Sports Concussions for Children and Teens

Posted February 25, 2016 by Orthopaedic Specialists

Management of Sports Concussions in the Pediatric and Adolescent Population

Sports concussions for soccer players There is an excellent review in the January/February issue of Orthopedics by Dr. Aaron Provance et al. which covers the management of sports-related concussions in the pediatric and adolescent population. Below is a summary of the key points in managing sports related concussions.

Concussions make up nearly 10% of all high school athletic injuries. The high school athletes associated with the greatest risk for sports concussions are football players for males and basketball and soccer player for females. One in five high school football players will suffer a concussion each academic year.

The majority of concussions do not involve loss of consciousness or observable neurological signs.

Sports concussions The cardinal symptoms of a concussion presentation are: confusion and amnesia. Other post-concussive symptoms may include: sleep disturbances, headaches, loss of consciousness, disorientation, increased emotion, irritability, slowed reaction time, difficulty with concentration or memory, fatigue, blurred or double vision, sleep disturbances, dizziness, poor balance, and sensitivity to light or noise.

Part of the challenge involved in diagnosing and treating a concussion is that there’s great variability between each athlete and their presentation with their symptoms.

Rules have changed significantly regarding treatment of concussions and return to play. Prior to 2002, it was not uncommon to allow an adolescent athlete to return to the same game or practice if his or her symptoms resolved within 15 minutes from the time of the injury. Now with new legislation and state mandates, it is recommended that the healthcare provider does not allow an adolescent or pediatric athlete to return to play on the same day. It should be of note that the majority of young patients will have complete resolution of their symptoms within 7 to 10 days from the time of the injury.

Concussion Management and Recommendations

If a sports concussion is suspected, the athlete should immediately be removed from play for evaluation by a medical professional such as their athletic trainer or a physician. Many times, the players will self-report injuries, but the coaching staff also play an important role in recognizing on-field incidents or signs and symptoms that may indicate the need for player to undergo a concussion evaluation. For example, if a player comes off the field and does not remember the last play or forgets what they are supposed to do when they are on the field. (more…)

Does Total Knee Replacement Take Away Knee Pain?

Posted February 15, 2016 by Orthopaedic Specialists

There have been recent studies assessing the incidence of knee pain after total knee replacement involving the operative knee. There was an article published in the Journal of Orthopedics, January/February, 2016 issue, offered by Dr. Thomas Sculco out of the hospital for special surgery at Cornell Medical Center in New York, New York.

This research found that patients that were one to four years post-surgery after a knee replacement, or 39% of the patients, still reported chronic pain involving the operative site. Their average pain score was 3/10 on the VAS pain scale, and the worst average pain score was 5/10 on the VAS pain scale. This research revealed that non-modifiable risk factors for chronic knee pain after knee replacement involved patients with diabetes, morbid obesity, and female gender.

Researchers Identify Factor Linked to Higher Risk of Pain following Total Knee Replacement Surgery

The researchers noted that whether the patient had a minimally invasive procedure such as a small or shorter incision did not make any difference compared to the patients that had a longer more standard incision for the procedure. Interestingly, they did find that for every minute of an extended operative time, the odds of developing a chronic pain were increased by 1.013 times. It showed that longer operative procedures resulted in worsening pain. It is not known whether this is associated with the actual surgical time or the fact that the patient had a “worse” knee preoperatively which may result in a less favored operative result postoperatively.

Typically, longer surgery means that the deformity is worse, there is more flexion contractures, more scar tissue, and that the patient may be morbidly obese. The authors were unable to comment as to why they felt the pain score worsened with longer operative time; however, based on my experience as an orthopedic surgeon and knee doctor, (more…)

ABC’s of Rotator Cuff Surgery

Posted February 9, 2016 by Orthopaedic Specialists

Rotator Cuff Surgery Information Your rotator cuff is a group of four tendons and muscles located around the shoulder joint at the top of your upper arm bone that connects to the humerus. These different parts of the arm work together to allow this part of your body to move in different directions. The issue with this part of your arm is that it’s very susceptible to overuse injuries and tearing. Many baseball, tennis and football players, along with swimmers sustain rotator cuff injuries.

