• I Broke My Collarbone… What’s Next?

    Posted by Stacie Grossfeld

    broken collarboneA clavicle fracture, more commonly known as a broken collarbone, is a common injury and one that is most often the result of a hard blow or fall. Athletes who participate in contact sports are highly likely to suffer from broken collarbones; however, clavicle fractures are also common in car accident victims. This is especially true of people who incorrectly wear their seatbelts. There have even been incidents in which newborns have sustained broken collarbones from passing through the birth canal.

    While broken collarbones occur in a wide variety of people and stem from many situations, the symptoms of a fractured clavicle are the same. A broken collarbone is an obvious injury and a crack is usually heard when the bone breaks. Afterwards, if your collarbone is broken you will have some of the following symptoms:

    • Swelling and pain in the area
    • Difficulty moving your arm and shoulder
    • Grinding when raising your arm
    • Shoulder sagging
    • A swollen bump around the area of the injury

    If you have any of these symptoms after suffering a hard blow or fall, visit a doctor’s office for a full physical exam and X-rays. These procedures will help a doctor diagnose you and confirm that your collarbone is, in fact, broken. What are the next steps to take once you are diagnosed with a broken collarbone? There aren’t many things you can do to speed up the healing process, but there are steps to take to ensure that the healing process goes as smoothly as possible.

    Steps to Take After Suffering a Broken Collarbone

    After you’ve visited a doctor and they’ve diagnosed you with a broken collarbone, it is a waiting game as you heal. Most of the time a broken collarbone heals on its own and all you can do is wait; however there are some ways to help speed up the healing process.

    Splint or Brace Your Shoulder

    Applying a splint or brace to the shoulder that is on the same side as the broken collarbone can help with the healing process. The bone will need to fuse back together in order to mend itself and limited mobility is the best way for that process to happen. When you apply a splint or a brace to the shoulder in question, you’re preventing unnecessary movement from disrupting the break.

    Sling Your Arm

    Getting your arm into a sling is another way to help speed up the healing process for a broken collarbone. With your arm in a sling, there will be little to no pressure to support the weight of your arm. This will allow your shoulder to relax and the broken collarbone will quickly start to fuse together. It is important to note that you won’t want to use the sling for more than just a few days.

    Treat Pain with OTC Painkillers

    Anti-inflammatory painkillers aren’t going to help speed up the healing process, but they will help with pain management as your collarbone heals. Over the counter (OTC) painkillers such as Ibuprofen and other aspirins will help ease pain and swelling in the injury area. Be careful on dosages though as painkillers have side effects that include increased risk of ulcers and bleeding. Check with your doctor prior to starting a pain management regimen.

    Participate in Physical Therapy

    Physical therapy is a strenuous part of recovery from any injury, but it is also so important to practice strengthening exercises and improve your range-of-motion slowly. Physical therapy exercises will help to strengthen the weakened collarbone and also increase your chances of avoiding a re-injury.

    Whether you practice some of these tips on speeding up the healing process or not, it will take anywhere from 6 to 12 weeks for your broken collarbone to fully heal. In some cases, you may need to consider surgery to completely fix a broken collarbone. This is especially true if ligaments were also damaged when the break occurred. Regardless of surgery and healing time, it is important to take it easy when returning to physical activity. Collarbones are extremely susceptible to suffering from re-breaks. This means it is especially important to exercise caution when participating in sporting events and exercise routines.

    If you have suffered from a broken collarbone and are still experiencing pain, contact Dr. Stacie Grossfeld today. Dr. Grossfeld is a double board-certified orthopedic surgeon by the American Board of Orthopedic Surgery with a specialty in sports medicine. She has a special interest in knee and shoulder reconstructions, shoulder injuries, and is currently accepting new patients. Contact Dr. Grossfeld at Orthopaedic Specialists today by calling 502-212-2663 or visiting one of her two office locations in Louisville, Kentucky.

    Surgical Risk Factors of Obesity

    Posted by Stacie Grossfeld

    surgical risk factorsSurgery, whether major or minor, comes with risks. Surgical risks factors can be either unprecedented and unpreventable, but others can. One of the most pressing and preventable surgical risk factors is obesity. The prevalence of obesity continues to rise and an estimated 35 percent of adults in the United States have a body mass index (BMI) greater than 30. Obesity is leading cause of preventable death worldwide with an increasing incidence and prevalence in adults and children. Being dangerously overweight is a worldwide epidemic. Medical providers know that obese patients have more complications with surgical procedures and also with their health in general.

