Posts

Dr. Blazuk and colleagues study the Validity of Indirect Ultrasound Findings…

Title: Validy of Indirect Ultrasound Findings in Acute Anterior Cruciate Ligament Ruptures

Ken Mautner, MD, Walter I. Sussman, DO, Katie Nanos, MD, Joseph Blazuk, MD, Carmen Brigham, ATC, Emily Sarros, ATC

Objectives: Ultrasound (US) is increasingly being used as an extension of the physical examination on the sidelines, in training rooms, and in clinics. Anterior cruciate ligament (ACL) injury in sport is common, but the literature on US findings after acute ACL rupture is limited. Three indirect US findings of ACL rupture have been described, and this study assessed the validity of these indirect signs.

American Institute of Ultrasound in Medicine /  J Ultrasound Med 2018; 9999:1-8 / 0278-4297

 

Click here for full article!

 

Dr. Lederman and colleagues discuss the outcome of a subscapularis peel repair with a stem-based repair after total shoulder arthroplasty

Title: Healing and functional outcome of a subscapularis peel repair with a stem-based repair after total shoulder arthroplasty

Reuben Gobezie MD, Patrick Denard MD, Yousef Shishani MD, Anthony Romeo MD, Evan S. Lederman MD

Background

The purpose of this study was to evaluate functional outcome and healing of a subscapularis peel with a stem-based repair after total shoulder arthroplasty (TSA). The hypothesis was that the repair would lead to subscapularis healing in the majority of cases.

Full article: https://doi.org/10.1016/j.jse.2017.02.013

Journal of Shoulder and Elbow Surgery

Volume 26, Issue 9, September 2017, Pages 1603-1608

Dr. Lederman, Dr. Lund and former fellows have described a new class of labral tears in the shoulder*

Title: The Glenoid Labral Articular Teardrop Lesion: A Chondrolabral Injury With Distinct Magnetic Resonance Imaging Findings

Evan S. Lederman MD, Stephen Flores MD, Christopher Stevens MD, Damien Richardson MD, Pamela Lund MD

*Identification of this lesion of MRI can help in diagnosis and treatment of labral tears.

Purpose

Evaluation and description of a pathognomonic lesion identified on magnetic resonance imaging (MRI) of a chondrolabral injury of the glenohumeral joint.

Methods

Patients were prospectively identified at the time of MRI by a characteristic teardrop appearance of a pedicled displaced chondrolabral flap in the axillary recess on coronal imaging and retrospectively reviewed.

Full article: https://doi.org/10.1016/j.arthro.2017.08.236

Arthroscopy: The Journal of Arthroscopic & Related Surgery

Volume 34, Issue 2, February 2018, Pages 407-411

 

Dr. Lederman and colleagues review how bone can react differently to shoulder replacements and document the potential benefit and safety of short stem shoulder implants

Title: Proximal Stress is Decreased with a Short Stem Compared to a Traditional Length Stem In Total Shoulder Arthroplasty

Patrick J. Denard MD, Matthew P Noyes MD, J B Walker, MD, Yousef Shishani, MD, Reuben Gobezie MD, Anthony A Romeo, MD, Evan S. Lederman, MD

Background

This study compared the outcome and radiographic humeral adaptations after placement of a traditional-length (TL) or short-stem (SS) humeral component during total shoulder arthroplasty (TSA). The hypothesis was there would be no difference in outcome or radiographic adaptations.

Full article: https://doi.org/10.1016/j.jse.2017.06.042

The Journal of Shoulder and Elbow Surgery

Volume 27, Issue 1, January 2018, Pages 53-58

Dr. Josh Vella – 5th Annual World Congress in Orthopedics-2018

Dr. Josh C. Vella, TOCA Hand and Upper Extremity Surgeon, is honored to carry the distinction of becoming an international lecturer at the 5th Annual World Congress in Orthopedics-2018 in Milan, Italy.

He was one of a few distinguished international lecturers who discussed various new treatment options with the theme of this years conference “Breaking Barriers in Orthopedic Research”.

Photo: Dr. Josh C. Vella (center), Dr Michael Boland (right) of The Hand Institute, University of Auckland, New Zealand and Dr  Scott Fried (left) in collaboration with Thomas Jefferson University Hand Center in Philadelphia.

Dr. Lederman was a recent invited lecturer at the American Academy of Orthopedic Surgeons Annual Meeting 2018

 

Complex Shoulder Arthroplasty: Primary and Revision, Anatomic and Reverse, Three-Dimensional Planning – When and How? A case-based, comprehensive review of shoulder arthroplasty.

