Great Questions to ask Your Doctor

Great questions to ask your doctor about options and outcomes before you begin a treatment can be found HERE.

Shoulder Separations

It is football season with hockey not too far behind so we are beginning to see shoulder separation injuries showing up at the Washington University Orthopedic Injury Clinic. Patients always are confused as is the media on the difference between a shoulder separation and a shoulder dislocation. A Shoulder Disloction and its Treatment as previously reviewed on this blog refers to the humeral head (ball) sliding off the glenoid (socket). This frequently needs to be put back in place and frequently requires surgery to prevent future episodes.

A shoulder separation on the other hand is typically treated conservatively and rarely requires surgical reconstruction except in severe circumstances such as the injury Sam Bradford sustained while playing for Oklahoma. The injuries most commonly occur in contact sports but are also frequently seen in cycling injuries when riders fly over the handle bars and land on their shoulder. It is typically a blow to the point of the shoulder that drives the shoulder blade down and stretches or tears the ligaments that connect the collar bone (clavicle). These ligaments are called the coracoclavicular

ligaments and are 2 tough bands running from the collar bone to the coracoid -- a bony prominence projecting from the scapula. It also occurs frequently in hockey when players are checked into the boards or fall and hit the ice. Typically it causes local pain in the shoulder area with limited range of motion and weakness. Initially it is treated with a sling ice. A plain x-ray showing the depressed shoulder blade and ruling out a fracture is all that is necessary. An MRI is not required.

Physical Therapy is begun soon after the injury with a focus on motion and strength. Once the pai n is tolerable and full motion and strength is regained the athlete can return to sports with no long term sequelae except some prominence of the clavicle in that area.

 There are 6 grades of injury with most falling into Grades 1,2 and 3. Grades 1 and 2 are always treated conservativeley. Grade 3 with worse ligament damage and more deformity is still usually handled without surgery. Occasionally throwers or other overhead repetitive workers require repair/reconstruction of the ligaments. Fortunately, despite several injuries of the Type 3 severity with the St. Louis Blues we have never had to perform a surgical reconstruction. Grade 1 injuries typically require 1-2 weeks for recovery, Grade 2 2-4 weeks of recovery and Grade 3 treated without surgery are 6 week injuries.

Cupping? Why Michael Phelps and others are doing it. Read about it here.

If you are wondering why Michael Phelps and other swimmer and athletes have those purplish circles over their body it's called cupping and aimed at improving recovery following workouts or competition. Read more details HERE

Want to eat like an Olympian? Look at these examples

The amount of food it takes to fuel an Olympian is unbelievable. See examples HERE

Oblique Muscle Strains

Once again this season baseball players have been affected by oblique muscle strains. Most recently it impacted the St. Louis Cardinals when their All Star infielder Matt Carpenter sustained the injury missing a month of games including the All Star Game. Why are these such significant injuries for some sports and playing positions while you never hear about them in other sports?

The oblique muscles reside on both sides of the abdomen and chest running from the pelvis to the chest and ribs in the front and chest and spine in the back. There are 2 muscle groups on each side--- the internal and external obliques. Rather than running straight vertically or horizontally they run “obliquely” across the body and thus their name is derived.

These muscles are critical for rotational activities and that is why they are more impactful for certain sports. While challenging for any athlete an oblique muscle strain is the worst for those athletes that repetitively rotate. Thus baseball pitchers and hitters are highly affected. Hockey players are also bothered by it while shooting especially during slap shots.

We have had several with the St. Louis Blues over the years that resulted in several man games lost. It much less frequently affects sports that are more linear such as track, swimming, football or basketball. It is an infrequent injury even for quarterbacks and I can’t remember a significant oblique injury with loss of time for any of the Rams quarterbacks.

Treatment is similar to other muscle strains and involves conservative management with ice, NSAIDs and rehabilitation including stretching and strengthening. Nothing seems to shorten

the recovery which for baseball position players is typically a month. If anything more than a minor strain for a pitcher it can cost 6-8 weeks. Cortisone injections can be utilized, but still time is the best ally and cortisone is relatively a quick fix. These muscle strains typically are diffuse over a relatively large area and thus difficult to pinpoint for an injection. Likewise there is no scientific evidence that platelet rich plasma (PRP) or stem cell injections will speed recovery. That is why these are difficult injuries for the athletes and the fans that follow them. It is hard to be patient.

Exercise Improves Memory

Exercise can improve skill and fact retention. I wish I had known that in Medical School! Read the details HERE

Pectoralis Muscle Injuries

It is the start of football training camps across the country and already there have been reports of pectoralis muscle injuries leading to lost time and frequently surgery. Manny Lawson the Buffalo Bills outside linebacker expects to miss time with a partial tear. The Bengals' first round draft pick William Jackson III a cornerback will have surgery shortly for a complete tear as did Desmond Bryant a defensive lineman for the Browns. Previously, we discussed rotator cuff injuries, but this represents a different type of shoulder muscle injury.

