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

    Posted 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 by Stacie Grossfeld

    sports injuries include Osteochondritis dissecansAn 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 by Stacie Grossfeld

    Massive Rotator Cuff Tear – Learn 8 Facts Including Risk Factors

     

    1. 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.
    2. Ten to forty percent of all rotator cuff tears are classified as massive.
    3. Eighty percent of recurrent tears are massive.
    4. Repair of a massive rotator cuff tear has a high failure rate, upwards of 94 percent
    5. 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.
    6. 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 by Stacie Grossfeld

    Orthopaedic Specialists Medical Resident Dr. Tiffany SimpsonOrthopaedic 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 by Stacie Grossfeld

    football injuries are commonAn 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 by Stacie Grossfeld

    shoulder replacementThere 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…)

    Pediatric Sports Injuries: An Epidemic

    Posted by Stacie Grossfeld

    Outdoor Play helps prevent Sports Injuries and Childhood Obesity

    As a sports medicine specialist and an orthopedic surgeon that treats youth sports injuries we are faced with two serious problems. They tend to be on opposite sides of the spectrum:  The rise of childhood obesity and the parallel rise in pediatric sports injuries.

    I would like to quote Dr. Lyle Micheli who is one of the leading sports medicine pediatric orthopedic surgeons and researchers in the world who  practices at Boston Children’s Hospital in Boston, Massachusetts. This is from his article in the August, 2013 American Journal of Sports Medicine: Pediatric Sports Injuries An Age Comparison of Children Versus Adolescents.

    Dr. Micheli states:

    “As a solution to the growing epidemic of juvenile obesity, it must be a priority for health care providers, policy makers and researchers to promote athletic activities among American children. Participation in competitive youth athletics has grown steadily over the past 4 decades reflecting a general trend toward specialization and competition during childhood. Early sports competition and specialization, combined with lack of physical preparedness and or lack of free play, predispose the young child to significant sports injuries that may have long term sequelae both physically and emotionally. The early drive and intensity of youth sports not only sacrifice fun but also produce overuse injuries. The increased competitive element also exposes children to more serious sports related injuries such as concussions, physeal injuries and ACL tears.”

    It’s important to teach our children the importance of a healthy diet and to promote physical fitness. It is also equally important as parents to make sure the amount and type of fitness is appropriate. (more…)

    Shoulder Pain – An Overview from Louisville Orthopedic

    Posted by Stacie Grossfeld

    Shoulder Pain from Shoulder InjuryShoulder Pain Common With Shoulder Injuries

    Your shoulder is comprised of three different bones – your humerus, clavicle, and scapula. Along with these bones, your shoulder also has a lot of ligaments, muscles, and tendons. Shoulder pain is a common symptom of a shoulder injury. Shoulder injuries are common and can happen as a result of an accident, some type of sports injury, or during a bad fall.

    People who engage in a lot of repetitive arm movements that involve the shoulder are also at an increased risk for some type of shoulder injury.  Certain jobs like painting ceilings and walls, fixing cars that are on an overhead vehicle lift, or carrying and raising objects overhead, may lead to a shoulder injury over a period of time.

    According to the CDC, millions of Americans experience chronic shoulder pain that lasts for longer than a few weeks. Shoulder injuries tend to be quite painful and can keep people off the playing field or out of work for an extended length of time.

    Looking at occupational injuries among full-time workers in 2011, data from the U.S. Department of Labor’s Bureau of Labor Statistics revealed that 12% of all injuries involved the shoulder. About one third of ergonomic injuries or musculoskeletal disorders (MSDs) required time off from work, and the most severe involved shoulder injuries, which required an average of 21 days off from work. (more…)

    Slap Tear: An Overview of this Common Shoulder Injury

    Posted by Stacie Grossfeld

    slap tearYour shoulder socket is surrounded by tissue called labrum. Sometimes this tissue is damaged or torn – and when this happens, it is called a SLAP tear, which is an abbreviation for “superior labrum anterior to posterior.”

    There are many different ways you can get a slap tear. For example, you can get a slap tear while lifting heavy things. You may get a slap tear if you fall on your arm or shoulder. Sometimes people experience a slap tear if they brace themselves during a car accident.

    A slap tear is also a common shoulder injury for those who participate in activities that require a lot of throwing or repetitive overhead movements. This includes sports like tennis, baseball, volleyball or swimming.  Sometimes football players suffer from a slap tear during a tackle or any intense force to the shoulder and arm.

    Diagnosing a Slap Tear

    If you think you have a slap tear, you should see a qualified medical professional like Louisville orthopedic surgeon Dr. Stacie Grossfeld for a thorough evaluation.  When you experience a slap tear, depending on the severity, it is possible that it may be treated without surgical intervention. In this case a combination of rest, ice, anti-inflammatory medicine like ibuprofen or aspirin, and physical therapy to stabilize and strengthen your shoulder muscles, may be recommended.

    If you have a more severe slap tear or if your slap tear is not healing with non-surgical treatment, you may need to have surgery. Your doctor will advise you on whether you need orthopedic surgery for a slap tear based on many different factors.

    Slap tears are often classified by severity. The least severe type of slap tear is a Slap 1 lesion. This typically involves degenerative tearing on the inner labrum. The most severe type of slap lesion is a Type 4 slap lesion. This tearing extends from the labrum into the tendon in the bicep. Type II slap tears tend to be one of the most common types of SLAP tears for orthopedic surgeons to repair.

    Surgery to Repair a Slap Tear

    Surgery for a slap tear generally involves arthroscopy to fix the labrum. Arthroscopic surgery is typically done as an outpatient procedure. (more…)

    Acromioclavicular Joint or AC Joint Injury

    Posted by Stacie Grossfeld

    acromioclavicular joint If you separate your acromioclavicular joint or experience an AC joint injury, are there other structures within the shoulder that may have been damaged?

    Separation of the AC joint typically occurs from a direct blow to the shoulder. This common shoulder injury may happen as a result of some type of sports injury, during an accident, or from some other type of impact.

    There are four common grades of an AC joint separation. Grade 1 through 3 typically do not involve surgical reconstruction and can be treated conservatively. A recent study found that three out of ten patients with grade 3 and grade 4 AC joint separations had concomitant pathology.

    Dr. Paula and colleagues published in the Journal of Shoulder and Elbow Surgery in June 2013 that they found additional shoulder injuries, besides the acromioclavicular joint separation, ranging from rotator cuff damage to labral tears. (more…)