Moderator: Asheesh Bedi, MD: Panelists: Evan Lederman, Anthony Romeo, Gilles Walch, JP Warner, Brad Parsons, john Tokish, David Dines, Josh Dines, Michael Freehill, Xinning Li

New Orleans, LA – AAOS 2018 – American Academy of Orthopedic Surgeons (AAOS) 2018 Annual meeting at the Ernest Morial Convention Center ,Tuesday March 6, 2018. With over 30,000 attendees, the conference is the preeminent meeting on musculoskeletal education to orthopaedic surgeons and allied health professionals in the world.

Dr. Padley has a long tradition of providing care for sports teams.

Dr. Padley returned to the Dominican Republic in April with the Cincinnati Reds for the annual opening of their Dominican complex. The trip included evaluations of 40+ Dominican athletes hoping to advance their way up the Cincinnati Reds baseball system. This marks the beginning of the baseball season for the Dominican teams. Most major league baseball teams have affiliates in the Dominican in search of that next great player! Dr. Padley is an orthopedic consultant and provider to the Cincinnati Reds for major league baseball spring training and throughout the year for their minor league and rookie league teams. In additional to this health care relationship, he is also a consultant to Japanese professional baseball for the Saitama Seibu Lions. With his expertise in hip disorders and injuries, Ballet Arizona benefits from his service as a consultant. He was a team physician for the WNBA’s Phoenix Mercury for four years including the 2014 championship season. Dr. Padley proudly serves as the team physician for Benedictine University in Mesa as well as Millennium and Verrado High Schools in Goodyear.

For more information on Dr. Padley, Click HERE

 

Congratulations to Dr. Evan Lederman for his recent publication!

Title: The Evolution of the Superior Capsular Reconstruction Technique

Alan M. Hirahara, MD, FRCSC; Evan S. Lederman, MD; Wyatt J. Andersen, ATC; and Kyle Yamashiro, PT, DPT, CSCS

Introduction

Irreparable, massive rotator cuff tears can result in unacceptable functional deficits in patients. When the supraspinatus tears and retracts medially, the superior capsule is also disrupted, and superior constraint is lost. With no superior restraint to the humerus, the humeral head migrates superiorly, causing a decrease in the acromial-humeral distance. [1-4]

Biomechanical analysis has shown that a defect in the superior capsule results in a minimum 200% greater glenohumeral superior translation and subacromial peak contact pressure compared with an intact capsule. [3] The malposition of the humeral head leads to functional abnormalities and pseudoparalysis.

Numerous proposed treatments for massive rotator cuff tears – including debridement and tenotomy, tendon transfers, and reverse total shoulder arthroplasty – have yielded mixed results and high complication rates. [5-12] In particular, reverse shoulder arthroplasty can result in humeral or glenoid fractures, persistent anterior or posterior instabilities, loosening of the glenoid or humeral cemented components, dislocations, and infection. [5-7]

The superior capsular reconstruction (SCR) was described by Hanada et al [13] in 1993 and by Mihata et al [1] in 2013 as an alternative procedure to increase function and decrease pain by restoring the restraint mechanisms in the shoulder. Using a graft to recreate the superior capsule, the humeral head is centered in the glenoid, allowing the larger muscles (ie, deltoid, latissimus dorsi, and pectoralis major) to function appropriately. Mihata et al [3,4] have found that the SCR reduces glenohumeral superior translation and subacromial contact force.

Full article link below.

ICJR.net  March 2018

HUDDLE UP ABOUT SPORTS SAFETY

BACK TO SCHOOL, BACK TO SPORTS, TIME TO HUDDLE UP ABOUT SPORTS SAFETY

For many kids, back to school means back to sports. Youth sports are, and should always be, a valuable experience, filled with challenges, competition and fun. But too many kids are stuck on the sidelines because of an injury that is preventable. It is that time of year to huddle up about sports safety!

Every year, millions of teenagers participate in high school sports. An injury to a high school athlete can be a significant disappointment for the teen, the family, and the coaches. The pressure to play can lead to decisions that may lead to additional injury with long-term effects. High school sports injuries can cause problems that require surgery as an adult, and may lead to arthritis later in life.

When a sports injury occurs, it is important to quickly seek proper treatment. To ensure the best possible recovery, athletes, coaches, and parents must follow safe guidelines for returning to the game.