The pectoral musccle is in the front of the chest and is active in use of the arm extended away from the body or in pushing objects away from the chest. It has 4 parts with the major portion attaching to the humerus (arm bone) as a thick tendon.

Many are muscle strains that represent a partial tear of the muscle much like a hamstring strain. These do not require surgery and will recover with ice and rest followed by physical therapy including stretching and strengthening. A complete pectoral tear involves the tendon pulling off the bone. This typically requires reattachment to the bone to restore function in healthy active individuals.

Frequently the injuries occur while weight lifting especially bench press. Also specific football acts that increase the risk is using the arms in extended fashion away from the body as offensive lineman do frequently.

Diagnosis is made by a loss of contour of the chest in the front, pain, weakness and significant bruising. An MRI can help determine the severity of a partial tear, but may not be necessary for a complete tear diagnosis.

Commonly this is a 3-6 month recovery for most athletes with 6 weeks of minimal activity followed by 6 weeks of intensive rehabilitation. At this point more functional rehabilitation and training can occur, but it is difficult to return to true sports before 4-6 months. Thus, it is frequently a season ending injury especially for offensive linemen.

Healthy Breakfast Ideas for Busy People

Busy weekdays can still result in a healthy breakfast to start the day. Find great tips HERE

Is remaining unfit as risky as smoking?

Physically unfit lifestyles with little aerobic capacity may be as bad or worse than smoking. Read details in this NY Times Review HERE

Ankle Sprains Can Be More Than They Appear

Ankle sprains represent one of the most common reasons people present to Emergency Rooms for musculoskeletal complaints. While nearly everyone has sustained a sprain in their lives if ignored they can present significant disability. Ankle sprains as depicted in this picture are tears of the ligaments around the ankle. The most common type is depicted here as an inversion sprain with the ankle rolling in on itself.

Typically significant swelling is noted and there may be dramatic bruising.

Frequently when seen in the Emergency Room patients are given crutches, instructed to ice and elevate and little else is done. In reality all ankle sprains severe enough to go to the ER should undergo physical therapy for range of motion, strengthening and balance training. Additionally, the patient may need to braces during recovery.

Upon returning to sports it may be a good idea to wear a functional brace which may be as effective or more effective than taping.

A significant ankle sprain may continue to ache with activity for several weeks. Read HERE for several more facts regarding ankle sprains. Always take these seriously.

Fall Sports Heat Acclimation Recommendations from the NATA

Consensus statement from the National Athletic trainers Association regarding heat acclimation for sports. Recommendations are for a 14 day period of acclimation with the following recommendations:

1. 1. Days 1 through 5 of the heat-acclimatization period consist of the first 5 days of formal practice. During this time, athletes may not participate in more than 1 practice per day.
2. 2. If a practice is interrupted by inclement weather or heat restrictions, the practice should recommence once conditions are deemed safe. Total practice time should not exceed 3 hours in any 1 day.
3. 3. A 1-hour maximum walk-through is permitted during days 1–5 of the heat-acclimatization period. However, a 3-hour recovery period should be inserted between the practice and walk-through (or vice versa).
4. 4. During days 1–2 of the heat-acclimatization period, in sports requiring helmets or shoulder pads, a helmet should be the only protective equipment permitted (goalies, as in the case of field hockey and related sports, should not wear full protective gear or perform activities that would require protective equipment). During days 3–5, only helmets and shoulder pads should be worn. Beginning on day 6, all protective equipment may be worn and full contact may begin. 
5. A. Football only: On days 3–5, contact with blocking sleds and tackling dummies may be initiated. 
6. B. Full-contact sports: 100% live contact drills should begin no earlier than day 6.5. Beginning no earlier than day 6 and continuing through day 14, double-practice days must be followed by a single-practice day. On single-practice days, 1 walk-through is permitted, separated from the practice by at least 3 hours of continuous rest. When a double-practice day is followed by a rest day, another double-practice day is permitted after the rest day.6. On a double-practice day, neither practice should exceed 3 hours in duration, and student-athletes should not participate in more than 5 total hours of practice. Warm-up, stretching, cool-down, walk-through, conditioning, and weight-room activities are included as part of the practice time. The 2 practices should be separated by at least 3 continuous hours in a cool environment.7. Because the risk of exertional heat illnesses during the preseason heat-acclimatization period is high, we strongly recommend that an athletic trainer be on site before, during, and after all practices.

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1.  Read the full article HERE

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