Typically, a rotator cuff injury may be caused by falling, lifting weights or from overuse. The symptoms for this type of injury include: pain, weakness, snapping noises and swelling. This injury, which often develops gradually over time, can be diagnosed through a physical exam. Your doctor may order some tests in order to rule out other conditions and to confirm a rotator cuff injury.

Louisville orthopedic surgeon Dr. Stacie Grossfeld specializes in treating rotator cuff injuries including rotator cuff surgery. Here is some important information about rotator cuff surgery from Dr. Grossfeld.

Before Rotator Cuff Surgery:

Rotator cuff surgery is performed arthroscopically – small incisions and as an outpatient procedure.
The surgery will repair the torn tendon, (rotator cuff) back down to the humerus bone where it was detached during the injury.
The surgery is accomplished by inserting 3 to 5 small suture anchors into the shoulder bone. The sutures are attached into the anchor.
The sutures are then placed through the torn rotator cuff and it is pulled back down to the bone to securely attach.

After Rotator Cuff Surgery:

A sling is typically worn 3 to 6 weeks after surgery.
PT is started 7 to 10 days after surgery to restore gentle and limited range of motion.
PT is divided up into three, six-week phases. Phase one is gentle passive range of motion with limits given based on type and size of tear and rotator cuff quality. Phase 2 is active assisted and active range of motion. There is typically no limits on the motion arc. Phase three is the strengthening phase.
Most people will be released to return to a labor type job 4 to 5 months after rotator cuff surgery.
However, most people will continue to improve over a year after the surgery with reduction in pain, improvement in range of motion and strength.

If you have shoulder pain (more…)

Celebrate Super Bowl 50 and Check Out These Findings on Return to Play after ACL Injuries in Football

Posted February 4, 2016 by Orthopaedic Specialists

With the Super Bowl right around the corner, there is a lot of excitement and preparation for coaches, players and even their fans. This year, the Carolina Panthers and the Denver Broncos will compete for the Vince Lombardi trophy at Super Bowl 50 on February 7th. Super Bowl Sunday has become an unofficial holiday in America because of its popularity and tradition. This event brings together some of the best athletes in the country to compete against one another for the highest award in their sport.

ACL injuries in football In 2015, football was ranked the No.1 sport in America based on TV ratings, revenue and overall interest. This sport has inspired viewers and athletes alike. Today, there are more than 1 million football players in the U.S. This number includes professional, collegiate, and recreational athletes. Many of these athletes got their start in youth football leagues and have continued to play for many years to come.

Football is a highly competitive, intense contact sport. With the level of competition increasing each year, athletes have experienced a greater amount of injuries. The most common injuries in football include: concussions, traumatic, overuse and heat-related injuries. Unfortunately, many football players sustain anterior or posterior cruciate ligament (ACL/PCL) knee injuries. ACL injuries in football are common because of the force and motion used to tackle a player to the ground.

ACL Injuries in Football

Even though football players wear a significant amount of protective gear, this does not prevent ACL injuries. This type of injury often requires surgery, rehabilitation and rest. For players returning from an ACL tear, the road to recovery could be elongated and frustrating. Fortunately, physicians have been working with athletes recovering from ACL injuries to make this recovery easier. Here is the latest findings on this type of injury:

A Group of NFL football players were studied by Dr. Keller out of the Henry Ford Hospital in Detroit Michigan, and the findings were published in the December 2015 issue of the American Journal of Sports Medicine. The authors of the study found that 98 NFL – caliber athletes who had undergone primary ACL reconstruction and had participated in the NFL scouting combine between 2010 and (more…)

Facts About ACL Injury Including Possible Risks of Delaying ACL Surgery

Posted February 2, 2016 by Orthopaedic Specialists

ACL surgery and ACL Injury are Common The anterior cruciate ligament or ACL is one of 4 primary ligaments located in your knee. It works to attach the tibia to the femur. ACL injuries are one of the most common knee injuries for athletes involved in sports like soccer, football and basketball.