The Adolescent Athlete

Teenage athletes are injured at about the same rate as professional athletes, but injuries that affect high school athletes are often different from those that affect adult athletes. This is largely because high school athletes are often still growing.

Growth is generally uneven: Bones grow first, which pulls at tight muscles and tendons. This uneven growth pattern makes younger athletes more susceptible to muscle, tendon, and growth plate injuries.

Types of High School Sports Injuries

Injuries among young athletes fall into two basic categories: overuse injuries and acute injuries. Both types include injuries to the soft tissues (muscles and ligaments) and bones.

Acute Injuries

Acute injuries are caused by a sudden trauma. Examples of trauma include collisions with obstacles on the field or between players. Common acute injuries among young athletes include contusions (bruises), sprains (a partial or complete tear of a ligament), strains (a partial or complete tear of a muscle or tendon), and fractures.

A twisting force to the lower leg or foot is a common cause of ankle fractures, as well as ligament injuries (sprains).

Reproduced and modified with permission from The Body Almanac. © American Academy of Orthopaedic Surgeons, 2003.

Overuse Injuries

Not all injuries are caused by a single, sudden twist, fall, or collision. Overuse injuries occur gradually over time, when an athletic activity is repeated so often, parts of the body do not have enough time to heal between playing.

Overuse injuries can affect muscles, ligaments, tendons, bones, and growth plates. For example, overhand pitching in baseball can be associated with injuries to the elbow. Swimming is often associated with injuries to the shoulder. Gymnastics and cheerleading are two common activities associated with injuries to the wrist and elbow.

Stress fractures are another common overuse injury in young athletes. Bone is in a constant state of turnover—a process called remodeling. New bone develops and replaces older bone. If an athlete’s activity is too great, the breakdown of older bone occurs rapidly, and the body cannot make new bone fast enough to replace it. As a result, the bone is weakened and stress fractures can occur—most often in the shinbone and bones of the feet.

Catastrophic Sports Injuries

Many sports, especially contact sports, have inherent dangers that put young athletes at special risk for severe injuries. Even with rigorous training and proper safety equipment, children are at risk for severe injuries to the head and neck with damage to the brain or spinal cord.

Catastrophic injuries have been reported in a wide range of sports, including ice hockey, wrestling, football, swimming, soccer, pole vaulting, cheerleading, and gymnastics. It is important for coaches, parents, and athletes to be aware of the guidelines and regulations developed for each sport to prevent head and neck injury.

Concussion

Concussions are mild traumatic brain injuries. They are caused by a blow to the head or body that results in the brain moving rapidly back and forth inside the skull.

Although some sports have higher instances of concussion—such as football, ice hockey, and soccer—concussions can happen in any sport or recreational activity.

In 2010, the American Academy of Pediatrics recommended that young athletes with concussions be evaluated and cleared by a doctor before returning to sports. The American Academy of Neurology issued a similar statement, and stressed that doctors who clear athletes for return to sports should be trained in managing and assessing sports concussions.

Growth Plate Injuries

Growth plates are areas of developing cartilage tissue near the ends of long bones. When a child becomes full-grown, the growth plates harden into solid bone.

Because growth plates are the last portion of bones to harden (ossify), they are vulnerable to fracture. Growth plates regulate and help determine the length and shape of adult bone, therefore, injuries to the growth plate can result in disturbances to bone growth and bone deformity.

Growth plate injuries occur most often in contact sports like football or basketball and in high impact sports like gymnastics.

 

Prompt Medical Attention

Whether an injury is acute or due to overuse, a high school athlete who develops a symptom that persists or that affects his or her athletic performance should be examined by a doctor. Untreated injuries could lead to permanent damage or disability.

Some athletes may downplay their symptoms in order to continue playing. Coaches and parents should be aware of the more common signs of injury, such as pain with activity, changes in form or technique, pain at night, and decreased interest in practice.

Doctor Examination

During the examination, the doctor will ask about how the injury occurred, the symptoms, and will discuss the athlete’s medical history. During the physician examination, the doctor will look for points of tenderness, as well as range of motion.

If necessary, the doctor may recommend imaging tests, such as x-rays or other tests, to evaluate the bones and soft tissues.

Treatment

Treatment will depend upon the severity of the injury, and may include a combination of physical therapy, strengthening exercises, and bracing. More serious injuries may require surgery.

 

Return to Play

A player’s injury must be completely healed before he or she returns to sports activity.

