. A direct trauma or calcification in the tendon may also prompt the condition.

Diagnosis
Following patient history, physical examination and pain analysis, radiographic testing will confirm diagnosis.

Treatment
Biceps tendonitis is generally treated with a conservative nonsurgical program involving anti-inflammatory medication and cold compression. A rehabilitative exercise program designed to strengthen and promote flexibility of the shoulder stabilizers is developed. Depending on the severity of the pain, corticosteroid injections may be indicated in order to reduce the inflammation and pain. And an ongoing rehabilitation program is developed specifically to the patient in order to ensure a safe return to sport with no recurrence.

The biceps muscle bends the arm at the elbow and rotates the forearm in order to allow the palm of the hand to face upward. It is located at the front of the arm and is attached by the biceps tendon to the shoulder blade (scapula) and the radius bone.

The biceps muscle separates near the shoulder into a long head and a short head - both of which attach to the shoulder in different places. The long head of the biceps tendon is subject to injury because it travels through the shoulder joint to its area of attachment.

A biceps tendon rupture may occur as a result of chronic tendonitis - and a long history of shoulder impingement and stability problems. While ruptures of the distal tendon near the elbow are less reported than those of the proximal tendon, they can occur with unexpected force on a bent arm in breaking a fall or shielding from a collision.

Most frequently diagnosed are ruptures of the proximal biceps tendons near the shoulder. Because of the broad range of motion the shoulder joint can attain and to which it is subjected, the proximal biceps tendon is more vulnerable to injury than the distal biceps tendon.

Proximal biceps tendons tears can be either partial or complete and are often times already a bit worn - particularly in the patient over 40 years of age.

Pain is usually sharp and sudden, often times preceded by a loud "snap." There may be a bulge in the upper arm above the elbow and an indention nearer the shoulder - possibly accompanied by bruising, pain or tenderness.

Those at Risk
Athletes subjecting their shoulder to extreme throwing force are vulnerable and likely to experience this condition during their career. Active adults who over exert in an activity, or who have a history of shoulder instability problems and degenerative tendon conditions are also at risk. In the elderly, proximal biceps tendon ruptures (in the shoulder area) are generally seen in conjunction with rotator cuff tears.

Diagnosis
Along with patient history, a physical examination involving arm movement and tightening of the biceps muscle will help determine diagnosis. For patients with a history of shoulder pain and instability, magnetic resonance imaging (MRI) or arthrogram (enhanced X-ray) may be indicated, in order to assess the condition of the rotator cuff muscles.

Treatment
Conservative nonsurgical treatment is usually successful in treating biceps tendon ruptures. This may entail cold compression in order to reduce swelling, nonsteroidal anti-inflammatory drugs (NSAIDs), and a period of rest followed by a rehabilitative strengthening and flexibility program that is specific to the patient.

When the condition is nonresponsive to conservative treatment, surgery to repair the tendon tear may be performed. This depends on the patient’s history, age and work requirements.

The triceps tendon is likely to become inflamed and rupture when overstressed while lifting weights or pushing something that is too heavy. It can also rupture when outstretched arms are used to break a fall.

The triceps tendon is located at the back of the upper arm and inserts into the back of the elbow. The symptoms of inflammation or a rupture may include elbow pain at rest or during activity, painful swelling at the back of the elbow, and reduction in elbow function.

Those at Risk
Those frequently lifting large amounts of weight at the gym without properly strengthening opposing muscle groups are at risk of triceps tendon inflammation or rupture. Also vulnerable are skateboarders or roller bladders, who rely on outstretched arms to break a fall.

Diagnosis
Along with patient history, a physical examination involving arm movement and tightening of the triceps muscle will help determine diagnosis. For patients with a history of elbow pain, magnetic resonance imaging (MRI) or arthrogram (enhanced X-ray) may be indicated in order to assess the condition of the elbow joint and associated tendons.