ACL tears may occur when the knee is twisted, bent, pulled backwards or strained.

Whether you are interested in learning more about an ACL injury or ACL surgery recovery, here is some important information you should know.

An ACL Injury Can Lead to Other Knee Ligament Injuries – Once an ACL injury has occurred the knee becomes unstable. The ACL-deficient knee increases mechanical stress on the meniscus and the chondral surfaces covering the bones in the knee joint. Because of the instability, there is an increased risk of injury of the meniscus and the articular cartilage after an acl injury has occurred.
An ACL Injury is Associated with Early Onset Osteoarthritis. A person with an ACL injury plus a meniscal tear is at even higher risk for developing early onset osteoarthritis.
Delaying ACL Surgery Can Lead to Further Damage. There is an increased risk of developing further meniscal and cartilage lesions with the lengthening of the time from injury to surgery.
Certain People May Be At Higher Risk to Further Injury When Delaying ACL Surgery – A scientific study in the December 2015 issue of the American Journal of Sports Medicine reported a study that noted if you were male with an increased BMI, and you waited greater than 12 months to have your ACL reconstruction surgery performed, you were at greater risk for tearing the medial meniscus during the time between injury and surgery.
BMI and Age May Be Primary Risk Factors for People who Delay ACL Surgery – The authors also found that there was a greater risk of cartilage damage to the medial femoral condyle if the patients waited greater than 12 months to have their surgery and had an increased BMI and increased age. The male gender did not put them at greater risk for this problem.

As with any medical condition, if you (more…)

U of L Music Major Lloyd Collins Reflects Back on his Experiences Serving as the Cardinal Bird from 1961 to 1963

Posted January 25, 2016 by Orthopaedic Specialists

In 1961 Lloyd Collins took on a role that he’d long remember… creating favorite memories to last a lifetime. He agreed to serve as the University of Louisville Cardinal Bird mascot. Originally from Alton, New York, Mr. Collins was a trumpet student in the University of Louisville School of Music from 1959 to 1963. During a recent visit to Louisville orthopedic surgeon Dr. Stacie Grossfeld, Mr. Collins mentioned his time as one of the original Cardinal Birds…And that is where the idea for this interview begins.

Mr. Lloyd Collins as an original U of L Cardinal Bird

Q: What was college life like for you?

A: I worked my way through college, washed pots and pans at the school cafeteria to get my food. I had a small band scholarship for a couple hundred dollars, but I really worked my way. In order to earn extra money, I sang at Highland Pres in the choir and got paid 20$ month. And I gave trumpet lessons at a music center downtown. In order to earn my lodging at school, I was a dorm counselor and the resident hall manager. Anything you want badly enough is worth working for. My parents were hard-working farmers from upstate New York.

Q: Why did you decide to go to the University of Louisville?

A: My band director in high school was getting his Master’s degree at U of L in the summer time. He told the U of L band director, Professor Leon Raper, that he had a good trumpet player. I auditioned. And they offered me a small scholarship to play in the band.

Q: How did you end up becoming the 3^rd “Cardinal Bird”?

A: The cardinal bird originated out of the U of L marching band. The first two guys to serve (Dick Dyson and Sam Badgett) were students in the Speed School of Engineering. When Sam was getting ready to graduate, I asked the band director if I could do it. He agreed, saying “yes” only if I was willing to continue to march in the band during the games at half-time. So I marched with the band at half-time and would go into the locker room after to put on the Cardinal costume. I enjoyed traveling out of town for ball games whenever possible. The marching band did not travel to out of town games, but I would go with the cheerleaders.

Q: What was the job of “Cardinal Bird” like?

A: Keep in mind that this was not a paying job. I would load up my 56’ dodge and take the cheerleaders along to the basketball and football games. We’d bum together enough money for gasoline and we’d drive to wherever the game was being held. Back in the day, money was tight. Sometimes I couldn’t even afford to get my white pants cleaned and Spalding’s Dry Cleaners was generous enough to comp them on the house.

Q: What did you do as the “Cardinal Bird”?