    “The Journal of Bone and Joint Surgery” published two excellent articles in February of 2017. Both articles discussed obesity, its prevalence among the American population, and the surgical risk factors that accompanied obese patients undergoing surgery.  The first article written by Dr. Eric Wagner came out of the Mayo Clinic in Westchester, Minnesota. The second article written by Dr. Kimona Issa, was in conjunction with the Sinai Hospital in Baltimore, Maryland, Seton Hall University of Health And Medical Sciences, Mt. Sinai Beth Israel, out of New York, and the University of Louisville.

    Both groups of researchers noted that as the average BMI of patients who were hoping to undergo surgery increased, the healthcare burden associated with obesity has become an important consideration in elective orthopedic procedures. It was noted that high BMIs are an independent risk factor for the development of osteoarthritis involving the hip. It is estimated that one-third of patients undergoing total hip arthroplasty have a BMI greater than 30 mg/meter square. Many are younger individuals. Both research papers looked specifically at postoperative and intraoperative complications in patients with a BMI of greater than 30.

    Surgical Risk Factors of Obesity

    Reoperation

    The study out of the Mayo clinic with lead author, Dr. Eric Wagner, found that with increasing BMI numbers, the post-surgical and intraoperative complications increased as did surgical risk factors. They looked at several different categories. The first category was reoperation. The authors found a strong association between an increased risk of reoperation with increasing BMI. They also found a significant association between increasing BMI and the risk of implant revision or removal.

    Hip Dislocation

    Patients with an increased BMI had an increased risk of hip dislocation within six months of the surgery. The risk of early dislocation increased in a nearly linear manner beginning at a BMI of 35 kg/meter square with a 5 percent increase for each BMI unit.

    They also discussed the high risk of hip dislocation within the first six months after total hip arthroplasty in patients with a higher BMI. This risk is associated with the extraarticular fatty tissue that acts as a fulcrum for dislocation. There is also greater risk of suboptimal implant position because of technical difficulties associated with the procedure in patients with a high BMI.

    Infection

    The heightened risk of infection is one of the most worrisome surgical risk factors these studies found. They found a striking association between BMI and complication risk same for wound infection (superficial or deep). There is an 8 percent increase in risk per unit of BMI greater than 25 kg/meter square. Patients with a BMI of greater than 40 kg/meter square had a fourfold increase in risk of infection relative to patients who had a healthy weight and BMI.

    They also found a strong association between the development of the deep periprosthetic infection. This means that the infection not only involved the wound, but around the total hip replacement components. They found an increased risk of about 9 percent for each unit of BMI greater than 25 kg/meter square.

    For patients with osteoarthritis, there was an increased risk of about 10 percent for each unit of BMI greater than 25 kg/meter square. The authors felt that the infection risk was probably higher because of the large adipose tissue layer present in obese patients which is associated with comorbidities, such as diabetes and a potential longer operating time required for patients with a high BMI.

    These studies prove that a high BMI can certainly affect one’s surgical outcomes. There are several risk factors for obese patients that may be going under the knife. It is beneficial for one’s health to lower their BMI before undergoing major surgeries. This could also improve one’s pain and open the possibility of avoiding surgery altogether.

    Dr. Grossfeld shares this information in order to inform her patients on the seriousness of orthopedic surgery and obesity. Call 502-212-2663 today to schedule an appointment with Dr. Grossfeld. She can help you with your weight loss goals and discuss treatment options for your pain.

    Lyme Disease and the Potential for Lyme Arthritis

    Posted by Stacie Grossfeld

    Catching Lyme disease alone is already an unwanted and complicated concern. To make matters worse, if left untreated for too long Lyme disease can lead to the development of lyme arthritis.It is especially important for doctors to be vigilant when it comes to examining patients who show symptoms of joint pain after being affected by Lyme disease.

    According to the Johns Hopkins Arthritis Center, approximately 60% of improperly treated Lyme disease patients will develop some manner of joint pain. Most commonly the knee is the main affected area. Both small and large joints having the potential for swelling. Typically the frequency and severity of swelling and pain will decrease over time. However, approximately 10% of ill-treated patients will develop chronic arthritis.