  • In case of a joint problem, the player must have no pain, no swelling, full range of motion, and normal strength.
  • In case of concussion, the player must have no symptoms at rest or with exercise, and should be cleared by the appropriate medical provider.

Media stories about the early return to competition by professional athletes following injury create the impression that any athlete with proper treatment can return to play at the same ability level, or even better.

It is important for players, parents, and coaches to understand that depending on the type of injury and treatment required, the young athlete may not be able to return to the game at the same level of play—no matter how much effort is put into injury rehabilitation.

 

Prevention

Many high school sports injuries can be prevented through proper conditioning, training, and equipment.

High school athletes require sport specific training to prevent injury. Many injuries can be prevented with regular conditioning that begins prior to the formal sports season. Injuries often occur when athletes suddenly increase the duration, intensity, or frequency of their activity. Young athletes who are out of shape at the start of the season should gradually increase activity levels and slowly build back up to a higher fitness level.

Using proper technique for the position being played is also key to preventing injury. Proper equipment—from the right shoes to safety gear—is essential. In addition, injuries can be prevented when athletes understand and follow the rules of the game, and display good sportsmanship.

Because many young athletes are focusing on just one sport and are training year-round, doctors are seeing an increase in overuse injuries. The American Academy of Orthopaedic Surgeons has partnered with STOP Sports Injuries to help educate parents, coaches, and athletes about how to prevent overuse injuries. Specific tips to prevent overuse injuries include:

  • Limit the number of teams in which your child is playing in one season. Athletes who play on more than one team are especially at risk for overuse injuries.
  • Do not allow your child to play one sport year-round—taking regular breaks and playing other sports is essential to skill development and injury prevention.

As we begin the new school year, Safe Kids is teaming up with Johnson & Johnson to keep kids healthy and injury-free so they can reach their full potential. We conducted a survey of parents, coaches and young athletes to explore how the current culture of sports may be leading to unnecessary injuries, and how that culture needs to change.

Here are three ways to get started.

  • Put an end to dirty play. One in four young athletes reported it is normal to commit hard fouls and play rough to “send a message” during a game. This norm leads to a disturbing number of injuries: 33 percent of athletes report being hurt as the result of “dirty play” from an opponent. Sports teach valuable lessons and should be competitive and entertaining but we have to move away from a “winning at all costs” mentality that is actually detrimental to the health and development of our young athletes.
  • Let’s give coaches the training they need and want. One in four coaches say they don’t take any specific actions to prevent sports injuries. Less than half of coaches say they have received certification on how to prevent and recognize sports injuries. Shouldn’t there be more training for coaches to ensure that they are well versed in the proper techniques for top performance and injury prevention?
  • Teach young athletes to speak up when they are injured.About 42 percent of players reported they have hidden or downplayed an injury during a game so they could keep playing. We can remove the terms “taking one for the team”, “suck it up” and “playing through an injury” from the dialogue. At the end of the day, young players must feel it’s OK to tell coaches, parents and other players that they’ve been hurt and it’s time to sit it out.

Changing the culture in sports isn’t about limiting kids. It’s about creating an atmosphere where our young athletes can compete, have fun and reach their full potential. Let’s get the conversation going. Working together, we can keep our kids active, strong and safe so they can enjoy the sports they love for a lifetime.

 

If you are injured the Team of Orthopedic Physicians and Orthopedic Sports Medicine Physicians here at TOCA are here to help! To learn more or schedule an appointment call: 602-277-6211.

 

Learn more at safekids.org. and STOP Sports Injuries 

Additional TOCA articles to consider reading: Knee Injuries, Ankle Sprains and Shoulder Injury Prevention tips! 

#Recovery #Results #Relief #TOCA #TOCAMD #STOPSportsInjuries #Safekids #MyOrthoDoc #SportsInjury #SportsMedicine

Memorial Day Safety and Injury Prevention

This Memorial Day, at TOCA and around the Nation we honor those Americans who have put their lives on the line to bravely defend our country’s freedom. Each day and especially on Memorial Day we take a moment to remember the men and women who served and sacrificed their lives to protect our great Nation and hard-won freedom.

Memorial Day Safety and Injury Prevention: The first three-day holiday weekend of the summer and the unofficial “kickoff” to summer is upon us. We all have various activities scheduled for the weekend, which may include cookouts, picnics, boating, swimming, motor sports, work around the house, etc. No matter what you have planned, please make safety a part of your weekend.

DRIVING SAFETY: This weekend, 33 million Americans are expected to hit the roads, according to AAA, but more traffic means more traffic accidents.