A: During the games I loved going out on the field or at Freedom Hall to perform, often with a hula hoop. One of the high points of the game involved the time when I would lay a cardinal bird egg.

Q: What was it like wearing the original “Cardinal Bird” costume?

A: As you can imagine, wearing the cardinal bird costume was incredibly hot. In fact, I actually lost between 5 and 10 pounds from sweating every time I wore the costume. The papier-mâché head was so top-heavy, it was hard to keep it from falling off…

Q: What was the “Cardinal Bird” costume like when you wore it?

A: The costume included white paints, white spats, and black shoes. I wore a black long-tailed colonels coat pulled over a big pillow with a felt covered L that hooked to my head. The head piece was made out of papier-mâché (which I inherited from the previous cardinal birds). The head was attached to a pith helmet with straps that went under my shoulders and arms. And while wearing the mask, I could only see through one eye hole. (more…)

Congratulations Dr. Grossfeld

Posted January 13, 2016 by Orthopaedic Specialists

Louisville Business Owners The National Association of Women Business Owners has announced the 2016 EPIC award finalists. Dr. Stacie Grossfeld and 11 other female top business owners in the community are considered for this honor. They will announce the winner 13on March 3 at the event.

Since 1975, this national organization has been committed to supporting 10.6 million female-owned businesses.The NAWBO Louisville organization works to provide support, resources and opportunities to allow women to succeed in the local business world. This organization helps foster economic, social and political growth for Louisville business owners. The main mission of this organization is all about women helping women to grow and learn from one another.

This not-for-profit, non-partisan organization is dedicated to promoting business ownership and experience for women. This local chapter of NAWBO connects with female business owners from large, multi-million dollar companies, to small, home-based businesses.

Here is the list of the 2016 EPIC award finalists.

Summer Auerbach, Owner, Rainbow Blossom
Pam Broadus, President & CEO, Splendid Events
Tricia Burke, President, Office Environment Company
Dr. Stacie Grossfeld, Owner, Orthopedic Specialists
Susan Hershberg, Owner, Wiltshire Pantry
Steph Horne, Owner/Attorney, Horne Title Services
Mo McKnight Howe, Owner, Revelry Boutique Gallery
Raquel Koff, President, Rodeo Drive
Amy Letke, Founder & CEO, Integrity HR
Kayla Mount, Co-Founder & COO, SuperFanU
Leigh Pittman, (Supporting Partner) Vice President, Director Global Program Management & Strategic IT Sourcing, Brown-Forman
Jesika Young, (Supporting Partner) Vice President, US Bank

At the event on March 3, the finalists will each deliver a short speech. From there, a live vote will be drawn and the winner announced. Congratulations Dr. Grossfeld on your nomination and good luck!

ACL Injuries in Non-Contact Sports

Posted January 10, 2016 by Orthopaedic Specialists

Over 100,000 ACL injuries occur every year in the United States. ACL injuries in non-contact sports account for 70 percent of all ACL injuries. Non-contact sports such as basketball, tennis, ice skating, and golfing have the potential to cause serious ACL injuries. For example, a basketball player dribbling down the court comes to a sudden stop. This causes his leg to shift forward from momentum and results in an ACL injury. ACL injuries also occur when basketball players are attempting rebounds and land incorrectly..

Prevention of ACL Injuries in Non-Contact Sports

Many researchers are trying to figure out ways to prevent ACL injuries in non-contact sports. They are also trying to deduce why these injuries occur at all. The American Journal of Sports Medicine published an article in December of 2015 that studied hip muscle strength and its correlation to non-contact ACL injuries in athletes. Dr. Khayambashi conducted this study by examining 600 athletes before their season officially started and measuring their hip strength. Dr. Khayambashi chose to measure hip strengthy because several articles indicated that reduced hip strength may play a role in no-contact ACL injuries. Prior to this article being written and researched, there weren’t any studies that related hip strength to non-contact sport ACL injuries with any athletic population.