    Cause of Lyme Arthritis

    Lyme Arthritis

    A tick bite can potentially lead to Lyme disease through transmission of the bacterium Borrelia burgdorferi. Being bitten by a tick does not guarantee Lyme disease, but if the tick is infected by the bacterium then the chances increase. If the bitten individual develops Lyme disease, they should immediately seek medical attention.

    After the development of Lyme disease, there is potential for the bacterium to invade the joints. This leads to inflammation in the surrounding tissue and can eventually wear down the cartilage of the joints. It is not always obvious to the affected individual that they have Lyme disease, let alone Lyme arthritis. This makes it especially important for medical practitioners to be attentive to patients with joint problems in areas where ticks are common.

    Prevention and Treatment

    Lyme arthritis

    The symptoms of Lyme arthritis often do not appear until the later stages of Lyme disease. Within the first few weeks of being bitten, patients feel flu-like symptoms, stiff neck, headaches, among other symptoms. But those who develop Lyme arthritis don’t usually notice joint pain for months or even a year after being bitten.To help avoid the potential for letting Lyme disease progress into Lyme arthritis look for the following symptoms if you’ve been bitten by a tick:

    • Rash near the insect bite
    • Aching, redness or swelling in one or more joints especially the knee
    • Fever
    • Lethargy
    • Headache

    While these symptoms are helpful indicators, sometimes they never develop or go unnoticed by the affected individuals. One of the best ways to prevent Lyme arthritis is to be aware of the potential symptoms. Once you are familiar with the possible effects, then you will better be able to inform your doctor. Lyme arthritis most commonly develops because it goes untreated for too long. If you and your doctor catch the symptoms early on, then the chances decrease.

    If you have been bitten by a tick recently, or think you might be developing Lyme disease it is essential that you contact your medical professional right away.Those who live in the Kentucky area, and want to know more about the treatment available for Lyme arthritis, should give Louisville Orthopaedic Specialists a call today at (502) 212-2663. To learn more about Lyme disease and its symptoms in women, read our previous blog post here.

    What Clicking Knees Could Mean

    Posted by Stacie Grossfeld

    Clicking Knees are Very CommonA common occurrence for a lot of people is the sound of their knee joints “clicking” when they sit down, stand up, or put a lot of weight on their knee. For the most part the issue of clicking knees is not any indication of injury or cause for concern. Most doctors advise that unless the clicking sound is accompanied by pain in the knee, then you shouldn’t worry. There are many harmless reasons for the clicking sound. However, if you are experiencing clicking in your knees that is accompanied by pain, or difficulty moving, then you should look into some potential causes with your primary care physician.

    Below are a few of the common explanations for clicking knees:

    Meniscus Tears

    The meniscus is often referred to as the “shock absorber.” It is made up of two disks that keep the kneecap in place. If one of the disks is damaged, it can disrupt the balance of the knee. A Mensical tear can cause a clicking sound in the knee because the disk is rubbing against parts of the area it usually doesn’t come in contact with.

    Cartilage Injury

    Occasionally the cartilage covering the kneecap can become worn down. This may cause a piece of cartilage to dislocate and catch inside the joint. When this happen, people describe the feeling as a grinding sensation within their knee.

    Extra Tissue

    Sometimes you can build up additional unnecessary tissue around the knee joint. The build up will cause the tissue to be trapped between parts of the joint. This will cause a clicking whenever the knee joint is moving.  

    Runner’s Knee

    This condition is often caused by an injury or overuse of the tibia. Runner’s knee happens when the kneecap isn’t aligned with the femur. This displacement will often make the knee pop, or click whenever utilized.

    Arthritis

    The inflammation that occurs with arthritis will cause the knee to align differently than usual. Along with clicking knees, arthritis can also cause stiffness in the joint.

    An ACL Tear or MCL Tear

    Injuries unto themselves, an ACL or MCL tear will cause pain and stiffness in the knee joint. The injury will also affect the location of the kneecap within the leg, which may cause clicking knees.

    If you are experiencing clicking knees that are accompanied by pain, or inhibiting you from movement, there are treatment options available. Call Orthopaedic Specialists at 502-212-2663 to schedule an appointment with Dr. Grossfeld today!