Treatment
Conservative nonsurgical treatment is usually successful in treating triceps tendon inflammation or ruptures. This may entail cold compression in order to reduce swelling, nonsteroidal anti-inflammatory drugs (NSAIDs), and a period of rest followed by a rehabilitative strengthening and flexibility program that is specific to the patient.

When the condition is nonresponsive to conservative treatment, surgery to repair a tendon tear may be performed. This depends on the patient's history, age and level of activity.

On top of the shoulder blade (scapula) sits a bony mass called the acromion. This composes the top of the shoulder and serves as the headquarters for the deltoid muscle - connecting to the collarbone (clavicle) to form the acromioclavicular joint or AC Joint. The AC joint is an important part of the shoulder as it connects the shoulder to the rest of the body.

This joint frequently incurs damage as a result of an impact to the outside of the shoulder - as often seen in contact sports as well as in biking and skiing accidents. When this happens it is called an AC joint separation.

As a result, patients may notice a visible bump on the top of the shoulder. While not extremely painful, this happens when the end of the collarbone becomes detached from the acromion and the arm correspondingly sags - making the bump more pronounced. The initial injury may cause pain in the AC joint area and may be accompanied by some bruising and swelling.

When a severe displacement occurs, patients experience a tremendous amount of weakness in the deltoid muscle - indicating more serious ligament damage.

An AC joint separation, or shoulder separation, is often confused with a shoulder dislocation. The primary differences lie in the bones affected. In a shoulder separation, the area where the clavicle and scapula connect is disrupted, but in a shoulder dislocation the humerus is displaced from the socket, which is formed by the scapula.

Those at Risk
Those involved in extreme biking, motocross racing and other action sports are frequently diagnosed with AC joint separation.

Diagnosis
The prominent bump at the top of the shoulder is a good indictor of AC joint separation. Patient history and detail of how the injury occurred followed by an assessment of pain and tenderness at the joint will also help in the diagnosis. An X-ray may be performed in order to confirm that there is no bone fracture.

Treatment
Most AC joint separation problems can be addressed conservatively and will include a period of rest, cold compression and anti-inflammatory medication in order to relieve pain and reduce swelling. Range of motion exercises begin shortly thereafter in order to rebuild shoulder strength and flexibility.

In the case of severe displacement and corresponding weakness of the deltoid muscle, an outpatient surgical repair may be performed in order to restore the ligaments, which maintain the AC region. Rest, cold compression and range of motion exercises follow the procedure.

Shoulder impingement syndrome generally happens gradually - caused by the compression of the tendons of the rotator cuff, between part of the shoulder blade and the head of the humerus. The result is pain, weakness and loss of motion, as well as the potential for other conditions such as bursitis, and rotator cuff tendonitis and tears.

The compression, or impingement, may be prompted by a number of factors - acromioclavicular (AC) joint arthritis, calcification, structural abnormalities of the acromion, and overstressed and weakened rotator cuff muscles.

Those suffering from an impingement are usually prompted to seek medical consultation once night pain begins preventing comfortable sleep. Progressively symptoms become more prominent and range of motion greatly reduced.

Those at Risk
Shoulder impingement can affect the young athlete involved in overhead sports and older adult with a history of shoulder pain and stress alike.

Impingement syndrome can be generally classified into stages. Stage I is often associated with overuse injuries and includes edema and/or hemorrhage - most often occurring in patients under the age of 24. Stage II is more advanced and occurs most often in patients between the ages of 25 and 40. Fibrosis and more severe tendon changes are evident in Stage II. Stage III is found most often in patients over the age of 50 and involves a tendon rupture or tear - most likely the result of long-term vulnerability and corresponding degeneration.

Diagnosis
Patient history and pain analysis are first assessed when determining a diagnosis. A physical examination noting signs of impingement during passive shoulder motion are also important in determining if a patient suffers from shoulder impingement.

Depending on patient history, radiographic testing may be indicated in order to rule out other conditions and clearly identify tissue changes. And when a rotator cuff tear is suspected, magnetic resonance imaging by also be indicated.

