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Elbow Ulnar Collateral Ligament Injuries in the Female Athlete

Introduction While there is abundant literature on ulnar collateral ligament (UCL) injuries in male athletes, predominantly professional baseball players, research remains sparse on the pathoanatomy, epidemiology, treatment, and outcomes of UCL injuries in female athletes. A literature review by Gardner and Bedi demonstrated that only 79 of 1902 (4.15%) patients within UCL studies are female. The majority of elbow UCL studies consist of either small case…

Elbow Anatomy and Biomechanics

Introduction The elbow consists of three joints: the ulnohumeral joint, radiocapitellar joint, and proximal radioulnar joint (PRUJ). Together, these three joints enable the elbow to flex and extend as a hinge joint as well as rotate about a longitudinal axis for pronation-supination. As such, the elbow is classified as a trochoginglymoid joint. The distal humerus has a 30-degree anterior tilt relative to the humeral shaft; therefore…

Rotator Cuff Function and Injury in the Female Athlete

Introduction Shoulder problems in the female athlete occur most commonly in sports that require repetitive or forceful use of the upper extremity. While there is extensive research in male overhead athletes, most notably baseball players and in particular pitchers, there is much less research involving female athletes. There is some research in sports where both male and female athletes compete in the same events or under…

Shoulder Instability in the Female Athlete

Introduction The shoulder is notable for being the most mobile joint in the body. Optimal function requires a delicate balance of stability and flexibility. This balance is achieved by contributions from both static and dynamic stabilizers. It is important to understand that some athletes, such as swimmers and dancers, inherently require greater amounts of flexibility, while others, such as overhead athletes, depend more on stability. Shoulder…

Shoulder Anatomy and Biomechanics

Osteology A variety of bony structures including the scapula, humerus, clavicle, and sternum are connected via soft tissue throughout the shoulder complex. The scapula is a flat, triangular bone that forms the posterior aspect of the pectoral girdle. Numerous muscles originate at and insert on the scapula. The four rotator cuff muscles (supraspinatus, infraspinatus, teres minor, and subscapularis), teres major, triceps, deltoid, and several other muscles…

Ankle Instability

Introduction Ankle sprains are common injuries accounting for up to 40% of all athletic injuries. It has been estimated that 75% of ankle sprains involve the lateral ligamentous complex. More than 23,000 ankle sprains occur per day in the United States affecting both males and females at approximately the same rates. Previous studies demonstrate that ankle sprains account for up to 53% of basketball injuries and…

Ankle Anatomy and Biomechanics

Introduction The ankle joint is composed of bones, ligaments, and tendons that provide an inherent balance between structure and function. Ligamentous structures connect the bones of the ankle to create a strong foundation for transmission of forces during weight-bearing activities. Traversing tendons work synergistically to create motion and generate power during ankle movement. Nerves and blood vessels provide sensation, proprioceptive feedback, and oxygen to all structures…

Hip Disorders in the Female Athlete

Femoroacetabular Impingement and Associated Labral Tears Femoroacetabular impingement syndrome (FAIS) refers to pathologic abutment between the femoral head-neck junction and the acetabular rim. This generally occurs due to a combination of structural, soft tissue, and activity-related factors. Two main forms of FAIS include cam morphology and pincer morphology, and many people have both. Cam morphology refers to an abnormally shaped femoral head and neck junction that…

Nonarthritic Hip Pathology

Introduction Due to the high loads received by the hip joint during walking and running, the hip and its surrounding structures are prone to numerous pathologies with varying degrees of severity. In a population of participants 65 years and older, near 20% had self-reported hip pain that consequently impacted their overall health such that without these symptoms, their average general health status would be similar to…

Hip Anatomy and Biomechanics

Introduction The human hip consists of a stable but very mobile skeletal framework for the surrounding capsule, ligaments, muscles, nerves, and vasculature. Understanding the anatomy and the development of intra- and extra-articular pathologies is critical in any patient population, and careful consideration must go into the evaluation of a painful hip in the female athlete. The anatomy, biomechanics, and pathologies specific to the female athlete are…