     

    15 Habits of Healthy People

    Posted by Stacie Grossfeld

    15 Habits of Healthy PeopleWhile eating nutritious foods and working out are great ways to improve your health, there is so much more to consider. Health and wellness requires a holistic approach that not only focuses on nutrition and fitness, but other areas as well. In order to achieve optimal health, it may be worth your while to take a look at the 15 habits of healthy people.

    1. Eat Well: Eating fruits and veggies is important, but don’t forget to add in other food groups. Healthy people are those that add in new food groups and make good choices in the kitchen and at restaurants.
    2. Exercise Often: Healthy people are constantly on the move and getting in their workout whenever possible. These people make time for exercise instead of simply fitting it in whenever convenient.
    3. Drink Lots of Water: Healthy people are constantly gulping down water throughout the day. Instead of drinking soda and coffee throughout the day, try getting your  recommended 8 glasses of water daily.
    4. Sleep: This may sound easy, but for some this is easier said than done. Healthy people are always well rested and stick to a solid sleep schedule. This will help you succeed throughout the day and stay focused.
    5. Smile: Healthy people tend to be happy people. Try smiling more and letting others see your radiant affection.
    6. Practice Good Hygiene: To be clean is another way to be happy. Always practice good hygiene and don’t forget to floss!
    7. Try New Things: Healthy people aren’t afraid to try new things from making a new recipe, to trying snowboarding for the first time. Be spontaneous and adventurous in your healthy lifestyle.
    8. Friends: Surround yourself with happy, positive people that care about you. These friends will help you stay focused on your healthy mission in life.
    9. Practice Portion Control: Healthy people allow themselves to have a treat now and then. The reason they are able to enjoy themselves is because they practice portion control and healthy serving sizes.
    10. Avoid Addictive Habits: Smoking and binge drinking keep individuals from living a healthy lifestyle. Those that lead a healthy, balanced lifestyle refrain from addictive behaviors like smoking and other harmful activities.
    11. Set Goals: Healthy people are constantly striving for improvement. This new year don’t forget to set goals and reward yourself for these accomplishments
    12. Schedule Routine Appointments: To maintain a healthy lifestyle, you should schedule regular appointments with your physician to monitor different areas of your health. You should also obtain preventative health screenings during your visits.  
    13. Balance: In order to be healthy, you have to address every aspect of your body and mind. Juggling, prioritizing and scheduling can get stressful at times. Limit your stress by learning how to balance your life.
    14. Quiet Time: Give yourself some time everyday to reflect, think and schedule all of your priorities and tasks. Take time for yourself each and everyday in order to reduce stress and maintain your balance.
    15. Be Flexible: It is important to realize that everyone is healthy in their own way. Don’t let the stress and structure of trying to maintain the perfect body or mind keep you from doing the things you love. Try and be flexible and understanding toward conflict and trials.

    Healthy, happy people are those who are able to bring a positive, disciplined attitude into the many areas of daily living. A healthy lifestyle involves a good attitude, conscious effort, determination and work hard. Try adding some healthy habits to your routine and read more of our health and nutrition blogs here. Your body and mind will thank you!

    Local Marathoner Shares Orthopaedic Specialists Experience

    Posted by Stacie Grossfeld

    When many of us are still at home sound asleep, Andy Gunkler has already completed his first workout of the day.

    Most days Gunkler wakes up at 4:45 a.m. and heads to the YMCA Norton Commons a short while later for spin classes, weight lifting and swimming. When not at the YMCA, you might see him around town taking long walks with his dogs, or riding his bicycle with the Louisville Bike Club.

    Describing himself as a “lifelong athlete,” Gunkler aims to take a minimum of 10,000 steps a day, and over the years he’s participated in nearly every sport you can imagine including: football, basketball, skiing, tennis, golf, racquetball, swimming, kayaking and cycling. And he’s run at least 10 marathons.

    Sustaining an Injury

    Andy Gunkler

    Andy Gunkler and Alyce Weixler after completing the 2017 New York City Triathlon

    After enjoying many injury-free years as an athlete, Gunkler experienced two major injuries in less than a year. The first, a painful lower back injury, was likely the result of long term wear and tear. Gunkler explains that he was in very serious pain, and after going to his regular doctor, he decided to consult with another regular from his early morning spin classes — Louisville orthopedic and sports medicine physician Dr. Stacie Grossfeld. Recognizing Gunkler’s symptoms, Dr. Grossfeld advised Gunkler on next steps and before long he was on the operating table undergoing surgery.