Treatment
Conservative nonsurgical treatment is effective in addressing many impingement conditions, particularly in the early stages. These may include; cold compression to reduce swelling, nonsteroidal anti-inflammatory drugs (NSAIDs), a period of rest and refrain from activity that aggravates the condition, and a rehabilitative exercise program designed to strengthen shoulder muscles.

Injection therapy including lidocaine and corticosteroid may be recommended when impingement does not improve with initial conservative treatment. This is determined based on the age, condition and activity level of each patient.

When conservative treatment does not improve the condition, arthroscopic surgery may be indicated in order to facilitate decompression.

With the greatest range of motion than any other joint in the body, the shoulder is vulnerable to injury as well as many problems that can cause pain, tenderness and weakness. The shoulder is surrounded by four muscles (the infraspinatus, teres minor, supraspinatus, and subscapularis) and accompanying tendons, which are collectively called the Rotator Cuff and serve as part of a delicate balance of strength, flexibility and stability.

Rotator Cuff tears can result from a single action or the cumulative affect of gradual degenerative stress caused by long term involvement in overhead sports such as throwing, tennis and swimming - possibly following rotator cuff tendonitis, impingement, or dysfunction. Tears can also result from the degenerative affects of aging. Damage is classified as either extrinsic (initiated from the outside and resultant of a trauma or overuse), or intrinsic (initiated from the inside and resultant of degeneration with aging and calcific presence).

Symptoms generally include pain, weakness and loss of motion. Pain intensifies during overhead or above the shoulder activities. There may also be night pain that disrupts sleep.

Those at Risk
Athletes involved in overhead sports and the elderly experiencing tissue degeneration in the shoulder joint are most often diagnosed with a rotator cuff tear. Though, calcific tendonitis, which can eventually lead to a rotator cuff tear, may occur in those ranging in age from 30 to 50 years.

Diagnosis
Patient history and physical examination is key in establishing any diagnosis, but particularly for a rotator cuff tear. Pain is assessed as patients move through a series of passive shoulder movements involving forward flexion, as well as internal and external rotation at various rotations.

Radiographic testing is also helpful in eliminating the presence of calcific deposits and other contributing factors. In patients with a history of severe trauma or who experience extreme weakness, magnetic resonance imaging or an arthrogram may be indicated in order to determine appropriate treatment.

Treatment
Most rotator cuff injuries can be addressed nonsurgically and may respond to a course of conservative treatment that includes anti-inflammatory medication and rehabilitative exercises - involving all muscle groups instrumental in shoulder function, with both positive and negative force. If pain persists, cortisone injection treatment may be indicated.

And in more serious cases non responsive to conservative treatment, arthroscopic surgery may be indicated and instrumental in removing damaged portions of the bursa and repairing the torn rotator cuff tendons with suture anchors. Arthritis of the AC joint and other shoulder pathology can also be addressed at the same time.

A winged scapula is a shoulder injury or condition causing the scapula or shoulder blade to protrude out at the back, which is exaggerated when pushing against an object. It is the result of damage or a contusion to the long thoracic nerve of the shoulder or area muscle weakness. This nerve damage may also be the result of a direct trauma to the shoulder.

Aside from the protrusion of the scapula at the back, those suffering from winged scapula also experience pain, a reduction in shoulder movement, difficulty lifting and pressure on the scapula when sitting or leaning against a solid surface such as a chair.

Those at Risk
Athletes involved in contact sports placing the shoulder in jeopardy of a direct blow are often diagnosed with winged scapula.

Diagnosis
The protrusion at the back is a strong indicator of winged scapula. Patient history and physical examination are generally all that is necessary for diagnosis. Though, an X-ray may be indicated to thoroughly assess the area of impact and rule out other damage.

Treatment
Initial treatment for winged scapula is conservative and involves a complete rehabilitation program designed to strengthen the shoulder and surrounding muscles. If the condition is not improved with conservative treatment, surgery may be required to correct the problem and restore full shoulder function.