Regular sport activities is beneficial to the health of the body. However overuse injuries and specific injuries around the joint in sport activities are directly related to the development of early osteoarthritis of the joints. For example knee abusers and heavy body builders who overuse their knee and shoulder joints lead to early development of osteoarthritis. An ACL tear, meniscus tear, cartilage injury or even intra-articular fracture can predispose early signs of osteoarthritis of the knee joint. Recurrent shoulder dislocation and acromioclavicular joint injury would also increase the risk of development of osteoarthritis of the shoulder joint.
What is osteoarthritis?
Osteoarthritis also known as “wear and tear” arthritis, is a condition that most often affects people over 50 years old, but may occur in younger people too. The smooth outer covering of the bone (articular cartilage) is worn out, and becomes frayed and rough. The joint space becomes narrow. This causes friction between bones in the movement of the joint, and produce bone spurs that will be visible on x-rays.
Osteoarthritis is most commonly seen in the knee joint. Shoulder joint osteoarthritis is less common in the Chinese population. Obesity is a major risk factor of osteoarthritis of the knee joint.
The symptom of osteoarthritis includes pain, swelling, stiffness (limited range of motion), grinding, clicking or crepitus as the knee or shoulder joint moves.
Overuse injury
For patients who come to see doctors for knee pain, it is not uncommon to find that some of the patients play soccer for two hours, few times per week, and had been doing this for many years since they were young. Physical examination and x-ray examination of their knees would find that they have significant osteoarthritis changes, despite only being in their 40s. These patients had overuse their knees for years causing early osteoarthritis.
Osteoarthritis of elbow and shoulder joint are not as common as osteoarthritis of the knee. However, many young patients with osteoarthritis of the elbow or shoulder are body builder or heavy weight lifter with big muscle mass.
Sports Injury
Anterior cruciate ligament (ACL) tear is a common knee injury in sport activities, such as soccer, rugby, basketball, skiing and etc. We know that long-term ACL deficiency knee is associated with early osteoarthritis of the knee. There is great variability in the reported rate of osteoarthritis after ACL rupture in the published literature, ranging between 21% and 86%1-3. We could observe osteoarthritis change of the knee joint in x-rays 10-14 years after ACL tear. Meniscus tear associated with ACL tear is of definitely high risk in development of osteoarthritis4. Because of knee instability after an ACL tear, recurrent injury is common and causes further meniscus and cartilage injury, which make the condition deteriorate further. Besides ligament injuries, in the situation of fractures affecting the joint surface (intra-articular fracture such as a tibial plateau fracture), which may happen in high impact injuries, may also cause complication of early osteoarthritis of the joint, especially if it is not treated properly.
Shoulder joint is the most mobile joint in the body. Because of high mobility, and little constrain in the structure of the shoulder joint (namely the labrum and glenohumeral ligament), shoulder dislocation is a common shoulder injury. It is estimated to occur in 1% of all individuals5. Once it has been injured the first time, there is a high chance it would dislocate again in the future. In addition, younger patients have higher risk of recurrence. With a repeated history of dislocation, the glenoid bone socket may damage along with bone loss, the cartilage overlying the humeral head and glenoid socket may damage. One study of 247 patient with first-time dislocation at the age of 40 or below, 11% of patients had radiographic evidence of mild arthrosis, and 9% had radiographic evidence of moderate to severe arthrosis 10 years later6. The clinical symptoms of shoulder joint osteoarthritis are pain, limited range of motion and crepitus inside the shoulder.
The acromioclavicular joint (AC Joint) arthritis is more common than shoulder joint arthritis. Heavy weight lifters or persons participating in sports activities with repeated overhead motion have a high chance of developing AC joint arthritis. Rugby players also have high incidence of acromioclavicular joint dislocation (shoulder separation). Some of the patients with AC joint dislocation would eventually develop post traumatic arthritis of the AC joint. AC joint arthritis normally causes local tenderness. AC joint pain occurs when hands try to reach the back, or crossing your arm to the opposite side of the shoulder.
Conclusion
Although regular exercise is good to the health, we need to pick suitable sports activities and not overuse our joints. Some sports activities are fun and exciting, but also carry higher risk of injury. We should know that injuries around the joints could precipitate the development of early osteoarthritis. Therefore early consultation to the doctors with proper management is important, to prevent these long-term consequences. Importance of adequate warm-up, cool-down and proper technique of individual sports should also not be underestimated.
Reference
- Von Porat, A. R. E. M., Ewa M. Roos, and Harald Roos. “High prevalence of osteoarthritis 14 years after an anterior cruciate ligament tear in male soccer players: a study of radiographic and patient relevant outcomes.”Annals of the rheumatic diseases 63, no. 3 (2004): 269-273.
- Lohmander, L. S., Anna Östenberg, Martin Englund, and Harald Roos. “High prevalence of knee osteoarthritis, pain, and functional limitations in female soccer players twelve years after anterior cruciate ligament injury.”Arthritis & Rheumatism 50, no. 10 (2004): 3145-3152.
- Øiestad, Britt Elin, Lars Engebretsen, Kjersti Storheim, and May Arna Risberg. “Knee osteoarthritis after anterior cruciate ligament injury a systematic review.”The American journal of sports medicine37, no. 7 (2009): 1434-1443.
- Roos, Harald, Torsten Adalberth, Leif Dahlberg, and L. Stefan Lohmander. “Osteoarthritis of the knee after injury to the anterior cruciate ligament or meniscus: the influence of time and age.”Osteoarthritis and Cartilage 3, no. 4 (1995): 261-267.
- Milgrom, Charles, Gideon Mann, and Aharon Finestone. “A prevalence study of recurrent shoulder dislocations in young adults.”Journal of Shoulder and Elbow Surgery 7, no. 6 (1998): 621-624.
- Hovelius, L., B. G. Augustini, H. Fredin, O. Johansson, R. Norlin, and J. Thorling. “Primary Anterior Dislocation of the Shoulder in Young Patients. A Ten-Year Prospective Study*.”The Journal of Bone & Joint Surgery 78, no. 11 (1996): 1677-84.
Written by Dr. Benjamin Chow