Patellar Instability

Introduction Patellar instability remains a problematic entity in the athletic patient population. Most studies agree that adolescent females represent the highest risk group of patients for first-time patellofemoral dislocation. Treatment of patellar instability must be individualized, with care taken to identify both historical and anatomic risk factors. First-time instability that results in a loose chondral or osteochondral body should be addressed with both attention to the…

Patellofemoral Pain in the Female Athlete

Introduction Patellofemoral pain is one of the most common sports-related knee conditions. , Patellofemoral pain is characterized by pain around or behind the patella during activities that load the patellofemoral joint, such as squatting, stair ambulation, running, jumping, and prolonged sitting with knees in a flexed position. Patellofemoral pain is particularly prevalent in younger, active populations, , , with females twice as likely to develop patellofemoral…

Meniscus and Articular Cartilage Injuries

Introduction Meniscal tears and cartilage injuries are common issues in the knee of a female athlete. As female athletes are significantly more likely to suffer anterior cruciate ligament (ACL), tears they are also prone to associated injuries to their meniscus and articular cartilage. The incidence of high-grade chondral injuries ranges from 5% to 10% in patients over 40 years old, , and cartilage lesions may be…

Anterior Cruciate Ligament Injury Prevention

Introduction Anterior cruciate ligament (ACL) injury is of major concern in the field of sports medicine and orthopedics. From 2002 to 2014 the rate of ACL reconstructions has increased by 22%. Those who experience ACL injury experience significant deficits in sports-related movement, including cutting, pivoting, decelerating, jumping, landing, and other functional movements. Concomitant injuries such as meniscal tear, chondral injuries, avulsion fractures, and collateral ligament injuries…

Anterior Cruciate Ligament Injuries in Female Soccer Players

Introduction Since the passing of Title IX in 1972, female participation in sports at every level has increased tremendously and continues to grow. , With that, however, the prevalence of sports-related musculoskeletal injuries has also greatly increased in the female athlete. In particular, anterior cruciate ligament (ACL) injuries have become a critical issue for a variety of reasons, including the severity of the injury itself; time…

Anterior Cruciate Ligament Injuries: Sex-Based Differences

Introduction and Epidemiology In spite of years of research and evolving techniques, rupture of the anterior cruciate ligament (ACL) continues to represent one of the most common traumatic injuries in competitive sports. Female athletes have been noted to be at particular risk for ACL tears, with injury rates as high as two to eight times as those experienced by males, especially in sports requiring quick or…

Anterior Cruciate Ligament Injury in the Female Athlete

Introduction Anterior cruciate ligament (ACL) injuries are one of the most common injuries seen by orthopedic surgeons and sports medicine specialists. Annually in the United States, there are 68.6 isolated ACL tears per 100,000 person-years. Worldwide there are roughly 1.4 million noncontact ACL tears annually. The ACL is subject to injury most commonly in sports that require movements such as cutting, pivoting, and jumping. These are…

Knee Anatomy and Biomechanics

Introduction Important morphologic differences have been found between the female and male knee. In addition to these anatomic differences, there are also significant neuromuscular differences between genders. This chapter outlines these differences, as they specifically pertain to the female athlete and risk for injury. The important characteristics of female knee bones, alignment, and soft tissues (ligament, meniscus) are covered first, followed by neuromechanical differences. The majority…

Caring for and Counseling the Ultramarathoner

Introduction Ultramarathon races represent any foot race longer than 42 km and can occur over single or multiple days. As the popularity of ultramarathon racing continues to grow throughout the world, there are an increasing number of races and participants, with estimates of 70,000 runners participating annually. Most races are continuous single-stage, point-to-point races that occur over a specific time period (i.e., 24–48 hours). Multistage races…

Caring for and Counseling the Peripartum Runner

Introduction Evidence suggests as little as 15 minutes a day of aerobic exercise improves health outcomes and helps prevent and manage common chronic conditions such as hypertension, diabetes, and obesity. Running has only recently been studied in risk factor reduction for these health outcomes, and like general physical activity, relatively low doses (5–10 minutes) of lower intensity speeds (<6 mi/hour) have similar health and longevity benefits…