    Fortunately, this determined 65-year-old bounced back with lightning speed, walking 5 miles just 48 hours after surgery. And then about 6 months later Gunkler took a serious fall while alpine skiing, crashing into a tree, and breaking some bones in his shoulder. “I don’t even remember falling,” he laughs, “and now I don’t have any pain, but it did impact the mobility in one of my arms.” Gunkler stretches both arms up to demonstrate and there is about a foot difference in his ability to extend the arm on his injured side.

    Recovery at Lightning Speed

    Despite the setbacks, Gunkler doesn’t seem to be slowing down. Most recently he and his wife
    (and favorite training partner) Alyce Weixler completed the New York Olympic Triathlon which
    included a 1500 meter swim, a 25 mile bike ride and a 10k run. Describing the experience,
    Gunkler lights up talking about swimming in the Hudson. “In most races, the older people start
    last, but in this one, they started first!” Gunkler explains enthusiastically, “The current really
    helped improve my normal swim time in the Hudson,” he goes on to explain, “and the running
    portion of the race was around Central Park which was wonderful!”

    Gunkler moved to Louisville about 5 years ago from New Orleans where he completed two half-Ironmans and he has his own business working in franchise consulting. Growing up in Fort Wayne, Indiana, Gunkler has many happy memories of the time he spent playing basketball with his dad. In high school he participated in football, basketball, track and field, and tennis, and as a student at Wobash College in Crawfordsville Indiana, he played both football and hockey. “I came from an active family,” Gunkler explains, “My dad was one of the star basketball players for his high school team, and
    my mom had a stint as a New York City model. She ate a healthy diet and walked up to 25 miles
    a day, with 10 miles completed by 7 a.m.”

    Staying Motivated

    When asked about what keeps him motivated, Gunkler explains that he doesn’t need any
    special books, training pros, music, or apps. He says that it’s just a mental thing … “You just kick
    yourself in the butt and get going,” he states matter-of-factly… “A lot of us know what to do,
    you just have to be disciplined enough to do it … And it helps if you have a little bit of attitude,”
    Gunkler says smiling.

    Reflecting on it more, Gunkler does emphasize the importance of having friends that are also
    physically active. He talks fondly of his bicycle group that often shares a meal and good
    conversations after their Tuesday night rides. He also enjoys getting involved in organizations
    focused on making Louisville a better place to live. This includes serving on the Board of
    Directors at the Norton Commons YMCA.

    And he also likes supporting organizations that focus on helping out kids including the Brendon
    P. Bachelor Foundation. This new organization recently launched Brendon’s Duffels of Hope, a
    program designed to offer comfort to children who are in the foster system due in large part to
    the drug epidemic in Kentucky.

    People like Gunkler are a huge inspiration and an asset to our community. We’re very excited to
    be able to consider him a part of the Orthopaedic Specialists family and we look forward to
    seeing what challenges and goals he successfully accomplishes next.

    Knee Osteoarthritis: 3 Types of Recommended Exercise

    Posted by Stacie Grossfeld

    knee osteoarthritisKnee Osteoarthritis is a common type of arthritis that often occurs in older people, but can affect younger people, as well. Osteoarthritis of the knee is a degenerative disease that occurs when the flexible, sponge-like tissue between joints wears down. When this tissue wears down, joints no longer have padding between them and bone rubs on bone causing extreme pain. Osteoarthritis can occur in hands, the lower back area, wrists, hips, the neck, and in the knees. Quite a lot of people think that the only resolution to Knee Osteoarthritis is to take it easy on using the knees, but that is actually not true. Exercise in small, monitored doses is commonly recommended by doctors as the first approach to treating Knee Osteoarthritis.

    Dr. Stacie Grossfeld of Orthopaedic Specialists in Louisville, KY recommends three types of exercise to help patients with knee osteoarthritis. The three exercises that she recommends include: flexibility exercises, resistance exercises, and cardiovascular exercises. Follow along to learn more about each type of recommended exercise.

