Sports Medicine

SPORTS MEDICINE
Pediatricians, pediatric orthopedic surgeons, physical therapists, athletic trainers, psychologists and others work side by side with each athlete, their parents and coaches to develop the best game plan for recovery.
Our Sports Medicine practice is located at:
7000 West Plano Parkway
Plano, Texas 75093
Monday – Friday, 8 a.m. – 4:30 p.m.
Sign up for our e-newsletter.
OUR SERVICES
SHOULDER

The collarbone is the only bony attachment of the shoulder to the trunk. Soft tissues surround the collarbone to provide stability and a great amount of mobility for the arm. A collarbone fracture most often occurs with high-force traumatic events.
SYMPTOMS
PREVENTION
In some sports, such as football, pads and gear may protect the collarbone. In other sports, proper balance of strength and flexibility in the neck and shoulder muscles may aid in preventing collarbone injuries. These injuries are often unpredictable and unpreventable.
DIAGNOSIS
X-rays are most useful in confirming diagnosis and guiding treatment.
TREATMENT
Nonoperative approaches include using a sling to immobilize the arm for comfort and monitoring the natural healing process of the bone. This proves effective in most cases. Surgical intervention is only a consideration where natural healing is not likely to promote normal function of the shoulder.
RETURN TO SPORTS
After a period of 6-8 weeks, with pain resolved and X-ray evidence of good bone healing, an athlete may often return to sports with instructions to progress as tolerated. For some collision sports such as hockey and football, a longer healing time may be recommended.
A complex network of nerves called the brachial plexus extends from the neck into the arm to allow the hand to feel and move. An extreme stretch to the brachial plexus can cause short-lasting symptoms with damage to the nerve tissues. Most often, this injury occurs with a fall on the head and shoulder. This is a common injury in high school and collegiate football players and occurs less frequently in adolescent athletes.
SYMPTOMS
Neurological symptoms include numbness, tingling and pain in the arm only on one side. These typically last less than 15 minutes, but in some cases may last days or weeks. Because the injuries can occur together, the athlete should be evaluated for signs and symptoms of a sports concussion.
PREVENTION
Proper equipment for the position played and proper tackling form for the tackler and the player being tackled may reduce the risk of a burner.
DIAGNOSIS
A fall combined with the description of one-sided neurological symptoms is typically sufficient for diagnosis. Imaging may rule out other problems in the neck, especially for patients with persistent symptoms or a history of multiple stingers.
TREATMENT
In the early phase, rest, a sling for comfort and nonsteroidal anti-inflammatory drugs (NSAIDs) may be used. Typically, healthy athletes will recover quickly and will not need treatment. Surgical treatment for this is extremely rare. Rehabilitation may be recommended for neck and shoulder strengthening.
RETURN TO SPORTS
Without signs and symptoms of another injury, athletes can typically return to sports quickly when they are symptom-free.
The bony surface of the shoulder socket is very shallow. A circle of soft tissue, called the labrum, sits on the edges to make the socket deeper. As the ball moves around in the socket, bone or other soft tissues may stretch or compress the labrum.
A labral tear can occur in a single traumatic event such as a dislocation or in repeated episodes of shoulder instability. In adults, this most likely occurs with repetitive movements that cause wear and, ultimately, tear. Softball pitchers, volleyball players and baseball pitchers are more likely to have overuse injuries to the labrum.
SYMPTOMS
Pain with activity, especially throwing and overhead activity, and instability are common symptoms of labral tears. Range of motion is usually normal.
PREVENTION
Stabilization exercises for the shoulder and shoulder blade can improve the strength of the muscles. More importantly, the stabilization exercises can put the shoulder in its best position, both for performance and for injury prevention.
DIAGNOSIS
A thorough conversation about symptoms, activities and any injuries can help a provider make a preliminary diagnosis. Radiographic X-rays and an MRI may help assess the bone and soft tissue, including the labrum. SLAP or Bankhart lesions are the most common tears in adolescent athletes.
TREATMENT
Not all labral tears require surgery. The athlete’s symptoms, like pain and instability, and ability to perform daily activities help determine if surgical treatment is required.
RETURN TO SPORTS
Nonoperative treatment plans sideline athletes for a short period of time to allow focused rehabilitation. After a surgical procedure, restrictions from sports and other activities vary from 4 to 6 months. Returning to sports is most safe after completing a rehabilitation program designed specifically for the athlete.
SYMPTOMS
PREVENTION
DIAGNOSIS
TREATMENT
RETURN TO SPORTS
Extreme forces in certain positions can cause the ball of the upper arm bone, the humerus, to feel unstable or even slip out of the socket completely, resulting in shoulder dislocation. Some athletes are predisposed to this because of naturally weak ligaments or changes to the bony surfaces with repetitive activity.