  • Be well rested and alert, use your seat belts, observe speed limits and follow the rules of the road.
  • If you plan on drinking alcohol, designate a driver who won’t drink.
  • Give your full attention to the road. Avoid distractions such as cell phones.
  • Use caution in work zones. There are lots of construction projects underway on the highways.
  • Don’t follow other vehicles too closely.
  • Clean your vehicle’s lights and windows to help you see, especially at night. Turn your headlights on as dusk approaches, or during inclement weather. Don’t overdrive your headlights.
  • Don’t let your vehicle’s gas tank get too low. If you have car trouble, pull as far as possible off the highway.
  • Carry a Disaster Supplies Kit in your trunk.
  • Let someone know where you are going, your route and when you expect to get there. If your car gets stuck along the way, help can be sent along your predetermined route.

GRILLING SAFETY: Hot dogs, hamburgers, and corn on the cob; nothing says summer like grilling!

  • Ensure that the grill has been thoroughly cleaned. Dirty grills cause many injuries, particularly propane grills.
  • Always supervise a barbecue grill when in use.
  • Never grill indoors – not in your house, camper, tent, or any enclosed area.
  • Make sure everyone, including the pets, stays away from the grill.
  • Keep the grill out in the open, away from the house, the deck, tree branches, or anything that could catch fire.
  • Use the long-handled tools especially made for cooking on the grill to keep the chef safe.
  • Do not wear loose clothing while you grill
  • Never add charcoal starter fluid when coals have already been ignited.
  • Always follow the manufacturer’s instructions when using grills.

WATER SAFETY: The beginning of summer also means the start of pool or beach season for many in the U.S.

  • Do your part, be water smart! Ensure that everyone in the family learns to swim well.
  • Appoint someone as lifeguard, rather than assuming one of your partygoers is keeping an eye on swimmers.
  • Adults: actively supervise children; stay within arm’s reach of young children and newer swimmers. And kids: follow the rules.
  • Don’t just pack it; wear your U.S. Coast Guard-approved life jacket – always when on a boat and if in a situation beyond your skill level. Inflatable children’s toys and water wings can be fun, but they are no substitute for a life jacket and adult supervision.
  • Swim as a pair near a lifeguard’s chair – everyone, including experienced swimmers, should swim with a buddy in areas protected by lifeguards.
  • Reach or throw, don’t go! Know what to do to help someone in trouble, without endangering yourself; know how and when to call 9-1-1; and know CPR.
  • Don’t fool with a pool: fence it in. Enclose your pool and spa with four-sided, four-foot fencing and use self-closing, self-latching gates.

Use Extra Caution with Fireworks: Nothing wraps up a great Memorial Day party better than a blazing fireworks display. Some towns and cities allow for select smaller fireworks to be enjoyed at home. If that’s the case, follow your local laws about what kind of fireworks are permitted.

  • Fireworks should be lit outside in an area without flammable branches or grass. Have a water hose or bucket of water handy to extinguish spent fireworks.
  • After you light a firework, get away to a safe distance. Don’t try to hold a firework in your hand after it’s lit, and do not light it into a container of any kind. Only responsible adults should light fireworks. Always ensure they are safely disposed of after the fun is over.

Stay Safe Under the Sun: There’s no better feeling than soaking in the new summer sun on Memorial Day — but don’t forget sunscreen and keep hydrated.

  • Skin can become severely burned after just a few hours in the sun, which can increase your risk of skin cancer in the long run.
  • Consider providing or looking for available shade, like umbrellas or covered picnic areas, to reduce sun exposure for yourself and your guests. A hat and sunglasses can offer extra coverage.
  • Don’t forget to reapply the sunscreen after two hours of sun exposure.
  • Drink plenty of water before, while, and after you are active. This is very important when it’s hot out and when you do intense exercise. You can drink water or rehydration drinks.
  • Encourage your child to drink extra fluids or suck on flavored ice pops, such as Popsicles.
  • Stop working outdoors or exercising if you feel dizzy, lightheaded, or very tired.

Injury prevention is not only part of our mission here at TOCA, the TOCA team and physician group are dedicated to adult and youth safety. Our experts work with and in the community year-round and emphasize injury prevention over the summer and around holidays.

Have a safe and enjoyable holiday!

“In the End, we will remember not the words of our enemies, but the silence of our friends.” ~Martin Luther King, Jr.

 #thankyouforyoursacrifice #injury prevention #holidaysafteytips #Recovery #Results #Relief #TOCA