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Ask Dr. Rick – November 2011 – Medial Collateral Ligament Injuries

December 12, 2011

With the beginning of hockey camp, the most common injury we will see is the medial collateral ligament sprain. Prototypically, when an athlete goes into the boards, is cross-checked or catches an edge, it causes a twisting stress to the inside part of the knee. At that point, one of two things can happen – either the medial meniscus or the medial collateral ligament can tear. In hockey injuries, some of the most common injuries we see are medial collateral ligament injuries. The medial collateral ligament is one of the four main ligaments that are critical to the stability of the knee. The medial collateral ligament is made of fibrous tissue; it is very strong and it stops the knee from going into what we call “valgus,” which is when the knee becomes “knock kneed.” The ligament tears, it is extremely painful, there is swelling and the athlete is sidelined. The medial collateral ligament goes from the femur to the tibia and stabilizes the inside part of the knee.

When the medial collateral ligament is torn, the knee opens up into valgus, causing shifting and significant pain. The ligament can either tear from the femur, the tibia or mid-substance, and the ligament can be grade 1, grade 2 or grade 3. A grade 1 medial collateral ligament tear is an incomplete tear. The tendon is still intact, and the athlete will miss one or two weeks of sports participation. Grade 2 medial collateral ligament tears are incomplete.There are some fibers intact, but the majority of the ligament is torn. There is pain, there is more swelling, there is some instability and the athlete will miss three to four weeks of participation. A grade 3 medial collateral ligament tear is a complete tear. The knee is unstable, and the athlete will mix approximately six weeks; this may necessitate surgery.

In general, medial collateral ligament tears are treated conservatively without surgery, and they are treated with physical therapy and a brace. The initial care and treatment is decreasing the swelling and pain and allowing the ligament to heal. Phase 2 is strengthening the leg by means of quadricep, hamstring and gluteal strengthening. The third phase is sports participation, where the sports activity is recreated in the physical therapy clinic. It is reasonable to brace the athlete after a complete medial collateral ligament tear to protect the ligament from reinjury. This also gives the athlete a sense of confidence when returning to full, unrestricted sports. In general, medial collateral ligament injuries heal uneventfully. They rarely require surgery, and the prognosis is quite good. Let’s play hockey!

Ask Dr. Rick

“Dear Dr. Rick: Frequently, when I sleep at night, I get tingling in my pinkie finger. This does improve as I straighten my elbow and shake my hand. Do you have any idea what this could be from? Thank you very much.” — Linda R., Wentzville, Mo.

Linda, typically, these symptoms are consistent with ulnar nerve entrapment. The ulnar nerve is the “crazy bone” nerve and can cause tingling and numbness in your fourth and fifth fingers. It may be that when you are sleeping, keeping your elbow bent is putting pressure on the nerve and causing tingling in your fingers. I would try sleeping with your elbow straight and possibly putting a pillow to protect the inside part of your elbow; if your tingling and numbness persists, I would see your physician.

“Dear Dr. Rick: I have been training for a marathon and have noticed my toes get black directly following my long runs. It appears that my toenails are dying or becoming black and thick. Do you have any suggestions?” — Sally W., Highland, Ill.

Sally, this is a common problem with long-distance runners and is usually due to the tip of your toe hitting the end of your shoe. The most common reason for this is that your shoes are either too small or don’t fit your foot appropriately. I would initially suggest buying a pair of shoes a half size larger and to make sure that the fit is perfect; this should resolve your black toenails. If this does not resolve your problem, you may need to go to an orthotic. An orthotic will unload your big toe, stop it from hitting the tip of your shoe and take the stress off your great toe. Good luck on your training.

November Medical Tip: Make sure you’re getting enough Omega-3 supplement in your diet.

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