Torn Meniscus and Meniscal Injury – Comparing Children and Adolescents

Posted January 6, 2014 by Stacie Grossfeld

More and more children are competing in sports, and with increased participation there is an increase in the number of knee injuries.

A knee injury like a torn meniscus can affect a young athletes knee for the rest of their life. Studies have confirmed early onset osteoarthritis in patients with ACL injuries and meniscal tears.

The meniscus is a very important structure in the knee. There are two in each knee: a medial and lateral meniscus. The meniscus provides shock absorption. It also protects the articular cartilage covering the bones within the knee joint.

Most people suffering from a torn meniscus experience this knee injury in conjunction with other knee injuries such as an ACL injury, chondral injuries, and fractures.

The incidence of meniscal tears in children versus adolescence has not be widely studied.

What is the rate (incidence) of experiencing a torn meniscus in the pediatric vs. the adolescence population?

A study from the Rady Children’s Hospital and Health Center in San Diego published by Dr. Alvin Shieh et al. in the December 2013 American Journal of Sports Medicine researched the meniscal tear pattern in relation to skeletal immaturity. (more…)

Brain Injury from Contact Sports Possible Even Without Concussion

Posted January 2, 2014 by Stacie Grossfeld

Research suggests that repeated impact to the head, like many contact athletes experience, can cause damage to the brain even without a concussion. Dr. Thomas McAlllister at Indiana University School of Medicine compared a group of college athletes engaged in contact sports like ice hockey and football with those participating in track and field.

The brains of all 159 athletes were scanned before and after the playing seasons. Other tests were also conducted to measure changes in learning. Accelerometers were attached to the helmets of those participating in contact sports to determine how frequently and intensely they experienced blows to the head. (more…)

Physical Activity for Kids: Why Are More Kids Less Active?

Posted December 30, 2013 by Stacie Grossfeld

A study led by Dr. Sandra Ortlieb and colleagues looked at factors that affect physical activity for kids in an effort to create successful interventions aimed at increasing physical activity levels. The research study included data on 1,843 girls and 1,997 boys.

Researchers found that body mass index (BMI), parental education, household income, number of siblings, TV/PC consumption, and method of arriving to school were NOT significantly associated with physical activity for kids.

Factors that did have an influence on children’s physical activity included:

Gender. For example, 10 year old girls were less active than boys, especially in regards to vigorous physical activity.
Sports Club Membership. Children who were members of sports clubs were also more active than those who were not, especially during the winter. (more…)

ACL Injuries More Common Among Girls

Posted December 20, 2013 by Stacie Grossfeld

Sports injury prevention programs are an important way to keep kids physically active and injury free. According to University of Connecticut researcher Dr. Lindsay DiStefano, middle school is an ideal time to implement a sports injury prevention program.

Research suggests that improving neuromuscular coordination and control is at the heart of reducing ACL injuries by upwards of 50% or more. ACL Injuries are injuries to the anterior cruciate ligament (ACL). This ligament is located in the knee. ACL injuries can be caused by stretching the ACL too much or from an ACL tear. ACL tears range in severity from a partial acl tear to a complete tear.

Neuromuscular strengthening involves focusing on developing the nerves that control your voluntary muscles. Voluntary muscles include all the muscles in your body that you control like your legs. (more…)

How to Diagnose a Distal Biceps Tendon Rupture Without an MRI Scan

Posted December 3, 2013 by Stacie Grossfeld

An MRI is a very expensive imaging study. A distal biceps tendon rupture can be difficult to diagnose by patient history and only using one common physical exam test. An excellent study from St. Joseph’s Health Centre in Toronto, Ontario, found that if three special physical exam tests are used in conjunction with a history from the patient, a distal biceps tendon rupture can be diagnosed 100 percent of the time, without the use of an MRI. Dr. Moira Devereaux et al. published their findings in the September issue of the American Journal of Sports Medicine.

Overview of a Distal Biceps Tendon Rupture

Distal biceps tendon ruptures occur primarily in men from the ages of 40 to 60 years old. The mechanism of injury occurs with a sudden eccentric flexion of the elbow. This commonly happens from lifting an item that is heavier than the person realized and a quick, forceful contraction to the elbow occurs.

A distal biceps tendon tear can be complete or partial. Complete tears are treated with surgery and partial tears are typically treated conservatively. A delay in the diagnosis of a complete tear can make surgical treatment very difficult, increase the complication rate and making the end surgical result less successful.

The history of a pop heard at the time of injury, swelling or discoloration at the elbow, and an asymmetric appearance of the biceps muscle can be signs and symptoms of a distal biceps tendon rupture. However the patient may not present without any of the above listed signs or symptoms, and still may have a distal biceps tendon rupture. (more…)

Common Pediatric Sports Injuries – An Overview of the Latest Sports Medicine Research

Posted November 25, 2013 by Stacie Grossfeld

An excellent article comparing pediatric sports injuries to adolescence sports injuries was published in American Journal of Sports Medicine August 2013. Authors Dr. Andrea Stracciolini and Dr. Lyle Micheli et al. from Boston’s Children’s Hospital looked at two groups of athletes based on age: 5-12 years olds and 13-17 year olds. Over 2,100 children were enrolled in the study. Their results are very interesting. The two groups had different sports injuries in terms of types and severity.