Approximately 9 out of 10 athletes who’ve experienced shoulder dislocation are likely to experience another.
SYMPTOMS
Severe pain with a traumatic dislocation often improves quickly when the shoulder returns to its normal position. With repetitive dislocations, there may be no pain because the tissues have changed over time to allow this movement to occur easily.
PREVENTION
Strengthening exercises for the shoulder’s rotator cuff muscles and muscles around the shoulder blade can improve stability. These exercises can also improve the body’s ability to respond to changes in movement. This is a combination of proprioception and neuromuscular control.
DIAGNOSIS
A thorough conversation about episodes of instability and dislocation help a provider confirm the diagnosis. X-ray or other imaging of the shoulder can help rule out a fracture and evaluate the joint surfaces and soft tissue for changes.
TREATMENT
With early recognition, physical therapy can help improve motion and stability while relieving pain. Most athletes return to play after an initial injury. In cases of repetitive injury, surgical reconstruction may be required. Physical therapy after a reconstruction helps to regain shoulder mobility and strength.
RETURN TO SPORTS
Nonoperative treatment plans sideline athletes for a short period of time to allow focused rehabilitation. After a surgical procedure, restrictions from sports and other activities vary from 4 to 6 months. Returning to sports is most safe after completing a rehabilitation program designed specifically for the athlete.
The collarbone is attached to the shoulder with soft tissues, including tough ligaments. With an injury such as a strong blow directly on the shoulder from a hit or fall, or an impact on an outstretched arm, the ligaments holding the collarbone can tear. In some cases, the collarbone visibly separates from the shoulder at the acromioclavicular (AC) joint.
SYMPTOMS
Typically, there is severe pain and limited ability to move the shoulder at the time of injury. Swelling and bruising follow soon after.
PREVENTION
Proper equipment for the position played and proper tackling form for the tackler and the player being tackled can reduce the risk of an AC joint separation.
DIAGNOSIS
The joint may appear abnormal in a visual exam. With a physical exam, there is tenderness at the AC joint. An X-ray typically rules out a clavicle or collarbone fracture. An AC joint separation is categorized based on the severity of the injury.
TREATMENT
In the early phase, rest and activity restrictions are recommended. Immobilization in a sling helps rest the shoulder during healing. Most cases will heal on their own with these treatments, and surgery is rarely needed.
RETURN TO SPORTS
Follow-up physical exams are important to assess the tightness of the healing ligament and the mobility of the shoulder. Returning to sports before healing puts the shoulder at risk of a more severe injury.
Successful pitching requires the arm to tolerate large forces. The tissues in the front of the shoulder become longer with repeated stretching at high speeds. Over time, the tissues in the back become shorter and, together, this limits the range of motion and can lead to thrower’s shoulder or Glenohumeral Internal Rotation Deficiency (GIRD).
SYMPTOMS
Generalized pain in the front of the shoulder may be a sign of changes in the shoulder, or it may be a sign of injury.
PREVENTION
It is unclear if this change in shoulder motion is necessary for successful pitching. Therefore, preventing symptoms related to this change is the goal. Recognizing signs and symptoms and responding promptly with proper rest are the most important steps.
DIAGNOSIS
A thorough diagnosis includes a conversation about past medical history, the current injury, onset of symptoms, as well as sport exposure. The latter includes position played, frequency of practices and games, length of seasons and number of pitches for baseball. Imaging is essential when the physical exam suggests other tissues may have been damaged.
TREATMENT
Treatment typically revolves around learning exercises like shoulder blade stabilization to reduce injury related to excessive rotation in one direction. Treating a change in motion may not be necessary, unless the symptoms are directly related to a change in motion.
RETURN TO SPORTS
ELBOW
The elbow is a combination hinge-and-pivot joint made up of three bones: the upper arm bone (humerus) and the two bones in the forearm (radius and ulna). The hinge part of the joint lets the arm bend like the hinge of a door; the pivot part lets the lower arm twist and rotate.
Muscles, ligaments and tendons hold the elbow joint together.
Cartilage, or soft tissue, protects the bony surfaces. It’s also found in young bones at areas that are still growing. These growth areas are at risk for injury.
Elbow injuries in young athletes are on the rise, partly due to year-round training and competition. Overuse injuries often occur in throwing sports and gymnastics. Early recognition of signs and symptoms can prevent problems and even career-changing injuries. In youth sports, preventing elbow injuries, particularly those requiring surgery, is a priority.