Study Findings

The findings were very interesting. The researchers noted that out of the 600 athletes they studied pre-season there was a 3 percent incidence of ACL injuries. They found that hip strength measurements with excellent rotation and abduction were lower in injured athletes compared to the non-injured athletes. Their P-values noted there was a statistical significance. They also assessed logistic regression analysis and indicated that impaired hip strength increased future injury risk. So, in conclusion, measurements of pre-season isometric hip abduction and external rotational strength independently predicted future non-contact ACL injuries in competitive athletes.

Are you an athlete who plays non-contact sports? Would you like more information on preventing ACL injuries? Contact Dr. Stacie Grossfeld of Orthopaedic Specialists in Louisville, KY today. Call her office at 502-212-2663 to schedule an appointment.

Facts about Concussions and Female Soccer Players

Posted January 4, 2016 by Orthopaedic Specialists

A concussion is a kind of brain injury that is typically caused by a fall, hit, or shake to the head. The long-term damages caused by concussions are an increasing concern for athletes in many different sports, including female soccer players.

Soccer is a popular sport for boys and girls across the
U.S. with over three million kids participating in the game in 2014 (according to US Youth Soccer). And the gap between male and female youth soccer players has continued to narrow. In 1995, 55% of youth soccer players were boys and now that percentage has closed to 52%.

The number of women’s soccer teams at colleges and universities has also significantly increased over the past two decades. In 1991 there were 318 U.S. colleges with women’s soccer. This number about tripled to 959 in 2009, as noted in a special report Title IX at 20 published by the National Coalition for Women & Girls in Education (NCWGE).

Follow along for 7 important facts about concussions and female soccer players as explained by Louisville sports medicine physician and orthopedic surgeon Dr. Stacie Grossfeld.

In all of women’s NCAA sports, soccer has the highest rate of concussions.
Women’s soccer is second only to football among all NCAA sports in the rate of concussions that are sustained.
Female soccer players have a significantly higher concussion rates than males.
Women soccer players primarily sustain concussions due to head-to-ground contacts and player-to-fall contact. Male soccer player sustain a greater proportion of concussions secondary to player to player contact.
There are intrinsic factors as to why female soccer players get more concussions than male soccer players . Women have 20% less neck mass then males so their ability to use their neck muscle as a shock absorber during head impact is less. Women also have a smaller head size than males therefore the smaller head to ball ratio, less neck girth and less neck muscle strength translates into a higher incidence of concussions.
There are things that may be done in the pre-season to help reduce the risk of concussion among female soccer players such as a neck strengthening program.
There has been discussion about female soccer players wearing protective headgear. Recent research however shows that female soccer players actually have greater head acceleration while wearing headgear. At this point, headgear may not provide adequate protection for female players.

Learning about the risk of concussions (more…)

Why is vitamin D good for you?

Posted December 29, 2015 by Orthopaedic Specialists

Vitamin D is an important vitamin for your body. This fat-soluble vitamin is found in fish oils and liver, and is sometimes added to foods as a supplement. You can also get vitamin D from exposure to the sun. There are many reasons why vitamin D is good for you. Here are 7 of them:

It helps your intestines absorb calcium. Vitamin D is important for maintaining your bone strength and muscle function.
It directly stimulates osteoblasts. Osteoblast are the cells in your body that produce bone and promote healing.
A recent study revealed that vitamin D with a calcium supplement was effective at raising vitamin D levels and reducing falls and secondary non-vertebral fracture risk in older patients.
It’s very important for people to maintain a good level, especially in light of the fact we have an aging population with a rising lifespan. As we age the risk of osteoporosis and subsequent fractures increase. Maintaining a normal vitamin D level is important for our bone health.
Vitamin D can be obtained from the sun, diet, and supplements. Although the primary source of vitamin D is the sun’s ultraviolet rays, synthesis decreases with increasing age, sun protection and darker skin tones.
Because of the risk of melanoma and skin cancer secondary to sun exposure, more and more people are wearing sun block which does not allow the production of vitamin D through sun exposure. Therefore this supplementation has become even more important.
Vitamin D supplementation is recommended in a dose of 1000 international units to 2000 international units per day. That number may change based on your levels. It’s important to have your levels checked by your healthcare provider and they will give you an accurate dose of vitamin D that you should be taking as a supplement.