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Question and Answer


Q: My son recently injured his shoulder during a wrestling match. The doctor he saw said it may be a SLAP lesion. What is a SLAP lesion or tear?

A: A SLAP tear or lesion refers to damage to the superior labrum in the shoulder from anterior (in the front) to posterior (towards the back). The labrum is a fibro cartilage rim in the glenoid or socket. It helps to form a suction and stabilize the joint. The biceps tendon attaches in this area and can be damaged along with the labrum. Tears of the labrum can be very painful and often are difficult to diagnose without an MR arthrogram or arthroscopic surgery.

Q: I recently had an athlete told she had a grade 3 ankle sprain. What does that mean and how are sprains graded?

A: A sprain is damage to one or more ligaments that affect the stability of a joint, where a strain affects a tendon/muscle. The following are the normal grades used for ankle or other sprains:

  • Grade 1: Microscopic tearing of collagen fibers, minimal impairment, and minimal tenderness/swelling. No splinting/casting is usually needed and full range-of-motion and stretching/strengthening exercises can be done as tolerated.

  • Grade 2: Complete tears of some but not all collagen fibers in the ligament, moderate impairment, and moderate tenderness and swelling, decreased range-of-motion, and possible instability. Immobilization with air splint is needed and physical therapy is usually ordered.

  • Grade 3: Complete tear/rupture of ligament, severe impairment, significant tenderness, swelling, and instability. Immobilization, a longer period of physical therapy and in rare cases surgical reconstruction is required.

Q: I recently have been golfing as much as three times per week and have started to notice increasing lower back pain after I play. How can I prevent low back pain from golfing?

A: The nature of the golf swing can stress the lumbar spine, especially the L5-S1 disc space. This is due to the joints at this segment allowing considerable rotation. One of the main things to consider is increasing the flexibility of the torso, hips, and hamstrings. Flexibility of the hamstrings allows more motion at the pelvis and will help reduce stress at the L5-S1 disc space.

Start with simple back, hip, and hamstring stretches and progress to gentle swinging of the clubs from smaller irons up to “warm-up” and prepare the muscle groups for the torque (force) and the torsion (twisting) of a golf swing.

View our list of specific stretches for golf.

View a video on stretching for golf with Mike Malaska of

Q: I recently heard in the news that a Major League Baseball player may have thoracic outlet syndrome. What is thoracic outlet syndrome and what causes it?

A: Thoracic outlet syndrome is a disorder that occurs when the blood vessels or nerves running between the collar bone and the first rib are compressed. This area is called the thoracic outlet. Common symptoms are pain in the shoulders and neck as well as numbness in the fingers. The causes range from trauma, repetitive injuries from a job or sport, anatomical defects, such as having an extra rib, and pregnancy. Lastly, the treatment usually involves physical therapy and pain relief measures, but surgery may sometimes be recommended in rare cases.

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