Pain typically occurs on the inside “bump” of the elbow during or after activity like throwing or pitching. Repeated pulling can tear ligaments and tendons away from the bone. This tearing may pull tiny bone fragments with it in the same way a plant takes soil with it when uprooted. This can disrupt normal bone growth, resulting in deformity and instability with throwing.
SYMPTOMS
- Elbow pain with throwing or after activity
- Pain and tenderness on the inside of the elbow (on the bump)
- Soreness for days to weeks
- Worsening control with throwing
- Inability to throw desired distance
- Difficulty fully straightening or bending the elbow
- Locking of the elbow
TREATMENT
- Rest. Continuing to throw may lead to major complications and jeopardize a child’s ability to remain active in a throwing sport.
- Common recommendations include 2-4 weeks of complete rest.
- Apply ice packs to bring down any swelling.
- Proper stretching and strengthening.
- May require a cast or splint if the pain does not resolve with rest.
- Therapy to focus on flexibility, strength, trunk and scapular stabilization.
- Focused training to improve throwing form is needed.
- Surgery to stabilize the medial epicondyle is rarely necessary, especially in girls over 12 years and boys over 14 years.
With this injury, the athlete will typically hear a pop and will have severe pain, swelling and bruising. The child may or may not have had elbow pain before the injury. With operative or nonoperative treatment, most kids may return to the same level of sports following treatment.
SYMPTOMS
- May hear a pop or giving way
- Immediate pain on inside of the throwing elbow
- Immediate, visible swelling and bruising
- May have pain with wrist movement
- May have numbness or tingling in the ring finger and little finger
- Unable to bend the elbow or pick up heavy objects
TREATMENT
- Ice may be helpful to reduce inflammation in early stages.
- Anti-inflammatory medication may be needed.
- For fractures in good position, a splint is recommended for 2-3 weeks.
- In all cases, aggressive range of motion early in healing stages (within 2-3 weeks) is recommended.
- Therapy to focus on flexibility, strength, trunk and scapular stabilization.
- Strengthening and proper throwing progression 8-12 weeks following injury.
- Focused training to improve throwing form is needed.
SYMPTOMS
- Pain in the back of the elbow during follow-through and when straightening arm
- Pain in the back of the elbow that becomes gradually worse over time
- Inability to completely straighten the arm
- Popping and locking may be present, but is rare
TREATMENT
- Rest. Continuing to throw with this problem may lead to major complications and permanently jeopardize a child’s ability to play.
- Common recommendations include 2-4 weeks of complete rest.
- Ice pack may help reduce inflammation.
- Anti-inflammatory medication may be needed.
- Therapy to focus on flexibility, strength, trunk and scapular stabilization.
- Focused training to improve throwing form is often necessary.
- Surgery is only needed in severe cases.
SYMPTOMS
- Dull achiness on the outside of the elbow
- Pain that worsens with activity and improves with rest
- Pain that gradually worsens over time
- Inability to completely straighten the arm
- Popping and locking
TREATMENT
- Rest. Continuing to throw with this problem may lead to major complications and permanently jeopardize a child’s ability to play.
- Strict throwing restrictions protect the elbow from further injury.
- Immobilization may be necessary in severe cases or if restrictions are ignored.
- If the elbow does not heal or the tissue becomes unstable or loose, surgery may be the best option.
- Therapy to focus on flexibility, strength, trunk and scapular stabilization.
- Resume throwing at a minimum of 6-12 months.
- Focused training to improve throwing form is often necessary.
These injuries rarely occur with a single event or throw. They’re more common in older adolescents, but may occur in younger athletes as well. An MRI with contrast injected in the joint gives the best view of a tear.
The surgical reconstruction of the UCL is named after Tommy John, a baseball player who returned to major league pitching after having this procedure. This surgery doesn’t always lead to improved performance. Though many athletes do return to play after this procedure, preventing the injury is ideal.
SYMPTOMS
- Pain over the inside of the elbow with throwing
- Gradually increasing pain
- May feel unstable or “give way”
- Rarely popping
TREATMENT
- Rest for at least 6-12 weeks. Continuing to throw with this problem may lead to major complications and permanently jeopardize a child’s ability to play.
- Immobilization for 4-6 weeks followed by a hinged elbow brace.
- Anti-inflammatory medication.
- Therapy to focus on flexibility, strength, trunk and scapular stabilization.
- Surgery is typically needed for complete tears or if the elbow is unstable.
- Focused training to improve throwing form is often necessary.
HIP
Conditions we treat:
- Femoral acetabular impingement (FAI)
- Labral tears
- Snapping hip
- Hip and groin strains
- Overuse hip conditions (such as those seen in dancers and gymnasts)
- Pelvic apophysitis
- Pelvic avulsion fractures