    Flexibility Exercises for Knee Osteoarthritis

    Flexibility exercises include stretching of the neck, upper body, lower body, and back, upper arm raises, and yoga. These types of exercise are very good for easing stiff joints and if the exercises focus on the knees then they will help relieve tension and pain caused by Knee Osteoarthritis. Dr. Stacie Grossfeld recommends that patients suffering from Knee Osteoarthritis complete their stretching exercises in the morning. When stretching is performed soon after waking up, your body is loosened up for the rest of the day and can make moving through it much easier. If joint stiffness is extremely bad in the morning, Dr. Grossfeld recommends performing flexibility exercises in warm bath water.

    Resistance Exercises for Knee Osteoarthritis

    Resistance exercises are important because not only do they help to ease arthritis pain, but they also help to build muscle back around the arthritic joints. Building muscle back helps to absorb shock in the knees and protects the joints from further injury. There are two types of resistance exercise: isometric and isotonic. Isometric exercises are typically the easier resistance exercise for patients with Knee Osteoarthritis because the joint angle and muscle length stay the same. Isometric exercises include: plans, push ups, wall sits, quads, and squat holds. In contrast, isotonic exercises maintain equal muscle tone while the muscle length shortens and lengthens during exercise. Isotonic exercise are mainly used to strengthen muscles and Dr. Grossfeld recommends sticking to isometric for improving joint flexibility.

    Cardiovascular Exercises for Knee Osteoarthritis

    Cardiovascular exercises use large groups of muscle while simultaneously raising your heart rate. Dr. Grossfeld highly recommends that patients with Knee Osteoarthritis looking to partake in cardio fitness try water aerobics or cycling – either indoor or outdoor. Both of these forms of cardiovascular exercise are highly effective, but low impact on joints. This ensures that patients will get the exercise they need to rebuild joint health and not hurt themselves further. Dr. Grossfeld also recommends visiting the website of The National Arthritis Foundation and using it as a resource for exercise DVDs.

    If exercise doesn’t seem to be helping, Dr. Grossfeld recommends a referral to a local physical therapist. Physical therapy can be helpful, especially for patients who like personalized instructions and the ability to focus on maintaining technique through fewer exercises. If you feel like you are suffering from Knee Osteoarthritis with older age or as a younger person, contact Orthopaedic Specialists today and make an appointment with Dr. Stacie Grossfeld.

    Top 10 Things You Should Know About Shoulder Dislocation Injuries

    Posted by Stacie Grossfeld

    Shoulder dislocation injuries can be painful and debilitating if one does not seek proper medical attention following the injury. For most, this injury occurs due to a traumatic event or during a sports game. In sports like football, hockey and basketball, shoulder dislocations are more prevalent due to the level of contact involved. While this injury is usually very simple to treat, it does require some healing time and possibly physical therapy or even surgery. If you dislocate your shoulder, immediately seek medical attention in order to readjust your arm and begin the healing process. Shoulder Dislocation Injuries

    Due to the fact that shoulder dislocations injuries are common in sports, Dr. Grossfeld has created a list of the top 10 facts patients should understand about shoulder dislocation injuries.

    Top 10 Facts About Shoulder Dislocation Injuries

    1. Most commonly occurs from a traumatic event.
    2. In patients under age 18 years and younger, males are more likely to undergo a shoulder dislocation compared to females.
    3. The highest rate of recurrent dislocation among younger athletes occurs in the 14 to 16 year old group.
    4. Athletes that are age between 10-13 years of age have a low risk of recurrent dislocation after initial shoulder dislocations.
    5. In general, patients younger than 20 years of age are at highest risk of sustaining a primarily anterior shoulder dislocation as well as to develop recurrent glenohumeral joint instability, i.e., recurrent dislocations.
    6. Patients that involve in contact sports are at highest risk for repeat discoloration after their initial dislocation.
    7. The most common dislocation is where the shoulder comes out the front, also known as an anterior dislocation. The most common dislocation among linebackers while playing American football is a posterior dislocation where the shoulder is dislocated out the back.
    8. Posterior dislocations are also associated with electrocution and seizures.
    9. For healthy patients, shoulder dislocations heal within 12 weeks of the injury.
    10. In summary, males, aged 20 years or less, in a contact sport are most likely to sustain a shoulder dislocation and sustain recurrent dislocations if returning back to the contact sport.

