SCIENCE MEETS PRACTICE: The effect of age-related medical conditions on shoulder function in athletes
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1 SCIENCE MEETS PRACTICE: The effect of age-related medical conditions on shoulder function in athletes Speakers: Ellen Shanley, PT, PhD Director, Athletic Injury Research, Prevention and Education CerOrtho Marisa Pontillo, PT, PhD, DPT Sports Team Leader, GSPP Penn Therapy at Penn Sports Medicine Center, Philadelphia, PA Scientific Consultant, Penn Orthopedics/University of Pennsylvania Athletics, Philadelphia, PA Chair of the Shoulder SIG of the American Academy of Sports Physical Therapy Moderator: Todd S. Ellenbecker, PT, DPT, MS Certified Strength & Conditioning Specialist Clinic director of Physiotherapy Associates, Scottsdale, AZ Vice President of Medical Services, ATP World Tour In addition to musculoskeletal age related changes, overhead athletes may be influenced by other medical conditions which affect their upper extremity function, performance, and injury. Examples for the youth athlete include an increased risk of instability secondary to a higher Beighton score and/or the presence of global joint supraphysiologic range of motion. Examples for the older athletes may include stiffness from a concomitant diagnosis such as diabetes metillus. Additionally, these need to be considered along with age related musculoskeletal changes, such as skeletal immaturity, osteoporosis, and osteoarthritis. Gender and age related hormonal changes also impact shoulder function secondary to their effect on bone and muscle health. The purpose of this session is to explore age related medical changes and how they specifically impact shoulder conditions in overhead athletes across the lifespan. Time table: 00:00-00:05 Overview of session format 00:05-00:35 Platforms 00:35 00:55 Moderator led Q&A; cases 00:55-01:20 Dialogue #1: Factors influencing the adolescent athlete 01:20-01:45 Dialogue #2: Factors influencing the older athlete 01:45-02:00 Moderator led Q&A/Summary of session
2 Age Related Upper Extremity Problems: Factors influencing the Adolescent Athlete Ellen Shanley PhD, PT Director, Athletic Injury Research, Prevention and Education CerOrtho Pathologies occur throughout the spectrum of the lifespan. Common factors that skew these injuries toward a particular segment of the population? Is age really a key factor? Impact or intersection of sport? Categories of Upper Extremity Problems Bone Pathology Joint Pathology Muscle/Tendon Neuro/Vascular Medical Issues Adult compared with Pediatric Problems Spectrum Adhesive Capsulitis Rotator Cuff Pathology Instability OCD Is it really that simple? Similar injuries in different populations- Are they the same problem with the same solution?
3 Pathologies to Consider Clavicle injuries: o Fractures- peak incidence o Os acromiale- Common presentation & treatment Rotator Cuff Pathology (Zbojniewicz 14 Ped. Radiology; Tashjian 12 Sports Med) o Incidence o Etiology o Location o Type of tears o Treatment Thoracic Outlet Syndrome o Neurogenic vs Vascular etiology Adults vs Pediatric Presentations o Mechanism o Type o Symptoms Sport Association Athletic Comparison Overhead Athletes D Arm Operative RTS Glenohumeral Instability o ¼ to 1/3 of all shoulder injuries reported in HS athletes o >70% recurrence rate in younger athlete s o Common risk factors include anatomic variants & alignment (bony version & capsular insertion) o Subluxation versus dislocation- Frequency & approach to treatment Ehlers-Danlos o Genetic predisposition
4 o EDS is thought to be the most prevalent connective tissue disorder(1:5000 1:10,000) o EDS-HT most common variant Symptoms & impairments o Consensus Spectrum o Risk Factors for Hypermobility type o Other associated pathology Growth Related Injuries Epiphyseal & apophyseal injuries - exclusive to pediatric populations Growth related injuries > in athletic youth & adolescents Pressure Traction End long bones Compression forces Pathology- impact growth Apophysis Tendon Attachment Growth LLS- highest years of age LLE- highest years of age Lateral elbow injuries o Related to management of compression forces o Osteochondrosis of the capitellum = Panners Disease o 5-10 year old; self limiting disorder o Treatment typically = rest & splinting o OCD > 10 years old Gymnasts wrist o Common in male & female gymnasts o Gradual onset of wrist pain o Pain worse with weight bearing activities esp in extension tumbling, vaulting, & back walkovers
5 Age Related Upper Extremity Problems: Factors influencing the Older Athlete Marisa Pontillo, PT, PhD, DPT Sports Team Leader, GSPP Penn Therapy at Penn Sports Medicine Center, Philadelphia, PA Scientific Consultant, Penn Orthopedics/University of Pennsylvania Athletics, Philadelphia, PA Chair of the Shoulder SIG of the American Academy of Sports Physical Therapy Degeneration: Causes: genetic; abnormal joint anatomy; joint instability; inadequate muscle strength; high impact/torsion injuries Age related bone changes: Osteoporosis Osteoarthritis o Damage to cartilage: acute traumatic versus progressive mechanical aka wear and tear o Metabolic imbalance o Conservative Interventions: PT; pharmacological; viscosupplementation; PRP; stem cells; topicals; nutritional supplements Joint Stiffness Idiopathic versus post traumatic "Frozen shoulder Fibrotic conditions: potentially genetically mediated Affected by hormonal changes in women Hx (+) for breast cancer/related interventions Sequelae of Adolescent Conditions Ehlers-Danlos Hx dislocations/instability Hx trauma or surgery Other Medical Conditions Diabetes metillus RA Surgical Interventions for the Older Athlete Arthroscopy and debridement RTC repair Shoulder arthroplasty Cartilage procedures?
6 Influence of tissue quality RTS prognosis References: Beck JJ, et al. What's New in Pediatric Upper Extremity Sports Injuries? J Pediatr Orthop 2018;38(2):e73-e77. doi: /BPO Cameron KL et al. Association of generalized joint hypermobility with a history of glenohumeral joint instability. J Athl Train May-Jun;45(3): doi: / Greenberg EM, et al. Physical and Functional Differences in Youth Baseball Players with and Without Throwing-Related Pain. Orthop J Sports Med 2017;5(11): doi: / Kapczuk K. Elite athletes and pubertal delay. Minerva Pediatr 2017;69(5): doi: /S Leonard J, Hutchinson MR. Shoulder injuries in skeletally immature throwers: review and current thoughts. Br J Sports Med Apr;44(5): doi: /bjsm Owens BD, et al. Serum Cartilage Biomarkers and Shoulder Instability. Orthopedics 2017;40(1): doi: / Epub 2016 Sep 30. Owens BD, Cameron KL, Clifton KB, Svoboda SJ, Wolf JM. Association Between Serum Relaxin and Subsequent Shoulder Instability. Orthopedics Jul 1;39(4):e doi: / Epub 2016 Apr 27. Quatman C, Yu JS. The aging athlete: part 2, "boomeritis" of the upper extremity. AJR Am J Roentgenol Sep;199(3):W doi: /AJR Tokish JM.. The Mature Athlete's Shoulder. Sports Health Jan;6(1):31-5. doi: /
7 Williams FM 1, Kalson NS 2, Fabiane SM 1, Mann DA 3, Deehan DJ 2. Joint Stiffness Is Heritable and Associated with Fibrotic Conditions and Joint Replacement. PLoS One Jul 21;10(7):e doi: /journal.pone ecollection Wolf JM 1, Cameron KL, Owens BD. Impact of joint laxity and hypermobility on the musculoskeletal system. J Am Acad Orthop Surg Aug;19(8):
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