Dr. Micheli et al. found that the sports injuries for the younger age group (5-12 years old ) were more traumatic and involved the upper extremity. The younger group had more fractures (broken bones), growth plate fractures, apophysitis (inflammation of the growth plate), and osteochondritis dissecans.

Osteochondritis dissecans also known as OCD is believed to be caused from repetitive micro-trauma resulting in death of the cartilage and some time the bone in the area of the injury.

Spine injuries were not as common in this younger age group as compared to the older children. What was interesting in this age group was the higher percentage of spondylolysis. This primarily occurred in the female patients (76%). Spondylolysis occurs from either a growth plate fracture in the spine or from a repetitive injury that does not let one or more of the growth plates in the spine to close.

The older kids (13-17 year olds) most commonly were treated for overuse injuries compared to their younger counterparts (54% compared to 49%). The overuse injuries tended to involve soft tissue (for example ligament tears) compared to fractures. Serious ligament injuries were more common such as ACL injuries and meniscal tears. Spine injuries were also more common in this older age group. Similar to the younger group the spine diagnosis was most commonly a spondylosis. (more…)

Massive Rotator Cuff Tear – 8 Facts

Posted November 22, 2013 by Stacie Grossfeld

Massive Rotator Cuff Tear – Learn 8 Facts Including Risk Factors

Defined as a tear of the rotator cuff that is greater than 5 centimeters in size or involves a tear of at least 2 of the 4 rotator cuff tendons.
Ten to forty percent of all rotator cuff tears are classified as massive.
Eighty percent of recurrent tears are massive.
Repair of a massive rotator cuff tear has a high failure rate, upwards of 94 percent
High failure rate after surgical repair is contributed to the poor quality of the rotator cuff prior to surgical repair. Massive rotator cuff tears are associated with advanced fatty infiltration of the tendon which is a risk fracture for recurrent tearing.
What is very interesting is that even if the patient has a failed surgical repair of a massive rotator cuff tear their pain will be significantly reduced and their function improved. Anatomical outcome is not associated with functional outcome. This means that even with a recurrent tear after surgery the patients are more functional postoperatively. (more…)

Orthopaedic Specialists’ Medical Resident Dr. Tiffany Simpson Provides Medical Care in Haiti

Posted November 18, 2013 by Stacie Grossfeld

Orthopaedic Specialists is excited to introduce medical resident Tiffany Simpson M.D. Dr. Simpson is a graduate of Bellarmine University and University of Louisville’s School of Medicine. She is in her second year as a medical resident specializing in Family Medicine.

With a long time interest in global health issues, Dr. Simpson heard about an opportunity to travel to Titanyen, Haiti, with Westport Baptist Church and Global Outreach International. Situated north of Port-au-Prince, Titanyen has a burn clinic where Dr. Simpson worked.

Burn injuries are common in the area, in part because most people cook their food outside over open fires. Talking about her interest in global health issues, Dr. Simpson explains:

“I’ve always been interested in helping people outside of our country – people who do not have access to the same resources and treatment options that we have. When the opportunity to go to Haiti came up with my church I was very excited to go. It was an eye opening experience. The level of need really surprised me.”

Dr. Simpson talked about her daily schedule during her time in Haiti. She started her days working at the medical clinic from around 7 a.m. in the morning to early afternoon. After working at the clinic, she and the other volunteers spent time doing needed jobs like painting and fixing things around the campus for Global Outreach International. She was also on call during the afternoon to provide medical assistance as needed.

Talking about her time working in Titanyen, Haiti, Dr. Simpson emphasized the serious need in Haiti for medical supplies and medical treatment. (more…)

Football Injuries – NFL Injury Update 2013

Posted November 4, 2013 by Stacie Grossfeld

An elite athlete who is a pro football player has a career in the NFL on average for 3.6 years. Pro football players tend to sustain football injuries at much younger ages than the general population.

Two interesting studies were published in the American Journal of Sports Medicine in 2013 looking specifically NFL football injuries. The first article was published in August and it reviewed quadriceps tendon injury. The second article, published in September, looked at operative and non operative treatment of cervical disc herniation.

From the years 1994 to 2004 all the quadriceps tendon injuries were identified and reviewed. There were only 14 quadriceps tendon injuries in the NFL during that time period. Complete rupture of the tendon occurred in 11 players with a partial tear in the remaining three players. Quadriceps tendon injuries commonly occur in the general population in people older than 40 years of age.

Predisposing factors for a quad tendon rupture in the general population are:

Male gender
Use of anabolic steroids
Statin use
Locally injected steroids
Prolonged use of oral steroids

Diseases such as: diabetes, renal failure, rheumatoid arthritis, and infection can predispose patients to rupture of the quadriceps. (more…)

Arthroplasty and Shoulder Replacement in Young Patients

Posted October 28, 2013 by Stacie Grossfeld

There are several surgical options for treatment of osteoarthritis, rheumatoid arthritis, or osteonecrosis in the shoulder. The options include a total shoulder replacement, reverse shoulder replacement, resurfacing procedures, and hemiarthroplasty. Shoulder hemiarthroplasty is a shoulder replacement procedure which involves replacing the broken humeral head with an artificial joint and reconstructing the fractured bone.

Many studies have proven that the revision rate in patients is much higher if shoulder surgery is performed before the patient is 50 years old.

The question is what surgical procedure should the patient undergo. An excellent study reported in the September 2013 edition of Shoulder and Elbow Surgery compared three different shoulder procedures in patients younger than 59 years of age and a second round that was 59 years or older. (more…)