ANKLE
Conditions we treat:
- Ankle instability
- Ankle sprain
- Ankle fractures
- Stress fractures of the foot and ankle
- Cartilage conditions such as osteochondritis dissecans (OCD)
- Sever’s disease

CONCUSSION

SIGNS
- Appear dazed or stunned
- Be confused
- Forget plays
- Be unsure of game, score or opponent
- Exhibit unsteadiness
- Move clumsily
- Answer questions slowly
- Lose consciousness
- Have memory loss
- Be more sleepy or tired than usual
- Seem sad, nervous or anxious
- Be irritable, easily frustrated or upset
- Have problems with academic performance
SYMPTOMS
- Headaches
- Concentration or memory problems
- Nausea
- Balance problems or dizziness
- Double or blurred vision
- Feelings of being “in a fog” or slowed down
- Sensitivity to light or noise
- Confusion
- Just “not feeling right” or “feeling down”
For additional information, view this handout.
Athletes 10 years of age and older without a recent history of a head injury can take a baseline test, used for future reference. For athletes with a recent head injury, we recommend making an appointment with one of our sports medicine physicians before scheduling a baseline test. In the event of a concussion, an athlete can repeat the test and the Credentialed ImPACT™ Consultant (CIC) can then analyze the results. The comparison of the post-injury scores to the baseline test helps the provider develop an individualized plan for the athlete.
Our Sports Medicine specialists, Shane M. Miller, M.D., and Jane S. Chung, M.D., are Credentialed ImPACT™ Consultants. Along with our athletic trainers, Josh Stevens, A.T.C., L.A.T., I.T.A.T., and Jamie Wightman, A.T.C., L.A.T., O.P.A.-C., I.T.A.T., they have undergone specialized ImPACT™ training to administer and interpret this test as part of their concussion care management.
PAYMENT
VISIT
A parent may remain in the room with the athlete during the test. If additional family members, particularly young siblings, are present, we request they remain in the waiting area with a parent.
RESULTS
FEMALE ATHLETE TRIAD

OSTEOCHONDRITIS DISSECANS
We see OCD most often in patients that are 12-16 years old. Though it can happen to anyone, we see this problem in athletes that perform repetitive motions like running, jumping, pitching or certain motions in gymnastics.
We’re unsure what causes this in some patients. It could be a change in the blood supply to the bone and cartilage. Sometimes an injury causes the changes. This is called an osteochondral fracture or injury.

SYMPTOMS
There may be pain in the joint that gets worse with activity. Or there may be symptoms like popping, clicking or swelling in the joint.
TREATMENT
RETURN TO SPORTS
KNEE
Conditions we treat:
- Anterior cruciate ligament (ACL) tears
- Posterior cruciate ligament (PCL) tears
- Collateral ligament tears
- Meniscus tears
- Discoid meniscus
- Cartilage conditions such as osteochondritis dissecans (OCD)
- Kneecap instability and dislocations
- Growth plate fractures
- Tibial spine fractures
- Osgood-Schlatter disease
- Sinding-Larsen-Johansson (SLJ) syndrome
