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Patient Question (Shin Splints):
For years I have been struggling with shin splints. When I wake up in the morning, my feet are extremely sore—even if I haven't been running or walking. When I do attempt to play, I can't make it more than a few holes before the pain in my shins begins. I use custom made arch supports but they don't seem to be working. I also ice my shins but that doesn't seem to help much, either. Is there any advice you can give me so that I can walk the course pain free?

Dr. Johnny Lin:
The term "shin splints" is commonly used to describe pain in the front of the leg which occurs with increased levels of activity. The most common cause of this problem is inflammation at the attachment site of the muscles in the front of the leg. This can be the result of abnormal mechanics during running or walking, as well as overuse. Although shin splints are more common in football, running, and soccer, it does affect golfers. In fact, pro golfer Rory Sabbatini was forced to withdraw from a tournament in late 2007 due to shin splints.

Treatment:
Treatment of shin splints revolves around a daily regimen of stretching for the ankle, hamstrings, AND hip (physical therapy). As you noted, if your foot is excessively flat or high arched, this can also contribute to abnormal mechanics. This can be treated with a corrective shoe insert; however the insert/arch support must be made appropriately to be effective. Finally, a training regimen implementing both impact and non-impact exercises such as cycling, swimming, and the elliptical machine can also decrease the stresses on the leg while improving muscular endurance and cardiovascular fitness.

A second common cause of "shin splints" is excessive exercise-induced swelling of the leg. In this situation, there is abnormal pressure on the muscles and nerves in the leg resulting in pain. This is also referred to as "exertional compartment syndrome." It also responds to the treatment regimen outlined above. However, if this fails, then surgical expansion of the connective tissues surrounding the muscles of the leg can provide relief of symptoms.

For more information about Dr. Lin and the foot and ankle physicians of Midwest Orthopaedics at Rush, call 877 MD BONES or visit them online at www.rushortho.com.

Disclaimer: The information contained on this page is intended only for general public education, and is not intended to serve as a substitute for direct medical advice. This information should not replace necessary medical consultations with a qualified orthopaedic physician.

Patient Question (Supraspinatus Tear):
I am suffering from a tear of the supraspinatus, confirmed by a medical examination and MRI test. Do I risk further damage by continuing to play golf? I am not in that much pain and would like to play this season before considering surgery. I had a cortisone shot and I'm currently taking Celebrex and doing physical therapy.

Dr. Nikhil Verma:
First, a little background information on your condition for our readers. The supraspinatus muscle tendon is one of the four rotator cuff tendons. The tendon runs along the top of the shoulder blade and works to lift the arm up sideways. It's important for motions such as throwing. It is also the most commonly ruptured rotator cuff muscle, often injured in sports involving sudden forceful movements of the upper extremities.

As long as your pain is controlled and your function is adequate, you may continue normal activities. If the pain is worsening, this can be a sign of enlargement of the tear and you should seek further medical attention. Otherwise, there should be no significant compromise to delaying surgery until after the golf season.

Treatment:
In the past, surgical treatment of a supraspinatus muscle tendon tear was typically performed through an “open” procedure. With this procedure, the surgeon makes a several-centimeter incision over the shoulder and detaches the deltoid muscle to gain access to the torn rotator cuff. Although this is a reliable method of repair, successful recovery requires a long rehabilitative process.

Today, supraspinatus muscle tendon tears can often be repaired through arthroscopic techniques. These less invasive procedures result in decreased pain from surgery, decreased postoperative stiffness, reduced surgical blood loss, and can even be performed on an outpatient basis.

For more information about Dr. Verma and the Sport Medicine physicians of Midwest Orthopaedics at Rush, call 877 MD BONES or visit them online at www.rushortho.com.

Disclaimer: The information contained on this page is intended only for general public education, and is not intended to serve as a substitute for direct medical advice. This information should not replace necessary medical consultations with a qualified orthopaedic physician.

Patient Question (Golfers Elbow):
I play quite a bit of golf, and lately my left elbow has been killing me! I've heard of tennis elbow, but is there such thing as golfer's elbow?

Dr. Gregory Nicholson:
Yes, golfer's elbow is a common overuse injury of the muscles and tendons of the forearm, leading to inflammation and pain around the elbow joint. Unlike tennis elbow, the pain emanates from the elbow joint on the inside of the arm instead of the outside. Symptoms include a stiff feeling in your elbow, possible weakness in your forearm and wrist, and pain running from the inside of the elbow down your forearm while gripping.

The best way to treat golfer's elbow is through behavior modification (i.e., playing less golf). A conservative treatment regimen includes ice, anti-inflammatory medications, and exercises to stretch and strengthen the muscles and tendons around the elbow joint. Also, you may benefit from a visit with your golf instructor. A modification of your swing mechanics, enlarging your club grips, or switching to cavity-backed clubs with graphite shafts can lessen the stress on your elbow.

For more painful cases, an orthopaedic physician may prescribe an elbow sleeve or strap as well as a cortisone injection. In over 90% of cases, the condition is self-limiting and improves on its own over time.

For more information about Dr. Nicholson and the Sports Medicine physicians of Midwest Orthopaedics at Rush, call 877 MD BONES or visit them online at www.rushortho.com.

Disclaimer: The information contained on this page is intended only for general public education, and is not intended to serve as a substitute for direct medical advice. This information should not replace necessary medical consultations with a qualified orthopaedic physician.

Patient Question (Elbow Injury):
I am a PGA Club Professional and I have recently been told that I have Cubital Tunnel Syndrome in my right elbow. X-rays showed some loose cartilage, but the doctor didn't seem to think that was causing the issue. I have been given a splint for sleeping at night, and some anti-inflammatories, but the pain during the day, even when not active, is intense burning in my fingers and constant numbness and discomfort. Should I opt for surgery now, wait the six weeks for the splint to possibly have an effect, or try something else? Obviously this is critical to my continued success as a teacher and player of golf. Also, what is the recovery time for surgery and expected success rate?

Dr. Mark Cohen:
Cubital Tunnel Syndrome is simply a pinched nerve in the elbow. The ulnar nerve passes through the cubital tunnel, a channel which allows the ulnar nerve to travel over the elbow. When you "hit your funny bone" and have tingling in the small and ring fingers, you are in effect hitting the ulnar nerve at the cubital tunnel.

Treatment:
In many cases, the condition can be treated without surgery. Night splints are a common treatment and can be very effective. Many people who suffer from Cubital Tunnel Syndrome have a habit of sleeping with either their elbows bent, their arms up by their head, or both. These positions aggravate the pinched nerve condition.

The indications for surgery depend on the history, level of symptoms, the clinical examination and often a formal nerve study. There are several different surgical procedures for Cubital Tunnel Syndrome, but the recovery is typically pretty short, on the order of weeks, as the most common operations involve soft-tissue only. Surgeries that don't involve bone usually have a more rapid recovery.

For more information about Dr. Cohen and the the hand, wrist & elbow physicians of Midwest Orthopaedics at Rush, call 877 MD BONES or visit them online at www.rushortho.com.

Disclaimer: The information contained on this page is intended only for general public education, and is not intended to serve as a substitute for direct medical advice. This information should not replace necessary medical consultations with a qualified orthopaedic physician.