    If you think your shoulder is dislocated you should seek emergency medical treatment immediately. Dr. Grossfeld is available to help assess the injury, determine treatment options and help you get back out on the field, court or life!

    Concussions in the NFL: A Study in Review

    Posted by Stacie Grossfeld

    Concussions occur frequently in the NFLThe frequency in which concussions occur in the National Football League (NFL) is an issue of concern. In the March issue of the American Journal of Sports Medicine, authors Michael Clark, Breton Asken, et al. explore the relationship between concussions and the mechanisms by which they occur. The authors state that although there is a significant amount of information regarding the prevalence of concussions in the NFL, there isn’t as much about the manner of those occurrences.

    Below we compiled pertinent statistics mentioned in the AJSM article. Also other relevant found data, and the findings that Clark, Asken, et al. provide in their compelling conclusion.

    • From 1945 to 1999, there were 497 reported deaths directly resulting from football participation.
    • Between 1965 and 1974, the highest number of football related fatalities occurred; 36 out of the 167 brain injuries happened in 1968 alone. These fatalities led to a rule prohibiting dangerous tackling techniques. A safety standard for football helmets was also implemented by the National Operating Committee on Standards of Athletic Equipment.
    • Concussions are a concern in every contact sport.  However, football accounts for the highest proportion of these sports related injuries.
    • A concussion is reported almost every other game in the NFL.  Also a substantial portion of football concussions have historically been under-diagnosed and under-reported.
    • In 2007, and again in 2009, the NFL implemented a revised concussion management policy. Since 2009, several rule revisions have been introduced to address goals of player protection:
      • In 2010, 2011, and 2012, language regarding defenseless receivers was broadened. Helmet to helmet contact was strictly prohibited and violent players were subject to fines.
      • In 2011, the kickoff line was moved up by 5 yards to reduce the number kick returns. The running start was reduced by 5 yards in hopes of decreasing the force of collision.
      • In 2013, crown of the head impacts were also made illegal.
      • Starting in 2009, any player with the common symptoms of a concussion was to be withheld from play until fully asymptomatic and cleared by both his team physician and an independent neurologist consultant.
    • Starting in 2011, independent certified athletic trainers began to watch from the press box for possible injuries during the game.
    • In 2013, an NFL PA mandated that a neurotraumatologist consultant should be on the sideline of every game to evaluate players with suspected concussion. They required that the neurotramatologist be unaffiliated with the NFL to avoid any collusion.
    • More concussions happen in the second half of play. Fatigue most likely causes the players to neglect proper technique. The risk of concussion increases by about 24% in in the second half of a game.
    • Just up to 2013, nearly 5,000 former NFL players brought lawsuits against the NFL for concussion-related injuries.
    • One of the most common issues is chronic traumatic encephalopathy (CTE). CTE is a degenerative disease caused by repetitive blows to the head. Frequently CTE is found in professional football players as well as boxers, wrestlers, rugby players, and other participants in contact sports.
    • As of 2016, 90 out of 94 former NFL players that underwent an autopsy were diagnosed with CTE.

    CTE caused by concussionsIn an attempt to combat the frequency of concussions, the NFL implemented concussion management policies, and changed rules to place greater emphasis on penalizing players for aggressive behavior. However, there is still an urgent need to further strengthen policies and introduce concussion prevention and management programs.

    The AJSM authors conclude their article with: “In-game concussions in the NFL occurred through a diverse variety of mechanisms, surprisingly tended to be well-anticipated, and, also surprisingly, occurred with <10 yards of closing distance. The impacts causing concussion were broadly distributed over the helmet.” While there is more and more research regarding concussions in the NFL, there is obviously still much more to be done. Safety in sports is extremely important, and those who participate in contact sports should be extra vigilant. Learn more about safety and concussions in an earlier Orthopaedic specialists blog here.

    For more information about concussions or other sports injuries, Dr. Stacie Grossfeld and Orthopaedic Specialists are here to help. For an appointment with a board certified orthopedic surgeon and sports medicine doctor in Louisville, Kentucky, call 502-212-2663 today!

    Four Layers of The Hip & How They Factor Into Athletic Injuries

    Posted by Stacie Grossfeld

    A recent article from the April edition of American Academy of Orthopaedic Surgeons focused on how hip injuries can lead to long-term negative effects within the athletic community. To thoroughly explain how these injuries occur, the authors Dean Lynch, Aseesh Bedi, and Christopher Larson discuss the hip joint according to four separate layers.

    The Osseous Layer

    Hip Joint Injuries in Athletes

    The first layer involves the femur bone, the pelvis and the hip socket. Hip injuries to this layer often include:

    • Static overload

    • Impingement

    • Dynamic instability

    Another less common hip injury is femoroacetabular impingement, or FAI. FAI is a condition that limits range of motion in the hip because of improper bone formation during childhood. The decrease in movement within the hip causes abnormal stress to the sacroiliac joint, pubic symphysis, and lumbar spine. Cam impingement is one variety of FAI where the femoral head is not round and therefore cannot rotate smoothly inside the acetabulum. A bump forms on the edge of the femoral head that grinds the cartilage inside the acetabulum. Also, if an anterior cam effect is present it can limit internal rotation. So it may cause levering of the femoral head which could also create posterior hip subluxation or dislocation and resultant labral tearing and cartilage damage.

    The Capsuloligamentous Layer

    This layer includes:

    • Labrum

    • Joint capsule

    • Ligamentum/capular complex

    • Ligamentous teres

    Asymmetric wear of the chondral surfaces of the femoral head and/or the acetabulum may result from stress of the Osseous layer. The authors noted in their study that the structure of layer one produces an injury pattern for the second layer. For example, if an athlete has FAI and hip pain then a labral tear is highly likely.

    The Myotendinous Layer

    Layer three includes all the muscles around the pelvis, lumbosacral and pelvic floor regions. Dynamic impingement from a cam deformity in layer one causes increased strain on the SI joints, pubic symphysis and ischium. Secondary strain is placed on muscles attached around the hip joint. Due to the increased strain of the muscles and tendons it can cause tendinitis of enthesopathies.

    The Neurokinetic Layer

    Layer four includes the nerves within the hip area:

    • Thoracolumbosacral plexus

    • Lumbo pelvic tissues

    • Ilio inguinal

    • Iliohypogastric

    • Genitofemoral

    The Neurokinetic layer is responsible for the posture and the ability to sense stimuli of the pelvis over the femur.

    Athletic Hip Injuries

    Common hip injuries for athletes include:

    Adductor Strains

    Specific muscles contribute to adductor strains. These muscles include: the adductor longus, adductor magnus, adductor brevis, gracilis, obturator externus and pectineus. The adductor longus is the most common muscle to sustain injury. On average, a soccer player with a strained adductor longus will lose 2 weeks of play time, and will have a 18 percent recurrence rate. It is important to take time to heal because player who return to practice too quickly will likely worsen their injury.

    Four layers of hip injuries

    Osteitis pubis

    This condition occurs from overuse and stress of the pubis symphysis. It can cause lower abdominal pain secondary to stress and abnormal motion of the joint. The rectus abdomens elevates the pubic bone and the adductor tensions depress the pubic bone. An imbalance can cause a stress injury to the pubic bone. Chronic pubic symphysis can cause chronic sclerosis and widening of the symphysis. The best imaging for diagnosis of the condition is a MRI.

    Athletic pubalgia/core muscle injury

    Athletic pubalgia/core muscle injury is commonly referred to as a sports hernia. There is no actual hernia associated with the condition, rather it’s more of a weakening or tearing of the abdominal wall. The pain radiates into the groin and proximal adductors during sporting activities. Pain will be reproduced with a resisted setup, palliation over the pubis and the abdominal obliques and or rectus abdominus. Most imaging studies will be normal. On occasion an MRI can pick up a thinning of the abdominal wall or a tear called a cleft sign. Management is done through activity modification, NSAIDS and physical therapy. Sometimes injections will help diagnosis and treat the condition. Sports hernias rarely resolve without surgical intervention. Surgical procedures fall under three classes. These classes include: open repair with or without mesh, scope repair, pelvic floor repair with or without adductor release/repair and neurectomy.

    Dr. Stacie Grossfeld is a double board-certified orthopedic surgeon in Louisville, KY with a specialty in sports medicine. If you are suffering from hip pain that is not going away or you have injured your hip and need medical attention from an experienced orthopedic doctor, contact Dr. Grossfeld today by calling 502-212-2663.